Did you just sprain your ankle? I did recently. It hurts! Ankle sprains occur so often that sometimes it can be easy to overlook helpful treatment strategies to accelerate the healing because, well, they will heal on their own, right?
Ankle sprains are the most common lower extremity injury in sport. The most common is an inversion sprain where the foot rolls under the inside portion of the ankle. There are eversion sprains and diastasis (aka "high ankle") sprains, but these are less common.
0 Comments
Now more than ever it seems the world wants effective means by which to naturally boost the immune system. We've already learned a lot about what strengthen our immunity before this pandemic and even more afterwards. What we know is that functional impairment of antigen-specific T cells is a hallmark of chronic infections and viral disease. There are many considerations for boosting immunity and T cell function. Supplements most notable for this are:
Want more tips and tricks on keeping your body healthy and strong? Hit us up at Gaitway Chiropractic @ Spokane Wellness in Spokane, Wa. 509-466-1366 References:
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. What conservative treatments for pain do Chiropractors and physical therapist typically use?12/18/2020 Effective conservative treatments for musculoskeletal related pain that you will most often find in the chiropractic or physical therapy clinic include:
Of course, there exists other conservative treatment options like nutritional needs analysis, topical analgesics, acupuncture, brain based therapy, hypobaric oxygen therapy, etc. However, the list above is what most often what a Chiropractor or physical therapist might recommend to you. Before you decide which treatment or combination of treatments you decide to go with, it is important for you to be an equal team member in the decision making process of your own health. Want tips and tricks on getting rid of headaches, back pain, neck pain, shoulder pain, hip pain, knee pain for good? Hit us up at Gaitway Chiropractic at Spokane Wellness in Spokane, Wa. 509-466-1366 Disclaimer
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Deep referred pain is also called "scleratogenous" referred pain and is far more likely a cause of symptoms referring down a patient's arms or legs than is a true nerve root or "radicular" problem. We also call deep referred pain "somatic referred pain" where the "soma" or body tissues like muscles, bone, joint, ligaments, skin and fascia. Once a trained clinician in the area of pain has ruled out central and peripheral nerve damage, their consideration of a patient's pain source causing referral should be that of joints, ligaments, or muscles. This is the most common scenario. The cause of this type of referred pain comes from our understanding of a patient's modulation of pain perception. There are several proposed theories for referred pain including:
Examples of a patient's deep referred, "somatic" or "scleratogenous", referred pain that is most commonly seen with spinal related complaints could be from things like:
Though describing the concept of deep referred pain as above may make it sound simple and easy to comprehend, the truth is that deep referred pain can overlap considerably with other clinical pain presentations and differentiation may be difficult. A way to remember "scleratogenous" pain is that it may be:
Want tips and tricks on getting rid of deep referred pain for good? Request an appointment now. Disclaimer
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The research linking Vitamin D deficiency and the effects of COVID-19 along with the severity of COVID-19 outcomes and treatment with vitamin D is mounting up.
