Fatigue matters. Today's article looks at pre and post exercise fatigue and how, on EMG, our body changes.

Photo credit:  pixabay.com

Photo credit: pixabay.com

Even for those of us who do (and should) know better, "the problem is, we are all often knee deep into compensations before we are aware of it, so most of us are always working on adding strength and endurance into our compensations without even knowing it. Our workouts layer things deeper. Yes, almost all of us are on this bus. Don't deny it. The next time you feel that tightness in your shoulder, or in your hip, or feel that tightness or soreness on one side of the low back, or one side of the neck, stop, and ask yourself that honest question. Again, you are on the bus with the rest of us."

We have spent much time discussing our order of things when intervening between a person and what ails them. Namely, our order is to first restore proper skill and patterning, then add endurance (move well often), and then add load, namely strength, power, force, explosive movements and the like. So, Skill, Endurance, Strength. This is a neurologic order, there is good reason for the necessity of this order. We have spend many an hour listening to Dr. Ivo explain why the CNS dictates this is the order with good reason. Cheat this order and you lay down neuroplastic patterns that are anything but what you want for your client. Enough said.

Today we introduce and article that the looks at the lumbo-pelvic-hip complex, a very complicated area, subject to large multi-planar movements and distortions (and hence, large complex multi-planar compensations). We must have good skill, endurance and strength in controlling this massive area safely, meaning, to avoid developing cheating compensatory patterns to negotiate around our days and activities and sports. The problem is, we are often knee deep into compensations before we are aware of it, so most of us are always working on adding strength and endurance into our compensations without even knowing it. Yes, almost all of us are on this bus. Don't deny it. The next time you feel that tightness in your shoulder, or in your hip, or feel that tightness or soreness on one side of the low back, or one side of the neck, stop, and ask yourself that honest question. Again, you are on the bus with the rest of us.

Today's article looks at pre and post exercise fatigue and how, on EMG, our body changes. Now keep in mind, and I will remind you of this again at the end of today's writing, keep in mind of the asymmetries, poor-skill, poor-endurance and poor strength in some areas that pre-exist, before even starting into our exercises. Imagine, assume, that these were there in all of this study's subjects, even prior to the exercise challenge. You should now fully grasp how layered things get for our clients.

Here is what the article said,

"fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability".-Chang et al.

"The purpose of this study was to compare trunk muscle activation patterns, and trunk and lower extremity kinematics during walking gait before and after exercise. Surface electrodes were placed over the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis of twenty-five healthy indviduals."

"The amplitude increased in the rectus abdominis during loading, midstance , terminal stance, and late swing after exercise. Amplitude also increased during swing phase in the erector spinae, vastus lateralis, and vastus medialis after exercise. There was less trunk and hip rotation from initial contact to midstance after exercise. Neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking. Increased muscle activation with decreased movement in a fatigued state may represent an effort to increase trunk stiffness to protect lumbo-pelvic-hip structures from overload."-Chang et al

What we found particularly notable was that they found less trunk and hip rotation from initial contact to midstance after exercise. And that, "neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking". As they concluded, increased muscle activation with decreased movement in a fatigued state plausibly indicates an effort to increase trunk stiffness as a protective measure. Translation, a protective compensation.

Here is what we have to say about that: do not leave the problem on the table and merely train your client around this. Resolve the underlying problem. The underlying problem may not, and likely will not, come out in a "functional screen". What will come out in the screen is how they are moving about with this existing compensation pattern(s). The screen shows WHAT they are doing with their limitations, not WHY Dive keep dear brethren. This is what it is all about, taking the time and diving deep. Find the "why".

So, as promised, here I am again, reminding you to keep in mind of the asymmetries, poor-skill, poor-endurance and poor strength in some areas that pre-exist, before even starting into our exercises. Imagine, assume, that these were there in all of this study's subjects, even prior to the exercise challenge. You should now fully grasp how layered things get for our clients.This is what can make, "helping someone get well", a difficult challenge, even on a good day.

*Muscle activation patterns of the lumbo-pelvic-hip complex during walking gait before and after exercise. Chang M1, Slater LV2, Corbett RO1, Hart JM1, Hertel J1.

