Treat the paraspinals in addition to the peripheral muscleAs people who treat a wide variety of gait related disorders we often emphasize needling the paraspinal muscles associated with the segemental innervation of the peripheral muscle you are tre…

Treat the paraspinals in addition to the peripheral muscle

As people who treat a wide variety of gait related disorders we often emphasize needling the paraspinal muscles associated with the segemental innervation of the peripheral muscle you are treating. For example, you may facilitate or needle the L2-L4 paraspinals (ie: femoral nerve distribution) along with the quads, or perhaps the C5-C6 PPD’s along with the shoulder muscles for the deltiods or rotator cuff for arm swiing. We do this to get more temporal and spacial summation at a spinal cord level, to hopefully get better clinical results.

White and Panjabi described clinical instability as the loss of the ability of the spine, under physiologic loads, to maintain relationships between vertebrae in such a way that there is neither damage nor subsequent irritation to the spinal cord or nerve roots, and, in addition there is no development of incapacitating deformity or pain due to structural changes.

Increased movement between vertebrae (antero or retrolisthesis) of > 3.5 mm (or 25% of the saggital body diameter) during flexion and/or extension suggests clinical instability. This often leads to intersegmental dysfunction and subsequent neurological sequelae which could be explained through the following mechanisms:

Recall that the spinal nerve, formed from the union of the ventral (motor) and dorsal (sensory) rami, when exiting the IVF splits into an anterior and posterior division, supplying the structures anterior and posterior to the IVF respectively. The posterior division has 3 branches: a lateral branch that supplies the axial muscles such as the iliocostalis and quadratus; an intermediate branch, which innervates the medial muscles, such as the longissimus, spinalis and semispinalis; and a medial branch, which innervates the segmental muscles, (multifidus and rotatores) as well as the joint capsule. Inappropriate intersegmental motion has 2 probable neurological sequelae: I) alteration of afferentation from that level having segmental (reflexogenic muscle spasm or vasoconstrictive/vasodilatory changes from excitation of primary afferents and gamma motoneurons) and suprasegmental (less cerebellar afferentation, less cortical stimulation) effects and II) compression or traction of the medial branch of the PPD, causing,  over time, demyelination and resultant denervation, of the intrinsic muscles, resulting in impaired motor control both segmentally and suprasegmentally. The segmental effects are directly measurable with needle EMG. This is a form of paraspinal mapping, which has also been explored by Haig et al. So, in short, instability can lead to denervation and denervation can lead to instability.

We often see clinically that treating a trigger point (needling, dry needling, acupuncture, manual pressure) can alter the function of the associated muscle . Improvements in muscle strength and changes in proprioception are not uncommon. Needling also seems to increase fibroblastic activty through the local inflammation it causes. Wouldn’t better muscle function and some scar tissue be a beneficial thing to someone with instability?

The next time you have a patient with instability, make sure to include the paraspinals in your quest for better outcomes.

and what have we been saying?Gait problems leave clues. Asymmetry is a BIG clue“Asymmetrical lower extremity neuromuscular control is predictive of repetitive stress injury in recreational runners, according to findings presented at the Combin…

and what have we been saying?

Gait problems leave clues. Asymmetry is a BIG clue

“Asymmetrical lower extremity neuromuscular control is predictive of repetitive stress injury in recreational runners, according to findings presented at the Combined Sections Meeting of the American Physical Therapy Association in February in Anaheim.”

http://lermagazine.com/issues/march/years-after-achilles-tear-injured-limb-demonstrates-elevated-knee-loading

Do you have enough in the anterior tank ? Dr. Allen’s quiz question and lesson of the week.One of my favorite sayings to my clients, “Do you have enough anterior strength to achieve and maintain posterior length?”  Translation, do you have enough an…

Do you have enough in the anterior tank ? Dr. Allen’s quiz question and lesson of the week.

One of my favorite sayings to my clients, “Do you have enough anterior strength to achieve and maintain posterior length?”  

Translation, do you have enough anterior lower leg compartment strength (tibialis anterior, long toe extensor muscle group, peroneus tertius) to achieve sufficient ankle dorsiflexion in order to achieve posterior compartment length (gastric, soleus, tibialis posterior, long toe flexor muscle) ?  You see, you can either regularly stretch the calf-achilles complex or you can achieve great anterior compartment strength, to drive sufficient ankle dorsiflexion, in effect EARNING the posterior compartment length. This is a grounded principle in our offices. It is the premise of the Shuffle Walk exercise (link) and many others we implement in restoring someones biomechanics.

Now on to today’s quiz question.

In this photo, both people are just mere moments before heel strike. 

1. Who is gonna need to have more eccentric strength in the anterior compartment ? And what if they don’t have it ? Repercussions ?  

