Hmmmm…

The question is: “is the earlier activation a good thing”?

What do you say?

“A study of patients with chronic ankle instability (CAI) suggests the onset of knee and ankle muscle activity occurs significantly earlier when shoes and orthoses are worn than when the patients are barefoot.”

http://lermagazine.com/issues/october/shoes-orthoses-improve-muscle-activation-onset-in-unstable-ankles

Eating up a cardinal plane.

Simple post, simple principle today.  We found this case on the web, somewhere. Wish we could remember so we could give credit. 

Looks like simple right leg length discrepancy but the point we wanted to make is that any time you deviate into a plane, you eat up length. In this case, the right knee is severely valgus and that has at least in part contributed to a shorter limb and unleveling of the pelvis. And, it is not uncommon that rotation axis are changed when frontal or sagittal planes are compromised. It is easy to see this on the x-rays, if the foot posturing isn’t at least noted, look at the spacing between the tibia and fibula .  .  .  . rotational planes have changed as well. Is it from the femur or tibia? That is the topic of another day. 

In the larger photo you will notice that even with the right foot lifted there is still a pelvis unleveling. How can that be, unless it was further unleveled that what we are seeing ?  Well, just because you lift to fix doesn’t mean the lift will not enable further collapsing into the weakness and deformity.  We have described this principle on the topic of EVA shoe foam deformation.  When the foot presses the foam into the deformation, it leaves more room for possibly further and faster deformation loads (perhaps more so than had a new shoe been prescribed). So in some cases, more lift can allow more deformation.  How far, well as in this photo, at least until the right knee slams into the left knee and stops further deformation.

So, seeing a plane deficit clues you into possible unleveling of the pelvis and abnormal joint loading responses. It should clue you into looking for another cardinal plane compromise as well. But make no mistake, just adding a lift doesn’t mean the deformation is remedied and not enabling further deformation. It is possible that you can make your client worse if you do not teach them how to find the appropriate motor patterns with the lift so they can learn to protect the parts. Often teaching these types of clients how to control their deformities (when and if possible) is where the gold lies, not in just leveling out the foundation. 

One more “beating of the dead  horse”, lift the whole foot, heel and forefoot with a sole lift when you are “lifting and leveling”. Lifting only the heel puts them into ankle plantar flexion and can often facilitated earlier and faster forefoot loading and even earlier knee flexion.  Save the heel lift as a possible consideration when there are posterior compartment contractures or inflammation.  Certainly we could have gone into functional and structural leg length discrepancies, but we have blogged excessively on that topic in the past. Go ahead and search our blog if you want more on those topics.

Take home point, “just because you lift, doesn’t mean you are truly lifting, you may enable the opposite”.

Shawn Allen, one of the gait guys

What types of tests do YOU use to assess lumbopelvic control? We have talked about the multifidus lift test before; here is another

“The clinical test of thoracolumbar dissociation was devised into assess a patient’s ability to perform anterior/posterior pelvic tilt in sitting while attempting to maintain a constant position of the thoracolumbar junction.

The results demonstrate that the clinical test of thoracolumbar dissociation has acceptable inter-rater reliability when used by trained physiotherapists. This test described here is the first to assess the ability to dissociate movement of the lumbopelvic region from that of the thoracolumbar region.”

From: Elgueta-Cancino et al., Manual therapy (2015) 418-424(Epub ahead of print). All rights reserved to Elsevier Ltd.

Welcome to Monday and News You Can Use. Got Arm swing? This exercise, borrowed from Shirley Saurmann can be a great adjunct to your rehab program, dispensed with some muscle physiology : )

Do it on your self
Try it on a client
Teach someone else

Happy Holidays from The Gait Guys

Twas the night before Christmas, and all through the land, and the Gait Guys were there to give St Nick a hand. 

This poor fellows knees had been in pain as of late. He had taken up running to help lose some weight. 

To his clinician he went, who prescibed an orthotic for pronation, without a look or thought, or a very methodic examination.

So across the country, Dillon, Chicago and the nation, He went to see the Gait Guys for a comprehensive evaluation.

They watched him run on the treadmill and analyzed his stride and they saw he had a heavy foot strike on one side

And his knees fell outside of center, left side more than the right and an adductory twist, from a heel cord wound too tight.

They looked at each other and at the same time said they thought that they knew what the problem was with the man who wore red.

Then they placed him on the table, with the highest efficiency, they found that he had a left sided leg length deficiency.

When his knees were straight, his feet pointed to the middle; internal tibial torsion they thought, and that solves the riddle.

An orthotic for internal torsion, without a valgus post is sure to macerate the meniscus, and turn it to toast. 

That orthotic they took, from his shoe in a jiffy and knees were more midline, now wasn’t that spiffy

and a sole lift for his shoe, to correct the difference, even though it was small, it had a significance…

And exercises they gave, to be done three times each day to anchor the medial tripod, and push off through the 1st ray. 

“Thanks Gents”, he said, as he took off running with a smile, His knees were much better, even after running a mile. 

Shawn and Ivo looked at each other feeling fulfilled, Having helped this poor fellow, and they hope they instilled

In each and every reader and follower and student the desire to look closer and do what is prudent

Happy Holidays we wish to all our sisters and brothers, We hope we have inspired you to continue to learn and teach one another. 

Have a great one : )

We always like to try and reproduce the problem. We like to say “If we can reproduce the pain, we can probably fix the cause”, which seems to hold true in many cases. This article makes us think about seeing the patient at a point in their training that they feel the discomfort or are having the problem (after 30 minutes, after 20 miles, etc). There may be some value to scheduling their exam later, rather than sooner. A nice fatigue article from one of our favs “LER”.

http://lermagazine.com/article/running-in-an-exerted-state-mechanical-effects

Hyperthermic Conditioning for Hypertrophy, Endurance, and Neurogenesis

An interesting take on “heat” conditioning by one of our new favs, Dr Rhonda Patrick. Some pretty cool stuff here. We have a talk on hyperthermic training on an upcoming PODcast. Check her out

Hyperthermic Conditioning for Hypertrophy, Endurance, and Neurogenesis