Welcome to rewind Friday, Folks. This week we have hammered on arm  swing. This one is from a year ago and seemed germane to this weeks posts.

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

It becomes clear that once you get the amazing feats seen in this video out of your head, and begin to watch just the variable use of the arms that you will begin to appreciate the amazing need for arm swing and function in movement.

We have written many articles on arm swing and its vital importance in gait and running. Have you missed all these articles ?  If so, go to our blog main page, type in “arm swing” in the search box and you will have a solid morning of readings at your fingertips.  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.

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 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. (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). 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 movements and energy conservation but protection has the cost of wasting energy and reduced mobility through a 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.   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 the functional movement assessment programs became popular.  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 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. 

Shawn and Ivo …  combining 40 years of orthopedics, neurology, biomechanics and gait studies to get to the bottom of things.

So you do not think arm swing is important huh ?  Read these 2 stats and recalibrate your thinking.  

This was yet another slide from last nights well attended teleseminar. Those that attended learned all of the up to date facts that doctors, trainers, coaches, therapists need to quickly understand what factors to look for when observing someones gait.  Including our favorite, “what you see is not the problem in their gait, rather it is there strategy around the faulty parts, problem or pain.”

If you think that changing arm swing at the local level is not a big deal, just digest the towering facts from this slide.  Arm swing is a big deal ! It is a CPG generated big deal (Central Pattern Generator).  

Sorry we missed you last night.  The teleseminar was recorded and should be up on www.onlinece.com or www.chirocredit.com in a few days for you to enjoy on your own free time (and so are a few dozen of our other lectures !).   

So, if you are coaching or making local-level arm-swing form running or training changes in yourself or your client, you are probably making some big mistakes.  Our lecture brings this all to light for you in one place !

Arm Swing matters…….. more than any of us previously knew !

Shawn and Ivo, The Gait Guys

Faulty Arm Swing provides clues to gait pathology.

Don’t think that just because you see aberrant arm swing that you should “coach” it out of someone.  It is very likely there for a reason. We discuss tonight how the leg swing is more deeply neurologically embedded, more so than arm swing.  So, fixing something you do not like in their arm swing is very possibly the wrong solution and by doing just that you are forcing your client into a new compensatory CPG (central pattern generator) which is essentially a compensation to their compensation.   Fix the problem, go for its roots !

This is one of our slides for tonights lecture.  This is from the European Spine Journal 2011.  More posterior arm swing can help improve impaired hip extension and gluteal function. A nice compensatory fix to reduce spine rotation in a spinal pain patient, more hip extension means that less pelvic obliquity needs to be acquired (less obliquity in the pelvic girdle means less spine rotation and thus less spine compression. This is a brain based phenomenon, the brain is engaging a pain avoidance CPG. 

You gotta know your biomechanics, you gotta know your neurology and you MUST understand and recognize normal and abnormal gait patterns if you choose to work with humans !

Join us tonight on www.onlinece.com for an in-depth hour talking about the biomechanics and neurobiology behind normal and abnormal arm swing.  7pm central Wednesday 19th.

Shawn and Ivo, the gait guys

Have you ever wondered why people who walk together quickly synchronize their gaits ?

From healthy heart cells that synchronize to a single beat, to women in school dormitories or work places who synchronize their menstrual cycles, to fireflies who begin blinking in synchrony when they all perch in the same tree synchronization is something that is abundant in nature.  It is no wonder that we find synchronicity in one of our most primitive and frequent motor patterns, walking together with someone shows the same synchronicity phenomenon.

Hold the hand of your favorite person and go for a walk. Within a few strides your gaits will synchronize. Is it because it is easier ? Is it because when synchronized the arm swings will match thus making it easier and more effortless to hold hands ?  Does the same effect occur if you are not holding hands ? Studies have concluded that although it does not happen all of the time, they found it occurs in almost 50% of the walking trials even among couples who do not usually walk together. This is far too high a percentage to not make it a statistically significant finding.

The synchronization between walking partners is more complex than it seems on the surface.  There are two types of synchronization, in-phase (both person’s right foot move forward at the same time) and out-of-phasesynchronization (where the right foot moves forward with the partners left foot).  You can see in the video above that the couple has subconsciously fallen into an Out-of-Phase synchronization, then after the tide splash that throws them off within just a few steps they fall right back into Out-of-Phase synchronization and hold it in that state.  There are multiple factors and communication mechanisms occurring. There are auditory mechanisms in play such as the sound of the other persons foot fall.  There are even visual mechanisms through peripherally seeing your partners arm swing and foot fall which encourages the imitation synchronization. However, the strongest in-phase synchrony occurred in the presence of tactile feedback meaning hand holding or embracing each others waist from behind, which couples often do when walking more slowly, seem to create a stronger synchrony.  When this tactile component is engaged between two walkers it is plausible that the upper and lower limbs move more freely when paired up, particularly with arm swing.

