GOT ENDURANCE?
We all realize the importance of endurance work, especially when it comes to core work. If we had a dollar for every patient that lacked lower back extensor endurance that had a gait problem......
In this video, Dr Ivo demonstrates his adaptation of Dr Eric Goodman's "Founders" sequence, along with some clinical commentary. Try this on yourself or with your patients/clients today. It's easy and effective.
What a great combination of therapies for folks with chronic ankle instability, or almost any injury for that matter! Taking 2 modalities that emphasize afferent input from the peripheral mechanoreceptor system, which has such a large influence on the cerebellum as well as the segmental and descending pain inhibition pathways.
Did you notice they used the trigger points in the peroneus longs muscle to needle? Though they didn't say it, did you remember that that the point correlates to a great point: Gallbladder 34, which is an empirical point for musculoskeletal pain? Interesting how this muscle influences both frontal and saggital plan stability.
Though the techniques of exercise could use some refinement (check out the gents posture in the photo, sure looks like he could use some gluteus medius work!), this is a good overview that provides evidence that utilizing spacial summation (combining multiple techniques that provide afferent input to more than one modality to cause an effect) has better outcomes than one alone. Put this one on your reading list : )
Salom-Moreno J, Ayuso-Casado B, Tamaral-Costa B, Sánchez-Milá Z, Fernández-de-Las-Peñas C, Alburquerque-Sendín F.Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial. Evid Based Complement Alternat Med. 2015;2015:790209. doi: 10.1155/2015/790209. Epub 2015 Apr 30.
link to FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430654/
We have often talked about how important it is to be able to achieve terminal hip extension for an athlete, and arguably for everyone. This means one must have strength of the glutes into that terminal range so one can actually achieve the range of motion and access it functionally. If one does not, then extension movements may occur in the lumbar spine via some anterior pelvic tilt. However, one must not dismiss that upright posture needs sufficient quadriceps strength as well -- meaning, hip extension and knee extension get us to an upright posture and make locomotion possible. If we make the hip flexors or quadriceps tight, due to weakness of the lower abdominals or glutes, we get anterior pelvic posturing and less hip extension (these are admittedly very rough principles, we all know it is far more complex that this). What I am saying is that there is an interaction amongst groups of muscles, functional patterns of engagement, recruitment and whatnot.
One must clearly realize how much knee and hip motions are coupled and work with and off of eachother. If we bend over in a squatting type motion, we are in hip flexion and knee flexion. When we stand, hip and knee extension. These guys play off of eachother. One must consider these issues when movements are more advanced and loading and loading rates are magnified, such as in squatting type lifting.
A few weeks ago Bret Contreras in conjunction with Strength and Conditioning Research put out an article by Yamashita , yes, a 1988 article. "EMG activities in mono- and bi-articular thigh muscles in combined hip and knee extension." What this article looked at was what happened during isolated hip extension and isolated knee extension, and more importantly, what happened to the forces when both joints loaded simultaneously, paired in generating extension at the hip and knee, as in a squat.
This article suggested that when hip and knee extension forces are generated in conjunction, the knee extensors are more activated than if the same force was generated in isolation. What this seemed to suggest is that during the extension phase of a squat, it is easy for the quad thigh muscles (rectus femoris, vastus medialis in this study) to to try and rule the movement, from an activation perspective -- the hip extensors (g. max and semimembranosus) take second seat. We have talked many times about the dangers of this principle when we frequently say "the glutes should be in charge of the hip, not the quads, when the quads try to apply dominant control of the hip motion, trouble may ensue." Admittedly, this may not be entirely true and it is very loosely stated, but the principle has some sound value when it is approached from how we intend it to be heard, that many athletes do not have sufficient glute strength, hip extension range of motion, and poor control of pelvic neutral. So, they dump into the quads because as we see here in this study, they are very appropriately positioned to help synergistically drive the positioning for, and activity of, hip extension motor pattern production. Is this why we see small buttocks and large quadriceps in distance runners, and the opposite in sprinters ? We think so, but we need to dive deeper into the research to prove or disprove it, but the principles seem to make sense.
This is why I like to initially drive my glute and hip extension work with my clients in a more knee flexed position, such as supine bridges. I cannot say it better than Bret Contreras did when he reviewed this article,
If you are not following Bret's and Strength & Conditioning Research's work, you are missing out, They are thorough and insightful, they do their homework, learn from them.
We clearly need to dive into some newer research on this topic, we will see if we can squeeze out the time.
