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

Most of us walk every day without really thinking about it – but this episode is guaranteed to change that. Because this simple, free, radical act is one of the most powerful things you can do for your body, your brain and your longevity. In this episode I’m joined by Dr Courtney Conley, for a conversation that will transform how you feel about your feet and how you use them. Courtney is a movement specialist who’s passionate about helping people move through life with strength, ease and confidence. She's co-author of the must-read new book, Walk: Your Life Depends On It, and this is her second appearance on the show, following one of our most listened-to episodes of the year. We begin by unpacking the 10,000 steps a day target – where it came from and what the research shows we really need (clue: it’s less than you think… but it matters way more than you think). We talk through the wealth of benefits walking brings, with Courtney explaining that wherever you are on the scale, adding just a thousand steps a day can lower your risk of dementia, depression and all-cause mortality. We cover chronic pain and why walking is more likely to help than hinder you. Courtney shares her practical cues for walking more efficiently, including rolling through your feet, walking tall and nasal breathing (try them as you listen and you’ll see why they work). And we discuss why strength and power are equally important components of fitness that we need to protect as we age. There’s also a wealth of information on foot issues from plantar fasciitis to Achilles’ pain, bunions and osteopenia. Plus Courtney’s how-to guide for transitioning from cushioned to functional or minimal footwear. Whether you currently walk a lot, a little, or somewhere in between, I think you'll come away from this conversation with a renewed appreciation for what your feet can do for you. All of us, whatever our age or starting point, can benefit from walking more or better – and this episode will help you do that, one step at a time. The Thrive Tour: Transform Your Health and Happiness, a live show: Book Your Tickets https://drchatterjee.com/live Thanks to our sponsors: https://drinkag1.com/livemore https://thewayapp.com/livemore Show notes https://drchatterjee.com/660 DISCLAIMER: The content in the podcast and on this webpage is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Speaker 00

  People take walking for granted until they can't. We forget that we need to incorporate this into our daily lives. It's never too late. Yes, 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. There's no better time to start than now.

• 0:24Rangan Chatterjee?

  Hey guys, how are you doing? I hope you're having a good week so far. My name is Dr. Rangan Chatterjee and this is my podcast, Feel Better Live More.

• 0:37Rangan Chatterjee?

  Most of us walk every single day without really thinking about it. But this episode is guaranteed to change that. Because this simple, free radical act is one of the most powerful things you can do for your body, your brain, and your longevity. This week, my returning guest is Dr. Courtney Conley. Courtney was last on the show only three months ago. And as soon as we finished recording that conversation, I invited her back on immediately because there was so much left for us to discuss about one of my favorite topics. Courtney is a world-renowned movement specialist who's passionate about helping people move

• 1:20Rangan Chatterjee?

  through life with strength, ease, and confidence. And she's also the co-author of a wonderful new book, Walk: Your Life Depends on It. In our conversation, we discussed the origin of the 10,000 steps a day target, how adding just 1,000 steps each day can lower your risk of dementia, depression, and all-cause mortality, and Courtney shares some of her best practical cues to help you walk more efficiently, including rolling through your feet, walking tall, and nasal breathing.

• 1:56Rangan Chatterjee?

  We also discuss the potential problems of walking too much, especially if that means you neglect strength and power. She shares practical tips for anyone wishing to transition from cushions to minimal footwear, and also how best to manage foot issues like plantar fasciitis, Achilles' pain, bunions, and osteopenia. Whatever your current level of health or mobility, I'm quite certain that there will be something in this conversation that deeply resonates. And my hope is that it inspires you to move forward in life, one small step at a time.

• 2:40Rangan Chatterjee?

  In your brand new book, you talk about the 10,000-step urban legend.

• 2:47Speaker 00

  Yes.

• 2:48Rangan Chatterjee?

  You describe it as a persistent myth that has actually had a deleterious effect and discouraged many people from walking because this daily step goal feels out of reach to many. Is 10,000 steps a myth?

• 3:02Speaker 00

  It is. It's actually based on a, we call it a marketing hangover. So in the 1960s, there was a Japanese company that produced a pedometer called a Manpo K, which actually means 10,000-step meter. So it was more designed just as a marketing campaign. And then what's really wild is that that has been adopted as the step count that we should all be trying to reach, when in fact, there is no science behind that number. And I think when people think 10,000 steps, it can be very daunting. But when you look at the science, it's actually much less.

• 3:38Rangan Chatterjee?

  So what does the science tell us about the amount of steps we need to gain certain health benefits?

• 3:44Speaker 00

  So it's very individualistic. So depending upon where you start, what your baseline is. But if you were to look at just an overall number, where are we going to maximize longevity benefit? You're looking anywhere from 7,000 to 8,000 steps.

• 3:59Rangan Chatterjee?

  7,000 to 8,000 steps. So. What's interesting as I sort of think about the walking literature and of course in walk, your life depends on it, which is certainly the UK name of your latest book. What I really like about it is that you make it very accessible, right? So we'll come back to 10,000 sets in just a minute because I actually have quite liked that as a guideline, but I totally understand where you're coming from, which is that can be off putting to people and some people might go, well, I can't reach 10,000, so what's the point? And I think you've quoted research in the book saying that even going from what 2,500 to 3,800 steps a day gives you some benefits.

• 4:41Speaker 00

  Reduces all cause mortality by 7%, which is, you know, I have plenty of patients that have been in chronic pain where these are the conversations that we're having, where anything is better than nothing. So I think that's very encouraging for people that live on that end of the spectrum where they've been in chronic pain for a while, they're afraid to put their foot on the ground and it's, okay, we're going to take what we've termed a micro walk, which is five minutes, which gives you about 500 steps. And it builds confidence in people's movement. They start to trust their body again and I think at that level, that really is priority.

• 5:19Rangan Chatterjee?

  So it's not that you have a problem with an individual doing 10,000 steps a day. You're not saying that's negative for that individual. You're saying as a public health guiding principle, we should be making it more accessible.

• 5:34Speaker 00

  Yes. And, you know, when you look at the research, it does seem to plateau from a longevity perspective at about 10,000, 12,000 steps. So on the other end of the spectrum, if my patients will say, I'm walking 15,000, 16,000 steps per day. Wonderful. Are you also strength training? Are you doing these other things that are necessary for living well as you age? And if the answer to that question is no, because some of my patients will say, well, I just don't have time because I'm walking 15, 16,000 steps a day. Then we have the conversation of what if we dialed it down? Let's bring you down to 10. Now I give you some time back.

• 6:17Speaker 00

  Now we can get you in the gym. We can strength train and start making your fitness a little more well rounded.

• 6:23Rangan Chatterjee?

  Yeah, I think that's a great case study in the book of Jane, who calls herself a cardio queen, who was doing 15,000 steps a day, right? And you had to actually bring her down so that she could add in strength. And I think you added a nasal breathing while she was walking and all kinds of things. Maybe we can talk about her a bit later. In terms of making walking more accessible, because I very much agree with you, the central message in this book is that walking is very much one of the most underappreciated elements of health and longevity. You were on the Chris Evans Radio Show yesterday. He described you as a love letter to walking, which I thought was a beautiful way of describing what's in the book. Let's, let's make it super

• 7:09Rangan Chatterjee?

  accessible for people. If you add a thousand more steps to your daily step counts, what could that potentially do for us?

• 7:21Speaker 00

  So if you were, if we were going to throw out some numbers, if you were to get to 3,800 steps per day, you can reduce your risks of getting dementia by 25%. If you were to jump to 5,000 steps per day, this is a big one, I think, you can reduce the symptoms of depression. And I just want to pause there for a second because my patients. That live below 5,000 steps, below 2,500 steps. There is very often this mental health challenge that they are also facing.

• 8:00Speaker 00

  It's almost like the lack of step count goes hand in hand with feelings of sadness and depression. And I think that makes sense because of the lack of movement, the lack of this core biological input that our brains need.

• 8:17Rangan Chatterjee?

  Yeah.

• 8:17Speaker 00

  And so depending upon where someone is along the spectrum, adding in 1,000 steps, for example, which is about 10 minutes, can really bump you into different categories. When you get to 7,000 steps, you reduce your risks of getting dementia. And I think it's this stacking of behaviors. So I start walking more, then I'm sleeping better, then I'm breathing better, then I'm eating better. So it's building this foundation that then our health can expand upon with something that is so easily accessible and underutilized.

