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

In this comprehensive discussion, acclaimed biomechanics expert Dr. Tom Michaud underscores the crucial role of foot strength in health and well-being. As a chiropractor that has worked with multiple Olympians, he knows his stuff, but it doesn’t only apply to Olympians. You and me, those exercising or wishing they could do it more safely, and for ages teen to elderly can all find something engaging in this conversation.  He outlines the significance of foot, leg, lower back and diaphragmatic strengthening in enhancing balance, averting falls, and its links with conditions such as plantar fasciitis and low back pain. The discourse explores a variety of topics including the influence of footwear, the personalized use of orthotics, and the benefits of minimalist shoes, along with recommended stretching techniques and exercise to improve foot strength. Additionally, Michaud shares his life philosophy promoting enjoyment, consistent sleep and exercise routines, and a low-inflammatory diet. 

Dr Tom’s website for a great collaboration on research and protocols: https://www.humanlocomotion.com/

Link to the Toe Pro Platform for foot and ankle strengthening: https://www.humanlocomotion.com/product/toepro-foot-ankle-exercise-platform/

*Use the code DRBECCA for a 10% discount!

Diaphragm strengthening device:

Amazon.com: Breather Pink │ Natural Breathing Exerciser Trainer for Drug-Free Respiratory Therapy │ Breathe Easier with Stronger Lungs │ Guided Mobile Training App Included : Health & Household

Dr Tom’s 5 exercises to help with aging (or getting back into exercise): The Sarcopenia Workout: 5 Simple Exercises to Prevent Age-Related Muscle Loss

