The Circle of Durability.


The article below for some reason inspired today's soft rant. I hope you feel this is worth your time. 
Yesterday I talked about arch height and ankle mortise dorsiflexion and how we can obtain more global dorsiflexion range through some pronation, loosely meaning, some arch compression/drop and splaying apart of the tripod legs of the foot. Global arch flexibility is a piece of that puzzle.  This action of arch compression/drop/tripod splay moves the tibia forward in the sagittal plane and this is global dorsiflexion. Let me be clear however, a reduced ankle mortise dorsiflexion range of sagittal motion which is met by more arch height reduction/prontation/tripod splay, is still dorsiflexion however it is less sagittal dorsiflexion and a little more adduction and medial drift. This can bring the knee into the medial plane and it does promote more internal spin of the limb, this can be a problem.  None the less, it is still global dorsiflexion. It is something we see at the bottom of a squat, we see it because to get there most of us do not have all that dorsiflexion at the mortise. It is not abnormal, the question is, "is it safe for you? Can you do it repeatedly, safely?" It is where we go when we need more sagittal motion, but it may not be ideal, and is often what creates functional pathology. We see it all the time, someone says in an email, "I have plenty of ankle dorsiflexion, that is not my issue".  Do you have plenty? Is it not really your problem? This is fine tuning stuff, it takes a skillful eye and assessment hand. It takes experience to see the whole picture. You cannot get this full 4k experience and understanding from a 2 dimensional youtube video. This arch compression and pronation is normal to occur, it should occur, it must occur. But, how much is too much, for you ? I like to explain it this way, 


"there is a point at which sound, economical, durable, biomechanics becomes a liability. And, at that point where the liabilities begin is in fact where we begin to skirt the edges of that durable skilled movement. Where we begin juggling our liabilities is where the risks begin to mount and begin to whittle away or trump our S.E.S.P (skill, endurance, strength, power). This is where injury often occurs, at that intersection where the gas tank of our S.E.S.P. begins to run low and our liabilities begin to run high." 


Sidebar: 
I have explained this concept many times before when talking about the cross over gait. Moving towards a narrower step width is fine if you have the durability to be there. The question is, how long are you going to be there ? A cross over gait tendency is more economical but you begin to risk liabilities toward injury if that durability becomes challenged. As a runner you must know where your safe zone exists and know how much durability you have at those fringes of your movement. It is when you are there too long, too often, or too much that you empty that durability gas tank which then increases your liabilities towards injury. This is why I give high volume and strength work once a problem is solved, to make sure that they can keep that circle of durability high. It is when we stop keeping our gas tanks large and full that we run on fumes and our risks increase. You might be able to run economically for 5 miles with a narrow step width cross over style running gait. But, can you do it safely at 10 miles ? How about 15?  Is it any wonder why people get injured as they fatigue their safe motor patterns ?  If they have worked hard to keep that circle of durability large (S.E.S.P.) they are bound to be safer and less injured. Injuries occur because we exit our circle of durability, its gas tank has run too low, liabilities now trump economy and durability.

- Dr. Shawn Allen, the gait guys

http://www.japmaonline.org/doi/abs/10.7547/8750-7315-2016.1.Song
 

Toe flexor strength and ankle dorsiflexion ROM during the countermovement jump

This study looked to evaluate the relationships between peak toe flexor muscle strength, ankle dorsiflexion range of motion, and countermovement jump height.

"The results showed (1) a moderate correlation between ankle dorsiflexion range of motion and countermovement jump height and (2) a high correlation between peak first toe flexor muscle strength and countermovement jump height. Peak first toe flexor muscle strength and ankle dorsiflexion range of motion are the main contributors to countermovement jump performance."

There could be variables missing here, and plenty of caveats. We should try to get the full text on this one to be fair. None the less, interesting facts to brain juggle however.
These muscles are posterior compartment muscles so it makes sense, however, when the first great toe (the hallux) is in relative flexion, the arch is easier to drop (conversely, hallux dorslflexion causes the arch to raise and keeps the ankle dorsiflexion more purely in the ankle mortise) where as, with relative toe flexion, the arch can drop, this can generate some pronation and arch splay, which can increase the "appearance" of more ankle dorsiflexion when in fact some could be from the arch drop/pronation. I wonder if the researchers are aware of this variable or if this study took it into consideration. Certainly when someone is dropping into ankle dorsiflexion ready to jump, is is easy to drop the arch. Go ahead, dry doing it with the toes down , and then with the toes up in extension, its very different in the amount of dorsiflexion you can get out of the entire arch-ankle mortise complex combined. IT is these kinds of things that can easily be over looked and skew findings.

