Archives: January 2011

Functional Hallux Limitus - The problems with testing it

Categories: exercise biomechanics
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Published on: January 30, 2021

Audience: Therapists

Functional Hallux Limitis (FHL) is a decrease in the dorsiflexion of the big toe during gait.  This limitation is assumed to be “functional” and is not structural.  This means that simply pushing the big toe into dorsiflexion will not identify whether there is a functional problem.
This lack of dorsiflexion of the 1st MTP joint can be associated with a lack of plantar flexion of the 1st metatarsal (i.e. the 1st metatarsal may be hypermobile in that it translates/rotates dorsally) .

Howard Dananberg has written and theorized extensively on the topic and I believe he is credited with postulating how limitation in big toe dorsiflexion can have negative effects right up the kinetic chain culminating in low back dysfunction.   (editors note: the following of  how FHL influences ground contact time is wrong - wow, I was taught this  years ago and still hear it .  Dr. Dananberg wrote to correct me. I have stroked out what my original comment was and italicized the corrected version. However, my inaccuracy does not change what theoretically happens at the hip which is what I was most interested in.   His comment is below) Very simply, Dr. Dananberg suggests that a limited big toe dorsiflexion results in a too early toe off (because the foot can’t stay on the ground long enough because of the lack dorsiflexion).  This early toe .   FHL may lead to a prolonged time to when the heel is raised off the ground.  The prolonged ground contact may then leads to prolonged periods of flat foot.  This abnormal function may lead to a decrease in  hip extension which  may cause the psoas and iliacus to actively fire to a greater degree than they would have had they been stretched with normal hip extension  (i.e. a decrease in the elastic strain energy storage in the soft tissue structures anterior to the hip joint).  I stress the use of the word “may” - While I greatly appreciate this theory and respect the thinking and work behind it I can’t find any biomechanical work (e.g. a kinematic analysis correlating these altered kinematics to one another and the Fhl) to support it.  (more…)

Shoulder Rehabilitation: Minimizing the Upper Trapezius to Serratus Anterior Ratio

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Published on: January 25, 2021

Audience: Therapists

Pushup plus protracted

Purpose: I like the idea of quantifying the “dosage” of an exercise.  We can do this with EMG and this post will be part of a larger theme that catalogues the EMG amplitude of various shoulder rehabilitation exercises.  Further, it will also try to justify a number of exercises for their ability to avoid negative loading on the shoulder and promote a possibly optimal way of working the shoulder.

Caveat:  This review only looks at a few papers addressing the Upper Traps (UT) to Serratus Anterior (SA) ratio.  Other exercises must obviously be incorporated into a rehab program.

Exercises to maximize the Serratus Anterior (SA) to Upper Trapezius (UT) Ratio

To simplify: SA = good, UT = bad.  Basically, activation of the SA moves the scapula out of the way of the humerus while too much or too early activation of the UT tends to

pushup plus retracted

anteriorly tilt the scapula and decrease the space for humeral movement.  Ann Cools has done extensive work in this area.  Here is a taste of her findings and recommendations.  You may want to consider using the exercises when you have a little scapular dyskinesis on your hands - you may see some medial border prominence of the scap, some winging during arm elevation and the scap can get a little jiggy with arm raising and lowering. (more…)

Hip Airplane Exercise Pictures

Categories: exercise pictures
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Published on: January 22, 2021

Purpose: I have found it difficult to find unlicensed exercise pictures of certain exercises.  One of the goals of this blog is to share exercise pictures with anyone that would like to use them.  Most pictures are in jpeg format so they can be inserted into documents that you create.  Below are pictures of a hard to find exercise - The Hip Airplane.  This exercise is ideal for training balance, a strong foot, posterior chain muscles and when you drop and rise from the open to shut position the hip external rotators (or is the piriformis now an internal rotator because of the hip flexion - I do not know), glut max/min/med.

All the best,

Greg Lehman, Physiotherapist/Chiropractor

Side Bridge Variation Exercise Sheet - training inside and out.

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Published on: January 20, 2021


Purpose: Exercise Sheet handout
Attached is a handout for four variations on the sidebridge.  If you do not know what you are doing please speak with a professional before incorporating these into  your strength and conditioning program.

