The Case of the Non Rotating Knee

Here is a runner, wanting to be an ultra runner, who recently developed right sided knee pain while running a 50K. He was pacing another individual and developed pain on the outside (lateral patella and knee) on the right, ascending and especially descending hills. The pain is dull and achy. He is able to “push through” the pain, but if he does, it remains painful for a few days.

He has an anatomically short leg on the L (tibial). There is no significant tibial torsion (he has normal external version) and not femoral torsion. There are adequate amounts of internal (>15 degrees) and external (>30 degrees) rotation of the hips.

He has 7 degrees ankle dorsiflexion on the right, 10 degrees on the left. On the table (and in the video) he has 0 degrees of hip extension during passive motion, walking and running. He has weakness of the long extensors of the toes, as well as the abductors.

Take a look at his video. Note the following:

·       the right knee has less medial excursion than the left (watch the dots)

·       rearfoot valgus is noted on the L  (ie. calcaneus is everted)

·       subtle lean to Left on L sided stance phase

·       when barefoot, the problem lessens

Why does the right knee rotate less than the left?

When folks have a short leg, we generally expect that leg to remain in supination (thus external rotation) more and the longer leg to internally rotate more, due to excessive pronation. But here, we see the opposite. You will notice he has a rearfoot valgus on the left. This means the midtarsal joint is in a greater amount of pronation on the shorter side. For every action, there is an equal and opposite reaction. In this case, less pronation (or supination) on the longer leg side. Remember, we said generally folks pronate more on the long leg side. This is one of the exceptions.

So, should he throw away his shoes?

The shoes, which have a certain amount of torsional rigidity, are compounding the problem. The Brooks Cascadia is an excellent trail running shoe, he just needs something with less torsional rigidity. the shoe does  not allow his knee to come midline sufficiently. Since he is a Brooks Fan, we suggested the “Grit” in the Pure line. 4mm drop and less rigid torsionally. He could also work his way into a “Drift” (4mm or zero drop, extremely flexible).

Why does he lean to the left on stance phase on the left?

Most likely, to clear the right long leg on swing phase. This is one of the 5 common strategies. For more strategies, click here.

Why is it better when he is barefoot? It must mean he should be a barefoot runner, right?

He is better, because there is less impediment to the foot pronating (ie. the shoe has less torsional rigidity)

The Gait Guys. Making you a better diagnostician, with each and every post.

Lebron James and his funky toes. We have the scoop as to what is going on.

http://bleacherreport.com/articles/1757693-everybody-look-at-lebron-james-toes

This is what happens when you get too much short extensor tone and/or strength in the digits of the foot.  Now this is his trailing foot and he has moved into toe off so he should be activating his toe extensors and the tibialis anterior (ie. the anterior compartment) to create clearance for that foot so that he doesn’t catch the toes on the swing through phase of gait.  In this case we do not see alot of ankle dorsiflexion (which we should see at this point) so we are  seeing a compensation of perhaps increased short extensor (of the toes) activity.  

We also see what appears to be a drifting of the big toe (the hallux) underneath the 2nd toe. This often happens when a bunion or hallux valgus is present.  Now we do not see a bunion present here but the viewing angle is not optimal however it does appear that there is a slight drift of the hallux big toe towards the lesser toes . We are not sure if we would qualify this as hallux valgus, and if so it is mild, but none the less we see a slight lateral drift. What is interesting is that despite the obvious activity of the lesser toes short extensor muscle (EDB) we do not see a simultaneous activity of the short extensor of the hallux (EHB, extensor hallucis brevis). Does he need to do our exercise ? See video link here ! 

And so, when the lesser toes are in extension as we see here and the big toe is not moving into extension, and when that is simultaneously combined with even a little hallux valgus tendency, the big toe will drift underneath the lesser toes as we see here, even appearing to push the 2nd toe further into extension.  

As for his little toe, well, Dr. Allen  has one just like it so perhaps he missed his calling in the NBA. Some folks just do not have as plantarward orientation of the 5th toe and so it migrates upward (dorsally) a little. This can be from birth but it can also come from trauma. But in time because the toe is not more plantar oriented, the dorsal muscles (the extensors) become more dominant and the toe just starts to take on this kind of appearance and orientation. It will reduce significantly when the foot is on the ground and the extensors are turned off, but it looks more shocking during the swing phase because of the extensor dominance in that phase.

This kind of presentation if left unchecked can lead to hammer toes, plantar fat pad migration distally exposing the metatarsal heads to more plantar forces without protection and a host of other problems.  Lebron needs to do our Shuffle Walk Exercise to get more ankle rocker (dorsiflexion) and also work to increase his long toe extensors (EDL) and lumbricals.  This will flatten his toes and improve mechanical leverage.  Remember, if you gait better foot function with increased ankle dorsiflexion you will get more hip extension and more glute function.  But does the big fella really need to jump any higher? We are sure he would accept being faster though … .  who wouldn’t ?

Fee for today’s long distance consult: …  Lebron, lets say 10,000$ and we will call it even.  Sound good ?  But a lifetime of prettier, stronger and more functional toes……priceless. Have  your people contact our people.  (Ok, we don’t have people, but we do have an email address here on our blog !).

Shawn and Ivo, The Gait Guys.  Even helping the elite, little by little.

Podcast 38: Usain Bolt, Arm Swing, Ballasts, & Running "Stuff"

Our show notes should interest you today. We have another great podcast ready for you !

Link to our server:

 http://thegaitguys.libsyn.com/podcast-38-usain-bolt-arm-swing-ballasts-running-stuff

iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

Today’s show notes:

1. Revealed: The science behind Usain Bolt power burst used to the 100m world record
http://www.independent.co.uk/news/science/revealed-the-science-behind-usain-bolt-power-burst-used-to-the-100m-world-record-8732545.html

2. Running and walking gadget:

Mashable (@mashable)
9/10/13 4:53 AM
This Clip-On Device Lets You Read Your Tablet While You Runon.mash.to/1akqMaK

3. National Shoe Fit program: 

http://store.payloadz.com/details/1050149-movies-and-videos-educational-shoe-fit-program-complete-parts-1-3-medical-version.html

4. Arm Swing:

- The Ballast Theory 

5. Off the web: Children’s Shoes

http://www.independent.co.uk/news/science/oldfashioned-plimsolls-with-flat-soles-are-better-for-kids-feet-8809800.html

6. Off the MEdical Journal:

Gait retraining improves symptoms of knee OA
http://lowerextremityreview.com/article/gait-retraining-improves-symptoms-of-knee-oa

7.  Clinical Case Questions from a Reader:

Hello there, I’ve been following your stuff for a while now after searching far and wide for solutions to issues I have with my feet/ankles … . .

Chris 

8. Topic: Bartold on heelstrike

m.facebook.com/photo.php?fbid=231864073629806&l=fe56c99fbb

9. From the Medical Journal:

Neuroscientist. 2004 Aug;10(4):347-61.

Regulation of arm and leg movement during human locomotion.

Zehr EP, Duysens J.

