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| Transcript Kuala Lumpur, Malaysia May 1-2, 2006 |
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Abnormal Biomechanics of Walking The effects on Accelerated Aging.
Third Malaysian Anti-Aging and Aesthetic Medicine Conference and Exhibition
May 1-2, 2006
Kuala Lumpur, Malaysia
Presentation 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 would like to thank the delegates of the Malaysian Anti-aging Medical Committee Board for inviting me to speak at this international medical conference.
Today we're going to talk about a very important topic. It's called “Abnormal Biomechanics of Walking”. That’s very interesting because everybody in the room has to walk.
Oh no wait a minute, pretty soon in Malaysia, they're getting so highly technical that we're going to have to install some of these escalator systems so that we don't have to walk from store to store. You know what I mean? Like yesterday I mentioned in my exercise program, that I didn't have to push down the plunger on the toilet because they had it done automatically for me here at the Sheraton. It's to the point like I have said, “We don't' have to do anything because it's all done highly technical for us now by computer people.”
That’s why we have some problems in our society, because you know what? We’re not doing all these things that we used to do to keep us fit and keep us with low body fat and also healthy muscles and joints.
I have several slides that I put together. We're going to go through them very quickly. However, I'm going to make sure that I give you as much information as possible. Today I'm giving you 20 years of hard work and research on the study of biomechanics of walking. This is something I discovered when I was a young chiropractor working in my father's clinic. We've been in practice for 57 years in Chicago and you know what? I kept having these pains in my feet, in my legs and my back. I was really tired all the time. I said, "You know what? I'm only 27 years old. I feel like an old man. There’s something wrong here.”
It’s like the barber with a bad haircut, the chiropractor with the stiff back. It’s like a bad thing. It’s like you should stop smoking because it’s bad for you. Do you know what I mean?
I said there's something I have to do about this. A guy came into the office. He was a person who worked in these tradeshows. He said, "How can you work in those Miami Vice Don Johnson loafer type shoes on this hard surface all day as a doctor?" I said, "What do you mean? I don't understand." So we went out for lunch and bought some new shoes. Two weeks later my pain was gone.
About a month later I was working with the American Powerlifting Federation. I just happened to have a guy who was breaking his 10th world record. He was 5 foot 6 inches, weighed 220 pounds. I don't know if that's 110 kilos. He was squatting about 920 pounds for reps. He broke numerous world records over those 6 years we worked together. I wanted to keep this guy going to world championship after world championship. But I knew the secret was biomechanics. How much weight can I put on that frame before it snaps? The way to do that was to make his body perfect; perfect the mechanics and every single muscle in his body. There was not a single spasm in his body.
I said to him, "What I want you to do is to come into my office Monday, Wednesday and Friday for an hour. I'm going to go through your body like a fine toothcomb. I went through his body between his toes looking for spasms, restrictions of movements, through the legs, all the way down to the bone with my hands finding every spasm.
I noticed things were repeating, over and over again and I found the patterns to repeat. And I thought that's good for him. It's good for my other patients too. So I started doing the same thing with them too.
Do you know what I found? I found that there were patterns of spasticity and abnormal movement patterns that were reoccurring in patient after patient after patient. I said, “Oh no, this can't be that simple. Everything from bunions to plantar fascitis to chondromalacia, patella or scraping patella syndrome, illiotibial band syndrome.”
Chronic fatigue syndrome is a combination of all these syndromes in a chronic way. We're repeating over and over again the same pattern. I said, “I'm onto something.” You know, Broadway performer after Broadway performer, and top recording artists were all coming into the office. People were putting me on tour with Aerosmith, the Wiggles and all these different people. "Doctor, you got to do that treatment on our group." People loved it because it made them feel great and it got rid of all their problems permanently.
I was really excited when I got a telephone call from Dr. Goldman. I had heard of Dr. Goldman. We were on the editorial advisory board for Muscle and Fitness Magazine for 15 years, but I never had a chance to meet him. He invited me to his house. He said, "You know, I have so much pain. I have drop foot syndrome." I said, "That's terrible." I was going to do an MRI, but I didn't want to scare the man. He'd run off and get a surgery on his back. So I worked on Dr. Bob for about 5 hours a day -this kinematic chain that I'm talking about in this presentation. We treated Bob's drop foot syndrome and it was gone in about 2 weeks. You can read about it in the website.
