Dr Jeff Cubos » Lower Extremity

What Is Really Up With Those Sneakers?

jcubos — Thu, 15 Jul 2010 19:28:10 +0000

Thanks goes out to Geralyn Coopersmith for your contribution to this video

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Dr. Richards on Biomechanics & Stretching

jcubos — Tue, 13 Jul 2010 02:28:07 +0000

A lecture by one of my university professors and mentors on biomechanics and stretching.

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Hamstring Length and the Patellofemoral Joint

jcubos — Sat, 26 Jun 2010 00:21:02 +0000

In the next week or so, my most recent review will be posted on Research Review Service, a site specifically for health care professionals of manual and rehabilitative therapy. The Influence of Reduced Hamstring Length on Patellofemoral Joint Stress During Squatting in Healthy Male Adults by Whyte et al was published earlier this year in Gait Posture.

Here’s a brief summary of the study:

Study Purpose:

To determine the presence of a relationship between hamstring length and PFJ stress at 3 specific knee joint angles of flexion.

Study Population:

16 recreationally active males divided into two groups based on knee joint angle-measured hamstring length.

Methodology:

A biomechanical model incorporating knee joint angle, knee extensor moment, and PFJ contact area was used to quantify PFJ stress.
MRI and 3D motion analyses were also utilized in this study.
A one-way ANOVA to determine the variations in PFJ stress between the 2 groups (with and without reduced hamstring length) was used.

Main Findings:

Patellofemoral Joint stresses differed significantly between the two groups at specific angles of knee flexion.
No significant differences in hip angles between the two groups.

Clinical Application:

This study demonstrated that subjects with reduced hamstring lengths have increased PFJ stress during various positions of the squatting movement. As a result, such a decrease in length MAY contribute to the pathogenesis of various conditions relating to the knee.
These results enable us to consider another factor when managing those with knee pathology.

For a complete and “evidence-informed” understanding of the study, look out for my review. I have obviously left out specifics from this study in this post as Research Review Service is a paid membership site. However, if you would like more information, please do not hesitate to ask.

Photo source

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More on the Deep Front Line

jcubos — Fri, 11 Jun 2010 17:56:23 +0000

Recently Patrick Ward wrote an article on Mike Robertson’s website about the Deep Front Line. Its a good read so make sure you check it out.

The Deep Line as Patrick states, consists of the following:

Posterior tibialis > interosseuos membrane > Knee capsule > adductor hiatus > intermuscular septum > femoral triangle > psoas > anterior longitudinal ligament > diaphragm > pericardium > mediastinum > parietal pleura > fascia prevertebralis > scalenes

Patrick goes on to explain how breathing plays a very important role in the function of this line and provides some excellent strategies for correction and progression.

This got me thinking…

Often times I will use the Bunkie Testing method to assess the various lines throughout the body. I wrote a piece about the Bunkie Test late last year and it can be viewed here. Kevin Neeled also wrote a piece and shot some video on how and why this testing method may play an important role in kinetic linking for hockey players. You can read that here.

As mentioned last fall, the Bunkie Test consists of tests for the following

Anterior power line
Medial stabilizing line
Lateral stabilizing line
Posterior stabilizing line
Posterior power line

Do we truly know that we’re testing each of the above? Who knows, but based on Patrick’s article, I think we need to revisit the test and see how we can start testing the DEEP FRONT LINE. That is, the Deep Stabilizing Line. Maybe we can’t. But perhaps we can. I am not trying to reinvent the testing method here. I am simply seeing a flaw in the testing procedure and am now looking for a way to improve it. Joe Heiler of Sports Rehab Expert recently invited me to do an interview and discuss the Bunkie Method of Testing. I hope to do this interview in July so maybe I’ll have some answers by then.

Perhaps there are other ways to test this. I can’t remember off the top of my head right now so if you can think of one, make sure you let me know.

