Aneesh Garg, DO, CAQ, is a nationally recognized, non-surgical sports medicine and regenerative orthopaedic physician with Dynamic Athlete Sports Medicine & Regenerative Orthopaedics in Boulder, Colorado. He is also a two-sport US National Team Physician as he works with USA Hockey and U.S. Soccer. Dr. Garg specializes in treating dynamic athletes of all ages and skill levels from head to toe.
At Dynamic Athlete Sports Medicine & Regenerative Orthopaedics, Dr. Garg also uses genetic testing for precision medicine. He is a continued asset for athletes looking to maximize their potential at the cellular level. Dr. Garg also leads the Dynamic Athlete Concussion Clinic and has been a certified ImPACT consultant specializing in the management of concussion injuries.
Listen to this episode of The MOVEMENT Movement with Aneesh Garg about alternatives to surgery.
Here are some of the beneficial topics covered on this week’s show:
– How having your feet closer to the ground enhances proprioception, balance, and gait.
– Why wearing barefoot shoes helps build foot and ankle strength.
– How barefoot shoes with a wider toe box can alleviate foot issues.
– Why runners shouldn’t avoid strength training.
– How overworking certain muscles groups while underworking others can lead to weaknesses and imbalances.
Connect with Aneesh:
Guest Contact Info
Links Mentioned:
dynamicathlete.com
Connect with Steven:
Website
Xeroshoes.com
Twitter
@XeroShoes
Instagram
@xeroshoes
Facebook
facebook.com/xeroshoes
Episode Transcript
Steven Sashen:
What if your doctor told you that the last thing you needed was surgery, and maybe the most important thing you need for recovery and dealing with whatever you walked in the door with is something different than what you walked in the door wearing? We’re going to be talking about that and much, much more on today’s episode of the Movement Movement, the podcast for people who want to know the truth about what it takes to have a happy, healthy, strong body. Starting feet first because those things are your foundation. We break down the propaganda, the mythology, and sometimes, frankly, the outright lies you’ve been told about what it takes to walk, or run, or play, or hike, or do yoga, or CrossFit, whatever it is you like to do, and to do that enjoyably, efficiently, effectively.
Did I say enjoyably? Trick question. Everyone who’s watched this knows that I always say that because if you’re not having fun, do something different till you are. You’re not going to keep doing it if you’re not enjoying it. I’m Steven Sashen, the co-founder and co-CEO, along with my wife Lena Phoenix of xeroshoes.com. We call it the Movement Movement podcast because we, that involves all of us, are creating a movement about natural movement, letting your body do what it’s made to do without getting in the way. The way you can be part of the movement is go to our website, for example, www.jointhemovementmovement.com. There’s nothing you need to do to join. There’s no secret handshake or song.
It doesn’t cost any money. That’s just where we have all the previous episodes, all the places you can find us on social media, and of course, the other places you can find the podcast if you want to pick a different place for finding your favorite podcast, but the gist is really simple. Give us a thumbs up or give us a five star review or leave a comment or hit the subscribe bell on YouTube. You know what to do. If you want to be part of the tribe, just subscribe. All right, so let us get started. Aneesh, a pleasure having you here. Why don’t you tell people who you are and what you do?
Aneesh Garg:
Thanks, Steven, for having me here. My name is Aneesh Garg. I’m at Dynamic Athlete Sports Medicine and Regenerative Orthopedics in Boulder, Colorado. What we do at Dynamic Athlete is look at everything from an injury standpoint, from a non-surgical point of view. When over 90% of the injuries you have don’t require orthopedic surgery, we’re hoping to be the very first place you think of when you get hurt.
Steven Sashen:
Now, let’s start with the fact that you started out as a real, I’m going to use a phrase that my grandmother used about my father who was a dentist. She would say, “He’s not a real doctor, he’s a dentist.” But in your case, you are a real doctor.
Aneesh Garg:
That’s correct. I think the biggest thing is noticing how do we get our athletes back to performing and doing what they want to do from a non-surgical route. The biggest thing for my background, I’m actually a two-sport US national team doctor for USA hockey and US soccer. I look after my athletes much in the same way I do for the national team players.
Steven Sashen:
People who come to you, do they have to be high level athletes or not?
Aneesh Garg:
Not at all, Steven. In our clinic we actually consider everyone an athlete. It doesn’t matter if you are 90 and you want to play pickleball, or you are a professional athlete or anywhere in between. The treatment is essentially the same for what we’re doing for the injury. The only difference is, how do we customize it for you and for what you’re trying to get back to.
Steven Sashen:
How did you make the change from, I’m going to now change it from real doctor to normal doctor, to this. Was there an aha moment or was there just an evolution in your thinking about how to treat people?
Aneesh Garg:
Steven, I tried really hard not to become a doctor and I know that sounds ridiculous.
Steven Sashen:
Dude, wait, hold on. You didn’t try hard enough because for me, it was pretty easy. I was a pre-med until I went, “Wait, they’re going to make me spend six more years in school before I can do the stuff that I’m already doing with clients? I’m done.”
Aneesh Garg:
Yeah, so it’s funny because my father’s a cardiologist and my sister’s a cardiologist and they’re brilliant. I grew up and I played baseball. Ironically enough, a first Indian born of my family and my parents were actually really, really lenient in the sense that they said, “Go do what makes you happy.” So, in college I played baseball.
Steven Sashen:
Hold on, pause there. Your Indian parents just said, go and do what makes you happy? Were they possessed in some way?
Aneesh Garg:
I’m telling you, I’m lucky, man. My parents are phenomenal and it’s really interesting because from religion to food or social, whatever it was, my parents didn’t do anything other than look after their kids and make sure that they were happy. My two younger sisters and I sought really whatever made us happy and what brought us joy. I think that’s maybe what got me into trying a lot of different things before trying medicine. I think that’s why I feel like I’m a better doctor that way because I feel like I can relate to people better. Sometimes when you have these different experiences, and I’ve traveled a ton, but I think the biggest thing was, like you said in the opening, if it’s not fun, I’m not going to do this anymore.
