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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’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. 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&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

image from : http://www.emeraldinsight.com/books.htm?chapterid=1775219&show=html

Podcast 49: Winter Running Biomechanical Problems

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-49-winter-running-biomechanical-problems

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience 

1. Skulpt Aim: World’s First Device to Measure Muscle Fitness with One Touch | Indiegogo

http://www.indiegogo.com/projects/skulpt-aim-world-s-first-device-to-measure-muscle-fitness-with-one-touch/

3. Something to consider when it comes to injuries, whether they are closed injuries and certainly when they are open injuries !
 
Bacteria directly activate sensory nerves
http://www.bodyinmind.org/bacteria-directly-activate-sensory-nerves/
Gait Talk:
4. walking on ice vs on slipper hardwood floors with socks.
what are the gait changes that need to be adapted
are their neurologic effects ?
5. The Pros and Cons of Stride Variability
Our Disclaimer !  
6. From a blog reader:
Hi Gait Guys - amazing wealth of info you’ve provided! I’ve been suffering from severe foot pain (peroneal tendonitis and general top/side foot pain) for about a year now which has turned me from very active to completely sedentary since I can hardly walk. My ortho gave up on me after 9 months of treatment incl. countless oral and injected steroids and 2 months in a boot. Then this morning I found your site - and the “The Gaits of Hell” video. That’s my walk!! Is it really all in my back?
7. From a blog reader
Question: when my feet point straight my knees point outward from my body. I’ve heard it called external femoral torsion …
8 . Effects of Nonslip Socks on the Gait Patterns of Older People When Walking on a Slippery Surface
9 . National Shoe Fit Program
10. Running Form: Recognizing Patterns and Posture
http://www.engagingmuscles.com/2013/12/03/running-form-recognizing-patterns-and-posture/
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And what have we here?

The above is a pedograph, a simple, effective pressure map of the foot as someone is walking across an inked grid. For more info on pedographs, click here.

Did you note the increased ink present under the great toe bilaterally? What could be causing this? If you look carefully, you will note that it is at the base of the proximal phalynx of the great toe. This could be none other than the tendon of the flexor hallucis brevis!

This bad boy arises from the medial part of the under surface of the cuoid and the adjacent 3rd cunieform, with a small slip from the tendon of the tibialis posterior. As it travels forward it splits into two parts, which are inserted into the medial and lateral sides of the base of the proximal phalanyx of the great toe. There is a sesamoid bone present in each tendon, which offers the FHB a mechanical advantage when flexing the toe.  The medial portion is blends with the abductor hallucis and the lateral portion blends with the adductor hallucis.

Had the increased printing on the pedograph been more distal, it most likely would have been due to increased action of the flexor hallucis longus.   Had it been more proximal (under the head of the 1st metatarsal) it would have been due to the peroneus longus.

Cool, eh?

Reading pedographs and making you a sharper clinician/coach/trainer/sales person is just one of the many skills we try to teach here on the blog. Keep up the great work!

The Gait Guys

“And the Grinch, with his Grinch-feet ice cold in the snow, stood puzzling and puzzling, how could it be so? It came without ribbons. It came without tags. It came without packages, boxes or bags. And he puzzled and puzzled ‘till his puzzler was sore. Then the Grinch thought of something he hadn’t before. What if Christmas, he thought, doesn’t come from a store? What if Christmas, perhaps, means a little bit more?” Wishing you a safe and blessed holiday! Keep your glutes engaged and your toes up! The Gait Guys

“And the Grinch, with his Grinch-feet ice cold in the snow, stood puzzling and puzzling, how could it be so? It came without ribbons. It came without tags. It came without packages, boxes or bags. And he puzzled and puzzled ‘till his puzzler was sore. Then the Grinch thought of something he hadn’t before. What if Christmas, he thought, doesn’t come from a store? What if Christmas, perhaps, means a little bit more?”

Wishing you a safe and blessed holiday! Keep your glutes engaged and your toes up!

The Gait Guys

Usain… Again!!! How good are your powers of observation?

Take a look at this video again. Yes, we have shown it many times before. It is from a 2001 race in Monaco.

These are all incredible athletes. What can we note about the fastest of the fast?

  • Most of them have excellent hip extension (ok, the gent immediately to Usain’s right does not appear to be optimal)
  • the fastest of the pack have a upright head posture with the neck neutral or in slight extension (gents in lanes 1, 3 and 6; notice the head forward posture of the others)
  • minimal heel rebound (see our last post on this here)
  • minimal torso motion (note the increased torso motion  with arm swing of the gents in lanes 1, 3, 4 and 5)
  • symmetrical hip flexion, with the thigh parallel or nearly parallel to the ground in float phase
  • what else?

Watch it a few more times. It took us a while too…

Really, go watch it again…

Did you see it?

Watch the vertical oscillation of the runners. At this level (or any level for that matter), outside of improving biomechanics and neuromechanics, there are really only a few things you can do to run faster. One is to have a faster cadence and another is to have a longer stride length. You can control both, but if not done concurrently, one gets better at the expense of the other.

