How to Prevent Falls: The Stability Skill Most People Skip

Physical wellness is a lot of times overlooked, and the way I think traditional healthcare approaches mobility is to wait till things get really bad and then operate on things.

You know, I love how you made that observation that oftentimes they don't go to PT until after surgery. I saw so many patients in the clinic setting that I wish I had seen before surgery because I think we could have done things where it wouldn't have become necessary. A lot of the times surgery isn't necessary anyway. I've I had some instructors from places like New Zealand and other countries where they've said we're sort of a little bit overboard in surgeries in this country, and you can reduce your risk of surgery if you just move. My name is Eileen Kapsaftis. I'm a licensed physical therapist with a background in nutrition education, and I spent the first 15 years of my profession learning manual skills, and the past 15 years I've been learning how to teach people how to move their bodies in a way that resolves pain and also greatly increases their odds of aging really well and not declining. So I really love what I do. And yeah, I'm just excited to be here. So thank you.

So we think about, you know, one of our big focuses is wellness and getting people to have as much additional healthspan as possible. And a big part of that is movement and exercise and activity. And, you know, we go at it from more of a medical standpoint of treating hormone imbalances and, you know, obesity and circulation problems, sleep apnea, and then put, put you in physical therapy after you've operated, which, you know, it's trying to get you back to where you were. But are you dealing with people who've had injuries or more of people who just are like having some decrease in mobility as they're as you're getting older?

I agree that there's a lot about movement that is misunderstood, even in the fitness industry. The— and I kind of joke and say we're sort of training our bodies like dead people because a lot of the understanding of human anatomy is based on studying cadavers. And this is where this muscle inserts. So when it shortens, it moves the body this way. So that must be how we need to train that muscle.. And unfortunately, the, the inaccuracy in that completely ignores the fact that the human body moves according to the context of the task at hand. So, and I'll give a really simple example. A lot of people wanna train their hamstring by bending their knee against resistance. They'll use a machine in the gym or they'll lay down and they'll have a weight on their ankle and they're bending their knee. Now, yes, the hamstring does attach to those, bones, and it does shorten, it does bend the knee. However, in the context of real life, we don't really do that motion. And I've asked a lot of audiences, and nobody's ever been able to give me a movement, even in sports, where we repetitively push against resistance to bend our knee. And so why are we training that way? And in the context of real life, if you're walking, In gait, when you swing your leg forward, the hamstring is actually assisting to straighten the knee. So it's a completely different context. So what I found is that when people learn how their body's actually designed to move and function in real life context, and they train that way, and they include all 3 planes of motion, which gets ignored more often than not, they see pain improve. They see their ability increase, uh, no matter their age. So yeah, movement is key, but it needs to be understood more accurately than I think mainstream knowledge is doing at the moment.

So who is kind of your target person you're trying to help? I don't quite understand that.

So, well, the majority of people who come to me, and I have surveyed my audience, those who come to me, and it's kind of a 50/50 split. Half of them really want to get out of pain. So they tend to be a little bit younger, not always, typically 40, ish, some are a little bit younger. I've worked with teenage athletes, I've even worked in pediatrics, but typically 40+. And then the other half don't want to end up like they've seen their family members, their loved ones who've become dependent and need assistance or even nursing home. Now, the interesting part is usually when people start eliminating the pain and they're feeling better, now they're starting to think about, oh, I am getting older, I think I want to age well too. So they sort of join the other camp. And those who want to age age well are certainly oftentimes addressing pain as well. So, you know, I'd say on average 50+ is the audience that comes to me. They tend to be people who are more proactive in their thinking, or they have found a great deal of dissatisfaction with conventional medical treatment and it hasn't helped them. They've tried everything, as they say, but then they'll hear my message. It will resonate because they can tell it's true. And they go, yeah, I am a whole body. I'm not a body part. Yeah, somebody does need to see me that way. And it just makes sense. And so they start, they try the training, and they see results, and we go forward from there.

