It is Rewind Friday. Today, we are reaching back to a brief 2009 lecture I did for the local NSCA chapter on the patterns of kinetic chain compensation that match with loss of medial and lateral foot tripod. (video starts at 49 seconds, for some reason) https://www.youtube.com/watch?v=yeCBGZkNaeM
You’re either part of the solution or part of the problem. Read and you decide if this kind of advice is actually helping people. We know what we think.
After all, everyone should fit the same mold right? And, altering what you are doing fixes the problem right? It must finally be time for Ivo and I to retire. Someone just build the DIY App for 2.99 and make all the running problems in the world go away. After all, truly “FIXING foot strike is relatively simple”. Clearly Ivo and I just enjoy making things terribly complex because we have nothing better to do. To be fair to this author, There is a reason why we stopped writing for venues, because everything got so cooked down by the editorial staff until our stuff said nothing , or worse yet, simplified things so much that a monkey could do it, that we said, “ thanks, but we will take a pass on the next one”. Oy vey. Feeling saucy tonight. Reader beware.
“That offseason, his symptoms worsened. Before, it might have taken 20 minutes of riding at 400 watts to feel the sensation. Now, if he rode for five minutes at 350, he’d be riding with one good leg and one numb, powerless appendage.”
Iliac artery endofibrosis is a circulatory condition affecting the legs and is sending more and more cyclists under the knife. If you are a bike geek like i am (been watching the Tour de France since i was 15) you may take interest in this. If you are a avid bike rider or triathlete you may take interest in this. But do not stop at the bike when you have symptoms in front of you that sound vascular. If your leg is doing numb on a long walk or run, dead or heavy during exertion, something is going on that needs evaluated. Get evaluated.
“If the knee is whining and doing things it should not be doing, the wise clinician first looks at the foot-ankle and the hip-pelvis complexes, where the blood has dried. Don’t look for the fresh blood at the knee” – Dr. Allen
If you cannot control pelvis position on the femoral head, or hip rotation or initial foot arch mechanics, the knee is going to give in to the directional loading response and that typically means medial valgus movement. This is internal tibial rotation or spin.
Here is an analogy i use with all my patients. The knee is like the middle child. In the simplest terms, you have 3 lower limb joint complexes. The foot/ankle, the knee and the hip. The knee is the middle of these 3 joint complexes.
Similarly if you put 3 children in the back of the car, the one sitting in the middle is the one directly impacted by the child on the right and the left. When you hear the middle child screaming and whining, the smart parent first looks at the two apparently “innocent” children looking out the windows (with blood dripping off their elbows).
Similarly, the knee takes this same seat. IF the knee is whining and doing things it should not be doing, the wise clinician first looks at the foot-ankle and the hip-pelvis complexes, where the blood has dried. Don’t look for the fresh blood at the knee
Changing landing strategies with the focus of control of tibial rotation, requires the astute clinician to look at all the children.
Another gimmick to sell shoes ? Likely. What do we always say … . “what you see in someone’s gait and movement is their compensation, not their problem”. Looking at how someone moves does not necessarily tell you what is wrong with them, and it surely isn’t likely to tell them what shoe they should be in. If it were this simple, no one would ever return a pair of shoes because shoe fit would be simple, perfect, repeatable and predictable. Trust us, comparing to a baseline knee-bend is like using an Abacus to solve a math question when we have much better ways…….. it is called a physical exam, watching someone walk and run, screening movement patterns, and bringing it all together. But, this is why we don’t sell shoes for a living. We would only sell a pair an hour. But, we would get it right almost every time.
“Before they do any running, customers perform a knee-bend to mimic the angle the joint will make during a run (roughly 40 degrees). This is to establish a baseline movement before the additional stress of running is placed on the joint. Customers then run on a soft-surface treadmill in their socks. Rather than just considering pronation (i.e. rear foot eversion/rotation) tendencies, Run Signature takes both knee and ankle motions into account and, crucially, analyzes the degree to which a customer’s running motion deviates from their baseline knee-bend. Runners with little or no deviation are recommended neutral-style running shoes, while those with greater deviation are steered towards support models. “
Look at this photo. Do you see it ? How much posterior rotation (left rotation) is being driven through that left shoulder/torso rotation. That is nuts! We have a hard time believing that is not a compensation. We would be assessing for stability and mobility issues elsewhere. Heck, the elbow practically crosses the spine posteriorly ! Sheesh ! When you cannot put the movement where it should be, or control it (stabilize) where it should be controlled, sometimes you try to get it or put it elsewhere. We would love to see this lady run, we bet there is a host of clean gait problems down below. We would bet some cross over gait is present as well, after all, that left arm swing is largely predicated off of the right leg swing. Arm swing is far less independent than people think, we have written about that here on our blog numerous times. Just search “arm swing” over on our Tumblr blog.
Remember this, and if you need to go back to read about phasic and anti-phasic gaits head over and search our blog, but the amount of shoulder “girdle” (essentially thoracic rotation) is typically met by the same amount of pelvis rotation. These should be symmetrical. And, when they are not, we can drive it through various means, even as in this case, through more arm swing unilaterally. We wish we could see some axial photos from above to see how much pelvis rotation is noted here.
Ishial tuberosity pain that looks like a hamstring but is not responding? Think QF.
We have always have found the quadratus femoris is one of, if not the, 1st hip muscle to become dysfunctional in hip pain patients. Perhaps it is due to it being the southern most stabilizer of the deep 6. Long known as an adductor, but also external rotator, we find it is employed eccentrically when the foot the planted and people rotate to the same side as weight bearing, or people take a “sudden stumble” while running. It often mimics an insertional hamstring strain with regards to location. We were happy to see it is getting some of the attention it deserves : )