Podcast 98: Stability, Mobility and The Brain

Topics: Plus, the central nervous system’s effects on Chronic Tendonopathies and Gait Problems.

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*newbalancechicago.com

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A. Link to our server: http://traffic.libsyn.com/thegaitguys/pod_98f.mp3

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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:

Stability, Mobility and The Brain plus, the CNS and Chronic Tendonopathies and Gait Problems. We have done 98 podcasts, it is easy to miss one or two, but this is not one of those ones you should pass up. Hope you will join us on the podcast today !

Endocanabioids
http://metro.co.uk/2015/10/07/runners-high-triggers-the-same-brain-receptors-as-getting-stoned-on-weed-5426140/

Exercise Pill
http://www.huffingtonpost.com/entry/exercise-pill_56128c64e4b0768127028b16

Swagger gait in primates
http://news.discovery.com/human/evolution/tree-climbing-extinct-human-had-swagger-151007.htm

Should we instruct changes in client’s gait ?
http://www.anatomy-physiotherapy.com/articles/musculoskeletal/lower-extremity/knee/1311-kinematic-variation-and-pain-in-dynamic-knee-collapse

The Brain and chronic tendonopathies
http://www.anatomy-physiotherapy.com/articles/musculoskeletal/1313-tendon-neuroplastic-training

Can you believe they missed this? Sometimes you just need to look. This gal has knee pain on the R a “funny gait” and right sided low back pain in the sacro iliac joint fr the last 3 years. She felt like she needed to keep her right leg bent and her left straight all the time. She was unable to hike or walk distances longer than 1 mile or time longer than 30 minutes without slowing down and having pain. She has had reconstructive surgery on the right knee for an ACL/MCL, physical therapy, medication, counseling and even stroke rehabilitation/gait retraining. On exam she has a marked genu varus bilaterally. Knee stability is good anterior/posterior drawer; valgus/varus stress. One leg standing with both eyes open is less than 15 seconds, eyes closed is negligible. She has an anatomically short L leg; at least 2 cm which is both tibial and femoral. She was unaware of this and noone had adressed it in any way. She was given a 10mm sole length lift for the L leg and propriosensory exercises. She was encouraged to walk with a heel to toe gait. She felt 50% better immediately and another 20% after 2 weeks of doing the exercises. She had gone on several 5 mile hikes for over 2 hours with minimal discomfort. Nothing earth shaking here. Just an exam which covered the basics and some common sense treatment. Too bad they are not all that easy, eh? The takeaway? Look and listen. The problem was on the side opposite her complaint, as it can be many times. Look at the area of chief complaint 1st, but then look everywhere else : ).

Effects of prior hamstring injuries

Previous hamstring injury is associated with altered biceps femoris associated muscle activity and potentially injurious kinematics.

“Previously injured athletes demonstrated significantly reduced biceps femoris muscle activation ratios with respect to ipsilateral gluteus maximus, ipsilateral erector spinae, ipsilateral external oblique, and contralateral rectus femoris in the late swing phase. We also detected sagittal asymmetry in hip flexion, pelvic tilt, and medial rotation of the knee effectively putting the hamstrings in a lengthened position just before heel strike." 

The biomechanics of running in athletes with previous hamstring injury: A case-control study. C. Daly1, U. McCarthy Persson2, R. Twycross-Lewis1, R. C. Woledge1,† andD. Morrissey1,
http://onlinelibrary.wiley.com/d…/10.1111/sms.12464/abstract

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En Pointe, Demi Pointe, Posterior Impingement ?

When we see pictures like this most of us are triggered to look at the toe and the challenges to the 1st MTP joint.  But what about all that compression and crowding in the back of the ankle ? Posterior compression is a reality in athletes who spend time at end range plantarflexion or pack much force and load through end range plantarflexion.

This is a photo example of what is referred to as “en pointe” which means “on the tip”.  “Demi pointe” means on the ball of the foot which is much safer for many areas of the foot, but this requires adequate 1st MTP (metatarsophalangeal joint range). We discussed this briefly this week on social media regarding hallux limitus and rigidus.

