|
|
|
|
| Transcript Tokyo, Japan June 15-17, 2007 |
|
|
|
|
|
|
|
Elastic Recoil Mechanisms and their effect on Performance and Premature Aging
Total Anti-Aging Japan (TAJ2007)
1ST World Anti-Aging Congress & Exposition in Japan Tokyo, Japan
June 15 – 17th 2007
Tokyo, Japan
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
Good afternoon. My name is Dr. Stoxen. I’m from Chicago. I would like to thank the organizers for inviting me. It’s a great honor to be here.
The topic of my presentation is “Elastic Recoil Mechanisms and Aging” and while it’s a very unusual topic because I don’t think that any one has ever presented on this topic, I think you’re going to find it very important for the treatment of your patient and it’s a very much overlooked aspect of performance and possible aging of your patients.
First of all, anti-aging medicine is a practice I enjoy very much. It is concerned with the earliest detection and prevention of age-related diseases. Anti-aging medicine, I feel exceeds the standard of care as the earliest detection and prevention of age related diseases; it eclipses the standard of care because the standard of care is to wait for the pain. .
Anti-aging medicine doctors don’t wait for the pain. They look for any abnormalities and the symptom do the right thing to prevent the problem from occurring or they work to improve performance. Sometimes I feel as a doctor in sports medicine and anti-aging medicine, I treat a lot of entertainers. My patients are breaking world records and my job as their doctor is to keep their energy levels very high looking for any noticeable imperfection in movement or performance not just wait for the pain.
Over the last 20 years I’ve developed a very sophisticated and more progressive approach to training patients than just waiting for pain and that’s why it’s fit very well into the anti-aging practice. First of all in anti-aging medicine, reducing inflammation is one of the most important components of your practice. Teach your patients to have activities that have minimum inflammation. Inflammation increases the likelihood of aging. Inflammation comes from diet, arthritis, wear and tear on the joints as well as pollution and other problems such as infections.
In my practice I have separated the different phases of aging into four phases. Mostly, I practice in the first three. The first phase is obvious inflammation where the patient has painful inflammation - where the patient as well as the doctor knows inflammation is released into the system.
Phase II is when the patient has been treated and is barely out of pain yet there is still inflammation coming from the joints, yet it’s not noticeable by the patient. It’s called ‘silent inflammation’. Dr. Barry Sears talked about that last year in his presentation, ‘Silent Inflammation’. Its one of the worst, because the patient is unaware because of its aging and disease is being accelerated at a possible risk.
Phase III and the green phase is where the patient has less stress and strain on the joints and exercise can be performed without increased inflammation. In fact, it’s healthy for the patient.
Phase IV I have reserved for those astute doctors that have developed techniques to reverse age. I don’t know if we have those techniques yet, but those are reserved for that reverse age.
I’m going to talk a lot about Phase II and Phase III, which are phases that I have enjoyed, practicing and experimenting in the last 15 years of my practice. Fifteen years ago I designed a medical center with a training center combined. In this facility, my treatment rooms have windows into the training center so I can observe my patients’ form and technique during training.
When I evaluate patients I have a long hallway in my office from which I observe their walking movements and other movements. The evaluation of biomechanics is very important in determining the acceleration of aging of the joints. When we are looking at biomechanics, we are looking at the transformation of movement patterns that have been developed since childhood. These are called engrams. These movements are developed in childhood; these movements don’t ensure just because you can walk that you have good form and technique. Watching walking patterns will help you to understand where stress and strain occurs in the body before pain is felt by the patient.
In our office, we are looking for engrams of movement that are negative. If you look at enough patients walking in your office, you can detect in time with practice what is considered normal and what is considered abnormal movements. Just like a trainer of a professional basketball team, can evaluate an athlete’s performance to determine if they have a good shot, or lifting technique. You too as a doctor can evaluate your patients’ walking performance.
Certainly there are far more sophisticated methods to determine walking performance and running performance; however, we as doctors don’t need this. One of the most important components of evaluating biomechanics as an engineer-doctor, engineers always look at the structure foundation. It’s in the foundation that I found that the majority of the reason why patients have chronic pain: lower back pain patient, 20 years of pain, evaluated by 5 or 6 doctors, and find out what each doctor has missed is defects in the movement patterns of the feet or the foundation for why the patient has chronic pain.
