A sprinter with arch pain. Kohlers AVN: Not everything is always mechanically pain driven.

More ankle rocker is not always the right answer. An orthotic or stability shoe is not always the answer.

IMG_1723.jpg

Thus, not everything will have a mechanical solution and a corrective exercise. People without a medical background will not likely know what Kohlers Disease is or Mueller Weiss syndrome is for that matter (the adult form of AVN (avascular necrosis)).

So, an athlete coming to you with pain in the arch, you as a trainer, coach, and maybe even a therapist or doctor for that matter, might easily think:
"impaired ankle rocker", too much pronation, wrong shoe fit, etc . . . , . the list can be very long.

But sometimes, the problem is unrelated, or indirectly related.
This case of Kohlers/Mueller Weiss came in this week from out of state in a sprinter.
The pain started with a shoe change, and some pain in the arch region, dorsally in this case. Could it just be a massive stress response?, but it also could be Kohlers. Time will tell, but as you can see, the STIR sequence MRI shows a MASSIVE inflammatory response in the navicular bone.
And if it is Kohlers AVN, we are in the early inflammatory stage. You must catch this in the early stage, and try to not let it progress to avascular stage and necrosis and collapse. That means utmost protection, taht means 100% non weight bearing. If you break through the cortex, and this is early AVN, a deformed collapsed navicular will result, and that *could mean foot pain for life. Certainly impaired foot biomechanics.

Don't dismiss unchanging pain, or worsening pain. Sometimes it is not mechanical.
This case remains unknown right now, meaning massive stress response (ie pre stress fracture)? or AVN early stange? I am not taking a chance, bag it up and reimage several weeks later. Over treat this one, just in case.

Shawn Allen, the other gait guy

#AVN, #Kohlers, #Muellerweiss, #osteonecrosis, #sprinter, #archpain, #gait, #gaitproblems

Hip flexors do not initiate hip flexon.

We have been saying it in writing and podcasts for years, the hip flexors are limb swing phase PERPETUATORS, not initiators of hip flexion.
It is the elastic response discussed below and the changing of the pelvis obliquity (from posterior positioning to anterior) via the abdominal wall acting on the pelvis-hip interval in conjunction with the stance phase hip musculature that drives hip flexion.
The next time you go after the psoas as a culprit in your meanderings for solutions, because that is what is all over the internet, think bigger, smarter, deeper.

"These experiments also showed that the trailing leg is brought forward during the swing phase without activity in the flexor muscles about the hip joint. This was verified by the absence of EMG activity in the iliacus muscle measured by intramuscular wire electrodes. Instead the strong ligaments restricting hip joint extension are stretched during the first half of the swing phase thereby storing elastic energy, which is released during the last half of the stance phase and accelerating the leg into the swing phase. This is considered an important energy conserving feature of human walking."

Dan Med J. 2014 Apr;61(4):B4823.
Contributions to the understanding of gait control.
Simonsen EB1.

#thegaitguys, #hip, #hipflexors, #pelvismechanics, #swingphase, #gait, #gaitanalysis, #gaitproblems

Circumducting gait , at the ankle level ?


We often circumduct a leg to get around a clearance problem. Sometimes the clearance problem is the leg length itself, and sometimes it is a foot clearance issue, one that doesn't dorsiflex/toe extend enough.

This is what the foot clearance circumduction strategy looks like (more clear on the left foot). It is a heavy peroneal, tib anterior (more lateral belly, interosseous) and lesser toe extensor strategy. The foot clearly dorsiflexes and everts the rear and fore foot during early swing. It is not until just before heel strike that the tib anterior seem to jump in to do its primary job of dorsiflexion AND inversion.
Finding out why a client is circumducting this way is the key. It could be from the opposite hip abductors being weak, and it could be poor abdominal control on the same side, or it could be down in the foot (perhaps extensor hallucis/big toe extensor) and of highest suspect is a weak or motor pattern delayed tib anterior. Bad lazy habits can happen around trivial weakness, and then can mushroom into other bigger things.

Your exam will help you.
Seeing a problem in someones gait is not their problem, it is their strategy to get around the parts that are not working well.

shawn allen, the other gait guy

#gait, #gaitproblems, #gaitanalysis, #anklerocker, #ankledorsiflexion, #shinsplints, #swingphase, #thegaitguys, #circumductinggait