Scapula Shmapula

With more than 15 different attachment points, the scapula is a major player in the upper body for sports and life. Having the ability to move your arm, especially overhead, is paramount to being a human.  The efficiency of your shoulder blade to slide, glide, and wrap around your rib cage is what separates those who have good shoulder health and have more  freedom to do activities and those who have pain

Image result for so much room for activities

   You see unlike most joints that come to mind, the scapula is not exactly a true joint. Instead, this devious flat shaped bone sits snug to our ribcage connected by only some ligaments and interacts with our ribcage which is coined the scapulothoracic joint. This false joint has a concave-convex relationship. Your shoulder blade is a concave surface (Here’s a good way to learn the difference between concave and convex; “Cave” is something you go into hence concave is a structure that has a bend in the middle and while convex would be the opposite where it bends to the outside)Image result for concave vs convex anatomyScapula                              Ribcage

What this means is your ribcage is perfectly anatomically shaped for your scapula to ride around on it like a train on a track. The scap then does its job allowing you to get your hands overhead and any other complex positions by wrapping around, sliding, and gliding across the ribcage. But what about the rotator cuff muscles that attach to the scapula? Mike Reinold explains it perfectly stating that they “Keep The Ball On The Tee”. They stabilize ball of the humerus on the glenoid fossa and make sure it doesn’t pop outImage result for ball on tee

Now where life isn’t fun and things don’t go according to plan with the shoulder are a couple of issues.  They could be thoracic position being influenced by less than stellar breathing, shoulder blade orientation in both static and dynamic movement, and shoulder pathologies that involve grinding against the capsule. Of course, this is not an end all be all but these issues are important, to say the least.

Enter T-spine!

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This issue should really be the first stop in understanding shoulder health since it serves as the foundation for the scap to move around on. An important issue within the t-spine which I’m sure people are going to roll their eyes and ignore is making sure the ribcage is in a good position and that you are able to breathe fully.

Image result for oh boy this guy again

Believe it or not, the inability to drive air into the top of your lungs can wreck shoulder mobility. Just like sides of the pelvis are able to move independently, so do the sides of the ribcage.  If you were to rotate your ribcage to your right, the left side of your rib cage would move down, in and back as air would get released from your right side. The right side of the ribs moves forward, out and up which opens up space to enter the right side.

Image result for thoracic rotation

The problem comes in at the inability to achieve the FULL EXHALE that’s needed for proper rib kinematics. By exhaling fully the trunk will actually be able to rotate further because your eliminating the air that is caged in our hyperinflated chest all day from breathing inefficiently.

This excerpt from an excellent article Trunk Rotation NOT T-Spine Rotation from Darkside strength which explains perfectly of being able to rotate effectively from your T-spine.

“Try this experiment:  take in the biggest breath of air that you can, hold it, and then try to perform your favorite trunk rotation exercise.  Rotate as far as you can still holding your breath.  Now, exhale all the air out, continue to exhale until you feel like there’s no air left in your body, and then exhale some more.  Sigh out at the end as if you’re fogging up glass in the winter.  Try to rotate more.  You will find that you are immediately able to rotate your trunk further in the desired direction. To take this one step further, following your full exhale, feel your abs on the side of your body opposite of the direction you’re rotating (if you’re rotating right, feel lefts abs) and keep them slightly engaged to keep your ribs down on that side as you maintain position and take a breath in through your nose.  You should feel the air go into your chest wall on the side you’re rotating towards, and you should pick up, even more, rotation in that direction. It drives me nuts when I watch coaches and therapists teach and then stand there while their clients crank their way through compensations, usually by further driving their thorax and lumbar spine into extension as they hold their breath while performing various popular “t-spine rotation” exercises. /At the same time, the Internet is full of countless so-called “movement experts” advocating the need for these t-spine rotation activities performed by twisting the trunk as much as possible without any regard for airflow or rib position.”

