Attempting to progress out of orthotics.

From our FACEBOOK PAGE…….The Gait Guys here is a dialogue i had with a doc in the field today.
Q: At what point do you ditch the exercises and need to go to an orthotic? Eccentric arch exercises are great, don’t get me wrong, but with any endurance/postural exercise it takes lots… of repetitions and time to retrain the pathway. Unfortunately, most patients aren’t quite patient enough to let the exercise work or diligent enough to follow through with their HEP. On my end, since we see insurance patient with visit caps and financial caps, I usually give it 3-4 weeks and harp on the home program to be done daily. No or limited progress and I’ll consider the orthotic device. What’s your call?

A:we do isometrics, eccentrics, concentrics and dynamic variations. In our opinion it takes more attention and focus than reps. Skill first, endurance second, strength third. Reps help, but they have to be slow….yes, up to 7 seconds…..perfect progressive loading into and out of the proper mechanics……less can be more if done right. It has taken Ivo and I 35+ years to put this together, but we have a formula that works well now, finally. It has been exhausting. Yes, some patients want a silver bullet, i tell them to get the bullet elsewhere most of the time, because most of those patients have adaptive troubles to the proper orthotic and that means time in the grinding lab in our offices. That isnt productive time. Most people can be convinced since most of them have waited several months to get in to see me. Heck, i had a marathoner drive from NY to Chicago to see me 3 weeks ago! That is a sad comment on the state of this small area of problem focus. She had 8 pairs of orthotics if i recall correctly. Bad skill, and strength on bad skill. Collapsed arch, weakness abundant, frontal plane cheating, multiple saggital plane deficits. After 3 weeks of homework she already has less plantar pain after just one visit. It is about doing it right. If we give an orthotic, it is prescribed as orthotic “Therapy”. We insist on the exercise progression to either allow us to downgrade the orthotic in our grind lab, or remove it completely in a few months once they champion the change. I rarely see someone more than once every 2-3 weeks…..so i draw care out long and far over just a few visits. But there is work to do for them in between visits. They must come back with perfect form and progress, and most do. We do “Donald Trump” some clients if they don’t want to do the work. There is always someone waiting who wants to learn it.