Patello femoral pain? Thinking weak VMO? Think again…
“Atrophy of all portions of the quadriceps muscles is present in the affected limb of people with unilateral PFP. There wasn’t any atrophy of the quadriceps in individuals with PFP compared to those without pathology. Selective atrophy of the VMO relative to the vastus lateralis wasn’t identified in persons with PFP.”
Your gait and peripheral vision: Part 2. There is more to it than what you do/don’t see.
Written by Dr. Shawn Allen
Yesterday we did a blog post on the loss of peripheral vision from drooping eye lids leading to the necessity (not vanity based) of a minor surgical procedure called a blepharoplasty. Here was that blog post (link), it had some important research based points you need to know.
Vision is typically the predominant sensory system used for guiding locomotion. Online visual control is critical for adjusting lower limb trajectory and ensuring proper foot placement, including optimal limb/foot crossing velocity, optimal trail-foot horizontal distance and lead-toe clearance. Research suggests that peripheral visual cues play a large role in this online gait control. 1
We have discussed many of these issues, the conscious and subconscious importance of vision on human gait, in many of our blog posts over time. Namely, blog posts on dual-tasking attention, negotiating stairs, and even in tandem walking holding hands. These all require a degree of peripheral vision function otherwise gait problems, including falls, rise on the risk list.
According to Timmis and Buckley (2), “although gaze during adaptive gait involving obstacle crossing is typically directed two or more steps ahead, visual information of the swinging lower-limb and its relative position in the environment (termed visual exproprioception) is available in the lower visual field (lvf).” Their study determined exactly when lvf exproprioceptive information is utilized to control/update lead-limb swing trajectory during obstacle negotiation.
Their study determined that “when (the) lower visual field (lvf) was occluded, foot-placement distance and toe-clearance became significantly increased; which is consistent with previous work that likewise used continuous lvf occlusion”. Their findings suggest that “ lvf (exproprioceptive) input is typically used in an online manner to control/update final foot-placement, and that without such control, uncertainty regarding foot placement causes toe-clearance to be increased. Also that lvf input is not normally exploited in an online manner to update toe-clearance during crossing: which is contrary to what previous research has suggested.” 2
Elliot and Buckley (3) showed the importance of peripheral visual cues in the control of minimum-foot-clearance during overground locomotion. In their study,
From their abstract: “eleven subjects walked at their natural speed whilst wearing goggles providing four different visual conditions: upper occlusion, lower occlusion, circumferential-peripheral occlusion and full vision. Results showed that under circumferential-peripheral occlusion, subjects were more cautious and increased minimum-foot-clearance and decreased walking speed and step length. The minimum-foot-clearance increase can be interpreted as a motor control strategy aiming to safely clear the ground when online visual exproprioceptive cues from the body are not available. The lack of minimum-foot-clearance increase in lower occlusion suggests that the view of a clear pathway from beyond two steps combined with visual exproprioception and optic flow in the upper field were adequate to guide gait. A suggested accompanying safety strategy of reducing the amount of variability of minimum-foot-clearance under circumferential-peripheral occlusion conditions was not found, likely due to the lack of online visual exproprioceptive cues provided by the peripheral visual field for fine-tuning foot trajectory.”
These appear to be important studies on the effects of vision and peripheral vision and proprioceptive cues. How we move our bodies depends much on visual cues, the ones we know we see, and the ones we are unaware that we “see”. Take this to the next level, imagine how the blind must adapt to gait without these cues. That is gait topic we will save for another time.
So, the gait analysis you are doing with your runners, your athletes, your clients takes into consideration their vision right ? Hmmmm, some how we just know that many gait gurus just sat back in their chairs and let out a long exhale. We go even more rogue in podcast 95 when we discuss head tilt and the vestibular system, we know that one is almost always overlooked. Another long exhale we presume.
Shawn Allen … . one of the gait guys
References:
1. Exerc Sport Sci Rev. 2008 Jul;36(3):145-51. doi: 10.1097/JES.0b013e31817bff72.Role of peripheral visual cues in online visual guidance of locomotion. Marigold DS1.