I love what I do and I think that’s really the biggest thing, is being able to try out all the other things that I wanted to do and I really felt like that wasn’t for me. Then, there was a time actually, and this little story, that I was coaching at a prep school in Ohio a couple of years after playing semi-pro baseball outside of Boston. One of my advisees had taken too much Tylenol and so they rushed her to the hospital and looked after. I just remember being on the other side of the window feeling really helpless. I think that’s what changed. I said, “You know what? I think I want to make a difference.” I think for that aha moment, I think that was probably it.
Steven Sashen:
What did you have to do? Actually, before I ask this question, I got to tell you a story speaking of parents, just for the fun of it. My parents, who were conservative Jewish parents, for years, most of my life was basically marry a nice Jewish girl. That was their admonition. When I introduced them to my then girlfriend Lena, and I said, “Lena is not Jewish, but how do you feel about her being your daughter-in-law?” My parents said, “In your previous relationships you started out happy and you got less happy. In this one you started out happy and you’ve been happier and that’s all we care about, so we are all for it.” I said, “Okay, where did you put my real parents?”
Aneesh Garg:
That’s right. That’s brilliant though. I think at the end of the day, that’s really what your parents want, is for your kids to be happy in that regard.
Steven Sashen:
Yeah, just sometimes they think that their idea of what you need to be happy is correct, and they may be right, but sometimes not so much.
Aneesh Garg:
I got asked to speak at my high school last summer and I joked, I thought they got the wrong sibling because my sisters are brilliant, frustratingly brilliant. I came back or they asked me to come back and speak. One of the things that a therapist once told me that he said, you need to give yourself permission to live your life. When I was going through a difficult time in Chicago, it was very, very freeing and almost liberating when you realize that you need to give yourself that permission to live your own life. It’s not anybody else’s. That’s what came to mind when you brought that up.
Steven Sashen:
I like it. Sorry, so backing up to your transition from normal, real doctor to regenerative medicine doctor, and I want you to dive into that a little more, and we will. What was it like, after that Tylenol moment when you’re thinking, wait, I got to change this? It’s not easy to, even if you’re basically staying in the same field, it’s not easy to change course.
Aneesh Garg:
Yeah, I think at that point I realized that I wanted to pursue medicine and what ends up happening is when you don’t pursue medicine early on, you have to take prerequisite courses. That had me going into Pittsburgh and studying there for a couple of years to do all of my pre-med requirements and then apply to med school. Then, the first year I did it in Arizona and then you’re in Brooklyn. It takes you on this very circuitous route sometimes if you don’t jump at it right away. I think the biggest thing is, when I’m doing residency in New Haven at Yale, the biggest thing that I noticed was there’s not a lot that’s fun in medicine, to be quite honest.
There’s a lot of what my dad does and my sister does from a cardiology standpoint. I don’t really find it all that fun. I knew that with my sports background and coaching that sports medicine was always an option. Then, you start to look at what you can do in the nonsurgical sports medicine world and that’s where you can do these biologics, which include bone marrow or as most people search for stem cells or PRP, platelet rich plasma. But I think a lot of it was to do with how do I make an impact from my athletes from a nonsurgical aspect, and that’s what led me to it.
Steven Sashen:
If you had to do your top three to top five things that people come in with and then top three to top five things that you do as non-surgical intervention, I’m doing this imagining people listening or watching, they’re probably thinking, “All right, what does that mean for me?” Give me the high level for what people come in for typically, and then the high level for some of the treatments, modalities that you would use.
Aneesh Garg:
Yeah, mostly it’s lower body stuff. Steven, I think with the population that we have here in Boulder where they’re doing a lot of running and a lot of climbing and hiking, it would be hip pain, it would be knee pain, foot and ankle pain, along with an upper body for the climbers. A lot of times we get shoulder, elbows, and hand and wrists. Really the only thing that I don’t do is spine from that standpoint. But imagine, if you’re running and you’ve got outside foot pain, these are some of the things. You look at a tendon that could be bothering you because of a various number of reasons, where it could be either pinching or getting stretched, and looking at that. That’s where some of the regenerative medicine can come into play and help.
Steven Sashen:
What are some of those interventions that you would use to be helpful?
Aneesh Garg:
Yeah, so it’s interesting. We just had a athlete yesterday actually came into the office and she’s 32 years young and has about three months of achilles pain. She just started running and training for a marathon and she’s developing this achilles pain. Sometimes you can get away with not doing any of these procedures, and that’s always the hope. We always talk about trying to maximize your recovery without intervention if need be. Be it surgical or nonsurgical. Really, if you can figure out a way to change your training. We talk a lot about runners, we don’t stop them, we just augment their training so that way they can actually heal and recover themselves. But we talked about putting her in a boot for a couple of weeks to see if that’s going to help her.
If that doesn’t help, then the next step would be a various combination of platelet rich plasma and platelet poor plasma, which is something that would be unique for her in her setting.
Steven Sashen:
For people who don’t know what PRP, platelet rich plasma is, can you describe that?
Aneesh Garg:
Yeah, so when we talk about PRP or platelet rich plasma, what we’re doing is drawing blood from your body, hyper concentrating the healing factors and growth factors, and then reinjecting them back into where your injury is. Now, the key is anybody can say they do PRP. Steven, you can go get a kit tomorrow and you can put up a shingle and say, “I do PRP.” You can charge, well, let’s say for the sake of conversation a hundred dollars. Now, it really matters on who does it.
Steven Sashen:
Sorry, wait, I got to interrupt. I’m very disappointed to the extent that we know each other that you think I would merely charge a hundred dollars
Aneesh Garg:
For the sake of the conversation, right? Yeah.
Steven Sashen:
Just for the ease of math, but please don’t insult me like that.
