Week 8: TZ1 and subtalar and midfoot joint motion

This week we covered the techniques to mobilise the subtalar joint and mid tarsal joint on the treatment table. These joints were mobilised by understanding how these joints connect and influence each other in weight bearing. These techniques were easy to use, and performed in as close to the normal hip and knee position as possible.

Using techniques on the treatment table fail to include the forces of gravity, ground reaction forces, mass and momentum when in weight bearing positions.  We can use environmental aids and in standing positons to best replicate normal funciton, and then mobilise the joints of the foot.

 

To be able to select the best position to place the body and then drive the body to get the desired chain reaction we can use TRAZMA analysis. In this analysis we look at what the bones are doing and what the relative joint motion will be. This is a key analysis to help confirm the correct drivers and body positions are used to get the desired chain reaction.

 

This week we covered balance and how we can mobilise the joints to get better stability with motion. There are many positions to use to test balance and they all involve movement, instead of standing still on one leg. 

 

We are one week away from Gift Gathering 1. There is a good build up of skill before the gathering. Time to test it out. 

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Physical Edge attends Jenny McConnell Course in Tunbridge Wells

Physical Edge sent Rhys Chong to Tunbridge Wells, to attend the Jenny McConnell  2013 edition of gait analysis and lower limb course. Jenny is a world leader in the treatment of knee pain and based in Sydney, Australia (www.mcconnell-institute.com).

Jenny McConnell believes in the KISS principle. She has identified common gait analysis issues over many years of practice,  and can provide evidence from scientific research to support her ideologies. She keeps the work her clients do at home to 5mins per day and knows “little and often” is the key to success. In her practice in Sydney, she works on a managing pain over a clients life time. It is like having an MOT for your car. She has MOT’s for the body and prevents pain before it happens.

The course looked at how the entire body compensates for dysfunction in the movement system. The hips are an area which is not treated well, and it was highlighted on the course. The course looked at the role of orthotics and shoes in supporting the body. McConnell has a new orthotic for high heeled shoes and sandles, a much needed invention (right ladies).

Physical Edge will be introducing orthotic prescription as an addition to its services. There will be MOT sessions to help people manage pain over their lifetime.  Physical Edge hopes to build strong relationships with clients, by learning over the long term how to help clients live healthy and painfree lives.

Personal Training series: Running shoes and running biomechanics

There are many shoes on the market at the moment for running. Running biomechanics have taken a big shift in the last 5 years.  Running brands such as Asics, Brooks and  Saucony have created shoes which are designed to prevent collapsing of the foot, or increased cushioning for those people with high arches. The general understanding of biomechanics and these types of shoes, is one which involves a heel strike pattern. In this pattern the heel will hit the ground first, the heel of the shoe absorbs the shock; the heel then controls the foot as it passes through mid stance and toe off.

Conventional shoes have worked over time for some people; however for others they have not made any difference, and some people who wear these shoes are still prone to knee, hip and lower back pain. When running with a heel strike pattern it is thought that as the heel strikes in front of the body there is a vertical force passed back up through the leg, the hip, the groin, the knee, and the lower back and that this results in injury.

Over the last 5 years there has been a wealth of research and contentious debate over the benefits of forefoot running. Forefoot running is where a person runs landing more towards the mid and front of their foot, instead of the heel being the first point of contact when the foot hits the ground during running. The foot also lands underneath the body and the stress imposed on joints are reduced.

Support for forefoot running comes from practical demonstrations on treadmills. When someone walks on a treadmill they have a characteristic heel strike pattern; however as the speed of the treadmill is increased they naturally start to run more towards the mid and forefoot. It has been theorised that the body is not designed to run with a heel strike pattern. When videoed at a faster speed on the treadmill the foot can be seen to strike more towards the mid foot and spring off. When seen at its best – like in Olympic marathon runners – the foot will actually hit the ground under the body; it is then kicked up behind their back using the hamstring muscles, before quickly returning to land again directly under the body.

The theory that running on the forefoot reduces joint pressure has been researched. With forefoot running the force of the body passes directly up through the body vertically –thereby relying upon the natural cushioning effect of the quads and the hip muscles. If the body is stiff enough – and the biomechanics are correct – the knee and hip joints can absorb the repetitive loading of running and hence reduce injury to the joints.

