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/

This Client went Phasic in their Gait. Do you know what that means ? We do, and so does McGill, Liebenson, Cook and many others.

Long ago on this blog we showed and discussed a video (link) that discussed Stu McGill’s research of the human movements of Georges St-Pierre and David Loiseau. The basic tenets of that video were that the hips and shoulders are used for power production and that the spine-core are used for creating stiffness and stability for the ultimate power transmission through the limb.  He made it clear that if power is generated from the spine, it will suffer. 

Here on TGG we have long talked about phasic and antiphasic motions of the arms and shoulder-pelvic blocks during gait and locomotion/sport activity.  Many of our 1000+ blog writings and 80 podcasts have talked about spine pain and how spine pain clients reduce the antiphasic rotational (axial) nature of the shoulder girdle and pelvic girdle. In the video above, we see anything but antiphasic gait, to be clear, this is a classic representation of a phasic gait. This is pathologic gait, the frontal plane sway is exaggerated and necessary because there is no axial antiphasic motion.  There is essentially frozen arm and torso movements. This client has a long standing history of severe spine trauma and pain, their central pattern generators (CPG) had to make this motor pattern choice in an attempt to avoid pain and negotiate force streams across trauma zones. If you are curious and wish to go deeper down this rabbit hole, read the 30+ articles we have produced more specifically on arm swing and locomotor phasics, just click here.

In these types of cases, the client subconsciously makes the subcortial pattern choice (overrides the normal CPG) to rotate them as a solid unit to reduce spine rotation, axial loading and compression.  We could say that quite often spine pain disables the normal arm-leg pendulums via altering the shoulder-torso and hip-pelvis phasics and the CPG that dictates them. Normally, the spine and core must present sufficient amounts of recruited stiffness, yet mobility where necessary, to enable the locomotive power and velocity generated by movements of the shoulders and hips. These are the two main portals of limb movement off of the spine/core.  These principles holds true in gait and sport. For and interesting example, in human gait the psoas is not entirely a hip flexor initiator when it comes to leg swing, it is a huge hip flexion perpetuator. The initial hip flexion in human gait comes from derotating the obliqued pelvis, via abdominal contraction, on a stiff and stable spine.  Once the pelvis rotation is initiated, the femur can further pendulum forward (via contraction of the psoas and other muscles) on the forward accelerated pelvis in the hip joint proper creating an energy efficient movement (the towel flick/whip effect). This premise holds true in gait, running, kicking etc.  This is a solid principle of effective and efficient human locomotion. This principle also holds true for a punch or throwing an object, the stable torso/spine provides a stable anchor upon which to accelerate the arm in order to create a high velocity limb movement with power.  But here is where we get annoyed much of the time.  (Soap box Tangent coming up) How often do you read articles about tight ITBand, tight psoas, tight piriformis and the like ?  As a “diagnosis” these are weak and they are the “go to diagnosis or cause” of the unseasoned clinician, trainer, coach, therapist. If we all are to be really good at our job, we must go beyond what we see in someone’s gait (since it is the compensation) and go beyond the CNS neuroprotective strategy of tightness/shortness when there is weakness or motor pattern failure.  This does not mean that you cannot, or should not, incorporate restoration methods and principles to restore length-tension relationships in your client, it means you have to resolve ALL of the problems, including the aberrant CPG they have set up as a protective default to avoid injury or further injury. 

In the case above, returning the discussion to arm and leg swing, one must understand clearly that faulty arm swing patterns and lack of antiphasic torso and pelvis oscillation is a product of surgery,  trauma and more so, pain. The client is avoiding the antiphasic presentation (hence, he is phasic) for a reason and coaching more arm swing would be just about the dumbest intervention, so don’t be “that guy”. We know this is an altered motor pattern choice, not a new fixed set point. We know this because on clinical examination the range is available, we know because we examined for it, it is just not being used.  In an example of this same principle, in this case talking hip ranges of motion, McGill discusses the same in his paper*:

“Despite the large increases in passive hip ROM, there was no evidence of increased hip ROM used during functional movement testing. Similarly, the only significant change in lumbar motion was a reduction in lumbar rotation during the active hip extension maneuver (p < 0.05). These results indicate that changes in passive ROM or core endurance do not automatically transfer to changes in functional movement patterns. This implies that training and rehabilitation programs may benefit from an additional focus on grooving new motor patterns if newfound movement range is to be used.”

Think about that next time you stretch, or are stretched by someone. As we have said before, just because you increase someone’s range of motion, does not mean they will be able to incorporate that range of motion into a movement pattern, or compensation pattern for that matter. It is only ¼ of the equation: Range of Motion,  Skill (or proprioception),  Endurance (or the proportion of slow twitch muscle) and Strength (the proportion of fast twitch muscle). There is our S.E.S. mnemonic again.

In this video case, lack of NORMAL antiphasic spinal motion (torso and pelvis moving opposite one another) is noted. Without the obliqued pelvis the swing and stance phases will be impaired. The psoas may have to become more of a hip flexor initiator, AS WELL AS the perpetuator of limb swing, because there is no pelvic obliquity from the antiphasic principles to drive it from. And so, when you see this fella in your office with bilateral tight psoas/hip flexor complex and tight quadriceps mechanisms with resultant impaired glutes and hip extension, please do not begin lengthening them as your point of initiation.  They are that way because he has gone phasic in his gait.  Change the motor patterns that drive this as best as possible, restore any weaknesses that are contributory to, or initiate, these motor patterns and then, if needed, encourage some progressive new length-tension in these muscle groups as improved motor patterning evolve to allow for it.  You are likely going to have to go back and reteach and restore primitive and postural sensory motor windows in these cases, so be patient, be kind, be wise. Oh, and do not forget that with impaired hip function, there will most likely be impaired ankle rocker,  you are going to need a wide angled lens to see, capture and remedy this lads problems.

