Before I get into the summary of the 4 days I spent in Austin a few weeks ago, I want to explain an angle I use in my own continuing education.  At least once a year, I try to attend a seminar or read a book on a topic I think I disagree with or am skeptical about.  Most of the time it’s a book or DVD since spending $30-50 on something that I think it garbage is a better choice than spending $300-500 plus travel, etc. to sit through a bunch of dribble.

My thinking is that there’s value in cementing something as really wrong, or finding out that I was wrong in my initial impressions.  Either way, it’s a Win-Win.  It is refreshing and honest to find out that initial impressions are wrong when you think there is gravity to something only to find out it’s not really there.  That’s not a bad thing.

So for some time, I have been critical of a few components of what I know of the Gary Gray system.  One of the things I find offensive is the silly attempt to disagree with McGill’s work, which is almost amusing when Tiberio says something to the effect that McGill’s work is only applicable to a fixed sacrum, and the sacrum is never fixed in “function.”  They don’t do crunches, which is good, but it’s because being on your back is not “functional,” not because there is a concern for repeated and/or loaded flexion.  Similarly the notion of bad movement occurs in real life and sport, so that is grounds to train bad movement for this elusive expression of “neurological preparedness.”  I’ve gotten into these issues in the past on my Website and others.  The links are below.  I just don’t get it, and it’s gotten to the point where I call professional patience.  It’s my way of giving up, as I don’t think I can continue the conversation with some of the points and counterpoints I can make which aren’t even really abstract.  There are truths in our profession.  There are some things that do not allow for debate or interpretation.

At the same time for several years after first seeing Todd Wright speak, there have been many components to the Gary Gray system that intrigued and interested me.  In fact, Gray Cook in front of the room has said that he was widely influenced by Gary Gray, and I can see and express the similarities very easily in the FMS system that seems so stark and different.  In comfortable conversation, I’ve messed with Todd and Logan saying that I agree with about 87.5% of the system.  The fact of the matter is that there are more similarities than differences, but the shroud of silly terms and jingles and the apparent disregard for relative compensatory flexibility make the Gary Gray program like fingernails on a chalkboard to me.  Everybody has an opinion, right?

So around this time last year, I had a SmartStep event in Austin, and Todd welcomed Daniel Martinez and I to see the facility @ the Irwin Center @ Texas.  A few hours that first day turned into 3 days and basically my own personal mentorship into a lot of the things Todd does @ Texas and Train 4 The Game.  From that point, it was clear to me that whether it was the different voice or the packaging, this was the Gary Gray stuff done the right way.  Aside from the education, his volunterns (technically volunteers because interns @ UT have to have some sort of school affiliation I think) treated Daniel and I with such hospitality that I had to send them a gift card to Twin Peaks despite Todd’s protest.  Slow down now, Twin Peaks is southwest version of Hooters.  Nobody ever hear of a gift card to a strip club.

Continuing to follow Gary Gray’s stuff on the Internet and then seeing Todd and Logan again present @ Perform Better-Providence, when Todd announced the Vertical Core Seminar, I immediately cancelled my plans to attend FAKTR-PM, a manual therapy seminar in NJ that same weekend.  I remember readings Andy Twellman’s articles on StrengthCoach.com, and I voted for it that they need to do a DVD or course because they were doing things in a way that needs to be exposed.  Last summer I told Logan Schwartz, the women’s basketball coach @ Texas, that they have something that I don’t have, and I want it.  That is how impressed I was with the movement skills.  When I was down in Texas the year before, when I was doing the movements, I was like, “This is teaching athleticism.”

So with all of this in mind, this whole weekend went down after about a week and a half into my new job with the Marines, which is pretty much living hell so far, it was a much needed diversion on many levels.

All right, so Anthony Renna (SCWebinars.com) set up our flights on Wednesday to get in around the same time.  Picked up the rental car and Josh Ford from Canada and zipped over to the hotel.  As my Facebook will attest, I try to eat at indigenous restaurants when travelling, so I was happy suggest the aforementioned Twin Peaks for dinner.  Our waitress was, if I remember correctly, the 2-time defending Twin Peak Calendar Girl.  And I ordered Rocky Mountain Oysters to add to the list of unique foods I’ve eaten.