2. Who is toeing off the lateral forefoot ? 

3. Who is crossing over more and thus could have more gluteus medius weakness ?

A picture is worth a thousand words. Answers and dialogue below.

.

.

.

.

.

.

1. The lady in the high heeled shoes. If she heel strikes first, the larger longer heel on her shoe will mean she will need more of a prolonged eccentric loading of the anterior compartment to lower the forefoot to the ground. I hope she shortens her strike so she can get close to mid foot strike, it will negate most of this issue.  Repercussions? Forefoot pain, clenching/hammering of her toes from use of the long flexors to dampen loading of the metatarsal heads, and even possibly anterior shin splint like pain.

2. The lady is clearly in more lateral toe off, this is from the intoe’ing we see. This is low gear toe off. She may have limb torsion, internal tibial torsion to be specific, or insufficent external hip rotation control as a possibility. There are several possibilities here.

3. Hard to say, but the man seems to be crossing over more.

There is also no arm swing, hands are in the pockets, this is a big hit to gait economy. We have discussed these numbers in previous blog posts, the numbers are significant and real.  Step width is also a real factor, reduced step width leads to joint stacking challenges and is found with weaker hip abductors and changes in the iliotibial band length.

A picture can be worth a thousand words. I am a few short of the mark today, but I wanted to keep it short.

Dr. Shawn Allen, one of the gait guys

… an industry wide concern if you ask us, and the problem with looking to solve your problem on the internet. When was the last time you went on youtube to look for your magic pill exercise ?Come read Dr. Allen’s blog post today and tak…

… an industry wide concern if you ask us, and the problem with looking to solve your problem on the internet. When was the last time you went on youtube to look for your magic pill exercise ?
Come read Dr. Allen’s blog post today and take his Case Quiz question of the week ! Come knock your brain around a bit.

Post/Quiz link: http://thegaitguys.tumblr.com/post/142737112319/is-your-client-feeling-better-because-they-are

This is apparently a growing thing, INTERVAL walking. Oy. We are not particular fans at this point, nothing exciting or earth shattering at this point (other than the concerns we hi light below) but we will look into it more.
What you need to see, and be aware of, is that this is what happens when you wear a shoe that has too soft a rear foot. At heel strike, instead of progressing forward into the mid and forefoot, the rear foot of the shoe deforms and forces you into more HEEL rocker, sustained heel rocker. If you stay in heel rocker too long, you won’t progress forward into ANKLE rocker (ankle dorsiflexion). This often causes knee hyperextension. If you have a good trained eye, you will see both of these things, prolonged heel rocker and never any ankle rocker/ankle dorsiflexion. IT is like the ankle in this video is frozen at 90 degrees the entire time, train your eye to see this absense of ankle rocker. This will cause premature heel rise and premature posterior compartment contraction which can cause premature forefoot loading. This is what happens when the heel of the shoe is too soft. A perfect example of “more cushion” is not always better. IT can be a liability as well. Remember the angry revolution over the MBT shoe and its mushy rear foot?. Same principle, same risks and concerns. Welcome to round two of the same old problems ????? Maybe. you decide. To be clear, this is a comment on the shoes being used, the technique is , well, perhaps interesting. That is all we are willing to comment on at this point until we look into it more. Look at the heel and ankle mechanics during the slow mo clips.
Sorry Ben Greenfield. We are not impressed, as of yet. We like your podcast Ben, you are doing us all a great service, but this one is promoting some potential problems that people need to know about.
Start with our “Shuffle Walk”. Google search it under the Gait Guys. That is a good start.

- Dr. Allen

Podcast 105: Adding strength to your system.

Show Sponsors:
newbalancechicago.com
Softscience.com

Other Gait Guys stuff

A. Podcast links:

direct download URL: http://traffic.libsyn.com/thegaitguys/pod_105f.mp3

permalink URL: http://thegaitguys.libsyn.com/podcast-105-adding-strength-to-your-system

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

C. Gait Guys online /download store (National Shoe Fit Certification & more !)
http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”

-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:

-Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E

-Barnes and Noble / Nook Reader:
http://www.barnesandnoble.com/w/pedographs-and-gait-analysis-ivo-waerlop-and-shawn-allen/1112754833?ean=9781466953895

https://itunes.apple.com/us/book/pedographs-and-gait-analysis/id554516085?mt=11

-Hardcopy available from our publisher:
http://bookstore.trafford.com/Products/SKU-000155825/Pedographs-and-Gait-Analysis.aspx

Show Notes:

Tech update:
*UPDATE: Fitbit lawsuit data and consumer reports
http://www.engadget.com/2016/01/23/consumer-reports-fitbit-tests/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810794/

