Steve Gangemi: Raising the Bar for What "Healthy" Means (LBP 032)

Dr. Steve Gangemi, aka The Sock Doc, is a chiropractic physician and MovNat certified trainer who is merging functional neurology and nutritional biochemistry into mainstream natural healthcare. We talk about foot health as a gauge of a person’s overall health, the recent Vibrams 5 Fingers lawsuit, orthotics, the dangers of stretching, why you want to move your ass often (but not too quickly), the long-term effects of doing only high intensity workouts (if you're dealing with adrenal burnout and/or thyroid and hormonal issues you'll want to check this out for sure), and much more.

*PS Huge gratitude to the lovely Julie Angel for introducing me to Dr. Gangemi's work!*




Show notes

Brooke: You are a huge advocate and an educator about natural injury treatment and prevention. In particular, you work a lot with athletes and I know that can be a really huge topic, but can you give an overview of what that means?

Steve: Sure, I guess it's multi-fold. Usually when I see someone first out they don't really see me for injury prevention or health enhancement or performance enhancement. Usually I end seeing someone because they've been injured. My philosophy being the way I treat has always been figuring out why someone has certain musculoskeletal or nervous system or even vitamin, mineral, or hormonal imbalances, to understand why they may be injured, rather just go and put a Band-Aid on whatever problem they may have.

Say someone all of the sudden has developed say Achilles tendinitis or plantar fasciitis one of the common foot problems. I like to go through and assess the entire body, not just the foot and ankle where the problem may be but to see how they may have developed that injury and then trace it back to the problem and hopefully resolve not only why they got it but also prevent it from happening again. I do that through a lot of natural hands on therapies, like trigger point therapy. It's a lot of body work, some acupressure work, a lot of nutritional therapies, lifestyle intervention, exercise rehabilitation programs and that sort of stuff.

I shy away from even certain modalities, like ultrasound and e-stim and things like that, even though they might be part of other therapist's protocols but I'm actually more of just a hands on type of guy and one who believes that we can fix everything through moving better and eating better and living healthier lifestyles.

Brooke: It's interesting you mentioned e-stim and ultrasound because they show up in a lot of offices. Are there some reasons why beyond what you just discussed that you shy away from them? Are there things you don't like about them in particular?

Steve: I'm not against them if someone is actually seeing some benefit from them. Let me say it this way, I think there's better methods to correcting someone's problem if the physician or a therapist is really skilled at understanding how to address the human body. I think most of these things if not all of them can be addressed through the lifestyle and exercise interventions and especially through hands on therapies.

In other words, you can get a lot of the muscle work done, a lot of the structural imbalances done through certain manual therapy modalities using your hands, using certain exercise and rehabilitation protocols. I've just never seen the need to actually have someone need to go and get some other therapy done, in terms of physical therapy modalities, whether it be like we said like an e-stim or ultrasound or one of those other typical therapies, even though they might not be harmful. I just don't tend to see a need for them.

Brooke: Unless a person has the obvious injury, like they had a car accident or skiing accident or something really clear, oftentimes people will say it came out of the blue which as we know isn't reality and that's also the most common way that people wind injured is the, "I don't why it happened," kind of mysterious origin stuff. Can you touch on why or some of the reasons why this does happen, this out of the blue type of injury?

Steve:Basically it comes down to that eventually if you trained wrong if your live an unhealthy lifestyle, if your diet is poor, if your too stressed out, whether that be working too many hours during the week or too stressed out at home or you're not sleeping well or just little things adding up here and there, too much overall stress then eventually your body breaks down and it can't recover to the ability to which you're putting the stress under it.

It comes down to the old training equation. Training is working out plus rest and you do your training too hard or you're not resting to balance out that stress period where you're training. What it comes down to is that eventually some area in your body is going to fatigue, whether that be your shoulder, your ankle, your back, your neck it can result in headaches and it can also be from too many stress hormones.

