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Defining Abnormal Pronation

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brian A. Rothbart, Oct 14, 2019.

  1. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Howard,

    What you are referring to is postpartum trauma (e.g., paresthesia) impacting gait. That has nothing to do with this discussion. Again, a definition of abnormal pronation needs to be agreed upon. And before that definition, one must first define normal pronation.

    Have you read Inman and Mann (Biomechanics of the foot and ankle, 1973) and Inman (The Joints of the ankle. II Biomechanics of the subtalar joint, 1976). They are the gold standards references in Biomechanics. Or you need further confirmation (re hip drive pronation) read Wright, Desai and Henderson (Action of the Subtalar and ankle joint, 1964). Or Levens, Inman, Blosser (Transverse rotation of the segments of the lower extremity in locomotion, 1948). Or Ryker and Glass (Prosthetic Devices Research Project Institute of Engineering Research, Berkeley, 1952). They all illustrate the same point - transverse plane rotation of the pelvis drive the foot.

    Howard, you can refute this as much as you want. It is not my intent to change your mind. Think what you want.

    Brian
     
  2. Dananberg

    Dananberg Active Member

    Brian,

    Just to be clear, I wasn’t responding to you, but to the comment regarding the tibial nerve block and the effect on push off.

    That said, there are top down rotational moments as well as bottom up. When they match, joint rotation is synchronized through the entire lower extremity. Since swing phase functions is a neurological constant (in predominantly normal individuals), the top down is, for clinical purposes, continually present. The etiologic basis for repetitive joint stress occurs when internal rotation from the bottom up (which coordinates with late phase pronation) exists simultaneously with external rotation from the top down. This is what creates significant joint stress as counter rotations accumulate to be quite negative. Most important is the TIME these events occur during the gait cycle, and far more clinically relevant than the concepts of either gravity or hip dominant pronation.

    Brian, I have zero desire to convince you of anything. What you have convinced me of however, is the single mindedness of your approach. Varus posting under the 1st met has a high rate of failure and potentially quite detrimental to patients. How can the Windlass possibly become active if plantarflexion is blocked by a post? The only reason I bothered to reply was to point out the potential hazards of the Rothbart approach to others who may mistakenly believe it.

    Howard
     
  3. Brian A. Rothbart

    Brian A. Rothbart Active Member

    So Howard, what is your definition of normal pronation?
     
  4. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Howard,

    To my surprise, we actually agree on several points ! (I guess miracles do happen).
    • First, I agree that swing phase is a neurological event.
    • Second, your concept of internal rotation from the bottom up and external rotation from the top down is exactly what I am saying, just using different terminology. The rotation from the top down is what I refer to as Hip Drive Pronation. The internal rotation from the bottom up is what I refer to as Gravity Drive Pronation.
    • Third, when you state it is the timing of these events during the gait cycle that is clinically relevant, I could almost hug you (figuratively speaking of course) for saying that. That is my mantra, it is the timing, not the degree of pronation that makes it pathologic or not.
    Now, where we might differ in opinion: Looking at stance phase only -

    I believe Inman nailed it when he discussed the triplane oscillation of the pelvis and its' impact on the foot. Specifically he states that during stance phase, the pronation/supination motion in the foot is determined by the transverse oscillations of the pelvis. This is the top down that is continuously present (as you have written) that I term Hip Drive Pronation. (And I suggest we could term normal pronation)

    In the absence of any inherited abnormal foot structures (e.g., Clubfoot Deformity, PreClinical Clubfoot Deformity or Primus Metatarsus Supinatus) or any post partum trauma or neurological deficits, the foot is under control of the pelvis.

    If we can agree on the above, then we could proceed to discuss what you call the internal rotation from the bottom up, which I term gravity drive pronation.

