Podcast 150: Subtalar joint control? Plus Heel raise effects on low back pain

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http://directory.libsyn.com/episode/index/id/10909609


Show notes


The HyProCure proceedure

https://images.search.yahoo.com/yhs/search;_ylt=AwrEeBmEH0RdlDUAiAUPxQt.;_ylu=X3oDMTByMjB0aG5zBGNvbG8DYmYxBHBvcwMxBHZ0aWQDBHNlYwNzYw--?p=hyprocure+sinus+tarsi+implant&fr=yhs-sz-001&hspart=sz&hsimp=yhs-001

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621198/
https://www.ncbi.nlm.nih.gov/pubmed/21106413
https://www.ncbi.nlm.nih.gov/pubmed/29786228

High-heeled walking decreases lumbar lordosis.EdenyBaaklini et al.
https://www.sciencedirect.com/science/article/pii/S096663621730108X

The effect of high-heeled shoes on lumbar lordosis: a narrative review and discussion of the disconnect between Internet content and peer-reviewed literature. Brent S. Russell
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206568/

Prolong Wearing of High Heeled Shoes Can Cause Low Back PainFarjad Afzal1* and Sidra Manzoor
https://pdfs.semanticscholar.org/afb4/641b8ed6450fcbdfa8ff99029d935c2bdc88.pdf

Relation between Wearing High-Heeled Shoes and Gastrocnemius and Erector Spine Muscle Action and Lumbar Lordosis. Cezar Augusto Souza Casarin
https://www.medscitechnol.com/download/index/idArt/892352

A flatter foot approach?
https://twitter.com/IzzyMoorePhD/status/1157034538192855041

Thoughts: titrate into speed work just like doing the same for longer and longer runs
Creating a "speed base"
https://www.fastrunning.com/?p=26410&preview=true

"monster walks"
Hip-Muscle Activity in Men and Women During Resisted Side Stepping With Different Band Positions. Lewis CL, et al. J Athl Train. 2018.
https://www.ncbi.nlm.nih.gov/m/pubmed/30615490/

Physical findings differ between individuals with greater trochanteric pain syndrome and healthy controls: A systematic review with meta-analysis.
Plinsinga ML1, Ross MH1, Coombes BK2, Vicenzino B3.
Musculoskelet Sci Pract. 2019 Jul 25;43:83-90. doi: 10.1016/j.msksp.2019.07.009. [Epub ahead of print]
https://www.ncbi.nlm.nih.gov/pubmed/31369906

High Heels...A requirement?

More on high heels.

We think high heel wear is largely geographical. Dr Ivo lives in the mountains of Colorado and rarely sees ANYONE in high heels, even at social events. Dr Allen, in Chicago, sees plenty of them.

Their popularity may be waning but the problems continue (see yesterdays post here). Required to wear them? Really?

"At the 2015 Cannes Film Festival, multiple women—some with medical conditions—were famously turned away from screening events for wearing rhinestone flats rather than heels. Cocktail waitresses at Foxwoods Resort Casino in Mashantucket, CT, complied with their employer’s 2-inch heel requirement for decades until their union successfully quashed it in 2013. A similar 2015 case in East London, involving a receptionist sent home for failing to wear shoes with a 2- to 4-inch heel, led to union involvement as well as scrutiny of prime minister Theresa May’s well-known fondness for kitten heels. And in 2013, the US Defense Intelligence Agency—helmed at the time by Lt. Gen. Mike Flynn, president-elect Donald Trump’s choice for national security advisor—included a “no flats” policy among its dress-code requirements for women."

