Does this foot look like your foot ? 

There are a few subtle issues here. At first glance this foot looks half-way decent but upon further observation you should note the subtle drift of all of the toes.  In the foot, the toe that delineates abduction and adduction of the toes is the 2nd toe. The 2nd toe is considered the anatomic middle of the digits and forefoot. Any toe or movement that moves away from the 2nd toe is abduction and any movement towards the 2nd toe is adduction. This is obviously different than in the hand where the 3rd digit is the reference digit.  

In this foot, look at the shape of the 2nd and even the 3rd digit, they have a curve to them. Remember, form follows function and the dead give away here is that the hallux (the big toe) is drifting into adduction towards the 2nd digit. This is referred to as early hallux valgus and it is accompanied by early evidence of a bunion at the medial foot at the metatarsophalangeal joint.  When the shaft of the hallux is not in line with the shaft of the metatarsal long bone we get the angulation between the two causing the hallux valgus.  This is often from excessive pronation (either rearfoot, midfoot and/or forefoot) that collapses the tripod, splays the distal MET head via its dorsiflexion, and the development of complicated long and short hallux flexor muscle dysfunction as well as abductor hallucis (transverse and oblique head) disfunction further driving the hallux pull medially.  When the distal toes are engaged on the ground and there is still forefoot pronation occurring through the medial tripod support, the toes will be forced into a twist or spin, and in time you will get toes that appear drifted or windswept like these toes appear.  A similar phenomenon occurs at the lateral foot and a Tailor’s bunion begins to occur there as the forefoot begins to widen as the MET heads separate and the toes funnel medially (often provoked to do so by pointed footwear).  

We can also see the 4th and 5th toes curl under from the probably weak lateral head of the quadratus plantae thus encouraging unopposed oblique pull of the long flexors of the digits (FDL). See this post here for an explanation of this phenomenon.  

This is a fairly typical foot that we see in our practices.  This is not a far-gone foot but one has to catch this foot at this stage or it is rather difficult to resuscitate back to a healthy foot. Like a spinal scoliosis, once a bunion and  hallux valgus gets too far, it becomes an issue of symptom management rather than repair.  Hallux abduction must be retaught, tripod skills must be retaught, intrinsic foot muscle strength must be regained as well as strength and endurance of the tibialis anterior and toe extensors to help raise the arch again and control pronation. Sometimes a temporary orthotic can help the person to passively regain some degree of competent tripod while homework earns the changes. In some cases, an orthotic needs to be a permanent intervention if tripod stability cannot be adequately achieved.  But, we never give up and neither should you or your client, amazing things can happen over long periods of time when correction is forced.

There is plenty of life left in this foot, but you have to get to it quickly and get them in lower heeled shoes if tolerable and ones with a wider toe box.  Support the midfoot with an orthotic or built up foot bed, if necessary, but don’t leave it there. It is a crutch, and even crutches are intended to be put aside at some point. 

Shawn and Ivo, The gait guys

Take this simple test. 

Want to be faster? Better incorporate some proprioceptive training into your plan. It is the 1^st part of our mantra: Skill, Endurance, and Strength (in that order). Proprioceptive training appears to be more important that strength or endurance training from an injury rehabilitation perspective as well part of an injury prevention program

 What is proprioception? It is body position awareness; ie: knowing what your limbs are doing without having to look at them.

Take this simple test:

• Stand in a doorway with your shoes off. Keep your arms up at your sides so that you can brace yourself in case you start to fall. Lift your toes slightly so that only your foot tripod remains on the ground (ie the base of the big toe, the base of the little toe and the center of the heel.). Are you able to balance without difficulty? Good, all 3 systems (vision, vestibular and proprioceptive) are go.

• Now close your eyes, taking away vision from the 3 systems that keep us upright in the gravitational plane. Are you able to balance for 30 seconds? If so, your vestibular and proprioceptive systems are intact.

• Now open your eyes and look up at the ceiling. Provided you can balance without falling, now close your eyes. Extending your neck 60 degrees just took out the lateral semicircular canals of the vestibular system (see here for more info). Are you still able to balance for 30 seconds? If so, congrats; your proprioceptive system (the receptors in the joints, ligaments and muscles) is working great. If not, looks like you have some work to do. You can begin with exercises we use every day by clicking here.

Proprioception should be the 1st part of any training and/or rehabilitation program. If you don’t have a good framework to hang the rest of your training on, then you are asking for trouble. 

The Gait Guys. Your proprioceptive mentors. We want you to succeed!

Is your 5th toe curled under ? What do you do when “this little piggy” can’t go wee wee wee all the way home.

Have a look at the 4 photos above.  You will see this curling of the lesser toes quite often in your practice, and when you know what it means it can help to guide your thinking, both from a diagnostic and treatment perspective.  

You should have noticed in the photos that the 4th and 5th toes curl under and are hyper-flexed, and this is at rest.  So, what does this mean ?

It means that the long flexors are overactive, the extensors are underactive, and the adduction pull of the long flexors is unopposed by the under appreciated quadratus plantae muscle.

Look at the clinical drawing. The quadratus plantae has 2 heads, a medial head and a lateral head.  Being able to clinically test these two heads will give you much insight into the function of the foot and when you see these outer two toes curling under, as you see in the photo, you will always see weakness of the lateral head of the quadratus plantae.  

The quadratus plantae arises from two heads separated from each other by the long plantar ligament. The medial head is larger and more muscular, attached to the medial calcaneus;  the lateral head is smaller and more tendinous, attaching to the lateral border of the inferior surface of the calcaneus and the long plantar ligament.  The two portions join and end in a flattened band which inserts into the lateral, upper and under surfaces of the tendons of the flexor digitorum longus, usually the second, third, and fourth toes.

But this time, if you have studied the drawing, you should notice the oblique line of pull of the long flexors.  This should in fact create this undesirable curling effect of the lateral two toes since they are so far out on the oblique line of pull. However, if you look at the insertion of the lateral head of the quadratus plantae you should be able to conclude that this head is designed to offset this oblique pull of the outer two long flexor tendons.  The quadratus creates a posterior pull on the outer long flexor tendons ensuring that the curling effect (as seen in the photo) is nullified. Thus, we have a clinical presentation of a weak lateral head of the quadratus plantae (and probably a few others which we will not discuss here so as to not dilute the purpose of today’s post). Now you just have to figure out why it is weak or if there is a biomechanical reason for its insufficiency

• is there a foot type presenting itself that makes it difficult for this muscle to create sufficient posterior pull to offset the tremendous leverage of the long flexors? Maybe a forefoot varus, which gives the flexor tendons a mechanical advantage or a forefoot valgus which puts the quadratus plantae at a mechanical disadvantage? (Taking our National Shoe Fit Certification Program will help you get closer to understanding many of these issues.)
• Are their other anatomical variants like an increased forefoot width or bunions (medial or tailor’s)
• is there excessive rear or midfoot pronation?
• Shoe choice problem ?

Some folks do have adequate function of the quadratus plantae. Note the lovely feet in the last picture … .  they must have strong lateral quadratus plantae and abductors of the lateral foot and toes ! And, they have great toe separation, thus great intrinsic interossei muscles, and nice flat toes (great balance between flexors and extensors).

