Foot strength, Balance, and Vitality with Tom Michaud, DC

Episode Transcript
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(00:00):
Hello and welcome to the WhatReally Makes a Difference
podcast.
I'm your host, Dr.
Becca Whittaker.
I've been a doctor of naturalhealth care for over 20 years
and a professional speaker onhealth and vitality, but
everything I thought I knewabout health was tested when my
own health hit a landslide and Ibecame a very sick patient.

(00:22):
I've learned that showing up forour own health and vitality is a
step by step journey that wetake for the rest of our lives.
And this podcast is aboutsharing some of the things that
really make a difference on thatjourney with you.
So grab your explorer's hatwhile we get ready to check out
today's topic.
My incredible guest network andI will be sharing some practical

(00:45):
tools, current science andancient wisdom that we all need,
no matter what stage we are atin our health and vitality.
I've already got my hat on andmy hand out, so let's dive in
and we can all start walkingeach other home.

(01:06):
Hey, before we start thisepisode, I just want to offer a
thank you.
Thank you so much for supportingme and the show and for helping
it come forward as a creation inthe world.
There are just so many helpfuland interesting people in this
world and I am excited to have avehicle to have conversations
with them and then also to sharethem with you.

(01:28):
Thank you so much for rating theshow.
Thank you for your feedback.
Thank you for sending inquestions.
All of that helps it to bebetter and I appreciate it so
much.
Also thank you for your patienceas we've had some sound
difficulties.
I switched to a different micand batch recorded three
conversations right in a row anddidn't catch.

(01:49):
That the mic was not doing wellwhen it was plugged in for
longer than 10 minutes.
So, lessons learned.
Gratefully, I have a fantasticeditor helping me and we're
getting the sound as good as wecan get it.
But, it will improve and we noware set up with a much better
set up.
So, thanks for being patientwith the sound for the few
episodes where it is a littlewonky and we have more to look

(02:12):
forward to.
Speaking of things to lookforward to, my guest today, Dr.
Tom Michaud, is one of thoseguests that I cannot be happy
enough to share with you.
In fact, we talk about so manyapplicable things in the world
of health and movement that itwould be harder for me to think

(02:35):
of someone I don't want to shareit with than someone that I do.
In fact, I've already sharedinformation that Dr.
Tom talks about on this episodewith patients and with friends.
People I know who are runners orwho are trying to strengthen but
coming back from an illness andsome of the elderly people that
I know who are trying todecrease their fall risk.

(02:55):
Dr.
Tom is one of those providersthat does not just teach dogma
passed down.
He has a sincere bug forresearch and you will see as we
get into the episode that he canremember and recall that
research.
with ease because he is so wellversed in it and he's digging
into it literally nearly everysingle day.

(03:15):
He has now transitioned out of aclinical practice and is doing
full time research and writing.
And it just makes him sointeresting to talk to because
research is coming out with morethings all the time that can
make it so we can exercise withmore safety and with less risk
and get the same gains.
As we thought we had to when wewere hauling really heavy

(03:37):
weights and doing very shortamount of reps.
So, pretty great.
We talk about plantar fasciitis.
We talk about running, walking,differences in minimalist shoes
or orthotics.
We talk about decreasing fallrisk with some really
interesting research.
And a device that he has usedthat I use and my family uses.

(03:58):
It has really, really helped myfoot strength and my balance, so
I'm excited for you to hearabout that.
And then we also talk about lowback pain and ways to help our
low back without even touchingour low back.
So, pretty cool.
I am really grateful that heagreed to spend time with me
today.
He is still a very busygentleman.
And he's not only doing theresearch and the sharing of

(04:22):
accurate clinical information,but he's also very kind.
And anytime with Dr.
Tom is Time well spent.
I actually saw him winchiropractor of the year at the
biggest chiropractic conventionin the world last year So it's
fun to both see him in action asa chiropractor and researcher
Winning awards and then be ableto talk to him in my own room on

(04:46):
the computer So I'm happy toshare that with you and without
further ado.
I gave you one of my favoritechiropractors.
Dr.
Tom Michaud Dr.
Tom, I am so happy that you arehere with us today.
And we just in the green room aswe were beginning already
started on conversations that Iwish I could share with six

(05:08):
people that I can countimmediately in my mind.
So thank you so much for joiningus.
I know your time is really,really valuable.
Thanks for sharing what youknow.
You're welcome.
And I'm retired now.
So my time isn't that valuable.
so much for joining us.
You're retired, but you justfinished a paper for
publication.
I just write all the time.
I stopped seeing patients fulltime.

(05:28):
So yeah, I still work all day,every day.
Yes, I was like, I think it'sbecause you have more to do for
the profession and the world inBeyond even just this
profession.
I'm so grateful.
We'll see.
I hope so.
We all hope we all hope our workis worth something to more
people than just us.

(05:49):
Okay.
So I talked to you a little bitabout my audience, but just to
say it as we're beginning.
So Dr.
Tom Michaud, so he works withvery high level athletes.
I know you're retired now, butthis is, you're still working
with them.
I know you are.
So athletes, but also teenageathletes and through the elderly

(06:11):
population, lots of work thatyou're coming up with now about
balance and coordination andelderly population, which I
think is perfect to have on thepodcast because we have such a
gamut in.
the audience that listens tothis podcast.
From those that are really sickand have a hard time exercising,
but really need the stimulationin their muscles to go to their

(06:32):
brain without it costing more,then, then it's giving them.
All the way through to, I have alot of middle aged women that
are really wanting to exerciseor feel better, but then when
they start something likeCrossFit or running with their
friends, then it They getinjured more frequently and I
would love to talk about that aswell as some of the things

(06:55):
you're coming out with about aswe age, things that we can do to
keep us moving in a way betterway, have much less risk of
injury.
So, fascinating things to talkabout today.
Absolutely.
To begin with, we start withsomething just as simple as
walking or or even moving up toa jog before we even run.

(07:17):
What are some things that we cando as we're walking around or as
we're climbing our stairs justin our normal activities of
daily living?
So whether you're really sickand that's the most you can do
or if you're a normal humanbeing and you're just walking
from point A to B.
What are some things to keep inmind in the way that we move our
bodies that can either beStrengthening us or hurting us?

(07:43):
Well, as far as strengtheninggoes, you're not going to get
stronger walking.
Walking, we are so efficient atwalking, and it's the reason
we've survived as a species.
Our tendons store energy in theform of elastic recoil, so you
can go through a walking cyclehardly consuming any calories
whatsoever.
You just need resilient tendons.

(08:04):
One of the things you mentionedbefore is that people start
exercising so they get injured.
Yeah.
The dose response for improvedhealth with walking is minimal,
you know, walking five miles aweek, which is, you know, not
that much of a commitment at sixyears to your lifespan.
So it's yeah, it's and thenagain, if you look at studies,
which people don't like talkingabout, because I've dealt with.

(08:27):
hundreds to thousands of peoplewho run 70 to 130 miles a week.
I've dealt with like Kenyans,Ethiopians.
Once you start running past 40miles per week, it has a
negative effect on yourlifespan.
Like our ancestors going back,you know, 2 million years, their
weekly, their daily distance offoraging was about 8 miles.

(08:48):
So they've shown a researchernamed O'Keefe, he's a
cardiologist, showed that if youexercise too much, if you're
running, especially if you'rerunning fast, If, if you're at
rest, your heart beats, youknow, say four or five gallons
of blood per minute.
When you exercise hard, it goesup to 35 gallons of blood per
minute that can stress themyocardium and it can damage it
over time.

(09:08):
That's why they showed that longdistance running at fast speeds,
you lose that increase inlongevity that exercise gives
you running, you know, 10 milesa week, you live, you'll live
six years longer, but runningmore than 40 miles per week, you
lose that six years.
So if you have a populationwhere you just, you're afraid of

(09:29):
exercising, you could just gofor short walks, like a 15 to 20
minute walk on a level surfacedoes all these wonderful things.
Paleoanthropologist by the nameof Herman Ponser spent his
entire life studying thebenefits of exercise.
He studied for the great apes inAfrica to see the caloric
expense of locomotion and greatapes versus people, and then he

(09:51):
wrote a book called burn showingthat exercise doesn't really
burn calories because when youexercise a lot, In order to
compensate for the caloricexpense of that, you actually
start shutting other systemsdown.
That's why women becomeamenorrheic if they run high
mileage, they, your liverbecomes less active.
So your, your body has toprioritize where calories go.

(10:13):
So if you exercise too much,you're not going to be burning
calories as far as weight lossgoes, but you do these amazing
things for your immune system,for your overall health, for
preventing cancer.
One of the best ways to decreaseyour cancer risk is to exercise
regularly.
And again, the dose responseisn't that high.
You don't have to do that much.