Aneesh Garg:
I’m not a math guy, so I think it’s something that lets me play easy numbers here. Yeah, so we’ll play say a hundred dollars, and I actually use my 18-year-old intern who just graduated from high school who’s going to Wyoming. She’s a big time runner. I use her a lot and I always say, “Well, if Rachel grabbed a kit or my athletic trainer Caitlyn, if she grabbed a kit and they charge a hundred dollars, and people would gravitate towards that lower price point and say, “Well, PRP didn’t work for me.” I always ask them and I said, “Well, who did it? How did they do it? What was their pre-procedure protocol? What did they do in the procedure? What was their post-procedure protocol and what was the follow-up?”
Then, Steven, people look at me like I’m speaking a foreign language to them, because they have no idea. Therein lies the challenge because people will come in and say, “PRP doesn’t work for me.” But then, there’s a lot of other factors that go into it.
Steven Sashen:
Interesting. I had another thought that went along with that, but I lost it entirely. Oh, actually, I know what it was. For this person who came in with an Achilles issue from running, you didn’t say the thing that I was frankly hoping you would say. It’s the kind of thing that, it’s an argument I have with doctors who are anti-barefoot, if you will, for lack of a better term. The way they do it is they usually say, “I love this barefoot running thing. I’m seeing so many more patients, it’s putting my kids through college.” I go, first of all, that’s what you guys said in 1972 when running shoes started getting popular.
Secondly, when someone said they were running barefoot, did you actually ask them if they were in bare feet or if they were in a shoe that was called barefoot? I don’t know why I put that quote around called, called “barefoot”, and is actually not. Did you analyze their form? Because it’s really not about footwear, it’s about form. Did you take a look to see how they’re running? That’s when the blood leaves their face. I go, so look, first of all, there are more people trying this than ever before. You’re never going to hear from the people who have no problems. You have a skewed sample set, and if there’s more people doing something, you’re going to see more injuries, to your point that you made before, pickleball.
Everyone’s doing it, more injuries than ever, and people are calling them pickleball injuries, which technically they are, but they’re really just injuries from something where more people are doing it that were not doing anything before and now they’re doing something. But even then, to call it a pickleball injury is a little bit of a misnomer. They got it while playing pickleball, but the question is what were they doing while playing that caused it? To that point, if it were me with that patient, I’d want to do some gait analysis to see what’s going on.
Aneesh Garg:
100%, I think you’re spot on. I think that really the big thing that we try to do at Dynamic Athlete is understand what you have and why you have it. That’s really the big thing. I think I told you this before when we met, that I think I’ve been looking at shoes wrong my entire life, my entire life. Think about this, having grown up playing sports, having worked with the national teams that are sponsored by different shoe companies and looking at this and having grown up wearing these other companies. I remember looking at this and fundamentally looking at footwear, I think I was looking at it all wrong. I think that’s the biggest thing that I noticed.
For being a proponent of barefoot shoes, this athlete yesterday was not actually in barefoot shoes. That’s one of the things, the entire office is outfitted in Xero shoes because we made that change. My parents are in those shoes. In fact, they came to visit a couple of weeks ago, and it’s almost like installing a program or installing something different where there are some skepticism to it. But when you start to have them feel the difference, and I think that really speaks for itself. But to your point, so seeing this athlete who just started a running program and the things that, when we ask about footwear and other brands that have a higher cushion amount and actually elevate you off of the ground.
I think that’s really the biggest thing from proprioceptive standpoint, balance and gait, is how close can you get to the ground that you are impacting with or interacting with, if you will. The equal and opposite force and reaction. When you look at this, and we have synthetic turf in our office, so we have people walk on that turf with their regular shoes and then walk on with barefoot shoes and I say, “Okay, which one do you feel more stable?” They’ll put on Xero shoes and they’ll walk on and they’ll say, “You know what? I feel more stable and more secure in these Xero shoes.” I ask them why and they said, “I can feel the ground more.”
To me, that was the biggest thing is when you’re doing that, it’s almost like you’re doing physical therapy by just walking around. We talk about that. How do you build foot and ankle strength? If you’re wearing barefoot shoes, you’re building foot and ankle strength.
Steven Sashen:
First of all, glad you saw the light. Secondly, I love the phrase like installing a new program, but I’m a little dismayed because it sounds like you may have just called us the MS-DOS of footwear.
Aneesh Garg:
No, no, no, no. I almost look at it like installing a program, you know when you’re a head football coach somewhere and you install it?
Steven Sashen:
Well, no, I don’t. But, okay, I’ll run with you on this one.
Aneesh Garg:
Say that you’re installing a program and it’s a sense of, we like to challenge the way people think in our office. I think that’s really what it is, and say, we have people try this on like a jacket and if it fits you, great, and if it doesn’t, it doesn’t. But it’s about challenging the way that you think. If you think about this, if that conference where I learned about barefoot shoes more in-depth, if I wasn’t open enough to say, “Hey, I might be looking at this wrong.” Then, I never would’ve been open enough to what I feel like is do a better service for my athletes and my patients. I think that’s what we try to do.
Steven Sashen:
Well, backing up a half a step, compared to what you’re thinking now or now that you’ve had this understanding that you’re describing, how were you seeing footwear prior to that?
Aneesh Garg:
Me, it was essentially opposite. It was more of, if we can cushion and use stabilizing shoes, that might be better. For example, plantar fascia, I think I was looking at it all wrong where I was trying to get them stiffer shoes and shoes where it wouldn’t affect the plantar fascia as much. Now, I look at this and the only thing I would ask them to do is make sure they get their feet analyzed, make sure they’re in the right shoe, make sure potentially they want a half size larger just to give themselves a bigger toe box. Now, if you think about it, barefoot shoes have that wider toe box already as part of their nature and as part of that foot anatomy essentially covering the basic foot anatomy.
It wasn’t an issue of the plantar fascia itself, it was more an issue of the footwear squeezing the foot and essentially squeezing that plantar fascia to the point where when it’s getting stretched out, it’s causing problems. That’s where I think most or majority of the physicians and the people that look at this are looking at it incorrectly. That’s where that came about.
