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Chronic Pain and Podiatry
I would like to talk about chronic pain and it’s frequent source in faulty posture and balance. How does an arthritic knee, and its necessary gait compensations create pain elsewhere, such as one’s heel or hip? Through feedback from the involuntary part of the nervous system. If one part is not working well or is in chronic pain, we will shift the effort to another part. We are usually not conscious to these subtle changes in balance and posture. So someone with a developing knee problem might first complain of their sore heel….
The more fit a person is, the more successful they tend to be in compensatory gait. They have more options, because more parts are in working order, to tolerate a shift in the load. A healthy runner who consistently logs 20 miles a week may get pain in ONE of many locations from an arthritic toe – heel, hip, iliotibial band or 5th metatarsal head.
A patient with an arthritic back, arthritic knee and rigid big toe joint will have pain in all locations. There’s nowhere else to go.
These multi-injured patients start to break down at a rate much faster than a healthier person with a single injury. They “wear and tear” faster. Here’s one reason why:
Nerve entrapment in the hand, foot or spine, or injured or arthritic joints lack the normal range of motion associated with walking. Walking is 70% a free ride on gravity, in which we benefit from momentum (the swing phase of gait)…we coast. If our balance is compromised by an unreliable body part, we slow down in order to not fall over. We move side to side instead of forward, and shorten our stride. When we shorten our stride, we increase our weight-bearing phase of gait and decrease the swing phase. This increases our energy costs – we aren’t taking advantage of swing. We aren’t taking advantage of the free ride. How many of you have more pain and fatigue standing than you do walking?
In order to benefit from the ergonomic economy of normal gait, your brain (interpreting sensory input) has to be secure in your balance – it can’t be afraid of falling over. Your involuntary nervous system will initiate balance strategies (COMPENSATION) in order for you to stay upright. It does this through feedback from your feet, as well as proprioceptive cells around our joints. This compensation slows you down.
The more patients promptly seek and implement treatment for their injuries, the more agile they remain.
I perform a balance test on my patients presenting with chronic injuries. It is a series of neurological reflexes to look for nerve entrapments and weakness from early-stage injuries. Then, I use a combination of orthotics (OTC and prescription), transdermal prescriptions for inflammation, cortisone shots and physical therapy to resolve patients’ injuries as quickly as possible. Surgery is a last resort. The less chronic pain in everyone’s lives, the better.
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