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  • Archives for 2011 (22)

A critique of Janda’s prone hip extension test

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Published on: April 13, 2011

Audience: Therapists and patients with too much time on their hands

Purpose:  Provide a mild critique of the utility of the prone hip extension test

 

Background

The prone hip extension test (or prone leg extension – PLE) is a very common clinical test in use for more than 20 years.  Two influential clinicians have advocated its use although for slightly different reasons.  Both Vladmir Janda and Shirley Sahrmann have described its use for decades.  This blog will focus more on the clinical rationale that Janda proposed.

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Running Biomechanics Introduction – Differences in range of motion with running and increasing speed

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Published on: April 7, 2011

Audience: Runners

Purpose: To give a pictorial basic background into the movements that occur in the sagital plane (i.e. looking from the side) of the lower extremity during running at 3.1 meters/second (about a 5 minute km) and “sprinting” at 3.9 meters per second (about a 4.17 minute km).  (more…)

Running and hip strength – my response to the Toronto Star

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Published on: April 1, 2011

Audience: Runners and therapists

Purpose: advocate hip strengthening exercises

 

The “core” gets all the press.    But when it comes to running research and injury prevention I would sooner extol the virtues the butt.  The side of the butt to be most specific.

 

These muscles (gluteus medius/minimus and gluteus maximus) are huge in the relationship to injuries to the knee, hip and spine.  If you want to split hairs you can call them part of the core (you should, but most people don’t).

 

For a decade, I swear its been that long, researchers (and their readers like me) have advocated that runners should train these muscles and forgo stretching if they had to pick between the two exercise possibilities (I’ve softened my stance on stretching, more posts to follow).  The exercises are easy to do and can be fit in after a good run.

 

To support these views the Toronto Star just published a summary of a paper by Reed Ferber out of Calgary.  He runs a great lab and worked with Irene Davis (a superstar researcher in running biomechics), before starting his lab in Calgary.  His research publications are quite exceptional and if I were still a researcher they would make me envious.

See the Star article here: http://www.healthzone.ca/health/dietfitness/fitness/article/960175–researchers-get-hip-to-the-root-of-knee-pain-for-runners

 

For those interested in training their hips here are a slew of exercise programs (click on the links):

 

1. Patellofemoral pain treatment

2. Neuromuscular control of hip and knee function

3. Hip airplanes

4. Side Bridge variations – the best exercise to work the gluteus medius

One of my favorites is below.  The one leg squat with leg raise.  Most Toronto Physiotherapy places advise that you do the clamshell or side lying leg raise.  The problem (click here for a detailed review) is that the exercises only work the hip stabilizing muscles about 40% of their max.  This is not enough.  Muscles get stronger when you stress them. Unless you just had a hip replacement forget about these remedial exercises – unless maybe you truly are super weak here, then  you need them.

 

Otherwise, train harder.  You are an athlete and a runner.

 

 

 

 

 

 

 

 

 

Have fun,

 

Your Toronto Physiotherapy snob,

 

Greg Lehman

Shoulder Pathology – a diagnostic algorithm and summary of dysfunction

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Published on: March 28, 2011

Audience: more for me but anyone interested in the shoulder can read it.

Purpose: quick reference card for thinking about a functional shoulder diagnosis

The algorithm below is from Ann Cools work:

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Shoulder Impingement Rehabilitation Part Two – Training the Rotator Cuff

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Published on: March 28, 2011

 

Subscapularis Exercise

Audience: Primarily my Patients in Toronto but other Physiotherapists, ATs, Chiropractors and Strength and Conditioning Pros may like this

Purpose: Review the literature for safe and effective exercises for shoulder rehabilitation of the Rotator Cuff – primarily for the treatment of the finding of shoulder impingement

Sources: Initially, this was going to be a larger review.  However, I have just focused on the main points from the work of Mike Reinold who published a great review in JOSPT (2008), Mike can be read at  (www.mikereinold.com).  A recent review by Rafael Escamilla (Sports Medicine 2009) is also an excellent resource. (more…)

Barefoot, forefoot strike and heel strike – a biomechanics summary

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Published on: March 19, 2011

Audience: Runners and therapists

Purpose: To summarize the biomechanics of running strike pattern and shod conditions

I feel like in the blogosphere and the popular running media that there is a love affair with all things barefoot.  Barefoot running is associated with forefoot striking and there appears to be changes in the biomechanics associated with alteration in running form when compared with heel striking.  However, the research gets presented as if it is very neat in tidy when in fact it is quite murky.  This post is a work in progress.  It attempts to summarize some of the work comparing barefoot running with shod running and the work that compares forefoot striking and rearfoot striking while running in shoes.  I hope that I have conveyed that the results are quite conflicting.  Hence, what a pain it was to try to summarize this work.