So, what do you do?

• you could do a surgery, amputate or fuse some of the joints to make them look better. Extreme for a problem like this
• you could ignore the issue and hope it goes away. (in all likelihood it will worsen)
• you could give them long flexor, toe scrunching Towel-curling, marble-grasping exercises , like you see all over the internet…and give the flexor digitorum longus even more of a mechanical advantage, and make the problem worse
• you could give them exercises to increase the function of the long extensors, which would increase the mechanical advantage of the quadratus plantae. like the shuffle walk; lift, spread and reach and tripod standing exercises (hmm…sounding better)
• be a real clinician and in addition to looking at the foot, look north of the foot to see what might be causing the problem (loss of ankle rocker, insufficient gluteal activity, loss of internal rotation of the hip, etc) Hmmm; sounding like a good idea too…

The Gait Guys. Hammering it home, day after day, about the importance of gait and giving you clues to be a better _________ (insert athlete, coach, trainer, clinician, shoe fitter, rehab specialist…).

Do you do manual muscle testing?

Following up on yesterdays post…

We all like to evaluate our patients; hopefully on the table as well as observation while weight bearing. Here is some food for thought.

When your patient or client is lying on the table, do you pay attention to where there head is in space (ie the position of their head)? Why should you care?

Remember our post on facilitation (if not, click here)? That has something to do with it.

Here is the short story. Make sure the head is neutral and midline (lined up between the shoulders), there is good preservation of the cervical curve , with a small pillow supporting the neck, but not altering it’s angle.

The long story involves the vestibular system. It is a part of the nervous system that lives between your ears (literally) and monitors position and velocity of movement of the head. There are three hula hoop type structures called “semicircular canals” (see picture above) that monitor rotational and tilt position and angular acceleration, as well as two other structures, the utricle and saccule, which monitor tilt and linear acceleration. I think you can see where this is going….

The vestibular apparatus (the canals and the utricle and saccule) feed into a part of the brain called the floccular nodular lobe of the cerebellum, which as we are sure you can imagine, have something to do with balance and coordination. This area of the cerebellum feeds back to the vestibular system (actually the vestibular nucleii); which then feed back up to the brain as well as (you guessed it) down the spinal cord and to predominantly the extensor muscles.

So, what do you think happens if we facilitate (or defaciltate) a neuronal pool? We alter outcomes and don’t see a clear picture.

Look at the picture above. Notice the lateral semicicular canals are 30 degrees to the horizontal? If you are lying flat, they are now at 60 degrees. If the head is resting on a pillow and flexed forward 30 degrees, the canals are vertical and rendered inoperable. This could be good (or bad) depending on what muscle groups you are testing.

OK. HEAVY CONCEPT APPROACHING

So if we defacilitate the extensors, what happens to the flexors? Remember reciprocal inhibition (If not click here)? According to the law of reciprocal innervation, the flexors will be MORE FACILITATED. If the extensors are faciltated, they will appear MORE ACTIVE and the flexors LESS ACTIVE.

Wow. All this from head position…The key herer is to know what you are doing, This gait stuff can get pretty complex; but don’t worry. We aren’t going anywhere and are here to teach you.

The Gait Guys . Gait Geeks are the new cool….

Just because a muscle tests weak doesnt mean it needs activated.

To Activate or Not Activate: That is the question…

Just because a muscle tests weak does not mean it can, should or needs to be activated.

Muscles become inhibited for many reasons.  Perhaps it is being forced into a substitution or compensation pattern because the primary motor pattern is not accessible.  Perhaps it is because there is a local inflammatory response (ie injury) near by or within the muscle. Perhaps the muscle is lacking in one or several of its primary tenants, S.E.S. (Skill, Endurance, or Strength). Perhaps the joint(s) that muscle crosses are arthritic, inflamed, damaged, remember that an inflamed joint does not like compression/loading. When a muscle contracts it will increase compression across the joint surfaces. Maybe it is being reciprocally inhibited by it’s antagonist, or does not have appropriate sensory feedback from its mechanoreceptors and is neurologically inhibited. The nervous system is wired with many “faults”, which shut things down. Often times, you need to explore the reason why.

So…What happens if you decide to “activate” the muscle regardless of any of the above, which should have been clearly determined by a clinical examination ?

You very well could be forcing that muscle back on the grid encouraging the muscle to perform in an unsafe or undesirable environment. You may be forcing compressive loading across a joint that is inflamed. You could be forcing compression and shear across a damaged cartilage interface, an osteochondral defect, a ligamentous tear or a combination of the above.  You will also be over riding the nervous systems inherent neuro-protective mechanism and by forcing the muscle to once again activate and work in a faulty movement pattern.  You very likely are reprogramming an unsafe and potentially damaging motor pattern.

Remember, when you “mess around” and over ride neuro-protective inhibition of a motor pattern you reteach a potentially dangerous sensory response telling the joint that the nervous system has been mistaken, that it is actually safe to place load and shear across the joint when in fact it is dangerous. Protective reflexes are there for a reason, to protect you!

We have seen the results of well intentioned or sometimes untrained individuals implementing activation into their clinical practices, coaching, or training.  Without a sound clinical examination to determine the reason for muscle inhibition one is taking a whole pile of warning signs and throwing them to the wind.  Remember, if you force a muscle back into activation despite all of the warning signs and reasons for inhibition, you will get a temporarily stronger muscle. This is not necessarily success.

In fact, what you have done, is enabled your client the ability to once again impart load and shear across a joint(s) and motor chain that was getting clear central nervous system signals to avoid the loading response.  You are essentially forcing a  compensation pattern and we all know where that leads to. 

As clinicians, we take an oath that states: “Primo Non Nocere”, which means “first, do not injure”. Know what you are doing. If you don’t, then get the training or don’t do it.

The Gait Guys. Were are here to help. We are watching. Do us proud and do the right thing.

Podcast 46: Georges St. Pierre, Regenokine & Compensation Patterns,

Podcast 46 is live !

Topics: Diffuse Axonal Shear in the nervous system, the new procedure Regenokine, the neurologic status of UFC fighter Georges St. Pierre, PCP thearpy, the new generation of slow running children, posture, compensation patterns, pre-race Tylenol effects/dangers, tibialis posterior tendonitis, shoe selection and so much more !  If you have not listened to one of our podcasts, this one will surely give you a good taste of what you are missing !