- Dr. Shawn Allen, the other "gait guy"
Here is an embedded code for the beautiful slide that accompanied Strength and Conditioning Research's summary of the study. If you cannot find it above in this post, goto their Facebook page and scroll to Sept 22nd, 2016. You will find it beautifully laid out there. Beautiful job S&CR!
<iframe src="https://www.facebook.com/plugins/post.php?href=https%3A%2F%2Fwww.facebook.com%2FStrengthandConditioningResearch%2Fposts%2F982124818565207%3A0&width=500" width="500" height="731" style="border:none;overflow:hidden" scrolling="no" frameborder="0" allowTransparency="true"></iframe>
Yamashita 1988. Eur J Appl Physiol Occup Physiol. 1988;58(3):274-7. EMG activities in mono- and bi-articular thigh muscles in combined hip and knee extension.
https://www.ncbi.nlm.nih.gov/pubmed/3220066
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).
Show links:
http://traffic.libsyn.com/thegaitguys/pod_112f.mp3
http://traffic.libsyn.com/thegaitguys/pod_112f.mp3
* and on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
Show notes:
Job security, become so good and so unique that Ai cant replace your skills as a doctor
http://www.techinsider.io/age-of-ems-machines-will-take-over-all-jobs-2016-8
How prosthetics are working now, and will in the future
and why you should be scared
http://thenextweb.com/insider/2016/08/04/researches-think-we-may-have-to-protect-our-brains-from-hackers-in-a-few-years/
Open talk about how coordination is the first strength changes someone notes. It comes before true strength is achieved. It is neurologic, and its can feel decievingly safe, but it is a lie.
Foot Strengthening ?
https://drjohnrusin.com/advanced-strength-training-for-feet/
http://www.jospt.org/doi/abs/10.2519/jospt.2016.6482?platform=hootsuite&
Impaired Foot Plantar Flexor Muscle Performance in Individuals With Plantar Heel Pain and Association With Foot Orthosis Use
Tags:
foot arch, foot intrinsics, short foot, yoga toes, gastrocnemius, soleus, heel pain, hammer toes, correct toes, foot exercises, thegaitguys, squatting, gait, gait analysis, gait assessment, orthotics, prosthetics
In this capsule, excerpted from a recent Dry Needling Seminar, Dr Ivo talks about one of his proprioceptive sequences and the neurological reasoning behind it
Today we give away some of the farm with a great proprioceptive exercise sequence that we use ALL THE TIME.
Skill (proprioception), Endurance, Strength. In that order.
Try incorporating this simple and effective sequence into your rehab program and watch your results get even better!
Comparative effects of proprioceptive and isometric exercises on pain and difficulty in patients with knee osteoarthritis: A randomised control study. Ojoawo AO, Matthew O, Mariam HA.Technol Health Care. 2016 Jul 8. [Epub ahead of print]
Efficacity of exercise training on multiple sclerosis patients with cognitive impairments. Chenet A, Gosseaume A, Wiertlewski S, Perrouin-Verbe B. Ann Phys Rehabil Med. 2016 Sep;59S:e42. doi: 10.1016/j.rehab.2016.07.097.
Exercise strategies to protect against the impact of short-term reduced physical activity on muscle function and markers of health in older men: study protocol for a randomised controlled trial. Perkin OJ, Travers RL, Gonzalez JT, Turner JE, Gillison F, Wilson C, McGuigan PM, Thompson D, Stokes KA. Trials. 2016 Aug 2;17:381. doi: 10.1186/s13063-016-1440-z.
Leg and trunk muscle coordination and postural sway during increasingly difficult standing balancetasks in young and older adults. Donath L, Kurz E, Roth R, Zahner L, Faude O.Maturitas. 2016 Sep;91:60-8. doi: 10.1016/j.maturitas.2016.05.010. Epub 2016 May 27.
Hip proprioceptive feedback influences the control of mediolateral stability during human walking. Roden-Reynolds DC, Walker MH, Wasserman CR, Dean JC. J Neurophysiol. 2015 Oct;114(4):2220-9. doi: 10.1152/jn.00551.2015. Epub 2015 Aug 19.
Proprioceptive Training and Injury Prevention in a Professional Men's Basketball Team: A Six-Year Prospective Study. Riva D, Bianchi R, Rocca F, Mamo C.J Strength Cond Res. 2016 Feb;30(2):461-75. doi: 10.1519/JSC.0000000000001097.