So to recap off these important points in t-spine rotation

  • t-spine rotation = rib cage position with full exhale as you rotate (Ribcage is moving in all 3 planes. The full quality exhale is what’s allowing your ribcage to get back to the internally rotated position since it was stuck in an externally rotated position)Image result for you're welcome america will ferrell                                                        Moving the ribs in 3 planes. Your Welcome America!
  • The ability to fill one or both chest wall with a good breath is called Apical Expansion, regardless of whether you’re rotating or not.
  • DON”T HOLD YOUR BREATH
  • You will feel it in chest wall your rotating to and in the contralateral abdominal wall

Building off the base of the ribcage position is whether someone’s static or resting posture is overly extended or overly kyphotic. The reason I bring it up is because the posture of the ribcage affects the orientation of how the scapula sits on it.  The best example would be those population of people who sit with flat thoracic spine and basically looks like there is a rod going through their upper back.

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Yours’s truly

One might say “Wait, they have good posture and are not hunched over so they should be able to get overhead pretty easy right? What’s the beef…..jerky?  (I know its so bad that its good!)

Heres the thing, The notion of their posture looking “good” (Which by the way there is no real or ideal posture since posture is just a snapshot of position) isn’t actually that great because the front of the ribcage pops out in front which will not only affect your scapula position but also your ability to take a quality breath! Also, people with a way extended posture (like myself) have the appearance that the scapula is winging. It’s actually a false winging because if you get the ribcage in a better position with a full exhale and cue “Reach” with the arm, the ribcage will go back to its regular down, in, and back position. Now the medial border of scap won’t tempt you to grab it like your going rockclimbing up someone’s back.  Image result for climbing  funny

Here’s an excellent demonstration of improving the ribcage position using the wall, the ground, and a load to regain some kyphosis in a stable ribcage.

Another point is how the scapula sits on the ribcage. Shirley Sahrmann’s quote “Ideal alignment facilitates optimal movement” displays how we want to have a good position of our scapula on the ribcage as well as good ribcage position. What the ideal position of the scap is a posterior tilt and slight upward rotation. The low trap, upper trap, and serratus all work together to bring upward rotation which brings your arm overhead.

Image result for serratus and trap

The low trap posteriorly tilts the shoulder blade to the ribcage while the serratus allows it to move it across the ribcage so the bottom border of the scapula gets the armpit or axillary line. Finally, the upper trap allows some elevation for some clearance so the humerus overhead. All of these motions described are what makes up the ideal scapulothoracic rhythm of the shoulder.  It is different from excessive glenohumeral motion which is usually what you see where people move way too much through their arm and think they ‘re moving well

Image result for cowbell gif Except if you play the Cowbell

 Again all of this builds upon the base of having a stable t-spine position which is a normal kyphosis in your ribcage. Your t-spine is like the train track and your scapula is the train and if those tracks aren’t set then good luck going overhead.

Image result for train tracks meme

Another important part of the scapula orientation is the dynamic portion of the eccentric where one controls the down portion of a movement. Here is Eric Cressey explaining using the correct scapulothoracic rhythm of how your shoulder blade position sets your motion of your arms whether you go out to the side or up overhead.

 

He starts with the horizontal abduction or “T” and shows how the scap should move across as you go overhead such as a “Y”. You’ll notice the scap will actually wrap around the ribcage allowing your hand to get to the “Y” position from the “T”.

With many pathologies of the shoulder, if one can make better repositions to the scap then changes can be made to the symptoms experienced by those with the pathologies.  This Study by Pontin et al. supports that “alterations in scapular positioning at rest and in movement, called scapular dyskinesis, are associated with various diseases of the shoulder, such as the impingement syndrome, rotator cuff tear, instabilities and adhesive capsulitis” or in other words both static and dynamic positions of the shoulder blade on the back play HUGE parts to shoulder health.

For any impingement pathologies, it could mean (I say “it could mean” because again not every case and situation is the same) that your scap does not get enough upward rotation and so the humeral head is slamming into the AC joint or irritating your biceps tendon. Those with labral issues involve wear and tear of the labral fibers in our shoulder showing what parts of the movement gets grinded away the most and one could probably guess what motions or actions irritate it the most from it.

Here is the golden rule: Wherever your arm goes, so does your shoulder blade and vice versa! Also when your shoulder blade stops moving the motion should stop especially for rows and unilateral upper body exercises. Get it in a good position and then get it moving and grooving.

 

 

 

 

References

https://dsstrength.com/trunk-rotation-not-t-spine-rotation/

Pontin, José Carlos Baldocchi et al. “Static Evaluation of Scapular Positioning in Healthy Individuals.” Acta Ortopedica Brasileira 21.4 (2013): 208–212. PMC. Web. 12 Nov. 2017.

