Treadmills, motorized or nonmotorized can have some pitfalls. Here are seven of our biggest concerns.

More on non motorized treads from Mike Reinold which came to my attention via Scott Tesoro (thanks!).

1. Watch out for how much ankle dorsiflexion(and great toe extension) your client has to be able to take advantage of the “curve”

2. The treadmill, whether motorized or not, is constantly moving, opposite the direction of travel. With the foot on the ground, this provides a constant rate of change of length of the gastroc/soleus (ie, it is putting it through a slow stretch); so, once the muscle is activated, it contracts for a longer period of time because of the treadmill putting a slow stretch on the gastroc and soleus.

3. The moving deck also has a tendency to put the ankle in dorsiflexion ( see point number one) initiating a stretch reflex in the tricep surae (gastroc/soleus) facilitating toe off through here and pushing you through the gait cycle, rather than pulling you through (with your hip extensors).

4. Likewise, the treadmill pulls the hip into extension and places a pull on the anterior hip musculature, especially the hip flexors including the rectus femoris, iliopsoas and iliacus. This causes a slow stretch of the muscle, activating the muscle spindles (Ia afferents) and causing a mm contraction (ie the stretch reflex). This acts to inhibit the posterior compartment of hip  extensors through reciprocal inhibition, especially the glute max, making it difficult to fire them.

5. Because the deck is moving, the knee is brought into extension, with stretch of the hamstrings, the quads become reciprocally inhibited.

6.  the moving deck forces you to flex the thigh forward for the next footstrike (ie footstance), firing the RF, IP and Iliacus, and reciprocally inhibit the g max

7. If your core isn’t engaged, the pull of the rectus femoris and iliopsoas/iliacus pulls the ilia and pelvis into extension (ie increases the lordosis) and you reciprocally inhibit the erectors and increase reliance on the multifidus and rotatores, which have short lever arms and are supposed to be more proprioceptive in function.

We are not saying they are bad and in fact, we tend to like self-propelled models more than motorized ones  and agree with many of the points made. We are just saying that treadmills are not the same as walking on a flat surface and approximate but do not simulate actual gait.

Podcast 107: Unilateral Training: Warping the Nervous System

Plus: Changing an existing orthotic to make it work, Meniscal tear truths, Shoe Insole truths, Plantar Pressures

Show Sponsors:

softscience.com
Altrarunning.com

Other Gait Guys stuff

A. Podcast links:

http://traffic.libsyn.com/thegaitguys/pod_107f.mp3

http://thegaitguys.libsyn.com/episode-107-0

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:

Running helps mice slow cancer growth
https://www.sciencedaily.com/releases/2016/02/160216142825.htm

The future of Wearables
http://readwrite.com/2016/02/19/future-of-wearables

mensicus surgery is dead ?
http://www.regenexx.com/should-i-have-meniscus-surgery/#

Why you should be training your CNS
http://www.outsideonline.com/2055066/cross-educate-your-body#article-2055066

The business of insoles
http://www.outsideonline.com/2057156/business-insoles-support-system-or-super-rip

Altered plantar pressures
http://link.springer.com/article/10.1007%2Fs00167-016-4015-3

The diaphragm and chronic ankle instability.

I have been treating the global manifestations of unaddressed chronic ankle sprains for decades now. I am never unsurprised to find frontal plane hip weakness and dysfunction of the same side obliques , shoulder and spinal stabilizers. Here is one more piece of proof that unaddressed ankles are monster problems, slowly eroding the stability of the system.
But, shame on those who attempt to simplify this, just correcting the breathing and throwing some corrective spinal stability work at this problem. This approach will fail, repeatedly. At some point the ankle has to be addressed and the impaired supra spinal programming. Gait will have to be retrained as well, forget to do this and your efforts will be muted.
-Dr. Allen

“Previous investigations have identified impaired trunk and postural stability in individuals with chronic ankle instability (CAI). The diaphragm muscle contributes to trunk and postural stability by modulating the intra-abdominal pressure. A potential mechanism that could help to explain trunk and postural stability deficits may be related to altered diaphragm function due to supraspinal sensorimotor changes with CAI.”

Reference:

Diaphragm Contractility in Individuals with Chronic Ankle Instability.

Terada, Masafumi; Kosik, Kyle B.; McCann, Ryan S.; Gribble, Phillip A.  Medicine & Science in Sports & Exercise:

http://journals.lww.com/acsm-msse/Abstract/publishahead/Diaphragm_Contractility_in_Individuals_with.97497.aspx

Do you know where your rocker is?

