How Your Feet and Spine Impact Your Health

Eric Gordon, MD

Welcome everyone. Today I’m speaking with Dr. Yonatan Whitten, is a someone I’ve known for a while and someone I deeply respect for understanding how important the physical body is. And that’s something that you all know, I think is often ignored in this world of chronic complex illness. You know, how we stand, how we move has a lot to do with how our how feel and how our immune system feels. We’re going to go through a bunch of different parts of the body, but start off with first how Dr. Whitten looks upon what we can do to return ourself to a more normal state, a more normal sense of life. 

So welcome, Yonatan, and really a pleasure having you. And because we were talking a little before your idea of people getting back to a sense of being normal.

Yonatan Whitten, DC

Yeah, it’s first of all, thank you so much for having me. Pleasure to be here with you. Yeah, like we were talking about before you pressed record there, there’s this common thing that happens with people with chronic illness where they really end up getting bogged down with all the different doctors and experts and test results that they go through and they have this long list of labels that they associate with their condition.

Oftentimes there’s not a lot that they can do about those labels. And so this concept of a return to normal is this idea that the body has deviated from its normal resting state, which we would refer to as homeostasis, where the body is in balance in order for that person to be in a state where they have some kind of disease process occurring. And what we would want to do is take the environmental conditions that that person is exposed to on a daily basis and return as many of those to normal as possible, essentially to ease the burden on the body. 

So examples would be normal sleep-wake patterns, which are often disturbed in people who have a chronic disease process going on or in my world dealing with people with chronic pain. Sleep disturbance is one of the most common things that I see with people’s normal dietary patterns, normal activity patterns, which also tends to go out the door when a person doesn’t feel like themselves. And then in my realm as well, a return to normal physical structure, which is not something that, as you said, is addressed very often in the doctor’s offices that many of these patients tend to find themselves in. It’s often completely overlooked.

Eric Gordon, MD

Yeah, and that’s where our focus is on, is how important structure is. Often people are told they need to go for this therapy or that therapy to begin to get it back to normal, they often, of course, leaving the home on a regular basis is stressful for many. So, gonna focus a little bit about how you approach helping people straighten up, get their systems back to getting some more positive feedback. One of the things we talk a lot about is we talk about lymph drainage is a big thing for chronic illness. When the body structure is being held in an abnormal way, we almost always impede lymph drainage. I know that in your work with chronic pain people, that that’s a big part of getting the local areas that are hurting to begin to work better. So how do you begin to think about it? I mean, we can start with any part of the body and work our way around.

Yonatan Whitten, DC

Yeah, what I’m looking for as a broad-based concept is the idea that I mentioned earlier, which is to minimize the load that that person has on their system. So, minimize the amount of stress that they’re under. This can be physical stress, this can be emotional stress, the body doesn’t really know the difference between the two.

The stress response is the stress response, whatever the cause is, real or perceived. And so the idea of minimizing that load on a patient with a complex chronic illness is oftentimes my primary concern. Now when you view that within the context of physical structure, things become really interesting because there’s a life cycle for all of us that is directly tied to physical structure. And here is the 10,000 foot overview of that life cycle. We’re all born into the world in a fetal position.

It’s a position of a primary curve. It’s a C-shaped curve. The feet are tucked in underneath us. The head is here. We’re all balled up inside a mama. We come out into the world. The first curve to form is the cervical curve. It’s known as a secondary curve. The fetal position is a primary curve. Secondary curve is the first time in our lives, once that cervical curve formed, which forms in the opposite direction as the primary curve, first time in our lives, that we are able to do for ourselves. The cervical curve allows us to hold the head up with a minimum of muscular effort. That is critical because it’s an efficiency curve. Anybody who has kids knows this because when that curve is forming and the baby’s holding up their head, they shake like crazy because it requires a ton of muscular effort.

Yonatan Whitten, DC

But once the curve comes in, it requires almost no muscular effort because all the muscles are doing is a balancing act to keep the head in place. They’re no longer having to work to actually hold it up against gravity because the curve is doing the holding like a spring. So that’s an efficiency curve. Same thing happens when the lower back curve forms, the lumbar curve. That’s our second secondary curve forms a little bit later as the kid starts to prop themselves up. It’s eventually what supports the weight of the torso, so that we can hold our entire upper body up with a minimum of muscular effort. And then the third secondary curve to form is the curve in the bottom of the feet. It’s the arches of the feet and what that is, again, an efficiency curve. It recycles energy when we walk so that we don’t have to spend as much energy. There’s not as much stress on us. And this was absolutely essential for a species that didn’t know where its next meal was gonna come from and didn’t know when it would take place.

So all of these things are critical efficiency characteristics, but here’s the really interesting thing. As time goes on in our lives and we lose those secondary curves, we lose the ability to function as an optimized human being. Cervical curve gets reduced, we can’t turn as far, we can’t tilt as far, and we’re having to spend more muscular effort to hold ourselves up. Same thing in the lower back.

Yonatan Whitten, DC

Same thing in the feet. More effort to do all the things that we used to do and they’re just, at some point, they’re going to become physically impossible when you start reversing those curves because the facet joints in the neck, the actual anatomy that guides movement, are no longer aligned properly and it’s like asking a square wheel to roll. And so there’s actually research, so you can see this timeline as the baby grows up and it becomes more and more functional and less and less dependent on others to have its basic needs met. And what we’re seeing now in modern society, and there’s plenty of research to support this, is that as we lose those secondary curves and we start tilting forward like this, we have massive increases in all-cause mortality.

