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Wednesday, October 27, 2010

Top 100 Biomechanical Guideline #5: Understand the many sound treatments of these pain producing mechanical problems

     Even though this guideline is mainly oriented to health care providers, the lay person I hope will be helped immensely. The 5 areas health care providers treat of a bio mechanical nature routinely are:
  1. Limb Length Differences
  2. Poor Shock Absorption
  3. Forefoot Abnormalities (Varus, Valgus, Bunions, Hammertoes)
  4. Excessive Pronation, and
  5. Excessive Supination
I implore health care providers and patients to expand your knowledge base in each of these areas. As your knowledge increases, so will the successes of your treatments or your care. From a lay person's perspective, when troubled by an ailment, always look for 2 or 3 layers of cause.

Our health care is more and more becoming problem focused alone. This means that you go to a doctor with a sore knee, and your knee will be examined (but nothing else). This is a time problem physicians face, so work with them by asking smart questions. Go after the cause of why the knee was injured in the first place. Even when the primary cause is obvious, always look for other causes or contributing factors. One bit of wisdom I love to share is that it is common to have 3 , 4, or 5 factors causing an injury to occur. So I try to at least look for 3 possible causes and work from there at the first visit. I will give an example of this at the end of this point.

Remember, pronation alone will not injure your knee. You need to look at what causes your knee to be the weak link? The next 95 of the 100 guidelines will improve your ability to recognize possible strategies if your treatment is not improving.

If you use a lift for a short leg,  or have a short leg, I will explore this area.

If you have had shock absorption issues developing stress fractures, having osteopenia or osteoporosis, pound when you walk, I will explore this.

If you have forefoot abnormalities sometimes diagnosed by bunions, hammertoes, metatarsal calluses, or pain in the front of your foot, I will explore this.

If you over supinate, roll your heel outward as if spraining your ankle, break your shoes down to the outside, have hip or low back pain, chronic ankle sprains, tailors bunions (5th metatarsal),  I will explore this.

And if you over pronate, I will explore all the methods available to help you avoid the 33+ injuries associated.

If we break this down to its basics, the following occurs:
  1. You develop pain.
  2. You see a health care provider for advice.
  3. The health care provider works in 3 areas all at once.
  •   Attempts to identify the problem (make a diagnosis)
  •   Attempts to look for a cause to reverse
  •   Attempts to initiate treatment
All in all this normally works splendidly, but occasionally problems occur in one, two, or all 3 of those areas.
  1.  It is difficult to identify the problem, so xrays, injections, MRIs, bone scans, ultrasounds, and surgeries may be performed.
  2. Several causes or aggravated factors initially not considered need to be identified and treated.
  3. Various treatments lead to aggravation of symptoms, or no help, and other avenues of treatment need to be explored.
Some of the big name injuries, which have been studied the most because of their frequency, have had many causes identified some common and some rare. The dilemma for your health care provider is that scientific method does not allow treatment of all these causes at once, because it success or aggravation occurred, you would not know what was the cause. So most providers methodically work with one at a time. For the patient's prospective, this is a too lengthy process, and it can take forever to address the true cause of the problem. This is why I normally throw caution into the wind and try to deal with 3 areas at a time.

Before I close, let us take look at Achilles tendinitis. There are numerous causes including tightness, weakness, technique faults, poor shoe selection, short leg, over pronation, etc. When I see a patient with this, I try to quickly check out leg length issues, tightness issues, and weakness issue. There I am dealing with 3 possible causes at once, and after several months, if the patient is feeling better, I look good. Hope this helps.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.