I thought it would be good to share an abstract that we wrote years ago. It seems that what we said then is starting to make more sense to people. The interdependent relationship of flexibility measures are also of interest. Just something to think about. Here is the link to the abstract that was presented with the European Congress of Sports Science in 2007.
Jessica, Ali and Ola
Over Easter vacation I wanted to use the terrain and an external load to see if I could position and load my trunk muscles in three dimensions. The result was the 3D Log Matrix. Calling it a log matrix might be a slight exaggeration, since it is more of a stick. However, the point is to load the trunk in three dimensions with how you walk in the terrain and where the load is applied to the body.
Jessica, Ali and Ola
Here is what was described about running and the hip a Norwegian newspaper. It was an attempt by Ola Eriksrud to say that the hip has to be considered in running function and dysfunction. This is important now in Norway, since a lot of people now pack up their skis and pick up their running shoes.
Sorry to all English speaking, but this is in Norwegian. Here is the article.
Jessica, Ali and Ola
Yesterday I spent the morning transforming myself into the right L5/S1 facet joint. I wanted to find out possible causes to increased compression to the right L5/S1 facett joint during gait. Here are some of the answers I came up with.
That was just to mention a few possible suspects based upon the lower extremities. There are many more. Find the cause, and the symptom, in this case low back pain, will take care of itself. You will be surprised with the answers you can come up with when you use the power of TRANSFORAMTION. Give it a try!
Jessica, Ali and Ola
We have decided to change the names of tow of our seminars and also the prerequisite of one of our seminars. Previously we had 3D Functional Performance that had a focus on the lower extremities that was a prerequisite to 3D Functional performance Advanced that consisted of the trunk and the upper extremity.
The new organization is 3D Functional Performance Lower Extremity and 3D Functional Performance Trunk and Upper Extremity. Now there is no prerequisite for 3D Functional Performance Trunk and Upper Extremity. This will allow for all of you choose between these two seminars. For more information click here.
Jessica, Ali and Ola
One hears the word shoulder rehabilitation and testing for athletes involved in throwing. This is also true for athletes involved in hitting an object with an instrument such as a racket. In the presence of dysfunction and pain in the shoulder isolated tests and exercises are commonly performed. This can be very helpful, however in order to treat for dysfunction and enhance performance in throwing one has to understand the contributing factors to the speed of the ball. In order to do so the entire kinematic chain has to be analyzed. Therefore to treat and train for throwing performance one has to be an expert on the entire kinematic chain.
The importance of the integrated kinematic chain in throwing can be exemplified by throwing in water compared to that of on the ground. Throwing in water polo is very different than handball. The speed of the throw in water polo is slower than that in handball, and we have to ask ourselves why is this. The ground certainly has something to do with this. As we are performing the throw, different joints from the ground to the hand will contribute rotational energy that ultimately leads to the speed of the ball.
Toyoshima and colleagues performed a simple analysis of segmental contribution to throwing in 1974. They imposed restriction of movement of different segments in the body while throwing. As motion in the lower extremity and trunk was restricted speed of the ball decreased by 60% when throwing. Then one might say that this is obvious, and it is. However, the obvious is not implemented in testing, rehabilitation and training of the shoulder. No wonder we end up with dysfunctional shoulders.
Jessica, Ali and Ola
The human body never stops to amaze me. Yesterday I evaluated a tennis player using functional testing. The ability to rotate is critical to functional performance, and especially in a sport such as tennis. The functional test that was for right rotation was to have the athlete stand with feet shoulder width apart and measure how far he could rotate to the right with his right arm at shoulder height. The same test was performed to the left. Rotating to the right he could reach to 90 degrees with his right arm, and rotating to the left he could reach to 110 degrees with his left arm. Remember this test integrates rotation of much of the body.
With a history of several left foot ankle sprains I was curious as to the motion available in the left foot. During the rotation test, as described above, there was a noticeable lack of eversion of the left subtalar joint. Further testing revealed a lack of subtalar joint eversion. Mobilization of the left subtalar joint would allow for better contact with the ground of the left foot. The result of this mobilization was an increase in right rotation of 10 degrees.
Tight hip adductors and flexors, which will impact hip rotation, were also found to be limited with specific functional testing of the hip. 3D dynamic hip mobility exercises were then performed for 5 minutes. As a result rotation to both the left and right increased with 10 degrees.
The ability of the scapula to rotate into retraction is also included in the overall rotational test described above. Further functional testing showed a lack of retraction of the right scapula due to soft tissue restrictions of the right pectoralis minor and serratus anterior. In addition thoracic spine rotation to the right was restricted. After3D mobilization of the thoracic spine and the right scapula an increase of another 15 degrees was measured.
Within 15 minutes he improved his rotation 35 degrees to the right. Based upon this increased rotation this specific player will have this much more motion to create speed of the racket. How this will affect his tennis and prevent him from injuries only the future will tell…
Once again, the body has to be considered as an integrated whole.
Jessica, Ali and Ola
David Tibero, Ph.D., PT is Professor Emeritus from the University of Connecticut where he worked in biomechanics. Currently he is the Dean at the Gray Institute. He has been my teacher and mentor for the last 16 years.
Dave will be giving a lecture in Oslo April 12th at the Norwegian School of Sport Sciences on the topic Functional muscle function – beyond the anatomical model. In order to truly understand muscle function, one has to consider how the body is interconnected in a three-dimensional manner. This will give you insights that will make you think about your approach to training and rehabilitation. David gives some of the best lectures on this topic, and you do not want to miss this opportunity.
When: April 12th, 17.00-20.00
Where: Auditorium D, Norwegian School of Sport Sciences
Prize: Free
Please send me an email at ola@3dfunctionalscience.com if you would like to attend. This is in order to ensure that we have room for all of you.
We hope to see many of you there!
Jessica, Ali and Ola
The core is made up of the spine, pelvis and proximal lower limb (Kibler, Press, & Sciascia, 2006), whereas the trunk is defined as the main part of the body to which the head and the limbs are attached. Both definitions describe a central part of the body that can be considered the dynamic crossroads of the body with tremendous loads in almost every athletic activity (Anderson, Strickland, & Warren, 2001).
The function of the core is to i) stabilize the spine to maintain upright posture ii) create counterforces in the chain of force transmission to the base of support as a response to the forces that accelerate the limbs in a dynamic movements iii) contribute to the regulation or the pressure within the trunk to protect and support the inner trunk organs and to stiffen the spine for stability, and iiii) control and generate motion of the thorax relative to the pelvis. In order to fulfill these functional demands there is a need for different types of core muscles with specific functions, that function together in a coordinated manner through their full range of motion.
With this is mind it is interesting to read and hear about core function in different contexts. One statement that I have seen presented in many places is that all motion starts from the core. This is a misconception about core training. Lets apply Newton’s three basic laws of physics to this statement. Lets make one assumption that we are on earth and that we are in contact with the ground. In order to create motion of the human body we are dependent upon external forces acting upon the body. These forces are always applied through point of contact with the external environment. Any movements of the upper or lower extremities are therefore dependent upon an effective force transfer from point, or points, of contact to the extremity performing the action. In such a context the core can be an effective transmitter and contributor of force and kinetic energy. The point is that all motion does not start at the core.
Jessica, Ali and Ola
Literature
Anderson, K., Strickland, S. M., & Warren, R. (2001). Hip and groin injuries in athletes. [Review]. The American journal of sports medicine, 29(4), 521-533.
Kibler, W. B., Press, J., & Sciascia, A. (2006). The role of core stability in athletic function. Sports medicine, 36(3), 189-198.
The shoulder is dependent upon the rest of the kinetic chain in any overhead activity such as throwing or tennis. In order to generate a force through the hand on a ball, with or without a racket, one has to generate this from the ground up. Kiebler described this in an article from 1995. In his article called “biomechanical analysis of the shoulder during tennis activities” he describes how the shoulder is dependent upon the rest of the body. One has to bear in mind that in any sports there will be technical advances. Regardless of this, there are some key aspects of the kinetic link that has to be understood in order to be successful in enhancing performance of the upper extremity.
