Barefoot Strong: Foot To Core Sequencing, Barefoot Shoes & How Barefoot Training Can Enhance Movement Longevity
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Welcome to the Back Pain Solutions Podcast – Barefoot Strong: Foot To Core Sequencing, Barefoot Shoes & How Foot To Core Training Can Enhance Movement Longevity.
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Introducing Barefoot Strong: Foot To Core Sequencing, Barefoot Shoes & How Barefoot Training Can Enhance Movement Longevity.
Research demonstrates that the anti-aging market is growing at a compound rate of 7.8% between 2013-2019 and a total market value above $281 billion. Whether it be fasting, bouillon, supplements, cold showers, or many of the other lifestyle and dietary changes now known to improve the functioning of your body, the anti aging market is becoming ever more popular as people continue to seek ways to improve their health.
Our guest on today’s podcast is passionate about anti aging medicine but believes a key focus of anti aging medicine should be focussed on movement longevity. ‘You want your brain young, you want your skin young, you want to think young, but you also want to move young and a linchpin of movement longevity is keeping your feet strong and keeping your feet connected to your core’. In her book Barefoot Strong: Unlock the Secrets to Movement Longevity Dr Splichal explores the science behind barefoot training and this growing area of health and fitness is the secret to youthful movement.
Dr Splichal is a podiatrist, human movement specialist and global leader in barefoot science rehabilitation. She’s the founder of the Evidence Based Fitness Academy, creator of the Barefoot Training Specialist, Barefoot Rx, & Bare Workout certifications and inventor of Naboso technology. With over 16 years in the fitness industry, Dr Splichal has dedicated her medical career towards studying postural alignment and human movement as it relates to barefoot science, foot to core integration and from the ground up training.
In this episode Dr Splichal and I discuss movement from the ground up. We dig into the growing barefoot movement, discuss the different foot types such as flat feet, and identify how foot health can influence back pain. From barefoot activation exercises and barefoot shoes to nutritional advice to support the protection of peripheral nerves this episode will give you insights, and actions, to improve foot health and enhance your movement longevity.
Some of the things you’ll discover…
- How the approach to medicine is shifting with a focus on preventative care & empower patients to help themselves
- You can’t rely on orthotics for foot health, you need to take an active approach to recovery & ensure the deep core muscles are engaged, whilst connected with the feet
- What are the different foot types and subclasses of those foot types and how can they impact the body
- How practitioners should be working in collaboration where necessary to help resolve your pain/injury
- There are both biomechanical, and sensory, considerations that must be made in relation to the feet and their influence on back pain
- A strong foot, or a strong core, in isolation does not offer any functional benefit, there has to be a connection between the two
- Shoes create a disconnect between nervous system and the ground so keeping sensory stimulation of the feet a part of your daily routine to offset some of the disconnect that happens from modern day shoes
For more episodes of the Back Pain Solutions podcast visit: www.smartstrong.co.uk Don’t forget to subscribe so you can receive updates on new episodes and direct links to additional content.
If you’re suffering from back pain, want to improve your posture, or want to build resilience to future injury then you’re in the right place. Join us and take an active approach to better back health.
Resources…
eBook: https://smartstrong.ck.page/dda17bdf60
Book: Barefoot Strong: Unlock The Secrets To Movement Longevity
Naboso Technology: The Naboso Mat & Insoles
Dr Splichal Contact Details…
https://www.facebook.com/dremilysplichaldpm/?ref=bookmarks
https://www.linkedin.com/in/dremily/
Send Us A Question…
https://smartstrong.co.uk/contact-us/
Website…
Interview Transcription for …..
Dr Splichal 0:00
When we’re young, we move with freedom and confidence with a great resilience to injury. But somewhere along the line we develop poor habits and become more vulnerable to back pain. Back Pain solutions features evidence based and practical advice to help you take back control of your health and get back to the activities you love. This is your guide to better back health through movement. So join us as we demystify some of the commonly held beliefs about back pain and build your confidence to a stronger back the smart way.
Ben James 0:27
So welcome back to the back pain solutions podcast everybody and today we’re talking all things feet with Dr. Emily Splichal. Dr. Splichal is a podiatrist, human movement specialist and global leader in barefoot science rehabilitation. She’s the founder of evidence based fitness academy, creator of the Barefoot Training Specialist, Barefoot RX and Bear workout certifications; inventor of Naboso barefoot technology and author of a book barefoot strong. With over 16 years in the fitness industry, Dr. Splichal has dedicated her medical career towards studying postural alignment and human movement as it relates to barefoot science, foot to core integration and from the ground up training. So do we give enough focus to our feet for health and fitness? Are we missing out when it comes to rehabilitation and performance? And what are the feet got to do with back health? Well, we’ll find out as we welcome on to the show Dr. Splichal Dr Splichal Hello.
Dr Splichal 1:34
Hi, how are you? Thank you so much for having me on the show.
Ben James 1:38
Oh, you’re welcome. Thanks for being on. It’s great to have you. I know. based on you know, the bio and your experience achievements in this area it’s clear that barefoot training/foot health is not just a job. It’s it’s a passion for you.
Dr Splichal 1:55
Very much. So a passion so much that I’ve traveled all around the world teaching about barefoot science feet foot two core, and how impactful our feet are with the rest of the body. And it’s led to the development of several companies. So yeah, I would say passion is definitely, definitely high when it comes to this topic.