• 8:53Rangan Chatterjee?

  Yeah, it really is incredible. It reminds us of something that we spoke about when you were first on the podcast a couple of months ago. This idea that, yes, exercise, movement, walking is good for us and, you know, can reduce your risk of dementia, can help you live longer. I mean, some research suggesting maybe 10 years, you can live longer, right? Reduce your risk of depression, all that kind of stuff. And the flip side is that maybe it's not that the movement is good for us, it's that the lack of movement that many of us have in the modern world is devastatingly bad for us.

• 9:30Speaker 00

  Yeah. I think, you know, after we spoke last time, I was thinking about that quite a bit. And if we were to flip the script, because I think people take walking for granted.

• 9:40Rangan Chatterjee?

  Yeah.

• 9:41Speaker 00

  Until they can't. Because if you were to ask someone, how would you feel if you couldn't walk? It's almost like a panic. Like, well, that would be terrible. I mean, think about it. You couldn't, you know, walk to your mailbox, walk around your block, walk with your friends, play with your grandkids. I mean, everything really is surrounded by and for human propulsion and gait. And so when we take that away, whether it's because we choose to by a sedentary lifestyle or we're in pain, it really compromises our health.

• 10:17Rangan Chatterjee?

  Yeah. In your experience, what are the common reasons why people don't get their steps in each day?

• 10:27Speaker 00

  I think with modern convenience comes responsibility. We have to think about it more now. You know, when you are working from home, for example, and you're sitting in front of your desk for eight, nine hours a day, you have to consciously be aware and take breaks. Or else you could just flow right through your day without getting much movement at all. So it has become more of this awareness. You have to really be diligent about saying, okay, it's time for me to go for a five-minute walk. It's time for me to get up and move around. In the book, we have all those movement snacks in there. You could do 10 air squats. You could do walking lunges. You could get outside and take a five-minute walk. You just have to interrupt prolonged activity.

• 11:12Speaker 00

  And it's become very easy to forget to do that. So that's where I think it's important. I think the other conversation there is when people get their morning workout in. So I ran for an hour. I went to the gym for an hour before my workday. That hour of activity doesn't excuse you from movement throughout the day.

• 11:37Rangan Chatterjee?

  Yeah.

• 11:38Speaker 00

  It doesn't take away prolonged activity like sitting all day long. So there has to be this interjection of movement that people need to be consciously aware of because it just doesn't happen easily anymore.

• 11:50Rangan Chatterjee?

  Yeah. I love this idea that with modern conveniences comes a responsibility. And this may not be the perfect analogy, but I guess. You know, if you were someone who liked vintage cars, for example, okay? Maybe this comes to mind because we've just spoken about Chris Evans. Chris does like vintage cars, right? You don't just leave that car, I think, and if there's an enthusiast listening who wants to correct me, please do, but I guess the point I'm making is if you just kept that not moving at all for like four months at a time, there would probably be an issue. Now, we're not cars, I understand that, but that whole idea of a responsibility to our body,

• 12:35Rangan Chatterjee?

  that it has to be moved, otherwise it won't function. It needs the lubrication, right? It needs the oil change or whatever it is. It's like, you know, that's kind of what happens when we move, right? You know, it, everything works better when we've moved and in particular when we've walked. So something quite different about walking, isn't there?

• 12:56Speaker 00

  It's this core biological input that stimulates every system in our body. Think about strength training, for example, which is very good. I'm very, obviously a very big proponent of that. Strength training happens a couple of times a week. There's needs, there's a recovery that has to occur. Walking is something that happens every single day, like breathing and like sleeping. It should be viewed as this physiological necessity that is non-negotiable. It's this low to moderate repetitive activity. So it's from an intensity perspective. So there's less loads per se than running. We get our heart rate up, but we're not maxing our heart rate.

• 13:40Speaker 00

  So it's this kind of constant churn that can stimulate our metabolic system, our musculoskeletal system, our nervous system, our circulatory lymphatic system, our brains. So it's just kind of the, you know, it ignites our bodies.

• 13:58Rangan Chatterjee?

  In terms of unexpected benefits of walking, one thing I used to see a lot of in practice is people who... Didn't walk enough or move enough, I should say, in general. I would find that sometimes when their movement increased, their guts functioned better. Right? Their constipation went, right? Without changing their diet because, you know, there is, I think we touched on this in the first conversation. There is this kind of contralateral movement going on. You know, this change, the upper body's going right, lower body's going left. And it almost twists the middle and your gut and your bowel, right? So it can massively help with gut function as well.

• 14:36Speaker 00

  Yeah, I think that when you look at that cancer research, which is really fascinating. I think the mechanism behind some of that cancer research, that when you get to X amount of steps, seven to nine thousand, for example, you reduce your risks by 16% when you're walking at a brisk pace. You're improving your insulin sensitivity. You're improving your gut biome. So I think those factors are why we're seeing these really exciting findings with this cancer research.

• 15:09Rangan Chatterjee?

  One of the things I've done recently, I've been walking more and more over the last few years. So I've recognized that, you know, how important it is. And we're currently recording this conversation in the British spring. So we're having light mornings now. Okay, so currently it's maybe getting light around five 20. And I'm an early riser, I always have been. I go to bed early, I get up early. And in the winter, I'll probably meditate first thing. And then at some point when it's light, sometimes after the kids have gone to school and depending on what's going on with work, I'll try and walk. But I've actually changed my pattern recently because I know the number one thing I want to get in each day is a walk.

• 15:54Rangan Chatterjee?

  Now, I personally am trying to get 10,000 steps a day. You know, I say that, understanding that not everyone is going to be able to do that.

• 16:03Speaker 00

  Sure.

• 16:04Rangan Chatterjee?

  But it's been transformative. You know, I get up, I have a coffee and I'm out.

• 16:09Speaker 00

  Yeah.

• 16:10Rangan Chatterjee?

  And then I'm back to make the kids breakfast or whatever it might be, right? And even if I play paddle later on in the day, like I remember the other day, I was like, wrong. Paddle, great. Okay, no problem. Have fun. A lot of coordination, a lot of sprinting on the court. But it's not a substitute for your daily walk. You still need to get the daily walk in when you can.

• 16:30Speaker 00

  That's if there's one message, that is, that is it, that that is so important and it cannot be missed. And there's something very special about that morning walk. It just kicks off your day. You have sunlight, you get your body moving. I mean, it is, it does kind of, I do the same thing. And if I were to miss it, it does change, change things.

• 16:52Rangan Chatterjee?

  Yeah. So we want to make this super accessible. Okay. So I totally recognize that people may not have the same level of autonomy that I have around my work. Okay. They may have a lot of family commitments or family pressures. So one of the things we didn't talk about in our first conversation that I wanted to, and I think we should talk about it today, is your build program.

• 17:13Speaker 00

  Yeah.

• 17:14Rangan Chatterjee?

  Right. So towards the end of the book, you, you really sort of break it down like we might do strength training or something else where it's like, okay, here's where you are. And there were sort of three different categories, weren't there? So can you kind of talk us through some of those general principles?

• 17:27Speaker 00

  Yeah, there's, when we decided how we wanted to outline these programs, you have to meet people where they are. So in the base program, this is for someone who has been in chronic pain, who is less than about 2,500 steps. And in that program, we encourage these micro walks. And again, we're building confidence in their movement, getting their foot on the ground. The build program is where we think most people are going to live. This is when you get to that 7,000 sweet spot range. This is eight weeks. So throughout the program, we talk about starting at your daily walk happening four times a week.

• 18:07Speaker 00

  Then we increase by 500 steps to 1,000 steps. So it's this very digestible program that is very focused. That's when we had talked about earlier, what has happened?

• 18:23Speaker 00

  We forget that we need to incorporate this into our daily lives. So it's very, it's outlined in an easy way for people to understand that. The other key thing with that program is working on cadence and speed. Because that's where the magic happens.

• 18:39Rangan Chatterjee?

  Well, it comes to speed in just a minute. This idea that we need to build slowly is something that runners are familiar with.

• 18:47Speaker 00

  Yes.

• 18:48Rangan Chatterjee?

  Right? People know if they get into running or they sign up for a half marathon and they look at any training plan. One of the things many of the fans will say is don't suddenly increase your volume.

• 18:58Speaker 00

  Correct.

