Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Run technique modification versus orthoses Mx

Discussion in 'Biomechanics, Sports and Foot orthoses' started by DaFlip, Oct 31, 2005.

  1. DaFlip

    DaFlip Active Member


    Members do not see these Ads. Sign Up.
    Heeeeeey.....DaFlip is back in the house! :mad:

    Run technique versus orthoses management. Big question...do they go hand in hand or are they at different ends of the ballpark. The thread regarding Runners World was quite critical of the podiatric profession by all accounts for various reasons....but are their concerns justified?
    What is the forums opinion of the level of education passed on to students regarding running technique. What are the fundamentals we need to understand regarding running...... the impact of different arm movement, the impact of poor scapula stabilisers, shorter stride length versus longer stride length, heel strike position in front of body versus under body, pelvic position etc. 100m versus 400m versus 5000m versus marathon versus multisport. All critical in the development of understanding why someone runs the way they do. Is anyone actually taught this and if so to what extent?
    When do we use orthoses? When do we suggest changes in technique? What do we suggest? How do we assess these changes are required? Do we own up and admit we don't understand run technique? If so, who do we refer to look at these issues?
    DaFlip :eek:
     
    Last edited by a moderator: Oct 31, 2005
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Been doing some work on it (I have fired of an email to Jason McLaren to get him to come here and comment) ....

    It is an area that I do have some problems with and I often get asked the question in workshops, especially by physiotherpists .... ie the use of foot orthoses vs modifying proximal influences. I just wish someone would rationally explain it to me and help me understand it, rather than give me a sales pitch, an irrational anti-foot orthoses rant, or brainwash me with their religious experience.

    There is no doubt that proximal influences do affect foot function, but what is correct and what can we do about it? How easy is it to "retrain" the neuromotor system for better function (what ever that is?) and more efficient biomechanical function (is efficient function also the same as a 'non-injury' function). I will be the first to change my clinical practice and come here to tell the world about it, when the data supports it.

    Issues like core stability, lower limb stiffness etc are big, but at the end of the day, just what efect do thy really have on foot function???? - we just dont know (we do have sales pitches, irrational anti-foot orthoses rants, and brainwash attempts about religious experiences)

    Don't you just pull your hair out (I have none left) at the that minority of physiotherpists who display their ignornace when they state silly things like get rid of foot orthoses as all you need is to strengthen the gluteal muscles!! ... I have had my fair share of them .... I talk slowly explaining to them (so they can get it) that if, for eg, someone has a forefoot varus (even though it rare), the medial side of the forefoot has to get to the ground - --- the only way it can do that is by the foot pronating --- you can make the gluteals as strong as you like, IT WON'T MAKE ONE IOTA OF DIFFERENCE, as that foot still has to pronate to get to the ground. Same for tight calf muscles - the midfoot has to collape so the tibia can move forward over the foot --- I wish they could explain to me how anything done proximal can change that??? Strengthening the gluteal muscles may be a good thing anyway, but the only way I can see that affecting foot pronation is that if they are weak and that weaknesses is causing the foot pronation .... which I have never seen ?? ... thats my rant for the day..
     
    Last edited by a moderator: Nov 1, 2005
  3. DaFlip

    DaFlip Active Member

    does anyone have any idea on run technique

    Certainly there appears to be considerable lack of response to this topic. So either i have got it wrong and everyone already understands run technique or as i suspect there are many out there with no idea when to integrate other therapies/modalities into assesing the etiology behind run injuries.
    I think this is a real concern for us as practitioners if we are relatively unsure of the impact of technique. The end result is a run magazine or like gets ten opinions from ten people all of which may be different because none has any idea as to how to assess a running injury secondary to a run technique error from within their practice. Those that frequent the run technique web sites and mags will understand there is a large swing towards modification of arm swing, leg movement, stride length etc. Certainly they are not all in agreement but as a practitioner it essential to have a broad based knowledge of many of these. Likewise a strong knowledge on the integration of the issues Craig outlined is essential, core stability(how this is defined is another topic altogether), gluteal firing etc
    I do not advocate throwing out orthoses by the way. I use them with many athletes. But let's face it if we want to be a profession that treats run injuries this is essential stuff. We must understand this. The question is who knows enough to teach us( because i don't think we know enough) and possibly of more importance is how can we implement this in a clinical situation... i'm sure not all of us have access to a 100m straight runway in our offices. I have my own theories but would be interested in the expertise of any running coaches or podiatrists on this forum discussing how they assess patients, select apprropriate plans of management and how do you determine when to change technique versus the use of orthotics, or can these 2 be integrated?
    DaFlip :mad:
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Its the later ... mainly because what I said:
    At the end of the day, we just do not have good information to 'digest' and consider integrating into practice.
     
  5. My first question is, DaFlip, why are you so mad?? (i.e. your icons) And it also would be nice to know your real name, profession and location.

