Look at his guys right leg, the lower leg and foot.

Look at his guys right leg, the lower leg and foot.

This photo was part of an insert in an old Altra shoe box when we got our shoes.

Is that internal tibial torsion, a fixed bony issue that is causing what appears to be the intoe? Or is it a drop of the right hemipelvis into anterior tilt, to try to get more hip extension, which often leads to full leg internal rotation from the hip ? Is it from a weak left hip complex, particularly the abductor players? Remember, internal hip rotation and hip extension can be paired events. Internal hip rotation is a precursor event, in gait, to hip extension. But this is beyond the normal hip extension-internal limb rotation pairing.

There is no way to know except to examine him.
Coaching this out is a mistake until you know what it is.
Prescribing a corrective exercise to attempt to correct it is also a huge mistake without examining the person hands on, and determining whether this is a fixed bony issue, or a functional pattern of choice/power/biomechanics.
It could also be a compensation to another issue, such as I eluded to in a possible weak right lower abdominal interval, allowing the pelvis to tip too far forward.
We have to understand anatomy, biomechanics, compensations and we have to examine our clients.
If a coach tries to train this out, because they do not like the way it looks, it is foolish. Just plain foolish. And if a coach notes this, but does nothing about it, and merely adds training and strength to the "potential" dysfunction, do not be surprised if injury arises. It might not, but adding strength, load and training onto faulty mechanics can have a consequence. There will be those who say, " if it is not a problem, don't fix it". Our response is, sure, that might work, and then again it might not work. Just take responsibility and honest self inventory if that athlete might injure. And learn from it. We are all students.
Do not add strength to dysfunction.

How do you know ? In this case, one has to get educated on osseous torsions and versions, anatomy, biomechanics, to start. Listen, read, learn. We do these things all the time, every day here on The Gait Guys.

Shawn Allen, one of the gait guys

#gait, #gaitproblems, #gaitcompensations, #tibialtorsion, #internaltibialtorsion, #intoed, #running, #sprinting, #thegaitguys, #hipextension, #powerleak

Wild Haggis? Leg length discrepancies on the uphill side? What?

An old Scottish myth has it that the wild haggis (given the fitting taxonomic moniker Haggis scoticus ) is a small fictitious creature (although many folks visiting Scotland believe they are real) that has legs that are longer on one side than the other. There are two varieties: in one the right fore and hind limb are shorter and the other, of course, the left. The asymmetry helps the haggis to circumnavigate the steep mountainsides of its native terrain, but only in a clockwise (if the right legs are short) or counter clockwise (if the left legs are short) direction, so as to not roll down the steep hillside and come to an untimely death; this is purported to be one of the reasons for their near extinction (the other was the introduction of sheep).

The two species coexist peacefully but are unable to interbreed in the wild because in order for the male of one variety to mate with a female of the other, he must turn to face in the same direction as his intended mate, causing him to lose his balance before he can mount her. As a result of this difficulty, differences in leg length among the haggis population are further accentuated, as is there dwindling numbers.

image source: https://en.wikipedia.org/wiki/Wild_haggis#/media/File:Haggis_scoticus.jpg

It’s an amusing concept, but unfortunately there’s a non-mythical human corollary: Leg-length discrepancies (LLDs), which do not discriminate and affect a wide variety of people, including children with cerebral palsy, people who’ve had hip and knee replacements, and those with scoliosis, pelvic obliquity, or certain muscle contractures/dysfunctions.

