Pod 102: Thermic adaptation & Gait/Running.

Podcast 102: Thermic adaptation, gait, running, odometer neurons, your brain’s GPS, rehab for cartilage, plantar fascitis and more.

Show Sponsors:
Softscience.com

Other Gait Guys stuff

A. Podcast links:

direct download URL:  http://traffic.libsyn.com/thegaitguys/pod_102ff.mp3

permalink URL: http://thegaitguys.libsyn.com/podcast-102-thermic-adaptation

B. iTunes link:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138
C. Gait Guys online /download store (National Shoe Fit Certification & more !)
http://store.payloadz.com/results/results.aspx?m=80204
D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”

-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:

-Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E

-Barnes and Noble / Nook Reader:
http://www.barnesandnoble.com/w/pedographs-and-gait-analysis-ivo-waerlop-and-shawn-allen/1112754833?ean=9781466953895

https://itunes.apple.com/us/book/pedographs-and-gait-analysis/id554516085?mt=11

-Hardcopy available from our publisher:
http://bookstore.trafford.com/Products/SKU-000155825/Pedographs-and-Gait-Analysis.aspx


Show Notes:

‘Odometer neurons’ encode distance traveled and elapsed time
http://www.eurekalert.org/pub_releases/2015-11/cp-ne102815.php#.Vj5xCP01e5w.facebook

Our GPS loss
http://www.fastcoexist.com/3053172/these-beautiful-mental-maps-of-cities-help-your-brain-regain-what-it-has-lost-to-gps?partner=superfeed

Athletic adjustments to the heat http://www.runnersworld.com/sweat-science/how-long-does-it-take-to-adjust-to-heat

Hyperthermic conditioning http://fourhourworkweek.com/2014/04/10/saunas-hyperthermic-conditioning-2/

The newest craze?  or a temp fad ? http://sproingsport.com

Muscle strength in Plantar fascitis http://www.runresearchjunkie.com/intrinsic-muscle-strength-in-plantar-fasciitis/

Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis
RTH Cheung, L.Y. Sze, N.W. Mok, G.Y.F. Ng
Journal of Science and Medicine in Sport ; Article in Press

What does stretching do to a joint ?http://www.greglehman.ca/2015/11/11/what-does-stretching-do-to-a-joint-we-really-have-no-idea-part-i/

Rehabing cartilage ?
http://www.thestudentphysicaltherapist.com/home/rehabing-cartilage-defects

Music piece: why you need good earphones to run with.
http://www.openculture.com/2015/10/the-neuroscience-of-bass-new-study-explains-why-bass-instruments-are-fundamental-to-music.html

Dry Needling and Proprioception. What a great combination.

Since dry needling and proprioception both have such profound effects on muscle tone, why not combine them to treat chronic ankle instability? We do all the time and here is a FREE FULL TEXT article that ties the two together nicely!

And what better to muscle to use than the peroneii? These babies help control valgus/varus motions of the foot and influence plantar and dorsiflexion AND the longus descends the 1st ray. We call that a triple win!

“This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the end of the therapy in individuals with ankle instability. Our results may anticipate that the benefits of adding TrP-DN in the lateral peroneus muscle for the management of ankle instability are clinically relevant as large between-groups effect sizes were observed in all the outcomes.”

link to full text
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430654/

photo from this past weekends Dry Needling Seminar: working on the dorsal interossei

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Toe sardines. What have we done to our feet ?

Note that form follows function. If you are observant, you will see the deformation of the 5 digit, just like in this case as the quadratus weakens and the long flexors dominate. The toe begins to spin laterally, and thus the plantar toe pad begins to deform medially, look closely, you can see that here in the video.

Does this look like your foot ? There are a few subtle issues here. 

In the foot, the toe that delineates abduction and adduction of the toes is the 2nd toe. The 2nd toe is considered the anatomic middle of the digits and forefoot. Any toe or movement that moves away from the 2nd toe is abduction and any movement towards the 2nd toe is adduction. This is obviously different than in the hand where the 3rd digit, the one you use during road rage, is the reference digit. Next time you are questioned, tell them you threw them your reference finger, not “the bird”, it is a more accurate descriptor.

In this foot, note how neatly and tightly packed the cute little toes are, all snuggled up to their brothers and sisters. Remember, form follows function. Obviously function has been low on these fellas, at least in abduction.  This often comes from snug toe box footwear and lack of abduction (toe spread) use.  But make no mistake, this is a weak foot.