Correlation between toe flexor strength and ankle dorsiflexion ROM during the countermovement jump

Sung Joon Yun1) 2), Moon-Hwan Kim2), Jong-Hyuck Weon3), Young Kim4), Sung-Hoon Jung5), Oh-Yun Kwon5)

Journal of Physical Therapy Science
Vol. 28 (2016) No. 8 August p. 2241-2244

link : https://www.jstage.jst.go.jp/article/jpts/28/8/28_jpts-2016-202/_article?platform=hootsuite

https://www.jstage.jst.go.jp/article/jpts/28/8/28_jpts-2016-202/_article?platform=hootsuite

Podcast 111b: Somnambulism. Locomoting when you are still asleep.

Podcast 111b: Sonambulism. Locomoting when you are still asleep. Ultramarathoners know about this one to a degree. Here is what you need to know. Do you ever wonder why you cannot sleep that first night in a new place, like a hotel ? We have answers.

http://thegaitguys.libsyn.com/podcast-111b-shorts-sleepwalking

http://traffic.libsyn.com/thegaitguys/pod_111b_Shorts-_Sleep_walkingg.mp3

Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our website and blog. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).

Are you a control freak?

While working with a post surgical ACL patient that has +2 laxity and  graft pain, I was reminded of something Dr. Allen and I were talking about while discussing this case. 

One of the primary goals post ACL is stated as improving range of motion, particularly getting to full extension. If you look at the mechanics of the anterior cruciate ligament, you'll see that placing the knee in full extension places this ligament under stretch. We often will try to increase range of motion by hyper extending the knee, or using it as a fulcrum, which can cause undue stretch to this ligament. This means the burden of oweness is on the musculature surrounding the joint to provide stability, similar to what we are seeing in my patient.

I asked him to perform a one legged stand keeping his knee over his second metatarsal and just hold it. I then had him perform a mini squat, but rather than a traditional knee forward squad I had him do a potty squat (tibia remains vertical, while flexion occurs at the knee by moving the femur and glutes backward). Note that his foot is in a tripod position and his toes are up. (see video here)  He was able to maintain good control of the knee for about the first 10° of flexion and then his motion started to degrade. Our goal will be to keep him in a range of motion where he has good neuromotor (find the first 10° of motion) and expand upon that. We remember from our principles of exercise that isotonic exercises (like a potty squat) have a physiological overflow of 15° on each side of the point of application. If I can get him to flex to 10° and be in control, I'm actually getting effects up to 25° flexion.

Simple? Yes. Important? Incredibly! If you can't control the range of motion that you have, why should you have more? Remember in your rehab procedures, keep it in a safe range.

Can you see what I see?Or...Can they see what you see?

While making a chickpea and Swiss chard succotash recipe out of the September issue of vegetarian times,  to go with the two racks of ribs and roasted beets and parsnips that I was making, I was reading an article out of August 2016 issue of one of my favorite journals "lower extremity review" by the editor Jordana Foster. Called "Out on a Limb: falling in with feedback". The "out on a limb" section is a monthly regular and always holds some compelling clinical ideas.  This particular one was talking about utilizing "visual feedback" with your patience.

It got me thinking about using visual feedback. The article spoke of some preliminary research from Rosalind Franklin University in Chicago utilizing visual feedback to control tibial acceleration.

It got me thinking. You could utilize some slick software and computer interface in your office or, if you were somewhat text savvy, use a simple video camera with a hook up of the screen real-time to a monitor device. This could be easily accomplished and most offices however there's an even easier for my feedback that could be utilized. A mirror. You can find a very large, great mirror at the local thrift store for a few dollars that you can have in front of your treadmill or Area where you were performing "gate rehab" with your patient or client. The simple tool can be extremely effective and low cost. Nothing like improving your bottom line without increasing your costs.

Try it and let us know what you think

 

#gait #rehabilitation #gaitrehabilitation #mirrortherapy #visualfeedback #visual #feedback

Hips, joint resurfacing and stem cells.

