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4: Feet, Running, and Performance with Guest Dr. Ben Cornell, PT, MPT, PhD, OCS
452 Plays3 years ago
Welcome to Episode 4 of the Movement Logic podcast! In this episode, Sarah is joined by her former professor from PT school, Dr. Ben Cornell, to discuss all things feet related from balance to running, and why you might want to start high-fiving the trees when you’re out for a run or a walk!
- Why shoes and bedcovers cause problems for not only feet but the rest of the body
- Why plantar fasciitis can be so challenging to treat and heal from
- How much can we change the bony structure of the foot – and does it matter if we can’t?
- Why a “window of neutral” is a better goal than a singular “neutral” position
- Connecting increased foot rigidity to fall risk for older people
- Why pronation isn’t a dirty word in running and there’s no single way for people to run
- The importance of giving your students self-efficacy and understanding their motivation
Guest Bio:
Dr. Ben Cornell, PT, MPT, PhD, OCS, is an Associate Professor at Mount St. Mary’s University and serves as the Musculoskeletal Clinical Coordinator in the program. He oversees the student-run, pro bono physical therapy clinic at the Union Rescue Mission in Los Angeles which provides physical therapy care to the homeless population. He has 17 years in clinical practice and is a board-certified orthopedic clinical specialist as well as an avid runner.
Reference links:
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Transcript
Introduction to Movement Logic Podcast
00:00:06
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beaverstorff and physical therapist Dr. Sarah Court. With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up-to-date and cutting-edge tools, evidence, and ideas to help you as a mover and a teacher.
Meet Dr. Ben Cornell
00:00:34
Speaker
Welcome to episode four of the Movement Logic podcast. I am Dr. Sarah Cort, physical therapist, and I am here with my guest today, Dr. Ben Cornell, PT, MPT, PhD, OCS. I just wanted to say all of your letters because they're hard to get the letters and I feel like we should recognize that challenge. Dr. Cornell is on a full-time faculty of the physical therapy doctorate program at Mount St. Mary's University in Los Angeles.
00:01:02
Speaker
where he is an associate professor and the musculoskeletal curriculum coordinator. And full disclosure was one of my favorite professors when I was there, which is part of why I've invited him on the show. And I'm sure you'll all appreciate his candor and his sense of humor.
00:01:17
Speaker
to continue. Professor Dr. Ben, that's what I'm going to just start calling you. Professor Dr. Ben. That works. Okay, good. He spent 17 years in clinical practice. He is a board certified orthopedic clinical specialist. He earned his PhD in general psychology with a performance psychology emphasis. He oversees the student-run pro bono physical therapy clinic at the Union Rescue Mission in Los Angeles, which provides
00:01:40
Speaker
physical therapy care to the homeless population. It is no small feat that we got him for the podcast today, as this gentleman is very busy. Dr. Ben Cornell, welcome to the podcast.
00:01:51
Speaker
Thanks for having me. And I liked your little feet pun. No small feet. I'm glad you got it. I was like, is this
Impact of Footwear on Foot Health
00:01:58
Speaker
funny? All right. So today we are talking about feet and all things feet related, which is an area that Dr. Cornell knows something about as an avid runner, as well as a physical therapist. Am I correct? Did you just do your first marathon? Is that right?
00:02:12
Speaker
Uh, no, it wasn't, wasn't my first. It wasn't, was not my first, but it was, uh, I set a goal five years ago when I was 45 that when I turned 50, that I could still run a marathon under three hours. And so that was the big deal. And so I somehow some way managed that goal. That's amazing. Congratulations. I famously hate running.
00:02:36
Speaker
All right, so let's get into it. Dr. Cornell, in your practice, what's the most common issue that you see people coming in with for feet and ankles that is from like habitual behavior, meaning like standing posture or shoe choice or type of exercise, things like that? What do you see most commonly?
00:02:58
Speaker
Like if I had to pick one category, I would say the fact that most people I see wear shoes and wear shoes a lot and wear shoes that look nothing like our feet look. And so when I see people coming in, their feet are either squished or pointy in directions that they're not supposed to be pointy. They don't splay out like they're supposed to.
00:03:26
Speaker
they lack a lot of dorsiflexion because they're wearing shoes all day that even if you're not in heels most shoes have at least a tiny heel so we're always standing in plantar flexion or our toes are below our heels and so the pathologies that I see I think many of them come really from that and I mean and it's it's well known in the literature that
00:03:49
Speaker
if you look at cultures that don't wear shoes versus cultures that wear shoes that feet look quite different and most of the shoes that people wear I think you know my thing is always you pull out the insole and look at it and does that look like the shape of your foot most of the times it most of the times it doesn't. Yeah I remember working with a patient one time who
00:04:12
Speaker
could no longer get her heel down to the ground barefoot because she had spent so much time in heels that her Achilles tendon, all the tissues on the back of her heel and calf had just shortened and could no longer allow that range, which was kind of wild. To me, it's crazy that we would expect that we spend
00:04:33
Speaker
all day in a shoe with a heel and then fall asleep at night with our feet underneath sheets that are pointing our toes down and that somehow some way that our calf and our Achilles tended wouldn't shorten up and
00:04:46
Speaker
and that magically three minutes of stretching it a day isn't gonna make it come back to its normal length. Right, yeah, I think one thing, I mean, this was something I sort of never thought about before PT school was that second part that you're talking about, which is when you sleep, your feet are pointed, you're in plantar flexion passively because of the covers.
Understanding and Preventing Plantar Fasciitis
00:05:05
Speaker
What kind of stuff do you see as a result? I mean, is it a lot of like plantar fasciitis? Is it bunions? Is it all of the above? Yeah, I'd say it's all of the above. Plenty of plantar fasciitis, a lot of,
00:05:16
Speaker
Certainly bunions. And I would just say just overall the mechanics of the foot being thrown off such that even if it's not foot problems coming in, that it's foot problems or lower quarter problems, everything from the foot up to the knee to the hip to the back because that thing at the bottom is the thing that touches the ground first. And if it's not doing what it's supposed to do when it hits the ground, something up the chain has to adapt.