At 1st pass, some articles may seem like a sleeper, but there can be some great clinical pearls to be had. I recently ran across one of these. It was a presentation from the  42nd annual American Academy of Orthotists and Prosthetists meeting in Orlando, March 2016 entitled “ Shifting Position of Shoe Heel Rocker Affects Ankle Mechanics During Gait”. The title caught my eye.

They looked at ankle kinematics while keeping the toe portion of rocker constant at 63% of foot length, angled at 25 degrees and shifting the base of a rockered shoe from 1cm behind the medial malleolus, directly under it and 1cm anterior to it. Knee and hip kinematics did not differ significantly, however ankle range of motion did.

The more forward the ankle rocker, the less plantarflexion but more ankle dorsiflexion at midstance. So, the question begs, why do we care? Lets explore that further…

• Think about the “average” heel rocker in a shoe. It largely has to do with the length of the heel and heel flare (base) of the shoe. The further back this is (ie; the more “flare”) the more plantar flexion at heel strike and less ankle dorsiflexion (and thus ankle rocker, as described HERE) you will see. Since loss of ankle dorsiflexion (ie: rocker) usually means a loss of hip extension (since these 2 things should be relatively equal during gait (see here), and that combination can be responsible for a whole host of problems that we talk about here on the blog all the time. Picking a shoe with a heel rocker based further forward (having less of a flare) would stand to promote more ankle dorsiflexion.

• Having a shoe with a greater amount of “drop” from heel to toe (ie: ramp delta) is going to have the same effect. It will move the calcaneus forward with respect to the heel of the shoe and effectively move the rocker posteriorly.
  

• Lastly, look a the shape of the outsole of the shoe. The toe drop is usually clear to see, but does it have a heel rocker (see the picture above)?
  

These are  a few examples of what to look for in a clients shoe when examining theirs or making a recommendation, depending on whether you are trying to improve or decrease ankle rocker. We can’t think of why you would want to decrease ankle rocker, but with conditions like rigid hallux limitus, where the person has limited or no dorsiflexion of the great toe, you may want to employ a rockered sole shoe. We would recommend one with the rocker set more forward.

Walking in sync makes enemies seem less scary

Walking in sync makes enemies seem less scary.
“When men match each others’ steps, purported criminals seem less physically formidable, a new study shows. The results, published August 27 in Biology Letters, suggest that matched movements in men may foster fighting alliances, a behavior seen in apes and some dolphins and whales.”
What this does not discuss, but that which we do all over our blog, is whether they are talking about in-phase or out-of-phase synchrony. This is an important distinction, though not likely when it comes to the topic at hand here. We discussed this and many other things on podcast 74.

http://thegaitguys.tumblr.com/post/96787952409/podcast-74-cross-fit-more-on-squatting-and-hip

https://www.sciencenews.org/blog/science-ticker/walking-sync-makes-enemies-seem-less-scary

Pain on the outside of the leg? Could it be your orthotic? What you wear on your feet amplifies the effect of the orthotic.

This woman presented with right-sided pain on the outside of her leg after hiking approximately an hour. She noticed a prominence of the arch in her right orthotic. She hikes in a rigid Asolo boot ( see below). Remember that footwear amplifies the effect of an orthotic!

In the pictures below you can see the prominent arch. The orthotic has her “over corrected” so that she toes off in varus on that side. The rigid footwear makes the problem worse. The peroneus group is working hard (Especially the peroneus longus)  to try and get the first Ray down to the ground.

The “fix” was to soften the arch of the orthotic and grind some material out. Look at the pictures where the pen is pointing to see how some of the midsole material was taken out. Notice how I ground it somewhat medial to further soften the arch.

She felt better much better after this change and is now a “happy hiker” :-)

Looking for the subtle clues will help you. You should have hypotheses and work to prove or disprove them. 

“Remember, this client is displaying these weight bearing differences side to side for a reason, this is their adaptive strategy. It is your job to prove that this is the cause of their pain, their adaptive strategy to get out of pain, or this is now a failed adaptive strategy causing pain, yet still not the root of the problem.”

We used to call this a “windswept” presentation. It is not that it is incorrect, but it is so vague.  

