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The Foot's Connection to Chronic Musculoskeletal Pain

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brian A. Rothbart, Jul 31, 2013.

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  1. Brian A. Rothbart

    Brian A. Rothbart Active Member

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    Hi Folks,

    I would like to start a discussion on that I believe more time needs to be spent on; namely, the connection between foot pathomechanics and chronic muscle and joint pain.

    First, let's start with definitions. Exactly what defines foot pathomechanics is still an ongoing subject. However, for this thread let's consider foot pathomechanics as being specifically abnormal pronation/supination.

    Again, for this thread, let's consider abnormal pronation as Gravity Drive - that is, where the foot's pronation/supinations pattern no longer are directed by the transverse plance oscillations of the hip (e.g., hip drive).

    In my practice and research experience, I have found a definite, repetitive connection between abnormal pronation and the development of chronic muscle and joint pain (foot to jaw).

    I would be very interested in hearing your observations and opinions.

    Professor Rothbart
  2. Is there any new "evidence" Brian?

    If not then my observations would be the same as every other time this has come up on this arena and elsewhere. Your definitions are tautologous and your terminology deliberately vague, and you infer causality even when correlation has not yet been shown.
  3. Brian A. Rothbart

    Brian A. Rothbart Active Member

    More and more clinical observations are confirming that postural distortions are linked to foot motion. And I believe the link between postural distortions and the development of chronic muscle and joint pain is well documented in the medical literature.

    This being the case, whenever one prescribes any type of insole or orthotic to be placed underneath the foot, they need to be aware of its impact on the entire body (not just the foot).

    Professor Rothbart
  4. efuller

    efuller MVP

    What's the definition of postural distortion? What postural distortions are related to foot motion? What literature supports postural distortions association with chronic pain?

  5. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Hi Eric,

    Postural distortion is used in the published literature in lieu of poor posture. Examples of postural distortions are: anterior rotation of the innominates, shoulder protraction, forward head position, scoliosis, genu valgum,etc.

    In the european literature a great deal is written on postural distortions. I have published several papers on the link between foot motion, postural distortions and the development of chronic musculoskeletal pain. I have listed some of my publications below in which I have linked abnormal foot motion (e.g., gravity drive) to postural distortions and musculoskeletal pain:

    Rothbart BA 2013. Preliminary Study: Adolescent Idiopathic Scoliosis Linked to Abnormal Foot Pronation. Podiatry Review Vol 72, No 2:8-11.

    Rothbart BA 2004. Postural Distortions. The foot connection. Online Journal of Orthodontics, May 10; 6(1): 1-8

    Rothbart BA 2008. Vertical Facial Dimensions Linked to Abnormal Foot Motion. Journal American Podiatric Medical Association, 98(3):01-08, May.

    Rothbart BA 2011. Primus Metatarsus Supinatus (Rothbarts Foot): A common cause of musculoskeletal pain - Biomechanical vs Neurophysiological Model. Podiatry Review, Vol.68, No.4, pp 16-18 July/August.

    Rothbart BA 2008. Malocclusions Linked to Abnormal Foot Motion. Positive Health Online, Vol 151, October.

    Rothbart BA 2006 Cranial Lesions Initiated by Abnormal Foot Motion. Health and Healing Wisdom (Price-Pottinger Nutrition Foundation Journal) Vol 30(1):6-7.

    Rothbart BA 2010. The Primus Metatarsus Supinatus (Rothbarts) Foot and the PreClinical Clubfoot Deformity. Podiatry Review, Vol. 67(1):

    Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46

    Rothbart BA, 2004. Postural Distortions: The Foot Connection. Online Journal of Sports Medicine

    Rothbart BA, Penzabene LF 2009. Forever Free From Chronic Pain. Happy About Publishers, California USA.

    Rothbart BA, Liley P, Hansen, el al 1995. Resolving Chronic Low Back Pain. The Foot Connection. The Pain Practitioner (formerly American Journal of Pain Management) 5(3): 84-89

    Rothbart BA, Esterbrook L, 1988. Excessive Pronation: A Major Biomechanical Determinant in the Development of Chondromalacia and Pelvic Lists. Journal Manipulative Physiologic Therapeutics 11(5): 373-379.

    Rothbart BA, Yerratt M. 1994. An Innovative Mechanical Approach to Treating Chronic Knee Pain: A BioImplosition Model. The Pain Practitioner (formerly American Journal of Pain Management) 4(3): 13-18.

    If you want to look at the european publications, do a Google search on Gagey PM, Bricot B, or Fusco MA (just several of many many authors). Or simply do a Google search on 'Postural Distortions'.