Photo credit: pixabay.com Thank you for making such beautiful photos like this available for free use. Gorgeous photography !

Threshold foot drop. Video case.

Threshold foot drop.
Do you see it in this gait? No. There is a clue though, the EHL on the right (extensor hallucis longus) does not seem to be all that hearty and robust during gait, the toe is not as extended/dorsiflexes as on the left foot. A Clue ? Yes.
This client had true blatant foot drop, but it was caught relatively immediately, and the source resolved and recovery ensued. There is still some residual weakness, as you see at the end of the video, but making steady gains. Previously, gait showed obvious foot drop, foot slap, abrupt knee flexion (the "catch" response as we call it as the client's knee suddenly flexed forward as foot slap occurs). But, as you can see , the gait is pretty much normal now except for a little EHL strength lag. But, at the end of the video, when they heel walk, one can see the weakness, they cannot keep the ball of the foot off the ground during attempted heel walk. We like to call this "threshold weakness", it is just hovering below the surface, when taxed, it can be seen, but doesn't show up in gait. But, it does show up in longer endurance based walking events. This may be when your client's symptoms show up, as fatigue expresses limitations in the system. It just goes to show you, if you are not testing and looking for these things, you just might not find the source of your clients knee pain, foot pain, hip or low back pain. Heel and toe walking takes 10 seconds, do not forget to check them off. It just might be the "big reveal" for you, and them ! #footdrop #gait

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Acupuncture and Endurance?

We were treating patient that with low back pain that had decreased lumbar endurance the other day (you should be able to hold a "superman" post with your arms at your sides for 150 seconds. He has been continuing to improve and is now virtually pain free.

many folks don't realize a nice side effect of acupuncture is increased increased endurance, among other things. How about trying this on other muscles as well? We ran across this article you may find interesting

"Acupuncture therapy is able to eliminate free radicals, resist lipid peroxidation, prevent dysfunction of the motor hypothalamus-pituitary-gonadal axis, reduce the creatine kinase content, and lower lactic acid concentration, so as to play an important role in the elimination of sports fatigue and improvement of athletic ability of the body. "

 

link to free full text:

https://link.springer.com/article/10.1007/s11726-009-0123-7

Kinematic changes furing running-induced fatigue

imagine that.... core endurance can affect running performance.

Let us see ...as you start to fatigue, you have a tendency to bend forward more at the waist. This is probably due to not only decreased quadriceps/hamstrings ratios but also decreased abdominal/lower back extensor endurance ratios. Of course, we could say that asyou fatigue, you become more quadriceps dominant and less gluteal dominant, which would also be correct.

Ankle eversion also increases as you fatigue. No surprise here. Think about the action of your gastroc/soleus group as the medial gastroc acts to invert the ankle and help promote supination, particularly after mid stance. Also think about all the posterior compartment musculature of the lower leg which contract eccentrically during the first phase of gait to assist in deceleration of pronation. From about mid stance on, the extensors should activate, along with the foot intrinsics to assist in providing a stable base. As we fatigue, this mechanism too appears to begin to fail.

Moral of the story? Keep your core in shape and do lots of endurance work!

https://www.ncbi.nlm.nih.gov/pubmed/23790535

Pod 133: Two Gait Cases & their Gait Rehab

Today we discuss a few cases we have seen.  We discuss 2 cases, both involved poorly adapted gaits from injury, adaptations that had become the client's new norm. Once you get past Ivo's case presentation, which is very in depth, the discussions quickly go into very important topics that we all over look, namely gait and gait rehab, gait thresholds, metabolic thresholds, cortical fatigue, and how to use some neurologic principles to restore a problematic gait.

