Knee hyperextension? Or does this photo suggest something more ?

You walk into the exam room and see a patient standing there just like this, What thoughts immediately flood your head ?
For me, I quickly start to juggle some things like, this:

- anterior-meniscofemoral impingement ? Are his first words going to be knee pain ?
- tibial tuberosity/osgood type traction issue due to quad dominance? Are his first words going to be knee pain?
-loss of ankle rocker? Are his first words shin pain or plantar foot pain?
- tibialis posterior tendinitis ? Is he going to point to the medial ankle gutter or lower medial shin as his pain area?
-likely anterior pelvis tilt (hence weak lower abdominals), weak glutes, low back pain ?
-hamstring tightness, cramps, pain, posterior knee pain?

Just rambling real fast this morning after seeing this picture on an old hard drive.
Train your brain to think fast, think of possibilities top to bottom, don't wait for your patient to tell you where their problem is.
I play this game when i ask all my patients to walk to the back of the office to my exam room. I am watching, thinking, mental gymnastics.
Our jobs are to solve puzzles, put meaningful pieces together, to solve problems.
I use the analogy of building a puzzle. You open the box, search out the straight peripheral edges, then clump together colors, patterns. Your history and examination and gait observation should be about a process of putting together the most likely clinical picture and puzzle. And then you start to execute. Sometimes you have to walk things back, but you have to start somewhere.
But, if you wait until you get into the room, wait for the patient to say, "anterior knee pain" to start your thinking, it is easy to get tunnel vision and forget all of the other possible pieces of the puzzle that might be playing into that anterior knee pain.
REmember this, how your client moves , poorly or well, is not the problem, it is just how they are moving with the pieces and patterns available to them or how they are avoiding patterns that are painful. How they move is not the problem, it is their strategy. It is our job to find out why they are moving that way, and if it is relevant to their complaint.
Start big, funnel to small.

Shawn Allen, the other gait guy
#gait, #gaitanalysis, #gaitproblems, #clinicalthinking, #buildingpuzzles

Normal walking and running have a certain degree of vertical oscillation, but we do not want too much

Normal walking and running have a certain degree of vertical oscillation, but we do not want too much, we want the body to move along mostly horizontal path but we do need some dampening of impact loads. We do not want to waste too much energy bouncing up and down. This is mitigated quite a bit by hip and knee flexion, the knee is well positioned to do this the easiest in many cases. Pronation and ankle dorsiflexion do dampen loads as well.

Ivo and I just recorded a class on leg length discrepancies. Here are some factors to keep in mind if there is even the smallest leg length discrepancy, anatomic or functional.

-the short leg may hyperextend at the knee , externally rotate at the hip, as well as supinate the foot (this supination is relative ankle plantarflexion, which can set up increased protective tone in calf complex and reduced strength and exposure to anterior compartment).

-the long leg side may knee flex , internally rotate at the hip, and as well as pronate at the foot (this is relative ankle Dorsiflexion)

Both of these scenarios can be going on at the same time on either leg, or it can be only on one leg. We are not perfectly symmetrical organisms, so these things can set up to help us run and walk more effortlessly, to compensate to get the head and neck properly positioned (normalizing the visual and vestibular centers on the horizon) for balance and movement through the 3 cardinal planes, and to compensate around challenging anatomy or biomechanics.

This is a complex machine, with infinite abilities to compensate and cope. But what we see is the compensation, not the problem. The joint range losses in one joint, the excesses in another, the weakness in one area, the over protection in another, the failure to tolerate loads in another, are all ways of coping and keeping us moving, . . . . . . but sometimes at a cost. . . . . pain.

shawn and ivo, the gait guys

A sprinter with arch pain. Kohlers AVN: Not everything is always mechanically pain driven.

More ankle rocker is not always the right answer. An orthotic or stability shoe is not always the answer.

Thus, not everything will have a mechanical solution and a corrective exercise. People without a medical background will not likely know what Kohlers Disease is or Mueller Weiss syndrome is for that matter (the adult form of AVN (avascular necrosis)).

So, an athlete coming to you with pain in the arch, you as a trainer, coach, and maybe even a therapist or doctor for that matter, might easily think:
"impaired ankle rocker", too much pronation, wrong shoe fit, etc . . . , . the list can be very long.

