|
|
|
|
| Transcript Bangkok, Thailand February 23, 2005 |
|
|
|
|
|
|
|
Foot Pronation - How a Simple Biomechanics Dysfunction Accelerates the Aging Process,
The Most Effective Diagnosis, Treatment and Prevention
2nd Annual Bangkok Anti-Aging Conference
February 23, 2005
Bangkok, Thailand
Lecture by Dr. James Stoxen DC
Team Doctors
Treatment and Training Center of Champions
6432 S Pulaski, Chicago Il 60629
To contact Dr James Stoxen DC
teamdoctors@aol.com
(773) 735-5200
I hope they decided to save the best for the last. Well first of all, I'd like you to please turn off your immune system that rejects all new ideas because I'm going to bring some ideas for you today that are going to change your way of thinking about how to treat lower back problems and problems of the lower extremities. You have permission to learn from me to take all the notes you want, to take all the information I have learned over the last 18 years and use it in your practice; use all my ideas and get your patients well. How's that? And also, you have to laugh at all my jokes.
This treatment technique has been used on over 1,500 national and world champions. Last year over 100 Broadway performers came to me for this treatment.
There's a particular story I'd like to tell you about. This patient that was lifting some groceries out of the back of his car and he felt a snap in his back. He went home, took some medication and got worse. He ended up in the hospital and he was on a morphine drip because the pain was so bad he couldn't stand it. He laid there for a week as many tests were run and found he had a large herniated disc crunching on the nerve that was causing a sciatic neuritis and the screaming pain in his back.
They brought him into the operating room and his blood pressure plummeted and he wasn't allowed to have the operation at that time. So he went back into the hospital and they waited. They brought him back into surgery again and his blood pressure went down again and they said there's no way we're going to do surgery on you. We're going to have to take you out of the hospital. They put him on the highest dose of medication that was allowed by law. He had to have his driver's license to present to the pharmacist to get the medication. And he crawled around on the floor like a snake in pain at home for 3 weeks till he came to me.
It's a true story.
An alderman brought him to me. I laid him on the table and I evaluated him. I found his legs were rigid. His muscles were rigid and stiff, like they were frozen. His feet were curled up. He couldn't lie down.
He couldn't sit. He couldn't stand.
I proceeded to work on him for 4 to 5 hours a day on his legs -on his feet. I did not work on his back.
The treatment that I'm going to talk about does not deal with the back. It deals with the legs and the feet. We're going to restore the function of the five floors below the sixth floor, which is the back Then, when we restore the function of those four floors, the back can kind of work its way out, level itself off and the disc will be fine.
He was fine in about 3 or 4 weeks and he is working out with weights now and he's back to normal function. As a result of that -the patient getting better, he went back to his medical doctor who was shocked and said, "I want to know what happened to this patient." I went to see this doctor and she came to see me. The doctor became a patient. During this time, I introduced her to several patients that had been through a similar circumstance, Mr. Johnson. And she decided to put me on her IPA.
I got on the phone with the president of the IPA and I said, "What I'd like you to do, please, if you don't mind, is I'd like you to send me all your surgical cases. So he said, "Fine. Well, you did a good job with Mr. Johnson:
He sent me 10 surgical cases; one patient with sciatica pain for 18 months. She was better in about 4 or 5 visits. Even I was shocked that the sciatic pain was gone. The last 10 patients that they sent me, they're all pain free and their function has been restored to the point where they can work out with weights I about 2 to 3 weeks. I hate to say it, but it's like a cookbook. It's like an assembly line. You bring them in, you work the program and they get better.
I haven't had a patient go to surgery in about 18 years as a result of this treatment. So with that, I'm going to start my program.
This is Team Doctors. We have a full treatment center inside the office. Most of the work is done on the table. And then I we have windows that I look into the training center and I monitor every patient. We have windows where Phase I of the treatment is where I go on hands-on correcting the maladies of the patient. Phase II and III is where they exercise and strengthen the areas so that the patient can be in full function.