• 18:59Rangan Chatterjee?

  But I think we intuitively understand that with running because it feels like, yes, high load on the body, right? You're applying this similar principle, I think, to walking. Whereas some people might go, yeah, but walking doesn't have the same loads on the body as running. Why do we need to build it slowly? Why can't I just go from 1,000 steps a day to 7,000 steps a day, for example?

• 19:23Speaker 00

  Some people might be able to.

• 19:24Rangan Chatterjee?

  Okay.

• 19:24Speaker 00

  It's their bottom line level of fitness. You know, maybe the reason that they're just not getting their step count is, is not because they can't, more of a time factor.

• 19:34Rangan Chatterjee?

  Hmm.

• 19:35Speaker 00

  So some might be able to. So that program outlines more of a time inventory for them. That might be how they focus. But then there's other people who actually need slow, progressive loads. And that's where that becomes important. It is still a load through your body, it's just less than running. The other conversation is if someone is working on that program and transitioning into different footwear.

• 20:01Rangan Chatterjee?

  Yeah.

• 20:01Speaker 00

  Because that is where we really wanted to highlight that those things take time and they need to be transitioned safely. Because those are definitely different loads.

• 20:10Rangan Chatterjee?

  Yeah. We spent a lot of time last time talking about footwear and foot health. And the difference between cushioned shoes, functional shoes and minimalist shoes. So we don't need to re-go into that. People can listen to that first one if they want to get all that information. But I think later on today, we should absolutely cover how to transition from cushioned shoes to minimalist shoes. Because we've had a ton of questions about that. Okay?

• 20:37Speaker 00

  It's probably the most frequent question I get in my clinics.

• 20:41Rangan Chatterjee?

  Yeah.

• 20:42Speaker 00

  How to do it?

• 20:42Rangan Chatterjee?

  How to do it, because people want to do it, I think, these days. They hear about the research on minimal issues. Like, yeah, it kind of makes sense. I want to be in that. But how do I do that when I spent the last 30 years in cushion shoes? Right? So we'll come to that. But in terms of this kind of build program, so you're saying at the moment, start small. Anything is better than nothing. You know, getting from two and a half thousand steps today, I think, to 3,800 steps a day. You know, I think, actually, I'm not sure you mentioned this one yet. I think you said in the book that if you can do that, if you add 1,000 steps per day on top of an existing baseline of at least 2,500 a day,

• 21:24Rangan Chatterjee?

  that decreases all cause mortality by 15%. And so you surmise that actually, if you're 70 years old, that could potentially extend your longevity by 10 years. Right? So, hey, listen, if you want to get to 10,000 sets, that'd be great. But if you're stuck at two and a half, even getting to 3,800 will give you, you know, measurable benefits, which is amazing. Foot pain, of course, is one of the things that stops people walking, right? And there was an example in the book of, I think, a firefighter called Christian.

• 21:59Speaker 00

  Yes.

• 22:00Rangan Chatterjee?

  Right? Do you remember the story?

• 22:01Speaker 00

  Oh, yeah.

• 22:02Rangan Chatterjee?

  Can you explain it? Because I think it's quite useful here to explain. So when they talk about the new model of, you know, why pain doesn't always mean stop moving.

• 22:12Speaker 00

  Yes. You know, when I first got into clinic, that was what I used to tell people, you know, come see me, we'll get you pain free. And I have really changed my tune there. I think that's not correct. I don't think the goal is to wait to move until you're pain free. People will be waiting a very long time. Pain is this normal human body experience. It's a signal for us. And we should look at it a little bit differently. We should reframe that concept, saying, how do I live well with this? How do I continue to move with my pain? Because we know it is so very complex, rather than saying, I'm not going to move until I'm pain free.

• 22:55Speaker 00

  And that's exactly what happened with Christian, is he had had foot pain for three years. He was training to be a wildlife firefighter, and he got some heel pain. And it lingered and three years later, he was in my office. And in three years, he had gone to see many people. In fact, the last person that he had gone to see said, they want him to decrease his step count to below 2,500 steps.

• 23:25Speaker 00

  Three years into this conversation, you don't want to be telling someone to decrease their step count. Remember, the less step count, right? That's highly correlated with not feeling too good mentally. Their mental health starts to decline. So you know that with him not getting these steps in, that that was not going to be a good idea. So he moves into his father's basement. And now he's pretty much become, I want to say, almost a prisoner in his house. And I do see this often with patients. So he came to see me and we really had to have a lot of conversations about pain, about education. And we started him with the micro walk,

• 24:10Speaker 00

  which was five minutes, which is about 500 steps.

• 24:14Rangan Chatterjee?

  Would that cause him pain?

• 24:17Speaker 00

  He was scared.

• 24:19Speaker 00

  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.

• 25:03Speaker 00

  Now, 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.

• 25:48Speaker 00

  And what's most detrimental is, I think, what it does to your, to your mental health. And it was just really encouraging to see that. And it took time.

• 25:58Rangan Chatterjee?

  Yeah.

• 25:58Speaker 00

  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.

• 26:25Rangan Chatterjee?

  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 wellbeing, 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. Plus, 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 what it is, but it's almost its own category, right? The human body, as you beautifully say, you know, walking is a physiological necessity on a par

• 27:10Rangan Chatterjee?

  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.

• 27:21Speaker 00

  Yeah.

• 27:22Rangan Chatterjee?

  And I recently had Howard Schubino on for the second time. The podcast has not come out yet, but I think you would love his work. It's 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.

• 27:42Speaker 00

  Yes.

• 27:42Rangan Chatterjee?

  Right? So the cycle starts, doesn't it? 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. You know, I think he was in his twenties when this happened. So I can't imagine what that does to you in your twenties in terms of how you feel about yourself.

• 28:04Speaker 00

  I think that's the biggest factor, especially three years into a diagnosis. You know, if this was, if he had seen me three months prior, 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. You 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, you know, really listen to people.

• 28:46Rangan Chatterjee?

  We previously spoke about this idea that all of us will have a different walking signature.

• 28:52Speaker 00

  Yeah.

• 28:52Rangan Chatterjee?

  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.

• 29:04Speaker 00

  Yes.

• 29:05Rangan Chatterjee?

  What does walking efficiency mean?

• 29:13Rangan Chatterjee?

  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/live. I really hope that you can join me.

• 29:56Rangan Chatterjee?

  Today's episode is sponsored by the daily health drink AG1. The clocks are about to change, the mornings are darker, everyone around you seems to be coming down with something, and suddenly that wellbeing you felt in the summer seems a long time ago. I certainly know that feeling, and that's why at this time of year, I remind myself to lean into the fundamentals. And one of those fundamentals is AG1. AG1 is a daily health drink that has been in my own life for over eight years. And one of the many things I like about it is the fact that many of the nutrients it contains, for example, vitamin C, vitamin A, zinc, and selenium, supports a healthy immune system. Some of the other things I really like about AG1 is that they are committed to continuous

• 30:39Rangan Chatterjee?

  improvement and updating their formula as a scientific research evolves. And each batch is independently tested for quality and safety markers, including heavy metals, allergens, and banned substances. This is how they can guarantee what's in your scoop and what's not. Right now, AG1 is offering a free AG1 flavour sampler and AGZ sampler to try all the flavours, 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. All you have to do is head to drinkag1.com/livemore to claim this offer before it ends.

• 31:32Speaker 00

  So 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

• 32:16Speaker 00

  get to that magic step count number and feel well doing it. So 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? Or 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?

• 32:59Speaker 00

  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.

• 33:12Rangan Chatterjee?

  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, 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?

• 33:35Speaker 00

  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. So 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 beautiful thing and you should be able to feel it.

• 34:10Rangan Chatterjee?

  So even just that, take a message to people, let someone go for a walk. They can start to think about rolling the earth away as they walk.

• 34:20Speaker 00

  When the heel strikes, it's this, think of it just this, almost like a wave. 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.

• 34:44Rangan Chatterjee?

  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, you know, on your soul. Almost like a massage every time you roll through, right? Having said that, I know we covered footwear last time. Well, 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 earth away, isn't it?

• 35:18Speaker 00

  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. And 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,

• 36:03Speaker 00

  there isn't any, there isn't this efficiency, or there's three rockers to the foot.

• 36:09Rangan Chatterjee?

  There's no fluidity, is there?

• 36:10Speaker 00

  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.

