So, here’s my (short version) story…
Around 2007, I began seeing quite a few runners in my practice. Word spread, and the percentage of my practice that involved treating runners had grown quite a bit until approximately 2011, when it hit the peak of approximately 80% of my patients being runners. It was quite unusual for these runners to be seeing a “chiropractor” for lower extremity tendinopathy and injury. After all, chiropractors just crack backs don’t they?
One of the main modalities I used when treating runners was to videotape them running and look at the entire body; cadence, pelvic positioning in the frontal and sagittal planes, leg position at initial contact, posture etc. I would link that with their physical examination, history and previous treatments. The entire picture provided a valuable resource for diagnosing and treating running injuries.
In 2009, I was hired to travel with Rev3 triathlon as the Active Release Techniques provider for the professional triathletes. During that time, I met and became friends with many professional triathletes however, Rev3 expanded my role and I became bound with the job of bringing other ART providers to treat all of the amateurs as well as the professionals.
I worked for Rev3 for four years and frankly, I was astonished (and disturbed) by what these professional and amateur triathletes were telling me about the treatment they were getting for their injuries from their hometown physical therapists, chiropractors and medical doctors. I heard tales of leg length discrepancies, orthotic footbeds, VMO activation, shoes prescribed based on arch height, iliotibial band stretches and bright pink and yellow Kinesiotape was plastered everywhere. Basically, I could not believe that these therapists were not staying on top of the literature that showed these treatments and diagnoses were straightforward rubbish.
“Has anyone watched you run?” I would ask. I would just get blank stares, or the standard,”Ya, the running shoe speciality store looked at my feet when I ran in the store.”
It was at that point that I decided someone needed to step up and provide proper gait analysis for the masses where they did not have access to someone who did it correctly. The only way to do that was online – a one-on-one, real time gait analysis where the client and I are looking at the same video simultaneously while discussing everything in real-time.
I rationalized that I could easily figure out what is wrong with running technique that may be contributing to the frustration of these runners. Over the past three years, based on the responses of some of the clients from the online gait analysis, I have helped people. However, it is fraught with problems:
Problem #1: The Missing Link – earlier in this post, I discussed how the proper history and physical examination links with the gait analysis. There is clearly a big hindrance without the physical examination. For example, a gentleman contacted me two weeks ago with pain on the outside of his knee when he runs. He self diagnosed it as iliotibial band syndrome. He may be right, however it may also be:
- A fibular stress fracture
- An entrapment/irritation of the common peroneal nerve
- Tendinopathy of the biceps femoris
- Tendinopathy at the origin of the popliteus
- Tendinopathy at the origin of the plantaris
- Tendinopathy of the lateral head of the gastrocnemius
- Joint dysfunction in the proximal tibio-fibular joint
- Lateral meniscus injury
- A cartilage defect in the lateral femoral trochlea
- Bone marrow edema in the proximal fibula, lateral tibial plateau or distal lateral femur
- A strain of the lateral collateral ligament
- Proximal peroneal tendinopathy
- Much more serious issues like tumors, infections etc.
Problem #2: Medicolegal Issues – I don’t have a license to be a healthcare provider in many states, Canada, Belize, Australia, Kyrgyzstan or Liechtenstein. What if I told the previously mentioned client that their lateral knee pain was from some gait abnormality when in reality it was bone cancer that had metastasized from somewhere? I was not a licensed healthcare provider in his state or country? What are the legal grounds that I have to stand on even though I have a disclaimer that says I’m not responsible for things like that? Would it really hold up in court?
Problem #3: Time – When someone submits a video, it takes about 15 minutes to go through the video and review their history that they submit. Following that, I always have questions regarding their pain. In addition, I need to know how some of their body parts move so I usually ask them to videotape themselves doing some other movement so that I can evaluate hip ranges of motion, ankle ranges of motion, hip stability etc. at that point, I review those videos and then write a detailed report for them. In all, this takes at least another hour. At that point, we set up an online consultation where we both watched the same video simultaneously and discuss their issues for approximately 45 minutes. Ugh. That’s a lot of time.
In theory, online gait analysis is a great idea. In practice, it’s much better than nothing, or someone just watching the feet. However, I’m not sure it can work to the quality that I want it to. I had the best of intentions in helping people based on the crappy healthcare I had seen in the four years I traveled working for Rev3 triathlon. People were just not getting the proper gait analysis. That was then, this is now. It seems like everyone and their brother is doing gait analysis (properly or not).
In the next couple weeks, my RunningReform website will be overhauled to eliminate the online gait analysis portion. I will still continue to blog on this website, so stay tuned. I will also keep an active Twitter and Facebook account.