Key Tag words:
gait, concussion, head trauma, cortical fatigue, endurance, strength, gait analysis, gait problems, gait rehab, running, running injuries, run-walk, SCFE, slipped epiphysis, femoral growth plate, hip stress fractures, growth plate injury, hip dysplasia, limping gait, club foot, step length, stride length

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_133final.mp3

http://thegaitguys.libsyn.com/pod-133-two-gait-cases-their-gait-rehab


Libsyn Directory: http://directory.libsyn.com/episode/index/id/6184651

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

Endurance and Injuries

S.E.S. , in that order.
We have been preaching this mnemonic for a decade now here at TGG. Skill first, then endurance, then strength. In other words, first move correctly/well, then move often (build a robust amount of endurance on that skill that you can maintain it throughout your activity without losing the skilled movement without fatiguing), then add strength to this patterned movement. Then rinse and repeat; add a higher skill, add endurance, add strength. Rinse repeat.
We tell this one to our athletes, distance runners in particular, because it is no surprise that most injuries come in the later miles, when fatigue sets in, and compensations have to make up the difference if the run continues. This is necessary and protective, but the wise choice is to never exceed the fatigue, but always be inching the endurance forward.
The question is, do you know where your risk threshold lives ? When are you moving the safety meter past the safe zone and into the risk zone ? Your tightness or pain, if you are lucky, and paying attention, may be your "check engine light" moment, again, if you are paying attention. Never dismiss the benefit of a 2 minute walk in the later part of a long run when a symptom creeps in, it just might get you enough recovery to push out that last 3-4 miles with the symptoms shut down again. If you are lucky. Listen to your body, it is your job.

From the study below:
"In conclusion, NOVICE runners showed larger kinematic adjustments when exhausted than COMPETITIVE (distance) runners. This may affect their running performance and should be taken into account when assessing a runner's injury risk."

-Shawn Allen, one of the gait guys

Reference:     https://www.ncbi.nlm.nih.gov/pubmed/28730917

Sports Biomech. 2017 Jul 21:1-11. doi: 10.1080/14763141.2017.1347193. [Epub ahead of print] Novice runners show greater changes in kinematics with fatigue compared with competitive runners. Maas E1, De Bie J1, Vanfleteren R1, Hoogkamer W2, Vanwanseele B1.

 

GOT ENDURANCE?

We all realize the importance of endurance work, especially when it comes to core work. If we had a dollar for every patient that lacked lower back extensor endurance that had a gait problem......

In this video, Dr Ivo demonstrates his adaptation of Dr Eric Goodman's "Founders" sequence, along with some clinical commentary. Try this on yourself or with your patients/clients today. It's easy and effective.

Take good look at these gals. The gal on the left (in blue) looks like she has a level pelvis, but look at the upper body. She&rsquo;s leaning to the left and has a great deal of torso rotation backward. One of the clues is the abduction of her left arm. Also note how her right arm crosses across her body. We wonder how she looks in right foot stance.  The gal on the left (in red) has a subtle dip of the right side of her pelvis and also has over rotation of her upper body. Her right on crossing the body is a good reason to believe she will have a crossover gait if viewed from straight on.  While both of these gals may have adequate strength, we question how much endurance they have as well as available rotation in the hips and lumbar spine.  This is an excellent, referenced review of some of the current literature and controversy of strength and injury risk. A good read and certainly worth your time to get caught up on what&rsquo;s current. We would love to see you study on endurance and injury risk.  &ldquo;While muscle strength may improve tolerance of loads during running, another reason for inconsistencies in the reported relationships between strength and injury risk may be that strength is typically assessed isometrically. It’s unclear how much of an influence peak isometric strength has on the dynamic task of running, and specifically on prolonged running in the presence of muscular fatigue. Schmitz et al found that, while isometric hip strength values were similar between novice and experienced runners, hip internal rotation motion during running was higher in the novice runners, suggesting isometric strength may not correlate strongly with muscular control and kinematics during running.&rdquo;      http://lermagazine.com/article/lower-extremity-strength-and-injury-risk-in-runners

Take good look at these gals. The gal on the left (in blue) looks like she has a level pelvis, but look at the upper body. She’s leaning to the left and has a great deal of torso rotation backward. One of the clues is the abduction of her left arm. Also note how her right arm crosses across her body. We wonder how she looks in right foot stance.

The gal on the left (in red) has a subtle dip of the right side of her pelvis and also has over rotation of her upper body. Her right on crossing the body is a good reason to believe she will have a crossover gait if viewed from straight on.

While both of these gals may have adequate strength, we question how much endurance they have as well as available rotation in the hips and lumbar spine.

