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Sole Brothers

Drs. Greg and Dan Stilwell, DPMs

Breath is Good!

Fighting to breathe, trying to get a lung full of air.  It just doesn’t seem like I can get my diaphragm to move the way it used to.  Charcot Marie Tooth disease (CMT) can affect myelinated nerves to the breathing muscles, and I suspect that is why I get this “sucking for air” feeling. It can be a borderline panic situation, like being underwater too long.

Nordic-style walking poles to the rescue! Setting their height so my chest opens, I can lift my spine and ribcage towards the sky. I begin to feel the back of my neck lengthen and air just naturally being drawn into my chest. Relief at last and a sense of peace and fulfillment spread throughout my body. Medical research proves that Nordic Pole Walking increases your oxygen consumption and elevates your heart rate.

There are many yoga poses that help with breathing. The problem is, I can’t do most of them either because of my poor balance and spinal scoliosis – both a result of my CMT.  However, with the poles, my balance is quite good and I can support my spine in such a way as it begins to lengthen and become more supple.

The gentle swaying rhythm of walking with these poles helps to lift the breastbone and calms the nervous system.  Part of healthy breathing is learning to fulfill the exhale and enjoy the inhalations, the feeling of expansion in the rib cage. Oftentimes, when we stop to do some stretching (like Pilates or yoga) we use the breath to “direct movement”.  Use the poles to inhale fully and then on the exhale, deepen the stretch.

A method called the “squeeze breath” is helpful in teaching the lungs to empty fully and can help enhance your body’s enjoyment of the Pilates and poles positions.  This is simply exhaling mindfully, somewhat slowly- and then at the end of the exhale squeeze out the last bit of air in the abdomen and make a sound such as “hah”.

Let’s do more of this!  Please let me know your suggestions and experiences.  All the best, Dr. Greg.

p.s. I’ve included several links to academic papers showing how breathing is helped with the use of the Nordic walking poles.  Always nice to see this stuff holds up to research methodology!

Here are some more resources about CMT and Nordic Walking!

The Effects of Nordic Walking Compared to Conventional Walking

Nordic Walking Enhances Oxygen Uptake

This website is dedicated to all things CMT News!

Ocean Swells ~Dr. Greg Stilwell, DPM

Bubbles of foam stretch out as the water expands in all directions.  The ocean undulates in a primal rhythm speaking to my deepest presence.  The wave suspends at the apex, halting ever so momentarily-pulling the molecules of water upward in a dynamic flow, reminiscent of taffy- oh so delicately balanced between stretching and contracting points.

My body gently sways to the side and lifts, much as the sea foam pulls, lifts, stretches and follows the contours of the adhesive glistening salt water surface.  An invisible impulse expands the wave in all directions, connecting an infinite interlocking web of fascia into an expanding, glorious blossoming, spiraling ring.

The tidal wave of my brain fluid follows the pull of my supporting, swinging surface- gracefully arcing into the expansion, gently separating apart near the top of the next swell. My transport vehicle slides effortlessly across the silicone silver of the glistening surface; for a brief time, I am caught in an energetic warp between the two opposing forces sliding away from my dance.

The inner suspense builds as I allow my web to expand naturally, inhaling a briny openness and the very mineral of my being is on this arched track into the next swing.  While intuitively I know, each swing is followed by a suspend, the journey upward still fills me with tingling anticipation of a lift generated somewhere from a very primal location.

Breath flows freely in on the upswing, and gracefully exits during the descent. My emotions hook on for a free ride on this lovely raft of ease and grace that I share so gratefully.  A sacred stillness settles any discordant spikes into a drawn-out note of delicious harmony.  Beauty and love partner with me now.

Fibromyalgia of my Emotions ~ Dr. Greg Stilwell, DPM

It would seem that nerves too, can become multi pointed tender much like muscles in the real fibromyalgia.  Will the real fibromyalgia please stand up?  I have a “degenerative” nerve condition, inherited and in a class of some 80(?) different types of the same nerve “atrophy” otherwise known as Charcot-Marie-Tooth (CMT) as first described by these three eminent neurologists in 188-.

