Podcast 151: Gait and neurology of movement, including, Tightness? shortness? What’s the difference? It's the Neurology.

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Truths about Stretching, a case of sesamoiditis, plus exercised induced muscle damage and impaired motor learning, central fatigue, POSE and Chi running and injuries. This is a good one gang, do not miss it !

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Other links for today's show:

http://traffic.libsyn.com/thegaitguys/pod_151final.mp3

http://thegaitguys.libsyn.com/gait-and-neurology-of-movement-including-tightness-shortness-whats-the-difference-its-the-neurology

http://directory.libsyn.com/episode/index/id/11168369

Show notes and links:

We lose muscular Strength as we age.
Changes in supra-spinal activation play a significant role in the age-related changes in strength.
This motor system impairment can be improved by heavy resistance training
https://www.ncbi.nlm.nih.gov/pubmed/25940749

Age (Dordr). 2015 Jun;37(3):9784. doi: 10.1007/s11357-015-9784-y. Epub 2015 May 5.
Strength training-induced responses in older adults: attenuation of descending neural drive with age. Unhjem R1, Lundestad R, Fimland MS, Mosti MP, Wang E.

Osteoarthritis and running
https://journals.lww.com/acsm-csmr/Abstract/2019/06000/Running_Dose_and_Risk_of_Developing.5.aspx
Recent literature adds to a growing body of evidence suggesting that lower-dose running may be protective against the development of osteoarthritis, whereas higher-dose running may increase one's risk of developing lower-extremity osteoarthritis. However, running dose remains challenging to define, leading to difficulty in providing firm recommendations to patients regarding the degree of running which may be safe.

Can even experienced orthopaedic surgeons predict who will benefit from surgery when patients present with degenerative meniscal tears? A survey of 194 orthopaedic surgeons who made 3880 predictions
Non-surgical management is appropriate as first-line therapy in middle-aged patients with symptomatic non-obstructive meniscal tears.
https://bjsm.bmj.com/content/early/2019/08/12/bjsports-2019-100567

Sports Biomech. 2019 Jul 31:1-16. doi: 10.1080/14763141.2019.1624812. [Epub ahead of print]
Running biomechanics before and after Pose® method gait retraining in distance runners.
Wei RX1, Au IPH1, Lau FOY1, Zhang JH1, Chan ZYS1, MacPhail AJC1, Mangubat AL1, Pun G1, Cheung RTH1.

Fatigue and muscle activation.

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"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"

No rocket science here . . . but good to remember that fatigue sets us all up for injury if one does not observe and listen to the signs of fatigue . . . . especially when athletic and loading demand is increasing rather than tapering at the same time as the fatigue is building. As we fatigue, compensation recruitment is supposed to generate more stiffness to protect the motor units. But, can this be at a cost ?

This study looked at whether fatigue may affect muscle recruitment, active muscle stiffness and trunk kinematics, compromising trunk stability. 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.

The study used surface EMG to look at the rectus abdominis, external oblique, erector spinae, gluteus medius, vastus lateralis, and vastus medialis in a group of otherwise healthy individuals.

Essentially the study concluded that:
"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. 
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Gait Posture. 2016 Nov 9;52:15-21. doi: 10.1016/j.gaitpost.2016.11.016. [Epub ahead of print]

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.

https://www.ncbi.nlm.nih.gov/pubmed/27846435

Podcast 79: Tightness vs. Shortness, Plantar Fascitis & more.

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plus, pelvic asymmetry, “wearables” and cognitive choices in movement.

This week’s show sponsors: 

www.newbalancechicago.com

www.lemsshoes.com

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Direct Download: 

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

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http://store.payloadz.com/results/results.aspx?m=80204

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:

The Brain and your choices.

http://exploringthemind.com/the-mind/brain-scans-can-reveal-your-decisions-7-seconds-before-you-decide#.VCx0P8ydUK4.facebook

 
 
Walking is the superfood of fitness, experts say
 
Hey Guys,
I have pelvis asymmetry and a snapping ankle, can you help me with … . 
 
New research on Plantar Fascitis
 
John from FB
Shortness vs tightness:
What protocol do you recommend for stretching ? I usually do static stretches1x2min. This article has the static stretch group doing 10x30sec. I’d have to set my alarm a half hour earlier! :-)

How injury and pain reorganize the brain.