Ben James 2:19
Yeah, sure. And so where did it all begin? For you?
Dr Splichal 2:23
Yeah. So I actually started in fitness, when I started as a competitive gymnast. And that’s where a lot of my appreciation for feet barefoot started, even though I didn’t really process or know that it would impact my career in the future. But started as a gymnast, and then got into fitness. Kind of by chance in the sense that my bachelor’s is actually forensic. So it’s not anything related to barefoot in feet. And I was not happy in that career path after my undergrad. graduate degree. So I left that and turned to fitness kind of by chance. I had missed movement because of being a gymnast. And then after being in fitness for several years, I wanted to pursue the body and exploration of the body mechanics a little bit further found out about podiatry as a form of medical school here in the United States, started podiatry, but kept doing fitness which is really important to what shaped my career because it kept the very Western medicine thought process kind of out of my mind and always kept me with this appreciation for movement, functional movement and integrative approaches to the human body. So after I finished medical school and had started residency, were here in the US you have to do with three years surgical residency as a podiatrist I was in my first year very unhappy because it was not in the direction of why I had wanted to go to podiatry school in the first place. So I left took a break, went back to school and got my master’s in human movement, which allowed me to actually connect my passion for fitness and I guess my passion for podiatry beads, and the glue in between them was my Master’s in human movement. And then that’s where everything started clicking and shaping and taking the form that it has today. I of course had to go back and get my finished my residency training and do surgery. And then when I graduated residency from day one private practice, I built in the philosophy of, of how I now teach other doctors to take in this philosophy of feet from an integrated perspective. I know feet to back pain. I can speak of that in many different ways versus just a kinematic way or a kinematic way. But how influential the feet are to so many aspects of our being. And now it’s, it’s kind of evolved even further from there.
Ben James 5:18
Okay. And so when have you been in practicing? So you in practice, still quite regularly, it’s still a pretty full time or there’s so many other things going on now that it’s when you can more than it is the regular schedule each week.
Dr Splichal 5:35
Yeah. So I do, I moved from full time patient care to, you know, three quarter time patient care to now like one quarter time care quite quite rapidly after I’ve launched my education company, which you had referenced edfa and that’s partly because I was just traveling around the world. So much to And other doctors and speaking at conferences, and doing consulting for some major footwear companies around the world that it just pulled away from from patient care. I actually stopped doing surgery about five, six years ago or sorry, three, four years ago. And that was a big decision to leave that training or that skill that I had. But it further reinforced that we really can’t be a jack of all trades, we really there’s a benefit to really specializing in a niche because of what we can provide to other practitioners and what we can provide to patients that need that that really specialized care.
Ben James 6:46
Sure, and is it fair to say you’re you’re quite unique in the podiatry world, how how did the podiatrist respond to the kind of barefoot approach and because a lot of podiatrist I’ve seen or certainly patients kind of looking for that quick fix orthotic. And is that the big focus for podiatry still? Are they kind of shifting to this barefoot strong rehabilitation approach?
Dr Splichal 7:18
Yeah. No, they are not. So I’m definitely a black sheep or a rebel or I don’t know what you want to call it in the podiatry community, I would say, in general, but really here in the United States because we’re so surgically focused, and that’s an unfortunate part of what the schools kind of teach around the progression of the profession is based around the fact of us being surgeons, so they really take a lot of pride in that and I think it’s important to have that skill and have that as a skill set of a podiatrist particularly here in the US, but you still have to appreciate that every decision you make for your patient, whether it’s directing them to surgery or directing them to orthotics, or to do let’s say corrective exercise is going to influence them years down the road. So you want to think think wisely on the recommendations that you make versus just thinking get this patient asymptomatic so they’re out of my office and then I don’t really have to, then I don’t know what’s going on in their future. I try to, you know, think further down the road. I would say the the next generation of podiatry select the younger ones are actually now more open to how I treat my patients. I’ve had quite a few younger podiatrists or podiatry students want to shadow me in my practice to see how I approach patients I’ve actually had several professionals that I’ve trained, they were more on the fitness side, and they loved feet, from what I’ve taught them through my education company that several have actually decided to go to podiatry school and become podiatrist, which is, I would say that is one of the biggest compliments that you convert someone to a profession or you introduce someone to a profession that they otherwise didn’t know a lot about. But I’m hoping that as we move into the future, the approach from an integrative perspective is there.
Ben James 9:43
Yeah, there seems to be an approach you see across the health spectrum. It’s more moving away from a reactive symptom based approach to preventative or at least long term functional management. That empowers patients to understand and help themselves.
Dr Splichal 10:04
100% I couldn’t agree more. And I love the words that you used and out with the empowering the patient is something huge. That’s what I try to empower every one of my patients. And then yes, instead of doing defensive medicine, or treating out of fear, or reactive medicine, preventive medicine is really the future of of health care, or public health, in my opinion.
Ben James 10:30
Yeah, I couldn’t agree more. And I think one of the things that you often hear for a lot certainly experience myself with patients is the feeling of frustration that it’s out of their control. So absolutely. Educating and empowering becomes such a positive and enjoyable way to approach the management of these kind of back pain or foot issues or any other muscular problem. So I’m interested in the approach or Simply the feedback you get from patients, do you find that some are a little bit resistant to having to take an active approach themselves and just want the orthotic and walk out the door? Is it simply a case that you’re always going to get those patients? How have you dealt with that and manage that? Because I’ve experienced that with trying to take movement based approach to patients with back health.
