XBox and gait analysis

The revised Xbox One Kinect, also known as the Microsoft Kinect V2 for Windows, includes enhanced hardware which may improve its utility as a gait assessment tool.
“In conclusion, while the Kinect V2 body tracking may not accurately obtain lower body kinematic data, it shows great potential as a tool for measuring spatiotemporal aspects of gait.”

J Biomech. 2015 May 28. pii: S0021-9290(15)00298-5. doi: 10.1016/j.jbiomech.2015.05.021. [Epub ahead of print]
Gait assessment using the Microsoft Xbox One Kinect: Concurrent validity and inter-day reliability of spatiotemporal and kinematic variables.
Mentiplay BF

The gluteus medius and low back pain.

We see this one ALL the time. We are sure you do as well.
“Gluteus medius weakness and gluteal muscle tenderness are common symptoms in people with chronic non-specific LBP.”
It is often more on the side of pelvic frontal plane drift. The abdominals and spinal stabilizers also often test weak on this same side. We often see compromise of hip rotation stability as well because , since the hip is relatively adducting (because the pelvis is undergoing repeated frontal plane drift, hence no hip abduction) there is often a component of cross over gait phenomenon which can threaten rotation stability of the lower limb (type “cross over gait” into the search box of our tumblr blog for a landslide of work we have written on that phenomenon).

Eur Spine J. 2015 May 26. [Epub ahead of print]
Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls.
Cooper NA1, Scavo KM, Strickland KJ, Tipayamongkol N, Nicholson JD, Bewyer DC, Sluka KA.

http://www.ncbi.nlm.nih.gov/pubmed/26006705

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Abs on the UP, Glutes on the DOWN

I had the opportunity to go on my 1st mountain bike ride of the season last Sunday morning. Yes, I am aware it is JUNE, but the snow has finally melted (we had over 7 FEET at arapahoe Basin in May) and you need to understand that I am usually a runner). In the cool morning 44 degree air I was reminded of the importance of my gluteal muscles (rather than just my quads) while climbing a technical hill which was clearly pushing my aerobic capacity. We have the opportunity to perform many bike fits in the office and treat many cycling ailments. We also train and retraing pedal stroke and one of our mantras (in addition to skill, endurance and strength) is “Glutes on the downstroke; Abs on the upstroke”. Meaning use your glutes to extend the hip from 12 to 6 o’clock and use your abs to initiate the upstroke. Quadricep (on the downtstroke) and hamstring dominance (on the upstroke) is something we see often and this mantra often proves useful in the “retraining process”.

I have been a fan of Ed Burkes work (“Serious Cycling” and “Competitive Cycling”) for years and have read (and lectured about) these books many times. In my effort to find a basis in the literature for my mantra, I ran across a paper (1) that seemed to substantiate, at least in part, the mantra. It is a small study looked at elite athletes that explores changes that occur in muscle recruitment as the body fatigues after a sub maximal exercise session.

Their conclusion “The large increases in activity for gluteus maximus and biceps femoris, which are in accordance with the increase in force production during the propulsive phase, could be considered as instinctive coordination strategies that compensate for potential fatigue and loss of force of the knee extensors (i.e., vastus lateralis and vastus medialis) by a higher moment of the hip extensors.”

This makes sense, although may be contradicted by this study (2), which showed LESS gluteal activity at higher mechanical efficiency, with increased tricep surae activity. They conclude “These findings imply that cycling at 55%-60% V˙O(2max) will maximize the rider’s exposure to high efficient muscle coordination and kinematics.”  Although this study looks at mechanical efficiency and the 1st lloks at muscle activity.

Being seated on a bike and having your torso, as well as hips flexed is not the most mechanically efficient posture for driving the glutes, but clinical observation seems to dictate that the less quad and hamstring dominant people are on the down and up stroke respectively, then the more pain free they are. This does not always equte to being the fastest, but it does equate to fewer injuries showing up in the office.

