/

Gait Problem ? But where is the problem ? A case of failed single leg stance in a runner during the “3 Second Gait Challenge”.

Remember, what you see is not the problem most of the time.
You have heard it from us over and over again. What you are seeing in someone’s gait or running, the thing that does not look right, is their strategy to cope with the body parts that are dysfunctional. You are quite often not seeing what is wrong.
For example, here during our “3 Second Gait Challenge” this gentleman shows a solid left stance phase of gait. At times it is so solid and calm that it looks like we still-framed the video. The right side is another matter. During right stance there is excessive “checking” of the frontal plane (side to side) at the ankle. You also clearly see him using the right arm as a ballast moving it out to the right during right stance phase to help offset and dampen the frontal plane challenges.
Now going back to our initial thesis (“Remember, what you see is not the problem most of the time.”) surely you will agree that what you are seeing that right arm doing is probably not the problem here. Correct ? 
Now, this is a patient of ours, so we know what is wrong with him.  But from an outsider looking in, the problem in this case is more likely in the right lower limb, but you cannot see what is wrong with it. So remember, what you see is frequently not the problem, rather it is a compensation strategy. This gentleman’s problem is coming from his right lower abdominal functional impairment (specificially the lower transverse abdominus and internal abdominal oblique functional weaknesses, we know because we  clinically muscle assessed him for strength, skill, and motor patterns in our office.) These muscles were clearly neurologically inhibited and weak and the motor pattern he has laid down is many years in the making, driving a deeply seated compensation pattern.  Basically, he cannot stabilize his torso on the pelvis-hip during single leg stance. This lets the pelvis drift to the right. In this case it was not gluteus medius weakness allowing for the drift, which is more common. The torso is weak on the right side making it difficult to stabilize right lateral torso movement so he cheats by moving his torso to the left (which you can see) but does so ineffectively and thus needs to use the right arm to “check” the poor strategy.  His Rolling patterns were clearly disfuctional however even after correcting them he still had the gait neurologic pattern as his default,  hence gait retraining is necessary in this and all cases. We do many other functional assessments, methods we have developed and they all clearly directed and confirmed the diagnosis.  Just remember, if you fix a person’s movement patterns but then do not fix the repetitive gait pattern they have been using then their gait is cycling the problems right back into the person and you are wasting your, and their, time. 

Additionally, It would be easy to say that this gentleman has a proprioceptive deficit and that he needs to do some balance work on a Bosu ball or  tilt board.  But that is “so last year” thinking. If someone is having troubles standing and balancing on a stable concrete floor why in the world would you make his stance surface training even more unstable ?  This again is just not wise thinking. You don’t first learn to drive on the freeway, you start in a parking lot or back street where you can learn skills at a slow speed first. Conquer stability on a stable surface, then progress them to a more unstable surface.

Today we showed you a small diamond in our assessments. The “3 second gait challenge”.  This one is a keeper for us.  As we always say “Speed kills”. And in gait speed also is a disguise, it blends and blurs the deficits and challenges.  Slow your clients done to 3-4 seconds and watch what jumps out at you !  (did you read our blog post on Speed and Gait deficits ? Here is the link.) Speed is the devil when it comes to gait. At a normal walking pace and running pace these deficits were not perceptible, because speed in the sagittal plane (moving forward) reduced the lateral challenges. Speed blurs, speed blends and speed kills.

We continue to ask “Of all the functional movement courses being offered out there now, why do they not get into functional gait screening?"  We think we have the answer.  It is likely because this stuff is difficult, it is because it takes a deep knowledge base of whole body biomechanics/functional anatomy (from arm swing to big toe function) and it is because what you see in someone’s gait is very often not the problem.  A deep and broad understanding of human gait is not something you can pick up in a single weekend seminar nor can it be something done simply by a "check off” sheet.  This is complicated stuff, our 700+ blog posts with 230 in the draft folder plus 90 YouTube videos proves that there is great depth to gait and proves how complex it can be. But, if you have been with us for awhile and continue to work at this stuff you are likely getting better and better at this gait stuff. Do not give up. This is a worthwhile journey.

We are The Gait Guys. Shawn and Ivo.

Providing a stable surface for your knowledge base!

/

Retail/Coach/Trainer Focus: When a stability shoe does not stop gait or running pronation.

This video is unlisted. You will need this link to view it if it does not show up in the player above this blog post:    http://youtu.be/Lt6RbEtALUY

This is a higher end stability shoe. We know what shoe it is and you can see the significant amount of dual density mid sole foam in the shoe, represented by the darker grey foam in the medial mid sole.  The point here is not to pick on the shoe or the brand. The point here is to:

1. not prescribe a shoe entirely on the appearance of the foot architecture

2. not to prescribe a shoe merely because a person is a pronator

3. not to assume that a stability shoe will prevent pronation

4. not to assume that technique does not play a part in shoe prescription

5. not to assume that all pronation occurs at the mid foot (which is the traditional thinking by the majority of the population, including shoe store sales people)

There you go, plenty of negatives. But there are positives here. Knowing the answers and responses to the above 5 detractors will make you a better athlete, better coach, better shoe sales person, a safer runner, a more educated doctor or therapist and a  wiser person when it comes to human locomotion. 

A shoe prescription does not always make things better. You have heard it here and we will say it again. What you see is not necessarily what you get.  This case is a classic example of how everything done for the right reasons when so very wrong for this young runner.

What do you see ?

Pronation can occur at:

  1. the rear foot (we refer to this as excessive rear foot eversion or calcaneal eversion driven sometimes by rearfoot valgus). This can be structural (congenital) in the bone (calcaneus or talus) or functional from weaknesses in one or several rear foot eversion controlling muscles.
  2. the mid foot as is traditionally assumed (this is often referred to as “arch collapse” ).
  3. the fore foot. (possibly many causes, such as a Rothbart Foot variant, short first metatarsal, a bunion , forefoot varus, hallux valgus, weakness of the hallux controlling muscles etc)

So, in this case you might assume that the stability shoe that is designed to prevent rear and midfoot pronation is:

  1. not doing its job sufficiently OR
  2. the pronation is occuring at the forefoot OR
  3. there is a myriad of of issues (yes, this is the answer)

However, the keen eye can clearly see that this is a case of heavy forefoot pronation but there are also mechanical flaws in technique (driven by weaknesses, hence just working on her running form will not solve her issues, it will merely force her to adopt a new set of strategies around those weaknesses !). The problems must be resolved before a new technique is forced.  This is perhaps the number one mistake runners make that drives new injuries.  They tend to blame the injury on new shoes, old shoes, increased miles, the fartlek they did the other day, the weather, their mom, there spouse, their kids…….runners come up with some great theories. Heck, all of our athletes do ! It keeps things amusing for us and we get to joke around with our athletes and throw out funny responses like, “I disagree, it was more likely the coming precession of the equinox that caused this injury !”. 

Although his individual does not have a fore foot varus deformity (because we have examined  her) it needs to be ruled out because it is  big driver of what you see in many folks.  In FF varus the forefoot is inverted with respect to the rear foot. This can be rigid (cannot descend the 1st ray and medial side of the tripod) or plastic (has the range of motion, but it hasn’t been developed).

