Dr. Emily Splichal DPM - The Feel and Function of Movement

Summary

In this conversation, Dr. Emily shares her journey into functional podiatry, emphasizing the importance of viewing foot health through an integrated lens that includes movement, sensory input, and overall body awareness. She discusses the shift from traditional podiatry to a more functional approach, influenced by her background in fitness and human movement. The conversation explores the significance of ground reaction forces, the role of the autonomic nervous system in chronic pain, and the potential of regenerative medicine. Dr. Emily also addresses common misconceptions in podiatry, the importance of patient education, and the need for innovation in the field.

Transcript

Dr. Beau (06:06.744)

and we've had like social media interactions and things like that, but I've known of you since I graduated school, which I graduated in 2013, but kind of give me your origin story on just a little bit about, know, who you are, but then also how you got into podiatry. And then we'll, we'll kind of extrapolate later into where you're at now. how'd you get into this whole world to begin with?

Dr Emily (06:26.837)

Yeah, so podiatrist, but really functional podiatrist, which is, it's not a formal title within podiatry as far as a training yet anyway, but I'm really trying to bring this awareness of.

functional podiatry to the profession, to the industry as a way to appreciate the foot from an integrated perspective, thinking of diet, sleep patterns, obviously functional movement, fashion lines, so very integrated as far as how I like to approach patients. I also have a master's in human movement, so I truly believe that I actually treat movement, not feet. Of course, because your feet are connected to the rest of the body. All of that appreciation began, I believe, from

being a competitive gymnast for 13 years. So I was barefoot, body weight, fascial, body tension, just these concepts and philosophies that were taught from a very early age that I carried into.

my adulthood, had been in fitness for over 23 years, and I did fitness while I was going through podiatric medical school and through residence. So everything I stayed within the fitness industry, which really just further reinforced my appreciation for movement. And that's really, again, what I believe that I'm treating is movement.

And then I did a lot of self-exploration out of school for breathing, pelvic floor, fascial lines, a lot into emotion. And then of course, anything sensory based. I'm very much into sensory stimulation of the feet, the body, really perception of self. And I believe that our movement begins with us being able to connect to where our body is in space.

Dr Emily (08:04.375)

And I actually think that that's where most people are missing as far as movement accuracy, movement efficiency, and then movement longevity is it is a sensory based process that begins with connecting to ourself in space.

Dr. Beau (08:18.222)

So to dig into that a little deeper, why podiatry? Why, I mean, you could have went a lot of different realms within movement and medicine. Was there anything, did you have any like personal stories that led you into that? Or is that just kind of like, well, I'll throw a dart and land on that. And then you've just built this empire around it.

Dr Emily (08:34.071)

you

Yeah, no, was really not a fancy story where I was doing fitness in New York City and those were two things at that moment in my life that it was speaking to my soul. Sounds kind of crazy. And I said, I want to go to medical school or graduate school, but those are the two requirements. I have to be able to stay in New York City and I have to be able to do fitness. And there in Harlem is the New York College of Podiatric Medicine. And here I am today.

Dr. Beau (09:04.172)

go. But that's, mean, environment, just like movement environment plays a huge or critical role. So I mean that, you know, that's, you know, not too dissimilar from a lot of people that just have personal experiences with specific areas of medicine, right? You just happen to be in that environment where, here's this facility. you mentioned that

Dr Emily (09:04.599)

I not think it would be.

Dr. Beau (09:25.656)

You know, early influences, but I also kind of read on your bio that, I mean, you were going through surgical training or were about ready to graduate or had graduated. You can, kind of elucidate that. But when was the shift from this, you know, let's say the, classic, you know, allopathic look at, you know, podiatry or medicine from an orthopedic standpoint, particularly with the feet. Two more of this function based model, like obviously came from fitness, but where was that actual medical shift?

Dr Emily (09:53.749)

Yeah, so I think the fact that I stayed in fitness while going through podiatry school is very important because we were learning things like plantar fasciitis and advising patients, stretch your ankles. And we were being told as students, a way and.

were like, that's the way, like the only way. And I was like, no, it's not. know, foam rolling was starting to get into the space, more fitness than in a medical training. So you wouldn't see that yet in like a medical setting of really understanding self-myofascial release and stuff. So trends will hit the fitness industry a little bit faster. So I was seeing this and I'm like, that's not the full story. So it started to...

bring in this questioning or challenging that I'm actually learning this very narrowed scope of advisement and recommendations for patients that it was starting to challenge like my beliefs or my entire my internal environment. Then as as I was kind of continuing through my training the barefoot running boom happened and this was really really important.

That's why I actually stepped away from my surgical training, took time off, went back to school, got my master's in human movement because I was like, wait, there is a lot more to this. So what I felt authentically.

was true and how I wanted to practice ultimately podiatry was more in that direction. I was like, the only way that I'm going to be able to do that is I have to step back, get this, connect these dots and then go forward so I can control the way that my future looks. So it was really around that point. And then when I did get my master's in human movement, I focused entirely on barefoot science, the nervous system, footwear surfaces. So I really was starting to carve out that niche.

Dr Emily (11:44.459)

Then when I went back to surgical training, because I had to complete my residency to get licensed, I was kind of playing the game a little bit where I was like, I knew that ultimately this is not what I believed. And I started to incorporate from day one, graduating residency and doing private practice of let me do a gait assessment. Let me get you out of the chair.

And I remember practicing in a large group in New York City, and I was the only one that came in with that belief. And all the other docs were like, what is Emily doing? Like all my patients were walking down the hallway. I'm explaining. I'm telling short foot to everyone. And everyone is just like, what is she doing? And then eventually it became quite apparent that I could not practice the way that I wanted under conventional insurance because I need more time with patients. And eventually that's how I shifted.

Dr. Beau (12:34.648)

So let's double click on something. you're going through podiatric training, but gait analysis was looked at as like a little bit of outside the box, like, well, what are you doing?

Dr Emily (12:46.291)

I know the irony of that. Yes, that we... I know, I know. So we learned gait, of course, not to the level of how I look at gait now, but we did learn it in podiatric medical school because it's part of podiatry technically. But there's this pressure under insurances that is the reality of healthcare. And I know that you understand this to some degree, is...

Dr. Beau (12:48.398)

You

Dr Emily (13:13.587)

You just have to funnel these patients in and out. Like if I have, they would book my patients so I would have 10 patients waiting in the waiting room, upset, and I'm like...

Like a young doctor, I'm like, I have to get them out. So I would just be like, right? Like you have heel pain, plantar fasciitis, this is what you do, boom, boom, boom, you're out in 10 minutes. And I was just like, my gosh, that does not sit with me. But I have no choice, because these people are in the waiting room and I have to get them moving. And it's just that I understand the struggle of why.

why traditional medicine starts to get that way and why doctors feel pressured even though they don't want to, right? So I was just like, no, I'm just gonna, I'm gonna say no more. And I stepped away from it.

Dr. Beau (14:02.946)

my, to back up to the barefoot running boom. I started grad school in 2009, which was the year that born to run came out. And I still remember I had started reading it, went home for Christmas break. It snowed like a foot overnight. And I finished the book that night and went out and ran a half marathon and like a foot of snow, just because I was so hyped up in new balance, Minimus, and the whole slew of all the idiocy that followed from me personally of, you know,

Medial shin splints and all the stuff I dealt with coming from a sprint background and trying to transition was just, I think actually really good for me. Cause it was firsthand learning of experiencing those injuries, why they occurred, that it was on me and all the broken rules that I disregarded. Did you, I know you came from a gymnastics background. Did you get into barefoot running or were you just kind of extrapolating, you know, that movement into your specific like sports of choice?