If your cadence is slower and you try and increase stride length, you increase your vertical oscillation (ie: how much you bounce up and down). Note the handrail at the far side of the track. It makes a convenient marker for vertical oscillation. Watch this bar and watch the video again. Usain and the gent in lane 6 (Nesta Carter) have little vertical oscillation compared to the rest of the pack. Note also the close finish. difficult to say if Usain’s knee or Carters foot crossed 1st. Usiain’s time was 9.88 and Nesta’s 9.90.

Decreased cadence = Increased vertical oscillation = Less horizontal motion = Slower speeds

How about watching this video a few more times and telling us what else is up?

The Gait Guys. We are trying to help you improve your powers of observation while stretching your mind. Are we succeeding? We hope so!

Ivo and Shawn

Podcast 48: Running Tech, Cadence and Running Shoes

Podcast 48 is live !  Topics: new gait and running technologies, general gait and running talk, generation slow-poke, cadence and barefoot, mixing up your running shoes, a case of hallux rigidus and more !  Join us for another podcast here on The Gait Guys !

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-48-running-tech-cadence-and-running-shoes

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience piece
 
1. The Sproutling: Why A Fitbit For Babies Might Be Brilliant
http://www.fastcodesign.com/3019806/the-sproutling-why-a-fitbit-for-babies-might-be-brilliant?partner=rss

2.Coming Soon: Workout Gear That Monitors Your Muscles
 
3. Micromovements hold hidden information about severity of autism
http://www.sciencedaily.com/releases/2013/12/131202171813.htm
4 Gait Factoid:
Q: Why do the two of us focus on gait so much ?  
A: Because it is such a deeply primary motor pattern that it is all encompassing.  
5. in the media this week:
Generation slowpoke? Kids don’t run as fast as parents once did, study finds - TODAY.com
http://www.today.com/moms/generation-slowpoke-kids-dont-run-fast-parents-once-did-study-2D11603599
6. CADENCE and BAREFOOT
7. In the media:
Can mixing up the running shoes prevent overuse running injury? | Running Research Junkie
 
9. From a Blog reader:
Hello the gait guys. I have over pronated rigid cavus along with hallux rigidus on my feet (also had one failed surgery for hallux rigidus on right foot). Having really hard time to be on my feet as well as find shoes and use orthotics. Due to the rigidity of my feet orthotics I’’ve been given create pain I can’t bear and mostly push medial side of my feet. Also without orthotics it is not much better - getting constant pain in my feet and knees. What would be your advise in my situation?Thanks
Disclaimer 
10. From a blog reader
Question: when my feet point straight my knees point outward from my body. I’ve heard it called external femoral torsion. Is this correct? Also is there any type of PT/stretching I can do to correct this? Would love to get things straightened out (no pun intended).
11 . National Shoe Fit Program

Ankle Dorsiflexion: Even in sprinters who land on the forefoot often heel strike, a retrograde strike if you will.

Many people think of heel strike followed by midfoot/tripod contact phase followed by ankle dorsiflexion, aka ankle rocker.  Heel strike is normal in the walking gait cycle. In some runners, depending on foot type, strength, flexibilty and several other factors, heel strike may be considered normal and may be essential for normal injury free mechanics. However, in recent years we tend to see the media and research investigate a midfoot or forefoot strike pattern. If you have been here with us on TGG for a year or 2-3 you will know we are big advocates of a midfoot strike pattern for several reasons which we will not go into again in this article. (Feel free to SEARCH our blog for MIDFOOT strike articles).  

However, one rarely sees anyone or any source talking about the retrograde heel contact when forefoot strike patterns are used.  Here, in this video, you can see several of these top level athletes who are trying to go forward at top end speed, but who are tapping the heel down on many loading responses. This can be thought of as a retrograde movement and could in a biomechanical way of thinking be considered non-productive. In other words, they are trying to move forward and yet the heel is touching down which is a backwards movement. This point can be argued but that is not the point of this article. The point that we are trying to make is that in order to drop the heel down, and especially if the heel touches, that the runner had better have sufficient ankle rocker/dorsifleixon otherwise the arch may be asked to collapse via excessive pronation (to perform the heel tap) which will drive an internal spin movement when the leg is supposed to be externally rotating to a rigid supinated foot for propulsive toe off. This negative scenario is a huge power leak for a sprinter, or any runner for that matter when they are ramping up speed.  

So, why does this happen ?  Well, for some it can help to load the posterior mechanism, the gastrocsoleus-achilles complex for conservation and power conversion.  It also enables more hip extension and thus more gluteal function. Longer stride means more efficient and greater arm swing which is a huge accessory power source for a sprinter. This also lengthens the stride, they feed off of each other. There are many benefits, if you have sufficient ankle rocker range in the ankle to begin with.  In some runners who do not have the requisite ankle rocker range, you may often see the increased foot progression angle and external limb spin and/or the dreaded adductor twist of the heel (aka  abductory twist of the foot).  These are strategies to get more hip extension and more gluteal function without finding it via the ankle dorsiflexion, where you want to see it.  Remember, the body is a brilliant compensatory and substituter. If the body cannot find a range at one joint it will find it at the next proximal or distal joint. And when that loss is at the ankle, motor patterns options dictate you either find it at foot pronation or hip extension.

Maybe, just maybe we should have called this blog article “Can you hold the foot tripod all the way through the stance phase, even through retrograde heel touch down ? If you cannot, trouble could be on the horizon. ”  But that is a really dumb title.  