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The Practical Plank

The Practical Plank

Ah, the plank! It’s easily the most identifiable exercise in most strength and fitness and even rehab programs. It’s the most expendable exercise since you don’t need a lot of space and can do it anywhere. There are an incalculable amount of articles on how to do it but this article won’t be about how to execute it, but instead the purpose of getting back to WHY the plank should be done. We can all do exercises we want but if we don’t know the purpose of why they are being done then what is the point? A good reason to use the plank should be a benchmark that everyone should strive for. The plank is an excellent indicator of core strength endurance and teaches full body tension needed for our other lifts. By reinforcing the full body tension, the plank also teaches the top and end positions of most exercises such as pushups and deadlifts.

Stu McGill’s work indicates that a person should be able to hold a plank for two minutes and thirty seconds. Now before we go chasing the challenge we must understand something. What’s the purpose of the plank anyway? The plank is an expression of the strength endurance of being in full alignment of our core, and all the total musculature connected to it in maintaining position. Expression of this stacked position of the core would be a line from the top of our head all the way down to the tailbone. If you were to look at it from the side the rib cage is locked on to the pelvis as one whole unit being propped up by the arms and legs.  In this position, we can allow our core to do what it is designed to do which is stabilize the spine and allow forces to be distributed evenly. By being on the ground we take gravity out of the equation. Once we master it then we can progress to programs in which we practice the top positions of deadlifting, swinging, and cleaning a kettlebell. Add in training the side plank and maintaining a quality position there and it reinforces other exercises such as farmer’s walks. Now your trip to the grocery store won’t be as dreadful since you’ll be strong enough to take the groceries in one sitting

Image result for planking in grocery store

 

 

Planks are all about QUALITY over quantity. We could all suffer trying to hold it for five minutes so we could brag about it, but you don’t get better or stronger by basing how sore or how much of an ass kicking your training gave you. You get better in seeing improvements from one training session to the next and how you feel from week to week. The better you are at making sure your ribs don’t flare and your hips don’t sag, the better expression of your strength endurance of your midsection in the plank. While it seems like such minute things to overlook, the devil is really in the details. Imagine if one side of your car’s transmission was on looser, or sagging down lower on one side, and you felt it but just kept driving. That side would wear out faster and you’d be in a mechanic shop pretty soon. Do things right now so you don’t have to deal with the mechanic later.

We would first program for breaths before we worry about time. The reason for this is because if you can’t breathe in that position then you don’t own that position. We don’t want to simply survive an exercise; we want to thrive from it. Everything we do must have a purpose for why we do it. We want to train people to be successful in positions where they can own it and then progress accordingly. The long-term goal is to be able to maintain alignment for two minutes and thirty seconds. It’s key to manage how long one can maintain the position and then program accordingly. We can progressively add more breaths and then slowly go for time. The plank is a basis for many exercises and a baseline for strength-endurance.

Set up planks so you can get up the mountain friends.

On Pain And The Biopsychosocial Model

I wanted to write this article because I wanted to further my understanding of pain and take a stab at capturing it. It’s easy to say you have pain because of bone spurs, disc herniations, arthritis, joint degeneration, or because the Knicks haven’t traded Carmelo. While all of these things sound ominous, they are not the exact reason for why your certain pain exists. Pain is a highly complex part of being a human and there are many factors to it. A good analogy would be if you were to ask five economists how to fix an economy. You’re going to get five different answers. It’s not just physical loads but also social, psychological factors involved as well. This is where the Biopsychosocial model comes in. The Biopsychosocial model takes into account the dynamic and complex interactions among physiological, psychological and social factors that contribute to individual experiences of pain uniquely (https://www.futuremedicine.com/doi/abs/10.2217/ebo.13.469). Ironically this model has been around for more than 30 years and now is being taken into consideration. I’m going to do my best to explain first how pain is mapped out in our brain and how the complexity of these different factors overfill our metaphorical cup which could lead to pain

 

Image result for load injury and pain

There are quite a lot of variables involved

    Lorimer Mosely and David Butler, authors of Explain Pain, have explained that pain is an output by the neuromatrix in our brain. The brain has to take inputs from proprioceptive, vestibular, and visual information systems to report the positions of all the different body parts. As I write this, my mind is literally blown because that is a ton of responsibility and only our brain can do that.