Eric Gordon, MD

Wow, that is amazing. And, you know, when I think about it, it just makes so much sense. And what we see is that not only do these curves allow for muscular ease and more efficient use of energy, but they also are when that alignment is there, we have what I keep loving to talk about is drainage, because then the vessels are not squeezed.

It’s amazing. I mean, that’s a fascinating way of looking at it. A lot in there. I don’t want to lose the thread of it. I was going to start at the top, but maybe we’ll start at the bottom because everybody talks about the cervical spine. When are we going to get to that? But the idea of that secondary foot at the arch, that seems to be, because that spring and how that affects, how does that affect how, you know, motion through the body?

Yonatan Whitten, DC

It’s the spring through the bottom of the foot is absolutely marvelous. It’s a wonder and it’s an anatomical marvel. The bone structure is incredible. The muscular structure is incredible. And the fascia on the bottom of the foot is tied directly into the Achilles tendon, which is tied directly into our big powerful calf muscles, which is absolutely essential. Like we were both saying for propulsion, which again, absolutely essential when you consider the evolution of our species and that we were typically moving with the seasons and we’re operating as hunter-gatherers. so being able to move efficiently is critically important for making sure that when you’re going out on these expeditions, you’re having a net gain in calories and not the other way around, which is pretty important for survival.

But the other cool thing about that tissue on the bottom of the leg, when you’re talking about moving fluid, is that people now are actually referring to it as our second heart. Which I wasn’t sure exactly how I felt about it when they started saying this, but it does drive home an important point. And that’s the point that you read in the pamphlet every time you go on an airplane.

Which is, watch out, you’re sitting still for too long, you’re gonna have stasis of your blood because the deoxygenated blood is not being pumped back to your heart and it ends up pooling in the lower extremity.

Yonatan Whitten, DC

Well, what prevents that from happening? The same thing that circulates lymph, which is muscular contractions.

Eric Gordon, MD

Wow. And so when we start to lose that flexibility, because there’s something, I mean, so like if the foot, if you start hitting the foot and it’s just kind of you know, flattened and doesn’t have that arch, so you’re losing a lot of that pumping.

Yonatan Whitten, DC

Yes, yeah, yeah, yeah. So the arch structure is really, there’s a ligament that runs across it called the spring ligament. And it’s named that way perfectly because the idea is that as the foot flattens out with the weight on top of it, it springs back together. And this recycles energy because it’s a ligament, not a muscle. It happens passively. So it doesn’t require caloric expenditure to get that to happen. And it recycles somewhere around 20% of the propulsive energy that we need to move around too.

Eric Gordon, MD

Yeah. Wow. Yeah. And it’s also, it’s also been, you know, increasing the energy in the calf and then up and probably it’s because everything is connected through the fascia. It’s probably beginning to even affect the pumping up to the up in the spine, I would think.

Yonatan Whitten, DC

Yeah, I mean, so if you’re talking about like the posterior fascia line, you would say that that line is going to run from the plantar fascia on the bottom of the foot up the entire backside of your body and wrap around and attach here. So it’s going to be involved in extending the body.

Eric Gordon, MD

Right, and getting those pumps working. So one of the common things we see is pain in the heel of the foot, you know, that for a lot of our patients, and though we sometimes it’s described to Bartonella, but a lot of people without Bartonella have very painful, you know, they have, especially if they’ve been, it seems to happen to people who, you know haven’t been able to move like they used to and then start moving again.

Yonatan Whitten, DC

Yeah, yeah, there’s a few things with that, you know, typical plantar fasciitis type pain. The first thing to understand about plantar fasciitis is typically what’s going on when you look at the tissue under a microscope is that there’s little, it’s referred to as an itis, which is, you know, implying inflammation. A lot of times they actually don’t see inflammation when they look at the tissue underneath the microscope. So this is important to mention. What they do see is, disorganized tissue, increased number of cells, and kind of not directionally oriented. So it’s the hallmarks of a scar where damage has been done. They also oftentimes see localized tissue necrosis, which for your audience members who are not clinicians, it’s localized tissue death.

So what we’re dealing with in these instances is localized tissue damage. And what’s required to repair that? Well, I guess I should take a step back and say what caused it. There’s a few things that are very common in modern society nowadays. And one of them is wearing footwear that is, what’s a nice way of saying it, “not physiologically compatible”.

Yonatan Whitten, DC

Yeah, so the majority of my patients don’t come in wearing shoes that are actually shaped like a human foot, very bizarre because if you had the same patient come in and their feet were bound like they did in the Far East years ago into these tiny blocks because they wanted to alter the shape and growth pattern of the foot, that’s what they did. And that’s essentially what we’re doing with modern shoes. 

We’re putting the foot into an abnormal shape and altering its growth patterns. And like we said earlier, when something is not its normal shape, how can you expect a square wheel to roll? Yeah, so the same thing is happening with the foot. We have research that shows that as soon as you, I’m gonna use my hand so I don’t have to lift my foot and hold it here in front of the screen, but if we imagine that this is the big toe, we have research that shows that as soon as you push that big toe medially, meaning you cram the toes together, the muscles that support the arch of the foot shut down a little bit.