This morning they had a special on ABC News regarding this pronation syndrome treatment. Unfortunately, we couldn't pull up the web site video to watch today. First of all, you're talking about a lot of very important things today. A lot of the things that I'm going to talk about I stole from the other doctors this morning. No, I'm only kidding. I told you that you could laugh at all my jokes. I guess that wasn't too funny,
Anyway, what you're talking about is hormone treatment and you're talking about Vitamins, nutrition and a lot of different allopathic remedies. But the first and foremost is diet and exercise. I think that if you're going to have a patient that's really interested in anti-aging medicine, if you don't consider diet and exercise number one. And number two, then you is making a mistake.
First of all, diet obviously and exercise. Exercise stimulates blood flow and countless positive effects on the body. When I'm talking about anti-aging medicine, what I'm talking about patients that do not have a quality frame. If your framework or your lower extremities have poor biomechanics and you have aces and pains and joint maladies, then you're not going to be able to exercise. So that portion of aging program is completely taken out
So when you evaluate the patient, the first thing you want to do is make sure that their frame is solid and that they can exercise.
Now what I'm going to talk about is biomechanical problems in the lower extremities. And the cascading effect that it has on the rest of the body. When the foot looses its biomechanical integrity, number one, it's foot pronation; which is rolling inward of the heel and supination which is the opposite. On the left in the blue, you'll see the man you'll see the man who has supination. On the right, you'll see the man who has pronation. You might say which one is the problem? I'll tell you that both of those patients are normal. Pronation and supination exist in the normal gait pattern.
However, what I'm speaking of is excessive pronation; whereas rolling of the heel on this patient 0 the right in the red where the actual heel will collapse inward causing a problem in the entire lower extremity on that side.
This is an example of foot pronation. Now what you have here is calcaneal eversion. Calcaneus is what I call the bridge -the arch or the bridge of the foot.
People always want to correct the ach. When you look to correct the arch, you're making a mistake. Because if you correct the heel, and if you keep it on center as a carpenter would, then what will happen because of the interlocking mechanism of the bones, specifically the cuboid, you will maintain the arch by itself. So, arch supports do not work. I have td so many feet and I've never used arch support.
In fact, when a patient brings a shoes and it has an arch support, I remove them immediately The talus displaces immediately on the calcaneus and we have increased stress on the first joint in the metatarsal phalangeal Plantar fascitis the feet hurt Misalignment may cause the following problems
Why do I say circulatory problems? The reason why is because when The foot goes out of alignment or has poor biomechanics, the muscles in the calf will actually stiffen and not allow for proper venous return. Also, the patient is not exercising as we said before. The number one reason for the patient having non-traumatic knee pain is called chondromalacia patella. That is a misalignment of the patella in the trochlear groove. The reason for that is because of what's happening below the knee which is actually the foot pronation. Now, it is practically the number one reason for non traumatic knee pain in my office.
So it's interesting that we can solve a number of maladies by learning this treatment technique that I'm going to describe for you today. We're going to be able to correct progressive bunions, we're going to correct plantar fascitis, and we're going to be ale to correct chondromalacia low back conditions, fatigue, and a lot of different problems.
Here's a picture of a herniated disc, L5/51. a herniated disc doesn't scare me. They're very easily corrected. A lot of doctors like to do surgery on them. Mr. Johnson had a herniated disc which walking style compressing on the disc and is no longer causing the sciatica. Now what was it that we were going to remove? It's hard for me to understand, I'm not a surgeon, but what was it that we were going to remove that is fine now after the treatment? It's hard for me to understand. I'm sure there are some disc cases that are not correctible with conservative care.
This is a particular patient of mine. The story of this right here is this is 1,023 pounds; that's about 140 kilos. Has never had a back problem. The reason Why I found these very interesting phenomena about pronation syndrome is because if you look at that athlete here, if we have a subtle biomechanical problem, that weight is going to come down on him and kill him.
Right?
Well, what I did was around 7:30 p.m. when the patients had all left. I said to these athletes, I want you to come into my office. we're going to turn on some music and I'm going to go through your body like a fine tooth comb, and I'm goanna check muscles between your toes. And I'm going to make sure that every single muscle in your body is perfect. That's where I discovered the patterns that I'm going to talk about today related to pronation of the feet that ride right up to the lower extremity into the hip and the back.
