More on the Minimalist Debate

“Nearly a third (29%) of those who had tried minimalist running shoes reported they had experienced an injury or pain while using the shoes. The most common body part involved was the foot. Most (61%) of those reports involved a new injury or pain, 22% involved recurrences of old problems, and 18% were a combination of both old and new musculoskeletal problems.

More than two thirds (69%) of those who had tried minimally shod running said they were still using minimalist running shoes at the time of the survey, but nearly half of those who had stopped said they did so because of an injury or pain. The most common sites of pain or injury that caused survey participants to discontinue minimally shod running were the foot (56%) and the leg (44%).

While some runners who tried minimalist running shoes suffered some pain and discomfort, a greater percentage (54%) said they had pain that improved after making the switch. The anatomical area most often associated with improvement was the knee. The results were published in the August issue of PM&R.”

Welcome to Monday and News You Can Use!

Any of your patients of clients taking anti inflammatories? Especially after a rehab session or dry needling/acupuncture? They may be thwarting the healing process. Excerpted from a recent lecture, Dr Ivo talks about how they can down regulate the healing process.

Walking changes our mental state, and our mental state changes our walking.

60 second audio pod.  Our mental state changes our gait, and our gait changes our mental state.
We highly suspect that this is not the “bouncy” gait we typically refer to, the loss of ankle rocker gait.
http://www.scientificamerican.com/podcast/episode/bouncy-gait-improves-mood/

Calf strength screen?  Um, maybe not. Specifics matter.
Thanks to barbellphysio.com for putting this up. We would like to take this deeper, because it is very important.
This screen in our strong opinion is mostly for testing sub optimal endurance, sure there is some strength assessment going on but if you are trying to determine strength, is it single rep strength ? Very likely what he truly meant is how does the calf strength hold up at a 20 rep endurance challenge.  This is more accurate and we are fussing about specifics here, but specifics matter.
*However, the potentially BIG HOLE here in the assessment, is that “perceived” top end calf/heel raise ROM is not necessarily top end FULL ROM. If one side is truly weak, and you cannot get to top end strength (say the heel is 10% lower than the other side) someone has to be there to assess and notice that top end strength failure (a top end ROM that could reduce as endurance challenge continues, but someone has to be there to observe. Going on just “feel” alone is a bad recipe there). One like is not going to feel that top end range loss even if it is large, you will perceive the effort which could feel the same as the good side but actually be a loss.  And is 20 reps enough? Sure, it is a start but is your test really telling you what you think it is telling you ? This is being shown as a gross screen in our opinion but it has holes even as a screen.  Top end strength, something we talk about here often, is critical to performance. Top end loss means  terminal plantarflexion ROM is insufficient, and this can lead to a whole host of injuries and biomechanical flaws including achilles tendonopathy to mention just one. Remember, the gastroc does  not play alone here (and gastrocs crosses the knee joint posteriorly, some of the other posterior compartment muscles do not). There is soleus, peronei, tib posterior, long flexors etc. So are you doing your test with bent knee or locked ? It makes a difference if you are trying to tease things out.  Are you ramming your toes into flexion to get more out of them to make up for a loss elsewhere ? Is the forefoot or rearfoot inverting or everting  on the up or down phase ? These things matter. Specifics matter.  For example, you can see in this video that the hip is a little lateral to the foot placement. This will mean that the heel rise will result in a lateral forefoot weight bearing load. Do you want to see if the peronei are doing their job during the heel rise ? Well then you should go into a hip hike to posture the hip over the foot so that you can get the weight bearing transition to occur terminally over to the big toe, the peronei and lateral gastroc help drive that last little shift and if they are weak and you are not driving that last piece of the movement the test may not show you the whole picture you are thinking it is. Clue, if you cannot feel the lateral compartment contract to finalize that medial foot weight bearing load shift, you may be weak there. You better assess then.

Can you do 20 reps at 80% of the full plantarflexion ROM or can you do 20 reps at 100% full plantarflexion ROM ? There is a performance difference, and to the client unobserved, the 80% on one side may feel and perform like the 100% on the other side. But make no mistake, there is a world of difference.  Someone has to  watch that you are comparing apple to apples, and not apples to figs, oranges, turnips or squash.
-Dr.Shawn Allen, the gait guys

https://www.youtube.com/watch?time_continue=55&v=QdWiXHsI8Q8

Ever wonder why Vladimir Putin Walks Like That?

the quotes below are from the NBC article referenced below.
“Neurology professor Bastiaan Bloem of the Radboud University Medical Center in the Netherlands and colleagues had noticed that Putin often walks with his right arm held rigid, while his left arms swings freely.”