So meaning that wonderful structure that we were talking about earlier cannot function properly the instant you push the toe immediately. It’s not possible. So what you end up doing is you end up overstressing the tissue here on the back where the heel is and you end up getting tears there because you’re altering the muscular activation patterns and functionality of the foot and you’re doing it with every single step that you take and it’s just compounding the damage over time. The other thing that happens with modern footwear is most of it has an elevated heel. Now, high heels are the obvious example, but most walking shoes and running shoes have a heel that is higher than the forefoot. 

Yonatan Whitten, DC

There’s another thing called toe spring where the front of the shoe is actually ramped up like a, think of Santa’s helpers, the elf shoes that are curved upward on the toe. Well, what you do when you curve the toe upward, and your audience that’s listening can try this now, and just sitting where they’re sitting or standing, pull their toes up towards their shins and feel how it stretches all the tissue on the bottom of the foot. This is not how we were designed for our feet to be resting. Our feet are supposed to be resting flat. The heel is supposed to be the same height as the front of the front of the foot and it’s supposed to all be level. 

But you have to go out of your way to get a shoe that’s what’s called zero drop where those two things are actually level and you really have to go out of your way to find a shoe that’s zero drop with no toe spring. And then you really have to go out of your way on top of that if you want to talk about an additional problem to find something that doesn’t have a massive arch support that’s holding you up and something that doesn’t have a ton of cushioning under your foot. What happens when you have a massive arch support holding up the bottom of your foot is the same thing that happens to your neck when you walk around wearing a cervical brace all the time. And that is, you know this as a physician, why do we not keep patients in cervical braces any longer than is absolutely necessary.

Eric Gordon, MD

Things weaken. That’s it. This is, mean, what you just explained is amazing. Cause like, you know, if we had done that to any other part of the body, I think there would have been a lot more outcry, but somehow modern shoe wear has just, you know, because I think, you know, shoe wear is considered decorative on a lot of levels, you know, and we’ve allowed our decorative taste to overcome our physical health.

When you think about it, what you’re telling me is that the shoe, just let me step back. My definition of chronic illness is the body has gotten stuck in compensating for something. Injury, inflammation, whatever, it’s your compensation which should be transient, temporary, to protect you while you’re injured doesn’t go away.

And so it stays and then it causes other secondary compensations. And before you know it, you’re really not feeling well. And what you’re describing is footwear is doing that to your foot. It’s just putting you in these compensatory places where, know, like, and everybody, people always, I have art support. But that’s really like putting somebody in a wheelchair on some level.

Yonatan Whitten, DC

Yeah, I mean the cervical brace is really a good example for it and it helps people to understand it. So check this out, there’s actually research that they did where they went in and used an ultrasound to measure the little intrinsic muscles in the bottom of the people’s feet that are responsible for holding up the arch. And they took a group of people and I believe they split them up into two and they measured, using ultrasound, they actually measured how big the muscles in the bottom of the feet were.

And then they put them in arch support for two weeks and they re-measured and there was like a 17 % atrophy in the muscles in two weeks. Which is what we would expect if we did the same thing to a person’s neck.

Eric Gordon, MD

But somehow it is fine for the feet.

Yonatan Whitten, DC

Yeah, and there’s one other thing, and this one is absolutely counterintuitive, and it should be mentioned because it’s important to understand. When we have thick cushions on the bottom of our feet, we actually land harder with every step that we take. And they’ve done studies on this in gymnasts, where they have them dismount off of a bar when they’re doing their flips and all the cool stuff that they do on there, and they land on a pad that’s, say, this thick, or they land on a pad that’s this thick, and they found that they land softer on thinner pads. Why? Because they engage their muscles more in the deceleration process. so they’re actually, and you can do this when you walk. If you hear somebody walking behind you where they’re, on every step that they take, you can guarantee that they have thick cushioned shoes, because there’s no way that you could get away with it if you didn’t. So their muscles are literally taking a break with every step that they take instead of being active and engaged with every step that they take. And that’s one of the reasons why we see this really high incidence of plantar fasciitis, because it’s a two-fold detriment. 

Yonatan Whitten, DC

Number one, they’re landing harder because of the cushioning. Number two, they’re not exercising their foot muscles, which is like free exercise just by walking around. And they’ve done studies where they compare a foot specific rehabilitation program where you’ve got like eight or 10 different foot only exercises, which let’s face it, who wants to do that many foot exercises? Not many people. And they compared it to just using barefoot minimalist shoes and being on a walking program. And the results in terms of muscle strength, and hypertrophy or growth of the foot muscles, almost identical.

Eric Gordon, MD

Well, yeah, I vote for that because I always like to listen to folks like you who like to exercise and those of us who are not being on a lot of time in the gym. It’s nice to know that living can keep us at least part way there.

Yonatan Whitten, DC

I mean it can get you almost the whole way, Eric. That’s the coolest thing. I like going to the gym, but I’ve got two little kids, I’ve got a wife, I’ve got a life like the audience has. And I don’t want to spend my life in the gym. I go to the gym to enhance my life, but I don’t want to spend my life in the gym.

Eric Gordon, MD

Right. And so it’s so nice when, I mean, that’s something I think we’ll keep coming back to is how we can, you know, change everyday life to make it more life enhancing. That’s bringing it back to your concept of, you know, what’s a normal life.

