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Why Mastering Biomechanics is Crucial to the Profession

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Kevin Kirby, Jul 31, 2010.

  1. bohujer

    bohujer Welcome New Poster

    kevin,it is not productive to confuse podiatrists aswell, because of "intellectual" discussions you have posted, the answers which are loaded with inneundos that causes confusion that you mainly post (yes spelt wrong for everyyone to critisicise, terroble english,yes).
    you are confusing your own profession,but are you?
    sounds confusing doesnt it.state registered podiatrists who know themselves and what they have learnt,can see through the confusion, we always have done.but can you?

    wriitten stone cold sober

    you bet it was

    sarah c
    :welcome: to our world intelligent podiatrists:drinks
  2. Seems like this is a big issue in the states, with this debate going on in Podiatry Today about the level and amount of biomechanics taught in schools. What I did note when reading the replies was the amount of discussion about Root mechanics.
  3. Griff

    Griff Moderator

    Probably the oddest and most confusing post I have ever read on this Arena...
  4. This is a big issue in the States since there seems to be a move toward teaching more advanced surgical skills at the expense of teaching biomechanics and foot orthosis therapy skills.

    And in regard to the amont of discussion about Root biomechanics, in general, the level of discussion here on Podiatry Arena on biomechanics is about 10 years ahead of the level of discussion with most podiatrists in the States. That is what happens when podiatrists value their surgical skills more than they value their knowledge of the biomechanical function of the structures that they are doing surgery on.:craig::bang:
  5. .....and I thought it was just me......but I did get a "thanks" so it must have been a positive comment????;)
  6. Graham

    Graham RIP

    The sad thing here, Not only that Kevin is right:drinks, Is that the majority of Podiatrists, especially teachers, have no idea that Podiatry Arena exists, or that Biomechanics has ever evolved beyond "rootian" principals.

    Until we can get the majority of Podiatrists, and 100% of teachers, involved in these debates the ignorance will remain:boohoo:

    So how do we spread the word?
  7. Dave Dunning and I were discussing biomechanics education on Friday evening at biomechanics summer school. I think the points made by Doug Richie are well made. You need teachers in the Podiatry Schools who are well educated and at the leading edge of podiatric biomechanics. Unfortunately, academic posts are often unattractive to many of these individuals.
  8. :good:

    Hmmm. I agree that the undergraduate educators are key. However I think there are some deeper problems, at least in the UK.

    Consider the podiatrists you know. In my experience the level of biomechanics knowledge they posess has little to do with what they learned at university. The problem, for me, is simply that many UK podiatrists just can't be bothered! To be sure they leave university knowing little (I certainly did) but they then have no desire to change this state.

    And then comes someone with a "product" they wish to sell and a "new":pigs: "paradigm" which justifies it. Never mind that the paradigm is a crock of warmed over pseudorootian pap, it looks great to the untrained (and by the by ties the person to that lab which is the only one which makes insoles which harmonise with that paradigm).

    They get comfortable with it. They even get results. So why should they seek further education?

    For me, this is the carbon monoxide in the air of biomechanics. It fools the cells (pods) into assimilating it, and then when the oxygen comes around, it is rejected, because it is not seen as needed.

    However we, as biomechanists, have an implied guilt as well. Those of the profession who ARE forging ahead, breaking ground, and doing the really GOOD stuff, (people like Simon, Greg, and the M level educators and many undergrad educators) run the risk of leaving the bulk of the profession behind. To the qualified masses, it is often too great a jump to get from where they are to where the educators are.

    The complaint I hear, ever so often, from undergrads and recent grads, is that whilst their tutors were GREAT and obviously very knowledgable, they simple left the students behind, trying to expound the theory which excited THEM rather than the basics.
  9. The great thing is that if the basics are taught well in the first place the student of biomechanics (we are all students) should then be empowered to read and learn at their own rate, following interests and topics which excite them.

    My experience suggests that many may not have the patience to discover their own meaningful learning experiences, and merely wish to be spoon fed.
  10. Greg Quinn

    Greg Quinn Active Member

    I must admit to being surprised at the extent of Rootian thinking that still exists within our profession. Nevertheless, this perhaps represents a combination of custom and practice and ‘don’t fix it if it ain’t broke’ thinking. That is to say, a little lethargy and some ‘fair’ results go a long way to maintaining the status quo for graduates.