If you're pumping out a lot of cortisol or epinephrine because you're just pushing yourself too hard overall in your lifestyle or training too hard then those cortisol imbalances and stress hormone imbalances can actually create musculoskeletal imbalances that will then result in someone becoming injured. All of the sudden you're out running one day or you're training, doing whatever and your foot starts to hurt and someone tells you, you have plantar fasciitis or shin splits even. That's just because your body has slowly altered the balance of the muscles in your foot, ankle, lower leg as a result of your training too heavily or as a result of your increased stress hormone level.

Eventually it catches up with you. The next thing you know you've got a little muscle imbalance and that muscle imbalance results in bio-mechanical instability so muscles aren't working as properly as they should. They're not balanced as well as they should. Then you end up with an injury when one area is working harder than it should or another one is not working as sufficiently as it should.

Brooke: It's worth mentioning that you are somebody who really uses your body- you're talking about rest and you're somebody who has competed in multiple Ironmans and you're a really physical person, so it's possible to get your general level of health to a place where you can really exert yourself without being at risk.

Steve: Correct. When you get to a certain level of fitness like that elite level, you're always riding that fine line. You know we say that red line between fitness and in health where the more and more you push your fitness level to try and just achieve that little bit extra to try and do that little bit more then your health suffers to a certain extent. The key is to find a balance between those two areas and not beat yourself up so much so that you're injured or sick or come down with even a bigger type illness like an autoimmune disease or something like that.

To find that balance so you can excel to a certain level without your health suffering, but I've done enough Ironmans in the past where you're just running your health down just that little bit to exceed that little bit extra. It's okay if you do that I think for a competition but you've got to be careful about doing that too much, too often because the next thing you know you don't recover well or you end up with some chronic injury that you just can't resolve and you can't figure out because it's due to an actual physical depletion of vitamins, minerals, hormones in your body and not just a straight out structural shin splint, shoulder problem or whatever type injury. It's not local. It's becomes more systemic.

Brooke: You have a quote, "Move your ass often but not too quickly," so can you expand on that a little bit?

Steve: I think I wrote that from all of the hype, and it's still out there, about the HIIT workouts, high intensity interval training. People are shying away from the longer, slower endurance type training, whether that be just a long walk or an aerobic type run lasting, thirty, forty minutes if not over an hour.

People being interested in the shorter high intensity workout: i.e. crossfit, sprints, heavy workouts really at high intensity which I'm all for when someone is in good physical shape, is healthy. The problem today is that most people are so time constricted, they only have twenty minutes, if that to work out so the high intensity activities are very appealing to them because if you only have twenty minutes you can get the most bang for your buck at least in terms of burning calories and burning fat throughout the rest of the day by doing some hard and intense for those twenty minutes rather than actually going out and actually walking a mile.

The problem is, if you're short on time then you're probably stressed out as it is. You're already excreting a lot of stress hormones as it is so doing these high intensity activities too often, too much throughout the week then you eventually break down. That's why you see a lot of Crossfit athletes who are really into it even if they're doing it three times a week, they end up being injured very soon after, several weeks after they get into that.

It's always important to be moving throughout the day. I'm a big proponent of always moving, always being active, not sitting too long in a chair, not sitting too long at a desk but moving as much as you can throughout the day at different intensities but doing it always high intensity can become a problem. Your body is going to break down and suffer from it. Maybe it will start out with some sleep problems, energy issues, blood sugar handling problems, and then result in maybe more of a body illness where you're getting sick often or you're not moving as well as you should. The next thing you know you've got a crick in your neck or a backache or some tendinitis somewhere.

It's important to move often but don't always be doing high intensity too quickly, too often all the time. You've got to mix this stuff up depending on where your fitness level and your health level are at the time in your life, in your training.

Brooke: Yeah, your article on that which I'll put in the show notes for people really got my attention because I had been doing HIIT training at a really smart training center run by an OT and I loved it, but I came into that off of a crazy, stressful period in my life and I had to deal with adrenal and thyroid burnout and get my way back from that.

