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Biomechanics Pearls of Wisdom

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Robertisaacs, Nov 25, 2009.

  1. Johnpod

    Johnpod Active Member

    No dentist makes his own dentures - no optician makes his own glasses. Use the laboratories for their expertise - this leaves you free to develop your own areas of clinical expertise.
     
  2. markjohconley

    markjohconley Well-Known Member

    ..you should be writing textbooks!
     
  3. Would hate to disappoint.

    "I've been a long term disappointment to myself, but it hit's like a hammer when I'm that to someone else"- Wonderstuff- circlesquare
     
  4. Sammo

    Sammo Active Member

    Sometimes it is better to remains silent and have everyone think you are a fool than to speak and confirm everyone's suspicion.
     
  5. markjohconley

    markjohconley Well-Known Member

    Bu**er, is it that obvious?
     
  6. Sammo

    Sammo Active Member

    Lol.. nope.

    It's kind of my mantra whenever I'm in a room of highly educated people.

    That and "don't fart!"
     
  7. markjohconley

    markjohconley Well-Known Member

    The shoe comes first!
     
  8. Nat Smith

    Nat Smith Active Member

    Young women don't want to wear Nanna shoes. Perfectly prescribed orthotics won't work if they don't fit in the shoes and your patient won't wear them...try to work with your patient on footwear compromises...and if all else fails, scare them into submission with some gory surgical photos...
     
  9. admin

    admin Administrator Staff Member

  10. nelsandr

    nelsandr Member

    The structure that is complaining (painful) is not the problem, but is actually the one that is tired of compensating for the one that is the problem and not complaining.

    There are those who know the truth, and then there are those who realize that knowing the truth takes one further from it!

    Andrew Nelson
     
  11. Griff

    Griff Moderator

    Andrew, I'm pretty certain I don't agree with this sentence - could you explain your thoughts in a bit more detail?

    Cheers

    Ian
     
  12. Hmmmmmm....
     
  13. Here we go, I'll have a pop on Andrew's behalf (if I may be so bold, Andrew). Lets take a foot striking the ground posterior lateral at the heel , creating supination moment at the subtalar joint. Under normal circumstances there are a number of tissues that can provide counter moment to that pronation moment: plantar fascia tension, tibialis posterior, tibialis anterior, spring ligament, floor of the sinus tarsi etc. If the tissues work in concert then all should play their part such that the counter-moment is distributed among them, none of them having to take on too much load. However, lets say the tibialis anterior decides to not play the game because the STJ axis is medially deviated and therefore the lever arm that the tibialis anterior has would result in zero or pronation moment at the subtalar joint. In this situation, the plantar fascia may become over-loaded as it's loading is increased. Plantar fasciitis ensues. Is this not the plantar fascia complaining because it's tired of compensating for the one that is the problem and not complaining- in this case the tibialis anterior? Just a thought.
     
  14. Griff

    Griff Moderator

    Simon,

    When considering Andrew's sentence:

    I guess whether we agree or disagree with this depends on what we define as the 'problem'. In your example is the problem the external pronation moment at the STJ? Is it the medially deviated STJ axis? Is it the poor lever arm/mechanical disadvantage of Tibialis Anterior? Or is it the increased tensile loading force in the plantar fascia? (or a combination of some/all of these??)

    I understand your point, and am certainly more comfortable with your paragraph than I am with Andrew's sentence (in the sense that I don't disagree with your points). However for me if something is complaining/painful then it is a problem. Be interested to hear Andrew's stance on his comment.

    Ian
     
    Last edited: Dec 2, 2009
  15. Indeed, it does depend on our definition of "the problem". The presenting problem is likely to be the plantar fasciitis. In my example, the problem could be the magnitude of external pronation moment or lack of distribution of internal supination moment among the tissues, I guess we could argue that the external supination moment is too small- is this what you are suggesting above? The pathomechanics may ultimately put the blame on the tib ant. or the axial position, so these could well be the source of the problem too.

    Like you said, depends what we think of as the problem, but as Andrew is a relative newbie, with only 4 posts under his belt and as I've just become the second highest poster (like I give a **** and I do realise that Craig has posted more than he pretends to) and I'm feeling philosophical (D. Smith's fault- he started it) and charitable this evening, I thought I'd give him the benefit of the doubt and a helping hand. This is the new me. You'll grow tired of it, but probably not before I do.:drinks
     
  16. Griff

    Griff Moderator

    Sorry that was a mistake on my part - I actually edited it while you were replying - it was me getting me internal and external moments temporarily confused.

    Wasn't intending to give Andrew a hard time, just interested in his rationale for his comment, and I think I'm right in assuming he is a Physio so maybe he looks at things differently to us.

    I don't like it already... bring back the baby peeler...
     
