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Joram 035, Kericho town, Kericho (2026)

23/04/2026

Important points

22/04/2026

Metatarsalgia – Forefoot Pressure Overload

Metatarsalgia refers to pain under the metatarsal heads due to excessive pressure and repetitive impact. It is often seen in runners, dancers, and people who wear high heels.

When load shifts forward — due to tight calves, short Achilles, or forefoot strike overload — pressure concentrates under specific metatarsals. Fat pad thinning further worsens shock absorption.

Treatment involves pressure redistribution, padding, footwear changes, calf stretching, and gait retraining. Reducing focal pressure is the main therapeutic goal.

21/04/2026

💪 Axillary Nerve Injury & Shoulder Conditions – Quick Guide
The axillary nerve is commonly injured in:
👉 Shoulder dislocation
👉 Fracture of the greater tubercle of humerus
⚠️ Effects of Axillary Nerve Injury:
• Weakness or loss of shoulder abduction (due to deltoid paralysis)
• Flattened shoulder contour
• Loss of sensation over the “regimental badge area”
• Difficulty lifting the arm sideways

🦴 Scapular Region – Clinical Insight
🔸 Dawbarn’s Sign
In subacromial/subdeltoid bursitis, the swelling (bursa) disappears when the arm is abducted because it slips under the acromion.
🔸 Common Cause
👉 Often secondary to inflammation of the supraspinatus tendon (rotator cuff pathology)

🚨 Symptoms to Watch:
• Shoulder pain (especially on movement)
• Restricted range of motion
• Tenderness around the shoulder

💡 Physiotherapy plays a key role in:
✔️ Pain relief
✔️ Restoring mobility
✔️ Strengthening shoulder muscles

21/04/2026

SHOULDER ABDUCTION BIOMECHANICS: THE 60°–120°–180° STORY

This image beautifully captures one of the most important biomechanical concepts of the shoulder—scapulohumeral rhythm, where motion is shared between the glenohumeral (GH) joint and the scapula to achieve full arm elevation.

In the first 0° to ~60° (green arc), movement is predominantly initiated at the glenohumeral joint. The humeral head rolls superiorly and glides inferiorly within the glenoid to maintain joint congruency. During this phase, the supraspinatus initiates abduction, while the deltoid progressively takes over. The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, subscapularis) act as dynamic stabilizers, compressing the humeral head into the glenoid and preventing superior migration.

From ~60° to 120° (orange arc), the scapula begins significant upward rotation. This is where the classic 2:1 ratio emerges—for every 2° of GH movement, the scapula contributes 1°. So, by the time the arm reaches 120°, roughly 80° comes from GH joint and 40° from scapular motion. The force couple between upper trapezius, lower trapezius, and serratus anterior becomes critical here, producing smooth upward rotation while also ensuring posterior tilt and external rotation of the scapula to clear the acromion.

From 120° to full 180° elevation (red arc), full overhead motion is achieved through combined scapular upward rotation (~60° total), clavicular elevation at the sternoclavicular joint, and posterior rotation at the acromioclavicular joint. The clavicle elevates about 25–30°, and the AC joint contributes additional fine-tuning, allowing the scapula to maintain optimal positioning relative to the thorax.

Biomechanically, this coordinated motion serves several essential purposes. It maximizes range of motion while minimizing impingement risk, maintains the length-tension relationship of the deltoid, and ensures that the subacromial space remains open during elevation. Without scapular contribution, pure GH abduction would lead to early impingement against the acromion.

Another key aspect is force distribution. Instead of overloading a single joint, movement is shared across the GH joint, scapulothoracic articulation, AC joint, and SC joint. This reduces localized stress and allows efficient overhead function.

If this rhythm is disrupted—due to weak serratus anterior, tight posterior capsule, rotator cuff dysfunction, or poor thoracic mobility—the result is altered kinematics known as scapular dyskinesis. This often leads to compensations such as early shoulder shrugging, reduced range, or pain syndromes like impingement.

In essence, reaching 180° is not just a shoulder movement—it is a symphony of coordinated joint mechanics, where every degree gained is the result of precise interaction between mobility and stability across the entire shoulder complex.

20/04/2026

PLANES OF MOTION – THE FOUNDATION OF HUMAN BIOMECHANICS

Understanding the human body starts with recognizing how movement is organized in space. The anatomical position provides a standardized reference, but the real power lies in how the body moves through the three primary planes: sagittal, frontal, and transverse. These planes are not just theoretical concepts—they define how forces are produced, absorbed, and transferred throughout the kinetic chain.

The sagittal plane divides the body into left and right halves and governs movements like flexion and extension. Walking, running, squatting, and jumping primarily occur in this plane. Biomechanically, it is the plane of forward propulsion and energy efficiency. Muscles such as the gluteus maximus, quadriceps, and hamstrings generate powerful linear forces here. However, efficient sagittal movement depends heavily on stability from the other planes. Without frontal and transverse control, sagittal motion becomes unstable and inefficient.

