RE: Orthotics and overpronation

April 5, 2006

Hey and others,

I'd like to use your post to open a thread on orthotics use and

overpronation. I'd be interested on any thoughts you folks have on the

following comments and questions, provided you can tear yourself away from

the most recent ODOC vs. CAO postings. As a disclaimer, I " believe " in

overpronation but the jury is still out on Santa Claus.

1. I have heard it said that overpronation occurs in ~80% of the

population, if so, is it pathological?

2. Do any of you use so called " short foot " exercises per Janda, to address

overpronation?

3. If long term restriction of motion about a joint results in muscle

atrophy and overdependence on primary joint stabilizers, then are shoes (by

their limiting of foot biomechanics) a primary cause of overpronation.

4. Have any of you had experience with Barefoot Science

(www.barefootscience.com) orthotics?

5. If Barefoot Science orthotics are so good, why do I now have plantar

fascitis in a previously well foot after following their instructions for

use?

6. If 80% of the population overpronates, and 50% of orthotics are

prescribed by DCs, how many chiropractors' incomes will be adversely

affected by critically thinking about whether orthotics interfere or aid the

body's innate ability to heal itself?

Faulty syllogisms, misspellings, and rambling nonsense freely submitted for

your appraisal. Take care and let's have fun out there.

W. Snell, D.C.

Hawthorne Wellness Center

3942 SE Hawthorne Blvd.

Portland, OR 97214

Ph. 503-235-5484

Fax 503-235-3956

drpsnell.chiroweb.com

>From: " Knecht " <allenknecht@...>

>Reply-allen@...

>skrndc1@..., dm.bones@...,

>Subject: RE: Don't cut those menisci

>Date: Wed, 05 Apr 2006 00:17:38 -0700

>

>Actually you need to address both the pelvis and overpronation syndrome to

>fix a knee and or hip degeneration.

>

><html><DIV> Knecht DC </DIV>Namaste Chiropractic

><DIV></DIV>1809 NW

><DIV></DIV>Portland, OR 97209

><DIV></DIV>503-226-8010</html>

>

>From: " sunny Kierstyn " <skrndc1@...>

>dm.bones@...,

>Subject: RE: Don't cut those menisci

>Date: Tue, 04 Apr 2006 07:29:32 -0700

>

>How long do you think it will be before they figure out that in order to

>fix

>a knee you have to fix the pelvis????? Bets, anyone?

>

>Sunny

>

>Sunny Kierstyn, RN DC

>Fibromyalgia Care Center of Oregon

>2677 Willakenzie Road, 7C

>

>Eugene, Oregon, 97401

>

>541- 344- 0509; Fx; 541- 344- 0955

>

>From: " dm.bones@... " <dm.bones@...>

>listserve (E-mail) < >

>Subject: Don't cut those menisci

>Date: Tue, 4 Apr 2006 06:39:53 -0700

>

><< mpt_print.gif >>

>

> Visit us online at www.MedPageToday.com

>

><< spacer.gif >>

>

>Arthritic Knee Procedures May Lead to Future Deterioration

>

><< blue_dot.gif >>

>

>By Jeff Minerd, MedPage Today Staff Writer

>Reviewed by Jasmer, MD; Assistant Professor of Medicine, University

>of California, San Francisco

>February 27, 2006

>

><< blue_dot.gif >>

>

>MedPage Today Action Points

>• Explain to interested patients with osteoarthritis of the knee that,

>according to this study, meniscectomy or arthroscopic debridement may place

>patients at increased risk for loss of cartilage in the joint.

>

>• Consider non-surgical alternatives to managing knee pain in

>osteoarthritis

>patients, including weight loss and exercise, knee braces, motion control

>shoes, and analgesics and anti-inflammatory drugs.

>

>Review

>BOSTON, Feb. 27 - Removal part or all of a damaged meniscus to ease

>osteoarthritic knee pain may be detrimental to the joint over the long

>haul,

>a study here suggested.

>

>Reductions in the thickness of menisci or the amount of joint area they

>covered were significantly associated with subsequent loss of cartilage in

>the knee, reported J. Hunter, M.D., of Boston University in the March

>issue of

>Arthritis & Rheumatism.

>

>Because menisci pad the medial and lateral joint surfaces of the knee,

>providing stability, shock absorption, and lubrication, the absence or

>reduction of menisci likely cause more wear and tear on the joint,

>resulting

>in cartilage loss, Dr. Hunter and colleagues said. But, they added, the

>study could not prove causation.

>

>The study focused on 257 participants with knee osteoarthritis enrolled in

>the Boston Osteoarthritis Knee Study. At baseline, 15 months, and 30

>months,

>the researchers evaluated the position and integrity of menisci and

>assessed

>cartilage loss in the joint over time.

>

>The majority of knees (86%) had a damaged or misaligned medial meniscus,

>while 63% had similar problems with the lateral meniscus.

>

>Patients whose medial meniscus covered the least amount of joint area were

>at nearly three times the risk

>for cartilage loss during the study period, compared with patients with the

>largest area of meniscal coverage (odds ratio=2.7; 95% confidence

>interval=1.5-5.2; P=.0031 for trend).

>

>Patients with the thinnest medial menisci also had three times the risk for

>cartilage loss compared with patients with the thickest medial menisci

>(OR=3.0; 95% CI=1.5-6.2; P=.0009 for trend).

>

>Similar results were found for the lateral meniscus.

>

>Although 27% of the study patients had undergone knee surgery, and 5% had

>undergone a meniscectomy, the study did not specifically assess the effect

>of surgery on subsequent cartilage loss in the knee.

>

>However, the study " highlights the importance of an intact and functioning

>meniscus in subjects with symptomatic knee osteoarthritis, since the

>findings demonstrate that loss of this function has important consequences

>for

>cartilage loss, " the authors concluded.

>

>The study also indicated that meniscal damage is " almost universal " in

>patients with knee osteoarthritis, Dr. Hunter said. While meniscectomies

>are

>often performed to relieve pain, " all efforts should be made not to go in

>and remove the menisci unless they are likely to be the cause of arthritis

>symptoms, " he added.

>

>A previous study found that tears of the menisci, common in osteoarthritis

>of the knee, don't necessarily lead to an increase in pain or other

>arthritis symptoms, Dr. Hunter said.

>

>Dr. Hunter added that he would also " strongly discourage " arthroscopic

>debridement unless absolutely necessary.

>

>Before resorting to surgery, clinicians should exhaust non-surgical methods

>to manage osteoarthritis pain, which include exercise and weight loss, knee

>braces, motion control shoes, and analgesics and

>anti-inflammatory drugs, he advised.

>Primary source: Arthritis & Rheumatism

>Source reference:

>Hunter DJ et al. The association of meniscal pathologic changes with

>cartilage loss in symptomatic knee osteoarthritis. Arthritis & Rheumatism.

>2006; 54(3):795-801.

>

> Sears

>PDX

>

> Be one of the first to try Windows Live Mail

>

>OregonDCs rules:

>

>1. Keep correspondence professional; the purpose of the listserve is to

>foster communication and collegiality. No personal attacks on listserve

>members will be tolerated.

>

>2. Always sign your e-mails with your first and last name.

>

>3. The listserve is not secure; your e-mail could end up anywhere. However,

>it is against the rules of the listserve to copy, print, forward, or

>otherwise distribute correspondence written by another member without his

>or

>her consent, unless all personal identifiers have been removed.

