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CT Band Biomechanics and CT Band Syndrome

Discussion in 'Biomechanics, Sports and Foot orthoses' started by admin, May 11, 2009.

  1. admin

    admin Administrator Staff Member

    Members do not see these Ads. Sign Up.
    Lets put this one out there for review:

    The CT Band, CT Band Biomechanics and CT Band Syndrome
    Jeffrey Oster, DPM, FACFAS
    The Foot and Ankle Online Journal 2 (5): 2

    Attached Files:

  2. Admin2

    Admin2 Administrator Staff Member

  3. Craig:

    I just read the article. Why would someone name a collection of pathologies that occur due to the interaction of our feet with the ground only one thing: "CT Band Syndrome"??

    In reading this paper, it appears as if the author did a brief review of biomechanics for the reader (a kind of biomechanics 101) and then decided to name a bunch of diagnoses collectively "CT Band Syndrome". In my opinion, this type of approach does not advance our knowledge any and is a step backward in the current way we look at foot and lower extremity biomechanics segmentally using modelling concepts. The paper appears to be a review article of a few of the many factors that affect the biomechanics of the foot and lower extremity, all lumped into one cause: "CT Band Syndrome".

    If I had reviewed this paper for JAPMA or JFAS, as it was published currently, it would have never seen the light of day.......without serious revision or total rewrite.
    Last edited: May 11, 2009
  4. I read this last week and thought about posting it here for discussion. To be honest, after consideration I didn't think it was worthy. I pretty much agree with Kevin's comments. Some terminology we have in contemporary podiatric biomechanics is poor and needs to be redefined, but some people seem to be making up new terms for the sake of making up new terms: "CT band syndrome" :mad::bang::mad: Is this making up of new terms seen by some as a way to "fame in the 21st century" ? Lets call the "hallux" the Spogwang from now on...... Spogwang rigidus is a condition caused by having a foot-type that is partially obscure at the rearfoot, particularly thwankald at the forefoot and a ceiling that is artexed (copyright, Spooner 2009)
    Last edited: May 11, 2009
  5. I think that if I wanted to write such a paper, I would have named the paper "Gravity Syndrome"...........then I could have included all foot and lower extremity mechanical pathologies in the paper, instead of only half of them.:cool:
  6. lol :cool: double :cool::cool:
  7. Foot Traffic

    Foot Traffic Member

    The staff in the clinic here wondered why I was laughing so much. This statement has brightened my day
  8. lcp

    lcp Active Member

    should see the look on the patients face when you tell them their pain is coming from their spogwang!!!
  9. Should see the look on my face when my royalty cheques start coming in for every time you use the term "spogwang" ;)
  10. David Smith

    David Smith Well-Known Member

    Hi simon and Kevin

    Now at the severe risk of a spanking :boxing: I quite liked this paper.

    I agree that the amalgamation of all lower leg biomechanically related pathology into one convenient of CT band syndrome is a little ambiguous and over confident to say the least.

    However I like the way this description of biomechanical pathogenisis avoids the usual classification of feet in terms of shape, posture, RoM, and all biometric standardisation. I suppose there is classification into planal or axial pathologies but I think a little leeway should be allowed here.

    The author has clearly read much and understands the basis of biomechanics in terms of tissue stress and its propogation and how various theories have attempted to explain this relationship.

    The description and distinct demarkation between pathologies relating to saggital plane translational progression induced stress and and frontal plane rotational stress and transverse plane (Planal dominance) stress are insightful even if perhaps a little simplistic.

    As an introduction to modern podo-biomechanics I think this would be a valid read for the student as long as they move on to understanding the intricacies of tissue stress theory and how each plane and axis of kinetic and kinematic action should not be conveniently separated into these catergories. (Just lose the title CT band syndrome)

    If put alongside Rothbart, Glaser or Shavelson theories/paradigms, I would say it is far and away more reasoned and reasonable than those.