Dr Emily (14:58.293)

Yeah, so I would just extrapolate it. And then my focus, even though was the barefoot running boom, the minimal shoe boom, I was really getting into the science of impact forces, muscle tuning theory, how the intrinsic muscles work, how our fascial system works. And then I would pull that into really barefoot training. And right away during the beginning of the barefoot running boom, I was coming in as the barefoot training voice, meaning the reason why a lot of people were getting injured as they trained.

transitioned very quickly. Many, many people did exactly what you did. And then the shoe companies would get blamed and it was, it's not the shoe, right? It's not Vibram's fault. It was that there was not this understanding of how our body actually relates to impact forces and the prehab to the transition you could say, or the pre-training.

that that's what I really wanted to focus on. And then I applied it to every sport. And that's why now I speak on a lot of conference circuits that are, you know, football, NBA, whatever sport it is, because it applies to...

everyone. But I remember when there was a lot of the press around like the five fingers and remember New York Times articles about, you know, how they're being sued or whatever. And everyone's like, aren't you concerned that this is going to just like take away your entire career? I'm like, absolutely not. This is actually validating what I'm doing and building strength that we need to really understand the training component. And it is a little bit unfortunate that the barefoot running boom or the minimal shoe boom

that's just kind of what I'll call it more that the minimal shoe boom was associated with running and people truly believed that to wear minimal shoes meant that they had to run and I was like that you don't have to become a runner because you want to wear those shoes I admittedly am NOT a runner I was a sprinter my body does not like long distance I like to do very quick movements

Dr Emily (17:04.423)

Very ballistic, do not do endurance. Emily and endurance are very much the opposite outside of cycling. Then I can do a little bit more endurance. yeah, I was like, I'm going to demonstrate that there's other benefits and power to this technique and this science and that it's not a trend that there is research and evidence behind what we are actually advocating here.

Dr. Beau (17:27.978)

when for let's say a student's listening to this, you know, today in 2024, almost 2025, the thought that this wasn't really a thing is probably pretty weird, right? That if we go back, you know, even five years, that's when I'd say the barefoot specialist stuff really became like very popular, right? There was this barefoot running and then the minimalist shoe. And then it, you know, it took that, you know, that Vibram lawsuit to kind of everybody to question. And then you actually saw the maximalist shoe, like

push and you know, that was the cascade coming back against that. so, you know, this, this shift from, know, typical podiatry into this, you know, functional movement and, you know, foot focused, practice base, but who were some of your specific early influences that helped shape, you know, what you're doing today, but also back then.

Dr Emily (18:17.343)

So I would say Dr. Perry Nicholson was, of Stop Chasing Pain, he was one of the most influential, partly because he was challenging kind of traditional chiropractic beliefs and philosophy. He's just a rebel. Yeah, to this day, he's very much of a rebel in saying like, no, there's more to what we were taught. There's more to what you can demand out of your body. he just really...

Dr. Beau (18:31.566)

to this day.

Dr Emily (18:44.777)

inspired me to kind of push into podiatry that same way and challenge a lot of the beliefs and then just be fine and say you need thick skin here'd be a black sheep push into it that's really how

industries move forward as you need someone who's essentially going to shake it up a little bit. So he was very influential on that side of things. A lot of the pelvic floor work, Diane Lee's work was great. Facially, absolutely love Robert Schleip. He is out of Germany. He is incredible. I love his work, his approach to everything. And then in the UK, James Earls, who wrote the

Dr. Beau (19:24.75)

Born to walk. Yeah.

Dr Emily (19:25.739)

Yes, he's amazing. He's spoken at several conferences that I've hosted. He's incredible. His approach. Everything is complimentary. No one is... Like we're not vying and saying like, no, it's not a competitive space. We're all just mutually trying to elevate and pull a little bit out of everyone's unique lens.

And I often tell people like my, my lens is from a podiatrist podiatrist movement perspective. Hear what I have to say. And then you might be talking about the exact same topic and hear how you say it. Cause you have a slightly different lens. were trained different, right? And then through both of what we're saying through our unique lens, does something I say or a word that I say resonates a little bit more with you or maybe similar with you and how I describe something they get completely confused. Like it's.

I love to learn from different specialties who have these different lenses because then that really broadens your understanding.

Dr. Beau (20:27.128)

Why this is something I say all the time, you know, whether it's with a, you know, an intern or whether I'm teaching is even in, you know, we're both in this realm of, know, the functional movement, you know, group and PT Cairo, all that is thrown into this giant pile. There seems to be a lot of conjecture and arguing, which is all in, you know, semantics and details that probably don't matter. But honestly, most people are saying the same thing, even when they're arguing over, you know, the same point because.

we're talking about, you know, human physiology, biology, anatomy, and, know, there might be minor discoveries that are being made that help like reshape some of that stuff, but really this stuff is principles, right? These are first principles. So that's what I want to ask you. If we kind of, you know, pull back the curtain a little bit, maybe more for the patient base of somebody listening, what are some of the principles that you live by, whether that's the lens that you specifically look at?

know, foot function through, you know, whether it's building, you know, a more, a stronger, more functional foot. What are some of those things that you, maybe find yourself telling, you know, patients or clients that you work with, but also topics that you're discussing at a conference with other physicians.

Dr Emily (21:35.863)

Yeah, so I have a few key ones that people know when they're referring me a patient that that's essentially how I'm going to be looking at them is very much the sensory story and that everything begins with our perception, our perception of where our body is in space. But if we kept it foot specific, just this high awareness of where your foot is in space and how your foot is contacting the ground. And then when your foot contacts the ground.

Do you actually perceive ground reaction forces and how quickly are you perceiving them? How accurately are you perceiving them? I find that most injuries that I see in my office are going to be a breakdown in either the timing or the accuracy of the perception of impact forces, which are vibrations. A lot of that has to do with shoes because there's cushion in the shoes, the cushion is absorbing the vibration, but the vibration is

our understanding of how hard we're striking the ground, the characteristics of the surface that we're walking on. So if that is inaccurate, the rest of that movement pattern essentially is going to be slightly altered.

So that's one of the biggest ones is this sensorial disconnection from the foot and the ground. The other one is the timing of the stabilization pattern between our foot, which is the only contact point between the body and the ground and our center of mass or deep core. And that's a lot of this foot to core sequencing that people know when they look at my work. It's a fascial connection. It is very fast. It is something that is pre-programmed into our nervous system, our myofascial neuromuscular system.

and it is something that has to be activating before our foot even contacts the ground. And I often find that a lot of compensation patterns are because that's just not happening fast enough, this foot to core. So I do a lot of pelvic floor work with patients and because your pelvic floor connects to your diaphragm, I do a lot of diaphragmatic work with patients.

Dr Emily (23:36.617)

and understanding that. So that would be another one. The third one just to mention, because I think that it is something that often comes up in the space of feet podiatry, foot strengthening, functional movement, is going to be different foot types. And that a lot of people may think that...

just because I'm a believer in minimal shoes or they may be a believer in minimal shoes, that there is no time and place for custom orthotics or supportive shoes. And there actually is, and there's certain foot types that are not just weak. not all flat feet are just weak. There's obviously ligament laxity. If someone comes to me and they have a torn spring ligament, which sits directly under your tailor head, that they're just going to be getting this mid-foot unlocking that is structural that you cannot strengthen.

than anything sufficiently to try to take that a wink to control that unlocking that is happening and contributing to this individual's movement patterns or injury risk. So those are like a few things that I often talk about or emphasize or we'll see in my office.

Dr. Beau (24:45.742)

from a patient standpoint, what are, if somebody's listening to this at home and you mentioned the first one, you're like, lot of people are suffering from like a sensory disconnect, which could be footwear driven. could be, know, habituated. What are some tells like what, you know, if somebody's not dealing with an injury, right? Because that's kind of our job is like, okay, let's go through diagnostics and see, okay, you know, that sensory perception is correlated to the dysfunction or the, you know, the injury. What could they pick up if they're like, I'm not dealing with a foot injury, but maybe that's going on.