Shawn and Ivo

the gait guys

Making a list and checking it twice… So you or someone you are treating/coaching/ rehabbing, etc has muscle weakness, either perceived by them or noted by you, by observation or muscle testing. Have you stopped to think what might be causing the weakness? Cross sectional area is directly proportional to strength. With strength, we are talking predominantly about Type II muscle (remember, Type I is predominantly endurance muscle, due to differing histological structure).  Type II muscle fibers are larger, have fewer capillaries, less myoglobin, fewer mitochiondra . They obtain most of their energy by anaerobic glycolysis, rather than aerobic respiration  (ie the Krebs cycle).  All muscles are made of a mixture of Type I and Type II fibers, but most muscles tend to have a predominance of one over the other. Here we are referring to strength. There are many causes of muscle weakness. Here are a few: Injury to the muscle Injury to the joint the muscle crosses Stretch weakness Tight weakness Neurogenic weakness Myopathic weakness Reflexogenic weakness And the list goes on… The 1st one on the list is an easy one to understand. If you break the machine, it doesn’t work. Torn contractile proteins with leaky sarcoplasmic reticulum (calcium reservoirs) do not allow for efficient contractions. The second on the list is a bit more complex. We remember that that the joint capsules are blessed with four types of mechanoreceptors, aptly named Type I, II, III, and IV, which when stimulated physically, chemically, or thermally apprise the nervous system of the forces acting on that joint as well as its position in space. For a great video review of mechanoreceptors, click here Joint pathology or inflammation will often cause distention of its capsule. The effect of the resulting joint effusion on the actions of the muscles crossing that joint have been examined extensively in the literature. Let’s look at one of the studies and its implications. Reflex Actions of Knee Joint Afferents During Contraction of the Human Quadriceps Iles JF, Stokes M, Young A: Clinical Physiology (10) 1990: 489-500 In this paper, the authors infuse hypotonic saline into the knees of eight asymptomatic individuals (including one of the authors) using a 16 gauge needle (ouch!) and studied its effects on the H reflexes and muscle recruitment. An H reflex is like performing a tendon jerk reflex (the involuntary contraction you would check with a neurological hammer) using an electrical stimulus. The onset time (also called the latency) and its amplitude are recorded. Muscle recruitment is the voluntary contraction of that muscle, measured with electromyography (EMG) by having an electrode either over (surface EMG) or within (needle EMG) the muscle and examining how hard the muscle is working based on the amplitude and frequency of the response. First of all, no one in the study experienced any pain (hmmm, not sure about that) , only the sensation of pressure in their knees (which was considered activation of only the proprioceptors of the joint). The authors found that any pressure increase within the joint capsule depressed the H reflex and inhibited the action of the quadriceps. They hypothesize that this may contribute to pathological weakness after joint injury. So how does all this apply to us? As we all know, lots of patients have joint dysfunction. Joint dysfunction leads to cartilage irritation, which leads to joint effusion. This will inhibit the muscles that cross the joint. This causes the person to become unable to stabilize that joint and develop a compensation pattern. Next the stress is transferred to the connective tissue structures surrounding the joint which, if the force is sufficient, will fail. Now we have a sprain and some of the protective reflexes can take over. Abnormal forces can now be translated to the cartilage. This, if it goes on long enough,  can perpetuate degeneration, which causes further joint dysfunction. The cycle repeats and if someone doesn’t intervene and control the effects of inflammation, restore normal joint motion and rehabilitate the surrounding musculature, the patient’s condition will continue its downward spiral, becoming another statistic contributing to the tremendous economic and physical costs of an injury. And that, my friends, is one mechanism as to how joint effusion disturbs the homeostasis of the musculature surrounding a joint. In future posts, we will examine other causes of muscle weakness. For now, make a list of possible causes before assuming it is just injured or “turned off”. Compensations happen for a reason, and if you remove someone’s compensation pattern, you had better make sure you have another one up your sleeve and that their system is ready for a change. The Gait Guys. Giving you the tools so you can be better. Period. 

Making a list and checking it twice…

So you or someone you are treating/coaching/ rehabbing, etc has muscle weakness, either perceived by them or noted by you, by observation or muscle testing. Have you stopped to think what might be causing the weakness?

Cross sectional area is directly proportional to strength. With strength, we are talking predominantly about Type II muscle (remember, Type I is predominantly endurance muscle, due to differing histological structure).  Type II muscle fibers are larger, have fewer capillaries, less myoglobin, fewer mitochiondra . They obtain most of their energy by anaerobic glycolysis, rather than aerobic respiration  (ie the Krebs cycle).  All muscles are made of a mixture of Type I and Type II fibers, but most muscles tend to have a predominance of one over the other. Here we are referring to strength.

There are many causes of muscle weakness. Here are a few:

  • Injury to the muscle
  • Injury to the joint the muscle crosses
  • Stretch weakness
  • Tight weakness
  • Neurogenic weakness
  • Myopathic weakness
  • Reflexogenic weakness
  • And the list goes on…

The 1st one on the list is an easy one to understand. If you break the machine, it doesn’t work. Torn contractile proteins with leaky sarcoplasmic reticulum (calcium reservoirs) do not allow for efficient contractions.

The second on the list is a bit more complex.

