We are pleased to announce that we have added a second location! We are also located at 211-B S. Salem Street in downtown Apex, starting on March 18th. We are excited to be working in a multidisciplinary office (chiropractor, massage therapist) which can only help the patient get better!
Health and happiness!
Recently, I had the honor of interviewing Dr. Spina via email. Dr. Andreo Spina is a Canadian chiropractor who is the Director of Sports Performance Centers, just outside Toronto. But he is most notably known as the creator and director of the popular Functional Anatomy Seminars, which focus on soft tissue assessment and palpation (Functional Anatomic Palpation Systems), soft tissue release and rehabilitation (Functional Range Release), and mobility conditioning and joint strengthening (Functional Range Conditioning).
(Q) Thank you for taking time out of your busy schedule to talk to me. It seems like your approach to treatment, rehabilitation and conditioning includes a heavy scientific basis. Was this something you saw missing by health professionals that spurred you to create Functional Anatomy Seminars?
(A) I believe that there is a general confusion in the manual therapy world as to what constitutes “evidence-based” care. There are people on one side that want nothing to do with evidence and research and choose rather to work with tradition, hearsay and beliefs. Then you have people on the opposite end of the spectrum that seem to believe that if direct research has not been conducted on a concept, it is reason enough to dismiss it entirely.
Of course like most things, the true answer lies somewhere in the middle. There are indeed concepts and methods that have not yet been subject to vigorous, direct scientific inquiry (the vast majority of manual therapy falls into this category), but as is often said, absence of evidence is not evidence of absence. Ideas always precede research, and it is important that the creation of new ideas is cultivated to ensure forward progress. However, the generation of ideas should be borne from the knowledge that already exists. If it is not, then the idea simply constitutes someone’s random opinion. In other words, where no direct evidence exists, we should ensure that our methods are created on the foundation of indirect, correlated evidence. We should at the very least be able to generate a scientifically grounded theoretical construct to explain why we do the things we do. This is what I found missing from various techniques of assessment, treatment and rehabilitation. Methods are utilized and then we look to research to see if there is justification for them. If there is, then people are happy to say they are “evidence-based”. However, if there isn’t, rarely do people change or alter their methodology.
For my systems, I worked in the opposite direction. I looked at what existing evidence has to say about how to maintain tissue health, how tissues respond to external force application (soft tissue work), how tissues respond to internal force application (exercise, muscle contraction), etc. Then I developed my systems out of this information.
(Q) I find your work and philosophy to be very similar to sports conditioning and training, where the goal is to move a sports movement from the conscious to the unconscious. Once this is mastered, there is an increased challenging activity in which the end goal is the same. Is this an accurate summation and analogy?
(A) It is. The fact is that most, if not all sporting activities are performed by the unconscious mind. In fact, many great coaches and teachers have spoken about clearing the mind and entering the flow state (or “the zone”) in order to optimize performance.
Assuming that the goal is to improve performance, training must take the conscious action of training and ensure that the nervous system can respond accordingly during live execution.
The idea of gradually increasing the complexity of training is essential as it allows the athlete to be able to unconsciously handle the many, many variables that one is subjected to during real time athletic activity.
(Q) I see lots of patients with restricted ankle joint range of motion, which I believe is the originating factor for their particular injury. How do you approach the ankle in terms of prevention and increasing mobility?
(A) That is, of course, a very difficult question to provide a detailed answer for over this medium. Generally however, I will say that it is not enough to simply stretch tissues to improve mobility. Passive stretching leads simply to the ability to passively achieve a particular range. In order to utilize that range for movement production, one must train the nervous system to be able to control newly acquired ranges. This includes developing strength, balance and coordination in new ranges. It is in this way that ones improves functional mobility, which is the ability to actively utilize ranges of motion.
With regards to prevention, luckily, the acquisition of mobility as outlined above tends to reduce the likelihood of injury simultaneously. The more the nervous system is familiar with the potential ranges of a particular joint, the more likely it will be able to compensate for variables as they arise during activity.
