October 27, 2009
Have you ever had a client complain of knee pain?
You give them some corrections and maybe it hurts less but it still hurts?
This is frustrating for you but, mostly for your client.
Perhaps no region of the body takes a greater beating, both figuratively and in actuality, than the knees. The knee is the largest joint in the body and also is the joint that suffers the most degenerative changes in our clients and patients. While there may be contributory factors, genetics, poor arch support, and even our unique anatomical make up there is much more to our knee issues. Let's take a look at the knee to better understand its function. The knee is considered a hinge joint. However, unlike a true hinge-joint the knee has an all-important rotational motion. As you are aware, during the loading phase of gait, pronation of the lower extremity involves flexion, adduction, and internal rotation at the knee. This pronation of the entire lower extremity is extremely important in appropriately loading both the ankle/foot complex as well as the posterior hip. So here in lies the potential problems with corrective shoes or orthotics when given to the wrong person. Too often we see patients who have been advised to purchase and wear, pronation control shoes and to complicate matters, they are often given an additional over-the-counter orthotics. This is great if you are a true pronator. However I have found in our clinic, only about half our patient population are true pronators and probably only a small minority of these individuals need long time support from orthotics. I am not suggesting to throw out your orthotics or pronation control shoes. I am suggesting that they can be potentially detrimental to the long-term function of the kinetic chain. Especially when it comes to the knees. How do orthotics or overly supportive shoes beat up the knees? Remember the function of pronation...to efficiently load the posterior hip as well as the foot. Spreading of the metatarsals and stretching of the interossei muscles reflexively activates contraction of the extensor chain. Orthotics can and often do, block this function and don't allow the big toe to contact the ground. In an attempt to get the big toe in contact with the ground, we will often drive the knee into further adduction and internal rotation. Guess what happens? Increased valgus position of the knees! Try this on yourself... If you have pronation control shoes or orthotics. When you go to squat or lunge are you able to get and keep you big toe down on the ground? Do your metatarsals spread?(I feel a song coming on, sorry) In an attempt to keep your big toe down does your knee or knees go into valgus. Possibly you are thinking...what about the tight adductors and weak abductors causing this problem? Could be... however that is not what we find most often in our clinic. Generally, we find weakness of the internal rotators (tensor fascia latae as well as the anterior fibers of gluteus medius and minimus) in addition to loss of ankle dorsiflexion. So how do we improve this function and reduce wear and tear on the knees? ü First, we must improve foot stability and get the big toe stable on the ground ü Next, we have to improve hip stability (improve the client's ability to centrate their hip) and dissociate (move the hip independent of the ilium (coming next issue of FITNESS INSIDER) ü Coordinate these functions into a proper movement progression. Go back watch last week's video again. I go through the progress of the foot to the knee. Conclusion: Improve foot stability, coordinate the entire lower kinetic chain, and follow the proper exercise progressions appropriate for your client. Coming next edition of FITNESS INSIDER: RAISING THE STANDARD - Part IV: 3 New Moves for Enhancing Hip Rotation If you missed Part I or II you may read it on our website: www.fitnesseducationseminars.com Coming next edition of FITNESS INSIDER: RAISING THE STANDARD - Part IV: Improving Hip Rotation
Train Responsibly,
Evan Osar
www.fitnesseducationseminars.com
October 21, 2009
Leonardo da Vinci considered it "a masterpiece of engineering and a work of art" and Greek philosopher Socrates said, "When our feet hurt, we hurt all over." The ankle and foot complex is one of the most intriguing regions of the body. Just consider: ü There are 26 bones in the foot and 33 joints ü There are over 100 ligaments and approximately 20 muscles that control the foot ü The average person takes approximately 10,000 steps per day and will walk over 100,000 miles in their lifetime Unfortunately we do many things to our feet and ankles that compromise their function. Consider: ü walking on flat surfaces ü wearing overly supportive shoes ü inappropriate or overuse of orthotics ü wearing high heels ü ankle sprains and injuries that are not rehabilitated appropriately Generally speaking, these things tend to lead to loss of ankle dorsiflexion and foot stability. Recall in our functional model the ankle must be mobile and the foot must be stable. However, this is a generalized look at this region. Consider for instance. the 26 bones and 33 joints contained within the foot. This suggests that the foot must be a mobile adapter to the ground. Obviously it doesn't have to conform much to flat surfaces however walk on some grass in bare feet and you will see just how many adjustments and positions the foot must adapt to. So therefore, the foot must be a mobile adapter to the ground yet become a stabile platform in which to push off and propel the body forward. Hence the problems we often run into with bunions, hammer toes, claw toes, and related foot dysfunction. How do we go about changing these patterns that are all-too-often blamed on bad genetics or familial traits? Improve foot stability. Recall in that in the presence of instability, the body will compensate by tightening certain muscles. In the case of the foot, weakness in the intrinsic muscles of the foot, primarily the: lead to overuse of the long toe flexors for support. This in turn leads to toe clawing for support during the loading phase of gait, loss of ankle dorsiflexion and eventually bunions and many of the other foot dysfunctions we see in our clients. While it is much more complicated then I have made it seem here, hopefully you begin to get the idea about the complexities of the foot and how the way we use our feet through out the day and life lead to many of our problems. And unfortunately, because of the reflexive patterns that are set up in our feet, we will see compromises far up the kinetic chain. We will discuss this further when we approach the thorax. In the meantime, let's address one key aspect of improving foot stability - stability of the great toe. If you missed Part I you may read it on our website: www.fitnesseducationseminars.com Coming next edition of FITNESS INSIDER: RAISING THE STANDARD - Part III: Enhancing Knee Stability
Train Responsibly,
Evan Osar
www.fitnesseducationseminars.com
P.S. I know some of you ran into problems trying to purchase the shirt I am wearing in the video. (Thank you to those of you that emailed us.) We have been told that problem is fixed. So if you would like to let the world know that you as a fitness professional can have profound affect the state of health care in our society you can purchase the shirt that says it all now. Buy shirt now!
October 19, 2009
Last weekend Jenice and I were walking down a path by the water out in San Francisco and I was wearing my shirt from the last symposium. Those of you that were there know what shirt I am talking about.
Two guys that were jogging stopped us because, they wanted to make sure they read the shirt correctly. They had!
Do know what they told us?
One guy said, "that shirt is so flipping great, I love it, it is so true." The other guy said, "you have to get that message out into the world."
So what does the shirt say that is so profound?
You know what, these guys weren't even fitness professionals but, they did understand how important our message is as fitness professionals.
So, will you help spread the value of our message as fitness professionals?
The shirts are available at: www.fitnesseducationseminars.com
Train Responsibly,
Evan Osar
www.fitnesseducationseminars.com
P.S. Coming next edition of FITNESS INSIDER: RAISING THE STANDARD - Part II: The Foot and Ankle