Steven Sashen:
I had a variation of that where I met someone, he was a very big deal investor. This is very early on. We had barely started the company, frankly. He said, “I love the idea of what you’re doing, but I can’t wear your shoes.” I said, “Why?” He goes, “Well, I have plantar fasciitis.” I looked at him, I said, “I got a sneaking suspicion you don’t.” He goes, “Well, my doctor’s one of the top doctors in Vail.” I went, “Yeah, even still, I was a pre-med. I can tell you that my friends who actually went to medical school we’re not the smartest guys that were in the room. He may be, but FYI.” I said, “Just out of curiosity, can you just get up on your tippy toes?” He said, “Yeah.” I said, “Does that hurt in any way?”
He goes, “No.” I said, “All right, yeah, you don’t have plantar fasciitis. Secondly, can you just, while you’re on your tippy toes, just bounce back and forth from foot to foot so you’re running in place, but just on your toes?” He goes, “Yeah.” I said, “Does that hurt at all?” He goes, “No.” I said, “So, once again, you don’t have plantar fasciitis. Now, while you’re bouncing back and forth, lean forward just a little bit and see what happens.” Of course, he starts running and I hear him just going, “What the fuck?” As he runs away. I said, “What you have is tight calves that are giving you the symptoms that mimic plantar fasciitis.
If you just spend a little bit of time just walking around in our shoes or just getting out of shoes entirely, you might discover that you’re actually okay. You need to rest and you need to stop using things too much and loosen up those calves.” He still got surgery. This is the part that blows me away. I’ve seen this happen.
Aneesh Garg:
Well, this is why we’re here, Steven. We want to be a resource for the community. I think this is the thing. My athletic trainer said to me. She was working with a division one college before she came to work with us here, and she said, “It’s amazing how many surgeries college athletes need.” I said, “Caitlin, I think you phrased that wrong. It’s how many surgeries they get, not necessarily need.” I think, Steven, I think that’s a great point. That’s why we talk about even in all of our materials, that over 90% of the injuries don’t require surgery. I say this a lot where if you have a heart murmur, you don’t go see a cardiothoracic surgeon first. Why do you do that with the rest of your body? That’s where we are from a resource standpoint.
Steven Sashen:
Well, and I do want to highlight and acknowledge/appreciate something about you, and that is that 90% number, many people who are doing something that is a little non-mainstream. I don’t want to say alternative because that’s a whole different can of worms, but non-mainstream. They get a little myopic and a little in their own little box. The fact that you keep reiterating 90%, I love because as a personal example, when I showed you the MRI results or the radiologist reports about the MRI from my shoulder, which had been causing me a bunch of problems, you called me and said, “Yeah, you know I don’t recommend surgery, right?” I said, “Yeah.” Your next response was, “You need surgery.”
I like that you understand, you’re able to look at people and understand what they actually do need or don’t need, rather than having just a fill in the box, mad libs checklist, paint by numbers approach to things and seeing everything is a bunch of different nails all needing a hammer.
Aneesh Garg:
I’ll tell you, that’s what’s fun about this Steven, right? I say this a lot. As soon as it becomes not fun anymore, I’m leaving. I’m not going to do it anymore. That’s the beauty of it, where I feel like my training at Andrews in Birmingham, Alabama, it’s one of the best places you can go for sports medicine. I got to work with a lot of the top orthopedic surgeons in the country. For me, to know what surgical indications there are is really important because I look after my athlete and whatever’s best for my athlete, either it’s a non-surgical route or it’s surgery, it doesn’t really matter. It’s not about me, it’s about the athlete in front of me. In your case, there’s people that’ll tell you, “Oh, I can fix this with PRP or I can fix this with some-”
Steven Sashen:
Oh, and there were.
Aneesh Garg:
Yeah, and to me, I don’t think that’s the best thing for you. Certainly, I think that the route is you look at, and that’s why I say, if you start from a non-surgical standpoint, because the surgery will always be there. There’s no problem with that. That’s always there. It’s really tough to go back once you’ve had surgery. That’s what we try to impress upon our athletes. Like I said, we call everybody an athlete. Just because you guys are hearing me say athlete and you feel like you’re not one, I will respectfully disagree when you come into our office because we treat everybody like an athlete.
Steven Sashen:
For people who are not living in or near or traveling to Boulder to be seen by someone with the outlook that you have, what would you recommend for them? If they have whatever issue is going on, how would you recommend someone proceed to, I don’t know, take their own health under their control to a certain extent, to identify what kind of practitioner they should see? How they might want to approach someone to find out what kind of practitioner they are, et cetera? What would you do if someone can’t see you?
Aneesh Garg:
Yeah, it’s funny because I’ve actually gotten some calls from people in Chicago for where I was practicing. They were asking me the same question, and I actually ended up seeing them just from a virtual standpoint. But I think if you do your homework, really one of the things that you look for is, has somebody done a sports medicine fellowship? I think that’s really a big key. If you look for a non-surgical sports medicine physician in your area, that’s one. See where they did fellowship and did they do a sports medicine fellowship. See what that fellowship background is, because I can give you insight as to either… There are some places that say they take care of athletes and there are some places that just take care of athletes.
It’s really one of the things that you have to look at. But I think that’s really the big key, is finding somebody with that background and also doing a little bit of your homework. Listening to podcasts like this that have specialists and people that are pretty well versed in what they do. Steve, I tell you a lot, there’s a lot of things I don’t know, but I think you try to hone in on the things that you do know. That’s going to be my best advice, is make sure you try to find somebody that has that background in your local area, or you can certainly call around. But I think that’s going to be the best bet.
Steven Sashen:
A lot of what we’ve talked about is ameliorative, that’s a word I don’t think I’ve ever said out loud. I know what it means.
Aneesh Garg:
You and me both.
Steven Sashen:
Yeah, it’s a good one. I remember when in high school there was a couple of words that we learned that if we use them in an English paper, we were guaranteed to get an A. Ameliorate was one, exacerbate the opposite, was another. Contrapuntal, so you could make-
Aneesh Garg:
Oh, I’m going to write these down and look them up.