The frontal plane divides the body into front and back halves and controls movements like abduction, adduction, and lateral shifting. This plane is crucial for balance and load distribution, especially during single-leg activities like walking or running. When you stand on one leg, your body must resist collapsing sideways—this is controlled by muscles like the gluteus medius. Poor frontal plane control often leads to compensations such as knee valgus or hip drop, which are major contributors to injuries.

The transverse plane divides the body into upper and lower halves and governs rotational movements. Nearly all functional activities involve rotation, even if they appear linear. The transverse plane is responsible for force transfer and torque generation, especially in activities like throwing, sprinting, or changing direction. Muscles and fascial systems coordinate spiraling forces that allow energy to move efficiently from the ground up through the body.

Biomechanically, real human movement is never isolated to one plane. Instead, it is tri-planar, meaning all three planes interact simultaneously. For example, during gait, the body moves forward (sagittal), maintains balance side-to-side (frontal), and rotates through the pelvis and trunk (transverse). This integration allows for smooth, efficient, and adaptable movement.

Another critical concept is the relationship between these planes and joint stability versus mobility. Certain joints are designed to move more in specific planes while being stable in others. When this balance is disrupted—such as excessive motion in one plane or restriction in another—the body compensates, often leading to overload and injury. For instance, limited hip mobility in the transverse plane may force the knee to absorb rotational stress, increasing injury risk.

The directional terms shown—superior/inferior, anterior/posterior, and medial/lateral—help define how forces act on the body. These directions are essential when analyzing center of mass, base of support, and ground reaction forces. Efficient movement requires maintaining the center of mass within a stable base while coordinating forces across all planes.

In performance and rehabilitation, understanding planes of motion allows for better exercise selection and movement correction. Training only in one plane limits functional capacity. True strength and resilience come from developing control across all three planes, ensuring the body can produce, absorb, and transfer force efficiently in any direction.

In essence, the planes of motion are not just anatomical divisions—they are the blueprint of human movement. Mastering them means understanding how the body truly functions in real-world biomechanics.

20/04/2026

ANTERIOR SHOULDER PAIN – THE BIOMECHANICS YOU’RE MISSING

Pain felt in the front of the shoulder and radiating down the arm, like shown in the image, is rarely just a “local” issue. Biomechanically, this pattern is strongly linked to dysfunction of the anterior shoulder complex, especially the pectoralis minor, rotator cuff, and scapular stabilizers.

The pectoralis minor plays a key role here. When it becomes tight or overactive, it pulls the scapula into anterior tilt, protraction, and downward rotation. This seemingly small positional change has a big consequence—it reduces the subacromial space, the critical area where the rotator cuff tendons pass. As this space narrows, the humeral head tends to migrate slightly upward during arm movement, increasing mechanical compression on structures like the supraspinatus tendon and subacromial bursa.

This altered alignment disrupts the normal force couple of the shoulder. Ideally, the rotator cuff stabilizes the humeral head while larger muscles create movement. But when scapular positioning is off, the rotator cuff is forced to compensate, leading to overload, irritation, and eventually pain that can radiate into the arm—exactly as depicted.

Another key factor is scapular dyskinesis. Weakness or delayed activation of muscles like the lower trapezius and serratus anterior prevents proper upward rotation and posterior tilt of the scapula during elevation. Without this coordinated motion, the shoulder joint loses its optimal biomechanics, and repeated movements—especially overhead activities—create cumulative micro-trauma.

The rib cage also plays a role. Since the scapula sits on the thorax, any change in thoracic posture (like excessive kyphosis) further promotes scapular protraction and anterior tilt. This creates a closed-loop dysfunction where posture, muscle imbalance, and joint mechanics all reinforce each other.

Clinically, this explains why patients often report not just shoulder pain, but also tightness in the chest, discomfort in the front of the shoulder, and radiating symptoms down the arm. It’s not just inflammation—it’s a mechanical problem driven by altered force distribution and joint positioning.

In essence, this condition is a problem of space, timing, and force balance. When scapular control is lost and anterior structures dominate, the shoulder loses its efficiency, leading to impingement and pain. Restoring proper biomechanics—through improving thoracic posture, releasing anterior tightness, and strengthening posterior stabilizers—is the key to long-term resolution.

Disclaimer ⚠️ for educational purposes
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20/04/2026

SCAPULAR ROTATION: THE BALANCE BETWEEN UPWARD & DOWNWARD FORCE COUPLES

The scapula is not just a passive bone sitting on the rib cage—it is a dynamic force transmitter that determines how efficiently the shoulder functions. This image highlights one of the most critical biomechanical concepts in upper limb movement: the balance between upward rotators and downward rotators of the scapula, and how their interaction controls arm elevation, stability, and injury risk.