We remember that that the joint capsules are blessed with four types of mechanoreceptors, aptly named Type I, II, III, and IV, which when stimulated physically, chemically, or thermally apprise the nervous system of the forces acting on that joint as well as its position in space. For a great video review of mechanoreceptors, click here

Joint pathology or inflammation will often cause distention of its capsule. The effect of the resulting joint effusion on the actions of the muscles crossing that joint have been examined extensively in the literature. Let’s look at one of the studies and its implications.

Reflex Actions of Knee Joint Afferents During Contraction of the Human Quadriceps

Iles JF, Stokes M, Young A: Clinical Physiology (10) 1990: 489-500

In this paper, the authors infuse hypotonic saline into the knees of eight asymptomatic individuals (including one of the authors) using a 16 gauge needle (ouch!) and studied its effects on the H reflexes and muscle recruitment. An H reflex is like performing a tendon jerk reflex (the involuntary contraction you would check with a neurological hammer) using an electrical stimulus. The onset time (also called the latency) and its amplitude are recorded. Muscle recruitment is the voluntary contraction of that muscle, measured with electromyography (EMG) by having an electrode either over (surface EMG) or within (needle EMG) the muscle and examining how hard the muscle is working based on the amplitude and frequency of the response.

First of all, no one in the study experienced any pain (hmmm, not sure about that) , only the sensation of pressure in their knees (which was considered activation of only the proprioceptors of the joint). The authors found that any pressure increase within the joint capsule depressed the H reflex and inhibited the action of the quadriceps. They hypothesize that this may contribute to pathological weakness after joint injury.

So how does all this apply to us?

As we all know, lots of patients have joint dysfunction. Joint dysfunction leads to cartilage irritation, which leads to joint effusion. This will inhibit the muscles that cross the joint. This causes the person to become unable to stabilize that joint and develop a compensation pattern. Next the stress is transferred to the connective tissue structures surrounding the joint which, if the force is sufficient, will fail. Now we have a sprain and some of the protective reflexes can take over. Abnormal forces can now be translated to the cartilage. This, if it goes on long enough,  can perpetuate degeneration, which causes further joint dysfunction. The cycle repeats and if someone doesn’t intervene and control the effects of inflammation, restore normal joint motion and rehabilitate the surrounding musculature, the patient’s condition will continue its downward spiral, becoming another statistic contributing to the tremendous economic and physical costs of an injury.

And that, my friends, is one mechanism as to how joint effusion disturbs the homeostasis of the musculature surrounding a joint.

In future posts, we will examine other causes of muscle weakness. For now, make a list of possible causes before assuming it is just injured or “turned off”. Compensations happen for a reason, and if you remove someone’s compensation pattern, you had better make sure you have another one up your sleeve and that their system is ready for a change.

The Gait Guys. Giving you the tools so you can be better. Period. 

Podcast 47: The Thigh Gap & Medial Tibial Stress Syndrome

Podcast 47 is live !

Topics: Lots of cool stuff for your ears and brains today. Don’t miss this show on Allen’s Rule Part 2, ankle biosensors, Parkinson’s syndrome gait disorder, Medial Tibial Stress Syndrome, The Thigh Gap disorder, and the ever confusing and much debated Abductory Heel Twist in walking and in runners. Don’t miss this show !

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-47-the-thigh-gap-medial-tibial-stress-syndrome

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience piece
1. Update on Allen’s Rule blog post:
2. Could a simple ankle sensor help with parkinsons symptoms ?
3. Probiotics Boost Running Performance in Heat
5 Gait Factoid:  the foot abductory twist
6.  Note from melissa on her 9 month leg pain.
Disclaimer 
7 . National Shoe Fit Program
8 . medial tibial stress syndrome
9. from a blog reader:
The thigh-gap obsession is not new but it’s the most extreme body fixation yet
Does this foot look like your foot ?  There are a few subtle issues here. At first glance this foot looks half-way decent but upon further observation you should note the subtle drift of all of the toes.  In the foot, the toe that delineates abduction and adduction of the toes is the 2nd toe. The 2nd toe is considered the anatomic middle of the digits and forefoot. Any toe or movement that moves away from the 2nd toe is abduction and any movement towards the 2nd toe is adduction. This is obviously different than in the hand where the 3rd digit is the reference digit.   In this foot, look at the shape of the 2nd and even the 3rd digit, they have a curve to them. Remember, form follows function and the dead give away here is that the hallux (the big toe) is drifting into adduction towards the 2nd digit. This is referred to as early hallux valgus and it is accompanied by early evidence of a bunion at the medial foot at the metatarsophalangeal joint.  When the shaft of the hallux is not in line with the shaft of the metatarsal long bone we get the angulation between the two causing the hallux valgus.  This is often from excessive pronation (either rearfoot, midfoot and/or forefoot) that collapses the tripod, splays the distal MET head via its dorsiflexion, and the development of complicated long and short hallux flexor muscle dysfunction as well as abductor hallucis (transverse and oblique head) disfunction further driving the hallux pull medially.  When the distal toes are engaged on the ground and there is still forefoot pronation occurring through the medial tripod support, the toes will be forced into a twist or spin, and in time you will get toes that appear drifted or windswept like these toes appear.  A similar phenomenon occurs at the lateral foot and a Tailor’s bunion begins to occur there as the forefoot begins to widen as the MET heads separate and the toes funnel medially (often provoked to do so by pointed footwear).   We can also see the 4th and 5th toes curl under from the probably weak lateral head of the quadratus plantae thus encouraging unopposed oblique pull of the long flexors of the digits (FDL). See this post here for an explanation of this phenomenon.   This is a fairly typical foot that we see in our practices.  This is not a far-gone foot but one has to catch this foot at this stage or it is rather difficult to resuscitate back to a healthy foot. Like a spinal scoliosis, once a bunion and  hallux valgus gets too far, it becomes an issue of symptom management rather than repair.  Hallux abduction must be retaught, tripod skills must be retaught, intrinsic foot muscle strength must be regained as well as strength and endurance of the tibialis anterior and toe extensors to help raise the arch again and control pronation. Sometimes a temporary orthotic can help the person to passively regain some degree of competent tripod while homework earns the changes. In some cases, an orthotic needs to be a permanent intervention if tripod stability cannot be adequately achieved.  But, we never give up and neither should you or your client, amazing things can happen over long periods of time when correction is forced. There is plenty of life left in this foot, but you have to get to it quickly and get them in lower heeled shoes if tolerable and ones with a wider toe box.  Support the midfoot with an orthotic or built up foot bed, if necessary, but don’t leave it there. It is a crutch, and even crutches are intended to be put aside at some point.  Shawn and Ivo, The gait guys