  17. K, cock, ****, ****, arse ;) That was getting too much for me.
     
  18. nelsandr

    nelsandr Member

    Thank you, Simon, for your example…spot on! Essentially, we see folks presenting with symptoms, which certainly deserve attention and sometimes direct treatment. However if we are treating only symptoms and not the ultimate problem the symptoms will persist. Whereas if we treat the problem, much of the time without even directly treating the symptom, the symptoms will abate.

    The medially deviated STJ axis would be the primary problem in Simon’s example. The anterior tibialis “not playing” (good terms) due to a mechanical insufficiency (force/tension/length) would then result in the plantar fascia, or posterior tibialis’ having to take on the extra force eventually leading to tissue failure, thus the complaints.
     
  19. OK kid, your on your own from here on in, no more helping hands from me- right . I have a reputation to up-hold (keep down) here;);):D:cool::cool:
     
  20. Griff

    Griff Moderator

    Hi Andrew,

    I agree with some of the above - and suspect we are just looking at things slightly differently, but let me explain how I would look at the above case and then it may explain why I initially disagreed with your original sentence (and still do).

    In Simon's example a patient presents with a painful plantar fascia. You are saying the primary problem is not the plantar fascia, but the medially deviated STJ axis - right? I am saying the primary problem is increased tensile loading force within the plantar fascia (the reason for which I would try to ascertain during my assessment, and the STJ axis position in the transverse plane is likely to be a factor of course).

    I would treat this by trying to reduce the pathological loading force on the fascia. In doing so would you say I am 'only treating the symptoms and not the problem'?

    Ian
     
  21. nelsandr

    nelsandr Member


    Hi Ian,

    No, you are also giving a perfect example of what I'm saying.

    In Simon's example he stated that the primary condition that he felt was causing the overloading of the plantar fascia was that of the medially deviated STJ axis that then “shut down” the anterior tibialis whose force was then sent to the plantar fascia, overloading it.

    In your assessment you will “ascertain” what you feel is causing the overloading of the plantar fascia or whatever tissue is “complaining” (symptoms), recognizing that it is probably not the plantar fascia that is causing the plantar fascia to be overloaded. Thus, treating what you have determined to be the problem outside of the plantar fascia (the component that is complaining) would be treating the primary problem.

    Clinically, though, this also plays out as a form of checks and balances. One could also state that if the treatment plan based on the ascertained problem didn’t resolve the symptoms, then perhaps it was the symptoms that we were treating rather than the problem and we then need to continue on trying to determine what the primary problem actually is (i.e. my second pearl statement).

    Hope that make more sense,

    Andrew.
     
  22. Hey Andrew Ian and the artist formerly known as the baby eating bishop of bath and wells ;).

    Sorry to be the fart in the jacuzzi but I can't join in the good spirited bonhomie.

    I do get the concept. However I have a bit of an issue with it.

    Firstly, from a treatment perspective this relies on us being able to consistantly Identify the lazy structure. Now we can do this in theory or on a thought experiment quite easily but in the murky sludge of complex and infinitely variable patients it may not be so clear. We can pretend it is, and say what we know with great confidence and firm rationale, but that don't make it so.

    I was learning from Derek Harland (DTT) the other day, a man with a wonderfully grounded view of biomechanics (I talk to him any time I think the theory is getting too lofty and he always brings me down to earth). He was setting forth on how any time he gets a patient from an osteopath they are referred with an LLD, from a chiropractor its a neurological issue and from a physio its core stability. All convince that they have identified the "root cause" of the problem. They can't all be right!

    So if we adopt that as our treatment methodology / philosophy we have to be very sure that our read of the function of the foot is 100%. I for one cannot muster that degree of certainty.

    Secondly it presumes that the pathology, the pain, arises from a functional deficit in another structure. What if the PF is because the patient got of the bus and landed badly? We go merrily ahead and look for a functional deficit, we may well find one, but its not the cause of the problem. As Simon observed earlier the world outside the window is not flat and the patient does not simply walk up and down in a straight line. There is a risk of overextrapolating what we see in clinic to the real world.

    Thirdly, and this for me is the biggy, It moves us away from treating the pathology and toward getting the foot to function "optimally". That, fundamentally, is how the Root protocol works. My problem with this is that it creates lazy thinking and before long we see podiatrists who don't even bother to GET the diagnosis. After all, why bother? We're looking for the structure which is not working, treat that and the pathology will sort itself out. Hey, perhaps we could lay down some criteria for how a foot SHOULD work and make a prescription protocol with that in mind. Perhaps based on foot typing to target prescription at different types of foot dysfunction.

    There. Rant over. Well done Andrew for having the guts to raise and argue a view that many hold but won't admit to. But I must respectfully disagree.