Yonatan Whitten, DC

I’ll piggyback on that and I’ll give you another one if you like that kind of stuff. So there’s been research that was done, the author of the study, Dr. Daniel Lieberman, he’s an author, he’s a researcher, he’s a professor. I want to say Stanford. I want to say Stanford, but it might be Harvard. One of those. He’s a fantastic author. He wrote a book called, uh, exercised. Uh, among others, um, history, history of the human body, phenomenal book. Um, but he did a study where he measured back strength in people who use chairs with back supports and people who, who don’t. And the differences were enormous. It was like 20%.

This is just from doing the things that you do every day in a slightly different way. So one of my biggest things for anyone who’s interested in maintaining their secondary curves, which should be everyone, because they are the key to being a fully functional human being. And when we lose the secondary curves, we lose functionality, but we also have massive increases in the incidence of pain and dysfunction. Like when you lose the normal secondary curve in the neck,

you’re like 18 times more likely to have chronic neck pain. 18 times. It’s gigantic. Maintaining the secondary curves is huge.

Eric Gordon, MD

And just as an aside, it’s something that we see in, I don’t want to say all, a vast number of our patients who go for cervical spine x-rays, they always come back with these normal x-rays, except for the straightening of the normal cervical, you know, mean, like they have straight spines in their neck and they’re always, it’s sort of like an incidental finding.

Yonatan Whitten, DC

You are so right on about that. It’s amazing how flippant radiologists are to a reduction or loss of the normal curve or reversal of the curve, especially when you consider what even the Journal of the American Medical Association says is associated with this type of reduction in structure in the neck. It just means that they haven’t read the research because you have everything from increases in pain like I was talking about to disc bulges and herniations chronic muscle strain soft tissue pain syndromes decreased blood flow to the spinal cord so like you were talking about fluid movement and and Impingement of that fluid early onset of degeneration and arthritis nerve compression. You’re talking like thoracic outlet sciatica carpal tunnel increased jaw tension TMJ type problems and then the big one impaired breathing and decreased lung

which can get as much as like 33 % it can impair one third of your ability to breathe.

Eric Gordon, MD

Wow, yeah, I mean, again, we see it in a lot of people with so-called sleep apnea because when that curve is straight, you’re losing the space.

Yonatan Whitten, DC

That’s exactly right. Yeah. Yeah. And the other thing that happens is when you lose the curve, which like we talked about earlier is the main thing that holds up the weight of the head. It means that you’re using more muscular effort to hold up the weight of your head. So a lot of times when you see these people who have the straight spines, like you’re talking about, their muscles are like bulging out of their necks like this because it’s like they’re lifting weights all the time. The head becomes 10 pounds heavier for each inch that it shifts forward and when you’re losing the curve that holds it this way and it straightens it means that the head is necessarily coming forward.

Eric Gordon, MD

And that’s where we have our tight traps, those shoulder muscles that everybody’s always wanting massaged.

Yonatan Whitten, DC

That’s exactly right. Yeah, there was a research study that was done. I think I’m the only person who ever read it, to be honest with you, but it’s an amazing study. These researchers, they took a bunch of people who had reversal or loss of the normal curve in the neck, and they x-rayed them, and they actually took photographs of the shape of their trapezius, and what they found was that there were absolute patterns in the shape of the trapezius muscles and the amount of tension in them that corresponded to the amount of loss of curve in the neck. And so they discovered, they named it cervical kyphosis upper trapezius sign and they said that it could be used diagnostically to say this person has not enough curve in their neck just by the appearance of their trapezius muscles. And they also found that normalizing the appearance of the trapezius muscles resulted in a significant reduction in people’s pain.

Eric Gordon, MD

So that’s where I was going to go next. It’s sort of like the foot. So right away, you know, with the foot, you know, working towards, you know, a zero balance shoe is a good way of just walking more barefoot at home, you know, just to start with, you know, just get your body used to that. So, so what would be the beginning, you know, for, as I said, for people with that, who have developed that straight neck, you know, is any, any things that are safe that people can start with?

Yonatan Whitten, DC

Yeah, great question. So I love what you did there because we mentioned the zero drop shoe, but not everybody’s going to want to go out and buy those shoes right away. And you just gave a free alternative, which is walking around barefoot in the comfort of your own home and slowly building yourself up that way. Just spend a little bit of time barefoot each day. If you’re not used to it at all, know, five minutes of being barefoot on a firm surface is a great foot workout and people are going to feel it.

As far as, let me give you another one before we get to the neck. And I’ve got a good one for you for the neck that’s free also. So for the lower back, my favorite one, because you were saying earlier for people who don’t like to go to the gym, what can you do that you’re already doing every day that you can make a slight modification? So like I said earlier, there was research showing that sitting without a back rest will give you a stronger back, which is not surprising. 

Your muscles are holding you up instead of the chair holding you up. But for people who want to take it a step further, one of the things that I use every single day in my home office is a kneeling chair. These are the Scandinavian chairs that were real popular in the 1980s. And specifically a kneeling chair with a rocker bottom. And the reason is because when you rock forward, your equilibrium centers in your ears and your eyes they get the feeling that you are going to fall on your face. And so imagine this, if I took a jump rope and I slid it behind the base of your neck and I started pulling you towards me like this, slowly, what would be your natural response to that?

