Closed Chain Kinesiology: More Accurate Than Biomechanics?

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Biomechanics research and practice has led to great advances including new terminology, hypotheses and protocols for treating chief complaints that deserve much praise. But in recent years, little high level evidence with clinical significance has surfaced in spite of the effort of many.

Perhaps we have focused too much on the "force" pillar and not enough on the "skeletal structure" pillar when experimenting and hypothesizing? Is the science that we practice best served by continuing to call it Biomechanics?

I wonder what The Arena feels about developing a new term that encompasses what we do more closely? Remember, biomechanics remains a miss-spellling on Word Spell Check and right here on The Arena as well (type it in and see).

Kinesiology:
the study of the principles of mechanics and anatomy in relation to human movement

Biomechanics:

the study of the mechanics of a living body, especially of the forces exerted by muscles and gravity on the skeletal structure



How about Closed Chain Kinesiology for what we do?
Dennis

 

Whilst it would doubtless be more acceptable to those who don't understand / can't be bothered to learn mechanics to remove mechanics from biomechanics, I think the rest of us are fairly happy with it.

Kinesiology is, I think, rather too associated with applied kinesiology, health kinesiology and assorted other woo. These systems are, IMVHO, pseudomedical smoke and mirrors based on the ideomotor effect which have no basis whatsoever in any kind of rational science and are used primarily to convince perfectly healthy individuals that they are in fact sick in order to sell them a miracle cure which has an excellent chance of treating the non existent pathology, greatly enriching the practitioner when the imaginary test comes back clear!

I have no time for a system which diagnoses almost everyone as in need of care in order to increase the pool of patients requiring treatment (I'm referring to HK obviously )

Not something I think I'd enjoy being associated with.

However, "wellness Kinesiology" has a nice ring to it so perhaps Dennis if you prefer this term, you could change the name of what you do, putting some clear blue water between your ideas and biomechanics proper.:drinks

You could start a WK forum to discuss it, perhaps a WK academy to teach it. Leave us poor unenlightened souls to cling feebly to the laws of physics (which are doubtless going to be proven inapplicable to living creatures any day now) and do something better!

Yes, I like this plan. Cut the cord Dennis. Embrace your idea and use it as a firm manifestation of the uniqueness and value of your approach, clearly demarcating it from those who don't accept its self evident truths, yet would use the same terms to describe their practice. :drinks

You could even incorporate some of your historical rebrandings. You've been very imaginative in the past with your conceptual labeling.

Wellness, Architectural, Neoteric, Kinesiology. Did I miss any? That's quite snappy!

 

Robert:

One of your best postings of 2012.:good:

 

Kinesiology = snake oil

 

Robert

I love it when you tap into your skepto-critical-ironic side, its a beautiful thing like if Bertrand Russell met Oliver Reed for a jam session on the meaning of life.

Keep up the good work

Dave

 

I don't know much about kinesiology and some practitioners seem to be very knowledgeble but this web site brings down the median wouldn't you say?
http://www.kinesiology.co.uk/

On the otherhand with the SCP and many podiatrists showing interest in kinesiology taping perhaps we shouldn't be to quick to throw stones
Dave

 

We have had a few threads on it:
Applied kinesiology and foot orthotics: True or scam?
Applied Kinesiology by Any Other Name…
Applied kinesiology Test protocol
Chiropractor / Applied Kinesiology test

 

It's not really possible to study the force without studying the structure it is applied to. To say that the tissue stress approach to biomechanics doesn't examine structure is just wrong.

Eric

 

I totally agree. Where would you think I differ?

My dissent revolves around your apparent focus and concern on diagnosing and treating the pathological forces in play case by case while leaving the diagnosis and treatment of the structure in the dust?
I am not in any way asking you to reduce the import of studying and controlling forces, I am asking you to expand your study and control of the structure.

So then, what is your method of diagnosing the structure of a foot in fromt of you, with or without a complaint?
and
How do you alter the structure of your orthotics on a case to case basis?

Dennis

I know you won't answer so I;ll stop this thread here.

 

Where have you all gone? Kinesiology does not equal snake oil. Maybe the podiatric interpretation does, but that is another story. Please Guys, science first, opinions later. Rob

 

Indeed. One of the finest books ever written on tissue stress and biomechanics is titled: "Kinesiology- application to pathological motion" by Soderberg G.L. Williams and Wilkins.

I think it is important to differentiate this from the "Applied Kinesiology" technique which Robert referred to and which is quite obviously snake oil.

 

How to you explain the nonsensical pseudoscience in these threads:

and the nonsensical pseudoscience on this "kinesiology" site:

 

Why thankyou sir.

As has been mentioned kinesiology itself is a harmless enough term, tragically hijacked by some frankly odd practices. Wouldn't want to be thought of in the same area as that nonsense.

 

There's plenty of structural observation in classical and modern biomechanics. Joint roms, varus's and valgus's and axial locations for eg all pertain to structure. I don't understand your point.

 

My point, kind sir, is that we can do better. You seem to be saying that we have enough "structural observation" in biomechanics and I can't disagree more. You capping of the skeletal structure piece of biomechanics and the anatomy piece of kinesiology remains my concern. I don't understand why you want to do that?