Haggis is actually a Scottish dish; lungs and liver of a sheep cooked with other ingredients inside its stomach. Yum (Not!) We are not sure why or how the two are related but it does make for an interesting post : )

Learn more about LLD’s and their compensations by joining us Wednesday, April 17th 5 PST, 6MST, 7CST and 8 EST on onlinece.com: Biomechanics 307

Dr Ivo Waerlop, one of The Gait Guys

#haggis #wildhaggis #LLD #leglengthdiscrepancy #leglengthdifference #leglengthinequality #gait #thegaitguys

https://en.wikipedia.org/wiki/Wild_haggis

https://lermagazine.com/article/limb-length-discrepancy-when-how-to-intervene

https://www.atlasobscura.com/articles/what-is-haggis

https://www.thehaggis.com/wild-haggis-all-about-haggis/

https://www.undiscoveredscotland.co.uk/usfeatures/haggis/wildhaggis.ht

the current understanding of how tendons respond to loading, unloading, ageing and injury

A muscle contract, transfers load across the tendon into the attachment to another bone on the other side of a joint, sometimes across 2 joints. There can be a mechanical flaw/injury in the muscle or tendon, or the joint, if inflamed, can neurologically inhibit that muscle-tendon team. The journal abstract has a nice diagram looking at the potential cellular and molecular changes at the tendon interval.
"Here we review the current understanding of how tendons respond to loading, unloading, ageing and injury from cellular, molecular and mechanical points of view. "- S. Peter Magnusson, Michael Kjaer

https://physoc.onlinelibrary.wiley.com/doi/10.1113/JP275450

There is more than one way around an LLD....

Leg length discrepancies. Love them, hate them, they happen. They can be either functional, anatomical or both.

No matter what the cause, there are numerous ways to compensate for a leg length discrepancy. Today we are going to look at one of the more common ones, "leaning" to the short leg side to create enough clearance for the opposite lower extremity. This patient has a left sided short leg. Note how he abducts his pelvis, utilizing both the stance limb gluteus medius and swing limb quadratus lumborum of the left leg to create enough space to swing the right leg through.

Want to know more about LLD’s and their compensations? Join us on onlinece.com, Wednesday, April 17th for Biomechanics 307. 6 PM Mountain time. See you there!

Dr Ivo Waerlop, one of The Gait Guys.

#LLD #leglengthdifference #leglengthdiscrepancy #leglengthinequality #compensation #gait #gait analysis #thegaitguys

When we try to dorsiflex through the midfoot instead of the ankle.

A foot bump. Read on . . .

We see this kind of thing all the time. This is a fixed pes planus (flat foot). When we dorsiflex the big toe, the arch does not go up as you see in the photo. That is passive dorsiflexion, if the arch does not go up passively, there is no way you are actively going to achieve this. And, using an orthotic to "attempt" to raise this arch is not only pointless, but it is futile and it will likely cause them pain. This arch does not rise, no matter how hard you put up into it. The bump, that is the navicular bone, and its associated arthritic build up at the adjacent joints, and likely soft tissue accommodation/hypertrophy. You can't needle, ultrasound, tape, adjust or rub this bump away, so stop wasting your and your patient's time selling them that wasteful thinking. It ain't gonna happen.
This is what happens when someone earns a collapsed longitidinal arch, the 1st metatarsal no longer plantarflexes (arch up) and it becomes fixed in dorsiflexion, thus affecting the mechanics at the proximal aspect of the 1st ray complex (navicular-cuneiform-met intervals).
Why? This happened because this client has significantly compromised ankle mortise dorsiflexion, and they chose to find it at the next joint complex distally, as mentioned above. So, they are finding pseudo-ankle rocker at arch collapse? Yes, we discuss this often, more pronation will advance the tibia forward. It is not desirable, but moving forward has to occur, and some people have no choice but to find it from excessive internal rotation and pronation of the limb. And this is what happens when it happens over years. Now the deformity is painful itself in the shoe, it is a new set of problems for this client.
Can this problem occur in reverse ? Yes, a loss of hallux dorsiflexion can afford the same end result.
We have a rule, at the very VERY least, check the joint above and below the area of problem/symptom. Often you will find another piece of the puzzle causing your client's pain.

Neuro-adaptation, motor skills and strength. Does it come

We have discussed on recent podcasts about the concept of neuro-adaptation.
Neuro-adaptation is the initial strength gains we see in the first few weeks of corrective exercise homework, often it is more so better "coordination" of the motor patterns taught, and less so brute strength. But, it applies to strength training as well.

