Redefining the fitness of performance With Joel Jamieson

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Joint Mechanics: The Foot

In this episode, Dr. Gerry Ramogida show you how he evaluates the foot and discusses the important concept of how micromovements lead to macromovements and big differences in performance. Dr. Ramogida is one of the top therapists out there and just returned from working in the UK with world renowned track coach Dan Pfaff. Watch the video to find out why so many athletes count on him when performance really matters.

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Read the transcript of this video

Joel: Hey there, I'm Joel Jamieson.

Howie: And I'm Howie Clark.

Joel: And in this week's episode of 8 Weeks Out TV, we have a special guest who's going to show how small changes can lead to big gains in your performance.
So today on the show we have Dr. Gerry Ramogida, who is really one of the top therapists in the world. He just got back from the UK, working with Dan Pfaff, who's widely regarded as one of the top track and field coaches out there. He's ART certified. He's done a lot of stuff with Guy Voyer. He does electro-acupuncture. I mean, this guy, really, he does it all.

Howie: I'm very excited to meet him.

Joel: Yeah.

Howie: You've spoken very highly of him for years now, and yeah, I think this is going to be a very nice change for everyone viewing out there.

Joel: Yeah. He's a guy I met back in the early 2000 range, working with the Seahawks. He's worked with a number of professional sports teams and athletes out there, and he's really the go-to guy to keep top athletes healthy. So we wanted to bring him on the show and talk about how he evaluates movement and what his overall philosophy is. Hopefully, you guys are going to get a lot out of it. So let's take a look with Dr. Gerry Ramogida.
Hi, so today I'm here with special guest, Dr. Gerry Ramogida, who I met first I think back in 2003 or '04, something like that. Dr. Ramogida was a therapist working with the Seahawks at the time, and since then he's gone over to work with UK Athletics and top track and field coaches, like Dan Pfaff. Actually just got back. What was that like over there?

Dr. Ramogida: Yeah, it was a good experience. I was over there, brought over by UK Athletics to be their lead performance therapist, doing some trackside work with their top athletes and coaches. As you mentioned, Dan Pfaff. Yeah, good experience overall. Good success.

Joel: Gerry's Canadian. We'll forgive him for going over there. But we brought him in today, and over the next few weeks we want to take a look at what Dr. Ramogida talks about in terms of micro movements adding up to macro-movements.
He's very unique in his approach to working with athletes, and obviously had a ton of success working with world-class athletes, and so we wanted to bring him in the next couple of weeks to look at some different stuff that he evaluates when he works with his athletes and show you guys what he does.
Today we're going to start off with the ankle, then work our way up.

Dr. Ramogida: Great.

Joel: Let's take a look.

Dr. Ramogida: We're going to start with the ankle and foot, like Joel just mentioned. A concept that was introduced to me by one of my mentors, Dr. Guy Voyer, is micro-movement dictates macro- movement.
Other influences, Dr. Mike Leahy, with active release techniques and the concept and ideas that have come with that have all played a part in how I've brought things together.

So, the first thing with the foot we look at, or I like to look at, is the integrity of the intrinsic muscles of the foot. There are a large number of muscles, and we know from the research that each muscle has a influence on proprioception. Therefore, it's important to ensure that the musculature is pliable, that there's good compliance, there isn't a lot of scar tissue, and just general good mobility in those tissues. That will ensure that you have good proprioceptive input to the spinal cord level, into the brain level, and ensure that you're getting good activation through the chain.

It's just kind of palpating, feeling the tissues. If you find anything of major significance, we're going to show some things that the athlete can do to self-manage that. That's the starting point.

From there, I like to look at the major joints through the foot. We have the first MTP point. We have the proximal end of the first metatarsal joint at the cuneiforms, and then we have the navicular, and then the navicular with the talus. Then we have the subtalar joint, all kind of critical in terms of contributing to the overall motion of the foot, which is primarily supination and pronation. It's a combination of small contributions of all of these joints.
So, when you start to lose mobility in any of these areas, the consequence may appear to be decreased pronation or result in excessive movements up the chain in the knee or hip. That's why it's important just to get a general idea if you're getting movement out of each of these.

So, the first one, the first metatarsal phalangeal joint, the biggest thing is do they have good quality extension? We know that when the athlete goes to push off, if they can't get extension, you can lose as much as 20% of your push-off strength, which can have a significant impact on performance.

Joel: Basically, the difference between winning and losing at the highest levels.

Dr. Ramogida: Yeah.

Howie: Twenty percent.

Dr. Ramogida: Twenty percent could be first or last. Absolutely. So the other thing that the degree of extension or the quality of extension will have is that when the athlete is on that foot at push-off, if they have a good quality, they can get a good base of support. If this is rigid and it becomes a less stable platform, now that's going to have impact on the ability to stabilize the ankle, the knee, the hip. It can lead to altered mechanics.
Moving up. If we continue up and we get into the midfoot, there's a number of joints here. What you want to just ensure (and I'm going to stand up here), is does the midfoot have good free motion, or does it feel really rigid to your contact?

