Enhancing the Health of the
Everyday Athlete – Moving,
Eating, & Sleeping
Stephen Gangemi, DC, DIBAK
ICAK International Meeting
Bordeaux, France - September 2011
Every Patient:
• Moves (to some extent)
• Eats and drinks
• Sleeps (Hopefully)
• I will discuss new techniques and therapies you can
use to help every patient live a healthier life
Moving - Gait
• Importance of gait evaluation
• Gait dysfunction  Health dysfunction
• Kinesthetic sense: the relationship between
the nervous system and the sensory feedback
provided by each foot – 7,000+ nerve endings
• Proprioception: sense of position, posture,
equilibrium
Why Check the Gait?
• To restore function
• To restore health
• So patients don’t “walk themselves
back into a problem”
What Disrupts Gait?
• Those which affect the Triad of Health:
– Structural
– Nutritional
– Emotional
• Improper footwear
• Orthotics – a brace that supports dysfunction
• Nothing worn on the foot can improve its
function
• A bare foot moves in the most efficient,
natural, and healthy way (in a healthy
individual)
Modern Footwear
• Soft midsole
Elevated Heel
Line of falling weight moves
forward with heels
Motion Control
Footwear Industry Claims
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Run faster
Jump higher
Be stronger
Exercise muscles not otherwise used with
competitor’s shoes or while barefoot
Yet there has never been any research to
validate such claims
Injury Prevention?
• None of which can be substantiated through
any scientific study
• Numerous studies on injury promotion:
– Journal of Injury, Function & Rehabilitation, Dec 2009: Running shoes
protect the feet at the expense of increased joint torques at the hip,
knee, and ankle
– British Journal of Sports Med 2010: Elevated heels and cushioned
shoes relationship to injuries
– Medicine & Science in Sports & Exercise 1991: Running shoes and
diminished sensory feedback and injury increase
– More: Runblogger.com, Trtreads.org, philmaffetone.com, sock-doc.com
Barefoot or Shod?
• Recently, there has been a significant move
towards minimalist type shoes and barefoot
walking and running
• Experienced, habitually barefoot runners will
avoid landing on their heel.
• The natural motion during barefoot running is
to land with a midfoot, or even a somewhat
forefoot strike.
• A heel strike (while running) most often
results in a significant stress to the body,
whereas a midfoot or forefoot strike does not
• Most running shoes are developed to promote
a heel strike, and therefore an unnatural
running and gait cycle
Heel strike
Ideally the body’s
center of mass
should be over
the foot for the
lowest loading
rate
Midfoot/forefoot strike
Healthy Footwear
• No arch support – the arch needs to flatten
upon impact to dissipate shock
• Arch supports support the arch, not the ends
of the arch  a weak and dysfunctional foot
Low Stack & Drop
• Stack Height
11mm heel
• Drop
• “Zero-Drop”
11-7=4mm drop
7mm forefoot
Shock
• No Stability or Motion Control – natural
pronation deflects shock
• Posterior Tibialis plays an important role
Toe Box
• No cramped toe box – so the toes can splay
apart to soften landing
Widest at the
toes
Cushioning? No!
• Cushioning does not absorb shock – it tricks
the body by sending false information to the
brain – “Is this a soft surface or hard?”
The Harder the Surface the Softer the
Landing
Nice Gait Kid!!
• The harder the ground the more the
body will adjust with more knee
flexion and pronation
• Pavement is the easiest to walk/run
on barefoot
• Natural terrain is unpredictable
The Ideal Shoe?
• Depends on the individual perform gait test
• But generally:
•Roomy forefoot (1/3-1/2” in front of big toe)
•Close to the ground throughout (low to zero-drop
and a low stack height)
•Wide Toe Box
•Flexible in all directions
The New Gait Test To Evaluate
Footwear
• During normal gait, there is a continuous
pattern of facilitation and inhibition
• The physician can easily determine a normal
and abnormal gait pattern based on manual
muscle testing (MMT)
General Gait Test – Latissimus Should
be Inhibited
General Gait Test – Deltoid Should be
Inhibited
New Addition to Gait Test – Wrist
Extensors Should be Inhibited
New Addition to Gait Test – Wrist
Flexors Should be Inhibited
Final New Addition to Gait Test Breathing & the Diaphragm
• Check the diaphragm with a full inspiration
and expiration, checking for gait distrubance
Barefoot Gait Ok?
