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Should Podiatrists Think More Like Engineers?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, Mar 27, 2014.

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  1. Rob Kidd

    Rob Kidd Well-Known Member

    I must have told you before, but then, when you are old and stupid like me, you can tell a story lots of times..... My mentor Prof Chas Oxnard MB ChB BSc PhD DSc etc, went to a course on engineering at The University of Salford way back in the early 1960's. All the other attendees had their pocket box girder bridges, aquaducts etc; he had a bag of bones from the butcher. The presenter simply said - "its all engineering - just look at this trabecular structure - there is a bridge in there, trying to get out...........
     
  2. Tensegrity

    Tensegrity Active Member

    This article makes a valid and pertinent point.
    My concern is it will substitute one set of notional values for another and the goal of attaining an understanding how movement of the body facilitates staying balanced upright and moving so there is the ability to determine an outcome will still be just as elusive.
    The key is an understanding of and working with, the body’s nervous system then fully involving the individual with the problem, in their own treatment.
    An integral part of such an approach is an orthotic that can accommodate change. We all know our body is in a state of constant change. So it all hinges on sharing knowledge with those individuals that have an imbalance causing pain. Then it is their choice as to how well they work with their body. Without that the long term prospect is bad i.e. pain will return albeit in a different location.
    In a nut shell a balance has to be struck between mind brain and body in order to attain and maintain a state of equilibrium. When that has been achieved by an individual, comfort reigns supreme all the time.
     
  3. Tensegrity:

    What actually are you trying to say above? How will trying to understand the internal and external forces acting on an injured body part have any effect on our ability to understand how the body moves and stays balanced or on our ability to determine a clinical outcome. Can you be more specific? :confused:
     
  4. Lab Guy

    Lab Guy Well-Known Member

    I would not be too concerned. Tissue Stress Theory (TST) involves ascertaining the pathomechanics behind the tissue that is stressed beyond its optimal physiological zone and takes into account static and dynamic imbalance as well as the effects of the CNS.

    TST advocates a complete static biomechanical exam including quiet standing (posture) as well as dynamic by carefully observing the gait of the patient. Without doubt, the CNS is of prime importance to ensure appropriate firing of the muscle units to stabilize the joints of the multisegmental lower extremity as the body vector shifts anterior, posterior, medial or lateral to the affected joint. There are those people that rarely sprain their ankle as their CNS quickly responds by stimulating the Peroneals to contract to counterbalance the strong supination moment.

    Besides examining the foot, the entire body is looked at. Obesity, contracted hip flexors from prolonged sitting, back issues, leg length discrepancy, hip arthritis, weak hip abductors, joint swelling, muscle weakness or spasticity are but a few taken into account to understand how they might contribute to the increase force (mass x acceleration) and stress of the tissue (force/area).

    TST embraces kinematics as the consequence of abnormal dynamic movement in is abnormal forces and stresses to the underlying tissues. To think like an engineer is to observe and examine the lower extremity both statically and dynamically to ascertain the best course of treatment to decrease the high forces and stress on the injured tissue. This may also involve a referral to a specialist for issues outside the scope of our training and license. Either way, when you think like an engineer, you become more consciously aware of putting the pieces of the puzzle together so it becomes less elusive.

    Steven
     
  5. wdd

    wdd Well-Known Member

    I think tensegrity is saying yes, podiatrists should think more like engineers but if they don't simultaneously have excellent people skills and think and act like psychologists their success will be very limited?

    But maybe I am putting words in his mouth?

    Bill

    PS With a name like Tensegrity, there would have to be a yes in there somewhere wouldn't there?
     
  6. efuller

    efuller MVP

    Staying balanced and upright is an engineering problem. You have to keep the center of pressure under the center of mass. Postural sway studies confirm the engineering predictions. Understanding movement of the body is also an engineering problem. F = mass x acceleration. When the body moves there is accelerations. Yes, the CNS sends the impulses to muscles to create accelerations, but you still need to model the forces and moments created by the CNS to understand the motion or how the body sways to keep the center of pressure under the center of mass to stay balanced. You need the engineering principles to define the problems that the CNS attempts to solve.

