It’s a marvel how little patients understand about the bodies they inhabit. In the healthcare arena, pain and discomfort are big factors for going to the typical medical doctor. Most patients have been trained to seek this type of healthcare practitioner from their early days of going to the pediatrician and then to their adult GP. It comes as no surprise to us that patients become frustrated when they are told to take medication, give it 4-6 weeks of rest, or get referred for therapy and exercises that don’t work as well as the patient hopes. They feel like they are spinning their wheels.
General allopathic medicine does not excel in understanding and treating neuromusculoskeletal disorders as it tends to focus solely on the location of the individual’s pain. This approach can falter because the true cause or major contributor to the discomfort is often located in an adjacent or distal region. The true root of the ailment is frequently missed if we chase pain.
Most human beings are unaware that different regions of their body are linked together in movement patterns. The connection between the ankle, knee, hip/pelvis, lumbar spine, thoracic spine, cervical spine, and head is referred to as the Kinetic Chain.
As Chiropractors, we understand how important this Kinetic Chain is and we realize the significance of how an issue with the feet can create stress patterns that move upwards and may eventually affect the neck. We see this time and time again in the stories patients relay to us. When was the last time a patient described how their sprained ankle caused them to walk differently and they are now getting knee, hip, or lower back pain? A less intimidating term for the kinetic chain is referred to as the foot-spine connection.
This foot-spine connection ends up being a significant concept in our form of Chiropractic health care. The basic concept is that the feet are the foundation of the body. The three arches that make up the plantar vault of each foot bear the body’s weight, absorb ground shock and support us during weight bearing activities like walking and standing. In essence this relationship from the feet up to the head normally functions as a coordinated, efficient symphony of movement.
The three arches begin forming at age four are fully formed around ages 6-7. This is significant because 6-7 are the ages children can start having arch issues. It has been observed that a multitude of common clinical conditions that present to our clinics can be traced back to the feet and lower extremities. Plantar fasciitis, Achilles tendonitis, knee pain, piriformis syndrome, hip pain and lower back pain are but just a few of a longer list of these ailments.
Ninety-nine percent of people in the world are excessively pronating in a mild, moderate or severe fashion. Thus, a bountiful harvest of pronating patients are walking into your clinic daily. These folks are already experiencing the negative effects of their foot-spine connection and they just don’t know it. They are ready and hungry to learn about the root cause of their musculoskeletal problem and you are just the person to teach them.
The emphasis turns to how we explain this foot-spine connection to the different types of patients we encounter. How do we provide a consistent message so that everyone understands the basic principles of how the feet are related to the spine and their pain? No matter if it’s a brand-new patient, an existing patient, an athlete, someone dealing with chronic conditions (like iliotibial band syndrome, plantar fasciitis, low back pain, etc.), or seniors who want to be more active. We can unite everyone by having a reliable, repeatable protocol that is easy to remember.
“4 steps to Success in Teaching Patients About the Foot-Spine Connection”
1) Every single patient is scanned or scans themself on the single or dual foot Kiosk.
Whether the person is new or an existing patient, getting them scanned is paramount. The Kiosk is a digital, 3-D, Laser scanner and the software that powers it is designed to produce an incredibly accurate image of the feet while saving time for the Chiropractor and staff. Each screen leads the patient through their own story so they understand which stage of pronation their feet are in, sprinkled with some other tidbits of data. The foot-spine connection is illustrated with colors and diagrams to explain how important orthotic intervention will be for their whole-body health.
2) Utilize the 3 Arch Advantage: Plantar Vault picture
When talking to a new patient, I hand them the following diagram illustrating the presence of the three arches.
Foot Levelers has this visual aid available for their customers. The patient holds this picture in their hands while I show them on their feet the location of the arches and how they begin to drop or flatten out after ages 6-7. People rarely notice what their feet look like and since they see them every day, they appear “normal”. Some patients hate their bunions or the remark how “ugly” their feet look. Everyone’s feet tell a story so it’s time for you to help them listen.
I also explain morphological changes of their feet as patients often have bunions, callouses, corns, hammer toes and hallux valgus. I tell them how these conditions can be symptoms of body instability.
Almost every patient is unaware they have more than one arch and they don’t realize that the 52 bones in both feet make up 25% of the bones in the human body.. They really start to understand that as their arches collapse and the feet undergo increased stress, the appearance of the feet change. It takes months to years for these negative changes to occur.
3) Show the Crooked Man Diagram:
I replace the three-arch diagram in their hands with the laminated crooked man diagram below:
While the patient holds this picture, I point out how the left foot is pronating more than the right foot and the resultant effect this has on the tibia all the way up the leg, pelvis, spine, shoulders, and the neck.
I use my hands to move and accentuate the internal rotation of the tibia/femur/patella. I continue by palpating and pointing out the posterior stress on the hip, the tilting and rotation of both sides of the pelvis, and the resultant slight curvature of the lumbar and thoracic spines. I reveal the shoulder asymmetry and finish with the neck and occiput regions. The Crooked Man picture gives an excellent visual of the body-wide changes that can affect the frame from the toes to the nose.
4) Muscle Testing with the Proprioceptive Test Kit:
This is where I bring it all together. I do a standing muscle test on the patient with their feet on top of a pair of “sample orthotics”. These samples are referred to as the proprioceptive test kit and can be ordered through Foot Levelers customer service. This test illustrates to the patient how arch stability can have an effect on the upper body and shoulders. It’s an amazing test that visually illustrates a before and after effect and patients really respond to it.
This test kit comes with two pairs of sample orthotics so you can accommodate for smaller or larger feet. If you look at the directions included in the packaging, you can see how the standing muscle test with using one (or both) arms illustrates how weak the patient’s arm is while standing on their bare, flat feet. Then, while standing on the test orthotics, the arm test is repeated as the patient notices their arms strengthen significantly.
Another option is to do the squat test with arms in the air, standing on their bare feet. Once you observe them squat once or twice, you point out the asymmetries and movement patterns between both knees, hips and the spine. Then place the test orthotics underneath them and have them repeat the test. When they do their squat this next time, she will see how much more symmetrical and smooth the squat becomes.
Patients are amazed at the difference the test orthotics make. I ask them to imagine how much greater the difference would be, and how much better they could feel, if they were using custom orthotics that matched their own prescription.
Utilizing these four steps outlined above allows you to fully explore and explain the foot-spine connection in ways that patients can understand. No matter if the person is young, elderly, an athlete, a desk jockey, injured or non-injured, this protocol covers many angles and will help you educate the patients on the foot-spine connection. Patients love learning about their bodies from the ground up and they appreciate the time you will take to help them understand. Afterward, you can extend the conversation by advising them on the custom orthotic stabilization that’s right for them.
Dr. Kevin M. Wong, DC is a graduate of the University of California, Davis, and a 1996 Summa Cum Laude graduate of Palmer College of Chiropractic West. He has been in practice for over 25 years and is the owner of Orinda Chiropractic & Laser Center in Orinda, CA.
As a member of Foot Levelers Speakers Bureau since 2004, Dr. Wong travels the country speaking on extremity and spinal adjusting. See upcoming events with Dr. Wong and other Foot Levelers speakers at footlevelers.com/seminars. Check out his monthly blogs with proven practice tips to help you achieve optimal patient outcomes.