The Source Physio 0:05
Welcome to the Australian Fashionista Collective. James it’s lovely to have you on board. Given that James is battling lockdown conditions and there’s uncertainty as to when to return to the UK, we really appreciate you agreeing to come on board and having a chat with us this morning or this afternoon your time. And so, first and foremost, would you like to introduce yourself?
James Earls 0:39
Sure and thank you, thank you for the invitation. And I feel a little more than a little guilty when you said battling lockdown conditions because I’m in Bermuda, which I think, along with New Zealand and only a few other handful of countries, because I think managed so far pretty well. So it’s actually very, very, very few if any restrictions are on here.
The Source Physio 1:02
I was actually being slightly sarcastic……
James Earls 1:06
so my apologies for…..
The Source Physio 1:09
Please don’t apologise.
James Earls – 1:11
I’m tanned and relaxed hanging around here rather than in London. So, thank you for the invitation, and it’s a privilege to be here and have a chat with so many familiar faces. By way of background or introduction. I’m originally from a small little town, kind of a pinprick, Atherton in Ireland, just about 15 miles south of Belfast, which I always have to say. Therefore, I have a slightly different accent, which means that I will say certain words that you think doesn’t sound like anything I’ve ever heard of in English before. So even anytime I say something that’s totally incomprehensible please just put it in the chat and ask me to repeat myself. I’m used to it. I got over completely any inhibitions with that. I originally trained in aromatherapy back in the early 90s. After studying psychology and taking a couple years off to work at a Peace and Reconciliation Centre in Ireland. There I was working for peace, doing a lot of conflict resolution and prejudice reduction work due to the conflict that was inherent, and it was while I was there that I got a strong interest in bodywork and particularly in essential oil with essential oils for aromatherapy, because we started using them as an introduction for some of the group work. We were dealing with groups of people that were very strongly affected either by the Troubles or physical abuse, alcohol abuse, sexual abuse…..Working with church groups with mixed marriages with all kinds of people or those being exposed to high levels of stress. And we just would bring them in, they would stay, do some kind of process work for two or three days. And I wasn’t really doing the hardcore work. I was a volunteer for a couple of years. And I was given the privileged position of just trying to help the process along, to try and facilitate it, and I had a small collection of essential oils. I was working with the Centre director’s wife, who had a background in massage. And so we ran little mini workshops, getting to know one another, where we all sit around in a circle, and we would teach a group how to make a blend of oils, then how to give a basic hand massage and foot massage. And that was my first introduction to the potential power of bodywork, and by no means we can claim that we changed anyone’s lives in those 30 to 45 minutes, but we gave them the potential just to kind of sit back and and to breathe for a moment. My interest in bodywork! And after I’d gone through school, through university, going to work for as long as possible for a couple of years’ voluntary work to try avoid proper work, my father’s dream of getting me into the civil service or into the bank….. And at the end of the two years of voluntary work I went home and my father said so do you know what you want to be? Do you know what you want to do with your life? Yes! And I always go back to the idea of seeing Monty Python’s “Holy Grail” where they’re talking to the King’s son, and where he just wants to sing and dance! And I went back to my father, he went “So what do you want to do?” I just want to be an aroma therapist and……
James Earls – 4:51
Not in this scene, son! (Sorry, I couldn’t help but complete the quote!)
James Earls – 4:55
My Father God bless him. Thank god eventually he made up his mind. And so I was allowed to go for training in aromatherapy. Early 90s. At that stage there were very, very few good resources so I subscribing to the American Massage Magazine, through the late 90s. 97 was the beginning of Tom Myers’ body cubed areas of anatomy articles. So I started collecting that, and it was the first time that somebody had explained anatomy to me. So I started just keeping an eye out for his articles, and they, just kind of brought anatomy a little bit more clearly to mind , into vision, something a little bit more comfortable and approachable. And in the same magazine, eventually in ’99, there was an advert saying Thomas Myers is coming to Dublin, to talk about Anatomy Trains. Like, no idea what the hell Anatomy Trains was, but I like the guy’s style of explaining anatomy so I thought, well very few people come to Ireland. It’s only two hours train journey so I jumped on the train and and went down and sat in that classic hotel conference room for three days. Listening to Tom Myers, his then wife was was there as well. And at the end of the three days I thought I still have no idea what the hell this thing is, but I liked the overall picture, it kind of made sense, it resonated. So, I then commuted between Belfast and Boston and the Structural Integration training with Tom over the next two years, along with with Gary [Carter], he was in the same class. So that was really kind of my introduction to to both body work and to fascial work.