Proprioceptive feedback contributes to the adaptation toward an economical gait pattern. Hubbuch JE, Bennett BW, Dean JC. J Biomech. 2015 Aug 20;48(11):2925-31. doi: 10.1016/j.jbiomech.2015.04.024. Epub 2015 Apr 23.
-by Dr. Shawn Allen
I recently saw yet another bulbous chronically inflamed achilles tendon, this one in an elite runner, a masters 1500 American record holder, so no slouch (this is not their photo, obviously) This thing had been baking for almost a year and they had achieved periods of zero pain and abilities to run and then flare ups would occur. There was a focal bulbous swelling (about 3/4 of inch in size) about one inch above the achilles insertion. The swelling was tendon intra-substance, not pre or post achilles soft tissue, this was clearly the tendon proper, you must be certain of this. There were no tiny nodular densities noted within the tendon proper (this is done slowly, with lotion, and fine palpation to look for nodules that might suggest enlarged microtears, not a full proof exam measure, but one I have made a habit of). The calfs were of equal size and shape.
The length of the posterior mechanism (gastrocsoleus-achilles complex) was good and ankle rocker was good. Calf strength, especially top end plantarflexion, was obviously and predictably weak. Lying prone it was clear to the naked eye that the same side glute was smaller. We know that a muscles maximal contractile force (strength) is the maximal contractile force produced per square centimeter of the cross sectional area of the muscle. Now, as a loose and low tech discussion here, moving through the sagittal universe we like to use our glutes and calf to push. If that glute is weaker, who is going to do all this work moving forward ? The calf is certainly in line to help out, (yes, there are others).
There was clearly gluteal weakness, same side quad tightness (this is obvious if you look at this from an anterior pelvis posturing perspective), lack of terminal hip extension range amongst other clues. But today, I wanted to just bring this principle forward to look all the way up the chain. Too many achilles tendonopathies get dozens of treatments of ultrasound, e-stim, acupuncture, cold, laser, orthotics, stretching, IASTM and the list goes on. There is nothing wrong with eccentric loading therapy for this posterior calf-achilles mechanism as long as it is not painful but one must find the reason behind this tissue failure. Local scraping is a silly choice over this tendon, do not be a fool, use your head. But, you must look at other failures along this chain. This client had obvious pain on heel rise in the office, but after 30 minutes of serious motor pattern restoration into hip extension and proper gluteal recruitment in all 3 cardinal planes of loading this client had pain free heel rising. Now, caveat, we tested this 3 times only, obviously this will not hold. But it gave us a clue, and proof, that restoring the proper posterior chain loading order and patterning, and restoring proper hip and pelvis stability loading patterns was a key parameter.
These are tough cases these achilles beasts. They will frustrate you to no end because they are frequently slow responders and frequently because there are several failed neuro, ortho and biomechanical components that must be addressed. But, these cases are more about being smart than volume treatments with passive modalities. And, it is near impossible to ask an elite runner not to run -- if you want to build a running practice, you will have to be smarter than all of the others in your community and not reflexively say "stop running". Tell them "lets just be a little smarter than we have been Mr. Jones", people want to be smarter and they want to be part of a team. Runners will find another doctor if you tell them to stop running (though, it is sometimes briefly necessary when they are just being knuckleheads about it), just get smarter, educate them, and spend some time with your client working through the bugs. I have not had ultrasound, e-stim, cold packs, hot packs, laser or any such toys in my office in my 19 years of practice for a reason, I spend 45 minutes with people and work through the bugs. Sure, go ahead and judge me, tell me I am missing out on tools to help, I am ok with you saying that. But I get results most of the time. Do I sometimes fail though ? Yes, we all do, I fail from time to time, but I tell my clients, "you will give up on this process before I do". I am just too curious for the deeper answers. I am in it to fix it, not to bandaid it. Anyhow, enough of my egoic rant, that was ridiculous, sorry, I just get really pissed off when I see someone who just fired their therapy place after 20 sessions of ultrasound, laser, e-stim, cook-booked rehab and stretching. We can and must do better than that dear brethren. But I guess that is why you are here with Ivo and myself, a team approach to getting wiser, here at The Gait Guys.
Oh, need research proof ? Here . . .
Neuromotor control of gluteal muscles in runners with achilles tendinopathy. Franettovich Smith MM1, Honeywill C, Wyndow N, Crossley KM, Creaby MW. Med Sci Sports Exerc. 2014 Mar;46(3):594-9. doi: 10.1249/MSS.0000000000000133.
