Premature heel rise: Part 2

VIDEO: an atypical case of Premature heel rise. A follow up video for yesterdays discussion on the topic.

You should easily see premature heel rise here in this video. We will discuss this case at length with other video projections on our Patreon site next week, if you wish to dive further.

But here you should see, lets focus on the right limb, premature heel rise (again, stick with just watching the right foot/leg). This is, in-part, because this person does not achieve adequate hip extension, you should clearly be able to see that. Loss of terminal hip extension means premature heel rise, no exceptions. Train your eye to see this, you do not need expensive video software to see this.

So, Why inadequate hip extension? Well, just look at the amount of right knee flexion going into terminal stance, it is still heavily flexed and this forces them to prematurely heel rise, avoiding terminal hip extension, and prematurely load the forefoot. Without a knee that extends sufficiently, the hip cannot extend sufficiently, and thus premature heel rise is inevitable. And, trying to solve this issue down at the foot/ankle level is foolish in this case. Stretching this calf day after day until aliens come visit earth will still not be enough stretch time to fix this premature heel rise (ie. get that heel to stay down longer). There is a good reason why this is happening in this person, and it is a neurologic one, one we will discuss on the Patreon site for our Patrons. And, the reason does not matter for the concept I am teaching here today.

For today, you need to be able to see premature heel rise, and know all of the issues behind it, including causes, so that you can direct your phyiscial examination to solve your client's puzzle.
I have included yesterday's post below so you can review and bring this further together.
This is the kind of stuff we will do at Dr. Allen's Friday night Gait Lab, over some beverages. A unique, clinically curious and hungry 25 people need only apply. If you want to get to the next level of your human movement game, this is a way to get there.

Yesterday's post: We know that early/premature heel rise (PHR) leads to premature loading of the forefoot.
We know that premature heel rise (PHR) speeds us through many of the timely mechanical events that need and should occur for to get to safe and effective toe off during walking and running gaits.
This is why there are so many variables that need to be assessed and checked before instituting care to address the premature heel rise, because many times the problem is not even near the heel.
Consider, examine, assess (this is not an exhaustive list either) of causes of PHR
-short calf complex
-short quad (limits hip extension)
- short hip flexors
-anterior pelvis tilt as one's deviated norm posture
- prolonged or excessive rearfoot inversion
-lack of appropriate pronation (sustained supination)
-hallux limitus, rigidus
- weak anterior compartment lower leg
-lack of hip extension/weak glutes
-knee flexion contracture
- neurologic (toe walking gait from youth)
-painful achilles tendon mechanism
- loss of ankle rocker (which has its own long list)
. . . . to name a few

This is why you need to examine your clients, even after a gait analysis. Because, as we like to say, what you see is not your clients gait problem, it is their work around to other mechanical deficits.
After all, telling someone they just need to lengthen/stretch their calf to keep that heel down longer is utterly foolish.

*want to learn more about this stuff, you can join the upcoming Dr. Allen, Friday night Gait Lab series that he will be having in his office one Friday a month, in his Chicagoland office. Stay tuned for that notice. I will take only 25 people per session. We will dive into videos, cases, concepts, white-board rabbit holes, and enjoy some beverages and learn together. Stay tuned. The first 25 to pay and sign up are in !

Shawn Allen, the other gait guy

#gait, #gaitproblems, #gaitanalysis, #heelrise, #PHR, #prematureheelrise, #achilles, #achillestendinitis, #anklerocker, #heelrocker, #forefootpain, #halluxlimitus, #halluxrigidus, #heelpain

Premature heel rise: Part 1

IMG_1603.jpg

We know that early/premature heel rise (PHR) leads to premature loading of the forefoot.
We know that premature heel rise (PHR) speeds us through many of the timely mechanical events that need and should occur for to get to safe and effective toe off during walking and running gaits.
This is why there are so many variables that need to be assessed and checked before instituting care to address the premature heel rise, because many times the problem is not even near the heel.
Consider, examine, assess (this is not an exhaustive list either) of causes of PHR
-short calf complex
-short quad (limits hip extension)
- short hip flexors
-anterior pelvis tilt as one's deviated norm posture
- prolonged or excessive rearfoot inversion
-lack of appropriate pronation (sustained supination)
-hallux limitus, rigidus
- weak anterior compartment lower leg
-lack of hip extension/weak glutes
-knee flexion contracture
- neurologic (toe walking gait from youth)
-painful achilles tendon mechanism
- loss of ankle rocker (which has its own long list)
. . . . to name a few

This is why you need to examine your clients, even after a gait analysis. Because, as we like to say, what you see is not your clients gait problem, it is their work around to other mechanical deficits.
After all, telling someone they just need to lengthen/stretch their calf to keep that heel down longer is utterly foolish.

*want to learn more about this stuff, you can join the upcoming Dr. Allen, Friday night Gait Lab series that he will be having in his office one Friday a month, in his Chicagoland office. Stay tuned for that notice. I will take only 25 people per session. We will dive into videos, cases, concepts, white-board rabbit holes, and enjoy some beverages and learn together. Stay tuned. The first 25 to pay and sign up are in !

Shawn Allen, the other gait guy

#gait, #gaitproblems, #gaitanalysis, #heelrise, #PHR, #prematureheelrise, #achilles, #achillestendinitis, #anklerocker, #heelrocker, #forefootpain, #halluxlimitus, #halluxrigidus, #heelpain

Forefoot running, achilles loads & gait retraining

tag/key words: gait, gaitproblems, gaitanalysis, forefootrunning, forefootstrike, achilles, heelstrike, elastography, thegaitguys, microvascularity, rockeredshoes, HOKA, metarocker, gaitretraining,

Links to find the podcast:
Look for us on iTunes, Google Play, Podbean, PlayerFM and more.
Just Google "the gait guys podcast".

Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
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).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:

iTunes page:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:
https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

Direct download URL: http://traffic.libsyn.com/thegaitguys/pod_150.2_-_42719_5.00_PM.mp3

Permalink URL: http://thegaitguys.libsyn.com/forefoot-running-achilles-loads-gait-retraining

Libsyn Directory URL: http://directory.libsyn.com/episode/index/id/9555122

Show notes:

Ultrasound elastographic assessment of plantar fascia in runners using rearfoot strike and forefoot strike. Tony Lin-WeiChen et al
https://www.sciencedirect.com/science/article/pii/S0021929019302775
J Sci Med Sport. 2015 Mar;18(2):133-8. doi: 10.1016/j.jsams.2014.02.008. Epub 2014 Feb 14.

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.. Sobhani S et al
https://www.ncbi.nlm.nih.gov/pubmed/24636129/


The increase in muscle force after 4 weeks of strength training is mediated by adaptations in motor unit recruitment and rate coding. Alessandro Del Vecchio et al
https://physoc.onlinelibrary.wiley.com/doi/10.1113/JP277250


Learning new gait patterns is enhanced by specificity of training rather than progression of task difficulty. ChandramouliKrishnan et al
https://www.sciencedirect.com/science/article/pii/S0021929019301927


The microvascular volume of the Achilles tendon is increased in patients with tendinopathy at rest and after a 1-hour treadmill run. Pingel J et al
Am J Sports Med. 2013 Oct;41(10):2400-8. doi: 10.1177/0363546513498988. Epub 2013 Aug 12.
https://www.ncbi.nlm.nih.gov/pubmed/23940204/

*** Our PODcast disclaimer:
This podcast is for general informational purposes only. It does not constitute the practice of medicine, nursing, rehab, treatment, therapy recommendations or anything of the sort. This podcast should not replace proper medical advise that should only be attained through proper medical channels that would entail a full medical and/or biomechanical physical examination and/or appropriate diagnostic testing. No doctor-patient relationship is formed by listening to this podcast or any information gleaned from our writings or social media work.
The use of this information and the materials linked to the podcast is taken at the users own risk. This podcast and the content shared is not intended to replace or be a substitute for appropriate professional medical advise diagnosis or treatment. Users should not disregard or delay obtaining medical advice for any condition they have and should seek the advice and assistance from their providers for any such conditions.

How do humans run faster ?


Runners appear to use two different strategies to increase their speed according to this article we are appreciating by Dorn, Schache and Pandy


In specific observance of the lower limb muscles,
"Humans run faster by increasing a combination of stride length and stride frequency. In slow and medium-paced running, stride length is increased by exerting larger support forces during ground contact, whereas in fast running and sprinting, stride frequency is increased by swinging the legs more rapidly through the air". . . . .
"For speeds up to 7ms–1, the ankle plantarflexors, soleus and gastrocnemius, contributed most significantly to vertical support forces and hence increases in stride length. At speeds greater than 7ms–1, these muscles shortened at relatively high velocities and had less time to generate the forces needed for support. Thus, above 7ms–1, the strategy used to increase running speed shifted to the goal of increasing stride frequency. The hip muscles, primarily the iliopsoas, gluteus maximus and hamstrings, achieved this goal by accelerating the hip and knee joints more vigorously during swing."

Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance
Tim W. Dorn, Anthony G. Schache and Marcus G. Pandy*
Department of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia. The Journal of Experimental Biology 215, 1944-1956
© 2012. Published by The Company of Biologists Ltd
doi:10.1242/jeb.064527

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Most likely this is common knowledge for most followers here on The Gait Guys and our podcast (another one will launch this weekend btw).

Screen Shot 2019-04-12 at 8.43.42 AM.png

But reducing the plantar flexion moment in the late stance phase of running and walking can make notable changes in the loading response to the posterior plantarflexor mechanism (the gastroc-soleus-achilles complex). A rocked shoe, according to this study, can reduce the plantarflexor moment without substantial adaptations in triceps surae muscular activity.
This of course brings to mind the HOKA family of shoes that have purposefully added a gentle rocker mechanism to some of their shoe line, some with an early and some with a late stage metarocker built in. Are you a HOKA hater? We were not fans in their early development because of the volume of stack height foam, but they have many more options in their line up now. But do this for us, do not pass judgement until you put one of these metarockered shoes on, and you will understand the function of it, and their place for your chronic posterior compartment clients. Don't reflexively judge until you try them. It is good to have options for your clients, because "stop running" is not an option for runners, for our runners, unless all else has failed.

Shawn Allen, the other Gait Guy

#thegaitguys, #gait, #hoka, #metarocker, #achilles, #tendinitis, #gaitproblems, #gaitanalysis, #calfpain, #running

J Sci Med Sport. 2015 Mar;18(2):133-8. doi: 10.1016/j.jsams.2014.02.008. Epub 2014 Feb 14.

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Sobhani S1, Zwerver J2, van den Heuvel E3, Postema K4, Dekker R5, Hijmans JM6.

LLD's and Achilles Tendinopathy

Sometimes, it doesn't matter whether it is long or short.

 Achilles tendinopathy .. there are many factors that can contribute. Have you considered leg length inequality? Generally speaking, People have a tendency to overpronate on the longer leg side and under prone only shorter leg side with strain on the medial and lateral aspects of the Achilles tendon respectively. It would make sense that this could be a contributing factor.

 "The mean inequality in length of legs (ILL) was 5 +/- 4 mm. Among the 48 patients with ILL > or = 5 mm, the side affected with ruptured tendon was longer in 48% of cases and shorter in 52%. "

Age and pathology can play a role with younger, healthy tender and having greater compliance.

Proprioception is impaired on the affected side of folks with Achilles tendinopathy. This is a "chicken and the egg" scenario. Did impaired proprioception cause the tendinopathy or is the tendinopathy causing the impaired proprioception? Probably, a little bit of both.

