The advantages of building and nurturing relationships of trust with other medical specialists in regard to feet and advanced orthotics
The 21st-century patient presents with many unique challenges. Technology-induced posture, prolonged sitting, high-intensity fitness training, as well as many other factors, can cause a myriad of musculoskeletal issues. Unfortunately, in today’s environment, sitting truly is the new smoking. With this being a reality, one of our primary focuses as health care providers should be to help our patients either maintain or improve their active lifestyles. In other words, get them moving with advanced orthotics support.
Designed to move, not sit
Our bodies are dynamic machines designed to move. Through proper movement, our musculotendinous units and joints receive nourishment and lubrication needed to function properly. Movement is performed most efficiently when our bodies are in alignment and are balanced in strength, conditioning and flexibility. Minimizing compressive forces on the spine and extremities is another key component to maintaining a healthy musculoskeletal system.
Looking at our patients with a different lens can provide a wealth of information about some of the causative factors for their musculoskeletal complaints. Our health care delivery model is in desperate need of a paradigm shift in its approach to managing back pain. Most physicians who see patients for back pain do not consider the feet as a contributing factor. We have an opportunity to educate our colleagues of all specialties on the vital link between the back and the feet.
Today’s multidisciplinary clinics
Multidisciplinary clinics are commonplace today. Having multiple specialists under one roof can provide wonderful opportunities for both the provider and the patient, with the end result being multidisciplinary accountability for outcomes of care. It is the patient who is the beneficiary in this model.
However, if you are not part of an official or formal multidisciplinary clinic, it is in your best interest and the best interest of your patients to build and nurture relationships of trust with other medical specialists. Each of us will see conditions in our office that may be unfamiliar to us. This does not mean that the condition is beyond our scope of practice. Reaching out to a specialist via text or phone call for further information can provide you with the necessary information to proceed with absolute confidence in managing the case yourself or in making the appropriate referral.
Chiropractic exposure in the medical community provides a great opportunity for our profession. It will enable us to see more patients who would have otherwise been lost in traditional medical management. As we position ourselves to be viewed as specialists, we will benefit from a greater presence in the health care delivery system. Our understanding of lower limb biomechanics and its relationship to issues relating to the kinetic chain is one of the areas where we can significantly impact back pain disease management.
Advanced orthotics and impacting low-back pain
Low-back pain is one of the major cost drivers in health care. The connection between the foot and the back is well-documented. However, many doctors of various specialties do not routinely consider this link when evaluating their patients. Explaining this link is a great talking point that you should consider as you discuss patients and/or conditions with other specialists.
Non-specific low-back pain is one of the most common reasons people seek the consultation of their primary care physician. Back pain disease management is considered a “medical disaster” based on the amount of dollars spent in this category annually in the United States. Bending, twisting and lifting are all risk factors for the onset of non-specific low-back pain.
However, there is a direct correlation between foot posture, biomechanics and low-back pain. Large national over-the-counter shoe insole companies spend millions of dollars each year marketing this connection between the feet and the back. Many clinicians are jumping on board as well and making custom advanced orthotics an option for addressing back pain. This learning curve is a vital component to the success of orthotics as an intervention for low-back pain. The phrase “You don’t know what you don’t know” applies to the successful implementation of orthotics as a device for managing back pain.
Linking the feet to back issues
Making this link for the patient needs to start during the initial evaluation. During the inspection phase of the evaluation, we have their undivided attention. This is when we can identify restricted movements and postural deficits.
During a typical evaluation, clinicians of all disciplines commonly focus on the target area reported by the patient. This is a perfect time for a paradigm shift, and for clinicians to pause and assess on a broader level contributing factors that could be related to their patients’ musculoskeletal pain.
Pain transferred up the chain
As we look at our patients as the mobile machines they are designed to be, it makes sense to look at issues that can be a contributor to their musculoskeletal pain. Technical issues with the feet can be a major contributor. Our feet are truly our foundation.
Every step we take, our feet are designed to absorb and disperse energy at impact. This is accomplished via a supportive plantar vault consisting of a balanced metatarsal, medial longitudinal and lateral longitudinal arches. If these arches are absent or compromised, the impact during the normal gait cycle is transferred up the kinetic chain to the knees, hips and spine.
Clearly, custom advanced orthotics that support all three arches can play a significant role in supporting the natural architecture of the feet and allow for a balanced structural foundation. This support can effectively reduce impact which will, in turn, reduce pain and stress on the back and lower extremities.
Education and outcomes
Success in implementing the use of stabilizing advanced orthotics is dependent on educating both the clinician and the patient. For the clinician, an under-standing of the relationship between the feet and the back is imperative. In addition, the clinician needs to inform the patient of expected outcomes. This will help with the patient’s positive engagement with custom orthotics.
Expected outcomes include decrease in pain and improvement in gait, balance and posture. For the patient, connecting the dots between the feet and the back and understanding the role orthotics can play will provide them with hope that there is another option in their treatment to help them with their back pain. The end result is a reduction in pain, increased mobility, enhanced structural integrity and improved function.
Making the effort to share your knowledge of the impact the feet have on the kinetic chain is worth the fight. It will open doors of opportunity for you and will ultimately help your patients live the active lifestyle they are meant to live.
Kurt Juergens, DC, CCSP, has been in private practice since 1989 and has had extensive post-graduate training in sports medicine. Juergens owns and operates Juergens Chiropractic & Sports Rehab Center in Houston, Texas. He graduated Summa Cum Laude from Texas Chiropractic College. In 1992 he was selected to be a member of the U.S. Olympic Track and Field Trials Sports Medicine team. He has also served on the sports medicine teams for the NCAA Track & Field Championships and the ATP World Tour’s Tennis Masters Cup and U.S. Clay Court Championships. Juergens continues to treat high school, college and professional athletes in all fields from all over the world, and lectures regularly for his profession on topics related to sports rehabilitation. He represents Foot Levelers and can be contacted at drjuergens.com.