The Source Physio Source Physio 6:50
Fantastic! So that really was what ignited your interest in fascial anatomy?James, everybody should be familiar with the fact that you wrote a very successful book called Born to Walk. Where did you get your ideas from? What what drove you to target that particular function of human anatomy?
James Earls 7:16
I appreciate that everyone should read my book [laughs]! I think I was teaching Anatomy Trains. It was about 2005 I started teaching Anatomy Trains through Europe. And I think it was between 2009-2010. I had just been teaching one weekend after the other. And I don’t know the truth of the story, but the myth that’s in my head was I was teaching one weekend and I said something and somebody put up their hand and said that sounds like something Gary Grey would say….. that’s interesting. We moved on. And the next weekend, I said something we were teaching Anatomy Trains somewhere completely different, and someone put up their hand and said, that sounds like something Gray Grey would say! But the next weekend, I was teaching somewhere else and somebody else completely different put up their hand and said I mentioned this Gary Grey. And I kind of I have a loose rule if I hear something three times I pay attention to it. So I thought well this is my third hearing so that night I went off into the hotel room and Googled Who the heck is Gary Grey. And all of this stuff came up about the Father of Function, is 40 years as a physical therapist teaching chain reaction mechanics through the US. I thought that sounds interesting. I need to know a little bit more. So, I found a weekend I was free and I jumped in another plane and flew to San Diego exactly in that classic hotel conference room, and listened to Gary Grey and his sidekick David Tiberio present what they then called the Chain Reaction Transformation. And this was 2011. And I found myself getting agitated, because they were standing in the front and I’d spent a lot of money and time and they were talking about “so can you see the when the skeleton does this that bone will do this and they don’t do this and bone will do this and the joint will do this so the next bone will do this and the next one, do this”… I’m sitting there thinking, my God, I have just stepped back at least a decade! Haven’t these people heard of…… It’s not about the bones and the joints it’s all about fascia! Why are they still talking about bones and joints? And I think it was after the second day, I was still having this agitation within myself. I didn’t want to hear about bones, but to hear about movement and fascia and even muscles. And I mentioned doing the Prejudice Reduction Work at the Peace and Reconciliation Centre and one of the tools that they have is, whenever you find yourself pointing the finger at somebody else and saying, there is a problem, there’s a fault, there’s a flaw, they’re not doing it properly. It’s actually a red flag to start pointing the finger back at yourself and asking, why, why do I feel that way. And it was then I thought, “Well actually, what they’re saying is just another vocabulary for the vocabulary of movement”. And actually, if I sit back and relax and look at what they’re saying, most of what they’re saying fits into a myofascial model. And, why couldn’t somebody put those two vocabularies together? Why couldn’t, why can’t we be talking in the in-between school? Why can’t, why don’t we mention the bones and the joints and movement? And in the skeletal-biased vocabulary, why aren’t they talking about myofascia? Nobody seems to be putting those together. And it was that they would particularly talk to the mechanics of walking. I thought well actually, that fits perfectly into that! A lot of the principles that that I’ve been teaching and I’ve been exposed to in the fascial world. And so my, my, programmes for myself, well can I try and blend these two stories? And then between 2012 and 2014 is the publishing of the book, and I spent a lot of time talking with the Grey Institute and obviously embedded a lot with the Anatomy Trains School. So the Anatomy Trains schools started taking on more of a functional story, looking at and being appreciative of the movement of the bones, the joints and the Grey Institute have embedded and embraced the fascial story as well, and me being a little bit in the middle between those two schools and kind of blending that story.
The Source Physio Source Physio 12:09
Brilliant! Now, I read the book when it came out in 2014, and knowing that I was going to be chatting to you I thought oh I better have another little read and I gleaned so much information. Now I’ve got to say that it became a real point of fascination for me that if it’s not happening correctly at the foot, then it’s not going to be happening, terribly well in the rest of the body. Now one of the points that came through time and time again, is you emphasise the importance of understanding movement, more so than understanding the anatomy. Do you want to expand on that a little bit James?
James Earls 12:44
Yes, you know, I think I can speak for many, many people many therapists, and anyone who’s had to go through anatomy school. There’s this expectation that if we can teach you all of these bits, somehow you’re going to be able to translate that into understanding, appreciating any movement that any client or yourself, or anyone that you’re working with, how they move. And that’s a really difficult step to actually take because I don’t think that the standard anatomical vocabulary actually empowers you to do that. I think we’re in a much better place in these decades than certainly we were in the 1990s, whenever I started. We didn’t have an appreciation for fascia, we didn’t have an appreciation of the tensegrity of the body. We had the idea that we had the words of yeah the whole body is complete and connected, but we didn’t know why we didn’t have an established vocabulary for it. And I think, for me to understand any system, I find it’s much easier if I start from a viewpoint of understanding the whole outer realm of that system, and then work inward to the detail.