• 36:31Rangan Chatterjee?

  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, or your spinal movements. 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, you know, I'm on a clouds, right? But actually, there's more impact going. So almost our feeling is misleading

• 37:16Rangan Chatterjee?

  because we think, yeah, I'm not putting any pressure on my joints at all. But we're actually overpressing them because it's inefficient walking.

• 37:24Speaker 00

  Yes. It's very counterintuitive.

• 37:26Rangan Chatterjee?

  Exactly.

• 37:27Speaker 00

  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. When 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.

• 38:06Rangan Chatterjee?

  Yeah.

• 38:06Speaker 00

  And that's those forces that she's referring to there.

• 38:11Rangan Chatterjee?

  Yeah. It's kind of interesting. This is so obvious when you are used to minimalist shoes, right?

• 38:18Speaker 00

  Yeah.

• 38:19Rangan Chatterjee?

  I think we've both had experiences recently, well, not that recently, but where we wear minimalist shoes. But for a wedding, for example.

• 38:27Speaker 00

  Yeah.

• 38:28Rangan Chatterjee?

  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're almost being, 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. 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.

• 39:01Speaker 00

  Yeah.

• 39:02Rangan Chatterjee?

  And you walk barefoot on the grass, you can start to feel that fluidity in the sole, can't you?

• 39:07Speaker 00

  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 said, this is what we're going to try. They come back and they're like, my foot feels better.

• 39:18Rangan Chatterjee?

  Yeah.

• 39:19Speaker 00

  My back feels better. Their gait changes because that's how we were supposed to, to walk is allowing our foot to feel. And 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.

• 39:43Rangan Chatterjee?

  Yeah.

• 39:43Speaker 00

  Because you put your foot in there like, man, this thing is tight. How was I wearing this before? My toes are going numb.

• 39:50Rangan Chatterjee?

  Yeah.

• 39:50Speaker 00

  So I'll always, I don't, which I don't know why I do this, but I have a couple of 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.

• 40:07Rangan Chatterjee?

  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?

• 40:16Speaker 00

  When we give people gait cues, you don't want them to think about too much. We 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, you know, beautiful things that happen in a walking gait, but it's complex and you cannot have people overthinking this. Walking should be enjoyable.

• 40:42Rangan Chatterjee?

  Yeah, you can't micromanage it in the moment.

• 40:44Speaker 00

  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.

• 41:24Speaker 00

  So when I say walk taller, there's all these biomechanical things that are occurring just from that cue that they don't, that someone doesn't need to think about other than walk taller.

• 41:36Rangan Chatterjee?

  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.

• 41:46Speaker 00

  Yeah.

• 41:47Rangan Chatterjee?

  But you're not necessarily saying you have to increase yourself. Let's say someone is getting 7,000 steps a day. And maybe that, 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.

• 42:08Speaker 00

  That's right. Nasal breathing is one.

• 42:10Rangan Chatterjee?

  So why is nasal breathing so important?

• 42:12Speaker 00

  We interviewed Brian McKenzie, who is really specialized in-

• 42:15Rangan Chatterjee?

  I love Brian.

• 42:16Speaker 00

  Yeah, he's great. And he said one of the lowest hanging fruits from human metabolism, uh, 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 mouths open. So if we can start to play around with this nasal breathing, we can also create efficiency. And I really like that as a little challenge for people, but you know, be smart about it.

• 42:57Rangan Chatterjee?

  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.

• 43:19Speaker 00

  That's right.

• 43:19Rangan Chatterjee?

  And you'll get all of these incredible benefits.

• 43:21Speaker 00

  Yes.

• 43:22Rangan Chatterjee?

  And I just want to highlight, this is free.

• 43:24Speaker 00

  Yeah.

• 43:24Rangan Chatterjee?

  Right? You don't have to buy anything in it. This is completely free of charge.

• 43:31Speaker 00

  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. So 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.

• 44:11Speaker 00

  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.

• 44:27Speaker 00

  And that's not what it should look like. It's calm.

• 44:31Rangan Chatterjee?

  Yeah. 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.

• 44:45Speaker 00

  Yeah.

• 44:46Rangan Chatterjee?

  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?

• 45:23Speaker 00

  That's a tough question.

• 45:25Rangan Chatterjee?

  I know it is.

• 45:26Speaker 00

  That's a tough question.

• 45:27Rangan Chatterjee?

  Because it depends.

• 45:28Speaker 00

  It does. And I think it's the and conversation.

• 45:31Rangan Chatterjee?

  Yeah.

• 45:32Speaker 00

  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. We lose power faster than we lose strength.

• 46:16Rangan Chatterjee?

  What's the difference?

• 46:19Speaker 00

  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?

• 46:30Rangan Chatterjee?

  Some people may think, well, isn't getting up off a chair strength? So I'm just trying to make sure people understand the difference between strength and power.

• 46:39Speaker 00

  I think when we look at power, some people look as training power only for athletes, for example.

• 46:46Rangan Chatterjee?

  Okay.

• 46:46Speaker 00

  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.

• 47:05Rangan Chatterjee?

  It's quite, 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 know, you wouldn't use the term explosive to really think about getting up off a chair, but in some ways it is.

• 47:20Speaker 00

  Well, how about walking? If we look at walking, would you say walking is a power movement?

• 47:26Rangan Chatterjee?

  Until I read your book, no.

• 47:28Speaker 00

  Think about speed. If I wanted to walk at a very, 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.

• 48:05Rangan Chatterjee?

  Yeah.

• 48:06Speaker 00

  So for example, if I was going to do a lunge, I would go down for three counts, right, slow, and up for one. So I'm just moving faster under load.

• 48:22Rangan Chatterjee?

  And we lose power faster than strength as we get older.

• 48:26Speaker 00

  Yes, and how, how am I supposed to walk fast if I can't produce power?

• 48:33Speaker 00

  At propulsion. You don't, 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.

• 48:56Rangan Chatterjee?

  So do we train power whilst walking? Or do we train power separately, which then enhances our walking?

• 49:03Speaker 00

  I think both. I 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.

• 49:27Rangan Chatterjee?

  Why?

• 49:27Speaker 00

  You can train double leg hopping, single leg hopping, depending upon what you're comfortable with.

• 49:32Rangan Chatterjee?

  It's the speed that we're looking for.

• 49:34Speaker 00

  It's the speed. And that's reactive. We need that reactivity.

• 49:39Speaker 00

  You know, we need to be able to be aware of our surroundings, be able to move with speed as we age.

• 49:48Rangan Chatterjee?

  It's really interesting thinking about power in the context of walking.

• 49:56Rangan Chatterjee?

  I've been thinking about it recently

• 49:59Rangan Chatterjee?

  since I've taken up paddle, which is really only maybe eight months ago now, but I'm playing more and more.

• 50:06Speaker 00

  It's pretty fun. I'd played for the first time a couple of months ago. I was like, this is pretty fun.

• 50:09Rangan Chatterjee?

  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. 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 for the last three years, I'm not really trained speed.

• 50:39Speaker 00

  Yeah.

• 50:39Rangan Chatterjee?

  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?

• 50:45Speaker 00

  That's right.

• 50:46Rangan Chatterjee?

  It's being faster. So I got these jumping blocks out of the shed in the garden a few days ago. 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, you know, to help prevent a fall when you're actually stepping down from the curb.

• 51:16Speaker 00

  I think I want to like scream that. That's very 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 in walking speed and being able to catch yourself, you know, if you were to stumble.

• 51:38Rangan Chatterjee?

  Yeah.

• 51:39Speaker 00

  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.

• 52:07Rangan Chatterjee?

  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.

• 52:24Speaker 00

  Yes.

• 52:24Rangan Chatterjee?

  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.

• 52:40Speaker 00

  Yes.

• 52:40Rangan Chatterjee?

  And I think you specifically said, excuse me for the lack of clickbait here, but this is an and conversation, right? So talk to us a little bit about walking the strength.

• 52:56Rangan Chatterjee?