Rehabilitation Neuroscience Laboratory, University of Victoria, BC, Canada. pzehr@uvic.ca

Abstract: Walking can be a very automated process, and it is likely that central pattern generators (CPGs) play a role in the coordination of the limbs. Recent evidence suggests that both the arms and legs are regulated by CPGs and that sensory feedback also regulates the CPG activity and assists in mediating interlimb coordination. Although the strength of coupling between the legs is stronger than that between the arms, arm and leg movements are similarly regulated by CPG activity and sensory feedback (e.g., reflex control) during locomotion

10. Off pubmed: 

J Am Podiatr Med Assoc. 2012 Sep-Oct;102(5):390-5.

Anatomical origin of forefoot varus malalignment.

Lufler RS, Hoagland TM, Niu J, Gross KD.

Forefoot varus malalignment is clinically defined as a nonweightbearing inversion of the metatarsal heads relative to a vertical bisection of the calcaneus in subtalar joint neutral. Although often targeted for treatment with foot orthoses, the etiology of forefoot varus malalignment has been debated and may involve an unalterable bony torsion of the talus. There was no association between forefoot alignment and talar torsion (r = 0.18; 95% confidence interval, -0.11 to 0.44; P = .22).These findings may have implications for the treatment of forefoot varus since they suggest that the source of forefoot varus malalignment may be found in an alterable soft-tissue deformity rather than in an unalterable bony torsion of the talus.

What Does Changing your Stride Cost You?

http://running.competitor.com/2013/09/training/study-changing-running-stride-does-more-harm-than-good_41136

A recent study cited in Competitor Magazine, talked about common stride “improvements” actually may reduce running economy. They looked at stride rate (cadence) and vertical displacement. One would think, with all the hoopla out there, that more steps per minute and less vertical displacement would be more efficient. The actual study concluded “Alterations led to an increase in metabolic cost in most cases, measured as VO2 uptake per minute and kg body mass,” Another study which had similar results can be found here.

Even though the study had a small sample size (16 participants), If you think about this, it makes sense.   Volitional effort usually has a metabolic cost. It does not make it right or wrong; they are just the facts. The nervous system will take time to integrate new (motor) patterns. Each person has a optimal (homestatic) stride “style” which includes vertical displacement as well as stride length, among other factors (lateral sway, ankle dorsi pantar flexion, knee flexion, thigh flexion, etc).

The study itself also concluded ““Mid- and long-term effects of altering … technique should also be studied.” we concur, we have not seen any long term studies that look at economy over time, but would love to read them if any of our readers run across them.

The Gait Guys.  Bringing you the facts without the bling.

 “… within months, hundreds of the young male inmates of the camp began limping, and had begun to use sticks as crutches to propel themselves about. In some cases inmates had been rapidly reduced to crawling on their backsides to make their ways through the compound …. Once the inmates had ingested enough of the culprit plant, it was as if a silent fire had been lit within their bodies. There was no turning back from this fire—once kindled, it would burn until the person … would ultimately be crippled …. The more they’d eaten, the worse the consequences—but in any case, once the effects had begun, there was simply no way to reverse them …. ” -insights from Dr. Arthur Kessler, prisoner and doctor within the concentration camp

What would you do if you were trapped out in the wilderness and your glutes and legs stopped working ? This is just what happened to Christopher McCandless (aka, Alexander Supertramp) in the wilderness outside Fairbanks Alaska.

Neurolathyrism is a toxic myelopathy caused from ingestion of Lathyrus sativus grass pea. It causes paralysis, lack of strength or inability to move the lower limbs and may involve the pyramidal tracts of the spine/CNS producing UMN signs (upper motor neuron signs).  A unique symptoms of lathyrism is apparently the atrophy of the gluteal muscles. 

Dear Gait Guys, why are you telling us obscure things about a toxic neuropathy ?

Ok, let us back up. But for you to understand we first need to tell you about a 1940’s Holocaust concentration camp in the Ukraine.

Vapniarka is a presently a small town of ~8600 in Vinnytsia, Obllast, Ukraine.  It was during the months of October 1941 through March of 1944 it became the site for the German occupied Holocaust concentration camp imprisoning Romanian Jews.  As most concentration camps go, food, water, sanitation and disease outbreaks were common problems and concerns. Food was so limited that the prisoners were at one point fed barley bread that had 20% straw mix within and a species of pea known as Lathyrus sativus typically used to feed livestock.  It was only a short time later that strange symptoms began to break out amongst the prisoners. At first they became weak but it wasn’t long before they had difficulties ambulating and then became paralyzed with what was diagnosed as Neurolathyrism also known more simply as Lathyrism, a form of spastic paralysis. The culprit was oxalyldiaminopropionic acid (ODAP) from the peas. Some sources say that by 1943 hundreds of prisoners were struck down with Lathyrism and apparently 117 Jews were left permanently paralyzed.

We believe we first read about this in early 2013 in an online news article by Ronald Hamilton in a paper entitled “The Silent Fire: ODAP and the Death of Christopher McCandless”. McCandless has been made famous for his story and death deep in the Alaska wilderness in the Jon Krakauer book “Into the Wild”. We were excited to see this paper quoted in Jon Krakauer’s The New Yorker article this month. In his paper Hamilton wrote, 

 "… within months, hundreds of the young male inmates of the camp began limping, and had begun to use sticks as crutches to propel themselves about. In some cases inmates had been rapidly reduced to crawling on their backsides to make their ways through the compound …. Once the inmates had ingested enough of the culprit plant, it was as if a silent fire had been lit within their bodies. There was no turning back from this fire—once kindled, it would burn until the person who had eaten the grasspea would ultimately be crippled …. The more they’d eaten, the worse the consequences—but in any case, once the effects had begun, there was simply no way to reverse them …. “

In Krakauer’s recent The New Yorker article "How Chris McCandless Died”, he gives an explanatory full-circle synopsis regarding the gripping conclusion in his book “Into the Wild”.  In the article he speaks about Hamilton’s paper, McCandless’s fate and also mentions that in the 20th century more than a hundred thousand other people worldwide have been permanently paralyzed from eating grass pea containing the neurotoxin ODAP. According to Hamilton, the neurotoxin over-stimulates the nerve receptors causing them to burn out. As he explained in his “The Silent Fire” paper,

“It isn’t clear why, but the most vulnerable neurons to this catastrophic breakdown are the ones that regulate leg movement…. And when sufficient neurons die, paralysis sets in…. [The condition] never gets better; it always gets worse. The signals get weaker and weaker until they simply cease altogether. The victim experiences “much trouble just to stand up.” Many become rapidly too weak to walk. The only thing left for them to do at that point is to crawl….”

You can read the Krakauer / Hamilton account and recent story in the article link found below. In it they both tell the most recent events in the laboratory testing of the seeds that McCandless ate in bulk during his last months/weeks.  The tested seeds were found to be in high enough concentration to cause the symptoms (of Lathyrism) McCandless wrote about in his last weeks of survival when he was more susceptible to the neurotoxin having already been in severe malnutrition and hunger.

