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April, 2010

Master the Art of Offering Orthotics to Your Patients

By Brian Jensen, DC

The use of orthotics has been successfully incorporated into every type of practice model by chiropractors from every school, completely independent of their philosophy, technique or specialty. The reason is fairly simple: within all of the diversity that exists in chiropractic, there are some universal truths that connect every one of these philosophies, techniques and specialties.

Generally speaking, structure dictates function, balance is better than imbalance, and optimal joint mobility is better than immobility. It has been my experience that custom-made, flexible orthotics that support all three arches of the feet, enhance the process of the body achieving a higher level of functional homeostasis.

We have an opportunity to improve the patient experience by expanding our thought process into how the feet may play a role in the conditions for which our patients seek care. There exists an opposing thought pattern that automatically defers non-spine issues to other specialists. In some instances, that is appropriate. However, to never look at a patient's feet because that is the "podiatrist's realm" is to categorically ignore one of the most influential factors in posture, gait and spinal health.

Doctors who utilize orthotics to enhance the results of their care have come to realize the magnitude of the influence the structural foundations of the feet have on the spine. Being aware of this influence leads to a high level of confidence in making the recommendation for orthotics, regardless of the area of specialty in which the chiropractor is practicing.

An abundance of information has been gleaned from research that shows the relationship between the feet and the knees. It has been shown that there is a relationship between navicular drop, excessive pronation and biomechanical stresses in the knee joint, which is linked to increasing the likelihood of a knee injury. There are two types of injuries to consider here: the sports-related sprain/strain trauma that often requires the intervention of a surgeon and the nontraumatic micro-injury that takes place over time and is responsible for the epidemic of degenerated knees and hips that are replaced each year, also requiring a surgeon.

Knees and hips do not come with a guarantee or warranty, but they do come with an incredible design capable of carrying us to a ripe old age. Look at your patient base and you will find examples of people that are active in their 80s and 90s and do not depend on medication or joint replacements to function. That is possible as long as the joint functions according to its design, which is to flex, extend and rotate within a specified range of motion and without significant amounts of deviation from that range. Those deviations are typically small and repeated over and over in the absence of pain. A chiropractor with a sharp eye is able to identify those signs that put these joints at risk.

Confidence Is Key

Virtually every chiropractor has undergone a positive personal experience with chiropractic, which often led them into the profession. It is easy for us to recommend chiropractic care to patients based on our experiences. That same principle applies to orthotic use. It is important to personally experience the benefits of orthotics in order to make that confident recommendation.

My personal experience began in the first year of practice, when I purchased a pair of custom-made, flexible orthotics at a convention. Within days, the recurring patterns of low back and knee pain that I had experienced changed dramatically. The realization that my feet, which had not been hurting, had such a significant influence on my spine and extremities led me to the understanding that the feet were likely a contributing factor to the chronicity of many of my patients' conditions. All I had to do was look.

If you think that there is no need for you to use orthotics because of a lack of foot pain, then you are falling into the same trap our patients do when they don't seek care until they have back pain.

You must identify if there is asymmetry in the foundation of the body. The most effective way to do that is with the latest digital imaging technology that is being offered. The intuitive nature of the images and report of findings generated by the scanning software will make clear to the patient the influence the feet have on the spine and pelvis and makes it easy for them to accept the recommendation. When patients understand, they want the benefits of custom-made, flexible orthotics that include a balanced, symmetrical foundation for the body.

This balanced foundation blocks the postural distortions that can silently create stress in the lower extremities, pelvis and spine. At a neurological level, custom-made, flexible orthotics enhance the effectiveness of the chiropractic adjustment by enhancing proprioception and inhibiting nociception.

They also improve the patient's quality of life by relieving postural stress on the body. It's not about foot problems; it's about whole-body support and function.

Here are my keys to becoming a master at making recommendations for orthotics:

Experience will give you confidence that custom-made orthotics are beneficial. Wear them for yourself first and you'll see why it's important for your patients to wear them as well. I use them every day in every pair of shoes. This helps prevent the low back pain to which I am susceptible.

Evaluate the feet as part of each new-patient exam. It is our obligation to determine what is contributing to the condition for which our patients come to us. Most of the pain syndromes are the result of postural stresses over time, and the feet are a contributing factor for a majority of our patients. Look for simple, but obvious, signs of structural imbalances, asymmetrical foot flare and internal knee rotation. Uneven shoe wear, pelvic tilting and forward head carriage are signs that may implicate the feet as a contributing factor.

Keep it simple. Use analogies your patients can relate to. The foundation of a house that settles creates stress that can cause cracks in the walls and ceiling. Putting a patch on the crack is a short-term solution. Your adjustments can be the short-term solution to pain, but stabilizing the structure from the ground up is a big part of the long-term solution.

Mastering these basics of recommending orthotics will enhance whatever technique and specialty you practice.


Dr. Brian Jensen, as the Associate Director of Education and Research for Foot Levelers, he shares more than 20 years of practice experience in chiropractic colleges and seminars around the world. A graduate of Palmer College of Chiropractic, Dr. Jensen speaks on a wide variety of topics, including orthotic therapy, structural preservation, breaking free of the medical model of health care, and innovations in nutrition.

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