But sometimes, the problem is unrelated, or indirectly related.
This case of Kohlers/Mueller Weiss came in this week from out of state in a sprinter.
The pain started with a shoe change, and some pain in the arch region, dorsally in this case. Could it just be a massive stress response?, but it also could be Kohlers. Time will tell, but as you can see, the STIR sequence MRI shows a MASSIVE inflammatory response in the navicular bone.
And if it is Kohlers AVN, we are in the early inflammatory stage. You must catch this in the early stage, and try to not let it progress to avascular stage and necrosis and collapse. That means utmost protection, taht means 100% non weight bearing. If you break through the cortex, and this is early AVN, a deformed collapsed navicular will result, and that *could mean foot pain for life. Certainly impaired foot biomechanics.

Don't dismiss unchanging pain, or worsening pain. Sometimes it is not mechanical.
This case remains unknown right now, meaning massive stress response (ie pre stress fracture)? or AVN early stange? I am not taking a chance, bag it up and reimage several weeks later. Over treat this one, just in case.

Shawn Allen, the other gait guy

#AVN, #Kohlers, #Muellerweiss, #osteonecrosis, #sprinter, #archpain, #gait, #gaitproblems

Can a loss of stance phase internal hip rotation cause us to circumduct the swing leg? My thoughts this morning.

This is why i like to read articles, and then sit back and say, "but what else?".

pixabay.com

Here is a study (link below) that said,
"It has long been held that hip abduction compensates for reduced swing-phase knee flexion angle, especially in those after stroke. However, there are other compensatory motions such as pelvic obliquity (hip hiking) that could also be used to facilitate foot clearance with greater energy efficiency. Our previous work suggested that hip abduction may not be a compensation for reduced knee flexion after stroke. "

Ok, maybe. . . . in stroke patients. We will give them that, but not the extrapolation to everyone else who is "non-stroke". They should have put that in their title, a little misleading in our opinion.

Clearly, hip abduction is a possible strategy for reduced knee clearance. Just because it is not a energy efficient strategy deemed by their study, it DOES NOT mean it is is not a possible pattern that is feasible for a client. People do not pick compensations by their calculated energy efficiency. The brain picks it because it is what makes sense at the time. Variables including pain avoidance, leg length discrepancy, weakness or strength or other variables are what the brain takes into account. One could argue that ANY compensation is less energy efficient than the optimal biomechanical pattern, but still we ALL compensate in some way every day around our weaknesses, limitations, pain, habitual patterns everyday. Energy efficiency is only one small variable, and i would argue that pain limitation or avoidance is a much stronger "choice" determinant that energy efficiency.

*But, here was my thought of the day, one that will percolate all day i suspect.
If a person has significant limitation of hip internal rotation on one side , completing swing phase on the opposite side is a challenge mechanically. Pelvis hike or obliquity is an option to help get that swing leg through. But is swing leg hip circumduction a possible strategy to help get past the internal hip rotation loss on the stance leg? Could it help hike the pelvis a little and assist the process as part of the package? We have to get that swing leg through. We can, and often do, work harder through the swing leg hip flexors, but that is not their job, they are perpetuators of swing, not drivers of the motion. This increased use and tone can be a contributing source of anterior hip pain. But, a more common strategy is to adductory twist the stance leg foot (spin it into external rotation) to help oblique the pelvis and thus get that swing leg through more effortlessly. But what about a little swing leg circumduction to add to that? MAybe a little of both is less drastic by just using one strategy ? Hmmmmmmm, something i need to be on the look out for. More on this another time.

We alter our kinematics to suit us, whether it is from pain, avoiding or minimizing pain, but i would fathom to guess that energy efficiency is not the top shelf choice. That is when we are healthy, strong, full ROM, pain free.

Shawn Allen, the other gait guy

#gait, #gaitproblems, #gaitanalysis, #hipinternalrotation, #adductorytwist, #abductorytwist, #hipcircumduction, #hipflexors, #kneeflexion, #swingphase, #gaitphases

J Biomech. 2019 Apr 18;87:150-156. doi: 10.1016/j.jbiomech.2019.02.026. Epub 2019 Mar 8.
Hip circumduction is not a compensation for reduced knee flexion angle during gait.
Akbas T1, Prajapati S2, Ziemnicki D2, Tamma P2, Gross S2, Sulzer J2.

Photo courtesy of Pixabay.com

Have you seen this?

