https://www.thegaitguys.com/thedailyblog daily 1.0 2021-04-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473602305872-GYWL17ACB0M43OOP9Q7N/dreamstimesmall_20549263.jpg Blog https://www.thegaitguys.com/thedailyblog/2021/4/3/podcast-167-foot-muscles-core-strength-and-more monthly 0.5 2021-04-03 https://www.thegaitguys.com/thedailyblog/2021/3/29/genu-varum-maybe monthly 0.5 2021-03-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615144993395-4R02LQ9T2FQN7PDJSHHO/Screen+Shot+2021-03-07+at+1.22.33+PM.png Blog - Genu varum ? Maybe https://www.thegaitguys.com/thedailyblog/2021/3/28/a-case-of-chronic-hip-pain- monthly 0.5 2021-03-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615144826846-MNGX86MGX0D6AL66BQ0E/Screen+Shot+2021-03-07+at+1.19.20+PM.png Blog - A case of chronic hip pain. ? https://www.thegaitguys.com/thedailyblog/2021/3/28/podcast-168-gait-speed-hip-extension-and-a-new-dawn monthly 0.5 2021-03-28 https://www.thegaitguys.com/thedailyblog/2021/3/27/why-does-it-feel-so-good-to-stretch monthly 0.5 2021-03-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615143718935-0O4BK2MUDV8NQUT931PE/Screen+Shot+2021-03-07+at+1.00.50+PM.png Blog - Why does it feel so good to stretch? https://www.thegaitguys.com/thedailyblog/2021/3/26/metatarsus-adductus monthly 0.5 2021-03-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615143965569-CESWQB5SZA1O75Z49UG6/Screen+Shot+2021-03-07+at+1.05.27+PM.png Blog - metatarsus adductus https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615143985235-ZP8ZUEK8XD7QVWU3J7NQ/Screen+Shot+2021-03-07+at+1.05.34+PM.png Blog - metatarsus adductus https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615144224029-3Z4Q1GL6VYC50AWDAAAW/Screen+Shot+2021-03-07+at+1.09.04+PM.png Blog - metatarsus adductus https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615144174645-XTRN5G3YB21VGTCN59PI/Screen+Shot+2021-03-07+at+1.08.52+PM.png Blog - metatarsus adductus https://www.thegaitguys.com/thedailyblog/2021/3/25/making-your-stretching-more-effective monthly 0.5 2021-03-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615143189503-W9ZJUE8L26FOX4OQG477/Screen+Shot+2021-03-07+at+12.52.37+PM.png Blog - Making your stretching more effective https://www.thegaitguys.com/thedailyblog/2021/3/23/more-stetching-tricks monthly 0.5 2021-03-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615142843454-M4CTH59P3NDEH7RB4JON/Screen+Shot+2021-03-07+at+12.46.52+PM.png Blog - More stetching tricks https://www.thegaitguys.com/thedailyblog/2021/3/22/more-on-stretching monthly 0.5 2021-03-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615142766888-NS09YG93SSOAUV74A4VT/Screen+Shot+2021-03-07+at+12.45.36+PM.png Blog - More on stretching. https://www.thegaitguys.com/thedailyblog/2021/3/21/want-more-stability-when-trail-running-through-snow-try-this-snow-running monthly 0.5 2021-03-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615142229192-BKPWVVJMHNGLA2JSYC7P/Screen+Shot+2021-03-07+at+12.36.46+PM.png Blog - Want more stability when trail running (through snow)? Try this… snow running https://www.thegaitguys.com/thedailyblog/2021/3/19/more-tibial-torsion-a-change-in-progression-angle monthly 0.5 2021-03-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615141836962-P8OP0B4Y6LMRRJDHAU7F/Screen+Shot+2021-03-07+at+12.29.57+PM.png Blog - more tibial torsion = a change in progression angle. https://www.thegaitguys.com/thedailyblog/2021/3/18/-lateral-knee-pain-in-a-nordic-skier monthly 0.5 2021-03-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615142098567-RUZJ75DH8Q2SGDH36EOV/Screen+Shot+2021-03-07+at+12.33.44+PM.png Blog - -Lateral knee pain in a Nordic skier https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615142081385-NA9YW01500SRU7EJPX6L/Screen+Shot+2021-03-07+at+12.33.36+PM.png Blog - -Lateral knee pain in a Nordic skier https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615142062960-LIM5E1231XBIUWTV2KF6/Screen+Shot+2021-03-07+at+12.33.28+PM.png Blog - -Lateral knee pain in a Nordic skier https://www.thegaitguys.com/thedailyblog/2021/3/18/snow-pedographs-part-2 monthly 0.5 2021-03-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615141598403-M6JHHAXJSWTZ4PSGPWSB/Screen+Shot+2021-03-07+at+12.26.22+PM.png Blog - Snow pedographs: part 2 https://www.thegaitguys.com/thedailyblog/2021/3/16/foot-progression-snow-pedographs monthly 0.5 2021-03-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615141498842-ZBEZ8KK0TIR0LNQ6LW0G/Screen+Shot+2021-03-07+at+12.24.37+PM.png Blog - Foot progression: snow pedographs https://www.thegaitguys.com/thedailyblog/2021/3/15/increased-proprioception monthly 0.5 2021-03-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615141387406-RBWU8CJO0PQZHCUVC8LQ/Screen+Shot+2021-03-07+at+12.22.52+PM.png Blog - Increased Proprioception https://www.thegaitguys.com/thedailyblog/2021/3/13/the-valgus-orthotic-posting monthly 0.5 2021-03-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615141051830-U98GI0CVX9UYNLUCTIJL/Screen+Shot+2021-03-07+at+12.16.04+PM.png Blog - The valgus orthotic posting https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615141018473-1GFV88BFQIQDRDUA6T85/Screen+Shot+2021-03-07+at+12.16.20+PM.png Blog - The valgus orthotic posting https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615141037798-3HVAQZADWVTSCCC63B3A/Screen+Shot+2021-03-07+at+12.16.11+PM.png Blog - The valgus orthotic posting https://www.thegaitguys.com/thedailyblog/2021/3/11/can-you-guess-why-she-has-knee-pain monthly 0.5 2021-03-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615140643297-VLZHTFBCNUO770R857M3/Screen+Shot+2021-03-07+at+12.10.14+PM.png Blog - Can you guess why she has knee pain? https://www.thegaitguys.com/thedailyblog/2021/3/9/knee-pain-when-skiing- monthly 0.5 2021-03-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615140305244-USH7R4IHILXK89T7NA4U/Screen+Shot+2021-03-07+at+12.04.08+PM.png Blog - Knee pain when skiing ? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615140321852-D6BTAJYBA3FO1CYTWYJF/Screen+Shot+2021-03-07+at+12.04.16+PM.png Blog - Knee pain when skiing ? https://www.thegaitguys.com/thedailyblog/2021/3/8/can-you-guess-why-this-patient-has-lateral-heel-pain monthly 0.5 2021-03-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615139345983-UQW45K6CH8M01HJGPPXA/Screen+Shot+2021-03-07+at+11.47.07+AM.png Blog - Can you guess why this patient has lateral heel pain? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615139289924-EUHLQGANHS5KZKOKK6E9/Screen+Shot+2021-03-07+at+11.47.29+AM.png Blog - Can you guess why this patient has lateral heel pain? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615139306245-WUT3S22WP1UJTKE7Z9XL/Screen+Shot+2021-03-07+at+11.47.23+AM.png Blog - Can you guess why this patient has lateral heel pain? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615139324700-5IUEN6ZKK01YFHU3VZZB/Screen+Shot+2021-03-07+at+11.47.16+AM.png Blog - Can you guess why this patient has lateral heel pain? https://www.thegaitguys.com/thedailyblog/2021/3/7/why-is-that-muscle-so-tight monthly 0.5 2021-03-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615143805355-3Y4YT9D24TK9ZKI7GOA4/Screen+Shot+2021-03-07+at+1.02.48+PM.png Blog - Why is that muscle so tight? https://www.thegaitguys.com/thedailyblog/2021/3/7/stretching-secrets-part-2 monthly 0.5 2021-03-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615139833862-SRZ91OG39ODXQURU10EZ/Screen+Shot+2021-03-07+at+11.53.38+AM.png Blog - Stretching secrets, part 2 https://www.thegaitguys.com/thedailyblog/2021/3/7/stretching-secrets monthly 0.5 2021-03-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615139668821-NN9QAEVSC5PEZ6HUCRWA/Screen+Shot+2021-03-07+at+11.53.38+AM.png Blog - Stretching secrets. https://www.thegaitguys.com/thedailyblog/2021/3/7/anterior-shoulder-pain-a-case monthly 0.5 2021-03-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615139082952-EOEX455YQUYOVXXO3LYP/Screen+Shot+2021-03-07+at+11.43.31+AM.png Blog - Anterior shoulder pain. A case https://www.thegaitguys.com/thedailyblog/2021/3/7/left-micro-fracture-and-meniscal-repair-in-a-patient-with-lateral-knee-pain monthly 0.5 2021-03-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615128829904-ZKFXO7A3AQ55IMHRVNE8/Screen+Shot+2021-03-07+at+8.50.18+AM.png Blog - Left micro fracture and meniscal repair in a patient with lateral knee pain https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615128736669-3J24KAVPE26K7W4RSRHM/Screen+Shot+2021-03-07+at+8.50.48+AM.png Blog - Left micro fracture and meniscal repair in a patient with lateral knee pain https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615128805775-2QJDTQ5JKHOGUJ4TA00Z/Screen+Shot+2021-03-07+at+8.50.26+AM.png Blog - Left micro fracture and meniscal repair in a patient with lateral knee pain https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615128763323-UB6B0GJMJ5VQV09JMUV1/Screen+Shot+2021-03-07+at+8.50.41+AM.png Blog - Left micro fracture and meniscal repair in a patient with lateral knee pain https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1615128784964-TGXIVRL6D1P4MSJZ4L0S/Screen+Shot+2021-03-07+at+8.50.34+AM.png Blog - Left micro fracture and meniscal repair in a patient with lateral knee pain https://www.thegaitguys.com/thedailyblog/2020/12/24/podcast-167-is-symmetry-important-for-biomechanics-and-energy-utilization monthly 0.5 2020-12-24 https://www.thegaitguys.com/thedailyblog/2020/12/11/podcast-166-senile-degeneration-of-afferent-mechanoreceptors monthly 0.5 2020-12-11 https://www.thegaitguys.com/thedailyblog/2020/12/3/ghs-generalized-hypermobility-syndrome monthly 0.5 2020-12-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1607009978236-46BIGUXXGGEB7295TWAF/Screen+Shot+2020-12-03+at+9.37.08+AM.png Blog - GHS: Generalized Hypermobility Syndrome https://www.thegaitguys.com/thedailyblog/2020/11/30/the-loads-are-going-to-go-somewhere monthly 0.5 2020-11-30 https://www.thegaitguys.com/thedailyblog/2020/11/27/fatigue-matters-why-a-quick-treadmill-analysis-of-someones-gait-will-lie-to-you monthly 0.5 2020-11-27 https://www.thegaitguys.com/thedailyblog/2020/11/25/we-often-say-that-arm-swing-should-not-be-coached-early-on monthly 0.5 2020-11-25 https://www.thegaitguys.com/thedailyblog/2020/11/24/what-do-the-hip-flexors-have-to-do-with-the-knee-extensors- monthly 0.5 2020-11-24 https://www.thegaitguys.com/thedailyblog/2020/11/18/why-are-you-putting-your-internal-hip-rotation-into-your-low-back-pain monthly 0.5 2020-11-18 https://www.thegaitguys.com/thedailyblog/2020/11/18/sacroiliac-joint-dysfunction-and-asymmetrical-gait monthly 0.5 2020-11-18 https://www.thegaitguys.com/thedailyblog/2020/11/16/is-there-a-linkage-between-the-toes-and-ankle-range-of-motion-yes monthly 0.5 2020-11-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1605537105427-5I2JABWUD1VV4LZD1EGW/Screen+Shot+2020-11-16+at+8.31.16+AM.png Blog - Is there a linkage between the toes and ankle range of motion ? Yes. https://www.thegaitguys.com/thedailyblog/2020/11/15/leg-exercise-is-critical-to-brain-and-nervous-system-health-clues-into-why-motorneuron-diseases-decline-so-quickly monthly 0.5 2020-11-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1605450221939-QJXC8ESUKXBBPAZQ17DL/Screen+Shot+2020-11-15+at+8.23.09+AM.png Blog - Leg exercise is critical to brain and nervous system health: Clues into why motorneuron diseases decline so quickly. https://www.thegaitguys.com/thedailyblog/2020/11/14/how-you-load-and-off-load-your-forefoot-bipod-matters monthly 0.5 2020-11-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1605365163168-01SYR4GLZUR2YW86IFHT/Screen+Shot+2020-11-14+at+8.45.37+AM.png Blog - How you load and off-load your forefoot bipod matters. https://www.thegaitguys.com/thedailyblog/2020/11/1/podcast-165-chronic-ankle-problems-a-long-form-discussion-on-functional-neurology-and-biomechanics monthly 0.5 2020-11-02 https://www.thegaitguys.com/thedailyblog/2020/10/13/hallux-limitus-anyone monthly 0.5 2020-10-13 https://www.thegaitguys.com/thedailyblog/2020/9/30/toe-walking monthly 0.5 2020-09-30 https://www.thegaitguys.com/thedailyblog/2020/9/30/bilateral-femoral-retro-torsion monthly 0.5 2020-09-30 https://www.thegaitguys.com/thedailyblog/2020/9/30/flip-flops monthly 0.5 2020-09-30 https://www.thegaitguys.com/thedailyblog/2020/9/30/leg-length-discrepancy monthly 0.5 2020-09-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1601490107512-RVF10JVBEV5W5EV1SUT4/IMG_8565.jpg Blog - Leg length discrepancy https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1601490037562-QECLCVZ43EPFSUKQQYJ3/IMG_8563.jpg Blog - Leg length discrepancy https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1601490066097-32LPUDRPZN4TUWGBX3HY/IMG_8564.jpg Blog - Leg length discrepancy https://www.thegaitguys.com/thedailyblog/2020/9/30/curly-toes monthly 0.5 2020-09-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1601489569391-UVHQB50VCKN0ATMLR1WQ/IMG_8467+%281%29.jpg Blog - Curly toes? https://www.thegaitguys.com/thedailyblog/2020/9/30/can-you-say-forefoot-adductus-1 monthly 0.5 2020-09-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1601484463629-YLPBAMN2VVXEWQWUNRXV/IMG_8466.jpg Blog - Can you say Forefoot Adductus? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1601484558190-P17SC8MDFKT4M31HG6U8/IMG_8468.jpg Blog - Can you say Forefoot Adductus? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1601484611449-9XZT390EHTVVKUII5OPT/IMG_8467.jpg Blog - Can you say Forefoot Adductus? https://www.thegaitguys.com/thedailyblog/2020/9/30/the-glute-max-does-that monthly 0.5 2020-09-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1601482255781-NFHFQFKLZO5HSFBF2ON3/8.24.20.png Blog - The Glute Max does that? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1601482338517-2Y4BBLSAWZY3TILE0PIY/8.24.20+2.png Blog - The Glute Max does that? https://www.thegaitguys.com/thedailyblog/2020/8/15/podcast-164nbsp-foot-placement-challenges-vestibular-issues-amp-spatial-orientation monthly 0.5 2020-08-16 https://www.thegaitguys.com/thedailyblog/2020/8/13/the-unhappy-triad monthly 0.5 2020-08-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1597361557835-GJUX7840Q8CKBV9PBUEV/IMG_8305.jpg Blog - The unhappy triad https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1597361536680-QL35XTMI20E13CMSA91W/IMG_8306.jpg Blog - The unhappy triad https://www.thegaitguys.com/thedailyblog/2020/8/13/what-happens-when-a-ganglionectomy-goes-south monthly 0.5 2020-08-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1597359047588-FNWQLUFOAZL5RDVHGATQ/22625D64-2E36-43DB-AA5E-27E3220B7DDB.JPG Blog - What happens when a ganglionectomy goes south https://www.thegaitguys.com/thedailyblog/2020/8/13/parkinsons-and-gait monthly 0.5 2020-08-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1597358865799-NMS4387KI4ELYX6YIY3V/unnamed.jpg Blog - Parkinson's and Gait https://www.thegaitguys.com/thedailyblog/2020/8/12/stretching-part-2 monthly 0.5 2020-08-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1597250268801-YB0DK9ZE6XYW5061A8SZ/Screen+Shot+2020-07-30+at+10.18.23+AM.png Blog - Stretching part 2 https://www.thegaitguys.com/thedailyblog/2020/8/12/stretching-part-1 monthly 0.5 2020-08-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1597249908707-Z0GSNL4L2E1V9NMLNZYK/Screen+Shot+2020-07-30+at+10.17.35+AM.png Blog - Stretching part 1 https://www.thegaitguys.com/thedailyblog/2020/8/12/hills-for-training monthly 0.5 2020-08-12 https://www.thegaitguys.com/thedailyblog/2020/8/2/podcast-163-the-hip-and-foot-talk-to-each-other-a-research-paper monthly 0.5 2020-08-02 https://www.thegaitguys.com/thedailyblog/2020/7/27/podcast-162-climbing-and-gait monthly 0.5 2020-07-27 https://www.thegaitguys.com/thedailyblog/2020/7/15/malleolar-fracture monthly 0.5 2020-07-15 https://www.thegaitguys.com/thedailyblog/2020/7/15/callouses-happen monthly 0.5 2020-07-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1594818871065-SKH0FJI7OIDG74GLXS53/IMG_8149.jpg Blog - Callouses Happen https://www.thegaitguys.com/thedailyblog/2020/7/1/what-does-progressive-weakness-of-the-posterior-compartment-look-like monthly 0.5 2020-07-01 https://www.thegaitguys.com/thedailyblog/2020/7/1/valgus-posts monthly 0.5 2020-07-01 https://www.thegaitguys.com/thedailyblog/2020/6/29/is-there-a-need-for-gait-retrainingwe-think-so monthly 0.5 2020-06-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1593455417825-QEOZCG24A3U2PGWM3113/Screen+Shot+2020-06-26+at+8.05.45+PM.png Blog - Is there a need for "Gait Retraining'?...We think so https://www.thegaitguys.com/thedailyblog/2020/6/24/cortical-repatterning monthly 0.5 2020-07-01 https://www.thegaitguys.com/thedailyblog/2020/6/24/a-simple-test-for-motor-programming monthly 0.5 2020-06-24 https://www.thegaitguys.com/thedailyblog/2020/6/21/central-pattern-generators-why-and-how-movement-goes-bad monthly 0.5 2020-06-21 https://www.thegaitguys.com/thedailyblog/2020/6/18/calf-size-matters-1 monthly 0.5 2020-06-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1592507128515-MK5I96EA1DY5L8F1LHHU/Screen+Shot+2020-06-18+at+8.25.41+AM.png Blog - Calf Size Matters https://www.thegaitguys.com/thedailyblog/2020/6/17/the-calcaneo-cuboid-locking-mechanism monthly 0.5 2020-06-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1592405231645-HRW67G33XQLOWW4SIOFB/Screen+Shot+2020-06-16+at+11.55.03+AM.PNG Blog - The Calcaneo Cuboid Locking Mechanism https://www.thegaitguys.com/thedailyblog/2020/6/17/appropriate-placement-of-metatarsal-pads monthly 0.5 2020-06-17 https://www.thegaitguys.com/thedailyblog/2020/6/11/bb0c3nvrybe0xm19id31t1y6lurpin monthly 0.5 2020-06-12 https://www.thegaitguys.com/thedailyblog/2020/6/10/the-gluteus-medius-and-low-back-pain monthly 0.5 2020-06-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1591801918618-GOSPLGWZGIQG84KIFDM4/Screenshot+%289%29.png Blog - The gluteus medius and low back pain https://www.thegaitguys.com/thedailyblog/2020/6/10/part-2-isometric-force monthly 0.5 2020-06-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1591801319340-K0PSVRTVL7ANT8CPNZJZ/Screenshot+%287%29.png Blog - Part 2 Isometric Force https://www.thegaitguys.com/thedailyblog/2020/6/10/part-1-isomentric-force monthly 0.5 2020-06-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1591801102715-ISFFR4WEQCQOO3J1JZBG/Screenshot+%285%29.png Blog - Part 1 Isomentric Force https://www.thegaitguys.com/thedailyblog/2020/6/10/awareness-is-key monthly 0.5 2020-06-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1591800321666-D574W4CGVDKE1ZO34C72/Screenshot+%283%29.png Blog - Awareness is key https://www.thegaitguys.com/thedailyblog/2020/6/10/one-cause-of-hammertoes monthly 0.5 2020-06-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1591798174239-45QL9O8BK2I10JMVTON8/IMG_8055.jpg Blog - One cause of hammertoes https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1591798136196-RZE93WYGGECZUITTPMK5/IMG_8054.jpg Blog - One cause of hammertoes https://www.thegaitguys.com/thedailyblog/2020/6/9/whats-wrong-with-the-big-toe-on-the-right monthly 0.5 2020-06-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1591714262764-Z0F4NBJ84UO25NDW68FB/IMG_8039.jpg Blog - What's wrong with the big toe on the right? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1591714290807-U4BOAGPWMU7G9OPS7FYN/IMG_8040.jpg Blog - What's wrong with the big toe on the right? https://www.thegaitguys.com/thedailyblog/2020/4/26/podcast-160-masterclass-in-gait-2-vimeo-q-amp-a-podcast monthly 0.5 2020-04-27 https://www.thegaitguys.com/thedailyblog/2020/4/26/podcast-159-accelerating-body-mass-foot-intrinsic-thickness-adhd-gait-and-more- monthly 0.5 2020-04-27 https://www.thegaitguys.com/thedailyblog/2020/3/24/gait-and-covid-19-motor-learning-shoes-and-injuries monthly 0.5 2020-03-24 https://www.thegaitguys.com/thedailyblog/2020/2/29/gait-ataxia-foot-strength-amp-glute-medius-tears monthly 0.5 2020-03-01 https://www.thegaitguys.com/thedailyblog/2020/2/12/podcast-156-round-2-coach-mike-lucchesi-olympic-trials-2020-atlanta monthly 0.5 2020-02-12 https://www.thegaitguys.com/thedailyblog/2020/2/12/mini-podcast-155-biomechanics-amp-shoe-foam-with-coach-mike-lucchesi monthly 0.5 2020-02-12 https://www.thegaitguys.com/thedailyblog/2020/2/4/masterclass-in-gait-part-zero-the-gait-guys-way monthly 0.5 2020-02-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1580824675915-6I7CP3S0E1AP3U8GSM0F/Screen+Shot+2020-02-04+at+7.57.30+AM.png Blog - MasterClass in Gait: Part Zero: The Gait Guys Way https://www.thegaitguys.com/thedailyblog/2020/1/26/podcast-154-a-farewell-to-the-king-knee-fences-and-durability monthly 0.5 2020-01-26 https://www.thegaitguys.com/thedailyblog/2020/1/17/the-funny-problem-with-the-stairs-at-brooklyns-36th-street-subway-why-we-trip monthly 0.5 2020-01-17 https://www.thegaitguys.com/thedailyblog/2020/1/12/153-the-podcast-reboot-a-deep-dive-on-knee-mechanics-loading-and-running monthly 0.5 2020-01-12 https://www.thegaitguys.com/thedailyblog/2019/1/31/the-future-of-ai-and-gait monthly 0.5 2020-01-02 https://www.thegaitguys.com/thedailyblog/2019/12/30/2019-comes-to-a-close-and-here-is-what-we-want-to-share monthly 0.5 2019-12-31 https://www.thegaitguys.com/thedailyblog/2019/12/30/internal-tibial-torsion-femoral-retrotorsion-twisting-low-back-pain monthly 0.5 2019-12-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1577728646419-O4AC0ZTEWFEEDCR4TMBC/IMG_7019.jpg Blog - Internal tibial torsion + femoral retrotorsion + twisting = low back pain note the internal tibial torsion and lack of internal rotation of the right hip secondary to femoral retroversion https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1577728711415-3OS75P80PB0JZTSTQ4I1/IMG_7020.jpg Blog - Internal tibial torsion + femoral retrotorsion + twisting = low back pain internal rotation of less than 0 on the left hip https://www.thegaitguys.com/thedailyblog/2019/12/23/the-case-of-the-lateral-thigh-leg-and-knee-pain monthly 0.5 2019-12-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1577126360703-VUJJ9RDFBKQYVCFPMDTN/image-asset.jpeg Blog - The case of the lateral thigh, leg and knee pain note how the bottom of the heel cup is rounded https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1577126392362-GYDPNV74WLHCTFXV9ZBF/IMG_7238.jpg Blog - The case of the lateral thigh, leg and knee pain https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1577126426109-C6GF5E5R6C60M9LO9YQK/image-asset.jpeg Blog - The case of the lateral thigh, leg and knee pain https://www.thegaitguys.com/thedailyblog/2019/12/9/two-things-we-hope-you-see-right-away-when-viewing-this-video monthly 0.5 2019-12-10 https://www.thegaitguys.com/thedailyblog/2019/12/9/the-consequences-of-an-inverted-forefoot monthly 0.5 2019-12-09 https://www.thegaitguys.com/thedailyblog/2019/12/3/internal-tibial-torsion-puts-pressure-on-the-outside-of-the-foot monthly 0.5 2019-12-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1575420552906-UU3IIFCM3LB17EV1559B/IMG_7174.jpg Blog - Internal tibial torsion puts pressure on the outside of the foot https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1575420568103-PXIYB2STZC80G67UMMEV/IMG_7175.jpg Blog - Internal tibial torsion puts pressure on the outside of the foot https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1575420584888-B04WFXU87T3GILA9EHZE/IMG_7176.jpg Blog - Internal tibial torsion puts pressure on the outside of the foot https://www.thegaitguys.com/thedailyblog/2019/11/19/unilateral-increased-tibial-varum-one-reason-why monthly 0.5 2019-11-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1574196230799-YS64Q8FVRZ6GOFITYECE/image-asset.jpeg Blog - Unilateral increased tibial varum; one reason why... https://www.thegaitguys.com/thedailyblog/2019/11/18/a-novel-way-to-look-at-functional-internal-rotation-of-the-hips monthly 0.5 2019-11-18 https://www.thegaitguys.com/thedailyblog/2019/11/6/the-hip-airplane monthly 0.5 2019-11-06 https://www.thegaitguys.com/thedailyblog/2019/11/5/the-hip-helicopter-exercise monthly 0.5 2019-11-05 https://www.thegaitguys.com/thedailyblog/2019/11/4/what-does-hip-drop-look-like monthly 0.5 2019-11-05 https://www.thegaitguys.com/thedailyblog/2019/11/1/the-banana-foot monthly 0.5 2019-11-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1572622386793-B0V2XJCUW4K9G3EFB7O1/IMG_7018.jpg Blog - The “ banana foot” https://www.thegaitguys.com/thedailyblog/2019/10/29/unilateral-calcaneal-valgus-what-can-it-mean monthly 0.5 2019-10-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1572378238167-4BSEZDTYUJVZ7C7LB90U/IMG_7025.jpg Blog - Unilateral calcaneal valgus: what can it mean? right calcaneal valgus https://www.thegaitguys.com/thedailyblog/2019/10/24/foot-types-do-they-really-matter monthly 0.5 