back pain doc……no,…it’s your

7/29/2019 Back pain Doc……no,…it’s your

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Back pain

Doc……no,…it’s yourfeet !

By

Gafin Morgan MChS Lic Ac.

Musculoskeletal Podiatrist, RGH



Thank you for inviting me to

talk!



Outline

• About me

• Introduction

• Background

• Theory

• Treatment

• Questions



Introduction : Brain Strain?!

• We only use 10% of our brains. (thought,metabolism..) ?

• 90% of energy output of the brain is used inrelating the physical body to gravity.

- Dr Roger Sperry, 1980 Nobel Prize recipient for brain research.



Spinal Strain?!

• “Loss of cervical curve stretches the spinalcord by 5-7cm and causes disease”

- Dr A. Breig, Neuro-surgeon (again aNobel Prize recipient).



Background.

• Common concept in general anatomy is thatstructure dictates function.

• Seen in human foot where anatomical structuresplay a role in bipedal motion.

• A complex activity involving precise timing andinteractions between segments in the entire kinetic

chain.• During gait the foot is at appropriate times a shock

absorber, a mobile adaptor and a rigid lever.



• Foot stability is influenced by the way inwhich body weight is transmitted to it by

the tibia, through the trochlear surface of the talus then inferiorly to the navicularand the medial column.

• Although the foot at this point is in firmcontact with the ground, motion within thefoot can occur.



• This motion mainly involves pronation(adduction, eversion and plantarflexion), andsupination ( abduction, inversion and

dorsiflexion)• These are normal motions that occur in the foot.• However, it is necessary for the foot to pronate

and supinate at the correct times during the gait

cycle in order for gait to be efficient.• It is in this process that abnormalities canoccur.



Malalingment Syndrome

• Used to define a host of problems relatedto posture and mechanical function.

• Related to whole kinetic chain.• Based on principles …



• A large amount of research suggests thatoveruse injuries may be the result of skeletalmisalignment and abnormal foot motion (Sobel et al 1999, McKenzie et al- 1985, Nicolopoulos et al – 1999…….).

• One of the most commonly treated

abnormalities, which may be the cause of thismisalignment, is excessive pronation of the foot.



• Excessive pronation of the foot can bespecifically caused by abnormal motion of the

sub-talar joint = Flat footedness.

• Abnormal or excessive pronation of the footwill alter the centre of pressure trajectory

occurring in the foot.( “projection on the ground plane of thecentroid of the vertical force distribution”

representation of the path of the vertical

component of the resulting ground reactionforce. )



Common causes of asymmetry

and dysfunction.• Various sources in the kinetic chain.

• Can be from the 1st MTP joint up to the

pelvis itself.• Various degrees of dysfunction or

asymmetry may result in changes further

up the kinetic chain.



Location Examples

• 1st MPT Joint

• Rearfoot complex

(STJ and AJ)• Calf Region

• Knee

• Limb Length

• Hallux Rigidus

• Excessive pronation

• Tight Gastroc / Soleus

• Genu Recurvatum

• Shortening etc.



Functional Hallux Limitus /

Rigidus.• 1st MTP Joint function

• Kinematic studies

suggest significantchanges in lumbo-sacral dysfunction.

• Especially when this is

asymmetrical.

• Why?

• Because the 1st MTP

joint plays animportant part in endphase of the gaitcycle at forefoot

rocker mechanism.



Figure 1: Normal 1st MTP joint function (extension) – La Trobe University 2005.

Figure 2: Abnormal Functional Hallux Limitus at the 1st MTP (restriction in extension) – La Trobe University 2005.



Illustration on right: Effects of

Functional Hallux Limitus on

upper body mechanics. Restriction at the 1st MTP joint

results in anterior positioning of

body to compensate for the lack

of forefoot rocker mechanism.

This can be seen by an anterior positioning of the body during

gait which is characteristic of

functional hallux limitus. – La

Trobe University. 2005.



Podiatry (biomechanical ) Assessment

• General medical Hx

• Medication…

• Muscle Balance andstrength tests.

• Neurologicalassessment…

• Gait Analysis

• Static / Stabilometric

Analysis.



Force Plate / Podometrie

Provides clinician with:

• Dynamic presentation of pressures and

timing during the gait cycle.• Dynamic presentation of Centre of

Pressure.

• Measure of instability and dysfunction.



Stabilometry

Reliable method for analysis of:

• Postural Instability (will show transverse

motion of joints and body).• Limb Length Inequality.

• Proprioception.



Treatments

• Foot Orthotic therapy

• Muscle Balance Techniques

• Acupuncture

• Osteopathy..



Foot Orthoses

• Not Arch supports!

• Alter mechanical

function of foot andconsequently if needed the wholekinetic chain.

• Existed since time of Greeks who utilisedstraw to alter thefunction of feet.

• Since then thingshave moved on…



• In 1940’s Merton Rootan AmericanPodiatristrevolutionised orthotictherapy and thetheories around it.

• Since then there havebeen variousdevelopments.

• Latest developmentsare based on theTissue StressParadigm and Centreof Pressure Theory.

• Types: Custom and

Non-Custom Footorthoses.



How do they work?

• By altering thefunction and timing of the various aspect of the foot and ankleduring gait.



Any Questions?Thank you for your time.



Multi-disciplinary working

• Important in the management of back pain.• Why? As even though mechanical function canbe altered with foot orthoses it is important thatpatients receive manual therapy to help them

adjust.

back pain doc……no,…it’s your

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