You need to tighten up a little bit, yeah.

Yonatan Whitten, DC

Yeah, you would, if I pulled you this way, the natural response without me saying anything, yeah, what you’re doing now, you would pull in the opposite direction. And however hard I pull, that’s how hard your muscles would engage. Without me even saying anything, it would be like a dance. I could literally pull a little harder, a little less, and your body would auto calibrate to match what I was pulling on you to keep you upright, right? Biological imperative, trying to keep you alive and not allow you to fall on your face, critically important so The kneeling chair ties into that so when you have a rocker bottom on a kneeling chair and you go to tilt forward Your muscles will engage more intensely to pull you back as your body tilts into this type of angulation.

So the rocker bottom allows you to spend periods of time where you’re more a little bit more tilted forward and then periods of time where you’re less tilted forward so it’s literally like almost like the concept of doing a set where it’s more intense here and less intense at the bottom. And so the same type of thing throughout the day, I can spend a little bit of time in the forward position, 30 seconds, come back up to the upright position, less strain on the body, and then I go back and forth. By the way, the body just loves movement. It does not like being in static positions all day long. And there’s tons of research that shows that getting people up out of their chairs, even for like 20 seconds to like move the body through a a few ranges of motion, literally 20 seconds, multiple times per day, reduces compression of the spinal discs visibly on MRI at the end of a four-hour workday and dramatically reduces people’s pain levels.

Eric Gordon, MD

Wow. Yeah. It’s funny how it can take so little to make a difference if it’s done in small amounts regularly.

Yonatan Whitten, DC

That’s it, that’s it, that’s it. Yeah. And then for the neck, so you’ve got two there, I wanna be clear. Number one is the kneeling chair. Number two is just getting up out of your chair periodically and spending five seconds going backwards, spending five seconds tilting to this side, spending five seconds tilting to this side, and, you know, you spend five seconds in each of the directions that your spine moves and you get dramatic reductions in disc compression and dramatic reductions in pain and discomfort and stiffness and all the things there. That second one doesn’t cost a dime.

Eric Gordon, MD

Right, right, right, right. And it’s things that it’s something that people who really are weak, you know, unless they’re bed bound weak, but anything short of that, it’s almost something that everybody can do because it’s you’re not asking them to do it fast or do it repetitively, you know, just yeah. 

Yonatan Whitten, DC

You’re exactly right. You’re exactly right. And in the study that I’m referencing, they checked it in a group of workers over a four hour period. And what they had them do was like get up every 15 to 20 minutes and spend 20 seconds in a standing position, stretching the spine for five seconds in each of the directions, only stretching through the range of motion that felt good to that person. So as you were saying, nothing extreme, nothing uncomfortable, nothing super demanding.

Eric Gordon, MD

Wow. Yeah, just ties in with that concept of trying to bring a little normalcy back to the system that’s been stuck in this self-protective mode that’s not useful.

Yonatan Whitten, DC

Yeah, that’s exactly right. It also ties into the overall concept of the summit that you’re running, which is structure and inflammation, because we know that one of the main drivers of inflammation in modern society is prolonged bouts of sitting. There’s research that shows that just sitting in one position for an extended period of time drives up inflammatory biomarkers. And there’s also research that shows that biomarkers for inflammation are inversely associated with increased time spent walking. So it’s like the inflammation is literally telling you what you should do and what you shouldn’t do.

Eric Gordon, MD

Yeah, it’s showing what stresses your body. That’s for sure. I was wondering, while we’re on this subject, what about standing during the day, you know, for long periods of time? What’s your feeling about that?

Yonatan Whitten, DC

My feeling is that the body… Yeah, the truth is that I’m talking to you right now on a standing desk, but if I go 20 feet that way, I’ve got my sitting desk with a kneeling chair at it. So the body is built for motion. And over here I’ve got a whole body vibration platform, and over there I’ve got a rebounder. So the body is built for movement. And what it likes is to be moved in different ways on a regular basis throughout the day. So when we started with this idea of a return to normal, what is normal for our ancestors? It was to walk five to nine miles every single day. I’m not talking a fast-paced walk, and I’m not talking five to nine miles at once. I’m talking you walk a little bit, you squat down, pick some stuff up, take a break, chat with your friends, gossip about people in the village, and then you get up and you walk again, and you kind of rinse and repeat throughout the day.

These are not people who are marathon runners, who are doing these colossal bouts of exercise because again, biological imperative is to ensure survivability. We need to make sure that all of these expeditions are a net caloric gain. So we don’t want to be moving super intensely, but we do want to be moving throughout the day. And when they sit, they do active sitting. Like I was just talking to you about that sitting without a back rest or sitting in a kneeling chair or squatting, you know, which is quite a bit more challenging, which is why I didn’t mention it, but it’s still a form of active sitting where the muscles are not super engaged, but they’re still working and they’re not completely shut down the way that they are in a lazy chair, a lazy boy or a chair that has arm rests and back rests and neck rests where really the chair is holding you up as an exoskeleton and your muscles don’t have to do anything, which is, you know, going back to that cervical brace idea.

Eric Gotdon, MD

Yeah, so I mean, yeah, I’m a great believer. Yeah, I mean, I squatting, you know, as a, you know, throughout the world until we, you know, that’s how lots of people eat meals and just sit around and chat is squatting. But, you know, most Americans, if they squat for within about 10 seconds, they’re screaming. So, we’ve shortened everything.