Here are two graphics of the foot looking back at the heel; you’re viewing the connective tissue on the left. On the right you're viewing muscular tendon attachments of a group of muscles that I call the pronator/supinator cuff. The foot is actually like a suspension bridge. It is supported from the top by a group of muscles that you see on the right. These muscles have strategic attachments at the arch that allow the arch to be suspended from above.
So I have focused on the number one area of my practice and I have found great results with treating this area in reversing other problems that other doctors have failed. It’s the most neglected area for diagnoses in musculoskeletal problems and it’s the most neglected area for exercise and training. In fact there are no training equipment in the health club to train these extra areas properly.
This is a slow motion video of exercise of the foot running and walking. As you can see in the diagram from running, the plant is much deeper. The arch springs down deeper on the left. The right is walking. When the foot plants, the muscles that suspend the arch have elasticity. They allow the foot to absorb the energy of the body weight. Some of this energy is dissipated as heat. The other energy is stored. The energy that is stored is then recycled back into the movement through the toe-off. When the toe pushes off this energy is then released into the movement pattern to allow the body to project forward.
Any defect in the spring mechanism of the arch joints or a weakening of the elasticity of the muscles that suspend the arch will cause the patient to have abnormal movement patterns, stress and strain. Stress and strain leads to wear and tear. Wear and tear leads to inflammation. Inflammation leads to pain, by that time, it’s too late. In this view, we see again, the plant of the foot and the absorption of the energy and depression of the arch. What I found in my practice is the number one condition that corresponds with or is paralleling lower back pain, knee pain, hip pain, foot pain, is this locking of the spring mechanism at the metatarsal cuneiform joint or the mid arch area.
Tomorrow we’re going to go over how I release the recoil mechanism back to he foot allowing the foot to function normally where we see a close-up. On the right is running, on the left is walking and you can see the spring down mechanism on the right through running is actually greater than on the left. In this view we see a close up of the spring mechanism as you can see, when the foot plants deeper, you can see the tendons through the skin. There are the tendons through the skin that support the foot. These tendons come from the sides.
What’s important to know is that exercise these tendons are not from front to back movements. They're coming from side movement and what we have to understand as anti-aging doctors and doctors of modern society are that the world has changed. We used to walk up the hill and to the market and down through valleys and through various terrains. Those have been flattened and eliminated for us in replacement for sidewalks. So, lost are the movement patterns that develop the arch and the spring mechanism of the foot to maintain good elastic recoil. However, we can learn through science to reestablish this recoil mechanism. It’s very important for efficiency. As what we’ve learned is that the feet are actually the body runs like a bouncing ball. It allows increased performance of your top athletes without a lot of training. It will allow your patient to walk with maximum efficiency. It will reduce stress and strain and potential of injury. It will reduce wear and tear and release of silent and painful inflammation. It will also reduce the speed of aging of your patients.
Fifty percent of the energy needed to accelerate the body and lift the center of mass comes from this elastic recoil mechanism. Patients that you see in their 50’s and 60s, they say that they feel older, when in reality they may need a tune-up of their spring elastic recoil mechanism.
Here we see on the left running and the right walking. An interesting fact that I noticed was while running planted first, the walking push off came early while the running push off hesitated, but finished faster. This is an example of the recoil mechanism. The muscle that maintains the foot in the proper position during recoil is called the tibialis posterior located here. As you can see, there are strategic attachments at the bottom of the arch for this muscle. This is the number one affected muscle for weakness that affects the recoil mechanism of the arch of the foot. When the recoil mechanism is affected, you’ll see a dipping in the pelvic area. The inability to elevate the hip on the one side is due to a flattening or a deadening of the recoil mechanism. Therefore, how can we exercise to develop this recoil mechanism? Or what can we do to develop this recoil mechanism?
There are three types of exercises I call exercise techniques. One is non-functional. Nonfunctional means that this exercise does you absolutely no good in your daily life. Dysfunctional are exercises that actually injure you, cause problems to your joints in your systems. And then functional exercises are what we’re hoping for our patients. This is a simple single calf raise. Calf raises and we want to know- is it functional? Is it dysfunctional or is it non-functional? If this is the only exercise performed below the knee, then it’s considered dysfunctional. The reason is because the foot moves in 6 different directions and this exercise is only for one direction. In balance in the movement or the strength in the other directions means that the foot will function in an abnormal movement pattern, and cause damage to the full extent of the body.