Look at these fippy floppers. Look closely at the dark areas, where foot oils and whatnot have played their changes in the leather upper of the flops. The right f.flop displays more lateral heel loading, rear foot inversion if you will. You can even see that there is less big toe pressure on this right side and even some increased lateral forefoot loading. This client appears to be more supinated clearly. You can even see there is more lightness to the arch leather on the right, again, more supination is suggested.

The left f.flop suggests the opposite. More medial heel pressures and more over the medial forefoot and arch. 

Now this clients f.flops tell a story.  So, this client is being windswept to the right we used to say, appearing to pronate more on the left and supinating more on the right.  Why are they doing this? Is the left leg functionally longer and by pronating they reduce the functional length of the leg (yet, increase internal spin of the limb and the host of naughty things that come with that). Is the right leg shorter, and by supinating they are raising the ankle mortise and arch which helps reduce the length differential ?  MAybe a bit of both, finding common ground for a more symmetrical pelvis ?  Who knows. This is where you need your physical exam, but, now you have some hypotheses to prove or disprove. 

“Remember, this client is displaying these weight bearing differences side to side for a reason, this is their adaptive strategy. It is your job to prove that this is the cause of their pain, their adaptive strategy to get out of pain, or this is now a failed adaptive strategy causing pain, yet still not the root of the problem.”

Is there some right hip pain from the right frontal pelvis drift creating some aberrant loading on the greater trochanter from ITB tension ? Perhaps a painful right hallux big toe, and they are unloading it to avoid pain? Maybe some knee pain or low back pain ? Who knows? Take your history and start putting the pieces together, it is your job. Just don’t screen them and throw corrective exercises at them, you owe it to them to examine them, take their history, watch them walk, teach them about what you see, and then sit down, spread the puzzle pieces out, look for the straight edges and corner pieces, and begin to build their puzzle. 

Clues, they are everywhere, if you look for them.

Dr. Shawn Allen, one of the gait guys

Landing strategies focusing on the control of tibial rotation in the initial contact period of one-leg forward hops - Chen - 2016 - Scandinavian Journal of Medicine & Science in Sports - Wiley Online Library→

“If the knee is whining and doing things it should not be doing, the wise clinician first looks at the foot-ankle and the hip-pelvis complexes, where the blood has dried. Don’t look for the fresh blood at the knee” - Dr. Allen

If you cannot control pelvis position on the femoral head, or hip rotation or initial foot arch mechanics, the knee is going to give in to the directional loading response and that typically means medial valgus movement. This is internal tibial rotation or spin.  

Here is an analogy i use with all my patients. The knee is like the middle child. In the simplest terms, you have 3 lower limb joint complexes. The foot/ankle, the knee and the hip. The knee is the middle of these 3 joint complexes.  

Similarly if you put 3 children in the back of the car, the one sitting in the middle is the one directly impacted by the child on the right and the left.  When you hear the middle child screaming and whining, the smart parent first looks at the two apparently “innocent” children looking out the windows (with blood dripping off their elbows). 

Similarly, the knee takes this same seat. IF the knee is whining and doing things it should not be doing, the wise clinician first looks at the foot-ankle and the hip-pelvis complexes, where the blood has dried. Don’t look for the fresh blood at the knee

Changing landing strategies with the focus of control of tibial rotation, requires the astute clinician to look at all the children.

Dr. Shawn Allen, one of the gait guys.

Does hill running equate to biking when it comes to pathomechanics ?Think about it, when  you are hill running, one leg is in extension while the lead leg is in more extremes (compared to road running) of hip flexion reaching up the hill for the next step. Isn’t this similar to biking ? On the bike one is bent over leaning forward, the lead leg is in extremes of flexion while the foot on the bottom crank has that same hip in extension.  So does hill running equate to biking ? Well, no. But then it comes to approximating anterior hip structures, there are some similarities. You cannot deny that there seems to be some similarities to pathomechanics.This was a post from a few weeks ago, but this week in our online teleseminar class we went over these principles.  We talked about some of the same biomechanical principles and vulnerabilities in hill running and when in biking.Might be a good time to revisit this brief blog post and see why we had hill running and biking in the same conversation.

Dr. Shawn Allen

Here is the hill running blog post where we mentioned a few things.
http://thegaitguys.tumblr.com/post/143841190479/when-you-run-up-a-hill-most-of-the-cross-over

Screens are valuable. But, only if they screen all the pertinent areas, only if the screener knows what to look for, and only if one realizes they are just a screen and not a platform for corrective exercise prescription. Guys like us and Gray Cook have been saying this for years.