Patterns. That’s what it’s about a lot of times. Dr Allen and I are always looking for patterns or combinations of muscles which work together and seem to cause what appear to be predictable patterns; like a weak anterior compartment and a weak gluteus maximus, or a weak gluteus medius and contralateral quadratus lumborum.

Here is an interesting story and a new combination that at least I have never seen before

I had a 11-year-old right footed soccer player from my son’s soccer team coming to see me with bilateral posterior knee pain which began during a soccer game while he was “playing up” on his older brothers team. He did need to do a lot of jumping as well as cutting. He is generally a midfielder/Forward. Well experienced player and “soccer is his life“.

My initial thoughts were something like a gastroc dysfunction or a Baker’s cyst. On examination, no masses or definitive swelling noted behind either knee. He did have tenderness to moderate degree over the right plantaris and tenderness as well as 4/5 weakness of the left popliteus. There was a loss of long axis extension of the talo crural articulations bilaterally with the loss of lateral bending to the right and left at L2-L3.

If you think about the mechanics of the right footed kicker (and try this while kicking a soccer ball yourself) it would be approximately as follows: left foot would be planted near the ball and the tibia/femur complex would be internally rotating well the foot is pronating and the popliteus would be eccentrically contracting to slow the rotation of the femur and the tibia. The right foot will be coming through and plantarflexion after a push off from the ball of the foot firing the triceps surae and plantaris complexes. He would be “launching“ off of the right foot and landing on his left just prior to the kick, causing a sudden demand on the plantar flexors; with the plantaris being the weak link. As the kicking leg follows through, the femur of the stance phase leg needs to externally rotate (along with the tibia) at a faster rate than the tibia (otherwise you could injure the meniscus) the popliteus would be contracting concentrically. A cleat, because it increases the coefficient of friction with the ground would keep the foot on the ground solidly planted and The burden of stress would go to the muscles which would be extremely routine leg and close chain which would include the semimembranosus/tendinosis  complex as well as the vastus medialis and possibly gracilis and short adductor, along with the popliteus.

I have to say and all of my years of practice I’ve never seen this combination type of injury before involving these two muscles specifically and am wondering if anyone else has seen this?

Dr Ivo Waerlop, one of The Gait Guys

#footproblem #gait #thegaitguys #soccerinjury #bilateralkneepain #popliteus #plantaris

image credit: https://commons.wikimedia.org/wiki/File:Slide2ACCA.JPG

Correcting movement problems : the power of opening a neurological window to change the brain's cortical representation.

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Show notes:

Hop strength
https://www.ncbi.nlm.nih.gov/pubmed/30844991
J Strength Cond Res. 2019 May;33(5):1201-1207. doi: 10.1519/JSC.0000000000003102.
Reactive Strength Index and Knee Extension Strength Characteristics Are Predictive of Single-Leg Hop Performance After Anterior Cruciate Ligament Reconstruction.Birchmeier T1, Lisee C1, Geers B2, Kuenze C

https://www.ncbi.nlm.nih.gov/pubmed/28605231

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110230/pdf/jpts-30-1069.pdf

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The banana hallux. When the big toe curls upward

Note: over-extension of the hallux and over-flexion of the 2nd toe. How can they both be so different at rest ? read on

This is common, but not commonly addressed. And, it can become a cause of symptoms.
Note how curled up into extension the hallux appears. This is just a representation of hyperextension of the distal phalange at the IP joint (interphalangeal joint).
This often occurs in hallux limitus/rigidus, where there is insufficient extension through the 1st MTP joint (metatarsophalangeal joint). In that condition, they client attempts to toe off, needing extension (dorsiflexion) at that joint, and they do not have it, so the extension can be found through arch collapse (1st metatarsal dorsiflexion) or through extension at the IP joint. Over time, form follows function and you will often see this presentation.

However, we do not need to see impaired ROM function at the 1st MTP joint, as in this case. This foot had full 1st MTP ROMs.
In this case, this toe represented massive imbalance between the long and short flexors and extensors. Specifically, increased use and strength in the EHL (extensor hallucis longus) and weakness and unawareness of how to even engage the short extensor (EHB).
Similarly, the pairing met the one we always see with this, that being weak and even difficulty of awareness to engage the FHL (flexor hallucis longus) and over-activity of the FHB (short flexor-flexor hallucis brevis).
There pairings: weak: EHB and FHL & overactive: EHL and FHB over time will result in this presentation.