Today we wish to really focus your attention to an old topic, just a revisit. We can see the 4th and 5th toes curl under from the probably weak lateral head of the quadratus plantae thus encouraging unopposed oblique pull of the long flexors of the digits (FDL). See this post here for an explanation of this phenomenon.  There is also obvious imbalance between the long and short flexors and extensors in these toes, the long flexors are expressing more tone, and that means the long extensors are deprived. 

Note that form follows function. If you are observant, you will see the deformation of the 5 digit, just like in this case as the quadratus weakens and the long flexors dominate. The toe begins to spin laterally, and thus the plantar toe pad begins to deform medially, look closely, you can see that here in the video. This spin can carry the toe nail so far laterally sometimes that the nail can begin to touch the ground during gait and cause painful nail lifting with even some losing the nail. 

There is plenty of life left in this foot, but you have to get to it quickly and get them in lower heeled shoes if tolerable and ones with a wider toe box.  The client needs to be retaught how to access the toe extensors and abductors. Lumbrical retraining, which is a recurrent topic here on our blog, should also be instituted. 

Shawn Allen, one of the gait guys

What are we listening to this week? 

Therapy Insiders interview with Stu McGill entitled “the mechanics of a treatment approach with Dr. Stuart McGill"This was an interesting interview with some nice clinical pearls. Anyone who has had the opportunity to see Dr. McGill speak will certainly appreciate his humor and candor.

After a lengthy discussion on mustaches, they began to talk about competency of therapists. Dr. McGill then explains some salient points in his three hour evaluation of patients. His goals are to "precisely define The pain triggers to that patient” and then to “remove them”. Pretty simple but effective. We think the keyword here is “precisely”.He then talks about utilizing your clinical knowledge based in the powers of observation. 

His assessment begins with a patient interview to determine The character of the patients pain. He’s very careful to listen to “exactly” what the triggers and really are for a patient’s pain. He then goes on to offer some nice clinical diagnostics pearls that we will leave for you to listen to the podcast to glean.

He then again emphasizes observing the patients movement and movement habits to establish their stability/mobility continuum. His examination consists of three parts: provocative motions, neural tests, and tissue specific tests. He looks for provocative motions postures and loads.  Once the pain should use identified, he then seeks to find positions postures or movements which will alleviate it. He then does neural tests, looking for things like neural or root tension. Finally he discusses some tissue specific diagnoses.

There’s an interesting discussion on pain and pain science. Dr. McGill emphasizes that people need to avoid the movement which causes pain not moving in general. He then goes on to talk about Central sensitization and how, if you can teach people to not invoke their “pain trigger” motion, that they will actually improve and central sensitization will decrease. in other words, don’t move “through” pain but find ways to work around the trigger.

There’s been a series of “Twitter” questions that are answered with an interesting discussion on Core stability and superimposed axial movement. All in all a informative interview with some clinical pearls. 

you can give it  listen here: 

http://updocmedia.com/mediacast/the-mechanics-of-a-treatment-approach-w-dr-stuart-mcgill/

Hmmm..What’s going on here? Can you see it?

Welcome to Monday, Folks, and News You Can Use! Sometimes, it’s the subtle things that make all the difference.

Take a look at this patients right leg versus left legs (knees in particular). What do you see?  Can you notice the subtle bend in the right knee?  Can you see how she hyperextends the left? Can you see that she has an anatomical deficiency (Tibial) of the left tibia? This is a common finding if you look for it.

 Noticing subtle changes like these in your examination can make all the difference in your outcomes. This particular patient happens to have right-sided knee pain. On examination (difficult to see from the photos) she has increased amounts of mid foot pronation.  She presented with right sided back pain running from the supra iliac region up along the right lumbar paraspinal’s. You can manipulate this patient forever and her problem is not going to improve until you address the cause.

 Develop keen sense of observation. Become a “student of the obvious”.  Keep your eyes and ears open. Expand your clinical skill set.  Sometimes, when all we have is a hammer, everything starts to look like a nail. 

Children: Postural control of balance

From the study:

“From these indexes it was established that the postural capacity needed just to control balance with the leg muscles was not attained before 4-5 years of independent walking, i.e., at about 5-6 years of age.” -Breniere

reference link:

Exp Brain Res. 1998 Aug;121(3):255-62.Development of postural control of gravity forces in children during the first 5 years of walking.Brenière Y¹, Bril B.

http://www.ncbi.nlm.nih.gov/pubmed/9746131/

Part 2: How relaxed, or shall we say “sloppy” is your gait ? The Cross over gait /Frontal plane drift gait.