Day 1 of the course began with Todd talking about how his own evolution as a clinician came to be.  Todd is one of the best speakers I’ve heard via a combination of an everyman tone, quality information, and a high profile body of work that lends credibility.  One of the best lines as usable advice was this, “Get good when you don’t need money.”  I have been so lucky in my career that my jobs have afforded me both time and funds to continue my education.  I understand that continuing education costs money, a lot of money.  So while it may mean sacrificing other pleasures, the message is that it should pay off in the end.  Todd’s first basketball job had no salary but unlimited continuing education.  Todd probably has the best and most powerful S&C job in D1 basketball.  Is that realistic for everybody?  Not sure, but I know it’s impossible if you don’t try.

At some point, I think Todd caught me talking to myself as he was talking about James Thomas.  James is a player we’ve both had in the past, and he was the watershed case that led Todd to believe in not just the Gary Gray model, but the whole what is known as regional interdependence.  It was a situation where some foot mobility training was the fix for James’ back pain.  When I had James in Philly the following year, I wasn’t nearly as keen as I am now to regional interdependence.  But when I had his right shoulder pop doing a high pull in a pre-game lift, and now know that his left foot as the problem, it makes very special sense.  James Thomas is a player I too will never forget.  I remember the miserable feeling I had having him get hurt in the weight room, rule #1 to never allow, as a non-guaranteed guy trying to hang on.  This is the same player and same special impact for both Todd and I.

Todd went on to talk about all the definitions and components to how the model looks at movement.  Yeah, I could do without the little names, but I guess there’s value to be definitive in how a movement is challenged.  And of course Challenge is one way to “load” up a movement.  I’m talking about drivers and tweaks and enhancements.  <rolling my eyes>

He talked about the key mobility zones of t-spine, hips, and ankles.  He talked about the value of the foot, which is nothing to roll your eyes at.  I certainly do not believe that bottom-up fixes everything, but I also don’t believe bottom-down fixes everything either.  The Joint by Joint prevails in his message as well, as does the Core Pendulum.  I do think there is a comfort level into outside-of-neutral scapula, lumbar, and knee that is not appropriate in my opinion, but he didn’t really get into it the whole course.  I don’t know if that was intentional or not, but it worked out in a very healthy way.

Todd continues to outline the exercise system that they use.  It is a combination of static vs. dynamic, positions and/or changes in all 3 planes, each with the arms and legs, and infinite directions of locomotion.  There are infinite combinations of all of the above that you can tailor to a specific need-based activity, maintain general, or support corrective exercise.  I like the progressions that are afforded and even regressions in using the stretching Cage to maintain overpressure where you don’t have mobility integrity, but use other body parts to drive the mobility.  This is very much in my view of “stretching:” get up to the barrier in some level of loaded and use other motion(s) to integrate the new length into a stable mechanism.

I especially appreciate the combinations of upper quarter dynamics performed in conjunction with lower quarter dynamics.  I like how this can take the FMS corrections to the next step of bodyweight movement.

Bodyweight movement is an interesting choice of words because I think a lot of discord not only with the Gary Gray system but many other prominent systems is just semantics.  I am very comfortable explaining the differences between something like Squat the movement and Squat the exercise.  Movements are baseline actions that may or many not have biomechanical integrity.  In fact these outside of neutral “movements” like touching your toes and rounding the back in a bodyweight squat are very necessary to possess in terms of gaining mechanoreception at the joint levels.

I bring all this up because the Gary Gray stuff would say everything is movement.  They have an entirely different hierarchy, again with their own terminology, for fundamentals.  These fundamentals have some things like squat that I would consider a fundamental, and others like hopping and skipping that I would not.  That doesn’t make them unimportant.  Remember I am glowingly positive of all the skipping I learned.  But to use skipping, hopping, pivoting, and jopping as your primary pattern may leave something behind.  Todd mentioned he may be reconsidering the developmental sequence, which I think is very positive simply because even if you don’t believe in NDT or DK, you are going to ensure you have the proximal core before you introduce the impacts of gravity and the knee/foot/ankle.

Here are some bullet points, some paraphrased, from the morning that I would like to comment on…………….

