0:02

Hey everybody, welcome back to the Healthy, Wealthy, and Smart Podcast.

0:06

I am your host, Dr. Karen Litzy, owner of Karen Litzy Physical Therapy,

0:09

located in New York City. And today we're going to talk

0:13

all about the foot and ankle. So we have an

0:17

amazing guest. This is what she does. It is her bread and

0:21

butter. DL is an educator, healer, diagnostic

0:25

detective with a fueled passion to get people back on their feet. Currently,

0:28

she keeps busy learning and developing healing strategies, honing

0:32

her clinical skills, teaching, coaching, consulting, and

0:36

creating courses with the intention of helping the

0:39

people of the world heal from soul to soul. S-O-L-E

0:44

to S-O-U-L for those of you out there

0:48

listening. So D.L., thank you so much for coming on.

0:58

Now, why the foot and ankle? Where did your interest spark

1:02

in that body part? Because there's a lot of body parts we as physical therapists

1:08

Well, back in 2008, I

1:12

started teaching a balance enhancement and fall prevention course for

1:16

PTs nationally. And as

1:19

I was teaching, and one of the things that I love about teaching is

1:23

that I learn as I'm teaching. So I learn something new

1:26

every time I teach. And I, obviously

1:31

most people do not fall when they're sitting. So I,

1:35

you know, define falling, which is

1:39

basically when you're Your center of gravity moves beyond your

1:42

base of support. Base of support is the foot, center of gravity

1:45

is the pelvis. Okay, anatomically, those are the two areas of

1:49

focus. So maintaining control of the center of gravity and

1:52

then maintaining mobility of the base of support.

1:56

So the more mobile the foot is, the more

2:01

leeway, right? The center of gravity has to

2:05

decrease the likelihood of falling and falls are

2:09

you know, such a problem, particularly with our seniors. So

2:13

I, you know, really got quite

2:17

good at evaluating the problems of the foot with

2:20

regard to function, which was basically

2:24

to, you know, again, increase that base of support

2:28

with regard to balance enhancement. And then I got into,

2:32

well, the foot and gait, which again, the

2:36

foot is so integral to locomotion. And

2:40

so many problems stem from our base

2:44

of support. So it's like, if you build

2:47

a house on a crooked foundation, the house is

2:51

never gonna work properly. And

2:54

I'd like to use the analogy of driving car. When

2:58

you're driving a car and that light goes on, that you've

3:01

got a flat tire, what do you do? you pull over

3:05

immediately. Because if you don't, you're going to ruin the car. Well,

3:09

so many people are functioning on

3:12

a either flat tire or a tire that is low. And

3:16

the warning sign is on, but they're not heeding that signal.

3:21

And when you're seeing, now people I know come from

3:25

all over the country to see you because they know you're an

3:28

expert in this area. If you were to share

3:32

with the listeners, what are the most common

3:36

things that you're seeing in the feet

3:39

and ankles of people who are coming to see you? Because

3:43

not everyone that listens to this podcast is a physical therapist, although a lot

