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MASS - Questions un-answered

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Graham, Dec 1, 2010.

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  1. In 2006 there was this thread re GIB test GIB test thread

    Ed you had some questions that you said you were going to respond to re reliability etc of the GIB test you said

    Must have had time for a response by now. I looked in pubmed but could not find any reliability studies are there any ?
     
  2. EdGlaser

    EdGlaser Active Member

    We are working on it. What I spent all day Saturday doing, and this has been a continuation of dozens of recent meetings and 10 yrs of research, was to create a device that gives continuous 3D measurements of the kinematic movement and amount of total force required to move the foot throughout its postural ROM. Leading up to a final measurement of force necessary to reposition the foot into a corrected posture. Prototypes are being created and modified daily. The resources I have assembled allow me to move relatively rapidly in this type of development. We try many things that do not work and draw continuously from other areas of design and engineering. The reason we will succeed is because our whole team is inspired and motivated by a passion to Make People Better. I say that a lot, because it is the difference between us and many others who are motivated by fame (credit) or fortune. It is the secret of our success and I share it openly. It was the difference between the Wright Brothers and Samuel Pierpont Langley, Phd. Langley had the credentials, he was a professor at Harvard, he had an office at the Smithsonian, surrounded by the greatest minds of his time, the US military gave him a sizable grant, money was no object, Media attention was on him. He had all of the traditional ingredients for success and everyone expected him to develop controlled manned flight. The Wright Brothers had none of the above, NO degrees on their team, very limited budget, no press but a passion to achieve their goal. Kevin is like Langley. He wears his credentials like military medals, his professorship like rank, his papers (although mostly opinion) like the gospel. But he is only concerned with credit. That is why he spent half of his afternoon debate time on, who gets credit....a silly waste of time. If we all spent more time working on Making People Better and less on petty arguments of who gets credit.......for calibration for example, we would get there faster. At Sole Supports, credit and money are not issues. My job is to take a team of creative brilliant men and women and inspire them to achieve our core value. I am usually the idea guy, but ideas come from everybody....even our HR director.....who spends his evenings scouring the web for related technology in other fields and has come up with some amazing contributions. Every floor employee are encouraged to create. My core creative staff is encouraged to spend at least an hour a day autonomously.....creating whatever they want. That is where great ideas come from.

    Ed
     
  3. efuller

    efuller MVP

    It is a straw man argument to equate mods with SALRE. Not that modifying an orthotic to make it better is a bad thing.

    How is the dysfunctional zone (definition needed) a zone of higher impact between the foot and orthotic? How do you support this claim.


    There are so many parts of the above paragraph to question.

    What do you mean when you say that when the foot enters the pathologic zone the ligaments tighten up. From the discussion you have implied that a MASS ortohtic prevents the foot from getting to the pathologic zone. Are you claiming that a MASS orthotic prevents the plantar ligaments from getting tight?

    You made the following statement followed by several things that you imply a MASS orthotic does. In the following statement I would add that reducing tissue stress below the threshold of symptoms is the desired goal of the orthotic. The other things implied are not necessarily good things.

    "The mods along with terminal shell contact, act to dampen the impact…..often reducing peak events below the tissue stress threshold of symptomatology while:"
    1. No significant change is made in kinematics

    If symptoms go away, why do you need to change kinematics?

    2. Deformities continue their development.

    You don't know either, that MASS devices prevent continued development of deformity, or that other orthotics don't. You can't make that claim.

    3. Posture is unaffected.
    Is changing posture a good thing? How do you know? If symptoms go away, why do we care if posture is unaffected?

    4. No meaningful measurement of kinetic forces is performed.
    How do you know that measurement of the rigidity of an orthotic is meaningful? How do you know that assessing the force required to supinate the foot with fingers is not meaningful in regards to reducing symptoms?

    5. Patients return for peel and move of pads.
    Or patients return to have a heat gun shot at their orthotic. No protocol will get the best orthotic first try. Practitioners earn their reputation when they can fix something that is not correct. If it were only so simple as to step into a foam box and have all your symptoms go away.

    6. It is masking symptoms without affecting function
    How do you prove that a MASS device affects function and a non MASS device does not. You can't prove that.

    Some parts of the foot are better designed to bear weight than other parts. I would maintain that there should be areas of higher pressure than others. When you describe full contact, do you think there should be equal pressure over the entire plantar surface of the foot?

    Finding the location of the STJ axis is a measurement and it does tell you where to put the heel skive. Someone could read how to find the axis and then perform the measurement. It doesn't have to be learned at the feet of a master. Ed, do you let other people teach your casting technique? Can anyone read a description and perform it?

    Again with the assumption that you need to change posture to make the foot better. Is better: reduction in symptoms; or achieving an idealized position of the foot. I know it would be wrong to extrapolate to all feet from my experience but, for my feet I have less symptoms with a medial heel skive device which is better than a non medial heel skive device, which is better than no device, which is better than the MASS device. There are some feet for which a MASS/full contact device fails.

    Ed, when are you going to produce the study that shows that MASS devices actually change posture. Then you could correlate posture change with symptom relief.

    I doubt that MASS or a medial heel skive device actually gets the talus to externally rotate enough to significantly change the position of the STJ axis.

    How do you know that a MASS device would improve the balance of forces around all other axes if it did change STJ axis position? You'd have to look at rotational equilibrium around all the other axes to prove that statement.



