The Life Changing Magic Of Walking & How To Do It Better with Dr Courtney Conley #660

24:14Dr Courtney Conley:Would that cause him pain? he was scared. He was scared. And his foot at this point is so sensitized. His nervous system was so sensitized to what his foot was feeling that when he experiences pain at his foot, it wasn't matching the tissue damage. You see, his sensitivity was high. So he's feeling his foot on the ground. He said, oh my gosh, my foot hurts. But from a tissue perspective, they weren't lining up. So we had to encourage him, listen, let's go for five minutes. See how you feel. See how you feel that night and the next morning. It wasn't any worse. It wasn't any better. So I said, this is good.

25:03Now over the next couple of days, you're going to add another five minute walk. So he started to adapt and he started to say, well, whether I go walking or not, it's not getting better or worse. So I might as well just keep going. And so we slowly started to build and then his confidence started to come. Then we started doing foot exercises. We got him into different footwear. And it was, it's one of my favorite cases because to this day, he sends me text messages when he's like hiking a mountain or hiking on a trail. And it just warms my heart. And it's why I'm reminded of why I do this, because when you cannot walk, it literally affects so many systems in your body.

25:48And what's most detrimental is I think what it does to your mental health. And it was just really encouraging to see that. And it took time. Yeah. And the other thing I told him was when you are experiencing pain, the recovery is not linear. It's not one day you're going to feel a little bit better today and the next day it's a little better. And the next day it doesn't work like that. It's up and down and up and down. But the trajectory goes up and that's what we really wanted to do with him. And he was just wonderful and he's really doing well now.

26:24Dr Courtney Conley:it's interesting that throughout this conversation already the word confidence has come up several times i think it's something we don't think about enough when it comes to our well-being how we feel about ourselves our self-esteem as you said at the start you know walking is fundamental to who we are just to walk around the house to pick something up let's say you even drive to the supermarket you still got to walk around when you're there to get the stuff right in many ways I sort of feel walking should be kept separate from exercise. It's like, I know it is, but it's almost its own category, right?

27:03Dr Courtney Conley:The human body, as you beautifully say, you know, walking is a physiological necessity on a par with breathing and sleeping, right? Very provocative statement for so many people. But the other thing, Courtney, there you said, which I think is really important is that Christian was scared. And I recently had Howard Shubino on for the second time. The podcast has not come out yet, but I think you would love his work. He's a consultant MD in pain science. And he has published lots of research and quotes many other researchers demonstrating how fear makes our pain worse. So the cycle starts, doesn't it?

27:45Dr Courtney Conley:You've got pain, you might have had an injury, but then the fear of moving on it starts to create this vicious cycle where you have even more pain. And then someone like Christian, three years later, he's still not walking. I think he was in his 20s when this happened. So I can't imagine what that does to you in your 20s in terms of how you feel about yourself. I think that's the biggest factor, especially three years into a diagnosis. If he had seen me three months after the injury, we're having a different conversation. But three years, this is a layered, there is a big, beautiful person behind that diagnosis of heel pain and you cannot just treat the heel.

28:25You have to treat their emotions, how they feel, their confidence. You have to build this trust so that they can start to trust their bodies again. And that's what I think is so important because the brain rules the roost. and you have to really listen to people.

28:45Dr Courtney Conley:We previously spoke about this idea that all of us will have a different walking signature. It's unique, very much like a fingerprint. But despite that, what you're hoping to help your patients and therefore us with is improving our walking efficiency. Yes. What does walking efficiency mean?

29:12Dr Courtney Conley:I am really excited to share that I am bringing my Thrive Tour, Transform Your Health and Happiness, to Canada and Europe this September and November. It's a live, interactive, uplifting show that over 20 ,000 people came to last year across the UK and Australia. I'll be sharing powerful stories, life-changing insights, and simple tools that will inspire you to feel better, think clearer, and live with more intention and joy. To get your tickets right now and see all of the dates and venues, go to drchatterjee.com forward slash live. I really hope that you can join me. Today's episode is sponsored by AG1, a daily health drink that has been in my own life for over seven years.

30:05Dr Courtney Conley:Now, this is the time of year when our immune systems are under the most pressure. Between spending more time indoors, travel, and seasonal bugs, it's natural to look for extra ways to support our immune defenses. But most people don't want to juggle multiple pills. They want something simple, effective, and easy to stick with. AG1 is a daily health drink that provides key immunity supporting nutrients, vitamin C, vitamin A, zinc and selenium, all of which contribute to the normal function of the immune system. These nutrients are included in highly bioavailable forms, meaning they are much easier for the body to absorb and use.

30:51Dr Courtney Conley:Backed by clinical research, expert formulation and continuous improvement, AG1 has been in my own life for around seven years now, and each batch is independently tested for quality and safety. That's how they guarantee what's in your scoop and what's not. And the best thing, of course, is that all this goodness comes in one convenient, tasty daily serving. For a limited time only, get a free AG1 flavor sampler and AGZ sampler to try all the flavors, plus free vitamin D3 and K2 and AG1 welcome kit with your first AG1 subscription order. That's$87 in free gifts for first-time subscribers. See all details at drinkag1.com forward slash live more.

31:53so as human beings we were designed to walk upright balanced for long distances it should be when you see someone walk i love it it's like it's a window to their soul it's like this neurological window and you can tell when they're happy or sad or in pain if they just got fired, if they just got promoted, all in this signature of how they carry themselves and how they walk. I don't think we want to take away the uniqueness of someone's individual gait. It could also come with traumas or what have you. But what we do want to create is this efficiency because we should be able to very easily get to that magic step count number and feel well doing it.

32:43So when we look at efficiency, it's, you know, when I first look at someone when I'm assessing their gait, do they look comfortable? Do they look relaxed? Are they holding their breath? Are they stepping into a pothole on one side where they kind of look like they're tilting? Are they swinging their arms? Those are the, you know, big things that I take a look at to see how comfortable they are in their walking gait. And then I break it down into if they aren't, where's the stone in the river? What's preventing this efficiency? Is it a range of motion issue? Is it a strength issue? So that's how we kind of go deep there.

33:33Dr Courtney Conley:So all of us could potentially think about our walking and think about some of those concepts and think about improving our efficiency. No matter how we currently walk, we could change the way in which we walk. There's a lot of practical guidance for how to do this in the book. I wonder if we could go through some of those steps, right? Roll the earth away. What does that mean? I love this. So when you're walking and your foot can feel the ground, a walking gait is different than a running gait. So when you're walking, the heel, you graze the heel, and this is what initiates the foot to lengthen or to pronate.

34:13So this is when we start absorbing shock. And then we absorb shock, we roll through the foot, we get to the big toe, and then we push the earth away. You're kind of rolling through your foot, pushing the earth behind you. It's a

34:28Dr Courtney Conley:beautiful thing and you should be able to feel it so even just that take home message to people next time they go for a walk they can start to think about rolling the earth away yes as they walk when the heel strikes it's this think of just this almost like a wave yeah and this foot is it adapts it's the central nervous system is causing this foot to change shape and to adapt to terrains, for example. And that's important. We need to be able to absorb shock and the foot needs to be able to stiffen for propulsion. Yeah. And as you say, roll the earth away, I'm just feeling in my head, I can just almost feel this beautiful stretch on the fascia at the bottom of the earth, you know, on your soul, you know, almost like a massage every time you roll through, right?

35:22Dr Courtney Conley:Having said that, I know we covered footwear last time, but we will definitely in this conversation as well. But one of the things you write about in the book is if you have one of these modern, stiff-soled shoes, it's hard to roll the other way, isn't it? Oh, yeah. If you look at some footwear and you try to bend it, just take the shoe and try to bend it in half. If that shoe can't bend, you can't roll anything. You can't roll your foot through there. You can't get big toe extension. So if you were to take the shoe and bend the front of it to see how well the tip of the shoe were to bend, some shoes are very stiff and you can't extend your big toe.

36:08And here's the problem with that. If I can't extend my big toe, it's not just a big toe problem. It's going to affect what happens at my ankle, at my knee, and at my hip. when I see people walk in that type of footwear, there isn't this efficiency or there's three rockers to the foot.

36:30Dr Courtney Conley:There's no fluidity, is there? There's no fluidity to the foot at all. And so you'll see them start to pick up their foot and place it down, pick up their foot and place it down. That is inefficient. So we can't take advantage of joint range of motion and strength when we can't actually feel what our foot is doing and the foot is moving like a block instead of dissociating. Yeah. I spoke to Helen yesterday, my movement coach, who I spoke to you a little bit about last time and Helen loved our first conversation together. And she's got this incredible piece of technology that I think there's only 10 in the world now where she can measure everything in your body as you're walking on a treadmill, all your spinal movements.

37:13Dr Courtney Conley:It's phenomenal. And she has measured for several years now. I'm talking about walking here, not running, okay? Walking. That when people wear cushioned shoes and walk, there is more impact going through on every joint. They don't feel the impact because they think, oh, I'm on a cloud, right? But actually there's more impact going. So almost our feeling is misleading because we think, yeah, I'm not putting any pressure on my joints at all, but we're actually overpressuring them because it's inefficient walking. Yes. It's very counterintuitive. Exactly. Because when someone has knee pain, for example, they think, I'm going to go wear this cushioned shoe and it's going to help shock absorb my joints.

