Author: Dr. Mundle

How often have you returned home from a day on your feet, craving a foot rub? Have you ever suffered from achy arches, painful balls of your feet, plantar fascitis, or achilles tendonitis? Do you have a propensity for going over on your ankles, or have chronic, recurrent knee or hip pain? You might be a candidate for custom foot orthotics.

I began researching foot orthotics in 1993 when I was the trainer for the University of Western Ontario Cross Country running team. I noticed inserts that some of the competitors were placing in their training shoes. When asked, they would often indicate that they could not train without them, as they would develop debilitating foot or lower limb pains without the orthotics. Unfortunately, most of the racing shoes would not accommodate the orthotics, so I always had lots of work to do after an event!

Since my days as a trainer, I have become fully convinced of the benefits custom foot orthotics offer.

Custom foot orthotics help the body deal with biomechanical faults commonly found in feet. “Flat footedness” or “fallen arches” are the most easily visible cues of these faults. The problems are usually due to an issue called Plastic Deformation. Plastic Deformation occurs over time, when connective tissue (ligaments and such) are placed under constant or repetitive stress. The tissue will stretch a bit when stressed, and will almost return to its pre-stretched state afterwards, but not quite. Over time, the “almost returns” accumulate, and these fractions of millimeters become millimeters. The increase in the length of the tissue allows the bones to move with more freedom, which can lead to instability and “fallen arches.”

“Fallen Arches” are a big problem. They signify a condition known as overpronation, which is a fairly complicated syndrome. Suffice it to say that overpronation can and does cause foot, leg, knee, thigh, hip and low back complaints.

Custom foot orthotics reduce the effects of overpronation. Orthotics are comfortable inserts that fit into your shoe or boot. Orthotics do not generally work well in sandals, so the orthotic companies have all developed customized sandals to deal with this problem.

The process is fairly simple. If orthotics are indicated, I will take a foam mold of your foot, then send that mold with my clinical impressions to the orthotic lab in Toronto. A little more than a week later the finished, custom-made-for-you foot orthotics are in your shoes. Customized shoes, boots and sandals are available, but they take a bit longer to ship.

The fees associated with custom foot orthotics and custom footwear are usually covered entirely or in part by your work health benefits. If you are not covered, rest assured that Napanee Chiropractic Care Centre offers the most competitive pricing in the area for custom foot orthotics.

If you remember the December issue of this newsletter, I planted a couple of seeds indicating sit-ups were bad, and I suggested why.  I will now begin to discuss a progression of exercises that have actually been scientifically proven to increasing spinal stability.  Note that I have paraphrased this information from Dr. Stuart McGill, who is considered one of the world’s foremost authorities in spinal stabilization techniques.  He is Canadian in Waterloo to boot!

Cats and camels refer to flexibility exercises.  They are relatively simple back flexion and extension movements that increase the fluidity of the entire spine.  The primary intention is motion, not stretching, so when you are doing these motions, do not over-stress the back at the ends of the motion.  You only need to do five or six of these in order to see the benefits.  Doing more repetitions will not hurt, but you will probably not see much more improvement after the first half-dozen.  If you do feel pain during these motions, I would suggest to continue to to them, but limit the range of motion to the pain free ranges.

We all know how a cat stretches when it wakes up from one of its 30 hour naps.  It is on all fours, and it arches its back up, convexly.  Guess what!  It is the same for us humanoids!  Camels have the opposite appearance. (Okay, for you picky readers, I am talking about the double humped Bactrian camels instead of the single humped Arabians)  Their backs appear to be curved downwards, in a concavity.

So, the cat/camel exercises involve getting onto all fours, then slowly and with full control moving between a relatively high arched position like a stretching cat and a relatively low arched position, pulling your belly button towards the floor.  Repeat this exercise five or more times in the morning and before you do any further stabilization exercises, and you will notice significantly more fluid motion of the back through the day.

Next time I will look into some actual stabilization exercises to do after you limber up with the cat/camel.

A recent research review has suggested what we have known for several years…that low intensity laser therapy is very effective for the treatment of acute neck pain.   The authors of the article in the December 2009 issue of the Lancet, one of the most respected medical journals, reviewed 16 randomized clinical trials, involving 820 patients.  They found that low intensity laser therapy does indeed offer statistically significant relieve from acute neck pain in both the short and medium terms.  They did not look at long term relief, as there were no studies available.

This study confirms what we have seen clinically.  For acute neck issues such as whiplash or other sprain strain injuries, I have found nothing that is more effective than our BioFlex laser.  Chronic neck issues can be frustrating at times, but we have never been disappointed in acute cases.

Paraphrased from Medscape.com

Antidepressant medications offer significant benefit in the treatment of the severest depressive symptoms, but the current standard of treatment may have little or no therapeutic benefit over and above placebo in patients with mild to moderate depression — a population which accounts for most cases.

An analysis of 6 randomized, placebo-controlled trials conducted by investigators at the University of Pennsylvania, Philadelphia, and published in the January edition of the Journal of the American Medical Association indicates that compared with placebo, the magnitude of benefit of antidepressants varies with the severity of depressive symptoms.

“True drug effects (an advantage of antidepressants over placebo) were nonexistent to negligible among depressed patients with mild, moderate, and even severe baseline symptoms, whereas they were large for patients with very severe symptoms,” the investigators, with first author Jay C. Fournier, MA, write.

“I think the most surprising part of the findings was how severe depression has to be in order to see this clinically meaningful difference emerge between medication and placebo and that the majority of depressed patients presenting for treatment do not fall into that very severe category”

According to the authors, although antidepressants are the best established treatment for major depression, there is little evidence demonstrating their efficacy in patients with less severe symptoms because most major clinical trials tend to exclude patients in the mild to moderate range.

In the meantime, he said, it is premature and potentially hazardous to suggest patients with mild to moderate depressive symptoms discontinue use of their antidepressants.

“Treatment decisions need to be made on an individual basis between patients and their doctors,” said Mr. Fournier.  He also pointed out that it is important for depressed patients to take an active role in their own care, regardless of the severity of their symptoms.  “One additional point that may be getting overlooked in the broader messages about this paper is that even placebo treatment helps a great many people, and although we don’t fully understand why that is, part of it likely comes from patients taking their symptoms seriously, acting on their concerns, and speaking with mental health professionals.

“Rather than walking away with the impression that nothing works for mild or moderate depression, I hope patients understand that treating their illness seriously and actively engaging in treatment can be quite beneficial,” he said.

For quite a few years, most personal trainers and therapists have been convinced that the best way to reduce the number of back injuries was to increase abdominal strength.  While there is some merit to this point, it is being mis-applied.  Most people, upon hearing this, decide to strengthen the abdominals by doing sit-ups or abdominal crunches.  This can lead their clients down bad paths.

In fact, researchers in the last decade have found that sit-ups drastically increase the amount of low back compression, which stress the low back discs and can lead to increased disc herniations and other pathologies.  Each sit-up produces low back compression levels that are close to the Occupational Health and Safety action limits, and repeatedly compressing the spine beyond the action limits have been conclusively shown to increase the risk of back disorders.  Instead of abdominal strength, research has shown that rehabilitation professionals and their clients should be concerned more with abdominal endurance.  This can be achieved through the implmentation of exercises such as curl-ups (much different than crunches!), planks and bird-dog exercises.  I will describe these movements in the coming issues of this newsletter.  But, for now, STOP THE MADNESS OF SIT-UPS AND CRUNCHES!!!