Why do so many of us merely consume healthcare, complacent with what an insurance company dictates we need? In every other aspect of our lives, we are we discerning customers. We should expect and seek expertise that will accelerate recovery and prevent injury in the first place. We only get one body, and it has to hold up to help us accomplish everything we dream of doing. Shouldn’t that be worth more than what you’re chalking it up to now?
We often have athletes come through our doors looking to achieve perfect alignment in their form, convinced that their asymmetries are what’s holding them back. While it’s true that asymmetries can lead to injury and chronic tightness, or be the culprit behind race day disappointment, the bottom line is, “perfect alignment” does not exist. The human body is naturally asymmetrical. The challenge is to work WITH an asymmetry, not against it.
So you’re running the NYC Marathon on Sunday. (!!!) Here are some tips for running it, and getting ready for it.
It’s our favorite time of the year! Nope, not the return of PSL — MARATHON SEASON.
The TCS NYC Marathon is less than two weeks away, and with the return of the barricades and bleachers near Tavern on the Green, comes an onslaught of panicked patients to our clinic.
The training’s in the bank and it’s time to taper. But when a runner backs off their mileage and tells their body to rest, sometimes, it revolts.
For the last few months, you’ve been pushing yourself to new limits and your body has responded. In fact, it’s gotten so used to that high volume and level of intensity that it’s addicted to it. So when you take some of it away in taper, essentially, the body goes into withdrawal. Your mind goes off the deep end like an irrational ex and won’t listen to reason — it convinces you that you’re injured and creates phantom pains out of race nerves.
How can you tell if that new pain is real or just in your head?
If you’re experiencing a totally new pain that just showed up in the last week or two, for no apparent reason, it’s highly likely that it’s all in your head. Your mind is messing with you and throwing a “taper tantrum” in response to lower intensity training and the body’s recovery process. Now that you’re hyper aware of your impending race, you’re allowing yourself to be hyper aware of every little thing you feel in your body. The filter that told you the pain was NBD during training and allowed you to keep running has been switched off by a brain that thinks it has nothing better to do than turn butterflies into scorpions, sending shooting pain to various parts of the body.
RELAX. Stretch and foam roll, and take some deep breaths. If you have a regular yoga practice — do it. (But if you don’t, this isn’t the time to start!) Do what you normally do to chill out, occupy your mind with things other than your race and see if the pain fades in a day or two. If it doesn’t, get it checked out.
What if the pain is legit, and you’re thinking the worst?
If you’re truly freaking out — an old injury pops up, or you’re worried that nagging ache in your foot will progress to a stress fracture while descending the Queensboro Bridge — the only way to know for sure is to seek medical help.
So who should you call?
With limited time before race day and needing to prioritize rest above all else, your best bet is to head straight to a physical therapist. Most runners assume they need to see a sports ortho doc first, but that’s not the case. The reality is, if it’s a musculoskeletal issue, that doctor will prescribe physical therapy anyway because they entrust PTs to handle these types of injuries and pain. So cut to the chase and save time, energy and money on co-pays by booking an evaluation with a sports and orthopedic PT first. Try to get in a few times before your race. You’ll get the care you need sooner, and feel a lot less stressed without scrambling to fit in multiple doctor visits.
My legs don’t feel better from taper. They feel heavy and sluggish.
That sensation of heaviness is a totally normal phase of taper as your body focuses on repairing itself. In the very last days leading up to your race, it could also be a result of your body holding on to a bit more water as you increase your carb intake. Execute a few short strides at the end of your shake-out runs. A stride is not a full-on sprint; just pick up the pace and heart rate for 15-20 seconds to feel more confident that your legs will remember how to respond on race day. And believe in the magic of race day! It really will all come together.
OK OK, I’m not actually injured. But how do I quiet that voice in my head?
Focus on what you CAN control. Read and re-read the race website and online race reports from other runners, and plan exactly when you’ll hit the expo to get your bib. Information and specific plans are kryptonite to doubt!
Visualize your perfect race from start to finish. Then visualize a version of the race where everything goes wrong, and solve each problem in your head. Knowing you can solve problems should they arise will give you even more confidence on race day. Before you fall asleep each night from now until the race, picture yourself crossing that finish line, looking strong, and utterly owning that moment.