We told you about a pilot study a while back that was released in August 2020 to assess the clinical effectiveness of treatment of patients hospitalized for COVID-19 with calcifediol (25-hydroxyvitamin D3). The highlights of this study indicated that the vitamin D endocrine system may have a variety of actions on cells and tissues involved in COVID-19 progression and that the administration of calcifediol or 25-hydroxyvitamin D to hospitalized COVID-19 patients significantly reduced their need for Intensive Care United admission. (Castillo et al 2020). Vitamin D seems to be able to reduce severity of the disease. But wait, there's more. Researchers in Spain found that 82.2% of COVID-19 patients tested were found to be deficient in vitamin D. (Hernández et al 2020) Aside from the impact of insulin resistance on the severity of COVID-19 outcomes, Vitamin D deficiency is emerging as a primary risk factor for the severity of COVID-19 infections. It would be foolish to not consider assessing one's current serum 25-hydroxyvitamin D (25OHD) and determining the best supplementation to address increasing that level over time. For instance, for an individual weighing 185 lbs that was categorized at a high risk for viral infection with low vitamin D levels in the blood measuring at 10 ng/ml and wished to increase their amount to a high vitamin D level of 60 ng/ml in order to lower their risk of infection, that person would need a supplementation amount of: 10000 IU* per day (more than their current intake) to be sufficient to achieve the recommended target serum level of 60 ng/ml. *Values rounded to the nearest 1000 IU Vitamin D plays a significant role in our health. It can reduce the survival and replication of viruses, reduce cellular inflammation, maintain vascular integrity by effecting vascular inflammation and clotting factors, reduce blood pressure by it's role in the conversion of angiotensin-converting enzyme 2, lower cancer risk, improve bone and connective tissue healing, decrease risk of autoimmune disease, and more. To optimize vitamin D absorption and utilization, be sure to take your vitamin D with vitamin K2 and magnesium. A person supplementing Vitamin D for the hope to raise serum blood levels should retest their serum 25-hydroxyvitamin D (25OHD) every three to four months. References: Castillo M.E., Entrenas Costa L.M., Vaquero Barrios J.M., Alcalá Díaz J.F., Miranda J.L., Bouillon R., Quesada Gomez J.M. Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study. J. Steroid Biochem. Mol. Biol. 2020;203:105751. doi: 10.1016/j.jsbmb.2020.105751 José L Hernández, Daniel Nan, Marta Fernandez-Ayala, Mayte García-Unzueta, Miguel A Hernández-Hernández, Marcos López-Hoyos, Pedro Muñoz Cacho, José M Olmos, Manuel Gutiérrez-Cuadra, Juan J Ruiz-Cubillán, Javier Crespo, Víctor M Martínez-Taboada, Vitamin D Status in Hospitalized Patients With SARS-CoV-2 Infection, The Journal of Clinical Endocrinology & Metabolism, , dgaa733, https://doi.org/10.1210/clinem/dgaa733 With COVID-19 still on the table and the upcoming seasonal occurrences of cold and flu, targeting the immune system and improving one's overall wellness is critical. The right vitality and nutrition plan during this time has the potential to help decrease the frequency, severity, or duration of cold and flu symptoms.
We can decrease this risk with:
This is even more important for high-risk populations, such as the elderly, those who are overweight, those with diabetes and other comorbidities causing compromised immune systems. Want tips and tricks on keeping your body strong during this upcoming cold and flu season? Are you sick now and wish you were more prepared to fight off the cold or flu virus so you can more quickly return to what you enjoy? Then follow along with this protocol developed using only quality evidence. The following protocol and ingredients below are a reflection of what current research findings show support for when trying to prevent or treat the immune system affecting by cold and flu viruses. Vitamin C Adults: 1 g daily as an ongoing maintenance dose3,4, or 3 to 4 g daily at the onset of symptoms and for the duration of illness2,4 Children: 1 to 2 g daily as an ongoing maintenance dose4,2
Zinc 75-100 mg of elemental zinc as zinc acetate or zinc gluconate lozenges, once per day, within 24 hours of the onset of common cold symptoms, minimum 1 to 2 weeks cold15,16,17,18,19
Probiotics Probiotics may reduce the incidence of colds with minor effects on prevention, as well as improve influenza vaccination efficacy for A/H1N1, A/H3N2, and B strains, but is dependent on strain and population.24,25,26 Pediatric: Common Cold
Common Cold
