Dr. Grove Higgins, Author at MedFitNetwork

Evolution of the Foot: How the Senses Shape the Foot

Dr. Grove Higgins/17 March 2023/ All MFN blog/

Everyone has had flat feet, and probably will again – and that’s normal!

While working in a biomechanics lab, part of my job was to read nearly 500 papers on childhood foot development. In doing so, I learned something extraordinary: we all had flat feet at one time and as we get older, we likely will again. This makes so much sense if you see the foot as a sensory organ and not just a mechanical part of the human machine.

Fat Flat Feet

Most babies have cute, pudgy, fat, flat feet! As the child grows, the foot develops and an arch becomes more and more evident, keeping pace with the child’s physical abilities. Evolutionarily this makes sense. Before birth we are water dwellers and do not need a well-developed vestibular system.

Only a few months after birth babies begin learning to roll, then crawl, eventually sit upright, and then “find their feet”. They begin to stand and squat and the vestibular system starts to adapt to gravity. Babies’ fat flat feet give them a broad surface to sense the effects of gravity, which allows the vestibular system to orient and develop.

As balance improves, the foot becomes stronger and the arch develops. The effect is a decrease in the amount of sensory surface area dedicated to gravity, making baby less structurally stable but providing a biomechanical environment for increased speed and agility. However, now the individual must rely on a very well developed and active vestibular system, supported by the mobile proprioceptive system of the foot joints.

The twilight of the arch

Understanding how and why the arch develops should then clarify the changes we experience as we grow older. The vestibular system slowly becomes less active and balance becomes more difficult. This leads to a natural decline of arch height as an attempt to increase proprioceptive input, like we needed when we were babies.

Gait tells us so much

The reality is, gait assessment is a window into your clients’ nervous system and, utilized properly, it informs how we help our clients improve, at every stage. Now that you know how the arches and vestibular system relate, help your clients rediscover their feet!

Dr. Grove Higgins is a chiropractor, rehabilitationist, soft tissue injury expert, researcher, anatomy instructor, biomechanist, human performance expert, speaker, and corporate health consultant. In 2015, Dr. Higgins cofounded Neuroathlete with Coach Patrick Marques (LTC, US Army Ret.) and Peter Hoversten. Neuroathlete’s goal is to more broadly deliver neurological training to a global audience.

Interesting studies and articles:

Does My Kid Need Arch Support: March 2020: Blog. (n.d.). Retrieved from https://www.vivobarefoot.com/nz/blog/march-2020/does-my-kid-need-arch-support

Gray, H., Carter, H. V., Pick, P. T., Holden, L., & Keen, W. W. (1887). Anatomy, descriptive and surgical / the drawings by H.V. Carter with additional drawings in later editions edited by T. Pickering Pick ; to which is added Landmarks, medical and surgical by Luther Holden with additions by William W. Keen. Philadelphia: Lea Brothers &.

Li, F., Harmer, P., Wilson, N. L., & Fisher, K. J. (2003). Health Benefits of Cobblestone-Mat Walking: Preliminary Findings. Journal of Aging and Physical Activity, 11(4), 487-501. doi:10.1123/japa.11.4.487

Rock Walking for Healthful & Graceful Aging. (2018, December 13). Retrieved from https://www.integrativehealthcare.org/mt/walking-on-rocks-benefits/

Tubbs, R. S., Mortazavi, M. M., Loukas, M., Dantoni, A. V., Shoja, M. M., & Cohen-Gadol, A. A. (2011). Cruveilhier plexus: An anatomical study and a potential cause of failed treatments for occipital neuralgia and muscular and facet denervation procedures. Journal of Neurosurgery, 115(5), 929-933. doi:10.3171/2011.5.jns102058

Trainer Challenge of Stroke

Dr. Grove Higgins/9 May 2022/ All MFN blog/

A stroke is an obvious turning point in most survivors’ lives. In a best-case scenario, it can be as minor as a mild concussion. At worst, it is a disabling brain injury that leaves the person incapable of caring for themselves—or even breathing on their own. In any case, stroke clients can provide a significant challenge to a trainer wanting to help them, once medical care and primary rehabilitation has plateaued. This is especially true considering the variety of experiences a survivor can have, following a stroke.