What is thought to happen is that one partner dominates the lead in the gait, just as in dancing, one person is the leader and the other is the follower. The lead partner’s lower limbs determine the movement of their arms, which in turn when holding hands, sets the arm movement pattern in the partner then determining the leg swing and stance phases. Thus, synchrony is achieved. 

However, it is important to note that many of the studies were clear to mention that even in non-tactile cases, many of the gaits of two people walking together are synchronized. This was likely due to the visual and auditory parameters however height, leg length cadence etc could also play into those successful non-tactile synchrony cases.

These are interesting findings at 50% because it is very unlikely that any two people are of the same height, leg length, cadence, stride and step length.  These are all parameters that are likely to change the likelihood of gait synchrony.  Zivotofsky found that “even in the absence of visual or auditory communication, couples also frequently walked in synchrony while 180 degrees out-of-phase, likely using different feedback mechanisms”. The studies below discuss many issues of this synchrony but it is perhaps most significant in clinical rehabilitation cases or in early or moderately advanced movement impairment disorders and diseases these findings may partially explain how patients can enhance their gait function when they walk with a partner or therapist.  It is in these movement impairment syndromes and diseases where the central processing and Central Pattern Generators (CPG’s) are diseased leaving them with the need for other cues such as those discussed here today, auditory, visual and tactile.  

You may have read our previous blog articles on arm swing and how intimately they are anti-phasically (opposite) paired with lower limb swing.  But today’s blog post article took limb swing to another level.  Stay tuned for more on arm and leg swing in human movement.  If you wish to read our other works on arm and leg swing and their deeper effects on gait, go to our blog www.thegaitguys.tumblr.com and enter the words “arm swing” into the SEARCH box. 

Shawn and Ivo…….. taking gait far beyond what you learned about it in school.
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References used:

J Neuroengineering Rehabil. 2007; 4: 28. The sensory feedback mechanisms enabling couples to walk synchronously. An initial investigation.  Ari Z Zivotofsky and Jeffrey M Hausdorff  Published online 2007 August 8. doi:  10.1186/1743-0003-4-28

Hum Mov Sci. 2012 Jun 22. [Epub ahead of print] Modality-specific communication enabling gait synchronization during over-ground side-by-side walking. Zivotofsky AZ, Gruendlinger L, Hausdorff JM.Gonda Brain Research Center, Bar-Ilan University, Ramat-Gan 52900, Israel.

What do you do with these Dogs?

Take a good look at these feet. Hard to not cringe, we know. In this photo, the gentleman’s feet are relaxed! Imagine what it they will look like with some additional long flexor tone!

So, keeping in mind his tibial varum (bend in the tibia) and uncompensated forefoot varus (inability to get the head of his 1st ray down to the ground), what can we do?

• how about we increase extensor strength? He could do the lift, spread, reach exercise while tripod standing. He could do the toe waving exercise.   He could do shuffle walks.
• teach him to stretch his long toe flexors. Frequently. 20-30 mins minimum; daily
• you could manipulate his feet to ensure better biomechnics
• you could massage his feet to improve mobility and circulation
• you could facilitate his long toe extensor muscles
• you could inhibit his long toe flexor muscles
• you could improve ankle dorsiflexion by showing him how to stretch the calves, 20-30 mins daily
• you could improve ankle dorsiflexion by making sure he has adequate hip extension
• he could wear correct toes, to improve the biomechanical advantage of the long toe extensors
• he could wear shoes with a wider toe box
• he could wear shoes with less ramp delta (or drop)
• he could wear shoes with less torsional rigidity

and the list goes on. There are many simple things you teach a person with feet like this. many of them we have introduced you to here on the blog. Spend some time. Learn some cool stuff. Read the blog. Follow us on Facebook. Attend a Biomechanics class we teach the 3rd Wednesday of each month on onlinece.com . Check out our Youtube Channel. Consider furthering your education and taking the National Shoe Fit Program.

The resources are there. All you need to do is dig a little deeper.

We are The Gait Guys and we are all things gait.

Arm Swing: The Straight up Truth

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

* On Wednesday of this coming week, Feb 19th at 7pm central on www.onlinece.com we will give an important 1 hour teleseminar on “Arm Swing”. We will discuss all of the current research. If you think you know when, why and how to correct Arm Swing deficits, you are probably lacking the research and honest truth. Today’s blog post will prepare your head for the event.

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

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

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

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

Shawn and Ivo, The Gait Guys.  

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

Limitations: The powers of observation will help you.

Physical examination, FMS, DNS, gait analysis … . . these are all very important tools for the coach, trainer, therapist, clinician.  They will all offer information and lead the “therapy giver” in a direction for intervention.  But when something doesn’t match up with the basic standard protocols, you have to go outside the standard box.  We have all been there and today is just a little reminder not to get caught up in the “proceedures” and merely running through protocol without an engaged brain putting the pieces together.  

