Do orthotics relieve foot, knee, hip, and/or back pain? - Upright Health

Do orthotics relieve foot, knee, hip, and/or back pain?

Orthotic insolePeople with foot, knee, hip, and/or back pain are often told that they need orthotics. Whether it’s the doctor, chiropractor, or physical therapist who’s recommending them, a lot of people wonder whether orthotics really are worth the (sometimes sizable) investment they represent.

But before you spend even $1 on a set of orthotics to help you with your foot, knee, hip, and/or back pain, it’s a good idea to answer two questions.

First: do orthotics really relieve pain?

The answer is a resounding sometimes.

I’ve worked with countless individuals who have used or continue to use orthotics and the results are staggeringly unclear for some reasons I’ll outline below.

I’m sure that if you do an informal poll of friends and family who have used them, and you’ll find that the answers will range from, “my orthotics instantly made my knees feel better” to “I think they made my back hurt worse.”

And, of course, you’ll also get the middle road: “I can’t tell the difference, even though I spent a month’s rent on these dang things.” I’ve had many clients walk into Upright Health and give me the whole gamut of opinions about their orthotics. I even tried out several kinds of orthotics years ago when trying to deal with back, foot, and knee pain, but they never provided me with any lasting relief.

The second question: do orthotics address the source of your problem?

It’s one thing to relieve pain (assuming you get any relief), but it’s a whole other order to actually address the source of the problem.

Let’s look at an example, if your kitchen faucet was streaming at full blast with water pouring over the sides and onto the floor, would you:

a) immediately start mopping the floor and bailing the water out the front door to prevent the rest of your home from being flooded and call the nearest friend, family member, or neighbor to help you mop and bail quicker OR
b) turn the faucet off and then start cleaning up?

The sensible solution is clearly option b.

Now both options would address the flooding problem so in that way are okay answers, but option b goes straight to the source of the issue and prevents the mess from getting bigger while option a is something only your black sheep cousin Steve would do.

When orthotics actually do provide some pain relief (the best case scenario), they are doing two major things: absorbing the force of impact and changing the way your body moves.

You could have a few other variations of option a as well.

You could, for instance, throw down a bunch of sponges on the floor, or line your floor with three hundred rolls of paper towels, or put every sham-wow in your house into action, etc. etc. etc. Some of those options would work better than others (sham wows really do absorb more than paper towels), but only option b would have very high statistical effectiveness.

When dealing with your aches and pains, orthotics, unfortunately, are more like option a and generally do not address the source of the problem. Sometimes they work (just like bailing water out the front door), but even if they do, they may not work for long.

When orthotics actually do provide some pain relief (the best case scenario), they are doing two major things: absorbing the force of impact and changing the way your body moves.

Do orthotics improve your ability to absorb impact?

Many people think that the “impact absorption” is a big deal, but it’s actually the equivalent of mopping the floor.

For runners, walkers, hikers, and anyone else whose activities require moving in the upright position, impact is actually supposed to be absorbed by your body. Think of all the stereotypes you have in your head of Native Americans, barefoot native peoples from around the world, and the Kenyan marathon runners who train barefoot on firm dirt trails.

Their bodies somehow — a bit magically it seems to modern day Americans — absorb impact just fine, thank you. And the reason their bodies can absorb that impact is because their bodies are aligned properly and the muscles and bones are able to absorb and distribute the impact appropriately.

Orthotics change the way your body moves.

If you’ve ever been to a running shoe expert, you’ve probably been told you’re one of the following three things: a pronator, a supinator, or a neutral.

If you’re a pronator your arch collapses when your foot strikes (and you probably have flat feet when standing), and if you’re a supinator, you have really high arches and tend to put all your weight out to the lateral (outside) edges of your feet. In this case, it’s good to be neutral because it means you have good arches that look good in a magazine and move properly through your stride (and you and Switzerland can be friends!).

Now what’s the big deal with being either a pronator or a supinator? The big deal is that getting out of neutral throws off the “arthrokinematics” (which is a fancy word for “the way a joint moves”) of all your joints.

Imagine mounting a bicycle wheel crooked. How far are you going to get if your wheel keeps rubbing against the fork or the frame of your bike? Not far.

Now imagine your knee is “mounted” crooked. How far are you going to be able to run or walk? I know you’re thinking, it’s impossible to have my knee “mounted” crooked!


An example of poor body alignment

Take a look at these knees.

Right knee is severely internally rotated

Notice something? Yeah, crooked. Were they “mounted” that way? Probably not.

For most people that kind of pattern starts showing up over time as the muscles, tendons, ligaments, and fascia that bind it all together pull things into the wrong position. And all that is very often reflected in what your feet are doing.

Being a supinator or a pronator means your knees are now mounted crooked (probably not as severe as in the picture). They will not be able to move with correct arthrokinematics.

If your knees no longer move properly, it’s (unscientifically speaking) about 99% certain that your hip joints are also not moving properly.

If your hip joints are not moving properly, your ability to absorb impact from walking and running is severely reduced (healthy butt muscles — a key part of your hip joints — help you absorb lots of impact) which puts extra strain in the feet, knees, and back (and don’t forget your feet and knees are already compromised!).

The odds that your back and all its muscles are moving properly are slim to none.


How do orthotics work when they do work?

When orthotics actually do help your foot, knee, hip, or back pain, they are adjusting your movement pattern to reduce some of the strain through your body.

That’s great! Whew! Pain relief! However, they are not restoring balance to the muscles that are supposed to help you walk and run without pain in the first place (it’s a sham-wow solution)!