Echinacea purpurea Prevention: 0.9 mL, three times per day (equivalent to 2400 mg of extract), minimum 4 months9 Acute: Up to 4.5 mL liquid extract (equivalent to 4000 mg), once per day at the first stage of cold development9
American ginseng (Panax quinquefolius) 400 mg, once per day, minimum 8-16 weeks in healthy adults as a preventative measure5,6,7
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Did you know we have a supplement protocol designed with the above cold and flu support topic discussed above. Check it out! https://us.fullscript.com/protocols/spokane-wellness-immune-health-cold-and-flu-support References 1https://www.ncbi.nlm.nih.gov/pubmed/30069463 2https://www.ncbi.nlm.nih.gov/pubmed/23440782 3https://www.ncbi.nlm.nih.gov/pubmed/19592479 4https://www.ncbi.nlm.nih.gov/pubmed/16247099 5https://www.ncbi.nlm.nih.gov/pubmed/16566675 6https://www.ncbi.nlm.nih.gov/pubmed/14687309/ 7https://www.ncbi.nlm.nih.gov/pubmed/23024696 8https://www.ncbi.nlm.nih.gov/pubmed/24554461 9https://www.ncbi.nlm.nih.gov/pubmed/16678640 10https://www.ncbi.nlm.nih.gov/pubmed/17597571 11https://www.ncbi.nlm.nih.gov/pubmed/14748902 12https://www.ncbi.nlm.nih.gov/pubmed/16177972 13https://www.ncbi.nlm.nih.gov/pubmed/28515951 14https://www.ncbi.nlm.nih.gov/pubmed/22566526 15https://www.ncbi.nlm.nih.gov/pubmed/27378206 16https://www.ncbi.nlm.nih.gov/pubmed/23775705 17https://www.ncbi.nlm.nih.gov/pubmed/28480298 18https://www.ncbi.nlm.nih.gov/pubmed/25888289 19https://www.ncbi.nlm.nih.gov/pubmed/18279051 20https://www.ncbi.nlm.nih.gov/pubmed/17344507 21https://www.ncbi.nlm.nih.gov/pubmed/23372900 22https://www.ncbi.nlm.nih.gov/pubmed/29416317 23https://www.ncbi.nlm.nih.gov/pubmed/29077061 24https://www.ncbi.nlm.nih.gov/pubmed/19651563 25https://www.ncbi.nlm.nih.gov/pubmed/20803023 26https://www.ncbi.nlm.nih.gov/pubmed/17352961 27https://www.ncbi.nlm.nih.gov/pubmed/21285968 28https://www.ncbi.nlm.nih.gov/pubmed/20180695 29https://www.ncbi.nlm.nih.gov/pubmed/18335698 I've heard this question asked so many times by new patients, whether it be over the phone or during the initial examination. I always try to gently explain to people that we most often can begin treatment without needing radiographic imaging. Patients understand what I'm telling them and are willing to proceed with the recommended treatment I outline not because some belief that "I'm the doctor therefore I should always be trusted" but rather because I provide my patients with evidence based clinical decision making from credible research journals, state guidelines, position statements of well-known manual therapy associations, and my own clinical experience.
Recently I was shocked to learn that an article was published titled "X-Ray Imaging is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks" by Paul A. Oakley, Jerry M. Cuttler, Deed E. Harrison. In their article the authors “encourage routine use of radiography in manual spine therapy” and opine that “radiographic imaging is necessary to deliver acceptable patient care in the practice of contemporary manual therapy of the spine.” This belief that routine radiographic imaging (x-ray) is necessary to deliver acceptable patient care in the practice of contemporary manual therapy or that regular imaging is needed to improve the safety of manual therapy in general or spinal manipulative therapy are not true. No reputable clinical practice guideline or high-quality evidence suggest that radiological imaging is a routine requirement for effective treatment of back pain. In fact, the opposite is often the case; when imaging is performed, there is evidence that it does not improve patient outcomes but can result in undesirable and unintended effects. I agree that timely imaging in musculoskeletal health care is indicated by many clinical practice guidelines when clinical findings indicate suspected pathology (eg, fracture), when surgery is being considered, a patient is not responding to the standard treatment of care, or when a patient is routinely suffering the same chronic, recurring problem. This is not just my professional opinion but that of many other colleagues of mine including, The World Federation of Chiropractic Research Council. In Health, Dr Jared L Wilson, DC, MS References 1.National Institute for Health and Care Excellence: Clinical Guidelines (NICE). Low back pain and sciatica in over 16s: assessment and management | Guidance and guidelines. Natl Inst Heal Care Excell; 2016. 2.Qaseem, A, Wilt, TJ, McLean, RM, Forciea, MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514–530. doi:10.7326/M16-2367. 3.Stochkendahl, MJ, Kjaer, P, Hartvigsen, J. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018;27(1):60–75. doi:10.1007/s00586-017-5099-2. 