Remember, race the first 20 miles with your legs and lungs. Leave the last 10K up to your heart and mind! GOOD LUCK.
Since we were old enough to do the quizzes in Cosmo, we’ve been lead to believe that the more kegels we do, the better our sex life will be, and we won’t pee ourselves when we laugh or run after having kids.
Turns out, it’s not quite that simple.
Like all exercise, kegels should be prescribed based on what’s going on inside you. You wouldn’t walk into a gym and do 100 bicep curls without working up to it first. Same logic applies down there.
Essentially, a kegel is a tightening or clenching of the pelvic floor — the group of muscles found at the base of the pelvis below the abs. And because it’s made up of muscles, the pelvic floor can get tight or weak. When that happens, a lot can go wrong. But it’s critical to know which category you fall into first. Don’t just assume you need your vagina to get jacked.
There’s a common misconception that kegels are related solely to sexual pleasure and performance. But we’re not in seventh grade anymore. The reality is, kegels work your pelvic floor to help it hold all your organs in and help prevent back pain by stabilizing your pelvis, on top of preventing you from peeing your pants if you’ve had a watermelon-sized human (or two, or more!) bearing down on your pelvic floor for months (a.k.a. been pregnant.)
Kegels increase the tone in the pelvic floor and improve your grip down there. You do them for the same reason you torture yourself at the gym and Barry’s — to make your muscles perform better. Many people need to do them to overcome weakness so when they sneeze, cough, crack up, jump or run, nothing leaks out. (Let’s be clear. Leaking is never OK. Not even a little bit. And if it’s happening to you, it can be fixed.)
But in some cases, the pelvic floor muscles are already super tight, and need to be lengthened before they can get stronger. If having sex or putting in a tampon or your annual GYN exam is painful, your muscles are most likely in a shortened position, and kegels will only make things worse by shortening them even more. If that’s you, put the kebosh on the kegels altogether and seek out a PT.
If you’re sure that kegeling is right for you, let’s discuss technique. It should feel the same as stopping your pee mid-stream. But never practice kegels while actually going to the bathroom. That could lead to a UTI, and no one wants that.
Eventually, you can kegel anywhere, but it’s best to start out lying down. Try to hold your kegel for 3 seconds, 10 times. Progress to a hold for 5-10 seconds, 30 times a day. To find that kind of time, you’ll have to fit in some stealthy squeezing on the go. But like any other training plan, the exact protocol differs for everyone. Some pelvic floors are built for endurance and can be held for 10 seconds right away. Other pelvic floors might be able to sprint a 5K, but can’t survive a marathon. So leaks might happen at the end of a workout class or run, or at the end of the day. It’s important to be mindful of when your muscles work — and when they don’t.
Like all other muscle training, form is everything and more isn’t always better. The relaxation of the muscle is just as important as the contraction. A kegel should have two phases —pulling up and in, then letting everything go and dropping back down. If you feel like you can’t do that last part — you can’t relax your pelvic floor muscles — consult with a PT. Similarly, if kegeling hurts or makes you feel like you need to pee, your pelvic floor is likely jammed up and too tight. See a pro.
A pelvic floor physical therapist has specialized training that allows her to evaluate your kegel externally AND internally. From the outside, she can tell if the pelvic floor muscles are able to contract and relax. But an internal exam can reveal a lot more about what’s going on. Getting up in there is really the only way to check out your technique, assess the strength of your pelvic floor contractions, check the integrity of the tissue, locate scar tissue, and tell if the muscles are too tight or too weak. Armed with all that detail, a pelvic floor PT can give you the right training plan to address whatever symptoms you have.
Fellas, if you’re still with us but thinking all this kegel talk is solely lady business, you’d be very wrong. Dudes have muscle covering the space underneath their pelvis, too. Everyone has a pelvic floor, which means guys can also benefit from a little squeeze-and-lift action, especially if they lift weights.
Regardless of whether you’ve had kids, or never intend to, or simply can’t because you have a penis, you need a strong pelvic floor. Find a pelvic floor PT who can customize a training plan just for yours. We’d be happy to recommend a great one.
