I can’t say enough good things about the USATF schools. I am one third the way into my career and I learn something every day from guys like Randy Gillon and Kebba Tolbert. Other great minds are also teaching at the USATF schools and it’s awesome to learn so much from not only the instructors but fellow coaches. The Level III school from Las Vegas was a true brain blast that inspired me to keep
USATF Education
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Participant -
Participant
amazing technical info and full of truth,thanks for sharing!
If you have any more vids like that one that you are willing to share,I’ll be the first one in line to watch.
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Participant
Good Stuff…now to the problem of bringing that type of care to the HS and collegiate athlete with no budget. Last I checked Guy V. was accepting the first born male child as payment.
Why are so many “kids” injured, check the education/training of the primary care givers in the schools, as well as in “reputable” sports medicine clinics throughout the US (can’t speak for Canada). -
Participant
Nice video…a reminder to consider some of those issues. Talking with Dan a while ago he recommended the book “Chiropractic Peripheral Joint Technique”. It is a good source of info…and wasn’t $100 a few years ago.
That being said, I have been at courses with a few “name” PTs/DPTs and when I ask about things like fibular upslip they say they have never heard of it (only anterior/posterior displacement). Therefore, some of these things Dan references are more difficult to learn (find instruction) or get treatment for. Like John said (above) there seems to be a very limited scope of education in the US for this type of information even in an “osteopathic” path.
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Member
Carl,
Thanks for posting the video. There was definitely some great information. After our conversation the other night, I took some time to read a bit more about the proximal tib/fib joint and was able to form a few “conclusions.”
1. It seems that the proximal tib-fib joint is synovial joint that, with dorsiflexion, will glide antero-laterally and superiorly to fix it to the tibia.
2. When this occurs, it forms a stable base for the peroneals/fibularis to contract. As well, biceps femoris and ITB are influenced by if this happens or not (as Pfaff mentions in the video).
3. A lateral ankle injury, forced plantar flexion and inversion, or maybe even lots of time spent in plantar flexion alone (Pfaff wonders if it is the shoes) can displace the fibular head anteriorly. Pfaff also seems to believe that it is “ground up,” which I interpret to mean that dysfunction at the foot and distal tib/fib lead to problems higher up.
4. In the case above, the proximal tib/fib cannot as easily migrate and “impact” to form that stable base, which typically occurs with simultaneous hypomobility at the distal tib/fib syndesmosis. Pfaff directly comments this to be the case, as well. Like it or not, this is in congruence with the concept of alternating mobility and stability concept that Boyle and Cook fans call “Joint by Joint” training.
So what, right?
The tib/fib joints influence one another, with one becoming hypermobile (proximal) and the other becoming hypomobile (distal) playing, more or less, opposite their intended roles. It stands to reason, then that fixing one segment leads to improvements in the other’s function.
Before I get into that, though, let’s consider some other things about the ankle.
1. The talus mechanics play a huge role in ankle function. In a healthy ankle it will glide posteriorly with respect to the tibia, however, it has been documented in dysfunctional ankles to maitain an anterior position, while migrating superiorly and rotating internally.
2. In tib/fib syndesmosis sprains, most often, the talus serves as a wedge in the mortise that expands the syndesmosis beyond capacity due to the shape of the talus and how it externally rotates (forcing the thicker portion of the bone into the mortise). Joint motion that causes this injury most often is hyperdorsiflexion.
So what, again?
The hypomobility at the distal tib/fib syndesmosis can be improved with dorsflexion exercises as the talus during dorsiflexion externally rotates and “spreads” the distal tib/fib.
To put it all together, if it is true that mobilizing the distal tib/fib joint will lead to improved mechanics of the proximal tib/fib joint and that dorsiflexion clearly serves to mobilize the distal tib/fib joint, why wouldn’t we go after the distal joint with some wall drills. It seems that the guy Pfaff uses for MT in Canada does very little for the proximal joint itself, but rather works the fascia of the foot and distal joint, applies some distraction and “Bam, all the joints line up.”
Now, it is entirely possible that you’ve come up with completely different set of conclusions from the same or similar sets of information, and that’s okay. I’m not claiming to be right and you be wrong, I’m just explaining how I have interpreted the literature and the video as well.
I look forward to some continued discussion. I love how it brings out more and more ideas and great information.
Best regards,
Carson Boddicker -
Participant
Thanks for posting the video. There was definitely some great information. After our conversation the other night, I took some time to read a bit more about the proximal tib/fib joint and was able to form a few “conclusions.”
