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| Transcript Tokyo, Japan June 16-18, 2006 |
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Abnormal Biomechanics & Anti-Aging Process
AISET 2006
June 16 - 18, 2006
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. First of all I want to thank the organizers of the conference for inviting me. It's quite an honor. I'm going to try to give you the most accurate information that you can not only learn from and expand upon in your practice, doctors, but also for the general public that's here. I'm hoping that on Monday, when you get back home, that you'll be able to use some of the advice that I give you to help prevent some pains and abnormal aging.
First of all, this presentation will be given in two parts. Part one will be about the problem and how to diagnose it or find it and its ramifications. Part two will be discussed in the morning, as I'm co-presenting with Dr. Goldman, the President of the Association, in Room C at 9:00 A.M.
There you'll be able to get an idea of exactly how I go about treating the patients. So, it'll be a hands-on workshop with an emphasis of demonstration of how these techniques work. (Now, if only I could figure out how the gentleman set up the computer here.)
Basically, Anti-aging Medicine is quite different from the way we are practicing now. It's an extension of prevention health and it is a practice, which I enjoy because it's the form of medicine that's based on the earliest detection and prevention and reversal of age-related diseases.
As you know, 90% of all degenerative processes in the body are a result of things that we can actually correct if we are able to get at them soon enough. As a doctor I don't find it enjoyable to talk to a patient and after having evaluated them and taken x-rays, find that there is no longer any joint surface left in the hip socket; that we have to tell the patient that they have to have a hip replacement surgery because we as doctors didn't do what we were supposed to do for the patient in their 20's and 30's.
So, it's important that there are things that we can do now to prevent these age-related diseases, and that's what I'm going to do now. Like Dr. Atsumi's comment, "In Anti-aging Medicine it's a combination of holistic and integrative medicine for the betterment of the patient in sort of a Team Care Preventive approach." I really like that comment the doctor made yesterday.
As I took my notes, nature is what governs whether we're going to have a healthy life or not, and technology. Tthose doctors who embrace nature are the ones that are closest to nature understanding exactly how the body works from a closer advantage point as opposed to technology, which is a very nice tool to be able to look into the body and to diagnose what is wrong with the patient. Those doctors that embrace nature are not necessarily rewarded financially as those who embrace technology. Some sort of a merger in between will help. My presentation will be primarily about using nature.
One of the factors that I gained from Dr. Atsumi's talk was about the removal of disturbing factors. Removal of disturbing factors, or activating the body's healing potential, and that's something that we as doctors sometimes overlook.
You can give all the growth hormone, treatments and medication and technological treatments; however, if a person has a sore knee, they're not going to be able to exercise, and therefore, those growth hormone treatments are of no value to the patient.
What I'm going to talk about today is the study of biomechanics and the study of biomechanics in the area of wear and tear. Degenerative arthritis and ailments of the human musculoskeletal system is in my opinion, the way that we can determine the earliest way to detect degenerative joint disease. And those types of illnesses of wear and tear that create this chronic inflammation – or silent inflammation that Dr. Barry Sears and the other doctors talked about – that not only musculoskeletal diseases, but also systemic diseases from Interleukin 6 and some of the other biomarkers of inflammation that the other doctors talked about.
Thus, biomechanics, in my opinion, is one of the earliest ways of detection of accelerated aging of the frame. With the study of biomechanics, I can actually predict for you by watching the way you walk where accelerated aging will occur. Being a doctor astute in the sports medicine field, I treat approximately 200 professional athletes and top-recording artists, Broadway performers in my practice every year. My main objective is to have the patient walk back and forth in my office observing the method of which the joints move through the space to determine where these abnormal movements will occur.
Because we take approximately 10,000 steps per day, any subtle changes, and minor changes in the movement patterns in the joints can cause significant wear and tear and release of this inflammation. This ia the systemic inflammation the doctors have spoken about that will accelerate the aging process creating more disease.
Patients with abnormal biomechanics: We have stated these aches and pains that we're talking about and that we suffer from every day. Ladies with your sore feet with the high heels and men with the aching back and problems that just don't seem to go away, these chronic conditions can set off a chain reaction of inflammation and diabetes.
You heard all the talks this weekend about all the systemic problems that stem from inflammation. The American Heart Association, Center of Disease and Control has come out with a position paper stating that these inflammatory biomarkers are actually more accurate than most other biomarkers we used to use, such as blood fats to determine whether or not the patient is aging.