 

 

Pain acts as an alarm system that the brain sends off to protect the individual from a supposed threat. While we know injury happens when a load exceeds the capacity of those tissues to withstand that load, there is more to pain than the simple biomechanical model. The neuromatrix in our brain is responsible for coding literally every conscious experience with a neurotag whether it’s eating a savory great cut of steak or feeling the need to stratch a poison ivy rash. It is the patterns of our brain activity that create pain (Lehman)

 

 

 

 

 

 

 

 

 

 

 

The neurotags that code for pain in our everyday conscious experience can either activate or not. This would help explain why those people who have MRI examinations of abnormal joint structures such as disc bulges and herniations could be completely asymptomatic to any pain. Here are some studies exemplifying it. Study 1, Study 2, Study 3.

The main difference between those who experience chronic pain and those who don’t experience it goes back to the software conditions of how the brains process it and make sense of it. The pain pathway that our brain sends out is individualized based upon how one maps out and associates things such as movement, feelings, and expectations. If one does not have a clear representation of how their brain maps specific regions of their body when they move such as not being aware or cognizant of one’s hip and where it is in space then we are given unclear signals. Add this to someone who has chronic pain, which actually changes the way the brain controls perception and movement, and the pain spreads. This pain spreads because of the imprecise input of the fuzzy and unclear body maps. The imprecision of the body map makes it difficult for one’s brain to locate or identify what is truly going on.

Image result for it's fine meme

 

Pain spreads because your body is trying to make sense out of nonsense so it might as well say “Might as well have pain here in your knee too since you have no awareness and or control of whats going on in your hip and ankle”.

This software fault of having unclear body maps exemplifies a concept known sensory motor mismatch. Sensory motor mismatch deals with how whenever we make a movement, the brain predicts the sensory information that will result and the predicted feedback is compared to the actual sensory result to determine if the movement was successful (Hardgrove). If the sensory data consistently conflicts with the prediction then the body maps are smudged or inaccurate. The confusion of sensory motor mismatch can cause the perception of threat and plays a role in chronic pain conditions.

Image result for danger zone archer meme

Just like regulating the body’s hormone levels, blood and temperature, the brain needs to regulate its ability to form clear pictures of what is actually going on in the body. Again, the brain takes in all the inputs from the different systems of the body and instantly processes and filters them. Once analyzed and integrated unconsciously, the brain asks two questions. The first is “How dangerous is this really?” and the second is “Is pain necessary for protection?” Pain is the result on how the questions are answered. Interestingly enough the brain doesn’t have to only choose pain as an output but can do other outputs which serve as protective behavior such as limping, flinching, muscle guarding or the fight or flight response. It definitely helps to develop a good relationship with how one maps movement and be aware of you move in space

Image result for Check yoself

This is why Feldenkrais or any type of Somatics training is excellent because for the first time we are slowing things down and making people truly aware of their entire bodies in space and how they map their own movement. Image result for Somatics    The simple motions help people develop clear maps of the limb moving in the three-dimensional world that we inhabit. People who are not aware of their body maps don’t have a good perception or feel for their own basic movement. Those with chronic pain have been shown to have difficulty in various tasks that require good perception of body location and motor control including

  • locating the outline of the back and position of the spine
  • two-point discrimination
  • right/left discriminations of pictures of body parts
  • reducing postural sway in response to disturbance
  • control of pelvis and low back

https://pdfs.semanticscholar.org/4332/ca068f811ccf315b7a708cd2bcaae6515f78.pdf

    It’s a two-way street between perception and pain and much research has to be continued.  Do problems with perception and movement cause pain or is pain causing problems with perception and movement? These two questions need to be deciphered in order to understand whats going on in the body. Here is probably the most interesting and counter-intuitive notion regarding pain. Pain has more to do with sensitivity than about damage!

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Pain is an output depending on your sensitivity threshold to a specific movement or specific way of doing something. This could be flexing your spine or just the chronic anxiety in going to a job that you absolutely hate. Some key factors that go into that threshold are how much volume is being stressed, how ready are you, and if it is progressed too quickly. You don’t have to apply these key factors to just the weight room but also to situations in life as well. This threshold could be likened to the analogy of an overfilled cup.

