Pain & Orthotics Introduction
One thing is for sure about custom orthotics, millions of people wear them and millions of people claim great benefits. Another thing that’s for sure is that hard surfaces like concrete that we live on are extremely hard, extremely flat and extremely unnatural. A third irrefutable observation we might make is that there is a virtual plague of lower limb and lower back pain conditions in our culture.
The lifetime prevalence of back pain in the UK is 80% of people.
28 million people are currently estimated to have hip arthritis in the United States
700,000 people receive knee replacements every year in the US. Over 90% of these are single knee replacements which casts doubt over the role of aging given that opposite knee is the same age in these individuals.
15% of all runners and 22% of all dancers suffer with shin splints. Runners knee accounts for 25% of all pain reported by those who run regularly.
15% of all adults are estimated to suffer with ankle pain on an ongoing basis.
Ankle sprains account for untold millions of emergency room visits each year, more than all upper body sports injuries put together.
Studies indicate that 77% of Americans have suffered with foot pain at some point despite being a first world demographic with the luxury of affordable, modern footwear.
An estimated 2 million people seek treatment for plantar fasciitis each year and many more attempt to self manage the condition.
Up to 60 percent of older adults are reported to suffer foot pain. Other data has indicated that 36 percent of those over 65 have bunions.
What is for certain is that there is an epidemic of pain in our lower bodies right now in much the same way as there was a plague of dental decay in the 16th Century. What’s far less certain is whether you need custom orthotics or not, and we sure as hell aren’t going to find out for here, but we may be able to gather some very useful clues.
Here are 5 signs you might have the type of mechanical issues that benefit from custom orthotic prescription.
The human body is very very good at healing. You can knit significant bone fractures, resolve huge infections and regenerate major muscle tears in a matter of weeks. Injuries by and large heal themselves given the right amount of blood flow, nutrition and appropriate rest.
Persistent pains like plantar fasciitis, hip bursitis, back pain and patellofemoral pain syndrome are all distress signals emanating from the bodies tissues. When multiple stubborn lower body pains present themselves in unison but in different ‘era’s’ it can be a signal that there is some underlying weakness or issue.
Plantar fasciitis/ankle pain/back pain may in some cases be analogous to sore throat, a cough and a high temperature, all distinct symptoms that relate to a single underlying issue. In this metaphore the ‘virus’ is weakness or dysfunction within the feet and their connections to back pain and the spine.
Stubborn pains in the lower body and lower limb are generally signs of repetetive strain or incompletely injury healing. The dynamic relationship between your leg and hard urban surfaces is by far the biggest challenge faced by the lower half of your body; and by far the most likely cause of any stubborn issues or failures to heal fully you may have. Custom orthotics are for a percentage of people an essential part of any comprehensive rehabilitation program for stubborn pains in the lower body because they assist with alignment of the foot when it bears weight on concrete.
Flat Feet or High Arches
You arches evolved while your ancestors had their bare feet ‘in the mud’. When humans move around in the big outdoors, more often than not our arches are supported by the natural squish or contour of the ground under their feet. On grasslands, sand, dirt and forest there is a certain amount of ‘flexibility’ to the ground under the foot. Soft ground works in such a way that the heel sinks in and the arch is given a supportive hug. In the urban environment there is no such support or stimulation of the human foot.
People with particularly high arches or flat feet suffer more from the stress of surfaces like concrete because they are at the extremes of the human foots need for support. This increased need for support, in combination with the urban environment is a recipe for increased incidence of not only back pain but hip pain, knee pain, ankle pain, ankle sprains, foot pain and plantar fasciitis.
Custom orthotics are an excellent way to assist flat feet and high arches with the challenge of living on hard flat ground. Flat feet receive the much needed push up from underneath from custom orthotics that natural terrain would have given them. High arches are prevented from dropping into the space left underneath them by hard flat ground, much like a natural footprint.
Most people I talk to about their bunions are labouring heavily under the assumption that their bunions have grown spontaneously, for solely genetic reasons.
The truth about bunions is that they do have a strong genetic component. The other truth about bunions is that the are brought on by the action of the arch collapsing in shoes that are too narrow, millions of times on hard surfaces over the course of a lifetime.
