Pod #124: Gluteal gripping, Runner's dystonia. Are leg length differences real ?

Key tag words:
running, gait, injuries, kidney, kidneydamage, marathoners, foot, feet, dehydration, heatstroke, elon musk, neural lace, hip pain, crossfit, squats, deadlifts,  LLD, short leg, dystonia, runner's dystonia, posture, 

Summary:  Today we hit some very important topics on how to examine a client and how asymmetries play into gait, running, posture and pathomechanics. We hope you enjoy today's show, it is our first one back in 6 weeks. We are back strong after a brief early summer sabbatical. Back to the "podcast every 2 weeks" again. Thanks for being patient while Ivo recharged for the second half of the year.   Plus, on today's show, we also dive into Runner's kidney, dehydration, gluteal gripping, runner's dystonia, functional leg length differences due to asymmetries, and more !

Show links:

http://traffic.libsyn.com/thegaitguys/pod_124final.mp3

http://thegaitguys.libsyn.com/pod-124

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Show Notes:

Kidney Damage in Runners. 82%  !?
http://www.newsweek.com/running-bad-you-marathons-damage-kidneys-runners-bodies-575829
 
Kidney nephropathy in mesoamericans.
http://www.ajkd.org/article/S0272-6386(15)01257-3/fulltext  
 
Elon Musk's Neural Lace.
https://www.scoopwhoop.com/elon-musk-launches-neuralink-which-hopes-to-combine-your-brain-with-artificial-intelligence/
 
Leg length discrepancies,do they really even exist ?
Dystonia ?
The Gluteal gripping phenomenon.

You are just breathing wrong dummy. (Um, maybe not. It is a little more complicated than that.)

There is a paradoxical idea that the fitter someone is, the more likely they will experience respiratory limitations.  This referenced article today suggests that every endurance athlete "has their own limit in endurance training", and that once exceeded it will produce all the possible respiratory disorders discussed in the article.

This article suggests there is a debate in the scientific community as to whether the lung can be defined “overbuilt” or “underbuilt” for facing strenuous exercise. In the ideal scenario,  your athlete will have a respiratory system perfectly tailored to meet their body’s metabolic demands under normal conditions.  However, it is when challenged by demand, whether that be intensity of exertion, environmental challenges or underlying physical pathology where limitations can impact the athletes demand and performance, thus, a pathological response can occur in a seemingly healthy athlete.  
Breathing, how to do it right, how you are doing it wrong. It is all over the internet these days and there are so many "experts" teaching it now. Some are also teaching it and diaphragm "activation" as the answer to every ailment you have, including why you received a "B minus" grade on your 6th grade spelling test. 
Make no mistake, how to breath properly is important. But, like much of the work Ivo and I do, and much of the preaching we do here on The Gait Guys is about getting to the root of the problem. Converting someone to diaphragmatic breathing from a thoracic cage breathing pattern (use whatever nomenclature you wish, we are trying to keep it simple here) is important, but not as important as finding out why someone is doing it. So are you looking deep enough? Are you asking the right questions before you just assume they forgot how to abdominally breathe ?  All to often we have our clients and athletes come in with their newest epiphany from their latest alternative "guru". Lately is it is, "my yoga/pilates/trainer/coach/bodyworker/massage therapist etc showed me how to belly breathe and use my diaphragm properly ! All is going to be ok now ! Everything will now be right in the world !"  However, all to often they fail to realize that all of the things this article delves into, not including the obvious things such as posture, thoracic spine mobility and stability, prehension patterns, workout habits, soft tissue tension/shortness/tightness, muscle weakness, motor pattern aberrancies, etc these are all just a piece of the potential "causes" of the breathing choice and problems. Fixing the problem helps to allow the natural breathing pattern to occur, with some helpful correction and re-education of course. 