Patients Need Personal Trainers: How personal training can impact millions

Dr. Grove Higgins/12 October 2021/ All MFN blog/

In the United States, 11.2 million people were diagnosed with obesity and/or diabetes over the last year.^(1,5) These are primary risk factors leading to stroke and total joint replacements, adding another 8 million people per year.^(6,7) This means that the fitness professional in the post-medical and post-rehabilitation space has more potential clients than they could hope to serve. The question is how to reach them and build a business around these problems.

Personal Trainer and marketer Joe Lemon has some advice. Two primary problems for trainers trying to innovate this post medical/rehabilitation space are trust and visibility. Both these problems are interrelated and so deserve to be tackled for this space to become profitable.

In the United States, less than 50% of physicians suggest patients go to a gym. Even less (20%) recommend a personal trainer.⁽⁴⁾ But the question is, why? First, we found a general ignorance of what personal trainers can do for their clients and, secondarily, if personal training was a safe, effective modality. This is partially due to a lack of standardization in personal training education and regulation across the USA. In addition, until recently, there has been a lack of specific training for fitness professionals in the medical fitness space that can be understood and trusted.

Even for those exceptional personal trainers who do provide the training to address specific clients’ post-medical/rehabilitation needs, there is a gap between their skills and clinicians’ knowledge that they exist. Joe has practical advice to close that gap and create a bridge to clinicians.

First, identify who these clinicians are. Sports medicine, orthopedic surgeons, neurologists, bariatric doctors and primary care physicians are all viable referral sources. Network and get to know someone who can make personal introductions for you directly to the doctor or their assistant or office manager, who is often the gatekeeper of the practice. Once you get the opportunity to talk to them, give them tangible, always take a pamphlet explaining your qualifications, education, and process. Providing them with hard copy printouts from the MedFit websites (medfitnetwork.org and medfitclassroom.org) are the most accessible sources of information you could use. And always, leave them with the material they can give their patients that link directly back to you in the form of business cards and pamphlets/brochures.

Lastly, get out and talk about what you do. Remember, communication is 7% what you say where 38% how you speak it, and 55% your body language.⁽³⁾ Getting in front of people these days is easier now than ever. Schedule talks at gyms and coffeehouses, video it, and post it online. The more you talk passionately about what you love doing, the better. Connect with your potential client recruit them to be your spokesperson to their physician for you.

References

(CDC), U. D. (2021). 2020, National Diabetes Statistics Report.
Lemon, J. (2021). Business Development, Market Research, & Strategic Partnerships. (G. Higgins, Interviewer)
Michail, J. (2020, 8 24). Strong Nonverbal Skills Matter Now More Than Ever In The “New Normal”. Retrieved from Forbes: https://www.forbes.com/sites/forbescoachescouncil/2020/08/24/strong-nonverbal-skills-matter-now-more-than-ever-in-this-new-normal
Pojednic, R., Bantham, A., Arnstein, F., Kennedy, M., & Phillips, E. (2018). Bridging the gap between clinicians and fitness professional: a challeng to implimenting exercise as medicine. BMJ Open Sport & Exercise Medicine, 1-5.
CDC f. (2021, 3 1). National Center for Health Statistics. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/nchs/hus/contents2019.htm#Table-021
Springer, B. D. (2021). Highlights of the 2020 American Joint Replacement Registry Annual Report. Arthroplasty Today, 9, 141-142.
Stroke. (2021, 5 25). Retrieved from Center for Disease Control and Prevention: https://www.cdc.gov/stroke/facts.htm

Gait! Everything You Need to Know

Dr. Grove Higgins/18 August 2021/ All MFN blog/

Assessing and training clients is challenging but skilled observation can give you important clues about your clients’ condition and readiness—and they don’t need to say a thing! Many trainers, and even therapists and doctors, are missing one of the most valuable assessment tools and training modalities they have at their disposal: the client’s gait.

Promoting the Medical Fitness Market

Dr. Grove Higgins/21 June 2021/ All MFN blog/

MedFit Classroom (through the MedFit Education Foundation) continues to expand education and specializations for Fitness professionals. However, simply earning a certification does not mean clients will flock to you, or that doctors/therapists will refer their post-medical/rehabilitation patients to you. Most trainers today working with these types of clients did not look for these clients and fewer were referred to them by a medical professional.