Does this foot look like your foot ? 

There are a few subtle issues here. At first glance this foot looks half-way decent but upon further observation you should note the subtle drift of all of the toes.  In the foot, the toe that delineates abduction and adduction of the toes is the 2nd toe. The 2nd toe is considered the anatomic middle of the digits and forefoot. Any toe or movement that moves away from the 2nd toe is abduction and any movement towards the 2nd toe is adduction. This is obviously different than in the hand where the 3rd digit is the reference digit.  

In this foot, look at the shape of the 2nd and even the 3rd digit, they have a curve to them. Remember, form follows function and the dead give away here is that the hallux (the big toe) is drifting into adduction towards the 2nd digit. This is referred to as early hallux valgus and it is accompanied by early evidence of a bunion at the medial foot at the metatarsophalangeal joint.  When the shaft of the hallux is not in line with the shaft of the metatarsal long bone we get the angulation between the two causing the hallux valgus.  This is often from excessive pronation (either rearfoot, midfoot and/or forefoot) that collapses the tripod, splays the distal MET head via its dorsiflexion, and the development of complicated long and short hallux flexor muscle dysfunction as well as abductor hallucis (transverse and oblique head) disfunction further driving the hallux pull medially.  When the distal toes are engaged on the ground and there is still forefoot pronation occurring through the medial tripod support, the toes will be forced into a twist or spin, and in time you will get toes that appear drifted or windswept like these toes appear.  A similar phenomenon occurs at the lateral foot and a Tailor’s bunion begins to occur there as the forefoot begins to widen as the MET heads separate and the toes funnel medially (often provoked to do so by pointed footwear).  

We can also see the 4th and 5th toes curl under from the probably weak lateral head of the quadratus plantae thus encouraging unopposed oblique pull of the long flexors of the digits (FDL). See this post here for an explanation of this phenomenon.  

This is a fairly typical foot that we see in our practices.  This is not a far-gone foot but one has to catch this foot at this stage or it is rather difficult to resuscitate back to a healthy foot. Like a spinal scoliosis, once a bunion and  hallux valgus gets too far, it becomes an issue of symptom management rather than repair.  Hallux abduction must be retaught, tripod skills must be retaught, intrinsic foot muscle strength must be regained as well as strength and endurance of the tibialis anterior and toe extensors to help raise the arch again and control pronation. Sometimes a temporary orthotic can help the person to passively regain some degree of competent tripod while homework earns the changes. In some cases, an orthotic needs to be a permanent intervention if tripod stability cannot be adequately achieved.  But, we never give up and neither should you or your client, amazing things can happen over long periods of time when correction is forced.

There is plenty of life left in this foot, but you have to get to it quickly and get them in lower heeled shoes if tolerable and ones with a wider toe box.  Support the midfoot with an orthotic or built up foot bed, if necessary, but don’t leave it there. It is a crutch, and even crutches are intended to be put aside at some point. 

Shawn and Ivo, The gait guys

Take this simple test.  Want to be faster? Better incorporate some proprioceptive training into your plan. It is the 1st part of our mantra: Skill, Endurance, and Strength (in that order). Proprioceptive training appears to be more important that strength or endurance training from an injury rehabilitation perspective as well part of an injury prevention program  What is proprioception? It is body position awareness; ie: knowing what your limbs are doing without having to look at them. Take this simple test: Stand in a doorway with your shoes off. Keep your arms up at your sides so that you can brace yourself in case you start to fall. Lift your toes slightly so that only your foot tripod remains on the ground (ie the base of the big toe, the base of the little toe and the center of the heel.). Are you able to balance without difficulty? Good, all 3 systems (vision, vestibular and proprioceptive) are go. Now close your eyes, taking away vision from the 3 systems that keep us upright in the gravitational plane. Are you able to balance for 30 seconds? If so, your vestibular and proprioceptive systems are intact. Now open your eyes and look up at the ceiling. Provided you can balance without falling, now close your eyes. Extending your neck 60 degrees just took out the lateral semicircular canals of the vestibular system (see here for more info). Are you still able to balance for 30 seconds? If so, congrats; your proprioceptive system (the receptors in the joints, ligaments and muscles) is working great. If not, looks like you have some work to do. You can begin with exercises we use every day by clicking here. Proprioception should be the 1st part of any training and/or rehabilitation program. If you don’t have a good framework to hang the rest of your training on, then you are asking for trouble.  The Gait Guys. Your proprioceptive mentors. We want you to succeed!

