Abs on the UP, Glutes on the DOWN

I had the opportunity to go on my 1st mountain bike ride of the season last Sunday morning. Yes, I am aware it is JUNE, but the snow has finally melted (we had over 7 FEET at arapahoe Basin in May) and you need to understand that I am usually a runner). In the cool morning 44 degree air I was reminded of the importance of my gluteal muscles (rather than just my quads) while climbing a technical hill which was clearly pushing my aerobic capacity. We have the opportunity to perform many bike fits in the office and treat many cycling ailments. We also train and retraing pedal stroke and one of our mantras (in addition to skill, endurance and strength) is “Glutes on the downstroke; Abs on the upstroke”. Meaning use your glutes to extend the hip from 12 to 6 o’clock and use your abs to initiate the upstroke. Quadricep (on the downtstroke) and hamstring dominance (on the upstroke) is something we see often and this mantra often proves useful in the “retraining process”.

I have been a fan of Ed Burkes work (“Serious Cycling” and “Competitive Cycling”) for years and have read (and lectured about) these books many times. In my effort to find a basis in the literature for my mantra, I ran across a paper (1) that seemed to substantiate, at least in part, the mantra. It is a small study looked at elite athletes that explores changes that occur in muscle recruitment as the body fatigues after a sub maximal exercise session.

Their conclusion “The large increases in activity for gluteus maximus and biceps femoris, which are in accordance with the increase in force production during the propulsive phase, could be considered as instinctive coordination strategies that compensate for potential fatigue and loss of force of the knee extensors (i.e., vastus lateralis and vastus medialis) by a higher moment of the hip extensors.”

This makes sense, although may be contradicted by this study (2), which showed LESS gluteal activity at higher mechanical efficiency, with increased tricep surae activity. They conclude “These findings imply that cycling at 55%-60% V˙O(2max) will maximize the rider’s exposure to high efficient muscle coordination and kinematics.”  Although this study looks at mechanical efficiency and the 1st lloks at muscle activity.

Being seated on a bike and having your torso, as well as hips flexed is not the most mechanically efficient posture for driving the glutes, but clinical observation seems to dictate that the less quad and hamstring dominant people are on the down and up stroke respectively, then the more pain free they are. This does not always equte to being the fastest, but it does equate to fewer injuries showing up in the office.

1. Dorel S1, Drouet JM, Couturier A, Champoux Y, Hug F. Changes of pedaling technique and muscle coordination during an exhaustive exercise. Med Sci Sports Exerc. 2009 Jun;41(6):1277-86. doi: 10.1249/MSS.0b013e31819825f8.
2. Blake OM1, Champoux Y, Wakeling JM.  Muscle coordination patterns for efficient cycling. Med Sci Sports Exerc. 2012 May;44(5):926-38. doi: 10.1249/MSS.0b013e3182404d4b.

Shoe lacing problems, things you need to know (that you don't).

How you lace your shoes does truly matter (according to this study).

We have talked about shoe lacing on more than one occasion. Everyone has played around with different laces and lacing strategies at one time or another. And, every shoe seems to lace just a little differently. Some shoes lace far into the forefoot, some have the potential to lace high up into the ankle.  But just because there are eyelets there, doesn’t mean  you have to thread a lace through the hole. It is about fit the majority of the time.  Some of our runners will use “skip” lacing to avoid pressure over the dorsum of the foot, especially if they have a saddle exostosis or hot tendon in that area, much of the time this works to alleviate the pain and pressure there. Just remember, impaired ankle rocker often via weakness of the anterior compartment muscles (toe extensors, tibialis anterior, peroneus tertius) will force dorsiflexion moments into the midfoot and can cause some joint-related compressive pressure on the dorsal foot which can seemingly (and mistakenly) come from shoes tied too tight across the top of the foot. Be sure to consider this fact before you “skip lace” your shoes, it is a big player, one we see all of the time.

In today’s journal article found below, we discover some other factors in a controlled study.  Here they look into the effects of lacing on biomechanics in running, specifically rearfoot runners. The results of the study showed reduced loading rates and pronation velocities as well as lowest peak pressures under the heel and lateral midfoot in the tightest and highest laced shoes. Whereas, the lower laced shoes resulted in lower impacts and lower peak pressures under the 3rd and 4th metatarsal heads (they proposed that this was from forward foot slide in the shoe because of this lacing). The study authors concluded 

 A firm foot-to-shoe coupling with higher lacing leads to a more effective use of running shoe features and is likely to reduce the risk of lower limb injury.

Remember, this is just data for you to cogitate over. It can help you work through some possible issues with your feet and your sport, however it does not translate to everyone as a standard protocol. Remember this, we have been known to say, “your problem is not often the shoe, it is the thing in the shoe (you and your faulty biomechanics)”. However, blaming your problems on you is not good shoe manufacturer advertising, so many shoe companies will offer a plethora of shoes choices for you to accommodate to your variables. This does not necessarily mean the problem is solved, rather it is often managed by a “better” shoe choice that seems to work for your variables. This is a good thing most of the time, if you understand shoes, shoe anatomy, and human anatomy (foot types) so that you can pair them up for a best outcome. The problem may lie in the fact that your shoe fitter is not likely to have all of the necessary pieces to put your perfectly matched picture together, including understanding your total body biomechanics and possibly understanding why a weak glute is impairing hip extension and thus limiting ankle rocker motion, causing premature heel rise, and thus forcing too much dorsiflexion into the arch of the foot and premature forefoot loading causing what seems to be too tightly tied shoes.  