    Coupled with this is the speed with which biomechanics thinking has evolved recently; staying up to date can often seem an incredibly daunting (rather than enjoyable) task. The option of being ‘spoon fed’ by someone who seems to know the subject can be very appealing.

    When practitioners do begin to get involved, they seem primarily to want to do no harm (laudable enough) rather than solve the problem at hand… and in my experience this is really an issue of confidence.

    Personally, I do feel that a little hand holding and simplification can be helpful for most people in the early stages of their biomechanical studies. After all, this approach is replicated in other educational environments e.g. Bohr’s original description of atomic structure is still used at school though now considered obsolete. This is because it introduces concepts that can be established in a simple way for the student prior to being challenged later on.

    Even though we may then be initially guilty of not delivering the full unexpurgated truth, we can establish some sound concepts, build upon them and then begin to challenge students understanding by presenting more advanced concepts (as per Simon’s post).

    Getting more Podiatrists to involve themselves in this fascinating subject is a real challenge. What I feel we lack sometimes is the ability to create what George Bush Senior dismissed as ‘the vision thing’.

    My real concern for Podiatry in the NHS is that at a time when EBP & value for money is a real issue for Podiatry, failure to properly & comprehensively integrate this element of patient care will result in it being be cleaved off to other departments or worse still, not provided at all!
  11. Johnpod

    Johnpod Active Member

    Y'know Simon, that's the first time I've every agreed with every word of one of your posts! You must be getting old! I absolutely agree about the importance of the basics, so that it can be built upon properly... the solid foundation, etc.

    I agree with Gregg, too. I reckon that not 1 in 20 of us actually practice biomechanics as part of our day-to-day practice. Highly unsatisfactory, and others (chiropractors, physiotherapists, osteopaths, etc) are only too pleased to take the work.
  12. 2 points I would like to add or highlight.

    Root mechanics would have lost it appeal long ago if the patient outcomes were not as high as they are, were.

    Grahams point about teachers not being upto date with the latest thinking is something that should be addressed, if the teachers were teachings a good overview of biomechanicial theory, or as I used to explain to me students. I´m going to give you an overview of the current ideas and show you the door, it´s up to you to open it. New gards would come out with a hunger for information, after a few years of this thinking will change. But if teach dogma then Status Quo
  13. Kerrie

    Kerrie Active Member


    I graduated last year and am really really interested in biomechanics. However, I have to say that I have learnt more from this arena, shadowing other professionals and personal research/reading than I ever did at Uni!

    My biomechanics lecturer was incredibly intelligent, I mean literally enviable at their knowledge (I sat through most lectures opened mouthed in awe). However, they often went off on tangents with their own theories and views on topics whilst we were shell shocked still trying to comprehend what STJ neutral was, I think some were thinking it was a shade of wallpaint ;) !

    I think that this is the main reason why alot of new graduates actually hate the topic and would rather run away from biomechanics screaming than give it the time of day.

    However, there are a few out there who remain interested :)
  14. fatboy

    fatboy Active Member

    Biomechanics is awesome, if you are a clinician and you cannot explain the 'theory' to your patient you are going wrong.

    If you are a lecturer and you cannot explain it to your students (without losing them or getting them glassy eyed stare) then you are definately going wrong. The lecturers have to provide the basics, and the desire to learn more.

    Like Simon Spooner said we are all students of biomechanics.

    and i agree with what Einstein said "everything in life must be made as simple as possible, but not simpler"
  15. Mark Smith

    Mark Smith Member

    I would like to agree with many of the previous contributors that one of the biggest problems (and I can only speak for my experience in the UK) is the level of undergraduate teaching.

    This is not always that the specific biomechanics lectures are poor, but more that the nature of the undergraduate degree is often delivered in such a way that seperates biomechanics form other core areas of knowledge, which is further compounded by a very low knowledge of biomechanics by "non-biomechanics lecturers".