Dr Ivo, one of The Gait Guys

Leppilahti J, Korpelainen R, Karpakka J, Kvist M, Orava S. Ruptures of the Achilles tendon: relationship to inequality in length of legs and to patterns in the foot and ankle. Foot Ankle Int. 1998 Oct;19(10):683-7.

Scholes M, Stadler S, Connell D, Barton C, Clarke RA, Bryant AL, Malliaras P. Men with unilateral Achilles tendinopathy have impaired balance on the symptomatic side. J Sci Med Sport. 2018 May;21(5):479-482. doi: 10.1016/j.jsams.2017.09.594. Epub 2017 Oct 6.

Intziegianni K, Cassel M, Rauf S, White S, Rector M, Kaplick H, Wahmkow G, Kratzenstein S, Mayer F. Influence of Age and Pathology on Achilles Tendon Properties During a Single-leg Jump. Int J Sports Med. 2016 Nov;37(12):973-978. Epub 2016 Aug 8.

#achilles,#tendon, #achillestendon, #tendinopathy, #proprioception

Chronic achilles tendonitis? Transferring a tendon ?

Screen Shot 2018-11-11 at 9.06.57 AM.png

On occasion we understand extreme measures are necessary, some things just do not heal sometimes. But tendon transfers have always boggled our mind. We can see the value in someone of senior age who is not all that active anymore and won't express some of the more extreme side effects of a tendon transfer, and benefit more from the positive effects of the outcome.
But, this article outlines just a portion of the concerns we discuss with our clients who have had these types of issues proposed.
First of all, what is crazy to us, is that these were just chronic achilles cases. We wonder if these cases had undergone some similar work following Jill Cooks tendon reloading paradigm. One has to wonder if ever outlet was attempted, surgery should always be the last option.

But, if you are tendon transferring the FHL (long hallux flexor) or the FDL (long digit/toe flexors) to the achilles to piggyback load, there is gonna be changes in biomechanics obviously.
- the balance between long and short hallux flexors and extensors will be disrupted, possibly leading to windlass mechanism impairments, leading to 1st MTP joint impairment and thus toe off impairment. This could also create complications in hallux extenson (dorsiflexion) which we know can change the foot's arch dynamics.
- the balance between long and short toe flexors and extensors will be disrupted, possibly leading to hammer toes, swan neck deformities of the toes and thus impairment of the lumbricals and thus proper metatarsal loading at late stance phases of gait, there might be fat pad migration issues, gripping attempts for foot stability, more or less pronation-supination events etc. The possible lists are long and winding.

This study also mentioned some changes in "single leg heel rise test in the operated extremity, although there was significant difference when comparing operated and uninvolved sides. One patient reported weakness for plantar flexion of the lesser toes, without balance or gait disturbances."
There are going to be biomechanical changes, and knowing the normal mechanics and gait cycles will help you determine what the post-operative impairments mean, are, and what things you might do to help your client in terms of coming up with some new forced compensations to teach your client.
However, we say, exhaust all of your options. For these chronic achilles problems, safe, pain free, progressive isometric loading does really well for these cases. It just takes time and lots of work for the client. Progressive loading seems to be a huge key though.

Foot Ankle Surg. 2017 Dec 19. pii: S1268-7731(17)31364-4. doi: 10.1016/j.fas.2017.12.003. [Epub ahead of print]
Outcomes of flexor digitorum longus (FDL) tendon transfer in the treatment of Achilles tendon disorders.
de Cesar Netto C1, Chinanuvathana A2, Fonseca LFD2, Dein EJ3, Tan EW4, Schon LC2.

Sometimes, it doesn't matter whether it is long or short.

Achilles tendinopathy (AT) .. there are many factors that can contribute.

Have you considered leg length inequality? Generally speaking, People have a tendency to overpronate on the longer leg side and under prone only shorter leg side with strain on the medial and lateral aspects of the Achilles tendon respectively. It would make sense that this could be a contributing factor.

 "The mean inequality in length of legs (ILL) was 5 +/- 4 mm. Among the 48 patients with ILL > or = 5 mm, the side affected with ruptured tendon was longer in 48% of cases and shorter in 52%. " (1)

Age and pathology can play a role with younger, healthy tendons having greater compliance, with compliance being considered a risk factor for AT.(2)

Proprioception is impaired on the affected side of folks with Achilles tendinopathy (3). This is a "chicken and the egg" scenario. Did impaired proprioception cause the tendinopathy or is the tendinopathy causing the impaired proprioception? Probably, a little bit of both.

All this and more to be discussed in one of the 3 cases we will discuss tomorrow evening, Wednesday, August 15th on onlinece.com: Biomechanics 320   5PST, 6 MST, 7 CST, 8 EST

Hope to see you there!

1. Leppilahti J, Korpelainen R, Karpakka J, Kvist M, Orava S. Ruptures of the Achilles tendon: relationship to inequality in length of legs and to patterns in the foot and ankle. Foot Ankle Int. 1998 Oct;19(10):683-7.

2. Intziegianni K, Cassel M, Rauf S, White S, Rector M, Kaplick H, Wahmkow G, Kratzenstein S, Mayer F. Influence of Age and Pathology on Achilles Tendon Properties During a Single-leg Jump. Int J Sports Med. 2016 Nov;37(12):973-978. Epub 2016 Aug 8.

3. Scholes M, Stadler S, Connell D, Barton C, Clarke RA, Bryant AL, Malliaras P. Men with unilateral Achilles tendinopathy have impaired balance on the symptomatic side. J Sci Med Sport. 2018 May;21(5):479-482. doi: 10.1016/j.jsams.2017.09.594. Epub 2017 Oct 6.

