🦀 PT Crab Issue 79 - Before the Freeze

This week PT Crab is getting into CrossFit, just like everyone else does at the beginning of the New Year. Even I have New Year’s resolutions, but they’re not CrossFit. My goals (they’re not SMART goals but I’m working on it) are to eat more mindfully at every snack and meal and to complete an ultra-marathon. I’ve never stepped beyond marathon distance and haven’t even done that in 6 years, so we’ll see how that goes. I’ll probably get an overuse injury, but I also have a theory that overuse injuries don’t exist, just bad mechanics, postures, or supports, or undertraining (saucy, I know. I’m open to disagreement on it, email or tweet me to argue).

Also this week, we’re talking about identifying freezing in Parkinson’s before it even happens. King Crab supporters (you know the drill) also got pieces on neural mobilization, and innovative Clin Ed models for Coronavirus times. Become a supporter here.

Oh, last thing! If PT Crab has been helpful to you, can you email or tweet me a really short testimonial about it? It can just be one sentence. I’m working on the website and these would really help. Thanks!

With that, let’s dive in!

Workout of the Day the Pain Away.

The Gist - These athletic trainers from Spain and Miami found 70 recreational athletes with Chronic Ankle Instability and randomized them into three groups. One took on CrossFit training alone, performing an organized workout that included elements of mobility and power. The other carried out the same CrossFit workout, but did ankle self-mobilizations first, then did some CrossFit. The other other group was the control, so they did nothing. The CrossFitters worked 2x/wk for 12 weeks.

Outcome-measure wise, they looking at Ankle-dorsiflexion range, subjective instability, and dynamic postural control using three different tests.

Afterward, those who performed the self-mobilizations improved most across all outcome measures while those who just performed CrossFit improved quite a bit. The control group did not improve. Self-mobilization was better than just CrossFit across all outcome measures except the CAIT, a questionnaire that assesses the severity of ankle instability. This piece really shows that motion is indeed lotion and focused motion is the best lotion.

Tell Me More - All groups started with about 8.7° of ankle dorsiflexion range and the self-mobilization folks increased that by 2.29° while the CrossFitters increased it by 1.6°. On the CAIT, self-mobilizers improved by 5 points (going from 18.8 to 24.16 on a scale where >25 indicates no chronic instability) and CrossFitters improved by 4.4 points (18.9 to 23.3). On the individual level, in dorsiflexion range, 56% of the mobilizers had changes that broke the MDC barrier which is great news.

All of the mobilizations they used were weight-bearing and referred to as “Mulligan-type”, AKA Mobilizations with Movement. They included a lunge with a kettlebell over the forward knee and max dorsiflexion, a talo-crural distraction with band and then passive dorsiflexion with another band, and talar posterior mobilization with a band while actively dorsiflexing. If my descriptions don’t cut it, the article has photos.

The best news was the improvement on the CAIT in both groups. According to the researchers, “Another important aspect of patients with CAI is the self-reported feeling of instability…. The improvements of 96% and 83% of the participants in the self-mobilization plus CrossFit and CrossFit-alone groups, respectively, can be considered the greatest strength of the present study.” And I agree.

Paper? Sure thing.

Before the Freeze. Predicting in Parkinson’s.

The Gist - Freezing of gait in Parkinson’s is obviously a problem and predicting it would obviously be fantastic. But can we do that? Probably, yeah. That’s what this paper indicates at least. It’s a systematic review from the journal Gait & Posture that tries to emphasize the biomechanics that come just before the freeze. What did they find?

They pulled together ten studies to find some general rules and also zoomed in on some subtypes of freezing that I’ll get to later. The general rules are dramatic reductions in movement excursions. Strides shorten, gaits slow down, double stance increases, and sagittal plane ranges of motion decrease while the pelvis tilts anteriorly. These can be seen with the naked eye to predict when the freeze is coming.

Tell Me More - The subtypes of freezing have their own elements and you’ll have to see the whole paper to see them all. One of these is start hesitation, a delay in starting walking. Their data showed that this is due to inefficient weight transfer and multiple postural adjustments before pushing off. These adjustments “disrupt the posture-movement coordination and may precipitate” freezing. There are other types too so check out the paper for it all.

The authors don’t posit a remedy for all this, but that’s not the point of the paper. They’re just looking to see if we can predict freezing and we can indeed. You may already have seen this from your practice, but now you know it can be done officially. The next steps is how to cue someone out of these freezing triggers before the freeze occurs. I’ll be keeping my eye on these authors to see what they come up wither the next couple of years.

Paper? Sure thing.

And that’s the week! If you think PT Crab would be more useful on another day or at another time, shoot an email, K? I want it to be as useful to you as possible and switching days could help. Never know til you try!

Bye!

Here’s this week’s bibliography:

• Cruz-Díaz, D., Hita-Contreras, F., Martínez-Amat, A., Aibar-Almazán, A., & Kim, K.-M. (2020). Ankle-Joint Self-Mobilization and CrossFit Training in Patients With Chronic Ankle Instability: A Randomized Controlled Trial. Journal of Athletic Training, 55(2), 159–168. https://doi.org/10.4085/1062-6050-181-18
• Cupertino, L., dos Reis, T. G., Los Angeles, E., Costa, T. M., Shokur, S., Bouri, M., de Lima-Pardini, A. C., & Coelho, D. B. (2022). Biomechanical aspects that precede freezing episode during gait in individuals with Parkinson’s disease: A systematic review. Gait & Posture, 91, 149–154. https://doi.org/10.1016/j.gaitpost.2021.10.021