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Gait, Arm Swing and Reorganizing the Brain

When we injure a body part there is a price to pay, how expensive it will be is entirely up to you. Upon injury, the brain takes note and typically dives into a backup plan of neurologic inhibition, neuro-protective tightness and alteration of motor patterns to protect that injured area and allow it to heal. Moderating and altering the forces and demands upon said tissues is the goal to enable healing, if we as humans, don’t get in the way first (“I have to get that run in, I am behind in my training with all these injuries !” or “Ah, its still not that bad, the pain wasn’t worse on Tuesday’s run, I will be ok.”). The bigger question for most folks is, will you listen to what your body is asking of you? Heed the warnings and messages, and your injury will come and go in a timely manner, ignore the messages and welcome to a chronic festering problem.

These protective mechanisms need to be in place, we just have to listen to them.  Failure to heed their warnings to dial things back and rest, recover and heal, the brain will make alternative changes out of necessity.

In the medpage today article in the references below, the authors discuss several important things.

“Getting a cast or splint causes the brain to rapidly shift its resources to make righties function better as lefties, researchers found.
Right-handed individuals whose dominant arm had to be immobilized after an injury showed a drop in (brain) cortical thickness in the area that controls primary motor and sensory areas for the hand, Nicolas Langer, MSc, of the University of Zurich in Switzerland, and colleagues reported.
Over the same two-week period, white and gray matter increased in the areas that controlled the uninjured left hand, suggesting “skill transfer from the right to the left hand,” the group reported in the Jan. 17 issue of Neurology.
The findings highlight the plasticity of the brain in rapidly adapting to changing demands, but also hold implications for clinical practice, they noted.”

This article highlights the rapid changes in motor programs that occur. It does not take long for the body to begin to develop not only functional adaptations but neurologic changes at the brain level within days and certainly less than 2 weeks.

So how long have you been in this pain ? If someone has to ask you this question, the process has already begun.

We tell our patients, if pain does not go away fairly quickly, that we need to get on top of the injury quickly. That is not to say you need to reach for the phone every time you have pain but you need to heighten your awareness of the injury’s status and  you need to make sure you are not driving session after session of training into a festering injury. If you do not let something heal and recover, the brain will find a way around it.  And it will imprint that new motor pattern into hard wiring, and into the hard wiring of other patterns, if you do not heed the warning signs.  This new wiring is a compensation pattern. And the longer it is there the more the neurologic pattern becomes embedded by layerings of myelin coating.  Which means that in the future, if you fatigue or injury another local tissue, this old compensation pattern is waiting in the shadows looking for an opening to rear its ugly head for old times sake.

Furthermore, on the topic of asymmetry, the above concept holds strongly true. In our clinics, we recognize asymmetry as a strong clinical finding. Despite the  Lathrop-Lambach study below, mentioning that they feel a 10% baseline asymmetry is the norm, if you do not rehab and correct both an injury and its new neurologic hardwiring changes, you have enabled and welcomed asymmetry. We feel, as many others do, that asymmetry can be a major component and predictor to injury. Logically, restoring as much symmetry as possible, both biomechanically and neurologically, is restorative and protective.

Don’t be a stoic knucklehead. Get your stuff fixed by someone who knows what they are doing. And remember, watching your gait on a treadmill or through some high tech gait analysis software and making recommendations from that information is just plain idiotic. Go see someone smart who can correlated it to examination findings. 

This article pertains to athletes and non-athletes of all walks of life. From 5 to 105 years of age, we are all susceptible to the brain’s overriding mechanisms. 

Shawn and Ivo

references:

1. Broken arm can reorganize the brain.

http://www.medpagetoday.com/Neurology/GeneralNeurology/30686

Gait Posture. 2014 Jul 1. pii: S0966-6362(14)00610-9. doi: 10.1016/j.gaitpost.2014.06.010. [Epub ahead of print]
Evidence for joint moment asymmetry in  healthy populations during gait.
"We found a high amount of asymmetry between the limbs in healthy populations. More than half of our overall population exceeded 10% asymmetry in peak hip and knee flexion and adduction moments. Group medians exceeded 10% asymmetry for all variables in all populations. This may have important implications on gait evaluations, particularly clinical evaluations or research studies where asymmetry is used as an outcome. Additional research is necessary to determine acceptable levels of joint moment asymmetry during gait and to determine whether asymmetrical joint moments influence the development of symptomatic pathology or success of lower extremity rehabilitation.”