“When you run up a hill, most of the cross over gait disappears. Runners will tend toward beautifully stacked lower limb joints.”- Dr. AllenAre people running up a hill more likely to tend towards a cross over gait style, in other words tend toward …

“When you run up a hill, most of the cross over gait disappears. Runners will tend toward beautifully stacked lower limb joints.”- Dr. Allen

Are people running up a hill more likely to tend towards a cross over gait style, in other words tend toward a more narrow gait step or a wider gait step ?

Watch people run up hill closely. Even if they are cross over (narrow foot fall) runners, when running up hills a few things will negate much of the narrow foot fall.

1- Running up hill requires more gluteals, more power is needed for all that extra required hip extension to power up the hill. More gluteal max use can, and will, spill over into the posterior fibers of the gluteus medius and this will tend to abduct the leg/hip and reduce some of the cross over tendency.

2- When one runs up a hill, there is a forward pitch of the upper torso, often with a some degree of forward pitch occurring at the hips. More importantly, because one is running up hill, they are stepping up and so more than normal hip flexion is necessary than in normal running. The forward pitch of the body and the greater degree of hip flexion is the culprit here. If the hip/leg is adducted in a cross over style, adding this to a more than normal flexing hip, it will create a scenario for anterior hip impingement and risk of femoral acetabular impingement (FAI) syndromes. Go ahead, test it for yourself. Lie on your back and flex your hip, drawing your knee straight up towards your shoulder.  Pretty good range correct ?  Now, flex the hip drawing your knee towards your navel, adducting it a little across your body. Feel the abrupt range of motion loss and possible pinch in the front of the hip ?  FAI.  This is what would happen if you utilized a cross over gait, narrow foot strike gait. The goes for mountain/sleep hill hikers as well. 

This is why, if you are a narrow foot striker, a near-cross over type of runner, you will see it disappear when you run up hills.  

If you get anterior hip pain running up hills, force a wider step width and reduce the possible impingement at the anterior hip joint. Just make sure you have enough ankle dorsiflexion to tackle the hill in the first place. If not, you may welcome some foot and ankle stuff to the table along with the hip.  

Likely obvious stuff to most of the readers here, but sometimes it is nice to point out the obvious.  Hills, just because they are there, doesn’t mean you have the parts to run them safely.

Dr. Shawn Allen

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 Every foot has a story. 

 This is not your typical “in this person has internal tibial torsion, yada yada yada” post.  This post poses a question and the question is “Why does this gentleman have a forefoot adductus?”

The first two pictures show me fully internally rotating the patients left leg. You will note that he does not go past zero degrees and he has femoral retroversion. He also has bilateral internal tibial torsion, which is visible in most of the pictures. The next two pictures show me fully internally rotating his right leg, with limited motion, as well and internal tibial torsion, which is worse on this ® side

 The large middle picture shows him rest. Note the bilateral external rotation of the legs. This is most likely to create some internal rotation, because thatis a position of comfort for him (ie he is creating some “relief” and internal rotation, by externally rotating the lower extremity)

 The next three pictures show his anatomically short left leg. Yes there is a large tibial and small femoral component. 

 The final picture (from above) shows his forefoot adductus. Note that how, if you were to bisect the calcaneus and draw a line coming forward, the toes fall medial to a line that would normally be between the second and third metatarsal’s. This is more evident on the right side.  Note the separation of the big toe from the others, right side greater than left. 

Metatarsus adductus deformity is a forefoot which is adducted in the transverse plane with the apex of the deformity at LisFranc’s (tarso-metatarsal) joint. The fifth metatarsal base will be prominent and the lateral border of the foot convex in shape . The medial foot border is concave with a deep vertical skin crease located at the first metatarso cuneiform joint level. The hallux (great toe) may be widely separated from the second digit and the lesser digits will usually be adducted at their bases. ln some cases the abductor hallucis tendon may be palpably taut just proximal to its insertion into the inferomedial aspect of the proximal phalanx (1)

Gait abnormalities seen with this deformity include a decreased progression angle, in toed gait, excessive supination of the feet with low gear push off from the lesser metatarsals. 

 It is interesting to note that along with forefoot adductus, hip dysplasia and internal tibial torsion are common (2) and this patient has some degree of both. 