37:56When in fact, when you take your shoes off, one of the things we talk about is how you adopt a softer gait because you're getting feedback from your foot. The receptors in the foot are going, hey, you're landing too hot and heavy. Lighten up a little bit. Bring your foot closer to your center of mass. So that's one thing that happens when you can feel the foot is you start to change how you're striking the ground. Not to mention with cushion, there's changes in the forces of how that foot hits the ground. And that's those forces that she's referring to there.

38:32Dr Courtney Conley:It's kind of interesting. This is so obvious when you are used to minimalist shoes, right? Yeah. I think we both had experiences recently, well, not that recently, but where we wear minimalist shoes, but for a wedding, for example, this was seven, eight years ago now, where I wore these Italian dress shoes. And you don't realize how they're restricting your movement until you're used to barefoot shoes or minimalist shoes. And you go in a stiff sole shoe, you're like, what? You know, it's, I can't move my feet. They're like, they've almost been, they're in prison here, basically. So I think it's obvious when you go the other way, it's probably not so obvious if you're used to these shoes, which most people are wearing.

39:15Dr Courtney Conley:You're like, they almost have to take our word for it, don't they? But I guess you could experience it by walking. If you're lucky enough to have a garden and you walk barefoot on the grass, you can start to feel that fluidity in the sole, can't you? My favorite thing my patients will say after they've been introduced to this type of footwear is I just kind of keep my mouth shut. I educate on the front end and I I said, this is what we're going to try. They come back and they're like, my foot feels better. My back feels better. Their gait changes because that's how we were supposed to walk is allowing our foot to feel.

39:48And so, you know, when you get on the other end, when your foot starts to change shape, your toes might splay some more, your foot gets stronger, trying to put that foot, that healthy foot into most traditional footwear. Now you really got problems.

40:03Dr Courtney Conley:Yeah. because you put your foot in there like, man, this thing is tight. How was I wearing this before? My toes are going numb. So I'll always, which I don't know why I do this, but I have a couple old shoes that I used to wear and I'm talking like 15 years ago. And I'm like, let me just see what it feels like. And I'll go out my door for three minutes and I'm like, nope, I'm coming right back because it does, it just feels so different. Yeah. Walk taller is something else you write about when it comes to walking efficiency. What does that mean and why is it so beneficial? When we give people gait cues, you don't want them to think about too much.

40:43We can't have people thinking about, well, what's my heel supposed to be doing? Should I be pushing through my big toe? Should I be rotating my pelvis? Should I be internally rotating my hip? All of those things are true. There's a lot of beautiful things that happen in a walking gait, But it's complex and you cannot have people overthinking this. Walking should be enjoyable.

41:03Dr Courtney Conley:Yeah, you can't micromanage it in the moment. That's right. So the cue of walking taller, just trying to get your head towards the clouds. So many things happen with just that cue. For example, one of them is the use of your diaphragm. So it changes our posture. And we can start utilizing one of the most important core muscles, which is our diaphragm, to keep us upright. It enables better breathing. The other thing that can happen is it changes our strike. So when I have a tall posture, my foot is going to strike closer to my center of mass. That's what we want. It's this grazing of the heel. So when I say walk taller, there's all these biomechanical things that are occurring just from that cue that someone doesn't need to think about other than walk taller.

41:57Dr Courtney Conley:This is great, Courtney, because I imagine there's going to be a lot of people listening who are very health conscious and have managed to create time in their day to walk more. Yeah. But you're not necessarily saying you have to increase yourself. Let's say someone is getting 7 ,000 steps a day. And maybe, hey, keep doing that. You found the time for that. You've got that in a rhythm. Great. Now, during those 7 ,000 steps a day, try and roll the earth away. Try and walk a bit taller. So you're actually getting more out of those 7 ,000 steps. That's right. Nasal breathing is one. So why is nasal breathing so important?

42:33We interviewed Brian McKenzie, who is really specialized. I love Brian. Yeah, he's great. And he said one of the lowest hanging fruits from human metabolism and human function is to be able to walk nasal breathing for 60 to 90 minutes. When you're nasal breathing, it does, it changes your inputs. It kind of calms your nervous system down. It changes how you're utilizing and using your diaphragm. So it becomes a challenge for a lot of people. When you start increasing your speed and your heart rate goes up, we need more oxygen so our mouth's open. So if we can start to play around with this nasal breathing, we can also create efficiency.

43:13And I really like that as a little challenge for people. but you know, be smart about it.

43:18Dr Courtney Conley:Well, interestingly enough there, you said when you walk taller, your diaphragm is able to work more efficiently. When you nasal breathe, as opposed to mouth breathe, your diaphragm is able to work more efficiently, right? Because of course, everything's connected. But I guess you can take that cue and go walk taller and try and nasal breathe. And you'll get all of these incredible benefits. And I just want to highlight this is free. Yeah. Right. You don't have to buy anything in. This is completely free of charge. When we look at what that does to our posture, for example, one of the things I'll notice when people are walking and they're either in pain or they are not efficient is they'll suck in their bellies.

44:06So they'll be sucking everything in. Okay. It is hard to breathe, period when you're sucking in your stomach. It's very hard to nasal breathe. So when someone's walking taller, it's also just relax. I will often give the cue of do the opposite of suck in. You know, we have this, you know, we'll see people walking around and they'll want to suck in their bellies. It's the opposite of sucking in. It's relax so that you can breathe, so that you can rotate your body and swing your arms. When you have this tension in your belly, when you're walking, the gait becomes very stiff. And that's not what it should look like.

44:50It's calm. Yeah.

44:53Dr Courtney Conley:I want to get to some more of these walking cues, but I had a thought relating to the start of our conversation, Courtney, and that is we're mentioning all the incredible benefits of walking a little bit more. And if we can walk more efficiently as well, even better. There's quite a lot of people out there who have grown up with the idea that intensity, intense cardio is really, really important for health, for weight loss, for fitness. I know you have to assess each individual, right? Because we're all going to be different. But as a general principle, would you say that, you know, as people get older, over the age of 40, over the age of 50, over the age of 60, that in many ways, the focus should be more on walking than intense cardio?

45:45Dr Courtney Conley:That's a tough question. I know it is. That's a tough question. Because it depends. It does. And I think it's the and conversation. Yeah. I think you need both. I think you need to be able to walk at a brisk pace for 30 minutes, 135 steps per minute. But I also think that we need to train VO2 max and get into the other end of the spectrum, regardless of age. I think that's very important. But this daily input of walking at that intentional walk with 30 minutes at that brisk pace, the health benefits there. This happens every single day. This is an input that occurs every single day. And I think also as we age, the other conversation I like to have there is about power.

46:34We lose power faster than we lose strength. What's the difference? Power is reactivity. So for example, it would be, can I get up and off of a chair? If I'm walking across the street and a car comes, can I quickly move?

46:51Dr Courtney Conley:move some people may think well isn't getting up off a chair strength so what i'm just trying to make sure people understand the difference between strength and power i think when we look at power some people look as training power only for athletes for example okay but power is being able to move loads with speed so if i were going to get up off this chair okay and i had to like slowly get up off the chair and use my hands. This is not power. I need to be able to get up off of the chair, pushing load at a certain speed. I didn't think about it like that, but getting up off a chair, in some ways it's quite an explosive movement, but you wouldn't use the term explosive to really think about getting up off a chair, but in some ways it is.

47:40Dr Courtney Conley:Well, how about walking? If we look at walking, would you say walking is a power movement? until I read your book, no. Think about speed. If I wanted to walk at a fast pace to really reap the benefits of what happens when we can push through our foot, that's power. That's foot and ankle power. Being able to roll through the foot, to propel through the ball of the foot, that's foot and ankle power that we lose quickly. So not only do we strength train, but we also have to power train, which is basically taking a same movement and moving it quicker. Yeah. So for example, if I was going to do a lunge, I would go down for three counts, right, slow, and up for one.

48:38So I'm just moving faster under load.

48:43Dr Courtney Conley:And we lose power faster than strength as we get older. Yes. And how am I supposed to walk fast if I can't produce power at propulsion? I was having this conversation with my father. He's like, you know, Courtney, he's like, you know, I was walking the other day and I just felt like I had to pick up my leg and drop it down and pick up my leg and drop it down. He was losing power because he couldn't push through his foot and ankle. And I said, dad, we need timeout conversation here. So do we train power whilst walking or do we train power separately, which then enhances our walking? I think both.

49:25I think we have to train power separately. So for example, calf raise, we could work on same concept, going down slow, pushing up fast, little vibrations. If you don't want to jump. There's always somewhere that you can fit along that. I'll have some patients put their hands on the wall and just bounce their heels. You can train double leg hopping, single leg hopping, depending upon what you're comfortable with.

49:53Dr Courtney Conley:It's the speed that we're looking for. Speed. And we need that reactivity. We need to be able to be aware of our surroundings, be able to move with speed as we age. It's really interesting thinking about power in the context of walking. I've been thinking about it recently since I've taken up Paddle, which is really only maybe eight months ago now, but I'm playing more and more. It's pretty fun. I played for the first time a couple of months ago. I was like, this is pretty fun. It's pretty fun. And as you advance through the levels and play at a higher level, which I'm now starting to compared to a few months ago, it really is quite intense.