00:05:45
Speaker
We're very adaptable creatures. We have a lot of range of motion. But depending on that human, if they're not getting the function at their foot and they can't adapt up the chain, then we see lots of other problems with people's knees and hips and low back. Yeah. It seems to me that plantar fasciitis in particular is something that people have a hard time getting rid of. I have patients come in where they're like, I've had it for 20 years.
00:06:13
Speaker
Is there something missing in the way that we try to deal with it? I mean, I know a lot of the treatment or even just like, you know, movement things that people do, people do a lot of like, you know, passive stretching and sort of dorsiflexion. They'll do like a massage ball or a foam roller or they'll roll on ice on their feet, things like that. And it seems like it doesn't
00:06:33
Speaker
always do the trick. Do you find that there's a different category of work that needs to be happening, like strengthening it and range? Is it something about other extrinsic versus intrinsic muscles in the foot? What do you think is the best approach for people?
00:06:50
Speaker
It's interesting that you ask about this because it is one of the the banes of my treatment existence is plantar fasciitis and I think... Mine's thoracic outlet syndrome. Yeah and I think part of it is because like even if the person says oh yeah my foot just started hurting a week ago whatever led to it has probably been going on for 20 years so by the time they have it to try to change some of those
00:07:18
Speaker
either weaknesses that they have or structures that they have that have shortened up become quite difficult. And we're on our feet all the time. It's like plantar fasciitis to me is a bit of an overuse injury. So what do we need to do with an overuse injury? Well, in some ways we need to underuse it a bit to let it calm down. But by the time it's become chronic, now we're not talking about as much of an inflammatory problem versus your tissue that's been stressed over and over and over again.
00:07:48
Speaker
kind of a roundabout answer in terms of what do we work on? Well, there's so much that I think needs to be worked on and those people with plantar fasciitis, what have they done? They've worn shoes their entire life and maybe overbuilt shoes and now their foot intrinsics haven't been awake for decades and we're trying to get someone to turn on muscles
00:08:09
Speaker
It's like, what's our plantar fascia? It's a passive structure that's there to help support the arch, but really it shouldn't be the primary structure. We've got beautiful foot intrinsics that if they're working, the plantar fascia just gets to hang out. But it's not just as simple as like, come on in, let's just do some short foot exercises and your plantar fascia is going to magically be better. And yes, if you don't have good, you know,
00:08:33
Speaker
dorsiflexion range of motion, does that end up putting more stress on the planet fascia? Certainly, that needs to be dealt with. This word fascia that you've used a lot, and I've been a slow adapter to it. Now, be quite honest, things I don't understand, I just say, oh, those are just out there. People talk about these things.
00:08:55
Speaker
as I was getting ready for this last marathon, guess what? My planar fascia started getting irritated again, which I've had it on and off over time. And like, seriously, it was like week one of a 16 week training program. And I wake up the next day and my foot hurts. And I was like, okay, I've tried everything under the sun to try to deal with it. And so I got online trying to be a good PT and let's look into the literature. Is there anything else I've missed? And then
00:09:21
Speaker
Somebody out there was like, you know, there's this posterior fascial line that, like, in my brain it's like, oh yeah, plantar fascia. Yeah, that hooks into this fascia that's coming from my cap all the way down.
00:09:38
Speaker
that this is me being quite the skeptic, but I gotta, you know, one of those instruments that you can do soft tissue with. And you know what I'm gonna do? I'm just gonna start working through my calf. And it was just like crunchy and all these weird noises. And I did it and I kid you not, I got up and I started walking.
00:09:56
Speaker
that is significantly better than when I was walking before. I'm like, okay, let's start working up into my hamstrings and it got a little bit better. So I think there's lots to look at. I think plantar fasciitis tells us that there's not just one thing going on.
Importance of Proper Foot Mechanics
00:10:15
Speaker
We've got to have
00:10:16
Speaker
functioning intrinsics, so that- And can you, sorry, just for a second, if anyone doesn't know what intrinsic, how can you explain what that is? So intrinsic muscles being those that attach within the foot itself. And so from the heel to the toes, from the heels to the metatarsals versus an extrinsic muscle being something that attaches maybe from your tibia down into your foot.
00:10:42
Speaker
Oftentimes we find that if you don't have the intrinsic stability before you train the extrinsics, or if I were to break down the foot, we've got the small muscles of the foot, which are kind of the protectors of the foot. And then we've got some longer, skinnier muscles, our tib posterior coming down the inside of our foot, our fibularis longus or pronus longus coming down the outside, which are kind of the positioners of our foot. They get it ready to land on the ground. And if those are doing a great job,
00:11:11
Speaker
now our calf can be this powerful muscle that can push us forward. But if we don't have all three of those working in sync and working in harmony, then problems start happening at the foot or things are gonna break down at the foot and we're gonna see problems in terms of symptoms at the foot, which may or may not be the actual problem. Up the chain, I think we have to think about this beautiful system that we have that's built into our lower extremity where
00:11:40
Speaker
we've got a gazillion hip external rotators and we don't have many hip internal rotators. We've got a lot of muscles that supinate our foot. We don't have muscles that pronate our foot. And the reason is because when our foot hits the ground and we have gravity and ground and reaction force coming together, that's the thing that creates this beautiful pronation internal rotation that when it's done correctly, it turns on all those muscles and they all together say, hey, it's time to now
00:12:06
Speaker
slow that down and then turn it the other direction. I'm going to slow down that internal rotation, that pronation to then accelerate that external rotation supination. And then all of a sudden I get everything gets propelled forward. So I can work on those little tiny foot muscles, but if my hips not doing a very good job, those muscles are far bigger and can do a much better job of slowing down things from the top.