(Q) I have started using orthotics as a rehabilitation modality, more so than something longstanding. My goal is to train the foot through such things as intrinsic muscle exercises. What is your view on orthotics?
(A) It has always struck me as strange that if you have a shoulder, knee or back injury, most manual therapists will assess the condition, provide a diagnosis, and then proceed to treat the problem using a combination of therapeutic techniques coupled with a prescription of rehabilitation exercises. On the other hand, if you have a foot problem, people are often simply handed a brace (orthotic) and sent away. It’s as if people consider the feet to be completely different from the rest of the body. As if they don’t weaken when placed in a cast for prolonged periods of time as do the “other” parts of the body. As if they don’t require ongoing training to maintain them as do the “other” parts of the body. This is simply not logical.
I have always said that we are born with the most technologically advanced shoes ever created. They are so advanced that placing more stress on them actually makes them structurally and functionally better. They are called feet.
An entire industry has been built on trying to treat and/or “prevent” foot pain and dysfunction in humans. We are constantly being told that our feet need “support” and our arches need to be “maintained”. Products abound with promises of decreased pain and increased comfort (soft shoes, athletic shoes, orthotics, etc.). However, the problem is that the “cures” that are offered are, to a large extent, contributing to the cause. It is thought that the evolution of Homo Sapien bipedalism began approximately 4.2 million years ago. In contrast, the first shoes are believed to have been used only ten thousand years ago (by the most generous estimation). What does this fact tell us? From an evolutionary perspective, footwear was invented only a moment ago. What are the long term consequences of this unnatural invention? A dramatically increased prevalence of *enter foot diagnosis here–plantar fasciitis, metatarsalgia, etc.*
To answer your question, I completely agree with you. Orthotics should be used as all other braces that we prescribe, as a temporary solution. The rare times that I prescribe them to patients, they are prescribed in conjunction with a foot-strengthening program, geared at getting the person out of them as soon as possible.
(Q) Plantar fasciosis is a common injury in my office. Unfortunately, it usually is long-standing when they come in, with scarring of the fascia. How do you treat fasciosis and what would be your expectations in terms of healing time?
(A) I approach the treatment of all human tissues in much the same fashion. The organization of tissues depend on the force inputs created by movement. When tissue becomes disorganized (scarred, fibrotic) due to injury or prolonged bouts of immobilization (as is created by “supportive footwear”-shoes, orthotics, etc.), it is the job of the therapist to send signals or inputs into the cells by way of soft tissue application, coupled with specific exercise inputs so that they will reorganize said tissue over time. Such reorganization cannot occur with one treatment encounter. Tissue requires multiple inputs over time to create lasting alterations. Thus the prognosis for complete “healing” is in the range of weeks/months vs. hours/days as is commonly believed.
The confusing factor for some is pain. When using pain as an outcome measure, people are fooled into believing that alterations in pain are directly coupled with changes in tissue. This is not the case. Thus even if someone “feels better” after a treatment, no scientific literature will support the idea that any lasting structural changes have been accomplished. What that means is that even when the pain begins to lessen, work still needs to be done, so exercises for the foot should continue.
In most cases of this condition, I utilize Functional Range Release (FR) soft tissue techniques to being the messaging process and reinforce this signal with the prescription of tissue stretching coupled with contraction, i.e., placing stretch on the plantar fascia, while contracting the tissues on the undersurface of the foot. This is done in an attempt to progressively adapt the tissue to the loads. Of course this process is impossible to explain, but that is the gist of the treatment plan.
Aside from that, all of my patients are placed on an intrinsic foot-strengthening program. The beginner exercises can be seen on the following link:
(Q) It seems like modern society has a hugh impact in using making us unhealthy, in terms of shoegear, diet and lack of movement. What do you suggest your patients or anyone can do in order to live healthier and happier?
(A) They further we stray from what we are naturally selected to do, the unhealthier we become.
If you look at the history of our species, we evolved in a time where we were required to move frequently in order to hunt, gather, defend ourselves, etc. This is evidenced by the fact that the human body actually produces rewarding chemical signals when we move (for example, the “runner’s high”) that makes us feel better. So the conclusion that can be drawn is to move more.