    Brian
     
  5. Dananberg

    Dananberg Active Member

    To understand the underlying etiology to late phase pronation, the following is necessary.
    1. Your concept of fixed osseous deformity is incorrect. Unless joints are fused, techniques at mobilization or manipulation are highly effective at reversing the motion limitations you observe. When coupled with motion enhancing orthotics, gradual motion improvement occurs.
    2. When we observe foot function without the aid of in shoe pressure analysis, it is nearly impossible to determine what is primarily restricted from what is compensatory.
    3. In the 2nd half of stance, the heel is raising simultaneous with COM advancement. This requires a rolling fulcrum at the MTP joints for both forward motion and the mechanical advantage required to lift and advance body weight.
    4. When the fulcrum either delays it own initiation or completely fails to function (ie Functional hallux limitus), the ability to raise and simultaneously advance body weight is lost or significantly curtailed.
    5. Two events occur in this scenario. 1st, with restriction of advancement, compensation must occur in joints proximal to the MTP joints as they are being pulled forward by the swing limb. These will move in the direction promoted by this swing phase motion. So mid foot dorsiflexion, knee and hip flexion along with torso flexion occur.
    6. Midfoot dorsiflexion causes the tibia to lower through the transverse plane (ie, weight falls). Since it sits directly above the talus, the “falling” is based on the motion the STJ permits. Functioning as a screw, the entire tibial-talar complex must rotate internally.
    7. Since internal rotation is 180 degrees opposed to the motion being imparted by the now externally rotating femur, counter rotations must occur about the joints between both ends. What is visually evident, is late phase pronation. When viewed with pressure analysis, what is and is not moving is discernible.
    8. By creating an orthotic which mobilizes the 1st MTP joint, the power of the Windlass is released and coordinated rotations initiate. Over time, ranges of motion increase and deformations as you have described resolve.

    Howard
     
  6. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Ok, let’s make sure our differences are not due to terminology. When I use the term Hip Drive Pronation it refers to the pronation/supination pattern that results from the transverse plane oscillations of the pelvis. When I use the term Gravity Drive Pronation it refers to the pronation/supination pattern that results from pathology in the foot.

    (1) The Primus Metatarsus Supinatus (PMS), from an embryological point of view, is the result of the incomplete unwinding of the medial column of the foot. Depending when this ontogenetic failure occurs during embryogenesis, determines the structure the individual is born with.

    If this failure occurs before Fetal week 10 (or thereabouts) the individual is born with a Clubfoot Deformity.

    If this failure occurs after Fetal week 10 but before Feet week 19, the individual is born with a PreClinical Clubfoot Deformity.

    And if the failure occurs after Fetal week 20 (or thereabout), the individual is born with a PMS. (See http://www.iarpt.com/embryology---key-to-understanding-abnormal-foot-structures.html ) Much of this comes from Guyton's Textbook on Embryology.​

    I view the PreClinical Clubfoot Deformity and PMS in the same way I view the Clubfoot Deformity – all three being osseous deformities. Whether they can be successfully reversed via manipulation is another discussion.

    If you want to go into more specifics on the embryogenesis of the lower extremity, I would be happy to do so. But that is another discussion.

    (2) I believe one can determine where the pathology in gait is originating, in many cases, without the use of shoe pressure analysis. But that again is another discussion.

    (3) When the heel lifts, that foot is no longer under the control of the transverse plane oscillations of the pelvis (e.g., it has escaped Hip Drive Pronation).

    (4) I would not argue to the contrary.

    (5) Interesting, again I would not argue to the contrary.

    (6) Here I disagree. I do not view midfoot dorsiflexion as driving the transverse plane rotation of the tibia. Rather I see the tibia being driven either by the pelvis or pathology in foot (e.g., PreClinical Clubfoot Deformity or PMS)

    (7) I am not entirely sure what you are driving at. This would be another discussion.

    (8) I am not an advocate of othotics. I use proprioceptive insoles which function on an entirely different paradign than orthotics. So this is probably one area we would not agree upon.

    So, my question still stands, What is your definition of 'normal pronation'?

    Brian
     
    Last edited: Oct 26, 2019
  7. Dananberg

    Dananberg Active Member

    6. What you are missing is the lack of metatarsal rotation thru the sagittal plane. When the MTP joints can’t dorisflex, were do you suppose this motion occurs? The next proximal site were sagittal plane motion can take place, it will. And since the weight of the tibia is borne by the foot, lowering the MLA lowers the tibia. Motion is internally directed as the screw like STJ predetermines the pathway. External rotation raises it, and internal lowers it. This issue becomes the cross in the neurology. It expects raising but instead drops.