THE NEW YORKER LINK : http://www.newyorker.com/online/blogs/books/2013/09/how-chris-mccandless-died.html?mbid=social_retweet&mobify=0

We dove a little deeper into this toxic myelopathy and discovered some helpful journal articles. According to Misra et al.  "patients complained of walking difficulty due to weakness and leg stiffness. The gait abnormalities ranged from spastic gait, toe walking and the need of assisted gait devises such as canes. They spoke of the weakness being mild to moderate and less prominent than was spasticity. In 8 of their subjects the physical signs were asymmetrical. Peripheral neuropathy was present in only one patient, but muscle atrophy and widespread fasciculation's were not found. A higher frequency of peripheral neuropathy and lower motor neuron involvement has been reported from Bangladesh and Israel. Severe spasticity in the absence of prominent weakness in lathyrism may be due to the involvement of certain specific groups of corticospinal fibres.“

We are big fans of Krakauer’s writing (and now Hamilton’s paper "The Silent Fire”) and this was a good story to close the Alexander Supertramp chapter hopefully once and for all. “Into the Wild” by Krakauer was a riveting book, one of our favorites.  Sean Penn’s cinematic interpretation of the story was good as well.  But for two gait geeks like us, to finally find out that poor Chris died of something so rare and complex, something that could be traced back as far as the holocaust concentration camps where people’s gait was first seen impaired was pretty fascinating. We are sure there billions of folks who have never looked at our blog and who will never likely read it.  Gait and gait related disorders and diseases do not get many people excited, but for us, this might as well be pornography. We are sure there are millions that are not fascinated by the fact that every organism on this planet locomotes in one manner or another, each with their own characteristic rules and biomechanics. It is sad to us that few really pay attention to how humans locomote and ambulate, at least not until they break a leg, sprain an ankle or come down with some complex motorneuron lesion. Gait is everywhere once you start looking for it. Whether you start to become aware of it at the local shopping mall, in TV commercials, during Sunday night football, during the Olympics, at your grandmama’s house, during your son or daughters walk to the dinner table , or even in the movies… . . gait is everywhere. Sean Penn’s interpretation of Krakauer’s “Into the Wild” is a touching sweeping movie and for us to now find out that the thing that ultimately led to McCandless’s demise was a gait related neurotoxic myelopathic disorder just goes to prove our point, gait is everywhere.  Why more people do not see this is beyond us, but hey, it would be a strange world if everyone was as nerdy as the two of us wouldn’t it !? 

Shawn and Ivo, The Gait Guys.  

 

References:

 

1. Paraplegia. 1993 Apr;31(4):249-54.

Clinical aspects of neurolathyrism in Unnao, India.

Misra UK, Sharma VP, Singh VP. http://www.ncbi.nlm.nih.gov/pubmed/8493040

2. J Neurol. 2012 Jul;259(7):1263-8. doi: 10.1007/s00415-011-6306-4. Epub 2011 Nov 12.

Neurolathyrism: two Ethiopian case reports and review of the literature.

Woldeamanuel YW, Hassan A, Zenebe G. http://www.ncbi.nlm.nih.gov/pubmed/22081101

3. Neurobehav Toxicol Teratol. 1983 Nov-Dec;5(6):625-9.

Lathyrism: a neurotoxic disease.

Spencer PS, Schaumburg HH. http://www.ncbi.nlm.nih.gov/pubmed/6422318

Podcast 37: Anandamide & Body Work, 3D Printed Shoes and Case Studies

Our show notes should interest you today. We have another great podcast ready for you today !

Link to our server:

http://thegaitguys.libsyn.com/podcast-37-anandamide-body-work-3d-printed-shoes-and-case-studies

iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

Gait Guys online /download store:

http://store.payloadz.com/results/results.aspx?m=80204

other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  "Biomechanics"

Today’s show notes:

Neuroscience piece:

McPartland et al (2005) measured Anandamide (AEA) levels pre- and post, Myofascial Release, Muscle Energy Technique, High velocity manipulation all of which load fascia patients experienced analgesic/euphoric cannabimimetic effects, which correlated with an increase in serum AEA levels (more than double pre-treatment evels). 

Neither cannabimimetic effects, nor changes in AEA levels, occurred in control subjects.

McPartland, J et al 2005.. Jnl. American Osteopathic Association 105, 283–291 
http://leonchaitow.com/2008/01/30/bodywork-high

2. Vibrating shoes could be the future of navigation and wearable tech

http://www.wired.co.uk/magazine/archive/2013/09/start/vibrating-shoes-the-new-navigation-tool

3. Tim Ferriss (@tferriss)

9/2/13 9:25 PM
Malcolm Gladwell: “Man and Superman” The New Yorker buff.ly/174jruO Drugs, genetics, and the fallacy of a level playing field.

 

4.FB reader sent us a message:

Hi Guys: Not quite sure how I came across your podcasts but really enjoying them, even if I’m only slowly starting to understanding them. I was catching up on some old ones during my marathon training and the ones on evolution reminded me of some of my musing on the arch in the foot (well I guess correctly that should be the medial longitudinal arch). I though you might be able to give me the answers or point me in the right direction

Are we only species with this?

What is the advantage?

When and how does it develop and why isn’t it formed in utero?

Are flat feet then a genetic or developmental issue and why?

Thanks 

Alex

5. off the web:

The imprecise art of foot orthoses

http://www.americaspodiatrist.com/2011/02/the-imprecise-art-of-foot-orthotics/

6. off the web:

3D-Printed Shoes Mean You’ll Never Need to Buy Another Pair
http://mashable.com/2013/08/20/3d-printed-shoes/

7. Another TUMBLR reader asks question about:

Hi Gait Guys,

I am currently a third year podiatry student needing some biomechanics and orthotic-making training. I enjoy your youtube videos but was wondering if you offer or could recommend a dvd that I could purchase to further my education. The way the information is presented it in class is not as good as the way you do it! I am also interested in the biomechanics of shoes… I am having trouble finding information about how walking in a cushioned/plantarflexed sneaker effects function (Does is help us get to forefoot running or hinder us?). I enjoyed your blog on different curved lasts as well. How would I be able to apply the way the shoe is lasted to a patient? For example, if the patient is rigid and I want them to be wearing a shoe that is lasted like a slipper how do I guide them into buying a shoe constructed as such? Do I just tell them to go for a shoe made with a straight toe box? Is there such a thing as a toe box curved laterally? 

One last question- do you recommend a medial FF post for a patient that has a mobile RF varus that causes a FF supinatus? I was told a post like this would limit PF of the first ray and DF of the hallux which would limit toe off and cause other problems. 
Thank you. I appreciate any advice you may have. I am out of my element with biomechanics and really want to improve at it.

8.Another off tumblr: 

sign-life-away asked you:

Is forefoot walking bad for you? Everyone says I walk awkwardly, as if i have something up my bum. I have been trying to walk “naturally” (heel-toe) but I go back to forefoot strike. Does this contribute to why my legs have always been muscular?

Forefoot Valgus or Plantarflexed 1st ray?

Hmmm. That IS the question, isn’t it?

We remember that Forefoot valgus is a condition where the forefoot is everted with respect to the rearfoot.

With a plantar flexed 1st ray, the forefoot is actually in varus (ie inverted) and the the 1st ray is dropped (thus, plantar flexed).

If you look at the picture, you will see the entire forefoot is everted, thus we are  looking at a true forefoot valgus. The question here, is “does the 1st ray move into dorsiflexion”? This would be the difference between a flexible (plastic or rigid deformity and is a function of the rigidity of the subtalar and midtarsal joints as well as the flexibility of the 1st ray.