4.Bussières, AE, Stewart, G, Al-Zoubi, F. Spinal manipulative therapy and other conservative treatments for low back pain: a guideline from the Canadian Chiropractic Guideline initiative. J Manipulative Physiol Ther. 2018;41(4):265–293. doi:10.1016/j.jmpt.2017.12.004. 5.Ash, LM, Modic, MT, Obuchowski, NA, Ross, JS, Brant-Zawadzki, MN, Grooff, PN. Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR Am J Neuroradiol. 2008;29(6):1098–1103. doi:10.3174/ajnr.A0999. 6.Kendrick, D, Fielding, K, Bentley, E, Miller, P, Kerslake, R, Pringle, M. The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomised (unblinded) controlled trial. Health Technol Assess. 2001;5(30):1–69. 7.Kerry, S, Hilton, S, Dundas, D, Rink, E, Oakeshott, P. Radiography for low back pain: a randomised controlled trial and observational study in primary care. Br J Gen Pract. 2002;52(479):469–474. 8.Djais, N, Kalim, H. The role of lumbar spine radiography in the outcomes of patients with simple acute low back pain. APLAR J Rheumatol. Wiley/Blackwell (10.1111). 2005;8:45–50. doi:10.1111/j.1479-8077.2005.00122.x. This New Blog post from Dr. Jared Wilson, DC, MS at Gaitway Chiropractic in Spokane, Washington discusses the mortality effects of being either unfit or fat. Dr. Jared Wilson blogs about chiropractic health and other relevant health news. He is an expert in musculoskeletal injuries and functional rehab. He holds a Chiropractic Doctorate degree and a Masters of Exercise and Sports Science degree.
Last year I posted this information to the Gaitway Chiropractic facebook page and I wanted to bring it up again in this health blog. In a recent meta-analysis (Barry et al 2014) researchers asked the question, " Which is a better predictor for death by all causes, cardiorespiratory fitness or fatness measured by one's BMI?" A meta-analysis is a study looking at a collection of other studies asking the same question in order to give a weighted average of the total effect. They determined that:
Bottom line conclusion from this article I think is we should be focused more on lifestyle modifications which include an increase in physical activity to be fit. This would improve a person's cardiorespiratory fitness and perhaps we should not be focusing too much on weight loss driven approaches to health. But let us not get carried away here. We know that being overweight and obese does increase your risk for disease. In another recent study (Vistisen et al 2014) of 6705 people, 35 to 55 years old, and an average follow up of 14 years, the researchers saw that 645 of those people developed diabetes. Of those 645 people, 94% were actually in the staying overweight group, 2% were in the progressively gaining weight group, and 4% were in the persistently obese group. The 6060 participants who remained free of diabetes were characterized by a mean BMI of just below 25 that rose only gradually over the follow-up period. At first glance it would appear that this second study possibly contradicts the first one and that being overweight and obese should be areas of concern. However, without knowing more information about the typical eating and exercise habits of the people in the second study it is difficult to correlate the two. Perhaps those who didn't get diabetes in the second study was due to the GRADUAL rise in BMI over the 14 years. It makes me wonder if these people were engaging in regular physical activity and if the people who got diabetes were mostly sedentary people. Hopefully you will find this information to be informative and most importantly motivating to live a healthy life by staying active and eating well. If you have any questions about how Dr. Wilson's expertise in Chiropractic, health, or sports medicine, please call Gaitway Chiropractic in north Spokane at (509) 466-1366, request an appointment online, or come by the clinic at 8611 N Division St, Ste A, Spokane, WA 99208. REFERENCES Barry, Vaughn W., Meghan Baruth, Michael W. Beets, J. Larry Durstine, Jihong Liu, and Steven N. Blair. "Fitness vs. Fatness on All-Cause Mortality: A Meta-Analysis." Progress in Cardiovascular Diseases 56.4 (2014): 382-90. Vistisen, Dorte, Daniel Witte, Adam Tabak, Christian Herder, Eric Brunner, Mika Kivimaki, and Kristine Faerch. "Patterns of Obesity Development before the Diagnosis of Type 2 Diabetes: The Whitehall II Cohort Study." PLoS Medicine 11.2 (2014): E1001602 This New Blog post from Dr. Jared Wilson, DC, MS at Gaitway Chiropractic in Spokane, Washington focuses on answering the question of how much protein should an athlete intake depending on the type of exercise, their state of training, and their gender. Dr. Jared Wilson blogs about chiropractic health and other relevant health news. He is an expert in musculoskeletal injuries and functional rehab. He holds a Chiropractic Doctorate degree and a Masters of Exercise and Sports Science degree.