The kinetic chain allows for generation, summation, transfer and regulation of forces from the feet to the hand. Sequential involvement of each link allows use of ground reaction force and activity of the large leg and trunk muscles to generate most of the force. This is summated in sequence and passed on to the distal link, which for tennis or throwing is the hand. The contribution of each link can be calculated based upon the basic principles of physics. Based upon these calculations 51% of the total kinetic energy and 54% of all force was developed in the legs and trunk, whereas the shoulder contributed 13% of the total kinetic energy and 20% of the force. It is obvious where the largest contribution is, but the shoulder has a significant contribution as well. Another study has shown how the legs and the trunk are responsible for 85% of the forces required for the deceleration of the arm in throwing.
Based on these results it is obvious that one has to consider the entire kinetic chain when performing an evaluation, rehabilitation or implementing a training program. The question you have to ask yourself is will isolated or symmetrical bilateral activities of the shoulder joint or shoulder girdle in a supine or seated position have any influence on upper extremity performance? Considering physics and basic exercise science the answer is obvious.
Jessica, Ali and Ola
3D Functional Science is proud to announce a new line of courses called 3D Athletics. This is a line of courses consisting of 3D Athletic Foundation, 3D Athletic Transformation and 3D Athletic Performance. The courses build upon each other in the order described above. The basic and fundamental course 3D Athletics Foundation will be introduced at the Royal Lawn Tennis Club of Stockholm on the 9th – 11th of March 2012.
3D Athletic Foundation is specifically designed for athletic and personal trainers that want to optimally train their athletes and clients functionally. The course is based upon principles from our basic sciences such as physics, biomechanics, anatomy, physiology and exercise science. The 3D Athletics courses are based on the training of healthy individuals without injuries. Upon completion of 3D Athletic Foundation you will have great knowledge and understanding of how the human system works in three dimensions based upon the principles of function. You will be able to use existing equipment in your gym to facilitate three-dimensional human function and performance, which will have great results on your athletes and clients. You will also be able to make choices about your exercise selection based upon the principles of function, and not what specific exercise that will train individual groups of muscles.
3D Athletic Foundation is great starting point for all trainers that want to enhance the functional performance of others, and it will open you to new thoughts and ideas. It is a great way to create a functional foundation to all your training. The other courses in 3D Athletics will expand upon this knowledge and allow you for optimal functional testing, training and program design. It is an exciting functional journey that we want to share with you.
Sign up here
Jessica, Ali and Ola
3D Functional Science is proud to announce 3D Functional Performance Advanced in Stockholm Sweden from May 7th – 9th.
This course builds on the knowledge and understanding from 3D Functional Performance, which therefore is a pre-requisite for this course. We will use the same principles and strategies as we used on the lower extremities, now they will ba applied to the spine, shoulder girdle and shoulder joint. It is a great learning experience where knowledge from 3D Functional Performance is integrated with the rest of the body. This will allow you use a functional approach to the entire body.
The course will consist of the principles that govern function from a biomechanical, anatomical and physiological perspective. Testing, rehabilitation and training of the trunk and upper extremities integrated with the lower extremities will also be an integral part of this course. We are excited about this course and hope to see many you in Stockholm this May.
For more information see this link. To sign up clik here.
Jessica, Ali and Ola
3D Functional Science is now established as a part of the KLTK Gym at The Royal Lawn Tennis Club in Stockholm Sweden. This is new as of this year and these are exciting times for all of us. We are currently establishing and implementing extensive functional testing for different sports. Based upon functional testing corrective treatment will be performed by either Jessica Parnevik-Muth who is a physical therapist, or Jenny Johansson who is a chiropractor and is a part of the GIFT class 2012.
Team Training has also been developed where athletes and clients will be able to train together in small groups. Depending on personal goals and results from functional testing we can offer different levels and specific types of training to meet individual and specific needs. These programs are highly effective in improving function of different parts of the body, as well as the entire system.
Based on the same system Ali Ghelem and Jessica Parnevik-Muth will provide Movement Quality Screens as well as designing functional personal training programs.
Jessica, Ali and Ola
3D Functional Science is proud to announce Ali Ghelem as a new part of our team. He will be a great contribution to the team and is an integral part of our future plans. We are all already working on new exciting products as it relates to functional training, rehabilitation, functional manual treatment and educational courses.
Ali went to school at Bosön’s Sport College. Upon receiving his degree he has been a dedicated professional that has always sought personal growth and professional development. He has taken continuing education courses from among others the C.H.E.K institute, Personal Training School and is now a part of the GIFT 2012 program. He has worked as an Athletic Trainer since 1996 where he has coached and trained many Swedish champions in Fitness and Athletic Fitness. Since 2002 he has primarily worked with tennis, and since 2005 he has primarily worked with professional tennis players on the ATP Tour.
His own athletic experience is primarily from alpine skiing and American Football
We are very excited about having Ali as a part of 3D Functional Science. He is an important addition to our team that has already made great contributions to our future plans. What we have planed for the future is very exciting, and it will have far reaching implications on the functional performance on many athletes, clients and patients. News about our future will be coming this spring.
Jessica, Ali and Ola
From basic muscle physiology we know that muscles function isometrically, concentrically, eccentrically and as springs. The spring function is where the whole muscle tendon unit will go through an elongation, however the muscle belly will either shorten or have a constant length while the tendon itself will go through an elongation. This is a very effective mechanism for storage and return of elastic energy, which is used effectively by humans and other animals in locomotion. If you are interested in reading more about this topic I recommend reading some of the work of Professor Andrew A Biewener. Considering this, the length of tendons could be a sign of muscle function.
As it relates to human movement muscles are generally considered to work tonic of phasic. The tonic function reflects posture and stability, whereas phasic reflects movement. This is the very basic description of muscle function. Then based upon a specific movement pattern one can define a muscles as either working as an agonist, synergist, antagonist or fixator/stabilizer. These descriptors makes sense as it relates to some movements, however in many complex and integrated closed-chain human movement patterns these descriptions does not make any sense when gravity and ground reaction force is considered. It seems that muscle function is not easy to understand, even though the anatomy book made this simple enough for us.
Lets use the hip joint as an example in describing some more of the complexities regarding muscle function. Donald A Neumann describes in his textbooks, and scientific papers, how virtually all muscles crossing the hip has lever arms in all three planes of motion. Therefore these muscles have the potential for creating a torque, or moment, in all three planes of motion, meaning that these muscles can create motions also know as flexion, extension, abduction, adduction, internal and external rotation as well as horizontal abduction and adduction across the hip joint. To make matters worse, it seems that the lever arms for some of these muscles change position relative to the axes of rotation for the different planes of motion as motion in one plane is taking place. What once was so easy with some basic functions, all of a sudden became a little more difficult based upon some basic mechanical descriptors of how muscle forces crosses the hip joint.
So what does fibertypes have to do with the three-dimensional nature of human function? There does not seem to be a uniform distribution of fibertypes in different muscles. Different parts of muscles can have different fibertype distributions. How biopsies are being performed, and how the muscefibers are analyzed histochemically will obviously influence these findings. However it could be a link to a greater functional spectrum of skeletal muscles. Johnson and co-authors speculate about this as it relates to the rectus femoris. A high proportion of type II fibers (70%) was found in the superficial region of the lateral head of the rectus femoris. It is likely that the medial portion, which has a lower percentage of type II fibers, is functioning together with the iliopsoas to support the pelvis on the femur, whereas the lateral head, or sector, is more involved in flexion of the hip joint and extension of the knee. This is not proven, but it is an interesting note on the complexities of human function made by these authors. These insights, combined with the lever arm of the rectus femoris in different planes of motion across the hip joint, makes the function of this muscle all the more interesting.
