BioPods Scientific Monograph and In-Clinic Educational Videos are located here.
How do I determine which patients need BioPods?
BioPods can be used to rehabilitate, and help diagnose, foot-related lower limb pathologies. Click to learn more.
Any patient that habitually wears shoes will benefit from BioPods.
Habitually shoe-wearing will cause some form of maladapted neuromuscular function in the wearer’s lower limb kinetic chain. This footwear induced maladaptive function predisposes the person to injury and is the significant underlying cause of most foot-related pathologies.
BioPods should be an integral component in any lower limb kinetic chain rehabilitative therapy. Biopods’ prophylactic benefits also prevent issues from occurring.
In addition, many of those with a history of foot-related pathology will exhibit non-presenting fibrotic tissue (anywhere within the lower limb kinetic chain), which hinders optimal neuromuscular function and movement. In these instances, BioPods will also function as a diagnostic tool. With regular use of BioPods, as the user’s neuromuscular function, skeletal alignment, and mobility improve, these non-presenting areas of fibrosis will become symptomatic. Once identified, soft tissue mobilization therapies can then be employed to regain health tissue elasticity, thereby removing any hindrances to optimal functional alignment and movement.
How do I introduce my patients to BioPods?
Tips on how to engage with your patients during their examination process.
As your patients’ healthcare authority, they are looking to you for solutions to their problems.
Most patients will be unaware of their footwear’s damaging effects, often believing that their “good supportive” footwear is helping them. Virtually all patients will not understand that their lower limb functional dynamics adapts in response to how they use their body daily.
During your examination process, introduce these “adaptive” concepts to your patients, by:
- bringing to their attention the maladaptations (functional symptoms and or limitations) that you are observing that are contributing to their problems/pain,informing them on how footwear causes their maladaptations (results in functional atrophy – similar to a cast or brace),explaining to them that you will address the damaged tissues and joint fixations, andadvising them on the importance of eliminating the footwear-related cause of the maladaptations via the use of BioPods Stimsoles in soft, flexible footwear.
- Engaging and educating your patients during the examination process takes little or no additional time. It establishes the rationale for using BioPods, and it helps ensure patient compliance.
- Regardless of the sound rationale, some patients will be unwilling to give up their current footwear. In these instances, all you can do is provide them with accurate information and advise them that their problems cannot be successfully “fixed” without a change in footwear.
Patient Examination Tips
In this video Dr. Comstock reviews what to look for during patient examinations and related patient recommendations.
Clinical Tips Overview
PLEASE READ before viewing the other Clinical Tips
By Bruce Comstock, DC
For the past 30 years, I have been indirectly involved with the development of the BioPods technologies, primarily testing various product iterations and applying the related therapeutic treatment methodologies, firstly on myself, then with thousands of my patients.
From my clinical observations, I have been able to discern Nine Clinical Tips that will hopefully be insightful to practitioners new to the technology and speed the learning curve for interested healthcare practitioners.
Reimagining Foot Care
During my early years of practise, I prescribed orthotics to my patients. Over subsequent years, one of the biggest challenges that I faced was letting go of the conventional and outdated “support and cushioning” foot care perceptions. In fact, through experience, I have been forced to relearn everything. Most importantly, I’ve learned that most foot-related pathologies are symptoms of maladapted neuromuscular mechanics rather than the result of genetics.
I have also learned that, within my clinic (or, for that matter, any clinic that has a primary focus on MSK issues), the BioPods technology is at least as important as I am (the treating practitioner) – in that:
- my essential service is to alleviate symptomatic manifestations of the “maladaptation syndrome,while the BioPods technology actually alleviates the cause of the “maladaptation syndrome.”
- The BioPods technology is (or ought to be) the cornerstone of every MSK clinic, regarding the weight bearing kinetic chain… anything else is merely symptom-oriented and is not capable of kinetic chain rehabilitation.
As an MSK practitioner, I believe that my highest guiding principle (after that of ruling out pathology) must always be to provide genuine therapy. Palliative is always part of treatment, but as an end point only if a therapeutic option is unavailable.