Foot Mobility and Balance in Aging
00:12:29
Speaker
Absolutely. Absolutely. Um,
00:12:32
Speaker
Sometimes I have people come in and they're having foot pain. We look at their foot. There is, to use your phrase, there are toes pointing in the wrong direction, things like that. And a lot of the time I'll start working on techniques to help people, depending on the actual mobility. For example, sometimes if someone has a bunion in their toe,
00:12:52
Speaker
is really strongly abducted for want of a better description. I don't know what that's called. It's probably got a PT word and I'm embarrassing myself in front of my teacher that I don't know, but I sort of, I'll look at the mobility of the great toe and see like, is this a toe that potentially could be more, you know,
00:13:11
Speaker
oriented to point straight forward. And sometimes there's a level of stiffness that's preventing that. But, you know, if people are actively working on things like the strength and mobility of their feet, if they're doing their rolling on their ball and they're doing their exercises with their toes and all of that stuff,
00:13:28
Speaker
What do you feel? Because sometimes people sometimes come in and they're just like, this is how my foot my foot's always been like this. You know, I've always had a really high arch. I've always my toes have always been together. Bunyan is genetic. You know, how much do you feel like people actually can change the sort of bony shape of their foot versus like, and this is kind of what you got.
00:13:50
Speaker
Yeah, I think there's a few factors and I think, you know, one of the biggest factors is, is age, and that's not me picking on old people because I'm slowly becoming one. I mean, that if there are structural changes that happen with age and if someone's had a bunion for
00:14:07
Speaker
25 years, chances are there are now some bony changes that have happened. If someone's at the inside of their foot, like their navicular, is sitting on the ground and it's been sitting on the ground and they're 70 years old, I don't know how much I'm going to be able to truly change their structure. But I think that's why doing exactly what you said. It's like, let me feel that.
00:14:28
Speaker
does it feel like can I can actually grab their toe and make it look somewhat straight? If I can, it probably can get there. If I'm grabbing their toe and it just feels like I'm running it into a brick wall, that's someone I'm going to have to adapt around. And so I think there's those folks we can figure out, it's like, no, they actually can make an arch.
00:14:45
Speaker
Like, as you said, people come in, my feet have been flat like this forever. And then you just have like twist their hips side to side. And as they twist their hips, you see their arch go popping up. It's like, no, there, there's actually an arch there. Like it's just, there's some motor control. There's some musculature that's not really doing a good job versus if they're twisting back and forth and their foot staying flat on the ground or I grab their foot and I try to move it around and see that that's really flexible. So I know I, with my hand, I can make them have an arch.
00:15:13
Speaker
or make their foot look normal, I feel pretty confident that they can as well. It may take some work and some time. If I'm sweating using all my might to try to mold their foot into something normal, chances are I'm not going to make it look amazing. Is there a little bit of difference I can make?
00:15:31
Speaker
that their foot slowly started falling towards the ground, and it was only the last millimeter that caused the problem, that if I can give them that millimeter of arch height back, that that makes a difference, then absolutely, I think we need to maximize each person's potential biomechanics that they have to have as good a foot structure as possible.
00:15:53
Speaker
That's so cool. And I love the, the, you talk about how the, the issue coming up for somebody, maybe just that last millimeter. I think sometimes, especially in, uh, practices where something like yoga where that can tend to be very, like everything must look like this. It can be very sort of like top down that you're trying to mold yourself into this shape, including like what you're, you know, the positioning of your feet where.
00:16:16
Speaker
to your point, it may be that you don't actually change the, you know, standing structure, the static structure of the foot that much, but you may be able to make the change that gets the person out of pain, even if the foot doesn't then look like, you know, what a foot is, you know, quote unquote, supposed to look like. Yeah, absolutely. Because I think we see plenty of people who come in who
00:16:36
Speaker
We look at them and my shoulder, my neck hurts and oh yeah, it's your posture. And they'll say it flat out to you. It's like, but this has been my posture for 25 years. I can show you a picture of me for 25 years, but you ask them how long have you had pain and they say a month. So it's probably having that posture for 20 years finally broke something down, but why a month ago did it become a problem? Was it just that they lost that? They're 1% further into that posture that puts stress on something.
00:17:06
Speaker
Sometimes in my mind, treating, I go, first things first, get them to a month ago. Because if I get them to a month ago, they're probably out of pain, but they're still living at the extreme where they don't have 1%. 1% is going to put them back into pain. But then it's like, and then can I take them a year ago? So maybe that gives them a 5% window to then be able to move and function that gives them that space where they probably won't end up in pain, or at least if I've
00:17:33
Speaker
given them some strategies to not allow themselves to get that get it right into their end range. That's very cool. I like that a lot. You know, in yoga in particular, there are a lot of standing balancing poses. There's a lot of poses where you're, you know, on one leg or you're maybe on both or you're
00:17:51
Speaker
You know, you're kind of not even paying attention to the leg you're on because you're trying to do something crazy with your other leg, like wrap it around your head. I used to, I don't do any of that stuff anymore, just to be clear. You gave up your, your yoga career. Yeah. When I was about one and I had flexibility. It's all downhill from there. Yeah.
00:18:11
Speaker
In terms of when we think about balance and how people achieve balance in their body, how much of it, I know we talk a lot about things like ankle proprioception and things like that as a source of how the brain is understanding where we are in space. How much do you think the sort of strength and mobility work that people do for their feet impacts their overall ability to balance and how much do you think it's
00:18:33
Speaker
related to actually understanding how to create more sort of global tension through the body. In particular what I see for people is that they're trying to balance, they're trying to do everything at the ankle and there's like a whole huge amount of movement but when we actually get them to sort of create some
00:18:52
Speaker
contraction through their lower abdominal muscles, through their lateral hip, things like that, that changes everything. But it's not to say that the foot is not important. What are your thoughts around where people can get the most bang for their buck if they're trying to improve their balance? Is it with the feet? Is it other places in the body? Yeah, I don't know if I want to go out on a limb and say it's one versus the other. But if we start with the foot, because
00:19:20
Speaker
We, you and I and hopefully some of your listeners know that there's multiple strategies for balance we have an ankle strategy which is, you know, normally the first one we use for those small perturbations and then as we start losing a little bit more balance we start going into our hips and they sway a little bit and if they get too far out then we, then we step and so
00:19:37
Speaker
So I want to know that the feet are doing what they're supposed to do so that I don't have to go as much into those other ones. But once I get into the other ones, yes, I certainly want to know that the hips are working well and someone has good core stability to be able to stabilize at that point in time. But back to the feet.
