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Is the Biomechanical Model Obsolete?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Brian A. Rothbart, Oct 5, 2013.

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  1. Brian A. Rothbart

    Brian A. Rothbart Active Member

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    Is the Biomechanical Model Obsolete?

    The Biomechanical Model was first introduced by Root et al to explain the link between foot pronation and resulting symptoms in the foot. Later this model was expanded to explain musculoskeletal symptoms occuring in the knee, hip, and back. Sometimes the link between foot pronation (and related internal tibia/femur rotation) was consistent with the symptoms observed in the weight bearing joints proximal to the subtalar joint. At other times this link was not apparent and, in some cases, what the biomechanical model suggested was contrary to what was actually seen clinically.

    To solve this paradox, I suggested an alternative model (2011), delineating the link between gravity driven pronation and musculoskeletal pain symptoms, the Neurophysiological Model:

    The plantar surfaces of the feet are embedded with millions of fast acting touch receptors (Meissner’s corpuscles). In a closed kinetic chain, at any given moment, certain areas of the foot are touching the ground. At each point of contact, the Meissner corpuscles are being stimulated. When a group of Meissner corpuscles are simultaneously stimulated, it is referred to as a pattern of stimulation. Rothbart has found that in PMS (a twisting or excessively pronating foot), the patterns ofstimulation are distorted compared to the patterns of stimulation in a non-twisting foot.

    That is:

    • In a non-twisting foot, the mechanical receptors (e.g. Meissner’s corpuscles) are stimulated linearly across the heel and ball of the foot (e.g., a non-distorted pattern of stimulation).

    • In certain abnormal foot structures (e.g.,Primus Metatarsus Supinatus), the mechanical receptors are stimulated in a non linear pattern across the heel and of the ball of the foot (e.g., a distorted patterns of stimulation).

    These Patterns of stimulation send signals to the cerebellum. These signals provide the cerebellum with a picture of where the body is in space (e.g., the body’s posture). Based on these signals, the cerebellum is constantly readjusting the body’s position in order to maintain an upright and stable posture.

    • Patterns of stimulation formed by hip driven pronation send non-distorted signals to the cerebellum. From these non-distorted signals, the cerebellum automatically maintains a non-distorted posture.

    Patterns of stimulation formed by gravity driven pronation send distorted signals to the cerebellum. From these faulty signals, the cerebellum automatically maintains a distorted posture.

    I link this distorted posture to the development of chronic muscle and joint pain, foot to head.

    I developed/proposed the Neurophysiological Model because the traditional biomechanical model does not explain the postural changes I was seeing using non-supported type (proprioceptive) insoles.

    Professor Rothbart
    Rothbart BA 2011. Primus Metatarsus Supinatus (Rothbarts Foot): A common cause of musculoskeletal pain - Biomechanical vs Neurophysiological Model. Podiatry Review, Vol.68, No.4, pp 16-18 July/August.
  2. Rob Kidd

    Rob Kidd Well-Known Member

    Biomechanical models will never be obsolete they simply get revised in the advent of new science. Not to be confused with pseudoscience, which in the end, does far more harm than good. Rob
  3. Biomechanics of the foot and lower limb did not start with Root, nor will it end with him. As ever, Brian's post here is full of self aggrandizement and misinformation. To paraphrase Julian Cope: "stand upon your own work Brian but it won't make you taller, it diminishes you with every thing you say". You crazy farm animal. http://www.youtube.com/watch?v=DzrIwgY1WxI
  4. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Hi Rob,

    Don't agree with you on this one. I believe that the biomechanical model does not reflect how the body functions. This gravity based model is truly alluring because it does seem logical, i.e., poor foundation, roof problems - gravity driven pronation, joint problems.

    However in my clinical and research experiences, the biomechanical model leads to many (not all) dead ends. This is why I proposed the new paradigm. In time it will either be proven correct or not.

  5. Rob Kidd

    Rob Kidd Well-Known Member

    Brian, I did not sat "Biomechanical model"; I said "Biomechanical models" A serious difference
  6. Ian Linane

    Ian Linane Well-Known Member

    Hi Brian

    I don't usually contribute to these discussions as they are frequently above me but you have said something that is interesting:

    "This is why I proposed the new paradigm. In time it will either be proven correct or not."