Steve: Did you get injured or you were just running down your hormones?

Brooke:No just running down my hormones. I actually didn't get injured, so that was lucky.

Steve: Yes, but you injured your endocrine system you can call that.

Brooke: I did. Yeah for sure.

Steve: Yeah a perfect example. That's really the only way when you get to that phase of depletion really a lot of times the only way to get out of it is to just do super easy workouts. I think strength can be included in that to some degree, like really controlled body work type or even some lifting to some degree but you definitely can't be doing too much like power stuff where you're doing high exertion, super sprints, hill sprints or even stuff like plyometrics to much because your body just can't handle that intense training for too often when you're that burnt.

Brooke: Yeah, it takes a while to get back from burn out for those who are listening and over training stop now.

You're a big advocate for going barefoot and foot health being tied to whole body health. I think probably a lot of people in the general public think of themselves as having healthy feet or they just don't think about their feet at all, but people would probably be surprised if they attempted to make their life a more barefoot lifestyle.

Steve: Correct. Let me say it this way. I'll say, "Well do you wear your shoes often?" They'll say, "Well I take them off when I get home and I'm around my house barefoot." Really for most people it's just they throw their shoes off when they get home. Hopefully at least that's a good idea. You're not wearing your shoes in your house but they're not really active in their house at that time, maybe they're cooking, standing at the kitchen counter, brushing their teeth maybe but usually they're sitting at their desk again getting work done, obviously on the couch watching TV and there's just not a whole lot of time where someone is actually active on their feet.

For most people what they realize is that once they are they end up with foot issues and they blame it on the hardwood floor or the tile that they're on or their type of flooring. Where a healthy foot, a healthy body you should be able to stand on any surface, stone, concrete, whatever really as long as you need to throughout the day and have zero body pain of course that includes foot pain from that.

A lot of people have lost that ability because they're wearing shoes throughout the day. They're wearing shoes that are too supportive. They're wearing shoes that control their motion. They're wearing shoes that are cushiony to their feet, helping to take some of the load off their body so they end up with really weak foot and ankle muscles and ligaments and tendons and as soon as they remove that brace if you want to call your shoes in a way a brace or a support device they really realize how weak their feet are.

Brooke: Foot health isn't just about feet. I think we're both similarly obsessed with getting the word out that foot health is actually a gateway to health everywhere in the body.

Steve: I actually wrote an article on the Sock Doc site called Healthy People Equals Barefoot People (in resources below) because really your feet are a great representation of how healthy you are overall. Now of course there's always going to be people out there who can be barefoot all day and they've just grown up that way and they have health issues, but for the most part your feet will be a good reflection of your health.

When you're run down, when you're body is fatigued whether emotionally or physically or nutritionally if you're not eating well oftentimes it will result in your feet suffering somehow. Maybe it's just to the point where you've got to get home and put your feet up or have your significant other rub your feet, not that there's anything wrong with that but you shouldn't finish the day with super fatigued feet that are just aching or tight calves or sore lower legs.

Your soleus muscles actually are the most aerobic type muscles in your body, so even in an elite sprinter over ninety percent of the soleus muscles are aerobic. If your body is really fatigued, if you're not burning fat as well as you should which is more of an aerobic system rather than a glycogen system like the anaerobic system in terms of biochemistry, and your body is just basically inefficient at the type of fuel source that's burning throughout the day, you're eating too many carbohydrates which is often the case or you're under too much stress drinking too much coffee, then you end up altering the functioning of those soleus muscles. Basically they fatigue because of the aerobic balance in those muscles, the aerobics system and you end up with really weak calf muscles.

Since the soleus muscles are such a big part of the feet and lower legs, then you end up with tight feet or sore feet I should say by the end of the day, achy feet are a representation of your overall health.

Brooke: I like to look at people's feet as a divining tool for how that general health is in that person.

