Is SALRE a "Single Axis Theory"

Hi Stu I guess your part of the MASS collective - got any peer review stuff that the long term, or even short term results of MASS device?

Really what the best study would be is to give the leading components of Podiatric tissue stress one side of the treatment and then leading MASS people the other. DBL blind or whatever study fits best here - large numbers research independent written and see who scores better in pain reduction, comfort etc Reviewed after period of time and then a review again after any required adjustments are made to the device.

But that maybe a dream which will never happen people are too busy, setting up the trial maybe somewhat of a nightmare, whos going to pay for it etc etc, buts it´s a paper I would like to read.




As I said before

and in this case evidence for positive results for lateral wedging much much more than peer review evidence for MASS type device for the use in medial knee pain.

 

Just want to highlight these points I missed last night and this morning..

But quantity of quality options is better than 1 option.

Ed big BIG BIG statement which I will hold you too an answer - Just to let you know every time you post I´m going to ask to explain this statement if you have not done so.

 

SALRE is one theory. Tissue Stress is another. Neoteric Biomechanics is yet another. The theory of Relativity is yet another. You can combine them any way you want but SALRE is still, on its own, a Single Axis Theroy. Period.

No, I only want to establish first that it is single axis. I think everyone on this thread can see how you all have squirmed around the question.

You, as usual were able to state the obvious.

Robert Isaacs still thinks that SALRE either has NO axes or multiple axes. He has used several different locations or positions of the axis to cloud the water but it is still one axis. I have to ask him to give me a list of all of the axes that SALRE is about. Maybe the knee or the elbow?

Weber has accepted the concept of one axis.

You already did that for me. Actually within the framework of false assumptions, the physics works out. We will go over each false assumption.

This is not about MASS. MASS is another theory.

We can discuss MASS later….. lets try to stay on topic.

I agree “something has to stop it sooner or later”.

Ed

As soon as Robert Isaacs figures out that the STJ is one axis we can move on.
We will continue to work with him, to help him count to ONE. I will give him one more day and then I have to move on without him.

 

Not a problem. We are all just waiting for Robert Isaacs to understand that the STJ axis is ONE axis and it IS the only axis used in SALRE Theory. Tomorrow we will move on but I hate to leave Robert Isaacs alone here thinking that SALRE is about the Middle Ear Bones or the Wrist or the Clavicle.

 

Robert Isaacs,

There have been all kinds of attempts to de-rail this thread.

Let's make it about MASS or Posture. We can discuss these separately.
Let's confuse different positions or temporal locations of the axis with the number of axes.
Let's try to protect SALRE under the umbrella of Tissue Stress Theory to confuse the two. If tissue stress has merit and we say that we are part of it maybe we will not have to admit SALRE is about ONE axis.
Or, my personal favorite, Weidermeyer's: Let's make it about personal attacks and contribute nothing (unless it is off topic an irrelevant) Sit down.... the grown-ups are talking.

ROBERT ISAACS: PLEASE enlighten us. LIST ALL OF THE MANY AXES THAT SALRE ITSELF IS ABOUT (NOT TISSUE STRESS, RELATIVITY, MASS OR ANY OTHER THEORY).

Maybe we should do a multiple choice:

Subtalar Axis Location and Rotational Equilibrium Theory is about:
a. The Knee axis.
b. The Subtalar Axis Only
c. The Left third metacarpal-phalangeal axis
d. I have had too much Kool Aid to tell
e. Tissue Stress Theory is nice too.
f. All of the above.

List for us all of the axes that SALRE is about..... PLEASE.

My God (giver of the sacred Kool Aid) MAN! Tissue Stress theory is about Tissue Stress Theory. No one is accusing you of using SALRE as your ONLY paradigm. Obviously NOBODY wants to be painted with that brush. SALRE by itself seems to be quite toxic to even its most ardent supporters. It must be hidden behind the barricade of the Tissue Stress Theory and protected ..... otherwise our God may be in danger of having to defending it.

