I have a new client who I have recently screened. He has worn orthotics for the last four years. Over the last year he has developed tendonitus in both knees and in Nov 12 he had a grade two tear in his right hamstring. He has a LLD of 1.5cm with his left leg being shorter, thus the orthotics. He was very asymmetric on 4 sign, in gillets he was negative. I gave him 4sign to begin with. I don't know much about orthotics, although I realise they were prescribed to address the LLD and the extra pressure on the left hip as a result of the discrepancy. They don't seem to have done much given the tendonitus and recent hamstring tear. He is a keen runner and five a side player.
Any info on orthotics and their effects would be useful.
Thanks
So many variables with this, its hard to be specific; I have known people take the orthotics out immediately and had better results and i've also known people take them out and their pain gets worse.
As a general rule though, do the foot screens and if they have biomechanical problems that would indicate orthotics being helpful, then leave them in. if they are presenting very mild foot mechanical problems and our screening protocol wouldnt suggest orthotics, then take them out (especialy if their symptoms are getting worse).
However, if their orthotics are corecting an LLD and they have a dysf****ional pelvis then the 'raise aspect' of the orthotics should be removed, irrespective of their biomechanical issue with their feet. Its hard to correct the pelvis if the heel raise is constantly causing it compensate abnormally.
Thanks Martin, unfortunately I have only completed the 1st biomechanics course so can't do the foot screens at present (am booked in for July), which probably means I only have half the information I need. He has been seeing a physio although I don't think it is the one who prescribed the orthotic, originally the prescription was to counter LLD & flat feet. Maybe i should speak to him. Aside from 4 sign, in the Thomas test his Rec Fem was tight, so I'm thinking of adding hip flexor brace to the 4 sign ex he is already doing? The pelvis was dysfunctional on the LHS in downings as well as 4sign although not Gilletts........ I will suggest changing the orthotics to remove the raise.
Thanks for the advice.
Hi, it may be worth asking the physio whether they feel there are any biomchanical problems with the feet which requires the orthotic prescription or whether the mechanical problems are compensations for intrinsic biomechanical problems further up the chain. the physio may not understansd that but thats what you need to know. eitherway the raise needs to be removed if the pelvic screens are posiitve.