To make matters even worse, consider this in light of how the rectus femoris acts as force transmitter of hip extension to knee extension. That was all for now.
Jessica, Ali and Ola
We all know the importance of full knee extension.
There are many methods to improve knee extension but the principles are a few. Let us use a strategy that is based on the principles of function. Some of the principles are as follows regarding the knee:
With these principles in mind, we need to know what motions the knee will go through when extending the knee, which is extension, internal rotation and varus. This internal rotation with extension is contradictory to the locking or screw home mechanism. This locking or screw home mechanism is based on how the joint surfaces roll and glide relative to one another and size of the medial and lateral joint surfaces. In locomotion there is an internal rotation of the hip in terminal stance with an external rotation of the femur in space. If this is occurring without the foot rotating on the ground, there will be an internal rotation of the knee if the motion is considered as being driven top down. Top down means that motion is being driven from the hip down into the knee, foot and ground. This top-down approach is based upon the opposite leg going through swing phase. However this relative motion is dependent upon friction from the ground. Therefore a pure top-down approach is not appropriate for describing relative rotation of the joints in the lower extremity in terminal stance in locomotion. However if the femur is going through more external rotation in space than the tibia there will be relative internal rotation occurring at the knee. Based upon all of this it is important to understand what the ankle and foot is doing since that obviously will influence knee function.
Therefore we need to find out if the foot and hip have enough motion to let the knee fully extend.
How can we drive the knee using a bottom up approach? Stand in stride stand with the affected leg back. Put a medial wedge under the heel causing the subtalar joint to invert.
In this position use a top down approach using the pelvis as a driver and rotate/turn the pelvis towards the back leg. Knowing the motion is driven from the top down the femur should externally rotate earlier and faster than the tibia resulting in a relative internal rotation of the knee. This motion is subtle and care should be used when performing and evaluation and treatment based upon this approach. Remember that this is a weight-bearing situation with extension and rotation occurring
At our last seminar one of the participants had significant decreased internal rotation at the hip. The limitation had been there for over 15 years. By evaluating the axis of the ankle joint we found that the distal fibula was more forward than the other leg. An anterior position of the distal fibula will change the orientation of the axis of rotation of the talocrural joint. This could have an impact on the rotational relationship within the lower extremity. Remember the relationship of torsion of the different bones of the lower extremity. Thus the hip internal rotation can be affected. This we have found in multiple patients and clients.
By functionally mobilizing the distal fibula posteriorly he gained full range of motion in the same side hip.
The question is how come the hip muscles and the capsule did not adapt to the decreased motion that has been there for so many years. We don’t have an answer of that, but the effect on hip internal rotation motion by mobilizing the fibula shows once again how integrated and linked the human body is.
We have both graduated from the Gray Institute GIFT program in Applied Functional Science. Mind Body and Spirit say it all. It has been a great journey that will keep on going. The day we say that we know it all, is the day we have stopped growing. I hope that day never comes. Being a part of this dedicated network of knowledgeable and inspiring professionals will allow us to continue to grow and to enhance the lives of others.
Dave was kind enough to come to Sweden just recently. He gave an excellent lecture about the knee in football and how the knee is dependent on the foot, hip and trunk. About 75 people showed up. They all loved it because it makes total sense the way he presents it.
We can recommend the GIFT program to all professionals interested in enhancing their knowledge in human function, training and rehabilitation. This journey will also affect your mind and spirit in a way you never thought was possible. GIFT will also help you to build the business you always dreamed of.
Big Hug and Thanks Gary, Dave, Dough, Bob, Brad, Randy, Terry, Keith, Fluff and the rest of the GIFT Community.
At one of our seminars one of the participant had hip impingement had the doctors had told him to quit ice hockey due to that.
Based upon an integrated functional evaluation we found a forefoot varus with a hypomobile midtarsal joint. This was one of the findings, and we decided that this was important since force enters the body through the foot, but also is the effector when force is generated into the ground in upright function.
The question and argument then becomes how this forefoot problem could lead to an anterior hip impingement. A forefoot varus of a hypomobile nature leads to an increased loading response in the rearfoot to allow for the big toe to reach the ground. An increased loading response in the rearfoot will increased this same response up the chain. As a result the timing, amount and duration of the loading response in the hip is affected. As the loading response on one side is occurring, the unloading is occurring in the opposite lower extremity. These two factors together have the possibility of creating problems in the integrated chain. In combination with limited mobility in the hip to start with, this could lead to problems
The first treatment that was decided upon was mobilizing the foot functionally both manually and in standing with and without the use of wedges to increase mobility of the forefoot. The hip was tested throughout the treatment, and standing hip internal rotation increased with the subject not reporting a pinch in the groin, but rather a sensation of stretching in the posterior hip region.
Once again this shows how integrated and linked the human body is.
Jessica and Ola
The purpose of the functional science part of our blog is to share important functional findings from the scientific literature as it relates to training, rehabilitation and manual treatment approaches. We will also interpret the scientific literature based upon the principles that dictate function. To read more about these principles visit our homepage at www.3dfunctionalscience.com.
The article to be discussed now was published in 2011 by Tateuchi and co-workers. The complete reference is: Tateuchi, H et al. (2011) Effects of calcaneal eversion on three-dimensional kinematics of the hip, pelvis and thorax in unilateral weight bearing. Human Movement Science 30:566-573.
The purpose of this article is to show the influence of calcaneal eversion all the way up into the thoracic spine. Through clinical work this relationship is evident, however this has scarcely been reported in the literature. Studies have shown how rearfoot motion will influence the forefoot, knee and ankle, but very few have made an attempt at reporting responses further up the integrated biomechanical chain.
By altering the input to the integrated biomechanical chain there obviously will be a reaction created further up in the chain. One way of doing this is to alter the position of the point of contact with the external environment. Similar studies have been conducted previously where one is standing on different kinds of surfaces such as wobble boards or different types of balance mats. What the researches have been looking at in these studies is the adjustment of the body as a system to an unstable interaction with the external environment. However this is most of the time functionally not appropriate. One is then measuring the interaction of the system with an artificial unstable environment. One should rather look at how the integrated system of the body responds to an interaction based upon a surface that is more functionally appropriate where the ability to correct with the ankle is limited and manipulated. That is what they have done in this study.
Calcaneal eversion where introduced to the system from 0°, 5° and 10° by standing on a wedge in unilateral stance. Three-dimensional kinematic analysis was then performed. The researcher found different results as a result of these manipulations to the foot. These changes were small and subtle from a biomechanical standpoint. With such small changes one has to be very aware of the limitations and errors associated with this kind of biomechanical analysis. Regardless of this, they found that an increase in calcaneal eversion produced significant increases in hip flexion, internal rotation, anterior pelvic tilt as well as lateral flexion and rotation in the thoracic spine. These are some of the findings the authors report.
What I find interesting is that the researches have taken on the task of trying to show the influence of calcaneal eversion further up into the spine. With a gradual increase in calcaneal eversion the foot will have a limited capability to further load, and thus change the demand further up the chain, or this could be a representation of what happens as a result of increasing calcaneal eversion. Regardless, it was fun to read. A big thank you for Ben McChesney for sharing this article with me today.
Until next time, keep looing for the functional links, they are right in front of you!
Last week a patient that came in with a shoulder impingement in her right shoulder.
She had been in a car accident over 20 years ago and broke her right upper and lower leg at several places. She still had screws and plates in her leg.
Her right knee fell into severe genu valgus and made the whole body rotate to the left causing her right shoulder being more forward than her left. As a result she had a classical protracted scapula and internally rotated shoulder joint. She also had a tight right pectoralis minor and some lower trap weakness. However this has to be considered and integrated with the rest of the system. Based upon the posture or presentation of the right lower extremity this had to be integrated with the dysfunction of the right upper extremity
I put her in a stride position with her right leg in the back. Wedges were used to build up her foot into a supinated position (a wedge on the medial side of the rear foot and a lateral wedge on her forefoot). This was to create a dissociation of the supinatory response of the rearfoot to the forefoot. The hands were then placed on the pelvis, which was used as a driver, and rotation to the R was introduced to create an unloading, or supinatory response, of the right side of her body. The patient was informed to stop the motion, right rotation, driven by the pelvis, just before the right big toe wanted to lift from the floor.
