Tuesday, January 1, 2002

Custom Orthotics Why, How and When

By Dr. Tim Maggs
© 2002

Many runners currently have one or more pairs of orthotics. Custom made orthotics are typically an investment made during some desperate phase of life that usually involves a chronic injury. This desperation is oftentimes met with less than successful results. In spite of this fact, most runners would benefit from orthotics, but the success comes when they are purchased before being injured. And here’s why.

First of all, custom orthotics are not just for runners with foot problems. The feet are the foundation of our entire structural system and are the sole or contributing cause of many structural problems. So, if you’re suffering with low back, hip, hamstring, calf, sciatic or other problems, even upper body, your feet will usually be involved. If we don’t balance and stabilize the feet as our primary goal, we limit the potential benefits when attempting to correct and balance our structures.

Generic orthotics that can be purchased “off the shelf” have limited benefits. Just as you would never think of wearing some generic running shoe from “off the shelf”, don’t be cheap when it comes to one of the more important decisions you’ll make involving your running life. Your foot is made up of 26 bones, 33 joints plus 126 ligaments, muscles and tendons. Your running longevity will be greatly impacted by keeping your feet happy.

So many patients of mine resort to buying orthotics only after injured. With a pro-active, instead of reactive, management of the structure, many of their debilitating injuries could have been prevented. Keep in mind, my goal is to help runners stay running, and if injured, to get back to running. Again, paying now is always less than paying later.

Foot Exam

The examination of the foot is a great place to start when concerned about the structure. With the athlete in the standing position, a simple “fingers under the mid-arch” test can be done. Both feet should have a similarly high arch, so that a good chunk of fingers can make it under the arch. If the feet are flat, different in arch height or have excessively high arches, custom orthotics are imperative.

A study of shoe wear should be done next. Keeping life simple, just look for different wear patterns on the base of the two shoes. If they exist, orthotics will help. Third, look at the runner from behind with no shoes on. If the achilles tendons bow or bend due to pronation of either foot, this adds to the urgency for orthotics. If either toe points in or out when standing, think orthotics. Finally, upon standing, note the center point of the knee cap, and then the bump on the bone (tibia) just below the knee cap. They should be almost in line with each other. If the alignment between the two points is more than a ¼” off, make sure you note this.

When deciding what type of orthotics to buy, here are a few guidelines. Some doctors recommend rigid orthotics instead of softer orthotics. A rigid orthotic has limited value, as it is designed to treat the foot as an independent part of the body. With running, this type of orthotic has no give, which is necessary for normal foot motion. There’s also no shock absorption in the orthotic, so the foot, leg and low back must absorb all shock. (Bad idea!) The foot is unable to move in a complete and normal manner due to the restriction of the orthotic, altering the normal motion relationship between the foot and the rest of the body.

A softer orthotic will allow the foot to move in it’s full range of motion while providing shock absorption in the heel with each foot strike. Some orthotics have better shock absorption than others, and this is an important feature to look at when deciding on which orthotics to buy.

The method used to get fitted for your orthotic is important too. Many doctors use the neutral casting method, which casts the foot in a non-weight-bearing position. The preferred method is to have the foot evaluated and casted in a weight-bearing position so the influence of gravity can be considered.


Custom orthotics are the very beginning of learning more about your biomechanical system. The foot is the foundation of your entire structure, and imbalances in the low back, neck, hips and entire muscle system can certainly originate from the feet. If attempts are made at correcting any structural condition without first considering the feet, the benefits will be limited.

So ask you doctors for a complete structural foot exam in the standing position with an evaluation of the wear patterns of your shoes. This should be done at least once a year on all athletes. Finally, if we could ever get all sports docs to include standing x-rays of the low back and neck and make specific structural recommendations, we'd be well on our way to a national network of help for all injured athletes. Ah, to dream.

Why All Runners Need The Stick®

© 2002 By Dr. Tim Maggs

It was January, 1993, when I first met Dr. Andrew Bonci. I was 6 years into my lifetime crisis, chronic calf pulls. My last marathon, April, 1987, was the beginning of a continual string of calf pulls, tears, strains, aggravations, whatever you wanted to call them. My life was reduced to 3 mile runs, and any attempt at more than that produced yet another pull. My entire circle of people were runners, yet I stood on the sidelines unable to run, or explain why.