We, as clinicians, like to assume that MOST FEET have a range of motion that folks are not using, which may be due to muscle weakness, ligamentous tightness, pathomechanics, joint fixation, etc. Our 1st job is to examine test the feet and make sure they are competent. Then and only then, after a trial of therapy and exercise, would you consider any type of more permanent “shoe prescription”.

If the individual has a rigid deformity, then you MAY consider a shoe that “brings the ground up” to the foot. Often time we find, with diligent effort on your and the individuals part, that a shoe with motion control features is not needed.

Sometimes the individual is not willing to do their homework and put in the work necessary to make things happen. This would also be a case where an orthotic or shoe can assist in giving the person mechanics that they do not have.

We have not seen many (or any) shoes that correct specifically for a fore foot varus (ie a shoe with fore foot motion control ONLY). The Altra Provision/Provisioness has a full length varus post which may help, but may over correct the mid foot as well. Be careful of what you prescribe.

Yes, we have been studying, blogging, videoing and talking about this stuff for a long time. Yes, much of it is often subtle and takes a trained eye to see. It is also the stuff that goes the “extra mile” and separates good results from great ones.

We are The Gait Guys. Watch for some seminars on some of our analysis and treatment techniques this fall and winter, and some pretty cool video, soon to be released.

/

Midfoot strike 5 year old running barefoot in grass.

So, heel strike you say ?  Have  a closer look.  This is a near perfect midfoot strike. What you cannot see is his torso progression. As long as the torso has enough forward lean heel strike cannot occur. Heel contact can occur, but not heel strike or impact.

We have talked about this on many occasions here on The Gait Guys Blog. No one else is talking about this fine line difference between heel strike and heel contact.  Everyone still seems hell bent on talking about forefoot strike. Forefoot strike in distance running is not normal, midfoot strike like you see here in this young child is natural and normal. This 5 year old was likely just asked to run barefoot, he was not likely coached. This is because midfoot strike is natural and normal.  As we said, as long as the torso is directly above or in front of the foot contact position there is no way that heel STRIKE can occur, rather heel CONTACT can only occur (unless you have hamstrings like cirque du soleil acrobats and do not mind going into a posterior tilted pelvis at contact). 

We tell our runners to:

  • lift the chest and lean
  • raise the toes and dorsiflex the ankle  (engage the anterior lower leg compartment) so that the arch is maximally prepared
  • a heel KISS of the ground is fine, just no impact
  • you do not need to forefoot strike to run naturally
  • * and, here is one more reason why we like a midfoot strike over a forefoot strike…. because a midfoot strike means that the body continues forward whereas a forefoot strike that then allows into a heel kiss/touchdown means that there is a posterior progression and eccentric lengthening of the posterior chain (hamstrings and calf muscles). This posterior directed motions is not exactly wise when forward progression is the goal of running !

This little fella is doing it right. Largely because he has not been in shoes long enough to corrupt the natural tissues and mechanisms (both the body parts and the natural neuromotor patterns).

* Addendum: after a really productive FAcebook dialogue with some readers we felt we needed to be more clear on some of our unspoken assumptions here.  If the heel hits first, it will be a STRIKE and not a KISS and the load will be high. The only way the heel can kiss the ground like we mention above is if the heel is absolutely contacting at the same time as the forefoot, one could say that there is a more dominant load on the mid-forefoot but the heel can still strike at this same time.  Striking clearly on the forefoot and then touching down the heel is satisfactory but there is still a retrograde movement which we believe is not as economical yet certainly better than heel impact/strike.  To get the perfect midfoot strike with barely a subtle heel CONTACT (not impact or strike) requires greater skill and more mastery as a runner.  And if you are wearing a shoe that is not minimalist or zero drop developing this skill will be a challenge and you will be misleading yourself.    This ammendment added 1 hour post blog post launch.

Shawn and Ivo…….. the Devil is in the Details. 

The Gait Guys Podcast #5 : S1E5

/
The Gait Guys Podcast #5: S1E5

This one will get you to the show player of all of our podcasts.
http://directory.libsyn.com/shows/view/id/thegaitguys

And this link will get you a nicely laid out “show notes”.
http://thegaitguys.libsyn.com/the-gait-guys-podcast-4-s1e4


Topics to be discussed in Podcast #5:

1-  more lectures available  on www.onlineCE.com   Go there and look up our lectures

2. EMAIL INQUIRY:

Hi guys,
I was wondering if you do distance/online consultations at all? I’m a
former athlete trying to get back into sprint training for decathlon
and am having great trouble with shin splints. I’ve been going to
various therapists in my area for months now, have spent loads of
money and am not really seeing any improvement. I’m at a bit of a loss
for what to do right now! I can easily provide good quality video of
me walking/running etc for assessment. Please let me know if you can
help and what the cost would be, it would be very much appreciated!
Thanks for your time.
Best regards,
Chae
Join us today for an in depth dialogue on this topic.

3. EMAIL CASE:
Hey Gait Guys,
I have just recently began watching your videos and must say it is changing the way I look at mobility and functionality. I have been vigorously exercising for 5 years now but seem to be stumbling over physical limitations that are obviously my way of compensating for asymmetries and weaknesses. In the last two years has been horrible bouts with over tight hams and weak glute issues. Re training is a slow process.
 From watching your videos, I already identify with being a toe curler. The awareness alone does not help and gets worst when running. I tried to switch to minimalist shoes for running but my left heel got so tight I had to shelve that plan. I am back in stability shoes for running. I use minimalist shoes for everything else. I have horrible time balancing and it seems to emanate from weak ankles stabilizers however, I do not have weak ankles (don’t roll them etc.) but the fatigue seems to emanate from the ankles. I have also noticed that my feet have straitened pretty good from a pronounced pigeon toe that I have had since I could walk (I’m 47 now). So the feet are straighter but when approaching a mirror at the gym, I notice that I have noticeable internal rotation on my legs and my gait looks awkward. My thinking is that this is a part of the puzzle that I need to solve to get more functional and hopefully out of stability shoes and learn to have an arch again instead of flat feet.
Regards, Charles
Join us today for an in depth dialogue on this topic.
 
4. REVIEW of our favorite BLOG POST OF THE WEEK:
forefoot strike……olympic trials video review.
4 of these runners seem to have a significant varus in either their fore foot or rear foot. However this is difficult to truly tell from such small single snapshot pictures.  And just because it appears to be a varus landing does not mean that it is true on examination, a foot that has reduced peroneal activity can appear to have a  varus strike, but that does not truly then comment on a true forefoot varus. Also, remember from our previous posts, if a runners is employing a notable degree of cross over gait technique the approach of the foot to the ground and at the ground can appear to be forefoot varus. * These are critical points, because what you see is not necessarily what you truly have.  There are possibly many variables playing out.
Join us today for an in depth dialogue on this topic.

5. STORY OF THE DAY:   
  A dialogue on muscle testing.  Be sure what you are testing is accurate and true.  Testing someone where they preposition themselves will always show strength.
 
6. SHOE TALK:
Darn Wool Socks

7. EMAIL CASE:

Hello Gait Guys!

I LOVE your educational videos. I have such a passion for foot bio-mechanics, and am eager to sort out my own issues without the use of supports.