  1. Dorel S1, Drouet JM, Couturier A, Champoux Y, Hug F. Changes of pedaling technique and muscle coordination during an exhaustive exercise. Med Sci Sports Exerc. 2009 Jun;41(6):1277-86. doi: 10.1249/MSS.0b013e31819825f8.
  2. Blake OM1, Champoux Y, Wakeling JM.  Muscle coordination patterns for efficient cycling. Med Sci Sports Exerc. 2012 May;44(5):926-38. doi: 10.1249/MSS.0b013e3182404d4b.
Abductory twist in your gait ?Last night on our www.onlinece.com teleseminar we discussed some clinical applications and critical thinking of gait parameters and pathology. We discussed the dynamic gait pedograph below. Possible evidence of Abductor…

Abductory twist in your gait ?

Last night on our www.onlinece.com teleseminar we discussed some clinical applications and critical thinking of gait parameters and pathology. We discussed the dynamic gait pedograph below. Possible evidence of Abductory Twist gait pathology (video linkhttps://youtu.be/F3DHRoHrYOs). In this case, client had loss of internal hip rotation, but they sure love external rotation pivot at the ground interface, as the pedo shows here (more details were provided on the teleseminar last night).
*Fix the problem, retrain normal gait skills, add endurance and strength to the new gait pattern and you have a solution. Add an orthotic to treat what you see on the pedograph and you have a bandaid (and potentially/probably a problem down the road). You can’t fix a motor pattern compensation by forcing a compensatory fix. Get to the root of the problem, in this case hip and pelvic biomechanics ! It is all about mobility and stability ! 

Cross Fit: Gray Cooks thoughts

Always a good read, he is always on the mark.
Gray Cook talks about CrossFit, injury rates, and protecting both elite and amateur level CrossFit athletes.
We couldn’t agree more about the fact that CrossFit often prioritizes reps and time which can lead to fatigue and compensation in lifters, often corrupting and even neglecting technique. (yes, not everyone and not ever cross fit gym, but enough that its worthy of dialogue).
https://www.t-nation.com/t…/how-to-prevent-crossfit-injuries

Gait changes on a treadmill

Something to ponder on those days when getting outside it just impossible because of weather.
Athletes might respond to fatigue differently when running on a treadmill compared with overground conditions, where pace is typically more variable.
“Before halfway, step length increased and cadence decreased, whereas during the latter stages, there were significant decreases in impulse and maximum force. Contact time decreased and flight time increased continually, but otherwise most gait variables did not change. The changes in contact and flight times suggested that athletes altered their gait so that more time was spent airborne to allow the treadmill to pass under them. In general, however, the runners maintained their techniques throughout the run. ”

http://www.ncbi.nlm.nih.gov/m/pubmed/23860291/

Muscle activity

Does variability in muscle activity reflect a preferred way of moving or just reflect what they’ve always done? In this study it was found that there isn’t always this tight relationship between activity in the muscles and the movement we’re seeing.
“Clearly, locomotion is not as simple as we thought it was,” Foster said. “This decoupling – big changes in movement without corresponding changes in muscle activity – suggests there are other important factors going on and we need to better understand them if we want to reproduce these movements in prosthetics or robotics.”
Hmmmm. thoughts. this makes everything more interesting doesn’t it ?!

http://esciencenews.com/articles/2014/03/14/motion.and.muscles.dont.always.work.lockstep.researchers.find.surprising.new.study

Muscle activity and movement

“We expected to see a one-to-one correlation between the muscle activity and movements because motion is generally driven by muscles,” Higham said, “but as we changed the structure of their habitat and they changed their motions, we were surprised to find very few accompanying changes in muscle activity.”

Context-dependent changes in motor control and kinematics during locomotion: modulation and decoupling. Foster and Higham
http://www.ncbi.nlm.nih.gov/pubmed/24621949

Gait on slippery floors.

You seem to see a glossy wetness to the tile floor ahead of you in the supermarket. Is that just a really polished floor or is that water? Hey, it might be slippery, lets make some adaptive changes up there in the brain.
Postural and temporal gait adaptations, which affected ground reaction forces occur.
This study found that “statistically significant gait adaptations included reductions in stance duration (SD) and loading speed on the supporting foot, shorter normalized stride length (NSL), reduced foot-ramp angle and slower angular foot velocity at heel contact. As a result of these adaptations, anticipation of slippery surfaces led to significant changes in lower extremity joint moments, a reflection of overall muscle reactions.”
Significant gait changes occur when there is percieved risk of slipping, and in this study, “even though subjects were asked to walk as naturally as possible”.