• After testing the patient barefoot, test them:
• Standing in their shoes
• Standing in their orthotics
• Standing in their shoes with orthotics in
Barefoot as much as possible, shoes
when needed
• Using MMT the physician can determine what shoes will not
harm the patient during their daily activities and during
exercise
• Notice that the word “benefit” was not used, as footwear is
not meant for this reason
• Footwear should only protect the feet from damage that may
occur from the particular environment
• Transition period into more barefoot walking and minimalisttype shoes as the weakened muscles, tendons, & ligaments
regain their strength
More on Barefoot, Minimalism,
and Injury Prevention & Treatment
www.sock-doc.com
A more detailed explanation of this gait assessment with more
research can be found at www.drgangemi.com under “Research” tab
Dysglycemia
• Now that your patient is walking about
efficiently, how is their diet affecting their
performance – both mental and physical?
• The TMJ will often reveal hidden blood sugar
handling problems which can be easily
addressed to improve overall health
Temporomandibular Joint (TMJ)
• Local tooth and jaw problems
• Immune system impairment
• Cranial faults
• Spinal subluxation
• Health distress anywhere in the body
• Blood sugar handling problems - Dysglycemia
Dysglycemia
• Disorder of blood sugar metabolism
• Blood glucose reading may be normal
• Headaches, feeling shaky, unclear thinking,
fatigue, pain, moody, (*tinnitus?)
• AK assessment: Latissiumus and triceps not
always inhibited
The Main Players
• Pancreas: Insulin (glucose  glycogen)
– Glucagon : glycogen  glucose (Glycogenolysis)
• Adrenal Glands: Cortisol (Lactate, amino acids,
glycerol  glucose) *Gluconeogenesis
– Epinephrine & Norepinephrine (inhibits insulin, stimulates glycogenolysis in
the liver and muscles and glycolysis in the muscles)
• “Tug of war” between the adrenals and pancreas
leads to an increased level of ACTH from the pituitary
Adrenocorticotropic Hormone
(ACTH)
• ACTH – the missing piece to the puzzle of
dysglycemia
• Barrage of ACTH to the pancreas
• Homeopathic ACTH creates a neurological
response to the pancreas resulting in an overfacilitation of the pancreas related muscles
• Slight rubbing over the pituitary Chapman’s
reflex (glabella), will elicit the same response
The TMJ’s Involvement With
Dysglycemia
• Positive TL to left TMJ
• Weak muscle strengthens with TL to left TMJ
regardless of another muscle, cranial, or
immune involvement affecting the TMJ (must
fix these first)
• Positive TL to right TMJ  patient is switched,
(neurological disorganization), this must be
corrected accordingly
• May or may not have jaw or TMJ pain
Evaluation & Correction - of the Dysglycemia
AND many TMJ Dysfunctions
For this…
And this…
And maybe this too
Procedure
• Left TMJ TL is positive (strengthens a weak muscle)
or TL to left TMJ with head in extension weakens a
strong extensor muscle
• No change with any jaw movement
• Spleen and lower sternum immune involvement is
not present or has already been corrected
• Right TMJ TL?  switched, or some other problem,
(such as a local jaw problem),which needs to be
addressed
Procedure Continued…
• ACTH or rubbing pituitary CR weakens both [long head] biceps
(over fires the lats and triceps)
• TL to left TMJ with the head in extension weakness or ACTH
weakening the biceps will be negated by either ATP, glucose,
or glycogen, (sometimes thyroid hormone or ribose), as well
as TL to the pancreas CR
• TL to the pancreas [lateral] CR with ACTH will weaken any
strong indicator muscle
Correction
• Investigate what caused the problem
– Diet?
• Processed foods/sugars, skipping meals
– Offender?
• Artificial sweeteners, caffeine, bad fats, food allergies,
medications, hormones (cortisol, estrogen)
– Nutrient imbalance/deficiency?
• Used up during metabolism of glucose/glycogen and
stress on organs – Making ATP
Correction Continued…
DIET
• Patient will strengthen with sugar (sucrose, not fructose),
glucose, and/or glycogen
– Obviously a patient like this does not need more refined sugar, but due
to their dysglycemia and continuous blood sugar swings they will test
positive for it
• Cortisol often the offender
• Glycogen stores could be depleted from a low carbohydrate
diet or prolonged heavy exercise
• More carbohydrates; eat more often?