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-46-slow-kids-regenokine-compensation-patterns-monty-python

B. iTunes link:

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

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

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

D. other web based Gait Guys lectures:

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

________________________________________

* Today’s show notes:

Neuroscience Pieces:

1.  Future of computing 

http://news.cnet.com/8301-1023_3-57613090-93/how-leap-motion-tracks-what-it-cant-see/

 

2. We have been talking about body part replacements like bionics etc……but this could be the stone in the road to this progress

http://www.wired.com/wiredscience/2013/11/end-abx/

3. http://singularityhub.com/2012/04/24/regenokine-the-unproven-treatment-that-professional-athletes-are-flying-to-germany-for/

 

REGENOKINE: THE UNPROVEN TREATMENT THAT PROFESSIONAL ATHLETES ARE FLYING TO GERMANY FOR

5. Gait Factoid, posture matters

This week you did another post on running faster and about  "lifting the head to engage extensors"……  here was an article in the news on posture

- can you give the listeners a neat neuro tidbit on posture and the brain ?

http://lifehacker.com/the-science-behind-posture-and-how-it-affects-your-brai-1463291618?utm_campaign=socialflow_lifehacker_facebook&utm_source=lifehacker_facebook&utm_medium=socialflow

6. Ivo: What is your take on leaving obvious problems and compensations alone or fixing them ?      

7 . National Shoe Fit Program

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

http://www.podiatrytoday.com/blogged/what-tell-patients-who-ask-%25E2%2580%2598whats-best-shoe-me%25E2%2580%2599

8 . Tylenol Boosts Performance in Hot Conditions

http://www.runnersworld.com/general-interest/tylenol-boosts-performance-in-hot-conditions

 9. from a blog reader:

Hello Gait Guys,

What would you look to do with a 20 year-old competitive 5k runner (me) with chronic posterior tibialis problems?

- a short background: surgery two years ago on left talo-navicular joint osteochondral defect, since then mileage has been extremely limited (now it begins to fatigue painfully on 30 minute runs). 

Both sides affected, or sometimes one or the other. Arch of right foot got so painful last summer I was on crutches and could not walk/stand without supportive shoes. Currently the left side is most troubling and I can see no pattern!

Many thanks for the fantastic blog

Joy

10. Facebook reader:

Katie 

• I thought I’d go the experts on this one. I just took a myofacsical release class and the instructor said the most efficient running gait is by using your psoas. So, forward lean until you are about to fall forward and then contract psoas to lift the leg just enough to catch up with the body. He said this is how all the Kenyans run… makes sense kind of.. but???

11. Disclaimer:

Want more stability when trail running? Try this…

While running the other morning through about 6-8” of fresh snow (yes, it is snowing here already at 9000 feet), something occurred to me as I almost fell several times due to the undulating surface beneath my feet and the terrain to match under that.

“I need to do something to improve my proprioception, or I am going to fall (again)” I thought (yes, we both think about this stuff while running or exercising! No, I was not listening to music on this run, though cranking up some AC/DC was tempting..). If I were to increase my surface area on the snow, and make myself less top heavy, I would be more stable. How could I accomplish that?

Here is what I did, and it worked great!

First, I spread my toes. No, I wasn’t barefoot, but in my Altra Lone Peak 1.5’s; why not maximize the real estate available to my feet in these roomy shoes?

Next, I widened my stance (or base of gait). My massive 145# spread over a larger surface area would be more stable and provide stability from my weight distributed over a larger surface area.

Third, I raised my arms out from my sides (no I didn’t try to fly) to provide more input from my upper extremities to my proprioceptive system (more input from peripheral joint and muscle mechanoreceptors = more input to cerebellum = better balance)

Lastly, I slowed down from my blistering 10 min mile pace. Though this did not improve my surface area, it did give my aging nervous system more time to react.

It occurred to me that these actions were all “primitive” reactions of the nervous system when learning to walk. We did a post on that when my youngest son was learning to walk a few years ago.

Want to have better balance?

• Spread your toes
• Widen your stance
• Raise your arms
• Slow down

Notice I didn’t say this would make you faster. Who is more likely to fall on a corner when being chased by a predator; the tortoise or the hare?

A little practical neurology for you this morning brought to you by the geeks of gait. Ivo and Shawn.

Allen's Rule: Is this why the Kenyan's are better marathoners ?

Allen’s Rule

So you want to be the next great distance runner do you? There are some genetic components that might (or might not) come into play, things you obviously do not have control over.

Proposed by Joel Allen in 1877, Allen’s rule has in many respects been proven to have little scientific support.  None the less, knowing and  understanding the Rule has some value, especially if you are researcher J.S. Alho of the Ecological Research Unit of the Univ. Helskini, Finland where recent renewed interest in the rule has arisen due to global warming and the microevolutionary changes it predicts. 

Allen’s rule states that endotherms from colder climates tend to have shorter limbs than those in warmer climates. The theory is based on the surface area of an organism.  The larger the surface area the easier it is to dissipate heat, but also the easier it is too cool.  Depending on the location the organism finds themselves, this can be an advantage or a disadvantage.

There is a theory (ecographical rules if you will) by Allen’s rule, that suggests that growth plasticity of the limbs and other body parts exists and which is correlated with the temperature conditions of the developing mammal, particularly during the periods of rapid skeletal development. Allen’s rule suggests that relative extremity length decreases with increasing latitude.  Thus, according to Allen’s rule, those living on either side of the first degree of latitude from the equator (suggesting the hottest 138 mile or 222km swath on earth) should have the longest limbs (keep in mind this is likely a carried-forward genetic trait). This plasticity of the human skeleton allows mammals to adjust to the exposed temperature conditions during early development. This suggests possible advantages to climate rearing for would be world-class athletes depending on the chosen sport. For example, Allen’s rule proposes that individuals reared in hot climates will develop longer thinner limbs which have more surface area whereby they can irradiate body mass heat into the environment thus creating a net cooling effect of the body enabling physical exertion to occur longer and at a higher rate (appendage length correlates with temperature and latitude from which the mammal was raised).  This is one of the theories proposed as to why Kenyan runners outperform so many other professional distance runners, long thin limbs seem to act as cooling vents.  It is also one of those theories that seems to hold little water, but it is good to know none the less. Sometimes theories that are proven to be false come back to have some truth down the road. And maybe Alho will discover just this is the case in time.

Shawn and Ivo…….. The Gait Guys….pulling out random facts, some useful, others not so useful (and some proven debunked) to expand your gait knowledge. The more you know, ……… the better you are a cocktail parties.  Tis the season !

References:

1. Anat Rec (Hoboken). 2013 Oct;296(10):1534-45. doi: 10.1002/ar.22763. Epub 2013 Aug 19.

Allen’s rule revisited: temperature influences bone elongation during a critical period of postnatal development.

Serrat MA.

2. J Evol Biol. 2011 Jan;24(1):59-70. doi: 10.1111/j.1420-9101.2010.02141.x. Epub 2010 Oct 21.

Allen’s rule revisited: quantitative genetics of extremity length in the common frog along a latitudinal gradient.

Alho JS, Herczeg G, Laugen AT, Räsänen K, Laurila A, Merilä J.

Podcast 45: Spock, Ankle Syndesmosis injuries and Subways.

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-45-spock-syndesmosis-and-subways

B. iTunes link:

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

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

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

D. other web based Gait Guys lectures:

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

________________________________________

* Today’s show notes:

Neuroscience:

1. http://www.nytimes.com/2012/07/17/health/research/signs-of-cognitive-decline-and-alzheimers-are-seen-in-gait.html?_r=0

http://archive.sciencewatch.com/ana/st/alz2/11julSTAlz2Matt/

http://matsuokalab.georgetown.edu/pubs/2007%20Neurobiol%20Dis%20Caloric%20restriction.pdf

2. Coyote Joins 5K at Arizona State XC Championships

http://www.runnersworld.com/high-school-racing/coyote-joins-5k-at-arizona-state-xc-championships

http://wildandfreemontana.blogspot.com/2012/11/the-basic-gaits-of-your-basic-coyote.html

3. Ankle arthroplasty makes strides, but issues remain | Lower Extremity Review Magazine

http://lowerextremityreview.com/article/ankle-arthroplasty-makes-strides-but-issues-remain

4.Scanadu scores $10.5M and paves the way for FDA trials

http://gigaom.com/2013/11/12/scanadu-scores-10-5m-and-paves-the-way-for-fda-trials/

5 . National Shoe Fit Program

http://lowerextremityreview.com/article/multiple-factors-affect-running-shoe-selection

6 . http://www.ncbi.nlm.nih.gov/pubmed/20020101

Knee Surg Sports Traumatol Arthrosc. 2010 Oct;18(10):1379-84. doi: 10.1007/s00167-009-1010-y. Epub 2009 Dec 18.