That's how I got to be on this stage today is by way of that story. All I can tell you, doctors, is that you give and give and give, then one day you're going to find yourself on this stage too. Just keep giving to your patients. You're going to find that one patient refers another and many times I've given away free care. You know what? It finally came back.
Anti-aging Medicine is preventive health care. It is a different thing from what you're practicing now. It is not disease-based medicine. It is early detection and prevention and reversal of related diseases. Ninety percent of the patients that have diseases are coming in for age related diseases in your office.
The paradigm shift is in establishing that if you let age-related diseases go and if you treat them when they're diseases, the patients don't want that. The healthcare system does not want that. And you know what? Who wants to have patients dying under your care? Who wants to have people that you can't help because you let them go too long. It's not very fun. As a practicing doctor, I would not like to have to tell the patient "There's nothing I can do, except for you to have surgery to remove the top of your hip bone. So we're going to saw off this bone. We're going to put in a metal piece and we're gong to replace that.”
By that time, it's too late. There are things that you can do that you are going to learn today that can stop that.
With biomechanics, we can actually predict when the aging process is going to begin by looking at the way the patient walks which is actually a more progressive approach. Or actually what Dr. Harnem’s wife likes me to do and asked me to do today is what I’ve done in London and in Las Vegas.
I will pull somebody out of the audience that has unilateral knee pain. I’m going to have them walk down the hall here and point out the knee that is actually involved by way of looking at their biomechanics.
I think that if you're really interested in helping people and if you really believe in what I'm telling you, that what you can do in your office is just let people walk back and forth in your hallway once or twice with their shoes off. After a while, it's like this: 25 red cars go by, one off-red car goes by I see that. I've seen that type before. What I'm saying is that after you see patients walk and you study it, you'll learn to pick it up. It's not difficult, but you have to do it.
There are other diseases that are involved here that you can help to correct and also help the patient feel much better. It's about making the patient feel much better in their quality of life.
If we take 10,000 steps a day, what happens is that these walking mechanics are very important in bringing blood back to the heart for venous return as well as each step you take. If the bones are abnormally positioned, then you're going to have wear and tear. Release of inflammatory chemicals into your body which will age you not only from biomechanical or musculoskeletal, but also from a systemic standpoint.
I don't know if you ever caught the lecture given by Dr. Anton? That was a real eye opener for me. When Dr. Anton was reading a lecture that was actually developed by a UCLA professor, he was not able to make it to the Bali lecture. But when I heard that lecture, the light went on. I said, "Inflammation! Autoimmune! Attacking the brain – the arthrosclerosis. I said that's really important because it directly relates to what I speak about, the acceleration of the aging process due to abnormal levels of inflammatory chemicals from subtle changes in biomechanics of the feet and walking. Studying and checking the Interleukins to check the patient’s level of inflammation. How to reduce that is very important. If you don't reduce these levels of inflammation in your patients, first of all, run a test on these patients to determine their level of inflammation when they walk in the door.
Find out what's going on. Have a plan of attack, whether you're a periodontist, orthopedic doctor, or a general practitioner, or whatever you do in your practice, have a plan to find out what four or five different sources of inflammation that patient can have. Maybe they have periodontal disease, if they have a trick knee, or if their feet hurt, their back hurts, or whatever it is that may be tripping that inflammation.
But according to the American Heart Association -I pulled it right off their website. And the Center of Disease and Control and Prevention recently published a joint scientific statement about the use of inflammatory biomarkers in clinical and public health practice. The statement was developed after systematically reviewing the evidence and association between inflammatory markers, mainly CRP's; but now things have advanced in coronary artery disease.
Therefore, it's important to not only look at the patient from a standpoint of aches and pains, and extra fat, but also it's important to look at the levels of inflammation. Now biomechanics is engineering. Basically, we're talking about a moving machine. It's a machine, if it gets out of alignment, it's very simple, and it will wear out faster. It's not any rocket scientist here; it's very basic. If the machine is not aligned properly, then it will wear out faster. That's abnormal wear and tear. And if it's in some joint that is involved in the walking process, then that happens in a daily and a monthly and a weekly and a yearly basis until it takes its toll on you and then you are in trouble. You've got to have a hip replacement. Systemic inflammation has invaded your system and can cause all kinds of aging of your body.
The study of prevention of abnormal walking or biomechanics is critical to your practice if you're really going to be an astute doctor of anti-aging medicine. We're going to talk about that now.