    How does an imbalance cause pain? Can you define that without using engineering principles? Can you give an example of an imbalance that would cause pain?

    Yes, sometimes you need to alter behavior to reduce stress on a structure to allow it to heal. There is an interaction between the brain and the mechanics of the body. However, the state of equilibrium that you talk about can be defined clearly using engineering terms. Are you using the term equilibrium in the engineering sense? If not, can you define what you mean by equilibrium?

    Eric
     
  7. HansMassage

    HansMassage Active Member

    " Can you give an example of an imbalance that would cause pain?"

    Repetitive use injury, If there is a postural distortion that is compensated by plantarflexion of the great toe on one foot and dorsiflexion on the other the repetitive stress on the joint often results in pain and deformity.

    In my work I find that reducing the posture deformity in turn reduces the repetitive stress and both pain and deformity is reduced over time.

    It would be nice if Tensegrity would answer because tensegrity is a good engineering principle.
     
  8. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,

    FYI

    Dr. Skyliar has written an awesome CME in the latest issue of Podiatry Management Magazine.

    If you want to start thinking more like an engineer.

    It will also help you better understand the mechanics of the spring lever orthotic device, if you want to think and act more like an engineer.

    A hui hou,
    Steve
     
  9. Steve:

    You are so predictable. Let me ask you one thing:

    Have you ever written anything here on Podiatry Arena that does not include an advertisement for your patented insole?

    I don't remember one. Why don't you go peddle your wares somewhere else and quit using Podiatry Arena for the advertising of your insole?
     
  10. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha Kevin,

    Yes I have.

    I guess you have not found that content as entertaining or educational to view it or remember it.

    A hui hou,
    Steve
     
  11. Then find me where five posts that you have made in the last 12 months here on Podiatry Arena where you did not mention something about carbon fiber or "advanced composites" or carbon fiber orthoses or your boots that you sell on your Kingetics website in some way or another. By the way, how much do your carbon fiber orthotics and boots cost now? I can't find the prices on your website any more. Are you really that one-dimensional in your practice also, Steve, that you can't talk about anything other than your patented products?
     
  12. Tensegrity

    Tensegrity Active Member

    To be succinct, our patients have to be given sufficient knowledge so there is a better understanding of how their body moves. What needs to be addressed are postural and psychological habits. If these are not resolved then a long term solution is impossible. Pains and aches will simply move about the body.

    Rob Kidd’s posting on trabecular structure is an example of how knowledge of the body is important; especially the triangular alignment in a calcaneum. This small but important snippet of information plays a role in elaborating on why a light and correct heel strike for improved foot function is important.

    LabsGuy’s posting on tissue stress theory is interesting and creates another useful tool in helping an individual understand their body better. The puzzle analogy is another way of involving an individual in their own treatment.

    Wdd – Bill that is an accurate précis. Due to the uniqueness of us all, every treatment programme has to revolve around team work. Transactional analysis is useful tool in assessing which way to develop the partnership.

    To achieve a state of equilibrium within the musculo-skeletal structure the centre of mass and centre of maximum pressure have to be within the base of support of the body.
    The challenge is to facilitate this in such a way that comfort is attained fast. Ideally within the first treatment, then the individual will be able to focus on the underlying postural issues.

    Please forgive me for stating the obvious. Pain is there to bring to our consciousness a problem. David Butler and Lorimer Moseley published a book ‘Explain pain’. It is quite expensive and the information is presented with some novel artwork. It gives a real insight into pain. Pain comes in various forms and cannot be shared. It can only be described and is very relative. What is pain to one person, could barely register with another. We are all unique.

    An example of a postural imbalance that is capable of causing a variety of presentations of pain is a pelvic tilt. HansMassage’s posting mentions repetitive strain.

    A real buzz phrase is “evidence based research”. My interest is muscle memory. It is this that underpins all repetitive movement i.e. our habits. In 2012 Hossein Hassanpoor, Ali Fallah and Molsin Raza published a paper “New role for astroglia in learning: Formation of muscle memory”. In the Abstract it states: Muscle memory can be described as gradual adaptation of muscles over a period of time to perform a new movement or action. Its precise mechanism is unknown. Finding evidence based research on muscle memory is not easy. Any suggestions as to where to look would be gratefully received.