This is an excellent, referenced review of some of the current literature and controversy of strength and injury risk. A good read and certainly worth your time to get caught up on what’s current. We would love to see you study on endurance and injury risk.

“While muscle strength may improve tolerance of loads during running, another reason for inconsistencies in the reported relationships between strength and injury risk may be that strength is typically assessed isometrically. It’s unclear how much of an influence peak isometric strength has on the dynamic task of running, and specifically on prolonged running in the presence of muscular fatigue. Schmitz et al found that, while isometric hip strength values were similar between novice and experienced runners, hip internal rotation motion during running was higher in the novice runners, suggesting isometric strength may not correlate strongly with muscular control and kinematics during running.”


http://lermagazine.com/article/lower-extremity-strength-and-injury-risk-in-runners

Podcast 87: Podcast 87: The Kenyan's Running Brain & "The" Anterior Compartment.

Plus, Some unknown facts about going minimalism and barefoot. We POUND anterior compartment strength today gang ! Hope you enjoy !

Show sponsors:
www.newbalancechicago.com

A. Link to our server: 
http://traffic.libsyn.com/thegaitguys/pod_87final.mp3

Direct Download: 
http://thegaitguys.libsyn.com/podcast-87

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 and 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”

Show notes:


On high heels and short muscles: A multiscale model for sarcomere loss in the gastrocnemius muscle

http://www.sciencedirect.com/science/article/pii/S0022519314006262

The Brain Needs Oxygen

Maintained cerebral oxygenation during maximal self-paced exercise in elite Kenyan runners.

http://www.runnersworld.com/racing/the-brain-needs-oxygen
http://www.ncbi.nlm.nih.gov/pubmed/25414248
J Appl Physiol (1985). 2014 Nov 20:jap.00909.2014. doi: 10.1152/japplphysiol.00909.2014. [Epub ahead of print]

The texting lane in China
http://www.theguardian.com/world/shortcuts/2014/sep/15/china-mobile-phone-lane-distracted-walking-pedestrians

Dialogue on endurance training,
NeuroRehabilitation. 2006;21(1):43-50. 
http://www.ncbi.nlm.nih.gov/pubmed/16720937

Effects of dorsiflexor endurance exercises on foot drop secondary to multiple sclerosis.  Mount J1, Dacko S.

APOS Therapy
we were asked out opinion on this
http://apostherapy.com/

Foot instrinsic dialogue
Motor Control. 2014 Jul 15. [Epub ahead of print]

Quantifying the Contributions of a Flexor Digitorum Brevis Muscle on Postural Stability.
Okai LA1, Kohn AF.

There are many factors in adults that impair gait. It is not all biomechanical. This is part of our ongoing dialogue on the aging population and why gait impairments and falls are so prevalent.
Acta Bioeng Biomech. 2014;16(1):3-9.
Differences in gait pattern between the elderly and the young during level walking under low illumination.
Choi JS, Kang DW, Shin YH, Tack GR.


Take this simple test.   
 Want to be faster? Better incorporate some proprioceptive training into your plan. It is the 1 st  part of our mantra: Skill, Endurance, and Strength (in that order). Proprioceptive training appears to be more important that strength or endurance training from an  injury rehabilitation perspective  as well part of an  injury prevention  program 
  What is proprioception? It is body position awareness; ie: knowing what your limbs are doing without having to look at them. 
  Take this simple test:  
  Stand in a doorway with your shoes off. Keep your arms up at your sides so that you can brace yourself in case you start to fall. Lift your toes slightly so that only your foot tripod remains on the ground (ie the base of the big toe, the base of the little toe and the center of the heel.).  Are you able to balance without difficulty?  Good, all 3 systems (vision, vestibular and proprioceptive) are go. 
   Now close your eyes, taking away vision from the 3 systems that keep us upright in the gravitational plane.  Are you able to balance for 30 seconds?  If so, your vestibular and proprioceptive systems are intact. 
   Now open your eyes and look up at the ceiling. Provided you can balance without falling, now close your eyes. Extending your neck 60 degrees just took out the lateral semicircular canals of the vestibular system (see here for more info).  Are you still able to balance for 30 seconds?  If so, congrats; your proprioceptive system (the receptors in the joints, ligaments and muscles) is working great.  If not, looks like you have some work to do.  You can begin with exercises we use every day by clicking  here . 
  Proprioception should be the 1st part of any training and/or rehabilitation program. If you don&rsquo;t have a good framework to hang the rest of your training on, then you are asking for trouble.  
  The Gait Guys. Your proprioceptive mentors.  We want you to succeed!