2.Gait Posture. 2012 May;36(1):160-2. doi: 10.1016/j.gaitpost.2012.02.008. Epub 2012 Mar 17.Obstacle crossing during locomotion: visual exproprioceptive information is used in an online mode to update foot placement before the obstacle but not swing trajectory over it.Timmis MA1, Buckley JG.
3. Gait Posture. 2009 Oct;30(3):370-4. doi: 10.1016/j.gaitpost.2009.06.011. Epub 2009 Jul 22.Peripheral visual cues affect minimum-foot-clearance during overground locomotion.Graci V1, Elliott DB, Buckley JG.
“I keep walking into doorframes,” : A visual aspect of problematic gait you likely have not considered.
Written by Dr. Shawn Allen
Recently i had an elderly client come in to see me, we were working on some arthritic knee problems post-total knee arthroplasty. He mentioned to me that he recently had eye surgery because he was having some gait difficulties. My brain immediately when into age related gait decline, you know, balance kind of stuff. He mentioned that he was banging into door frames because he was not clearing the sides of the door frames and was also banging up his knees, ankles, thighs and toes on many other things. He said he had been getting anxious about his gait and thought he might be experiencing some kind of neurologic gait problem. He wasn’t trusting his gait, he feared leaving his house. He happened to mention it to his eye doctor a few months ago and here is what he told him .
“Your upper eye lids are drooping so much that they are obliterating your peripheral vision. You can’t avoid banging into things that you cannot see. Your peripheral vision is imperative for normal safe gait.”
Drooping eyelids are an inevitable effect of getting older, but the sagging eyelids can impair peripheral vision and magnify gait risks. The procedure known as a blepharoplasty is a simple procedure performed on the upper eyelid when the lid drops down and creates a lateral blind or fold blocking out the lateral eye fields. When looking to the extremes of lateral gaze or depending on peripheral vision this fold blocks the lateral field on the affected eye while the bridge of the nose blocks the same lateral field of the other eye. Effectively, the lateral gaze and peripheral vision becomes progressively narrowed.
Watch the gait of your elderly clients. Observe how they move about your office, around furniture, tables, door frames. Ask if their gait is uncertain. Ask if they are running into things for no apparent reason. Think about this next time you are walking in close proximity of the elderly, just because you see them in your peripheral vision, does not mean they can see you. Remember, their balance and stability is likely not what yours is, it might not take much to knock them over for what appears to be little reason at all.
From the Graci study:
“However, under CPO conditions (circumferential peripheral visual field occlusion), the doorframe led to a further reduction in crossing velocity and increase in trail-foot horizontal distance and lead-toe clearance, which may have been because of concerns about hitting the doorframe with the head and/or upper body.”
From their conclusions, “exteroceptive cues are provided by the central visual field and are used in a feed-forward manner to plan the gait adaptations required to safely negotiate an obstacle, whereas exproprioceptive information is provided by the peripheral visual field and used online to “fine tune” adaptive gait. The loss of the upper and lower peripheral visual fields together had a greater effect on adaptive gait compared with the loss of the lower visual field alone, likely because of the absence of lamellar flow visual cues used to control egomotion.”
Shawn Allen, one of the gait guys.
1. Optom Vis Sci. 2010 Jan;87(1):21-7. doi: 10.1097/OPX.0b013e3181c1d547.Utility of peripheral visual cues in planning and controlling adaptive gait.Graci V1, Elliott DB, Buckley JG.
2. http://abcnews.go.com/blogs/health/2013/05/31/eye-lifts-fine-line-between-cosmetic-and-therapeutic/
Shoes, Minimalism, Maximalism, Motor fatigue, Brain stuff and more !
A. Link to our server:
http://traffic.libsyn.com/thegaitguys/pod_94final.mp3
Direct Download: http://thegaitguys.libsyn.com/podcast-94
-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:
movement and brain function; based on your piece: http://www.vancouversun.com/touch/story.html?id=11237102\
shoe fit:
http://running.competitor.com/2015/07/shoes-and-gear/sole-man-the-pros-and-cons-of-buying-cheap-running-shoes_129297
http://www.runresearchjunkie.com/relevant-gems-from-the-2015-footwear-biomechanics-symposium/
Clin Biomech (Bristol, Avon). 2006 Dec;21(10):1090-7. Epub 2006 Sep 1.
