Podcast 125: The spinal discs in Running and Sport

What happens to your discs when you run? Risk or no risk ? Can disc herniations resorb ? Also, some new research on ankle sprains and cross spinal cord reflex responses, compensation pattern, brain transplants and more !  Plus a rant on why we insist on 2 weeks non-weight bearing after ankle sprains. 

Key tag words:
running, gait, injuries, discs, spine, herniateddisc, transplants, ankle sprains

Podcast links for today's show:

http://traffic.libsyn.com/thegaitguys/pod_125f.mp3

http://thegaitguys.libsyn.com/podcast-125-your-spinal-discs-in-running-and-sport

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:

Brain transplants
Cryogenically frozen brains will be 'woken up' and transplanted in donor bodies within three years, claims surgeon

http://www.telegraph.co.uk/science/2017/04/27/cryogenically-frozen-brains-will-woken-transplanted-donor-bodies/

Running and spinal discs
https://spinalnewsinternational.com/running-significantly-benefits-human-intervertebral-discs/

Pain Physician. 2017 Jan-Feb;20(1):E45-E52.

Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis.

Zhong M1, Liu JT2, Jiang H2, Mo W3, Yu PF2, Li XC2, Xue RR3.
https://www.ncbi.nlm.nih.gov/pubmed/28072796/

long list of references here:
https://www.fixyourownback.com/public/articles/will-my-disc-herniation-ever-heal/

People like their NSAIDS, but do they know the risk ?
http://time.com/4746319/ibuprofen-painkillers-risks/

Windswept bimechanics

Foam rolling
"Arterial blood flow of the lateral thigh increased significantly after foam rolling exercises compared with baseline"
http://journals.lww.com/nsca-jscr/Abstract/2017/04000/Acute_Effects_of_Lateral_Thigh_Foam_Rolling_on.4.aspx

Myokymia

http://emedicine.medscape.com/article/1141267-overview#a4

https://twitter.com/scienceofsport/status/854241624997724161


Ankle proprio
http://natajournals.com/doi/abs/10.4085/1062-6050-52.2.08?platform=hootsuite&code=nata-site

The Case of the Curly Toes

Here, we talk about one common reason you may see a unilateral increase in long flexor tone.

The Power of Triangles

We talk about triangles a lot. Think about triangles. Hey Pythaogoras did! They are powerful distributors of force. Here we will talk about 3 of them.

There are 4 layers of muscles in the foot. The 1st triangle occurs in the 1st layer. Think of the abductor hallucis and the abductor digiti minimi. Proximally they both attach to the calcaneus and distally to the 1st and 5th proximal phalanges. Now think about the transverse metatarsal ligament that runs between the disal metatarsal heads. Wow, a triangle! this one is superficial.

Now think about the adductor hallicus. It has a transverse and oblique head. think about that transverse metatarsal ligament again. Wow, another triangle!

What about the flexor hallicus brevis and flexor digiti minimi? The former originates from the cuboid, lateral cunieform andd portion of the tib posterior tendon; the latter from the proximal 5th metatarsal. They both go forward and insert into the respective proximal phalynx (with the sesamoids intervening in the case of the FHB). and what connects these? The deep transverse metatarsal ligament of course! And this triangle surrounds the adductor triangle, with both occurring the 3rd layer of the 4 layers of foot muscles.

Triangles… and you thought geometry was boring!

Remaining triangular when we need to (because of our pointy heads)…

Ganu Valgus and Kids

Here we look at genu valgus in kids. What she needs to know and how to keep track of it.

What? Gait and hearing....

No, not how does the gait SOUND, but can they hear? We have long payed attention to the mechanics of gait, muscles and proprioception, and many times, if you have been following us for any length of time, the interplay of all three. But how often have you considered someones hearing in your evaluation?