En Pointe is a terrible challenge. So if you are thinking of putting your darling children in ballet…… just beware of the facts and do some logical thinking on your own when it comes to allowing the “en pointe” axially loading of the entire body over a single joint, a type of loading that this joint was never, ever, designed to withstand. This joint is a great problem for a great many in their lives, why start playing with the risk factors so early ? Let them dance, into demi pointe, but pull them once they are being forced in to En Pointe, if you want our opinion on the matter.

En pointe or classical point ballet it typically done in point shoes or slippers which have a reinforced toe box that allows a more squared off stable surface to stand in pointe position.  It does not however allow a reduction in the axial loading that you see in this picture and it certainly does not help with proper angulation of the big toe, if anything the slipper will gently corral the toes together rendering abductor hallucis muscle function nearly obsolete.   The box will also not stop the valgus loading that typically occurs at the joint. Despite what the studies say, this is one we would watch carefully.  Now, there are studies out there that do not support hallux valgus and bunion formation in dancers, we admit that.  However, we are just asking you to use common sense.  If you see a bunion forming, if the toe is getting chronically swollen, if the toe is drifting off line then one must use common sense and assume that the load is exceeding joint integrity.  Prolonged and excessive loading of any joint cartilage is likely to create a risky environment to crack, fissure, wear down or damage the cartilage or the bony surface underneath (subchondral bone).  If you screw up this joint, toe off will be impaired and thus the windlass effect at the joint will be impaired thus leading to a multitude of other dysfunctional foot issues in the years to come.

Now, back to the “en pointe” position.  Did you try it yet ? Heed our warning ! Just trust us, this is bloody hard.  Since serious foot deformities can result from starting pointe too early, pre-professional students do not usually begin dancing en pointe until after the age of 10 or so , remember, the adolescent foot has not completed its bone ossification and the bone growth plates have not closed.  Thus, damage and deformity are to be expected if done at too young an age.  If you asked our opinion on this, we would say to wait until at least the mid-teenage years……. but by that point in the dance world a prodigy would miss her or his opportunity.  Thus, we see the problems from going “en pointe” too early in many. In the dance world, there are other qualifications for dancers before En Pointe is begun. Things like holding turnout, combining center combinations, secure and stable releve, 3rd position, 4th position, 4th croise and 5th position all of which are huge torsional demands on the hips to the feet. Do you want your child undergoing these deforming forces during early osseous development ? 

Achieving en pointe is a process.  There is a progression to get to it.  Every teacher has their own methods but it is not a “just get up on your toes” kind of thing.

Are you a dancer with posterior ankle pain, impingement or disability. The Os trigonum and protruding lateral talar process are two common and well-documented morphological variations associated with posterior ankle impingement in ballet dancers. 

Think this stuff through. If you are going to be treating these things, you have to know the anatomy, loading mechanics and you have to know your sport or art. Dr. Allen was a physician for the world famous Joffrey Ballet for a few years, he knows a thing or two about these issues dancer’s endure. And he still has a few nightmares from time to time over them. 

Dr. Shawn Allen

reference:

Clin Anat. 2010 Sep;23(6):613-21. doi: 10.1002/ca.20991.Pathoanatomy of posterior ankle impingement in ballet dancers. Russell JA,Kruse DW, Koutedakis Y, McEwan IM, Wyon M

Custom orthotic or Sham for mid tendon achilles tendonopathy? It doesn’t seem to matter.This study prescribed eccentric calf exercises along with either a custom or “sham” foot orthosis for 140 people who were randomized as to whic…

Custom orthotic or Sham for mid tendon achilles tendonopathy? It doesn’t seem to matter.

This study prescribed eccentric calf exercises along with either a custom or “sham” foot orthosis for 140 people who were randomized as to which group got the real goods and which one did not.  A Victorian Institute Sports Assessment-Achilles questionairre was given at baseline, 1, 3, 6 and 12 months. No statistically significant difference between the groups.