In this photo (*credit below) the blurred right swing leg tells you this client has been photographed during gait/running motion. Can you see it ? Have we educating you well ?

Human gait is cyclical. A problem on one side will corrupt the other and the cycle begins, and usually continues until the cycle is broken. 

We wish to remind you of our time hammered principle that when the foot is on the ground the glutes are heavily in charge, and when the foot is in the air, the abdominals are heavily in charge.  For us to move cleanly and efficiently one would assume that the best way to do that would be to ensure that the lower 2 limbs are capable of doing the exact same things, with the same timing, same skill, same endurance and same strength. This goes for the upper 2 limbs as well, and then of course the synchronizing of the four in a cohesive antiphasic effort. This would be perfect and clean gait, a gait that would unlikely ever suffer pain or problems. Symmetrical durability wins every time. 

This photo demonstrates the cross over gait and we are beating it to a pulp here, again.  In this running gait photo, this momentary snapshot of global movement, it shows this client is engaging movement into the left frontal plane excessively, they have drifted to the left far outside the vertical plumb line from the foot. The question is, it is excessively enough to present as painful pathology or is it a painless problem at this time? We call what you see here a frontal plane drift, but more so, the cross over gait. You can even see suggestion of the left frontal drift as evidenced by the concavity of the lumbar spine curve to the left.  It should be clear that the right pendulum leg will scrape the left calf on its way through its oblique pendulum swing (instead of a pure forward sagittal swing) to a foot strike somewhere near to the line they are closely running on (a theoretical line). This is the cross over gait.  After this left frontal plane drift and right cross over, there will likely be a corresponding right frontal plane drift and left cross over to compensate on the very next step. Thus, the cycle begins, each on feeding and compensating off the other. To prevent it, it means you have to have an extra bit more of lateral line strength in the gluteus medius and lateral abdominal sling to fend off pathology. You have to  have the stability from S.E.S (skill, endurance, strength) to stack the hip, knee and foot over top of each other.  You have to have enough ankle stability and a host of other clean and strong and skilled layers to fend it off to be precise. One must be able to find functional stability in the stacked posture, and this can take some training and time.  Make no mistake, this is a faulty movement pattern, even if there is not pain (yet), this is not efficient motor patterning and something will have to give. Whether that is lateral foot pain from more supination strategizing, more tone in the ITB perhaps causing lateral knee or hip pain, posterior ischeofemoral impingment syndrome, a compensation in arms swing or thoracic spine rotation or head tilt etc … .  something has to give, something has to compensate.

To complicate the cyclical scenario, the time usually used to move sagittally will be partially used to move into, and back out of, the frontal plane. This will necessitate some abbreviations in the left stance phase timely mechanical events. Some biomechanical events will have to be abbreviated or sped through and then the right limb will have to adapt to those changes. These are simple gait problems we have talked about over and over again here on the gait guys blog. (Search “arm swing” on our blog and you will find 50+ articles around this topic.) These compensation patterns will include expressed weaknesses in various parts of the human frame as part of the pattern

Are you able to find the problem in the never ending loop of compensations of your clients and find a way to unwrinkle their system one logical piece at a time, or will you just chose to strengthen the wrinkled system and hope that the new strength on top of the compensations is adequate for you or your client ? One should not be forever sentenced to daily or weekly rehabilitative sessions or homework to negate and alleviate symptoms, this is a far more durable machine than that. Fix the problem.  Merely addressing things locally can be a crime.  If you are seeing an arm swing change, you would be foolish not to look at the opposite lower limb and foot at the very least, and of course assess spinal rotation, lateral flexion and hinging as well as core mobility and stability. 

For you neuro nerds, remember what Dr. Ivo says, that the receptors from the central spine and core fire into the midline vermis of the cerebellum (one of the oldest parts of our brain, called the paleo cerebellum); and these pathways, along with other cerebellar efferents, fire our axial extensor muscles that keep us upright in the gravitational plane and provide balance or homeostasis through stability.  It is why they assessed and addressed.  

Or, if this is too much thinking for you, … you can just train harder and get stronger . .  . in all your compensation patterns, after all, it is easier than figuring out why and how a right ankle for example started the whole mess, if in fact that is even the first piece of the puzzle.  No one said this would be easy. 