The same goes for our diet. Our systems were shaped during a time where we ate real food-be it meat from animals who lived in the wild, or fruits and vegetables grown in a natural setting. So eat real food as much as possible.
Although we assume that we have always lived in what can be considered “modern civilization”, on the timescale of human evolution, civilization was invented yesterday. Thus our bodies have not adapted to many of the unnatural stressors that we place on it.
Quite simply, eating real human food and moving like humans were meant to move makes humans better humans.
(Q) Again, thank you for your time. Tell us if you have anything new and exciting coming up in 2015 which you can share with us.
(A) I have a full schedule of teaching both my soft tissue therapy seminar, Functional Range Release (FR), as well as my functional mobility development seminar, Functional Range Conditioning (FRC) all over the globe in 2015. In addition to that, I am currently developing a few new seminars to add to our curriculum.
If you want to learn more about them, please visit http://www.functionalanatomyseminars.com/ You can also follow me on Twitter and Instagram: https://twitter.com/drandreospina and http://instagram.com/drandreospina
Please take the time to read this again and perhaps again, because there is much useful information in this interview. As always, please contact me if any questions.
Health and happiness!
I had the pleasure and honor of interviewing Dr. Emily Splichal via e-mail recently. A podiatrist and human movement specialist, Dr. Splichal is the founder and CEO of Evidence Based Fitness Academy (EBFA), a Continuing Education Institute which provides cutting information about human movement and exercise science. She is on the forefront of helping transform medicine from a static, passive experience into an active one.
(Q) Thank you for the interview. I am fascinated with your company, EBFA. Why did you decide to start it?
(A) Thank you for this opportunity, Kelsey. I originally started EBFA (Evidence Based Fitness Academy) back in 2011, while I was still in Residency, however EBFA that is known today began in 2012. Initially I had the vision to create an education company that focused on evidence-based fitness programming, however it quickly took the form of the go-to education company for barefoot training, foot to core integration, gait assessment and what we call from the ground up programming. Now as we are about to enter our 3rd year, our (bare)foot science programming is in over 17 countries and has been translated to 8 languages. It is so exciting to see the growth in excitement about barefoot training concepts for fitness, performance and rehab.
(Q) Thinking about the term, “Exercise is Medicine”, how important is dynamic activities in treating and preventing injuries?
(A) The concept of dynamic rehab and preventive programming is everything to successful treatment. As humans, we were made to move. Our nervous system is developed, challenged and molded through the stimuli of movement. What good is a rehab program that is all done on the table and never gets the patient up and moving in the functional state of their daily life?
This also reminds me of a great quote from Anthony Robbins, “Motion is emotion”, which is so true. Our emotional state is such a huge part of recovery that even the simple act of teaching a patient to reconnect to their breathing pattern is a great first step. From here you expand emotion, breathing, motion and then recovery.
(Q) Why the emphasis on barefoot? What advantage does it bring?
(A) I first began speaking about “barefoot” at public health and fitness conferences around 2009. My focus was around fall reduction and diabetic peripheral neuropathy prevention programming. Coincidentally this was around the same time as the release of Chris McDougall’s book, Born to Run and the launch of Nike FREE and Vibram Five Fingers. People really started to gravitate to this concept of “barefoot”, but they linked it only to running.
Like most trends, faux-experts were coming out of the woodwork to talk “barefoot science”, and it was all so one-dimensional and anecdotal. I happened to be finishing my Master’s around the same time, so as part of my graduate work, I started to further explore the science of the barefoot and the impact of footwear and surfaces on plantar stimulation. The research was and is absolutely fascinating. I immediately saw a greater power behind barefoot activation and let me tell you it is so much more than “barefoot running”. Now all my programs are built around using barefoot activation to tap into the neuromuscular system faster and more intentionally. Barefoot activation and the foot to core sequencing associated with plantar stimulation applies to movement prep, corrective exercise, power output, athletic performance, balance, loading of impact forces-the list goes on!
(Q) Due to your emphasis on barefoot training, I must ask about your views about barefoot running. How does a runner prepare to start?
