Near Flawless Running Technique…….it would have to be to be doing it at this pace on paved hardtop…….the first fellas techique is better, his step and strike are shorter and thus cadence is higher…….the higher the cadence, the less the acceleration/deceleration and less vertical changes. Apparently the first chap has been running barefoot his whole life, it shows. Nicely done boys !
We came across this video on Youtube. Look at the obvious deficiency on the right limb with the amount of internal spin of the foot. Much can be gleaned from this information. remind you that making assumptions of what is wrong or what the treatment is from what you see on a treadmill or in a person walking or running may not be their actual problem, rather it is quite often their compensation pattern.
In this case, we see an aggressive negative foot progression angle on the right. Normal foot progression angle is anywhere from zero degress (see this persons left foot) up to 15 degrees depending on their given anatomy.
This is likely from internal tibial torsion on the right but femoral torsion would need to be looked at. What is interesting is taking the concepts of what are seen here and projecting some other thoughts and considerations, as The Gait Guys always do. This person is “toeing off” the lateral column of the foot (3rd-5th digits). This will enforce a supinatory toe off, it is always nice to toe off a rigid lever but in time running in this case could eventually lead to some osseous stress reaction/response into these lesser metatarsals and could “couch” this person for a period. To gain more stability (plantar purchase of the foot on the ground) these clients frequently have over activity of their long toe flexors (FDL) and some toe hammering in the lateral digits is not uncommon. Be sure to look for this phenomenon in your clients.
Toe off from the lateral foot is not uncommonly seen pairing up with a shortened step length on that side and same side knee hyperextension, reduction in ankle rocker (dorsiflexion through the tibial-talar joint) which can lead to anterior impingement at this interval as the ankle dorsiflexion is prematurely terminated,
We also frequently see a reduction in strength of the anterior compartment musculature; the ankle dorsiflexors (primarily the tibialis anterior) and toe extensors which further impairs any chance of normal ankle rocker range. Additionally, these folks typically have weak lower abdominals on the affected side and tend to strategize through their quadriceps instead of the more effective glute-abdominal core stabilizing unit.In this case here, the more internal tibial torsion or internal spin a limb has, the less likely the client is able to engage the external hip rotators of which the gluteus maximus (iliac division) and gluteus medius (posterior division) are powerful proponents.
Lastly, for now, although this is likely a case of internal tibial torsion, it brings up the considerations in other cases that an internally rotated limb is typically shorter functionally and thus this can lead to an apparent leg length discrepancy.
These are all great “mental exercises” to keep your eyes and brain keen. But as we always say, what you may see may not be so. Be sure to test your muscles and motor patterns to see if what they are displaying is their deficiency or their compensation pattern, or a bit of both.
The Gait Guys , Shawn and Ivo
The Hokaone: Hoka or Hokey?
http://www.hokaoneone.com/en/technology.html
We have been off the grid for a week amassing new research for the website and looking into new products that have come online recently. But we are back now with new stuff. Lets start today on this shoe, the Hoka.
From their website “ By using an EVA 30% softer and increasing its total volume to 2.5 times that of a typical trail running shoe, we allow for more cushioning than any other shoe on the market today, dissipating up to 80% of the shock associated with heel striking when running. Allowing for as much as 20mm of compression in the heel, with a low ramp angle allows for tremendous confidence running downhill, as runners can now engage their gluteus and lower back as opposed to isolating their quads, relaxing the body and making running downhill fun and comfortable.”
What we like:
1-A low ramp angle definitely helps one to engage their glutes more.
2- light weight is often a good thing
What we don’t like:
There have been enough papers published that show increased cushioning decreases impact at heel strike, but increases overall impact forces sustained by the body. A thickened sole decreases the amount of proprioception and requires the body to work harder by compressing more of the EVA foam, and with this shoe, that will be quite a bit of body work.
A little sole rocker off the front endcan be a good thing, especially with people who lack great toe dorsiflexion, but enough to take up 50% of the sole length and 4 cm high? Wow ! This would decrease the amount of forefoot rocker and subtract from the 3 rockers that the foot was normally designed to work with (heel, ankle and forefoot). The research (which at least we have read) shows that rockered shoes increase knee flexion during the first part of the stance phase of ambulation, and less in swing phase. More significantly, ankle plantarflexion is increased at heelstrike through terminal stance, thus delaying pronation (plantar flexion, inversion and adduction are components of supination); this would dampen the shock absobtion afforded from pronaion and lowering of the ankle mortise. Interestingly, this increases the impact force at heel strike significantly as well.
“With 50% more surface area than the typical trail running shoe, and 35% more rubber crampons, you’ve never run as confidently as you will in a pair of Hoka’s.” Hmm. Doesn’t a larger footprint, especially at the midfoot, hamper the natural dampening mechanism of pronation? What about the increased mechanical requirements to move the extra sole? Sure, it will be more stable, but at the cost of mechanical efficiency.
