The Resilience of Structure and Posture

Welcome to the Evolution of Medicine podcast! This week, Mat Boulé, osteopath and posturologist, joins us to discuss his work on posture and health creation. In our Year of Resilience, it’s the perfect time for Mat to share his insight on the significant role posture plays in health resilience and how resolving patients’ mechanical issues can transform other important lab markers. But I think the biggest takeaway you’ll get from this episode is an understanding of why the best medical teams need practitioners who can support and improve structural integrity. It was a fascinating 30 minutes—enjoy! Highlights include:

• What posturology is, and how this medical discipline has the potential to revitalize health creation and resilience
• How resolving mechanical issues can transform important lab markers
• The interconnection among structure, posture and inflammatory markers
• The body-self matrix and how it relates to the biopsychosocial model of care
• And so much more!

Resources mentioned in this podcast:
goevomed.com/lmrc

Please note: This episode was recorded prior to the outbreak of COVID-19. The PLMI conference in Chicago, originally scheduled for May 1-2, 2020, has been cancelled due to the outbreak, with the rescheduled date to be determined.

James Maskell: Hello and welcome to the podcast. This week, we bring back Mat Boulé who is a posturologist and osteopath from Canada and is doing some interesting work on the forefront of posture and health creation. In this podcast, we’re going to learn about the role of posture in resilience, in line with our Year of Resilience. We talked about how resolving mechanical issues can transform other lab markers and we specifically spoke about inflammation and the roles in there. But I think what you’re going to get from this podcast is a really good understanding of why we need to have practitioners that can help structural integrity in an optimal medical team and plays into everything we’ve been doing here for a long time at the Evolution of Medicine. Thanks so much for tuning in. It’s a great half an hour. Enjoy.

A warm welcome back to the podcast, Mat, welcome back.

Mathieu Boulé: Thank you so much James. I’m happy to be back.

James Maskell: I’m super excited for you to be here and I’m super excited for this upcoming conference. I’ve had an opportunity to work with Dr. Bland more intensely for the last couple of years and so, he asked my opinion about this conference and how to really get the right kind of combination of speakers to really set up this idea of complexity and simplexity and resilience, which we’re going to get into today. And obviously there’s you, but some of the speakers like Dr. Jeff Geller, who’s going to be coming and speaking about group visits and his empowerment model is obviously very close to my heart now. And obviously pairing him with people like Dr. Bland and also some of the researchers talking about things like a phenotypic flexibility. I really feel like this is going to be a landmark conference.

I’m super excited to attend and be at and to also, make some Functional Forums over the summer with. For those people who may be listen to, who are avid listeners to the podcast, they remember our conversation a couple years ago about posturology and about structure and function. But for those people that may be listening for the first time, can you sort of give a sort of a quick wrap-up of what we spoke about last time and why people in functional medicine or people who care about health creation need to understand this posture concept?

Mathieu Boulé: Most definitely, James. Basically what we ended up speaking about last time was the fact that functional medicine practitioners ever since its inception, have really been looking at the body from the inside out, which is really, gut function for example and brain function. And they’ve been doing a phenomenal job of that. And when I started as an osteopath, I had realized early on that when people were dealing with musculoskeletal issues, it was literally putting a weight under overall health condition. And when I started addressing things more neurologically from a posturology and functional neurology standpoint, I really thought, geez, this is something that functional medicine docs really needs to look into. Because while they’re trying to create health from the inside out, what if from the outside in there are constraints that are creating stress on the body? And how about just attacking stress from all angles? This is where posturology comes in.

James Maskell: Yeah, and absolutely. And one of the reasons why I’m excited about functional medicine and why I’ve doubled down into functional medicine as opposed to naturopathic medicine or integrated medicine is because, from an economist point of view, what I see that functional medicine has is a prioritization system. And ultimately, what we’re trying to deliver at every moment is the maximum marginal benefit at the minimum possible cost as far as from an economics point of view. And when you go through that, you go through the functional medicine matrix and if it pops out that structural integrity is a big issue, then you know okay, well we better get someone on the team who knows how to deal with this. And I think that that’s something to me that really reinforces the fact that yeah, not everyone needs a posturologist but if structural integrity is coming up on your intake as something that is important, then that’s going to be important member of the team to bring this to full resolution.

Mathieu Boulé: And part of why I’m so excited to present at this conference in Chicago at PLMI is that I’ll be giving practitioners very easy to use assessment tools. For example, if the client or patient that you’re managing has a hard time standing on one foot, well, you could think, well if they just lead a more sedentary lifestyle, they won’t run into any issues if they have like a balance. But James, the thing is when you walk, 80% of the time you spend is on one foot. Even that can diminish the impact of the results you’re trying to get from a nutritional supplements lifestyle point of view. And so there’s nothing more, easier than just getting your patient to stand on a foot for five, 10 seconds. And then to think, geez, if this is tough, maybe we need to include that. As you say, and it’s even part of the matrix to begin with. But how about then intervening on it and posturology is the best tool to do that with.

