People 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 they 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.
This brings us to 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. 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.
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. This has to do with the second thing orthotics do.
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! Take a look at these knees.
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.
So 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.
Now here’s a third (surprise!) 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!