Podcast #115: Brain logging injuries and patterns

We go deep on how injuries get logged deep in the CNS, what to do and how to get around it all.  Join us today !


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http://traffic.libsyn.com/thegaitguys/pod_115f.mp3


http://thegaitguys.libsyn.com/podcast-115-brain-logging-injuries-and-patterns

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Show Notes:

Imagining workouts can improve strength
http://globalnews.ca/news/2885514/imagining-a-workout-may-be-almost-as-good-as-the-real-thing/

Your injuries are not forgotten
http://www.medicalnewstoday.com/articles/312665.php

Turning: Connecting the kinetic chain

Look at the photo, which way am I turning my head ? How hard am I turning ? Perhaps I am turning hard through my neck and thoracic spine to look over my shoulder.  The point is, you can see it in my feet and if you know your biomechanics you should easily know which way I am turned.

 It should be simple and clear that I am turning my neck and thoracic spine strongly to the left.  The left rotation has forced me to find stability over the lateral left foot while driving the rotation with the right foot.  Left foot had to supinate, right had to pronate. No rocket science here.
Earlier in the week I posted a brief discussion on the neck and proprioception and the upper and lower limb. I caught some questions on challenging the strength of the neurological linkages to the lower limb, so I promised a simple picture to solidify my point.
Where is what i wrote earlier this week.
"From the study: "Limb proprioception is an awareness by the central nervous system (CNS) of the location of a limb in three-dimensional space and is essential for movement and postural control. The CNS uses the position of the head and neck when interpreting the position of the upper limb, and altered input from neck muscles may affect the sensory inputs to the CNS and consequently may impair the awareness of upper limb joint position."

We say it is not just the upper limb however, the neck and head posture is used in interpreting the position of the lower limb as well. And similarly altered head/neck muscle input can impair awareness of the lower limb posture as well. Think about it, we are trying to stay upright in the gravitational plane while keeping the eyes and vestibular centers on the horizon. Gait is nothing more than a single leg balancing act repeated over and over. Faulty info on where our center of pressure is from a visual or vestibular aspect will alter where we put our foot in space. Just look at how many neurologic diseases end up with a wider based gait, because our proprioceptive centers no longer trust our base of support. It is all connected."

Exp Brain Res. 2015 May;233(5):1663-75. doi: 10.1007/s00221-015-4240-x. Epub 2015 Mar 13.

Neck muscle fatigue alters upper limb proprioception.

Zabihhosseinian M1, Holmes MW, Murphy B.
 

As in this study, and putting it together with my photo and discussion at the start here today, limb proprioception is an awareness by the CNS of the location of the limb and is essential for proper movement and postural control. If I had rotated to the left and had my CNS not known where the foot was in space and in relation to the rest of my body, I may have fallen over to the left. Instead, my CNS sensed the weight shift to the left from the neck and torso rotation, and moved my foot weight bearing into supination (affording a slightly greater lateral weight bearing on the foot) to accommodate the shift in my center of pressure and mass laterally.  So, the CNS used the position of the head and neck, and the weight shift, in interpreting the appropriate positioning of the lower limbs. Sometimes moving the foot into supination to accommodate the lateral load is not enough, and we need to actually step laterally to maintain upright.  Altered input from my neck muscles might affect the sensory inputs to the CNS and consequently may impair the awareness of my limb joint positioning in space. This happens often in vestibular challenged clients and in client of aging decline where the system is losing proprioception. If we do not know where a body part is in space, we don't know how to use it or how to load it (think about chronic ankle sprains).

As i said earlier this week, think about it, we are trying to stay upright in the gravitational plane while keeping the eyes and vestibular centers on the horizon. Gait is nothing more than a single leg balancing act repeated over and over. Faulty info on where our center of pressure is from a visual or vestibular aspect will alter where we put our foot in space. Just look at how many neurologic diseases end up with a wider based gait, because our proprioceptive centers no longer trust our base of support. It is all connected.

Think about how amazing this system is when it works right, we can run on a track leaning into the curve, we can ride a bike and lean into turns, we can run forward and yet turn to look behind us, all without falling over -- thanks to our CNS and joint proprioception.

Dr. Shawn Allen, the other gait guy

The 5 Point Turn (in a human).  Do you know this gait problem ?

Here is a video link for the full video case study with diagnosis and more details on this client’s gait but our point here today is to look at the uniquely pathologic turning motor pattern deployed by this patient.

Gait analysis is so much more than watching someone move on a treadmill. Forward momentum at a normal speed can blur out many of a person’s gait pathologies.  We discussed this in detail in this blog post on slowing things down with the “3 second gait challenge”.  Furthermore, most gait analysis assessments do not start seated, then watching the client progress to standing, and then initiating movement.  Watching these intervals can show things that simple “gait analysis” will not.  Finding stability over one’s feet and then initiating forward motion can be a problem for many.  Those first moments after attaining the standing position afford momentum to carry the person sideways just as easily as carrying them forward. In other words, once momentum forward begins, a normal paced gait can make it difficult to see frontal plane deficits.  Our point here, transitional movements can show clues to gait problems and turning to change direction is no different.