Dating back as far as Ancient Greece and the Olympics, athletes have added protein to their diets to modify the effects of training on physique and performance. Conventional thought held by many athletes and coaches is that very high dietary protein intakes are needed to maximize protein metabolism within a muscle leading to faster repair and hypertrophy, the increase in cell size. But what does the current research suggest is the adequate amount of dietary protein intake for differing forms of exercise as well as the gender and performance level of the athlete? In this blog I will try to provide the answer in a comprehensive yet simple review on this hotly debated topic. Generally speaking, most athletes engaging in resistance exercise desire to increase their muscle mass, strength, and power. Whereas, endurance athletes are looking to augment longer duration output, such as increased maximal oxygen consumption, or reduce body fat. Now before I jump right into discussing adequate protein intakes for resistance exercise, I want to address endurance athletes first because even these athletes need to pay attention. Multiple studies have shown that endurance exercise increases the breakdown and utilization of protein for energy as you increase the intensity of the exercise and depending on the state of training of the athlete. A recent study by McKenzie et al evaluated protein usage in both male and female athletes during a 38-day high intensity endurance training program. They found that:
Other studies looking at athletes engaging in low to moderate intensity endurance exercise programs indicate that these athletes need the same amount of dietary protein intake or only slightly above that of a sedentary individual. So how much protein should an athlete consume given the intensity of their endurance workouts? Recreational endurance athletes who are exercising 4 to 5 times per week for 30 minutes below moderate to high intensities need about 0.80-1.0 grams of protein per kilogram of body weight per day. This is the same for sedentary men and women. Moderate intensity endurance athletes who are exercising 4 to 5 times per week for 45 to 60 minutes need about 1.2 grams of protein per kilogram of body weight per day. Elite high intensity endurance athletes (regular marathon runners and triathletes) need about 1.4-1.6 grams of protein per kilogram of body weight per day. And in general, dietary protein recommendations for female endurance athletes may be 10-20% lower than males. Surprisingly, these recommended values are much lower than the average protein intakes of most male and female endurance athletes. The typical male and female endurance athlete today consumes about 1.8 and 1.3 grams of protein per kilogram of body weight per day, respectively. So now that I’ve summarized the adequate protein intakes for endurance athletes let’s switch to protein requirements for resistance training athletes. First off, resistance exercise is different than endurance training in that a primary end goal is muscle hypertrophy or the increase in muscle size. Therefore it would only make sense that protein intake will need to be in excess that of basic sedentary requirements to provide the building blocks for muscle repair and growth, right? Well what does the research say? A study way back in 1988 by Tarnopolsky et al calculated how much protein intake it would take to match protein metabolism in 6 well-trained bodybuilders compared to 6 sedentary people. Surprisingly, they found that only 12% more protein intake was needed for the bodybuilders. Even more surprisingly, the bodybuilders were regularly consuming protein amounts of 2.7 grams of protein per kilogram of body weight per day which if you look back above you’ll find that this is 170% more the recommendations for sedentary people of 1.0 grams. (Also remember that recreational endurance athletes and sedentary individuals are at the same recommendation.) Now this study was looking at resistance athletes at steady state given the bodybuilders had at least 2 years of consistent training. The recommended protein intake for steady state resistance athletes is 1.0-1.2 grams of protein per kilogram of body weight per day. What about people in the early stages of resistance training? Do they need more or less protein intake? 