This thread is about ONE thing only. You will find it in the title of the thread.

Correct answer above is "b. SALRE is about the STJ axis only".

I would love to move on to address the validity of SALRE but I just wanted to establish in this thread that it was a "single axis theory" period. This way, when I call it that, I will not be constantly accused of "strawman" arguments when I am simply stating obvious FACT.

Ed

 

Ed, Ed, Ed.

please read this post again http://www.podiatry-arena.com/podiatry-forum/showpost.php?p=180196&postcount=50

SALRE is part of the tissue stress approach to treatment.

Why not like everyone else call SALRE by it´s name Subtalar Axis Location and Rotational Equlibrium and move on.

 

We can discuss the quality of the mods later.
And I will go over the Mis-application of tissue stress as well.
.....as soon as we conclude that
SUBTALAR AXIS location and rotational equilibrium is about the STJ axis.
Mike, I believe you have already acknowledged that, Eric has got it too, David is in outer space.... we are all just waiting for Robert Isaacs to catch up here.
Some people have difficulty with math.... I understand. :bash::bang:
This is not an existential question. It is not deep, or complex. It is simple and easy.
SALRE is a single axis theory. Can we agree on that? ....and move on.

I am in Detroit. Had a lecture last night. I have a flight to catch now so gotta go,
Bye all for now.

Ed

 

Isn't this fun!

Ed, , remember you are talking to one of the people who developed Tissue Stress theory, and who knows more about SALRE, I suspect, than anyone on this thread (Eric, obviously). I think he is rather better qualified than you to state what tissue stress and SALRE are and how they fit together. Telling HIM what HIS model is is a bit... other!

Otherwise, there is the quote of Kevins which you ignored. And the link Mike gave.

SALRE is a part of tissue stress. They are NOT separate theories. You are wrong. Take my word for it, as someone who uses both, and Erics, as someone who has been involved in the development of one.

Here is the straw man you mentioned. If SALRE was separate to Tissue Stress, and a "stand alone" model then it is flawed as I know you are just itching to point out. However no matter how much you, as someone who does not use it and had nothing to do with its inception, might claim otherwise, It is inextricably linked with tissue stress.

Thats not to say it is toxic, or anything other than valid and useful. But its like the engine of the car. The engine does not "hide behind the car because its so useless". It is not "separate from the car". The engine is a vital part of the car. Without it, the car won't go! Without the car the engine merely revs on the ground and spins a drive shaft (which is no use to anyone.)

That, for me, is the relationship between SALRE and Tissue Stress. SALRE ALONE give us little which we can apply clinically. Tissue Stress ALONE simply does not "go" because it incorperates no means to determine and modify pathological forces. Put the two together and they make a clinically applicable model.



When YOU can accept THAT you might realise why this thread is going nowhere.

 

I get the point..... That SALRE by itself has absolutely no merit.

Whereas Tissue stress has merit when applied alone.

If you take antibiotics for the infection AND say the magic word you will get better.....but the magic word alone is useless. So the magic word should only be studied with the appropriate antibiotic and it will be found to be effective.

But it is still SINGLE AXIS.

Ed

 

Tetchy today old boy. Careful, your grip on civility is slipping.

Why ask the question if you intend to answer it for everyone? If you have a flaw, Ed, its that you do tend to take umbrage when someone disagrees with you.

I'll try to answer your question again in terms you will grasp but It's an uphill struggle!

a:
Yes. You seem determined to ignore the "rotational equilibrium" part of the paper in your fixation on the sub talar axial location part. Read it again. A good proportion of it is spent discussing rotational equilibrium in general. I've never seen a paper called "1st MPJ internal / external moments and rotational equilibrium", yet that is now the way in which many of us think of FnHL. Why? Because we are applying the principles of Rotational equilibrium, as discussed in SALRE to other joints.

