Podcast 164: Foot placement challenges, vestibular issues & spatial orientation.

Podcast 164:  Foot placement challenges, vestibular issues & spatial orientation.

This podcast is way more interesting than the title !

join us each month on the Masterclass in Gait

https://www.patreon.com/thegaitguys

Join at the $40 monthly level and get the masterclass each month, bonus material and the detailed monthly content we only share on Patreon.

The Masterclass is a formal LIVE presentation of slides, videos, demos, deep dives on topics you will not hear anywhere but here ! We hit the gait, biomechanics, neurology and orthopedics of all of the gait topics we present. This is not for the weak and timid, this is the deep dive you have been waiting for. Join us while we turn our normal 50 minute presentations into 3.5 hours on a regular basis ! The 40$ Patreon level will give you the Masterclass and also get you the $20, $10, and 5$ Patreon level content. What a deal ! It will not be here forever so lock in now !

Or, you can get less for your money (why would you do that?) and just buy our Monthly $40 Masterclass at our VIMEO on demand page: https://vimeo.com/ondemand/thegaitmasterclass


Links to find the podcast:
Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more.
Just Google "the gait guys podcast".
_______________________________________________________________________________
Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
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.

Where to find us, the podcast Links:
Apple podcasts:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:

https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

https://traffic.libsyn.com/secure/thegaitguys/Pod_164_was_pod_162_May_25_-_81520_6.20_PM.mp3

https://thegaitguys.libsyn.com/foot-placement-challenges-vestibular-issues-spatial-orientation

https://directory.libsyn.com/episode/index/id/15625700

The unhappy triad

The unhappy triad?

-internal tibial torsion, femoral retro torsion, tibial varum. We often see these three things occurring together which can create patellar tracking problems or, as in this lower back pain. We know that things often occur in threes and congenital abnormalities are no different. 

–The femoral retro torsion limit internal rotation of the hip so when that foot is planted on the ground, the patient rotates to that side, the hip stops and the lumbar spine keeps going. 

–The lumbar spine should only have about 5° of rotation from top to bottom so this often puts undue stress into the lumbar spine resulting in lower back pain.

The remedy?

– Things which we can do to utilize or help internal rotation of the hips such as chair exercises with internal rotation, the 90/90 seated stretch as well as patient education to keep shoulders and hips in the same plane when rotating or carrying a load as well as externally rotating the foot when spinning to that side (To create the range of motion that is not available).

#itt #internaltibialtorsion #internaltibialrotation #femoralretroversion #femoralretrotorsion #limitedhipmotion #gait #tibialvarum 

What happens when a ganglionectomy goes south

What happens when a ganglionectomy goes south?

- This patient had a ganglionectomy. Unfortunately, they tagged the joint capsule of the first MTP. By affecting the integrity of the capsule, as well as the surrounding musculature, she’s developed the beginnings of a hallux valgus (bunion) as well as hallux limitus (limited dorsiflexion of the first metatarsalphalangeal articulation). 

- she has degeneration of the first MTP as well as an osteophytic  crown at the distal aspect of the first metatarsal and tenderness over the capsule as well as the extensor hallucis tendon and proximal phalanx. 

-dorsiflexion is 30° on this side, 50 on the opposite side. We need about 50° to have adequate for foot rocker

– she also has moderate external tibial torsion, right greater than left and a left anatomically short leg secondary to a femur fracture.

– Since the mobility of the first ray was limited, we worked on first Ray mobility as well as exercises to descend the 1st ray, with acupuncture for pain control. 

-we are considering an orthotic to assist in raising the base and dropping the head of the first metatarsal to create more hallux dorsiflexion. When performed manually, she had a few extra degrees we would like to take advantage of. 

-We will keep you posted :-)

#ganglionectomy #footproblem #footproblems #halluxlimitus #bigtoewoes #bunion #bunions #bunionsurgery 

Parkinson's and Gait

Are gait changes predictive of Parkinson’s disease?

-We have all seen people with this slowing, festination type gait in our practices. Parkinson’s disease or Parkinson spectrum is due to degeneration of a dopaminergic pathway in your brain stem called the nigiostriatal pathway between the substantia nigra and corpus striatum of the basil ganglia. You probably remember that the basil ganglia is responsible for coordination of movement and background positioning of joints to superimpose motion on top of.

-A recent paper talks about gait changes; observing 14 different parameters and guess what? 

- Gait changes pre-dated Parkinson’s onset by about 4 to 5 years. The largest changes were in gait asymmetry including step length and speed of motion.

-The real question becomes “are these changes inevitable or are they preventable with appropriate therapy?“ 

–we think so, largely because of the brains amazing abilities and neural plasticity. Rehab has a cognitive component that we feel is just as important as the exercise component.

#parkinsons #gait  #parkinsonsdisease #clinicalexam #predictivefactors 

Del Din S, Elshehabi M, Galna B, et al. Gait analysis with wearables predicts conversion to parkinson disease. Ann Neurol. 2019;86(3):357-367. doi:10.1002/ana.25548

Stretching part 2

So, how can we utilize this reflex? 

How about to activate a weak or lengthened muscle?

