Months ago, my wife was watching television as I overheard a talk show conversation discussing the definition of beauty. They concluded that it was symmetry. The more symmetrical a person’s face was, the more attractive it was considered. This belief can be extended further into other areas. In bodybuilding, a criteria that the competitors are judged upon is the symmetry of the body.

However, what if I told you that none of us are symmetrical?

Does this mean that the talk show hosts were wrong or that the bodybuilding industry needs to totally change their judging criteria? No, well maybe. However this is essential to understand so that we can fully appreciate the human body.

We have a liver on our right side, heart on our left side, 2 lobes in our left lung, 3 in our right lung and a brain that processes information more effectively in the left hemisphere (which controls the right side of the body). These side to side differences, just to name a few, greatly influence the body’s patterns of movement.

These asymmetries result in people often shifting to the right and compensating to get left during walking and other activity. Take a look around and you will notice that the majority of people have a right shoulder that is lower then the left.

When the body is functioning optimally, we manage these asymmetries and can go to both sides well. However for a variety of different reasons we can stuck oriented to the right.

One way to manage this imbalance is to ensure that you can properly feel your left side. This is especially important as we are sitting at our desks working for extended periods. When you are sitting, can you feel your left sit bone? Is your left foot centered on the floor?

If not, go ahead and find these areas.

In standing it is common to roll onto the outside of the feet, specifically on the right as we shift towards that side. If you sense this occurring attempt to find and feel the right arch of your foot without your knee collapsing inward.

As you attempt to correct this, are you noticing that your back is over-extending? Perhaps your right hip is hiked up too much which is further driving you into the right side. These are things that can be corrected, just to name a few!

Our asymmetries predispose us to many common issues and areas of stress or strain. A high quality physical therapist or health care practitioner must understand this to provide the highest level of care possible. This is essential to get people out of pain and functioning at a very high level.

Furthermore, the next time a tv host talks about symmetry, you can understand that is impossible!

In recent years, barefoot training and minimalist footwear have become increasingly popular topics of discussion, particularly within the fitness and physical therapy communities. This trend can be attributed to several factors, including the rise of minimalist footwear options such as the Nike Free and Vibram FiveFingers, as well as the influence of the best-selling book Born to Run. The book highlights the indigenous Tarahumara tribe of Mexico, who are known for running barefoot over hundreds of miles with incredible endurance and minimal injury.

At first glance, the rationale behind barefoot training seems compelling. If people like the Tarahumara can run long distances barefoot and remain healthy, shouldn’t we be able to exercise barefoot or in minimalist shoes as well? However, while the concept might sound appealing, the reality is that what works for some may not work for others—especially when it comes to modern environments and physical therapy.

Why Minimalist Footwear Doesn’t Work for Everyone

For some individuals, barefoot training or minimalist footwear can be successful and even beneficial. These people have the right biomechanics and are often exercising on more forgiving surfaces like grass or dirt, which provide a natural cushion and reduce impact. However, for many others, especially those undergoing physical therapy, the story is quite different.

One of the main issues with minimalist footwear is that it often fails to account for the hard, unforgiving surfaces that are common in modern life—such as concrete and asphalt. These surfaces don’t absorb shock well, leading to increased ground reaction forces on the body. In other words, when you run or walk on concrete in minimalist shoes or barefoot, the impact on your joints, muscles, and bones can be significantly higher. This can lead to injuries, particularly for individuals who are already dealing with underlying issues that brought them to physical therapy in the first place.

The Importance of Proper Footwear in Physical Therapy

In physical therapy, footwear is often a critical component of both injury prevention and rehabilitation. A proper shoe provides the necessary support to allow your body to function optimally as you move. Shoes that offer adequate support help the foot transition through the various phases of the gait cycle—heel strike, mid-stance, and toe-off. This ensures that the body can alternate weight effectively from one leg to the other without placing undue stress on any particular area.

For people in physical therapy, supportive shoes are essential to the rehabilitation process. The right footwear can reduce stress on the lower limbs, improve posture, and prevent further injury. On the other hand, shoes that lack proper support may aggravate conditions like plantar fasciitis, Achilles tendonitis, or even lower back pain.

What Makes a Shoe “Correct” for Physical Therapy?

When it comes to selecting the right shoe for physical therapy, a few key features are important:

1. Optimal Heel Control: The shoe should provide enough support around the heel to stabilize the foot and control excessive motion. This helps to minimize unnecessary strain on the ankles, knees, and hips.

2. Arch Support: Proper arch support is crucial in a physical therapy setting. The arch of your foot should make proper contact with the shoe, ensuring even weight distribution across the foot. Lack of arch support can lead to conditions like flat feet, which can affect the entire body’s alignment.

3. Flexibility at the Toes: A good shoe should bend where the toes naturally bend. This allows for a smooth transition through the gait cycle and prevents stiffness or discomfort in the feet and legs.

Wearing the right footwear can have a profound impact on your overall health and the success of your rehabilitation. Whether you are recovering from an injury or trying to prevent one, the correct shoe choice can make all the difference.

Consulting Your Physical Therapist for Footwear Advice

Before you make any decisions about barefoot training or minimalist footwear, it’s essential to consult your physical therapist. Physical therapy is highly individualized, and what works for one person may not work for another. Your physical therapist will take into account your body mechanics, injury history, and rehabilitation goals to recommend the most appropriate footwear for your specific needs.

A thorough physical therapy evaluation will help determine whether barefoot training or a more supportive shoe is the right choice for you. Often, the goal is to strike a balance between mobility and support, ensuring that your feet and body are both protected and able to move efficiently.

Have you ever stopped to ask yourself, why am I stretching this? Better yet, does this area need to be stretched?