This strength increase is usually attributed to changes in the neural drive to muscle as a result of adaptations at the cortical or spinal level. This study investigated the change in the discharge characteristics of large populations of longitudinally tracked motor units in tibialis anterior before and after 4 weeks of strength training the ankle‐dorsiflexor muscles with isometric contractions. “

"We show for the first time that the discharge characteristics of motor units in the tibialis anterior muscle tracked across the intervention are changed by 4 weeks of strength training with isometric voluntary contractions.”
”The specific adaptations included significant increases in motor unit discharge rate, decreases in the recruitment‐threshold force of motor units and a similar input–output gain of the motor neurons.
The findings suggest that the adaptations in motor unit function may be attributable to changes in synaptic input to the motor neuron pool or to adaptations in intrinsic motor neuron properties." -Alessandro Del Vecchio et al

“These results demonstrate for the first time that the increase in muscle force after 4 weeks of strength training is the result of an increase in motor neuron output from the spinal cord to the muscle. “

The increase in muscle force after 4 weeks of strength training is mediated by adaptations in motor unit recruitment and rate coding
Alessandro Del Vecchio et al
Journal of physiology 06 February 2019

https://doi.org/10.1113/JP277250

The opposite upper and lower limbs model each other. Today we discuss adduction. See the photo.

The opposite upper and lower limbs model each other. Today we discuss adduction. See the photo.

This is a discussion we had last March 11 and 12, 2019 on this photo. Today, lets look closer at the photo.

Runners, athletes . . . Even in your drills, do it correctly !
Last week we discussed this and its relation to the Bird Dog exercise. This is no where near the same pattern as Bird Dog, as we discussed, the Bird Dog is neurologically incorrect. Today, Adduction is the topic at hand.

This runner is performing a skill, a proper neurologic skill when it comes to patterning limbs the way we repeatedly move in walking, running, and often (but not always) sports. If you want to know why Bird Dog is an outlier neurologically, go back and find our post last week on the topic.

Today, look at the right knee, he has allowed it to adduct. We discussed why this is a lazy pattern, unless he has a purpose for not abducting the hip (possibly addressing something we are unaware of). Now look at the left arm, it too is adducted towards the midline. When left to its patterned and balanced based ways, the brain will use balance and patterning to model the limbs with their counterpart. This is the neurologic "shaping" we have discussed previously. The upper limb can help to shape the movement of the lower, but we know there is the opposite effect as well. We also know that the lower limb has a higher "leading" affect, it runs the show more. This is why we feel coaching arm swing is not the best way to go about changing someone's gait issues/form.

Try what he is doing, stand up and try it. You will see that the upper limb and lower limb better follow the modeling and shaping when they are both doing the same things (in this case, hip and shoulder flexion, and adduction). Now, keep the right thigh flexed and adducted, and ABduct the arm, you will find a subtle balance challenge and it will feel like there is a slight disassociation, because you have taken one limb away from the midline. Now, instead, adduct the left shoulder, but abduct the right thigh/hip. It is harder to do, again. Not leaps and bounds harder, but you had to think about it, because one limb is moving toward the midline and the other is not , all the while in a static balance position. Now yes, some will argue that this was not hard at all, and this kind of thing happens in sport all the time, agreed. Sometimes balance and proprioception (i.e. the vestibular system) trumps neurological patterning because of the hierarchy in the CNS. BUT don't miss our point, that there are underlying neurologic patterns and principles that dictate limb function when we are not paying attention to it. This is our point, and you will see it in your clients when they walk and run. And you see it in this guys case, because we would bet that he was not doing this left shoulder left hip adduction on purpose. He was doing it because it felt right, felt normal, felt balanced, and it is neurologically sound. But, he could do better, if he abducted the left arm and right hip, he be earning a more pattern as a runner. And, he would reduce the tendency of the cross over gait pattern, because, as you can see here, if that right foot heads to the ground, he is going to be very narrow step width in his gait, and that COULD mean potential problems and power leaks.
One more thing, do not be surprised that the right arm is abducting while it is extending, this is spin off of the adduction of the other limbs we discussed today. If he likely remedies them, the right arm will no longer abduction, likely.
And, these same concepts play out if you are adducting your arms across your body when walking or running, if the arm is pulling hard across the midline, do not be surprised if your step width is narrow. Hence, if you wish to run with more glutes and a wider more powerful gait, reduce the arm adduction and the legs will have to follow from the "shaping" influence of the arms.