(A) Before I answer this question, I want to emphasis that EBFA’s education is not focused on barefoot running, but rather the. Power of barefoot stimulation for neuromuscular control and efficient movement patterns. Having said that, this obviously covers running. I take a very unbiased approach to barefoot running, or a midfoot strike pattern. Many patients who come to me and have chronic injuries ultimately are switched to a midfoot strike pattern. However, if I have a runner who is not injured and has a great running gait (heel strike), I do not and will not switch their pattern.
If I do have a runner who is intent on switching, I ensure that they are timing their transition to barefoot running with adequate foot strengthening and foot recovery. If someone has been in traditional shoes for say 20+ years and now you switch to a minimal/zero drop shoe, there must be an adaptation period for the intrinsic muscles of the foot, as well as to how your nervous system perceives impact forces. So many of us are actually numb to the impact forces encountered with each step. Foot recovery must match this transition in foot strength. Some of my favorite foot recovery techniques include standing on (not rolling) golf balls. If the golf ball is too painful, someone can use Yamuna Foot Wakers, MELT method, Reflexi foot. There’s a variety of products which doesn’t really matter which they use as long as it is done at least 5 minutes in the morning, at night and before exercise.
(Q) What is the most common dysfunction you see in your patient population? And which exercises do you prescribe?
(A) That’s a hard one. I’d say the most common include shin splints, posterior tibial tendonitis, plantar fasciitis and Achilles tendonitis-all of which I refer to as spiral or loading injuries. When we walk, run, jump–doesn’t matter what we do. If we are loading our lower extremity, we are moving though a loading spiral of subtalar joint eversion, tibial internal rotation and joint flexion. How we get injured in this loading spiral is not necessarily through faulty biomechanics, but more through a delay in the proprioceptive, fascial and neuromuscular control response to load.
As much as biomechanics were heavily taught in Podiatry school and everything seemed to revolve around excessive pronation, current studies actually show that improper biomechanics actually only dynamically shift joints by a couple of degrees. That it is actually much more in the neuromuscular responses and the timing of such which dictates injury vs. no injury. This may be a little hard to grasp (especially in just a few paragraphs), however I think this concept helps to understand: if say we take two runners both with the exact same foot type, degree of calcaneal eversion and internal rotation and one keeps getting injured, while the other has no injury history.
I’ve seen some top professional athletes with the worst pronation-pronation that every podiatrist would agree should be in orthotics. Yet these athletes do not get injured and can create high force output. So if it is not so much the biomechanics, what is it? I look much more at the timing of muscle activation patterns in my patients. I want them to be one step ahead of their movement versus responding to movements. This is where barefoot science comes in as the plantar foot is the gateway to sensory information from the ground up.
(Q) I see you have big plans in the near future. Tell us about them.
(A) I do–which I’m very excited about! In 2015, we will be hosting the first-ever Barefoot Training Summit both here in the USA as well as Asia. This 3-day educational event is designed for the health and fitness professional and will explore advanced concepts in efficient movements patterns, barefoot science, surface innovations. I am honored to have a great line-up of top international presenters, including Dan Edwardes (Parkour Generations), Rick Scrivener (Global Bodyweight Training), Stacey Lei Krauss (willPower Method) and Dr. Perry Nickelston (Stop Chasing Pain), plus many more!
In addition, we are launching our first product. I can’t say too much about the product yet due to patent applications, however it is a surface designed specifically for barefoot activation. It will have application in fitness, performance and rehab.
Finally, we are continuing our global expansion throughout Europe, the U.A.E and South America.
(Q) Thank you for your time. The medical community and the fitness community are certainly better because of your work.
(A) Thank you so much. Again, thank you for the opportunity to share additional information about EBFA and the power of barefoot science. If anyone wants to learn more about our courses, they can visit www.ebfafitness.com or check out our blog at: www.barefootstrongblog.com
Please contact me if you have any questions!
Health and happiness!
