Another type of proprioceptive orthotics

If you're in bed with your Mrs and you're passing your time by reading Kirby, you really should be going to relate.

Can I suggest viagra?

 

Touche Dr Spooner. The Mrs would side with you on this one - she even scratched Sacremento off of our planned west coast tour as she was scared I'd try to turn pleasure into business. Everytime she sees me on here (Pod Arena) I think she wishes I was looking a porn like a normal 31 year old instead.

 

That gives a whole new dimension to lower extremity joint stiffness.....

Kirby KA : Uncontrolled member dorsiflexion stiffness in post-pubescent adult males. Journal of Impotency and Infertility p 666-699 vol 3. 2010/01

 

Your correct David he is very funny !!!

 

Vote for study of the year! Is this the famous 'Kirby Skive' and how do ground reactive forces affect a member with a medially deviated joint axis?

 

LOL. I get that.

Replace "fix faucet" with "surf arena" and this covers it.

There are bad words.

http://www.youtube.com/watch?v=SQkC8LEud_I

 

The sound dubbing on this is embarrassing - and I grew up on nothing but martial arts films so I can normally tolerate it.

I feel ya though Rob - if someone came into my house and logged onto the arena on my laptop I'd start roundhousing.

I guess we are going to have to sustain this banter til Ed comes back and gets us back on topic...if he comes back that is...

 

Or you could put in your top 5 rock songs Ian, to fill a little time in.

 

I'm not much of a rocker sadly Mike, and I'm scared you and Spoon-dog will hunt me down when I slip some cheesy 80's soundtrack number in there...

 

Sorry Ian, best i could find on youtube. I had it on the album.

I'm guessing Dr butterworth Won't be back. Being as how the entire basis of his claimed mechanism has been shown to be spurious. With pictures.

 

Great name for a band: "spurious with pictures" cheers Robeer. Ian, you're too shy, you can come clean about your kajagoogoo obsession- I've got a cream for that.

 

What have you got for Journey or Bon Jovi? (Other than relentless mockery of course but thats standard).

 

I'll have to refer you to the wife- she holds a bit of a soft spot for Bon Jovi, I think it's because she's sported similar perms in the past. Is it a steel horse you ride, sir?

 

I hear he's wanted. Dead OR alive.

 

Keep the faith boys

(Especially you Ed)

 

WANTED!

 

We can all find references to suit our cause. I found five trials for AK of which 3 1/2 were positive and the allergy testing had a 19 out 21 correlation with RAST testing. I have attended many conferences on AK and am satisfied with its relevance as are the hundreds of practitioners that also attend.

I do not have the resources to mount the research you would like.

I have stated time and time again that this is the hypothesis that I have developed to account for the concept and success of proprioceptive orthotics. This required a knowledge of a type of medicine unfamiliar to this forum.

The criticism of the photographic evidence again challenges my integrity.

The location of the pockets cannot be anatomically precise but is my design to fit in with the concept of muscle chains. I make no apologies.

I have been fitting these orthotics 13 years as have many other practitioners with consistent success. Patients would not willingly purchase our orthotics and come back for more if they were not satisfied with the results. You can fool some of the people..... The allusion to crystals again typifies the culture of offence that typifies this forum. In Australia more patients consult alternate therapists than regular doctors. All of the people........

In those years I have refunded money on 2 occasions only and please be advised that Australia has a very advanced facility for complaints against doctors. I have never had one.

Naturally I have a commercial interest but no more so that any podiatrist who sells orthotics usually a price greater than mine.

These last few weeks have been a most unpleasant experience. I have been insulted, my intergrity questioned and finally lampooned. I shall unsubscibe from this forum. You have my email address. Anybody wishing to use our orthotics may contact me.

Finally as I write from Dubai where camels and donkeys roam in the desert a Biblical quote comes to mind about things they have to kick against. My turn!

Ed Butterworth

 

Well please don't keep us in suspense Ed, show us these studies.

How about case studies what you have offered thus far is completely anecdotal and as a physician you must have files on these patients, correct?

Ed I am probably one of the most sympathetic on this board towards the idea of alternative medicine and being familair with AK I would think we speak the same lexicon. At the same time I am completely unconvinced and would appreciate you defending your position with a modicum of science, however alternative your explanations might be.

We are challenging the veracity of your claims Ed not your integrity. There is a distinction.

I am still hoping for a valid explanation of this concept. Please indulge me (us)?

Statistically more office visits are made to alternative providers than allopathic physicians in the U.S. as well according to a report in late 1990. All the more reason for you to stay and defend your product Ed. Think of the market available to your adherents in the U.S. Convince me (us) please.