CONCLUSIONS:
"This study provides preliminary evidence of altered neuromotor control of the GMED and GMAX muscles in male runners with Achilles tendinopathy. Although further prospective studies are required to discern the causal nature of this relationship, this study highlights the importance of considering neuromotor control of the gluteal muscles in the assessment and management of patients with Achilles tendinopathy."
Bam !
- Dr. Shawn Allen
While getting ready to board my flight back from teaching a Level 1 dry needling seminar, this gent was in front of me. I couldn’t resist the opportunity to use the “Gait Cam” (yes, the Gait Guys are ALWAYS watching ) and make a few points.
Watch the video a few times through and come back.
Did you notice his large heavy bag over in his right hand? Can you see (and imagine) how it pulls his center of gravity to the right? Can you also see how he “corrects” and leans to the left during stance phase (on the left) to move his center of gravity over his left foot? ANYTHING that you have in one hand or over one shoulder will alter your center of gravity and cause a simlar reaction, however subtle that may be. I was reminded of this as I took a much needed “post teaching all weekend run” with my friend. Karly Foster, yesterday through some of the beautiful “rain forests” of the Pacific Northwest and was wondering if I should bring a water bottle or not and didn’t have a pack to carry it, so I would have to carry it by hand. I elected not.
Did you catch the subtle overpronation of the rearfoot on the right side (as evidenced by the valgus angulation) due to the increased load? Can you imagine what this must do to the lower extremity on that side, not to mention the asymmetry of mechanoreception reaching the cortex? Yikes! talk about potential neuroplastic changes!
Be a “student of observation”. Listen, look and think. Pay attention to the subtle details, as they will often provide what may be missing or the clues you are looking for.
The article below for some reason inspired today's soft rant. I hope you feel this is worth your time.
Yesterday I talked about arch height and ankle mortise dorsiflexion and how we can obtain more global dorsiflexion range through some pronation, loosely meaning, some arch compression/drop and splaying apart of the tripod legs of the foot. Global arch flexibility is a piece of that puzzle. This action of arch compression/drop/tripod splay moves the tibia forward in the sagittal plane and this is global dorsiflexion. Let me be clear however, a reduced ankle mortise dorsiflexion range of sagittal motion which is met by more arch height reduction/prontation/tripod splay, is still dorsiflexion however it is less sagittal dorsiflexion and a little more adduction and medial drift. This can bring the knee into the medial plane and it does promote more internal spin of the limb, this can be a problem. None the less, it is still global dorsiflexion. It is something we see at the bottom of a squat, we see it because to get there most of us do not have all that dorsiflexion at the mortise. It is not abnormal, the question is, "is it safe for you? Can you do it repeatedly, safely?" It is where we go when we need more sagittal motion, but it may not be ideal, and is often what creates functional pathology. We see it all the time, someone says in an email, "I have plenty of ankle dorsiflexion, that is not my issue". Do you have plenty? Is it not really your problem? This is fine tuning stuff, it takes a skillful eye and assessment hand. It takes experience to see the whole picture. You cannot get this full 4k experience and understanding from a 2 dimensional youtube video. This arch compression and pronation is normal to occur, it should occur, it must occur. But, how much is too much, for you ? I like to explain it this way,
"there is a point at which sound, economical, durable, biomechanics becomes a liability. And, at that point where the liabilities begin is in fact where we begin to skirt the edges of that durable skilled movement. Where we begin juggling our liabilities is where the risks begin to mount and begin to whittle away or trump our S.E.S.P (skill, endurance, strength, power). This is where injury often occurs, at that intersection where the gas tank of our S.E.S.P. begins to run low and our liabilities begin to run high."
Sidebar:
I have explained this concept many times before when talking about the cross over gait. Moving towards a narrower step width is fine if you have the durability to be there. The question is, how long are you going to be there ? A cross over gait tendency is more economical but you begin to risk liabilities toward injury if that durability becomes challenged. As a runner you must know where your safe zone exists and know how much durability you have at those fringes of your movement. It is when you are there too long, too often, or too much that you empty that durability gas tank which then increases your liabilities towards injury. This is why I give high volume and strength work once a problem is solved, to make sure that they can keep that circle of durability high. It is when we stop keeping our gas tanks large and full that we run on fumes and our risks increase. You might be able to run economically for 5 miles with a narrow step width cross over style running gait. But, can you do it safely at 10 miles ? How about 15? Is it any wonder why people get injured as they fatigue their safe motor patterns ? If they have worked hard to keep that circle of durability large (S.E.S.P.) they are bound to be safer and less injured. Injuries occur because we exit our circle of durability, its gas tank has run too low, liabilities now trump economy and durability.