No one wants to be in pain. So, when any kind of ache, tweak, mysterious twinge or more serious strain, chronic discomfort or injury occurs, your first instinct is to see a doctor. But heading to your primary care doctor or trying to get in to see an orthopedic specialist might not be the most efficient solution. Going to a physical therapist directly for musculoskeletal pain will save you both time and money – and the sooner you start treatment, the sooner you’ll feel better.
Training (and packing gear, pumping tires, checking Strava for kudos and doing epic loads of laundry) requires maximal efficiency. Here’s how to sneak in some extra exercises during your day and multi-task your way to an extra edge.
While you’re: Brushing your teeth
Sneak in: Balancing on each leg for :60
Why: Balancing challenges key muscles that support your spine. If you have trouble balancing for :60, imagine how hard your brain and body are working to keep you upright while pounding out miles.
Dr. Joshua Grahlman, founder and Athlete Mechanic® at Clutch Physical Therapy, says if balancing on one side is harder than the other, you have asymmetry in form that can lead to injury over time. Target your weaker side with single-leg squats off a bench or side-stepping with a resistance band.
While you’re: Schlepping a laptop, gym bag AND purse to work
Sneak in: Strengthening your weak side
Why: If you always sling heavy stuff over the same shoulder, you’re putting extra stress on your spine and creating strength imbalances. Switch sides frequently to improve your stroke in the pool and arm swing on the run.
While you’re: Waiting for the shower to heat up
Sneak in: Planks
Why: :90 of planks (:30 front, :30 each side) each day will change your core and improve stability, which means fewer injuries and faster splits.
While you’re: Behind the wheel
Sneak in: Preventing back pain
Why: Driving with laid back posture might make you feel in control, but it causes tightness and misalignment that’ll catch up with you in aero. Dr. Grahlman recommends checking the position of your left leg. Extend it with your knee slightly bent and align your left foot as closely and safely as possible with your right to keep your pelvis aligned and protect your back.
While you’re: Living the dream
Sneak in: Ambidextrous movements
Why: Reach for your coffee, swipe your Metro card or use chopsticks with your non-dominant hand. It’ll challenge your brain and improve balance on the bike. You should be able to grab a bottle with either hand. Just in case.
While you’re: Sitting on the train or at a restaurant
Sneak in: Hip opener
Why: Triathletes’ hips are chronically tight, but most of us blow off stretching. Dr. Grahlman advises sneaking in hip openers whenever you’re in a seated position. Pick up one leg, cross your ankle to the opposite knee, pull your shoulders back, engage your abs, tip your pelvis forward and press down gently. Aim to align both knees, take a few breaths (because it probably won’t feel awesome) then switch sides.
While you’re: In line at Trader Joe’s or waiting for the train
Sneak in: A posture check
Why: Unlock your knees, tuck your tailbone and lift your chest to engage your core and glutes. You won’t suddenly have better posture on a run if it’s not a habit all the time. Better posture leads to better performance in every sport. It’ll also make you look taller and more effective at your job. Probably.
Time is the most precious resource we have. To make the most of your training, here are 31 tips on how to maximize your athletic potential, find that extra edge and quit sabotaging yourself.
1. Know When to Stop.
It might seem counterintuitive that our first reco for how to train better is about knowing when to back off. But overtraining puts you at high risk for injury and burnout. Find the balance between pushing yourself and breaking your body down. Live to fight another day!
2. Check yourself before you wreck yourself.
Sitting at a desk for hours on end is bad enough for your body; sitting with bad posture is even worse. Uncross your legs, put your feet flat on the floor, scoot your toosh all the way back in your seat, keep your elbows at 90°, relax your shoulders and straighten your back. You'll be much more comfortable for sneaking in blog reading at your desk.
The ability to quiet your mind and focus are just as critical as proper form for athletic performance. Ten minutes of daily meditation can help you learn to block out pain, focus on the present moment, make you more resilient and improve the quality of your zzz’s. It can provide the extra edge to push you through that last mile when your body is ready to quit.
4. The habits we make make us.
It's easier to stick to a routine if you do it at the same time every day — ideally, first thing in the morning before you have time to talk yourself out of it. Feeling too tired? You'll have more energy if you get it done. And if a sunrise run seems too ambitious — start small. A set of squats, lunges and a plank will wake you up more than your coffee.