Things are moving fast in the research world. We need to keep up with our readings even though it seems like trying to drink from a firehose at times. These things will likely be upon us in a mere blink.

"scientists have programmed stem cells to grow new cartilage on a 3-D template shaped like the ball of a hip joint. What's more, using gene therapy, they have activated the new cartilage to release anti-inflammatory molecules to fend off a return of arthritis."

We have always encouraged our clients that joint replacements are the choices at the end of the road when it comes to options.

We must maintain mobility and stability and clean function and always drive the client status first into good quality of motion over power and speed. Without the proper assessment of function we can get these things backward because of skilled compensation patterns. It is highly suspect that many injuries occur because of increased strength, load, speed, power etc being born atop corrupt movement pattern foundations. After all, humans are great compensators. It is suspect that these mistakes are what lead young clients down expedited joint "wear and tear" paths, sometimes leading to joint replacements at a sub 60 year age if not sooner. This kind of research as described here in this article could be the life saver those folks are looking for. However, this should never take the place of abiding by the guidelines discussed above. There are principle rules, but as in life, many of us forget that they do not apply to us because we are "an exception".

 

Scientists develop new way to resurface arthritic hip joint

http://www.news-medical.net/news/20160719/Scientists-develop-new-way-to-resurface-arthritic-hip-joint.aspx

Scars of evolution

So this week has been much about the glutes. We stepped back earlier today into the evolution of bipedalism and some theories around glutes and what might have pushed us upright from 4 limbs onto two. And now as the grand karma of the internet has been listening in ....... we find this:

Lucy remains one of the most famous discoveries in paleontology. ""Her death, on the other hand, has been a mystery. Now, after poring over the celebrated bones, a team of scientists has concluded that Lucy died most unceremoniously: from a long fall out of a tree. If they are right, the discovery could yield an important clue to how our ancestors evolved from tree-dwelling apes into bipeds that walked the African savanna."

Listen to our 13 minute Podcast "shorts":Evolution of Upright Bipedal Gait & Glute Development released today. It is interesting stuff. Link:https://tmblr.co/ZrRYjx2BTf6mR 

 

A 3.2-Million-Year-Old Mystery: Did Lucy Fall From a Tree?

-By Carl Zimmer

http://www.nytimes.com/2016/08/30/science/lucy-hominid-fossils-fall.html?_r=1

A Blood flow restriction lesson from a yo-yo champ.

This is the finger of a professional yo-yo'ist. Extreme blood flow restriction damage.
We don't have a problem with the blood flow restriction training and therapy that is all the rage these days (*caveat: see below), though we don't hold a lot of value in it, we suppose things have their place. 
Our point today with this photo, just keep in mind what the heck you are doing to the stuff you cannot see. We continue to search for research that might come out in time showing arterial damage or possible clot formation in folks who over do Blood Flow restriction stuff too long, too tight, too often. Stuff is getting compressed and we wonder if arterial wall damage might be something we see down the road ??? Who knows, just thoughts. We are not trying to be alarmists by any means, it is just the kinda stuff we think about.
Sure, this is an angiogram of the permanently ruined veins in the finger from years of string soft tissue restriction, certainly an extreme case ! We just thought it was interesting and reminds us all that we need to keep in mind what our therapies are doing to the tissues beneath and what the activities of our clients can do over a long period of time. We don't have any pro-yo-yo folks in our office, maybe you do, and if so, educate

Foot skills: Edgework

 