Instead, they are providing a crutch to minimize the impact (both literal and figurative) of your muscles and joints being out of true. Often, clients of mine have found that orthotics were effective for a while and then ceased being effective (when the muscles of their body finally figured out how to be even more dysfunctional).

For those who got no relief from their pain, it was very likely because the orthotics weren’t enough to overcome the abnormal stresses throughout the body caused by faulty alignments. The crutch just wasn’t good enough.


A final question: even if the crutch is good enough to relieve pain, do you want to be dependent on a crutch for your entire life?

To get true pain relief without needing crutches (aka orthotics) for the rest of your life, you need to retrain muscles all up and down your body to restore proper strength, length, and firing patterns.

Reprogramming your body in this way means you’ll be healthier and happier, and you won’t have to shell out $600 every couple years for a new set of orthotics that may or may not work.

As an added bonus, part of the reprogramming process eventually often means developing stronger, bigger butt muscles, and both ladies and men tend to like that!

Reprogramming your body in this way means you’ll be healthier and happier, and you won’t have to shell out $600 every couple years for a new set of orthotics that may or may not work.


Leave a Reply 11 comments

angela lowrey - June 10, 2012 Reply

Matt, I love the way you explain dysfunction! As Posture Alignment Specialists, we get these type of questions all of the time!!!Thanks again for sharing your time and energy with people in pain and giving the knowledge and tools to get themselves out of the pain cycle.

Hip issue, strengthen it? - Page 3 - June 11, 2012 Reply

[…] google_ad_client="pub-5978157599538541";google_ad_slot="9470652193";google_ad_width=300;google_ad_height=250; Originally Posted by ItechWarrior It has, and I have a whole new lower back issue. I bought some custom orthotics for my shoes as my feet are really flat and have no arch. Itech, I wrote this partially for you and partially for almost every amateur athlete I've ever seen with back and hip pain/dysfunction that was using orthotics. There's a time and place for orthotics, but "forever" usually ain't the place! Upright Health – Do orthotics relieve foot, knee, hip, and/or back pain? – San Diego's Pain Relief a… […]

nickie - April 16, 2013 Reply

If not orthotics for back pain/hip pain/ occasional foot pain….who do I see ?

    Matt Hsu - April 16, 2013 Reply

    Hi Nickie,

    That’s a great question. Every individual’s back/hip/foot pain will be unique to them, so it’s a good idea to find a health professional who can help you rebalance the things that are throwing you off.

    If you have hip/back/and occasional foot pain like you’re talking about and your professional DOESN’T check the range of motion and sensitivity of muscles around your hips, palpate (feel around) your back muscles, and take a look at how your feet, knees, and hips align but instead just starts having you do back exercises, you’re probably with the wrong person.

Raymond - May 2, 2017 Reply

I am having an issue with my knees, back story. Hit by a car when 16, broke leg. In traction for 6 weeks. I think that they made that leg “straight”, as I have always been duck-footed. Fell off a roof five years ago, broke same leg/ ankle. Recently I have had extreme pain in both knee’s. Doc x-rayed hips and knees fine? Slightest bit of arthritis starting in the broken leg. Any suggestions? Tired of Tylenol and Aleve

    Matt Hsu - May 8, 2017 Reply

    Hi Raymond, sorry to hear about the accidents. Any time you get injured, it’s a bit of a process to re-educate your body to move properly. It can be slow-going, but it’d be a good idea to start learning how to open up your hips with massage, stretching, and exercise. Problems with muscle tension, weakness, and coordination are not on the radar of the medical system, and they won’t show up in x-rays or MRIs. You may want to take a look at Healthy Hips 1 to start improving your hip mobility.

Elly - May 8, 2017 Reply

Hi Matthew,

Very interesting read. Cutting my story short, I was provided with orthotics yesterday as I have metatarsalgia (caused by worn out shoes.. yes stupid me) and the podiatrist wanted to change my gait basically. The symptoms that I had from metatarsalgia are getting better now as I’ve been resting for 2 weeks. However, I wore the orthotics for the very first time yesterday for just over hour and a half, they felt okay didn’t hurt or anything. But his morning I woke up and other parts of my feet were so sore. E.g arches. I immediate knew the soreness was from the orthotics. I am thinking of using the orthotics as a door jam it’s that useless. I hope I didn’t create new injury to my feet or other body parts since I only wore it for an hour! Getting worried. What do you think?

    Matt Hsu - May 11, 2017 Reply

    It’s pretty unlikely you’ll drastically injure yourself in such a short period of time. Rest easy knowing that even if you do “hurt” yourself, your body has an amazing capacity to heal!

Jade Browning - August 8, 2017 Reply

Hi Matt,

I just saw a podiatrist for my lumbar back pain. I had already seen an orthopedic surgeon and there was nothing wrong with my back. I was told I have mild sculiosis, knock knees, and extremely flat feet. She told me even with custom orthotics, I would always have pain when running because of the way my body is built. What is your opinion on this? For the job I am trying to get, I will have to run 2 to 3 times a week in the academy.

Thank you,

    Matt Hsu - August 23, 2017 Reply

    I’d personally disagree. Your body can learn to absorb impact properly given the right training stimulus. It’d be difficult to argue that adding thin, stiff molds to the bottom of your feet drastically improves your body’s ability to absorb impact. Muscles that properly articulate joints and fire in proper sequence during movement, however, definitely improve your body’s resilience.

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