00:19:57
Speaker
If someone doesn't have the mobility, so with an ankle strategy, you need to be able to planter flex and dorsiflex. You need to be able to invert and invert. You need to be able to pronate and supinate. And if those are lost, back to someone who's been in shoes and
00:20:13
Speaker
their dorsiflexion is zero, so they can't pull their toes up. The minute that they lose their balance going forward, they have no strategy at their ankle. Their tibia can't move forward to help them balance, so where do they have to go?
00:20:31
Speaker
to their hip, and there's actually an interesting study last year just because I like to nerd out on this stuff, but they looked at folks and they looked at their foot posture index, which it's like six different measures. You look at how high the medial side of the foot is, calcaneal position, toe position, and they found that people sway increased in those who had a really rigid foot.
00:20:57
Speaker
And then people's ability to reach out of their center of mass was decreased in a very pronated foot and a very supinated foot. And my takeaway of that was you've got a really rigid foot. I talk a lot about windows. Their window for movement is small because a really rigid foot doesn't like to pronate. So they really only have one direction to go. That really pronated foot
00:21:19
Speaker
They tend to just hang out, flattening it out, and it's hard for them to then shift their weight to the side. And so, you know, balance to me is all about creating this window of opportunity and space for people to be able to move. And if their foot can't move back and forth, if their tibia can't advance forwards and backwards, we start taking away degrees of freedom that then somebody has to take up somewhere else.
00:21:44
Speaker
And I'd say the population that I saw this clinically in was my older patients who had fall histories. Like I've watched them and they had zero degrees of dorsiflexion, 10 degrees of plantar flexion. Their foot was so rigid, they can't move in and out. And so all it took was a tiny bit of a perturbation in their balance. And if their hips didn't move fast enough, they had to take a step. And if they didn't, they were falling down.
00:22:13
Speaker
I think if we miss that part of the foot and having adequate mobility in multiple planes of motion to be able to soak up any of that perturbation, I think we need that as a base and then we then absolutely going up the chain. But if someone doesn't have that strategy at their ankle, boy, yeah, I'd better make sure that the stuff up the chain is doing a much better job.
00:22:41
Speaker
It's so interesting when you talk about the sort of older population, because you certainly see, or I see as well, a lot of fear about falling and a lot of, you know, sort of manipulating their day-to-day living practices as a result of that, you know, being afraid, like, not
00:23:02
Speaker
trusting that like they can stand up out of a chair without also using their arms or not trusting that they can walk through the kitchen without holding onto the counter, things like that. And I think it's interesting, you know, I feel like for a lot of, you know, what I call gen-pop, which is just non-professionals, I think for a lot of gen-pop, like they sort of the same way that we've, you know, in our society agreed, agreed.
00:23:28
Speaker
that as you get older, your body's gonna start hurting, things are gonna start falling off or whatever, and you should just sit down and not stop doing things. And instead of recognizing that in some ways, unless you've been sort of doing it all along, this is actually when you kind of need to ramp
00:23:46
Speaker
up a little bit and start to address the things that you probably could have gotten away with not addressing earlier on. But now if you address them, that's going to actually change things. And I don't think that people necessarily link. I mean, it may seem obvious, but I don't think people necessarily link this idea of getting older and falling down with their feet necessarily. I think they just feel like, oh, I'm not as strong. And
00:24:13
Speaker
again, this idea around aging and strength that like you, your muscles just, you just get weaker or something, you know, and, and it's, I mean, obviously it's just, we know it's, it's not true. And, and I, I mean, my, one of my favorite patients that I used to work with was 102. And she walked with a Walker and I was like, that's fine. You're 102. You're amazing. You're coming into the clinic every week. We would do, she was tiny and incredibly strong. And, um,
00:24:40
Speaker
You know, just a testament to the fact that like, she hated it also, by the way, her daughter forced her to come and she complained the whole time. It was very, very funny. She was very entertaining, but her daughter at least understood that to keep her as healthy as possible, movement had to be just a really meaningful part of her life that was happening, whether she wanted to do it or not, basically.
00:25:03
Speaker
I just think that's a really interesting thing to start for people if they're working with older clients or older students. And a lot of yoga teachers will teach maybe like a balancing workshop or a ballet class where we're focusing on balance, things like that, and maybe take a lot of time to really work on that.
00:25:19
Speaker
range of motion and mobility through the ankle, as well as strength, so that they're not simply just like, well, try this pose. And if you fall over, just keep practicing it, but without like sort of a more guided concept to how, you know, rather than, because I could just keep working on it, but my foot, I'm not improving mobility in my foot. I'm probably not going to get that much better at it.
00:25:41
Speaker
Yeah, absolutely. And I frequently tell patients like if I'm doing something with balance and they're balancing, meaning they aren't falling down, but they're all over the place. And I was like, that's not what we're trying to train at this point in time. I'm not trying to see how out of balance. I want it to be challenging enough that I see your foot rocking back and forth and your foot moving and that happening. And I think
00:26:07
Speaker
circling back to this magical thing about age.
00:26:12
Speaker
For me, it's not age, it's activity. I go for a walk with my nine-year-old daughter and it's like, she sees a curb and what does she do? She goes and uses it like a balance beam. And as we get older, it's not like we're, I don't go seeking that out. And so she uses her balance. And so therefore her balance is better. And I don't care what age somebody is. If they start using it, they're probably gonna find it. Yes, they probably have some impairments that are gonna make it a little bit more difficult.
00:26:41
Speaker
but there's no reason why they can't gain it. I still remember a patient, this was probably 15 years ago. I had him skip in the clinic.