The literature states that forefoot valgus is the most commonly seen frontal plane deformity of the foot (McPoil 1988, Burns, 1977). We have not found this in clinical practice, but rather forefoot varus. This may be due to most folks seeing us have an issue, and more issues seem to be caused by rigid varus deformities, since they cause the knee to collapse inward.

It’s origin can be multifactorial, ranging from a congenital malformation of the calcaneocuboid joint (more on that joint here) with the absence of a calcanean process, which allows a greater degree of eversion (Bojsen-Moller 1979); over rotation of the talar neck (Sglaraato 1971), or association with a pes cavus foot in compensation to an inverted rearfoot and inflexibilty of the subtalar joint (Lutter 1981). Neuromuscular diseases are believed to cause as many as 95% of these deformities (Dwyer 1975).

The question is, what do we do with it?

• we insure that the foots mechanics are the best they can be through manipulation and mobilization
• make sure the joints proximal and distal to the foot are functioning properly
• muscle test and strengthen weak muscles (think about the poor peroneals in these folks!)
• make sure they are NOT in a motion control shoe; more flexible is better
• Make sure their shoe has adequate room in the toe box
• sometimes, we post the insole of the shoe (or orthotic) in valgus, especially with rigid deformities

A little lost? Take our National Shoe Fit Program, available for instant download 24/7/365 by clicking here.

The Gait Guys. Often a valgus slant on a varus reality. Still bald. Still good looking. Improving your gait competency with each post.

This is a follow up to our last post on forefoot varus, available here.

Remember, ou are looking at a person with an uncompensated, rigid fore foot varus. This individual is not able to get the head of the 1st ray to the ground at all, and he has a Morton’s foot to boot (no pun intended). 

So, what do we see?

• 1st of all, you will note his 2nd metatarsal is longer than his 1st. When he goes up on his toes, you see his foot invert and will see curling of the toes 3-5 in an attempt to stabilize the foot. 
• You will also see his foot looks pretty flat. He has an arch (you can see it as he goes up onto his toes) and the “flatness” is actually due to the fore foot varus.
• You will see a bunion forming bilaterally, due again to the uncompensated fore foot varus, and his inability to anchor the head of the 1st metatarsal. 
• The posterior view shows relatively vertical calcaneii (no no rearfoot valgus), but you can really see the effects of the fore foot varus, with medial fall of the midfoot.
• note the prominent “pump bumps” on the lateral calcaneus biaterally, from chronic rubbing on the shoes. 

The Gait Guys. Getting you closer to being a foot nerd with each post.

 

Lost? Having trouble with all these terms and nomenclature? Take our national shoe fit program, available by clicking here.

The Gait Guys. Uber foot geeks. Still bald and good looking. Separating the wheat from the chaff, with each and every post.

What ?! Arm Swing in Runner and Athletes: Part 18 ?!  Yes, Part 18.

Ok, this should tide you over until Monday, at least ! 

Below we have furnished the 18 links to “arm swing” involved blog posts we have done over the last 1-2 years.  If you think you know about arm swing in gait and running and sports you might want to dive a little deeper. We have done much work on this topic and yet we still see trainers and coaches correcting peoples arm swing and carriage issues like it is a local problem that needs fixed at the arm level.  

We showed a video of a parkour runner today for a reason. Got back and watch it again but focus only on arm swing. Go. Now ! Focus !

Arm swing in gait and running. Why it is crucial, and why it must be symmetrical.

We have written many articles on arm swing and its vital importance in gait and running. Have you missed all these articles ?  If so, below you will find 18 links of our writings on the matter.  We are still not done writing about this most commonly forgotten and overlooked aspect of gait and running analysis, and we probably never will be done.  Why is no one else focusing on it ?  We think it is because they do not see or understand its critical importance. It is very often not a local problem requiring a local solution.

Without the presence and use of the arms in motion things like acceleration, deceleration, directional change, balance and many other critical components of body motion are not possible.

What is perhaps equally important for you to realize, as put forth in:

Huang et al in the Eur Spine Journal, 2011 Mar 20(3) “Gait Adaptations in low back pain patients with lumbar disc herniation: trunk coordination and arm swing.”

is that as spine pain presents, the shoulder and pelvic girdle “anti-phase” (meaning they are not phasic, they oscillate in opposite rotation) begins to move into a more “in-phase” favor.  Meaning that the differential between the upper torso twist and pelvic twist is reduced. As spine pain presents, the free flowing pendulum motions of the upper and lower limbs becomes reduced to dampen the torsional “wringing” on the spine. When this anti-phase is reduced then arm swing should be reduced. The central neural processing mechanisms do this to reduce spinal twisting, because with reduced twist means reduced spinal motor unit compression and thus hopefully less pain at the motor unit whether it be at the endplate or at the posterior elements. (Yes, for you uber biomechanics geeks out there, reduced spine compression means increased shear forces which are favorite topics of many of our prior University instructors, like Dr. Stuart McGill, yes we were long ago (late 1980’s) sitting in on his fascinating courses at the University of Waterloo before his international fame which he so greatly deserves. We can only hope he reads this kind of work of ours with pride so he can know he passed a small torch beyond his immediate reach.). The consequence to this reduced spinal rotation is reduced limb swing.  And according to

Collins et al Proc Biol Sci, 2009, Oct 22 “Dynamic arm swinging in human walking.”

“normal arm swinging requires minimal shoulder torque, while volitionally holding the arms still requires 12 % more metabolic energy.  Among measures of gait mechanics, vertical ground reactive moments are most affected by arm swinging and increased by 63% without arm swing.”

So, it is all about efficiency and protection. Efficiency comes with fluid unrestricted, yet stable, movements and energy conservation but protection has the cost of wasting energy and reduced mobility through limb(s) and spine.

In past articles we have carried these thoughts into historical functional needs of man such as carrying spears and of modern day man in carrying briefcases.   Yesterday we even showed a video of a great SilverBack gorilla ambulating bipedally with a log in one hand showing the change in arm swing. Today we show a great high functioning video of another parkour practitioner.  Parkour is a physical discipline and non-competitive sport which focuses on efficient movement around obstacles.  Watch closely the use of the arms. The need for arm use in jumping, in balance, in acceleration etc. It becomes clear that once you get the amazing feats seen in this video out of your head, and begin to watch just the use of the arms that you will begin to appreciate the amazing need for arm swing and function in movement.

There is a reason that in our practices we treat contralateral upper and lower limbs so much.  Because if you are paying attention, these in combination with the unilateral loss of spinal rotation are the things that need attention. 

Yup, we are The Gait Guys….. we have been paying attention to this stuff long before many it seems.  If you just know gait, one of the single most primitive patterns other than crawling and breathing and the like, you will understand why you see altered squats, hip hinges, shoulder ROM screens and impaired rolling patterns etc.  You have to have a deep rooted fundamental knowledge of the gait central processing and gait parameters. If you do not, every other screen that you put your athlete or patient through might have limited or false leading meaning. The hard part is having enough command of all of the information to bring it all together and see it for what it is.  Sounds like the career journey’s of many of us doesn’t it ?! 

PLEASE find the 18 blog article links we mentioned earlier below. Enjoy.

Shawn and Ivo …  combining 40+ years of orthopedics, neurology, biomechanics and gait studies to get to the bottom of things. And glad to have great folks like you to join us on the journey.