B. See A

C. Could you but see, I am extending my 3rd MCP joint, with the others flexed to investigate.

d. Why are you incapable of accepting that someone might disagree with you out of something other than nepotism? Is the world divided into people who hang on your every word and people who agree with everything Kevin says? I have news. There are some who are in neither group.

E. Certainly is.

F, not really.

Why have a whole thread on a question which you consider has only one possible answer? Dinner must be fun at your house!
"
Ed:- Fancy pasta for dinner hun?

Mrs Ed :- How about Steak?

Ed (enraged) :-NO YOU STUPID WOMAN!!! DINNER IS SELF EVIDENTLY PASTA!!! WHY CAN YOU NOT ACCEPT THIS SIMPLE TRUTH?! ARE YOU STUPID OR SOMETHING? ITS PASTA! PASTA!!!!! I JUST WANT TO ESTABLISH THAT ITS PASTA SO WE CAN TALK ABOUT WHATS FOR PUDDING?!!

Mrs ed (bewildered) :- So why did you ask?

Why ask the question if you're going to spit your dummy when someone disagrees with what you think the answer is?



Sorry. To be serious.

So, to clarify, you wish to describe SALRE as a single axis model on the basis that it only has one axis at any intantaneous time. I don't accept that because

A: SALRE is about the sub talar axial location AND rotational equilibrium, and rotational equilibrium can be applied to any joint

B: Saying that the sub talar joint has one axis because it has one axis at any given moment is like saying a clock hand is unipositional because it only occupies one position at a time or that a tide is uni level because it is only one position at a time. The Sub talar joint has, as kevin and others have written, many instantaneous axes. That is different to it having one axis. Many, different to one.

Being sloppy with the terminology is A: bad form and B: makes me think you are planning to build on that dodgy definition to make a point. So sorry, no dice.

If you mean "does the sub talar joint have a bundle of instantaneous axis, only one of which it will occupy at any one time" then I'll agree and why was that not the question of the thread? If the question is "Is SALRE a single axis theory" the answer remains (self evidently) NO.

Be right back, my static (at any given instant) child is trying to kill my equally single position (at any given instant) cat and I suspect blood (which is unmoving and immutable at any given instant) is about to be shed.

 

Ed, how much merit does nuclear physics have? None alone. But put it with engineering and voila, a power station!

How much merit does histopathology have by itself? None. But put it with a doctor who knows what to do with the information and presto, we have a treatment.

Your spite, and the depths to which you stoop to misrepresent what you dislike, are breathtaking.

 

Puerile and pathetic, typical Ed Glaser. You insult me yet again Ed and it will eventually be your undoing. A number of people are watching this thread now, some of whom will be a complete surprise to you down the road.

The thin veneer of your fragile eggshell ego is cracking Ed. I'd like to point something very telling out surrounding the entirety of your contribution here on Podiatry Arena; the only people supporting and agreeing with you are your employees.

Since I tried to be civil and offer something related to the posture idea Don presented and you came out swinging again, consider this also:

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I think these stats tell the whole story. You three have nothing to say that doesn't involve you product, your lab and your goals. You contribute nothing that isn't related to you or your product, never attempt to see anyone else's point of view or contributions (especially by way of thanking them) and never participate but eagerly criticize everything else that isn't MASS. Pathetic.

What a colossal circle jerk you and your team are. :bang:

 

Is Tom McPoil aware that his Tissue Stress theory is only valid when combined with SALRE. It is like a care without and engine. I have to look at his article. Does he predicate the tissue stress model on SALRE? or even reference SALRE? If not, how could he ever put out a theory with such a gaping hole in it. It is right no matter how you combine it, because it is right independently. However SALRE does not enjoy such status.
No. Tissue Stress can stand on its own two feet. It is true and valid without SALRE.

Ed

 

David.

The world is full of such. My advice, for what its worth is to try not to feel :bang:, instead try to to cultivate an attitude of .

Look over the small people my friend. You know who you are. You know who they are. let that be enough.