Image result for overfilled cup analogy

Once that cup is filled to the brim and continues filling with liquid, it’s going to spill over. You might be filling that cup differently since pain is multidimensional. You can have a lot of physical, mechanical, emotional and social stressors and have no pain. But at some point, a sudden increase in one of those stressors or a new stressor puts you just over the edge and the water flows out and now you have pain. Often people will have more pain when there are changes in the stressors in their life. It is the inability to adapt to the new stressor that contributes to pain not necessarily the amount of the stressor in your life (Lehman)

To further expand upon the complexity of the pain we need to be aware of some of the psychological and social factors in The Biopsychosocial model. I believe they are the hardest to pin down because not only are they the most insidious and hard to see but also because it’s difficult to quantify them and test them out. You would need to walk in that person’s shoes or follow them around all day or weeks to know what dialogues they are having within themselves and understand the situations behind their lives. This goes more into more difficult waters to traverse such as the way they were brought up and the traditions, what they were made to believe, especially about themselves and many other things hard to quantify.

Image result for aint nobody got time for that

There are some statistics that we should be aware of and how they tie into pain into this model. Chronic pain is often associated with negative emotions and as many as 50% of patients with chronic pain have a co-morbid depressive disorder (Study on Depression and Pain). This study detailed that those with depression experienced their view of pain to be augmented larger than previously experienced. This has to be a display of changed neuro-pathway of pain and how largely sensitive they become to pain. Also, they stated one of the biggest factors in a cognitive process is negative expectancy. This is a self-fulfilling prophecy I like to call “always expecting bad stuff to happen to you so you can confirm your negative confirmation bias about yourself”. Many of us have probably in this situation by also telling ourselves “I told you so”. Anxiety is another negative emotion frequently seen in patients with chronic pain, and which may lead to maladaptive pain behaviors aggravating and maintaining pain and disability (Fear-avoidance model of chronic musculoskeletal pain).  Anxiety could be something that changes the way you move and could contribute to pain because of the patterns it causes you to partake in.

Some sociocultural contexts attributed to pain could deal with how one expresses pain. This would deal more with behaviors of how they were brought up by parents, significant others, and other operant learning process (http://www.jpain.org/article/S1526-5900(10)00746-7/fulltext).  Acculturation, which entails adaptation to a new set of cultural norms, beliefs, and values, (Rethinking the concept of acculturation: implications for theory and research)is inherently stressful, especially for first-generation immigrants (Generational differences in vulnerability to identity denial: The role of group identification). The stress of acculturation, in turn, may influence pain sensitivity (Ethnic differences in physical pain sensitivity: role of acculturation). An example could be the unnecessary pressures that parents put on their kids to get highly stable jobs or achieve and adopt all the cultural norms of that family because it’s expected of them. This was because they lived in a different time so they assume their children live in that same time as well. Another interesting study took into account personalities of subjects and found that certain personalities such as introversion and intuition dramatically increased spine loading compared with those with the opposite personality traits such as extroversion and sensing. Does this mean that introverts and those who are intuitive on the Myers Briggs scale are going to experience more pain compared to their counterparts? No but I think we have an understanding of a factor that fills their cup. Again, pain is a complicated matter and there are many variables that go into that sensitive threshold of experiencing it. The social emphasis and how it’s linked to pain is highly individualized and would need its own post to be elaborated further.

From Greg Lehman’s Recovery Strategies -pain-guidebook, he recommends three things to look at and or consider changing
1. How much you are doing
2. How quickly you progressed
3. What are you currently ready for.
#3 is very interesting. If you are fearful, hesitant or
believe that you can’t adapt then your readiness will                                                                    be decreased and this will influence what is too much                                                       (Lehman)

The body is an ecosystem. We are more than just some parts working together like a car. It’s amazing how we move and manifest our emotions in our muscular system. While pain is a not so pretty part of the experience in life, by learning how to desensitize to certain stressors and building the capacity to cope with them we can effectively limit and get out of pain. As humans, we are built to move and adapt.  To quote Thomas Hanna, the founder of Somatics, “If you can feel it, you can change it”

 

Good old Kenny Wayne Sheperd never hurt nobody.

Enjoy!

