Things which can cause pathological Pronation

[Admin]

Thanks for that Brian.

For those who aren't up to speed on the action of the pelvis, and transverse plane rotation at the hip I can thoroughly recommend Human Walking (Ed Rose and Gamble) Pub: Williams and Wilkins, ISBN 0-683-07360-5.
In the 2nd Edition it is comprehensively explained in Chaper One - Human Locomotion.

This is turning into a great discussion, and I appreciate the postings of Prof Rothbart.

Just to make it clear - I'm not a fan of "those insoles", but I have no doubts they do what is claimed for some patients. This is hardly suprising. At a Biomech Workshop last year Ian Linane and I, in front of twelve delegates were able to produce startling posture changes in one subject, and clear voice-change (easier breathing = stronger voice-pattern) in another subject. The magic "orthotics" were Ians own custom orthoses for the first subject (not a great fit but they did the job, along with a little EVA heel-lift), and, if I remember rightly, just simple EVA heel-lifts for the second subject. Thinking back, we also produced posture and expression-change in the second subject - did we, or am I embellishing now (Ian?).

Brian and contributors - good job - keep the science stuff coming .

Regards,

[dtt]

Hi davidh et al

Brian and contributors - good job - keep the science stuff coming

Sorry for bringing the threads down

Not having had the benefit of a Uni education ( just the Uni of life)

I make a public apology for my brain which looks ,analysis and converts EVERYTHING into clinical care format.

I am not an academic so I just follow the scientific discussions in awe of the brilliant minds that produce them.

Well Done ( sincerely)

Thank you all
Cheers
Derek

[dtt]

Hi Davidh

but I have no doubts they do what is claimed for some patients. This is hardly surprising. At a Biomech Workshop last year Ian Linane and I, in front of twelve delegates were able to produce startling posture changes in one subject, and clear voice-change (easier breathing = stronger voice-pattern) in another subject.

Couldn't be coz they actually affected the kinetic chain could it ??

Another example I can give (and relate frequently) is a very fit young lady ( personal trainer) to whom I fitted orthotics , looked at herself in the mirror and exclaimed " this is better than having a boob job" ;D

Why ? because her posture was improved by the orthotics thereby improving chest expansion ,air intake / expulsion etc.

Bloody ell David it ain't rocket science !!

Sorry just an old non academics thoughts

Cheers

Derek

[Admin]

dtt said:

Another example I can give (and relate frequently) is a very fit young lady ( personal trainer) to whom I fitted orthotics , looked at herself in the mirror and exclaimed " this is better than having a boob job" ;D

Why ? because her posture was improved by the orthotics thereby improving chest expansion ,air intake / expulsion etc.

Bloody ell David it ain't rocket science !!

Exactly my point!
;D

[robertisaacs]

Sorry for bringing the threads down

You're not bringing the threads down Derek. Your posts are well thought out and interesting and make good reading.

Now if i were to say that

At a Biomech Workshop last year Ian Linane and I, in front of twelve delegates were able to produce startling posture changes in one subject, and clear voice-change (easier breathing = stronger voice-pattern) in another subject. The magic "orthotics" were Ians own custom orthoses for the first subject (not a great fit but they did the job, along with a little EVA heel-lift), and, if I remember rightly, just simple EVA heel-lifts for the second subject. Thinking back, we also produced posture and expression-change in the second subject - did we, or am I embellishing now (Ian?).

this, and

Another example I can give (and relate frequently) is a very fit young lady ( personal trainer) to whom I fitted orthotics , looked at herself in the mirror and exclaimed " this is better than having a boob job"

Why ? because her posture was improved by the orthotics thereby improving chest expansion ,air intake / expulsion etc.

this along with Brians ptosis pictures could all be equally and amply explained by a placebo action. rather than a few degrees of transverse rotation of the hips.

THAT would be bringing the thread down. ;D .

I sometimes take templates for "simple " insoles by putting a carboard template in somebodies shoe, marking they're foot, and then getting them to walk up and down to get the print on the cardboard. I once had a patient who, bless her, had not understood and thought these were the insoles. She shuffled in like Mr Burns in the simpsons but the addition of a piece of cardboard (from a green banner folder if you want to try to recreate this evidence ) caused a significant improvement in posture and the patient effusing about how much better her back was now. She was almost gazelle like. This has not yet inspired me to issue cardboard insoles.

Kinetic chain correction or autosuggestion and the well documented ideomotor mechanism could all have a role here. Call me a miserable, cynical, closed minded g*t if you like (i'm used to that) but i remain unconvinced. Occams razor shows the way. Pelvic arch or no pelvic arch.

I might start a thread on placebos.

Regards
Robert

[dtt]

Hi Robert

all be equally and amply explained by a placebo action. rather than a few degrees of transverse rotation of the hips.

Kinetic chain correction or autosuggestion and the well documented ideomotor mechanism could all have a role here. Call me a miserable, cynical, closed minded g*t if you like (i'm used to that) but i remain unconvinced.

Ok you miserable, cynical..... ;D

Lets have a look at how I see it working (simple way).

With any pronatory action a percentage of internal tibial femoral rotation occurs to a greater or lesser degree which yes has an effect on the pelvis and thereby the rotation of the spine thereby giving instability = poor posture.

