Tuesday, March 15, 2011
shoulder rehab - a very (very) active approach - a journey log, pt 1
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Shoulder injuries suck. Getting one on one side after months of rehabbing the other side sucks even more. One may also imagine a revision to Oscar Wilde - To injure one shoulder may be regraded as a misfortune; to injure both looks like carelessness. And perhaps it was. So, can the knowledge gained in rehabbing one shoulder over months be applied to the other to rehab it in weeks?
The following posts are a few notes on my journey to take lessons learned about the shoulder from an injury last spring - 10 months ago'ish now - and applying them to my right shoulder. The result seems to be a surprisingly accelerated recovery occurring on the right.
I offer these notes not as a "here's what to do if this sounds like you" but just some observations on what i've found useful in my own rehab.
Cut to the Chase: main rehab strategy
If you want to cut to the chase, the biggest therapeutic work right now seems to be loaded mobility work exploring the edge of range of motion limits - where those limits are pretty clearly communicated by an edge of pain.
I am fascinated by how quickly this work into the edge of the limit seems to be having rapid restorative effects. I'll discuss the approach in more detail as we move on.
Background
Last spring not long after getting back from the amazing RKC II weekend in San Jose, Feb 2010, i somehow woke up one morning and my left shoulder was in significant pain. Reaching behind me to put on my coat was the most awful experience.
6 weeks or so after the initial pain, went to see the doc as things seemed to be getting worse. The doc suggested "painful arc syndrome" which meant rotator cuff issue and take some NSAIDs to bring down the inflammation. As i've written about before, the drugs really did bring down the pain, but my pressing goals got shot. I learned that a sore left side can screw up a functioning right side: i just could not press with as much vigour without inducing a pain response on the left. Yuck.
Where did this come from? What was it?
I learned a lot about repetitive strain injuries, and about resarch into eccentrics for healing these kinds of issues. I learned about the differences between itis or osis, and why most up on current practice medicos and resaerchers just talk about opathies instead. Eccentric training was not doing it for me. Physio not so much. Secrets of the shoulder - awseome stuff but wasn't giving me a breakthrough.
Mid October *finally* got some work done with me on finding a path into the shoulder; turned out, no not really a shoulder thing per se (the source of pain may not be the site of pain, i seem to recall hearing some where), more a biceps thing - got a super path to start rebuilding there. If you'd like to explore the detail of that analysis and the specific rehab for what was happening, that story is linked here.
More Recently
Finally, a little more than a month ago, as i wrote recently, i got back into my double KB work via Return of the Kettlebell. It was hard to deal with how much ground i'd lost, where i was doing three ladders rather than five; max on left was a 12 for reps not the 16, but there were also some definite wins. It only took about a week of effort to be able to press the 16 on the left again for singles; two weeks to get three reps. That's a far cry from doing three - four sets of five ladders - or 15 reps - but there was progress. All good. I was starting to snatch again - with just the 12 on the left, but it's a start.
And then it happened: on heavy day of the RTK pressing cycle, third ladder in with the 16 on the right, and something felt really not good. As far as i could tell, my form had been ok; i didn't feel anything go, but that was it. And there was pain.
My immediate response was to try some neural dynamic/ mechanic work to get at the nerves that innervate the shoulder and the biceps. The shoulder work was fine; the supraspinatus work, not so much; musculo-cutaneous (biceps nerve) not great.
Emotional Experience More debilitating than Injury?
Perhaps one of the most challenging aspects of an injury is the emotional game: here i was just a month off one injury that happened to unhinge my passion - pressing a 24 - and now my *best* shoulder was hit. It can be challenging to find a way to stay up with one's practice.
Suffice it to say i think that i did not want this right shoulder to unhinge me again. But what to do? Just lifting the covers off me in the morning was let's say a more sharply wakeful experience than an alarm; trying to reach my head to wash my hair, little own put any pressure on my head was not a good thing either. Big back away signals.