Can exercise hurt your heart ? How much does it take ?
http://www.npr.org/sections/health-shots/2016/02/01/464457884/can-extreme-exercise-hurt-your-heart-swim-the-pacific-to-find-out

Lowest effective dose of exercise
http://www.health.harvard.edu/blog/how-much-exercise-do-you-really-need-less-than-you-think-201512088770?utm_source=twitter&utm_medium=socialmedia&utm_campaign=120815kr1&utm_content=blog

Working out not live longer ?
http://www.details.com/story/apparently-exercise-doesnt-make-you-live-longer

Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552016005000136&lng=en&nrm=iso&tlng=en

Should you add strength training?
Effects of a concurrent strength and endurance training on running performance and running economy in recreational marathon runners.
Randomized controlled trial
Ferrauti A, et al. J Strength Cond Res. 2010.
http://www.ncbi.nlm.nih.gov/m/pubmed/20885197/?from=%2F22776883%2Frelated&i=8

The microcirculation of skeletal muscle in aging.
http://www.ncbi.nlm.nih.gov/m/pubmed/16611593/?from=%2F14630882%2Frelated&i=16

Microcirculation. 2006 Jun;13(4):279-88.
Effect of aging on the structure and function of skeletal muscle microvascular networks.Bearden SE1.

Future of injury management ?  Regrowing tissue ?
http://www.huffingtonpost.com/kevin-r-stone-md/the-future-of-surgery-regrowing_b_9073096.html

tumblr_o586ok0qOo1qhko2so1_1280.jpg
tumblr_o586ok0qOo1qhko2so2_1280.jpg
tumblr_o586ok0qOo1qhko2so3_1280.jpg

Go ahead, take the shot.

This runner came in with ankle pain after running across the slope of the hill with the right foot uphill left foot down. She slipped on the ice and heard a pop. She presented to the office with minimal swelling, ankle pain on the right-hand side. Very little discoloration. She said that her ankle was “bent sideways” but reduced overtime as she crawled home to get help.

 She slipped on the ice and heard a pop. She presented to the office with minimal swelling, ankle pain on the right-hand side. Very little discoloration. She said that her ankle was “bent sideways” but reduced overtime as she crawled home to get help.

  The ankle was moderately swollen and tender at the medial and lateral malleoli with little gross deformity. She was not able to bear weight on that side without pain. We took the first picture (top) which didn’t look too bad. We could’ve stopped there thinking that it was just a bad sprain. But we didn't… We always take three views of an area so we don’t miss things. You can plainly see in the second and third views that she has involvement of the deltoid ligament as well as the more obvious distal fibula fracture.

We did some acupuncture to do reduce swelling at the patient’s request and contacted the orthopedists office for her, placed her in the mobilization brace and give her some crutches.

When in doubt, take the shot. It can make a huge difference clinically. 

“Is your client feeling better because they are truly fixed, or have your prescribed corrective exercises merely raised the capacity and durability of their compensation ?  Welcome to a global industry problem.”  -Dr. AllenWhich hip will have troubl…

“Is your client feeling better because they are truly fixed, or have your prescribed corrective exercises merely raised the capacity and durability of their compensation ?  Welcome to a global industry problem.”  -Dr. Allen

Which hip will have troubles extending ?

Remember this quiz question from 2 weeks ago ? I talked about how the body will compensate to level the pelvis (and eyes and vestibular apparatus).

Lets go further down the rabbit hole.  Here is your question of the week (you may have to go back and review the prior blog post if you are unsure of how the body will cope with the slope.  Here is that first blog post.

Question: Which hip will have troubles getting into hip extension and thus terminal glute-hip-pelvis stabilization ?

Answer:  scroll down (at least think about it for a second)

.

.

.

.

.

.

Answer:

The leg on the up slope of the beach, the non-water side leg will have to be in a modest degree of knee flexion to shorten and accommodate to the slope. A Flexed knee is not an extended one and it will be far more difficult to extend the hip and get into the glutes. Propulsion will also be compromised.  For you indoor small track runners this will happen to you on the inside leg on the curves of the track. This is why we see so many hamstring injuries during indoor track.  Think about it ! It is not just bad luck.  Go ahead, tally up  your teams history of hamstring injuries, you should find more on the left leg for track runners. It is simple applied biomechanics.   Also, imagine the altered demand on the quadriceps on that flexed knee (the right knee in the picture above, and the left knee in circle track runners). Furthermore, what is the likelihood that the right pelvis will deviate into an anterior tilted posture ? You bet ya, a greater tendency, and thus a possibly shortened quadriceps/hip flexor mechanism.  Do you think this could inhibit hip extension and gluteal function ? You bet ya.  Oh, and one more thing, if you are true gait nerd, you should have asked yourself one more question, what about ankle rocker ?  Yes, you will need more ankle rocker on the beach side foot (flexed knee side). When the knee flexes, there must be more ankle rocker for this to occur, if not, you may implode into some unwelcome arch collapse, because arch collapse offers more false ankle rocker. What a mess huh !   Now, do not be shocked EVER again when your client’s come back from a sunny beach vacation from walking the beaches for hours every day, and find themselves a stark raving mad mess.  It is not the salty ocean air or the tequila, it is the slope. One could make a case that walking up and down the beach should balance things out, but that is only if we are balanced and symmetrical when we start out. Gravity always wins.