During arm elevation, especially beyond 60°, the scapula must undergo upward rotation, posterior tilt, and slight external rotation. This movement is driven by a powerful force couple between the upper trapezius, lower trapezius, and serratus anterior. The upper trapezius elevates and assists rotation, the lower trapezius depresses and stabilizes the scapula, and the serratus anterior protracts and anchors it against the thoracic wall while producing the majority of upward rotational torque. This coordinated action ensures that the glenoid fossa stays aligned with the humeral head, maintaining joint congruency and minimizing shear forces.

Biomechanically, this contributes to the scapulohumeral rhythm, typically a 2:1 ratio, where for every 3° of arm elevation, 2° occurs at the glenohumeral joint and 1° at the scapulothoracic articulation. Without proper upward rotation, the humerus would impinge against the acromion much earlier, drastically limiting range and increasing compressive stress in the subacromial space.

On the opposite side, the downward rotators—rhomboids, levator scapulae, and pectoralis minor—act as controllers and stabilizers, especially during lowering of the arm or when generating pulling forces. However, when these muscles become dominant or tight, they create a downward rotational bias, pulling the scapula into elevation, anterior tilt, and internal rotation. This disrupts the ideal scapular position and reduces the efficiency of upward rotation.

This imbalance leads to a cascade of biomechanical consequences. A tight pectoralis minor tilts the scapula anteriorly, decreasing subacromial space. Overactive levator scapulae and rhomboids resist upward rotation, forcing the glenohumeral joint to compensate. As a result, the humeral head translates superiorly, increasing the risk of impingement, rotator cuff overload, and labral stress.

The role of the serratus anterior is particularly critical. If weak or inhibited, the scapula loses its stable base against the thorax, leading to scapular winging and loss of efficient force transfer from trunk to arm. This reduces strength output and increases energy cost during movement.

From a kinetic chain perspective, the scapula acts as a link between the trunk and upper limb. Any disruption in its rotation pattern not only affects shoulder mechanics but also compromises force transmission during pushing, pulling, and overhead activities.

In essence, efficient shoulder movement is not about isolated muscle strength but about balanced force couples and precise timing. When upward rotators dominate appropriately, movement becomes smooth, powerful, and safe. When downward rotators take over excessively, the system shifts toward dysfunction, compensation, and injury.

Understanding and restoring this balance is fundamental in rehabilitation, sports performance, and even daily activities—because every overhead reach, lift, or throw depends on this finely tuned biomechanical relationship.

Disclamer ⚠️ for educational purposes

19/04/2026

🔵 The Trigeminal System, Neck Pain & Vestibular Integration

Why We Call the Trigeminal Nerve “Vagus 2.0” at The Functional Neurology Center

The trigeminal system (cranial nerve V) is one of the most powerful sensory networks in the entire nervous system—linking the face, jaw, eyes, dura, upper cervical spine, and deep brainstem centers that regulate pain, autonomic tone, balance, and head–eye control.

When this system becomes irritated or under-regulated—after concussion, whiplash, TMJ dysfunction, upper cervical strain, or chronic inflammation—it can create a cascade of neck pain, dizziness, visual strain, imbalance, facial pressure, headaches, and autonomic dysfunction.

At theFNC, we love integrating the trigeminal system into care because it acts like a master regulator of the brainstem… which is why we call it:

🧠✨ Vagus 2.0

A fast, powerful access point for autonomic calming, sensory integration, and neuro-modulation.

⸻

🔷 WHY THE TRIGEMINAL SYSTEM MATTERS FOR NECK PAIN

The trigeminal nucleus caudalis (TNC) and the upper cervical spine (C1–C3) share overlapping circuitry within the trigeminocervical complex.
This means:
• Irritation in the neck can activate the trigeminal system
• Irritation in the jaw/face/TMJ can activate the neck
• Both systems converge on pain processing pathways that project into brainstem vestibular nuclei

This is why patients with chronic neck pain often also have:
✔ Facial pressure
✔ TMJ tightness
✔ Light sensitivity
✔ Headaches
✔ Dizziness & unsteadiness
✔ Difficulty turning their head

The linkage is anatomical, neurological, and reciprocal.