The effect of lower extremity fatigue on shock attenuation during single-leg landing.
Coventry E1, O'Connor KM, Hart BA, Earl JE, Ebersole KT.
Dr. Ted Carrick podcast
http://thewellnesscouch.com/bc/bc-07-professor-frederick-ted-carrick-on-the-past-of-functional-neurology
https://itunes.apple.com/au/podcast/backchat/id972497993?mt=2
movement patterns talk: http://www.anatomy-physiotherapy.com/28-systems/musculoskeletal/lower-extremity/knee/1191-altered-movement-patterns-in-individuals-with-acl-rupture
http://lermagazine.com/issues/june/balance-data-suggest-somatosensory-benefit-of-minimalist-footwear-design
Wilson SJ, Chander H, Morris CE, et al. Alternative footwear’s influence on static balance following a one-mile walk. Med Sci Sports Exerc 2015;46(5 Suppl);S562.
http://lermagazine.com/issues/june/running-shoe-reveal-study-links-max-cushioning-higher-load
movement patterns talk: http://www.anatomy-physiotherapy.com/28-systems/musculoskeletal/lower-extremity/knee/1191-altered-movement-patterns-in-individuals-with-acl-rupture
If you plan to live that long, you better start thinking about preservation:
http://www.cnbc.com/id/102730128
Music piece/ Bass players:
http://mentalfloss.com/article/64955/science-proves-supreme-power-bassists
Components to be aware of during the “Bouncy Gait”.
Written by Dr. Shawn Allen
First, goto the bottom right of this video and click the “settings” wheel and slow the video as much as possible so you can see what is going on more clearly. There are many issues here, but lets focus on just one today.
Secondly, this gait would never happen in a real person for any reason we can think of or for any gait pathology to compensate around. It is not possible but it is fun to watch. But what we want to bring to light is the vertical head movements because this is not healthy and in a real person, with a true vertical gait (we call it the Bouncy gait) it could create some problems.
Most often when you see the vertical bouncy gait it is because someone has impaired ankle rocker (dorsiflexion) range. Clearly, we do not see this in this video, instead we see just the opposite, an insanely large ankle rocker and tons of glute and quad loads are theorized. In true vertical gaits however, where ankle rocker is impaired, those folks hit the sagittal limit of the dorsiflexion range at the ankle and have no choice but to go vertical (ie. progress into premature heel rise and premature calf contraction) to move the body mass forward. Incidentally, this will buy them more dorsiflexion range again, however too little too late most of the time. This puts untimely and undue load on the calf compartment and can lead to a plethora of knee, ankle and foot functional pathologies that we will not go into here at this time. (hint, achilles tendonopathy, anterior and posterior “shin splints”, foot stress responses/fractures, neuromas, hammer toes, bunions and the list goes on. This by no means this is the cause for all of these issues, not in the least, however, case by case we can create a logical path to these from a vertical gait response.)
Know your normal gait and you can pick apart pathological gaits. Just remember, what you see in their gait is not their problem, it is their strategy around the problem.
Keep all of this in mind when you think about vertical gaits because even though there are build in stabilization mechanisms to cortically “hold the world still” while we move through it, the control of the head requires a harmonious dialogue between the eyes, vestibular centers and postural/proprioceptive mechanisms to maintain equilibrium. When these centers do not synchronize we have major problems with balance and locomotion, and brain function goes south. So when you see a wonky gait and everything else seems to check out, do not forget the eyes and vestibular centers, at the very least.
Shawn Allen, one of the gait guys
1. J Neuroeng Rehabil. 2008 Nov 17;5:30. doi: 10.1186/1743-0003-5-30.Control of the upper body accelerations in young and elderly women during level walking.Mazzà C1, Iosa M, Pecoraro F, Cappozzo A.
Trunk control in locomotion:
What you may be realizing by now, if you have been with us here long enough, is that if you are getting good at the deepest of gait stuff, you are truly looking at your clients completely.