By using the pelvis as a driver there will be a top down approach to the right lower extremity driving this into a better unloading or supination response. The top down approach is based upon that the pelvis moves further and faster to the right, external rotation in space, as compared to the femur. This occurs all the way down the chain. Furthermore functional manual reaction skills were used to create the appropriate motions in all three planes primarily at the knee. The same pelvic driver will create a bottom-up sequence to the right shoulder girdle. Again the pelvis will move further and faster than the lumbar spine and so on all the way up to the shoulder girdle
After the treatment she could lift the arm overhead without pain. I gave her three exercises to do at home. The same exercise as described above, as well as working on more isolated movements in the shoulder girdle to elongate the anterior aspect of the chest. These “isolated” exercises were still integrated with the hips and spine.
She was still pain free when she came back the following week. She was so happy, not only for being pain free, but she could walk much better and she did not stand rotated or twisted anymore. Even her leg looked straighter. People at work had noticed the difference in her walking and posture when she returned to work.
This is a story about how the shoulder is integrated with the rest of the body and what the results can be. The protracted and internally rotated posture on one side has a driver, and in this case it was the same side lower extremity. This is not a story to impress you, but rather a story about the integrated shoulder.
To answer the question put forth in the title is YES. Right genu valgus can affect the shoulder by causing increased internal rotation of the knee and hip. This can cause the pelvis to rotate more to the left in space, and the spine will follow with less rotation to the left in space, but the overall result in this case was a left rotated position of the spine in space. This will the affect the spine, ribs, scapula and the shoulder joint. When the whole shoulder complex is more forward, the subacromial space can be affected. The common result is a decrease in this space, leading to impingement. All of this is a result of non-optimal working conditions for the shoulder girdle.
Hope you have enjoyed a little version on integrated shoulder function.
We have recently started our own facebook page. We share information about our seminars as well as from our blog here. There will be other interesting information from some of our friends, colleagues and other dedicated professionals around the world. Visit us at:
http://www.facebook.com/pages/3D-Functional-Science/271028779574407
The purpose of the functional science part of our blog is to share important functional findings from the scientific literature as it relates to training, rehabilitation and manual treatment approaches. Now we look at the Iliopsoas muscle. Much has been written about this muscle, and this is a little review of what was published by Santaguida and McGill in 1994. The complete reference is Santaguida, P.L. & McGill, S.M. (1994) The psoas major muscle: a three-dimensional geometric study. J. Biomech 28 (3): 339-345.
Many claims have been made about this muscle. First we have to understand its´ location. We know that the medial part originates on the vertebral bodies (T12 – L4) with the associated intervertebral discs, while the lateral part originates from the 12th rib, transverse processes T12 – L5 and the adjacent part of the ilium. The insertion is on the posterior part of trochanter minor.
This review will focus partially on the structure of the psoas major, but predominantly on the function of this muscle on the lumbar spine. In their review of the literature the authors comment on what claims have been made about this muscle, and here is a little recap of what they state; it can flex the lumbar spine on the pelvis, lateral flexor, stabilizer of the lumbar spine and hip joint (whatever that might mean), power source of bipedal ambulation, controller of lumbar lordosis. This is some of what the literature states. As it relates to rotation little was written in the introduction about this.
As it relates to structure they dissected 7 embalmed male subjects as well as performed an MRI on 15 male subjects for a better description of cross sectional area. From the dissection they found that the pennation angles of the muscles were hard to describe. The angulation was fairly vertical superior in the belly, but had more of a horizontal angulation at the lumbosacral junction. This is interesting as it relates to force transmission and function. The physiological cross-sectional area is greater in the lower compared to the upper region based upon this angulation, while the anatomical cross-sectional area was found to be greatest at L4/L5. The central tendon of this muscle extended at least up two levels in all subjects, where the lower muscle fibers inserted on the posterior and medial side of the tendon. Based upon this it seems that pennation angles in all three planes has to be taken into consideration if one is to accurately calculate force and understand function. We will post more on the issue and importance of appreciating pennation angles of the muscles. This will tell us something more about the function of muscles.
Now to the functional application of what the authors found. Based upon their model they found that the psoas major is most effective in lateral flexion of the lumbar spine, since it was found to have good moment arms in the frontal plane. The moments in the frontal plane was fairly evenly distributed with the exception of a low frontal plane moment at L1/L2. As it related to the sagittal plane the psoas major had moment arms for extension in the upper segments and flexion in the lower segments. Therefore this muscle would introduce extension in the upper lumbar segments and flexion in the lower lumbar segments. In terms of rotation the psoas major had moments for rotation that was small at L1/L2 and increasing down to L5/S1.
As it related to anterior shear forces it was the greatest at L5/S1, which is no surprise, based on what is found clinically. The axial compression was also greatest at this level, which again is no surprise. The lateral shear was also greatest at this level.
Based upon all of this is seems that the greatest total moments and shear is at L5/S1 from the psoas major. What is of great interest is the change from extension to flexion moment as it moves down the spine. Where the line of force falls through the vertebrae, the moment arm is the least. This seems to coincide with the apex of the lumbar lordosis.
We hope we have shed some light on the structure of the psoas major. The important aspect here is that it has a three-dimensional function in translation and rotation on the lumbar spine.
We interpret the scientific literature based upon the principles that dictate function. To read more about these principles visit our homepage at www.3dfunctionalscience.com
David Tibero, (Ph.D., PT Dean, Gray Institute Professor Emeritus, University of Connecticut) will be giving a lecture in Stockholm November 2nd. David gives some of the best lectures we have ever witnessed. You do not want to miss this opportunity. The lecture is based upon the principles, strategies, and techniques of Applied Functional Science to describe a logical approach for training and prevention of knee injuries in Football.
When: November 2nd, 18.00-20.00
Where: Nanna Schwartz aula, Karolinska hospital Solna
Price: Free for members of idrottsmedicinska föreningen, non-members 50 SEK
We hope to see many of you there!
We were fortunate to be able to share some basic exercises of the abdominal- and back muscles with the greater public on NRK, which is the national broadcasting company here in Norway. These exercises are based upon a top-down approach in an upright position were we wanted to show how stress can be introduced to the whole system in three dimensions. Very important to allow for motion through the lower extremities to allow for optimal function of the trunk. All of these exercises can obviously be expanded upon.
During the later part of stance in the propulsive phase one can often observe external rotation, or a medial whip, as the heel rises from the ground. There are a number or reasons why this is occurring. The include, but are not limited to the following:
1. Decreased dorsiflexion of the big toe on the same side
2. Thight hip flexor same side
3. Decreased dorsiflexion same side
4. Increased loading response or pronation in the opposite foot leading to increased pelvic motion
5. Decreased trunk rotation to the opposite side. This will be thoracic rotation to the opposite side and cervical rotation to the same side.
Needless to say, the body is an integrated mechanical and physiological machine. Dysfunction as a result of this medial whip can manifest anywhere in the body, therefore the site of dysfunction is not necessarily the cause of the dysfunction.
I am very privileged. This past week I have been a part of a great team from the Norwegian School of Sport Sciences and the department of Anatomy and Cell biology at the University of Heidelberg. We are making educational material for students of medicine and sport sciences. It is exciting to work with dedicated, intelligent and motivated professionals that execute and make things happen.
This past week we dissected the lower extremities. This was documented with film and pictures. We were unable to complete the entire lower extremity, with maybe some the most exciting stuff to come, namely opening up the joints of the feet. The arbitrary description of anatomical function of different muscles becomes very apparent during dissection. The fascial attachments are so strong and the lateral force transmission between different muscles becomes quite obvious. Maybe muscles all work synergistically to solve a task.