50:38Dr Courtney Conley:You know, you can have, you know, long rallies, which are all about patience, a lot of moving back and forward and waiting for your moment. And literally in the last two weeks, I've realized, wow, because I used to play a lot of squash when I was a teenager. I would do lots of sprint training. I was very quick on the squash courts. And I realized for the last three years, I'm not really trained speed. I've been moving a lot, but I haven't trained speeds. And I'm like, you know what's going to really help you on the paddle court? That's right. It's being faster. So I got these jumping blocks out of the shed in the garden a few days ago.

51:11Dr Courtney Conley:I was jumping on and off. But again, I just want to highlight the point that I was thinking about power as, you know, in terms of an athletic movement to help me on the paddle courts. But it's not just that, is it? You're saying as you get older, you may not be playing intense paddle like I am, but you still need that power to help prevent a fall when you're actually stepping down from the curb. I think I want to like scream that. Regardless of decade, regardless of decade of life, there is a way that you have to intervene with that type of training. It's very important for not only activity like you're doing, but just interacting with your environment, fall risk and walking speed and being able to catch yourself if you were to stumble.

51:59Yeah. So that's a very important conversation. And I don't think we should shy away from having these conversations as we age saying, okay, well, we're just going to do, you know, chair yoga, for example, which I am not like, there's a time and a place for all of that. But I also think it should be the and conversation. Challenge our systems a little bit, regardless, like I mentioned, of decade, there is always some way for that stimulus to occur.

52:27Dr Courtney Conley:it comes back to what you're saying before about with modern conveniences comes a responsibility if you want this body of yours to work well for the duration of your life there are certain inputs it requires yes so i love what you said before about intensity and walking you're saying it's not an either or it's an and you also made an instagram reel very recently where you were addressing the same question when it came to walking or strength. Yes. And I think you specifically said, excuse me for the lack of clickbait here, but this is an end conversation, right? So talk to us a little bit about walking v.

53:10Dr Courtney Conley:strength.

53:17Dr Courtney Conley:Today's episode is sponsored by The Way. Have you tried to meditate before? Perhaps you've heard about some of the benefits, like reducing stress and increased focus, and you've given it a go and thought it's not the practice for you. Well, I believe that may well be because you have not yet tried the right approach. You see, the way is the only meditation app with a single long-term pathway. You're not forced to make loads of choices each day. Instead, you're guided on an enjoyable and progressive journey that deepens your practice step by step. Now, I've been using this app for many months now and I absolutely love it.

53:59Dr Courtney Conley:In fact, I love this app so much that I recently decided to invest in the company and join them in their mission to get more people meditating. Since I partnered with The Way, I have had so much positive feedback. One listener said, Dr. Chatterjee, I came to The Way through your podcast. I've tried other meditation apps with limited success and likes the idea of following a single guided path. I'm nearly two months in now and loving it. Henry's gentle and concise approach is very calming and The Way is now a regular part of my morning routine. That's the sentiment that many people report when they start meditating with The Way.

54:42Dr Courtney Conley:And for listeners of my show, The Way is offering 30 free sessions to help you establish your meditation practice. All you have to do is go to thewayapp.com forward slash live more to get started.

55:05Well, people will ask me that all the time. If you, what would you choose? Would you walk or would you strength train? And like I said in that post, I'm like, I don't really like this, that question because it's the and conversation. They're two very different inputs. Just because you strength train one day does not excuse you from not walking. They're different biological inputs.

55:28Dr Courtney Conley:Might one argue, again, I think we should be doing all of them as well, but if we were just going to play the game of walking v. strength for a minute, just as a thought experiment, might want to argue that walking is this fundamental human movement. It's very unique to humans. And that you could, if you were time pressured, you could walk uphill to make your walking have a strength component to the lower limbs at least. Yep. You could get a weighted vest or a backpack, or, you know, we all get to rucking shortly. But again, I agree with you. It should be both. But if you were time pressured, if you, for example, let's say did, I don't know, a 30 minute walk each day, but you wore a weighted vest while you were doing it and you went uphill, you're kind of getting the best of both, aren't you?

56:26Well, welcome to the boost program. Welcome to the boost program. Because that's exactly what you can do. So if you wanted to amp up your walking, let's say time was a factor. There's lots of things you can do. You can throw on a weighted vest. You can add in walking lunges. Some of my favorites for the foot and ankle are heel to toe walks. So you just walk heel to toe. And this is also producing power because you're powering up onto the ball of your foot. So I'll have patients do that, you know, 20 steps on each side. So you can incorporate those things into that walk.

57:02Dr Courtney Conley:I think now's a good time to talk about Jane, who we mentioned before, because I think she beautifully illustrates the potential problems with being one dimensional with our movements. So she was getting 15 ,000 steps a day, which I think most of us would go, man, you're crushing it, right? In the modern world to get 15 ,000 steps a day, you're probably doing way more than most people. But she came into sea with lower back pain and osteopenia. So tell us a little bit about Jane and what you recommended to her. She was, she was, you know, Now for her, when she came to see me, she was in pretty good health.

57:37I mean, she was moving, she was walking, but she did have some low back pain and osteopenia. Now we know when we're walking, we can maintain bone health. It is a load to bones.

57:49Dr Courtney Conley:Can you just explain what osteopenia is actually for people who don't know the term? So osteopenia and osteoporosis, it's when you start to see changes in your bone health. So a decrease in the density of the bone. So it's a precursor, if you will, to porosis. Yeah. So it should be one of those, I need to start paying attention. Exactly. So while she was maintaining bone health with her walking, I knew we needed to start loading her more. So we had the conversation of we're going to decrease some of your step counts and we're going to get you in the gym a couple times a week for resistance training.

58:25This also helped with her low back pain. She was building up her strength around her spine. We changed her programming around. I also had her get on a rower, which she now loves. So we were doing more intense VO2 max work on the rower. So I was taking her picture of fitness and making it more diverse, creating more movement variability. And that's what I think is very important in her case in particular, because she was just walking. And we needed to broaden that picture a little bit. A lot of the things that we did were able to change that picture for her.

59:11Dr Courtney Conley:We spoke about efficiency when it comes to walking, but what we're talking about here is efficiency when it comes to time. Yeah. You know. And I think she beautifully illustrates, as I said, the problems with one-dimensional movements. But I think there's going to be many people who are listening to us right now thinking, oh, I go to the gym four times a week and lift, but I don't really walk much. Or the converse, people are saying, hey, I walk 45 minutes every morning and then I crack on, I'm sat down at work all day. I don't go to the gym, but I feel pretty good. I'm getting my morning light and my nature.

59:46Dr Courtney Conley:and I think that just illustrates that you know what I love when you were describing the Jane story is that by taking her down from 15 ,000 steps I think to 9 ,000 steps you freed up time in her week and it's not that that time went to just watching television you freed up that time so she could strength train and do other things and I think that's a really interesting one for us all to think about you know once you've met the based requirements are you better off increasing your step count to 12 ,000, 13 ,000, or are you better off doing something else? We talk about taking a time inventory in the book.

1:00:27And it was really interesting because I did that as well when I was writing the book and my workouts happen in the morning. That's when I'm like, I get my strength training in or whatever's on the docket for the day, it happens in the morning. And then on the days I'm in clinic, I'm typically not sitting down. I'm constantly like with patients, I'm moving around. And once I started monitoring my step counts, I'd get home from my days in the clinic and I'm thinking, I'm, you know, I have to be seven to 8 ,000. And I would look at my wash and man, I only hit 5 ,000 steps today, even though I was moving around all day long.

1:01:06And then I would get home and I'd say, okay, You got 20 minutes. So it would, it really would make me monitor my time, what I needed to get done. And I had, and I made time for it. So that's a good thing to think about because I think sometimes we think we're getting more movement in during the day and it, the day goes by fast.

1:01:35Dr Courtney Conley:that relates to one of the questions i've had when i announced that you're coming back on the show courtney where someone said i move around a lot during the day for work yeah why do i need to walk as well i guess you've semi-answered that to a degree but there's a flip side isn't there it depends on well what kind of movement are you doing right because there is something about the the kind of metronomic, rhythmic texture to walking that perhaps you're not getting if you're just moving around the office? Yeah, there's a difference between ambient walking and intentional walking. Ambient is what I get around my house, for example, which is still activity, but that intentional walk is exactly what you said.

1:02:23It's that repetitive motion, the rotation, the stimulation to the systems in our body. That is what's important. And so those intentional walks, we have to make time for those.

1:02:34Dr Courtney Conley:Yeah. Back to cues for walking efficiency. We did roll the earth away, walk taller, we did. Swing the arms or swing those arms and walk softer. Can we talk a little bit about those too? I think we can all probably know someone in our families where you can hear them coming from a mile away. you hear that really heavy strike. What does that mean? What does it signify? So I'll often see that with people that have very stiff feet, for example. So remember, when the foot hits the ground, it has to elongate. It's our first opportunity for shock absorption. So we want the foot to pronate. We want to absorb shock as soon as that foot hits the ground.