Neuromechanical adaptations in achilles tendinosis

It is not just about the tendon. A perspective on asymmetry.

We are coming back to this important article again.
When you have a tendon problem, you have other problems. There is the muscle-tendon relationship, there is the CNS component, and there are the other muscles regionally within the related loaded chains. Because of these multiple integrated components, this "illustrates the human body's capacity to adapt to tendon pathology and provide the physiological basis for intervention or prevention strategies".
"If a component in the loop loses its integrity, the entire system has to adapt to that deficiency. "
We have discussed on recent TGG podcasts this important ability of a tendon to have sufficient stiffness, to be more precise, to produce sufficient stiffness. Degenerative tendons exhibit less stiffness and so when this issue is present, we move into the adaptive strategies of the entire system that was alluded to above. Adaptation begins; agonist, synergist, antagonist muscles, CNS, motor pattern adaptive patterns ensue.
It has been suggested by this study that these compensations are unilateral, on the affected side, thus driving asymmetrical neuromechanical adaptations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553058/

Degenerative Achilles tendons have reduced stiffness.

On yesterday's podcast 127 recording (launch in 3 weeks), we go down this rabbit hole. A worthy hole.
This is important stuff, if you are treating people, (unlike Joe Rogan and the Scibabe, soft slap there, they should use their platform to interview really smart people when it comes to medicine :), you need to know this stuff.

"Achilles tendon, when degenerated, exhibits lower stiffness. This local mechanical deficit may be compensated for by an alteration of motor commands from the CNS. These modulations in motor commands from the CNS may lead to altered activation of the agonist, synergist and antagonist muscles. "

https://www.ncbi.nlm.nih.gov/pubmed/26046962

Podcast 129: The Random Topic Podcast.

Links to find the podcast:

iTunes page: https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

http://traffic.libsyn.com/thegaitguys/pod_129final.mp3

http://thegaitguys.libsyn.com/podcast-129

Key Tagwords:

usain bolt, gait, gait asymmetry, isometrics, isotonics, RF ablation, COOLIEF, OA, deafferentation, knee arthritis, ibuprofin, kidney damage, NSAIDS, heel drop, achilles, tendonitis, heel pain, 

Our Websites:
www.thegaitguys.com

summitchiroandrehab.com   doctorallen.co     shawnallen.net


Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
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).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

Healing Tech in Neuroscience:

New device can heal with a single touch
https://www.usatoday.com/story/news/nation-now/2017/08/07/miracle-device-can-heal-single-touch-and-even-repair-brain-injuries/537326001/

Cool radiofrequency ablation
http://www.nbcnews.com/health/health-news/cool-new-knee-procedure-eases-arthritis-pain-without-surgery-n771221

Updates on Ibuprofin in runners
http://womensrunning.competitor.com/2017/07/news/ibuprofen-risks-endurance-runners_78580#EyIoMyAdkPW9UBpP.97

PeerJ. 2017 Jul 19;5:e3592. doi: 10.7717/peerj.3592. eCollection 2017.
Sonographic evaluation of the immediate effects of eccentric heel drop exercise on Achilles tendon and gastrocnemius muscle stiffness using shear wave elastography.
Leung WKC1, Chu KL1, Lai C1.

Front Physiol. 2017 Feb 28;8:91. doi: 10.3389/fphys.2017.00091. eCollection 2017.
Quantification of Internal Stress-Strain Fields in Human Tendon: Unraveling the Mechanisms that Underlie Regional Tendon Adaptations and Mal-Adaptations to Mechanical Loading and the Effectiveness of Therapeutic Eccentric Exercise.
Maganaris CN1, Chatzistergos P2, Reeves ND3, Narici MV4.

Oman Med J. 2010 Jul; 25(3): 155–1661.
An Overview of Clinical Pharmacology of Ibuprofen
Rabia Bushra* and Nousheen Aslam
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191627/

Pharm Biol. 2014 Feb;52(2):182-6. doi: 10.3109/13880209.2013.821665. Epub 2013 Sep 30.
Zizyphus jujuba protects against ibuprofen-induced nephrotoxicity in rats. Awad DS1, Ali RM, Mhaidat NM, Shotar AM.
https://www.ncbi.nlm.nih.gov/pubmed/24074058

Gait asymmetry ?
https://www.ncbi.nlm.nih.gov/pubmed/28759127
Scand J Med Sci Sports. 2017 Jul 31. doi: 10.1111/sms.12953. [Epub ahead of print]
Kinematic stride cycle asymmetry is not associated with sprint performance and injury prevalence in athletic sprinters.
Haugen T1, Danielsen J2, McGhie D2, Sandbakk Ø1,2, Ettema G2.

Podcast 128: Usain Bolt, Plantaris Tears, Arm Swing

Podcast links:

http://traffic.libsyn.com/thegaitguys/pod_128final.mp3

http://thegaitguys.libsyn.com/podcast-128-usain-bolt-plantaris-tears-arm-swing

https://www.thegaitguys.com/podcasts/


Key Tagwords:

usain bolt, plantaris tear, plantaris, sole lifts, heel lift, leg length, short leg, heel drop, shoeque, symmetry, asymmetry, sprinters, scoliosis, tendinopathy, achilles, runners, marathons, running injuries, arm swing

Our Websites:
www.thegaitguys.com
summitchiroandrehab.com   doctorallen.co     shawnallen.net


Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
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).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

Superficial plantar cutaneous sensation does not trigger barefoot running adaptations.

https://www.ncbi.nlm.nih.gov/pubmed/28728130

Arm swing
http://www.medicalnewstoday.com/articles/173680.php

Usain bolt
https://mobile.nytimes.com/2017/07/20/sports/olympics/usain-bolt-stride-speed.html?referer=

Plantaris tears
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978447/

Podcast 127: Tendinopathies, Tendon Pain & more.