I am a big believer in “barefoot is best”. I exercise my feet in this manner regularly.
My question is regarding Morton’s toe, or Rothbarts’ foot. I have this on both feet, with it more pronounced on the right. I’ve got some compensations going on and would like to know if you can offer some exercise recommendations to help sort out my feet.
I consistently work on spreading the toes, and feel the need to stretch the left foot by twisting my leg to the left and stretch the right foot by twisting that leg to the left as well. When lying down, the left leg turns out, and the right leg turns in.
Am I doing enough? How long do you think it will be before my toes straighten out and I no longer get sore on the balls of my feet? 
I have had orthotics in the past which did not help, even after several adjustments. In fact, they made things worse because of course they weaken the foot.

Keep on doing what you're doing!
-Tracy - Toronto

/

Some Biomechanical Facts on Oscar Pistorius: 400 m London Olympic Games

Following Saturday’s 400m men’s preliminary heats Jere Longman’s wrote an article in the NYTimes entitled “Pistorius Advances to Semifinals”. In it were some interesting facts. Here is the link to the article. 

Ever since Pistorius’s shut out from the Beijing Olympics scientific and legal debate has continued about whether his prosthetic legs gave him an unfair advantage over sprinters using their natural legs. However, as we all knew, this time around would different in London 2012. Competing on carbon-fiber prosthetics called Cheetahs, Pistorius was going to get his chance and in the process further the debate on what is considered able and disabled.

Prior to Beijing the I.A.A.F. said Pistorius’ carbon-fiber blades violated its ban against springs or wheels that gave an athlete a competitive edge over able bodied athletes. The prosthetic legs allowed him to run as fast as elite sprinters while consuming less energy, the governing body concluded. None the less, the debate has continued over the past few years since Beijing pertaining to where to draw the line between fair play and the right to compete. In 2009 in The Journal of Applied Physiology a study concluded that Pistorius could take his strides more rapidly and with more power than a sprinter on biological legs.

An acquantance of ours who we talk to from time to time, Professor Peter Weyand at SMU Locomotor Performance Laboratory in 2009 looked at Oscar Pistorius-type carbon fiber Cheetah blades a little more closely. In his study (referenced below), in the Journal of Applied Physiology, he conducted three tests of functional similarity between an amputee sprinter and competitive male runners with intact limbs: the metabolic cost of running, sprinting endurance, and running mechanics. What he found was:

  • the mean gross metabolic cost of transport of the amputee sprint subject was only 3.8% lower than mean values for intact-limb elite distance runners and 6.7% lower than for subelite distance runners but 17% lower than for intact-limb 400-m specialists
  • the speeds that the amputee sprinter maintained for six all-out, constant-speed trials to failure were within 2.2 (SD 0.6)% of those predicted for intact-limb sprinters.
  • at sprinting speeds of 8.0, 9.0, and 10.0 m/s, the amputee subject had longer foot-ground contact times ,shorter aerial and swing times and lower stance-averaged vertical forces than intact-limb sprinters [top speeds = 10.8 vs. 10.8 (SD 0.6) m/s].

Weyand concluded that running on modern, lower-limb sprinting prostheses appears to be physiologically similar but mechanically different from running with intact limbs.

Longman’s article listed some of the other facts that have come up in recent years, facts that led to the eventual acceptance of Pistorius in London 2012’s Olympic events.  We have not captured these references specifically (yet, but we will) but in the mean time to keep this blog article timely, lets look at some of the other facts that Longman mentioned in his NYTimes article:

  • While calf muscles generate about 250 percent energy return with each strike of the track, propelling a runner forward, Pistorius’s carbon-fiber blades generate only 80 percent return, Gailey said.
  • Given that Pistorius has no feet or calves, he must generate his power with his hips, working harder than able-bodied athletes who use their ankles, calves and hips, Gailey said.
  • And because the blades are narrow and Pistorius essentially runs on his tip toes, he pops straight up out of the blocks instead of driving forward in a low, aerodynamic position for the first 30 or 35 meters, making him more susceptible to wind resistance, Gailey said.
  • Compared with runners with biological feet, Pistorius also must work harder against centrifugal force in the curves, and his arms and legs tend to begin flailing more in the homestretch, costing him valuable time, Gailey said. His stride is not longer than other runners, as many presume, Gailey said. “It’s not like he’s bouncing high with a giant spring,” Gailey said.
  • The blades “basically allow him to roll over the foot and get a little bounce,” Gailey said, adding: “The human foot operates like a spring, and his feet operate like a spring. But the human foot produces more power than the blades do.”

There is an abundance of interesting information here. We will likely return to some of these topics and facts in the future, but in the meantime we say that everyone has their own demons and deficits. We all have injuries and limitations we have to cope with, in life and in sport. So where the line gets drawn will always be a blurred. This debate on this specific case with Pistorius could go on for years and never reach an agreeable conclusion as to a fair playing field. So, let the games begin and may the best man or woman win, with his or her demons and deficits in tow.  Good work Oscar. Thanks for the inspiration.

Shawn and Ivo, The Gait Guys

____________________________

We found 3 other journal articles on Pubmed on Oscar.

  1. Enhancing disabilities: transhumanism under the veil of inclusion? Van Hilvoorde I, Landeweerd L.   Disabil Rehabil. 2010;32(26):2222-7.

  2. Oscar Pistorius, enhancement and post-humans. Camporesi S. J Med Ethics. 2008 Sep;34(9):639.

  3. By designing ‘blades’ for Oscar Pistorius are prosthetists creating an unfair advantage for Pistorius and an uneven playing field? Chockalingam N, Thomas NB, Smith A, Dunning D. Prosthet Orthot Int. 2011 Dec;35(4):482-3.

  4. J Appl Physiol. 2009 Sep;107(3):903-11. Epub 2009 Jun 18.

    The fastest runner on artificial legs: different limbs, similar function?

    Weyand PG, Bundle MW, McGowan CP, Grabowski A, Brown MB, Kram R, Herr H. LINK   http://www.ncbi.nlm.nih.gov/pubmed?term=2009%20journal%20of%20applied%20physiology%20weyand

The Essex Swagger: Are Gait (Walking and Running) Styles Cultural and/or Geographical ?

/

Do Australians move like Americans ?  Does a woman in Israel move like a woman in Ireland ? Do Swedish men move differently than a rural farmer in Tibet ?

Sure there are many variables that come to mind that can drive differing answers; things like foot wear (winter boots, rugged rural shoes/boots to fashionable Manhattan), terrain, tight or loose clothing an so on.  But the main question we are asking here is this: are there cultural and geographical differences in the way we walk devoid of issues related to climate, terrain, and fashion?  In other words, because of our deeply rooted genetic codes that may have been slightly tweaked over the centuries, are there subtle differences in the way these different cultures walk and run ?

Recently we came across an internet article on a gait study “College walking study to capture the Essex swagger” being done at the Chelmsford University . Scientists at Anglia Ruskin University, in Bishops Hall Lane, are calling on people to help them capture “the Essex swagger”, which could help provide better treatment for UK patients.  The gait analysis lab, at the university’s postgraduate medical institute, is a replica of the one at the Hospital for Special Surgery in New York, the leading hospital for orthopaedics in the United State so one might assume this is no meager investigation.

He believes establishing a local database will allow more accurate testing and analysis of patients, ranging from burns victims to those who have just undergone hip or knee surgery.

