Prof/Dr Brian A Rothbart

Marbella, Spain 29640 Albano Laziale, Italy 00041 phone: (000) 000-0000

Why is it important to correct bad posture?

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Saturday, August 01, 2009

This research into bad posture is part of a series of investigations that ultimately led me to a therapy that automatically corrects posture and, in many cases, permanently eliminates chronic musculoskeletal pain, without the use of drugs or surgery.

This therapy is called Rothbart Proprioceptive Therapy, in which I use:

a series of proprietary tests to analyze the patient’s posture

custom designed Rothbart Proprioceptive Insoles to correct the posture

computerized analyses to monitor the changes in the posture

Bad posture is an alignment problem. Using a car analogy, when the suspension of a car is out of alignment, the weight of the car is unevenly distributed across the surfaces of the tires. Some parts of the tires receive more weight than other parts. This causes the tires to wear unevenly. The thread is worn down (See Figure 1) until the performance of the tire fails completely.

Figure 1 - Tire that thread is worn down

Likewise, when you have bad posture, your body’s weight is unevenly distributed across the joint surfaces of your ankles, knees, hip, back, neck and jaw. That is some areas of these joints receive more weight that other areas.

this causes the cartilage within these joints to wear unevenly (See Figure 2)

the cartilage is gradually worn down until the joint surfaces are destroyed (referred to as Osteodegenerative Arthritis)

the end result is chronic, debilitating joint pain

Figure 2 - white arrow points to where the cartilage has worn unevenly

Correct posture maintains correct alignment of the weight-bearing joints. This prevents the cartilage from wearing unevenly. Your joints remain healthy,mobile and pain free.

So, you can see how important it is to correct your posture.

If you would like read about one the most common reasons for the development of bad posture and how to correct it naturally, read my book, Forever Free From Chronic Pain.

Prof/Dr Brian A Rothbart
Chronic Pain Elimination Specialist
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy for Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

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Will Surgery Salvage Yao Ming's Basketball Career?

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Saturday, August 01, 2009

In my book, Forever Free From Chronic Pain (Chapter 3), I discuss why I do not recommend reparative surgery on any of the joints (including the feet) if the underlying cause of the chronic pain is not known or is not addressed: "If surgery is done when the source of the pain is not known, you will undergo a highly invasive procedure that does not address the source of the problem. It will be painful, costly and potentially dangerous (Health World, 2008). After the surgery, the chronic pain usually returns or becomes worse."

The Houston Rockets are counting on an innovative and complicated surgical procedure to repair the hairline fracture in Yao Ming’s left foot. They hope it will create a base of support for his 7-foot, 6-inch frame that will withstand the unprecedented pounding Ming’s body takes every time he mounts the basketball court. However, privately the Houston officials have grave doubts that Ming will ever be sturdy enough again to play professional basketball.

This is truly a tragedy, for as the global games goes, Ming is basketball’s most important player since Michael Jordan. He is the reason that China has become enamored with the National Basketball Association. He is the reason why American players were treated like rock stars in the Beijing Olympics. He is regarded by many as the ‘Icon’ of professional basketball.

After watching a video and studying many photographs of Ming, I doubt he will ever recover from his reconstructive foot surgery unless they address the underlying cause that led to his debilitating foot injury, which I believe is: a Primus Metatarsus Supinatus (Rothbarts) Foot. Unfortunately, to date, the Houston Rocket's management maybe totally unaware of Ming’s embryological foot structure and the impact it has on his skeletal framework. And Ming is just another, of a long list of elite professional players, whose careers have been cut short or severely compromised by the apparent foot structures they were born with: Bill Walton, Micky Mantle and Tiger Woods just to name a few.

Let’s hope that Ming will prove to be the exception and that he will overcome the destructive forces generated from his feet. But the smart money is betting against this. And without addressing his apparent Rothbart’s Foot, one of the greatest players in NBA's history will abruptly and prematurely leave the sport in his prime. And what a needless shame that will be!

