and what have we been saying about loss of ankle rocker and achilles tendon problems for years now?

Here is a FREE, FULL TEXT article talking all about it

“A more limited ankle Dorsi Flexion ROM as measured in Non Weight Bearing with the knee bent increases the risk of developing Achilles Tendinopathy among military recruits taking part in intensive physical training.”

J Foot Ankle Res. 2014 Nov 18;7(1):48. doi: 10.1186/s13047-014-0048-3. eCollection 2014.Limited ankle dorsiflexion increases the risk for mid-portion Achilles tendinopathy in infantry recruits: a prospective cohort study.Rabin A1, Kozol Z, Finestone AS.

link to full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243387/

Wow!  Can you figure out why this person at the distal end of her first metatarsal under her medial sesamoid.

She recently underwent surgery for a broken fibula (distal with plate fixation) and microfracrure of the medial malleolus. You are looking at her full range of dorsiflexion which is improved from approximately 20° plantarflexion. She is now at just under 5°.

She has just begun weight-bearing and developed pain over the medial sesamoid.

The three rockers, depicted above from Thomas Michauds book, or necessary for normal gait.  This patient clearly has a loss of ankle rocker. Because of this loss her foot will cantilever forward and put pressure on the head of the first metatarsal.  This is resulting in excessive forefoot rocker.  Her other option would have been to pronate through the midfoot. Hers is relatively rigid so, as Dr. Allen likes to say, the “buck was passed to the next joint. ”

There needs to be harmony in the foot in that includes each rocker working independently and with in its normal range. Ankle rocker should be at least 10° with 15° been preferable and for footlocker at least 50° with 65 been preferable.

 If you need to know more about rockers, click here.

Screens are valuable. But, only if they screen all the pertinent areas, only if the screener knows what to look for, and only if one realizes they are just a screen and not a platform for corrective exercise prescription. Guys like us and Gray Cook have been saying this for years.

Eliminating the fake out of ample ankle rocker through foot pronation in the squat and similar movements:  How low can you go ? 

This is a simple video with a simple concept. 

* Caveat: To avoid rants and concept trolling, am blurring lines and concepts here today, to convey a principle. Do not get to tied up in specifics, it is the principle I want to attempt to drive home.  What you see in this video is clearly more lunge/knee forward flexion rather than hip hinge movement. However, keep in mind, that this motion does occur at the bottom of many movements, including the squat. 

You can achieve or borrow what “appears” to be more ankle dorsiflexion, a term we also loosely refer to as ankle rocker, through the foot, foot pronation to be precise. Do not mistaken this extra forward tibial progression range as ankle rocker mobility however. When you need that extra few degrees of ankle dorsiflexion deep in your squat, or similar activities, you can get it through your foot. Often the problem is that you do not think that is where it is coming from, you might just think you have great ankle mobility.  Many deep squatters are borrowing those last few degrees of the depth of the squat from the foot. This is not a problem, until it is a problem.  Watch the video above.  Why ? Because when the foot pronates and begins to collapse (hopefully a controlled collapse/pronation) the knee follows. Forcing the knees outward in a squat like some suggest is a bandaid, but I assure you, the problem is still sitting on the table. 

Go do a body weight squat with the toes up like in this video. Toes up raises the arch from wind up of the windlass and increased activity of the toe extensors and some assistance from the tibialis anterior and some other associated “helper” muscles.  When the arch is going up, it cannot go down. So, you raise your toes and do your squat. This will give you a better, cleaner representation of how much mobility in your squat/lunge/etc is from ankle dorsiflexion, knee flexion and  hip flexion. You can cheat and get some from the foot. The foot can be prostituted to magnify the global range, and like I said, this is not a problem until it IS a problem.   We know that uncontrolled and unprotected increases in foot pronation can cause a plethora of problems like plantar tissue strain, tibialis posterior insufficiency and tendonopathies, achilles issues, compression at the dorsum of the cuneiform bones (dorsal foot pain) to name a few. This dialogue however is not the purpose of this blog post today. You can read more about these clinical entities, proper foot tripod skills and windlass mechanics on other blog posts on this site. 

Today, we just wanted to bring this little “honesty” check to your awareness. Has been a staple in my clinic for over a decade, to help me see where limitations are and to show folks how they can cheat so much through the foot. Go ahead, try it yourself, see how much you use your foot to squat further if you have end range mobility issues in the hips, knees or ankles.  The foot is happy to give up the goat, it just doesn’t know the repercussions until they show up. 

So, lift your toes, do a full squat. Go as low as you can with good form with the toes up.  Then, at the bottom of the squat or the bottom of  your clean mobility, suddenly drop your toes and let the arch follow if it must. Here is the moment of truth, at that moment the toes go down, feel what happens to the foot, ankle, tibial spin, knee positioning, pelvis posture changes. Careful, these are subtle. You may find you are using foot pronation more that you should, more than is safe.  Now try this, bottom out your cleanest squat as you regularly would, and at the bottom, raise your toes and try to reposition the foot arch and talus height. In other words, reposture your foot tripod, see how difficult this is if you can do it at all. Perhaps you will find your toe extensors are too weak to even get there.  This is how we cheat and borrow. We should not make it a habit, it should be used when we need it, but it should not be a staple of your squatting diet, it should not be a regular event where you prostitute sound biomechanics.  Unless you wish to pay for it in some way.  What should happen is that you should be able to bring your toes down and not let the arch follow, but that is a skill most have not developed. It is a staple move in your clients’ movement diets.