Over this 6 year period, I visited orthopedists, chiropractors, acupuncturists, nutritionists, physical therapists, massage therapists and anyone who would listen to my story. The most humbling lesson learned through this experience was that no one, and I mean NO ONE, knew anything about muscle physiology. Sure, they all wanted to tell me how to heal the present pull, such as stop running, ice the injury, etc., but no one could tell me how to prevent the next pull. And, during this 6 year period, I estimate 50-60 pulls in both calves, different locations and different degrees of injury. I was truly alone and at a loss for solutions.

Dr. Bonci was the very first person who made any sense at all. He impressed me the first time I spoke with him. He talked about muscle physiology, about the damage that is done with each workout, the accumulation of toxins that occur in a muscle with repetitive use, and the means to address this physiological change in a muscle.

The Stick®

Dr. Bonci went out to his car and brought in a rolling pin like device. He called it The Stick®. I asked him what I was supposed to do with it, and he showed me how to roll it on my calves. Being desperate, I rolled my calves as I talked with him. The immediate sensorial response was wonderful. Regardless of whether there was any residual value or not, it still felt good. The next morning, my calves felt better than they had in the previous 6 years. I had no knowledge as to why, but after my 6 year saga, I didn’t care why. Over the next 2 years, I persistently used this tool, and my daily mileage climbed to 7 mile runs. 7 miles was a gift sent from heaven. Anything more than that was beyond comprehension.

The Maggs Muscle Management™ Program

Over the last 15 years, we’ve learned a lot. We now have research programs explaining why this technique helps with chronically pulled muscles, tight muscles, fatigued muscles and many other muscle based conditions. Florida State University did a PhD thesis on why this program helps with strength, flexibility and strength. The results were all positive.

Repetitive use of any muscle increases the toxin accumulation in a muscle, thus reducing the blood flow (oxygen and food) to a muscle. This produces a tightness in specific muscle fibers, and this tightness is the precursor to all muscle conditions. With a program that manages the muscles on a daily basis, all runners can eliminate conditions such as chronically pulled muscles, tight muscles, hip and ilio-tibial band syndromes, plantar fascitis, and many other conditions. The key is to keep muscles clean and well circulated instead of just stretching a toxic, poorly circulated muscle. The only way this can be done is to have the ability to massage the muscle multiple times per day, such as before you exercise, after you exercise and even later in the day. If you can practice these simple guidelines, you free yourself from the likelihood of joining the “pulled muscle support group”, a group you desperately need when you can’t get back to running, but despise if you’re running well.

If you roll a muscle, then stretch the muscle, the muscle becomes thoroughly prepared for activity. If you do the same after a workout, you can accelerate the recovery of that muscle. If you feed the muscle with proper nutrients, before, during and after, The Stick helps to drive nutrients into the muscle, increasing the recoverability of the muscle. With the epidemic proportion of muscle problems among runners, these guidelines will dramatically help all runners to stay out on the roads instead of spending time on the internet looking for that magical answer.

After 14 years of forgetting what it’s like to cross the finish line of a marathon, I returned to the list of marathon runners with my completion of the Vermont City Marathon in 2001. This monumental moment in my life re-enforced in me that anyone can improve if they are willing to step up and do what is available, not what is recommended by their managed care provider. I now have 3 marathons under my belt since that time, and hope to continue at a rate of 2 per year. My philosophy is that anyone running 2 marathons per year will perpetually stay in reasonably good shape. The joy I live with now exceeds my ability to express myself, and the tears and smiles I’ve shed since finishing that 14th marathon are indescribable.

When it was all said and done, my success originated with my meeting Dr. Andrew Bonci and his willingness to show me some simple product known as The Stick. My goal today is identical to what it was immediately following my first use of The Stick; every athlete would want one if they knew about it. I still believe this to be true, and my mission is to introduce it to all runners.

Redefining Sportsmedicine

© 2002 by Dr. Tim Maggs

Sportsmedicine has grossly misled athletes today. Athletes are educated wrong and suffer because of this inadequate education. The only time a runner would ever consider seeing their sportsmed provider is when they’re injured. This would suggest there is absolutely nothing beneficial that can be done for a runner prior to an injury. Imagine if the auto, financial and dental industry functioned with those guidelines.