    Professor Rothbart
  6. This is an intersting read on the move away from posture centred physiotherapy.

    Attached Files:

  7. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Dear Simon,

    "Who? What? When? Why? Yeah? And? So? What?" written by Simon Spooner

    Thank you for your punditry and illuminating comment. It is a classic example of what we, in the U.S., refer to as : "Calling the Kettle Black" - All of which offers little to this thread/discussion.

    Professor Rothbart
  8. Brian A. Rothbart

    Brian A. Rothbart Active Member

    My Dear Robert,

    You are certainly entitled to your opinions. However, many people would disagree with you (e.g., the peer reviewed journals who have published my research).

    Professor Rothbart
  9. Brian, It's my signature set here on Podiatry Arena. It's attached to all of my post's- it's an aide memoire to critical reading of scientific papers. Your reaction to it is what we in the UK call: "going off half cock". No change there then.
  10. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Dear Simon,

    Thank you for clarifying that. Much appreciated.

    Professor Rothbart
  11. blinda

    blinda MVP

  12. I'll take that as the nearest thing to an apology anyone is ever likely to get from you, Brian.
  13. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Eyal Lederman paper is an interesting read (The fall of the postural structural biomechanical model in manual and physical therapies: Exemplified by lower back pain).

    Eyal states that the link between postural distortions and musculoskeletal pain has been eroded by research in the last two decades. However, no where in his paper did I see him cite/challange my publish research.

    I disagree with Eyal findings. My research suggests that postural distortions play a pivotal role in the development of chronic musculoskeletal pain.

    Professor Rothbart
  14. Your research doesn't even make it on to the radar, Brian. I would suggest that a lack of quality supportive data, controlled trials, prospective studies and the quality of many of the journals that your opinion pieces have been published in mean that the vast majority are completely unaware of your punditry. In my experience, the vast majority of those who have come into contact with your musings dismiss them as non-science rambling from someone with an inflated opinion of their own importance.
  15. And in the US, I believe the late great Bill Hicks called it something else. Look at it...
    Really Brian? The vast, vast majority of your published articles contain nothing more than opinion, and most of them base this opinion on references to your other works of opinion. I was asked to review one of them. If an undergraduate had showed it to me as their undergraduate thesis, I'd have had serious reservations about passing them.

    Hence my question as to whether there was any actual new research. Not Brian stating how Brian thinks it works, but actual kinematic or kinetic data which supports "if we do X then Y happens". Clearly not. Still flogging that same old dead horse.

    You know, at the Biomechanics Summer School this year we had Beno Nigg talking about the decades worth of kinematic studies he'd undertaken and how the results challenged us to rethink what we thought we knew. Then we had Chris Nester presenting the research in which he'd implanted bone pins into numerous of the foot bones of his live subjects and studied how the bones moved in real walking. And indeed a cadavaric foot with the muscles attached to computerized motors on a mobile rig with even more bone pins. There was no word for it other than inspiring. That such brilliant men and women should go to such lengths and apply such rigor to themselves in the search for even the smallest nugget of understanding as to how the miracle of the human body works was nothing short of inspirational.

    That, my dear Brian, is research. That is evidence. When you have something of that nature to support your very profitable hypotheses, then we will have something to discuss.

    However what you reference as "evidence" is this.


    This is on your "research" website as "evidence" that your E30,000 insoles treat "facial distortion" (and if one observes the size of the skull apparently causes the skull to shrink).

    And this
    As "evidence" that a pair of insoles cures droopy eyelids.

    I'm afraid if that is what you're presenting to support your hypothesis, then serious people are unlikely to take you seriously Brian.

    But then, you knew this already, because of the many times in the past that you've started threads about your theories, like the one that wearing your insoles make infertile women have children, and had them absolutely destroyed by all and sundry. So really I'm at a loss as to why you keep coming back. Perhaps the hope is that enough people will have forgotten what a bad joke this is, or have joined the community since the last run around, that you might garner a few more converts. I really can't imagine.
  16. Oh and as a BTW, the evidence (that stuff with numbers and such) shows rather clearly that the effects of in shoe insoles, and indeed experimental changes to the supporting surfaces upon which a foot rests, are highly individual, subject specific, and unpredictable. And that's the effects of the devices on lower limb and foot kinematics. This being the case, any claims of repeatable or predictable the effects of insoles on posture, many links up the kinetic chain, would seem to be highly dubious. Unless of course any real data is available to show the contrary. Which there isn't.
  17. CraigT

    CraigT Well-Known Member

    Ah yes that gem.
    But this claim did lead to the comment...
    'do you have to be wearing them at the time?' - perhaps the best Pod Arena quote of all time!
  18. blinda

    blinda MVP

    Nice summary of both this years BSS (best yet) and the general consensus of `Proprioceptive Stimulation`.