    Second, it has only been a day since you posted this message. I think you must give people at least a week before you assume that there is a "considerable lack of response" on a subject. Not everyone lives on the computer.

    Now to your many questions......when I treat runners, and I have treated many over my 20 years of practice, I will consider many factors in an attempt to heal their injuries. One must consider training mileage, training intensity, shoes, training surfaces, racing schedule, amount and types of stretching exercises being performed, the influence of other physical activities, time of day that training occurs and other factors in addition to running style and biomechanical makeup if one wants to expertly treat runners. My first published paper as a podiatry student went more into detail on this subject (Kirby KA, Valmassy RL: The runner-patient history: What to ask and why. JAPA, 73: 39-43, 1983).

    My opinion is that running technique is important for novice runners but less so important as the runner becomes more experienced and skilled. I believe that the research on running efficiency tends to point out (and my own personal experience as a runner seems to support) that individuals will self-select a running style over time that is the most efficient for them. When I am treating a novice runner, I often will coach them on correct running style whereas I will only occasionally coach the competitive athlete in running style since the competitive athlete tends to already be fairly efficient with their specific gait pattern. However, from having been around track and cross-country coaches for the past 35 years and seeing how they operate, I have come to the conclusion that running technique modification is a big thing for them. This is probably true since they know so little else about the biomechanical etiologies of running injuries that this is the only thing they do know enough about to attempt to help the athletes they are coaching. The same is true in regards to "personal trainers".

    I don't have time to answer all of these questions now. However, very, very little on running technique is taught in podiatry school and it is generally up to the individual podiatrist to learn this on their own. The best scenario seems to be if the podiatrist was a runner long before they became a podiatry student. I believe that there is no formal education that will give individuals more intimate knowledge of the multitude of factors that cause running injuries other than the experience acquired by being a competitive runner.

    Foot orthoses are critical for some runners, and may be useless to other runners. Unfortunately, at our current level of knowledge, we still are not absolutely certain which runners will respond successfully to orthoses and which ones will find them problematic. However, that is not to say that a skilled clinician cannot accurately assess and make the vast majority of injured runners better with some form of mechanical foot therapy such as foot orthoses.

    I have a very strong working relationship with a few physical therapists in my area. I will use these specialists when I don't think I have all the answers for my runner-patients or I need help with evaluation and treatment. In addition, I may infrequently ask the orthopedic surgeon I work with to evaluate and treat a runner for me if I feel it is out of my expertise. You will find that the best sports medicine podiatrists all have these types of relationships since it is impossible for one person to know everything. Therefore, a health-care team approach is the often the best way to treat runners and other athletes.:)
     
  6. DaFlip

    DaFlip Active Member

    Thanks for the reply Kevin... i am not mad .
    It is just my 'bad boy' side coming out and it is purely an expression of the person i am striving to be. My real name is irrelevant, but i feel my self appointed title as a podiatric legend is enough for the moment. I am a also a part time professional athlete, track specifically over 100m with a PB of 18.25 which puts me right up there, and a PB marathon of 4.59, just under the magic 5hr barrier. Whilst i love to talk about myself and my athletic achievements it is probably time to get back to the topic at hand. Ahhh...the good old days.

    I agree there is not enough taught on running at podiatry schools. A huge issue. How can we treat biomechanical based problems if we do not understand the topic. We cannot assess this on a treadmill so how do we do this from within a practice? This is the area that interests me. If we cannot assess someone running in our office, what tools do we have available to predict someones run pattern? Any ideas?

    Kevin we agree on something eh!..... your suggestion of networking is essential reading especially for those with limited knowledge or inexperience. Provide your patient with better care and if you don't understand or don't have the network in place refer them out to avoid any problems later.

    I would however disagree with you Kevin in terms of technique becoming less important as one becomes more experienced or skilled. An Olympic athlete can make minimal changes to improve efficiency quite markedly, especially when .01 of a second can be the difference between winning and not. Certainly the changes made to a novice will show more visible change..but the changes to the elites make a greater impact.
    Thanks for taking the time to discuss this.
    DaFlip :mad:
     