    Howard
     
  8. Brian A. Rothbart

    Brian A. Rothbart Active Member

    (6) Ok, I understand what you are saying, that the pronation/internal rotation is directed internally, e.g., by thre MTP joints dorsiflexing. Where I suggest the pronation/internal rotation is externally controlled, by the transverse rotation of the pelvis. We both agree as to the motion occurring, we disagree as to where that motion is controlled.

    We both agree that the definition of normal pronation is based on timing not on the numerical degree of pronation. So let’s see if we can agree on the timing.

    One obvious point:
    • Normal pronation is a closed kinetic event. That is, we are defining what occurs when the foot is on the ground.
    This is what I suggest as to the timing of normal pronation:
    • At heel contact the foot pronates and continues to pronate until foot flat.
    • At foot flat the foot stop pronating and commences to supinate and continues to supinate until heel lift.
    • So the timing of normal pronation is between heel contact to heel flat.
    Agree or Disagree?
     
  9. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Hi Guido,

    Your response is 'right on' that

    "Abnormal pronation is any pronation occurring in the foot when it should be supinating."

    (answered on https://www.researchgate.net/post/How_do_you_define_Normal_Pronation_and_Abnormal_Pronation)

    Anormal pronation is not defined in terms of degree of pronation, or the velocity of pronation, but rather in the TIMING of pronation.
    • Hip Drive pronates the foot from heel contact to foot flat.
    • From foot flat to heel lift, Hip Drive supinates the foot.
    So by definition any pronation occurring between foot flat to heel lift is abnormal pronation.

    Comments?
     
  10. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Ruben Sánchez-Gómez
    European University of Madrid Wrote:

    "For me, normal and abnormal pronation its not defined like an hiperpronation movement: I think the key is in the acceleration or velocity of this movement and the moment in which it is producing.
    The amount of pronation is in relationship with tibial rotation, legs, pelvis, femur, hip... but these element movements will be more pathological when higher velocity they have and the incorrect moment in gait when they appear."

    James Amis
    Depuy Synthes Companies of Johnson & Johnson wrote:

    Agree with all above, particularly Gomez. Abnormal or abnormal pronation is pronation that causes symptoms either in the footer above in the ankle, knee hip or back. In most cases the key to asymptotic pronation becoming symptomatic is the isolated gastrocnemius contracture.

    To be clear I am talking about acquired flatfoot deformity secondary to PTTD or a primary spring ligament tear, midfoot osteoarthritis and Charcot foot formation to name a few.

    Above replies came from a discussion on Researchgate.net https://www.researchgate.net/post/How_do_you_define_Normal_Pronation_and_Abnormal_Pronation
     
  11. Brian A. Rothbart

    Brian A. Rothbart Active Member

    In March 2017 NewsBot noted a Article in press (subsequently published) entitled Defining excessive, over or hyperpronation: A quandary. The thrust of the paper was barely discussed on that blog. Instead the comments ranged from:

    • Just seeing the word "hyper-pronation" in the title of a paper would make me reject it for publication. Kevin Kirby (No surprise, vintage Kevin)
    • Possibly, had the author related the amount of pronation of the individual to an average or ideal, he might have had a better chance of getting away with it. Bill (Now that comment could open up an interesting discussion)
    • Thus their definition is completely hat stand. There are others. Simon Spooner (so Simon rejected their definition and stated there are other definitions (I wonder what definition Simon would be happy with)
    • It would be easier to list the parts that make sense. efuller (Typical comment from Fuller - sarcastic?)
    It appears trying to arrive at a definition of normal (or abnormal pronation) is like pulling teeth. And yet, how does one justify treating abnormal pronation (or whatever term you want to use) with the myriad of orthotics on the market, when they don't know what abnormal pronation is?
     
  12. scotfoot

    scotfoot Well-Known Member

    Brian ,
    How would you define the word "professor " , and do you fit that definition ?
     
  13. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Gerald,

    How would you define the word 'professor'? The American Heritage dictionary defines professor as: A teacher or an instructor.

    Read my CV on my patient website and decide for yourself.

    By the way, this discussion is about defining Normal Pronation/Abnormal Pronation. Any thoughts about an appropriate definition?