Here we see 2 classic examples of deviations from the mean, the client on the left has drifted further outside the frontal plane because of tibial varum and a little genu varus.  The client on the right has imploded deep into the frontal plane via rigid pes planus foot collapse and genu valgum.  These will both affect your physical screenings for these clients. And keep in mind, and this is probably the most important point of today’s blog post, either client may have good or bad strategies around their anatomy.  In other words, some clients will have great compensations to limit further functional pathology, and some will have poor compensation strategies, and thus, both will have different physical exam findings, different screenings and different neuromotor patterns embedded deep into their CPGs (central pattern generators).   Put yet another way, all of the scenarios discussed may/will have varying screening assessment outcomes but for different reasons.  If you know the cause of these faults and the impaired neuro-recruitment patterns that are likely, your assessments will make more sense, and so will your exercise/therapy/rehab prescriptions.  If you do not understand the fundamental differences (ie long bone torsions or various femoral-neck shaft angles, foot types such as an uncompensated forefoot valgus etc) , one could prescribe therapies that will not address the underlying problems, rather they might address the compensations and strategies found with these client’s challenges.

It can get sloppy messy.  Wear a bib.

Dig for the roots, don’t mow the grass…… Shawn and Ivo, The Gait Guys

A look at the Lunge. Are you ready to take the lunge?

Another one of our favorite exercises. Unfortunately, all too often it is executed improperly. Watch carefully, as we cover many points in detail.

Remember the mantra; Skill, Endurance, Strength. In that order. Not every individual is ready for every exercise you may give them. Be sure to build an adequate foundation before proceeding ti the next level.

This excerpt is taken from our video series, available for download here.

The Gait Guys. Join the movement and spread the word. .

Everyone need a good running partner! Never would have thought of taking our duck with us….

Have a great Friday Folks..

• when spine pain presents the shoulder and pelvic girdle “anti-phase” oscillations (oscillate in opposite rotation) begin to move into a more “in-phase” favor.  Meaning that the differential between the upper torso twist and pelvic twist is reduced. The brain does this to reduce spinal compression. And when we reduce compression shear forces increase.  This is not a good thing.

We are getting the last of the slides together for our www.onlinece.com international teleseminar on Feb 19th, 7pm central.   

You should join us.  This months lecture is on Arm Swing.  

Hope to see you all in 12 days online !  Be sure to sign up ahead of time, we will likely have a large audience.

Happy Friday !

Shawn and Ivo,   The Gait Guys

Treadmill Truths: Because there is alot of Crappy Myths being Laid Down this week on the net.

The Truth About Treadmills: A Neurological Perspective

Gender differences in walking and running on level and inclined surfaces. 

Chumanov ES, Wall-Scheffler C, Heiderscheit BC. Clin Biomech (Bristol, Avon). 2008 Dec;23(10):1260-8. Epub 2008 Sep 6.

What the Gait Guys have to say about this article:

This article highlights some of the differences in gait between males and females on treadmills. Though treadmills don’t necessarily represent real life, they are an approximation. While reading this article, please keep the following in mind:

1. the treadmill pulls the hip into extension and places a pull on the anterior hip musculature, especially the hip flexors including the rectus femoris, iliopsoas and iliacus. This causes a slow stretch of the muscle, activating the muscle spindles (Ia afferents) and causing a mm contraction (ie the stretch reflex). This acts to inhibit the posterior compartment of hip extensors (especially the glute max) through reciprocal inhibition, making it difficult to fire them.

 2. Because the deck is moving, the knee is brought into extension, with stretch of the hamstrings, the quads become reciprocally inhibited (same mechanism above).

 3. The moving deck also has a tendency to put the ankle in dorsiflexion, initiating a stretch reflex in the tricep surae (gastroc/soleus) facilitating toe off through here and pushing you through the gait cycle, rather than pulling you through (with your hip extensors).

 4. the moving deck forces you to flex the thigh forward for the next footstrike (ie footstance), firing the RF, IP and Iliacus, and reciprocally inhibit the g max

If your core isn’t engaged, the pull of the rectus femoris and iliopsoas/iliacus pulls the ilia and pelvis into extension (ie increases the lordosis) and you reciprocally inhibit the erectors and increase reliance on the multifidus and rotatores, which have short lever arms and are supposed to be more proprioceptive in function. Can you say back pain?

