The top 6 reasons we like hills for training ankle rocker and hip extension

image source: https://commons.wikimedia.org/wiki/File:Caer_Caradoc_hill.jpg

image source: https://commons.wikimedia.org/wiki/File:Caer_Caradoc_hill.jpg

1. Hills do not cost money and are almost always readily available : )

2. Being outside is good for your health

3. Hills do not pull the hip into extension and place a stretch (pull) on the anterior hip musculature including the rectus femoris, iliopsoas and iliacus. This causes a slow stretch of the muscle, activating the muscle spindles (Ia afferents) and causing a muscle contraction via the stretch reflex. This will inhibit the posterior compartment of hip extensors (especially the glute max) through reciprocal inhibition, making it difficult to fire them.

4. A hill does not force your knee into extension, eliciting a stretch reflex in the hamstrings like a treadmill does

5. A hill naturally puts the ankle into dorsiflexion, and, along with active pulling up of the toes, helps you to get more into your anterior compartment and eliminates the tendency of the ankle being pulled into dorsiflexion (like with a treadmill) which would initiate a stretch reflex in the gastroc/soleus and long flexors.

6. The increased hip flexor requirement of going uphill gives you more opportunity to engage the abs before the psoas and rectus femoris/TFL and on the stance phase leg, you can get an increased stretch of those muscles

Tips for picking the right hill and using it to your advantage

  • When just starting out, try and pick an incline that does not exceed the ankle dorsiflexion available to the patient/client

  • It’s OK if it’s uncomfortable, but not if its painful

  • Concentrate on pulling up the toes and dorsiflexing the ankle

  • Squeeze your glute at heel strike and toe off

  • leave your stance phase heel on the ground as long as possible

  • Place your hands on your abs and concentrate on activating them PRIOR to flexing your hip

Dr Ivo Waerlop, one of The Gait Guys

#walkinghills #traininganklerocker #thegaitguys # increasinghipextension



Muscle activation and gait: EMG studies that differentiate!

image credit:  Cappellini G ,  Ivanenko YP ,  Poppele RE ,  Lacquaniti F . Motor patterns in human walking and running.  J Neurophysiol.  2006 Jun;95(6):3426-37. Epub 2006 Mar 22.

image credit: Cappellini G, Ivanenko YP, Poppele RE, Lacquaniti F. Motor patterns in human walking and running. J Neurophysiol. 2006 Jun;95(6):3426-37. Epub 2006 Mar 22.

Got Muscle activation? Looking for some EMG data on what fires when in walking vs running gait? The conclusion and point of the study are good, but the EMG data and diagrams are awesome for those of you seeking a greater understanding of what goes on when

“The major difference between walking and running was that one temporal component, occurring during stance, was shifted to an earlier phase in the step cycle during running. These muscle activation differences between gaits did not simply depend on locomotion speed as shown by recordings during each gait over the same range of speeds (5–9 km/h). The results are consistent with an organization of locomotion motor programs having two parts, one that organizes muscle activation during swing and another during stance and the transition to swing. The timing shift between walking and running reflects therefore the difference in the relative duration of the stance phase in the two gaits.”

A great read and FREE FULL TEXT

Dr Ivo, one of The Gait Guys

Cappellini G, Ivanenko YP, Poppele RE, Lacquaniti F. Motor patterns in human walking and running. J Neurophysiol. 2006 Jun;95(6):3426-37. Epub 2006 Mar 22. link to free full text: http://jn.physiology.org/content/95/6/3426

#gait, #gaitanalysis, #thegaitguys, #gaitabnormality, #EMGgait, #muscleactivation, #musclerecruitmentpattern

Building a Better Bridge

Using bridge exercises? Want to make it more effective? Here's one simple way: bend the weight bearing knee to 135 degrees rather than the traditional 90. It preferentially activates the g max and med more (relatively, compared to the hamstring ; the actual values for the max and med remained similar) and the hamstring significantly less (24% vs 75%)

ijspt-12-543-F001.jpg
ijspt-12-543-F002.jpg

CONCLUSION:

"Modifying the traditional single-leg bridge by flexing the active knee to 135 ° instead of 90 ° minimizes hamstring activity while maintaining high levels of gluteal activation, effectively building a bridge better suited for preferential gluteal activation.