Rotational laxity greater in patients with contralateral anterior cruciate ligament injury than healthy volunteers. Branch TP, 

 7.from a blog reader:

schwad01 asked you:

Guys. I am a Parkinson’s patient … 

 

8. FAcebook reader:

http://thegaitguys.tumblr.com/post/12603104452/gait-ataxia-and-gluten-yup-what-you-eat-can-affect

9. In the News:

Russian Subways Now Accept Squats for Payment

http://mashable.com/2013/11/12/russian-subway-squats/#:eyJzIjoidCIsImkiOiJfbDF4b245djZqNnI2M2UyeiJ9

10.In the research:

Syndesmosis and Lateral Ankle Sprains in the National Football League | Orthopedics
http://www.healio.com/orthopedics/journals/ortho/%7B50517223-98e3-4c9e-ac4d-328e3efd6a9a%7D/syndesmosis-and-lateral-ankle-sprains-in-the-national-football-league

11.GAME:

How Existential: Two MacBooks Playing Rock-Paper-Scissors Forever

http://www.fastcodesign.com/3021052/how-existential-two-macbooks-playing-rock-paper-scissors-forever?partner=rss

Heads up!

Remember that song “Hold Your Head Up” by the British  band “Argent” in 1972? Ok, maybe not, but the principle is very important to runners and sprinters, so lets talk about it a bit. 

We are wired to maintain our visual axes parallel to the horizon. This involves a series of joint and muscle mechanoreceptors in the neck (for a review of joint mechanoreceptors, click here, muscle mechanoreceptors, click here). These muscle and joint mecanoreceptors receptors, through connections in the midbrain (or mesencephalon as we neuro geeks like to call it) and pons, interact with the vestibular system to keep our head (and our bodies) upright, by firing our extensor muscles.

Berta Bobath, physiotherapist, wrote a great book in 1965 entitled “Abnormal Postural Reflex Activity Caused By Brain Lesions”. In it she describes, among many things, reflexes involving the cervical spine and correlating them to motor function. One of these is the cervical extensor reflex.

To explain this reflex, think of a dog sitting to get a treat. As he looks up while sitting down he has to extend his head, extend his front legs and fires all the axial extensor muscles associated with performing this action. The opposite would also happen, but with the flexors, if he were to bend forward to take a drink; fire front flexors and rear extensors to bend down. There are many more reflexes (tonic neck, cervcio ocular, etc) that could be the subject of another post.

As we have learned from the principle of facilitation (see recent post here), when we fire pur extensors, we fire into the extensor pool, and as a result, ALL extensors get to benefit. The advantage of the receptors in the cervial spine is that the upper four fire DIRECTLY into the flocculo nodular lobe of the cerebellum, and thus have a PROFOUND EFFECT on extensor tone in general.

So, if you want to go faster, why not hold your head up and FIRE YOUR EXTENSORS MORE? Hmmm….Where have you heard this before?

Another magic bullet, courtesy of your built in neurology, we are sharing with you so you and your clients, patients and friends can be better at what they do

The Gait Guys. Stretching your neurology on a daily basis.

 Master of your own physiology

You don’t need perfect mechanics to win. Look at these fine gents and take note.

On the left we have Kenensia “Canny” Bekele, world and Olympic 5,000m and 10,000m world record holder, who sat back as Mo Farah and Haile Gebrselassie set the pace for most of the race, and then sprinted at the end and won by 1 second. Note the crossover and lack of space between his thighs. Note also the internal tibial torsion of the left tibia and slight head tilt to the right.

In the middle is Mo Farah, the current 10,000 meter Olympic and World champion and 5000 meter Olympic, World and European champion. look at the pelvic dip on the right..and the valgus angle of the left knee…and external tibail torsion of the left tibia…and the differing arm swing (right side abducted).

Finally, on the right,  we have Haile Gebrselassie, an Ethiopian like Bekele, who won two Olympic gold medals over 10,000 meters and four Wld Championship titles in the event. He won the Berlin Marathon four times consecutively and also had three straight wins at the Dubai Marathon.  At 40, he is the eldest of the group, with his right lower extremity external tibial torsion and subtle dip of the left pelvis on right sided weight bearing.

So What? All these great athletes have mastered their own physiology and overcome any biomechanical faults they may appear to have. Could they be faster? Maybe. We think so.

Your body will find a way to compensate. That does not mean you will be slower. It means, like each of these men, that you will probably be injured at some point.

In the words of Big Z from Surf’s Up “Winners find a way”. You can too and so can your clients and athletes. Skill, endurance and strength. The big 3. Make sure you an the folks you care for have them.

We are The Gait Guys. Teaching you more with each post we write and helping you sort through the sea of information out there.

The One Cheek Sneak and Your Gait.

Yup. You know what we are talking about.  Out gassing. Passing gas. Trouser coughing. Flatulating (is that a word?) Tooting. Farting.. Call it what you like. Exemplified by Shinta Cho’s classic “The Gas We Pass”. The question is, why is it relevant to gait?

If you have followed us for any length of time, you know how important we think the glutes are.  We have many posts and blog articles on their importance and exercises to strengthen them.  The problem is, when most people do them, they THINK they are contracting their glutes (and some are) BUT they are ALSO contracting their (external anal) sphincter (for you neuro nerds,  the internal sphincter is not under voluntary control). This results in gas retention, which may cause a stomach ache, or in rare instances, distention of the bowel. Chances are, when  you relax, it will come out then (yes, you fart in your sleep, as your bedfellow for an honest answer !).

Try this. Sit down and and contract your glutes and your external sphincter. Now try and contract your external sphincter, ONLY. Contracting the external sphincter also engages the pelvic floor. Not necessarily something you need to do (unless you are treating an incontinence issue but then again that more recently under hot debate, here read our blog post here for some truths and myths on this topic) when running. OK, now just the glutes. You can palpate them (glutes only please) to make sure they are contracting. You are now experiencing isolation of the individual muscles. You should be able to access them individually, as well as together. For an added challenge in your powers of isolation, you can then try this exercise after consuming beans (as you flog your gut with their poisonous lectins) , to test your true abilities.