Take this simple test. 

Want to be faster? Better incorporate some proprioceptive training into your plan. It is the 1st part of our mantra: Skill, Endurance, and Strength (in that order). Proprioceptive training appears to be more important that strength or endurance training from an injury rehabilitation perspective as well part of an injury prevention program

 What is proprioception? It is body position awareness; ie: knowing what your limbs are doing without having to look at them.

Take this simple test:

  • Stand in a doorway with your shoes off. Keep your arms up at your sides so that you can brace yourself in case you start to fall. Lift your toes slightly so that only your foot tripod remains on the ground (ie the base of the big toe, the base of the little toe and the center of the heel.). Are you able to balance without difficulty? Good, all 3 systems (vision, vestibular and proprioceptive) are go.
  • Now close your eyes, taking away vision from the 3 systems that keep us upright in the gravitational plane. Are you able to balance for 30 seconds? If so, your vestibular and proprioceptive systems are intact.
  • Now open your eyes and look up at the ceiling. Provided you can balance without falling, now close your eyes. Extending your neck 60 degrees just took out the lateral semicircular canals of the vestibular system (see here for more info). Are you still able to balance for 30 seconds? If so, congrats; your proprioceptive system (the receptors in the joints, ligaments and muscles) is working great. If not, looks like you have some work to do. You can begin with exercises we use every day by clicking here.

Proprioception should be the 1st part of any training and/or rehabilitation program. If you don’t have a good framework to hang the rest of your training on, then you are asking for trouble. 

The Gait Guys. Your proprioceptive mentors. We want you to succeed!

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Is your 5th toe curled under ? What do you do when “this little piggy” can’t go wee wee wee all the way home.

Have a look at the 4 photos above.  You will see this curling of the lesser toes quite often in your practice, and when you know what it means it can help to guide your thinking, both from a diagnostic and treatment perspective.  

You should have noticed in the photos that the 4th and 5th toes curl under and are hyper-flexed, and this is at rest.  So, what does this mean ?

It means that the long flexors are overactive, the extensors are underactive, and the adduction pull of the long flexors is unopposed by the under appreciated quadratus plantae muscle.

Look at the clinical drawing. The quadratus plantae has 2 heads, a medial head and a lateral head.  Being able to clinically test these two heads will give you much insight into the function of the foot and when you see these outer two toes curling under, as you see in the photo, you will always see weakness of the lateral head of the quadratus plantae.  

The quadratus plantae arises from two heads separated from each other by the long plantar ligament. The medial head is larger and more muscular, attached to the medial calcaneus;  the lateral head is smaller and more tendinous, attaching to the lateral border of the inferior surface of the calcaneus and the long plantar ligament.  The two portions join and end in a flattened band which inserts into the lateral, upper and under surfaces of the tendons of the flexor digitorum longus, usually the second, third, and fourth toes.

But this time, if you have studied the drawing, you should notice the oblique line of pull of the long flexors.  This should in fact create this undesirable curling effect of the lateral two toes since they are so far out on the oblique line of pull. However, if you look at the insertion of the lateral head of the quadratus plantae you should be able to conclude that this head is designed to offset this oblique pull of the outer two long flexor tendons.  The quadratus creates a posterior pull on the outer long flexor tendons ensuring that the curling effect (as seen in the photo) is nullified. Thus, we have a clinical presentation of a weak lateral head of the quadratus plantae (and probably a few others which we will not discuss here so as to not dilute the purpose of today’s post). Now you just have to figure out why it is weak or if there is a biomechanical reason for its insufficiency

  • is there a foot type presenting itself that makes it difficult for this muscle to create sufficient posterior pull to offset the tremendous leverage of the long flexors? Maybe a forefoot varus, which gives the flexor tendons a mechanical advantage or a forefoot valgus which puts the quadratus plantae at a mechanical disadvantage? (Taking our National Shoe Fit Certification Program will help you get closer to understanding many of these issues.)
  • Are their other anatomical variants like an increased forefoot width or bunions (medial or tailor’s)
  • is there excessive rear or midfoot pronation?
  • Shoe choice problem ?

Some folks do have adequate function of the quadratus plantae. Note the lovely feet in the last picture … .  they must have strong lateral quadratus plantae and abductors of the lateral foot and toes ! And, they have great toe separation, thus great intrinsic interossei muscles, and nice flat toes (great balance between flexors and extensors).

So, what do you do?

