Podcast 166: Senile Degeneration of afferent mechanoreceptors.

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Podcast 166: Senile Degeneration of afferent mechanoreceptors.

This podcast is way more interesting than the title !

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doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

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Eight-Week Inspiratory Muscle Training Alters Electromyography Activity of the Ankle Muscles During Overhead and Single-Leg Squats: A Randomized Controlled Trial

J Appl Biomech. 2020 Oct 12;1-8. doi: 10.1123/jab.2019-0315. Online ahead of print.
Behnam Gholami-Borujeni 1 , Ali Yalfani 1 , Leila Ahmadnezhad 1

Why Don't Runners' Knees Fail More Often?

Biology suggests that decades of running should invariably blow out your knees. Scientists are trying to understand why that doesn’t happen.

-suggests that 98% of knees should fail after three decades of running. But they don't, and the big question is why not. One possibility: contrary to the usual view, cartilage adapts to repeated loading.
https://www.outsideonline.com/2417356/runners-knee-cartilage-study-2020?utm_medium=social&utm_source=twitter&utm_campaign=onsiteshare

Lengthening of the gastrocnemius-soleus complex: an anatomical and biomechanical study in human cadavers
Gregory B Firth 1 , Michael McMullan, Terence Chin, Francis Ma, Paulo Selber, Norman Eizenberg, Rory Wolfe, H Kerr Graham. JBJS Am.: 2013 Aug 21;95(16):1489-96

Podcast 129: The Random Topic Podcast.

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Key Tagwords:

usain bolt, gait, gait asymmetry, isometrics, isotonics, RF ablation, COOLIEF, OA, deafferentation, knee arthritis, ibuprofin, kidney damage, NSAIDS, heel drop, achilles, tendonitis, heel pain, 

Our Websites:
www.thegaitguys.com

summitchiroandrehab.com   doctorallen.co     shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

Healing Tech in Neuroscience:

New device can heal with a single touch
https://www.usatoday.com/story/news/nation-now/2017/08/07/miracle-device-can-heal-single-touch-and-even-repair-brain-injuries/537326001/

Cool radiofrequency ablation
http://www.nbcnews.com/health/health-news/cool-new-knee-procedure-eases-arthritis-pain-without-surgery-n771221

Updates on Ibuprofin in runners
http://womensrunning.competitor.com/2017/07/news/ibuprofen-risks-endurance-runners_78580#EyIoMyAdkPW9UBpP.97

PeerJ. 2017 Jul 19;5:e3592. doi: 10.7717/peerj.3592. eCollection 2017.
Sonographic evaluation of the immediate effects of eccentric heel drop exercise on Achilles tendon and gastrocnemius muscle stiffness using shear wave elastography.
Leung WKC1, Chu KL1, Lai C1.

Front Physiol. 2017 Feb 28;8:91. doi: 10.3389/fphys.2017.00091. eCollection 2017.
Quantification of Internal Stress-Strain Fields in Human Tendon: Unraveling the Mechanisms that Underlie Regional Tendon Adaptations and Mal-Adaptations to Mechanical Loading and the Effectiveness of Therapeutic Eccentric Exercise.
Maganaris CN1, Chatzistergos P2, Reeves ND3, Narici MV4.

Oman Med J. 2010 Jul; 25(3): 155–1661.
An Overview of Clinical Pharmacology of Ibuprofen
Rabia Bushra* and Nousheen Aslam
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191627/

Pharm Biol. 2014 Feb;52(2):182-6. doi: 10.3109/13880209.2013.821665. Epub 2013 Sep 30.
Zizyphus jujuba protects against ibuprofen-induced nephrotoxicity in rats. Awad DS1, Ali RM, Mhaidat NM, Shotar AM.
https://www.ncbi.nlm.nih.gov/pubmed/24074058

Gait asymmetry ?
https://www.ncbi.nlm.nih.gov/pubmed/28759127
Scand J Med Sci Sports. 2017 Jul 31. doi: 10.1111/sms.12953. [Epub ahead of print]
Kinematic stride cycle asymmetry is not associated with sprint performance and injury prevalence in athletic sprinters.
Haugen T1, Danielsen J2, McGhie D2, Sandbakk Ø1,2, Ettema G2.

Podcast 42: Rhabdo, Bionics and Turf Toe

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Rhabdomyolysis, Bionics, Turf Toe, Low vs High threshold and a whole lot more in today’s show !

A. Link to our server:

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

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

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D. other web based Gait Guys lectures:

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

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* Today’s show notes:

Neuroscience pieces:
 
1.  a tiny chip in the new iPhone called the M7 “motion coprocessor.” is designed to track your movement and automatically figure out  … . 
 
 
2. Bionic Leg
3. Dying young.
By altering water temperature and day length to influence the growth rates of fish, researchers have provided the first empirical evidence that if you grow fast, you die young. 
http://pulse.me/s/q1TnO
4. Low vs high threshold strategies
 
5. Rhabdomyolysis 
6. In the media:
Why runners don’t get knee arthritis
 
7. Disclaimer

8. National Shoe Fit program and our Payloadz store

9. Online CE October 30th

10. Blog reader
 I’m a soccer player and suffered a “turf toe” type injury 2 years ago … 

11. Hi guys. Thanks for the great material. Are there any good exercises for helping correct fully compensated forefoot varus (I have it in both my feet). Orthotics have not helped at all in the past, and I have feeling that this is something I acquired. I am almost certain that this is the root cause of the horrible hip-back-neck pain I have experienced for the last 8 years. Thanks!
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When the knee hinges sideways. A clinical video case.