Emotions run rampant in those with untreatable diseases.  Thankfully, this particular disorder does not apparently shorten life span, just evolves your quality of life along a little quicker than otherwise. Nevertheless, the online forums for CMT that I read in Spanish and English highlight the extent of pain-both chronic and acute, balance accidents (falling down, usually), and extensive/recurring surgeries, especially in the lower leg and foot (seems fortuitous I am a podiatrist).

How lucky do I feel to be able to do Gyrotonic® related exercises three times a week, water based movement therapy virtually every day, and Pilates style pole walking, multiple times a week?  This is where mindfulness-the art of being able to momentarily rest quietly with your thoughts, helps to soothe my emotions. This active lifestyle helps to offset the effects of CMT, but the shadow is always there, lurking.  Acceptance and compassion for this reflective, shadow self I tug-of-war with, are not always my first emotions; more like frustration, hopelessness bordering on depression, the desire to get high, or probably the most healthy-journaling and blogging about emotions.

Self-acceptance treatment is at the heart of many psychologists’ practice; many patients/clients see themselves as less than adequate even without a progressive “dis-ease.” For me, spirituality and the belief that we have a divine purpose for our lives during this incarnation helps to make sense of the opportunities presented to us during this lifetime. Emotions relating to isolation and loneliness seem to be rampant for those with chronic disease; but strangely, these same feelings are also very common in the rest of the so called normal world too.

This may be the perfect time to toast each other with SALUD!

Walk well with Stilwell.

Hozhoni Balance Rail® barefoot style orthotic.

‘Triple A’ Supplements For Your Health~Dr. Greg Stilwell, DPM

Among the many supplements of herbs, vitamins, and drinks that are available to us now in your friendly health foods markets, there are three that stick in my mind.  Probably, this is because of the mnemonic of the “Triple A” that works to remember these three powerhouses.

Ashwaganda is an ancient herb first used in the east Indian style of health called Ayurveda.  Most think this healthcare system began some 5000 years ago;  while so called modern medicine may sometimes turn up their noses at medications that aren’t patented and formulated in a laboratory to serve up in a white pill at exorbitant prices-this one passes the test of time.  Usually, this plant is prescribed as an “adaptogen”, or a method of providing strength while in the midst of stress, and giving us the ability to stay healthy despite the onslaught of modern living-with the various sleep disorders, food challenges, lack of exercise, and mental stress brought on by various working conditions.  Look for a reputable organic brand, and start slowly with 500-600mg per day.  Usually, you will begin to feel the benefit within several days.  There are many other uses for Ashwaganda, but for now let’s emphasize its most important role.

Amalaki, also known as Indian Gooseberry, is a very potent source of Vitamin C. This is a restorative herb, and promotes good health by gently removing toxins from your body, and can be helpful if you have acid indigestion (GERD, or hyperacidity with reflux into your esophagus). This herb can be really helpful if you are feeling like you might be coming down with some kind of cold/flu or just too much “good living” has gotten your insides all worn down.  If you have never had a black colored paste called Chyvanprasha that has Amalaki in it, you are missing out on a delightful snack that offers many health benefits.  Plus, it tastes like a blend of wonderful fresh fruits and honey.  If you’d rather, tablets are available (500-1000mg daily is typical), but please look for the organic label before you buy.

Astragalus, is a several thousand year old prescribed Chinese herb used for increasing one’s “life force”, also called Chi (or Qi). This is another term for using the herb as an adaptogen, to help you stay healthy despite working long hours, not eating so well, and probably not exercising as much as one should.  Most people who take this herb use it on an acute basis, meaning that you feel a little sick, muscle tenderness, or other malaise that you don’t want to grow and make you lose work days.  Or maybe you’re just getting ready for vacation and feeling like you’re not up to full energy and need a little blast so you can feel excited about “getting away from it all.”