2019-10-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1571926140270-AQ5S6GD78HGVLKVL3USK/IMG_6218+copy.jpg Blog - Foot Types? Do they really matter? https://www.thegaitguys.com/thedailyblog/2019/10/22/asymmetries-can-make-all-the-difference monthly 0.5 2019-10-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1571772893835-P59UZIVACSP2T9Z3F56M/image-asset.jpeg Blog - Asymmetries can make all the difference… https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1571772969804-DV95SCHS24MYMFUJSHFK/IMG_7024.jpg Blog - Asymmetries can make all the difference… https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1571772993938-AXBDVG7TKL311FB8RNVC/IMG_7023.jpg Blog - Asymmetries can make all the difference… https://www.thegaitguys.com/thedailyblog/2019/10/16/obligate-pathomechanics monthly 0.5 2019-10-16 https://www.thegaitguys.com/thedailyblog/2019/10/15/determining-foot-typesin-a-nutshell monthly 0.5 2019-10-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1571193536126-AMFB388K9IB3534072VZ/Screen+Shot+2019-10-15+at+8.31.27+PM.png Blog - Determining foot types...In a nutshell https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1571193522824-QD431YWBCPM9FV93DADA/image-asset.png Blog - Determining foot types...In a nutshell https://www.thegaitguys.com/thedailyblog/2019/10/14/foot-types-do-they-really-matter monthly 0.5 2019-10-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1571089192595-384LXVEJGFD3IIB82YTF/IMG_6736.jpg Blog - Foot types: do they really matter? forefoot varus: note how the forefoot is inverted with respect to the rear foot https://www.thegaitguys.com/thedailyblog/2019/10/9/3-clues-that-someone-has-internal-tibial-torsion monthly 0.5 2019-10-09 https://www.thegaitguys.com/thedailyblog/2019/9/27/podcast-152-michael-lucchesi-head-coach-second-city-track-club monthly 0.5 2019-09-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1569580388293-92P3I66EAWI9Z242JVTX/IMG_2446.JPG Blog - Podcast 152: Michael Lucchesi : Head Coach, Second City Track Club https://www.thegaitguys.com/thedailyblog/2019/9/17/the-effects-of-aging-on-the-proprioceptive-system monthly 0.5 2019-09-17 https://www.thegaitguys.com/thedailyblog/2019/9/16/when-the-nervous-system-breaks-down-gait-becomes-more-primitive monthly 0.5 2019-09-16 https://www.thegaitguys.com/thedailyblog/2019/9/12/what-a-difference-a-few-months-makes monthly 0.5 2019-09-12 https://www.thegaitguys.com/thedailyblog/2019/9/9/yep-these-shoes-stink-for-this-gal monthly 0.5 2019-09-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1568068268638-96LZHW2K7AJ8JIH30ZFC/IMG_6882.jpg Blog - Yep, these shoes stink for this gal... https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1568068304837-5G0FLCNK3ZXWT7CCUJG9/image-asset.jpeg Blog - Yep, these shoes stink for this gal... https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1568068315850-FSAJUXPLHHLZYCUITCBF/image-asset.jpeg Blog - Yep, these shoes stink for this gal... https://www.thegaitguys.com/thedailyblog/2019/9/8/podcast-151-gait-and-neurology-of-movement-including-tightness-shortness-whats-the-difference-its-the-neurology monthly 0.5 2019-09-09 https://www.thegaitguys.com/thedailyblog/2019/9/3/plantar-plate-gait monthly 0.5 2019-09-04 https://www.thegaitguys.com/thedailyblog/2019/8/20/external-tibial-torsion-and-lower-back-pain monthly 0.5 2019-08-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1566933867090-DG59YHIIWMEXMFAK81QW/tumblr_o471xcV05d1qhko2so1_1280.jpg Blog - External tibial torsion and lower back pain knees neutral, note external rotation of the right foot and decreased progression angle https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1566933915133-NR66TR46ZP53SQEWMDQM/tumblr_o471xcV05d1qhko2so4_1280.jpg Blog - External tibial torsion and lower back pain note when the foot is neutral, the knee points inward https://www.thegaitguys.com/thedailyblog/2019/8/19/sometimes-its-ok-for-toes-in-squats monthly 0.5 2019-08-26 https://www.thegaitguys.com/thedailyblog/2019/8/18/podcast-150-subtalar-joint-control-plus-heel-raise-effects-on-low-back-pain monthly 0.5 2019-08-18 https://www.thegaitguys.com/thedailyblog/2019/8/14/the-fudge-factor monthly 0.5 2019-08-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1565829824728-2FM9ZT5ICLI20H64CK91/800px-Pieces_of_fudge_cut_from_a_slab%2C_April_2008_cropped.jpg Blog - The Fudge Factor image credit: https://commons.wikimedia.org/wiki/File:Pieces_of_fudge_cut_from_a_slab,_April_2008_cropped.jpg https://www.thegaitguys.com/thedailyblog/2019/7/31/xu21k30xsmocqm0ju5oxqmdy4j4abg monthly 0.5 2019-08-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1565052566993-URWWRYPC0KUS3LQ8110T/Plantar_aponeurosis_-_axial_view.png Blog - Botox for plantar fasciitis? Sounds like a bad idea to us.... image source: https://commons.wikimedia.org/wiki/File:Plantar_aponeurosis_-_axial_view.png https://www.thegaitguys.com/thedailyblog/2019/8/3/low-back-pain-and-asymmetry monthly 0.5 2019-08-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554649277475-894YWI6UI0U1WZV4EUZ5/Screen+Shot+2019-04-07+at+10.00.54+AM.png Blog - Low back pain and asymmetry. https://www.thegaitguys.com/thedailyblog/2019/7/30/incorporating-asymmetrical-tonic-neck-responses-into-your-rehab-program monthly 0.5 2019-07-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1564518526989-AUJRMBMBLW8TL7VTNKGS/tumblr_nfw1xxi7Yt1qhko2so1_250.jpg Blog - Incorporating asymmetrical tonic neck responses into your rehab program https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1564518565574-ZISUUEMN8EXYDCL947TP/tumblr_nfw1xxi7Yt1qhko2so2_540.png Blog - Incorporating asymmetrical tonic neck responses into your rehab program https://www.thegaitguys.com/thedailyblog/2019/7/29/when-you-see-this-you-should-be-thinking-one-of-3-possible-etiologies monthly 0.5 2019-07-30 https://www.thegaitguys.com/thedailyblog/2019/7/23/the-amazing-power-of-compensation-coming-to-a-patient-in-your-office-maybe-today monthly 0.5 2019-07-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563910337237-SXR9QDT7ZFFBVZOJKRE8/image-asset.jpeg Blog - The amazing power of compensation. Coming to a patient in your office… Maybe today https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563910358424-V9V7O3KZNHPGNO56STY3/IMG_6736.jpg Blog - The amazing power of compensation. Coming to a patient in your office… Maybe today https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563910372058-CK7MUDNGOE1FEPZ9H3E7/image-asset.jpeg Blog - The amazing power of compensation. Coming to a patient in your office… Maybe today https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563910399127-7WW1TY6ZUOAWVLBM0UQK/IMG_6740.jpg Blog - The amazing power of compensation. Coming to a patient in your office… Maybe today https://www.thegaitguys.com/thedailyblog/2019/7/22/external-tibial-torsion-or-femoral-retrotorsion monthly 0.5 2019-07-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563817575281-PBXK7QHR91L24CCTO1L3/IMG_6727.JPG Blog - External tibial torsion or femoral retrotorsion? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563817658975-PTKY9NFVKYG2AP6METCY/IMG_6759.jpg Blog - External tibial torsion or femoral retrotorsion? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563817696395-Q4OB6VL183MHIIKQC6AG/IMG_6726.jpg Blog - External tibial torsion or femoral retrotorsion? https://www.thegaitguys.com/thedailyblog/2019/7/16/when-the-big-toes-headeast-whats-the-deal monthly 0.5 2019-07-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563305435253-J4F7TCPS5DVUJMVDK44H/IMG_6721.JPG Blog - When the big toes head...East? Whats the deal? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563305462652-QN2KR7T6S3C1I8SMKMUK/IMG_6722.JPG Blog - When the big toes head...East? Whats the deal? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563305501010-CKKJAHUOCAXHYGLIU57O/IMG_6727.JPG Blog - When the big toes head...East? Whats the deal? https://www.thegaitguys.com/thedailyblog/2019/7/15/sixth-toe-diseasethat-growth-on-the-outside-of-your-foot-or-on-somebodys-foot-is-coming-to-see-you monthly 0.5 2019-07-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563229010051-SQ8F7K5579GZG42QBW1I/IMG_6704.JPG Blog - Sixth toe disease...That growth on the outside of your foot… Or on somebody’s foot is coming to see you… https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563229075210-L4OCDX5ZOO4Y372TZREL/IMG_6706.JPG Blog - Sixth toe disease...That growth on the outside of your foot… Or on somebody’s foot is coming to see you… https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563229102089-ASXFICE3LM66HYIVXA74/IMG_6707.JPG Blog - Sixth toe disease...That growth on the outside of your foot… Or on somebody’s foot is coming to see you… https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1563229145299-4RA50106T2PI4TX9UB6T/IMG_6710.JPG Blog - Sixth toe disease...That growth on the outside of your foot… Or on somebody’s foot is coming to see you… https://www.thegaitguys.com/thedailyblog/2019/7/13/podcast-149-a-runners-podcast-many-things-running-and-biomechanics monthly 0.5 2019-07-13 https://www.thegaitguys.com/thedailyblog/2018/10/24/gracilis-not-ready-yet monthly 0.5 2019-07-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1562709103657-5OVSM9DJQQDJU2617JN3/800px-Slide3rrr.JPG Blog - The Gracilis: Have you considered it in your medial knee pain patients? image credit: https://en.wikipedia.org/wiki/File:Slide3rrr.JPG https://www.thegaitguys.com/thedailyblog/2019/7/8/the-top-6-reasons-we-like-hills-for-training-ankle-rocker-and-hip-extension monthly 0.5 2019-07-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1562610761196-G78X1NBUFKAL2144LVF3/Caer_Caradoc_hill.jpg Blog - The top 6 reasons we like hills for training ankle rocker and hip extension image source: https://commons.wikimedia.org/wiki/File:Caer_Caradoc_hill.jpg https://www.thegaitguys.com/thedailyblog/2019/7/5/bunions-should-change-how-you-approach-shoe-fit-bet-you-didnt-consider-this-aspect monthly 0.5 2019-07-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554648915617-SY1DP57B35GYVM49AUWW/Screen+Shot+2019-04-07+at+9.54.47+AM.png Blog - Bunions should change how you approach shoe fit. Bet you didn't consider this aspect. https://www.thegaitguys.com/thedailyblog/2019/7/4/ots-over-training-syndrome-do-you-have-any-of-these-symptoms-a-blog-post-amp-2-podcasts-for-you-on-the-topic monthly 0.5 2019-07-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1562166223368-WVECZRL76E18CMYTOBLX/Screen+Shot+2019-07-03+at+10.03.14+AM.png Blog - OTS: Over Training Syndrome. Do you have any of these symptoms ? A blog post &amp; 2 podcasts for you on the topic. photo: courtesy of pixabay.com https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1562165910965-22HS80NZEF2ZPWOWSFR1/Screen+Shot+2019-07-03+at+9.58.06+AM.png Blog - OTS: Over Training Syndrome. Do you have any of these symptoms ? A blog post &amp; 2 podcasts for you on the topic. https://www.thegaitguys.com/thedailyblog/2019/7/4/glute-medius-targeting-training-exercise monthly 0.5 2019-07-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1562241954401-S751BY1EOXCFESLK1WW1/Screen+Shot+2019-07-04+at+6.50.09+AM.png Blog - Glute medius targeting training exercise. https://www.thegaitguys.com/thedailyblog/2019/7/3/the-glutes-medius-is-playing-target-practice monthly 0.5 2019-07-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1562165135898-DEMEGBEQL74WVD653UUE/Screen+Shot+2019-07-03+at+9.36.06+AM.png Blog - The glutes medius is playing target practice. https://www.thegaitguys.com/thedailyblog/2019/7/2/holy-forefoot-flare-batman monthly 0.5 2019-07-02 https://www.thegaitguys.com/thedailyblog/2019/7/1/metatarsalgia-happens monthly 0.5 2019-07-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1562019620841-K57L4XYT2WZ4BDPYPHAK/tumblr_nfzfwqcZBr1qhko2so4_r1_400.jpg Blog - Metatarsalgia happens... image courtesy of Tom Michaud: with permission https://www.thegaitguys.com/thedailyblog/2019/6/27/hallux-amputation-what-would-you-expect-to-present-in-this-case- monthly 0.5 2019-06-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1555937280459-94XXWJPIPOB1LT01F121/Screen+Shot+2019-04-22+at+7.47.07+AM.png Blog - Hallux amputation. What would you expect to present in this case ? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1555937262191-XIZ0GSRIJLCNOFP8L6FW/Screen+Shot+2019-04-22+at+7.47.16+AM.png Blog - Hallux amputation. What would you expect to present in this case ? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1555937300285-F651NI3Q5JRJPGNODL4P/Screen+Shot+2019-04-22+at+7.46.55+AM.png Blog - Hallux amputation. What would you expect to present in this case ? https://www.thegaitguys.com/thedailyblog/2019/6/26/the-muscle-they-named-wrong monthly 0.5 2019-06-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1561585884384-NS1VZB9L8GB5RP5PJBL9/tumblr_nn1ca5fx0C1qhko2so1_r1_1280.jpg Blog - The muscle they named wrong? https://www.thegaitguys.com/thedailyblog/2019/6/25/sometimes-too-much-shoe-is-too-much monthly 0.5 2019-06-25 https://www.thegaitguys.com/thedailyblog/2019/6/24/some-more-really-subtle-thingshow-sharp-are-your-eyes monthly 0.5 2019-06-24 https://www.thegaitguys.com/thedailyblog/2019/6/20/walking-on-all-four-limbs-the-quad-walkers-uner-tan-syndrome monthly 0.5 2019-06-20 https://www.thegaitguys.com/thedailyblog/2019/6/17/the-short-foot-exercise monthly 0.5 2019-06-17 https://www.thegaitguys.com/thedailyblog/2019/6/14/podcast-148-a-deep-dive-case-study-plus-central-and-peripheral-fatigue-explained monthly 0.5 2019-06-14 https://www.thegaitguys.com/thedailyblog/2019/6/12/weve-told-you-once-and-we-will-tell-you-again monthly 0.5 2019-06-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1560364390028-R2R3LF8FUGAFPNASMDDY/image-asset.jpeg Blog - We’ve told you once and we will tell you again… https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1560364434986-QWZT28B8XOKVOZ4YHQUJ/IMG_6520.jpg Blog - We’ve told you once and we will tell you again… note the internal tibial torsion. drop a plumbline from the tibial tuberosity. it should pass through the 2nd met or between the 2nd and 3rd met shafts https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1560364487743-QYOXIO4AW4S8MAXNUY3E/IMG_6521.jpg Blog - We’ve told you once and we will tell you again… note the internal tibial torsion. drop a plumbline from the tibial tuberosity. it should pass through the 2nd met or between the 2nd and 3rd met shafts https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1560364736589-8T8JL8664QU8734FQUNW/IMG_6522.jpg Blog - We’ve told you once and we will tell you again… bisect the calcaneus. the line should fall though the 2nd metatarsal or between the 2nd and 3rd met shafts https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1560364799186-5JWH463XVRS8J2U1NRXE/image-asset.jpeg Blog - We’ve told you once and we will tell you again… bisect the calcaneus. the line should fall though the 2nd metatarsal or between the 2nd and 3rd met shafts https://www.thegaitguys.com/thedailyblog/2019/6/10/if-you-are-a-sprinter-how-you-load-the-forefoot-bipod-might-be-a-variable-for-speed-or-injury-tendons-can-change-their-cross-sectional-area-if-you-load-them monthly 0.5 2019-06-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1560208671314-0LN19CRBW96RZ91RQEY6/Screen+Shot+2019-06-10+at+6.17.21+PM.png Blog - If you are a sprinter, how you load the forefoot bipod might be a variable for speed or injury. Tendons can change their cross sectional area, if you load them. https://www.thegaitguys.com/thedailyblog/2019/6/10/holy-twisted-tibias-batman-what-is-going-here-in-this-r-sided-knee-pain-patient monthly 0.5 2019-06-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1560191567237-JOHH5ORIVCBY8WQMP7NJ/Screen+Shot+2019-06-10+at+12.28.38+PM.png Blog - Holy twisted tibias Batman! What is going here in this R sided knee pain patient? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1560191992585-F70R7L8FXKY9OW7ZY81L/Screen+Shot+2019-06-10+at+12.28.56+PM.png Blog - Holy twisted tibias Batman! What is going here in this R sided knee pain patient? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1560192025776-EGXCH2KVYDM1OT8YQFLD/Screen+Shot+2019-06-10+at+12.28.47+PM.png Blog - Holy twisted tibias Batman! What is going here in this R sided knee pain patient? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1560192043259-LMEPJ1E8TL3Z708N9I7N/Screen+Shot+2019-06-10+at+12.28.38+PM.png Blog - Holy twisted tibias Batman! What is going here in this R sided knee pain patient? https://www.thegaitguys.com/thedailyblog/2019/6/6/whole-body-coordination-patterns-may-become-partitioned-in-particular-ways-as-a-function-of-task-requirements monthly 0.5 2019-06-07 https://www.thegaitguys.com/thedailyblog/2019/6/4/ode-to-the-popliteus monthly 0.5 2019-06-04 https://www.thegaitguys.com/thedailyblog/2019/6/3/arm-swing-let-the-cns-drive-the-show monthly 0.5 2019-06-03 https://www.thegaitguys.com/thedailyblog/2019/5/28/tricks-of-the-trade-backward-walking monthly 0.5 2019-06-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1559564502805-TD95ZB3RXZLID45KLARI/slide-151861__340.png Blog - Tricks of the trade: Backward walking image credit: https://pixabay.com/vectors/slide-sliding-falling-stickman-151861/ https://www.thegaitguys.com/thedailyblog/2019/5/30/the-dodgy-foot-a-uk-runners-dilemma monthly 0.5 2019-05-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1558884263369-9TH7J51JHVD6RK02Y9YK/Screen+Shot+2019-05-05+at+9.45.42+AM.png Blog - The “Dodgy Foot”, a UK runner’s dilemma. https://www.thegaitguys.com/thedailyblog/2019/5/20/right-sided-knee-pain-in-a-cyclistdue-to-his-hip monthly 0.5 2019-05-30 https://www.thegaitguys.com/thedailyblog/2019/5/28/knee-hyperextension-or-does-this-photo-suggest-something-more- monthly 0.5 2019-05-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1558884126935-POE1WJYONYXOCA3AOYJR/Screen+Shot+2019-05-16+at+2.53.10+PM.png Blog - Knee hyperextension? Or does this photo suggest something more ? https://www.thegaitguys.com/thedailyblog/2019/5/27/normal-walking-and-running-have-a-certain-degree-of-vertical-oscillation-but-we-do-not-want-too-much monthly 0.5 2019-05-28 https://www.thegaitguys.com/thedailyblog/2019/5/26/a-sprinter-with-arch-pain-kohlers-avn-not-everything-is-always-mechanically-pain-driven monthly 0.5 2019-05-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1558883766319-55X6VCXZVCQ4G4FB6ZBI/IMG_1723.jpg Blog - A sprinter with arch pain. Kohlers AVN: Not everything is always mechanically pain driven. https://www.thegaitguys.com/thedailyblog/2019/5/26/can-a-loss-of-stance-phase-internal-hip-rotation-cause-us-to-circumduct-the-swing-leg-my-thoughts-this-morning monthly 0.5 2019-05-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1558883425738-6F13YXR27JCBETNSM6CW/Screen+Shot+2019-05-26+at+10.10.02+AM.png Blog - Can a loss of stance phase internal hip rotation cause us to circumduct the swing leg? My thoughts this morning. pixabay.com https://www.thegaitguys.com/thedailyblog/2019/5/20/have-you-seen-this monthly 0.5 2019-05-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1558375127720-7U5FDCNR91XV02KPILK3/Slide2ACCA.JPG Blog - Have you seen this? image credit: https://commons.wikimedia.org/wiki/File:Slide2ACCA.JPG https://www.thegaitguys.com/thedailyblog/2019/5/19/correcting-movement-problems-the-power-of-opening-a-neurological-window-to-change-the-brains-cortical-representation monthly 0.5 2019-05-19 https://www.thegaitguys.com/thedailyblog/2019/5/18/the-banana-hallux-when-the-big-toe-curls-upward monthly 0.5 2019-05-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1547433518626-CSSILVLLP1H74OM8HTU9/Screen+Shot+2019-01-13+at+8.37.54+PM.png Blog - The banana hallux. When the big toe curls upward https://www.thegaitguys.com/thedailyblog/2019/5/15/3rd-wednesday-of-every-month-we-teach-a-class-online-link-below monthly 0.5 2019-05-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1556465236227-BBDQ26SCGURB3YKQOTI9/Screen+Shot+2019-04-22+at+1.20.16+PM.png Blog - 3rd Wednesday of every month we teach a class online. LINK below https://www.thegaitguys.com/thedailyblog/2019/5/14/whaddaya-think-of-these-shoes monthly 0.5 2019-05-14 https://www.thegaitguys.com/thedailyblog/2019/5/13/you-might-think-your-shoe-is-doing-more-to-control-motion-of-your-foot-than-it-is-actually-doing monthly 0.5 2019-05-14 https://www.thegaitguys.com/thedailyblog/2019/5/12/you-are-mostly-likely-not-getting-to-your-big-toe-at-push-off-if-you-are-doing-this monthly 0.5 2019-05-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542480602524-ZPN811A6PVDVSOSJTKC5/Screen+Shot+2018-11-17+at+12.45.13+PM.png Blog - You are mostly likely not getting to your big toe at push-off if you are doing this. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542480396759-UJ4OHCZ486V8W5M0CNTP/Screen+Shot+2018-11-17+at+12.45.50+PM.png Blog - You are mostly likely not getting to your big toe at push-off if you are doing this. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542480528355-UEJ9UTILYJ02EK3FHWN5/Screen+Shot+2018-11-17+at+12.48.24+PM.png Blog - You are mostly likely not getting to your big toe at push-off if you are doing this. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542480561925-UZYN2OSLM437HGQRK1RL/Screen+Shot+2018-11-17+at+12.48.17+PM.png Blog - You are mostly likely not getting to your big toe at push-off if you are doing this. https://www.thegaitguys.com/thedailyblog/2019/5/11/symptomatic-tendons monthly 0.5 2019-05-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1547429736731-8LR946JMKVZGQHNIA661/Footnotes+7+-+Black+and+Red.png Blog - Symptomatic tendons. https://www.thegaitguys.com/thedailyblog/2019/5/11/the-rigid-flat-foot-why-an-orthotic-may-not-work-well-at-all monthly 0.5 2019-05-11 https://www.thegaitguys.com/thedailyblog/2019/5/10/want-more-material-from-us-consider-our-patreon-page monthly 0.5 2019-05-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1556465386344-RFTJIQ5KTGVBLZ7SL9JM/Screen+Shot+2019-04-22+at+7.58.36+AM.png Blog - Want more material from us? consider our Patreon page. https://www.thegaitguys.com/thedailyblog/2019/5/9/the-knees-the-glutes-and-reverse-engineering- monthly 0.5 2019-05-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1557421199313-G2JRTREMAECGYTZS3ZSV/Footnotes+7+-+Black+and+Red.jpg Blog - Sometimes you may need to put the cart before the horse...The knees, the glutes and reverse engineering ? https://www.thegaitguys.com/thedailyblog/2019/5/8/the-last-wordon-lasts monthly 0.5 2019-05-08 https://www.thegaitguys.com/thedailyblog/2019/5/7/unique-adaptations-to-arm-swing-challenges-the-one-armed-runner-welcome-to-luke-ericson-an-amazing-athlete-and-man monthly 0.5 2019-05-08 https://www.thegaitguys.com/thedailyblog/2019/5/7/is-your-or-your-athletes-cleat-neutral-or-in-varus monthly 0.5 2019-05-07 https://www.thegaitguys.com/thedailyblog/2019/5/6/prp-platelet-rich-plasma-for-patellar-tendinopathy-no-more-effective-than-saline-in-this-first-study monthly 0.5 2019-05-07 https://www.thegaitguys.com/thedailyblog/2019/5/6/the-problems-with-some-cleats monthly 0.5 2019-05-06 https://www.thegaitguys.com/thedailyblog/2019/5/5/you-might-think-your-shoe-is-doing-more-to-control-motion-of-your-foot-than-it-is-actually-doing monthly 0.5 2019-05-06 https://www.thegaitguys.com/thedailyblog/2019/5/5/premature-heel-rise-part-2 monthly 0.5 2019-05-06 https://www.thegaitguys.com/thedailyblog/2019/5/5/the-externally-rotated-foot-a-video-gait-case monthly 0.5 2019-05-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1557068387705-DAJKFHPHCDT1SZNDRXT7/Screen+Shot+2019-05-05+at+9.55.13+AM.png Blog - The externally rotated foot: a VIDEO gait case. https://www.thegaitguys.com/thedailyblog/2019/5/5/premature-heel-rise-part-1 monthly 0.5 2019-05-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1557061157098-NP19ML4WBOMFA1DGZ7H2/IMG_1603.jpg Blog - Premature heel rise: Part 1 https://www.thegaitguys.com/thedailyblog/2019/5/4/a-video-primer-on-foot-biomechanics monthly 0.5 2019-05-05 https://www.thegaitguys.com/thedailyblog/2019/4/29/neuroma-triple-threat monthly 0.5 2019-04-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1556596564832-0WW4OSF97S5R74YX1PJM/IMG_6220.jpg Blog - Neuroma! Triple Threat.... Note the internal tibial torsion on the left and external on the right https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1556596588914-OFIVDD6XWKCMKSQPSBS7/IMG_6218.jpg Blog - Neuroma! Triple Threat.... https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1556596610348-F1AMNLSTLGIQVKSE4WZZ/IMG_6219.jpg Blog - Neuroma! Triple Threat.... https://www.thegaitguys.com/thedailyblog/2019/4/29/hip-flexors-do-not-initiate-hip-flexon monthly 0.5 2019-04-30 https://www.thegaitguys.com/thedailyblog/2019/4/25/knee-braces-and-long-legs monthly 0.5 2019-04-29 https://www.thegaitguys.com/thedailyblog/2019/4/28/where-do-you-want-to-load-your-foot-in-relation-to-your-center-of-mass- monthly 0.5 2019-04-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542412853768-6DNXJKQIB49SK1BBFWI5/Screen+Shot+2018-11-16+at+6.00.30+PM.png Blog - Where do you want to load your foot in relation to your center of mass ? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542412875264-MM0ISCI5H4ZGK3TYGNL7/Screen+Shot+2018-11-16+at+6.00.11+PM.png Blog - Where do you want to load your foot in relation to your center of mass ? https://www.thegaitguys.com/thedailyblog/2019/4/28/atprfd175n0eb4i10lan2ttroz2oqt monthly 0.5 2019-04-29 https://www.thegaitguys.com/thedailyblog/2019/4/28/circumducting-gait-at-the-ankle-level- monthly 0.5 2019-04-28 https://www.thegaitguys.com/thedailyblog/2019/4/27/the-standing-on-glass-static-footpedograph-part-2 monthly 0.5 2019-04-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1547430816108-P8UP32TLYVFDV7A6YKRM/Screen+Shot+2019-01-13+at+7.51.15+PM.png Blog - The “Standing on Glass” Static Foot/Pedograph... PART 2 https://www.thegaitguys.com/thedailyblog/2019/4/27/the-standing-on-glass-static-footpedograph-assessment-part-1 monthly 0.5 2019-04-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1547430187639-07WR24VIMS904I3UOE6D/Screen+Shot+2019-01-13+at+7.42.41+PM.png Blog - The “Standing on Glass” Static Foot/Pedograph Assessment: Part 1 https://www.thegaitguys.com/thedailyblog/2019/4/27/forefoot-running-achilles-loads-amp-gait-retraining monthly 0.5 2019-04-27 https://www.thegaitguys.com/thedailyblog/2019/5/19/top-end-heel-raises-the-top-end-might-matter monthly 0.5 2019-04-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1555717231064-QLN15FD0CB24LIJB1WRG/Screen+Shot+2019-04-19+at+6.34.09+PM.png Blog - Top end heel raises. The top end might matter. https://www.thegaitguys.com/thedailyblog/2019/4/23/you-are-mostly-likely-not-getting-to-your-big-toe-at-push-off-if-you-are-doing-this monthly 0.5 2019-04-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554758574086-H4V1XDK896IYF7KK0ETH/Screen+Shot+2019-04-08+at+4.20.41+PM.png Blog - You are mostly likely not getting to your big toe at push-off if you are doing this. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554758695726-PUMHWKMTAPJ56ZEVQZU1/Screen+Shot+2019-04-08+at+4.20.52+PM.png Blog - You are mostly likely not getting to your big toe at push-off if you are doing this. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554758543888-RAQ76MZEZ1BQE75W0CLL/Screen+Shot+2019-04-08+at+4.21.31+PM.png Blog - You are mostly likely not getting to your big toe at push-off if you are doing this. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554758718277-QPI03Q3E22RNXLXNZ0EB/Screen+Shot+2019-04-08+at+4.21.23+PM.png Blog - You are mostly likely not getting to your big toe at push-off if you are doing this. https://www.thegaitguys.com/thedailyblog/2019/4/21/support-for-visual-gait-analysis-with-respect-to-leg-length-discrepancies monthly 0.5 2019-04-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1555978663201-OLMQ3WYMFDWN7DF66I9Y/eye-691269_960_720.jpg Blog - Support for visual gait analysis... with respect to leg length discrepancies image credit: https://pixabay.com/photos/eye-blue-eyelashes-vision-make-up-691269/ https://www.thegaitguys.com/thedailyblog/2019/4/21/pronation-anyone-coupling-walking-speed-how-do-they-relate monthly 0.5 2019-04-23 https://www.thegaitguys.com/thedailyblog/2019/4/22/case-studies-in-gait-analysis-focus-on-the-short-leg-online-video-class monthly 0.5 2019-04-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1555957545259-NLE2CB1GH0DAMPSYKFA9/Screen+Shot+2019-04-22+at+1.20.16+PM.png Blog - Case Studies in Gait Analysis: Focus on the Short Leg (online video class) https://www.thegaitguys.com/thedailyblog/2019/4/21/the-hip-flexors-do-not-pull-the-leg-forward-during-swing-mostly monthly 0.5 2019-04-22 https://www.thegaitguys.com/thedailyblog/2019/4/21/more-on-the-scourge-of-flip-flops-riding-the-inside-edge-of-the-sandal-mystery-hunting-with-dr-allen monthly 0.5 2019-04-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1555721675158-UXAHIJE1IFL72MBA3FIC/Screen+Shot+2019-04-19+at+7.53.35+PM.png Blog - More on the scourge of Flip Flops. Riding the inside edge of the sandal. Mystery hunting with Dr. Allen. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1555721659873-9EDXQPM0RWADNGAAQRNM/Screen+Shot+2019-04-19+at+7.53.46+PM.png Blog - More on the scourge of Flip Flops. Riding the inside edge of the sandal. Mystery hunting with Dr. Allen. https://www.thegaitguys.com/thedailyblog/2019/4/20/so-forget-repairing-your-acl-tear-huh monthly 0.5 2019-04-21 https://www.thegaitguys.com/thedailyblog/2019/4/20/how-do-humans-run-faster- monthly 0.5 2019-04-20 https://www.thegaitguys.com/thedailyblog/2019/4/17/more-on-tendon-stiffness monthly 0.5 2019-04-18 https://www.thegaitguys.com/thedailyblog/2019/4/16/effects-of-high-loading-by-eccentric-triceps-surae-training-on-achilles-tendon-properties-in-humans monthly 0.5 2019-04-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1555382814306-8ZT4L2DPGZV1TLII93PU/Screen+Shot+2019-04-15+at+9.46.07+PM.png Blog - Effects of high loading by eccentric triceps surae training on Achilles tendon properties in humans. https://www.thegaitguys.com/thedailyblog/2019/4/16/look-at-his-guys-right-leg-the-lower-leg-and-foot monthly 0.5 2019-04-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554599383044-PA847Z9MMXS3LP48C1TQ/IMG_3850.PNG Blog - Look at his guys right leg, the lower leg and foot. https://www.thegaitguys.com/thedailyblog/2019/4/12/wild-haggis-leg-length-discrepancies-on-the-uphill-side-what monthly 0.5 2019-04-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1555105476866-9G7X7KYZLL2DW995ID3I/300px-Haggis_scoticus.jpg Blog - Wild Haggis? Leg length discrepancies on the uphill side? What? image source: https://en.wikipedia.org/wiki/Wild_haggis#/media/File:Haggis_scoticus.jpg https://www.thegaitguys.com/thedailyblog/2019/4/15/the-current-understanding-of-how-tendons-respond-to-loading-unloading-ageing-and-injury monthly 0.5 2019-04-16 https://www.thegaitguys.com/thedailyblog/2019/4/12/there-more-than-one-way-around-an-lld monthly 0.5 2019-04-15 https://www.thegaitguys.com/thedailyblog/2019/4/14/when-we-try-to-dorsiflex-through-the-midfoot-instead-of-the-ankle monthly 0.5 2019-04-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542412062472-GPNWU2CWDY0DJM3GSYWJ/Screen+Shot+2018-11-16+at+5.47.19+PM.png Blog - When we try to dorsiflex through the midfoot instead of the ankle. https://www.thegaitguys.com/thedailyblog/2019/4/14/neuro-adaptation-motor-skills-and-strength-does-it-come monthly 0.5 2019-04-14 https://www.thegaitguys.com/thedailyblog/2019/4/13/the-opposite-upper-and-lower-limbs-model-each-other-today-we-discuss-adduction-see-the-photo monthly 0.5 2019-04-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554923854618-8CK93PITS8WEE8OZDLJJ/Screen+Shot+2019-04-10+at+2.17.04+PM.png Blog - The opposite upper and lower limbs model each other. Today we discuss adduction. See the photo. https://www.thegaitguys.com/thedailyblog/2019/4/13/the-loads-are-going-to-go-somewhere monthly 0.5 2019-04-14 https://www.thegaitguys.com/thedailyblog/2019/4/12/key-moment-during-my-knee-exam monthly 0.5 2019-04-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554599008228-XUC21DQVAOT1DKIN361D/IMG_0962.jpg Blog - Key moment during my knee exam: https://www.thegaitguys.com/thedailyblog/2019/4/2/subtle-clues-to-an-lld monthly 0.5 2019-04-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554237880121-I31OAU0N9NUDT55GUFH4/IMG_6040.jpg Blog - Subtle clues to an LLD? can you see the difference ? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554237956344-I0QG4O9IP6KUH5M1YHB2/IMG_6046.jpg Blog - Subtle clues to an LLD? how about now? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554237995507-YGH2U5RW42Y6RN918EJC/IMG_6044.jpg Blog - Subtle clues to an LLD? compare right to left https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554238027661-Y1R07ZUSB40FHI54BL34/IMG_6045.jpg Blog - Subtle clues to an LLD? compare right to left https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554238054784-M5A3SY3F4BRHXRFFJMWQ/IMG_6049.jpg Blog - Subtle clues to an LLD? can you see the difference in the Q angles? https://www.thegaitguys.com/thedailyblog/2019/4/12/rocker-shoes-reduce-achilles-tendon-load-in-running-and-walking-in-patients-with-chronic-achilles-tendinopathy monthly 0.5 2019-04-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1555076900511-Y5PSBGPS63OWO0YV19GO/Screen+Shot+2019-04-12+at+8.43.42+AM.png Blog - Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy. https://www.thegaitguys.com/thedailyblog/2019/4/11/bone-marrow-lesions-in-runners monthly 0.5 2019-04-12 https://www.thegaitguys.com/thedailyblog/2019/4/11/increased-unilateral-foot-pronation-can-cause-cephalad-asymmetries monthly 0.5 2019-04-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554648382743-KUMKG928S7EMQC6ZI6DL/Screen+Shot+2019-04-07+at+9.44.59+AM.png Blog - Increased unilateral foot pronation can cause cephalad asymmetries. https://www.thegaitguys.com/thedailyblog/2019/4/9/acl-rehab-considerations-you-might-not-know-about monthly 0.5 2019-04-10 https://www.thegaitguys.com/thedailyblog/2019/4/9/habituating-a-gait-correction monthly 0.5 2019-04-10 https://www.thegaitguys.com/thedailyblog/2019/4/8/got-hip-extension monthly 0.5 2019-04-09 https://www.thegaitguys.com/thedailyblog/2019/4/8/running-cadence-doesnt-matter-maybe monthly 0.5 2019-04-09 https://www.thegaitguys.com/thedailyblog/2019/4/8/3-things monthly 0.5 2019-04-08 https://www.thegaitguys.com/thedailyblog/2019/4/7/heart-disease-and-changes-in-gait monthly 0.5 2019-04-08 https://www.thegaitguys.com/thedailyblog/2019/4/7/patreon-video monthly 0.5 2019-04-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554598560249-1OGEK4ZL6CZTEGM503UD/Screen+Shot+2019-03-21+at+7.49.25+AM.png Blog - Patreon video https://www.thegaitguys.com/thedailyblog/2019/4/6/toe-off-medial-or-lateral-the-hip-matters-and-do-does-forefoot-loading monthly 0.5 2019-04-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1547431664312-BE6HMLLAH82PA4DWWKCA/Screen+Shot+2019-01-13+at+8.06.45+PM.png Blog - Toe off: medial or lateral ? The hip matters, and do does forefoot loading. https://www.thegaitguys.com/thedailyblog/2019/4/6/running-gait-the-contralateral-pelvis-drop monthly 0.5 2019-04-07 https://www.thegaitguys.com/thedailyblog/2019/4/6/the-case-of-the-sneaky-aberrant-heel-rise monthly 0.5 2019-04-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554598037866-G10I84OIL6SQ8S86JFEI/Screen+Shot+2019-03-30+at+7.18.08+AM.png Blog - The case of the sneaky aberrant heel rise. https://www.thegaitguys.com/thedailyblog/2019/4/6/loss-of-terminal-knee-extension-how-quickly-can-you-process-the-facts- monthly 0.5 2019-04-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554597444112-ZESM13PMCCSUHXYSNDUN/IMG_0185.JPG Blog - Loss of terminal knee extension: How quickly can you process the facts ? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554597462993-UWH302BGC8F6VA9U1ZT7/IMG_0182.JPG Blog - Loss of terminal knee extension: How quickly can you process the facts ? https://www.thegaitguys.com/thedailyblog/2019/4/4/why-we-have-a-problem-with-web-based-gait-analysis-recommendations-what-is-visual-parallax-and-how-does-it-affect-gait-analysis monthly 0.5 2019-04-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554402651612-E7TS776KBTGA1T9IH3QM/Screen+Shot+2019-04-04+at+1.30.29+PM.png Blog - Why we have a problem with web-based gait analysis recommendations. What is Visual Parallax and how does it affect gait analysis? https://www.thegaitguys.com/thedailyblog/2019/4/2/things-seem-to-come-in-3s monthly 0.5 2019-04-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554236183844-87LI1OYLQT5AXQKZ9TKL/IMG_5999.jpg Blog - Things seem to come in 3's... this is his left hip in full internal rotation. note that he does go past zero. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554236238871-MJYPTY5GGQSFTLFJAGUE/IMG_6001.jpg Blog - Things seem to come in 3's... full internal rotation of the right hip; note he does not go past zero https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554236471846-XG6WWWLQKBQZ1ZMT5S4F/IMG_6002.jpg Blog - Things seem to come in 3's... note the internal tibial torsion. a line dropped from the tibial tuberosity should go through the 2nd metatarsal or between the 2nd and 3rd. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554236546768-SQ14LBMOEWLFOP2VLIKI/IMG_6003.jpg Blog - Things seem to come in 3's... ditto for the keft https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554236577948-G73QLX4EIYJFDXYV9KO2/IMG_6006.jpg Blog - Things seem to come in 3's... a line bisecting the calcaneus should pass between the 2nd and 3rd metatarsal shafts. If talar tosion was present, the rearfoot would appear more adducted https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554236715294-F6T7YH1PYTGS8VR7FF3A/IMG_6007.jpg Blog - Things seem to come in 3's... less adductus but still present https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554236747414-6QW43ZJO5K79A4B9XKFV/IMG_6010.jpg Blog - Things seem to come in 3's... look at that long flexor response in compensation. What can you say about the quadratus plantae? NO bueno… https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1554236813688-WP612Y54A3Q8YUAPJO29/IMG_6011.jpg Blog - Things seem to come in 3's... Ditto! https://www.thegaitguys.com/thedailyblog/2019/4/1/the-smell-of-napalm-in-the-morning-your-gait-and-trouser-coughs-a-clinical-entity-no-one-talks-about monthly 0.5 2019-04-01 https://www.thegaitguys.com/thedailyblog/2019/3/31/running-paths-and-the-cross-over-gait-and-narrow-step-width monthly 0.5 2019-04-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542411624294-D44DY3M7N2ZFQFMFG62J/Screen+Shot+2018-11-16+at+5.39.57+PM.png Blog - Running paths and the cross over gait and narrow step width. https://www.thegaitguys.com/thedailyblog/2019/3/30/increased-unilateral-foot-pronation-and-its-effects-upward-into-the-chain monthly 0.5 2019-03-31 https://www.thegaitguys.com/thedailyblog/2019/3/26/low-back-pain-check-for-femoral-retrotorsion-on-the-same-side monthly 0.5 2019-03-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1553604547786-1TS9YSWPH0XIFFSR9WMC/IMG_1281.jpg Blog - Low Back Pain? Check for Femoral Retrotorsion on the Same Side note the right sided leg length discrepancy https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1553604564452-GP440GRH4JA48DR4HSZC/IMG_1280.jpg Blog - Low Back Pain? Check for Femoral Retrotorsion on the Same Side right tibia is anatomically shorter https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1553604579266-XVQI2VXRUEWPKY0LQQKH/IMG_1279.jpg Blog - Low Back Pain? Check for Femoral Retrotorsion on the Same Side more internal rotation available on the left side at the hip. Note the internal tibial torsion as well https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1553604595446-V1WUA08M8LEVPOZZSEPZ/IMG_1278.jpg Blog - Low Back Pain? Check for Femoral Retrotorsion on the Same Side very little internal rotation available at the right hip https://www.thegaitguys.com/thedailyblog/2019/3/25/b0bvljor4a63lt9enx82dpt2kfen9o monthly 0.5 2019-03-25 https://www.thegaitguys.com/thedailyblog/2019/3/24/low-back-tightness-in-runners-spinal-muscle-fatigue monthly 0.5 2019-03-25 https://www.thegaitguys.com/thedailyblog/2019/1/13/when-you-run-do-you-kick-or-scrape-the-inside-of-your-ankle-with-the-other-foot- monthly 0.5 2019-03-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1547432534278-85N1SZFDAXVS556GG6RH/Screen+Shot+2019-01-06+at+10.57.30+AM.png Blog - When you run Do you kick or scrape the inside of your ankle with the other foot ? https://www.thegaitguys.com/thedailyblog/2019/3/17/loading-protocols-for-achilles-tendinopathy monthly 0.5 2019-03-18 https://www.thegaitguys.com/thedailyblog/2019/3/16/when-the-windlass-is-lost monthly 0.5 2019-03-17 https://www.thegaitguys.com/thedailyblog/2019/3/16/podcast-145-tendons-heel-drop-and-their-impacts-on-the-posterior-chain monthly 0.5 2019-03-16 https://www.thegaitguys.com/thedailyblog/2017/10/5/the-1st-mtp monthly 0.5 2019-03-13 https://www.thegaitguys.com/thedailyblog/2019/2/17/no-hip-internal-rotation-forget-the-glutes-have-you-looked-at-the-femur monthly 0.5 2019-03-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1550450392912-NZYWA9LSDRDQ9NARZRPC/Screen+Shot+2019-02-14+at+3.13.23+PM.png Blog - NO hip internal rotation? Forget the glutes, have you looked at the femur? https://www.thegaitguys.com/thedailyblog/2019/3/12/crawling-patterns-and-the-bird-dog-look-alike-but-they-are-clearly-not-do-you-understand-this- monthly 0.5 2019-03-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1551023370836-7REBI18LIGGYQVFUH1QI/Screen+Shot+2019-02-24+at+9.48.00+AM.png Blog - Crawling patterns and the Bird Dog look alike, but they are clearly not. Do you understand this ? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1551023386474-CHMV6IWQMCH5TFHL1MKV/Screen+Shot+2019-02-24+at+9.44.31+AM.png Blog - Crawling patterns and the Bird Dog look alike, but they are clearly not. Do you understand this ? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1551023403056-9DQUDKMXXZKW03PD6RKN/Screen+Shot+2019-02-24+at+9.44.19+AM.png Blog - Crawling patterns and the Bird Dog look alike, but they are clearly not. Do you understand this ? https://www.thegaitguys.com/thedailyblog/2019/3/12/an-often-overlooked-culpritin-hip-and-hamstring-insertional-pain monthly 0.5 2019-03-13 https://www.thegaitguys.com/thedailyblog/2019/3/11/the-bird-dog-rehab-exercise-is-neurologically-incorrect-know-what-you-are-asking-your-client-to-do-and-why monthly 0.5 2019-03-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1551023106414-EP8NZSOIH08WBSC5M136/Screen+Shot+2019-02-24+at+9.44.19+AM.png Blog - The Bird Dog rehab exercise is neurologically incorrect. Know what you are asking your client to do, and why.. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1551023123469-JHYN5A2B8QZ2W18TG0BP/Screen+Shot+2019-02-24+at+9.44.31+AM.png Blog - The Bird Dog rehab exercise is neurologically incorrect. Know what you are asking your client to do, and why.. https://www.thegaitguys.com/thedailyblog/2019/3/10/arm-swing-cross-over-head-over-foot monthly 0.5 2019-03-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542410222808-8JJRA78WC86VC7QODHMX/Screen+Shot+2018-11-16+at+5.16.36+PM.png Blog - Arm swing, cross over, head over foot? https://www.thegaitguys.com/thedailyblog/2019/3/7/when-runner-do-you-want-to-be-2-photos monthly 0.5 2019-03-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1551022222506-GIIBQW44YFLR5C8O62AV/Screen+Shot+2019-02-24+at+9.29.56+AM.png Blog - When runner do you want to be? 2 photos https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1551022236886-VYS6LG5L53B1BAN6I5C1/Screen+Shot+2019-02-24+at+9.29.44+AM.png Blog - When runner do you want to be? 2 photos https://www.thegaitguys.com/thedailyblog/2019/3/6/the-hip-flexors-do-not-cause-initial-hip-flexion monthly 0.5 2019-03-07 https://www.thegaitguys.com/thedailyblog/2019/3/6/the-mighty-multifidus monthly 0.5 2019-03-06 https://www.thegaitguys.com/thedailyblog/2019/3/5/a-foot-bump-what-might-this-be-and-mean monthly 0.5 2019-03-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1550928521330-ZT6NIV7QDLT79PE0V32R/Screen+Shot+2019-02-23+at+7.27.35+AM.png Blog - A foot bump. What might this be, and mean? https://www.thegaitguys.com/thedailyblog/2019/3/5/tibial-torsion-and-motion-control-shoes-be-careful monthly 0.5 2019-03-05 https://www.thegaitguys.com/thedailyblog/2019/3/4/right-arch-pain-can-you-see-a-possible-reason-in-this-video monthly 0.5 2019-03-05 https://www.thegaitguys.com/thedailyblog/2019/3/4/what-do-torsiona-dn-versions-look-like-on-exam monthly 0.5 2019-03-04 https://www.thegaitguys.com/thedailyblog/2019/3/3/when-your-calf-is-weak-things-can-dorsiflex-too-much-sometimes monthly 0.5 2019-03-04 https://www.thegaitguys.com/thedailyblog/2019/3/3/pigeon-holed-into-a-particular-running-form-some-thoughts monthly 0.5 2019-03-03 https://www.thegaitguys.com/thedailyblog/2019/3/2/adaptations-and-compensations monthly 0.5 2019-03-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1547433193785-O4T43FX02Y2EG55RKXBF/Screen+Shot+2018-10-25+at+10.54.01+AM.png Blog - Adaptations and compensations. https://www.thegaitguys.com/thedailyblog/2019/3/2/the-knee-follows-the-archankle monthly 0.5 2019-03-03 https://www.thegaitguys.com/thedailyblog/2019/3/2/you-do-not-have-a-shoe-problem-you-have-a-thing-in-the-shoe-problem-meaning-it-is-you monthly 0.5 2019-03-02 https://www.thegaitguys.com/thedailyblog/2019/3/1/the-alex-honnold-climb-you-havent-heard-about monthly 0.5 2019-03-02 https://www.thegaitguys.com/thedailyblog/2019/3/1/what-do-the-hip-flexors-have-to-do-with-the-knee-extensors- monthly 0.5 2019-03-01 https://www.thegaitguys.com/thedailyblog/2019/2/27/imposter-syndrome-and-careful-what-you-say-and-read monthly 0.5 2019-02-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1550887171962-FOMC5JIA5J3QM450TKD4/Screen+Shot+2019-02-20+at+5.11.33+PM.png Blog - Imposter syndrome and careful what you say, and read. https://www.thegaitguys.com/thedailyblog/2019/2/26/another-patreon-video-cast-study monthly 0.5 2019-02-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1547431072775-3HPW39JIE11BEZ4X08BV/Screen+Shot+2019-01-13+at+7.57.25+PM.png Blog - another Patreon video cast study https://www.thegaitguys.com/thedailyblog/2019/2/26/adding-strength-to-dysfunction- monthly 0.5 2019-02-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1550886934668-LPRA8J0HAI93JDO0AIB8/Image-1.jpg Blog - Adding strength to dysfunction ? https://www.thegaitguys.com/thedailyblog/2018/10/24/semitendinosis-not-ready-yet monthly 0.5 2019-02-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1551105655024-S8Q0SEOLF2E408CZSEES/Slide2DADE.JPG Blog - Knee pain and the the semitendinosis? image source: https://commons.wikimedia.org/wiki/File:Slide2DADE.JPG https://www.thegaitguys.com/thedailyblog/2019/2/25/climbing-and-quadrupedal-patterns- monthly 0.5 2019-02-26 https://www.thegaitguys.com/thedailyblog/2019/2/13/do-her-hips-get-weak-fatigue-or-both-when-she-runs monthly 0.5 2019-02-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1551104975375-X8UV8P57QJ8F3WPW4KPH/Footnotes+7+-+Black+and+Red.jpg Blog - Do her hips get weak, fatigue, or both when she runs? https://www.thegaitguys.com/thedailyblog/2019/2/24/house-md-is-he-using-his-cane-on-the-correct-side- monthly 0.5 2019-02-25 https://www.thegaitguys.com/thedailyblog/2019/2/24/four-puckered-anuses-and-a-heel-strike monthly 0.5 2019-02-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1550886065047-NNWTZ3FFDYLRUCDLTIR2/Screen+Shot+2019-02-22+at+7.40.36+PM.png Blog - "Four puckered anuses and a heel strike." https://www.thegaitguys.com/thedailyblog/2019/2/23/a-flexed-leg-is-a-shorter-leg-when-loss-of-knee-extension-really-matters monthly 0.5 2019-02-24 https://www.thegaitguys.com/thedailyblog/2019/2/23/gluteal-tendinopathy-and-the-cross-over-gait-pattern monthly 0.5 2019-02-23 https://www.thegaitguys.com/thedailyblog/2019/2/4/free-solo-the-movie-quadrupedal-gait-and-crapping-your-pants-all-in-one-blog-post monthly 0.5 2019-02-23 https://www.thegaitguys.com/thedailyblog/2019/2/16/l6zhv4r5bxpjgrso70qpw05x1jgavp monthly 0.5 2019-02-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1550449297791-TGJ7E71P1PRP8ETYNMLZ/Screen+Shot+2019-02-14+at+3.12.59+PM.png Blog - So your patents foot points in or out... Have you considered talar torsion in the differential? https://www.thegaitguys.com/thedailyblog/2019/2/17/shoe-flares-medial-and-lateral-do-you-want-both monthly 0.5 2019-02-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542123820014-H8DRK5M58BAMUQ9F1EBU/Screen+Shot+2018-11-13+at+9.40.50+AM.png Blog - Shoe flares Medial and lateral. Do you want both. https://www.thegaitguys.com/thedailyblog/2019/2/17/i-have-knee-pain-when-i-runhow-we-do-one-thing-is-how-we-do-all-things monthly 0.5 2019-02-17 https://www.thegaitguys.com/thedailyblog/2019/2/16/pod-144-grounded-running-glute-fatigue-amp-stress-fractures monthly 0.5 2019-02-16 https://www.thegaitguys.com/thedailyblog/2019/2/16/a-deeper-dive-30-minute-seminar-on-ankle-rocker-and-ankle-dorsiflexion-with-shawn-amp-ivo monthly 0.5 2019-02-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1549220682645-REX6YYCNKLHQ3HZH3O55/Screen+Shot+2019-02-03+at+1.04.17+PM.png Blog - A deeper dive 30 minute seminar on ankle rocker and ankle dorsiflexion, with Shawn &amp; Ivo https://www.thegaitguys.com/thedailyblog/2019/2/14/mwytvqcido7k41agnb1u6nanxyr292 monthly 0.5 2019-02-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1547430962511-ICQOR7LTBAWS282VSMKI/Screen+Shot+2019-01-13+at+7.55.42+PM.png Blog https://www.thegaitguys.com/thedailyblog/2019/1/31/stride-length-matters monthly 0.5 2019-02-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1548969279840-EPIP70ZWA18DPFI7KK3O/1running-iStock_000017285887Large-copy.jpg Blog - You are wondering: "Does the distance between footfalls make a difference?" https://www.thegaitguys.com/thedailyblog/2019/1/14/the-4-factors-of-heel-rise monthly 0.5 2019-02-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1547495369195-K2VI6AWYI1CVESCHNIFA/Screen+Shot+2019-01-14+at+12.48.19+PM.png Blog - The 4 Factors of Heel Rise. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1547495392151-LF4MK6EB7LDU5F3EK14B/Screen+Shot+2019-01-14+at+12.48.08+PM.png Blog - The 4 Factors of Heel Rise. https://www.thegaitguys.com/thedailyblog/2019/2/10/where-do-you-start monthly 0.5 2019-02-11 https://www.thegaitguys.com/thedailyblog/2019/2/10/approaching-hip-pain-differently monthly 0.5 2019-02-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1549220374979-3RT8IZ2NWLWL9XPPRD76/Screen+Shot+2019-02-03+at+12.59.05+PM.png Blog - Approaching hip pain differently. https://www.thegaitguys.com/thedailyblog/2019/2/10/an-alternate-view-of-crawling-and-quadrupedal-motor-patterns-a-correlation-to-free-solo-mountain-climbers- monthly 0.5 2019-02-10 https://www.thegaitguys.com/thedailyblog/2019/2/9/the-slow-creeping-death-of-our-wonderment monthly 0.5 2019-02-09 https://www.thegaitguys.com/thedailyblog/2019/2/7/novice-runners-show-greater-kinematic-changes-with-fatigue monthly 0.5 2019-02-08 https://www.thegaitguys.com/thedailyblog/2016/11/10/femoral-anteversion monthly 0.5 2019-02-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1478822970709-PSJDFRIHU95INP2GNGKH/image-asset.png Blog - 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. https://www.thegaitguys.com/thedailyblog/2019/2/4/gait-and-climbing-part-1 monthly 0.5 2019-02-04 https://www.thegaitguys.com/thedailyblog/2019/1/21/keep-your-eyes-up-and-your-toes-upand-it-doesnt-hurt-to-use-your-abs monthly 0.5 2019-02-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1548084892747-PF91JIHK6NWR9NLAVLF2/IMG_5822.jpg Blog - Keep your eyes up and your toes up...,And it doesn’t hurt to use your abs https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1548084910739-IK60YEZUKLZ4S109XNT0/IMG_5820.jpg Blog - Keep your eyes up and your toes up...,And it doesn’t hurt to use your abs https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1548084925260-ORI15BFFTWT30W5FDUHV/IMG_5818.jpg Blog - Keep your eyes up and your toes up...,And it doesn’t hurt to use your abs https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1548084956287-T4MQ7GXRZU31F4OT5XJI/IMG_5817.jpg Blog - Keep your eyes up and your toes up...,And it doesn’t hurt to use your abs https://www.thegaitguys.com/thedailyblog/2019/2/3/dont-coach-arm-swing monthly 0.5 2019-02-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1541953671447-4MVA3Y3UPPMNPFLTLLSP/Screen+Shot+2018-11-11+at+10.27.29+AM.png Blog - Don't coach arm swing. https://www.thegaitguys.com/thedailyblog/2019/2/3/can-runningloading-form-changes-last-and-translate-from-treadmill-into-the-outdoor-world- monthly 0.5 2019-02-04 https://www.thegaitguys.com/thedailyblog/2019/2/3/walking-and-running-require-greater-effort-from-the-ankle-than-the-knee-extensor-muscles monthly 0.5 2019-02-03 https://www.thegaitguys.com/thedailyblog/2017/5/1/rockered-shoestheyre-for-more-than-hallux-limitus monthly 0.5 2019-01-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1493673513518-UMPZ385A1KV806KNBGC2/image-asset.png Blog - Rockered shoes...they're for MORE than hallux limitus... Images illustrate different types of rockers, with fulcrum locations indicated by vertical red lines. (Images courtesy of Arnie Davis, CPed.) via LER magazine: https://lermagazine.com/article/rocker-bottom-footwear-effects-on-balance-gait https://www.thegaitguys.com/thedailyblog/2019/1/23/two-out-of-three-aint-badbut-sometimes-it-is monthly 0.5 2019-01-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1548271194083-MFOPEOV7CFZBICAAO2RH/image-asset.jpeg Blog - Two out of Three ain't Bad...But sometimes it is image credit: https://commons.wikimedia.org/wiki/File:Meatloaf_(1).jpg https://www.thegaitguys.com/thedailyblog/2019/1/27/kim-jong-un-has-no-shoulder-extension-video-proof monthly 0.5 2019-01-28 https://www.thegaitguys.com/thedailyblog/2019/1/23/muscle-activation-and-gait-emg-studies-that-differentiate monthly 0.5 2019-01-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1548269741325-ABYMXYLYJ5X61XGMU1YY/emgrun.jpg Blog - Muscle activation and gait: EMG studies that differentiate! image credit: Cappellini G, Ivanenko YP, Poppele RE, Lacquaniti F. Motor patterns in human walking and running. J Neurophysiol. 2006 Jun;95(6):3426-37. Epub 2006 Mar 22. https://www.thegaitguys.com/thedailyblog/2018/12/13/hearing-is-related-to-balance monthly 0.5 2019-01-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1544739665111-33GUE7YQ0ZI0THTNN2JO/Footnotes+7+-+Black+and+Red.jpg Blog - Hearing IS related to balance https://www.thegaitguys.com/thedailyblog/2019/1/21/what-does-a-pedograph-of-a-person-with-hallux-limitus-look-like monthly 0.5 2019-01-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1548083255537-AN4SNB6O73RESPQ2V45I/IMG_5779.jpg Blog - What does a pedograph of a person with hallux limitus look like? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1548083291506-PZVYA9WIVHCVUJAH53MK/IMG_5780.jpg Blog - What does a pedograph of a person with hallux limitus look like? https://www.thegaitguys.com/thedailyblog/2019/1/20/step-width-and-peak-knee-forces monthly 0.5 2019-01-21 https://www.thegaitguys.com/thedailyblog/2019/1/19/could-your-low-back-pain-be-related-to-your-big-toe monthly 0.5 2019-01-20 https://www.thegaitguys.com/thedailyblog/2019/1/19/podcast-143-future-of-movement-running-cadence-plus-gait-rehab-eye-control-plantar-fascia-talk monthly 0.5 2019-01-19 https://www.thegaitguys.com/thedailyblog/2019/1/19/leg-exercise-is-critical-to-brain-and-nervous-system-health monthly 0.5 2019-01-19 https://www.thegaitguys.com/thedailyblog/2019/1/19/heel-lift-or-sole-lift- monthly 0.5 2019-01-19 https://www.thegaitguys.com/thedailyblog/2017/1/21/a-happy-cerebellum-better-learning monthly 0.5 2019-01-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1485032425535-HTW2K3EHC2GCS524OAVA/image-asset.jpeg Blog - a happy cerebellum = better learning https://www.thegaitguys.com/thedailyblog/2016/11/10/testing-the-spinocerebellar-pathways monthly 0.5 2019-01-15 https://www.thegaitguys.com/thedailyblog/2019/1/14/loaded-carry-addendum-idea monthly 0.5 2019-01-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1541951551298-7POLH7NODIPV6JJUENI4/Screen+Shot+2018-11-11+at+9.51.59+AM.png Blog - Loaded Carry, Addendum idea https://www.thegaitguys.com/thedailyblog/2019/1/13/details-matter-in-a-loaded-carry monthly 0.5 2019-01-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1541951321191-R2RZ4EWV05T4RNPIDTGZ/Screen+Shot+2018-11-11+at+9.48.18+AM.png Blog - Details matter in a Loaded Carry. https://www.thegaitguys.com/thedailyblog/2019/1/12/hcz6wrq1vrnqf79z1jcw4ir5x9zkao monthly 0.5 2019-01-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1547430033614-2JTSE30F1P4AKCL1698I/Screen+Shot+2019-01-13+at+7.39.56+PM.png Blog https://www.thegaitguys.com/thedailyblog/2018/8/14/at-factors monthly 0.5 2019-01-09 https://www.thegaitguys.com/thedailyblog/2017/1/15/got-a-kid-that-toes-in monthly 0.5 2019-01-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1484523260865-00P26BQ316W0FUQGOC1J/image-asset.jpeg Blog - Got a kid that "toes in"? image source: W Phillips https://somepomed.org/articulos/contents/mobipreview.htm?38/8/39046 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1546966092432-QSJDC1D7PKVS5V9QV87O/to1-figure-9.jpg Blog - Got a kid that "toes in"? 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Even in your drills, do it correctly ! Is this Bird Dog standing up? No, look more closely. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542425764070-Q3CL9MW53OJU8OJ7PN1X/Screen+Shot+2018-11-16+at+9.34.29+PM.png Blog - Runners, athletes . . . Even in your drills, do it correctly ! Is this Bird Dog standing up? No, look more closely. https://www.thegaitguys.com/thedailyblog/2019/1/4/crawling-and-bird-dog-a-subtle-but-important-differencecan-you-see-it- monthly 0.5 2019-01-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542426117428-IKYY4AGQYDI1CG6QXCE9/Screen+Shot+2018-11-16+at+9.41.29+PM.png Blog - Crawling and Bird Dog, a subtle but important difference.Can you see it ? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542426142526-CBRE03V39LKJ39WDZYLZ/Screen+Shot+2018-11-16+at+9.34.48+PM.png Blog - Crawling and Bird Dog, a subtle but important difference.Can you see it ? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542426167950-ABCV71N3NHC8FYC7SHYS/Screen+Shot+2018-11-16+at+9.34.29+PM.png Blog - Crawling and Bird Dog, a subtle but important difference.Can you see it ? https://www.thegaitguys.com/thedailyblog/2019/1/1/in-the-vein-of-patello-femoral-pain monthly 0.5 2019-01-01 https://www.thegaitguys.com/thedailyblog/2017/4/26/3-things-you-can-do-now-for-patello-femoral-pain monthly 0.5 2019-01-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1493246690740-ACPCWK3LTVRGMG31KQBD/image-asset.jpeg Blog - 3 things you can do NOW for patello femoral pain... https://www.thegaitguys.com/thedailyblog/2018/12/31/does-manual-therapy-help-with-oa monthly 0.5 2018-12-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1546285840293-2HIG8E99NN3ZIHT3K13I/Footnotes+7+-+Black+and+Red.jpg Blog - Does Manual Therapy help with OA? https://www.thegaitguys.com/thedailyblog/2016/11/10/tibial-torsion-and-the-effect-on-progression-angle monthly 0.5 2018-12-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1478824080955-TNGZNIYH1ROP2KT2TL17/image-asset.jpeg Blog - Tibial torsion and the effect on progression angle https://www.thegaitguys.com/thedailyblog/2018/12/30/improper-loading-of-the-big-toehallux- monthly 0.5 2018-12-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1541949223484-P3Z9PCV4BPPO1W8KV1EL/Screen+Shot+2018-11-11+at+9.13.24+AM.png Blog - Improper loading of the big toe/hallux ? https://www.thegaitguys.com/thedailyblog/2017/10/5/why-is-she-losing-the-race monthly 0.5 2018-12-28 https://www.thegaitguys.com/thedailyblog/2017/12/18/happy-holidays-from-the-gait-guys monthly 0.5 2018-12-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1513625527181-JGQHXDHLE18AJIWELBX1/gnomes.jpg Blog - Happy Holidays from The Gait Guys https://www.thegaitguys.com/thedailyblog/2018/12/23/the-cross-over-running-technique-a-quick-case-study monthly 0.5 2018-12-24 https://www.thegaitguys.com/thedailyblog/2018/12/18/barefoot-running-is-barefoot-running-there-is-no-substitute monthly 0.5 2018-12-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1545164589541-ZK6KMB753GK8BBP1IT8W/06patriotsrun5.jpg Blog - Barefoot running is Barefoot running. 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IMAGE SOURCE: Michael T Cibulka; Determination and Significance of Femoral Neck Anteversion, Physical Therapy, Volume 84, Issue 6, 1 June 2004, Pages 550–558, https://doi.org/10.1093/ptj/84.6.550 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1493739548808-6U26G5WKBYH1EFMO9UVT/image-asset.png Blog - Do you know your Torsions? 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Here are some thoughts. Photo courtesy of Pixabay.com https://www.thegaitguys.com/thedailyblog/2018/12/1/whole-body-coordination-patterns-may-become-partitioned-in-particular-ways-as-a-function-of-task-requirements monthly 0.5 2018-12-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1543684029907-2KTBRRXOFG97KETMRJPQ/Screen+Shot+2018-12-01+at+11.06.21+AM.png Blog - Whole-body coordination patterns may become partitioned in particular ways as a function of task requirements https://www.thegaitguys.com/thedailyblog/2018/12/1/skeletal-muscle-in-running monthly 0.5 2018-12-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1543682834894-J4M3CLFZTZI9LNULW2G7/Footnotes+7+-+White+and+Red.jpg Blog - Skeletal muscle in running. https://www.thegaitguys.com/thedailyblog/2018/11/30/looking-for-year-end-cme-continuing-education-credits0 monthly 0.5 2018-12-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1541949390739-R0XKKVOXWDPKQGRHGO5R/Screen+Shot+2018-11-11+at+9.15.57+AM.png Blog - Looking for year end CME (continuing education credits0? https://www.thegaitguys.com/thedailyblog/2017/5/20/a-great-paper-on-hallux-limits monthly 0.5 2018-11-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1495467522585-9TTLUUN8TERIT7T5C7CM/image-asset.jpeg Blog - A great paper on Hallux Limits https://www.thegaitguys.com/thedailyblog/2018/11/28/when-the-boot-is-the-cause-of-your-clients-problemspain monthly 0.5 2018-11-28 https://www.thegaitguys.com/thedailyblog/2018/10/24/asymmetry-seems-to-matter-with-pathology monthly 0.5 2018-11-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540432699101-W09XS6S043IPRVMQ5OFC/image-asset.jpeg Blog - Asymmetry seems to matter with pathology. image credit: https://commons.wikimedia.org/wiki/File:PSM_V46_D167_Outer_surface_of_the_human_brain.jpg https://www.thegaitguys.com/thedailyblog/2018/10/24/want-to-bring-out-gait-pathology-add-something-new-into-the-mix monthly 0.5 2018-11-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540433151222-JDWC67IX2640QPO1TAVZ/image-asset.jpeg Blog - Want to bring out gait pathology? Add something new into the mix... image source: https://en.wikipedia.org/wiki/Walking https://www.thegaitguys.com/thedailyblog/2018/11/25/progressions-and-injuries monthly 0.5 2018-11-26 https://www.thegaitguys.com/thedailyblog/2018/11/24/podcast-141-deep-dive-podcast-lots-of-random-gait-and-running-thoughts monthly 0.5 2018-11-24 https://www.thegaitguys.com/thedailyblog/2018/11/22/patreon-and-exclusive-content-site-is-now-live monthly 0.5 2018-11-22 https://www.thegaitguys.com/thedailyblog/2018/10/28/more-subtle-cluesllds monthly 0.5 2018-11-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540761976963-HTMEW07LSQ98IM0ABCMS/IMG_5518.jpg Blog - More subtle clues..LLD's https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540761858362-A21548BMZ4NI6MCXAREX/IMG_5515.jpg Blog - More subtle clues..LLD's https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540761878531-ULXXSUC9SQXLPE63K1QY/IMG_5521.jpg Blog - More subtle clues..LLD's https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540761849124-SJJWVY2BVEJ7LFW43CMV/image-asset.jpeg Blog - More subtle clues..LLD's https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540761892829-DE8DSP22FOD4RU2IRI2L/image-asset.jpeg Blog - More subtle clues..LLD's https://www.thegaitguys.com/thedailyblog/2018/11/11/pincer-toe-nails-ZPkrx monthly 0.5 2018-11-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1541947667143-HWLPJH3JFHKBTN7PX4QO/Screen+Shot+2018-11-11+at+8.47.23+AM.png Blog - Pincer toe nails. https://www.thegaitguys.com/thedailyblog/2018/11/18/do-you-have-dorsal-top-foot-pain-think-you-are-tying-your-shoes-too-tightly monthly 0.5 2018-11-19 https://www.thegaitguys.com/thedailyblog/2018/11/17/your-center-of-mass-in-relation-to-foot-strike-position monthly 0.5 2018-11-18 https://www.thegaitguys.com/thedailyblog/2018/11/17/fatigue-matters-todays-article-looks-at-pre-and-post-exercise-fatigue-and-how-on-emg-our-body-changes monthly 0.5 2018-11-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542465362765-KHCD1CXIHVLFMKO8K7AR/Screen+Shot+2018-11-17+at+8.31.21+AM.png Blog - Fatigue matters. Today's article looks at pre and post exercise fatigue and how, on EMG, our body changes. Photo credit: pixabay.com https://www.thegaitguys.com/thedailyblog/2018/11/16/how-does-hallux-valgus-and-bunion-formation-cause-toe-hammering monthly 0.5 2018-11-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542414556014-IA2HTSK3B85A1L43RDUR/Screen+Shot+2018-11-13+at+4.36.12+PM.png Blog - How does hallux valgus and bunion formation cause toe hammering? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542414525409-NHFPWCVPBMAPTL3FMPUB/Screen+Shot+2018-11-16+at+6.28.27+PM.png Blog - How does hallux valgus and bunion formation cause toe hammering? https://www.thegaitguys.com/thedailyblog/2018/11/16/how-hallux-valgus-and-bunions-can-affect-the-shoe-toe-box-space monthly 0.5 2018-11-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542414255723-JV6V9AVAK2ZCNV6J5D9M/Screen+Shot+2018-11-16+at+6.23.31+PM.png Blog - How hallux valgus and bunions can affect the shoe toe box space. https://www.thegaitguys.com/thedailyblog/2018/11/16/ghs-generalized-hypermobility-syndrome-and-foot-loading monthly 0.5 2018-11-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542414046355-DLEEF0AXR4GT766TP7VZ/Screen+Shot+2018-11-16+at+6.20.23+PM.png Blog - GHS (generalized hypermobility syndrome) and foot loading. https://www.thegaitguys.com/thedailyblog/2018/11/16/hip-muscles-may-be-smaller-in-unilateral-oa monthly 0.5 2018-11-17 https://www.thegaitguys.com/thedailyblog/2018/11/16/adding-strength-to-compensations-and-asymmetry monthly 0.5 2018-11-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1542413762259-PHHLYL8HQ184DL884205/Screen+Shot+2018-11-13+at+4.36.12+PM.png Blog - Adding strength to compensations and asymmetry. https://www.thegaitguys.com/thedailyblog/2018/11/16/forget-face-recognition-gait-recognition-is-here monthly 0.5 2018-11-17 https://www.thegaitguys.com/thedailyblog/2018/11/16/this-could-happen-to-you-if-your-ankle-dorsiflexors-get-weak monthly 0.5 2018-11-17 https://www.thegaitguys.com/thedailyblog/2018/11/16/why-are-you-putting-your-internal-hip-rotation-into-your-low-back-pain monthly 0.5 2018-11-17 https://www.thegaitguys.com/thedailyblog/2018/10/24/the-next-time-they-have-gait-asymmetry-try-changing-out-the-insole monthly 0.5 2018-11-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540433867652-6ADLZ9K9BA6R1JC35PNE/Screen+Shot+2018-10-24+at+8.15.32+PM.png Blog - The next time they have gait asymmetry, try changing out the insole... image credit: https://torange.biz https://www.thegaitguys.com/thedailyblog/2018/11/11/toe-extension-matters-NmCcM monthly 0.5 2018-11-12 https://www.thegaitguys.com/thedailyblog/2018/10/24/more-asymmetrical-thoughts monthly 0.5 2018-11-06 https://www.thegaitguys.com/thedailyblog/2018/10/24/thought-experiment-on-symmetry-does-symmetry-always-matter monthly 0.5 2018-11-05 https://www.thegaitguys.com/thedailyblog/2018/10/28/subtle-clues-to-flexor-dominance monthly 0.5 2018-10-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540761517747-W0677BP80X3N4EBQFIFF/image-asset.jpeg Blog - Subtle clues to flexor dominance https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540761557073-CSYODT9YHCWBZFGGF1HE/IMG_5515.jpg Blog - Subtle clues to flexor dominance https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540761572646-KLFRYSX5JIA6FA9MGZ25/image-asset.jpeg Blog - Subtle clues to flexor dominance https://www.thegaitguys.com/thedailyblog/2018/10/28/shoe-causing-knee-pain-you-decidenbsp monthly 0.5 2018-10-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540761368243-QH7X523993YZONQAWRGR/IMG_5522.jpg Blog - Shoe causing knee pain? You decide…&nbsp; https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540761319064-TZ8PGEDJDV7ESSSRX97S/IMG_5526.jpg Blog - Shoe causing knee pain? You decide…&nbsp; https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1540761346740-ZDMIP7NC3ILHKORYDSLA/IMG_5525.jpg Blog - Shoe causing knee pain? You decide…&nbsp; https://www.thegaitguys.com/thedailyblog/2018/10/8/on-the-road-to-an-acl-reconstruction monthly 0.5 2018-10-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1539350796090-2D1J4CWB6YHH1IM11D3Y/Screen+Shot+2018-10-12+at+8.24.50+AM.png Blog - On the road to a cruciate reconstruction? https://www.thegaitguys.com/thedailyblog/2018/10/7/podcast-140-running-hallux-amputation-building-deeper-gait-concepts monthly 0.5 2018-10-07 https://www.thegaitguys.com/thedailyblog/2018/10/3/and-why-does-this-guy-have-hip-pain monthly 0.5 2018-10-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1538579217454-CXREUGWAL7USYX0WQ75K/IMG_5494.jpg Blog - And why does this guy have hip pain? line up the center of the heel counters with the outsoles, and what do you see? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1538579252765-3VNJH0YWS5ML0L3NT2AY/IMG_5493.jpg Blog - And why does this guy have hip pain? can you see how the heel counter is centered on the outsole, like it is supposed to be https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1538579235878-1E3S7ZQB9QMYO15SI2IA/IMG_5492.jpg Blog - And why does this guy have hip pain? notice how the heel counter of the shoe is canted medially on the outsole of the shoe, creating a varus cant https://www.thegaitguys.com/thedailyblog/2018/9/24/on-the-subject-of-manual-muscle-work monthly 0.5 2018-10-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1537798794775-2WEF8Y6JV0U6UYKIS0ZY/Muscle_spindle_model.jpg Blog - On the subject of manual muscle work… image credit: https://commons.wikimedia.org/wiki/File:Muscle_spindle_model.jpg https://www.thegaitguys.com/thedailyblog/2018/9/24/music-to-my-ears-movement-to-my-steps monthly 0.5 2018-09-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1537799575303-M2N48FDJP0R5ZADHNPYP/Frances_Densmore_recording_Mountain_Chief2.jpg Blog - Music to my ears. Movement to my steps... https://en.wikipedia.org/wiki/Music https://www.thegaitguys.com/thedailyblog/2018/9/22/podcast-139-stem-ampprp-therapies-for-athletes monthly 0.5 2018-09-22 https://www.thegaitguys.com/thedailyblog/2018/9/12/is-there-a-need-for-gait-retrainingwe-think-so monthly 0.5 2018-09-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1536762411677-3CBOKV5NOCZE1V1O4KR4/Severe_%28T%C3%B6nnis_grade_3%29_osteoarthritis_of_the_hip.jpg Blog - Is there a need for "Gait Retraining'?...We think so photo source: https://commons.wikimedia.org/wiki/File:Severe_(Tönnis_grade_3)_osteoarthritis_of_the_hip.jpg https://www.thegaitguys.com/thedailyblog/2018/9/11/people-who-are-injured-move-differently monthly 0.5 2018-09-11 https://www.thegaitguys.com/thedailyblog/2018/9/6/zonas-vs-k-tape monthly 0.5 2018-09-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1536258727200-401XE6IFURCVE1O4VGNV/Kinesio_Taping_for_Soleus_and_Achilles_tendon.jpg Blog - Zonas vs K Tape image source: https://commons.wikimedia.org/wiki/File:Kinesio_Taping_for_Soleus_and_Achilles_tendon.jpg https://www.thegaitguys.com/thedailyblog/2018/9/5/what-specific-movement-patterns-does-a-person-with-chronic-ankle-instability-have monthly 0.5 2018-09-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1536169760589-YT8XUEXW4WO6B0W9NFWP/Ligament.jpg Blog - What specific movement pattern(s) does a person with chronic ankle instability have? image source: https://en.wikipedia.org/wiki/Ligament https://www.thegaitguys.com/thedailyblog/2018/9/4/muscle-spindles-and-proprioception monthly 0.5 2018-09-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1536063897037-6OA5FWJS4GEMSF1EXK3B/Fusimotor_action.jpg Blog - Muscle Spindles and Proprioception image source: https://en.wikipedia.org/wiki/File:Fusimotor_action.jpg https://www.thegaitguys.com/thedailyblog/2018/9/3/all-that-creaks-may-not-be-pathological monthly 0.5 2018-09-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1535994572723-IWVAPHOMHYA9WH5RQT21/Runners-knee_SAG.jpg Blog - All that creaks may not be pathological... image source: https://commons.wikimedia.org/wiki/File:Runners-knee_SAG.jpg https://www.thegaitguys.com/thedailyblog/2018/8/29/medial-knee-pain-what-do-you-know-abou-the-pes monthly 0.5 2018-08-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1535564503567-GYTMW8RRQDCHCYHOV6SP/pes.JPG Blog - Recalcitrant medial knee pain? Have you heard about the "Problematic Pes"... image source: https://commons.wikimedia.org/wiki/File:Slide2DADE.JPG https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1535642662151-1ZY6EUXSV60YQJ162F6B/image-asset.jpeg Blog - Recalcitrant medial knee pain? Have you heard about the "Problematic Pes"... image source: Tom Michaud, with permission https://www.thegaitguys.com/thedailyblog/2018/8/29/podcast-138-for-real-are-you-fighting-your-own-gaitrunning-neurology monthly 0.5 2018-08-29 https://www.thegaitguys.com/thedailyblog/2018/8/27/perhaps-we-are-rehabbing-x-insert-your-favorite-weight-bearing-joint-all-wrong monthly 0.5 2018-08-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1535479827035-YHA97IBN7QLU4ZNSM48P/StrongBoard_balance_in_use.JPG Blog - Perhaps we need to change how we are are rehabbing X (insert your favorite weight bearing joint) image credit: https://en.wikipedia.org/wiki/StrongBoard_balance https://www.thegaitguys.com/thedailyblog/2018/8/27/podcast-shorts-1381-arm-swing-in-sport monthly 0.5 2018-08-28 https://www.thegaitguys.com/thedailyblog/2018/8/7/what-do-you-know-about-pronation-and-supination monthly 0.5 2018-08-22 https://www.thegaitguys.com/thedailyblog/2018/8/20/lessons-in-gait-from-autistic-kids monthly 0.5 2018-08-21 https://www.thegaitguys.com/thedailyblog/2018/8/14/sometimes-it-doesnt-matter-whether-it-is-long-or-short monthly 0.5 2018-08-14 https://www.thegaitguys.com/thedailyblog/2018/8/13/how-about-that-arm-swing monthly 0.5 2018-08-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1534186958848-OSVVXVZWT9Z8HKN0UEFJ/38846451_2134970409875956_3136689889865629696_n.png Blog - How about that arm swing? https://www.thegaitguys.com/thedailyblog/2018/8/10/part-2-the-amputated-hallux-the-complex-biomechanical-fall-out-from-it monthly 0.5 2018-08-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533911596737-3UNX899XT9H9CAKZ1N1V/Screen+Shot+2018-08-10+at+8.10.05+AM.png Blog - Part 2: The amputated hallux & the complex biomechanical fall-out from it. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533911565292-P671EN2ZDBUCUD2FZTG0/Screen+Shot+2018-08-10+at+8.10.19+AM.png Blog - Part 2: The amputated hallux & the complex biomechanical fall-out from it. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533911503925-54Z44GWHW31BRAP16VJR/Screen+Shot+2018-08-10+at+8.22.36+AM.png Blog - Part 2: The amputated hallux & the complex biomechanical fall-out from it. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533911522280-10KXQFCOU64AOQXJ9ICI/Screen+Shot+2018-08-10+at+8.10.27+AM.png Blog - Part 2: The amputated hallux & the complex biomechanical fall-out from it. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533911664796-0NSDUD2AQEYM0E8P8O13/Screen+Shot+2018-08-10+at+8.09.47+AM.png Blog - Part 2: The amputated hallux & the complex biomechanical fall-out from it. https://www.thegaitguys.com/thedailyblog/2018/7/10/better-gait-after-rhizotomies monthly 0.5 2018-08-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533236719945-51MQH5W1BJL5ZZLCONP6/background-information-musculoskeletal-key-within-spinal-cord-cross-section-tracts.jpg Blog - Better gait AFTER rhizotomies? image credit: http://realtyconnect.me/spinal-cord-cross-section-tracts/background-information-musculoskeletal-key-within-spinal-cord-cross-section-tracts/ https://www.thegaitguys.com/thedailyblog/2018/8/5/surgery-vs-castingsame-results monthly 0.5 2018-08-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533508385970-ID01NM0Z9IJAU6T5YMS4/Trimalleolar_Ankle_Fracture.jpg Blog - Surgery vs casting...same results image source: https://commons.wikimedia.org/wiki/File:Trimalleolar_Ankle_Fracture.jpg https://www.thegaitguys.com/thedailyblog/2018/8/4/gait-a-bottom-up-process-mostly monthly 0.5 2018-08-04 https://www.thegaitguys.com/thedailyblog/2018/8/3/hallux-amputation-what-is-next-for-this-person- monthly 0.5 2018-08-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533319555300-U4FJXPS2LDMKUHET4U3D/Screen+Shot+2018-08-03+at+12.52.22+PM.png Blog - Hallux amputation: Part 1 . What is next for this person ? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533319531607-EEL11E3A1L5DNFLP9R37/Screen+Shot+2018-08-03+at+12.52.29+PM.png Blog - Hallux amputation: Part 1 . What is next for this person ? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533319590829-OAM887WUXJHA4MDBTY4A/Screen+Shot+2018-08-03+at+12.52.13+PM.png Blog - Hallux amputation: Part 1 . What is next for this person ? https://www.thegaitguys.com/thedailyblog/2018/8/2/we-often-dont-see-people-when-it-counts monthly 0.5 2018-08-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533219242571-8RNSK1SL6Z6ZNXR6F3HU/Screen+Shot+2018-08-02+at+9.00.28+AM.png Blog - We often don't see people when it counts. https://www.thegaitguys.com/thedailyblog/2018/7/31/4ithzz6r686ddxq1l0r3knrzrea26f monthly 0.5 2018-08-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533041039674-9E17F1E8SNJDCEFY1I9D/image-asset.jpeg Blog - Get your foot in High Gear! image source: Foot Orthoses and Other Conservative Forms of Foot Care. Michaud 1997; Williams an Wilkins: with permission https://www.thegaitguys.com/thedailyblog/2018/7/31/mi1uozco3z2j3ma7qqajkc3rlhlwhf monthly 0.5 2018-07-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1533049714292-EKT61SC7YU5DYDH5D2AI/Screen+Shot+2018-07-31+at+10.05.54+AM.png Blog - Posture doesn't matter, until it does. https://www.thegaitguys.com/thedailyblog/2018/7/30/podcast-137-running-limitations-in-thoracic-spine-function-matter monthly 0.5 2018-07-30 https://www.thegaitguys.com/thedailyblog/2018/7/29/gait-when-loading-com-center-of-mass-gets-complicated monthly 0.5 2018-07-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517778662860-NJRPQNME4XHVYCQ422QT/Screen+Shot+2018-02-04+at+3.10.44+PM.png Blog - Gait: When loading COM (center of mass) gets complicated. https://www.thegaitguys.com/thedailyblog/2018/7/28/com-center-of-mass-between-the-feet-inside-step-width monthly 0.5 2018-07-28 https://www.thegaitguys.com/thedailyblog/2018/7/24/more-flip-flop-madness-can-a-flip-flop-reduce-impact-forces monthly 0.5 2018-07-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1532458562351-7RC65ANIH4A0I9V5O2G0/image-asset.jpeg Blog - More Flip Flop Madness. Can a flip flop reduce impact forces? https://www.thegaitguys.com/thedailyblog/2018/7/21/g297t8bxu36gera6i9lu99ezib2tu8 monthly 0.5 2018-07-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1532200051324-EWHQKRVJQ8YWDBW9ZY0F/journal.pone_.0193653.g001-374x500.jpg Blog - Flip Flops not so bad? We still think they suck and here's why... https://www.thegaitguys.com/thedailyblog/2018/7/22/hamstring-injuries-and-their-gluteal-relationship-the-dialgoue monthly 0.5 2018-07-22 https://www.thegaitguys.com/thedailyblog/2018/7/21/tendinopathy-video monthly 0.5 2018-07-21 https://www.thegaitguys.com/thedailyblog/2018/7/20/you-need-toe-extension-more-than-you-might-think monthly 0.5 2018-07-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1532096823606-KTPSP75VHKDMO3KHQKHD/Screen+Shot+2018-07-20+at+9.24.08+AM.png Blog - You need toe extension, more than you might think. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1532096842578-TOLLH0FZAF9FD9UQT0XX/Screen+Shot+2018-07-20+at+9.23.54+AM.png Blog - You need toe extension, more than you might think. https://www.thegaitguys.com/thedailyblog/2018/7/14/step-width-head-over-foot- monthly 0.5 2018-07-14 https://www.thegaitguys.com/thedailyblog/2018/7/3/this-simple-screening-test-becomes-a-form-of-exercise monthly 0.5 2018-07-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1530626201610-K1Z93JKAES2BG9IWZJJM/image-asset.jpeg Blog - This simple screening test becomes a form of exercise. https://www.thegaitguys.com/thedailyblog/2018/7/9/physiological-mechanisms-of-prp monthly 0.5 2018-07-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1531150038210-SBUM2A6JPQ8J2MYC8OOV/Blausen_0740_Platelets.png Blog - Physiological Mechanisms of PRP image source: https://commons.wikimedia.org/wiki/File:Blausen_0740_Platelets.png https://www.thegaitguys.com/thedailyblog/2018/7/7/running-with-deep-core-weakness monthly 0.5 2018-07-07 https://www.thegaitguys.com/thedailyblog/2018/6/28/so-you-do-weighted-carries monthly 0.5 2018-07-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1530556441263-HUCFBR1ZRJN102QZ4A8O/image-asset.jpeg Blog - So, you do weighted carries? https://www.thegaitguys.com/thedailyblog/2018/6/28/50dpd5so7jb4t2vsukwc2v0q7b1im7 monthly 0.5 2018-07-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1530224152120-M439S9AADJSM0N4LG5EB/image-asset.jpeg Blog - What were you thinking? https://www.thegaitguys.com/thedailyblog/2018/6/30/gait-help-how-and-where-to-carry-a-cane-and-why monthly 0.5 2018-06-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517777154180-DCSZY2EL784AKSICH7FL/Screen+Shot+2018-02-04+at+2.45.32+PM.png Blog - Gait help: How and where to carry a cane, and why. https://www.thegaitguys.com/thedailyblog/2018/6/23/gait-changes-with-your-weight-change monthly 0.5 2018-06-23 https://www.thegaitguys.com/thedailyblog/2018/6/8/the-power-of-facilitation-how-to-supercharge-your-run monthly 0.5 2018-06-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1528519903738-8WGR60E0015ANT5PEDIV/image-asset.jpeg Blog - The Power of Facilitation: How to supercharge your run. https://www.thegaitguys.com/thedailyblog/2018/6/7/when-the-going-gets-rough-we-have-a-tendency-to-look-down monthly 0.5 2018-06-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1528421697753-XH1HDQRNWA8XALD4H1AP/tumblr_mvtqrj0cqk1qhko2so1_500.jpg Blog - When the going gets rough, we have a tendency to look down... https://www.thegaitguys.com/thedailyblog/2018/6/17/dominance-of-the-lumbosacral-girdle-over-the-cervicothoracic-is-probably-preserved-in-humans monthly 0.5 2018-06-17 https://www.thegaitguys.com/thedailyblog/2018/6/16/you-cannot-make-gait-corrections-based-on-visual-assessment-and-oral-instructions monthly 0.5 2018-06-16 https://www.thegaitguys.com/thedailyblog/2018/6/9/the-interference-effect-between-strength-and-endurance-some-alex-hutchinson-thoughts monthly 0.5 2018-06-09 https://www.thegaitguys.com/thedailyblog/2017/10/5/we-hope-you-are-standing-up-while-you-read-this monthly 0.5 2018-06-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1507218027870-Y22POPCAJX7LSETWFMKR/21273746_1703488743024127_8985666039537126258_o.png Blog - We hope you are standing up while you read this…. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1507218047714-9RZAZBV0WST7QFOAQ58D/image-asset.jpeg Blog - We hope you are standing up while you read this…. https://www.thegaitguys.com/thedailyblog/2018/6/5/iliocapsularis-update monthly 0.5 2018-06-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1528218255831-FHYI3QHD86JIFSKP6D7K/Screen+Shot+2018-06-05+at+11.03.04+AM.png Blog - Iliocapsularis Update https://www.thegaitguys.com/thedailyblog/2018/6/2/early-motor-experiences monthly 0.5 2018-06-02 https://www.thegaitguys.com/thedailyblog/2018/5/29/the-adductor-magnus-not-just-for-adduction-anymore monthly 0.5 2018-05-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1527616553889-T8L2L6YN10OVUELVF5ZU/add+mag.png Blog - The Adductor Magnus; Not just for adduction anymore... https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1527616576452-UNSOVO8RFX0UBPDZBB11/brunkine6_ch12_f0018-2.png Blog - The Adductor Magnus; Not just for adduction anymore... https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1527612379216-BEO7DZL4SKXGTT3ZJAFZ/add+mag.png Blog - The Adductor Magnus; Not just for adduction anymore... https://www.thegaitguys.com/thedailyblog/2018/5/27/gait-how-we-stay-upright-in-the-gravitational-plane monthly 0.5 2018-05-27 https://www.thegaitguys.com/thedailyblog/2018/5/26/gait-and-spinal-cord-reflexes monthly 0.5 2018-05-26 https://www.thegaitguys.com/thedailyblog/2018/5/22/proprioceptive-clues-in-childrens-gait monthly 0.5 2018-05-25 https://www.thegaitguys.com/thedailyblog/2018/5/22/what-did-you-notice-the-devil-is-in-the-details monthly 0.5 2018-05-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1527004677573-4PKY2O7K4SC48DYKVJU5/image-asset.jpeg Blog - What did you notice? The Devil is in the details... https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1527004690677-89GZPTNBKUBXEZZ8PDEC/image-asset.jpeg Blog - What did you notice? The Devil is in the details... https://www.thegaitguys.com/thedailyblog/2018/5/19/hiit-high-intensity-exercise-and-parkinsons-disease monthly 0.5 2018-05-19 https://www.thegaitguys.com/thedailyblog/2018/5/16/thinking-while-walking-changes-arm-swing monthly 0.5 2018-05-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1526476170324-LRARIL5I7802M9TQQJ3H/image-asset.jpeg Blog - Thinking while walking changes arm swing... https://www.thegaitguys.com/thedailyblog/2018/5/14/arm-swing-and-instability-to-train-or-not-to-train-should-we-do-it monthly 0.5 2018-05-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1526314405174-SLJEKWHRT345U42UUS4Q/image-asset.jpeg Blog - Arm swing and instability. To train or not to train... Should we do it? https://www.thegaitguys.com/thedailyblog/2018/5/13/pod-136-part-2-head-over-foot-where-should-we-put-our-com-center-of-mass monthly 0.5 2018-05-13 https://www.thegaitguys.com/thedailyblog/2018/5/12/evolution-and-gait monthly 0.5 2018-05-12 https://www.thegaitguys.com/thedailyblog/2018/5/3/wider-flatter-less-mobile-feet monthly 0.5 2018-05-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1525352502236-5YAKMKPNIWV54DK0O8QY/Screen+Shot+2018-05-03+at+6.59.44+AM.png Blog - wider, flatter, less mobile feet https://www.thegaitguys.com/thedailyblog/2018/5/3/footwear-is-medicine monthly 0.5 2018-05-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1525351848859-ED018CS4EIAPQ3GI1E05/image-asset.jpeg Blog - Footwear IS Medicine https://www.thegaitguys.com/thedailyblog/2018/5/5/slipped-capital-femoral-epiphysis monthly 0.5 2018-05-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517775908440-6M1OH3JN666DV79T78D4/Screen+Shot+2018-02-04+at+2.24.49+PM.png Blog - Slipped capital femoral epiphysis https://www.thegaitguys.com/thedailyblog/2017/6/20/better-gait-better-cognition-better-gait monthly 0.5 2018-05-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1497971774379-STZACS0X4ONQWLJN1QAR/image-asset.jpeg Blog - Better gait = better cognition = Better gait https://www.thegaitguys.com/thedailyblog/2018/4/22/toes-spacers-anyone monthly 0.5 2018-04-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1524415720203-PDTHODD9GVC447F33EVZ/cc3.jpg Blog - Toes Spacers, anyone? https://www.thegaitguys.com/thedailyblog/2018/4/29/is-swinging-the-arms-worth-it-the-metabolic-cost-of-running monthly 0.5 2018-04-29 https://www.thegaitguys.com/thedailyblog/2018/4/29/what-ischial-femoral-impingement-might-look-like-as-aberrant-shoe-wear monthly 0.5 2018-12-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1523056063398-QUIGX1OYEXU65BBUHVQ7/Screen+Shot+2018-04-06+at+6.05.35+PM.png Blog - What ischial-femoral impingement might look like as aberrant shoe wear. https://www.thegaitguys.com/thedailyblog/2018/4/28/imaging-things-can-make-them-better monthly 0.5 2018-04-28 https://www.thegaitguys.com/thedailyblog/2018/4/24/a-bit-about-the-ql monthly 0.5 2018-04-24 https://www.thegaitguys.com/thedailyblog/2018/4/23/how-is-your-foot-is-connected-to-your-butt monthly 0.5 2018-04-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1524484241712-9FG5LOLNH5EDC44J3WV7/EVD-marcha-075.jpg Blog - How is your foot is connected to your butt....? https://www.thegaitguys.com/thedailyblog/2018/4/22/do-you-really-understand-what-it-takes-to-control-the-1st-metatarsal-during-loading- monthly 0.5 2018-04-22 https://www.thegaitguys.com/thedailyblog/2018/4/21/when-one-foot-is-shorter-and-smaller-gait-thoughts-to-consider monthly 0.5 2018-04-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1523021752856-ERP1QDBLGBOPG56C941X/Screen+Shot+2018-04-06+at+8.35.33+AM.png Blog - When one foot is shorter, and smaller. Gait thoughts to consider. https://www.thegaitguys.com/thedailyblog/2018/4/21/the-over-extended-knee-genu-recurvatum-watch-your-kids monthly 0.5 2018-04-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517680876858-UX2R2USXSEIRGPS53M3U/Screen+Shot+2018-02-03+at+12.00.39+PM.png Blog - The over extended knee, genu recurvatum. Watch your kids. https://www.thegaitguys.com/thedailyblog/2018/4/21/peroneus-brevis-is-a-more-effective-evertor-than-peroneus-longus monthly 0.5 2018-04-21 https://www.thegaitguys.com/thedailyblog/2018/4/15/arm-swing-and-gait-stability monthly 0.5 2018-04-15 https://www.thegaitguys.com/thedailyblog/2018/4/15/planks-for-10-seconds- monthly 0.5 2018-04-15 https://www.thegaitguys.com/thedailyblog/2018/4/14/nose-picking-and-your-running-form-problems monthly 0.5 2018-04-14 https://www.thegaitguys.com/thedailyblog/2018/4/11/got-short-leg monthly 0.5 2018-04-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1523465150335-HIT41OA354M3T63UVTIW/iStock-185217261-323x500.jpg Blog - Got Short leg? https://www.thegaitguys.com/thedailyblog/2018/4/10/ruminations-on-a-child-with-calcaneal-valgus monthly 0.5 2018-04-10 https://www.thegaitguys.com/thedailyblog/2018/3/26/so-what-attaches-to-that-hip-capsule-anyway monthly 0.5 2018-04-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1522077541337-7CK9HI7K2YI8RZ1D1DFJ/Screen+Shot+2018-03-26+at+9.18.31+AM.png Blog - So, what attaches to that hip capsule anyway.... https://www.thegaitguys.com/thedailyblog/2018/4/8/4-ways-to-fix-your-running-stride-ummmm monthly 0.5 2018-04-08 https://www.thegaitguys.com/thedailyblog/2018/4/7/plantar-flexion-matters-too-dont-get-stuck-only-on-ankle-rockerdorsiflexion monthly 0.5 2018-04-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517680502164-XGEDJE5PU74LRBY72NX9/Screen+Shot+2018-02-03+at+11.54.39+AM.png Blog - Plantar flexion matters, too. Don't get stuck only on ankle rocker/dorsiflexion. https://www.thegaitguys.com/thedailyblog/2018/4/7/do-you-really-understand-a-runners-hips-coaching-out-things-you-dont-like-to-see-doesnt-make-it-a-fix monthly 0.5 2018-04-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1523021167204-46UI4A0LZOE20WI1TUV1/Screen+Shot+2018-04-06+at+8.25.49+AM.png Blog - Do you really understand a runner's hips ? Coaching out things you don't like to see doesn't make it a "fix". https://www.thegaitguys.com/thedailyblog/2018/4/6/the-most-elusive-man-in-north-america monthly 0.5 2018-04-06 https://www.thegaitguys.com/thedailyblog/2018/4/6/rewind-walking-gait-in-a-pencil-skirt monthly 0.5 2018-04-06 https://www.thegaitguys.com/thedailyblog/2018/4/6/the-glutes-are-in-fact-great-internal-hip-rotators-too-open-your-mind monthly 0.5 2018-04-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1523020656013-PNFZN7YOKXSQLBQA2XMN/Screen+Shot+2018-04-06+at+8.17.11+AM.png Blog - The glutes are in fact great internal hip rotators, too. Open your mind. https://www.thegaitguys.com/thedailyblog/2018/4/6/pincer-toe-nails-youve-seen-them-did-you-know-what-they-were-and-how-they-got-that-way-or-did-you-dismiss-them monthly 0.5 2018-04-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1523020426845-FDWMYCMH4S39GUAL2XTF/Screen+Shot+2018-04-06+at+8.13.23+AM.png Blog - Pincer Toe nails: You've seen them; did you know what they were and how they got that way? Or, did you dismiss them? https://www.thegaitguys.com/thedailyblog/2018/4/6/the-season-to-pathologize-our-feet-is-upon-us-toe-extension-matters monthly 0.5 2018-04-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1523019959553-SFJSWRTR6OU73X8W9F6H/Screen+Shot+2018-04-06+at+8.05.18+AM.png Blog - The season to pathologize our feet is upon us. Toe extension matters. https://www.thegaitguys.com/thedailyblog/2018/4/4/functional-ankle-instability-and-the-peroneals monthly 0.5 2018-04-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1522866840281-ATELO3VXRBWWYP5BJAYB/tumblr_mgcawrDlDn1qhko2so1_400.jpg Blog - Functional Ankle Instability and the Peroneals https://www.thegaitguys.com/thedailyblog/2018/4/3/what-do-you-know-about-internal-tibial-torsion monthly 0.5 2018-04-03 https://www.thegaitguys.com/thedailyblog/2018/3/26/the-gluteus-medius-its-not-just-for-abduction-anymore monthly 0.5 2018-04-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1522074550273-ACY7PXULOROX4A9SK4DE/Albinus_rear-2.jpg Blog - The Gluteus Medius: Its not just for abduction anymore... https://www.thegaitguys.com/thedailyblog/2018/3/13/got-ankle-rocker monthly 0.5 2018-04-02 https://www.thegaitguys.com/thedailyblog/2018/3/31/coordination-of-leg-swing-thorax-rotations-and-pelvis-rotations-during-gait-the-organisation-of-total-body-angular-momentum monthly 0.5 2018-03-31 https://www.thegaitguys.com/thedailyblog/2018/3/24/ankle-inversion-sprain-or-off-loading-photo- monthly 0.5 2018-03-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517679871151-1PZVV5ADQA8LFV046W0Z/Screen+Shot+2018-02-03+at+11.44.01+AM.png Blog - Ankle inversion sprain ? or off-loading photo ? https://www.thegaitguys.com/thedailyblog/2018/3/19/the-beef-on-the-edl monthly 0.5 2018-03-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1521466838786-F3ZAFKBF9H2U5OO2QX2R/image-asset.jpeg Blog - The Beef on the EDL..... https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1521466972216-PUPRLR4OCJ2LXG9TZNKI/jhowardL.gif Blog - The Beef on the EDL..... https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1521467015044-J2TD1D516RYRLKWMU267/jhowardR.gif Blog - The Beef on the EDL..... https://www.thegaitguys.com/thedailyblog/2018/3/17/threshold-foot-drop-video-case monthly 0.5 2018-03-17 https://www.thegaitguys.com/thedailyblog/2018/2/22/building-a-better-bridge monthly 0.5 2018-03-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1519340086016-V6AY7XFJYNEQ4WD5SCRK/ijspt-12-543-F001.jpg Blog - Building a Better Bridge https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1519340102895-HVW3XZP882TZJ2NFTZLB/ijspt-12-543-F002.jpg Blog - Building a Better Bridge https://www.thegaitguys.com/thedailyblog/2018/3/11/arm-swing-during-gait-an-energetic-cost-of-locomotion monthly 0.5 2018-03-11 https://www.thegaitguys.com/thedailyblog/2018/3/8/you-wont-read-this-so-send-it-to-a-colleague-who-will monthly 0.5 2018-03-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1520523375524-I588PXJMWO761IBROVA6/Screen+Shot+2018-03-08+at+9.28.02+AM.png Blog - You won't read this. So send it to a colleague who will. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1520523419093-DJOBPO4LD9EOZ3QPS0F7/Screen+Shot+2018-03-08+at+9.34.29+AM.png Blog - You won't read this. So send it to a colleague who will. https://www.thegaitguys.com/thedailyblog/2018/3/7/is-this-a-gluteus-medius-foot-targeting-problem-in-swing-phase-or-is-this-a-loss-of-internal-hip-rotation-or- monthly 0.5 2018-03-07 https://www.thegaitguys.com/thedailyblog/2018/3/5/pronation-as-a-shock-absorber monthly 0.5 2018-03-05 https://www.thegaitguys.com/thedailyblog/2018/3/3/gait-is-all-encompassing monthly 0.5 2018-03-03 https://www.thegaitguys.com/thedailyblog/2018/3/2/runners-can-you-hop- monthly 0.5 2018-03-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1520010249799-VJEU1L1JCWCVP8283JJL/Screen+Shot+2018-03-02+at+10.53.21+AM.png Blog - Runners . . . can you hop ? Photo credit: Lenore Edman https://www.thegaitguys.com/thedailyblog/2018/2/22/building-a-better-brideg-part-2 monthly 0.5 2018-02-28 https://www.thegaitguys.com/thedailyblog/2018/2/27/pod-135-part-1-head-over-foot-where-should-we-put-our-com-center-of-mass monthly 0.5 2018-02-27 https://www.thegaitguys.com/thedailyblog/2018/2/26/acupuncture-and-endurance monthly 0.5 2018-02-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1519667324874-5YIBFPF124V9OV4KJNV8/image-asset.png Blog - Acupuncture and Endurance? https://www.thegaitguys.com/thedailyblog/2018/2/25/a-fresh-calf-tear-video-case monthly 0.5 2018-02-25 https://www.thegaitguys.com/thedailyblog/2018/2/22/the-gluteus-medius-is-playing-target-practice monthly 0.5 2018-02-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1519355078113-RQHO1NH02ZCMXZG6FJN3/Screen+Shot+2018-02-22+at+1.57.58+PM.png Blog - The gluteus medius is playing target practice. https://www.thegaitguys.com/thedailyblog/2018/2/21/75ksabo4uk9x04vywo9s1pfdq86h6a monthly 0.5 2018-02-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1519217945942-O7MEAUGZKKG4UD3CYLT0/Screen+Shot+2018-02-21+at+6.57.19+AM.png Blog - Where the knee hinges matters. https://www.thegaitguys.com/thedailyblog/2018/2/12/conservative-mangement-of-parkinsons monthly 0.5 2018-02-19 https://www.thegaitguys.com/thedailyblog/2018/2/17/do-you-really-need-your-5th-pinky-toe- monthly 0.5 2018-02-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517679290160-V79AKSLTDDYO98LBSXBK/image-asset.png Blog - Do you really need your 5th "pinky" toe ? https://www.thegaitguys.com/thedailyblog/2018/2/16/how-the-cns-adapts-exploratory-testing-of-the-ground monthly 0.5 2018-02-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1518800028651-9NN3RCZC2K2NP20O36NU/Screen+Shot+2018-02-16+at+8.33.03+AM.png Blog - How the CNS adapts. Exploratory testing of the ground. https://www.thegaitguys.com/thedailyblog/2018/2/16/too-much-extensor-tone-the-banana-toe monthly 0.5 2018-02-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1518799752049-Z82R8Q5AX0R8MDCIYG42/IMG_7618.JPG Blog - Too much extensor tone: The banana toe. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1518799723024-JRRCG2Z403318YCPQ11P/IMG_7620.PNG Blog - Too much extensor tone: The banana toe. https://www.thegaitguys.com/thedailyblog/2018/2/7/toe-break monthly 0.5 2018-02-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1518043291774-MXVIMHHNIHNTK3UOHQF8/tumblr_nj46ukTd3o1qhko2so1_1280.jpg Blog - Toe Break https://www.thegaitguys.com/thedailyblog/2018/2/11/childhood-long-bone-torsions-neurodevelopmental-considerations monthly 0.5 2018-02-11 https://www.thegaitguys.com/thedailyblog/2018/2/10/stacking-of-the-joints-a-runners-dilemma- monthly 0.5 2018-02-10 https://www.thegaitguys.com/thedailyblog/2018/3/10/the-effect-of-arm-swing-on-lumbar-spine-and-hip-joint-forces monthly 0.5 2018-02-11 https://www.thegaitguys.com/thedailyblog/2018/2/7/try-this-at-home monthly 0.5 2018-02-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1518027931680-ETDED0JXU2HT7EW7I4NT/Screen+Shot+2018-02-07+at+11.23.24+AM.png Blog - Try THIS at home... https://www.thegaitguys.com/thedailyblog/2018/1/29/the-calcaneo-cuboid-locking-mechanismrevisited monthly 0.5 2018-02-06 https://www.thegaitguys.com/thedailyblog/2018/2/5/sagittal-gait-change-in-arthritic-hips monthly 0.5 2018-02-05 https://www.thegaitguys.com/thedailyblog/2018/2/4/body-composition-and-gait-speed monthly 0.5 2018-02-04 https://www.thegaitguys.com/thedailyblog/2018/2/4/internal-hip-rotation-and-low-back-pain monthly 0.5 2018-02-04 https://www.thegaitguys.com/thedailyblog/2018/2/3/have-impaired-ankle-rocker-or-ankle-dorsiflexion-try-out-these-shoes monthly 0.5 2018-02-03 https://www.thegaitguys.com/thedailyblog/2018/2/3/neuromechanical-adaptations-in-achilles-tendinosis monthly 0.5 2018-02-03 https://www.thegaitguys.com/thedailyblog/2018/2/3/cannabis-users-walk-differently monthly 0.5 2018-02-03 https://www.thegaitguys.com/thedailyblog/2018/2/3/lumbar-spine-mechanics-and-boots monthly 0.5 2018-02-03 https://www.thegaitguys.com/thedailyblog/2018/2/3/more-on-the-z-angle monthly 0.5 2018-02-03 https://www.thegaitguys.com/thedailyblog/2018/2/2/forefoot-varus-vs-forefoot-supinatus monthly 0.5 2018-02-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517590988732-BOKFND6TBLR0UJ8OKJKF/tumblr_nry1ywvvjb1qhko2so1_250.jpg Blog - Forefoot Varus vs Forefoot Supinatus https://www.thegaitguys.com/thedailyblog/2018/2/1/a-shoe-inside-a-shoe-yup- monthly 0.5 2018-02-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1519266975061-G1E35GNA1AUNDN202K7I/Screen+Shot+2018-02-21+at+8.29.12+PM.png Blog - A shoe inside a shoe ? . . . yup ! https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1519266949313-UJLC8WEXFM6CML7P7UWE/Screen+Shot+2018-02-21+at+8.29.31+PM.png Blog - A shoe inside a shoe ? . . . yup ! https://www.thegaitguys.com/thedailyblog/2018/1/30/your-gait-analysis-is-lying-to-you-more-than-you-think-the-more-difficult-motor-program-your-client-is-running-occurs-before-the-gait-analysis-even-begins monthly 0.5 2018-01-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517320069402-VQNLRLC8PDJJYIF2M9O0/Screen+Shot+2018-01-30+at+7.32.33+AM.png Blog - Your gait analysis is lying to you more than you think. The more difficult motor program your client is running occurs before the gait analysis even begins. https://www.thegaitguys.com/thedailyblog/2018/1/24/parkinsons-patients-how-about-textured-insoles-or-walking-barefoot-more monthly 0.5 2018-01-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1516817544868-YKDAM2CAIKDYP0QVPXQR/parkinsons.jpg Blog - Parkinsons Patients? How about textured insoles or walking barefoot more? https://www.thegaitguys.com/thedailyblog/2018/1/27/asymmetry-doesnt-matter monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/walking-the-brain-leads-the-body-by-one-step monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/helping-the-shoes-bend-where-you-do monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/trying-again-here-video-case-is-this-lateral-compartment-weakness- monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/gait-and-peripheral-arterial-disease monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/degenerative-achilles-tendons-have-reduced-stiffness monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/jumping-is-a-skill-dont-do-it-like-this monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/video-gait-demo-the-couple-in-the-hats-are-they-in-phase-or-out-of-phase monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/video-gait-case-internal-tibial-torsion monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/crossing-over-running-on-the-line-the-narrow-step-width-we-know-you-do-it monthly 0.5 2018-01-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517071790684-HIDJIOJ6NO3EEZWH6NR8/Screen+Shot+2018-01-27+at+10.48.00+AM.png Blog - Crossing over, running on the line. 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What the 5th toe does for your COM (center of mass) https://www.thegaitguys.com/thedailyblog/2018/1/27/video-case-ankle-dorsiflexion-um-maybe-maybe-not monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/your-big-toe-is-impairing-your-limb-rotation monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/when-they-walk-back-what-we-are-not-aware-of monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/to-post-an-orthotic-or-not-to-post-that-is-the-question monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/quiz-walking-sideways-on-a-slope monthly 0.5 2018-01-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517064122056-LPNA8OUIWY6X8P75E8KN/Screen+Shot+2018-01-27+at+8.38.15+AM.png Blog - Quiz: Walking sideways on a slope https://www.thegaitguys.com/thedailyblog/2018/1/27/presence-of-bacteria-in-spontaneous-achilles-tendon-ruptures monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/cortical-remapping-and-injuries-redux monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/quadruped-patterns-part-1-redux monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/more-on-plantar-pressures monthly 0.5 2018-01-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517062035921-1KW0FW6EAI4LV3YPZSIK/Screen+Shot+2018-01-27+at+8.06.37+AM.png Blog - More on Plantar Pressures https://www.thegaitguys.com/thedailyblog/2018/1/27/the-quad-walkers-those-that-walk-on-all-4s monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/short-leg-and-pronation monthly 0.5 2018-01-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517061670806-UAIDGS6KFSFCNBG8X1EI/Screen+Shot+2018-01-27+at+8.00.13+AM.png Blog - Short leg and Pronation https://www.thegaitguys.com/thedailyblog/2018/1/27/myokymia monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/kidney-injury-running monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/running-and-life-expectancy monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/27/arterial-blood-flow-of-the-lateral-thigh-increased-significantly-after-foam-rolling-exercises-compared-with-baseline monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/26/fai-ankle-instability-proprioceptive-issues monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/26/extension-thrust-gait-varus-thrust-gait monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/26/dont-let-them-fool-you-thoughts-on-gait-analysis-programs-force-plates-etc monthly 0.5 2018-01-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517023839811-UWSXGS2VE2VAGNKBYEHZ/Screen+Shot+2018-01-26+at+9.29.57+PM.png Blog - Don't let them fool you. Thoughts on gait analysis programs, force plates etc. https://www.thegaitguys.com/thedailyblog/2018/1/26/hip-control-the-glutes-and-centration monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/26/treatment-of-internal-rotation-gait-due-to-gluteus-medius-and-minimus-overactivity monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/26/not-moving monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/26/simulated-knee-flexion-contracture-to-elucidate-knee-spine-syndrome monthly 0.5 2018-01-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1517023073479-P8NBPS87JDG0HYIY404W/Screen+Shot+2018-01-26+at+9.16.29+PM.png Blog - Simulated knee flexion contracture to elucidate knee-spine syndrome https://www.thegaitguys.com/thedailyblog/2018/1/26/video-gait-case-1 monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/26/video-gait-case monthly 0.5 2018-01-27 https://www.thegaitguys.com/thedailyblog/2018/1/25/central-pattern-generators-cpgs-and-gait-locomotion-do-the-arms-and-legs-talk-to-eachother- monthly 0.5 2018-01-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1516904884672-CEO9JYIVMX33T8PYHJO1/Screen+Shot+2018-01-25+at+12.27.39+PM.png Blog - Central Pattern Generators (CPGs) and gait / locomotion. Do the arms and legs talk to eachother ? https://www.thegaitguys.com/thedailyblog/2018/1/24/pod-133-two-gait-cases-their-gait-rehab monthly 0.5 2018-01-24 https://www.thegaitguys.com/thedailyblog/2018/1/22/what-do-you-know-about-the-ia-afferents monthly 0.5 2018-01-23 https://www.thegaitguys.com/thedailyblog/2018/1/12/the-scm-and-gait monthly 0.5 2018-01-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1515786861658-9KRO615OZ9UN1XHHK776/image-asset.png Blog - The SCM and Gait? https://www.thegaitguys.com/thedailyblog/2018/1/9/more-qp monthly 0.5 2018-01-09 https://www.thegaitguys.com/thedailyblog/2018/1/2/the-qpwhats-the-deal monthly 0.5 2018-01-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1514916308881-AL4YMXI8H9YJNQ99WR8K/tumblr_mau352bxll1qhko2so1_540.png Blog - The QP....What's the deal? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1514916386693-JJBT1BSYQP46SJXGI233/tumblr_mwzu9gTBzS1qhko2so1_500.jpg Blog - The QP....What's the deal? look at the 4th and 5th digits trying to "crawl under the foot" https://www.thegaitguys.com/thedailyblog/2018/1/5/vqshdh2wzkuy53s7z0touw4359ubz1 monthly 0.5 2018-01-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1515162559955-NWIWFKF3ESELTNTJ14WJ/anterversion-retroversion-femur.jpg Blog image from: http://boneandspine.com/what-is-anteversion-and-retroversion/ https://www.thegaitguys.com/thedailyblog/2017/12/18/want-to-be-faster monthly 0.5 2018-01-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1513623062022-H13S7WYQETN04AJ5QEAZ/superhero.jpg Blog - Want to be faster? https://www.thegaitguys.com/thedailyblog/2017/12/31/movement-can-it-make-us-better-humans- monthly 0.5 2017-12-31 https://www.thegaitguys.com/thedailyblog/2017/12/24/foznr3r5ylmlb1dixozvhrnl9s1fzk monthly 0.5 2017-12-25 https://www.thegaitguys.com/thedailyblog/2017/12/18/want-more-stability-now monthly 0.5 2017-12-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1513797733002-ZIQ05GJLCK18RA05JM9U/balancing-stones.jpg Blog - Want more stability, NOW? https://www.thegaitguys.com/thedailyblog/2017/12/18/something-you-can-do-now-to-help-parkinsons-folks monthly 0.5 2017-12-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1513621629411-DI0112TNVHTUILYDIST7/199px-Sir_William_Richard_Gowers_Parkinson_Disease_sketch_1886.jpg Blog - Something you can do NOW to help Parkinsons folks https://www.thegaitguys.com/thedailyblog/2017/12/9/gait-and-the-autism-issue monthly 0.5 2017-12-09 https://www.thegaitguys.com/thedailyblog/2017/12/6/the-future-of-gait-good-but-scary monthly 0.5 2017-12-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1512585691748-WZ0ZRIEHEHBBPPFJYZ5B/pexels-photo-9816.jpeg Blog - The Future of Gait? Good but Scary... photo credit: https://www.pexels.com/photo/people-crowd-walking-9816/ https://www.thegaitguys.com/thedailyblog/2017/12/4/headbonking-and-gait monthly 0.5 2017-12-05 https://www.thegaitguys.com/thedailyblog/2017/11/29/which-foot-exercises-activate-the-intrinsics monthly 0.5 2017-12-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1511981001354-JSFF8J902VIPKCAMQVBF/image-asset.jpeg Blog - Which foot exercises activate the intrinsics? https://www.thegaitguys.com/thedailyblog/2017/11/27/club-foot-anyone monthly 0.5 2017-11-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1511801340295-HRCQP89C6HTD1Q1OOUBF/Screen+Shot+2017-11-27+at+9.47.14+AM.png Blog - Club Foot, anyone? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1511801417658-P9CPRG6G17I51HEI4K1Z/Screen+Shot+2017-11-27+at+9.47.38+AM.png Blog - Club Foot, anyone? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1511801494403-18QKDOZ239IB27161KHC/Screen+Shot+2017-11-27+at+9.47.48+AM.png Blog - Club Foot, anyone? https://www.thegaitguys.com/thedailyblog/2017/11/20/the-tib-posteriorrevisited monthly 0.5 2017-11-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1511214219819-DOHF3SJV1S2VY8Q9AX6S/148px-Tibialis_posterior.png Blog - The Tib Posterior...Revisited... https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1511214239145-H70KE961RU9X0UQCI9Z7/1757-1146-2-24-4.jpg Blog - The Tib Posterior...Revisited... https://www.thegaitguys.com/thedailyblog/2017/11/24/imagining-can-make-things-better monthly 0.5 2017-11-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1511543118781-6MLL15T0EUHDGACAB4AU/Screen+Shot+2017-11-24+at+11.04.01+AM.png Blog - Imagining can make things better. https://www.thegaitguys.com/thedailyblog/2017/11/22/labral-tears-and-altered-motion-during-loading monthly 0.5 2017-11-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1511362269850-F083O1PG6XUNBULP07TO/Screen+Shot+2017-11-22+at+8.37.23+AM.png Blog - Labral tears and altered motion during loading. https://www.thegaitguys.com/thedailyblog/2017/11/22/more-anterior-hip-pain-dialogue monthly 0.5 2017-11-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1511362144664-4CG6G9KLFE2JS65HTG0D/Screen+Shot+2017-11-20+at+9.55.19+PM.png Blog - More anterior hip pain dialogue. https://www.thegaitguys.com/thedailyblog/2017/11/18/podcast-131-managing-your-injuries-and-body-mechanics monthly 0.5 2017-11-18 https://www.thegaitguys.com/thedailyblog/2017/11/14/a-tale-of-2-footies monthly 0.5 2017-11-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1510677729897-BB6UNLKOEWRHLGUAQ61P/image-asset.png Blog - A Tale of 2 Footies https://www.thegaitguys.com/thedailyblog/2017/11/14/whats-up-doc monthly 0.5 2017-11-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1510677424603-55M5FHA0HAQK4F1SEQ6R/image-asset.png Blog - What’s up, Doc? https://www.thegaitguys.com/thedailyblog/2017/11/12/the-pedograph-as-a-window-to-the-gait-cycle monthly 0.5 2017-11-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1510522562969-5H387842CS0KEG3XC53D/image-asset.png Blog - The pedograph as a window to the gait cycle https://www.thegaitguys.com/thedailyblog/2017/11/8/supination-anyone monthly 0.5 2017-11-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1510158557452-9GEV3GPCPM8ETX47SY45/external+leg+rotation+supination.gif Blog - Supination, anyone? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1510158668021-BAM5TULTZP78F2US5XAN/external+rotary+moment.gif Blog - Supination, anyone? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1510158587295-F577SBBPHUZUTCRALCQG/image-asset.gif Blog - Supination, anyone? https://www.thegaitguys.com/thedailyblog/2017/11/7/the-power-of-the-1st-ray monthly 0.5 2017-11-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1510059983682-PSSEEQ72IMM2AJU2EP1B/PSM_V24_D673_Deforming_pressure_of_high_heels_on_the_foot_bone_structure.jpg Blog - The Power of the 1st Ray? https://www.thegaitguys.com/thedailyblog/2017/11/4/a-few-minutes-with-shawn-episode-1 monthly 0.5 2017-11-04 https://www.thegaitguys.com/thedailyblog/2017/11/2/gh3grtrsgft5xq0yvbjxa0zrdlp75a monthly 0.5 2017-11-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1509637328762-XJGQ3VZVRUZLBBANR5ZP/9cover-iStock-492571407-300x232.jpg Blog https://www.thegaitguys.com/thedailyblog/2017/10/30/muscle-activation-and-gait-emg-studies-that-differentiate monthly 0.5 2017-11-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1509405187034-C12A5EXKJ5TU3NY0R57H/image-asset.jpeg Blog - Muscle activation and gait: EMG studies that differentiate! https://www.thegaitguys.com/thedailyblog/2017/10/30/zombie-gait monthly 0.5 2017-10-31 https://www.thegaitguys.com/thedailyblog/2017/10/29/needling-myofascial-meridians monthly 0.5 2017-10-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1509300614829-GUQM6B1QBJRD08TH7B0U/15079418828_c1a437b173_b.jpg Blog - Needling Myofascial Meridians? https://www.thegaitguys.com/thedailyblog/2017/10/29/podcast-130-change-your-running-form-plus-concepts-around-ankle-knee-injuries monthly 0.5 2017-10-29 https://www.thegaitguys.com/thedailyblog/2017/10/25/so-you-say-your-client-needs-more-ankle-rocker-faking-out-ankle-dorsiflexion-and-ankle-rocker monthly 0.5 2017-10-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1508937634589-8I8912EOSLKWT5J6RWDN/IMG_6907.JPG Blog - So you say your client needs more ankle rocker? Faking out ankle dorsiflexion and ankle rocker. https://www.thegaitguys.com/thedailyblog/2017/10/22/the-latissimus-in-gait monthly 0.5 2017-10-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1508696180779-OG07LW9BPITBX4NNLBK3/image-asset.png Blog - The Latissimus in Gait https://www.thegaitguys.com/thedailyblog/2017/10/19/inverted-cross-over-gait-how-we-do-all-things- monthly 0.5 2017-10-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1508437675692-7CCKH0ZFVYGMFQ5XFPHK/Screen+Shot+2017-10-19+at+12.45.46+PM.png Blog - Inverted ? Cross over gait? How we do all things ? https://www.thegaitguys.com/thedailyblog/2017/10/17/should-you-rotate-your-shoes monthly 0.5 2017-10-17 https://www.thegaitguys.com/thedailyblog/2017/10/17/threshold-foot-drop monthly 0.5 2017-10-17 https://www.thegaitguys.com/thedailyblog/2017/10/16/arm-swing-and-dynamic-stability-of-the-system monthly 0.5 2017-10-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1508179140061-XSHT9BNMUND06W8EQRS2/Screen+Shot+2017-10-16+at+1.33.03+PM.png Blog - Arm Swing and dynamic stability of the system. https://www.thegaitguys.com/thedailyblog/2017/10/12/vitamin-d-and-gait monthly 0.5 2017-10-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1507818975769-DUVM08TPN5BJYGNBMGWC/Vitamin-D.jpg Blog - Vitamin D and Gait? https://www.thegaitguys.com/thedailyblog/2017/10/12/podcast-129-the-random-topic-podcast monthly 0.5 2017-10-12 https://www.thegaitguys.com/thedailyblog/2017/10/11/heckert-prs-with-238-at-chicago-heckert-njeim-and-schneider-also-oly-qualify monthly 0.5 2017-10-11 https://www.thegaitguys.com/thedailyblog/2017/10/11/swing-matters-too monthly 0.5 2017-10-11 https://www.thegaitguys.com/thedailyblog/2017/10/9/the-ehbin-all-its-glory monthly 0.5 2017-10-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1507589326352-NQUOUNJO0FP129GC8J4V/tumblr_n3vbw7hW5t1qhko2so2_400.jpg Blog - The EHB....In all its glory... https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1507589351216-GN0XJTF3VALS62IU8SVH/tumblr_lij2n4n1mK1qggnse.jpg Blog - The EHB....In all its glory... https://www.thegaitguys.com/thedailyblog/2017/10/9/about-toe-walkers monthly 0.5 2017-10-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1507570329435-QR8W5R5ST4HMEJJPOE32/8ITW-MidwestOfficePatientShootLG-7696-1-1.jpg Blog - About Toe Walkers... Photo courtesy of Surestep https://www.thegaitguys.com/thedailyblog/2017/10/8/medieval-turn-shoes-how-we-used-to-walk monthly 0.5 2017-10-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1507477568895-6MZNY6N0OHJ6W7856PQO/Screen+Shot+2017-10-08+at+10.45.45+AM.png Blog - Medieval "Turn Shoes": How we used to walk. https://www.thegaitguys.com/thedailyblog/2017/10/5/more-on-fatigue-when-are-you-examining-your-patients monthly 0.5 2017-10-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1507216360157-9V9FFWW748YCA3EEPZ2G/86546852.jpg Blog - More on Fatigue... When are you examining your patients? https://www.thegaitguys.com/thedailyblog/2017/10/5/fatiguing-your-way-to-your-injury-endurance-injuries-part-2 monthly 0.5 2017-10-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1507199642240-JIK4UVVJ3H2P7G76AE6E/Screen+Shot+2017-10-05+at+5.33.31+AM.png Blog - Fatiguing your way to your injury? Endurance Injuries, Part 2 https://www.thegaitguys.com/thedailyblog/2017/10/5/gait-is-all-encompassing monthly 0.5 2017-10-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1507196370289-GBHAGW9KKH3FRR87927G/Screen+Shot+2017-09-27+at+1.12.58+PM.png Blog - Gait is "all encompassing" https://www.thegaitguys.com/thedailyblog/2017/10/5/endurance-and-injuries monthly 0.5 2017-10-05 https://www.thegaitguys.com/thedailyblog/2017/9/30/podcast-128-usain-bolt-plantaris-tears-arm-swing monthly 0.5 2017-09-30 https://www.thegaitguys.com/thedailyblog/2017/9/19/how-can-feet-relate-to-golf-swing monthly 0.5 2017-09-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1505835026719-7U9P519QEE7CIRUAEQNW/tumblr_n7yjctusWm1qhko2so1_1280.jpg Blog - How can feet relate to golf swing? Full internal rotation https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1505835061523-6I3L8X2YBE1DGSXG1E91/tumblr_n7yjctusWm1qhko2so2_1280.jpg Blog - How can feet relate to golf swing? full external rotation https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1505835146599-59OLVF2UFJURJI3PD1RA/tumblr_n7yjctusWm1qhko2so3_1280.jpg Blog - How can feet relate to golf swing? full internal rotation https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1505835177599-18ZPZDTX47AT3MH3JOVY/tumblr_n7yjctusWm1qhko2so4_1280.jpg Blog - How can feet relate to golf swing? full external rotation https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1505835223509-W8O9R4WN5239B2ZA7RAK/tumblr_n7yjctusWm1qhko2so7_1280.jpg Blog - How can feet relate to golf swing? neutral https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1505835254679-6TJLXG1W6HWGATJP8KQS/tumblr_n7yjctusWm1qhko2so9_1280.jpg Blog - How can feet relate to golf swing? neutral https://www.thegaitguys.com/thedailyblog/2017/9/18/subtle-clues-helping-someone-around-their-anatomy monthly 0.5 2017-09-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1505759598487-3LJN6OVYO8RXPSI3LNAT/tumblr_n9jt5dtWlc1qhko2so1_1280.jpg Blog - Subtle clues. Helping someone around their anatomy https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1505759693152-A9DVYEABSV6PO3H4TBGG/tumblr_n9jt5dtWlc1qhko2so3_1280.jpg Blog - Subtle clues. Helping someone around their anatomy https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1505759775660-R31X3WYW8G22QRBXKF6Y/image-asset.jpeg Blog - Subtle clues. Helping someone around their anatomy https://www.thegaitguys.com/thedailyblog/2017/9/10/your-gait-changes-when-you-text monthly 0.5 2017-09-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1505102131646-E9MHFIC8KJES95USVUGR/GettyImages-534572749web-57a3087d3df78c3276b9fc80-2.jpg Blog - Your Gait Changes when you text.... https://www.thegaitguys.com/thedailyblog/2017/9/12/more-foot-rocker-pathology-clues monthly 0.5 2017-09-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1505266569494-P8FI89ZMO4506N3QOBT2/image-asset.jpeg Blog - More Foot Rocker Pathology Clues. https://www.thegaitguys.com/thedailyblog/2017/9/10/when-you-text-while-walking-you-may-be-a-hazard-to-yourself-and-others monthly 0.5 2017-09-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1505101338995-GXY4KNVUG3LSMWA7SFUL/pedestrian-london.jpg Blog - When you text while walking, you may be a hazard to yourself and others https://www.thegaitguys.com/thedailyblog/2017/9/7/cannabis-users-walk-differently monthly 0.5 2017-09-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1504793662768-V8EADAFPB84CSBSKU3NV/Screen+Shot+2017-09-07+at+9.11.05+AM.png Blog - Cannabis users walk differently. https://www.thegaitguys.com/thedailyblog/2017/9/6/calf-strength-the-medial-foot-tripod-and-pain-in-the-great-toe monthly 0.5 2017-09-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1504711287873-Z0B5IWW4YNHYE23LPIBA/Screen+Shot+2017-09-06+at+10.21.01+AM.png Blog - Calf strength, the medial foot tripod, and pain in the great toe https://www.thegaitguys.com/thedailyblog/2017/8/30/caveat-emptor-foot-placement-is-a-complex-thing monthly 0.5 2017-08-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1504096940224-K7DPUX3RVZZ7SEL0QHTC/Screen+Shot+2017-08-30+at+7.41.43+AM.png Blog - Caveat Emptor: Foot placement is a complex thing. https://www.thegaitguys.com/thedailyblog/2017/8/28/ql-and-patellofemoral-pain monthly 0.5 2017-08-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1503945276967-OCEH2GEF18GEBYJ4UTFH/image012.jpg Blog - QL and Patellofemoral Pain? photo credit: https://www.t-nation.com/training/training-disasters https://www.thegaitguys.com/thedailyblog/2017/8/28/not-quite-the-ql-but-close monthly 0.5 2017-08-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1503938817721-AN248PDEHJ8EG0BYP38K/Screen+Shot+2017-08-28+at+10.13.40+AM.png Blog - Not quite the QL, but close.... https://www.thegaitguys.com/thedailyblog/2017/8/19/so-your-foot-is-turned-out-externally-rotated-huh monthly 0.5 2017-08-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1503151250165-ZLUK5GJS38E7QG9GN47H/Screen+Shot+2017-08-19+at+9.00.06+AM.png Blog - A return to "the Kickstand Effect". So your foot is turned out, externally rotated ? Amputee War Veteran Sergeant Christopher Melendez Became a Pro Wrestler Read more at http://www.craveonline.com/mandatory/1053779-standing-tall-how-amputee-war-veteran-christopher-melendez-beca#XeD2LrZ2xmtXQ6um.99 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1503152447316-908B0798F56C8BK8Q41K/Screen+Shot+2017-08-19+at+9.20.26+AM.png Blog - A return to "the Kickstand Effect". So your foot is turned out, externally rotated ? https://www.thegaitguys.com/thedailyblog/2017/8/16/what-do-we-have-here-and-what-type-of-shoe-would-be-appropriate monthly 0.5 2017-08-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1502927298110-6BL7DJ789HFVPMZZ5DVK/image-asset.jpeg Blog - What do we have here and what type of shoe would be appropriate? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1502927317226-3EROL704QDOXO5IFKV55/image-asset.jpeg Blog - What do we have here and what type of shoe would be appropriate? https://www.thegaitguys.com/thedailyblog/2017/8/17/r5ogidf1ropw0eo7zc6s79d5so5e4s monthly 0.5 2017-08-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1502989114917-YW2V3E5VGVVIUT6U8CIV/image-asset.png Blog - So you prescribe and fit orthotics you say ? https://www.thegaitguys.com/thedailyblog/2017/8/12/podcast-127-tendinopathies-tendon-pain-more monthly 0.5 2017-08-12 https://www.thegaitguys.com/thedailyblog/2017/8/9/achilles-tendinitis monthly 0.5 2017-08-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1502282695001-7XV4PPAN4R1KTHQXL1N5/image-asset.jpeg Blog - Achilles Tendinitis? https://www.thegaitguys.com/thedailyblog/2017/8/7/ankle-rocker-and-the-z-angle monthly 0.5 2018-07-06 https://www.thegaitguys.com/thedailyblog/2017/8/4/does-asymmetry-matter- monthly 0.5 2017-08-04 https://www.thegaitguys.com/thedailyblog/2017/8/3/new-shoe-old-shoe-the-rotation-it-matters monthly 0.5 2017-08-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1501765380321-2L7MSJF68TZNWKETVCLD/image-asset.png Blog - New shoe, old shoe. The rotation, it matters. https://www.thegaitguys.com/thedailyblog/2017/8/2/hearing-and-gait-parameters monthly 0.5 2017-08-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1501689054570-AU44AUHMNGOKCYVP8E6Q/image-asset.jpeg Blog - Hearing and Gait Parameters https://www.thegaitguys.com/thedailyblog/2017/8/1/the-extra-articular-hip-impingements monthly 0.5 2017-08-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1501611067648-8MMGYFKXEK0KAHQP0QBO/image-asset.png Blog - The extra-articular hip impingements https://www.thegaitguys.com/thedailyblog/2017/7/31/pronation-as-a-shock-absorber monthly 0.5 2017-07-31 https://www.thegaitguys.com/thedailyblog/2017/7/28/forefoot-pronation monthly 0.5 2017-07-28 https://www.thegaitguys.com/thedailyblog/2017/7/27/projecting-calculating-the-next-step monthly 0.5 2017-07-27 https://www.thegaitguys.com/thedailyblog/2017/7/26/party-over-the-weekend monthly 0.5 2017-07-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1501076197557-BWDLG8JK618662N5OTXZ/image-asset.jpeg Blog - Party over the Weekend? https://www.thegaitguys.com/thedailyblog/2017/7/26/we-hope-you-are-standing-up-while-you-read-this monthly 0.5 2017-07-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1501076044417-51S2HM0FWGBATD0YAOVM/image-asset.jpeg Blog - We hope you are standing up while you read this…. https://www.thegaitguys.com/thedailyblog/2017/7/24/some-basic-tenets-of-gait monthly 0.5 2017-07-24 https://www.thegaitguys.com/thedailyblog/2017/7/22/effects-of-too-much-of-a-good-thing monthly 0.5 2017-07-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1500734206563-CE74L0LHHFLX5EJZ9PN5/image-asset.jpeg Blog - Effects of too much of a good thing. https://www.thegaitguys.com/thedailyblog/2017/7/21/podcast-126-running-athletes-mtss-medial-tibial-stress-syndrome monthly 0.5 2017-07-22 https://www.thegaitguys.com/thedailyblog/2017/7/21/so-what-does-cause-a-change-in-strike-pattern-with-barefoot-running monthly 0.5 2017-07-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1500653062838-VI5ZRJX8FQZE4K28RG6V/image-asset.jpeg Blog - So, what DOES cause a change in strike pattern with barefoot running? https://www.thegaitguys.com/thedailyblog/2017/7/19/video-case-is-this-lateral-compartment-weakness monthly 0.5 2017-07-22 https://www.thegaitguys.com/thedailyblog/2017/7/17/why-some-elderly-take-stair-ascending-slowly-pad-peripheral-arterial-disease monthly 0.5 2017-07-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1500319313740-UIS1OK1Y0PA4CQTUMU29/Screen+Shot+2017-07-17+at+2.19.08+PM.png Blog - Why some elderly take stair ascending slowly: PAD, Peripheral arterial disease. https://www.thegaitguys.com/thedailyblog/2017/7/12/athletes-on-different-surfaces-asphalt-gravel-grass-it-matters monthly 0.5 2017-07-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1499866961481-OJER6TAXSMPWR39TW5LX/image-asset.png Blog - Athletes on different surfaces: Asphalt, gravel, grass. It matters. https://www.thegaitguys.com/thedailyblog/2017/6/29/podcast-125-the-spinal-discs-in-running-and-sport monthly 0.5 2017-06-29 https://www.thegaitguys.com/thedailyblog/2017/6/27/the-case-of-the-curly-toes monthly 0.5 2017-06-27 https://www.thegaitguys.com/thedailyblog/2017/6/26/the-power-of-triangles monthly 0.5 2017-06-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1498498632427-J8WMRVTR7A9GC5DLRX4Q/image-asset.png Blog - The Power of Triangles https://www.thegaitguys.com/thedailyblog/2017/6/19/ganu-valgus-and-kids monthly 0.5 2017-06-20 https://www.thegaitguys.com/thedailyblog/2017/6/19/what-gait-and-hearing monthly 0.5 2017-06-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1497895615139-9MCVFUU9M21HDE3N7LP6/image-asset.jpeg Blog - What? Gait and hearing.... https://www.thegaitguys.com/thedailyblog/2017/6/16/pod-124-gluteal-gripping-runners-dystonia-are-leg-length-differences-real- monthly 0.5 2017-06-16 https://www.thegaitguys.com/thedailyblog/2017/6/15/what-is-the-deal-with-toe-separators monthly 0.5 2017-06-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1497565802457-LEQEYYE6N8XYUL3TX9R7/image-asset.jpeg Blog - What is the deal with "toe separators"? https://www.thegaitguys.com/thedailyblog/2017/6/12/ankle-rocker-revisited monthly 0.5 2017-06-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1497311987945-QJ9P9ZNXSECAYOFOX8LP/image-asset.jpeg Blog - Ankle Rocker Revisited.... https://www.thegaitguys.com/thedailyblog/2017/6/12/slow-down-already monthly 0.5 2017-06-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1497292473136-ZYP1GQM9XGPVNVJ4PH11/image-asset.png Blog - Slow Down already... https://www.thegaitguys.com/thedailyblog/2017/5/30/an-often-overlooked-culprit-in-hip-pain monthly 0.5 2017-05-30 https://www.thegaitguys.com/thedailyblog/2017/5/22/more-on-rockered-footwear-and-hallux-limitus monthly 0.5 2017-05-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1495544932522-LNUZGCXWYDV99N7XCJR9/image-asset.png Blog - More on Rockered footwear and Hallux Limitus https://www.thegaitguys.com/thedailyblog/2017/5/22/the-big-toe-that-would-not-extend monthly 0.5 2017-05-22 https://www.thegaitguys.com/thedailyblog/2017/5/1/the-q-angle-and-kids-the-basics monthly 0.5 2017-05-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1493674509890-F5AZCDS7SJDSNU75DPY3/image-asset.png Blog - The Q angle and Kids: The Basics https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1493674735884-UV29XY8H2UYAHNNHABQF/Screen+Shot+2017-05-01+at+3.37.08+PM.png Blog - The Q angle and Kids: The Basics https://www.thegaitguys.com/thedailyblog/2017/5/17/to-drop-or-not-to-dropthat-is-the-question monthly 0.5 2017-05-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1495057375209-WZB6G09J0EHHLJ66E5QQ/image-asset.jpeg Blog - To drop or not to drop...That is the question... https://www.thegaitguys.com/thedailyblog/2017/5/2/medial-tibial-stress-syndrome-mtss-and-the-long-flexor-of-the-big-toe monthly 0.5 2017-05-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1493750362029-8TKZ1QBBZTKUM8NP9YN6/image-asset.png Blog - Medial tibial stress syndrome (MTSS) and the long flexor of the big toe. https://www.thegaitguys.com/thedailyblog/2017/5/1/tibial-torsion-and-genu-valgum monthly 0.5 2017-05-01 https://www.thegaitguys.com/thedailyblog/2017/4/30/podcast-123-the-rear-foot-understanding-your-rearfoot-type monthly 0.5 2017-04-30 https://www.thegaitguys.com/thedailyblog/2017/4/26/you-better-keep-that-hallux-dorsiflexion monthly 0.5 2017-04-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1493215457580-YFGJ4JDXJD6KQVRG6296/image-asset.jpeg Blog - You better keep that Hallux Dorsiflexion https://www.thegaitguys.com/thedailyblog/2017/4/24/metatarsus-adductus-the-basics monthly 0.5 2017-04-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1493136137922-JXSKULEOEVHAEXYQRERH/image-asset.jpeg Blog - Metatarsus Adductus: The Basics https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1493136196691-QRUV6U2FFW6R8BVMB9D1/image-asset.jpeg Blog - Metatarsus Adductus: The Basics https://www.thegaitguys.com/thedailyblog/2017/4/24/cuvy-feet-anyone monthly 0.5 2017-04-24 https://www.thegaitguys.com/thedailyblog/2017/4/20/take-the-minute-to-tie-your-shoes-properly monthly 0.5 2017-04-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1492697775206-MXB62HEGL5PZ7FWAAHH2/image-asset.png Blog - Take the minute to tie your shoes properly. https://www.thegaitguys.com/thedailyblog/2017/4/20/wool-socks- monthly 0.5 2017-04-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1492696722146-0UBY7RW68W2DZ0DRQRJ8/image-asset.png Blog - Wool socks ? https://www.thegaitguys.com/thedailyblog/2017/4/20/the-bad-guys-are-watching-your-gait-too monthly 0.5 2017-04-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1492694683456-TXT4P52Z08U0SRQ6KCW7/image-asset.png Blog - The "Bad Guys" are watching your gait, too. https://www.thegaitguys.com/thedailyblog/2017/4/15/podcast-122-achilles-problems-glutes-feet monthly 0.5 2017-04-15 https://www.thegaitguys.com/thedailyblog/2017/4/12/distracted-kids-walk-slower monthly 0.5 2017-04-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1492012828777-MM77HTJS6JKPYPV06H8I/kid-walking-on-road-2592x3408_47863.jpg Blog - Distracted Kids Walk Slower https://www.thegaitguys.com/thedailyblog/2017/4/4/you-can-only-take-so-many-whacks-to-the-head-before-it-starts-to-show monthly 0.5 2017-04-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1491327281376-ABZJWS5D3ZSDH0O2SMV7/image-asset.png Blog - You can only take so many whacks to the head before it starts to show... https://www.thegaitguys.com/thedailyblog/2017/4/2/podcast-121-carrying-things-overtraining-syndrome-ankle-rocker-and-more monthly 0.5 2017-04-02 https://www.thegaitguys.com/thedailyblog/2017/3/28/where-do-you-do-your-gait-retraining monthly 0.5 2017-03-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1490727208708-S1RR7GAYY9FCC3NHGOAU/image-asset.jpeg Blog - Where do you do YOUR gait retraining? https://www.thegaitguys.com/thedailyblog/2017/3/27/more-on-that-post-operative-foot monthly 0.5 2017-03-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1490636157381-AV9LCF2AI3O57RGWIPYP/image-asset.jpeg Blog - More on that post operative foot https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1490636172523-D276H85RBTC4WT5BN7MM/image-asset.jpeg Blog - More on that post operative foot https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1490636187138-JYFPCDOAV3NREZ27ZSUM/image-asset.jpeg Blog - More on that post operative foot https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1490636201469-HZR849S1JAJGS9HLU5HV/image-asset.jpeg Blog - More on that post operative foot https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1490636217802-5NOXGYY3N4HWEI07LAWG/image-asset.jpeg Blog - More on that post operative foot https://www.thegaitguys.com/thedailyblog/2017/3/14/varus-anyone monthly 0.5 2017-03-27 https://www.thegaitguys.com/thedailyblog/2017/3/13/v0kpf4haho53l7fd7qmy7ry1gyakjo monthly 0.5 2017-03-14 https://www.thegaitguys.com/thedailyblog/2017/3/13/things-often-work-better-in-pairs-especially-with-exercise monthly 0.5 2017-03-13 https://www.thegaitguys.com/thedailyblog/2017/3/11/podcast-120-runners-brains-glute-rabbit-holes monthly 0.5 2017-03-11 https://www.thegaitguys.com/thedailyblog/2017/3/2/ankle-stiffness-foot-collapse-achilles-tendonitis-and-its-blood-flow monthly 0.5 2017-03-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1488463648429-VHKRHSGADFOLKEC7ULTY/image-asset.png Blog - Ankle stiffness, foot collapse, achilles tendonitis and its blood flow. https://www.thegaitguys.com/thedailyblog/2017/3/2/ankle-stiffness-and-foot-collapse-correlation- monthly 0.5 2017-03-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1488463065517-K1K92RCO75LRTU0MZC9L/Screen+Shot+2017-03-02+at+7.57.05+AM.png Blog - Ankle stiffness and foot collapse, correlation ? 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It is a little more complicated than that.) https://www.thegaitguys.com/thedailyblog/2017/1/31/neuro-hack-of-the-week-using-tnrs-to-your-advantage monthly 0.5 2017-01-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1485887865571-DTY46H2YRIBL89H7MEW5/image-asset.jpeg Blog - Neuro Hack of the week: using TNR's to your advantage https://www.thegaitguys.com/thedailyblog/2017/1/29/podcast-118-the-z-angle-in-athletes-ankle-hip-function monthly 0.5 2017-01-29 https://www.thegaitguys.com/thedailyblog/2017/1/25/the-varus-thrust-gait-a-career-ender monthly 0.5 2017-01-25 https://www.thegaitguys.com/thedailyblog/2017/1/21/unless-you-have-ownership monthly 0.5 2017-01-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1485033153538-JL61K44WP8S0SEUVKEQ1/image-asset.jpeg Blog - Unless you have ownership.... https://www.thegaitguys.com/thedailyblog/2017/1/24/neuro-hack-of-the-week monthly 0.5 2017-01-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1485300823273-DBVGVTKUGOASI8VDZML8/image-asset.gif Blog - Neuro Hack of the Week https://www.thegaitguys.com/thedailyblog/2017/1/15/the-knee-and-macerating-menisci monthly 0.5 2017-01-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1484519150612-HE7EQMXZCINHZBDWHK49/image-asset.png Blog - The Knee and Macerating Menisci https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1484519118849-JLMGVWA39NGAPGQ66QD1/image-asset.png Blog - The Knee and Macerating Menisci https://www.thegaitguys.com/thedailyblog/2017/1/14/ots-it-is-taking-down-the-best-athletes-one-by-one monthly 0.5 2019-07-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1484451416533-DA4JMLJR8IVACA6960TS/image-asset.png Blog - OTS. It is taking down the best athletes, one by one. https://www.thegaitguys.com/thedailyblog/2017/1/13/walking-and-running-require-greater-effort-from-the-ankle-than-the-knee-extensor-muscles monthly 0.5 2017-01-13 https://www.thegaitguys.com/thedailyblog/2017/1/11/a-child-with-calcaneal-valgussome-thoughts monthly 0.5 2017-01-11 https://www.thegaitguys.com/thedailyblog/2017/1/8/mouthguards-and-improved-performance monthly 0.5 2017-01-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1483915366926-YABLJ0S4GOJSPU2QUG74/image-asset.png Blog - Mouthguard's and improved performance? https://www.thegaitguys.com/thedailyblog/2017/1/8/is-turning-off-the-quads-a-good-thing monthly 0.5 2017-01-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1483969190215-J6DHDXNZV89QYQ9AIZOK/foamrolling.jpg Blog - Is Turning off the Quads a good thing? https://www.thegaitguys.com/thedailyblog/2016/9/21/achilles-tendinitis monthly 0.5 2017-01-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1474494428583-V0NVTHTEH4068882I53R/image-asset.jpeg Blog - Achilles Tendinitis https://www.thegaitguys.com/thedailyblog/2017/1/5/forefoot-varus-and-patellofemoral-cartilage-damage monthly 0.5 2017-01-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1483617025099-ISE4GCEX0HZHFBK4POQQ/image-asset.png Blog - Forefoot varus and patellofemoral cartilage damage. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1483617039104-1E7V891I28ZKZS144PKY/image-asset.png Blog - Forefoot varus and patellofemoral cartilage damage. https://www.thegaitguys.com/thedailyblog/2017/1/4/ankle-function-be-a-chef-be-a-scientist-not-a-juice-bar-junkie monthly 0.5 2017-01-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1483547777381-GTV5M79MF6PTX3LVFO1Y/image-asset.png Blog - Ankle Function: Be a chef, be a scientist, not a juice bar junkie. https://www.thegaitguys.com/thedailyblog/2017/1/2/fatigue-and-muscle-activation monthly 0.5 2017-01-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1483397014358-TWPITECHGVS1KGR8GCHI/image-asset.png Blog - Fatigue and muscle activation. https://www.thegaitguys.com/thedailyblog/2016/12/31/movement-can-it-make-us-better-humans- monthly 0.5 2016-12-31 https://www.thegaitguys.com/thedailyblog/2016/12/28/stiff-person-syndrome-a-clinical-mystery- monthly 0.5 2016-12-29 https://www.thegaitguys.com/thedailyblog/2016/12/27/abnormal-forefoot-loading-creates-fatigue- monthly 0.5 2016-12-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1482855556136-NQ9SGWVQGYSQ0KLB8Q3A/image-asset.png Blog - Abnormal Forefoot loading creates fatigue ? https://www.thegaitguys.com/thedailyblog/2016/12/23/podcast-117-the-glutes-in-rotation monthly 0.5 2016-12-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1482499118160-JLZW3JEUQPLNBPU9GDNH/image-asset.png Blog - Podcast 117: The glutes in rotation https://www.thegaitguys.com/thedailyblog/2016/12/12/crawling-and-emg monthly 0.5 2016-12-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1481548207922-TWISUNKGFBH24XLG74CO/image-asset.jpeg Blog - Crawling and EMG https://www.thegaitguys.com/thedailyblog/2016/12/12/got-low-back-screen monthly 0.5 2016-12-12 https://www.thegaitguys.com/thedailyblog/2016/12/11/podcast-116-running-cadence-tricks monthly 0.5 2016-12-11 https://www.thegaitguys.com/thedailyblog/2016/12/7/the-glutes-are-in-fact-great-internal-hip-rotators-too-open-your-mind monthly 0.5 2019-04-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1481121321729-2NDWFB46DUEBJ8C09528/image-asset.png Blog - The glutes are in fact great internal hip rotators, too. Open your mind. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1481121363456-8L6FNM31VKMJ7YMOK14Y/image-asset.png Blog - The glutes are in fact great internal hip rotators, too. 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https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1478611750245-507SI4J6DWX6QIDW5LSL/image-asset.png Blog - Can you spot the problem? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1478611777733-3TF566DF7WN4UGUM55N9/image-asset.png Blog - Can you spot the problem? https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1478611800362-U3GDCI0NQK1ZQC7Z295P/image-asset.png Blog - Can you spot the problem? https://www.thegaitguys.com/thedailyblog/2016/11/8/when-the-wrong-shoe-meets-the-right-foot monthly 0.5 2016-11-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1478610588160-WNFSGXMDHMXHV9AZ265S/image-asset.png Blog - When the wrong shoe, meets the right foot https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1478610617587-QB3K3KGV3SG56MXIJQTQ/image-asset.png Blog - When the wrong shoe, meets the right foot https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1478610655820-YUY0XOSEZ8XRRLMVHOM7/image-asset.png Blog - When the wrong shoe, meets the right foot https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1478610681751-8Z2KSSYPVSHAPWHREV5S/image-asset.png Blog - When the wrong shoe, meets the right foot https://www.thegaitguys.com/thedailyblog/2016/11/4/compensation-patterns-and-the-baloney-sandwich-what-kinda-crap-are-you-feeding-your-clients- monthly 0.5 2016-11-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1478273428803-U67IYEY9OTEU2OW30G9R/image-asset.png Blog - Compensation patterns and the baloney sandwich: What kinda crap are you feeding your clients ? https://www.thegaitguys.com/thedailyblog/2016/11/3/hallux-valgus-can-affect-the-entire-kinetic-chains monthly 0.5 2016-11-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1478198945502-RR9B4QHRFJNICZUEZNZX/image-asset.png Blog - Hallux valgus can affect the entire kinetic chain(s) https://www.thegaitguys.com/thedailyblog/2016/10/30/a-little-more-on-the-tibialis-posterior-or-any-tendon-for-that-matter monthly 0.5 2016-11-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1477851279009-AOZUHMXP0M104ZHSTJB5/image-asset.png Blog - A little more on the tibialis posterior (or any tendon for that matter).... https://www.thegaitguys.com/thedailyblog/2016/10/31/south-loop-podcast-17-dr-shawn-allen-of-the-gait-guys monthly 0.5 2016-10-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1477935291813-0Q58GGL9C30FELGJGIV3/image-asset.png Blog - SOUTH LOOP PODCAST #17: DR. SHAWN ALLEN OF THE GAIT GUYS https://www.thegaitguys.com/thedailyblog/2016/10/30/lets-take-another-look-at-the-tibialis-posterior monthly 0.5 2016-10-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1477852083095-AXIK1MFN2M90ZU5GJUTV/image-asset.png Blog - Lets take another look at the tibialis posterior https://www.thegaitguys.com/thedailyblog/2016/10/29/podcast-114-pooping-your-pants monthly 0.5 2016-10-29 https://www.thegaitguys.com/thedailyblog/2016/10/27/case-forefoot-pain-from-achilles-repair monthly 0.5 2016-10-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1477615782795-DI1URRARNN6MSK7YLM1E/image-asset.jpeg Blog - Case: Forefoot pain from achilles repair. https://www.thegaitguys.com/thedailyblog/2016/10/26/dnku5d39k7s62a267ypsg9rjtuai3p monthly 0.5 2016-10-26 https://www.thegaitguys.com/thedailyblog/2016/10/24/and-then-there-is-245 monthly 0.5 2016-10-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1477320597542-Z792OZBLXF4XTG7WFN8F/image-asset.png Blog - And then there is # 245.... https://www.thegaitguys.com/thedailyblog/2016/10/24/whoa-2 monthly 0.5 2016-10-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1477319941612-4VZUBRL5V6WYGM2NMT9O/image-asset.png Blog - Whoa # 2 https://www.thegaitguys.com/thedailyblog/2016/10/24/whoa monthly 0.5 2016-10-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1477319770025-8CN2R3V4PXMBMLTUDMJQ/image-asset.png Blog - Whoa! https://www.thegaitguys.com/thedailyblog/2016/10/19/what-internal-tibial-torsion-and-tibial-varum-looks-like-in-a-world-champ monthly 0.5 2016-10-19 https://www.thegaitguys.com/thedailyblog/2016/10/19/podcast-113-the-hip-ankle-z-angle-gait-compensations monthly 0.5 2016-10-19 https://www.thegaitguys.com/thedailyblog/2016/10/18/3-points-to-use-with-ankle-instability monthly 0.5 2016-10-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1476845927434-84VP6UPJM5JZRMOR981B/image-asset.png Blog - 3 points to use with ankle instability https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1476844930624-0FFR0B5NTPLDTRG0ZPIE/image-asset.png Blog - 3 points to use with ankle instability https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1476844988325-FATZYLELM0FB7D0VOAPP/image-asset.png Blog - 3 points to use with ankle instability https://www.thegaitguys.com/thedailyblog/2016/10/17/keep-it-simple-even-with-those-foot-exercises monthly 0.5 2016-10-18 https://www.thegaitguys.com/thedailyblog/2016/10/16/music-to-my-earsand-steps-to-my-cadence monthly 0.5 2016-10-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1476672431694-8MMQEAQ6LW9DK81VHK0Z/image-asset.jpeg Blog - Music to my ears....and steps to my cadence image credit: http://www.holabirdsports.com/blog/which-type-of-music-is-best-for-running/ https://www.thegaitguys.com/thedailyblog/2016/10/16/step-rate-to-change-foot-strike monthly 0.5 2016-10-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1476671826686-T2AFXRPLBEKJF9G5DSS8/Screen+Shot+2016-10-16+at+8.37.02+PM.png Blog - Step rate to change foot strike? https://www.thegaitguys.com/thedailyblog/2016/10/16/cadence monthly 0.5 2016-10-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1476671686844-M4R379QIQPK8ZH9JKZ5B/Screen+Shot+2016-10-16+at+8.34.26+PM.png Blog - Cadence? https://www.thegaitguys.com/thedailyblog/2016/10/15/bend-ar-30-hour-adventure-race monthly 0.5 2016-10-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1476546011133-76FPJ751F8PJGDEBLNO3/image-asset.jpeg Blog - Bend-AR 30 Hour Adventure Race https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1476546029701-7KUAW9KVBU51DFMCRUZA/image-asset.jpeg