 

Lehecka BJ, Edwards M, Haverkamp R, et al. BUILDING A BETTER GLUTEAL BRIDGE: ELECTROMYOGRAPHIC ANALYSIS OF HIP MUSCLE ACTIVITY DURING MODIFIED SINGLE-LEG BRIDGES. International Journal of Sports Physical Therapy. 2017;12(4):543-549.

link to free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5534144/

Cortical Remapping and Injuries (Redux)

"The gist of this article is that cortical remapping occurs with injuries that are not 100% resolved." - from our archives

Facilitating muscles, "activating" muscles, it is a 2 way street. There is the input into the brain and a corresponding motor output. If you are just "rubbing" out some muscles and get a stronger muscle test afterwards, and that is as far as your thoughts go before you turn your athlete loose, then you may be considered by some to be a stick in the spokes of the bigger system. Simple facilitation without corrective measures or corrective exercises to more permanently remap the optimal pattern may lead to repeated and recurrent pain, problems, re-injury or new injuries, and the like.

As a client adapts to their unresolved, partially resolved (yes, even 95% is unresolved) injury(s) a secondary cascade of neurological changes ensue that often force new cortical remapping. A remapping that is not as fundamentally safe or as sound as the pre-injury mapping yet one that is necessary for protecting further or other injuries. Yet, because it is not the original pristine pattern, it is also one that can begin undercurrents to corrupt other patterns of stability, mobility and movement in cortical and subcortical mappings. Understanding cortical excitability is important, and it can work for you and your client or against you both. It can be used for good or evil.

read on here . . . .

https://thegaitguys.tumblr.com/post/80788172925/activation-cortical-remapping-and-what-you-are

Activation, Cortical Remapping and what you are doing wrong to your people.

We are getting ready to step back into the studio to record podcast 58. We have been touching upon this topic off and on in the last 2 podcasts and we are going back in for more on pod #58 because this stuff is just too important not to beat it to a further pulp.  

The gist of this article is that cortical remapping occurs with injuries that are not 100% resolved. Lots of coaches and trainers out there are trying their hands at muscle “activation” and other new trendy tricks and they are missing the boat and making people worse if they are not doing a good sound clinical history and examination. You can activate any muscles and get what appears to be a miracle response, we can teach a 8 year old how to do activation and get a miracle response, but is it the right response or have you created a temporary compensation for your client (right before you send them into training or competition) ?  Activation is a 2 way street, there is the input into the brain and a corresponding motor output. If you are just rubbing out some muscles and get a stronger muscle test afterwards, and that is as far as your thoughts go before you turn your athlete loose, then you are a liability in the system. Are you part of the problem or part of the solution ?

Here are 2 paragraphs from this brilliant article. This is worth your time. As a client adapts to their unresolved, partially resolved (yes, even 95% is unresolved) injury(s) a secondary cascade of neurological changes ensue that often force new cortical remapping.  A remapping that is not as fundamentally safe or as sound as the pre-injury mapping yet one that is necessary for protecting further or other injuries. Yet, because it is not the original pristine pattern, it is also one that can begin undercurrents to corrupt other patterns of stability, mobility and movement in cortical and subcortical mappings. Understanding cortical excitability is important, and it can work for you and your client or against you both. It can be used for good or evil.  

If after you read these 2 paragraphs taken from the Alan Needle article in LER (link) you think you might be part of the problem or realize that you are not the magician you think you are, then good, you are on the track to self enlightenment and actually helping people.  Go read Alan’s article and breathe deep, ready to absorb and start yourself into understanding that you are really fixing the brain and not always the muscle, and that means you are gonna have to learn about the brain and how it works and more so how it can deceive you and your client and your training, treatments or therapy.

Come join us on The Gait Guys podcast 58 later this week as we delve into this topic deeper and more broadly.

Shawn and Ivo

PS: nice article Dr. Needle. Thank you !

http://lowerextremityreview.com/article/the-brain-a-new-frontier-in-ankle-instability-research

The brain: A new frontier in ankle instability research

http://lowerextremityreview.com/article/the-brain-a-new-frontier-in-ankle-instability-research\

“Recently Wikstrom and Brown proposed a hypothetical cascade of events that would affect an individual’s ability to “cope” following an ankle sprain and provide a rationale for the varying contributors to instability. For an individual starting from a point of normal function, a lateral ankle sprain will trigger a consistent pattern of changes to the joint from the inflammatory process. Swelling will increase pressure on the joint’s mechanoreceptors, and pain will contribute to inhibition of the reflexes to the joint (arthrogenic inhibition). Together, this means patients will have difficulty sensing the joint and subsequently stabilizing it while excessive mechanical laxity will increase this loss of stability.19

