Why is that joint range of motion absent? Here are some thoughts.

Photo courtesy of Pixabay.com

Photo courtesy of Pixabay.com

Is this how you think ? It is how we approach puzzles. . . .

Said client has a loss of internal hip rotation (pick any joint for that matter). . . . .

-is the loss of rotation present because they cannot get the rotation range because there is weakness of the internal rotators . . .

- or perhaps external rotators more dominant, combined with the weakness of the internal rotators

-or, is the loss there because of neuro-protective shortness/tightness because the brain feels that the said internal rotation is a vulnerable range (pain, instability), a range where it cannot protect the joint ?

-or, is it a combination of the above? (not to dismiss other processes of course, such as pelvis, knee or foot mechanical issues, OA, pain etc).

If one does not examine a client, how are they supposed to know this all important information?

*What shows up on a functional screen is merely what they are capable of doing/ recruiting/ engaging. It does not tell you why, nor narrow down the causal possibilities. Hence, driving more internal rotation range is silly, driving more strength into the internal rotator is likewise silly. And, merely adding global strength just might provide the overall presentation with more armor, a better coping strategy. Hence, strength first is not always a brilliant solution.

IF all you have is a hammer, everything is going to look like a nail, or you'll at least treat everything like a simple nail.

Fatigue matters. Today's article looks at pre and post exercise fatigue and how, on EMG, our body changes.

Photo credit: pixabay.com

Photo credit: pixabay.com

Even for those of us who do (and should) know better, "the problem is, we are all often knee deep into compensations before we are aware of it, so most of us are always working on adding strength and endurance into our compensations without even knowing it. Our workouts layer things deeper. Yes, almost all of us are on this bus. Don't deny it. The next time you feel that tightness in your shoulder, or in your hip, or feel that tightness or soreness on one side of the low back, or one side of the neck, stop, and ask yourself that honest question. Again, you are on the bus with the rest of us."

We have spent much time discussing our order of things when intervening between a person and what ails them. Namely, our order is to first restore proper skill and patterning, then add endurance (move well often), and then add load, namely strength, power, force, explosive movements and the like. So, Skill, Endurance, Strength. This is a neurologic order, there is good reason for the necessity of this order. We have spend many an hour listening to Dr. Ivo explain why the CNS dictates this is the order with good reason. Cheat this order and you lay down neuroplastic patterns that are anything but what you want for your client. Enough said.

Today we introduce and article that the looks at the lumbo-pelvic-hip complex, a very complicated area, subject to large multi-planar movements and distortions (and hence, large complex multi-planar compensations). We must have good skill, endurance and strength in controlling this massive area safely, meaning, to avoid developing cheating compensatory patterns to negotiate around our days and activities and sports. The problem is, we are often knee deep into compensations before we are aware of it, so most of us are always working on adding strength and endurance into our compensations without even knowing it. Yes, almost all of us are on this bus. Don't deny it. The next time you feel that tightness in your shoulder, or in your hip, or feel that tightness or soreness on one side of the low back, or one side of the neck, stop, and ask yourself that honest question. Again, you are on the bus with the rest of us.

Today's article looks at pre and post exercise fatigue and how, on EMG, our body changes. Now keep in mind, and I will remind you of this again at the end of today's writing, keep in mind of the asymmetries, poor-skill, poor-endurance and poor strength in some areas that pre-exist, before even starting into our exercises. Imagine, assume, that these were there in all of this study's subjects, even prior to the exercise challenge. You should now fully grasp how layered things get for our clients.

Here is what the article said,

"fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability".-Chang et al.

"The purpose of this study was to compare trunk muscle activation patterns, and trunk and lower extremity kinematics during walking gait before and after exercise. Surface electrodes were placed over the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis of twenty-five healthy indviduals."

