Interview with Mat Boulé and James Maskell

Announcer:                       Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help transform your practice and the health of your community. Now, here’s your host, James Maskell.

James Maskell:                 Hello, and welcome to the podcast. This week, we feature Mat Boule, a posturologist from Montreal in Canada. We spoke about a number of things regarding structure and function.

We talked about the difference between the inside out approach of functional medicine and the outside in approach of posturology and functional neurology. We talked about some difference types of cases, like chronic fatigue and fibromyalgia and how to use those kind of techniques in those kind of diagnoses.

And we talked about some tips that any practitioner, whatever your degree type, can use on intake to determine whether or not structural or functional issues are going on with the patient. It was a really interesting half an hour for any practitioner interested in root cause resolution medicine. Enjoy.

So a warm welcome to the podcast, Mat Boule. Welcome, Mat.

Mat Boule:                        Thank you so much, James, for having me. I appreciate it.

James Maskell:                 Always great to have a French Canadian on the podcast. It’s been few and far between. Today, we’re going to be talking about posture and structure and function, something that is near and dear to the hearts of a lot of the people that listen to this podcast in the community. Before we get into the details of posturology, I know that you’ve had quite an interesting educational journey. So why don’t we just start a little bit about your story, how you ended up practicing the way you do today.

Mat Boule:                        Yeah, well, for sure we’ll start with that. So I started out as a personal trainer. I was interested in getting people fit and healthy. Migrated towards working with athletes moreso because I was a bit frustrated with mainstream clients limitations in terms of movement ability. And not that it was their fault, but I figured okay, well, I want to give this type of an exercise or this type of a training regimen. And often enough, the people I was working with were either injured or coming back from injuries or had different types of limitations.

So I figured maybe athletes had less of them. And I was quite shocked about 15 years ago to realize that athletes were pretty much just as messed up as regular folks were. They maybe had access to better tools and better caregivers in terms of recuperation. But essentially, it wasn’t that much easier to develop performance programs for them.

And then I started venturing out into well, how can I basically help these people function better but more on a physical therapy standpoint. So I became trained as an osteopath and that opened up a whole new world for me in terms of just making links and connections and appreciating physiology.

And then, what I realized is osteopathy and philosophy was fantastic. I just thought, and I found that the methods that were used were not providing long lasting relief. And quite frankly, I found the same with all manual therapies. They could help. They alleviated symptoms. But I wasn’t seeing long-lasting changes.

You go back to the anatomy books, James, and you realize there’s one system that governs all the other ones, and it’s the central nervous system. So I started looking into techniques that challenged or stimulated. And that’s pretty much how I came to practice the way I do know, which is a mix of posturology and functional neurology.

James Maskell:                 Yeah, super interesting. I think obviously functional neurology is something that’s becoming more and more popular as people start from the premise of structure equals function. And you start to see a lot of chronic pain and other types of neurological issues having a structural component. What are some of the sort of core issues?

The kind of people you’re talking to here are practitioners and doctors around the country who are seeing maybe all kinds of chronic illness that they’re not potentially that well-trained to understand to what degree structure is playing a role.

So, what are some issues that you see that you probably didn’t think that involved either the central nervous system or a functional neurology approach that have turned out to be very central for that and should be a warning for other practitioners to look at when they see those kinds of symptoms coming in?

Mat Boule:                        Functional medicine has done a phenomenal job of looking at the body from the inside out, and I believe what’s missing right now in functional medicine is looking at the body from the outside in. And, in saying that, if you address and you assess structure from a very critical standpoint where you don’t tolerate any imbalances. And physically speaking, what I mean by that is if you just simply look at someone’s shoulder height, there really shouldn’t be one that’s lower than the other. And the same goes for the pelvis. All physiological systems work towards trying to reduce energy expenditure.

So where posturology comes in is that it’s powerful enough to assess, address and correct these imbalances and give back to the body what it deserves, which basically is this notion of muscle balance. And this is a theme that’s very common amongst functional neurology practitioners is that muscles send an enormous amount of information to the brain and then the brain in turn can start controlling all of the physiological systems better. So whether that’s the digestive or immune, endocrine systems.