There are other related issues here to consider, one is the Kegal exercise. As we mentioned in another blog post (link here):

“A Kegel attempts to strengthen the pelvic floor, but it really only continues to pull the sacrum inward promoting even more weakness, and more PF (pelvic floor) gripping. The muscles that balance out the anterior pull on the sacrum are the glutes. A lack of glutes (having no butt) is what makes this group so much more susceptible to pelvic floor disorder (PFD). Zero lumbar curvature (missing the little curve at the small of the back) is the most [we would chose to say a nicely speculative] telling sign that the pelvic floor is beginning to weaken. An easier way to say this is: Weak glutes + too many Kegels = PFD.”-Nicole Crawford (1)

Many exercises are designed to help train your nervous system and create a new motor pattern, in addition to strengthening and or creating endurance in the targeted muscles.  Your external sphincter probably has plenty of strength and endurance.

The Gait Guys.  Bringing you the relevance in the seemingly irrelevant. All Gait; All the time…

 1. Here is Crawford’s article link.

http://breakingmuscle.com/womens-fitness/stop-doing-kegels-real-pelvic-floor-advice-women-and-men

All material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved. We have Lee and know how to use him

Podcast 44: New knee ligaments and Ankle Rocker

The newly discovered knee ligament, ankle rocker, hammer toes, yoga, joint flexibility and more ! Download Podcast # 44 today !

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-44-new-knee-ligaments-and-ankle-rocker

B. iTunes link:

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

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

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

D. other web based Gait Guys lectures:

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

________________________________________

* Today’s show notes:

Neuroscience:

1. Surgeons Discover Quirky Knee Ligament All Over Again
http://www.npr.org/blogs/health/2013/11/07/243710560/surgeons-discover-quirky-knee-ligament-all-over-again

New ligament discovered in the human knee
http://www.sciencedaily.com/releases/2013/11/131105081352.htm

2. Babies’ Immune Systems May Stand Down To Let Good Microbes Grow
http://www.npr.org/blogs/health/2013/11/06/243466416/babies-immune-systems-stand-down-to-let-good-microbes-grow

3. Brain and Motion

https://www.sciencenews.org/article/mind-motion

4. An Artist Attempts To 3-D Copy And Print Herself
http://www.fastcodesign.com/3021040/innovation-by-design/an-artist-attempts-to-3-d-copy-and-print-herself?partner=rss

5. Hero of week for POD?

Runner With Down Syndrome Makes History In New York
http://running.competitor.com/2013/11/news/runner-with-down-syndrome-makes-history-in-new-york_88642

6. National Shoe Fit Program

http://lowerextremityreview.com/article/multiple-factors-affect-running-shoe-selection

7.  http://www.sciencedaily.com/releases/2013/10/131024121804.htm

‘Anklebot’ Helps Determine Ankle Stiffness

8. Blog reader:

richies77 asked a questionHi, Incredible source of information. I have severe arthritis in the 2nd toe of my left foot. I have very little dorsiflexion and this has caused my hip flexor to become chronically, extremely tight. This has twisted my entire spine and made me pretty much disabled. I’ve been offered orthotics and perhaps rocker shoes but do you think surgery is the only way to bring back correct balance to my spine? Does anything else actually work? Thank you!

9. In the News:

Yoga and the Brain:

http://news.yahoo.com/brain-yoga-scientific-stretching-151820948.html

http://news.yahoo.com/brain-yoga-scientific-stretching-151820948.html

10. Women’s Flexibility Is a Liability (in Yoga)
http://www.nytimes.com/2013/11/03/sunday-review/womens-flexibility-is-a-liability-in-yoga.html

11. another blog reader:

What should I start doing for early cerebellar atrophy symptoms? I’m 6'5 195 and an athlete

 

12. CADENCE and BAREFOOT

http://lowerextremityreview.com/editor_memo/out-on-a-limb-benefit-without-bare-feet

Soccer/Football cleats: Do you know all you should in making the best choice of shoe ?

Is a flexible forefoot varus foot type going to safely perform in a bladed soccer shoe or would it do better in a studded shoe ? 

Recently an independent send us several pairs of revolutionary soccer cleats to get our opinion on them since we have somewhat of a history looking at and modifying cleats for NFL players.  

Soccer is a unique game.  During any one game players are expected to jog, sprint, run backwards, sideways, quick cut, cross over and many other variations.  The soccer cleat is supposed to be designed to help the foot engage the ground to maximize and optimize these gait variations.  A good cleat will enable and not disable or increase risk of injury. Accourding to some sources, a 90 minute professional soccer match can ask a player to run anywhere from 8000 to 11000 meters. One source suggested that two thirds of the game is walking or light jogging, One thirds is cruising, backing or sprinting and of the sprinting, 800meters requires maximal bursts of 10-40 meters over a total of approximately 800 meters.  Obviously, it is these 800 meters that are the critical ones that can make a game and it is at these times that the player is likely to need a good reliable cleat-ground interface to perform.  

It has previously been thought that the cleat cannot be too deep and ground-engaging otherwise torsional forces from the body will not play out into the turf and will rather move up into the ankle and knee and can lead to devastating injuries. However, one can make the case that a cleat could in some instances help to block excessive motion that could lead to injury. There are many grey areas when it comes to these kinds of issues.  Cleat choice for the ground type and playing conditions seems to be important. However, a small study in 2007 (1)  in the American Journal of Sports Medicine author Rajiv Kaila investigated knee loading patterns during various sidestep, cutting maneuvers and found no differences in the amount of force, stress or the degree of unwanted knee movement wearing any of the four styles of shoe. The study results were also backed by another similar study in the International Journal of Sports Medicine (2). The Gait Guys still remain somewhat skeptical however as these were unfatigued players and female players were not included in the studies as was suggested by this nice brief review article by Jay Williams.  That being said, there are studies that recently exist that discuss landing mechanics based upon gender, footwear, and the mode of landing as notable issues in injury incidence so not only do we need to consider the shoe, but also the person in the shoe and how they land as additionally relevant parameters.(3) When we speak of loading and landing patterns there are many issues to consider, and foot type and cleat pattern are variables to consider.  According to Queen (4) significant differences in forefoot loading patterns existed between cleat types. And when you put a forefoot varus or valgus forefoot type (and, one must know if that forefoot type is rigid or flexible, compensated or uncompensated) into a cleated shoe there are many variables that can play out. A forefoot varus is less likely to inversion sprain than a forefoot valgus foot type. Again, this is why we strongly recommend everyone take the National Shoe Fit Certification Program so that all of these variables can be taken into account.

When it comes to soccer shoes, comfort and fit are critical for performance.  (One must also realize that just like in hockey, soccer (we prefer to say FOOTBALL but it is not the preferred name here in the USA) players like to drop a half to full size in the shoes so that there is less foot-shoe interface slide and give. Players like the foot and shoe to perform as one because of the precision foot work and sudden pivoting that is often necessary.)  The issues of last shape are always critical depending on foot types. Just like in running shoes, a more straight, semi-curved and curve lasted shoes need to be matched to the appropriate foot types. We have talked about these issues many times before in previous blog posts here on our blog. Generically, a more pronated foot will get more control from a more straight lasted shoe and a more rigid-supinated foot will like a more curve lasted shoe.  This is why you MUST know the foot types and how to determine what foot type your client presents with. This is why everyone should take the National Shoe Fit Certification Program.  In this program we talk about the other shoe parameters like heel counter, sock liner, uppers, last patterns, vamp etc. 

There are basically three types of cleat types, blade, stud. The choice of which to use is based on the surface of play and the conditions.  The surfaces are broken down into 4 basic conditions: Soft ground, hard ground, firm ground (these are in decreasing order of ground “forgiveness”) and finally turf.