I would like to share a link (by Dr. Andreo A. Spina), which effectively expresses what every patient or individual should be doing. As a podiatric physician, my goal is to reduce the pain of patients, so they can continue with their daily living. But as a practitioner, it should not end there. There still is some damage involved that needs to be correctly for total healing. It requires continuous application of stress to the damaged part to allow it heal correctly. This is why I give exercises for patients to do by themselves beyond our office visits. Not only do they “fix” the patient, but they also allow them to achieve better mobility and strength to avoid future problems.
Inflammation of the Achilles tendon is arguably the most common injury of the lower extremity. The largest tendon in the body is a vital component during walking and running. If the Achilles tendon is unprepared for stressful activity, then damage can occur, leading to inflammation. If not properly treated, it can lead to long-term degeneration of the tendon (tendonosis, which is another subject entirely).
The Achilles tendon is made up of two muscles, the gastrocnemius and soleus. The gastrocnemius is the most prominent muscle that you can visibly see and it begins above the knee, crosses the knee joint as it becomes a tendon. In addition, it crosses the ankle joint as a tendon. The soleus is the muscle that is less visible, but only crosses the ankle joint as the Achilles tendon. Both of these muscles function based on their location in the body, i.e., both of them can plantarflex the ankle, but the gastrocnemius can also bend the knee, making its ankle joint motion less effective. The soleus can function irregardless o the knee’s position. During ambulatory activity, the muscles (and to a lesser extent the tendon) are both lengthened when the leg swings forward during walking or knee lift during running. The lengthening continues during foot contact and then begins to contract as the body moves over the planted foot, with the greatest activity during toe-off.
Like any overuse injury, there are intrinsic and extrinsic factors causing Achilles tendonitis. The biggest extrinsic factor (and arguably the most important of them all) would be activity that exceeds the strength of Achilles tendon. Examples include a sudden change of activity from low-intensity to high-intensity, i.e., walking to sprinting, introduction of hills to a walking or running program and returning to exercise after an insufficient or excessive long period of rest. In all these cases, the Achilles tendon was not sufficiently prepared for this change of activity, causing the tendon to become damaged.
Intrinsically, the foot posture is a large factor in Achilles tendonitis. A low-arched foot lengthens the tendon naturally by its position. This gives the Achilles tendon little opportunity to absorb foot impact during ambulatory activities, causing increased stress on the tendon. A high-arched foot has a natural reduction of flexibility in the Achilles tendon, so the increased stress of foot impact can cause damage to the tendon.
Treatment of Achilles tendonitis involves multiple steps guided by the injured individual and the simple fact that is usually takes three to five days for a normal tendon to recover from injury. First, the stress of the Achilles tendon must be reduced in order for the tendon to recover adequately. Heel lifts are a classic example, along with shoes with a higher heel. Orthotic therapy for foot posture can reduce Achilles tendon strain also. Next a progressive rehabilitation program to improve the function of the Achilles tendon. This program should be devised according to pain and activity level of the individual. An example of a program would be a progression of: isometrics (pressing ball of foot against the wall), toe raises (moving from double to single leg), short two-legged jumps, single leg hops, explosive hops, skipping and then running. The intrinsic factors must be continued to addressed in order to prevent recurrence, i.e., orthotic therapy or strengthening exercises for the foot posture. If it is not addressed, it could lead to tendonosis.
Please contact me if any questions!
Health and happiness!
A great site called Academic Earth (featuring online classes) made me aware of a great short video regarding the economics of obesity, and the inverse relationship between obesity and socioeconomic status. Yes, eating healthy is expensive, but it is much cheaper than paying physician bills for chronic diseases!
Health and happiness!
Just a link about the most obese states in the U.S. In general, observe the link between the more active states and more obese ones. Exercise, combined with healthy eating is the best solution to this obesity epidemic.
Health and happiness!
I had the privilege of speaking with Dr. Thomas Lam recently, the President, Director of Athletic Development and Chiropractor of FITS (Functional Innovative Therapeutic) Toronto. This facility uses sports science knowledge to help create a better individual, free from injury. This preventive and proactive approach definitely appealed to me, and we had a wide-ranging conversation, lasting about ninety minutes. Below is the main points from this conversation:
FITS Toronto was established in 2007 by Dr. Lam. The basic philosophy is “movement based healthcare”, where proper movement principles will lead to increased sports performance. They have strength and conditioning specialists, a chiropractor and a massage therapist on staff. They have the privilege of working primarily with basketball players and volleyball players from high school, college and professional levels.