Inflammatory changes may be similar across all patients; however, as symptoms remain and the patient adapts after his or her injury, a secondary cascade of neurological changes may occur that may include cortical remapping. In some patients, these adaptations may be beneficial and serve to protect the joint from further injury. Other patients may maladapt, as sensorimotor reorganization changes the nervous system’s perception of the joint. Variable amounts of laxity, proprioception, and cortical excitability exist throughout populations of healthy, previously injured, and functionally unstable joints. Where these populations diverge may be related to how each is scaled relative to the others. For instance, a joint with greater amounts of laxity may have higher proprioception and excitability to aid in stabilizing the joint, but following injury, these factors may become decoupled, leading to errors in movement and coordination.19”  -Alan Needle, PhD

 

Dry Needling and Muscle Activation Patterns

A nice study looking at how sequential muscle activation patterns can change with dry needling. Think about the applications for gait?

"Removing LTrPs changes the order of muscle recruitment to a more sequential, stable pattern that is not significantly different to that displayed by the control group prior to fatiguing exercise. This suggests that removing LTrPs may allow subjects to better cope with the effects of fatigue, as evidenced by the reduced variability in activation times and the reduced co-activation of the muscles investigated. "

FREE FULL TEXT here: https://isbweb.org/images/conf/2003/longAbstracts/LUCAS_198-208_SB_LONGE.pdf

Dry Needling and Myofascial Pain

Regardless of the mechanism, dry needling and ischemic compression both seem to reduce myofascial pain. How about some more studies looking at muscle function and activation patterns?

"This study compared these treatment techniques to one another using the Neck Disability Index (NDI), a numeric rating scale (NRS), pressure pain threshold and muscle characteristics. 42 female patients with myofascial neck pain were randomly assigned to a treatment group and the 4 most painful MTrPs were treated using DN or MPT. No difference was found between the two techniques on the short and long term. Both techniques showed an improvement in NDI on the short and long term. "

Dry needling or manual pressure in myofascial pain? - Anatomy & Physiotherapy

The aim of this study was to compare dry needling to manual pressure in patients with myofascial pain.

ANATOMY-PHYSIOTHERAPY.COM|BY <A HREF="/AUTHORLIST/3:JOANNA1988" TITLE="VIEW ALL ARTICLES FROM JOANNA TUYNMAN">JOANNA TUYNMAN</A>

 

Hmmmm&hellip;  The question is: &ldquo;is the earlier activation a good thing&rdquo;?  What do you say?  &ldquo;A study of patients with chronic ankle instability (CAI) suggests the onset of knee and ankle muscle activity occurs significantly earlier when shoes and orthoses are worn than when the patients are barefoot.&rdquo;   http://lermagazine.com/issues/october/shoes-orthoses-improve-muscle-activation-onset-in-unstable-ankles

Hmmmm…

The question is: “is the earlier activation a good thing”?

What do you say?

“A study of patients with chronic ankle instability (CAI) suggests the onset of knee and ankle muscle activity occurs significantly earlier when shoes and orthoses are worn than when the patients are barefoot.”

http://lermagazine.com/issues/october/shoes-orthoses-improve-muscle-activation-onset-in-unstable-ankles

tumblr_nv42pyzoQp1qhko2so1_1280.jpg
tumblr_nv42pyzoQp1qhko2so2_1280.jpg

Notice the differences in running (top) vs sprinting (bottom) activation patterns?

This picture (along with the MIchaud muscular firing pattern ones) are becoming some of my favorite ones to talk about. I just stare at them and look for differences and similarities. 

Check out that the abs do not seem to fire in running (in this study at least), but do in sprinting. Note also that most muscles fire longer (and we wil assume harder) during sprinting. Also check out the peroneals, which fire just as the foot touches down in sprinting, probably to make up for the instrinsics not firing, and assist in creating a rigid lever for push off. 



from: Mann et al 1986

Podcast 94: The Shoe & Motor Control Podcast

Shoes, Minimalism, Maximalism, Motor fatigue, Brain stuff and more !