Yonatan Whitten, DC

Yeah, what’s interesting about that is it’s something that kids do naturally. So kids don’t bend over at the waist to pick stuff up, they squat down to pick stuff up. So for all of us as children, that was normal. And that’s that idea of a return to normal. But for some reason, adults in Western society, like you’re saying, it’s use it or lose it is what it is, because plenty of adults in Eastern society squat, you know, all the time, when they’re waiting for a bus, when they’re chatting with friends, when they’re cooking meals, you know? It’s a normal position. When they go to the bathroom on an eastern toilet.

Eric Gordon, MD

Yeah, well, I said we unfortunately have taken the desire for comfort to the point where it actually is hurting us. That seems to be the thing. Comfort and ease, you know, between, you know, instant food and, yeah, and no physical activity. We have created, you know, our own mess. So getting back to the neck before I go off it, philosophizing.

What are any hacks for the neck, just everyday things that we can do to keep our necks out of this. I mean, I might tell you, it’s really hard to like not, especially if you’re sitting to get into that hunched forward head position?

Yonatan Whitten, DC

Yeah, it’s important to start off, to ground this conversation in a couple of things. Number one, there is, I had compiled the data myself, but there was recently a meta-analysis that came out that confirmed 70 % of the modern day population has a forward head position, which is a reduction in the normal amount of curvature that’s supposed to be in the neck. 70%. It’s enormous.

This is akin to type 2 diabetes, which when I was a child was called adult onset diabetes because my friend’s dad, who, you know, maybe didn’t watch his diet, maybe didn’t exercise, maybe was a little too heavy in his mid-50s, early 60s, he developed diabetes. And then we officially changed the name, as you know, to type 2 diabetes because adult onset was no longer accurate when so many children started to get it. Same thing is happening with forward head position. Forward head position used to be called reading neck or scholar’s neck. And the idea was it took five or six decades worth of having your head buried in the books to develop this problem. They talked about it with Rockefeller in a book that I was reading recently that

Yonatan Whitten, DC

They made fun of him, I think, he was in his late 20s or early 30s because of his posture, because he had spent so much time meticulously doing accounting work with his head buried in the books. So they literally made fun of this guy for his posture because it seemed out of the ordinary to them that somebody in their late 20s or early 30s would have a posture that was normally associated with people who are much, much older. Well, now we’re seeing it in little kids.

And the idea is the same as diabetes. used to take five or six decades worth of abusing your insulin response to develop this condition. Now you can develop it in one decade. And we see the same thing with posture where the secondary curve maybe never even forms normally because they have their heads buried downward looking at devices from such a young age.

Eric Gordon, MD

Oh yeah, yeah, mean, you know, I mean, I, this busy world, yeah, you, yeah, you have, uh, you know, literally one year olds, I think I’ve seen looking at devices, you know, while, you know, while their parents are doing something here, here’s the iPad, you know, they can’t even hold it up yet. They prop it up, but they still got to [look down].

Yonatan Whitten, DC

Yes. Yeah. And can you imagine the neck curve is not even solidified yet. And so it’s, it’s, and we see the same thing with the feet, honestly, if you jam the foot into a shoe with arch support, never even, you never even use the muscles in the first place. It’s like, have a lot of videos online, but I have little kids and I’m so, I’m so passionate about trying to allow them to be normal, you know, and so so Anyway, that’s I have some videos on that on that topic, but the idea is You can’t keep bashing yourself in the hand with a hammer and complaining of hand pain at some point.

You got to stop bashing yourself in the hand with a hammer now I’m not telling people to stop looking at their phones or looking at their iPads But I am saying that if you can take a less severe angle by propping it up in front of you at roughly eye level or even going from a 45 degree down angle to a 15 degree down angle is a massive improvement. We don’t have to be perfect, but we want to move in the direction of normal. And it’s not normal to walk around or to spend a great deal of time looking at the floor. It’s normal that we look straight out in front of us. removing the smashing of the hand with the hammer, removing the constantly looking down, because there’s research that shows that the greater the down angle of the head, the more muscular effort that you’re putting on the body. It’s like holding a grocery bag here out in front of you as opposed to hanging it down here. This is the area that requires the least amount of effort and the more you angle down, the heavier the head becomes.

Yonatan Whitten, DC

So that’s important to know. So I would encourage people to take it easy on themselves and not keep so much work by elevating the screen. One of those inexpensive devices that holds up the screen so that you don’t have to is a great investment. They have them for like seven bucks on Amazon. I don’t make them. I have no financial stake in this, but I’m encouraging people to not bash themselves with a hammer. The other big thing that I love, and there was just a study recently published about this, is everybody’s heard of the chin tuck exercise where you do this and you drop the chin back and you’re engaging the deep neck flexors. And it’s a fantastic exercise and there’s very solid research showing that it improves posture. Well, they just came out with a study and this is cool because you had mentioned five minutes ago, people who are bedridden who would have trouble doing certain exercises. 

Yonatan Whitten, DC

They just showed a study that where they compared different head positions and they found that simply by taking your tongue and pressing it hard up against the roof of your mouth with like moderate pressure, not super hard, you could engage the deep neck flexors, the same muscles that are exercised when you do a chin tuck, to the same degree that occurs when you’re lying on your back and you lift your head three centimeters off the floor.