00:00 Introduction and Gratitude

01:06 Introducing the Guest: Dr. Tom Michaux

01:49 The Importance of Research in Health and Movement

02:36 Discussion on Various Health Topics

03:05 Appreciation for Dr. Tom's Contributions

03:49 Beginning of the Interview with Dr. Tom

04:10 Dr. Tom's Transition from Clinical Practice to Research

06:02 Discussion on Exercise and Health

06:35 The Role of Walking and Running in Health

07:01 The Impact of Exercise on Longevity

10:04 The Importance of Strengthening Exercises

20:10 Discussion on Balance and Coordination

34:43 The Role of Toe Strength in Balance

38:58 The Power of Muscle Exercise in Lengthened Positions

39:44 Understanding the Role of Resistance Bands in Exercise

40:21 The Golden Rule in Sports Medicine

40:52 The Importance of Peronial Muscles in Running

42:39 The Connection Between Peroneal Muscles and Plantar Fasciitis

43:26 The Prevalence and Treatment of Plantar Fasciitis

47:43 The Role of the Medial Gastroc in Plantar Fasciitis

53:10 The Debate on Footwear and Orthotics

01:04:36 The Importance of Diaphragm Strength in Low Back Pain

01:10:47 Final Thoughts on Vitality and Wellness

Transcript

0:00

Hello and welcome to the What Really Makes a Difference podcast. I'm your host, Dr. Becca Whittaker. I've been a doctor of natural health care for over 20 years and a professional speaker on health and vitality, but everything I thought I knew about health was tested when my own health hit a landslide and I became a very sick patient. I've learned that showing up for our own health and vitality is a step by step journey that we take for the rest of our lives. And this podcast is about sharing some of the things that really make a difference on that journey with you. So grab your explorer's hat while we get ready to check out today's topic. My incredible guest network and I will be sharing some practical tools, current science and ancient wisdom that we all need, no matter what stage we are at in our health and vitality. I've already got my hat on and my hand out, so let's dive in and we can all start walking each other home. Hey, before we start this episode, I just want to offer a thank you. Thank you so much for supporting me and the show and for helping it come forward as a creation in the world. There are just so many helpful and interesting people in this world and I am excited to have a vehicle to have conversations with them and then also to share them with you. Thank you so much for rating the show. Thank you for your feedback. Thank you for sending in questions. All of that helps it to be better and I appreciate it so much. Also thank you for your patience as we've had some sound difficulties. I switched to a different mic and batch recorded three conversations right in a row and didn't catch. That the mic was not doing well when it was plugged in for longer than 10 minutes. So, lessons learned. Gratefully, I have a fantastic editor helping me and we're getting the sound as good as we can get it. But, it will improve and we now are set up with a much better set up. So, thanks for being patient with the sound for the few episodes where it is a little wonky and we have more to look forward to. Speaking of things to look forward to, my guest today, Dr. Tom Michaud, is one of those guests that I cannot be happy enough to share with you. In fact, we talk about so many applicable things in the world of health and movement that it would be harder for me to think of someone I don't want to share it with than someone that I do. In fact, I've already shared information that Dr. Tom talks about on this episode with patients and with friends. People I know who are runners or who are trying to strengthen but coming back from an illness and some of the elderly people that I know who are trying to decrease their fall risk. Dr. Tom is one of those providers that does not just teach dogma passed down. He has a sincere bug for research and you will see as we get into the episode that he can remember and recall that research. with ease because he is so well versed in it and he's digging into it literally nearly every single day. He has now transitioned out of a clinical practice and is doing full time research and writing. And it just makes him so interesting to talk to because research is coming out with more things all the time that can make it so we can exercise with more safety and with less risk and get the same gains. As we thought we had to when we were hauling really heavy weights and doing very short amount 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 fall risk with some really interesting research. And a device that he has used that I use and my family uses. It has really, really helped my foot strength and my balance, so I'm excited for you to hear about that. And then we also talk about low back pain and ways to help our low back without even touching our low back. So, pretty cool. I am really grateful that he agreed to spend time with me today. He is still a very busy gentleman. And he's not only doing the research and the sharing of accurate clinical information, but he's also very kind. And anytime with Dr. Tom is Time well spent. I actually saw him win chiropractor of the year at the biggest chiropractic convention in the world last year So it's fun to both see him in action as a chiropractor and researcher Winning awards and then be able to talk to him in my own room on the computer So I'm happy to share that with you and without further ado. I gave you one of my favorite chiropractors. Dr. Tom Michaud Dr. Tom, I am so happy that you are here with us today. And we just in the green room as we were beginning already started on conversations that I wish I could share with six people that I can count immediately in my mind. So thank you so much for joining us. I know your time is really, really valuable. Thanks for sharing what you know. 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 just finished a paper for publication. I just write all the time. I stopped seeing patients full time. So yeah, I still work all day, every day. Yes, I was like, I think it's because you have more to do for the profession and the world in Beyond even just this profession. I'm so grateful. We'll see. I hope so. We all hope we all hope our work is worth something to more people than just us. Okay. So I talked to you a little bit about my audience, but just to say it as we're beginning. So Dr. Tom Michaud, so he works with very high level athletes. I know you're retired now, but this is, you're still working with them. I know you are. So athletes, but also teenage athletes and through the elderly population, lots of work that you're coming up with now about balance and coordination and elderly population, which I think is perfect to have on the podcast because we have such a gamut in. the audience that listens to this podcast. From those that are really sick and have a hard time exercising, but really need the stimulation in their muscles to go to their brain without it costing more, then, then it's giving them. All the way through to, I have a lot of middle aged women that are really wanting to exercise or feel better, but then when they start something like CrossFit or running with their friends, then it They get injured more frequently and I would love to talk about that as well as some of the things you're coming out with about as we age, things that we can do to keep us moving in a way better way, have much less risk of injury. So, fascinating things to talk about today. Absolutely. To begin with, we start with something just as simple as walking or or even moving up to a jog before we even run. What are some things that we can do as we're walking around or as we're climbing our stairs just in our normal activities of daily living? So whether you're really sick and that's the most you can do or if you're a normal human being and you're just walking from point A to B. What are some things to keep in mind in the way that we move our bodies that can either be Strengthening us or hurting us? Well, as far as strengthening goes, you're not going to get stronger walking. Walking, we are so efficient at walking, and it's the reason we've survived as a species. Our tendons store energy in the form of elastic recoil, so you can go through a walking cycle hardly consuming any calories whatsoever. You just need resilient tendons. One of the things you mentioned before is that people start exercising so they get injured. Yeah. The dose response for improved health with walking is minimal, you know, walking five miles a week, which is, you know, not that much of a commitment at six years to your lifespan. So it's yeah, it's and then again, if you look at studies, which people don't like talking about, because I've dealt with. hundreds to thousands of people who run 70 to 130 miles a week. I've dealt with like Kenyans, Ethiopians. Once you start running past 40 miles per week, it has a negative effect on your lifespan. Like our ancestors going back, you know, 2 million years, their weekly, their daily distance of foraging was about 8 miles. So they've shown a researcher named O'Keefe, he's a cardiologist, showed that if you exercise too much, if you're running, especially if you're running fast, If, if you're at rest, your heart beats, you know, say four or five gallons of blood per minute. When you exercise hard, it goes up to 35 gallons of blood per minute that can stress the myocardium and it can damage it over time. That's why they showed that long distance running at fast speeds, you lose that increase in longevity that exercise gives you running, you know, 10 miles a week, you live, you'll live six years longer, but running more than 40 miles per week, you lose that six years. So if you have a population where you just, you're afraid of exercising, you could just go for short walks, like a 15 to 20 minute walk on a level surface does all these wonderful things. Paleoanthropologist by the name of Herman Ponser spent his entire life studying the benefits of exercise. He studied for the great apes in Africa to see the caloric expense of locomotion and great apes versus people, and then he wrote a book called burn showing that exercise doesn't really burn calories because when you exercise a lot, In order to compensate for the caloric expense of that, you actually start shutting other systems down. That's why women become amenorrheic if they run high mileage, they, your liver becomes less active. So your, your body has to prioritize where calories go. So if you exercise too much, you're not going to be burning calories as far as weight loss goes, but you do these amazing things for your immune system, for your overall health, for preventing cancer. One of the best ways to decrease your cancer risk is to exercise regularly. And again, the dose response isn't that high. You don't have to do that much. That's amazing. Can I just say right off the bat, people are so. worry justifiably about cancer, but one of the best things you can do to prevent cancer is simply to moderately exercise. Colon cancer is reduced just