Enter Darth Tatar with the orthotics

Stj stability , internal tibial /femoral rotation stabilised, pelvis stabilsed in Saggital plane ie the pelvis is thrust forward or backwards( thrust forward in pronation correction) ( try it yourself by moving your feet from maximum Abduction to maximum Adduction note pelvic movement) thus allowing the spine to lock correctly giving a more upright posture.

How many times does the Pt volunteer "I feel Taller, or my shoulders feel they are back and I'm upright" Loadsatimes here (not through suggestion other that "do you feel any different?")

Better posture = better control of chest muscles ( Stable spine to pull on ) better lung function = pts comment on boob job

So simply put, does that help to make you convinced ?? ;D

Cheers
Derek

[robertisaacs]

I've slid this over to a new thread for clarity. Look in Kinetic chain.

[rothbart]

Ciao All,

There is no doubt that putting any object underneath the foot that has vertical (height) dimension, may change the position of the body (posture) and impact the tonicity of the postural muscles. This was demonstrated, quite clearly in a published study by Kavounoudias et al, where they demonstrated that a tactile signal (1) underneath the forefoot moved the posture posteriorly, and (2) underneath the rearfoot moved the posture anteriorly [Kavoundoudias A, Roll R et al 2001. Foot sole and ankle muscle inputs contribute jointly to human erect posture regulation. J Physiol. 532(Pt 3):869-78)].

Derek, your female patient comment regarding the upward change in her chest position after being fitted with orthotics, is the result of the thoracic cage opening up. (By the way, in many patients this facilitates their breathing. I have had many Asthmatic patients dramatically improve by simply opening up their thoracic cage, in this manner).

Robert, regarding autosuggestion as being a possibility for the changes we see when computer analyzing the postural photos, our algorithms are carefully written and orchestrated to minimize this possibility from occurring. For example, facial photos (evaluating Ptosis) are taken with no instructions given to the patient other than ‘look straight ahead and relax’. The camera has no flash unit. The changes captured, pre vs. post proprioceptive stimulation, occur spontaneously. Many times, the patient is very surprised to see the changes, themselves.

Also, Robert, you are correct. By simply putting a cardboard template underneath a patient’s foot, you can dramatically improve their posture and diminish their back pain, as you noted. (But, allow me to also add, if the cardboard is placed incorrectly underneath the foot, you can dramatically worsen their posture and increase their back pain!). This is what Posturologists have talking about for years (read THE textbook on Posturology by Gagey PM and Weber B. 2003 Posturologic. Elsevier-Masson). Your remark, that this would not inspire you “to issue cardboard insoles” is very sage. There is no question that cardboard insoles (which, by the stretch of the imagination, could be referred to as a proprioceptive insoles) can change posture and influence musculoskeletal complaints (as you have noted yourself). HOWEVER, if cardboard insoles are used incorrectly, they can actually do harm to the patient. And this has been my message for the past several years!

There are many different types of Proprioceptive Insoles (Bourdiol, Fusco, Vabene, Rothbart, etc). They are all used for specific foot types. For example Rothbart’s insoles are used ONLY for stabilizing the PMs foot type. If they are used, for example, in an acquired PF 1st metatarsal, they could do harm.

Derek, regarding your comment regarding “any pronatory action a percentage of internal tibial femoral rotation occurs to a greater or lesser degree which yes has an effect on the pelvis and thereby the rotation of the spine thereby giving instability = poor posture”, I must respectfully disagree with you. In our recent research studies, we have found that, in most cases, abnormal foot pronation does not change the transverse plane rotations of the tibia and femur. The abnormal foot pronation is absorbed within the triplane oscillations of the subtalar joint (most aptly put by Verne Inman, as the universal transducer). Interesting enough, Resichl SF et al and Carcia CR et al, came to similar conclusions. Resichl et al found that the magnitude and timing of peak pronation is Not linked to the magnitude and timing of leg rotation. (An abstract of this paper can be read at www.rothbartsfoot.info/AbnorPronVsTibRot.html ). Carcia et al found that orthotics do not change the transverse plane rotation of the lower extremity. That is, by changing the pronation pattern within the SJT, the transverse plane rotations of the tibia are NOT concurrently changed. (An abstract of this paper can be read at www.rothbartsfoot.info/TrPlRotTib.html ).

Note: In 1988 I published a paper in the J Phys Ther Manipulation that stated abnormal foot pronation causes excessive internal tibial rotation. Looking back, I wish I had not published that paper.

Prof B

[dtt]

Hello Brian

Derek, your female patient comment regarding the upward change in her chest position after being fitted with orthotics, is the result of the thoracic cage opening up.

Yes as I said through a stabilising of the spine to allow better posture ( chest out)

Derek, regarding your comment regarding “any pronatory action a percentage of internal tibial femoral rotation occurs to a greater or lesser degree which yes has an effect on the pelvis and thereby the rotation of the spine thereby giving instability = poor posture”, I must respectfully disagree with you. In our recent research studies, we have found that, in most cases, abnormal foot pronation does not change the transverse plane rotations of the tibia and femur. The abnormal foot pronation is absorbed within the triplane oscillations of the subtalar joint

Hmm then we will have to agree to disagree on that one as I see many Pts with knee , hip and back pain to whom I fit orthotics and their quality of life is restored by in essence controlling internal tibial / femoral rotation by stabilising the stj.

I have no study to back that up just my own thoughts in practice.

Could we move this discussion to "Kinetic Chain" that Robert started as I am replying twice to similar comment.

Thank you

Cheers
Derek