 

http://lerfoothealth.com/archives/2016/popularity-of-high-heels-wanes-but-issues-remain/

Singer Songwriter Jewel and her knee hyperextension. 
 One of our favorite television shows is “Alaska: The Last Frontier”.  What some of you might not know is that the show is about Singer Songwriter Jewel’s family, the Kilchers. Yes, Her name is Jewel Kilcher.  The theme to the show is written and sung by Jewel and her father Atz Kilcher.  The Kilcher’s are tough folk who live off the grid (mostly) and maintain a subsistence living off the land in Alaska.   
 Use the photo above to help you clearly understand what we are talking about in this video  here (link)   where we see Jewel and her dad getting ready to sing the show’s theme. In this video, Jewel is in some insanely high heeled shoes and being the gait geeks that we are we could not help but notice the degree of knee hyperextension she was displaying.   
 What can we extrapolate from this genu recurvatum / hyper extension knee posturing  ?: 
 We are going to keep it to things from pelvis down or we will be here all day. 
   Anterior pelvis tilt.  She appears to be sitting back into her pelvis so to speak, doing so we can see an increased lumbar lordosis pressing the pelvis anterior.  In many cases combine this with suspect weak lower abdominals and the pelvis drops in the front. This position is often met with isometric contraction of the gluteals helping to maintain the forward/anterior shifted pelvis. 
 The above, will create an abnormal (possibly increased) tensile load on the hamstrings since the ischeal tuberosities are being drawn cephalad (up). This can create a net posterior shift of the knee joint since she is in relative hip extension, the pelvis is often also translated forward into the sagittal plane pushing the head of the femur into anterior glide into the front of the acetabulum. 
 The knees are often locked into hyperextension. This will create meniscal tensions and certainly cause increased patellofemoral pressures.  This can also create the rarely diagnosed, but often present, anteriormeniscofemoral impingement syndrome. In this type of presentation the anterior compressive forces are so great compared to what should be balanced forces around the entire joint that the superior leading edge of the anterior mensicus (can affect medial or lateral menisci) begins to become impinged and irritated as the femur rolls and translates too far anterior. You have to know it exists to make the diagnosis. 
 She will be in ankle plantarflexion because of the footwear instead of balancing the tibia neutrally over the talus.  The tibia will rest on the posterior talus. If constant, the plantarflexion means shorter posterior compartment (gastroc-soleus) and usually weak anterior compartment (tibialis anterior and long extensors of toes).  If she is a runner we bet shin splints were on her holiday list of things to resolve.  
  These are just the sagittal plane flaws we can assume. There are more but this is plenty to think about right now.  
 Remember, these are just assumptions. Like in video analysis, anything you pic up on film is just a compensation. It does not tell you what you have wrong until you can test them for neuromuscular integrity and motor pattern assessments.  Do not hang your hat on photos or video analysis. Do the extra work that is required.  After all, you know where ASSUMPTIONS get us. 
 The Gait Guys. 
 Shawn and Ivo

Singer Songwriter Jewel and her knee hyperextension.

One of our favorite television shows is “Alaska: The Last Frontier”.  What some of you might not know is that the show is about Singer Songwriter Jewel’s family, the Kilchers. Yes, Her name is Jewel Kilcher.  The theme to the show is written and sung by Jewel and her father Atz Kilcher.  The Kilcher’s are tough folk who live off the grid (mostly) and maintain a subsistence living off the land in Alaska.  

Use the photo above to help you clearly understand what we are talking about in this video here (link)  where we see Jewel and her dad getting ready to sing the show’s theme. In this video, Jewel is in some insanely high heeled shoes and being the gait geeks that we are we could not help but notice the degree of knee hyperextension she was displaying.  

What can we extrapolate from this genu recurvatum / hyper extension knee posturing  ?:

We are going to keep it to things from pelvis down or we will be here all day.

  1. Anterior pelvis tilt. She appears to be sitting back into her pelvis so to speak, doing so we can see an increased lumbar lordosis pressing the pelvis anterior.  In many cases combine this with suspect weak lower abdominals and the pelvis drops in the front. This position is often met with isometric contraction of the gluteals helping to maintain the forward/anterior shifted pelvis.
  2. The above, will create an abnormal (possibly increased) tensile load on the hamstrings since the ischeal tuberosities are being drawn cephalad (up). This can create a net posterior shift of the knee joint since she is in relative hip extension, the pelvis is often also translated forward into the sagittal plane pushing the head of the femur into anterior glide into the front of the acetabulum.
  3. The knees are often locked into hyperextension. This will create meniscal tensions and certainly cause increased patellofemoral pressures.  This can also create the rarely diagnosed, but often present, anteriormeniscofemoral impingement syndrome. In this type of presentation the anterior compressive forces are so great compared to what should be balanced forces around the entire joint that the superior leading edge of the anterior mensicus (can affect medial or lateral menisci) begins to become impinged and irritated as the femur rolls and translates too far anterior. You have to know it exists to make the diagnosis.
  4. She will be in ankle plantarflexion because of the footwear instead of balancing the tibia neutrally over the talus.  The tibia will rest on the posterior talus. If constant, the plantarflexion means shorter posterior compartment (gastroc-soleus) and usually weak anterior compartment (tibialis anterior and long extensors of toes).  If she is a runner we bet shin splints were on her holiday list of things to resolve. 

