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| Transcript Tokyo, Japan June 2007 Workshop |
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Workshop: The Stoxen Approach to Slowing the Aging Process of the Musculoskelital and other Bodies Systems - A hands on workshop demonstration
Total Anti-Aging Japan (TAJ2007) - 1st World Anti-Aging Congress & Exposition
June 15 – 17th 2007
Japan Tokyo, Japan
Workshop 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 morning. My name is Dr. Stoxen and I’d like to thank everybody for inviting me to this conference. Today my topic will be “Which Sports Are Healthiest for an Anti-aging Lifestyle?”
Sports medicine is an art form that I have been practicing and enjoying for 20 years. I have had the opportunity to treat many World Champions and national champions, as well as actually design the training programs for many athletes who were first just local athletes that had good gift and talent and through the efforts in our training center they have become titleholders or world champions. It is rather interesting being a doctor and actually having the opportunity to play the role of not only the caregiver and the doctor, but also to have the role as the person involved in creating the muscle strength, the speed, the agility and the power to allow the athlete to become the champion of the world.
So through that, there has been quite a bit of study over the last 20 years that I have conducted to be able to have the secrets to be able to create world champions. It’s interesting, and I encourage you to be more involved in sports medicine because it challenges the highest level of your expertise to learn and advance yourself more and more to know more about how to tweak or how to fine-tune the human body; and in that way, sports medicine parallels anti-aging medicine.
Sometimes I think of anti-aging medicine as taking a 55 year old man and preparing him for the Olympic Games: doing hormone assessments and nutrition, body analysis, BMI assessments and various different assessments that we also use in evaluating athletes.
Because anti-aging medicine parallels sports medicine, sports doctors cannot wait for the injury to occur. The reason is obvious: if the injury occurs, then we have a setback and maybe the competition is delayed or cancelled forever.
Also as a sports doctor, we can detect minor flaws in training form and technique. We can assess these minor flaws in the training technique and movement patterns, and make changes to perhaps allow our athletes to have the best technique to become the champion so that anti-aging medicine and sports medicine are the earliest detection and prevention of age-related diseases. Anti-aging, as I mentioned yesterday exceeds the standard of care. We are going to try to predict where the pain is going to be before it happens.
I work in the sports and entertainment field, as we mentioned earlier. Some of my athletes are world champions: here is one of them. This is a young man I started working with in 2001. He had a complete tear of the Achilles tendon. He came to me for rehabilitation after the hospital had ended his rehab at Northwestern University. That is a videotape of the highlight film when he won the WBC World Championship title a year ago. He is a current WBC champion and he is fighting in about 2 months to retain his title with Eric Morales in Chicago on August 4th.
What we know from sports is that sports involve the elastic accumulation of power from multiple segments. In other words, power and speed are developed through multiple joint segments, acceleration of the, say for instance of the boxing movement. The boxing movement begins at the feet, then the legs, the hips, and the shoulders. Then at the end point, the fastest movement comes at the snap of the wrist and the forearm.
We learned yesterday from my presentation that elastic energy is stored within the muscles and tendons to allow these accelerated forces to occur. We have to take advantage of these elastic recoil connective tissue mechanisms to preserve for maximum acceleration, as well as for maximum efficiency of the body. These applications have use in walking and running for your average patients.
Which sports are the healthiest for anti-aging medicine? I think that sports that are participated year round maintain the health of the athlete, or our patient year round is important. They should be team sports to allow the patient to have participation with their friends, develop relationships to stay in the sport longer. They should include all ranges of motion, not just running, which is the forward movement; but also movements from side to side to help them develop the balance reflexes of various different movements besides walking and running – forward movements. They should involve some cardiovascular components and sports that improve bone density.
One lady told me that she enjoyed swimming and that’s all she needed. However, swimming does not increase bone density, because you're in the water. The sports that increase bone density are those that provide resistance against the ground or against other athletes. In some sports that involves minimum inflammation, such as boxing would not be a good sport for anti-aging medicine. Ultimate fighting is another sport that would not be good. However, some form of soccer would be a good sport. Soccer is not supposed to have contact, however, it does periodically, but sports that involve minimum contact.
The one that I like the most is barefoot sports. Barefoot sports allows us to take our shoes off and allows us to develop the very important reflexes within the feet. That’s what we need: to take our shoes off because they are always in a leather-binding device all day long. That creates atrophy of the tendons and the ligaments and the joints and joint connective tissue.
What I have always recommend for the athlete is that they should train or do the exercises that they hate the most and follow up with the exercises that they like. We always hear the statement that ‘Practice makes perfect’. However, in anti-aging medicine, in my patients, I tell them “Perfect practice is anti-aging medicine”. Or the participation in sports demands perfect practice. Because when the body moves multiple times, this is how it learns or burns the memory of this movement in the brain. Every time the movement of the body occurs, the brain creates a mapping of the movement and is stored in the brain memory system.
Consequently when my athletes are practicing their sports, I’m looking at them very carefully. If they start to become lax or start to lose concentration, I stop them. I don’t know if you’ve ever seen a long distance race like a marathon where you see the athletes in the beginning of the marathon. They're all excited, they have good energy and they're running off at the start with good form and technique. And at the end, they look like 80-year-old men, creeping in through the final phase, falling down on the finish line. What we’re seeing is that as fatigue develops in the human body, form and technique are compromised. So when I see my athletes that are fatiguing, I stop them and make them rest and then we start up again with good energy level.
When you exercise with fatigue the bad memory of the movement pattern is stored in the brain, which is repeated again on the next exercise session. So it’s always important to monitor your athletes for this form and technique. Any type of poor form or technique creates systemic inflammation or arthritic inflammation. As you will find out from the lectures today, inflammation is linked to many chronic diseases including heart attack and stroke, Alzheimer’s disease, Parkinsonism. Over and over again we hear about inflammation, yet we don’t think about arthritic inflammation, chronic inflammation. That combined with a poor diet, arthritic inflammation, and systemic inflammation can create a toxic soup bathing you in this toxic soup, cytokines, Interleukin 1, 6, 8, and 10, tumor necrosis factor. These inflammatory chemicals cause premature aging and cellular death. This is definitely not what we are looking for in an exercise or training or sports program.
