Dr. Courtney Conley on Treating and Training the Foot - PhysPrep Podcast

[Music] foreign thank you so much for coming on super excited yeah thanks for having me love the IG page um thank you man I'll say this now I might say it on air we'll see but so many people I feel like that have like a niche are one-trick ponies so it's so nice to see somebody that is like yeah you're talking about the foot and that's your focus but you're talking about all the other parts of the system and how the foot impacts these other things so it's very cool yeah it's very cool it's been fun yeah thank you how long has that been going on um I started all of that in 2017. okay very cool but I've been seeing foot and gay patients for about 20 25 years so you're not new to this no I know I I try and think of it like this I just don't want my face to represent how old I really am so no doubt you know as long as I try and keep the facial freshness up and stay in some modicum of shape hopefully it'll yes thank you thank you you too hopefully people won't know how old I am so right um but yeah I mean I think we got some fun stuff to to tackle yeah for sure um you know again I think your page is just such a wealth of information so I tried to go there I mean obviously I know that's your Niche but to be able to go there and just some of the topics that you're talking about I think are super relevant too and yeah and you asked about audience generally trainers and coaches but I also like to kind of lump into that like the Highly Educated Fitness consumer right yeah like the person that just you know is into this stuff wants to learn more so you can feel free to nerd out as much as you want I think most of the people would enjoy that aspect of it so wherever you want to take it I'm happy to to go okay yeah I think it's a a good adjunct to everything that you're doing yeah for sure yeah I mean like that's kind of my thing right is like I try and find these really like world-class people and then okay like what makes them great let's break this down and then bring it back to like the big picture and how this fits into training coaching and all that stuff so great okay cool let's do it yeah all right give me a second here I think we're all set up I had to uh sorry you were waiting for a second I had to get rid of all the creatures anytime I try and close the door they're like oh what's going on like like we need to be in there so well I got one just uh he sits in the sun right there so okay oh nice Yes mine want to be in here or on my lap or whatever so it's like the second you close the door they want to be there so right all right all good ready to roll awesome let's do this hey Courtney thanks so much for coming on the show here today really really excited to have you on could you start by just telling us a little bit about yourself sure thank you so much for having me big fan of uh your stuff so thank you thank you thank you um a little bit about me I am a mom I have a um she's about to be 12. um she's spicy a spicy middle schooler so I have a spicy middle schooler too I know what that's like she um came home from school the other day and this will be a good segue for what we're going to talk about today she um said to me Mom I don't know why you make me wear these platypus shoes and all the other kids get to wear Nikes [Laughter] I love it so I'm sure we'll be talking about that later but um yeah so she's my uh my little pride and joy I am a chiropractor in Lakewood Colorado so I have a practice here um we have four you know kind of your Wellness we got four docs in here some physical therapists um when we have a gym so that's been a big okay a big um addition and then I started gate happens which is my online consultation company um that we started about five years ago so I've been I feel very blessed to have been able to spread the word of foot Health it's it took off on us pretty quickly and um it's been great so yeah that's awesome that's awesome well we'll come back to that before we go there I want to get like your backstory how did you get started in physical preparation when did you start working out like what got you into just this whole world that we live in now you know movement has always been my therapy ever since I was a kid my parents went through a divorce right when I was getting into High School and it was one of those really formative you know it's a very formative time and I was just a kind of a wild child and I was feeling all the things um and getting myself into some trouble and doing all that stuff and I the one thing I knew I could always Bank on to feel better was movement whether that was going for a walk or going for a run or I was a ballet dancer and it just from the very beginning I always remember that as being such an impactful and so necessary for not only my you know physical health which I really didn't care about at the time I mean I was in high school it was more I knew some I knew it was making me feel better so I just kept doing it and then that's it's really been it's really carried me um through my life and it's one of the reasons I ended up in Colorado I had um a practice in Chicago for a while and you know it's a little cloudy there I mean Chicago but I I just knew I needed something else and when I finally got to Colorado the sun's out a lot here and I just um you know you're in a bad mood you walk up the mountain and yeah I just wouldn't turn around until it changed so it's always been a very um important for my mental capacity and health and I think that's why it's just stuck with me for so long I love it are you originally from the Midwest Pittsburgh okay okay so I'm I'm Indiana just by and large yeah uh but yes the grayness can wear on you yeah we had a pretty mild uh year this year but that's actually my sister moved out to Colorado a couple years ago and that was a big part of it yeah she's like I just I need more sun I need to be able to get outside and hike and do all those things so very good it's it's makes such a difference it really does yeah okay okay last but not least really two-part question here talk to me about your career path you know take me from high school to chiropractic school all that and then walk us through like what got you into feet because it's a very like narrow topic so yeah I am I was a ballet dancer all from when I was a kid and all the way um through high school um I was in the Pittsburgh ballet theater and I spent a lot of time obviously on my feet in point shoes I remember shoving lambswool in my pointe shoes um and just thinking why this hurts so bad um but you know we spent hours and then I developed you know I had bunions and I had foot pain and then once I gave up the ballet I started I was a triathlete okay um so then I did all the running swimming and biking um and I just couldn't seem to get over this hump of continuous foot injuries from bunions to neuromas to a stress fracture um and so coupled with that and then my love for movement I was like all right let's get in let's get into a field where we can help people so I went to chiropractic school and we had I think we had a half a semester of foot and gate education that was it and I was like you got to be kidding me like this is all we're getting um and then orthotic companies would sponsor this Chiropractic schools so every student would get free Orthotics and you know that's what we did we had a half a semester of learning and and free Orthotics you're indoctrinated right and I was like oh okay um and so I got out of school and I started treating the feet and became obsessed with it um and I ended up um you know really dispensing a lot of orthotics that's what we knew to do it was you have foot pain I got very good at looking at someone's foot and figuring out oh how do we brace this thing yeah um and this was in Chicago and then when I moved to Colorado I ended up working in two orthotic labs so I was doing my you know foot and gate work but then I was working in the orthotic lab so it was a constant back and forth um and I really saw it at the time you know you're doing the best that you can for the patient and in the meantime I'm wearing