 

Thats good advice for you as well Ed btw if you flip it and reverse it.

 

I give Isaac Newton credit for RE. NOT Kevin Kirby. It applies to every axis everywhere. It is ONLY SAL that is Kevin’s. I have no problem with Newtonian Physics…..just its misapplication.

Clock hands do revolve around ONE axis. Usually, it’s the center of the clock face perpendicular to the surface. The tides are not an axial motion and irrelevant.

Wrong. The axis may move. Let’s see. We are rotating around the earth’s axis at 1100mph, rotating around the sun at approximately 67000mph and around the galactic central axis even faster and the galaxy is moving too. Does that mean that the STJ axis in your mind has all of these different axes. ….. that is ridiculous and not as much fun. The rest of us will consider the STJ as having one axis that translates a little or a lot depending on your frame of reference. The bundle of axes is a cadaver study, off weight bearing and shows three almost identical axis locations in different rotational positions due to the fact that the talus slides slightly while it rotates. These are not multiple axes, just different locations of the same axis.

“"does the sub talar joint have a bundle of instantaneous axis, only one of which it will occupy at any one time" then I'll agree”. Wow this is dangerously close to actually understanding this simple concept…..So, you think that SALRE depends on a “bundle of axes. Then why don’t you draw three or more axes on the bottom of the foot? Which of these many axes is relevant or should be depicted with its shadow on the bottom of the foot? Does it matter? Are you trying to support SALRE or invalidate it? Suggesting that there are multiple axes is certainly one very good criticism of SALRE…..but I don’t think it is what Kevin was stating in his peer reviewed expert opinion articles.

Ed

 

Where did anyone say that tissue stress is only valid when combined with SALRE I beleive Eric said Some of tissue stress theory can be explained using SALRE.

 

Robert did. In his analogy of the Car and Engine. One is useless without the other.

Ed

 

What makes you think I don't? Consider more than one axial position that is.

Depends. Probably all of them are relevant.

Depends on what you are trying to illustrate.

Hell yeah!

Suggesting that there are multiple axes is certainly one very good criticism of SALRE…..but I don’t think it is what Kevin was stating in his peer reviewed expert opinion articles.

So when Kevin said

He actually MEANT that the sub talar joint CAN be described as solitary axis and NOT as a multitude of axes. He's tricksie is Prof Kirby! Sayinf there were a multitude of axes when he meant there was only one!!

 

Thank you for that. You really highlight Kevin's misunderstanding of the article he is referencing. The author is talking about axial translation, not a multitude of axes. You are right he is tricksie.

Ed

 

Here I agree. The STJ axis free floats and will pitch and yaw in space likely dependent on the COP progression and GRF. The issue is where is the average of the whole? This can be clinically appreciated with the concept of Rotational Equilibrium and the palpation technique explained by Kevin. From this we can design a device to exert an influence on the average or the whole, such as medial or lateral heel skive.

Utilizing tissue stress principles we determine if this is necessary and if other orthoses modifications are required throughout the step cycle to reduce moments across joints which are likely causing the forces stressing the injured tissues.

MASS doesn't give an explanation of how it deals with the dynamic forces which change throughout the step cycle.

 

Can't have it both ways old boy. Either kevin meant there were multiple axes and you disagree, in which case salre is a multiple axial model OR kevin meant something other than he said in which case his interpretation of those studies matches yours.

Not both though.

Or do you reckon kevin meant it was multiple axial (as he said) but that salre SHOULD be uni axial....

In which case your critique is of what you think his model should be, not what it is.

 

Hey buddy. Got some photos to send you. Scooped the weirdest VP out of your friends foot that I ever did see!

Ok, try this. (This is for Graham, who has the integrity to disagree for the right reasons and the intelligence to consider an argument on merit. I don't expect Ed or his sales team to get anything from this so please feel free to ignore it)

Patient presents with a "munted" foot type. The axial position in paralell plantar position is just west of the 1st met head.

There is Axial position 1.