Dr Emily (25:16.033)

So anything related to gravity. So our relationship to gravity very much begins with our relationship to our feet and the foot and ground relationship. So it could be just postural fatigue. You cannot stand long hours. You just hit a fatigue point when you're standing. And I know many people that are just like, I cannot stand long hours. It kills my back, my feet, my lint. Just everything tightens up. They're essentially passive in gravity, which is a fascial response. And just maybe

reconnecting to it. It could be, I mean you said no foot pain, it could be foot pain because foot pain, plantar fasciitis, stress fractures, IT band, shin splints, these are all quote unquote overused injuries, but I don't like to just blatantly or easily blame impact as the cause and say well therefore impact is bad.

Dr. Beau (25:51.726)

Right.

Dr Emily (26:10.015)

It's actually the relationship and the disconnection to the vibration or to the impact forces that that's what's broken. You're out of synchrony with the ground and with ground reaction forces. It could be diffused foot fatigue. So those do become a little bit more gravitational or impact force related. It could be efficiency. It could be that you feel like you are running and you're like, whoo!

That is exhausting. I am running like I'm running through molasses or something like that. You're actually not working with the ground. And when you work with the ground and you find your fascial system and you understand how to connect to gravity and vibration, there should be an ease in your movement.

But that takes understanding and really feeling and sensing the energy that comes from the ground and working with it. That's a skill. And unfortunately, we don't teach that a lot in kind of day to day or you're going for a little 5K run on the weekend. Unless you're taught that, we don't know how to connect to that.

Dr. Beau (27:16.974)

I like that you, know, we sometimes in our world too, we would say, that's a, you know, what we could use these fancy terms, sensory motor integration, and that's going to be something where we just have to improve the sensation. You're to have this direct feedback loop that's built, but then you're saying, well, there is a skill to also being aware of that. Just like I wasn't aware of, you know, until Dr. Steve Capobianco, you know, the upwards of 60 % of the population can't feel their own heartbeat, which to me being somebody that can, I was like,

Dr Emily (27:42.487)

All

Dr. Beau (27:45.56)

That's wild to realize like people's feedback loops are wildly different. So yeah, it is about improving feedback, but then what do you do with that feedback? Which is what you're saying is like, that's a skill based outcome or output. Then, if we dove, if let's go into running just a little bit on that kind of thought process for a long time in the running research, especially when I was in school. So if we go back a decade, everything to do with decreasing running injuries had to do with decreasing impact.

So I just kind of want to get your stance on this because there's been a pushback against that of and you said this almost verbatim of using the ground or using ground reaction forces to your advantage So is there any you know, maybe you have a more eloquent way of saying it's not just about decreasing ground reaction forces or is it?

Dr Emily (28:32.523)

Yeah, so it's not about decreasing ground reaction forces. It's actually...

feeling them faster. And then when you feel them, what do do with them? Right? Like how does your body actually utilize and store ground reaction forces or impact forces? I mean, we are inherently designed to absorb ground reaction forces and use them. And when I do my teachings, I often say, okay, when we walk, we have one and a half times our impact force and you release two and a half, right? When you run, you experience three, you release five to six. When you jump eight to 10, okay, gymnast,

find this one fascinating. Gymnasts doing like a tumbling pass. So Simone Biles, right, the goat that she is, is getting 18 times her body weight in impact forces, right? But...

You could initially be like, what the, right? my God, how are her bones not fracturing as she's experiencing these impact forces? I like to look at it and say, well, of course, because how else is she going to do a triple back or the bios five or whatever it is, right? Of these incredible feats of.

human performance requires the energy that we achieve from the ground. Where else did that energy come from? It is coming from gravity and the ground and the acceleration and the impact forces. So we actually need impact forces to do dynamic movement. Now the way that your body absorb impact forces is through stiffening.

Dr Emily (30:02.239)

And this is the muscle tuning theory. This is not my theory. This is Dr. Benoni's theory that impact forces are vibration. And as that vibration is coming into your body,

It can't be uncontrolled because uncontrolled vibration to your bones is what causes stress fractures and shin splints. So we have to damp or stiffen the muscles as that vibration is coming in so that we can take the vibrational energy and store it within our connective tissue. That's where it is potentiated or stored as potential energy, which you release as elastic, elastic energy. That's what gives you the ballistic movements or it's called the catapult.

Polt effect and you are able to go forward. So that dance with the ground of stiffening is based off of isometric contractions. So a lot of foot strength and the intrinsic muscles of the foot contract isometrically to stiffen and protect the bones of the foot and to allow that energy to go into our connective tissue. So that dance, which is the muscle tuning theory,

starts to fall apart if you actually don't feel your feet, if you don't feel the ground, if the cushion is absorbing the vibration, not your muscles, not your fascia. So then how are you getting the energy to move? Well, you use your muscles. When you use your muscles, that's a lot of energy, that's a lot of work, you start to stress muscle tendon junctions and you get itises. So that's essentially the dance of how I look at movement. That's the lens at how I look at movement.

and that was not taught in pediatric school.

Dr. Beau (31:43.586)

Yeah, it's a lot. It's, know, with everybody here, you know, within this room, all medicine or, know, whether it's strength conditioning, lot of unlearning, and then it's, you know, reformulating same information, but reformulating your thought process around it. And then it's kind of creating a synergistic, you know, approach to, well, this is kind of what I think based on, you know, years of experience with all that information. That's why I like, you know, we had Keith Barr on the podcast not too long ago and, I love, I still.

use a slide all the time when we talk about almost the phenotypes right to that more flexible person versus the more stiff person and how we could use different training parameters to literally tune the system, differently, which I talk about all the time with like high school runner or sorry, middle school runners because they are, you know, and the nicest way possible, the notorious black sheep of sports, they get thrown into.

30 miles a week and they're usually, you know, like a baby giraffe and you know, maybe it's laxity from a lack of movement early in life, or maybe there's a legitimate, you know, mobility thing there. But then the motor control aspect is decreased. Then we add into it a sensory, you know, whatever we want to call it dysfunction deficit, you know, misappropriation. It's a nightmare. I mean, and then we come in and we want a typical treatment for, you know, a medial, you know, tibial stress syndrome or something like that. It's this, it's very hard for me nowadays to be like,

You know, this is more of a training and an environmental thing than a, know, decreasing pain, inflammation and strengthening a specific area. Cause you kind of have to look at it as like an organism, which is what you're kind of saying, which I want to kind of get to here in a second is too often we get siloed. All right. You're a barefoot X or a foot expert, but you're looking at the whole body, the whole person. And now you're even, you know, we let off the conversation with you're looking at, you know, this integrative.

or the environmental medicine piece to it. So what are some of the other areas that you, as you've gone further in your career, obviously you're looking at tissue health and anatomy and biomechanics, but what are other things where you're like, man, these are having a monumental effect on people that I'm seeing with the typical injuries that I saw 10 years ago, I just am having a different lens. Is there anything that really pops to mind where you're like, yeah, that's a big player?

Dr Emily (33:56.351)

So one area that I started exploring is the power of just the autonomic nervous system and the state that the individual is in. I'm not a trauma expert. I'm not a mental health expert. I appreciate it. And a lot of where I started to incorporate that is that I was starting to see

and specialize in, think just because of my approach, is chronic patients. So chronic pain, chronic movement dysfunction. I started getting a lot of CRPS patients. I started getting dystonias in my office. And things that, well, things that face value that you wouldn't know were dystonia unless you're looking at it from a different perspective. And a,

isolated dystonia that's coming in, like runners dystonia, oftentimes that there's something traumatic that's inducing that why are they housing this, you know, energy, let's just say, in their gastroc, right? And it just becomes a little bit more complex that if someone is trained to look at the human body and medicine too literal.

