Simply Inspiring.. Elephant with Amputation

Elephant who gets his foot destroyed in a hunter trap, gets a new lease on life!

Check story here: http://worldblog.msnbc.msn.com/_news/2011/11/04/8633536-wounded-elephant-walks-again-thanks-to-jumbo-sized-false-foot?lite

Away with the flat feet! AAF Beware! - Adult Aquired Flatfoot (AAF) and Posterior Tibialis Tendon Dysfunction (PTTD)

Adult Acquired Flatfoot - aka AAF - is a deformity of the foot and is a result of a number of different pathologies. In practice, the most common reason for the development of AAF is Posterior Tibialis Tendon Dysfunction (PTTD). We're done with the abbreviations for now...

Bilateral Posterior View

Taken from: http://www.podiatryandchiropodycentre.com/flatfeet.html

Bilateral Anterior View

Taken from: http://www.foottalk.com/d_flatfoot.html

Unilateral (R) Posterior View

Taken from: http://test2.aaos.org/oko/description.cfm?topic=FOO017

AAF is a technical way of saying that over time, your arches have collapsed. This can lead to significant pain in the foot, but because of the position the ankle is held it can also contribute to knee hip and low back pain. The foot being in a fallen arch position also leads to further degeneration of the joints of the foot and can make simple walking very uncomfortable.

PTTD is one of a number of ways to progress into AAF. The posterior tibialis muscle holds up the longitudinal arch of the foot, stabilizes the midfoot, and plantarflexes/inverts the foot. This tendon/muscle can become damaged with high-impact sports of jumping/landing/running (basketball, soccer - made worse by the fact that there is absolutely no support in soccer shoes!). Other risk factors for development include being a woman over the age of 40, previous injuries to the ankle, diabetes and high blood pressure. Obesity is also a huge contributing factor (no pun intended?).

Taken from: Travell and Simons

Predominantly, PTTD is treated with custom foot orthoses or ankle-foot orthoses along with a stretch and strengthening routine. This treatment regime was substantiated by a number of articles that were released and published by Kulig from the University of Southern California (Physical Therapy), one being: Nonsurgical management of posterior tibial tendon dysfunction with orthoses and resistive exercise: a randomized controlled trial published in 2008. It described a 12 week program comparing three categories of regimes: orthotic wear with stretching (1), orthotic wear with stretching and concentric exercise (2), and orthotic wear with stretching and eccentric exercise (3). Best outcomes came from the third group - the orthotic/stretch/eccentrics.

So how to we train the posterior tibialis muscle/tendon? Finally the meat and potatoes! Kulig is rampant with the research, and published another paper describing firing patterns of different muscles of the foot/ankle with different resisted movements. She found that the resisted movement that engaged the posterior tibialis muscle maximally without significant contribution of other foot muscles was planted foot adduction.

Images taken from: http://blog.runnersroost.com/blog/?p=840

You can see that she is seated (the knee has to be at 90 degrees to allow rotational motion at the knee joint) and that her heel remains in contact with the floor at all times. Concentration is emphasized on slowly releasing the elastic from an adducted position. This being an endurance muscle, we will train it as such: 3-4 sets of 20 reps.

 

Another great isolation exercise to add into the rehab of clients requiring it!

References:

Kulig, K et al. (2004). Selective Activation of Tibialis Posterior: Evaluation by Magnetic Resonance Imaging. Medicine & Science in Sports & Exercising, 36(5), 862-7.

Kulig, K et al. (2006). Non-operative management of posterior tibialis tendon dysfunction: design of a randomized clinical trial. BMC Musculoskeletal Disorders, 7(49), 1-7.

Hamstring, yes! Popliteus... what's that?

Many of us know the common muscles of the body, and are proud to be able to point them out on yourself or someone else. Now I want to make you aware of some of the important muscles of the body that may not be as familiar. Let's start with a small muscle called the popliteus.

The above image is taken from a textbook written by Travell and Simons (the first book to buy as a physiotherapist!). It shows the relation of the popliteus muscle in the posterior aspect (back) of the knee. It is the deepest muscle of this region, and is often forgotten by therapists. The muscle does cross the tibiofemoral joint, but does so in a position that is very proximal to the joint itself, decreasing the lever arm of the muscle.

Functionally, this is a muscle that stabilizes the posterior knee (giving aide to the PCL ligament - stopping the femur from sliding anteriorly when in a squat position), as well as takes the knee out of the lock-home position. When you straighten the knee fully in a weight-bearing position, the femur slightly internally rotates on the stationary tibia to 'lock' the knee in position. The popliteus will then externally rotate the femur (in weight bearing) to take it out of this position.

So why do I care so much??

To an overwhelming extent have I seen knee injuries that tend to result in popliteus spasm. Often if the client is unable to get to a fully extended position, the popliteus is the cause (I am speaking now from my experiences in the clinic and on the field). As described by Travell, pain is localized normally to the posterior aspect of the knee and presents typically with squatting, walking/running (decline worse than incline), and going down stairs.

Treatment of an irritates popliteus muscle can include myofascial release and self-stretches, but it is important to have your knee assessed by a physiotherapist before starting self-therapy. There are a number of injuries that can present with pain in the posterior knee that include a PCL tear or a Baker's cyst.

References:
Travell, J. G. & Simons, D. G. (1993). Myofascial Pain and Dysfunction: The Trigger Point Manual - The Lower Extremities. Philadelphia: Lippincott Williams & Wilkins.

Book Review: Maximum Strength - Get Your Strongest Body in 16 Weeks with the Ultimate Weight-Training Program

It's been a little while since my last post, and I've been doing a bit of reading... Eric Cressey is a strength and conditioning specialist based out of Boston, MA, who works with many world class athletes in his gym, as well as consultations overseas to those unable to meet with him in person.

Workout books can be very hit and miss. Some have nothing of value in them, and are boring to read. Complete opposite for this book.

Cressey looks at building strength vs size, and gets people involved with the lost art of power-lifting. I think the most worth-while part of this book is the warm-up routine that not only includes some specific static stretches, but also emphasizes trigger point release with a tennis ball and foam roll. There are even some useful self joint mobilizations, something which lacks in many warm-ups. Every routine begins with this 15 minute warm-up, and it's a great way to get limber for what's coming up in the workout.

The entire program begins with a self-evaluation of strength and power, as here is where we get our baseline values to base how much we lift. This test will be administered at the end of the 16 weeks to be able to quantify your gains as you go though it.

Workout weeks have only 4 training days, two upper and two lower quadrants. The sessions are also not very long: an added convenience! The 16 weeks are then split into four phases:

1. Foundation - getting used to lifting heavy, low reps
2. Build - load increase and cluster training
3. Growth - lighter load, but higher rep sets
4. Peak - single-rep sets of about 90% 1RM

The exercise emphasize global, and multi-joint strength, and very little on concentrated work (ie: machines).

If you are looking for a change in your routine and want to build strength, this is definitely a book that I would purchase.