There are now shoes which have been adapted for forefoot running. Vivo barefoot is one of these companies and has created a range of shoes designed for walking right through to cross country running. Forefoot running shoes are designed to have minimalistic cushioning in the foot. These shoes are designed for the foot to feel the ground and reaction forces of the ground as the foot hits the floor. When the foot can feel the landing onto the floor, it can stimulate muscles to fire and get immediate push off onto the opposite leg. The soles of these shoes are very thin and Vivo Barefoot have described the sole to being as close to skin depth as possible.

Clients have reported they enjoy using these shoes. They feel completely different to thick soled shoes. They also give a refreshing feel to the foot at contact with the ground. The key is that this ‘feel’ will stimulate better muscular activity, shock absorption and reduction injuries. There are many successful runners in Olympics and World Championships who do not have a forefoot running pattern. It is not advised that everyone run on their forefoot – and a physiotherapist and trainer will be able to tell whether your body is capable of withstanding the pressure required to learn how to forefoot run.

Recently a trainer started forefoot running; it has taken 4 months for him to be able to run on his forefoot for 10km continuous running. To change to a forefoot running pattern requires significant adaptation and change within the body. The runner must allow time for this adaptation to occur because if they push themselves too hard and too fast in training injuries will occur.

I believe forefoot running biomechanics seems to make sense; however I have also seen that not everyone is prepared to take the time to learn how to forefoot run and people who run heel strike can still become world champions.

If you want to learn how to forefoot run it is important that you see a forefoot running coach – such as a physiotherapist who has experience, or an independent specialised coach.

Learning to run on the Forefoot at Vivobarefoot running clinic

 Physical Edge attends Barefoot (Forefoot)  running Lab with Rollo from Vivobarefoot. This was a 6 hour Lab looking at the current biomechanics supporting Forefoot running and then how to run on the Forefoot itself.  The Laboratory is based in Farringdon, London and it contains the latest technology for gait analysis, including video analysis and force plate measurements. 
 
The training demonstrated the importance of correcting restrictions in the foot before starting Forefoot running. These restrictions can alter the flexibility of the first toe, Metatarsal and ankle. When running it was a key concept to feel pressure exerted through the knuckle of the first toe. This was called the Line of Leverage and shifted the Centre of Mass forward onto the Forefoot. The body is designed to take pressure through this Line of Leverage to help propel the body forward in running.
 
The way we walk, run and sprint require different biomechanics. If the body adopts the old paradigm of running, heel- to toe, it is constantly exposed to decelerating forces and subsequent injuries. Common areas for injury can be the ankle, knee, hip and low back. Primary areas to keep flexible to enable efficient Forefoot running are the Thoracic spine, hip and ankle. 
 
The day was an insight into the development of shoes designed to assist in Forefoot running. These shoes have very thin soles to replicate skin and assist in creating the sensation of running Barefoot. Forefoot running in the shoes is comfortable. In winter they can get cold but you can buy socks to keep your feet warm.
 
Physical Edge noticed when running Forefoot for the first time the calf muscles and soles of the feet can get very stiff and sore the next day. This is an adaption process and a reason why training is done gradually. If you have an injury you can learn to run Forefoot but it will require a period of rest from training. You can do alternative cardiovascular exercises like swimming, water running and possible cycling. 
 
Physical Edge can you help you prepare your body for Forefoot running and direct you to trained Forefoot running coaches. If you have any questions do call or email us and we look forward talking to you soon.

Temperomandibular training session

Today we had Sarah from New Zealand give us the latest updates on treating the temporomandibular joint.
She described how the joint contains a fibrocartilaginous disc and if has no nerve supply in its intermediate section. It is this section that is compressed in the joint normally. When the joint is pulled out of alignment the anterior or posterior sections of the disc can be compressed and there structures have nerve supplies and create pain.

The TMJ can be effected by Bruxism (clenching jaw), trauma, postural issues, and structural changes. The cause of the pain can involve the upper cervical spine as these three segments communicate with Trigeminocervical nucleus and can produce pain anywhere innervated by the trigeninal nerve (Supplies skin sensation to the face and head).

In the above conditions is important to address the muscle imbalances around the TMJ and his can be treated with trigger point release and muslce releasing inside the mouth. The neck posure can be improved with rehabilitation. Acupuncture will be effective in treating  sinus pain and headaches.

In trauma mobilisaiton of the TMJ will include traction and Mobilisation with movement.

The results have been great and symptoms can be changed in 2 weeks. In New Zealand botox is used to release muscles in acute pain before treatment starts. I am going to meet a chiropractor on the weekend to find out what chiropractors do in treating TMJ pain.