Take a look at the break points on the undersole; Why put a break directly under the calcaneus and then one immediately anterior (under the sustantaculum tali) at a 90 angle to the plane of the joint? The ones across the transverse metatarsal arch proximally are in an arc OPPOSITE the plane of the articulations; it seems to us that this would cause mechanical conflict at the metatarsophalangeal joints; the distal ones seem more appropriate, but the ones anterior to that serve to abduct the phalanges.
Summary:
In a nutshell ? We are sure this is a supercomfy foot spa that feels like walking on marshmallows but we question the science behind the design and would welcome the opportunity to review their research or even to trial a pair.
We think you will find that what we have addressed here merit some attention by everyone. As we always say though, every product has some uses and purpose, but also some drawbacks. Do your own homework though, go to their website…… http://www.hokaoneone.com/en/technology.html
Once again, We are and remain,…… The Gait Guys
Clinical Video Case Study: Tibial Varum with added Post-op ACL complications.
This is a case of ours. This young man had a left total knee reconstruction (Left ACL and posterolateral compartment reconstruction; allograft ligaments for both areas). This video is roughly 3 months post surgery.
Q: What anatomical variants are seen in this individual?
A: Note the genu and tibial varum present. This results in an increased amount of pronation necessary (right greater than left, because of an apparent Left sided short leg length;
* NOTE: post-operatively at this point the client had still some loss of terminal left knee extension. thus the knee was in relative flexion and we know that a slightly flexed knee appears to be a shorter leg. Go ahead, stand and bend your left knee a few degrees, the body will present itself as a shorter leg on that left side with all the body compensations to follow such as right lateral hip shift and left upper torso shift to compensate to that pelvic compensation.)
Normally, in this type of scenario (although we have corrected much of it at this point by giving him more anterior compartment strength and strategy as evidenced by his accentuated toe extension and ankle dorsiflexion strategies, these are conscious strategies at this point for the patient), the functionally shorter left leg has a body mass acceleration down onto it off of the longer right leg stance phase of gait. This sagittal (forward) acceleration is met by a longer stride on the right with an abrupt heel strike (in other words, the client is moving faster than normal across the left stance phase so there is abrupt and delayed heel strike on the right because of a step length increase. (again, this is just commentary, had we videoed this client weeks before this, you would have seen these gait pathologies. This video shows him ~70% through a gait corrective phase with us.)
Again, this client has bilateral tibial varum. You can see this as evidence due to the increased calcaneal valgus (ie. rearfoot pronation; look at the achilles valgus presentation).
He increases his arm swing on the Left to help bring the longer Right lower extremity (relative) through.
if you look closely you can also see early right heel departure which is driven by the increased forward momentum of the body off of the short left limb. In other words, the body mass is moving forward faster than normal onto the right limb (because of the abbreviated time spend on the left “short” leg) and thus the forward propulsed body is pulling the right heel up early and the heel is spinning inwards creating a net external rotation on the right limb (look for the right foot to spin outwards/externally ever so slightly in the second half of the video).
Early heel departure means early mid and forefoot weight bearing challenges and thus reduced time to cope well with pronation challenges. As we see in this case where the right foot is pronating more heavily than the left. You can think of it this way as well, the brain will try to make a shorter leg longer by supinating the foot to raise the arch, and the longer leg will try to shorten by creating more arch collapse/pronation.
In this F-Scan film we see increased pressure on the lateral column of the foot with forces traveling to the 2nd metatarsal as they come across the foot. This is most likely due to an uncompensated forefoot varus. Note the hot spots at the 2nd and 5th met heads. This patient also has a Morton’s toe which is a longer digit.
Rule #1…..never assume. Examine your clients even after F-Scans, pedographs, stop frame digital movie etc. What you see is often not the problem, rather their adaptive compensation around the parts that are working and those that are not. The problem can be local, where it appears the deficit is, or it can be elsewhere. Let the clinical examination draw the correct conclusions. For example, in this case, we could have metatarsus primus elevatus or a Rothbart Foot variant or a combination of all of the above with the FF varus.
There is nice engagement of the hallux flexors but when you see this in combination with a preceding insufficient 1st metatarsal grounding (as evidenced here of lack of “heat” under the 1st Metatarsal) a late supination attempt may be suspected to reduce a late midstance pronation vector. Again, let your clinical examination draw the correct conclusions.
This is a case of internal tibial torsion. In particular, watch the right limb. We see a decreased progression angle of the feet, Right greater than the left, a “crossing over” gait; and bilateral toe off in supination, Right greater than the left. This can impair a persons ability to engage the lumbopelvic stabilizers adequately, impair patellofemoral tracking, and generate a host of compensatory motor patterns that are sub-optimal.
This individual’s shoe choice renders a degree of over-correction and is magnifying the problem to a degree.
The First Biodegradable Shoe→
/Same quality, less filling.
Ever think about what happens to that old pair of running shoes you retired or gave to the dog? It takes about 1000 years (yes, that’s 3 zeroes) for the EVA ( the midsole material in most running shoes) to break down. Brooks has come up with a nice alternative, that under the right conditions , takes 50 times less or about 20 years.