A. Link to our server:
http://traffic.libsyn.com/thegaitguys/pod_94final.mp3

Direct Download:  http://thegaitguys.libsyn.com/podcast-94

-Other Gait Guys stuff
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:

movement and brain function; based on your piece: http://www.vancouversun.com/touch/story.html?id=11237102\

shoe fit:
http://running.competitor.com/2015/07/shoes-and-gear/sole-man-the-pros-and-cons-of-buying-cheap-running-shoes_129297

http://www.runresearchjunkie.com/relevant-gems-from-the-2015-footwear-biomechanics-symposium/

Clin Biomech (Bristol, Avon). 2006 Dec;21(10):1090-7. Epub 2006 Sep 1.

The effect of lower extremity fatigue on shock attenuation during single-leg landing.

Coventry E1, O'Connor KM, Hart BA, Earl JE, Ebersole KT.

Dr. Ted Carrick podcast

http://thewellnesscouch.com/bc/bc-07-professor-frederick-ted-carrick-on-the-past-of-functional-neurology

https://itunes.apple.com/au/podcast/backchat/id972497993?mt=2

movement patterns talk: http://www.anatomy-physiotherapy.com/28-systems/musculoskeletal/lower-extremity/knee/1191-altered-movement-patterns-in-individuals-with-acl-rupture

http://lermagazine.com/issues/june/balance-data-suggest-somatosensory-benefit-of-minimalist-footwear-design
Wilson SJ, Chander H, Morris CE, et al. Alternative footwear’s influence on static balance following a one-mile walk. Med Sci Sports Exerc 2015;46(5 Suppl);S562.

http://lermagazine.com/issues/june/running-shoe-reveal-study-links-max-cushioning-higher-load

movement patterns talk: http://www.anatomy-physiotherapy.com/28-systems/musculoskeletal/lower-extremity/knee/1191-altered-movement-patterns-in-individuals-with-acl-rupture

If you plan to live that long, you better start thinking about preservation:
http://www.cnbc.com/id/102730128  

Music piece/ Bass players:
http://mentalfloss.com/article/64955/science-proves-supreme-power-bassists

Can the VMO be selectively activated?

They have a common nerve innervation, so many studies say no. Perhaps altering internal/external orientation of the lower extremity (1) or joint angles (2) may play a role. Of course, it also depends on how you are measuring (3). Intramuscular seems to be most accurate!

In the Link Below, section 4, is a nice, brief review of the literature. Thanks to Daithi Grey for the inspiration to put this up!

1. J Strength Cond Res. 2014 Sep;28(9):2536-45. doi: 10.1519/JSC.0000000000000582.
Range of motion and leg rotation affect electromyography activation levels of the superficial quadriceps muscles during leg extension.Signorile JF1, Lew KM, Stoutenberg M, Pluchino A, Lewis JE, Gao J.

2. Phys Ther Sport. 2013 Feb;14(1):44-9. doi: 10.1016/j.ptsp.2012.02.006. Epub 2012 Jun 26.
Muscle activation of vastus medialis obliquus and vastus lateralis during a dynamic leg press exercise with and without isometric hip adduction. Peng HT1, Kernozek TW, Song CY.

3. J Electromyogr Kinesiol. 2013 Apr;23(2):443-7. doi: 10.1016/j.jelekin.2012.10.003. Epub 2012 Nov 8.
The VMO:VL activation ratio while squatting with hip adduction is influenced by the choice of recording electrode. Wong YM1, Straub RK, Powers CM.