Steve: Yeah, and you do see as someone gets healthier than their feet get stronger but at the same time they still end up having to rehabilitate them if they're not used to being barefoot. In other words, I can take someone who will say their adrenal glands are completely run down and get them healthier. If their feet are achy, fatigued, sore by the end of the day, or if they can't walk barefoot, sometimes actually just fixing their adrenal glands, getting them healthier again, their feet are better.

Sometimes if they have just been in shoes or poor footwear or not taking care of their feet or orthotics for so long then you've got to slowly rehabilitate them and get them out of their shoes to build the foot structure back over time.

Brooke: I just want to point out, because I personally find it really fascinating, often times I'm talking to people in the manual and movement therapy fields of which you are one but you're also a chiropractic physician so you're looking at a lot of the things that sometimes we just don't build bridges because we can look at the structural dysfunctions but we're not building the bridge about the other things you're talking about like adrenal health or nutrient problems. I just think that's such an important approach that gets missed often times. We put things in one basket or the other.

Steve: Absolutely, it's all related. That's why I joke that the overweight obese who never exercises in his or her life and just sits on the couch at night and watches TV, they get plantar fasciitis. You don't have to be an elite runner. That person can damage that area of that body from a poor lifestyle and poor diet and lack of exercise just as much as you and I could from training too hard and not resting enough.

It's really a total body system where you can never isolate or you should never isolate one area of the body regardless of what the problem is. Of course the one exception there I think eluded to when we started this is an accident. Obviously if you fall and trip in a hole or you just turn your ankle running or something like that well that's going to be a local problem. The extent to which that injury heals has a lot to do with your overall health though. Often times it's these injuries that creeped out of nowhere that are representative of your overall health.

Brooke: Going back to feet, Vibrams 5 Fingers took a pretty nasty legal hit recently. Sadly, I think it's created a lot more talk again about how we need support and we can't wear minimal shoes or go barefoot so can you speak a bit first of all that case. I'd be fascinated to hear your take on it but also what is the real problem here?

Steve: That started from someone- I believe a woman up in the northeast somewhere- who basically she went into the minimum world too quickly and I don't even think actually she got injured (she didn't- just an aside that she was simply sueing them based on marketing claims, not based on an injury). I might be wrong on that because it's been a while since I looked into that but some of my colleagues who really are into the barefoot movement updated me on this several months ago.

She really didn't even get that hurt from it if hurt at all. She just basically wanted to make some money off their poor marketing at the time which they eventually I should say changed. You never just want to lose your shoes and just start going from some super supportive shoes and start going barefoot if your body is not used to that. It's the same reason you would never go and run a marathon if you've never run a one mile in your life.

You can't move too quickly to the minimalistic or barefoot, I hate to use the word barefoot shoes because that's ...

Brooke: Right oxymoron.

Steve: Yeah it's an oxymoron to being barefoot so you have to slowly build up these muscles and wean yourself off of thicker shoes down into thinner shoes. For women who have been wearing high heels a lot their lives, your achilles, your calf muscles and your achilles tendon will shorten. That's just natural in an unnatural way if your heel is that elevated away from the ball of your foot if they're not level like we are when we are barefoot.

That takes time for that muscle to naturally stretch out or really should say naturally elongate. If you start ditching typical running shoes that might have a twelve, fifteen, or twenty plus millimeter drop that means the angle from the heel to the ball of the foot and you go down to a minimalistic shoe of four, three or zero drop shoe where there's no change, no elevation difference between the ball of the foot and the heel then those foot muscles, those foot tendons and ligaments, they can't adapt so you can easily get injured or at least be in a lot of discomfort for that period of time.

Everything tends to be a fad and that's how humans live and I joke around that gluten is a fad. In a way maybe it is and in a few years maybe people will be eating gluten like crazy again and we won't have to look at a bag of oranges at Whole Foods and know that it's gluten free and nobody will care anymore. Who knows, right?