But. When we consider the action of our orthoses we have to consider the positions / ranges of the axis in function. So we might look at the position of the foot in static WB. Lets say for the sake of argument that this is maximally pronated. Now we have a second axial position to consider, the position of the Axis at its medial most position within the bundle.

There is Axial position 2.

But. I look at the wear pattern on the shoe and it is all medial. Why is it all medial? Perhaps the position of the axis during swing phase is medial to the insertion of the tibialis anterior making it function as a pronator! Best we check that then!

There is axial position 3.

So in this one hypothetical patient we have 3 axial positions to think about already. Then of course, if our orthotic exerts a kinematic effect so the foot POSTURE is no longer in its fully pronated position our weight bearing functional axial range has changed! There is position 4.

So although it is true that the axis is only in one place at a time, in practical clinical application I believe we should consider more than just the paralell plantar position.

This is my interpretation of SALRE, and the point Kevin was trying to make when he referred to a multitude of axes. I think the "average" (as a mode or median) is a poor way to consider it, as one foot might function around the average and another might only see maximally pronated when weight bearing. The nice thing about a paper like SALRE is it makes other people think more, not less.

 

Robert,

I agree. However, I believe each axial position will have a range that it floats in and therefore an average. The modifications of the orthoses therefore are decided based on an appreciation of the multiple axial positions and the best way to direct the flow of the COP and GRF to achieve as close to the average for each axial position as the foot pivots from heel to toe. SARLE is a component of this decision making process, but as you say, part of tissue stress appreciation, not the only consideration .Perhaps..Oh yes! And throw in a first ray cut away just for good measure!:drinks

Love to see the photos. Any chance to get a copy of the video also? She's is doing well. Had a shoe full of blood when she got home! Looks like you did a great job! Thanks!

 

Video didn't take. Sorry! But I will get you the photos. Its a doozey. How she was walking about with that thing stuck in her foot for so long I have NO idea.

It was a long way to drive home. I did suggest she may want to get a lift!

 

Hi All,

This looks like an amuzing thread...

I have to admit, I scrolled through the bigger parts of this topic because I couldn't find the time to read it all as my wife is already sitting in the sofa waiting for me to stop ticking on the damn computer....
Where do you guys get the time to play with such intensity with the big boys?

anyway, Ed, in your first post you wrote:

I'm affraid that's not really true...
As a matter of fact, we investigated the reliability of the palpation technique and came to the conclusion that anyone (skilled or not) could locate the STJ axis using the technique described by Kevin (actually not invented by him if you actually read the publications carefully -> It was, if I recall well, Dr. Weed who demonstrated a more simple form of what is now called the "Kirby palpation technique")
a glimps of the ratio level data (Intra Test Reliability on the clinical detection and labelling of the Subtalar Joint Axis as described by Dr. K. Kirby.Authors: De Schepper, J., Van Alsenoy, K., Rijckaert, J., De Mits, S., Lootens, T., Roosen, P. accepted JAPMA, 2010):

So NO, it is accurate and repeatable...
I don't want to burst the bubble ... again...

I always learned that assumption is the mother of all f*ck ups, that's the reason why, when in doubt, you should do the research...

G'night
K.​

​

 

Ken, you are a legend!

 

Don, you were critical of podiatrists for not using the term posture. You were critical of me for not thinking posture was important. My point was: what you call posture, some of us call biomechanics. Bony alignment is engineering. So, it is just as easy and efficient as thinking about posture. They are the same thing but thinking about forces a stresses are more complete.

What you describe is simple demonstration of physics without the free body diagram. You make the observation that a certain position puts less stress on the back than another position. Physics can tell why that position is better.

Well, you can do something without knowing how it works or you can do something with knowing how it works. Yes, you can drive a car without knowing how it works. But we want to repair things, so we should know how it works. When you apply a treatment that supinates the STJ (raises the arch) forces are applied to change that position. Those changes in forces will create stresses in different structures. As you decrease stress in one location you may be increasing stress in another location. If you understand the forces involved, you can warn the patient, or make the device better. So, no you don't have worry to about the relative position of the STJ axis. However, I think you would be a better clinician if you did. What you don't know can hurt you.

