ARE YOU USING ORTHOTICS FOR KNEE PAIN?

    Knee pain, particularly patellofemoral pain is a common complaint seen in family medicine, orthopedic and sports clinics, running and sports shops. Although the use of foot orthotics has been widely used by health professionals many over-the-counter versions exist and are purchased regularly (can you say Dr. Scholls?). Foot orthoses have been used for a variety of painful conditions including foot/ankle pain, back pain, diabetes, and hip pain.
Determining which individuals may actually benefit from the use of the orthotics for complaints of knee pain have yet to be identified. There have been several studies evaluating the use of orthotics in individuals with patellofemoral pain syndrome with the intention to develop clinical prediction rules. Vincenzo et al identified that those most likely receiving benefit were those who were older individuals, shorter individuals, individuals with lower baseline pain, and those with greater foot mobility. Another study by Sutlive et al identified three different predictors: greater forefoot valgum, reduced first metatarsophalangeal joint dorsiflexion, and reduced navicular drop. Restricted ankle dorsiflexion range has also been reported to be a potential indicator for the use of foot orthotics.This recent study by Barton et al, in Medicine & Science in Sports & Exercise was aimed at developing a preliminary clinical prediction rule to help identify individuals with patellofemoral pain syndrome who might most likely benefit from foot orthotics. The results of the study showed that 25% of the participants demonstrated marked improvement in a 12 week program of non-custom orthotics wear.
The number of participants with marked improvement increased to 78%. When three of the four criteria were met:

•   Foot wear motion control properties score of less than 5.0, which indicated less supportive footwear properties
•   Reports of less than 22 mm on a visual analogue scale (lower levels of pain)
•   Ankle dorsiflexion range motion with the knee flexed less than 41°
•   Reduced pain with a single leg squat while wearing the orthoses.

There were several takeaways for me in this article. First, the article mentions several outcome measures that I was not familiar with – the links are attached below. Some of these outcome tools might be of benefit to some clinicians and researchers.

Secondly, I think that the easiest measures that can be performed quickly in the clinic would be that of assessing ankle dorsiflexion range motion and determining immediate reduction of pain with a single leg squat while wearing the orthoses.

      And finally there is mention in the article that patients often do not respond to just one single intervention tool. Therefore, continuing to perform a comprehensive examination including hip/core strength and joint mobility would certainly seem to more than likely help in reducing knee pain in conjunction with the use of orthotics.  Let’s not forget about addressing other health issues such as weight and general physical inactivity.

Comments? Questions?

OUTCOME TOOLS to check out:
International Physical Activity Questionnaire
Footwear Assessment Tool
Foot Posture Index

Ref: Clinical Predictors of Foot Orthoses Efficacy in Individuals with Patellofemoral Pain BARTON, CHRISTIAN J.; MENZ, HYLTON B.; CROSSLEY, KAY M. Medicine & Science in Sports & Exercise. 43(9):1603-1610, September 2011.

Understanding the 5 Stages of Change to Improve Healthy Behaviors

Examining the Stages of Change

Understanding some basic concepts about the process of change can be helpful to keep in mind as we move our patients/clients forward on their path to discovering better health.

Learning to recognize where our clients are in this process can not only help to move them forward from one stage to the next, but also help both you and the client learn how to handle any “backslides” that are bound to occur along the way.

There is more than one theory on how health behavior change occurs.  The Transtheoretical Model of Behavior Change developed by James Prochaska and colleagues which began in 1977 is a popular model currently used in many health and wellness practices. Prochaska’s book, Changing for Good along with research using this framework have made it a dominant model used for health behavior change.

What are the 5 Stages of Change?

