BIOMECHANICAL ASSESSMENT & ORTHOTIC SALES SCRIPTS

Transcription

1 BIOMECHANICAL ASSESSMENT & ORTHOTIC SALES SCRIPTS 1 Categories the client Categorise who the potential client actually is, as this will guide how you present the sale. a) Current patient of yours pre-existing level of trust and confidence. will generally feel comfortable with your clinical decision making b) External client who has presented solely for orthotics generally has some idea of what orthotics are may already have a pair and just need to get a replacement they could have heard about orthotics from a family member / friend who have a pair. c) New client who has presented with an injury which may be corrected with orthotic inserts would also benefit from orthotics may take a little longer to convert than the above client. This client may not even know what an orthotic is or how they would benefit from the inserts. d) New client who has been referred by a friend / family member who has also had orthotics from you These are the BEST and easiest clients to sell to 2 Type of patients / conditions a) Lower back pain from sports, exercise or posture b) Gluteal / buttock pain (with or without trigger points) c) SIJ dysfunction or pain d) Hip flexor strains / Anterior hip impingement e) Anterior Knee Pain / ITB syndrome f) Ankle pain and instability g) Plantar fascitis h) Anterior and posterior medial tibial pain syndromes i) Peroneal problems (in runners) j) Valgus and Varus deformities k) Arthritic and degenerative knee joint conditions l) High impact sports people (Marathon runners, Aerobic instructors) m) Occupations involving a high level of weightbearing / standing 3 When to pitch to the client take a full assessment (see below) determine if biomecanics are part of the cause of the symptoms (is a direct relationship between the clients presenting symptoms and foot mal-alignment) determine the need for prescription of custom orthotics to help in the recovery of the condition correction the problem prevent recurrence (establish whether or not orthotics are actually appropriate) develop a possible list of REASONS WHY orthotics are needed. (e.g. pronating feet, pes cavus arch+, pat/fem pain, met pain, dorsal interossei pain, compensatory foot/hip/knee mechanics with

2 gait, overactive / weak glutes/ VMO, calcaneovalgus / achilles tendonitis, patella tendonitis, shin splints etc etc). 4 Assessment Alingment As part of the initial assessment it is important to give the patient a visible cue as to what neutral foot position is & how far they are from that. Using a pen, mark down the anterior surface of the mid tibia and also between the 1 st and 2 nd mets. With the patient supine you can show them that the two lines should be straight to allow for even distribution of load through the ankle, knee, hip and L/spine. With the patient in standing they can see for themselves in the mirror that the lines are not straight and that there is an obvious discrepancy at the ankle/foot. (Once the client is able to make visible reference to this it is a lot easier to explain the mechanics of the orthotic. It also gives the client visible proof that something isn t quite right at the ankle/foot). Take a photo of this and show the client Sub-talar pronation Patient standing in bare feet look at the line of the Achilles Take a photo of this and show the client Look for bowing of the achilles, and medial angle of the calcaneus and arch height Note toe clawing or excessive use of extensors, tibilais posterior and anterior Test in one leg stance note any dynamic increase in pronation or complete dropping of arch Hold rear foot in neutral and watch movement when patient stands on one leg ROM of passive eversion in supine Balance (dominant leg or non dominant) Knee angle Look at Q angle and any varus or valgus deformity Internal rotation position of patella Internal rotation of the femur Hip and SIJ Trendelenberg in one leg stance, squat, one leg hop and walking Strength of gluteals in sidelying and in prone left vs right Anterior or posterior rotation of SIJ Video Analysis on treadmill Bare foot walking vs Running with shoes, and left vs right Posterior - dynamic pronation, knee angle, trendelenberg and Toe off / swing angle of tibia Lateral - Heel strike, forefoot strike Anterior - dynamic pronation, knee angle 3 Clinical Reasoning of Objective Findings Assess left compared to right, and determine which is the problematic side Determine the patient s dominant leg E.g. Right-footed people generally tend to be stronger and more co-ordinated on their right leg during swing phase (for kicking a ball), but stronger and more co-ordinated on their left leg in stance phase with better gluteal stabiliser control (to balance whilst they kick the ball) Determine if the problematic side is the dominant or non-dominant leg

3 If pronation side is NOT the symptom side the cause maybe the body weightbearing MORE on the stronger/more stable side and overloading that side Determine the prescence and impact of other causative factors such as gluteal weakness, rectus femoris tightness, gluteal muscle and ITB tightness, calf tightness and joint laxity (e.g. from previous ankle sprains) Compare this to pronation problems in the overall cause of symptoms. (i.e. what is greater problem gluteal weakness and tightness or foot pronation?) Determine patient s underlying base level of muscle co-ordination and athletic ability Determine onset of symptoms and environmental effects new to exercise / overuse / type of exercise / impact / type and age of shoes Is the cause not from exercise, but simply occupation where all-day loading and resting on one hip more than the other is to blame hence the need for a standard Orthotic rather than sport orthotic If needed: to be conclusive in the cause of symptoms, tape arch and heel (using low-dye taping) to mimic the effect of anti-pronation / unloading of soft tissues (Use taping as part of the treatment if applicable whilst they are waiting for casting and delivery of orthotics) Take a digital photograph of the pronation / differences left and right, to show the patient / give them a visual demo of their problem Video the client on a treadmill to reinforce the dymanic effect and the differences left to right 4 Explain the problem to the particular patient Dominant leg / stabilization leg in standing theory (e.g swing phase say for kicking a ball, but stronger and more co-ordinated on their left leg in stance phase) Effect of mechanics of pronation on tissue structures, (e.g. bowing of achilles = whiplash = injury, pain & inflammation) This is happening EVERY step, and when you run, the forces are even greater. Imagine how many steps you take in a hour run? Effect of secondary casues (e.g Weak gluts, internal rotation of hip /knee) can you see how that happens at my ankle when I switch off my gluts, roll my knee in? Healing rate of repair, inability to use muscle strengthening to correct pronation the tendon has a slow rate of repair and poor blood supply, unlike that of say, the calf muscle. It will take longer to repair that a muscle strain will. In all honesty, it is virtually impossible to try and prevent excessive pronation at the ankle with a set of exercises. This is a chance that you may never get over the injury / problem as the biomechanical effect of the pronation is most likely too much now for the tissue to recover back to normal but if we put the ankle in a corrected environment to keep it straight, like with a orthotic, it will have a chance to settle down and come right. Show the slow-motion on the video or digital photo to show the pronation Can you see on the photo and as we slow the video down how it happens only on your left foot when you heel strike, and is worse when you are walking compared to standing?