Steven Sashen:
Ameliorate, make it better, exacerbate, make it worse. Contrapuntal, they used to seemingly-
Aneesh Garg:
It’s that last one that I think you got me on.
Steven Sashen:
Oh, contrapuntal is a good one, counterpoint.
Aneesh Garg:
Okay.
Steven Sashen:
That’s where that comes from. There was one other that literally someone cracked the code with this one teacher. It’s hysterical. We’ve been talking about the post-injury side of the equation. Do you have any thoughts for people about anything preventative?
Aneesh Garg:
A lot of this stuff that we describe, so I’ll give you an example for runners just in the sense that runners are a different breed altogether. When you try to tell them to cross train, their idea of cross-training is just running potentially on uneven ground or doing something else like that. There lies the challenge. I often talk about this one foot box, where just if you draw out this one foot box and you think about triathletes where they swim, bike, and run, their whole body stays in that one foot box. Now, I take care of hockey players and those boys and girls will skate side to side and they get out of that one foot box. When we cross train and try to figure out injury prevention, a lot of that has to come from the hips and the stabilizers.
We’ve talked a lot about this, that this is, from a running standpoint, there’s a bookend foundation piece where the one side of the bookend is going to be your feet and the type of footwear that you wear. The second side of the bookend is going to be your hips and your hip stabilizers. Essentially, the rest of your upper body shouldn’t be staying relatively still or quiet as we like to say. That’s going to be the biggest piece. When we talk about cross-training, people don’t like to work on their core and hips, Steven, you know why? Four reasons. I will tell you why. One, it’s hard to do. Number two, it’s not sexy. Number three, it’s hard to do. Number four, it’s not sexy.
I told you I’m not a numbers guy, but that’s really the reason why. This is the problem. Everybody likes to look in the mirror when they go work out and do all this stuff, and it’s those small subtle things that make the biggest impact.
Steven Sashen:
I think you’re onto it ish. It’s definitely hard to do, but they’re not sexy since strong and bigger butts have become a big thing, I would argue that runners think it’s not sexy because they’re afraid of getting bigger. They’re afraid of putting on weight, they’re afraid of things like that. I used to be just amazed, I’d be on the track with this one coach and his athletes who were all Olympic level athletes, and they could barely do a pushup. They were using a kettlebell that was like two pounds and straining to do it. They couldn’t do a squat to save their life, let alone a deadlift. Now, they were great runners, but I used to argue with this coach, I’d say, “They’d be healthier runners, they’d have longer careers if they were stronger, like legit stronger.
Why don’t you just give them two days a week where the training volume is at best nominal, if not nothing, and let them get stronger for real?” You could see that there was no way he was going to do it because, frankly, he was under the misapprehension about what he was offering his athletes. He basically attracted one really good athlete to him that he didn’t destroy. That athlete did really well, and then suddenly a lot of other people came to him. He felt obliged to stick with what he was doing despite the inefficacy of it.
Aneesh Garg:
I think a lot of this comes down to, how do you customize your training for the athlete in front of you? We do genetic testing on our athletes. I’ll give you an example. Imagine if you want to improve your output or you want to improve your time by 1%, 2%, that makes a big difference in terms of understanding how it’s customized for you. To your point about strength training, it is remarkable to me that if you stay in that one foot box, that how you continue to overwork one subset of muscles and then under work another subset of muscles, which essentially ends up developing a house of cards, and that’s when you crumble. I’ve taken care of triathletes that work out eight hours a day and I tell them that their hips are weak.
Steven, they look at me and they go, “What are you talking about? I work out eight hours a day.” I can then push their leg down with one finger. I said, “You are over training one and under training the other.” I said, “You would become a more powerful runner, just think about that. Not even better, just in terms of pure power, you’d become a more powerful runner where you’d actually be able to recover faster. You’d be able to maintain and handle that mileage in that way because you are stronger and more powerful.” To your point.
Steven Sashen:
Bill Sands, Dr. Bill Sands, he was the head of biomechanics for the US Olympic committee for a while and then had a lab out at what’s now called Colorado Mesa University, and he said the same thing. Basically, glute medias on almost all runners was underdeveloped, and he would do something very similar and shock people when he showed them that. But glutes in general, actually, even glute max, I’ve seen so many distance runners who just have no glutes at all. They just don’t use them.
Aneesh Garg:
When I was in residency, I used to joke around, I said, you could probably solve all the world’s problems if everybody just worked on their gluteus medius. Maybe less cranky.
Steven Sashen:
Yeah, you’re not too far off probably. I think there’s a there there. In fact, it’s something that happens to me. I have a lot of good runners in my neighborhood, like very good runners. I’ve also got a lot of not very good runners. I saw something the other day that blew my mind. A woman ran by me and her left leg looked basically fine. Her knee was tracking forward. She wasn’t over striding. Everything was in line. Her right leg, she had valgus, so her knee was coming in about to hit her left knee. Her right foot was pointing out at the same time, knees pointing in, foot’s pointing out, and just the gait looked weird on top of that.
Then, I noticed she was a little bit overweight and I noticed that her left glute looked normal and her right glute did not exist. Now, I don’t know if she had had surgery, had some neurological problem, whatever, but it was so tempting just to stop her and say, “Do you know what’s going on here?” Fundamentally, that thing of watching runners where their knees are coming in towards each other is just the surest sign that their glutes are not functioning at all or barely. I know Irene Davis, when she get people into her lab to help them get better, the first thing she does is get them out of regular shoes and into shoes like ours. The second thing is doing gait retraining by focusing on people learning how to use their glutes.
This is leading to a very entertaining question. When you’re walking around town and you see people running by you who have something like that going on, what happens in your mind? I’ll tell you what happens in mine after you.
Aneesh Garg:
Oh, I’ll tell you. My fiance, Nicole and I, we travel quite a bit whenever we can. I feel for her because when we’re in airports or when we’re walking around and just people watch as one does, and I’ll say, “Oh, look at that poor guy. Watch his feet and watch the way that he’s walking here.” Or, “Oh, this poor girl, her knee is diving inward.” Like you say the valgus knee. You just start to look and you start to appreciate, and then you start to look at what kind of shoes are they wearing? You look at what’s their walking mechanism and what does their gait look like? Are they heel striking rather than using their whole foot?