because it increases the transit time that food goes through your system, so you have fewer toxins there. So if you have a population that wants to clear toxins, like Exercise and it's, and it doesn't have to be intense. I like, I don't like intense exercise. We were talking about it before you have athletes go out to CrossFit, which is fine for fit people. It's, I mean, you CrossFit people, CrossFit people I treat are amazingly fit. But I wouldn't have like a 75 year old person who's never exercised before. And that paper I wrote, five exercises to prevent age related muscle loss. One of the studies took people in their eighties who never exercised ever. They measured body fat, they measured muscle volume, and then they gave them low load protocols, light resistance, high reps, and got great outcomes. I would love to hear more about what you talk about that. So you do look at strengthening in a little different way. I've heard you say the research that showed doing American Journal of Sports Recommendation, it's the standard recommendation for strength and it's valid in regular people, but older people who are afraid of injury, you can't do 80 to 90 percent of one repetition, max three sets of 12, three times a week. Especially if you're doing squats and lunges, we were talking about lunges are fine, but squats, you go so deep, even if you're just doing sit ups from a chair, the pressure on the back of a kneecap, when you bend your knee more than 45 degrees like this, the pressure skyrockets, because when your knee is at 90 degrees, like when you're getting up from a chair, the patella gets pulled directly into the femoral condyle, and if you have knee arthritis, it's painful, so do lateral step ups, you get next to a four inch step, any stable surface that's four inches high, and a stair is eight inches, so even a stair is too high. You just hold a weight or resistance and then step up sidewards while holding on to a wall. It's, there's, I made a YouTube video of it that, that shows the exercise and I wrote an article. That's on human locomotion dot com site, and it's got pictures of the exercises. I wanted to figure out a way to fire every muscle in the body. So I did a lower trap exercise based on EMG studies where you pull your shoulders down and back low stress, easy on the shoulders. I did a lateral step up. I did a couple of easy foot ankle exercises and then a modification of the lunge and then a twisting exercise. All. Low stress. I've had hundreds of people who are over the age of 80 do them and nobody's getting hurt because it's it's easy to not get hurt when you're doing these exercises. If you sit exercise in a safe range, you know, you pick up any magazine, you know, New York Times anything and they will tell you get in a chair and stand up while holding on to resistance or do squats. Squats. A paper came out in Journal of Orthopedic and Sports Physical Therapy have dangerous high levels of pressure on the back of a kneecap if it's a full 90 degree squat. If it's a 45 degree partial squat, where you just go down a little, which is how you exercise in life. How many times have you, if you had to move a refrigerator or something, you wouldn't get to a 90 degree squat position and push, you'd bend your knee 45 degrees 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 45 degrees, like a partial knee bend. you will be strong should you ever have to load it at 90. That's that paper that showed they had the same increase in vertical jump height when they did full squats as when they did partial squats. And I've got nothing against full squats and healthy people, but you know, I damaged my kneecap when I was a kid. My left knee hit a concrete wall and my entire life, whenever I attempt to do squats, my knee has hurt. And once a year I go, ah, it's got to be better now, so I try it again. And now I just don't do it. And I exercise every day, and my knees 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 with fibromyalgia, People with myalgic encephalitis is another thing that I struggled with, which is where my brain and spinal cord swell and my muscles hurt. So, and I've met other people that have similar things. where you want to exercise and you want all the muscle groups to fire, especially because that affects your brain. You want the neurology to improve and your proprioception to improve or your awareness of your body to improve. But trying to do that, if I did two full squats, that would take me two hours recovery time. Right? And whether you're sick or not, just if, if you're looking for something that you can be effective at that doesn't take very long, five exercises is not that big of a deal. And with a way less risk of injury. I think the news that you can squat to 45 and the outcomes are the same instead of squatting all the way down, that's wonderful. Or that you can do five exercises where you're getting every part of your body and giving all of that information to your brain, but with much less 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 60 followed by one set of 12. In order to get strong, it's called the size principle of motor recruitment. When you use a muscle, your central nervous system says, well, I'm You're not going to be generating that much force. Like if you're walking, you're doing something easy. So you send a signal to like 20 percent of your muscle fibers. They're the slow twitch muscle fibers. They are loaded with oxygen and they are the first 20 percent you always go to. So if all you did was a few repetitions, you would only work that 20 percent of the muscle fiber. And then the rest of the muscle wouldn't get any benefit from it and would start to thin out over time. You lose 2 percent of muscle mass every year starting at the age of 50, and it correlates strongly with falls and other problems. So what these researchers showed that when you do one set of 60, which sounds like it's hard, but Because you have to do 60. It has to be incredibly easy. Otherwise you couldn't do 60. It just basically pumps blood out of the muscle. And when blood is squeezed out of the muscle, it forces you to not use your slow twitch fibers because they require oxygen, which is supplied by the blood vessels because you've just squeezed the blood out of the muscle, even though it was light resistance. And, but you did 60 of them, the next set of 12, you go to the fast twitch muscle fibers that function without oxygen. Those are the ones that people historically have used heavy weights to target. That's why the American College of Sports Medicine says you have to use heavy weights or you'll never recruit your fast twitch fibers. They meant well, but that research showing that if you did a set of 60 and followed with a set of 12 hadn't come out yet. And there's other protocols, four times 25 at 30 percent full effort produces more muscle hypertrophy than the high resistance stuff. Again, I think it's because it decreases blood flow and you know, it gets complicated, but there are other methods of training where you put a simple strap, a compressive strap around your thigh. It decreases circulation, which forces you to use your fast, which fibers. And the compression of the muscle also increases growth hormone, which accelerates repair and you're dealing with, you know, my algae patients, you people, you can't load too high. And remember, there's that after discharge principle. When you fire a muscle vigorously, there's an echo in the spinal cord where this. the muscle tightens later. Anyone who's done that kid's game where you push into a door jam, hold hard for 10 seconds, and then your arms float up afterwards, that's that after discharge. And that's a negative thing if you've got a history of muscle injury or muscle weakness. Get that with light contractions. So meaning if you're loading the muscle, so losing, using like a heavier weight or doing heavier exercise, you might be okay right then, but then after you get A series of tightening and it's a reverberating muscles, right? It's a reverberating cycle where you're significantly stiffer later. That's why heavy, big weightlifters always, they can't like put their hands behind their back. They, they tend to be stiff. If you fire a muscle very vigorously, it tends to stiffen it. So, you know, you can get around that with the light resistance protocols. So, I want to just review. 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 the strengthening, you get to those when the muscle doesn't have as much blood. So, you can do that either by doing heavy weights, small reps, or Just as good with less injury, you can do lighter weight and 60 reps and then a 30 second rest. I know you said was very important when we were talking before. And then you don't want blood to get back into it. There you go. So that's why. And then one set of 12 reps at 60 percent of your effort. About 40 percent full effort. So yeah, you should be tired, yeah. So full effort means like, as much weight as you could lift when you could only lift like one or two. So if I'm really tired, if 100 pounds is that, then what we're talking about is you go down to like For that last set of 12, you'd only lift. They use that in research all the time, and it's a confusing number for people. It's called one repetition max, the amount of weight you could just lift once and not lift it again. And then you multiply it, like American College of Sports Medicine says, multiply that one repetition max by point eight and then do a three sets of ten of them. So, because it has to be quantified in research, that's sixty twelve study. They did one set of sixty at fifteen percent their one repetition max. I hate bringing that up because no one wants to test their one repetition max. Exactly. And it's for research only. So, I tell people, Do a set of 60 with enough resistance that you're fatigued when you finish your 60. Then do a set of 12 with enough resistance that you're fatigued when you finish your 12. If you're hitting 9 and 10, and you're not tired, if you use an elastic band, just step back more, so that there's more resistance. So, once you get used to it, it's easy. But again, if it's someone who's dealt with myalgias, then, then keep it 15 percent and just see how you respond. Even mild muscle contractions, if you do enough of them, can be beneficial. Wonderful. And I mean, that moves the lymph system and the detox. So if you're sick or fighting some kind of illness, that helps you get the illness out any way that you're already. It improves immune function too. So, so another thing that I love you to speak about that helps in the elderly population, but also I really think about. the population with myalgia or neurologic problems or teenagers just starting off, as well as the aging population. You talk a lot about balance and I want to, I'm wondering if you'd share with me your information about balance and life predictability, but also about what really influences our balance, because your work with the feet is amazing, I think. So let's talk about that. Thanks. I, there's different centers that control balance in our