The first way of determining the arthritis is through an x-ray. -Wrong! The first way of determining whether you have arthritis is by doing a biomechanical analysis. Like I said, not only can we determine it, if we become very astute in studying and understanding it, we can pick up on joints that are going to hurt in the future. They don't even hurt. They're going to hurt. Because it picks it up that quickly. Like I said, all you have to do is have every patient in your office walk by. It's like looking at an x-ray or looking at 10,000 x-rays. As you get to look at more, you'll be able to look at more information that you normally would not have known. But you have to take the time.
Arthritis is a joint problem initiated from mechanical abnormalities. X-rays show that by midlife, 50% of us will be affected. Why? Why is that by midlife, they're affected? Also, they have arthritis in the joints that is seen on x-rays because were not doing what we're supposed to do when they're in their 20's and 30's.
As doctors, we just can't say, "Okay. My knee, I hear it grinding, I hear it grinding and you know what's going on" and then you prescribe some of the problems that are happening is that some of the patients did not have good footwear. They were not instructed properly on the form of exercises and the emphasis was placed on appearance rather than mechanics.
The other thing that's happening is we have lot of obesity in our country. First of all, the foot has a certain structure called the truss and it has three arches in it. This foot right here has to have a certain amount of strength in order to maintain the position and the movement pattern through walking. Now, if you gain 30 pounds and you don't increase the strength and power by 15%, then something is going to give. That's your foot; it will drop and lock. Gaining weight or your patients have gained weight, that's a perfect opportunity to have problems with the foot.
Causes of chronic effects of abnormal over pronation
1. Use of medication (chemical solution) for a mechanical problem
The other problem we had mentioned is that if we do have pain in the body and we prescribe medication, it can actually be a negative effect according to the researchers at Rush Presbyterian St. Luke's Medical Center who did a study on unilateral knee pain. What they found was that if they prescribed medication, they actually had taken some of the weight off of the knee before they gave the medication to the patient, because the pain is the warning signal. It's there to tell you something's wrong. After they gave the medication to reduce the pain the patients actually increased the weight on the knee with the arthritis effectively causing increased wear and tear or the stress and stairs which increase of accelerated arthritic aging of the joint.
Did you really need scientific proof of that or are we truly lacking common sense? After they gave the medication to reduce the pain the patients actually increased the weight on the knee with the arthritis effectively causing increased wear and tear or the stress and strains which increase of accelerated arthritic aging of the joint. Did you really need scientific proof of that or are we truly lacking common sense?
Pain, it's there to tell you something's wrong. I always use this analogy. I say, Okay, we're driving down the road and I see that the heat light on in my car because that means to pull over because the car is overheating. But I always look to my friend and I say "You know what? Will you do me a favor and give me some of that black masking tape out of the glove box because I have a problem with my car. That light keeps going on and it bothers me. Do you see what I mean? Let's just cover it up and we'll keep going." If you are going to allow these abnormal biomechanics to continue is up to you. You need to read this book cover to cover and tell me if you have still decided you want to do that.
I always use this analogy. I say, Okay, we're driving down the road and I see that the heat light is on in my car because that means to pull over because the car is overheating. But I always look to my friend and I say "You know what? Will you do me a favor and give me some of that black masking tape out of the glove box because I have a problem with my car. That light keeps going on and it bothers me. Do you see what I mean? Let's just cover it up and we'll keep going."
Do you know what I mean? So the idea that we're going to allow these abnormal biomechanics to continue is up to you. Doctors, you look deep into your soul and decide if you want to do that.
Two different types of abnormal biomechanics are the pronation and the supination. They keep it simple for you. In this picture here, we see two athletes that are running in Olympic teams. Here we have one which is abnormal supination and this one is pronation. Which one is abnormal? They're both normal.
Because when the foot drops, it drops in supination and then it pronates and then you push off. That's how the body works. It starts in supination, drops in push-off and pronation. So we're gong to learn all about that today.
Supination and pronation: The hype is always with the subtalar joint. We're going to go over that. This is the top. We're looking at the top of the talus right here and over the top of it would be the ankle mortis. Basically what they always talk about is the subtalar joint.
For instance, Doctor, can you come over here for a minute? I'm going to give you an idea how we examine patients. Can you take off one of your shoes? I never told him that we were going to do this. I hope you put on some nice socks here. Didn't your mother say, always wear nice underwear in case you get sick and end up in the hospital? But she didn't say anything about your socks.
Okay, I'm going to grab the back of the heel here and I'm going to tug on it and I feel a little clunking. Not too bad. What you're going to feel is a little clunk or if it's solid. That's the subtalar joint that's located right here. Okay? He's not too bad: a little clunking. Will you stay right here for a little bit for me?