From August 28, 2016 facebook post

* VIDEO: About 4-5 years ago some of you that have been with us for awhile will recall that i studied some latin and smooth ballroom dance for a few years. It was humbling to say the least. There are so many reasons why men suck at dancing. But, I have never been one to stray away from fearful and humbling experiences. I enjoy being curious and trying hard things and i am ok with looking like a fool to get an edge on wisdom seeking. This dance thing was the hardest thing i have ever done, the pros make it look easy, but it is hard. Movement, coordination, timing, rhythm, memorizing steps and principles, then learning to lead a partner through all that SILENTLY ! but one of the hardest things to learn was how to use the whole body to create movement. Dancing is whole body, latin dancing is a workout, and the core gets smashed when done right. There is a reason dancers have amazing bodies, because this stuff is hard ! One day one of the male coaches came over to me and said something resembling "you are not reacting into the floor with your feet, you have to feel the inside and outside edges of your rear, mid and forefoot at any one moment of time. If you cannot get that right, you cannot properly engage the leg muscles, hips and certainly not your core". He was right. I had no idea how to move. He then said, "go home, but on some socks and polish your floors, reacting into, and then off of, the floor. When you begin to feel your leg muscles and learn that the feet can be used in so many ways other than walking, things most people never even come close to in sports, you will be ready to START." This was what happened after one week of reacting into the floor, I came to name it, "EDGEWORK". I was learning to use the inside and outside edges of my rear, mid and forefoot, sometimes on the opposite sides of the body, pronating at times through the right rear foot while supinating through the left forefoot etc. This is why I laugh to myself when i see people posting what they call holy grail "foot exercises" on the internet. Much of it is novice stuff, but admittedly that is where most people have to begin, and should begin. This was just one reason I appreciated learning 10 different dances, from cha cha and jive which had extremely fast and agile foot work, to rhumba and salsa and their complicated foot work into the floor, and then dances like foxtrot or waltz that required an entirely different kind of footwork, skimming and floating across the foot with grace. Oh, and did i mention leading a lady about the floor, silently with just body jestures and gentle hints of pressure. Oh, and to music, on time, in rhythm etc. This was a journey in which i gave zero f#@&ks about about what people thought when they knew i was taking dancing lessons, because I knew I was learning to move and use my body like few others even remotely had a clue about, and likely never will. Enjoy my silly little FOOT EDGEWORK video i shot for this coach, so he could see what i had been able to do in just a week. You will see inside edges, outside edges, skimming, floating, pressuring into the floor, directional changes, pivots etc. From here, my journey into movement took a giant leap forward. I began to truly understand how the foot worked on the ground, truly "worked" and how that would translate into hip rotation, core engagement, upper body turning, spinning, posture, arm movements, glute and calf use, peroneal stability for the lateral ankle and many more things. There is a reason why some of the greatest athletes in sports took on dancing and ballet to improve their understanding and grace of movement to their chosen field. Because it was an edge no one else willing to embrace. Go ahead laugh at the silly video, i sure did. I just found it while purging computer files and immediately put the wool socks back on and went to polish the floors. Come on men, help keep the house floors sparkly clean like mine, give them a shine :) Oh, and thanks Bruce Lee, Hong Kong Cha cha champion for making it ok to follow you. You can take that to the bank Connor McGregor. (*the silliness begins about 10seconds into the clip, give it a sec)
- Dr. Shawn Allen, the other gait guy

https://www.facebook.com/thegaitguys/videos/1310391195667219/

<iframe src="https://www.facebook.com/plugins/video.php?href=https%3A%2F%2Fwww.facebook.com%2Fthegaitguys%2Fvideos%2F1310391195667219%2F&show_text=0&width=560" width="560" height="315" style="border:none;overflow:hidden" scrolling="no" frameborder="0" allowTransparency="true" allowFullScreen="true"></iframe>

 

 

Concussions and increased risk for musculoskeletal injury.

Concussion Increases Odds of Sustaining a Lower Extremity Musculoskeletal Injury After Return to Play Among Collegiate Athletes. -Brooks et al.

Perhaps we need to be paying far more attention to the musculoskeletal injuries in our contact sport athletes. We need to bring to light some important facts to our athletes (and their parents!).

From the Nauman Purdue football study:
"The worst hit we've seen was almost 300 Gs," Nauman said. A soccer player "heading" a ball experiences an impact of about 20 Gs." 
Here is what we say: now add 20 soccer headers in a week of game and practice. Or take 20 submaximal football tackles, in a week of game and practice. You do the math.

Concussions have been now shown to cause abnormalities in brain and motor functioning. These issues can last long after perceived clinical recovery. "Recent work suggests subtle deficits in neurocognition may impair neuromuscular control and thus potentially increase risk of lower extremity musculoskeletal injury after concussion."
Do NOT underestimate the impacts of a single concussion, and certainly NEVER in a second impact (Second Impact Syndrome (SIS)). SIS can at worst, lead to death within minutes, so certainly it can lead to impaired neuromuscular control. Our current society continues to ignore the immense long lasting effects of head injuries, even minimal ones. We continue to allow young developing brains to partake in football, soccer, and other jarring sports. Yes, we cannot live in a vacuum, but we can live in awareness and wise choices.