Might it be Parkinson’s disease, which can cause stiff movements?

in an old Russian KGB manual it was discovered:
“According to this manual, KGB operatives were instructed to keep their weapon in their right hand close to their chest and to move forward with one side, usually the left, presumably allowing subjects to draw the gun as quickly as possible when confronted with a foe.”
https://www.youtube.com/watch?v=K2yj2uMTqSs

http://www.nbcnews.com/health/health-news/why-does-vladimir-putin-walk-n480611

Gait Retraining: be careful.

Compensations and adaptive motor patterns that alter the normal joint mechanics can cause injury.

This study discusses whether a 10% increase in running cadence has a correlation to injury incidence. 

“With increased cadence, there was a decrease in peak knee flexion and a later occurrence of peak knee flexion and internal rotation and shank internal rotation. Segment coordination was altered with most changes occurring in mid-late stance. Coordination variability decreased with an increase in cadence across all couples and phases of gait. These results suggest examination of coordination and its variability could give insight into the risk of intervention-induced injury.”

The paper discusses the reorganization of movement patterns.  It is suggested that one follow our SES (Skill, Endurance, Strength) principles as adaptation ensues.  Gain safe skill on the new pattern and drive it suboptimally at high repetition (ie. gain endurance on the new skill set).  Then heighten the skill again, and then again drive more endurance on it.  Then add some strength, then more skill, then more endurance,  … . rinse and repeat).

Anything too much, too fast, for too long is a risk. The CNS needs time for adaptation. Any change, even if globally deemed good, can be a problem. 

The Gait Guys

http://www.tandfonline.com/doi/abs/10.1080/02640414.2015.1112021?journalCode=rjsp20

Changes in coordination and its variability with an increase in running cadence. 
Jocelyn F Hafer^a*, Julia Freedman Silvernail^b, Howard J Hillstrom^c & Katherine A Boyer^a Accepted: 20 Oct 2015Published online: 20 Nov 2015

Why can’t I squat.

Client presents to you:
On the exam table they have plenty of ankle dorsiflexion range of motion (ROM), full knee flexion ROM, full hip flexion ROM.
You then ask them to perform all 3 together in the form of a squat. The result is that they cannot even squat past parallel thighs. They have used a mere portion of the ranges which they showed plentiful on the exam table. Why ?

Possibilities: The exam showed passive movements, not active loading. Perhaps lack of Skill (unfamiliarity of the skill), lack of coordination (lack of knowing how to put the pieces together), lack of balance and body mass space awareness (ie. where do i put my parts so i do not fall over), lack of hip, knee, pelvis-core stability, etc.

“Just because you have it, doesn’t mean you own it. Nor does it necessarily mean you know how to use it or have the right to push the limits if you have never been there before.”

Gait stopping.

You are walking to the sink to wash dishes:
Your Brain: “ok, we are about 3 more steps from the sink, you had better slow down … . ok, 2 more steps … 1 more step, this is the last one … . ok, that is it, you have arrived at the sink, both feet I now command you to stop moving … . . now, initiate double stance support, 50% weight on both feet… . . begin standing mode.”

Can you imagine being unable to stop moving graciously? Imagine that every attempt to halt your walking or running was like smacking into a wall or stumbling to a halt ? Kind of like that amateur driver who uses no grace or finesse, every start is a stomp on the gas and every stop is a slamming on the brakes.
We take stopping for granted, as do we underestimate the complexity of initiating movement. It is one of those things, you do not know what you have until you lose it. Sometimes it is the simplest of things which we take for granted.
There is a brainstem pathway specifically dedicated to control locomotor arrest. Activating this pathway stops locomotion, while inhibiting the pathway enables locomotion.

enjoy this short blog post today: http://tmblr.co/ZrRYjx1ycc8Q4

Walking facts

“Those who walked an average of seven blocks per day or more had a 36%, 54% and 47% lower risk of CHD, stroke and total CVD, respectively, compared to those who walked up to five blocks per week.”

http://www.sciencedaily.com/releases/2015/…/151119122246.htm

Foot posture and kinematics

“Foot posture measures can explain only a small amount of variation in foot kinematics. Static foot posture measures, and in particular the FPI, were more strongly associated with foot kinematics compared with foot mobility measures. These findings suggest that foot kinematics cannot be accurately inferred from clinical observations of foot posture alone.”

http://www.ncbi.nlm.nih.gov/pubmed/26604987

“In physics, angular momentum is the rotational analog of linear momentum. Like linear momentum it involves elements of mass and displacement. Unlike linear momentum it also involves elements of position and shape.  It is an important quantity in physics because it is a conserved quantity – the angular momentum of a system remains constant unless acted on by an external torque.” - wikipedia

The Gait Guys Podcast #101 launches later this week. Here is a tickler. On the podcast we delve a little into this article based on Angular Momentum. We are not physics guys, but we try to give this idea some critical thought. Chime in if you know more than us, we would love to hear your research backed thoughts.

