Who's Zoomin' who?

A great old song from Aretha Franklin.

The feet pictured above belong to one of our cross country runners. This athlete approached me complaining of an annoying chronic right knee pain along the inferolateral patella. The past few years, when ever she gets to a certain point in her training volume/intensity it flairs up.

Looking at the overpronation in the left foot, you would think it was zoomin' the LEFT patellafemoral joint. Not the case here.

What is going on is the foot compensating for a leg length discrepancy- in this case, the left leg longer than the right. The calcaneus everting, the talus following to make the leg shorter.

I placed a full length 1/4" felt insert in her right shoe and within days the R knee pain/edema were significantly reduced. Of course more more needs to be done, ie some myofascial work on the R lateral knee structures.

Correcting the left foot overpronation could have made the pain worse.

So, be careful when deciding what to do with what you find on a movement screen. Decide what is a bonafide dysfunction, & what is a compensation.

In other words, do what Aretha does and ask, "Who's zoomin' who?

A little more about me.

A reader comments: "I would love to join the GAIN network and I would also love to join Gary Gray's GIFT program but it takes money and I ain't got it."

I want you to never forget that I am a real life high school ATC, just like you guys. And, I will never try to sell you something on this blog. As the title states, it is dedicated to you guys.

A little more about me. I have been fired from my position here at Elizabeth High School twice in the past 23 years. In both cases, combinations of a coach and administrator who had it in for me. I'm not sure what ever happened to the ATC who replaced me, or the coach & administrator. They're probably selling insurance or real estate some where.

The point is, the only reason I was asked to come back is because I produce. I produce because I am competitive, and want to do a better job then the next guy. Had I not met Vern Gambetta some 15 years ago, I'm not sure I wouldn't be selling insurance too. He introduced me to Gary's concepts, the kinetic link principal, and I still believe it's the fastest & most effective way to get the job done.

Elizabeth High School has not paid for a single continuing education credit. All of it has been out of pocket for me. This stuff is not only my profession, but also my hobby. Sorry, but the idea of spending thousands to hit a little white ball over a green doesn't excite me. But this stuff inspires me. If you think I'm a dope for doing it, fine. But, the little 60 minute bites I was getting at conferences was not enough in this era of competitive health care. Who says a chiropractor or P.T. can't learn how to tape and do what we do?

Look, I'm not suggesting YOU pay out of pocket for anything. But, many wouldn't think twice about asking their board of ed or booster club to purchase an electrotherapy unit for thousands of dollars. And like I asked in a previous post, are you getting the biggest bang for your buck? Can you take out your stop watch or goniometer and measure the improvement? If you can't, maybe think twice about how you budget your money. The kinetic link principal is the best modality I own.
I hope you'll continue to let me share it with you.

Recovery & Restoration

Make sure you read Vern Gambetta's blog today. He discusses the trend of using corrective exercise in place of performance training. Every sport has it's injury patterns, and an appropriate remedial program should be built into every athletic development program. My Mulligan Technique instructor used the phrase, "asymmetry is the norm". Attempting to correct it may have undesirable effects.

For instance, I recently had an ex basketball player of mine, who is training for in the police academy come to me complaining about lateral knee pain on his distance runs. He has has genu varum that is contributing to ITBFS. Basically, the same anthropometric makeup that made him great at jumping and lateral movements make him a lousy distance runner. Running long and slow will not be required once he graduates the academy (especially with the action he'll be seeing in this part of NJ!). So, a little ART with some active/passive stretching thrown in and he's doing just fine. If you body mapped him, I sure you could find plenty of stuff to work on. Orthotics and all that.

I think the muscle imbalances that may come up with non-cyclical sports such as baseball or tennis can be addressed as part of the recovery process. Why does recovery need to be passive? Why can't the athlete do some throwing or hitting or racket swinging with the opposite arm? How about the cross country runner running backwards or laterally?

Econcentrics

This term refers to the concept that muscles may be acting concentrically, eccentrically, & isometrically all at the same time, at different joints, and/or in different planes of motion. JH asked me to give an example of where this occurs in the human body, and the answer is everywhere. If you are going to buy into the concepts put forth in my blog, you have to re-examine the idea of agonists, antagonists, synergists, and stabilizers. In function, all muscle are synergists. I am not an expert in this area, and if you need more info, Gary Gray goes in depth on the concept in one of his functional video digests. If you really want to dive into this stuff, apply for next year's GAIN APPRENTORSHIP and learn hands on. Dr. Dan Cipriani, biomechanics professor at San Diego State will go over the theory, while Vern & Steve put it into practice.

Ay Dios Mio, here come the rotten tomatoes again, but here is an example:

The gastrocnemius at late mid stance: Proximally is isometrically contracting to prevent hyperextension at the knee, distally eccentrically decelerating dorsiflexion at the ankle, while concentrically inverting the calcaneus.

Why ask Why Comments

Kevin Moody says:

"I see quite a few high school runners with MTSS. When I ask them to squat they usually internally rotate at the hips, adduct at the knees and pronate at the foot/ankle."

There is a reason Kevin is the head ATC at the Lake Placid OTC. He is a great "functional listener". Right on Kevin- MTSS, stress fx are force reduction problems. Films on lower leg stress fx commonly show spiral or frontal plane patterns:

External Frontal Plane Loads May Be Associated with Tibial Stress Fracture/
Medicine & Science in Sports & Exercise. 40(9):1669-1674, September 2008.CREABY, MARK W. 1,2; DIXON, SHARON J. 2

Free moment as a predictor of tibial stress fracture in distance runners/
Journal of Biomechanics , Volume 39 , Issue 15 , Pages 2819 - 2825
C . Milner , I . Davis , J . Hamill

So, what I'm after here is moving the center of gravity to the inferomedial tibia & use contralateral LE drive to add a FP, TP force.

Why the arms up over behind my head? Right again Kevin, I'm influencing the core. In this case, I'm taking my glutes, lats, & erector spinae out of the picture as to make the leg itself work a little harder (integrated isolation, as G2 calls it).

JH, great comment about the pronation lengthening the tibialis anterior!! A very underrated force reducer. Dr. Dan Cipriani, biomechanist & GAIN faculty member makes a good point that every muscle has a triplane function, & contracts ECONCENTRICALLY. In other words, it may be working isometrically in one plane, eccentrically in another, and concentrically in third. I've seen some practitioners use variations of toe raises to strengthen it. A waste of time, I think.

Thanks again Kevin & JH...you guys keep me psyched up.

Why ask why?

These are two exercises I include in prevention/rehab for medial tibial stress syndrome. They are a RLB, LLE L lateral reach; & RLB, LLE L rotational reach- both c/ a BUE posterior overhead reach. OK, now put your thinking caps on, as Sister Vincent Marie, my first grade teacher told us.

Why these two exercises?

Why am I lifting my hands behind my head?

FMR

the acronym for functional manual reaction. The brain child of Gary Gray & Dave Tiberio, it's a type of joint mobilization done in functional positions, using authentic drivers , based on chain reaction biomechanics. It's a great time saver for the ATC because proprioception is built into the process. If you haven't done so yet, go the the Gray Institute's link on the right & sign up for their free internet news letter. FMR is featured in this month's installment. Pat Donahue, if you're out there, feel free to add in anything I missed.