The Power of Facilitation: How to supercharge your run.

While running intervalsone morning, something dawned on me. My left knee was hurting from some patellar tracking issues, but only on initial contact and toe off. I generally run with a midfoot strike. I began concentrating on my feet, lifted and spread my toes and voila! my knee pain instantly improved. Very cool, and that is why I am writing this today. 

Without getting bogged down in the mire of quad/hamstring facilitation patterns, lets look at what happened.

I contracted the long extensors of the toes: the extensor digitorum longus and the extensor hallicus longus; the short extensors of my toes: the extensor digitorum brevis, the extensor hallucis brevis: as well as the dorsal interossei.the peroneus longus, brevis and tertius were probably involved as well.

Do you note a central theme here? They are all extensors. So what, you say. Hmmm… 

Lets think about this from a neurological perspective:

In the nervous system, we have 2 principles called convergence and divergence. Convergence is when many neurons synapse on one (or a group of fewer) neuron(s). It takes information and “simplifies” it, making information processing easier or more streamlined. Divergence is the opposite, where one(or a few) neurons synapse on a larger group. It takes information and makes it more complicated, or offers it more options.

In the spinal cord, motor neurons are arranged in sections or “pools” as we like to call them in the gray matter of the cord. These pools receive afferent information  and perform segmental processing (all the info coming in at that spinal cord segment) before the information travels up to higher centers (like the cerebellum and cortex). One of these pools fires the extensor muscles and another fires the flexor muscles.. 

If someone in the movie theater keeps kicking the back of our seat, after a while, you will say (or do) something to try and get them to stop. You have reached the threshold of your patience. Neurons also have a threshold for firing.  If they don’t reach threshold, they don’t fire; to them it is black and white. Stimuli applied to the neuron either takes them closer to or farther from threshold.  When a stimulus takes them closer to firing, we say they are “facilitating” the neuron. If it affects a “pool” of neurons, then that neuronal pool is facilitated. If that pool of neurons happens to fire extensor muscles, then that “extensor pool” is facilitated.

When I consciously fired my extensor muscles, two things happened: 1. Through divergence, I sent information from my brain (fewer neurons in the cortico spinal pathway) to the motor neuron pools of my extensor muscles (larger groups of motor neurons) facilitating them and bringing them closer to threshold for firing and 2. When my extensor muscles fired, they sent that information (via muscle spindles, golgi tendon organs, joint mechnoreceptors, etc) back to my cerebellum, brain stem and cortex (convergence) to monitor and modulate the response.

When I fired my extensor muscles, I facilitated ALL the neuronal pools of ALL the extensors of the foot and lower kinetic chain. This was enough to create balance between my flexors and extensors and normalize my knee mechanics.

If you have followed us for any amount of time, you know that it is often “all about the extensors” and this post exemplifies that fact.

 Next time you are running, have a consciousness of your extensors. Think about lifting and spreading our toes, or consciously not clenching them. Attempt to dorsiflex your ankles and engage your glutes. It just may make your knees feel better!

The Power of the 1st Ray?

PSM_V24_D673_Deforming_pressure_of_high_heels_on_the_foot_bone_structure.jpg

Does the 1st ray complex have super powers? Perhaps Marvel should consider a new superhero “Ray”? We are not sure but here is a story that gets us one step closer to the answer. 

While teaching a course this past weekend and doing a teaching case, we examined one of the participants who had high arches, a rigid rearfoot varus, internal tibial torsion, R > L, and foot pain R>L and a dorsal exostosis (growth of extra bone from stress at the base of her 1st metatarsal) where it articulated with the  1st cunieform on the right. No surprisingly, she also had a partially compensated forefoot supinatus on the right. She had increased wear on the lateral aspect of her shoes and a walking strategy which involved hiking the right side of the pelvis during stance phase on the left, and a pelvic shift to the right during stance phase on the right, as well as an inability to get the head of either 1st ray complex to the ground, R > L. It was also determined she had, not surprisingly, locking of the 1st metatarsal cunieform joint on the right and a loss of anterior and posterior shear at the superior tib fib articulation on the right, as well as hypomobility of the right sacoiliac joint. There was weakness of the abdominal external obliques bilaterally and posterior fibers of the left gluteus medius, along with the long toe extensors on the left and short toe flexors, a pattern that we often see clinically.

We then proceeded to treat her tib posterior, peroneus longus and flexor digitorum on the right, all of which have an effect on descending the 1st ray, along with the long extensors on the right, which would effectively raise the distal aspect of the 1st ray, but we thought may provide better eccentric control of the foot from initial contact to loading response, and again from the end of terminal stance and through swing phase.  We then mobilized the 1st met cunieform articulation only. Ideally, we should have reassessed after we made EACH change, but due to time constraints, AFTER we had done ALL these things. 

