Every now and then I hear…
“I love my (insert traditional orthotic brand here), they’ve really helped my back pain.”
So what’s going on here?
As the Stimulation vs Support guy, am I calling these people liars? Are they just wrong?
Of course not.
Like so many things in the body, there’s a Goldilocks Zone, where too much is bad, too little is bad, but the sweet spot in the middle is just right.
In today’s issue of The Foot-Brain Connection I want to explore when to increase Stimulation, when more Support is appropriate and when a combination of both works best to create lasting clinical results.
(By the way, more often than the comment above, I hear… “I don’t feel like these orthotics are really doing anything.” Or even… “It feels like these orthotics actually screw up my knee/back/neck/everything.”)
When I say traditional orthotics don’t work… in fact, they’re part of the problem…
I’m not saying they don’t have an impact on the body. They do.
They just don’t actually fix anything.
I never make people wrong for wearing their traditional orthotics. If their experience is that it helps their knee pain or their back pain, that’s great.
However, my question is…
“What happens when they stop wearing them?”
Typically, the problem comes back.
In fact, it never went away… it was just being covered up by an external support.
This is one of my greatest frustrations with our medical system. So much of it is based on covering up a symptom and calling it fixed…
Without ever addressing the actual cause!
If you have to continue taking a medication for life, you are not fixing the problem, you are managing an ongoing, unresolved dysfunction.
I see this happening with many of the top-selling medications that people take… blood pressure, cholesterol, reflux… none of these treat the underlying cause of the condition!
The same is true when we wear traditional orthotics… or even just wear modern, supportive shoes!
So, is support always bad?
No.
If you break your leg… you need a crutch (or more commonly these days, a boot.)
If you’re an insulin-dependent diabetic… you need insulin.
Traditional orthotics are a crutch.
Sometimes a crutch is necessary… but does it actually do the healing?
No.
It just takes pressure off the bone so the body can naturally heal itself.
I understand that traditional orthotics can sometimes serve this purpose…
But what happens if you never stop using the crutch?
You don’t see plaster casts much these days, but when I was a kid, they were common. They were really the only treatment for a broken bone.
If you’re as old as me, I’m sure you remember what someone’s arm or leg looked like when it came out of that cast.
It was visibly shrunken and wasted…
And that was after only 6-8 weeks!
Imagine what would happen if they wore that thing for years?
Yet I see patients who’ve been wearing their traditional orthotics for 30+ years!
Now, I know their feet aren’t totally immobilized like they would be in a plaster cast….
But the same principle applies.
No wonder their feet are totally weak and dysfunctional.
And no wonder their gait, balance, posture and movement patterns are disrupted. Their spine, joints and muscles have all been adapting and compensating for years.
The body is incredible at intelligently adapting to stresses… but when the stress never goes away (like, for example, when we wear shoes and walk on flat surfaces all day) it leads to an endless cycle of compensation that is ultimately degenerative and destructive.
There are cases where the level of damage in the feet has progressed to a point where support may be necessary. I just hardly ever see them.
I think the body has way more healing capacity than we give it credit for.
A few years ago, I met one of the leaders of a barefoot shoe company. He told me that he used to work for a podiatry company, but that he’d “switched over from the dark side.”
When I asked what prompted this career change, he told me it was when he read research from within the industry that found only 2% of the population were candidates for traditional orthotics.
Yet they were being prescribed like hotcakes!
To be fair, I haven’t personally read that research… I’m just relating what he told me. It does seem to gel with a conversation I had with a podiatrist more recently though. In his words, he said…
“I see many patients whose navicular isn’t sitting on the floor… so I know orthotics aren’t really what they need. But I have nothing else to offer them… so I give them orthotics.”
Personally, I think that’s not a bad definition of someone who genuinely needs traditional orthotics…
Someone whose navicular is sitting on the floor.
To that I would add…
Someone whose 1st MTP joint is so dropped and degenerated that it’s causing pain and significantly impacting their ability to walk.
Dr. Emily Splichal is a functional podiatrist, human movement specialist, and author of the book Barefoot Strong. She’s a proponent of barefoot training, natural foot mechanics and the Stimulation vs Support paradigm. I have huge respect for her work and have learned a heap from her.
Although she is generally not an advocate for traditional, supportive orthotics, she also says that people with a completely dropped first metatarsal may need them.
Even in those cases I usually prescribe a hybrid approach- a combination of Support and Stimulation.
It’s ok to use the crutch… but you should also be doing the rehab work.
That’s where Better Balance Orthotics come in.
Even when someone’s feet are severely degenerated, you’d be surprised how much room for improvement there is (24 years as a practicing chiropractor has taught me this is true for almost everything in the body.)
I tell them to wear their traditional orthotics as needed, but to start with Better Balance for just a couple of hours a day, or even just on the weekends or when they get home from work.