But to go back to my aromatherapy background. I was consistently taught a number of times, three or four times the chemistry of essential oils. And every time the teacher would start with, let’s look at the molecule. And let’s look at the binding forces between the protons and the electrons and neutrons and let’s look at the different arrangement and how then they build up into between groups of alcohols and esters and I don’t understand that the beginnings of the molecule, I don’t understand bonding. So, I’m off. I’ve got no connection to it. Eventually I was hosting workshops and I asked the host or the teacher. He was a chemist, that I want to bring me to the to Ireland to teach the chemistry of essential oils, but I want you to teach in reverse. I want you to teach me from something I know. So let’s take Lavender. Let’s look at the qualities of lavender, the properties of lavender. Lavender is an anti-septic and anti-inflammatory, a-b-c, but what are the properties of an oil that amke it an antiseptic? Why is it an antiseptic? Because it contains alcohols, what are alcohols? Well we all know that alcohols are antiseptic. And you go “oh okay so that’s why lavender is antiseptic!” Because it contains a portion of alcohols. What are they? What are the notes of an alcohol? What does an alcohol smell like? Now you can bring me down into an understanding about the chemical families, and eventually you can bring me down into the molecule.
And I think we have the same problem with anatomy, that we try and start from….. Let’s look at the bone. Let’s look at the muscle. And let’s maybe look at the groups in the end, and take agonist and antagonist, and let’s move up into movement. Well you haven’t actually empowered me to understand movement. If you give me the vocabulary of movement and look at the reality of just what happens when people move, as opposed to we’ll give you this minute story to try and understand the complexity of the whole. And it’s the wrong way round. Because you’ve given me an individual, and atomized story to try and understand the connectivity. Let’s start with increasing sense of connectivity. Let’s start with basic exercises of…… in my workshops I always have the exercise no look at your right hand and keep looking at your right hand, as you turn, whenever you’re standing your left foot pronates your right foot supinates; your right hip internally your left hip externally rotates. That’s just an anatomical standard reaction. Oh, okay. So with with momentum and turning the whole body is reactive. I felt it. I’ve got the immediate kind of embodied sense of it. Now I can understand that the rhomboid contraction actually led to something happening right through my body.
It encouraged my foot to pronate and one foot supinate. Now you understand that the quality or the implication of pronation and supination. You understand why I need to check your shoulder if you come with a foot problem or your foot for a shoulder problem. And so, to me that it’s just we we’re so biased in that starting from the detail because we got fantastic stories of these little bits. And we don’t have a clarity for understanding the system. I think that that’s a shame because I think what we do with the work of, particularly for me the work of Gary Grey, and he’s given a wonderful vocabulary and understanding and appreciation of what happens when somebody moves.
The Source Physio Source Physio 18:08
Because I think we’ve got a far better appreciation now that you know, form and function that we used to think that that form was what it was all about and as you say the nuts and bolts but now that we’re looking much more at function. How does function inform form, and vice versa? And it’s getting that much bigger picture isn’t it? Yeah. Now that was a great explanation. I have a couple of comments that you know, there were a few big “aha” moments there for a couple of people so that’s great. So, to quote from Born to Walk. The body is not born to walk but born to move. But also, you know, looking at the Myofascial efficiency, I loved reading about that!
James Earls 18:57
Thank you! I think, yeah, I think that addition….. So not just born to walk but born to move, because you know there’s having a discussion with the publisher. And my fantasy best title for the book was “Born to Walk”, but I actually didn’t want “Born to Walk”, because it already been used by Chris McDougal and “Born to Run”. I didn’t want to be seen to be kind of stepping across that I definitely wanted to make sure that it was going to br “Born to Move”, or the, the idea that we want to move is in there because we also, we have a natural ingrained tendency to be binary with our arguments. So the Lieberman story Daniel Lieberman, University of Harvard paleoanthropologist. And it was from his work that Chris McDougall established a lot of the science behind the “Born to Run” idea. We have evolved to run. And I think that’s such a simplification of our anatomy, that we are, we can run, and we can walk, and we can climb and we can swim, and we’re generalists. And we have perhaps some anatomical specialisms that allow us to be very efficient bipeds. And I think we get into too many arguments, discussions and debates, particularly on social media about the mechanics of walking or the mechanics of running. And a lot of them are informed by treadmill papers. We did not evolve so that we could stick on a gas mask have our oxygen levels once we walked in and ran on treadmills, and which are generally flat and boring. And there’s this kind of binary argument of, well, gluteus maximus, we wouldn’t have a big gluteus maximus if we were only walking. We only need a big gluteus maximus for running, then you don’t understand what actually walking is! Walking is not walking on a flat steady boring surface. Walking is going up and down hills stepping across rivers, stepping across many different things where you need the extra power in the hip extension or to prevent hip flexion. It’s just, there’s so many things, so many variables that have to be appreciated. We have to try and build a vocabulary that appreciates the randomness of movement. We’re evolved to be able to walk and a lot of that being anthropological and discussions on the endurance or persistence hunting. But they don’t go out and just run, they’re running but most of it is not really running. Some people might just be jogging or kind of jogging speed. It’s not a sprint, it’s not a 10 k race. It’s just steady flow and it’s broken up with multiple runs. And it’s obviously random terrain. So we need to build it into that appreciation and stop these kind of arguments of is it running, is it walking? Is it gluteus maximus? No, it’s just bloody movement!