Strategy for come back
So what to do? Use what ya know; test it; refine it.
Over the past year i'd been training for my zhealth master trainer designation (the plaque just came the other day. cool. new wall gets started). Part of that training is a whole lot of anatomy, with a major focus on nerves and spinal sections related to joint movement. Cool stuff to get that something happening in one's neck is manifest in one's fingers, and that working with the source at the neck can affect the peripheral manifestation.
Walk the Walk; Eat one's own Dog FoodThere are a lot of expressions regarding integrity of practice: does one walk the walk or just talk the talk; does one eat one's own dog food - i.e. the products that one produces for a particular task.
My own injury has given me a chance to explore the techniques i know and the skills i've developed for investigating new (to me) approaches.
Coming Up
So here's a bit of a path i'll discuss in the upcoming posts:
In the coming discussion, i will make no claims that what i've done, what i'm doing in my rehab is great for everyone - or for that matter anyone else. What i will say is that the protocol i've learned with my colleagues going through the Master Trainer progressions is test and reassess everything. We have a lot of tools; they're not total; i've learned a bunch outside that program as well, but the thing i've found has been working for me is this simple concept of test and reassess. Try anything: just have a way to evaluate if it's having an effect, and if that effect is positive.
Principled Hack. Something else i've learned in the process is that there is great value - at least for myself - in having learned something of our fundamental mechanics, but almost even more so, of our fundamental wiring. Knowing something about our inner organisation has given me a more principled way to approach at least to picking a starting point: i think i have a better model about why i might see an effect or not.
At times i'm still stunned by these connections: working with a young gal with arthritis with really high pain and limited range of motion. We tried a drill to work the nerves involved firing the painful muscles; nothing. So we then engaged that spinal segment of where the nerve starts along with the drill, and wow, the range of motion went up; pain went down. I get a little verklempt every time i think of that. It's not an isolated example. What it means tho, is that by having a better model of us - how muscles, joints, nerves, guts connect, that helps me apply the tools i have better. Makes sense, doesn't it? Sounds obvious, but initially i didn't get that as clearly as i have of late able to add these models to practice.
In computing sometimes one might refer to a hack in code as a fast fix for a problem. Hacks are great. They are like the coding equivalent of duck tape. And about as robust. A principled hack will be something more robust, but no one is claiming that it's the absolute optimal solution to the problem. I guess i feel like i'm a bit further down the road where my approach to what i do is more principled. In many cases it's exactly the same, but perhaps more refined and efficient. Hence this test on myself.
Motivation to Learn: Load is a Great Teacher. One other thing i've found with respect to learning is that there is one thing that will accelerate learning: if one has to teach the material. Anyone who's had to teach at any level will know what it's like to be asked to teach a new course or fill in for a colleague. One has to get up to speed fast.
I'm finding that something else that drives one to learn, to develop new solutions is an injury. Perhaps with my left shoulder learning, the folks i've had the pleasure to work with on their pain/performance, and the fact that i have some great colleagues who are there to draw on for their experience, i have greater confidence to say i'm going to have a go at this myself; i'm going to treat myself as the client and see what i can do.
Progress. So far, i've been surprised (and occaisionally stunned) by the seeming rapidity of the results. It's too early to sign off on this injury: i'm in the middle of rehabbing, and i tell myself well maybe this is a way less intense injury than the left side was etc etc, but so what? i'll take it: it seems to be coming together much faster. I could lift the covers off me this morning without stiffling a yelp, and could almost put full pressure on my head when shampooing. Two days ago, i could not.
Gonzo Healing.
So why talk about this? I learned last night that what i had thought was gonzo journalism - no holds barred, deep risky reporting - was not right at all. Gonzo, it turns out, is more the destruction of the idea of journalistic objectivity; of being willing to put oneself explicitly in the story, rather than try to pretend one is an objective tape recorder.
So let's call this gonzo healing or healing practice: i'm in the middle of a process now; it may all end in tears; it may be great. Either way, it may be interesting to reflect on the process as it's happening.