Reference

"Back Pain, The Dangers of Surgery: What Doctors Don't Tell You." Health World, Volume 4, Issue 8, 25 July 2008.

Prof/Dr Brian A Rothbart
Chronic Pain Elimination Specialist
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy for Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

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Complex Regional Pain Syndrome (CRPS)

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Saturday, August 01, 2009

Background Information on complex Regional Pain Syndrome

Complex Regional Pain Syndrome (also know as Reflex Sympathetic Dystrophy) is a chronic pain syndrome characterized by severe, unrelenting pain. It has been estimated that upwards of 0.3% of the United States population is affected with this syndrome.

The exact cause of Complex Regional Pain Syndrome (CRPS) is unknown. However, CRPS appears to be a malfunction of the nervous system occurring after an accident or medical procedure. For reasons still poorly understood, the sympathetic nerve(s) begin to misfire. This misfiring results in constant pain signals being sent to the brain.

Symptoms of CRPS can include:

Persistent moderate-to-severe pain

Swelling (see photo below)

Abnormal skin color (see photo below)

Changes in skin temperature

Excessive sweating

Limited range of motion

Movement disorders

The mean age for the onset of CRPS is 42. However, young children can be affected. Reported cases of CRPS in 3 year old children have been reported. CRPS is nearly three times more frequent in females than males.

Current medical interventions for CRPS include:

Medication

Physical therapy

Psychological support

Sympathetic nerve blocks

Spinal cord stimulation

Suggested medical intervention to prevent CRPS:

Incorporating insoles into casts

In House Pilot Study - (1988-1991)

Study: Review of charts of nearly 500 patients at Ballard Sports Medicine Clinic, Ballard Washington, 1989-1990 and Bellevue Foot and Ankle Center, Bellevue Washington, 1988-1991 who:

Were casted following foot/ankle surgery or foot/ankle trauma

Had insoles incorporated into their casts

Summary: Based on a reported 5% occurrence rate of CRPS in post trauma patients (Loeser,2001; Plewes, 1956) one would expect to see 2-3 cases of CRPS in the above study.

Results: Not one case of CRPS was reported.

Conclusions: The results of this study are neither definitive nor inclusive, however, they do suggest a need for further investigation into using insoles inside casts to prevent the development of CRPS.

References

Loeser JD. Ed. Bonica's the management of pain. 3rd Ed. Philadelphia, PA: Lippincott, Williams & Williams; 2001:388-411.

Plewes LW. Sudek's Atrophy in the Hands. J Bone Joint Surgery 1956;38:195-203.

Coach Marla's website on Reflex Sympathetic Dystrophy - an excellent website on RSD which I strongly recommend.

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Clubfoot vs. PreClinical Clubfoot Deformity. A Technical Presentation

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Saturday, August 01, 2009

My research directly led to the discovery of the PreClinical Clubfoot Deformity. I was the first researcher to publish on this previously unknown foot deformity (Rothbart, 2002). Below is an embryological discussion on the differences between the Clubfoot and PreClinical Clubfoot Deformities.

This research was part of a series of discoveries that ultimately led to a therapy that, in many cases, permanently eliminates chronic musculoskeletal pain without the use of drugs or surgery. This therapy is called Rothbart Proprioceptive Therapy, in which I use a series of proprietary tests to analyze the patient’s condition, custom designed Rothbart Proprioceptive Insoles and ongoing monitoring to address all of the changes in the patients condition and necessary changes in prescriptions until the chronic muscle and/or joint pain is eliminated.

Clubfoot Deformity (redacted from Rothbart 2002. Medial Column Foot Systems)

If the calcaneus fails to unwind (remains in relative supinatus), the cuboid remains in supinatus, and with it, the lateral two cuneiforms, lesser four metatarsals and accompanying phalanges (Bohm,1929). The footplate unwinds heel to toe (Streeter, 1945, 1948, 1951), thus the maxim: as goes the calcaneus, so goes the talus.