One final rant. If you are offering “corrective exercises” to your clients, you had better know at least the basics of movement and biomechanics. And further more, you had better know how to examine for them, and that means hands on assessment of the body, not just looking at how your client moves through a battery of tests. If the prior blog post (here) and today’s blog post principles are not remedial principles of knowledge for you, offering corrective exercises without this knowledge and a physical exam to confirm your assumptions is fraught with disaster, or at least helping your client to build deeper compensations on their prior compensations. Is your client feeling better because they are truly fixed, or have your prescribed corrective exercises merely raised the capacity and durability of their compensation ?  This is the kind of stuff that keeps my new patient scheduling booked at 4-8 weeks out … . .  frustrated clients.

This is why we do not offer online consultations like some do. Because, we have not figured out how to obtain the third dimension needed in our gait and movement observation (thank you Oculus Rift, the future is near) but more so, we cannot take that information and put it together with our own physical examination to determine whether if what we are seeing is the actual problem, or a compensation. Here in lies the pot of gold.

Another clinical pearl from Dr. Allen

What’s wrong with this picture? The model is obviously well sculpted and hopefully will paid for the toll that this exercise will be taking on her nervous system overtime. Take a close look at the picture above on the left. Look carefully and …

What’s wrong with this picture?

 The model is obviously well sculpted and hopefully will paid for the toll that this exercise will be taking on her nervous system overtime. Take a close look at the picture above on the left. Look carefully and what do you notice? Do you see it?

This exercise is neurologically incongruent.  Her right arm is flexed at the same time as her right hip. When does this ever happen in gait?

 Do you remember crossed extensor responses or tonic neck reflexes? If not, see here and here. When we walk the right arm and left leg or flexed while the left arm and right leg are extended. During a tonic neck response, and that is rotated to one side the upper and lower extremity (upper greater than lower) should extend on that side with flexion on the contralateral side.

During a tonic neck reflex, the head is rotated to one side the upper and lower extremity (upper greater than lower) should extend on that side with flexion on the contralateral side. In the picture above her torso is rotated to the left while looking straight ahead which is effectively right neck rotation and her extremities are flexed on that side.

 In the picture above her torso is rotated to the left while looking straight ahead which is effectively right neck rotation and her extremities are flexed on that side.

Who thinks of these things? Certainly not folks that are paying attention to appropriate neurology and physiology!  Oh yeah, and the ad was for massage cream. Jeez…

There are few places we will accept a cross over gait as safe and normal, this is one of them.Anyone want to place a bet this person does not have a rigid pes planus ? We are happy to take your money if you bet against this one. (hint: a rigid pes p…

There are few places we will accept a cross over gait as safe and normal, this is one of them.

Anyone want to place a bet this person does not have a rigid pes planus ? We are happy to take your money if you bet against this one. (hint: a rigid pes planus, is RIGID, it will not form an arch like this, even from upward pressure, in most people who have it).
A rigid pes planus can result from a long standing (years) insufficient tibialis posterior or complete tear of one (again, moon’s ago) resulting in an inability to invert the heel and raise the arch. We saw one this week.

The Vasti

Do you treat runners? Do you treat folks with knee pain? Patellar tracking issues? Do you treat the quadriceps? Do you realize that the vastus lateralis, in closed chain, is actually an INTERNAL rotator of the thigh (not a typo), and many folks have a loss of internal rotation of the hip? Do you give them “IT band stretches” to perform?

In this short video, Dr Ivo demonstrates some needling techniques for the quads and offers some (entertaining) clinical commentary on the IT band. A definite view for those of you who have needling in their clinical tool box.

The Elusive IliocapsularisAs with many things, one thing often leads to another. I had a patient with anterior hip pain and what i believed was iliopsoas dysfunction, but I wanted to know EXACTLY which muscles attached to the hip capsule, to make su…

The Elusive Iliocapsularis

As with many things, one thing often leads to another. I had a patient with anterior hip pain and what i believed was iliopsoas dysfunction, but I wanted to know EXACTLY which muscles attached to the hip capsule, to make sure I wasn’t missing anything.