In gait, you will note poor compentence and purchase of the hallux on the ground and thus a sharing of that load through overflexion hammering of the 2nd digit through increased FDL activity (note the great evidence of this with the thick obvious callus at the tip of the 2nd toe).
These clients can also often have pain at the plantar aspect of the Metatarsal head because of sesamoid imbalanced loading (sesamoiditis) as well as frank pain at the MTP joint dorsally or plantarward. One will often note a medial pinch callus on these feet medial to the metatarsal head, from a rotational spin toe off. Hallux valgus and bunion formation are also not uncommmon at all in this incompetent hallux presentation.
PS: the solution is so much more complex and involved than just towel-scrunches and marble pick up games. I mean, come on, we can do better that this team !
This requires some serious reteaching of how to use the foot, arch, tripod, windlass and foot-ground engagement skills.

Shawn and Ivo, the gait guys

#gait, #gaitproblems, #gaitcompensatins, #gaitanalysis, #bunions, #halluxvalgus, #sesamoiditis, #turftoe, #halluxlimitus, #pinchcallus, #bananatoe, #metatarsalgia, #thegaitguys, #hammertoe

3rd Wednesday of every month we teach a class online. LINK below

Case Studies in Gait Analysis: Focus on the Short Leg
*link is below

*this is the online Continuing education class we did LAST MONTH, for those of you who could not get to the Wednesday evening class.
*our entire catalogue of lectures and seminars are all here on this site for CE/CEU

Case Studies in Gait Analysis: Focus on the Short Leg
- Review anatomical vs functional short leg
-Review the kinematics and kinetics of the short leg during the gait cycle
-View and discuss case studies looking at functional and anatomical short legs
-Predict pathomechanics that will arise from a short leg
-Propose remedies for the gait abnormalities seen

https://chirocredit.com/…/Chiropractic_Doc…/Biomechanics_211

Whaddaya Think of these Shoes?

Would you put YOUR patient/client/own feet in them?

Dr Ivo Waerlop, one of The Gait Guys, discusses a common manufacturers defect to look out for, especially in people with rear foot problems. You have to watch out for manufacturers defects in shoes : )

LEARNING OPPORTUNITY THIS WEDNESDAY NIGHT, MAY 15TH

Biomechanics 308
online.com 5 PST, 6 MST, & CST, 8 EST

#gait #thegaitguys #shoeproblem #manufacturersdefect#footproblem

https://vimeo.com/335772235

You might think your shoe is doing more to control motion of your foot than it is actually doing.

You might think your shoe is doing more to control motion of your foot than it is actually doing.

"The measurement of rearfoot kinematics by placing reflective markers on the shoe heel assumes its motion is identical to the foot’s motion."
The results of this study revealed that "calcaneal frontal plane ROM was significantly greater than neutral and support shoe heel ROM. Calcaneus ROM was also significantly greater than shoe heel ROM in the transverse and sagittal planes. No change in tibial transverse plane ROM was observed."

It is easy to underestimate the calcaneal ROM across all planes of motion. Motion is going to occur somewhere, hopefully you can help your client control the excessive ROMs that are occurring and causing their symptoms. But just do not think that a shoe is going to markedly help, it might, but let your interventions and your client's feedback on pain lead you.

Calcaneus range of motion underestimated by markers on running shoe heel.
Ryan S. Alcantara'Correspondence information about the author Ryan S. AlcantaraEmail the author Ryan S. Alcantara
, Matthieu B. Trudeau, Eric S. Rohr
Human Performance Laboratory, Brooks Running Company, 3400 Stone Way N, Suite 500, Seattle, WA 98103 United States

You are mostly likely not getting to your big toe at push-off if you are doing this.

You are mostly likely not getting to your big toe at push-off if you are doing this. Look at the shoe wear patterns in the photos below, they are not this runners, but another runner who also has a cross over gait. And, if you have a painful big toe, you will do it as well. Oh, and Head-over-foot related, yup. Read on . . .

Yes, the cross over gait. Yes, when you are into a cross over gait you are most certainly head over foot. And that is most likely not a good thing.