So, how sloppy is your gait ?

Dr. Shawn Allen, one of the gait guys

________________________

References and Credits

Note: photo linked to this article. Photo credit/property: REUTERS/Eduardo Munoz (Copyright Reuters 2016).  

Article: Workouts focused on motor skills may help ease lower back pain

 http://www.foxnews.com/health/2016/01/14/workouts-focused-on-motor-skills-may-help-ease-lower-back-pain.html

The Mighty Quadratus Femoris→

Ishial tuberosity pain that looks like a hamstring but is not responding? Think QF.

We have always have found the quadratus femoris is one of, if not the, 1st hip muscle to become dysfunctional in hip pain patients. Perhaps it is due to it being the southern most stabilizer of the deep 6. Long known as an adductor, but also external rotator, we find it is employed eccentrically when the foot the planted and people rotate to the same side as weight bearing, or people take a “sudden stumble” while running. It often mimics an insertional hamstring strain with regards to location. We were happy to see it is getting some of the attention it deserves : )

You mean a sauna can improve my endurance for running?

Did you know using a sauna can (in some areas) produce better results than exercise? I didn’t believe it either. What are we listening to this week? For 1, one of Dr Ivo’s new favs: Dr Rhonda Patrick

This is an absolutely great, referenced short on some of the benefits of hyperthermic conditioning (ie sauna use). One of the most surprising effects was benefits which exceeded exercising!

Here is one small excerpt:

Being heat acclimated enhances endurance by the following mechanisms:

It increases plasma volume and blood flow to the heart (stroke volume). This results in reduced cardiovascular strain and lowers the heart rate for the same given workload. These cardiovascular improvements have been shown to enhance endurance in highly trained as well as untrained athletes.

It increases blood flow to the skeletal muscles, keeping them fueled with glucose, esterified fatty acids, and oxygen. The increased delivery of nutrients to muscles reduces their dependence on glycogen stores. Endurance athletes often hit a “wall” when they have depleted their muscle glycogen stores. Hyperthermic conditioning has been shown to reduce muscle glycogen use by 40%-50% compared to before heat acclimation. This is presumably due to the increased blood flow to the muscles. In addition, lactate accumulation in blood and muscle during exercise is reduced after heat acclimation.

It improves thermoregulatory control, which operates by activating the sympathetic nervous system and increasing the blood flow to the skin and, thus the sweat rate. This dissipates some of the core body heat. After acclimation, sweating occurs at a lower core temperature and the sweat rate is maintained for a longer period.

waaaayyyyy more in her video. Check it out. I had to listen to it several times to catch all the details.

https://www.youtube.com/watch?v=aHOlM-wlNjM&feature=youtu.be

and what have we been saying for the last several years?

“The development of bone marrow edema after transitioning from traditional running shoes to minimalist footwear is associated with small intrinsic foot muscle size, according to research from Brigham Young University in Provo, UT.

The findings, epublished in late October by the International Journal of Sports Medicine, suggest that runners with small intrinsic foot muscles may benefit from strengthening exercises prior to attempting the transition to minimalist running.

Investigators randomized 37 habitually shod runners to 10 weeks of running in minimalist footwear or their own shoes, and performed magnetic resonance imaging at baseline and after the intervention to detect bone marrow edema and assess intrinsic foot muscle size.

Eight of the runners in the minimalist group had developed bone marrow edema at 10 weeks, as well as one in the control group. Those who developed bone marrow edema had significantly smaller intrinsic foot muscles than those who did not.

In addition, running in minimalist footwear was associated with a 10.6% increase in abductor hallucis cross-sectional area, a statistically significant change”.

Source:

Johnson AW, Myrer JW, Mitchell UH, et al. The effects of a transition to minimalist shoe running on intrinsic foot muscle size. Int J Sports Med 2015 Oct 28. [Epub ahead of print]

yet another cause of impaired ankle rocker. Be sure to do a thorough exam!

“Many pathogenic manifestations of equinus occur due to the center of pressure displacement that is seen in diseased states. Typically, the center of pressure on the foot can be measured 6 cm anterior to the ankle during gait, but with equinus, it is shifted distally and laterally. The pull of the Achilles tendon cannot adequately compensate for the new distal and lateral center of pressure and, as a result, an overall pronatory force remains.”

http://lermagazine.com/article/equinus-its-surprising-role-in-foot-pathologies

“The Deep 6” and their “not so talked about” role in the gait cycle.