(10:34):
That's amazing.
Can I just say right off thebat, people are so.
worry justifiably about cancer,but one of the best things you
can do to prevent cancer issimply to moderately exercise.
Colon cancer is reduced justbecause it increases the transit
time that food goes through yoursystem, so you have fewer toxins
there.
So if you have a population thatwants to clear toxins, like

(10:58):
Exercise and it's, and itdoesn't have to be intense.
I like, I don't like intenseexercise.
We were talking about it beforeyou have athletes go out to
CrossFit, which is fine for fitpeople.
It's, I mean, you CrossFitpeople, CrossFit people I treat
are amazingly fit.
But I wouldn't have like a 75year old person who's never
exercised before.

(11:18):
And that paper I wrote, fiveexercises to prevent age related
muscle loss.
One of the studies took peoplein their eighties who never
exercised ever.
They measured body fat, theymeasured muscle volume, and then
they gave them low loadprotocols, light resistance,
high reps, and got greatoutcomes.
I would love to hear more aboutwhat you talk about that.
So you do look at strengtheningin a little different way.

(11:42):
I've heard you say the researchthat showed doing American
Journal of SportsRecommendation, it's the
standard recommendation forstrength and it's valid in
regular people, but older peoplewho are afraid of injury, you
can't do 80 to 90 percent of onerepetition, max three sets of

(12:04):
12, three times a week.
Especially if you're doingsquats and lunges, we were
talking about lunges are fine,but squats, you go so deep, even
if you're just doing sit upsfrom a chair, the pressure on
the back of a kneecap, when youbend your knee more than 45
degrees like this, the pressureskyrockets, because when your
knee is at 90 degrees, like whenyou're getting up from a chair,
the patella gets pulled directlyinto the femoral condyle, and if

(12:27):
you have knee arthritis, it'spainful, so do lateral step ups,
you get next to a four inchstep, any stable surface that's
four inches high, and a stair iseight inches, so even a stair is
too high.
You just hold a weight orresistance and then step up
sidewards while holding on to awall.
It's, there's, I made a YouTubevideo of it that, that shows the
exercise and I wrote an article.

(12:48):
That's on human locomotion dotcom site, and it's got pictures
of the exercises.
I wanted to figure out a way tofire every muscle in the body.
So I did a lower trap exercisebased on EMG studies where you
pull your shoulders down andback low stress, easy on the
shoulders.
I did a lateral step up.
I did a couple of easy footankle exercises and then a

(13:08):
modification of the lunge andthen a twisting exercise.
All.
Low stress.
I've had hundreds of people whoare over the age of 80 do them
and nobody's getting hurtbecause it's it's easy to not
get hurt when you're doing theseexercises.
If you sit exercise in a saferange, you know, you pick up any
magazine, you know, New YorkTimes anything and they will
tell you get in a chair andstand up while holding on to

(13:28):
resistance or do squats.
Squats.
A paper came out in Journal ofOrthopedic and Sports Physical
Therapy have dangerous highlevels of pressure on the back
of a kneecap if it's a full 90degree squat.
If it's a 45 degree partialsquat, where you just go down a
little, which is how youexercise in life.
How many times have you, if youhad to move a refrigerator or

(13:48):
something, you wouldn't get to a90 degree squat position and
push, you'd bend your knee 45degrees and push.
That's when you walk and run,your knees bent 45 degrees.
It's not bent 90 degrees.
So why exercise it at 90?
And there is a carryover.
If you strengthen a muscle at 45degrees, like a partial knee
bend.
you will be strong should youever have to load it at 90.

(14:09):
That's that paper that showedthey had the same increase in
vertical jump height when theydid full squats as when they did
partial squats.
And I've got nothing againstfull squats and healthy people,
but you know, I damaged mykneecap when I was a kid.
My left knee hit a concrete walland my entire life, whenever I
attempt to do squats, my kneehas hurt.
And once a year I go, ah, it'sgot to be better now, so I try

(14:31):
it again.
And now I just don't do it.
And I exercise every day, and myknees never bother me, unless I
try to do squats.
Oh, that's so fascinating.
And the implications, I think,are for much larger than for
just the elderly population.
Because people withfibromyalgia, People with
myalgic encephalitis is anotherthing that I struggled with,
which is where my brain andspinal cord swell and my muscles

(14:55):
hurt.
So, and I've met other peoplethat have similar things.
where you want to exercise andyou want all the muscle groups
to fire, especially because thataffects your brain.
You want the neurology toimprove and your proprioception
to improve or your awareness ofyour body to improve.
But trying to do that, if I didtwo full squats, that would take

(15:17):
me two hours recovery time.
Right?
And whether you're sick or not,just if, if you're looking for
something that you can beeffective at that doesn't take
very long, five exercises is notthat big of a deal.
And with a way less risk ofinjury.
I think the news that you cansquat to 45 and the outcomes are
the same instead of squattingall the way down, that's

(15:39):
wonderful.
Or that you can do fiveexercises where you're getting
every part of your body andgiving all of that information
to your brain, but with muchless injury risk and much less
time or money allotment.
That's for everybody.
Yeah, one of the things that I,I liked about the paper where we
talked about one set of 60followed by one set of 12.
In order to get strong, it'scalled the size principle of

(16:02):
motor recruitment.
When you use a muscle, yourcentral nervous system says,
well, I'm You're not going to begenerating that much force.
Like if you're walking, you'redoing something easy.
So you send a signal to like 20percent of your muscle fibers.
They're the slow twitch musclefibers.
They are loaded with oxygen andthey are the first 20 percent
you always go to.
So if all you did was a fewrepetitions, you would only work

(16:25):
that 20 percent of the musclefiber.
And then the rest of the musclewouldn't get any benefit from it
and would start to thin out overtime.
You lose 2 percent of musclemass every year starting at the
age of 50, and it correlatesstrongly with falls and other
problems.
So what these researchers showedthat when you do one set of 60,
which sounds like it's hard, butBecause you have to do 60.
It has to be incredibly easy.

(16:46):
Otherwise you couldn't do 60.
It just basically pumps bloodout of the muscle.
And when blood is squeezed outof the muscle, it forces you to
not use your slow twitch fibersbecause they require oxygen,
which is supplied by the bloodvessels because you've just
squeezed the blood out of themuscle, even though it was light
resistance.
And, but you did 60 of them, thenext set of 12, you go to the

(17:09):
fast twitch muscle fibers thatfunction without oxygen.
Those are the ones that peoplehistorically have used heavy
weights to target.
That's why the American Collegeof Sports Medicine says you have
to use heavy weights or you'llnever recruit your fast twitch
fibers.
They meant well, but thatresearch showing that if you did
a set of 60 and followed with aset of 12 hadn't come out yet.

(17:29):
And there's other protocols,four times 25 at 30 percent full
effort produces more musclehypertrophy than the high
resistance stuff.
Again, I think it's because itdecreases blood flow and you
know, it gets complicated, butthere are other methods of
training where you put a simplestrap, a compressive strap
around your thigh.
It decreases circulation, whichforces you to use your fast,
which fibers.

(17:49):
And the compression of themuscle also increases growth
hormone, which acceleratesrepair and you're dealing with,
you know, my algae patients, youpeople, you can't load too high.
And remember, there's that afterdischarge principle.
When you fire a musclevigorously, there's an echo in
the spinal cord where this.
the muscle tightens later.
Anyone who's done that kid'sgame where you push into a door

(18:11):
jam, hold hard for 10 seconds,and then your arms float up
afterwards, that's that afterdischarge.
And that's a negative thing ifyou've got a history of muscle
injury or muscle weakness.
Get that with lightcontractions.
So meaning if you're loading themuscle, so losing, using like a
heavier weight or doing heavierexercise, you might be okay
right then, but then after youget A series of tightening and

(18:34):
it's a reverberating muscles,right?
It's a reverberating cycle whereyou're significantly stiffer
later.
That's why heavy, bigweightlifters always, they can't
like put their hands behindtheir back.
They, they tend to be stiff.
If you fire a muscle veryvigorously, it tends to stiffen
it.
So, you know, you can get aroundthat with the light resistance
protocols.
So, I want to just review.

(18:55):
So, you explained it so well.
Thank you so much, Tom.
You're welcome.
Dr.
Tom.
Tom is fine.
So, the fast twitch fibers,which are the ones that do the
repair, the bulk and thestrengthening, you get to those
when the muscle doesn't have asmuch blood.
So, you can do that either bydoing heavy weights, small reps,

(19:19):
or Just as good with lessinjury, you can do lighter
weight and 60 reps and then a 30second rest.
I know you said was veryimportant when we were talking
before.
And then you don't want blood toget back into it.
There you go.
So that's why.
And then one set of 12 reps at60 percent of your effort.
About 40 percent full effort.

(19:40):
So yeah, you should be tired,yeah.
So full effort means like, asmuch weight as you could lift
when you could only lift likeone or two.
So if I'm really tired, if 100pounds is that, then what we're
talking about is you go down tolike For that last set of 12,
you'd only lift.
They use that in research allthe time, and it's a confusing

(20:00):
number for people.
It's called one repetition max,the amount of weight you could
just lift once and not lift itagain.
And then you multiply it, likeAmerican College of Sports
Medicine says, multiply that onerepetition max by point eight
and then do a three sets of tenof them.
So, because it has to bequantified in research, that's
sixty twelve study.