Okay, that's how you check the subtalar joint. It's not too difficult; it's very easy. They're lying on their back, just pull on the back of the foot. It's real easy. The subtalar joint is located right here on the foot. It's a little hard to see from the back, I know. We just pointed it out on the doctor. We can go over it later.
Here's a picture of what abnormal pronation in a biomechanical standpoint. What we have here is a rolling at the subtalar joint. It just moves excessively. You see, in the body, there are two different things that happen with movement. Either you have hyper mobility or hypo mobility. We find that doctors that study motion of the spine and so on and so forth, chiropractors and physiatrists, physical therapists and other doctors is that we find out that if we have a lack of movement in this joint right here, called the metatarsal cuneiform joint, then somewhere along that line that lack of movement has to be made up for compensation.
So the compensation occurs at the subtalar cuneiform joint. In the literature, there are 160 articles that point this out that the subtalar joint is the problem. The piece of the puzzle that's missing, as you can see is what we have is the excessive pronation of the foot -you see this on patients when you're walking down the hallway in the shopping mall and so on and so forth. Maybe you have it yourself. How does the calcaneous slip into the varus position? And how and why does excessive subtalar movement or abnormal biomechanics of the kinematic chain occur?
Of those 160 research literature articles and papers about excessive subtalar movement and pronation, nobody tells you how it happens. We know that there it is, but where did it come from? That is the whole mystery. I will solve the mystery for you, thank you. It is very easy to figure out.
I am going to go over it now. Basically, excessive pronation: we talk about the information here. See how the foot is collapsed and rolled in this particular drawing? On this one here is your subtalar joint. That is where the excessive movement occurs. There's always pain along that joint line.
Here is the movement pattern. Basically when you walk, what happens is that you have springy type of movement in your arch, which you can see is very nice here, the arch springs. So when you drop your foot down, your foot absorbs shock with the spring mechanism of the arch or the truss of the foot. And then it springs you back out. So when I drop in like this, I'm absorbing all the shock of the kinematic chain; then I spring back out. That's nice because it gives a little spring to our step.
For athletes, it's critical; they have to be able to get above that rim if they want to dunk that basketball. If you want to be a top sprinter, you have to have that spring in your arch, because that's what gives you the power. That's what gives you the speed and the performance. If that arch collapses and locks, then you have to have extra effort just to get through the walking. But not only that, you have to have compensation.
Right here is the midsection of the arch when you have too much weight on the body such as being over weight or if you're standing on your feet too long; the muscles that support the arch are called the pronator/supinator cuff. It's like the rotator cuff. You have the rotator cuff; we all understand that. Those are the muscles that support the shoulder while the shoulder does this during bench pressing or anything like that.
Well, I coined the word "pronator/supinator cuff back" in 2002 because I decided that those funny sounding muscles like the tibialis posterior and the peroneus muscles support the foot. That allows the arch to have a nice springy movement. The truss movement is preserved through the body and you get that nice springy in your walk. Because once that springiness stops, then you have the arthritic changes and the abnormal movement pattern that walks right up to the back. It goes up through the kinematic chain all the way to your head.
In the position in this picture right here, we can see that the toe is turned up. The reason why that happens which you'll see in your patients is because when they step, they can't bend through this area of the arch. It's locked. The reason why we have excessive movement in the subtalar area is because of a locking of the mid portion of the arch in the subtalar area of the metatarsal cuneiform joint. It's located right in the mid portion of the arch. If you look at your feet, maybe you have a bony prominence like we see right here, you're going to start to see that in your patients.
That's a calcium deposit. That's abnormal osteoarthritis as a result of a locking mechanism of the foot. Once that happens, everything goes right up the line. The reason why this toe goes up like this is because when they step, they don't spring down and they don't spring back up again. So the foot is almost essentially like a rigid structure. They have to basically pick up the foot sooner than they would if they were able to just walk right through it with a normal gait.
In other words, here's normal. Here's how they pick it up sooner with an iliosolas muscle which puts pressure on the hip and the lower back. When this occurs, then you're going to find out that you're gong to have a lot of spasms in the calf which is going to restrict the blood flow down to the lower extremity. Then you're going to have the possibility of infection and also they just don't feel well. Their calves hurt.
In this picture, we see a nice drawing of the tendon structures of the foot that come around. Here we have the tibialis posterior which I alluded to before. Do you see how it attaches at the metatarsal cuneiform joint? It has a nice three-prong attachment here because it lifts the arch up. It keeps it elevated and it does not allow it to collapse and lock. .