    Looking forward to a thrashing as I haven't had one for ages :D

    All the best Dave
  11. Dave:

    I would tend to agree that the author's paper is much better than the stuff I have read from the three podiatrists mentioned above.

    However, that being said, and as someone that has been reviewing biomechanics papers from JAPMA now for over a decade and biomechanics papers from the Journal of Foot and Ankle Surgery for the past five years, the paper was too long, not focused enough on one premise, and would need a serious rewrite. I would specifically request that the term "CT Band Syndrome" be eliminated since it is a garbage-bag terminology (much like the term "shin splints") and is not at all helpful for the clinician and is not a step forward for the profession as a whole.

    Dave, I hope that when you submit your first paper to JAPMA for publication, which you should do sometime soon, that you will do better.:drinks
    Last edited: May 13, 2009
  12. David Smith

    David Smith Well-Known Member

    Keeping it short, now that is always a problem for me:dizzy:

  13. Dave:

    If the manuscript is of high quality, then length matters little. However, if the manuscript is of mediocre quality, like the one on CT Band Syndrome, cutting as much superflouos material out of the paper greatly aids its chances of being published in a quality journal.
  14. CraigT

    CraigT Well-Known Member

    While I agree with most of what is said above, the appropriateness of the content is dependent on the Journal it is going into. I have to admit I have not seen this Journal before.

    I have to agree with Dave that it is a reasonable overview of several theoretical models which would probably open the eyes of many Practitioners...
    Agree- if I wrote this paper I would have been accused of naming a syndrome after myself...
    Last edited: May 14, 2009
  15. Craig:

    If the paper was published as a review of several theoretical models, included the obvious kinetic differences between the gastrocnemius-soleus-Achilles tendon complex and the other deep flexors/peroneus longus on ankle and rearfoot plantarflexion moments and forefoot dorsiflexion moments, and was not called "CT Band Syndrome", and then I would have been more impressed.

    However, since the paper in question seemed more like a review of biomechanics of the ankle joint plantarflexors along with a mish-mash of other theories thrown haphazardly together, and all done for the purpose of offering up a new garbage-bag diagnosis of "CT Band Syndrome", then I will need to put "CT Band Syndrome" along with other favorites of mine such as "Rothbart's Foot", "Functional Foot Typing" and the "Bottom Block Theory".
  16. Jeff Oster

    Jeff Oster Welcome New Poster

    [Check4SPAM] RE: URL Attempt

    Hi guys,

    Thanks for your comments.

    This project began with a couple of simple questions. First, how can we quantify what we do when we perform a TAL? Second, what is the quantitative difference between a TAL and an EGR? And third, how can we monitor these changes to improve clinical outcomes. Those questions were asked some 5 years ago. And it's been a lot of fun trying to nail them down.

    A literature review found that there was a limited focus of papers discussing the concept of the leg, ankle and foot functioning as a lever. It was interesting to delve into literature of other professions, in particular, athletic training. There's some smart folks in that field who gave me a lot of insight into this project. The result of this literature search is a unique combination of biomechanics from many different profession.

    This paper is an introduction to the concept of the CT band and CT band syndrome. It represents the first of four papers. The second paper focuses on a non-weight bearing, indirect method of determining lever arm pressure generated by the CT band. Subsequent papers evaluate the reliability of these testing methods.

    So what's a guy to call a new research project? It seemed appropriate to focus on the physical properties of the CT band. From the proximal aspect of the effort arm to the distal aspect of the resistance arm is a measure from the calf to the toes. C>>T. CT band. Made sense to me.

    The Foot and Ankle On-line Journal is a peer reviewed journal. I want to thank editor Al Kline, DPM for his guidance with this paper. This paper was originally written as a three part paper; Introduction to The CT Band, The CT Band Index and Introduction to CT Band Syndrome. In its original form, it was a beast. Dr. Kline's editorial focus was very helpful in creating a more meaningful paper. But most importantly, it's important to recognize The FAOJ, Dr. Kline and The FAOJ editorial board for the courage to accept new research for publication.