(20:21):
They did one set of sixty atfifteen percent their one
repetition max.
I hate bringing that up becauseno one wants to test their one
repetition max.
Exactly.
And it's for research only.
So, I tell people, Do a set of60 with enough resistance that
you're fatigued when you finishyour 60.
Then do a set of 12 with enoughresistance that you're fatigued
when you finish your 12.
If you're hitting 9 and 10, andyou're not tired, if you use an

(20:44):
elastic band, just step backmore, so that there's more
resistance.
So, once you get used to it,it's easy.
But again, if it's someone who'sdealt with myalgias, then, then
keep it 15 percent and just seehow you respond.
Even mild muscle contractions,if you do enough of them, can be
beneficial.
Wonderful.

(21:05):
And I mean, that moves the lymphsystem and the detox.
So if you're sick or fightingsome kind of illness, that helps
you get the illness out any waythat you're already.
It improves immune function too.
So, so another thing that I loveyou to speak about that helps in
the elderly population, but alsoI really think about.

(21:26):
the population with myalgia orneurologic problems or teenagers
just starting off, as well asthe aging population.
You talk a lot about balance andI want to, I'm wondering if
you'd share with me yourinformation about balance and
life predictability, but alsoabout what really influences our

(21:47):
balance, because your work withthe feet is amazing, I think.
So let's talk about that.
Thanks.
I, there's different centersthat control balance in our
system.
Uh, pretty much everybody, whenthey think of balance, they
think of the vestibular systemin your inner ear.
You have semicircular canals,you've got the utricle and
sacral, and they tell you whereyou are with acceleration.

(22:09):
But.
Mostly where your head isaccelerating.
The bottom of your feet areloaded with four different
cutaneous receptors that areslow adapting and fast adapting.
They pretty much just sensepressure.
Like if you were to stand up nowand shift your weight to the
outside or shift on one foot tothe side, You'd put more
pressure on the outside of yourfoot.
You're that particular region.

(22:30):
The outside of your foot isloaded with sensory receptors
that tell you where you are inspace.
And then your muscle spindlesare length organs.
You know, when you tap a patellareflex, you stretch the spindles
inside the muscle, and thatcauses the knee to jerk.
Muscle spindles tell you whereyour muscles are lengthening.
When you're balancing, standingon one foot, and most falls

(22:51):
occur with the initiation ofgait.
You're standing still, you'reabout to start walking, that's
when people fall down.
And part of that has to do with,once you hit 50, you start to
lose sensitivity in thosecutaneous receptors in the
bottom of your feet.
By the time you're 70, you'velost 30 or 40 percent.

(23:11):
By the time you're in your 80s,you've lost 70 or 80 percent of
the sensitivity.
It takes significantly, almostTwice as much pressure to
stimulate the sensory neurons,so you don't know where you are
in space, especially whileyou're balancing.
And I just read a paper wherethey looked at the contribution
of your inner ear, your utriclesac, your semicircular canals,
and the skin receptors on yourfeet and spindles.

(23:32):
Skin receptors on the feettravel, the sensory nerves
travel way faster.
So they are responsible for morethan 70 percent of balance.
They're responsible for that ofbalance.
beginning of a fall, then yourinner ear can say, Oh, we're
falling.
So then you can bring an arm tothe right spot, or you can move
your upper body based oninformation from your inner ear.

(23:53):
I'm wondering two things beforewe proceed that number one, is
that a must happen, or is that ahappens with.
stagnation, like if you'resitting, do you get to keep more
of that sensitivity if you'remore active or if you're firing
the muscles in your feet?
And my second question is thatwould relate to like neuralgia
or diabetes or anything wherethey have trouble with their

(24:14):
feet.
Anything that interferes withthe sensory transmission of a
nerve will interfere with thepassing of pressure information
from the cutaneous receptors.
They just travel up the S1 L5nerve roots, sciatic nerve
roots.
If you had spinal stenosis, youwill have impaired balance.
If you have peripheralneuropathy, you will have

(24:34):
impaired balance.
Diabetics almost always haveimpaired balance, not because
the cutaneous receptors arebreaking down, but the nerves
aren't transmitting theinformation as fast.
So there's a way to predict ifthat's happening.
Someone recently published apaper showing if you go out to a
music store and you buy a 256cycle per second tuning fork,

(24:55):
they cost about 8, put it on thebottom of a heel, someone's
heel.
If they can't feel it, thatmeans that their nerves are not
transmitting the informationfrom the cutaneous receptors,
because if someone showed thecutaneous receptors travel along
similar pathways as vibration,so it's a simple little test.
I made a fall preventionprotocol.
It was like a 40 page paper withover a hundred references, and I

(25:18):
made a series of more than adozen tests that take seconds to
do, and then more than a dozeninterventions.
One of them is check open eyebalance standing on one foot.
If you can't balance, you getthree tries to stand on one
foot.
If you can't balance 10 seconds,it's a better predictor of
mortality than cardiovasculardisease and hypertension.

(25:39):
A better predictor.
Oh yeah.
Yeah.
If you will die, cardiovasculardisease.
They said every, if the statsare there, I wrote a paper on
it, it's called the 10 secondbalance test.
If they're all on humanlocomotion.
com, if you, if you fail thattest that there's, they're
telling doctors now that theyshould be doing that in office

(25:59):
with every visit.
because it is so easy to do.
I saw that data, and I wassurprised by it, and I've been
studying balance for years, andthere was like 1, 200 people in
the study, and they followedthem for, you know, almost 10
years.
It was a big paper.
But there are things that you'reteaching that can improve
balance, so if you can pick onething to improve that helps your
life now and then, and You know,this is interesting can help

(26:23):
you.
Yeah.
Yeah.
I never look up.
I would never try to diagnosesomething that there wasn't a
somehow solution to fix it.
That's terrible because it'sjust wisdom that that paper I
made up.
There were 12 tests, but thenthere were 12 to 14
interventions.
that you do based on whether youpass those tests or not.
I mean, some of the tests werefor strength, some were for

(26:44):
range of motion, the inabilityof tight ankles predict falls,
toe weakness predicts falls.
It's all fixable.
But this is what I loved aboutbalance.
You would think.
That if you had a balanceproblem, all you would have to
do to fix it is balanceexercise, right?
And that's true to some degree.
There's a balance protocol thatI put in there where you stand

(27:05):
on a piece of foam, it improvesbalance.
But several papers show thateasy strengthening exercises to
the foot and ankle improvebalance better than balance
exercise.
And the reason for it Is thatstrengthening exercise increases
circulation muscle spindles,which tell you where you are in
space live right next to theblood vessels that supply the

(27:27):
muscle.
So when you exercise, younourish those spindles, the long
nerves, the peripheral nervesget.
Increased nourishment when youexercise.
A researcher from Australiapublished a pilot study on
peripheral neuropathy where allshe had people do was toe
exercises against therabands andfoot strengthening stuff and
their peripheral nerves improvedin function.

(27:49):
So I'm trying to do Yeah, Iloved it.
I've contacted her, KarenMickle, M I C K L E.
I'm gonna pause you right therebecause peripheral neuropathy is
something that I struggled with.
So what that means is If youaren't familiar with it in the
audience, I am the, you are butthe periphery is like the, the

(28:09):
further down your legs or downyour arms and neuropathy means
those nerves are not firing,right?
So if your hands or your feet,you have a burning sensation or
phantom limb, pain can be alongthere too.
Or just pain in general in armsand.
and legs that doesn't stop.