Yeah, so we think about when somebody gets older and they do have an injury, their likelihood of premature death goes up significantly. And it's not from the injury itself, it's from the things that occur from decreased mobility. A classic example, is the fractured hip. And I know somebody that's in their 90s and they're very healthy. And the husband had an event, something happened to him, and the ambulance came. And the wife, who was also 90, she fell and broke her hip at that time, which is tragic. And you'd wonder if she had more mobility thought and more balance training, could she have avoided that fall? Because the fall occurs when you're older because of the inability to have a kind of a fast movement combined with strength, combined with some limited mobility. And can you kind of talk through how you'd address that and help the person manage that so that they really can prevent a fall, let alone survive it?

Yeah, so that is a fabulous question, Dr. Mocon. And I want to add a little bit of a different perspective to the longevity message of having broken a hip. Because I've worked in home care settings for a decade. I've worked in nursing home settings, and so I've seen these particular scenarios a lot. And what I have found is it's not necessarily the fractured hip and the resultant immobility that shortens their lifespan, because I've seen up close and personal these populations. And what I've seen is I've seen people in their 80s, even 90, who've experienced a fracture, maybe have a short-term stay at a rehab facility, nursing home setting that has rehab and gone back to their life because they were very active. They were relatively healthy for their age. We tend to experience a lot more disease the longer we live. It's not age-related, it's lifestyle-related. But those who were active and had real life quality prior to the fracture, I see them get back to their life. Now on the flip side of that, those that did die within a year, and that is the, the statistics do say, you know, 20, 10, what is it, 25% will end up in a nursing home and 10% will die within a year. I think it might be flipped. But those people that I see, and I don't mean to sound harsh, but I think they would have died in a year anyway, because they tend to already have their shoebox full of medications, they have multiple disease processes going on in their body. They're already sick people. They already were slightly dependent. They were using a walker, they were using some other device to help them get around. They were already getting a little bit of assistance even before the fall. So the fall was kind of the straw that broke the camel's back. It wasn't the, the real factor that shortened their life. I think they were already kind of headed there anyway. And that's what I've observed over the years of what I do.

So where should the person start thinking about this? Like if you're somebody that's maybe not exercising currently, that's, you know, probably a first good step. But when are they gonna see like a physical therapist if they're not having any specific symptoms and they're doing more preventative?

Yeah, so preventative is wonderful. Unfortunately, when we start getting into insurance coverage and we look at, and not wanting to get insurance or political here, but certain programs like Medicare don't tend to pay for prevention. So now you've got people having to pay out of pocket if they want to do prevention. And not everybody who's older has a lot of resources to, to apply to this. But really, there's the really amazing thing about the human body is that on a cellular level, our biology will allow us to improve muscle strength no matter our age, because the muscle cells don't really change. A lot of it has to do with the fact that we've been fed this narrative that as we're older, we can't build muscle, or it's harder to build muscle. Now, the only reason it might seem harder is because typically when somebody has lost strength, they've been sedentary, they, they've not done much, they might have some joint pain. So it is going to be more challenging. And they don't know what they're doing when they start out. So a lot of people injure themselves when they try to get stronger, they might not seek out expert advice or the expert they seek out might not be right for them. You don't want to hire somebody who's training you for a marathon when all you really want to do is to be able to squat and get that pot out from under the kitchen sink. So, you know, there's— your goals matter also for your training. But it doesn't matter the age, you can get stronger. And a lot of the balance issues have to do with strength and posture. I just recently did an event on posture, and people haven't understood the impact that poor posture can play on balance. And so a lot of the times they don't realize that as that forward head and that rounded upper back happens, they're going to be at a higher risk of falling because their center of gravity, their base of support are not lined up, and the body is struggling to find that that balance. And there's this, there's this little bit— it sounds like a play on words, but there's a difference between balance and stability. Yeah, a lot of the times, and the objective tests really frustrate me because they give a scale based on age, and for some reason, if you're older, you're not required to stand on one leg for longer than 10 seconds. But that doesn't mean that you're going to be good and you're not at risk of falling. However, when you're younger, you should be able to stand on your one leg for 30 seconds. So why are we changing that parameter? I've done events where I've had people in their 70s and 80s who could stand on one foot for a minute. So why are we saying 10 seconds is enough? I think they're at risk if they can only do it for 10 seconds. So, but stability isn't about balancing on one foot. Stability is about being able to regain the position you were in if it was disrupted. So what I mean by that is if you're out in a crowd and you get bumped into, can you restore your upright position without falling? That's stability. And we need that. And that does require a healthy posture and it does require strength. And those are the, you know, the posture gets overlooked, dramatically overlooked. And there are, there are causes of poor posture that most people don't even consider, and one of them is ankle function. So there's, there's so many really good functional strategies and effective trainings that people can do that can completely turn their life around. You're never too old to improve what's going on, and I've worked with people 100 years old doing squats and parallel bars to get them stronger.