The interesting thing about the minimalist movement is that, and I wrote an article on this on the Sock Doc site just within this past year, is that it's already gone backwards unfortunately. I mean it started in 2010, Born to Run Era, in 2011 and even after Vibrams, Vibrams just fell into the whole minimalist movement, Vibrams was around way before then as boat shoes. Sailors used them.

Born to Run by McDougall that just set off the barefoot movement more with his book. Even just over these past couple of years, it peaked in 2012. In 2013 and now within the last year really things have turned unfortunately sadly for the minimalist movement. I see minimalist running stores both online and real shops that you could walk into close.

I've seen a lot of other shops that promoted a lot of minimalist shoes no longer carry these shoes, either because they weren't selling them and they're losing money or even more unfortunate is that these shoes are no longer being made that these minimalist companies that were making zero drop or three or four millimeter drop shoes as of 2014 especially when the models came out in the spring March/April these shoes have come out with more cushion.

The 2013 models I told all of my followers and myself too I stocked up on shoes I really liked and I threw them in the closet because you can't get those models anymore. They're there but the models now have a couple or a few extra millimeters of cushion in them or they're no longer even being made because the market for that has just unfortunately turned already.

Brooke:Yeah, it makes me really sad.

Steve: It is really sad, because it really is a reflection of health and of course you should never do something because it's a fad. You should do something because you truly believe in it. It makes sense to you. For me that has always, always made sense. I mean I grew up in wrestling shoes because I wrestled in high school and then I grew up with cross country and I always ran in track like shoes and pretty much like slippers. I remember that's when I started using those in Ironman triathlons. I used them in a marathon. I remember going into a shoe store and telling the guy, "Hey I need some like this." he's like, "Oh what are you using these for like a one mile training run or a 5K maybe?" I'm like, "No I'm going to run the Ironman marathon in them." He's like, "You're going to wreck your knees!" Yeah it's crazy and those were even then I couldn't even wear those now because they're too cushiony for me and they have four to five millimeter drop depending on the model.

What happened is so many people got into the barefoot movement that shouldn't have been into it unfortunately and they did it too quickly. They were getting injured. We had a neighborhood kid who really tore up his feet bad because he was like, "This minimalist thing is awesome," and he ran like the two mile thing that they had to do in gym class at high school. He ran it barefoot and he wrecked his calves, so of course he actually went to his physician.

It's a true story, went to his physician, his orthopedic doc and the guy was like, "Well this is what happens when you run barefoot," No that's not what happens. It happens when you do it and you never run barefoot in your life and now you went out and ran two miles when you're used to wearing shoes twenty-four/seven so it's too bad.

The Vibrams thing is just ... People know me on the Sock Doc site for saying what I think and honestly I hope you don't mind me saying on your show but if you're taking money for the Vibrams lawsuit and you want your eight or nine dollars you're a loser. That's all I have to say to it.You shouldn't have wore them in a the first place. Sorry.

Brooke: Yeah, take responsibility for your own pace of adapting to things in your body. On the other end of the spectrum, we have orthotics which still get doled out constantly. Can we talk about that a little bit?

Steve: I've gotten the most hate mail- not as much anymore- but when I started the Sock Doc site going on four years ago now and I was so against them. I grew up in orthotics. I was told custom orthotics are going to help me run faster. I had them in my cycling shoes. I had them in my running shoes obviously. I learned how to make them even before I went to chiropractic school. I had physical therapist friends who taught me how to make them. I thought they were the best thing. I learned how to make them in chiropractic school.

Then I just realized that these aren't fixing anything. You're putting someone literally in a supportive brace that is altering mechanoreceptors, so mechanoreceptors to get a little technical on you because I think it's important is that mechanoreceptors are sensory nerves in your body, obviously especially in your hands and your feet and they recognize things like pressure, touch, vibration. It's basically your way to feel what's around, for you to feel your surface, the ground, the environment.