Take this simple test. 

Want to be faster? Better incorporate some proprioceptive training into your plan. It is the 1st part of our mantra: Skill, Endurance, and Strength (in that order). Proprioceptive training appears to be more important that strength or endurance training from an injury rehabilitation perspective as well part of an injury prevention program

 What is proprioception? It is body position awareness; ie: knowing what your limbs are doing without having to look at them.

Take this simple test:

  • Stand in a doorway with your shoes off. Keep your arms up at your sides so that you can brace yourself in case you start to fall. Lift your toes slightly so that only your foot tripod remains on the ground (ie the base of the big toe, the base of the little toe and the center of the heel.). Are you able to balance without difficulty? Good, all 3 systems (vision, vestibular and proprioceptive) are go.
  • Now close your eyes, taking away vision from the 3 systems that keep us upright in the gravitational plane. Are you able to balance for 30 seconds? If so, your vestibular and proprioceptive systems are intact.
  • Now open your eyes and look up at the ceiling. Provided you can balance without falling, now close your eyes. Extending your neck 60 degrees just took out the lateral semicircular canals of the vestibular system (see here for more info). Are you still able to balance for 30 seconds? If so, congrats; your proprioceptive system (the receptors in the joints, ligaments and muscles) is working great. If not, looks like you have some work to do. You can begin with exercises we use every day by clicking here.

Proprioception should be the 1st part of any training and/or rehabilitation program. If you don’t have a good framework to hang the rest of your training on, then you are asking for trouble. 

The Gait Guys. Your proprioceptive mentors. We want you to succeed!

Podcast 34: Chimp feet, Marathon Monks & Statin drugs

podcast link:

http://thegaitguys.libsyn.com/podcast-34-chimp-feet-marathon-monks-statin-drugs

iTunes link:

http://thegaitguys.libsyn.com/podcast-33-heart-beats-toe-walking-crawling

Gait Guys online /download store:

http://store.payloadz.com/results/results.aspx?m=80204

other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen  Biomechanics

Today’s show notes:

 1.Did Rock Climbing Help Us Start Walking Upright?   By Shaunacy Ferro A new theory suggests humans became bipedal so that we could scramble up rugged terrain.
http://www.popsci.com/science/article/2013-05/did-rock-climbing-help-us-start-walking-upright?src=SOC&dom=tw


2. http://en.wikipedia.org/wiki/Kaih%C5%8Dgy%C5%8D

The Running Marathon monks of Mt. Hiei

The Kaihōgyō is a set of the ascetic physical endurance trainings for which the Japanese “marathon monks” of Mt. Hiei are known. These Japanese monks are from the Shugendō and the Tendai school of Buddhism, a denomination brought to Japan by the monk Saichō in 806 from China.


3. http://www.runnersworld.com/general-interest/do-you-have-chimpanzee-feet

Do you have Chimpanzee feet ?

About 8% of people tested by Boston University researchers had midfoot flexibility of the sort that apes use to climb trees, according to a study published in the American Journal of Physical Anthropolgy.

4. Statins Linked With Risk of Musculoskeletal Injury

Michael O'Riordan

http://www.medscape.com/viewarticle/805369?src=wnl_edit_medn_wir&spon=34

http://archinte.jamanetwork.com/article.aspx?articleid=1691918

Can Statins Cut the Benefits of Exercise?