Actually an excellent track record!

Ed we provide a service based on medical need when we dispense custom orthoses. Of course we profit from our experience and the care we offer. I don't feel that comparing a commercial interest from a proprietary device to a medically necessary service is fair. We all profit of course from patient care. Medicine is a business but more than that it is a service we are trained for. Agreed?

Dr. Kirby once wrote regarding the similarities between those who claim superiority of their product over the prevailing theories and designs. He offered a checklist of qualities that all of them possessed and I am really hoping that you don't exhibit any of them, one being they abruptly disembark from the site when the going gets tough. Thus far I haven't witnessed you denigrate custom orthoses as inferior to your product but are making claims that should be substantiated with vigor since this is a private forum that can be accessed by the public.

Is this a reference to beating a dead horse? :deadhorse:

You won't find dullards who easily accept what is offered as truth here obviously. Podiatric biomechanics is a lofty subject but a worthy one and many of us have had to revise our own thinking in light of the discussions here. I should think this is a great opportunity for you to gain adherents if you have the constitution and I for one am trying to offer you that discussion free of vitriol and animosity. I hope you stay and offer us and your patients a better explanation than to cut and run. That would be most unfortunate.

Regards,

 

I would expect none. The pockets don't fit with the concept of the muscle chains because they don't correlate to the muscles at the beginning of said chains. Even within the rules of your own system and even if we accepted as fact the wholly unsupported concept that stimulating a tiny muscle in the foot straightens somebodies spine, it STILL doesn't work because the pockets don't sit anywhere near the muscles they are supposed to stimulate!

The invitation to answer the critisms of the concept, remain and I can't think of a good reason not to answer them besides that you cannot.

By the by, feel free to post those refs on the "applied kinesiology" thread on this forum. Are they Randomised double blinded trials?

As Simon said earlier in the thread

 

I am an orthotist and know less about the feet than most podiatrists on this forum. I also know even less about AK. However, I prescribe , design and fit footwear and I do know, anecdotaly at least, that there is approximately 5-10mm shift in the position of the foot within the shoe when I compare the static position of the bony anatomy and the dynamic position of the anatomy. I therefore cannot see how each of the different pockets can stimulate different muscles when the position of the foot on top of the inlay is a constantly changing factor.

Does anyone aggree or is everyone getting a bit past the stage of caring on this particular thread?

Robin

 

Yes.

 

I am a Podiatrist and a Dental Therapist. So I can get from the foot to the TMJ.

Julie

 

Colleagues,

I have taken 400 hours of Applied Kinesiology course work, and nowhere is flicking of a muscle taught as a challenge. The pushing down of the forearm is the poorest test that can be used. Just have a look through you tube, and you will find all sorts of supposed Applied kinesiology "experts" using this test and proven wrong. When people that have no training in something use it, the results are questionable, whether it be AK, brain surgery, or whatever.
Dave, AK has evolved a lot in the last 10 years. Years ago, I also found AK unusable. Now there is a protocol that makes it very effective. Your colleagues that performed the substandard treatment are in no way doing AK.
As far as the foot to TMJ, I see the TMJ affecting the feet. The postural pattern in standing of a TMJ dysfunction is a high ASIS, and normal dorsiflexion. The asymmetry results in unilateral foot pathology.

Regards,

Stanley

 

Stanley,

As a practicing chiropractor I was introduced to AK as I discussed previously. In my practice I have tried to adhere to a paradigm of treating my patients with actual physical complaints through traditional manipulative methods and conservative physical medicine adjuncts. I am a huge believer in active rehabilitative medicine. I am not a strong adherent to EBM but rather find that as long as I can observe repeatable objective and subjective progress in a patients complaints that the treatment is valid and worthy of incorporation into my practice.

I am not a reductionist by any means but do believe that say a lumbar intervertebral disc derangement exists and causes direct interference with the function of a nerve in a predictable manner and in a predictable physiologic pattern. That is science, we know factually that such an insult can be located and reproduced through manual orthopedic, neurologic and radiographic testing. We can predict often what treatment will effect a change in that condition and a reasonable time period for resolution of that complaint etc. Typically, a third party is paying the bill for that treatment and they require a modicum of evidence such a complaint exists and that clinically said treatment has a fair rate of resolution of that complaint to effect payment for that treatment. I believe that this is a fair request and honor it.

I do not believe that the type of muscle testing used in AK is firmly based in science. It ignores the known pathways of voluntary nerve function (myotomes), the known areas of sensory input supplied by those nerves (dermatomes) and the known locations of the deep tendon reflexes. ALL of the AK practitioners that I have encountered thus far engage in a type of manual muscle testing that coincides with the theory that if that muscle is weak upon testing, there must be a nutritional, organic insufficiency at the base of weakness.