these Orthotics I'm training for my races and I'm going something is not working here right because we'd be posting my orthotic and then I knew it hurt and then I'd take out the post and then my you know and it just wasn't something wasn't working so through kind of self-exploration I just thought to myself um the foot has more muscles in it we have four layers of intrinsic muscles in the foot like what am I doing here I would never brace my back for this long right and so I started to play around and then I started to do my own research and surround myself you know you stand on the shoulders of giants and just having lots of conversations and I started to pull myself out of them and focus on my foot strength and foot health and then things really started and it happened pretty quickly really um and I started to integrate that into with my patients and I was like I think we're on to something here yeah so it's been quite the kind of Journey with all of that yeah okay so I already want to go off script because this is super interesting to me uh and reminds me of something you know I dealt with a knee issue this is probably like 2005. I was powerlifting and couldn't quite figure it out and it led me on this path of you know all the traditional things that they say to do aren't working uh so I'm interested in that time you talked about this self-exploration like what were some things that you do like were you just trying stuff on yourself were you reading research like what were you into at that point in time that started to take you down this other path well I think it was I've always felt you know when I'm standing on my feet how do I feel you know of being in the the background that I was you're kind of aware of how your body's feeling and I remember taking my shoes off and just balancing and I'm like well I feel a lot better when I'm balancing without all this stuff underneath my foot right uh and to this day that's one of the assessments like when I talk to my patients because our clients will have been in you know really thick cushion shoes and Orthotics for a very long period of time as it was myself and you know to have these conversations can be difficult but every single time like just take your shoe off and just balance and tell me what you feel what does your foot feel yeah so it was little things like that and then I started to play around with somebody you know take this orthotic out for a little bit and see what happens and it was a you know gradual process um and then yes it was a lot of reading and saying well we can look at how strong the foot can get and now the research is just flying I mean it's it's coming out now yeah yeah very cool okay so I just want to hear your answer on this and it's kind of a warm-up question but I'd love to hear just your thoughts how big of an impact does the foot make on performance I mean you've created a whole business around it yeah okay so a good friend of mine Jada Cherry um he's a big biomechanical clinical researcher and he always said that you can't build a jet engine on a paper airplane [Music] and I always think about that because we're always looking at like strengthening our core and strengthening our glutes and doing all this stuff to put on a platform to put on a foundation that can't hold us up if you will yeah it doesn't make a lot of sense in if you look at the primary functions of the foot they're twofold one is to absorb shock and one is to become a rigid lever for propulsion yeah so if you look at any sport jumping for example when you land you have to absorb shock and the first opportunity for that is at the foot yeah and when the foot unlocks then you have this beautiful Cascade of exactly what was supposed to happen of everything unlocking to absorb shock and then from the foot the foot then becomes this rigid lever so that we can be efficient to jump up yeah um and I think you can apply that to really any activity and it's that foot that's extremely important especially when you look at sports like sprinting and jumping I mean that's power the power is going to come from push-off yep yep okay so how long did you say you had uh of like gait and foot anatomy and all that in school about a half a semester okay well I hate to tell you this but you're probably a half semester ahead of most of us right considering like we never talked about the foot yeah maybe we did in like clinical Anatomy like first year you know you talk about gastroc Soleus that's it right so what I would love for you to do is help us all understand kind of the differences between normal and maybe abnormal foot mechanics uh and I think to do that you know I believe all of us to start on the same page by having that foundational knowledge so would you just walk us through what normal gait looks like like what is normal gate and then go through kind of like the foot in the various phases that are going on as somebody takes a step yeah I think the easiest way to think about this is the foot is a rocker so when we're watching someone walk it should be beautiful it should be smooth it should be efficient and the foot has been designed to do just that so there's these different rockered systems to the foot yep so and keep this in mind there's a very big difference between a walking gate and a running gate so I'm talking about walking gait here yep okay um when we're walking the grazing of the heel is important there's a reason for that because it's that first rocker which is heel rocker yep when the heel hits the ground that's like the braking mechanism yep so the first stage of the walking gait cycle heel rocker is all about shock absorption so we I have my foot model here yes so when the heel hits the ground think of it as like um I like to equate it to a pole vaulter so the pole hits the ground and they kind of Vault over yep it's similar with this braking mechanism at the foot so you hit the calcaneus and then you start to Vault over the foot yep the heel starts to unlock and then the foot slowly starts to hit the ground and I use the word slowly because it should be controlled yep so I think when I when I teach my gate courses I always say just close your eyes and listen because when you're listening to someone walk you can really hear a lot because when someone hits the ground hot and heavy someone hits the ground hot and heavy and their foot slaps the ground yep you can probably be pretty certain that they don't have good eccentric control of their pre-tibial muscles so that's to be honest anterior extensors yeah so I think especially at the foot it really comes down to two things and this happens that each rockered phase is adequate ranges of motion and eccentric strength okay so at heel rocker I control the rate at which the foot drops now what happens if I don't have good strength capacity there I have a tibial stress fracture um I have shin splints I have medial tibial stress syndrome because you can't control the rate at which that foot hits the ground yep so you'll start to see those things so then after we get the heel rocker now I get into ankle rocker and this is when I think all the magic happens because again here's that eccentric word again as my lower leg starts to go over my ankle it's now my Soleus yeah that eccentrically controls the rate at which my lower leg comes over my ankle so again we have to have a very strong Soleus I love the plantar flexors yep and then our Arch starts to drop so we're still shock absorption here what helps control the arch dropping well now you have eccentric control of post-tib for example big time player so in the beginning of the gate cycle you have all these beautiful things happening to absorb shock in the the more strength and capacity we have of these tissues we can control the rate yep and when we can't control that rate and we start speeding through these rockered systems that's when you're going to start to see you know repetitive strain and symptoms of the foot yeah and then ankle rocker right now we have our body weight that's starting to drop the arch yep so now we're in pronation and now it's okay now it's time to Propel forward yeah it's that's really