In my experience, the vast majority of BioPods users will demonstrate smooth and often rapid symptomatic relief, which directly implies an alleviation of the underlying ‘maladaptation syndrome’ of the kinetic chain. However, there are some GREY ZONES in which we will find categories of a slow, resistant, or even a worsened clinical response.
It is immediately clear that there are 2 categories to consider as the causes of these GREY ZONES – (1) exterior to the foot, and (2) within the foot.
My Nine Clinical Tips include these two Grey Zones, and the 7 pathology categories below that require additional consideration:
- Heel Pain Individual
- Medial Foot Pain
- Toe Numbness
- Patella-Femoral Syndrome
- Posterior Knee Pain
- Unresolved Inversion Ankle Sprain
Clinical Tip #1:
“Exterior-to-the-Foot Causes” of GREY ZONE clinical responses
By Bruce Comstock, DC
Our traditional choices of footwear are typically too tight and too rigid. The most concise objective of BioPods technologies is to emulate the “barefoot experience.” This requires 2 components:
1. a constantly variable stimulus at the sole of the foot (i.e., natural ground contact for unshod and BioPods for the shod), and
2. minimal interference with the dynamics of foot function.
When implementing BioPods Stimsoles, the greatest hindrance to kinetic chain rehabilitation is the choice of footwear being utilized. In particular:
1. shoes MUST NOT BLOCK ELEVATION OF THE GREAT TOE, and
2. the SHOES MUST BEND, FLEX AND TWIST READILY IN ALL PLANES, SO AS TO NOT BIND OR RESTRICT THE ARCH/MID-FOOT’ ELEVATION CAPACITY.
The absence of these criteria, from the chosen footwear, will impede the capacity and/or the rate of kinetic chain rehabilitation.
Clinical Tip #2:
“Within-the-Foot Causes” of GREY ZONE clinical responses
By Bruce Comstock, DC
Hallux Extension Limitation
The BioPods educational material indicates that a rigid hallux creates a recognizable impediment to the expectations of ideal weight bearing kinetic chain rehabilitation, even with BioPods use.
I highly recommend that a steady therapeutic attempt be made to mobilize, manipulate, and remove adhesions/fibrotic tissue that even remotely limits hallux extension… because it can be the KEY to full rehabilitation of the lower limbs. I have patients that have demonstrated virtually immediate, and then sustained, correction of a chronic/recurrent dysfunctional sacroiliac joint the day that the ‘problem’ hallux showed notably increased extension capacity.
Sub-Talar Dorsiflexion Limitation
What I have learned over the years, and with approximately 2,000 cases, is that the more ideal the foot stimulus, not only is there better alleviation of painful symptoms, but also discernibly superior functional improvement of the entire weight bearing kinetic chain.
To that point, I have been using sacroiliac joint ‘end joint feel’ as an indicator of kinetic chain functional optimization. The presence of a palpably soft, end joint, ‘fine’ range of motion (as I challenge every patient, at each visit) indicates optimal BioPods’ influence over the weight bearing kinetic chain.
If I detect less than ideal sacroiliac end joint feel and range of motion, my next step is to examine the patient’s feet… specifically to identify the capacity for full sub-talar dorsiflexion. Inevitably, one or both feet will reveal visibly reduced dorsiflexion ROM and palpable fixation of the tibia-talus joint and, occasionally, the talo-navicular joint. Mobilization and/or manipulation of these joint dysfunctions inevitably (even if multiple sessions are required) optimizes the kinetic chain integrity. Subsequent visits reveal ideal, soft end joint feel range of motion within the sacroiliac joints.
I have observed that, as a patient’s gait and sacroiliac end joint feel and range of motion improve with BioPods use, an idealized, dynamic “open” kinetic chain alignment occurs during the gait-swing phase prior to the feet contacting the ground. This idealized dynamic alignment includes the synergistic raising of the toes and arches commonly observed in the Windlass Effect and Cuboid Pulley Mechanism, which inherently align and stabilize the foot and ankle.