  • you could do a surgery, amputate or fuse some of the joints to make them look better. Extreme for a problem like this
  • you could ignore the issue and hope it goes away. (in all likelihood it will worsen)
  • you could give them long flexor, toe scrunching Towel-curling, marble-grasping exercises , like you see all over the internet…and give the flexor digitorum longus even more of a mechanical advantage, and make the problem worse
  • you could give them exercises to increase the function of the long extensors, which would increase the mechanical advantage of the quadratus plantae. like the shuffle walk; lift, spread and reach and tripod standing exercises (hmm…sounding better)
  • be a real clinician and in addition to looking at the foot, look north of the foot to see what might be causing the problem (loss of ankle rocker, insufficient gluteal activity, loss of internal rotation of the hip, etc) Hmmm; sounding like a good idea too…

The Gait Guys. Hammering it home, day after day, about the importance of gait and giving you clues to be a better _________ (insert athlete, coach, trainer, clinician, shoe fitter, rehab specialist…).

Do you do manual muscle testing? Following up on yesterdays post… We all like to evaluate our patients; hopefully on the table as well as observation while weight bearing. Here is some food for thought. When your patient or client is lying on the table, do you pay attention to where there head is in space (ie the position of their head)? Why should you care? Remember our post on facilitation (if not, click here)? That has something to do with it. Here is the short story. Make sure the head is neutral and midline (lined up between the shoulders), there is good preservation of the cervical curve , with a small pillow supporting the neck, but not altering it’s angle. The long story involves the vestibular system. It is a part of the nervous system that lives between your ears (literally) and monitors position and velocity of movement of the head. There are three hula hoop type structures called “semicircular canals” (see picture above) that monitor rotational and tilt position and angular acceleration, as well as two other structures, the utricle and saccule, which monitor tilt and linear acceleration. I think you can see where this is going…. The vestibular apparatus (the canals and the utricle and saccule) feed into a part of the brain called the floccular nodular lobe of the cerebellum, which as we are sure you can imagine, have something to do with balance and coordination. This area of the cerebellum feeds back to the vestibular system (actually the vestibular nucleii); which then feed back up to the brain as well as (you guessed it) down the spinal cord and to predominantly the extensor muscles. So, what do you think happens if we facilitate (or defaciltate) a neuronal pool? We alter outcomes and don’t see a clear picture. Look at the picture above. Notice the lateral semicicular canals are 30 degrees to the horizontal? If you are lying flat, they are now at 60 degrees. If the head is resting on a pillow and flexed forward 30 degrees, the canals are vertical and rendered inoperable. This could be good (or bad) depending on what muscle groups you are testing. OK. HEAVY CONCEPT APPROACHING So if we defacilitate the extensors, what happens to the flexors? Remember reciprocal inhibition (If not click here)? According to the law of reciprocal innervation, the flexors will be MORE FACILITATED. If the extensors are faciltated, they will appear MORE ACTIVE and the flexors LESS ACTIVE. Wow. All this from head position…The key herer is to know what you are doing, This gait stuff can get pretty complex; but don’t worry. We aren’t going anywhere and are here to teach you. The Gait Guys . Gait Geeks are the new cool….

Do you do manual muscle testing?


Following up on yesterdays post…
We all like to evaluate our patients; hopefully on the table as well as observation while weight bearing. Here is some food for thought.

When your patient or client is lying on the table, do you pay attention to where there head is in space (ie the position of their head)? Why should you care?

Remember our post on facilitation (if not, click here)? That has something to do with it.

Here is the short story. Make sure the head is neutral and midline (lined up between the shoulders), there is good preservation of the cervical curve , with a small pillow supporting the neck, but not altering it’s angle.
The long story involves the vestibular system. It is a part of the nervous system that lives between your ears (literally) and monitors position and velocity of movement of the head. There are three hula hoop type structures called “semicircular canals” (see picture above) that monitor rotational and tilt position and angular acceleration, as well as two other structures, the utricle and saccule, which monitor tilt and linear acceleration. I think you can see where this is going….

The vestibular apparatus (the canals and the utricle and saccule) feed into a part of the brain called the floccular nodular lobe of the cerebellum, which as we are sure you can imagine, have something to do with balance and coordination. This area of the cerebellum feeds back to the vestibular system (actually the vestibular nucleii); which then feed back up to the brain as well as (you guessed it) down the spinal cord and to predominantly the extensor muscles.

So, what do you think happens if we facilitate (or defaciltate) a neuronal pool? We alter outcomes and don’t see a clear picture.

Look at the picture above. Notice the lateral semicicular canals are 30 degrees to the horizontal? If you are lying flat, they are now at 60 degrees. If the head is resting on a pillow and flexed forward 30 degrees, the canals are vertical and rendered inoperable. This could be good (or bad) depending on what muscle groups you are testing.

OK. HEAVY CONCEPT APPROACHING

So if we defacilitate the extensors, what happens to the flexors? Remember reciprocal inhibition (If not click here)? According to the law of reciprocal innervation, the flexors will be MORE FACILITATED. If the extensors are faciltated, they will appear MORE ACTIVE and the flexors LESS ACTIVE.

Wow. All this from head position…The key herer is to know what you are doing, This gait stuff can get pretty complex; but don’t worry. We aren’t going anywhere and are here to teach you.

The Gait Guys . Gait Geeks are the new cool….

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.

Podcast 46: Georges St. Pierre, Regenokine & Compensation Patterns,

Podcast 46 is live !
Topics: Diffuse Axonal Shear in the nervous system, the new procedure Regenokine, the neurologic status of UFC fighter Georges St. Pierre, PCP thearpy, the new generation of slow running children, posture, compensation patterns, pre-race Tylenol effects/dangers, tibialis posterior tendonitis, shoe selection and so much more !  If you have not listened to one of our podcasts, this one will surely give you a good taste of what you are missing !