I find that the missing piece right now, and this is what I’ve seen in my practice collaborating with functional medicine doctors. I’m actually in one of the offices now in Montreal where I operate out of Dr. Stavrinidis. She’s a cardiologist that I work with, functional medicine, IFM trained. And what we’re realizing, her and I, is that essentially, yeah, it’s great to treat from the inside out. But we get much better results when we do both at the same time.

James Maskell:                 Yeah, so what does that look like from the outside in? Let’s say you’ve got a patient that comes in and they’ve got one of the disease types that’s pretty well treated by functional medicine as opposed to conventional medicine, like a chronic fatigue or a fibromyalgia, something with sort of an unexplained etiology. What would it look like to sort of combine functional medicine and posturology in an initial workup, say?

Mat Boule:                        So I like both of the case you brought up, ’cause those are two cases where we actually see quite good changes. So let’s go with chronic fatigue, for example. What is often underappreciated is how much energy is used to stand upright. And often enough, when I give talks, I refer to this really old study back in 78, which is the influence of body position on the autonomic nervous system. And really what they found in that study, they were looking at 20 males, and they basically positioned them in either standing upright or lying down. And this would make sense to us, but essentially what they found was that standing upright actually created an increase in sympathetic tone.

So imagine if someone stands upright with these imbalances and with a, maybe let’s even go as far as to say stability issues where they lack balance, what we’re seeing there is essentially they’re expending way too much energy on something that should be easier. Although there’s a cost, we’re trying to decrease that cost.

And it basically, it helps the functional medicine practitioner achieve faster results because they don’t see the changes they’re creating being more or less swept away or dissipated by the fact that, when this person just goes about their daily activities, they’re burning the fuel way too fast.

James Maskell:                 Yeah, absolutely. That makes a lot of sense. And then, how about fibromyalgia?

Mat Boule:                        Fibromyalgia is obviously, and you know this maybe more than I do even, quite complex based on the people you’ve been speaking to in these last few years. But fibromyalgia, what we’ve noticed with a posturology approach where we look at, we actually look at four body parts. This will allow me to explain to answer your question better. We look at how four body parts contribute to standing upright. The main two are the feet and the eyes.

So the way I’ll always explain it is that the feet are like the wheels of a car. They need to be balanced, so we balance out feet, eyes. This is quite known in functional neurology. Eyes create your gaze so you report to the world horizontally when your eyes don’t move together. Your body has to tilt the head to compensate. That creates tilt and rotations from head to toe. But one of the other components is the bite, the occlusion. So it’s actually how the teeth from your lower and upper jaw come together.

So what we’ve noticed with fibromyalgia candidates is not only do they have eyes and feet that are quite dysfunctional, they also tend to be heavy clenchers. And when you look at the trigger points that seem to be correlated with fibromyalgia, they just about all match patterns of heavy duty clenching.

So it’s not rare to have success we’ll have to refer to someone who does mental health work. It could be a psychologist. It could be depending on the person’s preference. But essentially we find that, to get results with people that have fibromyalgia, we often have to add a third dimension. So functional medicine, posturology, but also a psychology approach.

James Maskell:                 Yeah, that’s super interesting. And it’s great to see the modalities being brought together. Could you talk into, just for a little bit, just a little deeper into the kind of relationship that you have with a functional medicine doctor, ’cause I hear a lot of functional medicine doctors or other people in the space right now are probably thinking, “Okay, I’m probably seeing patients that are having issues that are being contributed by structure equals function issues. And I may be referring to a chiropractor down the road or I may have physical therapist that I like. Or I may work with a DO.”

What have you learned from working with functional medicine doctors that other practitioners could learn from and how to sort of get the best possible input or the best possible outcome from the sort of least possible input?

Mat Boule:                        Yeah, that’s a great question actually, because since I’ve started working in this field, which was about 20 years ago, I’ve always thought that if we could just contribute to optimize clients’ or patients’ health, that was going to be the best option ’cause no one can do it all.

So where a functional medicine practitioner could come in, in terms of working with someone who does structural work, that we’ve discussed. But I guess your question is more so on the other side, basically what does a posturologist or osteopath benefit from working with functional medicine?