Thanks for joining the investigation.
Other Posts in this Series
Related Stories
Shoulder injuries suck. Getting one on one side after months of rehabbing the other side sucks even more. One may also imagine a revision to Oscar Wilde - To injure one shoulder may be regraded as a misfortune; to injure both looks like carelessness. And perhaps it was. So, can the knowledge gained in rehabbing one shoulder over months be applied to the other to rehab it in weeks?
The following posts are a few notes on my journey to take lessons learned about the shoulder from an injury last spring - 10 months ago'ish now - and applying them to my right shoulder. The result seems to be a surprisingly accelerated recovery occurring on the right.
I offer these notes not as a "here's what to do if this sounds like you" but just some observations on what i've found useful in my own rehab.
Cut to the Chase: main rehab strategy
If you want to cut to the chase, the biggest therapeutic work right now seems to be loaded mobility work exploring the edge of range of motion limits - where those limits are pretty clearly communicated by an edge of pain.
I am fascinated by how quickly this work into the edge of the limit seems to be having rapid restorative effects. I'll discuss the approach in more detail as we move on.
Background
 |
| Pondering rehab at the office. see the RKC II cert? |
6 weeks or so after the initial pain, went to see the doc as things seemed to be getting worse. The doc suggested "painful arc syndrome" which meant rotator cuff issue and take some NSAIDs to bring down the inflammation. As i've written about before, the drugs really did bring down the pain, but my pressing goals got shot. I learned that a sore left side can screw up a functioning right side: i just could not press with as much vigour without inducing a pain response on the left. Yuck.
Where did this come from? What was it?
I learned a lot about repetitive strain injuries, and about resarch into eccentrics for healing these kinds of issues. I learned about the differences between itis or osis, and why most up on current practice medicos and resaerchers just talk about opathies instead. Eccentric training was not doing it for me. Physio not so much. Secrets of the shoulder - awseome stuff but wasn't giving me a breakthrough.
Mid October *finally* got some work done with me on finding a path into the shoulder; turned out, no not really a shoulder thing per se (the source of pain may not be the site of pain, i seem to recall hearing some where), more a biceps thing - got a super path to start rebuilding there. If you'd like to explore the detail of that analysis and the specific rehab for what was happening, that story is linked here.
More Recently
And then it happened: on heavy day of the RTK pressing cycle, third ladder in with the 16 on the right, and something felt really not good. As far as i could tell, my form had been ok; i didn't feel anything go, but that was it. And there was pain.
My immediate response was to try some neural dynamic/ mechanic work to get at the nerves that innervate the shoulder and the biceps. The shoulder work was fine; the supraspinatus work, not so much; musculo-cutaneous (biceps nerve) not great.
Emotional Experience More debilitating than Injury?
 |
| office kb pile |
Suffice it to say i think that i did not want this right shoulder to unhinge me again. But what to do? Just lifting the covers off me in the morning was let's say a more sharply wakeful experience than an alarm; trying to reach my head to wash my hair, little own put any pressure on my head was not a good thing either. Big back away signals.
Strategy for come back
So what to do? Use what ya know; test it; refine it.
Over the past year i'd been training for my zhealth master trainer designation (the plaque just came the other day. cool. new wall gets started). Part of that training is a whole lot of anatomy, with a major focus on nerves and spinal sections related to joint movement. Cool stuff to get that something happening in one's neck is manifest in one's fingers, and that working with the source at the neck can affect the peripheral manifestation.
 |
| new plaque, functional side of office |
My own injury has given me a chance to explore the techniques i know and the skills i've developed for investigating new (to me) approaches.
Coming Up
So here's a bit of a path i'll discuss in the upcoming posts:
- looking at the new injury with the findings of the previous one: wrist extensors, brachioradialis and the tendon on the long head of the biceps
- mapping out some key nerve-joint-breath connexions towards relief.