3:47

are. So there might be like regular Joe out there

3:51

who may have the beginnings of maybe

3:55

a foot and ankle dysfunction, but can

3:58

maybe catch it early to stay healthy, right? So

4:02

the people that are coming to see you, what are the main diagnoses

4:09

You know, that's a great question. I, I usually see

4:13

the ones that have failed elsewhere. So

4:17

I typically see the really desperate cases, so

4:21

to speak, the ones that have not gotten better from

4:24

other other areas. What I

4:28

will say is that from

4:31

an observation standpoint. Obviously the

4:35

foot in general is one of the most undertreated parts of the human body,

4:38

I think, by PTs. And I believe that

4:42

that's a little bit because of our training, because we need to know so

4:45

much when we are being trained. And

4:49

then there aren't a lot of continuing education courses

4:52

that focus on the foot. To go back

4:56

to answer your question, there are the one

4:59

thing that I've learned from a functional standpoint, and if I could make the

5:03

world a better place, there are two things that I would restore

5:07

in the human body. The first is dorsiflexion, and

5:10

the second is pelvic extension, which

5:15

is partially controlled by the forefoot. So

5:19

when I was evaluating somebody's pelvis in class, actually, and

5:23

it was not working properly. It was kind of unstable

5:27

and all over the place. And it wasn't making sense that

5:31

it was a problem in the pelvis. I looked down at the foot and the foot

5:34

was completely dysfunctional. So by addressing

5:38

the foot, then I was able to restore the

5:41

pelvis. And again, so many of our patients lack safe

5:46

and appropriate pelvic extension and also dorsiflexion. I

5:50

think it's for two reasons. We have toilets, so we

5:53

no longer squat. So there's the dorsiflexion. And

5:56

two, we're in chairs from the age of about six until

6:00

the rest of our lives. And that really messes up

6:06

Right. Because when, when we're sitting, we were obviously in

6:12

Right. And, and, you know, going back to it, once again, the

6:16

pelvis is going to impact the foot because if you don't have full

6:19

pelvic extension, you're not going to be able to translate through the entire foot

6:23

and get adequate pushoff, which really goes

6:27

all the way to the, the end of the big toe. And

6:30

so to your point, and I think what we spoke about,

6:34

there are a lot of big toe dysfunctions. So

6:38

if I had to pick one, it would be the

6:42

big toe and probably the osteoarthritis in the toe, which

6:45

is oftentimes termed helix limitus. And

6:48

sometimes that joint actually, it's the first MPT

6:52

joint, which tends to be hypermobile, quite

6:57

frankly, maybe because of the pelvis. not

7:01

extending so that it doesn't translate through the IP

7:04

joint. I just thought of that. Thank

7:10

Thank you for asking. Right. So I

7:13

think what's the big takeaway here is that if

7:17

you're a therapist and you're working on

7:21

the foot and ankle, you can't just only

7:29

Absolutely, absolutely. To do your job properly. Yeah.

7:37

So this is, you know, what I teach functional

7:41

corrective diagnostic, functional corrective diagnosis,

7:45

right evaluation. And it is all about

7:49

looking at function from basically the diaphragm

7:55

And when you're looking at that function, what sort of functional

8:03

Yeah, there's a variety. So basically what

8:06

I found is that when I'm doing my evaluation with

8:12

the patient, the key question, there's two key questions

8:15

that I asked. And one that is integral is

8:19

when are you getting your pain, right?

8:23

What motions can you reproduce? That's exactly how

8:26

I do my functional testing. So if it's on

8:30

a certain phase of gait, analyze that phase of gait

8:34

with regard to function. And then I look at, I

8:38

look at things, if it's a motion that's in the closed

8:42

chain, which it usually is in the foot, I will look

8:46

at closed chain and I'll observe from proximal to

8:49

distal. And the proximal connective

8:53

tissue that extends down to the

8:56

toes basically starts in the spine, right? Because we

8:59

have nerve tissue that goes there. So that's where I start my evaluation.

9:03

And then I observe as they go down the kinetic chain, and

9:07

I look for smooth and sequential motion. I almost

9:10

look at it like a row of dominoes. So if

9:14

the row started at, let's say L4,

9:17

that's domino one, and then keeping going. And

9:21

if there is a deviation or they move

9:25

through an area too quickly, then

9:28

what I do is I locate that area and I palpate to

9:33

see whether it is a structural dysfunction, which means a

9:37

hypertonicity or a connective tissue that's restricted

9:41

that I need to release. And if it's not,

9:45

then it could be what I call a non-structural dysfunction, which

9:49

could be that it's due to instability, would

9:53

be one of the reasons orthopedically. Obviously it

9:56

could be due to an upper motor neuron or a lower motor

10:00

neuron dysfunction that would be non-structural. And then my

10:03

treatment plan is different and I'm addressing more

10:07

along the lines of stability because we need to have

10:10

stability in order to have mobility. And

10:14

something that was very interesting, I just taught a workshop for

10:17

regular people this weekend and I had

10:21

them do a calf stretch, typical runner stretch, right? And

10:25

what I did was I had them then activate their

10:29

big toe and look at the difference in range of

10:32

motion. So every one of them had more range of

10:35

motion. And as a result of that, every

10:39

one of them needed to improve the stability of

10:52

So I, you know, an exercise in this saved

10:55

me from knee surgery was that I was not putting

10:59

weight over my big toe because I had trauma to it years

11:03

prior. And then I went down a step and I missed a

11:06

step. So I went down two steps and I heard a palpable

11:13

Yeah. And I thought it was a

11:16

meniscus tear, but it wasn't I just given birth.