(28:29):
When I tried to look for helpfor that, it was hard to find
information.
My neurologist did not know whatto say.
Most of them are like, well,this medication can help, but it
has these weird side effects.
And so good luck was basicallythe thing.
You're saying that this researchis showing just the resistance
bands with even just lighterresistance even, but getting the

(28:52):
blood back into the muscle canhelp.
That's wonderful.
Well, It's also good for thecutaneous receptors and a friend
is, uh, Gabby Miller.
She's, she's a physicaltherapist.
She's writing a book onperipheral neuropathy now.
She works in an oncology clinicin the Midwest.
So all she sees is peripheralneuropathy patients all day,
every day.
And I made that footstrengthening exercise, the
ToePro, and she's been using iton every peripheral neuropathy

(29:15):
patient and sending me.
Before and after on improvementsin single leg balance, and then
because they lose sensationalong the lateral side of the
foot, I made, uh, it'sinexpensive.
I made this small pad that has aseries of elevation and as we
lose sensation on the outside ofthe foot.
That increases the probabilityof fall greatly inhabited with

(29:36):
peripheral neuropathy.
I made these little pads thathave elevations that the more
laterally you go, the more tothe side you go, the more it
digs into the skin and amplifiesthose cutaneous receptors that
aren't.
that receptive anymore.
Just like if someone's hard ofhearing, if you put a hearing
aid in, they can suddenly hear.
So she has been doing somestudies where she takes her

(29:58):
peripheral neuropathy patientsand put the balance pads in and
then immediately re measurestheir single leg balance.
And she sent me some really nicevideos where it's looking good
so far.
I just purchased a machinecalled a biothesiometer.
It, it sends vibrations in fromvery low to very strong levels
and then gives you a grade ofhow much, how well working your

(30:19):
cutaneous receptors are.
I'm going to do a study where wedo strengthening, not strength,
endurance exercise of the calfmuscles to increase circulation.
Use those balance buttons andsee how it improves people's
ability to perceive vibration.
Peripheral neuropathy patientsare an incredibly underserved
population.
For my first 30 years ofpractice, I really, every time I

(30:41):
walked in a room with aperipheral neuropathy person, I
felt bad for them because Ididn't know what I could do to
help them.
And you know, there's gabapen,there's all these drugs and they
help a little.
But when I saw that research byKaren Mickle and she just got
the pilot studies, she got anice outcome and then they never
went to a full study becauseit's hard getting funding now.
I've been contacting differentplaces to get a larger study

(31:02):
going because I, I want to seeif it works.
I think it will, but I dealtwith athletes most of my life.
I didn't deal with a ton ofperipheral neuropathy.
That's why I've been reachingout to Gabby and she's most of
the way through a book that I'm,I'm looking forward to reading.
Because it's, it's herexperiences with dealing with
chemotherapy induced peripheralneuropathy and she's getting
good outcomes withstrengthening.

(31:23):
That is beautiful.
But I'm also thinking thatapplies not just if your hands
and feet are burning.
Getting more blood flow into themuscle and activating the
spindle fibers, that helps yourbody awareness, period.
So, athletes or anybody who'swanting to not get injured,
yeah, I mean, you injure yourYeah, better improvements in

(31:45):
balance with endurance exercise.
Way better than improvementswith counterintuitive.
Like you could do Tai Chi, whichcan help a little bit, but
nothing beats light aerobicexercise to stimulate
circulation.
Well, also you talk about, letme see if I can word this
better.
What it's making me think of,when you're talking about

(32:07):
balance and maybe just doingbalance protocols is not the way
to fix it is sometimes if youare trying to do something, say
cooking, I was not fantastic atcooking and let me tell you,
just practicing cooking did notmake the cooking better, made my
family better at kindly eatingwhat I was trying to do, but I
had to strengthen Some of thethings that went into cooking,

(32:30):
like I had to strengthen myability to Mix things in a
better way or to understand howto bake like I had to strengthen
the steps of baking before ofcooking before it turned out
well.
And I think about that when Ithink about you strengthening
the individual toe muscles.
So we're going to go back towhat you created called the Toe

(32:51):
Pro.
So this is how I found you, Dr.
Tom.
I was at Parker Seminars, whichis the biggest chiropractic
gathering in the world.
And you won chiropractor of theyear last year.
I was there for that andcheering for you in the
audience.
I was surprised.
No one else was surprised, but Istick to myself.

(33:12):
So I was, I found you becauseLindsay MoMA is another person
that I follow.
She does so much wonderful workwith the pelvic floor.
And that is amazing.
That's a big thing that I treat.
But when I saw her at theconference, I said, where have
you been?
And she said, Oh, I just hangout at Dr.
Tom.
Michelle's the whole time.

(33:32):
If you haven't seen the Topro,you have to get over there.
Just hang out near him so youcan hear what he says and check
your balance.
So I went, but again, I am justgetting into a stage where I can
balance again and I was struck.
by, by the different things Ilearned at your booth.
I'm putting myself on the spothere because I'm hoping I

(33:54):
remember the percentages right.
But if I recall, I think yousaid there is for every one
percent gain in big toe strengththat a person has, there is a,
is it seven, eight percent?
Yeah, seven percent.
Way to go.
That's impressive.
Sweating in front of theteacher.
That was a year ago.
But I thought, my balance, Imean, people with MS have hard

(34:17):
balance for all kinds ofreasons.
There's all kinds of reasons notto have balance.
But you also have a way to checkthe strength from foot to foot
with your foot dynamometer.
And whoa, was I different fromone side to the other.
Where I had the brain injury,way different.
But my husband was also verydifferent.
He had a knee surgery on oneside that he has, his muscles

(34:41):
have just never Been the samesince then.
His, he was in a skiing accidentand it shattered his tibial
plateau and Really justdestroyed a lot of things in his
knee.
We, we purchased that, broughtit home.
I have a mother who is aging.
She has Parkinson's and somedementia associated with that.
We tested her.

(35:01):
I have a daughter who has feetthat pronate or.
Roll in both of them.
So her knees and feet oftenhurt.
I have a son who's on theautistic spectrum.
I have me with a brain injury.
And we were like, what is this?
What is this?
No one was the same side toside.
Some people we thought weregoing to be really weak.
We're really strong.

(35:23):
I had started exercising myfeet, but on one side to check
and see how fast I could go.
This thing is wild.
Everyone was different side toside.
And it really, really affectedtheir sense of being able to
balance.
We did one leg balance tests,and we also did, I can't
remember what you call it, webought yours, but we have done

(35:44):
wobble boards before, and Ireally liked how yours was
different.
But, wow, one side is not thesame as the other side.
So can you tell me, what affectsbalance, why checking toe
strength is important, and thentell me about the Toe Pro you
developed to help.
It's the best exercise I've everseen.
I have it sitting on my bathroomfloor by my sink because I do

(36:06):
toe pro exercises when I'mbrushing my teeth or when I blow
dry my hair.
That's my type.
A lot of people have commentedthat the fact that he could just
leave it there and do it, itmakes it easier to be complying
with the exercise.
Yeah.
But before when I was talkingabout balances related to the
cutaneous receptors, that, Thepaper that I wrote on predicting
falls, the single best predictorof falls, and it's been studied

(36:28):
multiple times with groups ofover 300 in senior centers, is
toe strength.
And it's easy to test onyourself.
Just stand up, put your arms atyour side, and lean forward.
What you will notice is thatyour toes push down to control
what's called your anterior fallenvelope.
If your toes are weak, you willlean too far forward, you won't
be able to stop it, and thenyou'll stumble with your first

(36:49):
pace.
And remember I said most fallshappen when you first initiate
gait.
As your toes push down, theycontrol that forward envelope.
In fact, there's one of thetests that I do in that paper is
you stand up and then you leanforward like this.
If someone measures the distanceyou lean forward without
falling, you should be able tolean forward four and a half

(37:09):
inches without falling and thenmove back people who can't.
And that.
distance correlates exactly withtoe strength.
If you do that dynamometer testand you're less than 10 percent
body weight beneath your bigtoe, you will not be able to
have, it's called the anteriorfall envelope.
You will not be able to leanforward while your body is
straight.
So the toe is one of their mainfunctions during gait is to make

(37:30):
you stable as your center ofpressure shifts forward.
We're always in a precariousposition while standing.
I mean, watch any toddler learnto walk.
They'll get up and they'll goside with the government, go
forward.
So it takes years for us tolearn how to control our center
of motion.
But unfortunately we wear stiffshoes.
We wear shoes with toe rock.
Those hokas, which are sopopular now are really

(37:50):
comfortable, but they have toesprings that go up.
So your toes don't have to fire,which makes them comfortable,
which is nice because it feelsgood.
But it produces weakness overtime.
A paper just came out showingthat excessive toe springs and
shoes like, oh, it's the upwardroll to the end of a sneaker.
It stops your toes from bendingwhen you push off.
Normally, when you push offduring gate, the toes bend and
then push down.

(38:11):
If you have a toe spring in, youjust kind of roll with no toe
action.
So I made that dynamometer.
A friend from Australia was theformer editor of Foot Ankle
International had a protocolwhere he would just take it.
In fact, you could To that, ifyou were, if anybody listening
wants to test it, you take abusiness card and you just put
it under someone's little toeswhile they're sitting and then
you pull it out and tell them toresist and someone with strong

(38:34):
toes makes it really difficultto pull out.
And if you put it under the bigtoe, you shouldn't be able to
pull it out at all.
People with weak toes, you canpull the card out easily.
He quantified that test andshowed it had an okay iterated
reliability, but I saw thattest.
I was like, just make a plasticsheet that has the same
coefficient of friction as thecard, and then put a scale on it
so you can measure it.
So you can get a number readout.