Facts: 
The 2 year Purdue Study of high school football players suggested that concussions are likely caused by many hits over time and not from a single blow to the head, as previously believed. "Over the two seasons we had six concussed players, but 17 of the players showed brain changes even though they did not have concussions," Talavage said. "The most important implication of the new findings is the suggestion that a concussion is not just the result of a single blow, but it's really the totality of blows that took place over the season," said Eric Nauman. "Most clinicians would say that if you don't have any concussion symptoms you have no problems," said Larry Leverenz, an expert in athletic training and a clinical professor of health and kinesiology. "However, we are finding that there is actually a lot of change, even when you don't have symptoms."

"New research into the effects of repeated head impacts on high school football players has shown changes in brain chemistry and metabolism even in players who have not been diagnosed with concussions and suggest the brain may not fully heal during the offseason."-Emil Venere
"We are finding that the more hits you take the more you change your brain chemistry, the more you change your brain's ability to move blood to the right locations," Nauman said.

'Deviant brain metabolism' found in high school football players. 
http://www.purdue.edu/…/deviant-brain-metabolism-found-in-h…

Biomechanical Correlates of Symptomatic and Asymptomatic Neurophysiological Impairment in High School Football
Evan L. Breedlove, BS1,Thomas M. Talavage, PhD2,3,Meghan Robinson, BS2, Katherine E. Morigaki, MS ATC4,Umit Yoruk, BS3, Larry J. Leverenz, PhD ATC4 , Jeffrey W. Gilger, PhD5, Eric A. Nauman, PhD1,2,6

http://www.ncbi.nlm.nih.gov/pubmed/26786903

Motor control and the immune system

Wow, interesting. Definitely podcast material. If you have been following the literature, recently the immune system and brain function and the gut have been dramatically linked in ways we never knew existed. Now this !

" Princeton University researchers have found that a family of proteins with important roles in the immune system may be responsible for fine-tuning a person’s motor control as they grow, and for their gradual loss of muscle function as they age. The research potentially reveals a biological cause of weakness and instability in older people, as well as a possible future treatment that would target the proteins specifically."

Immune System Proteins Responsible for Fine Tuning and Reducing Motor Control

NEUROSCIENCE NEWSAPRIL 12, 2016

http://neurosciencenews.com/mghi-motor-control-genetics-4035/

Do novice runners really have weak hips and poor running form ?

Folks are ramping up mileage here in Chicago-land for the October marathon. Lots of first timers trying to fill the bucket list, and lots of hip and knee stuff coming into the office. This older article reminded us of the paramount need to slowly build up safe durability. So many folks just follow the ledgers, "This week is 16 miles, 2 more than last sunday, this will keep you on track to get to your taper week". We get all that. But this recipe doesn't work for everyone. Some bodies are so weak and out of shape that their recipe is drastically different than the "average joe or jane". Many need their marathon program time frame doubled so they can build their durability. Yes, novice runners often have functionally unstable/weak hips (amongst other things), and some have bad running form, and many have BOTH ! We remind folks that 26 miles is something to endure for most, and that means preparation, probably preparation before the running training started. So it is about educating them for next time, if there is a next time for them ! Don't forget, running is a sagittal game, one is moving forward. The frontal and axial (rotational) stability is often neglected, and here lies the hole in the bucket that leads to unjuries. Even if you are half way there to your marathon date and doing fine, it is never too soon to start frontal and axial plane durability work, just in case the 18 miler is just beyond what you can endure to protect those joints.

http://www.physiospot.com/research/do-novice-runners-have-weak-hips-and-bad-running-form/

 

 

 

 

Brace2Play ankle brace. Caveat emptor.