Anatomically, the hearing organs (hair cells, otolithic apparatus, cochlea) are conveniently located right next store to the vestibular system (utricle, saccule and semicircular canals). The hearing organs start with mechanical vibrations of the tympanic membrane (ear drum) which move 3 auditory bones (or ossicles) called the incus, malleus and stapes. The vibrations move the stapes moves in and out of the fluid filled cochlea and vibrate crystals laying on a platform (otolith) in which hair cells are imbedded and if the vibration sufficient, the nerves attached to the hair cells fire and you can hear your favorite baseline by Cliff Williams (or Cliff Burton, John Myung, Bootsy Collins or whomever you like to listen to).

The vestibular system, as you probably know, monitors position and velocity of movement of the head. There are three hula hoop type structures called “semicircular canals” (see picture above) that monitor rotational and tilt position and angular acceleration, as well as two other structures, the utricle and saccule, which monitor tilt and linear acceleration.

The vestibular apparatus (the canals and the utricle and saccule) feed into a part of the brain called the floccular nodular lobe of the cerebellum, which as we are sure you can imagine, have something to do with balance and coordination. This area of the cerebellum feeds back to the vestibular system (actually the vestibular nucleii); which then feed back up to the brain as well as (you guessed it) down the spinal cord and to predominantly the extensor muscles.

Can you see how the 2 systems are “attached” to one another and could conceivably be interrelated? When you move fluid in one system (endo or peri lymph) you HAVE to move fund in the other. The fluid displaces, (like air, in air filled shoes or insoles), it does not deform (like EVA in an insole)

It is well established that hearing impaired folks (especially kids) have gait (and often balance) problems (1-3) and the worse the hearing loss, the worse the gait disturbance (1). This can occur in middle aged (4), as well as older adults as well (5-7). Perhaps this is due to viscosity changes in the endo or perilymph (8), otosclerosis of the ossicles (9,10) or other age related changes in utricle and saccule function (5-7). Also, for the 1st time, we are documenting a “sensory reweighting” which occurs when auditory cues are changed (4), with a greater reliance on visual cues. Hmmm. We wonder how this plays out with listening to music while walking or running?

So, The next time someone you see has a gait or balance problem, check their hearing and adjust your treatment program accordingly : )

References:

1. Melo RS.  Gait performance of children and adolescents with sensorineural hearing loss.
Gait Posture. 2017 Jun 3;57:109-114. doi: 10.1016/j.gaitpost.2017.05.031.

2. Jafarnezhadgero AA, Majlesi M, Azadian E. Gait ground reaction force characteristics in deaf and hearing children. Gait Posture. 2017 Mar;53:236-240. doi: 10.1016/j.gaitpost.2017.02.006. Epub 2017 Feb 14.

3. Janky KL, Givens D.Vestibular, Visual Acuity, and Balance Outcomes in Children With Cochlear Implants: A Preliminary Report. Ear Hear. 2015 Nov-Dec;36(6):e364-72. doi: 10.1097/AUD.0000000000000194.

4. Maheu M, Sharp A, Landry SP, Champoux F. Sensory reweighting after loss of auditory cues in healthy adults. Gait Posture. 2017 Mar;53:151-154. doi: 10.1016/j.gaitpost.2017.01.015. Epub 2017 Jan 24.

5. Agmon M, Lavie L, Doumas M. The Association between Hearing Loss, Postural Control, and Mobility in Older Adults: A Systematic Review. J Am Acad Audiol. 2017 Jun;28(6):575-588. doi: 10.3766/jaaa.16044. Review.

6. Layman AJ1, Li C, Simonsick E, Ferrucci L, Carey JP, Agrawal Y. Association Between Saccular Function and Gait Speed: Data From the Baltimore Longitudinal Study of Aging. Otol Neurotol. 2015 Jan 7. [Epub ahead of print]

7. Otol Neurotol. 2012 Jul;33(5):832-9. doi: 10.1097/MAO.0b013e3182545061.
Decline in semicircular canal and otolith function with age.
Agrawal Y1, Zuniga MG, Davalos-Bichara M, Schubert MC, Walston JD, Hughes J, Carey JP.