    In my humble opinion: knowledge of lower limb mechanics, functional anatomy and its relationship to tissue stress should be there as the base from which much of the rest of the course and its content should be built on, rather than being seen as a bolt-on specialist field which is ingnored or scares off the majority.:D
  16. p.s. while I've not taught undergraduate biomechanics for about 6 years now, I'd like to think I still could cut the mustard. It's only rocket science with anatomy. ~Why would I expect a fresh graduate with three years learning to have the same knowledge base that I have achieved in 22 years? The problem is, some come out with the opinion that they already have it, some come out with the opinion that they never could have it and some think there is a short-cut to it. All are wrong. Patience, persistence, a hunger for knowledge and a willingness to learn through experience may well help. And a good mentor helps too. I've been lucky enough to have (and continue to have) many of these- but you need to find them, they are not aware of you, until you go looking for them. As several already know, us that are passionate about biomechanics are more than willing to help those that show an interest. Look at how you have grown, Robert. Rightly or wrongly, I'd like to think some of that growth has come as a result of me, amongst others. My bosom swells with pride.

    Life-long learning is where it's at. What the Universities should be doing is enabling the students to learn how to learn. How many run modules within their undergraduate programmes on teaching and learning? The clinician as an educator: of themselves, their peers and their patients... Fundamental, in my opinion.
  17. Absolutely as a result of you simon. Among others. Kevin (of course), Eric, Dave, and others too numerous to mention.

    Even the likes of Brian have played their part. He's like the revolting picture on the packet of cigs. "look kids, this is what will happen if you don't study..."

    My bosom is likewise swollen that your bosom is swollen.
    Very much so. In many ways the level of knowledge one has is less important than the level one desires.

    Kerrie said:-

    Kerrie spent a day with me recently. Here, gentlemen and ladies, is the future. Enthusiasm such as I have rarely seen, and a passion to learn. Gives one hope.

    This is already happening in many places.
  18. SarahR

    SarahR Active Member

    I enjoyed it! Great Article Kevin. I agree, we need to understand what that orthotic is trying to do, and stop leaving it up to "lab evaluation" or doing a "post to vertical" for everyone who comes through the door or we will truly get left behind. Pedorthists, nurses, OT/PTs, "that dude at the gym who had me walk across a mat" are all cutting into our piece of the orthotics pie in Canada (Ontario especially) as "assessors and providers" since this is not yet a controlled act, but really, if we are not going beyond "Traditional Root" and don't start making better stuff then they are providing, we deserve to lose the market share.

    It does need to start at the schools. However, we would have to educate many of the educators, and here, it's almost impossible for people to get out to conferences with their teaching schedules.

    I had a rough time myself acquiring BMCH understanding. After a fantastic intensive introduction to basic biomechanics class on axis (including variations, high, low, medial/lateral deviation of STJ etc), functions of joint motions (unlocking/mobile adaptor/shock absorption, rigid lever/propulsion) and how muscles work in tandem around a joint axis to either slow down/control or initiate motion, which was excellent, we then went on to learn only "Traditional Root" pathomechanics/orthotics prescribing.

    I was inquisitive as a student and went into the library, photocopying Kirby's skive technique paper and any others I could find on how to prescribe, and carried them around with me. I'd ask instructors when to post, how much, etc, and got only "Post to calcaneal vertical with moderate fill, you don't want to over-correct". And everything was about orthotics "controlling pronation", just increase heel cup depth etc, never mind the fact that some people aren't pronating at all! And when I asked what would work for a patient in clinic, all I got was "there are so many different ways to prescribe, they all might work".

    Didn't realize until I went to a Conference after graduating that I'd totally forgotten about the cavoid foot types when assessing for and prescribing orthotics, that I'd only been looking for those forefoot/rearfoot varus deformities and the compensations of the root and modified root paradigm, not surprising since it was all I was taught and tested on in school when looking at orthotics prescribing. This information had been presented in a pod med class but was totally disjointed from our pathomech class. Doh, felt like a moron with that one.