There is a paradoxical idea that the fitter someone is, the more likely they will experience respiratory limitations. One's respiratory abilities as an athlete must be built up, just like any other component of their training. The lungs must be trained to satisfy the metabolic demands of the system, however, often their are parameters existing that are outside of the athletes training efforts. Ask any athlete who jumps into altitude training and this becomes painfully apparent. Endurance athletes do die, thankfully not very often, but they do die and it is not always directly from sudden cardiac failure. There is often a reason the endurance athlete dies shortly after the event, not during, when the physical exertion was actually occurring. Think about it. Exercise-induced respiratory disorders do exist in athletes and they are often the limiting factor in excelling physically. Ask any runner who has done a cold weather run, they will often be able to describe the thermal stress of cold air inhalation and dehydration. This is airway cooling followed by rewarming cycle. The coldness triggers a parasympatheic driven brochoconstiction and a vasoconstriction of the brochial venules. Subsequent rewarming follows and the opposite happens, followed by mucosal edema. 

This article proposes: "the question is precisely to understand if there is a limit in terms of intensity and/or in terms of duration in years to endurance training, before respiratory disorders can appear, and if we can apply any preventive strategies. To be an endurance champion, this inevitably means accepting all the labors of strong training but also enduring all possible health problems caused by the same."

There are many factors to consider, asthma, exercise induced asthma, temperature intolerance to cold or warm weather, a sensitive bronchial tree, long time smoker, prior smoker, medications, bronchospasms, reduced ventilation abilities, pulmonary edema, allergies . . .  the list goes on an on, read the article.

One must consider all of those cardio-respiratory limiting pathologies, but, do not forget posture, faulty breathing technique, tight scalenes and pectorals, weak abdominals, poor thoracic rotation and extension, faulty arm swing, protracted shoulders and the list goes on. And, even more so, think of all the things we do when we started getting "winded" as an athlete, we move into more chest wall breathing, tap into the accessory respiratory muscles and all the pathologic patterns that go with it. We begin to struggle, first subtly, then more profoundly until we must stop. Now, do that several times a week and see what happens to your breathing habits. Respiration in the sedentary and in the athlete is a real issue, but it is multifactorial and complex.  It is more than, "Mr. Jones, please lie down. I am now going to teach you to abdominal breath and use your diaphragm correctly (because I just went to a seminar) and all of the stars will align and your next born child will become the next Michael Jordan."  Don't be that guy/gal. 

Breath deep my friends.

Have a read of the referenced article , it should open up your world as to how complex this machine truly is.

-Dr. Shawn Allen, the other gait guy


Reference:
Respiratory disorders in endurance athletes – how much do they really have to endure?

Maurizio Bussotti, Silvia Di Marco, and Giovanni Marchese
Open Access J Sports Med. 2014; 5: 47–63.
Published online 2014 Apr 2. doi:  10.2147/OAJSM.S57828
 

OTS. It is taking down the best athletes, one by one.

Made famous in the beginning, first it was Alberto Salazar.  Now, just in the last decade it has been Anna Frost, Anton Krupicka, Geoff Roes, Kyle Skaggs, even Mike Wolfe. One by one they have fallen, to OTS.  More frighteningly, how many more have fallen to OTS that we never hear about? How many hundreds or thousands walking amongst us have OTS ? If you are a distance or heavy volume training athlete, do not brush off or take lightly what I have complied here today.

OTS, "Overtraining syndrome" is its name, but perhaps a better one would be "Insufficient Recovery Syndrome".  To use the broadest of terms, this is a self-generated, self-perpetuating dis-ease of one's own homeostasis. To be clear, there is a continuum here of multi-system failure, softer less severe forms of OTS. These less damaged states are referred to as Overreaching syndrome (OR). There are two forms of Overreaching syndrome, Functional OR and Nonfunctional OR. Nonfunctional OR shows decreases in performance for weeks to months while OTS being more severe and requiring months to years for recovery despite rest.
Over the past 10 years the best of the best are falling, one by one, victim to "too much".  They have just pushed themselves too much, too far, too long. It is the latest biggest thing in running these days, how far can you run ? Marathons are no longer enough for some, they have to see if 50 miles or 100 miles, or more, are enough and that means running 100-160 miles a week. And what is even more scary, some of these runners are in high school and college, they are still growing kids.