>

> ! GROUPS LINKS

>

> Visit your group " " on the web.

>

April 5, 2006

Hi ,

With SOT, Dr. DeJarnette, et.al, taught me that the pedal navicular will always droop with a PI pelvis, resulting in distorted biomechanics of much of the foot structure. In other words, the navicular drifts inferior, the lateral cuboid rotates medial, undermining the talus, fostering the tendency to pronate. If it continues long enough, the sole become stretched resulting is what is labeled plantar fascitis. Stabilize the pelvis (sometimes needs a trochanter belt to maintain between adjustments) and the navicular will begin to hold. At least that is what I find.

My 2 cents ....

Sunny ;'-))

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7C

Eugene, Oregon, 97401

541- 344- 0509; Fx; 541- 344- 0955

From: " Snell" <drpsnell@...> Subject: RE: Orthotics and overpronationDate: Wed, 05 Apr 2006 08:49:25 -0700Hey and others,I'd like to use your post to open a thread on orthotics use andoverpronation. I'd be interested on any thoughts you folks have on thefollowing comments and questions, provided you can tear yourself away fromthe most recent ODOC vs. CAO postings. As a disclaimer, I "believe" inoverpronation but the jury is still out on Santa Claus.1. I have heard it said that overpronation occurs in ~80% of thepopulation, if so, is it pathological?2. Do any of you use so called "short foot" exercises per Janda, to addressoverpronation?3. If long term restriction of motion about a joint results in muscleatrophy and overdependence on primary joint stabilizers, then are shoes (bytheir limiting of foot biomechanics) a primary cause of overpronation.4. Have any of you had experience with Barefoot Science(www.barefootscience.com) orthotics?5. If Barefoot Science orthotics are so good, why do I now have plantarfascitis in a previously well foot after following their instructions foruse?6. If 80% of the population overpronates, and 50% of orthotics areprescribed by DCs, how many chiropractors' incomes will be adverselyaffected by critically thinking about whether orthotics interfere or aid thebody's innate ability to heal itself?Faulty syllogisms, misspellings, and rambling nonsense freely submitted foryour appraisal. Take care and let's have fun out there. W. Snell, D.C.Hawthorne Wellness Center3942 SE Hawthorne Blvd.Portland, OR 97214Ph. 503-235-5484Fax 503-235-3956drpsnell.chiroweb.com>From: " Knecht" <allenknecht@...>>Reply-allen@...>skrndc1@..., dm.bones@..., >Subject: RE: Don't cut those menisci>Date: Wed, 05 Apr 2006 00:17:38 -0700>>Actually you need to address both the pelvis and overpronation syndrome to>fix a knee and or hip degeneration.>>>>>><html><DIV> Knecht DC </DIV>Namaste Chiropractic><DIV></DIV>1809 NW ><DIV></DIV>Portland, OR 97209><DIV></DIV>503-226-8010</html>>>>>>From: "sunny Kierstyn" <skrndc1@...>>dm.bones@..., >Subject: RE: Don't cut those menisci>Date: Tue, 04 Apr 2006 07:29:32 -0700>>>>>>>>>How long do you think it will be before they figure out that in order to>fix>a knee you have to fix the pelvis????? Bets, anyone?>>Sunny>>>>>>>>>>>>>>Sunny Kierstyn, RN DC>Fibromyalgia Care Center of Oregon>2677 Willakenzie Road, 7C>>Eugene, Oregon, 97401>>541- 344- 0509; Fx; 541- 344- 0955>>>From: "dm.bones@..." <dm.bones@...>>listserve (E-mail) < >>Subject: Don't cut those menisci>Date: Tue, 4 Apr 2006 06:39:53 -0700>>>><< mpt_print.gif >>>>> Visit us online at www.MedPageToday.com>>>>><< spacer.gif >>>>>Arthritic Knee Procedures May Lead to Future Deterioration>>><< blue_dot.gif >>>>>By Jeff Minerd, MedPage Today Staff Writer>Reviewed by Jasmer, MD; Assistant Professor of Medicine, University>of California, San Francisco>February 27, 2006>>>><< blue_dot.gif >>>>>MedPage Today Action Points>• Explain to interested patients with osteoarthritis of the knee that,>according to this study, meniscectomy or arthroscopic debridement may place>patients at increased risk for loss of cartilage in the joint.>>• Consider non-surgical alternatives to managing knee pain in>osteoarthritis>patients, including weight loss and exercise, knee braces, motion control>shoes, and analgesics and anti-inflammatory drugs.>>>Review>BOSTON, Feb. 27 - Removal part or all of a damaged meniscus to ease>osteoarthritic knee pain may be detrimental to the joint over the long>haul,>a study here suggested.>>>Reductions in the thickness of menisci or the amount of joint area they>covered were significantly associated with subsequent loss of cartilage in>the knee, reported J. Hunter, M.D., of Boston University in the March>issue of>Arthritis & Rheumatism.>>>Because menisci pad the medial and lateral joint surfaces of the knee,>providing stability, shock absorption, and lubrication, the absence or>reduction of menisci likely cause more wear and tear on the joint,>resulting>in cartilage loss, Dr. Hunter and colleagues said. But, they added, the>study could not prove causation.>>>The study focused on 257 participants with knee osteoarthritis enrolled in>the Boston Osteoarthritis Knee Study. At baseline, 15 months, and 30>months,>the researchers evaluated the position and integrity of menisci and>assessed>cartilage loss in the joint over time.>>>The majority of knees (86%) had a damaged or misaligned medial meniscus,>while 63% had similar problems with the lateral meniscus.>>>Patients whose medial meniscus covered the least amount of joint area were>at nearly three times the risk>for cartilage loss during the study period, compared with patients with the>largest area of meniscal coverage (odds ratio=2.7; 95% confidence>interval=1.5-5.2; P=.0031 for trend).>>>Patients with the thinnest medial menisci also had three times the risk for>cartilage loss compared with patients with the thickest medial menisci>(OR=3.0; 95% CI=1.5-6.2; P=.0009 for trend).>>>Similar results were found for the lateral meniscus.>>>Although 27% of the study patients had undergone knee surgery, and 5% had>undergone a meniscectomy, the study did not specifically assess the effect>of surgery on subsequent cartilage loss in the knee.>>>However, the study "highlights the importance of an intact and functioning>meniscus in subjects with symptomatic knee osteoarthritis, since the>findings demonstrate that loss of this function has important consequences>for>cartilage loss," the authors concluded.>>>The study also indicated that meniscal damage is "almost universal" in>patients with knee osteoarthritis, Dr. Hunter said. While meniscectomies>are>often performed to relieve pain, "all efforts should be made not to go in>and remove the menisci unless they are likely to be the cause of arthritis>symptoms," he added.>>>A previous study found that tears of the menisci, common in osteoarthritis>of the knee, don't necessarily lead to an increase in pain or other>arthritis symptoms, Dr. Hunter said.>>>Dr. Hunter added that he would also "strongly discourage" arthroscopic>debridement unless absolutely necessary.>>>Before resorting to surgery, clinicians should exhaust non-surgical methods>to manage osteoarthritis pain, which include exercise and weight loss, knee>braces, motion control shoes, and analgesics and>anti-inflammatory drugs, he advised.>Primary source: Arthritis & Rheumatism>Source reference:>Hunter DJ et al. The association of meniscal pathologic changes with>cartilage loss in symptomatic knee osteoarthritis. Arthritis & Rheumatism.>2006; 54(3):795-801.>> Sears>PDX>>>> Be one of the first to try Windows Live Mail>>>>>>>>OregonDCs rules:>>1. Keep correspondence professional; the purpose of the listserve is to>foster communication and collegiality. No personal attacks on listserve>members will be tolerated.>>2. Always sign your e-mails with your first and last name.>>3. The listserve is not secure; your e-mail could end up anywhere. However,>it is against the rules of the listserve to copy, print, forward, or>otherwise distribute correspondence written by another member without his>or>her consent, unless all personal identifiers have been removed.>>>>>>>>>>>>>>>> ! GROUPS LINKS>>>>> Visit your group "" on the web.>>