Lets be clear ! This brace is for above the ankle mortise sprains, ie. low and high ankle sprains, sprains to the syndesmosis. It is NOT for ankle mortise and below sprains (ie. lateral and medial stabilzing ankle ligament sprains, ATF, PTF, deltoid ligs etc). If you use this brace on those injuries, good luck......you will not have any protection to those torn ligaments. 
Also, i am hesitant to buy into the "treats shin splints". Braces are supportive, nothing more. So, "supports" shin splints is more accurate IMHO. 
I would also make a case that a syndesmosis sprain (low-high ankle sprain) is not an injury you should be looking for a brace to enable you to continue to play on. Rather, rest and heal and do your initial phase low load rehab. 
Like most things, devices like this have a place and a purpose, but you have to know what you have injury wise, and know what you are dealing with. For example, if you have both a syndesmosis (low-high ankle sprain) AND a deltoid or lateral ligamentous complex sprain, this brace is not what you should chose in our opinion.

https://www.edgemobilitysystem.com/products/brace2play-above-the-joint-ankle-brace?variant=21314299587

Toe grip strength and hallux valgus

#craigpayne over at Podiatry Arena said, "chicken or the egg", which came first ?
Weak Toe Grip Strength (TGS) correlates with hallux valgus . . . 
Do not yet take this study as "do more toe grip strength work", that is NOT what it is saying !!!!!!

We have taken note in our clinics that it "appears" that more long hallux flexor use often "seems" to accentuate a hallux valgus (HV). We continue to study this observation, but not hanging our hat on any conclusions as of yet. But, when someone with HV grips with the long toe flexor hammering down the distal toe, the valgus appears to accentuate. We shall see, its an observation. None the less, we try to get these folks into a pressing, then add the long flexor, and this seems to give adequate purchase on the ground without as much valgus posturing. Keep looking into more active toe extension, separation and hallux abduction as a means to an end. This will likely be a discussion on podcast 113, coming soon. Have you listened to podcasts 108 or 109 yet ? 109 launched Saturday. Keep up !

Weak TGS Correlates with Hallux Valgus in 10 12 Year Old Girls: A Cross- Sectional Study

https://www.researchgate.net/publication/304271421_Weak_TGS_Correlates_with_Hallux_Valgus_in_10_12_Year_Old_Girls_A_Cross-_Sectional_Study

Arm swing and hip ranges.

Most folks think they know a sufficient amount about arm swing, but the truth speaks otherwise for many. Many know heaps about upper quarter biomechanics and how to assess and evaluate the joints of the upper quarter but they have no clue what to look for when it comes to the client using the limb in locomotion. What really happens during the complex arm motions during gait and various forms of locomotion in runners and throwing sports ?
"For the first time, we provide evidence that the spinal interneuronal networks linking the forelimbs and hind limbs are amenable to a rehabilitation training paradigm. Identification of this phenomenon provides a strong rationale for proceeding toward preclinical studies for determining whether training paradigms involving upper arm training in concert with lower extremity training can enhance locomotor recovery after neurological damage.” -Shah et at, Brain 2013 Nov

"Our results demonstrate that altered hip rotational range of motion, measured clinically, has a direct effect on the amount of external rotation torque and horizontal adduction range of motion of the shoulder during the throwing motion." -Laundner et al, (article below)

Want to dive deeply into arm swing ? Want to really know what you are doing and missing ? Goto our blog (thegaitguys.tumblr.com) and in the search box type "arm swing". You will find nothing short of dozens of articles we have written on the topic.

The relationship between clinically measured hip rotational motion and shoulder biomechanics during the pitching motion

Kevin Laudner, Regan Wong, Takashi Onuki, Robert Lynall, Keith Meister

http://www.jsams.org/article/S1440-2440(14)00137-6/abstract

The Skill of walking

The Skill of Walking:
We enjoy most of what goes up on #BreakingMuscle. This one brings up a point we use in the clinic all the time, Mimicry.
We use to to help our patients "see" what we see them doing in their gait or movements. We mimic what we see in their gait while we explain the "what" and "why" of their dysfunctional gait. 
Sometimes we are so wrong when it comes to understanding exactly what we are doing. Think your posture is good ? Check it next time you walk pasta mirror, it is possible it is not as pristine as you think it is. We have mirrors up all over our clinic so people can see what they look like and what they are doing. We encourage them to check on their posture in the mirrors when they walk down to the treatment rooms (and, it is not just for the patients! !). Mirrors can be a real asset when it comes to feedback. 
Mimicry of our clients movements helps them to understand, in 3 dimensions, in many respects better than 2D video what they are actually doing (we discuss this more in podcast 112 launching in a few weeks). Virtual reality is going to clean up many problems we have teaching in the clinic.

http://breakingmuscle.com/natural-move…/the-skill-of-walking

Short foot exercise death.