These are just the sagittal plane flaws we can assume. There are more but this is plenty to think about right now. 

Remember, these are just assumptions. Like in video analysis, anything you pic up on film is just a compensation. It does not tell you what you have wrong until you can test them for neuromuscular integrity and motor pattern assessments.  Do not hang your hat on photos or video analysis. Do the extra work that is required.  After all, you know where ASSUMPTIONS get us.

The Gait Guys.

Shawn and Ivo

tumblr_lzmm1cj9x51qhko2so1_1280.jpg
tumblr_lzmm1cj9x51qhko2so2_500.jpg
tumblr_lzmm1cj9x51qhko2so3_1280.jpg

A Scientific Look at High Heels

http://well.blogs.nytimes.com/2012/01/25/scientists-look-at-the-dangers-of-high-heels/

PROCEED WITH CAUTION! INFO DENSE POST AHEAD!

Can you think of a better way to start the week than with a discussion of high heels? We all like high heels… Well, at least guys do (and we know quite a few women who do as well…some of you may be reading this post). NO, WE DO NOT LIKE TO WEAR THEM, but we can admire the way they make the calves look so great and the increased lumbar lordosis and accentuation of the greatest gait muscles ever created!

Were they based off “chopines” from the 15th century; an elevated shoe (7-30 inches high!) which kept the peoples feet literally “out of the muck” (they didn’t have modern plumbing back then) or are they older? Or was the heel invented out of necessity to keep horse riders literally “in the saddle” ? Chinese and Turkish history says maybe they were to keep women (particularly concubines) from escaping. For the intents of discussion, we will stick with this last premise, as it fits nicely with the findings of this article (based on the study published here)

Remember the neuromechanics posts on muscle spindles or golgi tendon organs (GTO’s) ? If not, click the links and check them out; suffice it to say that the take home message is: Spindles respond to length and GTO’s respond to tension.

We also remember that GTO;’s modulate the muscles function that they come from. In other words, they literally “turn off” the muscle they come from (it is a disynaptic, post synaptic pathway for you neuro geeks out there). In light of that, lets look at some quotes form the article:

“the scientists found that heel wearers moved with shorter, more forceful strides than the control group, their feet perpetually in a flexed, toes-pointed position. This movement pattern continued even when the women kicked off their heels and walked barefoot. ”

No surprises here. Go up on your toes and take a few strides (more difficult for guys, since the biggest heel we may have is about 12mm in our running shoes). Which muscles are engaging? See how difficult it is to take a full stride? Try to engage your glutes. Not so easy, eh? Now put your foot flat on the floor, extend your toes and NOW engage your glutes. Easier? Presyanptic loading of the motor neuron pool pays big dividends!

They go on to say: “As a result, the fibers in their calf muscles had shortened and they put much greater mechanical strain on their calf muscles than the control group did.”

Hmmm… shortened muscles put under greater tension. Sounds like a job for the golgi’s, and what do they do? Inhibit the muscle from contracting. No wonder is was harder.

“In the control group, the women who rarely wore heels, walking primarily involved stretching and stressing their tendons, especially the Achilles tendon. But in the heel wearers, the walking mostly engaged their muscles.”

Wow, here is evidence They changed their motor programming!  Did you ever think that high heels could change the way our brain works? Maybe it’s a secret plot to take over the world….or maybe not…

The Gait Guys…Lovers of high heels as long as you don’t walk in them….