    Stay tuned for more....


    PS..nice forum Craig.
    Last edited by a moderator: May 14, 2009
  17. Craig Payne

    Craig Payne Moderator

    Jeff :welcome:

    FAOJ's track record is of publishing mediocre research that has been already rejected from other journals or would not get published in mainstream journals, so its not getting a very good reputation. If the FAOJ wants any recognition it is going to have to massivly lift its game, especially letting bad research get through its so-called peer review process. Also, Al Kline has been banned from here.
    Last edited: May 15, 2009
  18. Re: [Check4SPAM] RE: URL Attempt


    Welcome to Podiatry Arena. It seems like there are a few of us who like your paper and a few of us who don't necessarily like your paper. That is what is nice about this forum. You can go into detailed discussion regarding the concepts involved in foot and lower extremity biomechanics without having a word limit as in other podiatry forums. Hope you don't take any of our comments personally.

    As far as my opinion of your paper, I don't find that the concepts you presented are anything new that hasn't been presented within the literature at other times in the past, other than the name you have given a group of muscles which are necessary for human locomotion: "CT Band". However, you do seem to have done your homework regarding some of the concepts we use in biomechanics. Why couldn't you haven't named your paper a less controversial name such as "A Mechanical Analysis of Possible Contributions of Ankle Joint Plantarflexors to Foot and Lower Extremity Biomechanics"???? You would have impressed me much more if you had not turned me off to your paper with your controversial paper title. :drinks
    Last edited: May 15, 2009
  19. EdGlaser

    EdGlaser Active Member


    I am glad that I am one of your "favorites". I am on the road right now in FL but will be lecturing to the podiatrists in your backyard next Tuesday. I hope you have the stones to show up. It would be fun to answer your questions in person and in front of your local colleagues. Dinner is on me at Ruth's Chris, 1185 Galleria Blvd., Roseville, CA. at 6:00 pm. I am introducing some new concepts I think you will find interesting. My presentation is 40 min. and there will be time for questions at the end of the presentation.

    Ed Glaser, DPM
    CEO Sole Supports, Inc.
  20. Ed:

    Thanks for the invite. If I don't show up it won't be for lack of "stones" as you stated. I would actually rather spend more time with my wife and family on Tuesday night since I have been very busy lately with my practice and Tuesday is my only afternoon off. However, I do love the steaks at Ruth's Chris, and since you would be paying for my dinner, I just may consider showing up for the food.

    So, Ed, if I don't show up for the lecture, don't take it personally. I'm sure you will receive a warm reception from my podiatric colleagues and many former students who practice here in the Sacramento area otherwise.:drinks
    Last edited: May 16, 2009
  21. EdGlaser

    EdGlaser Active Member

    This is your chance to challenge my thinking in a public forum. I could not make it more convenient for you. I will even have a video camera so the rest of the podiatry arena crowd can enjoy it. I certainly don't mind paying for your dinner but I would love the chance to handle all of your objections to my theory live. You seem to bring up my name over and over on this site. You try to lump me in with others, like Brian Rothbart, whose orthoses far more closely resemble your own (flat with tilts). You lob personal attacks freely. You attack my business success, my research, my motives but can you actually attack my theory and defend yours?
    As much time as you spend attacking me on this site, you certainly should not miss this opportunity......unless you feel threatened or insecure. If you were coming to Nashville to lecture, unless I was out of town, I would not miss it for anything. After all you are my self appointed arch-less enemy.

    Ed Glaser, DPM :boxing:

    Looking forward to seeing you there,
  22. Ed:

    I have decided to do something a little more interesting on Tuesday night with my little free time, rather than seeing another one of your infomercials about how great you think you are and how great you think your company's orthoses are....I'm going to sit in my backyard and watch my grass grow. :drinks
    Last edited: May 17, 2009
  23. drsha

    drsha Banned

    Kevin Stated:

    I have decided to do something a little more interesting on Tuesday night with my little free time, rather than seeing another one of your infomercials about how great you think you are and how great you think your company's orthoses are....I'm going to sit in my backyard and watch my grass grow.