James Maskell:                 Yeah, I think it’s more just what have you learned in what is the right way. Okay, obviously functional medicine does a big intake, right?

Mat Boule:                        Right.

James Maskell:                 And that’s a big part of the intaking form. Other things that come up in the intake that’d be like, “Oh, maybe this is a good time to refer across to an outside in approach”?

Mat Boule:                        Gotcha. Yeah. So a really simple way to answer that question is that, whenever complaints on a physical standpoint– First off, let me say I believe every client should be seen by a competent doctor before they even see someone like myself, where I can be considered as a complementary approach. So that’s the first thing.

Now second thing is, if that doctor’s trained in functional medicine, that’s an even better if anything, just because the outlook on things and the open-mindedness is there. Where I find my clients absolutely need a functional medicine approach is when symptoms tend to be more bilateral.

So, for example, and actually just today a client told me they were diagnosed with bilateral shoulder tendonitis. So, whenever things tend to be more bilateral, I found in my practice they tend to be more systemic in nature. Whereas on the other side of the coin, I’ve seen functional medicine practitioners get very frustrated with clients that presented often with maybe asymmetrical symptoms.

So, for example, right sciatica or left shoulder tendonitis, where I find often enough when things are more lateralized that the tendency seems to be that the issue is more structural or mechanical. And not that it would be exclusively that, but on a continuum, whenever someone presents with issues that are bilateral, this notion of just fatigue in some of their metabolic signs, you can tell they’re just not very healthy. I sometimes even insist on them being followed simultaneously by a functional medicine practitioner, just in terms of them seeing the relief that they came in for.

James Maskell:                 Yeah, absolutely. And is there anything that shows up, if you were to work with you, where do the results show up? Is it symptom relief? Is it pain relief? Do you typically see improvements in lab tests? What kind of lab tests? What are some of the metrics by which you know that you’re being successful?

Mat Boule:                        When I started practicing, I was really simply concerned with getting the type of feedback from the client where, week after week, they were improving, which already for physical therapy, that’s quite rare. I think on people for 12 months, posturology is a re-programation, no plasticity type technique, where the purpose is to allow someone to stand upright optimally.

Now, since the individual took one year to learn how to stand upright between zero to 12 months of age. Whenever it is that we take them on at this point, we’re going to use a 12 month window to do that. And I expect that every three to six weeks, they actually improve in their condition.

So, when I started seeing that take place more and more, and it was purely from feedback, I figured okay, well, we need metrics now. We need to be able to prove that this works.

So I measure in three ways. I use a force plate, where I get weight distribution and I also get a balance score. And so, classically, every six weeks, the individual I follow up on, we’re able to test to see if those two metrics improved.

And more recently, because I wanted to have a better idea of how posturology could have a systemic issue, I started using a software from a Canadian company called iHeart. And iHeart is developed by a medical doctor and a cardiologist, and it basically uses an algorithm that combines everything from heart rate, saturation in oxygen for the cells, and aortic stiffness. And we’ve been able to see in some cases that people’s internal age, as they call it, decreases. And in some case, when we combine with functional medicine and others where that wasn’t the case– And the sample I have is my client load, so I don’t have thousands. But I would say for the bulk of it, the results that I’ve had are posted on my website. So if people are curious, they can check that out.

James Maskell:                 Yeah, and we’ll have the link in the show notes to the website so you can check that out. For the average practitioner who’s listening, maybe they’re a functional medicine doctor, maybe they’re a health coach, maybe they’re a naturopathic doctor or a chiropractor or even like an acupuncturist or just a doctor that’s interested in the evolution of medicine generally, are there some little tips or tricks that you can share with the practitioner community?

Obviously one thing is you could go down the road of getting trained in posturology and start to understand it yourself. But I’m just wondering if there’s simple things that you can pass on to the community that would just raise the ability of our whole community to be able to help with some of these issues that have structural components.

Mat Boule:                        A hundred percent. I guess the first thing in functional medicine, doctors do this really well, is taking information in from the client. And whenever, again, symptoms tend to be more lateralized, for them to think that right away there could be more of a structural, more of a mechanical cause to it. So that’s even just in their note-taking that they’re already doing.

