So here is somewhat of a controversial subject.

Perhaps, though not discussed in this article, activating more axial extensors (vestbulospinal pathways, things like your erector spinae) could be somewhat protective, in that it could, at least theoretically, help to normalize flexor/extensor ratios in the lower extremity. 

We see flexor dominance (increased corticospinal activity) in many cases of lower extremity problems causing an imbalance. Perhaps activating extensors the lower extremity (tibialis interior, extensor digitorum longest, etc.) could explain, in part, some of these (controversial) results.

We’re not recommending or condoning taking up smoking to preserve your knees. This is merely food for thought in the ever-changing landscape of clinical application.

http://lermagazine.com/cover_story/smoking-knee-oa-from-clinical-controversy-to-therapeutic-possibility

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: http://whyfiles.org/…/chronic-pain-understanding-the-roots…/

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: http://whyfiles.org/…/chronic-pain-understanding-the-roots…/

Podcast 81: Gait, critical, pure and essential principles

This week’s show sponsors: 

www.newbalancechicago.com

www.lemsshoes.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_81f.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-81-gait-critical-pure-and-essential-principles

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

Show Sponsors:
 

* Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

* Other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

 
Show Notes and links:
 
Forget Cheetah Blades. This Prosthetic Socket Is a Real Breakthrough
http://www.wired.com/2014/10/forget-cheetah-blades-prosthetic-socket-real-breakthrough
 
Rebuilding and Regenerating Damaged Knees: The Future Has Arrived!
http://www.huffingtonpost.com/nicholas-dinubile-md/rebuilding-and-regenerati_b_6043374.html
 
the foot gym:
 
From a reader:
Thanks for sharing all the great information over the years. I would like to pose to you some simple questions. How do you decide what area/s are relevant to the issue a patient presents? How do you decide what is “normal” given anatomical variations, history of injuries, torsion’s, etc., and if pain is present, why would you address biomechanics, since pain is a neurological phenomenon not a biomechanical phenomenon?
This may not be that simple but would like to hear what you have to say on these topics.
Thank you,
Joe 
 
COMPARISON OF ISOMETRIC ANKLE STRENGTH BETWEEN FEMALES WITH AND WITHOUT PATELLOFEMORAL PAIN SYNDROME
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4196327/

 
the drawbacks of technology

Whoa!  It is amazing what the human frame can withstand…

This 300 pound individual is retired from working with tow trucks from a towing company as well as a service station.   He believes working with the tow trucks, particularly jumping out of them contributed to the O.A. of the ankles.

He has osteoarthritic ankles, a rear foot varus of 15 degrees left side, 5 degrees right.  He is currently in the New Balance 1040 shoe.  He would like some new orthotics built. He Fowler tests positive on his current orthotic set up (with the foot on the ground, dorsiflex the foot at the 1st metatarsal phalangeal joint (ie big toe joint), simulating terminal stance; the orthotic should hug the arch through the range of motion; ie about 45-60 degress of great toe dorsiflexion, which he incredibly has). He is unable to one leg stand because of the O.A. on the ankles and pain.

He has bi-lat. internal tibial torsion, Left > Right and moderate tibial varum, L > R. He has very little internal rotation of the hips bi-lat. Ankle dorsiflexion is about 5 degrees bilaterally.

He is currently in an older New Balance motion control shoe. You can see how he has worn the shoes into varus. More neutral shoes hurt his feet; attempts to put his rear foot into valgus causes increased ankle pain. Exercise compliance is minimal.

WHAT WOULD YOU DO?

The Gait Guys. Teaching and educating with each post.

Now here is something a little different. Check out this PhD Thesis submission. What you do DOES make a difference! as we have been saying: it is a cortical phenomenon.

http://www.graduate.technion.ac.il/heb/StudentsLec/amir%20haim/abstract.htm

Plasticity of Locomotor Patterns & Gait Conditioning via Controlled

Biomechanical intervention  

Amir Haim, MD (Ph.D candidate)

Supervisor: Dr. Alon Wolf

Biorobotics and Biomechanics Lab,  Faculty of Mechanical Engineering

 

Overall, the task of walking is attained by a proper kinematic trajectory command conveyed by the nervous system to its skeleto-muscular instruments which generate the appropriate kinetics. Extensive evidence indicates that motor program adaptations can compensate for losses in mechanical integrity through altered movement and muscle activation patterns. Further more, non surgical biomechanical manipulations, have been shown influence kinetic and kinematic parameters and to generate “active”-neuromuscular re-education. 

In the present study we hypothesized that specific biomechanical challenges will stimulate matching biomechanical responses trough out the musculoskeletal kinematic chain. We further hypothesized that repetitive exposure to a biomechanical stimulus would generate  a process of motor learning thus conveying  plasticity of existing  locomotor patterns and gait strategies.

To test our hypothesis; we examined two cohorts – healthy young male adults and subjects suffering from knee Osteoarthritis (OA). All participants underwent gait analysis comprising kinematic kinetic and ellcetromygragic patterns during gait. We modeled the direct locomotor response to controlled footwear-generated biomechanical manipulations utilizing a novel biomechanical apparatus comprising four modular elements . Further more we prospectively examined (via gait analysis and valid questioners) patients with abnormal gait patterns (due to knee osteoarthritis) who were subjected to extended biomechanical intervention.

Study results confirmed our hypothesis; A direct association was found between specific biomechnical challenges and  direct kinetic and kinematic response in both healthy and OA subjects. Like wise, OA participants who where exposed to long term biomechanical interventions exhibited normalization of cartelistic gait patterns and had a favorable subjective outcome. 

http://www.oandp.org/jpo/library/1993_02_039.asp

http://emedicine.medscape.com/article/320160-overview

http://books.google.com/books?id=S2YVKbu77uQC&pg=PA123&lpg=PA123&dq=altered+motor+patterns+and+gait&source=bl&ots=xY7jGQDXA4&sig=6HmLZRimLVjoc_iFjuWaWTjZdUo&hl=en&ei=iFqWS6yrB4vysgOx1LzCAQ&sa=X&oi=book_result&ct=result&resnum=6&ved=0CCMQ6AEwBTgK#v=onepage&q=altered%20motor%20patterns%20and%20gait&f=false

http://jn.physiology.org/cgi/content/full/80/4/1868

http://uppercervicaldr.com/wordpress/?p=58