9:00am-1:00pm Class

The goal of this class is to present concepts of how the body uses ground forces in the kinetic chain, and produces motion in the walk cycle.  We will cover fascial planes and how they transmit forces from the ground to the cranium.

Patterns of adaption will be discussed and the clinician will learn different approaches to biomechanical dysfunctions and how they relate to the health of the body.

The understanding of the specific nuances of each segmental motion pattern in both normal and abnormal gait will be discussed. Laboratory time will reflect concepts presented in lecture and treatment will be demonstrated.

By course end, the student should be able to correctly analyze common dysfunctions seen in the process of human locomotion and be able to devise and apply techniques for the correction of these dysfunctions.

The student will be guided through drills and lectures so that they may collect the necessary information to accomplish these tasks in a short period of time and be able to use this material in their clinical practices.

*WARM SPRINGS RANCH, a 300 acre ranch is the breeding site of the Budweiser Clydesdales, over 70 Clydesdales from foals to stallions.  The walking tours on ADA accessible paths run every day except Wednesday at 10 AM and 2 PM.  Tours cost $14 person (children under 2 are free), last between 60 to 90 minutes and include a gift ship and free Budweiser sample.  Reservations are required for the tours which fill up very fast, and I was told folks needed to call as far in advance as possible to be sure to get a place.  The ranch is just a 15 minute drive down the interstate from the hotel.

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*Les Bourgeois Vineyard and Winery at Rocheport, MO is less than a 15 minute drive down the interstate from our hotel.  The A-Frame is a popular picnic spot (okay for families) about a mile off the interstate, It's open noon till sunset, with a beautiful bluff top view overlooking the MO River valley.  Food items and wine for sale. It overlooks the nearby scenic KATY trail for hiking and biking.  The Les Bourgeois tasting room and gift shop are right on the interstate (about a mile closer than the A-Frame) open 10-6 Sunday through Thursday and 10-8 Friday and Saturday.

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*The Columbia Mall is right across the street from the Holiday Inn Executive Center. It's a good size mall with food court and a game area. 

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*Cosmo Park, a favorite outdoor area for families, is less than a mile away, but across the interstate and then down the road a short drive.  Also has a walking path around picnic and play areas. 

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*Great hiking and biking nearby on the MKT or the KATY Trail.  The MKT Nature and Fitness Trail (about 9 miles) takes you out of the heart of Columbia through wetlands and wooded areas and connects with the KATY Trail .  The KATY Trail (with great views of the Missouri River) extends for over 200 miles from St. Charles in eastern Missouri to Sedalia in western Missouri . Bike rental available (at various locations).

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*Museum of Art and Archeology and the Museum of Anthropology just 2 miles away at 115 Business Loop 70.

Late in the day on November 7 ^th , the governor's office issued  the report of the Governor's Task Force on Boards and Commissions. The Governor established this twelve member board in April. It was tasked with cutting the number of gubernatorial appointments to boards and commissions, with merging certain panels and eliminating others.  Before the report was released, rumors suggested that the Missouri State Board of Therapeutic Massage, along with the Missouri Acupuncture Advisory Committee would be eliminated and their duties transferred to the Missouri State Board of Chiropractic Examiners. In its final report, the Task Force recommends that the members of the Acupuncture Committee be appointed by the director of the Chiropractic Board. The report does not recommend any changes to the Massage Board. The Task Force's recommendations still need to be enacted by the legislature. We will continue to monitor the process in order to deal with any actions that may impact our profession and our licensing status.

Currently we are studying SB 604, a bill that was prefiled on December 1 ^st, by Senator Bob Onder, of Senate District 2 (parts of St. Charles County). This bill seeks to deal with human trafficking. The bill would require the display of posters which provide resource information for victims of human trafficking. The posters would need to be displayed in a variety of locations: hospital emergency rooms, bus terminals, airports, train stations, hotels, strip clubs, urgent care centers, job recruitment centers, women's health centers, shelters, and at "businesses or establishments that offer massage or body work services for compensation by individuals who are not licensed under section 324.265." Section 324.265 is a section of the law licensing massage, that identifies who may practice massage and what individuals are not required to be licensed by the massage board, but who may still practice massage. Supposedly this exempt group includes PT's and estheticians. We are still trying to determine what Senator Onder means by this language. It does not include licensed massage therapists, so we would not be required to display these posters. What else it means we will find out.