Retention of calcaneal supinatus is always accompanied by talar supinatus, the Clubfoot deformity (Bohm 1929). In the postnatal foot, the calcaneus articulates with the cuboid, which in turn articulates with the navicular, lateral cuneiform and lateral two metatarsals. From a structuralist viewpoint, one might conclude that the calcaneus only impacts these structures.

From an embryological prospective, this is not the case. Bohm (1929) describes how the ontogenetic unwinding of the calcaneus affects the lateral column of the embryonic foot. That is, the relative structural position of the cuboid, the lateral two cuneiforms and four lateral metatarsals/phalanges are determined by the sculpturing of the calcaneus. Retention of calcaneal supinatus in the prenatal foot is manifested as the Clubfoot Deformity in the postnatal (after birth) foot (See photo below).

PreClinical Clubfoot Deformity

If the calcaneus has unwound enough, where the cuboid is no longer in supinatus, but where the calcaneus is still in supinatus, the resulting foot structure is termed the PreClinical Clubfoot deformity. In this foot structure, the lesser four metatarsals and accompanying phalanges have assumed a plantargrade position. However, the heel bone is still in supinatus.

On weight bearing (e.g., standing), this foot structure forces the foot to excessively pronate to bring the medial surface of the heel bone down to the ground. This attenuates or obliterates the inner longitudinal arch. However, off weight bearing (e.g., sitting), where gravity is not acting/forcing the medial surface of the heel bone down to the ground, the foot is not excessively pronated and the inner longitudinal arch is visible (See animation below).

PreClinical Clubfoot Deformity. When the foot is weight bearing, the inner longitudinal arch is collapsed. When the foot is taken off weight bearing, the inner longitudinal arch becomes visible. This is pathognomonic of the PreClinical Clubfoot Deformity.

References:

Bohm M 1929 The embryologic origin of clubfoot. Journal Bone Joint Surgery, 11:2, 229

Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46

Streeter GL 1945, 1948, 1951 Developmental horizons in human embryos. In Contributions to Embryology, Vols. 21, 32, 34. Washington DC. Carnegie Institution of Washington

Prof/Dr Brian A Rothbart
Chronic Pain Elimination Specialist
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy for Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

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Education is the Key to Eliminating Your Chronic Pain and Regaining Your Health

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Saturday, August 01, 2009

A study done by the Gallup Organization in 2000(1) found that:

four out of five Americans believe that chronic pain is a natural part of aging

60% of the respondents believe that pain is something you just have to live with

28% felt there was no solution to eliminate their chronic pain

In the light of these statistics, one can surmise that these are a lot of misinformation about the cause of chronic pain.

Chronic pain is not a natural part of aging. If it was, all elderly people would be suffering from pain. This is not the case.

Professor Rothbart suggests that about 80% of the world’s population is born with a foot structure that predisposes them to chronic muscle and joint pain. It is known as the Rothbarts Foot. Even if you have this foot structure, how soon you develop chronic pain depends on many other factors that can add stress to your body, such as: poor diet, lack of exercise or an injury.

If you have the Rothbarts Foot and if your body is reasonably fit, you may not experience much pain until your later years. Hence the misconception that chronic musculoskeletal pain is a part of aging.

Pain is not something you have to live with. There are viable solutions. One just has to weed through the misinformation to get at the source of what is causing your specific chronic pain problem. One example of a viable solution to eliminate chronic pain is Rothbart Proprioceptive Therapy.

Rothbart Proprioceptive Therapy was developed by Prof/Dr Brian A Rothbart to permanently eliminate chronic muscle and joint pain resulting from the Rothbarts Foot.

Education is the key to eliminating your chronic pain and regaining your health.

To educate healthcare professionals on his research, findings and innovative therapy, Professor Rothbart has published in major medical journals such as Journal American Podiatric Medical Association, Biomechanics, Journal of Bodywork and Movement Therapies, Journal of Manipulative and Physiological Therapeutics and many others (See Publications by Professor Rothbart).