As I mentioned yesterday, we’re developing a nice program for our patients. As I love this chart, if you’d like a copy, I can email it to you after this program. This chart is excellent because it shows the patient the first phase which they're usually in when they come to you with pain. That’s something they understand. The pain component is the red phase, which means to “stop”. You can see the analogy with the stoplight. Stop. Caution. Go. I tell my patients “What I don’t want you to do right now because you’re in a painful inflammation state is I don’t want you to do any activity because if you do activity what will happen is your body will become more inflamed and that if patients were walking around or participating in sports with pain, they're accelerating the aging process. So that’s counter productive to what our plan is as doctors to have our patients decelerating or slowing the aging process through the participation in sports having a healthy lifestyle.
When a patient has pain, it’s definitely not the time to advocate exercise. In my office, my patients are not allowed to go into the exercise or training room until I have removed every single restriction, muscle spasm, and misalignment of the joints to perfection. I take the first 10 days and my goal is to remove every single spasm from the human frame from the toe to the mid section or to the head with meticulous treatments. Approximately 10 percent of the spasms and the restriction will be removed per each treatment. Treatments take up to an hour and a half. Some treatments take 6 hours. I don’t know if you have the endurance, but you will if you practice. I have patients that fly in from over seas that fly in from California; they’re put up in a hotel room. I say give us 4 days. I go to their room at 8:00 at night, work 4 hours. They have a pot of coffee. I work 4 hours on their musculoskeletal system with my hands removing every single restriction. My goal is to make their body as close to perfect as humanly possible. After I feel that I've made them as close to perfect as humanly possible, then I release them into phase II or the yellow phase, or the cautionary phase.
At this point still I feel that the patient has some inflammatory chemicals release from the joints. There is no pain associated with movement sports or activities; however, there is still some systemic inflammation. Not only that, but they have some dietary issues that are releasing inflammation because bad habits are hard to break. So when we start to meander our patient through this process to get to the green phase, there are some challenges there with diet, exercise, footwear and compliance that we have to be strict about.
As they move into the yellow phase, of course they are starting to exercise. But most of the exercises that we’re performing are frame-building exercises. As I mentioned yesterday, in order to run, it is required that there are five to six times the body weight placed on the arch of the foot during running movements. During walking there is only one to two. Therefore, before we can move our patients from walking to running which requires maybe only say 60 kilos of strength in the arch mechanism to 300 kilos of strength in the arch mechanism for running, there are some pre-running exercises that we’re going to do to increase the strength of the patient.
There are some biomarkers that you can use to determine the level of inflammation. Fortunately enough for Japanese ladies, what we found was that their level of inflammation is close to one on one; (1:1) EPA to arachidonic acid levels. In the United States, unfortunately because of our diet, it is twelve to one (12:1) on average. Phase II and III are the phases of exercises that I enjoy the most. We’re going to talk about that mostly today. After I get done with this, I’m going to go over and demonstrate for you how I remove the restriction or how we reestablish the elastic recoil mechanism in the foot.
So what exactly are we training when we train our athletes? As you can see, this beautiful girl is doing some exercises requiring tremendous amounts of strength, agility and balance techniques. Muscles have no power to guide themselves, but the manner in which they guide themselves, is through the brain. The nervous system actually guides the muscles and provides the necessary information and the input to be able to do those movements. Essentially what we’re doing is we’re training the nervous system. Whenever athletes talk to you about what they're training; they're training their muscles, you have to reorient them to the fact that they're not training the muscles; they're training the nervous system. Strict compliance with form and technique is essential for them to be able to be able to maintain their technique for proper participation. When we’re training these form and technique, the form and technique is trained in engrams, or neuron networks in the brain. They're either positive engrams, which means quality movement without any type of stress or strain on the joints, causing wear and tear and then eventually inflammation.
Negative engrams are those movements that are damaging to the body which cause stress and strain and weakness to the body. They're categorized into two separate classifications called “general movement patterns” which are movement patterns that are already in your body that you have now. They're developed in childhood. Your walking is developed in childhood and then there are specific movement patterns. What we do is we use specific movement patterns to retrain the general movement patterns.
For instance, if Tiger Woods felt that his golf swing, which we feel is perfect, needs a change, he uses specific movement patterns to alter the swing mechanism and practice them over and over again until they become general movement patterns. That’s how we retrain athletes.
A simple thing we do in our office is just having the patient walk through the hall as I’m showing here. This is my training center. And here he is walking. Then observing his movement pattern to be able to see where the weakness or damage may be occurring. I always check the foundation. I feel that the foundation is always number one to check. I don’t care – regardless if they have a shoulder problem, neck problem, chronic back problem, knee pain or anything. You must check the foundation; if you don’t then you're doing an inadequate job in my opinion.
Why do I say that? Because I found that 99% - the vast majority of the patients that have chronic low back pain have a subsequent pattern of muscle spasm and misalignment that leads to the foot-almost every single one of them. The ones that I found that don’t have one, the concomitant pattern of spasticity that repeats itself, by the way over and over again to the foot, are the ones that have been struck by an object in the back.
Therefore, those of you that are doing treatments for back problems without correcting the biomechanics of the foot, my opinion, based upon my experience is that you're leaving out a very important component to the treatment process. It is a vital component. So these are the muscles that actually maintain these spring mechanism and the integrity of the foot. They have names that are in Japanese, tibialis posterior flexor Digitorum longus, tibialis anterior, flexor hallucis longus, peroneus longus, and peroneus brevis. They’re not mentioned very commonly in the literature and it’s unfortunate because they're extremely important. I noticed here the tibialis posterior that in fact there’s actually a syndrome named after the weakness of the tibialis posterior tendon and muscle called the tibialis posterior tendon dysfunction syndrome. Doctors still even though they have mentioned that, the patient has the dysfunction which is a weakness of that muscle that actually supports the spring mechanism and the suspension bridge, a component of the arch, they don’t recommend any type of training for it. So they recognize that it’s there, but it is something for which they don’t recognize treatment.