 His forefoot adductus is developmental and due to the lack of range of motion and lack of internal rotation of the lower extremities, due to the femoral retrotorsion and internal tibial torsion.  If he didn’t adduct the foot he would have to change weight-bearing over his stance phase extremity to propel himself forward. Try internally rotating your foot and standing on one leg and then externally rotating. See what I mean? With the internal rotation it moves your center of gravity over your hip without nearly as much lateral displacement as would be necessary as with external rotation. Try it again with external rotation of the foot; do you see how you are more likely displace the hip further to that side OR lean to that side rather than shift your hip? So, his adductus is out of necessity.

Interesting case! When you have a person with internal torsion and limited hip internal rotation, with an adducted foot, think of forefoot adductus!


1.  Bleck E: Metatarsus adductus: classification and relationship to outcomes of treatment. J Pediatric Orthop 3:2-9,1983.

2. Jacobs J: Metatarsus varus and hip dysplasia. C/inO rth o p 16:203-212, 1960

One way to correct an dysfunctional Extensor Hallucis Brevis

The Extensor Hallicus Brevis, or EHB  (beautifully pictured above causing the  extension (dorsiflexion) of the proximal big to is an important muscle for descending the distal aspect of the 1st ray complex (1st metatarsal and medial cunieform) as well as extending the 1st metatarsophalangeal joint.

Since this muscle is frequently dysfunctional, and is one of THE muscles than can lower the head of the 1st metatarsal, along with the peroneus longus and most likely the tibialis posterior (through its attachment to the 1st or medial cunieform), needling can often assist in normalizing function and works especially well, when coupled with an appropriate rehab program. Here is one way to needle it effectively. 

Podcast 106: Understanding Tendonopathies & Asymmetrical Bone density in athletes.

* Plus the global effects of Hallux Limitus, & Chronic exposure to routine high-impact, gravitational loads afforded to the support limb preferentially improved bone mass and structure

Show Sponsors:

newbalancechicago.com
Altrarunning.com

Other Gait Guys stuff

2 Podcast links: 

http://traffic.libsyn.com/thegaitguys/pod_106f.mp3

http://thegaitguys.libsyn.com/episode-106

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:

New device to get people with paralysis back on their feet
Scientists have tested the world’s first minimally-invasive brain-machine interface, designed to control an exoskeleton with the power of thought
https://www.sciencedaily.com/releases/2016/02/160208124241.htm

Splicing out torsions, and aberrant foo types ? Club foot ? etc
http://gizmodo.com/everything-you-need-to-know-about-crispr-the-new-tool-1702114381

Scientists Capture Crispr’s Gene-Cutting in Action
http://www.wired.com/2016/01/crispr-modification/

The UK Just Green-Lit Crispr Gene Editing in Human Embryos
http://www.wired.com/2016/02/the-uk-just-green-lit-crispr-gene-editing-in-human-embryos/

Asymmetries in limbs
http://journals.lww.com/acsm-msse/Abstract/publishahead/Musculoskeletal_Asymmetry_in_Football_Athletes___A.97584.aspx

Tension or compression ?
link to full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676165/

Concept: the forces have to go somewhere, it is a “passing the buck” system.  
We did this blog post here to explain:
http://thegaitguys.tumblr.com/post/138680011664/the-banana-toe-the-force-has-to-go-somewhere

The new muscle discovery !
http://www.rmtedu.com/blog/tensor-vastus-intermedius
http://www.rmtedu.com/blog/tensor-vastus-intermedius
http://www.ncbi.nlm.nih.gov/pubmed/26732825

tendinopathy vasculature: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650849/

tendinopathy treatment paper: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505250/

Knee hyperextension and delayed heel rise in an interesting sport, Racewalking.If you have been in practice long enough, you should know by now that in order to truly help an athlete you have to know their sport, the subtleties and the specifics.  Y…

Knee hyperextension and delayed heel rise in an interesting sport, Racewalking.

If you have been in practice long enough, you should know by now that in order to truly help an athlete you have to know their sport, the subtleties and the specifics.  You have heard us talk about premature heel rise off an on for years. Today, you must consider the opposite, delayed heel rise and the bizarre loading responses that come into the kinetic chains from such a behavior.

Racewalking is a long-distance event requiring one foot to be in contact with the ground at all times. Stride length is thus reduced and so to achieve competitive speeds racewalkers must attain cadence rates comparable to those achieved by Olympic 800-meter runners for hours at a time. Most people cannot truly appreciate how fast these folks are going.