LINKS:

http://thegaitguys.tumblr.com/post/13920283712/arm-swing-part-2-when-phase-is-lost

http://thegaitguys.tumblr.com/post/25574512512/remember-by-clicking-on-the-youtube-logo-in-the

http://thegaitguys.tumblr.com/post/4989710612/arm-swing-matters

http://thegaitguys.tumblr.com/post/4959504732/dynamic-arm-swinging-in-human-walking

http://thegaitguys.tumblr.com/post/25020320076/video-gait-case-it-is-neuromechanics-wednesday

http://thegaitguys.tumblr.com/post/29123613733/gait-problem-but-where-is-the-problem-a-case

http://thegaitguys.tumblr.com/post/29333686230/have-you-ever-wondered-why-people-who-walk

http://thegaitguys.tumblr.com/post/31459106441/the-windmill-pitch-fastpitch-softball-more-proof

http://thegaitguys.tumblr.com/post/50570270440/human-gait-changes-following-mastectomy-taking

http://thegaitguys.tumblr.com/post/53926462035/the-power-of-observation-part-2-lets-take-a

http://thegaitguys.tumblr.com/post/24190026508/arm-swing-in-gait-and-running-why-it-is-crucial

http://thegaitguys.tumblr.com/post/59683119340/too-much-potential-gait-pathology-all-in-one

http://thegaitguys.tumblr.com/post/7852611676/a-brief-gait-review-from-a-youtube-clip-we-found

http://thegaitguys.tumblr.com/post/4989750795/arm-swing-privides-clues-to-gait-pathology

http://thegaitguys.tumblr.com/post/5014037442/gait-gaff-time-gaff-verb-tr-to-stand-or-take

http://thegaitguys.tumblr.com/post/45674661556/podcast-25-bionics-arm-swing-footwear

http://thegaitguys.tumblr.com/post/42841395809/pod-22-primates-limb-synchrony-motor-patterns

Look at that forward lean and glute development !

There now, maybe we tricked you into finally reading one of our bigfoot / Gigantopithecus blog posts. These blog posts were highly informative yet sadly under viewed compared to our regular posts. We suspect only the true gait geeks found those worth of their time but maybe they were misleadingly superficial to the quick browsing viewer. And that is ok, to each his/her own. But if you want to learn about your own species and problems we have as humans it is always helpful to look at our distant species “relatives” to see where we came from.

In this video you will see this Silver Back walking on 2 limbs, this is quite a rare event to see. In this clip you can see a gorgeous forward lean and the subsequent midfoot strike that occurs when the foot fall occurs with the body mass directly over the foot.  If you look closely you will also see that this gorilla is carrying a log in his left hand, which is one of the theories postulated as to why we evolved to bipedal ambulation, to carry objects over a distance. You should note the increased arm swing in the contralateral hand which is always seen when one arm swing is impaired from carrying things or from injury. This same pendulum alteration occurs in the lower limb when there is an injury and thus a weight bearing alteration, such as ambulating on a sprained ankle.  If you still do not believe us, strap a 5 pound ankle weight to one ankle and note the immediate change in step and stride in both limbs.  In subtle injuries or merely in the presence of pain, the gait cycle is altered a subtle level, and this is where gait compensations often begin.

in the normal walking gait cycle, rear foot strike is normal. But we at The Gait Guys tend to have our clients focus more on heel “contact” as opposed to a true “strike”. The difference is one of how aggressively the foot’s heel interacts with the ground at initial contact. We all have a family member or neighbor that can be heard upstairs sounding like they are pounding nails into the floor when it is really just their normal heel strike.  The best way to help someone to reduce this pounding habit is to increase their forward torso lean and to educate them on heel contact on impact.  The lean must come from the ankles, not from the waist. It is like walking into a heavy wind, you must lean your whole body (we use a queue of “raise your chest a little and lead from the chest” and this often helps stop a collapse into the core and flexion from the waist). And when one does this, the foot cannot progress so far out in front of the body and generate that aggressive heel strike. One is close to midfoot strike at this point when the correction is made properly.  This is similar to Pose running technique but it is just simply good form running technique to hit a nice soft midfoot impact each time.  

We talked more about heel strike in Gigantopithecus last week in this blog post. And, we also mentioned the perpetual knee flexion to dampen the head oscillations.  

Shawn and Ivo, The Gait Guys, and aspiring primatologists apparently.

Podcast 36: Heel lift lies, the Exercise Drug & Malcolm Gladwell's 10,000 hours.

http://thegaitguys.libsyn.com/podcast-36-heel-lift-lies-and-the-exercise-drug

iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

Gait Guys online /download store:

http://store.payloadz.com/results/results.aspx?m=80204

other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen  Biomechanics

Today’s show notes:

Neuroscience piece:

Description

1. Health Scanner Scanadu Scout: the future of medical info gathering ?

http://techcrunch.com/2013/07/12/health-scanner-scanadu-scout-breaks-indiegogos-crowdfunding-record/

2. The Exercise Drug:

www.gizmag.com/scripps-drug-sr9009-exercise-mimic/28651

3. FB reader sent us a message:

- am posting this to see if I can get a little bit of help from the best professionals in the area (you). 

I have read some of the information on your site and I think I have quite a problem on my right foot. It happens that the medial part of the foot tripod does not touches the floor at all and I have lack of support in that zone. So it seems like my forefoot is varus. I have also noticed that when I am standing it looks like my rear foot is valgus. So, I can’t really compensate this problem because if the forefoot is varus and I try to put it neutral, the rear foot gets even more valgus, and if it I try to put the rear foot neutral, the forefoot gets even more varus and my big toe does not touch any part of the floor. Can you please help me? I do not know what to do and I am a little bit desperate because nobody I went to could help me. You are probably my last hope. I know I can correct this and I have the will and dedication to pull it off. I bet there are some exercises I can do but I do not really know which at all. 
Thanks in advance. -Jorge

4. Another TUMBLR reader asks question about

Guys what are the possible muscular causes of genu varum during initial swing?

5. Another off tumblr:  Anything  you can talk about on this topic ?

How does running in low-to-no light conditions effect your gait/running/injuries/etc?

6. Topic: step  width

Changing step width alters lower extremity biomechanics during running

http://www.gaitposture.com/article/S0966-6362(13)00291-9/abstract

7.  heel lift vs. sole lift

why and when would you use only a heel lift…..unilaterally ?

8. National Shoe Fit program: 

Link: http://store.payloadz.com/results/results.aspx?m=80204

9. Questions from a field doc:

Hey guys,

 I have heard you guys say many times that many people who choose to venture into minimalistic footwear have not “earned their right" to do such without increasing their risk for problems.  I was wondering if you could explain what parameters you use to determine if and when they are ready.  

Thanks,

Ryan 

10. Shoes: does pronation matter

http://www.runnersworld.com/running-shoes/does-pronation-matter

11. Shoes #2:

http://www.theglobeandmail.com/life/health-and-fitness/fitness/runners-its-time-to-rethink-your-shoes/article13321948/

12. Malcolm Gladwell debate, 10,000 hours

http://www.theatlanticwire.com/entertainment/2013/08/malcolm-gladwell-defends-disputed-10000-hours-rule/68624/– 

What does sustained rearfoot and forefoot inversion look like in terms of shoe wear ?