⸻

🔷 HOW THE TRIGEMINAL SYSTEM CONNECTS TO THE VESTIBULAR SYSTEM

The trigeminal nucleus sends dense projections to:
• The vestibular nuclei
• The reticular formation
• The superior colliculus (eye-head integration)
• The cerebellum (nodulus, flocculus, vermis)

These pathways directly influence:
🔹 Balance
🔹 Gaze stability
🔹 Eye movement accuracy
🔹 Postural tone
🔹 Autonomic responses (nausea, heart rate, anxiety sensation)

Research in post-concussion cases shows that trigeminal dysregulation can worsen dizziness, head pressure, neck pain, photophobia, and sensory overload.
(Reference: Renga 2021)

⸻

🔷 ARPWAVE & TRIGEMINAL NEURO-MODULATION

At the FNC, we use ARPwave direct-current neuro-modulation to stimulate the trigeminal system for:
• Decreasing cervical and TMJ muscle hyper-activity
• Calming trigeminocervical nuclei
• Improving head and neck proprioception
• Reducing autonomic overdrive
• Enhancing vestibular responsiveness
• Improving visual-vestibular integration
• Accelerating recovery after concussion or whiplash

Because ARPwave uses direct current that never dips below zero, we can target one-way ionic flow, allowing more precise neuromodulation of trigeminal afferents.

This helps patients stabilize their gaze, move their neck without symptoms, and reduce those stubborn trigeminal-driven headaches or dizziness.

⸻

🔷 WHY WE CALL IT VAGUS 2.0

Like the vagus nerve, the trigeminal system heavily influences:
✔ Autonomic tone
✔ Pain modulation
✔ Heart rate variability
✔ Brainstem integration
✔ Emotional reactivity
✔ Sensory filtering

But unlike the vagus, trigeminal stimulation is:
⚡ Immediate
⚡ High-gain
⚡ Multi-sensory
⚡ Directly connected to vestibular and cervical nuclei

It gives us a faster, more targeted access point into the autonomic and sensory-motor systems—especially in complex vestibular, concussion, and cervical cases.

⸻

🔵 At theFNC

We combine:
• Upper cervical motor control
• Trigeminal and TMJ integration
• Vestibular and oculomotor rehab
• ARPwave neuromodulation
• Postural & autonomic retraining
• Cervical proprioception
• Laser & PEMF
• Sensory-motor coordination strategies

…to create a comprehensive approach for complex neck pain, dizziness, and visual-vestibular dysfunction.

If you or someone you know is struggling with chronic neck pain, dizziness, TMJ dysfunction, or post-concussive symptoms, our team can help you regain stability and function.

⸻

Reference:
Renga, Vijay. (2021). Clinical Evaluation and Treatment of Patients with Postconcussion Syndrome. Neurology Research International. 2021.

19/04/2026

WHY SITTING TOO MUCH IS SHUTTING DOWN YOUR GLUTES ⚡️

Lower back discomfort, hip pain, and poor movement performance are often blamed on weak muscles or lack of strength. However, research from the American Council on Exercise (ACE), NIH studies on physical inactivity, and biomechanical research indicates that one of the most overlooked causes is gluteal amnesia, also known as “dead butt syndrome.”

The glute muscles—particularly the gluteus maximus and gluteus medius—are designed to be primary drivers of hip extension and pelvic stability. They play a critical role in walking, standing, lifting, and maintaining proper posture.

However, prolonged sitting significantly reduces neural activation to these muscles. When the body remains in a seated position for extended periods, the glutes are placed in a lengthened, inactive state.

Over time, the brain reduces its ability to recruit these muscles efficiently. This does not mean the glutes are weak—it means they are not being activated properly.

As a result, when you stand, walk, or perform physical activity, other muscles are forced to compensate. The lower back and hamstrings often take over the workload that the glutes are supposed to handle.

This compensation leads to increased mechanical stress on the lumbar spine and posterior thigh muscles, creating pain, tightness, and reduced movement efficiency.

What makes this condition misleading is that people often try to stretch or strengthen the wrong areas without addressing the underlying activation issue.

The key problem is not strength—it is neuromuscular control and activation.

Effective correction involves reactivating the glutes, improving movement patterns, and reducing prolonged sitting that disrupts normal muscle function.

Understanding this is critical. Your glutes are not just weak—they may be switched off due to how you spend most of your day.

18/04/2026

Master the Diagnosis: Clinical Tests for Tennis Elbow
Lateral Epicondylitis, commonly known as Tennis Elbow, isn't just for athletes. It’s a frequent condition seen in clinical practice resulting from repetitive strain of the extensor carpi radialis brevis.
Accurate assessment is the first step toward effective rehabilitation. Here are three gold-standard orthopedic tests to keep in your diagnostic toolkit:
Cozen’s Test: Resisted wrist extension with the elbow flexed. A classic for eliciting pain at the lateral epicondyle.
Mill’s Test: A passive stretch into wrist flexion and forearm pronation while extending the elbow.
Maudsley’s Test: Resisted extension of the third digit (middle finger) to stress the extensor digitorum and lateral epicondyle.
Precision in testing leads to better outcomes! 🩺💪

Joram 035

23/04/2026

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