As you can see, it has a three-prong tendon to subtract attachment right under the metatarsal under the metatarsal cuneiform joint. You're going to find that that joint also has calcium deposits on it and there’s a restriction of the movement, which is related to why we don’t have the spring mechanism in the arch anymore. There is a better diagram of it from behind. As you can see, it starts from the back of the edge of the inside of the fibula here and it loops around and attaches again like I said at the metatarsal cuneiform joint.
The most painful area of the tibialis posterior muscle is right here along the edge of the fibula at the mid point. It will send your patients through the roof in pain. Just take your hands and place your hands underneath there and put a little bit of pressure there and they will look like they saw a ghost. Their eyes will bug out and they will turn red, it’s just a horrific pain. However, they never had pain there through daily life. “I never had pain there before. Why is it that I have pain there now when you press on it? It’s probably because you're pressing on it.” In reality, that muscle is sore and inflamed and releasing steady flow of inflammatory chemicals into the body causing aging process.
It’s a sub-clinical pain. It’s there because what happens when the weakness of this cuff muscles that I described earlier occurs, most commonly the foot rotates inward or pronates and locks. When it locks, then it creates excessive movement throughout the kinematic chain and points of inflammation through the kinematic chain and release of this inflammation throughout the body thus accelerating the aging process.
Thus, this attachment is very important. This treatment of this muscle and the training of it are extremely important. It’s also interesting that in a health club setting, I have never seen an exercise or a piece of exercise equipment that has been designed to train this muscle, ever. I have been in 100 health clubs and there isn’t even an exercise machine to exercise that muscle.
Another thing that we’re finding out is the aerobic capacity of this muscle to sustain standing positions. In other words, if we’re standing in line for 2 or 3 hours for concert tickets and we’re walking all day and our feet get sore and tired, it’s because it has exceeded the aerobic capacity. Therefore, the ability to accept oxygen and nutrients is no longer there. When the muscle tightens up, it chokes off its own blood supply. It’s almost like trying to push maple syrup through a bagel. It does not get through. The oxygen cannot fortify the muscle and then it fatigues faster. For the ability for the blood to penetrate the muscles, it is extremely important that we open up these channels to allow the blood to flow because what can happen is it can extend into adjacent muscles. This muscular spasm throughout the calf, even though it’s not in the gastroc or soleus which are the muscles that propel the body, these muscle spasms can choke off the blood supply back to the heart. This is called the venous return.
I had a patient who was 51 years old. She had suffered some strokes and underwent open-heart surgery because they had to remove the clots from the pulmonary artery as well as from the lungs. She had some strokes. She had been to five different doctors and after they performed the open-heart surgery, they asked her to carry the nitroglycerin tablets in case she suffered a heart attack.
The client flew me into location; I evaluated her, and what I noticed was a very vivid discoloration in the skin around her ankle, which was turning brown. I don’t know why her doctors didn’t notice this. What that means, of course is that the skin is dying. There is not enough oxygen and nutrients getting into the skin to provide necessary nutrients to keep the skin alive, so the skin was dying.
I mentioned to him, “Why don’t you give me a couple of hours on this one leg? I’ll try on this one leg and we’ll see how it goes.” I did the treatment on her and I focused on increasing the circulation through manipulative techniques that I’m teaching today to bring that blood flow down to the leg. What happens is that circulation passes through this area and goes back up to the heart.
So after the treatment, he looked at the leg and it was bright pink and the swelling was dissipating very quickly. He looked at the opposing leg and it was still brown and discolored. He was amazed by the increase in circulation that occurred so quickly in only 2 hours of work. He said, “Well how long will it take you to do the other leg, because we’re flying her to Germany tomorrow?” I worked on the other leg for a couple hours and we came back. She called me after the trip and said that immediately walking through the airport after only 15 feet, where normally she would have these symptoms of fatigue, she would have to sit down as she was having symptoms of a heart attack. After this treatment, she was walking around the airport without any fatigue whatsoever. After she returned from her trip, they flew her back to Chicago. We put her in a hotel room. What I did was spend 3 hours a day working on those muscles to bring back the spring mechanism and to remove the spasticity to allow the blood to flow down to the extremities. I think it took me about 12 treatments. You wouldn’t believe the day after I decided she reached maximum improvement with respect to every spasm removed from the human frame, she was working out with my athletes in the gym for 2 hours a day.
So, a lot of times we think that by medicating the patient with these cardiovascular problems, that that’s the answer because that’s what we’re taught. Unfortunately what we have to understand is that the heart is the pumping mechanism to the mechanical frame of which is either A: efficient, or B) it’s inefficient.
Because the problems with the mechanics of the body can cause spasticity and choke off the blood in the vital nutrients and the oxygen, which is required for human life, we have to look at this area here as one of the most important components to circulating the blood for vitality and for the cardiovascular function.
Not only that, the placement of the foot – when the foot actually lands on the ground. Either it lands in supination and goes to pronation with a healthy range or it goes to supination and rolls too far into pronation, it’s unhealthy. Too much rolling of the foot, we call it ‘overpronation’, setting up the spasms. If the foot is locked, what happens is we cannot project the foot forward any more. We have to turn it out because it’s locked. We have to roll our foot around the locked segment in order to be able to just walk. When we roll our foot out around the locked segment, which is in the metatarsal cuneiform area, what occurs is that we don’t get a good full contraction of the calf muscle allowing proper venous return to occur. Because we don’t get good venous return, the patient is fatigued and they have all kinds of health problems.