5. Loosen up at work.
Sitting at your desk tightens your psoas muscles, which are like the tenderloin of the body — you need them to be long and lean. When they get tight and angry, it can compromise your running stride. If you're having low back pain or feel tight when you stand up, you should do this stretch every 30 mins. For preventative maintenance, do it a couple times a day. (If pain persists or has been chronic, come see us.)
6. Let go of guilt.
So you skipped a workout or three, or haven't been doing the strength training you know you need, and you're letting it eat you up. Take a step back, re-focus and let yourself off the hook. The stress you're causing yourself is amplifying any downside to a few days off. Once that weight is off your shoulders, it'll be a lot easier to tackle that training plan again.
7. Look better at happy hour. (Posture is everything.)
Most of us spend way too much time hunched toward a screen, leaving us with crappy posture. And it's not enough to just stand up! Counter stretch before heading home for the day. Stand up tall, clasp your hands behind your tush and pinch your shoulder blades together to stretch out your pecs and elongate your spine. It's an easy way to look and feel 10 years younger. Approximately.
8. Roll out those shoulders.
We're harping on posture because most people aren't aware of the damage they do at their desks. If your posture sucks while you're NOT working out, guess what? It doesn't improve magically just because you go out for a run, unless you work on it. Here's a detailed demo on how to open up your spine using your trusty foam roller. You DO own a roller, right?
9. Race more.
Even if you’re not looking for an A race or PR, consider signing up for local events more often. There’s nothing like a start line staring you in the face to help boost motivation (and sometimes scare the bejesus out of you if it involves, say, an open water swim. Not that we're afraid of open water swimming or anything). There’s magic in race day. You can’t help but push yourself harder than you would on your own, and it always feels good to finish what you start. Either we win, or we learn.
10. Write it all down.
There's nothing better than a runners' high. But it fades eventually, along with the details of the day unless you commit them to paper. Writing race reports is a key habit in evaluating what's working and what isn't, both in training and in race day execution. Same goes for your training log. Keep track of how you feel, especially if something hurts. Your therapist will thank you!
11. The colder it is, the longer you need to warm up.
When it's cold, your muscles need extra time to get ready to work. Start out at a slower pace than usual and lengthen your warm up. Resist the urge to go hard from the get-go to be done faster! (Trust us, we're speaking to ourselves here too. Not an easy one to follow!)
12. Should I stretch or should I go now? (The answer is neither.)
Save the stretching for after your workout when your muscles are warm — but that doesn't mean you should hit the streets cold. Instead, warm up dynamically to get the blood flowing and muscles ready to work. Jumping jacks, high knees, butt kickers and walking lunges with rotation are all solid choices.
13. Hips don't lie.
How's your hip mobility? Not sure? Here's how to check. (And if you notice a significant difference from side to side, give us a shout.)
14. Seriously. It's all about the hips. Open them up.
Your hips are the bridge between your upper and lower body — everything flows through them. (Yeah, we know how that sounds.) Your hips control your balance, posture and every movement from sitting and standing to running and explosive athletic performance. Yet not only do we take them for granted, we force our hips into a compromised state by sitting most of the day. Ever get low back pain? Tight hips and hip flexors are often to blame. Here's one hip opening stretch you should be doing daily.
15. Loosen up those hammies.
Tight hamstrings can throw your back, pelvis and hips out of whack, setting you up for injury, especially during intense physical activity. Here's how to stretch them out properly.
16. Mix it up.
Vary your workouts and the muscle groups/HR level you’re working. Not two workouts in a week should look exactly the same. If you’re in a rut or not sure how to switch it up, let’s talk.
17. Stop looking for a quick fix.
Being injured blows — we get it. Find a practitioner you like and trust, make a plan and stick with it.
18. Get better Zzzz's.
Quality rest is critical for performance as well as proper recovery. Exercise daily (but not within 4 hours of bedtime), make a to-do list to get your tasks on paper and out of your dreams, pick a bedtime and stick to it, and kick work and screens out of your bed. Even if your face isn't in your screen, the ambient light from it is enough to disrupt your circadian rhythm and keep you up. If you have a race on the calendar this week, get to bed one hour earlier every night. Sweet dreams lead to sweet PR's.
19. Food is fuel. Not therapy.
There's no magic formula for getting down to race weight — it's calories in vs. calories out. Rely on your workouts, meditation and better quality rest to relieve stress instead of taking comfort in food. And if you find yourself popping energy gels or chews for every single workout, it's time for an intervention!
