Bones of the Foot

7 tarsal bones (only talus articulates with the leg bones)

5 metatarsals which articulate proximally with the tarsals and distally with the phalanges.

The hallux (big toe) has only 2 phalanges (the rest have 3) = 14 phalanges in total

The trochlea of the talus articulates with the tibia and fibula

The head of the talus articulates with the navicular bone

The calcaneus articulates with the talus superiorly and the cuboid anteriorly

Talus is like a snail!

Grades of sPrains

SPRAIN

"If it's got a 'P' it's a ligament injury"

Grade 1 - Some tenderness and minor pain at the point of injury. This indicates small tears in the ligament

Grade 2 - Noticeable laxity in the knee, major pain and tenderness on the inside of knee as well as swelling. Indicates larger tears in the ligament but not a complete rupture

Grade 3 - Considerable pain/tenderness, some swelling, marked laxity/instability of the joint. Ligament is completely torn/ruptured

LCL what you know about lateral collateral ligament?

Originates from - Lateral epicondyle of the femur

Inserts into - Head of fibula

Length - 5cm

Shape - Cord like structure and more circular in diameter (due to the pointy shape of head of fib it's necessary)

Limits - Varus stress on the knee

ELITE

ENVIRONMENT

LOAD

INDIVIDUAL

TASK

EQUIPMENT

Myostatitc Contracture

'True Muscle Shortening' - Number of sarcomeres in a row will reduce due to inactivity

End Feels

Soft End feel = Related to soft tissue approximation (e.g. muscles)

Elastic End feel = Related to stretching of joint capsule and ligamentous structures

Hard = Related to bony block

Empty = No end feel detected because the patient does not allow movement to end of range

Degrees of Freedom of Movement

Hip = 3 (flexion/extension, ab/adduction, med/lateral rotation)

Knee = 2 (flexion/extension, medial/lateral rotation)

Ankle = 1 (dorsi/plantarflexion)

Metatarsophalangeal = 2 (flexion/extension and ab/adduction)

Interphalangeal joints = 1 (flexion/extension)

Contraindications to movement

Infection - Potential to spread bugs around in a joint

Recent Unstable Fractures

Tumor

Pregnancy - Hormone relaxin released causing abnormal laxity in ligaments and muscles etc

Infection in a bone - Osteomyelitis

No consent

Unknown diagnosis

DVT - Can be a risk to anyone who's been immobilised for a significant period or post surgery, essentially thrombosis in the veins. Movement can cause the clot to come loose and potentially get stuck in lungs (pulmonary embelism), heart or brain.

Systemic

Systemic = refers to something that is spread throughout, system wide affecting a group or system such as a body

Thixotropic! Synovial Fluid

Thixotrophy is the property of certain gels of fluids that are thick and viscous under normal conditions, but flow (become less thick and viscous) over time when shaken and agitated.

Hip joint: ligament limitations

"The hip joint is a multiaxial ball and socket synovial joint between the acetabulum and the head of femur. The acetabular labrum deepens the acetabular cavity even further, and the fibrous joint capsule is reinforced by 3 ligaments..."

Iliofemoral (the inverted 'Y' shape) ligaments (ant/post) limit:

hyperextension and lateral rotation

Pubofemoral ligament limits:

Extension and abduction

Ischiofemoral limits:

Extension and medial rotation

Gait: Key Points

Velocity of gait will alter dynamic joint ranges

Timing of motion is crucial

e.g.

If patient has minimal knee flexion (e.g. 15 degrees) at pre-swing and rapid knee flexion occurs

only when limb is unloaded (during swing phase), although patient may have correct range of knee motion the gait will be affected by the incorrect PHASING of the knee flexion.

A gait cycle consists of a period of stance (60%) and a period of swing (40%)

Stance phase is subdivided into 2 periods of DOUBLE SUPPORT (20% = 2 x 10%)

and 1 period SINGLE SUPPORT (40%)

Proportion of time spent in each will vary with velocity

Footwear influences stride length

Gait does not require full joint range or full muscle power

"There is a excess capacity of both"

Hip abductors only require 40% of full strength for the patient to walk without a limp

Full knee joint range of motion is 140 degrees but only 60 degrees of motion are needed for an efficient gait pattern.

Gait: Velocity

Velocity is step length x cadence

or

stride length x cadence

Measured in distance travelled per unit time (usually metres per min)

DTF - DEEP TRANSVERSE FRICTION Massage

DEEP TRANSVERSE FRICTION...