cool right because I'm gonna um talk about this little tie bar mechanism which I think is one of the it's a free mechanism of the foot so when my foot unlocks I'm an ankle rocker now so now your foot is splaying yep the foot should lengthen and widen at Mid stance yep when that happens there's a ligament that runs across the metatarsals when we when the ligament is tugged on if you will there's receptors there that tell the body hey we're about to propel forward you better get into a rigid lever position it's called the tie bar mechanism okay so it the plantar fascia is right there so it inserts right at these metatarsal heads you have the Deep transverse metatarsal ligament so everything is just designed to say hey let's get out of pronation and let's get going here yep so when we take a take that away and we compress the forefoot I'm talking narrow shoes here you're taking away a free mechanism of the body don't make it harder on yourself right so as we start to propel now now this is where all the load happens so at four foot rocker I should be in a rigid lever my foot should be compacted and we should be very stable to propel forward and that's why I think you see so many injuries at the forefoot yeah um bunions metatarsalgia it's a generic you know diagnosis but neuromas and all of these things because the foot has to be strong at propulsion yep and they did a really cool study um you know the windless mechanism so the winless mechanism is when you lift the big toe and the arch you know compresses and they used to think that that was the primary reason of why we got into this you know rigid lever position that would allowed us to propel forward but they did a study where they anesthetized the intrinsic muscles of the foot and then looked at the power of push-off through the first MTP joint and it was decreased the power decreased so what we know now right and I think we've known this for a while is that as soon as that heel comes off the ground the intrinsic muscles of the foot are big players and putting that foot into that rigid lever position which I think is encouraging you know get your foot Stronger Yeah yeah you know I hope you're done and not not because I want you to be done but because I want to chime in here because like you just hit on two really important points and I think too often people miss the fact like oh like heel rocker is an important thing right like very important and you talked about shock absorption and distributing forces basically every basketball player that I work with has the anterior knee pain and what are two of the most common things I see either little or no heel contact whatsoever or when they get into that ankle rocker position like literally they hit and they're through it immediately like it's so fast it's so rapid so well no wonder they all have anterior knee pain right their ability to absorb and distribute forces from the ground up is significantly or negatively impacted because they don't have proper foot function proper foot contact 100 you can't build a jet engine on a paper airplane yeah 100 and I see a the yes that Community too I think could be very very well served by getting stronger from the ground up very well served well we do a lot of stuff the first month where they're just not in shoes and immediately they're like oh my gosh like I just feel better I'm moving better I'd like I'd like to think it's the programming but I'm sure uh the the getting them out of the shoes probably helps a little bit too okay so something you mentioned and I think this is really important to note too big differences from walking to running they're not necessarily one and the same so could you kind of break that down and what changes when we move from walking to running yeah I mean it's there's a lot to it but I I think there's really two things to consider and that people always talk about is strike patterns okay um so for example you know we could have a whole conversation about heel strike midfoot striking and forefoot striking right um and people love to get in arguments about this too yes um in a walking gait cycle you want to be grazing the heel that's what initiates that breaking mechanism yep in a running gait cycle you know there's a big camp out there that would say heel striking is a No-No because it puts too much load through the body and I I would argue that it's not necessarily how the foot strikes but where the foot strikes okay so when you strike I think the the enemy here is the heavy over striding that can occur in a running gate yep um if you can get your foot you want to think about getting your foot as close to your center of mass as possible and some some Runners are very good at doing that and they just compensate with a lot of knee flexion so you they can still strike that heel closer to their body they just get more knee flexion out of it right but when you bring your foot closer to your center of Mass Most will adopt more of a midfoot or even a four foot strike um and then that's you know it just changes load right so you heal strike you put load through the knee and through the hip and through the back you forefoot strike you put load through the foot through the ankle so it's just a matter of changing load and I think that's important when we're looking at you know getting our Runners back to running yep because if I'm a runner and I have an Achilles issue maybe when I'm running and I start to feel my achilles talking to me or I start to maybe I adopt a grazing of the heel for a minute or so just to change the load and then I can go back and you know so you can kind of play around with those things and you know our running population is going to run anyway so we've got to find ways to to work with them yeah um and then I think the another big factor with the running population is understanding that it's all about controlling rotation it's all about how well we control rotation if you think of um you know the lower limb is a skewer uh-huh so when my foot hits the ground we're fighting gravity I mean it's gravity that's internally rotating my entire lower limb and that's a good thing yeah right that's a good thing it's again this is our you know shock absorption Runners have to be very strong yeah to control that rotation because now I have more I have gravity and I have more load and I think from a gate perspective if we start running on our forefoot which you know some would argue is the way we were designed midfoot four foot striking you better have a really strong system yeah in order to be able to do it yeah and you know I still with my Runners my Runners out here I'm like they just want to run yeah I was one of them I know yeah and you CH you know the older you get I was uh talking to uh Dr Peter malliaris yesterday and he's a big tendon researcher and I was saying you know the risk factors of you know our Runners for you know maybe reducing the risk of tendinopathies and I said what can we do he's like well you just you just get old I was like yeah I was like yep but you have to train for capacity yes yeah so I think that's an important thing to consider yeah well I I just laugh because I've worked with my fair share of endurance athletes over the years and yeah trying to get them to do anything other than just go out and go for a run can be like pulling teeth but I feel like sometimes every now and then you get those little wins with them okay man just give me two days a week uh in the gym let's do some strengthening stuff let's do some things they're going to work on these underlying foundational issues that you have and hopefully that'll keep you running at a high level for the next 15 or 20. right but it's it can be difficult and it is if you can get somebody on board with that stuff it's game changing yes and then especially getting the foot strong yes absolutely okay so in the interest of full disclosure I've been stalking your IG page for a while now so be prepared for all the nerdy questions coming up here I'm here for it I'm here I know you are I know you are so one thing that you talked about quite a bit is the idea of a big toe push-off or high deer as you call it and I love