- Dr. Shawn Allen, the gait guys
http://www.japmaonline.org/doi/abs/10.7547/8750-7315-2016.1.Song
This study looked to evaluate the relationships between peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height.
"The results showed (1) a moderate correlation between ankle dorsiflexion range of motion and countermovement jump height and (2) a high correlation between peak first toe flexor muscle strength and countermovement jump height. Peak first toe flexor muscle strength and ankle dorsiflexion range of motion are the main contributors to countermovement jump performance."
There could be variables missing here, and plenty of caveats. We should try to get the full text on this one to be fair. None the less, interesting facts to brain juggle however.
These muscles are posterior compartment muscles so it makes sense, however, when the first great toe (the hallux) is in relative flexion, the arch is easier to drop (conversely, hallux dorslflexion causes the arch to raise and keeps the ankle dorsiflexion more purely in the ankle mortise) where as, with relative toe flexion, the arch can drop, this can generate some pronation and arch splay, which can increase the "appearance" of more ankle dorsiflexion when in fact some could be from the arch drop/pronation. I wonder if the researchers are aware of this variable or if this study took it into consideration. Certainly when someone is dropping into ankle dorsiflexion ready to jump, is is easy to drop the arch. Go ahead, dry doing it with the toes down , and then with the toes up in extension, its very different in the amount of dorsiflexion you can get out of the entire arch-ankle mortise complex combined. IT is these kinds of things that can easily be over looked and skew findings.
Correlation between toe flexor strength and ankle dorsiflexion ROM during the countermovement jump
Sung Joon Yun1) 2), Moon-Hwan Kim2), Jong-Hyuck Weon3), Young Kim4), Sung-Hoon Jung5), Oh-Yun Kwon5)
Journal of Physical Therapy Science
Vol. 28 (2016) No. 8 August p. 2241-2244
link : https://www.jstage.jst.go.jp/article/jpts/28/8/28_jpts-2016-202/_article?platform=hootsuite
Podcast 111b: Sonambulism. Locomoting when you are still asleep. Ultramarathoners know about this one to a degree. Here is what you need to know. Do you ever wonder why you cannot sleep that first night in a new place, like a hotel ? We have answers.
http://thegaitguys.libsyn.com/podcast-111b-shorts-sleepwalking
http://traffic.libsyn.com/thegaitguys/pod_111b_Shorts-_Sleep_walkingg.mp3
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our website and blog. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).
While working with a post surgical ACL patient that has +2 laxity and graft pain, I was reminded of something Dr. Allen and I were talking about while discussing this case.
One of the primary goals post ACL is stated as improving range of motion, particularly getting to full extension. If you look at the mechanics of the anterior cruciate ligament, you'll see that placing the knee in full extension places this ligament under stretch. We often will try to increase range of motion by hyper extending the knee, or using it as a fulcrum, which can cause undue stretch to this ligament. This means the burden of oweness is on the musculature surrounding the joint to provide stability, similar to what we are seeing in my patient.
I asked him to perform a one legged stand keeping his knee over his second metatarsal and just hold it. I then had him perform a mini squat, but rather than a traditional knee forward squad I had him do a potty squat (tibia remains vertical, while flexion occurs at the knee by moving the femur and glutes backward). Note that his foot is in a tripod position and his toes are up. (see video here) He was able to maintain good control of the knee for about the first 10° of flexion and then his motion started to degrade. Our goal will be to keep him in a range of motion where he has good neuromotor (find the first 10° of motion) and expand upon that. We remember from our principles of exercise that isotonic exercises (like a potty squat) have a physiological overflow of 15° on each side of the point of application. If I can get him to flex to 10° and be in control, I'm actually getting effects up to 25° flexion.
Simple? Yes. Important? Incredibly! If you can't control the range of motion that you have, why should you have more? Remember in your rehab procedures, keep it in a safe range.
While making a chickpea and Swiss chard succotash recipe out of the September issue of vegetarian times, to go with the two racks of ribs and roasted beets and parsnips that I was making, I was reading an article out of August 2016 issue of one of my favorite journals "lower extremity review" by the editor Jordana Foster. Called "Out on a Limb: falling in with feedback". The "out on a limb" section is a monthly regular and always holds some compelling clinical ideas. This particular one was talking about utilizing "visual feedback" with your patience.
