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Bunions, Biomechanics, and Dry Needling?
September 16, 2010

I've been experimenting with the effects of reduced heel strike and increased mid- or forefoot strike patterns on issues such as plantar fasciitis, heel spurs, bunions, and other foot maladies for my sixth book in the Fixing You series. It's been very interesting and I believe this should be an integral part of treating these conditions. But in many people, something more is needed, either because they are not being vigilant enough in changing their foot strike patterns or their issue is complicated by years of adaptations in the foot musculature and ligaments. I've begun addressing more specific soft tissue issues and my results are now even better.

In every person I've seen with bunions, however, I believe this extra attention to the soft tissues should apply specifically to the abductor hallucis and medial head of the flexor hallucis brevis muscles in addition to the transverse and oblique heads of the adductor hallucis muscle. I won't get too technical here but I believe these muscles, as well as ligament changes, must adapt over time to hold the bunion deformation in place. So even if the mechanics of the foot are restored, these muscles may not "release" the bones to return where they need to go.

I've just taken a dry needling course and will take the advanced course in the next couple of days to become certified in Colorado. Dry needling, among other things, is meant to relax needled muscles and promote healing. Regarding bunions, I wonder if I needled the muscles mentioned above, together with changing the foot strike mechanics, whether this would reduce the size and pain of bunions. It's just a thought but I'll be experimenting with this over the next few months to test my ideas. We'll see how it goes!

Marathon Training & Foot Strike Pattern
September 3, 2010

I've been training for my 3rd marathon testing my theories about foot mechanics by running in Chuck Taylors (Converse) shoes. And no, I'm not sponsored by Converse! I'm up to my 20-mile runs and am feeling very good about my foot strike mechanics (although wish I was a faster runner!). I've had no, foot, knee, hip, or back pain since switching. Previously, I would always have to correct a pelvic rotation which contributed to back and hip pain but no longer. I'm feeling very good about my new theories regarding our walking (running) patterns.

Yesterday saw a woman with bunion problems and we were able to temporarily reduce the size of her bunions by changing how she stood. Now the trick will be to get her to walk better, thereby correcting the mechanical issues, I believe to be behind her foot, hip, and back pain issues. I'm really enjoying experimenting with this as I believe our anatomy supports my theory. Of course, I have a lot to learn, however, to tweak it and make it applicable to everyone.

Holistic Success and Back Pain
August 14, 2010

Earlier this summer I flew out to California to be interviewed about back pain on The Holistic Success Show. I had a wonderful time meeting Dr. Puff, Elizabeth, and the crew. They really made me feel at home. Feel free to check out Episode 38 if you'd like to hear me speak about back pain. Feel free to contact me with your thoughts!

Plantar Fasciitis, Bunions, and Foot Mechanics
May 24, 2010

I've been experimenting with my theories about walking mechanics and chronic pain conditions such as plantar fasciitis, bunions, heel spurs, hammer toes etc. Although it has been simple to remove the pain of bunions through improved gait training, I haven't yet been able to reduce the size of the bunions--until now (I think). The problem is I took pictures of my client's bunions but mistakenly sent them to my trash. She believes (as well as I) they are reduced--dramatically. But I have no proof without those pictures!

The plantar fasciitis has been more difficult to treat. I can make the pain go away with my simple taping technique but getting people to actually alter their gait pattern consistently has been the problem. I'm now also experimenting with a simple knee taping technique to help change their gait mechanics even if they're not thinking about it. This is an interesting mental leap for me as I generally haven't considered the knee affecting the foot. Instead I've always thought of the foot affecting the knee. I think this should help though. We'll see! I'm also understanding that, for those with chronic plantar fasciitis, the foot mechanics are in a "deep hole" of poor function and so taping right off the bat is the right way to go instead of just altering gait patterns.

Ultimately my theory is that we should not need foot orthoses to fix our foot mechanics given the proper guidance.  This, in light of the fact that I cast for foot orthoses, would be a major revelation in the industry. What I am learning, however, is that changing foot strike patterns on a regular basis is more difficult than I expected. For those unable (or unwilling)  to change their patterns, foot orthoses are a good choice--assuming they are casted correctly (which many are not).

Anyway, my experiments continue and I am heartened by my results!

The Pelvis and Sciatic Pain
April 10, 2010

Sciatic pain is almost as ubiquitous as back pain in our culture. As with most chronic pain conditions, I've found sciatic pain to be a problem in people's habits such as sitting or sleeping postures as well as anatomical issues such as tight muscles in the front of the pelvis or weak muscles in the back of the pelvis.

Let's look at the anatomical players first. The sciatic nerve originates in the lumbar spine as nerve roots exiting the spine then coming together to form the sciatic nerve which passes through the back of the pelvis and continues down the leg. Often the pelvis can become tilted forward (anterior pelvic tilt), backward (posterior pelvic tilt), or rotated so that one of the pelvic bones is tilted forward while the other is not. The vast majority of sciatic pain I treat results from either an anteriorly tilted pelvis or one that is rotated.

This happens when the muscles in the front of the pelvis become symmetrically tight as with an anterior pelvic tilt or they can become asymmetrically tight creating a rotated pelvis. Correcting this tightness goes a long way toward correcting sciatic pain.

[caption id="attachment_246" align="alignleft" width="182" caption="Pelvic Asymmetry      Copyright Boone Publishing, LLC. 2009"][/caption]

Usually people with these issues also present with weakened or poorly performing gluteal muscles (the rear-end muscles). These usually turn off as a result of poor standing posture or walking mechanics. Turning these muscles on while walking or running, together with stretching the muscles in the front of the pelvis help restore normal pelvic mechanics which then restores normal spinal mechanics. The spine responds to the pelvis because both are linked so closely together. Fixing the pelvis will help fix the spine.

Let's look at sitting and sleeping postures that relate to sciatic pain now. When sitting, most often I find the knees are resting too low in relationship to the hips or the legs are too close together. This creates an anterior pelvic tilt and consequent spinal extension (arching) which can create sciatic pain. Another problem would be sitting asymmetrically so one leg is loaded more than the other. This can create a rotated pelvis also contributing to asymmetrical stress to the spinal nerve roots.

Standing habits involve locking out the knees and allowing one or both leg bones (femurs) to rotate inward too much. Both of these habits also create varying degrees of anterior pelvic tilt either symmetrical or asymmetrical.

Typically people with sciatic pain sleep on their sides which allows spinal sidebending and rotation to occur. Sleeping presents one of the hardest stresses on the spine because you are in this position for 6-9 hours each night. This can cause damage if care isn't taken to pay attention to your body. Often what I find helpful is folding a bath towel lengthwise and placing it under the waist. This removes sidebending and rotation stresses to the spine regardless of which side you are lying on. Consequently it helps sciatic pain.

These tips and others can be found in my book, Fixing You: Back Pain.

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