In summary, treadmills are not the scourge of humanity, but do have some pitfalls for training, and equal amounts of “backwards” running should be employed (with great caution, mind you)

With that being said, lets look at the results: increased hip internal rotation and adduction, as well as more glute activity for the ladies. Not surprising considering women generally have a larger Q angle (17 +/- 3 degrees for females, 14 +/-3 degrees for males) and greater amounts of hip anteversion (average 14 degrees in females vs 8 in males). The larger Q angle places more stress at the medial knee (compression of the medial femoral condyle and usually increased pronation as the center of gravity over the foot is moved medially) and thus more control needed to slow pronation (from the glutes to control/augment internal rotation). Greater hip anteversion means the angle of the femoral head is greater than 12 degrees to the shaft of the femur. This moves the lower extremity into a more internally rotated position, approximating the origin and insertion of the adductors, making them easier to access. With an increased Q angle and easier access, greater demands are placed on adductors in single leg stance (which is considerably greater in running), This increased adductory moment places more demand on the gluteus medius (and contralateral QL) as well, to stabilize the pelvis and this correlates with speed and incline, also found in the study.

The take home message? Don’t throw away your treadmill! The treadmill can be an excellent diagnostic tool! Gluteal and adductor insufficiencies will be more visible (and probably more prevalent) in females, especially those running or walking on treadmills. The hip extension and ankle dorsiflexion moment created by a treadmillworks against some of the stabilizing mechanisms (glute inhibition, ankle dorsiflexor inhibition) and help to highlight some of the subtle gait abnormailities you may miss otherwise.

Abstract from Article

BACKGROUND: Gender differences in kinematics during running have been speculated to be a contributing factor to the lower extremity injury rate disparity between men and women. Specifically, increased non-sagittal motion of the pelvis and hip has been implicated; however it is not known if this difference exists under a variety of locomotion conditions. The purpose of this study was to characterize gender differences in gait kinematics and muscle activities as a function of speed and surface incline and to determine if lower extremity anthropometrics contribute to these differences.

METHODS: Whole body kinematics of 34 healthy volunteers were recorded along with electromyography of muscles on the right lower limb while each subject walked at 1.2, 1.5, and 1.8m/s and ran at 1.8, 2.7, and 3.6m/s with surface inclinations of 0%, 10%, and 15% grade. Joint angles and muscle activities were compared between genders across each speed-incline condition. Pelvis and lower extremity segment lengths were also measured and compared.

FINDINGS: Females displayed greater peak hip internal rotation and adduction, as well as gluteus maximus activity for all conditions. Significant interactions (speed-gender, incline-gender) were present for the gluteus medius and vastus lateralis. Hip adduction during walking was moderately correlated to the ratio of bi-trochanteric width to leg length.

INTERPRETATION: Our findings indicate females display greater non-sagittal motion. Future studies are needed to better define the relationship of these differences to injury risk.

PMID: 18774631 [PubMed - indexed for MEDLINE]

Yup, we’re gait nerds….Don’t laugh….You are too if you are reading this…..

The Gait Guys: finding other uses for treadmills, other than for hanging the laundry…..

Podcast 53: Debunking Treadmills & Recovery Strategies

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-53-debunking-treadmills-recovery-strategies

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”

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* Today’s show notes:

By this time next year, you could be 3D printing custom comfortable inserts for your shoes
http://gigaom.com/2014/01/26/by-this-time-next-year-you-could-be-3d-printing-custom-comfortable-inserts-for-your-shoes/

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LeBron James, Kevin Durant Help Spearhead NBA Popularity of Legs Recovery System
http://bleacherreport.com/articles/1932257-lebron-james-kevin-durant-help-spearhead-nba-popularity-of-legs-recovery-system#articles/1932257-lebron-james-kevin-durant-help-spearhead-nba-popularity-of-legs-recovery-system

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Mechanism of orthotic therapy for the painful cavus foot deformity
http://www.jfootankleres.com/content/7/½/abstract

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The influence of incline walking on joint mechanics

http://www.gaitposture.com/article/S0966-6362(14)00002-2/abstract

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Biomechanics Expert Debunks Treadmill-Running Myths
http://www.runnersworld.com/treadmills/biomechanics-expert-debunks-treadmill-running-myths

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Ice baths:

http://www.theactivetimes.com/cold-hard-truth-about-ice-baths

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8:38am Jan 21

Hi guys,

I’m hoping you can help.

I have a severely arthritic 2 MTPJ on my left foot.

It seems to trigger extreme hip flexor tightness which has twisted my whole body, right up to my neck and jaw.

I can’t seem to get any definitive answers as to how to turn off this protective hip flexor tightness. I’m concerned if it goes on much longer I’m going to develop bone spurs throughout my body. This would destroy my life.

Is there any surgery you recommend?

Or any type of Rocker soled shoe? I’ve tried MBT’s but I think the forefoot is stiff enough and my Hipflexor hasn’t calmed down properly.