    My questions are:

    1. What length of time do you give it before you say there has been enough time?
    2. If your proposed model is proven incorrect will you cease to propose or refine or redefine it? This only really requires a yes of no answer.
    3. Whose biomechanical opinion or research outcomes would you accept as being definitive in your proposed not model not working (e.g which collegiate body or group would you accept)?
    4 If your model was shown to work I can understand only too easily, and perhaps appropriately, why you would want to shout it from the roof tops! if however it is shown not to work would you be as public in making its failure evident?

    Off tangent but probably relevant, would any member of the public who saw your declaration of your model not working, and who had bought devices from you (I don't mean your clinical skill or time) based on you model be offered a refund if they contacted you?

    I'm curious, that's all, because it is quite a determined statement you made. I guess it does depend on how much time you will let go by first
  7. Rob Kidd

    Rob Kidd Well-Known Member

    Ian, The Uni I went to for my science degree was big on the history and philosophy of science. In truth, science rarely proves anything, but merely provides evidence, more and more, that makes the hypothesis supportable (or the opposite - makes it untenable [eg geocentric universe] - but then, you knew that. What is missing here - and not from you - is a foundation in serious scientific method. There seems to be a trend recently, at least among some, that feel that "clinical" science is exempt from scientific rigour - absolutely not so. I am always reminded of my mentor - ex of Birmingham (UK), being told by his mentor to go to talk to this new guy "Fisher [Fishers exact test....] - he should be able to solve your problems. Fisher then said something like - Huxley said to me that..................... straight to the sources man - straight back to Darwin himself.

    I speak for myself here, but currently I have had a gut full of poor science or non-science; or is it nonsense?
  8. Sigh. The infomercials continue.

    Put as simply as I can. Firstly, using the root model synonymously with "Biomechanics" is akin to inferring that barbers adagio for strings is synonymous with "music". Root is an example of a biomechanical model, in the same way as adagio for strings is an example of music, one would not seek to obliviate music if one did not enjoy that particular example of it.

    But that aside. Even if we take the 40 year old root model and assume it's been in no way enhanced in that time, it still has vastly, vastly more evidence to back it up than the "neurophysiological" model as proposed by Mr Rothbart!

    Brains' argument makes as much sense as saying "democracy has some problems as a form of government, is it time to transfer to rule by dave the psychic octopus? My research shows date to be more reliable.

    Oh Btw, if we do transfer to dave, it will make me very rich.
  9. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Hi Ian,

    In the late 1990s I obtained a US patent based on a novel insole design, that at that time, I thought provided a much better motion control system for the foot. It was based on a foot structure I proposed impacted the medial 3 metatarsals. Several years later I discovered that embryologically this foot structure could not exist. What was my reaction. I went on, that patent was history (even though I spent nearly $100,000 to obtain it).

    My point is, if something doesn't work, don't use it.

    Now to answer your questions:

    1) What even length of time it takes - it may likely be longer then my time here on earth.
    2) If my proposed paradign is incorrect, just like my described patent above, it will be discarded. If it required being modified, it will be modified. None of this is written in stone.
    3) I am open to all proposed models. I am searching for what works. I hold no absolute allegiance to any one group or collegiate body.
    4) If you would go back and read my publications in the 1970s through and up to the mid-1990s, you will see that I was a firm advocate of Root's Biomechanical Model. I left that model when it became apparent, both clinically and in my research, that it failed to explain what I was seeing. To shout it from the rooftops, most likely not. To discuss it in my publications, absolutely.
    5) When I am practicing medicine - I give no guarantees as to outcomes. I only guarantee to do my very best and to apply all my expertise to help that particular patient regain their wellness.

    Professor Rothbart
  10. W J Liggins

    W J Liggins Well-Known Member

    Yawn, yawn. Please see the other current thread on this person.

    Still, for all that "....apply all my expertise to help that particular patient regain their wellness." is at least amusing - it's typical of a certain type of 'alternative practitioner' ie quack, here in the UK.

  11. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Interesting Bill. When I started my practice (1971), Podiatry was considered alternative healthcare at best and quackery by almost every Orthopod I met.

