This blog comes courtesy of a conversation I had with my good friend Mike. Its all about optimum range of a muscle. It kind of followed on from this piece of info…

The eccentrically-loaded muscle will start its contraction weak and then get stronger; the concentrically-loaded muscle will initiate strong, but get weaker as the contraction continues.

 I had never given this much thought before but this makes a lot of sense when we think of length tension relationships. A muscle will struggle to produce force when both too long and too short.  Being weak in both positions. Cross bridge attachment has an optimal range.  This will be true of both force production and conservation of energy. Too much cross bridge detachment will also cause a more thermodynamically expensive scenario as we split ATP and dissipate energy as heat.

Elastic energy will also I believe have an optimal range. Studies have shown that spring stiffness (ability to return energy) comes from optimal joint angles or ranges. Going beyond this range means that we dampen or absorb energy, again dissipating as heat through visceoelasticity of tissue. Different tissues have varying levels of stiffness and compliance, different ranges will bring into play these different characteristics as will our neurological intention (land or jump again) to move control stiffness through efferent spindle stiffness regulation.

If we look at the way we jump when we want to jump again, we can see that we use a shorter joint range than when we land for the final time.  When we finish we have a large bend of the knee to absorb ground reaction forces rather than reuse them. This has implications for our understanding of height, range and repetition programming for our training me thinks!!

Ecconcentric (both eccentric and concentric muscle contractions occurring in different planes) muscle action may also play a role in optimal cross bridge attachment. If a muscle was to lengthen in all three planes this may cause a scenario where we are going beyond the optimal range for the muscle in terms of force production and elastic energy recoil. By mitigating elongation of the tissue in a plane of motion through concentric shortening we may also keep an optimal range. It maybe this would happen in a more sub maximal scenario where energy return and energy conservation are more important than maximal force production. I feel that gait is a great example of this. Although maximal force production may also be mitigated by creating too much loading through joint range that is hard to transform.

This then got me thinking about how we train. Many times we are looking for maximal ranges in our training. Maybe we should be looking more at optimal ranges. This may have more implications for sports where we can control the range through skill however. Running is a great example. Controlling stride length will keep us within optimal joint ranges. We must also remember that optimal will be governed by the individual. This will be affected by tissue ability, limb length, speed ability and event. I expect it will be that different events within running e.g. 400 metres will need different joint ranges from a marathon as we balance need for all out power, power-endurance and endurance. Going beyond optimal means our ability to start the next phase of movement, either eccentric to concentric or vice versa, will be compromised. I think that deceleration and acceleration are part of running (unlike the pose method ideology!) However we can mitigate excessive amounts of both having to occur, increasing energy conservation.

If we look at a game of tennis it is much easier to hit a powerful shot when we can manoeuvre our bodies into position. When we are out of position our range of movement may have to be extended to reach the ball. The transformation from eccentric to concentric is sub optimal and affects the power of the shot. The tennis player many times at end range will hit a defensive shot back, aiming to get it in the court rather than a winner! Increases in amortisation from eccentric to concentric reduces cross bridge attachment also decreasing energy return. The closer we get to and stay at end range stretching for the ball the longer we have the amortisation phase reducing the energy gained in the loading motion.

This is a very theoretical piece and mainly my own thoughts (so blame me!!) but it may give us food for thought when we programme ranges/heights for our clients to move through when training.

More may not be better in all circumstances!!!

 

This blog post is all about my wife and our upcoming baby due in September.It has been very interesting to observe my wife’s change in movement over the course of her pregnancy.

She has suffered from some pelvic pain recently, something that many women suffer from in pregnancy. It has been very obvious why, when we look at the biomechanics from a functional perspective. As we should all be aware by now our pelvises move in all three planes. As the baby house as I like to call it grows, it may rotate the pelvis to the anterior as it has done in my wife’s case. It should be noted however that some women might rotate the pelvis to the posterior due to the changes in centre of mass and the law of individuality.