I turned up some great info, including a nice .pdf lecture, which I am including the link to along with a second paper that began my journey.

I had thought the iliopsoas attached to the hip capsule, but it turns out it doesn’t, but the iliocapsularis does along with a host of others, including one of my favs, the gluteus minimus, which was believed to be part of the psoas, but actually is a completely separate muscle.  Did I mention that these are  FREE, FULL TEXT articles?

Anyway, I began reading, with great interest, about the iliocapsularis and I found yet another great review paper on it, along with mechanical hip pain. This last paper has some real clinical pearls and I recommend reading it the next opportunity you have a bit of time.

I began thinking about when the iliopsoas fires in the gait cycle (terminal stance to mid swing). So, it is firing eccentrically at pre swing (perhaps limiting or attenuating hip extension?), then concentrically through early and mid swing, when it becomes electrically silent. During running gait, the activation pattern is similar. This muscle is also implicated in femoroacetabular impingement (FAI), or more correctly anterior inferior iliac spine subspine impingement (AIIS Impingement) or iliopsoas impingement (IPI). They all can cause anterior hip pain and they should all be considered in your differential.

The iliocapsularis muscle has its proximal attachment at the anterior-inferior iliac spine and the anterior hip capsule and does not attach to the labrum . Its distal insertion is just distal to the lesser trochanter. It can sometimes inset into the iliofemoral ligament and/or the trochanteric line of the femur. It is innervated by a branch of the femoral nerve (L2-4). It is believed to act to raise the capsule of the hip and be an accessory stabilizer of the hip. 

OK, there you have it. the iliocapsularis. Another muscle you didn’t know you could access. It pays to know your anatomy!


https://www.mcjconsulting.com/meetings/2012/asm/ePosters/files/ISHA_Poster_202.pdf

 http://pubs.rsna.org/doi/full/10.1148/radiol.12111320

Dr. Allen’s Quiz question of the week. See if you can get this one.Reference point is the Girl in the middle, big sister. Choose all that apply. Note: there is something deeper than the obvious going on here, it doesn’t make sense. Can you see it ? …

Dr. Allen’s Quiz question of the week. See if you can get this one.

Reference point is the Girl in the middle, big sister. Choose all that apply. Note: there is something deeper than the obvious going on here, it doesn’t make sense. Can you see it ? 

a. she (big sister) is out of phase with her little sister 

b. she is in phase with her little sister

c. she is out of phase with her little brother

d. she is in phase with her little brother

e.  A and C

f.  B and C

g. B and D

h. A and D

i. AC~DC rules

Yes, Answer  “i” is always right.

otherwise the answer is … . scroll down

.

.

.

.

.

.

.

.

F. she is in phase with her sister to her left and out of phase with her brother (at least if you are referencing her leg swing).  With her little sister, left feet are both forward in swing at the same time.

However, there is something deeper and requires some true critical thinking. IF you got the answer correct, congratulations. IF you did not, type in “in phase gait” or “arm swing” into the blog search engine and you will be able to read more about “in phase” and “out of phase” gaits.  

Now, look at the picture again. If she is “in phase” with her little sister to the left big sister should technically have her left arm in anterior/forward swing to meet little sister’s right arm swing. But, big sister’s left foot is forward, which technically means her left arm swing should be posterior to match her normal Anti-phasic gait.  But this does not pair with little sister. Can you see that this is a conflict in synchrony ? 

In phase and phasic are not the same thing, nor are out of phase and anti-phasic. Search our blog for these differences.  

Obviously you should glean by now that “In and out of phase” gait refers to the leg swing. Whereas, phasic and anti phasic gait refers to the synchrony of the upper and lower limbs in an individual.  The lower limb spinal cord motor neuron pools are more dominant than the upper arm pools (except in climbing, which is why I spent so much time last week talking about climbing and crawling here on the blog). Thus the lower legs often run the protocols and thus why arm swing changes should not be primarily or initially coached or amended in an athlete, they are very adaptive and accommodating.  The legs need to run the show, we need our arms free to be able to carry things while walking or running (water bottle, babies, spears, rifle, brief case etc) without disrupting the normal leg swing gait mechanics.  

Big sister is “out of phase” with her brother when it comes to the legs, but their arm swings are matching in phase so that there is no conflict. When people walk “out of phase” their arm swings will always match. Thus, it would seem that this is the more harmonious way to walk with a partner. 

So how are they all walking together ? Certainly not in harmony.

