Feel Better . . . Live Better    
Repetitive Microtraumas and Chronic Low Back Pain

Clinic Information
Fee Schedule
New Patient Intro
St. Malachy
Doctor Information
Cold Laser Therapy
Gua Sha
FREE Health Webinars
Conditions Treated
Work Injuries
Kinesio Tape
Spinal/Pelvic Stabilizers
Important Links
Expert Witness
Impairment Rating
Discredited ODG Guidelines
Orthopedic Diplomate
Collision Reconstruction
Community Outreach
Dynamic Chiro Charts
Site Map

Inside Spinal Pelvic Stabilizer Research
Back ] Home ] Up ] Next ]

Repetitive Microtraumas and Chronic Low Back Pain 

Your feet are the foundation of your body. At birth, most of us have perfect feet. Studies show that by age 20, 80% of those perfect feet develop some type of problem.1 By age 40, nearly everyone has a foot condition.

article4_pic3_1.jpgHowever, during standing, walking, and running the lumbar spine and pelvis balance on your lower extremities. As shown in Fig. 1, leg or foot asymmetries send abnormal forces along the closed kinetic/kinematic chain, interfering with spinal function.2 And interfering with spinal function can result in a myriad of bodily malfunctions. Many foot conditions eventually contribute to health concerns farther up the kinetic chain, especially the generalized condition of chronic back pain (or even neck pain).

The major source of most chronic low back pain is structural weakness or failure caused by repetitive microtraumas.3 Structural weaknesses and the resulting microtrauma effects can be seen in the bones and joints, and also in the connective tissues.

Bones and joints. There are two types of bone and joint asymmetries: a) Functional misalignments and joint dysfunction; and b) Anatomical discrepancies. Functional asymmetries develop over time in response to repetitive microtraumas, resulting in greater susceptibility to injury and breakdown. This condition often responds well to specific adjustments of the offending joint(s). Custom-made, flexible orthotics are effective in helping your adjustments last longer and hold stronger. However, a structural asymmetry due to discrepancy in the anatomical shape or size of the bones cannot be adjusted into alignment. In such a situation, comprehensive care requires the use of some type of compensatory support. Frequently an orthotic with an adjustable heel lift (Fig. 2), or an orthotic with a built-in heel lift, must be properly fitted and permanently used in order to normalize leverage forces and provide bony stability to the lumbar spine.


Tendons and ligaments. When imposed forces exceed the level of structural strength, something always fails. The result is symptomatic breakdown of tissues, and often permanent degenerative changes.

art9_fig_2_1.jpgDue to their specialized viscoelastic (stretching) properties, connective tissues are particularly susceptible to repetitive microtrauma (Fig. 3). This type of insidious injury causes permanent plastic deformation, which is the underlying factor in most overuse and repetitive trauma conditions, as well as many job-related spinal injuries. The end result is ligament laxity and/or disc degeneration, with excessive joint mobility (instability). These are both conditions which are very difficult to treat directly or reverse, and treatment usually requires compensation by muscle over-development and/or orthotic support.

Orthotic Supports

A significant factor in reducing excessive biomechanical forces on the lumbar spine is frequently overlooked: the use of external supports (orthotics with or without heel lifts) to decrease external forces. The following are commonly-seen conditions in which the lower extremity can have a major impact on lumbar spine function. In each of these situations, orthotic supports are not only appropriate, they contribute significantly to a cost-effective treatment outcome:

Stress forces. When excessive pronation and/or arch collapse
of the foot is present, a torque force produces internal rotation stresses to the leg, hip, pelvis, and low back (Fig. 4).4 The result is recurring subluxations and eventual ligament instability affecting the sacroiliac and lumbar spine joints. These forces can be decreased significantly with the use of flexible, custom-made orthotics.

Heel-strike shock. In patients with degenerative changes in the lumbar discs and facets, the external force of heel strike may aggravate and perpetuate low back pain. This force is easily reduced with the use of shock-absorbing shoe inserts5 or Foot Levelers’ Spinal Pelvic Stabilizer Orthotics which contain Zorbacel®. The reduction in symptoms is often dramatic due to the decrease in low level inflammation of the affected joints.

EffectsofExcessPron_2003.jpgLeg length inequality. An anatomical difference in leg length produces abnormal structural strains on the pelvis and low back. These strains can cause not only chronic pain,6,7 but also have been shown to result in specific degenerative changes.8 The use of lifts and SPS Orthotics has been shown to reduce these structural strains and bring about significant response.9,10 Lifts can be more effective when used in conjunction with spinal manipulation.6 Research on leg length inequality (LLI) patients revealed a greater reduction in pain scores when orthotic therapy was combined with spinal manipulation, as compared to orthotic therapy or spinal manipulation alone.

 Particularly dramatic results have been achieved by incorporating Foot Levelers’ SPS Orthotics in LLI case management. Yochum demonstrated in a set of before-and-after radiographs how a 15.5mm LLI in a patient could be reduced to just 4mm with the use of SPS Orthotics (Fig. 5).10 Not only had the pelvic deficiency been markedly reduced, but the right compensatory listing of the lower lumbar spine had also diminished.

When the amount of anatomical leg length discrepancy is not definite (or is complicated by functional discrepancy and arch collapse), fit the patient with SPS Orthotics without heel lifts initially. After 4-6 weeks of continued chiropractic care and wearing the orthotics, re-evaluate (clinically and/or radiographically) to determine if a significant difference in femur head height still exists when the patient is standing (5mm or more). If so, then the addition of a permanent heel lift is appropriate.

Chiropractic Care and Orthotics: A Solid Team

article5_pic2.jpgRecent research is increasing our understanding of factors involved in effective lumbar spine treatment. When faced with the complex and costly concern of low back pain and disability, patients are forced to seek out the most effective practitioners. Doctors who use a comprehensive treatment approach which includes the appropriate use of Foot Levelers’ custom-made Spinal Pelvic Stabilizer Orthotics are recognized as the most competent experts in the management and rehabilitation of lumbar spine disorders.

Here’s proof: In an independent survey conducted at Northwestern College of Chiropractic, 82% of patients wearing Foot Levelers’ SPS Orthotics for one month reported their problems had been “completely,” “mostly” or “somewhat” resolved.11 In the same NWCC study, almost 80% of patients wearing Foot Levelers orthotics would recommend them to a friend. So take care of your patients with chronic low back pain — include Foot Levelers’ Spinal Pelvic Stabilizer Orthotics to get the most out of your adjustments.

Helpful Hints

Asking your patients a few simple questions can provide valuable insight into the cause(s) of their back pains. When low back pain and spinal instability are present, look to the feet!
During your examination of a patient who expresses the vague complaint, “My back hurts,” make sure to get answers to the following ten questions:
1. Do you stand or walk on hard surfaces for more than 4 hours daily?
2. Do you participate regularly in any physical sport (basketball, baseball, tennis, golf, bowling, etc.)?
3. Are you age 40 or over?
4. Have you ever had a prior injury to your knee, back or neck?
5. Do your shoes wear unevenly?
6. Do you have joint pain while standing, walking or running?
7. Is one of your legs shorter than the other?
8. Do you have knock knees or bow legs?
9. Do you have any obvious foot problems (bunions, corns, flat feet, etc.)?
10. Do your feet toe out when you’re walking?
If your patient gives an affirmative answer to any of the above, consider this patient a likely candidate for flexible, custom-made SPS Orthotics.

Feel Better . . . Live Better