There have been many threads on the arena about terms like unstable, loose packed and unlocked. These terms are a sort of magical thinking. The things that determine how rigid a first metatarsal cuneiform joint are the ligaments surrounding the joint and other structures that apply moments about the met cuneiform joint. If you want to understand the joint you have to specifically look at the structures involved. The STJ is related to the first ray in that STJ pronation is stopped by medial forefoot loading. When the STJ stops in more everted position there is likely to be more medial forefoot load. This medial forefoot load is probably what a lot of people mean when they talk about unlocking of the first ray. There is no magical change in the ligaments of the joint when the STJ becomes pronated. This is one example of why it is important to look at forces and moments.

Actually, I can't give a definition of unstable. I don't think anyone has given a good definition of unstable, and they certainly not provided a way of measuring it. So, the term unstable doesn't really mean anything in the context of the foot.

Don, to address arch collapse you have to address SARLE. Things just don't magically move, forces are required to change position. If you believe, or measure, that an orhtotic changed the position of the the equilibrium around the axis has been changed.

Don, I think you have a good intuitive sense of these forces acting on the foot. However, there is more to it.

I think it is the other way around. Biomechanics includes the posture. If you are going to examine forces acting on anatomy, you have to know in what position the anatomy is in.

Yes, Ed casted me twice. Have, you ever thought about why it has to be done in stages?

Eric

 

I wrote:

Quote:
Originally Posted by efuller View Post
So would you agree there nothing wrong with SALRE being a single axis model that can be combined with tissue stress to make an orthosis.

Ed replied.

Ed, you didn't answer my question. Would you get to the point you are trying to make in this thread?

Ed, I'm going to let you in on a little secret. No one is going to convince all of the people all of the time.

Ed are you aware of this paper. The information in it is what makes the tread's question difficult to answer.

Van Langelaan E. J. van, A Kinematical Analysis of the Tarsal Joint an Radiographic Study. Acta Orthopaedica Scandinavica Suppl #204. 1983. Vol. 54


I asked Ed to provide an example of where SALRE didn't work and I mentioned that it explained PT dysfunction very well and it didn't work for explaining 2nd met stress fractures.

Ed, where in our writings do we say that SARLE explains everything?

Get to the point Ed.

There is no reason to wait. Let's move on. What is the point of the question posed by this thread?

Eric

 

Short back story on knee pain theory. Genu varum >>> external adduction moment at knee. External knee adduction moment resisted in part by high compressive forces in the medial compartment of the knee. A lateral wedge, that shifted the center of pressure under the foot more laterally will reduce the knee abduction moment.

When you look at the wear pattern on orthotics with high arches you may see high loads laterally. So, if the medial support shifted the load laterally, then you could explain the success by reduced external abduction moment.

Now we are back to the question, if there is medial support, how does one get a high lateral load. When there is high lateral load there will be high pronation moment from ground reaction force, unless the supinated position of the STJ shifted the axis to a much more lateral position. I doubt as to whether STJ axis position is changed enough to shift the axis that much in most feet. The other explanation is a pain avoidance response where pressure in the medial arch is uncomfortable and the subject uses there muscles (e.g. posterior tibial) to shift the load off of the medial arch on to the lateral forefoot.

Now there is a research project. How, much can an orthotic change STJ axis position and is the posterior tibial muscle more active in that position?