  Today's episode is sponsored by the daily health drink AG1. The clocks are about to change, the mornings are darker, everyone around you seems to be coming down with something and suddenly that wellbeing you felt in the summer seems a long time ago. I certainly know that feeling and that's why at this time of year, I remind myself to lean into the fundamentals and one of those fundamentals is AG1. AG1 is a daily health drink that has been in my own life for over eight years. And one of the many things I like about it is the fact that many of the nutrients it contains, for example, vitamin C, vitamin A, zinc and selenium, supports a healthy immune system. Some of the other things I really like about AG1 is that they are committed to continuous

• 53:39Rangan Chatterjee?

  improvement and updating their formula as a scientific research involves. And each batch is independently tested for quality and safety markers, including heavy metals, allergens and banned substances. This is how they can guarantee what's in your scoop and what's not. Right now, AG1 is offering a free AG1 flavour sampler and AGZ sampler to try all the flavours, 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.

• 54:18Rangan Chatterjee?

  All you have to do is head to drinkag1.com/livemore to claim this offer before it ends. Today's episode is sponsored by Lingo by Abbott. When glucose is relatively stable, you feel better day to day with steadier energy, mood and focus. But over time, unstable and elevated glucose can impair your metabolic health and increase the risk of type 2 diabetes and cardiovascular disease. Globally, more than 760 million adults are estimated to have prediabetes, many without symptoms or a diagnosis. Now, the problem is that our healthcare system often waits until you get sick before taking action, when we should take a proactive

• 55:03Rangan Chatterjee?

  ...approach. Now, most of us don't have access to our own glucose data and therefore don't have clear feedback on how our everyday choices impact our glucose. That's where Lingo by Abbott comes in. Lingo is a biosensor and app that helps you see how food, movement, and lifestyle choices affect your glucose in real time, so you can notice patterns and build healthier habits in the moment. With Lingo, you can get to know your glucose to build healthier habits for today and tomorrow. For listeners in the US and UK, Lingo by Abbott is offering an exclusive 10% off a four-week plan. Just visit hellolingo.com/livemore

• 55:47Rangan Chatterjee?

  for more information. Terms and conditions apply. Again, that's hellolingo.com/livemore.

• 56:02Speaker 00

  Well, 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.

• 56:25Rangan Chatterjee?

  Might want to 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 be 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

• 56:56Rangan Chatterjee?

  You know, make your walking, you know, have a strength component to the lower limbs at least.

• 57:01Speaker 00

  Yep.

• 57:02Rangan Chatterjee?

  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?

• 57:23Speaker 00

  Well, welcome to the Boost program.

• 57:24Rangan Chatterjee?

  Welcome to the Boost program.

• 57:26Speaker 00

  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-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.

• 57:57Rangan Chatterjee?

  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 movement. 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 in to see with lower back pain and osteopenia. So tell us a little bit about Jane and what you recommended to her.

• 58:28Speaker 00

  She was. She was, you know, for her, when she came to see me, she was in pretty good health. I 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.

• 58:45Rangan Chatterjee?

  Can you just explain what osteopenia is actually for people who don't know the term?

• 58:48Speaker 00

  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.

• 58:59Rangan Chatterjee?

  Yeah.

• 59:00Speaker 00

  So it should be one of those, I need to start paying attention.

• 59:03Rangan Chatterjee?

  Exactly.

• 59:04Speaker 00

  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 of times a week for resistance training. This 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.

• 59:49Speaker 00

  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.

• 1:00:07Rangan Chatterjee?

  We spoke about efficiency when it comes to walking, but what we're talking about here is efficiency when it comes to time.

• 1:00:13Speaker 00

  Yeah.

• 1:00:14Rangan Chatterjee?

  You know, 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 sort of, I go to the gym four times a week and lift, but I don't really walk much.

• 1:00:33Speaker 00

  Yeah.

• 1:00:33Rangan Chatterjee?

  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. 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, you know, once you've met the base requirements, are you better off increasing your step count to 12,000, 13,000?

• 1:01:17Rangan Chatterjee?

  Or are you better off doing something else?

• 1:01:19Speaker 00

  It's, we talk about taking a time inventory in the book.

• 1:01:23Rangan Chatterjee?

  Yeah.

• 1:01:23Speaker 00

  And, you know, I, 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, 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 eight thousand. And I would look at my watch and man, I only hit 5,000 steps today. Even though I was moving around all day long. And then I would get home and I'd say, okay, you got 20 minutes.

• 1:02:08Speaker 00

  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.

• 1:02:32Rangan Chatterjee?

  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.

• 1:02:42Speaker 00

  Yeah.

• 1:02:43Rangan Chatterjee?

  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 kind of metronomic rhythmic texture to walking that perhaps you're not getting if you're just moving around the office.

• 1:03:08Speaker 00

  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. It'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.

• 1:03:30Rangan Chatterjee?

  Yeah.

• 1:03:32Rangan Chatterjee?

  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.

• 1:03:46Speaker 00

  Yeah.

• 1:03:46Rangan Chatterjee?

  Can we talk a little bit about those two?

• 1:03:48Speaker 00

  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.

• 1:03:57Rangan Chatterjee?

  What does that mean? What does it signify?

• 1:04:00Speaker 00

  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. So 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.

• 1:04:45Speaker 00

  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.

• 1:04:58Rangan Chatterjee?

  Yeah.

• 1:04:59Speaker 00

  That's 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.

• 1:05:10Rangan Chatterjee?

  Yeah, 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.

• 1:05:19Speaker 00

  Yes.

• 1:05:20Rangan Chatterjee?

  Right? 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.

• 1:05:48Speaker 00

  The foot prepares you. It knows. It's like, hey, I'm about to hit something hard. Soften up.

• 1:05:54Rangan Chatterjee?

  Yeah.

• 1:05:54Speaker 00

  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.

• 1:06:05Rangan Chatterjee?

  Swinging those arms, you mentioned that that's really important.

• 1:06:08Speaker 00

  Yeah.

• 1:06:09Rangan Chatterjee?

  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.

• 1:06:20Speaker 00

  Yeah.

• 1:06:20Rangan Chatterjee?

  Right? And we'll get to relational walking shortly, right? So I, 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. So why is it important? And is there an issue here that we need to think about?

• 1:06:38Speaker 00

  I want to preface this conversation with saying something is better than nothing. So if you're walking with coffee, great. If you're not, if that's, 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.

• 1:07:18Speaker 00

  So 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.

• 1:07:41Speaker 00

  So I'm obsessing about this. I'm like, what am I missing? What am I missing? And one day he was running late.

• 1:07:48Speaker 00

  And he didn't have time to change his clothes. And so I watched him walk back into my office. And I said, um, what side do you keep your gun on? And he goes, my right side. And I was like, oh. So he had this gun in his holster on the right side. So he, when he was walking, his arm wasn't swinging like it should. It was almost like there was this barrier there. 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.

• 1:08:29Rangan Chatterjee?

  Yeah, he's conditioned to know how to pull it, how to use it.

• 1:08:33Speaker 00

  Yeah. It's so, it's actually a term called a gunslinger's gait. But it was really very interesting. So 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. Uh, and there's a very big reason for that when it comes to the foot. You know, that's, the foot has to be able to, um, pronate and supinate.

• 1:09:18Speaker 00

  And it's the rotation of our bodies, our arm, arm swing that facilitates what happens in the foot.

• 1:09:23Rangan Chatterjee?

  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, 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.

• 1:09:40Speaker 00

  Oh, sure.

• 1:09:41Rangan Chatterjee?

  I don't think that's.

• 1:09:42Speaker 00

  No.

• 1:09:42Rangan Chatterjee?

  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 war spot in your right hands and you're repeating that over and over again, there may be a consequence in terms of your gait.

• 1:09:54Speaker 00

  It certainly would be something to look into.

• 1:09:56Rangan Chatterjee?

  Exactly. You may also be fine, but yeah.

• 1:09:59Speaker 00

  Yes.

• 1:09:59Rangan Chatterjee?

  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.

• 1:10:10Speaker 00

  Yeah.

• 1:10:11Rangan Chatterjee?

  What is it?

• 1:10:14Speaker 00

  When I was writing this book, my daughter is now 15. And for anybody who has a teenager out there, it's fun times. You know, it's a, 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. How 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.

• 1:10:56Speaker 00

  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, 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. Within 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.

• 1:11:38Speaker 00

  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 brain, in blood flow, she really, really opened up. And it was mimicking exactly what I read in the research, which was relationship walking. You start to communicate a little bit differently. There's bonds that are created. Walking with your spouse, walking with your grandparents.

• 1:12:22Speaker 00

  There's just fascinating research on this, which sounds, it makes sense, doesn't it? Like?

