Music to my ears....and steps to my cadence

image credit: http://www.holabirdsports.com/blog/which-type-of-music-is-best-for-running/

This piece is a little different. More of an essay or narrative. We hope you enjoy it...

It was 12° when I woke up. It was mid October and fall is in full swing with the leaves still turning and left on many trees. I looked at the thermometer and it read 12°. When I looked outside I could see that 2 to 3 inches of fresh snow had fallen. Electing not to ride my bike because of the slipperiness of the snow on the roads, I donned my Altra’s and headed out for a run. I grabbed my iPod on my way out the door and queued up Nickelback's "All the Right Reasons".

It's amazing how much music can influence your work out. "Follow You Home" came on came on just as I approached the first hill. The song has a relatively strong beat which made me work harder to get up. This made me think of how much cadence can be influenced by music (1-3) and a few pieces we wrote on music therapy. 

Faster cadences have been associated with shorter step length and decreased vertical impact loading rates, in other words less force and theoretically at least, less injuries (4,5) . 

The snow was soft and forgiving beneath my feet and despite wearing tights and two layers on top, I was quite comfortable. “ Fight for All the right reasons" came on as I started my first set of lunges. I could feel my pace again matching the music.

I was making "first tracks of the season" in the snow. That brought a smile to my face. It was quiet and peaceful (except for my music through the headphones of course) and it was feeling like the beginning of a great run. I begin my ascent of the second large hail and “Photograph” came on which made me think about all things high school and brought a smile to my face. I wondered about some of the people I dated as well as a few that I probably should have dated and those that I definitely should not have dated :-)

My run continued, quite well I might add, with some quick intervals of lunges and squats throughout. “Next Contestant” finished up by brief workout as I came down the home stretch. Another smile came to my face as I know what my next blog piece would be about : )

If you just want the bullet, then here it is: “The applicable contribution of these novel findings is that music tempo could serve as an unprompted means to impact running cadence. As increases in step rate may prove beneficial in the prevention and treatment of common running-related injuries, this finding could be especially relevant for treatment purposes, such as exercise prescription and gait retraining.

• Music tempo can spontaneously impact running cadence.
• A basin for unsolicited entrainment of running cadence to music tempo was discovered.
• The effect of music tempo on running cadence proves to be stronger for women than for men.”

1. Van Dyck E, Moens B, Buhmann J, et al. Spontaneous Entrainment of Running Cadence to Music Tempo. Sports Medicine - Open. 2015;1:15. doi:10.1186/s40798-015-0025-9. link to full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4526248/

2. Lima-Silva AE, Silva-Cavalcante MD, Pires FO, Bertuzzi R, Oliveira RS, Bishop D.  Listening to music in the first, but not the last, 1.5 km of a 5-km running trial alters pacing strategy and improves performance. Int J Sports Med. 2012 Oct;33(10):813-8. Epub 2012 May 16.

3. Bacon CJ, Myers TR, Karageorghis CI. Effect of music-movement synchrony on exercise oxygen consumption. J Sports Med Phys Fitness. 2012 Aug;52(4):359-65.

4. Baggaley M, Willy RW, Meardon S. Primary and secondary effects of real-time feedback to reduce vertical loading rate during running Scand J Med Sci Sports. 2016 Mar 19. doi: 10.1111/sms.12670. [Epub ahead of print].

5. Lyght M, Nockerts M, Kernozek TW, Ragan R. Effects of Foot Strike and Step Frequency on Achilles Tendon Stress During Running. J Appl Biomech. 2016 Aug;32(4):365-72. doi: 10.1123/jab.2015-0183. Epub 2016 Mar 8.

Step rate to change foot strike?

Do you do gait retraining? Have you thought about manipulating step rate to change foot strike? If not, you may want to check this out. 

"The intent of our study was to determine whether step-rate manipulation alone was enough to change foot-strike pattern in shod recreational distance runners. We found increasing step rate above the runner’s preferred rate by 10% was successful in changing foot-strike pattern from a heel-strike to a midfoot- or forefoot-strike pattern in 17.5% of the runners, while increasing step rate by 15% changed foot strike pattern in 30%. These results suggest step-rate manipulation alone may be an effective way to change foot-strike pattern in a small percentage of shod distance runners."

http://lermagazine.com/…/step-rate-manipulation-and-foot-st…

Another way to alter loading rates and potentially reduce injuries?

How about providing something a simple as visual and auditory cues?

In his particular study they cued people to either
1. Forefoot strike
2. Decrease average vertical loading by 15% or
3.Decrease step length by 7-1/2 per cent (ie increase step frequency)

All 3 decreased eccentric knee joint work; but increased ankle joint work. Forefoot strike as well as cues to decrease average vertical loading (which would cause you to forefoot strike) increased ankle joint work. I guess that if you steal from Peter you need to pay Paul! Decreasing step length had no adverse effects.