system. Uh, pretty much everybody, when they think of balance, they think of the vestibular system in your inner ear. You have semicircular canals, you've got the utricle and sacral, and they tell you where you are with acceleration. But. Mostly where your head is accelerating. The bottom of your feet are loaded with four different cutaneous receptors that are slow adapting and fast adapting. They pretty much just sense pressure. Like if you were to stand up now and shift your weight to the outside or shift on one foot to the side, You'd put more pressure on the outside of your foot. You're that particular region. The outside of your foot is loaded with sensory receptors that tell you where you are in space. And then your muscle spindles are length organs. You know, when you tap a patella reflex, you stretch the spindles inside the muscle, and that causes the knee to jerk. Muscle spindles tell you where your muscles are lengthening. When you're balancing, standing on one foot, and most falls occur with the initiation of gait. You're standing still, you're about 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 those cutaneous receptors in the bottom of your feet. By the time you're 70, you've lost 30 or 40 percent. By the time you're in your 80s, you've lost 70 or 80 percent of the sensitivity. It takes significantly, almost Twice as much pressure to stimulate the sensory neurons, so you don't know where you are in space, especially while you're balancing. And I just read a paper where they looked at the contribution of your inner ear, your utricle sac, your semicircular canals, and the skin receptors on your feet and spindles. Skin receptors on the feet travel, the sensory nerves travel way faster. So they are responsible for more than 70 percent of balance. They're responsible for that of balance. beginning of a fall, then your inner ear can say, Oh, we're falling. So then you can bring an arm to the right spot, or you can move your upper body based on information from your inner ear. I'm wondering two things before we proceed that number one, is that a must happen, or is that a happens with. stagnation, like if you're sitting, do you get to keep more of that sensitivity if you're more active or if you're firing the muscles in your feet? And my second question is that would relate to like neuralgia or diabetes or anything where they have trouble with their feet. Anything that interferes with the sensory transmission of a nerve will interfere with the passing of pressure information from the cutaneous receptors. They just travel up the S1 L5 nerve roots, sciatic nerve roots. If you had spinal stenosis, you will have impaired balance. If you have peripheral neuropathy, you will have impaired balance. Diabetics almost always have impaired balance, not because the cutaneous receptors are breaking down, but the nerves aren't transmitting the information as fast. So there's a way to predict if that's happening. Someone recently published a paper showing if you go out to a music store and you buy a 256 cycle per second tuning fork, they cost about 8, put it on the bottom of a heel, someone's heel. If they can't feel it, that means that their nerves are not transmitting the information from the cutaneous receptors, because if someone showed the cutaneous receptors travel along similar pathways as vibration, so it's a simple little test. I made a fall prevention protocol. It was like a 40 page paper with over a hundred references, and I made a series of more than a dozen tests that take seconds to do, and then more than a dozen interventions. One of them is check open eye balance standing on one foot. If you can't balance, you get three tries to stand on one foot. If you can't balance 10 seconds, it's a better predictor of mortality than cardiovascular disease and hypertension. A better predictor. Oh yeah. Yeah. If you will die, cardiovascular disease. They said every, if the stats are there, I wrote a paper on it, it's called the 10 second balance test. If they're all on human locomotion. com, if you, if you fail that test that there's, they're telling doctors now that they should be doing that in office with every visit. because it is so easy to do. I saw that data, and I was surprised by it, and I've been studying balance for years, and there was like 1, 200 people in the study, and they followed them for, you know, almost 10 years. It was a big paper. But there are things that you're teaching that can improve balance, so if you can pick one thing to improve that helps your life now and then, and You know, this is interesting can help you. Yeah. Yeah. I never look up. I would never try to diagnose something that there wasn't a somehow solution to fix it. That's terrible because it's just wisdom that that paper I made up. There were 12 tests, but then there were 12 to 14 interventions. that you do based on whether you pass those tests or not. I mean, some of the tests were for strength, some were for range of motion, the inability of tight ankles predict falls, toe weakness predicts falls. It's all fixable. But this is what I loved about balance. You would think. That if you had a balance problem, all you would have to do to fix it is balance exercise, right? And that's true to some degree. There's a balance protocol that I put in there where you stand on a piece of foam, it improves balance. But several papers show that easy strengthening exercises to the foot and ankle improve balance better than balance exercise. And the reason for it Is that strengthening exercise increases circulation muscle spindles, which tell you where you are in space live right next to the blood vessels that supply the muscle. So when you exercise, you nourish those spindles, the long nerves, the peripheral nerves get. Increased nourishment when you exercise. A researcher from Australia published a pilot study on peripheral neuropathy where all she had people do was toe exercises against therabands and foot strengthening stuff and their peripheral nerves improved in function. So I'm trying to do Yeah, I loved it. I've contacted her, Karen Mickle, M I C K L E. I'm gonna pause you right there because peripheral neuropathy is something that I struggled with. So what that means is If you aren't familiar with it in the audience, I am the, you are but the periphery is like the, the further down your legs or down your 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 along there too. Or just pain in general in arms and. and legs that doesn't stop. When I tried to look for help for that, it was hard to find information. My neurologist did not know what to say. Most of them are like, well, this medication can help, but it has these weird side effects. And so good luck was basically the thing. You're saying that this research is showing just the resistance bands with even just lighter resistance even, but getting the blood back into the muscle can help. That's wonderful. Well, It's also good for the cutaneous receptors and a friend is, uh, Gabby Miller. She's, she's a physical therapist. She's writing a book on peripheral neuropathy now. She works in an oncology clinic in the Midwest. So all she sees is peripheral neuropathy patients all day, every day. And I made that foot strengthening exercise, the ToePro, and she's been using it on every peripheral neuropathy patient and sending me. Before and after on improvements in single leg balance, and then because they lose sensation along the lateral side of the foot, I made, uh, it's inexpensive. I made this small pad that has a series of elevation and as we lose sensation on the outside of the foot. That increases the probability of fall greatly inhabited with peripheral neuropathy. I made these little pads that have elevations that the more laterally you go, the more to the side you go, the more it digs into the skin and amplifies those cutaneous receptors that aren't. that receptive anymore. Just like if someone's hard of hearing, if you put a hearing aid in, they can suddenly hear. So she has been doing some studies where she takes her peripheral neuropathy patients and put the balance pads in and then immediately re measures their single leg balance. And she sent me some really nice videos where it's looking good so far. I just purchased a machine called a biothesiometer. It, it sends vibrations in from very low to very strong levels and then gives you a grade of how much, how well working your cutaneous receptors are. I'm going to do a study where we do strengthening, not strength, endurance exercise of the calf muscles to increase circulation. Use those balance buttons and see how it improves people's ability to perceive vibration. Peripheral neuropathy patients are an incredibly underserved population. For my first 30 years of practice, I really, every time I walked in a room with a peripheral neuropathy person, I felt bad for them because I didn'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 by Karen Mickle and she just got the pilot studies, she got a nice outcome and then they never went to a full study because it's hard getting funding now. I've been contacting different places to get a larger study going because I, I want to see if it works. I think it will, but I dealt with athletes most of my life. I didn't deal with a ton of peripheral neuropathy. That's why I've been reaching out 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 her experiences with dealing with chemotherapy induced peripheral neuropathy and she's getting good outcomes with strengthening. That is beautiful. But I'm also thinking that applies not just if your hands and feet are burning. Getting more blood flow into the muscle and activating the spindle fibers, that helps your body awareness, period. So, athletes or anybody who's wanting to not get injured, yeah, I mean, you injure your Yeah, better improvements in balance with endurance exercise. Way better than improvements with counterintuitive. Like you could do Tai Chi, which can help a little bit, but nothing beats light aerobic exercise to stimulate circulation. Well, also you talk about, let me see if I can word this better. What it's making me think of, when you're talking about balance and maybe just doing balance protocols is not the way to fix it is sometimes if you are trying to do something, say cooking, I was not fantastic at cooking and let me tell you, just practicing cooking did not make the cooking better, made my family better at kindly eating what I was trying to do, but I had to strengthen Some of the things that went into cooking, like I had to strengthen my ability to Mix things in a better way or to understand how to bake like I had to strengthen the steps of baking before of cooking before it turned out well. And I think about that when I think about you strengthening the individual toe muscles. So we're going to go back to what you created called the Toe Pro. So this is how I found you, Dr. Tom. I was at Parker Seminars, which is the biggest chiropractic gathering in the world. And you won chiropractor of the year last year. I was there for that and cheering for you in the audience. I was