Did you notice the other neuron in the picture? There is an axon collateral coming off the Ia afferent that goes to an inhibitory interneuron, which, in turn, inhibits the antagonist of what you just stretched or activated. So if you acitvate one muscle, you inhibit its antagonist, provided there are not too many other things acting on that inhibitory interneuron that may be inhibiting its activity. Yes, you can inhibit something that inhibits, which means you would essentially be exciting it. This is probably one of the many mechanisms that explain spasticity/hypertonicity

How can we use this? How about to inhibit a hypertonic muscle?
Lets take a common example: You have hypertonic hip flexors. You are reciprocally inhibiting your glute max. You stretch the hypertonic hip flexors, they become more hypertonic (but it feels so good, doesn’t it?) and subsequently inhibit the glute max more. Hmm. Not the clinical result you were hoping for?
How about this: you apply slow stretch to the glutes (ie “reverse stretch”) and apply pressure to the perimeter, both of which activate the spindle and make the glutes contract more. This causes the reciprocal inhibition of the hip flexors. Cool, eh? Now lightly contract the glutes while you are applying a slow stretch to them; even MORE slow stretch; even MORE activation. Double cool, eh?

Don’t believe me, try this on yourself, your clients, patients, willing family members and pets.

Image credit: https://commons.wikimedia.org/wiki/File:The_extensor_digitorum_reflex.jpg

Stretching part 1

Stretching secrets you need to know

OK, maybe they aren’t secrets, but these are some ‘shortcuts” you should know. 

We know from studies out there that static stretching can lengthen muscle (actually add sarcomeres), but you need to do it 30 minutes per day per muscle group. How about something a little faster doc?

How about taking advantage of the stretch reflex and reciprocal inhibition; or the “reverse stretch”

Reciprocal inhibition is a topic we have spoken about before on our blog, social media and our PODcasts. 1st described in1923 by Sherrington, this diagram sums it up nicely. Note the direct connection from the spindle to the alpha motor neuron, which is via a Ia afferent fiber. When the spindle is stretched, and the pathway is intact, the muscle will contract. This its a straight forward stretch or inverse myotatic reflex. 

Remember, ANY kind of stretch or anything that changes the length of the spindle will effect it. So what happens when you do a nice, long, slow stretch? You ACTIVATE the spindle, which activates the alpha motor neuron. If you stretch long enough, you may fatigue the reflex. So why do we give folks long, slow stretches to perform? Good question! Certainly not to “relax” the muscle!

So, how can we utilize this reflex? Read our next post tomorrow!



Image credit: https://commons.wikimedia.org/wiki/File:The_extensor_digitorum_reflex.jpg

Hills for training

The top five reasons we like Hills for training ankle rocker and hip extension

1. Hills do not cost money and are almost always readily available

2. Hills do not pull the hip into extension and place of stretch on the anterior hip musculature including the rectus femoris, iliopsoas and iliacus. This causes a slow stretch of the muscle activating the muscle spindles and causing muscle contraction via the stretch reflex. This will inhibit the posterior compartment of hip extensors through reciprocal inhibition, making it difficult to fire them.

3. A hill does not force your knee into extension, eliciting a stretch reflex in the hamstrings like a treadmill does

4. A hill naturally puts the ankle into dorsiflexion, And, along with active pulling up of the toes, helps you to get more into your anterior compartment and limits the tendency of the ankle being pulled into dorsiflexion (like a treadmill) which would initiate a stretch reflex in the gastroc/soleus and long flexors for the toes

5. The increased hip flexor recruitment of going uphill gives you more opportunity to engage your abs before the psoas and rectus femoris/TFL and, on the stance phase leg, you can get an increased stretch of those muscles

#hill #hills #rehab #rehabilitation#runningupthathill #runninghills#ankledorsiflexion #anklerocker#hipextension

Podcast 163: The hip and foot talk to each other. A research paper.

You cannot miss this mini-podcast. It is an excerpt from our Masterclass program. Come join us monthly on the Masterclass at for the monthly Masterclass installment hour.

https://www.patreon.com/thegaitguys

Formal presentations, slides, videos, demos, deep dives on topics you will not hear anywhere but here ! We hit the gait, biomechanics, neurology and orthopedics of all of the gait topics we present. This is not for the weak and timid, this is the deep dive you have been waiting for. Join us while we turn our normal 50 minute presentations into 3.5 hours on a regular basis ! The 40$ Patreon level will give you 50% off the Masterclass and also get you the $20, $10, and 5$ Patreon level content. What a deal ! It will not be here forever so lock in now !

Or, you can get less for your money (why would you do that?) and just buy our Monthly Masterclass at our VIMEO page: https://vimeo.com/ondemand/thegaitmasterclass


Links to find the podcast:
Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more.
Just Google "the gait guys podcast".
_______________________________________________________________________________
Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
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.

Where to find us, the podcast Links:
Apple podcasts:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:

https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

Other locations:

https://traffic.libsyn.com/secure/thegaitguys/163_mini_pod_peronei_-_8120_12.01_PM.mp3

https://thegaitguys.libsyn.com/the-hip-and-foot-talk-to-eachother-really-a-research-paper

https://directory.libsyn.com/episode/index/id/15439292

Today's article link: https://pubmed.ncbi.nlm.nih.gov/32717719/