The movements that are lacking in majority of exercise programs performed by personal trainers and those experts or gurus that are considered, that are taking control of your patients, the one exercise professionals that are in charge of your patients’ programs neglect these two movements of pronation and supination.
You as a doctor are now more well educated and know more about proper training techniques and know not to allow your patients to have programs that neglect these movements.
So, Monday morning the first thing you will do is get a copy of your patients’ exercise training regime, look it over and ensure that these training movements are not neglected. An interesting mechanism of the way the body moves, or the foot moves through the walking cycle is the foot first steps to the outside, called supination then rolls into pronation, then pushes off. This is a very ingenious technique for walking because it absorbs the shock of the body and transfers the weight through the movement of walking or running.
Excessive supination or too much supination causes abnormal stress and strain on the body and damage to the joints from toe to head. Not only that, but if there’s an injury, say in the back, or the neck or the knee, if there is excessive supination or pronation of the foot during walking, there are 10,000 steps performed on average per day by the patient. What will happen is that that area will not heal. It will become a chronic condition and release inflammation into the body. It causes accelerated aging, damage for the remainder of the patient’s life until you integrate and correct that. I call this the safe range- not too much supination, not too much pronation. Certainly, it’s important for us to develop the muscles that are in that cup of the earlier slide to prevent from too much supination, too much pronation. However, when the patient comes to our office they have maybe too excessive pronation, too excessive supination due to a weakness in this cup area. They’ve had this weakness for 20 years as a result of not getting enough exercise on uneven terrains or maybe they wear shoes all the time that restrict the movement. Initially, we are not able to strengthen the muscles within 2 or 3 days to resist this over supination and overpronation. So initially, my recommendation to you is to place them in a shoe that has an excellent counter support to keep the foot from rolling too much supination or too much pronation.
The second thing is that there is a use of arch supports or orthotics in medicine. As I mentioned to you, those who use arch supports don’t understand how the arch functions. As I mentioned earlier, the arch is suspended by an elastic bands of muscles ad tendons that allow it to function like a suspension bridge. Putting something underneath the arch throws the neurologic mechanisms of the foot off and the neurologic mechanisms of the entire body. Not only that, it’s not a permanent solution. It does not return normal biomechanics, as it would be naturally. I equate arch supports to having weak stomach muscles and recommending a girdle for the patient for the rest of their lives and neglecting exercise. So as doctors astute in biomechanics, you’ll know that’s not a suitable recommendation.
Here we have a picture of a normal foot on the left. This is a baby’s foot on the right. If you evaluate baby’s feet, you’ll see that they have a spread of the toes and they don’t touch. That’s normal. I will say that probably none of the doctors in this room have ever seen a normal. Foot unless they are pediatricians, because as soon as we get to be one year old, we put a restrictive leather device on our foot and it deforms the structure of the foot to the shoe. As you can see, the foot has a point and it is slowly and steadily deforming the shape of the foot. It causes a deformation of the structure of the patient’s foundation of their body. It alters the movement pattern of the joints permanently.
This alteration is seen in very minimal state to extremes. As you can see, the different between the baby’s foot and the adult foot with continuous footwear, you can see the deformation. What you’re going to see in your practice is that the majority of your patients will have this deformation. This is the extreme in alteration or deformation of the foot. Obviously this is foot binding that was practiced for 1000 years in China and I may make a comment that it’s reported that 10% of the young ladies that participated in the deformation of the foot, did not make it through life. They died from the binding from some form of gangrene or a circulatory problem.
Therefore, we have the extreme in foot binding or alteration of biomechanics. What we are going to deal with is a weakness in the muscles, which supports the arch and prevent overpronation and over supination.
On the left we see an excellent plant of the foot, not too much supination and not too much pronation. On the right, we see too much pronation and weakening of the spring elastic recoil mechanism. Here is another view on the left of the muscles, the elastic muscles that provide the recoil for the foot. On the right we see this flooring system of the foot. As I mentioned, training with footwear, you can see that this shoe actually binds the foot and prevents movement into the floors of the foot.