4 years later Lemon et al answered this question by calculating the estimated protein requirement during the early stages of resistance training. They had 12 young men participate in 2 months of resistance training and split them into two groups having them intake either 1.4 or 2.6 grams of protein per kilogram of body weight per day. The men exercised 6 days per week for 2 hours each day. The weights were set to 70-85% the maximum weight that they could only do 1 repetition of. They found that the estimated protein requirement during this early stage of resistance training was 1.6 grams of protein per kilogram of body weight per day. Would you be surprised if I told you that the average resistance athlete today is consuming far more their needed protein requirements regardless of their stage of training in resistance exercise? Probably not since I’ve already told you this is true for two other situations above. The average resistance athlete today consumes 2.0 grams of protein per kilogram of body weight per day. This is 25% more than the amount needed for early resistance training athletes (1.6 grams) and about 80% more for steady stage resistance training athletes (1.1 grams). At this point I might be hearing a pour of outrage from some athletes believing they still need more protein to meet the demands of their resistance training, usually from the intense football or rugby player. So let’s look at the protein requirements for football and rugby athletes involved in weight-training and high-intensity sprinting and power activities as evaluated by the research of Tarnopolsky et al in 1992. They found that the protein requirement for this group at the highest was only 1.7 grams of protein per kilogram of body weight per day. This is only slightly higher than those athletes who are early on in their resistance training. So to recap, see below the listed protein requirements for the various athlete type measured in grams of protein per kilogram of body weight per day.
I know this is a lot of information but I hope you found this blog to be informative. Perhaps you will save some money on protein supplements or foods by knowing these recommendations. If you have any questions about how Dr. Wilson’s expertise in sports medicine could help you or have other Chiropractic questions, please call Gaitway Chiropractic in north Spokane at (509) 466-1366, request an appointment online, or come by the clinic at 8611 N Division St, Ste A, Spokane, WA 99208. REFERENCES Lemon PW, Tarnopolsky MA, MacDougall JD, Atkinson SA. Protein requirements and muscle mass/strength changes during intensive training in novice bodybuilders. J Appl Physiol 1992;73:767-75. McKenzie S, Phillips SM, Carter Sl, Lowther S, Gibala MJ, Tarnopolsky MA. Endurance exercise training attenuates leucine oxidation and BCOAD activation during exercise in humans. Am J Physiol endocrinol Metab 2000; 278:E580-7. Tarnopolsky MA, MacDougall JD, Atkinson SA. Influence of protein intake and training status on nitrogen balance and lean body mass. J Appl Physiol 1988;64:187-93. Tarnopolsky MA, Atkinson SA, MacDougall JD, Chesley A, Phillips S, Schwarcz HP. Evaluation of protein requirements for trained strength athletes. J Apply Physiol 1992;73:1986-95. This New Blog post from Dr. Jared Wilson, DC, MS at Gaitway Chiropractic in Spokane, Washington looks to the research to answer if the posture or position taken when performing the resisted side-stepping exercise matters when trying to maximize gluteus medius activity and minimize tensor fascia lata (TFL) activity. Dr. Jared Wilson blogs about chiropractic health and other relevant health news. He is an expert in musculoskeletal injuries and functional rehab. He holds a Chiropractic Doctorate degree and a Masters of Exercise and Sports Science degree.