Dr Rajshree Mootanah, director of the university’s medical engineering research group mentioned that “When we are working with patients it is important to have a reference database of ‘normal’ gait to compare them to. The only database we have is of the New York population and we believe there may be slight, but still significant, differences to the way our local population walks due to the different racial make-up of the two groups.” 

So the bigger question is in fact, are geographic and/or cultural differences present significant enough to warrant different baselines for gait studies ? This question had us looking deeper into the research.  Unfortunately there is not much in the literature on transcultural movement differences but what we did find was supportive of our hypothesis.  To keep this blog article within readable limits for now, we have included the two journal articles we wanted to mention to support the hypothesis.  In Ebersbach’s study (references below) the

“healthy subjects in Berlin showed faster gait velocity than their counterparts in Tyrol, Austria, and patients with Parkinson’s disease were slightly slower than their respective healthy peers in both environments”.

Surprisingly, his study found that patients with Parkinson’s disease from Berlin had significantly faster walking speeds than both patients and healthy control subjects from Tyrol. There was a high gait tempo in Parkinsonian patients from Berlin characterized by fast step-rates and short strides. Thus, it appeared that in Ebersbach’s study there were sociocultural differences in gait, even in disease processes such as Parkinson’s disease. This certainly opens ones eyes into the understanding of disease. After all, we thought that a disease was a disease, not matter what part of the world you are in. And this study shows that this may not be the case.

In Al-Obaidi’s study the gait of healthy young adult Kuwaiti subjects from both genders were compared those in Sweden. The study indicated several significant differences between the subjects in their manner of walking regarding walking at “free, slow and fast” rates.

Both of these studies suggest that people move differently from each other around the world, and surprisingly, even differently from within the disease group of “movement impairment syndromes”. People in Australia move different from those in England, Canada, Germany, Sudan etc.  it suggests that our gait is as unique as our language and as subtle as an accent within a common tongue.  The studies also  suggest that if the gait world is to expand further in terms of research that multi cross-cultural data bases must be built.

Shawn and Ivo, The Gait Guys.

Two geeks looking for the missing links in how humans move.

_______

Mov Disord. 2000 Nov;15(6):1145-7. Sociocultural differences in gait. Ebersbach G, Sojer M, Müller J, Heijmenberg M, Poewe W. Source

Fachkrankenhaus für Bewegungsstörungen/Parkinson, Beelitz-Heilstätten, Germany.

Abstract

Transcultural differences in routine motor behavior and movement disorders have rarely been assessed. In the present study gait was studied in 47 healthy inhabitants of Tyrol living in rural or semi-urban (Innsbruck, Austria) settings and 43 healthy subjects residing in Berlin, Germany. In addition, gait was assessed in 23 patients in early stages of idiopathic Parkinson’s disease (11 in Berlin, 12 in Innsbruck). Healthy subjects in Berlin showed faster gait velocity than their counterparts in Tyrol, and patients with Parkinson’s disease were slightly slower than their respective healthy peers in both environments. Surprisingly, patients with Parkinson’s disease from Berlin had significantly faster walking speeds than both patients and healthy control subjects from Tyrol. High gait tempo in parkinsonian patients from Berlin was characterized by fast step-rates and short strides. Differences in normal gait in different sociocultural settings are thus reflected in parkinsonian slowing of gait.

________

J Rehabil Res Dev. 2003 Jul-Aug;40(4):361-6. Basic gait parameters: a comparison of reference data for normal subjects 20 to 29 years of age from Kuwait and Scandinavia. Al-Obaidi S, Wall JC, Al-Yaqoub A, Al-Ghanim M. Source

Department of Physical Therapy, Faculty of Allied Health Sciences, Kuwait University, Kuwait.

Abstract

This study obtained measurements of the spatiotemporal gait parameters of healthy young adult Kuwaiti subjects from both genders and compared the data to those collected in a similar study performed in Sweden. Thirty healthy subjects volunteered to participate in the study (which included being asked to walk at their “free,” “slow,” and “fast” self-selected speeds). We collected the spatiotemporal gait data using an automated system. Descriptive statistics were calculated for each variable measured at each walking condition. The data were then compared to those from the Swedish study. The results indicate several significant differences between Kuwaiti and Swedish subjects in their manner of walking. These results suggest a need to include data from subjects with diverse cultural backgrounds when a database on normal gait is developed or a need to limit the results of the database to a specified ethnic population.

More on Leg Length Discrepancies

/

Hi Guys,

I hope you guys are well?

I have a question I hope you can help me with?

Last week I assessed an entire football team, and over 90% have some sort of Leg Length Discrepancy (LLD). I am working with the physiotherapist to improve their weaknesses, including using sole lifts.

My question is if it’s a tibial short leg, then a lift with align the knee and hip. But a lift in a leg with a short femur will align the pelvis but raise the knee higher than the other side. Would you still insert a sole raise, and if not, what would you do?

Kind Regards

Luke

____________

Hi Luke

Yes, you are correct in your assumption of the change in mechanics, and yes, most often, we prescribe a sole lift, if a lift is indicated. Keep in mind that if they are asymptomatic and test out well, a lift may not be indicated. Hope that helps. You can also search LLD on the blog; we have written extensively on it: http://thegaitguys.tumblr.com

Remember sole lifts will correct the LLD but it could shift the pelvis off further…….many LLDs are from pelvic asymmetry and core weakness, this encompasses hip rotation differences which is a typical response to the core and pelvis that is distorted. 
merely forcing a change at the Sole does not mean you are making the positive change at the top……however it may in some cases……you have to determine that with your evaluations.

Most folks legs are of symmetrical length……..the changes at the top (core / pelvis/ hip) is what throws the apparent length off.

i wish i had a good answer for your great insight……..but it is about
1- making the right changes……..so that all parts are in cooperation for the restoration change
2- that you are directing change and not a further body compensattion to the compensation you have forced…….(if it is in fact a forced compensation and not the correction you are hoping for)….. time and re-evals will determine this
3- after restoration and strengthenging you must quickly wean off the lifts from them
4- you are speaking of tibial and femoral short………those are structural short LLDs , make sure you know if you are dealing with functional or structural shortness

Hope that Helps

Ivo and Shawn

Speed Matters: Brief Thoughts on Gait and Running.

/

The journal article below sparked a few thoughts for a blog post today.