What I'm going to tell you is that foot pronation is found to correlate in my office and I'll give you the statistics. 95% or more of the patients with lower back pain have the pattern of pronation syndrome with the cracking of the knees, and the bunions and the painful feet in the pattern that I'm gong to describe today. The other few have been bitten by a dog or something like that. So what I'm saying is that almost directly correlates to the patterns of pronation syndrome.
There have been a lot of studies done on pronation syndrome. Here are a number of them. Talking about the flock of birds, electromagnetic tracking, and load cell devices have been used. Foot posture index tools, Goniometry to measure the eversion of the heels, 6 camera motion analysis studies, 2 dimensional videos, EMG's, Isokinetic testing and gait analysis. 77 subjects, 17 SUbjects and then were going to talk about my study.
In 1987 I had pronation syndrome. I was wearing the shoes that Don Johnson was wearing in Miami Vice. And as a result, my arch on my left side collapsed and I had pains all the way up and down my legs into my back. I have personal experience with the problem.
And so what I decided was that I was not going to treat a back until I went down and checked every single foot on every single patient that came to my office on every single visit. So that's 140,000 backs that I've looked at -280,000 feet. I found a high correlation between this pattern of pronation and the back problems.
My prediction is that after seeing this talk, I want you to have an open mind. I'm not here to sell you anything. I'm just trying to tell what I found every day in my practice.
My prediction is that detection of pronation syndrome and the problems that it causes is going to be part of your protocols that you're going to want to have when you're evaluating a lower back condition.
Objective Findings -Painful and weak spasms occurring along a particular line. Can I just have one person here that has non-traumatic knee pain on one side? Can somebody come up here, please, do us a favor here. Can you come up here? Did you have a trauma? Okay. Do you have HIPAA laws here? .... I'm kidding. Only American doctors would know that. Okay, come on up here. Let's give him a round of applause for volunteering.
Applause
Maybe we can bring this up on stage. Can you help me? Do you mind lying on your back? Okay. Does this go with me? Now, this is when the fun starts. Okay. Lay on your back. Yeah Take those your socks) off here.
Okay. You want to keep that down, I think.
Just lay on your back. You're not going to tell me which side it's on.
Fair enough. I try to diagnose the patient before I actually examine them. I'm checking his Tensor fasciae latae. On the right side it's very stiff. What I'm going to do is go down here in the calf area.
Did you ever as a kid take your hands like this and hoist up your friend like this over a fence. I guess we only do this on the south side of Chicago.
Okay, what I'm going to check right here is on the lateral side of the calf, there are the muscles that actually loop around underneath the foot and support the arch. They're under the calf, under the gastroc and soleus. Not many people know the names because were so busy, we forget. Right? They're very important. I'm going to reach down and hes going to feel a little bit of pain. A lot of pain in there, right?
And when I was touching your TFL it was sore, right. Now right underneath the first metatarsal phalangeal joint there is usually right at the joint line, there's a little bit of a bony prominence point right at that joint line. A little bit of arthritis there.
And I'm looking for some swelling and muscle swelling. Feel it right there? But as I move towards the mid line, it starts to get painful, correct? The reason why it's painful is because it's under a lot of stress. Because the foot is rolled this way, the kneecap no longer
articulates in the trochee groove. That's why it has the popping and the cracking I the knee. There it is right there. Right? You have it on both sides. You tricked me, didn't you? You have pain on both sides? (Yes). The pain is mostly on the right.
See how easy? His pain is on the right. I was correct. It's very easy to find out. In fact, if he didn't speak English I could probably find out he had pain on the right side. That's how easy it is to detect this problem. What you're looking for like I said is painful spasms right underneath the metatarsal phalange joint right where it hooks up to the calcaneus, the plantar fascias area and the medial, the lateral aspect of the calf. You run your fingers along the fibula bone, the back of the fibula with your hand. This could be very painful right? Then the TFL is very painful and stiff. But if you press on the middle portion of the quad, he has no pain.
Patients are going to say, "Of course, Doctor, you're pushing and shoving on my muscles. Of course it's going to hurt; you stuck your thumb in my leg." But you have to explain to them, educate them. Because you're going to put your thumb in that muscle right there, and it does not hurt. Right? But when I move outward to the outside of the TFL, then the pain starts to gets worse and then it gets better when it gets closer toward the hamstring.
Turn on your side, please.