When a patient does present with “dysfunction” of this Deep Front Line, aside from attacking their breathing patterns, I progress to improving their rolling patterns as well. Generally, I will work the supine to prone rolling pattern to improve this line and specifically target the right arm / left leg or left arm / right leg combinations as needed. Carson Boddicker has written several pieces on these topics, one of which is a must read. For an introduction, make sure you read Core Competencies. Mark Young makes a good argument about testing the roll, but personally, I think quality is more important than quantity in this case…but that’s just my opinion!

Progression from here would be to the Dead Bug tract (not dissimilar to Patrick’s videos) and onward to chops and lifts (thanks Mike) and beyond to really attack their stabilizing function. Check out Nick Tumminello’s video of the Vertical Pallof Press for anterior stabilization (to combat lumbar extension).

Lots of info to digest here and certainly plenty of hot links to click on. So thanks to Patrick, Mike, Kevin, Mark, Carson, Nick, and Perry for unknowingly being participants in this post!

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But Is It Faster?

jcubos — Thu, 06 May 2010 01:12:30 +0000

“What happens is that you change your style of running depending on whether you are wearing shoes or not so that the impact forces are always similar…” ~ Benno Nigg

But Is It Faster? by Matt Fitzgerald: An excellent read providing an enlightening viewpoint in regards to the barefoot running craze.

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The 6 Minute Swim Prep

jcubos — Thu, 15 Apr 2010 03:49:20 +0000

Question # 1:

DO YOU SWIM?

If you answered “yes” to the above, please proceed to the next question. If not, thanks for visiting!

Question # 2:

DO YOU PREPARE YOURSELF TO SWIM?

If you answered “no” to the above, please view the following videos to help you prepare for your next run using the GRID by Trigger Point Performance Therapy.

Quadriceps – 60 seconds each leg (Total = 2 min)

Tensor Fascia Lata – 30 seconds each hip (Total = 1 min)

Mid – Latissimus Dorsi – 30 seconds each side (Total = 1 min)

Thoracic Spine Rotation – 30 seconds each side (Total = 1 min)

Quadruped Reach & Roll – 60 seconds

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The 6 Minute Run Prep

jcubos — Tue, 13 Apr 2010 18:59:24 +0000

Question # 1:

DO YOU RUN?

If you answered “yes” to the above, please proceed to the next question. If not, thanks for visiting!

Question # 2:

DO YOU PREPARE YOURSELF TO RUN?

If you answered “no” to the above, please view the following videos to help you prepare for your next run using the GRID by Trigger Point Performance Therapy.

Calves – 45 seconds each leg (Total = 1.5 min)

Quadriceps – 60 seconds each leg (Total = 2 min)

Tensor Fascia Lata – 30 seconds each hip (Total = 1 min)

Thoracic Spine Rotation – 45 seconds each side (Total = 1.5 min)

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Optimum Body Mechanics

jcubos — Sun, 11 Apr 2010 19:47:22 +0000

As a follow up to my interactive event this morning with the crew at Lululemon (West Edmonton Mall), here’s a brief summary of maximizing Optimum Body Mechanics in activity and sport. By no means is this a comprehensive article, it is merely a starting point to preventing injury and optimizing sport performance.

ANKLE:

What we need:

Dorsiflexion mobility

Why we need it:

Minimize stress on knee

How we can get it:

KNEE:
What we need:

We need to realize that the knee is often an innocent bystander

Why we need it:

We need to realize this because the research says so

How we can get it

We can achieve optimal knee mechanics by looking both above (the hip) and below (the ankle) this joint.

HIP:

What we need:

Saggittal plane mobility
Extension strength

Why we need it:

Minimize stress on lumbar spine

How we can get it:

What we need:

Frontal & Transverse plane dynamic stability

Why we need it:

Minimize dynamic valgus at knee and dynamic internal rotation at knee

How we can get it

Side Lying Abduction
Clam Shells (Hip – External Rotation)
Mini Band – External Rotation
Airplane (I’ll get a video of this up soon)

LOW BACK / CORE:

What we need:

Antirotation, Antiextension, Antilateral flexion STABILITY

Why we need it:

To be able to transfer forces THROUGH not TO the “joint” (aka Core”)

How we can get it:

Antirotation: “Pig on a Spit” Roll
Antiextension: Front Plank series including the Body Saw