Have you ever tried to walk slower than your normal pace ? How about running slower than your normal pace (  you know, running with that person who is clearly a minute slower pace) ? Why are both so uncomfortable and labor intensive ? Why does your balance, energy and stability become challenged ? After all, slower should be easier right ?!
There are many reasons and this study hints at a few issues but the bottom line is that speed matters.  Have you ever been driving down the road and you see a big pot hole in the road that you just cannot get around because it is either too big or you do not have time to steer around it ?  What is your first reaction ?  Many will press down on the gas pedal. Why is that ? Well, logic for many is that speeding up will possibly enable you to launch across the void and reduce the impact issues of dropping down into the void.  Men will rationalize the “launch across the pothole” theory, and in some respects they are not wrong.
Running and walking slowly sort of bring out some of the same issues.  When we move slowly the body is more likely to drift into the frontal/coronal (side to side) plane.  Moving more quickly ensures that the dominant path is forward. Slowing down does not ensure that forward will occur. side to side sway enters the picture. And when side to side sway enters as an option we have to spend more time and strategies negotiating the side sway.  This is why we see all kinds of corrections with the limbs and core when we attempt to stand on one foot, but we do not see these issues when we walk or run.  When running we are mostly trying to get the next foot underneath our body so that we do not fall forward flat on our face. Locomotion is a strategy of nothing more than trying to stay upright.  When we run the predominant motion is forward. But when we slow down and reduce the advantage of speed to blur out these issues the challenges begin and other planes of movement become an option and thus planes we need to control. It is much why the elderly have more difficulty moving about, because they have to negotiate and control so many other planes of movement.
So, if you want to bring out some faulty motor patterns, move more slowly and see where your deficits lie. One of our assessments for patients and athletes is to have them walk at a 3second pace meaning each foot fall must be held for 3 seconds before the next step can be initiated. This means stance and swing must be slowed to 3 seconds.  Amazing things will show up if you just slow things down and allow weaknesses to percolate to the surface.  Speed blurs them and keeps them suppressed. It is really a form of cheating and compensation.
So, like in your car, speed matters.
Think about this next time you have to walk or run with a slower person. It may be one of the issues, but there are others and we will eventually get to them.


Gait and Speed on Child Development
J Biomech. 2008;41(8):1639-50. Epub 2008 May 7. The effect of walking speed on the gait of typically developing children. Schwartz MH, Rozumalski A, Trost JP. Abstract

Many gait studies include subjects walking well below or above typical self-selected comfortable (free) speed. For this reason, a descriptive study examining the effect of walking speed on gait was conducted. The purpose of the study was to create a single-source, readily accessible repository of comprehensive gait data for a large group of children walking at a wide variety of speeds. Three-dimensional lower extremity joint kinematics, joint kinetics, surface electromyographic (EMG), and spatio-temporal data were collected on 83 typically developing children (ages 4-17) walking at speeds ranging from very slow (>3 standard deviations below mean free speed) to very fast (>3 standard deviations above mean free speed). The resulting data show that speed has a significant influence on many measures of interest, such as kinematic parameters in the sagittal, coronal, and transverse planes. The same was true for kinetic data (ground reaction force, moment, and power), normalized EMG signals, and spatio-temporal parameters. Examples of parameters with linear and various nonlinear speed dependencies are provided. The data from this study, including an extensive electronic addendum, can be used as a reference for both basic biomechanical and clinical gait studies.

The Gait Guys Podcast #4: S1E4 →

/

This one will get you to the show player of all of our podcasts.
http://directory.libsyn.com/shows/view/id/thegaitguys

And this link will get you a nicely laid out “show notes”.
http://thegaitguys.libsyn.com/the-gait-guys-podcast-4-s1e4

1. Our lectures are available  on www.onlineCE.com   Go there and look up our lectures

2. NEW PRODUCT DIALOGUE:  

This week, Correct Toes.  Join us for a nice discussion on the merits and possible limitations of the Correct Toes product.
https://nwfootankle.com/correct-toes

3. EMAIL CASE:
Dear Gait Guys,
For almost a year, I have had pain at and around the second metatarsal head of my left foot. When the pain started, I visited a podiatrist who diagnosed capsulitis, tendonitis, and metatarsalgia and prescribed a cortisone injection, a metatarsal pad, and a rubber bar glued to the outsole of my shoe (to redistribute the weight off the metatarsals). While the pain and swelling improved initially, it has never dissipated completely or returned to pre-injury levels. (I say ‘injury’ but I do not remember any trauma. I had mowed the lawn earlier in the day before the pain started.)
Kevin , Winston-Salem, NC
Join us today for a dialogue on this great case.

4. LISTENER  EMAIL:
Hi! Do you have a DVD that shows all the exercises to restore proper ankle rocker, and demonstrating what exercises to use to correct the different compensations you might observe. Where would I be able to order such a DVD or DVDs. Thank you for your time!- Gordon
Join us today for a dialogue on this topic.
 5. REVIEW of our favorite BLOG POST OF THE WEEK:The immature DEVELOPING system is very much like a mature system that is REGRESSING. We can learn a lot about gait from watching our children walk. An immature nervous system is very similar to one which is compensating meaning cheating around a more proper and desirable movement pattern; we often resort to a more primitive state when challenges beyond our ability are presented. This is very common when we lose some aspect of proprioception, particularly from some peripheral joint or muscle, which in turn, leads to a loss of cerebellar input (and thus cerebellar function). Remember, the cerebellum is a temporal pattern generating center so a loss of cerebellar sensory input leads to poor pattern generation output. Watch this clip several times and then try and note each of the following: …
 Join us today for a dialogue on this great case.

6. STORY OF THE DAY:   

Invisible gorilla story
 http://www.theinvisiblegorilla.com
Experiment at Harvard University several years ago, we found that half of the people who watched the video and counted the passes missed the gorilla. It was as though the gorilla was invisible.
This experiment reveals two things: that we are missing a lot of what goes on around us, and that we have no idea that we are missing so much. To our surprise, it has become one of the best-known experiments in psychology.
Summary:  * if you havent trained yourself and your brain to know about all of the gait and movement problems that can present in a client……. you wont see them at all.  Ingorance is bliss ! 
Join us today for a dialogue on this great case. 

7. EMAIL CASE
Hi Guys,
I’ve been watching your videos and attempting to correct issues with
my gait.  Thanks to your videos and blog, I’ve learned that the
cross-over gait is horribly wrong and inefficient and I’ve been
working to correct that. My email to you today is about muscle tightness.  I watched this video
(http://www.youtube.com/watch?feature=player_embedded&v=LHK8oj8fdjM)
but would like more information on how to correct my tightness. 
Craig
Join us today for a dialogue on this great case.

8. EMAIL CASE
Hello,
Thanks for your in depth information and your clarity.
I have learned so much from your posts, the videos are priceless!
Hip internal rotation assessment, position of the client in supine with leg staight, you mention it is more true to a standing position.
I have learned to check hip external and internal rotation when client in supine and hip at 90 degrees, holding at the foot and knee rotate tibia out brining the Joint in for an internal rotation,rotate tibia in to check joint for external rotation, combined rotation optimally should be 70 to 90 degrees, resilient end feel, pain free.
How do you assess the joint itself ? What do you think about placing hip joint at 90 degrees flexion ?
/

The hand walkers: The family that walks on all fours. Part 1

Quadrupedalism and its commentary on human gait.  To understand your athlete, your patient, your client, whatever your profession, you need to have a good understanding of neurodevelopment.  If your client has some functional movement pattern flaws it could be from a delayed or expedited neurodevelopmental window. Generalized training and rehab will not correct an early or late window issue; often your work must be more specific.

     When we began our journey into our daily writings on “The Gait Guys blog” we had no idea of the never ending tangents our writing would take pertaining to gait, human movement and locomotion. It has become plainly obvious over time that this blog will likely exist as long as we choose to continue it. 

In 2006 we saw a documentary documentary entitled The Family That Walks On All Fours and the video clip above was from the documentary. It was a fascinating documentary and with our backgrounds in neurology, neurobiology, neuroscience, biomechanics and orthopedics we had more questions than the documentary touched upon. The documentary opened up many thoughts of neuro-development since we all start with a quadrupedal gait. But there had to be more to it than just this aspect because people eventually move through that neurologic window of development into bipedial gait.  This has been in the back of our minds for many years now.  Today we will touch upon this family and their challenges in moving through life, today we talk about Uner Tan syndrome, Unertan syndrome or UTS.

