Podiatrist Lance Penn from Footsport guest posts

An orthotic is a custom made device designed to off load abnormal forces that can lead to damage of soft tissue structures, joints and bones.

What causes injury?

The direct cause of pain is a consequence of damage to the body (muscle/tendon/ligament/joint) as a result of abnormal forces. If the body cannot adapt to these loads then injury occurs. Physiotherapy principles aim to strengthen and or stretch tendon/muscular structures so that they can cope with the abnormal loads. Ideally, physiotherapy aims to achieve removal of the overloading forces directly from the sore tissues by spreading the abnormal forces more evenly about the area.

Orthotics work by altering abnormal loads around the joint axis, thus reducing the stress on the tissue. The best course of treatment is to tackle it from

both sides, strengthen/stretch and off load.

Certain feet are prone to over loading forces and this has nothing to do with the arch height. We now know that ‘flat feet’ are at no greater risk of injury than a ‘normal arch’. Traditionally foot assessments were based all around motion. Excessive inwards roll or ‘over pronation’ was presented as the root of all evil. This model of assessment has more or less been debunked. Current understanding is based around forces especially abnormal forces, and how they fit in with motion.

We still are not clear why some feet exert over loading forces while some do not and there is no link between over load and flat feet.

At Footpoint during our comprehensive biomechanical assessment we are able to identify the foot types that have abnormal loading forces and thus prescribe the correct orthotic that will reduce these forces. Pronation (or rolling in of the arch) is normal and in many cases we are trying to promote the natural ability of the foot to pronate. Most of our orthotics prescribed are flexible and always comfortable as we use the most up to date scanning technology that captures an accurate cast from which the orthotics are moulded to.

The orthotic process starts with the biomechanical assessment, casting then prescription of the orthotic. Once we fit the device we review you 6 weeks later to assess for the need to optimise the orthoses. This is part of the customisation process as fine tuning is needed to optimise function and comfort.

Orthotic customisation has come along away and we pride ourselves with having a comprehensive process that allows for easy communication and delivery of great clinical outcomes.

To find out more about Lance and his amazing orthotics, visit http://www.footsportpodiatry.com.au/ or call 9231 2707.

Ineffective? I say misleading.

You may have recently heard in the mainstream media that there is a big question hanging over the effectiveness of Paracetamol in the management of early back pain. This was based on a very recent study by Australian team of scientists who were published in the highly reputable journal, The Lancet. The link in this post about this study is to a newspaper article written in the UK about the findings.

http://m.nursingtimes.net/5073407.article

As a little background to all of this, it has been recently found and become an International medical guideline that with early lower back pain, the best course of treatment is to take simple and regular Paracetamol and keep moving, or stay as active as you can.

This new research challenges these guidelines and asks for further research and trials into the effectiveness of Paracetamol. However, in my opinion, this news really needs to be interpreted very carefully.

Here is why…

Firstly to this article’s title and the comments from the study’s authors that simple pain medication ‘does not work’ for lower back pain. To state that this is the case has me all but a little concerned. How very misleading. The actual study found that in those with mild to moderate lower back pain taking part in the study, there was little difference in return to pain free function between groups taking Paracetamol and those taking a placebo tablet. Both worked and had good rates of recovery. Here are the details of the main findings:

• The number of days to recovery in the Paracetamol group was 17 days, and the placebo group, 16 days.
• By 12 weeks, sustained recovery (not needing further management) had occurred in 85% of the Paracetamol group and 84% in the placebo group.

OK, so there is not much difference in the 2 groups, but

• Would you say that these results indicate that Paracetamol is NOT effective? Certainly not.
• Would you NOT consider taking the advice from your GP to take Paracetamol with an attack of back pain based on these results? Certainly not.

OK, so taking a placebo has the same effect. In my opinion, the main question (and an exciting one) to come out of these findings is this.

What is at work here when pain reduces and function increases equally in groups taking real medications and placebos?

My thoughts? As we discover more and more about the human pain response and see its complexity, explaining phenomenon like placebo effects becomes a little easier. As we are discovering, pain is a complex output system from the brain and involves brain centres of emotion, memory, movement and sensory (to name a few). There is a saying going around that translates to something like this:

‘If the brain thinks that you are doing enough to help to get better, then that is often enough.’

We are increasingly seeing that other ‘psychosocial factors’ predict good outcomes from injury and responses to pain. These can include ethics and belief systems about pain and exercise, confidence in health practitioners, positive outlooks to injury and life generally, socioeconomic status, happiness in the workplace, relationship happiness and general health and wellbeing. The list goes on and on.

So back to the study. I personally could hypothesise that there has been a list of probable factors influencing the similar rates to recovery in both placebo and Paracetamol groups. This could start with seeing a confident well spoken doctor with a clear management course communicated for the lower back pain attack. A simple and uncomplicated message involving a simple pill and the advice to ‘keep moving’. This instils confidence in the injured. Keeping as active as possible keeps the movement or motor centre in the brain functioning well and therefore feeding healthy impulses about the brain. As pain starts to ease after those first few days and movement becomes easier, ‘happy hormones’ and natural occurring pain endorphins kick in more, further speeding up the road to recovery.

And on it goes…

To say that Paracetamol is ineffective in managing early lower back pain is misleading. It would be fairer to ask by what means is the tablet you are taking making an effect.

Before enrolling, please carefully read and agree to the following terms and conditions:

1. Classes are paid for per term.

• This may be rebate-able through your private health fund provider and claiming must occur at the completion of your term. All classes are taught by a Physiotherapist.

• It is strongly recommended that you contact your health fund provider to discuss your eligibility and rebate amounts before enrolling in our programs. Not all providers will offer a rebate for group classes.

• You will be issued with a receipt on full payment at term commencement and this is to be kept for the purpose of claiming.

3. Full payment is required prior to commencement of the term to secure your place in the class.

4. Terms cannot be reduced from the designated number of weeks (usually 10 weeks) for the purpose of reducing fees.

5. Payment may be made by cash, cheque or bank transfer. Please make cheques out to “The Fix Program.” Bank details will be outlined in your class enrolLment email.

6. Classes are to be taken on the days and times enrolled, unless additional make up classes are pre-arranged with Fix staff.

7. Please notify Fix staff as early as possible if you are unable to attend your class.

8. If a class is missed, a make-up class must be made within the term. After this, the class is forfeited.

9. Missed classes cannot be refunded or carried over into the following term.

10. The Fix Program reserves the right to change or cancel a class if necessary and apologise for the inconvenience.