“To most runners and coaches, running is a series of jumps, says Svein Otto Kanstad, a physicist and former competitive runner based in Volda, Norway. Gravity isn’t considered helpful, because its force is perpendicular to the direction a runner is moving. But this mindset neglects the concept of angular momentum, Kanstad says. Rather than thinking of running as a series of jumps – leaping off one foot and landing again on the other – runners should view their sport as a series of falls, aided by gravity, he says.” -Boyle

Read the Rebecca Boyle and Kanstad articles then watch the World Record race video by Michael Johnson. Study his leg turn over on the straight away as compared to his closest 2 competitors. Something is different. His steps are shorter, and it is difficult to determine, but is he doing what Kanstad is suggesting ?

video: https://www.youtube.com/watch?v=6FEh7hDpGp0

As Rebecca Boyle suggests,  “a runner’s hips rotate to bring each leg forward, he or she gains angular momentum. But most runners don’t make the best use of this. At the moment their leading leg hits the ground, the second leg is usually stretched out behind. In Kanstad’s revised gait, the second leg will already have rotated forward again before the leading leg hits the ground. By doing this, the runner’s centre of mass is tilted far forward allowing for more forward momentum, but the recovery leg is there to stop a fall.”

As Kanstad suggests in his research: “A theory is developed to determine the magnitude and nature of these effects of gravity, showing that more than 10% of the energy needed for running can be obtained from the field of gravity. Likewise, at a particular optimum velocity, walking may become entirely driven by gravity-induced angular momentum without any muscular effort.”

*Addendums (copied discussions from our Social media pages, we have smart people follow our work, so we wanted to include some dialogues here. We do not necessarily agree with everything said here, but in turn we also do not know everything. So, it is worthy of sharing in the hopes it takes us all further down the road to enlightenment).

reader: For some interesting applications and background on whole body angular momentum check out Anne Silverman’s work (Col School of Mines). There’s some interesting implications for how gait is regulated. Hope all is well. http://www.ncbi.nlm.nih.gov/pubmed/22325978

Gait Guys:  Dear X, we very much appreciate your contributions and thoughts here. You seem to be a strong advocate of Romanov’s work. Can you furnish us with some of his research, we like to see the numbers and studies. His stuff has been around for awhile, certainly there has to be a few good papers you can lead us too to cut down our search to the good ones.

another reader:  After reading this (original article) I didn’t know whether to laugh or cry! It’s still amazing to me the confusion and mayhem surrounding running gait mechanics. With Nicholas Romanov already establishing the idea of gravitational torque as the propulsive force in running, how can Kanstad’s “new ” belief be taken seriously: vis-a-vis the Pose Method being conceptualized during the 1970’s. It truly makes me wonder whether scientists, researchers or coaches are actually trying to understand the truth or just emblazon their own reputations. From Bobby McGee to Daniel Lieberman, the misinterpretation of how we move in a gravitational environment is profound. The idea that we can generate anti-gravitational force via muscular effort to generate movement has an almost ludicrous logic to it. The idea of “just run barefoot” or “take smaller strides” or “land of the midfoot” trivializes the unique hierarchical interplay at the core of all human movement.

As a Movement Specialist, former student of Dr. Romanov’s and someone with a passion for the history of biomechanics, the fundamental flaw is obvious: science observed human gait and tried to conjecture based on the idea of the human body being a machine, rather than the body as another biological system on this planet. The ideas of everyone from Aristotle to daVinci, Galileo to the Weber brothers concluded that the the body must move in harmony with nature. Perhaps it was the rush of modern civilization via the Industrial Age which signified a change in the scientific method. Whatever the specific catalyst, the onslaught of data collection as evidence was born.

Even today, with all of the technology available, the idea of the foot being a fulcrum for the body to rotate over, is lost. What’s even further not understood is that the body, as a lever arm, must be aligned properly - if not, the fall forward is interrupted and all of the mistakes taught in classical stride mechanics (push-off, drive, etc.) become common error. It’s ironic that Kanstad mentions Michael Johnson (who I agree ran with proper “pose"technique), but who even today, would describe his own form differently. Which is why Usain Bolt, the who does pretty much everything correctly, is still a scientific conundrum.