Like I have to be able to see it. I have to be able to show something on the blood test or the MRI or the EMG, whatever it is, right? And you're too literal. You will then miss the...

huge complexity that is the human body and the human in general. And I started seeing this and getting a lot of idiopathic diagnoses, things that would just be falling under biopsychosocial or psychosomatic. And I was like, I have to create space for this person because no one is. And they're very hard patients to navigate when someone's coming in with something psychosomatic and just being told it's in their head. Like it's just a layer of complexity.

Dr Emily (35:55.801)

that then I would start referring them out. I got a lot into the benefit of, and that's more of a little bit literal approach, but the benefit of Botox for different dystonias and spasticity. Kind of side over here is I really got into regenerative medicine and I do a lot of that. Acupuncture, dry needling, photobiomodulation, hyperbaric. So I just really started to expand.

both emotional, energetic, alternative, holistic, and that's how I practice now because I've just realized that a lot of these things cannot be taken literally if I don't see it, touch it, feel it, see it on an imaging, then that's not what it is.

Dr. Beau (36:40.812)

And I mean, a lot of us, you know, within the medical realm and obviously even, you know, just general public are realizing that the siloed approach is probably not the best approach and it's created a lot of problems, even though, you know, it's necessary sometimes, but it's, created a disjointed and myopic approach to medicine, which doesn't really benefit the patient most of the time. That being said, and you know, you were mentioning some

newer therapies, most people, but a lot of these been around for a long time, you know, hyperbaric chamber, you know, biophoto modulation. This is kind of one of my, I'm undecided. So I feel like I'm on the ridge line of a mountain. I don't know which way I'm to fall down. Let me kind of explain that. I feel like I, I can very easily dive into that realm where I'm like, Hey, I want to really understand the complexity behind this case. This person has a unique history. There's things here.

Dr Emily (37:19.285)

Thank

Dr. Beau (37:32.034)

you know, whatever it is, know, chronic low back pain, recurrent injury at a certain, you know, training period, whatever it is. And, you know, I could dive in with all of my fancy tools and be very specific in my diagnostics. But then I have this other thought sometimes, and I want your opinion on this is it's almost like the environment we live in, we pander to that and not panders sounds like a dirty word, like, you know, I have a one year old and a four year old. If they fall down and you pay attention to it, it's worse. They will have a more.

extreme reaction to whatever happened regardless of the actual injury that occurred. And in our current state of health as a nation, in particular in the West, we're just not a very healthy population. Then we focus on the things that are bad. And it's almost like we kinda in my way of looking at it sometimes like, man, am I doing my patient to disservice by diving further in, right? To not necessarily the pathology, like pathologizing them, but like,

Well, let's make it as complex as we can or hey, there's all these other areas that you could work on that just make a human healthy. And if you do that, we're not saying it's, you know, it's not a specific like ICD 10, like, get more healthy. will, you know, cure your MTSS. But what are your thoughts on that? Because I just, I literally like day to day, I'm like, God, I don't know if I'm doing a disservice or I'm actually being the best clinician that I can possibly be. So any, any feelings on that?

Dr Emily (38:50.252)

Yeah.

Dr Emily (38:56.279)

my gosh, so many. And I wish I had a pen near me to write down all my thoughts that it was bringing up. So when I see a patient and they have a diagnosis, let's say it's idiopathic neuropathy on one in like a 30 year old. So they're like, I don't understand this, right? Like I'm 30, I don't have any comorbidities. Why do I now have this idiopathic and they don't even understand what that is. So.

Dr. Beau (39:21.102)

Mm-hmm.

Dr Emily (39:22.187)

that just as an example could be any of these diagnoses is that I will say, okay, this is your reality. This is your reality, right? You do not have to be, hi, my name is Emily and I'm neuropathy and therefore I cannot do anything. I'm like, no, it is here. It's just part of this phase. It's like a snapshot of your life,

day your presentation is here. You cannot be truly blended with this identity. And I feel that that's just what I've learned from chronic patients is they become so encompassed by that I am this diagnosis. Therefore, I cannot live to do what I want to do. And I'm like, if you understand that you have this and you're going hiking because you want to go hiking and you start to feel the neuritis symptoms, just say it.

I hear you, I feel you, I acknowledge you. I understand you're here, but I'm still doing this. So there has to be this, this separation in a sense, right? Oftentimes I will also tell patients with whatever it is, it's a, it could be something as like a ligament-laxed flat foot, which sounds not that big of a deal, but patients come to me because they're so set on trying to change their foot structure. I'm like, this is your reality.

How are we going to work with it? Or if you have another diagnosis that the only way to fix that is surgery, you are refusing surgery.

So I will teach you how to live with that reality. And I often tell them, I'm short. That's my reality. How do I work with this reality? Right. So we have to work within it. If I give programming, I tell them oftentimes that I'm not looking for a structural change. I'm not looking for your foot to go from this degree of pronation to this degree of new. That is not the goal. It is feel and function. It is not actually looking for a physical structural change in what your foot looks like, what the alignment is.

Dr Emily (41:21.909)

the degree angle. That's not my goal and that should not be your goal or the outcome that you're trying to follow.

I will often tell them also that let's say you're 55, 60, whatever it is, and you're having this presentation, I'll just say your body has this stress threshold. It's right here. It's multifactorial. It's emotional. It's energetic. It's sleep. It's inflammation. It's musculoskeletal, whatever it is. But we have this. Right now you are riding above it. I'm going to help to get you below that threshold, even if it's just below that threshold so you can have a higher quality of life.

and not feel whatever symptom it is every day throughout the day. You can start to push that threshold a little bit more, because you want to go for a hike. You want to walk your dog, whatever it is. But I'm going to try to get you to a place that you can push the system and just continue to ride under the radar. what I say. I just want you to ride under the radar. I'm not going to make you perfect, because that's not realistic. You're 60. I cannot get your connective tissue to look like you are 20.

or to get out of muscle imbalance and muscle compensation patterns that didn't exist when you were 20, because there's so much history, there's so much human that existed between 20 and 60. But if I can get you under the radar.

So things like photobiomodulation, acupuncture, hyperbaric, whatever it is, I say together, collectively, consistently incorporating modalities such as this move you towards this goal of riding under the radar.

Dr Emily (43:02.171)

Red light alone is not this magical treatment that is going to reverse things and take away all your problems. That's not the way that it is. We look collectively. They're all part of the story that have to be done in total to move you towards this forward. That's how I respond to something like that.

Dr. Beau (43:20.024)

Yeah, which I love your input on that. And in a sneaky way, you said in there, you know, the person going for a hike and you know, the neuritis symptoms kind of start to show up and you kind of acknowledge and you're aware, you like I'm going to press on. I mean, that's, know, if we, if we took the filter off, you know, we go on social media, that's people saying quiet the inner bitch. Like we're all what we're trying to figure out is, okay, is this a, is it a handling issue?

It's the language around these things. So people come in with, like you said, a diagnosis that they own. And I think sometimes we're told on the medical side that people want to own that diagnosis. Like they want to live in this pathologized, look what I can't do. And I think often the medical models that's built has put the label on them for all sorts of reasons, because it's over specialized, they've got siloed, they've lived with it for so long. They're like, I just thought this was the normal.

Dr Emily (44:01.495)

Thank

Dr. Beau (44:15.578)

so again, it's kind of an unlearning process and we become, know, maybe not the educator, but like the unlearning, you know, assistant at that point. So let's say somebody comes into you, and it's not just about, you know, chronic pain relief in the face of just getting out of pain. let's say somebody has a performance goal and there is a legitimate, like you said, you're looking for feel and function. And let's say they have a legitimate issue that they will not be able to change.