• 1:12:29Rangan Chatterjee?

  It totally makes sense. And it kind of, it feeds back into this central idea.

• 1:12:36Rangan Chatterjee?

  That walking is a physiological necessity. You could even expand that and 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.

• 1:13:06Speaker 00

  It's free.

• 1:13:06Rangan Chatterjee?

  It's free. You just, you just got to do it.

• 1:13:09Speaker 00

  That's right.

• 1:13:10Rangan Chatterjee?

  Yeah.

• 1:13:11Speaker 00

  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.

• 1:13:47Rangan Chatterjee?

  Yeah. Let's talk about walking with weight or rucking. What are the benefits?

• 1:13:53Speaker 00

  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. So 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.

• 1:14:29Rangan Chatterjee?

  Yeah.

• 1:14:30Speaker 00

  So those are things to consider. I think also it can be really good for your foot and ankle.

• 1:14:36Rangan Chatterjee?

  But you have to build up.

• 1:14:37Speaker 00

  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.

• 1:14:51Rangan Chatterjee?

  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?

• 1:15:03Speaker 00

  I would go minimal shoes first.

• 1:15:06Rangan Chatterjee?

  And build up there, get comfortable there before you start adding weight. Yeah, me too.

• 1:15:10Speaker 00

  You know, 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, you know, 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.

• 1:15:34Rangan Chatterjee?

  Yeah. Is that something to consider? You mentioned the equipment. If I think about me walking and all the kind of improvements in 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. I imagine some brands, I haven't tried it yet, it's on my list to try, is, 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?

• 1:16:11Speaker 00

  Yeah, I don't think there's enough people talking about the equipment for weighted walking.

• 1:16:16Rangan Chatterjee?

  Right.

• 1:16:17Speaker 00

  Because that rib cage expansion is crucial.

• 1:16:19Rangan Chatterjee?

  Yeah.

• 1:16:20Speaker 00

  You have to have rib cage expansion, not only for what's happening at, you know, from a breathing capacity, but that rib cage and the rib cage expanding also is what dials in rotation.

• 1:16:30Rangan Chatterjee?

  Yeah.

• 1:16:31Speaker 00

  It has a direct correlation to what's happening at your pelvis. So 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 was like, I can't believe I'm telling you this. This is very embarrassing, but my low back was so sore.

• 1:17:15Speaker 00

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

• 1:17:26Rangan Chatterjee?

  Yeah, it's a, it's not failure. It's a, it's a learning opportunity, right? It's don't have something heavy knock against your lower back while you walk.

• 1:17:33Speaker 00

  It's just doesn't make any sense.

• 1:17:34Rangan Chatterjee?

  You should have done a chapter on that in a book, you know?

• 1:17:38Rangan Chatterjee?

  Yeah, but, but, 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 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 5,000. Okay. Well, that program's 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, you're never going to run out of things to do if you're trying to improve the way that you walk.

• 1:18:15Speaker 00

  Yeah. I mean, when I was writing this, I'm, I consider myself a pretty active person. My whole career is built around movement. The changes in my life, in 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?

• 1:18:57Speaker 00

  My creativity would improve. Um, when I was stressed out, go take a walk, you know? So I was able to really.

• 1:19:06Speaker 00

  Think about the benefits and what it was doing for me. And it was really cool to see, to see what happened and to see how important it has become.

• 1:19:15Rangan Chatterjee?

  Today's the final day of your, you know, book promo trip to the UK, right? And interestingly, you've come with your mother.

• 1:19:23Speaker 00

  Yes.

• 1:19:24Rangan Chatterjee?

  Right? So you've been in London for a few days, doing all kinds of cool stuff.

• 1:19:27Speaker 00

  Yes.

• 1:19:28Rangan Chatterjee?

  The weather has been great.

• 1:19:29Speaker 00

  Yes.

• 1:19:30Rangan Chatterjee?

  Have you two been managing to walk a lot whilst you've been here?

• 1:19:34Speaker 00

  I'm so proud of her. She, um, first of all, this is very exciting. She got her a pair of Vivo barefoot's. She's 76 years old.

• 1:19:44Rangan Chatterjee?

  Love it.

• 1:19:45Speaker 00

  She put in 13,000 steps yesterday.

• 1:19:49Rangan Chatterjee?

  In her Vivos?

• 1:19:50Speaker 00

  In her Vivos.

• 1:19:51Rangan Chatterjee?

  Put it there. Fantastic.

• 1:19:53Speaker 00

  And, you know, I'm sitting there going, Mom, bring your other shoes. You know, I'm like, just in case, you know, let's, you know, but she's, she walks every day at home. She's in the gym a couple of 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.

• 1:20:11Rangan Chatterjee?

  Do you know what, which one she wore?

• 1:20:12Speaker 00

  She had the Primus Flex, I believe.

• 1:20:14Rangan Chatterjee?

  Yeah.

• 1:20:16Speaker 00

  But she really did, she really did very well. And, you know, now she has three pairs of them. But I was really proud of her because she, 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, uh, I missed the little fine print. And not only that, but the staircase is about a third of the size of this table.

• 1:20:42Rangan Chatterjee?

  An old traditional British staircase.

• 1:20:45Speaker 00

  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.

• 1:20:54Rangan Chatterjee?

  So she's on a fitness holiday?

• 1:20:55Speaker 00

  Yeah. But yeah, so she was able, and she, you know, she said to me, she goes, if some of her friends were here, and in fact, she said most of them, she's not sure they would be able to get to our flat.

• 1:21:13Speaker 00

  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 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.

• 1:21:43Rangan Chatterjee?

  But that is happening, Courtney. It's happening all over the shop. And there'll be people listening right now who that story, like it 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 mom.

• 1:21:58Speaker 00

  Yeah.

• 1:21:59Rangan Chatterjee?

  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 seventies wondering, why can't I do that stuff anymore? Well, I can't enjoy my grandchildren or play with my children. And it didn't start in your seventies.

• 1:22:19Speaker 00

  Yeah.

• 1:22:19Rangan Chatterjee?

  It started many decades before that. That doesn't mean, you know, you can't undo problems. You can. It's never too late, but it's never too early also.

• 1:22:29Speaker 00

  Yeah. I was, 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 until 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. Like, there's no better time to start than now.

• 1:23:12Rangan Chatterjee?

  Yeah.

• 1:23:14Rangan Chatterjee?

  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 Net Sum Courtney comes on, can you go through in detail how to transition?

• 1:23:32Speaker 00

  Yeah.

• 1:23:32Rangan Chatterjee?

  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.

• 1:23:44Speaker 00

  Yes.

• 1:23:45Rangan Chatterjee?

  And let's start off with that one. You know, what are some practical steps for transitioning from cushioned shoes to more minimalist ones?

• 1:23:53Speaker 00

  So 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.

• 1:24:08Rangan Chatterjee?

  Yeah.

• 1:24:09Speaker 00

  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.

• 1:24:32Rangan Chatterjee?

  Yeah.

• 1:24:33Speaker 00

  You know, what they will say is that sometimes it feels a little loose.

• 1:24:37Rangan Chatterjee?

  Yeah.

• 1:24:37Speaker 00

  Because their toes don't have the strength or the splay to fill up the toe box. But

• 1:24:45Rangan Chatterjee?

  But they will.

• 1:24:45Speaker 00

  But they will.

• 1:24:46Rangan Chatterjee?

  Yeah.

• 1:24:47Speaker 00

  So they can use toe spacers, for example, as a way to help them facilitate that splay. And 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.

• 1:25:31Rangan Chatterjee?

  And for people who are listening, the extreme version of that is the lady's high heel.

• 1:25:38Speaker 00

  Yes, if you were to wear a high heel all day long.

• 1:25:39Rangan Chatterjee?

  You'd understand that, but many other shoes have degrees off that, just not to that extreme.

• 1:25:45Speaker 00

  Correct.

• 1:25:46Rangan Chatterjee?

  Yeah.

• 1:25:47Speaker 00

  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.

• 1:25:54Rangan Chatterjee?

  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 feel good and they want to wear it out on a night out or to a wedding, you're like, sure, but make sure in those other times, you're doing something about it. So I just want to reemphasize that point, that you, I think one of the things people like about your approach is that it is very realistic.

• 1:26:21Speaker 00

  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 your husband, and that makes you want to wear that shoe, go for it and feel good and enjoy it.