Here is an article we wrote 5 months ago. It is worth reviewing in light of the other short foot articles we have shared this week.
" . . . this Short Foot exereise is a pretty prehistoric exercise if you ask me, it needs to be dusted off and updated and retaught correctly"- Dr. Allen

" . . . as we are bearing weight down on the foot the arch should be in a controlled pronatory deformation to shock absorb. There is no time to be reacting off the floor into a short foot, that opportunity moment is lost at contact, actually it really never occurs once the ground is met whether one is in initial rearfoot, midfoot or forefoot strike. The foot has to be prepared at the time of contact with its’ most competent arch, not busy reacting after the fact trying to achieve the competent structure. The value in the short foot is earning competence in its loading ability and learning to control its adaptive eccentric lengthening, this must be possible in both toe extension and toe flexion (ground contact)."

We have much more to say in the blog post...... link provided below.

https://thegaitguys.tumblr.com/post/139486938004/is-the-short-foot-exercise-dead-dr-allen

Slower walking in the elderly and calf strength.


"Conclusions: In older men, walking at preferred speed allows triceps surae muscles to generate force with more favorable shortening velocity and to enhance use of tendinous tissue elasticity compared to walking at young men's preferred speed. The results suggest that older men may prefer slower walking speeds to compensate for decreased plantarflexor strength."

Slower Walking Speed in Older Men Improves Triceps Surae Force Generation Ability.
Stenroth, Lauri; Sipilä, Sarianna; Finni, Taija; Cronin, Neil J.

http://journals.lww.com/acsm-msse/Abstract/publishahead/Slower_Walking_Speed_in_Older_Men_Improves_Triceps.97437.aspx

Obese Feet


Doesn't it just make sense ? It needs to be part of the dialogue with your clients.
"Obese feet differ significantly from those of healthy adults, particularly in width."
And a change in width may mean a change in function, changes in mobility and stability, which may lead to pain and at the very least, accommodation and compensation.

Foot dimensions and morphology in healthy weight, overweight and obese males

Carina Price [correspondence] Press enter key for correspondence information [email] Press enter key to Email the author

Christopher Nester
http://www.clinbiomech.com/article/S0268-0033(16)30101-2/abstract?platform=hootsuite

The Types of Jaywalkers

The jaywalker
The Veerer
The Plodder
The retroactive
The runner
The butters
The swaggerers

We walk amongst them all and it is never more ever-present than when moving amongst the masses in a big city. Especially, when we are in a hurry, do we notice the annoying nature of these people the most. However, the problem is ours, because we are all one of these walking types at some point. Next time you are waking in the big city, amongst the masses take note, instead of annoyance.

" . . . the history of pedestrian nuisances is a long and colorful one. The very term “jaywalker” — after jay, a silly person — was coined on August 3, 1924, in a New York Times editorial about the proliferation of pedestrian menaces."
In “The Confusion of Our Sidewalkers: And the Traffic Problem of the Future in the Erratic Pedestrian,” the original 1924 article by M. B. Levick writes:
"There are the veerers who come up sharply in the wind and give no signal. The runners who dash to a goal and then dash back again without even tagging another “it.” The retroactive, moving crabwise. Those who flee and turn swiftly to victory, making a commonplace of the ruse that gave Joe Choynski his fame in the ring. Left-ends and butters, the people who never met the Marquis of Queensberry and to whom Greco-Roman is more foreign than jiu-jitsu.

As mad as the satellite particles of an atom and amid each group, like a nucleus, a static type. The plodder, trudging through Times Square as o’er the lee and knowing neither near side nor off side. The inferiority complexes whose only sense of power is to make the world walk around them. Children of the cigar store Indians standing stock still, so that a couple passing must say “Bread and butter!” Others who are to movement what the color blind are to light and the swaggerers who in an earlier age would take the wall, but in this present confusion must take wall and gutter and all between to assert their precedence."

Here is the full article on Brainpickings.

The Four types of Jaywalkers. Maria Popova

https://www.brainpickings.org/2013/09/26/jaywalkers-wendy-macnaughton-1924/