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

Buenos Dias,

 

First of all I’d like to thank you for inviting me to this symposium. I've given presentations to over 20,000 scientists and doctors in all different countries around the world. I have to say that the foundation Santa Fe of Bogotá is one of the most kind and caring and generous groups to invite me to this presentation. If you’d all give them applause because they have done a great job with the foundation.

 

As I mentioned, I operate the Team Doctor’s Treatment Center in Chicago. In Chicago w have a lot of Latin American people what’s interesting is that Latin American people are very tough and very strong. When I examine the Latin American people, I say, “Tienes dolor aqui? And they say “poquito”. It doesn’t matter if it’s ‘poquito’ or it’s ‘poqueeeto’. Agggh… They are very tough. However, the toughest people can have a loss of spring in their step, a loss of energy and a loss of vitality. That’s where we doctors can come in and bring our science and expertise to help them. That’s what I’m going to talk about today.

 

I’m going to talk about how we can add the spring to the step. Sometimes we lose the spring to our step. In our office we are involved in the treatment and training of athletes and entertainers.

We have just recently celebrated the victory of world championship with David Diaz who came to my office with a complete tear of the Achilles tendon in 2002: normally a career-ending injury. However, I encouraged him to continue with his training and we rehabilitated him and focused mainly on the feet and the lower extremity to add elasticity and spring to his body so that he can be the most efficient athlete in the rink.

 

These sports such as boxing are not necessarily good sports for longevity. Something about hitting someone about the head and the face is not necessarily a good method of staying healthy for long term. However, we can learn from these sports in that with these techniques to maximize elasticity of the body, we can actually allow the body to become more efficient; therefore have additional energy to be able to get up in the morning and feeling excited about perhaps exercising. Sometimes we forget about those things.

 

This is a graph that I had devised because in my practice I focus mainly on two things. This is what you might want to think about on Monday when you get back to your office.

 

Number One: Systemic inflammation from diet and

Number Two: Arthritic inflammation from abnormal movement patterns of biomechanics:

In that we take 10,000 steps per day and if we have a problem with our foot, our ankle, our knee, our hip, and then these steps create abnormal releases of inflammatory chemicals that age the body from within: chemicals called cytokines and C-reactive proteins, which have been found to increase the likelihood of cardiovascular disease as well as other diseases of aging such as some cancers and neurological diseases.

 

When we talk about diet and exercise, we’re talking about those diets and exercises that produce minimal inflammation. As you can see, if a person is overweight or obese, in fact, what will happen is that they have systemic inflammation from the foods such as those foods that are high in arachidonic acid as well as they have all this extra load on their frame. The doctors from the earlier discussions stated that 60% of Americans are overweight and obese. There is an epidemic certainly with obesity. However, we forget about the other ramifications of obesity, which puts a tremendous load on the frame causing a collapse of the very structure, which is the arch of the foot. And if the arch of the foot is considered the foundation of the body, therefore if the arch of the foot collapses, it’s not difficult to understand the whole body will collapse.

 

This chart is what I use in my office to bring about the education process of what anti-aging medicine or prevention is all about to my patients. Certainly we can preach to them, saying, “Yes, have a better diet – get more exercise.” However, what we have to do is to bring it about in a goal-oriented way. Here we have a chart that has the red zone, which is when they come to you in pain. They have some form of knee pain or they have dolor en la espalda, or they have pain in some area. That’s frank inflammation causing pain, obviously an acceleration of the aging process.

 

The first phase is where we’re embarking on a program to change the physical mechanics of their musculoskeletal system to ensure that when they walk or when they exercise, in fact they’re actually reducing the aging process or slowing the aging process and not speeding it up. If in fact we have poor biomechanics or bad movement patterns in our bodies, just simple exercise will cause more inflammation rather than less and that’s not a good thing. Our first goal is to reduce the abnormal movement patterns of the joints and allow the bones to move in an efficient manner. After we have embarked upon this process, we’ve reached our goal or we reduced these abnormal biomechanics we come to an area of what I call ‘the silent inflammation phase’, or the yellow zone.

 

As you can see, this chart is developed sort of like a stoplight. So we stop activity during the time when our biomechanics are abnormal because it increases inflammation and aging. Then we begin to educate and bring the normal biomechanics by teaching them walking patterns, exercise patterns that will ensure they have better health; but in this phase-phase II they still have inflammation released into the body causing aging.

 

Patients should have their inflammation levels, CRP’s and the levels of their cytokines measured in the first visit if you’re going to embark upon a true anti-aging program. Then after time when we have educated them on diet and exercise, we can retest those levels to see if they’ve in fact reached the green zone, which is the safe zone for them to exercise.

 

Certainly injuries can occur, as in this video of a patient of mine exercising in their basement. Those are the ones that we all know about; however, there are other ways injuries can occur. 

