A flexed leg is a shorter leg: When loss of knee extension really matters.

A flexed knee is a shorter leg, period.
A knee with any loss of terminal extension, is more bent knee, and thus a shorter leg, period.

Stand up, bend one knee 10 degrees, you have shortened the global top to bottom length of that leg.
So when walking, you will plunk down onto that shorter leg, and there will be a cost.

This is old hat for our long time readers, but it is a good reminder to look for loss of terminal knee extension.

I just saw a lady with a uni-knee replacement of 5 months. Failing some aspects of rehab, they are stuck. There is hip,knee and ankle pain on walking.
She had a loss of terminal knee extension, thus a short leg, true shortness.
I placed a 2mm full sole length rubber-cork lift in the shoe (*DO NOT USE JUST A HEEL LIFT, please, for the love of God and all that is beautiful on this earth stop using just heel lifts and causing plantarflexion at the ankle. Heel lifts are specific unicorns you only use when you are trying to get more plantarflexion at the ankle, or want to rush someone to the forefoot, or want a shorter posterior compartment (amongst other stupid things you probably do not want in your client mechanics)).
She put the shoe back on with the 2mm sole lift in the shoe and walked 20 steps and started to tear up. No pain.

Sometimes things are simple. We more closely restored the leg length by adding more vertical height. Yes, the problem still exists, but its global effects are somewhat muted. She stopped premature heel rise, could feel her glutes, stopped the abrupt plunk onto the leg, *stopped the sudden abrupt knee flexion loading that was crippling her.

I then took it out, "shoe'd" her up again, and she was dumbfounded, all the pain returned as did her awareness of what she was coping with.

Now, sent her away with the sole lift to accommodate for 2 weeks, and we will restart the rehab once things have time to get used to the "new norm". Now the rehab will work, we think. Time will tell

One thing is for sure, and now yesterdays post rings more clear and true, if you build strength on compensation, you earn and own that compensation.

The Gait Guys

#gait, #gaitproblems, #gaitcompensations, #strength, #heellift, #solelift, #TKA, #hippain, #shortleg

Photo courtesy of Pixabay, beautiful photo isn't it !?

Gluteal tendinopathy and the Cross Over gait pattern.

Gluteal tendinopathy, often lateral hip pain at or around the region of the greater trochanter. (note: the pain referral of this problem can dispurse far and wide, from low back and even into groin or to the knee). It is not gluteal bursitis, the research barely supports that. You'd be better off using the term "greater trochanteric pain syndrome" (yes, its an ICD10 code).


The problem often involves the abductors, the gluteus medius and/or gluteus minimus tendons as weakness or poor co-contraction stabilization patterning creates a compressive adduction of the tendons and gr.trochanter. But, know this, mere strengthening is not the entire answer, and it is not supported as the cause or cure, it is just part of the solution. As with most problems, resolution is about load, how we load, load over time, tolerance to load, time under tension, loads we can manage, loads we are unprepared for. These are variables certainly pertinent to novice runners and athletes (though for some everyday folk even walking can be vulnerable) but also high level athletes who either mal-adapt, compensate, over protect or under-recover.
About 10 years ago I began my dive into something I was seeing often, something that did not seem to have a name from what I was able to determine, but one that was fraught with mechanical loading issues that was part of my athletes' symptom collage. I referred to it by what it appeared to be, a "cross over gait", and since then have written a few dozen pieces, at least, that go into the problem, pathomechanics, and correction for my athletes and patients. I have often referred this to as a "failure to stack the lower limb joints", but that is so remedial and non-descript. Almost a decade ago I did the 3 part video series (part 1 is below) and it brought a lot of light to gait problems in runners and a huge variable in unresponsive gluteal tendonopathies, amongst others. One can strengthen the glutes all they want, but if the pattern of pathologic loading is not amended, altered, improved, then the model will fail.
And here is another factor that is interesting brought forth at a recent conference,
"@Bill_Vicenzino Imaging over-estimates compared to clinical presentation - MRI positive for Gluteal Tendinopathy in 77% of cases but clinical presentation only positive in 52%"

Watch my 3 part series, starting with the video below. Get to understand the cross over gait variables and you will get better at remedying gluteal tendonopathy. It is more than just prescribing half a dozen glute exercises.

Shawn Allen, the other gait guy.

#gait, #thegaitguys, #gaitproblems, #gaitanalysis, #glutealtendinopathy, #hippain, #crossovergait, #hipadductors, #hipabduction, #greatertrochanter, #hipbursitis

Hip Abductor Strength In Individuals With Gluteal Tendinopathy: A Cross-sectional Study. Kim Allison et al.
https://bjsm.bmj.com/content/48/Suppl_2/A6.2

Free Solo. The movie, quadrupedal gait, and crapping your pants (all in one blog post).

I recently crapped my pants at the movie theater. Thanks Alex Honnold.

i have been waiting a year to see Free Solo on IMAX. I saw it on Saturday night. The theater quickly took on a particular odor. Yes, Alex lives, finishes the climb, you know this at the start. But the last 30 minutes of the full length documentary has you riveted, palm sweating, writhing in your seat, saying things inside your head like “he is 3000 feet up, there is no rope, he has nowhere to go, he is doomed”. And then he is not. I promise you this, you will not believe what you see. Please do not see this on anything but IMAX if at all possible, El Capitan and Alex deserve this format if at all possible. I promise, you will get the same pit in your gut that you get when you look over the top of the highest of roller coasters.

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

Some research has determined is that in quadrupeds the lower limbs displayed reduced orientation yet increased ranges of kinematic coordination in alternative patterns such as diagonal and lateral coordination. This was clearly different to the typical kinematics that are employed in upright bipedal locomotion. Furthermore, in skilled mountain climbers, these lateral and diagonal patterns are clearly more developed than in study controls largely due to repeated challenges and subsequent adaptive changes to these lateral and diagonal patterns. What this seems to suggest is that there is a different demand and tax on the CPG’s and cord mediated neuromechanics moving from bipedal to quadrupedal locomotion. There seemed to be both advantages and disadvantages to both locomotion styles. Moving towards a more upright bipedal style of locomotion shows . . . .

Here, read the entire post I wrote several years ago, instead of me piecmeal it here.

https://www.thegaitguys.com/thedailyblog/2019/2/4/gait-and-climbing-part-1

So your patents foot points in or out... Have you considered talar torsion in the differential?

Screen Shot 2019-02-14 at 3.12.59 PM.png

The talus is to the foot, as the lunate is to the hand. It is the only bone that has the entire weight of the body passing through it before being distributed to the foot. It’s motion during pronation should be flexion, adduction and eversion, and in supination: extension,  abduction and inversion.

At birth, the angle between the talar neck and talar dome is 30 degrees adduction. This reduces to 18-20 degrees in the adult (see above). During this reduction of angle, the talar head also everts or “twists” laterally (ie promotes pronation), which helps to correct the supination and adducted position of the forefoot in adults present in infants (Saffarian 2011).

Abnormal talar loading and “untwisting” in development  has been linked to formation of a Rothbart foot type, also known as metatarsus primus elavatus (Rothbart 2003, 2009,2010. 2012). The 1st metatarsal is elevated and inverted with respect to the rest of the foot, with it behaving much like a fore foot varus.

Talar torsion (sometimes called subtalar version) results when there is a 10 degree or greater change in the final position of the talar head. This can cause an adducted position of the forefoot, often mistakenly called “forefoot adductus’, which actually only applies to the metatarsals, and not at all to the talus.

An adducted forefoot provides challenges to gait with many possible compensations. As discussed previously, there are at least 3 reasons we need to understand torsions and versions:

1. They will often alter the progression angle. In talar adduction, there will often be a decreased progression angle of the foot. This causes the individual to toe off in supination.

2. They affect available ranges of motion of the limb. We remember that the lower leg needs to internally rotate the requisite 4-6 degrees from initial contact to midstance, If it is already fully internally rotated, that range of motion must be created elsewhere. This may result in external rotation of the affected lower limb, excessive pronation through the deformity (if possible), or rolling off the lateral aspect of the foot.

3. They often can effect the coronal plane orientation of the lower limb. In talar torsion, the head of the talus often does not “untwist” appropriately resulting in a functional forefoot varus, with excessive forefoot pronation occurring at terminal stance and pre swing.

There you have it in a nutshell. Talar tosion: Present in 8% of the population (Bleck 1982) and coming to your clinic (or maybe it has already been there!

We will be talking about talar torsion, as well as many other torsional deformities of the the lower limb this wednesday evening on online.com: Biomechanics 305. Hope to see you there

Dr Ivo Waerlop, one of The Gait Guys

#gait, #gaitanalysis, #thegaitguys, #talartorsion,#talus, #progressionangle, #toein, #toeout



Shoe flares Medial and lateral. Do you want both.

Wow, this shoe has incredible medial AND lateral flares at the rear foot ! But do you want both ?

Screen Shot 2018-11-13 at 9.40.50 AM.png

Want a shoe that controls rear and midfoot pronation ? This Adidas shoe has features that will do it. Want a shoe that controls rear foot supination, this Adidas shoe also has features that will do it. Want a shoe that SHOULD put that rear foot in a nice tight gutter, and keep the calcaneus on a nice tight fence between pronation and supination, this one has some potential. But, will the foot comply with the mandates of the shoe ? (That is the question, and i will address that tomorrow. ) But, do you even want both in a shoe ? What are the chances that someone pronates AND supinates too much at the rearfoot ? We have never see it that is for sure. But, just look at that wide platform, thing about the potential use of this shoe in someone with neuropathy who cannot "feel" the ground well, hmmmm. Now there is a thought.
We talk about the function of the medial and lateral flares of a shoe, and their effects on rearfoot medchanics in our National Shoe Fit Course
link: (http://store.payloadz.com/results/results.aspx?m=80204)

A lateral flare, grabs the shoe and forces the shoe (and the foot we hope) into a medial direction, pronation. A medial flare, does the opposite, it resists the pronation tendency. Which one does your rear and mid foot need ? Maybe you should consider our Shoe fit course, we take you through hours of material to teach you how, when, why etc. Shoe choices for you and your client is a complex algorithm of knowing your foot type and the right shoe anatomy for that foot type to give you cleaner mechanics. The wrong shoe can be devastating to a foot and to ones gait.

Furthermore, this shoe as a dual density built into the medial midfoot. At least they wisely did not waste the dual density on the medial rear foot. It is not necessary with that huge medial rear foot flare. But some companies do not use the flare, they will opt to extend that dual density back into the rear foot to control some of that pronation. (think Brooks Adrenaline shoe for example).
However, you approach should always be to help your client earn better foot mechanics, awareness, skill, endurance, strength and power so that they do not need super duper shoe accoutrements like this shoe has. But, some feet will just never get the gold medal for function, and they will need a little help (or a lot of help in terms of a shoe like this one).
- Dr. Allen

I have knee pain when I run."How we do one thing is how we do all things."

I am not sure who made this statement first, otherwise we would share attributes to it, but it is a good quote. If you saw the back of my truck, you would know what my closet looks like at home. Organization is not a top shelf priority of mine. I can neve remember where i put anything.

IF this is how someone does a double support jump on the up and down loading phases, what do you think is likely to happen in single leg hops ? how about forward hops with movement? Forget about it. Oh wait, that is what running is, forward hops.

Simple principle today, sometimes the best place to start with someone's suspected problematic loading strategies, is to peel it back to the simplest root strategies of the more complex faulty strategy.
All to often we just "run", but we have no idea how to load and unload effectively. If some one cannot double support jump with controllable skill, how then will they single leg hop in place with controlled skill, let alone hop forward progressively with controlled skill, and then do so alternating leg to leg, (running) with controlled skill ?

Sometimes the solution is not an orthotic, or a more stable shoe, or some magical elixer corrective homework seen on a guru's youtube feed.
Sometimes, we just need to start from the beginning. Sometimes it is that simple, start from the start, and build up from there. Sometimes there is no magic, it is just simple progressive loading, which to some will seem too crude and wasteful, and to others who truly "get it", magical.

Sometimes, "how we do one thing, is how we do all things".

Shawn Allen, the other gait guy

Pod 144: Grounded running, Glute fatigue & Stress Fractures

Topics: Grounded running, Glute fatigue, Stress Fractures, Duty Factor, Ankle stiffness & Gait and Concussions

Keywords: gait, gait analysis, gait problems, running, ankle, band, concussions, fatigue, fracture, gait, glutes, grounded, gait guys, glute medius, problems, stiffness, stress, syndrome, time under tension

Links to find the podcast:
Look for us on iTunes, Google Play, Podbean, PlayerFM and more.
Just Google "the gait guys podcast".

Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
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 websites. 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).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:

iTunes page:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:
https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

Direct download URL: http://traffic.libsyn.com/thegaitguys/pod_147_raw_-_21619_11.08_AM.mp3

Permalink URL: http://thegaitguys.libsyn.com/pod-144-grounded-running-glute-fatigue-stress-fractures

Libsyn Directory URL: http://directory.libsyn.com/episode/index/id/8666903

Show notes:

Hip muscle response to a fatiguing run in females with iliotibial band syndrome.
Brown AM1, Zifchock RA2, Lenhoff M3, Song J4, Hillstrom HJ3.
Hum Mov Sci. 2019 Feb 8;64:181-190. doi: 10.1016/j.humov.2019.02.002. [Epub ahead of print]

Balance and Gait Alternations Observed More than 2 Weeks after Concussion: A Systematic Review and Meta-analysis.
Wood TA1, Hsieh KL1, An R1, Ballard RA2, Sonoff JJ1.
Am J Phys Med Rehabil. 2019 Feb 5. doi: 10.1097/PHM.0000000000001152. [Epub ahead of print]

Does Running Faster Put You at Greater Risk of a Stress Fracture?
New research finds that speed might not cause as much strain on the shins as we thought
By Hailey Middlebrook
Feb 12, 2019
https://www.runnersworld.com/health-injuries/a26221848/stress-fracture-speed-study/

Fast Running Does Not Contribute More to Cumulative Load than Slow Running\
Hunter, Jessica G.1; Garcia, Gina L.1; Shim, Jae Kun1,2,3; Miller, Ross H.1,2
Medicine & Science in Sports & Exercise: January 25, 2019

https://journals.lww.com/acsm-msse/Pages/articleviewer.aspx?year=9000&issue=00000&article=96699&type=Abstract


Grounded running Reduces Musculoskeletal Loading.
https://www.ncbi.nlm.nih.gov/pubmed/30480615
Med Sci Sports Exerc. 2018 Nov 21
Bonnaerens S1, Fiers P1, Galle S1, Aerts P1,2, Frederick EC3, Kaneko Y4, Derave W1, De Clercq D1.

Duty factor:
duty-factor. The duration of a gait cycle where each foot is on the ground
https://www.researchgate.net/figure/Illustration-of-the-duty-factor-The-duration-of-a-gait-cycle-where-each-foot-is-on-the_fig2_221908232

Ankle intrinsic stiffness changes with postural sway
PouyaAmiri, Robert E.Kearney
https://www.sciencedirect.com/science/article/pii/S0021929019300387


A deeper dive 30 minute seminar on ankle rocker and ankle dorsiflexion, with Shawn & Ivo

Screen Shot 2019-02-03 at 1.04.17 PM.png

* This is a Patreon subscriber 5$+ VIDEO seminar post. Want exclusive content ? Come join us on Patreon (we will have another site for similar contributions and content once it is available, we are aware of the free speech issues with Patreon, so be patient with us).

Do you also want access to this content, PLUS MUCH MORE? When you make even the smallest (1$/month) donation to our Patreon Page, you will get access to SOME of these private content posts.

Any tier ($1, $5, $10, $20, $50) will receive exclusive content not shared anywhere else. The higher your tier, the juicier the content.
Help support The Gait Guys mission to continue to produce high level content that you have grown accustomed to here.

Click the link to get over to the PATREON page.

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You are wondering: "Does the distance between footfalls make a difference?"

1running-iStock_000017285887Large-copy.jpg

In short, when it comes to stress fractures, IT band syndrome and patellofemoral pain, the literature says yes…

"In conclusion, decreasing stride length has been proposed as a method to treat and prevent running-related musculoskeletal injuries. While not directly examining the effect of stride length, research examining the effect of barefoot running and minimalist shoes indirectly evaluates stride length, as barefoot/minimalist runners tend to adopt a reduced stride length. Evidence suggests that decreasing stride length results in biomechanical changes, including reduced GRFs and joint moments, that can contribute to reduced injury risk. Clinical studies indicate that reducing stride length may help decrease the likelihood of stress fractures, iliotibial band syndrome, and patellofemoral pain."


a good read: https://lermagazine.com/article/implications-of-reduced-stride-length-in-running. ALSO the photo credit


#gait, #thegaitguys, #gaitanalysis, #running, #stridelength


Dr Ivo, one of The Gait Guys

The 4 Factors of Heel Rise.

Screen Shot 2019-01-14 at 12.48.19 PM.png
Screen Shot 2019-01-14 at 12.48.08 PM.png

These SHOULD all happen to have appropriate heel rise and forward progression

1. active contraction of the posterior compartment of the calf

2. passive tension in the posterior compartment of the calf

3. knee flexion and anterior translation of the tibia ankle rocker

4. the windlass mechanism

a problem with any one of these (or more collectively) can effect heel rise, usually causing premature heel rise.

ask yourself:

  • Do you think the posterior compartment is actively contracting? not enough or too much? Remember the medial gastrocnemius adducts the heel at the end of terminal stance to assist in supination. Don't forget about the tibialis posterior as well as the flexor digitorum longs and flexor hallucinate longus.

  • Does there appear to be increased passive tension in the posterior compartment? How visible and prominent are their calf muscles?

  • Do they have forward progression of the body mass?

  • How is his windlass mechanism? Good but not good enough.

Dr Ivo Waerlop. One of The Gait Guys…

#gait, #gaitanalysis, #continuingeducation, #limp, #casestudy, #gaitparameters, #heelrise, #prematureheelrise, #windlassmechanism

Where do you start?

Know any coaches to say these kinds of things?
"straighten your head, pull that right arm in and pull that right knee out, and stop crossing over in your gait, widen your step width"

Yesterday I again discussed arm swing and perhaps why not to coach it out if you merely do not like how it looks in your client. I also mentioned that head tilt, torso/trunk deviations are likely compensations, but it can go both ways. One has to solve for the problem, and not coach the changes we wish to see into the client. Where do you start with a client? Their head tilt? the Right arm abduction? The medially collapsed knee? The abducting swing leg knee ? Where do you start? If you do not examine your client, understand the principles of cause and effect of aberrant human mechanics, you just might recommend an orthotic, a stability shoe, and coach "straighten your head, pull that right arm in and pull that right knee out, and stop crossing over in your gait, widen your step width". That is fine if that is what you choose to do, but i suspect i will also see you at the county fair playing "Whack a Mole". It is the same game. You'll always lose your money, and realize that game never ends, not until you solve for "X" (the cause). -Dr. Allen


Approaching hip pain differently.

Screen Shot 2019-02-03 at 12.59.05 PM.png

You might have fewer struggles with your hip pain clients if you start approaching the hip joint as the intersection of a long pole (the leg) with a ball on the end (the femoral head) and the pelvis' acetabulm/labrum sitting/balancing on top of the ball.
The game is to get the stick (the leg) stable and stiff enough that you can control the positioning of the frontal, sagittal and rotational planes of that ball on the end, and achieve enough control/skill, strength, stability, endurance of the interface of the pelvis socket (the pelvis' acetablum/labrum) on top of this ball. The key to success in this area is the understand that the pelvis, and the body mass above it, is terribly disadvantaged to find controlled equilibrium on top of the ball (femoral head). Thus, achieving sufficient skill of the muscles bridging the two, adequate endurance in them to last the duration of the challenges, and certainly sufficient strength of those muscles to control shear, compression, stability and controlled mobility are key components to successful and pain free hip function.
One has to think of things in a closed chain, one's limb is fixed on the ground, and one needs to see that the game is to control the pelvis and the massive entire torso mass on top of this small ball in a controlled fashion, while we are moving and changing position.
This is the game.

*This is why single leg lifts and rehab are so key in the success of a client. Remember, gait and running and most sports are for the majority of the time, spent in single leg loading.

Shawn Allen, the other #gaitguys

#gait, #thegaitguys, #gaitproblems, #gaitcompensations, #gaitanalysis, #hippain, #hipbiomechanics, #Singlelegloads, #unilateraldeadlifts, #stancephase,

photo, courtesy of pixabay.com

https://pixabay.com/en/soccer-football-soccer-players-kick-1457988/?fbclid=IwAR13Laep8KM-w4KaVl8Ip9vyz7Svk6BXbGgEE_UkSYU-3eoAV1suHtsbi80

An Alternate View of Crawling and Quadrupedal Motor Patterns: A Correlation to Free Solo Mountain Climbers ?

The one you haven’t heard about.

On janurary 15, 2014 Alex Honnold, Free-Soloed El Sendero Luminoso (The Shining Path) in El Potrero Chico, Mexico in a little over 3 hours. The climb rises 2500 feet to the summit of El Toro. At the time, it was considered to possibly be the most difficult rope-less climb in history, . . . until El Capitan.

Quadruped Patterns: Part 1, Redux
If you have been with us here at The Gait Guys for awhile, you will have read some articles where we discuss quadrupedal gait (link: Uner Tan Syndrome) and also heard us talk about CPG’s (Central Pattern Generators) which are neural networks that produce rhythmic patterned outputs without sensory feedback. You will have also read many of our articles on arm swing and how they are coordinated with the legs and opposite limb in a strategic fashion during gait and running gaits.

Lets get into it, full blog post here,

https://www.thegaitguys.com/thedailyblog/an-alternate-view-of-crawling-and-quadrupedal

An Alternate View of Crawling and Quadrupedal Motor Patterns: A Correlation to Free Solo Mountain Climbers ?