James Maskell: Beautiful. Well, look, let’s get into, I wanted to go a little bit deeper into this conversation about resilience. We announced 2020 is the Year of Resilience and in some of the conversations we’ve had since our first interview, I felt like we could go again because there was just a lot of great information as regards to the work that you’re doing and how it ties into this theme of resilience.

Mathieu Boulé: Most definitely. And resilience is at the core of what a great posturologist is always looking to create. There was a matrix created, James, in 1990, by a researcher named Ronald Melzack and it’s the body-self neuromatrix. Is that something you’ve heard about?

James Maskell: I haven’t heard about it, but I’m interested.

Mathieu Boulé: Yeah. The body-self neuromatrix is I would say a great embodiment of this bio-psychosocial model that is so popular right now, and for all the right reasons because it addresses many of the reasons why an individual would be suffering. And obviously what you can look at when you look at this matrix are the emotional factors, the social factors, environmental. But there’s also the fact that if your sensory system, the one that allows you to basically function on a physical level and to interact with the environment, well that’s part of that system. And if that system is not working well, for example, you have visual input, vestibular input, proprioception, those are all physical, very physical qualities that actually allow us to function in our daily lives. And if those aren’t functioning properly, what they actually create in the system is more stress. And it’s a form of stress that is mechanical, that becomes neurological and metabolic over time. And if it’s not dealt with properly, it does impede on the patient’s results when they undertake to improve in other areas of their lives, such as nutrition, lifestyle and supplementation.

James Maskell: Yeah. Yeah, I could definitely, I definitely see that. How does that play out into patient care?

Mathieu Boulé: Well, so what’s interesting is when you assess a patient, when you look at the matrix proposed in functional medicine, just structural integrity is a component of it, as you were speaking of. On a posturology standpoint, it’s nothing more complicated than to just say, you know what? We’re going to look at how someone stands upright. You test their posture when they’re standing relaxed. And if you see any imbalance, now, don’t get me wrong, no one’s perfect, but the bigger the imbalance is, the more it’s been shown to create three things, pain, the need for medication and the necessity to stop physical activity. That was from a report that was published in 2005. It was presented in France at an orthopedic congress. And so we know then, and it’s, correlations, but they’re highly statistically significant. We know that if we have asymmetries in posture, there is a strain on the body. And we also know which body parts we need to address that are the priority when it comes to standing upright and there’s two of them, there’s the feet and there’s the eyes.

James Maskell: How do imbalances in these areas play into dysfunction in other organs and systems?

Mathieu Boulé: And so on a very mechanical level, and this goes back to my training as an osteopath, if we figure that someone’s liver might not be producing the best outcome, it’s often associated with the fact that, again, from an osteopathic standpoint, it won’t be moving so well. But if that right shoulder is always tilted and forward, there could be compression on that organ, not allowing it to express itself properly. Now, that’s from a purely osteopathic standpoint, but if we look at it more systemically, for example, someone who has poor posture and poor balance, will need an increased demand from their vestibular system.

And vestibular system is connected to the stress response, so the sympathetic. You’re going to have typically more issues with heart rate, with blood pressure, if only because you’re dealing with just not having great balance, great motor control. That’s going to affect the outcome of the patient negatively. If on the other side of the coin, you can improve their balance and their posture, then you should have one less obstacle to worry about as you’re getting this person back to optimal health.

James Maskell: Have you seen examples of early work with posture that turns into lab marker improvement without touching actually the system that’s responsible for those labs?

Mathieu Boulé: 100 percent. For the last five years I’ve been contributing with both medical doctors and nutritionists that are certified in functional medicine, but even on my own in the office, I measure aortic stiffness and what I’ve seen specifically, there was this one case, he’s a CrossFit athlete, champion actually. When we first started with them, not only did he have so much physical pain in his elbow that he was not able to train, but we started with him working on these mechanical imbalances and I actually measured aortic stiffness in the whole process. It took about 15 months and the better we got him on a physical level, while all other variables remained the same, his training was the same, once he got back to it. Nutrition was the same. We just kept improving his says systemic profile. His aortic stiffness kept decreasing progressively every three to six months I would say. You can perform at life and you can be healthy if you’re in a state of balances, what that showed me.

James Maskell: Can you talk specifically about the inflammatory response because ultimately I feel like a lot of practitioners are focused rightly on kind of reducing systemic inflammation as it relates to, let’s say, autoimmune disease or chronic pain or even mental health and how the sort of the role of posture and inflammation and some examples off of how bad posture could be driving systemic inflammation, independent of nutritional or other factors.