The original story is about the Ulas family of nineteen from rural southern Turkey. Tan described five members as walking with a quadrupedal gait using their feet and the palms of their hands as seen in this video.  The affected family members were also severely mentally retarded and displayed very primitive speech and communication. Since his initial discovery several other families from other remote Turkish villages have also been discovered.  In all the affected individuals dynamic balance was impaired during upright walking, and they habitually chose walking on all four extremities. Tan proposed that these are symptoms of Uner Tan syndrome.

UTS is a syndrome proposed by the Turkish evolutionary biologist Uner Tan. Persons affected by this syndrome walk with a quadrupedal locomotion and are afflicted with primitive speech, habitual quadrupedalism, impaired intelligence. Tan postulated that this is a plausible example of “backward evolution”. MRI brain scans showed changes in cerebellar development which you should know after a year of our blog reading means that balance and motor programming might be thus impaired.  PET scans showed a decreased glucose metabolic activity in the cerebellum, vermis and, to a lesser extent the cerebral cortex in the majority of the patients. All of the families assessed had consanguineous marriages in their lineage suggesting autosomal recessive transmission. The syndrome was genetically heterogeneous.  Since the initial discoveries more cases have been found, and these exhibit facultative quadrupedal locomotion, and in one case, late childhood onset. It has been suggested that the human quadrupedalism may, at least, be a phenotypic example of reverse evolution.

Neurodevelopment of Children:

Children typically go through predictable windows of neurodevelopment. Within a set time frame they should move from supine to rolling over. Then from prone they should learn to press up into a push up type posturing which sets up the spine, core and lower limbs to initiate the leg movements for crawling. Once crawling ensues then eventual standing and cruising follow.  In some children, it is rare yet still not neurodevelopmentally abnormal, they move into a “bear crawl” type of locomotion where weight is born on the hands and feet (just as in our video today of UTS).  Sometimes this window comes before bipedalism and sometimes afterwards but it should remain a short lived window that is progressed through as bipedalism becomes more skilled. 

In studying Uner Tan Syndrome, Nicholas Humphrey, John Skoyles, and Roger Keynes have argued that their gait is due to two rare phenomena coming together.

“First, instead of initially crawling as infants on their knees, they started off learning to move around with a “bear crawl” on their feet.Second, due to their congenital brain impairment, they found balancing on two legs difficult.Because of this, their motor development was channeled into turning their bear crawl into a substitute for bipedalism.”

According to Tan in Open Neurol, 2010

It has been suggested that the human quadrupedalism may, at least, be a phenotypic example of reverse evolution. From the viewpoint of dynamic systems theory, it was concluded there may not be a single factor that predetermines human quadrupedalism in Uner Tan syndrome, but that it may involve self-organization, brain plasticity, and rewiring, from the many decentralized and local interactions among neuronal, genetic, and environmental subsystems.

There is much more we want to talk about on this mysterious syndrome and the tangents and ideas that come from it. We will do so in the coming weeks as we return to this case.  We will talk about other aspects of neurodevelopment which should be interesting to you all since most our readers either are having children, will have them, or are watching them move through these neurologic windows.  And we know that some of our readers are in the fields of therapy and medicine so this should reignite some thoughts of old and new.  In future posts we will talk about cross crawl patterning in the brain, bear crawling, the use of the extensor muscles in upright posture and gait as well as other aspects of neurodevelopment gone wrong. We are not even close to being done with this video and all of its tangents. In the weeks to come we hope you will remain interested and excited to read more about its deep implications into normal and abnormal human gait.

author:  Dr. Shawn Allen, one of the gait guys

References:

Open Neurol J.

2010 Jul 16;4:78-89. Uner tan syndrome: history, clinical evaluations, genetics, and the dynamics of human quadrupedalism.

Tan U

.Department of Physiology, Çukurova University, Medical School, 01330 Adana, Turkey.

link: http://www.ncbi.nlm.nih.gov/pubmed/21258577

Humphrey, N., Keynes, R. & Skoyles, J. R. (2005).

“Hand-walkers: five siblings who never stood up”

(PDF).

Discussion Paper

. London, UK: Centre for Philosophy of Natural and Social Science.

http://informahealthcare.com/doi/abs/10.1080/00207450701667857

http://informahealthcare.com/doi/abs/10.1080/00207450500455330

http://www.ncbi.nlm.nih.gov/pubmed?term=Uner%20Tan%20syndrome

Are you a Gait Troglodyte ? Are you sure ?

/

Are you a Gait Troglodyte ? Are you sure ? You might want to read on.

Most of us are all still in a cave and unacquainted with some of the affairs of the world. Some of us may find ourselves behind the times when it comes to GMO foods, social media, computers and the internet, smart phones while others may be behind on world issues and politics. Heck, some of us have never even seen “Ancient Aliens” on the History Channel !  It is hard to keep up with everything in this fast paced changing world. Something has to give for each of us and so we pick our poison and decide what it is that we are going to have to remain behind on when it comes to the learning curves of the world. And this is alright, but you have to first admit your “back of the pack” and “still living in a cave” type status on the issues and take some ribbing when acknowledging your limitations.  Failing to admit these inevitable shortcomings while pretending that you are still running with the pack can be a real problem. Not only are you faking yourself out but you may be deceiving those that you attempt to help.

Understanding gait, truly understanding it, is a monumental undertaking. This is why there are just no vast resources on it unlike other things in healthcare. Try going to PubMed and type in “arm swing”, you will see 318 articles. Try “pronation”, 2900 articles.  Now try “heart”, 1 million+ articles.  You get the point. Research is behind on gait, and thus our understanding of it is also poorly reflected in functional medicine and  human bodywork.  We are collectively gait troglodytes, living in stereotypical caveman times when it comes to gait.  Sure there are some good books like Perry’s text, or Michaud’s landmark work but there is a void on gait work and research. Human locomotion via gait (walking and running) is a small and poorly understood component by many. It is much the reason why we started The Gait Guys and began writing daily for over 600 days on gait issues. Little did we know that the door we had opened would continue to swing so wide and encompass so many other aspects that feed into human gait.

One of the aspects that worries us the most these days is the growing volume of “functional” work that is going on in the world of therapy and training.  There is a very important and critical place for this work and we fully admit that everyone needs to be on board with all of the great work that the leaders are teaching. What worries us is the apparent lack of integration of this work into gait assessment, gait therapy, and flawed gait neuro-biomechanics. Once again gait is not getting the pulpit it deserves. Yes, flaws in the functional screens and assessments need to be brought to light and remedied because they can impact bipedal locomotion but, the pendulum swings both ways. Gait can often be a cause of these functional problems that show up on the screens and assessments. If one fixes the functional pattern problems and the gait pattern is not restored then either the dysfunction will return or a new undesirable pattern will be generated. There needs to be more gait understanding and assessment from us all. Gait needs retraining as well, it is as much of a functional pattern as any other, if not more.  Gait deserves a pulpit as well.  Human assessment is clearly a two way street and it is not always clear who is the chicken and who is the egg. The problem may be that when gait does have its pulpit to speak from, who is the speaker ? A gait troglodyte or an expert ?