surprised. No one else was surprised, but I stick to myself. So I was, I found you because Lindsay MoMA is another person that I follow. She does so much wonderful work with the pelvic floor. And that is amazing. That's a big thing that I treat. But when I saw her at the conference, I said, where have you been? And she said, Oh, I just hang out at Dr. Tom. Michelle's the whole time. If you haven't seen the Topro, you have to get over there. Just hang out near him so you can hear what he says and check your balance. So I went, but again, I am just getting into a stage where I can balance again and I was struck. by, by the different things I learned at your booth. I'm putting myself on the spot here because I'm hoping I remember the percentages right. But if I recall, I think you said there is for every one percent gain in big toe strength that a person has, there is a, is it seven, eight percent? Yeah, seven percent. Way to go. That's impressive. Sweating in front of the teacher. That was a year ago. But I thought, my balance, I mean, people with MS have hard balance for all kinds of reasons. There's all kinds of reasons not to have balance. But you also have a way to check the strength from foot to foot with your foot dynamometer. And whoa, was I different from one side to the other. Where I had the brain injury, way different. But my husband was also very different. He had a knee surgery on one side that he has, his muscles have just never Been the same since then. His, he was in a skiing accident and it shattered his tibial plateau and Really just destroyed a lot of things in his knee. We, we purchased that, brought it home. I have a mother who is aging. She has Parkinson's and some dementia associated with that. We tested her. I have a daughter who has feet that pronate or. Roll in both of them. So her knees and feet often hurt. I have a son who's on the autistic spectrum. I have me with a brain injury. And we were like, what is this? What is this? No one was the same side to side. Some people we thought were going to be really weak. We're really strong. I had started exercising my feet, but on one side to check and see how fast I could go. This thing is wild. Everyone was different side to side. And it really, really affected their sense of being able to balance. We did one leg balance tests, and we also did, I can't remember what you call it, we bought yours, but we have done wobble boards before, and I really liked how yours was different. But, wow, one side is not the same as the other side. So can you tell me, what affects balance, why checking toe strength is important, and then tell me about the Toe Pro you developed to help. It's the best exercise I've ever seen. I have it sitting on my bathroom floor by my sink because I do toe pro exercises when I'm brushing my teeth or when I blow dry my hair. That's my type. A lot of people have commented that the fact that he could just leave it there and do it, it makes it easier to be complying with the exercise. Yeah. But before when I was talking about balances related to the cutaneous receptors, that, The paper that I wrote on predicting falls, the single best predictor of falls, and it's been studied multiple times with groups of over 300 in senior centers, is toe strength. And it's easy to test on yourself. Just stand up, put your arms at your side, and lean forward. What you will notice is that your toes push down to control what's called your anterior fall envelope. If your toes are weak, you will lean too far forward, you won't be able to stop it, and then you'll stumble with your first pace. And remember I said most falls happen when you first initiate gait. As your toes push down, they control that forward envelope. In fact, there's one of the tests that I do in that paper is you stand up and then you lean forward like this. If someone measures the distance you lean forward without falling, you should be able to lean forward four and a half inches without falling and then move back people who can't. And that. distance correlates exactly with toe strength. If you do that dynamometer test and you're less than 10 percent body weight beneath your big toe, you will not be able to have, it's called the anterior fall envelope. You will not be able to lean forward while your body is straight. So the toe is one of their main functions during gait is to make you stable as your center of pressure shifts forward. We're always in a precarious position while standing. I mean, watch any toddler learn to walk. They'll get up and they'll go side with the government, go forward. So it takes years for us to learn how to control our center of motion. But unfortunately we wear stiff shoes. We wear shoes with toe rock. Those hokas, which are so popular now are really comfortable, but they have toe springs that go up. So your toes don't have to fire, which makes them comfortable, which is nice because it feels good. But it produces weakness over time. A paper just came out showing that excessive toe springs and shoes like, oh, it's the upward roll to the end of a sneaker. It stops your toes from bending when you push off. Normally, when you push off during gate, the toes bend and then push down. If you have a toe spring in, you just kind of roll with no toe action. So I made that dynamometer. A friend from Australia was the former editor of Foot Ankle International had a protocol where he would just take it. In fact, you could To that, if you were, if anybody listening wants to test it, you take a business card and you just put it under someone's little toes while they're sitting and then you pull it out and tell them to resist and someone with strong toes makes it really difficult to pull out. And if you put it under the big toe, you shouldn't be able to pull it out at all. People with weak toes, you can pull the card out easily. He quantified that test and showed it had an okay iterated reliability, but I saw that test. I was like, just make a plastic sheet that has the same coefficient of friction as the card, and then put a scale on it so you can measure it. So you can get a number readout. So I made that device if you, so you can easily quantify the second through fifth toe, the big toe, and then you just. Measure both sides prior injury will cause weakness if you have plantar fasciitis cause weakness if you have sciatica on that side You're gonna get weakness 90 percent of tendon injuries happen on the side in which you previously had sciatica Because if the nerve gets injured it doesn't just weaken the muscle weakens the tendon and it's easy to check strength You just put this thing under and pull it out. So then once you find out there's weakness 30, 40 years ago, I used to give TheraBand exercises where people push down like this, but as they push down, the toe muscles are in a shortened position, and they never function like that in real life. They function when the toes are stretched. As you're going into your push off phase, the toes are cocked back, and a guy named Goldman did a study that made me Like reevaluate how I was strengthening the intrinsic muscles of the arch because toe weakness predicts plantar fasciitis. It predicts falls. It predicts metatarsal stress fractures. So because I've treated so many athletes from so many years, I've treated it forever to prevent stress fractures and to prevent plantar fasciitis, which is an incredibly common condition. So Goldman showed that If muscles are exercised in their lengthened positions, you get four times the strength gains as if they're in their neutral or shortened position. And as you know, muscles are made of actin and myosin filaments that stretch like this. 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, but we're going to increase production. We're going to make more muscle fibers. So they showed that when muscles are exercised in lengthened position, especially the newest research is showing when they're isometrically contracted in lengthened positions, it stimulates repair and remodeling at a really rapid rate. That is amazing. You said four times more? Four times. The Goldman paper. Wow. So I was taught in, in school and have seen, I don't even know how many times, you're talking about the TheraBand. For those who don't know brand names, that's just resistance bands. So to pull my foot back and then just push with the toes. But, or, and that happens with so many other exercises. You can't exercise muscles in shortened positions. Okay. Unless they fire that way in real life, but they rarely ever do. Muscles almost always, yeah. So you stretch them into the position that they will naturally be doing. Whatever activity they're meant to do. Exercise in a position of function. I mean, that's the golden rule in sports medicine. If someone's getting hurt as they're kicking a football and the leg is flexed in front of them, strengthen it in that position. And then, if it's a lengthening or eccentric or concentric contraction, duplicate how it's used in real life, which is simple. That's why I made that. toe pro platform. That platform has an elevation to cock your toes back 40 degrees to match the Goldman study, but then I also tilted it out sidewards to work the muscles on the outer side of the leg, the peroneal muscles, because research from the 90s showed that those muscles play a huge role in pushing you forward. The world's fastest sprinters have extremely strong peroneal muscles. When you transition from slow running to fast running, There's a linear increase in peroneal activity, not the rest of the calf. So then I also pitched it back to get the Achilles tendon. I apologize that I interrupted you again. You talk about so many interesting things. It's boring with my manners. So the peroneal muscles, they attach on the outside of the bottom part of your knee. And then they wrap, again, testing myself before the teacher, they wrap underneath the 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 comes from the outside of the lower leg, and then attaches to the outside of the fifth metatarsal, so the outside of the foot. Then the more important muscle, in my opinion, peroneus longus is the higher muscle that comes from just below the knee, comes down behind the outer side of the ankle, then it absolutely runs under the arch and attaches on the inner side of your forefoot. So it pulls the inner side of your forefoot down, which is important for stability. Someone just showed that that peroneus longus muscle is a key muscle for balance. So that muscle, I'm happy to be able to talk to you cause you know, you're that. expert here. I noticed in myself and also in practice that lots of times that muscle was so tight and I could not figure out what to do to help to loosen it. And I noticed it would make the fibula, that's the bone in the outside of the knee, start to shift which could create a bunch of knee pain and problems with the ankle movement. When I heard you speak, you were talking about that muscle also being a big factor in plantar fasciitis. So plantar fasciitis, we took all kinds of extra courses and classes about helping plantar fasciitis. Mostly