Vintage Shawn and Ivo podcast

This one was almost before Al Gore invented the internet (almost)

Vintage Ivo and Shawn talking on their Manual Medicine Advisor podcast. Come have a quick listen, see how far we have come, knowledge wise and technology wise.

http://thegaitguys.tumblr.com/post/14925482543/here-is-some-classic-shawn-and-ivo-talking-about

Compressing the Distal Tib-Fib joint. Really ?!
If you do not know your biomechanics, this could be a road to problems for your client. 

Many who viewed this video will not know the “Caveat emptor” we will expand upon below. 

Here is the meat of today’s blog post:
The distal tibia-fibular syndesmosis is supposed to separate during ankle dorsiflexion to accommodate for the wider ankle mortise anteriorly, compressing the two bones could nullify this range.

There are new ideas on the web every day; through new ideas come new innovations. These bands (some call them Voodoo bands) are all the rage right now, and they may have value depending on their use (and the wisdom of the user), but from what we can tell even the innovators are at a bit of a loss as to what the heck is truly happening with their use. All we have right now is theories, but understandably things have to start somewhere. We propose some logical thoughts on this video implementation here today.  
Some people are using the bands over larger muscle masses, perhaps using the compression and shear between tissue layers to act as a kind of “flossing” or “active release” to the muscle and myofascia. The goal seems mostly to gain more joint range and thus greater function through that joint. Some think the vascular/ischemic challenge is creating partial effects. Others appear to be using the band to change joint compression to change stability to change mobility. We suspect others are using them to manage joint shear, we hope they realize they are impacting that component. One must keep in mind that a joint that is cylindrically compressed (such as in the video) and then subsequently loaded may still undergo motion and shear at the opposing joint surfaces. The question is, are you getting what you want?  The even bigger question is have you the earned stability on that new mobility if you are about to go add activity on this new range? New “borrowed” range, meaning mobility that has been acquired but not been earned via the muscles that were supposed to achieve and maintain it, may be a recipe for injury risk. One must also not forget that with a primary motion there is an accessory motion (ie. roll and glide are in opposite directions for concave/convex joint relationships). This is a concept of joint centration, and when there is excessive uncontrolled shear there cannot be adequate centration. Too much axial compression may limit primary motion while minimizing shear but could impact accessory motion, a mulit-edged sword. There is really no good and certain way to do all this except intrinsically via the muscles surrounding the cylinder. Any extrinsic attempts must be met with the realization and understanding of the true mechanics of compression, shear, primary motion and accessory motions. So just keep in mind that things like impingement, shear and peripheral joint loading (as opposed to centrated loading) are risk factors when these components are not well understood.

That all said, we bring these concerns to light today in regards to the above mobilization video.  Many who viewed this video will not know the “Caveat emptor” we have eluded to above and will expand upon below. That caveat should have (in our opinion) been mentioned. We are not trying to pick on folks, trolling or being pricks, we know everyone is just trying to help contribute to the mass knowledge base here on the web but one has to understand biomechanics in order to deliver a clean honest method without tipping the risk reward scale. We think our caveat is very much worth mentioning so that the knowledge is available to everyone. We bet the doctor in the video knows all about what we are writing here today, but many others will not, and so by debating and critiquing we all raise the bar, for the good of all mankind. In turn, we expect the same critique should happen to our material, after all, the collective mind is more powerful than the individual mind.

Here is the meat of today’s blog post:

The distal tibia-fibular syndesmosis is supposed to separate during ankle dorsiflexion to accommodate for the wider ankle mortise anteriorly. More gently stated, as dorsiflexion progresses at the ankle mortise complex, the distal tibia-fibula must be able to change to accept the wider anterior mortise engagement. This is normal ankle biomechanics, for everyone ! So, why would you want to compress the distal tib-fib and attempt at arresting or limiting the normal spreading process during ankle dorsiflexion? What about the ligamentous structures that depend upon clean terminal dorsiflexion and congruent tib-fib-mortise orchestration ? Cylindrical compression could impair or limit terminal dorsiflexion range.  Wasn’t this the purpose of the mobilization in the first place?  This mobilization is just not something that we will be recommending you start tossing out in your rehab or training room unless you can justify on a case by case basis a reason for possibly working against normal clean biomechanics, unless of course you are sure to stay within reasonable compression limits.  If you compress these bones too much, you are potentially creating mid or end range joint impingement.  
We are sure the argue point will be that the band is not applied tightly enough to create sufficient compression to limit this normal range. This may be true. But, 

  • “Think of how stupid the average person is, and realize half of them are stupider than that.” -George Carlin

All joking aside now, but for the “average Joe” who might think that more is better, our caveat is worthy in our opinion especially when you see the volume of band used in some other videos.  