The Source Physio Source Physio 22:22
That raises an interesting point because you know I take a lot of the people that I treat, a lot of the people that come into my Pilates classes and we spend an awful lot of time loosening up feet. Because I think that the fact that so many people are in a shoes these days…. I mean in Australia, so many of us are barefoot a lot of the time. Whereas, you know, in the UK, for example, it’s too cold to go without shoes. I’m pretty sure Betsy Ann’s got shoes on right now because it’s really cold in Montreal, But you know just as an example, we’re seeing function change so much and I guess that’s what keeps people like me as a physiotherapist really really busy, because people aren’t looking after their feet enough.
James Earls 23:10
Yes, I think what’s been really useful over the last, I think it’s particularly speeding up over the last five years has been the barefoot movement, which has led to a better understanding, a better appreciation of the importance of good food mechanics, and particularly in some (I often think of things in right and left wing) in the very far right wing barefoot movements, they get a little bit too uptight about it. I think we do need to be appreciative that actually sometimes footwear, so toe springs can be really useful if you don’t have toe extension or extension of the big toe. If you can’t get into that position is going to influence the rest of the mechanics of either in the knee or the hip, so a toe spring can be really useful. So I do think we need to understand functional anatomy. And we also need to put it into an environmental context. It’s also footwear can be a really useful tool to either assist if there’s been a deficiency of mechanics, or to help create or by removing a lot of the support so by going into minimalist type shoes, then we can actually help to strengthen and stimulate.
But if I don’t, if I have a hallux rigidus I don’t want my client going into Five Finger or any barefoot shoe, because it’s probably just going to aggravate. Probably, I don’t know until we do it, but I’m probably going to argue against them going into that type of shoe because it has the potential to aggravate their symptoms. So I think this is one of the, for me, the excitements and one of the problems of understanding the system of movement is now we have to understand so many different variables. And that’s difficult. You had the privilege of going through about three or four year programme for physical therapy. Most therapists have whatever 12 month programme in the UK if they’re lucky, is that it can be really difficult to to portray the complexities that are involved in such a short programme.
The Source Physio Source Physio 25:41
I was reminded yet again. Once you were just talking about sort of toe extension at toe off, how that initiates extension of the knee, how that initiates extension of the hip, and that you know if you’ve got a hallux rididus or something like that then you aren’t going to get that movement further up. Now something that I come across all the time is people with particularly weak gluteal muscles, whether it’s max, med or min. And so of course we see function change around the hip quite dramatically. The other thing that we see is people that stand like Donald Duck, you know that they literally stand in external rotation through their hip. And of course, because they do that, it changes the complete dynamic of how they do something as “simple”as walking. So, as you say there are so many different variables to keep in mind but it’s all about sort of getting back to function. I don’t need to remind anybody here that wouldn’t be looking at a patient, and I’d have to say that one of the biggest errors that particularly physiotherapists make is that they they focus in on pain, and they treat pain and they they look at that area and they focus on that area and then they scratch their heads as to why we’re not getting anywhere.
So that was a really really interesting point for any of you who haven’t read “Born to Walk”. The opening parts about the evolution of the human body into bipedalism is particularly interesting and looking at the advantages of why that’s happened. So we’re going to be doing a replay of this interview for the people who couldn’t join us. I think we had nearly 50 people, no we did have 50 people, if not more, that that came on board that RSVP’d to our invitation. This will be being replayed on the second of March and of course we have a lucky door prize at that time. And of course the lucky door prize is going to be “Born to Walk”, so tune in. You also made a point about the importance of understanding eccentric muscle activity, and it’s relationship to the overall efficiency in terms of capturing kinetic energy that can be recycled, so enhancing muscle output. I found that that really interesting.