Mathieu Boulé: One of the ways that poor posture probably contributes to systemic conditions such as inflammation, and there’s actual research on this, is that if we look at a typical case of forward head posture, and this is one of the areas where there’s actually the most research on the topic, what’s been brought forward with cases of forward head posture is that there’s often compromised respiration as well as a circulation. And so if you figure the effects of that, well it would be that it’s harder for the body to remain in a state of homeostasis. Not so much because you’re doing a whole lot physically, but if only because you’re resisting the pull of gravity.

And so forward head posture is interestingly enough, as far as we’re concerned in posturology, often associated to flat feet. And so if the practitioner is trained in this methodology, then one will look at the head and neck. But then one will also look at the feet and we provide solutions to create arches so that we can create more symmetry into posture, which then leads to a better internal environment. That would be, as far as chronic inflammation, one of the ways that we could help.

James Maskell: Yeah. Obviously, one of the things that I’ve been involved with for the last six years is trying to make connections of practitioners and to bring practitioners together into groups. And ultimately the reason for that is because I see that the chronic care team of the future includes a range of practitioners. It can’t necessarily be executed by any one person. And in my latest book, in The Community Cure, we really showed sort of my vision for how the naturopathic therapeutic order, which is a concept on how to deliver the most marginal value for the least possible cost, could be executed. And how practitioners can work together with a combination of groups and integrative therapies focused on things like structure and function. And then, only really using one-on-one functional medicine and more deeper dives into lab markers and so forth.

If group visits plus integrative therapies didn’t completely resolve the issues, which we see examples like the Cleveland Clinic where if you get people into groups and get people healthy and empower them with information and help them to really learn the fundamentals of health creation, not just mentally but actually in practice that, this is sort of my vision for that future. And ultimately, I guess, I wanted to just dive into that because ultimately what do you think the chronic care team of the future looks like? And ultimately, given that posturology is not really mainstream at this moment and is obviously sort of growing in interest, but there’s not one on every corner, what are some easy ways that we can get the most maximal benefit from posturology without expecting that there has to be tens of thousands of posturologists in every zip code in order to get the population back to full health?

Mathieu Boulé: Yeah. It’s about engaging then in physical activity that the trains as much as possible the prerequisites for movement as we see it as adults. Because one thing to mention is that posturologists are quite interested in how we developed movement literacy. Basically we focus mostly on the sensory motor gains we’re supposed to make from zero to about two years of age. And so if the form of physical activity that people can get involved in require balance, agility, coordination, then those would be the types of activities to promote in terms of trying to achieve the gains that would make it easier for a team of functional medicine to intervene and to obtain better results.

James Maskell: Well, let’s dive into a little bit of something that’s close to my heart. I’ve been doing CrossFit here for a couple of years and I did it a few years ago because ultimately, I feel like look, there’s 15,000 of these boxers around. It’s really using the group structure. It’s really focused on functional movements and certainly I came face to face very quickly with my own lack of balance and certain movements there that have been really valuable. And I’m all about scaling up solutions. I’m all about trying to create a way that we could actually create a sustainable health system based on the assets that we already have. And I guess I just wanted to go a little bit deeper into that conversation with you because I know that, what are your thoughts on whether CrossFit can step into the breach? And what percentage of issues can be dealt with by having that sort of physical exercise with a focus on functional movements?

Mathieu Boulé: I find way too often CrossFit is getting a bad reputation in terms of it creates the injuries and so forth. I think we have to look at the profile of the people getting involved in physical activities and not so much blame the activity in and of itself. CrossFit is very popular for many reasons such as the ones you’ve mentioned. The community aspect is probably the number one reason why it’s grown so much. People that go to CrossFit, go see their friends, their family, they hang out together on the weekends. It’s a bit more than just getting your workout in. That being said, it’s about having the right abilities to perform the activities that you’re interested in. There’s a pyramid for the ones that are interested in looking this up, that was developed by two OTs, their names, they’re Williams and Shellenberger, it was from 1994.

And this is the, they call it the pyramid of learning, James. But really what they mean is the pyramid of how the nervous system develops and they put up the very top of that pyramid, what’s called activities of daily living. For example, for you that’s going to CrossFit. For an elderly person, it might be going up and down their stairs. But truth is that there are prerequisites to be gained in order to perform those activities at a high level. And so for example, one of them is eye hand coordination. How many people have you heard of that say, “Oh, I can’t really throw and catch. It’s just not something that I’m good at.” Or they’ll say something like, “I don’t really know my right from my left, I’m not very good at directions. If I’m going somewhere I always get lost.”

