I met a friend at a local Starbucks yesterday. He told me his running was completely curtailed due to a knee injury. This is a guy that already has completed an Ironman. I’ve cycled with him and he’s got an engine that is powerful and the legs to match. Typical rides with him average 24 mph on the flats. He can’t climb hills for crap like many triathletes, but don’t mess with him in the wide open.

So he’s no rube, but he has been through some crazy medical stuff the last couple years. Which is strange in a way, because he’s widely known as a brilliant diagnostic physician.

And that makes what I’m about to tell you all the more weird.

My friend tried to treat his knee problem through a couple channels. These include visiting an orthopedist and possibly a chiropractor. Neither has been able to solve his knee problem.

Having been through a few knee issues myself over the years, I asked where and how it hurt. I told him about my own case of chondromalacia and how, through a combination of physical therapy activity and new orthotics, the problem went away.

“Well, there are orthotics people and there are anti-orthotics people,” he answered.

I told him I was aware there is a divide in the sports world as to the effectiveness of orthotics. Some believe that all injuries are the results of strength imbalances. To an extent of course, they are correct. But there are also issues of raw biomechanical flaws, structural defects in the human body that include bone structure that can lead to chronic pressure and collapsing ligaments and joints. These lead to injury.

Fact is, biomechanical problems may or may not be fixable through strength training or surgery. My friend had already had surgery in fact. There are some orthopedic doctors that love to go in and mess around with things. Not all, but some.

Surgery should be the last resort of course. Any time you enter the human body there is risk of disturbing or even creating material such as scar tissue that complicates things even further. Great surgeons know how to avoid this for the most part. I’m very pleased with the work done on my clavicle by an orthopedic surgeon who repaired my busted collar bone.

But I trust correction of most of my biomechanical flaws to a physician that works from the ground up. As I’ve written before on this blog, I see a pedorthist who prescribes and creates my orthotics. The finished product are a little bulky in some respects yet I can race and train effectively in them.Without orthotics, I’d be dead in the water.

My companion Sue has had hip and back problems from running. She saw the pedorthist recently too, and the visit was truly revealing. Her new orthotics arrive soon.

I’ve tried self treatments and strength training for my calf muscles. I do the work to strengthen my quads, and do some yoga to increase flexibility. But problem are almost always underfoot. That is, biomechanical deficiencies almost always start at the feet and emanate up the body.

I illustrated a book with a sports podiatrist about this very topic 20+ years ago. Back then, sports podiatrist John Durkin was treating athletes like Sebastian Coe (world record holder and Olympic champion) Jim Spivey (Olympian at 1500 and 5000) and more. They all realized they needed help at the foot level to compete and train at a high level.

Seb Coe’s feet were flat. Yet he could leg lift 700 pounds. So it was a strength deficiency that was his problem and led to injuries. It was poor structural foundation in his feet.

Runners and cyclists who don’t want to be dependent on orthotics have a point. Once you choose to go forward with them, there really is no turning back. But using orthotics is like wearing glasses. No amount of eye exercising is going to correct your vision.

So I told my friend to go see the pedorthist. He seemed semi-convinced. I honestly believe he’ll be fully convinced once he tries running in orthotics and it solves his knee problem. There’s obviously an imbalance leading to a torque in the patellar tendon that is producing knee pain and possibly cartilage wear. You can go in there and scrape away tissue forever, but unless the patella tracks cleanly in its groove on top of the knee the problem will return and persist. It’s that way with a ton of cycling and running injuries. They all come from overuse or imbalances. Combine the two and the problem never goes away.

I wish I did not have to wear orthotics. It’s one of the tarsnakes of an aging athlete however. It’s always ironic to buy superlight shoes and then plop those orthotics inside. Without them I can’t run more than 2-3 miles at a time. I’ve tried. Been down that road. I put orthotics in my cycling shoes as well, so that my pedaling is in a balanced mode.

Pretending your body and feet are perfect won’t do y0u any good. Taking steps to correct your foot imbalances will.