Here is the exact mechanism that occurs when the foot lands incorrectly. Here we see an internal rotation of the tibula and fibula as a unit and external rotation of the femur. As you can see, if the tibia and fibula are internally rotating and the femur is externally rotating, then there is a torquing occurring at the knee. Not only that, but there is also a misalignment of the patella in the trocheal groove; we call that ‘chondromalacia’ or ‘scraping patella syndrome’. Your patients will be reporting to you that they have a clicking or cracking in the knee upon ascending or descending stairs; or sometimes they just have a clicking or cracking of the knee all the time. The way you examine them is to lay them on their back and then articulate the knee with your hand over the patella to check to see if there is any cracking.
Sometimes I see a lot of problems with the foot, and then when I go to check the knee, there is no cracking. The reason why that occurs is because the patient has architecture in the knee genetically that allows the knee to articulate correctly without cracking just because of their genetic makeup. Even though you’ll see problems with the foot after we evaluate, you're going to see a lot of times in the patients that it doesn’t follow exactly perfect with respect to the knee cracking or the crepitus.
Here we see, for instance if we have a patient who has an injury to the foot, and it has not been done properly, we have a problem with the elastic recoil mechanism on one side. What can occur is that on this left photograph here, we see that we have a healthy kinematic chain on the planted foot or on the supportive leg.
On this side we see that because of the problems with the mechanics or the disruption of the foot, we have a weakness of the kinematic chain, which allows the opposite side to weaken and to fall. You can see this with your patients. All you have to do is have them stand up in the clinic and then have them stand on one foot and they are required to keep their chest or their breastbone in the center of the space. Sometimes I have a mirror and look into the mirror with them. We have a crease in the mirror and tell them to lift their leg and they're going like this and like that (swaying). I ask them if they’ve been to the bar before they came to the office and of course they say “No.”. That’s my joke for today.
Anyway, what they do a lot of times is they do this and they turn their foot like that and they try to cheat. Then they go like this. You can’t let them do that. You have to let them just keep their foot loose and then just hold their leg up like that. When I’m doing this, I’m checking the left side and the right side of course when you’re doing the other side. If we have a disruption of the mechanics of the foot, we have a disruption of the swivel mechanism of the lower back.
Then of course, these problems can lead to more serious ramifications such as hip and knee replacement. It’s interesting to me that in unshod cultures such as India and China in areas where there aren’t any footwear, they never heard of these hip joint and knee joint replacements.
It’s really sad to me that the other day I had a patient that came to me and said that she went to the doctor with some hip soreness. He took an x-ray and there was a little arthritis there. She was 55 and he said, “Well, here are some pain killers and you’ll probably need to have that hip replaced eventually.”
That’s the most pathetic evaluation and treatment I have ever heard. I mean could you imagine? You know, just give up and tell the patient they're going to eventually need a hip operation. What kind of treatment is that? I said “It’s absolutely ridiculous and don’t listen to that presentation. We’re going to work very hard to make sure you don’t have to have that operation, obviously.”
The doctor was not thinking about all the inflammation that was being released that caused the aging of the cellular and cellular damage: probably because he has not attended any of these Anti-aging Workshops. Right?
Here we have some of the exercises like single joint brace exercises that’s like being on training equipment and then sports-specific or multiple joint exercises which we’re going to see today and then Plyometrics.
Plyometrics has gotten a bad name over the years. Plyometrics is excellent because it’s eccentric training. It’s like jumping, hopping or skipping – we do that. Hopscotch is Plyometrics. Jumping rope is Plyometrics. Running is Plyometrics because running is a series of hops or jumps. So Plyometrics is jumping or hopping eccentric contraction. The reason why Plyometrics got a bad name is because some of the Olympic athletes and the trainers felt that more was better. A depth jump is like me jumping down from this platform down to the floor and then jumping back up perhaps, or jumping onto another platform. But they felt more was better. If this is good, then maybe we should jump up from 60 inches. Then athletes were getting injured. This goes back to the old days before we knew a lot more. Since then, we’ve made changes.
Like we mentioned yesterday, a single joint exercise like this, if this is all you're doing and you're neglecting to train the supination and pronation muscles – the muscles that do this, then of course this is a damaging exercise. It’s a dysfunctional exercise because it will eventually create an imbalance in the foot and then a break down to the kinematic chain. These are the exercises here.
What I like about a lot of my athletes is that they don’t question my advice. They don’t ask me why I should get on the ball and do this for a half hour for boxing. They don’t ask me, and that’s why they win championships. I've had a guy who won a world title and was the best ultimate fighter of mixed martial arts in the world start questioning the training tactics. I said, “Well, you’re a World Champion and everybody wants to be like you and wants to know what we’re doing with you. But you want to know what they're doing and they're not World Champions. I don’t understand that.”
What I always do for my athletes and my patients is that we train in our office without shoes on. That may seem strange to you because of hygiene. Well, I don’t know if you’ve been to health club where you wear gloves in the health club. You don’t wear gloves, you grab the weight with your hands and you walk around in the health club in our office with socks on and our shoes off to allow full expression of the movement of the joints of the foot.
This exercise, or these movements cannot be performed with footwear. It’s not possible. In fact, it’s impossible. That’s why we have so many problems with this area of our body. So we start with the foundation and train without footwear. This joint right here is called the subtalar joint. This is the joint that scientists have determined to be the cause of overpronation syndrome. The reason why is because it does not get any support. The reason it does not get any support is because we haven’t created a training program to develop this region here. There are not a lot of exercises for that area. We are always wearing footwear, so that does not help matters because what it does is fixate or locks up, restricts movement within that subtalar area.
Thus training with footwear is just illogical. It’s not logical thinking. When we’re doctors and understand all the very details of the anatomy, we have advanced knowledge over and above the personal trainers and the gurus of fitness that you see in the magazines. It’s about time we take over our practices and look after the betterment of the health of our patients by evaluating their training program to ensure that it has good balance with respect to the movement patterns of the joints.