    I can remember vividly one day (1973) when I attended Grand Rounds at the teaching hospital in San Diego, the orthopods, not very politely demanded I leave because I was a DPM. Now we are welcomed at almost every teaching hospital in the US. In fact, many of our surgical residency programs are at these very same teaching hospitals.

    So I find it fascinating that you consider proprioceptive therapy alternative therapy. And that you find the phase 'regain their health' objectionable? I guess bias and intolerance just never dies.

    Professor Rothbart
  12. W J Liggins

    W J Liggins Well-Known Member

    Dear Professor Doctor etc. Rothbart

    I wouldn't normally lower myself to answer you directly. However, since you are unable to even reference (cite) yourself correctly, you did NOT (emphasis not shouting) state 'regain their health'. You stated 'regain their wellness'.

    You are all too fond of referencing yourself in your various weird, self promotional, exploitative and self congratulatory papers. At least try to get it (and your spelling and grammar) right when you do so.

    Bill Liggins
  13. Griff

    Griff Moderator

    Bri - are you still welcomed in the US? I'm sure I've read things to the contrary...
  14. Tess Bowen

    Tess Bowen Member

    Hi Prof. Rothbart,

    It looks as if you have upset a few decipeds with the obsolete statement.
    If we are to continue to evolve podiatric practice then surely we have to put questions forward when we see an anomaly in our clinics that doesn't sit well with existing biomechanics.
    As an old Pod who started with root ,I remember the huge amount of discussion around it's introduction in practice. I don't remember this amount of disrespect in those discussions. I'd like to see less ego and more explanation around this topic.
    I'm pretty certain that most pod's would be put off replying to most threads as I have been in the past when they see the responses.
    This is not directed at prof. Rathbart but at the people who have replied to his post.
  15. Craig Payne

    Craig Payne Moderator

    Tess - Rothbart has a long history of this self promotion. He named a foot type after himself --> really poor form. He promotes pseudoscience, snake oil and really badly flawed research. He has not earned the 'Prof' title.....etc etc

    Have a read of this thread from 2008 in which he rallied his fan boys to stick up for him:
    To this day he has still failed to answer the questions repeatedly put to him.
  16. Alex Adam

    Alex Adam Active Member

    It is no wonder New Graduates get so confused if experienced men such as yourselves can't agree.
    Biomechanics is no just a theory, it is the science of the human body. Physics and Chemistry all make up the response to gravitational effect and the action of motion. Proprioceptive and compensatory response through bare end nerves all are part of how the human body deals with gravity. Along with this the geographic origin of the individual has an impact.
    Whitman back over 100 years ago noticed, and asked the question regards structure and pathology.
    Hats off to Root etal for their bringing biomechanics into debate but we need to keep it simple because it is and understand the science rather than letting our ego's just confuse all the new graduates and have them leave such a noble profession.
  17. Tess:

    Rothbart deserves all of what he has gotten from the members of Podiatry Arena....and more. If he had wanted more respect, then he wouldn't have:

    1. Stated that his insoles would cure infertility and other such medical disorders that have nothing to do with the foot and lower extremity.
    2. Name a "foot type" after himself.
    3. Named himself "The Father of Chronic Pain Elimination"
    4. Named a week in the year after himself.

    and the list goes on and on....

    Tell me Tess, how should we treat such an individual who continually self-promotes himself and preys on people with chronic pain making claims that his very expensive insoles will cure their chronic pain.....with respect???!!!!
  18. Lab Guy

    Lab Guy Well-Known Member

    It is funny how the posters who contribute the least to Podiatry Arena are the first to criticize. Less informed members should be happy that the leaders in the profession are willing to bring light to the bad seeds so they do not take root.