Turf fields generally dictate smaller more grippy finely studded cleats that enable maneuverability.

Hard ground fields will require shorter studs with generally a more uniform pattern and they are softer to react with the firm surface. 

Firm ground fields require a longer more rigid cleat or blade. This is the most common cleat used. They can range from 10-15 cleats protruding from the outsole and can vary in depth and size. Pivot-mobility points, stability points are generally considered in determining number, size, depth and location of the cleats or blades.

In soft ground or wet conditions longer cleats are often necessary and they can range anywhere from 10mm to 20mm in depth. Some types of higher end shoes (usually professional level) allow cleat selection by screwing them into the shoes and this allows size and depth specificity. Cleat numbers can vary but are often much fewer (6-8) in number and location to offer even weight distribution.  A more circular forefoot cleat/blade pattern supposedly optimize directional acceleration while more laterally and linearly arranged patterns supposedly provide more laterally oriented movements. This type of cleat should not be used on other surfaces as injury risk can increase. 

There is much to consider when choosing a cleated football/soccer shoe. There is the foot type, the shoe last, the playing conditions, the cleat pattern etc.  The more you know, the safer you may be.

Shawn and Ivo, The Gait (and shoe) Guys.

references:

1. http://ajs.sagepub.com/content/35/9/1528.abstract

Influence of Modern Studded and Bladed Soccer Boots and Sidestep Cutting on Knee Loading During Match Play Conditions. Rajiv Kaila, MBBCh, MRCS, MSc*

2.https://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-965000

Effect of Soccer Shoe Cleats on Knee Joint Loads. D. Gehring1\

3. Scand J Med Sci Sports. 2012 Apr 20. doi: 10.1111/j.1600-0838.2012.01468.x. [Epub ahead of print]

Effect of soccer footwear on landing mechanics.

Butler RJ, Russell ME, Queen R.

4.

Br J Sports Med. 2008 Apr;42(4):278-84; discussion 284. Epub 2007 Aug 23.

A comparison of cleat types during two football-specific tasks on FieldTurf.

Queen RM, Charnock BL, Garrett WE Jr, Hardaker WM, Sims EL, Moorman CT 3rd.

“… knowing this will not mistakenly leave one with the interpretation that the joint is suffering restriction, that the joint is merely showing its limitation because of the return shift of the eccentric axis to a less mobile position.” - The Gait Guys  

This video is just the kind of stuff that drives us nuts.  We do not have a personal problem with the good doctor, he may know (and most likely does know) far more than he is letting on here but is merely simplifying things for some reason. We merely have a problem with the information that is missing that could make this a valuable addition, or omission, to someone’s care. There are times to simplify things, but when we put out a video on the web where the world can see it, we try to be as thorough as possible even if this means that something will come across seemingly overcomplicated. The fact of the matter is that human biomechanics are in fact complicated and simplifying something, when it is just not possible to do so, really doesn’t help anyone. People, and maybe some medical professionals, who do not know better will see this and not see what is missing, importantly so, here.

In this video there is no regard to the pre-positioning of the metatarsal to that big toe. This is a very unique joint, it has an eccentric axis that changes with metatarsal plantarflexion and dorsiflexion. This eccentric axis is shifted by the shifting position of the relationship of the metatarsal head with the base of the hallux. Here, at this joint, we have a concave-convex joint interface which with all said joint types, has a roll-glide biomechanical rule.  This rule at this joint is unique in that the axis of roll-glide is eccentric meaning that the joint has a shifting axis during the motion of dorsi and plantarflexion.  This is dictated and dependent upon the posturing of the sesamoid bones properly beneath the metatarsal head.  You can hear more about this premise here, in a video we did a few years ago. It is long, but it is all encompassing.  What is important, that which is not noted here, is that with more metatarsal plantarflexion there is opportunistically more dorsiflexion at the joint.  (This is precisely the joint range loss that occurs in “turf toe”, hallux limitus.)  Thus, in the above video, to properly mobilize the big toe into dorsiflexion, the foot must be taken into full metatarsal plantarflexion (pointing the foot) where greater amounts of joint dorsiflexion will be found (because of the eccentric axis shift) and the joint should be also mobilized in full ankle and metatarsal dorsiflexion, but the therapy giver must know, and be expected to find, that less toe/joint dorsiflexion will ALWAYS be found in this position.  Knowing this will not mistakenly leave one with the interpretation that the joint is suffering restriction, that the joint is merely showing its limitation because of the return shift of the eccentric axis to a less mobile position.   

* Here is a little experiment you can do to teach yourself this principle. It should also help you to realize the gait cycle.

Sit in a chair, cross one ankle over the opposite knee and see what happens to the joint ranges as you proceed.  

• dorsiflex the ankle and big toe. With your muscles only, not your hands, actively pull back the ankle and toe striving to get the most amount possible of dorsiflexion at both joints.  You should see that there is some toe dorsiflexion of the big toe.  
• now keeping that big toe dorsiflexed as strongly as possible, begin to plantarflex the foot, thus moving the 1st metatarsal into plantarflexion as well. You should note that the relative amount of toe-metatarsal dorsiflexion DRAMATICALLY increases !
• you can also do this passively. This time start at full foot plantarflexion (foot pointed) and passively pull that big toe back into dorsiflexion.  A huge range is likely to be found if you have a cleanly functioning foot.  Now, try to hold that significant range while you push the ankle into dorsifleixon.  At the end of the metatarsal and ankle dorsiflexion range you should feel the big toe start to resist this range you are trying to maintain, the big toe will forcibly start to  unwind the dorsiflexion. This is because of the eccentric shift of the joint and tension building in the passive tissues in the bottom of the foot. 
• You want, and need, these relationships to occur properly and timely in the gait cycle and there are milliseconds to get it right and that means the entire kinetic chain must be clean of flaws, otherwise compensation will occur. (Note: Blocking or trying to control these issues with a foot bed, shoe type or orthotic can either be helpful therapeutically, or harmful to the chain.)

This is precisely what happens in the gait cycle. During swing phase the foot/ankle is in dorsiflexion to create foot clearance and to prepare the foot tripod for the contact phase with the ground.  There is some big toe (hallux) dorsiflexion represented in this swing phase, but it is not a significant amount you likely learned from your own self-demo above, mainly because it is not possible, nor warranted.  But, once the foot is on the ground and moving through the late stance phase of gait into heel rise, the ankle is plantarflexing. Thus, the metatarsals are plantarflexing, and this is causing the slide and climb of the metatarsal head up onto the sesamoids.  This causes the requisite shift of the axis of the 1st MTP joint (metatarsophalangeal) and affording the greater degree of toe dorsiflexion to occur to allow full foot supination, foot rigidity to sustain propulsive loading and also, never to forget, sufficient hip extension for gluteal propulsion. At this point, the range of the big toe in dorsiflexion is far greater than the dorsiflexion of the joint at ankle dorsiflexion. Impairment of this series of events is what leads to turf toe, hallux limitus as it is called. And when that becomes more permanent, even mobilizing the joint, as seen in the video above or otherwise, is not likely to get you or your client very far in terms of normal gait restoration.  And forcing it, won’t made it so either.