 I can provide Pose-related research (though I suggest looking at the information in his Pose Triathlon book). But as you know, there are many contrary arguments and much conflicting information out there that is seemingly supported by data research as well. What I tried to elucidate is that it’s difficult to consistently quantify proper running technique. Research studies would have to be designed differently, the athletes trained for longer periods of time, acclimated to both normal ground and treadmill surfaces, freed from any musculoskeletal and psychological inhibitions to running better. With any athlete I work with, there is usually a period of (at least) a year’s time of training which must be performed: longer periods for endurance or injured athletes. Studies can try to isolate certain physical elements or characteristics of form: these clearly miss the perceptive and sensory aspects most critical to better form. Essentially what it always come down to is basic: where are you when your foot hits the ground, how long do you spend on the ground and what do you look like at terminal stance? If these concepts could be studied, then I’m all for it. Unfortunately, studies continue to observe and rely on the factorial by-products or results of error-filled running technique. In the end, who is deciding if the subjects are actually doing things well enough to warrant studying them?

another reader: As a PT I agree with Kanstad. While Michael Johnson appears to be fully upright, his chest and stomach are leaning forward. I’m willing to bet his COM is anterior to his trunk while he’s running. There’s probably some give and take though, just like anything else. Leaning too far forward will make you unsteady and you’ll end up slowing down to prevent a fall. Leaning too far backwards or even being vertically upright would, as Kanstad suggests, would prevent any angular momentum via gravity from assisting a runner, and would even work against them and push them backwards.

another reader: Sir Isaac Newton is turning over in his grave…and he is likely doing that by using zombie muscles to push down to overcome both the downward force of gravity and his inertia and then using multiple muscle to rotate about his transverse plane.  http://naturalrunningcenter.com/2013/07/30/posing-question-proper-running-form/

Reference sources:

Rebecca Boyle,  https://www.newscientist.com/article/dn28246-physics-of-falling-says-professional-athletes-are-running-wrong/

http://rspa.royalsocietypublishing.org/content/471/2181/20150287

Gravity-driven horizontal locomotion: theory and experimentSvein Otto Kanstad, Aulikki KononoffPublished 16 September 2015.DOI: 10.1098/rspa.2015.0287

Achilles tendonitis: Lift the heel, right? It does not appear so.

There was a recent article in one of our favorite journals, Lower Extremity Review which reviewed and expanded upon another study from Medicine and Science in Sports and Exercise titled “Running shoes increase achilles tendon load in walking: an acoustic propagation study.” We discussed some perspectives of this topic in one of our recent podcasts.
The article discusses a new technique (1,2) for looking at tensile loads in the achilles and looks at 12 symptom free individuals on a treadmill barefoot and in a shoe with a 10 mm drop (heel is 10mm higher than the forefoot) and found:

“Footwear resulted in a significant increase in step length, stance duration, and peak vertical ground reaction force compared with barefoot walking. Peak acoustic velocity in the Achilles tendon (P1, P2) was significantly higher with running shoes.”(1)

According to LER: “The researchers also found changes in basic gait parameters associated with walking in running shoes versus barefoot, which the author Wearing said may help explain the increased tendon load with shoes. Shoes increased mean ankle plantar flexion by 4° during quiet stance as measured by electrogoniometry. When walking with shoes, participants adopted a lower step frequency but greater step length, period of double support, peak vertical ground reaction force, and loading rate than when walking barefoot. The researchers also noted that participants’ stance phase was relatively longer (4%) during shod walking than during barefoot walking.” (3)

Of course, our big question is why?

Why would an increase in step length result in increased tension?

Perhaps, as the force that the heel would hit the ground would be increased because of a longer acceleration time (F=ma), and it so happens this is what they found. The friction of the heel striking the ground would accelerate anterior translation of the talus, which plantar flexes, everts and abducts, accelerating pronation. The medial gastroc would be called into play to slow calcaneal eversion and this would indeed increase achilles tension.

Or perhaps it’s the fact that

the foot will strike in slight greater plantarflexion

(at least 4 degrees according to the study) and this results in an immediate greater load to the Achilles tendon.  Go ahead and try this while walking even if you’re barefoot. Walk across the floor and strike more on your forefoot. You will notice that you have an increased load in the tricep surae group.

Does this slight plantarflexion of the ankle contribute to greater eccentric load during stance phase?

This would certainly activate 1a afferent muscle spindles which would increase tensile stresses in the achilles tendon.

This seems to fly directly in the face of the findings of Sinclair (4) who investigated knee and ankle loading in barefoot and barefoot inspired footwear and found increased achilles loading in both compared to “conventional shoes”.