Professor Rothbart has established a 450 hour curriculum, taught at the International Academy of Rothbart Proprioceptive Therapy, to give healthcare professionals the education and tools they need to help them identify the Rothbarts Foot and successfully treat their patients who have this foot structure.

To educate the layperson, Professor Rothbart has written a book, Forever Free From Chronic Pain. Using simple language, this book explains the source of most chronic muscle and joint pain and the therapy he developed on how to permanently eliminate it. This book contains diagrams, illustrations and a questionnaire to help the reader determine if he has the embryological foot structure that can lead to chronic pain.

Professor Rothbart has formed a group called Citizens for a World Free From Chronic Pain in order to gather people together to share their learned experiences on all approaches that actually work to eliminate chronic muscle and joint pain.

How do you conduct your research into causes and treatments for your chronic muscle and joint pain? Have you found treatments to be effective? If so, please consider joining Citizens for a World Free From Chronic Pain and share your findings with others who are also in search of effective solutions that will free themselves from their chronic pain.

Reference
(1) Pain in America: A Research Report, Survey conducted for Merck by the Gallup Organization, 2000.

Prof/Dr Brian A Rothbart
Chronic Pain Elimination Specialist
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of the International Academy of Rothbart Proprioceptive Therapy (IARPT)
Author of Forever Free From Chronic Pain

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Chronic Pain Changes How the Brain Functions

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Saturday, August 01, 2009

People suffering from chronic pain, not only suffer from the non-stop sensation of throbbing pain, but they also often suffer from:

insomnia

depression

anxiety, and

mental sluggishness (e.g., difficulty in making simple decisions)

In a paper published in the Journal of Neuroscience (Balilki et al 2008), investigators at Northwestern University's Feinberg School of Medicine have discovered an alteration in brain function that they feel may explain how suffering long-term pain could trigger these symptoms:

The front region of the cortex (brain), in a person suffering from chronic pain is consistently active. The neurons wear out prematurely, altering their connections to one another. This, Baliki et al. suggest, leads to permanent brain damage and the symptoms listed above. Interesting enough, this area of the cortex is associated with emotions.

Comparison of brains. These images show the brain from the left side,demonstrating striking differences between chronic pain patients and healthy subjects. Chronic Pain patients demonstrate an imbalance between areas of activity (red/yellow ) and inactivity (blue). Healthy patients demonstrate a balance between active and inactivated areas of the brain. (Image courtesy of Northwestern University)

Prof/Dr Brian A. Rothbart suggests that one reason for focal areas of hyperactivity within the cerebral cortex is ischemia (diminished blood flow to the brain) resulting from a forward head position. A forward head position can compress the carotid arteries, the arteries running along either side of the neck. Compressing these carotid arteries can diminish the flow of blood to the brain much like a kink in a water hose can diminish the flow of water through the water hose (See Rothbart, 2009. Forward head position can lead to debilitating symptoms in the brain).

A forward head position can be part of a postural distortional pattern caused by an embryological foot structure, now known as Rothbarts Foot.

This forward head position can be effectively corrected using Rothbart Proprioceptive Therapy, which uses a stimulation (proprioceptive insole) underneath the feet. This stimulation sends a signal to the brain. The brain, in turn, automatically corrects the posture and brings the forward head back over the spine. This opens up the carotid arteries allowing increased blood flow and oxygen to reach the brain.

Because the head is now in its correct position over the spine and the brain is receiving sufficient blood and oxygen, dysfunctional sleeping patterns are attenuated, symptoms of depression and anxiety abate and mental alacrity improves.

To read more about this link between chronic pain and brain function, go to Beyond Feeling: Chronic Pain Hurts the Brain, Disrupting the Default-Mode Network Dynamics.

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Ongoing Monitoring and Retesting is an Important Part of Rothbart Proprioceptive Therapy

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Saturday, August 01, 2009

Rothbart Proprioceptive Therapy is a process that involves ongoing engagement with the patient over a period of time – not a single act of placing an insole beneath the foot. Without engaging fully with the process, complete and full recovery cannot be ensured.