- looking at the right shoulder/liver connection
- exploring end range of motion, terminal flicking and isometrics
- tuning the lat; locking the pelvis
- the pleasures of rubber bands, anytime, anywhere: load to learn.
- the importance of time: time to make an assessment and test and readjust
"I am not young enough to know everything"
attributed to Oscar Wilde
In the coming discussion, i will make no claims that what i've done, what i'm doing in my rehab is great for everyone - or for that matter anyone else. What i will say is that the protocol i've learned with my colleagues going through the Master Trainer progressions is test and reassess everything. We have a lot of tools; they're not total; i've learned a bunch outside that program as well, but the thing i've found has been working for me is this simple concept of test and reassess. Try anything: just have a way to evaluate if it's having an effect, and if that effect is positive.
Principled Hack. Something else i've learned in the process is that there is great value - at least for myself - in having learned something of our fundamental mechanics, but almost even more so, of our fundamental wiring. Knowing something about our inner organisation has given me a more principled way to approach at least to picking a starting point: i think i have a better model about why i might see an effect or not.
At times i'm still stunned by these connections: working with a young gal with arthritis with really high pain and limited range of motion. We tried a drill to work the nerves involved firing the painful muscles; nothing. So we then engaged that spinal segment of where the nerve starts along with the drill, and wow, the range of motion went up; pain went down. I get a little verklempt every time i think of that. It's not an isolated example. What it means tho, is that by having a better model of us - how muscles, joints, nerves, guts connect, that helps me apply the tools i have better. Makes sense, doesn't it? Sounds obvious, but initially i didn't get that as clearly as i have of late able to add these models to practice.
In computing sometimes one might refer to a hack in code as a fast fix for a problem. Hacks are great. They are like the coding equivalent of duck tape. And about as robust. A principled hack will be something more robust, but no one is claiming that it's the absolute optimal solution to the problem. I guess i feel like i'm a bit further down the road where my approach to what i do is more principled. In many cases it's exactly the same, but perhaps more refined and efficient. Hence this test on myself.
Motivation to Learn: Load is a Great Teacher. One other thing i've found with respect to learning is that there is one thing that will accelerate learning: if one has to teach the material. Anyone who's had to teach at any level will know what it's like to be asked to teach a new course or fill in for a colleague. One has to get up to speed fast.
I'm finding that something else that drives one to learn, to develop new solutions is an injury. Perhaps with my left shoulder learning, the folks i've had the pleasure to work with on their pain/performance, and the fact that i have some great colleagues who are there to draw on for their experience, i have greater confidence to say i'm going to have a go at this myself; i'm going to treat myself as the client and see what i can do.
Progress. So far, i've been surprised (and occaisionally stunned) by the seeming rapidity of the results. It's too early to sign off on this injury: i'm in the middle of rehabbing, and i tell myself well maybe this is a way less intense injury than the left side was etc etc, but so what? i'll take it: it seems to be coming together much faster. I could lift the covers off me this morning without stiffling a yelp, and could almost put full pressure on my head when shampooing. Two days ago, i could not.
Gonzo Healing.
So why talk about this? I learned last night that what i had thought was gonzo journalism - no holds barred, deep risky reporting - was not right at all. Gonzo, it turns out, is more the destruction of the idea of journalistic objectivity; of being willing to put oneself explicitly in the story, rather than try to pretend one is an objective tape recorder.
So let's call this gonzo healing or healing practice: i'm in the middle of a process now; it may all end in tears; it may be great. Either way, it may be interesting to reflect on the process as it's happening.
Thanks for joining the investigation.
Other Posts in this Series
- PART II of this shoulder journal: liver/shoulder connection
- Part III: skin/fascia movement and shoulder rehab.
Related Stories
- The Shoulder: Part I - scapula world
- The shoulder: Part II - g/h joint
- tendon - opathies and eccentric contractions for repair
- The Biceps - not the shoulder - after all.
- Fish oil and being anti-inflammatory.
- One less rep: the differnece between injury and success?
- What's a movement assessment?
