Thursday, December 1, 2005
Orthotics for Everyone?
by Timothy J. Maggs, DCIssue:December 2005
Whether to function under a medical or biomechanical model is your choice
This afternoon, I met with eight-time National Basketball Association all-star Michael Ray Richardson. Michael Ray is taking over the head coaching position of the Continental Basketball Association’s Albany Patroons, while I’ll be providing Structural Management® to the team. In our meeting, I was asked exactly what it is that I do:
“The traditional services provided by a team doctor are to wait until a player is injured, then make the best recommendations possible,” I answered. “That makes no sense, especially when there is a wealth of biomechanical information available on all players right now that will help to determine their unique weaknesses and imbalances. Once we determine each player’s weak spots through our Structural Fingerprint®™ Exam, we can then set up a good proactive program to get all the players doing things that will help their balance, joint mobility, and muscle flexibility. This will dramatically reduce injuries during the year.”
His response was one that every sports-minded chiropractor would love to receive: “I need to set up a meeting with Kiki Vanderweghe and get this program into the Denver Nuggets’ locker room.” Now, for those who don’t know, the Denver Nuggets are a National Basketball Association team, and Kiki Vanderweghe is its general manager.
I can’t imagine any fewer words a chiropractor could say that would get a response as electrifying as that. If chiropractic had the ability to excite key people in sports and industry the same way I happened to in this conversation, we certainly would be in loftier positions in the health care food chain and would be seeing a whole lot more than 6%–8% of the population.
The response from Michael Ray is the same one we get from almost all parties we now meet. The need for Structural Management® is critical, yet it is absent in our modern-day health care system. The medical model is everywhere, despite the fact that everyone would love to learn how to preserve their structures so they can enjoy their lives injury free.
Where to Begin?
I’ve written quite a bit about the need for chiropractors to stop functioning under the medical model of care, especially if we want to fully realize this profession’s potential in our lifetime. Adjustments should not replace pills. Adjustments should be a spoke in the wheel of the necessary tools to keep a person healthier. Our profession truly needs to learn how to articulate this message to our community, because if we do, we will be busier than we have ever wanted to be.
Just last week, I was the guest speaker at a sports information night at one of the larger local high schools. Approximately 800 parents were present. I emphatically told them of the void in good-quality structural care for middle- and high-school athletes in this country. These kids go through medical tests (eyes, ears, nose, and throat) to determine if they are healthy enough to go into the weight rooms and participate in their sports.
The response was overwhelming. I ended the talk telling the parents that their school is now endorsing our Structural Management® Program, and it all begins with our Structural Fingerprint® Exam. This exam consists of a foot exam for foot type; a knee exam for Q angle; range of motion, stressing the key joints of the body; muscle tests, and standing x-rays of the neck and low back. The final test is a digital scan of the feet to determine if the body weight is evenly distributed right versus left. This information is invaluable for determining where the vulnerable and weak spots are on an athlete. We invited parents to fill out an application, and then we would contact them to set up this exam for their children. Within 24 hours, we heard from more than 30 families.
The exams were set up, and the appreciation by the parents was exactly what we’d hoped for. These parents have begged to have someone tell them something that makes sense regarding the injuries their children are suffering. Most of the kids examined have foot imbalances, knee imbalances, and many biomechanical abnormalities that will certainly predispose them to a greater likelihood of injuries, as well as a greater vulnerability to degenerative changes as they age.
How to Use the Test Information
In our office, we offer two products: The Structural Fingerprint® Exam and The Advanced Conditioning™ Program. A patient can purchase either one or both of these programs, but there is no obligation to purchase both. We encourage people to go through the examination, because understanding their structural status is invaluable in many ways, whether they elect to do anything about it or not. Once we have this information, we then design a plan tailored to their needs.
The very beginning of this plan includes the use of custom-made, stabilizing orthotics. Our goal in this program is to improve structural balance, joint mobility, and muscle flexibility. Many doctors use pain and symptoms as their benchmark; however, that superficial goal provides an artificial “correction” to the patient, as most people believe if the pain is gone, they’re healthy.
Most imbalances begin in the feet. We’ve found that approximately 80% of the population pronates (flat foot) with one or both feet. Either way, this produces a postural distortion pattern every time the patient stands up. We’ve also found that 10% of the population has reasonably normal arches, while the final 10% has supinated, or high, arches. This doesn’t take into consideration any of the other biomechanical measurements we look at on our exam, such as Ferguson’s gravity line, the sacral base angle, pelvic balance on the A-P L-S x-ray, femur heights, the cervical lordosis, the atlanto-axial relationship, or the integrity of the disc spaces. Each and every one of these measurements is impacted by the integrity of the medial arches of the feet.
Pronation. This, theoretically, will produce an increased Q angle, but not always. In fact, sometimes we’ll find an increased Q angle with a supinated foot. However, in most cases, the center of gravity going through the knee is abnormal when the medial arch pronates. The human body is a compensating architectural structure, and pronation begins the very “shifts” that accelerate wear and tear at many levels of the structure. Custom-made orthotics begin the balancing process that all structures need to go through.
Normal arches. Many doctors think this is a ticket for dismissing a patient, as “nothing is wrong.” Au contraire. Keep in mind that this patient, if he or she is lucky enough, will go through the aging process, and two factors will influence his or her future.
The first factor is that medial arches of the feet weaken and fall as time goes on. When patients tell you their feet are growing, keep in mind that their medial arches are simply falling. As they fall, the biomechanics of the structure will go through negative changes. Imbalances accelerate degenerative changes, and falling arches will only pour fuel on that fire. Why wait for that to happen? Purchasing custom-made, stabilizing orthotics is a nominal fee to protect against this, and people are desperately looking for this information.
Second, the shock-absorbing qualities of the orthotic reduce the wear and tear going up through the structure. Over the course of one’s lifetime, this is huge.
Supination. These high, rigid arches have very little shock absorption for the structure. It becomes critically important to incorporate some shock absorption into shoes to protect against the acceleration of degenerative changes, and addressing this issue on the front end is always more cost-efficient and logical than addressing it on the back end.
Regardless of foot type, custom-made, stabilizing orthotics are the very beginning of the preservation process of everyone’s structure. The key is for the doctor to learn how to articulate this message to all patients, despite the fact that insurance will seldom cover the cost of the orthotic. Ninety-five percent of all patients in our office are fitted with custom-made orthotics as part of their program, and our area economically is no better off than most other areas in the country. It’s purely a matter of confidence and desire on the part of the doctor as to how much they’re willing to help the patient over the course of his or her lifetime.
Many chiropractors want to argue the fact that our profession should function under medical-model guidelines. Certainly, that system is already in place and available if those are your parameters. However, another “pain reliever” who wears a stethoscope around his or her neck is not what the world needs. Industry, sports, pediatrics, and geriatrics are all begging for someone, anyone, to teach them how to preserve their structures and protect against injuries. The medical-model approach will never be able to do that.
Structural Management® is the key; custom-made, stabilizing orthotics are a tool; and chiropractors are the most qualified to provide this level of care. It’s all about choice and how you want to help your community. And, should I meet with the Denver Nuggets’ Vanderweghe, this may be the entry into pro sports that will provide many more chiropractors with respected roles in pro organizations. 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.