Blog January 09
Friday, January 30, 2009
Research - Orthotics Improve Back and Hip Pain
Foot orthoses provide viable treatment for back and hip pain
Extracts from an original article by Kristen J Light published in Biomechanics magazine – Nov/Dec 08
One-half of all Americans admit to having back pain symptoms each year, and chronic low back pain is one of the most common reasons for missed work, according to the American Chiropractic Association. The ACA also estimates that as much as 80% of the U.S. population will eventually experience a back problem.
Recent research suggests that back pain may be closely linked to poor or improper biomechanics. Many researchers, in fact, agree that chronic low back pain may be significantly related to gait style, a reason they are shifting their focus to the feet to treat hip and back pain.
“We can cut the cost of treatment worldwide by changing the way people walk, and we can do this with foot orthoses.”
Using custom foot orthoses to change the mechanics of foot function may improve hip extension and create prolonged relief of low back pain symptoms, according to Dananberg. This is because the functional limitation of hip extension during gait is one of the pathological events that can cause or perpetuate chronic low back pain.
Dananberg believes that the number of people who should wear foot orthoses is far greater than those who actually wear them.
When the pelvis is rotated due to a pelvic upslip, a manual adjustment in most cases can help resolve it. These manipulations are generally performed by chiropractors, physical therapists, osteopaths, and even some physicians who are appropriately trained. Although performing manual adjustments to the pelvis can improve pelvic tilts, Dananberg said that these patients often return again for care with the same problem.
“With the outcomes that I see, it would seem that prescribing foot orthoses should be part of the treatment protocols for most back pain treatment centers,” Dananberg said. “I just hope I live to see that day.”
Douglas Gross, MPT, ScD, a research associate with the Boston University School of Medicine Clinical Epidemiology Research and Training Unit and an assistant professor of physical therapy at the Massachusetts General Hospital Institute of Health Professions says:
It has been suggested by some researchers that mechanical strain on the hip can result from varus malalignment of the foot. Specifically, forefoot varus malalignment may be associated with ipsilateral hip pain or tenderness and total hip replacement in older adults, according to a study that explored the cross-sectional relationship between varus foot alignment and hip conditions in older adults, Gross was the primary author of the study, published in Arthritis and Rheumatism, in September 2007.
Results suggest that the mean standard deviation was 0.7° ± 5.5° for rearfoot varus alignment and 9.9° ± 9.9° for forefoot varus alignment. Subjects in the highest category of forefoot varus alignment had 1.8 times the odds of having ipsilateral hip pain, 1.9 times the odds of having hip pain or tenderness, and 5.1 times the odds of having undergone total hip replacement compared with those in the lowest category. No significant associations were found between rearfoot varus alignment and any hip conditions.
When the foot pronates excessively, the knee and hip alter their position so that the femur internally rotates and the patella points medial of the large toe. In addition, the knee goes into valgus movement and the hip is adducted. Whether these changes in lower-limb alignment and mechanics actually result in an increased risk for hip trochanteric bursitis or lower lumbar pain is unclear, but many patients with hip or lumbar diagnoses report feeling better when they use a supportive foot orthosis, according to Gross.
A great difference also exists between treatment of an existing hip or lumbar problem with foot orthoses and prevention of a possible future problem, Gross said.
“The latter is much harder and more expensive to study prospectively than the former, and yet this is where orthoses are likely to have their greatest impact,” he said.
Playing through the pain
Among athletic individuals, sports activities often inflict a great deal of pressure on the foot. Slight imbalances in the foot that are not harmful or even detectable under usual circumstances may make an individual more vulnerable to injury while playing sports. Foot orthoses, however, can reduce fatigue and promote efficient muscle function to enhance sport activity and performance by eliminating the need for one’s muscles to compensate for unnoticeable imbalances.
Wearing foot orthoses while playing golf may help reduce foot and back pain and improve foot posture, according to a U.K. study in the June 2007 issue of The Foot.
Gait analysis is the key
Decades of research on biomechanical evaluation and treatment of foot, ankle, and lower-extremity conditions have been performed by Bruce Williams, DMP, a podiatrist from Valparaiso, IN, who is the current vice president of the American Academy of Podiatric Sports Medicine. Modifying gait to achieve symmetry between right- and left-foot function is important when dealing with chronic hip and back pain.
In his practice, Williams specializes in custom foot orthosis evaluation and in-house manufacture and computerized gait analysis for chronic foot pain conditions, knee pain, hip pain and back pain. He also provides diabetic foot evaluations to prevent or eliminate foot ulcerations.
“Foot orthoses provide a viable alternative to surgery to treat hip and back pain,” he said. “There are specific things to look for in a patient’s gait that can contribute to chronic hip and back pain and what to do in those instances.”
Heidi Prather, an associate professor of physical medicine and rehabilitation at the Washington University School of Medicine in St. Louis, agrees that orthoses are a great alternative to other more invasive treatments.
“Orthoses are helpful for supporting the arch of the foot, offloading specific pressure points in the foot, and cushioning the heel,” she said. “It’s a noninvasive approach to improving biomechanics and possibly pain, and the great part about it is that there is no age or activity limit.”
Many researchers agree that foot orthoses can also increase stability in an unstable joint, prevent a deformed foot from developing additional problems, and improve overall quality of life.
“All you have to do is wear them to achieve your results,” said Williams. “No exercises or physical therapy is involved, and there is no surgery from which to recover.”
Article full text:
Thursday, January 29, 2009
Keeping supple helps to avoid back pain
As many of my regular clients will know, regular stretching is one of the most effective tools that we have to help maintain a healthy back, as well as a first aid measure if your back does become painful.
To assist clients in rembering the exercises that they have been prescribed, you will now find photographs of the various stretches for the lower back, neck and shoulder included on the website.
Remember each stretch should last a minimum of 12 seconds.
Follow this link and then click on the relevant section on the left: