Jumping is a skill. Look at his right knee, i wouldnt want to be his knee. The knee is a sagittal hinge, not a lateral hinge. This is going to likely lead to a Valgus Thrust degenerative joint. Jumping is a sagittal plane skill first , master that first.
It just hurts to watch his right knee !
http://www.menshealth.com/…/best-core-and-cardio-workout-men
*Video Gait demo: The couple in the hats, are they in phase or out of phase?
Have you ever wondered why people who walk together quickly synchronize their gaits ?
The synchronization between walking partners is more complex than it seems on the surface. There are two types of synchronization, in-phase (both person’s right foot move forward at the same time) and out-of-phase synchronization (where the right foot moves forward with the partners left foot). You can see in the video above that the couple has subconsciously fallen into an Out-of-Phase synchronization.
There are multiple factors and communication mechanisms occurring. There are auditory mechanisms in play such as the sound of the other persons foot fall. There are even visual mechanisms through peripherally seeing your partners arm swing and foot fall which encourages the imitation synchronization. However, the strongest in-phase synchrony occurred in the presence of tactile feedback meaning hand holding or embracing each others waist from behind, which couples often do when walking more slowly, seem to create a stronger synchrony. When this tactile component is engaged between two walkers it is plausible that the upper and lower limbs move more freely when paired up, particularly with arm swing.
Read on, there is more to it here in an post we did awhile back. . . . link below
https://thegaitguys.tumblr.com/post/29333686230/have-you-ever-wondered-why-people-who-walk
https://youtu.be/05XtMtap3Yg
Have you ever wondered why people who walk together quickly synchronize their gaits ?
From healthy heart cells that synchronize to a single beat, to women in school dormitories or work places who synchronize their menstrual cycles, to fireflies who begin blinking in synchrony when they all perch in the same tree synchronization is something that is abundant in nature. It is no wonder that we find synchronicity in one of our most primitive and frequent motor patterns, walking together with someone shows the same synchronicity phenomenon.
Hold the hand of your favorite person and go for a walk. Within a few strides your gaits will synchronize. Is it because it is easier ? Is it because when synchronized the arm swings will match thus making it easier and more effortless to hold hands ? Does the same effect occur if you are not holding hands ? Studies have concluded that although it does not happen all of the time, they found it occurs in almost 50% of the walking trials even among couples who do not usually walk together. This is far too high a percentage to not make it a statistically significant finding.
The synchronization between walking partners is more complex than it seems on the surface. There are two types of synchronization, in-phase (both person’s right foot move forward at the same time) and out-of-phase synchronization (where the right foot moves forward with the partners left foot). You can see in the video above that the couple has subconsciously fallen into an Out-of-Phase synchronization, then after the tide splash that throws them off within just a few steps they fall right back into Out-of-Phase synchronization and hold it in that state. There are multiple factors and communication mechanisms occurring. There are auditory mechanisms in play such as the sound of the other persons foot fall. There are even visual mechanisms through peripherally seeing your partners arm swing and foot fall which encourages the imitation synchronization. However, the strongest in-phase synchrony occurred in the presence of tactile feedback meaning hand holding or embracing each others waist from behind, which couples often do when walking more slowly, seem to create a stronger synchrony. When this tactile component is engaged between two walkers it is plausible that the upper and lower limbs move more freely when paired up, particularly with arm swing.
What is thought to happen is that one partner dominates the lead in the gait, just as in dancing, one person is the leader and the other is the follower. The lead partner’s lower limbs determine the movement of their arms, which in turn when holding hands, sets the arm movement pattern in the partner then determining the leg swing and stance phases. Thus, synchrony is achieved.
However, it is important to note that many of the studies were clear to mention that even in non-tactile cases, many of the gaits of two people walking together are synchronized. This was likely due to the visual and auditory parameters however height, leg length cadence etc could also play into those successful non-tactile synchrony cases.
These are interesting findings at 50% because it is very unlikely that any two people are of the same height, leg length, cadence, stride and step length. These are all parameters that are likely to change the likelihood of gait synchrony. Zivotofsky found that “even in the absence of visual or auditory communication, couples also frequently walked in synchrony while 180 degrees out-of-phase, likely using different feedback mechanisms”. The studies below discuss many issues of this synchrony but it is perhaps most significant in clinical rehabilitation cases or in early or moderately advanced movement impairment disorders and diseases these findings may partially explain how patients can enhance their gait function when they walk with a partner or therapist. It is in these movement impairment syndromes and diseases where the central processing and Central Pattern Generators (CPG’s) are diseased leaving them with the need for other cues such as those discussed here today, auditory, visual and tactile.
You may have read our previous blog articles on arm swing and how intimately they are anti-phasically (opposite) paired with lower limb swing. But today’s blog post article took limb swing to another level. Stay tuned for more on arm and leg swing in human movement. If you wish to read our other works on arm and leg swing and their deeper effects on gait, go to our blog www.thegaitguys.tumblr.com and enter the words “arm swing” into the SEARCH box.
Shawn and Ivo…….. taking gait far beyond what you learned about it in school.
______
References used:
J Neuroengineering Rehabil. 2007; 4: 28. The sensory feedback mechanisms enabling couples to walk synchronously. An initial investigation. Ari Z Zivotofsky and Jeffrey M Hausdorff Published online 2007 August 8. doi: 10.1186/1743-0003-4-28
Hum Mov Sci. 2012 Jun 22. [Epub ahead of print] Modality-specific communication enabling gait synchronization during over-ground side-by-side walking. Zivotofsky AZ, Gruendlinger L, Hausdorff JM.Gonda Brain Research Center, Bar-Ilan University, Ramat-Gan 52900, Israel.
Real time VIDEO of internal tibial torsion (at least highly suspect, the guy wouldn't stop for me to examine him :) Knee appears in the sagittal plane, foot, well, not so much.
Need a refresher on tibial torsion ? Here ya go !
https://thegaitguys.tumblr.com/post/43648553025/yes-we-are-all-twisted-part-3-continued-if
This one, on archive Friday, is a great follow up to our cross over video case earlier this week. Crossing over gait causes increased lateral foot strike, further than normal heel strike (if you choose or naturally deviate towards that type of strike) and often maintenance of lateral foot loads even into midfoot loading response times. It can, and often does, lead to greater, faster, more abrupt pronation and as we discussed earlier this week, troubles with efficient high gear toe off (medial foot/big toe off). It also requires more frontal plane pelvis and hip stability as we discuss here today on a blog post from 2014. The frontal plane will be challenged for its durability because it is obvious from the photo here, that the hip, knee and foot are not vertically stacked, not even remotely. Do you have enough frontal plane stability to endure the liabilities in this typically more efficient narrow step width style of running ? That is the big question. If your ITB is chronically tight, there is reason. if you run this way and have problems later into your long runs, there is a reason (endurance in even the muscles fade, not just cardiovascularly). Read on . . . https://thegaitguys.tumblr.com/post/86411021079/saucony-line-running-and-crossing-over-we-are
Saucony: Line Running and Crossing Over
We are big fans of the Saucony line of shoes. We have recommended them to our novice and serious runners for decades now. Currently one of our favorite shoes for our runners is the Saucony Mirage, a beautiful 4mm ramp shoe with no bells and whistles. It is as close to a perfect zero drop that you will find without going zero, in our opinion. That is not to say there are not other great 4mm shoes out there, the Brooks Cadence and the New balance minimus are other beautiful 4mm’s out there. The Mirage has never failed a single client of ours.
This was a photo we screen captured from the Saucony Facebook page (we hope that for the sake of educating all runners and athletes that we can borrow this picture for this blog post, please contact us if you would like us to remove it). It is a good page, you should follow it as well. This picture shows not only a nice shoe but something that we have been talking about forever. The cross over; this runner is running in such a line that it could be argued that the feet are crossing the mid line. In this case, is the line queuing the runner to strike the line ? Careful of subconscious queues when you run, lines are like targets for the eyes and brain. One thing we like to do with our runners is to use the line as training however, a form of behavioral modification. When you do a track workout, use the line underneath you, but keep the feet on either side of the line so that you learn to create that little bit of limb /hip abduction that helps to facilitate the hip abductor muscles. This will do several things, (and you can do a search here on our blog for all these things), it will reduce the reflexive tightening of the ITBand (pay attention all you chronic IT band foam rolling addicts !), it will facilitate less frontal plane pelvis sway, optimal stacking of the lower limb joints, cleaner patellofemoral tracking and help to reduce excessive pronation /internal limb spin effects.
There is really nothing negative about correcting your cross over, IF it truly needs correcting. That is the key question. Some people may have anatomic reasons as to why the cross over is their norm, but you have to know your anatomy, biomechanics and neuromechanics and bring them together into a competent clinical examination to know when the correction will lead to optimal gait and when it will drive suboptimal gait. Just because you see it and think it is bad, does not make it so.
New to this cross over stuff ? Head over to the search box here on our blog and type in “cross over” or “cross over gait” and you will find dozens of articles and some great videos we have done to help you better grasp it.
* you will also note that this runner is in an excessive lateral forefoot strike posturing. This means that excessive and abrupt prontation will have to follow through the mid-forefoot in order to get the medial foot tripod down and engaged. The question is however, is what you are seeing a product of the steep limb angle from the cross over, or does this runner have a forefoot varus (functional or anatomic, rigid or flexible)? Are the peronei muscles weak, making pre-contact foot/ankle eversion less than optimal ? This is an important point, and your clinical examination will define that right away … . . if you know what these things are. And if you don’t ? Well, you have found the right blog, one with a SEARCH box. Type in “forefoot varus”, if you want to open up the rabbit hole and climb down it … . . we dare ya ! :-)
Video case: Cross over gait and low gear toe off.
I have just made the assumption that this was a forgone conclusion, an obvious link. But after a dialogue with a very intelligent gait person, a debate occurred around the cross over gait and i suddenly realized that they did not understand normal gait mechanics and thus could in no way possible understand pathologic gait mechanics like the cross over gait, and in particular high gear toe off vs low gear toe off and all they both encompass. Ivo and i say it all the time, if one does not solidly know normal mechanics it is going to be difficult to truly understand pathologic mechanics. Here today, in this brief example, i hope i make a firm point. Sorry for the quality of the video, but the point should be clear. - Shawn
addendum: ;
The Gait Guys try it yourself, walk on a single straight line and try to effectively "high gear" (big toe/medial tripod) toe off. IT AIN'T GONNA HAPPEN DAWG ! Unless of course you go into a ridiculous degree of increased foot progression angle. But now you are compensating around a compensation.......the death spiral.
Video case:
another gait case from downtown Chicago. Pathology is all around us, if we are looking for it. Hopefully you are as tortured as we are.
-torso lean over the likely painful right hip (this is a compensated Trendeleburg, as opposed to an uncompensated, know the difference !)
- which side would a cane be best used on ? right or left ? (answer" left)
- she is carrying her purse on the wrong shoulder, it should be in her right hand, reducing compressive demand on the gmedius. The more the gmedius has to contract, the more compression it creates across the joint line, and if the hip is OA, it will create more pain). A cane and load in the right hand will passively manage the loads rather than actively doing it through the gmedius contraction and compression.
- heavy plunking down on the left leg. (careful not too much quad tone is developing, it can create some PF joint compression and aberrant loads and render left knee pain, that is the last thing she needs).
When you are walking about the world, play the game.
See it, and quickly gather the info, and sharpen your clinical reason skills. Get these concepts down, so you do not have to think through them in the clinic, instead, you just goto work fixing them.
If you tried to ease her burden with a sole lift (dont be a fool and use a heel lift), which side would it help her most on ? Answer: left.
I hope my final thoughts in today's important gait video will be profound to you as a clinician. It is the soft subtle presentations that are the tough ones, but the same messages are there, if you spend the time to assess for them.
* Remember, what you see in your client's gait is not their problem (as is obvious in today's video), instead you see how they are moving around their deficits. This is a key point we hammer home all the time. If you are making recommendations for your clients on how to move differently through corrective exercises that you THINK they need, merely because you see something in their movement that you do not like, you are very likely going to be fooled. You are not doing your client great service if that is your methodology. For example, telling this guy to engage his left tibialis anterior and lift his toes is the obvious visual correction, but the fact of the matter is, he cannot. So, what you see is how he has figured out how to move through the world, his compensation.
And for those who wish to argue, yes, hard neurologic deficits like you see here are not fixable. In this case, yes, you need to help them gain more skill endurance and strength in a better armored pattern for protective durability. But in many people, those without hardwired neuro or orthopedic deficits, you should be looking to fix their deficits, not merely fix aberrant movements that you just do not think LOOK good.
Look at this foot. What do you see ? See the asymmetry ? This is a perfect case to prove our point, for those out there that love the short foot exercise, that insist on towel scrunches, marble pick-ups, or just mere foot rolling on the ball. These things are useless in some cases, arguably to us, much of the time actually. This is about having sufficient foot integrity, normal heel rocker, ankle rocker, forefoot rocker mechanics, and especially in this case, a NORMAL balance between the long and short flexors and extensors. These 4 must work together in harmony, and this is clearly not happening on the left foot. Head on over to this Archived blog post from 2014, and learn what is wrong here. One has to understand it, to fix it. And throwing a short foot regimen, or pilates foot work at it or even more flexor tone into this foot will not fix this. Exercise prescription is supposed to be specific, not a shot gun approach of "try this exercise", lets see if it helps. A 5th grader can give that advice, sadly it is more the industry norm at times. Yes, every exercise is a test, but do not be mistaken that every test is the exercise.
https://thegaitguys.tumblr.com/post/85726861424/unilateral-heightened-toe-extensor-tone-what-do
Unilateral heightened toe extensor tone.
What do we have here ? Well, it is obvious. The left foot is showing increased short extensor tone (EDB: extensor digitorum brevis) and heightened long flexor tone (FDL: flexor digitorum longus). This is the classic pairing for hammer toe development. We also know from this post (link) and from this post (link) that this presentation is closely related with lumbrical weakness and distal fat pad migration.
So, at an assessment took we like to play games. Mental games to be precise. When we see something like this we immediately begin the mental gyrations of “what could have caused this, and what could this in turn be causing”. Remember, what you see is often not the problem, rather your clients compensation around the problem. In this case, what goes through your mind ? Without deep thought, our knee jerk thoughts are:
These are just some quick cursory thoughts, and by NO means a complete exhaustive list. Just some quick thoughts.
But what about hip function ? if ankle rocker is blocked in terminal stance and the FDL fire like this what will that do to hip extension ? Well, heel rise will be premature because of the limitation and thus hip extension will be abbreviated. Thus glute function will be impaired to a degree. This can become a viscous cycle, each feeding off of each other.
This diagnostic stuff is a tricky and difficult game. If you think you can diagnose or fix a problem from just changing what you see you are mistaken, unless you like driving compensation patterns and future injuries into your clients. There must be a hands on examination and assessment with an intact educated brain attached to the process.
Just some mental gymnastics for you today.
Dr Shawn Allen, one of the gait guys
Gluten ataxia, hypothyroid ataxia and others: The wobbly, unsteady client. Do not dismiss it.
Gait Ataxia, it is not uncommon especially in the aging population and it can come from many sources.
We have talked about it several times in the past, thyroid dysfunction can affect the cerebellum.
"Acquired cerebellar ataxia has been described with hypothyroidism, and is typically reversible by thyroid hormone replacement therapy. The cerebellar dysfunction has been attributed to metabolic and physiological effects of the endocrine disorder. "
The cerebellum is one of the main CNS targets of autoimmunity. Immune-mediated cerebellar ataxias include gluten ataxia (search our blog for this one), paraneoplastic cerebellar degeneration, GAD antibody associated cerebellar ataxia, and Hashimoto’s encephalopathy.
Progressive non-familial adult onset cerebellar degeneration (PNACD) will have raised antithyroid antibodies (Hashimoto's/autoimmune thyroiditis), and other autoimmune manifestations, in the absence of hypothyroidism and may express cerebellar disorder from the endocrine dysfunction.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1737486/
Watch this video, you have likely seen it already but did you notice it ? You will have to fast forward to 1:40 to see the video that applies to this screenshot here today.
How much knee flexion should occur during the initial loading response ? In this walking gait video, if you look closely enough, her high heeled shoes are forcing her to load in a what is technically a midfoot stride (because of the high heel) when in fact she is truly loading initially in a forefoot load, ie. plantarflexion. This abrupt load is forcing her to dampen the load with a quadriceps eccentric (if you watch closely enough, the knee flexes every time during loading, more than it should). Normally, in flat-er shoes, this knee eccentric is basically hidden (it is almost an isometric), it should never be this obvious unless one's quads are truly too weak. To be fair, the shoes are propping her into anterior pelvis tilt, as these high heeled shoes always do, which promotes lower abdominal challenges and premature quad loading, and delayed glute loading (don't believe us? stand up, dump into an anterior pelvic tilt and increased lordosis and try to engage your glutes. Nadda ! So the loading shifts into the quads).
Welcome to another ramification of high heeled shoes, again.
Admittedly, this lady does a great job. Her belt line stays pretty neutral and doesn't dip on each loading response and she is in good control. Ivo and Shawn on the other hand are terrible in their pumps :)
Sprinters, and those who forefoot load during running, are you surprised with anterior knee pain when it comes on, or achilles pain or calf tightness when the calf fatigues and can no longer hold you in adequate plantarflexion ? How about low back pain or tightness after runs ? No, you should not be surprised is the correct answer (unless you have enough durability in the quad and calf, and lower abdominals to sustain the length of your workouts, over and over and over.
We have talked about step with hundreds of times it seems. We get asked all the time about optimal or proper step width in our runners, especially the ones that have a tendency to drop into the higher risk category of "cross over" gait. We like to refer them to our standard reply, "many good things happen with increasing your step width, but there is no need to go beyond the hip distance width, no wider than the hips. You should find more gluteal activation there. However, this is less economical than a narrower step width. But, the narrower the step width, you are juggling the increased economy with increased liability (for injury) and riskier biomechanics. One must earn their way into the higher economy narrow step width with gaining durability in these potentially riskier narrow step with mechanics. Failure to do so is a choice taken at your own risk." This article suggest costly risks to a narrow step width as well.
From the Shorter Abstract
"Humans tend to walk economically, with preferred step width and length corresponding to an energetic optimum. In the case of step width, it is costlier to walk with either wider or narrower steps than normally preferred. Wider steps require more mechanical work to redirect the body's motion laterally with each step, but the cost for narrower steps remains unexplained. Here we show that narrow steps are costly because they require the swing leg to be circumducted around the stance leg. And, we could not agree more. There is definitely a sweet spot for every runner, finding it, and earning the durability required to fend off injury is where the magic lies. RAther than tell your runners where to place their feet , thus you defining their step width, give your clients the appropriate hip and frontal plane stability work to find their low risk sweet spot. After all, most of the foot posturing placement is dictated from the hip and pelvis mechanics, as we have written about extensively previously.
Gait Posture. 2017 Mar 23;54:265-270. doi: 10.1016/j.gaitpost.2017.03.021.
The high cost of swing leg circumduction during human walking.
Shorter KA1, Wu AR2, Kuo AD3.
https://www.ncbi.nlm.nih.gov/pubmed/28371740
Sagittal trunk flexion and extension in patients with chronic low back pain.
The study found the duration of gluteus maximus activity was shorter in the back pain patients than in controls during the trunk flexion (p<.05), and it ended earlier during extension. Nothing new here for many of our followers, but it is always worth discussing.
We have talked about the fatigue factor and endurance factor of the paraspinals in low back pain in previous podcasts, maybe a year or two ago. But, in looking for something else in particular today, I came across this article from 2000.
It once again suggests the critical function of the glutes, all 3 divisions and that they do play multiple parts other than just hip stability and movement. We see plenty of clients who have poor development of the upper iliac and sacral divisions of the glute max. This could be from anterior pelvis tilt presentations, faulty movement patterning, or even failure to get to end range hip extension to work on developing that portion of the muscle. Regardless, this once again proves that we are an under-developed glute species and all this sitting is a problem, and even the standing desk trend, will not fix this. The body must move, it must be loaded through to the full range of motion and we must incorporate compound movements with load if we are to get even close to the opportunity to see folks with healthy glutes and thus healthy hips and spines.
"RESULTS:
During early flexion, lumbar paraspinal and biceps femoris were activated simultaneously before gluteus maximus. At the end of flexion and during extension all investigated muscles were activated and relaxed in order. Lumbar paraspinal and biceps femoris muscles were activated in a similar order in low back pain patients and healthy controls during flexion and extension. However, the duration of gluteus maximus activity was shorter in the back pain patients than in controls during the trunk flexion (p<.05), and it ended earlier during extension. Active rehabilitation did not change the muscle activities of lumbar paraspinal and biceps femoris in the back pain patients, but in the measurements after rehabilitation the onset of gluteus maximus activity occurred later in flexion and earlier in extension."
"CONCLUSIONS:
The activity of the gluteus maximus muscle during the flexion-extension cycle was reduced in patients with chronic low back pain. The gluteal muscles should be taken into consideration in the rehabilitation of these patients." - Leinonen et al
Arch Phys Med Rehabil. 2000 Jan;81(1):32-7.
Back and hip extensor activities during trunk flexion/extension: effects of low back pain and rehabilitation.
Leinonen V1, Kankaanpää M, Airaksinen O, Hänninen O.
https://www.ncbi.nlm.nih.gov/pubmed/10638873
imagine that.... core endurance can affect running performance.
Let us see ...as you start to fatigue, you have a tendency to bend forward more at the waist. This is probably due to not only decreased quadriceps/hamstrings ratios but also decreased abdominal/lower back extensor endurance ratios. Of course, we could say that asyou fatigue, you become more quadriceps dominant and less gluteal dominant, which would also be correct.
Ankle eversion also increases as you fatigue. No surprise here. Think about the action of your gastroc/soleus group as the medial gastroc acts to invert the ankle and help promote supination, particularly after mid stance. Also think about all the posterior compartment musculature of the lower leg which contract eccentrically during the first phase of gait to assist in deceleration of pronation. From about mid stance on, the extensors should activate, along with the foot intrinsics to assist in providing a stable base. As we fatigue, this mechanism too appears to begin to fail.
Moral of the story? Keep your core in shape and do lots of endurance work!
https://www.ncbi.nlm.nih.gov/pubmed/23790535
In this study of 12 classical female ballet dancers, jump height was tested in both turn out and in a neutral hip position. This study was essentially looking at the effects of external hip rotation turn out on lower limb kinematics. The study seemed to control for forward trunk lean, but it is unclear if this included anterior or pelvis tilt pre-posturing. After all, we know very well that anterior pelvis tilt (APT) will significantly inhibit gluteal function (go ahead, dump into APT and try to fire your glutes ! Nadda !)
Here are the study results:
"The dancers jumped lower in the TJ (turn out) than in the NJ (neutral). The knee extensor and hip abductor torques were smaller, whereas the hip external rotator torque was larger in the TJ than in the NJ. The work done by the hip joint moments in the sagittal plane was 0.28 J/(Body mass*Height) and 0.33 J/(Body mass*Height) in the TJ and NJ, respectively. The joint work done by the lower limbs were not different between the two jumps. These differences resulted from different planes in which the lower limb flexion-extension occurred, i.e. in the sagittal or frontal plane. This would prevent the forward lean of the trunk by decreasing the hip joint work in the sagittal plane and reduce the knee extensor torque in the jump."
So, when was the last time your sport allowed you to jump cleanly from the neutral hip and pelvis position? Not likely right ?! So, our rehab and our training must include non-neutral drills and skills, since that is where we live most of the time in our sporting and active lives.
Sports Biomech. 2017 Mar;16(1):87-101. doi: 10.1080/14763141.2016.1205122. Epub 2016 Jul 14.
Comparison of lower limb kinetics during vertical jumps in turnout and neutral foot positions by classical ballet dancers.
Imura A1, Iino Y1.
https://www.ncbi.nlm.nih.gov/pubmed/27418231
Gait recognition.