1) Stimulates phagocytosis

2) Stimulates fibre orientation in regenerating connective tissue

3) Movements of the affected structure - prevent and destroy adhesions

4) Traumatic hyperemia (an increase in the amount of blood flow to a body part)

5) Temporary analgesia (a deadening of the sense of pain without loss of consciouness)

Skeletal Fractures: Avulsion Fracture

Avulsion Fracture = Bone attached to muscle or ligament has been torn away

Skeletal Fractures

Here are some types of skeletal fractures...

TRANSVERSE FRACTURE

OBLIQUE FRACTURE

SPIRAL FRACTURE

COMMINUTED FRACTURE

Patella Tap

What's it for?

Tests for presence of effusion* at the knee joint

How does it work?

Any excess fluid is squeezed out of the suprapatella pouch by sliding the index finger and thumb from 15cm above the knee to level with the upper boarder of patella.

Then press two fingers and thumb down (tripod) on the patella and quickly jerk it downwards.

A 'click' sound indicates the presence of effusion

NB: The test will be negative if the effusion is gross/tense e.g. haemarthrosis of the knee (blood within the joint) following an ACL rupture.

Escaped fluid from blood vessels or lymphatics and its collection into tissues or a cavity*

Trendelenburg Test

Positive test - Indicates hip abductors not functioning (stabilise the pelvis on the weight bearing leg) due to weakness or pain inhibition and

• Flex knee to a right angle
• Stand on unaffected leg - then affected leg (symmetry)
• Pelvis should remain level or tilt up slightly on non weight bearing side
• If pelvis drops on NWB side then it's a positive test

Thomas 'ThomARSE' test

Determines the presense of a fixed flexion deformity at the hip (among other things..)

With one hip passively fully flexed if the CONTRALATERAL (opposite) hip rises off the bed it's a

POSITIVE for fixed hip flexion deformity (of that hip)

Look at angle of the femur (is it parallel to the floor or going up?)

This may be due to tightness/restriction in the joint capsule, ilopsoas or rec femoris

How to differentiate between the source of restriction you say!?

Passively extend patient's knee and then we'll see...

If this results in the patient's hip dropping down then it's REC FEM baby!

WHY? Because by extending the knee an element of the stretch has been taken off.

If the hip remains unaffected by this and remains in same degree of flexion then ilopsoas is your culprit.

Look at the angle of the knee, is it falling back loosely or staying held up in extension?

PASSIVE/ACTIVE insufficiency

Passive Insufficiency - Occurs with 2 joint muscles and refers to the fact that these muscles cannot stretch maximally across both joints at the same time!

Example: Hamstrings may limit hip flexion when the knee is in full extension since they are maximally stretched in this position.

However... If the knee is flexed passively then the hip will be able to flex further - because the stretch on the hamstrings has been slackened.

Active Insufficiency - 2 joint muscles cannot contract maximally across both joints at the same time!

Example: Make a fist (finger flexors) you can make a strong fist when your wrist is in a neutral of slightly extended position. But when you flex your wrist with a clenched fist you loose some of the grip. This is because the finger flexors are unable to shorten any more than they have and so begin to extend and lose grip strength.

Cross Fit WOD 25/11/09

Buy in: 400m run, 10 pull ups, 10 knees to elbows, 10 ring push ups, 10 squats

Skill: Pull Ups + ring practice

WOD: 400m run - 7 rounds of 7 pull ups/7 wall ball - 400m run

Jay - 11.04

Strength Training: Principles

Principles of Strength Training:

• OVERLOAD
• SAID (specific adaption to imposed demands)
• REVERSIBILITY

1) Overload: For muscle performance to be increased, a load which exceeds the metabolic capability of the muscle must be applied.

NB: When an overload is applied is should be gradual and sufficient enough to elicit an adaption, but should NOT be excessive. Excessive stimulus can lead to pre-mature plateaus and decreases in performance.

2) SAID: Our body will adapt to the stresses placed upon it. Or to put it another way, any change in the body's muscles, organs and systems will be very specific to the type of training (stress) undertaken.

3) Reversibility: Any adaption that occurs in the body is 'non-permanent'. Any adaption can return to a genetically determined, pre-training state (somatotype) if the stress is not maintained or developed properly.