James Earls 28:07
Yeah, I think it’s important that we learn it as kind of the eccentric action of the muscle. It’s the standard textbook anatomy story. And so we think of it as maybe doing your eccentric bicep curls or leg extension work or something. And I think for me, it was one of the key points in being able to to visualise the anatomy of movement. I think, it seems to be a big stumbling block for many people in doing the translation from textbook anatomy to function. And so, I emphasise it and maybe too much but I think we need to kind of push the bias enough to let people get it, that if one of the best ways to see what is happening is to lose the bias that has been unconsciously ingrained of the concentric action of muscles, which is, it’s every bleeding exam question is, we have to learn that concentric actions. That’s how we we see movement as a series of concentric actions. One of the social media mistakes was, you mentioned that the toe-off position, and it’s just it was one of those right wing barefoot social media posts, was that you had to have to extend big toe extension because if you can’t get the triple extension that you mentioned, you can’t fire your glutes. So if you can’t get into that extended position you won’t fire your glute at push off. At push off that hip is already extended so this is an example of this, being stuck in the concentric action. So, if you’re firing your glutes when your hip is already extended, that pretty much at maximum all is going to happen is lumbar extension you’re going to be maybe jamming your lumbar spine and the movement is going to go somewhere else and to me it’s a lack of appreciation that there are other possible functional roles of muscles. We need to be able to take talk back and forth. Is this a concentrated action or an eccentric reaction? And whenever I say, eccentric I don’t mean the eccentric lengthening of the muscle fibres, because if it’s a repeated rhythmical movement then as we now know from the research from (unknown) and Kamizaki and many others, it’s preferably closer to isometric to lengthen the facial tissues.
The Source Physio Source Physio 30:57
That’s all about that deceleration in that cushioning and that that efficiency isn’t it is really what it comes down to……
James Earls 31:04
Yes, which is why that, coming back to your example of toe extension, if I don’t have toe extension we can’t get into the hip extension position. And if I couldn’t get into the hip extension position, I haven’t lengthened the tissue. I haven’t put it under some natural tensioning. So I haven’t loaded any passive elastic elastic energy….. So if I’m going to get my leg forward again I’m going to have to give it a little bit of concentric benefit, a little bit of extra work from the muscles. So, what one of my therapeutic strategies, would be if anyone coming with low back pain issues, I need to check their ability to go into toe extension, I need to check the ability to ankle dorsiflex on both sides.
The Source Physio Source Physio 31:57
I think most of us appreciate the effects of under activity, but you also emphasise how adaptable the body is to adopting sort of compensatory strategies and how this can affect the body as a whole, and reduce efficiency.
James Earls 32:12
Yeah, I mentioned the idea of being born to move. We are movement generalists. I think that it’s probably globally accepted that it was bipedal upright walking but that allowed us to be human, but after that we have the potential to move in so many different ways. And one of the benefits that we have is that we can be so darn creative in the compensatory patterns that we can compensate for lack of what I would consider to be my fascial skeletal efficiencies, by using a more muscular strategy. So, you will see the shoulders, do a little bit of extra work, you’ll see the pelvis, the hips hike a little bit more. And one of the wonderful things about, again, our human structure, is that we can we can get away with that for decades. We can adapt to it, we can change our makeup and change our shape. And we can be reasonably comfortable with it. And I’m interested in these sort of question for myself as much as anyone else. I’m interested in what is going to be the outcome of the challenges from the pain science people saying: well posture doesn’t really matter that much movement, compensatory patterns don’t really matter that much because pain and posture aren’t correlated. But what are the long term effects? Is that going to have lonf-term effects for our length of morbidity at end of life. What effect is it going to have on our enjoyment of movement in later life? How likely am I to be as a 77 year old man, am I going to feel safe? I don’t mean in terms of mugging but just safe to go for a walk along the street. Am I going to be able to walk fast enough to cross the street? Am I going to feel comfortable and fit enough to do that? And if I don’t, my world is going to shrink and shrink and shrink. The less that I move, the less likely I am to move, the weaker I become and my world gets smaller. So I’m interested in what what the potential outcome might be with this important discussion, and it needs to happen. But we also need to appreciate that there is potential for long term effects, if movement becomes less comfortable in the sense of less easy and less efficient for us.
