Dr. Stephen Gangemi is the founder and creator of the natural health care method, Systems Health Care. He has been in practice since 1998 and opened the Systems Health Care office in Chapel Hill, North Carolina in June of 2018.
Steve’s practice utilizes various holistic methods to help return a person to health as quickly as possible. He has been trained in the fields of functional neurology, biochemistry, acupressure meridian therapies, applied kinesiology as well as dietary, exercise and lifestyle modification methods. If you could sum up in a few words the most apt definition perhaps would be “complementary medicine” or “holistic health care.” Steve doesn’t use the word “alternative” because for him, his family and for many of his patients, this type of health care is not alternative; it is the only one they follow. Conventional medicine is their alternative. It is there if/when they need it in times of crisis only.
Therefore, the range of people who come to Steve include software engineers, professors, homeschooling moms and dads (and their kids), professional hockey players, dancers, and soccer players including athletes and coaches from both Duke and the University of North Carolina. Many of his patients also travel from other states or internationally to see him in his office.
Listen to this episode of The MOVEMENT Movement with Stephen Gangemi who dispels the myth of orthotics and plantar fasciitis.
Here are some of the beneficial topics covered on this week’s show:
– How orthotics are more harmful than they are helpful for most people.
– Why strengthening your core requires strengthening your feet and their connection to the ground.
– How there is no fascia on the bottom of your foot, and why that matters.
– Why your feet are a great reflection of your overall health.
– How feet adjust to barefoot running over time and get used to encountering the elements.
Connect with Steve:
Guest Contact Info
Twitter
@TheSockDoc
Instagram
@drgangemi
Facebook
facebook.com/thesockdoc
Links Mentioned:
sock-doc.com
drgangemi.com
Connect with Steven:
Website
Twitter
@XeroShoes
Instagram
@xeroshoes
Facebook
facebook.com/xeroshoes
Episode Transcript
Steven Sashen:
If you have foot pain or heel pain, what many people call plantar fasciitis, the treatments that you probably will hear about could be the worst thing you could ever do to not only get rid of that problem, but for foot health in general. We’re going to find out more about that on today’s episode of The Movement Movement Podcast, the podcast for people who want to know the truth about how to move efficiently, effectively, enjoyably, and to run, to play, to dance, to do all those things that bodies are meant to do. And we start everything with the feet because feet are your foundation. And we call it The Movement Movement because we are creating a movement about movement. We’re trying to make natural movement the obvious better healthy choice the way natural food currently is. I am your host, Steven Sashen and from xeroshoes.com. And if you like what you hear here, or hell, even if you don’t, just when you get a chance go over to join themovementmovement.com.
You can find all the past episodes, all the different ways you can interact with us. And of course, I’d love it if you subscribe, and share, and review, and like, and hit the bell if you’re on YouTube, and all those things you know how to do. As I like to say, if you want to be part of this tribe, please subscribe. And when I say the tribe, I mean this kind of literally because what’s going to make natural movement a thing is a grassroots groundswell of activity, not just some big top-down thing from some giant corporations, because frankly they’re the ones who are trying to make sure that you don’t let your feet and body move naturally because they’ve made a career out of doing the opposite of what we’re going to be talking about today with my guest, Dr. Steve Gangemi. Hello Steve. How are you man?
Dr. Steve Gangemi:
Hello, Steven. Good to see ya.
Steven Sashen:
Yeah, I’ll be the Steven, you be the Steve, that’ll make life easier for everybody. And so do me a huge favor. Tell people who the hell you are and what the hell you’re doing here.
Dr. Steve Gangemi:
So, as you said, my name is Dr. Steve Gangemi. I’m a chiropractic physician, holistic doctor out here in Chapel Hill, North Carolina. I’ve been in practice for going on 22 years. I pretty much practice complimentary sports medicine, in other words holistic treatments for, evaluation and treatments for lots of people with athletic injuries from weekend warriors to kids, to professional athletes of different calibers in different sports. And I run a family-based practice where I treat a lot of people with autoimmune conditions, and hormonal imbalances, thyroids, thyroid hormone adrenal hormone issues, a little bit of everything under the sun.
Steven Sashen:
Well, and since Chapel Hill is kind of like the Boulder of North Carolina, I imagine you also have people who sprain a chakra, or pull a third eye.
Dr. Steve Gangemi:
Yeah, we’re not as bad as Asheville, North Carolina, which is about three hours west out in the mountain. It’s pretty much anything goes there. I’m smack dab, or I used to be my office. I opened my new office about a year and a half ago, and I’m closer to the University of North Carolina in Chapel Hill now, where before I was smack dab between Duke and UNC, so it was more medical orientated. But yeah, we’re pretty open-minded here.
Steven Sashen:
Have we had the conversation that I went to Duke?
Dr. Steve Gangemi:
I didn’t know that.
Steven Sashen:
Oh yeah. I went to Duke, and it was long ago enough that basically between Durham and Chapel Hill, the only thing that was there was the Blue Cross building. And what was the only fancy hotel?
Dr. Steve Gangemi:
The Sienna.
Steven Sashen:
No, no, no. Different
Dr. Steve Gangemi:
Or the Omni, it might have been called The Omni.
Steven Sashen:
No, definitely wasn’t called The Omni. Whatever it was, it was this one little fancy, fancy hotel that once a semester we had enough money to go for their Sunday brunch. And we ate like we weren’t going to eat for the rest of the week. And what amazed me being in Boulder, which is another college town where everyone is way richer than we were back then, that’s how people eat every night here. But that was a big deal for us to spend 25 bucks to eat as much as a college student could eat. And we ate that place out of house and home. It was a blast.
Dr. Steve Gangemi:
Oh, there you go.
Steven Sashen:
Oh, there was another place, there was a jazz club called Steven’s After All, another Steven. It was a guy who realized that the jazz musicians, they were going from DC to Atlanta and had nowhere to go in between. So, they opened a club just in that same strip between Durham and Chapel Hill. And I performed tabletop magic. I worked for free and for tips, and he gave me a meal. And this was like a five star restaurant, so I worked there twice a week and also ate well from that. Food is a theme in my life, apparently. And then every now and then I got to open for some of the acts. So, I opened for like Etta James.
Dr. Steve Gangemi:
And you did magic?
Steven Sashen:
Yeah, I did magic.
Dr. Steve Gangemi:
I can picture you doing that.
Steven Sashen:
Well, I was a street performer and so I did a bunch of stuff at the Apple Chill. I don’t know if that still exists. A big street fair in Chapel Hill, and then tabletop stuff, mostly when I was at Steven. So, I’m having flashbacks.
Dr. Steve Gangemi:
Geeze, I never knew that about you. And I think we’ve known each other for maybe 10 or 15 years now.
Steven Sashen:
Yeah. It’s not like I walk around handing out my CV to people. It’s basically, it’s the resume of someone who should have gotten Ritalin as a kid. I was too old for that. In fact, how we met, just to let people know, was we were basically just on a bunch of email threads with the people that I think of as the smart people in the barefoot natural movement, or natural running game until we finally had a chat. And there’s a handful of people on that list that I’ve happily had chat on the podcast, Mark Cucuzzella, Irene Davis, et cetera. And I thought of that crowd as the only smart people on the planet about movement and running. So, thrilled to have you here. And now, in a related note, your website is also a nickname that I think Mark gave you. Is that true?
Dr. Steve Gangemi:
Actually, Mark’s friend, a guy named … Who unfortunately has passed away but started Triathlete Magazine back in the day, a guy named Bill Katovsky-
Steven Sashen:
Oh man, I miss Bill terribly.
Dr. Steve Gangemi:
… Bill I think passed away two years ago. Yeah, Bill was a good guy. And yeah, he actually came up with the name just because one day we were talking about running and things like that. And at that time I was only wearing socks in the office, kind of got rid of the shoes even in the winter. And today I actually don’t wear anything in the office on my feet. It’s completely bare because I was ruining socks and they were just too hot. So, I kept the name, the Sock Doc, but barefoot in the office most of the day, just like you actually.
