Zonas vs K Tape

image source: https://commons.wikimedia.org/wiki/File:Kinesio_Taping_for_Soleus_and_Achilles_tendon.jpg

image source: https://commons.wikimedia.org/wiki/File:Kinesio_Taping_for_Soleus_and_Achilles_tendon.jpg

In this case, flexibility and an elastic component (K Tape), which adds proprioception, rather than rigid (Zonas), which takes it away, seems to work better. 

"Compared to Athletic Tape, Kinesio Tape (KT)  provides a flexible pulling force that facilitates foot eversion during early stance, while not restricting normal inversion in late stance during walking. KT may be a useful clinical tool in correcting aberrant motion while not limiting natural movement in sports."

 

 

Yen SC, Folmar E, Friend KA, Wang YC, Chui KK. Effects of kinesiotaping and athletic taping on ankle kinematics during walking in individuals with chronic ankle instability: A pilot study. Gait Posture. 2018 Aug 28;66:118-123. doi: 10.1016/j.gaitpost.2018.08.034. [Epub ahead of print]

 

 

What specific movement pattern(s) does a person with chronic ankle instability have?

image source: https://en.wikipedia.org/wiki/Ligament

image source: https://en.wikipedia.org/wiki/Ligament

...it is unique and depends on their compensation

 

"The researchers concluded that multiple distinct movement patterns were found in a high percentage of CAI subjects and each person likely incorporates unique positions and loads that contribute to the chronic nature of instability. Additionally, the data revealed distal joint stiffness was lower in those with CAI than controls generally, while proximal joint stiffness was greater than controls. These data support the theory that the hop plays a vital role in controlling lower extremity movement in CAI subjects."

 

Hopkins JT, Son SJ, Kim J, et al. Joint Stiffness Alterations, Grouped by Movement Strategy, in Chronic Ankle Instability.

http://lermagazine.com/special-section/conference-coverage/identifying-cai-through-specific-movement-patterns

 

3 points to use with ankle instability

In this study they stimulated 3 points: ST41, BL60 and GB40. Take a look at their locations (above). ST41 is at the base of the long extensor tendons; gee, we never emphasize long extensor function, do we? GB 40 is at the lateral malleolus between the peroneus longus/brevis and peroneus tertius; how important are these for coronal plane stability, not to mention the ability to descend the 1st ray. BL60 is just anterior to the lateral malleolus, right by the peroneus longus and brevis (again). Could they have included K6, under the medial malleolus and near the long flexors? Sure. How about SP4 or 4, in the substance of the flexor hallucis brevis and anterior to the extensor hallucis longus. Of course. You can probably think of other points to include as well.

Do you think it was by accident that their muscle selection included dorsiflexors (excepting the peroneus longus) and everters? How about a muscle that would help descend the 1st ray and complete the medial tripod? Hmmm... There is always a reason and a rationale....

 

"CONCLUSION: Electroacupuncture can effectively improve the proprioception of athletes with FAI and achieves a superior efficacy as compared with the conventional physiotherapy."...or in this case, low level e stim to the medial and lateral malleolus.

How about adding these points, no matter how you would like to stimulate them, to your CAI toolkit?

 

Zhu Y, Qiu ML, Ding Y, Qiang Y, Qin BY. [Effects of electroacupuncture on the proprioception of athletes with functional ankle instability]. Zhongguo Zhen Jiu. 2012 Jun;32(6):503-6.

 

 

Acupuncture/Dry Needling and Proprioception. A Winning combination.

 

What a great combination of therapies for folks with chronic ankle instability, or almost any injury for that matter! Taking 2 modalities that emphasize afferent input from the peripheral mechanoreceptor system, which has such a large influence on the cerebellum as well as the segmental and descending pain inhibition pathways.

Did you notice they used the trigger points in the peroneus longs muscle to needle? Though they didn't say it, did you remember that that the point correlates to a great point: Gallbladder 34, which is an empirical point for musculoskeletal pain? Interesting how this muscle influences both frontal and saggital plan stability. 