The physiology of these people is failing, truly. Some might suggest they in some respects showing signs of a slow death.  “OTS is one of the scariest things I’ve ever seen in my 30 plus years of working with athletes,” says David Nieman, former vice president of the American College of Sports Medicine. “To watch someone go from that degree of proficiency to a shell of their former self is unbelievably painful and frustrating.” - Meaghen Brown Jun 12, 2015.  Outside online. 

The first reference in which OTS was suggested was by a researcher and athlete named Robert Tait McKenzie.  In his 1909 book, Exercise in Education and Medicine, he mentioned a “slow poisoning of the nervous system which could last weeks or even months.” Then in 1985 South African physiologist professor Timothy Noakes discussed what appears to be the same condition in "The Lore of Running". Runners examined by Noakes had so over exerted themselves that both mind and body were failing.

OTS is truly a deeper problem. This is an immune, inflammatory, neurologic and psychological problem as best as anyone can tell.  In essence it seems the body is slowly dying. The body's parasympathetic nervous system, the system that counteracts the ramping up of the sympathetic nervous system, fails to properly respond to bring the systems back into balance. This means that many of the physiologic responses to activity fail to properly return to baseline. This means that blood pressure, heart rate, breathing, digestion, adrenal and hormonal rhythms amongst many other things go awry. Even other important things begin to decline, things like normal restful sleep, sometimes even insomnia, libido decline, metabolism dysfunction, appetite problems and even heart rate recovery and recurrent colds and viral infections.  We are talking about multi-system failure in these people, and this is serious business. The problem is, these athletes do not listen to the signals until it is too late and they are in full blown multi-system decline or failure. 

Here is likely an incomplete list of things that might be slowing showing up, softly, one by one as multi-system failure ramps up:

- anemia
- chronic dehydration
- increased resting heart rate
- breathing changes
- digestive troubles , bowel troubles (ie. runners diarrhea)
- endocrine problems: adrenal and hormonal shifts
- insomnia and sleeplessness
- blood pressure changes
- libido changes
- metabolism and appetite changes
- recurrent colds and viral infections
- generalized fatigue
- muscle soreness
- recurrent headaches
- inability to relax, listlessness
- swelling of lymph glands
- arrhythmias
- depression (neurotransmitter dysfunction)

There is a way out of OTS. But, one has to wrap their head around the fact that one's goals and mental drive have pushed them to this point. This is one's own fault and they will have to take some hard advice and make some tough decisions, decisions they do not want to make, but ultimately will have no choice but to make. That means changing those goals and habits, otherwise this could get real serious real fast. And wrapping one's head around the toughest part will be the most painful part for most, many months of rest, sometimes a year or more, to fully recover if one hasn't done too much irreparable damage to begin with.  Of course, the immediate course of action is to see a doctor. Hopefully, a doctor who is familiar with elite athletes and one that can rule out any other more serious immediate health concerns and disease processes that can mimic OTS and OR syndromes.

As with solving most problems, one has to first start to realize one is heading towards a problem, and accept responsibility. In this case, over training and under recovering.  One must look at their habits, and the subsequent outcomes, and see if there are signs of impending problems and if so be willing to make behavioral changes. This is a hard thing for endurance athletes, because it is asking them to look at enjoyable, admittedly addictive, endeavors. Endeavors that have always improved many facets of their life, yet ones that have a double edged-sword nature to them which can very quickly chop down all the hard work that has been put in. Ultimately, the answer is balance, balance in all aspects of one's life. But, who is truly good with balance ? Very few of us I am afraid.

Dr. Shawn Allen, one of the gait guys
 

References:

Running on Empty By: Meaghen Brown Jun 12, 2015.  Outside online. 
https://www.outsideonline.com/1986361/running-empty

Sports Health. 2012 Mar; 4(2): 128–138.Overtraining Syndrome. A Practical Guide
Jeffrey B. Kreher, MD†* and Jennifer B. Schwartz, MD‡
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435910/

Med Sci Sports Exerc. 2013 Jan;45(1):186-205. Prevention, diagnosis, and treatment of the overtraining syndrome: joint consensus statement of the European College of Sport Science and the American College of Sports Medicine.
Meeusen R, Duclos M, Foster C, Fry A, Gleeson M, Nieman D, Raglin J, Rietjens G, Steinacker J, Urhausen A; European College of Sport Science; American College of Sports Medicine.