The anterior rotation of the pelvis will reduce the amount of extension that can be gained in the sagittal plane. The lack of sagittal plane motion will also reduce the amount of transverse plane motion available as well. The reduced stride length in the sagittal plane will reduce the amount the pelvis can rotate over the femur. This leaves us with the frontal plane as the least compromised plane of movement. However what if the woman is not all that great moving in the frontal plane?? That maybe where problems start! I think that my wife’s problem maybe compounded by my sons love of hanging out on the left side of the womb. It is very obvious as she stands that she displaces her weight onto the right hip, maybe to act as a counterbalance for the weight of the baby on the left side. This would tighten the right hip capsule in the frontal plane. With it already limited in the sagittal and the transverse I think this spells trouble. She has complained of pain on the lateral left hip. With the right hip adducted, the adductors and medial capsular ligament will limit abduction on the right hip and therefore adduction, both rotation and translation, on the left. This will not allow the lateral abductors on the left to lengthen and may become irritated as I believe is happening. It may also compromise the SI joints on both sides and also the lumbar facet joints. Both structures rely on compression and decompression in all three planes for healthy pain free operation.

My solution to this problem has been to hit the anterior capsule on the right side. I would dearly love to hit the posterior capsule on the left but due to her size at 6 ½ months that is proving problematic.  I have then followed this up with a more dynamic strategy to restore extension/rotation/abduction on the right and adduction on the left. It seems to have made a world of difference so far but she needs to perform the stretches quite regularly to stay pain free. The movement dysfunction will not go away until late September when the baby house, fingers crossed, turns into a beautiful bouncing baby boy!!!

I am writing this sitting over looking a beautiful bay in Crete. I now know why writers such as Hemingway and Greene got inspiration from tropical surroundings! Although I cannot rival their writing I will offer you a window into my soul (for what it is worth)!

One of the books I chose to bring with me was Bounce by Matthew Syed. Bounce is really about practice vs innate talent. It has very much struck a chord with me and given me both positive and negative thoughts on the subject of practice.

In the book Matthew talks about the formula for becoming an expert. This has apparently quite accurately been put at 10 years. In fact with an average of 1000 hrs practice per year this gives us the figure I have oft heard quoted of having to put 10 000 hrs in to become an expert. This reminded me however of a quote oft used by my friend Christian "have we had 10 years experience or 1 year 10 times??". So really an expert should have grown the knowledge they had originally adding to it as they practiced.
The fitness industry is a wonderful thing. It allows us to practice what we love doing daily. One of my students turned round to me and said "I have learned so much from the clients recently". I found this a beautiful comment. He was the expert in the relationship with his client but still found wonderment in how much he got outside of the financial transaction. That is the mark of someone who will continue to learn and grow into an expert. His desire to practice is admirable.  Something that I find invaluable in teaching is still treating and training on a daily basis. The more people you work with the more you learn and the more you can pass on. I think this side of what I do is integral to all the others and reminds me of why I have a passion for this business. All of the people I have learned from and respect in the industry have something to pass on from their 10 000 hrs. In fact this is what has driven them to educate as it has shaped there understanding of the body, adding to what they know rather than just passing on what they have learned elsewhere.

I certainly think that this reduces the number of experts in the industry. Learning something does not make you an expert. Practicing and adding to it year after year does. In fact I think that it would be strange to be able to follow a training system for so long and not experience things for yourself that would lead you to adapt or change it with your own personal experience. Many so-called experts seem to have very little personal opinion (Some would say I have far to many opinions!!) born from only educating themselves via one route or person, that means that their expertise is not from personal experience but from another. If this still makes you an expert or not I am not sure however! That is always in the eyes or ears of the individual making the judgment.

I for one will continue to try to add to my 10 000 hrs although I would regard myself as no expert! I daily still feel dumb when confronted with the wisdom of others but this I think is healthy as he who thinks he knows all probably knows nothing anyway!

Overpronation is one of the most frequently used terms I hear in fitness. This is from both trainers and clients. The plethora of pronation control shoes has plucked the word from the world of anatomy and physiology and biomechanics into everyday terminology.

Although the word is widely used it is not widely understood. Overpronation can happen in many ways and for multiple reasons but is generally used as a generic term and no more attention is paid to it.