Excerpted from a recent Dry Needling Seminar in, listen to this brief video and you will never look at these muscles the same way again.

It talks about the lesser known, eccentric role of the deep 6 external rotators during gait. This is really important from a rehab perspective, as these muscles are often neglected in the rehab process.

Do yourself and your clients/patients a favor and watch this informative short so you don’t miss out : )

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Eliminating the fake out of ample ankle rocker through foot pronation in the squat and similar movements:  How low can you go ? 

This is a simple video with a simple concept. 

* Caveat: To avoid rants and concept trolling, am blurring lines and concepts here today, to convey a principle. Do not get to tied up in specifics, it is the principle I want to attempt to drive home.  What you see in this video is clearly more lunge/knee forward flexion rather than hip hinge movement. However, keep in mind, that this motion does occur at the bottom of many movements, including the squat. 

You can achieve or borrow what “appears” to be more ankle dorsiflexion, a term we also loosely refer to as ankle rocker, through the foot, foot pronation to be precise. Do not mistaken this extra forward tibial progression range as ankle rocker mobility however. When you need that extra few degrees of ankle dorsiflexion deep in your squat, or similar activities, you can get it through your foot. Often the problem is that you do not think that is where it is coming from, you might just think you have great ankle mobility.  Many deep squatters are borrowing those last few degrees of the depth of the squat from the foot. This is not a problem, until it is a problem.  Watch the video above.  Why ? Because when the foot pronates and begins to collapse (hopefully a controlled collapse/pronation) the knee follows. Forcing the knees outward in a squat like some suggest is a bandaid, but I assure you, the problem is still sitting on the table. 

Go do a body weight squat with the toes up like in this video. Toes up raises the arch from wind up of the windlass and increased activity of the toe extensors and some assistance from the tibialis anterior and some other associated “helper” muscles.  When the arch is going up, it cannot go down. So, you raise your toes and do your squat. This will give you a better, cleaner representation of how much mobility in your squat/lunge/etc is from ankle dorsiflexion, knee flexion and  hip flexion. You can cheat and get some from the foot. The foot can be prostituted to magnify the global range, and like I said, this is not a problem until it IS a problem.   We know that uncontrolled and unprotected increases in foot pronation can cause a plethora of problems like plantar tissue strain, tibialis posterior insufficiency and tendonopathies, achilles issues, compression at the dorsum of the cuneiform bones (dorsal foot pain) to name a few. This dialogue however is not the purpose of this blog post today. You can read more about these clinical entities, proper foot tripod skills and windlass mechanics on other blog posts on this site. 

Today, we just wanted to bring this little “honesty” check to your awareness. Has been a staple in my clinic for over a decade, to help me see where limitations are and to show folks how they can cheat so much through the foot. Go ahead, try it yourself, see how much you use your foot to squat further if you have end range mobility issues in the hips, knees or ankles.  The foot is happy to give up the goat, it just doesn’t know the repercussions until they show up. 

So, lift your toes, do a full squat. Go as low as you can with good form with the toes up.  Then, at the bottom of the squat or the bottom of  your clean mobility, suddenly drop your toes and let the arch follow if it must. Here is the moment of truth, at that moment the toes go down, feel what happens to the foot, ankle, tibial spin, knee positioning, pelvis posture changes. Careful, these are subtle. You may find you are using foot pronation more that you should, more than is safe.  Now try this, bottom out your cleanest squat as you regularly would, and at the bottom, raise your toes and try to reposition the foot arch and talus height. In other words, reposture your foot tripod, see how difficult this is if you can do it at all. Perhaps you will find your toe extensors are too weak to even get there.  This is how we cheat and borrow. We should not make it a habit, it should be used when we need it, but it should not be a staple of your squatting diet, it should not be a regular event where you prostitute sound biomechanics.  Unless you wish to pay for it in some way.  What should happen is that you should be able to bring your toes down and not let the arch follow, but that is a skill most have not developed. It is a staple move in your clients’ movement diets.

Does all this mean you should squat with your toes up ? No, but it may serve you well in awareness, evaluation, and looking for potholes and power leaks. At the very least, give it some thought and consideration. You may see some smiles and have some lightbulb moments between you and your athletes and clients. 

Plan on blocking this foot pronation range with an orthotic ? How dare you ! At least try to do it through reteaching this and the tripod skill first. Give your a client a chance to improve rather than a bandaid to cope. 

