Broken System

Industry is a perfect controlled study that demonstrates the lunacy in our healthcare system today. Management wants to put the burden of health insurance on the workforce, while the workforce will scream eternally to keep costs on the backs of management. A modern day Hatfields and McCoys.

I've watched over the years, and have never understood why neither side will ever question the healthcare system by asking "Why do you cost so much?". It seems like an appropriate question. "Why have costs escalated so high? When might it stop? And, simply, how can they be lowered?"

This week in Sports Illustrated, this very topic jumps off the pages in Gary Smith's article Bitter Battle For The Old Guard, about Gene Upshaw, the 25 year Executive Director of the Player's Association. The flavor of this article is how retired NFL players are ignored, broken down and no one (The NFL Player's Association) cares.

The article reads, "Creeping along the sideline on a walker, bent at a 45-degree angle, was the alltime great Oilers running back Earl Campbell. Confused by foggy memory, neck locking up from damaged vertebrae, advancing on an artificial left hip was Hall of Fame Dallas Cowboys safety Mel Renfro........How had it come to this?........For three decades, from Pop Warner to retirement, they'd been groomed to spit at the pain, which was ever-increasing as the colliding bodies grew larger and faster, and they'd soldiered on in silence for years after they'd faded away. But then came the day when the consequence of all those head-ons, all that pounding on all that green pavement called astro-turf, demanded its reckoning. The mornings when they awoke and realized they could barely get up......or didn't even want to. The multiple knee and hip replacements, each one carving a year of recovery time out of their lives; the depression, vertigo, Alzheimer's and thoughts of suicide, which some doctors linked to the multiple concussions they'd suffered; the spiraling medical costs and the realization that neither their pension nor their disability plan--if they even qualified for it--could possibly keep pace, had combined to overwhelm them."

Wow. The end result of a broken system. This article wants to highlight the lack of concern the Player's Association has for it's retirees, while I only care to discuss a spoke out of that wheel, the physical condition of retired football players. Their futures have a backdrop of physical disability, pain and limitations, not the type of retirement anyone would aspire to have. The costs are overwhelming; emotional, physical, financial, relationships, employment, etc.

What is the solution? When does it begin? Success in any endeavor requires management. All athletes today, by default, learn the rules in taking care of themselves. Stretch, warm-up, lift weights and hope you don't break down. If you get hurt, well, we're not sure. Do you have a primary? Will they see you today? Or will it be the P.A.? Will they give you meds, a script for phyiscal therapy, a stint of chiropractic? No one really knows. There is no plan other than, we hope you don't get hurt. Maybe just take time off until the pain goes away.

The reason for such inefficiency and ignorance is that our injuries (Earl Campbell bent at a 45-degree angle, Mel Renfro's neck locking up from damaged vertebrae) are biomechanical injuries, yet we MUST deal with medical model healthcare providers. They don't do biomechanics. They don't know biomechanics. Even professional sports teams. And if the pros don't get it, what is the shot that our high school athletes or everyday athletes are going to get it.

Success at maintaining a healthy physical structure also requires management. It starts with a biomechanical exam and detection of the imbalances and faults. Correct those, now maintain these corrections throughout your lifetime. It's not about shots of cortisone, a short stint of physical therapy, surgeries after the injuries occur, early retirement due to broken down parts or retirements that leave you totally disabled.

The current system is broken, and the public must demand change! The answers are available, but don't call your primary and expect them to know. They, too, are victims of the problem. And certainly not the solution. We need biomechanics in our sports world to hope to help the middle and high school athletes of today not end up as a feature story in Sports Illustrated 40 years from now.

The famed comedian Lenny Bruce screamed at the judge as he was being dragged out of the courtroom, "Your honor, somebody needs to tell you when you're screwing up".

Ditto.

http://structuralmanagement.com/CPOYA/docs/highschool1.pdf

Orthotics and Biomechanics

by Timothy J. Maggs, DCIssue:August 2005
Chiropractic Products

The first step in helping anyone preserve their structure is to recommend custom-made orthotics

Chiropractors who have been in practice long enough quickly learn that the medical profession is doing nothing to endear itself to the aching public. The medical-model approach (looking for pathology) makes little sense to the lay public. The costly approach to solving the riddle of back pain (symptomatic relief) with many worthless tests just never feels quite right to any segment of the population. Ask employers how they like the current system, after paying such high workers’ compensation premiums for an aging, overweight, and out-of-shape workforce.

The sad fact is that no one in the medical community is looking at the patient from a biomechanical perspective. Human beings are architectural structures, yet it is virtually impossible for a person in our country to go into a medical office and ask his or her “specialist” for a personalized structural status report. Mechanics can tell you the status of any car you bring to them, and an engineer can quantify the value of a building or bridge. But try to find a doctor who can give a report on someone's structure, and you will probably have better luck finding a winning lottery ticket that’s been accidentally thrown away.

The Need for Biomechanics

Any human being who is seeking long-term wellness for their structure would do well to locate and work with a professional who can help them preserve their structure. “Preservation of the human structure” is a term not often heard in our current system, but it needs to be heard in an effort to reduce the amount of money currently spent on musculoskeletal breakdown, injuries, and symptoms in this country.

