Sagittal plane blockage of the foot, ankle and hallux and foot alignment-prevalence and association with low back pain

Director for Research and Associate Professor, Cleveland Chiropractic College Los Angeles.
Journal of chiropractic medicine 02/2006; 5(4):123-7. DOI: 10.1016/S0899-3467(07)60144-X
Source: PubMed


Some practitioners believe mechanical low back pain may be caused or aggravated by a stiff ankle, stiff great toe or flat feet. This study investigates subjects with and without mechanical low back pain and measures ankle and great toe range of motion and flattening of the medial longitudinal arch in both groups.
The study was a blinded, 2-arm, non- randomized clinical study involving 100 subjects with chronic or recurrent mechanical low back pain (intervention group) and 104 subjects without chronic mechanical low back pain (control group) between the ages of 18 and 45. A blind assessor performed weight-bearing goniometry of the ankle and big toe and the navicular drop test on all subjects in both groups.
An independent t-test (inter-group) revealed a statistically significant decrease (p </= 0.05) in ankle dorsiflexion range of motion in individuals with chronic mechanical low back pain. The independent t-test suggested individuals with chronic mechanical low back pain have a significantly smaller navicular drop and higher arches (p < 0.05).
This study supports previous reports suggesting decreased ankle dorsiflexion may be a factor in chronic mechanical low-back pain. Further research and replication of this study is necessary before firm conclusions or recommendations can be made.

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Available from: Junaid Shaik, Jan 15, 2014
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    • "Physical therapists often deliver manual therapy and/or orthotic interventions to the tarso-metatarsal, subtalar, or talocrural joints in order to manage patients with low back pain;195–199 likewise, the insertion of needles without injectate into bodily areas that are asymptomatic but distal or proximal to the site of pain is supported by the myofascial pain syndrome literature.149 As Melzack et al.27 points out: "
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    ABSTRACT: Background: Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an ‘intramuscular’ procedure involving the isolated treatment of ‘myofascial trigger points’ (MTrPs). Objectives: To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions. Major findings: According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. ‘sensitive loci’ or ‘nociceptors’) when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners. Conclusions: Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as ‘pistoning’ or ‘sparrow pecking’; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical ‘acupuncture’ literature that have used the very same ‘dry needles’ to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, physical therapy associations and state boards of physical therapy should consider broadening the definition of dry needling to encompass the stimulation of neural, muscular, and connective tissues, not just ‘TrPs’.
    Physical Therapy Reviews 08/2014; 19(4):252-265. DOI:10.1179/108331913X13844245102034
    • "It is therefore, difficult to determine which of these factors causes the other. Brantingham and colleagues [38] conducted a blinded non-randomised study of 204 participants, with and without recurrent or chronic mechanical LBP, and found that persons with mechanical LBP were more likely to have an average of 2.2  less dorsiflexion in the right ankle (p = 0.002), and 1.7  in the left (p = 0.032); and an increased navicular drop by an average of 1.7 mm on the right (p = 0.003) and 1.6 mm on the left (p = 0.009). The same researchers were not able to confirm these findings in a smaller subsequent study [39], which suffered from limitations such as: small sample size; low power; and mild severity of back pain in the subjects recruited. "
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    ABSTRACT: Mechanical low back pain is a very common, expensive, and significant health issue in the western world. Functional musculoskeletal conditions are widely thought to cause mechanical low back pain. The role of foot posture and leg length discrepancy in contributing to abnormal biomechanics of the lumbopelvic region and low back pain is not sufficiently investigated. This critical review examines the evidence for the association between foot function, particularly pronation, and mechanical LBP. It also explores the evidence for a role for foot orthoses in the treatment of this condition. There is a body of evidence to support the notion that foot posture, particularly hyperpronation, is associated with mechanical low back pain. Mechanisms that have been put forward to account for this finding are based on either mechanical postural changes or alterations in muscular activity in the lumbar and pelvic muscles. More research is needed to explore and quantify the effects of foot orthoses on treatment of particularly chronic LBP, especially their effects on lumbopelvic muscle function and posture. The clinical implications of this work are significant since foot orthoses represent a simple and potentially effective therapeutic measure for a clinical condition of high personal and social burden.
    The Foot 06/2014; 24(2). DOI:10.1016/j.foot.2014.03.004
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    • "Dysfunction of the foot and the ankle joint of stroke patients are closely associated with functional and kinetic aspects of the lumbar region and lower limbs, inevitably triggering overall body imbalance9). The ankle joint and the hip joint play important roles in providing body stability during stroke patients’ balance training. "
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    ABSTRACT: [Purpose] This study examined the effects of an ankle-foot orthosis worn during balance training on lower limb muscle activity and static balance of chronic stroke patients. [Subjects] The subjects were twenty-five inpatients receiving physical therapy for chronic stroke. [Methods] The chronic stroke patients were divided into two groups: thirteen patients were assigned to the ankle-foot orthosis group, while the remaining twelve patients wore only their shoes. Each group performed balance training for 20 minutes, twice per day, 5 days per week, for 6 weeks. The lower limb muscle activities of the paralyzed side tibialis anterior, medial gastrocnemius, and the stability index were measured before and after the 6-week intervention. [Results] Comparison of the groups indicated a significant difference in the muscle activity of the paralyzed side tibialis anterior and the stability index of the eyes-open standing position. After the intervention, the ankle-foot orthosis group evidenced a significant difference in the muscle activities of the paralyzed side tibialis anterior and paralyzed side medial gastrocnemius as well as the stability index of the eyes-open standing position, eyes-closed standing position, eyes-open standing position on a sponge, and eyes-closed standing position on a sponge. The group that only wore their shoes showed significant differences in the stability indexes of eyes-open standing and eyes-open standing on a sponge. [Conclusion] Using the ankle-foot orthosis was effective during the initial training of lower limb muscle activities and the static balance training of chronic stroke patients. However, it was not effective for a variety of dynamic situations.
    Journal of Physical Therapy Science 02/2014; 26(2):179-82. DOI:10.1589/jpts.26.179 · 0.39 Impact Factor
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