So let's say they had a knee replacement. Let's say, you know, I've had numerous patients with a, you know, an ankle that's been fused because of a previous injury in those scenarios, is it just, okay, this is our reality. We got to learn to live with it or, know, how far do you go with people that are like, you know, I've had people that are like, I'm to do this and I'm the eternal movement optimist. And in the back of your mind, you're like, it's going to be tough.

Like, have you had any those cases where you're like, yeah, that's my, that's what my job is to get them there. Or you just kind of hit them with, Hey, this is the reality. That's not going to happen. I know that's, you know, a very specific question, but again, that's, we're seeing more and more people being led to the path of extremism. got to push for this crazy goal to get yourself out of the scenario or you just don't do anything. So think it's good to have the conversation of, what is appropriate in the face of, you know, all of this information out there.

Dr Emily (45:35.485)

Yeah, so,

I will share a story of a patient who is a, like a master shot putter and he still will compete on it. He does a lot of power lifting and he has one of his feet is he had a fracture. I think he fell from a ladder. So he had a very classic telescoping into the calcaneus and it was fused in a certain way and he lost some of his limb length. But he was, he came to me then with compensation patterns from trying to

to do these things, not understanding that that was his foot and he had a leg length difference. So part of it was saying, okay, this is your reality. You now have a limb length difference and you have a foot that is fused in like a supinated position with limited ankle mobility from the hardware and the fusion.

So part of it is, okay, we understand this, that's it's your reality. Step two of it is I explain so that the patient or the individual actually understands how the foot is designed to move and how those movements translate into the tibia, into the knee movements, into the femur, into the hip, into the lower back, and how just energetically this coupling goes up the rest of the body.

then I have him understand that your right foot cannot do that. And also because your limb length, your pelvis is now sitting oblique, right? So I'm getting him to understand just integrated mechanics of the foot and energy transfer just so he gets it. Then I say, you can't do that. But you're still doing these activities that demand that. So what you need to do, I will give you the skills so you can keep doing that.

Dr Emily (47:15.105)

But there's going to be a level of transfer stress because of your foot structure, your reality, we'll call it. So I'm going to teach you what you need to do before you do those movements to try to get a little bit pliability and a little play in your system so that you can tolerate the stress of the activities that you are going to continue to do. And then I'm going to teach you how to reset to try to just decompress the system, take pressure off the pressure cooker, whatever you want, do a little reset so that we can avoid this stress.

threshold as much as possible given your reality and that you're going to do those activities. So I try to work and empower them as much as I can especially if they're refusing to do a certain activity as such which I actually get a lot of patients who do that and I've had professional athletes come to me and essentially I say this is really what you need you can't do that right now because you are at the prime of your athletic career.

So how can I teach you or empower you to essentially just...

put a bandaid on it for sake of better word and avoid any major issue. So you can keep playing at this peak knowing that when you retire, you're going to have to this surgery. It is kind of working with the reality of the situation so that one, always want them to understand what's going on. I want them to always understand their body, understand the stress of their activity.

Ultimately, this is how we fix it. We can't do that right now because either you refuse it or it's not the appropriate time. And then let's empower you as much as we can. Boom, go here.

Dr. Beau (48:57.238)

Yeah. In meeting them where they're at, you know, but regardless, regardless of their expectations. And I think that's where we both know this being in the clinical model. A lot of this is like, you know, it is a lot of patient management or people management, right? It's, it's like corralling thought processes, like cows in a field. Like nobody wants to think about it like that. Cause it seems like you're manipulating somebody, but that's not the, what we're saying here. We're saying there's realistic.

Dr Emily (48:59.573)

That would be a good way to say it as well. Yes, I'm them.

Dr. Beau (49:28.386)

Barriers there's also Sometimes people push past things. I mean, I've seen things I can't explain or things you're just like wow I never would have thought you could do that or changes from a biomechanical sample. They're like, wow, I should have had a little more, you know or a little less Cynicism around that scenario But all of the that to be said is we still have to put on our clinical hat first and like, you know rule out Well, are you going to cause a bigger issue or hey? Yeah, you can you know keep going and we can have that surgery later

When we're talking about, you know, right, wrong, the gray zone in between, when we're talking about the barefoot movement in general, which is, I don't know if it's, it's height now, if that was a few years ago, you probably have a better pulse on it than me. Are there any things that really stand out that you're just like the general public or maybe it's, social media or popular media at this time are absolutely getting wrong.

They're just like, if I see another message about this or somebody asking about this, you're just, I'm going to pull my hair out. Anything stand out.

Dr Emily (50:29.719)

I mean, my big one's not necessarily about the barefoot running. It just, you hit it when you said that, is the correcting of every single foot. There is a professional, unmentioned, that said, I've never seen a flat foot that a strengthening the glutes cannot fix. And that is actually...

highly inappropriate to say because yes, your glutes are external rotators that can create a little bit of an inversion or a lift to the kilcaneus in the subtalia joint which lifts your navicular. So yes, that stabilizes the foot, but then that overrides everything that we just said about ligament laxity, a torn post-tib tendon, torn spring ligament. So things like that create a lot of...

consumer confusion or patient confusion going into things. And then unfortunately, most of those patients I see because they try to do it and I've had many patients say, I have been awesomely diligent, strengthening my foot and doing these protocols for a year and my foot is exactly the same. And I was like, dude, you could have come to me a year ago and I would have told you if your foot was not going to change yet.

feeling function probably did, but they were looking at the wrong outcome. The other big one is bunions. And I wish I had a dollar for every one that I see online that says that they can reverse. I guarantee my program will reverse your bunions without surgery. I would just, I be a millionaire if there was a dollar for every person that said this. And that is just grossly inappropriate for...

patients and consumers as well, because that's not possible. Because people are looking at bunions as a toe problem. It's not a toe problem, it's a first ray problem. The bunion is actually the opening of the first and the second metatarsal, which is more of a mid-foot issue or a first ray metacuniform instability. And that's not how it's being proposed.

Dr Emily (52:29.655)

through social media and other programs. And they just think it's literally the angulation of the tone. If I make the toe look straight, then I fixed the bunion. Again, that is grossly inappropriate for someone. So those are two big ones that come to mind. I think also...

On the regenerative side, where I really focus on things and where I hope to bring clarity in the space through podcasts such as this is, let's say an example of chronic plantar fascial symptoms, osis, apathy, call it what you want.

it will be addressed from a where your glutes are weak or your core is weak or it's the movement pattern. They're looking at it what would be called globally that there's what contributed to this happen in the first place, which is accurate. You need to be asking why did it happen to the right foot, not the left foot? Why is it?

persisting to a degree from a movement pattern. But what is being overlooked is if you really zone and you like microscopically look at the plantar fascia and you see that the collagen and the organization of the connected tissue and the fibers is highly chaotic and it's very sticky and there's neovascularization, there might be even some partial tearing, that just looking globally at the movement pattern and the timing of the glutes in relation to

of the foot will never take away that patient's pain because you have to first fix the actual collagen fibers and the connective.

Dr. Beau (54:07.426)

Ooh, watch it, you're gonna get your functional movement card pulled here.

Dr Emily (54:12.496)

I know. I know. All right. So you have to first fix that. So what I do with that is that's where I will do regenerative injections in their shockwave and this whole category of regenerative medicine.

where oftentimes how I will propose it to a patient that I see is if they've been doing all of this, we'll call it functional movement approach if we want, which I'm a big believer in, it's just the timing of it. That's what I'm saying. So I will take my card back. Is that if they've been spinning their wheels.