NB: Sufficient rest & recovery between stresses must be allowed for adaption to occur. Adaption or anabolism will only occur during the inter-training recovery periods. How much recovery time is needed depends on the: type, duration and intensity of training and level of individual.

One more thing...


Tissue Tolerance: Before commencing strength training you need to make sure your tissues are able to tolerate the load and intensities required to obtain the benefits from this phase (don't want to get injured!)

Gait: Foot Position 2

In terminal stance/pre-swing the foot is supinated!

At the end of stance phase the foot is usually slightly supinated...

A rigid position which acts as an effective lever for the transmission of propulsion forces.

Gait: Foot Position

IN MID STANCE THE FOOT IS PRONATED!

This is a mobile position that accomodates for and adapts to any uneveness in the supporting surface

Gait: McDonald's Theory

LR = Loading Response

TS = Terminal Stance

"Vertical GRF peaks at LR & TS"

WHY? Because those two points are when the greatest amount of acceleration is being applied into the ground.

Therefore, vertical GRF is greatest during: Loading Response (1st peak) & Terminal Stance (2nd peak)

F = m x a

The force is greater due to increased acceleration (a)

WHY THE DIP AT MIDSTANCE?

At midstance no acceleration is being created, the foot is just fixed while weight passes over it

"These peaks are due to the body acceleration into the ground following inital contact & pushing down into the ground to propel the body upwards."

PES ANSERINUS

Pes Anserinus: "The anatomic term used to describe the position of the conjoined tendons into the anteriomedial proximal tibia."

From anterior to posterior the pes anserinus is made up of the tendons of the: SARTORIUS, GRACILIS and SEMINTENDONOSUS (S.G.St)

It lies SUPERFICIAL to the the tibial insertion of the MCL (over it)

The SARTORIUS, GRACILIS and SEMITENDONOSUS are all primary FLEXORS of the KNEE, influence MEDIAL ROTATION of the TIBIA and protect rotary and valgus stress.

WHO NORMALLY HAS IT?

• Obese middle aged women
• Patients 50-80 with OA knees (common)
• Young individuals in sporting activities

Usually women (maybe due to broader pelvis > greater angulation of legs at the knees > additional stress placed on these structures)

HOW CAN IT HAPPEN?

• Acute trauma to medial knee
• Athletic overuse
• Chronic mechanical and degeneative processes

TELL-TALE SIGNS...

• Pain over the proximal tibia at the insertion of the conjoined tendons (S.G.St) approx 2-5 cm below the anteriomedial joint margin of the knee

Chronic Variant...

• Local pain in area of bursa, on palpation no pain at joint line (unless other conditions are active)

Sports related variant...

• Pain on resisted internal rotation and flexion of the knee
• Valgus stress may reproduce symptoms (easy to mix up with MCL injury, typically painful tenderness in association with MCL injuries is superior and posterior to the pes anserinus bursa)
• If swelling can be traced more proximally along the pes anserinus tendons, a formal tendinitis may be present and a snapping of the pes anserine tendons can occur
• An exotosis of the tibia has been described in athletes and may contribute to chronic symptoms (exotosis = formation of new bone on the surface of bone)

Cross Fit WOD 19/11/09

Buy in: 400m run, 10 Shoulder Press, Push Press, Front Squat, Cleans

WOD: Barbell Complex

5 deadlifts, 5 hang cleans, 5 push press, 5 front squats (all in a row)

Jay - 55 (60 broken)

I had one push press left and arms just died! Dam! Still had to finish set, I know if I'd got to the front squats it would have been done. Well that's my target for next time :)

Later on...

Deadlifts:

3 reps: 110, 120, 125, 130kg
1 rep: 140 (old PB), 145, 150, 155, 160 kg (new PB!)

Thanks to Si and Pete's encouragement and actually writing down 160 on my card before I'd done it lol!

Physiology of Stretching: Part 2

The Inverse Stretch Reflex

Located within the musculotendinous junctions (MTJs) are sensory nerves called golgi tendon organs (GTOs).

These guys are here to prevent excessive TENSION occuring within a muscle, or tendon of that muscle.

They are activated by the contraction of a muscle and, in contrast to muscle spindles, their stimulation triggers a reflex relaxation of that muscle rather than a reflex contraction (like the myotatic reflex). This is known as the 'INVERSE STRETCH REFLEX'!