Dr Splichal 11:22
Yeah, so I mean, I make it really clear on my website, everything I, any lecture that I have or podcasts that I’m on so from a from a consistency of how I approach patients is very transparent. So I actually have on my website, that if someone is making an appointment, they have to consent and essentially say, yes, I’m going to be an active part of this treatment program that you know, what I recommend to them is not going to be a quick fix. These are oftentimes lifestyle changes or you know more chronic changes and habits that we have to establish to have the longer effect on them. So they actually have to consent to something, knowing that I’m not going to give them you know, like the orthotic and then say, Okay, now all your problems are gone. And I tell them that that if they do need orthotics, which some of them do, and I do orthotics out of my office, I say that this is not the only part of your treatment, you cannot just rely on the orthotic, we also need to do release in our feet, we need to strengthen the foot muscles, we need to make sure that our deep core muscles are engaged and that they’re connecting to the feet. And you know that it’s a part or piece of the bigger puzzle, in a sense, and they understand that because again, they’re seeking me out primarily for someone who’s thinking outside of the box. And what’s interesting, and what’s actually great for your show, is that a lot of my patients actually aren’t coming with foot pain, which, which would be unique from a typical podiatrist setting is them coming in and their chief complaint is hip pain, back pain, knee pain, shoulder pain, groin pain, whatever it is. And they’re referred to me in some cases, to see if it’s something that the way that the walking or something with the way that their foot is interacting with the ground, and that’s what’s causing it or preventing them from getting better.
Ben James 13:32
Okay, so a lot of your patients are those that maybe aren’t getting better. They’ve seen a chiropractor, osteopath, physical therapist, and there’s a blocker somewhere and someone’s seeking out some further input, whether that’s the practitioner or the patient themselves.
Dr Splichal 13:49
Exactly, yes.
Ben James 13:51
Okay, okay. And do you think that there’ll be a time when the kind of barefoot approach to podiatry will be the frontline approach because it seems that genetically foot-wise, we haven’t changed that much in many thousands of years and yet our footwear has, and yet we seem to be taking an orthotic based approach to managing the problem that seems a little backward.
Dr Splichal 14:22
Yeah, that’s gonna take changing the schools, I believe, the footwear industries. I’m definitely interviewed on a quasi frequent basis as far as you know, people who are trying to change this, and whether that’s changing it by exposing footwear industries or changing it by you know, exposing kind of the Western medicine approach to two different things. I think that it is definitely an uphill battle, but the more that we can bring everybody together who’s thinking similarly, such as what you’re doing, even though it’s not podiatry, it’s still within, you know, health and integrative and empowerment and ownership of your your well being for patients. All of that is important. And then with the internet, it makes it easier for patients to do some self exploration. And if they’re told something initially by a doctor that, oh, the only thing that will help you is orthotics, they could technically go online and start researching and then see that there are other options. So I think that the internet has empowered the patient as well. So I I do see it in the positive direction. It’ll be slow, but it’s a positive change. And I’m willing to do the slow climb up that hill.
Ben James 15:47
Yeah, absolutely. It takes takes time to make a big change like that because I think you’re right to approach or changes in modules and approaches that college universities are going to be fundamentally Important in influencing those changes for sure. So talking about the feet that the feet anatomically wise very similar in terms of number of bones limit joints, but from your book and from my own experience, not every field is the same. Yes, there’s different types. Neutral, you talk about the everted, inverted for, is that kind of the foundation, is that the starting point for you, with your patients or for the listeners to understand.
Dr Splichal 16:40
I think that understanding the general classifications of foot types is important. And then understanding is it structural or is it functional, so that’s usually where I start with patients. So doing my my whole assessment with them, and then I started explaining to them What I see in their foot type, knowing that there’s many foot types, and there’s some subclasses of foot types that say so it’s hard to say, okay, these are your 10 potential options No, because there might be more and there’s deviations and subtleties. But let’s say if they have a high arch just as an example, and there’s a type of a foot that’s called anterior cavous, cavous is means high arch. The anterior cave is means that the front of the foot is technically the high arch part of it from a definition perspective, but this foot classically looks like it’s in a high heel when they’re just sitting on the examination table and the foot is plantar flexed. The forefoot is actually dropping lower than the rear foot, which is it’s a type of cave as high arch foot. So I explained to a patient if they have this, I just educate them that’s a structural foot type, you can’t change structure, can you modify it a little bit or controls some of the features of structure? Sure. But can I take that foot and completely turn it into, let’s say a neutral foot? No, because it’s structural. So I have them understand that they have a structural foot type. And then that foot type as an example, cavous feet. High arch feet are typically, not always, but typically more rigid, or more stiff. Which means that when they are doing dynamic movement and striking the ground, that foot type typically has a little bit harder time unlocking or decelerating to take in impact forces. So is that foot type a little bit more susceptible to impact related injuries? Potentially? Yes. And then another feature of that foot type is It can be associated with tight ankles. So then that would be a structural reason for limited ankle dorsiflexion. And then if I see patterns of them having limited ankle dorsiflexion, when they walk, I can say, you’re walking the way you are because you have a structural foot type. Now, let me explain to you what it does to the whole body, to what you can do from a daily basis to offset some of the impacts of that structure. And then here’s some baseline ways that you can strengthen your feet that everyone should strengthen their feet. So you become a little bit more quick on how you’re anticipating the ground. So that’s kind of how I would go into that conversation. That was an example on the rigid side. Of course, you have the example on the opposite side, which is the unstable foot which is probably what almost all your listeners are thinking about, which is the overpronated foot. So if you haven’t over protonated for it, then this is where I’m explaining to the patient, is it structural? I go into that conversation? Or is it functional? You want to differentiate the two? Is it rigid. So some people have a rigid flat foot, which means it can’t really change its shape. And then some people have a flexible flat foot, or over pronation, and flat foot is going to be synonymous with this conversation. So now you can start to as a patient or an individual, I understand you have a structural foot, do you have a a flexible foot? Do you have a functional foot? Do you have a rigid foot? And then what is the impact of that feature on the body? And then what can you do on a daily basis to balance some of those effects of that foot type? And then how do you start to strengthen that type. And that’s that’s really how I go into all of my appointments with my patients.