- Pressing Matters: a wee chat with Dan John.
PDF
Sunday, March 13, 2011
Different Speeds have Different Meanings in our Bodies' Performance in Pain
Follow @mcphoo
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Every little thing in the complex systems that are us seems to impact every other thing - or at least a whole lot of other things. Take speed. Have you ever tried to do a familiar movement either really fast or really slow? Say whipping an egg in a bowl, making a shoulder circle, lifting a knee up and down. Speed changes performance, doesn't it? Something else we've seen change performance is pain: pain will change even what muscles get recruited,when, performing an action (Cools; Ferguson). Recent research has put pain and speed together to see what happens in normal walking mechanics.
I'm fascinated by the study because of how it reinforces how quickly we see systemic adapatations to the new demands of a change in the system: in this case, two changes: pain and various speeds.
The researchers used a standard protocol to induce DOMS at the knee. Perhaps not surprisingly, they found that with the DOMS effect up, different speeds showed different kinds of compromise.
Here's the abstract:
In the Discussion section of the article, the authors speculate about what might be happening at say the hip or knee or ankle such that the gait changes in different parts of the gait cycle, and even what may be happening with pain messaging.
Just for context, here's a look at the walking gait cycle:
Main thing: the cycle has two phases: stance and swing. Swing phase is where the action is: toes are cleared; limbs move forward.
Some Observations by the Authors:
Less knee flexion in the swing phase was observed in slow speeds. The authors speculate that this is as a result of less desire to call upon the hamstrings to work to pull up the knee/clear the foot due to pain. At faster speeds though, the ankle goes wonky - destabilizing at the ankle. THe authors wonder if fear of falling from walking fast on a narrow treadmill is why this is happening. In other words, the knees look "normal" at faster speeds, but the ankles pay for it.
Also, hip flexion is shrunk as speed goes up: greater hip flexion means more involvement of the quads and they're sore: so compensation is more steps; tinier range of motion. Another compensation here is that to keep the stride length more or less up (tho compromised), without involving the hip flexors, the authors suggest a kind of psuedo hip extension by getting anterior pelvic tilt to compensate for missing hip flexion. Indeed, the authors note, there's a well observed pattern of positive correlation from other studies between reduced hip extension and anterior pelvic tilt. So a little bit of DOMS brings on a variety of gait pattern changes and systemic effects depending on speed.
It's just the Knee muscles? And that's screwing up Ankle Flexion, hip flexion and pelivic tilt?One of the things that really strikes me about this is that the only muscles worked into the DOMS state were the knee extensors and flexors (we talked about these when we discussed the ottoman pistol: extensors; flexors). In other words, all these effects from giving one DOMS in the knees.
To induce the muscle damage and hence DOMS, the resaerchers have the participants do finely set up leg extensions from 100 degrees to 0 degrees (knee fully extended, getting the quads) and then knee flexions of 0 to 100 degrees (getting the hamstrings). 5 sets 15 reps each set; 3 min break btwn sets on an isokinetic dynamometer. As hard as possible with the dyno set at 60o/s. (If you're really intrigued, here's a video of the cybex; if you'd like to learn about active dynomometry and overview is here).
From here, at different times after these exercises, a standard set of muscle damage / doms tests were run via bloodwork and other measures. They were really thorough (review of doms measuring here).
The researchers pre and post tested the participants using a treadmill set at different speeds, including letting participants choose their own comfortable walking speeds/transition speeds.
Pain changes everything?
Perhaps it's not novel at all to suggest that pain changes everything when it comes to movement.
I guess why this study is so striking to me is that it looked in a very controlled way at inducing and measuring a particular level of actual damage and correlated pain and muscular limitations to investigate specifically what pain does to problably our most basic movement pattern, walking. It focued on typical measures of lower body involvement in the gait cylce, and saw that especially when changing speed, gait mechanics change, but even when not changing speed, spatio-temporal movements changed: widened base of support, different tempo of gait. None of these changes is positive. More anterior pelvic tilt is not a happy compensation for reduced hip ROM as anyone with chronic low back pain may attest.