This relaxation or inhibition of a muscle is important for certain stretches because it allows muscle fibres to lengthen and stretch further (a relaxed muscle is easier to stretch than a contracted one!)

Autogenic Inhibition

Relaxation that occurs in the same muscle due to GTO activation is known as autogenic inhibition.

How do we achieve autogenic inhibition? By contracting a muscle immediately before passively stretching it. The contraction will increase GTO activation which increases muscle relaxation!

Reciprocal Inhibition

This is the relaxing effect that occurs in a muscle when the antagonist is contracting.

When an agonist contracts to cause a motion it forces the antagonist to relax (when one builder gets up to do some work, he makes the other sit down to have a cup of tea). The antagonists are INHIBITED from contracting (reciprocal inhibition)

Cross Fit WOD 18/11/09 TABATA

Buy in: 500m row, 10 Burpees, 20 lunges, 20 sit ups

Skill: 3 rm back squat 3-3-3-3

3 rep max: 100kg

WOD: TABATA

- 32kg Kettlebell OHS (8 rounds - 20 secs on/10 secs off) ? 40 ~
- Push Ups 57 ~
- Sit Ups 96
- Squats 161 (PB) 19,20,20,20,20,20,20,22

Awesome workout and although I completely forgot to count reps for the first few exercises, my score for the squats made up for it. Really pleased with it apart from that Chris just beat me with 162 (bastard lol!). But a good standard set for next time. Also on another positive note, my first time at cross fit doing backsquats I could barely do 1rm 100kg and today I did 3 reps not too badly :)

Physiology of Stretching: Part 1

What's really going on when we're stretching? Way down deep inside the muscles you wonder...
The two proprioceptors (sensory receptors) that play the major role in stretching are: muscle spindles and golgi tendon organs (GTOs).

Muscle spindles live within the muscle fibres (that's their crib) and their 24hr job is to text (send msgs) from the muscle to the CNS to inform it about their state of stretch (like a non stop telephone salesman trying to inform you about their great deals).

When the muscle is stretched the muscle spindle is stretched and distorted (as it's coiled around the fibres). This distortion of the muscle spindle causes the myotatic reflex (stretch reflex) or automatic contraction to occur, a protective mechanism to avoid damage to the muscles fibres through over-stretching.

"This triggers the stretch reflex which attempts to resist the change in muscle length by causing the stretched muscle to contract."

That feeling of tension in the stretch is that muscle spindle activation occuring. An important fact to remember: The amount and rate of contraction elicited from the stretch reflex is proportional to the amount and rate of stretching

(This is the principle plyometrics or 'jump training' is based on)

So the faster and more forceful you stretch, the faster and more forceful the reflex contraction of the stretched muscle will be (this is where tears are likely to occur usually in an untrained muscle). Every action has an equal and opposite reaction (just like Newton's 3rd Law).

This is one of the reasons why it's advised that when stretching you slowly progress into it at a low load. Stretching a muscle for an extended period of time begins to 'habituate' the muscle spindle to the new length i.e. it becomes accustomed to the new length and reduces signaling (less frequent txt msgs from spindle to CNS) will show as less discomfort.

Some research suggests that with extensive training, the stretch reflex of certain muscles can be controlled to a point where there is little or no reflex contraction in response to a sudden stretch.

This might provide an opporunity for the greatest flexibility to be achieved but also the greatest risk of injury. Essentially this training is turning off that protective mechanism which prevents the risk of muscle tear from over-stretching.

It's very important that when stretch training once a new elongation has been achieved, neuromuscular training should be done to ensure a patient/client develops neuromuscular control of that new length to avoid the risk of injury.

Daily Protein Requirements

The daily amount of protein varies significantly in relation to different individual factors:

- Size (of the person)
- Metabolic Rate
- Genetics
- Digestive capacity (how much you can absorb in a serving)
- Activity Levels

While there's no simple calculation to get this amount exactly right, the basic starting point is to think about the amount of protein required depending on bodyweight and predominant activity levels.

Daily Protein Requirements: grams of protein per kilogram of body mass

• Sedentary Adult = 0.8
• Recreational Adult Exerciser = 0.8 - 1.5
• Adult endurance athlete = 1.2-1.6
• Growing teenage athlete = 1.5-2.0
• Adult building muscle mass = 1.5-1.7
• Estimated Upper Limit = 2.0

National guidelines suggest that protein should make up 15-17% of daily calories, but considering how vital this macronutrient is for numerous reasons that seems pretty low.

