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Overpronation.

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

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Foundations.

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

 

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It's all about assessment….

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!!!

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Does charging more make you better!!??

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!!

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The curse of the short leg

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!!!

 

 

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