• 1:26:50Rangan Chatterjee?

  Yeah.

• 1:26:50Speaker 00

  What 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.

• 1:27:04Rangan Chatterjee?

  Okay.

• 1:27:05Speaker 00

  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. They'll say, well, my calves got sore. And then they'll want to blame the shoe.

• 1:27:43Speaker 00

  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.

• 1:27:55Rangan Chatterjee?

  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 minimalist shoes, oh, there's something wrong with the shoes. It's like, no, no, no, you're just using your muscles in a different way and the way that they're probably meant to be used once you start training them.

• 1:28:16Speaker 00

  It's like if you were squatting and you were squatting 100 pounds one week and 200 pounds the next week and you were like, man, I am so sore. People wouldn't say, well, stop squatting. They would just say, hey, maybe only squat 10 more pounds than you were.

• 1:28:29Rangan Chatterjee?

  Yeah.

• 1:28:30Speaker 00

  It's a very different conversation at the foot. It's, well, there must be something wrong.

• 1:28:35Rangan Chatterjee?

  So we take this gradual transition.

• 1:28:37Speaker 00

  Yes.

• 1:28:37Rangan Chatterjee?

  Okay, and again, I 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

• 1:28:50Speaker 00

  Yeah.

• 1:28:50Rangan Chatterjee?

  sort of phase as you get to true minimalist shoes.

• 1:28:56Rangan Chatterjee?

  As I mentioned in that conversation, 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? I will say for Vivo Barefoot that the

• 1:29:20Rangan Chatterjee?

  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.

• 1:29:51Speaker 00

  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.

• 1:29:59Rangan Chatterjee?

  Yeah.

• 1:30:00Speaker 00

  The 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.

• 1:30:37Rangan Chatterjee?

  Yeah. Okay. So, and 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 minimal 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, you know, 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.

• 1:31:10Speaker 00

  Yes.

• 1:31:12Rangan Chatterjee?

  Once they've got this, let's say this new shoe, let's say someone walks 30 minutes a day. 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?

• 1:31:25Speaker 00

  That's literally what I'll-

• 1:31:25Rangan Chatterjee?

  Take them in a backpack with you.

• 1:31:26Speaker 00

  Yeah. I'll say either walk five minutes away from your house, come back, 10 minutes, put your old shoes on.

• 1:31:32Rangan Chatterjee?

  Do the rest of your walk.

• 1:31:33Speaker 00

  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.

• 1:31:49Speaker 00

  They're like, this isn't a problem, my mom. But she's, you know, she's a walker. She's, you know, she is healthy.

• 1:31:57Rangan Chatterjee?

  And she's your mom. So I imagine there's been some foot exercises in her life for some time.

• 1:32:05Speaker 00

  That would not be very good if we had some problems there. But yeah, so that's, some people transition quicker. And that's okay.

• 1:32:14Rangan Chatterjee?

  Okay, so basically, take it easy, listen to your body. And as you get more comfortable, it starts to increase.

• 1:32:21Speaker 00

  Yeah.

• 1:32:21Rangan Chatterjee?

  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, then you could, you know, go to a minimalist shoe and apply the same principles again.

• 1:32:36Speaker 00

  Yep.

• 1:32:37Rangan Chatterjee?

  Yeah.

• 1:32:37Speaker 00

  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.

• 1:33:21Rangan Chatterjee?

  Yeah.

• 1:33:22Speaker 00

  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 and that is a problem.

• 1:34:06Rangan Chatterjee?

  Yeah, I would just add there, the Vivo Bearfoot Tracker hiking boots are insanely goods. 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 footfall, so.

• 1:34:25Speaker 00

  When you think about that hiking shoe too, you still have to have the boot to be flexible at the ankle.

• 1:34:34Rangan Chatterjee?

  You don't want a stiff boot where you certainly can't move your feet and ankle anymore.

• 1:34:38Speaker 00

  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.

• 1:34:54Rangan Chatterjee?

  Yeah.

• 1:34:54Speaker 00

  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.

• 1:35:20Rangan Chatterjee?

  Yeah.

• 1:35:20Speaker 00

  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.

• 1:35:33Rangan Chatterjee?

  That leads on to the second question on the sheet. How can we restore full mobility and confidence in our ankles, especially after previous ankle injuries?

• 1:35:44Speaker 00

  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. So when we're working on, especially patients that have had ankle instability, we're working on all these different ranges.

• 1:36:26Speaker 00

  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 stability around the ankle. We can train the body to do that.

• 1:36:48Rangan Chatterjee?

  Are you a fan of those Bosu balls? Or is it those half Bosu balls where it's an unstable surface to stand on?

• 1:36:54Speaker 00

  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? What is your intent? What is your goal?

• 1:37:37Rangan Chatterjee?

  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, there's all kinds of things that are going to help people build that up, aren't there?

• 1:38:03Speaker 00

  Yeah.

• 1:38:05Speaker 00

  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. When 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.

• 1:38:49Speaker 00

  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. But when that foot is doing what it's supposed to do, and I have toes play, 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.

• 1:39:24Rangan Chatterjee?

  I would 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 kind of shoes, and I've been in minimalist shoes, my feet have changed. They're stronger, they're meatier, they're, there's an arch now.

• 1:40:06Rangan Chatterjee?

  It's, you know, this isn't just one thing, oh, I've got a flat foot or I don't. It's like, okay, you might do it at the moment, but maybe with the right inputs, it will change.

• 1:40:16Speaker 00

  When I started doing this, my foot looked atrophied.

• 1:40:19Rangan Chatterjee?

  Yeah.

• 1:40:20Speaker 00

  It was just, you could, 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

• 1:40:33Speaker 00

  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. So 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.

• 1:41:18Rangan Chatterjee?

  Yeah.

• 1:41:19Speaker 00

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

• 1:41:54Rangan Chatterjee?

  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?

• 1:42:18Speaker 00

  Yes, you can. Your foot needs to be, when you look at someone's foot, and this will be a good example of, for a bun, 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.

• 1:42:34Rangan Chatterjee?

  Yeah.

• 1:42:35Speaker 00

  If you can move that, if that's flexible, that's, it's a muscular imbalance. There'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.

• 1:42:55Speaker 00

  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 to address.

• 1:43:12Rangan Chatterjee?

  Can toe spacers sometimes help with that?

• 1:43:15Speaker 00

  With the more rigid?

• 1:43:17Rangan Chatterjee?

  Well, no, when there's when toes are starting to overlap each other.

• 1:43:21Speaker 00

  If I can get a toe spacer on someone, we're doing it. I wear them every day. I've been wearing them for, gosh, years.

• 1:43:29Rangan Chatterjee?

  Do you wear them in your shoes?

• 1:43:30Speaker 00

  I wear them in my shoes. Because I was a little late to the 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. You know, I run, I walk with these spacers on. It helps keep my toes in alignment. And it's a low hanging fruit. It's easy. It's like, just wear it around the house. Start with a couple of minutes a day. It can be difficult for people to break in, too, because people aren't used to having their toes splay.

• 1:44:05Rangan Chatterjee?

  At GaIt 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. If they've got toe spacers, I think toe strengtheners. What else you got in there?

• 1:44:18Speaker 00

  There's bands, a ball. I wanted to keep it simple.

• 1:44:21Rangan Chatterjee?

  Where can people get that if they if they choose to get one?

• 1:44:24Speaker 00

  Amazon, right here.

• 1:44:25Rangan Chatterjee?

  Just on Amazon.

• 1:44:26Speaker 00

  Yep, and on our website.

• 1:44:27Rangan Chatterjee?

  They just look at your name or GaIt 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? And I'm guessing they're talking about osteopenia in the foot, although I don't know that from the question.

• 1:44:47Speaker 00

  Yes. So.

• 1:44:50Speaker 00

  Think about what happens when you're walking from a bone perspective.

• 1:44:55Speaker 00

  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 blastocic activity and it's this,

• 1:45:13Speaker 00

  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. And 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.

• 1:45:57Rangan Chatterjee?

  Yeah.

• 1:45:58Speaker 00

  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.

• 1:46:08Rangan Chatterjee?

  Yeah. Okay, now there's been a lot of questions around two common issues. Plantar fasciitis and Achilles tendonopathy.

• 1:46:18Speaker 00

  Yeah.

• 1:46:19Rangan Chatterjee?

