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What does the term ´Biomechanical specialist´or ´Biomechancial´treatment mean these days ?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by mike weber, Jan 25, 2010.

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    Was at a friends place for dinner on Saturday and some people we have never meet were there.... Got the classic What do you do for work Type Question. As Podiatry is only 3.5 years old in Sweden I could not just say Podiatry blah blah blah .

    This got me thinking.... Since 1996 I´ve based most of my patient load around ´Biomechanics´ but if we consider the word Biomechanics

    Does that really describe what we discuss and how we treat our patients these days. If we consider that most of our day is spent getting people symptoms reduced. We do this by reducing the loads on the tissue by whatever means we can, sometimes involving Newtons laws of Physic sometimes not. Sometimes with bits of plastic sometimes with a scaple sometimes with a stretching program, FMT etc. If we are just using orthotics maybe we are missing a huge % of the best treatment plans for our patients.

    So what we are really doing ( to quote Simon Spooner) Z.O.O.S.. We are trying to get the body to work in it´s Zones Of Optimal Stress.

    So considering that I came up with this... What is a ´Biomechancial´ Podiatrist they are a " Lower Limb tissue Stress Specialist". This can also be used by all Podiatrist it does not matter what field you work in I guess.

    What do others think ? Or have I been thinking too much or not enough !!

    What does ´Biomechanics´mean to you ?
  2. I think ZOOS was originally Kevin's baby from way back. That was one of those "OMG that makes SO much more sense post" which I printed out and stuck to the wall in the lab.

    However. Biomechanics in general is certainly a more holistic definition, however by usage most AHPs and medics I meet seem to associate it with us as per.

    So far as

    I guess you could take the TSS bit to apply to anyone involved in any vaguely orthopaedic therapy.

    It has always interested me how professions define themselves. Physio's, for eg, are defined by the type of therapy they carry out (viz physical). We, however, are defined by an area of the body (lower limb) then subdivided by the types of therapy (bio, diabetes, derma etc).

  3. Sorry Kevin For giving the Quote to Simon..

    But thats the thing Robert I beleive the lines between professions are becoming less rigid. Maybe 20 years ago the Physical side of treatment was considered the Physio´s area and the orthotics the Pods, but we are not set in those boundries and patients demand that you can help them so our role has changed and developed, where now orthtoics are an important but 1 card up our deck we have many others to play.
  4. The term zone of optimal stress (ZOOS) camer from a discussion that Simon Spooner, Tony Achilles and I were having some years back on Podiatry Arena. If my memory serves me correctly, it was Simon's idea. However, until he writes about it in a peer-reviewed publication, it probably won't catch on past Podiatry Arena. Time to get to work Dr. Spooner!:drinks
  5. We already did. It's in our preliminary study of the STJ locator, Kevin. Although not directly referred to a ZOOS we discussed the potential benefit of limiting extremes of excursion of the STJ axis.
  6. G Flanagan

    G Flanagan Active Member

    this has always been a particular bugbear of mine, particularly in the NHS. Myself i am a PODIATRIST, not a specialist podiatrist or a highly specialised podiatrist or an extended scope podiatrist, as all these terms, IMO, are a load of nonsense. Yes i suppose you can a be a particular specialist in a field, however, the nhs seem to throw specialist, highly specialised around for fun, thus confusing other healthcare professsionals and making us look rather stupid.
  7. OK George now that got that off your plate, what does a biomechancial treatment mean to you. Is it angles and bits of plastic or it more or even less ?
  8. Not just us. That is the new AFC banding for a lot of AHPs, written by people who could not quite bring themselves to beleive that we were not basically nurses.

    I preferred being a "senior 1" in the days of whitby rather than a "highly specialist" in the AFC terminology, but thus it goes.

    I think you are very right! As that brings opportunities and threats in equal measure. If we drag our feet (sorry) then another group, be it osteopaths, physios or whatever, will be quick to fill the void.

  9. Which then Links in with LL thread are the schools of Podiatry set up for this or is it expected that you look after yourself when you graduate.