what we were taught, and we do, we did a lot of treatment of that, is to get in there and Mash the heck out of it and stretch the calf and the soleus and do more exercises where the ankle can flex further, like dorsiflex, which means, you know, like what would happen when you go down in a squat, but when you were talking, you said things very different than that. You talked about the peroneal muscles having a whole lot to do with plantar fasciitis, and it does not involve the very painful work of stripping the membranes of the fascia. Can you talk about that? Can you dive into that a little more? Because I know a lot of people with plantar fasciitis as well. Yeah, that was 11 percent of the population deals with plantar fasciitis on a regular basis. That was a study by a researcher named Sullivan. He took 200 people with plantar fasciitis and compared them to 70 controls and then measured ankle dorsiflexion, measured everything you could possibly measure, body weight, all this stuff, and then evaluated the data to see what correlated with the development of plantar fasciitis. Toe weakness predicted it, which had previously been done. A tight calf predicted it, not the soleus. But the medial gastroc, so the long, the surface calf muscle predicted it. So basically, ankle range of motion when your knee is straight, because the gastroc crosses the knee joint. So calf stiffness predicted it. But the single best predictor of plantar fasciitis was peroneal weakness. And I had never seen that before. I had never strengthened the peroneals as a rule with plantar fasciitis before. So when I saw that paper, I started treating everybody with peroneal exercises and the outcomes markedly improved. But having said that, another paper recently came out, it was based on the work by D. Giovanni. If you look at a calf, and maybe you could explain it better than me, because I tend to make things too technical. If you look at the back of someone's calf when they're standing, there's like two big muscles, the medial gastroc and the lateral gastroc. They're the surface calf muscles. The inner calf muscle, which is on the inside, has, it fires constantly to help you balance, that they do different things. The medial and lateral gastroc behave differently. The medial gastroc is very important with balance. When you're standing up for a long period of time, arm is at your side, you're constantly leaning forward and you don't know it, and your gastroc pulls you back. It lets you, it keeps you balanced on the verge of a fall. So your gastroc is pretty much constantly active. As a result, it tightens more. So D. Giovanni was this researcher who wanted to see what a tight soleus versus what a tight gastroc did. So he just measured ankle range of motion when the knee was straight and when the knee was bent. And when the knee is straight, if gastroc is tight, You are way more likely to get plantar fasciitis because it causes the heel to lift off the ground prematurely Which stretches the plantar fascia and pulls on it And I'm writing a paper now to put all this stuff together based on a paper that just came out that was fascinating They showed that the calf and the Achilles come down and have a certain amount of tension in them and then force is Transmitted into the plantar fascia, which has a certain amount of tension in it And if you are really tight in your calf You'll transmit more pressure into the plantar fascia and vice versa. If you really tighten your plantar fascia, you transmit more pressure here. So a lot of people do stretches where they pull their toes back and things like that. I no longer do that. If someone has plantar fasciitis, that means that was the weak point in the link. And I have them get on a toe pro or any, like, elevated disc, any slant board, I have them hang their toes off the edge of it so that the plantar fascia, because the plantar fascia invests the toes, it runs into the toes, I have them bend their toes down, the ankles dorsiflexed or up, and then I have them do straight leg calf stretches for 90 seconds, and then I have them do that six times. A paper came out. Tons of papers over the last 20 years have shown that stretching doesn't do a thing when you do it 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 did 90 second stretches. held it and they did like 15 minutes they did five or six different stretches in different positions and they showed that the muscle physically got longer, it physically got stronger, the tendon got more resilient and the muscle mass increased and it was muscle mass increase because when you put that much tension on a muscle, you impair circulation, which produce increases growth hormone. So it was like, it was like blood flow restriction training. It was really clever. And I saw that type one muscle fibers 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 of people with plantar fasciitis 15 years after they have it. They're still dealing with it. And the best predictor of it was the meteor gas truck. That is amazing. So that's two really super helpful tools, because I, I, I know people very close to me. That was one of the questions of one of my friends that she wanted to ask is you want to be fit. And so you start. running with your friends, or you start doing Zumba or whatever. But if the plantar fasciitis kicks in, then if you can't figure out how to get it away, then every time you rest, you stop doing the things that you love, you get out of the habit of exercise, then you start again, but the load on the foot starts it again. So it, what is happening in the bottom of your foot is can really, really mess with your life, but you're saying, so let me make sure I have this correct to summarize for people. So the gastroc is just the calf and the medial gastroc that you're talking about that had it, that just, just the side of the calf that is the closest to the midline of your body. So, I know if, When I am feeling the calf of a lot of patients in the clinic, I feel trigger points or tightness in the muscle most often on that inside part of the calf or around the very outside of either the back of the calf or the front of the of the leg, like just to the side of the shin. That Those are the areas where you are talking about. That's the peroneal muscles, and that's the gastroc, and you're saying if you put your Get on a slight incline. Did you say 30%? 30%? A 10 degree incline. 10 degree incline. Put your toes over the edge of the incline, keep your knees straight, Bend forward and stretch Slight toe in, too. You did a slight toe in, that targets medial gastroc. Oh, perfect, perfect. And the peroneal muscles, is that hitting that also? I know you're toeing a little bit because it angles. With the peroneals, it's more important to strengthen them. With the medial gastroc, it's more important to lengthen them. Okay, so So, you've got to lengthen the medial gastroc so the heel doesn't pop off the ground and then strengthen the peroneals to stabilize the forefoot. Okay. So if the forefoot is stable, the plantar fascia is not getting sheared like this. And the same thing if, if the arch muscles are weak, then the plantar fascia separates. The arch muscles hold the plantar fascia together and prevent it from getting strained. Oh, so two separate things. So let me go back to the, if you're stretching it, so you toes over. Knees straight, bend over for 90 seconds. And how many times do you have to do that? Like five, at least five, the study, they did it for 14 minutes and the 90 second hold is really hard. So I have people build up to it. They can start at 40 seconds and then 50 seconds. So take your time getting none of these things should hurt. So if you're really tight. Don't do it for 90 seconds for a couple 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 short break. Just whatever you can You switch from one stretch to the other. So, again, I wrote an article that has illustrations of all of it, and it was new techniques to make sure your plantar fascial injury doesn't return and it's on the site, and it has images of the exact stretches used in the study. Oh, wonderful. Yeah. The data hadn't come out showing that you had to unload the plantar fascia, so I didn't tell people to hang their toes off the edge, which I am now. So tell me about strengthening the peroneal muscles. Now, the reason I want to know is you said something that I think is fascinating. So the muscles are peroneal muscles. intending to unload, which means take more pressure off of the plantar fascia. So we go into a plantar fascia that's hurt and we mash it and we rub it, we try to get the bumps out, but really that will come right back if your foot muscles are not strong enough to take off some of the pressure. So yeah, I actually think that you could cause problems by mashing and ripping up a plantar fascia because again, it, it's being irritated because it has no support. I call it variable load transfer when synergists are strong. They, uh, when other muscles are strong, they offload the plantar fascia and protect it from, from being ripped. Like, it's nice to massage it to break adhesions that are in there, but you'd be better off targeting the tight spot. So work the calf, strengthen the toes, like some areas should be strengthened, some areas should be 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 article about it and I can just go click on it to see the exercises. Do you have information on your website for strengthening those muscles? Yes. Yeah, the, the, just the article on the Topro specifically goes into how to strengthen the peroneals, and there's videos on most of them. So that's balance. Again, I don't like making videos. That's balance. That's proprioception. That's fall risk. That is plantar fasciitis. That's just, and it's not an expensive tool. I'm, I know in our clinic I think our patients can get a Yeah, we've got discount codes for people, so just get affordable, but it's, it's 69 as it is. So, and if anybody, I, we give, I give discount codes to anybody who asks, I'm like, what's the deal? Okay. I had another question and this is leading right into it. So I hear a debate very often between two schools of thought about the foot. One, which I taught often in chiropractic seminars says. If a foot, it tends to roll in, or we call it pronate. If a foot tends to roll in, that also rolls in your knees, it makes problems in your hips and your low back, just to simplify it. And so you need to be, if you have a, a genetic reason that you're rolling in, or a lifestyle or an injury, then you 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 seminar and they talk about how if you are in orthotics, it weakens your foot and that's going to create a dependency on the orthotics and a weakness in general so it will create more problems. Then you go to the barefoot or minimalist population. They talk about having a wide toe box or having nothing around your foot so that you can run as our ancestors did and gain increase in strength. What I have found is in every single one of those schools of thoughts. There are patients that match