1:03:22So someone who has very rigid feet, for example, or very stiff feet, they have an inability or it's difficult for them to absorb shock. So when they hit the ground, it's just hot and heavy, very loud. So we'll work on kind of dialing their nervous system down. I want you to try to walk softer. For some people that happens a little bit easier than others. when you have footwear on where you cannot feel your heel for example you don't know how heavy you're walking or how soft you're walking because you're not getting any feedback yeah that's the the beautiful thing about the calcaneus about the heel is you have this bone and then there's also this fat pad with a bunch of receptors in it and it's designed to tell you information yeah people

1:04:14Dr Courtney Conley:People just don't realize enough, I think, that if your foot can't feel the ground, it doesn't know where you are in space. In that chat with Helen yesterday, she was talking to me about research in the 1970s showing that gymnasts, when they land on a cushioned pad as opposed to on the ground, there is way more force going through their entire system because they don't know where they are. the foot's trying to find some sort of, you know, some kind of metric to say, oh, here you are, here's the ground. You're much better off just landing straight on the ground where your feet can actually, oh, they know what they're doing there.

1:04:53The foot prepares you.

1:04:54Dr Courtney Conley:It knows. It's like, hey, I'm about to hit something hard, soften up. Yeah. You know, it can change the fascial compartments can change their pressures. And that's what it was designed to do. But we have to be able to feel that. Swinging those arms, you mentioned that that's really important. I'd love you to talk about why that's important, but also, you know, a modern thing you will see a lot is people walking with coffee cups. Yeah. Right? And we'll get to relational walking shortly, right? So I'm not criticizing that. I'm just commenting on that. Clearly, when you're walking with a coffee cup in one hand, you're not swinging your arms.

1:05:38Dr Courtney Conley:So why is it important? And is there an issue here that we need to think about? I want to preface this conversation with saying something is better than nothing. So if you're walking with coffee, great. If that was what is going to get you walking, great. But I have a story for you. So this is an interesting story. I was treating this gentleman who was an FBI agent. And he was always my last patient of the day. And so when he would come in, He had changed out of his, you know, work attire. So I would only see him in his, you know, sweatpants and gym clothes. And his gait, he had this little, you know, hiccup to his gait, as I call it.

1:06:21So he was kind of stepping in a pothole on his right side and he wasn't swinging his right arm. And so we started working on these things. And he started getting better. but I wasn't nailing it. It was one of those cases. If you get on my list that I'm thinking about at night when I'm laying in bed, that's not the list you want to be on. So I'm obsessing about this. I'm like, what am I missing? What am I missing? And one day he was running late and he didn't have time to change his clothes. And so I watched him walk back into my office and I said, what side do you keep your gun on?

1:07:04Dr Courtney Conley:And he goes, my right side. And I was like, oh. So he had his gun in his holster on the right side. Wow. So he, when he was walking, his arm wasn't swinging like it should. It was almost like there was this barrier there. Yeah. And it was really this wild kind of thing that I noticed. And I said, oh my gosh. I said, we need to, I was like, what are your thoughts on moving that to the other side? He's like, yeah, that's his, this has been years. Yeah, he's conditioned to know how to pull it, how to use it. Yeah. It's actually a term called a gunslinger's gate. But it was really very interesting.

1:07:44So once we, I kind of determined that, at least we had a mechanism for the why. But I think it's interesting when you see these patterns. For people who walk their dogs, for example, I'm like, can you switch the leash into the other side? Just switch up the input. because when you're walking and you're only moving one side, that's not efficient. We have to be able to rotate. We have to be able to move our bodies from side to side. And there's a very big reason for that when it comes to the foot. The foot has to be able to pronate and supinate, and it's the rotation of our bodies, our arm swing that facilitates what happens in the foot.

1:08:26Dr Courtney Conley:Yeah, I hate carrying something in one hand when I'm walking. I'll always take a backpack if I need to take something. But, you know, just to reassure people, I presume you agree with this, but if you're out for an hour's walk and for five minutes of those or 10 minutes of those, you're drinking something, then you... I don't think that's, you know, I think we're robust, aren't we, as humans? We can deal with stuff. It's just if every walk you're doing, you've got a wall spot in your right hands and you're repeating that over and over again, there may be a consequence in terms of your gait. It certainly would be something to look into.

1:09:00Dr Courtney Conley:Exactly. You may also be fine, but yeah, exactly. I mentioned relationship walking. I know that you have said that this is one of the funnest bits of research you did when writing this book. what is that? When I was writing this book, my daughter is now 15. And for anybody who has a teenager out there, it's fun times. We've certainly have had our challenges, but when she comes home from school, I can always tell what kind of mood she's in. Is she happy? Is she sad? Just by her gate, right? Like, is she, you know, excited to walk through the door? And I always will ask her, how was your day? Fine.

1:09:49How are your friends? Fine. What about your schoolwork? Fine. And I don't get a lot of, I don't get the answers that I'm quite looking for there. And even if we have dinner and I ask her these same questions, fine, fine. Can you take me to Starbucks? That's usually what I get. And I started doing the research for this book. And I said, gosh, Courtney, take your kid for a walk. And so I told her, I said, Addie, just give me 10 minutes. Just give me 10 minutes. And then we won't have to, you know, we don't have to go through these questions. And I will tell you what, we started doing that after dinner.

1:10:32Within five minutes, This is no joke. That kid couldn't keep her mouth shut. She's telling me about her friends and about the boys and about her classes. And I'm like, it touched my heart so much. I was like, okay. Because when you get outside and there's this change of environment, you know, there's some research looking at maybe with the teenagers, it's eye contact where she can still be looking around, being stimulated by different things. But the activity, the increase in heart rate, the increase in blood flow, she really, really opened up. And it was mimicking exactly what I read in the research, which was relationship walking.

1:11:17You start to communicate a little bit differently. There's bonds that are created. Walking with your spouse, walking with your grandparents. There's just fascinating research on this, which sounds, it makes sense, doesn't it?

1:11:31Dr Courtney Conley:like it totally makes sense and it kind of it feeds back into this central idea that walking is a physiological necessity you could even expand that go walking is a social necessity a relational necessity because that research you know i think what you just described with your daughter i think many people will have experienced and there is in your book there's some really good research on relationships. And as a, you know, as a romantic couple, what going for a walk together a couple of times a week will do for your relationship. And again, it's pretty simple. It's free. It's free. You just got to do it.

1:12:13That's right.

1:12:14Dr Courtney Conley:Yeah. I read once that it's hard to have anxiety when you're looking out at an ocean, at the horizon. And I kind of think about that with walking too. It's hard to sustain being in a bad mood or to sustain being cranky when you're outside walking. It's hard because again, it's this input. Our brain is starting. We have neurotransmitters. We have all this action happening in our systems. And I think that's a really special thing that we have forgotten about. Yeah. Let's talk about walking with weight or rucking, what are the benefits? So amping up your walking. So if you want to, again, that time conversation, it's going to burn more calories, it's more loads.

1:13:05So you can also increase your heart rate, depending upon how much, you know, load you're putting on your back, what type of terrain. And it can get difficult. So it can be very beneficial for people. I also want to preface the importance of the gear, the correct type of, you know, vests, because you don't want anything that's constricting your, you know, neck and shoulders where your breathing becomes altered.

1:13:32Dr Courtney Conley:Yeah. So those are things to consider. I think also it can be really good for your foot and ankle. But you have to build up. That's right. That's right. Because if you're walking in a minimal shoe, for example, that is more loads going through your foot and ankle. It's a harder environment, but that's also the environment where you can get stronger. If you were in a cushioned shoe already and you had a choice of either adding weight and going what is called wrecking or moving to minimalist shoes, what would be the better step to take first? I would go minimal shoes first. And build up there, get comfortable there before you start adding weights.

1:14:13Dr Courtney Conley:Yeah, me too. You definitely don't want to do those at the same time. So you wouldn't want to grab a minimal shoe and put weight on your back. It's too many variables. So if your choice would be, hey, I want to get my steps in, I want to amp up my walking and I want to add weight and I'm not in minimal shoes, that's one option. But you don't want to do those things at the same time. Yeah. Is there something to consider? You mentioned the equipment. if I think about me walking and all the kind of improvements and efficiency I've made over the years, I've realized and experienced how important that lateral rotation is when you walk, you know, you swing your arms, you know, there's that counter rotation in the body.

1:14:57Dr Courtney Conley:I imagine some brands, I haven't tried it yet. It's on my list to try as, you know, having a weighted vest, for example. But I imagine some brands are going to maybe restrict that lateral movement, whereas some are probably a bit more ergonomic. Yeah. I don't think there's enough people talking about the equipment for weighted walking because that rib cage expansion is crucial. You have to have rib cage expansion, not only for what's happening from a breathing capacity, but that That rib cage and the rib cage expanding also is what dials in rotation. Yeah. It has a direct correlation to what's happening at your pelvis.