There are really only two rules that govern racewalking:

1-The first rules states that the athlete’s trailing foot’s toe cannot leave the ground until the heel of the leading foot has created contact. 

2-The second rule specifies that the supporting leg must straighten, essentially meaning knee extension (and for some, terminal extension, ie. negative 5-10 degrees !) from the point of contact with the ground and remain straightened until the body passes directly over it. Again, essentially meaning full range knee extension for the entire stance phase of gait (early, mid and late midstance phases). 

Delated heel rise ?

Clearly some folks are going to take knee extension a little more literally. Look at the fella in the red and yellow. Can you say knee HYPER extension ? This is right knee anteriormeniscofemoral impingement looming on the horizon, this is an anterior compression overload phenomenon via the quadriceps. This is often met in this sport with the delayed heel rise that the sport seems to often drive. Prolonging the foot ground contact phase, attempting to abide by Rule#2, “the support  leg must straighten”, can lead to knee hyperextension if one is not careful. This will put a longer stretch load into the achilles and posterior compartment mechanism and this prolonged stretch-contract load can eventually lead to local pathology let alone in combination with the anterior knee compression we just eluded to. These folks will also be at risk for more anterior pelvic tilt, distraction of the anterior hip capsule-labral interval, unique hip extension and gluteal integration, and even possibly altered hip extension motor patterning driving abnormal loads into the hamstrings and low back.  Just imagine the changes in the hip flexor strategies in this scenario. 

To help your athletes, know their sport, know your normal biomechanics and know the pathologies when the rules of clean biomechanics are broken.

Today, on Rewind Friday, we will repost a more in-depth, with video, piece we did a few years ago on Race Walking. You may learn more about normal and abnormal gait than you think, today we translate some of the rules of the sport of race walking into deeper thoughts on gait mechanics.

Here is the link to our more in-depth video assessment and dialogue on the fascinating sport of race walking. If you have never truly looked at this sport before, you should enjoy this Rewind Post. (link).

- Dr. Shawn Allen

Not sure we agree this is the best direction. Imaging how much shoulder stability will be necessary. As least with the Axillary/rib cage crutch placement people can splint their arms and torso into a more stable tripod. The load is shared between the arm-shoulder and the torso. The thorax is taken out of the equation with this new design and that means 100% of the stability must come from the scap-thoracic and glenohumeral intervals. And, most people will not have the endurance stability capacity in those joints either. Sure, it has some great design principles, but we do not things all the variables have been taken into account. We see more shoulder problems coming out of this kind of crutch design. We feel pretty strongly about this. What do you guys think ?

Treat the paraspinals in addition to the peripheral muscleAs people who treat a wide variety of gait related disorders we often emphasize needling the paraspinal muscles associated with the segemental innervation of the peripheral muscle you are tre…

Treat the paraspinals in addition to the peripheral muscle

As people who treat a wide variety of gait related disorders we often emphasize needling the paraspinal muscles associated with the segemental innervation of the peripheral muscle you are treating. For example, you may facilitate or needle the L2-L4 paraspinals (ie: femoral nerve distribution) along with the quads, or perhaps the C5-C6 PPD’s along with the shoulder muscles for the deltiods or rotator cuff for arm swiing. We do this to get more temporal and spacial summation at a spinal cord level, to hopefully get better clinical results.

White and Panjabi described clinical instability as the loss of the ability of the spine, under physiologic loads, to maintain relationships between vertebrae in such a way that there is neither damage nor subsequent irritation to the spinal cord or nerve roots, and, in addition there is no development of incapacitating deformity or pain due to structural changes.

Increased movement between vertebrae (antero or retrolisthesis) of > 3.5 mm (or 25% of the saggital body diameter) during flexion and/or extension suggests clinical instability. This often leads to intersegmental dysfunction and subsequent neurological sequelae which could be explained through the following mechanisms:

Recall that the spinal nerve, formed from the union of the ventral (motor) and dorsal (sensory) rami, when exiting the IVF splits into an anterior and posterior division, supplying the structures anterior and posterior to the IVF respectively. The posterior division has 3 branches: a lateral branch that supplies the axial muscles such as the iliocostalis and quadratus; an intermediate branch, which innervates the medial muscles, such as the longissimus, spinalis and semispinalis; and a medial branch, which innervates the segmental muscles, (multifidus and rotatores) as well as the joint capsule. Inappropriate intersegmental motion has 2 probable neurological sequelae: I) alteration of afferentation from that level having segmental (reflexogenic muscle spasm or vasoconstrictive/vasodilatory changes from excitation of primary afferents and gamma motoneurons) and suprasegmental (less cerebellar afferentation, less cortical stimulation) effects and II) compression or traction of the medial branch of the PPD, causing,  over time, demyelination and resultant denervation, of the intrinsic muscles, resulting in impaired motor control both segmentally and suprasegmentally. The segmental effects are directly measurable with needle EMG. This is a form of paraspinal mapping, which has also been explored by Haig et al. So, in short, instability can lead to denervation and denervation can lead to instability.

