During my 44 years in practice, I have tested many patients on their performance capabilities. I've evaluated them in the office, on a staircase, down a hallway, on training fields and even on a trail. I have found you don't have to be an advanced kinesiologist to test the athlete. The key is to put them in a position of performance and test an extremity for strength and stability.
Testing Performance Positions
I first test the patient in prone, supine, sitting, standing and standing challenge positions, which reveals what they cannot perform. Each test has a correction sequence, after which that sequence never has to be performed again in that challenged position. I then explain how the body compensates for these failures to perform and that over time, adaptations occur that develop into a cause of symptoms complexes at least as bad as the original injury.
I tell the patient there are two main sources of pain, from the head down and from the feet up. After demonstrating and correcting the basics of "from the head down," the patient realizes their pain syndrome is really a manifestation of neurological imbalances, secondary to other injuries that over a lifetime, stacked upon themselves.
From Pain Consciousness to Performance Consciousness
By the end of the first, second or third visit, I tell my patient: "Now that you can see how your brain and structures of the cranium and upper cervical regions affect everything, the next step is to test from the feet up and see how that plays in your functional performance." In doing so, I have moved the patient from pain consciousness to performance consciousness.
I have the patient attempt to perform a dynamic kinesiological challenge test specific for the pedal foundation. If the patient fails the test, I have them stand on a sample pair of custom orthotics with three-arch support and redo the test. In nearly all cases, the patient is so perplexed by how dramatic their strength performance has improved that they want it repeated. I repeat the tests until the patient realizes their feet are a major source of their problem, whether it is a knee, hip, low back, shoulder or neck issue.
I explain that the effects of foot dysfunction are no different than physical changes following an accident; that the chronic adaptation to an uneven pedal foundation is harmful, has long-term effects and must be corrected. If the patient has their own orthotics, I still perform the tests on them. If they pass, they are congratulated on having good orthotics. But in most cases, the patient fails the test, indicating the orthotics they have do not help the rest of the body.
I tell them, "I care more about how your feet affect your body than I do about your feet. Your podiatrist or professional who made these cared more about your feet than your body function." At this time, nearly every patient wants to order the stabilizing orthotics I offer or change to them.
Making the Connection Between Foot Stabilization & Athletic Performance
For the athlete, I'm much more involved with the patient's specific performance positions and balance in those positions. I'll have the patient demonstrate movements that are particular to the sport and while in those positions, I test their muscles for strength or stability.
The key is to put the patient in the position of performance and test an extremity for strength and stability. This is done with the patient not wearing orthotics, with their own, and finally with a sample of three-arch-supporting custom orthotics.
Here are a few examples of sports performance situations I see regularly:
A bodybuilder having shoulder issues was put in a squat position and tested. He failed dramatically on one side. The analysis showed pronation worse on one side, with the knee misaligning medially and the shoulder weakening. Repeating the performance wearing custom orthotics completely changed the dynamics.
An NFL receiver was having multiple pains in the knee and ankle. He was put into every catching position, including standing on one foot reaching out, and tested. He failed in three positions. With custom orthotics, he was stabilized correctly. He ordered 20 sets of orthotics after such an experience.
A college baseball player came in with back pain. He received chiropractic care from his local chiropractor, but the pain always came back. Analysis of his motions on the field and his weightlifting positions revealed severe knee and pelvic misalignment when under the stress of the dynamic position. His trainer had him lifting weights barefoot. Placing custom orthotics in his shoes stabilized all positions.
A professional boxer came in wanting to be fine-tuned for an upcoming fight. He was put into positions of punching, and his key punch was demonstrated to be weak. He was also put into a hold position and shoved around. In both positions he lost stabilizations and strength, prompting him to ask: "What does this mean?" My answer was, "You are not going to win without healthy foot biomechanics." With stabilizing orthotic samples put in his shoes, he was able to perform at his maximum level.
Getting Athletes to "I Get It!"
Even more than we see professional athletes, chiropractors see teenagers who play sports: soccer, basketball, etc. Nearly every one of these young athletes will sprain an ankle or hurt a knee unless they wear custom orthotics that stabilize all three arches of the foot.
In the athlete's eyes, they get it. It is all about performance. They feel the difference. Most of the time, the patient or extreme athlete asks the question, "Why are these working while others don't work?"
I answer, "There are three arches in the foot and each of those arches has specific effects on postural dynamics, proprioception and muscle balance. It is the use of the custom orthotics made in a weight-bearing position that aligns all three arches, which creates the stabilization and therefore improves the performance ... and most importantly, prevents injury while in difficult positions." They get it!
Dr. Edward Wagner is a 1977 graduate of the Los Angeles College of Chiropractic; owner of the Wagner Holistic Center in Pacific Palisades, Calif.; and the author of Dr. Edward D. Wagner's Complete Guide to Healing the Entire Body, Mind and Spirit and Applied Concussion Neurology.