11:19

So there was like surgery was not an option. And

11:23

years later, I was able to manage it. I got some good PT and I

11:26

was able to manage it. But then like 10 years later, it started acting up. And

11:30

then I realized I wasn't putting weight over my big toe. And

11:34

I believe that The number one postural dysfunction

11:38

in the body, the compensation is to get weight over

11:41

the big toe and people will do that in a number of ways. They

11:45

will either bend forward, they'll stoop forward.

11:49

They might become hyper lordotic to get their weight forward. They

11:53

will develop genuine recurve bottom to get their

11:56

weight forward. they will push their head to get their

12:00

weight forward. And for me, I believe that the human body

12:03

will do anything to get weight over the big toe because it is the primary stabilizer

12:07

in the foot and possibly, you know, the primary stable, one

12:11

of the primary balancers in the human body.

12:15

So when you're looking at somebody's alignment,

12:22

Oh yeah. I mean, I had a patient last week who said when

12:26

he's walking, and I don't know if you've ever heard this one, said he

12:29

feels like his toe is floating. Yeah. Well,

12:33

like it's not, you know, he just doesn't have that

12:37

push off of that perception that the

12:43

Yeah. For those people, very simply, I'll just throw a piece of

12:46

kinesio tape or dynamic tape under the big toes to pull it down.

12:50

I have a piece on right now, actually. Yeah,

12:54

you know, and and it what it does is just increases awareness to

12:57

the big toe. And then, you know, I have my

13:02

method, which is release, realign, rebalance,

13:05

reinforce. So you release any

13:09

connective tissue that's restricting motion from occurring, then

13:12

you realign it, I usually realign with tape. And

13:15

then you reinforce it with exercise. And so

13:19

you rebalance by strengthening what

13:22

is weak and creating the

13:26

balance between flexibility and, and mobility, and

13:30

then reinforce it. So the reinforcing is just, you

13:37

Yeah, it's pretty amazing how important that big toe

13:40

is. And I think a lot of people, I don't think, well,

13:44

I don't know. I don't think a lot of physical therapists overlook it, but I think the

13:48

average person will overlook it. Or

13:54

they will externally brace by

13:59

wearing really stiff shoes, for example, right? So then

14:03

they don't even have to move through that foot anymore. What are your

14:08

Yeah. So rigid, you know,

14:11

here's the thing is that I believe that, you

14:15

know, footwear modifications should protect for

14:18

a period of time because in the big toe in particular, because

14:22

sometimes the lack of mobility is because of a lack of

14:25

stabilization, which is because of inflammation, which is caused by abnormal

14:30

mechanics and something becoming hypermobile. There's usually that component

14:33

going on. And one of the key things is

14:37

that for every cubic centimeter of inflammation, a muscle will shut down

14:40

by 1%. And the muscles that are closest to the

14:43

joint are the stabilizing joints. So they then become

14:47

weak. then it becomes more hypermobile. It's kind of just like

14:50

that, that negative cascade that occurs in the rotator cuff, right? Yeah.

14:55

So you have a weak rotator cuff, then you move the arm, you get

14:58

continued inflammation. It's usually not until you get that cortisone shot and

15:02

that you get it back. But what I think a lot of people do,

15:05

particularly with how it's limitless is they'll stretch it. And

15:09

don't, you know, get get that stabilization

15:13

first mobilize the areas around it

15:16

that are causing that hyper mobility, but I,

15:24

Yeah. It's so funny. You should say that. Cause I said that to this patient that

15:27

I saw last week said he felt like it was floating and it was, you

15:31

know, range of motion wise, less range of motion on the more problematic side.