or do not match it at all. And I'm guessing it's one of those, let's use some common sense sort of things. It depends on the surfaces you're on. It depends on probably your specific alignment. And I'm certain it depends on the muscle weaknesses or strengths in your body. Where I was interested to see that you talk about foot alignment and strengthening, but you also have been in the orthotic world. Can you Guide me through to find some sanity in that when people are wondering, should, when they read Born to Run and they're thinking now they should take off their shoes and run for three miles. Yeah, I remember I've been in the orthotic industry for 45 years. My mom was the vice president of the world's first large orthotic laboratory, Langer Laboratories. So I started making orthotics when I was in my teens and with the elite athletes I was seeing in the 80s and 90s, orthotics have a patient satisfaction rating 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 controversies that is out there because they were overutilized. They were so popular in the 80s that people started coming in asking for them. I was like, you don't need them. An orthotic distributes pressure and decelerate the velocity of motion, but so can your muscles. So like I rarely put people in orthotics anymore, my last few years of practice. And as far as the minimalist craze goes, I've written several papers on that. And I talked about it in a couple of books I've written. You can predict, they did one study comparing injury rate with minimalist shoes and then with conventional training shoes with a heel toe drop of 12 millimeters, people who wear minimalist shoes have higher injury rates. Now you could get around that by like significantly higher injury rates in the first few months. You can get around that by saying, yeah, but if you break it in properly, they'll get stronger, which is true. So my beef with the minimalist. Problem and it's why Vibram faced multiple multi million dollar lawsuits because the injury rates were so high is if you take someone with a wide forefoot, strong toes and a flexible calf, put them in a minimalist shoe, they will love it. They will get stronger and they will be happy. You take someone with a narrow forefoot. The population that ran barefoot four million years ago, we didn't start wearing shoes until 27, 000 years ago. So our foot evolved to be used to not wearing shoes. So up until 29 30, 000 years ago, our forefoot was 20 percent wider. Our toes were 15 percent wider, and they were stronger. When you put a kid in shoes from the time they're Two or three. You prevent muscles from forming, and the forefoot becomes narrow. The intrinsic muscles become weak. They did a study of India with over a thousand kids. Kids who were barefoot from birth had neutral arches, stronger feet. When kids wore shoes constantly, then it's supposed to press the activity of muscles, a bone called the talus drop down. And there's a little elevation on your heel bone called the sustentaculum tali. If the talus presses on it long enough, when you're before the age of like between the ages of four 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 the population gets a hypermobile flat foot, which buckles during push off. I just did a thing with Courtney Connelly and Jen Perez at Gate Happens. The injury rates when you're a hypermobile flat foot person are through the roof. The, you're more dependent upon muscular restraining mechanism because the foot is so flexible that it buckles. So, Irene McClay Davis did a great study where she quantified arch height with a very precise method and she showed that low arch people And it correlated with x ray findings. They got injured on the inner side of the foot. High arch people got injured on the outer side of the foot. And there is some great data showing that low arch people, if they're strong, they don't get injured. So I look at it rather than put an orthotic in. One paper came out that showed if you put orthotics in people and don't give them strengthening exercises, There, the arch muscles atrophy between 10 and 15%. The abductor hallucis, the big muscle in the arch, atrophied in 12 weeks, 17%. So I made a series, if someone's low arched and I've, I've never liked supporting the arch, when you make an orthotic, you actually tell the lab to lower the arch so that the foot can move through a normal range of motion, a well made orthotic. doesn't interfere with, with movement. And that's part of the problem. There's a thousand different types of orthotics out there. You know, my brother owned an orthotic lab up until recently, and probably 90 percent of the casts that came in were taken inappropriately or the prescriptions were wrong. People don't, people who make orthotics often aren't the best at making them. They just do stuff they were taught in school. And as you know, everything's changing so fast in a good way, because now you realize. You can have a low arch, and if it's strong, it's not problematic. But if you have a narrow forefoot and a tight calf, be very careful about minimalist shoes. But then again, also, everybody loves those hokas with the toe springs, and any other shoes with, with rigid toe springs in them, they can weaken toe muscles. So, get a shoe that fits the heel counter. 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 research is showing. If a doctor prescribes a shoe based on your foot architecture, it is no, it is not that protective. But if you pick a shoe based on comfort, you're significantly less likely to get injured. And that's what I came to the conclusion after reading everything ever published on the prescription of running shoes. So it's all about fit. And comfort, because when your foot hits the ground, your tibia, the leg bone oscillates at 200 cycles per second, and your central nervous system senses that oscillation and can tell you which shoe is the best for you. It pretenses muscles, and if those muscles are strong, you're not going to get injured. So it's, it's about comfort and there'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 foot architecture for them, they're amazing. They can strengthen. In my, that first book I wrote when they first came out, I said, wear them on occasion to strengthen. Don't go for a 20 mile run with them. Um, and unless you've got the foot architecture that supports it, which is like a, like our hominid ancestors, a crazy wide forefoot and a tight calf. What you're talking about matches my experience. Pretty exactly. I had knee pain that we could not figure out. For most of my growing up life, I was super athletic, but it was hurting often. And my father in law is a chiropractor. He saw me when I was in college, and he looked at my knees, and he looked at my feet, and he put me in an orthotic, which helped my knee pain. So much. But I did notice if I wasn't in the orthotic, my hips and knees would start to hurt way faster than they ever did. So I kind of went back and forth with what I should do to strengthen it and still stay in the orthotic so I could stay on my feet adjusting patients all day. But when I got sick, I wasn't wearing traditional shoes very much. I was wearing moccasins as my slippers. So wider toe box and I also started coming across your work and actually just Paying attention to my foot as I was just walking and we call it a toe off but basically when your toes push and you're pushing and The more that I got the strength even just that simple way of paying attention to my foot position when I was walking in moccasins Paying attention as I was going up the stairs Flexing my foot differently flexing my glutes differently just paying attention Really then I could tell what shoes helped or didn't help me And now, I honestly don't have to wear orthotics very much. I do wear them if I know I'm going to be standing on a hard surface for a long time. Then, it helps my knees and my hips not hurt so much, but I let my foot move and breathe and I exercise it. It feels much better. I wear, I wear an orthotic that is, it's called a neutral orthotic. It's not posted and the arch is lowered, but it has a good heel counter on it because our ancestors who were around. Up until, you know, recently, the lifespan of the hominids was around 35 years, and beneath your heel and beneath your forefoot, you have these special fat pads that are unlike fat anywhere else in the body. They're contained in elastic chambers. They have polyunsaturated fat, so they don't freeze. So you can go. barefoot across ice without the fat pad freezing it. They're amazing. That's, I mean, we didn't wear shoes until 27, 000 years ago. That means we went up through Alaska and down over the Bering Strait barefoot. And the fat pad absorbed shock better than any connective than any, any synthetic material ever made. So they've shown that containment of the fat pad. is good for it. It protects it. So I wear an orthotic with a moderately deep heel counter just to hold my heel pad in place 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. So I, I couldn't imagine not having, but again, I've been in the industry my whole life. I've always worn like zero degree orthotics. Without arch elevation and done foot strengthening. Well, I'm also thinking of shoes that women often wear, where we'd not only put pressure more on our metatarsals or on our toes with the heels, but, but flat, even if it's flat, flat, really hard sandals, not, not so great. The heel cup, I like how you talk about the heel cup. That is one thing I've seen consistently is if you're wearing shoes and they just happen to be a shoe you love, but you tend to wear one side or the other. I know that is a thing to make sure that if that is happening, don't keep wearing those shoes because that really will mess you up. Just one more question. I saw some of your work about low back pain and the diaphragm muscles being a very important part of the core that we don't really address very often. So most people think about the core as the front muscles. We can call them the vanity muscles, the six pack muscles, or the muscles that help you bend side to side, your transverse muscles. But I have found also the lower pelvic diaphragm and the upper respiratory diaphragm, so the diaphragm that's just under your lungs, to be very under assessed, and every time that I start to treat them, I see amazing things happen, but I had not thought about the diaphragm connection to the low back pain. Can you talk to us more about that and ways there are to strengthen the diaphragm? Because when I heard your work, I went to YouTube. I typed in strengthen the diaphragm. That was a mistake. There's information all over the place and lots of it. It's really weird. First mistake is going to YouTube. But I know that's what listeners might do. So I know low back pain is really prevalent. So can you give us just a couple minutes of your time on that? Sure, sir. Once every five, I've kept up with the literature for 40 years and once every five or six years, you'd come out, you'd see a paper where people did diaphragm strengthening exercises and got amazing