Hmmm..

We wonder just what were the custom and sham like? When we use orthoses, we use full arch contact devices. Perhaps the type of orthosis makes a difference? What has been your experience?

Munteanu SE, Scott LA, Bonanno DR, Landorf KB, Pizzari T, Cook JL, Menz HB.  Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial.
Br J Sports Med. 2015 Aug;49(15):989-94. doi: 10.1136/bjsports-2014-093845. Epub 2014 Sep 22.

National Shoe Fit Certification Course

A quote made by a loyal follower on social media:

“someone asked for the best certification/certificate programs out there, and I posted this with a link to your YouTube promo video, even though I haven’t even went through it, yet. Hopefully this drives a handful of coaches your way. There are over 6k coaches in the group. “National Shoe Fit Program. The most unknown program out there. 2 overwhelmingly smart biomechanical clinicians put together a program to teach people how to integrate foot and shoe anatomy, then apply that to the various foot types to get people standing, walking, running and moving as correctly as they can on a basic level. Good luck trying to correct most of the squatting, deadlifting and Olympic lifting compensations without addressing how the foot interacts with the ground. Good luck trying to improve fitness without addressing gait. Good luck addressing gait without addressing foot types and shoes.”

thanks Michael !  

we blush

Psoas, iliacus. . . .  hip flexors ?

How many times have you heard us say, “hip flexion in the swing phase of gait is not driven by the hip flexors. In swing phase, the psoas and iliacus complex is not a hip flexor initiator, it is a hip flexion perpetuator/” ?
More evidence … . .
“These experiments also showed that the trailing leg is brought forward during the swing phase without activity in the flexor muscles about the hip joint. This was verified by the absence of EMG activity in the iliacus muscle measured by intramuscular wire electrodes. Instead the strong ligaments restricting hip joint extension are stretched during the first half of the swing phase thereby storing elastic energy, which is released during the last half of the stance phase and accelerating the leg into the swing phase. This is considered an important energy conserving feature of human walking. ”

http://www.ncbi.nlm.nih.gov/pubmed/24814597

How quickly does your brain start working when you start your client evaluation ?  Answer: as quickly as possible.Stepping up to the plate today for the first pitch I see this.  Do you see the ever so slight evidence of “possible” right toe extensor…

How quickly does your brain start working when you start your client evaluation ?  

Answer: as quickly as possible.

Stepping up to the plate today for the first pitch I see this.  

Do you see the ever so slight evidence of “possible” right toe extensor tone ? It is subtle but it is staring you right in the face if you care to embrace the subtle clue.  From this angle you can see more of the fat pad and plantar aspect of the RIGHT forefoot. The very next thing we did was look at the dorsum of the foot, and yup, more prominent extensor tone, short extensors to be specific.  The next question was why was I seeing this ? Short flexors usually pair with long toe flexors, and that means gripping the ground and distal displacement of the fat pad and even sometimes lumbrical inhibition or frank weakness. Possible attempts to gain more foot purchase on the ground ? Hmmmmm, perhaps.  The client had right hip pain and right lateral sesamoid pain.  Time for an examination to find out the “whys” and then fix things.

The powers of observation should always get your clinical juices flowing. Even the smallest of things should help guide you or at least clue you in to things.

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Notice the differences in running (top) vs sprinting (bottom) activation patterns?

This picture (along with the MIchaud muscular firing pattern ones) are becoming some of my favorite ones to talk about. I just stare at them and look for differences and similarities. 

Check out that the abs do not seem to fire in running (in this study at least), but do in sprinting. Note also that most muscles fire longer (and we wil assume harder) during sprinting. Also check out the peroneals, which fire just as the foot touches down in sprinting, probably to make up for the instrinsics not firing, and assist in creating a rigid lever for push off. 



from: Mann et al 1986

Podcast 97: Decomposition of human movement.

Topics: Decomposition of movement, sacrificing speed and efficiency for movement, gait efficiency, arm swing, more on injuries and unshod running and more !

