Archive for November, 2012

Subtalar Neutral: Why it’s Important and How to Achieve it

The following article is a guest post by San Francisco based physical therapist Jeff Lam, MSPT, CSCS.  You can read oare about Jeff below after the article.

It happens almost everyday in my rehabilitation clinic and I don’t mind it at all, because it gives me the opportunity to educate and help correct something that can become more destructive later. It occurs when I ask a patient to perform a functional squat test, a closed chain test that involves observation of one’s ability to perform a graded squat. Amongst the items that I look for including thoraco-lumbar symmetry and pelvic rhythm, I make a concerted effort to assess what the foot-ankle complex is doing. When the foot-ankle collapses medially or towards midline, this is known as pronation (see picture below). This will occur along with calcaneal eversion or heel directed outward and commonly an increased valgus angle at the knee, picture both knees buckling inward. These are all tell-tale signs of weakness and inflexibility throughout the lower kinematic chain, all of which can be corrected by putting the foot in ideal alignment.

This is where subtalar neutral comes into place. Simply put, the orthopedic definition of subtalar neutral is the position in which the forefoot is locked on the rearfoot with maximum pronation of the midtarsal joint. Or you may say, when the foot is neither pronated nor supinated. Another consideration is the subtalar joint axis, an axis at which the subtalar joint (the meeting point of the talus/midfoot and calcaneus/heel) functions (see picture below). Unlike a simple hinge joint like the elbow, this joint is unique in the sense that its axis is oblique and at an angle.

The subtalar joint is a key joint, a good starting point to address in correcting lower kinematic chain deficiencies. In collaboration with the talocrural joint and midtarsal joint, these three joints combine to form the ankle-foot complex, and ultimately allows an athlete to adapt to uneven terrain and absorb shock in open chain activities. In the case of closed chain activities such as the functional squat or a power lifting squat for that matter, this complex assists in absorbing lower extremity rotation and providing a rigid lever for effective propulsion.


When it comes to foot injuries and dysfunctions, knowing how to achieve subtalar neutral may become an important element in exercise prescription in addition to orthotic assessments where findings in non-weight bearing neutral are accounted for. I am in belief that the closer one is to subtalar neutral, the more functionally sound one’s movement will be and in effect will be more efficient and safe because of it.


So this is what I do to help achieve this in the clinic. I have a patient stand shoulder width apart without shoes and ask them to rotate their trunk to the left and right. This will naturally produce pronation/eversion in one’s ankle and supination/inversion in the other. As a practioner, I have my thumb and index finger palpating for symmetry in talar pronunciation anteriorly (in the front) as I help to rock the client’s calcaneus into what would be “ballpark” subtalar neutral (see picture below). This simple tactile feedback has proven effective for me clinically and does not require much time. It can also be isolated to one lower extremity as in single leg standing and forward lunges where the effected limb is in the front. With practice and consistent cue, whether verbal or tactile, I can help progress a client from doing low grade rehabilitation (i.e. 3 sets of 10 wall slides and 1 x 60 seconds wall sit) to a more high velocity exercise that borders a power lift, all awhile holding subtalar neutral.


The video below demonstrates more of Jeff’s therapy techniques to achieve subtalar neutral.

Jeff Lam works at MoveWell Physical Therapy in San Francisco. He received his degree in physical therapy from Columbia University in New York City. His relationship with Doug Fioranelli at Rise Above Strength Performance Training dates back to their days as Exercise & Sport Science students from the University of San Francisco, NCAA Division I collegiate cross country teammates for the Dons, and numerous pre-sunrise roadtrips to triathlon events throughout Northern California.


Jeff would like to hear from you about interests in future topics.

Email him at

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Aj’s Double Trouble Kettlebell Complex

Aj shares his “Double Trouble” kettlebell complex circuit. This includes 25 reps of push ups, 10 reps of double kettlebell snatches, 10 reps of double kettlebell front squats and 10 reps of double kettlebell military press. Rest no longer than 30 seconds between exercises and repeat for four rounds.
Check out his video and see if you are up for the challenge.