 

This is one of the more obvious ways of injuries. Some of these dangers to exercise and sports are not so obvious. Such as when we analyze biomechanics, we analyze them with very sophisticated measures in the laboratories with PhD’s and doctors; however there are simpler ways that you can analyze biomechanics. One of the best things that I can tell you is that if you have 20 million Americans embarking upon a running program to become better fit and healthier. You can guarantee that 70% of them will pull out with an injury within one year. If you tell your patients to start running they have a 70% chance of becoming injured before the first year. So understanding biomechanics and how to run and walk is very important. Good running technique is the best means of preventing injury and a lot of the shoe companies talk about the high tech cushioning and the high tech counter support and the different soles of the shoe. Those are all marketing ploys to get us to purchase the shoes. In fact there was a study made where over 5,000 athletes were evaluated and found that those patients that purchased the shoes over $120 had more injuries than those that purchased the shoes that were $40. So those are not exactly the ways to assess.

 

Doctors are going to correct the problems of the patient. Here’s what we can do. We have a simple hallway in our office; we can evaluate walking technique and evaluate whether our patients are walking with good biomechanics just by having them walk down the hall. It does not have to be sophisticated or high tech. What we are looking for is what the central nervous system is doing or how the central nervous system is guiding the body through the walking style. The central nervous system is what governs the movement pattern of the body. The muscles and the joints do not. The central nervous system has different memory patterns, called ‘Engrams’, either positive, which means it’s a good walking or running pattern or negative, based upon a good walking pattern.

When were looking at patients walking or running which is safe or they have a pattern that will cause damage to their body. You may think this is too complicated, however you seem to be pretty good at evaluating your Colombian soccer players form the privacy of your home while you’re watching television. Certainly if you can evaluate the poor performance of your soccer team, you can certainly evaluate the performance of your patient in the office. So what we’re going to try to do is determine is if your patients have positive engrams, which are good walking patterns that are established in childhood, or negative engrams. Negative engrams are those that create damage to the body. These are broken into general movement pattern or specific movement pattern. General movement patterns are those that are developed in infancy when you teach your children how to walk; it’s determined at that level as a child.

 

I remember my Dad was a doctor who was Chairman of the Shriner’s Hospital Committee for Crippled Children. The parents would bring the children to us because they had an unusual walk or they had a foot that looked fumy. My father and I would evaluate them and determine if they were in fact walking funny or if it was just the parents’ obsessive nature with their child’s walk. But in fact, children should be evaluated for their walking style to ensure that they are not developing bad habits of walking that will create damage to their bodies.

 

When we’re changing the walking pattern from a poor walking pattern that causes damage to a good walking pattern - that’s called a specific movement pattern. That’s called training. When we’re looking at a walking pattern the main area we focus on are the foot and the ankle. It’s interesting that ankle injuries are the number one injury in sports. Yet, we have no exercise equipment in the health club. Do we have such a thing at Foundation? I don’t know! We’re going to look at that tomorrow. Exercises for the foot and ankle are as essential as those for the chest the hips, the back, and the stomach because it’s the foundation from which all other joints stack upon.

As you can see, the calcaneus or the heel – the talon – and the talus, and you see the tibia and fibula form three joints. Subtalar joint is what doctors in literature focus on. Weakness of the subtalar joints which cause that kind of weak ankle look in patients. That’s where the ligaments that support it become weak and allow the joints to collapse.

Did you know there are only 160 scientific papers on pronation syndrome which causes systemic multiple joint inflammation throughout the body and a lack of exercise in difficulty walking. It causes spasms in the muscles of the calf that inhibit blood flow down to the extremities that could predispose the patient to gangrene and other infections and may even inhibit the ability for blood, oxygen, nutrients and the antibiotics that you're prescribing the patient to get down to the region to kill the infection.

 

I read an alarming report about a study that prosthetics: the study of making fake limbs was a good business to get into because of all the diabetics that were having their legs amputated – that’s very sad, I think. We have to look at every aspect of why these patients are having their legs removed from their body to be able to prevent that. That’s what this is all about that. So when we look at the foot, we see there are some interesting structures that have an elastic mechanism – these connective tissue structures as you can see on the left which actually have spring mechanism built into the arch of the foot: it’s like a bow and arrow. On the right you can see the tendon attachment. As you can see, these groups of tendons I call the pronation/supination cuff, like the rotation cuff of the shoulder they hold the foot in a neutral and a balanced healthy position for good walking and running. With a weakness in these tendons you can see they have strategic attachments at the arch and they provide support as well as a certain phenomenon called ‘spring recoil’ or elasticity. Just think of my hand as a tendon and I’m holding up the mid arch. As the arch plants itself, this arch actually sinks down a centimeter and this tendon stretches to the bottom, then when the arch hits the bottom, this tendon springs the arch back and sends the body forward allowing the body to become efficient and move with the spring. So many people say, “I lost the spring. I’m feeling old. I don’t have the energy I used to have.” And is that because they’re old or because they lost the spring to their step?