Right? And I just guide the patient in it. I don't say this is what you need to do. I give them their options and I tell them things. And I say, if you've been continuing to do the same thing, let's say for several years, and you're still in the same place.

just take a step back and say something is not working. If your plantar fascial symptoms wax and wane, right, and as soon as your symptoms start to increase, you back off, you stop running, maybe you throw on some supportive shoes, you do that for a couple weeks, you're good. Everything calms down, right? Then you say, I'm good, I'm going to go running again.

several weeks of running, boom, boom, boom, you amp it up, boom, you're right back to where you started. You do the same thing and you're doing this over and over and over, right? Then I'm like, something is not working. What is there's the saying of like doing something is like you keep doing the same thing over and over is then you are like, don't know. Yes, something like that. Where I'm like, I just want to help you.

Dr. Beau (55:48.011)

insanity. Yeah.

Dr Emily (55:54.699)

to finally get your connective tissue to a place that it can hold and tolerate stress even 50 % better than where you are right now.

But the only way that you can do that is you have to look locally at the connective tissue and the organization or the disorganization of the connective tissue fibers itself. Let's bring some integrity. Then let's look at the global pattern that contributed to that in the first place. And then it's going to stick a little bit better. So that's, that's just one thing that I really try to create and just say, it's just the timing, right? You just, you just did step three before step two.

And that's why I'm here. We're just going to do it in a different order and then hopefully guide you towards success.

Dr. Beau (56:42.894)

Yeah, I call that fancy, or fancy functional manner woman. So I was on the board with a company for a long time rehab to performance that basically helps, you know, create a better model for PT and Cairo students of this, you know, rehab to performance of how do we take somebody from. Whatever I'm going to say a traditional physical therapy model into strength conditioning and delight, you know, whatever they want to do in life. What I actually probably helped perpetuate in a negative fashion was

more of the, the ladder, right? That all of a sudden we started seeing students, new docs skipping right ahead to this functional movement approach, which if you listen to somebody like Greg Cook, the first thing is protect, right? And then move into that. And sometimes you are protecting by offloading things, by changing movement, right? It's a dance. It's not just, you know, protocol of, you know, we got to get this tissue to change. have to have fascial lines kind of appropriated. Then we move into function. No, it's, it's whatever's appropriate for the patient based on, you know, diagnostic.

Dr Emily (57:29.879)

Thank

Dr. Beau (57:41.386)

approach. But I just saw this over and over that people were throwing out classic diagnosis because they got so bastardized. nobody has plantar fasciitis. That's your job is to if they do is it osis is it apathy, whatever it is. and then we saw people skipping to it then running into the exact brick wall that you said of clinical insanity of, why isn't this getting better? they have a legit, you know,

Dr Emily (57:55.893)

Yeah.

Dr. Beau (58:06.158)

A tissue change, if you do, if you do bicep curls, you'll get a bigger bicep because the tissue is accommodating to that stress that, know, and you can have a misappropriated response or an appropriate response to stress, or, you know, load management, whatever you're to call it. So I love that last sentiment and had a little, you know, let a little steam out of my valve because that's something that I'm just like, your, if you're a clinician, your first job is to actually create a diagnosis to make sure that they can keep moving forward in the face of that. But then secondarily, what

that determines your treatment. So if you have all of these tools and you just lean on, well, I'm gonna get them to move a little bit different and strengthen this and optimize this synergistic client, that's not a being physician, that's a high level strength, condition coach. And no knock to them, but that's like, why did you go to school to create that diagnosis if you're not even gonna use it or weaponize it? So that's a personal, if you wanna call it a pet peeve that I think I can actually help.

on the student base, which I like openly talk about now, like, whoa, back up. You gotta give me something here. And if there's nothing, yeah, move forward with that approach. But you did that in a protocol or checkpoint system. Let's stay with this theme. Go ahead. Yeah.

Dr Emily (59:18.079)

And I can just add that, I'm sorry, that everything that we're talking about for the listeners is there is the way that I approach a patient and say this or literally anything that I've said over the last hour, how long we've been talking, you can't take everything of direct context and face value because there's many, many questions that are actually under the analysis and the decision-making of what I'm doing and what you're doing, right? So...

You know, that's why I don't want people to like come to some conclusion or A equals B in literally anything I'm saying. This is a lens, but then there's a lot of peripheral consideration that is being done for the appropriateness of what I just said for each patient and what I'm adding into that and how I'm guiding them through this regenerative protocol. And that's...

probably what you had meant when you were really pushing into that functional approach is that in your mind just from clinical experience, there was a lot of peripheral consideration you had that they just didn't have the clinical experience yet. So they then just took it as a literal path to go down and.

It is hard to teach and explain clinical experience that is being done in the background that we probably don't even realize is being done as we're looking at a patient and making these decisions.

Dr. Beau (01:00:47.416)

Yeah, and even, you know, pruning the treatment and appropriate clinical process as the antithesis of everything that's supported on social media. I mean, it's the exact opposite. Like you said, I can, you know, change anybody's foot, you know, function and form based on, you know, glut me, you know, activation or strengthening. It's like, that's the expectation because that's what we're sold as sound bites and protocols and a plus B equals C. Humans are.

the most complex organism on the planet, yet we somehow think that this reductionist view that's, know, shown or highlighted on social media and even, you know, I've probably, some of the stuff that I've probably put out seems like that, because you kind of have to, you're talking without context of each patient, you're talking without context of within a diagnosis, there are so many different variations of the exact, like thousands of,

You know how that's going to present and that's what I you know, I was just reading a comment on a video I did from years ago on IT band syndrome and I was like, yeah, I guess they you know, they totally missed a point or did I completely miss construe? You know what I was trying to say and I think that's you know, you have had a you know, decent social media present for a long time as well as I have and I think that's one of our goals.

Is to help educate the general public along with other physicians, but sometimes even when we're trying our best It's like if you lack that context, like you said it You're never gonna miss hit the point if you were in a treatment room with us all day You would realize like my god The same conversation never exists even though the same concepts and first principles are always at play And that's that's the only thing that persists Everything else is just you know water Sticking with maybe the pet

Dr Emily (01:02:26.649)

Thank

Dr. Beau (01:02:31.522)

P even I don't want to say in a negative we'll get a positive or not really positive negative just different lights I ask everybody else or everybody of the same question. So is there anything that you Long held true or you know, you're like that's the way it works that maybe in the past year or two You're just like wow. I have totally

Dr Emily (01:02:36.599)

Thank

Dr. Beau (01:02:52.686)

know, 180 or change my opinion based on new evidence or, you know, things that I've seen in practice, is there anything that stands out that you're like, yeah, I've completely flipped or changed my mind on that thing.

Dr Emily (01:03:03.674)

I wouldn't say necessarily for...

for my patients and how I approach them, what I will say is, one that I will give credit towards is like muscle testing and some of the benefit of just table work. And it is one that I would knock a little bit. So I'll throw myself under the bus. Is that I'm very much a believer of how our body works in gravity. And if we do muscle testing on a table

to activate muscles on a table and then nothing is done when a patient stands up in gravity and starts to move in gravity, I don't see how that transfers as much because then we fall into these gravitational induced stabilization patterns. So that maybe it wouldn't even be a pet peeve in how it would transfer, but I had NKT done to me for a back spasm that I had.

This is this weekend. a little. So I didn't have a class, so I Sky Robertson Lang Robertson, she works with Dr. Perry. So she did it on me.

Dr. Beau (01:04:12.974)

Who taught your class?

okay.

Dr Emily (01:04:25.375)

long story of how I had pulled my back out anyway. And she was doing a, it's called Nervy and another cranial sacral test on it, right? Where you look at an X and you look at parallel lines, something that's beyond my scope, but she was doing it on me and I was like, Hey, I'm game cause my back is spasming and I want to get back into the gym. So she was doing it. And normally I take this philosophy of table work, not transferring to gravity. So I'm just like, man, it's like a mobile.

Dr. Beau (01:04:25.506)

Mm-hmm.