However, many trainers fall in love working with these clients, whether they are a stroke survivor, had a knee replacement, or other physical complications. So, how do you find and attract new clients in this growing niche?

Researching Medical Fitness

I interviewed Brian White, an MBA student at the University of Colorado, a transitioning military veteran, and an expert in messaging and analysis of popular media. After studying the post-medical rehabilitation and personal training industry, Brian had several takeaways focusing on education — of both the medical community and the fitness community, standards, and networking.

Brian observed that in a survey of physicians, only “17% of the respondents have a formal alliance for stimulating activity with an exercise provider.” (Leemrijse, 2015) In other words, few physicians have a professional relationship with a personal trainer who they would then refer patients to, after completing physical therapy. Additionally, the main reason for low collaboration was that they did not know any qualified fitness professionals and so could not inform their patients of exercise options, outside of the medical system.

The global problem of standards

Further, lack of collaboration between medical providers and fitness professionals was not only a problem of ignorance but also a lack of trust for an industry that has few standards. According to Brian’s research, there is a general lack of credibility “of the medical fitness professionals within the healthcare community” and a need for “better prepare[d] medical fitness professionals for practical application, further education, [and] potential elevating to graduate-level coursework [which] should be implemented to support prevalent chronic conditions.” (White, 2021)

Anyone can use the term personal trainer, legally — whether certified or not. A 2017 fitlegally.com article exposed how in the USA, regulation of the industry is state-by-state and no federal statute concerning who can be a personal trainer, what their education must be, or how they may practice. In Australia, only validly certified personal trainers can get mandated insurance. Brazil demands a bachelor’s minimum education. (Rabe, 2017)

The point is this: medical fitness professionals must be educated on the fitness needs of their clients. Courses provided by MedFit help ensure that personal trainers have the specialized knowledge to make a world of difference for a client such as a stroke survivor, after physical therapy. Beyond that, medical professionals, as well as potential clients, must have a dependable source of knowledgeable, experienced fitness professionals who can be trusted to address the needs of the client. Long term, legislation along with education from organizations like MedFit could help to build awareness, validation, and could help to provide a pool of knowledgeable and trustworthy fitness professionals.

MedFit Education Foundation standing in the breach

In the meantime, professional organizations can bridge the gap for personal trainers. MedFit’s board of directors has stacked their medical and education advisory boards with highly qualified experts. Thus, fitness professionals can be confident they are receiving courses with quality content and validation from recognized medical and fitness professionals.

Furthermore, MedFit is advocating for fitness professionals by actively networking with the medical community and sharing with them information about the organization’s courses and the caliber of professionals taking their courses. MedFit is effectively building the post-medical fitness market.

Building medical fitness

Strategy #1
Besides online marketing, Brian has advice on how to build your own medical fitness network and allow clients to find you.

Reaching out to introduce yourself to medical/rehabilitation providers is tried and true. You might ask if you could drop a packet off describing your services. You could ask if they would let you put your brochures in their waiting room or add your cards to their business cardholder. A simple one-page flyer about the specific disorder you are educated to help with (i.e. MedFit’s Stroke Recovery Fitness Specialist), will help them have confidence in you and be a ready resource at their fingertips. Speaking directly to a Physical Therapist is likely to be even more successful.

If you choose the cold outreach method be prepared to face a lot of rejection.

Strategy #2
Patient support groups and organizations also offer wonderful contacts. In Colorado, for example, there is a Stroke Advisory Board and dozens of support groups that can be found online (https://www.strokecolorado.org/co-stroke-support-group-list). These lists represent opportunities to speak directly with stroke survivors and allied health professionals, who have direct contact with both providers and clients.

Strategy #3
The personal trainer turned marketing guru, Joe Lemon, advises learning about content-based networking. This technique is creating mutual content with people who can influence your market, like potential referring doctors and therapists. This is proving to be one of the most effective strategies for personal trainers to build trust and community with medical professionals. In fact, this can help the private fitness professional boost awareness for their business and drive down client acquisition costs. By collaborating on content, build strategic partnerships with a win-win mindset and allows personal trainers to demonstrate their level of fitness expertise and commitment to their craft. (Lemon, 2021)

Keep in mind, your network cannot grow unless someone acts—take action and do not overthink it.