like cool terminology that like resonates with people with athletes so kind of two-parter here number one what is why like why is high gear important and what are some of the common compensations you might see when someone doesn't have access to high gear so when you think of the foot pushing off of the ground if you if you can visualize this high gear push-off is when the majority of the body weight is pushing through the first and second toes the first and second metatarsals yep so the the forefoot should be in one plane I'm pushing through one and two and then my rear foot is inverted so it's in that locked position the first metatarsal is twice as wide and four times as strong as the Lesser metatarsals that's it it's just the way this thing was designed right we were designed to push off of the toe that is bigger and stronger and I know there's arguments out there about that but it's just basic facts yeah so high gear push-off is getting to es one and two and the foot in that rigid position a low gear push-off would be if you can if you're watching someone walk and you were behind them instead of it looking like they were pushing through their big toe it would look like they're almost going to sprain their ankle like they'd be pushing off their lesser metatarsals and they can do that either to the side like you know in the frontal plane or they can spin through the foot in a rotational plane yep so they're either going to push off laterally or they're going to kind of spin through and those are both considered low gear push-offs so why would someone do that first they could have changes at their big toe so with our athletes we'll see a lot of turf toe for example you'll see you know in to be clear I I think a functional hallux limitus is very different than Alex rigidus and a lot of these athletes that I see they'll be diagnosed with the rigidus when they still have some range of motion of that big toe that I really think can be restored with proper function okay you know it's a fine line you have to make sure you're not impinging the joint but with activation of peroneus longus and getting the foot stronger if you catch those cases early enough you can make all the difference in the world um but if they have pain at their big toe at push off they're not going to want to propel through it so they're going to go into low gear push-off right um ankle Mobility if there's restrictions in ankle dorsiflexion for example they'll spin through their foot and go into low gear push-off I mentioned peroneus longus peroneus longus is a beautiful muscle that stabilizes the first Ray drops the head of the metatarsal so that the big toe can extend over it so what injuries cause disruption or dysfunction of peroneus longus ankle sprains so your chronic ankle sprains even so you know your mild ankle sprains that that should be immediately assessed to see how the function of that tissue is and can they actually get to their big toe because if not guess what's coming another ankle sprain yeah so you just see these recurrent issues um so yeah I mean I think all of those things need to be addressed so that we can get to high gear push off and then what you'll see on the other end of that if you cannot get to high gear push off and you're pushing off the Lesser toes you start picking a diagnosis neuromas stress fractures if I'm pushing off laterally that's where those compressive fifth metatarsal structure stress fractures can occur yep um if they're pushing off the Lesser metatarsals and more of a rotational position bunions hosted plantar fasciitis so that's why I'm not a big diagnosis person you know like and I think I think clients get too caught on like I have this it's hey let's just let's just improve your function rather than Chase all this you know diagnosis around mm-hmm man a lot to unpack there a lot to unpack because literally as you're describing these different low-gear push-off positions I'm thinking oh that's a fifth metatarsal injury that's a bunion um I mean would you mind just giving us a little insight like if somebody comes to you I probably could have started with this earlier but like what is the assessment process look like for you is it as simple as like hey let's do a case history let's watch you walk like you know how in depth are you going with that because at some point you have to see them do these things right so you can say okay hey this is I'm seeing X Y and Z and here's how we're going to go about treating it yeah one of the things I love about the foot is I think it's the first place where you can see a Barren load and really the only place in the human body because you can see a bunion you can see a Taylor's bunion you can see a hammer toe you can see these things yep and you don't come out of the womb with them so I know that you inherit you have connective tissue things that you we have and there's genetic factors but that's why I think tapping into the kids is where it's at but that's a whole nother conversation but I first just look at them what am I seeing yep and then we go from there I asked them how do they when they're standing where do they how does their foot feel what part of their body are they loading and half the time when you have poor sensory awareness at your foot they won't even be able to feel parts of their foot they're like I feel the inside of my big toe I'm like where's all your pain my big toe so you know a lot of it is just I spend a lot of time on education hey I want you to feel different parts of your body stop hanging out and loading just the medial calm of your foot yeah um and then we do gate assessments so I watch them walk I say that gate assessment takes you to the stadium it doesn't take you to the seat okay so it's a tool to see things like low gear push-off and then I can say Okay I want to look at the range of motion of their big toe I want to look at the range of motion of their ankle um and then we get into you know a lot of capacity testing I think a calf raise is like you can see so much so much yeah I mean most I mean granted I see people that have been in pain for a while or you know surgeries things like that but to do a solid calf raise where I'm like yes that's beautiful I get excited because you have to be able to come up onto your forefoot and I mean High I think when we do um Rehabilitation often for you know Achilles and plantar fascia issue issues a calf raise isn't a it's not mid-range unless that's what you're looking to do but you got to get up on the ball of the foot yeah and people will be like leaning into the wall or bend their knees or they'll they could be outside on their toes and you know I think that it's a very very good assessment to see what their motor patterns are yes and I love those I love those little tests um and I think one of the other ones that is a big one is getting people to actually find pronation at their foot um I don't think people feel what it's like to actually lengthen and widen their Arch yeah and especially when you've had patients that you know have been you know they had plantar fasciitis 20 years ago and they've been in an orthotic for 20 years in like a Brooks Beast they they their their Arch hasn't lengthened in 20 years right you know and then they wear the shoe at home and then they and then they wonder why things aren't getting better or they're having this symptom and this symptom because there's no load happening yeah so getting people to actually feel what it what the foot feels like to unlock and lengthen is a lot of the work that I've been doing recently um super interesting and kind of fits in well here because you know a lot of times people will get diagnosed right I'm sure you've seen and heard every diagnosis in the book at this point but people get diagnosed with having flat feet right and it'll sound like oh my gosh you have stage four cancer something super serious what I would love to hear from you because I don't think flat feet are a bad thing they're a part of the gate cycle right uh and for a lot of my athletes they're performance enhancing right for certain reasons but I'd love to hear your thoughts on just flat feet