Eric

 

Sorry All,
I was hoping on getting on today but a drunk driver totally destroyed my van when it was legally parked in a shopping center. Luckily, no one was hurt except the drunk driver who lost a lot of blood and finally agreed to go to the hospital. Well I guess I will not be driving a soccer mom van anymore. I think tomorrow I will go out car shopping. This may delay my continuation of this discussion for a bit...we are so far out in the country, a car is a necessity...but I promise to return soon to finish this discussion. This took most of my day.
I just want everyone to see how difficult it is to have a discussion when people cannot accept even the simplest point of fact. Stating a fact like: the STJ having but one axis is near impossible to get agreement on. Disagreeing vehemently with everything I say seems to be a knee jerk reflex among the disciples of Kevin, the God of Podiatry.

If Kevin meant that the STJ axis was more than one, why did he not use the plural, axes? He is very exact in his language.

If SALRE was meant to just apply as a part of the tissue stress model.....why is the tissue stress model not referenced in the six peer reviewed articles?

I have to look again.....does Tom McPoil reference Kevin's SALRE article in his Tissue Stress article? How could he leave it out knowing it is the very engine of the car? There is a serious disconnect here.

Does SALRE stand on its own two feet or not? If independently it is so flawed then what does it contribute to Tissue Stress? It is like a turd in the punch bowl.....it doesn't make the punch better.....the punch would be far better without it.

Ed

 

Ed,

Classical mechanics a branch of Newtonian Physics was developed from the concepts put forward by Kepler and Galileo. Now would we argue on who gets the credit? Galileo or Kepler and not Newton?. Newton has used the concept put forward by Galileo and Kepler to describe the motion in objects. Kinetics and Kinematics, Moments and Forces were described by Newton as factors to create movement. Eminent scholars in the past have used these concepts to describe the nature of motion within different bodies.

Dr.Kevin Kirby described the Subtalar joint motion using classical mechanics. He found the relationship. Newton didn’t, neither did others. Hence it would be his theory based on ‘classical mechanics’ concept.

Equilibrium: Sum of the forces acting on a body is Zero. Dr.Kirby explains pathogenesis of foot and ankle conditions to be due to loss of equilibrium between “the internal and external joint moments”. Orthotics were prescribed for decades and the reason as to how an orthotic work cannot be explained until Dr.Kirby started talking about internal and external joint moments and moment arms. Now, classical mechanics has been in this world long enough. Dr.Kirby found the connecting link between joint forces and foot and ankle pathology using the laws of classical mechanics.

You ask if his SALRE is a single axis theory? I ask you to pick a plane. X Y Z axis for A B C planes. A particular axis for a particular plane not interchangeable. Orthotic modifications are therfore used to regulate motion in a plane of interest.

Thanks for the thread Dr.Ed. this certainly got me thinking.

Regards

David

 

Ed Ive posted Eric reply to your latest you may have missed it , he has already answer the questions more than once.

SALRE is not flawed and fits very well in tissue stress theory it help explain how forces at play can lead to tissue stress, but and I will say it again it´s not the only theory that goes into making up tissue stress.

Eric has even given you an example 2-3 times of when it is of use and when it can not be applied.

Eric wrote :

Ed your language you have got upset at others please read your post and take a look in the mirror.

 

Ed,

The biomechanical discussions in this arena are invariably heated but "academic". We all apply various theoretical frame works to our practice but these are hopefully directed by the best available "scientific research".

You are not achieving anything by attempting to discredit the work of Kevin et al. You, and a VERY few others are a voices being drowned out by those of reason and science. Perhaps you should start Eds Arena? Then you can preach your beliefs all you like with no opposition!:sinking:

 

Sorry to hear that Ed. A car accident, even in a car park, is always a pain in the hole at best and a trauma at worst. Glad to hear that no one was hurt except the prat who caused it.

 

Ed,

Just so that you don't say that no one ever answers your questions

Again, have you read the Van Laangaalan article I mentioned in the previous post. Read that and tell me if your question has a simple answer.

Why do you care if it has one axis or not????? What is your point.

Why should it have been?? It stands quite well on its own, when used correctly.

Look again. Tom McPoil only described the pressure is force/area part of tissue stress. We don't even know if Tom McPoil was aware of Kevin's paper in 1995. There is some disconnect here.