It got me thinking about using visual feedback. The article spoke of some preliminary research from Rosalind Franklin University in Chicago utilizing visual feedback to control tibial acceleration.
It got me thinking. You could utilize some slick software and computer interface in your office or, if you were somewhat text savvy, use a simple video camera with a hook up of the screen real-time to a monitor device. This could be easily accomplished and most offices however there's an even easier for my feedback that could be utilized. A mirror. You can find a very large, great mirror at the local thrift store for a few dollars that you can have in front of your treadmill or Area where you were performing "gate rehab" with your patient or client. The simple tool can be extremely effective and low cost. Nothing like improving your bottom line without increasing your costs.
Try it and let us know what you think
#gait #rehabilitation #gaitrehabilitation #mirrortherapy #visualfeedback #visual #feedback
Things are moving fast in the research world. We need to keep up with our readings even though it seems like trying to drink from a firehose at times. These things will likely be upon us in a mere blink.
"scientists have programmed stem cells to grow new cartilage on a 3-D template shaped like the ball of a hip joint. What's more, using gene therapy, they have activated the new cartilage to release anti-inflammatory molecules to fend off a return of arthritis."
We have always encouraged our clients that joint replacements are the choices at the end of the road when it comes to options.
We must maintain mobility and stability and clean function and always drive the client status first into good quality of motion over power and speed. Without the proper assessment of function we can get these things backward because of skilled compensation patterns. It is highly suspect that many injuries occur because of increased strength, load, speed, power etc being born atop corrupt movement pattern foundations. After all, humans are great compensators. It is suspect that these mistakes are what lead young clients down expedited joint "wear and tear" paths, sometimes leading to joint replacements at a sub 60 year age if not sooner. This kind of research as described here in this article could be the life saver those folks are looking for. However, this should never take the place of abiding by the guidelines discussed above. There are principle rules, but as in life, many of us forget that they do not apply to us because we are "an exception".
Scientists develop new way to resurface arthritic hip joint
http://www.news-medical.net/news/20160719/Scientists-develop-new-way-to-resurface-arthritic-hip-joint.aspx
So this week has been much about the glutes. We stepped back earlier today into the evolution of bipedalism and some theories around glutes and what might have pushed us upright from 4 limbs onto two. And now as the grand karma of the internet has been listening in ....... we find this:
Lucy remains one of the most famous discoveries in paleontology. ""Her death, on the other hand, has been a mystery. Now, after poring over the celebrated bones, a team of scientists has concluded that Lucy died most unceremoniously: from a long fall out of a tree. If they are right, the discovery could yield an important clue to how our ancestors evolved from tree-dwelling apes into bipeds that walked the African savanna."
Listen to our 13 minute Podcast "shorts":Evolution of Upright Bipedal Gait & Glute Development released today. It is interesting stuff. Link:https://tmblr.co/ZrRYjx2BTf6mR
A 3.2-Million-Year-Old Mystery: Did Lucy Fall From a Tree?
-By Carl Zimmer
http://www.nytimes.com/2016/08/30/science/lucy-hominid-fossils-fall.html?_r=1
This is the finger of a professional yo-yo'ist. Extreme blood flow restriction damage.
We don't have a problem with the blood flow restriction training and therapy that is all the rage these days (*caveat: see below), though we don't hold a lot of value in it, we suppose things have their place.
Our point today with this photo, just keep in mind what the heck you are doing to the stuff you cannot see. We continue to search for research that might come out in time showing arterial damage or possible clot formation in folks who over do Blood Flow restriction stuff too long, too tight, too often. Stuff is getting compressed and we wonder if arterial wall damage might be something we see down the road ??? Who knows, just thoughts. We are not trying to be alarmists by any means, it is just the kinda stuff we think about.