Obviously the little sister is not in sync with big sister. She is much shorter, and thus her step length is going to be different and that is the likely answer. She will have to pick up cadence to keep up and that will mean much of the time she will not synchronize with her big sister. As I mentioned in a prior post on these topics, often the larger or more dominant person’s arm swing will dictate the arm swing pattern of the other partner, and this will in turn, dictate how the lower limbs synchronize to the dominant partner. It would make sense that perfect harmony would bring about “out of phase” leg swing, but it does not always occur. Why? There are many reasons I discussed here today, things like differing arm and leg lengths and step lengths come to mind.

* There is one more option, none of them are in anti-phasic gait. Maybe they all have back pain :) Back pain patients tend to shift towards phasic gait to reduce spinal torsion and shear. If they all are anti-phasic then arm and leg swing matter very little in terms of full limb swing propulsive gait. This is quite possible as well, perhaps this is just a still photo representing a very slow strolling gait and thus little need for anti phasic gaits from all 3 of them. 

Neat points if you are a true gait nerd. Did you catch it ? A picture is worth a thousand words.

Hope this little quiz helped you to put some pieces together.

One more thing, here is a clinical pearl. By walking hand in hand with someone, you can help a person learn arm swing and leg swing and how to create a clean cadence, the normal anti-phasic gait, and learn how to dual task as well as add audible, visual and tactile queues to one’s gait. It is a great tool for helping neurologic gait pathologies, post stroke gait training and helping someone who has joint replacements or back pain regain normal anti-phasic gait traits where gait has become phasic and apropulsive. 

Dr. Shawn Allen

Manipulation and Mechanoreceptors

Do YOU do joint manipulations or mobilizations? Could you explain how they are working and accomplishing what you think (or say) they are accomplishing?

All of this information applies to ANY articulation, not just the spine. This is essential information that all folks performing manipulations or mobilizations should know.

What ARE the different types of mechanoreceptors and how do they work? How does that relate to manipulation and its effects? How can mechanoreceptors inhibit pain and influence muscle tone? Dr Ivo answers these questions and more in this video, excerpted from a recent seminar. 

Gait and Climbing (and DNS): Part 2.  Introducing 14 year old Ashima Shiraishi.

14 year old “sends” V15 , a 30 move roof climb in Hiei, Japan, called “Horizon”.

“the present work showed that human QL (quadrupedal locomotion) may spontaneously occur in humans with an unimpaired brain, probably using the ancestral locomotor networks for the diagonal sequence preserved for about the last 400 million years.” - 2005 Shapiro and Raichien

I am flipping the script a little today for DNS’ers (Dynamic Neuromuscular Stabilization). Watch the video if you wish, but the point I will be drawing your attention to is the 2:15 mark when she goes inverted on the roof of this apparently “more simple” V9 route. Note, this is not a video of her historic ~30 move V15 route. Stay tuned for that, it is not available yet.

Look closely. In the video, a then 9 year old Ashima is climbing upside down, a roof climb, defying gravity’s push. Spin this picture 180 and she is crawling, finding points of “fixation” or “punctum fixum”. What is neat about climbing is that you can have one, two, three or four points of fixation, unlike walking (one or two points) and crawling (two, three or four points of fixation). The difference in climbing is that gravity is a bear, wearing you down, little by little. A deep similarity in climbing to any variety of crawling is that both involve pulling and pushing, compressing and extending over fixation points. Other common principles are those of fixation, stability, mobility and neurologic crawling patterns in order to progress.

Ashima just recently, in early 2016, was the first female to complete a V14d (it is said it may even be upgraded to a V15a, maybe even a V16). Not many pros of any gender can say they can complete a V15 so this is a real big deal for a 14 year old. Stay tuned for that video.

DNS, Kolar and Climbing

I took my first DNS course with Prof. Kolar 10 years ago. It was an interesting eye opener and I had just enough clinical experience (9 years at that point) to grasp just enough to take it back to my practice and integrate it. Since that time, it has been fun to see it grow and see young practitioners excited to get their first face palm epiphanies. I have been returning to it often, blending it into my rehab work much of the time. There are few hip, shoulder, spine, breathing or global stabilization exercises I prescribe that do not have a DNS component to them, with my own flare and alterations and amendments as necessary. If you have taken a DNS course you will know why I am bring the topic into climbing. If you have not taking a course, you will be a little lost on the conceptual spill over.

As you can see in the video above, start really paying attention at the 2:15 mark in the video when she goes inverted on the roof. Cross crawl patterns, concepts of fixation, compression, expansion, crossing over, and tremendous feats of shoulder and hip stability on spinal stiffness and rotation.  Now add breathing, oy !  Now add doing all of this by mere finger tip and toe tip fixation ! When you consider all of this, it becomes almost incomprehensible what she and other climbers are doing when they go inverted like this. Amazing stuff, finger pulling/compression and foot pushing to compressively attach the body to the wall and progress forward.