15:35

And I was like, just, I said, what I don't want you to do is just grab that toe

15:39

and be yanking it back and hold like, don't do that. Please

15:45

Right, right. But creating mobility, particularly in

15:49

the medial compartment of the foot, which tends to be very, very rigid, especially

15:53

in my arch, the, you know, the navicular, the,

15:57

the talus, the tibia, the medial cuneiform, the calcaneus,

16:02

and the first the first metatarsal. Yeah, approximately more

16:06

so than distally. Yeah. get range of motion there, get better alignment

16:09

there, and then you'll have better translation. Remember I said the row

16:13

of dominoes, right? That person is probably getting,

16:17

let's say, you know, domino one is, is the, is

16:21

the tibia, domino two is the talus, domino three is the

16:25

navicular, four is the medial cuneiform, five is

16:28

the metatarsal. He's probably going one,

16:31

four, five. Right. Right. So that's

16:35

why he's having the issues that he's having. And

16:39

the other thing too, is that like, if you have a dropped metatarsal, right,

16:43

then you're going to have an elevated proximal IP

16:47

and then a, probably a plantar flex distal IP.

16:51

Right. So it's about, again, creating that better, um,

16:55

that better alignment because alignment, uh,

17:03

Right, right. So you have, and I think we've all

17:06

seen that presentation of the drop metatarsal,

17:11

the elevated, the flexed, because that

17:16

The human body will do anything to get the big toe on the ground. That's

17:19

why people have flat feet. Right. Right. Right. Right.

17:23

You know, it's a Greg Johnson taught me

17:26

this is that it's a compensated supinated foot. So it's really

17:30

supinated, but it is compensating to get

17:33

the big toe on the ground because people that's the

17:36

primary stabilizer. The human body will do anything not to fall. rising.

17:42

So, if that means that the

17:45

talus slips, then the talus slips, you

17:48

know, these adaptations occur at a very young

17:55

Right, right. And wouldn't it be nice to kind of get

17:59

people before this cascade of events, which rarely

18:03

ever happens because they might not have any pain. So

18:07

why would you go to a physical therapist if you don't have any pain? When

18:11

in fact, you can go to a physical therapist before.

18:15

Right. It's okay. Everybody, obviously the

18:19

earlier the better. Um, the thing though, is

18:22

that for me, it's easier to treat hypo-mobility than

18:26

hyper-mobility. Hyper-mobility requires work.

18:30

Yeah. On the patient's part. You know, if it's hypomobile, I

18:35

can do the work and then they can just walk, walk, you know, be

18:38

free. Right, right, right. But when

18:41

it is a hypermobile foot, there are

18:45

going to be hypomobilities that need to be addressed, but

18:49

then you really need to stabilize and change

18:53

the alignment of the foot. And that does take, um, it

18:57

does take some effort. And a young kid,

19:00

I don't know that really they understand that. But maybe

19:04

that's when you put them in orthotics after you've

19:07

corrected the hypomobility and

19:12

you get them in a better alignment. And again, you address up the kinetic chain

19:16

because the flat foot will get compensated

19:20

at the calcaneus, the talus, the tibia, and

19:24

the femur. So you need to

19:28

de-rotate, put those all, and the femur then is pelvis. So

19:35

Right, right. Absolutely. For

19:40

those of you who are perhaps watching this on YouTube, you've

19:43

just gotten a nice picture of

19:47

my big cat here. So

19:51

let's talk about surgeries, right? So,

19:55

so often I think people will go straight

19:59

into a surgical procedure for the foot or ankle versus maybe going

20:03

to a physical therapist first, right? So can you talk a little bit about foot

20:07

and ankle surgeries and the success of those surgeries or maybe

20:11

Yeah, in general, compared to other joints, it's

20:15

not so good. And I think the reason being is because the

20:18

foot is 52 joints. And the,

20:22

and quite frankly, a problem is not, it

20:26

may manifest in one place, but the cause is not there. And

20:30

I think that's why the surgeries fail. And we were just talking about this

20:33

off camera a little bit that the

20:37

PT is really, really, really important. And, you

20:40

know, one of my ambitions is to speak to

20:44

podiatrists or surgeons and offer

20:47

them a prehab program. for their,

20:51

their patients to, you know, and to use with physical therapists.

20:55

And I, I know that prehab has been shown to improve

20:58

patient outcomes. It's going to also, you know,

21:02

get the patient mentally psychologically ready for

21:05

surgery that they feel like they're training, like for a marathon they're

21:09

in training right now to make their surgery more successful. And,

21:13

um, And then obviously, you know, the care right after

21:17

because a lot of times, then they get immobilized and put in a boot, right?