How do they prove this? By placing vials of various substances in the hand or holding them on the person of the subject being tested and if the subject comes up weak they either have an allergic tendency to that stimulus or are deficient in it and then sell them either a program to eliminate the noxious stimulus, 'adjustments' to clear the body of the stimulus or a number of supplements to overcome the deficiency. Sound familiar? Sorry but this is not science, it is not even ethical in my opinion but it does generate a boatload of income for the practitioner. It certainly isn't chiropractic, although Goodheart was a DC.

As for the link between TMJ and the foot I require some evidence. I treat a lot of spines, a lot of feet and a good number of patients with TMJ. I have encountered a great number of feet as I am also a certified pedorthist. Every patient in my office with a complaint of headache or jaw pain is evaluated orthopedically. Many of those with TMJ I have helped with chiropractic manipulation of the jaw (the TMJ has a disc and exhibits the mechanical joint properties of the spinal and other articulations of the appendicular skeleton) and upper cervical spine. Much of TMJ is not a true malocclusion but an alteration of TM joint mechanics due to cervical misalignment at the atlas and muscular overuse (gum chewing is a prime example). Some are afforded manual therapy to correct a bite imbalance caused by muscular imbalance of the masticatory muscles and all are given corrective exercises. An even greater number are referred out to dentists who practice a specialty in TMJ (the most qualified practitioner for this patient subset).

Never and I emphasize never, have I seen a link between a patients feet and their TMJ problem. Never have I encountered a patient who's dental issue was resolved through AK or insoles. Perhaps I am obtuse and clinically bereft of my title because I feel that I cannot be all things to all patients, examine them with proven, accepted and valid methods of physical examination and demand objective clinical evidence that their treatment is effective or refer them to a more appropriate provider.

Someone recently suggested that I should be more sympathetic to AK because I am a chiropractor. I found the suggestion insulting professionally because I am one the harshest critics of the ancillary technique cowpie in my profession. I see that this 'holistic' mindset has invaded podiatry as well. One step forward, two steps back...

Stanley can you please explain the above postural distortion and why you believe this is so? Are there other causes of a high ASIS? What unilateral foot pathology are you referring to?

Stanley you may disagree with everything that I have written and that is your right. I am not attacking you, I am expressing my opinion of a subject that I do have some experience in. You are obviously passionate about AK and I can respect that we agree to disagree. I feel that if a causal link between TMJ and foot pathology truly exists that explaining your clinical experience and findings would be of interest, especially to me.

 

http://ejo.oxfordjournals.org/cgi/content/abstract/cjm071v1

 

David

Thanks for this - one of the best pieces of writing I've read on the subject, firmly grounded in common sense. Clear and unequivocal.

All the best

 

Dave,
You sound like you are describing Contact Reflex Analysis, and not AK. I have not taken any course work in it, but I have heard of it. Those that practice AK have little regard for it, and say it is not part of AK. An analogy would be talking to someone who practices foot reflexology who says he is practicing podiatry. Muscle tests are taught to be very specific for one muscle. They have to be done properly. A muscle test that tests a group of muscles is not AK. In the seminars we were taught how to get improper results, so that we know what not to do.

I agree. The masticatory muscles are what is treated in AK via Strain-counterstrain ( a modified Jones’ technique) or reverse strain-counterstrain (Boven’s technique)

AK treats the muscular skeletal system, not dental problems. AK treats the muscles of mastication.