Appropriate Biomechanical Tests

The first test done on a patient should be a check of the patient’s foot type. It is well-established that there are three different foot types (low arch, medium arch, and high arch), and the running shoe industry has even gone so far as to make specific shoes for specific foot types. So wouldn’t it make sense for doctors to alert the patient as to their foot type? With a low arch/flat foot (or flat feet), a motion-control shoe is recommended. This is the foot type of 70%–80% of the population.

Those with a normal, medium arch (about 10% of the population) would benefit from a stability shoe.

A high medial arch, or a supinated foot, constitutes about 10% of the population, and it works best with a cushioned shoe, as a supinated foot typically will be rigid and more sensitive.

Two basic tests are performed when checking body-weight distribution and foot type. The first is to manually check standing arch height by getting down on your knee and inserting your middle and index fingers under the patient’s medial arch.

See Figure 1, a DC prepares a patient for a digital foot scan, which will yield digital images of the feet, as Figure 2 illustrates.

The second method for checking foot types and identifying weight-distribution imbalances is with a digital scan of the feet. With proper software, you will see the difference in the patient's weight, right versus left, and front versus back, and this visualization for the patient is extremely important when motivating the patient to take action. As you can see in Figures 1 and 2, digital scanning provides a wonderful visual.

The next test of concern is the Q angle of each knee. An increased Q angle is nothing more than a crooked hinge joint. The greater the imbalance, the greater the wear and tear on the knee. If neglected, over time, the likelihood for a knee replacement increases greatly.

Range of motion, muscle-tension tests, deep tendon reflexes, leg-length measurements, and spinal-compression tests are all part of biomechanical testing. In addition, and most importantly, standing biomechanical x-rays are taken on all patients, to rule out pathology and look for biomechanical findings.

Figure 4 shows a center of gravity check using lateral x-rays.

Figure 3 shows a center of gravity check using anteroposterior x-rays..

There are multiple biomechanical findings that we look for on x-rays. First of all, we check centers of gravity, both anteroposterior, as Figure 3 illustrates, and lateral in the neck and lower back, as Figure 4 illustrates. Second, we check for positional abnormalities, such as reversal of the normal cervical lordotic curve, rotation of the pelvis as seen on the anteroposterior lumbosacral, or rotation of the axis in relation to the atlas.

When biomechanical imbalances and joint dysfunction occur for a prolonged period of time, the degenerative process accelerates. Trauma, repetitive motion, structural imbalances, and joint fixations lead to an acceleration of joint degeneration. When degenerative changes are found on the x-ray, the practitioner should determine the history behind the degenerative change. For example, when C5 alone is going through degenerative changes, it is clearly a fixation due to abnormal stresses at that level. When a joint other than C5 or L5 undergoes degenerative changes prior to C5 or L5, it is due to prior traumas that have been unresolved. A joint left “locked” or subluxated for an extended period of time will produce a premature degeneration of that joint space.

Lifetime Preservation

No profession is out there selling “preservation” of the human frame. Yet, think of the savings in the health care field if we can help preserve everyone’s neuro-musculoskeletal system. And, this savings is based upon individuals proactively doing what they need to do to preserve their structure.

The first step in helping anyone to preserve their structure is to recommend custom-made orthotics. In my office, since we do Structural Management® exclusively, 95% of our patients are fitted for such orthotics at the beginning of their programs. Regardless of whether they are covered by insurance or not, patients understand the role custom-made orthotics play in their future. There are different reasons why these supports are recommended, and there are different types of custom-made orthotics that we need to understand.

First of all, any structural imbalances, centers-of-gravity imbalances, rotations, or dysfunction of joints need to begin correction with the fitting of custom-made orthotics. Un-less that medial arch is addressed so that it is bilaterally even, there will be an ongoing imbalance in the structure. As the aging process continues, premature degenerative changes will occur.

Figure 5 shows that foot imbalances can lead to postural imbalances throughout the body.

If the patient pronates, it becomes obvious why custom-made orthotics are needed, especially if right and left are different. The “crooked man” image (Figure 5) clearly shows why imbalances in the medial arches of the feet have exponential implications in the structure above. In this case, the left foot pronates, leading to compensation in the knee, hips, and shoulders. This imbalance will clearly lead to other imbalances and premature wear and tear of joints. This obviously sets the patient up for an increased vulnerability to injury.

When the patient presents with degenerative changes in any joints, the need for custom orthotics increases, as there is clear evidence that a certain joint has been under an increased level of stress for a prolonged period of time, and the outcome is premature degeneration.

Options for Orthotics

The podiatric and orthopedic professions recommend rigid, non weight-bearing orthotics to their patients. This type of orthotic addresses foot imbalances, but is not in any way designed to address the biomechanics above the ankle. A flexible orthotic, measured in the weight-bearing position, produces an orthotic more appropriate for the entire human structure. Additionally, shock-absorbing qualities in these orthotics are critically valuable to the longevity of the structure. As I tell my patients, “The more shock absorbed in the orthotic over the course of your lifetime, the less stress that goes up your structure.”

