Pincher nails.  Who knew !?

Written by Dr. Shawn Allen

*note: there are two photos here in today’s blog post, look for the side scroll arrows and click on the small box in the upper left corner if you cannot see the photo

 We have seen this one for years in our clinics but we never got around to researching it and pondering the condition more deeply.  Here is our mantra for today, Form follows Function.

Studies seem to be undecided on the cause of this entity. Some suggest that pincer nails are caused by lack of upward mechanical forces on the toe pad where others remark that they can be observed amongst the healthy mechanical walkers. Hitomi’s study suggests that the affected toes fail to receive adequate physical stimulation from proper toe and forefoot loading. Please read on, this gets interesting.

According to Hitomi’s study, in both the barefoot and shod state,

“the pincer nail group had significantly lower pressure on the first toe than the control group. In both the barefoot and shod state, the peak pressure area was mostly the metatarsal head area in the pincer nail group, whereas it was mostly the first toe area in the control group. Binomial logistic regression analysis revealed that peak pressure area was a significant risk factor for pincer nail development.”

This seems to suggest that there is insufficient or aberrant use of downward pressure on the toes and into the toe pads. Hitomi speaks of the locale of the peak pressure, seemingly proposing from this study that it should not be under the metatarsal heads. This, in our experience and thinking, could suggest that more long flexor dominance is present. This long flexor activity seems to create some disfunction not only in the activity of the lumbrical muscles but also altered pressures in the metatarsal (MET) heads.  It certainly alters distal toe pressures which can alter skin and nail responses (see our blog post on subungal hematomas for more on this topic where we discuss principles of counter pressure and shear forces). We try to teach a “spread and reach with long flat toes” approach to our clients in correcting bad habits such as toe hammering and gripping (which are often a result of flawed biomechanics elsewhere).

The nail bed is very rich in vasculature (hence the cause of the dreaded hematoma, the black toenail) and nerve endings.  The nail bed is a derivative of the epidermis containing keratin which gives it its hard nature. The nail consists of the nail plate, the nail fold, the nail matrix, the sterile matrix and the hyponychium. There are many factors that go into the formation of a normal nail, including blood flow, nutrition, local neurogenic factors and not to forget, mechanical loading issues. Failure of any of these issues can lead to softening, brittle, thinning, diseased or malformed nails. The nail grows from a nail root in front of the cuticle and grows distally at a slow but (usually) steady rate.  It is interesting to note that the long extensor tendon (EDL) attachment is close to the proximal nail bed root area thus it brings forward thinking of possible imbalances between long and short flexors and extensor tendons/muscles and their patterns of imbalance in toe gripping and hammering that could cause a change in function which could drive a change in form.  We have all heard it, form follows function, why should this area be any different ?

Hitomi also mentioned something interesting in his study, the observation that bed ridden clients seem to have a predilection to pincer toes.  This at least seems to fit the aberrant loading patterns, in this case an absence of. The study also started some interesting thinking in us when it mentioned a hypothesis,

“that human nails are constitutively equipped with an automatic shrinkage function that allows them to adapt to daily upward mechanical forces.”

This was a fascinating hypothesis to us. It seems to make sense. If constant downward pressure on the toe pads were present, the toe nails would always be undergoing a flattening and spreading response so it could make sense that the nails have a built in curve and shrinkage function offsetting and adapting to the constant distorting pressures (the flattening and spreading forces).  Hence, some possible clarity in Hitomi’s hypothesis that pincer nails are caused by lack of (and in our thinking, distorted) upward mechanical forces on the toe pad.  And, when those distorting pressures are placed elsewhere (ie. the MET heads or tips of the toes as in our subungal hematoma hypothesis) or faulting gripping or hammering loading the automatic shrinkage function is left to dominate.

We think Hitomi’s hypothesis is correct. Here is why (this is paraphrased from our blog post on subungal hematomas and our revolutionary thinking on why they occur and it seems to fit well with pincer nail formation as well).