    PS, you omitted `taste` after bad....
  19. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Again folks, everyone is entitled to their own opinion.

    However, I was hoping we would stay on track with a discussion on the connection (or not) between foot pathomechanics and chronic musculoskeletal pain. Anyone out there with an opinion they would like to voice. I promise not to bite.

    Professor Rothbart
  20. .....

  21. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Before this thread is closed - is there anyone who would like to share their experience(s)/observations: patients' chronic pain symptoms that have abated while using insoles?

    These musculoskeletal pain symptoms can impact any weight bearing joint or postural muscle(s) crossing those weight bearing joints: knee, hip, spine, jaw.

    Professor Rothbart
  22. Brian:

    One of the fatal mistakes you have made in your professional life through your bizarre obsession to make yourself "famous" by naming previously-named conditions after yourself and to make money off of selling insoles the way you have for years on the internet is that not a single, intelligent podiatrist or other health practitioner will ever take you seriously again. If you think that the responses you get here are harsh, you only have yourself to blame since it was your past behavior that has earned these responses. My suggestion is to go hide out in what ever new country you are now living in and stay away from Podiatry Arena since you will never get the respect that you oddly think you deserve.
  23. Lab Guy

    Lab Guy Well-Known Member


  24. The thing is Brian old bean, not everyone is as blind to the post hoc ergo propter hoc fallacy as you.

    I did have a patient who came out after I gave them insoles. However I don't propose that that data point is anything other than an anecdote and certainly not that it demonstrates a link between insoles and Homosexuality.

    Most people will suffer back pain in their life. Most will get better by themselves (regression to the mean). Therefore most things one does to a patient with back pain will appear to improve it.

    That's why we, and I don't necessarily mean that we on an inclusive sense, do studies rather than asking for anecdotes on the Internet to investigate their theory.
  25. HansMassage

    HansMassage Active Member

    Two quotes from the article:
    "However these studies can only be used to inform us about the changes
    that are due to the condition but they cannot indicate
    its cause, that is, the consequence of LBP is not necessarily its cause. This distinction is important clinically. Often the PSB assessment is made when the
    patient is already in pain, once the individual/body
    has reorganised to cope with the condition."

    "The alternative: a Process Approach

    A clinical alternative to the PSB model is a Process
    Approach model. The aim in this approach is to identify the processes underlying the patient’s condition and provide the stimulation/signals/management/care that will support/assist/facilitate change."

    The concluding quote seems to indicate that the failure of the posture measurement model is that wastes time that could be spent on identifying the process underlying the patients condition.

    The most common condition I treat is acceleration/deceleration injury of the spine from rotation around the shoulder belt in automobile accidents. The neuro-muscular response to this injury is seldom recognized. Measuring the apparent leg length discrepancy and arch difference does not identify the process underlying the condition. It takes careful interview and motion palpation the engages and disengages the pain to identify the causative agent.

    When the condition has been there for 70 years the supportive devices from the podiatrist can be very supportive [if they are not put in the wrong shoe].
  26. As soon as I see mention of chronic pain these days I immediately associate it with Rhubarb, not for any contribution he may have made in this field, but because that is what he has become. The man is a fraud, charlatan and con-man and his contributions on this thread merely reinforce that hypothesis.
  27. Mark:

    I'm surprised at you! How can you say, after reading that Brian Rothbart, the self-proclaimed Father of Chronic Pain Elimination, can diagnose and treat a person with chronic pain for only a 100 Euro phone consultation, think that this man is a fraud, charlatan and a con-man!:rolleyes:


  28. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Disappointing - I was hoping that a discussion could be had regarding the link between foot function, posture and chronic pain.

    Professor Rothbart
  29. It could have Brian. I gave you some perfectly reasonable and coherent arguments which you decided to ignore.

    I'll ask again, join in if you like.

    Given that the bone pin studies and kinematic data show that the kinematic effects of foot orthoses are unpredictable at best and confounding at worst, how can we infer any sort of predictable effects further up the kinetic chain?
  30. Brian:

    Disappointing?! Looking through your multiple websites where you are making diagnoses over the phone for 100 Euros to people who are desperate for a cure for their chronic pain is what is disappointing for any health professional to be offering. How do you sleep at night stealing these poor people's money?!