The Source Physio Source Physio 34:57
Well we know we’re all hardwired to avoid pain, and if something’s uncomfortable we’re not going to do it. We’re certainly not going to do it in a way that is either efficient or particularly useful to us and that’s really what I’m “threatening” my teenagers sitting on their beds and using their iPads in these horrible postures that, you know, it might feel okay now and you might feel bulletproof and that you’re going to get away with this forever and ever but we don’t! You know that’s why movement practitioners and manual therapists are so busy all the time is that people have assumed that all those compensations that there won’t be any kind of compromises of their movement or their comfort levels later in life. And really it’s not about how long you live, it’s how long you live a useful life!
James Earls 35:49
Yes, I think our healthcare system, frankly, excellent at prolonging life. But is that is that a productive healthy fulfilled life.
The Source Physio Source Physio 36:02
Quality vs. quantity. Yeah,
James Earls 36:04
It’s difficult to appreciate as a teenager. I don’t want to be 77!
The Source Physio Source Physio 36:11
Yeah, exactly. Yeah, well you’re coming to see me as a teenager so that tells you something. I heard in a very good podcast that you did at one stage, about the very simple things like walking with your hands in your pockets or with your arms crossed how that changes the whole dynamic of how we move, reducing that efficiency. It certainly reinforces that point of the whole body walks. It’s not just a function of the legs. So I love that you point out that the trunk and the shoulders girdles are constantly adapting to keep the head steady. It’s something that a lot of us don’t appreciate that this thing’s [the head] got to be upright so that our visual and our vestibular systems work correctly and what compromises we’re making elsewhere in the system by habitual walking postures, for example.
James Earls 37:17
You might be familiar with Jacqueline Kirby’s “Gait Analysis”, wonderful standard physio textbook. It’s a wonderful book, but one of my disappointments is the division they make between the local motor portion and the passenger portion. And so the local motor for walking is everything below the waist, and it carries or is responsible for carrying a HAT. It’s related to the head, arms and trunk. And so it kind of encourages the idea of separation kind of again, anatomizing the body, and also that everything else being passive, rather than being involved and, and having a role to play in the efficiency of movement. There was a lot of a lot of debate within the literature of what actually are the rules of the upper girdles: are they active, are they reactive? I think, again, you’re into a binary discussion. Why can’t they be both? In a normal relaxed, walk, they’re reactive. They act as counteractive ballasts. So, to be familiar with the idea, the open and closed mechanics. So, as your foot hits the ground it closes the chain so you’re into closed mechanics, but we think of this upper body has been open mechanics, whereas the counter movement, and the counter-weight of the arm going back to some degree, anchors the tissue and then this becomes a relatively closed chain with allows that build up of tension and assists with that myofascial efficiency. So, it can be a passive counter-movement efficiency-building mechanism. And then of course once you speed up, then they become more active and engaged. They help to push us forward. And again, a lot of the debate is built from anatomy and research. Why not just go out and watch people in the real world, and then work back from that. Everyone – researcher is a frustration for me – the researchers know that walking and running on treadmills is not the same as walking and running on a flat surface.
Unknown Speaker 0:06
Yeah, they keep doing it. They’re undermining the research to me.
The Source Physio Source Physio 0:12
Robert Schleip shows on a regular basis – sorry to interrupt – but it shows a beautiful bit of footage that most people will be familiar with of African women walking with such grace and elegance and such efficiency of movement to the point where they can carry very heavy loads on their head, without any, any well, as far as we know, without any negative effects to the body. And I think that that’s certainly a lovely demonstration.
I must say I had to laugh to myself when you said that you had to limit yourself to analysing the body’s neuro-myo-fascial-skeletal-vestibular system with your main focus on the myofascial elements and their cooperation. That was a pretty big scope!
