Human gait is cyclical. For the most part, when one limb is engaged on the ground (stance phase), the other is in swing phase. Before we continue, you should recall that there is a brief double limb support phase in walking gait, that which is absen…

Human gait is cyclical. For the most part, when one limb is engaged on the ground (stance phase), the other is in swing phase. Before we continue, you should recall that there is a brief double limb support phase in walking gait, that which is absent in running gait. Also, we wish to remind you of our time hammered principle that when the foot is on the ground the glutes are heavily in charge, and when the foot is in the air, the abdominals are heavily in charge.  

For us to move cleanly and efficiently one would assume that the best way to do that would be to ensure that the lower 2 limbs are capable of doing the exact same things, with the same timing, same skill, same endurance and same strength. This goes for the upper 2 limbs as well, and then of course the synchronizing of the 4 in a cohesive effort. For this clean seamless motor function to occur, one must assume that there would be no injuries that had left a remnant mark on one limb thus encouraging a necessary compensation pattern in that limb (and one that would then have to be negotiated with the opposite limb as well as the contralateral upper or lower limb).  For example, when right ankle rocker (dorsiflexion) is impaired, early heel departure will occur and hip extension will be limited. An alteration in right glute function will most likely follow.  One could theorize that the left step length (the length of measure from right heel strike through to left heel strike) would thus be shortened. This would cause a premature load onto the left limb, and could very well force the left frontal plane to be more engaged than is desirable. This could lead to left core and hip frontal plane weakness and compensation patterns to be generated (ie. right arm abduction. One can see all of these components in the photo above, and in this case here). It could also lead to a pelvic distortion pattern which would further throw off the anti-phasic nature of symmetrical and efficient gait.  To complicate the cyclical scenario, the time usually used to move sagittally will be partially used to move into, and back out of, the left frontal plane. This will necessitate some abbreviations in the left stance phase timely mechanical events. Some biomechanical events will have to be abbreviated or sped through and then the right limb will have to adapt to those changes. These are simple gait problems we have talked about over and over again here on the gait guys blog. (Search “arm swing” on our blog and you will find 45 articles around this topic.) These compensation patterns will include expressed weaknesses in various parts of the human frame as part of the pattern, and merely fixing those weaknesses does not address the right ankle rocker problem. Fixing said weaknesses merely encourages the brain to possibly continue to perpetuate necessary tightnesses in other muscles and engrain the compensations (challenges to mobility and stability) further or more complexly.  It is easy to find something weak, it takes a sharp brain to find the sometimes silent sparking event. Are you able to find the problem in this never ending loop of compensations and find a way to unwrinkle the system one logical piece at a time, or will you just chose to strengthen the wrinkled system and hope that the new strength on top of the compensations is adequate for you our your client ? One should not be forever sentenced to daily or weekly rehabilitative sessions/ homework to negate and alleviate symptoms, this is a far more durable machine than that. Fix the problem.

Now, lets add another wrinkle to the system.  What if there were problems before any injuries ?  Meaning, what if there were problems during the timely maturation and suppression of the primitive reflexes ? Or problems in the timely appearance or maturation of postural reflexes? A problem in these areas may very well result in a central or peripheral nervous system malfunction and a representation of such in one’s movement and gait.  That is a larger discussion for another time.

There is a reason that in our practices we often assess and treat contralateral upper and lower limbs as well as to address remnants from old injuries whether they are symptomatic or not. This is a really tough puzzle and game you are playing. For example, when there is insufficient hip internal rotation unilaterally you can regain some of the loss through increased foot pronation unilaterally, but at a consequence to both the local and global pictures.  Remember, most of the time you are trying to walk in a straight line from A to B and if the parts are not symmetrical you have many options to compensate. It is not as simple as telling your athlete to swing one arm more, or to stop pulling it across their body; they need to do those things, it is called a “compensation”. It is often not as simple as finding an impaired Rolling Pattern and driving it back to symmetry, in doing so, you may have just added strength and skill to a compensation.  Merely addressing things locally can be a crime.  If you are seeing an arm swing change, you would be foolish not to look at the opposite lower limb and foot at the very least, and of course assess spinal rotation, lateral flexion and hinging as well as core mobility and stability.  For your neuro nerds, remember the receptors from the central spine and core fire into the midline vermis of the cerebellum (one of the oldest parts of our brain, called the paleo cerebellum); and these pathways, along with other cerebellar efferents, fire our axial extensor muscles that keep us upright in the gravitational plane and provide balance or homeostasis.  So, those need assessed and addressed as well.  

Or, if this is too much thinking for you, … you can just train harder and get stronger . .  . in all your compensation patterns, after all, it is easier than figuring out why and how that right ankle started the whole mess, if in fact that is even the first piece of the puzzle.

Welcome to the matrix.

shawn and ivo, the gait guys

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More on Stretching? Enough already, eh?

The last few weeks , we have been talking about techniques to improve your (or your clients) stretching experience. 1st, we talked about reciprocal inhibition here. Next we talked about post isometric inhibition here. The we spoke about the symmetrical tonic neck reflex (response) here. If there is a symmetrical tonic neck reflex, then there must be an asymmetrical one as well, eh? That is the topic of todays discussion

The asymmetrical tonic neck reflex was 1st described by Magnus and de Kleyn in 1912 (1). Like in the pictures above, when the head is rotated to one side, there is ipsilateral extension of the upper and lower extremity on that side, and flexion of the contralateral (the side AWAY from where you are rotating) upper and lower extremity. Take a few minutes to see the subtleness of the reflex in the pictures above. Now think about how this occurs in your clients/patients.  The reflex is everywhere!

The reflex persists into adulthood (2) and is modulated by both eye movement and muscular activity (3). When there is neurological compromise, the reflex can be more prevalent, and it seems to arise from the joint mechanoreceptors in the neck and its connection to the reticular formation of the brainstem (4). It may modulate blood flow and cardiovascular activity as well (5). 

So, how can we take advantage of this? We could follow in the footsteps of Berta Bobath (6) and incorporate these into our rehabilitation programs, which we have done, quite successfully. But rather than read a whole book, lets talk about how you could incorporate this into your stretching program. 

Let’s say you want to stretch the right hamstring:

  • actively rotating the head to the right (see reference 3) facilitates the right tricep and right quadricep AND facilitates the left bicep and left hamstring
  • through reciprocal inhibition, this would inhibit the right bicep and hamstring AND left tricep and left quadricep
  • To get a little more out of the stretch, you could actively contract the right tricep and quadricep (MORE reciprocal inhibition), amplifying the effect

We encourage you to try this, both on yourself and your clients. It really works!

Wow, isn’t neurology cool? And you thought it was only for geeks!

The Gait Guys. Giving you info you can use in a practical manner, each and every post. Be a geek. Spread the word. 