Binding any joint during training is not recommended. Joints need free movement; in other words, to develop without damage. Abebe Bikila, who was an Ethiopian runner who competed in the 1960 Olympic Games Marathan Race. He actually not only won the marathon in the Olympics, he set the Olympic World record, he ran without shoes. He ran barefoot.
So anyone who tells you that you cannot train barefoot because it’s not good hygiene for the body is definitely incorrect. Not only did he win the marathon race, but also in 1964, he repeated it and won again. He’s the only track athlete to win back-to-back marathons in the history of the Olympic games. Bringing this flexibility back to the foot can be as simple as stretching of the toes. These are recommendation for your patients to bring the flexibility back to the foot. This is a stretch that will help to prevent bunions, which is very common for the ladies and for the men. Spreading the feet after patients come home from working all day. You can help to teach them to separate their toes preventing the deformation of the foot, and then training.
It’s interesting to me that 23 million people begin training by jogging or running and after one year, 16 million of them have stopped their training because of an injury. So if your patients are running or jogging they have a 70% likelihood of not running or jugging and getting injured.
What I noted was that walking was actually 1 to 2 times the body weight. For example, if you weigh 50 kilos, walking puts 50 kilos of pressure on your foot. If you’re running or sprinting, it’s 5 times the body weight. Therefore, running for 50 kilos human being is 250 kilos of pressure on the foot. It’s amazing to me that the patient sits in the office all day doing technical paperwork. They have no strain on the foot whatsoever, so the foot weakens. Then after work they decide to run, putting 250 kilos of pressure on their feet. What I recommend for my patients is that they start with fast walking, light jogging, jogging, slow running and then running. That’s a more scientific approach to bringing your patients into a healthy active cardiovascular program, than just telling them to run for exercise.
Exercise is very important, as we know. When we evaluate exercise, sometimes the patients can get hurt and while we always think of injury because of some trauma, it’s actually some of these injuries that occur in very unlikely ways, which we’re going to discover now. However, exercise to develop a highly tuned elastic recoil mechanism is very important. What do we have to develop the arch of the foot for maximum recoil capacity?
This is an athlete who is a patient of mine. As you can see, he has excellent elastic recoil. He is 5’9. He is my height and weighs 350 pounds. So obviously, he has excellent elastic recoil mechanism. We have acceleration, deceleration, and change of direction as some of the ways we can develop elastic recoil. When we are developing elastic recoil, we are working in what we call an ‘eccentric movement pattern’. Eccentric movement is when the foot plants down and absorbs the weight.
Therefore, by developing eccentric training mechanisms, what we can do is increase recoil and efficiency without a large increase in strength of the muscle. It’s interesting when I talk to doctors; many times doctors make the mistake by being too conservative with their patient. Many doctors, I hear, tell the patient, ‘don’t do this, don’t do that, you could get hurt.’ In reality, in my office and what I recommend is that you push your patient to do more.
The ability to produce velocity eccentric contractions can be done at age 5, 25 or 75. We have to look at exercise and eccentric movements like jumping, hopping, skipping as mechanisms that will cause remodeling of tissues, rather than damage to joints. If we are conservative with our patients and tell them ‘not to do jumping, don’t do this, don’t do running’, what we’re doing is allowing our patients to become weaker rather than stronger.
Certainly, having a controlled environment like I have brings me advantages to help my patients develop elastic recoil mechanisms and strength. However, you as a doctor can also do the same. When we look at elastic recoil mechanism or spring of the joints, we look at it from the cellular or microscopic level. The muscle has elastic properties and the tendons do as well. What we see is that there is a giant cytoskeletal protein called ‘the Titin protein’. It is the only protein to span an entire sarcomere from Z disc to
M line and has cross links from the Titin molecules of the adjacent sarcomeres. It is made of prolene, urmade, baline and lysine.
I call this component Titin Tuning. We’re tuning the Titin protein with specific types of exercise to develop the spring down mechanism. These are done with hops, jumps and those types of exercises. What has been noted in scientific research is that this elastic recoil mechanism developing or tuning this elastic recoil mechanism through eccentric training has allowed patients to reduce sarcopenia, or weakening of muscle tissue. In elderly subjects, mean age of 78 years suffering from sarcopenia, there has been reported a large isometric leg strength and significant increase in whole muscle mass following 11 weeks of high force eccentric training. In comparison to 70 year old patients who did just walking and weight type exercises, it was a significant improvement, whereas minimal improvement with those who did not do eccentric training. Also eccentric training is very alluring and very positive because it improves patients’ osteopania.