(38:56):
So I made that device if you, soyou can easily quantify the
second through fifth toe, thebig toe, and then you just.
Measure both sides prior injurywill cause weakness if you have
plantar fasciitis cause weaknessif you have sciatica on that
side You're gonna get weakness90 percent of tendon injuries
happen on the side in which youpreviously had sciatica Because

(39:18):
if the nerve gets injured itdoesn't just weaken the muscle
weakens the tendon and it's easyto check strength You just put
this thing under and pull itout.
So then once you find outthere's weakness 30, 40 years
ago, I used to give TheraBandexercises where people push down
like this, but as they pushdown, the toe muscles are in a
shortened position, and theynever function like that in real

(39:39):
life.
They function when the toes arestretched.
As you're going into your pushoff phase, the toes are cocked
back, and a guy named Goldmandid a study that made me Like
reevaluate how I wasstrengthening the intrinsic
muscles of the arch because toeweakness predicts plantar
fasciitis.
It predicts falls.
It predicts metatarsal stressfractures.
So because I've treated so manyathletes from so many years,

(40:00):
I've treated it forever toprevent stress fractures and to
prevent plantar fasciitis, whichis an incredibly common
condition.
So Goldman showed that Ifmuscles are exercised in their
lengthened positions, you getfour times the strength gains as
if they're in their neutral orshortened position.
And as you know, muscles aremade of actin and myosin
filaments that stretch likethis.

(40:21):
And when you lengthen a muscle,there are satellite cells on
muscles.
When they're stressed like this,the satellite cells go, I don't
know what's going on there, butwe're going to increase
production.
We're going to make more musclefibers.
So they showed that when musclesare exercised in lengthened
position, especially the newestresearch is showing when they're
isometrically contracted inlengthened positions, it

(40:44):
stimulates repair and remodelingat a really rapid rate.
That is amazing.
You said four times more?
Four times.
The Goldman paper.
Wow.
So I was taught in, in schooland have seen, I don't even know
how many times, you're talkingabout the TheraBand.
For those who don't know brandnames, that's just resistance
bands.
So to pull my foot back and thenjust push with the toes.

(41:06):
But, or, and that happens withso many other exercises.
You can't exercise muscles inshortened positions.
Okay.
Unless they fire that way inreal life, but they rarely ever
do.
Muscles almost always, yeah.
So you stretch them into theposition that they will
naturally be doing.
Whatever activity they're meantto do.

(41:27):
Exercise in a position offunction.
I mean, that's the golden rulein sports medicine.
If someone's getting hurt asthey're kicking a football and
the leg is flexed in front ofthem, strengthen it in that
position.
And then, if it's a lengtheningor eccentric or concentric
contraction, duplicate how it'sused in real life, which is
simple.
That's why I made that.
toe pro platform.

(41:48):
That platform has an elevationto cock your toes back 40
degrees to match the Goldmanstudy, but then I also tilted it
out sidewards to work themuscles on the outer side of the
leg, the peroneal muscles,because research from the 90s
showed that those muscles play ahuge role in pushing you
forward.
The world's fastest sprintershave extremely strong peroneal
muscles.

(42:08):
When you transition from slowrunning to fast running, There's
a linear increase in peronealactivity, not the rest of the
calf.
So then I also pitched it backto get the Achilles tendon.
I apologize that I interruptedyou again.
You talk about so manyinteresting things.
It's boring with my manners.
So the peroneal muscles, theyattach on the outside of the

(42:30):
bottom part of your knee.
And then they wrap, again,testing myself before the
teacher, they wrap underneaththe outside of your ankle bone,
and then down under your foot,right?
So, that is Well, there's two,there's two peroneal muscles.
One is peroneus previs, it comesfrom the outside of the lower
leg, and then attaches to theoutside of the fifth metatarsal,
so the outside of the foot.

(42:51):
Then the more important muscle,in my opinion, peroneus longus
is the higher muscle that comesfrom just below the knee, comes
down behind the outer side ofthe ankle, then it absolutely
runs under the arch and attacheson the inner side of your
forefoot.
So it pulls the inner side ofyour forefoot down, which is
important for stability.
Someone just showed that thatperoneus longus muscle is a key

(43:12):
muscle for balance.
So that muscle, I'm happy to beable to talk to you cause you
know, you're that.
expert here.
I noticed in myself and also inpractice that lots of times that
muscle was so tight and I couldnot figure out what to do to
help to loosen it.
And I noticed it would make thefibula, that's the bone in the

(43:35):
outside of the knee, start toshift which could create a bunch
of knee pain and problems withthe ankle movement.
When I heard you speak, you weretalking about that muscle also
being a big factor in plantarfasciitis.
So plantar fasciitis, we tookall kinds of extra courses and
classes about helping plantarfasciitis.

(43:55):
Mostly what we were taught, andwe do, we did a lot of treatment
of that, is to get in there andMash the heck out of it and
stretch the calf and the soleusand do more exercises where the
ankle can flex further, likedorsiflex, which means, you
know, like what would happenwhen you go down in a squat, but
when you were talking, you saidthings very different than that.

(44:18):
You talked about the peronealmuscles having a whole lot to do
with plantar fasciitis, and itdoes not involve the very
painful work of stripping themembranes of the fascia.
Can you talk about that?
Can you dive into that a littlemore?
Because I know a lot of peoplewith plantar fasciitis as well.
Yeah, that was 11 percent of thepopulation deals with plantar
fasciitis on a regular basis.

(44:38):
That was a study by a researchernamed Sullivan.
He took 200 people with plantarfasciitis and compared them to
70 controls and then measuredankle dorsiflexion, measured
everything you could possiblymeasure, body weight, all this
stuff, and then evaluated thedata to see what correlated with
the development of plantarfasciitis.

(44:58):
Toe weakness predicted it, whichhad previously been done.
A tight calf predicted it, notthe soleus.
But the medial gastroc, so thelong, the surface calf muscle
predicted it.
So basically, ankle range ofmotion when your knee is
straight, because the gastroccrosses the knee joint.
So calf stiffness predicted it.
But the single best predictor ofplantar fasciitis was peroneal

(45:22):
weakness.
And I had never seen thatbefore.
I had never strengthened theperoneals as a rule with plantar
fasciitis before.
So when I saw that paper, Istarted treating everybody with
peroneal exercises and theoutcomes markedly improved.
But having said that, anotherpaper recently came out, it was
based on the work by D.

(45:42):
Giovanni.
If you look at a calf, and maybeyou could explain it better than
me, because I tend to makethings too technical.
If you look at the back ofsomeone's calf when they're
standing, there's like two bigmuscles, the medial gastroc and
the lateral gastroc.
They're the surface calfmuscles.
The inner calf muscle, which ison the inside, has, it fires
constantly to help you balance,that they do different things.

(46:04):
The medial and lateral gastrocbehave differently.
The medial gastroc is veryimportant with balance.
When you're standing up for along period of time, arm is at
your side, you're constantlyleaning forward and you don't
know it, and your gastroc pullsyou back.
It lets you, it keeps youbalanced on the verge of a fall.
So your gastroc is pretty muchconstantly active.
As a result, it tightens more.

(46:25):
So D.
Giovanni was this researcher whowanted to see what a tight
soleus versus what a tightgastroc did.
So he just measured ankle rangeof motion when the knee was
straight and when the knee wasbent.
And when the knee is straight,if gastroc is tight, You are way
more likely to get plantarfasciitis because it causes the
heel to lift off the groundprematurely Which stretches the

(46:45):
plantar fascia and pulls on itAnd I'm writing a paper now to
put all this stuff togetherbased on a paper that just came
out that was fascinating Theyshowed that the calf and the
Achilles come down and have acertain amount of tension in
them and then force isTransmitted into the plantar
fascia, which has a certainamount of tension in it And if
you are really tight in yourcalf You'll transmit more

(47:07):
pressure into the plantar fasciaand vice versa.
If you really tighten yourplantar fascia, you transmit
more pressure here.
So a lot of people do stretcheswhere they pull their toes back
and things like that.
I no longer do that.
If someone has plantarfasciitis, that means that was
the weak point in the link.
And I have them get on a toe proor any, like, elevated disc, any

(47:28):
slant board, I have them hangtheir toes off the edge of it so
that the plantar fascia, becausethe plantar fascia invests the
toes, it runs into the toes, Ihave them bend their toes down,
the ankles dorsiflexed or up,and then I have them do straight
leg calf stretches for 90seconds, and then I have them do
that six times.
A paper came out.

(47:49):
Tons of papers over the last 20years have shown that stretching
doesn't do a thing when you doit for 30 seconds, other than
temporarily stretch the muscle,then it goes right back to where
it was.
So these researchers said, hey,no one's ever studied the effect
of long term stretching.
So they took calves and they did90 second stretches.

(48:09):
held it and they did like 15minutes they did five or six
different stretches in differentpositions and they showed that
the muscle physically gotlonger, it physically got
stronger, the tendon got moreresilient and the muscle mass
increased and it was muscle massincrease because when you put
that much tension on a muscle,you impair circulation, which

(48:30):
produce increases growthhormone.
So it was like, it was likeblood flow restriction training.
It was really clever.
And I saw that type one musclefibers we talked about before
too.
Exactly.
So, yep.
So I saw that and I just said,for starters, that was the best
predictor.
Something like 40 percent ofpeople with plantar fasciitis 15
years after they have it.
They're still dealing with it.