  1. http://www.worldneurologyonline.com/article/arthur-simons-tonic-neck-reflexes-hemiplegic-persons/#sthash.6QS3Eat3.dpuf 
  2. Bruijn SM1, Massaad F, Maclellan MJ, Van Gestel L, Ivanenko YP, Duysens J. Are effects of the symmetric and asymmetric tonic neck reflexes still visible in healthy adults?Neurosci Lett. 2013 Nov 27;556:89-92. doi: 10.1016/j.neulet.2013.10.028. Epub 2013 Oct

  3. Le Pellec A1, Maton B. Influence of tonic neck reflexes on the upper limb stretch reflex in man. J Electromyogr Kinesiol. 1996 Jun;6(2):73-82.

  4. Michael D. Ellis, Justin Drogos, Carolina Carmona, Thierry Keller, Julius P. A. Dewal Neck rotation modulates flexion synergy torques, indicating an ipsilateral reticulospinal source for impairment in stroke Journal of NeurophysiologyDec 2012,108(11)3096-3104;DOI: 10.1152/jn.01030.2011

  5. Hervé Normand, Olivier Etard and Pierre Denise Otolithic and tonic neck receptors control of limb blood flow in humans J Appl Physiol  82:1734-1738, 1997.

  6. Berta Bobath, Chartered Society of Physiotherapy (Great Britain)  Abnormal postural reflex activity caused by brain lesions Aspen Systems Corp. Rockville, MD, 1985 -

Podcast 84: Toe Walkers, Hip Impingment & Olympic Lifting Shoes

Plus: pulmonary edema syndrome in Triathlete swimmers, truths about olympic lifting shoes and more !

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Show notes:

Are Triathletes Really Dying of Heart Attacks?

 
We had some stuff on FB last week about head positioning during running.  Alot of people tried to simplify it.  There is more to it. Here is another perspective.
 
Toe Walking children
 
Olympic lifting shoes ? or Converse Chuck Tailors ?
 
Journal of Foot and Ankle Research | Abstract | The associations of leg lean mass with foot pain, posture and function in the Framingham foot study
http://www.jfootankleres.com/content/7/1/46/abstract
 
Hip Impingements
 
Achilles oddity: Heeled shoes may boost load during gait | Lower Extremity Review Magazine
http://lermagazine.com/news/in-the-moment-rehabilitation/achilles-oddity-heeled-shoes-may-boost-load-during-gait
 
Toe Walking in Children. Do you know what you are dealing with ? Part 2
So you have now ruled out possible Autism-spectrum, possible CMT (Charcot-Marie Tooth Disease), CP (Cerebral Palsy), MD (Muscular Dystrophy) in your young toe walking individual…

Toe Walking in Children. Do you know what you are dealing with ? Part 2

So you have now ruled out possible Autism-spectrum, possible CMT (Charcot-Marie Tooth Disease), CP (Cerebral Palsy), MD (Muscular Dystrophy) in your young toe walking individual.  Now you have been left with the aftermath foggy diagnosis of “Idiopathy Toe Walking”, that doesn’t leave you as a parent or clinician with much to work with or likely to be confident about. Let us try to help make things clearer and give you some other cognitive options to entertain. New research in recent years has brought new light onto the issue and we wanted to use today’s blog post as a platform to share it with you. 

In a previous week’s “Part 1” blog post & video (link) you can see in the gait on the video that nothing appears to be terribly abnormal in the foot structure (from what we can tell), the client is merely remaining in the plantarflexed posture and forefoot weight bearing.  This is highly ineffective gait and can be very fatiguing let alone to mention the sustained loading into the posterior compartment and plantarflexor mechanism (gastrosoleus-achilles) not to mention the sustained forefoot loading response on the foot bones and joints. Remember, the tibialis posterior and long toe flexors are close neighbors with capabilities of plantarflexion moments, so there are possible clinical manifestations there as well not to mention the obvious (especially to long-time Gait Guys readers) deficits that will be found in functional ankle dorsiflexion, ankle rocker and S.E.S. (skill, endurance, strength) of the anterior compartment mechanism (tibialis anterior, long toe extensors, peroneus tertius).  Even if this client were to go into normal heel strike and stance phases right now, they would have lots of work to do to restore the anterior-posterior compartment balance, the 3 foot rockers (heel, ankle and forefoot) abd posterior compartment length to avoid functional pathology not to mention the timely coordination of all these events. 

Idiopathic toe walking is suggested to be as prevalent as 12%. Toe walking is categorized when there is an absence, or at least a limitation, of heel strike during initial walking gait contact phase. We are not referring to, at all, forefoot running principles. Neuromotor maturation comes about via the suppression of the primitive reflexes/windows and appearance of the postural reflexes and responses. Delays or subtractions of these windows/reflexes may cause challenges in the normal development and maturation of the central and/or peripheral nervous systems.  With toe walking, the clinical window most studies suggest is to begin investigation after 3 years of age when the primitive motor patterns should have solidified and the gait and postural patterns have begun to layer on top of those primitive reflexes.  Remember though, the primitive patterns are not sequentially fixed, meaning that infants move in and out of these reflexes until they become skilled and permanent.  It is not until they are fixed that the postural patterns, which are volitional, can be gradually built. This should bring some deeper thoughts to your mind right now.  Is toe walking behavior a missed primitive window or a non-volitional postural window? These kids are not doing this by choice, anyone who has worked with these types of cases knows this very well, and we have seen our share. 

In the literature and clinics a plethora of things have been tried and discussed (ie. serial casting, botulinum toxin, surgical tendon lengthening, gait retraining, orthoses/orthotics, night splints, day splints and the like). Keep in mind that only one of the above is addressing a functional change via cognitive and higher brain center demand, “gait retraining”. The others are passive forced attempts.  But is gait training enough ? And how far back into primitive and postural gait pattern training do you have to go? Gait training certainly does something as eluded to by two research papers we posted on our Facebook page in previous weeks. See those references below.

“For both feet, contact time of the heel was increased after the training period, whereas contact time of the forefeet decrease. Also positive changes in the active range of joint motion of the ankle (dorsal extension) were observed in both feet. These positive effects were visible also in the follow–up assessment.” -Pelykh study

Daily intensive gait training may influence the elastic properties of ankle joint muscles and facilitate toe lift and heel strike in children with CP. Intensive gait training may be beneficial in preventing contractures and maintain gait ability in children with CP.” - Willerslev-Olsen study

So what else could be going on here ? Is this neurodevelopmental ? Yes, for sure.  But where did things go awry ?  And how do we fix it ? Remember, the development of primitive and postural reflexes is supposed to occur proximal to distal (ie. from core to hand/foot).

In a recent study in the Journal of Child Neurology,  

“for the first time, motor and sensory challenges presenting in healthy children with an idopathic toe walking gait have been identified.These challenges imply an immaturity or mild impairment at the cerebellum or motor cortex level.”

As the article suggested, the research did not render direct cause(s) for the gait pattern, rather some very viable theories on the topic. They found that only the areas of balance, upper body coordination and bilateral coordination were areas found to be problematic in the toe walkers. These 3 components require the integration of the tactile, vestibular and proprioceptive systems as a team. Diving deeper into how these 3 outputs are linked, there is a required “mix of occulomotor control and cues together with subtle and gross postural adjustments” (3). As Williams et al (3) suggested, “they are skills requiring the coordination of movements in which each side of the body moves simultaneously or in sequence”.  Kind of sounds like some topics on Arm Swing/Leg swing and also on the topic of phasic/antiphasic gait we have discussed over and over again here on TGG and in recent podcasts (82) doesn’t it ?  It was proposed that perhaps idiopathic toe walkers negotiate their sensory challenges by unconsciously engaging toe walking behavior to change or challenge these inputs.  Here were some of the proposed thoughts from the Williams study.

