1. OPTIMAL CORE ALIGNMENT WOCN Regional Conference 2015

2. SPEEDING RECOVERY through IMPROVING MOVEMENT Melanie Carlone,DPT, MS, RYT Custom Orthotic SolutIons, Inc.

3. LEARNING OBJECTIVES: 1. Principles of Optimal Core Alignment and physiological effects on wound healing

4. Optimal Core Alignment ~unites feet body and gravity

5. Alignment means better movement

6. Better movement promotes healing

7. Best Healing Possible is supported by Optimal fluid return from the lower extremities…

8. Venous Foot Pump Mechanism 25 mL of blood ~Each step ~Healthy gait

9. Alignment Foot Core Body Core

10. And Active client participation in the healing journey increases compliance

11. LEARNING OBJECTIVES: 2. Consider when internal and external forms of support are most useful

12. Internal Support Empowers Clients

13. Active Client Participation Negativity Bias is real 10-30 seconds of TAKING IN THE GOOD overcomes bias and hardwires change R. Hanson, PhD, Hardwiring Happiness: The New Brain Science of Contentment, Calm and Confidence.

14. Experience Dependent Neuroplasticity Taking in the GOOD…

15. Internal physical re-education Lasting Change

16. External Support

17. Wound Offloading Can Take Many Forms

18. LEARNING OBJECTIVES: 3. Know when referral for foundational evaluation and support is necessary

19. COLLABORATION

20. Optimal Core Alignment exercise

21. How you hold yourself in relationship with gravity?

22. POSTURE & FUNCTION

23. We are structurally designed to be walking… NOT sitting

24. When Gravity wins…

25. STABILIZATION BODY CORE

26. STABILIZATION FOOT CORE

27. INTEGRATION AN INSIDE and OUTSIDE JOB

28. CORE ALIGNMENT IS THE NAME OF THE GAME

29. Rene Cailliet, MD 1917- 2015 Pioneer Physical Medicine and Rehabilitation, US Army, WWII

30. UNIVERSAL TISSUE RESPONSE Cailliet, Rene. Pain: Mechanisms and Management Philadelphia: F.A. Davis, 1993.

31. Inhibition = Mal-alignment = PAIN = Increasing Dysfunction

32. ARTHRITIS= “Itis” in your “arth”

33. Gait Abnormality

34. Mal-alignment leads to Poor proprioception Balance disorders Reduced core stability Reduced venous pump

35. Review of the venous foot pump mechanism Not active at rest

36. Review of the venous foot pump mechanism 80 mm of mercury on standing

37. Review of the venous foot pump mechanism Falls to 30 mmHg walking

38. Review of the venous foot pump mechanism 25 mL pumped upwards each step

39. Review of the venous foot pump mechanism Forward momentum causes the pump action deep in foot intrinsic muscles

40. http://www.phlebolymphology.org/the-plantar-venous-pump-anatomy- and-physiological-hypotheses/ Venous pump deep in the arch NOT in the sole

41. " Impairment of the foot muscle pump by static foot disorder is an important cause of chronic venous disorder.” Vaidyanathan, Subramoniam, Riju Ramachandran Menon, Pradeep Jacob, and Binni John. Chronic Venous Disorders of the Lower Limbs: A Surgical Approach.: Springer India, Print

42. Optimal Core Alignment System clarifies: Support core alignment = Support optimal function & venous return = Speed in healing times

43. MORE ON THE FOOT CORE

44. These feet are made for walking…

46. WINDLASS EFFECT

47. Passive Sub- system

48. 4 arches in the foot Inner and outer arches

49. 4 arches in the foot Transverse arches

50. LIGAMENTOUS SUPPORT

51. Active subsyste m

53. The Neural Sub- System

54. Altered feedback

55. ALTERED FEEDBACK INCREASES FALL RISK

56. Optimal Core Alignment trains and supports inside and outside body and foot.

57. ASSESSING FOOT CORE ALIGNMENT

58. Talar Neutral

60. INTRINSIC FOOT MUSCLE TEST

61. TRADITIONAL FOOT EXERCISES MAY NOT TRAIN INTRINSIC MUSCLES

62. SHORTENED FOOT EXERCISE

63. Referral to a Core Support Team Biomechanics Education Custom Orthotics Offloading Apply and Reassess

64. WOUND OFF LOADING

65. REDUCE PRESSURES

66. In Summary… “I have a choice. Do I want to align with the greatest vision of myself or do I want to align with my excuses…” -Debbie Ford