We often see clinically that treating a trigger point (needling, dry needling, acupuncture, manual pressure) can alter the function of the associated muscle . Improvements in muscle strength and changes in proprioception are not uncommon. Needling also seems to increase fibroblastic activty through the local inflammation it causes. Wouldn’t better muscle function and some scar tissue be a beneficial thing to someone with instability?

The next time you have a patient with instability, make sure to include the paraspinals in your quest for better outcomes.

and what have we been saying?Gait problems leave clues. Asymmetry is a BIG clue“Asymmetrical lower extremity neuromuscular control is predictive of repetitive stress injury in recreational runners, according to findings presented at the Combin…

and what have we been saying?

Gait problems leave clues. Asymmetry is a BIG clue

“Asymmetrical lower extremity neuromuscular control is predictive of repetitive stress injury in recreational runners, according to findings presented at the Combined Sections Meeting of the American Physical Therapy Association in February in Anaheim.”

http://lermagazine.com/issues/march/years-after-achilles-tear-injured-limb-demonstrates-elevated-knee-loading

Do you have enough in the anterior tank ? Dr. Allen’s quiz question and lesson of the week.One of my favorite sayings to my clients, “Do you have enough anterior strength to achieve and maintain posterior length?”  Translation, do you have enough an…

Do you have enough in the anterior tank ? Dr. Allen’s quiz question and lesson of the week.

One of my favorite sayings to my clients, “Do you have enough anterior strength to achieve and maintain posterior length?”  

Translation, do you have enough anterior lower leg compartment strength (tibialis anterior, long toe extensor muscle group, peroneus tertius) to achieve sufficient ankle dorsiflexion in order to achieve posterior compartment length (gastric, soleus, tibialis posterior, long toe flexor muscle) ?  You see, you can either regularly stretch the calf-achilles complex or you can achieve great anterior compartment strength, to drive sufficient ankle dorsiflexion, in effect EARNING the posterior compartment length. This is a grounded principle in our offices. It is the premise of the Shuffle Walk exercise (link) and many others we implement in restoring someones biomechanics.

Now on to today’s quiz question.

In this photo, both people are just mere moments before heel strike. 

1. Who is gonna need to have more eccentric strength in the anterior compartment ? And what if they don’t have it ? Repercussions ?  

2. Who is toeing off the lateral forefoot ? 

3. Who is crossing over more and thus could have more gluteus medius weakness ?

A picture is worth a thousand words. Answers and dialogue below.

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1. The lady in the high heeled shoes. If she heel strikes first, the larger longer heel on her shoe will mean she will need more of a prolonged eccentric loading of the anterior compartment to lower the forefoot to the ground. I hope she shortens her strike so she can get close to mid foot strike, it will negate most of this issue.  Repercussions? Forefoot pain, clenching/hammering of her toes from use of the long flexors to dampen loading of the metatarsal heads, and even possibly anterior shin splint like pain.

2. The lady is clearly in more lateral toe off, this is from the intoe’ing we see. This is low gear toe off. She may have limb torsion, internal tibial torsion to be specific, or insufficent external hip rotation control as a possibility. There are several possibilities here.

3. Hard to say, but the man seems to be crossing over more.

There is also no arm swing, hands are in the pockets, this is a big hit to gait economy. We have discussed these numbers in previous blog posts, the numbers are significant and real.  Step width is also a real factor, reduced step width leads to joint stacking challenges and is found with weaker hip abductors and changes in the iliotibial band length.

A picture can be worth a thousand words. I am a few short of the mark today, but I wanted to keep it short.