    Finally got to do a vacation seminar with Kevin last summer. The BEST seminar I've been to. Finally, now I understand how to work with the foot and achieve better function by working with those darn variable joint axis we talked about initially but totally left behind, and how to help people achieve functional joint motions necessary to achieve the goals of each part of the gait cycle, and stop focusing on "pronation control". And why was I sticking pads in the shoes before, and asking if the patient feels they are working instead of tacking them on the feet and watching them work?? So simple, so effective.

    I was shocked to discover when I went to visit a friend studying in the United States that they simply refer orthotics cases to the pedorthist across the hall!!! Clinical biomechanics was not being taught at all.

    Pronation is not bad, but it's treated like a dirty word. And supinated foot types are only "really rare" if you don't look for them. People with supinated feet WB and laterally deviated STJ axis have knee, hip and back pain, but don't report with foot pain so "don't have foot problems" and don't get investigated. They just want their toenails cut, and most of us happily oblige and miss an opportunity to improve these patients quality of life.

  19. Sarah:

    Good to hear the seminar was enjoyable and productive for you. It was a fun one and hope to do it again sometime soon.:drinks
  20. Kerrie

    Kerrie Active Member

    WOW, thank you very much!!! :D
  21. Ballantyne_23

    Ballantyne_23 Member


    This is my 1st post and this topic certainly caught my attention.

    I am a recent grad and I am really interested in biomechanics. What would be the most valuable reading materials ie, books, papers and pod arena posts to further my knowledge in biomechanics, especially the newer theories such as saggital plane and tissue stress?.

  22. eddavisdpm

    eddavisdpm Active Member


    Thank you for your post. You are involved in the educational system so please tell us what is going on at the schools with respect to the teaching of podiatric biomechanics. I have worked with a number of recent graduates and residents who appeared to have minimal interest in biomechanics.

    One issue to consider is the reimbursement system and the means of reporting services, ie. the CPT or Current Procedural Terminology system which is copywrighted by the AMA. Those of us who practice biomechanics have available a paucity of CPT codes to describe what we do. It puzzles me that the APMA has not lobbyed for the inclusion of such codes. Surgery is billable, abundantly via the CPT system, in contrast. The APMA has lobbied for surgical codes in the past such as the code for EPF.

    Dr. Wedemeyer has discussed his opinions of the AMA's monopoly of the CPT system.
    Another reason that we need such reporting codes is that we, as professionals, need to be able to differentiate the services we provide from lay purveyors of orthotics.

    I used to practice in the Seattle area where there is a dominant insurer, Regence Blue Shield. According to Regence, orthotics need be reported as L3020, left and right, with no additional coding involved that may describe the processes a podiatric physician goes through to provide a proper device.

    Biomechanics is what got me interested in podiatry and it was my expectation that the field would expand from where it was in the 1980s, not contract. Sound biomechanical principles need also be learned in order to enhance surgical decision making...it has been what has differentiated podiatric foot surgeons from orthopedic foot surgeons.


    Ed Davis, DPM, FACFAS
  23. Why not get in touch with kerrie? She's in a similar situation, you could share ideas, references etc.

    A thought occurs. To kerrie and ballantyne and anyone lurking,. This is something I've been trying at work. What if you could join an email list with which every week or so you got sent some biomechanics Home study. Case studies, lit reviews, rx reading and such, with some questions for you to send in answers to to make it interactive and make sure you've grasped the learning points.

    Would anyone be interested in that?
  24. BillW

    BillW Active Member

    I have to say upfront that I am a practice manager and not a podiatrist, however this issue is real to us here in our clinic in rural Australia. Firstly I do not think it is reasonable for any university degree to completely educate a graduate. Every graduate of university should have the feeling that they learnt more in the first year of work than they did in the years they attended uni. This is also common to all other professions.

    At our clinic we have a number of biomechanic referrers and our podiatrist spend roughly 50% of their day doing biomechanical work. As such we spend a lot of time mentoring our podiatrist to experience and learn the art of biomechanics. We do try and stop graduates being overwhelmed in the early couple of months, however they gain the exposure and the teaching to assist them to become excellent podiatrist.

    Their are a number or employers of graduate podiatrist who only trust them to do general work and then scoop the bio work themselves. It may make business sense at the time but it does nothing to further the profession, or the clinic.