    Dennis replies:
    I find it very significant that you are avoiding Dr. Glaser's invitation. If you do not show up for even a moment, in your own backyard, I would think you have something that you are afraid would be exposed, in the real world, in real time.

    Furthermore, as an added invitation,
    As I visited with Jeff Root and discussed biomechanics with him at The Midwest Conference, I will be exhibiting at The Western Conference in June and I assume you will be there as well. I would like to meet with you privately or in any manner which you suggest but would most enjoy offering an open forum for us to examine, present our biomechanical presentation and treat the same patient biomechanically in open view of the podiatry community in attendance and let the pateint and open court decide a victor.

    I think it would be very educational, come what may.

    If you decide not to enage us
    I suggest that you have grass to watch when not protected by your Arena flock and the separation of the internet and exposes your inability to answer and define questions and terms face to face.

    I wish I had the talent to paste your face on the cowardly lion as a potential alter ego, Darth.

    Definition, Coward:
    coward adj.
    Word History: A coward is one who "turns tail." The word comes from Old French couart, coart, "coward," and is related to Italian codardo, "coward." Couart is formed from coe, a northern French dialectal variant of cue, "tail" (from Latin cda), to which the derogatory suffix -ard was added. This suffix appears in bastard, laggard, and sluggard, to name a few. A coward may also be one with his tail between his legs. In heraldry a lion couard, "cowardly lion," was depicted with his tail between his legs. So a coward may be one with his tail hidden between his legs or one who turns tail and runs like a rabbit, with his tail showing.

    a person who is easily frightened and avoids dangerous or difficult situations.

    Your aggressive bravado and meanness on The Arena is replaced by someone passively watching grass grow.
    Now whose off his meds?
    Dr Sha
  24. Dennis:

    Treating feet has never been a form of competition for me. If you and Ed and Brian Rothbart, want to all compete with each other, then have at it. My only goal is to make my patients better and teach others how to do so, not to sell my products to as many podiatrists as possible.
  25. EdGlaser

    EdGlaser Active Member

    Thank you. Eloquently stated........ my sentiments exactly. Your challenge to Kevin is interesting.

    I recently lectured at the Kern Civic Hospital residency alumni meeting. Dr. Rich Segmuller, from Utah got up and told a story about his first experience with Sole Supports. He took 10 patients who he already had dispensed orthotics to (much like the ones Kevin uses) who had varying levels of satisfaction with their treatment (mostly satisfied). He cast all 10 in MASS position and at his own expense without our knowledge, gave them to these patients for free. After one month he recalled them and asked which orthotic they preferred. 9 out of 10 chose the Sole Supports. He has been using us exclusively ever since and reports significantly better results.

    Res Ipsa Loquitur.

    My course does not aggrandize myself however it does offer an alternate paradigm which I hope the attendees find interesting enough to explore further. Yes, this is how I spread the word......the same way that Merton Root, Tom Sgarlotto, John Weed and Bill Orien spread the word about Neutral Position Theory.....through lectures and seminars. Yes, I do hope that the attendees try my lab. And YES, I do believe that the orthotic technology I offer is superior to what they learned in school.....otherwise I would be just another me-too lab.

    I will be introducing a new measurement technology to replace the 17 static biomechanical measurements you discounted in Gheluwe et al, in JAPMA June 2002. We have been two years in development on this.

    Dr. Paul Scheerer said that you cannot improve something unless you can measure it....we are about to fill that void.

    Anyway, you have nothing to fear. My intention is not to attack you, just to introduce our colleagues to a new theory. You are still invited to attend.

  26. Ed:

    As I said earlier, Tuesday afternoon and evening is my one half day where I can do things during the week with my lovely wife. She prefers that I don't go to any meetings on these nights, since I am so busy with my practice and other academic matters on the other days. Who knows, we may just be watching the grass grow together on our deck in the back yard. After 29 years of marriage, and all the time I have spent during those years in podiatry and podiatric education, I believe I owe her this time.