“The tactile receptors of the skin may be stimulated through pressure at the ball of the foot or lessened by a reduction of surface contact by raising the heel off the ground. Proprioceptive input may be changed at the knee, ankle and even toe joints by unconsciously repositioning of the foot posture.  The vestibular input may be increased by the vertical stimulation of the bouncy type gait that results from toe walking.”(3) Williams

It seems clear from the Williams study that these children demonstrate a number of sensory needs that motivate toe walking to alter (increase or decrease) or improve sensory input.  The study also suggests that the toe walking gait is an attempt to modify input on postural stimuli during gait to serve diminished postural and position awareness.

The findings of this study are important.  Our most recent blog posts and podcasts (Nov 2014) have discussed some of the components to build, control and coordinate gait on a higher neurologic level. The Williams article seems to support these discussions, that some pathologic gaits are initiated on a neurologic level as opposed to biomechanical at the foot and ankle level.  This sounds like the work offered by “the functional neurologist”, graduates of the Carrick Institute for Graduate Studies ! (carrickinstitute.com)

Have a great day gait brethren !

Shawn and Ivo, The Gait Guys

References:

1. Eur J Phys Rehabil Med. 2014 Oct 9. [Epub ahead of print]

Treatment outcome of visual feedback training in an adult patient with habitual toe walking.

NeuroRehabilitation. 2014 Oct 15. [Epub ahead of print]

2. Gait training reduces ankle joint stiffness and facilitates heel strike in children with Cerebral Palsy.

3. Is idiopathic toe walking really idiopathic ? The motor skills and sensory processing abilities associated with idiopathic toe walking gait.  J Child Neurol 2014, 29:71 Williams, C. , Curtin, Wakefield and Nielsen
More Tricks for stretching, part 3

We have been talking about ways to enhance stretching, talking about taking avvantage of reciprocal inhibition (please see part 1 here) and autogenic  (or post isometric) inhibition (please see part 2 here). 
Befo…

More Tricks for stretching, part 3

We have been talking about ways to enhance stretching, talking about taking avvantage of reciprocal inhibition (please see part 1 here) and autogenic  (or post isometric) inhibition (please see part 2 here). 

Before we talk about this next one, we need to give you a little background (neurologically speaking). 

Take a look at the picture above and note the posturing of the baby in the 2 positions. These neurological reflexes (or postures) are called symmetrical tonic neck reflexes or responses (STNR’s for short) and were described in animals and men by Magnus and de Kleyn in 1912 (1). This work was later studied and reported by by Arthur Simons in 1916  (2) and later by Francis Walshe in 1923 (3). These were later made popular by Berta and Karl Bobath in the 70’s (who studied Walshes work), whom they are often attributed to (4). 

You next question is “Do these persist into healthy adulthood”? and the answer is a resounding YES (5).

Take a look at the picture above again and note the following: 

  • When the neck is flexed, the fore limbs flex (and the muscles facilitating that, bicep, brachialis, anterior deltoid are contracting) and the hind limbs are extending (relatively), with the glutes maximus, quadriceps, foot dorsiflexors contracting.

  • Note that when the head is extended, the forelimbs are extended and the hind limbs flexed. Think about the muscles involved. Upper extremity tricep, anconeus, posterior deltoid, lower back extensors, hamstrings and foot plantar flexors facilitated.

The reflex is based on the mechanoreceptors in the neck articulations and muscles and are frequently used by us and many others in the rehabilitation field. Generally speaking, looking up facilitates things which make you extend above T12, and flex below T12. Looking down facilitates flexion above T12 and extension below. 

We would encourage you at this point to “assume” these positions and feel the muscles which are active and at rest.

So, how can we take advantage of these while stretching? 

Think about your head position:

  •  If you are standing up and hinging at the hips to stretch your hamstrings (notice we did not say “bent at the waist”; there is a BIG difference in shear forces applied to your lumbar spine) you would probably want your neck bent forward, as this would fire your quads which would in turn ALSO inhibit your hamstrings, in addition to the STNR inhibiting the hamstring. 

  • If you were in a hip flexor stretch position, you would want you head up, looking at the ceiling to take advantage of the reflex. 

We are confident you can think of many more applications of this reflex and trust that you will, as it can apply to both upper and lower extremity stretches. Just remember that this reflex is symmetrical and will affect BOTH sides. Of course, there are reflexes that only effect things unilaterally, but that is the subject of another post. 

The Gait Guys. Helping make you better at what you do for yourself and others and assisting you on using the neurology that God gave you. 

  1. http://www.worldneurologyonline.com/article/arthur-simons-tonic-neck-reflexes-hemiplegic-persons/#sthash.6QS3Eat3.dpuf 
  2. Simons A (1923) Kopfhaltung and Muskeltonus. Ges.Z. Neurol.Psychiatr. 80: 499-549.
  3. Walshe FMR (1923) On certain or postural reflexes in hemiplegia, with special reference to the so-called “associated movements.” Brain 46: 1-37. 
  4. Janet M. Howle . Symmetrical Tonic Neck Reflex in Neuro-developmental Treatment Approach: Theoretical Foundations and Principles of Clinical Practice.   NeuroDevelopmental Treatment, 2002  p 341 ISBN 0972461507, 9780972461504
  5. Bruijn SM1, Massaad F, Maclellan MJ, Van Gestel L, Ivanenko YP, Duysens J. Are effects of the symmetric and asymmetric tonic neck reflexes still visible in healthy adults?Neurosci Lett. 2013 Nov 27;556:89-92. doi: 10.1016/j.neulet.2013.10.028. Epub 2013 Oct 21.

Podcast 83: Gait & Brain Injury, and Compression Wraps Theories

Plus: Rocker Shoes, Knee Replacements, and Strong Ankles

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Texting on the Loo

Hepatic encephalopathy: effect of liver failure on brain function.

http://www.nature.com/nrn/journal/v14/n12/fig_tab/nrn3587_F1.html

The Bouncy Gait: Premature heel rise gait. Taking another look.

This is a great video example of a premature heel rise during gait. You should be able to clearly see it on the left foot (and this was toned down after we brought it to his awareness!).  The heel rise occurs early in the stance phase of gait, instead of the late stance phase.

We have talked about this bouncy type vertically oriented gait many times in blog posts and in our podcasts.  This is a pretty prevalent problem in the world, mostly because so many people have impaired ankle rocker/dorsiflexion from weak anterior compartments and short/tight posterior compartments.  None the less, for the majority, this is a pathologic gait pattern and it will impart undue stress into the posterior mechanism (calf-achilles complex). Just think about it, this person is going vertical at or prior to the tibia achieving 90degrees (perpendicular to the ground) instead of continuing to progress the tibia to 110+ degrees to enable normal timely pronation and foot biomechanical events.  This is not a normal gait. Period. This will change the function of the entire posterior chain upward. 