So this is very cool because if you just extend the idea here and tease it out, we know that chin tucks can improve posture and reduce neck pain. But not everybody can do chin tucks. It’s not always an easy exercise. You can do it in a seated position, but lying on your back and lifting the head off the floor while chin tucked, that’s pretty challenging.

But if you just lie on your back and you keep your head resting on the floor and you press your tongue moderately hard up into the roof of your mouth, you can get the same degree of activation here in the neck, which means less pain, more stability in the neck, and better posture just by using your tongue. And that’s something that almost everybody can do. Yeah, and if you’re doing it now, I can actually see the muscle.

Eric Gordon, MD

Yeah, I would just wonder, know, you know, TMJ or the dysfunction of the temporal mandibular joint, that sort of old jaw thing. I mean, to me, I’m never sure what’s the chicken or the egg, you know, like when, you know, like what comes first, the jaw just imbalances in pain, you know, or the cervical spine, because they always, seem to, people tend to have both.

You know, I was just wondering, what’s your thought on that? Do you have a chicken or the egg? Do you have a way to cut that circle or it just is and it just depends on the person?

Yonatan Whitten, DC

I love that you asked because it’s something that I’m passionate about. So the jaw and the cervical spine, as you said, are related. And there’s very solid biomechanical research that shows that the more the head moves forward, the more the bottom jaw retracts and jams up into the condyles. So condyles are the pockets where the joint sits for the audience members that are not clinicians.

The more the head comes forward, the more the jaw retracts. Those two are in a relationship like this. There’s also research that shows that the more that the head retracts, the more the bottom jaw shifts forward. So forward head position is associated with an overbite posture and a military neck, which is seen in some populations more than others, is associated with an underbite posture and it’s reliable. And there’s research showing that in the people who have that overbite posture, if you do a little bit of rehabilitation to correct forward head position, you can get, I don’t want to misquote this, I believe it was eight millimeters of forward jaw movement in a single session of rehabilitation.

Eric Gordon, MD

Wow.

Yonatan Whitten, DC

Yeah, it’s a big deal. So what’s cool about it is, to answer your question, they are interrelated. I heard a theory that I’ve never seen proven, but it makes sense. It’s called tripodization. So the idea is that the vertebrae in the spine have three points of stability like a bathroom stool. There’s the facet joint on the left facet joint on the rear right and then the body of the spine. Those are the three support structures. So it forms like a tripod of support. The one vertebrae that doesn’t have a vertebral body is the atlas, the first cervical vertebrae. And so the theory of tripodization is that because the atlas has two facets that sit up against the condyles of the occiput, the functioning tripod of support for the atlas is the jaw. That is the third point of support for the cervical spine.

Which makes sense if you consider the fact that when the head goes back, the jaw goes forward. Jaw moving right or left can induce cervical rotation. and so the idea, I don’t think of it so much as chicken or the egg. think of them as like nervous system, muscular system, like you can’t have one without the other.

Eric Gordon, MD

Right, that is amazing because so many, I mean, it’s so hard to convince patients that there is like, that they are, it’s the same system, you know, that EMJ and their cervical spine are not two separate problems.

Yonatan Whitten, DC

Yeah. Yeah, yeah. The number one thing that I do with patients with TMJ is restore cervical curve. That is the first thing that I do. Because more often than not, that is going to have them well on their way to completely resolving the problem without, and I’m certified in intra oral TMJ release and all of that. And I love rehabbing the muscular system and all that. The point of it is what I said earlier many times, which is a square wheel can’t roll.

And so if you’ve got a forward head position, it means automatically that the TMJ is not sitting properly in the socket. And it’s a very complicated joint that has to work. It’s the only joint that has to be bilaterally symmetrical in its operation. So you have to have the muscles on this side and the muscles on this side working in a coordinated fashion to have both ends of that joint moving exactly the same. It’s a very complicated structure.

Eric Gordon, MD

Yeah, well, that’s why all the people, you know, when they close their mouth, it’s not, you know, like they’re making a circle instead of an up and down motion.

Yonatan Whitten, DC

That’s exactly right. That’s exactly right. And there’s all kinds of, I don’t want to oversimplify it. The cervical spine has a major role in that condition. If you had a dentist on right now, they would tell you that the power of a person who had a tooth problem that went on for too long that was undiagnosed, and they were chewing on one side of their mouth for five years without even noticing it.

Eric Gordon, MD

Right, that will affect their neck.

Yonatan Whitten, DC

Sure, necessarily. There’s no way that it couldn’t.

Eric Gordon, MD

Yeah, and what I love, so I mean, I’ve seen some of your videos. So do you have, you know, I know some of your programs are just aimed at, you know, kind of balancing these different parts of the bodies.

Yonatan Whitten, DC

Yeah, yeah. So my Pain Fix Protocol program is designed to address all of the most common causes of chronic pain in the world. And it’s all based around this return to normal concept. chronic neck pain, chronic lower back pain, chronic foot problems, all stemming from the same thing. I have a pain fix diet program that is about a return to normal, in terms of how human beings are designed to eat, and it actually centers around the science of what happens in the body when we deviate from that and how it specifically relates to pain.