Dr. Beau (01:04:35.086)

huh.

Dr Emily (01:04:55.289)

and in time, like I just don't really believe in it. Mind you, I haven't studied it. So anyway, so she did it on me and she's doing it and I'm like, my gosh, okay. So I'm sitting there and I'm like, my QL and my glutes are no longer spasming me. And I'm like, okay, well, I feel great right now. So I'm going to be a believer. Then I got up and I started walking around and it started, started going right back to where it was. So I was like, uh-huh, see. And then I just kept doing the reset of what she taught me. And it just started to consistently.

quiet the QL and the glutes. So maybe part of that was, okay, it's the consistency of what's found on the table and then doing it as you are in gravity to make sure that this pattern sticks. Again, it's a fragment of a much more complex story of me. It's not factoring in my posture, my pelvis, my foot. Do I have a limb-like discrepancy? It's just this fragment in this moment in time.

to try to quiet the storm of the spasming QL in the glutes. And she had used NKT. So that was one where I was like, okay, maybe my perspective on table work muscle testing is changing or I'm open to that change to see how maybe that could be woven in with my patients. And...

Could it be a tool for a certain patient that something else isn't working to get them in a state of comfort and something that can help them? So, I'm open to it.

Dr. Beau (01:06:28.116)

And we could have a whole conversation on that, which I've had entire podcasts on, you know, theory surrounding trigger points and peripheral sensitization and how that plays into central. there's a very, you know, interesting, it's not new information. just how you again, synthesize the existing information and Dr. Phillips knows integrate with, great amount of work with the neurocentric approach of like, you know, if you have a trigger point or something that's in this like heightened state or, know, this,

high threshold, you know, strategy, like you have less feedback. And if we talk about sensory input and then, you know, that table work may translate to just better sensory input and then you can change movement and who knows there's lots of theories. But like you said, the context again is apparent because it was you. So you have, know, your N equals one. yeah, NKT or neurokinetic therapy, anybody that's never heard of that David Weinstock. my professor of neuroanatomy at Logan was Kathy Dooley, who's one of their preeminent instructors. She's

Amazing. and anybody, know, muscle testing gets beat up because of, you know, apply kinesiology and, know, maybe some of how that gets used. But if you want to learn how to isolate muscles, which even if you're just talking about pathology, Hey, did you strain this muscle? You have a tendinopathy in that area. Like it's the best way to learn that. So that's my little plug on that methodology. let's flip the question around. go ahead.

Dr Emily (01:07:50.671)

What I will say with that, just because I'm not shitting on NKT because I have a lot of patients and a lot of NKT therapists refer me patients, is it is part of the collective collaborative approach that I think people should take with patients. It's the one thing that podiatric medicine podiatrists, even though I've trained myself a lot outside of...

a typical podiatrist of how I want to approach human movement. It is not a big part of podiatry of body work and testing and a lot of what you would see under chiropractic that that's just part that is not emphasized in any way. I wish that it was because it all

obviously ties into the human being who is moving and breathing under, you know, on our table. So, yeah, I'm not knocking it in any way. I have very, very, very little experience and exposure to it. I teach a lot of NKT therapists about foot types and, you know, gait patterning and the sensory stuff. So I think sometimes it's about how do we appreciate enough of another method for referral and that when, let's say you...

are referring me a patient that you know that I'm coming at it appreciating the methodology that you use with a patient so that there's never a conflicting or confusion to the patient then of the messaging that's being delivered by different professionals. So.

Dr. Beau (01:09:18.254)

Yeah, our profession's great at that. I I say our profession, overall, the physical medicine space of just conflicting ideals, getting thrown at patients, and then you have to reconcile that at your next doctor's visit, which is amazing. So let's flip the question and we'll wrap up with this. So is there anything that you are like, I think this is the way it is, I think this is my truth behind this thing, that doesn't have any,

Dr Emily (01:09:32.428)

Yes.

Dr. Beau (01:09:47.18)

white papers, peer-reviewed articles, substantiated evidence out there. Yeah, they're just like, I think this is how it works. It's been working for my patients. Anything that stands out in that realm, they're like, yeah, people would absolutely call me crazy or it's woo-woo, but you're just like, yep, I see it work and that's what I'm sticking with.

Dr Emily (01:10:03.308)

I mean, I would say so I'm very much into body schema, connection to self. There is facets of research you could say that because I work a lot in chronic neurological conditions is bringing in texture of the feet, compression apparel, weighted apparel, wrist weights, and then I just want them

to actually just visualize the movement and see their body moving in space in their mind's eye and just really strengthening that component of human performance, injury prevention, injury rehab is this kind of the power of the mind and the visualizations role.

in the way that we are connecting, improving our movement. Almost as if you were, I'm going to visualize my planter fascia healing, right? Obviously you to give it some injection or some growth factor or something. But the role of how that plays in movement optimization and injury prevention. That's the space of where I am right now in my career. And I just think it's because I've slowly moved through the literal, which was school, then became a little bit more fascia.

now it's kind of more abstract and it's become this area of energetic abstractness and the power of the nervous system in the mind and the brain from a healing perspective that a lot of that can't be picked up on Western medicine imaging or testing. But that's where I actually just feel. So maybe I'm moving in this whole space of like energy medicine. I don't even know.

Dr. Beau (01:11:46.062)

Well, can, the further I get into it, you can tell why some, you know, there are people that I knew when I was in school that were, you know, 30 years in practice that were, you know, world famous and acclaimed. And then they moved into this very woo woo, etheric realm. And you could see how it can happen. Not that that's where I'm saying you're going that, you know, you're going to be, you know, having a mandala on the wall and, you know, chanting around your patients anytime soon. But you could see because you, I think because

The more you know, the more you realize how little you know and you realize when you start to see that chasm of like, dear God, I've done physiology and biology and anatomy and neuroanatomy. It doesn't explain 90 % of what occurs because everybody has such a unique experience with pain and injury and recovery that it starts to lead you into this like.

we don't really have good terms to explain it. So then it comes out as this like energetic and then we start going over to like Eastern medicine side and trying to reconcile that with Western medicine ideals. And it's like, it's messy, right? But that's why I could see people like kind of, they seem like they got off the radar. It's like, actually that's probably more truthful of saying, I don't know. And then when we try to unlabel stuff, people attack you of like, what do you mean energy or, know, and that's where the disconnect.

happens for a lot of people is they can't reconcile traditional Western medicine with the unexplained and then whatever language you use around that is, know, I guess that depends on what part of the country lived in, how well it's responded to.

Dr Emily (01:13:12.811)

Yeah. You know what, what I was going to add on that also, and maybe you could feel this way, that when I'm evaluating a patient just because of the repetition of it or the years of experience is it's like I can see the tissue healing. That sounds so crazy because I'm not seeing the tissue healing. But as I guide a patient through a regenerative protocol, it's

I just am feeling each phase of how I'm progressing that patient.

And I don't know how to explain it in any other way except I'm literally guiding them. And after the first two weeks, they're like, I'm kind of here and I'm kind of like gauging and understanding the timing of remodeling and tissue healing and how they're presenting to know how to guide that patient specifically based off of how they're presenting at this many weeks after the injections to know where to take them without stressing them too much to then kind of take a few steps backwards. So that's the other part that I'm like,

I just, I can't put words to how I handle my regenerative patients and guide each of them uniquely in that process. But I feel like I can, I have this deep understanding of how tissue heals and remodels.

Dr. Beau (01:14:28.728)

I think what you're explaining is intuition and you know as Yuval Harari would say is intuition is just pattern recognition overlaid with experience and then pretty soon just like the chess master is not aware that they recognize the pattern it seems again it seems etheric or inexplicable it's not it's just that now you're operating on a subconscious level which is not pre-frontally regulated and you're like well I can't explain it just because it's not

Dr Emily (01:14:30.357)

There we go. You just...