Steven Sashen:
Yeah, people find it entertaining when they walk in and half of our office is in Xero Shoes and the other half is walking around barefoot. And they go, “Wow, you guys are serious.” Yeah, this is the real deal.
Dr. Steve Gangemi:
Yeah. Yeah. And it’s funny because I mean, that’s what my patients say too because we have a sign at our front door that says, “Please leave your shoes out here, or as you enter and if you want to keep them warm inside or keep the spiders out.” Yeah, we’re a barefoot office in my practice-
Steven Sashen:
Oh, it would be even better if you had a wood burning stove or something you said, “Please burn your shoes here.” That would be a thing to do. It’s something we’d actually wanted to do, a thing that I call swap your flop, where you would come in with a pair of flip-flops or shoes and we’d put them in a giant meat grinder, and take all the dust. And the more we collect, the more we donate to some worthy cause-
Dr. Steve Gangemi:
See, I always want to do that with the orthotics. Have a big orthotics meat grinder, because you and I have gone after orthotics for years.
Steven Sashen:
Oh man. Yeah, we’ll get into that. Actually, we will talk about that. But before we do, since it is The Movement Movement podcast, I always let us try and start, although start usually means 15 minutes in or 20 minutes in with our conversations, but start with some movement, something that people who are listening or watching can do. Is there anything you can think of that you would like to share for the humans who are part of our little conversation here?
Dr. Steve Gangemi:
Yeah. Well, and just so everybody knows you hit me with this right away, so I haven’t had more than a few seconds to think about it. But that’s okay.
Steven Sashen:
Well, and just to let people know, the amount of preparation that goes into having these conversations is as close to zero as humanly possible. So yes, I gave you no warning right before we started. 30 seconds earlier I said, “Think of some movement thing that you’d like to share.”
Dr. Steve Gangemi:
So, here’s what I’m going to share because I’ll be able to do this standing up, and what I’ve been doing with people who have an imbalance, which most people do with their breathing diaphragm, which is up here by our chest. A lot of people think their diaphragm is below their ribs here, but diaphragm, I tell people it’s kind of like bra level or nipple level, and it’s a little bit higher up than what people think. It’s way up here. And when you breathe in, your diaphragm obviously descends. It goes towards your pelvic floor. And likewise, your pelvic diaphragm, which people still call the pelvic floor, both are accurate terms, should also descend. And then when you exhale, the pressure releases and your diaphragm comes back up, and your pelvic diaphragm should basically correlate with that.
So, you should have a consistency between your pelvic diaphragm and your diaphragm-diaphragm, your chest breathing diaphragm. When one goes up, the other one goes up, and descends, descends. So, as you breathe in, a lot of people’s pelvic diaphragm doesn’t correlate with your breathing diaphragm. And what somebody can do right now is just sort of stand up and see how much they can touch their toes without bending their knees, and kind of get a pre and post here. How far can you go down and touch your toes and put your hand on the hands on the floor? You going to do it?
Steven Sashen:
Okay, so I’m keeping my legs straight and just bending over and touching my toes.
Dr. Steve Gangemi:
Yeah, just a straight leg. See how far you can bend forward, how far do your fingers go towards you to your shoes.
Steven Sashen:
Okay, I’m moving-
Dr. Steve Gangemi:
Or some people can run their hands flat.
Steven Sashen:
Okay, so I got my palms end up about an inch off the ground.
Dr. Steve Gangemi:
That’s good. So, what we’re going to do is basically we’re going to have people take their thumbs and put it on their navel here, and then drop their fingers to the top of their pubic bone. And your pelvic diaphragm pretty much starts right in between there. So, you’re going to go halfway between your belly button and your pubic bone right around in here. So, maybe an inch or so below your belly button, depending on your body type. And what you’re going to do is you’re going to push in like this, you’re going to scoop down and in, kind of like you’re pushing almost towards your tailbone in the back of you. And as you take a deep breath in, you’re going to push down and in, and bend forward down to your chest to knees again. So, like what you just did, you’re going to push down and go down.
You’re going to flex your trunk forward as you take a deep breath in. So, it’s three things. It’s push down and in, deep breath in through your nose, and then bend forward. So, like a three-second count, lean forward, press in with ideally both fingers, you might just be able to do one, and go as far as you can. Try and get your chest as close to your knees as you can, drop your head. So, you’re going all the way down and pushing in hard, as long as it’s comfortable. Don’t hurt yourself if you’ve got some gut pain or anything. And then as you come up, you scoop up and breathe out through your nose. So, it’s going to look, push down and in. And then as you come up, if you can see my fingers, then as you come up, you scoop up and breathe out.
So, you’re basically going to do five of those. So, you’re going to breathe in, push in, go all the way down chest to your knees as much as you can. And as you come up, you breathe out through your nose and scoop back up and pull up.
Steven Sashen:
Oh, okay.
Dr. Steve Gangemi:
So, it’s down and towards the floor, and then pull up like this. And you’re basically going to do five of those. And after you do that, you’re going to see how much further you can go towards the floor. So, my experience with this is, for whatever reason-
Steven Sashen:
I only did two. I was only using one hand because I was moving the camera.
Dr. Steve Gangemi:
Do three more.
Steven Sashen:
But hold on. Wait. Yeah, I just got my palms on the floor.
Dr. Steve Gangemi:
So, just from doing two.
Steven Sashen:
Yeah.
Dr. Steve Gangemi:
So, this is something I came up with about seven or eight months ago because my kids were making fun of me that I couldn’t put my fingers on the floor. I could barely touch my toes. So, I did about five or six of these thinking, “Okay.” And I breathed in really hard. So, when you breathe in hard, your diaphragm goes down and your pelvic diaphragm goes down. So, I was pushing my pelvic diaphragm down as I flex forward. And then as you come up, you scoop up, you scoop up like this, and then you’re pulling towards your belly button, and you exhale always through your nose, in through your nose, out through your nose, and you stand back up. And basically after I did that, I literally put my palms on the floor. And the best thing about it is it didn’t go away. I mean, it stayed for several weeks. And even when it regressed a little bit, I only lost like 10% or 15% of it.
Steven Sashen:
Since what many people think of as flexibility is actually just a neural pattern thing, your brain telling you what it thinks your body can do. What do you think is happening here? What’s getting reset? Because it’s not creating flexibility, it’s not making your muscles suddenly longer. It’s obviously doing some neurological thing that allows this to happen. What do you think’s happening?
Dr. Steve Gangemi:
Well, let’s say this way, it is in a way creating flexibility. It depends how we use the word. It’s not stretching anything out, but it is creating a flexibility due to creating more of a balance between the tension that is most likely there between the two diaphragms. So, we’re basically neurologically resetting the diaphragmatic pattern. So, when you breathe in, maybe my diaphragm was doing this when I was breathing, and my pelvic diaphragm wasn’t descending. So, as I breathe in, maybe my breathing diaphragm was coming down, but my pelvic diaphragm was stuck. And then as I exhale, they weren’t coming. So, I was resetting this pattern of breathing in, descend, breathing out, pressure released, ascend.
Steven Sashen:
It would be interesting just for the sake of being a dork and curious about these things, to do some sort of EMG test, electromyography, basically testing what your muscles are doing to see what muscles are turning on or off differently before and after this. Because there’s definitely things, maybe piriformis, maybe hip flexors. I mean, there’s a lot of stuff-
Dr. Steve Gangemi:
Yeah. And really when you get into your diaphragm psoas, iliacus, and those deep … Some people might remember, the anatomy nerds, like your gemelli, your obturator muscles, but your psoas is really a big link between your pelvic diaphragm and your breathing diaphragm. A lot of people think of psoas as your hip flexors. The majority of it does attach to your lumbar spine, but actually your psoas fascial connections go up and wrap around to your diaphragm, what’s called the crux of your diaphragm, and actually wrap around where your esophagus and your diaphragm come together in the hiatus. So, some people can actually have pelvic problems resulting in heartburn, and reflux, and stomach issues because of the imbalance between the two diaphragms.