People have the misbelief that their insurance will pay to make them healthy. And if the insurance doesn't cover it, they ought not do it. And I think that's a big mistake. We look at where we spend our money at, you know, on our phones and on maybe premium food, whatever happens to be it. I just want to kind of influence people to say that if your insurance doesn't cover it, it doesn't mean you can't have it done. I've had an example, one of my family members, we had a screening test for him. He had pretty severe atherosclerosis, which is hardening of the arteries in his 50s, young 50s. He has young children. We talked to his doctor. He says, well, you should go on this specific drug that is the most effective for letting you live, but you can't have it because your insurance won't cover it. And I said, well, it's $300 to just pay for it. Well, he had the ability to pay for it. He's not in a situation where $300 is more important than his family. But he wasn't really given that option. His doctor would not write it for him because it was not covered. It never really told him, well, you could actually just write a check for it if you can afford it. And I know that's not in the cards for everybody, but he wasn't even given that choice, which is, I think, very interesting that as doctors, we tend to feel that the insurance company says they're not going to pay for it, the patient should just live with it. Or if they're saying that the treatment that's inferior should be done. That that's the only option for them. And people are seeking out, you know, other things. Our business, we mostly treat people that we do a lot of things that are not covered by insurance that benefit people's health. These are decisions I think people have that should be given the choice to make on their own versus saying, well, your insurance is uncovered, therefore it's not in the cards.

You know, a lot of the times the guidelines for these insurance coverages is The state would be, well, we're trying to protect the patient from being taken advantage of by people. And I want to speak to that for a minute because I think it's gone so far in the wrong direction that it's preventing people from accessing quality care. And I agree, as you said, people are paying out of pocket now. And I completely agree about the whole insurance thing. It was always meant to be catastrophic type coverage, not maintenance. And now we expect it to be maintenance. And if it's not covered, we don't want it or we think we shouldn't have to pay for it. Yet, as you said, people are spending their money somewhere. And yes, there are a percentage of people who struggle financially. But the bottom line is the— I know for a fact that Medicare will— there are some laws in place for licensed medical professionals that ideally they're not allowed to provide care that supposedly Medicare would cover as a cash pay. And the goal of that is to protect the elderly, the people who get Medicare. The problem with that is there are a lot of extremely skilled and effective people out there who don't take insurance because they don't want to jump through those hoops. They don't want to be told how many times they can see somebody. They don't want to be limited to to how they're treating the person. Because Medicare, if somebody comes in to see a PT for, say, a knee problem and the therapist is extremely skilled and understands that it's their ankle below or their hip above that's causing the knee problem, if they document they're treating the hip or the ankle, Medicare will review the chart and refuse to pay because they treated a body part that wasn't on the prescription. So there's a lot of nonsense that goes on. Because if you understand how muscles connect, it's, it's, you know, the, the muscles that cross the knee start at the hip and, and, and the ankle. So it's kind of craziness. And if the therapist isn't allowed to provide the care that Medicare would cover technically, but they're not in the Medicare thing, and they're really good at what they do, and a lot of times it saves people money— I'm guessing the people that come to you save a fortune in what the fallout would be if they didn't seek your services because of the copays and all of the other stuff that they do have to pay that insurance would cover. And I've also seen if you go to a clinic, and this is not me bashing my profession, but I have seen many PT clinics where people are seeing 3 and 4 people an hour. You know, they've got an aide putting the ice pack on them. The PT barely spends 8 minutes with them because they're seeing so many patients at the same time. So that quality of care is really deficient and they're paying a copay, maybe it's a $25 copay, and maybe they're doing it 3 times a week, but they're not getting anywhere. So now they might be spending hundreds of dollars for, I don't wanna say incompetent care, but care that's not effective. There's a lot of things we can do that are free, but there's adjunct care that can be very effective, um, and better than conventional medicine more often than not.