You are considering vision, vestibular, cerebellar, postural patterns, sensory and motor aspects, movement patterns, proprioception, coordination, S.E.S., stability, mobility, compensation patterns, dual tasking abilities and so much more.
We are working on new presentations and projects, soon for your eyes. Here is a slide from a new presentation to wet your whistle.
Thought for the day. Are you doing video gait analysis ?
How do you justify that the data you are getting is almost purely based on your client’s “reactive postural and movement adjustments” to their compensation patterns ? Much of the research driven data today is also mensuration on just this reactionary data. This data is not what is wrong with your client, it merely represents their strategies to react and subsequently anticipate the next motor strategy. This all goes back to one of our favorite sayings, “what you see is someone’s gait is not their problem, it is their strategy around (or to cope) with the problem(s)”. One best not recommend exercises and therapy based on what you “see” in your client. They should be based on what your clinical evaluation can determine.
If your solution for your client with the turned out foot is to tell them to start turning the foot in, you are asking them to consciously add a compensation strategy to their unconscious compensation strategy. You are getting even further away from their solution.
Earlier today we posted on quadrupedal perspectives in locomotion. Now we find this to drive home the point.
A University of North Florida study “focused on "proprioceptively dynamic activities,” that is, ones that involved proprioception and a second factor (like locomotion or navigation) at the same time" such as climbing trees.
“All participants had their working memory tested at the start and two hours later (after climbing trees, running barefoot, and walking on a balance beam) and the researchers found that while the control groups showed no change, those who completed the proprioceptively dynamic tasks had a 50% jump in their working memory capacity.”
http://www.newser.com/story/210569/study-climbing-a-tree-is-good-for-your-brain.html
Do the intimate relationships of the upper limbs and lower limbs suggest that quadrupedal skill sets, if not true quadrupedal gait, were a piece of our past locomotion strategies ? Or is it just representative of the close linkages for gait efficiency? Or maybe both?
Join us on the blog today for a short rewind piece where we discuss beaucoup things … . such as:
“this study’s results provide strong evidence that actively engaging the forelimbs improves hindlimb function and that one likely mechanism underlying these effects is the reorganization and re-engagement of rostrocaudal spinal interneuronal networks. ”
Here is the blog link:
http://thegaitguys.tumblr.com/post/111383241429/spinal-interneuronal-networks-linking-the
Last night I (Dr Shawn Allen) received an email from a patient asking how many reps to do for their prescribed homework. Here was my response:
“hi Jon Doe:
as i may have mentioned, i do not give or care about absolute numbers……..it is about finding clean patterns and ramping up a number count towards fatigue in the movement pattern. As you approach fatigue we want to stop at this early stage. This is NOT about strength at this point, skill and endurance are the first pieces of a neurologic motor pattern…….so, clean, precise movements on high volume slowwwww repetitions not exceeding fatigue. Go up to fatigue, but not past it.
Yes, you are paying attention to the right things that you mentioned when running……..but do not force them. Running is a complex motor skill ……and so you cannot truly cerebrally make the corrections happen right now and make them stick, all you can do and should do at this stage is PAY ATTENTION to the movements. Your brain needs to know what is right and what is wrong. That is were learning begins. There will be much frustration and failure at the start, but coaxing the stacking awareness we discussed is the starting point. The exercises will drive the skill and endurance you need to correct the physicalities of what you are doing wrong.”
perhaps not a perfect response, but not bad either. We thought we would share smile emoticon
Gait … . walking.
Movement is medicine, nothing new.
A recent study out of Stanford University found that walking for at least 10 minutes enhances a person’s creativity.
” Dr. John Ratey states, “when his patients stopped exercising, many not only became depressed, by some actually developed adult ADHD.”
Some famous scientists were known to walk to stimulate creativity.
“Ratey is especially a fan of walking with no purpose. He says that’s when the brain can pick up more information and walking can allow one’s thoughts to come and go in a way they don’t when a person is focusing on something specific.“When we’re walking,” says Ratey, “We are stimulating the brain in many, many ways.”“
Are we the only ones that did a “face palm” after reading this study? I mean, “duh”. Or are we missing something ?
Pronation gets more dorsiflexion all on its own so how in the world can this be a translatable study ?