Lets first define pronation. It is the triplane action of dorsiflexion, eversion and abduction at the rearfoot.  These joint motions are relative to the bone motion of the talus which is the primary moving bone in a closed chain scenario. This rearfoot motion will also create relative forefoot dorsiflexion, inversion and abduction. The forefoot can have quite an impact on rearfoot pronation that we will talk about later in the blog!

Now lets look at the different ways in which we can overpronate.

1. Range-I think this is the "classic" definition of overpronation. The amount of distance that the joint goes through. Obviously far too much range places stress on the joint and muscles all through the kinetic chain of the lower limb. The associated tissues have to work hard to control the excess range. Common problems that can arise are posterior tibialis syndromes, Achilles problems and ITB problems.

2. Rate-Along with range goes the rate or speed/acceleration of pronation. The larger the range, the more distance to accelerate into. This again causes problems for the muscles/tissues that have to decelerate this increased acceleration.

3.Sequence-This is the most overlooked element of overpronation. Pronation should occur at initial heel strike and be followed by supination. If the range and rate are excessive then the foot is unable to reverse the motion in time to go into supination. This means that someone may pronate through midstance and also through the propulsive phase of gait. If any of the motions associated with supination are restricted it may also lead to a return to pronation late in the gait sequence.This can also be because of the instability created by the pathomechanics of different foot types. This can lead to plantar fascia problems and HAV bunions as the foot remains in its unlocked mobile state rather than becoming the rigid propulsive unit that the supination process creates.

The question most often overlooked when it comes to pronation problems is WHY??           A good knowledge of foot dysfunction is required to really answer this question. The most overlooked area in my opinion that causes pronation problems is ontogenic (developmental) forefoot positioning relative to the rearfoot. However I am also really interested in the spatial location of the STJ (subtalar joint) axis. The medial  deviation of the STJ will increase the moment arm of GRF (ground reaction forces) associated with pronation and decrease the moment arm of the supinatory muscles. It will also increase the area of the foot laterally to the STJ that  cause pronation to happen when force is applied. The lateral deviation will do the opposite with more internal muscular supinatory force and decreased GRF pronatory force occurring and increased medial area of the foot that will cause supination.

Anyway, back to the forefoot!! An inverted or varused forefoot position will be compensated for at the rearfoot by excess pronation. Another scenario is that the foot is able to get into supination but the extra instability of the varused forefoot causes a pronation response to get the forefoot on the ground and create stability. This would happen late and out of sequence in the gait cycle. This means that just controlling the longitudinal arch as many pronation control shoes do, does not gain quite the control anticipated.

Many times I also see short or half foot orthotics. These orthoses have arch control but do not provide stability at the forefoot. This is done by bringing the ground up to the foot, to stop the foot trying to search out the ground. Without the forefoot control I see the foot unable to pronate to compensate because of the arch control, instead using the transverse plane to rotate the foot and tip onto the forefoot. This maybe a reason behind a medial heel whip!! A similar thing can happen when the STJ axis height is high and favours transverse plane motion over frontal. The STJ axis height should be around 42 degrees from the transverse plane, slightly favouring frontal plane motion.

I realise this a bit of a big post, but is also a really big subject. Much more complicated than many give it credit for, so thanks for reading. Until next time....

Ben Cormack

This blog post is all about the foundations that we build our treatment or training on. First however I want to take this opportunity to tell you all about the new educational company Cor-Kinetic that I have set up. After delivering some weekend courses I thought that I wanted to make it a little more formal and this is the result. I will keep you updated through the blog and also for your functional fix check out the facebook page.

http://www.facebook.com/#!/pages/Cor-Kinetic/213918865295605.

Right, lets talk about foundations. Foundations form the basis of how we go about doing what we do. For me they are a checklist to make sure what I am about to do is right for the job in front of me. It is not what I did to the person before, it is not what I saw someone else do and liked the look of. It is the right and applicable thing to do based on the foundations of what I have learned and applied many times to refine the technique I am about to use.

I always make sure I understand fully the reasoning behind what I am doing. In fact many times I have steered away from doing things till I feel I have the proper knowledge to apply them. It may mean reading additional information or learning new terminology, but I feel that this leads to a more rounded approach in the end, even if it takes more time. In fact it has led to lots of frustration until the penny clicks, but when it does it becomes a more powerful tool in the box.