The WHO (world health organisation) and the FAO (food and agricultural organisation) published a report in 2007 on protein requirements for humans. The minimum was identified as being 0.83g of protein per kg of body weight. Furthermore, they suggested that there is no evidence to suggest that intakes of twice that amount (1.66g protein per kg of bodyweight) will have any adverse effects.

3-4 times the minimum intake was cautioned and this suggests that intakes any greater than 2.1g protein per kg is not warranted for safe intake.

62kg sedentary female: 62 x 0.80 = 49.6g protein required daily

62kg recreational exerciser (4x week): 62 x 1.3 = 80.6g protein required daily

85kg sedentary male: 85 x 0.80 = 68g protein required daily

85kg adult hypertrophy (4x week): 85 x 1.6 = 136g protein needed daily

Recommended sources for dietary protein:

• Fresh, good quality meat: beef, pork, lamb, venison (ideally organic) Poultry: chicken/turkey
• Fish (salmon, tuna, mackerel, herring, haddock, cod, sardines, plaice, trout)
• Raw Nuts
• Organic whole milk (least refined possible and non-homogenized i.e. U.H.T)
• Eggs (chicken eggs - range from 7 to 12g of protein per egg)

What is a CONTRACTURE?

A contracture refers to an "adaptive shortening of a muscle tendon unit"

- Described in relation to the function of the limb
- This term tends to be used when a joint is restricted to the point that it cannot be moved into its normal anatomical position.

What is CADENCE?

Cadence is the number of steps per minute!

(a measurement of how many steps taken per min)

A toddler compared to an adult will have increased cadence due to the lack of stride length, shorter legs and if they spot the Disney store or something.

Increasing your cadence is one way of increasing your speed of walking

Define a gait cycle...

"A period of gait from first initial contact with one foot to the subsequent contact with the same foot."

"Made up of stance phase and swing phase." (60% stance phase, 40% swing phase)

"The stride equivalent to 2 steps."

NB: Of the 60% stance phase, 20% of that is spent in double support (2 periods of 10% - start/end of swing phase)

Ground Reaction Force: A definition

"GRF is the force exerted through the body, equal and opposite to the force the body exerts on the ground. It is a vector i.e. it is defined in terms of magnitude and direction."

Understanding the action of ground reaction force helps us to understand muscle action work in movements.

Functional Hamstrings

Simon Whitnall 12 November at 12.49

Hey Bud,
Cheers for the message. As usual it all comes back to the principles. If you remember the gravity and the ground reaction force reaction ones... Well it's gravity pushing down on us and then the foot contact with the ground that causes the knee to bend (flex). Depending on specifically which hamstring muscle we're talking about, it is the muscles job to decelerate and control the bending on the knee (how much, how far, how fast) and the bending of the hip, but also the frontal plane and transverse plane motions at the knee and hip.
I hope that helps mate, it is the short answer, if you want the long answer and you have a couple of days let me know ;-)

Cheers,

Si

Quote of the day

"Belief at the beginning of any successful undertaking is the one ingredient that will ensure success"

William James

Cross Fit WOD 8/11/09 400m of death!

Today's WOD was a tasty one (ummm tasty) with 4 round of flat out 400m runs and a welcome 3 min rest in between each round. Being the fool that I am, I'd done 2 rounds before we actually started because SOMEBODY (ehem Simon..) had written it under 'Skills' and a left a blank under 'WOD' (I'll come back to that later).

Anyway after a 1st round of 51 seconds I realised we had this 3 min rest in between (a nice relief!) so upped my game for the next lot.

Round 2 was an incredible 34 SECONDS! Oh..wait I touched the wrong lampost and my world record time was actually a lame assault course of dodging a van, car and then finally realising I wasn't quite Usein Bolt lol!

Round 3 was a nice 44 seconds, really maxed out on that one, followed by a 4th round of 49 seconds.

Back to blank under WOD, after some amount of joking it turned out there was actually more haha! Which came in the form of 4 rounds: 7 wall ball, 7 kettle bell swings and 7 burpees.
Me and Tim went first and after finishing the 1st round of wall balls came to my voluntarily opted 32kg kettle bell starring at me like "Yeah? Get on with it weirdo" (I know I can hardly believe I actually chose that sucker). But it was a good test and I coped much better than I thought I would with it :)

Time: 4.47 @ 32kg OOh Yeah!