If you are not closer to stacking the hip over the knee, and knee over the foot (like in the photo "SUI" bib runner) you are not likely getting to much of your big toe at terminal stance loading, when you could be getting more power at push off.
Said another way, if you are attacking the ground with the feet closer together, as if you are running on a line (as in the photo) you are going to be more on the outside of the foot (note the lateral foot contact), show a similar wear/loading pattern as in these shoes, and hardly load the medial foot tripod effectively.
Go ahead, walk around your office or home right now . . . . with a very narrow step width and see how little you can load into the big toe-medial foot tripod (note how little effective glute engagement you get as well by the way. there is a reason why there is a limit to the effectiveness of a very narrow step width). Then, walk with a wider step width, note the easier more effective big toe-medial tripod loading, and, note the glutes come into play much more profoundly.
Thus, head over foot/cross over gait is foolish for effective gait. You have a big toe, don't you wish to use it ? One has to find that balance between an economical step width that still allows an effective toe off event in walking and running. A very narrow cross over-style gait does not afford us this.
So, should it be any surprise to any of us that someone with pain in the big toe or medial tripod complex will choose a narrow step width to avoid the painful loading ? No, no surprise there at all.
We have been writing about the cross over gait for 10 years, bringing little pieces of research to the forefront to prove our theories on it as the research presents itself. We first brought it to you with our 3 part video series here. Search our blog, type in "cross over gait" into the search box on the site www.thegaitguys.com and get a LARGE coffee before hand, you are going to be reading for several hours.

https://www.youtube.com/watch?v=LG-xLi2m5Rc
https://www.youtube.com/watch?v=WptxNrj2gCo
https://www.youtube.com/watch?v=oJ6ewQ8YUA

Symptomatic tendons.

A symptomatic tendon affects more than the local area it finds itself, it "affects the neuromuscular control on the involved side but not the non-involved side. The muscle–tendon unit on the tendinotic side exhibits a lowered temporal efficiency, which leads to altered CNS control. The altered CNS control is then expressed as an adapted muscle activation pattern in the lower leg". - Yu-Jen Chang and Kornelia Kulig

The rigid flat foot. Why an orthotic may not work well at all.

Just because the foot is flat (arch collapsed) does not mean you have a right to try and lift it !
This is a perfect example of a foot that is troubled. It is a rigid flat foot deformity. This acquired over a long period of time. Sometimes tibialis posterior insufficiency over time finally gives way to an incompetent tib posterior, with eventual arch gradual collapse into a pes planus flat deformity, and then time takes its effect to contracture and shorten tissue and arthritic change makes it permanent.
This arch will no longer lift, it is a rigid pes planus. IT will not tolerate an orthotic, SO DO NOT PRESCRIBE ONE ! Even a mild orthotic lift will feel like a golf ball under this arch.
And, to take this one step further, a rockered shoe is, in part, the right idea, but not when the foot does not sagittally toe off. This foot is permanently locked into a full limb external rotation because of hip arthritic change. The point is that his foot progression angle is 45 degrees++, and the rocker will not work if it cannot rocker in the sagittal plane.
This guy wanted an orthotic, and i would not give it to him, and you shouldn't either. He will wear it for 1 minute and throw it away.

Shawn Allen, the other gait guy

#gait, #anklerocker, #forefootrocker, #footprogression, #archcollapse

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Brief 4 part Patreon video series for subscribers.

4 brief discussions on proper pelvis and hip mechanics during skate skiing in a client with chronic peroneal tendinitis.
Last week we also put up a 70 minute lecture by Dr. Allen and 2 complex gait case breakdowns for our patrons.
If you want to go deeper, come join us.

https://www.patreon.com/thegaitguys

Sometimes you may need to put the cart before the horse...The knees, the glutes and reverse engineering ?

We have talked about looking at things “from the bottom” up in the past, so we can understand things like why the vastus medialis is an external rotator in closed chain as are the semi membranosis and tendinosis. Perhaps we need to think more about this traveling proximally, where the knee effects the glutes. We found this paper looking at women with patello femoral problems and gluteal inhibition. Prospective studies have not found gluteal weakness to be a risk factor for patello femoral problems, but perhaps it is the other way around and patello femoral problems are a risk factor for gluteal weakness? It makes sense, especially if you consider the vastus lateralis like we talk about here and here.

“We hypothesize that muscle inhibition is present in the gluteal muscles of females with PFP compared to healthy controls and it is associated with both decreased subjective function and longer duration of symptoms.”