Though the techniques of exercise could use some refinement (check out the gents posture in the photo, sure looks like he could use some gluteus medius work!), this is a good overview that provides evidence that utilizing spacial summation (combining multiple techniques that provide afferent input to more than one modality to cause an effect) has better outcomes than one alone. Put this one on your reading list : )

Salom-Moreno J, Ayuso-Casado B, Tamaral-Costa B, Sánchez-Milá Z, Fernández-de-Las-Peñas C, Alburquerque-Sendín F.Trigger Point Dry Needling and Proprioceptive Exercises for the Management of Chronic Ankle Instability: A Randomized Clinical Trial. Evid Based Complement Alternat Med. 2015;2015:790209. doi: 10.1155/2015/790209. Epub 2015 Apr 30.

link to FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430654/

Ankle sprains and the reorganization of the sensorimotor system

“Our subjects with unilateral chronic ankle sprains had weaker hip abduction strength and less plantar-flexion range of motion on the involved sides. Clinicians should consider exercises to increase hip abduction strength when developing rehabilitation programs for patients with ankle sprains.”-Friel et al

Awhile back we wrote about the principle that if the hip abductors are weak, the leg will posture more adducted (ie, cross over type pattern) and this places the foot more directly below the body midline plumb, this will posture the foot in inversion and thus at greater risk for future inversion sprains.  This sets up the vicious cycle of hip abductor weakness, frontal plane drift of pelvis, inversion of the foot and more ankle sprain risks/events.  The cycle must be broken. The hip must be addressed. That lateral chain must be restored all the way up from the foot.  

Another newer study by Bowker discusses the somatosensory feedback necessary for postural adjustments, walking, and running stating that they may be hampered by a decrease in soleus spinal reflex excitability.  The study adds more validity to what we are all growing to know more clearly, that the central nervous system via supraspinal circuitry plays deeply into chronic ankle instability (CAI). The studies suggest that CAI may be more about coordination and control of dynamic stabilizers and changes in the motor neuron excitability rather than the function of static stabilizers.

“A successful reorganization of the sensorimotor system after an initial ankle sprain is the critical point when individuals suffer chronic ankle instability or become copers [individuals who do not develop chronic instability after an ankle sprain] who break the cycle of recurrent injuries and disabilities seen in CAI,” Masafumi Terada, PhD

According to LER and the Terada work, 

The slow-twitch fibers in the soleus muscle are mostly innervated by small alpha motoneurons, Terada explained, so the study findings suggest that some people may restore their ability to reflexively recruit alpha motoneurons after ankle injury, and some may not.

“Therapeutic interventions that can increase the H-reflex in the soleus may help to break the cycle of recurrent injuries and disabilities seen in CAI,” he said. “Lower-intensity transcutaneous electrical stimulation, joint manipulations, and reflex conditioning protocols may be effective in increasing the soleus spinal excitability.”

The Gait Guys


Reference:

CAI and the CNS: Excitability may influence instability. Larry Hand

http://lermagazine.com/news/in-the-moment-sports-medicine/cai-and-the-cns-excitability-may-influence-instability

Taken from original source:

Bowker S, Terada, M, Thomas AC, et al. Neural excitability and joint laxity in chronic ankle instability, coper, and control groups. J Athl Train 2016 Apr 11. [Epub ahead of print]

J Athl Train. 2006; 41(1): 74–78.PMCID: PMC1421486Ipsilateral Hip Abductor Weakness After Inversion Ankle SprainKaren Friel,Nancy McLean,Christine Myers, and Maria Caceres
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421486/

The diaphragm and chronic ankle instability.

I have been treating the global manifestations of unaddressed chronic ankle sprains for decades now. I am never unsurprised to find frontal plane hip weakness and dysfunction of the same side obliques , shoulder and spinal stabilizers. Here is one more piece of proof that unaddressed ankles are monster problems, slowly eroding the stability of the system.
But, shame on those who attempt to simplify this, just correcting the breathing and throwing some corrective spinal stability work at this problem. This approach will fail, repeatedly. At some point the ankle has to be addressed and the impaired supra spinal programming. Gait will have to be retrained as well, forget to do this and your efforts will be muted.
-Dr. Allen

“Previous investigations have identified impaired trunk and postural stability in individuals with chronic ankle instability (CAI). The diaphragm muscle contributes to trunk and postural stability by modulating the intra-abdominal pressure. A potential mechanism that could help to explain trunk and postural stability deficits may be related to altered diaphragm function due to supraspinal sensorimotor changes with CAI.”