Rothbart Proprioceptive Therapy involves the running of tests and proprietary computer analyses to determine the type of foot structure inherited and the exact prescription of the custom designed insole needed to give the fastest and best results for each patient.

Once the patient begins to use his prescriptive proprioceptive insoles, shifts in their posture begin to take place, providing immediate pain relief. These shifts in posture creates shifts throughout the body and hence the entire body goes through changes during the therapy. Because individualized attention is given and the patient is carefully and regularly monitored, these changes are handled as they occur and this insures the speediest possible recovery of the patient.

The following example shows the importance of close monitoring and specific testing throughout the therapy:

Osni D., a 30 year old male, came to me to eliminate his chronic knee and low back pain. After running the initial battery of tests and proprietary analyses, I found that not only were there problems coming from the feet, but also potential problems coming from the cranium.

Osni informed me that 20 years earlier he had suffered head trauma, but had not experienced any pain after the incident. I suspected a locking of cranial sutures had taken place during the incident which could cause potential problems. (The cranial sutures are fibrous joints in the cranium (skull) that permit a tiny amount of movement to allow elasticity of the skull). I told Osni certain symptoms to watch for after starting therapy and to advise me of any changes lasting more than one or two days, with special attention to changes in the head and neck.

Within two weeks of Rothbart Proprioceptive Therapy, Osni indicated that his chronic knee and low back pain were dramatically reduced. But he also informed me that he was starting to have severe headaches and jaw pain.

A re-examination of the patient revealed that the patient’s cranial sutures were indeed locked, likely a result of his head trauma of twenty years ago. A second series of computer analyses were run, which revealed that the prescription of the proprioceptive insoles had to be changed to now address what was happening in the cranium.

I also determined that cranial sacral therapy was required to unlock the cranial sutures. The patient was referred to a cranial sacral therapist, who restored the elasticity (slight movement) between the cranial bones. After several visits to the cranial sacral therapist, Osni’s headaches and jaw pain dramatically reduced.

As you can see, Rothbart Proprioceptive Therapy affects the entire posture, foot to head, including leveling of the cranial bones (Rothbart BA 2008. Vertical Facial Dimensions Linked to Abnormal Foot Motion Journal American Podiatric Medical Association 98(3):01-08, May). In the case of this patient, this leveling of cranial bones could not occur because his cranial sutures were locked. When the cranial sutures are locked and you are applying a force to move them (such as Rothbart Proprioceptive Therapy), the result is pain e.g. headaches and jaw pain.

Through close patient monitoring, ongoing tests and proprietary analyses, and through changing the prescription of the insoles when required, cranial symptoms were prevented from becoming a major problem. Through dealing with the patient holistically, not just focusing on the feet, I was able to help the patient achieve freedom from his pain.

This example also stresses the importance of being treated by a physician who has been fully trained (450 hours) and certified at the International Academy of Rothbart Proprioceptive Therapy (IARPT). This is particularly the case when a person has been suffering from chronic musculoskeletal pain for years and has had multiple treatments and/or surgery and significant damage to the body as a result.

Currently, there is a 30 minute video being sold and classes being taught on how to treat the Rothbarts Foot. None of these are sanctioned by the International Academy of Rothbart Proprioceptive Therapy. If your physician does not use Rothbart Proprioceptive Therapy and insoles as taught at the IARPT, the result of your therapy may not only be disappointing, but could actually make you worse.

If you would like to read more about What is Rothbart Proprioceptive Therapy, go to What is Rothbart Proprioceptive Therapy? on Professor Rothbart's patient informational website.

Prof/Dr Brian A Rothbart
Chronic Pain Elimination Specialist
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy for Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

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Are Shoes Destroying Our Feet?

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Saturday, August 01, 2009

There is no doubt that the mantra – “Walking without shoes is healthier for the feet” is being repeated and written about more and more over the past few years.