The pattern turns right into the gluteus area right in here, the gluteus medius right in there It does not continue unless there's a very significant sacral subluxation or misalignment of the sacroiliac joint right in this area right in here.
Now ifyou don't mind, could you stand up for me? I think we're done with this (table).
So what I just did was: he didn't tell me what knee had the pain, but I was able to determine the painful knee just by physical examination.
Old you see that?
Okay what I want you to do is a Trendelenburg test. What I want you Ito do is stand like this. Lift up one leg, but I want you to keep your body on center for me, okay? Go ahead and lift this leg right here, all Ithe way up. The knee is wobbling a little bit. See that? And also he's using his foot to keep himself up. Go ahead and do that over again, but this time just keep it kind of loose. Okay, he's a little wobbly and it's hard for you to stay on center. Now let's do the other side.
How does it feel?
Better. It's easier, more balanced.
The reason why his balance is off on the right side is because the gluteus medius has been in an atonic protective spasm. How long have you had this pain? Years.
Now you probably never heard of the commercial: I've fallen and I can't get up. : In the United States, they have this medical thing that you press and it calls the ambulance by older people. It's kind of a funny commercial, but it's not really funny. She's fallen and she can't getup. The reason why she's fallen is because we walk straight all the time. After we stop playing soccer, of course we walk straight so we don't develop the lateral muscles of the hips.
That's where we lose our balance, as well as this arch pronation.
You're gong to find a lot of older ladies and men, and even young people who wear shoes based upon the fact that they feel comfortable with a softer shoe. In reality it causes more discomfort because the shoe does not support the heel allowing the heel to pronate and then tricking this entire domino effect up the legs and then as I mentioned before, the progressive muscular spasm that is there during the day is also there at night. In fact, he was laying down on the gurney and I was pressing on his muscles and we found some muscles that were in spasm.
What you have to understand is that this gentleman is going to go to bed tonight. He's going to try to get a restful sleep and wake up energized. When in reality, he's like working out all night long while he's asleep because the muscles are in a constant protective spasm.
When he gets up he's tried, when he goes to work he's tired, and when he comes home he's tired and he sits down because he's tired because he worked all day and he goes to bed tired.
You could vitamin, you could supplement, growth hormone, you could exercise until you're blue in the face; and you're not going to get any results with this man until you rectify the biomechanics of his lower half.
Let's give him a round of applause.
We went over the objective findings; they're in your materials. The most common reason why we have problems with the feet is because of the shoes. I see in Chicago, it is cold. And we have shoes on, and here in Thailand, you're wearing sandals. If you open up right down the street on the sidewalk, you're about to be swamped with patients because they're not even wearing shoes. I don't even know how they can get by without having good support for the heels.
In the United States, I don't know, you probably have the hip hop generation. That program that we were watching from ABC News was about hip hop shoes and how kids do not tie their shoes. Did you know that that style came from the prisons? They did not have shoe laces during prison and when they get out of prison, they don't want to tie their shoes. And these kids emulate prisoners. It's absolutely ridiculous. My daughter does tie her shoes, and if she does not, she's in big trouble.
These steel laces that are on these shoes are not good because they're slippery and they open up. The shoes that have sort of like a sleeping bag -like Marshmallow shoes, those are horrible shoes. They make the feet hot. Then you open them up to be able to get some air in them. It's like insulation. There is insulation between these walls, protective air barrier so that you don't get too hot or too cold. What happens is that when the air gets inside the shoe, it actually makes it hotter. So you need a thinner material on the shoe.
This is some advice you can give your patients tomorrow. You can help them. That's why I'm here. Work boots should be very strong. A lot of your patients work on concrete floors. That takes its toll on the body. You have to make sure that you have them go to the store and purchase the shoes and make sure that these shoes are solid and make sure that they keep the receipt when they bring the shoes. You're going to evaluate the shoes yourself and say "Yes" or "No". If you don't like the shoe, you send them back to the shoe store and get a new pair of shoes.
Then, of course you have the patients that don't wear any backs at all. Ladies that are out there, I know how you feel, not because I wear sexy ladies' sandals, but because I know, my girlfriend -she wants to wear sandals. However, the advice that you give these patients is simple. You should wear a solid shoe to protect your frame as long as you possibly can. Then at night when you go out with your boyfriend or husband you can get a little wild with your shoes.