April 5, 2006

Phil - What are the short foot exercises? This is all I could find,

sounds like afoot crunch without toe flexion. Do you have anything else

on it?

http://www.chiroweb.com/archives/13/15/09.html

gracias

Don , DC

400 NW Walnut Blvd., Ste 400

Corvallis, OR 97330

(541) 758-2225

don@...

Don't cut those menisci

>Date: Tue, 4 Apr 2006 06:39:53 -0700

>

><< mpt_print.gif >>

>

> Visit us online at www.MedPageToday.com

>

><< spacer.gif >>

>

>Arthritic Knee Procedures May Lead to Future Deterioration

>

><< blue_dot.gif >>

>

>By Jeff Minerd, MedPage Today Staff Writer

>Reviewed by Jasmer, MD; Assistant Professor of Medicine,

University

>of California, San Francisco

>February 27, 2006

>

><< blue_dot.gif >>

>

>MedPage Today Action Points

>. Explain to interested patients with osteoarthritis of the knee that,

>according to this study, meniscectomy or arthroscopic debridement may

place

>patients at increased risk for loss of cartilage in the joint.

>

>. Consider non-surgical alternatives to managing knee pain in

>osteoarthritis

>patients, including weight loss and exercise, knee braces, motion

control

>shoes, and analgesics and anti-inflammatory drugs.

>

>Review

>BOSTON, Feb. 27 - Removal part or all of a damaged meniscus to ease

>osteoarthritic knee pain may be detrimental to the joint over the long

>haul,

>a study here suggested.

>

>Reductions in the thickness of menisci or the amount of joint area they

>covered were significantly associated with subsequent loss of cartilage

in

>the knee, reported J. Hunter, M.D., of Boston University in the

March

>issue of

>Arthritis & Rheumatism.

>

>Because menisci pad the medial and lateral joint surfaces of the knee,

>providing stability, shock absorption, and lubrication, the absence or

>reduction of menisci likely cause more wear and tear on the joint,

>resulting

>in cartilage loss, Dr. Hunter and colleagues said. But, they added, the

>study could not prove causation.

>

>The study focused on 257 participants with knee osteoarthritis enrolled

in

>the Boston Osteoarthritis Knee Study. At baseline, 15 months, and 30

>months,

>the researchers evaluated the position and integrity of menisci and

>assessed

>cartilage loss in the joint over time.

>

>The majority of knees (86%) had a damaged or misaligned medial

meniscus,

>while 63% had similar problems with the lateral meniscus.

>

>Patients whose medial meniscus covered the least amount of joint area

were

>at nearly three times the risk

>for cartilage loss during the study period, compared with patients with

the

>largest area of meniscal coverage (odds ratio=2.7; 95% confidence

>interval=1.5-5.2; P=.0031 for trend).

>

>Patients with the thinnest medial menisci also had three times the risk

for

>cartilage loss compared with patients with the thickest medial menisci

>(OR=3.0; 95% CI=1.5-6.2; P=.0009 for trend).

>

>Similar results were found for the lateral meniscus.

>

>Although 27% of the study patients had undergone knee surgery, and 5%

had

>undergone a meniscectomy, the study did not specifically assess the

effect

>of surgery on subsequent cartilage loss in the knee.

>

>However, the study " highlights the importance of an intact and

functioning

>meniscus in subjects with symptomatic knee osteoarthritis, since the

>findings demonstrate that loss of this function has important

consequences

>for

>cartilage loss, " the authors concluded.

>

>The study also indicated that meniscal damage is " almost universal " in

>patients with knee osteoarthritis, Dr. Hunter said. While

meniscectomies

>are

>often performed to relieve pain, " all efforts should be made not to go

in

>and remove the menisci unless they are likely to be the cause of

arthritis

>symptoms, " he added.

>

>A previous study found that tears of the menisci, common in

osteoarthritis

>of the knee, don't necessarily lead to an increase in pain or other

>arthritis symptoms, Dr. Hunter said.

>

>Dr. Hunter added that he would also " strongly discourage " arthroscopic

>debridement unless absolutely necessary.

>

>Before resorting to surgery, clinicians should exhaust non-surgical

methods

>to manage osteoarthritis pain, which include exercise and weight loss,

knee

>braces, motion control shoes, and analgesics and

>anti-inflammatory drugs, he advised.

>Primary source: Arthritis & Rheumatism

>Source reference:

>Hunter DJ et al. The association of meniscal pathologic changes with

>cartilage loss in symptomatic knee osteoarthritis. Arthritis &

Rheumatism.

>2006; 54(3):795-801.

>

> Sears

>PDX

>

> Be one of the first to try Windows Live Mail

>

>OregonDCs rules:

>

>1. Keep correspondence professional; the purpose of the listserve is to

>foster communication and collegiality. No personal attacks on listserve

>members will be tolerated.

>

>2. Always sign your e-mails with your first and last name.

>

>3. The listserve is not secure; your e-mail could end up anywhere.

However,

>it is against the rules of the listserve to copy, print, forward, or

>otherwise distribute correspondence written by another member without

his

>or

>her consent, unless all personal identifiers have been removed.

>

> ! GROUPS LINKS

>

> Visit your group " " on the web.

>

April 5, 2006

That's it Don, you can find other descriptions in Liebenson's book and in

Don 's book Conservative Management of Cervical Spine Syndromes.

Think about trying to activate the quadratus plantae and flexor hallicus

brevis rather than the long toe flexors.

W. Snell, D.C.

Hawthorne Wellness Center

3942 SE Hawthorne Blvd.

Portland, OR 97214

Ph. 503-235-5484

Fax 503-235-3956

drpsnell.chiroweb.com

>From: " Don , DC " <don@...>

> " ' Snell' " <drpsnell@...>,< >

>Subject: RE: Orthotics and overpronation

>Date: Wed, 5 Apr 2006 11:49:03 -0700

>

>Phil - What are the short foot exercises? This is all I could find,

>sounds like afoot crunch without toe flexion. Do you have anything else

>on it?

>

>http://www.chiroweb.com/archives/13/15/09.html

>

>gracias

>

>Don , DC

>400 NW Walnut Blvd., Ste 400

>Corvallis, OR 97330

>(541) 758-2225

>don@...