Remember this, the kinetic chain exists and functions in both directions. If you are starting with a hip problem that limits hip extension, and thus full range toe off during gait, in time you will lose the end range of the toe-off dorsiflexion range. And any attempts to try and regain it at the foot will fail long term if you do not remedy the hip.  "If you don’t use it, you will lose it". So to gain it back actively, sometimes you have to restore all of the functional losses of the entire kinetic chain to get what you are hoping for.  And for all you people doing “activation” to the glutes on your athletes, finding you are having to do it over and over and over again…….day after day after day, well … . . we hope you take this blog article to heart and put this thought process into action.

Remember, if you do not have the requisite strength, skill and endurance of the 2 toe extensors and 2 toe flexors as well as sufficient strength of the tibialis anterior (as well as many other components) you are likely to see impairment of this joint.  In this environment, do not expect joint mobilizations to offer you anything functionally lasting.  

We are not saying that joint mobilizations are useless and unnecessary, not by any means.  We are saying that you have to know what you are doing when you do them, so you can get the results you desire or, to realize why you are not getting the results you desire.  

Treat your clients with clear biomechanical knowledge and you will get the results you desire. If you go in with limited knowledge, results may speak for themselves. 

Gait analysis and understanding movement of the human body is a difficult task. It takes many years to learn the fundamental parameters and then many decades to implement the understanding wisely and with effectiveness.  Here at the gait guys, we hope to someday get to this point. We too, are students of gait and gait pathology. It is a journey.

“Once you understand the way broadly, you can see it in all things.”  -Miyamoto Musashi

Shawn and Ivo, The Gait Guys

Pod 43. Achilles problems, Neurology of watching sports, PEDS, hip joint centration.

Pod 43. Achilles problems, Neurology of watching sports, PEDS, hip joint centration, risks of swaddling babies and so much more. Join us today for this great podcast !

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-43-achilles-problems-neurology-of-watching-sports-peds-hip-joint-centration-risks-of-swaddling-babies-and-so-much-more-join-us-today-for-this-great-podcastB.

iTunes link:

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

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

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

D. other web based Gait Guys lectures:

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

________________________________________

* Today’s show notes:

Neuroscience pieces:

1. Brief Exposure to Performance-Enhancing Drugs May Be Permanently ‘Remembered’ by Muscles

http://www.sciencedaily.com/releases/2013/10/131027205618.htm

 

 Brief exposure to anabolic steroids may have long lasting, possibly permanent, performance-enhancing effects, shows  … .

2- Watching is like doing http://www.theglobeandmail.com/technology/science/go-neurons-go-science-explains-why-it-hurts-to-be-a-leafs-fan-sports-diehards-are-wired-that-way/article15214848/

This summer, Australian researchers at the University of Western Sydney published a study in which volunteers lounged comfortably in reclining chairs and watched a bland video of someone walking and running. The faster the person on the screen ran, the higher the pulse and breathing rates of the spectators rose, along with  … .

3. Economy and rate of carbohydrate oxidation during running with rearfoot and forefoot strike patterns.

http://www.ncbi.nlm.nih.gov/pubmed/23681915

4. Radiolab.org    

http://www.radiolab.org/story/runners/

5. Neuromuscular strategies for lumbopelvic control during frontal and sagittal plane movement challenges differ between people with and without low back pain.

http://www.physiospot.com/research/neuromuscular-strategies-for-lumbopelvic-control-during-frontal-and-sagittal-plane-movement-challenges-differ-between-people-with-and-without-low-back-pain/

6. Achilles: How Much Energy Does Your Achilles Tendon Store? Stiffer tendons help you run more efficiently, but it’s not clear how.

http://www.runnersworld.com/general-interest/how-much-energy-does-your-achilles-tendon-store

7. Ivo: blog post on toe extensors, the neuromechanics behind it

8. From onlineCE.com, last weeks course

9. Hip centration principles……. principles of accessory motions

http://thegaitguys.tumblr.com/post/65339107752/the-power-of-facilitation-how-to-supercharge-your

10. Swaddling babies can cause them hip problems, doctors warn
http://www.theguardian.com/society/2013/oct/28/swaddling-babies-blankets-hip-problems-doctors-warn

from a blog reader

11 Q: can metatarsalgia be caused by ITband tighness ?

 

12. Disclaimer

13. National Shoe Fit program and our Payloadz store

14. Take a monthly course from us at www.OnlineCe.com

 

15. Blog reader:

Guys I feel a little ridiculous asking this ? considering the amount of time I’ve spent reading your info but here goes: I understand the concept of the foot tripod and it’s importance for stabilization and balance when static or during single leg with eg squats, but when should the tripod be utilized during the normal gait cycle?

16 .From a blog reader:

Hello Gentlemen, I was wondering if you could point me in the right direction in terms of addressing a Tailor’s bunion on the 5th met. Thank you!!

Video case: The King’s Preference: Short and Sweet. A quick and easy case demonstrating the patellar tracking struggles with external tibial torsion.

Our favorite functional evaluation piece of equipment as well as our favorite piece of therapy equipment is the Total Gym.  Here we clearly demonstrate, to us and the client, in partial weight bearing load, the effects of external tibial torsion.  

Remember, the knee is sort of the King of all joints when it comes to the lower extremity.  The knee is a sagittal plane hinge, and so all it wants to do is hinge forward, freely without binding from deficits at the hip or knee. But we cannot ignore the simple fact that pre-pubescent kids the long bone derotation process is still undergoing, and in adults the process may have been corrupted or insufficient.  

In this case it should be obvious that the knee is sagittal and free to hinge when the foot is at a large foot progression angle.  This allows the knee to hinge cleanly. But when the foot is corrected to the sagittal plane, as you see in the second half of the video, the knee tracks inward and this can cause patellofemoral pain syndromes, swelling, challenges to the menisci (and possible eventual tears) and challenges to the ACL and other accessory restraints.  Additionally, this medial drift is a longer and more difficult challenge to the eccentric phase external rotators such as the gluteus maximius not to mention many of the other muscles and their optimal function.  

So, the next time you see a large foot progression angle in a client or in their walk (duck footed if you will) try to resist the natural urge to tell them to corrrect the foot angle. They are likely doing it to keep the King happy.  And furthermore, be careful on your coaching recommendations during squats, olympic lifts, lunges and running.  Just because you do not like the way the foot looks doesn’t mean you should antagonize the King of joints.  

External tibial torsion, its not something you want to see, but when you do see it, you have to know its degree, its effects at the knee, hip and foot as well as how it might impact hip extension, pelvic neutrality, foot strike, foot type, toe off and so many other aspects.

Whoever said gait analysis was easy was a liar. And if all they use is a video camera and fancy analysis software they have show up with only part of the team. And if they said they were an expert  in gait only a few years into practice, you had better also look for a jester’s hat somewhere hiding in the corner. After all, the King would want to know !

Shawn and Ivo, your court jesters for the last 3+ years.  Maybe we will get a promotion from the King someday soon !

Podcast 42: Rhabdo, Bionics and Turf Toe

Rhabdomyolysis, Bionics, Turf Toe, Low vs High threshold and a whole lot more in today’s show !