Dr Ivo Waerlop, one of The Gait Guys

Glaviano NR, Bazett-Jones DM, Norte G. Gluteal muscle inhibition: Consequences of patellofemoral pain? Med Hypotheses. 2019 May;126:9-14. doi: 10.1016/j.mehy.2019.02.046. Epub 2019 Feb 27.

#gait #foot #patellofemoralpain #PFP #quadriceps #thegaitguys #glutes #gluteal muscles

The LAST word....on Lasts

The last (look inside the shoe on top of the shank) is the surface that the insole of the shoe lays on, where the sole and upper are attached).

Shoes are generally board lasted, slip lasted or combination lasted.

A board lasted shoe is very stiff and has a piece of cardboard or fiber overlying the shank and sole (sometimes the shank is incorporated into the midsole or last) . It can be effective for motion control (pronation) but can be uncomfortable for somebody who does not have this problem.

A slip lasted shoe is made like a slipper and is sewn up the middle. It allows great amounts of flexibility, which is better for people with more rigid feet.

A combination lasted shoe has a board lasted heel and slip lasted front portion, giving you the best of both worlds.

When evaluating a shoe, you want to look at the shape of the last (or sole). Bisecting the heel and drawing an imaginary line along the sole of the shoe determines the last shape. This line should pass between the second and third metatarsal. Drawing this imaginary line, you are looking for equal amounts of shoe to be on either side of this line.

Shoes have a straight, curved or semi curved last. The original idea of a curved last (banana shaped shoe) was to help with pronation. A curved last puts more motion into the foot and may force the foot through mechanics that is not accustomed to. Most people should have a straighter lasted shoe.

The shape of a last will effect the biomechanics of the foot. It should match why shape of the foot as closely as possible. Generally speaking, we recommend straighter lasts for folks that have a tendency to overpronate through the midfoot and curvier lasts for folks that have a more rigid foot.

Because the fore foot abducts during mid stance, if the last is curved, the lateral aspect of the foot can rub against the side of the shoe and create blistering of the little toe and if present long enough, a tailors bunion. A general rule of thumb is: "when in doubt, opt for a straighter one"

Dr Ivo Waerlop, one of The Gait Guys

#last #gait #foot #thegaitguys #lastshape #curvedlast #straightlast #gaitanalysis #pronation

Unique adaptations to arm swing challenges: the one armed runner. Welcome to Luke Ericson, an amazing athlete, and man

Luke Ericson is tough as nails.

Human gait is cyclical. For the most part, when one limb is engaged on the ground (stance phase), the other is in swing phase. Before I continue, you should recall that there is a brief double limb support phase in walking gait, that which is absent in running gait. Also, I wish to remind you of our time hammered principle that when the foot is on the ground the glutes are heavily in charge, and when the foot is in the air, the abdominals are heavily in charge.  

For one to move cleanly and efficiently one would assume that the best way to do that would be to ensure that the lower 2 limbs are capable of doing the exact same things, with the same timing, same skill, same endurance and same strength. This goes for the upper 2 limbs as well, and then of course the synchronizing of the 4 in a cohesive effort. For this clean seamless motor function to occur, one must assume that there would be no injuries that had left a remnant mark on one limb thus encouraging a necessary compensation pattern in that limb (and one that would then have to be negotiated with the opposite limb as well as the contralateral upper or lower limb).  

Removing a considerable mass of tissue anywhere in the body is going to change the symmetry of the body and require compensations. One can clearly see the effects of this on this athletes body in the video above. He even eludes to the fact that he has a scoliosis, no surprise there.  There is such an unequal mass distribution that there is little way the spine had any chance to remain straight.  Not only is this going to change symmetry from a static postural perspective (bulk, weight, fascial plane changes, strength etc) but it will change dynamic postural control, mobility and stability as well as dynamic spinal kinematics.  I have talked about this previously in a blog piece I wrote on post-mastectomy clients display changes in spatiotemporal gait parameter such as step length and gait velocity.

-mastectomy post: http://tmblr.co/ZrRYjx1XB8RhO

If you have been with The Gait Guys for awhile you will know that impairing an arm swing will show altered biomechanics in the opposite lower limb (and furthermore, if you alter one lower limb, you begin a process of altering the biomechanical function and rhythmicity of the opposite leg as well.) You can search the blog for “arm swing part 1 and part 2″ for those dialogues.