Sure, this is an angiogram of the permanently ruined veins in the finger from years of string soft tissue restriction, certainly an extreme case ! We just thought it was interesting and reminds us all that we need to keep in mind what our therapies are doing to the tissues beneath and what the activities of our clients can do over a long period of time. We don't have any pro-yo-yo folks in our office, maybe you do, and if so, educate
From August 28, 2016 facebook post
* VIDEO: About 4-5 years ago some of you that have been with us for awhile will recall that i studied some latin and smooth ballroom dance for a few years. It was humbling to say the least. There are so many reasons why men suck at dancing. But, I have never been one to stray away from fearful and humbling experiences. I enjoy being curious and trying hard things and i am ok with looking like a fool to get an edge on wisdom seeking. This dance thing was the hardest thing i have ever done, the pros make it look easy, but it is hard. Movement, coordination, timing, rhythm, memorizing steps and principles, then learning to lead a partner through all that SILENTLY ! but one of the hardest things to learn was how to use the whole body to create movement. Dancing is whole body, latin dancing is a workout, and the core gets smashed when done right. There is a reason dancers have amazing bodies, because this stuff is hard ! One day one of the male coaches came over to me and said something resembling "you are not reacting into the floor with your feet, you have to feel the inside and outside edges of your rear, mid and forefoot at any one moment of time. If you cannot get that right, you cannot properly engage the leg muscles, hips and certainly not your core". He was right. I had no idea how to move. He then said, "go home, but on some socks and polish your floors, reacting into, and then off of, the floor. When you begin to feel your leg muscles and learn that the feet can be used in so many ways other than walking, things most people never even come close to in sports, you will be ready to START." This was what happened after one week of reacting into the floor, I came to name it, "EDGEWORK". I was learning to use the inside and outside edges of my rear, mid and forefoot, sometimes on the opposite sides of the body, pronating at times through the right rear foot while supinating through the left forefoot etc. This is why I laugh to myself when i see people posting what they call holy grail "foot exercises" on the internet. Much of it is novice stuff, but admittedly that is where most people have to begin, and should begin. This was just one reason I appreciated learning 10 different dances, from cha cha and jive which had extremely fast and agile foot work, to rhumba and salsa and their complicated foot work into the floor, and then dances like foxtrot or waltz that required an entirely different kind of footwork, skimming and floating across the foot with grace. Oh, and did i mention leading a lady about the floor, silently with just body jestures and gentle hints of pressure. Oh, and to music, on time, in rhythm etc. This was a journey in which i gave zero f#@&ks about about what people thought when they knew i was taking dancing lessons, because I knew I was learning to move and use my body like few others even remotely had a clue about, and likely never will. Enjoy my silly little FOOT EDGEWORK video i shot for this coach, so he could see what i had been able to do in just a week. You will see inside edges, outside edges, skimming, floating, pressuring into the floor, directional changes, pivots etc. From here, my journey into movement took a giant leap forward. I began to truly understand how the foot worked on the ground, truly "worked" and how that would translate into hip rotation, core engagement, upper body turning, spinning, posture, arm movements, glute and calf use, peroneal stability for the lateral ankle and many more things. There is a reason why some of the greatest athletes in sports took on dancing and ballet to improve their understanding and grace of movement to their chosen field. Because it was an edge no one else willing to embrace. Go ahead laugh at the silly video, i sure did. I just found it while purging computer files and immediately put the wool socks back on and went to polish the floors. Come on men, help keep the house floors sparkly clean like mine, give them a shine :) Oh, and thanks Bruce Lee, Hong Kong Cha cha champion for making it ok to follow you. You can take that to the bank Connor McGregor. (*the silliness begins about 10seconds into the clip, give it a sec)
- Dr. Shawn Allen, the other gait guy
https://www.facebook.com/thegaitguys/videos/1310391195667219/
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Concussion Increases Odds of Sustaining a Lower Extremity Musculoskeletal Injury After Return to Play Among Collegiate Athletes. -Brooks et al.
Perhaps we need to be paying far more attention to the musculoskeletal injuries in our contact sport athletes. We need to bring to light some important facts to our athletes (and their parents!).
From the Nauman Purdue football study:
"The worst hit we've seen was almost 300 Gs," Nauman said. A soccer player "heading" a ball experiences an impact of about 20 Gs."
Here is what we say: now add 20 soccer headers in a week of game and practice. Or take 20 submaximal football tackles, in a week of game and practice. You do the math.
Concussions have been now shown to cause abnormalities in brain and motor functioning. These issues can last long after perceived clinical recovery. "Recent work suggests subtle deficits in neurocognition may impair neuromuscular control and thus potentially increase risk of lower extremity musculoskeletal injury after concussion."
Do NOT underestimate the impacts of a single concussion, and certainly NEVER in a second impact (Second Impact Syndrome (SIS)). SIS can at worst, lead to death within minutes, so certainly it can lead to impaired neuromuscular control. Our current society continues to ignore the immense long lasting effects of head injuries, even minimal ones. We continue to allow young developing brains to partake in football, soccer, and other jarring sports. Yes, we cannot live in a vacuum, but we can live in awareness and wise choices.