Iliotibial band syndrome, which is a symptomatic description, is often associated with patellafemoral pain or dysfunction. This syndrome becomes quite interesting in the light of understanding true structural and functional anatomy. The tractus iliotibialis is only something that exist in a anatomy atlas. This is a lateral thickening, or reinforcement, of the fascia lata, which is the fascial structure surrounding the thigh. There is an increased mechanical stress laterally which results in this thickening, or there is a thickening to be able to absorb or transmit a mechanical force. However one has to bear in mind that this is a continuous structure with the fascia of the rest of the thigh. Some of the mechanical stress introduced to this structure comes from the posterior, lateral and anterior thigh, also known as the tensor fascia lata and the gluteus maximus.
This thickening of the tractus iliotibialis could have been anterior, but it is not, it could have been posterior, but it is not. It is lateral. The question then becomes why? Could this be a direct mechanism of controlling the knee in all three planes of motion? The extension of the knee from the structures feeding into the tractus iliotibialis is important and it exists. The gluteus maximus will assist in the control of knee flexion. But what about the control of the valgus and internal rotation that also constitutes the loading response of the knee together with knee flexion. Could the structures that feed into the tractus have a role here? If one considers the line of force from the tractus iliotibialis relative to that of the biceps femoris we see that the line and insertions are similar and very close together. It has been established that the biceps femoris will control knee internal rotation. Therefore the gluteus maximus together with the tensor fascie lata will do the same thing. Could these same structures also control the valgus of knee during the same loading response? A lateral force on the tibial plateau in a closed chain function will create varus, thus controlling valgus. In open chain it will be the exact opposite. With this in mind, is not function in the anatomy book described based upon open chain function? Just some thoughts from Heidelberg Germany.
A patient of mine came to me with pain in her right SI-joint. She was 30 weeks pregnant and had difficulty walking. While evaluating her gait I saw that she was pronating more with her right foot. She had pain in her right SI-joint during gait. I checked her leg length difference by having her doing a hip hiking test with straight knees and found out that she could lift up her left leg 1 cm higher than the right. I also tested her in supine and in sitting with straight legs. I even measured the leg length with a tape measurement from the ASIS to the medial malleoleus and all test showed that the right leg was longer.
When I evaluated her pelvis and sacrum I found that the right pelvis was higher than the left and her sacrum was slightly rotated to the right. During a small anterior lunge with the right leg I found the right pelvis was moving fast in to left rotation and the sacrum had difficulty following along. The pelvis should rotate faster than the sacrum due to the ground reaction force coming from the ground coming up but the increased pronation of the right foot (a foot that is trying to make itself shorter because it is longer than the left) increased the speed and the sacrum couldn’t follow along for the ride and got stuck in relative right rotation.
I pressed on her Sacrotuberal ligament and stretched her Iliopsoas and quadratus lumborum and then functionally mobilized her pelvis and sacrum by having her in a stride stance postion with the right leg in the back. I had her stand on wedges that made her right foot supinate, medial wedge on the heel and lateral wedge on her forefoot. This is the position the foot should be in just before heel lift during gait. By having the foot in this position ground reaction force will make it easier for the talus to come up on the calcaneus and the tibia and femur to external rotate and the pelvis to rotate to the right. I used a right arm driver and had her moving the arm in a diagonal from her left anterior hip to overhead to the right. While she reached overhead to the right I increase the speed of the pelvis that was rotating to the right while I decelerated the motion of the sacrum that was also rotating to the right. That way the relative right rotation of the sacrum disappeared. I also gave her a little lift in her left shoe. She could walk away from the Clinic with no pain.
The answer to the question is yes. A leg length difference can affect the SI-joint. Just make sure it is a true leg length difference. Most of the time I found that it is not.
Jessica and Ola
I visited my dear friend David Tomsich in Michigan a couple of weeks ago. He is a person I REALLY admire. His knowledge of functional biomechanics is hard to beat. He teaches Ortho Elite Seminars and he gave me the compendium that he has written for the seminar. I would like to share with you what he wrote about decreased ankle dorsiflexion.
How can decreased Ankle dorsiflexion (DF) affect the rest of the body?
DF comes from the talocrural Joint (TCJ), the oblique axis of the Metatarsal joint (MTJ), the first ray, the Subtalar Joint (STJ), distal and proximal tib-fib Joint.
During gait we need 10 degrees of DF during terminal stance. For running and stairs we need between 10-30 degrees of DF. Squatting and jumping up to 30 degrees.
Lack of Dorsiflexion can lead to decreased shock absorption. It interferes with the quadriceps and knees ability to load. This can lead to heel pain, lumbar pain, knee pain, lateral hip pain, anterior hip impingement.
You may see an early heel lift during gait and that can lead to achilles tendinosus and shortening of the hip flexors.
You may see compensation by using toe-out gait. This can lead to groin injuries, shortening of the hip external rotators, medial knee loading, medial foot/arch pain, first MTP dysfunction.
Other compensations related to loss of TCJ dorsiflexion can be shortening opposite step length-hamstring, excessive posterior pelvic rotation interminal stance/pre-swing, excessive lumbar flexion/rotation/sidebending, it may limit opposite trunk rotation.
The foot may compensate for the lack of DF by pronating more in the subtalar Joint- increased tibial and femoral internal rotation. This may lead to pes anserine tendinosus, Patella femoral pain, lateral hamstring/proximal tib-fib dysfunction, patellar tendinosus, ACL/MCL injuries, hip bursitis, plantar fascitis, first MTP dysfunction, posterior tibialis tendinosus and achilles tendinosus.
You may also see compensation by an opposite pelvic drop – femoral adduction/femoral internal rotation and genu valgus. This may contribute to the development of hip bursitis, lumbar pain, ACL/MCL sprain, pes anserine tendinosus, patellofemoral pain, patellar tendinosus.
Needless to say, human function is integrated and linked.
The purpose of the functional science part of our blog is to share important functional findings from the scientific literature as it relates to training, rehabilitation and manual treatment approaches. We will also interpret the scientific literature based upon the principles that dictate function. To read more about these principles visit our homepage at www.3dfunctionalscience.com.
The article to be discussed now was published in 2004 by Allen and co-workers. The complete reference is: Allen, M.K et al. (1999) Relationship between static mobility of the first ray and first ray, midfoot and hindfoot motion during gait. Foot & Ankle 25 (6): 391-396.
In order to give some background to this article, some of the anatomy and biomechanics of the foot have to be reviewed. The hind- rearfoot is the talus and calcaneus. The midfoot consists of the naviucular, cuboid and the three cuneiform bones, while the forefoot consists of the metatarsals and phalanges. This results in the foot being an incredibly complex structure of 28 bones and over 70 joint surfaces. The primary articulations in the rearfoot are the ankle and subtalar joint, whereas the primary midfoot articulations are between the talus, navicular, calcaneus and the cuboid bone. However one has the bear in mind the articulations associated with the cuneiform bones as well in regards to the midfoot. The forefoot is associated with joints where the metatarsals articulate with the structures of the midfoot, but also all the joints associated with the different phalanges. This was a quick review of some of the anatomy.
Therefore there is clearly a need to understand how these joints behave together in function. Allen and coworkers use motion in the frontal plane within the foot to look at the relationships and the interdependence of function. In order for us to understand this article the integrated biomechanics of the foot during contact with the ground in a rearfoot striking pattern in walking or running has to be reviewed. As the foot hits the ground the rearfoot, with the subtalar joint, will go through eversion driven by the ground reaction force, momentum and gravity, also known as a bottom up loading behavior. This results in relative inversion in the midfoot, even though the midfoot will be going through eversion in space. The rearfoot will go through eversion further and faster than the midfoot, therefore the result in terms of joint motion is inversion. Extending this thought process further anterior or distal in the foot to the articulation between the navicular bone and the cuneiforms dictate that this articulation also will go through inversion. Furthermore the articulation between the medial cuneiform and first metatarsal will also go through inversion. In space the absolute motion can be eversion, but the relative motion of the different joints are inversion as one moves anterior in the foot from the subtalar joint. Based upon an previous post on this blog the inversion of the first ray is coupled with dorsiflexion. See www.3dfunctionalscience.com/functional-science-–-anatomy-and-biomechanics-of-the-first-ray/. All of this is happening in the loading or pronatory phase of gait. This is what was studied in this study by Allen and co-workers.