Again, we're going to go into some self-management exercises that will allow one to see what the quality of movement is at the midfoot, between the first metatarsal and the midfoot. Now, if we move up into the talocrural joint, or the ankle joint, we know that dorsiflexion is very important for athletes. Going into dorsiflexion is important because it puts pre-stretch on the big muscles of the calf, gastro- soleus, and then the deep flexors - flexor hallucis longus, flexor digitorum longus, and tibialis anterior. All those muscles, when we go into dorsiflexion, are in pre-stretch. And when you come into contact with the ground in that position, in a slightly dorsiflex position, or when you maintain that, it gives you a lot more power because that muscle is in a position to absorb shock and then push off.

Joel: Basic transfer of kinetic energy.

Dr. Ramogida: Absolutely. So often what we see is athletes landing in a plantar flex position. What occurs is when you hit the ground in that position, you have to absorb the impact and then gather and then push off. What that translates into is increased ground contact time.

Joel: Slows you down.

Dr. Ramogida: Yeah. And we know that when we want power, we want that ground contact time to be as short as possible while we generate maximal force. When you maintain dorsiflexion and that pre-stretch, you're just putting yourself in a much better position to get that power.

Howie: So I just found out why I wasn't fast. That's good.

Dr. Ramogida: A simple technique change.

Howie: A few years late, yeah. No problem.

Dr. Ramogida: Exactly.

Joel: Let's say that they don't have a therapist or experienced trainer to evaluate the overall range of motion. Is there something that athletes can do on their own to see maybe where their range of motion in their ankle joint is?

Dr. Ramogida: Yeah, absolutely. There are a few simple things that we can show that will allow one to identify if they're lacking.
On a table with a therapist, it's kind of easy. You're getting pretty much to neutral. We'd like to see up to 20 degrees of dorsiflexion, and there are things that we would do to improve that. You have a history with some ankle injury.

Howie: I do. Yeah, I kind of jacked my ankle up a few years back and never properly rehabbed it. Then when I came back to playing, I did notice some loss of motion in my range of motion. And then . . .

Dr. Ramogida: Loss of dorsiflexion.

Howie: . . . loss of dorsiflexion. I ended up having some knee issues. I'm sure it's contributed, but yeah, that's something I was definitely aware of.

Dr. Ramogida: Yeah, because the biggest thing in terms of dorsiflexion is the talus is wider anteriorly. So to get good quality dorsiflexion, the talus has to be able to glide under the tibia. Again, there are certain techniques we would use to make sure we get that quality.

Joel: Let's take a look. I know you mentioned there's a way that athletes can evaluate their range of motion through the ankle joint. Let's take a look at that.

Dr. Ramogida: So this is a quick test. We were talking about dorsiflexion, and this is just a quick assessment. You can see we've put a little piece of tape there on the floor. We're going to mark, whichever foot he does first, just from the distance from the wall.
What I'm going to have him do is face the wall. He's going to put his foot on the mark where he thinks he can get his knee to the wall. What we're going to do is I want to make sure he's in a position where he keeps his hips straight. Then, the instructions you're going to give them, when they bring the knee forward, we want to make sure that the knee stays over the midline of the foot, and he can get to the wall without the heel lifting off. If he can't, he's going to move his toe in a little closer. If he gets to it easy, he just brings the foot back. What we're looking for is the point that the knee can get to the wall good and the heel not lift off.

So that was pretty good, and I don't think we've get much farther. So we're going to lift there.

Okay. And then we're going to compare that. That was pretty good. His knee cleared the foot adequately, and I'm happy with that.
So now we're just going to compare the other side. Again, make sure the hips, there you so. Go ahead and move forward. Keep the hips straight. Keep this hip there, good. Go ahead, come back.

So you can see already he's got significantly more range. He's over the midline of the foot, and the knee is easily getting there. We can stop there. He's got double the range on the left versus the right. We knew the right was the one that was more restricted. Therefore, that can serve as a stretch. So you can have an athlete do that as a stretch, keeping the heel down, bringing the knee toward especially on the side that is restricted, and it serves as a good screen. We should have symmetry between the sides.

Joel: That's awesome. Great stuff. I really appreciate you coming down. Next week we're going to be talking about . . .

Dr. Ramogida: The knee.

Joel: . . . the knee. Awesome. So thanks again to Dr. Ramogida for coming down here and Howie for being the guinea pig, as always. It's your job.
But we will see you again next week. We'll be talking about the knee and how we go ahead and evaluate that as well. Thanks again for watching 8 Weeks Out TV, and we'll see you again next week.

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