Why Mastering Biomechanics is Crucial to the Profession

Not at all. Merely a caution to those less enabled to withstand a southwesterly breeze from the nether regions! Just returned from distant shores.....You're a very fortunate bugger, Spoons.....

 

Hi everyone
This topic has finally brought me out of the podiatry arena lurking space. This is my first post since joining in 2004. Great article Kevin. Are you the new back page columnist for Podiatry Today? I hope the whole profession reads the article but I am not holding my breath.
I have taught biomechanics at the undergrad level in both class and clinic on and off for the past 22 years.
I can sympathize with some of the musing of past students and their biomechanics class experience. I can tell almost right away the students who are interested and will excel in podiatric biomechanics. However, I also have observe the students who are blown out of the water with the amount of biomechanical terminology and concepts they have to assimilate. Unfortunately, students will integrate knowledge at different rates. I know from feedback sometimes the biomechanics "light" doesn’t really click until they are out in practice.

Other problems:
• Are classroom teachers in clinic with students on a regular basis?
• Are all of clinical teachers on the same page as the classroom biomechanics teachers?
• Is enough time spent on mastering plaster casting?.
Maybe 3D laser casting will make the process easier. But I have my doubts. I have been associated with lab over the past 10 years, I have seen my share of bad casts when I visit the lab. This is the biggest complaint of lab owners
• What theory is best to teach?
o Do we outline everything and hope the student makes their own decision based on the best evidence
o Teach only evidence base medicine and eliminate most of the previous podiatric knowledge and innovation
o Stick with the simplest mechanical concepts and tissue stress models
o How do we integrate new info without overwhelming students.
• Do students get enough exposure when a custom foot orthoses comes back with a need for modifications.
I am sure this has all been discussed before in other topic threads.
In the final analysis the “keep it simple stupid” is the best bet for teaching students. Unfortunately, the profession needs to establish what KISS is for teaching biomechanics. Maybe we have developed a biomechanics curriculum that is so packed with information that only a "biomechanics superstar" can only understand all the concepts and by default we leave behind the rest of the podiatry masses. Food for thought!.

Cheers Pete

Peter Guy BSc DCh
Whitby Family Footcare Clinic
Peterborough Family Footcare Clinic
Professor Chiropdy Program Michener Institute
painfreefeet.ca

 

This is just my opinion as a current student studying podiatry. Please, be aware of this. My knowledge is not as great, structured or as co-ordinated as one who has many years of experience behind them.

I know for myself, that trying to get what seems like a straight and logical answer out of my superiors is often hard and confusing due to the differences in beliefs and knowledge. Knowing the borders of too much information and relative information is often blurred as well. I love the fact that you (used as a collective term for all professors/professionals) are trying to share your wealth of knowledge but I am still trying to take baby steps and make the connections between the patient and biomechanical information.

Think of a sponge that has soaked up too much water. This is often what I think my brain would look like if I were to examine it closely.

The issues that myself and a lot of other students are facing is that biomechanical theories and the biomechanical "exam" are never broken down and applied with examples for us. It's almost like only explaining half the instructions to us and expecting us to be experts. Many of us struggle with the basic building blocks because we over-complicate things as it wasn't explained to us that a+b does in fact equal c and not 2x.

Showing us is just as good as tell us and making us write it down. My opinion is that showing us, in some circumstances is actually more beneficial. Practice makes perfect.

This is just the opinion of a slightly confused and overwhelmed podiatry student who has stumbled across podiatry arena and is now willing to explore the corners of the world.

 

Pete:

Good to see you on Podiatry Arena. I do the "Forum" once every four months for Podiatry Today magazine. In addition, I am still writing my monthly newsletters for Precision Intricast Orthotic Labs (24 years and 286 newsletters.....so far).

I hope you continue to provide your excellent comments here on Podiatry Arena since you are very high on my list of the best podiatric biomechanics educators in the world.:drinks

 

Hi Everyone,
Just thought that I would say this on this thread as I have had a few people who have posted on here or looked at it I guess PM me asking about bio resources for beginners etc.
To anyone new out there who wants to develop their bio knowledge like me just drop me a message and I will let you know which resources I think are good. I think I have nearly every book available on the topic....seriously my shelves are collapsing haha.
Take Care all x

 

Thank you very much Dr. Kirby..