Steven Sashen:
Oh, that’s really interesting. I’m amazed at all the neurological connections in your abdominal … Everything in your abdominal cavity. And I say this because two weeks ago I had a massive kidney stone. And the pain that it was referring, where I was feeling it, was so different than where things were actually going on. And I found that really, well, now fascinating, then confusing and extraordinarily painful. But it’s interesting to see how these things work. It reminds me, there’s a friend of mine, a doctor named Tom Raven, who’s a completely crazy, wonderful human being who does prolotherapy where where you’re basically just sticking needles into your ligaments and tendons to initiate a healing response. And he treated me once, and I think it was working on my shoulder, and I felt something go down my arm. And I made some comment about him hitting a nerve, and he said, “No, there’s no nerves where I’m sticking a needle.” But you have to think about it, when you were developing, going from a fetus to a person-
Dr. Steve Gangemi:
Yeah, embryologic.
Steven Sashen:
… your fingers were basically coming out of your shoulder, and then it turned into an arm. So, there’s something that’s going on there that we don’t really know a whole lot about that’s creating these sensations, which is a freaky thought.
Dr. Steve Gangemi:
Yeah. And that’s a very common issue, especially actually with people with sciatic pain. They think, “Oh, I’m irritating my sciatic nerve, I have pain in my hamstring or something like that. But a lot of times it’s actually not your sciatic nerve, or in your case, you felt like a nerve in your arm. But it’s that embryologic origin in the name for that is called scleratogenous referred pain. It’s an embryologically referred pain pattern.
Steven Sashen:
Oh yeah. It’s really crazy to think about that because, well, actually there’s a very, how do I want to put this one delicately? There’s a whole theory about why people have foot fetishes. This is not where I expected this conversation to go. And it’s related to what you just said because at some point your feet were coming out of your pelvis, right next to your genitals. And if you look on the brain map where your brain is receiving sensations, right next to your genitals is your feet. And there was a guy who had gangrene of his penis and they had to amputate it, which is a crazy, horrible thought. And when you have some amputation, the nerves tend to remap and the nerves for his genitals remapped to his toes. And so, even putting on socks was apparently very erotic.
Dr. Steve Gangemi:
Well, I will tell you a quick patient story. This one time, sometimes it’s crazy what women will tell me especially, but she told me, I asked her, we were talking about feet and calves, and she wrote down on her sheet that her calves cramp. And usually for women, that means that their calves are cramping at night while they’re sleeping, they wake up with this massive locking up of their calves. She said, “No, my calves cramp only when I orgasm.” And the reason for that is because the sacral nerves that are linked to the genitals also go right down to your calves and your feet. So, people will get a foot or they can get a calf cramp during that experience because of the connection between the-
Steven Sashen:
Oh, what a riot.
Dr. Steve Gangemi:
So, there you go.
Steven Sashen:
Very interesting. All right. Okay. Anyway.
Dr. Steve Gangemi:
Hey, there’s your warmup.
Steven Sashen:
I like how we’re both mildly red. So, I want to back up and take a whole different direction. So, backing up to your being in socks and then barefoot in your office. So, how did the whole natural movement thing come to you? How did you become aware of it? What was that sort of come to aha, whatever moment?
Dr. Steve Gangemi:
Yeah. I mean, that’s a good question. I always ran in minimalist shoes when I started … I started doing Ironman races. I grew up as a triathlete, even in high school, started doing triathlons. So, I’m 46 now, so this was a quarter-century ago or so. And I always wore minimalist type shoes, which people call the waffle racers, the Nike Waffle Racers, that sort of thing. Way before-
Steven Sashen:
When that shoe came out, I mean, the first Nike Waffle Trainer came out. I was about 11 or 12. I remember putting that thing on. It was just magic because it was A, so thin, and B, it had a bunch of toe spring, actually. But as a sprinter, when I leaned forward and it just put me on my toes, that’s how I run. So yeah, people forget that the very earliest running shoes were minimalist shoes, and then all hell broke loose.
Dr. Steve Gangemi:
So, I wasn’t wearing the super minimalist, but I was wearing what people would wear maybe in a one or 800 meter, or a 1,600-meter race. I was wearing those in Ironman. Whenever I used to go get them at a local running store, people would freak out that was going to destroy my knees and that sort of thing. And I just felt so much better. And really I got into minimalist shoes strictly because I didn’t have a lot of knowledge, and there wasn’t a lot of information out there in the late ’80s, early ’90s. I pretty much started wearing them because of the weight difference. People started talking a lot about that, “Hey, if your shoes weigh X grams lighter, you’re going to be carrying this much less weight and you can run faster.” And that’s all I cared about. So, I just looked for lighter shoes.
And then I realized in high school, and my first couple years of college in the early ’90s, I had every injury under the sun. I had plantar fascitis, iliotibial band syndrome, shin splints, anything, knee pain, you name it. And I soon realized after that, even though my training got smarter at the same time, where I just wasn’t always doing hard, high intensity miles, but wearing the more minimalist shoes, I eventually resolved all my injuries, especially in my crazy Ironman years where I did 20 Ironmans in my 15 years I think it was, or 12 years. And I never had injuries at all be since I started wearing minimalist shoes, and during those Ironman years and even today.
So, I only got stronger. Not to say I never had pain or I never had to take a day off just from training hard, but I recovered fast. And I never had an injury that kept me out of a race. I never had an injury that kept me from prolonged training. It was more like, hey, chill out because you’re training too hard types of pains. And so, then a lot of the minimalist stuff started come out later in the ’90s and early two 2000s up until mid 2000s, 2010. And yeah, so that’s how it evolved for me.
Steven Sashen:
And how did that interplay with the whole chiropractic training, since most chiropractors get introduced to the idea of orthotics and posting the foot? In fact, tell me, I don’t know if this is true, this is something I heard from a friend of mine who went through physical therapy school. She said that the whole idea of building an orthotic to post the foot, to put it in a particular orientation, was actually invented by a chiropractor who just pulled it out of his butt, totally made it up. And then it became a way for a lot of doctors just to make a bunch of extra cash with an easy to do diagnostic tool, or-
Dr. Steve Gangemi:
Yeah, I don’t know if that’s a history behind it. I mean, I wouldn’t doubt it, but I can’t say that’s true or not. But yeah, I mean, that’s how we’re trained. I know even more so today than when I graduated 20 plus years ago. But yeah, so it is kind of funny. People come into your office, most of them are wearing not so great shoes, especially women in high heels or thick type shoes to make them a little bit taller. I mean, that’s just the way it is, the shoe industry. And then you do your corrections. For me, it’s muscle testing, it’s correcting muscle imbalances. It’s a lot of work. My appointments are an hour or so longer. And then why would you want to put them back in the same shoes that perhaps caused some, or maybe even all of their dysfunction, especially if it’s a foot, knee, back?
Or you can make the case for even a neck issue anywhere in the body. So, it’s more of an education process now in my office where people know what good shoes are and what bad shoes are, and people come in, we do gate testing with the shoes on, various types of different muscle testing with shoes on to show people, hey, this shoe is doing this to your gate. And sometimes it’s actually because the shoes are literally not the correct size for them. A lot of people don’t even wear the correct size. But also they’re obviously wearing shoes that are over supportive, too cushiony, too thick, you know the deal.
Steven Sashen:
Well, so backing up to the chiropractic training thing, when you were in school and they were talking about orthotics and posting the foot, were you just biting your tongue or were you making yourself obnoxious?