Your casting positions and many of your corrections dominate on the frontal plane when most of the pathology that we see clinically dominate on the sagittal and transverse planes.

Varus and valgus RF Posts, Varus and valgus forefoot posts, medial and lateral skives, inverted casts can be replaced with sagittal plane care at well selected moments.

In addition, your focus on controlling biomechanical forces are applied to the orthotic shell that you construct without much regard to skeletal anatomy or the ability of the human form to morph and remodel in both positive and negative directions.

Once again, orthotic reactive forces (modifications to an orthotic shell that create counter forces to pathological ones that have been diagnosed) when properly applied, play a very important part of our care but when one pays more attention to structure, one realizes that there are better casting positions that can be developed on a case to case basis. it turns out that many of these live on the transverse and sagittal planes.


We can seek to position the weightbearing structure of the foot with shells that make the subject's muscle engines more trainable, better leveraged and more productive so that they can defend against pathological forces internally as they morph the architecture of the foot (think subtalar stenting).

This eventually, in select cases reduces the need for the orthotic and its ORF's.

This in turn opens doors to prevention, performance enhancement and quality of life upgrading which do not eliminate tissue stress theory, they expand on it.
Dennis

 

How does a casting position "live" on any plane?

Varus and valgus wedges are in the frontal plane yes. Kinetic wedges, heel raises, mortons extensions, striker mods reverse mortons extensions, met domes, are more involved with the sagital plane. Any casted shape is triplanar.

Can't really comment on "forces living on the orthotic shell", because I have no idea what you're talking about.

I'm not sure you do either.

 

Rob is right.

Kinesiology is not snake oil.

Here is the definition of kinesiology from the Merriam-Webster online dictionary:

Many undergraduate academic departments which focus on the study of biomechanics principles are called "Department of Kinesiology". http://www.csus.edu/hhs/khs/

In fact, many people use the terms "biomechanics" and "kinesiology" synonomously. However, in the international scientific literature currently, "kinesiology" has fallen out of favor in favor of "biomechanics".

There is no need for us to change the term of what many podiatrists study from "biomechanics" to "kinesiology". What is needed, however, is for podiatrists to become more educated as to the principles of biomechanics so that they can all understand its far-reaching importance over what we do on a daily basis in the diagnosis and treatment of mechanically-related foot and lower extremity disorders.

 

"Kinesiology" may have legitimate uses as a term, but it image has been tarnished by those who have hijacked the name and used it as a magical nonsensical pseudoscience.

 

Agreed, but what about Biomechanics?

Dennis

 

But so has 'orthotics'...

 

You bet.

The point here is to develop language and logical progressions of biomechanical theory that are acceptable mainstream, to the medical community and to the foot suffering public that can get them to the point where they can separate the charlatans from the legitimate practitioners.

Calling for the masses to educate themselves more about physics and engineering put the onus on them. Instead, we could be sending our message out there in a more understandable and teachable manner.

What my patient with a foot/postural problem wants to know is what their problem is, what caused it and how, in simple terms, I can institute and support them to a cure.

They don't care what research there could or should or will be or what letters I have after my name or if I am patented or trademarked.

They want the better functional life that we can offer them biomechanically or closed chain kinesiologically that we share in common here at The Arena.
Dennis

https://podiatry.com/ezines/index.p...TB_iframe=true&height=700&width=768&full=true

 

I examine the anatomy of the foot in front of me. I don't diagnose a structure. From examining the structure of the anatomy I can deduce structures that have been placed under too much stress. (They are the ones that hurt.) Then, for a specific case, I design my orthotic to reduce the stress on the injured structure. To do that you have to examine the structure of the anatomy. You can see my windlass paper for how this is done when I decide one of the anatomical structures that make up the windlass has been injured. From the analysis in that paper, I predict that high pronation moments from the ground and high loads under the first metatarsal head will lead to more stress within the windlass mechanism. So, I alter my orthotic to incorporate a varus wedge effect in the heel when the patient has a medially positioned STJ axis and I add a forefoot extension, when I suspect they have high loads under the first met head. Not all feet with windlass structure symptoms have a medially positioned STJ axis. So, on a case by case basis, I examine the position of the STJ axis and then decide whether or not to add a varus wedge effect (e.g. medial heel skive) to my prescription.


With future research, I feel that there will be some predictive value to examining some aspects of structure for example, subtalar joint axis position and relative lengths of metatarsals. There has been some research to show that pressure under the metatarsal heads is related to relative metatarsal length, but I don't recall if this has been examined and reported upon in prediction with stress fractures. I would bet quite a bit that there will be strong correlation found between posterior tibial tendon dysfunction and STJ axis position. It would have to be a study that has a large number of subjects because not everyone with a medially deviated STJ axis gets posterior tibial dysfunction. I am predicting that a lot more people with medially positioned STJ axes will get posterior tibial dysfunction than in people with laterally positioned STJ axes. There is a sound theoretical basis for this. A much better explanation than you could come up with when compared to some other proposed measurements like supination end of range of motion. Dennis, I challenge you to come up with a coherent explanation of why supination end of range of motion should be related to any common complaint in the foot.