(48:51):
And the best predictor of it wasthe meteor gas truck.
That is amazing.
So that's two really superhelpful tools, because I, I, I
know people very close to me.
That was one of the questions ofone of my friends that she
wanted to ask is you want to befit.
And so you start.
running with your friends, oryou start doing Zumba or

(49:11):
whatever.
But if the plantar fasciitiskicks in, then if you can't
figure out how to get it away,then every time you rest, you
stop doing the things that youlove, you get out of the habit
of exercise, then you startagain, but the load on the foot
starts it again.
So it, what is happening in thebottom of your foot is can
really, really mess with yourlife, but you're saying, so let

(49:33):
me make sure I have this correctto summarize for people.
So the gastroc is just the calfand the medial gastroc that
you're talking about that hadit, that just, just the side of
the calf that is the closest tothe midline of your body.
So, I know if, When I am feelingthe calf of a lot of patients in
the clinic, I feel triggerpoints or tightness in the

(49:55):
muscle most often on that insidepart of the calf or around the
very outside of either the backof the calf or the front of the
of the leg, like just to theside of the shin.
That Those are the areas whereyou are talking about.
That's the peroneal muscles, andthat's the gastroc, and you're

(50:16):
saying if you put your Get on aslight incline.
Did you say 30%?
30%?
A 10 degree incline.
10 degree incline.
Put your toes over the edge ofthe incline, keep your knees
straight, Bend forward andstretch Slight toe in, too.
You did a slight toe in, thattargets medial gastroc.
Oh, perfect, perfect.
And the peroneal muscles, isthat hitting that also?

(50:39):
I know you're toeing a littlebit because it angles.
With the peroneals, it's moreimportant to strengthen them.
With the medial gastroc, it'smore important to lengthen them.
Okay, so So, you've got tolengthen the medial gastroc so
the heel doesn't pop off theground and then strengthen the
peroneals to stabilize theforefoot.
Okay.
So if the forefoot is stable,the plantar fascia is not
getting sheared like this.

(51:00):
And the same thing if, if thearch muscles are weak, then the
plantar fascia separates.
The arch muscles hold theplantar fascia together and
prevent it from gettingstrained.
Oh, so two separate things.
So let me go back to the, ifyou're stretching it, so you
toes over.
Knees straight, bend over for 90seconds.
And how many times do you haveto do that?
Like five, at least five, thestudy, they did it for 14

(51:23):
minutes and the 90 second holdis really hard.
So I have people build up to it.
They can start at 40 seconds andthen 50 seconds.
So take your time getting noneof these things should hurt.
So if you're really tight.
Don't do it for 90 seconds for acouple of weeks.
Okay.
So, just build up to it.
Is there a break in between,like, 90 seconds, rest 30
seconds, or just A very shortbreak.

(51:44):
Just whatever you can You switchfrom one stretch to the other.
So, again, I wrote an articlethat has illustrations of all of
it, and it was new techniques tomake sure your plantar fascial
injury doesn't return and it'son the site, and it has images
of the exact stretches used inthe study.
Oh, wonderful.
Yeah.
The data hadn't come out showingthat you had to unload the

(52:04):
plantar fascia, so I didn't tellpeople to hang their toes off
the edge, which I am now.
So tell me about strengtheningthe peroneal muscles.
Now, the reason I want to knowis you said something that I
think is fascinating.
So the muscles are peronealmuscles.
intending to unload, which meanstake more pressure off of the

(52:24):
plantar fascia.
So we go into a plantar fasciathat's hurt and we mash it and
we rub it, we try to get thebumps out, but really that will
come right back if your footmuscles are not strong enough to
take off some of the pressure.
So yeah, I actually think thatyou could cause problems by
mashing and ripping up a plantarfascia because again, it, it's

(52:48):
being irritated because it hasno support.
I call it variable load transferwhen synergists are strong.
They, uh, when other muscles arestrong, they offload the plantar
fascia and protect it from, frombeing ripped.
Like, it's nice to massage it tobreak adhesions that are in
there, but you'd be better offtargeting the tight spot.
So work the calf, strengthen thetoes, like some areas should be

(53:11):
strengthened, some areas shouldbe lengthened.
Of course.
Of course.
So do you have a thing, I have,by now you've said like five
times that you wrote an articleabout it and I can just go click
on it to see the exercises.
Do you have information on yourwebsite for strengthening those
muscles?
Yes.
Yeah, the, the, just the articleon the Topro specifically goes
into how to strengthen theperoneals, and there's videos on

(53:32):
most of them.
So that's balance.
Again, I don't like makingvideos.
That's balance.
That's proprioception.
That's fall risk.
That is plantar fasciitis.
That's just, and it's not anexpensive tool.
I'm, I know in our clinic Ithink our patients can get a
Yeah, we've got discount codesfor people, so just get

(53:53):
affordable, but it's, it's 69 asit is.
So, and if anybody, I, we give,I give discount codes to anybody
who asks, I'm like, what's thedeal?
Okay.
I had another question and thisis leading right into it.
So I hear a debate very oftenbetween two schools of thought
about the foot.
One, which I taught often inchiropractic seminars says.

(54:16):
If a foot, it tends to roll in,or we call it pronate.
If a foot tends to roll in, thatalso rolls in your knees, it
makes problems in your hips andyour low back, just to simplify
it.
And so you need to be, if youhave a, a genetic reason that
you're rolling in, or alifestyle or an injury, then you

(54:38):
need to be in orthotics.
And that strengthens the, well,it helps the alignment from the
ground up is the phrase.
Then you go to another seminarand they talk about how if you
are in orthotics, it weakensyour foot and that's going to
create a dependency on theorthotics and a weakness in
general so it will create moreproblems.

(54:58):
Then you go to the barefoot orminimalist population.
They talk about having a widetoe box or having nothing around
your foot so that you can run asour ancestors did and gain
increase in strength.
What I have found is in everysingle one of those schools of
thoughts.
There are patients that match ordo not match it at all.

(55:21):
And I'm guessing it's one ofthose, let's use some common
sense sort of things.
It depends on the surfacesyou're on.
It depends on probably yourspecific alignment.
And I'm certain it depends onthe muscle weaknesses or
strengths in your body.
Where I was interested to seethat you talk about foot
alignment and strengthening, butyou also have been in the
orthotic world.

(55:42):
Can you Guide me through to findsome sanity in that when people
are wondering, should, when theyread Born to Run and they're
thinking now they should takeoff their shoes and run for
three miles.
Yeah, I remember I've been inthe orthotic industry for 45
years.
My mom was the vice president ofthe world's first large orthotic

(56:04):
laboratory, Langer Laboratories.
So I started making orthoticswhen I was in my teens and with
the elite athletes I was seeingin the 80s and 90s, orthotics
have a patient satisfactionrating with them higher than hip
replacements.
They're a very effective, yeah,they're a very effective way to
treat and prevent injuries.
I love all the controversiesthat is out there because they

(56:26):
were overutilized.
They were so popular in the 80sthat people started coming in
asking for them.
I was like, you don't need them.
An orthotic distributes pressureand decelerate the velocity of
motion, but so can your muscles.
So like I rarely put people inorthotics anymore, my last few
years of practice.
And as far as the minimalistcraze goes, I've written several

(56:48):
papers on that.
And I talked about it in acouple of books I've written.
You can predict, they did onestudy comparing injury rate with
minimalist shoes and then withconventional training shoes with
a heel toe drop of 12millimeters, people who wear
minimalist shoes have higherinjury rates.
Now you could get around that bylike significantly higher injury
rates in the first few months.

(57:09):
You can get around that bysaying, yeah, but if you break
it in properly, they'll getstronger, which is true.
So my beef with the minimalist.
Problem and it's why Vibramfaced multiple multi million
dollar lawsuits because theinjury rates were so high is if
you take someone with a wideforefoot, strong toes and a
flexible calf, put them in aminimalist shoe, they will love

(57:32):
it.
They will get stronger and theywill be happy.
You take someone with a narrowforefoot.
The population that ran barefootfour million years ago, we
didn't start wearing shoes until27, 000 years ago.
So our foot evolved to be usedto not wearing shoes.
So up until 29 30, 000 yearsago, our forefoot was 20 percent

(57:57):
wider.
Our toes were 15 percent wider,and they were stronger.
When you put a kid in shoes fromthe time they're Two or three.
You prevent muscles fromforming, and the forefoot
becomes narrow.
The intrinsic muscles becomeweak.
They did a study of India withover a thousand kids.

(58:18):
Kids who were barefoot frombirth had neutral arches,
stronger feet.
When kids wore shoes constantly,then it's supposed to press the
activity of muscles, a bonecalled the talus drop down.
And there's a little elevationon your heel bone called the
sustentaculum tali.
If the talus presses on it longenough, when you're before the

(58:39):
age of like between the ages offour and eight, you suppress
formation of that support bone,then you end up with what's
called a hypermobile flat foot.
About 10 percent of thepopulation gets a hypermobile
flat foot, which buckles duringpush off.
I just did a thing with CourtneyConnelly and Jen Perez at Gate
Happens.
The injury rates when you're ahypermobile flat foot person are

(59:01):
through the roof.
The, you're more dependent uponmuscular restraining mechanism
because the foot is so flexiblethat it buckles.
So, Irene McClay Davis did agreat study where she quantified
arch height with a very precisemethod and she showed that low
arch people And it correlatedwith x ray findings.
They got injured on the innerside of the foot.