    Hope you have a good lecture with my friends, former students and colleagues in Roseville.:drinks

    Here is a little history segment for you regarding the railroad town of Roseville which may be interesting to you, especially if you are a train enthusiast. Roseville was one of the most important cities along the western section of the Central Pacific Railroad when the Transcontinental Railroad was completed in 1869.

  27. drsha

    drsha Banned

    Kevin Stated:
    Tuesday afternoon and evening is my one half day where I can do things during the week with my lovely wife. She prefers that I don't go to any meetings on these nights, since I am so busy with my practice and other academic matters on the other days. Who knows, we may just be watching the grass grow together on our deck in the back yard. After 29 years of marriage, and all the time I have spent during those years in podiatry and podiatric education, I believe I owe her this time.
    Treating feet has never been a form of competition for me.

    Dennis Replies:
    Some rules are meant to never be broken and I certainly understand the no tolerance thought in being with your wife on Tuesdays.
    The Western is Thurs-Sunday, so I hope you can find the time to schedule a meeting with me, either privately or in public.

    Kevin, I agree with you that you are not competitive when it comes to biomechanics, I sense that you are Dictatorial.
    Asserting or tending to assert one's authority or to impose one's will on others.
    Dictatorial stresses the highhanded, peremptory manner characteristic of a dictator: ordered the staff about in her usual dictatorial manner.
    The expectation of unquestioning obedience: the timid child of authoritarian parents.
    The imposing of one's will or opinion as though these were beyond challenge.

    I did not suggest a fight to the death, I suggested an open forum debate.
    In FLEB, where every theory of biomechanics including SALRE is UNPROVEN, making yours no better than mine, a little healthy competition would most likely prove educational and purposeful.
  28. No, Dennis, I am not the dictator of Podiatry Arena. I am just a podiatrist that has a keen interest in biomechanics and has tried, throughout his practice career, to gain a better understanding of how the foot and lower extremity functions during weightbearing activities so that I may use that knowledge to improve the lives of my patients, and teach others how to do so also.

    Even though I won't be able to attend the Sacramento meeting that Ed is lecturing at (Ed....I hope that more than 5 podiatrists show up for your talk since that is all that showed up when I spoke at my own local podiatry society's meeting a few years ago....and a free dinner was provided even!!), I will be attending the Western Podiatry Congress in Anaheim again. In addition, I will not be lecturing on anything, for a change. Maybe Ed can also attend and we can get a group photo of the three of us (won't that raise some eyebrows here if we posted that photo up here on Podiatry Arena!). I would be happy to sit down with you at that time and talk biomechanics, but will probably be also attending many of the lectures since I need to stay current.
  29. MR NAKE

    MR NAKE Active Member

    Cummmmon kevin (good lad), just attend the blxxdy forum, you are equiped for success both of you, so give us a showdown for 2009/10 and i will sponsor for it to be at Las Vegas MGM( ha ha ha lol, joke:D), and the referees are Spooner & Graig, very neutral and fair.........:boxing:

    I hope all involved PARTIES are highly qualified/dignified proffessionals who will always understand the debating rules:

    Never debate from a personal and emotional point of view not only does it show arrogance but ignorance...........:drinks
  30. I have no idea who these three individuals are, yet all three seem strangely familiar to me.

    Attached Files:

    Last edited: May 18, 2009
  31. EdGlaser

    EdGlaser Active Member

    I am sorry that you will not be there.
  32. What does that have to do with Gravity Syndrome........?:rolleyes::cool:
  33. Sammo

    Sammo Active Member

    The one on the left is pulling the same expression Robert used to when I mentioned words like "Acupuncture", "homeopathy", "holistic" and "marigold".
  34. The one in the middle will be unaffected by Gravity Syndrome because he's in space, man... In case of need for future reference: that's a pig.:D

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