If you want to see another great example  from the frontal plane, check out this cute video representation of a vertial/premature heel rise bouncy gait. 

This gait style is caused by a premature heel rise from joint range limitation and/or from premature engagement of the gastrosoleus (and sometimes even the long toe flexors, you will see them hammering and curled in many folks). It can be a learned habitual pattern and nothing more, we have even seen it even in child-parental gait modeling in our offices. These people will never get to NORMAL full late-midstance of gait (without biomechanical compromise) and thus never achieve full hip extension nor adequate ankle dorsiflexion / ankle rocker. The gait cycle is an orchestrated symphony of timely events and when one or several timely events are omitted or impaired the mechanics are passed into other areas for compensation. This vertical gait style is very inefficient in that the gluteals cannot adequately power into hip extension into a forward progression drive, because the calf is prematurely generating vertical movement through ankle plantarflexion.  This strategy is sometimes deployed because the person actually is significantly ankle dorsiflexion (ankle rocker) deficient.  Meaning, they hit the limitations of dorisflexion and in order to progress forward they first have to go vertical.  This vertical motion, because they are moving into ankle plantarflexion, re-buys more ankle dorsiflexion range which then can be used if they so choose. Obviously, the remedy is to find the functional deficit, remove it and retrain the pattern.  There are a whole host of other problems that go with this compensation pattern but we wanted our mission to stay focused today.  Remember, this is usually a subconscious motor pattern compensation. Is it like the toe walking issue we talked about last week (post link here) ? It is similar in some ways and can have primitive and postural motor pattern implications. We will follow up the “Idiopathy Toe Walking Gait: Part 2” shortly but we wanted to strategically put this blog post ahead of it, because there are similar characteristics and implications. Trust us, there is a method to our madness :)

Shawn and Ivo

The Gait Guys

More effective stretching, Part 2
Last week we looked at one (of many) methods to make stretching more effective, utilizing a neurological reflex called “reciprocal inhibition” If you missed that one, or need a review, click here. 
Another way to ge…

More effective stretching, Part 2

Last week we looked at one (of many) methods to make stretching more effective, utilizing a neurological reflex called “reciprocal inhibition” If you missed that one, or need a review, click here

Another way to get muscles to the end range of motion is to utilize a technique called “post isometric relaxation”. Notice I did not say to lengthen the muscle; to actually add sarcomeres to a muscle you would need to use a different technique. Click here to read that post.

Contracting a muscle before stretching is believed to take advantage of a post isomteric inhibition (sometimes called autogenic inhibition), where the muscle is temporarily inhibited from contracting for a period immediately following a isometric contraction. This has been popularized by the PNF stretching techniques, such as “contract hold” or “contract relax” . EMG studies do  jot seem to support this and actually show muscle activation remains the same (1, 2) or increased after contraction (3-6). Perhaps it is due to an increased stretch tolerance (7,8). 

The technique was 1st described by Mitchell, Morgan and Pruzzo in 1979 (9). These gents felt it was important to utilize a maximal contraction (using 75-100% of contractile force) to get to have the effect. It was later shown by Feland and Marin (10) that a more minimal, submaximal contraction of 20-60% accomplished the same thing.  Lewit felt that a less forceful contraction offers the same results, and combined respiratory assists (inspiration facilitates contraction, expiration facilitates relaxation) with this technique (11). Interestingly, there are bilateral increases in range of motion with this type of stretching, indicating a cross over effect (12). Regardless of the mechanism, the phenomenon happens and we can take advantage of it. 

This is how you do it: 

  • Bring the muscle to its end range (maximum length) without stretching, taking up the slack. This should be painless, as this will elicit a different neurological reflex that may actually increase muscle tone. 
  • resist with a minimal isometric contraction (20-60%) and hold for 10 seconds.  You can inspire to enhance the effect.
  • relax and exhale slowly. It is important to wait and feel the relaxation. Stretch through the entire period of the relaxation. You should feel a lengthening of the  muscle.
  • repeat this 3-5 times

This technique can also be used with the force of gravity offering isometric resistance. In a hamstring stretch, you could lean forward while maintaining the lumbar lordosis and allowing the weight of the upper body to provide the stretch. 

Wasn’t that easy? Now you have another tool in your toolbox for yourself or your clients.

The Gait Guys. Giving you useful information and explanations in each and every post.

  1. Magnusson SP, Simonsen EB, Aagaard P, Sorensen H, Kjaer M. A mechanism for altered flexibility in human skeletal muscle. J Physiol. Nov 15 1996;497 (Pt 1):291–298
  2. Cornelius WL. Stretch evoked EMG activity by isometric coontraction and submaximal concentric contraction. Athletic Training. 1983;18:106–109
  3. Condon SM, Hutton RS. Soleus muscle electromyographic activity and ankle dorsiflexion range of motion during four stretching procedures. Phys Ther. Jan 1987;67(1):24–30 
  4. Mitchell UH, Myrer JW, Hopkins JT, Hunter I, Feland JB, Hilton SC. Neurophysiological reflex mechanisms’ lack of contribution to the success of PNF stretches. J Sport Rehabil. 2009;18:343–357 
  5. Youdas JW, Haeflinger KM, Kreun MK, Holloway AM, Kramer CM, Hollman JH. The efficacy of two modified proprioceptive neuromuscular facilitation stretching techniques in subjects with reduced hamstring muscle length. Physiother Theory Pract. May 2010;26(4):240–250 
  6. Osternig LR, Robertson R, Troxel R, Hansen P. Muscle activation during proprioceptive neuromuscular facilitation (PNF) stretching techniques. American journal of physical medicine. Oct 1987;66(5):298–307
  7. Mahieu NN, Cools A, De Wilde B, Boon M, Witvrouw E. Effect of proprioceptive neuromuscular facilitation stretching on the plantar flexor muscle-tendon tissue properties. Scandinavian journal of medicine & science in sports. Aug 2009;19(4):553–560 
  8. Mitchell UH, Myrer JW, Hopkins JT, Hunter I, Feland JB, Hilton SC. Acute stretch perception alteration contributes to the success of the PNF “contract-relax” stretch. J Sport Rehabil. May 2007;16(2):85–92
  9. Mitchell F Jr., Moran PS, Pruzzo NA: An Evaluation of Osteopathic Muscle Energy Procedures. Pruzzo, Valley Park, 1979.  
  10. Feland JB, Marin HN. Effect of submaximal contraction intensity in contract-relax proprioceptive neuromuscular facilitation stretching. Br J Sports Med. Aug 2004;38(4):E18.
  11. Lewit K: Postisometric relaxation in combination with other methods of muscular facilitation and inhibition. Man Med, 1986, 2:101-104.
  12. Markos PD. Ipsilateral and contralateral effects of proprioceptive neuromuscular facilitation techniques on hip motion and electromyographic activity. Phys Ther. Nov 1979;59(11):1366–1373

Podcast 82: Phasic vs Antiphasic Gait, Cross Over Gait & more.