James Earls 1:01
Well even that obviously in, whatever it is 210 ish or 190 pages, and didn’t do any of them particular justice. I think what I was trying to say is, there is no possibility of ever writing the textbook on walking. Because it’s just, it’s everything! And our whole system to be able to understand the vestibular system is….. well that’s a library! To be able to understand the fascial system? We’re currently building that library. That sort of the muscular system on every, every system plays plays its role, which is much easier to, for me, much easier to understand if we go, let’s look at the whole thing first. Can’t you see that it will require balance and cooperation, it requires a relatively straight leg, and heel strike which requires a certain kind of anatomy? And those points, hopefully are more understandable. So, what have you mentioned in myofascial efficiency a while ago. But the for me that the skeleton plays a hugely significant role in the efficiency as well. And sometimes in the fascial world we forget about the role of the skeleton. I mentioned that in the old style of physical therapy language they didn’t know we didn’t know the efficiency mechanisms of the fascial tissue. It’s all happening all at the same time. So I took a couple years out, and did a master’s degree in human anatomy and evolution. And in that we were able to do a lot of computer modelling and my thesis was looking at the shape, the arrangement, the form of the femur and modelling, the muscular forces around it, and showing that the form of the femur is optimised to go under compression. At its peak reaction force at heel strike, and in the lead up to toe off the bone is compressed by the tension of the surrounding muscles. So all of the architecture is shaped, is formed by the forces that we are interacting with in context of the force surrounding the bone of the femur, of the muscles contracting. And with that, with any kind of imbalance, again this goes into a lot of the research looking at why long bones are bent. The femur has an anterior to posterior curvature. And a lot of the historical discussion about that curvature was that the bone acts as a spring. But any kind of understanding of bone mechanics, we say, “well, if that’s the case, the bone will just keep building itself in that direction because there’ll be a stimulus to the osteoblasts/ osteoclasts and so on and we’ll just keep getting bone growth”. Whereas, if the bone is actually compressed by the myofascial tensions in their normal function, then there’s no stimulus, or less stimulus to the osteoblasts/osteoclasts, so that form that anterior posterior curvature is perfectly aligned to your pattern of gait. We only looked at four or five….. any one of those variables, remove one and everything else changes. If I change the shape of the form of the femur, I’ve changed the force balance. If I change the force moments or strength of output of the muscles, I’m going to get more force into the bone which is going to change the form of the bone. If I change the way in which I walk, that’s going to potentially put a little more stress and strain through the bone because it’s not being put into its optimal force environment. So this is why I try to emphasise, I need to understand the whole darn system, and that that’s not easy.
The Source Physio Source Physio 5:39
No. You did a beautiful job of describing tensegrity in your book, and I think you’ve just, highlighted that beautifully there, that interplay between the compression and the tension structures of the body, and that cooperation to optimise, form and to keep it optimised for as long as possible. I really enjoyed reading that in the book. The other particular area that I enjoyed…. that tensegrity description, was the sacrum, and how the sacrum literally floats, rather than it being that arrowhead or that keystone of the arch, that is so often described. It helped me understand a lot more when I was doing my assessments, particularly with respect to ground reaction force. I’d never really understood that before I read your book. I do some running assessments with people. I get data about ground reaction force, so then I could explain to them a lot better the actual significance of what was showing up, particularly if there was a difference between left and right. So, one thing and we are sort of going to be running short on time because I want to leave a little bit of time for questions. I’ve followed motorcycle racing all my life and one of the really interesting things that comes up – I’ve spent a lot of time in Northern Ireland up round Dundrod and the NorthWest 200, a lot of motorcycle racers have fasciotomies done on their arms because they get arm pump in their forearm muscles. One of the things that I’ve talked to a lot of people out of is having iliotibial band releases, and I just wanted you to expand on the effect of of fasciotomies. I know why I don’t agree with them …..
James Earls 7:36
Yeah, unless you’re having absolutely acute symptoms, you’ve got blood loss. So, in some cases it’s absolute. To preserve tissue before your hand dies and falls off. But as a prophylactic, then no. My inner sense would be why why would you break the integrity of our body unless absolutely essential? So, yes, I would have a similar kind of bias towards not doing it. I haven’t seen enough research. The few elements that I have seen in the cases where there has been a fasciotomy – so if you’re not familiar with a fasciotomy, then it’s a cutting, a release of the fascial compartment. So they cut the fascial compartment to release the pressure from the tissues contained inside. Kind of essential because of that increasing pressure. Most common that most therapists would come across will be in the leg. So, compartment syndrome of the leg where it can either decrease the blood flow to or from the leg or decrease the neual flow. And in acute cases, it has to be cut in order to release the pressure. So, that can be absolutely essential. But for those motorcyclists who are having repeated pain, kind of like the runners who have shin splints type symptoms, where it’s temporary. It’s the increase in volume within the compartment and having that compartment artificially expanded. I don’t know, I wasn’t familiar with muscle pump of the forearm. So, you told me something new so thank you for that.
So, what they have on this. It does reduce, and this is old research, reduce the muscle power output by 12 to 16%. So without cutting any of the muscle fibre, then by only cutting the compartment, the muscles contained within have lost some significant amount of power or force or potential force output so potentially weaken the system to try and improve the system you weaken the system. And in case of it in terms of the muscle pump, you’re also adding all the other complications of surgery and the scar tissue and so forth. So, for me, yes, I would be of the same opinion.
The Source Physio Source Physio 10:49
Thank you. I’m going to throw the floor open now if people would like to ask any questions of James. If you would like to just unmute yourself, make sure that we know that you’re there. But, if, if anyone would like to ask please go ahead. Because I have another few questions myself anyway.