Thank you so much if you decide to answer this

Richard

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Blog reader: moham17

How does subtalar supination/pronation affect plane deviations farther up the chain, specifically at the pelvis? I was going over some notes and found something saying that increased pronation leads to increased frontal plane motion at the pelvis during gait, and increased sup leads to increased transverse plane motion. However, in this video I was watching, the clinician states that increased sup will lead to increased frontal plane motion. Is this not a contradiction? Can both be true? Thanks

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Fighting falls with feedback: Virtual reality training improves balance | Lower Extremity Review Magazine
http://lowerextremityreview.com/issues/january/fighting-falls-with-feedbac-virtual-reality-training-improves-balance

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Brooks Transcend and Altra Olympus: Max Cushioning In a Lightweight Package Appears To Be The New Trend in Running Footwear

http://runblogger.com/2013/08/brooks-transcend-and-altra-olympus-max.html

Stacking of the joints, and something that can go wrong when they don’t stack well.

Here is a short, sweet and simple case to open up some thoughts.  We have read on several occasions  of people making changes to arm swing as a solitary independent issue.  Arm swing, when aberrant, is quite often a compensatory change to something else. It is quite often a problem in the opposite lower extremity.  We will be doing a 1 hour teleseminar in 2 weeks on www.onlinece.com on the topic of arm swing. Why don’t you come and join us ?

 This photo proves our point. It is clear to anyone that the right arm is far too abducted , yet it should make one question as to whether it is a product of the “failure to stack” the left lower limb. One should easily see that the right hip  has drifted beyond the perpendicular line of the left foot and that we are witnessing somewhat of a Trendelenberg presentation. The left hip should be over the left foot. We classify what we see  here however, as “stance phase” frontal plane sway. It is a POSSIBLE product of many things, but remember that what you see is a compensation around a functional or ablative problem, and not the actual problem most of the time.  One could easily hypothesize that the left gluteus medius is weak or that the left abdominals are frontal plane weak but these are only the two major assumptions most people make. Remember one of our cardinal rules, when the foot is on the ground the glutes are in charge, and when the foot is in the air, the abdominals are in charge. So, do not forget to look at the right sided abdominal component here as well.  How about foot and ankle stability ? Something is causing her frontal plane drift. It is your job to find it and correct it, not the arm swing (unless you determine it as the cause). But it is not your job to guess !  

Is it luck or predictable fact that the left pelvis is left frontal plane deviating and that the right arm is right frontal plane deviating ?  Not in our opinion, she is trying to maintain balance and symmetry during power production.  Balance maintenance comes from many areas.

Because of the neurologically embedded crossed extensor reflex and cross crawl response that permeates all human locomotion, anything that changes one of the limbs, whether it be a direct limb issue or something to do with the stabilization of the limb can impair and change locomotion, motor pattern choices and programming.

So, be careful where you make your demanded changes in your clients and your athletes. If you are guessing you are playing with fire and potential injury. The patterns are centrally generated and not by conscious choice, and hence they should not be completely remedies by the athletes conscious choice.  According to Zehr, “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.” (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)

There is alot more to this topic, but you will just have to join us in two weeks on www.onlinece.com.  Third Wednesday of every month, 7pm central time, that is where you will find us !

shawn and ivo,

the gait guys

So you want to do a Gait Analysis: Part 3

This is the third in a multi part series. If you missed part 1, click here. For part 2, click here.

 Again, a quick review of the walking gait cycle components:

There are two phases of gait: stance and swing. 

Stance consists of:

• Initial contact
• Loading response
• Midstance
• Terminal stance
• Pre-swing

Swing consists of:

• initial (early) swing
• mid swing
• terminal (late) swing

today, lets explore Midstance

we remember that midstance is the mid point of the stance phase of the gait cycle. It is when the maximal amount of midfoot pronation should be occurring

Lets look at what is happening here at the major anatomical areas:

Foot

• Pronation begins: The talus should have slid anteriorly on the calcaneus and it then plantar flexed, everted and adducted to its greatest degree. The subtalar joint should have its axes parallel with the calcaneocuboid joint, essentially “unlocking” the midfoot.  This allows the midfoot to assist in absorbing shock, along with knee flexion, hip flexion and a dip of the contralateral pelvis.
  

•  the calcaneus everts to a max of approximately 5-8°

•  the center of gravity of the foot is lowest at this point, and the ankle mortise its deepest. 

• The lower leg should be internally rotated (as it follows the talus) 4-6°

• The thigh should follow the lower leg and should also be internally rotated 4-6°; sometimes to a greater extent due to the shape and size of the medial condyle of the femur (which is larger than the lateral)

• these actions are (still) attenuated by eccentric action of both the long flexors and extensors of the ankle, as well as the foot intrinsics

Ankle

• The ankle should be neutral, as it should be at the mid point of ankle rocker

Knee

• Flexion to 20°. This is attenuated largely by the quadriceps, contracting eccentrically. The popliteus has often concentrically contracting to assist in internal rotation of the thigh up until midstance. It is quiescent at midstance and will begin to contract eccentrically as soon as the knee passes midstance.