Of course this also begs the question of what type of shoes were they wearing? High top or low top shoes and were the shoes tied or not? High top shoes seem to reduce Achilles tension more so than low top shoes, especially if they are tied (5).

Whatever the reason, this questions the use of putting a lift or a higher heeled shoe underneath the foot of people that have Achilles tendinitis.  Once again what seemed to make biomechanical sense is trumped by science.

We think training people to have greater amounts of hip extension as well as ankle dorsiflexion,  as well as appropriate foot and lower extremity biomechanics with the requisite  skill, endurance and strength is a much better way to treat Achilles tendonitis regardless of whether they’re wearing footwear or not.

Dr. Ivo Waerlop, one of The Gait Guys

References:

1. Wearing SC, Reed LF, Hooper SL, et al. Running shoes increase Achilles tendon load in walking: An acoustic propagation study. Med Sci Sports Exerc 2014;46(8):1604-1609.  http://www.ncbi.nlm.nih.gov/pubmed/24500535
2. Reed LF, Urry SR, Wearing SC. Reliability of spatiotemporal and kinetic gait parameters determined by a new instrumented treadmill system. BMC Musculoskelet Disord 2013;14:249.
3. Black, Hank. Achilles oddity: Heeled shoes may boost load during gait. In the Moment:Rehabilitation   LER Sept 2014  http://lermagazine.com/news/in-the-moment-rehabilitation/achilles-oddity-heeled-shoes-may-boost-load-during-gait
4. Sinclair J. Effects of barefoot and barefoot inspired footwear on knee and ankle loading during running. Clin Biomech (Bristol, Avon). 2014 Apr;29(4):395-9. doi: 10.1016/j.clinbiomech.2014.02.004. Epub 2014 Feb 23.
5. Rowson S1, McNally C, Duma SM. Can footwear affect achilles tendon loading? Clin J Sport Med. 2010 Sep;20(5):344-9. doi: 10.1097/JSM.0b013e3181ed7e50.

Welcome to News You Can Use. Listen as Dr Ivo explains some twists in the standing tripod exercise.

Try it. Use it with your clients. Teach someone else

Welcome to Monday folks and news you can use! Have a patient with weak hip abductors? Here is another great closed chain gluteus medius/ Maximus/minimums exercise we utilize all the time called “"hip helicopters” Try it in yourself, then try it on your patients and clients, then teach others : )

Pod #100: Hill Running + Cortical Brain Changes in Injuries

Pod #100  Hill Running + Cortical Brain Brain Changes in Injuries, Plus leg length challenges, Sole vs Heel lifts, Varying your Running Surface, Frontal plane biomechanics, Baker Cyst and Popliteal Muscle problems and more !

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Other Gait Guys stuff

A. Podcast links:

direct download URL: http://traffic.libsyn.com/thegaitguys/pod_100f.mp3

permalink URL: http://thegaitguys.libsyn.com/podcast-100-hill-running-cortical-brain-brain-changes-in-injuries

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 Cortical change in chronic low back pain

http://www.anatomy-physiotherapy.com/articles/other/nervous/1329-cortical-change-in-chronic-low-back-pain
-Chronic low back pain is characterised by a range of structural, functional and neurochemical changes within the brain. Functional changes in individuals with chronic low back pain are reflected in a cortical reorganization, altered cortical activity and altered cortical responsiveness.

2  Lifting weights can change the brain
http://www.techvibes.com/blog/lifting-weights-can-beneficially-change-structure-of-brain-2015-10-27

3  Importance of varying running surfaces
http://triathlon.competitor.com/2015/05/training/importance-varying-running-surfaces_100995

4  Emergence of postural patterns as a function of vision and translation frequency.
http://www.ncbi.nlm.nih.gov/pubmed/10322069
J Neurophysiol. 1999 May;81(5):2325-39.
Our results suggest that visual information was important to maintaining a fixed position of the head and trunk in space, whereas proprioceptive information was sufficient to produce stable coordinative patterns between the support surface and legs.     *The CNS organizes postural patterns in this balance task as a function of available sensory information, biomechanical constraints, and translation frequency.

5  Previous hamstring injury is associated with altered 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,

Have a patient with weak hip abductors? Here is a great closed chain gluteus medius exercise called “"hip airplanes” we utilize all the time. Try it in yourself, then try it on your patients and clients, then teach others : )

Starting and stopping your gait. How we do it gracefully.