http://www.mikereinold.com/2009/05/10-principles-of-patellofemoral.html

10 Principles of Patellofemoral Rehabilitation - Mike Reinold

“Emphasize the QuadricepsThe next principle of patellofemoral rehabilitation is to strengthen the knee extensor musculature. Some authors have recommended emphasis on enhancing the activation of the VMO in patellofemoral patients based on reports of isolated VMO insufficiency and asynchronous neuromuscular timing between the VMO and VL.While the literature offers conflicted reports on selective recruitment and neuromuscular timing of the vasti musculature, the VMO may have a greater biomechanical effect on medial stabilization of the patella than knee extension due to the angle of pull of the muscle fibers at approximately 50-55 degrees.  Wilk et al(JOSPT 1998) suggest that the VMO should only be emphasized if the angle of insertion of the VMO on the patella is in a position in which it may offer a certain degree of dynamic or active lateral stabilization.  As you can see by the figure, if the fibers are not aligned in a position to assist with patellar stabilization, VMO training will likely not be effective.  This orientation of the muscle fibers will differ from patient to patient and can be visualized.Several interventions and exercise modifications have been advocated to effectively increase the VMO:VL ratio, based mostly on anecdotal observations. These include hip adduction, internal tibial rotation, and patellar taping and bracing. Powers(JOSPT 1998) reports that isolation of VMO activation may not be possible during exercise, stating that several studies have shown that selective VMO function was not found during quadriceps strengthening exercises, exercises incorporating hip adduction, or exercises incorporating internal tibial rotation. Powers also states that although the literature offers varying support for VMO strengthening, successful clinical results have been found while utilizing this treatment approach.My belief is that quadriceps strengthening exercises should be incorporated into patellofemoral rehabilitation programs. Strength deficits of the quadriceps may lead to altered biomechanical properties of the patellofemoral and tibiofemoral joints. Any change in quadriceps force on the patella may modify the resultant force vector produced by the synergistic pull of the quadriceps and patellar tendons, thus altering contact location and pressure distribution of joint forces. Furthermore, the quadriceps musculature serves as a shock absorber during weightbearing and joint compression, any abnormal deviations in quadriceps strength may result in further strain on the patellofemoral and/or tibiofemoral joint.In reality, I believe that quadriceps strengthening is very important for patellofemoral rehabilitation, but many exercises designed to “enhance VMO” strength or activation may actually be disadvantageous to the joint.  Take for example the classic squeezing of the ball during closed kinetic chain exercises such as squatting and leg press.  This creates an IR and adduction moment at the hip that is now known to be detrimental to patellofemoral patients.  I would actually propose that we work on quadriceps strengthening without an adduction component and rather emphasize hip adbuction and external rotation.  This can be performed with the use of a piece of exercise band around the patient’s knees during these exercises. “

Prof. Ted Carrick and the eyes, and some cursory thoughts on gait and brain function as a whole.  We have been blessed to learn from this man and those from his institute, come listen and find out why.

The movements of the eyes are keys to human brain function and movement such as gait.  What kind of eye stuff you ask ? 

How are your clients eye pursuits, saccades, VOR, vergence, OPK or fixation abilities ? All 6 of these are necessary for normal eye and brain function. Without these working properly gait can also be impaired and muscles will not function correctly if they are tied directly to the gait and movement systems.

This is just the tip of the ice berg however.  What about the function of your client’s basal ganglia, thalamus, cerebellum, mesencephalon, cortex, or the vestibular system, as a small sampling. What about the tracts that feed and interconnect all of this stuff, like the corticospinal, vestibulocerebellar, spinocerebellar, rubrospinal, recticulospinal, or vestibulospinal tracts, to name a few ? What about the lobes of the brain, the frontal, parietal, occipital, temporal ?  

Dear gait brethren, you must see that human function is about the nervous system. Nothing happens to the end organ receptors, the muscles, joints, motor patterns and others without proper orchestration of the central, peripheral and autonomic systems. Gait is nothing short of a miraculous event bringing all of the nervous system’s amazing parts into a beautiful symphony of timed and rhythmic events, arm swing, balance, vision, proprioception, postural restrain from gravity and so much more. 

Don’t get too caught up in the latest greatest treatment fad or exercise on the web without understanding that safe, effective, efficient, pain free human locomotion is a product of the orchestra’s grand conductor, the brain.  
The brain is organized beautifully. Do you find yourself over and over again activating your client’s proximal flexors ? You are plugging into the rubrospinal pathways, and perhaps that is not where the golden honey and buscuits are found.  And if you find yourself delving into your client’s distal extensors ? Well, you are plugging into their recticulospinal pathways. How about their proximal extensors ? … . lateral vestibulospinal pathways.  Treatment cannot, and should not, be random. There is a recipe and a right way.  You are either part of your client’s solution or part of their problem. 

Thank you for your brilliance Dr. Ted Carrick, you have changed our lives and those that want the deeper answers as to why and how.  When you know these answers, you don’t need to dip into the latest greatest super double chocolate fudge brownie ice cream “exercise” of the week, when cool and calculated pure Vanilla bean at the right place and the right time will serve as the best answer … .  if you know what you are dealing with, and if you have the right tools.

More on this fun stuff another time. Have a great week gait brethren !

Shawn and Ivo

the gait guys

Do you know your stuff? Would you correct this child’s gait ? Give them orthotics, exercises, force correction, leave them alone ? 