Reference:

Diaphragm Contractility in Individuals with Chronic Ankle Instability.

Terada, Masafumi; Kosik, Kyle B.; McCann, Ryan S.; Gribble, Phillip A.  Medicine & Science in Sports & Exercise:

http://journals.lww.com/acsm-msse/Abstract/publishahead/Diaphragm_Contractility_in_Individuals_with.97497.aspx

Dry Needling and Proprioception. What a great combination. Since dry needling and proprioception both have such profound effects on muscle tone, why not combine them to treat chronic ankle instability? We do all the time and here is a FREE FULL TEXT…

Dry Needling and Proprioception. What a great combination.

Since dry needling and proprioception both have such profound effects on muscle tone, why not combine them to treat chronic ankle instability? We do all the time and here is a FREE FULL TEXT article that ties the two together nicely!

And what better to muscle to use than the peroneii? These babies help control valgus/varus motions of the foot and influence plantar and dorsiflexion AND the longus descends the 1st ray. We call that a triple win!

“This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the end of the therapy in individuals with ankle instability. Our results may anticipate that the benefits of adding TrP-DN in the lateral peroneus muscle for the management of ankle instability are clinically relevant as large between-groups effect sizes were observed in all the outcomes.”

link to full text
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430654/

photo from this past weekends Dry Needling Seminar: working on the dorsal interossei

Hmmmm…The question is: “is the earlier activation a good thing”?What do you say?“A study of patients with chronic ankle instability (CAI) suggests the onset of knee and ankle muscle activity occurs significantly earlier when…

Hmmmm…

The question is: “is the earlier activation a good thing”?

What do you say?

“A study of patients with chronic ankle instability (CAI) suggests the onset of knee and ankle muscle activity occurs significantly earlier when shoes and orthoses are worn than when the patients are barefoot.”

http://lermagazine.com/issues/october/shoes-orthoses-improve-muscle-activation-onset-in-unstable-ankles

Podcast 95: Head tilt while squatting or running.

We have a strong show for you today. Ankle instability from a neurologic perspective, shoe wear, head tilt and the neurologic and functional complications… we also talk about Efferent Copy and motor learning.

A. Link to our server:
http://traffic.libsyn.com/thegaitguys/pod_95final.mp3

Direct Download:  http://thegaitguys.libsyn.com/pod-95

-Other Gait Guys stuff
B. iTunes link:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138
C. Gait Guys online /download store (National Shoe Fit Certification & more !)
http://store.payloadz.com/results/results.aspx?m=80204
D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”

-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:

-Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E

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-Hardcopy available from our publisher:
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Show notes:

Human exoskeletons: The Ekso
http://www.thedailybeast.com/articles/2015/08/03/the-mechanical-exoskeleton-shaping-the-future-of-health-care.html

Ankle muscle strength influence on muscle activation during dynamic and static ankle training modalities
http://www.tandfonline.com/doi/abs/10.1080/02640414.2015.1072640?rfr_id=ori%3Arid%3Acrossref.org&url_ver=Z39.88-2003&rfr_dat=cr_pub%3Dpubmed&#.VcYWR-1VhBc

Chronic ankle instability:

http://tmblr.co/ZrRYjx1akudcm

http://tmblr.co/ZrRYjx1ah6ThV

http://thegaitguys.tumblr.com/post/68785250796/just-because-a-muscle-tests-weak-doesnt-mean-it
http://thegaitguys.tumblr.com/post/117109093439/last-week-we-ran-an-archived-piece-named-just

the future of footwear and orthotics ?
http://lermagazine.com/special-section/conference-coverage/the-future-of-footwear-and-orthoses-is-here-now-what

squats- head posture-gait vision-gravity
http://thegaitguys.tumblr.com/search/vision

Music: brain rhythm
http://www.kurzweilai.net/the-brains-got-rhythm