Reproduced from Sternbergh's article, You Walk Wrong

It is self-evident, in my opinion, that walking barefoot is healthier and better for our feet, (in the right environment) compared to walking in shoes. However, the key phrase in that sentence is “in the right environment”. One of the reasons shoes have evolved and become progressively more prevalent in our societies, is the plethora of ‘land mines’ that clutter our city’s pavements (broken glass, nails, other sharp objects etc etc). Shoes offer a barrier of protection to these potential dangers. However, on a safer walking surface, e.g., sand or the countryside, shoes should be discarded and walking barefooted should be the norm.

However, there is another piece to this mantra that needs to be evaluated. That is, embryological alterations in the structure of the foot that leads to problems when we walk. Over the past 40 years of research, I have discovered several embryological foot structures (foot structures that are present at birth) that actually distort the way you walk. If you have one of these foot structures, the way you walk will be distorted “in or out of shoes”. I have linked this distortion in the way you walk to the development of chronic pain in the muscles and joints. (See Rothbart, 2009. Forever Free From Chronic Pain)

For more information, I highly recommend that you read You Walk Wrong in New York Best Doctors by Adam Sternbergh (Apr 21, 2008)

Prof/Dr Brian A Rothbart
Chronic Pain Elimination Specialist
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy for Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

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Pressure Plate Studies on the Rothbart Foot Structure

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Saturday, August 01, 2009

I was the first researcher to run pressure plate analyses on the Rothbarts Foot ( Italian Journal Sports Medicine, 2004). I compared this to the normal pronation pattern directed by hip drive in a Non Rothbarts Foot.

This research was part of a series of discoveries that ultimately led to a therapy that, in many cases, permanently eliminates chronic musculoskeletal pain without the use of drugs or surgery. This therapy is called Rothbart Proprioceptive Therapy, in which I use a series of proprietary tests to analyze the patient’s condition, custom designed Rothbart Proprioceptive Insoles and ongoing monitoring to address all of the changes in the patients condition and necessary changes in prescriptions until the chronic muscle and/or joint pain is eliminated.

As can be observed in the above animation, the hallux in Rothbarts Foot does not participate in the propulsive stance phase of gait. Instead, most of the thrust at toe off occurs within the second toe. This is compared to a non Rothbarts Foot in which the hallux acts as the major thrust area of the foot during late stance phase of gait.

For more information regarding pressure plate analysis on Rothbarts Foot, read Pressure Plate Analysis of the Medial Column Foot Insole.

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Rothbarts Foot vs PreClinical Clubfoot Deformity

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Saturday, August 01, 2009

In 2002, I published on two previously unknown embryological foot types, the Primus Metatarsus Supinatus (Rothbarts) foot and the Preclinical Clubfoot Deformity (Journal Bodyworks and Movement Therapy, 2002).

Both of these embryological foot types distort the signals being generated from the foot to the cerebellum (brain). Both of these foot structures result in postural distortions that frequently result in chronic debilitating muscle and joint pain. And both of these foot structures are treated using Rothbart Proprioceptive Therapy.

However the type proprioceptive insole used in treating Rothbarts Foot is very different than the type of proprioceptive insole used to treat the Preclinical Clubfoot Deformity.

Hence it is very important to make a differential diagnosis (determine which foot structure is present) before therapy is initiated.

The Knee Bend Test (a clinical test I invented) is used to help make this differential diagnosis (See animation below).

Knee Bend Test

When the body's weight is over the heel bones (e.g., the knees are straight), foot twist (pronation) is observed only in the Preclinical Clubfoot Deformity.

When the body's weight is over the front part of the foot (e.g., the knees are bent), foot twist (pronation) is observed in both the PreClinical Clubfoot Deformity and Rothbarts Foot.

For more information regarding Rothbarts Foot and the PreClinical Clubfoot Deformity, read Medial Column Foot Systems: An Innovative Tool for Improving Posture.

Prof/Dr Brian A Rothbart
Chronic Pain Elimination Specialist
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy for Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

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