Is he Internal Tibial torsioned ? Is he “pigeon toed” ,if that is the only lingo one knows, :(  Does he have femoral torsion ?  A pronation problem locally at the foot or an internal spin problem through the entire limb ? Or a combination of the above ? 

What’s your solution?

It MUST be based on the knowledge necessary to fix it, not the limits of YOUR knowledge. You can never know what to do for this lad from his gait evaluation, no matter how expensive your digital, multi-sensor, 3D multi-angle, heat sensor, joint angle measuring, beer can opening, gait analysis set up is. You can never know what to do for this lad if you do not know normal gait, normal neuro-developmental windows, normal biomechanics, know about torsions (femoral, tibial, talar etc), foot types etc.  It is a long list.  You cannot know what to do for this kid if you do not know how to accurately and logically examine them. 


Rule number 1. First do no harm.

If your knowledge base is not broad enough, then rule number one can be easily broken ! Hell, if you do not know all of the parameters to check off and evaluate, you might not even know you are breaking rule number one !  If everything looks like a weak muscle, every solution will be to “activate” and strengthen and not look to find the source of that weakness.  Muscles do not “shut down” or become inhibited because it is 10 minutes before practice or because it is the 3rd Monday of the month. You are doing your client a huge disservice if you think  you are smarter than their brain and activate muscles that their brain has inhibited for a reason. What if it were to prevent joint loading because of a deeper problem ?  If every foot looks flat and hyper pronated, and all you know is orthotics or surgery or shoe fit, guess what that client is prescribed ? If all you see is torsions, that is all you will look to treat. If all you see is sloppy “running form” and all you know is “proper running form” forcing your client into that “round peg-square hole” can also lead to injury and stacking of compensation patterns.  

One’s lack of awareness and knowledge, are one’s greatest enemies. If you don’t know something exists, because you’ve never studied or learned it, how can you be aware of it ? If you’re not spending enough time examining a client, you might not be aware of an issue even though you may be knowledgeable about the issue.
One must have both awareness and knowledge. One must also be aware that compensations are the way of the body. What you see is not your client’s problem. It is their strategy to cope.

Are you helping your client ? Hurting them ?  Adding risk to their activity ? Are you stepping beyond your skill set ?  

Rule Number 1: First do no harm. 

Shawn and Ivo

PS: we will get to this case another time, we just wanted to make a point today about the bigger problems out in the world.

the gait guys

Activation, Cortical Remapping and what you are doing wrong to your people.

We are getting ready to step back into the studio to record podcast 58. We have been touching upon this topic off and on in the last 2 podcasts and we are going back in for more on pod #58 because this stuff is just too important not to beat it to a further pulp.  

The gist of this article is that cortical remapping occurs with injuries that are not 100% resolved. Lots of coaches and trainers out there are trying their hands at muscle “activation” and other new trendy tricks and they are missing the boat and making people worse if they are not doing a good sound clinical history and examination. You can activate any muscles and get what appears to be a miracle response, we can teach a 8 year old how to do activation and get a miracle response, but is it the right response or have you created a temporary compensation for your client (right before you send them into training or competition) ?  Activation is a 2 way street, there is the input into the brain and a corresponding motor output. If you are just rubbing out some muscles and get a stronger muscle test afterwards, and that is as far as your thoughts go before you turn your athlete loose, then you are a liability in the system. Are you part of the problem or part of the solution ?

Here are 2 paragraphs from this brilliant article. This is worth your time. As a client adapts to their unresolved, partially resolved (yes, even 95% is unresolved) injury(s) a secondary cascade of neurological changes ensue that often force new cortical remapping.  A remapping that is not as fundamentally safe or as sound as the pre-injury mapping yet one that is necessary for protecting further or other injuries. Yet, because it is not the original pristine pattern, it is also one that can begin undercurrents to corrupt other patterns of stability, mobility and movement in cortical and subcortical mappings. Understanding cortical excitability is important, and it can work for you and your client or against you both. It can be used for good or evil.  

If after you read these 2 paragraphs taken from the Alan Needle article in LER (link) you think you might be part of the problem or realize that you are not the magician you think you are, then good, you are on the track to self enlightenment and actually helping people.  Go read Alan’s article and breathe deep, ready to absorb and start yourself into understanding that you are really fixing the brain and not always the muscle, and that means you are gonna have to learn about the brain and how it works and more so how it can deceive you and your client and your training, treatments or therapy.