21:21

Oh, you know, a whole slew of problems, right, just

21:24

by being in the boot. And again, that's

21:28

going back to kind of the rigid footwear, there's the point where

21:31

we do need to protect. But once we don't, then

21:35

it should be a transition from a

21:39

protective footwear to maybe a strong tape

21:43

like dynamic tape, which has 33 pounds of

21:46

force available for force attenuation or for

21:50

holding a joint in place. So it's a really nice,

21:54

rigid, but flexible option. And

21:58

that is, you know, I think that is the appropriate transition

22:03

because if you never do that and you never get the appropriate range of

22:06

motion back, you know, that's

22:09

going to cause even more problems, you know? So the idea with

22:13

corrective functional therapy is to correct function when

22:21

Yeah, absolutely. And I think the other thing about these

22:24

surgical procedures is that if you're the patient,

22:29

you have to have the ability to stay off your

22:32

foot. So I had a patient who

22:36

did have surgery for, what

22:41

was it? I think lack of, it was either, oh,

22:45

it was arthritis of the big

22:49

toe. And it was either try this surgical procedure or

22:52

fuse it, right? So they did this surgical procedure.

22:56

He had to be off of his feet for like all

23:00

but two hours a day. Right? Off

23:04

his feet, elevated, all but two or three hours a

23:07

day. You know, it was something crazy. So if you work,

23:12

right? If you have kids, if you

23:15

live alone and you have to do for yourself, that's

23:18

really hard to do. And so this patient

23:22

of mine was retired and had the ability to

23:26

sit with his feet elevated X number of hours a day. So he had really good

23:29

outcomes. And I think

23:33

like, like you said, having some prehab and some

23:40

Yeah. And you know, the thing is too, is that the most important

23:46

training post-surgically, because again, remember about

23:49

inflammation and core muscles, right? It

23:52

would be is like, okay, when are they clear for isometrics and

23:56

just doing isometrics straight away? just

24:01

do it. And again, technically they really should not affect

24:04

any sort of surgical procedure because it's a non-moving contraction. Right.

24:09

So, you know, in my mind, there's no reason not to

24:12

do it, but then some of the surgeries actually cut the

24:15

core muscles of the butt on top of it. And,

24:21

you know, Oh, you know, the flexor halicis

24:25

brevis, it's not important. Who needs that?

24:30

But that's where, like, you could use something like kinesio tape

24:33

or dynamic tape to offset that,

24:38

you know, that lacking, certainly at the beginning,

24:44

Yeah, yeah, absolutely. So it's, I think what

24:47

I'm hearing is that, the foot

24:51

can be complicated because there's so many joints and

24:54

so many bones and muscles and ligaments and things like that. But if

24:58

you have a good system to evaluate and

25:02

a good system to organize your thoughts during

25:09

Absolutely. And you know, that's what I, that's what I, that's my bread and

25:12

butter because I was not a phenomenal

25:16

student, but it was a great observer. And

25:21

when I observe function, it

25:24

reveals, you know, when I take myself out

25:28

of the diagnostic clinical mode and I go into functional mode

25:31

and I see where the problem is, I don't need to know what it's

25:34

called. I just need to know that it needs to be

25:38

treated. And so then I just do, you know,

25:41

I do a release, two release techniques. One

25:45

is in the plane

25:49

of rotation, which is the sagittal plane, right?

25:54

As well as the frontal and the transverse.

25:59

Yeah. I don't know. It's late for me. I might've mixed

26:02

that up. But anyway, yeah. Now,

26:05

rotation occurs in the transverse plane about the sagittal plane. sagittal

26:11

axis, I believe. But anyway, three

26:14

planes of motion, right? Whatever they're lacking, and

26:18

again, locating that area of hypertonicity, and

26:21

then I just address it in a very simple

26:25

way, using functional movement in an

26:28

indirect way to get that area of

26:31

hypertonicity moving again. So using motion,

26:35

because that's what the patient needs to do. So to

26:38

just sit there and joint mob. You

26:42

know, and, and here's another big mistake that

26:47

wouldn't say mistake but something that could be done very much better is

26:50

to treat in the close chain because that's when, and

26:54

where most of the problems are in the foot. And

26:58

the alignment changes of the foot very, very drastically between the

27:01

open and closed chain. Yes. It's a treat in the open

27:04

chain is really not functional. I will treat

27:08

in the open chain to, um, look at how the

27:11

foot. Articulates with the floor because again,

27:15

there will be compensations, um, in standing. So

27:19

I kind of just moved passively, pretend my hands as the floor. and

27:22

see what happens up the kinetic chain and where I can address

27:26

so that the foot lay better on the ground, right?