Besides, in the pronation posture, length if achieved was perhaps mostly medial gastrocoleus divisions.
And……was the knee bend or straight? Hint: This matters, both those posterior muscles do not cross the knee, only one does.
Conclusion: After a 3-wk gastrocnemius-stretching program, when measuring dorsiflexion with the STJ positioned in supination, the participants who completed a 3-wk gastrocnemius stretching program with the STJ positioned in pronation showed more increased dorsiflexion at the ankle/rear foot than participants who completed the stretching program with the STJ positioned in supination.
Gastrocnemius Stretching Program: More Effective in Increasing Ankle/Rear-Foot Dorsiflexion When Subtalar Joint Positioned in Pronation Than in Supination
2015, 24, 307 – 314
Fact:
Mini-strokes affect up to half of the population over forty, but usually go unnoticed until damage builds.
Physical and mental health. Just put on your shoes and get moving. It is often that simple. My parents are both 81. They speed walk 4 miles a day and they are on zero medications. They eat exceptionally clean, zero alcohol, lots of vitamins.
Get your parents, friends, patients walking. It is a start, a big start, and for many, most of all they need.
From the article: “Despite what we know about exercise, for whatever reason, people still have the thought that it can’t work. Maybe they think it’s too easy,” says Liu-Ambrose.
Rather than put on a pair of runners and head outside, they’re willing to pay for online cognitive training, for instance, even though there’s less evidence that it works, she adds.
How fast you should move in order to improve your health?
In many studies, the more intense runners are healthier than those who walk or run more moderately. However, this is not the entire picture, there are studies that say moderation is wiser. Confusingly, and perhaps unfortunately there is literature that will support whatever makes you happy.
From the linked blog:
“This risk of death is lower even with a very minimal energy expenditure. The lowest-energy-expenditure group in each study is walking at about 3 mph for 20 to 40 minutes per day. In other words, a mile or two of walking. In exchange, their risk of death goes down by 10 percent.
"Walking a bit farther — say, 2 to 3 miles at 3 mph — gets you an additional death reduction of about 30 percent. But walking more than that, or more than an hour a day at this speed, is no better.”
“If we take this research at face value, we learn a few things. First, some exercise reduces your risk of death. Second, the optimal walking/jogging exercise is light to moderate jogging. The optimal speed is between 5 and 7 mph, and if you do 25 minutes about three times a week, you’re all set. Nothing in the data suggests that running more — farther, or faster — will do more to lower your risk of death.”
What do you think ? Agree /Disagree?
http://fivethirtyeight.com/features/whats-the-optimal-speed-for-exercise/
How deep are you willing to take your gait understanding ?
“In conclusion, these data suggest that the gait and balance deficits in higher level gait disorders (HLGD) mainly result from the lesion or dysfunction of the network linking the primary motor cortex and the mesencephalic locomotor region (MLR), brain regions known to be involved in the control of gait and balance, whereas cognitive and ‘appendicular’ hypokinetic-rigid signs mainly result from deep white matter lesions (DWML) that could be responsible for a dysfunction of the frontal cortico-basal ganglia loops.”
http://www.ncbi.nlm.nih.gov/pubmed/24202784
J Neurol. 2014 Jan;261(1):196-206. doi: 10.1007/s00415-013-7174-x. Epub 2013 Nov 8.
High-level gait and balance disorders in the elderly: a midbrain disease?
Demain A
Thank goodness the body can compensate. Here is a perfect example of this discussed in this study.
“ … it has been shown that a fatigued muscle decreases the body’s ability to attenuate shock from running. The purpose of the study was to determine the effect of lower extremity fatigue on shock attenuation and joint mechanics during a single-leg drop landing.”
This study suggests that as one part fatigued, the joint and muscle strategies elsewhere in the limb made up for it.
“Hip and knee flexion increased and ankle plantarflexion decreased at touchdown with fatigue. Hip joint work increased and ankle work decreased.” The results suggested that the lower extremity is able to adapt to fatigue though altering kinematics at impact and redistributing work to larger proximal muscles.
The effect of lower extremity fatigue on shock attenuation during single-leg landing. Clin Biomech (Bristol, Avon). 2006 Dec;21(10):1090-7. Epub 2006 Sep 1.