    You should have thought of all that before you proclaimed yourself the "Father of Chronic Pain Elimination". With a self-appointed title such as that, you now expect us to waste our time by trying to have an academic discussion with you. Not a chance!!!
  31. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Chronic musculoskeletal pain is pandemic. It affects 100s of millions of sufferers across the globe.

    My clinical research suggests that one of the most common causes of CMP is the foot structures that I have written about (PreClinical Clubfoot Deformity and the Primus Metatarsus Supinatus). This being the case, Podiatrists have the unique opportunity to attenutate this pandemic.

    I am baffled that on this forum very little (if anything) is discussed regarding these links between foot function, posture and CMP. While, In Europe, this is an area of research.

    Professor Rothbart
  32. Brian A. Rothbart

    Brian A. Rothbart Active Member

    It has recently come to my attention that a group of Osteopaths (approximately 150) in Australia are using a type of proprioceptive insole to treat chronic pain patients. Apparently they are using a proprioceptive insole partially based on my US patents (2001).

    It saddens me that this group does include DPMs (at least none that I am aware of).

    Craig, question. Are you aware of these DOs treating CPM using proprioceptive insoles. They are reporting a very positive response to their interventions. This being the case, and considering the numbers of DOs using this approach, do you not believe that this is an important subject to be discussed on this forum?

    My attempts to do so have obviously failed.

    Professor Rothbart
  33. Death is also pandemic and is even more of a problem than chronic msk pain and yet in some people it may be the answer they are looking for when the latter becomes intolerable. We don't discuss death much either, Brian, nor do we promote any insoles that claim to cure it. As clinicians, we deal with the issues death brings on almost a daily basis. Perhaps more than most health professionals, podiatrists are regularly exposed to the impact this condition has on our patients and their loved ones - to the extent that grief counselling almost becomes routine. I dont see many podiatrists writing books claiming to be the father of grief resolution or a master of death. Few will willingly discuss anything with someone who is patently dishonest.
  34. Brian A. Rothbart

    Brian A. Rothbart Active Member


    You are using a biomechanical model in reference to kinematic effects of foot orthoses being unpredictable/confounding regarding changes up the kinetic chain. I have long ago arrived at the conclusion that this model is flawed.

    Recently I published a paper on a different model that I have termed Neurophysiological (see citation below). Based on this model I have published data on the outcome of a clinical research projects, completed several years ago, that suggests the link between 'gravity drive' pronation and changes in the position of the innominate and temporal bones.

    Professor Rothbart

    Rothbart BA 2011. Primus Metatarsus Supinatus (Rothbarts Foot): A common cause of musculoskeletal pain - Biomechanical vs Neurophysiological Model. Podiatry Review, Vol.68, No.4, pp 16-18 July/August.

    Rothbart BA 2008. Vertical Facial Dimensions Linked to Abnormal Foot Motion. Journal American Podiatric Medical Association, 98(3):01-08, May.

    Rothbart BA 2006. Relationship of Functional Leg-Length Discrepancy to Abnormal Pronation. Journal American Podiatric Medical Association;96(6):499-507
  35. Brian A. Rothbart

    Brian A. Rothbart Active Member


    No disrespect, but are you taking mind altering medication. You just don't make any sense.

    Professor Rothbart
  36. Clearly it was written beyond your comprehension, Brian, suffice to say that as it concerned you and your products, it is unlikely to make any sense whatsoever.
  37. And this is coming from someone who claims that his insoles can cure prolapsed uterus and infertility?! Talk about the pot calling the kettle black!
  38. Brian A. Rothbart

    Brian A. Rothbart Active Member

    As I said, Mark - no disrespect. But your recent posts worry me. If you are taking drugs, I wish you a speedy recovery.

    Professor Rothbart
  39. Brian A. Rothbart

    Brian A. Rothbart Active Member


    Apparently, your understanding of ascending/descending postural distortional patterns is limited. Otherwise, you would fully appreciate how an anteriorly rotated innominate can compress the fallopian tubes resulting in a functional sterility.

    Prolapsed uterus? In reference to what? Please refresh my memory.

    Professor Rothbart
  40. Refresh your memory???



    I'm not the one offering phone consultations for 100 Euros for "chronic pain elimination". I'm not the one that named a commonly recognized foot type after themselves, "Rothbart's Foot". I'm not the one that named himself the "Father of Chronic Pain Elimination". I'm not the one that says his foot inserts cures infertility. I'm not the one that started "Rothbart's Foot Awareness Week". I could go on and on, Brian. You are a disgrace to our profession.
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