I think the biggest thing when I put on the Xero shoes was noticing that I was a big heel striker. Changing the way that I walked in terms of being more upright and being more using my core and understanding that look, your core might not be that strong, and then having to work on that. I think that’s really a big thing. We break down, it’s gotten to the point where I think Nicole can probably do my job at this point. She’s been so good at that. But I think that’s really the biggest thing, Steven, is that you look and you start to see these patterns. They happen over and over again. Then, you start to correlate them with body size or shoe or the way they’re working. To your point, you can start to see what muscles are developed and what muscles are underdeveloped.
Steven Sashen:
Yeah, next time, Danny Dreyer, the guy who created Chi Running us in town, the three of us will go sit down by Boulder Creek and have entertaining time. When Danny and I lasted that literally as everyone walked by, you could hear both of us go, “Jesus.” There’s people that we almost wanted to tackle and just stop and just like, “You’re going to be hurt by the time you’re done with this run if you keep doing that.”
Aneesh Garg:
Yeah, my athletic trainer says, you should just throw cards at people and just have them say, look, we’ll see you Monday at 10:00 o’clock.
Steven Sashen:
It’s not a bad idea. Variation on that. When Born to Run came out, the book, I took business cards and every time I’d walk by a bookstore, I’d go in, I’d find copies of Born to Run and put my business card in as a bookmark.
Aneesh Garg:
Oh, it’s a beauty idea. Actually, Steven, can I tell you one thing?
Steven Sashen:
Yeah.
Aneesh Garg:
I don’t know if I should really say this out loud because I actually really want to do this, but I want to go to a baseball game and sit in the upper deck and have a whole bunch of business cards and just when I do the wave accidentally knock them over, so it just snowfalls upon all the people. Anyway, if you see that happening in the future, it was an accident.
Steven Sashen:
Yeah, no, I would not recommend that at all. Nor would I recommend having boxes scattered around the stadium so that it might happen. Other people might be similarly clumsy. That would be a horrible thing that I would never recommend.
Aneesh Garg:
I don’t condone that, just it would happen in the dream.
Steven Sashen:
Nor would I replace a T-shirt in a T-shirt gun with a bunch of your business cards just by accident, because you never know. Definitely, oh, I was going to make a horrible joke. I’m not going to do that one. If anyone needs to hear it, you can email me and I will tell you.
Aneesh Garg:
Yeah, I was going to say, we can do that off air. That’s fine.
Steven Sashen:
Yeah, it’s pretty rude. Anyway, so there was something else I was going to say about that. It’s funny you mentioned Nicole being able to do your job. Lena from hanging out with me, same thing. She’s starting to see people and identify movement patterns. It’s the same idea. This is the thing that’s just so crazy for me, I liken running to writing. What I mean is that everyone thinks they can write because they had to write a paper in class or whatever it is. Same thing, everyone thinks they can run because you can run, but that doesn’t mean you’re doing it correctly. It’s like no one would think that if you want to become a better bowler, you don’t need a lesson about how to bowl differently than holding the ball two hands and throwing it between your legs.
Or, even if you’re using one hand and you’re crossing your fingers rather than having a hook that’s designed to pin just right. But when it comes to running, people think all you do is get some shoes and away you go. Even worse, they think if it’s not working, they just need a different pair of shoes that are fundamentally the same. This is the mindset that I’m wrestling with, if you will, or trying to deal with, overcome, et cetera. From your perspective, as a regenerative medicine specialist, is there something similar about the way you’re seeing things, the way you’re looking at the way most medicine is practiced, the way most people think about medicine, how you’re really trying to upset that applecart or engender some new thought?
Aneesh Garg:
Yeah, I think the way medicine’s taught, and I find this a lot with the students that I take, it’s pretty antiquated. It almost seems like it’s more about the physician rather than the patient and the athlete in front of them. I always say this a lot, that I’m really proud of where I went to school and the level of training that I’ve gotten, but at the end of the day, Steven, it’s two people talking and trying to figure out how do we get the person in front of me back to what they’re doing? To your point, when you look at different shoes, and one of the things that I’ve asked my runners to do actually is to get two different styles of shoes.
Now, if you think about this, it has to do more with the pressure of what you’re actually exuding up into your body off of the shoe than the actual shoe itself. What do I mean by that? Imagine if you are using the HFS and the Prio. Rather than running, and I say this, they’re stylistically different, so they’re going to put different pressure points on your feet. My preference would be actually to alternate those shoes every other day, so that way you’re essentially giving your body a day off from that direct pressure point. If you’re just running in HFS every day, then I don’t think you really get yourself that off day, if you will. That’s just philosophically what my suggestion would be for my runners.
Steven Sashen:
That’s interesting. There’s a footwear and biomechanics researcher named Benno Nigg. He’s in Canada. I’m trying to remember where he came from, somewhere in Eastern Europe, if I’m remembering correctly. But he’s been here for most of his life. Anyway, he is often misquoted, and the way he’s misquoted is that running shoe companies say, “Well, Benno says everyone has a preferred movement pattern that you can’t change, so we’re making shoes for you, unique little special snowflake.” I confronted Benno with this, and he said, “Well, that’s not what I say. I say, you have a preferred movement pattern and you don’t want to arbitrarily change it.”
Now, I argue with him about that too, because you may have a preferred movement pattern that, A, is already influenced by the shoes you started wearing when you were a kid. You’ve gotten used to that one, preferred. He’ll say it’s using the least amount of energy, arguably, but only because if you’re learning a new movement pattern, it’s going to take more energy to use the new one because your brain is wired into the old one. That’s misleading as well. The other thing is to suggest that arbitrarily changing a movement pattern is always going to be detrimental. Makes no sense to a gymnast where every movement pattern you learn is something novel, it has to be.