"The amplitude increased in the rectus abdominis during loading, midstance , terminal stance, and late swing after exercise. Amplitude also increased during swing phase in the erector spinae, vastus lateralis, and vastus medialis after exercise. There was less trunk and hip rotation from initial contact to midstance after exercise. Neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking. Increased muscle activation with decreased movement in a fatigued state may represent an effort to increase trunk stiffness to protect lumbo-pelvic-hip structures from overload."-Chang et al

What we found particularly notable was that they found less trunk and hip rotation from initial contact to midstance after exercise. And that, "neuromuscular fatigue significantly influenced the activation patterns of superficial musculature and kinematics of the lumbo-pelvic-hip complex during walking". As they concluded, increased muscle activation with decreased movement in a fatigued state plausibly indicates an effort to increase trunk stiffness as a protective measure. Translation, a protective compensation.

Here is what we have to say about that: do not leave the problem on the table and merely train your client around this. Resolve the underlying problem. The underlying problem may not, and likely will not, come out in a "functional screen". What will come out in the screen is how they are moving about with this existing compensation pattern(s). The screen shows WHAT they are doing with their limitations, not WHY Dive keep dear brethren. This is what it is all about, taking the time and diving deep. Find the "why".

So, as promised, here I am again, reminding you to keep in mind of the asymmetries, poor-skill, poor-endurance and poor strength in some areas that pre-exist, before even starting into our exercises. Imagine, assume, that these were there in all of this study's subjects, even prior to the exercise challenge. You should now fully grasp how layered things get for our clients.This is what can make, "helping someone get well", a difficult challenge, even on a good day.

*Muscle activation patterns of the lumbo-pelvic-hip complex during walking gait before and after exercise. Chang M1, Slater LV2, Corbett RO1, Hart JM1, Hertel J1.

Photo credit: pixabay.com Thank you for making such beautiful photos like this available for free use. Gorgeous photography !

Functional screens will not always give you the answer, the  screen might only show you another level of compensation. Only the keen  at that game will get it right. What do we mean by this ? Well, lets  take muscle testing and motor pattern assessm…

Functional screens will not always give you the answer, the screen might only show you another level of compensation. Only the keen at that game will get it right. What do we mean by this ? Well, lets take muscle testing and motor pattern assessments for example.

When we started with muscle testing we used to look for the weakness of the muscle or pattern we were isolating. But now, with more experience and wisdom, our keen eyes are now focused on the clients attempts to “cheat” around the assessment rather than basing our assessment entirely on the isolated tests. Many athletes will quickly figure out how and where to get more strength in a given muscle test, often because they are used to compensating for a weak muscle…..studies even show that clenching your teeth, or squeezing another muscle (often called a Jendrassik Maneuver) can affect the outcome of a muscle test.  So, you have to watch for your client’s attempts to “cheat” through your assessments.  Just one more thing to think about! 

In the screen above, would you know if the person had internal or external tibial torsion?  How about femoral retro or ante torsion ? In doing a screen, only the astute assessor will know what the screen is telling them.  For example, is the foot turned out because the person has external tibial torsion, or is the knee going inwards because they neutralized the foot progression angle before the test and now the knee is drifting inwards ….. it is still external tibial torsion in both cases.  What about internal tibial torsion, where is the foot, where is the knee? (More on Torsions and Versions in Thursday’s post)

The squat can give you information but you might want to think about this.  Really how useful is a squat in relation to the most fundamental pattern we use the most, gait ? Well, it is not. 62% of normal gait is stance phase and of that, 51% of that is on one foot (38% of a total gait cycle). We still vividly remember when Professor Janda visited our residency program back in the 90’s for a week.   He spoke of many things but one that stuck with us was a discussion about the need for stable single leg stance function, that it was a key motor skill easily cheated.  That is not to say that the squat test is not a valuable assessment, there are just better ones in our humble opinion.

You see, a functional screen does give information, but it is only the person who understands the parameters of normal and abnormal function and anatomy who can glean what the screen is telling you. Guys like Gray Cook  who are big into this stuff are going to be awesome at this because they have the background to know what the test is telling them and know the anatomical parameters that can skew the test.  What we are saying, is that it is not the test that is the gem, it is the knowledge to understand the results of the test that is the key.

Oy vey, why can’t anything be simple,  huh ?!

It’s Tuesday, we are The Gait Guys…….. and so much more.

Shawn and Ivo