>

> Don't cut those menisci

> >Date: Tue, 4 Apr 2006 06:39:53 -0700

> >

> ><< mpt_print.gif >>

> >

> > Visit us online at www.MedPageToday.com

> >

> ><< spacer.gif >>

> >

> >Arthritic Knee Procedures May Lead to Future Deterioration

> >

> ><< blue_dot.gif >>

> >

> >By Jeff Minerd, MedPage Today Staff Writer

> >Reviewed by Jasmer, MD; Assistant Professor of Medicine,

>University

> >of California, San Francisco

> >February 27, 2006

> >

> ><< blue_dot.gif >>

> >

> >MedPage Today Action Points

> >. Explain to interested patients with osteoarthritis of the knee that,

> >according to this study, meniscectomy or arthroscopic debridement may

>place

> >patients at increased risk for loss of cartilage in the joint.

> >

> >. Consider non-surgical alternatives to managing knee pain in

> >osteoarthritis

> >patients, including weight loss and exercise, knee braces, motion

>control

> >shoes, and analgesics and anti-inflammatory drugs.

> >

> >Review

> >BOSTON, Feb. 27 - Removal part or all of a damaged meniscus to ease

> >osteoarthritic knee pain may be detrimental to the joint over the long

> >haul,

> >a study here suggested.

> >

> >Reductions in the thickness of menisci or the amount of joint area they

> >covered were significantly associated with subsequent loss of cartilage

>in

> >the knee, reported J. Hunter, M.D., of Boston University in the

>March

> >issue of

> >Arthritis & Rheumatism.

> >

> >Because menisci pad the medial and lateral joint surfaces of the knee,

> >providing stability, shock absorption, and lubrication, the absence or

> >reduction of menisci likely cause more wear and tear on the joint,

> >resulting

> >in cartilage loss, Dr. Hunter and colleagues said. But, they added, the

> >study could not prove causation.

> >

> >The study focused on 257 participants with knee osteoarthritis enrolled

>in

> >the Boston Osteoarthritis Knee Study. At baseline, 15 months, and 30

> >months,

> >the researchers evaluated the position and integrity of menisci and

> >assessed

> >cartilage loss in the joint over time.

> >

> >The majority of knees (86%) had a damaged or misaligned medial

>meniscus,

> >while 63% had similar problems with the lateral meniscus.

> >

> >Patients whose medial meniscus covered the least amount of joint area

>were

> >at nearly three times the risk

> >for cartilage loss during the study period, compared with patients with

>the

> >largest area of meniscal coverage (odds ratio=2.7; 95% confidence

> >interval=1.5-5.2; P=.0031 for trend).

> >

> >Patients with the thinnest medial menisci also had three times the risk

>for

> >cartilage loss compared with patients with the thickest medial menisci

> >(OR=3.0; 95% CI=1.5-6.2; P=.0009 for trend).

> >

> >Similar results were found for the lateral meniscus.

> >

> >Although 27% of the study patients had undergone knee surgery, and 5%

>had

> >undergone a meniscectomy, the study did not specifically assess the

>effect

> >of surgery on subsequent cartilage loss in the knee.

> >

> >However, the study " highlights the importance of an intact and

>functioning

> >meniscus in subjects with symptomatic knee osteoarthritis, since the

> >findings demonstrate that loss of this function has important

>consequences

> >for

> >cartilage loss, " the authors concluded.

> >

> >The study also indicated that meniscal damage is " almost universal " in

> >patients with knee osteoarthritis, Dr. Hunter said. While

>meniscectomies

> >are

> >often performed to relieve pain, " all efforts should be made not to go

>in

> >and remove the menisci unless they are likely to be the cause of

>arthritis

> >symptoms, " he added.

> >

> >A previous study found that tears of the menisci, common in

>osteoarthritis

> >of the knee, don't necessarily lead to an increase in pain or other

> >arthritis symptoms, Dr. Hunter said.

> >

> >Dr. Hunter added that he would also " strongly discourage " arthroscopic

> >debridement unless absolutely necessary.

> >

> >Before resorting to surgery, clinicians should exhaust non-surgical

>methods

> >to manage osteoarthritis pain, which include exercise and weight loss,

>knee

> >braces, motion control shoes, and analgesics and

> >anti-inflammatory drugs, he advised.

> >Primary source: Arthritis & Rheumatism

> >Source reference:

> >Hunter DJ et al. The association of meniscal pathologic changes with

> >cartilage loss in symptomatic knee osteoarthritis. Arthritis &

>Rheumatism.

> >2006; 54(3):795-801.

> >

> > Sears

> >PDX

> >

> > Be one of the first to try Windows Live Mail

> >

> >OregonDCs rules:

> >

> >1. Keep correspondence professional; the purpose of the listserve is to

> >foster communication and collegiality. No personal attacks on listserve

> >members will be tolerated.

> >

> >2. Always sign your e-mails with your first and last name.

> >

> >3. The listserve is not secure; your e-mail could end up anywhere.

>However,

> >it is against the rules of the listserve to copy, print, forward, or

> >otherwise distribute correspondence written by another member without

>his

> >or

> >her consent, unless all personal identifiers have been removed.

> >

> > ! GROUPS LINKS

> >

> > Visit your group " " on the web.

> >

April 5, 2006

I'd rate succes as about 50%, very dependent on the patient. The successes

are Tai Chi folks, folks who practice " conscious walking " a la Tich Nat

Han's walking meditation, and the earth muffin folks who relate well to

" grounding " .

W. Snell, D.C.

Hawthorne Wellness Center

3942 SE Hawthorne Blvd.

Portland, OR 97214

Ph. 503-235-5484

Fax 503-235-3956

drpsnell.chiroweb.com

>From: Bingham <drdc@...>

> Snell <drpsnell@...>

>Subject: RE: Orthotics and overpronation

>Date: 5 Apr 2006 21:21:47 GMT

>

>Have you had any success with the short foot. I have horrible arches and I

>can't seem to commit to these exercises. I decided to go with the crutch.

>

>Dr. Bingham

>Highland Chiropractic

>3531 ne 15th Suite E

>Portland OR, 97212

>(503) 546-9987

>

>---- Original Message ----

>From: " Snell " <drpsnell@...>

>Date: 4/5/06 1:10 pm

> " " < >

>Subj: RE: Orthotics and overpronation

>That's it Don, you can find other descriptions in Liebenson's book and in

>Don 's book Conservative Management of Cervical Spine Syndromes.

>Think about trying to activate the quadratus plantae and flexor hallicus

>brevis rather than the long toe flexors.

>

> W. Snell, D.C.

>Hawthorne Wellness Center

>3942 SE Hawthorne Blvd.

>Portland, OR 97214

>Ph. 503-235-5484

>Fax 503-235-3956

>drpsnell.chiroweb.com

>

> >From: " Don , DC " <don@...>

> > " ' Snell' " <drpsnell@...>,< >

> >Subject: RE: Orthotics and overpronation

> >Date: Wed, 5 Apr 2006 11:49:03 -0700

> >

> >Phil - What are the short foot exercises? This is all I could find,

> >sounds like afoot crunch without toe flexion. Do you have anything else

> >on it?

> >

> >http://www.chiroweb.com/archives/13/15/09.html

> >

> >gracias

> >

> >Don , DC

> >400 NW Walnut Blvd., Ste 400

> >Corvallis, OR 97330

> >(541) 758-2225

> >don@...