Speed of Adaptation/Compensation: It's Immediate. Look at how quickly the body begins to compensate to this single joint pain: Compensations are seen at the hip, pelvis ankle and the knees as well. They're different at different speeds. This study only looked at gait; it would be interesting to have seen shoulder and head involvement in these altered patterns as well.
What happens when we move from an acute pain bout to something more chronic, and those adaptations become more chronic too? Those adaptations are going to stick around and cause their own compensations.
Training at Speeds: High Payoff Future Proofing.
The authors conclude pretty much that pain impacts performance across gait at all speeds, but how particularly it effects mechanics depends on speeds.
One of the things wer're taught in z-health starting at R-Phase (overview of R here) is to practice mobility drills to "own" them at all speeds, and four speeds are spec'd from super slow to athletic. Pain is pain, but i wonder from this if practicing movement at different speeds, which means at different loads, too, would see one able to recover good form faster, better? Maybe keep more of that form?
We seem to see such recovery in folks who practice mobility work regularly, and who have strategies for understanding and working with the movement of their bodies.
Indeed, consider the authors' hypothesis that ankle flexion may be compromised post the muscle damaging exercise because there's a fear of being able to keep stable on a narrow track going at higher speeds, so we get weird dorsiflexion and gate.
This hypothesis reminds me of work that has been done with athletes to future proof them from ankle sprains by doing deliberate mobility work with them to improve balance and proprioception. This kind of loaded future proofing is a big part of z-health's i-phase work (follows r-phase): once the core mobility work is owned, start getting it into sport/life specific positions. An overview of i-phase: loading for the real is here.
Take Aways:
Addeda - Personal Testimony; where to start: i tend to recommend z health for pain/performance because i've found it works for myself and for the folks i have the pleasure to coach.
Optimal place to start? with a zhealth coach / master trainer for a movement assessment and introduction to zhealth drills. If that assessment doesn't feel possible right now, dig in with R-phase for mobility drill learnin', or with the Essentials of Eliter Performance, if you'd like more of a workshop style theory + practice overview. Tons of z discussions at the movement index on b2d.
By all means leave questions in the comments, below.
Citations
Related Posts
Every little thing in the complex systems that are us seems to impact every other thing - or at least a whole lot of other things. Take speed. Have you ever tried to do a familiar movement either really fast or really slow? Say whipping an egg in a bowl, making a shoulder circle, lifting a knee up and down. Speed changes performance, doesn't it? Something else we've seen change performance is pain: pain will change even what muscles get recruited,when, performing an action (Cools; Ferguson). Recent research has put pain and speed together to see what happens in normal walking mechanics.I'm fascinated by the study because of how it reinforces how quickly we see systemic adapatations to the new demands of a change in the system: in this case, two changes: pain and various speeds.
The researchers used a standard protocol to induce DOMS at the knee. Perhaps not surprisingly, they found that with the DOMS effect up, different speeds showed different kinds of compromise.
Here's the abstract:
Eur J Appl Physiol. 2010 Nov;110(5):977-88. Epub 2010 Jul 29.In other words, different speeds, but especially punching up the tempo in a walk a wee bit seriously effected ankle joint ROM (it decreased) knee joint flexion (bigger), hip extension (leg going back) got smaller, pelvic tilt (more strain on the lower back) also increased, and just general tempo was also buggered up: participants were taking a wider stance while walking.
The effects of muscle damage on walking biomechanics are speed-dependent.
Tsatalas T, Giakas G, Spyropoulos G, Paschalis V, Nikolaidis MG, Tsaopoulos DE, Theodorou AA, Jamurtas AZ, Koutedakis Y.
Institute of Human Performance and Rehabilitation, Center for Research and Technology, Trikala, Thessaly, Greece.