Antilateral flexion: Farmer walk / Suitcase carry

What we need:

Lumbar intersegmental stability

Why we need it:

To be able to transfer forces THROUGH not TO the “joint” (aka Core”)

How we can get it:

Effective “core activation” methods

THORACIC SPINE:

What we need:

Rotation & Extension mobility

Why we need it:

Lumbar relief & Shoulder mobility

How we can get it:

SHOULDER:

What we need:

Scapular stability

Why we need it:

Shoulder mobility

How we can get it:

For those of you who are unfamiliar with this approach of looking at the body, please have a look at Coach Boyle’s The Joint by Joint approach and FITS Toronto’s 5-site Integrity

Anatomical photos courtesy of Primal Pictures

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Minimizing Hip & Groin Injuries

jcubos — Wed, 07 Apr 2010 14:55:45 +0000

It goes without saying that the hip and pelvis region is one of the most complex of the entire body. Largely due to its role in transferring loads from the lower body to the upper body and vice versa, how well our body actually transfers these loads will dictate how efficient our body will be.

As a result, the hip and pelvis must be a dynamically stable series of joints during sport and activity.

An inability to stabilize the pelvis while performing dynamic lower body movements (i.e. performing lunges in the weight room or skating in hockey) may result in shear forces sustained by the spine, creating a compensatory pattern of inefficient/lack of gluteal activation, muscle spasm, and undue stress on the hip joints and muscles.

Therefore, to minimize the risks to specific muscles that cross this joint, we must maximize the integrity of the slings that cross it. Four myofascial slings are involved here, and they include:

Posterior oblique sling – located across the back from gluteus maximus, through the thoracodorsal fascia, and up to the latissimus dorsi.
Anterior oblique sling – in the front of the body from the external oblique, through the anterior abdominal fascia, to the contralateral internal oblique and the adductor musculature
Longitudinal sling – from the peroneii/fibularis group in the lateral lower leg, up the biceps femoris, the sacroiliac ligaments, through the deep thoracodorsal fascia, and up the erector musculature
Lateral sling – containing the PRIMARY frontal plane stabilizers for the hip joint – the gluteus medius, tensor fascia lata, and the lateral stabilizers of thoracopelvic region (i.e. quadratus lumborum)

Therefore, to assess and correct one’s risk for hip and groin injuries, it would be prudent to test the integrity of these slings and their myofascial components through such testing procedures as the BUNKIE TEST.

One of the most important tenets in minimizing these injuries is the ability to CONTROL and STABILIZE this region while power is being generated. We want loads to be generated THROUGH THE JOINT and not to it!

Other considerations include ADDuctor to ABDuctor strength ratio, hip static and dynamic mobility, and joint centration.

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Do You See What I See?

jcubos — Thu, 24 Dec 2009 15:07:28 +0000

For the holiday, my gift to you is a little case study that we can all work on together.

Here is a 29 year old female massage therapist. Her goal is to be able to run 21K by next April. She currently runs 3 times per week of varying distances and had reached 11K earlier this week.

She complains of left lateral knee pain with running, but is able to continue and complete each session. Pain is vague and located just superior to the fibular head and slightly anterior to the LCL. Orthopaedic testing for all pertinent structures were found negative.

Her basic movement patterns are shown below:

What do you see?
What other questions would you ask this individual?
What other testing procedures would you incorporate and why?
What corrective exercise strategies, rehabilitative protocols, and therapeutic methods could you incorporate to manage this individual’s presentation? (this will obviously be based on additional info once the ball gets rolling)
What, if any, are your recommendations?

I would like to get this discussion going so the more contributers the better! Tell your peers. Everyone is welcome to participate in this case study and you certainly do not need to be a doctor, therapist or exercise professional to do so. All I ask is that you try as best as you can to be clear with your comments so that we can be as productive as possible.

*NEW*

ADDITIONAL INFORMATION:

Right Iliacus very tender to touch
Right external hip rotators very tender to touch
Decreased passive right hip internal rotation @ 90 deg of hip flexion
Right Glute Med/Min complex tender to touch

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