Can you imagine being unable to stop moving graciously? Imagine that every attempt to halt your walking or running was like smacking into a wall or stumbling to a halt ? Kind of like that amateur driver who uses no grace or finesse, every start is a stomp on the gas and every stop is a slamming on the brakes.  Or can you imaging suffering from FOG (freezing of gait) as in some Parkinson’s patients ?  
When we are healthy, we take locomotion for granted. When we are in pain, movement can become labored and challenging; when we have a neurologic disease to the locomotor centers, we can find it almost impossible.  On occasion, it can be the seemingly simplest of things that can cause the greatest of difficulties, for example, we take stopping for granted and we underestimate the complexity of initiating movement. It is one of those things in life, you do not know what you have until you lose it.  When was the last time you even thought about starting or stopping your movements ? It is so natural that the thought doesn’t even reach the surface of our conscious thought.  When was the last time you walked towards your kitchen sink to wash the dishes and you consciously thought, 

“ok, we are about 3 more steps from the sink, you had better slow down … . ok, 2 more steps … 1 more step, this is the last one … .  ok, that is it, you have arrived at the sink, both feet stop moving … . . initiate double stance support, 50% weight on both feet… . .  begin standing mode.”

There is a brainstem pathway specifically dedicated to control locomotor arrest. Activating this pathway stops locomotion, while inhibiting the pathway enables locomotion.

In the study below, researchers Julien Bouvier and Vittorio Caggiano together with Professor Ole Kiehn and colleagues studied how the complex brainstem neuronal circuits control locomotion in mice.  What they found was this, 

Neuronal populations in the Reticular Formation of the brain “constitute a major excitatory pathway to locomotor areas of the ventral spinal cord. Selective activation of these neurons (V2a) of the rostral medulla stops ongoing locomotor activity, owing to an inhibition of premotor locomotor networks in the spinal cord. Moreover, inactivation of such neurons decreases spontaneous stopping in vivo. Therefore, the V2a “stop neurons” represent a glutamatergic descending pathway that favors immobility and may thus help control the episodic nature of locomotion.”-Bouvier et al.

Human locomotion is an extremely complex task. It is one that requires all sensory and motor pathways to be intact and reflexive controls such as central pattern generators to function properly.  Gait is a complex task that requires synchrony, rhythmicity, balance, coordination, endurance and strength to name a few.  Initiating gait is highly complex, as is arresting one’s gait.  We take for granted how complex these task are at coordinating muscles, joints, limbs, vision, proprioception, vestibular inputs and many other components not to forget the cerebral connection bring it all together to get us from one place to the next is a safe fashion. It is only when things go wrong that we realize how fragile, and how complex, the system truly is.  Don’t believe us ?  Well then, try to over ride the system next time you are coming to a curb at the corner of the busiest street in your town.  Try to over ride the coordinated stop mechanism that enables you to suddenly stop perched on the curb, observing oncoming traffic, standing safely without falling into the lane.

Shawn Allen, one of The Gait Guys

“Descending command neurons in the brainstem that halt locomotion” by Julien Bouvier, Vittorio Caggiano, Roberto Leiras, Vanessa Caldeira, Carmelo Bellardita, Kira Balueva, Andrea Fuchs, and Ole Kiehn in Cell. Published online November 19 2015 doi:10.1016/j.cell.2015.10.074

This brief blog post was inspired from this article on the same topic. http://neurosciencenews.com/v2a-neurons-locomotion-neuroscience-3119/

Now THERE”S some internal tibial torsion!

So, this gent came in to see us with L sided knee pain after it collapsed with an audible “pop” during a baseball game. He has +1/+2 laxity in his ACL on that side. He has subpatellar and joint line pain on full flexion, which is limited slightly to 130 (compared to 145 right)

 We know he has internal torsion because a line drawn from the tibial tuberosity dropped inferiorly does not pass through or near the plane of the 2nd metatarsal (more on tibial torsions here)

What would you do? Here’s what we did:

• acupuncture to reduce swelling
  
• took him out of his motion control shoes (which pitch him further outside the saggital plane)
  
• gave him propriosensory exercises (1 leg balance: eyes open/ eyes closed; 1 legged mini squats, BOSU ball standing: eyes open/eyes closed)
  
• potty squats in a pain free range
  
• ice prn
  
• asked him to avoid full flexion

Is it any wonder he injured his knee? Imagine placing the FOOT in the saggital plane, which places the knee FAR outside it; now load the joint an twist, OUCH!

Podcast #99: How foot placement, the glutes and cross over gait all come together and make sense.

Topics: Plus, How foot placement, the glutes and cross over gait all come together and make sense. Plus, discussions on vibration,proprioception, cerebellum and movement.