  19. GavinJohnston

    GavinJohnston Member

    Just An Observation !
    Im a physio who has used orthotic therapy in my practice for over 15 years. I use a variety of methods including full custom plaster cast , heat moudable and Rothbarts proprioception innersoles.
    I offer a full refund for unsatisfied customers.
    I have never met Brian Rothbart.
    Rothbarts innersoles are the only device(in my clinic) with a 100% no refund rate!
    Why is this so?
    I beleive clinical practice has already moved into a Neurophysiological Model .
    Postural control is a centrally driven process and it is our job a clinicians to make this process as easy as possible for our patients CNS.
    Our input (treatment) must have a measurable outcome in relation to postural control. Some measurements I use include postural sway , static weight distribution and postural fatigue tests (Becks Tests).
    Rothbarts devices often out perform custom devices .
    I often reflect on the muscles that have a huge effect on the first ray and assume the function of these muscles radically changes with the Rothbart devices.
    Maybe worth some reflection ?
    I would like to thank Brian for his contribution to my clinical practice .
    Kind Regards
    Gavin Johnston
  20. Rob Kidd

    Rob Kidd Well-Known Member

    Possibly so, possibly not: but where is the science? where is the tested hypotheses? where is the randomised controlled trials (which I am not into - I leave those to the clinical people)?

    In science, and clinical science is absolutely no different, "I am therefore I am" does not, and have never cut the mustard. Rob
  21. Alex Adam

    Alex Adam Active Member

    Thanks for that Rob and as an evolutionist you must agree that the science of Physics has had a direct relationship on Osseous and soft tissue development of the human body.
    The science is there it just takes reading of basic physics, neurology, physiology geographic and environmental implications of evolutionary traits along with a good understanding of social pressures.

    Yep hand ball as much as we like to this theory and that but the Universities have failed to encourage our young Podiatrists to 'Think' and read laterally.

    The quest for knowledge through thought and non ego based debate.
    The Science is there and has been since 1906, we just chosen ' to throw the baby out with the bath water'
    It is found in the most basic science book we just need to apply it and ask the relevant questions.
    This is not new, the debate that Whitman began in 1906 was discarded by the main stream in 1926 when it was concluded that footwear was the etiological factor of foot pathology. !940's Wood-Jones continued the debate and it was again shut down by the main stream and on it goes.
    We have many great thinkers at our Universities and I find it bemusing that they have ignored the one basic thing, Science.
    For science to be understood we need a nomenclature and methodology that has a basic foundation and while we use the word 'orthotic' without standardization of what it means then any theory no matter how obscure will have weight in the discussion.
  22. Rob Kidd

    Rob Kidd Well-Known Member


    I am writing slowly while I formulate a reply to this. Yes I am an evolutionist - but to me that is another way of saying I am a scientist; I do not separate evolutionary biology from any other brand of science. As I matter of interest, I also have a degree in geology - but I do not practice; does this make me a geologist? I do not think so.

    For the record, I have no concept of the relevance of 1906 - evolutionary biology started in perhaps 1700, but maybe the Greek philosopher guys can help me out here?

    As for that great Manchester boy, Wood Jones (yes, he did de-camp to Adelaide), his work is just wonderful. I have on my shelf a copy of both his hand and his foot book. The price of which to me is classified information if I wish to escape the room with both testicles still attached.............. they are willed to a rather gangly pod from Leeds, by the way.

    I tried in times gone to talk some sense into a creationist who habitually bit at me on this arena - and eventually realised there was not point, and gave up.

    My mentor - who I believe you know, at least a little, has written volumes on his "Life long love affair with cancellous bone"; why is it that pods are reticent to escape their blinkered views and look at where others are coming from? For instance, the cancellous structure of the orang-utan vertebrae says much about their function - and compared to hominids gives us huge insights to out own structure

    Just stop to look at cancellous trabeculae in the calcaneus - and not how their radiations pass through one bone to another - and another - magnificent. And now look at how how a few arrive on the plantar aspect of the heel in an area which was once weight bearing............. phylogeny or what?

    As a final comment I pick up in your comment of schools of podiatry failing to encourage students to think. When I was at Curtin Uni - when I knew you - I wrote several papers about thinking outside the square. The manner in which I was rewarded, and indeed my wife was rewarded cannot be commented upon in a complimentary manner. This was all over 20 years ago; I think time tells the truth. Some persons in West Australia need to be ashamed of them selves - and they know who they are.