There will be folks who say we are over thinking this issue. There will be some who are offended. There will be some who cheer. There are some that will say “it will all come out in the wash” once the functional patterns are corrected elsewhere. They are wrong, it just is not that simple. Next to breathing, gait may be the second most compromised and corrupted functional pattern that humans express thousands of times daily. So, it is time to get busy.  It is time to peel off your Gait Troglodyte cloak and step into a 3 piece suit when it comes to understanding and interpreting gait.  If you are working in the world of human movement, locomotion, training, rehab and human biomechanics this is your next challenge.  Lets face it, we can either continue to walk around with our 10 year old flip phone understanding of gait or we can step up to a smart phone understanding of gait.  It is up to you, but know where you are and know your limitations. So be honest with yourself and your next client the next time you assess their gait. Be sure to ask yourself after seeing something that just doesn’t seem right in their gait, is what you see really what you are seeing ? Is that really what is wrong ? Or is it a compensation ? Do you know enough to see things for what they really are ?

Shawn and Ivo, The Gait Guys. 

We may not be Gait Troglodytes……. but some accuse us of living in a cave none the less.  However, if you have seen our cave, you will know it looks much like Bruce Wayne’s Batcave.  It isn’t your everyday cave.

Shoes and Shoe fit→

/

“It was suggested that the most important criteria in the selection of running shoes are fit and comfort. Running shoes that meet these criteria are likely to provide
optimal levels of cushioning and stability.”

www.med.nyu.edu

More evidence that perception is reality; just like one of our other posts about a persons perception of what the shoe will do and what it actually does. Looks like the brain may know best!

The Gait Guys

Run and Bike Training using Music and Cadence.→

/

Using music in your training is smart. We have been saying this for over a year in some of our blog articles regarding music and dance and incorporating some of the advantages of brain development and music. Today we have more research to prove our point.

 In The Journal of Sports Medicine and Physical Fitness (link) British researchers concluded that “exercise is more efficient when performed synchronously with music than when musical tempo is slightly slower than the rate of cyclical movement.” Scott Douglas summarized the study nicely:

    The study had cyclists pedal at 65 revolutions per minute (i.e., 130 pedal strokes per minute) while working at 70% of their aerobic max, which in running terms would be between recovery pace and half marathon pace. The cyclists listened to music at three tempi:

  • faster than their pedal rate (137 beats per minute),
  • synced with their pedal rate (130 beats per minute)
  • and slower than their pedal rate (123 beats per minute).
Although the cyclists rated their perceived effort the same in the three conditions, their oxygen cost was greater when they pedaled along to music that was slower than they were riding. Their heart rates were also slightly higher when listening to the slowest of the three music speeds.

Anyone who has frequently run with music knows how a peppy tune can jump start things. This study suggests you’re asking to work a little harder if your playlist includes songs slower than your turnover, which for running purposes ideally means around 170 or more beats per minute.

In one of our favorite Gait Guys blog posts on June 7th, (here is the link)
we mentioned some other great benefits of strategically using music to further your training:

Music provides timing. Music taps into fundamental systems in our brains that are sensitive to melody and beat. And when you are learning a task, timing can access part of the brain to either make it easier, easier to remember, or engrain the learned behavior deeper. When you add music to anything you are exercising other parts of your brain with that task. It is nothing new in the world of music and brain research when it comes to proving that music expands areas of learning and development in the brain. As Dr. Charles Limb, associate professor of otolaryngology and head and neck surgery at Johns Hopkins University states “It (music) allows you to think in a way that you used to not think, and it also trains a lot of other cognitive facilities that have nothing to do with music.”

Several weeks ago we asked you as an athlete, and this pertains to runners and even those walking, to add music to your training. If you are walking, vary the songs in your ipod to express variations in tempo. Use those tempo changes to change your cadence. If you are a runner, once in awhile add ipod training to your workouts and do the same. Your next fartlek (a system of training for distance runners in which the terrain and pace are varied to enhance conditioning) might be a new experience. Perhaps an enjoyable one. Trust us, we have done it. Here at The Gait Guys, with our backgrounds in neurology and biomechanics amongst other things, we are always looking for new ways to learn and to incorporate other areas of brain challenge to our clients. To build a better athlete you have to use training ideas that are often outside the box.

Remember what Dr. Charles Limb said,

“It (music) allows you to think in a way that you used to not think, and it also trains a lot of other cognitive facilities that have nothing to do with music.”

It is nice to see more studies on music. All to often we use music for pleasure, but here we once again show that it can be a useful training tool if you are paying attention and thinking outside of the iPod. 

Shawn and Ivo, The Gait Guys ……… music lovers as well.

/

BIKE FIT: Case Study

Along the vein of bike fit, to go with Thursday and Friday’s posts last week, here is gentleman with right sided low back pain ONLY when ascending hills on his mountain bike. Can you figure out why?

*Stop, watch the video and think about it before we give you the answer… .

____________________________

This gentleman presented with low back pain, only on his mountain bike, only on long ascents.

He measures out with an 83 cm inseam which should put him on a 44 to 45.5 cm frame (measured via our method). His frame has a dropped top tube and measures 55 cm.

He has a knee bend angle of 20 degrees at bottom dead center. Knee is centered well over pedal axis.

His stem falls far in front of his line of sight with respect to his hub. Stem is a 100 mm stem with a 6 degree rise.

There is a 2" drop from the seat to the top of the handlebars.

He has an anatomically short Left leg (tibial)

Here is some additional video of him with a 3 mm lift in the left shoe. Look at the tissue folds at the waist and amount of reach with each leg during the downstroke in this one as well as the last. no changes were made to the seat height, fore/aft position of seat. or handlebars.

The frame, though he is a big dude (6’+), is too big and his stem is too long. He is stretched out too far over the top tube, causing him to have an even more rounded back (and less access to his glutes; glutes should rule the downstroke and abs the upstroke). This gets worse when he pushes back (on his seat) and settles in for a long uphill. Now throw in a leg length discrepancy and asymmetrical biomechanics.

Our recommendations:

  • smaller frame (not going to happen)
  • lower seat 5-7mm
  • shorter stem (60-75mm) with greater than 15 degree rise
  • lift in Left shoe


We ARE the Gait Guys, and we do bikes too!

Podcast #3: S1E3 (Season 1, Episode 3)→

/

The Gait Guys Podcast #3

Here are 2 links for the podcast.

This one will get you to the show player of all of our podcasts.

http://directory.libsyn.com/shows/view/id/thegaitguys

And this link will get you a nicely laid out “show notes”.

http://thegaitguys.libsyn.com/rss

Here is a brief outline of the topics on today’s podcast #3.

- Computer simulation of stress distribution in the metatarsals at different inversion landing angles
- Pencil Skirts: walking in one and how it is troublesome for normal gait.
- an email from a coach
- a youtube video about gravity and its effects on humans
- the Secrets to Running Downhill fast
- Shoe talk: The vivobarefoot
- a case of a sprained my left ankle
- we discuss a case study from a listener in Ireland (rock on Damien! )

___________________________

And, below is a detailed outline of podcast #3.

