May 2003

Spinal health and orthotic support

by Dr. Mark N. Charrette

Proper spinal care requires a combination of adjustments, stabilization, and neuromuscular rehabilitation. Abnormal lower‑extremity biomechanics represent a primary source of structural weakness that promotes chronic forms of back pain. [1] Custom‑made orthotics are designed to make caring for spinal joints and supporting musculature easier and more effective. Helping patients adapt to healthier postures requires only a few simple steps, and checking the feet and lower extremities could make all the difference for exceptional treatment outcomes.

Check the feet

The most common lower‑extremity structural misalignment is excessive pronation. There are three natural arches in the foot, and the strength and functioning of this postural foundation depends on the proper alignment of all three arches. Any compromise of arch structure or supporting soft tissue adversely affects the entire body. A review of the common global distortion pattern reveals how anything from knee pains to shallow breathing and TMJ disorders can be linked to unhealthy, unsupported feet.

As your care reverses this pattern of distortions, fixations, and muscular imbalance, the entire body's condition generally improves. There is no substitute for adjusting the spine and balancing paraspinal muscle tonus, but it is essential to provide the same level of expertise for the extremities.

The hyperpronated foot pulls the tibia and femur into excessive internal rotation during weight bearing. Leg rotation affects patellar tracking, pelvic rotation, and muscular tonicity. On the same side of hyperpronation you can expect to find knee pain, piriformis irritation, weak psoas, visual foot flaring in non‑weight bearing, and the combination of AI sacrum and AS pelvis. The anterior shift of the pelvis is accompanied by an increase of the thoracic kyphosis, rounding of the shoulders, and anterior head translation.

Postural distortion

Cailliet has demonstrated the negative impact and increased effort associated with even slight deviations from normal posture. [2,3] For example, when the head is centered over the cervical lordosis, minimal muscle effort is required to maintain this position. However, a one‑inch translation from neutral results in a ten‑fold increase in effort required by the supporting musculature. Anterior head translation is a very common postural distortion, so show your patients how the cervical spine affects the feet and vice versa.

You can make a graphic demonstration of increased anterior head translation with your patient in front of a full‑length mirror. Have her jut her head forward and:

1. Report where she feels the shift in weight on her feet. The weight will shift forward onto the more sensitive structures of the forefoot.

2. Abduct her arms toward her ears. In the translated posture, she will be unable to touch her arms to the side of the head.

3. Take a deep breath. Thoracic expansion and depth of inspiration are decreased.

4. Attempt to keep the mouth closed. Anterior translation increases tension on the anterior neck muscles of mastication and the TMJ.

Until the feet are properly supported and the muscular imbalances and fixations that accompany this presentation are removed, any treatment will be incomplete.

Orthotic support

Supporting the feet with custom‑made orthotics is the first step toward postural stabilization and rehabilitation, but the lower extremities also require a combination of adjustments and neuromuscular rehabilitation. Orthotics can isolate hidden fixations in the feet and lower extremities that become irritated as joint alignment improves. You can help patients through this adaptation process so they get the most from their orthotics.

Fixation, adjustment, and exercise

For your analysis and care, the general rule is that joints will be fixated in the direction of the global distortion pattern, as described, and muscles will be hypertonic and irritated opposite the direction of fixation. Whatever your preferred technique, the chart of suggestions will help.

*With Hx of inversion sprain, evaluate cuboid for superior and lateral fixation

Conclusion

As you improve posture and support the feet, you stabilize the relationship between the lower extremity and the pelvis and spine. Repeatedly adjusting the same spinal segments without long-term improvements suggests poor postural support for that region. Providing patients with custom‑made orthotics early in their care is an effective way to break up global patterns of fixation, misalignment, and muscular irritation ‑‑ and maintain healthier spinal conditions.

References

1. Fulton M. "Lower back pain: new protocols for diagnosis and treatment." Rehab Management 1988; Nov/Dec:39‑42.

2. Cailliet R. "Neck and Arm Pain." Philadelphia: FA Davis, 1981.

3. Cailliet R. "Soft Tissue Pain and Disability." Philadelphia: FA Davis, 1977.

(Dr. Mark N. Charrette is a 1980 summa cum laude graduate of Palmer College of Chiropractic. Over the past 15 years he has lectured extensively on spinal and extremity adjusting throughout the U.S., Europe, the Far East, and Australia. He received a Bachelor's degree from Illinois State University (summa cum laude) in 1976, where he was an NCAA All-American in 1974. Dr. Charrette is a featured speaker in Foot Levelers' 2003 Spring Seminar Series )