27:29

So that's when I'll treat in the open chain, but then every other

27:33

function I'm treating in closed chain, because that's when they're having,

27:36

that's what's going to make the biggest difference. So

27:41

it is seemingly, potentially, it could

27:44

be looked at as complicated, but it really isn't when

27:48

you know what to do and how to do it. And what is

27:51

also very interesting, a patient came to mind when I,

27:55

when we were just speaking, but because I did a functional evaluation, her,

27:59

her fracture was on the right. And it

28:02

was because she fell and she fell a couple of times. Once I

28:06

think she broke her pelvis and the other time she broke foot. What

28:09

was interesting is that when I evaluated her for her basis

28:13

support, she was a tennis player. Um, what wound

28:16

up happening is that her dysfunction was on the other side. So

28:25

Yeah. That's a really good point people. So if you are treating

28:30

patients, don't just look at one side, don't just

28:33

look up the kinetic chain on one side. You got to look up on the other

28:38

And once again, you know, my, my, my, my, my

28:42

thought process, right? The diagnostic test detecting was that

28:46

she didn't fall walking, but it was on the tennis court where you

28:50

have to go laterally. So I mimicked the lateral motion,

28:54

right? Watching her. And as soon as she moved like

28:57

into, I think it was pronation on the right, like five degree, five

29:02

degrees, or it was supination actually. She walked into, went

29:05

into supination, just immediately her big

29:14

Exactly. And that's why she fell on the tennis

29:20

Right, right. Yeah, that makes a lot of sense. So the

29:24

big takeaway is treat the person, at

29:28

least treat, evaluate, and then treat

29:32

the person in the positions in

29:35

which they move, like you said. Where they have

29:38

the problem. Where they have the problem, right, right. So that way

29:42

you can work on what is functional

29:47

Exactly. And, you know, I use the same strategy, whether

29:51

I'm treating a foot or a shoulder, you know, or

29:54

any part of the body, any person, you

29:57

know, from, you know, a three year old to, you

30:01

know, 103 year olds, it's the same, I use the

30:04

same process. And so that

30:09

is what I love about it because I don't have

30:12

to learn all these other structures in the body. I just

30:15

go back to the thought process. And again,

30:19

I have it very, very systematic so that you

30:23

can figure out the root cause of the problem,

30:29

Right, right. Which is important because people don't want to be going

30:33

to PT for years on end. People

30:36

want to feel better as quickly as possible, which

30:40

is good PT. I remember, I think it was Peter O'Sullivan, he

30:44

had said, good PT is sometimes bad

30:51

Because you don't have someone in for this super long

30:55

plan of care, but I would argue you get

31:00

That's exactly right. And you know what? Yeah. You

31:04

want to serve your patients the best way that you can. Exactly. Exactly.

31:09

And, you know, again, they don't care if they have a,

31:13

you know, herniated disc as long as they can do what they love without pain. 100%. Yeah,

31:19

and so treat the function and and truthfully if you

31:22

are working in an insurance based practice that

31:25

you have to, you have to show functional gains. So, why

31:31

Absolutely. Correct function. Absolutely. And speaking

31:35

of correct function, if people want to

31:39

learn more about what you teach, corrective functional foot

31:42

and ankle therapy, where can they go to learn more and

31:49

Absolutely. So it's dlwalkerconsultant.com. And

31:54

there is a section for professionals. The courses are approved in

32:00

31 US states for physical therapists. all states for

32:03

athletic trainers, and then also

32:07

in the UK for podiatrists, physical therapists,

32:11

and actually any profession can take those courses.