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Tuesday, November 27th, 2012 Kettlebell Training, Videos No Comments

Concern for Calories?

Some of the greatest debates in our world revolve around several epic topics; religion, politics and nutrition.  Though I have some opinions about the former two, I will not be discussing either, rather I will stick to one closer in my field of health and wellness and discuss a common subtopic in the area of nutrition.

It would be difficult to avoid a day without hearing some reference towards the amount of calories a particular item of food or a meal has.  You hear it all the time, “Man I shouldn’t have eaten that bagel it has about 300 calories” or one of my favorites comes right out of those commercials we are bombarded with daily, “Try our new Pop Tarts lite with only 100 calories per serving.”  We are meant to believe that our bodies operate on a series of binary codes and complex algorithms.  That somehow our bodies internally crunch the caloric numbers we consume and simply use the exact number we need while either eliminating or storing the excess.

Wouldn’t this be nice if it were all that simple?  We would just magically know our personal number that corresponds to the number of calories we should consume on a given day to lose, maintain, or gain weight.  With the number of people struggling to understand this concept maybe calories are not necessarily as simplistic a formula as they are made out to be, nor should they be completely ignored when consuming meals.

To begin with, we have to think about the food we eat in a few different ways; first off there is food for fuel for our bodies and food to build or break down our bodies.  We not only run on everything we put into our guts but we also use those nutrients as the raw materials to build all of the cells in our bodies.

We need to put the all calories are equal to rest.  Like one of my favorite nutritionists, Dr. Eric Serrano, likes to mention, “100 calories of Lucky Charms is not the same as 100 calories of broccoli.”  The focus here should not be on the quantity butrather the quality of those 100 calories that are going into our bodies.  After all, would you want cells made from Lucky Charms or broccoli?

Here is a little scientific research to support the above point; a study done in the Journal of the American Medical Association suggested that, “Certain foods and diets may be better than others for burning calories and helping people maintain weight loss.”  The subjects agreed to follow low-fat, very-low-carb, and low-glycemic-index diets for a month each.  Although all of the participants ate the same number of calories on each of the three plans, results showed that the study participants burned about 300 calories a day less on the low-fat eating plan than they did on the very-low-carbohydrate one.

The very-low-carb plan and the low-glycemic-index plan which included a variety of high fiber and minimally processed foods resulted in better insulin sensitivity and cholesterol levels.  The researchers also concluded that very-low-fat diets may actually slow down a person’s metabolism to a level where it is not burning calories as effectively as it could.

Understanding that not all calories are equal may not give us free rein to go out and eat as much healthy food as we can without concern for the total number of calories consumed.  Our bodies do have a limit and operate on a sliding scale dependant on several factors including exercise, goals, age, current hormonal state and the list can go on and on.  There should be some concern with the number of calories the body needs for fuel and cell repair.

Calorie counting is not going to be an exact science and it will fluctuate with reasons stated above.  Weighing your food daily and calculating the gram for each macro nutrient might be a little excessive.  However, it may be more important to keep your total caloric intake within a specific range (assuming of course you calories are coming from excellent food sources).

Another one of my go to nutritionists is Nate Miyaki who does not only touts clean eating but proper caloric intake to meet the individual’s goals.  Sounds like a lot of math, however this is why I like Nate so much, he likes to keep things real simple.  His formulas are the following based on the individual’s goals:

Lose Fat                                             10-12 calories/lb of bodyweight

Maintain/Body Recomposition              13-15 calories/lb of bodyweight

Build Muscle                                       16+ calories/lb of bodyweight

A simple example would be for a 185 lb active male who is looking to maintain their muscle mass and weight while decreasing their body fat percentage should consume about 2,400-2,775 calories per day consisting of good clean foods.

Seems simple enough: know your goal, have an idea about which foods your should consume, then approximate calories in a serving and with a little trial and error you can fine tune the right diet that you need to maintain and constantly achieve the personal result you desire.

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Tuesday, November 27th, 2012 Nutrition No Comments


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