Dr. Steve Gangemi:
Neither at that time. So, my story behind that is even when I was in high school, my senior year of high school, 1992, I had a good friend up in Massachusetts where I grew up. He was a physical therapist, and he actually made old school orthotics. Those are the ones where they used the calcium and literally made a cast of the foot. And I started to learn how to do those at the time. I actually grew up in orthotics. I mean, I had them in my cycling shoes, every pair of running shoes. I thought a custom orthotic sounds so awesome. I mean, why would you not want a custom orthotic? Why would you not want something that can support your feet and help you run faster, and support your body function daily and during race? So, I never was without them unless I was barefoot at the beach.
So, I ate that whole story up. And then when I took orthotic classes in school, I started using them but then that was about the same time, and we’re talking late ’90s, early 2000s, where I started to see the light and really see what they were doing and how they truly affected people. So, I kind of got out of them professionally as I was getting them in them. So, I really was never a big orthotic supporter. But at the same instance, I wasn’t obnoxious at those classes because I really was still learning about them. And if patients came in with them, I really didn’t give them a hard time at the time, where today I do. Very few of my patients are still allowed to wear, or at least recommended to wear the orthotics.
I shouldn’t even say recommended because I’m really there … There’s basically a group of people, patients who I see, and I mean very small, I’m sure it’s under a dozen, who they like the orthotics so much and I don’t see them screwing up. I’m like, “Fine, if you want to leave them, go ahead.” But for most people, the other 95%, they’re only causing problems and they’re no longer wearing the orthotics.
Steven Sashen:
Yeah, when people ask me about them, I say the simplest thing, I go, “So, we know that if you support any joint in your body, if you put your arm in a cast, it gets weaker. Why would you think it’s any different for your feet?” And what that means for your feet is you lose the ability to do something simple like balance. And over time, what that leads to is something like what happened to my dad a few years ago where he’s shuffling down the hall, tripped on a little ledge, fell down, broke his hip and was dead two weeks later. And I’m not trying to put the fear of God into them thinking that they’re going to die from wearing orthotics, at the same time I kind of am because I mean, it’s just so amazing how if you walked into a doctor and said, “My neck is bothering me,” he said, “Oh, we’re going to have to put you in a wrist brace for the rest of your life.”
Dr. Steve Gangemi:
Or a neck brace. I mean, I use the cervical collar analogy all the time. If you hurt your neck and you need to now let that heal up, go ahead and go in a cervical collar, but you’re only going to go in that for a week or so.
Steven Sashen:
A while. But I like doing the thing where it’s completely unrelated. So, it’s like your neck, put you in a wrist brace, or the other way around. It’s like, tell me how that makes any sense. But feet are such an interesting thing because it is our foundation. It is the connection. And so, there is an easy to rationalize a metaphor image of like, oh, we need to have a supportive foundation. We need to really bolster that in some way. It’s an easy story to tell. But once you do any amount of research, it falls apart.
Dr. Steve Gangemi:
And you know what I’d like to add to that is we still hear all the time when people train, especially athletically, muscular skeletal system, think free weights and that sort of thing. People always want to talk about their core. How strong is your core? Let’s work on your core. But there’s a growing group of anatomists out there who, I’ve taken some pretty high-end anatomy classes in Scotland in the past couple years. And these anatomists feel that your core is really starting, or is pretty much your feet. Your core is your feet. And if you’re not strengthening your true core, being grounded to the ground by strengthening your feet, you might as well forget about the rest. And that’s true, not only if you’re just trying to strengthen your feet, but literally if you’re trying to strengthen your arms too. You can make the case that your core is actually your feet and not your glutes, abdominal region, obliques, all that.
Steven Sashen:
Talk to powerlifters for the bench press. They say it all starts with your feet.
Dr. Steve Gangemi:
Yeah. That’s good to know. There you go.
Steven Sashen:
Which is a crazy thing to think about when you’re lying down on a bench trying to push something off of your chest. That movement is driven by your feet, and yet it is. Which is a fascinating thing. I’m not a powerlifter obviously, but I get a kick out of watching those guys and hearing how they’re training because they’re doing insane things. So, one thing I want to transition, when people email me, and I get these emails on a very regular basis about plantar fasciitis, I usually point them to your website because you’ve written some great articles and done some great videos about that. And like I said at the beginning of this, the treatments that are typically recommended for plantar fasciitis, from my perspective, are often the worst thing you could possibly do. Can you talk about how you got hip to what plantar fasciitis is or isn’t, and the treatments that you are recommending for dealing with that?
Dr. Steve Gangemi:
Yeah. So, the interesting about plantar fasciitis is actually going back to the unanimous is the unanimous today will actually say there’s no such thing as plantar fasciitis because there’s actually no fascia in the bottom of your foot. Now, some will say, “Yeah, there is some. There’s 10 to 20%,” but the amount of fascia that we think is truly in the bottom of your foot, this isn’t more just anatomically speaking, it’s really not much, or some would say any to what we’re all have been taught. Really what is at the bottom of your foot is what’s called aponeurosis. And these are basically the muscle extensions of all your calf muscles, your tibialis posterior, your soleus, your gastroc, your peroneus figularis muscles they’re called today. So, think of the bottom of your foot as just one giant muscular sheath. And just like anything, or a lot of injuries, when you have a problem in an area, typically it’s either from proximal or distal, either somewhere else, before or after where the injury is felt. There’s some muscle imbalance there.
And typically with plantar fascitis issues, what I see is one of two muscles being affected. And it’s either tibialis posterior, which goes from just behind your tibia bone, that bone right behind your kneecap, or just below it all the way and kind of inserts and makes up the bottom of your foot, especially your medial longitudinal arch. That’s what people know as your foot arch. And then the other one is your soleus, which is the lower part of your calf, sometimes can be your gastroc. Pretty much if you take your calf muscles, your gastroc soleus, more so your soleus, and your tibialis posterior, and if there’s some imbalance between one of those muscles or both, you’re going to end up with pain distal to that, meaning down at the bottom of your foot, either in the heel or in the arch, or something like that. So, really the treatment involves going back up the line in behind the tibialis muscles or the lower leg bone, and looking for muscle imbalances between or in that area, in the calf and then tibialis posterior.
Steven Sashen:
Two things. So, I wish I could remember the name of the guy. There was someone who lives around here who used to do a whole presentation about plantar fasciitis. And he was showing some interesting MRI images where there was, as actually Mark Cucuzzella likes to point out, and Phil Maffetone likes to point out, that usually it’s not an itis, it’s not an inflammation, it’s an osis. It’s something-
Dr. Steve Gangemi:
It’s an osis. Yeah, exactly.
Steven Sashen:
But he is showing some problems with the tissue in the foot. But like you said, I mean, 80% of the time when someone tells me they have plantar fasciitis, I can just look at them and I can spot where there’s something going on typically in the bottom of their calf, stick your finger in there and they fall to their knees. And I go, “Go roll the crap out of that. Go work on that and tell me how you feel.” And then usually five minutes later it’s like, “Wow, it’s 80% better.” And so, it amazes me the number of people who get misdiagnosed because, for whatever reason the medical practitioner they’re seeing just, I don’t know what it is, they just take it all at face value. I had this twice happen where I met someone or knew someone who said, “Well, I love your shoes but I can’t wear them because I have plantar fasciitis and I’m having surgery coming up soon.”
And I look at them, I go, “Well, I don’t think you have plantar fasciitis.” And they go, “What?” I go, “Can you stand on your toes?” And they go, “Yeah.” I go, “If you really had plantar fasciitis, you couldn’t do that.” I said, “Can you just bounce back and forth from one foot to the other while staying on your toes?” They go, “Yeah.” I said, “Does that hurt?” They go, “No.” I said, “Yeah, if you really had plantar fasciitis, you couldn’t do that.” I said, “Lean forward while you’re doing that bouncing back and forth thing.” And then suddenly they’re running pain free. And what amazes me is both of them still went and had surgery anyway. I mean, and look, I get it-
Dr. Steve Gangemi:
And then unfortunately with surgery, to get to that area where the surgery is felt like it’s needed, cutting through some pretty significant tissue. You are really creating a giant fascial lesion in there, you’re creating a new injury, which people don’t realize. And so, you’ve distorted, you’ve created a dysmorphology, you’ve created tissue problems more so than what you already had.