 

If you look at this video, you’re going to see some slow motion videotaping in my clinic. My clinical research determined what really happens when the foot lands on the ground. As you can see, you're going to see a nice drop of the foot to allow the foot to absorb energy. Forty percent of the energy is released in heat and the other 60% is released as recoil to allow the body to be very efficient. In this view you can see some tendons that actually support he foot on the next video. You can see along the medial malleolus, some tendons are showing through the skin. Those are the tendons that actually support the foot. Essentially, what’s interesting about the foot is that it functions like a bouncing ball. If we lose the elastic recoil because we are overweight, we don’t have the right exercise program, for whatever reason or injury, what’s going to happen is we’ll become tired, have chronic fatigue and we’re going to have problems with aging. As you can see, these are pictures of adult feet on the left. On the right are a child’s feet. These are normal feet in human beings. Unfortunately, as doctors, we probably never see normal feet any more. Because when you put the shoe on the foot of a child you immediately change the structure of the foot. The shoe will actually deform the foot into the position of the shoe. If you can see the next picture, the shape of the shoe actually deforms the foot into the shape of the shoe. As a result, the mechanics will never be the same. These types of lacing or strapping deformities have been around for thousands of years. One of the most drastic examples of this is in China where for a thousand years, one of the empresses had the clubfoot, and she wrapped her feet. The women all thought it was beautiful and they decided to wrap their feet. By age 4, every young girl had her feet bound by her mother. Did you know that 10% of the children died from this procedure: from gangrene and problems with circulation.

 

In modern day the footwear that we are wearing and recommending to our patients: what we are wearing for fashion and style actually cause restriction of the movement for maintenance of foot strength and elastic recoil.

In this situation: here’s what we’re looking at as far as the lack of elastic recoil. Like I said we don’t’ even have exercise machines in the health club to develop our feet. The health club won’t even allow us to exercise with our shoes off. Could you imagine? You want to exercise with your shoes off and they ask you to put your shoes back on. How am I supposed to exercise my foot and ankle when I have my shoes on? It’s binding my bones, not allowing full expression of these joints to strengthen and the bones and tendons to become stronger – more balance, agility and coordination of the body. What holds up this arch is a muscle and tendon group. However this particular tendon which scientists have been looking at, called tibialis posterior. Pero this muscle has an interesting attachment on the metatarsal cuneiform joint; it’s a three-prong attachment, like a goose’s foot. This attachment actually maintains the arch in a springy fashion. This muscle is exercised with movement from side to side. 

 

Very interesting when this muscle gets weak, the method of treatment is to put something underneath the arch. As if in the San Francisco Bridge, if one of those wires holding up the bridge was go get weak, we would put in a new wire, or we’d strengthen the wire to hold or better suspend the bridge. Instead, we don’t consult the engineer; we put a post underneath the San Francisco Bridge to hold up the bridge because that’s the way to do it. It’s quicker; we don’t have to deal with the exercise component. We send the patient off on their way.

 

I’m here to tell you that this method of treatment is not a good approach for longevity or anti-aging or increasing performance of patients. This approach – we have strength from either side of these muscle groups, maintain the arch in a suitable position that allows not enough pronation, not too much pronation and not too much supination. I coined this the ‘safe range’. You can see this when you watch your patients walk down the hall if they have over pronation or excessive internal or rolling of the foot or supination. You can also evaluate them from the sides; it’s more difficult. What happens when we have over pronation or over supination, it causes excessive stress and strain up the entire framework and multiple joint arthritis and obviously fatigue and back problems, hip problems and hip arthroses. Why is it that we’re commending those procedures that are to replace knees and hip replacement surgeries.

 

In fact, if I was the doctor and evaluated the patient in their teens and monitoring their health throughout their life and at age 55 my patient needed a hip joint replacement because of excessive wear and tear, stress and strain on the joints, I would feel embarrassed because I didn’t do what I was supposed to do for that patient when they were in their 20’s and 30’s. I allowed this abnormal pattern to occur which caused damage - permanent damage to my patient and not allow them to live a healthy active life again.

 

This trickle effect also happens in the spine. What I found is that patients who have come to me, where they have been recommended to have back surgery. In the majority of them, the doctor did only a regional exam and failed to look at the floors beneath the spine to determine whether or not there was something they missed that might have caused irritation to the kinematic chain and not allow these patients to have proper healing.

 

So – what kind of exercise do we do? Exercise broken down into non-functional does you absolutely no good. Dysfunctional means it causes more damage to your joints. Functional- which is directly improving the bone density, the muscle strength, the agility and the step the elasticity of the body.

