A Chiropractors view of the importance of balance in gait

OPTIMAL PERFORMANCE…THE ULTIMATE DOMAIN OF CHIROPRACTIC

an article by chiropractors Dr. Peter Gorman and Dr. Chelsea Keesler published in the New York Chiropractic Association Journal Sept 2019

06 SEP, 2019

No doctor is better prepared than the New York State Doctor of Chiropractic in handling the healthcare performance of all, whether they be 9 or 99.  The well-trained Doctor of Chiropractic must be able to help all patients move from ‘Point A to Point B’ as effectively and as efficiently as possible for as long as possible.  To do this, the Doctor of Chiropractic performs protocols based on the triad of health which shows that all must be evaluated from an EMOTIONAL, CHEMICAL, and PHYSICAL understanding. The physical understanding of our patients has been the classic role of chiropractic since DD Palmer made the first well placed adjustment to a patient.

Gait Balance and Movement

Gait is the great interpreter of movement. The parameters of gait: step, stance, swing, single-support, double-support, load response, pre-swing, etc., all tell a story that must be understood so that care can be most beneficial. Within these parameters, balance is the common denominator for function. As our patients walk, they go from single support to double support to single support, and repeat this process over and over. As injury takes place, whether it be physical or neurocognitive, balance is negatively affected and function is diminished. Balance is not only the critical component of movement but balance has been shown to be related to brain function. In his classic study, Dr. Tabara shows us that the better the balance, the better the MRI of the brain. We would like today for all chiropractors to band together to not only help their patients feel better but to also make sure that each and every patient is helped in improving their balance and their dynamic function.

Today we declare the formation of the Chiropractic 2-minute Club. Each doctor is asked to challenge their patients and help them to become a member of this club by being able to stand for one minute with eyes open on each leg. YES! There will be extreme challenges to do this; America is already plagued with a 70 billion dollar healthcare crisis caused by falls. Knowing this, whether the patient is 9 or 99, the Doctor of Chiropractic will help each and every one start at a comfortable level-which may mean standing at the kitchen sink and holding on and only lifting their hands for a second or two. But whatever the starting point, a sincere and concerted effort must be made to help each and every one to improve their own balance control.

Proprioception…the hidden deficit

Balance is affected by visual, vestibular and proprioceptive input. Of the three, it is proprioception where a hidden deficit may lie and go unnoticed. If our vision became slightly blurry, we would know right away. If our vestibular system acted up, whether it be through mild infection or degeneration, the resulting vertigo and dizziness would be easy to recognize. However, because many are visually dominant, a proprioceptive deficit can exist in the patient and not be detected because of compensations through the visual process. This HIDDEN DEFIICT is simple and easy to challenge to see if it exists. Have your patient stand on one leg with eyes open for 15 seconds and then repeat by having the patient perform the same test with their eyes closed. Any sway or movement is an indication that a proprioceptive deficit does exist.

Barefoot Science insoles…Proprioceptive stimulation

In our office, Barefoot Science (BFS) has been effectively used to help improve this proprioceptive deficit. Barefoot Science is a non-orthotic mid-arch stimulator.  Due to its ability to create mid-arch activation, BFS mimics barefoot walking in sand and over time can dramatically help to reduce a proprioceptive deficit and improve foot strength. We highly recommend that all take a look at this wonderful product.

Testing balance through the Gait cycle

We’ve talked about balance, we understand proprioception, and now we can make a judgement on each position of the foot as it goes through the foot-strike cycle (FSC). The FSC: dorsiflexion-pronation-supination-plantar flexion can be very easily mimicked and understood by using a classic slant board. We highly recommend, if you purchase a slant board, to get one that is at least 16” x 18”, starts at 13 degrees and can increase its angle at least two times. To use the slant board, have the patient look straight ahead, stand with one foot in the middle of the board in dorsiflexion and then be instructed to lift their opposite leg and hold for five seconds. The doctor and the patient will note ease to do so or difficulty for each foot position of each leg. Each patient must be equally strong in all foot positions. This very simple device is almost like putting a high speed camera on the patient, by having the patient hold position and interpreting instant results. If you find a moment of weakness, for example- if pronation is difficult, then we must understand that as the foot goes through its cycle, each time it reaches pronation, the foot is no longer efficient and may cause saccadic movement and inherent dysfunction to the patient that can manifest itself anywhere along the kinematic chain. If a weakness is noticed in any position, check for restrictions in range of motion then check to see if the patient can activate the muscles by now understanding that they are going to shake and see if through repeated movement they can tell the involved muscle to wake up and start working properly. We have seen many times a person be weak in one of the positions and then, by having them repeat and THINK about what they are doing multiple times, they can now show strength within a few repetitions. Why say a hip or a hamstring is tight, proceed to do trigger point reduction therapy and range of motion enhancement, if we don’t investigate further the probable cause. Correcting weakness in the foot can only help enhance the kinematic sequence that will follow.