32:15

So they are, yeah, they're different,

32:19

they're fun, and they are available online, although I

32:23

am putting it out there to get back out

32:30

Yeah, yeah, something that I think we all missed for the last

32:34

couple of years. And it's starting, I think, more and more to come back,

32:38

I really like the idea of a hybrid class, because I know for

32:42

myself, you know, a four day intensive class

32:46

was grueling. And by the end

32:50

of the four days, your head was about to explode. Yeah. You're like

32:53

a vegetable. Yeah. And what's nice about the online

32:56

is that the videos, you always have a good seat, especially

33:02

You're not trying to look over the person in front of

33:07

I can't see. I'm very old school. I remember those days.

33:11

It's like, where was he going? Totally.

33:16

So yeah, so it's lovely to have

33:19

the videos available to not only learn from prior to

33:23

class, but afterwards, and if you're having a bad

33:26

day, or you're not feeling well, right. So

33:30

I really love the idea of hybrid, too. And it

33:34

keeps people, you know, interactive and

33:37

being able to be live, but also, you

33:44

a lot of time away from home. Absolutely, absolutely. I

33:47

think that's great. And now as we wrap things up, what

33:50

do you want our listeners to take home? What's

33:56

Well, by the way, you said learn more

34:00

too. I have given you a link to

34:04

sign up for more training for anybody who's interested and

34:08

also receive a little discount on a course if you would

34:16

I would say, well, you know what, I'm going to share three things. These

34:20

are three things I learned my first day of orthopedics, physical therapy class.

34:24

And I remember them and I apply them to even

34:28

today, 30 years later. The first is

34:32

that alignment dictates function, frequency flow and

34:36

force absorption. So if you want to have lasting change,

34:39

you need to correct the alignment, right? You

34:43

need to have stability in order to have mobility. So

34:46

if you are unstable, you will lack flexibility. And if

34:50

somebody is lacking mobility, which a lot of our patients are,

34:54

it could be not because of connective tissue restriction, but

34:58

also that they lack stability. So you need to look

35:02

at and address both, quite frankly, because one will

35:05

cause the other, truthfully. And

35:09

people can be unstable because their alignment is

35:12

off because of the

35:15

lane tension ratio. A muscle will contract with greatest vigor when

35:19

it's at a particular length. If it's too long or too short, it won't work properly.

35:23

And the last is release, realign and reinforce. Perfect.

35:30

That's it. That's PT. That's PT in a nutshell. You do those three

35:36

Right. Well, thank you so much. I think this was a great

35:40

conversation. I've been taking lots of notes and as you're talking, I'm

35:43

thinking about patients that I'm seeing in my head. So

35:46

hopefully listeners, you are doing the same. And

35:50

now the last question that I ask everyone, is

35:53

knowing where you are now in your life and in your career,

35:57

what advice would you give to your 20-year-old self? So maybe, you know,

36:01

you're in PT school, not

36:07

Yeah. You know, for me, it was finding

36:12

the strategy that worked to

36:16

my strength. Oh,

36:19

that's good. Because everyone has a different talent.

36:24

And there are many, many different people to learn from and

36:27

different strategies out there. And, you

36:31

know, finding the system that aligns

36:39

Oh, that's great advice. I think that's the first time we've heard that one. That is really

36:42

good advice. OK, so one more

36:46

time. Give us your give us your

36:53

All right, it's dlwalkerconsultant.com. should

37:01

Yes, yes, yes. So for those of you on YouTube or

37:04

wherever, everything is in the show notes. So all

37:09

you'll have to do is one click, you'll go straight to that

37:13

website. We'll go straight to the

37:16

discounts or the sort of free gift for all the listeners. It's

37:20

in the show notes regardless of what podcast platform you

37:26

Excellent. Perfect. I just have to ask you,

37:31

Oh, Oliver. It's Oliver. Yes, yes, yes.

37:37

I don't know. I don't know what it is. I love cats. So

37:43

He can feel the energy coming. Exactly. Coming

37:46

through the computer. Absolutely. Well, D.L.,

37:50

thank you so much for coming on. I really appreciate your time

37:54

and your sharing your expertise. So thank you so much. Thank

37:57

you, Karen. Anytime. And everyone,

38:00

thank you so much for listening. Have a great couple of days and