The Kinetic Chain and Orthotics

by Dr. Jeremiah Davis

Hello everyone! Maybe you have been coming to see us for your health needs for decades or perhaps you have just started within the last few months or weeks. Initially, many who come to our office are seeking to alleviate some sort of ache or pain. Over the course of care though, the mindset tends to shift from one of obtaining relief of symptoms to one in which they want to maintain their new found health and not regress to the point which caused them to seek care in the first place. Patients at Riverview are educated that symptoms, which are last to show up in the disease model, are usually what brought them in to see us in the first place. Here patients learn to be proactive in seeking care early to maximize treatment effects.

Secondly, as the body starts to heal patients learn their symptoms are the first thing to leave so the journey to optimal health requires additional healing time past the symptomatic phase in order to have longer lasting relief. To that end, our doctors are regularly having conversations and fielding questions on how our patient base can maintain their new found level of health as in “Doc, what sorts of exercises or stretches can I do to keep my health and body trending upwards? What sorts of foods should I be eating or avoiding?” Perhaps you have been faithful in coming for a course of care and may still have some lingering symptoms. Or perhaps relief from adjustments is not lasting as long as you or your doctor thought it should by a certain point. Another possible solution may lie with the feet.

The feet are the foundation to our bodies! They take us everywhere we go. From the work we do, to our recreations and hobbies, to spending time with our family and friends our feet are always there carrying us. They are the pillar upon which our bodies rest, but all too often they remain an afterthought. That is, until they start to hurt or we have problems further up the kinetic chain in areas like our knees, hips and lower back which seem to be that nagging pain that just won’t quite go away. Some reasons for this are: how our society functions and the repetitive stressors on our feet as we go through life. Did you know that from the time we are babies and for the rest of our lives we walk around with “soft casts” on our feet? Wait Doc!, I thought only people who were seriously injured wore casts? Yes, this is true…. usually. These soft casts we wear every day… we call them shoes, sneakers, heels, flats or work boots etc.. They go by many names, but their function is the same: wrap our feet up tight and protect them against any and all traumas they may encounter.

Speaking of traumas, humans have gone from living outdoors to living in the “concrete jungle”. That brings up my next point. Can you think of anywhere you walk on a daily basis whether it be at home, on the way to work or recreational activities that you are not on some type of hard surface almost all day long? If you can, now try to think of a combination where you are not on a hard level surface and not wearing those tiny little casts called shoes? I bet it is tough! Okay, so now by this time I bet you are more aware of just how important your feet are and how much abuse they actually take. The next question is how does this process happen over time to cause us to have pain in areas other than our feet?

The answer lies somewhat in the little tiny cumulative stressors our feet face on a daily, weekly, and yearly basis for all of our lives and also in the kinetic chain of the body! If you are a patient at Riverview you know by now that movement is important at a macro level, like the way we walk, down to the micro level, like each of the individual joints and how they move and function. It all contributes to our overall health and well being. So what is the kinetic chain? We all sang about it in elementary school! The foot bone is connected to the knee bone, the knee bone is connected to the leg bone, the leg bone is connected to the…. you know the tune! That song is true! Our feet are under a lot of repetitive stressors as mentioned above. The ligaments that make up the arch of the foot (actually three separate arches) and help all those 26 bones hold their shape are under a lot of stress. That stress pulls on the ligaments and creates elastic deformation (ligament stretch) and if done long enough days weeks years as mentioned above will create other changes. Next, plastic deformation happens, here, those stretched ligaments stretch too far and ultimately are not able to rebound back to their original length. This is when the arch breaks down. When the arch loses its height the foot “pronates” (rolls in towards the middle. This in turn causes the tibia (lower leg bone) to roll towards the outside. In kind, the femur (upper leg bone) turn in which pulls down on the hip joint and the ilium (big bone in the pelvis hands on hips bone) which causes the ilium to rotate forward or anteriorly. When the pelvis is out of alignment it can cause problems inducing abnormal rotation in the lumbar vertebrae. All of this is not normal and creates stress on the musculoskeletal system and ultimately can cause pain.

Perhaps many of you have felt the affects of kinetic chain dysfunction without knowing it. So what is the solution you may ask? Support the kinetic chain. Support it with orthotics. Custom shaped shoe inserts which place the foot and ankle in a neutral position taking stress off these foundational joints and helps alleviate potential concerns further up the chain. Here at Riverview we use a brand of orthotics called PowerStep. They were chosen because of their ability to make a custom orthotic quickly and easily in office. In an effort to make our orthotics more affordable, Riverview has placed their price point lower to ensure a very competitive cost and value for our patients. If you are curious about price just ask us!

So how do I know if I need orthotics? Can you answer yes to any one of these questions? Do you have pain in your feet, knees, hips, or lower back? The kinetic chain can extend up further so even mid-back and neck pain can be the result of dysfunction at the feet! After all if a house’s foundation is not intact then the whole structure is at risk! It’s like that song, “The Bones” by Maren Morris which goes, “The house don’t fall if the bones are good”! I focused on pronation and its affects on the kinetic chain as it is the most common reason for orthotics. There are other problems like pain in the joints leading up the kinetic chain. Plantar fasciitis a painful condition in the foot with pain just in front of the heel or in the arch can be caused by over pronation. These are just some of the issues that can arise from improper support of the foot. If any of this applies to you please be sure to ask one of our doctors for more information. We are always here to make sure you are your most healthy self!

Office News

  • In an effort to keep up proper social distancing, as well as improving office flow, we would ask that all patients with Saturday appointments wait in their cars. Call when you arrive and we will let you when it is your turn to come in. This way you can simply go straight back to the treatment room.
  • Felicia Dawes, LMT will be back in the office starting October 14, 2020. She will be scheduling Wednesday mornings and Thursday afternoons. Please call the office at 877-0676 to book.
  • The office WILL be open on Columbus Day (Monday October 12, 2020).

Recipe of the Month

Broiled Salmon with Herb Mustard Glaze


2 garlic cloves
3/4 teaspoon finely chopped fresh rosemary leaves
3/4 teaspoon finely chopped fresh thyme leaves
1 tablespoon dry white wine
1 tablespoon extra-virgin olive oil
2 tablespoons Dijon mustard
2 tablespoons whole-grain mustard
Nonstick olive oil cooking spray
Six 6- to 8-ounce salmon fillets
Salt and freshly ground black pepper
6 lemon wedges


  1. In a mini food processor, combine garlic, rosemary, thyme, wine, oil, Dijon mustard, and 1 tablespoon of whole-grain mustard. Grind the mustard sauce until combined, about 30 seconds. Transfer to a small bowl. Add remaining 1 tablespoon of whole-grain mustard to the sauce and stir to combine. Set aside mustard sauce.
  2. Preheat the broiler. Line a heavy rimmed baking sheet with foil. Spray the foil with nonstick spray. Arrange the salmon fillets on the baking sheet and sprinkle them with salt and pepper. Broil for 2 minutes. Spoon the mustard sauce over the fillets. Continue broiling until the fillets are just cooked through and golden brown, about 5 minutes longer.
  3. Transfer the fillets to plates and serve with lemon wedges.