SIDEBAR: Dear Gait Guys brethren, as members of those on the web who are supposed to know better, we all have a responsibility to act and portray truth and accuracy to those that are not in our lines of profession and knowledge. There are videos on line demonstrating a cavalier approach to using these bands (we are not at all referring to today’s video), we beg you to think about who is seeing these videos, possibly herds of runners and athletes looking for quick answers to their problems.  Know that you may be the first line of intervention to help direct these folks to an informed way to implement self-treatment.

Back to the video for one final point.

We see that after some cylinder compression is rendered by the band, as terminal ankle dorsiflexion is mobilized we see end range mobilizing of internal and external rotation. Remember, if the compression is too much (and again, it may not be in this case if band tension application is reasonable), as dorsiflexion is attempted we will have more closed pack-type joint compression binding mid-range, and this may mean risk to articular cartilage. Just something to keep in mind. Listen to your client feedback when they do this or you instruct them, pain is obviously not a welcome outcome when you are performing potentially impinging therapies.

Here on The Gait Guys we previously shared our mnemonic , “anterior strength achieves posterior length to drive ankle dorsiflexion range”. That does not in any way mean that mobilizations are not worthy efforts at any time during a treatment.  As a clinician, sometimes you have to address the tissue length of the posterior compartment tissues, but if that is not the primary cause of loss of dorsiflexion you are commissioned to look elsewhere.  Also, remember that ankle dorsiflexion can be disguised through foot pronation and this in itself can enable pathology. This is perhaps one of the biggest omissions in ankle dorsiflexion mobilization videos across the board.

Make no mistake, you can mobilize all you want but at the end of the day you must improve skill, endurance and strength (S.E.S.) as well as functional stability and capacity on these new patterns of mobility if you are to do your client justice. Failure to do these things will result in loss of the gained mobility and risk for injury. Almost anyone can gain more joint motion, we have all been doing this various ways for decades. Can you earn enough capacity to keep the new mobility on a clean and correct motor pattern without corruption is the bigger question. Remember, just because you force a joint range, as opposed to earning it, doesn’t mean it is wise. Try this logic on any adhesive capsulitis shoulder patient, you will surely receive a five finger death punch in return. 

There is much in the way of innovation and free thinking out there today and everyday the internet opens our collective eyes and minds to new ideas and possibilities. We all must keep in mind that many of these new things are in their infancy, some will survive with validation and some will wither away without it. It is up to the practitioner to take their client’s case to heart, do the best they can with the knowledge they have, accept when their scope of knowledge and practice has been met, and always first “do no harm”.  Most things can be fixed, or at the very least improved upon but the tough cases often require deep wells of knowledge and experience. Sometimes we have to tread into uncharged waters, we just have to make sure we do no harm and try to work around a framework of science based knowledge.

We talk about this concept and video in greater depth in Podcast 90. Feel free to listen in,

here is that link

Dr, Shawn Allen

… . just two guys trying to provide logic to things we do not have complete answers for at this time.

 

For your reading pleasure, here is another fella who has gone through some  similar internal dialogue trying to find answers regarding this Voodoo band stuff. We respect his thoughts and dialogue, very much so.  He covers many thoughts and theories, it is worth your time if you are using this type of therapy. 

http://valeohealthclinic.com/voodoo-floss-really-voodoo/

Podcast 91: Gait, Vision & some truths about leg length discrepancies

Show sponsors:
www.newbalancechicago.com

A. Link to our server:
http://traffic.libsyn.com/thegaitguys/pod_91f.mp3

Direct Download:
http://thegaitguys.libsyn.com/91

Other Gait Guys stuff

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

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

Gait and vision: Gaze Fixation
What’s Up With That: Birds Bob Their Heads When They Walk
http://www.wired.com/2015/01/whats-birds-bob-heads-walk/
 
Shod vs unshod
 
Short leg talk:
11 strategies to negotiate around a leg length discrepancy

From a Reader:

Dear Gait Guys, Dr. Shawn and Dr. Ivo,  I was referred to this post of yours on hip IR…http://thegaitguys.tumblr.com/post/14262793786/gait-problem-the-solitary-externally-rotated   I am impressed by the level of details of your understanding of the gait and biomechanics. Although I am still trying to understand all of your points in this post, I would like to ask you:  What if my IR is limited due to a structural issue? The acetabular retroversion of the right hip in my case. 

I.e. if I am structurally unable to rotate the hip internally.
What will happen? 
What would be a solution to the problem in that case? 