Biomechanics is very useful to the anti-aging doctor. It unites the science of engineering with the science of biology and its analysis of human motion. You can detect abnormal movement patterns by way of just observing the patient, but there are far more sophisticated methods of observing movement patterns in patients through the use of videotaping and other methods.
These movement patterns are broken down into two specific methods. They're called "generalized movement patterns". Generalized movement patterns are those that are developed in childhood. Tiger Woods is a professional golfer whom we all know who developed this generalized movement pattern. His golf swing was analyzed to our walking. It was so engrained into his nervous system that it wasn't difficult for him to play the game of golf and beat all the other opponents. His generalized movement pattern, when he became a professional golfer was so precise and accurate that at an early age he won all the tournaments.
One day he decided that this generalized movement pattern that was renowned in the golf world as one of the greatest golf swings of all time; he then decided it wasn't good enough. So after winning many tournaments, he decided to change his golf swing, which others thought was perfect and make it better. During that time, he didn't win as many tournaments; because he was going from a generalized movement pattern or a movement pattern that was something he didn't even have to think about. He didn't have to give it much thought and still the golf ball went straight where he wanted to put it, to a movement pattern that was changing. He was retraining his golf swing to become a better golf swing. And after 2 years he started to win the majors again. He then said, "Now I feel as if I'm in the pattern. I'm in the zone."
It's because his golf swing that changed became part of his brain function – a generalized movement pattern that was now a part of his normal daily life. In our bodies and in our practices,-my practice specially, as I watch patients walk through the hallway, I can see that they have generalized movement patterns that are causing damage to their joints and they don't realize it. And you know, patients find it odd that I tell them that after I am going to correct the abnormal biomechanics with my hands. Essentially what I'm doing in my treatment is completely rebuilding the patient's lower half of their body by hand. It takes 10 or 12 hours of detailed hands-on work to rebuild their framework completely by hand. Afterwards, there's not a single muscle spasm in the entire framework, and the joints are moving as close to perfect as possible.
That is the demand that is placed on a sports medicine doctor who practices on athletes that are lifting 900 or 1,000 pounds – 400 or 500 kilos with their body.
Arthritis is the most common disease of the elderly – 43 million in the United States and it's from mechanical problems: the majority of them, 50% by midlife, and 80% by the 7th decade. Why? Like I said before, because we're not catching these abnormal movement patterns when our patients -you folks –are in their 20's, 30's and even younger.
An astute doctor in Anti-aging Medicine does not wait for the pain. As Dr. Sears talked about yesterday. I took a lot of notes from his presentation. Silent inflammation: Patients will come to me for back pain or a herniated disc shooting down the leg. I evaluate them and I find out that they have some painful muscle spasms underneath the big toe and into the outside of the calf between the bones of the calf by pressing on their muscles with my hands. Of course, they didn't know they had the pain there. That's called "sub clinical pain".
But it still means that there's abnormal stress and strain placed on that joint. Except it does not appear as what we call as doctors' clinical pain, but it still produces the inflammation, or what we call silent inflammation that Dr. Sears speaks about in his talk.
What are some of the problems that we're experiencing as a generation? First of all, this generation that we're living in is a very modern and high-tech generation. Sometimes as doctors we have to realize that there are a lot of medical problems that are avoidable. First of all, I got a kick out of going to Malaysia last month. When I went to the bathroom in the hotel, I was looking for the plunger to flush the toilet and it was done automatically, as if I was too weak to press the button. And all the escalators in the shopping mall bring us to the second floor without our having to do so. The floors are hard concrete. These types of modern, high-tech environments that are trying to save time for us are actually creating problems in our joints.
More and more women were exercising during the exercise craze in the 60's and 70's. There was an emphasis mainly on appearance, and not necessarily on biomechanics. As we adopt more of the Western diet, which I don't like – I am more of a sushi fan – we are developing more obesity, which places more pressure on the arches that are our foundation of our frame.
There are other reasons why we hare having problems with our joints. A study by Rush Presbyterian St. Luke's in Chicago stated that several patients who had problems with their joint of the knee – pain in the knee were given anti inflammatories and painkillers. After they retested them, it was found that they put more load, more pressure on the knee that was once painful.