By GRETCHEN REYNOLDS

http://well.blogs.nytimes.com/2013/05/22/can-statins-curb-the-benefits-of-exercise/

http://www.ncbi.nlm.nih.gov/pubmed/23583255

5. Shoes: The Primal Professional.com

http://theprimalprofessional.com/products/pre-order-the-primal-professional

http://well.bradrourke.com/2013/05/my-new-primal-dress-shoes/

6. Hallux valgus and lesser toe deformities are highly heritable in adult men and women: The Framingham foot study

Marian T. Hannan
http://onlinelibrary.wiley.com/doi/10.1002/acr.22040/abstract;jsessionid=99975015C3EE5678E6351273C2CD42A0.d02t04

7. Forefoot strikers exhibit lower running-induced knee loading than rearfoot strikers

Kulmala, Juha-Pekka; Avela, Janne; Pasanen, Kati; Parkkari, Jari

http://journals.lww.com/acsm-msse/Abstract/publishahead/Forefoot_strikers_exhibit_lower_running_induced.98324.aspx

8. Why Where You Land On Your Foot Isn’t That Important

http://www.kinetic-revolution.com/why-where-you-land-on-your-foot-isnt-that-important/

Podcast #30: Running your heart out ?

podcast link: 

http://thegaitguys.libsyn.com/podcast-30-running-your-heart-out

iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

Gait Guys online /download store:

http://store.payloadz.com/results/results.aspx?m=80204

other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen  Biomechanics

Today’s show notes:

Neuroscience Piece:

1. Nanosponges could soak up deadly infections like MRSA from your bloodstream
http://www.theverge.com/2013/4/15/4225834/nanosponges-kill-deadly-bacteria-mrsa-clinical-trial

2. iPhone-controlled bionic hands allow father to hold daughter’s hand for first time since accident
http://9to5mac.com/2013/04/15/iphone-controlled-bionic-hands-allow-father-to-hold-daughters-hand-for-first-time-since-accident/

3. The science behind Obama’s BRAIN project.
http://blog.brainfacts.org/2013/04/the-science-behind-obamas-brain-project/#.UXQraILeb8g
4. Blog reader asks:
I’ve noticed that I’m developing some calluses - on the outside of my big toes. They don’t hurt normally but if I walk for awhile or run a few miles, those (I’m assuming) calluses really starts to ache. Any suggestions for what I can do to help with that?
5. FACEBOOK readers asks:
Hello, I am new to “The Gait Guys,” and was wondering if you have done any blogs about Morton’s Neuromas and bunion treatments. I’m looking for ways other than surgery to fix this ailment. I would love to be able to run and exercise again. Thank you.
Jared

6. What Cardiologists Tell Their Friends

http://shine.yahoo.com/healthy-living/cardiologists-tell-friends-134500478.html
“Go easy with the exercise”
http://www.ncbi.nlm.nih.gov/pubmed/22953596

Mo Med. 2012 Jul-Aug;109(4):312-21.

Cardiovascular damage resulting from chronic excessive endurance exercise.


7. Brisk Walking Equals Running for Heart Health: Study

http://www.medicinenet.com/script/main/art.asp?articlekey=168974
By Steven Reinberg

8. Shoes:

9. Runners Can Improve Health and Performance With Less Training, Study Shows

http://www.sciencedaily.com/releases/2012/05/120531102205.htm

10. A Lesson in Neurology from Jimi Hendrix

by ;luke barnes
letterstonature.wordpress.com/2007/11/30/a-lesson-in-neurology-from-jimi-hendrix

On the topic of endurance training.....

On the topic of endurance training (which we discussed on this weeks PODcast, forthcoming in the next day or so; we have both been extraordinarily busy in our clinics); if you are a well trained athlete (ie endurance junkie), how might this effect your running gait?

So, you run 103 miles with an elevation change of over 31,000 feet, how do you think you would fare? These folks were tested pre and 3 hours post race on a 22 foot long pressure walkway at about 7.5 miles per hour. Here’s how this group of 18 folks did:

  1. increased step frequency
  2. decreased “aerial” time
  3. no change in contact time
  4. decrease in downward displacement of the center of mass
  5. decrease in peak vertical ground reactive force
  6. increased vertical oscillation
  7. leg stiffness remained unchanged

So what does this tell us?

  • wow, that is a lot of vertical
  • holy smokes, that is really far
  • don’t know how I would do with a race like that
  • they are fatigued (1, 2, 6)
  • they are trying to attenuate impact forces (2, 3, 4, 5, 7)

The system is trying to adapt the best it can. If you were to do a standard hip screen test (like we spoke about here)  you would probably see increased horizontal drift due to proprioceptive fatigue. Remember that proprioception (our bodies ability to sense its position in space) makes the world go round. Proprioception is dependent on an intact visual system (see our post yesterday) , an intact vestibular system and muscle and joint mechanoreceptors functioning appropriately). We would add here that central nervous system fatigue (ie central processing both at the cord and in the cortex) would probably play a role as well.

