A Chiropractors view of the importance of balance in gait

ByStuart Gordon | 17 September, 2019

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

Anyone that puts Barefoot Science insoles in their shoes will have an increase in performance and a greatly reduced chance of injury. I now wear my Barefoot Science every day and recommend them to all of my clients.

Richard Pady, Canada
Triathlon Coach, Trainer and Competitor

I have used Barefoot orthotics on some of my toughest casesof plantar fasciitis, tibialis posterior tendinosis and metatarsal- gia and have had excellent results. These are people who have tried and failed traditional orthotics, stretches and various other devices. Barefoot orthotics are easy to sell as people can see the logic in the approach. Thoroughly happy with the product and service

Mark Gillham
Physiotherapist, Cowra NSW, Australia

Immediately from stepping onto my insoles with level one insert I felt a subtle but reassuring change in posture and balance. 8 weeks later I am up to level 6 and two weeks ago I was able to start running again pain-free for the first time in 14 months since a back injury. By way of an update; "Thank you Barefoot Science:- I am completely stoked as I just ran a personal best for a 10k trail over mixed terrain, pain-free!" ...........This afternoon's time was 57:28 - pretty ordinary for many but great for me as my goal has been to get 10k covered in under an hour......... and, after all, I am 186cm, 108kgs and 49 1/2 yrs old! I first 'ran' again in May and took 11 mins to cover 1.6km / 1 mile!

Tim in Alton, Hampshire
A member of EDC Crossfit

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.

Dr. Peter Gorman and Dr. Chelsea Keesler
Chiropractors New York

I wanted to let you know how I’m getting on with the Barefoot Science insoles as I just moved up to insert no.5 after almost 6 months, which I am finding very comfortable. I can feel them, but in a comforting sort of way. I have to report that I have had hardly any instances of dizziness since about a week from starting to wear them. I am so IMPRESSED! I am trying to do a few balance exercises every day as you recommended, and as a near 70 year old with seven small grand-children, four of them only two so they need floor level attention, I am conscious of the need to keep my balance while getting down and back up! The knee bending is okay up to a point and I’m hopeful it will improve as I use it more. But, as far as the balance side of things go I am thrilled. I think it is positively miraculous and am very grateful to you for suggesting them.

Veronica Barratt
A Guildford lady with balance issues

Hi There, My name is Andrew Coltart. I was a golf professional on the European Tour for 19 years and a former Ryder Cup player. I now walk the fairways of the world commentating for a Major Satellite TV Company. My problem came to the fore when I was 47 years old. I had developed Plantar Fasciitis and it was becoming unbearable and debilitating with pretty much constant pain out on the course and in spite of various types of treatment no signs of improvement. I was starting to wonder if I’d be able to carry on working in my current role. Then I met Stuart Gordon of All About Balance and he explained The Barefoot Science Foot Strengthening System. Basically, because of these simple little nerve stimulating plugs that you insert into the underside of the insole, walking has become pain free and enjoyable again. These are no ordinary insoles. Don’t be fooled by expensive orthotics. The Barefoot Science Foot Strengthening System worked wonders for me, not only helping me continue in my work without any pain, they have also improved my balance…an essential factor in general life and massively important to achieving a consistent golf swing! I highly recommend investing in some.

Andrew Coltard UK
Former European Tour and Ryder Cup Golf Pro., Satellite TV on course Golf analyst.

I have been using Barefoot Science insoles consistently since the beginning of the year. They took me a while to use regularly but with the addition of extra pairs, I am able to ensure that I am using them on almost all occasions. This includes walking, CrossFit WOD's, running and every day wear. As you know, my flat feet caused me terrible pain with shin splints and tight calves every time I did any high impact training including running, even just the shortest distance. I haven't rushed through the stages and have only just moved onto level 3. Tonight I completed a 5km run with zero pain. This is the furthest I have run since 2011 and I even shaved 1 minute off my best 1 mile time!! I've found something comfortable that offers me a solution to pain free training, and I'm only half way through the 6 level programme. Thank you so much for introducing me to the Barefoot Science insoles. ☺

Claire Chivers
Crossfit athlete EDC Alton, Hants.