This is a client who came to us with a history of several months of big toe pain (specifically 1st metatarsophalangeal joint pain). The pain was dorsally located (ie. top of the big toe joint).  It was clear that on examination the pain was being caused by osseous and soft tissue dorsal impingement due to a progressing hallux rigidus/limitus. 

This painful status obviously is creating both a conscious medial toe off pattern during the propulsive phase of late stance phases.  The client is more than obviously steering push off laterally as can be seen in this photo. The grey lateral pods are almost obliterated. This means the foot is perpetually supinated during the entire stance phase of gait and this means that pronation shock absorption is not present.

Remember, a perpetually supinated foot means the talus and arch never descend as part of the pronation/shock absorption cycle and so the same side limb will always remain longer than the other limb which is seeing the internal rotation/pronation effects which functionally shorten the leg during stance phase.  So in this case, we have a pelvic unlevelling and a frontal plane shift to the functionally shorter leg during its stance phase.  It should not surprise you that this client has hip pain contralateral to this abnormal shoe wear/hallux limitus side. 

There are plenty of other issues here to be discussed, like eccentric weakness of the same side g.maximus, patellar tracking issues, lack of hip extension and thus weakening of the glutes and thus resultant shortness of the quadriceps group which will all often be found in this clinical picture. But we will save that all for another time.

Remember, the longer this client stays in this shoe, the easier it is mechanically on them because the eVA foam and the shoe are broken down into their compensatory avoidance behaviour.  But, this is where the pattern becomes subconsciously embedded and thus when the pattern drives many of the other compensatory patterns off of this one since it is the new norm. The faster you address this problem, the sooner you stop the compensatory cascade.  And on that note, if you read our blog post re-run of the Arm Swing last week you will understand why  these folks will begin altering the opposite arm swing phase.

Shawn and Ivo, The Gait Guys

Too much potential gait pathology all in one sport ? Racewalking … . 

Do not underestimate this title, you may learn more about normal running form from today’s blog post than you think.

 

For the best clips start watching at the 4:15 mark. 

The sport of race walking is an interesting one to say the least.  We had the pleasure for years of treating and working closely with one of our countries best race walkers and she taught me so much, not only about the sport but about the strange mechanics of the sport and the functional pathologies the sport drives from its unique requirements driving abnormal gait mechanics on each step.

Racewalking is a long-distance event requiring one foot to be in contact with the ground at all times (and a couple of other unique and wacky rules that we will discuss in a moment). Stride length is thus reduced and so to achieve competitive speeds racewalkers must attain cadence rates comparable to those achieved by Olympic 800-meter runners for hours at a time. Most people cannot truly appreciate how fast these folks are going, most folks will have to move into at the very least a gentle run to keep up with these folks.

 

There are really only two rules that govern racewalking:

1-The first rules states that the athlete’s trailing foot’s toe cannot leave the ground until the heel of the leading foot has created contact. The rule violation is known as "loss of contact". 

2-The second rule specifies that the supporting leg must straighten, essentially meaning knee extension (and for some, terminal extension, ie. negative 5-10 degrees !) from the point of contact with the ground and remain straightened until the body passes directly over it. Again, essentially meaning full range knee extension for the entire stance phase of gait (early, mid and late midstance phases). For those who do not study the details of gait, this may not seem like a huge issue, but it is because full lockout really never occurs in either walking or running.  And there is nothing like impacting a joint in full extension lock and heavy heel strike to take away all of the natural shock absorbing mechanisms of the lower limb. (watch the video at the 4:30 mark, Dang ! the dude in the red looks like his knees are going to fold backward there is so my knee extension !) There is some great slow motion technique breakdown at the 6:28 minute mark of the video. 

In getting around these 2 major rules:

- the hips must rotate a tremendous amount, with full pelvis rotation, to prevent the frontal plane pelvis motion which would be a loss of sagittal power. This produces the visually painful waddle that is classic to the sport.

- the arms are used aggressively to generate power and to help the lower limbs move through the cycle because of the unnaturally apropulsive nature of the overall technique. The arms also often move excessively into the frontal plane since they mirror the lower limb

- excessive lateral heel strike quite often ensues help keep the knee extended and in an attempt to keep the foot on the ground longer, to avoid getting red carded. 

- there is plenty of cross over gait and severe lack of ankle dorsiflexion for everyone to observe, both of these components combined with the above characteristics give the “Close to the ground” appearance that is attempted by all racewalkers.

- want to see some seriously gut wrenching biomechanics, forward the video to the 7:55 mark. Tell us that won’t cause problems down the road !

Breaking the Rules:

The rules are entirely subjective and enforced by real-time human eye (not video) judges along the course (3 red card violations render an event disqualification). Interestingly, and we have seen this first hand, athletes quite regularly lose contact (meaning initiating a float phase, which is what dictates the difference between running and racewalking) for a few milliseconds per stride.  This float can be detected on film/video which can be caught on film, but such a short flight phase is said to be undetectable to the human eye. Disqualifications (losing contact or bent knee) are routine at the elite level as evidenced by the famous 2000 Summer Olympic case of Jane Saville who was disqualified on her way to a gold medal.

Racewalking … .  a highly technical sport, more so than running.  If you ever get a chance to see someone do this sport first hand, it is truly engaging to a gait geek. Lots of eye candy, gait geek eye candy that is !

Shawn and Ivo… … the gait guys. 

What do we have here and what type of shoe would be appropriate?

You are looking at a person with a fore foot varus. This means that the fore foot (ie, plane of the metatarsal heads) is inverted with respect to the rear foot (ie, the calcaneus withe the subtalar joint in neutral). Functionally translated, this means that they will have difficulties stabilizing the medial tripod (1st MET head) to the ground making the forefoot and arch unstable and likely rendering the rate and degree of pronation increased.

Having trouble with terminology? check out this post on FF varus.

The incidence of this condition is 8% of 116 female subjects (McPoil et al, 1988) and 86% of 120 male and female subjects (Garbalosa et al, 1994), so it happens more in males.

Fore foot varus occurs in 3 flavors:

• compensated
• uncompensated
• partially compensated

What is meant by compensated, is that the individual is able to get the head of the 1st ray to the ground completely (compensated), partially, or, when not at all, uncompensated.

What this means from a gait perspective ( for partially and uncompensated conditions) is that the person will pronate through the fore foot to get the head of the 1st ray down and make the medial tripod of the foot (ie, they pronate through the subtalar joint to allow the 1st metatarsal to contact the ground). This causes the time from mid-stance to terminal stance to lengthen and will inhibit resupination of the foot. We will have an upcoming additional post on this soon and will put a link here when we do.

Today we are looking at a rigid, uncompensated forefoot varus, most likely from insufficient talar head derotation during fetal development and subsequent post natal development. They will not get to an effective foot tripod. They will collapse the whole foot medially. These people look like severely flat-footed hyperpronators.