We have become a very technique based industry but without the underpinning knowledge or foundation are we less effective with these techniques?? Some times we need the basics before the fireworks. No learning of knowledge is a waste even if you can't apply straight away, but it may serve you well in the future you just may not know when!!!

Also when we do learn new stuff are we suddenly a master? Or do we need to refine the process?? Did the person who taught us dream it up or did they teach from years of experience, mistakes and eventually refinement into something tangible to pass on. This practice forms part of our foundations. If we just learn from picking up what others do it becomes monkey see monkey do, almost a game of Chinese whispers with a barely recognisable outcome to the original concept.

Make sure you have your foundations in place!!!

Ben

 

As the oft quoted saying goes "if your not assessing your guessing". Well today's blog post is all about assumption.

In the fitness industry we are often guilty of assuming that one type of dysfunction will lead to another or create a certain posture type. While I definitely believe there are trends and patterns to peoples movement and movement dysfunctions, when we start to believe they are truths is when we start to let our clients and patients down.

I often read claims from people that they can tell amazing things just from looking at one part of the body. One thing I have learned about the body in my years of dealing with it is that the body has more ways than anyone can imagine to compensate for dysfunction. I always take the time to back my assumption up with rigorous testing that lets me know exactly what is going on in each segment of the body. Someone I respect very much makes a vast number of assumptions but makes it his job to prove them right. And guess what, he does it through rigorous testing! If proved wrong then on to the next assumption but he would never leave it at the assumption stage with out proving it as fact.

Another classic is when we pin the blame on a muscle when hearing of a chronic injury. "Its the hamstrings" is a favourite of mine or a joint motion "dorsi flexion" being another favourite. I have often thought to myself certain things about why someone may have a problem when hearing about their exercise history and I have been proved many times to be right but also wrong.I have done this through assessment.

The biggest tool any one dealing with sports injury can have in their tool box is a solid function based assessment process. This is a foundation to use all of our techniques from. If we are going to treat tissue are we being symptomatic?? So many times injury site is far removed from the source. In fact I will be as bold as to say that often the more better functioning joint in the chain is the one taking the hit. Chronic problems tend to be chronic because we take a symptom only approach to treating. That's easy, point to where it hurts!! The hard part is having the assessment tools to truly find out why the tissue is in pain. Usually we need to look above and below the joint in question and many times it can be problems with both ends creating pain. The only way will know is to test and not ASSUME!!!

I was reading an article recently about celebrity personal trainers. There seemed to be within the article a real obsession with what the trainers charged and who they trained rather than actually what they did or had learned or achieved.

The article left me with the feeling that they felt the more you charged the better you were at your job. In my experience in the fitness industry this simply is not true. Does this give the message to up and coming trainers that it is more about who you train or charge than what you actually do??!! For an industry with such little regulation this is a poor place to be in terms of quality control. If someone is willing to pay an outlandish fee for an hour of someones time then that is between the two people making the transaction. However let us not fall into the trap of believing that the fee or person makes someone better at what they do. A great job with a super model is no better than a great job with a housewife, let us make no mistake. You are not who you train by proxy. If you want to be a celebrity do it through what you do and say, not who you do or charge.

By default generally the more you charge the less people you will see. Although there will always be exceptions to every rule!! As the amount goes up the smaller the pool of people able to afford your charge. This means that only the very experienced, educated and with a long track record of success should charge the most. Why I hear you ask?? Well if you are seeing less people then you are able to gain less experience and also practice your skill set less. This is where success is built, the hard yards of practicing and refining your craft to get to a level where you can justify your increased cost. We cannot expect to walk straight out of a training course and have a skill set that is worthy of an inflated arbitrary figure. It is the application of knowledge over time to a wide variety of different people that allows people to be able to have those "go to" moments that differentiates them from the crowd and justifies the higher charge.

Ask yourself the question am I worthy of what I charge. It may be that you are undervaluing yourself, but if you are gaining valuable experience to add up to the 10,000 hours of experience that is talked about as being a measure of an expert then almost you are being payed for your education.