The loads are going to go somewhere.

You cannot change one thing, and not expect the other parts to change, have to adapt, and possibly complain at some point.
The loads are going to go somewhere.

Too much pronation means the arch may be reduced in height, but it also means that the first ray complex (the 1-2 metatarsals essentially) is dorsiflexing more than normal. This means they will not likely get to their adequate plantarflexion by the time the foot is ready to heel rise and toe off at supination. In other words, if you have pronated and dorsiflexed too long and too much, you will eat up the time you needed to plantarlfex and supinate.
This means that "Increased foot pronation may compromise ankle plantarflexion moment during the stance phase of gait, which may overload knee and hip."-Resende et al

If you cannot plantarflex the foot-ankle complex sufficiently, or in a timely manner, you should understand that you are carrying this fault forward while moving into heel rise during the forefoot rocker stance phase of gait, and you are doing it over a less stable, less rigid foot-ankle complex because it is still in relative pronation. This means you are placing higher propulsive loads over an unprepared ankle-foot complex. This means different/altered posterior compartment function, which can mean altered knee and hip function. Sagittal plane function, to name the most obvious, will have to create and endure compensatory loads. Sure, they may be fine for a time, but perhaps there will be a cost over time. Now, many might say, "if it is not a problem now, it is not a problem", let them build robustness on their chosen pattern; that can be very hopeful and shortsighted thinking in our opinion. Why not change things that are obviously aberrant and build robustness on a pattern and correction that is suspected to be more sound? This can be a cyclical argument that no one wins, EVER, we all see it all the time. After all, the arguments become silly after time, and we resist our own silly comments like "well, why change the oil in your car right now, nothing bad is happening at this time. Or, well that front right tire, though bald and nearly flat, is still rolling along so why bother changing it out?" But that stuff gets no one anywhere, other than pissed off, so we hold back. The debate never gets furthered along, because no one can see the future.

So, we will leave this rant with this thought, we cannot change one thing, and not expect the other parts to change, have to adapt. And adaptation can be both good OR bad. Or maybe we should say, good AND bad.
The loads are going to go somewhere. Lets leave it at that.

photo: credit pixabay.com

Gait Posture. 2018 Oct 23;68:130-135. doi: 10.1016/j.gaitpost.2018.10.025. [Epub ahead of print]
Effects of foot pronation on the lower limb sagittal plane biomechanics during gait.
Resende RA1, Pinheiro LSP2, Ocarino JM3.

Key moment during my knee exam:

Key moment during my exam:

Today, a small slice of the Sagittal plane:
Here are just a few of the things going through my mind as i go through the lower limb sagittal plane. Everyone has a different way, this is a piece of mine. . . . .

Do they have sufficient ankle dorsiflexion, active passive?
Are the ankle dorsiflexors strong enough to achieve sufficient ankle dorsi and rocker, and are the ankle plantarflexors long enough, to allow said sufficient ankle dorsiflexion.

And to match with that in terms of gait cycles and loading patterns, do they have sufficient hip extension?
Meaning, are the hip extensors strong enough, and the hip flexor groups (hip flexors and quads of course) long enough, to allow sufficient hip extension.
Are the abdominals strong enough to anchor the pelvis from dropping into uncontrolled or excessive anterior pelvis tilt and paraspinal loading? Because when then do drop into APT, they will convert, likely, into quad dominance and paraspinal dominance (instead of glute-abdom). In otherwords, can they adequately control the hip into the pelvis (acetabulum) and the pelvis into the spine?
When there is a conflict between the foot/ankle and hip in the sagittal plane, problems may occur at these joint levels, and/or above and/or below these joints (ie, low back, knee, or deeper into the foot).
To be clear, none of these joints exclusively work in just the sagittal plane. That many of these joint complexes are multiaxial, and there is always the issues of protective stability in other planes that ensure another planes clean function. This is what makes more deeply explaining how to fix something very difficult on the internet, because it is in fact complex and requires juggling many clinical insights all at once to determine where things have gone wrong in an injured client. And, this was only discussing the sagittal plane today, on the most simple and crudest of levels. What about deeper issues?
And then , of course, how are they doing in frontal and transverse planes? And then how do the 3 planes come together, functionally or dysfunctionally? And, if they cannot control sagittal, are they dumping it into frontal hip or transverse hip ? (ie. see the FB post last week that had a few people all in a butt clench of the runner with the right leg internally rotated/torsional questions).
These are the balls i am juggling when i examine people, slowly building a puzzle from a fresh open box.

Today was just a slice of the pie on lower limb sagittal assessment, just a blip into my mindspace.
And so, if you are not adding an assessment to training or corrective work, and there is a problem that is left unaddressed, then we can be adding strength to dysfunction.

Subtle clues to an LLD?

Leg length discrepancies, whether their functional anatomical, have biomechanical consequences north of the foot. This low back pain patient exhibited 2 signs. Can you tell what they are?

can you see the difference ?

how about now?

compare right to left

compare right to left

can you see the difference in the Q angles?

Look at the first picture and noticed how the left knee is hyper extended compared to the right. Sometimes we see flexion of this extremity. This is to "functionally shorten" that extremity.

Now look at the Q angles. Can you see how the left QL angle is greater than the right? This usually results from a long-term leg length discrepancy where the body is attempting to compensate by increasing the valgus angle of that knee, effectively shortening the extremity.

Dr Ivo Waerlop, one of The Gait Guys

#subtle #clues #LLD #leglengthdiscrepancy #leglengthinequality #thegaitguys #gaitabnormality

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Most likely this is common knowledge for most followers here on The Gait Guys and our podcast (another one will launch this weekend btw).

But reducing the plantar flexion moment in the late stance phase of running and walking can make notable changes in the loading response to the posterior plantarflexor mechanism (the gastroc-soleus-achilles complex). A rocked shoe, according to this study, can reduce the plantarflexor moment without substantial adaptations in triceps surae muscular activity.
This of course brings to mind the HOKA family of shoes that have purposefully added a gentle rocker mechanism to some of their shoe line, some with an early and some with a late stage metarocker built in. Are you a HOKA hater? We were not fans in their early development because of the volume of stack height foam, but they have many more options in their line up now. But do this for us, do not pass judgement until you put one of these metarockered shoes on, and you will understand the function of it, and their place for your chronic posterior compartment clients. Don't reflexively judge until you try them. It is good to have options for your clients, because "stop running" is not an option for runners, for our runners, unless all else has failed.

Shawn Allen, the other Gait Guy

#thegaitguys, #gait, #hoka, #metarocker, #achilles, #tendinitis, #gaitproblems, #gaitanalysis, #calfpain, #running

J Sci Med Sport. 2015 Mar;18(2):133-8. doi: 10.1016/j.jsams.2014.02.008. Epub 2014 Feb 14.

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Sobhani S1, Zwerver J2, van den Heuvel E3, Postema K4, Dekker R5, Hijmans JM6.

Bone marrow lesions in runners.

"More than half of the lesions (bone marrow edema) (58%; 26/45) fluctuated during the season, with new lesions occurring (20%; 9/45) and old lesions disappearing (22%; 10/45)."