Key Tagwords:

neuroscience, hip pain, tendonopathy, DNA, running, injuries, achilles, tendonitis, gait, shoecue

Show Links:

http://traffic.libsyn.com/thegaitguys/pod_127f.mp3

http://thegaitguys.libsyn.com/podcast-127-tendinopathies-tendon-pain-more

 

Our Websites:


www.thegaitguys.com

summitchiroandrehab.com   doctorallen.co     shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
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).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

New neuron science
http://trendintech.com/2017/04/05/groundbreaking-study-reveals-neurons-communicate-in-a-way-we-never-imagined/

Exercise strengthens you DNA
http://www.mensfitness.com/training/build-muscle/exercise-strengthens-your-dna

Development of overuse tendinopathy: A new descriptive model for the initiation of tendon damage during cyclic loading
Tyler W. Herod, Samuel P. Veres
https://twitter.com/stijnbog/status/875270547562692608

The neuromechanical adaptations to Achilles tendinosis.
J Physiol. 2015 Aug 1;593(15):3373-87. doi: 10.1113/JP270220. Epub 2015 Jun 30.
Chang YJ1, Kulig K1.

Hip muscle strength is decreased in middle-aged recreational male athletes with midportion Achillestendinopathy: A cross-sectional study.
Phys Ther Sport. 2017 May;25:55-61. doi: 10.1016/j.ptsp.2016.09.008. Epub 2016 Sep 13.
Habets B1, Smits HW2, Backx FJG3, van Cingel REH4, Huisstede BMA5.

Changes of gait parameters and lower limb dynamics in recreational runners with achilles tendinopathy. Kim S1, Yu J2.
J Sports Sci Med. 2015 May 8;14(2):284-9. eCollection 2015 Jun.

Vibrations and strides
http://www.popsci.com/measuring-vibrations-runners-strides-could-prevent-muscle-injuries

ShoeCue product:
https://www.shoecue.com/?gclid=CKL1mI_e8tQCFZi4wAodgXMPJA

RULES of tendonopathies:
https://pbs.twimg.com/media/C3BbmWlXgAAg-ZA.png:large

Roger Enoka
http://www.humankinetics.com/products/all-products/neuromechanics-of-human-movement-5th-edition

http://onlinelibrary.wiley.com/doi/10.1002/jor.23629/abstract?campaign=wolacceptedarticle

Achilles Tendinitis?

You should read this study if you haven't already

We all treat different forms of achilles tendinitis and tendonosis. This landmark study uses loaded eccentrics and showed better tendon organization and decreased tendon thickness at follow up. 

Tendons do seem to respond better to tension and loaded eccentrics certainly seems to do the job. Though, this study is 2004 and much new research has leaned us all more toward looking at pain free isometrics , in other words, taking that tension in a pain free single range load and helping the tendon to reestablish appropriate stiffness. Tension and time under pain free load is the key, then expanding from that into more dynamic load challenges like eccentrics. But, as always, it is finding the load your client can pain free tolerate, get the organism to reload the tissue without threat and then build durability and tissue tolerance to load.

"Conclusions: Ultrasonographic follow up of patients with mid-portion painful chronic Achilles tendinosis treated with eccentric calf muscle training showed a localised decrease in tendon thickness and a normalised tendon structure in most patients. Remaining structural tendon abnormalities seemed to be associated with residual pain in the tendon."

Ohberg L, Lorentzon R, Alfredson H, Maffulli N. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. British Journal of Sports Medicine. 2004;38(1):8-11. doi:10.1136/bjsm.2001.000284.

link to abstract: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724744/

Podcast 126: Running, Athletes & MTSS (Medial Tibial Stress Syndrome)

Key tag words:
running, gait, injuries, achilles tendon, CRIPSR, swearing, limbic system, MTSS, stress fractures, tibial stress fracture, medial tibial stress syndrome, shoe drop, treadmill running, treadmills, barefoot, cortisone, cartilage loss, runners, marathons

Plus a plethora of other great running geeky stuff, clinical pearls, swearing, why not to use cortisone injections and more !

Podcast location links:

http://traffic.libsyn.com/thegaitguys/pod_126fmp3.mp3

http://thegaitguys.libsyn.com/podcast-126-running-athletes-mtss-medial-tibial-stress-syndrome

http://directory.libsyn.com/episode/index/id/5563258

Our Websites:
www.thegaitguys.com

summitchiroandrehab.com   doctorallen.co     shawnallen.net



Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
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).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

Implantable computer chips will control your body’s movement
http://nypost.com/2017/05/16/implantable-computer-chips-will-control-your-bodys-movement/?utm_campaign=partnerfeed&utm_medium=syndicated&utm_source=flipboard

ANU researchers grow brain cells on a chip that can be used for neural implants
http://tech.firstpost.com/news-analysis/anu-researchers-grow-brain-cells-on-a-chip-that-can-be-used-for-neural-implants-376218.html

How Scientists Think CRISPR Will Change Medicine
http://time.com/4764488/crispr-genomic-technology/

'Exercise-in-a-pill' steps closer with new study
http://www.medicalnewstoday.com/articles/317263.php

Swearing can boost muscle strength and stamina, scientists claim
http://www.mirror.co.uk/lifestyle/health/swearing-can-boost-muscle-strength-10358340

MTTS: medial tibial stress syndrome
https://www.thegaitguys.com/thedailyblog/2017/5/2/medial-tibial-stress-syndrome-mtss-and-the-long-flexor-of-the-big-toe

Corticosteriod coffin
Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee OsteoarthritisA Randomized Clinical Trial

Timothy E. McAlindon, DM, MPH1; Michael P. LaValley, PhD2; William F. Harvey, MD1; et al

https://twitter.com/JAMA_current/status/864631934483345408

http://jamanetwork.com/journals/jama/fullarticle/2626573?utm_source=TWITTER&utm_medium=social_jn&utm_term=901304561&utm_content=content_engagement|article_engagement&utm_campaign=article_alert&linkId=37665463

Achilles Tendon Load is Progressively Increased with Reductions in Walking Speed.
http://journals.lww.com/acsm-msse/Abstract/publishahead/Achilles_Tendon_Load_is_Progressively_Increased.97204.aspx

Shoe drop has opposite influence on running pattern when running overground or on a treadmill.   Nicolas Chambon et al
https://link.springer.com/article/10.1007%2Fs00421-014-3072-x

Podcast 122: Achilles problems, glutes, & feet.