Personal, Barefoot Science testimonial 26 April, 2013 To my fellow Pod people and persons that have foot related problems, I've found a product called Barefoot Science. I like this product and I use it daily, both for myself, and my Podiatric patients, I personally have had foot related injuries and deficits that caused daily foot pain for years as a result of my military service, not any longer though with my Barefoot Science inserts. I would not go without these inserts in my shoes. I was introduced to this product at a foot healthcare symposium, by Mr. Derek Denton of Alamo Medical services... As an employee of a Podiatry Service of a VA hospital in Texas, I perform highly technical work involved in the design, development, fabrication, alteration, assembly, fitting and repair of orthotic foot braces and orthotic shoes for Veterans as related to their post military service, i.e.: disease ,injury and overuse of the feet and ankle(s). I interpret Podiatrist' prescriptions and perform all steps required in the fabrication and fitting of the several types of orthotic braces, for many of which there are no models or precedents, including but not limited to ankle, foot and lower limb, as related to Podiatric disabilities and advise physicians concerning all types of corrective devices available and modification necessary; to help heal or ameliorate these conditions. *Presently now with the Barefoot Science product(s) I personally have noticed over the years the Pedorthic/Podiatric appliances and more complex appliances in the Pedorthic /Podiatry labs were more accommodating to the “functional foot conditions” that kept the foot aligned and rigid, yet never strengthened the foot, although there is a myriad of devices that claim they do so. I have tried most and until now none of them worked for this purpose of strengthening the intrinsic muscles. I started working with Barefoot Science a few years ago, and it has really turned our practice into a healing clinic. Helping ameliorate painful Podiatric conditions such as plantar fasciitis, metatarsalgia, claw toes, hammertoes, corns, plantar fasciitis, patellar misalignments, chrodromalacia patella, ITB syndrome. I have been working in this field of Podiatry since the mid 1980’s, both with U.S. Navy and Marine Corps personnel, now with Veterans of all armed services as a triple Board Certified Pedorthist and Podiatric clinic manager. I wished we would have had this Barefoot Science product while I was on active duty as a Navy Corpsman, this may have prevented a lot of future/past foot related conditions that we see now. I have also noticed currently within our Podiatric practice a remarkable shift for continuity of care while using these barefoot science rehabilitative foot inserts. The patients get better and stronger while walking not sitting with their feet elevated and hoping the Nsaids do the job. I’ve noticed a reduction of fatigue from all our patients now that they can walk and repair themselves; we have reduced the need for pharmaceuticals (pain meds), orthotics, foot-braces, or surgical interventions, finally solutions ,for these chronic and painful foot problems! *I agree with the following statement of use, and I could not have said it better! Each Barefoot Science Arch Activation SystemTM comes with a pair of insoles to fit into your existing footwear and a series of progressive arch activation inserts. To start, just pop Level 1 into the underside of the insole, slide them in your shoes and get on with your day! It feels like a mini foot massage, sending waves of comfort throughout your body. That sensation is actually your foot muscles waking up and getting stronger. When the sensation fades, usually within a week, your feet are ready to move up to the next level. It’s that easy! With each step, your feet become stronger and more efficient. I recommend this product, and I am not just a practice of one, I work with Dr Karen Brooks, a Podiatrist, we tag team on every Veteran that enters our offices for Podiatric services, she too has over 25 years’ experience in Podiatry Practice and is also very happy with the results of this innovative design and the multiple uses of this barefoot Science rehabilitative and preventative shoe insert to help our Podiatric patients/Veterans. Sincerely, Mike Olden... P.S. Please note: We have a Zebris gait lab pressure measuring platform onsite in our clinic’s Pedorthic lab, that is used to measure our results on every patient pre and post usage of the Barefoot Science rehabilitative inserts. Both static and dynamic is monitored, along with postural sway, including the shoes that they are worn in. The proof is in the pudding, try it for yourself! Michael P.Olden, H.t; Ost; C-Ped; Pmac. Department of Veterans Affairs American Board for Certifications in Orthotics, Prosthetics and Pedorthics. *Board Certified Pedorthist cert no: Cped0724. KD DIV.HERT Team Decon Coordinator /Instructor KD DIV.Podiatry PAVE TEAM Coordinator/Trainer KD DIV.Local AFGE 2281 Steward+SGT-AT-ARMS KD-Disaster Emergency Medical Personnel System-Team Coordinator Advanced Disaster Life Support Instructor-Cert. Advanced Disaster Medical Response for Providers-Cert. AHA-Basic Cardiac Life Support Instructor-VA-Cert. ECU2 Containment Unit- Staff Trainer-KD-Div. Surgical Service, Code 11C Podiatry / Pedorthic Clinics KD -Div. South Texas Veterans Health Care Systems 3600 Memorial Blvd., Kerrville, Texas. 78028-5768 Wk: (830)-792-2660 Fax :( 830)-792-2532 VA Cell (830)370-2887 Twitter – DEMPS17 Email: Michael.Olden@med.va.gov

Michael P.Olden, H.t; Ost; C-Ped; Pmac.
Department of Veterans Affairs American Board for Certifications in Orthotics, Prosthetics and Pedorthics. *Board Certified Pedorthist cert no: Cped0724

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