Addressing Structural Asymmetries: The Role of Heel Lifts in Gait Mechanics

How do you determine when a leg length discrepancy requires structural intervention? In this episode of Untold Physio Stories, Dr. Wells presents a case study of an 80-year-old patient managing the long-term effects of a complex total hip replacement. Following a revision surgery two decades ago, the patient was left with a 2cm leg length discrepancy on her right side.While she remained active with yoga and Pilates for years, a recent decrease in activity led to noticeable changes in her gait and discomfort in her lower extremities.Structural Findings: A functional and anatomical measurement confirmed the right lower extremity was 2cm longer than the left.Gait Observations: Assessment revealed a compensatory trunk lean to the right to facilitate clearing the left leg during the swing phase.Joint Mechanics: The patient exhibited significant pronation in the right ankle and a varus thrust in the left knee during ambulation.Strength Deficits: Evaluation showed weakness in the left gluteal and quadriceps muscle groups.Dr. Wells opted for a dual-track approach:Conservative Structural Support: A 0.5-inch heel lift was introduced to the shorter side to improve gait symmetry without causing discomfort or heel slippage.Targeted Exercise Prescription: Resistance training was initiated to improve quadriceps and gluteal strength, specifically focusing on knee tracking and core stability.We also contrast this with Dr. E’s experience managing a post-polio patient, where the goal was actually reducing an excessive 3-inch external lift to restore lost hip and knee extension. This episode explores the balance between providing structural support and maintaining joint mobility.Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

Ever had a patient ask for a full refund after a rock-solid evaluation? 🤦‍♂️It happened to me. Even after 20+ years of clinical practice and teaching hundreds of therapists, I realized that "good clinical results" don't always equal a "satisfied patient."In this episode of Untold Physio Stories, I’m joined by my good friend Donis Gil from Professional Seminars. We dive deep into the awkward, frustrating, and eye-opening moments when patient expectations don’t align with our clinical reality.We’re breaking down:The Refund Story: Why a "perfect" lecture can still result in a disgruntled customer.The "Sandwich" Approach: Is starting with a positive always the best way to handle critiques?Love Languages in the Clinic: How the 5 Love Languages (Quality Time, Acts of Service, etc.) apply directly to your patient's recovery journey.The Power of the Pause: How to handle high-conflict patients (like the "Atlas Rotation" lady) without losing your cool.Framing the Win: Why finishing a 60-minute eval in 40 minutes should be a bonus, not a "ripoff."Stop guessing what your patients want and start mastering the Expectation Management game.Check out the links in the show notes to connect with Donis Gil and level up your patient experience!Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

Ever feel like the PT world is just one big "small world"? 🌎In this episode of Untold Physio Stories, I’m joined by a long-time peer and fellow manual therapy "survivor," Dr. Paul Vidal. We take a trip down memory lane to the late 90s and early 2000s—back when the S1 course was 5 days of pure intensity, Stanley Paris was throwing shoes out of windows for wearing jewelry on the plinth, and Mariano Rocabado’s notes were still 90% in Spanish.But it’s not just about the "glory days." Paul shares a fascinating clinical deep dive into how he stumbled into the world of Vestibular Rehab. We discuss:The Origin Stories: Comparing our paths through the University of St. Augustine and the manual therapy fellowship "challenges".The Stanley Paris Lessons: The discipline (and fear) that shaped a generation of therapists.The Cervical Vestibular Link: How Paul realized the upper cervical spine was the missing link for many of his dizzy and balance-impaired patients.Evolution of Practice: Transitioning from a solo "manual therapy guy" to scaling a multi-site practice with 9 therapists and an integrated gym.Whether you're an OMPT nerd or interested in the Cervical Vestibular crossover, Paul’s journey from "pressing and guessing" to clinical mastery is a must-listen.Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

Ever meet a clinician who is so married to their "system" that they stop listening to the person in front of them? 🚩In this episode of Untold Physio Stories, Dr. Sean Wells and I dive into the murky waters of professional networking gone wrong. Sean shares a story about a virtual meet-up with a "posture guru" that went south the second the word "complexity" was uttered.We’ve all seen it:The Posture-Only extremist who thinks every disease state starts at the pelvis.The Fascia-Fixated provider who hasn't heard of central sensitization.The Three-Hour Exam trainer whose model is as un-replicable as it is exhausting.The reality? Most of these "successful" gurus are just victims of their own success. They have a high-energy personality that sells a flawed model, creating a feedback loop that convinces them they’re never wrong.As clinicians, we have to stay humble. Whether it’s VR-based rehab or manual therapy, the second you close the door to other models is the second you stop growing.In this episode, we discuss:The danger of black-and-white clinical reasoning.Why "authoritative" personalities attract certain patient types (and fail others).The balance between virtual care efficiency and the power of the therapeutic alliance.A sneak peek at what’s coming to CSM 2026 with Immergo Labs.Don’t be the "My Way or the Highway" PT. Listen in and learn why staying open-minded is the best thing you can do for your outcomes.Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