as a whole and maybe why someone might present with them you know I I have so many patients to come in here and that's the first thing they tell me almost all of them yeah I have flat feet and I have to tell you I have a little um it's called a pedograph it's a footprint like an old school like nothing nothing fancy there's nothing digital it's you walk across this ink pad and you get to see the pressures on the foot okay I cannot tell you how many times I've put people on there and I'm like this is not a flat foot this is not a flat foot I don't know like Crush their soul I've had this like thought for 20 years well I'm always like who told you this right and you know and listen there are certainly very well educated people in running shoe stores um but there's some you know where it's like you go in someone takes their shoes off and when we're standing if you were standing in front of me most of us stand in a position of mild to moderate sub Taylor joint pronation so it will look like the foot is pronated which is completely normal there's so many variations of the design of the subtaler you know of the talus and the articulation of the joint that we should not be all up in arms seeing this going this is a flat foot right um and then trying to block it with you know an orthotic and a shoe and of this and that um but to get back to your question with flat feet um it's I think it's like a it's like an epidemic you know and and it shouldn't be um there's a difference between rear foot pronation and midfoot pronation so rear foot pronation is when it looks like the you know like I was just talking about like that mild to moderate you know where the rear foot looks like it's caving in and I use that word Loosely don't I don't like to even say that word to my clients right right those feet typically when they do a calf raise for example they can get into that rigid lever position and that's when I know I'm like you're all you're all mine let's go to town here because this is a foot that needs to be stronger let's just get this foot stronger right when you see midfoot pronation so that's when the navicular that's the the highest you know the navicular is the highest point on the arch the medial aspect of the arch you will have patience that come in where that guy's on the ground luckily you won't see too many of them they are out there and that can be a little trickier because a foot that stays in that really excessively pronated position for very long periods of time when Once may have been flexible has now become rigid yes so it's a four foot supernatus it's it can be driven by forefoot and that's a you know we won't go down that road but you have to really differentiate the two because one foot you're going to have really good success on strengthening and like I said you will see more of those but the one where the foot is stiff and rigid in that mid foot is on is your pancake do you have to say can I rehab this foot is it can I you know in a good assessment for that right is I'll just have them here's your pancake foot standing on the ground when they take their foot off the ground if I get a little recoil there yeah like I see that Arch start to pop up I get excited about that and like we can restore some of this okay but if I go pancake on the ground and I lift it up and that thing stays flat that's a definitely a more complicated flat foot case because now that has turned rigid yep or has become rigid and that's when you gotta you really have to find ways to make them comfortable because that can be a very uncomfortable gate gotcha okay so you've mentioned a handful of times foot strengthening and I feel like there's a lot of ways we could take this and we're going to talk about Barefoot training later so I don't want to go there just yet but just talk to me about low level foot strengthening somebody's listening to this show you know it's like the person that wants to go to the gym and start working out a little bit yeah right like oh I you know read these articles I know I should do a squat and a hinge and a push-up or whatever what are some foundational foot strengthening exercises maybe somebody doesn't have pain but they're like no I can see the value in this where do I start well I have like some fun at home assessments that you can kind of okay do right yeah so if you were just standing and you were gonna Lean Forward right so your whole body would Lean Forward yep at the tips of your toes they should flatten and you should see what's called like a wink sign so it looks like a little crease in the distal aspect of the toe that means that flexor digitorum brevis so the muscles of your foot are working as you start to tip forward sometimes what you'll see there is people will claw they'll Hammer they'll curl their toes that is a sign that foot strengthening needs to occur which by the way is one of the big the Biggers of falls in the elderly so it is a it is a mandatory thing that we do in here for prevention as well or reduce risk if you're not a prevention person um the other one is to take a a credit card and you're sitting on a chair right your foot's directly underneath your knee put a credit card underneath your big toe and have somebody try to pull the credit card out from under your big toe can you grip hold the card there without hammering the toe and when you press the big toe into the floor you should feel your arch engage you should feel like there's tension underneath the arch right and then I take that card and you put it underneath two through five and you do the same thing can I press two through five into the floor and feel my Arch engage there can I can I hold that card there and those are kind of it's always very interesting to me because I have a dynamometer where I muscle test all of that and I get a nice number but you know people can't do that at home always it is so consistent that the side that cannot do these things I have plantar fasciitis I have this I have that so it's a good Baseline I think for people to do to start at home to get going on this stuff and then from a basic you know if you wanted to just get started I think dexterity toe dexterity is important feel the foot you know can you lift just your big toe can you lift just your four toes can you get fancy and lift all of your toes and just tap your big toe can you just tap your little toe which you know shouldn't be difficult right but it is you talked about your daughter up top were you in defeat when you had your daughter I was I have a funny story for that because you know when they're kids they do those um paintings at school and they put their feet on like and then they make a butterfly with the soles of their feet Yes I haven't in my office everyone's like oh my gosh your daughter's feet so cute and I'm just sitting there going she needs to be barefoot more I need to we need to start working on our feet and the kids like three and I'm like just stop Courtney yeah I know I know but but I mean like that's the way we think right and you see kids and you see the amazing foot dexterity that they have and then you look at your foot and you're like oh my gosh I'm a disaster you know uh yeah okay that's perfect every kid every kid on the planet the first thing they want to do is take their socks off yeah yeah because they that's they want to feel the ground there's all these sensory receptors yeah yeah yeah I love it man and you literally when you started talking about those self-assessments and you're talking about hammer toes and Claw toes I mean you described every athlete I've ever worked with in the history of ever so you know I don't know if I've ever seen one where you get them out of shoes and you're like oh that's a really solid looking foot yeah so so many of them you're just like wow we've got some work to do from the ground up so I think that hammer toe thing too can be a huge window for assessment of what needs to happen because if you watch someone walk mhm you'll see really where those hammer toes start to come into play in one of them is that terminal stance so when I go to push off yep my toes if I have a weak foot I'll hammer the toes I'll claw