If you don't have the level of experience or education and hence skill set and are charging more than those that do, you have to ask yourself why!!?? If it is to be the best then this is clearly not true. If it is to earn more, then money and status is more important than your craft, which is fine if we hold our hands up and state this loud and proud.

The old Stella Artois advert that stated "reassuringly expensive" does certainly not ring true for me in the fitness industry!!

I have read so much recently about barefoot training/running and the amazing ability of the foot. While a lot of what I read tends to have many elements of scientific truth to them I don't think the people writing them always have an understanding of the foots effect on the system as a whole.

Barefoot training seems to be heralded as a "one size fits all" fix to whatever problems people have. Suddenly shoes have become the pariah of human function. Understanding the function of an area of the body is important however we seem to do this only in an "ideal" sense. If A + B = C, then everything would be fine, we could take our shoes off and never have any problems ever again. If we look back however at every other amazing resolution that has been thrown at us over the last 10 years and take stock, we still have people with the same problems seeking help.

Maybe a key to this is understanding dysfunction. Only by having knowledge of the many things that can affect the foot to disrupt its success can we truly find an answer. Lets look at an example. On a localised level the foot will create an environment that makes it successful. This however may not be successful for the system as a whole. A Varus deformity of the forefoot will 99% of the time cause the foot arch to collapse, if it is able to compensate then the forefoot will stop the body having a top down influence on the foot (which will also cause a bottom up inhibition!). This creates a success of stability at the forefoot but will reduce motion elsewhere in the functional chain. Now the question is will taking my shoes off help this??

The are a few points to the answer of this question (which I am not totally sure I have the answer to!!). Firstly a shoe might limit the range the STJ goes through to get the Forefoot to the floor improving joint start position, motion and systemic influence. Much has been made of the cushioning affect of footwear on proprioception.  While this maybe true, in the example of the Forefoot Varus however, a reduction of force maybe advantageous to a system that cannot attenuate force through muscular deceleration because of joint position or osseous restriction. This can lead to shin splints, stress fractures and forces being absorbed by structures further up the functional chain. A point going one step beyond would relate to more sophisticated interventions such as orthosis. Now by creating tailored stability to enhance the success of the system we will improve the environment around the foot that barefoot training cannot do. This is because the dysfunction of the foot will not allow it. If I could simply tell people to run and train barefoot and all these problems would go away then believe me I would!!! We need to go back to the principle of individuality that tells us that no one thing will work for all. Only by individual assessment and also understanding of why and how things go wrong can we find the appropriate cure.

This brings me on to my favourite quote by Betrand Russel:

"The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt"

Now I would not regard anybody as stupid in the context of the topic of this blog but sometimes those that lack an understanding of dysfunction can tend to make bold or "cocksure" statements regarding "cure all" methods of training!

This brings me on to my second topic in this rambling blog. This relates to a conversation I had recently with a very intelligent Osteopathic friend of mine. We were talking about dysfunctions in the system and the use of interventions such as orthosis. He did not seem convinced about the need for such things. I do certainly agree that the body has the ability to "heal" itself to some degree. However my belief is that when we factor in scenarios such as short legs (a favourite topic of mine) that the body in certain cases (generally people with problems) cannot overcome them. Factor in changes in training e.g. running a marathon, and this tends to become to much for the system to deal with leading to pain. Now the demand on the tissue has become to great and keep up with change in function we need to create a better environment for the body or cease the increase in activity.

I suppose the real question is can we as practitioners create a systemic change that is able to cope with the structural deformities presented to us through manipulation and exercise. Of course the answer maybe yes in some examples, then the question would be how long would that take and what level of activity could they continue to do. Many times I believe the answer is no, foot deformities being a good example, the localised problem can cause to big an influence on the chain reaction of the system that cannot be "compensated" for anymore or allow us to increase demand such as training on the system. We cannot change bony orientation or length and the muscles and connective tissue cannot cope with the demand any longer, this is why we have many cases that are chronic (for years even) until we can find the problem in the system that is causing various chronic problems. Many time the only way to solve these structural problems is to add in a structural intervention!!!!

