Do orthotic insoles help with knee pain in runners? Leading Brighton Chiropractor answers

Knee pain is common in runners and a common cause is the patella or knee cap. Pain caused by the patella is often called patello-femoral syndrome or PFS for short. The pain can be severe enough to stop runners going out but also occurs in other sports people and non-sports people alike.

Chiropractor and physio treatment in Brighton

The research on PFS treatment is poor. The studies that have been done are often of poor quality and come up with conflicting results for all sorts of treatment and this can be confusing not only if you are a runner looking for something to help but also if you are a physio or a chiropractor treating these common knee problems.

One of the recent reviews (1) looking at all the evidence for orthotics in the treatment of PFS, sometimes called Runners Knee, found little difference between the groups given orthotics and those given flat insoles which were supposed to do nothing. The other trial which met the criteria compared physio exercises and orthotics. Again not much difference was found between the 2 groups. Delving deeper into the 2 trials reveals why the orthotics groups did not do so well as groups in other trials – but more of that below.

Another study (2) into patello-femoral pain found that orthotics may indeed help. In fact more than three quarters of the runners involved improved. The authors concluded that orthotic or orthoses as they called them may have had a significant effect. This study was excluded from the larger review because it did not meet all the inclusion and exclusion criteria. For example some of the patients were only 12 years old and the study was not a randomised controlled trial.

The difference with this small study and the previous review is that the runners were analysed much more carefully. Their feet, ankles and knees were measured and an orthotic prescribed if they had the right sort of problem.

Chiropractic treatment may help

There are many different causes of PFS. One cause is thought to be over-pronation or excessive flattening of the arch after the heel strikes the ground. If you have over-pronation and it is contributing to PFS then you may respond well to the correct orthotic. If you have PFS from another cause, a weak thigh muscle for instance an orthotic will be a waste of time. In this case a pelvic joint manipulation by a chiropractor may help as in this study (3).

A correct diagnosis of the knee pain is essential for the correct treatment to be applied. A thorough examination should reveal the cause of the problem so that the right treatment can be applied. Too often clinicians use a one size fits all approach that is doomed to fail. This may well also explain why some studies don’t show an improvement whereas others do.

Orthotic buying advice

You can spend a fortune on a custom made orthotic and except in rare cases it is completely un-necessary. Other trials comparing custom made orthotics, often costing several hundred pounds, with much cheaper off-the-peg versions fail to show a difference in the outcome of symptoms.

We have found Superfeet insoles an effective and cost-effective option. They cost between £25-32 and are available on an unconditional money back guarantee from the manufacturer. So even if you don’t have faith that they might work for you it is worth giving them a try but only if you over-pronate. Many running and hiking shops as well as clinics sell them.

For more information you might like to look at a presentation given in June 2011 to the European Chiropractors Conference in Zurich here

Matthew Bennett DC

Sundial chiropractor working with Brighton and Hove Albion and previously with the British Alpine Ski Team.

References

1.Hossain M, Alexander P, Burls A, Jobanputra P. Foot orthoses for patellofemoral pain in adults. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD008402. DOI: 10.1002/14651858.CD008402.pub2.

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008402.pub2/full

2.The Lower Extremity 5(2): 95-102, 1998. Copyright © 1998. Reprinted with permission from Elsevier and the American College of Foot and Ankle Orthopedics and Medicine. Journal of the American Podiatric Medical Association http://www.japmaonline.org/content/93/4/264.abstract

3. Journal of Manipulative and Physiological Therapeutics Volume 22, Issue 3, March-April 1999, Pages 149-153

http://www.jmptonline.org/article/S0161-4754(99)70128-4/abstract

4. A comparison of rearfoot motion control and comfort between custom and semicustom foot orthotic devices. Davis IS; Zifchock RA; DeLeo AT. Journal – American Podiatric Ass, Sep 1, 2008; 98(5): 394-403

Counselling & Chiropractic in Brighton, by guest contributor Diane Hedge

Just as chiropractic allows your body to start its own healing process, so counselling can help you recognise how the way you think and feel impacts on your physical health.