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A. Link to our server: http://traffic.libsyn.com/thegaitguys/pod_99final.mp3

Podcast Direct Download: http://thegaitguys.libsyn.com/podcast-99-how-foot-placement-the-glutes-and-cross-over-gait-all-come-together-and-make-sense

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:

Evaluating the Differential Electrophysiological Effects of the Focal Vibrator on the Tendon and Muscle Belly in Healthy People ARTICLE in ANNALS OF REHABILITATION MEDICINE · AUGUST 2014 DOI: 10.5535/arm.2014.38.4.494 · Source: PubMed

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 BL

J Neurophysiol. 2015 Oct;114(4):2220-9. doi: 10.1152/jn.00551.2015. Epub 2015 Aug 19.

Hip proprioceptive feedback influences the control of mediolateral stability during human walking.

Roden-Reynolds DC1, Walker MH1, Wasserman CR1, Dean JC2.

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

Prog Brain Res. 2004;143:353-66. Role of the cerebellum in the control and adaptation of gait in health and disease. Thach WT1, Bastian AJ.

You’d have to be smart to walk this lazy, and people are

Research suggests that humans are wired for laziness

http://www.sciencedaily.com/releases/2015/09/150910131451.htm#.VfWquNKaf3s.facebook

Jessica C. Selinger, Shawn M. O’Connor, Jeremy D. Wong, J. Maxwell Donelan. Humans Can Continuously Optimize Energetic Cost during Walking. Current Biology, 2015; DOI: 10.1016/j.cub.2015.08.016

The “Dodgy Foot”, a UK runner’s dilemma.

We get “help me” emails from all over the world on a regular basis. Recently we received this photo from a runner in Oxford, UK,  The runner was frustrated, explaining a “dodgy foot”.  We like the word. 

dodg·y    däjē/

-dishonest or unreliable; potentially dangerous; of low quality.

We can guarantee you that the solution here to this runner’s form issue is not wholly at the foot which appears “in toed” and slanted and appears ready to kick the back of the right heel, not to mention the knees that are about to brush together.  Thus, merely working on their foot strike would be so remedial and corrupt that it would a crime. 

Ivo and I do not take on cases via the internet because we cannot give all the information because we cannot examine the client, many do offer such services but people are not being given the whole story and we pledged long ago not to be part of the problem.  Anyone who recommends exercises from things they see on a video gait analysis are basically doing the same disservice in our opinion. But sometimes, as in this case, their inquiry is simple, there is a photo or video and it allows us to highlight an important component of an individuals gait which can lead them on a road to appropriate discovery. This is one of those cases.  I will not be presenting a solution, because I do not have the examination information I need, but I will propose a solid thought process that further investigation may afford progress towards resolution.

This is a non-pathologic cross over gait in my mind until proven otherwise, there may be other sources, causes and components, but when it quacks like a duck you’d be silly not to check for webbed feet. This runner even confirmed upon questioning that the left foot scuffs the inside of the right ankle/shin often, both sides scuff in fact but more left shoe on right shin. No Einsteinian epiphany there. 

• This means a narrow swing through  (adducting) left limb. 
• This means stance and swing phase gluteus medius communication problems. 
• This means swing leg foot targeting problems. 
• This often suggests right, but sometimes both right and left, frontal plane pelvis sway problems which means pelvis control is challenged which means core lumbar stability control is challenged. 
• This means adaptive arm swing changes from the clean norm.  
• This does NOT mean this runner has pain, or pain yet, or maybe never will have pain but there are many determinants of that which I will discuss below. 

But, make no mistake, this is flawed gait mechanics. The left swing leg is clearly targeting a more medial placement, meaning limb adduction (active or passive or both is to be determined) and this is a product of the cross over gait (unfamiliar with the cross over gait ? SEARCH our blog for the term, you will need a few hours of free time to get through it all).  Some would call the cross over gait a lazy gait, but I would rather term it an efficient gait taken too far that it has now become a liability, a liability in which they can no longer stabilize frontal plane sway/drift. A wider gait on the other hand, as in most sprinters, is less efficient but may procure more power and the wider base is more stable affording less frontal plane drift. Just go walk around your home and move from a very narrow line walking gait to a wide gait and you will feel a more powerful engagement of the glutes. Mind you, this is not a fix for cross over gaits, gosh, if it was only that simple !