Back in university, in my first year, there was a fella on our dorm floor who was basically blind. He could see shapes, light, darkness, figures moving but he could not truly recognize faces until he was about 6 inches from your face. What was amazing though was how quickly he tuned into voice recognition and how we all walked. He could label you from across the room by how you walked it seemed. He had developed a fine tuned sense of movement. I learned something from him by talking to him about this and i use it in my clinic every day when i watch people's gait. Aside from the visual, even the sound of one's foot fall is taken into consideration, there is information there. This is a skill, it comes easily to though who have one of their primary senses, usually visual, blunted. It is about not getting caught up in the details, it is about the quality of the movement of a person that i first glean, then i go back and dissect the details. But, when it comes to the clinical dissection of gait, one has to know all of the time stamp normal gait parameters, the phases, the acts that should occur at each phase, and what should not. If one is a self-labelled gait expert and one cannot spout off the normal phases and what should happen at each phase, and what should not, one should consider down grading their guru label.
"Our brains are especially tuned to see the movements that we and our fellow humans perform and there are particular circuits concerned with perceiving somebody else’s walk, known in the trade as ‘gait’. Studies have shown it is possible to recognise an individual from their walking pattern from any angle. So powerful is the mechanism that even when the walking body is reduced to points of light, carefully placed at the joints of the body, it can still trigger identification, so it may not be the shape or indeed the dress that is the most distinctive feature when it comes to recognising the walker. And we can also reliably infer a person’s emotion from how they walk. "
https://www.theguardian.com/lifeandstyle/2017/may/28/walk-this-way-how-the-brain-recognises-someone-by-their-gait-pippa-middleton
See that foot turned out into the frontal plane ? Ya, all the time. Finding the cause is where the meat is though.
"Individuals with gluteal tendinopathy use different frontal plane kinematics of the hip and pelvis during single leg stance than pain-free controls. This finding is not influenced by pelvic dimension or the potentially modifiable factor of body mass index, but is by hip abductor muscle weakness."
https://www.ncbi.nlm.nih.gov/pubmed/27395451
"Biomechanics of unobstructed locomotion consists of synchronized complex movements of the pelvis, torso, and lower limbs. These movement patterns become more complex as individuals encounter obstacles or negotiate uneven terrain."
This data was taken on 10 healthy young adult individuals investigation specifically the mechanics of the pelvis, torso, and lower limb segments and how they relate to obstacle negotiation of varying sized objects combined with temporal constraints to perform the task.
The data "revealed a significant increase in sagittal (posterior tilt) and frontal (ipsilateral hike) plane pelvic angular displacement and higher sagittal plane posterior torso lean angular displacement with increased obstacle height. Furthermore, both sagittal plane hip and knee maximum joint flexion were significantly higher with increasing heights of the obstacles during negotiation."
https://www.ncbi.nlm.nih.gov/pubmed/28297177
"The shape of the human pelvis reflects the unique demands placed on the hip abductor muscles (gluteus medius and gluteus minimus), which stabilize the body in the frontal plane during bipedal locomotion. This morphological shift occurred early in hominin evolution, yet important shape differences between hominin species have led to significant disagreement about abductor function and locomotor capability in these extinct taxa." -Warrener
Anat Rec (Hoboken). 2017 May;300(5):932-945. doi: 10.1002/ar.23558.
Hominin Hip Biomechanics: Changing Perspectives.
Warrener AG1,2.
Just the other day we saw this article in Popular Science written by Sally Zhang. Sally obviously does not read our blog, but she got a lot of stuff right.
“If you’re born without a pinky toe or have an accident and it’s removed, you can completely do everything you wanted to do,” Dr. Anne Holly Johnson, instructor in orthopaedic surgery at Harvard Medical School, says.
Above you will see a photo of one of the gait guy’s feet. It is quite clear from the photo that competent use of the pinky toe is not necessary for adequate, and possibly exceptionally skilled, foot function. But . . . .
Archived blog link:
https://thegaitguys.tumblr.com/post/96538178584/do-i-really-need-my-pinky-toe-just-the-other
Do I Really Need My Pinky Toe?