    Here is LL thread for those who missed it LL Thread

    This then gets me back to the point of the thread, what is biomechanics these days ? Does the term Biomechancis mean all MSK treatments and orthotics all the vectors, physics and other theories that we discuss daily here or ?
  10. I think we need a paper on ZOOS itself.:drinks
  11. I get the message ;)
  12. And it was a fine paper, Simon. A more careful read of the discussion section of this paper will clearly reveal the concept.:drinks

    Attached Files:

  13. Sammo

    Sammo Active Member

    I'm unsure whether the term Biomechanics Podiatrist is a misnomer..

    I feel that what biomechanics podiatrists do is more a specialism in MSK injuries of the foot and lower limb relating to gait (and applying principles of biomechanics) rather than true biomechanics. Having spent a bit of time working with a couple of PhD candidates in true Biomechanicsand I am slightly uncomfortable with using the term Biomechanics Podiatrist, as I do not feel that I have anywhere near enough knowledge to claim that title.

    I've sat and worked through Kevin's thought experiments (which I found revelatory), have a reasonable grasp of physics and feel I can visualise what is happening in the foot, but I would not call myself a Biomechanist.

    When asked I say that I'm a podiatrist who specialises in MSK injuries of the foot and lower limb relating to gait.

    Just my thoughts..

  14. Here is that I think you refer to Kevin.

    1st time ZOOS was referred to on PA thread
  15. I read thru the most of the thread and for those that missed 1st time around like me it has some great discussion In my option.
  16. Alex Adam

    Alex Adam Active Member

    Biomechanics is one of those words used by all in sundry these days, Podiatrist amongst them. Do we specialise in soft tissue or osseous biomechanics, they are very different?
    Some Podiatrists deal in soft tissue stresses and others in skeletal stresses. Some only interested in the foot and others in the total system.
    If we consider just the foot then the use of felts and soft insoles help and for those interested in the total system then a strong understanding of physics, propriceptive response, spinal reflex and the inner ear is essential.
    "Lower Limb tissue Stress Specialist" describes well most of Podiatrists, however there are some that consider the total skeletal system and have a good understanding of Closed and Open chain motion together with how the compensatory mechanism works. All are Podiatrists just with a different frame of reference.
    To understand and treat the full skeletal mechanical structure we need to incorporate studies in functional anatomy, dissection, cellular histology and orthotic manufacture and it's effect on all the systems of the body.
    It is here we consider the Universities and their method of training, are we, like the Medical Schools, becoming too academic?
  17. The bit in red here Adam your going to have to explain cause it a big sweeping statement which basically make no sense to me. Please supply good references on how your inner ear assessment goes and how the device effect it in a good or bad as an example.
  18. Alex Adam

    Alex Adam Active Member

    Well as for 'all in sundry' Melbourne is full of various health professionals and some not so professional that claim to be Biomechanists with not clarification of their study.

    Inner Ear is responsible for the basis of balance, Grays Anatomy, this will determine the position of the head in whatever postural situation is in. As such the two frames of reference is that of the head( inner ear balance) and the ground reaction force. What happens between these two points we would consider compensation. Taking into consideration the individual genetic makeup we can determing the areas of compression and thus the areas Wolf's and Davies Law applies.
  19. Ah, you are considering the GRF aspect of balance to be significant.

    Fair enough. Sorry you foxed me by not mentioning it in your list of

    Do elucidate. How do you extrapolate this into insole design?
  21. Alex Adam

    Alex Adam Active Member

    Well insoles are just that, to consider how we counter the proprioceptive response we need to understand the physic of the lines of force that act on all the joints of the skeletal system. Once again considering the geographic and genetic nature of the patient we are considering.
    The important aspect to is observe and take the necessary measurements to ascertain if the forces through the STJ are compensated for and then determine the compensation that has occurred in the MTJ while removing/considering anatomical alignment. We then consider that available motion of the hip and does the ROM allow of the pronation produced at the STJ. Has the lumber region been compromised and does a scoliosis exist? How active is the trapezium muscle group and does the balance within the inner ear produce a hyper extension of the cervical spine?
    Once this is determined can we cast the foot in the most desired position, if yes we do this and the line of force becomes the first frame of reference. This is transferred to the pour of the cast and the horizontal of the liquid plaster becomes the new frame of reference. The process continues until the device is manufactured. The result is to accomplish a position where the inner ear is in balance while the spine is perpendicular, providing no scoliosis is present, removing the need for the hip and lower back to compensate for the increased internal rotation produced by the STJ, taking into consideration the axis of the STJ as well as negating the MTJ involvement. This entire process is depended on a number of issues including the age and ethnic background of the patient.
    The most important aspect for the professional is to control the entire process or have a laboratory that they have total faith in.
  22. WILL the stj be held in the desired position in which the foot is cast?
  23. Alex Adam