Arm swing impairment is a real issue and it is one that is typically far overlooked and misrepresented. The intrinsic effects of altering the body through subtraction of tissue are not all that dissimilar to extrinsic changes into the system from things like  walking with a handbag/briefcase, walking with a shoulder bag, walking and running with an ipod or water bottle in one hand. And do not forget other intrinsic problems that affect spinal symmetry, for example consider the changes on the system from scoliosis as in this case.  It can cycle back on its own feedback loop into the system, either consciously or unconsciously altering arm swing and thus global body kinematics.  

There is a reason that in our practices we often assess and treat contralateral upper and lower limbs as well as to address remnants from old injuries whether they are symptomatic or not. It all comes together for the organism as a concerted effort in optimal locomotion.

Here on TGG, and in dialogues with Ivo on our podcast, I have long talked about phasic and anti-phasic motions of the arms and shoulder-pelvic blocks during gait and locomotion/sport activity.  I have written several times about the effects of spine pain and how spine pain clients reduce the anti-phasic rotational (axial) nature of the shoulder girdle and pelvic girdle. In the video above, you can see anything but anti-phasic gait, to be clear, this is a classic representation of a phasic gait. The shoulder block and the pelvic block show little if any counter rotation, they are linked together which is not normal gait. Furthermore, if you look carefully, the timing of the right arm swing is variable and cyclically changing in its timing with the left leg. Look carefully, you will see the cyclical success and failure at the beginning of the video.  This is pathologic gait, he must be constantly fighting frontal plane sway because there is no axial anti-phasic motion. He is also constantly fighting the unidirectional rotation that the absence of an entire limb and limb girdle is presenting, you can see him struggle with this if you have looked at enough gait samplings. There is essentially frozen torso movements.  Want to see more of our work on arm swing ? search the gait guys blog.

There is so much more here to discuss, so I will likely return to this video another time to delve into those other things on my mind. Luke is an amazing athlete, he gets much respect from me.

I hope this dialogue helps you to get a deeper grip on gait and gait problems. I have written many articles on the topics of arm swing, phasic and anti-phasic gait, central pattern generators. The are all archived here on the blog. I try to write a new original thought-process article each week for the blog amongst the other “aggregator” type stuff we share from other folks social media. My weekly article serves to go deeper into things, sometimes they are well referenced and in this case, I am basing today’s discussion on the referenced work in the other pieces I have written on arm swing, phasic and anti-phasic gait, central pattern generators etc. So please do your readings there before we begin debate or dialogue, which i always welcome !

Dr. Shawn Allen, the other gait guy

Is your (or your athletes) cleat neutral or in varus?

Cleats are often the athletes primary interface with the ground and are responsible for transmitting the forces from the core and appendicular muscles down to the ground. The construction of the cleat as well as its characteristics (such as a forefoot varus cant in the forefoot, like this one here) can make all the difference in the world in athletic performance.

Dr Ivo Waerlop, one of The Gait Guys

#gait #thegaitguys #forefoot #varus #valgus #gaitanalysis #cleatproblems #cleatconstruction

PRP, platelet-rich plasma for patellar tendinopathy: No more effective than saline (in this first study).

"Combined with an exercise-based rehabilitation program, a single injection of LR-PRP or LP-PRP was no more effective than saline for the improvement of patellar tendinopathy symptoms.:"

*this is the First randomized controlled trial comparing PRP (platelet-rich plasma) injection to saline, for patellar tendinopathy.

Platelet-Rich Plasma for Patellar Tendinopathy: A Randomized Controlled Trial of Leukocyte-Rich PRP or Leukocyte-Poor PRP Versus Saline

Alex Scott, PhD*, Robert F. LaPrade, MD, PhD, Kimberly G. Harmon, MD,

Link: https://journals.sagepub.com/doi/abs/10.1177/0363546519837954?journalCode=ajsb&fbclid=IwAR2p8pj3cugbIafBLaUj8zoaKm3hHyBfIIw6m3rBfDVgBDVKBj73s4jaK30

The problems with some cleats....

Spring is here and Dr Ivo Waerlop of The Gait Guys talks about some common problems seen due to manufacturers defects in cleats and how they can affect athletes. From uppers put on the outsole incorrectly and contributing to and potentiating rearfoot varus and valgus to poor cleat placement affecting the 1st mtp mechanics; they all contribute to athlete performance.