What we truly need an e-Harmony for matching shoes and feet ! But since that perfect scenario doesn’t often exist at the shoe store level or gait analysis level, here at The Gait Guys we have put together the next best thing, The National Shoe Fit Certification Program if you care to take this all to the next level. 

Shoe fitting is an art, and lacing is just another paint brush you can  use to get the job done. You just have to know what brush to use for each given piece of art (ie. the athlete). 

Shawn and Ivo, The gait guys

J Sports Sci. 2009 Feb 1;27(3):267-75. doi: 10.1080/02640410802482425.

Effects of different shoe-lacing patterns on the biomechanics of running shoes.

Hagen M, Hennig EM.

 

Video case: The King’s Preference: Short and Sweet. A quick and easy case demonstrating the patellar tracking struggles with external tibial torsion.

Our favorite functional evaluation piece of equipment as well as our favorite piece of therapy equipment is the Total Gym.  Here we clearly demonstrate, to us and the client, in partial weight bearing load, the effects of external tibial torsion.  

Remember, the knee is sort of the King of all joints when it comes to the lower extremity.  The knee is a sagittal plane hinge, and so all it wants to do is hinge forward, freely without binding from deficits at the hip or knee. But we cannot ignore the simple fact that pre-pubescent kids the long bone derotation process is still undergoing, and in adults the process may have been corrupted or insufficient.  

In this case it should be obvious that the knee is sagittal and free to hinge when the foot is at a large foot progression angle.  This allows the knee to hinge cleanly. But when the foot is corrected to the sagittal plane, as you see in the second half of the video, the knee tracks inward and this can cause patellofemoral pain syndromes, swelling, challenges to the menisci (and possible eventual tears) and challenges to the ACL and other accessory restraints.  Additionally, this medial drift is a longer and more difficult challenge to the eccentric phase external rotators such as the gluteus maximius not to mention many of the other muscles and their optimal function.  

So, the next time you see a large foot progression angle in a client or in their walk (duck footed if you will) try to resist the natural urge to tell them to corrrect the foot angle. They are likely doing it to keep the King happy.  And furthermore, be careful on your coaching recommendations during squats, olympic lifts, lunges and running.  Just because you do not like the way the foot looks doesn’t mean you should antagonize the King of joints.  

External tibial torsion, its not something you want to see, but when you do see it, you have to know its degree, its effects at the knee, hip and foot as well as how it might impact hip extension, pelvic neutrality, foot strike, foot type, toe off and so many other aspects.

Whoever said gait analysis was easy was a liar. And if all they use is a video camera and fancy analysis software they have show up with only part of the team. And if they said they were an expert  in gait only a few years into practice, you had better also look for a jester’s hat somewhere hiding in the corner. After all, the King would want to know !

Shawn and Ivo, your court jesters for the last 3+ years.  Maybe we will get a promotion from the King someday soon !

Beautiful Glutes!     Part 1

Place your hands on your buttocks and stand up from a seated position. Did you feel them fire? Now walk with your hands in your back pockets. Do you feel them active at the end of your stride? No? Maybe you should be in rehab. You should!

The glutes have been the fascination of many, including Michaelangelo (Ever seen the sculpture of David?). Perhaps if you have a patient with recalcitrant back or hip problems, you should consider looking closer at their gluteal group.

anatomical perspectives

The gluteus maximus, the most superficial of the 3 gluteii, is the largest, coarsest fibered muscle in the body. It attaches proximally on the ilia, sacrum, coccyx and sacrotuberous ligament and slopes 45 degrees inferolaterally to attach distally, predominantly to the iliotibial tract with a smaller contribution attaching to the gluteal tuberosity of the femur. In open chain, it is an extender and lateral rotator of the thigh, as well as the upper fibers acting as abductors and lower fibers adductors of the hip.

The superior fibers of the gluteus maximus are part of the lateral line of musculature (as described by Myers in “Anatomy Trains”) as it diverges at the hip, along with the gluteus medius and tenor fascia lata. This lateral line helps provide stabilization in the saggital plane, beginning at the peroneus longus and traveling ultimately to the splenius and sternocleidomastoid. From this perspective, we can view gluteal function during gait (ie closed chain) as rotators and abductors/adductors of the pelvis and an extensor of the torso

The gluteus medius and minimus attach proximally between the anterior and posterior gluteal lines and distally at the lateral surface of the greater trochanter for the former and anteriorly for the latter . They act as abductors and medial rotators of the thigh in open chain, and abductors and external rotators of the pelvis in closed chain,  the anterior fibers of the minimus and medius probably assisting in forward motion of he contralateral pelvis. Sahrmann states “the posterior portions of the medius act as abductors, external rotator and extenders of the thigh, with the anterior portion also assisting in hip flexion”.

The Glutes; they’re more than just another pretty muscle….

We are…The Gait Guys