8. Wu T, Marcus DC. Age-Related Changes in Cochlear Endolymphatic Potassium and Potential in CD-1 and CBA/CaJ Mice . JARO: Journal of the Association for Research in Otolaryngology. 2003;4(3):353-362. doi:10.1007/s10162-002-3026-6.

9. Grayeli AB1, Sterkers O, Toupet M. Audiovestibular function in patients with otosclerosis and balance disorders. Otol Neurotol. 2009 Dec;30(8):1085-91. doi: 10.1097/MAO.0b013e3181b0fd5d.

10. Ozmen AO1, Aksoy S, Ozmen S, Saraç S, Sennaroğlu L, Gürsel B. Balance after stapedotomy: analysis of balance with computerized dynamic posturography. Clin Otolaryngol. 2009 Jun;34(3):212-7. doi: 10.1111/j.1749-4486.2009.01915.x.

Pod #124: Gluteal gripping, Runner's dystonia. Are leg length differences real ?

Key tag words:
running, gait, injuries, kidney, kidneydamage, marathoners, foot, feet, dehydration, heatstroke, elon musk, neural lace, hip pain, crossfit, squats, deadlifts,  LLD, short leg, dystonia, runner's dystonia, posture, 

Summary:  Today we hit some very important topics on how to examine a client and how asymmetries play into gait, running, posture and pathomechanics. We hope you enjoy today's show, it is our first one back in 6 weeks. We are back strong after a brief early summer sabbatical. Back to the "podcast every 2 weeks" again. Thanks for being patient while Ivo recharged for the second half of the year.   Plus, on today's show, we also dive into Runner's kidney, dehydration, gluteal gripping, runner's dystonia, functional leg length differences due to asymmetries, and more !

Show links:

http://traffic.libsyn.com/thegaitguys/pod_124final.mp3

http://thegaitguys.libsyn.com/pod-124

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:

Kidney Damage in Runners. 82%  !?
http://www.newsweek.com/running-bad-you-marathons-damage-kidneys-runners-bodies-575829
 
Kidney nephropathy in mesoamericans.
http://www.ajkd.org/article/S0272-6386(15)01257-3/fulltext  
 
Elon Musk's Neural Lace.
https://www.scoopwhoop.com/elon-musk-launches-neuralink-which-hopes-to-combine-your-brain-with-artificial-intelligence/
 
Leg length discrepancies,do they really even exist ?
Dystonia ?
The Gluteal gripping phenomenon.

What is the deal with "toe separators"?

Less pain through better mechanics?

We have been using toe separators for various foot problems like hallux valgus, hammer toes and flexor dominance/extensor weakness. Our reasoning is that through changing the angle of attachment of the muscle, you alter the mechanical advantage of that muscle and help it to work more efficiently. This seems implied in the literature with respect to foot orthoses (1-3) but we could not find any data regarding toe separators. Toe separators DO seem to reduce pain and increase function (4-6). Perhaps this is through better biomechanics, mechanical deformation, proprioceptive changes, or most likely a combination of all these factors and more.  We think clinical results speak volumes. It is nice to see more data coming out on these easy to implement clinical tools.

What is you clinical reasoning or rationale for using these devices? We would love to hear and if you have an article for reference you could share, that would be great.

TGG

1. Scherer PR, Sanders J, Eldredge DE, Duffy SJ, Lee RY. Effect of functional foot orthoses on first metatarsophalangeal joint dorsiflexion in stance and gait. J Am Podiatr Med Assoc. 2006 Nov-Dec;96(6):474-81.

2. Halstead J, Chapman GJ, Gray JC, Grainger AJ, Brown S, Wilkins RA, Roddy E, Helliwell PS, Keenan AM, Redmond ACFoot orthoses in the treatment of symptomatic midfoot osteoarthritis using clinical and biomechanical outcomes: a randomised feasibility study. Clin Rheumatol. 2016 Apr;35(4):987-96. doi: 10.1007/s10067-015-2946-6. Epub 2015 Apr 28.