So sometimes using the painkillers is actually counter-productive rather than going through the biomechanics route. The foot biomechanics I'm going to talk about specifically because this is kind of my expertise, even though I'm a chiropractor and the foot biomechanics are the foundation. The foot is the foundation for our frame. Any type of abnormal problem in the foot will translate stresses and strains throughout the entire body.
So, it will make it easy on you. There are two abnormal movement patterns: abnormal or over-supination, which only represents 8% of the population and abnormal or over-pronation, which represents 92% of the population. When we look at this picture, we see two athletes running. Each athlete has a different presentation to the foot as it lands through the running.
I was with a group of doctors Thursday night giving a presentation, and I asked the doctors which athlete they felt was abnormal. One doctor said left and another doctor said right; I tricked them. They're both normal. The patient on your right is in abnormal pronation and the athlete on the left is in normal supination. These are normal movement patterns that the foot goes through during the walking. It first starts as supination; the foot rolls over in pronation and pushes off. So depending on what phase of the walking the patient is in, will determine what position the foot is in.
Weak ankles: In the medical research, there are a total of approximately 160 research papers published on over pronation syndrome or abnormal movement patterns of the foot. This is very disappointing by the way, because there are 10,000 or 20,000 articles on usage of anti-inflammatory. The over pronation syndrome or poor movement in your foot is the reason for excessive wear and tear which is the very cause of arthritis and inflammation. In other words there are 160 articles on the cause of the arthritis and 20,000 articles on drugs to treat the inflammation but few on the cause. No wonder we have so many chronic arthritic patients. It's all propelled by the desire to make money on the next anti-inflammatory drug.
When doctors and scientists talk about abnormal movement in the foot in the research papers their focus is on something called excessive "subtalar motion". That's when you see a person walking, where the foot seems to be collapsed. You might call it weak ankles. I will show you a picture so you can see better.
As you can see from this drawing, the arrows will point towards the abnormal movement pattern. The dark arrow is the abnormal subtalar excessive movement. The foot elongates or lengthens, and the upper arrow shows that when the foot collapses or has excessive subtalar motion, the tibia and fibula, or the lower leg will twist causing a chain reaction of twisting up the lower extremity, into the back and through the entire framework of the body. So as you can see, this common ailment affects a large majority of you in the audience. It can cause a wave of destruction through your joints causing you to have aches and pains and release of inflammation.
The piece of the puzzle that was always missing from the literature when I read through it was: How is it that the calcaneus collapses inwards or goes into a valgus position? How does the excessive subtalar motion occur? If we don't know how it occurs, then we can't practice early detection and prevention.
Therefore, we need to look at the arch to understand how it works to figure that out. As you can see from this picture, this is the arch and it's very springy. And if you can see when we step down, the arch absorbs the shock through the spring mechanism of the arch, which is a very flexible structure. It's like a truss. When you step off with your foot, it unloads all that energy and your body is proposed through that space. Having a strong spring mechanism in your arch is what will give you the speed and the power in sports. It will allow you to walk through the shopping mall for 6 hours, instead of being tired after 2 hours with achy calves and feet. It will allow you to stand on your feet longer without having backaches.
This arch is extremely important. It's an energy saving advancement and it is an engineering marvel that we cannot ignore what happens. The pathology is when the arch drops and locks because there are muscles that support the arch that are not the favorite or the popular muscles. They have names like "tibialis posterior" and "peroneal muscles" and muscles that are not Hollywood muscles, or muscles that are not brought up in regular conversations in daily life.
When these muscles fatigue from standing on our feet, these muscles have an ability to hold us standing for 3 or 4 hours. Then if it exceeds the aerobic capacity, the arch will drop. It will lock, and then if it locks permanently, you'll have abnormal movement patterns in your feet for the rest of your life if not corrected properly.
The evidence of this locking and the arthritic changes that occur are evidenced in this picture. You can see right there: a calcium spur and a bump on the mid portion of the arch. I find that calcification, calcium deposit on many, many of my patients who have pronation problems. Arthritis occurs in the mid arch area and the arch actually no longer has the springy movement that it's supposed to have for proper walking. Instead, it has an abnormal movement pattern that uses up more energy and makes you tired and creates inflammatory conditions all the way up the kinematic chain of bones.