    Professor Rothbart
     
  14. scotfoot

    scotfoot Well-Known Member

    My understanding is that the term professor is not a title given for life . That is , if you are a professor at any given University and retire , you can no longer call yourself a professor . Can I ask which University you are currently engaged by .

    And my name is not Gerald .
     
  15. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Gerald,

    Again, read my CV. And again, what does this have to do with defining Normal Pronation and Abnormal Pronation?
     
  16. scotfoot

    scotfoot Well-Known Member

    "Can I ask which University you are currently engaged by ? " a simple question to which I can find no answer in your CV .

    Which University ?
     
  17. Last edited: Oct 31, 2019
  18. efuller

    efuller MVP

    Pronation is a rotation. Rotations are caused by torques aka moments (Force x distance) If you want to understand the cause of pronation you have understand the force applied. To be able to use terms like hip drive pronation, or gravity drive pronation, you would have to explain the forces involved with those terms for those terms to have any meaning.
     
  19. Gerrard:

    He uses the title "Professor" since it makes him feel better about himself.

    In much the same way, Rothbart has chosen to name a foot type after himself, "Rothbart's Foot", which has been previously described but Rothbart decided it would make himself feel more important if he added his name to a previously described foot-type.

    In addition, he has named himself the "The Father of Chronic Pain Elimination". http://www.rothbartsite.com/a-compa...-rothbarts-foot-and-preclinical-clubfoot.html

    Even more wild is his paper claiming that abnormal foot motion causes distortions in the skull. http://ada-posturologie.fr/RothbartPiedCrane.pdf

    He comes on here acting like he is an informed scientist, but a short search on Google shows what type of person he really is. It's useless trying to reason with a person like this.
     
  20. Brian A. Rothbart

    Brian A. Rothbart Active Member

    If there is no one else who wishes to suggest a definition of normal pronation. I will conclude this discussion with a demonstration on the usefulness of the definitions I propose for normal pronation and abnormal pronation.

    The definition, that I contend, of normal pronation is derived from the research of Inman and Close who established the link between the hip and foot. They demonstrated that inward rotation of the pelvis relative to the ipsilateral (same side) foot, pronates the foot. Outward rotation of the pelvis relative to the ipsilateral foot, supinates it.

    Apply this paradign to stance phase, from heel contact to foot flat, the pelvis directs the foot to pronate. From foot flat to heel lift, the pelvis directs the foot to supinate. This pelvic to foot link is termed Hip Drive Pronation. I suggest Hip Drive Pronation is synonymous with the term Normal Pronation.

    Once the term Normal Pronation is established, Abnormal Pronation can be defined as any pronation that is not normal (that is, pronation occurring between the interval of foot flat to heel lift). I have suggest this abnormal pronation be termed Gravity Drive Pronation.

    Gravity Drive Pronation is exactly what one observes in the patient with the Primus Metatarsus Supinatus foot structure. A treadmill animation is presented on my research site at: http://www.iarpt.com/rothbarts-foot.html

    Observe Gravity Drive Pronation in the left foot:
    • Frame 1 at heel contact - the lateral border of the heel first reaches the ground
    • Frame 2 at midstance, the foot is pronating (it should be supinating)
    • Frame 3 just before heel lift, the foot is pronating (it should be supinating)

    Regarding torques, when dealing with Gravity Drive Pronation, the force applied to the foot is the pull of gravity or G = 9.81 m/s2

    The distance is determined by degree of supinatus. The greater the supinatus (angle of slope) the greater the vertical distance to the transverse plane (the distance traveled by the elevated medial column of the foot)

    M = F x D
    = 9.81 m/s2 x A

    Now, I believe my computations are correct. However, I only had one year of physics at my alma mater ( a long time ago).


    Brian
     
    Last edited: Nov 2, 2019
  21. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Since we are dealing with Pythagorean Theorem, we can define the vertical distance (D) traveled by the foot as Leg A of the right triangle where:

    C = hypotenuse, length of the slope of the medial column of the foot (measured at the level of the 1st metatarsal head)
    Leg A = Vertical distance traveled by the first metatarsal head to the ground (this is a function of the degree of supinatus present in the medial column of the foot)
    Leg B = Width of the plantar surface of the medial column of the foot, measured from the medial border of the 1st metatarsal head

    C2 = A2 + B2
    A2 = C2 - B2
    A = Square Root of C - B (which is the CosA)
     
    Last edited: Nov 2, 2019
  22. For anyone who cares, Rothbart’s calculation is wrong.... and obvs he’s talking non-science to boot.
     