The take home message? The human machine is a neuro mechanical marvel and much more complex than having the right shoe or the right running technique. Training often makes us more competent and efficient, but everything has it limits.

The Gait Guys. Making it real with each and every post.

all material copyright 2013 The Gait Guys/ The Homunculus Group

J Biomech. 2011 Apr 7;44(6):1104-7. doi: 10.1016/j.jbiomech.2011.01.028. Epub 2011 Feb 20.

Changes in running mechanics and spring-mass behavior induced by a mountain ultra-marathon race.

Source

Université de Lyon, F-42023 Saint-Etienne, France. jean.benoit.morin@univ-st-etienne.fr

Abstract

Changes in running mechanics and spring-mass behavior due to fatigue induced by a mountain ultra-marathon race (MUM, 166km, total positive and negative elevation of 9500m) were studied in 18 ultra-marathon runners. Mechanical measurements were undertaken pre- and 3h post-MUM at 12km h(-1) on a 7m long pressure walkway: contact (t©), aerial (t(a)) times, step frequency (f), and running velocity (v) were sampled and averaged over 5-8 steps. From these variables, spring-mass parameters of peak vertical ground reaction force (F(max)), vertical downward displacement of the center of mass (Δz), leg length change (ΔL), vertical (k(vert)) and leg (k(leg)) stiffness were computed. After the MUM, there was a significant increase in f (5.9±5.5%; P<0.001) associated with reduced t(a) (-18.5±17.4%; P<0.001) with no change in t©, and a significant decrease in both Δz and F(max) (-11.6±10.5 and -6.3±7.3%, respectively; P<0.001). k(vert) increased by 5.6±11.7% (P=0.053), and k(leg) remained unchanged. These results show that 3h post-MUM, subjects ran with a reduced vertical oscillation of their spring-mass system. This is consistent with (i) previous studies concerning muscular structure/function impairment in running and (ii) the hypothesis that these changes in the running pattern could be associated with lower overall impact (especially during the braking phase) supported by the locomotor system at each step, potentially leading to reduced pain during running.

Copyright © 2011 Elsevier Ltd. All rights reserved.

http://www.ncbi.nlm.nih.gov/pubmed/21342691

Phidippides cardiomyopathy, a condition caused by chronic excessive endurance exercise.

In 490 BC, Phidippides, a young Greek messenger, ran 26.2 miles from Marathon to Athens delivering the news of the Greek victory over the Persians, and then he collapsed and died. This is probably the first recorded incident of sudden death of an athlete.

ScienceDaily Article LINK (June 4, 2012)

“ Micah True, legendary ultra-marathoner, died suddenly while on a routine 12-mile training run March 27, 2012. The mythic Caballo Blanco in the best-selling book, Born to Run, True would run as far as 100 miles in a day. On autopsy his heart was enlarged and scarred; he died of a lethal arrhythmia (irregularity of the heart rhythm). Although speculative, the pathologic changes in the heart of this 58 year-old veteran extreme endurance athlete may have been manifestations of "Phidippides cardiomyopathy,” a condition caused by chronic excessive endurance exercise.  “

See the rest of the article via the links provided.

More is not always better for some folks.

Get your heart checked yearly if you are an endurance athlete and watch for the signs you may have issues. Sadly the most consistent sign of Phidippides cardiomyopathy is sudden death.  So it is kinda hard to get ahead of the signs ! Be sure there is not a family history of Marfan’s type disorders that can affect the integrity of the artery walls amongst other things (clue: are you tall, skinny, long fingers and toes, abnormally formed sternum/protruding or sunken chest, loose jointed, loose skin, eye problems ?) If you have any of the following symptoms get checked out immediately:

  • chest pain
  • fainting
  • dizziness
  • chest palpitations
  • fatigue
  • shortness of breath (excessive or prolonged)

In closing we are going to paraphrase the Science Daily article one more time:

"Although it has been recognized that elite-level athletes commonly develop abnormal electrocardiograms and atrial and ventricular entropy, these adaptations traditionally have not been thought to predispose to serious arrhythmias or sudden cardiac death. However, it now appears that the cardiac remodeling induced by excessive exercise can lead to rhythm abnormalities. Endurance sports such as ultramarathon running or professional cycling have been associated with as much as a 5-fold increase in the prevalence of atrial fibrillation. Chronic excessive sustained exercise may also be associated with coronary artery calcification, diastolic dysfunction, and large-artery wall stiffening.”

