Rothbart Proprioceptive Therapy normalizes global muscle tonus - Cuernavaca Study
The purpose of the Cuernavaca Study was to determine if Rothbart Proprioceptive Therapy using Rothbart Proprioceptive Insole(s) is effective in normalizing tonus (tension) patterns (trigger points) in the postural muscles.
Abstract
Pressure plate analysis is used to collect surface area (sA) and media pressure (mP) readings on 17 Primus Metatarsus Supinatus patients. All 17 patients are fitted with medial column foot insoles. Two sets of surface area (X) and media pressure (Y) readings are recorded on each patient: a baseline set before treatment and a second set after Rothbart Proprioceptive therapy. The observed changes in surface area (∆X) and media pressure (∆Y) are statistically correlated: (1) are ∆X∆Y patterns randomized events or are they the result of medial column insole therapy, and (2) if the ∆X∆Y patterns are the result of Rothbart Proprioceptive therapy, do they have any correlation to postural tonicity? The results are compelling: (1) the probability that these patterns are randomized events (based on chance alone) is exceeding small (p < .01) and, (2) there is a high level of confidence that postural tonicity shifts towards homeostasis when Rothbart Proprioceptive therapy is effective. From a clinical point of view, ∆X∆Y patterns may prove useful in prognosticating the appropriateness of Rothbart Proprioceptive therapy.
Cuernavaca Study
The Midicapteur’s Podolab 2000™ pressure plate analysis system was used to capture changes in surface area (sA) and media pressure (mP) readings after insole therapy. These readings were hard copied in both numerical and graphical format (See Figure 1 below) and then statistically evaluated to determine if the observed changes were the result of insole therapy or chance occurrence alone.
Figure 1 - Hard copy of data generated by force plate analysis (Medicapteur's Podolab 2000)
Protocol
17 patients diagnosed as Rothbarts Foot were selected to participate in this study. Patients were excluded from this study if they were (1) diagnosed as having an upper or motor neuron lesion or any foot pathology that altered gait patterns, (2) amputees, or (3) if they required the use of a crutch or cane to walk. The selection of patients was not randomized relative to age, weight, height, sex, social or ethnic backgrounds. Each patient was fitted with a medial column foot insole determined Computerized Postural and Gait Analyses. The insoles incorporate a medial bar into a 1mm thick, flexible, flat base plate.
Media pressure and surface area readings were obtained via the following protocol: (1) wearing shoes, the patient walked for several minutes, (2) shoes and socks removed, standing barefooted on the pressure plate, baseline mP and sA readings were recorded, (3) mcf insoles were fitted and placed in the shoes, the patient again walked (shod) for several minutes, (4) standing barefooted on the pressure plate, a second set of mP and sA readings were recorded. In all, 34 sets of measurements were obtained. Of salient importance was that all measurements were recorded while the patient was standing barefooted on the pressure plate.
Results
Baseline surface area (Xi) and media pressure (Yi) readings for each of the 17 patients are presented in Table 1.
Table 1 - Means and Standard Deviations of Baseline Set of Readings.
Patients 1-11 (clinically diagnosed as releasers) recorded higher surface area readings (mean = 164.82 cm2) and lower media pressure readings (mean = 390.27 gms/cm2) compared to patients 12-17 (clinically diagnosed as bracers). The second set of surface area (Xi+1) and media pressure (Yi+1) readings are listed in Table 2.
Table 2 - Means and Standard Deviations of Second Set of Readings.
Table 3 - Computed Changes in mP and sA Readings.
This null hypothesis was tested for level of confidence using the Chi-Square (X2) test:

Where Ni are the observed frequencies in each pattern and ni are the expected frequencies in each pattern if based on chance occurrence alone.
The results of the Chi-Square (X2) test (See Table 4 below) rejects the null hypothesis.
Table 4 - Statistical Analysis
The statistical probability of ∆X∆Y patterns being generated randomly is less than 1% (X2 = 2.90E-09). This gives us a very high level of confidence (> 99%) that the observed ∆X∆Y patterns in the Cuernavaca study were the result of insole therapy and not the result of chance occurrence. A postulate for the observed ∆X∆Y patterns is: (1) baseline readings are skewed left in hypertonic patients (bracers) and right in hypotonic patients (releasers), and (2) effective Rothbart Proprioceptive therapy shifts surface area (∆X) and media pressure (∆Y) toward homeostasis (See Figure 2 below).
Figure 2 - Cartesian graph demonstrating the normalization (towards homeostasis) of mP and sA readings. The vectors towards normalization have both directional and magnitude properties.
This premise is substantiated in 15 of the 17 patients (See Table 3). The probability of this occurring randomly is less than 1 in 847 (based on a binomial distribution where p = 0.5).
Cuernavaca Study – One Year Follow-up
15 patients responded very positively to insole therapy. Their level of musculoskeletal pain was significantly less. However, patients #11 and #17 discontinued wearing their insoles for a sundry of visceral and musculoskeletal complaints. Interesting enough, their ∆X∆Y were skewed (away from homeostasis). ∆X∆Y may prove to be an invaluable tool in prognosticating the appropriateness of insole therapy (towards homeostasis = appropriate; away from homeostasis = inappropriate). However, more research needs to be done.
Discussion
It appears that media (average) pressure readings actually represent the summation of two separate but concurrent forces: (1) the vertical component of the body’s weight and (2) a smaller vertical component which represents the state of tonicity within the foot. This author suggests that the degree of tightness (digital contracture) of the toes against the pressure plate determines this reading and that it can vary when an afferent tactile stimulation is applied to the bottom the foot.
Conclusions
Statistical evaluation (chi square test) of the data obtained in the Cuernavaca study yielded a > 99% level of confidence that the observed ∆X∆Y patterns were the result of insole therapy. It was postulated that effective insole therapy shifts surface area and media pressure readings toward homeostasis: (1) in releasers, surface areas would decrease (improved arch contouring), media pressures would increase (improved tonus in postural muscles), (2) in bracers, surface areas would increase (severity of arch diminished) media pressures would decrease (improved tonus in postural muscles). This was observed to be true in 15 out of 17 independent trials. The probability of this occurring randomly is < 0.5%.
Since all pressure plate readings were taken weight bearing and barefooted, what we were measuring appears to be the body’s ability to maintain improved homeostasis without support or continual tactile input, a process referred to as engraming. This correlated to our clinical experience of patients using their medial column foot insoles less and less, while still maintaining their level of wellness.
Reference
Rothbart BA 2004. Pressure Plate Analysis of the Medial Column Foot Insole. A Statistical Study. Online Journal of Sports Medicine (Italian), November Issue.
Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot and PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain
Sign Up Now to get your free chapter from Professor Rothbart's book, Forever Free From Chronic Pain

Figure 1 - Hard copy of data generated by force plate analysis (Medicapteur's Podolab 2000)






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