There are several general guidelines in regards to taking any herb or vitamin on your own.  If you have very little experience with supplements, I recommend you begin by visiting a licensed Naturopath (N.D., or Naturopathic Doctor).  These highly schooled doctors specialize in recommending dietary changes, and prescribing supplements to help you achieve your health goals.  M.D.’s that are certified in “functional medicine” are very similar to what an ND can do, albeit usually with more laboratory testing and probably a greater expense.  Perhaps someone with a complicated chronic condition should have a team of natural health practitioners that can coordinate services and insights.

Here’s to your health, and may you long be “Stilwell.”  Please keep those comments and suggestions coming in!

In the Loss, I Gained . . .scoliosis training continues ~ Dr Greg Stilwell, DPM

After 4 days of lazing about- nursing some respiratory virus’ effect on my muscles- I am starting to rebuild. During a private Gyrotonic® lesson recently, my instructor and I noted some loss in the mobility of my spine. With scoliosis, one is always on the hunt for flexibility and strength to keep the spine going vertical as much as possible and allowing for as many “normal” activities as is feasible.

In the process of understanding which part of my spine bends or twists, and which part seems stuck-I think a person gains a greater awareness of how the ribs and shoulder blades play a role in arching or twisting the spine. One of the basic precepts in the circular and spiral motions of Gyrotonic® is moving the pelvis first, and then letting the spine respond.

For me, I notice one side of my ribs stick out further than the other side, and some parts of my spine bend greater to the backside than other parts. Utilizing the equipment (with springs, pulleys, and creatively arranged cables) helps to lift the ribcage, and to promote more even rotation in the trunk.

The simple inflatable exercise ball (55-65cm is ideal) is a great home based way to lengthen your spine and begin to allow the arms and legs to help you flatten the curves and overly enlarged muscles that have developed along the sides of the spine. You can also just lay on your back, allowing the curve of the ball to bring your spine into a more normal arched position.

The push/pull, the ebb and flow, the growth and pruning- are all metaphors for keeping your body in its best possible shape.  While initially I am frustrated at the lost spinal motion, I learn that a deeper awareness lies waiting for me.  This exploration of the other muscles and joints that can help straighten and strengthen me gives me a beautiful appreciation for the work of art called scoliosis. May you find your own deeper awareness of mindful movement.  It’s as if a light emerges from the depths of darkness created during sickness.  Here’s to health: Salud!

 

 

 

The Benefits of Balance Walking ~ Dr.Greg Stilwell, DPM

Imagine being a four-legged animal, using Nordic walking poles to prowl city streets with the strength and balance of a big cat on a savannah. Now imagine using Nordic walking poles to participate in yoga and Pilates. Imagine walking outside, breathing deeply, chest wide and spine lifted tall.

Exercise walking? Some of us just want to increase our confidence on stairs, step gracefully over a curb or get help with a weak ankle or painful back. Nordic walking poles have a patented three-piece strap that allows the user to open the palm of the hand and push downward into the poles, lifting the rib cage and giving the lungs plenty of room for expansion. A whole hour can be spent using the poles for bending, stretching or squatting—all exercises that help with balance.

Those of us with Charcot-Marie-Tooth disease are used to walking a little differently. We may “lurch” when fatigued, the result of our upper bodies favoring one side or another as we walk. With a set of walking poles, though, we become rhythmic, smooth and mostly pain-free. While few of us can achieve the physical therapists’ ideal of symmetry between the two halves of the body, with walking poles we can function as if our length, strength and flexibility were equal throughout our bodies.

 

Walking poles offer people with CMT not just a way to get and stay fit, but also a training aid for walking and balance. Medical studies on “pole walking” uniformly show better breathing, less stress on joints, and other significant advantages over running, including more calories burned in less time. In a related note, evidence has been mounting that using a tempo like a simple musical rhythm helps with neurological re-training. Walking with poles at a basic metronome-like pace results in smoother nerve conduction. For urban or hard surface walking, a rubber tip can be placed on the end of each pole. This allows one to truly push into the pole, lift the spine and propel the legs forward. These high-traction rubber tips help keep one from sliding when performing a leg up stretch or pushing the body into a lifted twist using the arms and shoulders.