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A lot of what we've been taught about the ilio-tibial band/track (ITB), its issues and treatments is wrong. What we were taught about its anatomy is incomplete; what we were taught about its dysfunctions is mostly wrong; and, what we were taught about the treatments of its dysfunctions is wrong.

Recently a certain amount of clarity about the ITB has begun to appear in print. About a year ago, I read a blog post that was reposted to Face Book, entitled, "Ilio-tibia Band: Please do not use a foam roller!" People who know me would appreciate that the title alone excited me, since I have been preaching that message to the athletes I work with for more than ten years. (The author of the original post, Dr. Andrew Franklyn Miller, has lots of excellent blog posts. Current posts can be found on the web page of the SSC Sports Medicine Center: www.drandyfranklynmiller.com).

Since then, I have read a number of posts by physical therapists and by athletic trainers about not foam rolling the ITB. In all these posts, blogs, and articles, the descriptions of the ITB vary a little. The descriptions of the function of the ITB is typically: extension, abduction, and lateral rotation of the hip, as well as the lateral stabilization of the knee, etc. The ITB itself is usually defined as "a thickening in the fascia lata." This information is good as far as it goes.

 Two years ago at the state convention in St. Louis, I was able to use a cadaver specimen to demonstrate that the ITB is much more than a thickening of the fascia lata. Workshop participants saw that the ITB is continuous with the periosteum of the femur via the intramuscular septum that separates the qudraceps from the hamstrings. They appreciated that  the ITB is an extension of the periosteum of the femur.

Most blogs note that the tensor fascia lata (TFL) and the gluteus maximus insert into the ITB. In this context, they detail the normal functions of the ITB, as listed above. In so doing, they miss the mark.

While the gluteus maximus attaches directly to the femur at the gluteal line (at the top of the linea aspera), the TFL has no direct attachment to the femur. Yet, it abducts and internally rotates the femur. It performs these functions by means of its attachment to the ITB, which is attached to the femur at the linea aspera. This means that the ITB is not just a thickening of the fascia lata, nor is it just an extension of the periosteum of the femur. It is the tendon of attachment of the TFL to the femur. In other words the ITB is an aponeurosis. And it functions as an aponeurosis not just for the TFL, but also for the gluteus maximus.

The effects of this interesting arrangement became clear after studying a coaching video of the 100 meter final at the Athens Olympics. That video showed that as the runners' feet touched the track, their TFLs contracted, then a fraction of a second later their gluteus maximi contracted. This observation led to the question, "What is the reason for this pattern?"

Considering the anatomy results in an important insight. In the static thigh, the ITB is a relatively slack structure attaching to the iliac crest and to Gerdy's tubercle at the tibia. When the TFL contracts, it anchors the ITB at a third point--lateral of the anterior superior iliac spine. The contraction of the TFL makes the ITB a rigid structure. Then, when the gluteus maximus contracts, it uses the ITB to extend the femur, pulling at the femur along the entire length of the linea aspera.

The direct attachment of the gluteus maximus to the femur creates a lever that is five inches long. Via the ITB, the gluteus maximus inserts into the entire length of the femur. This is a fifteen inch long lever, three times longer than the lever created by the direct attachment. Long levers are more efficient than shorter ones. This is an elegant and efficient arrangement.

 You can easily feel this function in action. As you walk, place a hand on your TFL. You will feel it contract when your foot hits the ground. It continues that contraction as your hip moves through hyperextension. During the swing phase of gait, the TFL softens as it releases its contraction, which allows the ITB to become slack during this phase of gait.

While knowledge is good for its own sake, this understanding can help in a clinical setting. Understanding the relationship between these structures changed a number of my practices. I stopped stripping the ITB of patients who complained of pain in it. I stopped applying direct pressure and cross-fiber friction to the ITB. Instead, I treat the TFL and/or the gluteus maximus. For example, if a patient, who complains of IT pain, has a positive Ober's Test, treating the TFL results in a negative Ober's Test and an end to the pain (I usually spend less than five minutes on such a treatment).

In my work with collegiate runners, I treated many distance runners who were unable to "kick" at the end of a 5 or 10 K race. In many of these cases they reported that they could not "fire their glutes."  In most of these cases the problem was not in the glutes, but was in their TFL's. Working on the TFLs restored their "kick."

When we understand the structure and function of the ITB and the muscles that attach to and use it, we can change how we treat some forms of hip and knee pain. The outcomes for my patients have been positive.

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