Changes in gait when anticipating slippery floors.
Cham R, et al. Gait Posture. 2002.
http://www.ncbi.nlm.nih.gov/m/pubmed/11869910/

Reteaching sensory-motor patterns

Trying to reteach your client’s CNS new sensory-motor patterns so they can move better ? We like to say that the first few weeks are like paying down a mortgage, you do not own them, you are cerebrally renting those changes and barely paying down the principle. It takes focused work and time to truly own the changes so that they translate into better movement.
“Depending on the complexity of the activity, [experiments have required] four and a half months, 144 days or even three months for a new brain map, equal in complexity to an old one, to be created in the motor cortex.” -Swart
New connections and pathways are fragile and only through repetition and practice and focused attention can those connections be established enough to become habitual or default behaviors.

Neuroscience for Leadership: Harnessing the Brain Gain Advantage (The Neuroscience of Business). Tara Swart

Ankle Plantarflexors as Gait compensators ?

We are always talking about compensations. We have worn out our statement “what you see in someone’s gait is not their problem, ti is their compensation stratetgy(s).”
Here is a study with an interesting thought.
Just remember, try to fix the underlying problems. But, realizing sometimes you cannot, especially in the elderly population, sometimes you have to give a strategy to help them even though it is not the solution you want. And remember also that driving the anterior compartment with appropriate exercises as our “shuffle walk” might stop any loss of ankle dorsiflexion that might be met with the extra calf work that this article seems to suggest.

From the study: “ Of particular importance were the compensatory mechanisms provided by the plantar flexors, which were shown to be able to compensate for many musculoskeletal deficits, including diminished muscle strength in the hip and knee flexors and extensors and increased hip joint stiffness. This importance was further highlighted when a normal walking pattern could not be achieved through compensatory action of other muscle groups when the uniarticular and biarticular plantar flexor strength was decreased as a group. Thus, rehabilitation or preventative exercise programs may consider focusing on increasing or maintaining plantar flexor strength, which appears critical to maintaining normal walking mechanics.”

Gait Posture. 2007 Mar;25(3):360-7. Epub 2006 May 23.
Compensatory strategies during normal walking in response to muscle weakness and increased hip joint stiffness.
Goldberg EJ1, Neptune RR.
http://www.ncbi.nlm.nih.gov/pubmed/16720095

Achilles TendonitisThe motion needs to occur somewhere…Make sure you look at the whole pictureSince the knee was bent, perhaps we should be looking at the soleus? And the talo crural articulation?“A more limited ankle Dorsi Flexion Rang…

Achilles Tendonitis

The motion needs to occur somewhere…Make sure you look at the whole picture

Since the knee was bent, perhaps we should be looking at the soleus? And the talo crural articulation?

“A more limited ankle Dorsi Flexion Range Of Motion as measured in Non Weight Bearing with the knee bent increases the risk of developing Achilles Tendonitis among military recruits taking part in intensive physical training.”

J Foot Ankle Res. 2014 Nov 18;7(1):48. doi: 10.1186/s13047-014-0048-3. eCollection 2014.
Limited ankle dorsiflexion increases the risk for mid-portion Achilles tendinopathy in infantry recruits: a prospective cohort study.
Rabin A1, Kozol Z1, Finestone AS2.

GOT GLUTE MEDS?Want to strengthen that gluteus medius we were talking about Monday? Have you considered walking lunges with dumbbells? These seem to activate the side contralateral to a better extent than split squats. We wonder if you get the same …

GOT GLUTE MEDS?

Want to strengthen that gluteus medius we were talking about Monday? Have you considered walking lunges with dumbbells? These seem to activate the side contralateral to a better extent than split squats.

We wonder if you get the same effect with a medicine ball. Anyone out there have some data or experience with that?