The second thing I would suggest is to start assessing people physically maybe a little bit more. And it might take up to three minutes really in a given session. The first, first thing I would look at is their balance. So, for example, a very basic Romberg test, which is clinically used in neurology and medicine as a whole, can give you a lot of information. If the person, when they put their feet together, they cross their hands on their shoulders, they close their eyes, if you notice a lot of instability and uncomfortableness, some people start sweating. So, when we’re looking at, again, the tone between parasympathetic and sympathetic output, this is really useful information that the practitioner can use to say, “Okay, you know what? We need to improve this client’s balance.”

I believe they’ll get the best results using a combination of posturology and functional neurology. But even if, let’s say they don’t have access to that right away, if they even just suggest balance exercises to their clients, they should see a change in a person’s function. So test balance, and if they want to get a bit more specific, a quick posture scan. Essentially just, when the patient sits in front of them, is their head tilted to one side or is their head really level on their shoulders? That kind of tells you right there if they have an eye motor discrepancy.

So maybe those three things are a good place to start. Head tilt when the person is seated, balance, and in the note-taking, noticing any type of laterality to the mechanical issues that people speak about.

James Maskell:                 Yeah, absolutely. Yeah. Super interesting to have those kind of things. Ultimately, one of the things that we’ve been on and on about for practitioners is the intaking. One of the things that we see is that you’ve got to find a way to do the intaking more efficiently, to have people fill out their forms before they come. We’ve recommended technologies to do that. We’ve heard podcasts like Dr. Laura Salyer’s podcast, where she’s doing like a group visit where everyone’s filling out their matrix together.

And part of the reason why you want to get that stuff done in sort of a scaled up environment, either through technology or in a group, is so that when you’re spending the time sitting across from someone in the office, that you’re using that time as effectively as possible to be able to get the information that you need to get to the root cause.

And I can see that, if we’re in the business of root cause resolution medicine, that we need to be able to spend the time. And if there is a neurological root cause or if there is a structural root cause, this might be the reason why no physician has been able to get to the root cause of their issue, or no naturopath doctor or naturopathic doctor has been able to get to the root cause, because the root is structural and not something that they’ve been able to ascertain.

So I really appreciate those tips because, in just a couple of minutes, you can get way, way more information. And if you’re the first person that does something like that with a patient who’s had unexplained fatigue, unexplained pain for a long time, and they may have tried different things that “work for pain” or work for taking even supplements and are still not cutting it, we have to be able to look at these kind of things. So I really appreciate you sharing that.

If a practitioner’s listening to this, maybe they do structural stuff already or maybe they’re interested in going further or maybe they’re interested in having someone like this on the team, what are some educational options that you’ve taken that have been good for you that you would recommend to other practitioners?

 Mat Boule:                    The one-stop shop right now to learn posturology in the English language worldwide, which I believe would appeal to your audience, is a company that I used to teach for for about 10 years and then things kind of got busy for myself so I did other projects. But essentially, the name of the company is Posture Pro, and their website is PosturePro.co.

And so, these guys have been training practitioners I would say across the world at this point and all types of practitioners, including very open-minded dentists and DOs from the states, trainers, acupuncturists, psychologists. ‘Cause you see the thing is, a lot of different types of practitioners can be quite interested in having that mechanical system function better. And so, on that note, if someone wants to actually get trained, that would be the way to go.

The technology is about 40 years old. Posturology was born in 1985. And it’s the brain child of an orthopedic surgeon who basically got very disinterest very fast in using very invasive methods. His specialty was pediatric scoliosis. And he swore to himself that he would try to do as much as possible to not have to operate on such young children for such a heavy duty procedure. And so, it’s been evolving since 1985.

So what we teach and what is taught now is really the resultant of something that’s quite remarkable, just in terms of how much growth it’s had, mostly in Europe, but it’s starting to catch people’s interest in North America.

James Maskell:                 Absolutely. And obviously you’re working in Canada. Do you know from other practitioners, how in America is this being billed as a cash service or can some of it may be billed under codes for physical therapy? How are practitioners actually implementing it in practice?