A. Link to our server: http://traffic.libsyn.com/thegaitguys/pod_97final.mp3

Podcast Direct Download:  http://thegaitguys.libsyn.com/podcast-97

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:

-Brain Friendly Interface Could Change the Way People with Spinal Cord Injuries Lead Their Lives
http://neurosciencenews.com/extracellular-matrix-brain-interface-2395/

-Barefoot vs Shoe debate
http://www.theglobeandmail.com/life/health-and-fitness/fitness/barefoot-vs-shod-running-its-a-dead-heat/article26180292/

-Sacrificing speed and efficiency for stability as we age (1) . Not a bad plan. Kind of like what we spoke about here below in this video: returning to a more primitive state as the system starts to break down.

1. Zurales K, DeMott TK, Kim H, et al. Gait efficiency on an uneven surface is associated with falls and injury in older subjects with a spectrum of lower limb neuromuscular function: A

prospective study. Am J Phys Med Rehabil 2015 Jun 5. [Epub ahead of print]

https://www.youtube.com/watch?v=_fBjyutWQvU  video link to our video on this

-http://lermagazine.com/news/in-the-moment-gait/speed-trap-slowest-seniors-have-increased-mortality

-Shoe:  the UnderArmor Fat Tire GTX Trail shoe.

https://www.underarmour.com/…/mens-ua-fat-tire-g…/pid1262064

- assessing the different genders: http://www.ncbi.nlm.nih.gov/pubmed/12689785

Ferber R, Davis IM, Williams DS 3rd. Gender differences in lower extremity mechanics during running. Clin Biomech 2003;18(4):350-357.

-Arm Swing
http://thegaitguys.tumblr.com/post/128715659449/unique-adaptations-to-arm-swing-challenges-the

Medial or lateral foot placement ?

Foot placement matters. We have repeatedly beaten this topic in our dialogues on “the cross over gait” for years now.
Lack of Stability often, if perhaps not always, limits mobility.
Mediolateral stability can be efficiently controlled through appropriate foot placement. This study hypothesized that humans control mediolateral foot placement through swing leg muscle activity, basing this control on the mechanical state of the contralateral stance leg. Thus, obviously, if thestance phase limb has sensory-motor deficiencies, which might be easily translated into “balance” or control issues in single leg stance evaluation, this will impact the swing leg and thus subsequent foot placement.
In this study, “During Unperturbed walking, greater swing-phase gluteus medius (GM) activity was associated with more lateral foot placement.”
“The Perturbed walking results indicated a causal relationship between stance leg mechanics and swing-phase GM activity. Perturbations that reduced the mediolateral CoM displacement from the stance foot caused reductions in swing-phase GM activity and more medial foot placement." 

The swing leg is taking cues from the stance leg mechanics. If stance phase has challenges, the swing limb will be forced to accommodate and adapt, and that means altered foot placement.  

Once again, remember, (broken record moment)……. "what you see is not your client’s problem, it is their strategy to get around/compensate for the problem”. Don’t you dare correct your client’s foot placement without examining why they are doing what they are doing. Get to the root of the problem you are “seeing”.

-Dr. Shawn Allen


http://www.ncbi.nlm.nih.gov/pubmed/24790168

J Neurophysiol. 2014 Jul 15;112(2):374-83. doi: 10.1152/jn.00138.2014. Epub 2014 Apr 30.A neuromechanical strategy for mediolateral foot placement in walking humans.Rankin BL1, Buffo SK1, Dean JC2.

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A cause of ishial pain?

How many of us treat runners on a regular basis? Most of us I would say. While lecturing, I had an epiphany about recalcitrant hamstring insertional pain, that does seem to respond to conventional therapy. Take a look at the trigger point referral pattern for the semimembranosis/ semitendonosis. Note that in closed chain, these are external rotators of the thigh. Thinking about this, they would eccentrically contract (theoretically) to decelerate internal rotation of the thigh (such as with excessive midfoot pronation at initial contact and loading response.