"Don't Assess Yourself."Gray Cook told me that years ago during an SFMA course, but apparently, I needed a painful reminder.I’ve been dealing with this nagging, chronic left-sided low back pain for a while now. Being the "Modern Manual Therapy" guy, I threw the absolute kitchen sink at it:Dry Needling 📍Shockwave Therapy ⚡Specific loading & trunk rotation 🏋️‍♂️General tissue work 💆‍♂️Everything gave me transient relief—maybe a 1 to 4 out of 10 improvement—but nothing stuck.Finally, I decided to stop overcomplicating it. I went back to basics. I checked my Repeated Extension in Standing (REIS).The result?It was stiff. It was blocked. It was painful.But after 10-15 reps? The pain melted away.I was so busy looking for the "fancy" fix that I missed the huge sagittal plane block right in front of me.In this episode of Untold Physio Stories, Dr. Sean Wells and I break down why physical therapists make the worst patients. Sean shares his own recent battle with acute back pain where he had to put his ego aside, get on oral steroids, and let a colleague dry needle him to break the cycle.The Takeaway:Pain is an emotional and sensory experience. You cannot be objective about your own body. Whether you are a new grad or have been practicing for 20 years—get an outside set of eyes.Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

Stop me if you’ve heard this one before: "The patient’s PSIS is 2 degrees higher on the right, so their pelvis is rotated and that’s why their back hurts."In this episode of Untold Physio Stories, we’re diving into the weeds of the Sacroiliac Joint. We’ve all been taught the intricate palpation models, but when we look at the actual kinematics, we’re often talking about movements so small they’re nearly impossible to reliably detect with human hands.In this episode, we discuss:The "Two-Degree" Threshold: Is a 2-degree shift a clinical "aha!" moment or just measurement error (or normal human asymmetry)?Reliability vs. Reality: Why our obsession with "alignment" might be distracting us from what actually gets the patient moving.The Untold Story: A real-world case where focusing on the "degrees" led a clinician down a rabbit hole, and how shifting to a multi-modal, loading-based approach changed the outcome.The bottom line: If your treatment plan changes based on a 2-degree palpation finding, you might be treating the map, not the territory. It’s time to stop over-complicating the SIJ and start focusing on what the evidence actually tells us.Don’t let a minor deviation in a "test" dictate a major shift in your "treatment." Sensitivity matters, but clinical relevance matters more.Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

We've been seeing lots of videos and promotion on MSKUS training for PTs.We all love new toys. And let’s be honest, showing a patient their supraspinatus in real-time looks cool. It builds buy-in. It feels high-tech.But does it change what you do Monday morning?Does seeing the calcification actually change your loading protocol? Does the image change the fact that you need to treat the person in front of you, not just the tissue?In this week's episode of Untold Physio Stories, we’re breaking down the ROI of Musculoskeletal Ultrasound.We discuss:The steep learning curve (it’s harder than it looks).Diagnostic accuracy vs. Clinical utility.When it’s a "Game Changer" and when it’s just a "Nice to Have."If you've thought about or gone through the training leave a comment or reach out! We'd love to hear from you!Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

Let's get real. Every one of us has been there: the patient who churns, the bad review that stings, the demand for a refund. You think it's because your manual therapy technique wasn't perfect or your exercise prescription was lacking. Wrong.In this must-listen episode, Dr. E sits down with cohost Dr. Sean Wells to dissect the uncomfortable truth about business, clinical practice, and patient satisfaction.We pull back the curtain on two recent, personal cases where even we—the experts—had our expectations utterly torpedoed, resulting in a frustrating experience (and almost a negative review!). We dig into the core principle that governs all service-based businesses:Negative Experiences = Unmet Expectations. Have you had similar hard learned lessons?Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

Why is "conservative care" treated like the alternative, while surgery is the default setting? 🛑In this episode of Untold Physio Stories, Dr. Wells shares a case of a patient that highlights exactly what is broken in our healthcare system.The patient reached out with a simple, heartbreaking question: "Am I getting the right care?"Here is the patient's timeline before ever talking to a PT:The Scan: Went in for low back pain, immediately received a scan.The First Surgery: Based on the image (not the function), they operated. It failed.The Second Surgery: The surgeon’s solution to the failed surgery? Cut again.The patient eventually made his way to Dr. Wells, but asked him, what do you think of the recommendations I've been given so far?Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

When an acute ankle sprain hobbles into your clinic, do you treat them all the same? 🛑If you treat a high ankle sprain like a standard lateral inversion sprain, you are going to flare that patient up. Fast.In this episode of Untold Physio Stories, Dr. Sean Wells and I break down two very recent, very acute cases that walked through the door.Case 1: The Classic Lateral Sprain.Patient presented with immediate swelling and loss of ROM. We discuss why checking the distal fibula for positional faults immediately can restore movement before they even leave the table.Case 2: The "Combo" (Lateral + High Ankle).This one is tricky. The squeeze test was positive. Dorsiflexion was painful and limited. We break down why you have to stabilize the syndesmosis differently than you treat the ATFL.In this episode, we cover:💥 Manual Therapy in the Acute Phase: Yes, you can touch it! We share the safe MWMs to regain dorsiflexion. Plus bonus - e-stim combo for early WB💥 Taping Strategies: When to use a fibular repositioning tapeStop guessing with acute ankles. Assess the mechanics, classify the injury, and load them appropriately.Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com