Tags: physiotherapy

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…)

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…)

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…)

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
Comments: No Comments
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…)

The Side Bridge: The best exercise. ever.

Comments: 3 Comments
Published on: January 3, 2021

Intended Audience:  anyone who has not already been doing this for years

OK, OK.  There is not just one perfect exercise for everyone.  But this one comes close and for reasons you don’t expect.  The side bridge is an exercise that is typically thrown into the category of the “core” and people think it is just done as a replacement for oblique ab crunches.  While yes, it is a great replacement for that exercise it provides so much more. (more…)

Jewels from Juker (1998). Insight into the Psoas Part One

Categories: running biomechanics
Comments: 2 Comments
Published on: December 20, 2020

Stu McGill was an author on this paper when it came out back in 1998.  At the time, I was one of Stu’s grad students putting electrodes onto anyone I could find for the price of Gyro sandwich.  I even burned (chemically and transiently) the thigh of a girlfriend at the time.  I knew how to treat the ladies.  Unfortunately, I never really picked Stu’s brain about this paper.  It was only relevant to me at the time because we were strongly questioning the necessity of double leg lifts as an exercise for the “lower abs”.  We felt they were unnecessary to recruit the lower abs and too costly because of the compressive and anterior shear component applied to the lumbar spine. Our argument was that there is no difference between the upper section of the rectus abdominis and the lower section.  I still stand by it and the paper is here ( http://ptjournal.apta.org/content/81/5/1096.full ). Regardless of my youthful oversight, I still love the paper and the ideas of sticking needles into the psoas.  It must feel awesome hence the “n” of only 5. Below are a few tidbits that will lead into future posts on psoas function. (more…)

The danger of hip extension - self care for Labral tears.

Categories: hip pain, physiotherapy
Comments: 3 Comments
Published on: January 28, 2021

Audience: Therapists, Strength Coaches and Patients

Purpose: Pointing out that not everyone has tight hip flexors and stretching the Psoas may be a very bad thing

Anterior hip pain is common and many of us feel a pinching, catching or inside thigh pain with squatting and other hip movements.  Physiotherapists and chiropractors will see this everyday and it is often challenging to treat due to its multifactorial cause.  This pain can manifest during walking, squatting (a pinching sensation felt during a squat) or during different exercises. There are certainly many causes and one possible cause of this anterior hip pain is stress applied to the anterior capsule of the hip joint.  In severe cases this can lead to what is called a labral tear. Functionally, you can refer to the dysfunction as excessive anterior femoral glide. (more…)

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