The other significant component with aging, as we know doctors who practice as with our patients, the number one cause of injury in elderly patients in accidental death is from falling. The reason is because they cannot negotiate walking downstairs. Walking downstairs demands a very well tuned elastic recoil mechanism of the foot. Those with flat feet, which are frozen without elastic recoil, have a difficult time walking down the stairs and end up falling. If they fall, and they break a bone such as the hip, the mortality rate is very high.
Elastic recoil mechanisms develop the fibers of the muscles and the most important way of doing this is by these types of hops and skips and these types of hops and skips from the sides. As you can see, there is really no difficulty in performing that exercise and certainly a 70 year old can do that. Then we get a little more complex with our training. In this exercise, this is called the multiple hop exercise where we will hop over cones. It demands coordination, balance and agility.
One thing I noticed is that when patients have fallen, it was usually when they reached for something to the side. When athletes are performing gymnastic movements or movements that are for sport, what they’re doing first is starting by maybe getting up on the balance beam and attempting to walk across the balance beam, and as they practice, the training, these movements become burned into the nervous system of the brain. These patterns are learned movements that are learned techniques, like the pattern of walking. Thus, as doctors, to prevent a patient from falling, or injuring himself or herself, what we should do is recommend they move in directions other than just simple running and walking. They should move in directions that demand more balance and coordination. That way, when they get themselves into a situation that demands they move in this direction, their brain will have a memory of it and they won’t lose balance and fall.
During running, the foot strikes the ground at the heel first, or walking and immediately, the foot the skin and the muscles send signals to the brain as to how much elastic strength to apply to the arch to allow it to lower to a safe position. These neurologic mechanisms are developed from childhood as I mentioned. This is very important because the sensation that the foot picks up from the ground is what sets the tone for the muscles as they lower the foot into a safe position.
In walking, as I mentioned, it’s 1 to 2 times the body weight. In running, it’s 5 times the body weight. So as we go from walking and accelerate into running, the tension must increase controlled by the brain. That brings up a very interesting point in science. Scientists have decided that these certain types of footwear that are cushioned footwear actually removes the patient from nature. Because you cannot feel the ground with your foot, you lose touch with nature with the amount of pressure that your foot is applying to the ground. Therefore, it throws off the mechanism as to what support is necessary for the arch to maintain a safe position. In fact, there have been surveys of over 5,000 patients. They found that athletes were getting injured more frequently with these soft cushioning surfaced shoes, which were expensive at a cost of $150, than with simple shoes that were $40.
People say that barefoot training is risky. However, a barefoot runner is constantly alert to the ground to which they are stepping. It develops a more advanced nervous system with coordination, balance and agility. Not only that, but Roe and Joseph, 1992 examined over 2,000 children from India, ages 4 through 14 and found that the incidents were more than 3 times greater than those who wore footwear than those who did not. Wearing less footwear developed a more normal arch.
In 1988, Hamel & Bates showed that as running shoes lose their cushioning through wear and tear, subjects actually had less risk for injury. Other studies by Robins suggests that balance and the ability for man to walk across beams was better with a thinner harder sole shoe with less impact resistance. A study by Robbins and Waked in 1977 had 3 cushioned pads. The first cushioned pad said ‘superior impact absorption’. The second cushioned pad said ‘poor impact absorption’ and ‘Warning, high injury risk’. The third pad ‘said impact, absorption unknown’. What they found was the ones that jumped on the superior impact absorption pad jumped with more force thinking that they were protected. Those pads had all the same impact absorption. They tricked the patient. What we’re saying is that that our patients are sometimes buying the advertising from certain footwear companies with impact resistance or impact absorption, these shoes may be unhealthy and the patients should be made aware.
With that I would like to conclude my presentation for today. I’d like to thank the organizers for bringing me here. Tomorrow morning, I’m going to go over my methods of reversing this lack of spring mechanism in the foot. I’m going to give a hands-on demonstration of my techniques at 9:00 in the morning until 11:00 in the morning. I hope you learned something and I’d like to entertain questions if the organizers will allow me. With that, I would like to urge you and your friends to live life like a champion.
***
Thank you very much.
|
|
|
|
|
|
|