00:26:49
Speaker
And he's like, I honestly have no idea when the last time I skipped was. And so number one, it brought a smile to his face. Number two, it was beneficial for what he was doing. But I remember he checked out, made his appointment. And all of a sudden I look out in the, as he's going to his car and he's skipping to his car. It was just like this like magical moment of like childhood coming back where it's like, why don't we do this? Like skipping is a great balance exercise. It's fun. It's hard to skip and not smile at the same time. If you're smiling, you're probably having fun. It's probably something you're going to keep doing.
00:27:20
Speaker
Totally. Totally. One of the things Laurel and I talk about is how, especially here in this country, we tend to turn, everything becomes work. Like even fun sometimes becomes work because we get, we have that sort of like, you know, achievement mindset around it where we lose sometimes the joyfulness of just moving for the sake of moving, not like, well, I'm training for something or I'm, you know,
00:27:44
Speaker
working on my technique of blah, blah, blah. Like sometimes, I don't know if you ever watched Friends, but there was an episode where Phoebe ran, and the way that she ran was just like crazy arms and legs. And one of the other people on the show was like, what are you doing? She was like, it's so much more fun this way. And so then they just like ran around, just totally crazy. Yeah, I have a good friend of mine who's a professional triathlete, and he's doing a lot more like mindfulness things when he runs. And so one of the things he,
00:28:14
Speaker
Yeah. He's been talking about lately. He's like, you know, I go out and I like, I high five the trees. He's like, I pretend like I'm coming down the finishing line. And so I just started doing that where I just like go for a run. I high five the trees, like they're fans. And it just, it changed my, it changes my run from just being one foot in front of the other to like looking around and oh, there's a bush. I got low five the bush. And then I'm changing my body, changing my body position, challenging my balance differently and being a little bit, just being a little bit more present in the moment during, during the run. Totally, totally. I love that. I love that.
Debunking Running Mechanics Myths
00:28:44
Speaker
Um, I'm glad we're talking about running because I wanted to ask you because I am, I am a non runner. So I, whenever someone who is a runner comes on, I want to take advantage of the fact that they know a lot more about this than I do. Um, is there, you know, I remember learning about running mechanics from you in school and you know, all the different pieces of it. Is there something, is there like sort of like, um,
00:29:07
Speaker
you know, one greatest myth around running mechanics, like everyone pronates too much or people are, you know, their stride length is too long or they're hitting the wrong, like what do you, what do you see when your runners come in and they're like, well, the problem with my running is like, what, what do they think is the problem that maybe isn't? Yeah. So, so I, I, I got to give you, I got to give you two answers just because I don't know who all is going to be listening to this. So I, I got to give the answer of.
00:29:37
Speaker
what the society of non-runners says. And that is, aren't you afraid you're going to get arthritis from all this running? And so I just want to put it out there. The research says, absolutely not. Our bodies are meant to be able to handle that stress. Sedentary people get arthritis at a greater rate than those who run. So just want to put that away in case you're like, oh, don't run. It's bad for you. It isn't bad for you. Loading our joints is good. But then going back to the
00:30:07
Speaker
the average runner who comes in, I would say, and I think it's, they go to running shoe stores and they're, and this is, I'm not bagging on running shoe stores because I think there are some people who work in those stores that are amazing and probably are better at analyzing running than me. And it's never about the fact that I have degrees and silly letters behind my name and they don't, but I get so many who come in who,
00:30:36
Speaker
The first thing they say is, yeah, I was told I pronate. And so they gave me these $150 overbuilt shoes and these insoles to put in them. And to me, it's like, when someone says I pronate, I'm like, yes, I want you to pronate. Pronation is a good thing. Pronation loads the entire system so that your muscles know what they can do. And so we've got these overbuilt shoes for their feet. And even though, again,
00:31:03
Speaker
nerd me. The research completely shows that trying to put a shoe on a foot type doesn't change injuries in any sort of way. So I think that's one of the big ones. And I think the other one is that there's one correct way to run. And I think this is something that's taken me time because I'd say
00:31:24
Speaker
10 or so years ago. I read the book, Born to Run, and I think anybody out there who deals with runners should read that book just because it's a beautiful story about running, but there's some great
00:31:36
Speaker
biomechanics about running in there. And there's some great anthropology story that's written about human evolution and running. But I came out of that book going, everybody should forefoot strike or, or, or, or, or midfoot strike. If you don't, you're not, sorry, what is that? What's forefoot strike?
00:31:54
Speaker
Okay, so people tend to run and land on three different areas of their body. They either land on and hit their heel first, so that would be rear foot striking. They tend to land somewhat of a flat foot, which would be mid-foot striking, or they land on their toes, which would be forefoot striking. And if anybody is listening to this right now, what I would do is pause it and then
00:32:19
Speaker
something I do when I do this lecture every single year just stand and jump up and down and just feel how you land and then jump up and down and land on your heels. So now you've you've restarted the podcast and and hopefully when you're landing on your heels you're doing something like
00:32:37
Speaker
And you realize that you lose a lot of shock absorption when you land on your heels because you don't use your calf and your Achilles tendon to store energy. And so in my mind, I was like, everybody needs to do that. Why wouldn't we want to use this beautiful calf and this beautiful Achilles tendon that has a ton of elastic fiber where I get free energy from it? And so I wanted everyone to be a forefoot runner or a midfoot runner. And then I realized that not everybody can. They've run for 30 years in a
00:33:07
Speaker
in a different way. And so it's like, oh, all I'm going to do is create Achilles tendon. I just send that person. I'm going to give them another overuse injury. And so my running approach, and this is a term from another guy out in the podcast world, ZDoggMD, but he talks about taking an alt-middle approach. So my alt-middle approach is that
00:33:32
Speaker
Rather than saying everybody needs to forefoot a midfoot strike or some people need to heel strike, it's like let's try to make people efficient. Dan Lieberman, who's an anthropologist at Harvard who wrote this beautiful study in Nature about running, I heard him talk a few years ago and it was really the switch that was made in my mind. He's somebody who runs in
00:33:55
Speaker
either barefoot or the tiniest little sandals. And he said, you know, I used to be really pedantic about everyone should barefoot run. And then he said, but over time what I've realized is I should teach my runners to run efficiently in whatever shoes that they run in. And so if someone's a bit of a heel striker because they don't have great range of motion to be able to get hip extension, then I need to make them better at that. If they're a forefoot striker or a midfoot striker, I probably need to maximize their range of motion and
00:34:24
Speaker
strength to be able to do that. That's very cool. I like that a lot.
