OESH: a model of success in innovation

This past week Bob and I were asked by two different groups of business executives / movers and shakers to share with them the OESH story. One of the groups wanted to feature OESH as a model of success in innovation. First, we’re flattered. The only other nationally based company that they had asked to present to them was Whole Foods.

I started by going through everything in my usual lecture style…completely unrehearsed. There’s all my research, then there’s all the manufacturing. And then there’s the disruptive technology and the entire re-inventing of everything. With only an hour, I had to leave out about a million things but that’s what the question and answer session is for. So, one question…“What was the worst day you had in all of this?”

That would be that one particular day last summer that I was in the factory until almost midnight, cleaning the resin bath on the filament winder. Every day, it took a full two and a half hours to clean the resin bath. It wasn’t the actual cleaning as much as it was the stress that if we missed a spot, the equipment would be permanently frozen the following day. I had to figure out a better way but just hadn’t yet.*

And another question…“What was your best day?” The answer to that one is easy. “Today.”

It’s the feedback from you all that gives me that satisfaction that a physician can only dream of. I am helping in a way that I know no one else ever could. I get a lot of hugs…all you local folks, keep them coming. And all of you who are too far away, keep emailing us your stories…we’ll keep posting them on “OESHers: SAY”.

*I did figure out a way such that cleaning the resin bath only takes about 15 minutes, and is, I daresay, an absolute joy.

Speed of lightning, Roar of thunder…OESH is here!

Happy Thanksgiving to all of you OESHers! This photo of Underdog is from the Macy’s Parade the first year we actually saw it, in 1983.

I especially remember walking around 77th street and watching them blow this guy up at 11 o’clock on Wednesday night. It’s a good thing Underdog was netted that evening–it was quite windy and if he had gotten loose he might not have responded to traditional canine commands to get in line for the parade (had he blown across the Hudson River, for instance) on Thursday morning.

And here is a certain young lady “I’m a size 8 but a size 10 feels real gooooood” from that same year. As we see Olive approaching the Dakota on Central Park West, clearly Ms. Oyl would have gained benefit from OESH–that tendency to create a 180° angle with her feet (common to many cartoon characters, apparently) would clearly be mitigated by a compliant weight-bearing architecture allowing for a unique and healthy re-distribution of forces leading to more efficient foot motion and even, perhaps, a realistic view of proper footwear sizing. I shudder at the size of the required cantilevers, though.

Have a great Holiday!

 

The one and only stretch I recommend

One of my discoveries in the gait laboratory that led to a number of research publications as well as a prestigious multi-million dollar research award from the National Institutes of Health, culminated in my recommending one, and only one, stretching exercise that I think we all need to do on a daily, if not twice a day, basis.

I found that for many of us, when we walk, our hips do not fully hyperextend (bend backwards). This might not seem like a big deal, but in order to take a step, if your hip does not fully hyperextend to a normal 20 degrees of hyperextension, your low back ends up having to hyperextend more than it otherwise would. While movement through your hips is a good thing, you really don’t want to have a lot of movement, especially hyperextension, through your low back because that causes excessive wear and tear through the spinal structures that can contribute to low back pain.

It took biomechanical studies to make this discovery. It is impossible for even the most astute clinician to distinguish between hip and low back movement during walking. But with the use of cameras and markers placed on various anatomic landmarks on the body, I was able to not only distinguish between these two movements during walking, but quantify them as well.

I found that the majority of us over the age of 40 have reduced hip hyperextension during walking (compared to 20 something year-olds) that is invariably associated with increased low back motion and/or a shortened stride. Hip motion during walking is substantially less in elderly adults (over 65 years) compared to young adults and is even less in frail compared to healthy elderly people. Associated with this finding, low back motion during walking tends to increase while stride length decreases with age. People with recurrent low back pain demonstrate less hip hyperextension and greater hyperextension motion in their backs as compared to age-matched controls. People who have what is known as lumbar spinal stenosis (a narrowing of the spinal canal due to degenerative changes in the surrounding spinal structures) have especially reduced hip hyperextension and increased hyperextension motion in their backs.