> >

> > Don't cut those menisci

> > >Date: Tue, 4 Apr 2006 06:39:53 -0700

> > >

> > ><< mpt_print.gif >>

> > >

> > > Visit us online at www.MedPageToday.com

> > >

> > ><< spacer.gif >>

> > >

> > >Arthritic Knee Procedures May Lead to Future Deterioration

> > >

> > ><< blue_dot.gif >>

> > >

> > >By Jeff Minerd, MedPage Today Staff Writer

> > >Reviewed by Jasmer, MD; Assistant Professor of Medicine,

> >University

> > >of California, San Francisco

> > >February 27, 2006

> > >

> > ><< blue_dot.gif >>

> > >

> > >MedPage Today Action Points

> > >. Explain to interested patients with osteoarthritis of the knee that,

> > >according to this study, meniscectomy or arthroscopic debridement may

> >place

> > >patients at increased risk for loss of cartilage in the joint.

> > >

> > >. Consider non-surgical alternatives to managing knee pain in

> > >osteoarthritis

> > >patients, including weight loss and exercise, knee braces, motion

> >control

> > >shoes, and analgesics and anti-inflammatory drugs.

> > >

> > >Review

> > >BOSTON, Feb. 27 - Removal part or all of a damaged meniscus to ease

> > >osteoarthritic knee pain may be detrimental to the joint over the long

> > >haul,

> > >a study here suggested.

> > >

> > >Reductions in the thickness of menisci or the amount of joint area they

> > >covered were significantly associated with subsequent loss of cartilage

> >in

> > >the knee, reported J. Hunter, M.D., of Boston University in the

> >March

> > >issue of

> > >Arthritis & Rheumatism.

> > >

> > >Because menisci pad the medial and lateral joint surfaces of the knee,

> > >providing stability, shock absorption, and lubrication, the absence or

> > >reduction of menisci likely cause more wear and tear on the joint,

> > >resulting

> > >in cartilage loss, Dr. Hunter and colleagues said. But, they added, the

> > >study could not prove causation.

> > >

> > >The study focused on 257 participants with knee osteoarthritis enrolled

> >in

> > >the Boston Osteoarthritis Knee Study. At baseline, 15 months, and 30

> > >months,

> > >the researchers evaluated the position and integrity of menisci and

> > >assessed

> > >cartilage loss in the joint over time.

> > >

> > >The majority of knees (86%) had a damaged or misaligned medial

> >meniscus,

> > >while 63% had similar problems with the lateral meniscus.

> > >

> > >Patients whose medial meniscus covered the least amount of joint area

> >were

> > >at nearly three times the risk

> > >for cartilage loss during the study period, compared with patients with

> >the

> > >largest area of meniscal coverage (odds ratio=2.7; 95% confidence

> > >interval=1.5-5.2; P=.0031 for trend).

> > >

> > >Patients with the thinnest medial menisci also had three times the risk

> >for

> > >cartilage loss compared with patients with the thickest medial menisci

> > >(OR=3.0; 95% CI=1.5-6.2; P=.0009 for trend).

> > >

> > >Similar results were found for the lateral meniscus.

> > >

> > >Although 27% of the study patients had undergone knee surgery, and 5%

> >had

> > >undergone a meniscectomy, the study did not specifically assess the

> >effect

> > >of surgery on subsequent cartilage loss in the knee.

> > >

> > >However, the study " highlights the importance of an intact and

> >functioning

> > >meniscus in subjects with symptomatic knee osteoarthritis, since the

> > >findings demonstrate that loss of this function has important

> >consequences

> > >for

> > >cartilage loss, " the authors concluded.

> > >

> > >The study also indicated that meniscal damage is " almost universal " in

> > >patients with knee osteoarthritis, Dr. Hunter said. While

> >meniscectomies

> > >are

> > >often performed to relieve pain, " all efforts should be made not to go

> >in

> > >and remove the menisci unless they are likely to be the cause of

> >arthritis

> > >symptoms, " he added.

> > >

> > >A previous study found that tears of the menisci, common in

> >osteoarthritis

> > >of the knee, don't necessarily lead to an increase in pain or other

> > >arthritis symptoms, Dr. Hunter said.

> > >

> > >Dr. Hunter added that he would also " strongly discourage " arthroscopic

> > >debridement unless absolutely necessary.

> > >

> > >Before resorting to surgery, clinicians should exhaust non-surgical

> >methods

> > >to manage osteoarthritis pain, which include exercise and weight loss,

> >knee

> > >braces, motion control shoes, and analgesics and

> > >anti-inflammatory drugs, he advised.

> > >Primary source: Arthritis & Rheumatism

> > >Source reference:

> > >Hunter DJ et al. The association of meniscal pathologic changes with

> > >cartilage loss in symptomatic knee osteoarthritis. Arthritis &

> >Rheumatism.

> > >2006; 54(3):795-801.

> > >

> > > Sears

> > >PDX

> > >

> > > Be one of the first to try Windows Live Mail

> > >

> > >OregonDCs rules:

> > >

> > >1. Keep correspondence professional; the purpose of the listserve is to

> > >foster communication and collegiality. No personal attacks on listserve

> > >members will be tolerated.

> > >

> > >2. Always sign your e-mails with your first and last name.

> > >

> > >3. The listserve is not secure; your e-mail could end up anywhere.

> >However,

> > >it is against the rules of the listserve to copy, print, forward, or

> > >otherwise distribute correspondence written by another member without

> >his

> > >or

> > >her consent, unless all personal identifiers have been removed.

> > >

> > > ! GROUPS LINKS

> > >

> > > Visit your group " " on the web.

> > >

April 5, 2006

Thanks , I already cast for them, and have them in my shoes as we

speak. I think the cognitive dissonance I'm speaking aloud about is more

of a philosophical issue. Do we do a body a service by training dependency

on an exogenous device? We certainly improve our bottom lines, as orthotics

can be a big profit center. For my patients, I usually go from short foot,

to Dr. Scholl's, to $100 soft insoles, to Sole Supports.

W. Snell, D.C.

Hawthorne Wellness Center

3942 SE Hawthorne Blvd.

Portland, OR 97214

Ph. 503-235-5484

Fax 503-235-3956

drpsnell.chiroweb.com

>From: " Knecht " <allenknecht@...>

>Reply-allen@...

>drpsnell@...

>Subject: RE: Orthotics and overpronation

>Date: Wed, 05 Apr 2006 10:54:29 -0700

>

>,

>

>Check out www.solesupports.com

>

> Knecht DC Namaste Chiropractic

>1809 NW

>Portland, OR 97209

>503-226-8010

>

>From: " Snell " <drpsnell@...>

>

>Subject: RE: Orthotics and overpronation

>Date: Wed, 05 Apr 2006 08:49:25 -0700

>Hey and others,

>

>I'd like to use your post to open a thread on orthotics use and

>overpronation. I'd be interested on any thoughts you folks have on the

>following comments and questions, provided you can tear yourself away from

>the most recent ODOC vs. CAO postings. As a disclaimer, I " believe " in

>overpronation but the jury is still out on Santa Claus.

>

>1. I have heard it said that overpronation occurs in ~80% of the

>population, if so, is it pathological?

>

>2. Do any of you use so called " short foot " exercises per Janda, to address

>overpronation?

>

>3. If long term restriction of motion about a joint results in muscle

>atrophy and

>overdependence on primary joint stabilizers, then are shoes (by

>their limiting of foot biomechanics) a primary cause of overpronation.