20. Find balance. Literally.
Balance requires core stabilization and challenges muscle groups to work in ways they're not used to — which adds up to better athletic performance, higher cognitive function and lower risk of injury. How's THAT for a hat-trick?
Test yourself right now! Most people can't balance on one leg for more than :34. Can you? Give it a shot and post your PR with #onelegphysio. Challenge yourself to do better each day.
21. Accountability is everything.
Find a friend who will be pissed if you bail on a workout, join a team that will expect you to show up, or commit to a streak challenge (run/burpee/plank etc for 30 days). Or take a tip from Gigi Hadid who does squats every time she walks by the post-it note reminder in her kitchen. Seems to be working for her.
22. Train with someone faster/stronger/better than you.
Pushing yourself will only get you so far. To get to the next level, be smart about the company you keep and learn their tricks. There's no better motivation than putting a target on someone's back and taking them down. (Do this within reason; if you push too hard too soon or too often, you could wind up injured.) Keep your friends close and your competitors closer! Can't find a team or group to run with on your schedule? Head to a park and find a person whose pace is slightly faster than yours as your next victim — strangers are fair game, too.
23. Go low tech.
When was the last time you ran just to run? At least once a week, unplug. Run without a watch or phone or GPS-enabled anything. Let your legs pick the pace. The miles still count, even if they’re not recorded on Strava. It’ll force you to listen to your body and while letting your brain zone out and recharge.
24. Visualize what you want.
Looking for an extra edge? Train your brain. Create intention and build confidence by picturing yourself executing perfectly, over and over again, until you make it happen. Feel it, hear the crowd, imprint every detail on your brain. Then mentally rehearse how you’ll handleeverything that could possibly go wrong, so nothing will catch you by surprise. In the same way repetition improves muscle performance, making visualization a habit can improve your ability to execute on race day.
25. The attitude of gratitude.
Our bodies are amazing machines that we take for granted. Be grateful. A bad run is still a run – something not everyone can do. Even when you’re injured or frustrated with performance, there’s always something for which you can be thankful. A positive attitude and kindness toward yourself can go a long way to help heal your body. Appreciate your health, and the fact that as long as you can put one foot in front of the other, your heart and head will follow.
26. Roll out your ITBs in 3 sections.
Your illiotibial band is thick fascia that runs from your hip to your knee and stabilizes your knee when you run. If it gets pissed off and tight, it can be really stubborn to fix. So stay ahead of it and roll it out, especially if you've increased your mileage recently. Here's how.
(NOTE: If you feel a stabbing pain on the outside of your knee when you run, you're already SOL. Stop running and come see us!)
27. Loosen up those calves.
Tight calves can be the sneaky culprit for lots of problems like foot pain, plantar fasciitis, Achilles tendonitis, shin splints, and even hip and back pain. So here's how to roll them out. (Ladies who spend a lot of time in heels... this is for you.)
28. Suck it, shin splints.
The cause of shin splints can usually be summed up as doing too much, too soon — and they're the bane of our existence as athletes. Use this rolling technique to help keep them at bay.
29. Do things that scare you.
Playing it safe can be dangerous to your well-being. To grow, you have to force yourself out of your comnfort zone. Fearing failure will hold you back and never allow you to realize your full potential. Don't be afraid to push yourself and take risks. Make your lungs burn, feel the puke coming, find your edge by going past it. It's time to get comfortable with being uncomfortable.
30. How fit are you really? Take this test right now.
Think you don't have time to exercise (or stretch or strength train)? Find out the toll it's really taking on your body. Cardiovascular fitness isn't enough — flexibility, balance and muscle strength are key indicators of true fitness and longevity. (Lose your shoes and socks! You have to be barefoot for accuracy.)
31. Success won’t come to you. Go out and get it.
Nothing crushes performance faster than self-doubt, and plans won’t do any good without taking action. Tell yourself you WILL do it, instead of questioning whether you can or cannot. Even if you don’t accomplish your goal, you’ll have no regrets that you gave it everything you had. Be all in. Be bold. And BELIEVE.
All our best for a happy, healthy, strong new year!