What are you trying to accomplish? If it is decreased knee joint loading, such as in patients with patellofemoral problems, then this could be a very good thing. If you have a patient with a raging achilles tendinitis, then perhaps not.

Having someone decrease their step length (effectively increasing their cadence) can be one of the safest ways to decrease vertical loading rates.

Baggaley M, Willy RW, Meardon S. Primary and secondary effects of real-time feedback to reduce vertical loading rate during running Scand J Med Sci Sports. 2016 Mar 19. doi: 10.1111/sms.12670. [Epub ahead of print].

Difficult hip presentations. Coordination of deep hip muscle activity is often altered in symptomatic femoroacetabular impingement (FAI).

If your clinic is anything like ours, you are regularly seeing failed therapy cases of hip pain walk into your clinic. Many of these cases have been diagnosed clinically or with imaging as FAI (femoral acetabular impingement (syndrome)). FAI can give all kinds of hip pain presentations around the front, side or back of the hip, groin and pelvis, even with referral into the knee. Lets make no mistake, these are difficult cases.
The attached study suggests that these often difficult cases are fraught with undefined parameters. These cases can be difficult for us all, particularly if one do not have the clinical examination skills to tease out what muscles are not working, which ones are over working, what has happened to joint centration, how the client loads the hip, what the pelvis posturing attitude is and what motor stabilization strategies are being deployed. Lumbar, pelvis and hip posturing and stabilzation is key in understanding FAI and these often vague and frustrating cases. Determing how the client deploys stacking of the lower limb joints and how they then deploy these strategies in gait and running is paramount to your success in assisting these client cases. This is a deeply multifactorial problem and often why these issues do not get resolved. 

Recently I just closed yet another case with a 21 year old female who had FAI and labral tear surgery 2 years ago. She had been told she would always have some pain and never run again. As many of these cases often proceed, after defining all of the issues above, it was clear she had many unaddressed components postoperatively. It appeared many components had not been addressed preoperatively, and had they been addressed, I suspect she may have not needed surgery. These multitudes of dysfunctional components can lead to FAI and labral damage. Many torn labrums do not need surgery, as evidenced by how many clients come out of surgery still having the same pre-operative pain as well as how many improve or resolve by a non-surgical approach to addressing all of the components above.

This study, by Diamond et al compared coordination of deep hip muscles between people with and without symptomatic FAI using analysis of muscle synergies (i.e. patterns of activity of groups of muscles activated in synchrony) during gait. The study utilized intramuscular fine-wire and surface electrodes EMG activity of selected deep and superficial hip muscles.  
This study found a significant correlation with the quadratus femoris muscle, one we have repeatedly found problematic over the years. This study was nice to read, it confirmed many of the issues we have found rooted in these often difficult cases. The study surmised that 

“coordination of deep hip muscles in the synergy related to hip joint control during early swing differed between groups. This phase involves movement towards the impingement position, which has relevance for the interpretation of synergy differences and potential clinical importance. ”

We strongly refer you back to our podcast #99 to look into the gluteus medius during swing phase. This is a key component to one’s deeper understanding of how complex the hip works, during both stance and swing. We all tend to get too caught up in stance phase mechanics because that is the one we can see and assess most clearly, however, if one does not understand how vital the gluteus medius is in swing phase limb targeting through the sagittal plane, one is likely missing a big piece of a client’s clinical puzzle. One can do all the dynamic and functional movement and stabilization therapy they wish, but if one does not understand the swing phase mechanics, and perhaps most importantly, if one does not reteach a client how to make the necessary adaptive gait changes to employ the therapeutic work the changes remain on the therapy table and never cross over into functionally using them. The clinician must address the client’s previously deeply rooted gait motor program. A client may have in their bank account the new functional abilities they have been taught, but they likely have not been taught how to deploy them in a new more appropriate gait strategy. 

-Dr. Shawn Allen

1. Coordination of deep hip muscle activity is altered in symptomatic femoroacetabular impingement.
Laura E Diamond, Wolbert Van den Hoom, Kim L Bennell, Tim V Wrigley, Rana S Hinman, John O’ Donnell, Paul Hodges

2. J Neurophysiol. 2014 Jul 15;112(2):374-83. doi: 10.1152/jn.00138.2014. Epub 2014 Apr 30. A neuromechanical strategy for mediolateral foot placement in walking humans.  Rankin BL

3. Podcast 99: How foot placement, the glutes and cross over gait all come together and make sense.

4. https://thegaitguys.tumblr.com/post/133206339519/podcast-99-how-foot-placement-the-glutes-and