This post will be updated consistently. Please view it as a work in progress. (more…)

The SI joint – a cause of low back pain

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Published on: March 5, 2011

Audience: Patients

Purpose: Info sheet for patients to learn why the SI joint can be a pain in the butt.

The sacroiliac joint (SI joint) occurs where the bottom of your spine meets your hip bones.  You have two of them and they must bear all of the stress that goes from your upper body through your lower body and vice versa.

SI joint pain can be felt in the lower part of your back, into your buttock, down your thigh and even into the shin.  People will often feel their leg give out and will feel a catch when walking.  It is often confused with Sciatica. This pain is often preceded by simple actions like picking up a pencil.  Last pain perceived to be felt in the area of the SI joint can even come cranky nerves beside the joint and from above the joint (the superior cluneal nerves). (more…)

What is injury treatment? The judicious use of stress.

Categories: physiotherapy
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Published on: March 5, 2011

Audience: Patients

 

What is this about:  Injury Treatment

 

Injuries can be treated a number of ways and many different ways are often successful. But if I am asked to be very simple about what treatment is I start with one basic assumption.  THE BODY ADAPTS TO STRESS.  (more…)

Patellofemoral Pain Syndrome – 2 day exercise program

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Published on: February 18, 2011

Audience: Patients

Contents: Attached is a pdf of a two day (6 day a week) basic exercise program for someone with patellofemoral pain syndrome.

For therapists, this would obviously be modified for the specific needs of your patients/clients.

 

Program One here: pfps bodymechanic sheet

Program Two Here – hip and knee dysfunction two day program for le dysfunction

Have fun,

Greg Lehman

Your Toronto Physiotherapist

Chronic Pain – Do therapists contribute? An unsolicted rant

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Published on: February 9, 2011

Become invisible and walk into a Chiropractic, Physiotherapy or Massage Therapy office one day. Watch them speak with a patient who has back pain or maybe a little bit of knee pain. You may hear the following:

-you need stability exercises
-these muscles are very tight
-you need therapy as you don’t want this degeneration to progress
-no more running or arthritis will certainly flare up and you will have real problems down the road
-you have dysfunctional movement patterns
-your glut muscles don’t turn on
-oh, it hurts here (pressing on upper traps). There some adhesions in the muscle
-I need to see you 2-3 times a week for the next 4-6 weeks.

All of the above statements are from good, well meaning people. And some of these statements might even be appropriate under certain conditions. These statements typically are not from the quacks and crooks that look to exploit anyone who has been in a car accident or might have fallen off their bike when they were six (and therefore their spine is permanently in trouble because of this “trauma’).

My concern is how all of these things sound to our patients – which is different from what we hear. If you tell someone they need stability exercises they probable assume their spine is unstable. That probably does not sound good to a patient with an incredible amount of pain. When we poke on areas that are “tight” or “sore” in everyone (e.g. the upper traps, you can’t find someone who is not tender there) we catastrophize, comment on how tight it is and reinforce a pain belief with our poking and create beliefs in people that there is something wrong with their muscles.

Not encouraging patients to resume their normal activities and to keep active contributes to fear and movement avoidance.

Telling patients that the way they move is dysfunctional based on an arbitrary standard of how someone should move again creates the belief in people that something is seriously wrong when there is usually no serious dysfunction.

Seeing someone 3x/week for 6 weeks for whiplash or a simple backache. Come on. Common sense says this is bad practice even though it is somehow in many guidelines.

The bottom line is we  need to watch our words.  I am no exception,  I catch myself doing this too often.  An unstable spine means something completely different to a therapist than it does to a patient. The phrase degenerative joint disease should be banned – they have a joint that is changing like everyone’s joints  and most minor symptoms have nothing to do with those normal changes.

Just some thoughts,

Greg Lehman

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