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www.lemsshoes.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_82final.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-82-phasic-vs-antiphasic-gait-cross-over-gait-more

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

 

Show notes:

 
Blog posts we reviewed:
 

Muscle Activity Differences in Forefoot and Rearfoot Strikers
http://www.runresearchjunkie.com/muscle-activity-differences-in-forefoot-and-rearfoot-strikers/

www.runnersworld.com/injury-treatment/forward-lean-while-running-might-reduce-knee-pain?cid=social33696857

Weight-Bearing Ankle Dorsiflexion Range of Motion—Can Side-to-Side Symmetry Be Assumed?
http://www.natajournals.com/doi/abs/10.4085/1062-6050-49.3.40

extras for this piece:

and you can use this to substantiate it: http://www.ncbi.nlm.nih.gov/pubmed/23997389

Effect of step width manipulation on tibial stress during running. J Biomech. 2014 Aug 22;47(11):2738-44. doi: 10.1016/j.jbiomech.2014.04.047. Epub 2014 May 21.

This Client went Phasic in their Gait. Do you know what that means ? We do, and so does McGill, Liebenson, Cook and many others.

Long ago on this blog we showed and discussed a video (link) that discussed Stu McGill's research of the human movements of Georges St-Pierre and David Loiseau. The basic tenets of that video were that the hips and shoulders are used for power production and that the spine-core are used for creating stiffness and stability for the ultimate power transmission through the limb.  He made it clear that if power is generated from the spine, it will suffer. 

Here on TGG we have long talked about phasic and antiphasic motions of the arms and shoulder-pelvic blocks during gait and locomotion/sport activity.  Many of our 1000+ blog writings and 80 podcasts have talked about spine pain and how spine pain clients reduce the antiphasic rotational (axial) nature of the shoulder girdle and pelvic girdle. In the video above, we see anything but antiphasic gait, to be clear, this is a classic representation of a phasic gait. This is pathologic gait, the frontal plane sway is exaggerated and necessary because there is no axial antiphasic motion.  There is essentially frozen arm and torso movements. This client has a long standing history of severe spine trauma and pain, their central pattern generators (CPG) had to make this motor pattern choice in an attempt to avoid pain and negotiate force streams across trauma zones. If you are curious and wish to go deeper down this rabbit hole, read the 30+ articles we have produced more specifically on arm swing and locomotor phasics, just click here.

In these types of cases, the client subconsciously makes the subcortial pattern choice (overrides the normal CPG) to rotate them as a solid unit to reduce spine rotation, axial loading and compression.  We could say that quite often spine pain disables the normal arm-leg pendulums via altering the shoulder-torso and hip-pelvis phasics and the CPG that dictates them. Normally, the spine and core must present sufficient amounts of recruited stiffness, yet mobility where necessary, to enable the locomotive power and velocity generated by movements of the shoulders and hips. These are the two main portals of limb movement off of the spine/core.  These principles holds true in gait and sport. For and interesting example, in human gait the psoas is not entirely a hip flexor initiator when it comes to leg swing, it is a huge hip flexion perpetuator. The initial hip flexion in human gait comes from derotating the obliqued pelvis, via abdominal contraction, on a stiff and stable spine.  Once the pelvis rotation is initiated, the femur can further pendulum forward (via contraction of the psoas and other muscles) on the forward accelerated pelvis in the hip joint proper creating an energy efficient movement (the towel flick/whip effect). This premise holds true in gait, running, kicking etc.  This is a solid principle of effective and efficient human locomotion. This principle also holds true for a punch or throwing an object, the stable torso/spine provides a stable anchor upon which to accelerate the arm in order to create a high velocity limb movement with power.  But here is where we get annoyed much of the time.  (Soap box Tangent coming up) How often do you read articles about tight ITBand, tight psoas, tight piriformis and the like ?  As a “diagnosis” these are weak and they are the “go to diagnosis or cause” of the unseasoned clinician, trainer, coach, therapist. If we all are to be really good at our job, we must go beyond what we see in someone’s gait (since it is the compensation) and go beyond the CNS neuroprotective strategy of tightness/shortness when there is weakness or motor pattern failure.  This does not mean that you cannot, or should not, incorporate restoration methods and principles to restore length-tension relationships in your client, it means you have to resolve ALL of the problems, including the aberrant CPG they have set up as a protective default to avoid injury or further injury. 

In the case above, returning the discussion to arm and leg swing, one must understand clearly that faulty arm swing patterns and lack of antiphasic torso and pelvis oscillation is a product of surgery,  trauma and more so, pain. The client is avoiding the antiphasic presentation (hence, he is phasic) for a reason and coaching more arm swing would be just about the dumbest intervention, so don’t be “that guy”. We know this is an altered motor pattern choice, not a new fixed set point. We know this because on clinical examination the range is available, we know because we examined for it, it is just not being used.  In an example of this same principle, in this case talking hip ranges of motion, McGill discusses the same in his paper*:

“Despite the large increases in passive hip ROM, there was no evidence of increased hip ROM used during functional movement testing. Similarly, the only significant change in lumbar motion was a reduction in lumbar rotation during the active hip extension maneuver (p < 0.05). These results indicate that changes in passive ROM or core endurance do not automatically transfer to changes in functional movement patterns. This implies that training and rehabilitation programs may benefit from an additional focus on grooving new motor patterns if newfound movement range is to be used.”

Think about that next time you stretch, or are stretched by someone. As we have said before, just because you increase someone’s range of motion, does not mean they will be able to incorporate that range of motion into a movement pattern, or compensation pattern for that matter. It is only ¼ of the equation: Range of Motion,  Skill (or proprioception),  Endurance (or the proportion of slow twitch muscle) and Strength (the proportion of fast twitch muscle). There is our S.E.S. mnemonic again.

In this video case, lack of NORMAL antiphasic spinal motion (torso and pelvis moving opposite one another) is noted. Without the obliqued pelvis the swing and stance phases will be impaired. The psoas may have to become more of a hip flexor initiator, AS WELL AS the perpetuator of limb swing, because there is no pelvic obliquity from the antiphasic principles to drive it from. And so, when you see this fella in your office with bilateral tight psoas/hip flexor complex and tight quadriceps mechanisms with resultant impaired glutes and hip extension, please do not begin lengthening them as your point of initiation.  They are that way because he has gone phasic in his gait.  Change the motor patterns that drive this as best as possible, restore any weaknesses that are contributory to, or initiate, these motor patterns and then, if needed, encourage some progressive new length-tension in these muscle groups as improved motor patterning evolve to allow for it.  You are likely going to have to go back and reteach and restore primitive and postural sensory motor windows in these cases, so be patient, be kind, be wise. Oh, and do not forget that with impaired hip function, there will most likely be impaired ankle rocker,  you are going to need a wide angled lens to see, capture and remedy this lads problems.

On another note, can you imagine what this client’s video gait analysis would show and interpret ? Let alone the diagnostics and recommendations that could come from it?  What about the appearance of their foot pressures across a dynamic foot pressure plate (or God forbid a static one !), surely what is seen at the foot is this client’s problem (not !) And forgive those poor fools who recommend a shoe for this client based off of just those mediums alone.  Without a complete hands-on clinical examination to correlate gait cycle observances, any recommendations for this case will be traumatic on many levels. 

