#005- How to decide between orthotics or strengthening exercises?

I'm regularly asked about how I decide between whether a client is best suited for orthotic therapy, or for a course of exercise rehab.

With the?increasing demonisation of orthotic over-prescription in the podiatry community, and the?acceptance of exercise rehabilitation, it can be hard to make a decision as to what you should do when you have both tools up your sleeve!

Say for example someone comes in with plantar heel pain. We know that heavy slow resistance training in the form of calf raises will stimulate healing and increase the resilience of the tissue. We also know that a custom orthotic script can relieve stress on the tissue and cushion the area, improving pain.

So, which one should we do?

The answer is both-??Porque no los dos?

It doesn't have to be an?either/or.

I often recommend both custom made orthoses AND a strength and rehab plan to help my clients achieve the best result possible in the fastest timeframe. I view orthoses as a useful tool in speeding up the rehabilitation process.

If I can get a quick win with pain reduction using orthoses that?helps us to progress through the early load progression phase of rehab- happy days.

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In my opinion, there are?only two scenarios where?the use of orthoses is detrimental

1. When?the narrative we use to "sell" the orthoses?to our clients is rubbish (e.g. "you need these because you have flat feet and if you don't correct them you will be crippled for life").

2. When the expectations on the orthoses are set too high, or not addressed at all (e.g. client comes back a few weeks later and is disappointed that they are still in pain despite having orthoses because they?don't understand?that?there's a bit more to it than that).

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Back to the main question... context is king.

An athlete who has an acute flare up of pain after increasing their training loads probably doesn't need orthoses. They just need to recover and re-load smarter.

An old lady who has chronic pain could go either way, but I'd suggest both would be the best option there.

A tradie who works 12 hour shifts 6 days a week?and won't have time to come in for rehab would benefit from just orthoses.

A determined young athlete who genuinely can't afford orthoses but will commit to a strength program may just get that.

At the end of the day, it is the client's choice as to which one they want to choose. Just educate on the benefits of both approaches, make your recommendation based on their goals, and then let them be the final decision maker.

You can't go wrong getting strong though ??

P.s. if you have a question about orthotic?or exercise prescription, just?let me know by commenting below and I?will answer it!