1. 1. PRECOMTEMPLATION –the patient or client has no interest in change– they may state I’m not even thinking about it, “I Won’t” or “I Can’t”
2. 2. CONTEMPLATION – Statements such as “I May” or “I’ve thought about – getting more active, improving my eating habits or changing other health behaviors but haven’t done so yet, indicate they are in the contemplation stage.   They are ambivalent about changing.   During this stage, patients assess barriers (e.g., time, expense, hassle, fear, “I know I need to but …”).   They are sizing up, or contemplating the barriers versus the benefits.  People can stay in the contemplation stage for months to even years!
3. PREPARATION STAGE – If the patient has been increasing their activity level, exercise, or eating better but it has been inconsistent, they are in the “I Will” or Preparation Stage.  During the preparation stage, patients are starting to make a specific change. They may experiment with small actions or changes as their determination to change that specific behavior increases.
4. ACTION STAGE – If the patient has been exercising, eating better, or engaging in other activities to improve your overall health status consistently, but for less than 6 month.  They are in the “I AM” or Action Stage.  This stage can last up to 6 months while they are establishing your new habit
5. MAINTAINANCE STAGE – If the patient/client has been engaging in their new healthy activity for more than 6 months, they are in the Maintenance Stage, or “I Still Am!”. It is in this stage that the new behavior change has become a habit.  They are more confident in their ability to maintain the new behavior

Early in my career as a physical therapist, I struggled trying to figure out why some patients progressed more easily than others.  We all know those patients or clients that we love to work with – they listen to you, are more compliant with their treatment or rehabilitation program, and seem to get better with less difficulty.

Then there are the ones that I asked “what on earth can I do to help you, why aren’t you doing what you need to get better?  Learning to incorporate the Stages of Change into practice was instrumental in determining how to approach that particular individual, what information might be best for them at that particular time, and what might be the best intervention strategy for them to help move them forward along the spectrum of change.

Now that you know the basics of the stages of behavior change, in the next post, we’ll discuss how to incorporate them into your practice to help your clients achieve a healthier lifestyle.

This is the second in our series on Leading your Clients to Good Health.  If you missed the first one, go here:  http://www.healthpathtoday.com/?p=504

Does Barefoot Running Cause or Prevent Injury?

I just got back the American College of Sports Medicine Annual Conference in the beautiful city of Denver. It was held in conjunction with the Exercise is Medicine meeting so you can imagine how much great information was packed in over the almost full week of lectures, symposiums, forums, etc.

One of the lectures that I found quite timely and informative was that on the differences between barefoot running, minimalist shoes and shod (that mean shoes for most of us). The research presented some fairly compelling evidence against those who are shod heel strikers.

The forces transmitted up the kinetic chain were shown to be significantly greater tin heel strikers compared to those who were forefoot or mid foot strikers. 75% of runners are heel strikers which creates a very high magnitude of force – 1.5-2x body weight.  Shoes make this heel striking pattern more comfortable and can slow the rate of loading.  Wearing shoes actually encourages you to heel strike.  Shoes also tend to be easier on calf muscles – they don’t have to work as hard.

Research by Dr. Daniel Lieberman has shown that 75% of habitual barefoot runners forefoot strike; 12% midfoot;12% heel strike.  He points out that there are variations in striking patterns.

Forefoot striking tends to encourage a softer, more gentle landing.  The same impact peak that appears on a force plate with shod running is significantly reduced to almost non-existent barefoot running.

Barefoot running forces you to run lightly and gently because where there is no collisional impact.  That all sounds great but does that mean that we should all kick off our shoes?  Of course not – you obviously can still have injury if not done correctly and so far, there are many unanswered questions.

We don’t yet know the impact of barefoot running on injury.  30-70% of habitually shod runners are injured per year.  There is no current evidence for decline over past 30 yrs despite all the really cool shoe features that keep coming out.

There is also no current evidence that says barefoot running decreases injury yet though either.  We don’t yet know: Are they running with proper technique? Are they getting injured at higher rates than shod runners?  More questions will be coming.

Although I certainly would never call myself a runner,  I did get a pair of what I affectionately call  ”fingerfeet” for my birthday and found them surprising quite comfortable (once I found out how to get the on!).  You definitely don’t feel like you want to heel strike in a minimalist shoe or barefoot as it is does not feel good at all.  Those who do, or try to go into barefoot or minimalist shoe running too quickly are more likely to pay the price.

The verdict is still out and up for debate as more research comes out – and it will!   If you are going to discuss it with your patients/clients, suggest to them that following a gradual training progression would be much to their favor – even if they are experienced runners.  As we know, many injuries occur from improper training.  So far, I haven’t seen too many injuries in my clinic as a result, but I don’t think that it is quite as popular yet in my area.