Hip

• The hip is at full flexion at loading response, decreasing as it approached midtsnce and now begins to extend. This is facilitated by a brief contraction of the gluteus maximus (which started at initial contact)

Can you see what is happening? Try and visualize this in your mind. Can you understand why you need to know what is going on at each phase to be able to identify problems? If you don’t know what normal looks like, you will have a tougher time figuring out what is abnormal.

Ivo and Shawn. Gait and foot geeks extraordinaire. Helping you to build a better foundation to put all this stuff you are learning on.

It is Rewind Friday on the blog !

see you on our social media sites for today’s blog article rewind !

http://thegaitguys.tumblr.com/post/26911904995/gait-pathomechanics-walking-in-a-pencil-skirt

Podcast 52: Limb Dominance & Other Cool Stuff

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-52-limb-dominance-other-cool-stuff

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. The Potential Downside of Wearable Biomechanical Monitoring Devices for Running

http://runblogger.com/2014/01/downside-of-wearable-biomechanical-monitoring-devices-for-running.html

2. Google’s Next Crazy Project: Smart Contact Lenses | Entrepreneur.com
http://www.entrepreneur.com/article/230927

3. How Humans Burn Fewer Calories Than Other Mammals

http://www.runnersworld.com/weight-loss/how-humans-burn-fewer-calories-than-other-mammals

4. Update: I was listening to your podcast and you said Ice Bug was out of business. I sell them in my store in Fairbanks Alaska where we have snow and ice on the ground for 6-7 months a year. The US distributor is Ice Bug USA. I also carry a the Salomon Snow Cross studded shoe.

http://www.salomon.com/us/product/snowcross-cs.html

http://icebug.se/en/grip-tech/grip/ 

The effects of limb dominance and fatigue on running biomechanics
http://www.gaitposture.com/article/S0966-6362(13)00702-9/abstract

5. Email case:

Dear Gaitguys,

   I have been on a search since October to determine the cause of my chronic tendonitis in my knees and right hip. Through my search I was told that my femurs are rotated internally and my tibia are externally rotated. This is causing my patella to face inward.

  I was told by one PT that I will never be able to run long distances without developing tendonitis. I want to believe he is wrong because I love running. I came across something called Femoral Anterior Glide in my research and was wondering if you guys believe this is a real condition. Also is there a way a person can know if they have this problem?

Thank you for all of your great posts!

 Kate 

6. Blog reader:

My 11 year old son walks with a very noticeable external tibial torsion. We just recently noticed this and I came upon your site while trying to research it. I also read that many time it has to do with a problem with the patella. Both my husband and daughter have had patella problems but do not have the duck walk like my son. I did ask a a pediatric sports medicine specialist about the problem and he said some kids just walk that way. Where should I bring my son for help with this?

7. Blog reader asks:

About a year ago there was an article posted called: “A case of the non-resolving ankle sprain. Things to think about when the ankle and foot just do not fully come around after a sprain”. I am 15 weeks into an identical problem and I was wondering if there was any way you guys could follow up with “MR” to see if he was ever able to resolve his issue. It is such a unique and frustrating case (being able to walk but not run) and I haven’t found any other instance of it until now. Thank you.

8. Shoe Fit Certification program

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

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

http://runblogger.com/2014/01/why-cant-science-determine-the-best-running-shoe.html

http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=56486– 

9. Second metatarsal osteotomies for metatarsalgia: A robotic cadaveric study of the effect of osteotomy plane and metatarsal shortening on plantar pressure - Trask - 2013 - Journal of Orthopaedic Research - Wiley Online Library

http://onlinelibrary.wiley.com/doi/10.1002/jor.22524/abstract;jsessionid=BCFFA5207512C41214E7F3D601729EFE.f01t01

The unbalanced athlete, motor pattern, team, joint etc…… is not efficient.

Like him or not, believing he should have lost his last fight (or not), Georges St-Pierre was/is one of the best MMA fighters of all time. He was once quoted as saying, 

“In fighting, in evolution, in life, efficiency is the key,” says St-Pierre. 

 "It’s not the most powerful animal that survives. It’s the most efficient.“

This certainly describes most of Georges fights. There were always bigger, faster, meaner, stronger opponents. However, most of his fights went the distance. Eight of his last nine fights went to a five round decision. Now, there are those who will say that he didn’t have the finishing power or submission skills to close fights in the earlier rounds, and that is debatable for sure.  However, there is no doubt that anyone’s best fighting attributes will diminish as the rounds progress and fatigue sets in.  But, perhaps this is an equalizer when someone doesn’t have one single "golden right hand”, or what have you.  Efficiency can be the great equalizer.

St-Pierre isn’t your typical fighter. He’s arguably the best mixed martial artist in the world, a 5-foot 11-inch, 190-pound destroyer. Up until his most recent fight with Johnny Hendricks, he had not lost a round in more than 3 years, that is pure efficiency ! Arguably, he is faster than other fighters, he is more fit, has a greater range of skills, has better endurance …  in a Darwinian sense, perhaps more efficient ?