A rigid orthotic is designed for an imbalanced foot; however, it offers no shock absorption for the entire structure. These orthotics last an eternity, but their restriction of normal foot mobility, their overcompensation of joints and muscles above, and their absence of shock-absorbing qualities make flexible, weight-bearing orthotics preferable.

Scanning the Horizon

I use a digital scanning system, which educates the public that symptoms are not the issue; it’s biomechanical imbalances. In industry and sports—in most issues of postural health, for that matter— biomechanics is the key. The chiropractor is best suited to respond to these needs, but the chiropractor must be willing to “step up” outside the normal insurance guidelines to provide such help. In time, chiropractors will realize the benefits of this type of work.

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.

Biomechanics Injuries - Above the Ankles! There's more than just the feet

By Dr. Tim Maggs, © 2001

Sports biomechanics has always put emphasis on the feet. But, sports doctors worldwide are beginning to recognize there's more biomechanics to the runner than just the feet. The general assumption used to be that above the feet, everything was okay. It's time to further eliminate this age-old myth that's has kept many runners sidelined needlessly. Back pain, knee pain, hip problems, radiating nerve pains, bursitis', tendonitis', muscle pulls and more are direct results of biomechanical faults.

Biomechanics Made Easy

The word biomechanics tends to scare people. It's also a general assumption that all doctors know what's wrong. In sports medicine, that assumption is on par with a "can't fail business deal". Most sports doctors don't know biomechanics and totally miss the correct diagnosis and treatment/rehab program appropriate for each runner. So, for those docs and runners who care about the health and longevity of their (patient's) structure, please read on.

Biomechanical Findings

All people tend to be one side dominant, so having symmetry between right and left is wishful thinking. We're not looking for symmetry though. We're looking for a better level of balance between right and left, both muscular and structural. We're looking for improved range of motion in the joints of the spine, pelvis, hips, knees and ankles. We're looking for any hereditary defects that may influence the function of our unique structure. We're ultimately looking for specific defects, whether conditional or constitutional, that can be improved. For if we can improve the balance and function of our structure, there will be exponential gains in our future. We may be able to run longer. We may not suffer with pains and disabilities as much. We may reduce the likelihood of degenerative changes in our joints. We may just enjoy life a little bit more.

Last month we talked about the Q angle in the knees. Upon standing x-rays of the low back, we have the all-important angle of the pelvis. This is known as the sacral base angle, that should fall between 36-42. We have the gravity line in the low back, which represents the weight of the body and where it happens to land in the joints and bones of the lower back and pelvis. You can't believe how distorted the weight distribution is on some people. Add running to the equation, and it's a wonder any low back can tolerate the stress. We have the joint spaces of the spine, better known as disc spaces, that show wear and tear, or degeneration. This is usually suggestive of prior traumas with a subsequent loss of normal joint motion followed by reduced blood flow to the joint, thus increasing the rate of degeneration.

We need to look at range of motion in all joints, both passively (assisted) and actively (unassisted). You'd be amazed to see the subtle losses of motion in certain directions. We need to measure the leg lengths, from the side hip bone to the outside ankle bone. A true, or anatomical short leg, will show a difference in measurement. This type of short leg represents about 5% of the population. The functional short leg (measures the same length but is due to pelvic rotation, abnormal medial arches of the feet, abnormal Q angles in the knees and other distortions), should never be treated with a lift and represents 95% of the population. These are but some of the tests that should be done on all runners, athletes and humans. At least those who care about the future and well-being of their structure?

The Structural Fingerprint® Program

All of the tests described above are part of The SFP. There is such a global need for more doctors to become active in examining the entire structure of runners. Only after a full and complete exam is done can we know what recommendations are appropriate, including treatment, exercises, habit modification, nutritional, orthotics, etc. As I asked a financial consultant recently at a clinic, "Would you ever consider giving financial advice to someone without knowing their specific circumstances?". "Absolutely not", he said.

The corrective program needs to rehabilitate the weak areas of the structure, re-educate the muscles and joints with proper information, such as habits, exercise and motion, and learn how to manage our structures for the rest of our lives. How on earth can any of us hope to keep our castles healthy and functional for 90 years without ever testing them and maintaining them? It's just too illogical an approach.

I have this dream of audio/video taping all of the runners who tell me their story. Sadly, they're all so similar. The only difference usually is the names of the doctors and the location of the injury. "I went to Dr. 1 who found nothing, and then tried Dr. 2 who gave me a pain killer. He sent me to Dr. 3 who gave me a different diagnosis, but his medication didn't work. I then went to a chiropractor who treated me for 2 weeks and discharged me. I saw a physical therapist, but my insurance ran out and now I can't see them anymore. Do you think acupuncture would work?"

We've got a long road to travel, but until each and every runner has close access to a full and complete biomechanical exam, I'll continue my mission to elevate the awareness of such a program. And please, don't let your criteria be pain and disability before you consider one. Actively running is always more attractive than being desperate and injured.