Ben James 21:08
Okay, does it always start in terms of a change process with the foot itself, whether that’s doing some strength, some flexibility, potentially, I guess in some cases, from what you’re saying orthotics or is it always a case of incorporating that into, because you talk a lot in your book about the foot to core link and training that kind of linked together as opposed to just in isolation or is there some work to do initially just on the foot directly as a starting point?
Dr Splichal 21:41
Yes. I’m really glad that you asked that because one thing that I do differentiate myself from other podiatrists is that I don’t just look at the foot. So I’m also looking at pelvis and T-spine mobility, stability and then taking in both of those and translating that into a gait assessment or a squat assessment, so I’ll have patients I look at the foot, I look at the foot open chain, which means them just sitting on the table, and then closed chain, which is them standing in gravity on the ground, have them do certain things to see the way that the foot moves. I have them do a few squats, I do step up, step down. There’s a T spine test, so a rotational test for the thoracic or the ribcage to see how that moves. And then I have them do a walking gait assessment. And then if it’s sports specific, like if it’s a golfer, I have them, show them, show me their golf swing, if it’s someone who does fencing, if it’s, you know, pole vaulting, I’ll have them bring videos clearly these are types of patients that I’ve seen, whatever it is the sport that I want to see a video or them in my office replicating that movement. And then what I’m doing is I’m taking in what I see from the foot structurally and functionally. And then what I’m seeing from the movement of their pelvis and their rib cage, and then I’m seeing that in the mobility slash stability, dynamics and coordination of their walking pattern. And then their their sport that they’re doing. So if I see something that is triggering what could cause their pain, it could be and it not out, it’s not always the feet, it could be something top down. And I will tell patients that I have patients a lot that will come in and I’m like, I’m sorry, it’s not your feet. That doesn’t mean I can’t help you. But your feet are completely neutral, you have good dorsiflexion you have you know, a neutral arch, your the way your foot is reacting to the ground is checking all of my boxes, which means that this is something like top down that I said. Did you do have an underactive pelvic floor from giving birth 10 years ago, do you have, you know, a underlying strain within your adductor in your abdominal fracture that’s being missed? Is it something in your hip and maybe the way your hip joint is centering and all of that stuff is causing all of this chaos in your pelvis, which is causing your low back pain will tie to low back pain that’s causing the low back pain and then the foot really is isn’t seen any of the effect of this. I see it when you walk, but I’m not seeing it from the foundation of the of the foot type. So in that case, I would then give them appropriate hip opening exercises, deep stabilization exercises, pelvic and T spine mobility exercises. So all of my patients essentially get a protocol that is based off of inhibition, mobilization, activation, integration, that is my, my recipe or the skeleton of my treatment. So they’re inhibiting something, mobilizing a joint, the pelvis, the T spine, whatever it is, activating a stabilizer, and then integrating their feet with their core. So integration is always integrating with gravity is essentially what it means. So that it has to be a closed chain standing in gravity exercise where they’re activating their feet and their core at the same time. That would be the cherry on top or the glue that keeps the whole protocol sticking.
Ben James 25:47
Yeah, sure. And it’s interesting how you talked about the triggers and things. That’s very much our approach in terms of trying to identify those pain triggers and remove those triggers or faulty movement patterns. And then building into that, that core endurance. And it sounds like you’re you take the approach of looking at their feet first with the background. And if they’re functioning well you kind of, then follow it up the chain. Yeah, if we kind of look at it in reverse, and start at the top and work down, maybe because there’s similar integration and consideration there in terms of how we work and what you’re relaying there, which is fascinating.
Dr Splichal 26:29
Yes, it’s good to see that there’s synergistic approaches by different specialists. And then when there’s any elephants in the room or wherever you want to call it, the elephant, something that’s like deviating a little a little bit beyond the scope of what I understand from pelvis, low back, you know, pelvic floor, deep hip, like I understand that anatomy, but at the end of the day, I am a podiatrist. So a lot of that is taught from going to conferences self taught, you know, reading a lot. Yes, my master’s, I learned some through that. But like the deeper, deeper rabbit hole, and then that’s where, here in the States, I’ll get referrals from specialists such as yourself when they get that patient that has that just completely obscure foot presentation that they’re like cave. This is beyond what this is beyond just your standard over pronation or high arch cave is foot. So let’s have you take a look. But it’s great to have that team approach. Because I do assessments. I’m not a manual therapist either. I assess patients and then I teach the patient how to heal themselves essentially. And if that requires going to let’s say a massage therapist or someone who does dry needling, or acupuncture or any of that that’s part of their recommendations. But I don’t do any of those. I’m essentially the captain to the ship. You want to say?