Not being critical but it does look like what you read last night is being pressed into your beliefs this post today. You can have restrictions proximal/distal at the same time. Alternating stability and mobility doesn’t work that way as you want optimal moblilty on all joints. The foot is too complicated and contains too many joints to simplify it. Start with the metatarsals and go up the “food chain” and see if the stability/mobility format works. You want optimal stability and mobility on all joints not just alternating in absolute characteristics.
Just like the Tom Myers tennis ball rolls on the plantar fascia releasing the superficial backline, I will put Daniel Andrews warm-up over that nonsense anyday. You have spent a lot of time putting your words down and I will review what we are doing after a quality evaluation was done by a real therapist. You have posted your belief and I will respond later.
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Member
Carl,
It is additive to what I know and understand, yes. I’m not saying I’m right, I’m just looking for an argument and evidence that PROVES me wrong. Just saying that dorsiflexion is altered by mobility or lack thereof at the proximal tib/fib (which I agree that it does) is not going to do it.
You said, “Alternating stability and mobility doesn’t work that way as you want optimal moblilty on all joints.” BINGO! I agree 100%. As would the guys who wrote it, likely. Would you agree that the optimal mobility at one joint is different than optimal mobility at another in a RELATIVE sense? Nobody ever said that “stability” means no movement whatsoever. I like the way Charlie Weingroff puts it: stability is “control of joints within a moving environment.” For example, the foot appears to be build for mobility to accomodate stress, but it also needs to be instantaneously stable to provide a stable lever for push-off. This is a function of proper joint mechanics AND motor control.
I agree that joint by joint is more complex than just in alternating “stack” form. The tibio-femoral joint, for example, while it has a need for mobility in the saggital plane (flex-extend) it demands stability in the transverse plane. Joint by Joint applied willy-nilly (like we agreed in our phone call many of our colleagues do) is not correct. That said, there still seems to be some consistency to the idea, and (Gray Cook says) it also forces people to evaluate above and below instead of just the joint itself.
I don’t see us disagreeing here. It seems that you are against a concept that your (correct) gut reaction said didn’t make sense, but you haven’t evaluated the other party’s argument in depth enough, thus making the same error that all of those “simpleton” coaches who hear joint by joint and sincerely believe alternating patterns or mobility and stability are only absolute.
With regards to Thomas Myers’s concept you mention. Is anyone using that as their only warm up? If that’s what you are arguing against, consider me standing right beside you.
Let me know your thoughts.
Best regards,
Carson Boddicker -
Participant
I enjoy the banter, and am having flashbacks to the last few months I spent in chiropractic school.
My main question was…when someone says a joint is fixated, what is fixating it? Sure there may be some “scar tissue” which arises in extreme cases, but why would an otherwise healthy young individual have a “stuck” talus? There are no muscular attachments to the talus, so no muscular contracture can directly freeze it up. Ligamentous scarring? Not pliable in the first place. If they were injured then they would be hypermobile if anything. Why would a joint “lock up” like the mainstream names continually tell us they do? -
Member
John,
There are volumes of evidence showing positional faults of many bones and joints following ankle injury (both acute, and “sub-acute”) that have a negative influence on joint mobility. Given that 23,000 ankle sprains occur daily and it is one of the most common athletic injuries, it’s safe to say that this may have played a role.
Likewise, there is evidence that immobilization in a shortened position leads to a decrease in the number of sarcomeres in series, creating a soft-tissue extensibility deficit.
Add that to the terrible posture and propensity toward a forward head posture, shortened hip flexors (Janda’s Upper, Lower, or Stratified Crossed Syndromes) and you have a recipe for an anterior weight shift that perpetuates the problem.
Just theory. Anyone else?
Best,
Carson Boddicker -
Member
So, muscular causative factors?
Muscular causative factors, sure, to some extent. Obviously if it were muscular only, some good, low-load prolonged stretching and some smart manual therapy would handle it pretty quick. You and I both know, however, it’s not that simple.
Maybe there is some fascial involvement. We know that the inferior extensor retinaculum plays a role in stabilizing the lateral portion of the ankle joint (I keep reference lateral ankle injuries because that’s what we have in the literature). We also know that disruption to fasica in one place causes disruption in other places. Tensegrity. Likewise, we know that the peroneals are put on a rapid stretch and subsequently demonstrate delayed onset in comparison to the uninjured side. Maybe lose the tug-o-war to the inverters, and the inverters lose a tug-o-war to the peroneals (both muscularly and fascially) and the result is a loss of motion.