Abstract
The purpose of the present study was to examine the effects of muscle damage on walking biomechanics at different speeds. Seventeen young women completed a muscle damage protocol of 5 × 15 maximal eccentric actions of the knee extensors and flexors of both legs at 60°/s. Lower body kinematics and swing-phase kinetics were assessed on a horizontal treadmill pre- and 48 h post-muscle damaging exercise at four walking speeds. Evaluated muscle damage indices included isometric torque, delayed onset muscle soreness, and serum creatine kinase. All muscle damage indices changed significantly after exercise, indicating muscle injury. Kinematic results indicated that post-exercise knee joint was significantly more flexed (31-260%) during stance-phase and knee range of motion was reduced at certain phases of the gait cycle at all speeds. Walking post-exercise at the two lower speeds revealed a more extended knee joint (3.1-3.6%) during the swing-phase, but no differences were found between pre- and post-exercise conditions at the two higher speeds. As speed increased, maximum dorsiflexion angle during stance-phase significantly decreased pre-exercise (5.7-11.8%), but remained unaltered post-exercise across all speeds (p > 0.05). Moreover, post-exercise maximum hip extension decreased (3.6-18.8%), pelvic tilt increased (5.5-10.6%), and tempo-spatial differences were found across all speeds (p < 0.05). Limited effects of muscle damage were observed regarding swing-phase kinetics. In conclusion, walking biomechanics following muscle damage are affected differently at relatively higher walking speeds, especially with respect to knee and ankle joint motion. The importance of speed in evaluating walking biomechanics following muscle damage is highlighted.
In the Discussion section of the article, the authors speculate about what might be happening at say the hip or knee or ankle such that the gait changes in different parts of the gait cycle, and even what may be happening with pain messaging.
Just for context, here's a look at the walking gait cycle:
Some Observations by the Authors:
Less knee flexion in the swing phase was observed in slow speeds. The authors speculate that this is as a result of less desire to call upon the hamstrings to work to pull up the knee/clear the foot due to pain. At faster speeds though, the ankle goes wonky - destabilizing at the ankle. THe authors wonder if fear of falling from walking fast on a narrow treadmill is why this is happening. In other words, the knees look "normal" at faster speeds, but the ankles pay for it.
Also, hip flexion is shrunk as speed goes up: greater hip flexion means more involvement of the quads and they're sore: so compensation is more steps; tinier range of motion. Another compensation here is that to keep the stride length more or less up (tho compromised), without involving the hip flexors, the authors suggest a kind of psuedo hip extension by getting anterior pelvic tilt to compensate for missing hip flexion. Indeed, the authors note, there's a well observed pattern of positive correlation from other studies between reduced hip extension and anterior pelvic tilt. So a little bit of DOMS brings on a variety of gait pattern changes and systemic effects depending on speed.
It's just the Knee muscles? And that's screwing up Ankle Flexion, hip flexion and pelivic tilt?One of the things that really strikes me about this is that the only muscles worked into the DOMS state were the knee extensors and flexors (we talked about these when we discussed the ottoman pistol: extensors; flexors). In other words, all these effects from giving one DOMS in the knees.
To induce the muscle damage and hence DOMS, the resaerchers have the participants do finely set up leg extensions from 100 degrees to 0 degrees (knee fully extended, getting the quads) and then knee flexions of 0 to 100 degrees (getting the hamstrings). 5 sets 15 reps each set; 3 min break btwn sets on an isokinetic dynamometer. As hard as possible with the dyno set at 60o/s. (If you're really intrigued, here's a video of the cybex; if you'd like to learn about active dynomometry and overview is here).From here, at different times after these exercises, a standard set of muscle damage / doms tests were run via bloodwork and other measures. They were really thorough (review of doms measuring here).
The researchers pre and post tested the participants using a treadmill set at different speeds, including letting participants choose their own comfortable walking speeds/transition speeds.
Pain changes everything?
Perhaps it's not novel at all to suggest that pain changes everything when it comes to movement.
