Aug
21
Written by:
Cherri Choate, DPM
8/21/2009
The most recent E-Journal article review about knee pain reminded me of a group of patients that I have seen over the years. These patients often make an appointment specifically to request fabrication of custom orthotics to alleviate their knee pain. They may be anywhere between 20 and 80 with chronic knee pain that is usually activity related. Although the activity of choice may vary, running, hiking and biking are common. They all, without exception, are active individuals who want to stay that way.
As a clinician I am always challenged by these patients. They have usually invested in a variety of orthotics and a bag full of pricey athletic shoes. Despite all their attempted interventions, their pain remains. My prescription would commonly be for a stable orthotic with a small heel lift and some type of wedge, skive or extension. Fortunately, most of the patients did improve, although I was not always clear why.
A few years ago, I started reading articles that mentioned the concept of joint coupling, which is the coordinated motion between joints and joint segments. This quantifiable relationship between joint segments may indeed be a sound basis for intervention, such as orthotics and braces that attempt to control or alter one joint by acting on a distal segment. Just how the coupling may be influenced by joint axis position, timing and pathology, has yet to be determined. The first step is to establish normal coupling expectations for each joint relationship during normal walking and running. Following this, treatment may be instituted with expected quantifiable and repeatable results.
If this subject is intriguing to you, I have listed a few articles below that are worth reading:
Dierks TA, Davis I. Discrete and continuous joint coupling relationships in uninjured recreational runners. Clin Biomech 22:581-91, 2007
DeLeo AT, Dierks TA, Ferber R, Davis IS. Lower extremity joint coupling during running: a current update. Clin Biomech 19:983-91, 2004
Woodburn J, Helliwell PS, Barker S. Changes in 3D joint kinematics support the continuous use of orthoses in the management of painful rearfoot deformity in rheumatoid arthritis. J Rheumatol 30:2356-64, 2003
Enjoy!
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