Rexamination had better 1st ray motion, restoration of tib fib motion and restoration of R sided SI mechanics. Her 1st ray descended much better, tib fib motion was normalized, L sided hip hiking strategy and R sided pelvic shift were greatly improved. For the 1st time in 10 years, the participant had no foot pain. Coincidence? Perhaps. Placebo? Maybe. You decide. 

Sometimes, doing a little of the right thing can be a good thing. Sometimes we overdo. I have to admit, because I am a chiropractor, I would have started with manipulation 1st of all 3 articulations with a recheck immediately post treatment AND THEN treated the other dysfunctions. For those of you who are manual therapists, I am sure you see miraculous things happen when we cavitate joints and change their instantaneous axes of rotation. I can thank Dr Ted Carrick and my good friend and colleague, Dr Paul Chille, for teaching me that. The students, in this case, were driving the bus and I went along with it.  I was surprised (though I shouldn’t have been) to see the pathomechanics resolve WITHOUT manipulation, but it got me thinking I should consider treating the muscular dysfunctions 1st, and then recheck and manipulate later. It makes sense that the receptor density of the lower extremity musculature has a much larger population of muscle mechanoreceptors, especially in the foot, since it has a greater cortical representation than the joint mechanoreceptors.

My students never cease to teach me something new...

Whoa # 2

And what about # 260?

Things are certainly different for this chap compared to # 172. His take off from his right foot looks pretty good. His left foot looks like it is going to cross over with some medial knee fall as it descends to hit the ground. Just before it hits the ground, it should be supinated in some degree of dorsiflexion (he is sprinting, so we expect some plantar flexion because he is sprinting), inversion and adduction. His pelvis is nice and level. His arm swing looks pretty good with only a slight cross over on the right as it is coming through. With form this good, no wonder he is out front!

 

Whoa!

Whoa! What's wrong with #172?

 Where do we start? Look at all of that tibial and genu varum! Notice how his knee is outside the sagittal plane? This means that he also has internal tibial torsionand he is rotating his foot out to create the requisite 4-6° internal rotation needed to move forward. It also looks like he has limited internal rotation of the thighby the positioning of his body.  This could be due to femoral retroversion as this commonly occurs with internal tibial torsion. Check out the interesting hand posturing bilaterally. Notice the extended thumb and wrist on the left? He may be trying to fire into his extensor pool to help gain more hip extension.  I sure wish we had a Sideview. Thankfully his pelvis is relatively level, isn't it? No, it actually isn't. That's just his shirt. Look closely at the tops of the iliac crests and you will see what I am talking about. Did you catch the slight head tiltto the right? With that much tibial and genu varum his center of gravity is moving to the left and he needs to tilt his head to the right to equalize things out.  What about the posterior rotation of the left shoulder? Again probably this is due to a lack of or failure to use internal rotation of the left hip.

Lots to talk about on this picture and we will do some more next time.

Got Motion Control? Sometimes too much of a good thing is a bad thing!

Welcome to Monday and News You can Use, Folks.

Today we look at short video showing what someone with internal tibial torsion looks like in a medially posted (ie motion control) running shoe. Note how the amount of internal rotation of the lower leg decreases when the shoe is removed and when he runs. Be careful what shoes you recommend, as a shoe like this is likely to cause damage down the road.

You can follow along listening to Dr Ivo’s commentary. This was filmed at a recent seminar he was teaching.

We always like to try and reproduce the problem. We like to say “If we can reproduce the pain, we can probably fix the cause”, which seems to hold true in many cases. This article makes us think about seeing the patient at a point in their training that they feel the discomfort or are having the problem (after 30 minutes, after 20 miles, etc). There may be some value to scheduling their exam later, rather than sooner. A nice fatigue article from one of our favs “LER”.      http://lermagazine.com/article/running-in-an-exerted-state-mechanical-effects

We always like to try and reproduce the problem. We like to say “If we can reproduce the pain, we can probably fix the cause”, which seems to hold true in many cases. This article makes us think about seeing the patient at a point in their training that they feel the discomfort or are having the problem (after 30 minutes, after 20 miles, etc). There may be some value to scheduling their exam later, rather than sooner. A nice fatigue article from one of our favs “LER”.


http://lermagazine.com/article/running-in-an-exerted-state-mechanical-effects

More on the Minimalist Debate  “Nearly a third (29%) of those who had tried minimalist running shoes reported they had experienced an injury or pain while using the shoes. The most common body part involved was the foot. Most (61%) of those reports involved a new injury or pain, 22% involved recurrences of old problems, and 18% were a combination of both old and new musculoskeletal problems.  More than two thirds (69%) of those who had tried minimally shod running said they were still using minimalist running shoes at the time of the survey, but nearly half of those who had stopped said they did so because of an injury or pain. The most common sites of pain or injury that caused survey participants to discontinue minimally shod running were the foot (56%) and the leg (44%).  While some runners who tried minimalist running shoes suffered some pain and discomfort, a greater percentage (54%) said they had pain that improved after making the switch. The anatomical area most often associated with improvement was the knee. The results were published in the August issue of PM&R.”