Coventry E1, O'Connor KM, Hart BA, Earl JE, Ebersole KT.
http://www.ncbi.nlm.nih.gov/pubmed/16949185
Written by Dr. Shawn Allen
This is our very last gait guys blog post. Yes, all good things come to an end, even this trusted blog.
But, keeping in good faith, we will finish on a strong note ……. One of gardenia and lavender. Thanks for the last 5 years gait brethren, is has been a great ride. Shawn and Ivo
_______________________________
The technical title of this blog post should have been, “The reactive influence of non-normopressure bowel distention and spontaneous high vapor dissipation on bipedal locomotion.” but no one but true gait nerds would have read it had we stuck with this pubmed-type title. Yes, we are talking about farts and gait here today folks, buckle up.
One biomechanical principle we will link to this entity of “off-gassing“ is that excessive or sustained ankle plantarflexion could inhibit dorsiflexion and certainly, at the very least, works against it. We have talked about this often here on the blog and how the lack of ample ankle dorsiflexion can impair many of the biomechanical events higher up into the human frame. So, how can someone’s bowel gas translate into gait problems ?
Think about this … to squeeze out a right “cheek sneak” (fart) with optimal crowd pleasing pitch and peak vibrato, some elevation and relaxation of the lower and middle gluteus maximus divisions (coccygeal and sacral) seems imperative to optimally control off-gassing . Seemingly, to do this, a significant degree of right ankle plantarflexion may be necessary to lift the right hemipelvis driving a subsequent intentional clockwise pelvic distortion assisting in the relaxation of these gluteal divisions. This consciously driven right side of the body “lift” via the right ankle plantarflexion can also be met and assisted via ipsitlateral abdominal and contralateral gluteus medius contraction to further enable the optimal right hemipelvis elevation. Go ahead, stand up and mimic the posture and note these biomechanical pieces. Recall our mantra,
“when the foot is on the ground, the glutes are in charge, when the foot is in the air, the abdominals are in charge”.
These coordinated motor patterns might be considered dual/multi tasking. This honed series of biomechanical events is one often perfected in frat houses and basement gaming rooms. But make no mistake, there is a biomechanical danger lurking here if this becomes a habitual compensation pattern, one common in large volume legume consumers (beware vegans). Habituation of this motor task, or demonstrating poor technique over time can render right quadratus lumborum shortening and weak lower abdominals rendering an anterior pelvic tilt. This tilt may lead to gluteal inhibition/weakness (because it is difficult to contract the gluteals in an anterior pelvic tilt, go ahead stand up again and try it) which over time can impair stance phase gait mechanics. However, relating to the off-gassing, this physical posturing might optimize low frequency gluteal vibrations that can optimize vibrato during gas dissipation if pressurization is in fact optimal for an “audible”. It is important to note that conscious variable control of the tonus of the muscular anal sphincter complex plays a big part in the pitch and vibrato. There is always a drawback it seems, it does truly come down to motor control it seems, doesn’t it always ?
This is not to say that avoiding “audibles” through holding “one” in doesn’t have consequences. The exotic gas (nitrogen, carbon dioxide, hydrogen, methane, oxygen) induced gut distention that could only make your collage roommate proud can inhibit the abdominal wall and thus the lower thoracic canister and disable normal breathing mechanics. This could be a serious complication to the coupled events of respiration and thoracic mobility. So, holding that big one in for your friends rather than engaging the compensatory Trendeleburg-type off-gassing posture as described above is also fraught with problems. We know that functional disconnection of the thoracic canister from the pelvic core can disrupt the normal anti-phasic mechanics of the contralateral upper and lower limbs as well as possibly impair the normal spinal cord mediated central pattern generators.
Farts…..Call them what you want, those ear pleasing, nose hair curling, trouser coughs that only a teenage boy can truly relish and recognize as a function of boyhood success. All joking aside, they truly should be your biggest concern in your gait analysis evaluation, bar none. Ask your patients about their bowels and off-gassing, it should be part of your clinical history intake. Maybe even consider taking out the discomfort of open dialogue, and put it on your intake forms. We found that a stick figure diagram in a good biomechanical squat posture with a mushroom cloud formation hanging overhead eases dialogue tension about this sensitive topic. We even give the young children crayons to they can color the cloud. What fun !