00:34:31
Speaker
And it goes back to, you know, a lot of the time, the conversation, a sort of similar conversation that's taking place in the yoga world or some parts of the yoga world right now is this idea that there is no, this idea, this concept of like neutral posture or spinal neutral, like is not something that really exists in the world. And it's not, it shouldn't necessarily be a goal to try to like take everybody you work with and jam them into that shape. And what I see in my practice as well with things like this is like,
00:35:01
Speaker
you know that you do what you you maybe are ending up causing new just causing new problems because that's not the mechanics of how their body works well so that it's more about things that we we consider like you know range of motion strength
00:35:16
Speaker
mobility, motor timing, the way the muscles are coming on, and that the person's bones, for want of a better word for it, skeleton is probably the better word for it, but their skeleton will. What is it called when all of the bones come together?
00:35:32
Speaker
Does that have a name? Did I learn that in school ever? But that will sort of optimize where their bones like to be, I guess, for one of a better way to discuss it. Yeah, and I gotta go back to the thing I keep talking about.
00:35:51
Speaker
I hate that whole neutral position. For me, it's my neutral window. It's like I need to create space so that someone can move safely in a broader range of motion. And sometimes I'll talk to patients and I'll say it's like a sliding door.
00:36:07
Speaker
like is the door only open enough that you have to go sideways through it because that's it that's like you're only safe so unless you you can move through it like that it's like okay then what's my job my job next is to open their sliding door so they can walk through facing forward it's like it's that wide but they still might bump their shoulders into the door and into the
00:36:26
Speaker
into the door jam. It's like, but can I open it a little bit more? And now they can walk through without touching it. And then I can walk through it a little bit more. And now they can take multiple options through that front door or through that sliding door without bumping into either thing. And so, so to me, that's the neutral I'm looking for is creating that space so that they have more options for movement that doesn't put them at end range. Cause like, I agree.
00:36:50
Speaker
or one of my patients who had had L5-S1 fusion and then he had L4-5 fusion and he came in and he was like, I'm going to this yoga class and let me show you some of the poses and I was like,
00:37:05
Speaker
Like he did not have the, like every pose that he was doing was at complete end range. And I was like, do you want to have the next level fused up? It's like, you need like, I don't know yoga, but I know that you're at end range and I feel like you need to be in a range that's not always holding you at that spot. That spot, if you're trying to hold every pose at that last.
00:37:25
Speaker
that last 1%, something is going to break down. You've got to come back out of that. If someone tried to take me and get stretching something that everyone else should do, I honestly don't, but try to put me in downward facing dog. I'm a downward facing T-Rex. My shoulders don't have the motion, my hamstring, my nerves. And so I need someone to modify that for me because my ugly looking downward facing dog is still probably in range. And if I'm there,
00:37:53
Speaker
It's probably not the best thing for me. Yeah. Yeah. Yeah. It's, um, I love that idea of a new window or a sliding door versus, you know, you're trying to get someone into a position. I think it's, it's really so much what we're trying to help people do is give them options and give them, uh, strategies for movement so that that's not.
00:38:16
Speaker
strategy is not only you know hold on to the handrail when I'm going down the stairs because otherwise I fall things like that. Yeah and I've been to some amazing yoga classes where the instructors have done that where it's like
00:38:28
Speaker
gathering every block to make me. Sorry everyone else in class, there's none left for you because I've got it propped up. And when I got propped up, I'm like, oh, now this feels like a place that I can be and that I can hold this rather than that previous spot was not a spot that I could hold. It's like, I don't think that I'm supposed to be in pain. I don't think that's the purpose of this.
00:38:49
Speaker
Yeah, and I really think, and I think most of our listeners do too, whatever their movement modality is, that one of the skills, one of the super skills of being a movement teacher is the ability to have so much range, how many ideas in your head of ways that you can help somebody
00:39:05
Speaker
you know, change a pose, regress it, put a block, do something different, turn it upside down so that everybody in the room gets to participate versus three quarters of the room are totally happy because they possess the, you know, the range and the flexibility and the strength to be in the position and then like 25% of the people are just sort of
00:39:22
Speaker
trying as hard as they can, but kind of bummed out. And then there's always the one person in the corner who's just like, well, I can't do this, right? So that's not a yoga class. Now that's just like a show off class, right? Now it's just like, well, who's the bendiest? Who's the strongest? Who's
Inclusive Yoga Practices
00:39:36
Speaker
all those things? Yeah. And I don't even know if the bendy person who's hanging out at end range is doing that much good for themselves either. I think that super, super bendy person needs to back off 10% as well. So they're working within that, their neutral window of movement instead of end range.
00:39:51
Speaker
Right. And that's, you know, as a, as a bendy person, I've backed off of so much of what I used to do. And it's a very sort of, if you have that, if you're hypermobile, or you have just like a lot of range of motion, it's very easy. And yoga often indulges us to in that just kind of like,
00:40:08
Speaker
flop and hold thing where you just get to that end range or you're using, you know, other parts of your body to wedge yourself into that end range, but you actually don't have the strength to put your body there without it. Right. And so, like, again, a lot of a lot of yoga and movement teachers are really starting to see that and are starting to with any of their own practice and within the way they're teaching pull back from that kind of like showboat, like, oh, I'm balancing on one arm and I've got my leg behind my head, you know, which is actually how I
00:40:36
Speaker
uh, murdered my hamstring one time, uh, you know, and I, because I was just like, well, I can do this. And then it would pop. And I was like, Oh, that, that was bad. Um, and, and realizing what's actually important. And again, you know, as we get older, what's important for our body to retain, uh, health and strength and mobility versus just continuing to push for this end range and, and, you know, for, to, to what end?