On another note, can you imagine what this client’s video gait analysis would show and interpret ? Let alone the diagnostics and recommendations that could come from it?  What about the appearance of their foot pressures across a dynamic foot pressure plate (or God forbid a static one !), surely what is seen at the foot is this client’s problem (not !) And forgive those poor fools who recommend a shoe for this client based off of just those mediums alone.  Without a complete hands-on clinical examination to correlate gait cycle observances, any recommendations for this case will be traumatic on many levels. 

Today’s bottom line……. read, learn, think, stay hungry, be wise.

Shawn and Ivo, The Gait Guys

* Improvements in hip flexibility do not transfer to mobility in functional movement patterns.  Moreside, Janice: McGill, Stuart

link: http://journals.lww.com/nsca-jscr/Fulltext/2013/10000/Improvements_in_Hip_Flexibility_Do_Not_Transfer_to.1.aspx

“Georges St-Pierre, MMA Limb Power & Spinal Stiffness” … Gait Guys style.

Here at ‘The Gait Guys’ we have been going at this teaching, writing and filming process for many years now. On our blog we have written over 900 articles, our YouTube Channel and Facebook page continue to grow  and our podcasts continue to be heard presently in 64 countries.  We have a long way to go to get our message heard but we trust that our message is clean and clear and based on science and fact. Today we share with you a video of one of our personal professors from our undergraduate studies in human kinetics back in Canada in the late 1980’s, the world renowned Dr. Stuart McGill. In this video he speaks some of these clear honest facts about the spine, movement, joint loading and the sport of MMA (Mixed Martial Arts).  Watch the video, but be sure to read on here, where we bring things full circle for our readers.

We have been on a long academic quest when it comes to learning about different types of movement and we are willing to go to great lengths to humble ourselves to further this mission. Many of our long time readers are aware by now that at the end of 2012 Dr. Allen completed 3 years of private study of smooth and Latin dance to better understand the intricacies of core strength, foot work and complex limb coordination amongst other things. If it was good enough for Bruce Lee (1958 Hong Kong Cha Cha Champion) it is good enough for us ! Just like Tim Ferris, one of the modern day bio and brain hackers, who also took up the Tango to put to the test some facts about brain learning, we too are in it to learn and take things to the highest level possible.  You can read more about some of Dr. Allen’s neurologic and orthopedic revelations over the 3 years of dance study here in these articles he wrote with Dr. Waerlop.

Many of you by now know that I have moved on from dance (for now) into a different kind of study in human movement. I have now committed my brain and body to learning Brazilian Jiu-Jitsu under the instruction of World renowned World Champion Professor Carlos Lemos Jr. and Champion Professor Ryo Ominami. You can read about them here, Gracie Barra Downers Grove

There are many similarities between dance and jiu-jitsu (believe it, it is true) and we have completed a comparative article which we will post on The Gait Guys blog in the coming days to validate these thoughts on the human frame in both sports.  However, this is not the point of this brief blog article today, our point was to share the teachings of one of our mentors Dr. McGill.  In this video, showing the research of human movements of Georges St-Pierre and David Loiseau, Dr. McGill discusses the basic tenet that the hips and shoulders are used for power production and that the spine and core are used for creating stiffness and stability for the ultimate power transmission through the limb.  He makes it clear that if power is generated from the spine, it will suffer.
McGill implies that martial artists find themselves near the top of the heap when it comes to power, strength and speed with an ability to contract muscles with great velocity but also the ability to relax the muscles with a terrific rate of speed. It is this ability to effectively and timely contract and relax that gives a martial artist the advantage.
However, these advantages can only be realized with a special ability to create spinal stiffness effectively, efficiently and with speed and coordination. These are huge advantages when in combat. We all hear about the importance of the core but these are the tenants that are key when referring to the core. And as McGill states, in martial artists who kick and punch, there must be an ability to create an initial pulse of energy, premised off of a stiff and stable spine. This is then followed by a relaxation of some of the limb muscles to ensure maximal velocity (a kinetic chain whip effect, like snapping/flicking a towel) and then followed by a sudden and timely re-stiffening of the spine, core and limb muscles to ensure that maximal force is transmitted to the opponent.
The spine and core must present sufficient amounts of recruited stiffness, yet mobility where necessary, to enable the power and velocity of the movements of the shoulders (punching) and hips (kicking) which are the two main portals of limb movement off of the spine/core.  These principles holds true in gait as well. For example, in human gait the psoas is not a hip flexor initiator when it comes to leg swing, it is a hip flexor perpetuator. The initial hip flexion in human gait comes from derotating the obliqued pelvis, via abdominal contraction, on a stiff and stable spine.  Once the pelvis rotation is initiated, the femur can further pendulum forward (via contraction of the psoas and other muscles) on the accelerated pelvis in the hip joint proper creating an energy efficient movement (again, the towel flick/whip effect). So, this premise holds true in gait, in an effective martial arts kick or even in a soccer kick. This is a solid principle of effective and efficient human locomotion. This principle also holds true for a punch or throwing an object, the stable torso/spine provides a stable anchor upon which to accelerate the arm in order to create a high velocity limb movement with power.

Watch the attached video of Georges St-Pierre, David Loiseau and Dr. Stuart McGill. These are foundational principles of movement in many sports and the martial artists seem to have it down pretty darn well.  These are the things we study and write about here at The Gait Guys. We are more than just gait.
Dr. Shawn Allen (white belt Brazilian Jiu-Jitsu)
Dr. Ivo Waerlop (black belt in neurology)
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