So can you walk us through how you help people in your business, which I think is different than traditional physical therapy?

Yeah. So what I do, I'm trained in aspects of teaching that don't require PT licensure to teach. So I teach 3-plane movement. I do have a nutrition educator diploma that I'm able to utilize that information. I also have a background in working in neurofascial health. So how to work the fascial system. And I've created online trainings to help people more and more and more. And, you know, you can only see so many people face to face, but when you create programs that you know can work, and I've seen it, I've taught these classes at the local community college, I've seen the class setting is, is ideal for many people. They don't need specific help. They need to understand the basics of how the human body is designed to move. They don't have to become an exercise expert. They don't have to become an anatomy expert to understand this is connected to that. Everything's connected. Let's stick to standing up exercises because that's where we live our life. Laying on the floor and doing exercises doesn't necessarily make us more functional. And so, you know, when people know this and they understand they have to move in 3 planes of motion instead of 1, because most training is just 1 plane, and you don't isolate muscles because that tends to put us at more risk of tendinitis, tendinopathy, those kind of things, because the whole body is designed to work together, not isolate things. And when people understand these, they hear these things and they go, yes, that makes such sense. You know, I am a whole person. Yes. Why am I doing that movement? That's an I would never do that movement in real life. They just hear this stuff, it resonates with them, and they start doing the trainings and they see success. It works.

So you said you're treat— you're working both with people are trying to preserve and potentially augment what they have, and people that have had injuries. When they're going through your services, are they signing up for a particular— like, let's take a back pain would be one of the ones that's really just, just so hard to manage. No good surgery for it, surgeries generally fail, the causes aren't always super clear. So how would that person kind of figure out what program's right for them, engage with you, and hopefully see success?

So I do have, I have a website that has a little 5-question quiz. And when people answer those simple 5 questions, it will aim them toward the resources I have that would best address their specific concerns. Now, when it comes to back pain, it's interesting because 70% of back pain diagnoses are of unknown cause. Because it's not specific, it's not a disc, it's not, you know, something that we can clearly point out on an MRI. And people are unique. And I can have 3 people come into the clinic with the same diagnosis, the same symptoms, but they will need 3 completely different plans of care to address their problem, because one person might really— it's more of a range of motion issue. Another person, it might be really more a pain issue, you know, that kind of thing. However, what I have found in the low back, the reason the low back is because the low back tends to be the victim and the culprit is almost always above or below. And I'll explain that in, in terms of how the body moves. So the lumbar spine, I don't know if you remember, Dr. Moak, many, many, many years ago, there was a lot of information telling us not to twist when we exercised because it would put our back at risk. Do you remember that? It was maybe 20 years ago, something like that. And the problem with that is somebody must have got ahold of a Kapanji book on joint motion because they saw that the lumbar spine really doesn't rotate very much. It's like maybe 7 to 13 degrees. The lumbar spine's job, that lower spine between the trunk and the pelvis, its strength is bending forward and back. That's its strength. It's really good at that. It will do some side bending, but it will do very little rotation. So the reason they were warning people not to twist is because they thought, well, gosh, if the spine in that area doesn't turn, then it's all that twisting that people are injuring themselves for. Well, here's the truth about the human body. The lumbar spine's job is to translate that rotation or that turning above and below. So a simple example is if I'm standing here and I turn my body, my trunk is rotating. And as I turn, my lumbar spine's job is to translate that rotation down into my hips. The lumbar spine doesn't need to rotate. It translates it. It moves it below. So I do this. My lumbar spine sends the rotation into my hips, and everything's good. Now everything's good because my hips can rotate and my trunk can rotate. But if I've got restrictions in the trunk above the low back and the hips below the low back, When I rotate, my low back is going to feel it because that rotation can't be translated. And so if somebody's sitting in their car and they go to back up their car and they have back pain or they have neck pain, it's almost never where they feel the pain. It's almost always the trunk that lacks rotation. It's kind of like the silent saboteur. You know, if it's like Ginsu knives, it's supposed to do it all. But if it's lost motion, you're gonna feel it above and below. It's gonna impact shoulders. And that's where that whole everything's connected. So if somebody's seen as a back, you know, that walks through the door or a shoulder that walks through the door, whoever's working with them is gonna be kind of limited in how much they can help them because they're not seeing the connection.