Even for running, you look at, it’s fun, you look at a video of Usain Bolt running in slow motion, and you go, “God, that’s amazing. Look at his form.” Then, you look at the other seven runners in that race, and they all have the exact same form, and they didn’t start that way. You look at them when they were kids, they learned to run that way, and that’s what made them along with great genetics and great training, the fastest people in the world.
Aneesh Garg:
Well, the other thing too that, Steven, just to jump on that is if your strength doesn’t allow you to have a different movement pattern, then you are going to be in that movement pattern. Imagine if you cross train and you are stronger, and you look at how Usain Bolt from a strength standpoint versus some of his competitors. He’s a guy that can play various sports just based on his physique. To your point, a lot of it has to do with, if you can make yourself a more powerful runner, really you can start from bottom up and making the foot and ankle as strong as possible. That’s going to propel you into being able to do some of these things.
Because if you have more stability with your foot and ankle, your output in the gym and your output in actually trying to get stronger with your legs and your glutes and your core, because you feel more stable on the ground, is vitally important.
Steven Sashen:
You and I have talked about this because of your involvement with hockey. We have professional hockey players who say, “I’m skating better than ever because as soon as I get out of my skates, I’m putting on your shoes.” That’s translating to mostly accelerating and jumping, which is relevant for them, and it makes total sense. But back to Benno’s point for the fun of it, just to land on that, I said, “Are you suggesting that if someone… ” Oh, and the idea that you can’t change your gait, again, misrepresented. He’s saying you don’t want to artificially change it. But the way running shoe companies have misrepresented that is, again, they need to make something special for you.
I said to Benno, “Are you suggesting that people’s gait wouldn’t naturally change if they switched into Xero shoes or went barefoot?” He goes, “Oh, no, no. It would change instantly. What I mean is that with the running shoes that are out there for most people, they’re all basically the same. It’s not going to make a difference.” The only difference happens as they wear out, but fundamentally, they’re all doing the same thing, so it really doesn’t make a difference. It amazes me how that information has not, well, again, has just been misused in ways that blow me away. I harp on this one, so pardon me for anyone who’s heard me say this a million times, but my favorite and by favorite I’m putting air quotes around that.
I really mean least favorite, bit of information that has done nothing is on their website Nike has published the abstract or part of the abstract of a study that they designed and commissioned, where they took their bestselling running shoe and they compared it to a new shoe they had developed. It was a 12-week, half-marathon training program. In the 12 weeks, the people wearing their bestselling running shoe, over 30% got injured in that 12 weeks. In the new shoe, only about 15% got injured in 12 weeks. Now, imagine going to a running shoe store and saying, “Hey, I’m looking for a good shoe.” They go, “Ah, here’s our bestseller. One out of three people who wear this will get injured within the next 12 weeks.”
It’s like, can you give me something better? Okay, here’s a better one. Roughly one out of seven people get injured in 12 weeks. It’s like, do you have one that isn’t going to injure me? That would be my favorite. But the kick is, Nike proved that after 50 years of development and research and all the things that have gone into making their latest shoes, the best they’ve been able to do is get one out of seven people injured in under 12 weeks. By the way, if you ask what they changed in the better shoe, “better shoe”, they say, and this part they didn’t publish on their website, we removed many of the protective features.
Now, here’s the kick. If 15%, let alone 30% of the people who switched to Xero shoes got injured in under 12 weeks, not only would we be out of business, but I’d probably be in jail. How people have misused information or how big companies have misused information and basically made people unwilling to look at data in a way that should make them go, “What the. This is not okay.” That just blows me away. Clearly, there are similar things happening on the medical side, whether it’s mainstream medicine or “alternative medicine”.
Aneesh Garg:
We talked about this, and I think one of the things that sometimes is antiquated in medicine is, “Well, this is how it’s been done and this is how we’re going to do it.”
Steven Sashen:
Right.
Aneesh Garg:
Not having the openness and being, I think, really securing yourself to say, “Okay, well, could I be looking at something incorrectly or to continually be trying to find better things or better options?” When I walk into the conference and say, “You know what? I may have to look at this differently.” Then, go try it on myself, and I was wearing Nike Pegasus, those were my shoes. I remember putting on the Xero shoes and just walking around for five minutes, and then putting on the Pegasus again and my feet, it felt like my feet were begging to be back in the barefoot shoes. Now, we said this, I’m not that tall. I would love the extra height advantage in those Nike shoes.
But at the end of the day, it’s about what’s right for what my foot and what my body feels better and more comfortable in. But to your point, Steven, it comes from being open and having a willingness to experience change where it’s to your benefit, because it’s really easy to just stay in your shoes for the rest of your life and find some other reason. But these are opportunities missed if you’re not open to these ideas that have been around for a while, but just have been overshadowed by a big marketing budget and athlete sponsorships and things like that.
Steven Sashen:
PS, you’re already engaged. You don’t need to be an inch taller.
Aneesh Garg:
Fair enough. No, that’s why I like wearing my hockey skates, right? I’m six foot tall in the hockey skates, but we were talking about this, that hockey skates are minimal issues at its core. There’s nothing there. You look at soccer cleats. The two sports, the US national teams that I’ve taken care of, hockey and soccer, both of them are essentially minimalist shoes. One with a blade on the bottom and one with cleats on the bottom of it.
Steven Sashen:
Well, except that soccer shoes typically bind your feet like crazy and you have really pointy toe boxes. Some people will argue, well, that’s for better kicking and having more control. It’s like, well, then tell it to all those kids, including many people who are now playing professionally, who grew up playing barefoot.
Aneesh Garg:
Correct. I think you’re going to see a shift there. I think that’s where you’d see a shift. But my point is that when you wear the barefoot shoes prior to going on skating, I’ll use myself as an example. I’m a terrible skater, and I continue to try to get better at it, but one of the things that I noticed was when I wore my Xero shoes prior to skating, my feet didn’t hurt as much and I felt stronger on my skates. Now, it takes somebody that knows what they’re doing on skates and translate that. Then, on top of that, you have these kids that are skating, eight years old, nine, 10, 11, 12, that have very weak foot and ankle strength. Imagine putting them in these shoes and then having them play, you are going to accelerate them.