3. Bishop C, Arnold JB, May T. Effects of Taping and Orthoses on Foot Biomechanics in Adults with Flat-Arched Feet. Med Sci Sports Exerc. 2016 Apr;48(4):689-96. doi: 10.1249/MSS.0000000000000807.

4. Chadchavalpanichaya N, Prakotmongkol V, Polhan N, Rayothee P, Seng-Iad S. Effectiveness of the custom-mold room temperature vulcanizing silicone toe separator on hallux valgus: A prospective, randomized single-blinded controlled trial. Prosthet Orthot Int. 2017 Mar 1:309364617698518. doi: 10.1177/0309364617698518. [Epub ahead of print]

5. Tehraninasr A, Saeedi H, Forogh B, Bahramizadeh M, Keyhani MR. Effects of insole with toe-separator and night splint on patients with painful hallux valgus: a comparative study. Prosthet Orthot Int. 2008 Mar;32(1):79-83. doi: 10.1080/03093640701669074.

6. Tang SF, Chen CP, Pan JL, Chen JL, Leong CP, Chu NK. The effects of a new foot-toe orthosis in treating painful hallux valgus. Arch Phys Med Rehabil. 2002 Dec;83(12):1792-5.

Ankle Rocker Revisited....

How many times have we talked about ankle rocker and its importance? So how are YOU measuring ankle rocker? Are you looking at it on the table? On the ground? Weight bearing? Knee flexed or extended (or both?). The knee is extended at initial contact, flexes through midstance, extends at terminal stance and pre swing and flexes again during swing phase until extending at the end of terminal swing for initial contact again.

What you see on the table may not (and many times doesn't)  translate to real life. Someone with limited ankle dorsiflexion non weight bearing may have normal amounts during gait and vice versa. With gravity in place and a functioning (or malfunctioning) vestibular system, things can change rapidly. Remember that the vestibular system drives the extensors and if inhibited, you will often have flexor dominance. Talk about a tight gastroc/soleus group!

"These findings indicate that nonweightbearing and weightbearing measurements of ankle DF PROM with knee extension should not be used interchangeably and that weightbearing ankle DF PROM with the knee extended is more appropriate for estimating ankle DF during gait."

Kang MH, Oh JS. Relationship Between Weightbearing Ankle Dorsiflexion Passive Range of Motion and Ankle Kinematics During Gait. J Am Podiatr Med Assoc. 2017 Jan;107(1):39-45. doi: 10.7547/14-112.

"There is no relationship between a static diagnosis of ankle dorsiflexion at 0° with dorsiflexion during gait. On the other hand, those subjects with less than -5° of dorsiflexion during static examination did exhibit reduced ankle range of motion during gait."

Gatt A, De Giorgio S, Chockalingam N, Formosa C. A pilot investigation into the relationship between static diagnosis of ankle equinus and dynamic ankle and foot dorsiflexion during stance phase of gait: Time to revisit theory? Foot (Edinb). 2017 Mar;30:47-52. doi: 10.1016/j.foot.2017.01.002. Epub 2017 Feb 6.

Slow Down already...

"too much tripping, soles worn thin.... too much trippin and my souls worn thin"
Scott Weiland: Stone Temple Pilots

Nothing earth shattering here. Tripping (no, not THAT kind) can be due to many variables including biomechanical as well as alterations in surfaces and/or terrain. For probable proprioceptive reasons and less brain "interpolation", walking slower decreases your trip risk. This study looked at minimal clearance of the great toe (requiring adequate ankle dorsiflexion as well as great toe dorsiflexion). This was classically used to determine trip risk. This new measure called the "trip risk integral" calculates stability throughout the gait cycle rather than just a single point in time.

The results?
 "... slower gait is both an important covariate and potential intervention for trip-related falls."

our conclusion: Look at the WHOLE gait cycle, not just at one point intime...

Schulz BW A new measure of trip risk integrating minimum foot clearance and dynamic stability across the swing phase of gait. J Biomech. 2017 Apr 11;55:107-112. doi: 10.1016/j.jbiomech.2017.02.024. Epub 2017 Feb 27.