Dr. Shawn Allen, one of the gait guys

How relaxed, or shall we say “sloppy” is your gait ?

Look at this picture, the blurred left swing leg tells you this client has been photographed during gait motion. 

Now, visualize a line up from that right foot through the spine. You will see that it is clearly under the center/middle of the pelvis. But of course, it is easier to stand on one leg (as gait is merely transferring from one single leg stance to the other repeatedly) when your body mass is directly over the foot.  To do this the pelvis has to drift laterally over the stance leg side.  Sadly though, you should be able to have enough gluteal and abdominal cylinder strength to stack the foot and knee over the hip. This would mean that the pelvis plumb line should always fall between the feet, which is clearly not the case here.  This is sloppy weak lazy gait. It is likely an engrained habit in most people, but that does not make it right. It is pathology, in time something will likely have to give. 

This is the cross over gait we have beaten to a pulp here at The Gait Guys over and over … . . and over.   This gait this gait, this single photo, means this client is engaging movement into the frontal plane too much, they have drifted to the right. We call it frontal plane drift. To prevent it, it means you have to have an extra bit more of lateral line strength in the gluteus medius and lateral abdominal sling to fend off pathology. You have to be able to find functional stability in the stacked posture, and this can take some training and time.  Make no mistake, this is a faulty movement pattern, even if there is not pain, this is not efficient motor patterning and something will have to give. Whether that is lateral foot pain from more supination strategizing, more tone in the ITB perhaps causing lateral knee or hip pain, a compensation in arms swing or thoracic spine rotation or head tilt  … … something has to give, something has to compensate. 

So, how sloppy is your gait ? 

Do you kick or scuff the inside of your opposite shoe ? Can you hear your pants rub together ? Just clues. You must test the patterns, make no assumptions, please.

Shawn Allen, one of the gait guys

Podcast 101: Physics of falling & running.

Podcast 101: Physics of Falling & Running
Plus: calf strengthening problems, odometer neurons help you find your way, Chi running and more !

Show Sponsors:
newbalancechicago.com
rocktape.com

Other Gait Guys stuff

A. Podcast links:

direct download URL:http://traffic.libsyn.com/thegaitguys/pod_101fmp3.mp3

permalink URL: http://thegaitguys.libsyn.com/podcast-101

B. iTunes link:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138
C. Gait Guys online /download store (National Shoe Fit Certification & more !)
http://store.payloadz.com/results/results.aspx?m=80204
D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”

-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:

-Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E

-Barnes and Noble / Nook Reader:
http://www.barnesandnoble.com/w/pedographs-and-gait-analysis-ivo-waerlop-and-shawn-allen/1112754833?ean=9781466953895

https://itunes.apple.com/us/book/pedographs-and-gait-analysis/id554516085?mt=11

-Hardcopy available from our publisher:
http://bookstore.trafford.com/Products/SKU-000155825/Pedographs-and-Gait-Analysis.aspx


Show Notes:

‘Odometer neurons’ encode distance traveled and elapsed time
http://www.eurekalert.org/pub_releases/2015-11/cp-ne102815.php#.Vj5xCP01e5w.facebook

Snap on shoehttp://www.digitaltrends.com/cool-tech/minimal-shoe-3d-printed-programmable-fabric-snaps-into-shape/

Physics of falling/runninghttps://www.newscientist.com/article/dn28246-physics-of-falling-says-professional-athletes-are-running-wrong/

Foot strike and (pre)positioning ?
http://www.runnersworld.com/sweat-science/where-should-your-feet-land-while-running

Non-local fatigue
http://www.runnersworld.com/sweat-science/the-mystery-of-nonlocal-fatigue

Chi running, less injuries?http://www.runresearchjunkie.com/chi-running-did-not-lead-to-less-injuries/  

CAlf strength screen?http://thebarbellphysio.com/2015/10/09/calf-strength-assessment/stupid screen 

http://blog.brainfacts.org/2013/08/human-grid-cells/#.Vk-TemSrQ_V

http://www.nature.com/neuro/journal/v16/n9/abs/nn.3466.html

Did you know using a sauna can (in some areas) produce better results than exercise? 

I didn’t believe it either. What are we listening to this week? For 1, one of Dr Ivo’s new favs: Dr Rhonda Patrick

This is an absolutely great, referenced short on some of the benefits of hyperthermic conditioning (ie sauna use). One of the most surprising effects was benefits which exceeded exercising!