1:15:37So you do not want anything that is going to be compressing that rib cage. So that's where I think the gear is very important. I made, this is a funny story. When I first started weighted walking, I had a backpack, like my hiking backpack in my garage. And I was like, yeah, this makes sense. I'm going to add some weight. So I didn't have a sandbag or anything, but I had a 25 pound kettlebell. So I just threw it in my backpack and I'm walking around. I'm like, all right, you know, I'm an hour in. And the next day I woke up and I was like, man, I can't believe I'm telling you this. This is very embarrassing.

1:16:16But my low back was so sore. And it was because every time I was walking, the kettlebell was smacking into my low back. And then I was like, okay, this is a good concept, but I need the right gear.

1:16:29Dr Courtney Conley:Yeah, it's not a failure. It's a learning opportunity, right? Don't have something heavy knock against your lower back whilst you walk. It just doesn't make any sense. You should have done a chapter on that in the book. Yeah, but I think it all plays into this idea that, you know, walking is amazing. There's so many benefits. And, you know, it depends on your starting point, right? if you currently not even hit two and a half a thousand steps a day okay no worries yeah let's get you there first and you've got a program in the book to help people get there if you're at two and a half thousand you want to get to five thousand okay well that program is going to help you build up and if you want the boost program to really max your walking you know i think that's fantastic as well so you know you're never going to run out of things to do if you're trying to improve the way that you walk.

1:17:19Yeah. I mean, when I was writing this, I consider myself a pretty active person. My whole career is built around movement. The changes in my life and my lifestyle from researching this and writing it, I'm so grateful for because walking has taken on a whole new kind of meaning for me, even though activity has always been a part of my life. It continues to be this calming measure for me, this bringing me back to baseline. When I was writing and I'd get into, you know, I'd be challenged, right? Things weren't flowing. I'd go take a walk. You know, my creativity would improve. When I was stressed out, go take a walk.

1:18:06You know, so I was able to really think about the benefits and what it was doing for me. and it was really cool to see what happened and to see how important it has become.

1:18:19Dr Courtney Conley:Today's the final day of your book promo trip to the UK, right? And interestingly, you've come with your mother. Yes. So you've been in London for a few days doing all kinds of cool stuff. Yes. The weather has been great. Yes. Have you two been managing to walk a lot while she'd been here? I'm so proud of her. She, first of all, this is very exciting. She got her a pair of Vivo barefoots. She's 76 years old. Love it. She put in 13 ,000 steps yesterday. In her Vivos? In her Vivos. Put it there. Fantastic. And, you know, I'm sitting there going, Mom, bring your other shoes. Just in case. Just in case, you know, let's, you know, but she walks every day at home.

1:19:06She's in the gym a couple times a week. And so her transition, you know, And of course, the next morning I was like, how's your feet, mom? She's like, I feel great. Do you know which one she wore? She had the Primus Flex, I believe.

1:19:18Dr Courtney Conley:Yeah. But she really did. She really did very well. And now she has three pairs of them. But I was really proud of her because she put the steps in. And not to mention the place that I'm staying in is on the fourth floor, which I didn't. I missed the little fine print. And not only that, but the staircase is about a third of the size of this table. An old traditional British staircase. So God bless her. She's had to walk up and down these stairs a million times. I carried her 50 pound suitcase up those stairs, by the way. So she's on a fitness holiday. Yeah. But yeah, so she was able and she said to me, she goes, if some of her friends were here.

1:20:08And in fact, she said most of them. She's not sure they would be able to get to our flat. Yeah. Because they wouldn't be able to navigate the staircase or have the power or have the strength to do so. And that like broke my heart. I was like, oh. I literally looked at her and I said, that's why I wrote this book. That is one of the reasons why I wrote this book. so that people don't have to have those conversations when they get older. I can't go on this trip with my daughter. I can't go on this trip with my grandkids because I'm afraid or I won't be able to do things like walking up a flight of stairs.

1:20:47Dr Courtney Conley:But that is happening, Courtney. It's happening all over the shop. And there'll be people listening right now who that story, like a little bit did for me, makes you a bit tearful because, you know, I can't remember the last time I was able to do stuff like that with my mum. Yeah. and it just highlights why the message in this book is so important because so many people they neglect their health throughout their life they end up in their 70s wondering why can't I do that stuff anymore why can't I enjoy my grandchildren or play with my children and it didn't start in your 70s yeah it started many decades before that that doesn't mean you know you can't undo problems.

1:21:29Dr Courtney Conley:You can, it's never too late, but it's never too early also. Yeah. I was, um, when I was at the radio show yesterday, there was a gentleman there that ran the marathon and I asked him when he started running, he was older and he goes, I didn't start running till I was 60. And he had just finished the marathon. So that was also like, I love having that conversation that it's never too late. It's never too late. Yes. Do you think, is it easier the earlier I start? Yeah. We want to avoid some of these problems. We want to take a proactive approach, not a reactive approach. And so I think it's hopeful on both ends.

1:22:12Like there's no better time to start than now.

1:22:16Dr Courtney Conley:Yeah. Courtney, since you came on last time, that episode was so well received. I can't tell you, you know, we've had one of our most popular episodes of the year. The amount of questions I've had, the amount of people who said, I've got minimal issues, but next time Courtney comes on, can you go through in detail how to transition? Right. So I have a list of questions from many people in my audience. I don't think we'll get through them all, but I thought it might be quite good to try and get through a few of them if possible. And let's start off with that one. You know, what are some practical steps for transitioning from cushioned shoes to more minimalist ones?

1:22:57So when you think about the characteristics of functional footwear, we'll start there. We have a wide toe box, a low heel to toe drop. So that's defined as six millimeters or below.

1:23:12Dr Courtney Conley:Yeah. Yeah. And varying degrees of cushion. So if we were to start with the first one, if you're in a traditional shoe, this is the majority of footwear out there. Transitioning to the wide toe box, that's my non-negotiable, that's what happens first. And that's usually pretty easy because there's not a person that says, well, I have more space for my toes. I don't like that. You know, what they will say is that sometimes it feels a little loose because their toes don't have the strength or the splay to fill up the toe box. But they will. But they will. Yeah. So they can use toe spacers, for example, as a way to help them facilitate that splay.

1:23:57And then they can do the exercises that we talk about. So that transition into the wide toe box, it's usually pretty easy and people adapt to that quickly and they like it. When we move into heel to toe drop, I think a lot of people don't realize that the majority of traditional footwear, and this is trainers, what have you, the heel sits higher than the toe. So 10 millimeters, 12 millimeters. And over time, if I'm constantly in this position, it's going to affect, for example, the mobility of my ankle. It could make my calf tight.

1:24:35Dr Courtney Conley:And for people who are listening, the extreme version of that is the lady's high heel. Yes. If you were to wear a high heel all day long. You'd understand that. But there are many other shoes have degrees off that, just not to that extreme. Correct. And in the book, we have a high heel rehab section. So if you've worn high heels your whole life, again, have hope there's something you can do about it. And I just want to reemphasize that. Something we covered in the first conversation is that you have a very holistic approach to this. You're not against people wearing high heels. If they want to, if they feel good and they want to wear it out on a night out or to a wedding, you're like, sure, but make sure on those other times you're doing something about it.

1:25:16Dr Courtney Conley:So I just want to re-emphasize that point that you, I think one of the things people like about your approach is that it is very realistic. You don't want to instill fear in people. That's not what we want to do. We want to encourage people. We want to empower people. You don't want to have the always or never conversation. You always have to wear these shoes. You never can wear those shoes. People don't want to hear that. And it's not realistic. If you feel good in a high heel going out to dinner with, you know, your husband and that makes you want to wear that shoe, go for it and feel good and enjoy it.

1:25:54What I'm saying is when you get out of that heel, Don't wear the heels all day long. Pay attention to your foot. Do some exercises. So that's where that conversation becomes much more digestible. You meet people where they are. Okay. So with the heel to toe, the higher heel to toe drop, if you were to transition into a functional shoe, so that would be five millimeters or six millimeters. We're not taking you all the way down to zero. It's like a nice halfway point. And then we talk about doing ankle mobility exercises, for example, working on your foot and calf strength. That is one of the things that we'll hear when people transition into a zero drop.

1:26:39They'll say, well, my calves got sore. And then they'll want to blame the shoe. And it's not the shoe. It's just a signal saying you probably didn't have the capacity in your calf or the range of motion to drop down as quickly as you did.

1:26:58Dr Courtney Conley:You're working your muscles and tendons in a different way. If you went to the gym and did bicep curls and the next day had a sore bicep, you'd be like, yeah, great. Okay, I really worked those biceps. Great, they're going to grow about stronger. But somehow when it comes to minimal issues, oh, there's something wrong with the shoes. It's like, no, no, no. You're just using your muscles in a different way in the way that they're probably meant to be used once you start training them. It's like if you were squatting and you were squatting 100 pounds one week and 200 pounds the next week. And you're like, man, I am so sore.

1:27:26You, people wouldn't say, well, stop squatting. They would just say, hey, maybe only squat 10 more pounds than you were. It's a very different conversation at the foot. It's, well, there must be something wrong.