  23. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Simon,
    Kindly expand on your statement.
     
  24. Go back to physics school Rothbart. Let’s be clear here: I think that everything about you is despicable, you are the epitome of everything I despise in an individual- your fake titles, fake qualifications, ripping off desperate people, fraud... go work out the problems in your math yourself. It’s wrong and you don’t understand basic physics.

    which University are you currently a professor at?

    Meanwhile, I’m going to take a shower as I feel dirty just by having communicated with you.
     
  25. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Simon,

    You stated:

    Again, kindly expand upon your statement? Or is this all 'bravado'?

    Professor Rothbart
     
  26. At which University are you a professor, or is it a fake title?
     
  27. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Simon,
    Waiting for your explanation!

    Professor/Dr Rothbart
     
  28. Waiting for yours... “professor”. Apologise for intentionally attempting to deceive and for misleading people and I will gladly point out the errors in your calculations
     
  29. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Simon,

    You're coming apart at the seams! Consider enrolling into Anger Anonymous.
     
  30. Brian:

    I see you like to put the term "Professor" in front of your name. At which university are you currently a professor at? By the way, do you still charge $10,000 for a consultation and a pair of foot orthoses?

    Maybe you can explain this?

    "While Dr. Rothbart was still living in the State of Washington, he enthusiastically participated in promoting his invention to a large consumer company selling insole products to the general public through drugstore outlets.
    In 1999, for personal reasons, Dr. Rothbart abruptly left the State of Washington and moved to Florida and shortly thereafter to Mexico, then to Italy. He currently resides in Spain He remained in contact with GRD for a short time, but only in an advisory role. Dr. Rothbart owned stock in GRD, and collected royalties from GRD until 2009 but since publishing Forever Free From Chronic Pain, and pronouncing himself the "Father of Chronic Pain Elimination", Dr Rothbart severed his relationship with GRD including divesting himself of his stock and royalty rights.
    GRD developed and manufactured the first standardized Rothbart Proprioceptive Insoles in 2002 under the trademark Posture Control Insoles® and with the coperation of Dr. Rothbart authored a 50 page training manual which provides basic information about the theories behind the the Posture Control Insoles®, how they differ from traditional arch support orthotics, how to use them and why they are an extremely beneficial adjunct to treating chronic posture related musculoskeletal dysfunction and pain.
    Dr. Rothbart have offered Posture Control Insoles® to his patients since leaving GRD, but after declaring himself the world's foremost expert on chronic pain, his consultation and insole charges have increased. As most rescently confirmed in November of 2011, his price for a pair of insoles is $10,000. That includes his consultation fees.
    In his book, Forever Free From Chronic Pain, and on his web pages, Dr. Rothbart and/or Linda Penzabene make statements that are disagreeable to GRD."

    Why did you move from Washingon, to Florida, then to Mexico, Italy and Spain?

    For those who want to learn more about Brian Rothbart and how he "practices", you may want to read this website. http://rothbartsfoot.com/
     
  31. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Time to bring this discussion to a conclusion.

    I have presented/suggested a protocol for defining normal and abnormal pronation. Using Inman and Close's research linking the transverse plane rotations of the pelvis to STJ pronation/supination - which is termed Hip Drive, I suggest Hip Drive as the definition of normal pronation.

    Hip Drive pronates the foot from heel contact to foot flat. And supinates the foot from foot flat to heel lift.

    Abnormal pronation would then be defined as any pronation that is occurring when the foot should be supinating (In the case of the PMS foot structure, between foot flat to heel lift)

    The resulting abnormal pronation is termed Gravity Drive pronation.
     
  32. efuller

    efuller MVP

    Inman and Close did not demonstrate that rotation of the pelvis causes movement of the STJ. They demonstrated a correlation. Correlation is not causation.
     
