Tag Archives: biomechanics

Foot Center of Pressure Reduces Kinetic Chain Dysfunction and Chronic Pain

If you read my blog before you are well aware that I am a big proponent of identifying human movement dysfunction and correcting functional imbalances to reduce chronic pain, such as knee osteoarthritis (OA), patellofemoral pain syndrome (PFPS), and low back disorders such as sacroiliac dysfunction, facet arthropathy, or generalized lumbago.

A few years ago I read about a new neuromuscular technique called AposTherapy.  For those unfamiliar, AposTherapy corrects gait abnormalities by retraining muscles to adopt an optimal gait mechanics. The primary goal of AposTherapy is to correct the foot center of pressure (COP) during gait. This is done by wearing a unique, foot-worn biomechanical device. At the time, I heard good results about the use of AposTherapy, but data was too young to consider valid just yet or share-able, just yet.

Recently, when looking at functional rehabilitation techniques for chronic knee pain I came across an interesting study in the Journal of Biomechanics the evaluates the benefits of AposTherapy, to correct kinetic chain dysfunction responsible for the development of knee OA (1). The results of the study were significant. Following the intervention patients demonstrated significant reduction in knee adduction (valgus) moment (KAM). Several authors have demonstrated KAM to be a primary cause of knee OA, including Miyazaki, who noted KAM correlates with the progression of knee OA (2). In addition, patients who participated in AposTherapy demonstrated increased walking velocity, reduced pain, and improvement of functional living (1).

The foot-worn biomechanical device alters foot COP, allowing for proper kinetic chain alignment neuromuscular efficiency. Clark and Lucett, noted that dysfunction at one joint precipitates altered movement patterns, at adjacent joints, both proximally and distally (3). This is the foundation of AposTherapy. By correcting  foot COP during gait, altered joint mechanics up the kinetic chain are nullified and neuromuscular efficiency is enhanced. Overtime, strength gains occur allowing for optimal gait patterns. Sharma, stressed the role of neuromuscular ineffciency, suggesting that secondary to elevated joint stress with higher impact loads and altered joint mechanics facilitate the pathogenesis of the chronic joint disease (4).

Biomechanical interventions focusing on foot COP, neuromuscular development and agility, enhance functional ability, reduce pain and increase spatiotemporal patterns of gait (1).  Working knowledge of human movement dysfunction and human movement compensation patterns are prudent to health practitioners.  Health practitioners should emphasize and correct human movement dysfunction when treating clients with chronic joint pain such as and certainly not limited to knee OA, PFPS, SI pain, and other  low back disorders like facet arthropathy.  Training to enhance neuromuscular recruitment, force-coupling, as well as the correction of altered length-tension relationships and poor joint arthrokinematics will go far in reduction of pain, prevention of chronic pain, and improved functional outcomes.

What techniques do you implement to train for optimal neuromuscular efficiency?

References:

1. Haim, A, et al. Reduction in knee adduction moment via non-invasive biomechanical training: A longitudinal gait analysis study. J of Biomechanics. 45 (2012) 41–45.

2. Miyazaki, T., Wada, M., Kawahara, H., et al. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Annals of the Rheumatic Diseases.  2002. 61, 617–622.

3. Clark, MA, and Lucett, SC. NASM Essentrials of Corrective Exercise Training. Lippincott, WIlliams and Wilkins. 2010.

4. Sharma, L., Dunlop, D.D., Cahue, S., et al. Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Annals of Internal Medicine. 2003. 138, 613–619.

Personal Trainers, Are you Bored?

Let’s face it, everyone gets bored with day-in, day-out monotony. Although Personal Trainers have unique clients and face unique challenges everyday – they too can get bored with the gym scene. Some may begin to look for other opportunities. Personal trainers have a profound knowledge of functional anatomy and mechanics. So how can this knowledge be utilized elsewhere? I would like to open your mind to an avenue of exploration that combines, your knowledge of function with ergonomics; a practice I call BioErgonomics.

BioErgonomics comes from Biomechanics (mechanical principles in biological systems) and Ergonomics (Greek for work laws) and means addressing biomechanical dysfunction with ergonomics to prevent and correct work related musculoskeletal disorders. This practice speaks to health and wellness professionals as they are experts at identification of human movement dysfunction. Take a look at these staggering numbers:

  • Currently, corporate wellness is a $1.6 billion dollar industry and is projected to be $5.8 billion by 2015.
  • The insurance information institute says indemnity (time lost from work) rates have doubled over the past 12 years.
  • Over the past 2 years there has been a 69% increase in corporations offering corporate wellness.
  • 65% of companies recognize the value of corporate wellness and state they will increase funding and incentives for employees participating in wellness programs.
  • Avg. cost per permanent disability claim is ~$41,000
  • Musculoskeletal disorders account for 29% of all days lost at work
  • 33% of all injuries are a result of poor ergonomics and biomechanics
  • An employer’s return on investment for corporate fitness programs can be as high as 6 to 1.
  • 42% of large firms will require employees to complete health coaching or a disease management programs
  • 65% of respondents said that for 2011 they’ll increase incentives to take part in corporate fitness programs
  • Insurance companies strongly advocate corporate fitness programs
  • Lower back injuries account for 24% of all injuries and 65% of these are caused by over-exertion and poor mechanics.

These data points prove companies need help. They also prove companies recognize the value in corporate fitness and have already started to incorporate programs within the company. Many have invested big money on staffing in-house ergonomist. Unfortunately ergonomist, do not understand functional human mechanics like health and wellness professionals do. These companies need extra help! Why can’t you be the one to help them?

Many companies have ergonomic consultants or internal safety teams that purchase high-tech gadgets and ergonomically correct workstations to mitigate injury or reduce risk of injury for employees. Unfortunately, this does not fix the issue. As health and wellness professionals, we have the ability to recognize movement dysfunction. By applying the proper exercise techniques we can help employers address these issues and save companies huge money on workers compensation costs and eliminate wasted money spent on expensive equipment.

Market yourself, become entrepreneurial, several job opportunities exist for positions in corporate fitness, these include working for a company, or even better you can create your own position by becoming a consultant.