1:27:39Dr Courtney Conley:So we take this gradual transition. Okay. And again, I would just want to emphasize, we went in detail in our first conversation into the difference between functional shoes and minimalist shoes. And functional might be considered a transitional, sort of phase as you get to true minimalist shoes. As I mentioned in that comment, I just want to repeat this. I have been wearing Vivo Barefoot shoes for almost 14 years now, pretty much exclusively. So I know their range very well. The show is also sponsored by them. So I want to make that very, very clear. But it's not about that for me. It's about, you know, choose your brand that you want, right?

1:28:19Dr Courtney Conley:I will say for Vivo Barefoot that the, I think it's the Primus knit, A, it's my favorite shoe, but B, the people who I have transitioned or helped transition over many years, friends or, you know, family or patients who wanted to, I found the Primus knit to be a really good shoe because there is a bit of, I won't call it cushioning, but there is a bit of substance under it. So you don't, I love the Primus flow as well, which is very, very barefoot. But I think the Primus Knit is a great transitional shoe for people if they're looking for something there. If you look at the sole of that shoe, so we talked about wide toe box, heel to toe drop, and then the last thing is the sole of the shoe.

1:29:03The difference between a functional shoe and a minimal shoe is minimal has a thin and flexible sole. So you can feel more of the ground. This is probably the hardest part that takes people to transition into. That shoe, if you were to look at the sole, it has these lugs on them. It's almost like a trail shoe. So it gives a little bit of space between the sole of the foot and the ground. So that is a great shoe for people to transition into a more minimal shoe, but their foot still has a little bit of... Yeah.

1:29:41Dr Courtney Conley:Yeah. Okay. So once people have chosen the shoe that they want to transition, if we put it through the lens of walking. So we're not talking, you know, running in minimalist shoes can be done. It's a separate conversation. We're not addressing that here at the moment, okay? And I think if you go from three decades of cushioned shoes into buying some barefoot shoes and going for a one hour run on a road in them when you're not used to it, don't blame the shoe afterwards. It's like that was the wrong thing for you to do, right? Let's get people walking in these shoes first. Yes. Once they've got this, let's say this new shoe, let's say someone walks 30 minutes a day.

1:30:22Dr Courtney Conley:Is it just a case of like, I don't know, you do some of the walk in those and some of them in your old shoes or yeah, that's literally take them in a backpack with you. Yeah. I'll say either walk five minutes away from your house, come back 10 minutes, put your old shoes on, do the rest of your walk, walk around your house barefoot, five, 10 minutes, slowly transition and then see how you feel that night and the next morning. If you're feeling pretty good, add a little bit of time. Some people make that transition quickly. They're like, this isn't a problem, my mom. But she's, you know, she's a walker.

1:30:57She's, you know, she is healthy.

1:31:00Dr Courtney Conley:And she's your mom. So I imagine there's been some full exercises in her life for some time. that would not be very good if we had some problems there um but yeah so that's some people transition quicker and that's okay okay so basically take it easy listen to your body and as you get more comfortable start to increase yeah and i guess if you go to a functional shoe and you get to the point where you can walk 30 minutes a day no problem you're wearing them the whole time and you're walking to the shops and the office and then you could, you know, go to a minimalist shoe and apply the same principles again.

1:31:40Dr Courtney Conley:Yep. Yeah. Like in the build program, for example, when we talk about these different walks per day, you could start with taking one of those walks or a portion of one of those walks with your minimal shoes, you know, and then start to build up, build the capacity of the foot and ankle. I mean, it took me, you know, I got into this because I had some pretty significant foot pain for a very long period of time. Bunions, neuromas, stress fractures. It took me years to be able to walk in minimal shoes for long periods of time, for all day long. I mean, it took a long time. And I would still, that's why I'm this big, you know, shoe spectrums are important.

1:32:25Dr Courtney Conley:Yeah. I want to spend the most of the time that I can in footwear that is going to improve my overall function. It's going to put my foot and ankle in the position that it was supposed to be in. I'm going to be in an environment where I can get stronger. Now, there are times where I'm like, I want to go hike 10 miles in Colorado. You know, I like to have a little more stack height. It's like the least amount of cushion necessary to complete the job. But if you look at the footwear out there now, that's not least amount of cushion of anything. That is, you're walking on a cloud and you're walking on a pillow and you're interfering with sensory acuity.

1:33:08And that is a problem.

1:33:09Dr Courtney Conley:Yeah. I would just add there, the Vivo Barefoot Tracker hiking boots are insanely good. You've got incredible grip, which you often want if you're hiking trails, but so comfortable. You can really feel your foot flexing with every football. When you think about that hiking shoe too, you still have to have the boots to be flexible at the ankle. You don't want a stiff boot where you can suddenly can't move your feet and ankle anymore. If you were walking down a mountain and you don't have ankle dorsiflexion, so your ankle is not allowed to move, those loads have to go somewhere. So what we'll see is that people will transfer that weight or load from the ankle up into the knee.

1:33:57Dr Courtney Conley:Yeah. So you don't want to interfere with those types of ranges of motion. I think people think those hiking boots are like this, you know, it's going to provide all of this stability. And I have to have it there. Guess what? Your ankle was beautifully designed to be a very good stabilizer. There are muscles that sit on the inside and outside of the ankle that when trained are better than any stabilizing boot you could buy. So rather than avoid it, we train it, we use it, we introduce the foot to varying positions, various terrain and get stronger and more resilient. That leads on to the second question on the sheet.

1:34:39Dr Courtney Conley:how can we restore full mobility and confidence in our ankles, especially after previous ankle injuries? Yeah. When we think about the ankle, we don't want to avoid ranges of motion. I think for someone who had a history of ankle sprains, for example, the thought of putting their foot on a slant board that's kind of tilting them into that position of the ankle sprain sounds very frightening to people. So we kind of adopt this, well, I'm just not going to do it. You have to train the ankle. We have to train for movement variability. You don't want to avoid these ranges. You want to work into them.

1:35:20So when we're working on, especially patients that have had ankle instability, we're working on all these different ranges, pointing the foot, flexing the foot, inverting and everting the foot and training in all those different positions, Those muscles, the intrinsic muscles of the foot and ankle are very good stabilizers. And so rather than I need a boot, I need all of this, you know, stability around the ankle, we can train the body to do that.

1:35:52Dr Courtney Conley:Are you a fan of those BOSU balls or those, is it those half BOSU balls where it's an unstable service to stand on? It's a great question. You have to know what you're doing before you get on one of those. and a lot of people have a difficult time. So why put someone's foot in an environment that's going to challenge them more when they're having just as much of a difficult time with their foot on the ground? The foot on the ground is more, we want to train for function. Now, if you can put your foot on a BOSU ball and you look like you can control those motions, that's one conversation. But when you see people all over social media and they're like on a BOSU ball and they're wobbling all over the place, how functional is that?

1:36:37You know, what is your intent? What is your goal?

1:36:40Dr Courtney Conley:Yeah. I just want to add there that the first time you came on the show a couple of months ago, we mentioned a lot of the things in your book, but the book wasn't out. The book is now out. Okay. And there are so many exercises, practical ones in the book. So for someone who's had a previous issue, I would say, get the book and take a look because at the start, at the back, Like there's all kinds of things that are going to help people build that up, aren't there? Yeah. And I love treating the foot in looking at this part of our body that can get stronger. We haven't treated the foot like that.

1:37:18When we have the conversation of arch support, for example, people say, well, does the foot need arch support? And I say to them, do you know how well that your foot is designed? It has the best arch support you can imagine. When we talk about the medial arch of the foot, so that's the inside arch, there are so many muscles there that are designed to help your midfoot and stabilize your arch and stabilize your big toe. So no, the foot doesn't need arch support. Now, if we shove it into a shoe where the toe box is tapered or the anatomy is changed, then yes. Yeah, you need arch support because you're compromising the integrity of the foot and ankle.

1:38:10But when that foot is doing what it's supposed to do, and I have toe splay, and I have a strong foot, and I have capacity, and I can push off through my toes, then no, that foot does not need arch support. It's well designed to handle many times our body weight when we walk and run.

1:38:28Dr Courtney Conley:I will just want to highlight that 12, 13 years ago, people would have said I had a flat right foot. Now I've got an arch in it because I've been using my foot for the last 12, 13 years. I've not been putting it in deforming footwear. You know, that's quite a provocative term, but it is. if your shoe is literally squeezing the front of your feet and it's narrow, you are literally deforming your feet. We just have to be honest about that. That's what is happening. And since I stopped wearing those kinds of shoes and I've been in minimalist shoes, my feet have changed. They're stronger, they're meatier, there's an arch now.

1:39:10Dr Courtney Conley:It's, you know, this isn't just one thing. Oh, I've got a flat four or I don't. It's like, okay, you might do at the moment, but maybe with the right inputs, it will change. When I started doing this, my foot looked atrophied. Yeah. It was just, there was no muscle in the foot. And yes, those things do change. And I would encourage people, that conversation of flat feet, I think we've been really trained, if you will, to think that flat feet are bad. And if I have a flat foot, then I have to have some type of support and I need this very aggressive shoe. That is not the case. I have plenty of patients whose flat feet are very strong.