Eric

 

Aloha,

I agree with Eric,

"It's not really possible to study the force without studying the structure it is applied to."

For example: we can influence and descibe how a cyclist reacts with the bike under him by changing seat and handle positions, pedal lengths and we can describe and influence how the bike works mechanically by changing gear ratio's, tire size etc. So when we combine the bike machine with the living/moving engine we can call it BioMechanics.


And i think this quote from Kevin is very close to the truth, I would add that a greater understanding of mechanical engineering is needed now and in the future.

"What is needed, however, is for podiatrists to become more educated as to the principles of biomechanics so that they can all understand its far-reaching importance over what we do on a daily basis in the diagnosis and treatment of mechanically-related foot and lower extremity disorders. "

And i disagree with Dennis on this because the only way we can ensure informed constent is with an educated patient...

"Calling for the masses to educate themselves more about physics and engineering put the onus on them."

Mahalo,
Steve

 

What is your method of examination for structure if you "don't diagnose structure"?

To do that you have to examine the structure of the anatomy.
What protocol do you use to examine the structure?

Do you ever alter the structure of the injured structures of the windlass or do you only change the forces reacting on that structure?

Have you ever proven that?

So, if I have you understood, when you have a first ray that has pathological pronation moments, you add a varus wedge into the rearfoot of your orthotic instead of considering a method to elevate the first ray structure at the location of pathology without impacting the RF or the suprastructure very much? It seems like you are treating the kitchen for a problem that exists in the living room?

Why is the subtalar joint axis of paramount importance here and how do you decide which orthotics get your RF varus post and which don't What if the patient was elderly and had a poor transfer of weight from RF to FF when heel contacting? What if the patient was a forefoot contact walker or runner?

I disagree, if you are correct, why haven't you come up with the research you predict as your windlass paper is dated?

There has been some research to show that pressure under the metatarsal heads is related to relative metatarsal length, but I don't recall if this has been examined and reported upon in prediction with stress fractures.
That would support my thought that RF Varus posting is misplaced in your treatment and that treatment should be focused in the forefoot when the pathology is in the forefoot.

So you have no evidence currently?

 

I agree that Kinesiology is a term miss appropriated by pseudo professionals. But in its original use it allows for more study of nervous system involvement, in human movement.
I advocate for Biomechanical Kinesiolagy.

 

Dennis, things that happen in the rearfoot effect the forefoot and vice versa. As the rearfoot everts there will be increasing loads on the medial forefoot. Attempting to invert the rearfoot will decrease load on the medial forefoot. By the way the first ray does not have pathological pronation moments. Problems in the first ray are usually related to high ground reaction force loads under the first met and hallux.

I'm not at CCPM any more. I don't get paid to do research. If you'd be willing to set me up a research facility, I'd be glad to start on the research.

Dennis, the rearfoot varus wedge effect is only one part of the design or the orthosis. You use the rearfoot varus wedge effect when there is a medially positioned STJ axis as there will be a higher pronation moment from the ground in these feet. As I stated above, rearfoot eversion causes increased medial forefoot load and this will be more pronounced in feet with medially positioned STJ axis. When the foot does not have a medially positioned STJ axis you treat high loads under the medial forefoot with other methods for example forefoot valgus wedging or a reverse morton's extension. If you are going to make a custom orthotic, you should change the design based on what you see in the foot.

Dennis, your statement above does not make any sense. Why does one foot type get PTTD and another not? It seems that you are trying to say that the foot type you describe has a more medial position to it's STJ axis. Are you agreeing that a medial STJ axis is likely to cause PTTD? If one thinks that a medial STJ axis is the cause of PTTD, why would one bother typing the foot? Just look at the STJ axis. Again, how do you change how you make the orthotic based on foot types. If you do make the orthotic differently for different foot types why do make that change?

To give you an example of a good explanation. A foot with a medial STJ axis will have a higher pronation moment from the ground than a foot with a lateral axis. The posterior tibial muscle resists pronation moment from the ground. Therefore, the posterior tibial muscle will have to work harder in feet with medially positioned axes. When the muscle has to work harder it's more likely to develop overuse injuries like PTTD.

Dennis, the difference between the tissue stress approach and functional foot typing is that there is a logical rationale for the prediction of pathology. You have not explained why SERM is related to anything. You have given even less to potential researchers on what to do with functional foot typing. There are no predictions. Why should one foot type be more likely to have a particular pathology than another foot type?

One of the reasons that I'm on this forum is that I can suggest possible research projects to the forum. I hope that there are people out there who have the ability to carry the projects out.

Playing chess with a chicken is a weak path to follow.

Eric

 

Kinesiology:
the study of the principles of mechanics and anatomy in relation to human movement

Biomechanics:

the study of the mechanics of a living body, especially of the forces exerted by muscles and gravity on the skeletal structure



How about Closed Chain Kinesiology for what we do?
Dennis


" As Shakey said, "A rose by any other name would smell as sweet". Altering names per se does nothing but cause confusion. One must also bear in mind that the opposite holds true - 'Excrement by any other name, would smell the same.'

Bill Liggins