Dr. Shawn Allen, one of the gait guys

… an industry wide concern if you ask us, and the problem with looking to solve your problem on the internet. When was the last time you went on youtube to look for your magic pill exercise ?Come read Dr. Allen’s blog post today and tak…

… an industry wide concern if you ask us, and the problem with looking to solve your problem on the internet. When was the last time you went on youtube to look for your magic pill exercise ?
Come read Dr. Allen’s blog post today and take his Case Quiz question of the week ! Come knock your brain around a bit.

Post/Quiz link: http://thegaitguys.tumblr.com/post/142737112319/is-your-client-feeling-better-because-they-are

This is apparently a growing thing, INTERVAL walking. Oy. We are not particular fans at this point, nothing exciting or earth shattering at this point (other than the concerns we hi light below) but we will look into it more.
What you need to see, and be aware of, is that this is what happens when you wear a shoe that has too soft a rear foot. At heel strike, instead of progressing forward into the mid and forefoot, the rear foot of the shoe deforms and forces you into more HEEL rocker, sustained heel rocker. If you stay in heel rocker too long, you won’t progress forward into ANKLE rocker (ankle dorsiflexion). This often causes knee hyperextension. If you have a good trained eye, you will see both of these things, prolonged heel rocker and never any ankle rocker/ankle dorsiflexion. IT is like the ankle in this video is frozen at 90 degrees the entire time, train your eye to see this absense of ankle rocker. This will cause premature heel rise and premature posterior compartment contraction which can cause premature forefoot loading. This is what happens when the heel of the shoe is too soft. A perfect example of “more cushion” is not always better. IT can be a liability as well. Remember the angry revolution over the MBT shoe and its mushy rear foot?. Same principle, same risks and concerns. Welcome to round two of the same old problems ????? Maybe. you decide. To be clear, this is a comment on the shoes being used, the technique is , well, perhaps interesting. That is all we are willing to comment on at this point until we look into it more. Look at the heel and ankle mechanics during the slow mo clips.
Sorry Ben Greenfield. We are not impressed, as of yet. We like your podcast Ben, you are doing us all a great service, but this one is promoting some potential problems that people need to know about.
Start with our “Shuffle Walk”. Google search it under the Gait Guys. That is a good start.

- Dr. Allen

Podcast 105: Adding strength to your system.

Show Sponsors:
newbalancechicago.com
Softscience.com

Other Gait Guys stuff

A. Podcast links:

direct download URL: http://traffic.libsyn.com/thegaitguys/pod_105f.mp3

permalink URL: http://thegaitguys.libsyn.com/podcast-105-adding-strength-to-your-system

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:

Tech update:
*UPDATE: Fitbit lawsuit data and consumer reports
http://www.engadget.com/2016/01/23/consumer-reports-fitbit-tests/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810794/

Can exercise hurt your heart ? How much does it take ?
http://www.npr.org/sections/health-shots/2016/02/01/464457884/can-extreme-exercise-hurt-your-heart-swim-the-pacific-to-find-out

Lowest effective dose of exercise
http://www.health.harvard.edu/blog/how-much-exercise-do-you-really-need-less-than-you-think-201512088770?utm_source=twitter&utm_medium=socialmedia&utm_campaign=120815kr1&utm_content=blog

Working out not live longer ?
http://www.details.com/story/apparently-exercise-doesnt-make-you-live-longer

Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-35552016005000136&lng=en&nrm=iso&tlng=en

Should you add strength training?
Effects of a concurrent strength and endurance training on running performance and running economy in recreational marathon runners.
Randomized controlled trial
Ferrauti A, et al. J Strength Cond Res. 2010.
http://www.ncbi.nlm.nih.gov/m/pubmed/20885197/?from=%2F22776883%2Frelated&i=8

The microcirculation of skeletal muscle in aging.
http://www.ncbi.nlm.nih.gov/m/pubmed/16611593/?from=%2F14630882%2Frelated&i=16

Microcirculation. 2006 Jun;13(4):279-88.
Effect of aging on the structure and function of skeletal muscle microvascular networks.Bearden SE1.

Future of injury management ?  Regrowing tissue ?
http://www.huffingtonpost.com/kevin-r-stone-md/the-future-of-surgery-regrowing_b_9073096.html

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Go ahead, take the shot.

This runner came in with ankle pain after running across the slope of the hill with the right foot uphill left foot down. She slipped on the ice and heard a pop. She presented to the office with minimal swelling, ankle pain on the right-hand side. Very little discoloration. She said that her ankle was “bent sideways” but reduced overtime as she crawled home to get help.