Key tag words:
neuroscience, elon musk, achilles, tendonitis, tendonopathy, eccentric loading, tendon loading, gluteus maximus, gmax, glutes, abductor hallucis, foot pain, hip biomechanics, navicular drop, BEAR, ACL tear, ACL reconstruction, plantar fascitis
 

Show links:

http://traffic.libsyn.com/thegaitguys/pod_122f.mp3

http://thegaitguys.libsyn.com/podcast-122-achilles-problems-glutes-the-feet
Show sponsors:
 www.newbalancechicago.com


www.thegaitguys.com
That is our website, and it is all you need to remember. Everything you want, need and wish for is right there on the site.
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).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

Stanford Develops Computer That Literally Plugs Into People's Brains

https://www.entrepreneur.com/article/289645


Elon Musk says humans must become cyborgs to stay relevant. 

https://www.theguardian.com/technology/2017/feb/15/elon-musk-cyborgs-robots-artificial-intelligence-is-he-right

1. achilles tendonopathy:

http://www.jospt.org/doi/abs/10.2519/jospt.2016.6462?platform=hootsuite&code=jospt-site

2. achilles tendinitis and tendonosis.

Ohberg L, Lorentzon R, Alfredson H, Maffulli N. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. British Journal of Sports Medicine. 2004;38(1):8-11. doi:10.1136/bjsm.2001.000284.

link to abstract: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724744/

3. Is Achilles tendon blood flow related to foot pronation?
 E. Wezenbeek,T. M. Willems,N. Mahieu,I. Van Caekenberghe,E. Witvrouw,D. De Clercq

http://onlinelibrary.wiley.com/doi/10.1111/sms.12834/full

4.  The effects of gluteus maximus and abductor hallucis strengthening exercises for four weeks on navicular drop and lower extremity muscle activity during gait with flatfoot

Young-Mi Goo, MS, PT,1 Tae-Ho Kim, PhD, PT,1,* and Jin-Yong Lim, MS, PT1  J Phys Ther Sci. 2016 Mar; 28(3): 911–915.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4842464/

5. BEAR
https://www.youtube.com/watch?v=k3g-CagCrZM

Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) procedure uses stitches and a bridging scaffold (a sponge injected with the patient’s blood) to stimulate healing of the torn ACL eliminating the need tendon graft.

References:
Murray, M., Flutie, B., Kalish, L., Ecklund, K., Fleming, B., Proffen, B. and Micheli, L. (2016). The Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) Procedure: An Early Feasibility Cohort Study. Orthopaedic Journal of Sports Medicine, 4(11).

L. Proffen, B., S. Perrone, G., Roberts, G. and M. Murray, M. (2015). Bridge-Enhanced ACL Repair: A Review of the Science and the Pathway Through FDA Investigational Device Approval. Annals of Biomedical Engineering, 43(3), pp.805-818.

Achilles Tendinitis

You should read this study if you haven't already

We all treat different forms of achilles tendinitis and tendonosis. This landmark study uses loaded eccentrics and showed better tendon organization and decreased tendon thickness at follow up. 

Tendons do seem to respond better to tension and loaded eccentrics certainly seems to do the job. 

"Conclusions: Ultrasonographic follow up of patients with mid-portion painful chronic Achilles tendinosis treated with eccentric calf muscle training showed a localised decrease in tendon thickness and a normalised tendon structure in most patients. Remaining structural tendon abnormalities seemed to be associated with residual pain in the tendon."

Ohberg L, Lorentzon R, Alfredson H, Maffulli N. Eccentric training in patients with chronic Achilles tendinosis: normalised tendon structure and decreased thickness at follow up. British Journal of Sports Medicine. 2004;38(1):8-11. doi:10.1136/bjsm.2001.000284.

link to abstract: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724744/

David and Goliath: The calf and the glute.

-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

Podcast 109: A clinical case of a total knee replacement and achilles tendonopathy.

Great open clinical discussions today on things we see in the clinic. We start with a great case that opens up the dialogue, a case of a total knee replacement and achilles tendonitis.  Hope you will join us on this clinical journey today.

Interested in our store ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.tumblr.com) and you will come to our blog. In the left tab, you will find tabs for STORE, SEMIANRS, 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). 

A. Podcast links:

http://traffic.libsyn.com/thegaitguys/pod_109f.mp3

http://thegaitguys.libsyn.com/podcast-109-a-clinical-case-of-a-total-knee-replacement-and-achilles-tendonopathy

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:

Loose dialogue  on Anterior pelvis tilt and training it out

https://www.t-nation.com/training/dont-be-like-donald-duck?utm_source=facebook&utm_medium=social&utm_campaign=article3173

Ivo put up 2 articles recently on “Why is your muscle tight” and “iliocapsularis” muscle.
Why training the upper body might help integrate arms into gait for sporthttp://thegaitguys.tumblr.com/post/141990433844/gait-and-climbing-and-dns-part-2-introducing

http://journals.lww.com/acsm-msse/Abstract/publishahead/Influence_of_Step_Rate_on_Shin_Injury_and_Anterior.97596.aspx
- cross over looked at ?- ankle rocker looked at ?  endurance of anteiror compt looked at ?