I am sure this will be controversial but I believe good debate is something we can all learn from if we are less "cocksure" at the risk of sounding cocksure of course!!!

Ben

A fair while since my last blog post but I have been so busy it has fallen a little by the wayside!! A couple of recent highlights have been training one of my Pro boxers Phil Gill for his 11th pro fight on the 30th of April and Olympia, and also a great day with a bunch of Osteopaths going through the functional assessment process down in Brighton. I am also really looking forward to the upcoming functional assessment course in London on the 16/17th of April which has had a great response but require lots of prep!

The topic of this blog post is about a client I have been seeing recently who had lower back pain. When I assessed him I discovered a minor short leg (2-3mm) but was so small and short leg assessments so unreliable in terms of actual measurement that I payed less attention to it than I normally would a short leg. Short legs can be hugely destructive on the system and create a myriad of compensatory patterns.

The upshot was we created much better motion in the sessions but this reduced when he went off and did stuff on his own. Something else in the system was shutting it down. Very frustrating for me, but I think I may now know the reason why!

A usual compensation pattern that I see in the feet is that the long leg pronates to become shorter and short leg stays inverted or supinated to remain longer. With this individual however the long leg also had a large uncompensated Rearfoot Varus. This means that it cannot pronate and takes away this compensation mechanism and actually makes the short leg shorter in comparison (or the long leg longer!!) and therefore more significant and destructive on the system. The uncompensated rearfoot varus will create a lack of shock absorption in the chain and the inability to compensate for the short leg will create an obliquity in the system which can also cause it to shut down motion in favour of stability.

I have addressed this temporarily with a small heel riser, although a full length lift is always better because we do not create so much plantar flexion and shorten the calf. Watch this space for an update on the progress of this interesting case.

This definitely shows that when more than one structural deformity presents itself then things do not follow a set pattern. We must always remember the principle of individuality when helping our clients. A + B does not = C!!! We cannot simply have solutions without a thorough assessment process that takes many things into account.

This is something I will be teaching the guys on the upcoming functional assessment course!!!

 

 

Today's blog has come about from a conversation I had with a friend of mine who is running the marathon. Like many runners when they get beyond then 10 mile mark he has been struck down by IT band pain.

After consulting the physio he was given some classic stretches for this. General hip ADuction off weight bearing etc. This got me thinking about the predominant view of muscle function and how if we length or strengthen a muscle then it will do this by default.

First of all the ITB and muscles that attach to it maybe individually fine, but when they interact with the foot in a functional position such as stride stance this may change.

A flat or high arched foot may cause excessive lengthening or a lack of lengthening of the IT band and associated muscles. However much we lengthen or strengthen these muscles in isolation, when placed in a functional chain they will be limited or affected by other sections of the chain e.g. the foot. This means that in isolation and decompressed from gravity these muscles will appreciate the stretch but this may make little difference to their ability when back in a functional position during such as during running.

Many times I have treated people who have foam rolled and performed all manner of stretches in an isolated way but to no avail. Once we have found a cause rather than a symptom they have become much better.

The real point here is just because we spend time lengthening or shortening a muscle it may not choose or be able to use the motion or strength we have given it in a functional scenario. It maybe that another part of the system will not allow it to or the muscle or group of muscles have to perform another role because another part of the body has not done its job.

Another example of this would be kyphosis. People send hours retracting the scapulae to 'strengthen' the muscles of the upper back but their postures never change. This maybe because something further down the chain such as the hips and ankles are not able to effectively flex and attenuate the ground reaction and gravitational forces. This means the upper back will have to lengthen to decelerate the spine flexing forward so that the neck and head can remain in a relative upright position. In this scenario would these muscles choose to lengthen and decelerate motion to create relative upper thoracic and cervical extension or, shorten and force the superior distal segments at the cervical to lengthen disrupting head/eye function. I believe the latter regardless of the 'strength' we have given them. One thing we cannot 'beat' or get away from is gravity and ground reaction (unless you have a spaceship of course!!!)

This maybe a reason why people with limited thoracic motion get an anterior head position. The inability of the spine to relatively extend means the neck muscles have to decelerate the forces and end up at lengthened and at end range.

Just some thought out loud really!!!!

Ben