Facts:
The 2 year Purdue Study of high school football players suggested that concussions are likely caused by many hits over time and not from a single blow to the head, as previously believed. "Over the two seasons we had six concussed players, but 17 of the players showed brain changes even though they did not have concussions," Talavage said. "The most important implication of the new findings is the suggestion that a concussion is not just the result of a single blow, but it's really the totality of blows that took place over the season," said Eric Nauman. "Most clinicians would say that if you don't have any concussion symptoms you have no problems," said Larry Leverenz, an expert in athletic training and a clinical professor of health and kinesiology. "However, we are finding that there is actually a lot of change, even when you don't have symptoms."
"New research into the effects of repeated head impacts on high school football players has shown changes in brain chemistry and metabolism even in players who have not been diagnosed with concussions and suggest the brain may not fully heal during the offseason."-Emil Venere
"We are finding that the more hits you take the more you change your brain chemistry, the more you change your brain's ability to move blood to the right locations," Nauman said.
'Deviant brain metabolism' found in high school football players.
http://www.purdue.edu/…/deviant-brain-metabolism-found-in-h…
Biomechanical Correlates of Symptomatic and Asymptomatic Neurophysiological Impairment in High School Football
Evan L. Breedlove, BS1,Thomas M. Talavage, PhD2,3,Meghan Robinson, BS2, Katherine E. Morigaki, MS ATC4,Umit Yoruk, BS3, Larry J. Leverenz, PhD ATC4 , Jeffrey W. Gilger, PhD5, Eric A. Nauman, PhD1,2,6
http://www.ncbi.nlm.nih.gov/pubmed/26786903
Wow, interesting. Definitely podcast material. If you have been following the literature, recently the immune system and brain function and the gut have been dramatically linked in ways we never knew existed. Now this !
" Princeton University researchers have found that a family of proteins with important roles in the immune system may be responsible for fine-tuning a person’s motor control as they grow, and for their gradual loss of muscle function as they age. The research potentially reveals a biological cause of weakness and instability in older people, as well as a possible future treatment that would target the proteins specifically."
Immune System Proteins Responsible for Fine Tuning and Reducing Motor Control
NEUROSCIENCE NEWSAPRIL 12, 2016
http://neurosciencenews.com/mghi-motor-control-genetics-4035/
Folks are ramping up mileage here in Chicago-land for the October marathon. Lots of first timers trying to fill the bucket list, and lots of hip and knee stuff coming into the office. This older article reminded us of the paramount need to slowly build up safe durability. So many folks just follow the ledgers, "This week is 16 miles, 2 more than last sunday, this will keep you on track to get to your taper week". We get all that. But this recipe doesn't work for everyone. Some bodies are so weak and out of shape that their recipe is drastically different than the "average joe or jane". Many need their marathon program time frame doubled so they can build their durability. Yes, novice runners often have functionally unstable/weak hips (amongst other things), and some have bad running form, and many have BOTH ! We remind folks that 26 miles is something to endure for most, and that means preparation, probably preparation before the running training started. So it is about educating them for next time, if there is a next time for them ! Don't forget, running is a sagittal game, one is moving forward. The frontal and axial (rotational) stability is often neglected, and here lies the hole in the bucket that leads to unjuries. Even if you are half way there to your marathon date and doing fine, it is never too soon to start frontal and axial plane durability work, just in case the 18 miler is just beyond what you can endure to protect those joints.
http://www.physiospot.com/research/do-novice-runners-have-weak-hips-and-bad-running-form/
Lets be clear ! This brace is for above the ankle mortise sprains, ie. low and high ankle sprains, sprains to the syndesmosis. It is NOT for ankle mortise and below sprains (ie. lateral and medial stabilzing ankle ligament sprains, ATF, PTF, deltoid ligs etc). If you use this brace on those injuries, good luck......you will not have any protection to those torn ligaments.
Also, i am hesitant to buy into the "treats shin splints". Braces are supportive, nothing more. So, "supports" shin splints is more accurate IMHO.
I would also make a case that a syndesmosis sprain (low-high ankle sprain) is not an injury you should be looking for a brace to enable you to continue to play on. Rather, rest and heal and do your initial phase low load rehab.
Like most things, devices like this have a place and a purpose, but you have to know what you have injury wise, and know what you are dealing with. For example, if you have both a syndesmosis (low-high ankle sprain) AND a deltoid or lateral ligamentous complex sprain, this brace is not what you should chose in our opinion.
https://www.edgemobilitysystem.com/products/brace2play-above-the-joint-ankle-brace?variant=21314299587
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