Quadruped Patterns: Part 1

In the last 3 years, if you have been with us here at The Gait Guys that long, you will have read some articles where we discuss quadrupedal gait (link: Uner Tan Syndrome) and also heard us talk about CPG’s (Central Pattern Generators) which are neural networks that produce rhythmic patterned outputs without sensory feedback. You will have also read many of our articles on arm swing and how they are coordinated with the legs and opposite limb in a strategic fashion during gait and running gaits. Through these articles, we have also eluded to some of the fruitless aspects of focusing solely on retraining arm swing in runners because of the deep neurologic interconnectedness to the lower limbs and to the CPG’s.
IF you are interested in any of these articles we have written please feel free to visit our blog and type in the appropriate words (Uner Tan Syndrome, arm swing, cerebellum, cross over gait) into the Search box on the blog.

Here we briefly look at interconnected arm and leg function in crawling mechanics in a high functioning human (as compared to the Uner Tan Syndrome) in arguably the best solo free climber in the world, Alex Honnold. Here we will talk about the possible neurologic differences in climbers such as Alex as compared to other quadruped species. Primarily, there is suspect of an existing shift in the central pattern generators because of the extraordinary demand on pseudo-quadrupedal gait of climbing because of the demand on the upper limbs and their motorneuron pools to mobilize the organism up the mountain. The interlimb coordination in climbing and crawling biomechanics shares similar features to other quadrupeds, both primate and non-primate, because of similarities in our central pattern generators (CPG’s). New research has however determined that the spaciotemportal patterns of spinal cord activity that helps to mediate and coordinate arm and leg function both centrally, and on a cord mediated level, significantly differ between the quadruped and bipedal gaits. In correlation to climbers such as Alex however, we need to keep it mind that the quadrupedal demands of a climber (vertical) vastly differ in some respects to those of a non-vertical quadrupedal gait such as in primates and those with Uner Tan Syndrome. This is obvious to the observer not only in the difference in quadrupedal “push-pull” that a climber uses and the center-of-mass (COM) differences. To be more specific, a climber keeps the COM within the 4 limbs and close to the same surface plane as the hands and feet (mountain) while a primate, human or Uner Tan person will “tent up” the pelvis and spine from the surface of contact.

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

The take home seems to suggest that gait retraining is necessary as is the development of proper early crawling and quadruped locomotor patterns. Both will tax different motor pools within the spine and thus different central pattern generators (CPG). A orchestration of both seems to possibly offer the highest rewards and thus not only should crawling be a part of rehab and training but so should forward, lateral and diagonal pattern quadrupedal movements, on varying inclines for optimal benefits. Certainly we need to do more work on this topic, the research is out there, but correlating the quad and bipedal is limited. We will keep you posted. Next week we will follow up on this quadrupedal topic with a video that will blow your mind ! So stay tuned !

Shawn and Ivo
The Gait Guys


Scand J Med Sci Sports. 2011 Oct;21(5):688-99. Idiosyncratic control of the center of mass in expert climbers. Zampagni ML, Brigadoi S, Schena F, Tosi P, Ivanenko YP.

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

"The slow creeping death of our wonderment."

Something different for a Sunday morning.

"The slow creeping death of our wonderment."

Today, kinda random thoughts, but not entirely. It is about our kids and their possible progressive loss of wonderment from all of this technology around them. Which, I guess, is also germane to us adults as well. It is about climbing trees, sitting in silence, about letting ideas flow, about thought experiments, where many great things percolate from deep inside our minds. It is about taking chances, free thinking, stepping to the edge, and being alright with being wrong.

I wrote this back in 2017 on my personal website (shawnallen.net). Seemed valuable to share today after a soft attack on fresh ideas.

On the topic of "wonderment" . . . .

I have to admit, some of my greatest clinical insights as a student of human movement have come from long periods of wonderment. What intrigues me is when logically proposed wonderment is attacked. What I am referring to is the rare, yet often enough, occurrence on my clinical blog (thegaitguys.com) where a fresh idea or theory, a thought perhaps admittedly without a solid research base is attacked as unsubstantiated. Sometimes, I am left rolling my eyes when some purist in the comments section might write, "show me the research and data on this idea, otherwise it's crap". Questioning something unsubstantiated is just fine with me, but attacking is not. When did fresh ideas become crap, unworthy of consideration? Research does not necessarily set up our rules and guidelines to follow, it is perhaps more so there to foster our present knowledge on a topic, to afford us with information to base choices and thoughts upon. If someone thinks that the up to date research on a topic is the template, then they will be stuck in time. Growth will evade them. I feel sorry for those people, I feel sorry that their biases were not confirmed, that their belief system has felt questioned and rattled. I fear for these folks, they will never develop their own thoughts, never their own moments of Einsteinian genius. They will merely be followers of other's research and work, never free thinkers, and certainly never become those researchers who had just the same sort of questions and wonderment and yet sought out to prove or disprove their wonderment. The world has proven over and over again that the free thinkers, the wonderers, are often the leaders, the risk takers, the inventors, the forgers of human progress. And, they are handsomely rewarded for their time, their risks of looking like a fool. I feel blessed when I can steal a mere shot glass of insight from the deep wells of these types of people. All great ideas first started with a thought, a hypothesis, a wonderment. Just because no one has written a paper on a topic does not mean the ideas are invalid or not worthy of consideration. This is how we all grow, these wonderments, it is where all good research paper hypotheses begin, it is where we can leap to deeper insights and learn from each other. Without wonderment we remain stagnant, never to move farther ahead. The key is to not get trapped too firmly in our own biases, always looking for confirmation of said biases. This is a dark place where we all can fail to grow, and at times, I am guilty as charged, I admit it." -Shawn Allen

There is more in the link below. Click if you wish.

https://www.shawnallen.net/dailyblog/2017/9/24/the-slow-creeping-death-of-our-wonderment

Shawn Allen, the other gait guy
#gait, #wonderment, #thoughtexperiment, #learning, #gaitproblems, #gaitanalysis, #research, #personalgrowth

Novice runners show greater kinematic changes with fatigue.


Soft face palm here, most of us could have assumed this, but it is always nice to see a study to prove it.
This is the stuff we see in practice all the time. Throw some asymmetry and pathomechanics on top of these runners and then allow them to fatigue and it is a perfect storm.
The point today is that these are not the hard patients to help, it is the seasoned runners, the ones on their 30th marathon if you will. They have ground into their system deep durability and adaptability. They have learned to accommodate to loads under fatigue, they adapt to the environment well. These are the runners who might say to you, "at mile 15 i was getting some lateral hip pain, and then through mile 16 it went away". What did they do to manage to do that? That is your puzzle to solve Sherlock.
This is the game we/you play everyday.
What went wrong, find the source, prevent it next time, find the adaptive pattern, tease out the asymmetry, find the strategy they deployed.
Oh, and one more time, what you see them doing on the treadmill, in your gait analysis, is their adaptable pattern, not their problem.

The gait guys, Shawn and Ivo

#gait, #gaitanalysis, #gaitproblems, #novicerunners, #fatigue

Novice runners show greater changes in kinematics with fatigue compared with competitive runners

ArticleinSports Biomechanics 17(3):1-11 · July 2017

https://www.researchgate.net/publication/318640014_Novice_runners_show_greater_changes_in_kinematics_with_fatigue_compared_with_competitive_runners?fbclid=IwAR0t-fAr8fzh1y6MQa0c35jbzwkrJfNb8QUlpdLpxyq0N3TuioOJLju0FOY

Femoral Anteversion?

image source: Byun HY, Shin H, Lee ES, Kong MS, Lee SH, Lee CH. The Availability of Radiological Measurement of Femoral Anteversion Angle: Three-Dimensional Computed Tomography Reconstruction. Ann Rehabil Med. 2016;40(2):237-43.

image source: Byun HY, Shin H, Lee ES, Kong MS, Lee SH, Lee CH. The Availability of Radiological Measurement of Femoral Anteversion Angle: Three-Dimensional Computed Tomography Reconstruction. Ann Rehabil Med. 2016;40(2):237-43.

 

Here is a free, full text article that talks about using 3D CT for a precise measurement of things like femoral and tibial torsions and versions. Remember that this will directly influence the amount of internal and external rotation of the hip, which will have a direct influence on gait. Remember you need 4-6 degrees of internal and external rotation to ambulate normally

Dr Ivo Waerlop, one of The Gait Guys

Byun HY, Shin H, Lee ES, Kong MS, Lee SH, Lee CH. The Availability of Radiological Measurement of Femoral Anteversion Angle: Three-Dimensional Computed Tomography Reconstruction. Ann Rehabil Med. 2016;40(2):237-43.

#gait, #measurement, #femoraltorsion, #femoralversion, #antetorsion, #anteversion, #retrotorsion, #retroversion

link to free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855117/

 

Gait and Climbing: Part 1

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

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

Author: Dr. Shawn Allen

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

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

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

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

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

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

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

- Dr. Shawn Allen

References:

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

Scand J Med Sci Sports. 2011 Oct;21(5):688-99. Idiosyncratic control of the center of mass in expert climbers. Zampagni ML , Brigadoi S, Schena F, Tosi P, Ivanenko YP

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

Keep your eyes up and your toes up...,And it doesn’t hurt to use your abs

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While out cross country skiing after a few inches of fresh fallen snow it dawned on me, especially when going uphill on my cross-country skis, lifting your toes up definitely pushes the head of the first metatarsal down and helps you to gain more purchase with the scales on the bottom of the skis. It also helps to press the center portion of the camber of the ski downward so that you can get better traction. Thinking about this further, lifting your toes up also helps you to engage your glutes to a greater degree.