In conclusion, working with special populations like stroke survivors or joint replacement clients is extremely rewarding and very necessary. Work is still needed to bring awareness to the availability of quality, safe, and effective training provided by educated professionals. But the payoff for both fitness specialists and clients is great and with MedFit support and education, the possibilities are exciting. Together, we can change the face of post-medical fitness.

References

Leemrijse, C. d. (2015). Collaboration of general practitioners and exercise providers in promotion of physical activity, a written survey among general practitioners. BMC Family Practice, 16(1), p1-9.

Lemon, J. (2021, April 5). https://anchor.fm/sales. (G. Higgins, Interviewer)

Rabe, A. (2017, September 5). Do fitness professionals legally need to be certified? (US, Australia, Canada, UK & Brazil). Retrieved from Fit Legally: https://fitlegally.com/2332-2/

White, B. (2021, 4 2). “Untitled”. Monument, CO, USA: Brian White.

Is Your Brain Really “Plastic”? – The Key to Stroke Recovery

Dr. Grove Higgins/14 May 2021/ All MFN blog/

Neuroplasticity is the brain’s ability to reorganize itself by forming new neural connections. This occurs through the changing of neurons, the organization of their networks, and their function via new experiences. Neuroplasticity is also called neural plasticity, brain plasticity, cortical plasticity, or cortical re-mapping.

You are experiencing neuroplasticity every time you learn something new, such as how to use a new computer program, a new line of music, a new app on your phone, or a new exercise in your workouts. Learning is neuroplasticity.

For brain injuries such as stroke, neuroplasticity takes on an even greater importance. Because the injury literally damaged or even destroyed neurons, we must harness neuroplasticity to build new neural connections to do regain or improve upon the resulting dysfunction. The cool thing is that other areas of the brain, those not normally associated with a given action, can assist if the stimulus is strong enough.

Why neuroplasticity matters for all brain injury survivors

The concept of neuroplasticity is very important and if you work with stroke survivors it is a concept you will want to explain at some level. Here are some points of why neuroplasticity is so important:

Neuroplasticity provides hope – Despite the fact that the concept of neuroplasticity has been around for several decades, it is still not widely understood in the public arena. When we explain neuroplasticity to our pain and brain injury clients, they often reply that knowing this gives them hope. Hope is especially important for a stroke survivor, in which the loss of a major motor function occurs so swiftly that it can seem to be a very daunting process to recover from.
We can target neuroplastic change – The great thing about learning a neuro-centric approach to training and exercise therapy is that the nervous system is very orderly and so we can be very targeted in our training to regain or improve dysfunctions.
Neurons that wire together, fire together – Understanding some basic neuroanatomy can go a long way. The bottom line is that areas of the brain that live close to one another can affect one another. Here is an easy example:

- In the picture above, we see the sensory (purple) and motor (blue) cortices of the brain; if we had an issue with knee articulation, we could stimulate that area by moving the hip and/or ankle, which would “fire” into the knee area just by their proximity.
- Here is a less obvious example: Also, notice how close the eyes and the hands are in the sensory and motor maps; you can help motor control of the hands by doing eye exercises.
You have lots of “backup disks” in the brain – A stroke can damage whole neuronal areas beyond repair. While this sounds daunting, it is still possible to regain function. One aspect of neuroplasticity is that other areas of the brain can actually take over to learn and perform tasks they are not normally associated with, given the right kind and amount of stimulus.

The concept of neuroplasticity and how to harness it is not only for stroke recovery, but also for general fitness, performance, and pain clients! Begin learning a neuro-centric approach to medical fitness and how to work with stroke survivors with our Stroke Recovery Fitness Specialist online course, available through the MedFit Classroom!

Master Trainer Pat Marques served in the Active Duty Army for 20 years in the Infantry and Special Forces, including combat tours in Iraq. Upon retiring Pat decided to try and combine his two passions – soldiers and fitness. He was able to work with soldiers through adaptive physical training, helping them deal with amputations, chronic pain, PTS, and traumatic brain injury. Pat has completed over 600 hours of neurological training, becoming a Z-Health Master Trainer. He currently provides exercise therapy, movement reeducation, and strength and conditioning for all levels of clients at NeuroAthlete, from chronic pain sufferers to Olympic-level athletes.