Come join us on The Gait Guys podcast 58 later this week as we delve into this topic deeper and more broadly.

Shawn and Ivo

PS: nice article Dr. Needle. Thank you !

http://lowerextremityreview.com/article/the-brain-a-new-frontier-in-ankle-instability-research

“Recently Wikstrom and Brown proposed a hypothetical cascade of events that would affect an individual’s ability to “cope” following an ankle sprain and provide a rationale for the varying contributors to instability. For an individual starting from a point of normal function, a lateral ankle sprain will trigger a consistent pattern of changes to the joint from the inflammatory process. Swelling will increase pressure on the joint’s mechanoreceptors, and pain will contribute to inhibition of the reflexes to the joint (arthrogenic inhibition). Together, this means patients will have difficulty sensing the joint and subsequently stabilizing it while excessive mechanical laxity will increase this loss of stability.19

Inflammatory changes may be similar across all patients; however, as symptoms remain and the patient adapts after his or her injury, a secondary cascade of neurological changes may occur that may include cortical remapping. In some patients, these adaptations may be beneficial and serve to protect the joint from further injury. Other patients may maladapt, as sensorimotor reorganization changes the nervous system’s perception of the joint. Variable amounts of laxity, proprioception, and cortical excitability exist throughout populations of healthy, previously injured, and functionally unstable joints. Where these populations diverge may be related to how each is scaled relative to the others. For instance, a joint with greater amounts of laxity may have higher proprioception and excitability to aid in stabilizing the joint, but following injury, these factors may become decoupled, leading to errors in movement and coordination.19”  -Alan Needle, PhD

 

Just because a muscle tests weak doesnt mean it needs activated.

To Activate or Not Activate: That is the question…

Just because a muscle tests weak does not mean it can, should or needs to be activated.

Muscles become inhibited for many reasons.  Perhaps it is being forced into a substitution or compensation pattern because the primary motor pattern is not accessible.  Perhaps it is because there is a local inflammatory response (ie injury) near by or within the muscle. Perhaps the muscle is lacking in one or several of its primary tenants, S.E.S. (Skill, Endurance, or Strength). Perhaps the joint(s) that muscle crosses are arthritic, inflamed, damaged, remember that an inflamed joint does not like compression/loading. When a muscle contracts it will increase compression across the joint surfaces. Maybe it is being reciprocally inhibited by it’s antagonist, or does not have appropriate sensory feedback from its mechanoreceptors and is neurologically inhibited. The nervous system is wired with many “faults”, which shut things down. Often times, you need to explore the reason why.

So…What happens if you decide to “activate” the muscle regardless of any of the above, which should have been clearly determined by a clinical examination ?

You very well could be forcing that muscle back on the grid encouraging the muscle to perform in an unsafe or undesirable environment. You may be forcing compressive loading across a joint that is inflamed. You could be forcing compression and shear across a damaged cartilage interface, an osteochondral defect, a ligamentous tear or a combination of the above.  You will also be over riding the nervous systems inherent neuro-protective mechanism and by forcing the muscle to once again activate and work in a faulty movement pattern.  You very likely are reprogramming an unsafe and potentially damaging motor pattern.

Remember, when you “mess around” and over ride neuro-protective inhibition of a motor pattern you reteach a potentially dangerous sensory response telling the joint that the nervous system has been mistaken, that it is actually safe to place load and shear across the joint when in fact it is dangerous. Protective reflexes are there for a reason, to protect you!

We have seen the results of well intentioned or sometimes untrained individuals implementing activation into their clinical practices, coaching, or training.  Without a sound clinical examination to determine the reason for muscle inhibition one is taking a whole pile of warning signs and throwing them to the wind.  Remember, if you force a muscle back into activation despite all of the warning signs and reasons for inhibition, you will get a temporarily stronger muscle. This is not necessarily success.

In fact, what you have done, is enabled your client the ability to once again impart load and shear across a joint(s) and motor chain that was getting clear central nervous system signals to avoid the loading response.  You are essentially forcing a  compensation pattern and we all know where that leads to. 

As clinicians, we take an oath that states: “Primo Non Nocere”, which means “first, do not injure”. Know what you are doing. If you don’t, then get the training or don’t do it.

The Gait Guys. Were are here to help. We are watching. Do us proud and do the right thing.