**Isometric core training promotes a rigid t-spine, hip, and foot.
Agreed, however, long spine stiffness in the  plane may be the weakest link in the chain and addressed accordingly.  Planks are not bad.  There is a direct to indirect scale of movement and exercise sagittal choices.  There are components to function, and there should be room to focus on one part of the chain.

Can we not expect better neutral stability to allow for more mobility in another expression of function?
Plank, Rib Roll, Goblet Squat sounds like a very good core/mobility prep for a lot of people.

**The spine needs relative, controlled motion.  Why does it have 24 vertebrae?
Agreed.  But I would be very, very clear that certain spinal motions are okay in movement, but not exercise.  Training movement may feel like exercise, but the joint by joint should prevail.

**Isometric training teaches the body to resist and counter eccentric loads
Absolutely.

**Motion excites proprioceptors which drive function and proper biomechanical control
Agreed, but there are lots of tangible sidebars that can challenge this.  It all lies in the type of motion.  This is where I chimed in in terms of applying these methods to a rehab setting.  You slow the movements down, drop the amplitudes, and rely on static postures.  That leaves a lot on the table in all of the exciting movements, but if you’re in rehab, you need to earn the right to get out.

**Enhanced abdominal recruitment and lumbar protection by promoting mobility (mostability – no clue what this means, and I refuse to even type it again) about t-spine, hips, and ankles
–Joint by Joint at its finest.  87.5%.  See, I told ya.

I would almost rewrite the Functional Performance Pyramid to change the bottom floor to Functional Fundamentals and add in Functional Movement as a 2nd level.  Functional Fundamentals would still be the principles of mobility, stability, and motor control via the FMS.  Functional Movement would be jump, leap, skip, pivot, shuffle, etc..  They are all general and very worthy of screen and assessment.  And they also qualify the foundation of putting speed and power on top of the system.  I just don’t think you can start there when there is something out there to guide you to an even lower level of movement screening.  Why can’t we do both and then access the literature from the FMS?

Logan was up next after we headed over to T4TG, which is a fantastic facility.  Think long runway with gear along the sides.  Plenty of room for the type of training they do.  UCS racks, Keiser functional trainers, medballs, VIPR logs, cages, lots of toys, all of which they use.

I love listening to Logan speak.  Some people you just like listening to.

**Hamstrings extend the knee
Hamstrings as a hip extender in hip extension take the knee into extension via line of pull and momentum.

**Quads do not extend the knee
I’m not sure there’s a purposeful human or athletic movement where the quads concentrically extend the knee in the open-chain.  Kicking is isometric I think.  Not really worth the argument.  If you are doing knee extensions, Logan says to stop.

**Lumbar Curves are set up to buttress compression.
Boing, boing, boing.  Also keep in mind that I think furthering the lordosis of the lumbar or cervical in the -crosses will be compensated throughout  the entire spine.  Think links of chain.  If you mess with the top, the bottom will be addressed.  I will have a post up shortly recapping some things I posted on SC.com about this topic.

**Relative Motion of the Spine
I would have preferred Logan was a lot more direct in discussing lumbar rotation.  He was correctly discussing that the lumbar spine has to rotate in accordance with rotation anywhere else in the body.  The tibial to femoral rotation in gait and level changes must be met with lumbar rotation.  Absolutely.  Same from the top down.  However, if anyone in the room was hearing such things for the first time, the way Logan was presenting it gave me the feel that someone could pick up any piece speaking against lumbar rotation and be like, hey, Logan said it was okay.  This CW guy is an idiot.  The message should have been categorically do not try to increase lumbar rotation range of motion through end range movements, and do not train end range rotation with load or repetition, i.e. bicycle crunches, russian twist, dumb stuff.
Please read this article by Mike Boyle if you have never read it.

The afternoon session was the Level 1 progressions with mobility drills and stationary matrix drills.  Again, the combinations are endless with the directions, 1- or 2-arm drivers with.  The low level moves would be steps, pivots, reverse lunges.

I’d also like to add that even though they don’t use developmental patterns, the system lends to using literally any position or choice of locomotion with any of the strategies.  In the winter, we had a 9-year old all over the gym doing bear crawl matrix.  You can be stationary in half-kneeling and add to the family of chops/lifts and halos.  No one owns a movement.  I find myself saying this all the time: The shit’s all the same.