    To conclude, our habits play a large part in many of our aches and pains. These arise because the brain perceives the changes going on in parts of the body as threatening and instigates changes to address this by compensating in a variety of ways. It is coming to understand the cascade of compensations going through the body that is fascinating, interesting and so rewarding when it is successfully worked out.

    On a positive note habits allow our minds to get lost in our thoughts and as such allowed me to write this response.
     
    Last edited: Mar 30, 2014
  13. Tensegrity

    Tensegrity Active Member

  14. Lorcan

    Lorcan Active Member

    Yes podiatrists should think more like engineers, ie use Tissue Stress Paradigm. Perhaps another way to phrase it that they should learn to apply clinical reasoning above a formulaic approach of measure A + B= treatment C.

    Wouldn't podiatrists be well served to investigate any professions methods including engineers and utilise this knowledge base to enable us to apply it when delivering clinical reasoning based treatment plan. This can be hard as we are all guilty of implicit bias.

    There is good podcast on physioedge on itunes with David Butler where he discuss pains physiology in the CNS in chronic situations if your considering his book as Tensegrity suggests.
     
  15. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha Kevin,

    I suppose you missed this one.

    The one that keeps my focus sharp on what really matters to me.

    I hope someday you can also find that type drive.

    A hui hou,
    Steve

    Ps would this thred count now that I have not mentioned the US Department of Defense and Army Medical Research and Materials Command for SBIR A11-109 "Advanced Composite Insoles for the Reduction of Stress Fractures" posted here?
    http://kingetics.com/store/m-a-r-e-n/

    Build your own pair if you can Think Like an Engineer...
     
  16. Dr. Steven King

    Dr. Steven King Well-Known Member

  17. No, Steven, I would rather you be able to somehow, in our discussions of the biomechanics of the foot and lower extremity and foot and lower extremity injuries and surgery, have a discussion where you do not mention your company, your product or allude to some reference about "advanced composites", your composite orthoses and the like. Honestly, I think you are so one-sided and profit-driven, that you can't carry on an intelligent biomechanical or surgical discussion otherwise.

    Please prove me wrong.
     
  18. Dennis Kiper

    Dennis Kiper Active Member

    Kevin,

    Your discussions with me never turned to biomechanics, nor the technology of another platform. Instead, you always just accused me of "making things up". And BTW, don't you advertise here at the arena every time you have a new book coming out?

    When you can divest yourself from your hidden agendas, maybe the public will benefit from all the prose you profess.
     
  19. Ian Drakard

    Ian Drakard Active Member

    There is a difference between promoting a book, course or product or anything else and hijacking threads to which it is irrelevant.
     
  20. Both Dennis Kiper and Dennis Shavelson made comments regarding my article in Podiatry Today on "Should Podiatrists Think More Like Engineers". Those of you who have opinions on this matter regarding whether podiatrists would benefit from "thinking more like engineers", or not, may consider commenting on this subject on the Podiatry Today magazine website since I believe this is a critical step forward for the international podiatric profession.

    http://www.podiatrytoday.com/should-podiatrists-think-more-engineers
     
  21. Dr. Steven King

    Dr. Steven King Well-Known Member

  22. Dennis Kiper

    Dennis Kiper Active Member

    F=M x A

    How appropriate, "science" or "magic". Now, if you can relate that in any way that even makes a "little sense" that would be better support for your theories
     
  23. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,

    OK

    Please read Dr. Skyliars CME in Podiatry Management Magizine.

    Then read US Pat. # 8,353,968 page 34

    F1 x D1 = F2 x D2

    Then read SBIR A11-109

    Then let's talk about thinking and acting more like engineers.

    Since that is what Kevin would like us to do with this post. Unless Black Humors have your equiliblium so off ballance and that you need some blood letting done...

    A Hui Hou,
    Steve
     
  24. Dennis Kiper

    Dennis Kiper Active Member

    “OK

    Please read Dr. Skyliars CME in Podiatry Management Magizine.