When you have poor health like we've been talking about this podcast, whatever that may be whether it's just a poor foot, a poor knee or a poor nervous system, something is going on with you and your foot or somewhere in your gait is being altered then you have an imbalance of mechanoreceptors which typically results in one thing. It results in pain and mechanical dysfunction.

They [patients] say, "Well I have pain," so the therapist, physician, whoever says, "Well your foot is doing this and we can basically put you in this custom orthotic which is literally a support device to correct that."It is not correcting that. I would say it's supporting the problem. It's supporting the dysfunction. It's actually altering mechanoreceptors which is true in some instances- it's altering those mechanoreceptors normal state which people may say, "Well that's good."

The thing is it's not correcting them. It's supporting those mechanoreceptors for the time being that you're wearing, but remove the orthotic, remove the insole, heel lift or whatever you may be using and the mechanoreceptors were never rehabilitated during that time. They're right back to where they were if not worse than where they were because the mechanoreceptor activity in other areas of your body has been altered during that period.

I see nothing good of orthotics. I honestly never use them. I don't think they should ever be used. I only have one patient who has ever used them and I'm okay with that because she's a seventy plus year old woman who had Rickets growing up and one of her legs is several inches different in length than her other leg, so she had a growth plate problem growing up.

There are very rare instances where these things can benefit someone. In her case, it's more like a lift to balance out her hips but for the typical person meaning ninety-nine percent plus of people out there you don't need an orthotic and if you do need an orthotic to get you over pain and to get you moving again. That's cool. I don't think you're wrong or a bad person for wearing orthotics but just realize you're actually not correcting anything. If you're staying in that orthotic or if you can't get out of it, then you're going to create other imbalances in your body.

You might be out throwing a ball one day or just screwing around and doing whatever, picking your kid up or picking up a piece of luggage to put in the overhead on a plane and all of the sudden you throw your shoulder out or you wake up with a bad neck or you're out playing tennis and your knee turns. You're probably not going to look back and say, "Hey that's because I've been wearing orthotics for two months, two years or longer." Because you're not going to put two and two together. You might not end up with that compensatory pattern that quickly.

Over time, you end with gait imbalances and these bio-mechanical disturbances they show up somewhere else. Obviously there's plenty of people who wear orthotics and they're not even correcting their problem or say they are correcting their problem but then they end up with some other problem. I see a lot of times someone says, "Well I was put in the orthotic for plantar fasciitis and now I have shin splints or now I have patella tendinitis or something like that." It's pretty obvious to them.

I also see way more often where someone says, "Yeah, I'm still wearing them because it helped my pain," and then I see all of these other shoulder or hip, lower back, just a crazy amount of other problems that the orthotics have resulted in because of how it's altered their body mechanics. That's the issue with the orthotics and why I'm so against it.

You would never hopefully listen to a physician or therapist if you were in a bad car accident and had bad whiplash and they put you in say a soft cervical collar. You would never listen to them and say, "Well you're going to put this on so your neck doesn't hurt anymore and you're never going to take it off. I want you to put this on, anytime you get out of bed put this cervical collar on, wear it unless you're in the shower or lying down in bed and then you can take it off at night, but other than that you're going to wear it the rest of your life."

That would sound insane to most people hopefully. Yet we do the same exact thing with orthotics and nobody thinks twice about it.

Brooke: Yeah, we can hide them in our shoes so we don't think about them the same way.

Steve: I really don't think that that analogy is extreme. It really isn't if you really want to look at how our bodies are meant to move, so yeah.

Brooke: It's a great analogy. Another hotly debated topic these days is ...

Steve: Oh, we're hitting them all today aren't we!?

Brooke: We're hitting them all, the big hitters.

Steve: Stretching, you're going to talk about stretching then.

Brooke:Stretching yeah, so I just have to quote you because it's so great. It's some bold words here. You said that, "Stretching is one of the worst activities that you can participate in," so of course I want to hear more about that.

