Howdy Readers! Today is Monday and hopefully the beginning of a new tradition here at Eat.Run.Rehabilitate.! I hope to continue to upload and post videos weekly and sometimes even biweekly if I get overly ambitious. I have been trying to take some time and pre-record some videos so that way when I do have time to do some editing and posting it will allow me to be more caught up on everything.
Anyways, today's video is going to be about the Vertical Compression Test. This is another test that I learned from Jay Dicharry's Anatomy for Runners book. I've said it before and I'll say it again...not a bad book to have around for reference! This is a great way to go about assessing a person's overal posture on their postural stability and its effect on the entire kinetic chain. Check out my video below!
Howdy Readers! A lot of people like to talk the talk when it comes to assessing running gait/form. However, a lot of what people seem to say regarding gait sometimes boils down to just that...all talk. Some people look at a still frame or picture of an individual running and make claims based off of one moment in time. Somebody hook these people up with Miss Cleo because they must be able to look into the past and the future! Amazing!
In reality, there are very specific things that you should be looking at from very specific reference points. Specifically, to best evaluate a person's running gait you would want to be able to evaluate their form from both frontal plane and sagittal plane views. Do you know what they are already? Well I didn't have this handy dandy knowledge until after I attended the Healthy Running conference (see my review here) and learned this from Dr. Mark Cucuzzella and Jay Dicharry, MPT, CSCS.
Before this I put most of my faith into my clinical assessments and often shied away from visual gait assessment. You shouldn't try to separate these two entities...they should be combined together to draw conclusions. There were two main reasons for this. One, I didn't have a nice high-speed camera for this. It is pretty difficult to be sure of what you are seeing unless you have the ability to record at higher frame-rates. Secondly, I didn't have this nice little handy-dandy checklist that I am about to share with you. Note: Please remember to compare left to right for these items when possible.
Frontal View
Back when I first started running, on the left in the white.
Excessive Heel Strike!!
The Frontal View
Step Width
Narrow, Neutral, or Wide?
Arm Movement
Abducted, Cross-over, or In-line?
Trunk
Ipsilateral, Neutral, or Contralateral tilting/lurching?
Hip Stability
Adduction vs. Abduction?
Internally vs. Externally Rotated?
Neutral?
Dynamic Knee Alignment
Valgus vs. Varus vs. Neutral?
Midstance Foot Position
Supinated vs. Pronated vs. Neutral
Cadence
Slow? Excessively Quick?
Other Abnormalities?
The Lateral View.
The Lateral View
Vertical Displacement
<4cm li="" limited="">
4-6cm = Optimal
>6cm = Increased
Arm Movement
Excessive anterior/forward motion
Neutral
Excessive posterior/backward motion
Torso Orientation
Anterior vs. Posterior vs. Neutral
Lumbopelvic Posture
Lordosis vs. Neutral vs. Flat
Hip Extension during Toe off
15-20 degrees = normal
5-15 degrees = limited
<0 degrees="severely" li="" limited="">
Knee Excursion during Stance
>25 degrees = flexed
20-25 degrees = optimal
<20 degrees="stiff</li">
Foot Strike Pattern
Heel vs. Midfoot vs. Forefoot
Neutral Contact point vs. Foot contacts anterior to COM (Center of Mass)
We all run different, but there are general things that we should look for and look to avoid for all running gaits!
Conclusion: There you have it folks! A simple check list to use for each view! I don't really use a posterior view anymore but you could still use the frontal view checklist for a lot of the same things that you might see on the posterior aspect. Additionally, don't assume that a duck is a duck when performing these analyses. Just because a person runs with zero hip extension does not necessarily mean that they have zero hip extension! Check their passive mobility! This could easily be a stability or motor control problem.
Another example of this could be that just because you see something like excessive dynamic knee valgus don't assume they have a weak set of glutes! It could be due to poor ankle dorsiflexion that produces compensatory subtalar joint pronation and then causes compensatory knee valgus. Practice these assessments to work on being able to assess these things individually but quickly. You want to get to the point where you notice the "abnormal" instead of having to check for "normals" everywhere.
I have been keeping busy down here in Miami, Florida. I am about a quarter of the way through my first semester as a PhD student and I have been kept busy with teaching my first class (Introduction to Athletic and Sport Injuries) and by being a research assistant for my adviser as well. I have also had the opportunity to keep myself busy yet physically active by taking back up a long-lost but much loved hobby of mine: Brazilian Jiu Jitsu (BJJ).
BJJ took a backseat for me after training regularly during my bachelor's degree. It stayed on the back burner as I worked on my master's degree but my schedule has normalized enough to allow me to resume training. My sports medicine breadth of knowledge has grown and advanced while my BJJ was placed on hold, and because of that I feel that I have a expanded view on the biomechanics of the sport that I didn't necessarily have previously.