It’s part of our language to recognise the body/mind connection, as in:  “He’s a pain in the neck.”  “It’s a headache”.

What counselling can do is help you tune in to the message that your body is giving you.  It allows quiet and reflective space to acknowledge what may be the real source of your pain.  Stress, anxiety, depression and grief don’t just happen in our heads, they’re right in there at a cellular level, in the gut, in our breathing, in our stiff backs and necks.  When we start to listen to what our bodies are saying, we can work with it.  I often say to clients:  “If you treated your car like this, what would happen?”  And their rueful response is often “It’d be broken down at the side of the road.”

The most body-focussed counselling is psychodynamic.  It works on the principle that our history is stored in our feelings.  So, instead of dismissing “random” thoughts and feelings as illogical, you’ll be encouraged to be respectful of the source of those feelings.  Very often we run on old software without realising it.  Counselling allows us to “map” old patterns of behaviour.  And knowing the map means we can recognise when what we feel is in the now or belongs to us, say, when we’re growing up.  That insight is empowering, gives us choices in how we run our lives.

Brighton Chiropractors and Counsellor working together

Your chiropractor, of course, is there to treat your body.  He/she will, as part of that, be asking how you are “using” your body.  Are you hunched over a computer for much of the day?  Do you have to drive a lot?  What are the stressors (physical and emotional) in your life? How do you handle them?  In short, listen to your body – it may be trying to tell you something.

Diane Hedge mbacp

Counsellor & Psychotherapist

www.brighton-hove-therapy.com

Back Pain in Children – top tips for prevention

It is incredible to think that even children can get back pain but it’s true. At Sundial we did free half-term kids and teachers chiropractic checks in Brighton. 32 per cent of six and seven year olds get back ache at some time according to research by the British Chiropractic Association. This rises to 45 percent by the age of eleven. To highlight this issue the focus of last year’s BackCare Awareness Week, 17th-23rd October, was school children and their teachers.

One of the main reasons school children are prone to getting back strains is because they are carrying heavy school bags. Now school lockers are no longer available in most schools, children have to carry a bag with the full day’s books as well as all the other stuff that they need. Some kids carry all their books around for the whole week and then games bags as well. An adult wouldn’t put up with it.

Not only are the bags heavy they are often not very well designed. A hand strap sport type bag or book bag means all the weight is carried on one side of the body. A better option is a shoulder strap ideally carried across the body. The option, however, is a rucksack with both shoulder straps used and has been shown to reduce back pain by a third.

School Chairs Cause Back Problems

Schools themselves can also do more to prevent back problems in their students. Budget constraints mean that classroom chairs are often cheap and nasty providing poor support and no adjustability. If an adult was provided with a similar design of chair they would refuse to work in it for more than a few minutes with out screaming for a better one. Indeed, employers have a legal duty to provide a decent chair which is fully adjustable and supportive. Schools have no such duty.

Brighton Chiropractor Interviewed by BBC

The fashion of having children seated in groups around circular tables also adds to back strain some children have their back to the teacher and are constantly twisting round to see what is going on at the front of the class. Chairs that swivel would make this much safer. See an interview with Brighton chiropractor, Matthew Bennett by BBC Newsround on this issue here.

It is not just poor chairs that are associated with more back pain in school kids. The length of lessons themselves is also associated with more back aches. The longer the lesson the more aches and pains children reported in a study at the University of Surrey. Researchers visited classrooms and looked at what children were sitting on and how they perched on chairs as well other factors like length of lessons and how much movement was allowed. They found that if children sat in a flexed posture they had an increased incidence of low back pain. If the children did not move much and sat still they had an increase in upper back and neck pain.

Lifestyle Factors

A recent survey by Ofcom showed that computer game use and watching DVD’s has actually declined in teenagers it has been replaced by other screen based entertainment such as iPads and laptops to browse the internet as well as texting. In fact most teenagers do these things whilst also watching television. It is not just teenagers who are glued to screens, 40 percent of five year olds use an internet enabled computer at home.