Steven Sashen:
I think it’s a new villain for the Avengers. Dysmorphia. I don’t know what his power is, but I just like dysmorphology.
Dr. Steve Gangemi:
It’s just injuring people. That’s it.
Steven Sashen:
Oh, that could be it. But in a way that’s different than what it looks like. That’s what it has to be. That’s what dysmorphia does. It’s like, “I have this pain right here.” “Yeah, but it’s your foot.” “Yeah, but it hurts right here.”
Dr. Steve Gangemi:
Yeah, I always tell people, and I think like you do too, is your feet and foot symptoms, plantar fasciitis would probably be at the top of my list. Maybe achilles tendonitis a close second. And they are a lot of times related to the soleus issues, lower calf issues there. Your feet are a great reflection of your overall health. So, people tend to think, “Hey, plantar fasciitis is a running problem. You’re putting in too many miles, you’re not recovering well.” But I see people don’t run at all and it’s just because they’re under too much stress, they’re not eating well, they’re working too much, they’re not sleeping well. And your feet are such a great reflection of your overall health. I tell my patients and people, “How do your feet feel first thing in the morning when you get out of bed? Are they supple? Could you get up and run out of your house if you had to? Or would you feel like you’re walking on eggshells, and you’re like, ‘Ah.’ And I got to loosen my feet. I got to stretch them out.”
Because that’s a great indication of your overall health and how well you slept. I mean, we’ve all had, I have when I’ve trained too hard, you get up one morning, you’re like, “Man, my feet are kind of achy. I got this little sharp pain here in my heel or my toe, things aren’t moving as well as they should.” And it’s telling you got to chill out or you’re pushing yourself too hard, so you got to listen to your feet.
Steven Sashen:
Well, as a competitive sprinter I have a different answer, which is I could roll out of bed and I could run, but I’d really like to do some warmups and drills first because otherwise I won’t be running as fast as I can. And I’m 57 years old, I could use a little warming out. Actually, it’s funny. I was visiting my sister and I have a nephew, he’s 20 now, and I think this is when he was about 17. He’s a pretty good athlete. And we just woke up and I made some comment about going to the track. And he said, “I’ll race you.” I said, “Oh, I don’t think that’s a good idea.” He goes, “Why not?” I said, “Well, because there’s no upside for you. Either you’re going to win or lose to a really old guy.”
Dr. Steve Gangemi:
So, did you race him?
Steven Sashen:
No. He realized that it wasn’t a good idea and that I would probably crush him. It happens every now and then. It’s my favorite thing in high school track meets is if there’s an open track meet, I’ll go race it because they have electronic timing-
Dr. Steve Gangemi:
What do you first sprint to 100’s?
Steven Sashen:
Yeah. Or indoor, the 50 or 60 depending on the track. And so, I’ll beat a lot of the high school kids and it’s one of my favorite things to do. I don’t do it to be obnoxious, but it is obnoxious. I’ll walk up to them and go, “Hey, just so you know, I’m older than your dad.” And I do it just to see how they react, because the ones who get depressed, it’s kind of disappointing. But the ones who get really mad and they want to beat me, I like to hang out with these kids, and train with them, and work with them because I know I’ve just put a target on my back that’s going to be good for them. It’ll be motivating. And they’re really fun because that’s how I was. I was stupidly competitive in high school. And it’s fun to hang out with those kids.
So, when someone comes in, they’re presenting something that they’re thinking is plantar fasciitis, and maybe, let’s say again, maybe it is something that really is going on, let’s use the phrase plantar fascia to refer to the bottom of the foot. What are the things that you do, or what are the things that you can tell people who are dealing with this to do … Or actually, let’s go back to the very beginning of the show. What are the typical treatments that you know about that most people do that don’t work, and why? And then what do you do that does, and why?
Dr. Steve Gangemi:
So, definitely one of the most common ones is people have orthotics. They were put in months to years ago, and they’re still wearing them today. And unfortunately now they’ve weakened their feet so bad that they can’t be without their orthotics. So, I have some people, they’ll say to me, “I can’t take my shoes off in your office because I literally cannot walk from the 50 feet from the entrance to back to your room because my feet hurt-
Steven Sashen:
The one that I hear, I ask people, “How is it walking barefoot in your house?” And they’ll the phrase, “I have hardwood floors.”
Dr. Steve Gangemi:
Yeah, or tile.
Steven Sashen:
They say, “I have alligators, piranas, and cactus for floors.”
Dr. Steve Gangemi:
So yeah, I mean, all my floors are hardwood, so the floor is too hard for people and their feet have just weakened so poorly. So, that shockwave therapy unfortunately has gotten popular where they just go in there, and I’ve never seen someone do it but I’ve heard patients tell me about it where it’s super painful and they’re just trying to break up adhesions in there. Usually only on the bottom of the foot-
Steven Sashen:
Oh, the thing with whatever it’s called, it’s a piezoelectric … It’s basically, it just spends a giant spike of something. I’ve never had them do it to my … Wait, have I had them do it to my foot? I’ve done it. I’ve had them do that to my shoulder. And yeah, it’s the weirdest sensation. It feels like some tiny little person just punched you inside your body, and it’s really unpleasant, and it really created a whole lot of movement. It was super cool. In fact, I’m going to be at an event this weekend where there’s someone who, that’s their device that they sell and they’re going to be demoing. I’m going to have them beat up my shoulder. I’m two years out of shoulder surgery and any little thing, I mean, I’m just a dork for that. So yeah, it’s fascinating, but definitely not the most pleasant thing to go through.
Dr. Steve Gangemi:
Yeah. And every now and then, then I think somebody gets lucky and it happens to break up the one adhesion that was there and is causing a plantar fascia. But usually it’s not addressing the issue at all. And obviously ultrasounds is really big, and taping, and cortisone shots of course are still pretty common.
Steven Sashen:
Have you looked at a SkyMall catalog in the last couple years?
Dr. Steve Gangemi:
Oh yeah, yeah.
Steven Sashen:
There’s usually like five or six shoes that basically immobilize your foot that are advertised as a cure for-
Dr. Steve Gangemi:
Or I forget the name of the sock off the top of my head, but that sock that keeps your foot dorsey-flexed when you sleep at night, pulls it back.
Steven Sashen:
Hold on. There’s a-
Dr. Steve Gangemi:
Strassburg Sock or something.
Steven Sashen:
… there’s a woman, I don’t remember what kind of metal medical practitioner she is, but she’s selling a sandal that she claims … Well, she says there’s a study that shows that it reduces the effects of plantar fasciitis, or eliminates the symptoms, or cures plantar fasciitis, she might even say. And the study was basically just people self-reporting what it is to wear this sandal. But when I looked at the sandal, it’s basically a boot. I mean, it just doesn’t let your foot move at all. And yeah, it’s like, okay, cool. The pain goes away if you’re not using it, but that doesn’t mean you’ve cured the thing.
Dr. Steve Gangemi:
Exactly. And I get that all the time. So people, they’ll put a comment on the Sock Doc site with a shoe that I’ve maybe talked poorly about, and they’ll say, “No, I actually wore this shoe and this got rid of my problems. I don’t understand why you’re talking badly about the shoe.” And it’s like, you don’t quite understand the point here is that if that shoe is literally correcting your problem, then you should not need to wear that shoe after a little while, and you should be able to block barefoot and move freely again. But they can’t do that. They have to stay in that shoe because the shoe is like an orthotics supporting some dysfunction. It’s supporting some imbalance that they have.
