Peripheral Artery Disease Treatment

The Successful Treatment of Peripheral Artery Disease

with Manipulation, a Case Study

An elderly man (79, Caucasian) presented with congestive heart failure, reduced kidney function and bilateral Peripheral Artery Disease (PAD) in the lower legs. The condition had been present for at least 2 years prior. The skin of the lower legs was papery and flakey with a black cast. He had several open sores that were not healing properly and his physicians were considering amputation as an option (see figure 1).

Figure 1

He was able to walk with the aid of a walker and an assistant, but was slow and unsteady on his feet. His daughter had brought him to me because she wanted him to be able to accompany the family on a trip to Europe. She asked that I try a manipulation to restore circulation to his legs, because the doctor would not allow him to travel if his sores did not heal.

I borrowed concepts from classes I had taken in neuro-meningeal and visceral manipulation as taught by the Barral Institute. I have previously observed a visceral rhythm in the vasculature in more centrally located arteries. The challenge was to find this rhythm in the distal arteries of the legs. I wanted to use an indirect method of treatment to avoid putting undue pressure on the diseased arteries. The treatment consisted of contacting the distal posterior tibial artery at the medial ankle and the femoral artery just above the popliteal fossa. The contact was only as much as was needed to feel the pulse to confirm contact on the artery. Then I engaged the artery by feeling for its intrinsic visceral rhythm. This rhythm makes the artery oscillate in a longitudinal direction up and down the leg at a speed of about 8 to 10 seconds per cycle. I followed this motion listening for any tension or restriction to the ease of movement. I determined that there were a couple of points of restriction to the movement in the calf. Light, slow transverse mobilization of the muscles and fascia was performed in those regions, followed by repeating the listening to the intrinsic artery rhythm. On the second listening a light intention was added to assist the artery in its normal movement past the areas where the restrictions were identified. Normal ease of glide in the rhythm returned quickly.

Figure 2

Next week, when the patient returned for treatment, the left leg was pink and beginning to heal. The right leg had a sharp demarcation of color along the shin with the medial side pink and lateral side black (figure 2). The restriction to the right anterior tibial artery was found where it passes through the interosseus membrane between the proximal tibia and fibula. I performed a gentle mobilization of the fibula and tibia by lightly compressing the two bones together and then assisting them through a range of movements in the longitudinal and transverse directions. After a tissue release was felt the anterior tibial artery was again palpated for intrinsic longitudinal rhythm. The glide was gently assisted until ease of movement was detected.

A follow up photo was taken a week later at the patientʼs home (figure 3). It showed that the patient had pink skin throughout both lower legs and the open wounds were healing nicely. In a few weeks the sores had healed and the patient was able to travel to Europe with his family.


Figure 3

The rapid response to this manipulative treatment suggests that in this case reduced artery function was due to a combination of fascial restrictions and chronic arterial spasms rather than the usual description of arterial plaque. The etiology of PAD should be reevaluated in light of these findings.

Russ W. Kalen, DC, CST Chico, CA Feb. 8, 2012

© Craniosacral Specialists 2013