I always tell the story about this young lady who wore the sexy shoes during the day and then she went out on her first date with the man and he said, "After dinner, let's go dancing." And she said, "Well, I'm not rally sure, because I'm kind of tired and my feet hurt." And she's crabby and her back is sore. He dropped her off early.
After the date, he called his friend up and he said how the date was. And he said "Well, you know, she was tired, and she was crabby, and her back ached and her feet hurt, but she had some nice shoes." These are the stories that you have to tell your patients. You're going to run into resistance from your patients. They're not going to want to change. And you have to make them change.
If a patient does not purchase shoes that support the heel by the third visit, they are dismissed. They are released.
It takes a lot of work to be able to get these patients better. I have to limit the pronation or I have to provide the brace to keep the heel on center. It's a brace. The shoe is a brace. Just as much as it is a back brace or brace for a broken arm. This is a brace for the frame. I'm here to support the frame. I want to add motion or mobility to the foot because it's been locked up in a collapsed state.
I am going to teach the proper gait. The proper gait is not walking like a duck. That is the opposite of a proper gait. T.he proper gait is to walk with your feet in front of you, slightly inward. It may feel odd, but it will come around. You start to develop better habits. Teach your patients to walk straight. You're going to rebuild the body from the bottom up. Now, here's what were going to talk about -what I was examining on the gentleman doctor.
Pronation - Supination Cuff: You're not going to find this in the literature because I invented the word. It's like the rotator cuff. Fair enough? The rotator cuff supports the shoulder so the major movers can push the heavy weight. That's the same thing that these muscles
do. They support the arch of your calf so your tibialis anterior, your gluteus maximus, and your hamstrings and your quads can move the weight. If these muscles are not intact, you're going to have arch collapse. You're going to have major problems.
Flexor Hallucis Longus -You can see the attachments right on the back of the fibula. It's all in your notes.
Peroneus Longus -Little tiny muscles. See the attachment there on the little tiny foot? the muscles on the bottom of the foot. Isn't it interesting how that muscle will move around and get a hold of the arch -or the bridge and lift it up. We have no need for arch supports because these muscles if they're doing their job will be fine.
Flexor Digitorum Longus - Comes around, loops around the foot. Strategically lifts the arch.
Tibialis Anterior -
Tibialis Posterior - A very important muscle. The attachment of the muscle is right on the area of the pain on the arch. Intrinsic muscles of the foot also keep the arch intact. Here's me, treating the foot. I have my thumbs in the foot treating the foot. And does it hurt? Absolutely, it hurts because the muscle is sore.
Doctors, you are here to work on sore muscles. That's what you tell your patients.
I had a doctor who was going to go to a Rugby game. I asked him to come and see my presentation. He was from Australia. I met him in the spa over at the JW Marriott. And he said, "Oh, I know the chiropractors and they're all about the feet and make sure they're structurally sound and everything. I have my patients just roll their foot on a tennis ball.
I said, "You need to get in there and stick your thumb in that muscle and hold that point until the pain absolutely goes away completely. Because if you start with a pain of 10 and go down to a 3, or a 4, in the pain, they say "Oh it's gone.« You feel that muscle you can start to feel it melt away under your fingertips when you feel that muscle. You feel it just melt away under so when that starts to go away to zero, then you have corrected it.
You corrected it not in the foot; you're correcting it in the brain.
Reflex Spasms -if you can understand that.
What I'm saying is that if the patient lies to you when they have a 4, tomorrow they're going to hurt all over in that foot. Now, the patients -I have had thousands of patients who have had this treatment. Does it hurt? Yes, in the first 5 or 6 visits, it's somewhat painful. But about 10% of the pain goes away per visit. Pretty soon it's all gone. By the time I'm on the 10th visit or about 2 weeks when I put the pressure on the muscles, there is not a bit of pain.
I'm here to tell you that after 2 -3 weeks I can have every single spasm in the lower extremity removed from the patient completely with this treatment. It takes time. Then you have to manipulate the foot to restore the motion. We use the therapy too. Trust me. If the therapy is broken, it is a bad day for me. I don't like it because this therapy helps.