    The best resource is not in a book, in my opinion, it is in spending time with a podiatrist who is skilled. New graduates if you want to improve your skills get a job in a clinic who wants you to develop. Even if you are not a new graduate but would like to develop your bio skills do the same it is never too late. The profession needs skilled practitioners in biomechanics or risk damaging the podiatry name. There are plenty of physios and chiro willing to have a crack, and the only thing that will protect us is the ability to do things right.

    Employers don't blame universities play a role yourself. It was recently pointed out to me that the only thing worse then putting a lot of training into an employee and then losing them, is to give them no training and keep them.
  25. posalafin

    posalafin Active Member

    I believe there is a new biomechanics text by Kevin Kirby. Can anyone tell me where I can purchase this from?
  26. admin

    admin Administrator Staff Member

    Cast your eyes to near the top right of the screen and refresh the page a few times... ;)
  27. Excellant points. I agree that there is no substitute for hands on mentoring. There is a lot you can't learn from books.

    Do you find difficulty finding people who are willing to embrace that level of commitment? And if not, where are you finding them ;)
  28. steve90

    steve90 Welcome New Poster

    Robert, I think that sounds like a great idea and something that I would be interested in.

    Please keep me updated if it bears fruition.

  29. Depends how many people would be interested. I'm always happy to help people who want to learn, but I don't want to put the work in if no one is bothered!

    Anyone who is, feel free to send me an email at rissacs@nhs.net and I'll start a list. To reiterate this would be very basic from scratch type stuff for new grads (or people who've been out of the loop with bio for a while.)
  30. Griff

    Griff Moderator


    I think this is a great idea. I'm happy to help if needed - not that I'm suggesting you'd need help of course - but even if its just to get full text articles in pdf form for the 'reading list' (there aren't many journals I can't access at present)

  31. Kerrie

    Kerrie Active Member

    HELL YES!!!!!! :D
    I would definitely be interested, please please do it :)
  32. Ed:

    At the California School of Podiatric Medicine, I think the curriculum is improving every year. Students are just now getting more clinical exposure in their third and fourth years which seems to be helping. As far as the other podiatric medical colleges, from what I know, it is a very mixed bag with different things being taught at every institution. It can surely be improved, but it is a very slow process to change curriculum at all the schools since there are so many opinions as to what curriculum should be taught.

    I give lectures about 4-5 times a year at CSPM for the students and, every year I train three Kaiser Sacramento third year podiatric surgical residents at my office a half day a week. That is all I can manage to do with student/resident tachingand still keep my busy practice running and keep up with all my other academic lecturing, writing, research and editorial responsibilities for my profession.
  33. drsha

    drsha Banned

    The DPM's are going to be making career saving or destroying decisions in the near future and like Kevin, I plan to put my eggs into the biomechanical basket both surgically and non operatively.

    i however, am spending more energy and time practicing as a therapist rehabilitating and training the muscle engines of the foot to strengthen and become under motor control.

    I say this as an addition to Kevin;s statement that we should be mechanists as I feel we should also be therapists.

    Dr Sha
  34. By inference then: until you (as a therapist) train the muscles they are not under motor control? This is hatstand, Dennis- as well you know, your going to have to expand upon this statement. Are you talking about reflex routes?
  35. I believe that's a tenner you owe me spooner ;)
  36. I don't think so Mr. Isaacs, you were up there merely minutes after that bet was placed, as Prof. Kirby pointed out to you at the time. I can find the post and the thread where you lost that bet if you wish. I've been checking my post for the cheque daily.

    P.S. I've missed the entertainment value.
  37. Ballantyne_23

    Ballantyne_23 Member

    I would definetley be interested Rob in starting a Bio home study mailing list I will forward my contact details to ur email add

  38. Robert:

    Beware the bearer of spoiled fruits, espeshially those engaged in the fermentation of rotten apples. Job 11.7: reject the mitigation of the weaklings of these poor souls tortured by inebriation and misrepresentation - for they know not what they want nor what they desire; such is the power of the pips.
  39. Mark, have I ****** you off somehow?

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