Steven Sashen:
Well, I remember, so when I first got back into sprinting I was getting injured constantly. And I don’t remember how or why I got them, but I got a pair of MBT, the Masai Barefoot Technology shoes. And I loved them for one completely counterintuitive reason compared to how they were selling them. And that is when I was getting all these injuries, the biggest injury that I got was calf strain. And I could wear those shoes and walk without having to use my calves. I was basically just rolling over in a way where I wasn’t using my muscles. In fact, here’s a crazy one, the Nike Vaporfly where everyone’s going, “Hey, this shoe is amazing. It’s making people 4% faster.” It’s not. Roger Crom here at the University of Colorado, he’s been studying that shoe, and he says it gives people 4% improvement in their VO2 max, their ability to process oxygen.
And then he finally conceded that there’s no direct correlation between having a better VO2 max and actually how you perform. But researchers are trying to figure out why people are seemingly better in that shoe. And what he’s concluded most recently, from what I’ve seen, he may have updated this since, is that you don’t have to use your muscles as much. Is that it’s allowing you to do more by just jamming into your joints without having to actually use your body the way it’s supposed to be used. And sure, if you’re trying to win a gold medal, that may be the way to do it.
That doesn’t mean you’re going to be able to run when you’re five years after winning that gold medal. But that was an amazing thing. It seems like it’s working better by having you not have to use your body. It’s like, what? Okay, so immobilizing, basically everything that we talked about as the common treatments are some form of immobilization, which if you do have real tissue damage that’s part of it. Of course, you want to get moving as quickly as-
Dr. Steve Gangemi:
Temporarily. Yep.
Steven Sashen:
So, what do you recommend that is not that?
Dr. Steve Gangemi:
And as you alluded to earlier on the videos, what I show people do at home, because in my office I’m able to muscle test each individual muscle and see where the dysfunction is, and see exactly how to correct that, whether that be a manual therapy to the foot or the calf, hip, ankle, knee, whatever, and find out where those fascial points that need to be manipulated are. In other words, what people might call those trigger points or those mild fascial points. So, we can find out exactly where those are, and I show some of those in the videos, like the common ones on the tibialis posterior muscles in as well in the calf. And aside from that, at least for home therapies, after that it’s really starting to strengthen your feet, which means you’re doing some barefoot exercises, you’re maybe doing some eccentric heel drops on the stairs. You’re doing some-
Steven Sashen:
Describe what that is for human beings who don’t know.
Dr. Steve Gangemi:
So, basically a calf raise. You’re standing on a step or something a few inches off the ground, maybe five, six inches off the ground. You’re doing a calf raise, so your tippy-toe on the end of the stairs. And then you’re slowly lowering so your heels are dropping below the steps, below parallel. And you’re sort of getting a stretch in your calf.
Steven Sashen:
Do you recommend doing that, or doing push up with both feet and go down with one foot so you’re really getting an actual eccentric load rather than just-
Dr. Steve Gangemi:
Well, at first some people, I mean, eventually you want to do just one foot, absolutely. But some people can’t even start with that because their feet are so bad. So, I have them start with two and then if they can balance okay, even if they got to hang onto a handrail, ideally, yeah, you’re doing it just with one leg. You’re going up on the one foot doing a knife calf like tippy-toe raise, and then slowly lowering maybe five or six seconds into the heels all the way down, hold it for a second, and then pushing up quickly, and lowering. So, something like that. That’s going to be more for calf, soleus gastroc issue. Tibialis posterior, a little bit more hard to isolate that muscle because it’s so involved with pronation.
That muscle is drastically intertwined between the two lower leg bones, your tibia and your fibula, in this membrane called your interosseous membrane, similar to what holds your radius and your ulna together here. It’s a thick, almost like spiderweb sheath of connective tissue and your tibialis posterior is all integrated in there. And then the bottom of your foot and what we call the fascia. So, to really rehab your tibialis posterior, in my opinion, you’re looking at actually just moving it. You’re walking, you’re trying to really do a nice full range of motion walk. In other words, use your entire foot, the flexibility of your foot, and then work up to a good walk on a hard surface as well as eventually into a light run if you can do that, or even if that means running in place place, you actually strengthen the entire foot.
Steven Sashen:
I don’t remember if I got this idea from you or where I picked it up, but I recommend for people often just walking barefoot on something like gravel where they can’t just walk, but they have to place their foot somewhat deliberately, and they have to engage their foot to do so. And it also, it’s activating the nervous system as well. It doesn’t feel like just a muscular thing, it really gets your brain involved and where am I putting my foot and how am I putting my foot? And you have to keep things sort of pretension.
Dr. Steve Gangemi:
Yeah. It really activates what’s called that kinesthetic sense, and that’s awesome. I have part of my walkway at my office is a pea gravel. It’s not any of the sharp stuff.
Steven Sashen:
Yeah, that’s what I was thinking of.
Dr. Steve Gangemi:
Yeah. But I mean that, I’ve watched people walk on that before they hit the hard paver surface, and it just overstimulates their brand like crazy. It’s not really hurting their feet, but it’s too much sensory stimulation. It drives them nuts.
Steven Sashen:
Yeah, that’s a really interesting point because, well, I’ve talked about that or I’ve thought about that just when talking about going barefoot is I think a lot of people confuse either doing too much too soon and muscular issue with exactly that, that over stimulation. At first, when you let your brain feel what’s happening with your feet, it feels great because yes, that’s what I’ve been asking for. But if you’ve had things so numb for so long, then there’s definitely that thing of just like, whoa, whoa. Chill out. Which is it’s funny. People ask me with our sandals, with the Z Trek and the Z Trail, the Trek is just five and a half millimeters of rubber. The Trail has some foam in there to give it a little extra cushion.
And people ask me about the difference. And I say, “If I wear the Trail for a while,” which has that little bit of extra cushion, and it’s a tiny amount, “It just feels super smooth. And then I put on the Trek,” which is basically barefoot with a layer of rubber between you and the ground, “My brain’s like, ‘Oh, right. I can feel things again.’ And then every now and then it’s like, yeah, I need a break from that. Can you get those other ones back on?” And so, I alternate just based on what feels like the right thing for that day.
Dr. Steve Gangemi:
Yeah. A few years ago I was at a movement workshop out in Santa Fe, New Mexico, and I was the one to lead this 5K run at 6,000 elevation through one of the mountain ranges. It was all a gravel type trail. And I had never run on that before. So, I did it barefoot, and one other guy chose to do a barefoot too. And by the end he actually tore up his feet back because he wasn’t used to running barefoot. It was a bloody disaster. My feet didn’t get nicked at all. But by basically after about two, two and a half miles, I stuck it out the whole three miles. But my brain was so wasted after that, that’s what I felt like. My feet weren’t hurting, but the rest of the day I was jacked up. It was just so much for me to process because I wasn’t used to running on that type of surface for a good 30 minutes or so.
Steven Sashen:
I think people forget that one of your brain’s biggest functions is to not pay attention to certain things. It’s weeding out things that are extraneous, and you really can just give yourself too much stimulation and need to find a way to mitigate that or modulate that. And this is the thing that I see often is people, they get so excited about the idea of barefoot or natural movement, the too much do it’s more about what’s happening with their sensory input than it is all the muscular stuff going on.
Dr. Steve Gangemi:
You’re absolutely right. And that goes back to what we were saying a little while ago, how your feet feel in the morning will determine how your overall health or a lot of it, I’ll say. I mean, obviously not all the time. And how much you can handle walking on a uncomfortable surface. How much stimuli is that to you? That’s a good indication of how much static you have. I use the analogy, if you’re one of those old school radio stations, you’re trying to find the dial on that radio but there’s so much static. If you’ve just got so much static, meaning so much stress in your life you can’t handle any little bit more sensory stimulation, if somebody drops a pan in the kitchen, you freak out. Or a bright light really makes you squint.
You can’t handle light stress, you can’t handle sound stress, your feet are going to be even more of a reflection of your overall health. Forget about the hard surfaces, but just that little stone under your foot or some gravel, some pea gravel, if that drives you nuts, your brain’s already maxed out most likely.