Ben James 28:08
Sure, yeah, no, I understand. I mean, it’s refreshing conversation because that’s how it should be really the patient at the end of the day is at the heart and the solving their problem is, is the key. So if it needs collaboration, then collaboration is what we should see rather than trying to do everything ourselves or jack of all trades and Master of None maybe.
Dr Splichal 28:29
Right and that’s why I try to not I would love to do you know, polities therapy and actually having a format where I’m the one doing it with the patient or I’m the one doing the drawing the billing, but then you’re right, you start to become the jack of all trades and master of none and I would rather just keep my eye trained for the the subtleties of movement. So I don’t know why I have that gift. But I love watching people walk and move and, you know I can, I’m able to kind of zoom in and zoom out on the human body when it’s moving. And I see it, not mechanically and this is something really important as well that I see it from a sensory perspective. So when I’m looking at someone walking in, I’m seeing somehow in my mind, the the timing the foot hits the ground and the rate at which it is stiffening and stabilizing and how the fascias tensioning and then what the reciprocal arm is, is doing to load cross pattern flashes and it’s, it becomes much more of this, you know, neuro muscular thing that I’m seeing in patients versus bones and joints moving. And that’s really what my passion is in movement. That’s where I think my gift is. And that’s why I stay with that gift versus like what we were saying to literally do everything with the patience.
Ben James 30:04
Yeah, absolutely focus in on the niche and the passion and what you do well, and, and collaborate where needed in other areas makes a lot of sense. So in terms of you kind of alluded to the fact that the flat for the more pronated foot is more commonly associated with back pain is that the pattern you see?
Dr Splichal 30:29
I would say that it’s the most well understood that if if a if a patient or a lay person consumer were to guess a foot type, they would probably guess, you know, flat feet or over pronation partly because of media and orthotics. orthotics have arches. So people assume that the purpose of the orthotic is to support the arch which it does in many cases. And that we need In arch, so therefore, when the foot goes bad, the direction it goes bad and is typically in the flat foot direction. Again, there’s just so much around that doesn’t mean that the high arched foot cannot cause it. But then even another layer to that is, right now we’re just talking about arches. We could also have a conversation of the amount of mobility they have in their great toe, which is a huge contributor as well. So that could be a completely neutral foot, but they happen to have arthritis in the in the big toe or the first MPJ that is preventing sufficient movement of the toe when they are walking and take a step. So every time their leg is behind them, and they’re about to take a step because they can’t flex their toes they compensate in a certain way, or they don’t bring their leg as far back as they should which is hip extension. So now their glutes start to become inhibited, and the glutes are critical to back stability, SI joint pelvic stability. So now they start to get compensatory stabilization patterns of the pelvis. And the driver of that is the fact that they don’t have motion in the big toe. So that’s a foot up cause of back pain that may or may not have an association to a foot type.
Ben James 32:35
Sure. Okay. So is that got anything to do with the fascial connections that you talked about in the book from from the big toe, you talk about the fascial lines and how that can influence this foot to core sequencing.
Dr Splichal 32:52
So the connections of the great toe, I would say that there would be two. So the one that I just explained is more of a biomechanical approach to it for everything. There’s a biomechanical side and a sensory side. So the biomechanical side is if the joint doesn’t move, you cannot take a long step so your stride length becomes shorter or closer together because stride, stride length is directly related to how much you can bend your big toe back. Now, stride length is really what’s stimulating the glute activation trigger. All of that that I’m explaining, that’s the biomechanic way or connection between big toe function and back pain. Now the sensory way is that the muscle that attaches to your big toe on the bottom, so on the bottom, the tip of the big toe bottom, there’s a muscle called your flexor hallucis longus flexor hallucis longus the action of that muscle is that it pushes your toe down into the ground. And when you push your toe down into the ground, that flexor hallucis longus actually connects to blends. And neuromuscularly, kind of becomes one with muscles in your lower leg and then your inner thigh that’s called your adductor and then up into your pelvic floor, which is important to the pelvis, and then that becomes part of the diaphragm and then you have your psoas and it goes all the way to the neck and to your tongue. That connection of pushing the big toe down and activating deep core stabilizers is critical to how we walk and how we stabilize the pelvis. When we walk, that is the sensory side. So if we don’t have that connection, because maybe we’re in shoes, and we have weak feet, but we’ve never trained it, or whatever the reason could be, you then are walking without really optimally engaging those muscles, the flexors that activate the deep core. And if your deep core is not engaged fast enough, your entire pelvis is not stable and your glutes cannot engage. So that’s a sensory cascade way of approaching foot to core or foot-back pain.
Ben James 35:44
Yeah, could you talk about how that that sequencing kind of culminates in the glutes, activation or firing for and that involves the core to then the glutes firing, so if that sequence isn’t right And a you can brace the core effectively. And also then like you say you’re losing the input of the glutes because a big focus for us around back health is around that core stiffness, preventing micro movement within the vertebra, which can itself lead to pain and discomfort. So there’s a clear link there between the foot and the impact on those muscles firing effectively. And it just shows how you’ve got to look at it holistically rather than just in isolation.
