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!
Recently, I have been seeing lots of blog articles about shin splints, which I believe have been rather generic in nature. I would like to submit my thoughts about the subject, which are a little more unique in nature.
“Shin splints” is a common problem, affecting athletes of all ages. The pain in the shins can be gradual in intensity and debilitating in nature. It can be an injury that gets worse and could lead to a stress fracture.
“Shin splints” is really a “catch-all” terms that refers to pain on the inside of the shin bone (tibia). It really seems to be caused by tension of three muscles on the fascia of the bone. This friction between the muscles and the fascia causes an inflammatory state (fasciitis), which can occur during walking or running. If this inflammation continues, the bone could get involved, and you can get periositis (inflammation of the covering of the bone) and then potentially a stress reaction/fracture of the bone itself.
Like any overuse injury, the adage, “Doing too much, too soon”, certainly applies to “shin splints”. The body that is unaccustomed to increased stress will breakdown. It is usually seen in overweight individuals who are beginning to run as exercise, especially on hard surfaces, i.e., sidewalks. The pain appears when starting out for a run and gradually disappears, only to reappear after the run is complete. The pain can usually be replicated by hopping on the affected side.
Individuals prone to this injury may have either a “flat foot” or “high arch foot”. A “flat foot” already has increased tension of two of the muscles involved in “shin splints”, in addition to increased internal (turning in) rotation of the legs. Running or walking places increased force on the feet, exacerbating the “flat foot” position, i.e., increasing the muscular tension and internal leg rotation. A “high arch foot” places tension on the other muscle involved in “shin splints”, in addition to the commonly restricted ankle joint motion. This type of foot is rigid and running/walking activity creates more forces, leading to more pressure on the foot and more muscular tension.
Treatment and prevention of this injury involves a multifaceted approach. The key is that the inflammation must be reduced and controlled. One way to do this is the usual ice, rest, compression and elevation; the other way is by reducing the tension of the affected muscles causing the inflammation. I usually do both of these and tailor the treatment plan according to the individual. To reduce the muscular tension, an insole or even an orthotic can be used to allow the affected muscles to “rest” for up to six to eight weeks. Activity modification is also emphasized, i.e., limited exercise-related weightbearing activity.
Individuals with “flat feet” can benefit from hip strengthening exercises, specifically hip abductor strengthening (http://runninginjuryclinic.com/resources/exercise-videos/), short foot protocol (http://vimeo.com/43187129) and intrinsic foot exercises (http://www.youtube.com/watch?v=2OOJ9AQ1AEg). Individuals with “high arch feet” benefit from hip strengthening exercises, specifically hip adductor strengthening and calf muscle stretching. These exercises work to reduce tension on the affected muscles, by mobilizing and utilizing other ones. Once inflammation control is achieved, a slow gradual return to activity from low stress, i.e., short job to high stress, i.e., hopping, jumping.
Of course, prevention is the key for “shin splints”. It is important for beginner runners to follow a structured workout plan, conceived by a knowledgeable running coach. Running on softer surfaces is also recommended, in addition to flatter surfaces.
As always, if you have any questions, please contact me.
Health and happiness!
- About Armstrong Podiatry
- barefoot running
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- Children feet
- Fascial Manipulation
- Foot and ankle injuries
- Foot type
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- Overuse injuries
- Physical Activity
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