Barefoot, forefoot strike and heel strike - a biomechanics summary

Comments: 7 Comments
Published on: March 19, 2020

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, 2020

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 can occur from simple picking up a pencil.  Last pain in the area of the SI joint can even come from inches above the joint in the area called the T-L junction. (more…)

What is injury treatment? The judicious use of stress.

Categories: physiotherapy
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Published on: March 5, 2020

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, 2021

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

Comments: 3 Comments
Published on: February 9, 2021

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

Running Biomechanics: The knee is NOT flexed by the hamstrings

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Published on: February 2, 2021

Audience: Therapists, Trainers & Runners

Main Point: The hamstrings do NOT significantly flex the knee at toe-off.  In other words, runners do not consciously flex their knee when they are running and training this is most likely folly.  I have read a number of chiropractic and physiotherapy running “experts” who advise people to actively flex their leg off the ground and keep it flexed so as to change the moment of inertia about the thigh when someone is running.  The idea is to get the weight of the leg closer to the hip joint so it is easier to swing the leg forward. The problem with this idea is that the hamstrings do not do this when you are running.  Knee flexion occurs passively. It is a result of the hip flexing rapidly and powerfully. While the knee is flexing the quadriceps are actually active.  They are acting to control the amount of knee flexion.  This is what puts strain on the rectus femoris. (more…)

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

Comments: 3 Comments
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…)

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