Objective data to identify asymmetry

In our office, once investigations have been made into balance, range of motion, proprioception and strength; we use an optical instrument to measure the effect of these weaknesses on the gait cycle. Having objective data helps us to clearly understand if our treatment protocol is not only helping the patient to look and feel better through reduction of asymmetrical differences in the movement cycle, but to see if the patient is actually becoming more effective and efficient in their movement by reducing their coefficient of variability (CV) for every step that they take. Once identified, asymmetries in the movement cycle can be treated in real time through the use of biofeedback while the patient is walking, running or marching. By employing neuromuscular re-education in real time with precise data to help guide the movement, we see that many imbalances are functional in nature and can be easily “walked off” in five to ten minute treatment intervals. If anyone would ever like to review this procedure, you are welcomed to our office to see and share ideas.

Cognitive ability

As asymmetries are reduced in the gait cycle, better timing and coordination of the patient is noted. Balance, timing and coordination are the hidden factors of performance. However, the mastermind component is cognitive ability, which can be easily baselined by performing validated cognitive trainings on the BrainHQ.com platform. NO INJURY CAN TAKE PLACE TO THE BRAIN WITHOUT AFFECTING BRAIN SPEED. Baselining brain speed for all should be an integral part of all treatment protocols; especially in the land of contact sport where return to play protocols should be constantly upgraded for effectiveness.

Brain HQ

Every moment of every play of every movement, whether on the athletic field or in the game of life itself, is think and move. No one just moves randomly. Every action is preceded by a thought and then a reaction to that thought and then a reaction to that thought. NO MATTER HOW PHYSICLLY PREPARED THE PERSON IS, IF THEY THINK SLOW, THEY WILL MOVE SLOW. It is said that “what the mind perceives the body achieves”, what it should say is “what the mind perceives the body achieves….eventually”. The gap delay between perception and achievement is known as a person’s reaction time. We already know that chiropractors are the masters of physical involvement, but by performing cognitive training for their patients, the Doctor of Chiropractic can become masters of performance from the emotional side. The BrainHQ platform allows all doctors to help their patients with brain nourishment and improve speed of processing. If a person came to the office, and wanted to be helped with their running ability, would we give them lessons in running and performance first? Or, if they had a pebble in their shoe would we take the pebble out then supply the proper counseling? A patient suffers from rage, dementia, alcoholism; these patients need to be referred to proper counselors, psychologists, etc. However, with the BrainHQ platform we can help to identify imbalances in the brain (such as, the amygdala is a certain number of standard deviations above or below normal). By performing validated cognitive trainings, we help to remove the metaphorical pebble from the brain and start it on the road to nourishment and then refer it to the proper counselor for ultimate improvements in well-being. We highly recommend that everyone take a look at the BrainHQ platform.  Our own Department of Defense has knowing its effectiveness. Our own Department of Defense has bought the platform for ALL active and retired military personnel. Because of its effectiveness, BrainHQ is covered by Medicare in many states. BrainHQ also can be started for free by using their program called the Daily Spark.

The last component of the triad that we should take a quick look at is the chemical side. Many chiropractors already help in the proper nourishment and dietary correction of their patients.  And there are so many different approaches to the chemical side, which is beyond the scope of this simple introductory letter. We will leave it to its own letter at  a later date. There is an old saying “you are what you eat”. We have always said- what is the most important thing a person does every day, what the most important nutrient a person gets every day, it always started with air. If you don’t believe us try going without it for a few minutes and see how you feel. From air we went to water and we want to make sure that you are well hydrated, not because you drank eight 8oz glasses in a day, but because your urine was clear and plentiful. No hydrogenated fats, no trans fats and, depending on the patients insulin resistance, make a judgment on where on the glycemic index can they make choices from. Like we said, at a later time we can address more thoroughly chemical and nutritional approaches.

We firmly believe that the well trained DC is the master of that wonderful universe known as the human body. Nobody comes close to the Doctor of Chiropractic in helping each and every one reach optimal performance in that ultimate challenge known as the game of life. We look forward to sharing our office with everyone to get together to share ideas and to create simple solutions that can have profound effects for all. Looking forward to seeing and hearing everyone in the near future.

Yours in health,

Dr. Peter Gorman

Dr. Chelsea Keesler