    Good to hear from you, Rob
  23. Alex Adam

    Alex Adam Active Member

    Rob it has been some time and like you I revel in the world of Anatomy and the function dictated to by structure, The work I have been carrying out for the past 15 years regards the chondrocyte structure( histologically) at the Peroneus longus /cuboid interface made me realize just the extent of knowledge we need to even partially understand structure/function/evolution.
  24. Rob Kidd

    Rob Kidd Well-Known Member

    Alex, Oddly it was peroneus longus that got me started on a research career. I was sitting in a caravan park in the South West of France - about 150km north of the Spanish border - this was 1988 - when after about the nth bottle of red plonk with my brother in law, he started talking. He had had a chronic ST inversion injury issue, and eventually had P. Longus harvested to support his lateral calcaneus. Well, by "conventional theory", he should now develop H rigidus issue due to lack of 1st ray pl flexion. He did not - and this set me thinking. After the nth + 10 bottle of wine I started reading and writing - and here we are today
  25. Brian A. Rothbart

    Brian A. Rothbart Active Member

    I stand corrected - regain their wellness.
  26. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Thanks Tess, your imput is much appreciated.

  27. Alex Adam

    Alex Adam Active Member

    LOL well my beginning wasn't so fluid in nature. It was after trawling through Lewis and Oxnard's work that got me thinking about the control point of the foot and indeed was there one. CCP was the key but if I was to understand it I needed to totally rule out the action of P.L. as previously thought and so the start of hundreds of hours of dissection and histology at Melbourne University, Anatomy dept. under Chris Briggs. Breaking things down to the root I sectioned the fibro cartilage of the PL and the facet joint of the Cuboid as well as the contact point of the medial process of the cuboid and the inferior aspect of the sustentaculum tali and eureka, the action of P.L. Function through structure. Interesting enough though there is no categorizing of Fibro Cartilage with regards function. M. Benjamin of Cardiff has touch on the subject but nothing formalized.
  28. Brian A. Rothbart

    Brian A. Rothbart Active Member


    In all due respect, normally I just ignore your comments, but the ones above need to be answered.

    1) I did not name Primus Metatarsus Supinatus after myself. It was first coined by Bjorn Svae in the late 1990s and just caught on.
    2) My research is questioning some of the long held beliefs regarding orthotic therapy. I understand it has made some individuals very uncomfortable and even angry. Never the less, we must always search for the truth, no matter where it takes us. To say my research is flawed, well, that is your opinion. But the fact is, my research has been published in many peer reviewed medical and dental journals, including the JAPMA.
    3) The title Professor is bestowed on those that hold a PhD and teach at a University level or higher. I have done both (refer to my CC at http://rothbartsite.com/About_Professor_Rothbart.html)
    4) Normally my fellow researchers will not post on this forum. They do not wish to get involved in what they have referred to as unprofessional vituperations. The thread in 2008 was a rarity in that some of these well known and respected people did provide their opinions on this forum.
    5) My research and work is fully presented, both in my publications and on my research website (www.Rothbartsfoot.es). However, I just plainly ignore all personal perjoratives, and in fact, have become so tired of the repetitive disrespect I have received from certain individuals on this forum, that I have added their names to my spam list.

    To be very candid with your Craig, I am very ashamed of the comments I have received from my compeers regarding the demeanor on this forum. It just doesn't speak well for our profession.

    Professor Rothbart
  29. Rob Kidd

    Rob Kidd Well-Known Member

    Just look at the people you proselytise (?SP?) OJ Lewis - known to his friends and enemies alike as "Orange Juice", was a serious anatomist from London. His work of comparative was such that: If he said it was there - well then, it was there......." And as for Oxnard, nothing new needs to be said; he is both a living monument to modern anatomy, but also a monument to the proselytisation of modern podiatry; this is perhaps an explanation of why he speaks (with no fee) at your conference each year.

    As I am sure you know, he is my mentor; he tells me that I was very naive when I started, totally different when I finished - well that is the story of most graduate students! I share dinner with him each year at the Australasian Society for Human Biology's annual conference in December; this year it is my turn to pay. Alex - why are you not there? Tell you what: you enrol as a punter, I will pay for your dinner with Chas, El and myself.................. It is at The Womens College College at Uni Sydney. Rob
  30. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Hi Rob,

    Your points are well taken.

    However, I remember the days when subjective outcomes were the norm for publications. That is, we were very concerned with the patient's response to our therapy. For example, if I saw that my patients were repetitively having a negative response to a specific intervention, I would search for an alternative approach.