More on the Minimalist Debate

“Nearly a third (29%) of those who had tried minimalist running shoes reported they had experienced an injury or pain while using the shoes. The most common body part involved was the foot. Most (61%) of those reports involved a new injury or pain, 22% involved recurrences of old problems, and 18% were a combination of both old and new musculoskeletal problems.

More than two thirds (69%) of those who had tried minimally shod running said they were still using minimalist running shoes at the time of the survey, but nearly half of those who had stopped said they did so because of an injury or pain. The most common sites of pain or injury that caused survey participants to discontinue minimally shod running were the foot (56%) and the leg (44%).

While some runners who tried minimalist running shoes suffered some pain and discomfort, a greater percentage (54%) said they had pain that improved after making the switch. The anatomical area most often associated with improvement was the knee. The results were published in the August issue of PM&R.”

Today’s Rewind includes an older “Gait Guys at the Movies” clip of Carey Grant! Sit back and enjoy!

Run, Carey, Run?

Lets look at this Hitchcock classic “North by Northwest” and check out Cary’s form.

1st of all, what an arm swing! Think of all that energy it is sapping from the rest of his muscular system. He must be hiding something, but what? We can only see him from the waist up, so we may never actually know. Did you notice how he initially only turns to the right? Did you pick up on the flexion at the waist? How about that torso bob from side to side? Not much to his hip abductors now are there?

The only thing he has going for him is he is wearing leather soled shoes, which have been shown to have one of the lowest impact loading on the body (yes, you read that right; increased cushioning INCREASES impact forces, but that’s not what we are here to talk about). Oh yea, he actually impacts the ground at the end of the sequence. I guess if his technique was better, he would have hit even HARDER.

Next sequence, we are off to a good start, look at that forward lean to start! This is essential to good technique. He loses that form pretty quickly; we can still see that forward flexion at the waist; certainly costing him energy by not using his core.

Finally, we get a posterior view at the end, but the uneven surface makes it difficult to make an analysis.

We think Cary would certainly give Lola a run for her money. Cary, next time, engage your core and watch your step…

We Remain….The Gait Guys

Born to Run?
Perhaps we really were born to run. This study looks at the forefoot, the phalanges and their potential role in the evolution of our feet. 


We know impact forces increase with running, so it makes sense that physical and metabolic demand to continue forward momentum would increase as well. Longer lever arms (such as longer toes) would require greater torque on the muscles as well as increased lift of the foot (to provide ground clearance), and most likely a different orientation of the rearfoot and trochlea that the flexor tendons would have to pass through. This would probably result in a more cavus, rigid foot as well.
The study did not state, but suggested muscular recruitment of the flexors is distinctly different in walking vs running, and that there is less “balance” between the flexors and extensors. We contend that with appropriate gait patterns (ie, using the glutes as a primary hip extensor), long flexor activity would be more balanced with long extensor activity and this disparity would not be seen.

The video has nothing to do with the study, we just thought it was pretty funny

Sorting out the details so you don’t have to; The Gait Guys

J Exp Biol. 2009 Mar;212(Pt 5):713-21. Walking, running and the evolution of short toes in humans. Rolian C, Lieberman DE, Hamill J, Scott JW, Werbel W. Source http://www.ncbi.nlm.nih.gov/pubmed/19218523

Department of Anthropology, Harvard University, Cambridge, MA 02138, USA. cprolian@ucalgary.ca

Abstract

The phalangeal portion of the forefoot is extremely short relative to body mass in humans. This derived pedal proportion is thought to have evolved in the context of committed bipedalism, but the benefits of shorter toes for walking and/or running have not been tested previously. Here, we propose a biomechanical model of toe function in bipedal locomotion that suggests that shorter pedal phalanges improve locomotor performance by decreasing digital flexor force production and mechanical work, which might ultimately reduce the metabolic cost of flexor force production during bipedal locomotion. We tested this model using kinematic, force and plantar pressure data collected from a human sample representing normal variation in toe length (N=25). The effect of toe length on peak digital flexor forces, impulses and work outputs was evaluated during barefoot walking and running using partial correlations and multiple regression analysis, controlling for the effects of body mass, whole-foot and phalangeal contact times and toe-out angle. Our results suggest that there is no significant increase in digital flexor output associated with longer toes in walking. In running, however, multiple regression analyses based on the sample suggest that increasing average relative toe length by as little as 20% doubles peak digital flexor impulses and mechanical work, probably also increasing the metabolic cost of generating these forces. The increased mechanical cost associated with long toes in running suggests that modern human forefoot proportions might have been selected for in the context of the evolution of endurance running.