Saturday, January 1, 2005

Up and Running

by Timothy J. Maggs, DCOrthotics Advisor
Issue: January 2005

The first step toward peak conditioning for any athlete is the body’s foundation—the feet

Timothy J. Maggs, DC

Anyone familiar with the running world will recognize the name George Sheehan, MD. He was a tremendous writer, philosopher, runner, and cardiologist who passed away in 1993 in his mid 70s.

During his illustrious career, Sheehan wrote of his many experiences and had the ability to articulate his feelings and emotions better than most. He wrote what all of us thought and felt, but just seemed to say it better.

Sheehan’s running career after college was halted and not considered again until he was 45 years old, when his desire to get back into the sport he loved sent him back to the roads. However, what he experienced was a series of physical breakdowns. From his writings, it is clear Sheehan suffered not only from his injuries, but also from the frustrations of not finding reasonable answers.

“When I began running, I was an educated specialist who concentrated on one area of the body. I was an expert who relied on other experts for advice. Serious running led swiftly to a series of foot, leg, knee, and low back injuries that threatened to end my newfound happiness back on the roads.

“I went dutifully to my specialist friends and found, to my surprise, that they were of little help. They were preoccupied with giving relief to my aching foot, my swollen knee, and my throbbing sciatic nerve. They treated the effect, not the cause. And, when I resumed running, back came my misery and pain. Clearly, I needed someone more sophisticated, some superspecialist. I had not gone high enough on the specialist ladder to find the wise man to help me. I soon discovered, there was no such wise man.”1

Little did Sheehan know there was a wise man. Little did he realize there was someone out there who could make sense of all he was going through and provide him with information needed to get back and stay back. Sheehan needed Structural Management®.

As he continued his journey to find happiness on the roads and solutions to his injuries, Sheehan learned what most are never able to find. He ran right up until his death, and that was only due to his persistence to find answers.

I receive hundreds of emails every month from athletes around the country, all of them looking for answers to their injuries, just like Sheehan. Most of them have gone down the path of conventional medicine, and many of them end up doing a search on Google or Yahoo for a superspecialist. Some end up at my site; others, who knows?

I often reflect back to Sheehan, as his pearls of wisdom would be advanced thinking today. In sports medicine and medicine, not to mention care for the masses, the methodology is based on the medical model of care. Sheehan wrote: “I am a cardiologist, but my relationship to sports medicine has been as an athlete rather than a doctor. What I have experienced as a runner and what judgment I have been able to bring to this experience as a physician has convinced me that traditional medicine is not dealing adequately with athletes’ problems.

“In more than 10 years as a distance runner, I have experienced almost every injury of the foot, leg, knee, thigh, and back. During this time, the medical profession has only been able to provide me with symptomatic relief.”1

Structural Balance
The reason Sheehan wrestled with his medical care was because his desire to run exceeded his loyalty to medicine. He could see firsthand that athletes, and all people for that matter, could not get credible or logical care for their structural injuries. What medicine was offering just did not make sense. So, he looked and looked, desperate at times, and at some point in his life, reached peace, as he found some form of solution.

“The human body is a marvelous instrument. When in perfect alignment and balance, there is almost no feat of endurance the body cannot handle, even on a regular basis. However, structural imbalance of even minor degrees can result in incapacitating injuries and persistent disabilities.”

The Starting Point
As with any structure, the foundation is the key to the overall balance. To address any musculoskeletal issues, the feet must be considered. Knowing that 80% of the population pronate, 10% supinate, and 10% are normal should encourage any health care provider to first look at the feet when addressing neuromusculoskeletal problems.

“It wasn’t until I came under the care of a podiatrist that I was able to run for prolonged periods and be free of foot, leg, and knee difficulties.

“This convinced me that no matter what an athlete’s problem is, we should look first to the feet as the source of the problem. The foot is an architectural marvel—an engineering masterpiece that has 26 bones, four times as many ligaments, and an intricate number of tendons that act as guy ropes or slings for the arches.”1

Sheehan evidently improved greatly with the introduction of orthotics in his shoes. What he was never able to do was combine the use of custom-made orthotics with structural correction. He never had the opportunity of having his biomechanics above his ankles examined. If he had been provided this, he certainly would have minimized all his years of complaining. And, had he been examined prior to any of his breakdown, he might have even eliminated all of his heartbreak and frustration, having to look for that superspecialist.

If Sheehan were alive today, there is no doubt he would be an advocate of structural examinations and corrections. He would be a vocal proponent of this approach to all athletes. In 1975, Sheehan had the guts to tell it like it was. Here we are, 29 years later, and his words still ring true.

“I cannot emphasize too strongly that most athletic injuries are structural, almost architectural, not medical. You would be better off in the hands of an engineer than a medical doctor when this type of injury occurs. At least you would not have your problem complicated by medication that in the long run will do no good. What the runner needs is to be restored to structural balance.”

The Structural Fingerprint® Exam
This exam begins with the feet and considers structural balance, joint mobility, and overall flexibility. The feet dictate the course of action taken. If there are imbalances, areas of increased wear and tear, and chronic injuries that do not respond to care, custom-made orthotics are indicated.

Secondly, the type of custom-made orthotic is important. There are at least two benefits that should be considered with custom-made orthotics: 1) symmetry of the medial arches; and 2) shock absorption. With rigid orthotics, shock absorption and normal foot mobility cannot happen. Flexible orthotics are preferred when full biomechanics are considered.

With this comprehensive exam, it does not matter if patients have symptoms or not. The goal is to evaluate athletes, employees, and people in general long before symptoms occur. Why should we have to wait for people to break down before we see them? And, why should our only goal be to get them out of pain? Our current standards of care are inadequate, and until we re-educate our communities to get structurally evaluated and proactively work to improve, we can never hope to reduce the current suffering that exists out there.

The standards should be maximum structural function, not just the relief of symptoms. This can only happen with structural exams before injuries occur, and the willingness to rehabilitatively improve distortions, even in the absence of symptoms. For this to ever happen, re-education can never stop.

On a final note, the Chicago Bulls, as well as many other professional teams, have all players fitted for custom orthotics at the beginning of each season. Do you think they know something the rest of us don’t know? CP

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements. Maggs can be reached via email . or via his Web

1. Sheehan G. Dr. Sheehan on Running. Mountain View, Calif: World Publications; 1975:204.