 

This could be considered a good exercise because it increases the strength of the gastroc and soleus and it makes our legs look sexy. However, by itself it is not a good exercise because it creates an imbalance in the foot and ankle because were not incorporating these movements called pronation and supination. What we have to understand is that in modern day, things have changed. Our world is not the same as it was 30–40 years ago. Modern technology has flattened the surface not allowing our foot to come into positions that will strengthen the foot from different directions. Before we walked to the market, different hilly terrains and on uneven surfaces that allowed proprioception to be exercised and our balance to be challenged as well as strengthening of these muscles. This is no longer; now we’re on a flat surface and we no longer have the stimuli to develop these muscles. As a result, these areas become weak and we also wear shoes everywhere we go and we exercise with our shoes on. This causes weakening of our foot and ankle.

 

Its amazing that doctors will actually try to tell me that exercising with your shoes on will cause damage, when in fact as children we run around barefoot everywhere. This is a photograph of Abebe Bikila, who is the only marathon runner in the history of the Olympic Games to win two marathons back to back. He won the first marathon running the entire course barefoot. He repeated the event – the accolade in 1964 in Tokyo, Japan. Therefore, barefoot sports are excellent ways to help your patients have stronger, healthier foundations, good biomechanics as well as exercise of the feet.

 

These are exercises to release the arch to make it more elastic anti-bunion stretch. Patients pay me a lot of money to do this for them, when you could do this at home. You could recommend this to them. Anti-neuroma stretch: exercises that actually develop the foot and ankle. I'm going to show you one that we devised in our office. This is a very good exercise, which also develops the side movements, which we don’t get in our daily life, as well as this exercise, which is only done when we have ankle strength. After the ankle heals, there’s no need for it; that’s ridiculous! All my athletes and all my patients are required to do it. “Well I don’t want to do it.” Well, it’s too bad, I’m the doctor and you're the patient and thank God for that. You must do it; it’s required of you.

 

Here’s another thing. You may think its funny, do you know patients need guidance and sometimes they just need a swift kick because they just don’t want to do it, and you must say “You must do it and no you can’t have 4 blueberry pancakes for breakfast, lunch and dinner.” Here’s the thing, why is it that we have so many foot and ankle problems during running? It’s just simple engineering. Walking is one to two times your body weight. If you weigh 100 kilos, that’s 200 kilos for walking. For running it’s 5 times your body weight, so that’s 500 times your body weight. If your patient is sitting at a cubicle all day, they get no stress on their structure for adaptation. Adaptation is where we stretch or exercise. We have great dominant muscle, and then rebuild the muscle to make it stronger for tomorrow. If we’re sitting at our cubicle we get no adaptation, improvement of strength.

Then in our infinite wisdom, we run along the path in the evening for exercise and we wonder why we are getting these problems. My recommendation is to tell your patients to run in circular patterns to increase the development of balance in the foot and zigzag patterns as if they're running through maize and multiple terrains. Also, first start with walking fast, jogging, fast jogging, and then running.

 

There is a certain protein that we exercise when we run. Running is a series of hops and jumps. This is called the “titan protein”. Scientists believe that this protein is what gives the body elasticity. It’s formed by prelyme, glutamine, faline and lysines. This protein is a gigantic cytoskeletar protein and it’s in the muscle that allows the muscle to become more elastic. 

 

When we are developing this protein, we develop it in all areas of the muscle belly. By allowing our patients to run in circular patients, we’re developing the muscle tendons cuff that actually strengthens the arch of the foot. This can help to reduce sarcopenia. In fact, studies have found that eccentric contraction, or bounding skips and hops actually increase muscle tone and strength in 70 year olds than plain weight lifting. Don’t be afraid to have your patients do jumping ad hopping. This study was done on 75 year olds; it’s not going to affect them. Increase muscle and bone density as well to prevent osteopenia.

 

The number one cause of death in geriatrics is because of falls. When you fall, you break your hip. The mortality rate has increased dramatically. Patients will not fall if you put them in positions where they can practice. It’s from different positions that they’re not used to. What happens is that if you don’t have engrams or neurological patterns of movements that are actually movements of daily life, when they get into that position, their bodies don’t have a pattern to rely on that’s why they fall. Exercising them in different patterns will assist them in becoming more stable; they won’t fall.

 

I’m just going to wind up my presentation with some quick exercise. First of all, I really wanted to thank all of you for inviting me here.

There’s a funny story I have to tell. Like I said, I do a lot of presentations around the world. Doctors say, “Where are you going to present next?” Some of the doctors at the Academy of anti-aging Medicine have asked and I said, ‘Well I’ll be presenting in Bogotá, Colombia.’ “Bogotá! That’s interesting.” Everybody- the scientists, the doctors want to speak in Bogotá. This is one of the most prestigious places for me to be a presenter.... Live your life like a champion.

Thank you very much.