Dr Splichal 36:31
Correct? Yes. And so what I always tell people is that if your foot is strong in isolation, and your core is strong in isolation, but they’re not talking to each other, functionally, who cares? Like I don’t need an isolated, strong foot because that does not apply to function. And when we’re talking functional movement here, the baseline functional movement is walking. So I’m just trying to help you know the listeners and my patient. To just meet the demands of walking, and if you can do that from a stabilization, tensioning stiffness perspective, then we can start to build off of that into, you know, a myriad of other of other movement patterns. But yes, you’re right. So the, the stiffness in the deep core, you want to have a synonymous stiffening in the foot because technically your foot has a core, I’m quoting my fingers right now has a core similar to your core core, and the core of the foot or the intrinsic muscles or the small muscles of the foot. Those I try to train similar to how I train the pelvic floor and my patients, and you want them to work together.
Ben James 37:52
Yes, and it’s interesting. You talk about the intrinsic muscles and in the book, you talk about the isometric contraction the vibration that the feet experience or should experience if we’re barefoot and how that’s limited by footwear. How do you how do you overcome that? Because clearly barefoot training or barefoot living is challenging to some degree with the workplace the way it is and the ground we walk on the pavements and hygiene and all those factors that limit us just being barefoot on a daily basis or day. Is there is that where the naboso concept or product came to fruition or to the corporate in your mind in terms of how we we kind of help to counteract that issue?
Dr Splichal 38:46
It is and I’m so glad that you would mention that because I didn’t want to kind of selflessly bring that into the conversation. But it is so for any of the listeners that are not familiar with naboso, naboso is a texture insole and mat company that I started several years ago, with the purpose of let’s just look at the insoles with the purpose of understanding the reality of shoes, just like what you said. So we have to wear shoes or certain surfaces, there’s work environments or certain sports that require it. Understanding that shoes create a disconnect between our nervous system, and the ground its just inevitable. So instead of just thinking, How do I make the shoe more minimal, which is what a lot of companies have done, but that’s still a barrier. And maybe it’s not appropriate for all patients or individuals. So let’s actually see how could we bring necessary important stimulation into the shoe. So like the interior design of the shoe, to then try to get some of the neuro feedback that we would get if we were barefoot? So the Naboso insole which is textured, there’s a little pyramids across the entire texture, and it’s stimulating a nerve in the bottom of the feet, that is sensitive to two point discrimination. When you stimulate the nerves in the skin and the bottom of the foot, there’s a trigger to activate and contract the intrinsic muscles of the feet. So this is yes, why I developed a naboso to try to offset some of the reality of footwear. But another way that people could do that is to make sure that they’re keeping sensory stimulation part of their lifestyle. So I tell my patients at least 30 minutes every day to have barefoot stimulation, whether that’s morning, evening, you know at the gym in the middle of the day, and then two to three times a week to do another 30 minutes of focused foot strengthening exercises and that can start to offset some of the disconnect that happens from modern shoes.
Ben James 41:08
Yes, sure, no, it makes a lot of sense in terms of overcoming that footwear issue that is, I guess changing because we are seeing more and more of the Barefoot type shoes come into the market and it seems to be driven by some of the books, Born to Run another well more and more stories around barefoot running and things is you see more and more uptake in the Barefoot footwear.
Dr Splichal 41:41
I am Yes, more of a adopting it or an embracing it. I think that the more that it becomes seen as not barefoot running footwear, where is the beginning that’s what it was associated with. And that was because of the book that you referenced Born to Run. So a lot of people would say, Well, I can’t wear those shoes because I’m not a runner. And that that’s just a huge misconception, because of, you know, really, media, I would say are kind of consumer association of words. So now that there’s more natural footwear or minimal footwear companies that start to cross lifestyle, and work is is really great to see that.
Ben James 42:33
Yeah, no, absolutely. I think it’s one of those things. I guess you’ve got to be careful about though, to transition too quickly, I guess.
Dr Splichal 42:44
Yes. So I, I do a lot of transitional programs for my patients when they switch. Having them make sure that they’re focusing on inhibiting their feet, releasing their feet. So I think that everyone, just by My healthy foot lifestyle perspective should be doing five minutes of releasing the feed in the morning, five minutes released the feed in the evening, just get a lacrosse ball or a golf ball or something, keep it in the bathroom, and then morning, evening, you’re releasing the feet, and then do the Barefoot stimulation that I had said. So this is before you even go to minimal shoes, you want to make sure that you are barefoot even around your home, releasing your feet. And then from there, you can you know, increase the amount of foot strength in if you would like. A lot of times when people are switching from traditional shoes to minimal shoes. And let’s say they go to the gym on a regular basis. I’ll say that that’s the that’s the best first environment for you to use those shoes so be barefoot at the gym, in that environment. And then as you get used to that, then start introducing it when you’re doing walks and things like that. If you are doing a lot of walking like, you know, I know London’s a walking City, New York is a walking city. You do want to be careful walking on concrete in them like all day Saturday you’re going on a shopping trip or whatever. Because concrete is very hard on the body concrete does not vibrate so your body takes a lot of excess vibration. So that’s where you can start to see plantar fasciitis and stress fractures and stuff from minimal shoes. It’s not the fault of the shoe. It’s just that the the ratio of stress recovery has been essentially off balanced.
Ben James 44:48
Yes, just about the foot and going barefoot, it’s about the surface as well. That also has an impact. It’s not just walk on any surface barefoot and you should be okay because like you say concrete isn’t a natural surface.