>

>4. Have any of you had experience with Barefoot Science

>(www.barefootscience.com) orthotics?

>

>5. If Barefoot Science orthotics are so good, why do I now have plantar

>fascitis in a previously well foot after following their instructions for

>use?

>

>6. If 80% of the population overpronates, and 50% of orthotics are

>prescribed by DCs, how many chiropractors' incomes will be adversely

>affected by critically thinking about whether orthotics interfere or aid

>the

>body's innate ability to heal itself?

>

>Faulty syllogisms, misspellings, and rambling nonsense freely submitted for

>your appraisal. Take care and let's have fun out there.

>

> W. Snell, D.C.

>Hawthorne Wellness Center

>3942 SE

>Hawthorne Blvd.

>Portland, OR 97214

>Ph. 503-235-5484

>Fax 503-235-3956

>drpsnell.chiroweb.com

>

> >From: " Knecht " <allenknecht@...>

> >Reply-allen@...

> >skrndc1@..., dm.bones@...,

> >Subject: RE: Don't cut those menisci

> >Date: Wed, 05 Apr 2006 00:17:38 -0700

> >

> >Actually you need to address both the pelvis and overpronation syndrome

>to

> >fix a knee and or hip degeneration.

> >

> ><html><DIV> Knecht DC </DIV>Namaste Chiropractic

> ><DIV></DIV>1809 NW

> ><DIV></DIV>Portland, OR 97209

> ><DIV></DIV>503-226-8010</html>

> >

> >From: " sunny Kierstyn " <skrndc1@...>

> >To:

>dm.bones@...,

> >Subject: RE: Don't cut those menisci

> >Date: Tue, 04 Apr 2006 07:29:32 -0700

> >

> >How long do you think it will be before they figure out that in order to

> >fix

> >a knee you have to fix the pelvis????? Bets, anyone?

> >

> >Sunny

> >

> >Sunny Kierstyn, RN DC

> >Fibromyalgia Care Center of Oregon

> >2677 Willakenzie Road, 7C

> >

> >Eugene, Oregon, 97401

> >

> >541- 344- 0509; Fx; 541- 344- 0955

> >

> >From: " dm.bones@... " <dm.bones@...>

> >listserve (E-mail) < >

> >Subject: Don't cut those menisci

> >Date: Tue, 4 Apr 2006

>06:39:53 -0700

> >

> ><< mpt_print.gif >>

> >

> > Visit us online at www.MedPageToday.com

> >

> ><< spacer.gif >>

> >

> >Arthritic Knee Procedures May Lead to Future Deterioration

> >

> ><< blue_dot.gif >>

> >

> >By Jeff Minerd, MedPage Today Staff Writer

> >Reviewed by Jasmer, MD; Assistant Professor of Medicine,

>University

> >of California, San Francisco

> >February 27, 2006

> >

> ><< blue_dot.gif >>

> >

> >MedPage Today Action Points

> >• Explain to interested patients with osteoarthritis of the knee that,

> >according to this study, meniscectomy or arthroscopic debridement may

>place

> >patients at increased risk for loss of cartilage in the

>joint.

> >

> >• Consider non-surgical alternatives to managing knee pain in

> >osteoarthritis

> >patients, including weight loss and exercise, knee braces, motion control

> >shoes, and analgesics and anti-inflammatory drugs.

> >

> >Review

> >BOSTON, Feb. 27 - Removal part or all of a damaged meniscus to ease

> >osteoarthritic knee pain may be detrimental to the joint over the long

> >haul,

> >a study here suggested.

> >

> >Reductions in the thickness of menisci or the amount of joint area they

> >covered were significantly associated with subsequent loss of cartilage

>in

> >the knee, reported J. Hunter, M.D., of Boston University in the

>March

> >issue of

> >Arthritis & Rheumatism.

> >

> >Because menisci pad the medial and lateral joint surfaces of the knee,

> >providing

>stability, shock absorption, and lubrication, the absence or

> >reduction of menisci likely cause more wear and tear on the joint,

> >resulting

> >in cartilage loss, Dr. Hunter and colleagues said. But, they added, the

> >study could not prove causation.

> >

> >The study focused on 257 participants with knee osteoarthritis enrolled

>in

> >the Boston Osteoarthritis Knee Study. At baseline, 15 months, and 30

> >months,

> >the researchers evaluated the position and integrity of menisci and

> >assessed

> >cartilage loss in the joint over time.

> >

> >The majority of knees (86%) had a damaged or misaligned medial meniscus,

> >while 63% had similar problems with the lateral meniscus.

> >

> >Patients whose medial meniscus covered the least amount of joint area

>were

> >at nearly three times the

>risk

> >for cartilage loss during the study period, compared with patients with

>the

> >largest area of meniscal coverage (odds ratio=2.7; 95% confidence

> >interval=1.5-5.2; P=.0031 for trend).

> >

> >Patients with the thinnest medial menisci also had three times the risk

>for

> >cartilage loss compared with patients with the thickest medial menisci

> >(OR=3.0; 95% CI=1.5-6.2; P=.0009 for trend).

> >

> >Similar results were found for the lateral meniscus.

> >

> >Although 27% of the study patients had undergone knee surgery, and 5% had

> >undergone a meniscectomy, the study did not specifically assess the

>effect

> >of surgery on subsequent cartilage loss in the knee.

> >

> >However, the study " highlights the importance of an intact and

>functioning

> >meniscus in subjects with symptomatic knee

>osteoarthritis, since the

> >findings demonstrate that loss of this function has important

>consequences

> >for

> >cartilage loss, " the authors concluded.

> >

> >The study also indicated that meniscal damage is " almost universal " in

> >patients with knee osteoarthritis, Dr. Hunter said. While meniscectomies

> >are

> >often performed to relieve pain, " all efforts should be made not to go in

> >and remove the menisci unless they are likely to be the cause of

>arthritis

> >symptoms, " he added.

> >

> >A previous study found that tears of the menisci, common in

>osteoarthritis

> >of the knee, don't necessarily lead to an increase in pain or other

> >arthritis symptoms, Dr. Hunter said.

> >

> >Dr. Hunter added that he would also " strongly discourage " arthroscopic

> >debridement unless absolutely

>necessary.

> >

> >Before resorting to surgery, clinicians should exhaust non-surgical

>methods

> >to manage osteoarthritis pain, which include exercise and weight loss,

>knee

> >braces, motion control shoes, and analgesics and

> >anti-inflammatory drugs, he advised.

> >Primary source: Arthritis & Rheumatism

> >Source reference:

> >Hunter DJ et al. The association of meniscal pathologic changes with

> >cartilage loss in symptomatic knee osteoarthritis. Arthritis &

>Rheumatism.

> >2006; 54(3):795-801.

> >

> > Sears

> >PDX

> >

> > Be one of the first to try Windows Live Mail

> >

> >OregonDCs rules:

> >

> >1. Keep correspondence professional; the purpose of the listserve is to

> >foster communication and collegiality. No personal

>attacks on listserve

> >members will be tolerated.

> >

> >2. Always sign your e-mails with your first and last name.

> >

> >3. The listserve is not secure; your e-mail could end up anywhere.

>However,

> >it is against the rules of the listserve to copy, print, forward, or

> >otherwise distribute correspondence written by another member without his

> >or

> >her consent, unless all personal identifiers have been removed.