The beauty of using two Nordic-style poles when walking is that as your legs get tired and foot drop or ankle rolling gets worse, the poles can be “push-pulled” to use the stronger muscles of the shoulders and trunk to take stress off the tired legs and feet. Plus, you can always stop and do some stretches, deep knee bends or twists with the poles to bring a spring to your step.

My wife and son and I recently pole-walked through the Loop area of Chicago. It was a joy to be able to gaze upward at the tall buildings with confidence that our poles would keep us upright, stable and able to lean back to peruse the beautiful architecture. The same technique works in wooded areas or parks where we can admire the tree tops, listen to nature’s sounds and even muse at the clouds—much like being a kid again.

In shopping for poles, the choice is among one-, two- and three-piece poles. The cheaper poles (under $50) are probably not worth the price, unless one just wants a quick trial of the technique. Opt for the true Nordic poles with the fancy Velcro wrist strap. I find that my one-piece carbon fiber poles bend more easily when I really need them to stabilize or lift me. Adjustable multi-piece poles are easier to transport, but check for a reputable brand with good-quality locks on the adjusting mechanisms. I have not personally seen anyone injured with a collapsing pole, but one should always be on high alert for such a travesty.

To learn to use poles, Foot Solutions Inc. has a Nordic walking program called Balanced Walking, which offers incentives for those wanting to teach pole walking and earn money selling walking poles and accessories. (Many of the videos online show relatively healthy people walking at a rather fast pace with poles, but these techniques may be too advanced in the beginning for anyone with CMT and associated musculoskeletal conditions.)

There are dozens of wonderful teachers of Nordic walking across the United States, but nowhere near enough to meet the demand of the CMT population, much less those looking strictly for fitness or weight loss. It usually takes three hour-long sessions to become a “pro,” walking with ease and grace and utilizing the poles to stand tall and swing the legs smoothly.

SPECIAL POLE WALKING DEAL
Pick up a Pair of Poles at 10% off and the CMT Association  Gets $15
Interested in implementing Dr. Greg’s recommendations and getting Nordic fit? Balance Walking will donate $15 to the CMTA for each set of poles sold. The CMTA and your body will both thank you! Visit www.balancewalking.com and enter the coupon code “CMTA” to get started! A free motivational book is included in your order!

Hey, I think your Gout just called ~ Dr. Greg Stilwell, DPM

Gout called on my friend Bill the other night.  He said it was right at 2:19 AM; funny how the time freezes in one’s vision-to help balance the drastic onset of pain, I guess.

Acute attacks of gout are not just any pain, of course. That salmon red/pink color of your foot and even the pressure of the sheets can cause a grown man to cry.  Bill said even the breeze of the ceiling fan hurt.

OK, so he went to his internist the next morning, and was told he needed a “joint aspiration.”  For those of you not familiar with this term, it involves a large bore needle inserted directly into that inflamed joint.  Remember, that joint even the fanning breeze made hurt? This medical procedure has a long and storied history (meaning, clinically valid) and does help to see if there are uric acid crystals in the synovial fluid of the joint.

The uric acid crystals responsible for gout look like a saw blade when viewed under a microscope.  Gee, maybe that is why an excess concentration of them hurts like a son of gun. The thinking goes, areas of the body away from the warm center allow these crystals to precipitate out and accumulate in your big toe joint.  Painful depositions of crystals can also occur in hands, ear lobes, and heaven forbid-your penis.

The old saying is there are “over-producers” or “under-eliminators” of urate, or the byproducts of excessive purines in your body.  Most patients, when answering honestly will admit to some variation in their diet recently.  Bill had been eating beef pot-roast and gravy multiple times in the days leading up to this attack. Most medical specialists focus on the lack of excretion through the kidneys; drink a lot of water and even your fondness for pot roast may not cause a gout flare up.