As taper pains inevitably surface in the last days before a marathon, I hear from a lot of panicked patients. Those aches and sluggishness are completely normal, and very common. Most likely, they will magically disappear on race day. While your legs are resting up, give your brain something else to focus on — your race plan.
Running a marathon requires just as much mental strength as it does physical preparedness. Here’s our list of things to keep in mind (literally):
Preparation starts at the beginning of race WEEK, not the night before race day.
You can’t cram for a marathon. Carb loading, banking sleep and proper hydration including electrolytes should all start at least several days before the race, not the night before. In fact, the most critical night of rest is 2 nights before the race. Chances are, you won’t get much shuteye on race eve.
Picture your perfect race.
Before you get to the start line, picture yourself crossing the finish, and handling everything in between. Close your eyes and run the race you want to have in your mind. If you think about what could go wrong – and mentally solve it – before you hit the course, you’ll instinctively know what to do should those things actually happen.
Start out slow. Respect the distance.
On race day, you’ll be high on adrenaline and the crowd energy, and your legs will be ready to GO coming off taper. But the goal is to run a negative split, which means starting out conservatively. Hold back for the first half to ensure a strong finish. It’s all about that last 10K.
If you like it, lube it.
Run your own race, at a realistic pace.
Don’t get competitive. Let others pass. You’ll pass a lot of them back later on. Every five seconds you run faster than your planned pace in the first half will double to your detriment in the second half of the race. You will not ever suddenly get faster in a marathon.
Don’t get too emotional.
It’s tempting to high-five spectators, enthusiastic kids and your family. Unless you’re just out there for fun, don’t waste the energy. You’ll need it later on. For NYC marathoners, this rule goes into effect much earlier in the day — don’t feel obligated to chat with other runners for the hours you’re stuck on Staten Island. Save that nervous energy for the run.
Have a realistic pace plan and stick to it. Run the first 20 miles with your head. Run the last 10K with your heart.
Do not give in to self-doubt or pain (unless it’s severe injury pain). Remind yourself of all the training you put in, and have faith in it. Your body knows what it’s doing, don’t let your brain ruin it. Name that inner critic of yours before the race – and if he speaks up, tell him (by name) to shut the F up. It works.
Sing. Count. Have a mantra (or ten).
Distract yourself from the repetitive motion by focusing on simple mantras that reinforce a high cadence. Try repeating “1-2-3-4” or “I can, I will” or the lyrics to your favorite song to match your foot falls. Just don’t be surprised if an annoying song is the one that pops into your head first! Just go with it and thank Taylor Swift later.
Set small milestones.
Aid station to aid station. Friend to friend. Break it up into manageable chunks of distance and tick them off.
Don’t forget to eat and drink.
Set your watch to remind you if you need to, or make a plan to eat at specific time intervals (not miles, since some of those miles might stretch out if something goes wrong.) This is not the time to wing it! Nothing will derail your ability to stay in the game, both physically AND mentally, than bonking. You should have your nutrition plan nailed from your long runs, but if not, consider this a wake up call and figure it out.
Nothing new on race day.
Use the same clothing, gear, shoes and nutrition you’ve used on all your long runs. Do not get crazy ideas and new stuff at the expo! Or, if you can’t resist, save it for the next race – not your A one.
Have fun and SMILE at the FINISH.
Remember, this is supposed to be fun. So enjoy the moment! Read the spectator signs, feed off the crowd, take it all in. Stay focused, but also allow yourself to feel proud of what you’re doing. Our brains are powerful machines, and that positivity electrifies us and helps fend off the wall and physical pain better than even the most successful training runs.
If we THINK we can, we will.
Good luck out there!
Orthotics are such a frequent topic among my athlete patients, I wanted to post my thoughts on them. Here goes:
In my opinion, there are four reasons clinicians prescribe orthotics. (There really should only be one reason, and unfortunately, it’s usually the least common):
1) Lazy clinician
2) Greedy clinician
3) Soft tissue problem
4) Structural/postural deformity
Let me expand on that.
1) As physical therapists we are taught to find the biomechanical problem and fix it. But many clinicians don’t look at the body as a whole anymore. The patient comes in with foot pain, a fallen arch, a non-mobile MTP joint, etc., and rather than finding the true problem or weakness that is causing the issue, they use an orthotic to correct the biomechanics of the foot. This will help in the short term but won’t fix the real problem. An expensive, short-term crutch that doesn’t solve the patient’s problem? Seems pretty silly.