Does all this mean you should squat with your toes up ? No, but it may serve you well in awareness, evaluation, and looking for potholes and power leaks. At the very least, give it some thought and consideration. You may see some smiles and have some lightbulb moments between you and your athletes and clients. 

Plan on blocking this foot pronation range with an orthotic ? How dare you ! At least try to do it through reteaching this and the tripod skill first. Give your a client a chance to improve rather than a bandaid to cope. 

Dr. Shawn Allen, one of the gait guys

Ankle Dorsiflexion stretching ?

Are we the only ones that did a “face palm” after reading this study? I mean, “duh”. Or are we missing something ?
Pronation gets more dorsiflexion all on its own so how in the world can this be a translatable study ?
Besides, in the pronation posture, length if achieved was perhaps mostly medial gastrocoleus divisions.
And……was the knee bend or straight? Hint: This matters, both those posterior muscles do not cross the knee, only one does.

Conclusion: After a 3-wk gastrocnemius-stretching program, when measuring dorsiflexion with the STJ positioned in supination, the participants who completed a 3-wk gastrocnemius stretching program with the STJ positioned in pronation showed more increased dorsiflexion at the ankle/rear foot than participants who completed the stretching program with the STJ positioned in supination.

Gastrocnemius Stretching Program: More Effective in Increasing Ankle/Rear-Foot Dorsiflexion When Subtalar Joint Positioned in Pronation Than in Supination
2015, 24, 307 – 314

http://journals.humankinetics.com/jsr-current-issue/jsr-volume-24-issue-3-august/gastrocnemius-stretching-program-more-effective-in-increasing-anklerear-foot-dorsiflexion-when-subtalar-joint-positioned-in-pronation-than-in-supination

Pod #93: Ankle Rocker, Sacroiliac Joint symmetry , Landing mechanics

Ankle Rocker, Sacroiliac Joint symmetry , Landing mechanics, Gait Tech, Gray Cook theories, movement and music and so much more !

A. Link to our server:
http://traffic.libsyn.com/thegaitguys/pod_93Final.mp3

Direct Download:  http://thegaitguys.libsyn.com/pod-93-ankle-rocker-sacroiliac-joint-symmetry-landing-mechanics

Sponsor: www.newbalancechicago.com

-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 & 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:

-Landing mechanics
http://www.ncbi.nlm.nih.gov/pubmed/26117159

-Shock absorbing landing loads
J Athl Train. 2015 Jun 11. [Epub ahead of print]
Weight-Bearing Dorsiflexion Range of Motion and Landing Biomechanics in Individuals With Chronic Ankle Instability. Hoch MC1, Farwell KE1, Gaven SL2, Weinhandl JT1.

-Neuroscience:
Trying to reteach your client’s CNS new sensory-motor patterns so they can move better ?
New connections and pathways are fragile and only through repetition and practice and focused attention can those connections be established enough to become habitual or default behaviors.
Neuroscience for Leadership: Harnessing the Brain Gain Advantage (The Neuroscience of Business). Tara Swart

-Does variability in muscle activity reflect a preferred way of moving or just reflect what they’ve always done?
http://esciencenews.com/articles/2014/03/14/motion.and.muscles.dont.always.work.lockstep.researchers.find.surprising.new.study

-Context-dependent changes in motor control and kinematics during locomotion: modulation and decoupling. Foster and Higham
http://www.ncbi.nlm.nih.gov/pubmed/24621949

-gait technology problems 😕
http://www.buzzfeed.com/stephaniemlee/who-owns-your-steps#.twn1Bg28P

-Dance video discussed, Alvin Ailey Dance Company
https://vimeo.com/36286106

-SI joint anatomy/rehab piece: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3512279/
more rehab strategies here: http://lermagazine.com/article/music-therapy-and-gait-rehab-to-a-different-beat

-a few minutes on Gray Cook quotes. pick a few we can talk about (pic attached)

movement patterns talk: http://www.anatomy-physiotherapy.com/28-systems/musculoskeletal/lower-extremity/knee/1191-altered-movement-patterns-in-individuals-with-acl-rupture

The eccentric aspect of the shuffle walk

Hey guys,
I’m an Osteopath from Australia and am a keen follower of your work. I just had a quick question about your tib ant training via the shuffle gait. I am comfortable with the theory behind it, my only issue is that clinically, tib ants role as an eccentric controller of pronation is significant. Therefore, shouldn’t we develop an exercise which trains it in an eccentric fashion? perhaps there is some controlled pronation in the shuffle gait that I have missed, but i’m interested to hear your thoughts as they are thoughts I respect!
Thanks very much for all your work, it’s great to see practitioners using evidence based practice in a creative and practical way.
Cheers,
D

________

our response:

Hi D. Good question and it is a major point.. If you think about the exercise, you are slowly putting the ball of the foot back on the ground AND maintaining the arch as best as possible. In essence, the arch will drop a bit as your weight is born on the foot, so it will pronate, but you are trying to hold it up, so in a manner of speaking you are controlling the arch descent, so you are eccentrically focusing on the activity. If we were to reshoot the video, this would be part of teh dialogue, because we do have our clients focus on this.  Remember, we are giving this exercise to many folks who have pronation control issues (yes, and ankle rocker issues) so we are kinda hitting the aspect you are questioning.  How this helps a bit.  As they get better, they take bigger steps in the shuffle walk, so that means more acceleration of the prontation, so they will have to try to maintain the arch under greater loads…….hence, more eccentric focus.  That is the way we see it anyways.