HERE IS THE FULL SHEET IN PDF: side bridge variations sheet (more…)

Shoulder Impingement Rehabilitation: Part One

Comments: 1 Comment
Published on: January 18, 2021

Audience: Health Professionals and Patients

Source of Information: Paula Ludewig, Ben Kibler, Ann Cools, Rafael Escamilla, Mike Reinold, Kevin Wilks

Disclaimer: The information below really just scratches the surface.  References at the end of post are excellent.  The point of this post is to get people to think more about culprits of dysfunction when it comes to the shoulder rather than just labeling shoulders with victim diagnoses (e.g. bursitis, tears, “tendinitis” - I hate that word - a future post will address my disdain).

Shoulder Impingement is not a diagnosis.  It is a finding and can be both a cause and the result of dysfunction.  Impingement is pretty much what it sounds like - something is getting pinched.  Ever reach into your back seat or reach to put your coat on and feel a sharp pain somewhere around your shoulder (and often down to your elbow).  That is impingement.  Some structure under the shoulder blade is getting pinched and does not like it.  Who likes to get pinched? (more…)

Stu McGill’s Big Three Exercises for Spine Stability

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Published on: January 13, 2021

Bird Dog

Audience: Patients, Trainers & health professionals

Utility: Exercise sheet handout for basic spine “stability” training

What exercises: Bird dog, side bridge, curl up

Stability is in quotes because you can certainly debate whether these exercises actually increase “stability”.  Or more accurately make the stable system more Robust.  What these simple but great exercises definitely do is work the entire trunk and hip musculature without imposing a large compressive or shear load on the spine.  The initial research justification for those exercises (almost 16  years ago but they have only been catching on for the past 5 or so) is that they train the spine musculature but do so in a manner that does not increase the injury risk.  Many exercises can train the spine musculature (e.g. double leg raises, back hyperextensions) but do so in a manner that might increase your risk of injury.  These exercises avoid this which is ideal in a low back injured population.  Athletes are a separate kettle of fish. (more…)

Patellofemoral pain syndrome exercise sheet

Attached is a basic exercise protocol as part of a large physiotherapy regime I might use for someone with some lower extremity dysfunction.  Many of these exercises would be used for non specific knee pain (PFPS, ITB syndrome).  The nordic hamstring exercise could be skipped but should certainly be used for anyone with posterior chain weakness/dysfunction.  I use that ol’ nebulous word ‘dysfunction’ when something is wrong (e.g. pain) but I’m not willing to commit to some BS therapist jargon about the cause of the problem.  You could put in the same room 5 great therapists (physiotherapists, chiropractors, massage therapists, sport med docs) who could all get someone better but they would each explain the problem completely different and often contradict each other.  So, I use the general word dysfunction. (more…)

Scapular Retraction/Protraction Exercise Sheet

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Published on: January 6, 2021

Attached is a simple one page exercise sheet to train the lower/mid trapezius (scapular retraction) and the serratus anterior.  The assumption is that these exercises, along with other training and physiotherapy (ART etc), will position the shoulder blade in a better position.  Ideally, avoiding forward tilt and a position that may be related to impingement.

Below is the pdf file:

thebodymechanic shoulder retraction basic


Greg Lehman

Neuromuscular knee control exercise series

Audience:  Patients

Format:  Patient Handouts

Topic:  Trunk, hip and knee motor control exercises to improve control of knee position

This post is  a handout that I give to patients.  As with all exercises they should be done under some supervision (physiotherapist, personal trainer, chiropractor) and always with a health professionals guidance.  In no way are these exercises stand alone.  They should be tailored to each patient’s needs and progressed or modified accordingly.

Greg (more…)

Why the side lying hip abduction exercise is way overrated.

Categories: Muscle Function
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Published on: January 3, 2021

Audience: Health professionals

I used to be a researcher (exercise biomechanics, physiotherapy,  chiropractic) - one of my goals was to quantify how hard muscles worked during different exercises.  This was important for determining which exercises may be best for targeting a certain muscle or determining how modifications to exercises (e.g. doing it barefoot or on a wobbly surface - for a simple paper look here) changed the targeted muscles response.

I used surface EMG which quantifies the electrical activity of that portion of a muscle that was under the electrodes.  Surface EMG is messy and you are required to process the crap out of it to get something meaningful.  (more…)

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