    Then read US Pat. # 8,353,968 page 34

    F1 x D1 = F2 x D2

    Then read SBIR A11-109 “

    and this applies to which “theory”?

    “let's talk about thinking and acting more like engineers. “

    My girlfriend said that sounded so cute, she could imagine you strutting around like that cartoon character and talking like an engineer

    There you go, put a little valgus post in there, 2 maybe 2.5 degrees. Let's stiffen up the rear with a 4 or 5 degree varus post too. Don't forget when taking the cast to give it 2-5 extra lbs of pressure. (no mind to how much you shift the joint axis).

    Put it all together or rather engineer that all together and what have you got?

    An orthotic that fits the shape of the foot, but doesn't fit the stable dynamics of that foot. That's the whole enchilada (new pod term?) . Traditional technology cannot meet this demand!-”Stable dynamics” (now that's a new pod term)?

    An orthotic that can be worn constantly, and comfortably. That’s what makes an orthotic supposed to do, what it's supposed to do. While the bio-mechanics are in constant, dynamic, healing and usage.

    To do that I simply fill up the empty space under the arch with silicone fluid until the arch is filled to capacity, such that the foot is in stable contact with the surface (shoe or floor) performing to what I expect to see bio-mechanically happen for the pt. I know, “this” is engineering, because adding or removing fluid increases or decreases the planes of motion at the tarsus and is in direct correlation with stability, optimal position, pt satisfaction and noticeable improvement.
    This allows me to assess joint congruency and optimal biomechanical efficiency.

    Hydrodynamics- engineers the rest of the biomechanical and dynamic fit for the pt. And reaches an equilibrium state of stability at midstance and is prolonged at heel off. Now, this is what I'm talking about. In clinical trials, this technology would probably beat the old technology (or any) by 4 or 5:1

    These are the biomechanics we should talk about, because there's some real engineering going on. Instead others think “buzz words” like forces and axis in conjunction with lever arm forces are getting you someplace. It may be more articulate, but it's the same old technology platform of a shell orthotic.

    You're applying engineering to theories about the foot. As far as I'm concerned you've got the cart in front of the horse.

    Just wearing a fluid orthotic, is a health benefit. It will take up to ten years to reverse the way you felt in your feet or other areas of your lower extremity the way you did 10-30 years ago. (I'm fudging a little, I've only been working with this technology 26 years)

    I recommend wearing as a daily and as much as possible around the house utilization.

    Some of you have referred or equated this technology with “snake oil” What kind of engineering background can you possibly be thinking about when you come up with that, or tell me you can “prove” my technology doesn't work?

    And in the final breath, say you wouldn't be adverse to considering this technology, just engineered a different way—say whaaat?
     
  25. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,

    Well if you are not going to read the material you asked me to provide for you there is little i can do to enhance your engineering know how.

    But perhaps this may help, no reading required... Just Thinking Like an Engineer...

    http://www.youtube.com/watch?v=gsSYq8x6oyU

    Mahalo,
    Steve
     
  26. wdd

    wdd Well-Known Member

    I like this 'thinking like an engineer'.

    It seems to produce some pretty good infighting and masses of disagreement.

    What more can you ask for?

    Get stuck in lads. Give 'em laldy.

    Have a nice day.

    Bill
     
  27. Dennis Kiper

    Dennis Kiper Active Member

    Aloha and hooey mooey

    Thanks for your effort with all the reading materials, but I already think engineering with fluid technology based on principles of physics. So, instead of enhancing my engineering, I still only see
    principles of science applied to theory with your traditional technology, but I bet F1 x D1 = F2 x D2 makes a good varus post.
     
  28. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,

    Here is a fellow ultimate frisbee player and science guy that thinks like an engineer.

    If you had to lift a heavy weight off the ground say the heel of your foot what would be the most economical way to do it?

    Perhaps with simple machine mechanics? ie F1D1=F2D2

    https://www.youtube.com/watch?v=xgDGLVd9QxI

    A hui hou,
    Steve
     
  29. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,

    Here is another good example of simple engineering priciples.

    https://www.youtube.com/watch?v=jAPxALm9fZA

    Funny how i have never heard of a decline plane as a simple machine but that is exactly how all shoes with an elevated heel to forefoot works. Increasing the velocity over a shorter distance.