Steve: Yeah, well I guess shooting an apple off someone's head might be worse or something.

Brooke:That's worse probably in the scheme of things.

Steve: I say a lot of things on my site to be sarcastic, and to have to fun and to get someone's attention. Unlike most chiropractors, even most doctors, my appointments are an hour to two hours long so I get to know people pretty well and talk to them about everything. I always chuckle when I ask someone what they're doing for exercise and the most common response I get is, "Well I stretch. I do stretches every day," which stretching is not an activity.

It's not some form of physical activity. We're talking about now pretty much static stretching. I'm all for moving of course. I'm all for dynamic motions. I'm all for moving your body as freely and fully and to the full extent that it can move.

I'm all for someone pushing a range of motion especially if it's a weighted eccentric type motion where they're able to go a little bit further to get more flexibility if the motion is a natural motion, if it's something within their means and if it's a healthy type of movement.

In other words, I'm not for let's talk about some typical stretches that are really bad that everybody tends to do like a hurdle or a stretch, sticking a leg out just trying to stretch your hamstring, or a quad stretch. These are mindless stretches that we've all been brought up to think result in decreased injury or improved performance.

The truth of it is is none of those things have ever been proven and none of those things are even true. Actually stretching in terms of those types of static mindless stretches typically are going to cause someone to have more issues or if you're lucky hopefully not impair you at all. They sure aren't going to make you a better athlete or healthier in any way. We have this idea that flexibility is a result of stretching where flexibility isn't. Flexibility is a result of your overall health. It's about muscle balances as a result of a healthy nervous system and that nervous system reflecting on your musculoskeletal system.

The healthier you are overall, the more freely your body will move. That's why let's just take an example of someone who wakes up with a crick in their neck. That's what we hear down here in the south. You wake up with a stiff neck and you've lost the flexibility of your neck. You can't turn either direction. You can't turn one way. Well is that because you haven't stretched enough? Of course not. It's typically because what people like to think that's how they slept but really people who wake up with a crick in their neck it's more often and this is maybe more than we wanted to get in tonight but usually that's what you ate the night before or it's something that you did to disrupt your digestive system.

It actually causes neck pain the next morning or thirty-six hours later, so that's not a result of not stretching. Correcting that is not a result of you stretching it more because the thing when a muscle is actually tight and fascia and connective tissue and all these things are super tight you actually can't loosen them up through stretching. It's just not how your body has ever worked. I mean I'm working on people all day long with my hands and if I see a muscle imbalance, I've tried stretching those muscles before. They never show a need to need more stretching to rehabilitate that or to get the muscle to function properly again.

What you do see is they need some other type of therapy, like some good trigger point work, some direct muscular work or some exercise to help rehabilitate that or even a change in their diet, but you don't see a need to stretch an area more. Stretching is this thing that we always think more is better or you need to stretch before and after you work out but it's not something that you should really need to do even though you want to and you should be able to move your body through full ranges of motion but if you're actually sitting there and stretching and holding these static stretches even for ten or fifteen seconds, just mindlessly, you're most likely doing yourself more harm than good.

Now of course as I mentioned earlier doing dynamic stretches or doing a certain warm up after or doing stretches after a warm up can be somewhat beneficial moving your body through normal ranges of motion but definitely not holding these stretches. You're pretty much just going to hinder performance and most likely increase your chances of getting injured.

Brooke: Are there any exceptions to the never stretch rule?

Steve: There's always an exception to everything, right? I mean when I wrote that article Stop Stretching that was one of my first articles on the Sock Doc site and it's still one of the most popular, and just like anything I think after once I rewrite it I'll change a few things in there.

People will say, "Well what about martial arts? What about certain dances, gymnasts, of course?" Well, yeah, there's always exceptions. I don't see any gymnasts in my office right now. I see a few martial artists but I do see some really high end ballet dancers, females so I have a lot of experience with professional dancers who obviously have crazy range of motion. They stand on one leg and they take their other leg and their ankle goes above their head right up by their ear.