We assume that these trainers and gurus that we are leaving in charge of our clients have enough knowledge and experience to guide our patients through their exercise programs, when in reality, maybe they don’t. We have to take a look at that. My advice to you to evaluate is that on Monday approach your patients and say “Why don’t you bring me a copy of your exercise program so I can take a look at it; because I want to make sure that it’s balanced and has what is necessary to keep you healthy.”
As a result in the arch area, the flexibility allows for maximum recoil. If this arch is flexible, then it will have the maximum absorption of shock. That absorption of energy is then reintegrated into the walking pattern to allow you to run without using so much energy from the big muscles. This arch actually will depress approximately 1 centimeter upon landing. That’s extremely important because if it does not, then we have to use accessory muscles in order to be able to do the work.
As a matter of fact, here is a very nice graphic of the arch. You can see how it depresses in the middle. As you can see right here, the tendons that are coming through the skin – that’s the tibialis posterior tendon that’s actually supporting the arch as it’s depressing. That’s a slow motion photograph of a landing of a foot. Actually, the athlete ran and I told him to land right on that line and the slow motion camera picked up the beautiful movement of the foot and was very surprised so see that.
As yesterday we talked about the excessive use of footwear and footwear like I’m wearing today which damages the foot. Here we have the adult foot, which never wore footwear, which we as doctors will never see in our lives because we all wear footwear. That’s the baby’s feet. Then on the bottom, as you can see the deformity of the feet as a result of the excessive wearing of shoes that cause damage to the feet. Here we see some exercises that I developed in my office to strengthen the movements of the cuff of muscles that are actually supporting the foot.
Exercise like this brings blood, oxygen and nutrients. I’ll tell you something. This is only 5 pounds of weight that is on the cable that comes out that you can see. It’s not easy to do this exercise. These exercises demand a lot of coordination. The most I've ever seen anyone do is 35 pounds, which was one of my professional basketball players.
Here is another exercise. This is called the scoop – the abduction/adduction movements. The scoop is what I call the “scoop and the wave” to the patient when those are inversion/eversion, abduction/adduction movements of the foot. These are very easy. These cuffs cost about $10 U.S. currency and are hooked up to a low pulley system and then you perform these movements. You get the picture.
Then we’re going to add some other exercises that have other components, which means hip abduction. That develops more coordination as well.
We’ll go through these very quickly. I think you get the picture. Make sure that their form and technique is good. We’re just warming up the patient in Phase II, that’s the yellow phase because we’re going to add more ballistic movements, or eccentric movements later coming up. And of course, you’ve seen this. This is just the balance board – pass board. What’s really remarkable is that personal trainers and physical therapists use this board to be able to better develop balance reflex in patients after an ankle injury. Well why is it that after the ankle injury has been repaired, we don’t need those balance reflexes any more?
My patients are required to do this every single day. My athletes are required to do this exercise every single day as well. Because all of a sudden, we don’t need balance tomorrow? We need balance every day. What we’re going to do is let’s just say we are training an athlete who is going to compete in a boxing match with 20,000 people in the room, and there are all kinds of cameras panning and there is screaming, heckling and yelling – what we’re going to do is turn on some music as a distraction. Then in fact we’re going to put them on the balance board and add another component by throwing playing cards to have them perform an activity while they're actually on the balance board.
We can increase the amount of complexity of the training each time with these types of movements. This is called the BOSU ball. It’s very good for providing different types of surfaces that will challenge the foot.
This is the most important piece of equipment, but less used. In fact, I surveyed five health clubs in my region and only one health club had it. They had this piece of equipment and they think they were hanging their laundry on it. In fact, this is the most important piece of equipment. Why is it not used much? Because it does not develop the exercises for the muscles that you can see.
If anatomy was so simple, we should only exercise the muscles that make us look good. That’s not anti-aging medicine.
Here’s adduction. Notice the foot position. The foot position must be maintained forward at all times. So like I said, Plyometrics involves acceleration and deceleration. Like I said, Plyometrics training could be as simple as a basic hopscotch. What we’re going to do in this situation is use the camera to evaluate the running movement. On the left, we see good foot position. On the right, we see a toe-out. Here we have a simple exercise where all I’m asking the athlete to do is run in a circle. That may seem silly, but in fact, if you look at the movement of the feet, the feet are actually required to move in a way that demands a lot of balance and coordination.
Then we make it easier by setting up the figure 8 pattern. By changing directions, we’re actually moving, working the inside and outside muscles of the ankle and the foot. While these are very simple, that makes everything very easy for you as a doctor.
Well you say, set up a figure 8 type of thing in your back yard and perform these drills. Of course, my daughter is here in the second row, and she’s playing her Nintendo game while I’m doing my presentation. When she says, “Let’s go out and play tag in the park.” I’m not going to deny her of that because I know I need those free plays. According to the National Academy of Science for Children, they said that children require one hour of free play, which is running around without structure. Then one hour of structured play per day. Now what happens when we become adults? I think we need more than an hour.
In this situation, we have some drills that will help us to get that out of the way a little faster. Here we are going to add a little complexity. We’re going to ask the athlete to actually touch these scones, which demands that their body be put in a position, which has to have more balance, coordination and agility and then these seem very simple. But as you can see, as the height of the cone is higher and here it’s lower the body has to assume a more angular position during those training movements that will require increased balance. Here we have an exercise where we’re hopping in an 8-point pattern. It demands that you have good agility.
We can also ask that the athlete touch the cone at the end, which means that their foot placement has to be perfect, and their hand placement as well.
Therefore, we’re adding these coordination and agility movements to the training. Here we have the single hop with double foot plant. That means that he’s hopping from side to side which demands good coordination and strength in the outer hip area. These are movements that we don’t do in daily life and that’s why they're so vitally important. Then were going to increase the complexity by hopping from two feet to one foot. Also, it requires having strength to be able to hold up the body with one foot landing. Here we have a single response stabilization just hopping over a cone. Then of course I asked the patient to stop in mid air like that. – No I’m just kidding.
Here we have multiple response hops, which demand that the placement of their feet is perfect and that they are working their muscles, and also that eccentric loading of the foot upon landing is very important to developing the elastic recoil mechanism of the foot.