    What would happen if we combined multiple simple machines into a closed kinetic chain?
    Well just read SBIR A11-109 and US Pat. # 8,353,968 to find out. If you want to think like an engineer...

    A Hui Hou,
    Simple Machine Steve
     
  30. David Wedemeyer

    David Wedemeyer Well-Known Member

    Nice article Kevin. Would you summate that the shift should be from kinematics to kinetics, less on structure and more on moments and forces?
     
  31. David, both are quintessential in podiatric biomechanics. Either one in isolation leaves us floundering.

    Kevin, the problem here is not about clinicians thinking like engineers, rather it is about clinicians thinking like salesmen. When we have capitalist economies and health care lessened to nothing more than money making schemes, we are left with salesmen. Nothing more nor less. Salesmen. Salesmen. Salesmen...

    "All this machinery making modern music
    Can still be open-hearted.
    Not so coldly charted, it's really just a question
    Of your honesty, yeah, your honesty.

    One likes to believe in the freedom of music,
    But glittering prizes and endless compromises
    Shatter the illusion of integrity.

    For the words of the prophets were written on the studio wall,
    Concert hall
    And echoes with the sounds of salesmen. Of salesmen. Of salesmen."


    Rush- Spirit of Radio. Boom, turn it up and play it loud: http://www.youtube.com/watch?v=5Tq-UsaRchI
    Sell me a God, it's love time.
     
  32. blinda

    blinda MVP

    Tune.
     
  33. David Wedemeyer

    David Wedemeyer Well-Known Member

    Simon, I may not have posed the question clearly enough. It seems as though kinetics took a back seat to kinematics in the past and now the reverse is true?

    BTW Rush was my first concert..mind blown :eek:
     
  34. David, the words "band" and "wagon" spring to mind; many have jumped on the "kinetic" bandwagon, without the prerequisite understanding of biomechanics. Sure kinetics were ignored in the past with kinematics taking the fore, but lets not make the same mistake twice.

    "And when the angels come to knock upon your door, will you know and understand?" Sands of Time- Aslan http://www.youtube.com/watch?v=eNOjE8Lu7Yg

    These guys were a band that I got friendly with when i was about 17-18. They blew it when the world was about to be at their feet.

    If you've got the time, watch them much later when they grew up a bit: http://www.youtube.com/watch?v=rR57TUYvGbk
     
  35. David Wedemeyer

    David Wedemeyer Well-Known Member

    Simon, I'm not suggesting anyone follow the bandwagon. All that I am saying is that increasing emphasis has been placed on kinetics, I am not suggesting we completely abandon kinematic contribution. I understand your point though and agree.
     
  36. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,

    Simon for some reason your quote stikes a cord with me.
    "And when the angels come to knock upon your door, will you know and understand?"

    Get your heads out of foam and start thinking about how we can better midigate the high impact forces (longitudinal waves of energy) our bodies absorb and compensate for during ground contacts.

    Here is a good video to assist in your thinking like an engineer.

    https://www.youtube.com/watch?v=jAXx0018QCc

    A Hui Hou,
    Steve
     
  37. Dr. Steven King

    Dr. Steven King Well-Known Member

    Aloha,

    Here are a few examples of blast-compression-longitudinal waves in destruction.

    What are the mechanics and engineering principals of the ground impacting on our bodies?

    Why are patients that are having bariatric surgery seeing a marked improvement in their arthritic joints?

    https://www.youtube.com/watch?v=TjC4SvZIARY

    https://www.youtube.com/watch?v=-_6vGj67Iq8

    We could talk about subtalar joint neutral instead...

    Energy just does not disapear if you believe in the engineering principal of conservation of energy.

    https://www.youtube.com/watch?v=UW0KlU1FfU0

    My first concert was YES. But i would love to see these science guys in concert !
    https://www.youtube.com/watch?v=-p3msL1P8bw


    A Hui Hou,
    Steve
     
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