Here at the Gait Guys we are always considering efficiency.  As you can see from the slide above, there are many factors that can diminish efficiency.  We strive for as much symmetry as we can because with neuromuscular symmetry efficiency can be maximized.  Keep in mind however, that total symmetry is not always possible. Most people have two different feet, often one is more varus because it sat against the mothers rounded belly in utero.  And, one tibia is often more bowed or torsioned than the other for the same reason.  So, perfect symmetry is not always possible or guaranteed. But, one can do alot to gain as much physical symmetry as possible through detailed study of your client. (Remember, just because things look symmetrical does not mean that they function symmetrically ! This game is not that easy ! But, for some of the uneducated, it may seem to be !)  When physical symmetry is regained often the sensory-motor nervous system becomes functionally more symmetrical.  And, this is a flippable phenomenon, when neuro symmetry is driven often physical symmetry will be driven in time.  

Think about the afferent input to the cortex from the peripheral receptors in the skin (Paccinian corpuscles, Merkels discs, etc); the joint mechanorecpetors (types I-IV) and muscle receptors (spindles and Golgi tendon organs). Generally speaking, they travel up the dorsal columns on the back of the spinal cord to the thalamus and then the cortex; up the dorsal spinocerebelllar tract, to the cerebellar hemispheres; the spino- reticular tract to the reticular formation, or in the case of the upper cervical spine, directly into or flocculonodular lobe of the cerebellum. This information needs to be equal and opposite from each side of the extremity (flexors and extensors) as well as the right and left sides of the body. This “Balance” or “Homeostasis” or what the Chinese called Yin and Yang is key to efficiency.

In your workouts and rehab, strive for symmetry. We like to say “Tailor your exercises to the weaker side”. This helps to create more equality rather than a larger disparity.

The Gait Guys. Making it Real…Each Day….On the Blog…

How well do your boots fit your ride?

Whether you ski, ride, nordic or tele, having the right boot fit can make the difference between a good day and a great day. It can accelerate your learning curve, prevent injuries, keep you warm and make you more comfortable. Not all feet are made the same and neither are ski boots. Good fit requires time and patience (lots of both). Here are a few tips for better fit.  

What kind of a skier/rider are you?  Recreational, competitive, racing, extreme?  How you’ll use the boot will often determine the type of boot that is appropriate for you.  In my opinion, you should get a boot that is a little above your ability (unless you are not interested in improving your skiing and/or riding), so that you will improve and “grow into” the boot.  This will ensure that you’ll continue to improve in your snowriding abilities.  Boots are very high tech these days and a subtle change in stiffness or angles can make a drastic difference in your skiing/riding.

The first thing you need to do is look at your feet.  Are they feet to the same from side to side (ie. same size and shape)?  These are the platform for the rest of your body.  What happens down there will affect everything else. Take a good look at your feet while you are standing. Are there bunions, calluses, hammertoes (toes curled under), or a Morton’s toe (2nd toe longer than your big toe)?  Do you pronate excessively while standing or walking (this will look like your arches are collapsing)? What is the relationship of the forefoot (front of your foot) to the rear foot (is the ankle sideways when viewed from behind? It should be neutral without your heel turning in (inversion) or turning out (eversion). The forefoot (front of your foot) should be flat on the ground. Does your ankle bend back as far as it should (this is called dorsiflexion). This will have an effect on the forward lean of the boot. Are you bowlegged or knock-kneed? This will cause you to ride on the outside or inside edge of your ski/ snowboard.

If you pronate excessively, have increased or decreased flexibility in the forefoot, rearfoot or big toe, have bunions or hammertoes, or are excessively bowlegged or knock kneed, proper fit and comfort while skiing will probably require a full contact orthotic or footbed. Hard deformities, such as bunions, may require liner and or boot shell modification.

Good socks are next on the list.  Wool or wool blend socks are best. The intertwining fibers of wool create air pockets, which make it both insulating and breathable. Wool absorbs sweat in its vapor state, before it liquefies, keeping you dry. It utilizes your own body heat to evaporate the moisture. This also helps to eliminate odor. No cotton socks, as they hold moisture, often creating blisters and providing a breeding ground for bacteria that cause odor; no multiple pairs, as they make feet cold. Remember, thin is in… let the liner do its job.

Have your foot measured utilizing a Brannocks device in a standing position.  Remember that your arch will flatten as you put weight on it. Remembering that the foot elongates with weight on it, will be useful for the next step.