Really, it’s something that I didn’t realize how much research there was about that. It ties directly into what you’re talking about here with inflammation and what we mentioned earlier as far as levels of inflammation fluctuating and almost can be viewed as a guide for what we should be doing and what we shouldn’t be doing. And then one thing that I’m really excited about, which is going to be coming out next year, because it is the most pop, most common structural deviation in the entire world, more so than forward head position, which as I said is 70 % of the population. The only one that is more common than that is a pelvic torque. After, geez, I’m embarrassed to say.

Almost 20 years in practice, I’ve figured out a way to teach people how to accurately and quickly self-diagnose and self-correct that problem. So next year, I will have a program coming out to permanently resolve the most common postural dysfunction in the entire world. Something like, in my estimation, there’s no study documenting this, but based on what I’ve seen in practice over almost two decades, it’s somewhere around 95 % of the population.

Eric Gordon, MD

Wow. the pelvic, I mean, when you say pelvic, are you talking about like that anterior pelvis or?

Yonatan Whitten, DC

So what I’m talking about more commonly is the pelvic ring has done this [makes motion].

Eric Gordon, MD

Right, right, that torsion.

Yonatan Whitten, DC

Yes, exactly right. And so what that does is it unlevels the entire foundation that the spine sits on. And so when you asked me about what I would do for TMJ, automatically I’m correcting neck. When somebody comes in with lower back, mid back, automatically I’m correcting pelvic torque. It’s like building a house. I’m never going to try and build a house on an unlevel foundation because it means that everything that’s constructed on that unlevel foundation has to

adjust for the fact that it’s sitting on an unlevel foundation. Well, I’ve known for years how I can diagnose and correct a pelvic torque, but I didn’t know, I didn’t have a consistent definitive way to teach a person who has no experience with anatomy how to self-diagnose easily and a hundred percent accuracy.

Eric Gordon, MD

Well, no, because I know when I used to do osteopathy, I could feel that pelvic torque, but getting it to stay balanced is, another matter, but then that requires attention to a whole bunch of other structures.

Yonatan Whitten, DC

Yes, yeah, yeah, yeah. I’m, that’s the thing that I’m most excited about right now.

Eric Gordon, MD

Cool, cool, cool.  Well, so how can people find your courses? ’cause I said they’re, I think this is the kind of stuff where, um, you know, even if it’s not going, uh, you know, just, just people understanding the biomechanics of what’s going on with them can help them. If they’re going to other practitioners to get help, they can get an understanding of like, you know, maybe sometimes, I guess one of the problems I have with referrals is that there are people who are really good at one thing, but they don’t pay attention to the, the other part of the, of the body. You know, there are people who are great at necks, but they act like the feet don’t matter.

Um, you know. Not that they, but they just don’t, they’re not aware enough. You know, they’ll, they’ll keep working on the neck when you, you worked on the neck and it’s not working. Maybe you gotta look lower down.

Yonatan Whitten, DC

Yeah, yeah. My concept is return to normal. There is no such thing as super normal. So there is a definitive guide for what shape a neck should have, how much curve should be in it, and function will reflect whether structure is normal or not. So you don’t get extra credit for being able to move more than you’re supposed to.

In fact, there’s quite a bit of research that shows that moving more than you’re supposed to can be as detrimental as not moving enough.

Eric Gordon, MD

 Right. Well, that, that, that, that’s our, our, we, we unfortunately, have a large population of the hypermobile world because it’s connected to lots of other problems.

Yonatan Whitten, DC

Yeah, and you also see it a lot with people who are very inflamed where they’re hypermobile.

Eric Gordon, MD

 Yeah. Well that’s usually what happens. They start with a tendency to hypermobility once they get inflamed that hypermobility ’cause it just, um, those ligaments just get, uh, tenderized and, and, and loosened. But, so, but I wanna, I, we didn’t get, how can people, ’cause I, I said I really like your, um, your teachings. You know, like, you know, here, look at this. Learn that. How can people find them? 

Yonatan Whitten, DC

Yeah, www.painfixprotocol.com.

Eric Gordon, MD

 Okay. And they can, they can get different ones on different parts?

Yonatan Whitten, DC

Well, actually, my Pain Fix Protocol is my flagship program that addresses all of the most common pain conditions in the world. So it’s one program. And the gem of that program is what I call the quick screen self-assessment, where I teach people how to assess themselves against what normal would be. And normal is optimal, like we were just saying about hypermobility. It’s the same way that the body operates with everything. It’s homeostasis is balanced. You think of it in terms of body temperature. You go too high, that’s a fever. You go too low, that’s hypothermia.

Either one of the extremes will kill you. Same thing with pH. Same thing with what you’re saying about mobility. know, too much is detrimental, too little is detrimental. We’re looking for the sweet spot on all of these things, and that’s what the Pain Fix Protocol is built around is returning people to that sweet spot.

Eric Gordon, MD

Well, I look forward to people giving it a try because, um, you know, just listening today, I’ve gotten lots of little tips on the things I’m gonna keep. Actually, luckily I’ve been listening for a while, so I I, I, I’ve been doing them, but I gotta make sure I keep doing them because Yeah. I, that, that head wants to go forward. So thank you so much, so much, Yonatan. It’s really been a pleasure talking to you and, uh, exploring. Um, you know what, when, when you talk about it, it seems like, oh, that’s obvious, but, it’s so, so not. So thank you so much. 

Yonatan Whitten, DC

It’s always great to chat with you. Thank you for having me on.