1. NEWS  OF THE DAY:

Hello:  I recently saw you guys speak at the NSCA clinic at Chicago State University and I am immensely impressed and relieved to find someone able to clearly explain gait in such thorough detail. The Gait Guys blog has been immensely helpful in myself and my running clients. I would like to inquire if “either of you” would be interested in being a guest speaker at the AMA as a part of our Wellness Program’s monthly seminar series.

2. TOPIC:

 Computer simulation of stress distribution in the metatarsals at different inversion landing angles using the finite element method
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903174/

Abstract:  Metatarsal fracture is one of the most common foot injuries and is often associated with landing in inversion. The deformation and stresses of the metatarsals during landing at different inversion angles (normal landing, 10 degree inversion and 20 degree inversion angles) were comparatively studied. The results showed that in the lateral metatarsals stress increased while in the medial metatarsals stress decreased with the angle of inversion. The peak stress point was found to be near the proximal part of the fifth metatarsal, which corresponds with reported clinical observations of metatarsal injuries.Landing in inversion is another factor which potentially could affect the metatarsals leading to deformation and fractures; however, most published studies on landing in inversion have focussed on ankle ligaments and sprains during this abnormal movement

3. TOPIC:
Pencil Skirts: walking in one and how it is troublesome for normal gait

4. EMAIL FROM A COACH:
*( we will be answering most of your questions on these podcasts. It may take a week or 2-3 to get to them. We hope to have a “podcast table of contents for each podcast” on our new website when it gets launched. That way you can search for topic lists and look for your email. We will only use your first name, or whatever name you wish to provide. We will not give out your email. 
 \5. YOUTUBE AUDIO CLIP:

The body’s biomechanics are different running up and down hill,  but you are also dealing with gravity differently.

  Einstein did these things called “Thought experiments”.
 It is a YOUTUBE CLIP , type “albert einstein-2"  into the SEARCH box.
we will start the clip at 4:14 min clip  to 8:40
   http://www.youtube.com/watch?v=x2vx_UOaiRY&list=FL0L4QWkefZUvID-3XGsAEJg&index=12&feature=plpp_video
6. REVIEW of our favorite BLOG POST OF THE WEEK:

The Secrets to Running Downhill Fast.Last month we contributed to Jene Shaw’s article in Triathlete Magazine.

Please hit the link here for the entire great article by Jene Shaw. There is lots more here. LINK

http://triathlon.competitor.com/2012/05/training/the-secrets-to-running-downhill-fast_54031

Here were some of our Form tips used in Jene’s article for going fast downhill. Hear about them on the podcast.

7. EMAIL CASE
Hi there
I’ve been going to physio therapists for a while with lower back and posture problems, which I now think are related to how I walk (duck footed). So far the only thing I have really got from this would be a nice massage.
What is the main issue with the "Duck footed” posturing and what kind of professional or practioner should I see about correcting issues like this?
Thanks very much, MIKE

8. SHOE TALK:

The vivobarefoot

9. EMAIL CASE

Hello Gait Guys,
In the past, I have sprained my left ankle in which has led me to think that this is the cause for me having a flat foot.
This in turn has led me to having problems around the knee and the hip.
Are there any exercises I can do to improve my medial arch? 
If there are videos that you are selling to teach how to deal with this problem, could you link me to it?
Sincerely, Zac
response:   youtube video:  The foot tripod: the importance of the toe extensors in raising the arch.  also read our blog post ( February 16th, 2012 blog post for more)

10. EMAIL CASE:

Hi There,

My name is Damien and i am writing you from Ireland. I’ve watched a lot of your videos online on YouTube. They are amazing. Congratulations on such a great and informative service. It’s so refreshing seeing people want to diagnose and fix feet rather than putting insoles or arch supports in place. I have alot of things going on with my body, let me get started … . .

______

So that is the topic list for this week, podcast 3. We hope you can find time to lend  us your ears.

Shawn and Ivo…….. The Gait Guys

/

Running Technique Video with Complications:

Here we have a good running video with a nice teaching component to it.

We found this on the web on some random site.  Nice to see others are helping to spread our good word.  Here is what the website said, and below that are our comments.

FROM:http://paraganek.blogspot.com/2011/08/stride-analysis-video.htmlNathanAugust 30, 2011 11:18 AM

Daniel,
You should send your video to The Gait Guys:
http://www.facebook.com/pages/The-Gait-Guys/169366033103080

Actually, they did a 3 part video on crossover gait recently. I looks like you’ve got a bit of crossover going on (hips are swinging side to side). Most people do some crossover. Another thing The Gait Guys always say is that what you can see in the video is usually not the problem (the right foot turning out), it is usually the compensation you are seeing…the problem is somewhere else.

@Nathan:
Thank you Nate. I will see what The Gait Guys say.

*What The Gait Guys have to say:

The most obvious thing we see is that the right foot is spun out (this is more evident on the video clips running away from the camera). This is referred to as the “foot progression angle” and here it is increased.  Depending on the source you reference, the upper limit of normal can be 25degrees. But, it is more important to do a case by case comparison.  Without the advantages of a hands on exam this case seems to indicate that the right foot progression is increased beyond the left, assuming the left is normal.  (yes, it is possible that the right is this chaps normal and that the left foot progression angle is decreased. But the usual presentation is that of increased, usually.)


What we do like is the great form his is displaying. Great natural barefoot technique. Pure barefoot technique does not allow heel strike to occur. Do not believe us? Go try it yourself, just don’t email or call us afterwards and complain !  His strike is midfoot, cadence is high, and body posture is clean and upright.  There is a minor cross over gait here. The readers were right.  Good eyes, good call !

The increased right foot progression angle will often accelerate pronation and increase its degree. This can also increase and accelerate the rate of internal spin of the tibia and limb, all the way into the hip and pelvis.  This can challenge the eccentric capabilities of the gluteals and other external hip rotator muscles and in time this can represent itself and mechanical hip joint pain or low back/Sacroiliac joint symptoms.  The increased pronation amount and rate can challenge other structures at the foot, namely the posterior tibial tendon, abductor hallucis muscle and the first ray stabilizers such as long and short hallux muscles (EHL, EHB, FHL, FHB) and thus loss of longitudinal arch capabilities and stabilizers. 

We also see, if you look closely particularly on the running away from camera views, that the left arm seems to cross the body more than the right. We always look for this in the opposite upper limb to try and help confirm or suggest which of the lower limbs is the problem.  Since the left upper arm is crossing the body, it is neurologically matched up with the right limb during swing and stance.  It can act like a ballast. This fella would most likely have some pelvic asymmetry because of this cross body deficit. 

PS: the issue can be reversed.  We have had plenty of frozen shoulder clients present with biomechanical deficits in the opposite lower limb so beware of the total body complexities and compensations.  We have also have had runners who always carry a water bottle in the same hand showing changes in the opposite lower limb. Our treatment success with one runner did not occur until we convinced this ultra trail runner to go with a camel back water supply.

Nice little case. Wish we had more information on the runner and what is bothering him.

Maybe in time we will hear from him and update him.

To get the most out of this case you should watch the 3 part cross over gait series on our youtube channel. Just type in thegaitguys and it will be right there.  You should also goto the search box in our tumblr blog and type in “arm swing” and read some of our writings on this topic.  We think it is fascinating stuff.

Shawn and Ivo……….. world wide web gait geeks……. and victims of radical hackers everywhere…… ok, just in Algeria.