This runner must investigate whether there is right frontal plane drift, and if it is in fact occurring, find the source of the drift.  It can come from many places on either limb. (This client says they are scuffing both inside ankles, which is not atypical and so we likely have drift on both right and left). We have discussed many of them here in various places on the blog over the years. Now as for “Why” the foot looks in toed, well that can also come from many places. Quite simply the adducted limb once it leaves toe off can look like this. But, perhaps it is also a product of insufficient external rotation maintenance occurred during that left stance phase, affording more internal rotation which is being unchecked and observed here during early swing.  Remember though, if this is in fact a cross over gait result, in this gait the limb approaches the ground unstacked (foot is too far inside a left hip joint plumb line) the foot will greet the ground at a far lateral strike and in supination.  Pronation will thus be magnified and accelerated, if there is enough time before toe off. However, and you can try this on your own by walking around your home, put yourself in terminal stance at toe off. Make sure you have the foot inverted so you are toeing off the lateral toes (low gear toe off). Does this foot not look like the one in the photo ? Yes it does, now just lift the foot off the ground and you have reproduced this photo. And when combined with a right pelvis drift, the foot will sneak further medially appearing postured behind the right foot. 

Keep this in mind as well, final pronation and efficient hallux (big toe) toe off does often not occur in someone who strikes the ground on a far lateral foot. I am sure this runner will now be aware of how poorly they toe off of the big toe, the hallux.  They will tend to progress towards low gear toe off, off the lesser toes. This leaves the foot inverted and this is what you are seeing in her the photo above. That is a foot that is inverted and supinated and it carried through all the way through toe off and into early swing. It is a frequently component of the cross over gait, look for it, you will find it, often. 

Final thoughts, certainly this can be an isolated left swing phase gluteus medius weakness enabling an adducted swing limb thus procuring a faulty medial foot placement, but it is still part of the cross over phenomenon.  Most things when it comes to a linked human frame do not work in isolation.  But i will leave you with a complicating factor and hopefully you will realize that gait analysis truly does require a physical exam, and without it you could be missing the big picture problem.  What if she has a notable fixed anatomic internal tibia torsion on that left side. Yup, it could all be that simple, and that is not something you can fix, you learn to manage that one as a runner.  

* Side bar rant: Look at any google search of runners photos and you will see this type of swing limb foot posturing often, far too often.  And yes, you can take the stance that “I do it as well and i have no injuries or problems so what is the big deal?”.  Our response is often “you do have an issue, it may be anatomic or functional, but you do have an asymmetrical gait and you think it is not a problem, YET”. And maybe you will run till you are 6 feet under and not have a problem because you have accomodated over many years and you are a great compensator, yes, some people get lucky. Some people also do not run enough miles that these issues express themselves clinically so lets be fair. But some of these people are reality deniers and spend their life buying the newest brace or gadget, trying a different shoe insert, orthotic or new shoe of the month and shop over and over again for another video gait analysis expert who can actually fix their pain or problem. And then there are those who have a 45 minute home exercise program that they need to do to keep their problems at bay, managing, not fixing anything.  Or, they spend an hour a week on the web reading article after article on what are the top 4 exercises for iliotibial band syndrome for example. They shop for the newest Graston practitioner, the newest kinesio taping pattern, Voodoo bands, breathing patterns, compression socks etc.  And sometimes they are the ones that say they still dont have a problem.You get the drift.  Gosh darn it, find someone who knows what the hell they are doing and can help you fix the issues that are causing the problem.  And yes, some of the above accoutrements may be assistive in that journey. 

I have dealt with this unique toe off issue way too many times not to roll my eyes at it any longer. It is to the point that it is an automated evaluation and solution program that begins to run in my head. Once you see something enough times, you learn all of the variations and subtle nuiances that a problem can take on. But, trying to fit everyone into a similar solution model is where the novice coach, trainer or clinician will get into trouble. Trust us, it all starts with an examination, a true clinical physical examination.  If one leaves the investigatory process to a series of screens or functional movement patterns, “activation” attempts, digital gait analysis or strength tests one is juggling chainsaws and the outcome you want is often not likely to occur. There is nothing wrong with making these components part of the investigation process, but on their own, they are not enough to get the honest answer many times.  Of course, Ivo and i were not able to jump the pond and examine this runner with our own eyes and hands so today’s dialogue was merely to offer this runner some food for thought to open their mind to our thought process, in the hopes that they can find someone to help them solve the underlying problem and not merely make the gait look cleaner. Making someone’s walking or running gait look cleaner is not hard, but making it subconsciously competent and clean (without thought or effort) requires a fix to the underlying problem. We can ALMOST guarantee you that the solution here to this runner’s form issue is not wholly at the foot that looks in toed and slanted. Merely working on their foot strike would be so remedial and corrupt that it would a crime.

Dr. Shawn Allen, one of the gait guys