Tibialis posterior tendon syndrome is a new syndrome that the doctors are talking about. It's just a part of the whole gamut of what I'm talking about here. Why do they call it the tibialis posterior? I don't know, but it's because they don't understand the full gamut of the problem. They just don't understand.
Do you see how these tendons loop around the foot from behind like this? And you're finding that these loop around like when you were a kid and you wanted to hoist up your friend over a fence and you had them step up in here and you threw them over like that? It's a very powerful structure.
It's funny; I see therapists that tell you that you should practice picking up a towel with your toes to help your feet. Are you kidding me? The towel only weighs a couple ounces. When you're walking, your feet have to absorb 2-3 times your body weight in walking. If I weigh 170, that's 340 pounds. If I'm running, that's 5 times the body weight pounding like this. Multiply it out-almost 800 pounds. Lifting a towel is not going to develop a foot strong enough to be able to withstand additional pressures of walking and running. You have to be able to do a lot of different exercises with the foot other than just flexion and extension, but to reverse this abnormal biomechanics in this inflammatory process. So you see here, we have the tibialis posterior. What I like about this is it loops around that metatarsal cuneiform joint and attaches right there and just absolutely supports it.
What happens is these muscles are actually involved in the movements of inversion/eversion abduction and adduction. Do you know when we used to do that? When we used to go to the market up the side of the hill to the side of the hill. On the street there used to be a little bit of a curb, and now it's flat. When we used to play tag in the park and play soccer. That's when we exercised these muscles. But we are like in a sidewalk like this. Then we go and stand, go to the restroom, don't have to do anything else. Then we go and do our X-box and then we wave at our friends like this. We're too stiff. We don't do any of these exercises anymore to develop the body. That's where the problem is; as we age, we don't do any of these exercises.
Because we have all these time saving technologies, but we're too busy developing time saving technologies like I said yesterday to do exercises. We don't have time; we're too busy. People don't want to exercise when they come to your office. They don't like to sweat. Like I said, tell them to go dancing. They don't want to do the exercises, they're too boring. Well, maybe we make it boring for them. Running on a treadmill is about as boring as you can get.
You know, there is some really nice country side out here. You have to get out and do it. Anyway, get out and exercise. But here we have another picture right here. Lack of awareness is creating a lot of problems in our society. You're going to either allow the personal trainer to exercise your patients or you're going to step in. You know what's really great about you attending this presentation is because all the personal trainers do the same old song and dance exercises.
Why don't you put together the letters to that: Same Old Song And Dance = SOSAD.
Because you're going to be hurting if you continue doing what he tells you to do. If you want to have that personal trainer show you up because he knows more about vitamins and exercises, etcetera and makes you look bad, enough of that. We've had enough of that, doctors. We need to pull that in and say, "Look, let me evaluate your program." And I'll tell you something. I guarantee you that I if you have 1,000 patients and you evaluate their programs, not one of them have included exercise for the truss to protect the foot to make sure that they don't have abnormal pronation. And when they get it and they're runners, these personal trainers and exercise enthusiasts, they don't know the first thing about how to correct it, and now you do.
When you get that patient in your office and you look at their program. And they're doing calf contractions like this that are pulling on the back of the heel. That's actually extending the arch and making it longer causing plantar fascitis and causing all kinds of problems with the foot, if you don't include the other exercises to develop the supportive mechanisms of the foot. So now that you have gained, and are armed with this knowledge, you can take back your people which you need to do because they're not getting good advice. These people don't have the educational level that you have. They're not able to intervene when it’s time. You are doctors. They are not doctors. You are educated; they have some book they read. Trust me; you need to take back your practice from these people.
Over 500 hospitals have added rehab centers. I encourage you to put an exercise facility in your office because your patients are not getting the exercise they need. We already know that because they have been taken away from us. Static evaluation of the foot – you look at the back and you see, like I said, the different types like we saw in the pictures. It's very simple to see the abnormal movement in the foot as you saw in the picture.
Arch is actually developed in childhood which is really sad. Because according to this study, the majority of them that they saw they said that they had growing pains because their arches had collapsed. If you tell your patients that they have growing pains, and that child has pain in their legs, they are going to take them to another doctor. (You know) you need to look at the foot.
This was an ABC News program that they did on children and their feet. I am not able to show it to you due to technology compatibility.