Open Access J Sports Med. 2016; 7: 115–122. Published online 2016 Sep 8.  Diagnosis and prevention of overtraining syndrome: an opinion on education strategies. Jeffrey B Kreher

Overtraining, Exercise, and Adrenal Insufficiency
KA Brooks, JG Carter
J Nov Physiother. Author manuscript; available in PMC 2013 May 9.
Published in final edited form as: J Nov Physiother. 2013 Feb 16; 3(125): 11717

Related citations:
https://scholar.google.com/scholar?ion=1&espv=2&bav=on.2,or.r_cp.&biw=1179&bih=705&dpr=1.5&um=1&ie=UTF-8&lr&cites=3025342060917260626
 

Allen's Rule: Is this why the Kenyan's are better marathoners ?

Allen’s Rule

So you want to be the next great distance runner do you? There are some genetic components that might (or might not) come into play, things you obviously do not have control over.

Proposed by Joel Allen in 1877, Allen’s rule has in many respects been proven to have little scientific support.  None the less, knowing and  understanding the Rule has some value, especially if you are researcher J.S. Alho of the Ecological Research Unit of the Univ. Helskini, Finland where recent renewed interest in the rule has arisen due to global warming and the microevolutionary changes it predicts. 

Allen’s rule states that endotherms from colder climates tend to have shorter limbs than those in warmer climates. The theory is based on the surface area of an organism.  The larger the surface area the easier it is to dissipate heat, but also the easier it is too cool.  Depending on the location the organism finds themselves, this can be an advantage or a disadvantage.

There is a theory (ecographical rules if you will) by Allen’s rule, that suggests that growth plasticity of the limbs and other body parts exists and which is correlated with the temperature conditions of the developing mammal, particularly during the periods of rapid skeletal development. Allen’s rule suggests that relative extremity length decreases with increasing latitude.  Thus, according to Allen’s rule, those living on either side of the first degree of latitude from the equator (suggesting the hottest 138 mile or 222km swath on earth) should have the longest limbs (keep in mind this is likely a carried-forward genetic trait). This plasticity of the human skeleton allows mammals to adjust to the exposed temperature conditions during early development. This suggests possible advantages to climate rearing for would be world-class athletes depending on the chosen sport. For example, Allen’s rule proposes that individuals reared in hot climates will develop longer thinner limbs which have more surface area whereby they can irradiate body mass heat into the environment thus creating a net cooling effect of the body enabling physical exertion to occur longer and at a higher rate (appendage length correlates with temperature and latitude from which the mammal was raised).  This is one of the theories proposed as to why Kenyan runners outperform so many other professional distance runners, long thin limbs seem to act as cooling vents.  It is also one of those theories that seems to hold little water, but it is good to know none the less. Sometimes theories that are proven to be false come back to have some truth down the road. And maybe Alho will discover just this is the case in time.

Shawn and Ivo…….. The Gait Guys….pulling out random facts, some useful, others not so useful (and some proven debunked) to expand your gait knowledge. The more you know, ……… the better you are a cocktail parties.  Tis the season !

References:

1. Anat Rec (Hoboken). 2013 Oct;296(10):1534-45. doi: 10.1002/ar.22763. Epub 2013 Aug 19.

Allen’s rule revisited: temperature influences bone elongation during a critical period of postnatal development.

Serrat MA.

2. J Evol Biol. 2011 Jan;24(1):59-70. doi: 10.1111/j.1420-9101.2010.02141.x. Epub 2010 Oct 21.

Allen’s rule revisited: quantitative genetics of extremity length in the common frog along a latitudinal gradient.

Alho JS, Herczeg G, Laugen AT, Räsänen K, Laurila A, Merilä J.