…  when the skin is pulled at a differential rate over the distal phalange (from gripping of the toes rather than downward pressing through the toe pad) there will be a net lifting response of the nail from its bed as the skin is drawn forward of the backward drawn phalange  (there is a NET movement of skin forward thus lifting the nail from its bedding).  For an at-home example of this, put your hand AND fingers flat on a table top. Now activate JUST your distal long finger flexors so that only the tip of the fingers are in contact with the table top (there will be a small lifting of the fingers). There should be minimal flexion of the distal fingers at this point. Note the spreading and flattening of the nail.  Now, without letting the finger tip-skin contact point move at all from the table, go ahead and increase your long flexor tone/pull fairly aggressively. You are in essence trying to pull the finger backward into flexion while leaving the skin pad in the same place on the table. Feel the pressure building under the distal tip of the finger nail as the skin is RELATIVELY drawn forward.]   This is fat pad and skin being drawn forward (relative to the phalange bone being drawn backward) into the apex of the nail. Could this be magnifying the curvature of the nail and not offsetting the “automatic curving and shrinkage” function of the nail ? We think it is quite possible.

So, there you have it. We will dive deeper on this topic another time, but after reading Hitomi’s study our brain’s started buzzing because we had discussed this process similarly a few years back in our Subungal Hematoma blog post.

And, if you are thinking about chronic repeated ingrown toe nails with this clinical entity, your thoughts are clearly on a logical path.  There is a correlation it seems.

And, as for the horrific metal bar correction you see in the other photo above, this too is new to our eyes.  It seems rather medieval, something one might see in the gallows of yesteryear.  And if that doesn’t curl your hair and make you nauseated, try looking at what this one guy did, a DIY remedy (caution, not for the feint of heart). https://www.mja.com.au/journal/2005/182/4/diy-pincer-nail-repair-brace-yourself

ShawnAllen, one of the gait guys

References:

Foot loading is different in people with and without pincer nails: a case control study  Hitomi Sano^1*, Kaori Shionoya² and Rei Ogawa¹  Journal of Foot and Ankle Research 2015, 8:43

Hamstring Reverse Engineering:

The biceps femoris is an internal rotator of the thigh? You heard correctly. Think of how the lower extremity works in closed chain, not open. Check out this quick video with Dr Ivo on “reverse engineering”

What creates muscle tone, anyway?

Not for the timid, here is an excellent , free, full text article on spasticity. More importantly, it is an excellent review on what creates muscle tone and how it is maintained, starting and the spindle and moving centrally.  Think about this the next time you have a patient with mm spasm and you can se things in a whole new light

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009478/

Irregular Arm Swing Could Be Early Sign Of Pending neurological disease.

Written by Dr. Shawn Allen

We’ve been saying this for quite some time now, the small subtle gait changes are often the first sign of things to come.

The attached article suggests that scientific measurement investigating irregular arm swing during gait could help diagnose the Parkinson’s disease earlier, giving greater opportunity to slow brain cell damage and disease progression.

In the study below Huang suggests that although we all know that classically the Parkinsonian disease is met with tremors, slow movements, stooped posture, rigid muscles, bradykinesia, speech changes etc, “by the time we diagnose the disease, about 50 to 80 percent of the critical cells called dopamine neurons are already dead,”

Previously, here at The Gait Guys, we have gone deep into discussions of arm swing and the phasic and anti-phasic natures of limb action in gait and how the four limbs interact neurologically, both centrally and peripherally. You can click here for just a sampling of our “arm swing” writings,   

In the study, because arm swing changes are one of the first gait parameters to diminish and decline, and because the decline is typically asymmetrical due to the fact that the disease is an asymmetrical one, the authors compared arm swing magnitude and asymmetry in patients with and without Parkinson’s as parameters to begin the assessments.  Most research to date has commented on the early loss of arm pendular swing but as they said here, “ but nobody had looked using a scientifically measured approach to see if the loss was asymmetrical or when this asymmetry first showed up,“ explained Huang.

What they discovered was that compared to the control group, “the Parkinson’s group showed significantly greater asymmetry in their arm swing (one arm swung significantly less than the other while walking),” and when the subjects walked faster, the arm swing increased but the amount of asymmetry remained unchanged.

On a slightly different tangent of thinking, an aside from the Parkinson’s disease disucussion, how truly sensitive is this limb swing thing you might ask ? Here, read this from this piece (How injury and pain reorganize the brain) we wrote a few years ago.