Now look at when these guys fire during running gait. The left side of the graph (up to TO)  represents the stance phase of running gait (Mann 1986). The right side represents swing (or float) phase. Note that the medial hamstrings should fire from about foot descent to mid support (or midstance), with a little blast after the foot leaves the ground (asumed eccentrically) to assist in slowing the leg.

Now think about if the foot is a poor lever and remains on the ground just a little longer and rotates medially a little too far (overpronation); this muscle could conceivably be over worked and result in the trigger point referral pattern seen above on the ishial tuberosity.

Ah, but how to fix it? 

We could dry needle it and rehab it (better train it eccentrically, since that is how it is working), but it is already overworked, and in my cllinical experience, only provides temporary relief of the symptom. What other muscles seen in the chart could help? Hmmm… Take a look at the tibialis anterior (dorsiflexor/inverter), gastroc (medial) (plantarflexor/inverter), foot intrinsics and glute max/ posterior fibers of the glute medius. All external rotators (save for the foot intrinsics, which should fire from midstance to toe off) and a bonus pronatory decelerator for the tibialis anterior and able to slow an excessively internally rotating lower leg. You better check and make sure they are all on line before just treating the area of the chief complaint!

The Gait Guys. Keeping it real and giving you the tools to do a better job at what we all love to do : ) .

Taking advantage of the stretch reflex and reciprocal inhibition; or the “reverse stretch”Reciprocal inhibition is a topic we have spoken about before on the blog (see here). The diagram above sums it up nicely. Note the direct connection from the s…

Taking advantage of the stretch reflex and reciprocal inhibition; or the “reverse stretch”

Reciprocal inhibition is a topic we have spoken about before on the blog (see here). The diagram above sums it up nicely. Note the direct connection from the spindle to the alpha motor neuron, which is via a Ia afferent fiber.  When the spindle is stretched, and the pathway is intact, the uscle will contract. What kind of stimulus affects the spindle? A simple “stretch” is all it takes. Remember spindles respond to changes in length. So what happens when you do a nice, slow stretch? You activate the spindle, which activates the alpha motor neuron. If you stretch long enough, you may fatigue the reflex. So why do we give folks long, slow stretches to perform? Certainly not to “relax” the muscle!

How can we “use” this reflex? How about to activate a weak or lengthened muscle? Good call.

Did you notice the other neuron in the picture? There is an axon collateral coming off the Ia afferent that goes to an inhibitory interneuron, which, in turn, inhibits the antagonist of what you just stretched or activated. So if you acitvate one muscle, you inhibit its antagonist, provided there are not too many other things acting on that inhibitory interneuron that may be inhibiting its activity. Yes, you can inhibit something that inhibits, which means you would essentially be exciting it. This is probably one of the many mechanisms that explain spasticity/hypertonicity

How can we use this? How about to inhibit a hypertonic muscle?

Lets take a common example: You have hypertonic hip flexors. You are reciprocally inhibiting your glute max. You stretch the hypertonic hip flexors, they become more hypertonic (but it feels so good, doesn’t it?) and subsequently inhibit the glute max more. Hmm. Not the clinical result you were hoping for?

How about this: you apply slow stretch to the glutes (ie “reverse stretch”) and apply pressure to the perimeter, both of which activate the spindle and make the glutes contract more. This causes the reciprocal inhibition of the hip flexors. Cool, eh? Now lightly contract the glutes while you are applying a slow stretch to them; even MORE slow stretch; even MORE activation. Double cool, eh?

Try this on yourself. Now go try it on your clients and patients. Teach others. Spread the word.

A great, FREE, full text on forward and backward walking kinematics and a possible link to central pattern generators. “Leg kinematics during backward walking (BW) are very similar to the time-reversed kinematics during forward walking (FW). T…

A great, FREE, full text on forward and backward walking kinematics and a possible link to central pattern generators.