    Simon, any chance you could put me in touch with your anger management therapist?

    Robert
     
  23. Just let him get a coke with no stress........
     

    Attached Files:

  24. Great film!
     
  25. efuller

    efuller MVP

    This is one is a partial truth. Say someone has pain and a callus under their first met head. The problem is they have too much force on their first met head. Now, if that same person starts to develop pain under their styloid process and complains in both locations you have to think about how the brain is making the foot avoid the pain. You watch them walk and they go ouch when there first met head hits the floor and then the next few steps he walks while holding his foot inverted and the first met head does not touch the floor.

    Very few real world patients are like this, but you should be thinking about the "compensations for pain in other locations.

    Regards,

    Eric
     
  26. jerseynurse

    jerseynurse Member

    Motion is like water, it always seeks a path out. If you change the motion of the foot/ankle be aware that it changes the motion farther up the kinectic chain which may or may not be tolerated by the person even it the prescription seems "correct"
     
  27. runningdoctor

    runningdoctor Member

    Listen doctor . . . your patient is telling you the diagnosis!
     
  28. m.mouck

    m.mouck Active Member

    Hi guys,

    How about this piece of information. There are currently very few people in the world who know this fact.

    All bipeds (with feet and a pelvis), whether adult or infant, human, robot or cartoon, can use only 4 general movement patterns for changing position.

    In the new gait measurement system which I've created (The Mouck Method for Gait Analysis), these movement patterns are described using the 8 fundamental parameters of gait.

    If you'd like me to elaborate, please post.


    Mike M
     
  29. Prey do!

    Make it a new thread though please.
     
  30. Mike:

    Do you happen to be one of those "few people"?:rolleyes:
     
  31. admin

    admin Administrator Staff Member

  32. m.mouck

    m.mouck Active Member

    Hi Kevin,

    As far as I know, I discovered and defined these patterns, so, yes, I'm one of the few people. It's hard to say how many others realize they know it also. I don't know how much of what I say sinks in.

    But, I've discovered a lot more than just this. For eg., if anyone uses the measure "base of support" (step width, etc.) diagnostically, I have very important info which you should read. This measure is totally misunderstood.

    I'm going to continue in the other thread, though, (link in the admin post, above) starting with a verbal description of the general movement patterns during walking.


    Mike M
     
  33. footsteps2

    footsteps2 Active Member

    As a rookie Podiatrist (qualified 3 years) I am finding this thread very entertaining.
    Just run it again in a few years time and I may be able to add a worthwhile comment!!
     
  34. Don't underestimate the wisdom of inexperience!:drinks As Yoda says, "truly wonderful the mind of a child is, uncluttered!" I've learned a lot from students over the years because they do not have the prejudices and presumptions the rest of us have developed. Sometimes "rookies" are the best people to see the wood for the trees.

    C'mon Footsteps, hit me with your clear minded wisdom. If you had one piece of advice to give an undergrad on biomech, what would it be?

    You can do it!
     
  35. m.mouck

    m.mouck Active Member

    This one might be of use.

    "No one ever walks straight, even if they're following a straight line."

    Mike Mouck
     
    Last edited: Jan 5, 2010
  36. Sammo

    Sammo Active Member

    How about..

    Never be too proud to pull out a textbook/google to look up some obscure condition that you have never seen before that comes up in a patient history. Might be relevant to their symptoms.
     
  37. footsteps2

    footsteps2 Active Member

    OK Robert, wish I was a child but am a mature student I'm afraid. For undergrads on Podiatry degree (bearing in mind they do a lot more Bio training in Oz than in Uk where I studied)!

    "When you're sat in the lecture theatre, confused by levers, forces, range of motion, timing, axis etc (head in hands)......and your lecturer assures you it will all make sense when you put it into practice....do believe them, it does. However, then you delve deeper into why,what, where and how and the confusion returns. Things that are too easy aren't interesting to me, I love a challenge!"

    "
     
  38. Nice one ;). Like it a lot!

    Did'nt really think you were 6 years old, just a figure of speech.
     
  39. Laetoliluna

    Laetoliluna Member

    1. Read Sherlock Holmes's Methods of Deductive Reasoning, I'm not joking it will open your eyes to see what is there, and not what you want to see/know how to treat.

    2. The human foot does not inhabit the natural world - hard flat surfaces indoors and out. Even over rough ground, they interface with hard flat walking boots! Therefore do not be too quick to dismiss common abnormalities as 'natural' or normal for human anatomy - it hasn't had a chance to catch up/evolve.

    3. An orthotic will only work if it is worn - get the patient to bring in an example of all their most popular footwear, for all occasions. This can be amusing, you discover the Ecco's you normally see are only ever put on to visit you surgery!
     
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