Aren’t blood tests an easier way to diagnose gout?  It seems that during an acute flare up, most of your gout crystals are in your foot-not in your blood.  So, after the swelling and inflammation has decreased, then blood tests can give you a better idea of the more chronic nature of your “Hyperuricemia.”

Black cherry juice (also available in capsule form, which is even more concentrated) is a potent anti-oxidative and anti-inflammatory which can help. Prescription drugs can be of great help too, of course.

The main idea is to be aware of what foods increase your uric acid.  Think red meats, shellfish, and of course-alcohol.  Alcohol helps to dehydrate your body, and we want to flush out your kidneys with lots of healthy fluids like water, coconut water, and unsweetened beverages.

Be well, my friend.  Many times a Naturopath (N.D.) is helpful in establishing a healthy lifestyle to prevent future gout attacks.  Your local walk in clinic can certainly get you out of pain in relatively short order, however.

Here’s to happy walking!

 

Evidence Based Medicine: Barefoot Orthotic™ Gait Study ~ Dr. Greg Stilwell, DPM

A study recently completed at Ft. Lewis College in Durango, CO has demonstrated how the novel and innovative stick-on device, Barefoot Orthotic™ positively changes gait and pressure patterns in the feet. Runners were noted to have a decreased stride length and increased forefoot strike pattern, consistent with decreased “ground reaction force” when the foot hits the ground.

These devices were originally designed with a minimalist runner in mind; typically, minimalist shoes afford no space for a traditional, in shoe foot orthotic.  While clinical results with this self-adhesive device have been overwhelmingly positive, evidence based studies have been lacking for all orthotics, and especially the new to market Barefoot Orthotic™.

The most revealing finding of this study was how the devices change gait patterns; the 10 runners analyzed changed their running patterns to be like barefoot. Generally speaking, the running patterns associated with barefoot running are considered to be healthier and physiologically correct for human gait patterns.  The advantage of wearing the Barefoot Orthotic™ with shoes is twofold:  you get the protection from rocks, glass or other ground based dangers, while still gaining the healthier stride associated with barefoot running.  Sounds like a win-win to me!

The Exercise Science department at the college is planning on submitting this manuscript for professional journal publication.  Stay tuned as we continue to explore evidence based attributes of the Barefoot Orthotic™!

Information for Doctors, Therapists and Specialists

How Does the Barefoot Orthotic(TM) Work?
MECHANICAL
  1. Cuboid Pad: the cuboid bone has been called the “keystone” of the arch. The Peroneus longus muscle passing under this bone appears to be stimulated to fire by the presence of the Barefoot orthotic adhering to the plantar skin. This helps to plantarflex the 1st ray, as well as providing midfoot support.
  2. Balance Rail: centered between the lateral and medial columns of the foot, both pronation and supination misalignments show improvement with the orthotic.  This appears to be secondary to increased proprioception, and the foot adapts by centering itself on this balance beam.
  3. Metatarsal support: the lesser metatarsals are protected from overloading, and flexible hammer toes are seen to lie flatter during weightbearing.  Many times, neuroma pain & plantar MTP joint pain can be successfully treated with this device.

PROPRIOCEPTIVE

  1. Shore A, 50 durometer gel material has been utilized to provide shock absorption as well as viscoelastic recoil. Patients often comment on the springiness in their step while wearing these orthotic devices.
  2. Our evidence based research studies show a shortened stride and increased midfoot strike while wearing the barefoot orthotic™ with running shoes. The devices create a healthier stride and gait pattern similar to running barefoot.
  3. The bottom cover, or substrate: creates a firmer base for the gel devices, limiting travel to enhance the visco-elastic recoil effect, increasing dampening of shock, while wearing the self-adhesive material from which the orthotic is made.

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