October 2003

Determining orthotic need

by Dr. Mark Charrette

Why do many chiropractors look to the feet to help solve a spinal subluxation? Why do these doctors recommend spinal pelvic stabilizers (orthotics) to support their adjustments? This article looks at the reasons why many chiropractors use spinal pelvic stabilizers to help them win the battle on the table.

Five categories of need

There are five general categories for using spinal pelvic stabilizers with chiropractic patients:

1. Adjustment enhancement ‑‑ keeps negative forces out of the spine by enhancing the 'holding power' of the adjustment

2. Structural alignment ‑‑ compensates for malformations and misalignments

3. Keeping the body balanced ‑‑ reduces excessive rotary forces transmitted to joints

4. Shock absorption ‑‑ reduces chronic stress‑loading to improve cartilage health

5. Lower extremity symptoms ‑‑ relieves local pain to reduce secondary spinal problems

It's common to see a patient who demonstrates several of these problem areas, yet no provider has ever suggested spinal pelvic stabilizers. A quick review of each of these topics also helps with the important job of communicating findings and explaining the need for spinal pelvic stabilizers to a patient (and to the payer).

Adjustment enhancement

When people spend long periods of time on their feet or perform activities which place higher forces on the lower extremities, the likelihood of foot instability increases. A 1999 study showed that the use of custom‑made, flexible spinal pelvic stabilizers improves pedal stabilization. [1] A more stable foundation keeps negative forces out of the spine by enhancing the 'holding power' of the adjustment.

Structural alignment

When standing, walking, and running, our feet and legs are the structural support for the spine. In some people, especially in those with back and neck symptoms, the structural system supporting the spine is uneven or canted. If there is a growth abnormality, a pelvic tilt or obliquity, a leg length discrepancy, or other static osseous misalignment, chiropractic care must include custom‑made spinal pelvic stabilizers to reduce the structural stresses on the spine. These conditions are frequently seen in patients with recurring neck and back symptoms.

Postural compensations often develop which give some initial relief, but eventually result in subluxations which are resistant to care. Since no two patients' musculoskeletal conditions are exactly alike, custom‑made spinal pelvic stabilizers are recommended. They are scientifically designed for the individual's unique postural problems.

Keeping the body balanced

Walking and running movements create twisting forces from the feet into the legs, pelvis, and spine. When the forces are balanced and even, no individual body part is exposed to damage or excessive microtrauma. Asymmetrical twisting stresses, however, can develop into abnormal movement patterns, and can be the underlying source of spinal complaints.

The results of functional asymmetry and imbalance can be detected by studying shoe wear patterns, watching for foot flare (toe‑out) during walking, or performing the navicular drop test. Improving symmetrical joint function can frequently be accomplished by a spinal pelvic stabilizer with a pronation wedge and/or extra support for the three arches of the foot.

Shock absorption

Our patients frequently stand, walk, and run on rigid, non‑resilient surfaces. This source of joint damage is so pervasive that we often overlook it in our diagnoses of spinal conditions. Degenerative changes ‑‑ osteophytes, spurs, disc thinning, joint space narrowing, and bony remodeling ‑‑ are often the result of years of abnormal stress. The chronic strain of gravity, when multiplied by the unyielding surfaces we have created to stand on, eventually causes spinal symptoms.

Reducing these damaging forces on spinal joints not only provides current relief, but the decreased joint loading greatly improves cartilage health in the long term. Spinal pelvic stabilizers containing shock‑absorbing materials, such as Zorbacel, can significantly reduce spinal joint microtrauma and relieve chronic degenerative symptoms. [2]

Lower extremity symptoms

Many lower extremity conditions can result in spinal problems and symptoms if left uncorrected. A Morton's neuroma, an unstable ankle joint, tracking problems of the patella, and hip joint asymmetry can all result in chronic subluxations with recurring back and neck pain. In such cases, chiropractic care must address the lower extremity problem in order to provide effective treatment for the spinal complaint. It is frequently necessary to supply spinal pelvic stabilizers to relieve local pain in order to reduce and prevent secondary problems and symptoms in the spine.

Conclusion

Most patients who need spinal pelvic stabilizers have problems in more than one category. By understanding and explaining the clinical rationale(s) to patients, family, and third‑party payers, a greater acceptance becomes likely. The chiropractor who evaluates patients with these categories in mind provides quality, efficient care in a cost‑effective manner. This is why chiropractors, who are spine specialists, must also look at feet and legs, and why spinal pelvic stabilizers are such an important aspect of chiropractic care.

References

1. Kuhn DR, Shibley NJ, Austin WM, Yochum TR. "Radiographic evaluation of weight bearing orthotics and their effect on flexible pes planus." J Manip Physiol Ther 1999; 22(4):221‑226.

2. Hyland JK, Yochum TR, Barry MS. "Bone marrow edema and postural misalignment: a preliminary report." Success Express 1996; 16(3):13.

(Dr. Mark N. Charrette is a 1980 summa cum laude graduate of Palmer College of Chiropractic. Over the past 17 years he has lectured extensively on spinal and extremity adjusting throughout the U.S., Europe, the Far East, and Australia. In 1976, he received a Bachelor's degree from Illinois State University (summa cum laude) where he was an NCAA All‑American in 1974. Dr. Charrette is a featured speaker in Foot Levelers' 2003 Fall Seminar Series and Mega Conference Series.)