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-46-slow-kids-regenokine-compensation-patterns-monty-python

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience Pieces:
1.  Future of computing 
 
2. We have been talking about body part replacements like bionics etc……but this could be the stone in the road to this progress
 

REGENOKINE: THE UNPROVEN TREATMENT THAT PROFESSIONAL ATHLETES ARE FLYING TO GERMANY FOR

5. Gait Factoid, posture matters
This week you did another post on running faster and about  "lifting the head to engage extensors"……  here was an article in the news on posture
- can you give the listeners a neat neuro tidbit on posture and the brain ?
6. Ivo: What is your take on leaving obvious problems and compensations alone or fixing them ?      
7 . National Shoe Fit Program
8 . Tylenol Boosts Performance in Hot Conditions
 9. from a blog reader:
Hello Gait Guys,
What would you look to do with a 20 year-old competitive 5k runner (me) with chronic posterior tibialis problems?
- a short background: surgery two years ago on left talo-navicular joint osteochondral defect, since then mileage has been extremely limited (now it begins to fatigue painfully on 30 minute runs). 
Both sides affected, or sometimes one or the other. Arch of right foot got so painful last summer I was on crutches and could not walk/stand without supportive shoes. Currently the left side is most troubling and I can see no pattern!
Many thanks for the fantastic blog
Joy
10. Facebook reader:
  • I thought I’d go the experts on this one. I just took a myofacsical release class and the instructor said the most efficient running gait is by using your psoas. So, forward lean until you are about to fall forward and then contract psoas to lift the leg just enough to catch up with the body. He said this is how all the Kenyans run… makes sense kind of.. but???

11. Disclaimer:
Want more stability when trail running? Try this… While running the other morning through about 6-8” of fresh snow (yes, it is snowing here already at 9000 feet), something occurred to me as I almost fell several times due to the undulating surface beneath my feet and the terrain to match under that. “I need to do something to improve my proprioception, or I am going to fall (again)” I thought (yes, we both think about this stuff while running or exercising! No, I was not listening to music on this run, though cranking up some AC/DC was tempting..). If I were to increase my surface area on the snow, and make myself less top heavy, I would be more stable. How could I accomplish that? Here is what I did, and it worked great! First, I spread my toes. No, I wasn’t barefoot, but in my Altra Lone Peak 1.5’s; why not maximize the real estate available to my feet in these roomy shoes? Next, I widened my stance (or base of gait). My massive 145# spread over a larger surface area would be more stable and provide stability from my weight distributed over a larger surface area. Third, I raised my arms out from my sides (no I didn’t try to fly) to provide more input from my upper extremities to my proprioceptive system (more input from peripheral joint and muscle mechanoreceptors = more input to cerebellum = better balance) Lastly, I slowed down from my blistering 10 min mile pace. Though this did not improve my surface area, it did give my aging nervous system more time to react. It occurred to me that these actions were all “primitive” reactions of the nervous system when learning to walk. We did a post on that when my youngest son was learning to walk a few years ago. Want to have better balance? Spread your toes Widen your stance Raise your arms Slow down Notice I didn’t say this would make you faster. Who is more likely to fall on a corner when being chased by a predator; the tortoise or the hare?   A little practical neurology for you this morning brought to you by the geeks of gait. Ivo and Shawn.  

Want more stability when trail running? Try this…

While running the other morning through about 6-8” of fresh snow (yes, it is snowing here already at 9000 feet), something occurred to me as I almost fell several times due to the undulating surface beneath my feet and the terrain to match under that.

“I need to do something to improve my proprioception, or I am going to fall (again)” I thought (yes, we both think about this stuff while running or exercising! No, I was not listening to music on this run, though cranking up some AC/DC was tempting..). If I were to increase my surface area on the snow, and make myself less top heavy, I would be more stable. How could I accomplish that?

Here is what I did, and it worked great!

First, I spread my toes. No, I wasn’t barefoot, but in my Altra Lone Peak 1.5’s; why not maximize the real estate available to my feet in these roomy shoes?

Next, I widened my stance (or base of gait). My massive 145# spread over a larger surface area would be more stable and provide stability from my weight distributed over a larger surface area.

Third, I raised my arms out from my sides (no I didn’t try to fly) to provide more input from my upper extremities to my proprioceptive system (more input from peripheral joint and muscle mechanoreceptors = more input to cerebellum = better balance)

Lastly, I slowed down from my blistering 10 min mile pace. Though this did not improve my surface area, it did give my aging nervous system more time to react.

It occurred to me that these actions were all “primitive” reactions of the nervous system when learning to walk. We did a post on that when my youngest son was learning to walk a few years ago.

Want to have better balance?

  • Spread your toes
  • Widen your stance
  • Raise your arms
  • Slow down

Notice I didn’t say this would make you faster. Who is more likely to fall on a corner when being chased by a predator; the tortoise or the hare?

 

A little practical neurology for you this morning brought to you by the geeks of gait. Ivo and Shawn.

 

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 JSHerczeg GLaugen ATRäsänen KLaurila AMerilä J.