Try this: stand comfortably with your knees slightly flexed. Lift up your toes leaving the balls of your feet on the ground. Do you feel the first metatarsal head going down and making better contact with the ground? Can you feel your foot tripod between the head of the first metatarsal, head of the fifth metatarsal and the calcaneus? Now let your toes go down. Squeeze your glute max muscles. You should still be able to fart so don’t squeeze the sphincter. You can palpate these muscles to see if you’re actually getting to them. You can do this by placing your hands on top of your hips with your fingers calling around forward like when your mom used to put her hands on her hips and yell at you. Now relax with your toes up again leaving the balls of your feet on the ground. Now engage your glutes. See how much easier it is?

Now stand with your feet flat on the ground and put your hands on your abs, specifically your external obliques. Now raise your right leg. Do you feel your external oblique engage? Now, lift your toes up leaving the balls of your feet on the ground. Now lift your leg. Do you feel how much more your abs engage?

Little tricks of the trade. That’s why you listen here and why your patients/clients come to see you. Now go out and do it!

Dr. Ivo, one of The Gait Guys

#gaitanalysis, #crosscountryskiing, #skiing, hallux, #engage, #abs

Don't coach arm swing.

We often say that arm swing should not be coached.
Here are some of our deeper thoughts as to why we stand firm on this.

Look at this photo, there are lots of different arm swings in every group of runners. These differences are not choices for the most part, the arms are just doing what they must, based off of many parameters in a runner, things that are working right, and not so right.

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To be more clear, aberrant arm swing is often a compensation to cope with other flawed mechanics elsewhere, things such as a weak core on one side, loss of thoracic lateral bend or rotation, altered limb stability patterns, hip stability challenges etc. Thus, it is almost foolish to change an arm swing that you do not like in you or your client, because often that is not the problem. Arm swing is a power producer, but it is also a huge ballast like appendage that is used to help maintain balance changes. So, look for all possible causes of what you so, that which looked aberrant, and fix those mechanical flaws first.

From Canton: "Current research has yet to determine how passive dynamics and active neural control contribute to upper limb swing during human locomotion. The present study aimed to investigate these contributions by restricting pelvis motion during walking, thereby altering the upward energy transfer from the swinging lower limbs."

Here at The Gait Guys we have discussed for years the principles of the antiphasic nature between the pelvis "girdle" and shoulder "girdles" in that they should move in opposite rotational planes, and yet be equal in their amplitude, and that when this occurs, arm and leg swings are mostly symmetrical, equal in amplitude and symmetrical in their swing planes. This study found that when the pelvis was restricted, that the ranges of motion of the shoulder and trunk, as well as the vertical trunk center of mass movement, were also reduced, as we have said many times in our writings and in quoting the research over the years. This study also supported our long standing position that arm swing is more of a passive phenomenon, yet with complex coupling of the upper and lower limb neural networks, but also strongly taking its queues from the trunk, pelvis and leg swing.

One final thought from us, coaches, especially sprint coaches, are still going to coach arm swing and force arm swing drills, the ones they want to see, to achieve more power. . . . sigh (we get it, speed is important, but there could be a cost to making the body do what is it naturally struggling to do cleanly). So, if you are going to employ these arm swing sprint drills, get someone to fix the aberrant patterns first, if you want to see fewer injuries. Otherwise, don't be surprised if you see in your runners more thoracic lean to one side, a head tilt to one side, athletes complaining of mid or low back or neck pain, tightness, shoulder pain and the list goes on. Forcing your desired coached arm swing pattern on a clients already compensated physiology may have some unwanted costs.
-Dr. Allen (of the gait guys)

From the -Canton and MacLellan paper:
"Relating shoulder muscle activities to upper limb kinematics suggested these muscles mainly acted eccentrically, providing evidence that passive elements are a significant factor in arm swing control. However, the conserved muscle activity patterns and temporal coupling of limb movements when pelvis motion was reduced are suggestive of an underlying active maintenance of the locomotor pattern via linked upper and lower limb neural networks."

Active and passive contributions to arm swing: Implications of the restriction of pelvis motion during human locomotion.Canton S1, MacLellan MJ2. Hum Mov Sci. 2018 Feb;57:314-323. doi: 10.1016/j.humov.2017.09.009. Epub 2017 Sep 25.