  7. Ann PT

    Ann PT Active Member

    My name is Ann McWalter and I have been a Physical Therapist for 18 years and making custom orthotics for 15 years. I am new to the forum and coincidently this post was one of the first I read. I believe Physical Therapy plays a big role in some of the issues discussed and I thank Kevin for acknowledging our role. I also believe that no one practitioner knows everything-that's why there's so many of us! Why not take advantage of each other's expertise! Orthopedic Physical Therapists have extensive training and knowledge regarding biomechanics and rehabilitating musculoskeletal injuries. Of course we may not all be experts at every joint, however, joint function is our specialty. A couple statements caught my eye-particularly the discussion about the role of proximal forces in foot function and running (or walking) pattern. I believe we can "retrain the neuromotor system for better function." Working on proprioception and strengthening the glut. medius are well documented effective treatments following an ankle sprain even if the patient has a very supinated foot due to a forefoot valgus or rigid plantarflexed first ray. Yes, I would certainly make this person an orthotic, but I would be more complete in my evaluation to determine what else besides the supinated foot contributed to the sprain (i.e. proprioception problems or weakness). If the runner is overpronating because of some intrinsic foot problem, yes-make an orthotic, but we know that hip flexion and internal rotation are proximal components of pronation so I would assess the flexibility of these tissues and prescribe stretching if needed. What if the gastrocs are tight causing compensatory pronation in addition to whatever intrinsic foot problem there may be. I believe we should treat these proximal influences and I believe Physical Therapists are very qualified to do so. Why not attack the problem, complaint or dysfunction from different angles? Unfortunately a lot of what we do in P.T. is not yet fully supported by research but perhaps there may be more research than Craig is familiar with. And if it's just a "minority of physiotherapists who display their ignorance" about orthoses vs. proximal influences, is it worth mentioning? Perhaps there is not a body of evidence-based research documenting the effect of core stability or lower leg stiffness on foot function, but as PTs we wouldn't be working in these areas to address foot function specifically. We would be working in these areas because we think they contribute to the patient's complaint, limitation, faulty movement pattern, etc. Foot function and orthotics would be only one piece of the puzzle.

    I've probably been too wordy...I'm just responding off the top of my head. I hope I didn't misunderstand anyone's intended meaning. I simply want to make the point that there is a lot to consider when looking at running technique or any other patient problem. Orthotics and foot function are a component. Proximal influences are a component. As Kevin said, perhaps a team approach when needed is the best approach.
     
  8. PF 3

    PF 3 Active Member

    I think we need to be little clearer on what type of running we are talking about. There is no doubt in my mind that up to 400m technique is a very big part of runnig. After that it becomes less of a factor with each athlete seemingly finding a running technique or style that suits them best. I think Marion Jones in her hay day (lets forget about the allegations against) shows the gap in technique the best. She actually sprints like a man (thighs/knees getting to hip height without over-striding) and subsequently when in form was literally miles ahead of the field.

    I would also tend to think that pelvic strength and stability play a bigger role in sprinting, with actual foot function not so important. I say this because in sprinting the athlete is mainly on there "toes" and the chance for orthotic therapy is severely limited (In my case a large forefoot varus post on some formthotics was required to keep my achilles tendinosis under control. I would also wear middle to long distance shoes for as many sessions as possible-I was a 200-400m runner)

    What tother options have people tried with sprinters?


    Tom
     
  9. PF 3

    PF 3 Active Member

    I think we need to be a little clearer on what type of running we are talking about. There is no doubt in my mind that up to 400m technique is a very big part of running. After that it becomes less of a factor with each athlete seemingly finding a running technique or style that suits them best. I think Marion Jones in her hay day (lets forget about the allegations against her) shows the gap in technique the best. She actually sprints like a man (thighs/knees getting to hip height without over-striding) and subsequently when in form was literally miles ahead of the field.

    I would also tend to think that pelvic strength and stability play a bigger role in sprinting, with actual foot function not so important. I say this because in sprinting the athlete is mainly on their "toes" and the chance for orthotic therapy is severely limited (In my case a large forefoot varus post on some formthotics was required to keep my achilles tendinosis under control. I would also wear middle to long distance shoes for as many sessions as possible-I was a 200-400m runner).

    I'm unsure of any research to support it but the general consensus in sprinting is that a stable pelvis will result in less stress on the hamstrings and adductors. Once again, watch the best sprinters in the world and you will see little if any "hitching" of the pelvis with each foot strike.

    Cheers

    Tom
     
  10. Freeman

    Freeman Active Member

    Briefly, I do think form is a big deal in preventing injuries in runners, e specially as they celebreate more birthdays. I think if a person has poor form, it does affect the "core" or pelvis area, and subsequently a person will suffer more from IT, hamstrnrg and hip flexor injuries.> When those areas are injured or are working poorly, I believe the feet will suffer to a degree whcih is impossible for me to elaborate here in a short piece. I encorage runners to lead with the knee and very specifically not with the foot,keep their turnover at/above 85 stride per minute whether they are running quickly or not and to listen to their foot strikes as they run. Are they symmetrical in sound or is there a significant sound discrepency? I watch them on treadmills which is better than nothing and will run outside with them after work when I run home. It helps me greatly in solving some of their problems. Not only has changing form reduced some of their problems but also helped knock down their times in all distances of races.
    I use physios, chiropractors and massage therapists alot and do orthotics too!
    Sincerely
    Freeman Churchill, Certified Pedorthist...once upon a time fast runner
     
Loading...

Share This Page