  33. efuller

    efuller MVP

    Yes, time to bring this to a close. Only one podiatrist has stated the above definitions and that is you Brian. If you claimed there was a consensus on podiatry arena for your definitions, you would be misleading the person you are communicating with.
     
  34. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Correlation is not causation.

    • As I said - Inman and Close's research linked the transverse plane rotations of the pelvis to STJ pronation/supination - which is termed Hip Drive. That is the correlation.
    • My published research: Two of the causes of Gravity Drive Pronation are the inherited abnormal foot structures: PMS and PCFD.
    Hopefully that clarifies what I have said. And incidentally, if you have published any research that invalidates what I have suggested (and published on) above, this is the time to present it.

    However, let's continue the discussion you started earlier on torques and moments when you wrote:
    • "If you want to understand the cause of pronation you have understand the force applied. To be able to use terms like hip drive pronation, or gravity drive pronation, you would have to explain the forces involved with those terms for those terms to have any meaning."
    Which I responded:

    Regarding torques, when dealing with Gravity Drive Pronation, the force applied to the foot is the pull of gravity or G = 9.81 m/s2

    The distance is determined by degree of supinatus. The greater the supinatus (angle of slope) the greater the vertical distance to the transverse plane (the distance traveled by the elevated medial column of the foot)

    M = F x D
    = 9.81 m/s2 x A

    I am waiting your response.
     
  35. Dananberg

    Dananberg Active Member

    Brian,

    As I said earlier in this discussion, supinatus is not a fixed deformity and completely reducible by 1) manipulation and 2) by allowing the 1st ray to plantarflex. Using any type of post under the 1st metatarsal blocks plantarflexion and induces a Functional hallucinate limitus, which perpetuates 1st ray elevation. From what I heard you say in the past, the orthotics you recommend need ever increasing posting the longer they are worn. And while you may think this is ok, it’s not. Making feet need more control over time is a mistake and will eventually hurt more patients than it helps.
     
  36. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Howard,

    I disagree. PMS is a fixed deformity. The talar neck and head remain in supinatus and with it, the entire medial column of the foot and cannot be reduced with present day medical technology.

    FHL is an entirely different animal than PMS. It is a positional abnormality that can be reduced manually. And placing any type of elevation underneath the 1st metatarsal head will jam the 1st MPJ and create a myriad of clinical problems.

    In the past I stated that increased proprioceptive signals are required when treating the PMS deformity. This has proven not to be the case. In fact, with engramming I find many patients maintaining their level of wellness using their insoles part time only.
     
  37. Dananberg

    Dananberg Active Member

    Brian,

    Time to get your head out of the sand. Having seen this foot type countless times, I can assure you that reducing it not only possible but predictable. It may take a few weeks to months depending on the duration and severity, but it does remain reducible. What you are missing is that your approach does not work! It promotes the deformity and therefore, you never see it improve.

    Howard
     
  38. His physics is wrong as well.
     
  39. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Howard,

    Again, I disagree. What you fail to recognize or acknowledge is that the PMS and FHL are two different foot types.
    • The PMS is an abnormal, fixed, genetic foot structure that can not be manually adjusted without pronating the foot.
    • FHL is an acquired foot structure that can be manually reduced.
    My approach has worked for hundreds of chiropractors, osteopaths and podiatrists. The proprioceptive insoles are being sold internationally and the feedback from healthcare providers has been very positive. That is factual. If you need another opinion, contact Dr George Stylian in Australia. He has been using the proprioceptive insoles I designed to treat the PMS (which he refers to as Rothbarts Foot). He has trained nearly 200 healthcare providers who are currently using the ProKinetic Insoles.

    Whether you accept my research on the PMS or not, is your affair. Again, it is not my intent to convince anyone of anything. I am simply presenting information I have published on, in many different peer review journals. Each reader can decide for themselves.

    By the way, I appreciate your deferential and professional input. It provides the reader with a well rounded understanding of our differences in opinion.

    One last thing, on my research website the reader can excogitate the presented synopsis delineating the difference between Hip Drive and Gravity Drive.

    Brian
     
  40. Plus, he is only a professor in his mind. Makes one wonder when a podiatrist needs to move from Washington, to Florida, then to Mexico, and then Italy and finally Spain, what or who is he running from???
     
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