The relationship is an observation of mine, and not taught in AK. As you know, AK was invented by Goodheart, a chiropractor, and is used by chiropractors. There is limited knowledge of the foot, as patients with foot problems do not typically see a chiropractor as the promary treating physician (Likewise, I have never seen a patient come to me for a primary dental problem). As a podiatrist it has taken me a while to develop a way to use AK. In AK, there is a postural exam. The purpose is to find a weak muscle. In Goodhearts book published in 1964 or 1965, he goes over the posture for every weak muscle. Goodheart originally used manual muscle techniques (origin-insertion) to tonify weak muscles. This helped in a certain percentage of cases. Over the years, additional treatments were added. The first of which was the neurolymphatic reflex points (Chapman reflexes), then the Bennett reflex points (neurovascular reflex points). Getting back to the posture, as a podiatrist, I always looked at equinus and asymmetry as extrinsic pronatory factors. So my postural exam looks at these things. I started noticing patterns.
I first work on balancing the ASIS to the ground and equinus. I gave a lecture at the AAPSM on this, and it is an hour lecture. So to answer your question, ASIS that is elevated with an equinus on that side is due to a weak quadratus lumborum on the opposite side. You will also notice a weak anterior scalene and peroneals on the side of the equinus. This is a pretty common pattern. Correcting any of these muscles properly using the AK protocol will correct this postural pattern.
Another equally common pattern is a high ASIS on the side opposite the equinus. This is the classic short leg that is treated by podiatrists all the time with a heel lift. This is not a bad treatment; however, the rolling to the outside is related to weakness of the peroneals. This is usually caused by a subluxed lateral cuneiform. (If there is a cuboid subluxation, this comes later as a result of the inversion and equinus) Manipulation of the lateral cuneiform and orthoses to maintain the correct position is a better treatment. Mind you, I have done both of these treatments earlier in my career. Currently, I correct the weak peroneal using the AK protocol and the posture is corrected.
You can find a high ASIS with a mild equinus. Remember that equinus is not looked at by the real AK practitioners (not the charlatans you know). As a podiatrist, I am always looking at ankle dorsiflexion, so I see these patterns. When there is a mild equinus, there is usually a problem in the acupuncture system. To treat the acupuncture system is a day long seminar in AK. Suffice it to say that the point and its associated point on the bladder meridian is treated along with its underlying dysfunction. My personal belief about the acupuncture system is that it is an additional proprioceptive communication system found in the fascia and periosteum. I personally start by looking at GB 42, and if it is sensitive, treat the bifurcate ligament by distal friction. I then check the midfoot for subluxations. I correct this and then go to the AK protocol for acupuncture.
As far as the PSIS to the ground, I treat this after I have corrected the equinus and leveled the ASIS. If I find an unleveling of the PSIS, I check for a lateral talus.
Dave, I am sure you are familiar with all the foot subluxations/dysfunctions. I find that a posterior calcaneus does not affect equinus or the pelvis.
Sorry for the long answer on this, but I am not sure whether I have written too little or bored everyone with too much.
As far as the mechanism of the relationship of TMJ dysfunction to an unleveled ASIS, you can look at the Lovett pairs which I am sure you are familiar with and use everyday. The temporal bone relates to the Ilium. A weak masticatory muscle will allow an upward drift of the temporal bone with a resultant temporal bulge and change in the ilium. Another way to look at this is neurologically. Any joint dysfunction sends faulty information to the brain. Output is based on the information, so the output is also faulty resulting in postural distortion. I don’t know each faulty input and subsequent postural distortion, I know a few. For instance any dysfunction along the lateral line of fascia (from anatomy trains) will result in weak peroneal muscles. So a subluxed cuboid, posterior fibula, or a limbic fixation, can result in the weak peroneal.

Dave, I find your discussions meaningful, and the main disagreement we have is that you see practitioners of CRA saying they are doing AK, and you believe them.
What I am giving you is what I have evolved to doing over the last several years. I don't see you asking me questions as an attack. If what I have has any merit, then I should be able to defend it. If you want a copy of my lecture, I would be more than happy to email it to you. A certain percentage of it is AK. If you want to learn the real AK, then take a 100 hour course given by a Diplomate of the International College of Applied Kinesiology.
Finally, today I checked the flicking of the muscle to see if it tests. I checked it on an abductor hallucis that needed strain counterstrain for a medial plantar fasciitis. Flicking has no effect.

Regards,

Stanley

 

Simon,

Thanks for the reference. How does the posterior cross bite affect TMJ functioning, specifically what does it do to the muscles of mastication?

Regards,

Stanley

 

Stanley, I'm not an expert in this field, but if you read the paper I cited it references a number of studies including:
Alarcon et al.: Effect of unilateral posterior crossbite on the electromyographic activity of human masticatory muscles. American Journal of Orthodontics and Dentofacial Orthopedics, Volume 118, Issue 3, Pages 328-334
Abstract

Studies dealing with the electromyographic activity of masticatory muscles in patients with unilateral posterior crossbite are infrequent. The purpose of this study was to assess the electromyographic pattern of masticatory muscles at rest position, during swallowing, and during mastication, in 30 subjects with right posterior crossbite and to compare them to 30 normocclusive subjects. The 2 groups were matched according to age, gender, skeletal Class I, and mesofacial growth pattern. Electromyographic activity of right and left anterior temporalis, posterior temporalis, masseter, and anterior digastric muscles was recorded at rest position, while swallowing water, and while chewing. Disposable bipolar surface electrodes were used in both groups. Data were compared between groups and between right and left sides within each group. The results revealed that the posterior temporalis of the non-crossbite side was more active than that of the same side in subjects with crossbite at rest position and during swallowing. The activity of both anterior digastrics was higher in the crossbite subjects during swallowing. During chewing the right masseter muscle was less active in the crossbite patients than in normocclusive subjects. The results obtained during chewing indicate a bilateral masticatory pattern in both groups. (Am J Orthod Dentofacial Orthop 2000;118:328–34).