So, how do you increase the amount that your hip hyperextends during walking? Easy. You do a simple two-minute stretch. If you already have a limitation in hip hyperextension (like the majority of people over the age of 40), this one stretch, if performed twice a day, will increase your hip hyperextension and reduce motion in the low back within ten weeks if not sooner.

Now mind you, I’m not one for recommending stretching in general. I think most muscles, tendons, and ligaments are better off being dynamically stretched through natural activities, such as walking. But the muscles, tendons, and ligaments in front of the hip are different. They are not fully stretched during most natural activities. Standing, leaning over backwards and even doing a gymnastics type backbend will not fully stretch those tissues around the hip. (Most of the hyperextension in a backbend occurs in the back, not the hip). Only walking and to a lesser extent, running, regularly stretches the hip structures. But regular walking and running may not be enough to prevent a decline in hip hyperextension. And a decline in hip hyperextension only leads to trouble.

Go here to see a video of the one and only stretch that I recommend and regularly do.

What is a physiatrist?

I am a physiatrist and although I don’t actively see patients now that I am making OESH Shoes, I am still frequently asked, “What is a physiatrist?”

A physiatrist is a physician who has completed four years of medical school and then has completed an additional four years of residency training in the medical specialty of physical medicine and rehabilitation (PM&R). When I was chair of the department of PM&R at the University of Virginia, every year we would have a graduation ceremony for that year’s graduating class when the residents’ parents and often their new families would fly in from wherever to help celebrate. I would give a little introduction that kicked off the evening…

“You may still wonder what your child or spouse’s medical specialty is exactly. The problem is that it takes a little more explaining than most fields. Unlike most medical specialties, we don’t specialize in just one organ system or in just one orifice…”

Physiatrists take care of people of all ages with all sorts of diagnoses. We are expert in helping people recover from traumatic events such as a stroke, brain or spinal cord injury. But we are also expert in taking care of all types of musculoskeletal aches and pains. I used to say if you had to pick one word to describe what we are then we should say “function.” We’re function doctors. We help get people to their fullest capacity, to their full function.

A physiatrist studies the whole body in relationship to the outside world. We have a keen understanding of movement. We typically prescribe exercise, not medicines. We don’t do surgery. And we tend to recommend things that go on the outside, not the inside of the body — like leg braces, canes, walkers, and…shoes.

Another point of confusion is that the word “physiatrist” sounds a little bit like the word “psychiatrist” or “podiatrist.” My own dad in fact thought I was a podiatrist for awhile (it didn’t help that I was studying the biomechanical effects of shoes). But as a physiatrist I was more interested in the effect of shoes on the entire body than on any one particular anatomical structure, such as the foot. Sure, I found particular areas of the body to be especially prone to things like osteoarthritis and stress fractures but it was my understanding of how the body works as a whole that allowed me to figure out why those areas are especially prone to injury.

If Hollywood ever did a show on physiatrists, say “PM&R,” it just wouldn’t have the same drama as “ER.” PM&R is more like Mary in the “Mary Tyler Moore” show. PM&R has just never gotten the glamour that Ted Knight got, but all the meanwhile, there is a huge growing need for a physiatrist’s services. We are all living longer. Eventually we all get things that limit our mobility. At this very moment, a full one in ten people in the United States have difficulty walking. Not just because of a stroke, spinal cord injury or traumatic brain injury. But because of musculoskeletal related issues, like osteoarthritis. These musculoskeletal issues don’t get much attention on prime time but meanwhile, in medical schools around the country, perhaps because of the growing need for our services, PM&R has become the new “hot” field.

My last year as department chair in 2009, we had over 600 highly qualified medical school applicants for only 4 residency spots. Comparatively, in 1993, when we had just established our new residency program in PM&R at Harvard Medical School, we had about a dozen applicants for 4 spots, and one of that dozen, was just finishing up a prison term for murder. Okay, it was just manslaughter and he had done very well, moving up from high to low security confinement and had done loads of community service. But his application was a bit different than the applicant in 2009, who received top grades in medical school, scored the highest on the national medical examination, was an accomplished musician and athlete, was a joy to talk to, and hadn’t committed murder (at least to my knowledge).

To learn more about what a physiatrist is or how to find one in your area, visit our specialty’s main organization, the American Academy of Physical Medicine and Rehabilitation.