Today’s bottom line……. read, learn, think, stay hungry, be wise.

Shawn and Ivo, The Gait Guys

* Improvements in hip flexibility do not transfer to mobility in functional movement patterns.  Moreside, Janice: McGill, Stuart

link: http://journals.lww.com/nsca-jscr/Fulltext/2013/10000/Improvements_in_Hip_Flexibility_Do_Not_Transfer_to.1.aspx

Making your stretching more effective. 
While I was making linguine and clam sauce for my family, one of my favorite foods that I haven’t had in quite some time( and listening to Dream Theater of course) I was thinking about this post.  Then I remem…

Making your stretching more effective. 

While I was making linguine and clam sauce for my family, one of my favorite foods that I haven’t had in quite some time( and listening to Dream Theater of course) I was thinking about this post.  Then I remembered about voice recognition on my iMac.  Talk about multitasking!

What do you agree that stretching is good or not, you or your client still may decide to do so possibly because of the “feel good” component. Make sure to see this post here on “feel good”  part from a few weeks ago. 

If you do decide to stretch, make sure you take advantage of you or your clients neurology.  There are many ways to do this. One way we will discuss today is taking advantage of what we call myotatic reflex.

The myotatic reflex is a simple reflex arc. The reflex begins at the receptor in the muscle (blue neuron above) : the muscle spindles (nuclear bag or nuclear chain fibers). This sensory (afferent) information then travels up the peripheral nerve to the dorsal horn of the spinal cord where it enters and synapses in the ventral horn on an alpha motor neuron.  The motor neuron (efferent) leaves the ventral horn and travels back down the peripheral nerve to the contractile portion of the myfibrils (muscle fiber) from which the the sensory (afferent) signal came (red neuron above).  This causes the muscle to contract. Think of a simple reflex when somebody taps a reflex hammer on your tendon. This causes the muscle to contract and your limb moves.

Nuclear bag and nuclear chain fibers detect length or stretch in a the muscle whereas Golgi Tendon organs tension. We have discussed this in other posts here.   With this in mind, slow stretch of a muscle causes it to contract more, through the muscle spindle mechanism.

Another reflex that we should be familiar with is called reciprocal inhibition. It states simply that when one muscle (the agonist) contracts it’s antagonist is inhibited (green neuron above).  You can find more on reciprocal inhibition here.

Take advantage of both of these reflexes?   Try this:

  • do a calf stretch like this: put your foot in dorsiflexion, foot resting on the side of the doorframe.
  • Keep your leg straight.
  • Grab the the door frame with your arms and slowly draw your stomach toward the door frame. 
  • Feel the stretch in your calf; this is a slow stretch. Can you feel the increased tension in your calf? You could fatigue this reflex if you stretched long enough. If you did, then the muscle would be difficult to activate. This is one of the reasons stretching seems to inhibit performance. 
  • Now for an added stretch, dorsiflex your toes and try to bring your foot upward.  Did you notice how you can get more stretch your calf and increased length? This is reciprocal inhibition at work!

There you have it, one neurological tool of many to give you increased length.The next time you are statically stretching, take  advantage of these reflexes to make it more effective.

 The Gait Guys. Teaching you more  about anatomy, physiology, and neurology with each and every post. 

image from :www.positivehealth.com

pronation

Here is an abstract you should look at.
Br J Sports Med. 2014 Mar;48(6):440-7. doi: 10.1136/bjsports-2013-092202. Epub 2013 Jun 13.

Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study.

http://www.ncbi.nlm.nih.gov/pubmed/23766439
And then there is this article we came cross at Runner’s World online. Here is the article “Five things i learned about buying running shoes”.
In all fairness we do not think the article was meant to teach or say much, but we do feel like it robbed 2 minutes of our productive life, at least it was entertaining.
So it is our turn now, let us serve you some real meat.  Here are some loose thoughts on why shoe fit and research has limitations in our opinion, mostly commentary on the first article and why you need to takes its commentary with a grain of salt.
The problem lies in the knowledge base. Most researchers just do not seem to know enough about the foot types , osseous torsions, the kinetic chain, and the like, to do an ALL ENCOMPASSING study. Plus, such a study would be an infinite nightmare. This is where a clinician is needed, to draw upon all of the issues at hand, not just some of the issues.  
For example, in this study, they just looked at arch heights and their determination as to whether the foot was pronating to a degree  (foot-posture index and categorized into highly supinated (n=53), supinated (n=369), neutral (n=1292), pronated (n=122) or highly pronated (n=18).)
No where did they talk about foot types such as the very common forefoot variants of varus and valgus let along their compensated and uncompensated forms. No where were there discussions of tibial or femoral torsion or the possibly necessary foot pronation needs to bring the knee joint back to the sagittal plane. Plus, just because a foot is flat, doesn’t truly mean it is over pronated. It may be flat because of genetics, we have talked about genetic trends here in previous blog posts.  We see plenty of flat competent feet in our clinics. The may appear flat or over pronated , but that is not the case for many people. The FUNCTION must be examined, and this does not come from visual inspection or from gait analysis video. We always say “what you see in someones gait or foot function is often their compensation around other issues, it is not their problem”.
Shawn and Ivo, the gait guys

Podcast 81: Gait, critical, pure and essential principles

This week’s show sponsors: 

www.newbalancechicago.com

www.lemsshoes.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_81f.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-81-gait-critical-pure-and-essential-principles

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

Show Sponsors:
 

* Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

* Other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

 
Show Notes and links:
 
Forget Cheetah Blades. This Prosthetic Socket Is a Real Breakthrough
http://www.wired.com/2014/10/forget-cheetah-blades-prosthetic-socket-real-breakthrough
 
Rebuilding and Regenerating Damaged Knees: The Future Has Arrived!
http://www.huffingtonpost.com/nicholas-dinubile-md/rebuilding-and-regenerati_b_6043374.html
 
the foot gym:
 
From a reader:
Thanks for sharing all the great information over the years. I would like to pose to you some simple questions. How do you decide what area/s are relevant to the issue a patient presents? How do you decide what is “normal” given anatomical variations, history of injuries, torsion’s, etc., and if pain is present, why would you address biomechanics, since pain is a neurological phenomenon not a biomechanical phenomenon?
This may not be that simple but would like to hear what you have to say on these topics.
Thank you,
Joe 
 
COMPARISON OF ISOMETRIC ANKLE STRENGTH BETWEEN FEMALES WITH AND WITHOUT PATELLOFEMORAL PAIN SYNDROME
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196327/
 
the drawbacks of technology
One way compensations develop
We have all had injuries; some acute some chronic. Often times injuries result in damage to the joint or articulation;  when the ligament surrounding a joint becomes injured we call this a “sprain”. 
Joints are blessed …

One way compensations develop

We have all had injuries; some acute some chronic. Often times injuries result in damage to the joint or articulation;  when the ligament surrounding a joint becomes injured we call this a “sprain”. 