However, if prior to ground contact, a patient’s sub-talar region of the foot cannot dorsiflex ‘sufficiently,’ the hallux will not be capable of reaching sufficient extension to effectively align and stabilize the foot and ankle during ground contact. The resulting poor alignment throughout the closed kinetic chain compromises the sacroiliac joint function.
Clinical Tip #3:
By Bruce Comstock, DC
This category of knee pain is the most common knee-region manifestation of the foot-based, maladaptation syndrome. Put simply, when the vector of maladapted kinetic weight bearing forces no longer aligns with the longitudinal axis of patella motion, damaging stressors are created:
- the cartilage under surface of the patella (due to the poor tracking of the patella) which, over the long-term, can result in degeneration, fibrillation and/other maladaptive modelling of the cartilage, and
- in any of the peri-patellar tissues (as a ‘defensive’ response to the ongoing stress) which can result in a variety of tissues becoming thick and fibrotic, but, predictably, always within the maladapted vector of force.
In my 36 years of clinical practice, I have discerned 2 different (but not necessarily mutually exclusive) patterns of fibrotic tissue build-up, that do in fact present with different, specific symptoms.
Symptom #1 – anterior knee pain when ascending or descending stairs
Examination will show full active and passive ROM’s and all orthopedic ligament stress tests negative, but peripatellar tissue palpation reveals notably sensitive, ropey/gritty tissue embedded within the following sites: medial joint line fascia; the MCL; the lateral joint line fascia; and the distal VLO muscle.
Symptom #2 – painful kneeling, worsened by more full/forceful flexion
Examination will show full active and passive ROM’s and all orthopedic ligament stress tests negative, but palpation reveals the pain source… fibrotic tissue build-up in the midline of the distal 25% of the quadriceps, sometimes with palpable, tender swelling, and sometimes with fibrous tissue within the patellar tendon/tibial tubercle.
(As an aside… this condition is labelled “Jumper’s Knee” in the realm of sports medicine.)
The treatment that I recommend for each includes:
1. Therapeutic ultrasound to eliminate the fibrotic sites;
2. Ice and/or electrotherapy, for palliative purposes; and
3. BioPods Stimsoles in compatible footwear to alleviate the underlying cause of the maladaptation syndrome.
Clinical Tip #4:
Unresolved Inversion Ankle Sprain
By Bruce Comstock, DC
It is a safe assumption that all people have sustained at least one notably severe ankle sprain by their mid teen years. Such an injury will serve to magnify, or even create, a manifestation site of the concurrently developing, foot-based, maladaptation syndrome.
When an MSK practitioner examines feet (regardless of the presenting symptom), a tell-tale indication of an unresolved ankle sprain is the simple observation of a passive foot position (with the feet dangling, either supine or sitting) of unilateral inversion. Palpation of the lateral ankle ligaments may or may not show any fibrotic thickening, and likely only requires therapy if it becomes symptomatic. However, when palpation reveals notably sensitive fibrotic tissue embedded in the belly or myotendinous region of the fibularii muscles, I suggest that it is a virtual necessity to eliminate this damage site in order to rehabilitate the kinetic chain.
In fact, fibrotic tissue in either the fibularii muscle bellies or their myotendinous regions can inhibit the rehabilitation process otherwise expected with BioPods usage. In essence, dysfunctional fibularii muscles represent the failure of critical muscles that, when firing correctly, will ideally align and stabilize the foot (i.e., the other muscular components being the tibialis anterior, tibialis posterior, and the extensor hallucis longus). Thus, if left untreated, foot function rehabilitation is hindered significantly by fibrotic fibularii muscles.