 

 

References

A Guide To Better Movement- Todd Hargrove

https://www.futuremedicine.com/doi/abs/10.2217/ebo.13.469

Recovery Strategies – Pain- Guidebook by Dr. Greg Lehman

https://spine.osu.edu/sites/spine.osu.edu/files/uploads/Publications/2000/Ergonomics_2000_43-7_880-902.pdf

Air Bubbles in Shoes…Do They Cushion Impact Forces?

Growing up I fell in love with basketball. I’d race home after school to go to the park and just get lost in shooting shot after shot. As I grew older I started noticing all the different current trends and fashion in shoes and what kids wore on their feet. Everywhere I went kids wore Jordans, Nike Shox or any shoe that had some kind of air bubble. These flashy looking shoes were all the rage. In my young fifteen-year-old mind I thought it was the greatest thing since sliced bread and wanted to get a pair to show off. The “Walking on Air” vibe was certainly brilliant marketing to sneakerheads trying to display luxury built on comfort. During gym class, I’d play with these type of sneakers more and more and I even competed in my youth group basketball with a set of Jordans VI that had the air bubble in the heel. I can remember what I said to myself almost every time I slipped those bad boys on. “These feel narrow and when I land it feels like something is off but who cares”. I remember how awkward it felt to move and run but I didn’t want to make excuses thinking “Hey it’s not the shoe that makes someone great its the way they play so” and so I continued to wear them. Plus I just really cared about playing no matter what I had on my feet. I continued to compete despite slipping and sliding awkwardly with them on.  That overlooked feeling would soon come to a head when during my final youth group championship game I sprained ankle severely the first two minutes of the game scoring a layup. I landed on another person’s foot awkward as every person who sprained their ankle knows but I tried to reverse the motion trying to get my balance back toward the midline and compensated further injuring the other side as well. But, hey, I sprained it while scoring for my team so that shows dedication right?

https://imgflip.com/i/1pglcl

This injury made me reconsider what I wore on my feet and even how I moved. This also led me to appreciate the human body and appreciate all the complexity that goes into movement.

David Forland, Nike’s director of cushioning innovation, changed Nike’s approach during the late 80’s in order to sell more sneakers. In order to sell the sensory perception of walking on air, Forland inversely made each model having a greater volume of air than the last one and decreasing the amount of foam. He stated that “Foam breaks down; air doesn’t”. All that fancy air bubble unit is just a polyurethane pouch filled with inert gas and they just connect it to the foam sole. They obviously had major success since some of these sneakers are some of the most lusted after sneakers for decades catering to many populations of people and different athletes. Here were some of the so called benefits of the MAX AIR

  • Versatile: Max Air cushioning is designed to meet each athlete’s exact specifications of athletic performance
  • Cushioning: absorbs impact forces when the foot strikes the ground protecting muscles, joints and tendons and recoils to protect against the next impact forces. which will protect athletes from stress and fatigue.
  • Durable: provide cushioning throughout the life of the shoes

These are tempting but dubious claims. I think it’s quite a claim to say that a pocket of injected air works for every athlete and their exact specification for their sport. So what works for a basketball player will also work for a marathon athlete?

Image result for square peg in round hole

That’s a perfect example of a cookie cutter approach. A physical therapist and biomechanics expert named Jay Dicharry probably hits the nail on the head telling The Atlantic “Part of the problem is the shoe industry as a whole does a really horrible job of matching footwear to feet,” Sadly this is what good marketing does. It just sells products without any regard to the activity. It’s even dumb easier when you’re able to use star athletes to endorse your product.

While the air bubble certainly revolutionized the sneaker world, does this air cushioning unit really absorb the shock? Unfortunately they don’t do as they claim to and in fact, dampens your ability to feel the ground. This messes with the way you move by delaying the proprioceptive response of the ankle. These air units aren’t absorbing shock not because they aren’t strong enough to resist the ground forces but because it’s robbing you from feeling it all! It’s hiding the input! Add a one to two inches in the heel and it complicates the kinetics of your foot. Here are some studies showing that highly cushioned shoes don’t decrease the impact forces Study 1Study 2Study 3, Study 4 but this particular Study 5 was a big one because it showed that one of the risk factors to ankle injuries were players that wore shoes with air cells in the heel were 4.3 TIMES MORE LIKELY TO INJURE AN ANKLE than those wearing shoes without air cells  The fifth study hypothesis is that the air cells located in the heels of basketball shoes decrease rear foot stability, which may, in turn, increase the risk of ankle injury. I believe it makes sense since the extra air in the heel puts an extra inch or two in your shoe and so now your much higher off the ground which leverages into spraining your ankle easier. Add that you have something that is supposed to act like a pillow underneath your heel which disrupts how you sense the ground below you and you got yourself a problem.