That's news to me that as a physical therapist, they cannot treat outside what's, 'cause I know when we write prescriptions, we either be specific, but I didn't know that kind of handcuff the physical therapist to do?

Well, it depends on their insurance. So if it's Medicare or if it's workers' compensation, and if the therapist really knows their stuff, if they're skilled, they can document appropriately and still get paid. Because you can talk about muscle origin insertion and you're not saying you're working the wrong body part. You're speaking exactly what you're doing.

One of the, you know, our most common patient in our clinic is a woman that's perimenopausal or menopausal. And a big part of our practice is, is bioidentical hormone replacement. We use these testosterone and estrogen pellets, but I'm wondering if we're like leaving things short about not getting somebody to see a, somebody that works with movement to increase their, their fitness. 'Cause the most common complaint I hear from women in perimenopause and menopause is, is the weight gain. And that's often accompanied by decreased activity, which is accompanied by more weight gain. And then we put them on hormone replacement therapy and that definitely slows down the weight gain, doesn't stop it. There's a lot of this use of the GLP drugs that's very effective for weight loss, but it doesn't help with maintaining strength, potentially works a little against that if you're not exercising. But have you seen an uptick in women interested in this since there's such a big surge in using these GLP drugs that for weight loss and they might interested in getting healthy again, and then now women are allowed to get back on hormone replacement therapy, which they were kind of deprived of for the past 20 years?

I haven't specifically sought out that connection. The majority of the people who come to my content are seeking to address pain and to improve their, their aging process. I haven't really been asking specific questions as far as have they done hormone replacement therapy. You know, the GLPs are kind of new on the horizon here. So, you know, that's not audience-wide at this point, which that may change because of what's happening now. So I can't be accurate in answering that question. I wish I could, but I haven't really sought out that specific connection.

Well, these GLP drugs have come down precipitously in cost. So I think we're going to see a lot more adoption of that. We still have to get to the, you know, the, the bottom line for why we gain so much weight as Americans through our lifestyle and dietary choices. But they, they have been, had a big impact. But I think I'm seeing a selected group of people that are, you know, paying out of pocket for, you know, their weight loss or hormone replacement therapy. And it's not exactly a complete even slice through the middle of America. 'Cause I found that there's, people that maybe love their possessions and money more than their health, or they're biased to think that if it's not free, they ought not do it. And I think we'll see a tide changing because when we start thinking about longevity, and I know part of you, that's part of your interest is helping people with longevity. Longevity will not be achieved through your health insurance. How do we encourage our patients to think on movement? I go to one of these stretch places or stretch zone and stretch lab. I go to the stretch zone. And I do that actually once a week. Physical therapist once a month, just for, just for prevention. I see people are interested in like, what can I do to live your, live a healthier life? Because in the prior generations, the idea is where you would retire and then you just go on and die. And now we're seeing that people want to enjoy the second half of life as much as the first half. Because without movement, there's a shortened lifespan.

Yes. Yeah. That, it's actually the fourth leading cause of early death is lack of movement, right behind heart disease, blood sugar. Yeah.

Yeah. So somebody wanted to reach out for me, you wanted maybe just kind of talk about how would somebody getting hold of you and what kind of they should know before they start, you know, either ignore it or wanna move forward.