We put the muscle stim on that TFL like I showed you; the doctor patient had the pain on the lateral thigh -the Tensor fasciae latae. I put that muscle stim on it and I'll tell you what, the girls are not as nice as I am. But when that patient is sitting on that table, I crank up the muscle stim until that leg starts to come right off the table. They jump up a little bit. But not in 18 years have I had a patient injured from muscle stimulation. It is a very safe modality. You can chronically contract that muscle and kill off that spasm in about 10 visits. We hit a vibrator on there that's very powerful to stimulate circulation and also do deep tissue work on the patient.
Phase I -Get rid of joint fixation and get the bones moving. Now, we talked about arch supports. Arch supports do not support the heel. The heel is the center of the lower extremity, not the arch. The arch collapses as a result of the heel collapsing. Chicken -egg. Heel first. The arch collapses second.
DO not try to fix the arch, you are making a mistake. Why would you ever want your patients to walk around with arch supports for the rest of their life when you can fix them in about 2 weeks.
When the heel is supported, the cuboid bone will maintain the rest of the foot in a supported position. It has a locking mechanism the cuboid. You have to look at your anatomy. The heel can and often still collapses over an arch support.
1?
If you have an arch support and the patient's foot is on the arch support and the sides of the shoe are weak, it will slide right off from underneath that arch support and the leg will collapse. It's a waste of time and money for your patients. Trust me, I have never used an arch support once, ever.
Motion Control Shoes -Actually there's a particular brand or style of shoe. You know its always athletes and sports come out with new things before it makes it to modern medicine or the mainstream. Well they've come out with Motion Control Shoe which corrects for pronation syndrome and you can get it from every manufacturer. Each manufacturer makes two styles of motion control shoes. They have arch locks and they have a pronation limiting brace that keeps the foot stable. I took this right off the internet. "They're designed to slow down or limit the extreme inward rolling of the ankle which can cause injury. Motion Control Shoes are generally heavy." They are not heavy. They look just like your regular exercise shoes. Alright.
Phase II -We're gong to work with flexibility and still manipulate the patient. Do a lot of stretching. Concentrate on joint alignment. Form a technique thought the training. We're going to start building up the frame again. They're going to come in 3 days a week like a regular training program. This is going to be nice for your anti-aging centers. You're going to be able to see them 3 days a week. They're going to get healthier. They're going to lose weight because they're exercising. They're going to get that vitality back. They're going to get the muscle mass back. You're going to have them lose some weight. You're going to have control over the patient for about 8 weeks. You can check their body mass before and after.
It's a nice way of monitoring the patient through those initial stages of anti-aging protocols. If you're going to put them on the growth hormone, manipulate their hormonal profile, that's fine. You're going to see a more rapid improvement in the patient in all ways, not only for healing, but as well as with muscle development and better attitude. Their diet will improve just because of their attitude.
This is Andre Arlovski. He's one of the athletes that I work with. He just won the world title for heavy weight fighting. I don't know if you're big into ty bOXing here in Thailand. I've worked with him for 4 years. He broke his hand 4 times and suffered shoulder problems.
Just before the fight I checked his legs and he had a slight pronation syndrome. He did not have any symptoms. I ran the pattern with the deep tissue work down the legs and about 3 or 4 days later he said, "James, running better now. Good./I Okay. Now, does that help him? Absolutely. He did not have any symptoms. But, working on those muscles in the legs, rectify and normalize the biomechanics helped him to be a better athlete, to normalize and make his running more enjoyable. This is something that you can do for you patients.
Phase III -this is still joint mobility. Now were getting into more aggressive training. We're adding more exercises and concentrating on more speed and strength. This is how we develop the foot. We develop it In inversion/eversion, abduction and adduction. This covers all the muscles that loop around and protect the arch.
(Strength training of the gluteus medius as I mentioned, the gentleman who was having a difficult time standing on one leg: thank God he's not driving because he would be put into prison for not being able to pass a sobriety test. Right?
There are patients out there whose hips are so bad that they wobble around and fall in your office. They have no clue that this was going on in their bodies. They're 40 and 50 years old. Maintain a neutral position of your foot and only go about 30 degrees. That's all the hip goes anyway. If you look at the range of motion of the hip, that's all that it goes.