The only negative, which really isn’t a negative to me because I think I can coach it, is the seeming disregard for Relative Compensatory Flexibility.  If you use momentum in a rotational arm driver to drive the core, I think the core “turns on” to get you out of a bad position.  Todd himself will admit though that you can coach the drills however you want.

That evening Daniel Martinez and I had a pre-game meal of some sushi and went to Austin Community College for an Olympic Lifting session with his coach Ursula Garza.  Ursula is I believe the only female Senior International Coach for USAW.  Through Ursula and Olympian Oleg Kechko, Austin has quite a swell in Olympic Lifting.  They have been doing a lot with Crossfit, which is only a good thing in at least some form of insurance that the teaching isn’t the problem with their OL forays.

I’ve played with some skills since going to USAW, but I wasn’t feeling the snatch, so I stayed @ 60-70kg for my terrible technique in clean and snatch high pulls.

120 is 120. LOL.

Day 2 began with a 630am Bootcamp.  I am not much of a bootcamp guy as I don’t much care for the screaming and bravado, but I wanted every little opportunity to pick up what they do @ T4TG.
Bootcamp is bootcamp, meaning it is so hard to blend HIIT variety and good movement.  But I enjoyed seeing the context to the stations keeping the same drill just a change in plane or other option.

The morning session of Day 2 was the 3rd workout for me in about 16 hours, and for my dollar it was the best.  It was the same locomotion drills that Todd presented @ Perform Better-Providence.
So you have these options
–Walk, Run, Shuffle, Skip, Carioca
—-Any combination of the above
–Moving forward, backwards, sideways, in a circle
—-Any combination of the above
–Any move widened out in stride, width, toe-in/out, or crossing midline
–Any combination of 1 leg doing 1 drill, the other leg doing the other drill
This stuff is straight brilliant.  It helps that I can do almost all of the drills like forwards/backwards skipioca, which is carioca forwards, which no one can do 1st try, skipping on every step.  The one that I can’t do is skunioca.  That is running on 1 leg and skipping in forward/backward carioca.  It’s hard to even visualize.
My mind is racing at the ways to set up general warm-ups as all the progressions are built in, and I can even see a group doing different things based on speed.  If you keep it general, it can be used for conditioning.  Throw a vest on or some light DBs, it’s even more metabolic.  How about pulling a sled or a chute with some of these techniques?  By this time, I so got what I paid for.  The lecture and workout for the locomotion drills are absolutely priceless, they have integrity, and they are downright fun.  This is how we will do dynamic warmup @ MARSOC.
I also came up with some better cues that will work for me because as I mentioned before, I refuse to use the Gary Gray terms.  I think they just make things more complicated.  I’ll live with tweak.  That’s about it.

Next was coming back in to hear from Josh Ryan and the evaluation system.
Josh is a veteran of the T4TG system.  You can see him in action in a YouTube of some of the movements we’ve practiced up to this point.

Aside from the manual foot evaluation, I understood the evaluation as some of the static positions, basic locomotion (walking) patterns, and Phase 1 matrix with arm drivers.  The view is for the weak link in the baseline of patterns.

The test becoming the exercise is a solid approach.  Of the models I’m familiar with Sahrmann and DNS employ this approach.  My exception taken would be that the upright dynamic positions can be broken down to static and supported positions.  I think this is more opinion than anything.  I can’t call out this approach.  I’d just rather break down a simpler pattern without the complexities or dynamics, bring up the weak link, and re-progress the pattern up where Josh would like us to start.

Back to the gym for a lecture and lab on what the system calls Movement Acquisition.  I think this is a programming principle based on the perceived specificity of the individual’s terminal movements.  So if you are watching a golfer in a freeze frame of the backswing or a basketball drop his shoulder and dribble left, this is what they call the Transformational Zone.

Again, I’m going to refrain from the jingles and rhymes, particularly because I think it might take away from the importance of this concept.  Whether you call it the Transformational Zone (TZ) or not, we are all using this concept of amoritization.  We typically hear this term in traditional plyometric training to describe the absorption of force upon landing and transferring it to another direction.  This efficiency can be trained and improved.  We know this.