(59:21):
High arch people got injured onthe outer side of the foot.
And there is some great datashowing that low arch people, if
they're strong, they don't getinjured.
So I look at it rather than putan orthotic in.
One paper came out that showedif you put orthotics in people
and don't give themstrengthening exercises, There,
the arch muscles atrophy between10 and 15%.

(59:42):
The abductor hallucis, the bigmuscle in the arch, atrophied in
12 weeks, 17%.
So I made a series, if someone'slow arched and I've, I've never
liked supporting the arch, whenyou make an orthotic, you
actually tell the lab to lowerthe arch so that the foot can
move through a normal range ofmotion, a well made orthotic.
doesn't interfere with, withmovement.

(01:00:03):
And that's part of the problem.
There's a thousand differenttypes of orthotics out there.
You know, my brother owned anorthotic lab up until recently,
and probably 90 percent of thecasts that came in were taken
inappropriately or theprescriptions were wrong.
People don't, people who makeorthotics often aren't the best
at making them.
They just do stuff they weretaught in school.
And as you know, everything'schanging so fast in a good way,

(01:00:25):
because now you realize.
You can have a low arch, and ifit's strong, it's not
problematic.
But if you have a narrowforefoot and a tight calf, be
very careful about minimalistshoes.
But then again, also, everybodyloves those hokas with the toe
springs, and any other shoeswith, with rigid toe springs in
them, they can weaken toemuscles.
So, get a shoe that fits theheel counter.

(01:00:47):
If you've got a wide forefooter,that should have a wide toe box.
It's all about fit.
And that's what all the researchis showing.
If a doctor prescribes a shoebased on your foot architecture,
it is no, it is not thatprotective.
But if you pick a shoe based oncomfort, you're significantly
less likely to get injured.
And that's what I came to theconclusion after reading

(01:01:07):
everything ever published on theprescription of running shoes.
So it's all about fit.
And comfort, because when yourfoot hits the ground, your
tibia, the leg bone oscillatesat 200 cycles per second, and
your central nervous systemsenses that oscillation and can
tell you which shoe is the bestfor you.
It pretenses muscles, and ifthose muscles are strong, you're
not going to get injured.

(01:01:28):
So it's, it's about comfort andthere's no one size fits all.
So that's why, I mean, to me,that controversy is over.
You know, it's minimalist shoes,if done universally, will cause
injury.
If you have a good footarchitecture for them, they're
amazing.
They can strengthen.
In my, that first book I wrotewhen they first came out, I
said, wear them on occasion tostrengthen.

(01:01:48):
Don't go for a 20 mile run withthem.
Um, and unless you've got thefoot architecture that supports
it, which is like a, like ourhominid ancestors, a crazy wide
forefoot and a tight calf.
What you're talking aboutmatches my experience.
Pretty exactly.
I had knee pain that we couldnot figure out.
For most of my growing up life,I was super athletic, but it was

(01:02:10):
hurting often.
And my father in law is achiropractor.
He saw me when I was in college,and he looked at my knees, and
he looked at my feet, and he putme in an orthotic, which helped
my knee pain.
So much.
But I did notice if I wasn't inthe orthotic, my hips and knees
would start to hurt way fasterthan they ever did.

(01:02:30):
So I kind of went back and forthwith what I should do to
strengthen it and still stay inthe orthotic so I could stay on
my feet adjusting patients allday.
But when I got sick, I wasn'twearing traditional shoes very
much.
I was wearing moccasins as myslippers.
So wider toe box and I alsostarted coming across your work
and actually just Payingattention to my foot as I was

(01:02:52):
just walking and we call it atoe off but basically when your
toes push and you're pushing andThe more that I got the strength
even just that simple way ofpaying attention to my foot
position when I was walking inmoccasins Paying attention as I
was going up the stairs Flexingmy foot differently flexing my
glutes differently just payingattention Really then I could

(01:03:15):
tell what shoes helped or didn'thelp me And now, I honestly
don't have to wear orthoticsvery much.
I do wear them if I know I'mgoing to be standing on a hard
surface for a long time.
Then, it helps my knees and myhips not hurt so much, but I let
my foot move and breathe and Iexercise it.
It feels much better.
I wear, I wear an orthotic thatis, it's called a neutral

(01:03:37):
orthotic.
It's not posted and the arch islowered, but it has a good heel
counter on it because ourancestors who were around.
Up until, you know, recently,the lifespan of the hominids was
around 35 years, and beneathyour heel and beneath your
forefoot, you have these specialfat pads that are unlike fat

(01:03:58):
anywhere else in the body.
They're contained in elasticchambers.
They have polyunsaturated fat,so they don't freeze.
So you can go.
barefoot across ice without thefat pad freezing it.
They're amazing.
That's, I mean, we didn't wearshoes until 27, 000 years ago.
That means we went up throughAlaska and down over the Bering
Strait barefoot.
And the fat pad absorbed shockbetter than any connective than

(01:04:21):
any, any synthetic material evermade.
So they've shown thatcontainment of the fat pad.
is good for it.
It protects it.
So I wear an orthotic with amoderately deep heel counter
just to hold my heel pad inplace because our hominid
ancestor died, lived to 35.
They weren't making it to 85,90.
And once you lose that fat pad,there's no replacing it.

(01:04:42):
So I, I couldn't imagine nothaving, but again, I've been in
the industry my whole life.
I've always worn like zerodegree orthotics.
Without arch elevation and donefoot strengthening.
Well, I'm also thinking of shoesthat women often wear, where
we'd not only put pressure moreon our metatarsals or on our
toes with the heels, but, butflat, even if it's flat, flat,

(01:05:04):
really hard sandals, not, not sogreat.
The heel cup, I like how youtalk about the heel cup.
That is one thing I've seenconsistently is if you're
wearing shoes and they justhappen to be a shoe you love,
but you tend to wear one side orthe other.
I know that is a thing to makesure that if that is happening,
don't keep wearing those shoesbecause that really will mess

(01:05:26):
you up.
Just one more question.
I saw some of your work aboutlow back pain and the diaphragm
muscles being a very importantpart of the core that we don't
really address very often.
So most people think about thecore as the front muscles.
We can call them the vanitymuscles, the six pack muscles,
or the muscles that help youbend side to side, your

(01:05:47):
transverse muscles.
But I have found also the lowerpelvic diaphragm and the upper
respiratory diaphragm, so thediaphragm that's just under your
lungs, to be very underassessed, and every time that I
start to treat them, I seeamazing things happen, but I had
not thought about the diaphragmconnection to the low back pain.

(01:06:09):
Can you talk to us more aboutthat and ways there are to
strengthen the diaphragm?
Because when I heard your work,I went to YouTube.
I typed in strengthen thediaphragm.
That was a mistake.
There's information all over theplace and lots of it.
It's really weird.
First mistake is going toYouTube.
But I know that's what listenersmight do.
So I know low back pain isreally prevalent.

(01:06:30):
So can you give us just a coupleminutes of your time on that?
Sure, sir.
Once every five, I've kept upwith the literature for 40 years
and once every five or sixyears, you'd come out, you'd see
a paper where people diddiaphragm strengthening
exercises and got amazingimprovements and not just low
back pain, but lower extremityinjuries.
And then.
nothing would come out on itanymore and then people would

(01:06:51):
ignore it.
And then they did a study wherethey used infrared spectroscopy
where they could evaluate inreal time blood flow to the back
muscles and lower extremitymuscles and they gave people
exhaustive exercises for thediaphragm.
And as the diaphragm was gettingexhausted they noticed that your
central nervous system tookblood from your back.

(01:07:12):
And your lower extremity bloodvessels and shuttled it to the
diaphragm because activity ofthe diaphragm is prioritized
over any other muscle becauseyou need oxygen.
So they showed that when anathlete is fatigued, that when
that blood gets pulled away.
It interferes with the abilityof spindles to tell you where
you are in space becausespindles are require blood and

(01:07:33):
they're the length regulatorswithout adequate blood flow to
the spindles, you loseproprioception and balance.
And the author said, this is whyin the last five minutes of a
basketball game, people getinjured.
Then they looked at people withlow back pain and measured
diaphragm strength, which iseasy.
a power breathe K3 device whereyou just go, it measures volume,

(01:07:56):
force, all sorts of parametersfor diaphragm function.
They showed low back painpatients have weak diaphragms.
Then they also showed thatpeople who are get like
pulmonary conditions and thentheir diaphragm gets weak, then
they get back pain.
So there's a strong connectionbetween diaphragm strength and
low back pain.
And a researcher named Hodgesdid a great study where he put

(01:08:17):
people on a treadmill.
And then put a, like alaboratory coat around them with
cables that went in differentdirections.
Then he put sensors inside theirdiaphragm muscles and their core
muscles.
And then while they wereblindfolded, he pulled them
rapidly in one direction oranother to initiate the
beginning of a fall.
And he showed that the diaphragmwas the first muscle to fire to
protect you from falling.