Secondly, there is no insurance coverage for un-injured runners. Insurance guidelines are designed for the masses, primarily those who don’t exercise, who are not conditioned and whose body’s break down from under-use and abuse. The conditions they suffer with, and the insurance coverage will provide for, are far different from those who use exercise as a big part of their life. They suffer with diabetes, heart disease, mental disorders and other degenerative illnesses. Overuse injuries, the need to get back quickly and structural problems are not descriptive terms when talking about the 7 out of 10 who don’t exercise. And, to date, I’ve not heard of any insurance rider that will specifically cover athletic injuries. It’s ludicrous that an athlete must attempt to fit their square injuries into the round hole of insurance guidelines. They must first wait until they’re injured, then begin with their primary who typically has no knowledge of typical sports injuries, who then refers the injured athlete to the next in line. As I will discuss in a bit, most athletic injuries are from overuse syndromes or structural imbalances and distortions. The “specialist” who usually gets the referral is looking to quickly, and cost effectively, help the athlete to eliminate the symptoms, but who is looking for the underlying cause?

Conditioning and Injury Prevention

This is the necessary path if good fortune in injury prevention is the goal. And, what athlete has any other goal than a long and healthy career? We must think differently, act differently and be different if we want results better than what the masses are getting. We must act today in doing the things that are now available to us in an effort to improve conditioning and prevent injuries. And, if you become injured, the first call should never be to your primary. They are just not prepared to deal with you or your maladies.

The Structural Management® Program

As years have gone by, I’ve recognized more and more how futile our present industry is for the appropriate care for athletes. The result is the development of several programs that will help athletes to have a more successful career, either preventing injuries or treating them effectively. The Structural Management® Program is made up of 3 programs; The Structural Fingerprint® Exam, The Maggs Muscle Management™ Program and The Advanced Conditioning™ Program.

The Structural Fingerprint® Exam is a structural exam that can be performed on every athlete with or without symptoms. Obviously, we encourage athletes to be examined before their season begins, as structural defects and imbalances can be detected anytime. It’s always easier to locate these defects when the athlete is not symptomatic, but it’s hard to change the thinking of athletes to do anything until they have symptoms. Once examined, we often find the athlete is suffering with many deferred maintenance conditions, and proper treatment and exercises is necessary to correct these conditions before they become a full blown injuries. This exam consists of physical tests as well as standing x-rays, looking for structural imbalances and wear and tear.

The Maggs Muscle Management™ Program is a program designed to keep the entire muscle system functioning at peak capacity. After my 8 year hiatus from running with over 70 calf pulls, my persistence helped me find people around the country who could help to keep muscles clean, improve circulation, increase warm-up, accelerate recovery from workouts and injuries and improve performance. During the development of this program, I missed 14 years of marathoning, but am pleased to say I’m back to 2 per year. This after not being able to run more than 3 miles without a calf pull for 8 years.

The final program, The Advanced Conditioning™ Program, is the treatment and rehabilitative program designed once imbalances are detected from The Structural Fingerprint® Exam. This program is a 6 month program, and is one that every athlete would benefit from. With the data collected on the exam, the goal is to objectively improve range of motion in all joints, improve flexibility of key muscle groups, improve alignment and other structural measurements, as well as help the athlete to move further and further away from the vulnerability line of injury. At the end of 6 months, re-x-rays should show improvement in balance and alignment of the structure. This program should be a once in a lifetime program, and once done, the athlete should be put on a maintenance program, with specific exercises and treatments to keep them well.


Until athletes begin caring for their structures and muscles on a pro-active and preventive basis, they will most likely end up as victims in this current health care system that really has no place for them. In an effort to avoid these frustrations and enjoy more time out on the road, the above recommendations should help you go a long way.

Tribute to a Running Partner

By Dr. Tim Maggs
© 2002

I’ve had the enjoyment over the past 25 years of having very special training partners. In our complicated and busy lives, a training partner becomes our other self. They listen to us, talk to us, live through us and share our aches, pains and joys.