Basically it said is that kids are wearing hip-hop shoes; they're not tying their shoes and not getting enough exercise. They're overweight because they've developed the western diet and their trusses are breaking down and having pains in their bodies. It's going down into their backs.
Tibial torsion is when the foot drops in and when the excessive movement occurs in the subtalar joint -the tibia rolls. The tibia rolls like this and it causes a linkage system to carry with it -it goes with it. The tibia rolls like that. And what happens is your kneecap is no longer in alignment with the trochlear groove and you start to have knee problems. That's called chondromalacia. That is like very articular pain and is usually around the knee cap.
So when you're having pain like that, Dr. Harnem, you'll be able to know that those are the problems of having excessive pronation of the foot. So in our practices were going to find this. Destructive foot syndrome is when the foot locks; the metatarsal cuneiform joint is creating the cascading downward effect. Because you cannot toe off, the foot cannot follow and therefore it compensates with a premature toe off as we discussed before. The patient also turns the foot out like this to roll around that fixated joint (like that -you see them walk around like that). And they're using external hip rotators to do that. Every time they walk, their back is twisting -a walk that is straighter.
So their back twists when they walk with that abnormal gait. Am I crazy, or is it kind of weird to see the leg going this way and the body is going that way. You know something in the middle is going to give.
That's kind of crazy. Your foot is supposed to go toward the target.
The second toe is the axis. The big toe is inside and the hips need to be exactly the width of the socket. Like the hip socket.
I have patients that walk like this -too close. They must be practicing to be a runway model. But you know that the angulation of the joint is not correct. When this causes the iliosolas to contract, it also causes weakness in the gluteus medius and the maximus which is the hips.
The worst part of it is that the calf muscles of the pronator/supinator cuff don't contract during walking. The gait causes reduced venus return to the heart and can cause a stroke as well as the muscles are inflamed; that's a serious problem.
The feet are the foundation of the body and here are the different symptoms. Plantar fascitis, heel spurs, shin splints, foot and ankle pain, adductovalgus which is bunions, claw toes, Achilles tendon strain tears.
Here's an athlete who was in the 1996 Olympic Games as a boxer. He stepped back in the ring, and oops, there went one of his Achilles tendons. Look at his arch, it isn't there. When I started working with him after he had the surgery, I had never met him before. We went and rebuilt his leg all the way up. He said, "My God, I'm running like a gazelle, like a cheetah. I'm just running so fast now." And he had five knockouts and 13 fights before he came to me. Then we worked on that and I started to do exercises to develop his foot.
Because when you have a solid foundation like in golf, it comes from the legs -the power. If you've had bad legs all your life, you have to have strong legs. When we developed the power from his legs, he started knockout after knockout. He had seven knockouts in a row. Then he discontinued because his manager in his infinite wisdom told him he needed to run up in the mountains instead of doing his strengthening condition. Then he went back to the same old five knockouts in 13 fights. So this treatment usually works not only from the standpoint of anti-aging, but also works from the standpoint of power and development of strength and speed for sports.
Now what happens is because when the foot collapses, the muscles in the supinator cuff, namely the tibialis posterior goes into atonic protective spasm. Then the load can no longer be held on those muscles and is transferred to the Achilles tendon. Then the Achilles tendon snaps. So stretching of the Achilles tendon is wrong. The Achilles tendon does not need to be stretched. It is tight because it's overloaded.
So if you're going to stretch an overloaded muscle, pretty soon it's going to snap like crazy. That's what happened to him. He snapped
Chondromalacia patella is when the kneecap is out of alignment because when you step down, the tibial torsion occurs. The knee is no longer in proper alignment and it creates a scraping of the undersurface of the patella.
The hips are stiff. You have the iliotibial band syndrome (the ITB syndrome) and all those different symptoms related.
Herniated discs that don’t heal
A quick story – a news reporter who came into my office told me that her husband who was an FBI agent, a real tough guy was coming out of a flaming building with a woman.
When they first met, she was a news reporter in Florida. She said that he was lying on the ground crying in tears because he was told by his doctor, and he was right, that he needed a disc operation to have his disc removed to have a disc bearing type discs. The new artificial discs in and the second opportunity was to do a laminectomy and a laser surgery of the spine disc and the third option was just a disc fusion. Those were his three options.
So he came to me. I said to his wife, this was a news reporter from NBC news -you know what -I will see him at 8:00, but it seems like a very dire situation. What I'm going to do is treat him as long as I can to remove all the abnormal mechanics that are etched in the brain. Actually protective spasms come from the brain is the control system. But by using these techniques I'm going to teach you, you're going to be able to communicate with the brain.