2) Think of an orthotic as a bottle of wine at your favorite restaurant. You want to splurge a bit, so you don’t mind the overpricing. Orthotics are marked up by clinicians who have contracts with manufacturers in a similar way as that wine — about 300-400%. Call it what you want… greedy, shady, ambitious? Bottom line, that prescribing clinician stands to gain a wad of cash from your purchase.
An athletic friend of mine recently saw a podiatrist for ankle pain and was told he needed orthotics after a very brief, non-functional evaluation of his foot. My friend refused, told the doc he was having ankle pain, not a problem with his foot, and the podiatrist replied “but we’ve already verified that your insurance covers them, so it won’t cost you anything.” This story is so disheartening to me as a clinician because the real problem was not diagnosed and the clinician was pushing something that wasn’t needed solely for his own gain. Luckily my friend is smart and still declined, got the script he needed to come see me for physical therapy, and is feeling much better. (FYI: his problem was a posterior tibialis strain that was manifesting pain around his malleolus. He didn’t need an orthotic at all). If you’re scratching your head over why this matters since the insurance would’ve covered them in the first place, think about this — unnecessary prescriptions make money for clinicians and drive up health care costs for all of us. If you don’t think this affects your premiums, you’re kidding yourself.
3) Soft tissue problems in the foot can often benefit from the support of that tissue. Foot support can keep the tissue relaxed and relieve some pressure. My issue with orthotic prescription in this scenario is the cost vs. benefit analysis. There is no need to purchase an expensive pair of custom orthotics when an over-the-counter substitute works just as well (in most cases, not all). When I do prescribe orthotics for a patient, I usually recommend Superfeet. I’m not a retailer for them, nor do I make any money off their sales. But I have seen their products work for many patients, for many different problems. Superfeet cost approximately $35 for a pair, and will last anywhere from 6 months to a year, depending on your use and frequency. A good pair of prescription orthotics for an endurance athlete won’t last much longer than a year before they have be replaced either, so you can see the cost analysis here. As an aside, Superfeet also offers a range of products that will work with shoes other than sneakers, so patients can receive the benefit of support whether they’re training or not. (I’m never going to endorse high heels for my female patients, but if you’re gonna do it anyway, at least you can minimize the damage).
4) If you have a leg length discrepancy, or other serious structural problem, custom orthotics can truly help. Depending on the case, I sometimes recommend trying a more rigid Superfeet insole for awhile prior to prescribing custom ones, but this is one scenario where it may be worth it to spring for them. There are many complicating factors to address, and custom orthotics can be the best way to adjust height in one shoe without damaging gait, etc.
Here’s a case study to show my point:
I had a patient with chronic bilateral ITB problems, knee pains, ankle problems, very supinated (rolled out) feet, whose dad is a podiatrist. She had been running (trying anyway) in orthotics for years. They were regularly updated to try to fix each of her pains as they arose. This kind of customization is not possible for most people, but it proves that orthotics can’t fix the underlying problem causing her pain. Despite going to multiple PTs, an orthopedist, and even another podiatrist, she wasn’t getting better. That’s when she came to me. I told her to ditch the orthotics. She wouldn’t. I treated her on and off for almost a year. After we had addressed every muscular imbalance that she had in her body outside of her foot and ankle, she finally got fed up enough to give it a shot. Once she got a more free-motion shoe and we worked on her ankle stability, she started to pronate on her own without the orthotics. They were actually holding her normal motion back. She has been running in normal shoes, without orthotics, for almost a year now — PAIN FREE.
Enough to make you think twice about those orthotics? I hope so!
If you’ve been prescribed orthotics or are wondering if they might be right for you, find a good functional-based practitioner who will evaluate your entire body and see why the foot is doing what it’s doing, and correct it.
Note: This article is based on personal experience and individual patient case study. This is not peer-reviewed, and therefore has not been published or written up for publication. Other clinicians may say their way of prescribing or fitting orthotics is superior, and their patients respond well to them. I hope for the athletes’ sakes, that’s the case. But in my experience, the underlying cause of pain needs more than a pricey insole.