Steven Sashen:
I also noticed, and it’s not quite contrary to that, but I think it’s part of a feedback loop that when I first started going barefoot, which is now 12 years ago, things that were uncomfortable to walk on now are not a problem. And in part it’s because I’ve just gotten more familiar with how to use my feet to adapt to those things. In part it’s because I’ve become a little more, how do I want to put it? If something starts to hurt, I just step off of it rather than trying to stay on it. And in part that’s because I’m walking differently, so I’m not putting so much weight on my foot immediately that I can’t step off of it. But I also think that what’s happened is that my feet have gotten more flexible and the reflex arc has improved. So, I’m still more responsive and able to just bend around things that I previously couldn’t bend around.
Dr. Steve Gangemi:
Yeah, and your pressure receptors change, your chemoreceptors, all these things. I just got back from a one month, or a one-week now, a one-week field course in Southern Utah, as you know. And we were in the mountains at this Boulder Outdoor Survival School, a great organization. They’re in Boulder, Utah, which is several hours south of Provo. And I did a good bit of it, or at least one day before it got too hot, barefoot. And one of the guys looked at me, he’s like … We’re walking on these slick rocks where the sun’s beaten off the rocks, we’re 6,000 feet up. And he’s like, “How are your feet not hurting?” And it’s not because I’m tougher or anything, it’s just that my feet have adapted to the heat.
And I stepped on a cacti, and it didn’t feel good but I was able to pull the little needles out of my foot without it being a huge deal because I think my foot was able to move right away. As soon as I hit it, it can adapt and shift right away so I’m not causing some significant damage. Then by middle of the day, some of the sand there is way too hot. I put on my Xero sandals actually. But yeah, you’re going to develop stronger, more resilient feet overall, the more you adapt to that.
Steven Sashen:
One of the things that amazes me when I talk to some people is you do present this option of natural movement, and suggest that it might take some number of months till you get familiar with it, depending on when you’re starting, and how your brain adapts, and how your body adapts. And people are resistant to that. And let’s go back to putting your arm in a cast, that analogy, it’s like you get your arm out of a cast, are you not going to do physical therapy? Are you not going to use your arm again because it’s been in a cast? Are you going to spend some time getting it back in shape and hopefully even getting it better than it was before you started?
I’m thinking about this out loud. What is it about feet, or I don’t know what, something about feet where people are seemingly reticent to just do the simplest things, spend a little time barefoot a little more every day to develop lifelong strength, and balance, and sensitivity and all these things that feet provide. I don’t know what it is that people just are reluctant to do that in ways they aren’t for other parts of their body.
Dr. Steve Gangemi:
Well, I agree with you 100%, and working with patients directly every day for the past many, many years is, I can say overall people are reluctant overall for most of their body. I mean, they really are. It’s their last thing to correct. I mean, people will spend the time and the money fixing an appliance of their house or their car. I mean, our bodies, it’s amazing to me how people don’t put the time into their bodies actually. So, even when you say something like their shoulder, yeah, most people will go to physical therapy after a shoulder injury, rotator cuff say repair or whatever. But very rarely do I see somebody truly vested in making that as good as what it was. Or I’d say stronger, almost never.
Most people are just like, “I can’t raise my arm this up anymore. I want to be able to do that again like I can my other arm,” they just want some normalcy. They’re happy with like, “Yeah, I just had this, and I just injured this. I know I’m never going to be able to throw a ball again, but I just want to be able to put my arm over, or I want to be able to wash my hair without pain.” They’re almost comfortable with mediocracy. It’s pretty sad actually how little … I think I see more and more every year how people want to put time into their body, it’s literally because we’re just too busy with other things that we come last.
Steven Sashen:
I’m going to give you a counterargument to that because the way you said it actually made me realize something. One of the reasons for doing prolotherapy is because this is the way Tom Raven, my crazy prolo doc described it, he goes, “One of the things about healing is your body isn’t designed, unless you get some injury, your body isn’t designed to get you back into the same shape you were or better. It’s designed to get you good enough so that you can get moving again as soon as possible, so you can get out of whatever situation has caused a problem.” So, I don’t think we are physiologically designed to get back to the status quo, let alone to get better.
And so, I think what both of us are really describing is just a slightly more intellectualized version of that same thing, that what the body’s going to do naturally, just the tissue itself, I mean, this is why we develop scar tissue, it’s we’re not going to get back to where we were or better, it’s just going to do just good enough. And I think what we’re talking about is the psychological version of just good enough.
Dr. Steve Gangemi:
Yeah, I think you’re right.
Steven Sashen:
Which is kind of a shame. I mean, the thing that you can do to combat that is obviously if your livelihood is dependent on being in shape, or getting better, or if you’ve got some other thing that shows up as a motivation for doing it. But I think what we’re talking about, similar to critical thinking, we’re not wired for doing critical thinking, I think we may not be wired for doing critical healing, if you will. Which now makes me think of what can we do to tweak that? How can we turn that into a game? How can we do something where we can make an end run around some natural process that might not be as effective or as efficacious as we would like. I have no idea where that’s going, but it’s suddenly seeming like an interesting line of inquiry. Who knows?
So, anything else that you want to think of about natural movement? And I’m going to say, as I asked that question I’m going to give it a caveat. What are you seeing as the trajectory of this whole concept of natural movement in particular, and when it applies to running and walking more specifically? I have my perspective from what I’m seeing on the footwear side. I’m curious what you’re seeing on your side, both as a practitioner, as someone who’s been involved in this whole conversation for a long time as well.
Dr. Steve Gangemi:
Sorry, I kind of lost the actual question-
Steven Sashen:
That’s okay. I did too. So, I’ll say it this way. So, many people think that the whole barefoot running thing died, which is completely patently false. And we see it, or our evidence that that’s false is just the fact that our company has just grown significantly year, after year, after year, after year. And people are asking for more and more products that accomplish different things, that we have so many customers who own multiple pairs of our products for different activities. And then when we go to Europe where there wasn’t this whole argument about barefoot or natural movement, it’s just been a part of the culture for a long time. Same thing in Asia. We’re seeing that the United States is its own peculiar little thing, but we’re also seeing that some of the bigger companies are starting to try and do a little more of what we are doing.
They’re not actually getting to what we’re doing or anything close to it, but they’re trying to use the same language. They’re using some of the same similar design ideas that aren’t applied well enough. So, I’m seeing that it’s starting to become a thing, that my whole idea of making natural movement the obvious choice, like natural food, may have some real merit to it. But I’m wondering what your perspective is. We haven’t talked about this, what you see both in your practice and just however you’re observing reality around you.
Dr. Steve Gangemi:
Yeah. I mean, I think people are putting that more into their everyday movement. Where before, coming from a running background, a triathlete background, I probably only talked about cross-training before, like I’m going to do different sporting activities. Where today you’re going to get more athletes doing different types of almost play movements. Like adult games, you’re going to go out maybe even if it’s running around on the front yard and playing tag with your kids, or some sort of natural movement that’s using different types of muscular connections, or fascial connections, or something different than what you’re used to doing. And hopefully doing that barefoot.
So, I do agree with you that yeah, it’s more talked about every year. But I got to say, and this isn’t counter to what you’re saying at all, but unfortunately what I see, and maybe it’s because of where I live in the hustle and bustle triangle, Raleigh, Durham, Chapel Hill here in North Carolina is that unfortunately it’s still not on people’s priority list. It’s their last thing when their health unfortunately is still coming last, and exercise, or training, or activity, whatever words you want to use, play, is still unfortunately not on the top of their list. Eating is important.
They’re like, “Oh, I’m going to go to Whole Foods, or I’m going to go to the healthy food store and get this.” Or they’re still going and they got to get in there 30 minutes on the treadmill or the dreaded elliptical, which I think is the worst machine ever developed.
Steven Sashen:
Wait, hold on. Why?