I worked on him for 5 hours. I sent him home at 1:00 in the morning. By Monday, 85% of the pain was gone. He is now working out with weights doing fine. What was really happening is that his foot locked up just like I said. He was picking up his foot too soon. He had the iliosolas contraction. It kept irritating the disc and didn't allow it to heal.
How are you going to get the disc to heal if you keep twisting it every day? With every step you take, you keep twisting it. It's not going to heal.
Idiopathic back pains that are not caused by a trauma are probably related to a pronation type of syndrome. There is a direct correlation between patients that I have seen. Like if a patient comes in with right-sided back pain, they have pronation syndrome on the right side. They have the whole spasm pattern. It happens in 999 out of 1,000. It's a direct correlation.
The other thing is: Is it fibromyalgia, chronic fatigue syndrome, or is it overpronation syndrome? · They're achy all over, their legs are heavy, and they have a brain fog, negative lab, decreased sex drive, poor sleep. They're tired all the time. What is it? You have to stop and think. We have a lot of patients that have fibromyalgia and they do just fine.
Objective Findings: This is a patient who actually did better. She had four surgeries that did not work. She had calcium spurs, swollen ankles because of the inflammation which we know is not good.
Calcaneal eversion and painful lateral calf spasms, their gait is off and we know that because we looked at that.
Clark's test and Waldron's test are for iliotibial band syndrome. We're just going to go through this because we are all doctors and we know this: Modified Obers, TFL spasms we talked about that. Gluteus maximus, stiff and piriformis – weak. As I said, because when the foot drops in, and rolls and goes into tibial torsion, it goes through the hip as well. That's why the hip muscle is weak.
One of the tests that you can do which we did out in the hallway just recently is the modified Trendelenburg's test. Have one or mirror or on either side or use the little line here. Have the patient stand on one foot, but keep the body on center. The gluteus medius is the muscle that is used for that on the opposite side.
Sometimes they'll do this. Sometimes they'll do that: they'll do all kinds of crazy things to try to trick you into thinking they're doing it right. But you know better. "Oh, no, don't do that" and then when they start going like that, you have to say, "Oh boy, are you driving home today, because if you get pulled over today, you're gong to be in trouble." No, I'm kidding.
They look as though they're slightly intoxicated because they don't have the balance. They weave all over the place. You know what, you need to correct all that because that's what happens
Why is it that older people fall and end up causing hip fractures? It's because they lose their balance. It comes from weakness in that area: low back and straight leg test and a lot of different low back tests.
Herniated discs do just fine with this treatment. Here are the phases of anti-aging practice -what we talked about earlier. The shifting your patient from a disease based practice to a model of anti-aging demands that you do tests of inflammation and determine where they are.
If they have pain, they're going to be in this zone. When you've taken them from the pain-free state, which is about two to three weeks in our office then you're in a silent inflammation zone. Where the inflammation is still causing an aging effect and causing systemic disease processes, but they just can't feel the pain. And then where they have the reduction in inflammation and here is where you release them into an anti-aging type of care.
This is as I said before, where I list the symptoms here. I provide the services in these locations. Then we check off what they can handle and then we move them through this process of reducing their inflammation.
Phase I includes rectifying their abnormal biomechanics. We don't want them to do too much. They may be depressed. Or they have an abnormal gait pattern. They may have a musculoskeletal weakness. They're in a pro-inflammatory catabolic state which means that during high levels of inflammation, and also their bodies are tired. They're in a catabolic effect, which means the breakdown. So we need to move them into Phase 1. This means that we start out with a pro-anabolic, anti-inflammatory, weight reduction diet, which includes fish oil, lean meats and fish and vegetables. Then get them into motion control footwear. Mobilize the metatarsal cuneiform joint, do some physiotherapy to improve the kinematic chain and gait train. You have to motivate them because they're not exactly in a good mood.
Diet: like I said fruits, vegetables, Omega 3, and shift the patient into an anabolic state. Basically what the motion control footwear does is keeps the heel on center and is like a brace. If you tell the patient, they need to get these shoes, give them a list. If they don't have them within the first three visits, you dismiss them. You fire them. I'm sorry but I can't help you. When you decide to become a good patient, to get the brace, then we'll go ahead and help you.