So I think the easiest way for people to find out what I do and sort of get a a flavor of how I teach would be to go to my YouTube channel because it's absolutely free. So there's no investment required and they can hear how I teach. They can, they can see the movement. I have quite a few videos on there. And then the main website that will give them that little quiz and it will aim them toward things is havelifelongwellbeing.com. And they can answer the quiz and it will aim them whether their concern is more of a pain nature. You know, I do have a private club, an online private club. I call it Move Without Pain. And there are kind of tracks in there where if back pain is their biggest issue, knee pain, shoulder pain, they can choose that track and it will give them a couple of dozen different workouts that will treat the body as a whole and ensure that the body parts required for that pain part to work properly are being addressed as well. So for instance, if they choose the knee track, they're going to train their ankles to restore mobility and stability. They're going to train their hips to restore stability and strength. And they're going to do it in a way where the knee is being provided with what it needs to function correctly. So that's the way the training is designed in that club. And if their goal is to really be very kind of maintain good strength or regain strength as they get older, then I have my online academy and those people, they're 50s, 60s, 70s, even in their 80s. And we do a live class every week. We have a ball together, um, and, you know, every class is aimed at something. Like, I just did a class for Max— gluteus maximus. I call him Max, and that's our power source. And a lot of people have been sitting on their power source for decades, and Max kind of, you know, he shrinks, he flattens, he gets weak when you sit on him. And so we wake him up, in the class. And, and people love it. I mean, I've had people in their 80s doing— oh my gosh, one class we did, I think we did like 80 squats in 7 minutes. And it wasn't, you know, they did it according to their ability, if they had to hold on, if they couldn't go all the way down, but nobody gets injured. Like I said, I've worked with people, I treat people based on their ability and their goals, not their number of years. And I think that's One of the things where the medical profession tends to fail is they look at the, the year the person was born and they automatically determine what they think is okay for that person to experience or suffer through. Because, you know, you are 68, you know, you are 75, what do you expect? And it's, it's all nonsense. It's their, their age isn't it. And stop treating them based on their age. And start meeting people and treating them with respect and concern and helping them and not just blanket, oh, it's a certain age and they're supposed to have pain because that's not true.

Now you're saying that over New Year's, I was with some friends, went to Nashville with a few couples and some of my friends about my age were talking about some limitations they had or aches and pains and they brought up the, well, it's not bad for my age. I'm like, what the heck? You shouldn't be thinking that way. You're, you're throwing in a towel now. These days it's not gonna get better unless you address it today.

Yes.

If you wanna be a badass when you're 80, you better be in pretty damn good shape when you're 60. Yes.

Yes. I mean, I'm 67. I don't take any medications. I don't even have Tylenol in my medicine chest. I'm doing movement. I'm teaching movement all the time. I'm not an anomaly. I'm not an outlier. I'm simply somebody who's applied these pillars, you know, for decades. And the cool thing is, is you can regain, it doesn't matter how old you are.

Yeah. So Eileen, we treat people with pain, most commonly knee pain. I wrote a book on this back in '16. When somebody has knee arthritis, the normal modus operandi is they go to see their doctor, do an X-ray, maybe give them some Motrin or something. If it goes worse, they go see an orthopedic doctor. The first thing they do is inject it with steroid. And maybe you can do that a couple times before that cartilage gives out. And then when it gets bad enough, they, they replace it. And the tolerance to knee replacement, it's kind of low. So there's about probably women over 60, it's estimated about 32% of them have single joint arthritis that's affecting their gait in some way. But only about 2% of people will go through and, you know, get it treated because the treatment is potentially worse than the disease for a lot of people. And even after the surgery, you have a 2% major complication rate. And about 20% of people still have some degree of pain afterwards related to the surgery or something. So, it's not like a— I mean, it definitely works and it's the only thing we had for the last, say, 70, 80 years, but it's problematic. So, people seek us out for doing stem cell therapy or platelets, which works quite well in the vast majority of patients for a few years. Platelets, maybe a year. Stem cells, maybe 3 to 7 years. And I guess I, you know, we do have people who see physical therapists to kind of work with their, their movement. But I wonder if, you know, we should be talking to people more about doing some online classes and doing some strength training. Because what happens is they say, well, how long is this going to last? It's like, well, if everything was perfect, it would last forever because your stuff's growing back. But whatever caused this problem in the first place that's still occurring, you know, unless it was like a, you know, athletic injuries like that, which is usually not. So this is something that maybe, um, even in our case, you know, we're not doing the surgery, we're doing the regenerative medicine. I don't think I put enough emphasis or focus on how do we change your gait mechanics, your biomechanics, enough that you don't keep stressing that joint, then ultimately save themselves money because the stem cells are not covered by insurance and they do tend to be expensive.