“Leg kinematics during backward walking (BW) are very similar to the time-reversed kinematics during forward walking (FW). This suggests that the underlying muscle activation pattern could originate from a simple time reversal, as well…

"We concluded that the changes in muscle contributions imply that a simple time reversal would be insufficient to produce BW from FW. We therefore propose that BW utilizes extra elements, presumably supraspinal, in addition to a common spinal drive. These additions are needed for propulsion and require a partial reconfiguration of lower level common networks.”

http://jn.physiology.org/content/107/12/3385


Similar muscles contribute to horizontal and vertical acceleration of center of mass in forward and backward walking: implications for neural controlKaren Jansen, Friedl De Groote, Firas Massaad, Pieter Meyns, Jacques Duysens, Ilse JonkersJournal of Neurophysiology Published 15 June 2012 Vol. 107 no. 12, 3385-3396 DOI: 10.1152/jn.01156.2011

Gait and Climbing: Part 1

Lucid Dreaming is the name of a rock in the Buttermilks of Bishop, California. This is no ordinary rock. It is a V15. Summiting this rock is basically only 3 moves off of 3 holds, from your fingertips. The remainder of the climb is sliced bread. If you can do the 3, you can get to the top. The problem is, only a handful of people in the world can do it. How hard can this be, after all you start sitting down.

Strength, stability, mobility, endurance, skill, experience, movement patterns … . it is all here, today, on The Gait Guys blog.

Author: Dr. Shawn Allen

There are things that other people can do in life that rattle your brain. These are tasks that these individuals make look fairly simple, but in actuality are nearly impossible to the average person.  The honest fact is that many of us could do many of these things to a degree if we would dedicate a portion of our day to building the engine to perform these tasks, but the truth is that many of us would rather sit down and be entertained than get up and struggle.

Here on The Gait Guys blog, bipedal and quadrupedal gait has been discussed for over 5 years. Discussions have gone deep into the strange quadrupedal gait of Uner Tan Syndrome and have delved into the critical neurology behind CPG’s (Central Pattern Generators) which are neural networks that produce rhythmic patterned outputs. We have gone on and on about arm swing and how they are coordinated with the legs and opposite limb in a strategic fashion during walking running gaits.

Today I will look briefly at the interconnected arm and leg function in a high functioning human arguably one of the best new hot shots in climbing, Alex Megos. This year the German, as seen in this video link today, managed to summit Lucid Dreaming, a V15 in the Buttermilks of Bishop, California. Hell, you can say that this is just a big boulder, but there are not many V15s in the world like this one. Only a few of the very best in the world have even tried this rock, and you can count even fewer who have reached the summit. So, what does V15 mean to you? “virtually impossible” just about sums it up. Watch the video, this V15 starts from a “sit-start”, many folks wouldn’t even get their butts off the ground to complete the first move, that is how hard this is.  Watch the video, if this does not cramp your brain, you perhaps you don’t have one.

Are there possible neurologic differences in climbers such as Megos as compared to other quadruped species?  Primarily, there is suspect of an existing shift in the central pattern generators because of the extraordinary demand on pseudo-quadrupedal gait of climbing because of the demand on the upper limbs and their motorneuron pools to mobilize the organism up the mountain. We know these quadrupedal circuits exist. In 2005 Shapiro and Raichien wrote “the present work showed that human QL(quadrupedal locomotion) may spontaneously occur in humans with an unimpaired brain, probably using the ancestral locomotor networks for the diagonal sequence preserved for about the last 400 million years.”