These muscles have to be evaluated – the tibialis posterior. This is looking at the foot from behind like this. I always remember as a child, we wanted to have a strong way of lifting our friends over a fence. We would interlock our hands and they would step in the hands and we would lift them over the fence. And that's the same exact way that this muscle group acts. I coined the word "pronator/supinator cuff" because it's much like the rotator cuff in the shoulder that pulls the shoulder solid while the power muscles do the activity like the boxing or washing the dishes or whatever activity the shoulder does. So these muscles are supportive muscles, not very popular in exercise fitness magazines that we read from the newsstand, but they're extremely important in maintaining the delicate balance between pronation and supination.
As you can see, this is one of the most important muscles; it's called the "tibialis posterior". In fact, there's even a syndrome, called "the Tibialis Posterior Tendon Dysfunction Syndrome". (I'm sorry to my translator; I hope I'm not going too fast.) But this muscle – how interesting – as it attaches at the mid arch at the metatarsal cuneiform joint area.
It supports the springiness of the arch. So, that muscle never gets exercised as we age because we're too busy. We don't have time. We're tired. We don't want to go to the health club, etcetera. However, even if you went to the health club, I will tell you that there are no exercise machines that exercise these muscles in this direction. There are a lot of Hollywood magazines; fitness gurus and fitness experts who only exercise the muscles that make you look beautiful, handsome and strong.
But in reality, you will be strong until the breakdown of your arch occurs and the entire structure collapses. Then you're going to need to find someone with a very intimate knowledge of how to treat it, because it's very difficult.
How soon does this aging process occur? Children actually get their arch developed in the first and second year, and it's helpful with shoes that support the foot. Patients as young as 2, 3, and 4 years old will go to the doctor saying they have aches and pains, and if you are writing it off as growing pains, or saying don't worry about it, without first checking the patient – the young boy, the young girl's foot, then you're making a mistake. They should be evaluated and placed in proper footwear and encouraged to exercise. When excessive pronation occurs, when the foot plants with a locked arch, then the tibia or the lower leg will twist at 20 degrees in less than a tenth of a second. It causes compensating damages.
Some of the symptoms that are related to this problem are shin splints, heel spurs, bunions, ankle pain, calf spasms, and muscle spasms in the leg and Achilles tendons tears in sports. When the muscles that support the arch of the foot become stiff, then what happens is the load is transferred to the Achilles tendon and it snaps. When the foot plants, and has abnormal movement, the upper leg will twist. That causes misalignment or bad alignment on the kneecap on the knee and you have pain around the kneecap. Your hips and legs are tired. Your hips are arthritic and you have lower back pain and your back has chronic backaches. It is so simple; you should look toward the foot as a possibility.
It is so simple: this is not rocket science. The body is like a building; it has a foundation. If the foundation is not leveled and springy, then you will have difficulty in healing the other floors. Other physicians in Chicago refer patients to me. I'm a chiropractor. That's how it works there. They are not able to take care of the herniated disc and the sciatica.
In the United States, HMO plans are looking for the best option on the treatment and certainly chiropractic treatments or treatments that don't demand surgical, sweet costs are better priced. Also the outcome: if the outcome is good, they will go ahead and refer the patient.
What I found is that where the mistakes have been made with the previous practitioners, is that they overlooked or they did not look to the floors beneath the back to see the abnormal movement pattern that actually didn't allow the disc to heal. As the doctor said in his talk, removing disturbances that didn't allow the body to heal is exactly what I'm talking about. If the foot plants with more of a jarring force, that will not allow a proper environment to heal. (How much time?)
These are pictures of herniated discs. If you sprain your ankle, your ankle will heal in 2 to 3 weeks, given the right environment. If you sprain your disc in your back, given the right environment below the disc, the disc will heal.
What I found in my practice, is that there is a direct correlation between lower back pain and herniated discs that don't heal and pronation syndrome, or locking of the foot. In other words, if a patient has back pain on the right, with sciatica on the right, they have more positive advanced findings of pronation syndrome on the right.
What happens if this is left undetected untreated is it creates a spiraling, downward effect of your health. The weak pronator muscles, supinator muscles that don't support the arch will cause the arch to drop and lock. The ach lock prevents a proper movement or toe-off in the foot. The patient has to put their foot out to the side to get around the locked foot -the locked joints. Or they pick up their foot sooner, or it's a combination of both.