I believed that biomechanics is very crucial in assessing patients related to thier lower limb problems, apart from the surgical issues. Mechanical problem of the lower limb can be the cause or the effect of an underlying structural problem. i.e scoliosis deformity, lld's/, hallux valgus on one side.....and their overall gait and posture, foot wear, lifestyle and fitness activities has to be assessed as well.....

Thank you once again....
Chrotech

 

Kevin
I just got back from holidays, thank you for the kind comment.

 

Is Jedd trying to say that his teaching may be falling short clinically?

Is he verbalizing that his teaching is too weighted in explaining and applying the laws of physics and requiring evidence so that it falls short when it comes to providing a level of clinical applicability?

Dr Sha

 

I noiced that the interest level dramatically increased when it came time to apply for a certain scholarship...

Good questions to ask. Maybe we need a "history of biomechanics" class along side, show the progression of the field but only after the basics and evidence based stuff is taught. I think the history is necessary, it helps one's ability to critically evaluate new theories and distinguish them from reworkings of old stuff and marketing schemes masquerading as ligitimate biomechanical theory.

We need specialists involved in clinical edu, thanks to Kevin and Pete and all others who take on as much of this role as possible. It is unfortunate that all students are not exposed to good clinical biomechanics in action. Supervision levels also must facilitate more than a superficial exam and treatment, and some one-on-one mentorship should have a role, and the earlier the better. Students in the clinical setting often need help to recognize that most patients have some sort of biomechanical anomoly whether clinical or sub clinical, and that they can learn from investigating it even if the person either doesn't need custom interventions or has declined orthotics therapy. This doesn't happen as often when faculty supervising are not interested in biomechanics.

However, these goals could perhaps be best achieved in a private setting where curriculem is dictated by the needs of the profession with respect to growth and further development rather than curriculem based on available (usually inadequate) funds, offering the minimum required clinical hours and meeting the check list of competencies required for licence. I get the idea from Simon's post in the other thread that similar pressures are being exerted in the UK.

Pete, keep your eyes peeled for a suitable nominee for the 3rd year scholarship. Think it's due December or January.

Sarah

 

For those of you who are interested, here is a clean pdf copy of my article (Kirby KA: Why mastering biomechanics is crucial to the profession. Podiatry Today. 23(8):89, 2010).

This and my other articles are available on my password-protected website.

 

There are a number of professions that require a professional year. Universities cannot deliver absolutely everything, and yes somethings are better designed to happen in the workplace. I think podiatrist should have to work under the supervision of another podiatrist for a year or two at least before they can run there own show. This would then allow a program of supervision to be built into the initial years run by the podiatrists who is employing them. Universities could have some say in what needs to be included. We see the podiatrist that we put through our mentoring program rocket ahead where as others seem to flounder. It would help the profession if everyone had that boost to their skills from the beginning. Just a thought

 

What I was trying to bring to light is often a multi-faceted way of teaching is more beneficial. Many people not only rely on hearing about a topic but seeing it in use or applying it themselves. All aspects of teaching are important when it comes to the biomechanical theories. However if we, as students do not understand the theories than how can we apply them in a clinical sense?

Think of someone who has no prior knowledge of any of the biomechanical theories.
How would you explain to them what each one is and how it effects them?
How would you show them how to apply the theories?

This is essentially what students are when you first introduce them to each theory. Depending on who you ask there can be a variety of different understandings regarding even just one of the theories which only adds to our confusion.

Essentially, I'm saying it's something we need to get a good understanding in and different opinions make it hard for us to determine what it is we are looking at. I'm sure with constant study and years of experience behind me all the "little things" will start to make sense.

 

Surely this is an issue which is never going to be resolved until Musculoskeletal Podiatry is recognised as a separate profession and taught in its own right? As several above have said, when teaching undergrads it rapidly becomes obvious that there are some students with an aptitude for and an interest in podiatric biomechanics and some who are happy to provide palliative care to at risk patients. These latter students are going to feel out of their depth in the MSK lectures/labs and impede the progress of those who wish to specialise in this area. In my opinion a restructuring of the podiatry degree course to allow more specialisation in the 3rd year would address this. I know of no other profession which fails to specialise to such an extent. How can a recent graduate (or any clinician for that matter) be expected to treat a fungal nail infection in the morning, perform minor surgery before lunch and alter ground reaction forces in the afternoon? Even GPs who spend twice as long studying and are paid rather more than podiatrists would recognise the scope and limitations of their expertise better.