Podcast 139: STEM &PRP therapies for athletes

Topics:
We are all over the board today folks, topics like PRP but more so we go down some paths that are more fundamentally clinical and neurologic with a sprinkling of orthopedics to round things out. Sometimes these are our best shows.

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doctorallen.co

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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.

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 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>

 

Fatigue and muscle activation.

"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"

No rocket science here . . . but good to remember that fatigue sets us all up for injury if one does not observe and listen to the signs of fatigue . . . . especially when athletic and loading demand is increasing rather than tapering at the same time as the fatigue is building. As we fatigue, compensation recruitment is supposed to generate more stiffness to protect the motor units. But, can this be at a cost ?

This study looked at whether fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability. 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.

The study used surface EMG to look at the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis in a group of otherwise healthy individuals.

Essentially the study concluded that:
"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. 
."

 

Gait Posture. 2016 Nov 9;52:15-21. doi: 10.1016/j.gaitpost.2016.11.016. [Epub ahead of print]

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.

https://www.ncbi.nlm.nih.gov/pubmed/27846435

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

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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

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

 

tumblr_myl1kjZFFR1qhko2so1_1280.jpg
tumblr_myl1kjZFFR1qhko2so2_400.jpg

On the subject of manual muscle work…There is more to it than meets the eye….

Following with our last few posts, here is an article that may seem verbose, but has interesting implications for practitioners who do manual muscle work with their clients. We would invite you to work your way through the entire article, a little at a time, to fully grasp it’s implications.

Plowing through the neurophysiology, here is a synopsis for you:

Tactile and muscle afferent (or sensory) information travels into the dorsal (or posterior) part of the spinal cord called the “dorsal horn”. This “dorsal horn” is divided into 4 layers; 2 superficial and 2 deep. The superficial layers get their info from the A delta and C fibers (cold, warm, light touch and pain) and the deeper layers get their info from the A alpha and A beta fibers (ie: joint, skin and muscle mechanoreceptors).

So what you may say.

The superficial layers are involved with pain and tissue damage modulation, both at the spinal cord level and from descending inhibition from the brain. The deeper layers are involved with apprising the central nervous system about information relating directly to movement (of the skin, joints and muscles).

Information in this deeper layer is much more specific that that entering the more superficial layers. This happens because of 3 reasons:

  1. there are more one to one connections of neurons (30% as opposed to 10%) with the information distributed to many pathways in the CNS, instead of just a dedicated few in the more superficial layers
  2. the connections in the deeper layers are largely unidirectional and 69% are inhibitory connections (ie they modulate output, rather than input)
  3. the connections in the deeper layers use both GABA and Glycine as neurotransmitters (Glycine is a more specific neurotransmitter).

Ok, this is getting long and complex, tell me something useful...

This supports that much of what we do when we do manual therapy on a patient or client is we stimulate inhibitory neurons or interneurons which can either (directly or indirectly)

  1. inhibit a muscle
  2. excite a muscle because we inhibited the inhibitory neuron or interneuron acting on it (you see, 2 negatives can be positive)

So, much of what we do is inhibit muscle function, even though the muscle may be testing stronger. Are we inhibiting the antagonist and thus strengthening the agonist? Are we removing the inhibition of the agonist by inhibiting the inhibitory action on it? Whichever it may be, keep in mind we are probably modulating inhibition, rather than creating excitation.

Semantics? Maybe…But we constantly talk about being specific for a fix, not just cover up the compensation. Is it easier to keep filling up the tire (facilitating) or patching the hole (inhibiting). It’s your call

The Gait Guys. Telling it like it is and shedding light on complex ideas, so you can be all you can be.

link: http://jn.physiology.org/content/99/3/1051

Muscle Activation Concerns  
 We are concerned about some things that are showing up in our clinics lately. Strange injury patterns we have not seen before. We know you are all very busy, because you are the best what you do, but we hope that by sharing these 2 articles with you we can all further raise this team of practitioners, coaches, physical therapists, trainers, pilates and yoga instructors, surgeons etc and work even more effectively as a team.   
  
 This issue is about muscle activation or facilitation. 
  
 As you are all learning, this game is more than just turning muscles on, and there are risks to turning something on when the central nervous system has decided it is not safe to turn something on. We are all treating people who are slouched over all day either as students or at desk jobs and thus everyone (seeing as they are all dropped into hip, knee and cervical, thoracic and lumbar spine flexion) will have some degree of inhibited glutes (and thus reciprocal neuro-protective hip flexor tightness) that appear to need activated when the truth is that they need more central extension facillitation. Activating the glutes when there is a central flexion inhibition driver overrides the nervous system&rsquo;s protective inhibition response. Hence the near-epidemic of hamstring and hip flexor/groin/labrum tear problems we are seeing !   There are logical reasons why something is not activated. Sometimes it is a  
  
 1. muscle skill pattern (large diameter nerve, all muscle fiber diameters),  
 2. sometimes it is an endurance problem (large diameter nerve, small muscle fiber diameter), 
 3.  sometimes it is a strength problem (largest diameter nerve, largest diameter muscle fibers).  
  