Joints are blessed with four types of mechanoreceptors.  We have covered this in many other posts (see here and here).  These mechanoreceptors apprise the central nervous system of the position (proprioception or kinesthesis) of that body part or joint via the dorsal column system or spinocerebellar tracts. Damage to these receptors can result in a mismatch or inaccuracy of information to the central nervous system (CNS). This can often result in further injury or a new compensation pattern. 

Joints have another protective mechanism called arthrogenic inhibition (see diagram above). This protective reflex turns off the muscles which cross the joint. This was described in a few great paper by Iles and Stokes in the late 80’s an early 90’s (vide infra). Not only are the muscles inhibited, but it can also lead to muscle wasting; there does not need to be pain and a small joint effusion can cause the reflex to occur. 

If the muscles are inhibited and cannot provide appropriate afferent (sensory) and efferent (motor) information to the CNS, your brain makes other arrangements to have the movement occur, often recruiting muscles that may not be the best choice for the job. We call this a “compensation” or “compensation pattern”. An example would be that if the glute max is inhibited (a 2 joint muscle, with a larger attachment to the IT band and a smaller to the gluteal tuberosity; it is a hip extender, external rotator and adductor of the thigh), you may use your lumbar erectors (multi joint muscles; extensors and lateral rotators of the lumbar spine) or hamstrings (2 joint muscles; hip extenders, knee flexors, internal and external rotators of the thigh)  to extend the hip on that side, resulting in aberrant mechanics often observable in gait, which may manifest itself as a shortened step length, increased vertical displacement of the pelvis, lateral shift of the pelvis or increase in step height, just to name a few. Keep this up for a while and the new “pattern” becomes ingrained in the CNS and that becomes your new default for that motion.

Now to fix the problem, you not only need to reactivate the muscle, but you need to retrain the activity. Alas, the importance of doing a thorough exam and thorough rehab to fix the problem.

Often times, the fix is much more involved than figuring out what the problem is (or was). Take your time and do a good job. Your clients and patients will appreciate it!

Ivo and Shawn, the gait guys

Young A, Stokes M, Iles JF : Effects of joint pathology on muscle. Clin Orthop Relat Res. 1987 Jun;(219):21-7

Iles JF, Stokes M, Young A.: Reflex actions of knee joint afferents during contraction of the human quadriceps. Clin Physiol. 1990 Sep;10(5):489-500.

image from: http://chiroeco.com/chiro-blog/results-to-referrals/2013/04/03/neurology-based-simplified-musculoskeletal-assessment/

Podcast 80: Muscle Receptors, Building your Gait Brain

This week’s show sponsors: 

www.newbalancechicago.com

www.lemsshoes.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_79f.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-79

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

A revolutionary new implant of regenerative cells … . 
The U.S. Military Wants to Inject People’s Brains With Painkilling Nanobots That Could Replace Medicine
Random thoughts on the Symmetry of the Gait Cycle
Human gait is cyclical. For the most part, when one limb is engaged on the ground (stance phase), the other is in swing phase (in walking gait there is a brief period of double limb support), then th…

Random thoughts on the Symmetry of the Gait Cycle

Human gait is cyclical. For the most part, when one limb is engaged on the ground (stance phase), the other is in swing phase (in walking gait there is a brief period of double limb support), then the limbs switch tasks. For us to move cleanly and efficiently one would assume that the best way to do that would be to ensure that both limbs are capable of doing the exact same things, with the same timing, same skill, same endurance and same strength. For this clean seamless motor function, one must assume that there is complete limb symmetry (length, long bone torsion, the same rate and degree of pronation, supination, ankle dorsiflexion, hip internal/external rotation, same strength, power output etc) and one would hope there would be no injuries that had left a remnant mark on one limb thus encouraging a necessary compensation pattern in that limb (and one that would then have to be negotiated with the opposite limb).  For example, when right ankle rocker (dorsiflexion) is impaired, early heel departure will occur and hip extension will be limited. An alteration in right glute function will follow.  One could theorize that the left step length (the length of measure from right heel strike through to left heel strike) would be shortened. This would cause a premature load onto the left limb, and could very well force the left frontal plane to be more engaged than is desirable. This could lead to left core and hip frontal plane weakness and compensation patterns to be generated. To complicate the cyclical scenario, the time usually used to move sagittally will be partially used to move into, and back out of, the left frontal plane. This will necessitate some abbreviations in the left stance phase’s timely mechanical events. Some biomechanical events will have to be abbreviated or sped through and then the right limb will have to adapt to those changes. These are simple gait problems we have talked about over and over again here on the gait guys blog. These compensation patterns will include weaknesses as part of the pattern, and fixing those weaknesses does not address the right ankle rocker problem. Fixing said weaknesses merely encourages the brain to possibly continue to perpetuate necessary tightnesses in other muscles and motor linkages and engrain the compensations further or more complexly.  It is easy to find something weak, it takes a sharp brain to find the sometimes silent sparking event underneath it all. One’s focused task should be, are you able to find the problem in this never ending loop of compensations and find a way to unwrinkle the system one logical piece at a time, or will you just chose to strengthen the wrinkled system and hope that the new strength on top of the compensations is adequate for you our your client ? One should not have to do daily or weekly rehabilitative sessions and homework to negate and alleviate symptoms, this is a far more durable machine than one that needs daily support.  Rather, one that “seems” to need daily supportive homework/rehab is one that likely needs the underlying limitation to be uncovered. However, there are always exceptions. If one has a fixed issue, for example Foot Baller’s Ankle, then regular doses of lower limb anterior compartment work may be necessary to ensure that further ankle dorsiflexion range is not eroded.  

Now, lets add another wrinkle to the system.  What if there were problems before any injuries ?  Meaning, what if there were problems during the timely maturation and suppression of the primitive reflexes ? Or problems in the timely appearance or maturation of postural reflexes? A problem in these areas may very well result in a central or peripheral nervous system malfunction and a representation of such in one’s movement and gait.  But, that is a discussion for another time.

Shawn and Ivo, the gait guys

photo: courtesy of Thomas Michaud, from the excellent textbook, Human Locomotion

tumblr_ne2sg64OZ11qhko2so1_400.gif
tumblr_ne2sg64OZ11qhko2so3_500.jpg
tumblr_ne2sg64OZ11qhko2so2_1280.jpg

More thoughts on stretching

   We get a lot of interest in our posts on stretching. Seems like this is a pretty hot subject and there is a lot of debate as to whether it is injury preventative or not. Are you trying to physically lengthen the muscle or are you trying to merely bring it to its physiological limit?  There’s a big difference in what you need to do to accomplish each of these goals. Lets take a look at each, but 1st we need to understand a little about muscles and muscle physiology.

 Muscles are composed of small individual units called sarcomeres. Inside of these “sarcomeres” there are interdigitating fibers of actin and myosin (proteins) which interact with one another like a ratchet when a muscle contracts.  Sarcomeres can be of various lengths, depending on the muscle, and are linked and together from one end of the muscle to the other. When a muscle contracts concentrically (the muscle shortening while contracting) the ends of the sarcomere (called Z lines or Z discs) are drawn together, shortening the muscle fiber over all (see the picture above).
 