> >

> > ! GROUPS LINKS

> >

> > Visit your group " " on the web.

> >

April 5, 2006

,

1. The current level of populous pronation is not excessive if you are

walking on rocks, dirt and clumps of grass. However of the surfaces of

our current culture our feet over pronation as a result of the lack of

need to adapt to uneven surfaces.

2. Janda's short arch exercises are great, but can not sustain the

endurance for prolonged standing or activity. Janda also turned to be an

advocate for orthotic use. So much so that he started lecturing for

Biomechanical Services feeling that orthotics provide propriocetive feed

back, a.k.a. Niggs research. As much as the exercises do provide needed

proprioception, it can not compensate for osseous deformities.

3. Shoes increase over-pronation via midsole height. However they are a

necessary evil for protection, hygiene, and shock absorption.

4. Too long to comment on.

5.

6.Unfortunately most chiropractors prescribe arch supports as orthotics.

As you know, the arch is a tunnel not designed to bare weight.

Ted

Ted Forcum, DC, DACBSP, FICC, CSCS

ACA Sports Council, 2nd Vice President

Back In Motion Sports Injuries Clinic, LLC

11385 SW Scholls Ferry Road

Beaverton, Oregon 97008

On Wed, 05 Apr 2006 15:11:31 -0700 " Snell " <drpsnell@...>

writes:

> Thanks , I already cast for them, and have them in my shoes as

> we

> speak. I think the cognitive dissonance I'm speaking aloud about

> is more

> of a philosophical issue. Do we do a body a service by training

> dependency

> on an exogenous device? We certainly improve our bottom lines, as

> orthotics

> can be a big profit center. For my patients, I usually go from

> short foot,

> to Dr. Scholl's, to $100 soft insoles, to Sole Supports.

>

> W. Snell, D.C.

> Hawthorne Wellness Center

> 3942 SE Hawthorne Blvd.

> Portland, OR 97214

> Ph. 503-235-5484

> Fax 503-235-3956

> drpsnell.chiroweb.com

>

> >From: " Knecht " <allenknecht@...>

> >Reply-allen@...

> >drpsnell@...

> >Subject: RE: Orthotics and overpronation

> >Date: Wed, 05 Apr 2006 10:54:29 -0700

> >

> >,

> >

> >Check out www.solesupports.com

> >

> > Knecht DC Namaste Chiropractic

> >1809 NW

> >Portland, OR 97209

> >503-226-8010

> >

> >From: " Snell " <drpsnell@...>

> >

> >Subject: RE: Orthotics and overpronation

> >Date: Wed, 05 Apr 2006 08:49:25 -0700

> >Hey and others,

> >

> >I'd like to use your post to open a thread on orthotics use and

> >overpronation. I'd be interested on any thoughts you folks have on

> the

> >following comments and questions, provided you can tear yourself

> away from

> >the most recent ODOC vs. CAO postings. As a disclaimer, I " believe "

> in

> >overpronation but the jury is still out on Santa Claus.

> >

> >1. I have heard it said that overpronation occurs in ~80% of the

> >population, if so, is it pathological?

> >

> >2. Do any of you use so called " short foot " exercises per Janda, to

> address

> >overpronation?

> >

> >3. If long term restriction of motion about a joint results in

> muscle

> >atrophy and

> >overdependence on primary joint stabilizers, then are shoes (by

> >their limiting of foot biomechanics) a primary cause of

> overpronation.

> >

> >4. Have any of you had experience with Barefoot Science

> >(www.barefootscience.com) orthotics?

> >

> >5. If Barefoot Science orthotics are so good, why do I now have

> plantar

> >fascitis in a previously well foot after following their

> instructions for

> >use?

> >

> >6. If 80% of the population overpronates, and 50% of orthotics are

> >prescribed by DCs, how many chiropractors' incomes will be

> adversely

> >affected by critically thinking about whether orthotics interfere

> or aid

> >the

> >body's innate ability to heal itself?

> >

> >Faulty syllogisms, misspellings, and rambling nonsense freely

> submitted for

> >your appraisal. Take care and let's have fun out there.

> >

> > W. Snell, D.C.

> >Hawthorne Wellness Center

> >3942 SE

> >Hawthorne Blvd.

> >Portland, OR 97214

> >Ph. 503-235-5484

> >Fax 503-235-3956

> >drpsnell.chiroweb.com

> >

> > >From: " Knecht " <allenknecht@...>

> > >Reply-allen@...

> > >skrndc1@..., dm.bones@...,

> > >Subject: RE: Don't cut those menisci

> > >Date: Wed, 05 Apr 2006 00:17:38 -0700

> > >

> > >Actually you need to address both the pelvis and overpronation

> syndrome

> >to

> > >fix a knee and or hip degeneration.

> > >

> > ><html><DIV> Knecht DC </DIV>Namaste Chiropractic

> > ><DIV></DIV>1809 NW

> > ><DIV></DIV>Portland, OR 97209

> > ><DIV></DIV>503-226-8010</html>

> > >

> > >From: " sunny Kierstyn " <skrndc1@...>

> > >To:

> >dm.bones@...,

> > >Subject: RE: Don't cut those menisci

> > >Date: Tue, 04 Apr 2006 07:29:32 -0700

> > >

> > >How long do you think it will be before they figure out that in

> order to

> > >fix

> > >a knee you have to fix the pelvis????? Bets, anyone?

> > >

> > >Sunny

> > >

> > >Sunny Kierstyn, RN DC

> > >Fibromyalgia Care Center of Oregon

> > >2677 Willakenzie Road, 7C

> > >

> > >Eugene, Oregon, 97401

> > >

> > >541- 344- 0509; Fx; 541- 344- 0955

> > >

> > >From: " dm.bones@... " <dm.bones@...>

> > >listserve (E-mail) < >

> > >Subject: Don't cut those menisci

> > >Date: Tue, 4 Apr 2006

> >06:39:53 -0700

> > >

> > ><< mpt_print.gif >>

> > >

> > > Visit us online at www.MedPageToday.com

> > >

> > ><< spacer.gif >>

> > >

> > >Arthritic Knee Procedures May Lead to Future Deterioration

> > >

> > ><< blue_dot.gif >>

> > >

> > >By Jeff Minerd, MedPage Today Staff Writer

> > >Reviewed by Jasmer, MD; Assistant Professor of Medicine,

> >University

> > >of California, San Francisco

> > >February 27, 2006

> > >

> > ><< blue_dot.gif >>

> > >

> > >MedPage Today Action Points

> > >• Explain to interested patients with osteoarthritis of the knee

> that,

> > >according to this study, meniscectomy or arthroscopic debridement

> may

> >place

> > >patients at increased risk for loss of cartilage in the

> >joint.

> > >

> > >• Consider non-surgical alternatives to managing knee pain in

> > >osteoarthritis

> > >patients, including weight loss and exercise, knee braces, motion

> control

> > >shoes, and analgesics and anti-inflammatory drugs.

> > >

> > >Review

> > >BOSTON, Feb. 27 - Removal part or all of a damaged meniscus to

> ease

> > >osteoarthritic knee pain may be detrimental to the joint over the

> long

> > >haul,

> > >a study here suggested.