    Alex Adam Active Member

  24. Alex Adam

    Alex Adam Active Member

    Yes providing the medial process of the cuboid is stabilised under the the Sustentaculum Tali, the mimicing of the process allows the control of the calcaneous and we note resupination just prior to propulsion.
  26. Alex can you post up an article or 2 on this one I would like to have a read in more detail.

  27. Gosh!

    You know of course that ALL the research on the kinematic effects of insoles on foot position show either no kinematic chance at all or at best a slight kinematic change.

    Presumably because they did not sufficiently stabilize the sus tali.

    A bold claim indeed!
  28. Alex Adam

    Alex Adam Active Member

    The function of muscle is to act on a stable skeletal system, for this to occur to allow the muscles to develop in a well balanced way is for the joints to be in a position that is at it's most stable position, locked. It is at this position that the liganemts allow for the proprioceptive response to instigate muscle contraction, though the bareend nerve fibres. Movement beyond this point under normal gavitational influence is sublxation. This will see an exagerated motion in the opposing muscle groups, hence damage to the deltiod ligament in a severe ankle inversion sprain.
    So to answer your enquiry, yes in the above explaination.
  29. Alex Adam

    Alex Adam Active Member

    Well as I have posted in the past, the research does not give methodology in the style of device they use and so if it does not control the axis of motion of STJ and MTJ no effect would be noted and in some cases the concave shape of a basic device will produce an increase in transverse plain motion thus compromising any research being carried out.
  30. Alex Adam

    Alex Adam Active Member

    Secondary to this the research I have read usually uses either a form of gait plate or groos anatomy observations, we all are aware that the former only gives us the mean and standard deviation of force and the latter does not take into consideration the compensatory response to the device.
  31. Before I go on Alex can I ask a question to see where you are coming from. Is pronation bad ?
  32. Alex Adam

    Alex Adam Active Member

    Pronation is essential for normal addaption and sock absorption of the skeletal system, if we look at the bipedal evolution we note that early hominids had little pronation and were extremely supinated. Pronation is an evolutionary trait the delema is, can the western hip deal with the amount of pronation being produced?
  33. Have you got an article on that as well ?
  34. Quite true. Apart from the bit about the research not giving the methodology in the style of device they used. Which isn't. However.

    This is a fascinating exploration. Your insoles sound well clever! How does a device "control" the STJ axis?

    (You might want to reconsider talking about the MTJ axis unless you want to open a really REALLY big can of worms. Lets not go there!)
  35. Here what Alex said earlier.

  36. Yeah. Saw that.

    Funny thing is, I know what almost all of those words mean. But not the sentance.

    Determine what about the STJ motion? Its range? its quality? Determine what about the axis? Its position in 3d space at RSCP? Its position at STJN? Its position in plantar paralell position? The range of STJA movement during gait? The range of STJ movement during gait?

    How do you calculate a plane of motion? This bit makes no sense whatsoever however I try to interpret it.


    What is to "lock" the MTJ?

    And what is the paster correction system? Is it something to do with the church?
  37. I think we lost Alex for the night in OZ, hope I get some papers to read tomorrow.
  38. Alex Adam

    Alex Adam Active Member

    Hearing what is being asked for so I'm off to go through my papers and provide reference to the methods I have discussed.
  39. Please provide whole papes as Abstracts and reference won´t really help much. Look forward to some reading as to honest I´m getting more confused about what your writting the longer we go on here.

    Have a good weekend and look forward to the papers

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