So the concept of the TZ is the same in principle in analyzing movements when motion is decelerated and funneled into another direction significant to the movement.  This isn’t a concept that I am going to employ right way as I have never been any kind of fan of trying to recreate the specific movement in athletics.  But I am not as put off by this strategy as much as foolishness like swinging a weighted golf club or jump soles.  There is a blend of general and specific with these crafted moves, but I’m not so sure I’m into them.  I think you find those moves in the matrix and locomotion, and I would probably lean to training more of the movements that are NOT in the athletic patterns, rather than the ones that are.  I am just leery of sport-specific programming.  I’m just not sure it exists.

This evening followed with a group meal that was taken care of for everybody by Chris Poirier at Perform Better.  Todd gave us the whole history of T4TG which is really an amazing story that includes getting into their space that originally had graffiti all over it and no lights.  They were only open for business during the day until they could afford lights.  It’s really qutie a story, and 5′ll get ya 10 that Todd writes a book one day.  His life experiences and travels are probably enhanced by his particular story telling ability and delivery, but it’s really hard to make the stuff up that he has gone through.  I think people would pay to see the TV miniseries of Todd’s route with freeze frames, and him walking across the screen and breaking the 4th wall.  I was very moved by the dinner experience and just listening.

The final day of the seminar was more presentation of the matrix combinations with loaded implements.  The lab was set up in stations in using the same principles and the patterns of the stationary, matrix, and locomotion patterns.  The 4 stations were using the Keiser Functional Trainer, the VIPR log, med balls, and sandbells.  When it comes down to it anything will work.  But, and this is a big but, when you add momentum, which is a prescribed principle of this system, to a loaded pattern, you have to have a very keen sense of body awareness to not go into bad positions.  I think it was, in fact, during one of these breakouts that one of Todd’s coaches made mention that you will probably pick up your child with less than perfect form, so you should train that free-flowing form in the matrix.  I wrote this article some time ago to challenge that notion.  But make no mistake about it.  These techniques when performed with integrity via the Joint by Joint are fantastic displays of mobility, stability, motor control, and athleticism.

We finished the day with another coaching and service philosophy lecture from Todd, which was a lot like dinner and his introduction on day 1.  As a part of the logo for T4TG, Todd had the 4 developed below.  The shape is made up of sayings and phrases that have special meaning to him, his trainers, and athletes over the years.

Finally, keeping to my attempts to always hit indigenous restaurants when I travel, Anthony and I knew right where to go on the way back to the airport.  Rudy’s, the Worst BBQ in Texas, was the spot.  They give you free samples of all the meats and sides at the counter if you tell them you’re a first timer.  Then all the folks behind the counter do this little song and dance for you as a rookie.  I might have wanted to eat a little bit more, but I had no complaints.  Not sure if Rudy’s is on the 1000 places to Eat in America, but I’ll check it off anyway.

Throughout this review, I know I keep reverting to getting my digs in, but I hope my message is clear that this was a fantastic experience, and one that I needed to grow my skill set.  The gravity to a movement-based approach is clearly there; I just think there are a couple pieces that go too far.  And I think I can provide some science to why I think the way I think.  I would love to challenge Todd’s trainers to go through the searching process that he did before he stumbled upon what he has found to be best practice and success.  Go to a 2-day course with Stuart McGill.  Read Sahrmann’s books.  Read Porterfield and DeRosa.  Appreciate the difference between the Joint by Joint and the Core Pendulum theories.  Then tweak it, challenge it, enhance, and coach it up.

I think T4TG is going to do this mentorship once a quarter.  I highly recommend this for clinical, social, and business mentorship skills.  These are good people and good information.

ABSOLUTELY!

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I recently filled out a written Q&A for Dr. Kelsey Armstrong, who is a Podiatrist in Raleigh, NC. Dr. Armstrong recently became exposed to some of my messages and asked me to expand on some things for his Website.  What I just sent off to Dr. Amstrong is below.

http://www.armstrongpodnsportshealth.com

http://www.armstrongpodnsportshealth.wordpress.com

1) Tell us a little about yourself and why you chose to become a physical therapist?