Here is one small excerpt:
Being heat acclimated enhances endurance by the following mechanisms:

It increases plasma volume and blood flow to the heart (stroke volume).  This results in reduced cardiovascular strain and lowers the heart rate for the same given workload.  These cardiovascular improvements have been shown to enhance endurance in highly trained as well as untrained athletes.

It increases blood flow to the skeletal muscles, keeping them fueled with glucose, esterified fatty acids, and oxygen. The increased delivery of nutrients to muscles reduces their dependence on glycogen stores. Endurance athletes often hit a “wall” when they have depleted their muscle glycogen stores. Hyperthermic conditioning has been shown to reduce muscle glycogen use by 40%-50% compared to before heat acclimation. This is presumably due to the increased blood flow to the muscles. In addition, lactate accumulation in blood and muscle during exercise is reduced after heat acclimation.

It improves thermoregulatory control, which operates by activating the sympathetic nervous system and increasing the blood flow to the skin and, thus the sweat rate. This dissipates some of the core body heat. After acclimation, sweating occurs at a lower core temperature and the sweat rate is maintained for a longer period.

waaaayyyyy more in her video. Check it out here. I had to listen to it several times to catch all the details.

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Pronating around internal hip rotation loss.

This is a remedial principle, but it is always nice to capture it on video like this. Watch this clients left foot. On initial impressions you might just say too much foot pronation, and you would be right. Some of you might say abductor-adductor twist of the foot. These are all correct. But, if we told you that this was a hip complaint client, and lack of internal hip rotation this foot action should be a simple 60Watt “light bulb moment” (translation: “epiphany”), certainly not a 100Watt moment (but for some it might be).  

This client cannot internally rotate through the hip adequately, so they have found the opposite end of the limb to internally rotate through.  They collapse through the arch/tripod, which essentially in the crudest of analogies “internally screws the limb” into the ground.  They are finding internal femur rotation through foot pronation.  Internal hip rotation is being achieved from a bottom up process if you will. Pronation through the foot complex is adduction, medial rotation and plantarflexion of the talus which will carry the tibia (and thus the femur) with it into internal rotation.  There is a problem in many clients who find that extra little bit of rotation at the hip via a foot/ankle cheat.  That problem is one of corruption of the pelvis antiphasic motion of the pelvis, they will most often dump the same hip laterally and thus drift into the frontal plane instead of achieving the antiphasic motion of the pelvis.  This will decouple the rotation of the torso in the opposite rotation of the pelvis, and thus begin the corruption of arm swing.  Want to take it another level deeper ? Ok, eat this for lunch……. asymmetrical thoracic rotation from side to side will set up. This will mean more work through scapulothoracic stabilization and cervical rotation on the side of the thoracic rotation deficit.  Still not deep enough ? Ok, evaluate their respiration symmetry.   Too many are doing respiratory work before hip rotation is clean and symmetrical, especially during gait that necessitates 1000′s of engraining steps a day.  If the hips are not clean, gait is not clean, and that means repetitive arm swing-thoracic-respiratory mechanics are not clean.

If you want to truly fix someones rooted problems, you have to be willing and able to go down the rabbit hole. 

Shawn Allen, one of the gait guys

When is a hamstring strain not a hamstring strain?

We have always have found the quadratus femoris is one of, if not the, 1st hip muscle to become dysfunctional in hip pain patients. Perhaps it is due to it being the southern most stabilizer of the deep 6. Long known as an adductor, but also external rotator, we find it is employed eccentrically when the foot the planted and people rotate to the same side as weight bearing, or people take a “sudden stumble” while running. It often mimics an insertional hamstring strain with regards to location. We were happy to see it is getting some of the attention it deserves : )

http://www.anatomy-physiotherapy.com/articles/musculoskeletal/lower-extremity/hip/1528-function-of-the-quadratus-femoris-and-obturator-externus

What were they thinking? Oh, they weren’t thinking…

Here is a simple case of knowing your anatomy. 

make sure to use the toggle bar to the right and left of the picture to see all the pictures : )

This woman came in with right sided lateral knee pain with hiking and skiing; worse with fatigue, better with rest. The pain was localized at the lateral joint line and at the tibial fibular joint. 

She had been previously been diagnosed with tibial fibular hypermobility and subsequently had an arthrodesis (fusion) performed at that joint for knee pain. The surgery helped for a short time and a newer, slightly different pain developed. 

