Should you be using orthotics in your practice?
At a recent seminar, in a discussion about the use of orthotics that covered some of the technical aspects of providing and fitting them for patients, one of the doctors present asked, “What I don’t understand is, why do chiropractors need to use orthotics? I don’t use them in my practice and I don’t see what the big deal is.”
As orthotics have been an integral part of chiropractic and rehabilitation for many years, his question suggests that there are still DCs who don’t appreciate the value and benefits of orthotics for their patients. You could list all of the spinal and lower extremity conditions that can be improved with an effective combination of chiropractic care and orthotics; however, the primary reason you should use orthotics is to benefit your patients.
Key orthotic benefits
Orthotics are helpful in addressing a variety of conditions, but the benefits fall roughly into three areas:
First, they can alleviate many symptomatic musculoskeletal conditions, including the No. 1 reason patients visit a chiropractor: low-back pain.
Next is their ability to improve musculoskeletal efficiency and sports performance.
And finally, custom-made orthotics can aid in the prevention of future problems. These benefits are due to the combination of improved lower
extremity biomechanics and better absorption of repetitive skeletal impact.
Better biomechanics
One of the major goals of custom- made orthotics is to improve foot and ankle function by supporting the foot’s arches and reducing pronation forces. In addition to interfering with gait and decreasing athletic performance, excessive pronation is dangerous for two major reasons: The likelihood of developing painful foot and ankle disability over time and (especially important for doctors of chiropractic) the probability of transferring abnormal stresses up the lower extremities and into the pelvis and spine.
Athletes often suffer from a number of overuse injuries that can be linked
to excessive pronation. Often, these developing problems go unnoticed for months or years, and it is only when a new walking or recreational program is begun that symptoms arise.
Other times, it is the painful end stage of abnormal biomechanics that brings a patient in for care. The following is a list of symptomatic conditions and musculoskeletal pathologies that are associated with excessive pronation.
Foot conditions
- Calcaneal periostitis (heel spur)
- Hammer toes
- Hallux valgus
- Interdigital neuroma
- Longitudinal arch collapse
- Medial calcaneal compartment syndrome
- Metatarsal calluses
- Metatarsalgia
- Navicular stress fracture
- Plantar fasciitis
- Sesamoiditis
- Spring ligament sprain
- Tailor’s bunions
- Tarsal tunnel syndrome
- Toe extensor muscle spasms
Lower Leg Problems:
- Achilles tendinitis
- Fibula stress fracture
- Flexor digitorum longus strain/tendinitis
- Flexor hallucis longus strain/tendinitis
- Peroneal tendinitis
- Tibialis posterior strain/tendinitis
- Tibial periostitis
- Tibial stress fracture
Knee Pathology:
- Anterior cruciate injuries
- Chondromalacia patellae
- Knee joint capsulitis
- Patellofemoral pain syndrome
- Pes anserine bursitis
- Hips, pelvis, and spine
- Anterior pelvic tilt
- Excessive lumbar lordosis
- Functional scoliosis
- Hip adductor muscle strain
- Hip flexor muscle strain
- Hip joint capsulitis
- Iliotibial band syndrome
- Piriformis muscle strain
- Sacroiliac problems
- Tensor fascia lata strain
- Trochanteric bursitis
Reduced skeletal impact Orthotics can significantly reduce the deleterious skeletal effects of the repeated stresses of walking. At the moment of impact during heel strike, a shockwave is propagated through the entire musculoskeletal system.
This shockwave passes through the skeleton at over 200 miles per hour, and jolts the base of the brain up to half a millimeter in normal walking.
Benefits of orthotics
– Alleviate musculoskeletal symptoms
-Improve musculoskeletal efficiency and sports performance
-Prevent future musculoskeletal problems
This amount of force can be the cause of persistently painful and stiff joints, especially in patients with degenerative changes in their spinal discs and joints. When made with modern viscoelastic materials, orthotics can decrease current symptoms and can help to prevent further degeneration.
Desirable outcomes
The combination of better biomechanical function during gait and decreased skeletal impact when walking and running provides significant benefits to patients. Symptomatic conditions are more easily treated, sports and daily activities are less taxing thanks to improved mechanical efficiency, and numerous musculoskeletal problems can be either avoided or minimized.
Orthotics should be considered a vital component of chiropractic care for many if not most patients. Doctors of chiropractic who employ these effective tools are bound to experience better outcomes and greater treatment satisfaction.
John K. Hyland, DC, DACBR, DABCO, CSCS, is a graduate of Logan College of Chiropractic. A popular speaker, Hyland is a postgraduate lecturer for several chiropractic colleges and a frequent contributor to chiropractic publications.
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