Clinical Tip #5:
By Bruce Comstock, DC
I have had many occasions in which a patient presents with an inaccurate diagnosis of “plantar fasciitis”—equally often as a self-diagnosis or as the diagnosis offered by a previous health care practitioner. At their presentation, I suggest that we call it “heel pain” until all the features are discerned and confirmed. I now subdivide “heel pain” into 3 distinct diagnostic categories, each with their uniquely different causation and treatment needs:
1 – Plantar Fasciitis
This is the correct diagnosis if the pain is under the anterior region of the calcaneus and is at its worst intensity with the first few steps out of bed in the morning. It is the result of increased tension within the plantar fascia, via the increased distance between the calcaneus and the metatarsal heads, of a maladapted foot. Treatment entails therapeutic ultrasound to the damaged plantar fascia and rehabilitation via BioPods Stimsoles and optional palliative measures such as ice packs, electrotherapy, and OTC meds, etc.
2 – Deep Calf Fibrotic/Contractures
This is the correct diagnosis if the pain is either: (1) around the calcaneus (like a ‘horseshoe’ but not under the calcaneus; or (2) in the Achilles tendon.
2.1- Palpation of the outer margins of the calcaneus may be sensitive (but not necessarily) while palpation of the flexor hallucis longus and/or fibularii and/or tibialis posterior muscle bellies (ie; FFT muscles) is exceptionally painful with a fibrotic/ropey texture throughout much of their length.
2.2- Palpation of the Achilles tendon is neither fibrotic nor tender, whereas palpation of the flexor hallucis longus and/or fibularii and/or tibialis posterior muscle bellies is exceptionally painful with a fibrotic/ropey texture throughout much of their length.
In essence, certain maladapted feet will have developed damage in the flexor hallucis longus and/or fibularii and/or tibialis posterior muscle(s), which puts the hallux in a fixed position of flexion, but with a fixed position of forefoot eversion… the net result being a rigid, angular heel-strike position that stresses the Achilles tendon and the calcaneal fascia/periosteum. Treatment entails therapeutic ultrasound to the fibrotic regions of the flexor hallucis longus and/or the fibularii, and/or the tibialis posterior muscles, full rehabilitation via BioPods Stimsoles and palliative measures (such as ice packs, electrotherapy, OTC meds, etc.) but applied to the symptomatic site… not necessarily to the FFT muscles themselves.
3 – Achilles Tendonitis
This is the correct diagnosis if the pain is in the Achilles tendon at or above its calcaneal attachment, and the pain is intensified by firm palpation or squeezing the tendon. Additionally, more gentle palpation will localize site(s) of fibrosis within the tendon, the myotendinous region, or even the soleus or gastrocnemius muscle bellies. The cause should be considered as either/both an unresolved trauma, and/or a repetitive strain – as a result of maladapted feet.
Treatment entails therapeutic ultrasound to the fibrotic regions, rehabilitation via BioPods Stimsoles, and optional palliative measures such as ice packs, electrotherapy, OTC meds, etc.
Clinical Tip #6:
Posterior Knee Pain
By Bruce Comstock, DC
Knee pain that is located at either the posterior/medial or posterior/lateral region indicates a damaged hamstring insertion tendon. Past trauma (i.e., hyperextension) is a possible mechanism of injury. However, at such an occurrence, the primary concern is injury to the anterior cruciate ligament. After the initial pain fades (and the cruciate was either not injured or was subsequently repaired) via time and ongoing physical activity, the tendon will become progressively thicker/fibrotic until symptoms manifest well after the initiating event due to the cumulative loss of tissue elasticity.
On the other hand, the far more prevalent means of causation is hard heel strike with internal or external hip/thigh rotation (as a manifestation of a maladaptation syndrome) with the knee in full extension by a long-stride, gait pattern.
This results in a repetitive strain site that becomes steadily more fibrotic/thicker/unable to withstand the previous forces through it, thus developing pain.
Treatment entails therapeutic ultrasound to the fibrotic site, full rehabilitation via BioPods Stimsoles, and optional palliative measures (ice packs, electrotherapy, OTC meds, etc.).
Clinical Tip #7:
Medial Foot Pain
By Bruce Comstock, DC
Foot pain that is located along the medial region of the 1st ray (with neither plantar nor dorsal pain components) and is tender to touch, with sites of fibrotic/gritty thickness located at either (or both) the proximal/medial hallux or the posterior/medial navicular, is due to a damaged abductor hallucis muscle. This muscle suffers repetitive strain via pronation of a maladapted foot that persistently and excessively (via arch collapse) elongates the abductor hallucis muscle into a painfully fibrotic condition.
