Session 18 – The Myth of ‘Over-Pronation’ with Ian Griffiths

Jun 07, 2015
CH Admin

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Session 18 – The Myth of ‘Over-Pronation’ with Ian Griffiths

Session 18 features an interview with Ian Griffiths, self employed sports podiatrist consulting out of a variety of top sports medicine clinics in London and more recently in Dublin. Jack and Ian discuss a variety of myths and misconceptions around the foot and ankle including; the mechanism of effect of orthoses, the tissue stress approach and far flung proximal kinematic ‘flaw’ corrections.

Many thanks to Firefly orthoses who have sponsored session 18. Check out their website if you’re in the market for custom devices, www.firefly.ie

Twitter: @TPMPodcast @Chews_Health @Sports_Pod

Podcast Timeline:

00.00 – 1.29

Podcast Intro and monthly review

Intro to Firefly.

 

1.32 – 7.00   Intro to Ian “Griff” Griffiths.

– Ian’s Clinical journey and evolution of thought processes through the multidisciplinary team.

– The effect of isolation on potential clinical complacency.

– What were your podiatry foundations following university.

 

7.10 – 15.45   The problem with the “Over-Pronation” paradigm and Setting the record straight 

– The current model of “normal”/optimal foot parameters.

– Making complexity too simple.

– Inter and intra-rater reliability issues in measuring foot posture categories.

 

15.45 – 18.57    How the classic model dictated treatment – “If you’re not vertical or neutral, you’re not right.”

– Where does the evidence suggest we focus the management of foot problems?

– The 1000 Norms Project – What do we mean by “normal”.

– The foot posture index in pain free individuals and the deviation from the mean.

 

18.58 – 25.07   “What do you therefore assess?”

– The tissue stress model and the 3 step process.

– Why the old model doesn’t work within this tissue stress model.

– Embracing the variation of the individual.

 

25.08 – 36.45    “What does an orthotic device do?”

– Historical thoughts on orthoses mechanism of effect.

– Load management

– Neuromotor and psychological effects of orthoses.

– Kinematics vs kinetics and the See-Saw metaphor.

 

36.53 – 44.42   “How to approach the patient who believes pronation as a causative factor in their problem?”

– Picking your communication style based on the patient.

– If not over pronation then what should we use instead?….Danny Dyer’s Chocolate Homunculus.

– “I pronate more than I supinate” – The problem with sub talar neutral and the hotel lift metaphor.

– Being brave enough to challenge beliefs and debunking myths.

 

44.50 – 50.45    “Why would the same pair of orthotics help treat the pain of 2 different patients with 2 different problems?”

– The introduction of change to the loading of tissues – the relationship between internal and external forces.

– When are orthotics indicated?

– Feasibility of effect of orthoses on proximal structures – the variability of motion coupling in the body.

 

50.48 – 55.20   “Is the foot the route of all heartache” – the system wide effects of biomechanics.

– Understanding of the human foot – a work in process…..

– Embracing variation.

– Childhood ankle injury and adulthood shoulder pain?…..”Keep an open mind, but not so open your brain falls out!”

– The scientific method, “Just because A is wrong, doesn’t mean B is right.”

 

55.27 – 1.02.27   Take home messages for clinic.

– “Should an orthotic be permanent?” – The spectacle (false) metaphor.

– Foot position and clinical correlation with pathology.

– Customised vs off-the-shelf orthotics.

– “What are you trying to achieve?” – Clinical reasoning.

– The envelope of success.

 

1.02.28 – 1.05.19   “Longing for the ‘good old days’!”

– The reality of prescribing orthotic measurements based on symptomology

– Firefly orthotic lab – the future of orthotic design and manufacture.

 

1.05.20 – 1.07.05   Summary and acknowledgements.

 

1.07.12 – 1.09.10   Jack’s thoughts and statement from Firefly Orthoses.

Previous episodes:

Session 1 – Patellofemoral Pain Syndrome with Dr Lee Herrington – Part 1

Session 2 – Patellofemoral Pain Syndrome with Dr Lee Herrington – Part 2

Session 3 – The Rugby Shoulder with Dr Ian Horsley

Session 4 – Know Pain: Metaphoric Expression with Mike Stewart – Part 1

Session 5 – Know Pain: Metaphoric Expression with Mike Stewart – Part 2

Session 6 – Achilles Tendons with Seth O’Neill

Session 7 – Critical Thinking, Twitter & Manual Therapy Myths with Adam Meakins

Session 8 – Haemodynamics with Alan Taylor

Session 9 – Psychological Interventions in Physiotherapy with Dr Richard Bennett

Session 10 – Exercise Promotion with Ann Gates

Session 11 – Treating Tendons with Seth O’Neill

Session 12 – The big Kinesiology Tape Debate – ‘To KT, or not to KT’ with Paul Coker and Paul Westwood

Session 13 – A Year in Podcasts with The Physio Matters Podcast Team

Session 14 – The Unstable Concept of Core Stability with Ben Smith

Session 15 – Does Work Matter with Heather Watson

Session 16 – Biomechanics and Pain: The Ongoing Dilemma with Greg Lehman

Session 17 – Building & maintaining an award winning MSK service with Paula Deacon