When the arch drops body’s weight ‘falls’ on to the head of the first metatarsal (base of the big toe). Like any bone that is constantly overloaded that metatarsal develops a callus, that’s what the enlargement of the bone is. And like any joint that is permanently overloaded the joint of the big toe deforms, that’s why the toe starts to point in a funny direction.
Basically, if you have bunions and you have issues with back pain there is a very good chance that the 2 are connected.
It is near impossible for your arch to drop often enough and hard enough to cause bunions without also doing damage to the soft tissues of your spine. If you have bunions but you don’t have custom orthotics it’s probably high time you remedied that situation. Custom orthotics will impact your bunions and feet over time the same way sitting up straight at your desk will impact the tissues of your shoulders over time. If we can sustain proper alignment over a long period of time we prevent the hunched back from developing, bunions and back pain are similar topic. The intention of custom orthotics for back pain, bunions, plantar fasciitis and just about any other lower body pain you care to mention is that they help maintain alignment!
Heaps and heaps and heaps of people suffer with plantar fasciitis, heel pain, arch pain and foot pain. Even more heaps suffer from back aches, back pain and sciatic pain. If you suffer from both back pain and foot pain there is a very good chance the 2 are connected.
The intricacies of how foot pain, plantar fasciitis and back pain manifest together is beyond the scope of this post. The basics are easy though. All persistent pains are distress signals from the body. If your feet and/or your back hurt repeatedly or persistently, by far the most likely cause of that stress is repetitive mechanical strain. That mechanical strain is most likely travelling through the foot causing strain to the soft tissues and then up the leg into the delicate spinal tissues causing stress there.
The themes here tie in with the rest of this post. High arches and low arches leave you more likely to suffer with back pain and foot pains like plantar fasciitis. Both high and low arched individuals benefit the most from custom orthotics.
If custom orthotics can prevent your arches from collapsing, they may leave you less likely to suffer with back pain and foot pains like plantar fasciitis.
Hard flat surfaces leave all of us open to strain and weakness from the foot right up to the spine. The goal of custom orthotics is to reduce tissue strain and stimulate the nerve fibres in your feet in a way that reduces weakness. All this means that in theory at least a combination of back pain and foot pain is a pretty damn good reason to consider looking into custom orthotics for your feet.
Sore Back, Hips, Glutes & Pelvis
That which we call ‘back pain’ from person to person and case to case varies a lot, ‘back pain’ is after all a symptom and not a specific disorder that can identified in the blood or even on scans and x Rays.
When I work with people who complain with lower back pain around half of them point to a section of their lumbar spine higher in the low back region. The other half point much lower down at the base of the spine (sacrum) or the no man’s land where their glute muscles meet the lowest portion of their trunk (their iliac crest).
If you have pain along your iliac crest or around your sacrum you will almost certainly feel that you have back pain. In my world though you have pelvic or hip pain, this is because your sacrum, iliac crest, their ligaments and the gluteal insertions are all portions of the hip/pelvis mechanism as opposed to the lumbar/trunk mechanism.
The reason this isn’t just nit picky medical jargon land we have arrived in is that the hip/pelvis structures are more involved in walking and running mechanism than the lumbar spine.
If you have pain very low down in your back it is likely to be feedback from your pelvic and hip structures about your gait. If you have pain ‘higher up’ in your lower back it could still be caused by your gait, but it might relate to the more common variety of trunk or core weakness. Both areas can benefit from custom orthotics prescription but the lower areas usually respond much more quickly to custom orthotics.
If you do in fact have pelvic / hip pain and opposed to true blue lumbar lower back pain there is a very good chance that custom orthotics could be a major part of the answer. This is because custom orthotics assist with movement issues in the gait cycle when we walk and run. Custom orthotics are an excellent way to reduce the strain that occurs when our feet slam down onto the likes of concrete. This reduction in strain that comes with the support and shock absorption of custom orthotics can infer great benefit to the tissues around the hips and pelvis.
Concluding Thoughts on Back Pain & Custom Orthotics
Over 25 years of research has confirmed beyond any shadow of doubt that back pain is a complex biological, phychological and even to some degree cultural phenomena. The specific physical factors that perpetuate your back pain are almost certainly complex. For this reason it is safe to assume that there is no magic bullet although breakthroughs are commonplace when you are using the right tools. Custom orthotics are (if you need them) a crucial part of the approach necessary to manage many back pain cases in the longer term.