This is a picture of me September 1, 2002. This is the second one. This is a before and after. They were some Buddhists that were using my picture to model some paintings for the Buddha. No, I'm just kidding. As you can see, this was a dramatic transformation. I will tell you that I have a pronation syndrome on the left side that bothers me. I'll tell you something, it was difficult, but it was worth it. I couldn't run 20 feet. I was huffing and puffing. You know what I did? I decided I was going to run 2 miles, whether it took me 3 days or not. I ran from one street corner to another and walked the rest. Pretty soon the amount of times I had to stop became less. Pretty soon I just ran those 2 miles Without stopping and that was a great accomplishment.
Doctors, you need to be in shape. Now if you're going to practice anti¬aging medicine, you need to practice what you preach. I have boxers that come into my office. I have 40 professional that come into my office. I teach them how to do these different trainings and they say,
"Well let's see you do it." This is a 27 year old kid. And I knock off 100 lateral side abs hanging from a suspended bridge. I say, I'm 43 and you're 27 and a professional boxer. You have a lot of work to do. You know how good that feels? It feels great.
This is something I encourage you to do. Take what you've learned here at these fantastic seminars from these amazing doctors and bring it home and use it on yourself. Have a good time in your practice.
I want to thank everybody for being a good audience. This is a picture of me with the Wiggles from Australia. I toured with them this year and had a lot of fun. If anyone has any questions, I'll be glad to answer them.
Thank you very much for inviting me. It was very enjoyable being in Thailand.
QUESTION:
Answer: With pronation syndrome, when the foot drops in, a little bit of pronation and your step off. What happens is with excessive pronation the foot rolls too much, the tibia and fibula roll about 20 degrees in an eighth of a second. It's a big twork. It's like taking your elbow and doing this with it. Do not do that. It's bad. It tworks the tibia and fibula. So that's why you have this dreadful pain on the outside of the calf. Dreadful and burning pain when you push on it. What I found is that the bicep femoris lateral is also a restrlctor. It tries to keep the tibula and fibula from tworking. The attachment is here, so it grabs a hold of it.
On patients that are more advanced or more athletes and running a lot like basket ball players. What were going to do is we're going to hit this much of the lateral hamstring as well. You want to hit that one as well because you're going to find that in about 40% of the cases.
I did find that in the gluteus medius here. I don't find a lot of spasms in the overall hamstring itself. Sure its hype. When the hips roll in the back goes into hyper extension. When the hips roll out, the back flattens. That's why the discs get better, because when you roll the hips out, when you take away the lateral aspect of the hips and the legs, the sacrum rides itself and the pressure comes off itself and thereby, one after another they get better.
QUESTION:
Intrinsic muscle: advice:
First of all, I don't allow the patient to do any exercise until all the spastic activity is removed. I know they're going to be walking around. What the doctor described is the intrinsic muscle of the foot is right. What we do is we have the patient take off their shoes and do calf contractions, either standing. What were trying to do is get the foot to be straight, like this. They probably go up about this much. Our goal is to get them to go all the way up.
The problem is that you have to understand when the pronation/supination muscles are in an atonic protective spasm, then the load is transferred off of those muscles onto the gastroc and soleus. So you're going to have a high risk for Achilles rupture when they step back in the ring. This happened to one of my boxers before he came to me and he ruptured his Achilles tendon with just that little bit of pressure.
The reason is that when his arch collapsed, the muscles that protect the arch were in a constant spasm, the load transferred onto the Achilles and it snapped. See what I'm saying. The Rehab at Northwester University Hospital in Chicago was to have him stand on the edge of a stair and do calf contractions. The problem with that was that it was overloaded already, and that's why it snapped.
What we have to do is rebuild the muscles that are weak, establish the strength pattern there to remove the load from the gastroc and soleus and place it back on the pronation and supination muscles so that it's more easily distributed. Does everyone understand. That will take the pressure off the gastroc and soleus and allow those calves to contract and keep the patient at a lower risk for Achilles tendon tear and more improvement on circulation and venous return to the heart as well.
QUESTION
inaudible
No, none. If you grab your heel and hold it and try to collapse or rotate the forefoot, it's impossible. If the heel is stabilized because of the interlocking mechanism of the arch, it will not collapse. So, just adding counter support to the heel will keep the arch from collapsing.