  Okay. So, let's start with plantar fasciitis. How do you treat and cure it is one of the questions.

• 1:46:26Speaker 00

  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. So, 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...

• 1:47:11Speaker 00

  The plantar fascia gets pissed.

• 1:47:13Rangan Chatterjee?

  Yeah.

• 1:47:13Speaker 00

  Because now, instead of having this foot that was designed to share loads, the plantar fascia has to take on more of it.

• 1:47:24Rangan Chatterjee?

  Hmm.

• 1:47:24Speaker 00

  And so when we look at treatment for these types of things, it's not just keep de-loading. It's not just, here's a foot orthosis, and here's a shoe that's gonna rocker, that's gonna rocker for you. It is, why wouldn't I look at bringing the friends back to the party?

• 1:47:40Rangan Chatterjee?

  Yeah.

• 1:47:41Speaker 00

  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. It's, 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. That also happens at the pelvic floor,

• 1:48:26Speaker 00

  and it also happens at someone's foot. That's what's so cool about the foot.

• 1:48:29Rangan Chatterjee?

  Yeah.

• 1:48:29Speaker 00

  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?

• 1:48:40Rangan Chatterjee?

  Yeah.

• 1:48:41Speaker 00

  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.

• 1:48:49Rangan Chatterjee?

  Yeah.

• 1:48:49Speaker 00

  And it helps them quite a bit. It's really pretty neat.

• 1:48:54Rangan Chatterjee?

  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 gonna have an impact on your feet. 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 tendonopathy? Is that something you see a lot of?

• 1:49:29Speaker 00

  Yes.

• 1:49:31Rangan Chatterjee?

  For people who don't understand the term tendinopathy, what are we talking about here?

• 1:49:36Speaker 00

  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 their Achilles tendon bothers them, the immediate reaction is, I gotta get off of it. I'm gonna 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.

• 1:50:18Speaker 00

  And what helps share those loads or absorb some of those forces are strong calves. So when we look at treating for Achilles tendonopathies, 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. He was a physician. And I said, you're gonna leave that scooter at home.

• 1:51:00Speaker 00

  We're done with this 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,

• 1:51:13Speaker 00

  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.

• 1:51:37Rangan Chatterjee?

  Yeah.

• 1:51:37Speaker 00

  And those are very, very important conversations. We cannot deload forever.

• 1:51:42Rangan Chatterjee?

  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.

• 1:51:50Speaker 00

  Yeah.

• 1:51:51Rangan Chatterjee?

  You know, I can think back to Christian, the firefighter.

• 1:51:54Speaker 00

  Yeah.

• 1:51:55Rangan Chatterjee?

  Right? And how he was told to move less. Three years on.

• 1:51:59Speaker 00

  Mm hmm.

• 1:52:00Rangan Chatterjee?

  Right? And as you beautifully explained, you know, whether he walked on it or not, the pain was the same.

• 1:52:06Speaker 00

  Yeah.

• 1:52:06Rangan Chatterjee?

  Right? So you might as well walk on it then.

• 1:52:08Speaker 00

  Living well with pain rather than having it dictate your life and saying, I'm not doing that.

• 1:52:14Rangan Chatterjee?

  Yeah. Yeah. And if you just superimpose onto that, this idea that Howard Schubert spoke to me about, and his research has shown that maybe even 90% of chronic pain has a neuroplastic component, i.e. 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 is healed.

• 1:52:46Speaker 00

  That's right.

• 1:52:46Rangan Chatterjee?

  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?

• 1:53:08Speaker 00

  Yeah.

• 1:53:09Rangan Chatterjee?

  I love that idea. How do you live well with pain?

• 1:53:11Speaker 00

  Yeah. It'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.

• 1:53:54Rangan Chatterjee?

  Yeah. There's a question on gait analysis for running. 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?

• 1:54:11Speaker 00

  Yeah, it's, uh, that's deep.

• 1:54:12Rangan Chatterjee?

  Without an individual assessment, yeah, that is deep. Top line.

• 1:54:17Speaker 00

  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 gait. It's, do you really want to mess with those things? So 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, Pod Chat Live. He talks about, they go in depth about shoe, shoe research and really looking at what's happening at the foot.

• 1:55:00Speaker 00

  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.

• 1:55:19Rangan Chatterjee?

  Yeah, exactly.

• 1:55:20Speaker 00

  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. If you put a super shoe on someone that has a weak foot and calf and they start running on their forefoot and their midfoot. You can cause problems because the demand is greater than what they have the capacity for.

• 1:55:54Rangan Chatterjee?

  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 had been, I mean, you know, at the formative years of their life and their, their running gate were, they had exceptional mechanics. And now this is, as you put, as you said on our first conversation together, it's the icing on the cake.

• 1:56:28Speaker 00

  Yeah.

• 1:56:29Rangan Chatterjee?

  Right? But so many people are getting injured by thinking, I'm going to get a 4% improvement in my 5K.

• 1:56:37Speaker 00

  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.

• 1:57:06Rangan Chatterjee?

  It's like elastic, isn't it?

• 1:57:08Speaker 00

  So 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, 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.

• 1:57:28Rangan Chatterjee?

  Yeah.

• 1:57:28Speaker 00

  And it's, it's really pretty cool to see.

• 1:57:31Rangan Chatterjee?

  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?

• 1:58:05Speaker 00

  Yes. And in a safe environment. What would make her feel safe? Would that be walking with poles, for example? Sometimes my patients, if we put poles in their hands, it gives them that kind of sense of stability.

• 1:58:22Rangan Chatterjee?

  That's a great idea.

• 1:58:23Speaker 00

  You know, it'll give them a little more real estate, if you will. So that's an option.

• 1:58:30Speaker 00

  The 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.

• 1:59:01Speaker 00

  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.

• 1:59:07Rangan Chatterjee?

  Yeah.

• 1:59:09Speaker 00

  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. It'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.

• 1:59:34Rangan Chatterjee?

  Yeah. I love that. I think it's such an important message. And it reminds me, when my mom was more active, I think I put mom in vivos maybe 10 years ago.

• 1:59:48Rangan Chatterjee?

  Something like that. And she was in her mid 70s at the time.

• 1:59:54Rangan Chatterjee?

  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.

• 2:00:03Speaker 00

  Yeah.

• 2:00:04Rangan Chatterjee?

  You, 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 that elderly are a fantastic place to, to, to really be targeting. I think we could all benefit, but certainly the elderly. Get them feeling the ground and they'll probably, you'll probably find a lot of them feel a lot more stable.

• 2:00:27Speaker 00

  I think this is a conversation that no one's having either. Let's say they were in a cushion 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's a 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. So that's another conversation that is if you are, if this minimal conversation isn't making sense to you and you are in cushioned footwear, you have to change those shoes

• 2:01:11Speaker 00

  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.

• 2:01:21Rangan Chatterjee?

  Yeah. It stays the same.

• 2:01:23Speaker 00

  It's more stable.

• 2:01:24Rangan Chatterjee?

  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. Conley, 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.

• 2:01:56Speaker 00

  Yeah.

• 2:01:57Rangan Chatterjee?

  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, you know, physical benefits, dementia risk, lower risk of heart attack and cancer. And yes, those things are incredibly important. But walking is also who we are.

• 2:02:18Speaker 00

  Yeah.

• 2:02:19Rangan Chatterjee?

  It helps us understand who we are. And those long haul walks you 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?

• 2:02:39Speaker 00

  Yep, I was gonna 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. That 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.

• 2:03:05Rangan Chatterjee?

  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.

• 2:03:47Rangan Chatterjee?

  Courtney, I've thoroughly enjoyed this conversation and my previous one with you this year. I think you're doing incredible work. I'd really encourage you 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?

• 2:04:21Speaker 00

  That you can. That...

• 2:04:25Speaker 00

  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. It 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 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.

• 2:05:09Rangan Chatterjee?

  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.

• 2:05:18Speaker 00

  Thank you so much.

• 2:05:23Rangan Chatterjee?

  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 5. 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,

• 2:06:06Rangan Chatterjee?

  and quotes that have caused me to stop and reflect. 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/friday5. 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, behaviour change and movement, weight loss and so much more. So please do take a moment to check them out. They are all available

• 2:06:50Rangan Chatterjee?

  as paperbacks, ebooks and as audiobooks, 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. Making lifestyle change is always worth it, because when you feel better, you live more.