Dare us to write a part two on this topic. “Blue Angels” (unfamilar with this clinical phenomenon? look it up). Go ahead, dare us for a part 2.
By now, if you haven’t realized that The Gait Guys just punked you, then you likely haven’t had your cup of morning coffee. Yes, we have no clue what we were talking about on this blog post, well, ok maybe, after all we do have that y-chromosome. Yes, we are NOT ending the blog either :)
Are you now considering us juvenile ? Ok maybe we are a little, but don’t deny it, you thought about some unique and honest body biomechanics for a moment here and it is these mental gymnastics that will take your creative thinking about gait to the next level. If you are upset, so be it. There will be no apologies here in this growing PC world. Off-gassing is a human thing, we all do it. We have been writing serious stuff daily for 5 years here on The Gait Guys. It was time for us to write something a little lighter. We can only hope that you will think of us and the complexities of the gait cycle the next time you sneak one out while having dinner at the in-laws. Try not to giggle when you do, but for certain, think about your body mechanics when you do, we can’t be responsible for off-gassing injuries. Think of us.
Shawn Allen, remaining here, for the duration.
disclaimer: we cannot be responsible for injuries that might be sustained by improper off-gassing events. We also do not recommend attempts at performing Blue Angels, this is a potentially dangerous activity and could cause great bodily harm (seriously). :)
The mighty Quadratus Plantae! Here is a video short on this awesomely important muscles function, testing and exercise. Enjoy!
Ankle Rocker, Sacroiliac Joint symmetry , Landing mechanics, Gait Tech, Gray Cook theories, movement and music and so much more !
A. Link to our server:
http://traffic.libsyn.com/thegaitguys/pod_93Final.mp3
Direct Download: http://thegaitguys.libsyn.com/pod-93-ankle-rocker-sacroiliac-joint-symmetry-landing-mechanics
Sponsor: www.newbalancechicago.com
-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:
-Landing mechanics
http://www.ncbi.nlm.nih.gov/pubmed/26117159
-Shock absorbing landing loads
J Athl Train. 2015 Jun 11. [Epub ahead of print]
Weight-Bearing Dorsiflexion Range of Motion and Landing Biomechanics in Individuals With Chronic Ankle Instability. Hoch MC1, Farwell KE1, Gaven SL2, Weinhandl JT1.
-Neuroscience:
Trying to reteach your client’s CNS new sensory-motor patterns so they can move better ?
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
-Does variability in muscle activity reflect a preferred way of moving or just reflect what they’ve always done?
http://esciencenews.com/articles/2014/03/14/motion.and.muscles.dont.always.work.lockstep.researchers.find.surprising.new.study
-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 technology problems :?
http://www.buzzfeed.com/stephaniemlee/who-owns-your-steps#.twn1Bg28P
-Dance video discussed, Alvin Ailey Dance Company
https://vimeo.com/36286106
-SI joint anatomy/rehab piece: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3512279/
more rehab strategies here: http://lermagazine.com/article/music-therapy-and-gait-rehab-to-a-different-beat
-a few minutes on Gray Cook quotes. pick a few we can talk about (pic attached)
movement patterns talk: http://www.anatomy-physiotherapy.com/28-systems/musculoskeletal/lower-extremity/knee/1191-altered-movement-patterns-in-individuals-with-acl-rupture
Just because it looks good, doesn’t mean that it is.
We have all had patients with seemingly negative knee x rays and pain, only to develop arthritic changes at a later date. Find and treat the cause!
“Our analysis found that incident radiographic knee osteoarthritis is preceded by prodromal symptoms lasting at least 2-3 years. This has potential implications for understanding phasic development and progression of osteoarthritis and for early recognition and management.”
Case R, Thomas E, Clarke E, Peat G. Prodromal symptoms in knee osteoarthritis: a nested case-control study using data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2015 Apr 2. [Epub ahead of print]
picture from: http://whyfiles.org/…/chronic-pain-understanding-the-roots…/
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