I think like many of us in our profession, I began as an athlete playing ice hockey and baseball through high school.  I enjoyed weight training, and I found it very cool to be strong.  I used typical young bodybuilding approaches and had success at that time.  Going into college, I played baseball, but I knew that was done after college.  To stay in sports, I eschewed being an orthopedic surgeon since even though I was very good at carrying or moving large objects, I wasn’t very good at putting them together.  So I became set on being a Certified Athletic Trainer and go on to graduate school.  My undergrad had the same Premed program for the ATC program, so that also gave me all the prereqs for physical therapy school.  My advisor said I could still do everything I wanted to do as an ATC even if I went to PT school, and it would make me more marketable and  have a good backup plan as well.  So I graduated undergrad in ’96, got my ATC in ’97, MSPT in ’99, and DPT in January of 2010.

In the summer of ’98, I was working as a PT aide, and one of the referring physicians asked the owner of the PT office if they knew any ATCs interested in working with a minor league basketball team coming to the area.  I got that job while still in PT school, and after graduating, the connections from that minor league job got me to the New Jersey Nets for the ’99-00 season.  From 2000-03, I was a Head Athletic Trainer in the IBL and NBDL, which also included responsibilities of Strength Coach, Equipment Manager, and Travel Secretary.  In ’03, I got back to the NBA with the Philadelphia 76ers as Game Day Athletic Trainer and Rehab Consultant.  At that point, the 76ers did not have a Strength Coach, so given my build I think the players found some confidence lifting with my guidance.  That earned me Head Strength Coach and Assistant Athletic Trainer for the 76ers through 2006.  After not getting renewed in Philadelphia, I  moved to my home area in NJ where I became Director of Sports Performance and Physical Therapy @ CentraState Sports Performance, which is a hospital-owned sports training center where we trained and rehabbed folks as PTs, Personal Trainers, and Strength & Conditioning Coaches all as one entity.  Currently, my job title is Lead Physical Therapist for Marine Corps Special Operations Command (MARSOC).  At Camp Lejeune, NC, I am responsible for contributing and managing programming for both rehab and general physical preparedness for the PERRES program, which is MARSOC’s Performance and Resiliency Program.

2)Your knowledge of the human body goes beyond any physical therapist that I know.  What drives you to this level of understanding?

I’m not sure there is a becoming or humble way to answer this question.  Learning, integrating, and clinically growing all will lead me to both the status and quality I want to achieve and more importantly, a level of provision and service to the folks that trust me with their body.  I don’t want to be good at what I do.  I don’t even want to be the best I can be.  I strive to be the best to ever live.  While that is likely an unattainable goal, if that is indeed the goal, then the best I can be and good are automatic.  I just want to be the equivalent of every great athlete and historical figure put together.

I guess I blame and credit my parents and coaches and mentors that have held my hand for the past 34 some years.  And also the confidence that the folks that trust me with training and education have had a huge impact on my continued development.

3) Tell how devastating to the body is limited motion of the big toe joint (hallux limitus)?  And what is your usual protocol for treatment?

To begin the explanation globally, the body’s appropriate mobility is set up to allow stability to drive propulsion.  Propulsion is the ultimate goal in any of its forms, such as locomotion, pushing, pulling, squatting, stepping, etc.  Like most primitive movement patterns, the mission is thoroughly ingrained in our neural programs of the CNS.  So regardless of the quality of our mobility and stability, the CNS will usually succeed in driving propulsion or locomotion in this case.  Win if you can.  Lose if you must.  But always cheat.  That is the CNS’s way.

So like with many other ingrained movements patterns, the brain will find a way, and it doesn’t always care if the pattern is mechanically efficient.  It only cares if it is neurologically efficient.  Neurological efficiency equates to motor learning and associated feedback.  If there is success in the ultimate goal, going back to this case of forward locomotion, the brain registers efficiency, quality, and begins to cement that pattern in the brain.

So the first thing to consider with a loss of big toe mobility, if it is not dominant enough to 1) cause enough nociception for failure, or 2) limit a compensatory pattern for success, the dysfunctional pattern will begin to revise and/or cement the motor pattern.  And as the mobility loss causes an inefficient pattern, this pattern alters the motor program that can be very challenging to change even when/if mobility is restored.  This is more principle-based than specific to the big toe, but the key is to acknowledge that regardless of mobility or stability qualities, an altered motor program will  continue unchanged until motor learning is reinstalled with new success and feedback.