Typically when we turn we use a classic “plant and pivot” strategy.  We step forward on a foot (right foot for example here), transfer a majority load on that forward right foot, we then pivot the left foot in the next anticipated direction of movement, and then push off the right foot directionally while spinning our body mass onto that left foot before initiating the right limb swing through to continue in the new direction.  This is not what this patient does. Go ahead, stand up and feel these transitions, if you are healthy and normal they are subconscious weight bearing transitions but for some one who is old and losing strength and proprioception/balance or some one with neurologic decline for one reason or another, these directional changes can be extremely difficult as you see in this video here. A full 180 degree progression is often the most difficult when things get really bad.  And more so, if one leg is more compromised than the other, turning one way a quarter turn (a 90 degree directional change) might be met with an alternative 270 degree multiple-point turn in the opposite direction over the more trusted limb to get to the same directional change. When there is posterior column disease or damage this seemingly simple “plant/weight shift/ pivot and push off” cannot be trusted. So a 5 point (or more) turn is deployed to be sure that small choppy steps maximize minimal loss of feel and maximal ground contact feel. This can be seen clearly in this video above.

Full video case link here:https://www.youtube.com/watch?v=AYmzQL_NSeI

Just some more things to think about in  your gait education.  Watch your clients move from sit to stand, from stand to initiating gait, and then watch closely their turning strategies. At the very least, have them make several passes making their about-face turns both to the right and the left. You will often see a difference.  Watch for unsteadiness, arm swing changes, cross over steps, reaching for stability (walls, furniture etc), moving of the arms into abduction for a ballast effect and the like. Then correlate your examination findings to your gait analysis.  Then, intervene with treatment and rehab, and review their gait again. Remember, explaining their deficiencies is a huge part of the learning process. Make them aware of their 5 point turns, troubles pivoting to the right or the left, and make them understand why they are doing the goofy one-sided rehab exercises. Understanding what is wrong is a huge part of fixing your client’s problems.

* Remember: if your client is having troubles on a stable surface (ie. the ground) then they should engage some rehab challenges on the ground. Giving them a tilt board or bosu or foam pad (ie. making the ground more unstable) will make things near impossible.  This is not a logical progression, we like to say, “if you can’t juggle one chainsaw we won’t give you 3”. Improve their function on a stable surface first, then once improvements are seen, then progress them to unstable surfaces.  

Shawn and Ivo

The gait guys.  

Podcast #31: Walking Straight, Mastalgia & Shoes


podcast link:

http://thegaitguys.libsyn.com/podcast-31-walking-straight-matalgia-queen

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:

1. Neuroscience Piece:

http://www.cell.com/current-biology/abstract/S0960-9822(09)01479-1

http://www.npr.org/blogs/krulwich/2011/06/01/131050832/a-mystery-why-can-t-we-walk-straight

Today we have a neuroscience piece on “turning”, in a matter of speaking. So why, when blindfolded, can’t we walk straight?

These “Turning” field studies appear in Chris McManus’ book, Right Hand, Left Hand, The Origins of Asymmetry in Brains, Bodies, Atoms and Cultures (Phoenix, 2002). 

NPR Story Produced by Jessica Goldstein, Maggie Starbard.

2. neuroscience 2 at the end of the show.
The myth of the 8 hour sleep
3. Blog reader asks:
Any shoe recommendations for an uncompensated forefoot varus?

4. and another from the Blog:
Hi The Gait Guys, what can I do to regain medial tripod? I have a forefoot varus and when I am standing it compensates and my rearfoot everts and gets valgus. I have been having some pain lately and it is annoying me a lot. Please help. Thank you.

5. FACEBOOK readers asks:

Bringing the Foot Back To Life: Restoring the Extensor Hallucis Brevis Muscle.

http://youtu.be/1iZg_e4veWk
6. PUBMED

Foot loading patterns can be changed by deliberately walking with in-toeing or out-toeing gait modifications.

Gait Posture. 2013 Apr 25. pii: S0966-6362(13)00190-2.

7. The Gait Guys are always talking about ankle rocker, dorsiflexion strength and the importance of the anterior compartment of the lower leg. Here is another study to add fuel to our fire.

Ankle dorsiflexor strength relates to the ability to restore balance during a backward support surface translation

Gait & Posture

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8. Shoes:

NB new Minimus 10V2

The Minimus 10 is back - and better than ever. The MR10v2 is the latest version of the previous Minimus Road 10,


9.
http://www.runnersworld.com/health/study-one-third-female-marathoners-report-breast-pain

Study: One-Third of Female Marathoners Report Breast Pain

10. Painkiller meds taken before marathons

http://www.labspaces.net/127827/Painkillers_taken_before_marathons_linked_to_potentially_serious_side_effects

from the British Medical Journal

11. The myth of the 8 hour sleep

http://www.bbc.co.uk/news/magazine-16964783
By Stephanie Hegarty BBC World Service