Here the patient is actually doing this with shoes on. In reality, they're done without shoes. The person I hired to do it for me did this in another facility that did not allow us to do this with shoes off.
Like I said, this is called Ricochet, which develops the muscles of the ankles and the hips, as well as coordination. See how he’s moving his upper body. It’s called the Ricochet Jump.
Now these exercises may seem simple. These are the exercises that I learned from the world- the top track and field coaches that I have come in contact with and integrated into my program. It’s called ‘Ricochet Box Jumps. Like I said, these are very simple exercises that you can teach your patients. A 70-year-old person can do them.
This is called the Obstacle Course. You can do this with your children in the back yard. Here we have different movements from side to side, forward and then these are done slowly for you to see. Actually you should time them.
So obstacle courses and these types of exercises can be done by your patients in family-type activities to make them fun. If these exercises not fun, they're just not going to do them. You can recommend them to do that so they can develop this recoil system in the foot so they will have better energy, better balance, agility and coordination.
Here are some simple training exercises that you can do, such as Pilates, obviously. Also, Martial arts for children and for you are very good.
As I said before, I want to thank you very much. Live your life as a champion. Go ahead and seek out the best! With that I’d like to thank you all for coming to the workshop.
We’re going to convene down here for a hands-on demonstration of what techniques I use to reestablish the elastic recoil mechanism in the foot and how I manipulate and work with the lower extremity to establish this recoil mechanism.
By the way, from what I can see, I think this is the first that I’ve ever seen. I've taught this technique to approximately 20,000 doctors and scientists all over the world. We have a nice small group here, so you’ll have the advantage of seeing it a lot closer. If you’d like to come up, we’ll take a look. It’s basically the first non-orthotic treatment for fallen arches or that type of condition.
(If I can have some help here, we’re going to bring this down. Lower where I can get to it.)
Okay, come on down. Don’t be shy.
Who has a knee pain on one side that bothers them everyday? Anybody? Let’s do this: why don’t you take off your shoes? What we’re going to do is find out which knee it is. Don’t tell me which knee the pain is in. Now roll your pants up over your knees so they stay. Okay, the other one now. What I’m going to do is have you walk about 10 feet that way. Okay, come on back. There is more of what we call pronation on the right side than the left, but they're both bad. The right side is worse? Yes, the right side. Right? See how easy? I’ve done this so many times.
But anyway, what you're going to do is stand over here so they can see. We’re looking at the second toe here to determine whether this ankle and this foot are lined up properly. We can see that her feet are kind of like this – we call it “pronated”. That’s a static pronation. But when I saw her walk, I saw that her foot dropped and then rolled excessively inward which causes damage and problems to the knee. I’m going to have you take off your socks,
You have some pain in your left knee there also, right? Just more on the right? Right? So that was easy. That would be $100. No.
Here, lay on your back, there. There you go. Lay nice and comfortable and we’ll have a TV brought in for you to relax and watch. We’ll make sure that this is sturdy. Okay, go ahead and lie down. Do you know why she has the knee pain? It’s because this big rock on her finger is heavy on the right side, and not on the left. See, women! – Men would just take off the big rock on this side. Women would ask for another rock for the other side to balance the other side. Right? Isn’t that what you ladies would do?
Now as we look at the foot, the first thing we’re going to look at is how this big toe is situated. When you walk all the weight is on the first toe and the second toe and these three are guides. They just guide the foot. Usually when I evaluate feet, what I’m finding is that we never have a problem in these three toes. It’s very rare. We always have a problem here in this toe right here. The first thing I want to look at is the position of the first toe. As I mentioned to you as you saw a picture of the normal foot, it should have separation between the toes. They should actually be like this; that’s not very sexy for ladies to have your feet laid out like that, but that’s what’s healthy. The reason why her toes are too close together is because she’s been wearing shoes for too long and they're crunched in and they re not separated any more. That makes the foot actually a smaller landing surface, which is not good for balance. It’s a smaller landing surface. Okay?
The next thing I want to look at is the subtalar joint. The subtalar joint finds its attachment you can find the little groove right here where the Achilles tendon attaches and she’s wincing because that’s painful. If her foot is turned like this when she walks, then there’s going to be damage to the subtalar joint right here. So when I put my thumb right here it’s going to be painful right? How much pain on a scale of 1 to 10? Six? Seven? Okay. I pushed a little harder. Right here, there’s a little pain here too, right? As we’re following the path of the subtalar joint which is right in this area, right? It’s sore and then right here? Right? Not as bad, though? Right? Maybe? Kind of just a little bit? Okay.
Now when I’m going to check the integrity of the subtalar joint, I’m going to get a hold of the calcaneus here and do a little tugging to see how it feels. It’s a little stiff. What you're going to feel is a little (crack-crack) separation. That’s abnormal. What’s normal is that it is tight because the ligaments are still healthy and they're holding the joint. So the evaluation of this is shows there’s a little clicking in this area right here and that’s painful.
Now, what I’m going to do is treat that. It may seem strange but this is how I’m treating it. I’m going to apply pressure to the joint. In the beginning it hurt a lot, didn’t it? Now it’s starting to melt away? Isn’t it? What’s the pain level at now? It went down quickly, didn’t it? Now it’s still going down, right? I’m working with a mild tactic reflex that parallels the muscle in the connective tissue. What we’re doing is reorganizing reflexes in the brain. We’re kind of tricking the brain.
Still sore? It’s gone. The pain is gone now. Now if I apply pressure along this joint all the way along here, and do your Tai Chi like this, “I don’t feel the pain. It feels good.” Yes.
My daughter would rather I not act, right? No rapping or acting, right? Still a little sore, but it’s going away, right? What’s the pain level at now? It was about a six (6), before, right? What she’s feeling is the actual pain melting away. What I feel is a reduction in the tension of the muscle of the connective tissue. It’s almost gone, right? Okay. And right here, some pain, right? I think you're getting the idea. I’m treating the subtalar joint. I’m going to go around to the opposite side and treat the other side, but I’m going to use this foot so you can see it better.