It causes a reduction in the contraction of the calf muscle, which is instrumental in squeezing the blood back through the veins to the heart for proper filling. It also causes twisting of the lower leg and more problems with inflammation. The other thing that we're finding is that if left gone too long, a year, 2 years, as it creeps through the body, it creates these other symptoms: "I hurt all over; My legs are heavy; I can't sleep very well; I'm tired all the time.” – The symptoms of fibromyalgia and chronic fatigue syndrome. There is quite a similarity between those syndromes, which affect approximately 6 million people who have given up hope that they can get better in the United States when they have fibromyalgia or chronic fatigue syndrome.
The last slide I' going to show is regarding the stages of care. I'll be going over that; and I'm going to be having a table in Room C tomorrow at 10:00 A.M. Dr. Bob Goldman and I will be co-presenting the workshop in Room C in the morning. I'm going to demonstrate the ways which I reverse the abnormal locking of the foot and pronation syndrome and the various problems that occur as a result of this phenomenon.
I'm going to just brief you. This is the area of what Dr. Sears calls "screaming pain". The first phase of care in my office is where we reduce the pain that you can feel by rebuilding the legs with therapies and by hand. After about the first 10 treatments or 2 weeks, the pain should be gone and all the spasms in the legs and restrictions of movement should be cleared. That's our goal. You can actually – it's very interesting how this problem –to reverse the aging causative factors is actually not predicated on visits. In fact it's determined by how much time is spent in the pattern of spasticity or muscle spasm in the area of restriction. In other words, I have given a 6-hour treatment and then a 2-hour treatment the following day and had all the restriction and abnormal patterns of spasm reversed in 2 days. It's how much work is applied in the area of the condition.
The second phase is when we begin to rebuild the pronator/supinator cuff to bring the springiness back to the arch so that the patient can function on his/her own. I always start with a good supportive shoe before we allow them to proceed through Phase I. Exercise is more of an exercise that moves the foot in directions that we normally don't move in our daily life. We encourage our runners to run in circles and zigzag patterns first before they start their long runs to stimulate the muscles that support the arch. This is a phase called reduced inflammation, or "Silent Inflammation" as Dr. Sears calls it, and tissue repair is occurring which is the laying down of scar tissue.
The third phase is where the tissue remodels. As the body exercises, the scar tissue will line up with the lines of force creating a protective bond in the tissue that will make it more structurally strong and sound.
And the final phase is when the patient is released, more fully educated on how to care for themselves through their later years. In other words, we don't always walk forward. We're finding activities that stimulate the muscles from the sides such as walking up hills and through the countryside, instead of always on flat surfaces.
With that, I'd like to thank my interpreters, the doctors for inviting me to the conference and the delegates. I very much appreciate my time here in Tokyo.
Questions after the lecture:
Guest: I'd like to ask you about the knee problem. The problem of the aging people is the knee problem, predominant, I understand. And any exercise can be stress for the knee, except walking in water. Now, from your talk, is there any solution for that by changing the usage of the foot or other measures?
Dr. Stoxen: Well, the knee is like a platform and it's a hinge joint. The knee is a hinge joint. Primarily it does have some twisting movements. In other words, it has what we call "joint play" that allows a little twisting to it. Mainly it's a hinge joint. The problem that I found with the knee is that as long as the knee is projected forward, with the foot – the second toe is the axis that points toward the target. So if the foot is locked, the patient cannot bring the foot through a normal movement pattern anymore because it's locked; there's no spring to it.
So as a result, they place the foot out and roll around the foot because it's frozen. By mobilizing the foot and bringing the spring back to the foot and then educating the patient to keep the foot projected forward, a lot of the peri-articular pain from the scraping patella syndromes can be relieved as well because the platform of the foot is more normalized, it will allow the knee to come to a more restful, natural position so it can heal.
Exercises such as: I think that you've seen these exercise balls -correct? The Swiss balls - and you sit on them and exercise. There is another one called the "Bosu ball". That's a half ball you can stand on and move your feet in these directions and force the foot into the ball to exercise the feet aerobically, as well as you can hook a cuff like around your foot with a linkage and you can hook it to the low pulley. It's called a "low pulley".
You can exercise the foot almost as much as you would exercise the bicep muscle without any real strain on the knee. However, by building up the real structural framework, it can help the knee to come to a more normalized state as well as bring blood and nutrients in the area to help the healing of the leg.
Thank you very much, Dr. Stoxen. Thank you.
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