Yes, she has a moderate genu valgus, R > L. Yes, she has a left, anatomically short (tibial) Left leg. Yes, she has has NO MOBILITY at the tib/fib articulation and the focus of pain is just above at the joint line and at the lateral aspect of the patello femoral joint. 

The tibial fibular joint is a syndesmosis (not a true synovial or diarthrodial joint) that is supposed to have a a superio/inferior gliding motion (see diagram) with ankle dorsiflexion, due to the wedge shape of the talar dome and talo crural articulation. It also is supposed to have an anterior/posterior gliding movement at the superior aspect of the joint and a reciprocal movement in the opposite direction at the ankle (see diagram).

Whenever we take away movement in one area, it needs to occur somewhere else; in this case, at the femoral tibial joint and patello femoral joints.

Does it make sense that her left sided leg would cause hypermobility on the right side with a supinatory moment of the foot on the left to attempt to lengthen the leg and a pronatory movement of the foot on the right, in addition to valgus angulation of the joint on the right to attempt to “shorten” that extremity? Would this increased valgus angluation of the knee, in turn, cause abnormal, lateral, tracking of the patella? Wouldn’t the increased pronatory moment cause a more supple foot on that side with increased requirements for “push off” on that side with increased calf recruitment? Do you think that may impair proprioception on that side?

What if you put a sole lift in the left shoe (like we did) to help to alleviate some of the discrepancy and gave her some anterior compartment exercises (toes up walking, lift/spread/reach exercises, heel walking, simple balance on 1 leg exercises? Her world becomes a much better place to live in and she can return to the activities she loves to do with her 65 year old friends, like hiking 14′ers, skiing and mountain biking,

What we do to one joint affects all the others. You cannot make one change without expecting others. Be on the lookout and know your anatomy! This case was relatively straight forward. Many are not. Do a thorough exam and expect the unexpected. 

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The Great toe’s effect on external hip rotation.

We have a simple video for you today. 

When we assess our clients for gait and locomotion we do a quick screen of all the big player joints, from the toes at least up into the thoracic spine to start. Loss of mobility/range of motion means probable functional impairment. 

In this video we display the effects of the Windlass Mechanism of the great toe. A windlass mechanism according to Wikipedia is:

a type of winch used especially on ships to hoist anchors and haul on mooring lines and, especially formerly, to lower buckets into and hoist them up from wells.

In this case, dorsiflexing the big toe spools the plantarfascia and flexor hallucis longus and brevis around the metatarsophalangeal joint (1st. MTPJ), thus pulling the heel towards the forefoot thus raising the arch. When the arch raises, the talus moves cephalad (upwards) and because of the supinatory movement orientation, it spins the tibial externally which in turn spins the femur externally. This is what you see in this video, note the blue dots being carried laterally with the limb external rotation.

The point here today, if you have loss of external hip rotation, it could be crying for you to evaluate the range of motion of the 1st MTP joint , it could be crying for you to evaluate the skill of toe extension, strength or endurance or all of the above. Impairment of the 1st MTP has great inroads into ineffective locomotion. You must have decent range of motion to effectively supinate, to effectively toe off, to externally rotate the limb, to effectively acquire hip extension to maximize gluteal use.  Thus, one could easily say that impaired hallux/great toe extension (skill, ability, endurance, strength) can impair hip extension (and clean hip extension patterning) and result in possible terminal propulsive gait extension occurring through the lumbar spine instead of through the hip joint proper.

Think of the effects of two asymmetrical great toe extensions, comparing the great toe left to right. Asymmetry in the limbs, pelvis, hip extension and perhaps worse, the lumbar spine, is a virtual guarantee.  Compare hallux extension side to side, if you can achieve symmetry through skill, endurance and strength retraining, you must do it. If you have a hallux limitus, a bunion or anything that impairs the symmetry of great toe extension side to side, you have some interesting work to do. 

You have to know what you have in your client, and know what it means to their locomotion.  Seeing or recognizing what you have must translate into understanding and action. 

Play mental games with clinical entities.  In this case, if at terminal toe off you did not have full hallux extension like in this client, and thus you did not get that last little final external rotation spin in the limb at the hip … . . what could that do to your gait ? Go tape your toe and limit terminal extension (terminal dorsiflexion) and walk around, to feel it in yourself is to get first hand experience. 

Shawn Allen, one of the gait guys