I guess why this study is so striking to me is that it looked in a very controlled way at inducing and measuring a particular level of actual damage and correlated pain and muscular limitations to investigate specifically what pain does to problably our most basic movement pattern, walking. It focued on typical measures of lower body involvement in the gait cylce, and saw that especially when changing speed, gait mechanics change, but even when not changing speed, spatio-temporal movements changed: widened base of support, different tempo of gait. None of these changes is positive. More anterior pelvic tilt is not a happy compensation for reduced hip ROM as anyone with chronic low back pain may attest.
Speed of Adaptation/Compensation: It's Immediate. Look at how quickly the body begins to compensate to this single joint pain: Compensations are seen at the hip, pelvis ankle and the knees as well. They're different at different speeds. This study only looked at gait; it would be interesting to have seen shoulder and head involvement in these altered patterns as well.
What happens when we move from an acute pain bout to something more chronic, and those adaptations become more chronic too? Those adaptations are going to stick around and cause their own compensations.
Training at Speeds: High Payoff Future Proofing.
The authors conclude pretty much that pain impacts performance across gait at all speeds, but how particularly it effects mechanics depends on speeds.
One of the things wer're taught in z-health starting at R-Phase (overview of R here) is to practice mobility drills to "own" them at all speeds, and four speeds are spec'd from super slow to athletic. Pain is pain, but i wonder from this if practicing movement at different speeds, which means at different loads, too, would see one able to recover good form faster, better? Maybe keep more of that form? We seem to see such recovery in folks who practice mobility work regularly, and who have strategies for understanding and working with the movement of their bodies.
Indeed, consider the authors' hypothesis that ankle flexion may be compromised post the muscle damaging exercise because there's a fear of being able to keep stable on a narrow track going at higher speeds, so we get weird dorsiflexion and gate.
This hypothesis reminds me of work that has been done with athletes to future proof them from ankle sprains by doing deliberate mobility work with them to improve balance and proprioception. This kind of loaded future proofing is a big part of z-health's i-phase work (follows r-phase): once the core mobility work is owned, start getting it into sport/life specific positions. An overview of i-phase: loading for the real is here.
Take Aways:
- Pain changes movement, immediately, causing perterpations in range of motion and engagement of joints
- Pain's particular changes are often speed dependent - from slower through to faster.
- Better, praciticed mobility at various speeds, loads and ranges of motion strongly seems to help recovery of optimal motion and thus pain reduction (see related discussion on pain).
- Z-Health (overview) is a great way to learn and practice some of this movement self-awareness
Addeda - Personal Testimony; where to start: i tend to recommend z health for pain/performance because i've found it works for myself and for the folks i have the pleasure to coach.
Optimal place to start? with a zhealth coach / master trainer for a movement assessment and introduction to zhealth drills. If that assessment doesn't feel possible right now, dig in with R-phase for mobility drill learnin', or with the Essentials of Eliter Performance, if you'd like more of a workshop style theory + practice overview. Tons of z discussions at the movement index on b2d.
By all means leave questions in the comments, below.
Citations
Tsatalas, T., Giakas, G., Spyropoulos, G., Paschalis, V., Nikolaidis, M., Tsaopoulos, D., Theodorou, A., Jamurtas, A., & Koutedakis, Y. (2010). The effects of muscle damage on walking biomechanics are speed-dependent European Journal of Applied Physiology, 110 (5), 977-988 DOI: 10.1007/s00421-010-1589-1
Ferguson SA, Marras WS, Burr DL, Davis KG, & Gupta P (2004). Differences in motor recruitment and resulting kinematics between low back pain patients and asymptomatic participants during lifting exertions. Clinical biomechanics (Bristol, Avon), 19 (10), 992-9 PMID: 15531048
Cools AM, Witvrouw EE, Declercq GA, Danneels LA, & Cambier DC (2003). Scapular muscle recruitment patterns: trapezius muscle latency with and without impingement symptoms. The American journal of sports medicine, 31 (4), 542-9 PMID: 12860542
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