 

Is this not to crux of the matter, If we as a profession are still trying to work out how the foot works and how orthotoics work in more detail, why are we discussing the jaw? Should we not get good at what is our area before we move to the jaw or dare I say the inner ear. Or is it just me ?

 

Michael, I can see where you are coming from, but think on this: lets pretend we "know" that TMJ dysfunction has a direct effect on the foot, should we not endeavour to understand this relationship? Diabetes is an endocrine disorder, I'm not an endocrinologist, but I'd say its pretty important for podiatrists to understand diabetes. What's the difference?

 

Ok for the case of discussions, but as was discuussed in the stj/tmj thread the research seems pretty thin on the ground, even between tmj and back prostual changes I think ther was a lot of slight change but not significant type of stuff written. Which is where endocronology differs there is a huge amount of research that we as profession can read and understand etc.

But for the discussion the pretending we know I can see. But as I have not got a single idea how the TMJ works I´ll follow along and see what comes of it and re-read David great posts on the subject again and maybe again.

 

Actually I'm with Mike on this one.

Diabetes affects the feet. To understand the feet we must therefore understand diabetes. There is a very, very firm proven link and things we know will work for different aspects. We can't say that of stj / tmj stuff.

It seems to me there are two CLINICAL concerns around this (leave alone the academic stuff).

Can I use the TMJ to treat foot disorders?

Can I use orthotics to treat TMJ disorders?

Both of these rely on a firm and clinically useful link being present, which in spite of a huge amount of ****e studies has not been shown.



We are still lacking much in terms of data for orthotics affecting as high up as the pelvis or lower back! There IS a proven link there... but lets be perfectly honest, we don't fully understand what it is! And there is not a huge amount of hard data.

And further down still, feet still surprise me! Sometimes things which have no busines working do and things which should work don't.

As much fun as this all is, should we not work on establishing a firm correlation between orthotics and lower limb / lower back kinematics / kinetics before we start getting exotic? Its like we discovered the wheel, drew up plans for a cart, then tried to build a pagani zonda. Very exiting but we need to invent all the intervening steps first!

 

But equally we can't say that there isn't a link- right Robert? It is interesting that some of the research, albeit of a lower quality does report relationships. I'm not saying go out and start examining your patients dentition, but it is worthy of further reading around this subject- it relieves my boredom anyway, while I'm waiting for a surgical training post to become available. And I did use a pretty big caveat in my original response to Michael. Lets be honest how many of the papers i linked to had you read before i linked them here? Personally I hadn't read any of them, so now I'm a little wiser on the subject than I was a couple of days ago, and that makes me a better practitioner.

 

Simon in your reading is there a good proposed mechanism of how this all works bone, joint ,ligament etc wise or do they just discuss cllagen pathways and the like.

 

Michael, why don't you read the papers for yourself and then maybe you'll expand your knowledge base too .

You lot make me laugh at times. Only last week we were discussing sticking needles in VP's without any decent evidence to support it, now we are critical of something, which to be frank, has better evidence to support it than sticking needles into VP's, but happily we'll keep sticking those needles in, but won't try and find out a little more about a topic which might not fit with our mindsets.

I don't know if there is something in this yet or not, I don't think enough good quality research has been done yet to either prove or disprove any relationships between the TMJ and lower limb function, but I'll keep dipping into the topic every now and then, as I have an open mind on these kind of things and I want to know everything I can about foot and lower limb mechanics.

 

Fair point, I should have asked which article that you have seen would be the best place to begin read up on the proposed mechanism. I go look through the links.

 

I wouldn't waste too much time, I've not seen a reasonable mechanism yet

I'll keep posting on this in the TMJ thread as I find more papers.

 

Funny Guy

 

Hi Simon,
It appears that the patients with the right sided posterior cross bite are holding their jaw at rest in a position of better occlusion. From what I read, the molars of the mandible are buccal in a posterior cross bite. The temporalis muscle pulls the mandible to the ipsilateral side. The temporalis muscle imbalance seen in this study has an effect of pulling the mandible so the mandibular molars are in a better position in space.

Since there is an asymmetry of occlusion, it doesn’t seem unreasonable that there will be an asymmetric muscle activity of the masseters to even out the force of one side to the other.

The question is whether this translates into a problem with the muscle spindle cell of the muscles, which would cause an uneven for during mastication, which is treated in AK.

Regards,

Stanley