00:41:04
Speaker
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00:41:33
Speaker
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00:41:56
Speaker
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00:42:16
Speaker
I want to switch topics a little bit.
Psychology in Performance Enhancement
00:42:18
Speaker
So you specialize in performance psychology for your patients, or it's been part of your study. For listeners of ours who are unfamiliar, what is performance psychology? Performance psychology is really just the study of how to optimize human performance.
00:42:38
Speaker
A lot of people are familiar with like sports psychology, which is performance psychology for specifically the athlete to improve, improve the athletes performance, but it's a, it's a much broader. Practice or much broader subject in terms of performance psychology can be for the student. I use it. It's one of the reasons I went back to get my PhD in it is.
00:43:03
Speaker
I saw two groups of people that I felt like I was reaching a lot of them and not all of them. And it was my patients and it was those who were struggling with motivation or goal setting or not getting the performance that I thought that they could, that I was like, I need to know more about how to get into their psychology to help them. Or it was my students where they were struggling. It might've been motivation or resilience or,
00:43:30
Speaker
not feeling that they had self-efficacy to be a good graduate student. I was like, I really want to know more about this. And so the field looks at all of those. It's how to make a worker a more efficient worker or a worker who enjoys their job a whole lot more because we know that when people enjoy what they're doing, they tend to be more productive, whether that's a student, whether that's an athlete, whether that's the average human being who just wants to be more healthy.
00:43:56
Speaker
That's interesting. So what are some techniques that you use with your patients or that our listeners could maybe start trying to adapt for themselves if they're trying to practice more or if they're trying to improve their teaching or if they're just dealing with any of those sort of self-doubt
00:44:15
Speaker
aspects of working with other people because it's not easy. It's not easy to be in the human service industry, which is sort of what we're in, right? The human body service industry. I think if there's one thing, it's
00:44:32
Speaker
And to me, this is like, this is a performance psychology technique, but I think it's what I might've been missing where I then get to fit these things in. And it's understanding the patient's perspective, understanding, you know, it's like, what is not motivating about it? What are their goals and how can I help them with their goals? Why don't they have self-efficacy? So back to yoga class, if I go into a yoga class,
00:45:01
Speaker
self-efficacy being, do I believe I have the ability to be able to do this? No, I'm going to walk in going, I know that like 90% of the poses, I can't do them well. And so if I go into a class that just proves that to me, then guess what? I'm probably not going to come back versus if you give me self-efficacy, if you say, Hey, Ben,
00:45:24
Speaker
It's okay that you don't look like that. Here's what we're aiming for. We want you to be able to get into a pose that looks something like this. And then it's like, oh, I feel like I actually can do this. I'm optimistic about the fact that I can change. Or you could show me someone across the room. This person four months ago looked more like you and they've been working at this and look where they are now. Oh, great. It's like now I feel like I can and I feel more optimistic that I can get there.
00:45:54
Speaker
But I think it's all too easy. I see this a lot, at least in PT, and you can tell me if you see it in the movement world, where there's a lot of patient blame and client blame that happens. And if there's one thing that I can change going forward, and I hammer the students now about it,
00:46:17
Speaker
The minute that we start blaming someone, it's like they're lazy. It's not important to them. They're not taking the time to take care of themselves. To me, that's a client blaming thing. And chances are if I'm blaming a client, it's because I didn't do a very good job of getting to know the client. And so it's my ego getting in the way of them being able to
00:46:47
Speaker
maximize that client's potential.
00:46:54
Speaker
I heard a guy on another podcast a few weeks ago, I was named Daniel Schbacktenberger. It's like too many continents and he needs to buy a valve. But he said this really interesting thing that I was like, wait a minute. So he was talking about stages of development.
Client-Centered Treatment Approaches
00:47:12
Speaker
And it used to be that we thought that when you did perspective taking, that was a really high level of development where you actually sought someone else's opinion.
00:47:20
Speaker
But he said what they're finding now is the higher level is perspective seeking. And I was like, that's the thing. It's like we have to put our ego aside enough to go, I need to seek the perspective of each of these people. What is it about them that's
00:47:37
Speaker
that's not allowing them to maximize their potential. I know as a PT, if I were to ask 100 PTs, what's the most frustrating thing in the clinic once they got through like documentation and stuff like that, they'd say, patients who don't do their home exercise program. It's like, why would they come in to see me who went to school for all these years, who gives this amazing advice and they go home and don't take it?
00:48:04
Speaker
That's a me thing. That's an ego thing. Versus why? Well, maybe my question should be, hi, can you share with me why you haven't done that? Because they don't understand it. They don't like it. It doesn't make them smile. They don't have the time.
00:48:20
Speaker
They don't see the connection between why you're doing it. Just because I know in my head, and I've answered all those questions for them, it doesn't mean that they haven't. I think when we get to that point where we see it from their perspective, we can truly modify it in a way that's meaningful for that human and not trying to put a one size fits all on everybody and not letting my ego get in the way.
00:48:42
Speaker
I guess they just don't want to get better. It's like, well, I don't know. Maybe they don't know how to get better. Maybe my amazing pain talk I gave them just didn't resonate, didn't hit home with them. And I need to come up with a different set of analogies. I've used my window and my sliding door analogy a bunch of times. Maybe for that person, it makes no sense to them. So I need to be more creative. I can't. It's not their fault. So I need to go in with that assumption.
00:49:07
Speaker
it's not their fault, their motivation is because of me. I'm not finding a way to motivate them and I need to find some skills, some skills to get to that. So I think that's one part of it. So that's like a super long answer, but I'm gonna add another part because I think it fits this and that for those who haven't heard of it, I would encourage everybody to go out and read about the trans theoretical model of change. And when I learned about that model, it made a huge difference in my life.
00:49:37
Speaker
what the model says in a nutshell is before someone changes, they're in one of five different stages. They're either in the pre-contemplation phase, the contemplation phase, the preparation phase, the action phase, or the maintenance phase. And so what that means is to pre-contemplation, someone isn't even intending to change their behavior versus contemplation. They're like, oh yeah, I guess I have a problem. Maybe I should do something. And then preparation, they're actually intending to do something.
