Key Points:
- Review of Many of the Components of a Biomechanical Practice
- Review of Common Pain Syndromes
- Quiz on Orthotic Type and Symptom Complaint (answers at the end of the post)
The Coordination of Orthoses and Symptoms
So much of our understanding of the complexity of injury treatment will be enhanced by our expanding understanding of the biomechanics involved. By biomechanics, I am referring to the incredible power in prescribing the proper orthoses, the appropriate shoe selection, the appropriate strengthening program, the appropriate stretching program, possible lift therapy for limb length discrepancies, physical therapy for gait and postural changes, and other treatments including deep tissue mobilization, nutritional changes, etc. The direction of someone’s individual treatment will depend on your toolkit and experiences. Articles, such as this, are meant to merely encourage the development of a deeper toolkit at your disposal.
How does one typically navigate the biomechanics world? First of all, the understanding of biomechanics is crucial in almost everything we treat in the lower extremities if we choose to use its modalities and techniques. It is vital in acute and overuse injuries. It is vital in hoping to avoid surgery, in the decisions on what surgery should be done, and what should be instituted post operatively. Biomechanics requires measurements at times when you are classifying a patient’s structure, deciding on orthotic Rx writing, and following the progression of soft tissue deformities, tight muscles being stretched out, or weak muscles being strengthened. Our measurements are typically static defining the incredible diversity of patients, but should include dynamic assessments also.
Secondly, biomechanics involves our understanding of pain syndromes and injuries in respect to both abnormal structure and motion. The abnormal forces generated are fairly reliable in the effects that they produce. When you couple abnormal kinetics and kinematics with an individual’s weak areas in an overuse environment, pain is produced. This is why abnormal pronation can produce 27 different areas of pain, and these areas of pain can be helped when we reduce the overall pronation. Abnormal supination, limb length discrepancies, poor shock absorption, weak and tight muscles all have a similar pattern of pain.
Where should you start? I could give you a checklist of skills to master before embarking on such an adventure, but that would be totally unnecessary. Hopefully you are gradually improving your skill levels. If not, set a goal to get better monthly with your examinations. I am currently using my weekly blogs to remind you of the range of foot orthoses out there for you to prescribe based on the functional change you want to produce. Try to decide with my descriptions what is your gold standard orthosis. Once I am done with that, I will move onwards to another topic. I want however to give you the assignment of connecting pain with possible orthoses prescribed. Choose the one that is possibly the most suitable with acknowledgement that there can be more than one answer. You can only use each answer once (answers at the end of the post)
Orthosis:
- Root Balancing 5 degrees Forefoot Valgus
- Medial Lateral Instability Orthosis
- Inverted 25 degrees
- 35 degrees Inverted with medial 3 mm medial Kirby Skive
- Medial Kirby Skive with low arch profile
- ASIS balancing
- Cushion Device
- Root Balancing 4 degrees Forefoot Varus
- Dananberg Sagittal Plane Device
- Modified Root Device with 5 degree FF and RF varus posting
- 3 mm Lateral Kirby Skive with Denton Modification
Symptoms from Patient:
- Arch Strain
- Tarsal Tunnel Syndrome and Arch Pain
- PTTD
- Medial Shin Splints
- Posterior Tibial Tendinitis with Lateral Ankle Sprains
- Plantar Fasciitis
- Peroneal Strain
- Low Back and Big Toe Joint Pain
- Hip Arthritis
- Ankle Sprain
- Achilles Tendinitis
Orthosis with Symptom (one that seems best suited)
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Answers: A7, B5, C4, D3, E2, F1, G9, H11, I8, J6, K10