It is important to remember, just because you are not having any symptoms or signs does not mean you are free of risk either.  Train wise, rest and recover and remember “everything in moderation”. When you know you are at an imbalance in your training, your risks may increase. And remember, this disorder takes years to develop so a clean slate exam now doesnt mean you are risk free forever.

RIP Micah. 

Shawn and Ivo……. not trying to scare anyone…….but an informed athlete is a smart runner and alive.

This video pretty much sums up our entire philosophy. Skill, Endurance, Strength; in that order. Why? Skill requires the largest diameter afferent (sensory) nerves to accomplish (Ia and Ib afferents from muscle and joint mechanoreceptors); they are the fastest pathways; Endurance comes from larger sized Type I (and sometimes Type IIa) endurance muscle, which are oxygen dependent (aerobic) and are rich in myoglobin, glycogen, mitochondria and capillaries; Strength last, because it comes from smaller, Type IIb fibers, and is largely glycolytic (depends on anaerobic respiration) and is dependent on the other 2 (skill and endurance).

When you take amazing skill and body awareness and combine it with strength and flexibility and control you can do these kinds of wild things.

Exploring the links between human movement, biomechanics and gait.

The Gait Guys

The Psoas Muscle in a Runner: An Endurance Savy Muscle ?

 We received a question yesterday from a doctor. We felt it was worthy of sharing. Here it is, followed by our response.

Doctor:  I do have a question about one of my athletes in particular.  He is a fairly good (All-State in IL) high school track distance runner that has some left sided femoral acetabular impingement.  He gets some capsular hip pain that also will ‘tighten up’ his low back during speed endurance/threshold running only.  Moderate and easy distance runs cause no problem and neither do track/speed workouts.  Only during speed endurance does he have issues.  Upon evaluation after these sessions he does seem to have some low back QL tightness, but joint mobility is fairly good in his lumbar spine.  He does show marked hypertonicity through his left hip joint.  I’m not quite sure the mechanism here- why he would only flare up with speed endurance running- any insights?
Thanks a bunch and I look forward to hearing from you!

The Gait Guys response:

 You state “only during speed endurance” does he have issues. We will assume you mean a long, hard anaerobic workout, which would tax type II b fibers. You also mention he has hypertonicity through his hip joint.  Since the psoas crosses this joint it should be considered in sprinting and long, hard endurance activities, especially if the patient is flexor dominant. The psoas major muscle is composed of type I, IIA and IIX muscle fibers. It has a predominance of type IIA muscle fibers. The fiber type composition of the psoas major muscle was different between levels of its origin starting from the first lumbar to the fourth lumbar vertebra. The psoas major muscle has dynamic and postural functions, which supports the fact that it is the main flexor of the hip joint (dynamic function) and stabilizer of the lumbar spine, sacroiliac and hip joints (postural function). The cranial part of the psoas major muscle has a primarily postural role, whereas the caudal part of the muscle has a dynamic role. This is all very much supported in this journal article here (link) (http://www.ncbi.nlm.nih.gov/pubmed/19930517) and making it work in an endurance capacity would certainly cause issues. Flexor dominance is a common scenario we see clinically, due to insufficient extensor activity (and decreased vestibulo and reticulo spinal drive to extensors) and increased cortico spinal drive (to the flexors, including the iliopsoas). This would fuel the “bail out” (lack of stability) of the lower abs. The anterior tippage of the pelvis would drive the femur posteriorly, binding the joint (the opposite of an anterior femoral glide).

Video footage and some pix of your athlete would provide more insight for us to help.

we are……The Gait Guys