There is a “silver-lining” to nearly every negative situation in which you find yourself. If you open yourself up, you can find the positives and then use your experience and knowledge gained to help others…hopefully, creating a “greater good” in the universe. I hope the following story, lessons learned, perspective, and insight are informative.
The aftermath of a very personal health situation brought me in to see Lori Thomsen at the Hruska Clinic. She took me on as a patient one year ago. Realizing quickly that I was a candidate for PRI Vision intervention, I was assessed by Ron Hruska and Heidi Wise the same day and prescribed a specific pair of PRI lenses. I filled the prescription and followed up with Lori the next day.
Lori guided me through a program consisting of upright exercises. (Exercises in the Vision program are primarily upright activities, because you are learning how to use the floor to propel yourself forward through all phases of the gait cycle, using the PRI Vision lenses as a tool.) Coincidentally, at this same time, I was beginning to more fully appreciate the need to get my own clients “on their feet”. Admittedly, I was designing exercise programming primarily for the supine, side-lying, and all-fours positions. Having received Lori’s instruction for my own upright activities, I was able to more adeptly implement upright activities with my own clientele, especially when it came to teaching L mid-stance. I believe I have been able to avoid major pitfalls/setbacks and progress my clients more quickly than I might have, if I had not been a patient of Lori’s.
[Side Note: It is important to make a distinction between assessing one’s ability to center themselves in L or R mid-stance (as is part of the PRI Vision assessment) versus teaching L mid-stance and other phases of the gait cycle at the appropriate time in one’s rehab/training program. Assessment does not involve cueing; teaching does.]
The most enlightening piece of information Lori taught me was the use of the quad during mid-stance. As a member of the PRI faculty, Lori teaches the Pelvis Restoration course. She frequently refers to her “3 Amigos”: L abdominal wall, L quad, and L hip. It wasn’t until I was a patient, when she actually took me through the integration of the “3 Amigos” on MY body, that I fully appreciated the quad in L mid-stance.
I think perhaps that the quad is overlooked when teaching L mid-stance, due to overemphasis on the L heel. Let me try to explain in an admittedly round-about way J
In L mid-stance you should feel 75-80% of your body weight traveling down into the back half of your foot (mid-arch to center of heel). Your left foot should be firmly planted on the ground without the toes lifting up in front. I have witnessed individuals lifting their toes or entire forefoot into dorsiflexion when cued to: “find your left heel” or “press down through your left heel” . I have inadvertently used these types of cues and seen those little toes wiggling around in the shoe, trying to lift up. Sometimes it helps to have the client go barefoot, so you can see if they are “cheating” with their toes. “Cheating” with the toes IS cheating, because it is extension. Toe extension kicks on dorsiflexors…kicks on hip flexors…kicks on low back, etc. etc. (There are certainly those who walk as “heel-diggers”, pulling themselves forward through this entire list of muscles. These are very extended individuals who tend to use their pecs as their abdominals and present with significant FHP.)
PRI programming accentuates “sensing” or “feeling” your left heel making contact with the ground in mid-stance, because those in LAIC patterns tend to bypass the L heel altogether during the gait cycle. Their L foot tends to be in constant plantar flexion, so the first part of the foot that hits the ground on heel-strike is the arch or the ball of the foot (late mid-stance to early toe-off phase). Maybe we take the client/patient through proper heel-strike phase, but in mid-stance, we should be teaching them to merely “sense” or “feel” their left heel vs. “press” or “dig” their left heel.
Back to the quad… In L mid-stance, the quads should be in an eccentric contraction phase around the knee joint, counter-balancing the eccentric contraction of the hamstrings. Because the knee is slightly flexed in mid-stance, the quad is on a slight stretch but holding tension, getting prepared for the propulsion phase where the concentric action of the quad takes over (stretch-shortening). There is a “springiness” to the quad, unless the L foot is not firmly planted or the L hemi-pelvis is anteriorly tilted. In either of these cases, the quad is acting more concentrically.
I like the word “springiness”, because it reflects my most recent reflections on mid-stance. “The first modal peak [of the vertical component of ground reaction forces (GRF)] occurs during the first half of support and characterizes the portion of support when the total body is lowered after foot contact.” (Hamill and Knutzen, Biomechanical Basis of Human Movement). This is mid-stance.
When I ask my clients if they “feel” the floor under their feet, sometimes they look at me like I am crazy. When teaching L mid-stance, I have begun asking them if can “drop” their bodyweight (75-80%) into the L foot and “allow” the L left leg to “accept” that weight. Now, maybe they can sense some weight, actually the GRF pushing up into their left foot (through the “springy” eccentric quad). Now they have a point of contact from which to propel forward. They are not in a constant state of “pulling” or “lifting” themselves off the floor with vision, jaw, neck, shoulder, low back, and/or gastroc muscles. [Side note in regards to Cervical Revolution: all of this “lifting” and “pulling” through the kinetic chain, bottom-up, is to no avail, because ultimately there is gravity crushing down on all of those lifting forces, meeting at the skull and generating cranial compression.]
When you really think about this, walking is hard stuff!! Each leg has to be able to “accept” 75-80% of your body weight in able to propel forward and not evade this difficult task with the above-listed extensor and pulling muscles.
Again, back to the quad… “If you can feel your L quad, Lilla, your L abs should automatically be kicking on”, Lori says during our session. The quad is one of the markers for integration from the ribcage to the pelvic inlet through the pelvic outlet to the femur.
I’m in L stance with pelvis rotated left, L foot flat on ground, upper body rotated right, reaching out and down with left arm to facilitate both trunk rotation and thoracic flexion, a bit of thoracic abduction to help find L abs. I’m doing everything right, but still no abs. When I “press” down into the ground, as suggested, I am concentrically activating my quad, and it is difficult to posteriorly tilt my pelvis and reach the knees forward. However, when I think of “dropping” my weight onto my L leg (feeling those GRFs and a “springy” eccentric quad), I can reach my knees forward with posterior pelvic tilt, effectively bringing my pelvis under my ribcage so that they are in a position to access the side abs. YEAH and whew!
I didn’t mention the third amigo, the L hip (Glute Med), which comes into play in the frontal plane, balancing the forces of the IC Adductor. I am certainly not downplaying the role of this amigo in L mid-stance! I only wanted to emphasize the important role of the quad (a muscle that is not given as much “press” in teaching L mid-stance), because Lori’s instruction certainly helped me, both personally and professionally.
Attached are 2 short video demonstrations.
Toe Extension MCS
Lilla Marhefka, PhD, HFS, CSCS, PRT