Dr. Steve Gangemi:
Because it’s so unnatural. The elliptical is the exact opposite of natural moving. I really think, I’m not sure if this is true or not, but I think the elliptical is made because people could never do cross-country skiing, the Nordic Track machine, which is a natural movement to some degree and require coordination at the level-
Steven Sashen:
It does require coordination. No man, the first time-
Dr. Steve Gangemi:
Elliptical, you can just stand mindlessly on and move your arms and legs in some un-uniform fashion to get your heart rate up. So, I am so anti-elliptical. Yeah. Do you have one in that? Do we need to turn the camera around-
Steven Sashen:
No, no. I don’t have an elliptical. In fact, we’re getting a TrueForm treadmill in here. So, one of the curved treadmills-
Dr. Steve Gangemi:
Those are great. Those are different, but it’s because it’s a true running form. I mean, I still see that that’s not on the huge priority in people’s life, even though they’re aware of it, and I hope it’s going to change because growing up in this, being in the business now for 20 plus years, I can say even 10 years ago people are like, “Oh yeah, I know about hydrogenated fats. I know how bad they are,” but they would still eat them. Or, “I know how bad corn syrup is, but I still eat them.” Where now I don’t see that today. I almost never have to talk to my patients about high fructose corn syrup or hydrogenated fats. I’m hoping in another few years, five years, that they’re going to come in and more people are going to say to me, “Hey, yeah I’m doing this fun activity,” or, “I’m doing this movement activity,” more so than it’s only happening because I’m recommending it.
And unfortunately, I don’t see any patients who come in. I see patients who wear your shoes and other minimalist company shoes, which is nice, but very rarely I could say out of all my patients over the years, I’d like to say one or two are actually truly barefoot like me.
Steven Sashen:
Well, look. Admittedly we’re freaks, and one day-
Dr. Steve Gangemi:
But we also are true to what we believe in.
Steven Sashen:
Oh, absolutely.
Dr. Steve Gangemi:
I mean, especially you. I mean, I’ll plug you for a minute. Here you are, you sell shoes, that’s your living. How often do you wear shoes during the day? Some days you don’t even put shoes on.
Steven Sashen:
Most days. Yeah.
Dr. Steve Gangemi:
Most days you don’t even wear shoes. So, you don’t even wear your own product because you understand that really the best is to wear no shoes.
Steven Sashen:
Well, this is what I’ve said since day one is barefoot is best, and when it’s not appropriate that’s why we have Xero shoes. So, when I’m on the track on the weekends, I do most all my warmups and drills barefoot. And then when it’s time to do speed, I’m in our shoes. And when else do I wear shoes? If it’s exceedingly hot out and I know I have to spend a lot of time on, not concrete-
Dr. Steve Gangemi:
Asphalt.
Steven Sashen:
… yeah, on asphalt or-
Dr. Steve Gangemi:
Or you’ve got to go into a store or something and you don’t want someone yelling at you.
Steven Sashen:
Most stores I have no problem with. The only store that I have a problem with? Whole Foods.
Dr. Steve Gangemi:
Whole Foods, yeah.
Steven Sashen:
Yeah. Whole Foods-
Dr. Steve Gangemi:
Grocery stores. Yeah.
Steven Sashen:
No, not grocery stores.
Dr. Steve Gangemi:
Oh, really?
Steven Sashen:
King Supers is our regular grocery store. The only thing anyone’s ever said to me is, “That looks cool.” And Whole Foods, the number of times people have said, “Yeah, you can’t do that here.” And I go, “Why?” I go, “Well, it’s an insurance thing.” I said, “No, actually it’s not.” They go, “Well, it’s a health care,” or what’s the word? “Health code thing.” I go, “No, actually it’s not. It’s for employees you have to wear shoes. But it’s nowhere about patrons.” But they have a sign that says that have to wear shoes.
And I go, “Well, how come it’s okay to have dogs in here barefoot? Why is that all right?” They go, “Well …” So, they’ve gotten mad at me. I was in Costco once wearing shoes because I’d just gotten off the track, and one of the employees stopped me and said, “Is everything okay?” I said, “Why?” He said, “You’re wearing shoes.” “Yeah, it’s okay. They’re mine.” But in fact, I was in a hospital-
Dr. Steve Gangemi:
It is funny how you get that. I was recently at one of my patient’s funerals, no joke, up in Virginia. And the family came up to me after, “Thank you for coming,” all this. Then they gave you the smart-ass comment, “We didn’t recognize you, you’re wearing shoes at the funeral.” And I’m like, “I thought shoes were appropriate at the funeral.”
Steven Sashen:
Check this one out. So, when my dad died, I think it was about four years ago, I can’t remember if it was three years or four years, let’s call it four years ago, my dad dies and I had a dress shoe from another minimalist company because we weren’t making one, and they didn’t fit my feet. I mean, they hurt like crap. And so, I took them off as quickly as I could. And the rabbi comes up to me and he says, “You know, in Orthodox families, the family doesn’t wear shoes while they’re mourning the loss of whomever it is, because it’s one of the sonnets.” You don’t look at a mirror, you don’t wear shoes. And I went, “Oh, I’m in.” And so, for the rest of the couple weeks I wasn’t wearing shoes. And we’re not an Orthodox Jewish family, but I just took that as something I could do.
But the thing, Irene Davis made a comment, Irene’s from Harvard, and you know this, of course. Irene said, “If we just get kids in natural movement footwear for when they need footwear, in 20 years we won’t have to treat them for the problems that adults currently have.” And it may be that what we’re talking about is a hopefully not multi-generational issue where this does become the obvious choice. And we start seeing barefoot as a more acceptable thing. I mean, look, I’m the first to admit it but I’m occasionally self-conscious about it when I’m going into certain places barefoot and I’m waiting for someone to say something. And one day I’m walking into the office, and I’m dressed like I am now, I’m in pair of shorts, I’ve got a Xero Shoes tee shirt, my hair was unnaturally big that day, and bare feet. And I catch my reflection in the window and I just stopped. And I went, “Oh, I’m that guy. Okay.”
Dr. Steve Gangemi:
Yeah, you are that guy.
Steven Sashen:
I was not aware of that. And part of it is from being 57 too. I mean, so being an old guy walking around like this, that adds to it as well. And I kind of enjoyed that. I’m okay getting crazier as I get older.
Dr. Steve Gangemi:
There you go.
Steven Sashen:
Because they cut you more slack. So, anything you can think of before we call it whatever day, morning, evening, afternoon, this happens to be?
Dr. Steve Gangemi:
No. I mean, geez, you and I could talk forever. It’s always fun.
Steven Sashen:
So, if people want to find out more about what you’re up to and what you’re doing, and just what you’ve been sharing and teaching, what’s the best way for them to do that?
Dr. Steve Gangemi:
Yeah. Well, my website’s unfortunately which I haven’t updated for a long time, but you got sock-doc.com, so that’s S-O-C-K dash D-O-C.com. And then my other site, DrGangemi.com. D-R-G-A-N-G-E-M-I. And then for practitioners out there, those who are interested in manual therapy techniques, I have my whole line of work, and videos, and manuals. And that’s Systems Healthcare, that’s the technique that I developed. Systemshealthcare.com.
Steven Sashen:
Awesome.
Dr. Steve Gangemi:
And you can find those all online.
Steven Sashen:
Beautiful. And we’ll link to them as well. So first of all, thank you again. As you said-
Dr. Steve Gangemi:
Thank you.
Steven Sashen:
… always a pleasure, totally a treat. And for everyone else, thank you for being part of this episode of The Movement Movement Podcast. If you want to hear the other episodes, head over to jointhemovementmovement.com. If you have any questions or comments, or somebody you want to recommend for being on the show, drop an email to [email protected]. And again, remember to subscribe, and like, and share, and do all those things to say thanks and to pass on the word. And as I like to say, if you want to be part of the tribe, please subscribe. Always a pleasure to have you here. And as always, live life feet first. Take care.