Correction Continued…
COMMON OFFENDERS
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Cortisol
Trans fats
Food allergies
Caffeine
Another hormone besides ACTH
Ammonia toxicity
Neurotransmitters
Medications
Excitatory chemical/neurotransmitter such as MSG, homocysteine, aspartic
acid/Aspartame
Heavy metals
Correction Continued…
NUTRIENT IMBALANCES OR DEFICIENCIES
• Nutrients to effectively make ATP: (B1, B2, B3, B5,
B6, Mg, Zn, Mn, Biotin, Lipoic Acid)
• To make glycogen: (B6 (P-5-P), Mg, Ca)
• Check for COQ10 as it is the main component in the
electron transport chain
– 500 to 1500mg of COQ10 a day may be necessary
for short durations
• Thyroid helps modulate the CAC
Correction Continued…
• Treat the pancreas CR (parasympathetic activity –
rubbing) with offender, (unless the thyroid has been
shown to need treatment)
• Use ACTH if no specific offender can be found
• Counsel patient on diet, especially if the pattern
reoccurs
• Once corrected, TL to the left TMJ should be negative
and ACTH or glabella stimulation should not weaken
the biceps
• No need to be constantly performing the
painful origin-insertion technique on the
ptygeroid muscles over and over again!
Tinnitus & Dysglycemia?
• Link between the TMJ and the auditory system is evident by way of the
discomallear ligament- ligamentous structure connecting the malleus in
the tympanic cavity to the articular disc and capsule of the TMJ
• Study in 1992 found that 19 of the 20 subjects had “one or more clinical,
electromyographic, and radiographic indications of a temporomandibular
disorder”, yet all were completely asymptomatic
• Other studies have shown that tinnitus can be a primary or secondary
complaint of TMJ disorders
• October 2008, the International Journal of Oral & Maxillofacial Surgery
published a study suggesting that “extreme stretching of the condyle in
conjunction with the ligaments between the ossicles of the inner ear and
the TMJ could be the reason for unexplained otological problems
Lifestyle Adjustments to Resolve
Dysglycemia
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•
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Aerobic exercise
Eat every few hours
Reduce or eliminate refined foods
High protein and good quality fats
Remove offenders
Monitor stress levels
Sleep…
Time to Sleep
Hopefully like this
And not like this…
Or this…
Or because of this
Nocturnal Dysglycemia
• A major reason for a restless night of sleep
• Abrupt changes in glucose levels most often
due to increased stress hormones cortisol and
epinephrine
• ↓ Melatonin
(Stress) Hormones
• Cortisol – adrenal cortex
– Glucose from other substrates – most often
protein catabolism (gluconeogenesis)
– Liver
• Epinephrine (and NE) – adrenal medulla
– Glycogen into glucose (glycogenolysis)
– Liver and muscles
Adrenal Hormones  Liver Stress
• Liver related muscles: pec sternals & rhomboids
• Liver horary period 1am-3am
Procedure
1.
2.
3.
4.
5.
Test a liver related muscle, (rhomboid or pectoralis major sternal
division) – muscle needs to be strong
Patient closes the eyes and slowly rolls them in either direction,(REM
sleep),  weak doctor must address this first
Patient’s eyes open, challenge with cortisol by using either oral nutrient
testing of homeopathic 6X cortisol or vigorously rubbing the adrenal CRs
for 2-3 sec weak  cortisol burdening the liver
If neither test shows a problem, test simultaneously, (cortisol with
REMs) weak nocturnal gluconeogenesis
– No weakness in #3 or #4, then:
Perform #3 and #4 again substituting epinephrine homeopathic or having
the patient clench their fists hard for 2-3 sec  #3 weak  epinephrine
burdening the liver; #4 weak  nocturnal glycogenolysis
Treatment
• Investigate common offenders (remove the cortisol
or epinephrine homeopathic if used and perform the
REMs test substituting the suspected offender
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–
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Caffeine
Sugar
Food allergies/intolerances
Medications
Other hormones
• estrogen, testosterone, thyroxine
– Emotional stress (patient should therapy localize to the stomach
neurovascular points)
Treatment Continued…
Supplementation & Dietary Advice
• Cortisol identified as the problem:
• B1, B2, B3, B5, Phosphatidylserine,
choline,vitamin E, vitamin C, and magnesium
• Protein!
Treatment Continued…
Supplementation & Dietary Advice
• Epinephrine identified as the problem:
• B2, B5, B12, selenium, zinc, glucuronic acid,
cysteine, glutathione, and copper.
• Carbohydrates!
Honey
Treatment Continued…
• Address any emotional or dietary problems
identified during the nocturnal dysglycemia
testing
• Dietary suggestions:
– Protein: 1.5g-2.0g/kg bodyweight per day; 20-25g
of protein approx. 30 mins prior to bed
– Carbohydrates: eat regularly throughout the day,
low glycemic carbs
Address Other Sleep Factors
In Summary…
Proper footwear throughout the day (or no
footwear)
A healthy diet and proper
supplementation throughout the day
Restful sleep
Your energy efficient patient – walking,
eating, & sleeping better than ever before
More Questions, Information &
Research Papers
• My email: drgangemi@gmail.com
• Websites: drgangemi.com
sock-doc.com
• Thank you for your attention