Stastny P1, Lehnert M, Zaatar Zaki AM, Svoboda Z, Xaverova Z. DOES THE DUMBBELL CARRYING POSITION CHANGE THE MUSCLE ACTIVITY DURING SPLIT SQUATS AND WALKING LUNGES? J Strength Cond Res. 2015 May 8. [Epub ahead of print]

Foot orthoses and patellofemoral pain: frontal plane effects during running | Lower Extremity Review Magazine

We all see people with patellofemoral pain. Some of those cases may have responded to orthotic therapy. Some studies show that the effects on frontal plane kinematics are minimal (1 degree); this doesn’t mean it didn’t work, or this amount is not clinically significant. So why do they help? Perhaps it is a “timing” issue and the knee abduction moment.

“Our results are consistent with a 2003 study by Mundermann et al that compared the effects of custom orthoses (with posting, molding, or a combination of both) to flat inserts. For each orthotic condition, these authors reported a significant delay in the timing of the peak knee abduction moment. This finding may be related to the aforementioned clinical effects, as delaying the peak knee abduction moment would effectively decrease the rate of loading at the knee joint. The rate of loading has been previously implicated as a possible contributing factor in running-related overuse injuries, as runners with a history of injury have demonstrated a higher rate of loading of the vertical ground reaction force than runners with no history of running-related injury.”

This is an interesting take. If you have a few moments, give it a read:

Forefoot Varus or Forefoot Supinatus?Forefoot varus is a fixed, frontal plane deformity where the forefoot is inverted with respect to the rearfoot. Forefoot varus is normal in early childhood, but should not persist past 6 years of age (i.e. when d…

Forefoot Varus or Forefoot Supinatus?

Forefoot varus is a fixed, frontal plane deformity where the forefoot is inverted with respect to the rearfoot. Forefoot varus is normal in early childhood, but should not persist past 6 years of age (i.e. when developmental valgus rotation of forefoot on rearfoot is complete, and plantar aspects of fore- and rearfoot become parallel to, and on same plane as, one another (1)

Forefoot supinatus is the supination of the forefoot that develops with adult acquired flatfoot deformity. This is an acquired soft tissue adaptation in which the forefoot is inverted on the rearfoot. Forefoot supinatus is a reducible deformity. Forefoot supinatus can mimic, and often be mistaken for, a forefoot varus. (2)

A forefoot varus differs from forefoot supinatus in that a forefoot varus is a congenital osseous where a forefoot supinatus is acquired and develops because of subtalar joint pronation.

“Interestingly, only internal rotation of the hip was increased in subjects with FV – no differences were present in hip adduction and knee abduction between subjects with and without FV. The authors nevertheless conclude that FV causes significant changes in mechanics of proximal segments in the lower extremity and speculate that during high-speed weight-bearing tasks such as running, the effects of FV on proximal segments in the kinetic chain might be more pronounced.”

We wonder if the folks in this study had a true forefoot varus, or actually a forefoot supinatus (3).


The Gait Guys


1. Illustrated Dictionary of Podiatry and Foot Science by Jean Mooney © 2009 Elsevier Limited.

2. Evans EL1, Catanzariti AR2. Forefoot supinatus.
Clin Podiatr Med Surg. 2014 Jul;31(3):405-13. doi: 10.1016/j.cpm.2014.03.009.

3. Scattone Silva R1, Maciel CD2, Serrão FV3. The effects of forefoot varus on hip and knee kinematics during single-leg squat. Man Ther. 2015 Feb;20(1):79-83. doi: 10.1016/j.math.2014.07.001. Epub 2014 Jul 12.

#92: Your Brain on running. Ankle tightness, Femur rotation and more.

Plus a little on Oliver Sacks and homeostasis.