Ed, can you give an example of where we have applied SALRE incorrectly? Can you explain why it is flawed? Just because you repeat over and over again that it is flawed, does not meant that it is. In the number of posts where you claim that SALRE is flawed you could have explained why you think it is flawed.

Sorry to hear about your van.

Eric

 

Orthotic modifications may regulate moments without any perceivable change in motion.

 

Hi Dr Glaser,

I'd like to offer my two cent's worth and make some comments on what you have recently written in this thread. In the last couple of days, you have stated the following:

<<Is Tom McPoil aware that his Tissue Stress theory is only valid when combined with SALRE. It is like a care without and engine. I have to look at his article. Does he predicate the tissue stress model on SALRE? or even reference SALRE? If not, how could he ever put out a theory with such a gaping hole in it.>>
<<I have to look again.....does Tom McPoil reference Kevin's SALRE article in his Tissue Stress article? How could he leave it out knowing it is the very engine of the car? There is a serious disconnect here. >>

It is true that McPoil and Hunt do not cite Dr Kirby's landmark papers in their article ['Evaluation and management of foot and ankle disorders: Present problems and future directions' Journal of Orthopaedic and Sports Physical Therapy (1995): 21(6): 381-388.], and Dr Fuller makes a valid point when he states that we don't even know whether Dr McPoil was aware of Dr Kirby's paper in 1995. Putting that point to one side, it is my feeling that there is no serious disconnect (as you put it) here whatsoever.

In the section of McPoil and Hunt's paper entitled 'Tissue Stress Model as a Basis for Evaluation', they list four steps to the model. For the sake of brevity, I'll mention the first two steps:

Step 1 involves "identifying the tissue being excessively stressed based on the history, symptoms and other subjective information provided by the patient"; Step 2 involves "the application of controlled stresses to tissues identified in Step 1 through the application of weightbearing and nonweightbearing tests, as well as palpation, range of motion, and muscle/function strength assessment".

Further on in the summary of their paper, they state: "It is not the author's intent to suggest that the "tissue stress" model described is the only method that should be used to examine and manage foot and ankle disorders. That would be whimsical at best. It is, however, the authors' hope that this model will provide the start of a continual dialogue among physical therapists to determine the optimal methods for managing patients referred with foot disorders."

I would venture to suggest that the integration of SALRE as part of a "tissue stress" model of approach is part of the evolving optimisation process in the development of the "tissue stress" model that McPoil and Hunt suggested and envisaged. The subsequent work of Dr Eric Fuller in this regard has been admirable. Indeed, SALRE would fit very well within Step 2 of McPoil and Hunt's list.

With the greatest of respect, asking whether Tom McPoil is aware that his Tissue Stress theory is only valid when combined with SALRE and if not how could he ever put out a theory with such a gaping hole in it is at best childish and at worst fatuous. What is more, the imagery of turds floating in punch bowls isn't exactly the high watermark of academic debate and scholarly comment is it?

To conclude, I have had the privilege of both corresponding with Dr Kirby many times over the past years, and meeting him. Furthermore, I have studied his work (and by that I mean his published papers and textbooks) in great detail, and I in no way find him "tricksy". His written publications are lucidly written, and in consequence of this, they are very accessible to practitioners and undergraduate students alike - not "tricksy" in any way, shape or form. As a correspondent and teacher/mentor, he is eminently approachable and not (to repeat myself yet again) in any way "tricksy". Most people can see this except perhaps those who - if I may quote you - "cannot find a cup of coffee in Seattle or Mickey Mouse T shirts in Orlando FL".

Regards,

Eric Lee.

 

:good: Great to see you contributing here Eric. I hope you will continue to contribute on a regular basis. I'm sure you'll enjoy this and make the extrapolation to this thread...

http://www.youtube.com/watch?v=toHlMD50eYY&feature=related

 

Thank you very much Simon. It is great to be here. :drinks

Regards,

Eric.