Achilles Tendonitis/Tendinopathy and Needling    Achilles pain. You can’t live with it and you can’t live with it. Can needling help? The obvious answer is yes, but there is more as well.    There appears to be sufficient data to support the use of needling for achilles tendon problems . Perhaps it is the “reorganization” of collagen that makes it effective or a blood flow/vascularization phenomenon. 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, affecting the alpha receptors and causing vasodilation.   Loss of ankle dorsiflexion is a common factor that seems to contribute to achilles tendinopathies . It would seem that improving ankle rocker would be most helpful. In at least one study, needling restored ankle function and in another it improved strength.   And don’t forget to go north of the lower leg/foot/ankle complex. The gluteus medius can many times the culprit as well. During running, the gluteus medius usually fires before heel strike, most likely to stabilize the hip and the pelvis. In runners with Achilles Tendonitis, its firing is delayed which may affect the kinematics of knee and ankle resulting in rear foot inversion. Perhaps the delayed action of the gluteus medius allows an adductory moment of the pelvis, moving the center of gravity medially. This could conceivably place additional stress on the achilles tendon (via the lateral gastroc) to create more eversion of the foot from midstance onward.   Similarly, in runners with achilles tendoinopathy, the gluteus maximus does not fire as long and activation is delayed. The glute max should be the primary hip extensor and decreased hip extension might be compensated by an increased ankle plantarflexion which could potentially increase the load on the Achilles tendon.   So, in short, yes, needling will probably help, for these reasons and probably many more. Make sure to needle all the dysfunctional muscles up the chain, beginning at the foot and moving rostrally.    Effectiveness of Acupuncture Therapies to Manage Musculoskeletal Disorders of the Extremities: A Systematic Review. Cox J, Varatharajan S, Côté P, Optima Collaboration. J Orthop Sports Phys Ther. 2016 Jun;46(6):409-29. doi: 10.2519/jospt.2016.6270. Epub 2016 Apr 26    Acupuncture’s role in tendinopathy: new possibilities. Speed C. Acupunct Med. 2015 Feb;33(1):7-8. doi: 10.1136/acupmed-2014-010746. Epub 2015 Jan 9.   The effect of electroacupuncture on tendon repair in a rat Achilles tendon rupture model.  Inoue M, Nakajima M, Oi Y, Hojo T, Itoi M, Kitakoji H. Acupunct Med. 2015 Feb;33(1):58-64. doi: 10.1136/acupmed-2014-010611. Epub 2014 Oct 21.  KIishmishian B, Selfe J, Richards J A Historical Review of Acupuncture to the Achilles Tendon and the development of a standardized protocol for its use Journal of the Acupuncture Association of Chartered Physiotherpists Spring 2012,  69-78  Acupuncture for chronic Achilles tendnopathy: a randomized controlled study. Zhang BM1, Zhong LW, Xu SW, Jiang HR, Shen J. Chin J Integr Med. 2013 Dec;19(12):900-4. doi: 10.1007/s11655-012-1218-4. Epub 2012 Dec 21.  The effect of dry needling and treadmill running on inducing pathological changes in rat Achilles tendon. Kim BS, Joo YC, Choi BH, Kim KH, Kang JS, Park SR. Connect Tissue Res. 2015 Nov;56(6):452-60. doi: 10.3109/03008207.2015.1052876. Epub 2015 Jul 29.  Tendon needling for treatment of tendinopathy: A systematic review. Krey D, Borchers J, McCamey K. Phys Sportsmed. 2015 Feb;43(1):80-6. doi: 10.1080/00913847.2015.1004296. Epub 2015 Jan 22. Review.  Acupuncture increases the diameter and reorganisation of collagen fibrils during rat tendonhealing. de Almeida Mdos S, de Freitas KM, Oliveira LP, Vieira CP, Guerra Fda R, Dolder MA, Pimentel ER. Acupunct Med. 2015 Feb;33(1):51-7. doi: 10.1136/acupmed-2014-010548. Epub 2014 Aug 19.  Electroacupuncture increases the concentration and organization of collagen in a tendon healing model in rats. de Almeida Mdos S, de Aro AA, Guerra Fda R, Vieira CP, de Campos Vidal B, Rosa Pimentel E. Connect Tissue Res. 2012;53(6):542-7. doi: 10.3109/03008207.2012.710671. Epub 2012 Aug 14.  Changes in blood circulation of the contralateral Achilles tendon during and after acupunctureand heating.Kubo K, Yajima H, Takayama M, Ikebukuro T, Mizoguchi H, Takakura N. Int J Sports Med. 2011 Oct;32(10):807-13. doi: 10.1055/s-0031-1277213. Epub 2011 May 26.  Microcirculatory effects of acupuncture and hyperthermia on Achilles tendon microcirculation. Kraemer R, Vogt PM, Knobloch K. Eur J Appl Physiol. 2010 Jul;109(5):1007-8. doi: 10.1007/s00421-010-1442-6. Epub 2010 Mar 28.  Effects of acupuncture and heating on blood volume and oxygen saturation of human Achilles tendon in vivo. Kubo K, Yajima H, Takayama M, Ikebukuro T, Mizoguchi H, Takakura N. Eur J Appl Physiol. 2010 Jun;109(3):545-50. doi: 10.1007/s00421-010-1368-z. Epub 2010 Feb 6.   Insertional achilles tendinopathy associated with altered transverse compressive and axial tensile strain during ankle dorsiflexion. Chimenti RL, Bucklin M, Kelly M, Ketz J, Flemister AS, Richards MS, Buckley MR. J Orthop Res. 2016 Jun 16. doi: 10.1002/jor.23338. [Epub ahead of print]  Forefoot and rearfoot contributions to the lunge position in individuals with and without insertionalAchilles tendinopathy. Chimenti RL, Forenza A, Previte E, Tome J, Nawoczenski DA.Clin Biomech (Bristol, Avon). 2016 Jul;36:40-5. doi: 10.1016/j.clinbiomech.2016.05.007. Epub 2016 May 11.  Ankle Power and Endurance Outcomes Following Isolated Gastrocnemius Recession for AchillesTendinopathy. Nawoczenski DA, DiLiberto FE, Cantor MS, Tome JM, DiGiovanni BF. Foot Ankle Int. 2016 Mar 17. pii: 1071100716638128. [Epub ahead of print]   In vivo quantification of the shear modulus of the human Achilles tendon during passive loading using shear wave dispersion analysis. Helfenstein-Didier C, Andrade RJ, Brum J, Hug F, Tanter M, Nordez A, Gennisson JL. Phys Med Biol. 2016 Mar 21;61(6):2485-96. doi: 10.1088/0031-9155/61/6/2485. Epub 2016 Mar 7.  Changes of gait parameters and lower limb dynamics in recreational runners with achillestendinopathy. Kim S, Yu J. J Sports Sci Med. 2015 May 8;14(2):284-9. eCollection 2015 Jun.  Gastrocnemius recession for foot and ankle conditions in adults: Evidence-based recommendations. Cychosz CC, Phisitkul P, Belatti DA, Glazebrook MA, DiGiovanni CW. Foot Ankle Surg. 2015 Jun;21(2):77-85. doi: 10.1016/j.fas.2015.02.001. Epub 2015 Feb 26. Review.  Limited ankle dorsiflexion increases the risk for mid-portion Achilles tendinopathy in infantry recruits: a prospective cohort study. Rabin A, Kozol Z, Finestone AS. J Foot Ankle Res. 2014 Nov 18;7(1):48. doi: 10.1186/s13047-014-0048-3. eCollection 2014.  Perry J. Gait Analysis: Normal and Pathological Function. Thorofare, NJ: Slack 1992.    Chan YY, Mok KM, Yung PSh, Chan KM. Sports Med Arthrosc Rehabil Ther Technol. 2009 Jul 30;1:14. doi: 10.1186/1758-2555-1-14.   Bilateral effects of 6 weeks’ unilateral acupuncture and electroacupuncture on ankle dorsiflexors muscle strength: a pilot study. Zhou S, Huang LP, Liu J, Yu JH, Tian Q, Cao LJ. Arch Phys Med Rehabil. 2012 Jan;93(1):50-5. doi: 10.1016/j.apmr.2011.08.010. Epub 2011 Nov 8.  Franettovich Smith MM1, Honeywill C, Wyndow N, Crossley KM, Creaby MW. : Neuromotor control of gluteal muscles in runners with achilles tendinopathy.
Med Sci Sports Exerc. 2014 Mar;46(3):594-9.