    Now, do not get me wrong. I believe statistical and evidence based studies have their place. But I also believe that subjective outcome studies are just as important.

  31. Rob Kidd

    Rob Kidd Well-Known Member

    We disagree
  32. Brian A. Rothbart

    Brian A. Rothbart Active Member


    Are you now censoring my comments. I just responded to your statements above and it does not appear on this thread.

    Professor Rothbart
  33. https://soundcloud.com/mark-russell-uk/professor-rhubarb

    Not sure how to embed soundcloud in this forum - Craig?

    In case you feel the need to join in...(apologies to Jansch)

    Professor Rhubarb

    When darkness fills the air
    And pain takes the joy of life away
    Don’t fall down in despair
    For I can change your life from today

    I’ll make you laugh
    I’ll make you cry
    I’ll make you wonder why
    You ever came my way

    When conception fails again
    Just call me and I’ll tell you what to do
    And tears will fill your eyes
    When I tell you it’s all caused by Rhubarb Foot

    I’ll make you laugh
    I’ll make you cry
    I’ll make you wonder why
    When you come to pay

    When gangrene climbs your leg
    And it threatens to fall off below the knee
    Just take my magic sole
    And you’ll run like you’re born to be free

    I’ll make you laugh
    I’ll make you cry
    I’ll make you wonder why
    I’m still in practice today

    When your head hurts so bad
    And your posture falls like a rubber band
    I’ll make you stand up tall
    When you find out I work from distant lands

    I’ll make you laugh
    I’ll make you cry
    I’ll make you wonder why
    I have no conscience too

    I can’t explain myself
    Not that I’d ever really want to do
    I work in mysterious ways
    Putting weird rubber things in your shoes

    I’ll make you laugh
    I’ll make you cry
    I’ll make you wonder why
    You gave your trust to me

  34. Ah yes, your PhD- which if we follow the link from your website was on:
    Mutated hydrogen-bonding pattaerns [sic] induced by free radical pathology
    the key mechanism in carcinogenesis

    And awarded by the now defunked Columbia Pacific University http://en.wikipedia.org/wiki/Columbia_Pacific_University

    Perhaps you could tell us some more about your PhD work, the thesis you "wrote" appears to be 39 pages in total?

    Did you get it through this company or another one? http://www.expressuniversitydegree.com/buy-a-phd/
  35. Brian A. Rothbart

    Brian A. Rothbart Active Member

    Thank you Craig for added my comments.

    I know you are an ethical, honest and unbaised healthcare educator. Censoring my comments is something I honestly believe you would not do.

    Professor Rothbart
  36. You mean they were on page 1, you didn't realise you were looking at page 2 of the thread and went off on one at Craig for censorship, when your comments had not been censored at all and where there for all to see all along. Nice. You could always say sorry to Craig.

    Now, can you tell us the methodology you employed in your PhD thesis to examine mutation in the hydrogen bonds?
  37. Brian - Father of Chronic Pain Elimination:

    Next time, before you accuse Craig of "censoring your comments", why don't you pay better attention to the thread, like Simon said.

    You owe Craig an apology.


    Kevin - Father of Chronic Charlatan Elimination
  38. And here are some interesting facts from Wikipedia about why Columbia Pacific University was closed due to giving out bogus academic degrees:

    When did you earn your "PhD" from this questionable organization, Brian??
  39. 1984. "The bureau further stated that students who received degrees or credentials from CPU before June 25, 1997 should not be affected because the school had legal authorization to operate until that date. This merely means that the school was allowed to issue degrees. It does not mean that the school was accredited or that employers should regard the degrees as representing education equivalent to that of accredited schools. During the 1980s, an official of the California Postsecondary Education Commission confirmed to me that CPU had been authorized to operate but was not accredited [4]" http://www.quackwatch.org/04ConsumerEducation/News/cpu.html

    Kevin, is it normal for a PhD thesis to consist of only 39 pages in the US?

    Anyway, back to biomechanics, how do we get to 2013 and have a situation where someone believes that biomechanics of the foot and lower limb begins and ends with the works of Merton Root? You've got to have been living under a stone and have read nothing other than Root to believe this to be the case, surely?
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