Show sponsors:
www.newbalancechicago.com

A. Link to our server:
http://traffic.libsyn.com/thegaitguys/pod_92final2.mp3

Direct Download:

http://thegaitguys.libsyn.com/92-your-brain-on-running-ankle-tightness-femur-rotation-and-more


Other Gait Guys 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 & more !) 
http://store.payloadz.com/results/results.aspx?m=80204
D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”

Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:

Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E

Barnes and Noble / Nook Reader:
http://www.barnesandnoble.com/w/pedographs-and-gait-analysis-ivo-waerlop-and-shawn-allen/1112754833?ean=9781466953895

https://itunes.apple.com/us/book/pedographs-and-gait-analysis/id554516085?mt=11

Hardcopy available from our publisher:
http://bookstore.trafford.com/Products/SKU-000155825/Pedographs-and-Gait-Analysis.aspx

Show notes:

A General Feeling of Disorder: Oliver Sacks

http://www.nybooks.com/articles/archives/2015/apr/23/general-feeling-disorder/

How Running Keeps Your Brain Humming
http://www.runnersworld.com/sports-psychology/how-running-keeps-your-brain-humming?adbid=10152565232831987&adbpl=fb&adbpr=9815486986&cid=socBeg_20150123_39089627

Hey Gait Guys,
I’ve been reading your blog and listening to your pod-casts (now on 71 but have listened to some new ones too so maybe 10 more to go). I’ve become so much more aware of the body’s biomechanics. Maybe this has been discussed by you guys before but I haven’t come across it yet. I was in Walmart and saw the Dr. Scholl’s foot map system and arch supports. I don’t know if you’ve seen the machine or have tested it out but they are everywhere. I found it interesting that for EVERY foot type they are recommending a ‘specialized’ heel lift. It involves statically standing on the machine on one leg. Interestingly there are handles which one can hold to help support the body on this single leg stance. After listening to so many podcasts and applying my new found knowledge, it immediately raises red flags in my brain. Thought you might be interested.
http://www.drscholls.com/productsandbrands/CustomFitOrthotics.aspx#tablink_2

Overtightening of the ankle syndesmosis: is it really possible?
Tornetta P 3rd1, Spoo JE, Reynolds FA, Lee C.
http://www.ncbi.nlm.nih.gov/pubmed/11315776
J Bone Joint Surg Am. 2001 Apr;83-A(4):489-92.

Femur rotation
http://journals.lww.com/acsm-msse/Abstract/publishahead/Femur_Rotation_Increases_Patella_Cartilage_Stress.97824.aspx

Reader:
Hi there Dr Ivo and Dr Allen
I thought this article may interest you.
http://leonchaitow.com/2015/01/21/rediscovering-better-posture-a-foot-related-personal-saga/

http://www.mortonsfoot.com/pickingrightpci.html
This last paragraph/quote in particular caught my eye.
I was wondering what your opinion of this would be and wether you agree with it entirely?
Wenger et al (1989) suggest that, since flexible flat foot is generally a benign condition, it rarely requires treatment.

wreck method, squats ?
https://www.weckmethod.com/articles/improve-squatting-form-using-the-neutral-squat-technique

High performance high heels ?

oy. At $925 a pair, maybe she is the smart one (but we don’t think so). There is always an opportunist it seems.

“If I was to continue to [wear heels] in the same level as I did in my 20s, I would literally end up with super deformed, damaged feet,” said Singh, 36.
Traditionally, the structure of a high heel relies on a single metal shank running along the sole of the shoe providing a very stiff — and uncomfortable — platform that puts 75 percent of the pressure on the ball of the foot.
Singh and her team are trying to adjust the distribution of load so that the ball of the foot carries 50 percent of the weight and the heel carries the other 50 percent such that the impact — and with it, the pain — is lessened.

http://nypost.com/2015/05/03/these-high-performance-heels-wont-kill-your-feet/

One of our favorite (and biggest brained) people in the world !In his own words: “Gait is the most important biomarker for neurological integrity and is considered a quantifiable variable that might serve as a window of disease or functional n…

One of our favorite (and biggest brained) people in the world !
In his own words: “Gait is the most important biomarker for neurological integrity and is considered a quantifiable variable that might serve as a window of disease or functional neurological progression or attenuation.”

Prof. Carrick has had almost 4 decades of clinical experience in this gait knowledge area. His knowledge application base in this functional approach to human stance, balance and gait is world renown. He will share his clinical experience so that the learner will be able to gain a fluency in this exciting evidence based clinical area of expertise.
Check out this teaser 15" talk on his Amsterdam course coming up in June.

http://lp.carrickinstitute.org/advanced-human-gait/