Single-leg drop landing movement strategies 6 months following first-time acute lateral ankle sprain injury – Doherty – 2014 – Scandinavian Journal of Medicine & Science in Sports
http://onlinelibrary.wiley.com/doi/10.1111/sms.12390/abstract

Hey Gait Guys,

I understand that 1st MP Joint dorsiflexion, ankle rocker, and hip extension are 3 key factors for moving in the sagittal plane from your blog and podcasts so far. I really love how you guys drill in our heads to increase anterior strength to increase posterior length to further ankle rocker. I’ve seen the shuffle gait and was curious if you had a good hip extension exercise to really activate the posterior hip extensors and increase anterior length. 

From Abby Road to Vivaldi; the Sensory information in has a corresponding motor output.

Going for a run or a workout? What you listen to has an impact on your motor output, but why ? Functional MRI of the listening brain found that different regions become active when listening to different types of music and instrumental versus vocals.
From Abby Road to Vivaldi; the Sensory information in has a corresponding motor output. The brain shifts the sound to different areas depending on the music. This is why ACDC is likely a better sound track for your next run than Vivaldi.
“Computer algorithms were used to identify specific aspects of the music, which the researchers were able to match with specific, activated brain areas. The researchers found that vocal and instrumental music get treated differently. While both hemispheres of the brain deal with musical features, the presence of lyrics shifts the processing of musical features to the left auditory cortex.” – Allie Wilkinson

A 60 second podcast.
http://www.scientificamerican.com/podcast/episode/different-brain-regions-handle-different-music-types/

A case of gait spasticity.

We have been saying it for a long time now. Gait is a huge window into the function of the human brain and nervous system. It is often the first presenting sign that something is wrong. In the case below, a 48 year old woman presented because of a gradually developing spastic gait. 
Lab testing showed mild increases of transaminase and total bilirubin. Blood manganese level was markedly elevated. 
MRI showed high signal intensities at the globus pallidus and cerebral peducles, and bilateral deep white matter, posterior limbs of the internal capsule and right upper cervical spinal cord. 
A diagnosis of Idiopathic portal hypertension was made. 
According to this article:

“Hepatic diseases often show high signal intensities at the basal ganglia on T1-weighted images, and this seemed to be due to accumulation of manganese in our case. Because demyelination or axonal injury of the spinal cord are found in hepatic disease, we speculate that the high signal intensities at the spinal cord on T2-weighted images of our case reflect hepatic myelopathy, which may also be caused by high blood levels of manganese.”

The Gait Guys say once again, “gait changes in a client may be the first clinical presentation of other pathology, not all the time, but enough that you should be looking for anomalies.

Rinsho Shinkeigaku. 2002 Sep;42(9):885-8.
[A case of idiopathic portal hypertension (IPH) with hypermanganemia presenting as spastic gait].
Obama R1, Tachikawa H, Yoshii F, Takeoka T, Shinohara Y.

Lets make a resolution…Or not…

Cool guy, cool picture, cool scenery. Motivational? He is the fitness guru the developed the “Insanity” workout series, amongst others.

But looks may be deceiving.  

For reference, draw a line from the philitrium, interpec interval, symphisis pubis to area bisected between feet. 

Did you notice the following?

  • crossing arms across midline; look how far that left arm is abducted.
  • look at pelvis list to left. If you bring that arm in, you need to compensate somewhere
  • did you notice the hip hike on the left? That may have something to do with the excessive internal rotation of the thigh on the left. Is that because of the pelvis shift to the left (to compensate) or is he making up for limited internal rotation of the right hip?
  • what about the subtle head tilt to the right? is that driving the compensation or is it another compensation?

Questions, questions, questions…

We are choosing to make a resolution without him for the time being : ) More on this photo another day.

Lets make a resolution…Or not…

Cool guy, cool picture, cool scenery. Motivational? He is the fitness guru the developed the “Insanity” workout series, amongst others.

But looks may be deceiving.  

For reference, draw a line from the philitrium, interpec interval, symphisis pubis to area bisected between feet. 

Did you notice the following?

  • crossing arms across midline; look how far that left arm is abducted.
  • look at pelvis list to left. If you bring that arm in, you need to compensate somewhere
  • did you notice the hip hike on the left? That may have something to do with the excessive internal rotation of the thigh on the left. Is that because of the pelvis shift to the left (to compensate) or is he making up for limited internal rotation of the right hip?
  • what about the subtle head tilt to the right? is that driving the compensation or is it another compensation?

Questions, questions, questions…

We are choosing to make a resolution without him for the time being : ) More on this photo another day.