Any time a joint system does not explore its full range of motion on some level of regularity, and yes, the joint surfaces will degenerate.  The full exploration of as much of the joint surfaces as possible is the “swishing” mechanism that flushes synovial fluid through the joint.  Synovial fluid is the motor oil for the joints, and the value of joint mobility AND using it to some degree through appropriate natural and free movement (i.e. yoga) is joint health.  A loss of mobility in the big toe, from a joint or soft tissue restriction, will accelerate DJD at this local level.

Next at the regional level, the minimization of plantarflexion can cascade into a number of reactions.  Some things don’t have to do as much of what they should do, and others may have to do too much.  Regional can be defined in a number of different ways, but in considering regional, we will call that the lower quarter continuing to the hip.  There is a litany of issues that can evolve all based on the individuals’ specific stiffness through the chain.  Where the final stress is funneled or funneled away from is very specific to the individual.  It can be predicted with screening, but not without some individual analysis.

The mid-foot will not have the proprioception to stabilize which can lead to plantar fasciitis or medial arch stress.  Deep foot musculature may become long and tight with a lack of reactive stabilization in the mid foot.

Ankle mobility into dorsiflexion may become limited as the stride will reflexively shorten.  As a part of an altered motor pattern, the stride length will shorten in an effort to limit hip extension on the stance side.  This creates what the CNS perceives as neurological efficiency as now the big toe will not have to extend as much to locomote.  With less hip extension, less dorsiflexion is required to establish foot flat.  This scenario welcomes the lunacy of wearing heel lifts, Nike Shox, and rocker bottom shoes to accommodate for the biomechanical scenario.

A loss of hip extension mobility in this chain can be straight extension, or it can be expressed through a toe out posture from hip external rotation, which in turn can lead to a loss of mid-foot stability that we mentioned previously.

The potential for anterior knee pain can also result.  The sagittal restriction from the toe can translate into further sagittal movement at the knee.  If this is accompanied with a dorsiflexion loss, the process of stabilizing the lower quarter can fall onto the bony stability between the femoral heads and the retro-patella.  The body again will find a way to gain forward propulsion.  The toe can be the initiator, or it can be the reaction, but it all leads to this loss of mobility or stability at the segments that should allow these expressions.

I have discussed before how something like big toe dysfunction can correlate to distant dysfunction of the upper quarter or cervical spine as well.  Aside from the specific biomechanics that are addressed in the lower quarter, looking at mobility loss more globally will always relate to an anterior weight shift.  It is such as struggle for me to discuss with folks that suggest biomechanics and posture don’t matter.  Any loss of mobility, be it from tone, shortening, or joint restriction, will result in an anterior weight shift.  Repetitive function with an anterior weight shift yields facilitation and inhibition in a very predictable pattern.  Where the foci results is not as predictable as I mentioned before, but in this case, propulsion without big toe extension can result in a resting or compensated upper-crossed syndrome.  It can happen anywhere along these same lines.

Limitations that do not register as pain or go unnoticed as dysfunction can also expose limitations in power expressions such as vertical jump as and sprint speed as well.

4) I believe that your view of flat feet is quite on the mark.  Please explain your view about flexible flat feet and how you would treat it?

Flexible flat feet get trained.  That’s all there is to it.  You find the weak link from a corrective standpoint, and you train the system.

If posting or foot-based compensations are required for end-stage function, then by all means, please use them to get the job done.  We should not be holding people out of games if a heel lift allows them to play full speed.  Sometimes we can even forego training in-season and treat symptoms and then regroup when we have a more amenable schedule.

In the end, the foot is the reaction.  If the foot is truly supple, and the Cyriax Evaluation yields nothing remarkable (assuming the assessment is not during a state of previous irritation), it can’t be the foot’s fault. But because the foot has such a pliability, it can compensate from what can be a litany of up the chain dysfunction.  When stability is lost through the chain, the brilliant foot can find it through reacting with the floor and stealing its ultimate stability.

Find the corrective strategies that provide the most efficient proprioceptive environment to get the quality to appear.  Keep in mind, this is primarily focusing on stability and/or motor control training.  We identified that the foot was flexible, so there were no mobility issues.  Also consider what looks mobile may not always be mobile.  Consider the big toe, mid-foot, subtalar, talo-crural, and even the proximal and distal tib-fib joints.  And always consider mobility through the chain before asking for stability.