improvements and not just low back pain, but lower extremity injuries. And then. nothing would come out on it anymore and then people would ignore it. And then they did a study where they used infrared spectroscopy where they could evaluate in real time blood flow to the back muscles and lower extremity muscles and they gave people exhaustive exercises for the diaphragm. And as the diaphragm was getting exhausted they noticed that your central nervous system took blood from your back. And your lower extremity blood vessels and shuttled it to the diaphragm because activity of the diaphragm is prioritized over any other muscle because you need oxygen. So they showed that when an athlete is fatigued, that when that blood gets pulled away. It interferes with the ability of spindles to tell you where you are in space because spindles are require blood and they're the length regulators without adequate blood flow to the spindles, you lose proprioception and balance. And the author said, this is why in the last five minutes of a basketball game, people get injured. Then they looked at people with low back pain and measured diaphragm strength, which is easy. a power breathe K3 device where you just go, it measures volume, force, all sorts of parameters for diaphragm function. They showed low back pain patients have weak diaphragms. Then they also showed that people who are get like pulmonary conditions and then their diaphragm gets weak, then they get back pain. So there's a strong connection between diaphragm strength and low back pain. And a researcher named Hodges did a great study where he put people on a treadmill. And then put a, like a laboratory coat around them with cables that went in different directions. Then he put sensors inside their diaphragm muscles and their core muscles. And then while they were blindfolded, he pulled them rapidly in one direction or another to initiate the beginning of a fall. And he showed that the diaphragm was the first muscle to fire to protect you from falling. Yeah, pretty cool. Yeah. Yeah. So they then did studies to see where they know diaphragm weakness correlated with low back pain because it draws blood from other muscles, which increases susceptibility to injury. So they said, how can we strengthen the diaphragm? And they did deep breathing and stuff they do in yoga classes. And it did not strengthen the diaphragm at all. Because remember when we started about this? talk. We talked about how you have to have resistance. So they did a study where they took, uh, uh, just a simple power breathe tool. They cost around 30 and get them on Amazon. You just set the resistance on it and you go, you do 30 repetitions of inhales so that you're fatigued by the time you hit your 30th and you do that twice. And I have people do that five times a week. Incredibly effective for chronic low back pain stretch. It's unbelievable. I wish I could shout this stuff out. So if you are, uh, Coach or an athlete that wants to mitigate your injuries, especially in the last part of the game, or increase your sustainability or your blood flow still in your muscles, in your arms and legs. Even your balance. And your balance. You have to strengthen your diaphragm, because when your diaphragm gets weak and it's hard to get air and you're really struggling, your body will shunt the blood to the diaphragm. You're going to lose your body awareness. That's when injuries happen, so amazing for that, but also low back pain patients are put through so many different kinds of weird stuff that I can tell you takes a whole lot longer than doing the breathing exercises with resistance with an inexpensive tool for two rounds a day. I had some chronic low back pain patients that failed at every other intervention, and when I just give them the diaphragm exercises and send them home, and I have tools in the office where we can measure pounds and stuff, I couldn't believe the outcomes that I was getting, and like, 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 episodic back pain. Uh, the percentage of that population that improved was shocking, but then I also see it at very high level athletes. I just saw one of the fastest runners in the country and she had, again, she's going to the Olympics. She had a surprisingly weak diaphragm and diaphragm strengthening exercises can improve blood flow to her lower limb while she's running. I mean, it's, and it's hard if you don't check it, you just would never think it was you. You wouldn't think it was until you had it. Yeah. If that's an Olympic runner, you would think her diaphragm is very strong, but like you said, breath work, yoga, all that stuff would be what I would think. And that could be kind of like hoping you're going to improve your balance with balance exercises. You aren't necessarily going to improve your diaphragm strength with. Diaphragmatic breathing, unless you have resistance and you're doing it in the correct way. So my last question is not about research or biomechanics. And again, just thank you so much for your time. Our podcast is called What Really Makes a Difference. So what would you say is Based on your experience, the thing that can really make a difference in people's vitality in, in just your own or in a general person's, if you could leave a message for humanity. Oh, that's a tough one. I would say one of the most important things is find something you enjoy doing in life. I mean, I'm not exercise obviously is important for vitality and stretching helps you. I personally. I pay attention to what I enjoy doing. I love learning this stuff and I'll spend three or four hours a day just like trying to keep up with stuff and find things that, that interest me. And then like I find exercise calming. So I exercise every day. I probably exercise an hour and a half. To two hours a day and have most of my life and then diet. Like I, I've always had a low inflammation diet. I, I just find that that calms me down and, and rest. I've always tried to sleep seven and a half to eight hours a night. So like, if I were to rate all those things, you know, I was talking about it with my wife because she loves what she does. Find something you love doing and, and you're happy. Like, we don't even, okay. Travel, we have all these friends who go to all these exotic places, like, I'm, I'm fine not doing that. Exactly, and I think when you find those things that light you up, that ends up not only lighting you up, but when you're Doing what you're happy doing you cannot help the like light and interest that shines from your eyes Or your being as you share it and then we all can have the information to thank you so much for your time You're welcome anytime. I'm so good. It's been a pleasure. Yeah. No, it's really been great talking with you. Absolutely So thanks for having me on. Okay, I will put links to your website and I think you're Pretty tops. You have my vote for best chiropractor. Thanks a lot. Can't believe that was a year ago. Hey, great talking with you. Take care. You're welcome. And now you see what I mean. I never hear Dr. Tom Michaud speak that I don't whip out whatever little piece of scratch paper or notebook I have and just start writing things down. In fact, since this interview, I have been able to exercise in a different way. In recovering from my illness, it's been difficult for me to go back to weightlifting without having the cost of that weightlifting be perhaps more than the joy of doing it in the first place, but I've wanted to move. I want to move my lymph. I love feeling stronger and I've been looking for a way to ease into that. So I started looking at some of his YouTube videos and I also, um, tracked what we talked about in this conversation. And as I have started, it has just felt so good to feel like myself again, that I can exercise and be a part. of doing things like mobility and weights, but in a way that is safer and that I can get gains without it having such a high cost. So before we started the interview, he told me about a YouTube video that he had done for older people, but it is very relevant for anyone who is getting into exercise or who just wants to, or who Or who just wants to hit all the major muscle groups in a way that is backed by research and that is super helpful. So he referenced me to his video, but warned me that the sound was terrible because they just did it on the side of his clinic one day and there's cars driving by. And he's right, the sound is terrible. But it's still definitely worth a listen and that has been what I have incorporated into my routine. I do it three or four days a week and it's feeling great. So I will make sure that link is also in the show notes. And he also talked about the low back and strengthening the diaphragm strength, which got me really interested in the device that he suggested. So I started doing more research on it and diaphragmatic strengthening in general. And what I found was unsurprisingly, Dr. Michelle was right. This is a fantastic apparatus. I actually had a meeting with someone in the company and pretty soon I'm going to be able to start. Making that available for my listeners at a discount. So that is coming forward and that's pretty cool news. I'll put the link in the show notes as promised, but again, you'll be able to get that at a discount and I'll let you know the code for that when I receive it. So moving on to our next episode, I am overjoyed to be able to share this one and I mean that genuinely. We're going to be sharing a conversation 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 Mindful NYU, which is the largest campus based meditation, mindfulness, and spiritual life facility in the country. She has also served as the chief mindfulness consultant for Procter Gamble, and she's been all over TV. Good Morning America, CBS, news publications, multiple magazines. And she now has her own mindfulness consulting business. She's a regular contributor to apps like 10 percent Happier and Roundglass. And she's also the author of one of my very favorite books. It's entitled What Now? and it's written primarily for people in their 20s and 30s. who are facing transitions like going to college or having a career, maybe beginning a family. And truthfully I found it's not just for people in their 20s and 30s, it's for any of us. Facing transitions or just looking for ways that we can find more mental health and more of that space in our mind and in our lives that we want to lean into that is full of more heart, that is full of more presence and more truth. She teaches. mindfulness in such a relatable way. She tells stories often taught in Zen and Buddhist practices but relates them to real life and to today's real environment where there's so much anxiety, depression, or worry about the future. I love the stories that she shares and this book has been just going around with me shoved in my purse or on my desk or side table for the last month and a half. Every single page is marked. So I'm excited to share her insights with you. Please tune in next week and then you can share in her wisdom as well. We'll see you then.