Lucid Dreaming, A climb in the Buttermilks

Last year I wrote a piece on Lucid Dreaming, the name of a rock (another V15 climb) in the Buttermilks of Bishop, California. Here is that blog post. Lucid Dreaming is no ordinary rock.  To summit this rock is basically only three moves off of three holds, from your fingertips, starting from a sitting position. The remainder of the climb is sliced bread. If you can do the three, you can get to the top. The problem is, only a handful of people in the world can accomplish the feat. In the piece I outlined many principles of crawling, quadruped and climbing from a neuro-biomechanical perspective. Here is a excerpt from what i wrote in Gait and Climbing, Part 1:

In climbing there is suspicion of a shift in the central pattern generators because of the extraordinary demand by pseudo-quadrupedal gait climbing due to the demand on the upper limbs and their motorneuron pools to mobilize the organism up the mountain.  We know these quadrupedal circuits exist. In 2005 Shapiro and Raichien wrote “the present work showed that human QL (quadrupedal locomotion) may spontaneously occur in humans with an unimpaired brain, probably using the ancestral locomotor networks for the diagonal sequence preserved for about the last 400 million years.”

Some research has determined that in quadrupeds the lower limbs displayed reduced orientation yet increased ranges of kinematic coordination in alternative patterns such as diagonal and lateral coordination.  This was clearly different to the typical kinematics that are employed in upright bipedal locomotion. Furthermore, in skilled mountain climbers, these lateral and diagonal patterns are clearly more developed than in study controls largely due to repeated challenges and subsequent adaptive changes to these lateral and diagonal patterns.  What this seems to suggest is that there is a different demand and tax on the CPG’s and cord mediated neuromechanics moving from bipedal to quadrupedal locomotion. There seemed to be both advantages and disadvantages to both locomotion styles. Moving towards a more upright bipedal style of locomotion shows an increase in the lower spine (sacral motor pool) activity because of the increased and different demands on the musculature however at the potential cost to losing some of the skills and advantages of the lateral and diagonal quadrupedal skills. Naturally, different CPG reorganization is necessary moving towards bipedalism because of these different weight bearing demands on the lower limbs but also due to the change from weight bearing upper limbs to more mobile upper limbs free to not only optimize the speed of bipedalism but also to enable the function of carrying objects during locomotion.

The take home seems to suggest the development of proper early crawling and progressive quadruped locomotor patterns. Both will tax different motor pools within the spine and thus different central pattern generators (CPG). A orchestration of both seems to possibly offer the highest rewards and thus not only should crawling be a part of rehab and training but so should forward, lateral and diagonal pattern quadrupedal movements, on varying inclines for optimal benefits. 

Dancing, Jiu Jitsu and Climbing. Bringing things together.

So, what am I doing with all this information? As some of you may know, I have been expanding my locomotion experiences over the years. First there was three years of ballroom and latin dance, some of the hardest stuff I have ever done, combining complex combined body movements to timing and music at different speeds, each time changing to different rhythms or genres of music. Some of my deepest insights into foot work and hip, pelvis and core stability and spinal mobility originated from my dance experiences, particularly Rumba, Cha Cha, Jive, Waltz and Foxtrot. On a side note, some of my greatest epiphanies about the true function of the peroneal-calf muscle complex came during a private session on a difficult Waltz step concept. It was such an epiphany I sat down and wrote scratch notes on the enlightenment for 20 minutes right there in the ballroom. Next I moved into the very complex martial art of Brazilian Jiu Jitsu, and after three years it is clear it is an art that you could do for a lifetime and never get to the end of the complex algorithms of defense and offense. This art will stay in my wheelhouse to the end if I am able to keep it there.

Rock climbing, this one is the next on the list. After years of sharing my hands on peoples physical problems I know I already have above average grip and finger strength, so this could either prove to be a blessing or a “career ender” in terms of finally finishing off my hands for good. But it is on the list, and it won’t leave my head, so for me that is the tipping point. Climbing is next. I need to understand and experience this, so I can understand human locomotion better.

I will have the video of Ashima “sending” V15+ when they put it up, stay tuned. I have a feeling it is going to be a jaw dropper, I hear the whole send is inverted which boggles my mind. We will dissect her roof crawling and I will try to have some new research for you.

If you want to come down my rabbit hole, come read some of my other related articles:

Part 1: Gait and Climbing. Lucid Dreaming

and my 3 part series on Uner Tan Syndrome. The people who walk on all fours.