 Knowing a problem is driven by 2 or 3 will tell the practitioner that activation will not solve the problem and that activation can force a compensation pattern that can lead to a future injury. Also, sometimes it has nothing to do with the muscles motor nerve activity, it may in fact be about the reciprocal inhibitory neurosensory input (see our post on reciprocal inhibition  here ).  
  
 Hence we wanted to share 2 articles we wrote. These articles were spurred by the magnified influx in the last year of injuries that appear compensatory, meaning they seem to have occurred because alternative compensatory motor patterns were encouraged where there appear to be clear signs that they should not have been encouraged.  In other words, sorry to say this, people with a weaker understanding of how and why the nervous system works are using muscular activation as a tool when it is the wrong tool. When you are pounding a nail, using a screwdriver won&rsquo;t get you good results, and might get you the wrong results. But, if all you have is a screwdriver &hellip; . . 
  
 The blog posts are below. We strongly believe that many of these injuries we are seeing are not necessary. We always ask ourselves when a person who we have been working on says to us &ldquo;honest doc, I really did not do anything, I was just running comfortably and the hamstring grabbed at me for no apparent reason.&rdquo;  These stories always make us look in wards and ask &ldquo;is this injury my fault ?&rdquo; &ldquo;Did this occur because I was activating the wrong muscles and wrong patterns thus forcing them into a less worth protective pattern because I thought I knew better than their nervous system did ?&rdquo; When we want to learn we judge ourselves and our actions  harshly, for we know we make mistakes and we know we are still students. We know that if it appears simple, it might be a good time to step back and think it through a little more.  
  
 Don&rsquo;t just be an muscle &ldquo;activator&rdquo;, be a thinker who occasionally activates when it is appropriate.  The nervous system knows better than you do, accept this and try to figure out why it is shutting things down. 
  
  http://thegaitguys.tumblr.com/post/68785250796/just-because-a-muscle-tests-weak-doesnt-mean-it-needs  
  
  http://thegaitguys.tumblr.com/post/68879743040/do-you-do-manual-muscle-testing-following-up-on  
  
 Shawn and Ivo 
  
  image from :  http://www.emeraldinsight.com/books.htm?chapterid=1775219&amp;show=html

Muscle Activation Concerns

We are concerned about some things that are showing up in our clinics lately. Strange injury patterns we have not seen before. We know you are all very busy, because you are the best what you do, but we hope that by sharing these 2 articles with you we can all further raise this team of practitioners, coaches, physical therapists, trainers, pilates and yoga instructors, surgeons etc and work even more effectively as a team.  
This issue is about muscle activation or facilitation.
As you are all learning, this game is more than just turning muscles on, and there are risks to turning something on when the central nervous system has decided it is not safe to turn something on. We are all treating people who are slouched over all day either as students or at desk jobs and thus everyone (seeing as they are all dropped into hip, knee and cervical, thoracic and lumbar spine flexion) will have some degree of inhibited glutes (and thus reciprocal neuro-protective hip flexor tightness) that appear to need activated when the truth is that they need more central extension facillitation. Activating the glutes when there is a central flexion inhibition driver overrides the nervous system’s protective inhibition response. Hence the near-epidemic of hamstring and hip flexor/groin/labrum tear problems we are seeing !   There are logical reasons why something is not activated. Sometimes it is a 
1. muscle skill pattern (large diameter nerve, all muscle fiber diameters), 
2. sometimes it is an endurance problem (large diameter nerve, small muscle fiber diameter),
3.  sometimes it is a strength problem (largest diameter nerve, largest diameter muscle fibers). 
Knowing a problem is driven by 2 or 3 will tell the practitioner that activation will not solve the problem and that activation can force a compensation pattern that can lead to a future injury. Also, sometimes it has nothing to do with the muscles motor nerve activity, it may in fact be about the reciprocal inhibitory neurosensory input (see our post on reciprocal inhibition here). 
Hence we wanted to share 2 articles we wrote. These articles were spurred by the magnified influx in the last year of injuries that appear compensatory, meaning they seem to have occurred because alternative compensatory motor patterns were encouraged where there appear to be clear signs that they should not have been encouraged.  In other words, sorry to say this, people with a weaker understanding of how and why the nervous system works are using muscular activation as a tool when it is the wrong tool. When you are pounding a nail, using a screwdriver won’t get you good results, and might get you the wrong results. But, if all you have is a screwdriver … . .
The blog posts are below. We strongly believe that many of these injuries we are seeing are not necessary. We always ask ourselves when a person who we have been working on says to us “honest doc, I really did not do anything, I was just running comfortably and the hamstring grabbed at me for no apparent reason.”  These stories always make us look in wards and ask “is this injury my fault ?” “Did this occur because I was activating the wrong muscles and wrong patterns thus forcing them into a less worth protective pattern because I thought I knew better than their nervous system did ?” When we want to learn we judge ourselves and our actions  harshly, for we know we make mistakes and we know we are still students. We know that if it appears simple, it might be a good time to step back and think it through a little more. 
Don’t just be an muscle “activator”, be a thinker who occasionally activates when it is appropriate.  The nervous system knows better than you do, accept this and try to figure out why it is shutting things down.
Shawn and Ivo

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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.