the ground to try to propel forward okay so at Terminal stance when you see hammer toes it's flexor stabilization they're trying to activate their flexors to stabilize their foot so you know you got to work on their foot strength yeah you'll see it is as their foot starts to swing through and swing phase if you'll see the toes Hammer coming through swing phase you need to look at their extension dorsa ankle dorsiflexion do they have good ankle range because that can be a substitution extensor substitution yep to try to clear the ground so they don't trip on their toes and fall forward gotcha gotcha so depending on where you see those hammer toes terminal stance flexor stabilization or swing phase extensor substitution it's just that's why I said gait assessment takes you to the stadium and then you know right where to go I'm either looking at their ankle range of motion or I'm looking at the strength of their feet gotcha very cool okay so one other thing that I was loving and I talked about this before the show I wasn't sure if I was going to say it but I'm going to say it anyway uh I love people like you who are focused in one area but don't lose the forest for the trees right like you're looking at the big picture you're looking at how all of the body works together in this Dynamic cohesive fashion so I loved one of your posts and I don't know if you create all of them yourself but the post that you had a while back about tibial internal rotation right you talked about it before tibial like internal rotation as a whole is important so would you elaborate on the need for tibial internal rotation and why it's an integral component of effective gait it's such a good question and I think it's so overlooked um we everything's about rotation and what starts the Cascade of rotation is pronation right so the the foot hits the ground we have different places in the body for shock absorption and number one is at that foot when we go into pronation and then ankle dorsiflexion yep when the foot pronates the tibia can internally rotate so those motions are coupled yep so I have ankle dorsiflexion my tibia starts to internally rotate so now I get knee flexion and then that goes up the chain because now my femur can internally rotate there's place number three for shock absorption and that also allows contralateral hip drop placed four for shock absorption so when you start disrupting from the ground these opportunities for shock absorption and in particular at the ankle and then not allowing that tibia to internally rotate you're going to have problems up the chain so that when I was talking about earlier about finding pronation you'll see um clients try to do this in the tendon of tibialis anterior would just be like I'm like settled calm calm right I'm like petting it you know like stop firing this right because if if my foot stays in that very rigid position then I can unlock the foot I can't get ankle dorsiflexion and I can't get tibial rotation and that to me is a is a recipe for problems up that kinetic chain again you pretty much described every athlete that I've worked with that has knee pain right yeah they they lack that tibial IR they lack that pronation so again they just they they can't decelerate they can't absorb or distribute I hate all the terminology right like you know some people want to say you can't absorb Force whatever you know however you want to think about it absorb distribute you can't do those things effectively if you don't have tibial internal rotation and it's just not something I hear a lot of people talk about quite frankly so that's why I was so excited to see you guys talking about it yeah once you get it going to it's and I think you said a key word there too is deceleration now controlling the rate we I always say that at the foot it's about controlling the rate and when we have these opportunities to help slow things down like tibial internal rotation and being able to control that I think is just massive we got to take advantage of it yeah well you set it up top the gate pattern has to be smooth right there's an element of smoothness or Rhythm and so either sometimes people just won't have it all together or two again what I see a lot as well is sometimes they'll have it but they just blast through it right so they're not really like slowing down they're not letting things unlock store energy release energy it's just like this rigid quick and then you wonder why they have okay you can see it you can see it literally literally you can see it coming yes okay I'm excited about this next one okay Barefoot training yes all the rage 10 to 15 years ago right everybody had Vibram five fingers and was walking around Barefoot everywhere it seems to have cooled a bit since then but I mean this is your world this is your jam so yeah I want to know your thoughts on Barefoot training barefoot running anything in between so I think it's interesting and I was actually talking to Steven session about this and he's the guy who owns zero shoes Okay um that Vibram lawsuit kind of put a a big kind of halt and what you know this barefoot running Community was trying to do because the lawsuit was um you know intended for it ended up being an advertising issue right that they made a claim and then that was the you know that was the reason for the suit but what it ended up being explained to the public was that this was causing injury right not that it wasn't supporting something but that running Barefoot was actually causing injury and in fact that wasn't the claim at all so it's been interesting to see this world kind of recover from some of that because you know it was a it did it kind of stopped it in its tracks there for a bit um you know there's a study and I sent this over to you um looking at it was a small cohort so there were 28 people involved and they ended up having 20 people in the study and there were all you know as with any study there were you know certain factors that weren't there there wasn't a control group but I think the thing that was really interesting about this is they had 20 people that had symptoms of plantar fasciitis and we know how difficult that is to treat yep it can be extremely chronic they can come back years later um I forget what the numbers are but I think it's something ridiculous like 44 of people can have recurring symptoms years to up to 10 years after an initial diagnosis so it's just one of those things that can linger and our treatments in the past for that you know have been Orthotics and don't get me wrong that therapy orthotic therapy can be very beneficial for things like this yeah but it's therapy it's I'm gonna do this for a little bit and then we're going to look at strengthening your foot so in any case 20 people what they had them do was run for 15 minutes Barefoot on grass every other day for six weeks 19 out of 20 of them 19 out of 20 at the six-week marker had a decrease in pain and at the 12-week marker wow so call it what you will but that is extremely like I know that like I said that there's all these well there's always well there wasn't a control group and there wasn't this but at the end of the day these people felt better at running so what happened and when you look at strength capacity and you look at strengthening the foot that's what's going to help with these patients yeah because flexor digitorum brevis the muscle where you actually get the spur and plantar fasciitis not in the plantar fascia you know is getting strengthened when you run barefoot it's load yeah I mean I think it's interesting especially when we talk about like we need to load our Squat and we need to load our deadlift but we don't want to load our foot right yeah it's the tissue is no different in the foot than it is everywhere else but that load has to be very slow and Progressive you would never tell someone to squat 100 pounds today and then they're going to squat 200 pounds tomorrow right so as far as the barefoot running I I think that it's not for everyone if you've had surgeries or traumas or you have a forefoot where they're you know you're trying to decrease the progression of your bunions or you