Stuff happens to your bones during a marathon, or on that long weekend training run. Make sure you give yourself time to recover adequately before you pound out that next run.
The incidental finding of bone marrow edema (BME) on MRI in professional runners is not well understood. Bone takes on load, as it should. In this study, it is suggested that many asymptomatic athletes show BME lesions, many of which will come and go with training. It is most like proper and ample recovery that allows athletes to heal and not let these lesions turn into greater stress responses, or stress fractures. It is when the load comes too often, to long, heavy and hard that things might mount.

Methods:
Sixteen athletes (13 men and 3 women; mean age, 22.9 ± 2.7 years) were recruited from the Dutch National Committee middle-distance and long-distance running selection. All athletes had been injury free for the year before the study. Magnetic resonance imaging scans were obtained before the start of the season and at the end of the season.

14 of the 16 athletes had BME lesions before the start of the season (45 BME lesions in total). Most BME lesions (69%; 31/45) were located in the ankle joint and foot. More than half of the lesions (58%; 26/45) fluctuated during the season, with new lesions occurring (20%; 9/45) and old lesions disappearing (22%; 10/45). The few clinical complaints that occurred throughout the season were not related to the presence of BME lesions.

Am J Sports Med. 2014 May;42(5):1242-6. doi: 10.1177/0363546514521990. Epub 2014 Feb 20.
Bone marrow edema lesions in the professional runner.
Kornaat PR1, Van de Velde SK.

Increased unilateral foot pronation can cause cephalad asymmetries.

Increased unilateral foot pronation affects lower limbs and pelvic biomechanics during walking. Nothing earth shaking here, we should all know this as fact. When a foot pronates more excessively, the arch can flatten more, and this can accentuate a leg length differential between the 2 legs. But it is important to note that when pronation is more excessive, it usually carries with it more splay of the medial tripod as the talus also excessively plantarflexes, adducts and medially rotates. This action carries with it a plantar-ward drive of the navicular, medial cuneiforms and medial metatarsals (translation, flattening of the longitudinal arch). These actions force the distal tibia to follow that medially spinning and adducting talus and thus forces the hip to accommodate to these movements. And, where the hip goes, the pelvis must follow . . . . and so much adaptive compensations.
So could a person say that sometimes a temporary therapeutic orthotic might only be warranted on just one foot ? Yes, of course, one could easily reason that out.
-Shawn Allen, one of The Gait Guys

#gait, #gaitanalysis, #gaitproblems, #thegaitguys, #LLD, #leglength, #pronation, #archcollapse, #orthotics, #gaitcompensations, #hippain, #hipbiomechanics

Gait Posture. 2015 Feb;41(2):395-401. doi: 10.1016/j.gaitpost.2014.10.025. Epub 2014 Nov 3.
Increased unilateral foot pronation affects lower limbs and pelvic biomechanics during walking.
Resende RA1, Deluzio KJ2, Kirkwood RN3, Hassan EA4, Fonseca ST5.

ACL rehab considerations you might not know about.

ACL rehab consideration.
Once referred to as "the dark side of the knee" due to the limited understanding of the anatomy and biomechanics, the posterolateral corner (PLC) of the knee still remains off the radar for many clinicians.
Whether surgical repair or not, is your patient not progressing? Did you check for damage to the PLC of the knee?

Injuries to the (PLC) comprise a significant portion of knee ligament injuries. Complete PLC lesions rarely heal with non-operative treatment, and are therefore most often treated surgically. Posterolateral corner injuries are commonly associated with ACL or PCL tears, with only 28% of all PLC injuries occurring in isolation, this means there are likely many of these injuries lurking in your injured knees. Posterolateral rotational instability (PLRI) is a real thing, and it is missed often enough.
This was a nice review article, outlining the primary and secondary restraint anatomy and some guidelines to consider.
We discussed this article in our onlineCE lecture last night. Huge class ! Great to see many of you there !
See you again in 4 weeks !

