September 2005

Orthotics in the sports chiropractic practice

by Dr. Terry A. Rondberg

In recent decades, we've learned a great deal about the impact of subluxation on the entire human musculoskeletal and neurologic system. It's no wonder, then, that chiropractors are quickly becoming a primary health resource for both professional and amateur athletes.

Being a great ball player means more than having a strong pitching arm. Excelling at tennis requires more than quick reflexes. Swimming competitively takes more than exceptional lung capacity. For each of these sports ‑‑ in fact, for ANY sport ‑‑ the entire body must be able to perform at its optimum capacity. For that to happen, the person should be subluxation‑free.

That is the primary goal of the chiropractor, and the only service a DC can offer that can't be obtained from some other type of health care provider.

Yet, is it enough to ensure that interference to the nerve flow is eliminated? For most chiropractors, particularly those who specialize in sports chiropractic, the answer is no.

That's because, particularly for athletes, adjustments don't address the root cause of many subluxations. Unlike most other patients, athletes engage in sports activities that put unique stresses on their bodies. These repeated stresses make it almost certain that they'll trigger subluxations repeatedly, unless the DC goes beyond correction and directs attention to subluxation prevention.

To do this, it's important to focus on the feet. After all, as Lou Pack, DPM, Director of Certification, Functional Foot Orthotics, Division of Enhanced Performance, United States Sports Academy, puts it, "all function, in every single sport, begins with the foot."

Pack also notes that, "there is no perfect foot, no more than any other part of our body is perfect... any degree of abnormality increases the risks of injury and decreases performance." The chiropractor might well add that any degree of abnormality increases the risk of subluxation.

In addition to helping to prevent subluxations, addressing foot problems will mean helping to prevent sports injuries, many of which are caused by over‑ or under‑pronation of the foot.

"A range of common and apparently unrelated sports injuries can be triggered by the same mechanical fault ‑‑ a tendency of one or both feet to pronate to an abnormal extent," explained British sports chiropractor Cherye Roche in Peak Performance magazine.

Controlling the pronation and the gait can vastly improve the athlete's health ‑‑ and performance. The way to control that motion of the foot is with orthotics.

"The key is to have that excessive amount of motion controlled as precisely as possible. That can often make the difference in winning ... most athletes can improve their performance and decrease injuries with a precisely made orthotic. Symptoms often disappear and optimal function is created; again, just like a pair of prescription eyeglasses. Most importantly, for the competitive athlete, a good set of orthotics can take a negative mechanical influence and make it a performance advantage," states Pack.

The American Orthopaedic Foot & Ankle Society gives the following examples of the uses of orthotics in various sports:

***  Runners and joggers wear orthotics to absorb shock at heel contact, provide control and set up the forefoot for pushoff.

***  Sprinters wear orthotics to control the movement of the forefoot.

***  Cyclists have a limited need for orthotics and wear them primarily to control the internal and external rotation of the lower leg.

***  Skiers wear orthotics to stabilize their foot in neutral and inhibit motion within the ski boot.

***  Tennis players wear orthotics to provide lateral support, to decrease shear factors, to absorb shock (especially in the forefoot) and to allow subtalar motion.

***  Basketball players wear orthotics to control the forefoot during jumping, to control the rearfoot during running and to control excessive inversion.

Although there are many different orthotic products available today ‑‑ from generic "off the rack" shoe inserts to high‑end custom made products.

According to Mark N. Charrette, DC, an NCAA All‑American who went on to become a chiropractor and an expert in orthotics, spinal and extremity adjusting: "The best orthotic for an athlete is one which will improve the function of the foot and ankle during complex and strenuous sports endeavors. This means controlling the amount of pronation, supporting the arches, and preventing excessive ankle and calcaneus eversion. Additionally, the orthotic should help improve gait, knee alignment, and both balance and the proprioceptive feedback system. The entire foot, ankle, and lower extremity must have excellent mobility to respond immediately to changes in posture and alignment."

Dr. Charrette, a featured speaker in the Foot Levelers' Seminar Series, also notes: "An orthotic used during sports must be supportive, yet flexible. It has to provide guidance for the foot and ankle, but must not hinder the natural biomechanical performance. Torsional rigidity (the ability of the orthotic to resist twisting) combined with longitudinal flexibility (especially at the forefoot) are major indicators of a good sports orthotic. I would characterize such an insert as a firm‑yet‑flexible orthotic."

Fortunately for chiropractors and their patients, tools are available that allow DCs to detect pronation and other gait problems and to help athletes obtain the best in customized orthotics. Foot Levelers, Inc., the company that has worked closely with doctors of chiropractic for years, makes it easy to provide information to patients, and even fit them for orthotics. Patients simply stand in a foam "mold," which the doctor sends to Foot Levelers. They do the rest, by making the orthotic to fit the patient's foot. Foot Levelers has become the most successful orthotics company in chiropractic since it has the top‑rated product line as well as the most complete customer support.

For more information about orthotics in sports chiropractic, contact Foot Levelers at 800‑553‑4860 or visit www.footlevelers.com.

(Dr. Terry Rondberg is president of the World Chiropractic Alliance and publisher of The Chiropractic Journal and the Journal of Vertebral Subluxation Research. A popular speaker at chiropractic conferences and seminars, Dr. Rondberg is also a frequent guest on TV and radio shows. He has written numerous articles on chiropractic for the profession and the public, as well as several best‑selling books, including "Chiropractic First," "Under the Influence of Modern Medicine," and, with Timothy J. Feuling, the "CBS Malpractice Prevention Program," and "Chiropractic: Compassion and Expectation.")