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-42-rhabdo-bionics-and-turf-toe

B. iTunes link:

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

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

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

D. other web based Gait Guys lectures:

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

________________________________________

* Today’s show notes:

Neuroscience pieces:

 

1.  a tiny chip in the new iPhone called the M7 “motion coprocessor.” is designed to track your movement and automatically figure out  … . 

 

http://reviews.cnet.com/8301-6452_7-57602497/should-fitness-gadget-makers-fear-the-iphone-5s/

 

2. Bionic Leg

First mind-controlled bionic leg a ‘groundbreaking’ advance
http://www.nbcnews.com/health/first-mind-controlled-bionic-leg-groundbreaking-advance-8C11257732

3. Dying young.

By altering water temperature and day length to influence the growth rates of fish, researchers have provided the first empirical evidence that if you grow fast, you die young. 
http://pulse.me/s/q1TnO

4. Low vs high threshold strategies

http://www.aaronswansonpt.com/low-vs-high-threshold-strategy/

 

5. Rhabdomyolysis 

http://news.yahoo.com/video/crossfit-linked-potentially-fatal-condition-125412461.html

6. In the media:

Why runners don’t get knee arthritis

http://well.blogs.nytimes.com/2013/09/25/why-runners-dont-get-knee-arthritis/?_r=2

 

7. Disclaimer

8. National Shoe Fit program and our Payloadz store

9. Online CE October 30th

10. Blog reader

 I’m a soccer player and suffered a “turf toe” type injury 2 years ago … 

11. Hi guys. Thanks for the great material. Are there any good exercises for helping correct fully compensated forefoot varus (I have it in both my feet). Orthotics have not helped at all in the past, and I have feeling that this is something I acquired. I am almost certain that this is the root cause of the horrible hip-back-neck pain I have experienced for the last 8 years. Thanks!

According to the CDC, falls are the number one reason for death and injury among people age 65 and older. More than two million older people went to an emergency room in 2010 because of a fall.

From the article “The Science of Trips and Falls” (link)

“After a fall, older people often say they tripped or slipped. Researchers at Simon Fraser University, in Burnaby, British Columbia, wanted to observe what really happens. The team outfitted a long-term-care facility with video cameras and recorded residents going about their daily lives. They recorded 227 falls from 130 individuals over about three years. Tripping caused just 1 out of 5 of the incidents. The biggest reason for falling—accounting for 41% of the total—was due to incorrect weight shifting, like leaning over too far, says Stephen Robinovitch, a professor in the biomedical physiology and kinesiology and engineering science departments. Other, less frequent reasons for falling included loss of support with an external object, like a walker, or bumping into something.”

Using Tai Chi in the gait retraining process. Watch the attached video above.

This is particularly useful in reteaching weight transfer in the elderly or in the post operative hip, knee or foot clients. It is most useful in post operative total hip or total knee replacements. Note the slow loading responses which focus on effective weight transfer and loading as well as forcing safe balance challenges because the other foot is always skimming across the floor if  needed. 

Also, note that the transfers are always facilitating ankle dorsiflexion, just make sure you are not teaching this with knee extension lockout because it will cheat the amount of effort and wanted challenge to the anterior compartment.

We use the tai chi transfers as shown in our rehab in specific cases, but if you are dealing with the elderly, this is a great part of a daily program to reduce the fall statistics we listed earlier.  It helps the post operative cases and elderly where exactly are the limits of their safe weight shifting and where the risk zone of excessive weight shift begins.  

If you are looking for a good soft gentle way to:

1- improve balance

2- increase awareness of weight shifts that are not beyond the frontal plane stability of the hip (ie. improve awareness of the gluteus medius and lateral hip stabilizers)

3- improve the awareness of the back leg hip extension and gluteus maximus use during the forward weight transfer

4- improving anterior compartment awareness, skill and strength

5- improve weight bearing ankle rocker motion

… . then the basic tai chi walking weight transfer is an excellent start. I have taught my 80 year old parents this simple daily challenge and I think it will reduce their falls. We have used this in post operative knees and hips and it is a nice gentle start for many clients.  And when done super slow in a deep knee bend the challenges as described by our upper level athletes are surprising to both us and them.  Do tai chi for 30 minutes and learn its secret values. Millions of people around the world all can’t be wrong.

Shawn and Ivo, taking gait to new dimensions.

Hip Abduction moment?

This was a great question we received, so we thought we would make a post of it, so everyone could benefit.

“@GregLehman: @KineticRev @TheGaitGuys do you guys have a link to your thoughts on how an ER leg allows the quads to create a hip abductor moment? Thanks”

First of all, What IS a hip abduction moment?

In posts, we often refer to a “moment”, meaning almost literally, a few seconds where a certain motion occurs. When are watching someone from behind and see their heel adduct as they get to terminal stance and pre swing (just before they toe off), you are seeing an “adductory moment” of the heel, sometimes referred to as an “adductory twist”.

Now lets think about the hip. Have you ever seen a framing square used by a carpenter? It is an “L” shaped device to make sure things are square (like hanging a door). The hip is kind of like this. It is shaped like an “L” with the neck and head forming the shorter side of the “L” and the femoral shaft forming the longer side. If you imagine the short side of the square attached to the pelvis and now hinging that away from the body, you have abduction of the hip. Normally, this task is tended to (primarily) by the middle fibers of the gluteus medius and posterior fibers of the gluteus minimus, assisted by the quadratus lumborum on the opposite side.

How can the quad be involved?

We remember that the quadriceps has four parts, the vastus lateralis, vastus intermedius and vastis medialis (collectively called “the vasti’) and the rectus femoris.

The rectus femoris proximal attachments are at the anterior inferior iliac spine (this is called the straight or anterior head) and the superior lip of the acetabulum (called the reflected or posterior head) Please see the top of the 2^nd picture above, you can see the 2 heads. The distal attachment, after blending with the vasti, is into the patellar tendon and ultimately the tibial tuberosity.

The rectus is an accessory hip flexor and knee extensor, though it not normally a prime mover for either of these motions. It’s amount of action depends on the position of both the knee and hip.  When the knee is flexed, the rectus has less mechanical advantage, because it is placed in a lengthened position; same goes if the hip is extended.  It will be shortened if the hip is flexed and if the knee is extended at the same time, will have a mechanical disadvantage.

Now think about the direction of travel of each of the heads.

The “straight” head actually runs more obliquely from lateral to medial from its proximal attachment (AIIS) to the distal attachment (blending with vasti and patellar tendon); the refelected head runs a similar course, but not as oblique. If you were to externally rotate the thigh (remember, some folks may have an externally rotated foot due to external tibial torsion), it would actually give these heads more mechanical advantage (when the knee is relatively extended, such as at heel strike/ initial contact and toe off/ preswing) as abductors (remember to think from the ground up, closed chain, so the distal attachments are acting more like the origin); thus, the abductor moment we have talked about.

There you have it @Greglehman. Thanks for the great question.

The Gait Guys. Uber Gait Aficionado’s Extraordinaire. Come and learn with us. Watch us on Youtube; follow us on Facebook and Twitter, see many of our downloads on our payloadz site by clicking here.

All material copyright 2013 the Gait guys/ The Homunculus Group. All rights reserved; don’t make us call Lee.