 Signals are sent from the brain (actually the precentral gyrus of the cerebral cortex areas 4, 4s and 6) down the corticospinal tract to the spinal cord to synapse on motor neurons there.  These motor neurons (alpha motor neurons) then travel through peripheral nerves to the muscles to cause them to contract (see picture above).

   The resting length of the muscle is dependent upon two factors:
The physical length of the muscle
2. The “tone” of the muscle in question.

The physical length of the muscle is determined by the length of the sarcomeres and the number of them in the muscle.   The “tone” of the muscle determined by an interplay of neurological factors and the feedback loops between the sensory (afferent) receptors in the muscle (Ia afferents, muscle spindles, Golgi tendon organs etc.), relays in the cerebellum and basal ganglia as well as input from the cerebral cortex.

 If you’re trying to “physically lengthen” a muscle, then you will need to actually add sarcomeres to the muscle. Research shows that in order to do this with static stretching it must be done 20 to 30 minutes per day per muscle.

 If you were trying to “bring a muscle to its physiological limit” there are many stretching methods to accomplish this.  Pick your favorite whether it be a static stretch, contract/ relax, post isometric relaxation etc. and you’ll probably be able to find a paper to support your position.

  Remember with both not to ignore neurological reflexes (see above). Muscle spindle loops are designed to provide feedback to the central nervous system about muscle length and tension. Generally speaking, slow stretch activates the Ia afferent loop which causes causes physiological contraction of the muscle (this is one of the reasons you do not want to do slow, steady stretch on a muscle in spasm). This “contraction” can be fatigued overtime, causing the muscle to be lengthened to it’s physiological limit.  Do this for an extended period of time (20-30 mins per day) and you will physically add sarcomeres to the muscle.

 Next time you are stretching, or you were having a client/patient stretch, think about what it is that you’re actually trying to accomplish  because there is a difference.

We are and remain The Gait Guys.  Bald, good-looking, and above-average intelligence. Spreading gait literacy with each post we publish.

thanks to scienceblogs.com for the corticospinal tract image

Hip muscles and postural control related to ankle function.

Hip exercises boost postural control in individuals with ankle instability
http://lermagazine.com/news/in-the-moment-sports-medicine/hip-exercises-boost-postural-control-in-individuals-with-ankle-instability

-“Four weeks of hip external rotator and abductor strengthening significantly improves postural control in patients with functional ankle instability (FAI) and may be useful for preventing recurrent instability, according to research from Indiana University in Bloom­ington.”

Nothing new here, at least not here on The Gait Guys blog. We have been talking about these kinds of issues for a long time. We  have long discussed the necessary control of the glutes (and their anchoring abdominals) to eccentrically control the loading response during the stance phase of gait, we especially like to discuss the control of the rate of internal rotation (read: eccentric ability of external rotators as a component) of the leg with the glutes. It is why we think it is so important to eccentrically test the glutes and the core stabilizers (all of them !) when the client is table assessed because it is a huge window for us as to what is happening when there is ground interface. Sure one is open chain and the other is closed, but function is necessary in both. 
What this article is again, like others, telling us is that the ability to stack the joints (knee over foot, hip over knee, level stable pelvis over hip) improves postural control, especially when there is a risky environment of ankle functional or anatomical instability. 
And yes, we are talking Cross over gait and frontal plane challenges and faulty patterns here.  Failure to stack the joints usually leads to cross over gait challenges (type in “cross over or cross over gait into our blog SEARCH box). Remember though, you must selectively strengthen the weak muscles and weak motor patterns, if you are not specific you can easily strengthen the neuro-protective tight muscles and their patterns because they have been the only available patterns to your client. If you are not careful, you will help them strategize and compensate deeper, which in itself can lead to injury.  This is a paramount rehab principle, merely activating what appears weak does not mean you are carrying them over to a functional pattern. Just because you can show a change on the table doesn’t mean it carries over to the ground and sport or training. 
Shawn and Ivo, the gait guys
Why does it feel so good to stretch? 
We are sure you have read many articles, some written by us, about the good the bad and the ugly about stretching.  Regardless of how you slice the cake, we think we can all agree that stretching “feels” good. T…

Why does it feel so good to stretch? 

We are sure you have read many articles, some written by us, about the good the bad and the ugly about stretching.  Regardless of how you slice the cake, we think we can all agree that stretching “feels” good. The question of course is “Why?”

Like it or not, it all boils down to neurology. Our good old friends, the Ia afferents are at least partially responsible, along with the tactile receptors, like Pacinian corpuscles, Merkel’s discs, Golgi tendon organs, probably all the joint mechanoreceptors and well as a few free nerve endings. We have some reviews we have written of these found here, and here and here.

What do all of these have in common? Besides being peripheral receptors. They all pass through the thalamus at some point (all sensation EXCEPT smell, pass through the thalamus) and the information all ends up somewhere in the cortex (parietal lobe to tell you where you are stretching, frontal lobe to help you to move things, insular lobe to tell you if it feels good, maybe the temporal lobe so you remember it, and hear all those great pops and noises and possibly the occipital lobe, so you can see what you are stretching.

The basic (VERY basic) pathways are:Peripheral receptor-peripheral nerve-spinal cord-brainstem-thalamus-cortex; we will call this the “conscious” pathway:  and peripheral receptor-peripheral nerve-spinal cord-brainstem-cerebellum- cortex; we will call this the “unconscious” pathway.

Of course, the two BASIC pathways cross paths and communicate with one another, so not only can you “feel” the stretch with the conscious pathway but also know “how much” you are stretching through the unconscious pathway. The emotional component is related through the insular lobe (with relays from the conscious and unconscious pathways along with collaterals from the temporal lobe to compare it with past stretching experiences) to the cingulate gyrus and limbic cortex,  where stretching is “truly appreciated”. 

As we can see, there is an interplay between the different pathways and having “all systems go” for us to truly appreciate stretching from all perspectives; dysfunction in one system (due to a problem, compensation, injury, etc) can ruin the “stretching experience”. 

Hopefully we have stretched your appreciation (and knowledge base) to understand more about the kinesthetic aspect of stretching. We are not telling you to stretch, or not to stretch, merely offering a reason as to why we seem to like it.

The Gait Guys

Podcast 79: Tightness vs. Shortness, Plantar Fascitis & more.

plus, pelvic asymmetry, “wearables” and cognitive choices in movement.

This week’s show sponsors: 

www.newbalancechicago.com

www.lemsshoes.com

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Direct Download: 

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https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

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http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

The Brain and your choices.

http://exploringthemind.com/the-mind/brain-scans-can-reveal-your-decisions-7-seconds-before-you-decide#.VCx0P8ydUK4.facebook

 
 
Walking is the superfood of fitness, experts say
 
Hey Guys,
I have pelvis asymmetry and a snapping ankle, can you help me with … . 
 
New research on Plantar Fascitis
 
John from FB
Shortness vs tightness:
What protocol do you recommend for stretching ? I usually do static stretches1x2min. This article has the static stretch group doing 10x30sec. I’d have to set my alarm a half hour earlier! :-)