But if they keep coming in with the same shoes that don't support the heel, then they have to go. Aren't I a mean guy? Sometimes I am because it's a lot of work and I don't want to keep doing it all the time. It's like 5:00 on a Friday afternoon, I'm really tired and then a patient walks in with the same shoes again. I say, "Look I don't know what we're going to do here. But today is going to be your last visit because you can't come in with these same shoes." Patient responds, "I don't have any money." Well sell your TV set. You know what I mean? I say that. You may think I'm kidding; I'm not kidding you.
Foot Orthotics: they can help, but I would like to have a good supportive shoe, leather, solid, which I have brought with me. (Stomp) what I love about this shoe – it's made by Drew. It has a really solid support mechanism. It's very powerful. I can show you after the program. You'll love this shoe. It really supports the foot. It's just solid leather. It's a great shoe and it will help remove the strain off of them.
The problem with orthotics is that they occupy space within the foot.
Number 1: There is no perfect orthotic.
Number 2: They can be expensive: $300 or $400. A pair of shoes is less than $200, less than $100. Also, they don't mobilize the metatarsal cuneiform joint. So you're really not rectifying the spring mechanism that's been lost by just putting an orthotic in the shoe. So that's not a good option and they can't reduce protective spasms. You have tp do that with therapy. So just putting an orthotic in the shoe does not help them completely. We know that now.
Also, they don't strengthen the body which you need to do in your office and give them exercise, like I said, they have to occupy the space and some arch supports do not allow that spring down. If the arch support is in the shoe, then it does not allow the natural spring mechanism within the arch. That's not a good option. They can't be worn barefoot or when wearing sandals. So that's not good.
Here is the support mechanism. That's holding the calcaneus in a neutral position, thus reducing the stress on the area.
Electrical muscle stimulation, vibrational massage, neuromuscular reeducation, these are some of the techniques that are used to break up the spasms of the kinematic chain. We're going to go through this very quickly. We don't have the video. See now here I am doing a technique where I'm busting up the spasm between the first and second metatarsal area. I am also going to do that around the first metatarsal. I'm busting up the protective spasm so that I can get it to move. Otherwise, it won't move.
Here are the tendons right here. We're going to go through this quickly. I want to demonstrate my machines here on one of the doctors.
Neuromuscular reeducation: This is manipulation of the metatarsal cuneiform joint. I'm going to do that on the doctor in a moment.
Manipulation of the lower back: Then we move into Phase II which is the training session.
After we remove all the spasms from the kinematic chain and the joints are moving smoothly, then you can exercise. You don't exercise when the joints are moving poorly because, it's like saying I have to take a trip to Singapore and the front end of my car is out of alignment. So if I drive my car really fast, maybe the front end will go back into alignment. No that is not going to happen. You're just going to wear the tires faster.
So exercising joints that are not biomechanically sound creates accelerated wear and tear. So having the patient exercise when they're in pain is not a good idea.
Purchasing motion control shoes happens in phase II when they're exercising. That's like motion control – I don't know what's going on, but shoe manufacturers have picked up on this. They have a motion control shoe to stop the pronation. So they know it's all out there. So you doctors have to pick up on it now.
Okay, we have a few more slides, real quick I'm going to do a demonstration of a machine I use in my office. It's a favorite of Dr. Bob's. It's called the G-5. I know you don't like to do all that extra moving. And I love it too. We have four of these in the office and they keep breaking because we're so four of these in the office and they keep breaking because we're so highly technical. I'm just going to show you the adjustment because we couldn't do the video.
Okay. This is the metatarsal cuneiform joint right here. I told you that the foot is able to absorb 500 to 1,000 pounds of pressure when we run. Right? Okay, so we can really give it a good movement here. Looks like it hurts, but it does not. Hear that? That was nice. He likes that. That cracked. It made a nice loud cracking sound. It's the manipulation of the metatarsal cuneiform joint. You get on one side of it, and then you do a shearing mechanism. You get the first and second. You have to put a little power behind it. That's how you break it loose and we adjust his toe like that. There we go.
Now it would have been a lot easier if we had removed all the protective spasms around his foot and then made the manipulation on his foot. Now he'll have a nice springy arch in his foot. See how he has a nice springiness in his foot? That's what you're looking for.
Well I really enjoyed being here in Malaysia. Doctor, thank you for introducing me. Thank you, Dr. Harnem, Dr. Bob Goldman, and Dr. Klatz for inviting me, and the delegates of the Malaysian Anti-aging Conference. Thank you very much for inviting me. I really enjoyed myself.
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