Dr. Shawn Allen, one of the gait guys

___________

References:

Shapiro L. J., Raichien D. A. (2005). Lateral sequence walking in infant papio cynocephalus: implications for the evolution of diagonal sequence walking in primates. Am. J. Phys. Anthropol.126, 205–213 10.1002/ajpa.20049

Scand J Med Sci Sports. 2011 Oct;21(5):688-99. Idiosyncratic control of the center of mass in expert climbers. Zampagni ML , Brigadoi S, Schena F, Tosi P, Ivanenko YP

J Neurophysiol. 2012 Jan;107(1):114-25. Features of hand-foot crawling behavior in human adults. Maclellan MJ, Ivanenko YP, Cappellini G, Sylos Labini F, Lacquaniti F.

What Are Motion Control Features, anyway?

In this brief video, Dr Ivo talks about common motion control features found in many shoes shoes. terms like “medial posting” “dual density midsoles” and “lateral flares” are discussed

SoftScience “The Terrain Ultra Lyte” shoe update:Introducing “The Terrain Ultra Lyte”.  Fresh off the UPS truck today 
and just unboxed ! Uber excited. Wearing them right now. Dang, zero drop
 with good cush. I could run in these babies …

SoftScience “The Terrain Ultra Lyte” shoe update:

Introducing “The Terrain Ultra Lyte”.  Fresh off the UPS truck today and just unboxed ! Uber excited. Wearing them right now. Dang, zero drop with good cush. I could run in these babies ! And I will just to try, even thought that is likely not their intended purpose.  Gorgeous roomy toe box. True to fit. These feel like a favorite pair of worn in favorite leather gloves …  they are soft cotton canvass right out of the box.  I don’t think i even need to wait a few days, they should have a label that says “pre-worn in”. I may have just found yet another new favorite weekend casual shoes, I will save my Altra Everyday’s for work. I can see where the thinking came when the partners brought their wisdom over from Crocs (only the best parts were brought, the materials, from what i can see).  
Removable, washable Trileon™ insole, non-marking, slip-resistant outsole
Ultra lightweight, a pair in size 10 weighs just 1.6 lbs. (that is per pair !)

*Welcome to Soft Science. one of our Podcast sponsors. Because we believe in them.

Update one day later:

Some have been asking about this shoe. I think they have done something unique here. This shoe is about 6 oz, yes, that is seriously uber light. That means there is no room for stabilizing rigidity factors in this shoe. It appears to be a well thought out “outsole” and a soft cotton canvas upper. That is it. If you need control, this shoe may not be for you. The outsole however offers a nice wide foot print with some flare of the sole out from the foot (look at their website, look at the shoe from behind), and that in itself offers stabilizing over something compared to like a glove type shoe.
Now, on to the insole:
I know what the website says, a “minimal heal to toe elevation”. I emailed the guru over as Soft Science. I have been told they are zero drop and after wearing i believe they are, and if not, maybe a millimeter ? I have sensitive feet, I wear zero drop all day long at work because I can. Not everyone can and this is important to note.
I do not have any info outsole thickness of this particular shoe, the foot does recede somewhat into the outsole that you see, so there is not a tremendous amount of stack height as portrayed in photos, some of that is the outsole lipping up to grab onto the shoe’s upper.
TRileon Insole:There is a VERY mild arch contour, not as much as in crocs (as one person asked) but it is present and mild. If you have a flatter arch, you will feel it, but, Trileon is uber cush so it is not offending at all. If you have a normal arch posture, you may not even notice it, it is that subtle.
Insole: there feels like a 1-2 degree or 1-2 mm varus forefoot post, i have pretty sensitive feet and can tell these things readily, i may choose to grind this down on the insole, it wouldn’t take much to do this. If you take out the insole and put it on a hard floor and stand on it, you will notice the subtle forefoot varus posting of the foam. And if you put the insole in your hands and pinch finger tips together at the 1st metatarsal head and 5th met. head you will notice the thickness difference. * It is not much, but it is there. Some people can really benefit from it since many feet are have a slight FF varus. Some may not notice it at all. I did notice it because my forefoot is not varus’d at all.  I noted it less so when the insole was in the shoe so it may be off setting a slight depression in the outsole shell. I am not sure, so do not quote me on this. For most folks, this is “princess and the pea” subtle jibber jab talk and is not worthy of noting.  But we are shoe geeks and some of you want to know about peas.
To be clear, I like this shoe so far, very much actually. It will be on my feet all week and all weekend……..many weekends.  Soft, uber light, no break in, zero drop, good looks, minimal, wide platform, ….. things i like and things that are important to me. The question is, “is it for you ?” That is up to you.  Nice work Soft Science.
-Dr. Allen

http://www.softscience.com/mens/the-terrain-ultra-lyte.html