QUESTION
What if somebody has been walking on severely pronated feet for many years?
To be hones with you, they come around just fine. I think the difference is, doctor, that when I treat the patient Im spending 10 to 15 minutes sometimes on each foot breaking down the tonic protective spasms for the first 3 – 4 visits. When the spasms are no longer there that allows for the muscles that are rejuvenated to provide some strength and elasticity for the arch and they actually creat a mechanism of support and you don’t need orthotics.
Honestly, what it does: a lot of patients have jacked the foot up into the shoe and it does not feel good. And the compliance is not good either. When a patient does not wear a shoe with good counter support that does not support the heel and is not well fitting, the heel
is going to collapse from underneath the patient anyway. Later in the day, when the shoe gets loose, the heel rolls right out from underneath the arch support.
A lot of these arch supports are slippery leather. I've never used an arch support in 18 years. Every patient just gets better without it. Just try it and see what you think. Give it a shot.
QUESTION:
Pronation problem is weak shoes. We found this pronation problem in young people in 3 or 4 years old. At this age, I work on the foot of course. Then I use arch support for stimulation with very small thickness which permits to go into inversion and not pronation. It's not compensation, it's stimulation. In very young with pronation syndrome we have to do this. We have to work manual therapy and then support to stimulate.
Right, I agree. Some of the literature that I read and what I see in some young people: my dad was the President of the Shriner's Hospital for Crippled children for 17 years, so we've had a lot of kids that have come into our office for evaluation with different problems. What I found was that at youth, kids automatically have a little bit of pronation. The arch actually develops over time, but I understand the doctor's point.
If you feel that that arch mechanism is going to establish an arch for that child, by all means use it. What is paramount is that you secure the heel in the upright position, because it's the tibia and fibula that rest upon the talus. The word talus means saddle. The tibia and fibula rest on the talus and they rock back and forth. If that talus is not stable, it is absolutely a very unstable mechanism and very easily can pronate. So by locking the heel down you're going to find that the tibia and the fibula will stack up very nicely. Take a lot of stress out of your patients' hips and backs.
Here's the last thing: by about the 6th or 7th treatment by busting up these spasms in the legs -remember that the legs are very big muscles and they demand a lot of energy from the patients, especially when it's 24 hours a day, which is what these spasms are. Once you've treated these patients 6 or 7 times, what you're going to find is they're going to get a surge of energy. Patients who are normally tired at 9:00 at night, they are still going at 11 or 12 at night.
I'm just telling you from experience. I see it clinically in my office every day. They are cleaning the basement when they haven't cleaned it in 10 years. They are running around with this energy and they never had it before. Of course you take the restriction away from their legs, you remove the spasms, allow the blood to flow. They're going to feel better. They're going fee rejuvenated. So try to employ this in your practice. Internal medicine, or a doctor who does not work with orthopedics, it is way to increase the energy level and revitalize these patients.
Bring somebody into your practice that can do this because there are so many people out there, thousands and thousands who are suffering from this problem that you can help. So go ahead and bring somebody into your practice that can do this, or start to implement this and you will see a tremendous improvement in your patients and patients will refer patients to you. You will have a successful practice.
Anymore questions.
QUESTION:
For a working woman, do you recommend any kinds of shoes for a lady with pronation syndrome?
I tell the ladies in my office that there's a shoe made by a manufacturer named Drew. I don't know if you have them here in Thailand, but that is the shoe that I've been locking into with these ladies. If the pain is bad enough, they'll wear any shoe. If they are hurting bad enough, they will do what you tell them. I always tell them that when they're picking out the shoes, squeeze the sides here, like when you're picking out fruit at the market, if it does not move much and it's a nice solid thick leather, you're in good shape. The heel means nothing to me. I don't care if you wear a high heel occasionally. It's the sides that are important. If you get a shoe that’s solid and it's a lace-up shoe, you're in real good shape. You'll see the difference in a couple of weeks. Trust me.
Are there any other questions?ı I do not recommend that patients wear gym shoes all day long. This is a mistake
Thank you, Dr. Stoxen.ı
Applause, applause
|
|
|
|
|
|
|