But does this digital overload lead to health problems. Previously boffins in Scandinavia found that increasing television watching led to an increase in back ache in children. Certainly sedentary lifestyles have been associated with more back pain in children but does screen time also lead to obesity. The answer is maybe.

Studies are unclear whether gaming and computer use are one cause of obesity. Still, it is probably a good thing if children are running around rather than sitting around. Weak core abdominal and back muscles are more likely in children who get back trouble. It seems however, that you can have too much exercise if you are a child. High level sport and training is associated with more pain.

If a child does get a bout of back pain it will usually disappear in a few days. For a third of kids this doesn’t happen however and they go on to have longer term or recurrent symptoms.  It is important to take steps to reduce the postural stresses and other lifestyle factors that can aggravate the spine and if symptoms are not resolving to get a chiropractic check up.

At Sundial we are doing free half-term kids and teachers checks and have reduced our treatment fee to £24, saving £10 per visit. For a video showing treatment of a six year old go here.

Top Ten Tips to Prevent Back Pain In Children

  1. Use a back pack and use both shoulder straps
  2. Ask the school if they have ergonomic chairs
  3. Don’t sit on the floor to play computer games, use a chair
  4. Don’t allow long periods of laptop use in a poor posture
  5. Limit television to 1-2 hours maximum per day
  6. Ideally use a PC rather than a laptop
  7. Set up the computer screen so the top is at eye level
  8. Consider a office swivel chair at a desk for homework
  9. Build in active games and moderate levels of sport
  10. Get a chiropractic check-up if back or neck pain persists

Further information

https://sundialclinics.co.uk/2008/11/

http://www.advms.pl/?q=system/files/53_52SBockowski.pdf

http://www.ft.com/cms/s/0/779f55c2-5110-11dc-8e9d-0000779fd2ac.html#axzz1b7a3nwEv

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=40136

Troussler B et al. Back pain in school children: A study among 1178 pupils. Scandinavian Journal of Rehabilitative Medicine, 1994, Vol 26, 143-146.

Lifting Training Video From the Archive Starring Brighton Chiropractor

Nearly 20 years Matthew took part in a training programme to help a national pub chain reduce injuries due to lifting. He helped put a seminar series and video together to help publicans and their staff prevent back pain on the job. Roy Castle and Geoff Capes were the talent. Matthew says “It was a gruelling 16 hour day of shooting. The director couldn’t make his mind up about how to do it and the shots took ages to set up. Geoff and I were getting tired and cranky by 10pm but Roy was as cheerful at the end as he was at the start of the day.”
Here it is.

Is the pop necessary for our chiropractic adjustment to be effective?

Chiropractic BrightonSome people love it, some people hate it but the pop or click associated with chiropractic spinal adjustments or manipulation is thought to be the beneficial bit of chiropractic care by many people. But is this right? If a joint doesn’t pop does this mean the treatment hasn’t worked and you won’t get better.

This very question was studied recently using 40 people as guinea pigs. There pain sensitivity was measured by using a hot probe on their leg or foot. Ouch! The individuals then received a spinal manipulation and then retested to see if they could bear a hotter probe. Interestingly, the people who popped and the people who didn’t pop both had the same improvement in pain sensitivity. In other words they could bear hotter probe after treatment whether or not they’re back popped with the manipulation.

So what does this mean for you if you have chiropractic treatment? Well, essentially it means if your back doesn’t pop when we adjust it, you will still get better just as quickly. This is good news for people who don’t like the click because, as much as chiropractors like it, it doesn’t seem to make much difference. For a chiropractic technique without the clicking that we carry out here in Brighton go here.

Of course the other thing to remember from this study is that if a researcher asks you if you want to take part in an experiment to do with pain – run a mile!

Reference:-

The relationship of the audible pop to hypoalgesia associated with high-velocity, low-amplitude thrust manipulation: a secondary analysis of an experimental study in pain-free participants.

Bialosky JE, Bishop MD, Robinson ME, George SZ; University of Florida Department of Physical Therapy.

Journal of Manipulative & Physiological Therapeutics 2010; 33: 117-124.