Two years ago I gave a running clinic at the Olympic Training Center in Lake Placid. Mary Peck was there. A short time later, Mary came in as a patient and, as a result, we began to train together. Once, twice and even three times a week for the next two years, we ran together. We had so much not in common, but we also had a need for each other. She was 18, I was 46. She was totally driven, I was laid back. She didn’t like to talk, I loved to tell all. Opposites attract, evidently. And with each and every run, Mary’s grandmother would drive her to my office and sit and wait for us to return. I don’t know if Mary ever really understood how blessed she was.

In May, 2001, I needed Mary to help me reach a goal I thought was virtually impossible. I had gone 14 years without running a marathon. I had no confidence I would ever get back to running marathons, while Mary’s youthful optimism had me running marathons and her running in the 2004 Olympics. I stole this fire from Mary each and every run. I was the benefactor.

I finished that marathon, my first in 14 years, and wildly celebrated this improbable accomplishment. Mary deserved much of the credit because she believed when I didn’t. But, I believed in her. Not once in 2 years did Mary ever fail to show for a run. She also pushed every step of every run. I finished my first marathon in over 14 years. Mary helped my life get so much better.

Another Road Traveled

While Mary helped me reach improbable successes, her life continued to suffer. Although her back problem certainly played a part in her training, she also suffered with other issues, and much of our energy was spent on helping her get well. Mary worked obsessively every day of her life, one hour at a time. There were many days I wanted to cancel due to my busy schedule, but she’d patiently sit in my waiting room, and I wouldn’t have the guts to not run with her.

After finishing 3 marathons since my return back, with the latest being this year’s Vermont City Marathon on May 26, 2002, Mary was always the first to congratulate and celebrate with me. She may have even lived through my successes.

Fast forward to June 10th of this year. Mary waited longer than usual this day to do our 4-mile run through the woods. Never a complaint, as this was not a part of her make-up. Before treating her that day, I asked her how she felt, and it was the first time in a long time she replied, “better”. Mary ran that day as well as she had in the prior 6 months. Several times during the run, I’d ask, “Are you okay Mary?”. “Yup”. That day was a great run. The best we’d had in weeks. She was starting to feel good again.

For me, that day’s routine continued as usual. The next morning, my life changed forever. I sat at my computer reading e mails. My wife, Trudy, was reading the morning paper, and let out a horrible sound; “Where does Mary live?”. I told her, and she froze. There in the paper, in bold, clear and horrible, horrible print were the words that would change my life forever---“Mary Peck killed in a cycling accident”. As simple as that, Mary had died. She died. Mary was gone. That simple. The 4 miles we ran the day before would be the last I’d ever run with her. Almost 2 years of together, and now, just like that, we were apart. A short 25 minutes after leaving my office, Mary was hit by a dump truck while riding her bike home and killed almost instantly. Where do you go when something like this happens? Can life ever be the same?

As hard as this loss has been for me, I live with unconditional faith in God’s plan. There is some larger purpose for what I see as a senseless death, but in time, I’m sure I’ll better understand why this happened.

Mary’s grandmother, who took total care of her, is relieved to know that Mary is now out of pain. I’m saddened by the fact that Mary took such good care of me and I was helpless when she needed me most. I cherish the opportunity to have spent so much time over the past couple years with her, and hope I gave as much as possible whenever possible.

In reflecting back over the many runs we had together, one common question would always be, “Mary, are you okay?”. She never answered anything but “yeah”. She was one of the most focused, determined people I’d ever met. I wonder if I have the ability to train and run a marathon without her help.

Life is a fragile and perilous trip, and the loss of someone so close, so fast is difficult. Mary represents all of our training partners. Please realize the value of all of them, before it’s too late. I run most of my runs alone now, and I’ll continue to do so, as running is still the answer, not the problem. All of us have had troubles in our lives, and running should be part of the reason we’re able to handle them better than those who don’t run. We know the price, the pain, the lessons of life. That’s what it’s all about. Mary’s death taught me more than any life experience I’ve ever had.

As a representative of all training partners, please consider giving to the Mary C. Peck Scholarship Fund to help provide support to 5 female athletes with Olympic aspirations. If interested, donations can be sent to my office, with checks made out to The Mary C. Peck Foundation. My office address is 1310 Union St., Schenectady, New York 12308. Never take your partner for granted.