My experience with that is when I correct imbalances in that dancer's body and I get that person eating well and if you've ever been around a dancer, a ballet dancer, they're mostly eating white bread and jelly and really poor diets throughout the day and they're taking ibuprofen and they're taking things to dampen the pain because it's such an intense activity. I'd say the same with professional gymnasts too. Once you actually get a person like that healthy, they're eating well again, they're taking care of themselves, and the body issues are corrected, the injuries are corrected and muscle imbalances are corrected, what you see is their range of motion increases dramatically.

I remember seeing one ballet dancer, she was pretty much living off of ibuprofen meaning taking several hundred milligrams a day, like two hundred milligrams several times a day, just to dampen the pain. She would get to the bar and do her bar work and then do this crazy amount of stretching before, during, after, throughout the whole day and once she cleaned up her diet and didn't just eat an English muffin for breakfast and lunch and got off of the ibuprofen not only was she moving better but she didn't need to do this crazy amount of stretching that she once did.

She was still doing it lightly to go through the ranges of motion, to keep her flexibility which is definitely necessary but she didn't need to do it to the extent to which she always has. I mean dramatically. In other words, she didn't have to do a certain stretch for say ten or fifteen minutes. It knocked it down to she just did it for one or two minutes and it wasn't nearly as difficult to her as it once was because her nervous system was so much more in balance and as I mentioned a little while ago, flexibility, not stretching, flexibility is really a reflection of your overall health.

Everybody has their normal flexibility to a certain degree. If you're in a professional sport or if you're an elite type athlete like a dancer or a ballerina, martial arts, gymnasts, yeah there's going to be exceptions where you might need to stretch to gain that little extra flexibility and that's when you can use more active type stretching where you're contracting the antagonist muscle.

In other words if you are stretching your hamstring you would contract your quadriceps hard so you don't overstretch. Or you could do some really good weighted eccentric type stretches like good mornings exercises or straight leg deadlifts where you're getting further range of motion with some weight on your body to help with stability and mobility.

Because what happens is people will just mindlessly stretch. They lose a lot of stability in the area. That's why they end up injured. They might create more mobility, more flexibility but they lose the stability so they lose power, they lose the integrity of the joint because they're just stretching the hell out of an area without actually ... Well they're compromising the area is what's happening .

Brooke: What are you currently working on or fascinated by in your own practice right now whether for yourself or with your patients?

Steve: I was trying to think of what I could tell you there when you asked me that question on email. I mean I guess right now I've been more into ... I've always eaten really well and followed a paleo type diet. More recently I've been into getting people even more down to earth with what they're eating, visiting more farms, eating more not just organically but understanding where their food is coming from, looking at local meats. I've been getting into some organ meats recently like liver and heart and that sort of thing.

Just taking nutrition up to the next level. That's not for everybody. Most people you've just got to try and get them out of the white food diet, the processed food and just eating somewhat better but for those who are already eating really well and not eating much or hopefully any processed foods or anything artificial or unnatural they can take the next level and start to look like fermented foods and some really highly nutritious free range eggs and meats and that sort of thing.

Brooke: Wonderful. Well thank you so much for all of the great work that you're doing and for talking with all of us today.

Home play!

I thought it was interesting when Steve talked about how we are almost always in bare feet when we are inactive. Also interesting is the oxymoron "barefoot shoes". No matter how fab our minimal shoes, barefoot is still different. So, even though it is January, can you get outside into the world at all in actual bare feet? If not, I promise I'll revisit this in spring! But free your tootsies as much as you can!


Sock Doc- Dr. Steve Gangemi's site

Trigger Point Therapy- A Powerful Tool to Treat and Prevent Injuries

Build Your Aerobic System (Move Your Ass Often, But Not Too Quickly)

Healthy People = Barefoot People

Stop Stretching!

Why the Minimalist Footwear Trend Won't Last

Born to Run- book

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