Posterolateral Corner of the Knee: Current Concepts
Jorge Chahla, MD, Gilbert Moatshe, MD, Chase S. Dean, MD, and Robert F. LaPrade, PhD
Arch Bone Jt Surg. 2016 Apr; 4(2): 97–103

Habituating a gait correction

We tell our patients all the time that the key to acquiring the gait correctives is the number of times a day they show the nervous system the corrective gait patterns. It is not about 2-3 solid episodes of homework a day, rather, it is an hourly 2-3 minute focused episode driving nothing be the cleaned up motor skill we are trying to neurologically "rewrite".
We have 3 tiers in my office, Gold, Silver and Bronze.
Gold medal homework= 2-3 minutes every hour.
Silver medal homework= 2-3 min every 2 hours
Bronze medal homework= 2-3" every 3 hours (that is still a medal, because it is still 6x a day)

We start with one corrective in their gait and homework to set that pattern up. Then next visit we up the difficultly on that skill/pattern, and introduce another new one that is part of the overall gait correction was want to see. Thus, they are juggling 2 balls, one that is more familiar but a little harder, and now a new one that is at the basic level. The next visit, we add a 3rd ball, upping the demands on the other 2.
Rinse and repeat.
This goes for walking and running gait problems.

IF they want this pattern to be come more habitual faster, one has to go for gold, or gold++.

-Shawn Allen, the other gait guy
#gait, #gaitproblems, #gaitcorrections, #gaitretraining, #gaitanalysis, #thegaitguys, #habits, #runningform

"The findings indicate that the amount of practice in the criterion task is more critical than the difficulty and variations of task practice when learning new gait patterns during treadmill walking."

https://www.ncbi.nlm.nih.gov/pubmed/30905405

Got hip extension?

Because she sure could use some...

we have see this gal before… yesterday in fact

• left plantar plate lesion (yes, conformed on ultrasound)

• left sided anatomical leg length discrepany

• bilateral internal tibial torsion

• incompetent L quadratus lumborum

• adequate hip extension and ankle dorsiflexion available to her

• lack of endurance in her abs

yep, lots more, but that is enough for now

note that she has plenty of ankle dorsiflexion, more on the right. this is due to her right leg being anatomically longer and has to travel through a greater range of motion

look at the knee and the hip articulations to assess hip extension. It should match ankle dorsiflexion, no?

Dr Ivo Waerlop, one of The Gait Guys

#gait #gaitguys #thegaitguys #hipextension #LLD #quadratuslumborum #internaltibialtorsion #anklerocker #ankledorsiflexion

Running cadence doesn't matter? Maybe.

Does running cadence matter? Not as much as previously thought (in terms of speed and efficiency, but this is not a comment on altering biomechanics to avoid or manage running through injury. One of the first things we ask of a runner, who insists they will be running with their injury while we attempt to get ahead of it, is to increase their cadence and land with more finesse (if they are a heavy "plunker", which often happens on longer runs when people fatigue).

“Some ran at 160 steps per minutes and others ran at 210 steps per minute, and it wasn’t related at all to how good they were or how fast they were,” Burns said. “Height influenced it a little bit, but even people who were the same height had an enormous amount of variability.”

"Another unexpected finding is that by the end of a race, cadence varied much less per minute, as if the fatigued runner’s body had locked into an optimal steps-per-minute turnover. It’s unclear why, Burns said, but this deserves further study."

https://news.umich.edu/step-it-up-does-running-cadence-matter-not-as-much-as-previously-thought/?fbclid=IwAR07mIPxVEPXlkkXoU-XxyCIQY7MwfpX0HHXW7lxMqrcx69ZHHjLO1SxPXw

3 things

Its subtle, but hopefully you see these 3 things in this video.

I just LOVE the slow motion feature on my iPhone. It save me from having to drag the video into Quicktime, slow it down and rerecord it.

This gal has a healing left plantar plate lesion under the 2nd and 3rd mets. She has an anatomical leg length deficiency, short on the left, and bilateral internal tibial torsion, with no significant femoral version. Yes, there are plenty of other salient details, but this sketch will help.