What this does is allows this joint to move more freely the way it was designed to move. So we are reestablishing the biomechanics of the foot. I will tell you that it’s a beautiful thing – it’s powerful. When I work on this area for the patient, what happens is that when you lose elastic recoil, first of all, you don’t get that bouncing effect from the foot, which adds zip to the foot. The second thing you have to do is use bigger muscles to just do very basic movements.
I find that patients are tired all day, they drink coffee or tea just to stay awake and they're almost completely exhausted around 8:00 P.M. and they're ready for bed, but they have massive insomnia. They have insomnia because their mind is not tired; only their joints are tired. The other thing is that these muscles are big muscles. These in here are the biggest muscles of the body. While they're sleeping at night, these muscles are continually contracting, taking away energy from the body. So when they wake up in the morning, they are already beginning the day exhausted. Then they're trying to get through the day and by the time they get started they're still tired.
You're going to do a lot of blood work on them and wonder why they're tired all the time. You know what happens? They get tired of going for blood work and they don’t get the answers and turn to amphetamines and higher stronger stimulants to keep them awake. They sometimes end up on stimulants.
Still sore? Okay. Now wiggle your foot around and see how that feels.
(Laughter) How does it feel, though? It feels good, right? Yeah, it feels different from this one. This feels a lot looser, right. It took me like 4 minutes to do. As you can see, I worked on the outside, so what we’re going to do is repeat the same thing on the inside and just come up along where that groove is where the Achilles tendon attaches. Get the pad on my thumb right on it and hit it. There you go. This is when I usually ask them where they buried the money and to confess to me everything. Right? If they haven’t given me their insurance card, I usually get it at this point. – I’m just kidding. Does that hurt you? It’s starting to go down, right?
What would happen if I worked both sides of the joint on the right lower extremity? I only worked one side. She still felt better. But if I worked both sides she’d really feel better and it’s quick. Still sore? But it was about an 8 before. Pretty painful? Eleven , right? Out of 10. Okay. We’re going to work our way. Now see the depression here? That’s a pitting edema. That’s because there’s a lot of swelling there. But I bet you didn’t think there was any? But look at all that swelling. See that? Her leg and ankle are swollen. They're full of inflammation. Her tissues are bathing in inflammation from these joint problems.
I remember when my daughter was chasing me around the park and I tripped and fell and hit my knee very hard. The next week my ankle was black and blue. But I didn’t hurt my ankle. It’s because the blood seeped down to my ankle and collected there. That’s what you're going to find with these patients. When they have hip pain, they have knee pain and inflammation of these joints and that inflammation seeps down through the tissue and it collects in the ankle.
So you're feeling the pain going away right? Is it almost gone? Very good, right?
Yeah.
Now you can see that it’s - one more spot here. This is the subtalar joint. This is how we treat the subtalar joint. You can do this on yourself. Because, doctors if you're on your feet for a long period of time, you’re going to get sore and stiff and have joint problems. You have to take care of yourselves so you can live longer to take care of your patients. Still sore? Good.
Anyway, that’s how you fix the subtalar joint. When the ankle actually rolls like when it plants, and it rolls in like this what happens is the talus joint will slide medially. So the adjustment that we used for that is kind of tricky. What I do is use my middle finger right on the talus and then roll the foot out like this and just give it a little tug like that. There we go. Sometimes it makes a nice audible release and we can actually set the talus adjustment. There it goes. Let me bring you right up there. She’s kind of tiny. Anyway, it’s important to set that talus bone. It releases and allows the joints to move more freely, thus improves the elastic recoil.
The next thing is that to use this foot, what you're going to find is that all the musculature around the medial aspect of the big toe – here we have a bunion. Let’s just start off with some of the articulate things. First of all what you’re going to find is that right up here at the metatarsal cuneiform joint - if you run your finger across this bone you're going to feel a little lump here. Not too bad on this side. Let me check the other side. This one is a little bigger.
Here, come on up for a minute: I’m going to show you. Let me have your hand here. Just go gently along the edge of this bone. Do you feel that little bump right there? What do you feel? It’s a bump, right? Yes. Okay. Want to come up and feel it? Come on up. Just run your finger along right about right here? Do you feel it? Like a little bump right there? That’s a calcium deposit on the metatarsal cuneiform joint of the big toe. What happens with the foot is that because the big toe is out on its own and it’s not, the second toe is between the first and third, so it’s locked in there pretty good. The big toe is out on its own a little bit, so that when you roll around it, that’s why the big toe turns off medially. That’s why we have this medial deviation of the big toe.
Also, it gets kind of manipulative on its own through walking, but it becomes damaged and usually the locking of the big toe- you're going to find that there’s going to be a locking about right here. Mostly right about right there where it joins up to the medial aspect where the big toe actually attaches to the cuneiform joints. First and second are here. So what we are doing is actually – first we’re going to start on the inside of the big toe and apply pressure. The Chinese human inch is a thumb pad. I make sure that I get full treatment of this area by just going up one pad. Now it’s going to be painful there, right? It does not hurt me any. I don’t know. See, what you have to do is develop part of training patients. I feel you have to have a decent bedside manner. What I mean by bedside manner is that when you're putting pain on these patients, you have to have a few jokes. Otherwise, they don’t like you. No, I’m kidding. It’s nice to make them laugh a little bit when they're going through the pain. Otherwise, it’s just not a good feeling. It’s starting to go away, right?
What’s the pain level now? About a one. What’s going to happen is I’m going to go up along the medial aspect of the big toe. The next place I’m going to work is right underneath the big toe. What I do is place my hand here and put their foot here in my stomach and I get a hold of it. Apply pressure there. She has a lot of pain there. The reason she has a lot of pain is because I’m right underneath the area of fixation. I’m right underneath the metatarsal cuneiform joint. Like I said, the spring mechanism of the foot is vital to energy efficiency and power and speed as well as your patients are tired. When we get underneath there, we’re going to find that’s going to be very painful, but it’s going to go away. Right?