Dr. Beau (01:14:53.774)

You don't have a language model for the abstraction that's occurring in your 80 % or 85 % process subconscious mind. That's what we're hoping all clinicians go to. And if you go to a good clinician, you're hoping what's not happening is that their peripheral cortex is shutting down because they're lazy, they're tired, they're burnout. Rather they've explored.

you know, continuing education and had a bunch of patient encounters and keep an open mind. And pretty soon it's like, holy cow, how did they come up to that conclusion? Why am I getting better under their care versus somebody else? And it's who cares if it's unexplained at that point, or you can't, you know, button down the exact diagnosis and why this one, you know, progress better than the other. yeah, that that's hard for people to digest, especially like I can imagine a student listening to that and be like, what the hell are they talking about? But anybody that's in practice, you know,

Dr Emily (01:15:41.249)

Mm-hmm.

Dr. Beau (01:15:44.686)

you know, five, 10, 15, 20 years, you're like, that's kind of more of what I'm doing. And if somebody like sat in my corner and literally had to review every case, I'd like, why'd you do that? And you'd be like, I don't know if I could give you the peer reviewed answer right now. But that's the truth, right?

Dr Emily (01:15:55.787)

you

Dr Emily (01:16:00.095)

Yeah, that was so well articulated. You said that so much better than me. So thank you for bringing that to that.

Dr. Beau (01:16:03.956)

well, I think it's because I think about that all the time, right? Is that I, again, I have to reconcile sometimes like my wife was, I had like a giant trigger point and like my SCM that was radiating up into my head, you know, just last night. And I was like, can you work on this? And she started like poking around and like my second rib and like behind my scapula. And I was like, what, what are you, why'd you do that? was, you know, painful, but it's referring directly into like my mastoid for any nerds listening. And I'm like, how'd you know to go there? She goes,

I don't know, like just kind of seemed like where I should go and she goes, I couldn't tell you that there's some protocol. And I think the people that have come up, this is my like kind of last note on this, the people that have come up with like different methodologies, NKT, ART, whatever it is, they actually are just those pattern recognizers that can then bring it back to the frontal cortex and put a structure around it. All right, we could all have our own methods. Like you have your own methods, own courses you teach. That's what you've done, right? You've taken that.

Dr Emily (01:16:54.956)

Yeah.

Dr. Beau (01:17:02.126)

you know, all of that stuff and then said, well, this is what I'm to put out to the public. And the people that do that the best are the ones that are, think, the most honest that like, Hey, I don't know everything. This is kind of what I believe to be true. And it's going to continue to change as more information comes to light. And that's the people that I like to talk to, like yourself. so again, I want to thank you so much for coming on. And, like I said, I've been following you forever. I've been aware of your work. I remember, you know, just watching videos, reading blogs from back in the day, but.

We didn't even talk about Noboso, so I apologize. When did you start Noboso?

Dr Emily (01:17:37.431)

Yes, so Niboso, for the listeners, if they're like, what are you talking about? Is a sensory based product line that I started in 2017. That was kind of beta testing how it is. All of the products from Niboso feature these tiny little...

pyramids, little triangles that are creating a textural pattern. Really it is two point discrimination, kind of like braille. And it is on all of the mats, insoles, socks, release tools. We have fitness equipment or rehab equipment. So there's over 40 SKUs now. And my goal of starting Noboso was to get even more out of the foot. This is initially, I was.

advocating that people take their shoes off, do barefoot training. And then I started really getting into surface science and just essentially saying, if we're taking our shoes off, then what do we stand on? No one is talking about that. Like, does it matter what we stand on? What's up with turf versus wood? And so then I started getting into it and I was approached by someone in the industry as far as creating a product. was working with a lot of the companies out there that everyone.

now appreciates and integrates as kind of that foot specialist and they were like, I know you've danced with product ideation. Do you want to create something? And I knew that I wanted it to be sensory based.

Our first product was a barefoot training mat. And now we actually sell 90 % of our products are everything but mats. Because we've seen the utility of texture be much further than just this mat. So it's been a fun journey. We just closed an investor. And it's a strategic partner. So my goal is to hopefully have it acquired soon. And then I can focus on other fun stuff.

Dr. Beau (01:19:27.82)

that's, you, your team was kind enough to send over some of the small wedges, which for what we do from a functional rehab standpoint are really cool because obviously you have the sensory input or the tactile input that's being played, but then we can change the input based on the position the foot's in, which is much like playing with an active orthotic almost with like, you know, a specific rehab drill. I really, we've played around with all sorts of stuff like Thomas showed and different, you know,

you know, people in the realm. And so I just like when people play with different ideas. So again, that gets back into the taking a principal playing with something that like, Hey, there was this kind of evidence out there. Nobody ever done this. Let's put it together, see what happens. And he's kind of got to fall or pull on those strings and, you know, follow it and tell hopefully it gets acquired and you get some time back and keep learning more and do something different.

Dr Emily (01:20:13.175)

Yes, yes, encourage, I encourage honestly the younger generation to do that because I feel that there is not as much innovation in this space as of late.

And I don't know why that is. We're around the same age as far as pushing trigger point, kinesiology, TRX. There were these different modalities that were pushing into the fitness, athletic, rehab space. And I just feel that there's less of that now. So don't know if you have theories on why that is, but it's.

Dr. Beau (01:20:26.894)

I think

Dr. Beau (01:20:46.296)

I think people are scared social media, you know, we think that, if you're going to create a product, you would use something like social media or, know, something like that to push it. And I think people are scared to put their ideas out there because so many people come and, you know, rain hellfire on it for whatever reason. And I think the biggest thing here is to, to end on this note, I think is actually a great kind of wrap up.

is nobody really knows what the hell's going on. It's the people that are honest about that within our profession are actually the ones that live at the top because they're aware of it. And then they can eloquently describe or explain that to a patient while also letting that patient know that like, I got your back and I do know a lot, but that doesn't mean that we know near everything. But that's where I think students and new docs and you know, people newer in the field are kind of just like, I don't want to put my opinion out there because I don't know how it's going to be, you know, seen or reflected back to me. It's like,

At end of the day, you are following, you know, adhering to first principles, you are following, following sound science. And I don't mean peer reviewed articles. mean like what physiology, anatomy, biomechanics, why wouldn't you put out there? That's your job is to help like grow the field, innovate both for patients and the field, right? Your colleagues. So I'm with you, you know, whether that's ideas, you know, products, we need more and more of that, but we also need

conversations like this so we can talk about these things where it's not, you know, a one minute video or a little post that people just, you know, write comments on and find out like, why do you think that? Why do you do that? And I think we had a lot more of that. We would all again, probably realize we're saying mostly the same stuff and we're just like disagreeing on, you know, the words you used or semantics or something like that.

Dr Emily (01:22:27.903)

We're all just trying to improve humanity. I mean, that's ultimately what we're doing, right? Advance a profession. My goal with Noboso and my work is that this concept of the sensory foot and texture specifically, but just neurosensory stimulation goes far beyond me so that when I'm no longer doing this stuff that people still are looking at the foot, not just as a biomechanical gateway into movement, but as a very powerful neurosensory activation.

area of the body that if utilized can improve movement, reduce injury, athletic performance, all of that and just really further push into that.

Dr. Beau (01:23:07.118)

Well, you're a perfect description of preparation meets luck, right? Because timing is everything and like I said, there's never been a bigger time for kind of the foot movement and everything that we've kind of seen spilling over. So again, I want to thank you for coming on and being a big part of kind of what I've learned, but also just overall, our medical community and keep pushing the limits. yeah, thanks again for coming on. I really appreciate it.

Dr Emily (01:23:32.801)

Thank you so much, it was an honor.