00:50:03
Speaker
And what they find with this research is that you can't take someone from pre-contemplation, they don't think they have a problem, to action. But I think we try to do that a lot, where it's like, well, you came to PT, or you came into, you know, for a Pilates session or for a yoga session, you must want to change something, and then they don't, and we're like,
00:50:23
Speaker
What's wrong? It's like, oh, no, they didn't have any intention to change. And so if they don't have an intention to change, my whole goal is just to get them to acknowledge that they need to change. Because once they have that, now I can then set them up to what are ways to change. And then finally, I'm getting to that action phase. But I think there's this assumption that because someone walks in the door, they're ready to change. And one of my biggest mentors was my old boss. And he would tell me, he's like,
00:50:52
Speaker
Not everyone who comes to PT is ready for PT. He's like, you might see some people year after year after year for the same thing. And finally, the fourth time you see them, they come in and they say, you know what?
00:51:06
Speaker
I realize I haven't gotten better because I haven't done the things that you've asked me to do and I'm here and I'm ready. It's like, oh, that person's in the preparation phase. They're now ready for my action plan. And I can move that person forward. But I think the ones that we get frustrated on, it's because we expect that because they came and walked in the door, they're completely ready for action and they aren't. And again, that goes back to perspective seeking. Where is this person coming from? Why are they here? What is their purpose? And then what is the next step I have to take with them?
00:51:34
Speaker
I think that's so interesting. I think one of the things we see a lot in the movement teaching world, you'll have, I mean, this is true for me as well, you'll have clients that you work with privately. You go to their home and you teach them for years.
00:51:51
Speaker
I'm thinking of one person in particular that I've worked with for a long time, and the times that I've tried to introduce different things, like maybe a little bit more strength training, a little bit more something else, it's not really very well received. And I finally sort of realized,
00:52:09
Speaker
to your point about, is this person ready to make a change? That's not why I'm there from their perspective. It's not about, I'm there to make sure that something happens at all. Because if I'm not there, it doesn't. And then
00:52:22
Speaker
understanding that that's that they're not trying to they're not trying to get out of something they're trying to just move at all basically right and I think that's you know I think there's there's people who come into the PT clinic for the same reasons and they they want to just make sure they want to sort of have a
00:52:40
Speaker
some combination between a cheerleader and a cop, telling them what to do, keeping an eye on what they're doing. They want someone professional watching them so that they're moving well. But the goal is not to ever graduate. And that's sort of its own category of people, I think, as well. But it is so easy to do what you're saying, to sort of lob it off onto the client and be like, oh, well, they don't want to get better. They don't want to change this thing.
00:53:09
Speaker
In fact, they may not even understand that they can. And then that's, to your point, that's a lack on our part in education and communication and understanding the building blocks of the character, the personality of the person that we're working with so that we can talk to them in a way that is
00:53:33
Speaker
uh creates an opening you know and i and i think it is easy if we if we're not if we don't have that malleability in ourselves to be able to understand okay well this person actually wants a little bit more of a drill sergeant and this person over here i have to kind of hold their hand a little bit more you know that that we have to have that malleability in ourselves to be able to not only see that but change how we approach people and i think people run into trouble when they when they're just like well this is how i am and you know you have to just
00:53:59
Speaker
work with me the way that I am, I'm not going to try to adapt anything about myself to try to help you get better. Yeah, and it's well known that information on its own does not change behavior that much. There's, there are, I would doubt, many people who smoke who don't know that smoking is bad for them. There are many people who don't eat well, who don't know that eating better
00:54:23
Speaker
So they have all the information and it's not the information, it's the motivation. And so I can't just say, here, but let me tell you how good this is for you. That person has to be in that space that they want to make that change. Otherwise, it's just me.
00:54:40
Speaker
singing platitudes about all this great information I have that's falling on ears that aren't yet ready for it. And it's not that the person is a bad human being. They aren't ready for it. Or I need to change my approach to make it more meaningful for them. Or I need to get to the real bottom of their motivation, to your point. Some people just want someone to be their accountability partner. Is there a problem with that? No. Some people
00:55:10
Speaker
Their goals are lower than my goals. Is that a problem? No, I should get them to their goals. No, when I get there, I might ask them, it's like, you've reached your goals. You got there quickly. Is there something else now that you've gotten here that you'd like to? Yeah, actually, I didn't think that I would be able to do this. Do you think I can? It's like, great. But it's coming from them rather than from me. It's like, sometimes I need to get out of my own way and just listen to the person who has the answers. And that's that person sitting across from me. That's right. That's right.
00:55:40
Speaker
This has been a fascinating conversation and wide ranging and hopefully for our listeners, very interesting as well. Thank you so much, Dr. Ben Cornell for coming on, sharing some time and your wisdom with us. And I'm just gonna stop saying, ah.
00:56:00
Speaker
Nice space filler. Yeah. All right. Thank you so, so much. We really appreciate having you on the show. Thanks for having me. I always enjoyed having you in class. I've said your name in vain a few times, even over the last couple of weeks, having conversations with people and not in vain. It was actually having conversations about, Hey, I had this prior student who had a ton of knowledge who came in here without ego and was open to learning who I got to learn from, who learned from me and just, you know,
00:56:30
Speaker
My parting words are, I think we all can learn a lot from one another when we don't set ourselves up as, I have a PhD, I have more knowledge, you're a student, you know nothing. It's like, let's have conversations, let's learn from each other as professionals who wanna make people better and have conversations between us and the people we are trying to maximize their ability to move through this world. I love it, thank you so much. Absolutely.
00:57:01
Speaker
Well, I think we can all agree that was a great conversation with Dr. Ben Cornell. Thank you so much for listening. If you enjoyed today's episode and you want to support us, please subscribe, rate, and review on Apple, Spotify, Stitcher, or wherever you listen to podcasts. And if you'd like to watch, head over to our website at movementlogictutorials.com slash podcast, where you can catch the full unedited video version. We'll be back in your ears next week to nerd out about movement without taking ourselves too seriously in the process.