Next you need to have the right sized ski/snowboard boot shell. This is as important for hard boots as soft boots Take the liner out of the boot and put your foot inside the shell so that your toes are just touching the front of the shell.  There should be approximately ½ - ⅝ of an inch (two crossed fingers thickness) behind the ankle to the back of the shell.  More than ¾ of an inch will cause too much heel rise once the shells are “packed out”.  There should be ¼ - ⅜ of an inch space between the feet and the side shell of the ski boot.

Now comes the liner. The liner should fit snugly.  Very snugly.  There should be no pressure spots anywhere on your foot.  Put in your foot bed or custom orthotic if available, before sizing the shell.  Remember that you’ll gain between ⅛ and ¼ of an inch of space with break-in when the liners “pack out”.

Buckle the boots loosely and flex the boot forward.  This will help to “seat the heel”.  Remember that if the you cannot flex the boot at room temperature, you will not be able to when the plastic is very cold. Now that the heel is seated, buckle the boot more firmly.  They should not be on the last buckle.

Now simulate some ski/ride movements.   If the boot is relatively comfortable, proceed to the next step otherwise repeat with different shell/liner size.

The cant of the boot (cuff alignment) needs to be adjusted next. This needs to be done by someone other than yourself (because you are standing in the boot). A plumb line dropped from the knee should pass between your second and third toe.  This ensures an even transfer of weight from edge to edge. Most boots are built with about 4 degrees of varus (lateral cant).  If you are not able to adequately align the foot, consider orthotics or having the boot shimmed. Remember that boots with higher cuffs will have more of an effect on your stance.  

Most boots provide between 12-16 degrees of forward lean.  If there is less than 12 degrees, consider a heel lift to place your body weight forward.  Remember to consider how much ankle dorsiflexion you have.

Once these adjustments are made, simulate skiing/riding movements in the shop for at least an hour.  Remember that ski/snowboard boots are made for snowriding, not walking. Now remove the boots and socks and look for “hot spots” on the feet that will show up as red marks.  These may represent areas in the boot liner or shell that need to be stretched and/or fitted better.

Well. There you have it. Now you know lots more than you knew when you began this article. As you can see, it is a very time consuming and labor intensive ordeal. Often times, people need professional help with the whole process and often require a foot bed or full arch contact orthotic. Become familiar with your own feet and then become familiar with the people or shops that do good boot fitting (ask around) and consider enlisting their help on your journey to the perfect boot.

The Gait Guys. Making it real…here….on the blog…with every post…

Gait is a Fingerprint.  

“Just because you see something you do not like, does not mean that it is wrong. ”

How many times have you heard us say this ! Yes, we are getting tired of saying it, too. But, it is the honest truth.   

The above slide is one that we are using in an upcoming teaching presentation for you folks.  And this slide pretty much tells it like it is.  That being, that gait is a unique and variable fingerprint.  The slide suggests, with references, that gait is so variable, that even people with the same disease process have different presentations miles apart from one another. 

This gait analysis thing is not simple. If you are using a piece of analysis software that has you comparing your patients to normative data, be careful. You are very likely not comparing “apple to apples”.  So, do not pigeon-hole your client to normative data. Do your hands on physical examination and find out where THEIR limitations are, not what the normative data says their capacities should be.  This could be one’s first mistake in trying to help a client.  

Bottom line, no 2 people’s arms swing, leg swing, pelvic posture, hip extension etc are the same. Even side to side on the same client there may be variability due to degrees of long bone torsion or foot type (we have discusses these embryologic issues previously many times here on our blog). So, just try to improve your clients function and stability and mobility to what their body needs.

This is not a templated game. This an art form that takes years to develop. We too are learning and growing, so thanks for being on this journey with us !

Shawn and Ivo, the gait guys

Start with the basics: One of our favorite Core Exercises for the obliques.

Following up on yesterdays post, here is one of our all time favorite exercises for core stability. It focuses on the external obliques, but hits all the major players. This exercise has been adapted and modified from from Shirley Sahrmann’s book “Diagnosis and Treatment of Movement Impairment Disorders”. It is shown here excerpted from our video series, available by clicking here.

Her is a quick summary you are free to reproduce for home or clinic/ shop use (they are copyrighted) but not for resale. Please give us credit if you pass them along!

Non Tripodding Exercise

The purpose of this exercise is to improve the strength of your abdominal muscles.  You will also learn to prevent lower back (lumbar spine) motions associated with leg movement.

STARTING POSITION: Lie on your back on the floor. Bend both knees about 90 degrees with the feet flat on the floor.

Contract your abdomen, do not hold your breath or hollow. 

Lift one foot off the floor slightly and hold it there. Lift the opposite leg until your thigh is vertical. Do not push down with the opposite leg while lifting! Repeat for 5-10 repetitions with good form. Repeat with the opposite leg. Remember not to contract the muscles on the back of your thigh on the leg you have on the floor.

Perform 5 repetitions 2 times per day increasing to 3 sets of 10 repetitions.

The Gait Guys. Showing you how to get it done, each and every post!