However one has to remember that the unloading or supinatory phase of gait. In this phase the rearfoot will go through inversion now driven by the forces created further up in the integrated chain. This is known as the top down loading. The relative inversion of the rearfoot will lead to relative eversion in the mid- and forefoot. Now the eversion of the first ray is coupled with plantarflexion. One can clearly see that the timing and amount of motion of these different joints is necessary for optimal function and to avoid dysfunction.
Allen and co-workers were interested in look at the dorsiflexion mobility of the first ray to see if that would have an impact on the function of the rest of the foot as it related to the loading or pronation phase of walking. They hypothesized that an increased mobility or laxity to the first ray into dorsiflexion would impact the time to maximum excursion and amount of motion in the frontal plane of the mid- and rearfoot during the pronation phase. This was based on previous studies where it has been indicated that increased first ray mobility could increase the amount of motion in the pronation phase and delay the supination phase. This can have great ramifications on performance and also dysfunction since the supinatory phase is important for effective force production into the ground.
In the biomechanical analysis the lower extremity was divided into four segements; leg or shank, rearfoot, midfoot and first ray for analysis in the frontal plane. Static first ray mobility of the first ray was tested in a boot to stabilize the rearfoot and isolate the first metatarsal from the other four. This is also a common clinical test used to get a sense for first ray mobility. This was the dependent variable. The independent variables were time to max eversion and amount of max eversion in the first ray, mid- and rearfoot.
What Allen and co-workers found what not surprising, but reassuring in that the first ray in fact has an impact on the function on the rest of the foot. They found that increased first ray mobility will increase the duration of the pronation phase based upon time to maximum eversion as well as there was an increased amount of eversion in the mid- and rearfoot of those subjects with increased first ray dorsal mobility.
Looking closer at the data one can clearly see how motion is coupled in the foot, and that there has to be a relative inversion occurring the midfoot and first ray during the pronatory phase. This has not been discussed by the authors, but the table on page 394 indicates this relationship. One can clearly see how max eversion occurs first in the rearfoot, then the midfoot and then the first ray. As a result there is a relative inversion of the joints even though the absolute motion in space is eversion.
What the researchers also found was that there was no relationship between the static dorsiflexion of the first ray and the dynamic mobility of the first ray in both the frontal- and sagittal plane. This has also been indicated elsewhere in the literature that some of the clinical tests that we do actually does not always represent dynamic function all that well. In an unpublished Mastersthesis at the Norwegian School of Sport Sciences it was found that the clinical tests of navicualar drop, navicualar drift and rearfoot angle did not reflect dynamic function of the foot in running well.
Why is this important? The first ray can impact function of the rest of the foot as the authors argue. This can obviously be true, however this can also be viewed as a compensation for something else in lower extremity chain that is not doing their job. What is described could therefore be a compensation rather than the cause of the altered biomechanical response as the authors describe. Regardless of this, the work of Allen and co-workers is important in that they show the integrated link of human function during such a simple, yet complex, task of walking. What is most certainly true, and a great point that the authors make is that the peroneus longus, which inserts at the base of the first metatarsal and medial cuneiform, loose a great deal of mechanical advantage in plantarflexing the first ray during the supinatory phase of gait if the pronatory phase is prolonged. The rest of the lower extremity is not performing optimally to supinate the foot and the poor peroneus longus is desperately trying to plantarflex the first ray for an effective lever for propulsive force into the ground. Needless to say this is not optimal function when the demand for force production into the ground is great.
Once again thank you for reading, and this was only some of the points from the article that shows the integrated nature of functionnin the foot. Keep on following our blog for more functional posts on everything from biomechanics to anatomy and neurophysiology.
I just got back from the GIFT program about Applied Functional Science in Michigan. We all had a GREAT time. The main topic was the thoracic spine and the scapula.
Science has shown that the proprioceptors in our muscles are stimulated and react to amongst others change in length, speed and direction. Therefore it should not surprise anyone that we can end up with shoulder and neck problems if we sit too long in front of the computer or drive too far in the car while keeping both scapula still.
We have 17 muscles that are attached to the scapula. The key is to get them moving and get the thoracic spine, hips and the rest of the chain involved in this movement. We have to ask ourselves if the hips, thoracic spine and the rest of the chain have enough motion to let the scapula and shoulders to do what they are supposed to do.
I wonder who ever came up with the rotator cuff exercises with a rubber band, keeping the scapula perfectly still and not involving the rest of the chain. When, if ever, during function do we use our muscles that way? We have to load to be able to explode!
A couple of weeks ago I had a patient that was 8 months post operative right hip replacement. The patient was sore and had a feeling of tightness in the right anterior hip. The patient showed right hip weakness, poor balance and decreased motion in the right subtalar- and midtarsal joint.
The patient was asked to perform a functional test. This was a right single leg balance test while reaching anterior with opposite leg. This proved to be difficult, but after practicing two times she managed to do this without holding on to anything. After performing a mobilization to the right subtalar joint and midtarsal joint there were some very interesting changes that can be seen on the video (see link below). Two minutes later there was a significant improvement in balance, and the anterior reach with opposite leg increased with almost 100%. The patient also reported that she felt that she could stabilize the hip much better. The soreness and tight feeling in the hip also went away.
http://www.youtube.com/watch?v=AvIVi5Jc8S8
What happened biomechanically? The increased motion in the subtalar joint and midtarsal joint will cause the talus to fall down and in. This will allow the tibia to internally rotate, so that and femur also will internally rotate in space creating internal rotation of the hip. This will proprioceptively “wake up” the muscles in the hip and lower leg that attaches to the femur, tibia and midfoot. As Gary Gray says, “make phone calls to the muscles”. We totally agree; “As you call you shall receive”.
This video clip is a proof that human function is global, integrated and linked, but also fascinating and incredibly interesting to work with.
Jessica and Ola
The purpose of the functional science part of our blog is to share important functional findings from the scientific literature as it relates to training, rehabilitation and manual treatment approaches. We will also interpret the scientific literature based upon the principles that dictate function. To read more about these principles visit our homepage at www.3dfunctionalscience.com
The article to be discussed now was published in 1999 by Glasoe and co-workers. The complete reference is: Glasoe, W. M et al. (1999) Anatomy and biomechanics of the first ray. Phys Ther 79 (9): 854-859.
In order to give some background to this article, some of the anatomy and biomechanics of the foot have to be discussed. In order to describe the medial aspect of the foot one has to start with the ankle joint. The talus, which is the distal bone of the ankle joint, will articulate with the navicular bone making up the medial part of the midtarsal, or transverse joint. The navicular bone will then have an anterior articulation with the medial, intermediate and lateral cuneiform bones. The medial cuneiform bone will then articulate with the first metatarsal bone that then will articulate distally the proximal phalanx. The proximal phalanx will then articulate with the distal phalanx of the big toe.
This is a great article looking at the biomechanics and anatomy of the first ray of the foot. The first ray can be viewed at the metatarsal and the phalanges of the big toe, or hallux. However the medial cuneiform bone should not be ignored in this context, and nor should the more proximal structures toward the mid- and rearfoot described above. This article gives a great description of the anatomy of the joints associated with the first ray, which I will not discuss in detail here. However there a multiple muscles converging on the first metatarsal. The tibialis anterior, tibialis posterior and peroneus longs will insert into the first ray. The first metatarsocuneiform joint has a very interesting joint axis in the context of function. Hicks described in 1954 how the axis of rotation of this joint runs nearly horizontal from posteromedial to anterolateral. The result of this is coupled motion of dorsiflexion with inversion and plantarflexion with eversion. In order to understand this one has to see understand the biomechanics of the foot.