And we tend to think, well those aren’t really big deals and we can kind of do without them. But funny enough, not knowing your right from your left typically means that you’re not very good at using your right and your left. In CrossFit that’s huge because they’re going to have to lift the bar overhead and ideally do it with both arms even evenly. And if you’re not good at coordinating your eyes and your hands, you’re probably stiffer between your neck and your hand. If your shoulders are stiff, it’s going to be hard to perform muscle ups. You see how looking at gains you should make early on in life, how that’s going to affect your performance later on, for example, when you want it to get into CrossFit.

James Maskell: Yeah, and I just want to make one point is that there is something that’s happened in the last couple years which will be coming out very soon. In fact, on next month’s podcast, I’m going to be talking to Dr. Julie Foucher who’s a very, one of the top CrossFit athletes. Because I’ve had a chance to actually go to CrossFit HQ recently. And one thing I found out is that, and I’m going to say this, I guess as clear as I can, as CrossFit is to injuries what chiropractic is to quackery. In that, people think of chiropractors as quacks because in the 1980s the American Medical Association went on a very specific PR vendetta to position them as such. And so, really it became into the lexicon of the world by associating chiropractic with quackery. In the same way, the Strength and Conditioning Board did exactly the same thing to CrossFit.

And that’s not just my opinion. That is the opinion of a court that has already decided that that happened. And in April of this year, there will be a judgment made against the Strength and Conditioning Board for what they did. And that judgment has not happened, but they have already lost the case. And I would say that there will be press to show that, a lot of people do, even in today, and I’ve been around it for a long time and me for a long time had in my mind that CrossFit caused injuries at a very high rate. And the truth is that to whatever degree you think that’s true, your viewpoint on that has been affected by a specific campaign, by the Strength and Conditioning Board to create that feeling or to spread that concept. And so watch this face because I think it will actually have a dramatic impact on the industry.

It might even lead to the end of that conditioning board because it’s going to be a huge number, 15,000 sort of CrossFit gyms multiplied by all of that press. The potential for lost earnings by that effort is significant. As I say, the case is already lost. They’ve already lost the case and CrossFit has won. And so I’m very interested to see what happens on the other side of that. I just wanted to share that because not a lot of people know that and you’re going to find out about it soon.

Coming into this conference, Mat, and I guess kind of the reason why I wanted to talk about this, you mentioned some of the things that people are going to learn. Are there any other things that people can expect to learn and I guess I’d love to just get your thoughts on now that you’ve seen who else is speaking, who else are you excited to hear from at that conference?

Mathieu Boulé: I got to see a Dr. Vojdani for the first time at the IAFNR Conference in Vegas, which is for the functional neurology crowd, not too long ago. And I have to say I had always been very impressed with him, but what I was even more so impressed outside of his academic knowledge was just how kind and humble of a man he is. And how he made the lectures so accessible so that everyone in that room, and we’re all trained professionals, but nutrition is not my forte. And I have to say, I left that conference feeling very confident that what I had learned I would be able to use. And so I was quite impressed with, again, not only the amount of knowledge that this man has, but his way of communicating it and the humility that he had in doing so.

And I wouldn’t be surprised that I would get the same feeling from the people that attend, knowing how Dr. Bland is for having spoken to him now a few times since this has been organized. Just so kind and so willing to, and curious, that’s probably the number one trait that makes us all really like working with each other, James, is the fact that we’re forever looking for how can we make this better? How can we make this more accessible? And to be surrounded by these speakers who all have the same purpose but come in with different expertise, yeah, it’s going to be one hell of a party. I’m quite excited about it actually.

James Maskell: Yeah, I’m very excited too. We’ll have all the details in the show notes, but it’s May 1st and 2nd in Chicago. It is going to be the PLMI conference. It’s the mastering the implementation of personalized lifestyle medicine conference. I’ll be there, Dr. Bland will be there, Dr. Geller will be there, Mat will be there and it’s a really great lineup this year, which I’m really, really excited about. And this is kind of, I’ve never put on a conference but ultimately I was very happy to have some input into it and also conversations about simplexity and really the fact that we are dealing with a complex body and complex systems, but ultimately sometimes the solutions are very simple and certainly some of the things that you’ve mentioned here on this podcast, Mat, are very simple and could be implemented by any practitioner with any certification or any license and would increase the potential of their care to get to more root causes and to help more people.

And so, I really appreciate you coming back here on the podcast. Looking forward to hanging out in-person in Chicago. If you are listening to this and you’d like to come and join the party, as Mat says, we’d love to see you there. We will be also videoing the conference for use in future Functional Forums as we set out this year of resilience. But in the meantime, Mat, thanks so much for being here as part of the Evolution of Medicine podcast. Again, if this is the first conversation you’ve heard with Mat, make sure to go back and listen to our first episode, but in the meantime I’m your host James Maskell. Thanks so much for listening and we’ll see you next time.

Thanks for listening to the Evolution of Medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.