 She slipped on the ice and heard a pop. She presented to the office with minimal swelling, ankle pain on the right-hand side. Very little discoloration. She said that her ankle was “bent sideways” but reduced overtime as she crawled home to get help.

  The ankle was moderately swollen and tender at the medial and lateral malleoli with little gross deformity. She was not able to bear weight on that side without pain. We took the first picture (top) which didn’t look too bad. We could’ve stopped there thinking that it was just a bad sprain. But we didn't… We always take three views of an area so we don’t miss things. You can plainly see in the second and third views that she has involvement of the deltoid ligament as well as the more obvious distal fibula fracture.

We did some acupuncture to do reduce swelling at the patient’s request and contacted the orthopedists office for her, placed her in the mobilization brace and give her some crutches.

When in doubt, take the shot. It can make a huge difference clinically. 

“Is your client feeling better because they are truly fixed, or have your prescribed corrective exercises merely raised the capacity and durability of their compensation ?  Welcome to a global industry problem.”  -Dr. AllenWhich hip will have troubl…

“Is your client feeling better because they are truly fixed, or have your prescribed corrective exercises merely raised the capacity and durability of their compensation ?  Welcome to a global industry problem.”  -Dr. Allen

Which hip will have troubles extending ?

Remember this quiz question from 2 weeks ago ? I talked about how the body will compensate to level the pelvis (and eyes and vestibular apparatus).

Lets go further down the rabbit hole.  Here is your question of the week (you may have to go back and review the prior blog post if you are unsure of how the body will cope with the slope.  Here is that first blog post.

Question: Which hip will have troubles getting into hip extension and thus terminal glute-hip-pelvis stabilization ?

Answer:  scroll down (at least think about it for a second)

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Answer:

The leg on the up slope of the beach, the non-water side leg will have to be in a modest degree of knee flexion to shorten and accommodate to the slope. A Flexed knee is not an extended one and it will be far more difficult to extend the hip and get into the glutes. Propulsion will also be compromised.  For you indoor small track runners this will happen to you on the inside leg on the curves of the track. This is why we see so many hamstring injuries during indoor track.  Think about it ! It is not just bad luck.  Go ahead, tally up  your teams history of hamstring injuries, you should find more on the left leg for track runners. It is simple applied biomechanics.   Also, imagine the altered demand on the quadriceps on that flexed knee (the right knee in the picture above, and the left knee in circle track runners). Furthermore, what is the likelihood that the right pelvis will deviate into an anterior tilted posture ? You bet ya, a greater tendency, and thus a possibly shortened quadriceps/hip flexor mechanism.  Do you think this could inhibit hip extension and gluteal function ? You bet ya.  Oh, and one more thing, if you are true gait nerd, you should have asked yourself one more question, what about ankle rocker ?  Yes, you will need more ankle rocker on the beach side foot (flexed knee side). When the knee flexes, there must be more ankle rocker for this to occur, if not, you may implode into some unwelcome arch collapse, because arch collapse offers more false ankle rocker. What a mess huh !   Now, do not be shocked EVER again when your client’s come back from a sunny beach vacation from walking the beaches for hours every day, and find themselves a stark raving mad mess.  It is not the salty ocean air or the tequila, it is the slope. One could make a case that walking up and down the beach should balance things out, but that is only if we are balanced and symmetrical when we start out. Gravity always wins.

One final rant. If you are offering “corrective exercises” to your clients, you had better know at least the basics of movement and biomechanics. And further more, you had better know how to examine for them, and that means hands on assessment of the body, not just looking at how your client moves through a battery of tests. If the prior blog post (here) and today’s blog post principles are not remedial principles of knowledge for you, offering corrective exercises without this knowledge and a physical exam to confirm your assumptions is fraught with disaster, or at least helping your client to build deeper compensations on their prior compensations. Is your client feeling better because they are truly fixed, or have your prescribed corrective exercises merely raised the capacity and durability of their compensation ?  This is the kind of stuff that keeps my new patient scheduling booked at 4-8 weeks out … . .  frustrated clients.

This is why we do not offer online consultations like some do. Because, we have not figured out how to obtain the third dimension needed in our gait and movement observation (thank you Oculus Rift, the future is near) but more so, we cannot take that information and put it together with our own physical examination to determine whether if what we are seeing is the actual problem, or a compensation. Here in lies the pot of gold.

Another clinical pearl from Dr. Allen