As we all know, the interlimb coordination in climbing and crawling biomechanics shares similar features to other quadrupeds, both primate and non-primate, because of similarities in our central pattern generators (CPG’s). New research has however determined that the spaciotemportal patterns of spinal cord activity that helps to mediate and coordinate arm and leg function both centrally, and on a cord mediated level, significantly differ between the quadruped and bipedal gaits. In correlation to climbers such as Megos however, we need to keep in mind that the quadrupedal demands of a climber (vertical) vastly differ in some respects to those of a non-vertical quadrupedal gait such as in primates, in those with Uner Tan Syndrome and during our “bear crawl” challenges in our gyms. This should be obvious to the observer in the difference in quadrupedal “push-pull” that a climber uses and the center-of-mass (COM) differences.  To be more specific, a climber must reduce fall risk by attempting to keep the COM within the 4 limbs while remaining close to the same surface plane as the hands and feet (mountain) while a primate,  human or Uner Tan person will choose  to “tent up” the pelvis and spine from the surface of contact which narrows the spreading of the 4 contact points. Naturally, this “tenting up” can be reduced, but the exercise becomes infinitely more difficult, to the point that most cannot quadrupedally ambulate more than a very short distance. I will discuss this concept in Part 2 of this series on climbing.  If you study childhood development and crawling patterns, you need to be familiar with UTS (search our blog, save yourself the time), the flaws in the neurology behind the "Bird Dog” rehab pattern, and crawling mechanics … and of course, study climbers.

Some research has determined is that in quadrupeds the lower limbs displayed reduced orientation yet increased ranges of kinematic coordination in alternative patterns such as diagonal and lateral coordination.  This was clearly different to the typical kinematics that are employed in upright bipedal locomotion. Furthermore, in skilled mountain climbers, these lateral and diagonal patterns are clearly more developed than in study controls largely due to repeated challenges and subsequent adaptive changes to these lateral and diagonal patterns.  What this seems to suggest is that there is a different demand and tax on the CPG’s and cord mediated neuromechanics moving from bipedal to quadrupedal locomotion. There seemed to be both advantages and disadvantages to both locomotion styles. Moving towards a more upright bipedal style of locomotion shows an increase in the lower spine (sacral motor pool) activity because of the increased and different demands on the musculature however at the potential cost to losing some of the skills and advantages of the lateral and diagonal quadrupedal skills.  Naturally, different CPG reorganization is necessary moving towards bipedalism because of these different weight bearing demands on the lower limbs but also due to the change from weight bearing upper limbs to more mobile upper limbs free to not only optimize the speed of bipedalism but also to enable the function of carrying objects during locomotion.

The take home seems to suggest that gait retraining is necessary as is the development of proper early crawling and progressive quadruped locomotor patterns. Both will tax different motor pools within the spine and thus different central pattern generators (CPG). A orchestration of both seems to possibly offer the highest rewards and thus not only should crawling be a part of rehab and training but so should forward, lateral and diagonal pattern quadrupedal movements, on varying inclines for optimal benefits.  Certainly I need to do more work on this topic, the research is out there, but correlating the quad and bipedal is limited. I will keep you posted. Be sure to read my 3 part series on Uner Tan Syndrome, here on The Gait Guys blog. Some of today’s blog is rehash of my older writings, naturally I am setting the stage for “Part 2″ of Climbing.

- Dr. Shawn Allen

 References:

Shapiro L. J., Raichien D. A. (2005). Lateral sequence walking in infant papio cynocephalus: implications for the evolution of diagonal sequence walking in primates. Am. J. Phys. Anthropol.126, 205–213 10.1002/ajpa.20049

Scand J Med Sci Sports. 2011 Oct;21(5):688-99. Idiosyncratic control of the center of mass in expert climbers. Zampagni ML , Brigadoi SSchena FTosi PIvanenko YP

J Neurophysiol. 2012 Jan;107(1):114-25. Features of hand-foot crawling behavior in human adults. Maclellan MJ, Ivanenko YP, Cappellini G, Sylos Labini F, Lacquaniti F.

Thoughts on the adductor grouping to ponder. I found this while prepping for the dry needling course I am teaching this weekend and thought you may enjoy it. Though the primary actions of the addcutors are well established, secondary actions (whethe…

Thoughts on the adductor grouping to ponder. 

I found this while prepping for the dry needling course I am teaching this weekend and thought you may enjoy it. Though the primary actions of the addcutors are well established, secondary actions (whether they are acually internal or external rotators) remains to be elucidated.

Here is a nice abstract that supports the dynamic function of them as external rotators (eccentrically) during gait.