Just the other day we saw this article in Popular Science written by Sally Zhang. Sally obviously does not read our blog, but she got a lot of stuff right.
“If you’re born without a pinky toe or have an accident and it’s removed, you can completely do everything you wanted to do,” Dr. Anne Holly Johnson, instructor in orthopaedic surgery at Harvard Medical School, says.
Above you will see a photo of one of the gait guy’s feet. It is quite clear from the photo that competent use of the pinky toe is not necessary for adequate, and possibly exceptionally skilled, foot function. Here, check out this video of our foot in these 2 videos (here and here) for some advanced foot function (sans pinky toe). As you can see in the photo above, this 5th toe has likely never felt the ground, this is a fixed deformity. Flexor and extensor function of the toe are intact, but it does not reach the ground and so assistance in gaining adequate purchase of the 5th metatarsal on the ground is absent.
This brings us to a deeper question, what about the 5th metatarsal then? Is it necessary ? Our answer even without deeper research is a solid “yes”. The foot tripod is severely compromised without the 5th metatarsal. The lateral stability of the foot is impaired without the 5th MET. The natural locking of the calcaneocuboid joint mechanism will be impaired, the peroneal muscles that provide such critical lateral ankle and foot stability will have fascial planes and tendon attachments disengaged, the natural walking gait lateral to medial foot progression would be impaired, propulsion would be impaired and the list goes on and on. And, not even on the local foot/ankle level. Because, if you take out the function and stability of the lateral foot the hip is very likely to suffer lateral (frontal plane) stability deficits. Meaning, the gluteus medius and abdominal obliques will have more difficulty guarding frontal plane drift when in stance phase rendering all of the “cross over gait” risks (link) highly probable.
So, not much exciting stuff here today. The presence of a functioning pinky toe does not appear to be critical but don’t take away its big brother neighbor, the 5th Metatarsal or trouble is just around the corner. Don’t believe us? Just ask anyone with a non-union fracture (Jones fracture) of the 5th metatarsal.
The answer goes back to the evolutionary history of humans, explains Dr. Anish Kadakia, assistant professor in orthopaedic surgery at Northwestern University. "Primates use their feet to grab, claw, to climb trees, but humans, we don’t need that function anymore,“ Kadakia says. "Clearly we’re not jumping up and down trees and using our feet to grab. We have toes embryologically, evolutionary for that particular reason because we descended from apes, but we don’t need them as people.”
The gait guys, working with 4 toes on each foot, one step ahead of evolution it seems.
Dr. Shawn Allen
one of the gait guys
reference:
http://www.popsci.com/science/article/2013-05/fyi-do-i-really-need-my-pinky-toe?dom=tw&src=SOC
The more i talk to people about ankle rocker and ankle dorsiflexion, the more i realize they just do not have all the anatomical understanding behind it. But how does one apply the concepts if they don't fully understand it ? It is baffling.
The client should be assessed both passively and actively. When you look at someone's ankles during their gait, do you look at the knee response at ankle dorsiflexion or at heel rise or during forefoot loading? Do they momentarily hyperextend the knee? Flex the knee? Rotate the foot or leg internally or externally ? To they prematurely heel rise ? Do they prematurely unload the limb and lurch to the other limb thus shortening step length? Do they progress strongly to the lateral forefoot during loading or do they find a middle ground and begin the pronation phase timely with a proper progression to the medial foot tripod ? Remember, what you see is their strategy, not their problem, do not correct what you see, correct the cause of what you see.
In this video, look at the excessive right knee flexion that occurs here during active ankle dorsiflexion. One must understand what this could mean, and then should be able to see some of the causation during gait. One of the calf complex muscles crosses the knee, one does not. One of them is short on this right side in this client with acute achillies tendonitis. It is not necessarily the cause, but it a piece of the puzzle. Both the clinician and the client do not realize that there is often a knee flexion response during active and passive ankle dorsiflexion assessment, especially when there is mechanical pathology. Having a foam roller under the knee can really bring it out, as in this case. But, remember, this should not be the standard of your assessment, because you are putting slack into the posterior mechanism.
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