have you know there's been changes to the foot you need to be wise the structure has changed can you still benefit from strengthening a foot absolutely but I think getting into that type of running is certainly um you know how we were more designed to run yes and I I think there's ways to meet everybody where they are with that yeah you know um if you're not going to Barefoot run you better be running in some type of shoe that allows your foot to be in a functional position yes so I'm a big big fan of wide toe boxes for example so you can still like here's the spectrum of barefoot to we can still live in this functional foot World it doesn't necessarily have to be barefoot yeah but you can still get the benefits of improving your foot strength of adapting this running gate position if you will to strengthen the body strengthen the foot and you know reduce the risk of injury yeah I mean I just think it's such a more powerful way to look at things too versus I think so many times with feet we've just been conditioned to like you started right it's like oh get a better shoe oh get an orthotic you know versus being able to kind of unpack that and be like wait what can I do for myself right that's going to help my foot better function better outside of all these other things right and and look I'm sure you've seen them probably more than I have but like you've seen some feet where the structure does dictate function right and the structure is significantly altered the rules are different but for a lot of people that are listening and maybe working with people hey you know there's a lot of stuff that you can do low-hanging fruit that can probably make a big impact on how people move and feel oh I think it's huge especially with this you know we talk about physical performance you know we're always looking for that one one other thing to take it to the next level this is such an easy win I think when you start to look at getting stronger from the ground up because a lot of it has never been addressed I can't tell you how many people and athletes I've looked at that I'm like I can't you're running an ultra and you can't give me 20 single leg calf raises here yeah yes it's a it's a low-hanging fruit just like you said and and one that can have very very good implications for future uh performance agreed okay Courtney big question time cat if you if you could alter the space-time Continuum and give young Courtney Conley one piece of advice what would it be oh how much time do you have um biggest thing I think would be uh to get some weights in my hand okay I think as a young um female athlete um we just we never talked about it and I think even now I'm in the process of um designing a strength training program for young girls I'm sparked by my daughter and um you know I just think it would help so much and that also means down at the foot like I wish I'm like Mom like put me in the right shoe it would have saved so much like the being you know take the time back and you put kids in the right shoes yeah I'm probably out of work yeah yeah seriously yeah because you put their foot in a position they want to be in their foot gets strong their mechanics look good they can start to add load and then it's just you know we don't have these evolutionary mismatches yeah and that's what I think we're seeing I think we're seeing especially at the foot a lot of evolutionary mismatches we weren't you know these high numbers of cases with these diagnoses at the foot we weren't designed to see so yeah that's what I would do is and I still yell at my mom for putting me in point shoes why'd you why'd you do that to me right right look it's it's probably not the the best litmus test but I think something that I always come back to when I'm concerned or have questions about something is like what would I have had to do 200 years ago right yeah so like well chances are I wouldn't sit at a desk for 12 hours a day 200 years ago right I wouldn't have had Fancy Shoes whatever it's like you kind of put things through that filter of okay how can I get my body back to more of that right yep like it's probably not the best filter and I'm sure the naysayers will will have their their gripes with that but I think it's a pretty good filter to like Hey how do we get back to some of these base level uh movement foundations that we've really frankly lost over the last 40 to 50 years so and I think we make it harder harder Reasons I'm so passionate about this is one of the best things with the the Panacea of medicine is going for a walk yeah I know right just go for a walk and that's why it like my heart is so in this because when people can't walk because their foot hurts yes it's it's brutal it's painful it hurts me you know because I know what it did for my mental health and my mental capacity and still does every day so you know I don't think we need to make it harder than it is we just need to get up and walk a little more you know agreed agreed okay last but not least got our lightning round so four fairly short questions okay your answer can be as long or short as you like number one favorite thing about Colorado oh I'm looking at it right now the sun yeah I'm done I'm dying 300 days out of the year right yes that's awesome and it's an all-season State you know like you're doing something outside all year round yeah I love it okay number two obviously super successful with gate happens the IG all that um like what was the impetus obviously you've been into feet but like what was what was like the moment when you're like no I'm doing this I'm gonna create this and it's gonna be a thing um when I saw how what an impact it had on my life yeah personally and physically and then it's to this day when I talk to my patients um it's like their eyes light up because this is information that they have not heard even if they've had multiple surgeries or they've had it's sometimes it's just as simple as putting them in a shoe that feels good on their foot which is just allowing their foot to splay and I that will never get old to me my happy place is coming into this office and educating on this stuff because I think it we still have a lot of work to do and I I that will never get old I love it yeah okay I'm gonna put this out there and if you want me to edit it I will because I know people like you obviously you've got a huge audience right and I'm sure there's a lot of people that want you know your influence or they want your thoughts on shoes is there just like a general shoe that you like or that you're willing to share with us um benonig is one is a researcher he's up at the University of Calgary and he has done a ton of research on Footwear okay and at the end of the day the best shoe because we get this asked all the time yeah is the one that is the most comfortable on your foot okay now with that being said you're gonna it you can't argue that a foot that allows your that a shoe that allows your foot to be in a functional position so there's room in it and you're not you know in a heel to toe drop of 10 millimeters is going to be less comfortable so that's where it's a very easy sell as far as Footwear for me because I'm like listen just put this on your on your foot and tell me how comfortable it is compared to what you're wearing now so with that being said I always meet the patient where they are my non-negotiables for Footwear is a wide toe box number one yeah and ideally putting their heel and toe on the same plane I love that I mean yeah I love that like those are two things I didn't think of it like that but yeah especially because we get so many people in the sporting World they love you know like it's the equivalent of a high heel right but it's just an athletic shoe yes and you can play around with you know the cushion or the stack height right so people are like well I stand at it you know I'm I'm in a grocery store all day and I stand on concrete that's fine we're still going to allow your toes display I'm still gonna get you on a Level Playing Field for your heel and your toe but I'm going to put a little more cushion under you like you know an ultra running shoe for example yes