A frontal plane analysis of the foot In gait shows that the rearfoot with the subtalar joint will go through eversion with a rearfoot-striking pattern. This results in relative inversion in the midfoot, even though the midfoot will be going through eversion in space. The rearfoot will go through eversion further and faster than the midfoot, therefore the result in terms of joint motion is inversion. Extending this thought process further anterior or distal in the foot to the articulation between the navicular bone and the cuneiforms dictate that this articulation also will go through inversion. Furthermore the articulation between the medial cuneiform and first metatarsal will also go through inversion. Based upon the axis of rotation, as described by Hicks, this inversion will be coupled with dorsiflexion. Surprisingly enough this is what should happen with the first ray when the foot hits the ground. This argument is then reversed in the propulsive phase where the rearfoot will go through inversion further and faster than the anterior or distal joints of the foot. The consequence is relative eversion at the first metatarsocuneiform articulation. Once again the findings of Hicks comes in handy where eversion is coupled with the important plantarflexion at metatarsocuneiform joint of the first ray. Based on the axis of rotation of this joint is seems very important that the timing and amount of motion dictated by the rearfoot is correct. This is based on a rearfoot-striking pattern.
Hicks work shows another important aspect of science where studies are ignored. Just because they are published prior to 2000 does not make them bad. It seems that newer for some reason is better these days. Just look at literature reviews published on various topics where one criterion could be published after the year 2000. Should Newton be ignored?
Now back to the first ray. There are multiple ways of determining clinically mobility and function of the first ray. There are two common dysfunctions seen. There is the stiff or rigid first ray and the more hypermobile first ray, both of which can lead to all sorts of dysfunction. If any of you have had some problems with this part of your body you have probably felt how this can impact function of your lower extremities as well as spine.
The stiff first ray can lead to problems in the loading phase, which is occurring as the foot hits the ground. This will limit and inhibit function of the mid- and rearfoot. It will also decrease internal rotation of the tibia in space, which an incredible important component of function as the foot hits the ground. Overall this leads to poor shock absorption and tissues are not loaded in an optimal manner.
A hypermobile first ray will also lead to all sorts of problems. The biggest problem is that there is a lack of plantarflexion at the metatarsocuneiform joint as one propels off the foot. This plantarflexion is of great importance to the dorsiflexion of the big toe. Dorsiflexion of the metatarsophalangeal joint of the first ray is coupled 3:1 with plantarflexion of the metatarsocuneiform joint of the first ray. Needless so say there will be problems in propelling off the foot in an efficient manner if the timing and amount of plantarflexion of the first metatarsal is dysfunctional. A lack of this plantarflexion, based upon function of the rearfoot, will also render the peroneus longus inefficient in further plantarflexing the first metatarsal.
To summarize it seems that the first ray is designed to work well with the rest of the foot, and if it does not it will impact function of the entire foot, the rest of the lower extremity as well as the spine. Or as the authors put it; “Examining the mobility of the first ray and assessing the relatively static position of the metatarsal are only part of a careful foot evaluation”
Thank you for reading. More discussions to follow
The purpose of the functional science part of our blog is to share important functional findings from the scientific literature as it relates to training, rehabilitation and manual treatment approaches. We will also interpret the scientific literature based upon the principles that dictate function. To read more about these principles visit our homepage at www.3dfunctionalscience.com
The article to be discussed now was published in 1997 by Nyland and co-workers. The complete reference is: Nyland, J.A. et al. (1997). Fatigue after eccentric quadriceps femoris work produces earlier gastrocnemius and delayed quadriceps femoris activation during crossover cutting among normal athletic women. Knee Surg Sports Traumatol Arthrsc. 1997;5(3):162-7.
For a long time, I have been wondering how the muscles and joints work together and how they are friends in solving a functional task. However some friends are not always the best of friends, which leads to compensations elsewhere in the chain. This is an indication that friends will stand up for each other and are more than willing to take on a bigger responsibility in solving the functional task. This is also known as a compensation.
This study by Nyland and co-workers looks at this relationship within the lower extremity, and more specifically between the quadriceps and gastrocnemius muscle. What was done specifically in this study was to train 20 females for a couple of weeks in crossover cutting. They were then tested for the effect of fatigue of on the quadriceps muscle. The quadriceps was isolated and isokinetically eccentrically fatigued. Then muscle activation patterns were evaluated during a cross cut maneuver. The result showed that the fatigued quadriceps femoris led to a delayed activation of vastus medialis, vastus lateralis and rectus femoris. What they also saw was that gastrocnemius muscle was activated earlier. Based on this the authors concluded that the gastrocnemius seem to compensate for a fatigued quadriceps and gives the knee a dynamic stability during close chain exercises with high risk for ACL injury. They recommend that gastrocnemius exercises should be included in all knee rehabilitation programs.
Based upon this we have to ask ourselves why the quadriceps activated later after eccentrically being fatigued. Could the gastrocnemius provide stability of the knee in controlling knee extension, even though all the anatomy books clearly states that it is a knee flexor? Would the gastrocnemius now provide stability in the frontal and transverse plane now that the quadriceps have been fatigued? Or could it be that the quadriceps not only is fatigued but also proprioceptively confused?
It would also be interesting to do a similar study and look at the relationship between the gastrocnemius, hamstring- and the piriformis muscles. What would happen with to the activation of the hamstring and piriformis if the gastrocnemius was eccentrically fatigued. We are currently designing studies to start to look at relationships of this nature within the body which all of you should look forward to.
To summarize it seems that we still have a lot to learn about the human body in function. If we have a better understanding of how the muscles and joints work together, we will better be able to treat the cause rather than the symptom in the presence of dysfunction. We will also be better at determining what is the limiting factor in optimal performance when working with athletic performance.
Jessica and Ola
The purpose of the functional science part of our blog is to share important functional findings from the scientific literature as it relates to training, rehabilitation and manual treatment approaches. We will also interpret the scientific literature based upon the principles that dictate function. To read more about these principles visit our homepage at www.3dfunctionalscience.com.
The article to be discussed now was published in 2008 by Brughelli and co-workers. The complete reference is: Brughelli, M. et al. (2008) Understanding change of direction ability in sport. Sports Med 38 (12): 1045-1063.
The publication is a review article that looks at one aspect of agility, which is change of direction. Agility is the ability to rapidly change direction or velocity of the whole body in response to a stimulus. This review is on the change of direction aspect rather than the change of velocity. This is ability is important to many sports, and is frequently used as a talent identification in many sports such as football, basketball, American football and handball to name a few. This is also important at a lower level of performance in everyday life. It is common that traditional Olympic-style weight-lifting exercises are used to train for this ability. The purpose of this review is to look at how effective these exercises are at improving the ability to change direction.
The authors select articles for the review based on clearly defined standards. Furthermore there are many tests that are used to determine the ability for change of direction. The authors classified the tests based upon requirements in terms of energetics, type of force application, and number of changes of direction. Energetic classification is based upon the physiological demand on the system where the duration of the test becomes important. A test of shorter duration could describe change of direction ability better than a test that has a longer duration, which has a greater demand on the energetic system. Furthermore some tests incorporate only a few changes of direction, whereas others will have many changes of direction. It is difficult to determine the laterality of the force during the change of direction since this is individual. Which brings us back to one of the principles of function, which is that function is individual. Reliability of the included tests was found to be good.