So, what do you do and what type of shoe is appropriate? Here’s what we did:

• try and get the 1st ray to descend as much as possible with exercises for the extensor hallucis brevis and short flexors of the toes (see our videos on youtube)
• create more motion in the foot with maniipuulation, massage mobilization to optimize what is available
• strengthen the intrinsic muscles of the feet (particularly the interossei
• increase strength of the gluteus maximus and posterio fibers of the gluteus medius to slow internal rotation of the leg during initial contact to midstance
• put him in a flexible shoe for the 1st part of the day, to exercise the feet and a more supportive, medially posted (ideally fore foot posted) shoe for the latter part of the day as the foot fatigues
• monitor his progress at 3-6 month intervals
• a rigid orthotic will likely not help this client and they will find it terribly uncomfortable because this is a RIGID deformity for the most part (the foot will not accommodate well to a corrective orthotic. Besides, the correction really has to be made at the forefoot anyways. We will talk about medial forefoot postings again at a later date.)

Lost? Having trouble with all these terms and nomenclature? Take our national shoe fit program, available by clicking here.

The Gait Guys. Uber foot geeks. Still bald and good looking. Separating the wheat from the chaff, with each and every post.

Bigfoot Gait. Part 2. The Patterson Video: Human or Gigantopithecus ?

Last week on the blog we discussed some of the unique gait characteristics we saw in the famous Patterson Bigfoot video and how many of them are seen in humans as compensatory strategies. Today we will mention a few more interesting things that will have you think about your human gait assessments a little differently.

Renowned chimpanzee researcher Jane Goodall last year surprised an interviewer from National Public Radio when she said she was sure that large, undiscovered primates, such as the Yeti or Sasquatch, exist.”

Why does Jane believe this ? Well, Gigantopithecus blackiwere, the largest apes that ever lived (10 feet tall, 1000+ lbs), lived as recently as 100,000 years ago. Giganto can be placed in the same time frame and geographical location as several hominin species. Its means of locomotion are uncertain since no pelvis or leg bones have ever been unearthed however the dominant view is that it walks on all fours like modern day gorillas and chimpanzees.  There are those however that believe that Gigantopithicus also walked bipedally just like many of today’s apes do.  There was a fascinating theory brought to light by Grover Krantz who made the bipedal assumption from jaw bones which were U-shaped and widened posteriorly leaving room for the windpipe to be located within the jaw, just like in humans.  This had to translate to bipedal ambulation to afford the skull to squarely sit upright on a completely erect spine as compared to being carried anteriorly (when on all four limbs) as in the great apes and chimpanzees.  It is a fascinating theory, but none the less, there are researchers on either side of the debate and proof may never occur … .  until perhaps one day we find a full skeleton or the real life version. Maybe someday we can get a team of Gait Geeks together and create a “Squatching Team” to head out deep into the Pacific northwest on a discovery mission.

1- Vertical Oscillations:

Today, in the video above, we draw your attention to the lack of vertical oscillations of the head.  Take a moment to watch this in the video once again. You should see that there is very little vertical displacement of the body (focus on the head). This minimal vertical type gait can only occur with a continuous slightly bent knee gait and we could make the case that a midfoot strike will dampen the vertical parameter even further. In humans, and in bigfoot here, limiting terminal hip extension also buffers some of the vertical movement, just as you see in the video.   Humans use a slight degree of knee flexion at foot strike to accomplish the same task, it is partly a strategy to keep the eyes steady on the horizon and some anthropological papers have suggested that this was a necessity in order to be able to run, visually track and accurately launch a spear at prey back in our plains hunting days. 

2. Heel Strike vs Heel Contact

A midfoot strike and heel strike are different.  A midfoot strike is often accompanied by a heel contact phase, which is different than a heel strike. With heel strike, the heel is the first point of contact, whereas heel contact can occur if the entire foot is placed flat all at once or it can occur after a forefoot or midfoot strike occurs (ie. placing the heel down).

By many sources, only great apes exhibit a true heel-strike, other primates present with a heel contact after a midfoot strike first occurs. As determined in this study heel contact is a by-product of an active posterior weight-shift mechanism involving highly protracted hindlimbs at touchdown.

 From the Schmitt study a variety of primates (32 species) were viewed walking on the ground and on simulated arboreal supports at a range of natural speeds.

“The study’s results indicated that Pongo as well as the African apes exhibit a "heel-strike” at the end of swing phase. Ateles and Hylobates make “heel contact” on all supports shortly AFTER mid-foot contact, although spider monkeys do so only at slow or moderate speeds.  No other New or Old World monkey or prosimian in this study made heel contact during quadrupedalism on any substrate. Thus, heel contact occurs in all apes and atelines, but only the great apes exhibit a heel-strike.“

Schmitt also concluded that "although heel contact and heel-strike may have no evolutionary link, it is possible that both patterns are the result of a similar weight shift mechanism. Therefore, the regular occurrence of heel contact in a variety of arboreal primates, and the absence of a true biomechanical link between limb elongation, heel contact, and terrestriality, calls into question the claim that hominid foot posture was necessarily derived from a quadrupedal terrestrial ancestor.”

So, in the Patterson video above, we see a lack of vertical oscillations just as in man. Apes also tend to waddle side to side, much more so than what we see in the Patterson video.  We also see a heel strike, which is know to occur in great apes but also in man.  

So, is this a man or is this a great ape ? It points to a human in an ape suit, unless this is actually Gigantopithicus who over 100,000 years has improved upon the skill and coordination of bipedal gait, just as modern day man has done.

Nothing shocking  here today. This was kind of fragmented a little but we just wanted to bring up the vertical oscillation and heel strike components to human and ape gaits. And then, let you decide for yourself about the Patterson video.

Shawn and Ivo……. when not making crop circles we are just two guys in ape suits……. walking the night forests, keeping folks believing…..

PS: here is an interesting excerpt on vertical oscillations from an old blog post we did. It seems pertinent here.

This study’s findings findings clearly demonstrate that human walkers consume substantially more metabolic energy when they minimize vertical motion.

Anyhow, the summary of this peer reviewed article by Ortega concluded that :

“in flat-trajectory walking, subjects reduced center of mass vertical displacement by an average of 69% but consumed approximately twice as much metabolic energy over a range of speeds . In flat-trajectory walking, passive pendulum-like mechanical energy exchange provided only a small portion of the energy required to accelerate the center of mass because gravitational potential energy fluctuated minimally. Thus, despite the smaller vertical movements in flat-trajectory walking, the net external mechanical work needed to move the center of mass was similar in both types of walking. Subjects walked with more flexed stance limbs in flat-trajectory walking, and the resultant increase in stance limb force generation likely helped cause the doubling in metabolic cost compared with normal walking.Regardless of the cause, these findings clearly demonstrate that human walkers consume substantially more metabolic energy when they minimize vertical motion.”

J Appl Physiol. 2005 Dec;99(6):2099-107. Epub 2005 Jul 28. Minimizing center of mass vertical movement increases metabolic cost in walking. Ortega JD, Farley CT. Source– 

 References:

-http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409101/

-Am J Phys Anthropol. 1995 Jan;96(1):39-50.

-Heel contact as a function of substrate type and speed in primates. Schmitt D, Larson SG.. Department of Anatomical Science, School of Medicine, State University of New York, Stony Brook 11794, USA.

-http://thegaitguys.tumblr.com/post/46851286689/more-on-the-great-debate-does-decreased-step-height

-http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1571309/

To orthotic or not to orthotic, that is the question

A concerned mother of this 3 year old boy came in, wondering if her son should have orthotics. What do you think?