Now, the problem is the patient will actually tell you that the pain is gone. You have to go down until you feel nothing. Otherwise, you just irritate the muscle if you don’t bring it down to where you feel nothing. They're going to be sore tomorrow. With this treatment, its amazing that all this manipulation of painful muscles they absolutely feel no pain the next day. It is pain free. During the treatment there is some pain. I always tell the patient, “Look, if you go to a doctor and they don’t work on your painful muscles, they're not doing anything for you. They are wasting your time. Because if you don’t work on that patients painful muscles, what exactly are you doing? Nothing is going to change. Still sore? Okay. And one more right here. She has a small foot; that makes it a lot faster. You have to do a lot more for some people with big feet. Is there pain there? About a 3. Good. But the other one was about a 9, right? Very painful. Okay.
Now, since I've removed the spasm along this side and this side, I have to go between the toes, so I am going to get that real vital point that I've always found on patients, which is the lateral aspect of the metatarsal cuneiform joint of the first digit. Right?
This by far will be the most painful area of the patient. It’s the lateral aspect of the metatarsal cuneiform joint. It’s very, very painful. The reason is because the medial aspect actually moves better because it’s being manipulated with every walking step. But this remains locked because the movement does not – it just locks and you can’t manipulate it by just walking. She’s doing a good job, though. She’s getting into a zone trying to release the pain. It’s almost gone, right?
As a vote of encouragement, I’ll tell her that tomorrow she’ll have less pain during the treatment and it will go away a lot faster. I’ve found that after three or four treatments, the pain is the same for the first three or four treatments, but by the fourth treatment its going away faster, by the fifth treatment, there is maybe only 30% of the pain from previously. By the sixth treatment, all the hip muscle spasms are gone; all the Tensor fasciae latae spasms are gone. We’re only working from 6 to 10 treatments on the lateral aspect of the fibula, which is the tibialis posterior and a few muscles in here and then by the 10th treatment, they don’t feel a thing. Every single restriction is gone. Period.
Unless you feel it, the only reason why it’s not gone is because they're not wearing good shoes. Still sore? Okay
Now the last one is where we’re going to go between the big toe and the two toes and we put our thumb on an angle like that. Get up between them, apply pressure right here and try to get between them. It’s really painful. It does not hurt me at all. And if they laugh during the painful areas, you have to refer them to a psychologist, because they are crazy. Anybody that laughs during pain, they are a little coo-coo. Just kidding.
Still sore right there? It was like really painful before. Now it’s good.
Now what I’m going to do is manipulation of the big toe, which is very easy. But the second one is not because it’s between the two so we have to get a hold of it. We get a hold of the foot on the cuneiform side and get a hold of it on the metatarsal side. Hear it clicking? Come up here and feel this. Get a hold of the big toe. Just kind of wiggle it back and forth. Feel it clicking? Come on up here. Just the big toe. Just wiggle it back and forth. A little bit more. Whoa, he just did it. Yeah! Congratulations. Let’s give him a big round of applause. He just did it. That’s good. So you just did your first round of manipulation. Did you feel it move? What happened was that he just set the bone. Are you licensed to do that? No, I’m kidding. Did you feel it move? Now that’s less right? Yeah, you actually set that bone very nicely. There wasn’t much to it.
To get a hold of the second one, you get your PIZA form right over the top of it if you can and you work it a little bit harder. That doesn’t hurt you, right? Ooh, there it goes, did you feel it crack? There it goes. There it goes again. What you have to understand, like I said, if she weighs 90 pounds, and if she’s running that’s 450 pounds of pressure on the foot. You can manipulate this foot pretty good without hurting it and you're not going to break any bones or hurt anything. You have to give it a good adjustment. You have to really work it because this is used to a lot of pressure, so you can work it pretty good. A little sore, right? I didn’t really do enough of soft tissue with her. Ah, there it goes again. Then I’m doing a little twisting movement here to get it moving a little better. Then what I’d like you to do is just take a little walk and see how that feels now. Go ahead. Just walk. Keep your foot and your shins loose as you walk. Feel a little better? Clicking? What’s going to happen is once she starts walking all the reflexes will be reset in the whole body from the foot. Okay. It feels a little better, right?
Okay, lay on your back here one more time. All right, I can fix that for you. Now, like I mentioned before, the tibialis posterior has the three-prong attachment right here on the bottom of the foot on the metatarsal cuneiform joint. What it does is comes around medially around this malleolus. These malleolus are like pulleys. Muscles actually loop around them in these grooves important muscles and so this muscle is located right here and it comes around in back of the calf and it’s along the edge of the fibula.
She has this patch? Do you know what that is? I see, a de-toxin patch. Toxins. Now, feel the pain right there? Yes, you’re going to feel some pain right here. You can do it standing up which is tougher. And you get up underneath there. Do you feel that? Feel that pain right there? It feels like a rope. That patch is unfortunately not going to help you. You get a hold of it and it hurts like heck. It’s just going to go down like all the other muscles. You get the idea. So we bust up all the spasticity along the kinematic chain.
I will tell you that if you have 1,000 lower back patients with lower back pain, that 1,000 will have this pattern of spasm. I’m not kidding you. It’s just repeated over and over again and the same problem here: The reason why I think that the Swiss ball and those exercises for the abs to fix the back are very nice. However, engineers would not look at it that way and I definitely would not look at it that way. I just cannot see the point in working out the sixth floor when we have a problem in the fifth floor. When you look at the body, we have the two legs and the hip attachments.
What happens below the spine is really what’s important when we’re trying to correct back problems or any type of problems above the foot. If you don’t look at these joints, I’m telling you, I can’t do that with a clear conscience any more to treat the spine or anything, i.e., herniated disc or this type of problems. I cannot with a clear conscience just treat the spine anymore. Its just not possible I can’t do it anymor
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