you're gonna have a bad time guy - If you can't feel the ground You're going to have a bad time

https://memegenerator.net/YouRe-Gonna-Have-A-Bad-Time-Guy/caption

Because I like to play devil’s advocate, I tried to find some studies that showed that some high cushioned shoes did decrease the impact of forces. The studies that supported this notion showed a decrease in EMG musculature in the legs Study 1Study 2. While the evidence does support that it decreases the EMG in the musculature, does that truly mean that the impact forces are being absorbed and the shoes are doing their job? I don’t think the EMG tells the entire story. Perhaps the decrease in muscle activation is because your body doesn’t anticipate anything happening and so it doesn’t have to respond. It leaves me with the question of is this perceived safety of muscles not turning on a problem in of itself?

Then there is one Study that flips the notion that impact forces are the cause of injury. In it, Nigg states “A new paradigm for impact forces during running proposes that impact forces are input signals that produce muscle tuning shortly before the next contact with the ground to minimize soft tissue vibration and/or reduce joint and tendon loading. Muscle tuning might affect fatigue, comfort, work, and performance. Experimental evidence suggests that the concept of “aligning the skeleton” with shoes, inserts, and orthotics should be reconsidered. A new paradigm for movement control for the lower extremities proposes that forces acting on the foot during the stance phase act as an input signal producing a muscle reaction”. Here is another Study showing that muscle damps soft tissue resonance at heel strike. Wakeling states that “Muscles generate forces which act across the joints and, therefore, shoe design may be used to modify muscle activity and thus joint loading during walking and running”. The second study in this paragraph shows how the different shoe designs modify muscle activity because each design has specific pros and cons in which it robs how you sense the input and so the muscle doesn’t allow itself to tune in to the forces coming in.

So the body encounters these impact forces and perceives them vibrations. but what do vibrations have to do with impact forces? According to Benno Nigg’s work on Muscle Tuning, the body dampens and absorbs the vibration of the impacts of everyday loads through isometric contractions (Nigg, B.M., Liu, W). So the muscle tuning happens by the muscles isometrically contracting in order to decrease the vibration in soft tissues in joints and tendons. Nigg saw the impact forces as a source of feedback in response to the vibrations. The tuning function of muscle activity (muscle tuning) suggests that impact signals are sensed and the central nervous system responds by tuning, if necessary, the activation of the corresponding major muscle groups, in reducing impact loading during athletic activities (Nigg and Wakeling, 2001). The isometric contractions serve as a pre-activation of muscles prior in order to prepare for impact to the ground. It’s a signal used to detect what’s going on and adjust accordingly with vibration (Nigg,2000). Add the different surface types such as hardwood, concrete and the muscle tuning frequency changes. There was also a study by O’Flynn (1996) that showed the pre-activation changed based on surface (https://www.ncbi.nlm.nih.gov/pubmed/15336933). This muscle tuning is calibrated to the surface in order to control the soft tissue vibrations. If someone was running on concrete the muscle/bone vibration was much higher than running on a soft track. I think we can guess that the muscle contractions are the bodies own mechanism in responding to the vibrations. Perhaps the shoe influences how the body perceives the signals coming in and how to respond. This brings me back to full circle of maybe impact forces are not the problem but maybe it’s the input of the signal that is lost. Also, it makes me think that if the signal is being lost then our feet wouldn’t be able to respond accordingly and so we wouldn’t be able to condition our feet to withstand the volume and demands of the specific sport or activity.

Emily Splichal, the founder of evidencebasedfitnessacademy.com and author of Barefoot Strong, notes that if muscles cannot create enough tension to create the necessary intra-compartmental pressure to dampen the impact force vibrations, the vibrations will default traveling into the soft tissue and bone and cause many issues such as stress fractures and shin splints. So perhaps these air-bubbles mess with the signal because it’s robbing it of the input for the lower leg muscles to isometrically contract so they can respond and adapt to the stress. Wouldn’t it make sense that some of the best athletes and jumpers have exquisite timing patterns to contract and respond to the stress and high volume of jumping?

