Great, FREE FULL TEXT article on the hip.

an EXCELLENT review with some great rehab tips at the conclusion like this

“Once isolated contraction of the deep external rotator muscles
is successfully achieved, progression can be made to the
rehabilitation of secondary stabilisers and prime movers of the
hip, particularly the gluteus maximus, initially using nonweight
bearing exercises and progressing to weight bearing
exercises once motor control and strength allows. Pre-activation
of the deep external rotators may make these exercises
more effective. Deficits in flexibility and proprioception
should also be addressed at this stage. Once adequate hip muscle
strength and endurance is achieved, functional and sports
specific exercises can then be implemented. ”

Can local muscles augment stability in the hip?: A narrative literature review T.H. Retchford, K.M. Crossley, A. Grimaldi , J.L. Kemp, S.M. Cowan J Musculoskelet Neuronal Interact 2013; 13(1):1-12

image from:…/258427127_fig12_Fig-11-Anato…

Why don’t some folks pay attention to anatomy?

Movement isn’t important…until you can’t…

Grey Cook

Manipulation of a joint appears to change the instantaneous axis of rotation of that joint (1). It would stand to reason that this change would effect muscle activation patterns (2). Can this be applied to the lower extremity? Apparently so, at least according to this paper (3). 

“…The distal tibiofibular joint manipulation group demonstrated a significant increase (P<.05) in soleus H/M ratio at all post-intervention time periods except 20 min post-intervention (P=.48). The proximal tibiofibular joint manipulation and control groups did not demonstrate a change in soleus H/M ratios. All groups demonstrated a decrease (P<.05) from baseline values in fibularis longus (10-30 min post-intervention) and soleus (30 min post-intervention) H/M ratios. Interventions directed at the distal tibiofibular joint acutely increase soleus muscle activation.”

So, what does this mean?

The peroneus longus contracts from just after midstance to pre swing to assist in descending the 1st ray and assist in supination. The soleus contracts from loading response (medial portion, eccentrically, to slow calcaneal eversion) until just after midstance (to assist in calcanel inversion and supination). 

The tibiofibular articulation is a dynamic structure during gait, and the fibula appears to move downward during the stance phase of gait (rather than upward, as previously thought from cadaver studies)(4), with the distal articulation having a rotational moment (5). 

Consider checking the integrity of these joints, and asuring their proper ranges of motion, particularly in patients with chronic ankle instability (6). A little joint motion can go a long way : ) 

1. The Effect of Lateral Ankle Sprain on Dorsiflexion Range of Motion, Posterior Talar Glide, and Joint LaxityCraig R. Denegar, Jay Hertel, Jose FonsecaJournal of Orthopaedic & Sports Physical Therapy 2002 32:4, 166-173 

2. Decrease in quadriceps inhibition after sacroiliac joint manipulation in patients with anterior knee painSuter, Esther et al.Journal of Manipulative & Physiological Therapeutics , Volume 22 , Issue 3 , 149 – 153

3. Immediate effects of a tibiofibular joint manipulation on lower extremity H-reflex measurements in individuals with chronic ankle instability.Grindstaff TL, Beazell JR, Sauer LD, Magrum EM, Ingersoll CD, Hertel JJ Electromyogr Kinesiol. 2011 Aug;21(4):652-8. doi: 10.1016/j.jelekin.2011.03.011. Epub 2011 May 4.

4.  Dynamic function of the human fibula. Weinert, C. R., McMaster, J. H. and Ferguson, R. J. (1973), Am. J. Anat., 138: 145–149. doi: 10.1002/aja.1001380202

5. Kinematics of the distal tibiofibular syndesmosisAnnechien Beumer , Edward R Valstar , Eric H Garling , Ruud Niesing , Jonas Ranstam , Richard Löfvenberg , Bart A Swierstra  Acta Orthopaedica Scandinavica  Vol. 74, Iss. 3, 2003

6. Effects of a Proximal or Distal Tibiofibular Joint Manipulation on Ankle Range of Motion and Functional Outcomes in Individuals With Chronic Ankle InstabilityJames R. Beazell, Terry L. Grindstaff, Lindsay D. Sauer, Eric M. Magrum, Christopher D. Ingersoll, Jay HertelJournal of Orthopaedic & Sports Physical Therapy 2012 42:2, 125-134 

Just because it looks good, doesn’t mean that it is.