Treatment entails therapeutic ultrasound to the fibrotic site(s), full rehabilitation via BioPods Stimsoles, and (optional) palliative measures such as ice packs, electrotherapy or OTC meds, etc.).
Clinical Tip #8:
Individual Toe Numbness
By Bruce Comstock, DC
Approximately once per month, a patient requests relief for one or more of their toes’ “numbness.” After ruling out diabetic neuropathy and peripheral nerve entrapment neuropathy, the cause is presumed to be either local soft tissue trauma or repetitive strain within fascia that pressures/’traps’ the sensory nerve that serves the toe, due to maladapted feet.
The diagnosis is essentially established by dorsum surface palpation from distal to proximal from the base of the involved toe, noting any soft tissue fibrotic irregularities (often very small) along the entire dorsal surface of that metatarsal. Where a fibrotic ’hot spot’ is palpated, sustained pressure will often reproduce the ‘numb’ sensation of the toe. Subsequent elimination of the fibrotic tissue via therapeutic ultrasound relieves the ‘numb’ complaint, usually very rapidly.
Several points of discussion can be gleaned from this clinical setting. First, trauma to the dorsum of the foot is common from dropping of a heavy or a hard-edged object. This can lead to the development of fibrotic tissue, which presumably ‘traps’ the sensory nerve to a toe. Second, the same damage can occur, non-traumatically, from years of excessively rigid or tightly laced footwear that creates repetitive compression or friction on the soft tissues on or near the sensory nerve.
The appropriate therapy to eliminate the fibrotic tissue would include therapeutic ultrasound and or deep tissue massage. Furthermore, if the patient has been deemed to have maladapted feet concurrent to the sensory nerve repetitive strain fibrosis, BioPods Stimsoles should be employed to assist foot rehabilitation.
Clinical Tip #9:
By Bruce Comstock, DC
This common (often severe) pain at the plantar surface of the metatarsal heads can have 3 separate (or combined) causes:
1 – Direct trauma as a cause of local pain seems obvious, unless the traumatic event from the past has not been recalled by the patient. An interesting (and surprisingly predictable) ‘triggering trauma’ can occur via prolonged or frequent standing on a ladder rung upon just the metatarsal heads.
2 – Repetitive strain to the fascia of the metatarsal heads is likely to occur within a maladapted foot that is encumbered frequently within footwear with a rigid, tight, toe box.
3 – Shoddy footwear design, materials, or workmanship that:
- features a concave supporting surface under the metatarsal heads, or
- allows the inner sole and or shoe midsole/outsole to break down and compact beneath the metatarsal heads.
These aspects of footwear design, materials, or workmanship cause the metatarsal heads to “drop.” This ‘drop’ causes maladaptive neuromusculoskeletal foot function and modelling, which are the leading causes of a vast array of foot-related pathologies, including metatarsalgia-related inflamed soft tissues. Footwear, even supposedly “good” shoes with these features, pose the greatest challenge in preventing pain to the metatarsal heads. This is especially true when shoes are new because it is virtually impossible to evaluate the materials and durability of the inner sole, midsole, or outsole. Therefore, it is important to observe a shoe’s forefoot characteristics and wear patterns when metatarsal-related symptoms arise.
In each scenario, small palpable sites of painful/gritty/fibrotic fascia will be found surrounding the plantar region of the (most commonly) 2nd and/or 3rd metatarsal heads. In an early presentation there may only be palpable, painful swelling.
Discerning between these 2 conditions is important but sometimes difficult because the treatment approach is different for each.
The treatment for the ‘swollen’ version entails anti-inflammatory measures (i.e., ice pack, electrotherapy, OTC meds, etc.) while treatment for the ‘fibrotic’ version requires therapeutic ultrasound plus the anti-inflammatory measures. In each case, full rehabilitation requires the BioPods Stimsoles, plus the utilization of looser, softer, flexible footwear, of quality materials and workmanship.