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

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