It’s like going to the gym… even a few hours a week creates measurable benefits.
That way they are starting to build muscle activation in their feet, increase sensory stimulation to their brain, and re-educate their myofascial system… all whilst maintaining the level of support they have come to rely on.
Over time most people are able to gradually increase their use of BBO, often ultimately transitioning out of their old orthotics all together. The key is to let them do it at their own pace as their body strengthens and adapts.
I see this approach being used in the medical management of injuries like sprains and fractures too. Advice has gone from total immobilisation in a cast and bedrest, to use of a less restrictive boot or brace and a graduated reintroduction of movement and weight bearing as soon as practically possible.
The research supports this, showing it creates better long-term outcomes and faster healing…
But for some reason that thinking hasn’t trickled into the way we address feet with traditional orthotics and over-supportive shoes.
This doesn’t just apply to people with severely degenerated feet… I take a similar approach with anyone who has been using traditional orthotics.
These people have been relying on a crutch for a while.
For most of my patients I tell them there is no need to wear their orthotics in gradually… they can just chuck them in their shoes and away they go.
Just don’t wear them for the first time if you’re going to be on your feet for 10 hours that day!
For patients currently wearing orthotics I suggest they transition a little more gradually- usually within 2-3 weeks they no longer feel like they need their old orthotics.
The same can apply to sports people- I suggest they don’t wear them for the first time during the big game. Better to wear them in their regular daily shoes for a couple of weeks and then wear them in their sports shoes.
It generally unlocks a whole new level of performance… but it happens more smoothly with a period of adaptation.
So to answer the central question of this issue…
Is support ever appropriate?
The answer is…
Sometimes, yes.
But usually only in short-term, highly specific situations.
And even then, outcomes are usually better and faster if you include a Stimulation approach along with that support.
This brings to mind an analogy I heard from Dr. James Chestnut years ago when I was attending his Move Well, Eat Well, Think Well training.
He said…
“The medical system is like the fire department. If your house is on fire, you better call the fire department. They will come to your house, chop down your door with their axes, spray down your precious possessions… and if you’re lucky, they may just save your house.
But when it comes to rebuilding your house… you don’t call the fire department.”
Although he was talking about chiropractic, I’ve come to understand that the same is true when talking about your feet (and posture, balance, neurology etc.)
Traditional orthotics are the fire department.
But when it comes to rebuilding your whole-body function…
You need Better Balance Orthotics.
One last thought before I leave you this week…
(You might get a laugh out of this one.)
My last patient last night was a rheumatoid arthritis case. He said to me… “I’ve had this pain in my toe for the last 2 years… I haven’t mentioned it until now because so many other things were more important, but now everything is doing better…”
I cleared the toe problem using some new techniques I’ve recently developed, then moved on to the rest of our treatment.
Right after I adjusted him, he said to me…
“Andrew… I can’t feel my toes.”
I wasn’t sure I heard him right… “What?”
“I can’t feel my toes!”
These are not the words you want to hear from the patient you just treated!
So I asked him…
“What do you mean?”
He replied…
“I’m flexing my toes and I can’t feel any pain. I’ve had that pain for 2 f**ing years… what did you do?”
Talk about a moment of relief!
Some of the stuff I’ve been developing to treat feet… and by extension, the entire body, is actually pretty cool. It’s changing my entire practice.
I taught the first part of it in Aspen a few weeks ago. And I’m teaching it again in Auckland at the ICAK meeting next week.
I taught a more complete version to my associates a couple of weeks ago and it really shifted their understanding of how small changes in the feet creates major changes in the structure above… and helps everything else they do clinically to work better, faster and actually hold once their patients walk out of the clinic.
I feel this information needs to be shared, so I’m thinking of running a 1-day workshop for practitioners here in Sydney. It will be clinically focused, with a clear protocol you can implement immediately to improve your patient outcomes.
It’ll also massively increase your confidence and certainty in prescribing Better Balance Orthotics to accelerate and lock in those outcomes.
Obviously there is a significant amount of time and investment required to make a workshop happen, so if this sounds interesting to you, please let me know… if the numbers make sense I’ll set the wheels in motion.
For all my Aussie and NZ docs, I guarantee it’ll be worth your time getting to Sydney for the event. I’m not kidding when I say this work is changing my whole practice. Correcting the feet has become one of the first steps in my treatment protocols… almost regardless of a patient’s presenting complaint. It literally multiplies the effect of everything you do after that.
For my docs in the US… I understand it’s a little far to travel for a single day!
I’ve been invited to speak at 3 events later in the year in Boston, Washington and Florida, so I’m thinking of planning a road trip through eastern USA and running small group trainings along the way. If you can gather a group of local docs and would love to have me come and teach in your clinic, let me know… I’d love to connect, share what I’ve learned, and help us all serve our patients better.
Looking forward to hearing from you.
Cheers,