(01:08:38):
Yeah, pretty cool.
Yeah.
Yeah.
So they then did studies to seewhere they know diaphragm
weakness correlated with lowback pain because it draws blood
from other muscles, whichincreases susceptibility to
injury.
So they said, how can westrengthen the diaphragm?
And they did deep breathing andstuff they do in yoga classes.
And it did not strengthen thediaphragm at all.
Because remember when we startedabout this?

(01:08:59):
talk.
We talked about how you have tohave resistance.
So they did a study where theytook, uh, uh, just a simple
power breathe tool.
They cost around 30 and get themon Amazon.
You just set the resistance onit and you go, you do 30
repetitions of inhales so thatyou're fatigued by the time you
hit your 30th and you do thattwice.
And I have people do that fivetimes a week.

(01:09:21):
Incredibly effective for chroniclow back pain stretch.
It's unbelievable.
I wish I could shout this stuffout.
So if you are, uh, Coach or anathlete that wants to mitigate
your injuries, especially in thelast part of the game, or
increase your sustainability oryour blood flow still in your
muscles, in your arms and legs.
Even your balance.
And your balance.

(01:09:41):
You have to strengthen yourdiaphragm, because when your
diaphragm gets weak and it'shard to get air and you're
really struggling, your bodywill shunt the blood to the
diaphragm.
You're going to lose your bodyawareness.
That's when injuries happen, soamazing for that, but also low
back pain patients are putthrough so many different kinds
of weird stuff that I can tellyou takes a whole lot longer

(01:10:02):
than doing the breathingexercises with resistance with
an inexpensive tool for tworounds a day.
I had some chronic low back painpatients that failed at every
other intervention, and when Ijust give them the diaphragm
exercises and send them home,and I have tools in the office
where we can measure pounds andstuff, I couldn't believe the

(01:10:22):
outcomes that I was getting, andlike, that was the general
population where they'd come in,they had chronic low back pain,
they were treated with PT,chiropractic, all sorts of
stuff, and still had episodicback pain.
Uh, the percentage of thatpopulation that improved was
shocking, but then I also see itat very high level athletes.
I just saw one of the fastestrunners in the country and she
had, again, she's going to theOlympics.

(01:10:43):
She had a surprisingly weakdiaphragm and diaphragm
strengthening exercises canimprove blood flow to her lower
limb while she's running.
I mean, it's, and it's hard ifyou don't check it, you just
would never think it was you.
You wouldn't think it was untilyou had it.
Yeah.
If that's an Olympic runner, youwould think her diaphragm is
very strong, but like you said,breath work, yoga, all that

(01:11:04):
stuff would be what I wouldthink.
And that could be kind of likehoping you're going to improve
your balance with balanceexercises.
You aren't necessarily going toimprove your diaphragm strength
with.
Diaphragmatic breathing, unlessyou have resistance and you're
doing it in the correct way.
So my last question is not aboutresearch or biomechanics.
And again, just thank you somuch for your time.

(01:11:26):
Our podcast is called WhatReally Makes a Difference.
So what would you say is Basedon your experience, the thing
that can really make adifference in people's vitality
in, in just your own or in ageneral person's, if you could
leave a message for humanity.

(01:11:47):
Oh, that's a tough one.
I would say one of the mostimportant things is find
something you enjoy doing inlife.
I mean, I'm not exerciseobviously is important for
vitality and stretching helpsyou.
I personally.
I pay attention to what I enjoydoing.
I love learning this stuff andI'll spend three or four hours a

(01:12:12):
day just like trying to keep upwith stuff and find things that,
that interest me.
And then like I find exercisecalming.
So I exercise every day.
I probably exercise an hour anda half.
To two hours a day and have mostof my life and then diet.
Like I, I've always had a lowinflammation diet.
I, I just find that that calmsme down and, and rest.

(01:12:36):
I've always tried to sleep sevenand a half to eight hours a
night.
So like, if I were to rate allthose things, you know, I was
talking about it with my wifebecause she loves what she does.
Find something you love doingand, and you're happy.
Like, we don't even, okay.
Travel, we have all thesefriends who go to all these
exotic places, like, I'm, I'mfine not doing that.

(01:12:57):
Exactly, and I think when youfind those things that light you
up, that ends up not onlylighting you up, but when you're
Doing what you're happy doingyou cannot help the like light
and interest that shines fromyour eyes Or your being as you
share it and then we all canhave the information to thank

(01:13:18):
you so much for your time You'rewelcome anytime.
I'm so good.
It's been a pleasure.
Yeah.
No, it's really been greattalking with you.
Absolutely So thanks for havingme on.
Okay, I will put links to yourwebsite and I think you're
Pretty tops.
You have my vote for bestchiropractor.
Thanks a lot.
Can't believe that was a yearago.
Hey, great talking with you.
Take care.

(01:13:39):
You're welcome.
And now you see what I mean.
I never hear Dr.
Tom Michaud speak that I don'twhip out whatever little piece
of scratch paper or notebook Ihave and just start writing
things down.
In fact, since this interview, Ihave been able to exercise in a

(01:14:02):
different way.
In recovering from my illness,it's been difficult for me to go
back to weightlifting withouthaving the cost of that
weightlifting be perhaps morethan the joy of doing it in the
first place, but I've wanted tomove.
I want to move my lymph.
I love feeling stronger and I'vebeen looking for a way to ease

(01:14:22):
into that.
So I started looking at some ofhis YouTube videos and I also,
um, tracked what we talked aboutin this conversation.
And as I have started, it hasjust felt so good to feel like
myself again, that I canexercise and be a part.
of doing things like mobilityand weights, but in a way that
is safer and that I can getgains without it having such a

(01:14:46):
high cost.
So before we started theinterview, he told me about a
YouTube video that he had donefor older people, but it is very
relevant for anyone who isgetting into exercise or who
just wants to, or who Or whojust wants to hit all the major
muscle groups in a way that isbacked by research and that is

(01:15:08):
super helpful.
So he referenced me to hisvideo, but warned me that the
sound was terrible because theyjust did it on the side of his
clinic one day and there's carsdriving by.
And he's right, the sound isterrible.
But it's still definitely wortha listen and that has been what
I have incorporated into myroutine.
I do it three or four days aweek and it's feeling great.
So I will make sure that link isalso in the show notes.

(01:15:32):
And he also talked about the lowback and strengthening the
diaphragm strength, which got mereally interested in the device
that he suggested.
So I started doing more researchon it and diaphragmatic
strengthening in general.
And what I found wasunsurprisingly, Dr.
Michelle was right.
This is a fantastic apparatus.
I actually had a meeting withsomeone in the company and

(01:15:52):
pretty soon I'm going to be ableto start.
Making that available for mylisteners at a discount.
So that is coming forward andthat's pretty cool news.
I'll put the link in the shownotes as promised, but again,
you'll be able to get that at adiscount and I'll let you know
the code for that when I receiveit.
So moving on to our nextepisode, I am overjoyed to be

(01:16:16):
able to share this one and Imean that genuinely.
We're going to be sharing aconversation with None other
than Yael Shai.
If you don't know who she is,then I'm so excited to introduce
you to her.
She founded and directed MindfulNYU, which is the largest campus
based meditation, mindfulness,and spiritual life facility in

(01:16:39):
the country.
She has also served as the chiefmindfulness consultant for
Procter Gamble, and she's beenall over TV.
Good Morning America, CBS, newspublications, multiple
magazines.
And she now has her ownmindfulness consulting business.
She's a regular contributor toapps like 10 percent Happier and

(01:16:59):
Roundglass.
And she's also the author of oneof my very favorite books.
It's entitled What Now?
and it's written primarily forpeople in their 20s and 30s.
who are facing transitions likegoing to college or having a
career, maybe beginning afamily.
And truthfully I found it's notjust for people in their 20s and
30s, it's for any of us.

(01:17:21):
Facing transitions or justlooking for ways that we can
find more mental health and moreof that space in our mind and in
our lives that we want to leaninto that is full of more heart,
that is full of more presenceand more truth.
She teaches.
mindfulness in such a relatableway.

(01:17:42):
She tells stories often taughtin Zen and Buddhist practices
but relates them to real lifeand to today's real environment
where there's so much anxiety,depression, or worry about the
future.
I love the stories that sheshares and this book has been
just going around with me shovedin my purse or on my desk or

(01:18:04):
side table for the last monthand a half.
Every single page is marked.
So I'm excited to share herinsights with you.
Please tune in next week andthen you can share in her wisdom
as well.
We'll see you then.

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