4 Explain the effect of running / lots of steps / training intensity / frequency / new to exercise / overtraining Now the reason it s come on just now is because the you have just started this new class, and you have not done this sort of thing before. It means that the lower legs are not really that conditioned to this sort of impact the achilles is a strong tendon and will last a long time, (usually a life time!) however the amount of training has increased, and I d say its at the point where the abuse is too much and the tendon is starting to break down. It probably started a long time ago in fact and has been building up to this point. Effect of bad shoes / footwear on pronation can you see how I can squash the medial side of your shoe easily with my fingers, - imagine what your body weight does to it! Two ways to approach this problem (reactive to the symptoms or be preventative) The treatment will definitely help, however, it won t ever fix the biomechanics underlying the problem and you will continue to get ankle pain. To ensure best practice for your ankle & to reduce the amount of physio required we need to be PREVENTATIVE Chance of Recurrence having the foot corrected means you are not at risk of having the biomechanics causing the same problem again a recurrence of re-injury before the race is the last thing you want!. 5 Explain the Orthotic / Sell the Orthotic Biomechanical problems/ pronation is quite common Unique Orthotic Casting system done in weight bearing to correct and prevent these problems. Promote better alignment not only through your feet but also your knees, hips and lower back Show an example Orthotic Can you see how the heel has been tilted up to stop rolling in at the ankle more on the left than the right? an orthotic will outlast over 5 pairs of shoes, making it very cost-effective custom made to the exact corrected shape of your foot, as the mould of your foot is made in weight-bearing Cost Now orthotics DO cost a bit the sport ones are $430 and the standards are $385, however you ll save on future physio bills and it s better fixing the problem for good rather than just patching you up. The reason why they cost so much is because of durability. The majority of the cost goes into custom making the orthotic based on your exact casting. The materials used in the orthotics have to be strong enough to counteract the large loads which are currently causing you to roll your ankle in, resulting in your tendon pain Health Fund rebates (IMPORTANT NOTE: You should already know whether or not the client has private health insurance. Check their details on the GUMNUT or check their patient rego form. The worst thing to do is explain that private health insurance companies give big rebates on orthotics and then find out they don t have the cover. If the client does not have private health insurance there is no point mentioning it) What health fund are you with?.as you are with [MBF/HCF/MEDIBANK] you will be entitled to a rebate of generally $ per orthotic. (NB: MUST TELL THE CLIENT TO

5 CHECK WITH THEIR HEALTH FUND TO MAKE SURE THEY GET A REBATE). Therefore, the orthotics will only cost you the price of a new pair of running shoes. But even better, the orthotics will outlast the runners five times over! Casting timeframe The best thing for you to do in my opinion is to get you casted for the moulds as soon as we can, as the castings take about an hour and you will have your custom made orthotics back in approximately 3-4 weeks. We are very busy with bookings at the moment, but if you give me a second I ll check the bookings and see if I can squeeze you in over the next few days. How does that sound? Using Taping What we can do is tape the foot up now to reduce some of the pronation, and to mimic the effect of the orthotics. This helps settle it down and you feel better, whilst you think about getting the Orthotics. If it works, then the best option is go for the Orthotic - as we can t tape you forever, and it shows that stopping the pronation corrects the problem. The Orthotic will give also give you more relief that the taping will. (Use taping as part of the treatment if applicable whilst they are waiting for casting and delivery of orthotics. This will reinforce the need for having orthotics all day hence 2 pairs On-Sell The Product As you are only running 3 times a week, and wear business shoes to work, you are only in the Orthotic for 30min-60mins x 3 a week. This is not enough time spent corrected in standing for the problems to settle down and come right. I suggest do is what most other people do with your problem and that s get a pair for your business / court shoes so you can wear them all day. You see, the sports ones are designed to replace an innersole in a running shoe and you business / court shoes have one, and are much narrower. Some people swap the sport Orthotic between shoes everyday if they wear non business type shoes like work boots, but that is not the case for you. What we can do is go for the sports ones now, and then you can think about the standard pair for work later. Or we can just order both when we cast you I think it s the best option for you long term anyway, as we want you corrected all the time from day one to help this all settle quickly. Otherwise you will have to wear your running shoes everywhere all the time and that s not always feasible. The second pair will also cost less it s $385 for the standard, but we ll give you 10% for the second pair, bringing it down to $347, which is just a bit more than good running shoes these days.