Achilles Tendonitis/Tendinopathy and Needling


Achilles pain. You can’t live with it and you can’t live with it. Can needling help? The obvious answer is yes, but there is more as well.

There appears to be sufficient data to support the use of needling for achilles tendon problems . Perhaps it is the “reorganization” of collagen that makes it effective or a blood flow/vascularization phenomenon. 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, affecting the alpha receptors and causing vasodilation. 

Loss of ankle dorsiflexion is a common factor that seems to contribute to achilles tendinopathies . It would seem that improving ankle rocker would be most helpful. In at least one study, needling restored ankle function and in another it improved strength. 

And don’t forget to go north of the lower leg/foot/ankle complex. The gluteus medius can many times the culprit as well. During running, the gluteus medius usually fires before heel strike, most likely to stabilize the hip and the pelvis. In runners with Achilles Tendonitis, its firing is delayed which may affect the kinematics of knee and ankle resulting in rear foot inversion. Perhaps the delayed action of the gluteus medius allows an adductory moment of the pelvis, moving the center of gravity medially. This could conceivably place additional stress on the achilles tendon (via the lateral gastroc) to create more eversion of the foot from midstance onward.

Similarly, in runners with achilles tendoinopathy, the gluteus maximus does not fire as long and activation is delayed. The glute max should be the primary hip extensor and decreased hip extension might be compensated by an increased ankle plantarflexion which could potentially increase the load on the Achilles tendon. 

So, in short, yes, needling will probably help, for these reasons and probably many more. Make sure to needle all the dysfunctional muscles up the chain, beginning at the foot and moving rostrally.

Effectiveness of Acupuncture Therapies to Manage Musculoskeletal Disorders of the Extremities: A Systematic Review. Cox J, Varatharajan S, Côté P, Optima Collaboration. J Orthop Sports Phys Ther. 2016 Jun;46(6):409-29. doi: 10.2519/jospt.2016.6270. Epub 2016 Apr 26

Acupuncture’s role in tendinopathy: new possibilities. Speed C. Acupunct Med. 2015 Feb;33(1):7-8. doi: 10.1136/acupmed-2014-010746. Epub 2015 Jan 9.

The effect of electroacupuncture on tendon repair in a rat Achilles tendon rupture model.  Inoue M, Nakajima M, Oi Y, Hojo T, Itoi M, Kitakoji H. Acupunct Med. 2015 Feb;33(1):58-64. doi: 10.1136/acupmed-2014-010611. Epub 2014 Oct 21.

KIishmishian B, Selfe J, Richards J A Historical Review of Acupuncture to the Achilles Tendon and the development of a standardized protocol for its use Journal of the Acupuncture Association of Chartered Physiotherpists Spring 2012,  69-78

Acupuncture for chronic Achilles tendnopathy: a randomized controlled study. Zhang BM1, Zhong LW, Xu SW, Jiang HR, Shen J. Chin J Integr Med. 2013 Dec;19(12):900-4. doi: 10.1007/s11655-012-1218-4. Epub 2012 Dec 21.

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