I’m curious about the fasciotomy work because I’ve helped some ballet dancers avoid fasciotomies. But they’re moving, they’re in movement. Whereas a motorcycle person is kind of in that state of “grab”. I’m just wondering, Alison, James, you know what, if there was that myofascial work through the system. Has that been done? I can’t say I’ve done research but I’ve had some positive clinical results.
The Source Physio Source Physio 11:55
And so have I. So you know I think given half an opportunity to work with these people who are experiencing that I think there is a lot of potential to alleviate some of those symptoms. But, I don’t know about anybody else? I certainly haven’t found much research on the potential to improve without surgery. But I also haven’t seen very much that is not supporting fasciotomy because a lot of the people writing the papers are the surgeons…..
James Earls 12:56
In terms of ballet dancers or anyone else with shin splints, it’s always, to me it’s why, why, why is that compartment having to overwork. And I don’t need to treat that compartment. I need to probably treat something else, I might need to alleviate the symptoms and I know this is preaching to the choir as they say. It’s best to use the portion that’s crying out. It’s been put under too much work, too much strain, for some reason, and that was probably, either because something else in our system isn’t working adequately, like toe extension for example, or it’s an environmental change, which might be a biomechanics decision. So barefoot running- one of the potentials of forefoot strike is that it automatically changes the loading into the soft tissue of the leg. If I do that too quickly too soon, then I’m going to get the expansion of the muscles and not give the myofascial compartments time to adapt. So I need to also investigate the mechanics, and also investigate the environmental and biomechanical forces.
The Source Physio 14:21
From my perspective coming back to walking per se….. A child who is a toe walker right from the word go, then obviously, trying to work out why are they a toe-walker in the first place? Then trying to support their myofascial system to normalise their gait sooner than later? Because a heck of a lot of people have always had tight calves. “Mum said I always walked on my toes as a kid”. Have you seen any research on the subject, James?
James Earls 15:04
I’ll be honest, I have not specialised in any paediatric work. I consider toe-walking to be a “specialisation”. My approach is as soon as something like this comes up, I refer.
The Source Physio Source Physio 15:30
It can be really interesting because you know it comes back to whether somebody in running is a heel strike or a mid foot runner, or toe runner, and just appreciating how that enforces the myofascial loading and how that in turn influences joints further up the system.
Has anyone got any more questions? Christine, would you like to unmute yourself plea
Hello. I have a question about pre surgery. So I see a lot of people before and after. And in particular bunion surgery which seems to be quite popular at the moment, removal of bunions. What would be a practical thing to prepare somebody for how they’re gait will change post surgery to prepare them/
James Earls 16:31
First I’m trying to complete the question with as complete as screen as possible. Because, depending on what the surgery is going to be – if there’s going to be any kind of fixation in one big toe, then that’s going to be a significant – loaded words, my apologies – deficit within the biomechanics. And if there are other deficits in the system well that’s what’s going to be one huge addition, an extra load. So my approach is I want to minimise the challenges, would perhaps be a better wording, through the rest of the system. So, I’m going through kind of a checklist simplified. So we’ve been through toe extension, ankle dorsiflexion, ability to pronate/supinate, knee extension/flexion, hip extension, hip aBduction, low back side flexion and extension rotation. So those would be the major first ones. I can go “okay so this is, this is going to happen. I need to make sure you can achieve all of these other positions, so we can minimise the effect”. And also check their beliefs. What do they expect? What do they what beliefs, do they have an expectation to hold on footwear? If you just had that surgery, then don’t believe social media, and say it’s okay to go into a shoe with a toe spring, because that’s going to help you progress over that toe, then feed that momentum into your hip, in what I would consider to be a mechanically appropriate fashion.
That’s, that’s very cool. Thank you very much.
The Source Physio Source Physio 18:16
Just that kind of guy James, very cool! Well, I’d like to thank everybody especially James for joining us from lots of different places around the world. As I said before, this will be replayed on the second of March. It’ll be 7pm Australian Eastern Daylight Time. I’m just so pleased that everyone could join us but if you’re so inclined, as I said, this will be replayed come and join in the fun because you’ve got a chance to win James’s book so thanks again and I wish you all a good day Good evening. Good night. wherever you are. So, thank you, thank you, James and
James Earls 19:17
Thank you for hosting and for the questions and doing your reaserch
The Source Physio Source Physio 19:19
My absolute pleasure. All right. Thanks so much everyone
thank you Thank you.
The Source Physio Source Physio 19:23
Transcribed by https://otter.ai