Specifically, I am going to touch briefly on a bit of injury prevention for anyone out there that may be into BJJ or for those of you that may treat people that participate in BJJ (actually this stuff applies to everybody not just BJJ guys). Nevertheless, this post is definitely geared more for the BJJ practitioner and not the clinicians out there...this may not even be new information for those who have visited this blog before.
While I am not somebody that you should go to for submission or any BJJ advice for that matter...I feel that I can give some good insight to help you stay on the mats. Specifically, when I was training I often saw a lot of people struggle with shoulder injuries. In fact, traumatic shoulder dislocations and subluxations were more prevalent than one might assume. Perhaps one wouldn't be surprised considering this is a sport where people enjoy catching each other in joint locks and submission-holds that work by forcibly placing one another's joints at their respective end ranges of motion. So when it comes to a sport where we are already pushing the limits with our body (within reason) then we need to ensure that we are not already at risk of damaging ourselves or our training partners.
I'm no Kenobi.
Having strong, mobile, and stable shoulders is just as important for your ability to submit as well as your ability to not get submitted. The status of your shoulders can also have repercussions up and down the kinetic chain. This is evident when a shoulder issue can manifest itself as a grip strength (I won't be touching on it in this post but proper grip strength can also play a huge role on proper shoulder stability) problem. Not to mention proper shoulder function, especially based upon the tests that I am about to show you, is entirely interdependent on proper function of the elbow joint, glenohumeral (shoulder) joint, the scapula (shoulder blade), the thoracic spine, and arguably the neck or cervical spine as well.
You can bet this guy needs some help, even if he doesn't have symptoms...yet.
So what is a quick an easy way to check for potential shoulder dysfunction? If you know me by now you know I am a fan of the Selective Functional Movement Assessment (SFMA) and think its a great way for everybody to look at movement despite the fact that we may all treat movement in many different ways. So that is where these tests originate!
1) Upper Extremity Pattern #1
What does this shoulder position look like?
This test requires adequate motor control and mobility of many different segments including: Shoulder internal rotation, shoulder extension, and horizontal adduction of the shoulder. Additionally it requires elbow flexion and thoracic spine extension/rotation. Any issues found here indicate a potential stability and/or mobility problem. One must not assume that it is a mobility/flexibility issue that needs stretching or cranking on.
Looks a lot like our test above...If you can't easily put your own arm here, how do you expect it to feel when does it for you?
What is a passing test? The ability for the finger tips to reach the inferior angle of the contralateral scapula without excessive scapular winging of the moving arm, without excessive effort, no deviations in starting posture, and a symmetrical result when compared to the other side. A failing test would require a local biomechanical assessment and to break down of the components of the movement to search for the weakest link. This is a normal range of motion to be able to move through. Deficiency here can lead to increased strain, tension and shearing forces through your upper extremity and its soft tissues.
#2) Upper Extremity Pattern #2
For this test you need adequate shoulder external rotation, shoulder abduction, shoulder flexion, and elbow flexion on top of thoracic extension/rotation as well. To pass this test you must be able to reach your fingers to your contralateral scapula. Where at on the scapula? The midpoint of the spine of your scapula is our targeted destination. However, you need to look for symmetry of movement from side to side, check out how much effort is required, and if there is any deviation of posture to achieve this position. Additionally, a person is not allowed to "crawl" their hands up or down their back for either test. It has to be done with one smooth motion and without "warming" up.
This is not the same as Upper Extremity Pattern #2 but it IS the same. Get it?
If you want a quick and easy way of doing this if you are unsure of your anatomical landmarks just grab yourself a tape measure and assess the distance from your longest finger tip to the first wrist "crease" or wrinkle of your wrist just below your palm. Got that measurement? Okay well you want your hands to be within 1.5 times that measurement to be considered acceptable and don't forget to switch arms and check both ways.
So what do you do if fail these tests? That is a debate for another day but you honestly need more information. However, if you want to use a trial-and-error method then all you need to do is try something out like flopping on a foam roller, lacrosse ball, or getting a massage and seeing if there is a difference afterwards. How will you know if there is a difference? Retest! Mobility may work may not fix this so don't assume that is what it is! It could just as easily be a motor control or stability issue. Here is a sample of what breaking down one of these tests looks like.
While these tests are far from all-inclusive or the be-all-end-all they are a great starting place to screen or assess for potential risk of injury. If you can do this it doesn't mean you won't injury your shoulder or that you are 100% good to go but if you can't I do know that you deviate from normal into abnormal. Abnormal or dysfunction in my book is the same as pathological and may lead to future injury down the road. Get to work on bullet-proofing your shoulders before it is too late and you are under the scalpel.
!!Update!!
Some people asked for a video to help clarify a few questions that they had regarding this post and I have finally gotten the time to deliver. Here it is...
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Caution
All content on this blog is meant as instructional and educational. The author and guest authors of this blog are not responsible for any harm or injury that may result. Always consult a physician or another proper medical professional for medical advice.
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