Getting to 1- and 2-leg level changes to drive the foot is where the training path takes you: Squats, Split Squats, Step-ups, Deadlifts, Jumps, Lands.

5) Barefoot running is the hottest thing right now in the running community and podiatrists’ offices.  Tell me what do you think about this “movement” and it proposed goal to reduce running injuries?

I think it is an excellent addition to a corrective or conditioning catalog.  Unfortunately though, I am seeing this more in theory than in practice.  Just because it is a good thing doesn’t mean it’s a good thing for everybody.  If indeed it is deemed a good thing for you, it may just not be a good thing for you……yet.

People like to do.  They like to add and complement.  No one likes to be told to stop or told that there are things that they can’t do.  So in terms of barefoot training, it has a positive attachment, so everybody tries it.  But this is without screening or assessment when required.  This is a major mistake.  Barefoot training is a great tool, but it must be instituted with attention and progression.

When mobility and stability are proper, even the deconstructed sneakers have some level of stability.  With a fantastically stable barefoot, there is brilliant proprioception sent up the chain creating fantastic reflexive stabilization elsewhere.  Consider the homunculus of the brain, where we see the feet holding larger surface area of the motor cortex than other areas outside of the face and hands.  When the foot does the right thing, lots of good things happen in the brain.

Training barefoot in itself may be the access point for proprioception to improve function.  Or it may not, and I think this is the more likely senario.  Not everybody should be wearing Vibrams just yet, and certainly nobody should be taking them off the shelf and going into big cleans and 10 mile runs.

6) In a similar-related question, what functional problems do you usually see in runners and what can they do about them?

Runners are typically prototypes for Stratified Syndrome, which is concurrent Upper and Lower Crossed Syndromes.  These are Vladimir Janda terms as he used these postural presentations to categories movement disorders.

Tight hips and tight ankles dominate because long-distance runners (assuming this is who you mean by “runners”) engage in a plodding pattern of very short amplitude.  This short amplitude isn’t the problem per se.  The 15,000 steps in a “short run” is the problem in terms of minimal requirement of mobility, so the limited excursion locks in at a soft tissue level and a motor control level.  The incredible repetition of running is the deadbolt to the key of the shortened pattern of running.  But proper training against the evils of running does not need to be on a rep to rep basis.  Training 2-3 times a week with corrective approaches and large amplitude conditioning will easily keep long distance runners away from problems.

Poorly executed or uncoached running can be considered a controlled fall where you let the body drop forward and catch it with the other leg reaching the ground.  When the body senses the fall, there is both a biomechanic reaction to facilitate and inhibit muscles of the Upper and Lower Crossed, but we should also consider the Startle Response.  What we overtly recognize as running may be recognized as a threat to the body.  The brain thinks we are falling and further supports the CNS to go into protective mode, the Upper and Lower Crossed.

7) I am a big proponent of integrating collective knowledge of medical specialties to achieve long-lasting total health to the patient population.  How can we realistically achieve this in this present healthcare system?

I think this issue starts and ends with like minds.  People have to agree on a system of training and divide up the work.  Obviously this also includes this “team” to all be comfortable with how the money is divided up from providing this service.

I think finding like minds is a challenge, but it is far more challenging to find that group of clinicians that can also agree to freely refer and consult and share clients and patients.

The healthcare customer is the most misinformed customer in the market.  They are not ignorant or undereducated.  I think they really do do their homework.  They are just getting poor and subjective information in choosing their clinicians.  A key to making it all happen is that when you get these folks into your system, you hit a home run every time, and allow their feedback to others to drive the goals of working with your team.

8. Tell us what exciting things you are presently working on right now?

Well, actually this week (week of 8.30), I started with MARSOC that I mentioned before.  This is a big time for me in terms of a new job and all the social changes coming with moving 500 miles away from home.  Outside of this, my DVD, Training = Rehab, Rehab = Training is set to go to final any day now.  I was hoping for an end of the summer release, but we all would rather it be as close to perfect as we can get it.  The information will still be very contemporary, and my marketing guy is very exciting about what we can do with it.  Please look out for it at http://www.charlieweingroff.com, my Facebook updates, and the affiliates that we will be working with to get the product out there.

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