“Getting a cast or splint causes the brain to rapidly shift its resources to make righties function better as lefties, researchers found.
Right-handed individuals whose dominant arm had to be immobilized after an injury showed a drop in (brain) cortical thickness in the area that controls primary motor and sensory areas for the hand, Nicolas Langer, MSc, of the University of Zurich in Switzerland, and colleagues reported.
Over the same two-week period, white and gray matter increased in the areas that controlled the uninjured left hand, suggesting “skill transfer from the right to the left hand,” the group reported in the Jan. 17 issue of Neurology.
The findings highlight the plasticity of the brain in rapidly adapting to changing demands, but also hold implications for clinical practice, they noted.”

This article highlights the rapid changes in motor programs that occur. It does not take long for the body to begin to develop not only functional adaptations but neurologic changes at the brain level within days and certainly less than 2 weeks.

If you know your literature on this topic of arm swing symmetry, you know it is an arguable point.  According to the Lathrop-Lambach study (see link in the article just mentioned above), they mentioned that they feel a 10% baseline asymmetry is the norm.  This symmetry issue is an arguable point that no one is likely to ever win.  We tend to feel, as many others do, that asymmetry can be a major component and predictor to injury, and in today’s topic of discussion a possible determinant of higher level gait disease. 

Still think you should retrain arm swing ? Dive into our blog archives here on arm swing, you will find out that perhaps it is not your best first choice. Discover from our old writings who tends to dictate how much arm swing occurs. 

Shawn Allen, one of the gait guys

References:

http://www.medicalnewstoday.com/articles/173680.php

“Arm swing magnitude and asymmetry during gait in the early stages of Parkinson’s disease.”
Michael D Lewek, Roxanne Poole, Julia Johnson, Omar Halawa, Xuemei Huang
Gait & Posture, 2009, In Press, Corrected Proof, Available online 27 November 2009  DOI:10.1016/j.gaitpost.2009.10.013

Does gait (re)training alter peoples biomechanics? 

You bet it does! Should we be retraining peoples gait? We like to think, yes. What do you think?

“Overall, this systematic review shows that many biomechanical parameters can be altered by running modification training programmes. These interventions result in short term small to large effects on kinetic, kinematic and spatiotemporal outcomes during running. In general, runners tend to employ a distal strategy of gait modification unless given specific cues. The most effective strategy for reducing high-risk factors for running-related injury-such as impact loading-was through real-time feedback of kinetics and/or kinematics.’

Br J Sports Med. 2015 Jun 23. pii: bjsports-2014-094393. doi: 10.1136/bjsports-2014-094393. [Epub ahead of print]
Gait modifications to change lower extremity gait biomechanics in runners: a systematic review.
Napier C1, Cochrane CK1, Taunton JE2, Hunt MA1.

Development of the arch: Functional implications | Lower Extremity Review Magazine→

A nice, referenced piece from one of our fav’s, Dr Michaud.

“Although early research suggested a limited connection between arch height and lower extremity function, more recent research confirms that arch height does indeed affect function. Information obtained from measurements that accurately identify the height of the medial longitudinal arch may lead to more effective treatment protocols. By identifying specific injuries associated with low and high arches, it may also be possible to prevent these injuries.”

Reciprocal Inhibition anyone? Thanks to The Manual Therapist (Erson Religioso) for this great post.

What they are doing here is taking advantage of what Sherrington know many years ago. Activating a muscle (agonist for a movement) will inhibit the muscle with the opposite action (antagonist for a movement), through a disynaptic, post synaptic pathway. It is a great way to gain additional movement and remove or reduce muscular inhibition. Try it!

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.”

http://www.physiospot.com/research/atrophy-of-the-quadriceps-is-not-isolated-to-the-vastus-medialis-oblique-in-individuals-with-patellofemoral-pain/

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/

Podcast 94: The Shoe & Motor Control Podcast

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.

Doing video gait analysis ? Really? Are you ?

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.

Quadrupedal gait and tree climbing

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

Quadruped facts.

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

Doc, how many reps and sets should I do ?

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.:Why movement matters.

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.”“

http://hereandnow.wbur.org/2014/05/19/why-walking-matters

Ankle Dorsiflexion stretching ?

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

http://journals.humankinetics.com/jsr-current-issue/jsr-volume-24-issue-3-august/gastrocnemius-stretching-program-more-effective-in-increasing-anklerear-foot-dorsiflexion-when-subtalar-joint-positioned-in-pronation-than-in-supination

Walking, strokes, movement.

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.

http://www.vancouversun.com/touch/story.html?id=11237102