“Anatomical texts agree on most muscle actions, with a notable exception being the action of the adductors of the hip in the transverse plane. Some texts list an action of the adductor brevis (AB), adductor longus (AL), and/or adductor magnus (AM) as internal rotation, whereas others list an action of external rotation. The purpose of this article is to present a functional model in support of the action of external rotation. Transverse plane motion of the femur at the hip during normal gait is driven by subtalar joint motion during the loading response, terminal stance, and preswing phases. During the loading response, the subtalar joint pronates, and the talus adducts. This talar adduction results in the lower leg, and subsequently the femur, internally rotating. During terminal stance and preswing, the opposite occurs; the subtalar joint supinates as the talus abducts in response to forces generated from the lower extremity and in the forefoot. Electromyographic (EMG) studies indicate varied activity in the AB, AL, and AM during the loading response, terminal stance, and preswing phases of the gait cycle. A careful analysis of EMG activity and kinematics during gait suggests that, in the transverse plane, the adductors may be eccentrically controlling internal rotation of the femur at the hip during the loading response, rather than the previously reported role as concentric internal rotators. In addition, these muscles may also concentrically produce external rotation of the femur at the hip during terminal stance and preswing. Physical therapists should consider this important function of the hip adductors during gait when evaluating a patient and designing an intervention program. Anatomical texts should consider listing the concentric action of external rotation of the femur at the hip as one action of the AB, AL, and AM, particularly when starting from the anatomic position.”

Leighton RD. A functional model to describe the action of the adductor muscles at the hip in the transverse plane.Physiother Theory Pract. 2006 Nov;22(5):251-62.Leighton RD. A functional model to describe the action of the adductor muscles at the hip in the transverse plane.Physiother Theory Pract. 2006 Nov;22(5):251-62.

Podcast 96: Minimalism Shoes, Toe Trauma, Meniscal Impingement.

The Minimalist Shoe Index, Pincer toe nails, toe problems, anteromeniscofemoral impingement syndrome and much more on today’s show !

A. Link to our server: http://traffic.libsyn.com/thegaitguys/pod_96f.mp3

Direct Download:  http://thegaitguys.libsyn.com/podcast-96

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:

1. New Cameras In Japan Can Detect Drunks At Train Stations
http://www.popsci.com/cameras-japan-detect-drunks-train-stations

2. It takes a lot of nerve: Scientists make cells to aid peripheral nerve repair
http://www.medicalnewstoday.com/releases/297854.php
-Scientists at the University of Newcastle, UK, have used a combination of small molecules to turn cells isolated from human skin into Schwann cells

3. The Minimalist Shoe Definition study

http://www.jfootankleres.com/content/8/1/42

A consensus definition and rating scale for minimalist shoes
Jean-Francois Esculier123, Blaise Dubois13, Clermont E. Dionne14, Jean Leblond2 andJean-Sébastien Roy12* http://www.jfootankleres.com/content/8/1/42

modified Delphi study, 42 experts from 11 countries

http://www.jfootankleres.com/content/supplementary/s13047-015-0094-5-s1.pdf

-Results

The following definition of minimalist shoes was agreed upon by 95 % of participants: “Footwear providing minimal interference with the natural movement of the foot due to its high flexibility, low heel to toe drop, weight and stack height, and the absence of motion control and stability devices”. Characteristics to be included in MI were weight, flexibility, heel to toe drop, stack height and motion control/stability devices, each subscale carrying equal weighing (20 %) on final score.

4. CASE:
Ivo: broken toe, prioprioception
this: http://www.ncbi.nlm.nih.gov/pubmed/2245598
and this http://www.ncbi.nlm.nih.gov/pubmed/19955289

5. CASE: anterior meniscofemoral impingment syndrome
http://tmblr.co/ZrRYjx1d8503W

http://thegaitguys.tumblr.com/post/17713779565/anterior-knee-pain-in-a-young-marathon-hopeful

6. Pincer Toe nails:

http://thegaitguys.tumblr.com/post/127638788139/pincher-nails-who-knew-note-there-are-two–