We have all had patients with seemingly negative knee x rays and pain, only to develop arthritic changes at a later date. Find and treat the cause!

“Our analysis found that incident radiographic knee osteoarthritis is preceded by prodromal symptoms lasting at least 2-3 years. This has potential implications for understanding phasic development and progression of osteoarthritis and for early recognition and management.”

Case R, Thomas E, Clarke E, Peat G. Prodromal symptoms in knee osteoarthritis: a nested case-control study using data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2015 Apr 2. [Epub ahead of print]

picture from:…/chronic-pain-understanding-the-roots…/

Previously unreleased Video Available for download

“Performance Theories: Dialogues on Training Concepts”

How about some one on one with Shawn and Ivo? Hear our thoughts on:

• What is the definition of the core and what does it entail ?

• Physiologic overflow of muscles with respect to joint motion

• Isotonic Exercise concepts

• Physiologic characteristics of muscle types

• Strength Training: Neural Adaptation

• Motor Pattern Muscle Compensation Concepts

• Exercise Prescription Concepts

• Hip Extension Motor Pattern: A discussion on compensations

• Neurologic Reciprocal Inhibition: Principles of joint movement and stability

• The Concept of Tight and Short Muscles: They are different

• Stretching: Good or Bad?

We tackle the tough questions and provide real world answers.  An hour packed with hours worth of information! Download your copy here from Payloadz.

all material copyright 2009 The Homunculus Group/ The Gait Guys. All rights reserved.

Shoe News You can Use…

The Heel Counter– the back of the upper

This is the back of the shoe that offers structure (just squeeze the back of a shoe. this is the rigid part you feel between your thumb and 1st finger, unless of course, you are using your teeth). This is often part of or integrated with the upper.

A strong, deep heel counter with medial and lateral support is important for motion control; It offers something for the calcaneus (heel bone) to bump up against when as it is everting (moving laterally) during pronation. Look at folks that have a bump on the outside of their heel (particularly the ladies(sorry, true); this is often called a “pump bump”). Now look at the inside of their shoes. See that worn away area on the inside of the back of the shoe? Now you know where that worn away area is coming from!

Lateral support especially for people who invert a great deal or when you’re going to place an orthotic in the shoe which inverts the foot a great deal.  The lateral counter provides the foot (or orthotic) something to give resistance against.  The lateral counter needs to extend at least to the base of the fifth metatarsal, otherwise it can affect the foot during propulsion. A deep heel pocket in the shoe helps to limit the motion of the calcaneus and will also allow space for an orthotic. The heel counter should also grip right above the calcaneus, hugging the Achilles tendon.

We know you want to know more. We can help. Take the National Shoe Fit Certification Program. If you like, sit for the exam and get certified as well. Email us for details

The Gait Guys. We’re your heel counter!

all material copyright 2012 The Homunculus Group/ The Gait Guys. All rights reserved. If you want to use our stuff, please ask. If not, Captain Cunieform may pay you a visit…

Shoesday Tuesday:

Shoe News You Can Use: The Shank

Look at the “skeleton” in the photo on the left. Now look at the black material above the white area of the midsole (above the outsole) on the right. This is the “shank” of the shoe. The shank is the stiff area of the shoe between the heel to the transverse tarsal joint. It should correspond to the medial longitudinal arch of the foot. It is designed (along with the midsole material: see post here), to provide additional torsional rigidity to the shoe and helps to limit the amount of pronation and motion at the subtalar and mid tarsal joints. It also acts as a “plate” between the outsole and ininsole to provide protection to the foot from rocks, sticks, broken glass, shrapnel and small animals : ).

Not all shoes have a shank, so it may not always be present. We usually dissect shoes sent to us so we can see what they are all about if the manufacturer or rep is unable to provide us with an “exploded” or sectioned model. Look for our take on the new SKORA soon, complete with a dissected version!

The Gait Guys. Making sure you know what you need to so you can make more educated decisions

all material copyright 2012 The Homunculus Group/ The Gait Guys. Please ask to use our stuff. If you don’t, you have to deal with Lee. You don’t want to deal with Lee….