As with most things, the answer is that it depends, which begins with knowing the reason why a muscle has become stiff in the first place.

Soft tissues will adapt to being in a chronically shortened position and thus become stiff. This often occurs as a result of movement compensations and postural dysfunction. When attempting to correct these issues (ie. The cause of the stiffened tissue), stretching or inhibition of stiff tissues is often necessary.

However, if you attempt to simply stretch an area that feels stiff without also correcting the reasons for it then you are wasting your time.

A muscle may become stiff in an attempt to protect against an injury. For example, those with chronic lower back pain often have stiff hamstrings. The hamstrings can provide added control to the pelvis as they attach to it. The hamstrings are “tightening” to provide added control to the lumbo-pelvic region due to an instability or lack of control in this region.

Therefore, one must learn optimal motor control and stabilization strategies for the lumbo-pelvic region, rather than stretch the hamstrings. When the spine and pelvis are under better control, the brain can then allow the hamstrings to let go as this added layer of defense is no longer necessary.

An increased risk of injury occurs when compensations (ie. Stiff muscles) are taken away (ie. Stretched) without addressing the reasons why they occurred initially.

Next time you are attempting to stretch a muscle, ask yourself why is this muscle stiff in the first place?

Imagine that you are walking through a museum and you stumble across a particular painting that you love. Do you attribute this work of art to the painter that worked to create it, or the paintbrush that he or she used?

This is very much the same in health field. It is the clinician, not the technique that a physical therapist, chiropractor, massage therapist, etc. uses that dictates patient outcomes. Manual techniques such as Dry Needling, Active Release Techniques, Myofascial Release, etc. are all incredible tools when used properly. However they are just that…tools.

A handyman knows when a wrench needs to be used versus a screwdriver, much like a qualified clinician must know if or when an aggressive manual therapy technique is most appropriate.

For this reason, a quality clinician must constantly be assessing and re-assessing his/her patient. This provides the information necessary to determine the tool best used for the job. This also holds true for exercise, as an exercise can be appropriate, thus help address a patient’s pain and contributing/resulting dysfunctions, or be inappropriate and make things worse.

Be skeptical of a clinician that swears by a particular technique. He/she will often justify that “tool” working for his/her patient regardless of the “fit.” You wouldn’t use a screwdriver to drive in a nail would you?

A comprehensive thought process and plan of attack to address the source and true cause of your pain is most essential. I make sure to fully explain the true cause of pain for every patient I see here at Cohen Health and Performance, as well as elaborate on what is going to be done to address it.

It is very difficult to know if you are getting the best care possible. However, you can be confident in your clinician when he/she has a comprehensive plan to address not only the source, but the cause of your pain. This way treatment is a permanent solution, rather than a series of band-aids only addressing the symptoms that result.

When in doubt remember that it is about the painter and not the brush!

To put it simply, yes. There is evidence linking optimal trunk control with an improved ability to tolerate stress. There are neurons in the brain that influence glands that are located on top of the kidneys called the Adrenal glands. These glands are responsible for secreting your stress hormones (epinephrine, norepinephrine-ie. Adrenaline). The neurons located in the brain that influence these glands, are also located in the region that controls the trunk musculature, often referred to as “the core.”

These neurons are facilitated a great deal in the presence of poor core control. When the most central portion of the body feels unstable and uncontrolled, the brain interprets this as a state of high stress or threat. As a result, the sympathetic (ie. Fight or flight) branch of the autonomic nervous system is facilitated. This causes an increase in neuromuscular activity throughout the body. Symptoms may include tight muscles, cramping, headaches, lower back pain, various aches/pains throughout the body and teeth clenching to name a few.

The sympathetic branch of the autonomic nervous system is necessary for survival as it enables us to escape threat. However, this system needs to be managed if it is constantly on as it is meant to be used a temporary strategy. You wouldn’t use the same way of stabilizing the body to perform a maximum effort back squat as you would to walk down the street.

One way to manage this is by improving core function or utilization of the trunk musculature. Notice that I did not say core strength!

Having a well-functioning core tells the brain that you are not in a state of threat, therefore activity in the adrenal glands is kept under control. The body can remain relaxed, move fluidly and feels balanced.

To learn how to do this, check out some of my past blog posts or reach out to me at zacharyc@cohenhealth.com!

Most people think of a flat arch when thinking of a poor foot type. However in the performance physical therapy world I commonly see the complete opposite extreme in a very high arch, known as a supinated foot. This is a foot that is extremely rigid and cannot shock absorb well. As a result more force is placed onto the lower back, hips and knees, just to name a few areas.

Furthermore, this high arch shifts the majority of the bodyweight laterally, onto the outside of the foot as this is what is mostly in contact with the ground. The body is essentially floating away as less of the foot is in contact with the ground and we will eventually compensate in an attempt to find the ground. These compensations can occur in the foot/ankle, knees or higher up leading to future ailments.

A good pair of shoes is paramount in this situation to provide an arch for the foot to press down on and feel. As the brain senses the arch of the foot it will feel more centered on the ground and the need to compensate will immediately decrease. Furthermore the heel of the foot should be secure within the shoe so that a stable foundation is created for the mid and forefoot (located further down the foot) can function appropriately.

For this reason I recommend a good pair of running shoes to these patients regardless of whether or not they are runners. A good running shoe can reinforce optimal walking/running mechanics, while a bad shoe (running or training) can force the body to compensate, eventually leading to injury. An example of one shoe that I like is the New Balance 1080v6.

Therefore if you have a very high arch, take a look at the shoes you are wearing and check to see if your heel feels secure and you can feel the arch of your foot. If not then you may be floating away!