1. 1st if all, do you see how the pelvis on her left dips WAY more when she lands on the right? There is a small amount of coronal plane shift to the right as well. This often happens in gluteus medius insufficiency on the stance phase leg (right in this case), or quadratus lumborum (QL) deficiency on the swing phase leg (left in this case) or both. Yes, there are other things that can cause this and the list is numerous, but lets stick to these 2 for now. In this case it was her left QL driving the bus.

2. Watch the left and right forefeet. can you see how she strikes more inverted on the left? this is a common finding, as the body often (but not always) tries to supinate the shorter extremity (dorsiflexion, eversion and adduction, remember?) in an attempt to “lengthen” it. Yes, there is usually anterior pelvic tilt accompanying it on the side, because I knew you were going to ask : )

3. Look how her knees are OUTSIDE the saggital plane and remain there in her running stride. This is commonly seen in folks with internal tibial torsion and is one of the reasons that in our opinion, these folks should not be put medially posted, torsionally rigid, motion control shoes as this usually drive the knees FURTHER outside the saggital plane and can macerate the meniscus.

Yep, lots more we could talk about on this video, but in my opinion, 3 is a good number.

Dr Ivo Waerlop, one of The Gait Guys

#thegaitguys #gaitanalysis #footpain #gaitproblem #internaltibialtorsion #quadratuslumborum #footstrike

https://vimeo.com/329212767

Heart disease and changes in gait.

Research is finding some clues. . . . ankle plantarflexion. The calf as a locus of impaired walking capacity.

Dr. Ted Carrick was once heard saying that even in the earliest phases of neuropathology, stages possibly so early that neuropathology is absent from most testing results (incidentally, we discuss this on a recent podcast, 137 or 138 and what tests might help in the discovery when things like EMG/NCV are "normal"), that subtle changes in one's gait might be the first sign(s) of aberrant sensory-motor function when all other methods prove unfruitful in the discovery process.

Reduced walking capacity is a hallmark of chronic heart failure (CHF). Why is this? It is reduced fitness ? It is weakness, stiffness, reduced metabolic capacity ? It could be all of them, and many more.
This interesting study found "over two times greater ankle plantarflexion work during stance and per distance traveled is required for a given triceps surae muscle volume in CHF patients. This, together with a greater reliance on the ankle compared to the hip to power walking in CHF patients, especially at faster speeds, may contribute to the earlier onset of fatigue in CHF patients."

This makes sense to us, after all, the much work (perhaps 50%~?) should be provided by the glutes and core in the propulsion phase of gait. But we know that the elderly, and especially the weak elderly, who walk with shorter steps and strides, who walk slower, who are weaker and more fragile, that their capacity for propulsion is notably diminished in the later years. The later years when CHF is also found. Thus, how do these folks find ways to effectively move forward? This study provides one possible clue, the ankle plantarflexors, the gastrocsoleus-achilles complex.

"This observation also helps explain the high correlation between triceps surae muscle volume and exercise capacity that has previously been reported in CHF. Considering the key role played by the plantarflexors in powering walking and their association with exercise capacity, our findings strongly suggest that exercise-based rehabilitation in CHF should not omit the ankle muscle group."

J Biomech. 2014 Nov 28;47(15):3719-25. doi: 10.1016/j.jbiomech.2014.09.015. Epub 2014 Oct 11.
Gait analysis in chronic heart failure: The calf as a locus of impaired walking capacity.
Panizzolo FA1, Maiorana AJ2, Naylor LH1, Dembo L3, Lloyd DG4, Green DJ5, Rubenson J6.

Patreon video

Last night on Patreon i uploaded a brief exercise and discussion VIDEO on how not to load the hips, core and spine in overhead sports, lacrosse in this case.
Join us on Patreon for the "how to address" problems with corrective work.

https://www.patreon.com/thegaitguys