Awkward photos…Date smarter but necessarily walk that way…

Take a look at this photo from an airplane magazine I was leafing through on my way home from teaching a recent needling seminar.

I am not really interested in matchmaking (which this ad is for), but the “awkwardness” of the gait caught my eye (not much on the gait cam this time, sorry).

Yes, their feet and legs seem to be in synch (for the most part), but take a look at the arms and hands. First of all, he has his right hand in his pocket, which will restrict its motion during forward movement of his left leg. In the shot, his right leg is forward (as is hers), though they are slightly out of synch. His left arm and hand don’t move forward that much in that he adducts it across his body, so he seems to move his left shoulder up and forward to compensate. She appears to be resisting this motion somewhat with her right arm as her right leg comes forward and she needs to lean her body to the right. Also note the increased abduction of her left arm and forearm as it extends in tandem with her left leg and thigh.

Try walking with your right arm moving forward with your right leg. Notice how your right shoulder resists moving forward in tandem with the right hip? This is phasic, as Dr Allen likes to say, and because there is not an opposite force to counteract the forward movement of the hip in the saggital plane, you often lean to move the center of gravity to that side in the coronal plane.

Wouldn’t it make slightly more sense, when walking hand in hand to have the opposite legs in synch, rather the same ones? Hmm…Food for thought and fodder. All that from a  little picture : )

1st met pain in an orthotic?

This patient came in with pain at the base of the first metatarsal that she believed was related to her orthotic. The first picture shows the foots relationship to the orthotic. Notice how the sesamoid bones and distal aspect of the first metatarsal under lap the orthotic shell. In other words, the shell is longer than her foot. When she dorsiflexes her big toe, she’s hitting the distal of the orthotic.

The next view shows the orthotic with a typical first ray cutout. Notice how far forward the shell of the orthotic goes (next picture). I have placed a pen pointing to the area where the orthotic shell is too long.

In addition to reviewing her first ray descending exercises, a simple fix was to grind back the orthotic shell and be careful to bevel the edge so that it was not hitting the sesamoids and it did not impinge upon the descending first ray. I have placed a pen where the cut out now is (pre and post gluing in the pictures). The cork underlying the base of the first ray was also ground away (last picture)

A simple fix for a common problem. Make sure that your orthotic shell lengths fall just short of the 1st ray and not impinge on the sesamoids!

I think one must study hard, every day, for decades, just to be even remotely decent.

Training out a crossover gait?

This gal came to see us with right-sided hamstring insertional pain. During gait analysis we noted that she has a crossover gait as seen in the first two sections of this video. In addition to making other changes both biomechanically (manipulation, gluteus medius exercises) and in her running style (“Rounding out her gait” and making her gait more “circular”, running with less impact on foot strike, extending her toes slightly in her shoes) she was told to run with her arms at her sides rather than across her body. You can see the results and the third part of this.

Because of her bilateral gluteus medius weakness that is seen with the dipping and lateral shift of the pelvis on the footstrike side, she moves her arms across her body to move her center of gravity over her feet.

Yes, there is much more work that needs to be done. This is one simple step in the entire process.

A nice, referenced review on a often hotly debated topic. 

“Can you emphasize vastus medialis activation in squats?Reading time:By Chris Beardsley, S&C Research columnistSome strength coaches have suggested that squats with either a narrow stance or with elevated heels can preferentially increase vastus medialis activation. They argue that training the vastus medialis is essential, because they believe it is more important than the other quadriceps at the bottom of the squat.But can we actually emphasize vastus medialis activation in the squat by changing stance width or adding a heel lift?And if we can, is the vastus medialis really more important at the bottom of the squat than the other quadriceps, anyway? Let’s take a look!”

link to full text: http://www.strengthandconditioningresearch.com/perspectives/vastus-medialis-squats/

Arm and leg swing gait quiz. Today I combine concepts from my previous quizes ! This one may really put you to the test. 

Two women walking on a sloped beach. They are arm in arm.

Take the principles I have taught you on slope walking, functional leg length differentials to level the pelvis, and arm swing to answer the question.

Here is the question: Are these two more likely to walk “in phase or out of phase”? 

* Do not mistaken the question for anti-phasic or phasic. These are two different concepts. If you are out of the loop on these 4 terms, just search the blog for them. Then come back here to answer this brain thumper.

Make for your case in your head and then scroll down to hear my reasoning for my answer.