It’s the same thing across any other sports. When I talk to families or parents, these are some of the things that they see, and this is not coming from a salesman or anything else like that. This is coming from somebody that’s looking out for your best interest and seeing what we can do to get to your optimal potential.
Steven Sashen:
Yeah, there’s a lot to be said. Well, first of all, again, we hear this all the time from… Actually, I’ll say it differently. Our friend, Dr. Emily Splichal, who’s a surgical podiatrist, had a course that she was selling that I think was called Catwalk Confidential. It was basically how to walk in high heels, except it was a lie. It was really a foot strengthening program, so you could tolerate walking in high heels. She’s all barefoot all the time, but she realized that there’s women who are not going to get out of their heels, so what do we do? Let’s build some foot strength so you can handle it.
Aneesh Garg:
Right, and we talked about this, that this isn’t something that you have to go run five miles in. You could wear these shoes around in your day-to-day activities and build foot strength that way. There’s other companies that have talked about, there’s one company in particular that talked about a very large rocker bottom type of style shoe that said it was a workout while you were walking, and it’s essentially quite the opposite. I think everybody in the audience knows who I’m talking about.
Steven Sashen:
Well, here’s the thing, they’re right for the wrong reason. It was a workout to use their shoes, because they weighed so much.
Aneesh Garg:
Yeah, and you were walking. That’s the other thing too. For sure, we talk about the number of steps that you need to have it be beneficial, but I think that’s the challenging part. I’m not saying that this is a workout for you when you wear the Xero shoes or barefoot shoes in general.
Steven Sashen:
Yes, I’ll say it.
Aneesh Garg:
Well, it’s more of a strength program is what I look at it. I guess maybe I’m incorrect. You can look at it as a workout, but not in the sense that that other shoe company was talking about.
Steven Sashen:
Oh, yeah, yeah. No, no. The research, look, it’s not even about the research. It’s simply it’s this, it’s use or lose it. If you’re not using something, it’s going to get weak, if you’re using something, it can get strong, that’s the bottom line. We just let your feet move. If they haven’t been, that’s going to make them stronger, and that’s what the reason-
Aneesh Garg:
This is why in my office, Steven, I have my students, they’ll come in and say, “Well, let’s just rest them for a little bit.” I said, “Rest is usually the wrong answer in my clinic.” Unless something is broken, it’s a different situation, but a lot of it is going to be augmenting what you do, which is what I talked about at the top of this, was augmenting what you do from a training standpoint. When you wear these shoes, you are augmenting your training because you are changing the way that your foot and your ankle, and it comes in contact with the ground underneath you.
Thereby, building strength when you are just in the grocery store walking around, or you’re with your kids or you’re doing whatever you want to do. You’re continually using those intrinsic muscles in your feet that will help stabilize you when you are running or when you’re doing other things.
Steven Sashen:
Yeah, we’ve even had cyclists who report, they’re putting more force into their pedals, getting more watts out when they’re in our shoes instead of clipped in. I said, “Yeah, it’s because the cycling shoes you’re wearing basically make your feet just a brick that you can only control with your ankle. You’re not really getting that initial force that you can use by using your foot correctly, nor are you getting the signals to the upstream muscles, both anterior and posterior chain, your quads, your glutes, your hamstrings, et cetera.” That’s part of what your foot’s trying to do, is to tell those other muscles, “Oh, yeah, get ready.” And you’re not doing any of that.
Aneesh Garg:
No, even neurologically, so if you look at the neurological connection, the proprioceptive connection that you get with the bike or the ground. We have hockey players that don’t even like to wear socks, Steven, because they don’t want to have anything that is coming into contact besides their foot into the skate and into the blade. It doesn’t surprise me because those players say, I feel more powerful, I feel like that neuro connection is so much stronger. You actually are getting more whole body experience because you’re going from foot to your brain and back. I don’t think you do that with other shoes that have so much padding.
Which is why I put my parents in these shoes as they’re getting older, and you look at injury prevention. Now, I’ve talked at both spectrums here, Steven. I’ve talked about the eight, nine, 10-year-old who’s got weak ankles. From a foot strength standpoint, now I’m talking about my parents, and my dad’s in his 70s, and so he’s got bad arthritis in his knees. But I put him in these shoes and you could see a difference in the way that he walked. He felt more stable. If it’s good enough for my parents, it’s good enough for everybody else that’s out there, in my opinion.
Steven Sashen:
I think your parents are definitely the yardstick by which all things should be measured.
Aneesh Garg:
I told you, we talked about how lucky I am, but that’s the thing, you want the best for the people that you care about, and that’s what I did. To see him be able to move more confidently and more stable is a thing of beauty because now he can go enjoy what he wants to do much more. That’s the full spectrum, Steven, and everybody in between. I think that’s really the big thing. You could be a runner, a pickleball player, you can be a climber, I think it’s the same thing. You look at climbing shoes, for example. What are climbing shoes? They’re essentially the same.
Steven Sashen:
The difference, again, if you’re a serious climber, squeezy, pointy toe. Then, actually, it was really fun. I watched some videos with Alex. I can’t even remember how to say his last name, guy who climbed El Cap, free soloed El Cap.
Aneesh Garg:
Oh, I know who you’re talking about.
Steven Sashen:
Anyway, I’m horrible with names. You’re looking it up? Good for you.
Aneesh Garg:
I am. Yeah.
Steven Sashen:
Well, while you’re looking it up and then you’ll say it, I’ve watched him do different climbs and talk about which shoe he wants for different climbs.
Aneesh Garg:
Alex Honnold.
Steven Sashen:
Honnold, thank you. For some, he’s looking for something really flexible, and for some he’s looking for something really stiff. Depending on whether he needs to jam his toe into something and use that as a lever versus get a grip on the rock. That was really, really cool to see. My favorite thing to a point you just made is we’ve been testing out some shoes with some pro basketball players. Man, they know so much about their feet, but they didn’t know
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