and then once their foot gets stronger and then they're gonna say you know I feel a little wobbly on all this cushion let me just dial it down a little bit and then you have that like transition that really will start to happen naturally because people will start to say I feel better when my foot can hit the ground yep okay very cool thank you for answering that because I'm sure I know if I'm thinking it other people that are listening are thinking it like yeah what are what are the the general wrecks so toe splay the ability for the toes display and level front to back love it and on our um as far as Footwear questions on my website gay happens there's a favorite product section we have a list of shoes and it'll be like athletic shoe casual shoe dress shoe kids shoes so everything and they're all compatible with that wide toe box in what we just talked about perfect well I'll make sure I put a direct link in the show notes so people can find that easily uh two more number three what's the most difficult foot issue you've ever seen that's a good question probably the ones that have had multiple surgeries those are the ones when I seen them coming through the door because now I'm more on what can we do to prevent this from getting worse yeah and how we can prevent you from not going underneath that knife again yep and those are the tough ones because once you start you know cutting into the foot and disrupting the fascial integrity and you know and listen I'm not here there's a time and a place and I work with some excellent foot surgeons and I you know we have very good relationships because when they're done with the surgery if it's necessary then they come to me and then we start rehabbing and strengthening the foot but when they have these surgeries and there's no care for the patient on the other end of that of what needs to happen those are the ones that I'm like ah you know it's tough but it's always hopeful I mean I had a woman in here the other day she had four surgeries on her left foot and one on her right and she came in and this is you know this is why I love what I do she's like I just want you to know that I took um or made me cry now um a walk with my husband for the first time in like eight years and I'm like wow you know so and it was I'm certainly not putting her in a thin sold shoe right so I have her with some cushion underneath her foot but she's in a wide toe box we've worked on strength and mobility and it's just you know that that's why we do what we do right absolutely like and I know you know this as well but man those tough cases you learn so much yeah right like like you earn your money right like you earned the money that because these people are challenging but man you learn so much as a practitioner because the rules are different right yes different constraints in play more things you have to think about take into account they're hard and challenging but man they make you better for sure yep yeah last but not least okay what's next what's next for Courtney Conley what are you working on what are you excited about anything um yeah um I am well we're launching our level two course so I'm very excited about that so looking at um you know our first one was assessing and now we're getting into treatment so I'm excited about that um but I'm really I think my the next couple years is going to be a heavy focus on the kids you know and really starting to see what we can do because I think that impact there like I said but you know will really change the course of a lot of what we're seeing now of this evolutionary mismatch if you will I'd love to intervene there and say how can we work with these kids now so that you know they can become better athletes with getting less injured especially with foot injuries and things like that so I'm kind of uh that's sparking my interest and I probably will never retire I my dad and I talk about my dad and I talk about that all the time um he's uh 76 and he's still like has his business and he's still you know when it's never um I never looked at it as work you know it doesn't feel like it most days does it no and I feel very blessed to be able to say that yeah agreed uh years ago my wife and I met with our financial planner and you know they do the whole oh when do you want to retire and I'm like oh let's just you know say 55 and my left my wife generally a little bit more reserved laughs out last she's like you're never gonna retire I'm like yeah you're probably right right right yeah so I'm glad I'm with somebody else that gets that like I don't know I'm just wired I enjoy it I love what I do so yep well Courtney this has been amazing thank you so much for your time like you are such a thank you so much knowledge like super fun to talk to where can my listeners find out more about you gate happens all that good stuff it's pretty much everything it happens our Instagram account is Skate happens our Facebook account gate happens our website gatehappens.com so it's it's pretty easy I love it that makes it very streamlined and easy to find I'll put this uh in the show notes so those of you that are listening in can find all this easily definitely I'm not just saying this because you're on here like easily one of the most impactful IG pages I found not a one-trip pony like so much great information and a nice blend of theory like things to start thinking about and actionable stuff so yeah fantastic work Courtney again thank you so much for your time I really appreciate it thank you man that was killer that was so fun okay good I try and make it fun I don't want it to yeah I realize like everybody has a podcast now right everybody and so I can only imagine I know how many podcasts requests and invites I get I can't even imagine what it's like for you so well I have to say I enjoyed the questions up front Okay I like that some of some of these podcasts that I've been on they don't do that and I just think it's has such a nice like slow and you know where it's going and I can make sure I have everything I want to talk about ready to roll and yes I appreciate that well good because like there's certain things I know I want to talk about but I find it helps too to kind of put them in some logical sequence yeah too it just makes the show flow better versus if you know we're talking about feet and then we're talking about assessments then we're talking about training if it's just all over the place yeah you don't have the same flow so but no this was really fantastic and I appreciate your time thank you um so I think your show will be up next week oh great yeah just to let me know when it's ready yes I'll send you uh like there's like social media and stuff that we do with it so I'll send you all that awesome would you be okay with like you know when you kind of walked through some of the foot stuff I mean I got this recorded if we just took like that segment out and put it on like YouTube or something like that please yeah that'd be great okay and I'll make sure I share it all with you so you can do whatever you want with it as well that'd be awesome I'll have to thank uh John because he's the one that got us in touch with each other right yeah how do you know him man so the basketball world is a small space and so I met a guy like this random seminar and he's like oh you'd love my guy John he trains JJ Redick and I'm like oh wow that's like a big basketball game so then he connected us and we talked randomly over the years and he's just a great dude yeah he's a great great guy to talk to you know again our world is such a small space um so to meet like real genuine people uh that's fun so yeah well I have to thank him again yeah all right well it was nice to meet you yeah we'll stay in touch yes thank you so much Courtney have a great day okay you too okay bye-bye [Music] thank you [Music]

Channel: Mike Robertson

Views: 15,732

Keywords: MikeRobertson, IFAST, RobertsonTrainingSystem, CompleteCoachCertification, gunshow, pecz, getswole, conditioning, energysystems, heartrate, HRV, basketball, football, baseball, podcast

Id: KhLhVLtz_WM

Length: 74min 59sec (4499 seconds)

Published: Fri Mar 10 2023