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education classes?

Discussion in 'General Issues and Discussion Forum' started by bartypb, Jul 15, 2009.

  1. bartypb

    bartypb Active Member


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    Hi all I am currently working within a small nhs podiatry dept as a biomechanics lead , obviously we have long wait lists approx 5 months and I have been asked to find solutions for this wait list problem as we will be entering into an 18wk pathway plan in the next few months. I know many users are NHS workers and I would like feedback on something that we have been asked to do.

    We have noted a lot of referrals from GPs etc for heel pain/ plantar faciitis, and I mentioned that gastrosoleus stretches is part of our general treatment plan (along with others). To get the wait list down I have been asked to look into running education classes for stretching exercises for heel pain. I mysef don't think this would be a great idea as I think it is clinically wrong to introduce any treatment regeme without assessment first?

    In my experience hitting heel pain with anumber of modalities ie strapping, insoles, stretching, possibly accupuncture and steroid injection seems to give the best outcome but obviously the focal point to the treatment is a comprehensive assessment and working diagnosis.

    There are of course many different causes ie systemic, neural and mechanical and I feel it would be hard to differentiate without assessment, not to mention the inaccuracies of the actual referral?

    Any thoughts would be appreciated

    thanks

    Bartypb
     
    Last edited: Jul 15, 2009
  2. The Hooded Claw

    The Hooded Claw Welcome New Poster

    Hi

    Firstly, I'm not NHS, nor am I a podiatrist! Oops - please don;t kick me off!
    I run a company called Anatomy in Motion (.co.uk) and am obsessed with the role the
    foot plays in the overall structure of the human body.

    I use gait analysis as a means of determining the body's failings or inhibitions (be it at the foot, ankle, knee, hip spine or higher up the chain) and use movement based corrections to realign the body so that pain/injury/pressure/discomfort is removed.

    I am aware through biomechanical research and my experience of using a footscan/pressure plate that by changing the centre of pressure through the foot to be optimal completly changes the way the whole body functions. I am able to eliminate pathologies such as anterior/medial knee pain, shin splints and have worked on many a slipped disc using this approach.

    Just last week I had a guy diagnosed with a calcaneal spur & plantar fasciitis and was told to give up his love of golf and tennis (not a great pod or doctor granted) but I noticed his hip alignment was poor and his leg length was different. In one hours session, I had evened his leg length out, balanced his hips and altered his spinal movement. No need for orthotics (in fact we ripped them out!) and he has been playing tennis three times a week since with zero pain.

    The movement work I do is a kind of whole body stretching mimicking whole body gait patterns (i.e. what are the hip, knee and spine doing at the point of heel strike, foot flat etc) and replicating that, assisting where necessary.

    I always assess their motion and understand their ailments.... NOW in response to your question:
    Gastrosoleus stretching is ok but has no long term if the cause is a leg length discrepancy... and a heel riser is of no purpose if the discrepancy is functional i.e. due to muscle adaptations rather than a longer femur! Experience shows it is possible to transform foot function through motion - you will be amazed. The motion transforms the internal influences within the human. Strapping, insoles, footwear are all external influences that change speeds, timing, ground force etc.
    Why Anatomy in Motion is so effective is because we aim to balance the internal and external influences so the internal structure knows what is hapening in it's external environment. The two influences when put together determine the amount of energy used in motion, which is where the universal law of energy conservation kicks in and the body determines the least resistant posture for it;'s everyday patterns. Just the insole or just the stretching is not enough. WE have to upgrade our learning and awareness of a global picture of the human body. It doesn't stop at the knee... and likewise for a physio but in the other direction.

    I get results that most practitioners can only dream of... in sometimes one session. it's remarkable and is the only reason I make this post. There are courses that already exist for you guys, if only you dare step outside the field of podiatry. It's the whole human body you are dealing with...

    I should post more then they wouldn't be so long! if you didn't switch off half way through you might like to know that we run gait courses called GAIT 101 and this information will come to life for you. The website is being updated to reflect this.

    I'm not an arrogant b****** - I'm just madly passionate about my work.
    :hammer:
    The Hooded Claw
     
  3. Ian Linane

    Ian Linane Well-Known Member

    Hi there Hoodie

    You said: "I get results that most practitioners can only dream of... in sometimes one session. it's remarkable and is the only reason I make this post. There are courses that already exist for you guys, if only you dare step outside the field of podiatry. It's the whole human body you are dealing with..."

    I have in the past looked at some of the Anatomy in Motion stuff but it was a while ago so don't recall too much. However, at the risk of seeming slightly discourteous to your first post, I think that you had best read many more of the posts of the many and hugely varied members here and consider whether to retract the assumption in the above quote. Otherwise it might be feeding time for some, again.

    Ian
     
  4. W J Liggins

    W J Liggins Well-Known Member

    Hi Bartybp

    I do not intend to dignify the Hooded Claw's post with a reply.

    I agree that there is a moral/ethical dimension to the situation which you find yourself in. However, it does seem that central heel pain on rising, reducing following weight bearing and recurring after rest is pathognomic of PF. If the referral so states then you are certainly not going to cause harm by teaching gastroc/soleus stretching etc. The powers that be will be delighted because your patient contact count will rise. Certainly some of the group will improve, leaving the others for consultation/treatment as appropriate. 25 years ago, I could not have imagined myself making such a statement, but nothing is ideal, times change and our duty is still to as many patients as possible.

    I would make it clear, in writing, that you are doing this under pressure and that it is against your best clinical judgement.

    All the best

    Bill
     
  5. Griff

    Griff Moderator

    Dear Hooded Claw,

    As Ian L has already suggested, perhaps you should evaluate the audience you are addressing before posting such replies. This is not a lay community who will hang on your every word, and our community certainly do not take too well to individuals popping up on here and telling us all that they have finally worked it all out for us. Such individuals that have tried this in the past include Brian Rothbart, Dennis Shalveston and Burton Schuler. All of them introduced themselves to us with posts not disimilar to yours, all then refused to enter in scientific debate and all are now conspicuous by their absence. Why not take a little look at our snake oil threads - I suspect you'll join them at some point.

    Ignoring some of the questionable content of your post for now, I will ask just one question: If you are so 'proud' and sure of your particular approach, why is it you remain anonymous?

    Ian

    PS Apologies to Bartybp for the detour from the original thread - perhaps this needs seperating into an 'Anatomy in Motion' thread...
     
    Last edited: Jul 18, 2009
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