Peroneals/Fibularis function is also dependent upon the proximal tib/fib reaching a closed-pack position, which says that ankle mobility/optimal function depends too on the ability of the joints to move well. Here you have positional fault theory, that states (and is confirmed in the literature) that certain things can lead to altered talus position, calcaneal inversion/eversion, proximal fibula position, distal fibula position. Positional faults then become self perpetuating.
Maybe these kids spend so much time in relative plantar flexion you start running into issues where their talocrural joint loses mobility (requiring more pronation and abduction at the mid-tarsal), so they start to move at the subtalar joint (“B” Game, a reference to the video) which is not ideal. Rotations at the subtalar are translated to the tib tibia and we start to see some of these “ground-up” injuries and dysfunction that Pfaff mentions.
How do you feel about it, John?
Best,
Carson Boddicker -
Participant
You said it Carson, footwear is atrocious!
The development of “forced” gait patterning begins as soon as the parent straps a pair of designer kicks to the feet of their 9 month old, and continues up until 7-8 years of age and by that time it is a well ingrained computer program within the noggin of the said child.
What we end up dealing with is the fall out of the neurological programming A-bomb. Movement has to occur in the joints of the foot, ankle, leg, etc. for afferentation to signal efferentation (messaging in to signal messaging out). Crap in…crap out. Incomplete messaging in…incomplete solutions out. Clinical example could be the common mistake of having a “weight loss client” perform his/her walking in a running shoe. Elevated heel, “wave like” propulsion system built in as well as a running lever system.
Do we think the linear velocity of the individual will justify the mechanics of the shoe. In a mechanism similar to overspeed training, will the client unconciously attempt to decelerate themselves throughout the entire walk with whatever musculature is available to them secondary to their developed gait patterning. May this bias an eccentric pattern within say the post tib (random) causing a break down of the agonist antagonist relationship with the peroneous tert, and extensor dig long/brev? So many available scenarios in the foot and ankle but the fun part is that with a good system of analysis these issues can be addressed as they are identified, whether they be neuro patterning, with secondary musc./fasc./capsular restrictions, or just bad parenting!
By looking deeply into the predictable close chain kinematics of the human bipedal gait mechanism, we can CSI the crap out of most problems, but in my experience the neural component has to be addressed in order to make plastic changes. -
Participant
Good Stuff…now to the problem of bringing that type of care to the HS and collegiate athlete with no budget. Last I checked Guy V. was accepting the first born male child as payment.
Why are so many “kids” injured, check the education/training of the primary care givers in the schools, as well as in “reputable” sports medicine clinics throughout the US (can’t speak for Canada).I know a few people that spent time with Guy Voyer and, being that he is French, felt it was tough to understand him at times.
This is a great clip, not only for the information, but also for non-track types to see that some track guys are years ahead of the curve. I hope Mike Boyle changes his message to ” Don’t listen to BAD track coaches.”
To what extent should coaches go to in trying to learn more about this? Is it wiser to outsource?
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Participant
Learning more is always good just know your limits logically and legally (don’t start trying Grade 5 manipulations, etc). Outsourcing is always better but not always practical. Remember that you can never be as good of a ‘weekend therapist’ than someone who does it all day, every day.
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Participant
[quote author="john marchese" date="1262625738"]Good Stuff…now to the problem of bringing that type of care to the HS and collegiate athlete with no budget. Last I checked Guy V. was accepting the first born male child as payment.
Why are so many “kids” injured, check the education/training of the primary care givers in the schools, as well as in “reputable” sports medicine clinics throughout the US (can’t speak for Canada).I know a few people that spent time with Guy Voyer and, being that he is French, felt it was tough to understand him at times.
This is a great clip, not only for the information, but also for non-track types to see that some track guys are years ahead of the curve. I hope Mike Boyle changes his message to ” Don’t listen to BAD track coaches.”
To what extent should coaches go to in trying to learn more about this? Is it wiser to outsource?[/quote]
NO. The key is looking at the etiology of the injury and managing budget, training, and competition schedule. Spending time doing motor program stuff with a PT and risking a TIB/FIB adjustment by yourself is a problem both legally and money wise.
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Member
Good video, very informative thanks 🙂
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