> > >

> > >Reductions in the thickness of menisci or the amount of joint

> area they

> > >covered were significantly associated with subsequent loss of

> cartilage

> >in

> > >the knee, reported J. Hunter, M.D., of Boston University in

> the

> >March

> > >issue of

> > >Arthritis & Rheumatism.

> > >

> > >Because menisci pad the medial and lateral joint surfaces of the

> knee,

> > >providing

> >stability, shock absorption, and lubrication, the absence or

> > >reduction of menisci likely cause more wear and tear on the

> joint,

> > >resulting

> > >in cartilage loss, Dr. Hunter and colleagues said. But, they

> added, the

> > >study could not prove causation.

> > >

> > >The study focused on 257 participants with knee osteoarthritis

> enrolled

> >in

> > >the Boston Osteoarthritis Knee Study. At baseline, 15 months, and

> 30

> > >months,

> > >the researchers evaluated the position and integrity of menisci

> and

> > >assessed

> > >cartilage loss in the joint over time.

> > >

> > >The majority of knees (86%) had a damaged or misaligned medial

> meniscus,

> > >while 63% had similar problems with the lateral meniscus.

> > >

> > >Patients whose medial meniscus covered the least amount of joint

> area

> >were

> > >at nearly three times the

> >risk

> > >for cartilage loss during the study period, compared with

> patients with

> >the

> > >largest area of meniscal coverage (odds ratio=2.7; 95% confidence

> > >interval=1.5-5.2; P=.0031 for trend).

> > >

> > >Patients with the thinnest medial menisci also had three times

> the risk

>

> > >cartilage loss compared with patients with the thickest medial

> menisci

> > >(OR=3.0; 95% CI=1.5-6.2; P=.0009 for trend).

> > >

> > >Similar results were found for the lateral meniscus.

> > >

> > >Although 27% of the study patients had undergone knee surgery,

> and 5% had

> > >undergone a meniscectomy, the study did not specifically assess

> the

> >effect

> > >of surgery on subsequent cartilage loss in the knee.

> > >

> > >However, the study " highlights the importance of an intact and

> >functioning

> > >meniscus in subjects with symptomatic knee

> >osteoarthritis, since the

> > >findings demonstrate that loss of this function has important

> >consequences

> > >for

> > >cartilage loss, " the authors concluded.

> > >

> > >The study also indicated that meniscal damage is " almost

> universal " in

> > >patients with knee osteoarthritis, Dr. Hunter said. While

> meniscectomies

> > >are

> > >often performed to relieve pain, " all efforts should be made not

> to go in

> > >and remove the menisci unless they are likely to be the cause of

> >arthritis

> > >symptoms, " he added.

> > >

> > >A previous study found that tears of the menisci, common in

> >osteoarthritis

> > >of the knee, don't necessarily lead to an increase in pain or

> other

> > >arthritis symptoms, Dr. Hunter said.

> > >

> > >Dr. Hunter added that he would also " strongly discourage "

> arthroscopic

> > >debridement unless absolutely

> >necessary.

> > >

> > >Before resorting to surgery, clinicians should exhaust

> non-surgical

> >methods

> > >to manage osteoarthritis pain, which include exercise and weight

> loss,

> >knee

> > >braces, motion control shoes, and analgesics and

> > >anti-inflammatory drugs, he advised.

> > >Primary source: Arthritis & Rheumatism

> > >Source reference:

> > >Hunter DJ et al. The association of meniscal pathologic changes

> with

> > >cartilage loss in symptomatic knee osteoarthritis. Arthritis &

> >Rheumatism.

> > >2006; 54(3):795-801.

> > >

> > > Sears

> > >PDX

> > >

> > > Be one of the first to try Windows Live Mail

> > >

> > >OregonDCs rules:

> > >

> > >1. Keep correspondence professional; the purpose of the listserve

> is to

> > >foster communication and collegiality. No personal

> >attacks on listserve

> > >members will be tolerated.

> > >

> > >2. Always sign your e-mails with your first and last name.

> > >

> > >3. The listserve is not secure; your e-mail could end up

> anywhere.

> >However,

> > >it is against the rules of the listserve to copy, print, forward,

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> > >

> > > ! GROUPS LINKS

> > >

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> > >

April 5, 2006

I believe that shoes are absolutely toxic and are a direct major cause

of the mess that is at the end of many people's legs. I guess they are

a necessary evil though and i feel that orthotics can actually

mitigate the damage of shoes....i.e orthotics are like going from a

OTC cast (shoes) to a custom cast that is slightly more

physiologically/biomechanically-compatable with a particular foot and

too me that is allowing the body to move toward a more " natural "

state so as to better express its innate intelligence to some small

degree. I am rather weak on Rx-ing foot exercises...my own personal

experience with them on/off as a runner for 30 years is that they

don't do much, they are clunky and mechanical and un-natural....I

might be wrong and am not familiar with many of them but the ones I

have done just never worked for me. My absolute fave foot " cure-all "

therapy is barefoot walking/ambling at gradually-increasing intervals

on a nice surface that yields to create at least a mild inprint (ie

grass, wet sand sand(preferably free of crack viles and heroine

needles) or even a shaggy type carpet with thich under-padding...I

have been jogging a few miles on the grass at the Fox track( no

needles!) about once per week from June -september, for the last five

years....it is heaven and it ABSOLUTELY whipped butt on a 3-year case

of chronic PF that I struggled with back in late 90s. Dealing with

orthotics is definitely as much an art as a science...you can create

more stress in the biomechanical environment if you don't know what

you are doing. I like to Rx alot of superfeet green capsule OTCs for

just general help and AMFITs and also even Foot levelors ( Ted will

probably have a field day with that last one)...I do not know anything

re. those Barefoot science orthotics....but, speaking of barefoot this

Ken " Barefoot " Saxton is " my man " ..I have had the honor of hanging and

running with " Ken Bob " ....this guy rocks, and I think there is even a

clip of me raving on about how great he is (at the Shamrock run about

5 years ago)...in a documentary they made about him.

http://www.runningbarefoot.org/

then click here and scroll down to " the ballad of the barefoot runner "

http://www.runningbarefoot.org/?name=Videos

cheers

>

> Hey and others,

>

> I'd like to use your post to open a thread on orthotics use and

> overpronation. I'd be interested on any thoughts you folks have on the

> following comments and questions, provided you can tear yourself

away from

> the most recent ODOC vs. CAO postings. As a disclaimer, I " believe " in

> overpronation but the jury is still out on Santa Claus.

>

> 1. I have heard it said that overpronation occurs in ~80% of the

> population, if so, is it pathological?

>

> 2. Do any of you use so called " short foot " exercises per Janda, to

address

> overpronation?

>

> 3. If long term restriction of motion about a joint results in muscle

> atrophy and overdependence on primary joint stabilizers, then are

shoes (by

> their limiting of foot biomechanics) a primary cause of overpronation.

>

> 4. Have any of you had experience with Barefoot Science

> (www.barefootscience.com) orthotics?

>

> 5. If Barefoot Science orthotics are so good, why do I now have

plantar

> fascitis in a previously well foot after following their

instructions for

> use?

>

> 6. If 80% of the population overpronates, and 50% of orthotics are

> prescribed by DCs, how many chiropractors' incomes will be adversely

> affected by critically thinking about whether orthotics interfere or

aid the

> body's innate ability to heal itself?

>

April 5, 2006