Hip abductor weakness is a common problem with people suffering from a variety of hip conditions such as femoroacetabular impingement, iliotibial band syndrome, and patellofemoral pain. It can even contribute to chronic ankle sprains. Weakness of the gluteus medius muscle will usually cause excess compensation from the TFL. Allowing the TFL to be recruited continually can lead to gluteus medius atrophy. Corrective exercises can increase gluteus medius strength and improve muscle firing patterns. Usually exercises involving a variation of resisted hip abduction are given. However, it is important for clinicians prescribing these exercises to be aware of excessive firing from the TFL when their patient is performing them. A recent study by Selkowitz et al (2013) looked at gluteus medius and TFL activation during 11 different exercises. The researchers used fine-wire electromyography (EMG) to determine the maximum voluntary isometric contraction (MVIC) of both the gluteus medius and TFL with each exercise. Their report showcased 5 exercises that activated the gluteus maximus and medius muscles without getting as much unwanted TFL activation. Those exercises included the clam exercise, single-leg bridge, hip extension (quadruped) with knee straight and knee bent, and the resisted side-stepping exercise. Specifically regarding the resisted side-stepping exercise, they found significantly lower TFL activation (13.1% MVIC) compared to gluteus medius activation (32.2% MVIC). Bottom line is resisted side-stepping should be included in any corrective exercise program designed to strengthen the hip abductors. But does the position or posture you take when performing the resisted side-stepping exercise matter? A study by Berry et al (2015) addressed this question. They had all 24 participants perform the exercise with an elastic resistance band around their ankles in both standing and squatting postures. Like the Selkowitz et al study, these researchers also used fine-wire EMG to determine the MVIC of the gluteus medius and TFL. Interestingly, they found that the EMG activity of the muscles being tested were actually higher in the stance leg rather than the moving one. They also saw that the EMG activity in the gluteus medius was significantly higher in the squat position than the upright position while activity in the TFL was lower in the squat position compared to the upright position. So to answer the question…yes! It does matter what position or posture you take when performing the resisted side-stepping exercise. Performing the resisted side-stepping exercise should be done in a squat position rather than an upright one. But how does this happen? Willcox and Burden (2013) gave a biomechanical explanation for the decreased TFL activity in the squat position. In the squat position the center of mass of the trunk is forward compared to the hip. This creates a hip flexion position and thus reduces the need to activate more muscles involved in hip flexion. Since the TFL acts also as a hip flexor in addition to being a hip abductor, the squat position would reduce the need to activate the TFL in order to stabilize the hip and pelvis. Increased TFL activation would be counterproductive. I hope you found this blog to be informative. If you have any questions about how chiropractic care could help you, please call Gaitway Chiropractic in north Spokane at (509) 466-1366, request an appointment online, or come by the clinic at 8611 N Division St, Ste A, Spokane, WA 99208. REFERENCES Selkowitz DM, Beneck GJ, Powers CM. Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? electromyographic assessment using fine-wire electrodes. J Orthop Sports Phys Ther. 2013;43(2):54-64. Berry, Justin W., Theresa S. Lee, Hanna D. Foley, and Cara L. Lewis. "Resisted Side-Stepping: The Effect of Posture on Hip Abductor Muscle Activation." J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy (2015): 1-30. Willcox EL, Burden AM. The influence of varying hip angle and pelvis position on 531 muscle recruitment patterns of the hip abductor muscles during the clam exercise. J 532 Orthop Sports Phys Ther. 2013;43(5):325-31. Image: Photographer unknown. (2015, August 6). Participant side-stepping to the right in the squat posture [digital image]. Retrieved from http://www.jospt.org/doi/pdfplus/10.2519/jospt.2015.5888 |
Dr. Jared Wilson, DC, MSDr. Jared Wilson blogs about chiropractic health and other relevant health news. He is an expert in musculoskeletal injuries and functional rehab. He holds a Chiropractic Doctorate degree and a Masters degree in Exercise and Sports Science. Archives
January 2021
Categories |