This is an EXTREMELY difficult mind bender of a question. You will need to understand the concepts of 2 prior blog posts to even get to the starting line of the solution.  These are the questions I will often pose to myself so that I force the mental gymnastics of gait biomechanics, and quicken my “gait mind” so that I can leave room for processing unique factors in someone’s individual gait. If you have to take time to process the basics, you are gonna run out of time during a consultation and your client will notice you scratching your head. This is a maturation process, you must put in the work that Ivo and I have, if you want to solve the really tough cases. Simple cases are a break, a vacation if you will, they are welcome during a clinic day, but it is the tough cases that make you stretch that truly fulfill your day.  When you are in the clinic, you have to think fast, efficiently and effectively. Recently I had a powerlifter drive from out of state to see me. His case problems were unresolved for many years.  The treating clinician was on the right page, doing a great job actually, but there were so many issues going on that it was hard to see the root of the problem so the case was just being more “managed” than solved. His case was much like this one, all of the findings and factors were related but because I had seen this hodge podge of complaints before (right foot, right knee, left hip, low back, pelvis distortion and a classic Olympic lift compensation fail) so I knew quickly how to piece it all together into a logical solution and find the single spot to focus the therapy, at the root of the problem. My point is that I had done the hard “head scratching” work long ago, so I readily was able to dismiss the distractors and recognize this beast for what it was.  

Back to the two ladies beach walking, I am basing things on a simple assumption that on most beaches the slope gently levels out at the water line, and that the sand several feet up the beach from the water is on a steeper incline, simple tide erosion principles.  Thus, the woman higher up on the beach will be on a steeper slope, this means more beach side leg knee flexion which means less hip extension, meaning a shorter right step length.  This will impair left arm swing, likely shortening it. Less right hip extension will be met by less left arm extension (posterior arm swing behind the body). This often leads to left arm cross over, arm adduction. 

Here is where things get squirrelly. The lady lower on the beach is on a slightly more gentle slope but her issues are the same just muted slightly. So her right beach side leg is in less flexion at the knee and hip, so hip extension is greater and step length will be longer (relative to her friend higher up on the beach). However, she (ocean side lady) is being led by the impaired arm swing, as discussed above, of the lady on the beach side.  That is, if in fact she is being led or if she is the leader. Oy ! There is the brain bender !  

One must consider who is the more corrupting force. In this case, the more corrupting forces will likely trump out the cleaner forces. The ocean side lady is clearly going to have a “more normal” gait with more normal arm and leg swing and step lengths, quite simply the slope she must negotiate is less so there is less corrupting forces on her. The lady on the beach side is having to accomodate more to her greater slope. The lady up the beach is working harder to keep her pelvis level, her eyes and vestiular apparati on the horizon, her differing step lengths from pulling her off from a straight line course, to keep her from falling over (the steeper the slope, the greater the balance challenge to fight from falling into the beach or falling down the slope. Laws of physics say that things roll down hill, so she is fighting this battle while trying to walk a straight line down a sloped beach, with a friends arm in tow).

So, with all that said, one could logically assume that the gal up the beach is definitely working harder, she has greater differing arm and leg swings from side to side, different step lengths, greater struggles with staying up on the slope when gravity wants her to move down the slope, she has more left arm flexion and adduction to help pair with the struggling and perpetual right hip flexion (and loss of right hip extension), she will have to demonstrate more spinal stiffness to deal with these limb girdle torsional differences side to side and a host of other issues I have outlined in these prior “beach walking” quiz posts. Clearly beach side lady is working harder. Thus, just to maintain her gait posturing up on the slope, she will have to dominate the gait. If she gives in to the signals of her ocean side gal, she will have to soften her slope work strategies and she will move down the slope to easier ground. 

Now, back to the question: Are these two more likely to walk “in phase or out of phase”? 

Who truly knows is the answer ! However, we know beach lady is working harder and must continue to do so to stay up on the slope, so her left arm will remain dominant and the ocean side gal will have to accommodate to a very jerky yet cyclically synchronous gait. To walk linked together they will have to find some rhythm. Walking slower will be easier for them to find a harmoniously rhythm. However, one could make the case that “out of phase” gait will be easier (mental image to help you, if they tie ocean side lady’s right ankle to beach side ladies left ankle you will create “out of phase” gait. Thus, the ocean side lady will not mirror her beach side friend. Thus, when beach lady has right leg in extension, ocean side lady will have her left leg in extension. Why? Well, the left arm swing , their point of union, is the trouble zone. With beach side lady having the left arm in more flexion and adduction, the ocean side lady has to accommodate and meet that troubling arm swing. This means her right leg will be in extension at the same time beach side lady has her left leg in extension. This will be more accommodative work for ocean side lady, but she will just have to go with it. Failure to do so will pull her friend down off the beach and making life harder for her friend.