Proper movement is important in everyday activities. If you can master proper movement, you can not only prevent injuries, but help overall well-being.
Proper movement can be achieved first, through proper assessment (i.e., overhead squat–looking at the positioning of the knee, trunk, spine and scapula), and then by motor skill training to correct the movement. No one can develop or increase power output until these movements are corrected.
They have developed a specialized program to prevent and treat jumper’s knee, as it is so common in basketball players. The top five methods they have identified to prevent jumper’s knee include: complete knee control, leg flexibility/mobility, appropriate practice, game and training exposure, jumping and landing mechanics and system stability. (www.fitstoronto.com/jumpers-knee)
They have started doing some dynamic activities barefoot with some of their athletes, and have seen an increase in explosive ability. They are in the process of deciding on designing a protocol, which would make this enhance athletic success.
The work at FITS Toronto not only applies to athletes, but applies to everyone. Everyone can benefit from “movement based healthcare”. To learn more about Dr. Lam and his great work in Toronto, check out his website at: www.fitstoronto.com
Health and happiness!
Armstrong Podiatry & Sports Health, PLLC is proud to present a monthly series of information sessions about the foot and ankle. You will not see the topics you typically find by most podiatrists; in fact, these sessions are made to enpower the listener and keep them out of physicians’ offices!
Topics include: “Barefoot/Minimalist Running”, “Prevention of Foot Pain”, “Flat Feet: Real or Fantasy?” and “Orthotics: The Truth Behind Them”. All sessions are thirty minutes in length, which includes a question and answer portion.
The dates for 2012 are: July 21st, August 18th, September 15th, October 20th, November 17th and December 15th, all at 12:30 pm in the office (2206 Page Road Suite 101 Durham, NC 27703).
Space is limited, so please either call (919-806-3668) or e-mail (email@example.com) to RSVP!
Health and happiness!
My son has now started taking karate classes. For his age (four years old), the classes involve lots of games and fun ways to incorporate karate moves into a thirty minute time span. Most of the stuff initially seemed to have little fitness value, until I thought about some of the drills they are doing, i.e., army crawls, frog jumps, bear walks. These drills mirror a lot of the drills I do with my athletes which helps reinforce and build basic movement patterns. These drills help build stability in the joints, flexibility in the muscles and a coordinated effort of tendons, nerves and muscles.
These basic movement patterns become the precursor for such activities as standing, walking and running. If these patterns are not properly established by mastering these preceding drills, problems arise in the neuromuscular system, for example, a muscle does not work when it is supposed to when running. When I looked at the children performing these drills at my son’s karate class, I can see that there were several that had great difficulty in performing these simple drills. Dan Pfaff, arguably the greatest and smartest track and field coach ever, offers an explanation for this lack of function:
It is my belief that general activities that enhance posture,
joint strength, muscle and joint coordination and all aspect of mobility
are in short supply with today’s youth. A highly sedentary lifestyle
exhibited by today’s society has precluded the acquisition of
these general qualities once found in abundance several generations ago.
(“Alternative Methods for Developing Strength, Power and Mobility”, p.2)
I wholeheartedly agree with this assessment. Our sedentary society has trickled down from the adult to the children with devastating results. When basic movement patterns should be developed by crawling and jumping, they are being delayed or blunted by sitting while watching television or playing video games. This leads to a lack of function when it comes to doing higher levels of activity such as walking and running and a higher incidence of injury.
If you look at things in this perspective, you will understand the importance of recess in school and general outdoor play for children.
Health and happiness!
- About Armstrong Podiatry
- barefoot running
- Bowen Therapy
- Children feet
- Fascial Manipulation
- Foot and ankle injuries
- Foot type
- Massage therapy
- Overuse injuries
- Physical Activity
- Resistance training
- Robert Schleip
- track and field