    Ed, could you explain: "Actually, the downward force of the human body should exceed at Midstance, the upward force of the orthotic allowing for orthotic flexion."

    In RCSP, the body's total downward force is body weight, it's not just related to body weight. Weight = mass of body x acceleration of gravity. Or more precisely the force applied by gravity to the body is body weight. Ground reaction force is an equal and opposite force to gravity. It is an upward force from the ground. If these forces are not equal then the body will accelerate.

    There is an error in your statement: "Therefore the additional force placed in the arch is not trying to counteract weight. " In RCSP the total force from the floor and the orthotic has to equal body weight.

    I would agree that higher arched devices are trying to put more of ground reaction forces under the arch and this would decrease the force on the heel and metatarsal heads because the total force from the ground has to equal body weight. I really don't see how a full contact orthotic makes body weight more relevant. I think that is what you were claiming in the above paragraph.

    Actually, I'm not sure what you are trying to prove in the last 2 paragraphs. Let's start over. Body weight is not correlated to supination resistance. (Craig's study) Our criticism of MASS is that it uses body weight to determine how rigid to make the device. So different feet will need differing amounts of force applied to the foot to change posture and this force is not related to body weight.

    Eric
     
  4. Neil, pressure mats only measure normal force, so by inserting a pressure mat between the foot foams of your device will not likely give you the answers you desire. The reasons for this were outlined in our recent paper: http://www.japmaonline.org/cgi/content/abstract/100/6/518

    If you want a copy for research purposes then send me a message to: skspooner@blueyonder.co.uk
     
  5. EdGlaser

    EdGlaser Active Member

    Simon, Eric, Robert, Graham and All,

    Thank you all for your participation in this thread. After reading Eric’s last post, I decided that we seem to be going in circles and repeating ourselves. So I want to summarize.

    I made an Excel file and imported it into Word….I hope it copies into the forum. If not I will attach the file as well in Word format.

    Others may find other areas of comparison.

    Try to keep them biomechanically relevant and true to the published work on the theory…..not how one or a few individuals are applying it differently.

    Dennis might want to add a column for FFT.

    It might serve as a useful comparison.

    Ed
     

    Attached Files:

  6. An interesting comparison, spoiled only slightly by the fact that half of it is factually innaccurate, that it makes unsupported claims, that it has no evidence based, that it takes the worst of other models and the best of MASS, and that it is STILL working on the basis that SALRE is an applied model for assessment casting and prescription rather than a theoretical model which explains foot function. Oh and that it misses any mention of tissue stress theory which is what most people here (including Kevin) use.

    But otherwise fine. C'mon ed, are you being deliberately provocative here? If so, I won't bother to "correct" your chart. If you actually mean the above to do more than get a reaction do you need me to address the discrepancies?
     
  7. Have put my comments. This is off the top of my head. Hopefully the attatchment worked.

    The key point here is that where Root and MASS are both clinical models with protocols for casting and prescription, SALRE is a theoretical model addressing base principles.

    There is no such thing as a SALRE orthotic. There is no such thing as a SALRE casting position or method. There is no fixed protocol for SALRE assessment. Therefore most of the points in the SALRE boxes are inaccurate because they refer to a non existant protocol.

    Using the principles of SALRE, I cast feet weight bearing and non weight bearing in a variety of positions. Some are lower than neutral. Others are higher than Mass. So to make a blanket statement about what effect a SALRE device has is ludicous. There is no such device.

    You just can't generalise what other people are doing Ed. You don't know what they are doing!
     

    Attached Files:

  8. I've made a chart for you with tissue stress on it, in the same vein.

    This, Ed, is how it feels to have someone attack a straw man image of what you do. I don't believe everything in this comparison is accurate, nor would I be so crass as to make these claims without evidence. I'm doing this to make a point.

    Generally I like to argue with you on my turf. That is, asking you to justify those things you say which I disagree with. But based on your chart I'm going to try it on your turf, that is, I'm going to try denigrating a caricature of your work. See how it feels for you.

    You may feel angry that I have misquoted you.

    You may feel resentful that I have made claims for myself that I cannot back up

    You may feel concerned that onlookers will think that my description of what you do is accurate

    You may feel pity, that I cannot promote my own work without denigrating someone elses.

    Above all, I hope, you may understand why a chart like you posted (and remember I have done nothing you have not done first) is a poor way to make a case.

    Happy Christmas.
     

    Attached Files:

  9. Might just be me, but I can't download your attachment above, Robert.
     
  10. Griff

    Griff Moderator

    Worked ok for me.
     
  11. You might add Ed doesnt know what hes doing also. The thought making it up as he goes alone comes to mind.

    Never answers a direct question.

    Someone else discussing someone Ed says we have done that for years.

    Keeps the straw man attachs going instead of discussing. I beleive its because he has a bad case of NFI but would not admit it.
     
  12. You're powers are weak old man. :rolleyes:
     
  13. Watched that yesterday. You can't win, Robeer. If you strike me down, I shall become more powerful than you could possibly imagine. ;)

    No, it was downloading, it just wasn't automatically opening in word for some reason, so I'd actually managed to download it 6 times before I bothered to look in my download folder- doh :bash:
     
  14. Oh well. Its in your inbox as well anyway.

    The forces are indeed strong within you.
     
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