Mat Boule:                        My understanding of it is that the situation here in Canada is the same just about everywhere because it’s fairly unknown, although not so much that it’s new but more so unknown. It is rare that it, as a service, is recognized, whether it be by insurance companies or any official agencies. So in very much of the cases, this is a cash service.

James Maskell:                 Got it. Okay, cool. Yeah, so, are there anything else that you need to share with the community? I think you definitely shared some super valuable tips on things that we can do on intaking. We had a chance to talk about some of the conditions outside of, I said just chronic fatigue and fibromyalgia. And that was just based on my understanding of the kind of things you’re working with. Are there other sort of disease categories or symptom clusters that you feel practitioners should be on the lookout for?

Mat Boule:                        You know what I’ll do? I took out of the literature maybe two or three studies that maybe will answer your question in a really objective way, just to give practitioners the overall on really what is possible when you address mechanics or neurology from more of a mechanical standpoint.

So one of the key links that can potentially explain why we would see systemic changes with an approach like posturology is that, and I have two references here we’ll be able to post them up when we put the podcast up. But basically two studies here that show that there’s a direct link between the cerebellum and the hypothalamus, which we’ve know forever that the cerebellum projects to areas of the brain for motor and to some extent non-motor areas. But the fact that there’s this direct link to the hypothalamus or at least some of its nuclei, kind of goes to show us that if we can improve the input going into the cerebellum, which the bulk of that is muscle spindle information which really boils down to muscle balance, that could be one of the reasons why we actually improve someone’s health by affecting in some way the hypothalamus and all of its inferences.

So I would say that’s possibly one link that most of the practitioners that listen to your show maybe don’t know about, yet it basically makes the link between the systemic and the mechanical.

James Maskell:                 Absolutely. Well, look, I really appreciate you sharing this, Mat, and coming on and sharing your wisdom with our practitioner community. One of the themes that we’ve been looking at all the way through this month and ongoing is how do we reduce the long-term costs of chronic disease.

And ultimately what I can see is that, with these kind of techniques, you’re sort of getting to a point where you can restore function to a point where people aren’t– Like the kind of people that need this care are the kind of people that are going from doctor to doctor to doctor, from medication to medication to medication. They’re calling pharmacy. They’re just in the system because no one’s been able to get to the root cause of their issues.

And ultimately, it’s those people that need the help because it’s those people that cost the most. And it’s those people that ultimately cause the cost to be unsustainable. And ultimately when you see a sort of such an elegant resolution as working with some of these tools, getting people to a point where they don’t need medication anymore, where they’re happy and healthy, ultimately that’s the goal. Whether it be in a health cost sharing cooperative, whether it be in traditional insurance or otherwise, or just for the sake of humanity, getting people out of pain.

So I think that this is a great tool. And I hope that, if you’re a practitioner listening out there, that you at the very best have someone with these skills in your local community but at the very least you’re connected to people who understand posture and understand structure equals function. There’s probably a functional neurologist in every city now. And part of the reason why we started the functional forum meetup groups was so that practitioners can meet each other.

And so ultimately if you’re listening to this and you don’t have people in your ecosystem who you can refer to when you expect or suspect there might be structural issues, you start showing up at these meetups. You need to invite people from these meetups. You need to start to connect locally because we need to develop the teams that are capable of getting to the root cause, whatever that root cause is.

So, yeah, I really appreciate you coming in and sharing, Mathew.

Mat Boule:                        I appreciate it though, James. This was really cool. And I’m up for anything you propose. I love the work that you do and the mission that you have to connect people in this industry. Honestly, it’s a great idea and I’ve been falling for a while. So thank you for having me. I appreciate it.

James Maskell:                 No problem. Well, this has been Mat Boule. He’s a posturologist. He’s coming from Montreal in Canada. And it’s great to have you here on the podcast. Please put your thoughts or questions or comments into the comment box below. And yeah, thank you so much for being part of our Evolution of Medicine community. I’m your host, James Maskell. Thanks so much for listening. And we’ll see you next time.

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