A high performance hockey lads who has been experiencing shin pain (more pronounced in the left). The pain is currently affecting his game and training and therefore I wondered if I could try orthotics. I have bought the Quadrastep starter kit. I screened Tom today and found significant median and sciatic nerve tension. Median nerve R + L - 0 degrees. Just rotating the hand backwards caused significant tension in the forearm on both sides and caused the hand to shake. Sciatic nerve - R 40 degrees - back of knee and big toe / L 45 degrees - back of knee and toes - left felt significantly heavier during testing. The sciatic tension was in the toe region on both legs. Pelvic and shoulder mechanics were normal (pec minor on the right was showing slight spasm). Jacks test was worse on the right side but both were not great. R 4 - 4.5 / L 3.5 - 4. Interestingly when his foot was not fully relaxed, he went into slight supination and this affected the results. He also said that he had recently seen a physio in Australia due to the shin pain and they had taped his feet into a more supinated position. He has no LLD. The player only has 2 weeks before he goes to pre season training in the UK so we have a time element to consider. John felt it would be a good idea to try him with orthotics to see if it improved the shin pain. He has already been doing some of the POC exercises as part of his regular training and I was planning on including the other POC exercises along with the slump and median nerve releases, whilst he started with the orthotics. I know this is not normal protocol but as his pelvic and shoulder mechanics were almost normal I felt this would be okay. (Agreed) I wondered if you would take a look at the photos I took of his feet today and give me your opinion on the arch height. I found it quite confusing on the Left foot as the line is fairly steep but the arch visually looks high.
-- Edited by admin on Sunday 7th of October 2012 03:02:14 AM
Ignore the actual arch height, it’s pretty much irrelevant. Assuming your navicular points are correct, I’d say medium height. So assuming your jacks tests for a 4(you need to confirm that though), I’d look for a D, as you say he is also unlocked. If you ever unsure, go by the actual measurements (not what you see) and the logic system, and then prescribe the lowest possible prescription to have the least possible affect. Even the smallest correction can have profound impact.
MB: I saw him this morning before I managed to see your email. I tried him in both medium D and high B arch otrthotics. The B orthotic worked best for the left foot and improved his Jacks score to a 2. It felt significantly better. It didn't improve so much in the medium D although there was a very slight improvement to a 3.5. The right foot improved slightly in both the high and medium arch orthotics. He said he felt much better in the high arch B orthotics and they seemed to fit his feet much better in both the arch area and the front. As he will be going away to training camps in the UK I would appreciate your input. Both MTJs were unlocked. I know I would also retest Jacks and supination resistance with the orthotics to look for improvement.
Make sure he builds into wearing them and not just start training with them immediately full time. If his problems persist he may need something personalized, but certainly give it a go.
I have given him instructions to build up slowly and not to use them full time. I recommended 15 - 30 minutes each day and then a gradual increase. I hope this email makes sense! Thankyou so much for taking the time to read through and make your comments.It has really helped and I think I needed some confidence with this one as I am just starting out witht he orthotics (this is my second one). Sorry i wasn't more specific with the biomechanics results. On reading your notes though I feel I may have provided too much adjustment with the High arch othtoic option. My primary focus this morning was seeing which one improved his Jacks result the most but maybe I should have been happy that the medium orthotic did cause an improvement, albeit less than orthotic B. Or am I looking for the greatest improvement in foot function with the Jacks assessment?
Good question, the minimum prescription required to get a better score is where you should start, especially with an athlete. Let them adapt to that and then if necessary and possible progress to a bigger prescription (which may actually fit better)
As a final point I did consider how they felt and looked on the clients foot - I feel this is maybe wrong now and that i should stick to the testing results.
I had told the client I was not charging for the assessment and would use him as a case study, so this has taken the pressure off slightly whilst I get used to this new part of my biomechanics process.