Dr Splichal 45:02
Correct? Yeah, so part of my master’s was really looking at barefoot science, but we’re science and surface science. So I learned a lot about different surfaces. And every surface vibrates differently. The best surfaces for vibration are natural. So this is grass trail wood. So like a dance studio or like exercise studios would be wood floors that would kind of not balanced but they’re essentially vibrating. They’re flexing with you. Where some that are harder on the body is obviously concrete asphalt are going to be harder on the body. But then in a gym setting with a thick rubber floors, you don’t get a lot of sensory feedback from those surfaces. So those can also be very hard on the body. I will see a lot of personal trainers who get foot pain, back pain from wearing minimal shoes, too often on the gym. floor when they’re training clients, I see a lot of nurses, doctors who are on their feet, obviously police officers and people who are standing on their feet because of the surfaces at which they stand.
Ben James 46:13
Yeah, you tell a great story in the book about the circus lay and how they, they were training. And they’re so fantastic in terms of technique, etc. But there was a new floor described and there was some support beams that were harder than the general area of the floor. And there were a lot of repetitive injuries occurring as a result of that. It just shows how influential that that surface can be.
Dr Splichal 46:39
Yeah, people people don’t realize that but everything is built along. You had used the word reactive in the beginning, that we don’t want to be doing reactive medicine, but we also want to make sure that our patients are not moving reactively you need to anticipate the ground before you strike the ground. that’s built into how much you can actually sense the ground. You know proper deceptively or mechanic deceptively, that’s where shoes get in the way of actually sensing the ground. So the more you can anticipate your movements, or let’s see if we bring it back to low back pain is there’s a lot of studies that will show that people with chronic low back pain have delayed transverse abdominal activation. So the transverse abdominals, which is the TBA muscle, is a anticipatory muscle in our core that engages before you lift your arm in before you consciously lift your arm, your tibia is already engaged. That’s a very intelligent side of our nervous system that it is able to almost I mean, it’s anticipating the movement of the arm before you lift the arm. That’s super sophisticated, but But it’s there for a reason. And we need to make sure that we are training that sophisticated side of the nervous system to prevent, in that case, low back pain, or in some cases with my patients, stress fractures or plantar fasciitis.
Ben James 48:18
Yeah. And furthermore, on the nervous system, you talk about looking after those peripheral nerves as well. And they, they’re fundamentally important and the plantar surface of the foot, and nutritionally sugar levels glycation over the long term. Can I have an impact on that and diabetic patients who are a great example of that?
Dr Splichal 48:40
Yes. So as we age, the health of our nervous system, both central nervous system, so a lot of people will think of cognition and dementia prevention. But we also want to think from a peripheral nervous system perspective, because that’s a huge part of how we move We process movements, but it also has an impact as I’m going more and more into the research in memory and mood, so not just doing crossword puzzles Institute go and stuff like that, you know to keep your brain sharp, central nervous system but the more sensory rich and sensory sensitive your feet and your hands are it actually feeds your cognitive abilities, which is really fascinating and important. So then yes, knowing how to protect those nerves, what inflammatory or oxidative stress markers actually can interfere with that peripheral nerve health and then what do you do in my book barefoot strong and go into various supplements, vitamin supplements that I recommend to my patients that actually increase nerve growth factor?
Ben James 49:58
Yes, no, I was gonna Say that I’d read read through those. And it’s another area of interest for us with with the smart strong back pain solutions podcast, you know, the nutritional influence and chronic inflammation and our long term health it’s, again back to that preventative and proactive approach to health and how important it is for people to, to take ownership and look at these factors that influence pain injury and long term health. Because again mentioned already, we often take such a reactive approach. And we’re often at the point where it’s harder to solve a problem. Whereas if we were so much more proactive, we could prevent some of these problems or certainly make them less serious.
Dr Splichal 50:50
Yes, it’s definitely easier to prevent a condition then to try to reverse a condition where the more We can, let’s say protect, you know the vertebral discs and things like that is much easier than after a patient has a disc herniation or a spondylolisthesis and things like that. So, yes, and nutrition, inflammation, oxidative stress, sleep, gut biome, mind, body, all of those things are things that I actually speak to my patients about, which is another unexpected thing from a podiatrist. But I’m hoping that more podiatrist started having that conversation as well with their patients.
Ben James 51:37
Yeah, and I think hopefully, in the longer term, more and more health care professionals because that’s, that’s what we need to see for sure. And back to the kind of preventative and proactive approach. She talked a lot in the book about the foots course sequence in short for and activating the glutes. Can you just talk us through a little bit about that? That kind of exercise practice approach that the listeners could start to incorporate on a daily basis.