Here are a few tips you can suggest to your patients or clients:

• Start slowly – follow a transitioning program
• Pick smooth paved surfaces
• Good barefoot landing should feel gentle, relaxed
• Don’t point your toes too much – this will over work the calf muscles
• Land as soft and quiet as possible, keeping your center of mass as low as possible
• Do not over stride
• Listen to pain
• Cut mileage or number of days that you are running
• Slowly wean orthotics and/or shoewear down
• Do stretching, strengthening, balance/stability exercise

If nothing else, I think the ‘Fingerfeet’ are just darn cute!

What have your experiences been with barefoot running for you or your clients?

Health Bytes

Sunday News Round-Up, If This is May Edition « Women’s Health News

Some Indiana politicians voted to defund Planned Parenthood, which received federal Medicaid/Title X funding for non-abortion health care, like cancer screenings and contraception. In response, HHS sent the state a …

Publish Date: 06/05/2011 12:49

http://womenshealthnews.wordpress.com/2011/06/05/sunday-news-round-up-if-this-is-may-edition/

By Innovation_Unit at 06/06/2011 6:09

Sesame Street: Michelle Obama and Elmo – Healthy Habits

First Lady Michelle Obama visits Sesame Street part of Sesame Workshops Healthy Habits For Life initiative. Mrs. Obama and her pal Elmo talk about eating right, exercising regularly and being a healthy and positive role model for children. Please vis…

By blueskyyyc at 06/06/2011 5:39

This Weeks Health Bytes

• Today’s Heatlh Tip: 5 tips to losing 5 pounds by summer http://today.msnbc.msn.com/id/43101327/ns/today-today_health/

• Anti-inflammatory pain killers are known to increase heart risks, and new findings from more than 83,000 people suggest that even a couple of days of treatment can be dangerous in people with a history of heart problems.  Read more:   http://www.msnbc.msn.com/id/43083991/ns/health-heart_health/

• McDonald’s Stockholders reject obesity proposal OAK BROOK, Illinois (Reuters) – McDonald’s Corp spurned calls to assess the impact of its food on childhood obesity, and said its trademark clown Ronald McDonald would be hawking Happy Meals to kids for years to come……….Read more: http://www.reuters.com/news/health

• Foods with benefiits, or so they say Labels proclaiming health benefits of foods almost shout out in the aisles of supermarkets. But shoppers, and regulators, have their hands full trying to sort it all out……Read more http://www.nytimes.com/pages/health/nutrition/index.html

• CDC Links Obesity, Arthritis, and Lack of Exercise Obese adults with arthritis are 44% more likely to be physically inactive than obese people who do not suffer from the painful disease that causes inflammation and stiffness of the joints, the CDC says in a new report…….Read more  http://arthritis.webmd.com/news/20110519/cdc-links-obesity-arthritis-and-lack-of-exercise

What’s your guess?

No…..it’s not a supplement, new fad diet, work out ’til you drop exercise program or some crazy device “proven” to shed pounds while lying on the couch………..

The answer:  WATER.   Although some people are probably aware of this already, water is still very under-rated in many health, diet, and exercise programs.  Folklore and personal experience have suggested that water can aid in weight loss but there has been little scientific evidence to show it until now.

A recent study by Brenda Davy, PhD, associate professor in nutrition from Virginia Tech  showed that drinking 2, 8 ounce glasses of water before a meal can help people lose more weight than those who did not.

Her study included 48 adults between age 55 and 75; all participants also ate a low-calorie diet throughout the study.

After 12 weeks, water drinkers lost about 15.5 pounds, compared to non-water-drinking dieters, who lost only 11 pounds.  Better yet, was that those water drinkers who continued for a 12 month period, not only maintained the weight loss, but also lost additional weight.  The reason is simple – drinking water makes you feel more full, therefore tending to eat less and it has no calories.

Davy recommends that women drink up to 9 cups of fluids per day while men should consume up to 13 cups.  People should not substitute with diet drinks or other liquids that contain calories.

So, it’s a “no brainer”……….encourage your friends, family, or clients to drink more water – for all of it’s health benefits!

DRINK UP!