This is not a difficult case today, not by any means. Most people will can see what is not normal  here. But there are some simple principles we wanted to highlight and remind you of that this case shows nicely.

This is a fairly typical advanced degenerative arthritic right knee and the gait that accompanies it.

Here you can see that when the gentleman steps onto the right limb the knee has a small lateral hinge moment, you can see the knee joint buckle sideways.  This is not normal, the knee is supposed to hinge only forward and backwards (flexion and extension) in the sagittal plane.  Here it is hinging in the frontal plane. You can easily see that after many years of abnormal stresses that the tibia has deformed into a varus bowed position.  This is a great example for you engineer-type out there about long term deformation of solids.

* Deformation of Solids:

  • Stress: is a measure of the force required to cause a particular deformation.
  • Strain: is a measure of the degree of deformation.
  • Elastic Modulus: the ratio of stress to strain:

                  Elastic modulus = Stress divided by Strain    or 

                                     EM= Stress / Strain

The lateral forces and hinging over time forced the tibial to varus bow which is a reactionary measure. In simplest of terms, as the bone cells (osteoclasts and osteoblasts) continued to cyclically turn over they laid down new osseous structure along lines of stress which happen to be in the frontal plane, hence the frontal plane bow. At the joint line it was simple to feel and advanced gapping and shifting of the joint in medial-lateral-medial stressing. One can only imagine the maceration of the cartilagenous menisci in such a knee from the abnormal shear forces. Oy !

In this gait, this joint is quite clearly painful as evidenced by the pronounced limp.  As right limb weight bearing is initiated carefully and slowly to reduce pain and gain stable purchase of the limb with balance the lateral shift is seen to occur.  This lateral shift challenges all of the frontal plane stabilizers so it should be no surprise to anyone that he has significiant gluteus medius, peroneal and abdominal weaknesses in guarding that right frontal plane (to name just a few). 

It is most difficult to see on this video because of the loss of 3D specs and because we do not have a frontal view of this gait, but what you typically see in the gait of these clients is a normal left to right step length and an abbreviated right to left.  As the brain loads that right limb there is pain and instability sensed by joint and pain receptors. This sparks an early and abrupt departure off of the right limb and hence an abbreviated and shortened right to left step length. This will impart a quick load onto the left leg with an abrupt loading into the left quadriceps. It is not uncommon at all for these clients to develop anterior knee pain syndromes (such as patellofemoral tracking syndromes) or foot problems because of repeated abrupt mid-forefoot loading which drives significant of calf-posterior compartment loading (this will also drive long toe flexor strategies). Also, an abrupt right to left weight bearing shift will generate excessive left lateral (frontal plane) forces thus it is not uncommon to show or develop left hip issues or to see more sustained supination of the left foot.  The Peronei can be challenged too to fend off this over-supination that can frequently occur.

* clinical pearl: In our clinics when we see a one sided increase in toe clench and long flexor tone, even when the client lies down, we will once again review gait and look and test for clinical instabilities of stance phase mechanics on the OPPOSITE side of the long toe flexor evidence (in this case there was increased left long toe flexor evidence and early hammer toe formation). This is a huge key, we  have just sold a few acres of the farm giving away this pearl. This is one of our goto tricks to find deeper embedded clinical problems. It is not always the case, because the long flexor problem can be local or same sided but you have to at least consider the thought we have proposed.

This is the exact same gait pattern as in a sprained ankle, in fact, same pattern when any part of a limb is painful.  As you leave the healthy left foot the brain already knows that right foot impact is going to be painful so a pre-calculation is make to soften the loading and to reduce the loading time, hence the premature limp off the right and onto the left. 

It is also important in these cases of significant unilateral bow/varum of the tibia to investigate whether a true leg length discrepancy has developed. It can be a part of the visual limping/lurching gait but it is part of the deformation of the tibia.  In this case we ended up using a 3mm sole lift (don’t use a heel lift, why would you just raise the heel ?) to level out his pelvis to decrease the frequent low back pain and tightness that goes with such a gait and also to reduce the step-down drop onto that degenerative knee. In this case, the lift reduced the degree and rate of lateral hinge and thus reduced much of his pain and back discomfort. By bringing the ground up to his foot he thus did not have to step down onto the right limb which accelerates the lateral shift.

* Try it yourself, find a curb on your street and walk along the top surface of the curb with the left foot, stepping down onto the right foot to street level.  Do this for a year and you would quickly appreciate what this gentleman was experiencing daily……to a degree of course. The lift on the right would be warmly welcomed !

We were actually able to keep the client very comfortable for almost a year which got him to a time frame that worked for his work and vacation time frame to have the surgery. This is often what a client needs, time. Just time to plan, to prepare mentally for a TKA (Total Knee Arthroplasty (replacement)).

The laterally hinging knee.  It is so much more than just a degenerative joint. There is much to be appreciated and learned from pathologic gait patterns.

We are…… Shawn and Ivo…… The Gait Guys ……. center focused but considered by many to be a little off plumb.