Pros for orthotics:

• will make calcaneii more vertical
• will make feet look better
• will decrease progression angle while walking
• will halt most of the midfoot pronation you see on the single leg standing views
• will make left calcaneal valgus better that we see on the post view

Cons for orthotics:

• may interfere with derotation of the talar head, causing a permanent forefoot varus deformity or Mortons foot (need to more about development? click here)
• will make the child use their intrinsic muscles less, weakening the feet, causing problems later on in life
• will inhibit descent of 1st ray, and peroneus longus function (if you don’t use it, you lose it. More on peroneus here)
• will alter gait and affect motor development

What did we do?

• have the mother have the child walk barefoot more, especially in the sand
• have the child hop on one leg and do tandem gait walking
• have the child balance on one leg at a time
• place the child in flexible shoes
• recheck the child in 6 months to assess progress

Does this mean kids should NEVER be in orthotics? No, certainly not, but we fell this is neither the time or the place. A lot of development (and learning) occurs in the 1stf five 5 years of life. How about we let nature do its thing, try and stay out of the way of normal development and monitor?

The choice is yours

The Gait Guys. Offering firm, but gentle clinical guidance through the maze of gait information out there.

Bigfoot Gait. Yup, taking a look at the “big guy”.  The famous Patterson video.

Man or Ape? That is the question ! Lets see what can be noticed :

1. protracted head, shoulders and a forward and downward drop of the anterior rib cage through probable weak upper abdominals
2. internally rotated upper limbs with excessive forward arm swing (overswing, likely pulling/flexing too much from the pectorals to drive arm swing as opposed to driving normal pendular arm swing from triceps extension)
3. no hip extension during gait, (see #2 above. Without adequate triceps use/posterior arm swing the degree of hip extension/gluteal use cannot be optimized.

These are clearly attributes of a animal that has moved from quadipedal gait to bipedal before they have earned the postural right to do so.

Just like any modern man,  as evidenced by clear observance of said gait in the local mall or airport, most of modern man has difficulties with the degree of motor coordination and postural control necessary to walk with clean upright biomechanics.  Most modern gait exhibits the pathologies we discussed above. So, this must be a man in an ape suit then, right ? The only problem is that this film was from 1967 ! Clearly we know that Bill Gates and Steve Jobs were not doing their thing at that time, and people were not driving that much nor sitting in board rooms as much as they do now. So the question remains, if this is a man how did he get so posturally imploded ? Unless of course, he was trying to walk like a bipedal monkey.  The only problem there is that ape contra-body movements (symmetrical fluid opposite arm-leg swing) are not this clean even though this is pretty poor gait for a human.  So, either this is a non-computer age man trying to walk like an experienced ape, or, this is bigfoot.

There you go, we successfully made no progress in our forensic analysis to help in the mystery of bigfoot.  Then again, no one has.  National Geographic has a something else to say……. read on.

article: Forensic Expert says Bigfoot is real. (click for link)

From the article…..”It’s been the subject of campfire stories for decades. A camera-elusive, grooming-challenged, bipedal ape-man that roams the mountain regions of North America. Some call it Sasquatch. Others know it as Bigfoot.

Chilcutt says one footprint found in 1987 in Walla Walla in Washington State has convinced him that Bigfoot is real.

“The ridge flow pattern and the texture was completely different from anything I’ve ever seen,” he said. “It certainly wasn’t human, and of no known primate that I’ve examined. The print ridges flowed lengthwise along the foot, unlike human prints, which flow across. The texture of the ridges was about twice the thickness of a human, which indicated that this animal has a real thick skin.”

Renowned chimpanzee researcher Jane Goodall last year surprised an interviewer from National Public Radio when she said she was sure that large, undiscovered primates, such as the Yeti or Sasquatch, exist.”

click the link above to read the whole article.

Shawn and Ivo……. when not making crop circles we are just two guys in ape suits……. walking the night forests, keeping folks believing…..

Holy Late Cretaceous Therapods. Those Veliciraptors were twisted!

The dinosaur made famous by Jurassic Park (We never understood why they put this dinosaur in the movie, the Jurassic period was many millions of years earlier, but that’s another story).

Dr Ivo was able to take some pictures of a rare, preserved skeleton from Mongolia at the dinosaur museum in Fruita, CO, while visiting with his family.

These bad boys (and girls) were fast predators, and one of the things that made them that way, was the fact that they were built for speed!

Take a look at theses hips! Note the extreme retro torsioned angle of the femur heads. We remember that femoral retro torsion limits internal rotation of the hips (OK, so you don’t remember? click here for a review).

Now lets think about this. Externally rotate your thigh and lower leg. What do you notice? Hopefully you notice it puts your foot in more supination. This makes it into a more rigid lever, better for pushing off and better for sprinting!

Have you ever seen a sprinter? do they run on their toes? Is their foot more supinated? Ever see a velociraptor run? Check out this sequence from the “Dinosaur Planet” series. Remember, only their toes are on the ground and the thing that looks like a backwards knee is actually their ankle. 

Since their legs are so close to the body, there is little need for internal rotation, so why not maximize the effect and assist in supination?

Wow! Are you finally convinced that torsions are cool? After all, they appear to have been around for at least the last 75 million years and probably longer. 

The Gait Guys. Quarternary Geeks of the Cenozoic Era. Yes, we study dinosaur gait too…

Subtle clues often tell the story. A case 

A young athlete that wants to be faster (he is a 4:17 miler).

In the 1^st shot we see he has an anatomically short R tibia (and the gait to match it). You will note the right tibial plateau is lower than the left. The 2^nd shot backs this up; look at the malleoli.

The next shot shows a FABER test f the L hip. Compare the range of motion with the right one. Hmmm.  Limited external rotation and abduction on the right.  It should be noted he had normal and relatively symmetrical internal rotation of both hips.

Now come the feet. 1^st the left. A relatively neutral foot. Next the right. What’s different? Note how much more pronounced the right 1^st ray (ie 1^st metatarsal phalangeal joint).

Think about his short side. Most likely, he will be trying to lengthen it, right? How would he accomplish that? By supinating the foot (making it more rigid) and attempting to lengthen that leg, by anterior rotation of the pelvis. If you anteriorly rotate the pelvis (ie the innominate rotates forward, bringing the ASIS forward), what happens to external rotation of the hip? Stand up, edtend your hip on your pelvis and find out. It limits it.

How else might he try to lengthen that leg? If he supinates the foot (ie planytarflexion, adducion and inversion), the foot will be more inverted. He will be trying to get that medial tripod down to the ground. How might he accomplish that? By plantarflexing the 1^st ray!

So how can we make him faster?

• Place sole lift under r foot
• Correct pelvic pathomechanics with manipulation
• Support coorection with appropriate exercise (he had weak R lower external oblique’s)
• Foot mobilization
• R Foot intrinsic exercises to promote rasing of the 1^st ray (extensor hallicus longus  and flexor hallicus brevis exercises)  and lowering of the lesser metatarsal heads (extensor digitorum brevis exercises ).

The answers are often in the details. Be detail oriented. That’s one of the things that makes us foot geeks.

Ivo and Shawn

Happy Friday Folks!

Today, a classic rerun with a take on one of our favorite movies. Sit back and watch Trinity outrun Agent Brown, with full biomechanical explanations!

This was originally run for the Natural running Center in July 2011. Click here for that version.