The first part of this review was based on correlational studies. First the authors looked at how straight running speed was correlated to the ability to change direction. Some studies show that these two variables are correlated but the overall conclusion was that straight running speed and the ability to change direction has to be seen as different motor qualities. Furthermore maximal leg strength tested with multi-joint exercises and more conventional open-chain isolated testing of different muscle groups was found to be variable at best. This could be due to a number of factors, but the fact that none of the conventional tests take the specificity of the function from a movement perspective into consideration could be a very important factor. Leg power and jump height was found to have a moderate correlation with change of direction. Leg power and horizontal distance was found to have variable correlation to change of direction. What was interesting to note was the both vertical jump height and horizontal distance had greater correlations with change of direction for females than for males. It seems that a combination of the these tow variables could be a better predictor since it could give a representation of how well an athlete could create force with different directions into the ground.
The second part of the review looked at training studies. Sprint training was found to improve sprinting performance and not change of direction performance, whereas change of direction training improved change of direction and not sprinting performance. This is a great example of the specificity principle in exercise science. Training with a uniform directionality of force, vertical, will give results in this dimension, but not in others. If you train in one dimension you will become good in that dimension. This is not very surprising, and it is great to see this in the scientific literature.
Leg strength and power training based upon traditional Olympic style exercises, such as squats, deadlifts and goodmornings and sagittal plane lunges, as well as vertical jump training did not improve change of direction performance. Bilateral and unilateral vertical and horizontal jump training did influence change of direction performance. Since vertical jumping alone has been found to have no influence, it seems logical that the horizontal jumping performance had the greater effect. This makes functional sense since horizontal jumping involves a control and change of direction outside the vertical dimension, or along the z-axis. Once again this shows how one as a trainer or clinician has to consider the specificity of force creation in the training or rehabilitation program. Therefore there should be no surprise that the training programs that integrated change of direction in their training programs and considered the specificity of force creation had good results on change of direction performance.
In conclusion I would like to quote the authors;
“In terms of the training studies, traditional strength and power training methods (i.e. Olympic-style weightlifting, traditional strength training, plyomterics, and vertical jump training) have been shown to enhance functional performance (i.e. running and jumping) in athletic and non-athletic populations. These training methods have been utilized in several training studies and are commonly used in by strength and conditioning coaches. However, these traditional training methods have failed to improve change of direction performance”
There is a feature about our seminar 3D Functional Performance in All Sport & Idrott. It is great to see how other professionals perceive what we do. This particular review is written by a great chiropractor who is very passionate about sports and performance. This written in in Swedish, so it might be difficult for you non-english speaking to understand this. For those of you who do understand Swedish, here is the link:
http://www.sportidrott.se/articles/view/kroppen-ror-sej-i-3d
This week 3D Functional Performance is taking place in Stockholm Sweden. Both Jessica and I are looking forward to three days filled with the integrated nature of function. The most important lesson that we will teach, and should use in our training and rehabilitation is the principles that dictate and govern human function. Without a thorough and sound understanding of the principles that dictate function we can not design functional training and rehabilitation programs.
What we start out with tomorrow are the principles of biomechanics. These were elegantly described and presented by a well known scholar called Newton. What he wrote hundreds of years ago still holds true today. Some people are intimidated by mechanical physics and how they apply to the human body. However once these principles are understood and implemented in our training and treatment, we can see the great results in our patients and clients. We are excited about the upcoming seminar, and look foreward to another one next week here in Stockholm as well.
3D Functional Science and Ola Eriksrud was in a national newspaper in Norway describing how it is important to look at the entire kinematic chain when optimizing performance. The examples given are quite simple and common sense, however it is important to share and create interest around the integrated nature of human function and performance.
http://www.dagbladet.no/2011/04/25/tema/klikk/helse/sykdom/16302122/
In rehabilitation and training there is a lot of focus on training the back and abdominal muscles. From our anatomy we know that many of these muscles connect the pelvis to the ribcage or thorax. In function these muscles will therefore control and create motion as well as transfer energy. A simple way to understand the function of these muscles is to look at the relationship between the pelvis and the thorax. In doing so one quickly can observe how the thorax and the pelvis will move in three-dimensional space relative to one another.
The three-dimensional motion of the pelvis can do an anterior and posterior pelvic tilt in the sagittal plane, right and left pelvic drop in the frontal plane and anterior and posterior pelvic rotation in the transverse plane. The three-dimensional motion of the spine is flexion and extension in the sagittal plane, right and left lateral flexion in the frontal plane and right and left rotation in the transverse plane. These three-dimensional capabilities of motion of both the pelvis and the spine relative to one another is easily observed in function.
These three-dimensional capabilities of motion for both the pelvis the spine raises some important concerns and questions regarding different training methodologies where the pelvis is supposed to be in neutral. This neutral position is based upon the position of the pelvis relative to the two femurs distally and the proximally the lumbar spine. The pelvis can be considered as one segment between the femurs and the inferior lumbar segments. The relationship of movement between these segments is commonly referred to as the pelvifemoral rhythm.
Finding a “neutral” position of these segments relative to each other and maintaining this is considered important in different methodologies of training the back and abdominal muscles. If this is so important and following this thought-process should not the thoracic spine then also be maintained in a neutral position? This for some reason is ignored, and finding a thoracic spine neutral position can be very hard, and maybe impossible since it consists of twelve segments. Most importantly, it does not make any functional sense.
Function is movement. Think of motion of the spine as a car. Training in a neutral position of the pelvis, or rest of the spine for that matter, is like training for always driving in the middle of the road. It is hard to drive off the side of the road when one is always driving in the middle of the road. This is very safe, and not how driving is done. So if one is to learn how to drive a car, one has to be able to steer the car by turning and finding the edges of the side of the road. In driving, as in function, the whole road has to be known and controlled. So put your car in neutral and start driving!
I was in Copenhagen and Odense last week giving lectures together with CAMP Scandinavia. The topic was Functional Biomechanics. When the foot hits the ground everything changes….
The more I learn about biomechanics the more I realize the importance of the foot. Recently I treated a young girl with plantarfascitis. In prone and in subtalar joint neutral I found a severe compensated forefoot varus (it felt stiff), vertical calcaneus, and limited first ray motion, leading to decreased dorsiflexion of the big toe. When I asked her to perform a single leg squat, the knee fell in to severe genuvalgus. The foot remained pronated all through stance phase during gait. I also found weakness in the gluteus muscles, posterior tibialis and quadriceps.
By mobilizing the midtarsal joint, first ray and big toe in sitting and in standing I managed to get rid of most of her forefoot varus. I gave her one exercise to do at home to keep the motion in the midtarsal joint and two functional exercises for her feet, legs and hips to build up stability.
One exercise was single leg squats with the arms reaching posterior lateral of the stance leg at shoulder level (to reinforce external rotation of femur and tibia and supination of the foot, preventing the knee from falling in to severe genuvalgus and overpronation of the foot).
The question is now, – what would have happened if I would not have done the mobilization, and instead would have made foot orthotics right away? Would that have changed the outcome of the orthotic? It must be hard to get the foot in the correct position if you make the orthotic in standing, the mid foot was so stiff. If you make a cast in prone it must be important that you don’t make an orthotic with a forefoot varus post that must just reinforce the compensated forefoot varus. The foot looked completely different in both prone on a table in subtalar joint neutral and in standing on a mirror after the mobilization.
How often do we suggest orthotics to our patients without asking ourselves why the foot and the rest of the body acts/reacts the way it does? How long should we wait until we make foot orthotics? I believe in orthotics and have seen great results with it but I have also seen great results with patients that I first thought needed foot orthotics but tried mobilization and training first and found out they did not need any.
I don’t have all the right answers but I truly believe we should ask ourselves the question WHY more often. I believe if we make orthotics for a compensated forefoot varus (supinatus), building up the medial side of the forefoot, we could end up treating the symptom instead of the cause and even maybe make the problem worse.
We must ask ourselves why so many orthotics end up in the closet?
I will fly to Michigan next week and attend the GIFT seminar with Gary and Dough Gary and David Tibero. They will probably be able to give me an answer….
The great think with biomechanics is that we will never know it all. That’s what makes it so much fun and interesting. I can’t wait to learn more…..