1:39:54So it's more in how the foot functions. And if you have a flat foot that is weak, do what you did, which is strengthen your foot because here's where the problem is going to be. If you have a flat, weak foot and you don't do anything about it, over time, where that foot may have been flexible right you're still able to move it it will start to become stiff and rigid yeah so now instead of having a flexible flat weak foot that i can strengthen i now have a rigid stiff flat foot and that is a very different conversation and those are the people that have a very difficult time with walking gait as they age because their foot has lost the ability to adapt those are the ones we have the conversations with, I need a specific type of foot orthosis.

1:40:47We need to get in some type of rockered shoe to help them do something that we as human beings were very born to do, which is to walk for long distances upright.

1:40:58Dr Courtney Conley:Some of the questions that have come in relate to this idea that people are listening to me talk about this, you talk about this, and they're thinking, okay, I want to start paying attention to my foot and my foot health, but I've neglected it for several years. Is it too late? Can you undo 20, 30 years of being in incorrect footwear? Yes, you can. Your foot needs to be, when you look at someone's foot, and this will be a good example with a bunion, for example. A bunion is when the big toe starts to dive in. You'll see that bump on the inside of the foot. If you can move that, if that's flexible, it's a muscular imbalance.

1:41:44There's a muscle that straightens the big toe. I'm a perfect example of that. So when the foot is still flexible and I can work on it and I can train it, then by all means, yes, that foot gets stronger. If the foot has become, like I said, stiff and rigid, where you have toes overlapping one another, the conversation becomes more difficult because now you're getting structural change and that can be difficult to

1:42:15Dr Courtney Conley:to address can toe spaces sometimes help with that with the more rigid well no when there's when toes are starting to overlap each other if i can get a toe spacer on someone we're doing it right i wear them every day i've been wearing them for gosh years do you wear them in your shoes i I'm wearing my shoes because I was a little late to the foot party here. I wish I would have started doing this work much sooner. But my bunion, for example, has improved significantly. It is no longer painful. I run, I walk with these spacers on. It helps keep my toes in alignment. And it's a low-hanging fruit.

1:42:57It's easy. It's like just wear it around the house. Start with a couple minutes a day. It can be difficult for people to break in too because people aren't used to having their toes splay.

1:43:09Dr Courtney Conley:At Gate Happens, you have this box, don't you? With lots of goodies, which you kindly brought me a few months ago, which has been amazing. They've got toe spaces, I think toe strengtheners. What else have you got in there? There's bands, a ball. I wanted to keep it simple. Where can people get that if they choose to get one? Amazon, right here. Just on Amazon. Yep, and on our website. They just look at your name or Gates happens, G-A-I-T happens. Okay. Okay, back to the questions. What do you think about barefoot shoes or minimalist shoes for people with osteopenia? I'm guessing they're talking about osteopenia in the foot, although I don't know that from the question.

1:43:51Yes. So think about what happens when you're walking from a bone perspective. It's all about dosage. That's why the dosage is very important because when you're walking barefoot or say in a minimal shoe, there's more loads going through the bone. This can be stimulatory. So you get this osteoclastic and blastic activity and it can be this environment that is good for your bone health. Now, if I go too fast too soon, right, my dosage is too much, then that positive bone response can turn into a stress reaction because I went too fast too soon. So from a bone perspective, when done correctly, we can stimulate tissue.

1:44:45And when done incorrectly, we can cause problems. So again, it's that conversation. Start small. If you're transitioning into minimal footwear and you haven't walked for long periods of time, don't start running in them yet.

1:45:01Dr Courtney Conley:Yeah. Because there's many more times your body weight going through your foot in a running gait than in a walking gait. So start with this slow transition in a walking gait. Yeah. Okay, now there's been a lot of questions around two common issues. plantar fasciitis and Achilles tendinopathy. Okay. So let's start with plantar fasciitis. How do you treat and cure it is one of the questions. It's one of those diagnoses that I really think is this evolutionary mismatch. Because when you look at the foot, there's tissues share, we share loads. So when I'm walking, for example, we have two muscles, tibialis anterior and posterior that help absorb force when the foot hits the ground.

1:45:54So they're friends with the plantar fascia. When I go to push off, so when I'm pushing off of my gait, I have my toe flexors in my calf that facilitate propulsion. They're also friends with the plantar fascia. If they're not doing their jobs, the plantar fascia gets pissed. Yeah. Because now, instead of having this foot that was designed to share loads, the plantar fascia has to take on more of it. And so when we look at treatment for these types of things, it's not just keep deloading. It's not just, here's a foot orthosis and here's a shoe that's gonna rocker for you. it is why wouldn't I look at bringing the friends back to the party?

1:46:44Dr Courtney Conley:Yeah. Start strengthening the foot so that we can actually make change here. You know, one thing I think is very interesting, and if I had time to go back to school, I would for this, but when you see bilateral heel pain, so people that have plantar fasciitis, fasciopathy on both sides, I'm more and more convinced that this is a up-the-chain conversation. that there is a very big correlation between the pelvic floor, hypertonicity of the pelvic floor, and what we're seeing at the feet. If you think about it, if I was under high stress, for example, right? I get into this like fight or flight, everything's tense.

1:47:27That also happens at the pelvic floor, and it also happens at someone's foot. That's what's so cool about the foot. You look at it, and you can tell if someone is like, why are they gripping their toes so much? It's like, do they have an inability to actually relax their entire system?

1:47:44Dr Courtney Conley:Yeah. So it's been really some interesting work to do a lot of breath work, pelvic floor work with my patients with bilateral heel pain. Yeah. And it helps them quite a bit. It's really pretty neat. It also makes me think about even higher up because, you know, when you've got a forward head posture, that goes, you know, as we said last time, the feet are the foundation of the body. So you want a strong foundation. And to add to that, you know, they also respond to what's going on up the chain, right? It goes both ways. So if your head's jutting out forward, well, that is going to have an impact on your feet.

1:48:23Dr Courtney Conley:And of course, if it's bilateral, it indicates there's something a bit more central going on than something local in that foot. What about Achilles tendinopathy? Is that something you see a lot of. Yes. For people who don't understand the term tendinopathy, what are we talking about here? Anytime you have a tendinopathy or a tendonitis, you have to ask yourself, what happened to the tendon? Why is it starting to not be efficient, if you will? It's a very common diagnosis. And it's also counterintuitive to people because when their heel hurts, when Achilles tendon bothers them, the immediate reaction is, I got to get off of it.

1:49:04I'm going to do less. And we know that tendons need load. And when we load our tendons, it's basically this concept of mechanotransduction. We're loading the tendon. It's what stimulates the health of the tendon. And what helps share those loads or absorb some of those forces are strong calves. So when we look at treating for Achilles tendinopathies, for example, a lot of the research is heavy, slow loads. You have to improve the capacity of the muscles that insert at the Achilles tendon. I had a patient once that we were working on and again, several years with Achilles tendon pain. and every time his foot would hurt in the morning, he would get his scooter out.

1:49:59He was a physician. And I said, you're gonna leave that scooter at home. We're done with the scooter. Because it's not that the rest was bad per se. He was feeling better, but you can't rest a tendon. It will not, when you go to return to activity, you have now a calf that has gotten weaker. So a tendon that is not maintaining or improving its integrity or health. And so then it just becomes this cycle. So with those diagnoses, tendinopathies, plantar fasciopathies, we have to look at movement and we have to look at progressive loading. Yeah. And those are very, very important conversations. We cannot deload forever.

1:50:46Dr Courtney Conley:Yeah, that's a principle I think that has come up on multiple occasions through this conversation, Courtney, that you need to load the body. Yeah. You know, I can think back to Christian, the firefighter. Yeah. Right? And how he was told to move less three years on. Right? And as you beautifully explained, you know, whether he walked on it or not, the pain was the same. Yeah. Right? So you might as well walk on it then. Living well with pain rather than having it dictate your life and saying, I'm not doing that. Yeah. Yeah. And if you just superimpose onto that, this idea that Howard Schubiner spoke to me about, and his research has shown that maybe even 90 % of chronic pain has a neuroplastic component, i.e.

1:51:33Dr Courtney Conley:it's not structural, it's been created by the brain, maybe due to fear, worry, anxiety, stress. And you layer that into what you're saying. It's like, hold on a minute, if you've had pain for two years maybe the injury's healed that's right maybe there's something else now it's that you know his book is called unlearn your pain right maybe there's a learned cycle here that you know actually that word confidence again that small amounts of movements micro walks get you going build up that confidence make you realize i don't need to fear my body anymore my body is capable it all starts to play in doesn't it i love that idea how do you live well with pain Yeah.

1:52:16It's my practice over the years has changed in that more recently, I think since I've started doing more and more of this work, I'm seeing more chronic pain patients that are afraid to put their foot on the ground. and those are my like, these people become very, very dear to me because it's heartbreaking. And it is that conversation of, you know, the diagnosis, the musculoskeletal diagnosis is one thing, but the bigger conversation is the one of fear and getting them to trust their bodies and getting them to feel confident again. Yeah. There's a question on gait analysis for running.

1:53:04Dr Courtney Conley:Do you support gait analysis for running? And related to that was, how do we know if our running shoes are causing us issues with our posture or not? Yeah, it's... Without individual Yeah, that is deep. Top line. Top line. You know, there's some some very good runners out there and you'll see on social media these people breaking down their mechanics and they're like, oh, my gosh, his foot's pronating and it's he's this. And I'm like, he just won. He just broke a world record. You know, like the guy has clearly, you know, he's running and he has this gate. It's do you really want to mess with those things?