Dr Splichal 52:07
Yes, so my go to exercise is short for it. I will explain briefly on how it is and then I have a video on my YouTube channel, which goes into it, which is youtube.com backslash e BFA fitness and or you could just search my name short foot in YouTube search channel, and it’ll come up. So short foot is a exercise that I did not create it. It was something that was created by a Czech physiatrist. This is years ago, and it was used initially as an exercise to strengthen the foot more locally. But as I had mentioned earlier, I like integrated exercises. So I want your foot to be strong and I want your core to be strong so they have to talk to each other. The exercise that I used to Get your feet and your core to talk to each other is short for. So short foot is simply the or the simple way to describe it is that when you push your toes into the ground, the tips of your toes go down into the ground, the flexor, the flexor hallucis longus that I had referenced. And this is where your long flexors connect into the back of the leg into your adductors into your pelvic floor into your diaphragm. So that’s a factual pathway that you are activating when you do short forward and short foot is pushing the tips of the toes into the ground. Now let me just break it down a little bit further and you’ll see it if you go to the to the YouTube channel, is I start patients doing one foot at a time. So I would have you going to a split stance position where your right leg is forward, your left leg is back. If you’re focusing just on your front foot or your right foot, you’re going to start by finding your foot tripod, which is first fifth and heel that’s To the tripod, you’re going to lift your toes and spread them out nice and wide, and then put them back down onto the ground. And then to do short foot, just like I said, you’re going to push the tips of your toes down into the ground. When you push the tips of your toes down, like the toenail down, you should see or feel that you’re inside arch starts to lift, you might actually see the shadow of one of the muscles contracting when you do that. And then some people will come off of the ball of their foot when they do that. And then I typically have people relax and then they do that again and relax and then do that several times just to get how that feels. And then we would repeat the same thing on the left side, and then we would go back to the right side. And now this time, what I want you to do, instead of engaging your foot first, so get the same setup foot tripod, spread your toes. Okay, now before you engage your foot, I want you to engage your core. So lift your pelvic floor. Engage your TBA, whatever kind of words you need to tell yourself to do that create the stiffness or pressure. Now hold that. And now push the tips of your toes down into the ground and see if you notice anything different. And then release both corn feet. Totally relax. Do that again, engage your core, hold it, push the tips, your right toes down in the ground. As soon as you did that, did you notice any difference? Hold it for a minute, push your toes down harder. Do you feel like something happens in your core did your core stiffness go higher, and then engage your core harder, does your foot want to engage more and then release both? Okay, and then repeat the same thing on the other side. So that’s that second way was a way to demonstrate and hopefully get patients or individuals to feel that the feet are part of the core, that they’re connected and they have this
communication with each other Now if you want to kind of play with it the other way. So you do this on your left side, go back to your right side. So the last way that we can add on this is go back to your right side, find the foot tripod, lift the toes, spread them out, okay, don’t engage your core. But now I want you to shut your eyes. Hold on to something if you’re if you don’t want to balance, but your eyes are shut. Now, push your toes down. So do short foot, and then release it. Keep your eyes shut, push your toes down, and then release it. So just keep doing that. And every time you do that, do you happen to notice that any muscles are kind of engaging, you feel like your deep hip is engaging. Do you feel like a deep part of your glutes want to engage did your pelvic floor want to engage? So this is helping or hopefully demonstrating to people as well, that the foot can trigger these higher stabilization cascades and we might not even feel it or Be aware of it, but it’s happening. So I’m curious for anyone who was listening if they actually felt that like, Oh yeah, it’s like my, my deep hip, I feel like something is contracting in my hip every time I push my toe down. That’s so interesting. I never noticed that before. Okay, that is part of how we are able to balance and stabilize when we are walking upright in gravity. And then I typically build this into exercises, squats and single leg balances, movement patterns. You know, one last layer I would add is that every time you push your toes down, because we want to get our diaphragm involved, I would cue the patient to exhale. So toes go down, core engages, or technically your pelvic floor lifts and then you exhale and that is all happening at the same time. So toes down, pelvic floor, lift, exhale, and and I’m simply doing that in a repetitive pattern that is training. The nervous system or the neuromuscular system to coordinate along that cascade. That’s really what foot two core sequencing is.
Ben James 58:12
Yeah, no, that’s a great, great explanation, great insight. And I guess, like we would with all our patients, it’s, it’s about repetition, practice and making ultimately the conscious, subconscious.
Dr Splichal 58:25
Perfect.
Ben James 58:27
Brilliant. Oh, there’s an awful lot of insight there. There’s a lot of information and it’s clear how the foot is so important and influential in fundamental musculoskeletal health and the influence it can have on back health, and we’ll have all their notes and links in the episode notes so that you can learn more about Dr. cyclicals work. I get hold of a copy of the book. It’s only about 100 pages long. There’s no excuses there. And just one final question for me. That’s a squiggle for you. I’m pretty sure I know the answer. This is not just about doing some work to recover from injury this, this really is a lifestyle choice.
Dr Splichal 59:10
100% I believe that keeping your feet strong keeping your feets connected to your core is one of the linchpins to movement longevity, which is the subtitle of the book. I don’t have in front of me, I think it’s secret to anti agency was to movement, longevity or unlock the secrets to movement longevity. But it’s really built around I see optimal foot health and foot function from an integrative perspective as critical to our ability to move as we become 70 8090 100. A huge passion of mine is anti aging medicine. A lot of anti aging medicine is you know, aesthetic. You want your brain young, you want your skin you want to look young, you want to think young, but you also want to Move young. And the youth of your movement or the longevity of that movement is dictated by how you perceive and interpret sensory information. So how can we build that into our habits now, so that we can ensure that movement longevity?
Ben James 1:00:20
Wow, what a great way I think to end the show up by the way to end on that advice and on that vision. So guys, take note, and no excuses. Read more, learn more about the foot and integrate it into your daily activities because, as you’ve heard, it will contribute to your movement, longevity, and your ability to continue functioning into old age as effectively as possible. Dr. spittle thanks so much for the insight. Thanks again for the time, no doubt, we’ll stay in touch.
Dr Splichal 1:00:56
Absolutely. Thank you so much. Thank you. It was a pleasure.
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