Yes. Yes. So the knee, you know, it's similar to the back. It's stuck between the hip and the ankle and no place to go, like the back is stuck between the trunk and the pelvis. So a lot of the times people have a history of an ankle issue. I mean, almost, I mean, it's a massive, I haven't looked at data that would confirm this, but from my observation over the years I've been doing this, probably 9 out of 10 patients have some history of an ankle issue, whether it was a sprain in college because of sports or athlete, you know, athletic stuff, gymnastics, whatever, when they were younger, or maybe they had a bunionectomy and they were non-weight-bearing for 6 weeks, or they had some other surgery or injury that caused them to be non-weight-bearing. So what that does is that impacts the ankle function and the ankle, and you may or may not be aware of this, but the ankle's function will impact the entire body up the chain. And, and I'll give a very simple explanation. When you go to take a step, when you land on your heel, there's a motion that has to occur. And it's all based on biomechanics and gravity and ground reaction force and all that fun stuff that people's eyes would glaze over if I went into. But you want the heel bone to move a certain way, which causes the bone that sits on top of it. It's the only bone in the human body that has no tendon attached to it. And it completely depends on the movement below and above.. And that bone is called the talus bone. And it rotates down and in when you land on your heel. And when that happens, the leg bones internally rotate, they turn in, and it switches on muscles. And it causes this huge chain reaction all the way up to practically the neck of the, of the person. And then as that happens in the foot, the person starts to go into a midfoot. And now everything starts to shift, and because of that rotation, it causes the opposite. It comes out of that internal rotation, and when that gets back down to the ankle, it causes that talus bone to rotate up and out, and it pulls the foot into this beautiful arch, and it gives a very strong toe-off. So between heel strike and toe-off, with every step we take, All of that stuff has to happen all the way up and down the body. So if the ankle has a history of injury, and it's lacking the ability to perform, it will impact the knees, the hips, the low back, the shoulder, the neck. I've resolved people's neck pain by restoring ankle function. And it's not some, you know, woo-woo kind of a thing.

It's biomechanics.

It's how the body's designed to work. And if they're doing a lot of walking, and the mechanics are off, it's going to stress and strain their body in a lot of different places. And, you know, I had one guy who had neck pain and he, he, it was his ankles and he was being seen by conventional PT and they were doing ultrasound and massage and range of motion and all that. He got on my schedule because his therapist went on vacation. And I said, well, this isn't working for you, obviously, because he said nothing had changed, 8 or 9 sessions. Of PT that was, that was even before copays. So it was completely free, but it wasn't helping him. And I said, I asked him about his ankles because it would happen when he was walking. And he said he sprained them all the time in college in sports. And when I checked his ankles, he was completely lacking a specific motion that's required for healthy gait. I did some mobilization to restore it, gave him some exercises to do to get his calf muscles to get longer again because they had shortened. And he never had to come back. His neck pain no longer occurred when he walked. So it's, you know, the knees are really counting on those ankles. The knees are really counting on those hips.

We all learned that in kindergarten that the head bone was connected to the neck bone, which connected to the backbone, which connected— so they taught us that early on and maybe we forget that as we get to be adults that they are.

Yeah, because we isolate things just like the spine. You know, we isolate it into the neck, the trunk, the low back, and the pelvis. Like it's not one piece of anatomy that's all connected.

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