1:53:41So there it gets into these kind of fine lines. As far as the footwear is concerned with the super shoes, there's actually a great podcast here in the UK with Ian Griffiths, Podchat Live. He talks about, they go in depth about shoe research and really looking at what's happening at the foot. But when you look at these super shoes, we know they give people economy. Two to 4%, some studies would say more. but I think what we need to consider is these shoes work best when someone knows how to run. Yeah, exactly. When you have an elite runner who has a faster cadence and they're striking their foot on their midfoot or their forefoot, they have a strong posterior chain, they have an efficient gait, then these shoes provide that economy.

1:54:40If you put a super shoe on someone that has a weak foot and calf and they start running on their forefoot and their midfoot,

1:54:49Dr Courtney Conley:you can cause problems because the demand is greater than what they have the capacity for. That's the piece people miss. We're literally two days post one of the most iconic marathon races in history. Two people broke two hours in an official race. I mean, phenomenal. And of course, the elites are pretty much all wearing these super shoes. But these guys, I mean, a lot of them are from East Africa. A lot of them grew up barefoot. And I mean, you know, at the formative years of their life and their running gait were they had exceptional mechanics. And now this is, as you said on our first conversation together, it's the icing on the cake, right?

1:55:33Dr Courtney Conley:But so many many people are getting injured by thinking, I'm going to get a 4 % improvement in my 5K. It's like do some plyometrics, you'll get 4 % improvement, you know, like pay attention to what you're putting in the shoe, let the shoe be the icing on the cake. I think it was really cool to see some of, of course, I'm obsessing over all of their gates, but when you see these runners that have this, you know, this pronation, this excessive pronation, it's a beautiful thing to see because tissues need to lengthen before they can contract. You know, the foot has to recoil. It's like elastic, isn't it?

1:56:11So that's what, when you see a foot that's going into pronation, you know that they're getting ready to, you know, propel forward and spring forward. We don't want to eliminate arch recoil. We want to learn how to strengthen it and control it. And then you have this foot that can basically be this spring off the ground. And it's really pretty cool to see.

1:56:35Dr Courtney Conley:We've covered most of the common questions. I don't think we can get through all of them, but there is one question that came up, which I think is quite relevant to some of the things we've been talking about today, but also at the end of our first conversation, when you spoke about how walking speed could be the sixth vital sign and predict dementia by up to seven years sometimes. And someone wrote in to say, Rangan, I'm worried about my elderly mother. She used to like walking, but now she's a lot less stable. Should I really be asking her to increase her walking? um yes and in a safe environment what would make her feel safe would that be uh walking with poles for example sometimes my patients if we put poles in their hands it gives them that kind of sense of stability it's a great idea you know it'll give them a little more real estate if you will So that's an option.

1:57:33The counterintuitive option is what kind of shoes are on her feet. If she can't feel the ground and fall risk is a factor, put her foot on the ground, take smaller steps, you know, start with five minutes. even in that in the aging population i think that's really important because if they can't if you can't feel the ground then our fall risk is going to increase so we could start with again that transition conversation that we had yeah um but making it in an environment we can't say don't walk we can't it is it's like telling someone not to sleep yeah so we have to find ways that's the conversation I want really is from a movement perspective, it's not what people can't do.

1:58:20It's what can we do to modify, to get someone to be able to do these things. So it's not a question of no, it's how do we do it? Whether that's poles, different footwear, small increments, building confidence. Yeah. I love that.

1:58:39Dr Courtney Conley:I think it's such an important message. and it reminds me when my mum was more active I think I put mum in vivos maybe 10 years ago something like that and she was in her mid-70s at the time and she just couldn't believe how much more stable she felt in them she was like oh because of course it makes sense if you can feel the ground if you're not on a pillow though, you've got better balance. So I think sometimes when people think about, oh, minimalist shoes, they think about athletic people in their 20s and 30s. It's like, I've always said the elderly are a fantastic place to really be targeting.

1:59:23Dr Courtney Conley:I think we could all benefit, but certainly the elderly, get them feeling the ground and you'll probably find a lot of them feel a lot more stable. I think this is a conversation that no one's having either. Let's say they were in a cushioned shoe. Those materials in the shoe break down pretty fast. And so people will have these highly cushioned shoes for a year, a year and a half. And if you watch someone walk in a highly cushioned shoe that has worn down, it can be scary. You're like, oh my gosh, because the materials have worn down. So it literally looks like their foot is trying to feel something and they can't.

2:00:05So that's another conversation that is if you are, if this minimal conversation isn't making sense to you and you are in cushion footwear, you have to change those shoes out pretty frequently. And you can't have those shoes for one year, two years. I mean, those materials break down. In a minimal shoe, there's nothing to break down.

2:00:25Dr Courtney Conley:Yeah. It stays the same. It's more stable. Yeah. I could talk to you about feet and walking forever. I just love this topic. I'm obsessed with it. I think about it. I live it. Connie, I think you've written such a beautiful book. I know you wrote it with someone called Melissa McDowell. I think it's, you know, I think Chris put it beautifully yesterday when he said it's a love letter to walking. It really is. Something we've not spoken about, but I'll leave people to read about it in the book is long haul walking, which you put right at the end, which I kind of feel is such a beautiful thing for us to think about because it's easy to think about walking as physical benefits, dementia risk, lower risk of heart attack and cancer.

2:01:17Dr Courtney Conley:And yes, those things are incredibly important. But walking is also who we are. It helps us understand who we are. And those long haul walks you describe at the end, these three-day walks, these four-day walks, these 10-day walks that whatever it might be that people go on as a way of discovering who they are. I just love that stuff. There's a real spiritual component to walking, isn't there? Yep. I was going to say it's a spiritual component and it is pretty amazing when you either cross that finish line or you challenge yourself to the point where you're making things a little uncomfortable.

2:01:59That sense of achievement from putting one foot in front of the other for long periods of time, I don't think it gets anything, I don't think it gets any better than that.

2:02:09Dr Courtney Conley:Yeah. One of the things you write about is the Camino de Santiago, you know, a long haul walk. And I think someone you guys interviewed for the book said after days of walking when your body is tired and your mind starts to quiet the soul begins to speak what unfolds is rarely just about the miles it becomes a rite of passage a time to let go to reflect to move through grief or transition and to reconnect with what really matters. Absolutely beautiful. And that's what the book is about, right? Walk your life depends on it. Courtney, I've thoroughly enjoyed this conversation and my previous one with you this year.

2:02:56Dr Courtney Conley:I think you're doing incredible work. I'd really encourage people to pick up the new book. I think it's wonderful. And I just want to finish off by asking you, You get asked a lot about the feet and about walking and people will tell you their problems and tell you the reasons why they can't. What is the key message from all your work that you want to leave people with? that you can. That anything is, when you look at the foot and what it is capable of doing, it literally is what carries us through our lives. And to see movement deterred from the ground up when every step is painful, those things can change.

2:03:50It is a hopeful conversation. It is what we as human beings were designed to do was to keep our foot on the ground and to keep walking and to keep moving forward. There's so many, you know, analogies we could use here. One step in front of the other, just to keep going. Nothing allows that to happen more than our feet.

2:04:13Dr Courtney Conley:Well, Courtney, thank you for everything you do. Thank you for writing with your co-partner walk it's a great book and thank you for coming back thank you so much

2:04:27Dr Courtney Conley:really hope you enjoyed that conversation do think about one thing that you can take away and apply into your own life and also have a think about one thing from this conversation that you can teach to somebody else remember when you teach someone it not only helps them It also helps you learn and retain the information. Now, before you go, just wanted to let you know about Friday Five. It's my free weekly email containing five simple ideas to improve your health and happiness. In that email, I share exclusive insights that I do not share anywhere else, including health advice, how to manage your time better, interesting articles or videos that I've been consuming, and quotes that have caused me to stop and reflect.

2:05:12Dr Courtney Conley:And I have to say, in a world of endless emails, it really is delightful that many of you tell me it is one of the only weekly emails that you actively look forward to receiving. So if that sounds like something you would like to receive each and every Friday, you can sign up for free at drchatterjee.com forward slash Friday 5. Now if you are new to my podcast, you may be interested to know that I have written five books that have been bestsellers all over the world, covering all kinds of different topics, happiness, food, stress, sleep, behavior change and movement, weight loss and so much more.

2:05:50Dr Courtney Conley:So please do take a moment to check them out. They are all available as paperbacks, ebooks and as audio books, which I am narrating. If you enjoyed today's episode, it is always appreciated if you can take a moment to share the podcast with your friends and family or leave a review on Apple Podcasts. Thank you so much for listening. Have a wonderful week. And please note that if you want to listen to this show without any adverts at all, that option is now available for a small monthly fee on Apple and on Android. All you have to do is click the link in the episode notes in your podcast app. And always remember, you are the architect of your own health.

2:06:33Dr Courtney Conley:Making lifestyle change is always worth it. Because when you feel better, you live more.