So there you have it. The person up the slope is working harder to stay here, the person down the slope is working harder to accommodate to a gait that their  lower slope is not requiring. Thus, they are both working hard, but for different reasons. But the winner, the dictator, is the one with the greater slope risk. And thus, she will dictate an “out of phase” gait of her ocean side partner, if they are to still walk embraced. 

How did you do ? Can you make a case for “in phase” as the solution ? I can, but I think that “out of phase” is more likely, for the above reasons.

Thanks for playing  this tough one. Congratulations to you if you followed things smoothly. IF you did not, go back and play the mental game again, I think these are important fundamentals everyone should have if you are doing gait work.

Dr. Shawn Allen

How Brooks Plans to Reinvent the Stride Analysis Test→

Another gimmick to sell shoes ? Likely. What do we always say … .  “what you see in someone’s gait and movement is their compensation, not their problem”. Looking at how someone moves does not necessarily tell you what is wrong with them, and it surely isn’t likely to tell them what shoe they should be in. If it were this simple, no one would ever return a pair of shoes because shoe fit would be simple, perfect, repeatable and predictable. Trust us, comparing to a baseline knee-bend is like using an Abacus to solve a math question when we have much better ways…….. it is called a physical exam, watching someone walk and run, screening movement patterns, and bringing it all together. But, this is why we don’t sell shoes for a living. We would only sell a pair an hour.  But, we would get it right almost every time.

 “Before they do any running, customers perform a knee-bend to mimic the angle the joint will make during a run (roughly 40 degrees). This is to establish a baseline movement before the additional stress of running is placed on the joint. Customers then run on a soft-surface treadmill in their socks. Rather than just considering pronation (i.e. rear foot eversion/rotation) tendencies, Run Signature takes both knee and ankle motions into account and, crucially, analyzes the degree to which a customer’s running motion deviates from their baseline knee-bend. Runners with little or no deviation are recommended neutral-style running shoes, while those with greater deviation are steered towards support models. “

Leg Pain? Are you SURE its a disc?

Gluteus minimus dysfunction is often present in gait disorders, including stance phase mechanical problems, since it fires from initial contact through pre swing, like it better known counterpart, the gluteus medius. It is interesting that the trigger point referral pattern of the gluteus minimus has a sciatic distribution, whereas the gluteus medius is more in the local area of the hip. 

 There are several, well known effects of dry needling:

decreased central sensitization

increased range of motion

changes in muscle activation

changes in the chemical environment surrounding a trigger point

changes in local and referred pain

and now we can add (not surprisingly), changes in autonomic function. The mechanism probably has something to do with pain and the reticular formation sending information down the cord via the lateral cell column (intermediolateral cell nucleus) or pain (nociceptive) afferents sending a collateral in the spinal cord to the dysfunctional muscle (Dr Ivo talks about these mechanisms in his dry needling and acupuncture lectures). 

Conclusions

The presence of active TrPs within the gluteus minimus muscle among subacute sciatica subjects was confirmed. Every TrPs-positive sciatica patient presented DN related vasodilatation in the area of referred pain. The presence of vasodilatation suggests the involvement of sympathetic nerve activity in myofascial pain pathomechanism.

BMC Complement Altern Med. 2015; 15: 72. Published online 2015 Mar 20. doi:  10.1186/s12906-015-0587-6PMCID: PMC4426539 Intensive vasodilatation in the sciatic pain area after dry needling

link to full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426539/

What’s wrong with this picture? (Besides the fact that you probably shouldn’t run with your dog on asphalt) 

There’s been a lot of incongruency in the media as of late. This particular gal, with your head rotation to the right is going against the harmony of neurology and physiology. Let me explain…

 This particular gal, with her rotated to the right is going against the way the nervous system is designed to work.

In a post  in the last week or so (the massage cream one and  incongruent movement) we talked about tonic neck responses. When the head is rotated to one side, that upper and lower extremity should extend while the contralateral side should flex. This poor gal is fighting her own neurology! 

 Also note that she really doesn’t have that much hip extension on the right and increases her lumbar lordosis to compensate. Gee whizz. You’d a thought they would have done better…

 So much for the photo op : -)