Image result for vince carter dunking forearm

http://www.sportsnet.ca/basketball/nba/the-oral-history-of-vince-carters-dunk-contest-win/

I’m not sure if this is even close to what’s really happening in our body but it sure does make me think. Here’s a fascinating story about Dr. Benno Nigg working with Cirque du Soleil in 1999 (http://www.calgaryherald.com/news/calgary/professor+pioneer+peak+athletic+performance/9974516/story.html). The performers were getting Achilles tendonitis and plantar fasciitis injuries and the company was befuddled as to wonder why this was happening. Nigg searched and found that the problem was that underneath the stage were a bunch of hidden beams. The performers had no idea whether they were secretly landing on the stage or where the beams where.  Nigg thought the beams changed the vibration frequency of the above stage and their body couldn’t anticipate what vibrations to receive when they landed. They couldn’t perceive the accurate input when they landed and the volume was taking a toll on them. Nigg advised to simply remove the beams and ensure the stage had a consistent frequency throughout when they landed. This would allow the performers to accurately perceive the vibrations and allow their muscles to do what they were meant to do in their specific activity. At first, the organization was skeptical but they followed through and the performer’s injuries went away.

I think we can hypothesize that the muscle contractions are the bodies own mechanism in responding to the vibrations. The bottom line is the body adapts to the sensory input it’s given and if we are covering the input of how much force we are receiving then this could be deleterious in overcoming our environment.  This could lead to injury because we might not even be aware of the damage being done. Imagine if you didn’t have any pain receptors in your skin against a hot stove. Not to get all sciency but while you wouldn’t feel the sensation of pain from the stove, it would still impact your body in a negative way without us even knowing. This is why we have pain receptors to tell us that we are in danger.

While these air bubbled shoes are perfectly fine to wear casually, we must understand they were not designed to truly take the demands of many sports no matter how cushiony or flashy they look. There is no correlation to cushion and injury because that’s not the question we should be even asking. Perhaps the question we should be asking is “Are we receiving the right input in this activity and do our feet have enough resilience to adapt and respond to it? Funny how sometimes the best looking shoes aren’t always designed for performance that we are sold on. You wouldn’t want a Ferrari to tow your car even though you might be breaking people’s necks trying to do it. That’s what tow trucks were designed for.  It’s hard in this day in age to focus on keeping things simple since we are always looking for novel stimulus to escape from the simple boring truth. It’s important to critically think for ourselves the next time someone sells us a flashy product telling us it will enhance our life. But before we pick something to wear for our sport or activity, we should consider the novelty of the specific demands of that sport and how they allow us to load our feet and our body. The next question, which I think is a good idea, is to ask ourselves how much of this activity can we do before we feel like we can’t walk for a week.  Consider your own anatomy and how it may be a bit different and run with it. I’ll leave you with this golden quote by Daniel Lieberman, a Harvard professor,  “How one runs probably is more important than what is on one’s feet, but what is on one’s feet may affect how one runs.” Our shoes or maybe lack of them and how we move in them certainly play a role in our movement.

Kick off your shoes with this jam

Cheers!

Also I have to pay homage to my favorite singer of all time Chris Cornell! RIP

 

 

 

References

Happy Feet?

http://www.barefootrunning.fas.harvard.edu/

http://www.fix-knee-pain.com/proprioception-shock-absorbing-shoes-faulty-running-mechanics-and-knee-pain/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384048/?report=reader#j_hukin-2017-0018_ref_031

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384048/?report=reader

http://news.nike.com/news/the-evolution-of-visible-air

Nigg, B.M., Liu, W. The effect of the muscle stiffness and damping on simulated impact force peaks during running. Journal of Biomechanics. 1999;32:849–856.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5384048/?report=reader

https://www.ncbi.nlm.nih.gov/pubmed/16131701

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1724316/pdf/v035p00103.pdf

http://www.scienceofrunning.com/2010/01/why-running-shoes-do-not-work-looking.html

http://www.wefixfeet.ca/sites/default/files/biomechanics.pdf

http://www.otpbooks.com/emily-splichal-understanding-impact-forces/

What the Foot by Gary Ward