Blog - Bend-AR 30 Hour Adventure Race https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1476545994416-H7Z4982DY2QSSH8X53ZP/image-asset.jpeg Blog - Bend-AR 30 Hour Adventure Race https://www.thegaitguys.com/thedailyblog/2016/10/15/a-unique-version-of-the-circumducting-gait monthly 0.5 2016-10-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1476545575205-T4Y2T484FPIR576G6XXS/image-asset.png Blog - A unique version of the circumducting gait. https://www.thegaitguys.com/thedailyblog/2016/10/13/another-way-to-alter-loading-rates-and-potentially-reduce-injuries monthly 0.5 2016-10-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1476405381804-849RL4GY1PFYSM1KEFZ6/image-asset.png Blog - Another way to alter loading rates and potentially reduce injuries? https://www.thegaitguys.com/thedailyblog/2016/10/13/a-metabolic-cost-to-the-cross-over-gait monthly 0.5 2016-10-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1476381718155-83LKKLR8F15HEO6C3M5Q/image-asset.png Blog - A Metabolic Cost to the Cross over gait. https://www.thegaitguys.com/thedailyblog/2016/10/12/welcome-to-the-posterolateral-corner-plc-of-the-knee-the-dark-sleepy-hollow-of-post-acl-knees monthly 0.5 2016-10-12 https://www.thegaitguys.com/thedailyblog/2016/10/11/acute-tendon-changes-in-intense-crossfit-workouts monthly 0.5 2016-10-11 https://www.thegaitguys.com/thedailyblog/2016/10/7/more-foot-exercise-studies-to-confuse-you monthly 0.5 2016-10-07 https://www.thegaitguys.com/thedailyblog/2016/10/6/impact-matters-how-you-put-your-foot-on-the-ground-matters monthly 0.5 2016-10-06 https://www.thegaitguys.com/thedailyblog/2016/10/5/0qze7m2w360atxkctu8aew43ef39ci monthly 0.5 2016-10-05 https://www.thegaitguys.com/thedailyblog/2016/10/5/acupuncturedry-needling-and-proprioception-a-winning-combination monthly 0.5 2016-10-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1475697632096-OY7LS5M9G1ZREI84T3RD/image-asset.png Blog - Acupuncture/Dry Needling and Proprioception. A Winning combination. https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1475697750193-UR12VBSJDTY5B2N2Q4JD/image-asset.png Blog - Acupuncture/Dry Needling and Proprioception. A Winning combination. https://www.thegaitguys.com/thedailyblog/2016/10/5/who-rules-the-glutes-or-the-quads-well-it-is-complicated monthly 0.5 2016-10-05 https://www.thegaitguys.com/thedailyblog/2016/9/30/podcast-112-strengthening-the-foots-arch monthly 0.5 2016-09-30 https://www.thegaitguys.com/thedailyblog/2016/9/29/rock-your-rehab-process-with-these-simple-proprioceptive-exercises monthly 0.5 2016-09-29 https://www.thegaitguys.com/thedailyblog/2016/9/28/david-and-goliath-the-calf-and-the-glute monthly 0.5 2016-09-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1475068796059-C0TA27CHJ2ZIGXRAZ4AS/image-asset.png Blog - David and Goliath: The calf and the glute. https://www.thegaitguys.com/thedailyblog/2016/9/26/the-devil-is-in-the-details monthly 0.5 2016-09-26 https://www.thegaitguys.com/thedailyblog/2016/9/22/the-circle-of-durability monthly 0.5 2016-09-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1474548995392-QK4EARHZ2M7NQQBUO16Z/image-asset.png Blog - The Circle of Durability. https://www.thegaitguys.com/thedailyblog/2016/9/21/toe-flexor-strength-and-ankle-dorsiflexion-rom-during-the-countermovement-jump monthly 0.5 2016-09-21 https://www.thegaitguys.com/thedailyblog/2016/9/21/podcast-111b-somnambulism-locomoting-when-you-are-still-asleep-1 monthly 0.5 2016-09-21 https://www.thegaitguys.com/thedailyblog/2016/9/20/are-you-a-control-freak monthly 0.5 2016-09-20 https://www.thegaitguys.com/thedailyblog/2016/9/19/can-you-see-what-i-seeorcan-they-see-what-you-see monthly 0.5 2016-09-19 https://www.thegaitguys.com/thedailyblog/2016/9/12/hips-joint-resurfacing-and-stem-cells monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/scars-of-evolution monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/a-blood-flow-restriction-lesson-from-a-yo-yo-champ monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/foot-skills-edgework monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/concussions-and-increased-risk-for-musculoskeletal-injury monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/motor-control-and-the-immune-system monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/do-novice-runners-really-have-weak-hips-and-poor-running-form- monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/brace2play-ankle-brace-caveat-emptor monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/toe-grip-strength-and-hallux-valgus monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/arm-swing-and-hip-ranges monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/the-skill-of-walking monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/short-foot-exercise-death monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/slower-walking-in-the-elderly-and-calf-strength monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/obese-feet monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/the-types-of-jaywalkers monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/preschool-children-and-barefoot-policies monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/dual-tasking-pokemon-and-cross-walks monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/short-gastrocnemius- monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/running-economy-and-joint-stiffness monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/achilles-tendon-properties monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/2016/9/12/exercise-is-the-best-medicine monthly 0.5 2016-09-13 https://www.thegaitguys.com/thedailyblog/gait-pathomechanics-walking-in-a-pencil-skirt-we monthly 0.5 2016-09-11 https://www.thegaitguys.com/thedailyblog/podcast-111-gait-movement-the-messengers monthly 0.5 2016-09-10 https://www.thegaitguys.com/thedailyblog/take-a-good-look-at-this-gals-gait-in-the-1st monthly 0.5 2016-09-11 https://www.thegaitguys.com/thedailyblog/seen-this-take-a-look-at-these-legs-have-you monthly 0.5 2016-09-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553407370-G1TQGV4983119GCX0D6A/tumblr_od3njlIc131qhko2so1_1280.jpg Blog - Knee pain and hyperpigmentation. Seen this? Take a look at these legs. Have you seen anything similar in a client, patient or perhaps yourself? This gent came in with knee pain  and we were looking at his feet. It turns out that this was a reaction to an antibiotic he had taken 3 years ago! Hyperpigmentation can be caused by bacterial infections, congenital problems, lime Cafe au Lait spots, endocrine disorders, like Addison’s disease and hyperthyroidism, hemochromatosis as well phototoxic reactions from the use of systemic or topical antibiotics (1, 2) or from contact with certain plants or foods in conjunction with sun exposure (3).   Often initially, patients develop an reddened skin response caused by an allergic reaction. The inflammatory response often includes lymphocytes, eosinophils, and edema, which can result in a “blister like” reaction on sun-exposed skin. Over time, hyperkeratosis and melanocytic hyperplasia (increased numbers of the cells that give your skin pigmentation) develop, causing hyperpigmentation (1).   Some medications result directly in hyperpigmentation, without sun exposure, in a diffuse pattern, like on the gent we see here (4-9). The tables included in reference 2 can provide additional clues Keep your eyes open! Who knows what the medications may have done to thwart your efforts in the healing response! Gould JW, Mercurio MG, Elmets CA. Cutaneous photosensitivity diseases induced by exogenous agents. J Am Acad Dermatol. 1995;33:551–73. http://www.aafp.org/afp/2003/1115/p1955.html Friedlander SF. Contact dermatitis. Pediatr Rev. 1998;19:166–71 Crowson AN, Magro CM. Recent advances in the pathology of cutaneous drug eruptions.Dermatol Clin. 1999;17:537–60.,viii Pepine M, Flowers FP, Ramos-Caro FA. Extensive cutaneous hyperpigmentation caused by minocycline. J Am Acad Dermatol. 1993;28(2 pt 2):292–5. Kelly AP. Aesthetic considerations in patients of color. Dermatol Clin. 1997;15:687–93. Goroll AH, Mulley AG Jr, eds. Primary care medicine: office evaluation and management of the adult patient. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2000 Skin diseases of general importance—part II. In: Cecil RL, Goldman L, Bennett JC. Cecil Textbook of medicine. 21st ed. Philadelphia: Saunders, 2000: 2288–98 Friedlander SF. Contact dermatitis. Pediatr Rev. 1998;19:166–71. https://www.thegaitguys.com/thedailyblog/podcast-110b-shorts-evolution-of-upright monthly 0.5 2016-08-31 https://www.thegaitguys.com/thedailyblog/gaining-anterior-length-through-posterior monthly 0.5 2016-09-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553410984-FM4EM5IIVN1LJNLVGHPS/tumblr_oco89rcuI61qhko2so2_1280.png Blog - Gaining Anterior Length, Through Posterior Strength. A Lesson in Reciprocal Inhibition https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553407390-YF2TRPII0ENCYHFTREYX/tumblr_oco89rcuI61qhko2so1_1280.png Blog - Gaining Anterior Length, Through Posterior Strength. A Lesson in Reciprocal Inhibition https://www.thegaitguys.com/thedailyblog/video-about-4-5-years-ago-some-of-you-that-have monthly 0.5 2016-09-11 https://www.thegaitguys.com/thedailyblog/podcast-110-step-width-breasts-and-diaphragm monthly 0.5 2016-08-26 https://www.thegaitguys.com/thedailyblog/a-cool-paper-on-taping-and-reciprocal-inhibition monthly 0.5 2016-08-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553407002-4C8V2KK32VYK13DHIXHX/tumblr_ocfq8x0l6V1qhko2so1_1280.jpg Blog A cool paper on taping and reciprocal inhibition.  “Hip extension increased significantly with gluteal taping (p < 0.05) for both walking speeds at late stance phase of walk compared to sham taping and control. The mean absolute difference between gluteal and control conditions for self-selected velocity was 14.2 degrees (95% CI 8.6 to 19.8) whereas the difference between sham and control conditions was 2.0 degrees (95% CI –2.0 to 6.0). Also, for both speeds, step length on the unaffected side increased significantly with gluteal taping compared with either the control or placebo” conditions.  link to full text: http://www.sciencedirect.com/science/article/pii/S0004951406700629 Aust J Physiother. 2006;52(1):53-6.Gluteal taping improves hip extension during stance phase of walking following stroke.Kilbreath SL, Perkins S, Crosbie J, McConnell J. https://www.thegaitguys.com/thedailyblog/providing-you-more-ways-to-listen-to-us-we-are-up monthly 0.5 2016-08-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553407076-AROIA9TLNKRSB06WA4WV/tumblr_oc7u5mBRtc1qhko2so1_1280.png Blog Providing you more ways to listen to us. We are up on Soundcloud now, next pod should also launch to iHeartRadio, Youtube and a few other places. Just trying to share our love in more places :) https://soundcloud.com/user-152640364 https://www.thegaitguys.com/thedailyblog/podcast-109b-shorts-the-gluteus-medius-during monthly 0.5 2016-08-19 https://www.thegaitguys.com/thedailyblog/difficult-hip-presentations-coordination-of-deep monthly 0.5 2016-08-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553408527-44FK0H3A9NZ9E2QM95TC/tumblr_oc5rfpsc911qhko2so1_1280.png Blog Difficult hip presentations. Coordination of deep hip muscle activity is often altered in symptomatic femoroacetabular impingement (FAI). If your clinic is anything like ours, you are regularly seeing failed therapy cases of hip pain walk into your clinic. Many of these cases have been diagnosed clinically or with imaging as FAI (femoral acetabular impingement (syndrome)). FAI can give all kinds of hip pain presentations around the front, side or back of the hip, groin and pelvis, even with referral into the knee. Lets make no mistake, these are difficult cases. The attached study suggests that these often difficult cases are fraught with undefined parameters. These cases can be difficult for us all, particularly if one do not have the clinical examination skills to tease out what muscles are not working, which ones are over working, what has happened to joint centration, how the client loads the hip, what the pelvis posturing attitude is and what motor stabilization strategies are being deployed. Lumbar, pelvis and hip posturing and stabilzation is key in understanding FAI and these often vague and frustrating cases. Determing how the client deploys stacking of the lower limb joints and how they then deploy these strategies in gait and running is paramount to your success in assisting these client cases. This is a deeply multifactorial problem and often why these issues do not get resolved.  Recently I just closed yet another case with a 21 year old female who had FAI and labral tear surgery 2 years ago. She had been told she would always have some pain and never run again. As many of these cases often proceed, after defining all of the issues above, it was clear she had many unaddressed components postoperatively. It appeared many components had not been addressed preoperatively, and had they been addressed, I suspect she may have not needed surgery. These multitudes of dysfunctional components can lead to FAI and labral damage. Many torn labrums do not need surgery, as evidenced by how many clients come out of surgery still having the same pre-operative pain as well as how many improve or resolve by a non-surgical approach to addressing all of the components above. This study, by Diamond et al compared coordination of deep hip muscles between people with and without symptomatic FAI using analysis of muscle synergies (i.e. patterns of activity of groups of muscles activated in synchrony) during gait. The study utilized intramuscular fine-wire and surface electrodes EMG activity of selected deep and superficial hip muscles.   This study found a significant correlation with the quadratus femoris muscle, one we have repeatedly found problematic over the years. This study was nice to read, it confirmed many of the issues we have found rooted in these often difficult cases. The study surmised that  “coordination of deep hip muscles in the synergy related to hip joint control during early swing differed between groups. This phase involves movement towards the impingement position, which has relevance for the interpretation of synergy differences and potential clinical importance. ” We strongly refer you back to our podcast #99 to look into the gluteus medius during swing phase. This is a key component to one’s deeper understanding of how complex the hip works, during both stance and swing. We all tend to get too caught up in stance phase mechanics because that is the one we can see and assess most clearly, however, if one does not understand how vital the gluteus medius is in swing phase limb targeting through the sagittal plane, one is likely missing a big piece of a client’s clinical puzzle. One can do all the dynamic and functional movement and stabilization therapy they wish, but if one does not understand the swing phase mechanics, and perhaps most importantly, if one does not reteach a client how to make the necessary adaptive gait changes to employ the therapeutic work the changes remain on the therapy table and never cross over into functionally using them. The clinician must address the client’s previously deeply rooted gait motor program. A client may have in their bank account the new functional abilities they have been taught, but they likely have not been taught how to deploy them in a new more appropriate gait strategy.  -Dr. Shawn Allen 1. Coordination of deep hip muscle activity is altered in symptomatic femoroacetabular impingement. Laura E Diamond, Wolbert Van den Hoom, Kim L Bennell, Tim V Wrigley, Rana S Hinman, John O’ Donnell, Paul Hodges 2. J Neurophysiol. 2014 Jul 15;112(2):374-83. doi: 10.1152/jn.00138.2014. Epub 2014 Apr 30. A neuromechanical strategy for mediolateral foot placement in walking humans.  Rankin BL 3. Podcast 99: How foot placement, the glutes and cross over gait all come together and make sense. 4. https://thegaitguys.tumblr.com/post/133206339519/podcast-99-how-foot-placement-the-glutes-and https://www.thegaitguys.com/thedailyblog/too-much-tripping-soles-worn-thin-too-much monthly 0.5 2016-08-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553410842-NGN0AENM11P6DX4MNZ8N/tumblr_obz6qgMirk1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553411459-98DLY84U71IF5B9G386P/tumblr_obz6qgMirk1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553410061-PZLO96JNCF6U1VAVQ1D6/tumblr_obz6qgMirk1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-109-a-clinical-case-of-a-total-knee monthly 0.5 2016-08-13 https://www.thegaitguys.com/thedailyblog/podcast-108-calf-muscle-power-motor-signatures monthly 0.5 2016-08-06 https://www.thegaitguys.com/thedailyblog/achilles-tendonitistendinopathy-and-needling monthly 0.5 2016-08-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553410091-MMC9HC13YBLPBSDP5KAL/tumblr_ob9ewd6arg1qhko2so2_250.jpg Blog Achilles Tendonitis/Tendinopathy and Needling Achilles pain. You can’t live with it and you can’t live with it. Can needling help? The obvious answer is yes, but there is more as well. There appears to be sufficient data to support the use of needling for achilles tendon problems . Perhaps it is the “reorganization” of collagen that makes it effective or a blood flow/vascularization phenomenon. The mechanism probably has something to do with pain and the reticular formation sending information down the cord via the lateral cell column (intermediolateral cell nucleus) or pain (nociceptive) afferents sending a collateral in the spinal cord to the dysfunctional muscle, affecting the alpha receptors and causing vasodilation.  Loss of ankle dorsiflexion is a common factor that seems to contribute to achilles tendinopathies . It would seem that improving ankle rocker would be most helpful. In at least one study, needling restored ankle function and in another it improved strength.  And don’t forget to go north of the lower leg/foot/ankle complex. The gluteus medius can many times the culprit as well. During running, the gluteus medius usually fires before heel strike, most likely to stabilize the hip and the pelvis. In runners with Achilles Tendonitis, its firing is delayed which may affect the kinematics of knee and ankle resulting in rear foot inversion. Perhaps the delayed action of the gluteus medius allows an adductory moment of the pelvis, moving the center of gravity medially. This could conceivably place additional stress on the achilles tendon (via the lateral gastroc) to create more eversion of the foot from midstance onward. Similarly, in runners with achilles tendoinopathy, the gluteus maximus does not fire as long and activation is delayed. The glute max should be the primary hip extensor and decreased hip extension might be compensated by an increased ankle plantarflexion which could potentially increase the load on the Achilles tendon.  So, in short, yes, needling will probably help, for these reasons and probably many more. Make sure to needle all the dysfunctional muscles up the chain, beginning at the foot and moving rostrally. Effectiveness of Acupuncture Therapies to Manage Musculoskeletal Disorders of the Extremities: A Systematic Review. Cox J, Varatharajan S, Côté P, Optima Collaboration. J Orthop Sports Phys Ther. 2016 Jun;46(6):409-29. doi: 10.2519/jospt.2016.6270. Epub 2016 Apr 26 Acupuncture’s role in tendinopathy: new possibilities. Speed C. Acupunct Med. 2015 Feb;33(1):7-8. doi: 10.1136/acupmed-2014-010746. Epub 2015 Jan 9. The effect of electroacupuncture on tendon repair in a rat Achilles tendon rupture model.  Inoue M, Nakajima M, Oi Y, Hojo T, Itoi M, Kitakoji H. Acupunct Med. 2015 Feb;33(1):58-64. doi: 10.1136/acupmed-2014-010611. Epub 2014 Oct 21. KIishmishian B, Selfe J, Richards J A Historical Review of Acupuncture to the Achilles Tendon and the development of a standardized protocol for its use Journal of the Acupuncture Association of Chartered Physiotherpists Spring 2012,  69-78 Acupuncture for chronic Achilles tendnopathy: a randomized controlled study. Zhang BM1, Zhong LW, Xu SW, Jiang HR, Shen J. Chin J Integr Med. 2013 Dec;19(12):900-4. doi: 10.1007/s11655-012-1218-4. Epub 2012 Dec 21. The effect of dry needling and treadmill running on inducing pathological changes in rat Achilles tendon. Kim BS, Joo YC, Choi BH, Kim KH, Kang JS, Park SR. Connect Tissue Res. 2015 Nov;56(6):452-60. doi: 10.3109/03008207.2015.1052876. Epub 2015 Jul 29. Tendon needling for treatment of tendinopathy: A systematic review. Krey D, Borchers J, McCamey K. Phys Sportsmed. 2015 Feb;43(1):80-6. doi: 10.1080/00913847.2015.1004296. Epub 2015 Jan 22. Review. Acupuncture increases the diameter and reorganisation of collagen fibrils during rat tendonhealing. de Almeida Mdos S, de Freitas KM, Oliveira LP, Vieira CP, Guerra Fda R, Dolder MA, Pimentel ER. Acupunct Med. 2015 Feb;33(1):51-7. doi: 10.1136/acupmed-2014-010548. Epub 2014 Aug 19. Electroacupuncture increases the concentration and organization of collagen in a tendon healing model in rats. de Almeida Mdos S, de Aro AA, Guerra Fda R, Vieira CP, de Campos Vidal B, Rosa Pimentel E. Connect Tissue Res. 2012;53(6):542-7. doi: 10.3109/03008207.2012.710671. Epub 2012 Aug 14. Changes in blood circulation of the contralateral Achilles tendon during and after acupunctureand heating.Kubo K, Yajima H, Takayama M, Ikebukuro T, Mizoguchi H, Takakura N. Int J Sports Med. 2011 Oct;32(10):807-13. doi: 10.1055/s-0031-1277213. Epub 2011 May 26. Microcirculatory effects of acupuncture and hyperthermia on Achilles tendon microcirculation. Kraemer R, Vogt PM, Knobloch K. Eur J Appl Physiol. 2010 Jul;109(5):1007-8. doi: 10.1007/s00421-010-1442-6. Epub 2010 Mar 28. Effects of acupuncture and heating on blood volume and oxygen saturation of human Achilles tendon in vivo. Kubo K, Yajima H, Takayama M, Ikebukuro T, Mizoguchi H, Takakura N. Eur J Appl Physiol. 2010 Jun;109(3):545-50. doi: 10.1007/s00421-010-1368-z. Epub 2010 Feb 6.  Insertional achilles tendinopathy associated with altered transverse compressive and axial tensile strain during ankle dorsiflexion. Chimenti RL, Bucklin M, Kelly M, Ketz J, Flemister AS, Richards MS, Buckley MR. J Orthop Res. 2016 Jun 16. doi: 10.1002/jor.23338. [Epub ahead of print] Forefoot and rearfoot contributions to the lunge position in individuals with and without insertionalAchilles tendinopathy. Chimenti RL, Forenza A, Previte E, Tome J, Nawoczenski DA.Clin Biomech (Bristol, Avon). 2016 Jul;36:40-5. doi: 10.1016/j.clinbiomech.2016.05.007. Epub 2016 May 11. Ankle Power and Endurance Outcomes Following Isolated Gastrocnemius Recession for AchillesTendinopathy. Nawoczenski DA, DiLiberto FE, Cantor MS, Tome JM, DiGiovanni BF. Foot Ankle Int. 2016 Mar 17. pii: 1071100716638128. [Epub ahead of print]  In vivo quantification of the shear modulus of the human Achilles tendon during passive loading using shear wave dispersion analysis. Helfenstein-Didier C, Andrade RJ, Brum J, Hug F, Tanter M, Nordez A, Gennisson JL. Phys Med Biol. 2016 Mar 21;61(6):2485-96. doi: 10.1088/0031-9155/61/6/2485. Epub 2016 Mar 7. Changes of gait parameters and lower limb dynamics in recreational runners with achillestendinopathy. Kim S, Yu J. J Sports Sci Med. 2015 May 8;14(2):284-9. eCollection 2015 Jun. Gastrocnemius recession for foot and ankle conditions in adults: Evidence-based recommendations. Cychosz CC, Phisitkul P, Belatti DA, Glazebrook MA, DiGiovanni CW. Foot Ankle Surg. 2015 Jun;21(2):77-85. doi: 10.1016/j.fas.2015.02.001. Epub 2015 Feb 26. Review. Limited ankle dorsiflexion increases the risk for mid-portion Achilles tendinopathy in infantry recruits: a prospective cohort study. Rabin A, Kozol Z, Finestone AS. J Foot Ankle Res. 2014 Nov 18;7(1):48. doi: 10.1186/s13047-014-0048-3. eCollection 2014. Perry J. Gait Analysis: Normal and Pathological Function. Thorofare, NJ: Slack 1992. Chan YY, Mok KM, Yung PSh, Chan KM. Sports Med Arthrosc Rehabil Ther Technol. 2009 Jul 30;1:14. doi: 10.1186/1758-2555-1-14. Bilateral effects of 6 weeks’ unilateral acupuncture and electroacupuncture on ankle dorsiflexors muscle strength: a pilot study. Zhou S, Huang LP, Liu J, Yu JH, Tian Q, Cao LJ. Arch Phys Med Rehabil. 2012 Jan;93(1):50-5. doi: 10.1016/j.apmr.2011.08.010. Epub 2011 Nov 8. Franettovich Smith MM1, Honeywill C, Wyndow N, Crossley KM, Creaby MW. : Neuromotor control of gluteal muscles in runners with achilles tendinopathy.
Med Sci Sports Exerc. 2014 Mar;46(3):594-9. https://www.thegaitguys.com/thedailyblog/take-good-look-at-these-gals-the-gal-on-the-left monthly 0.5 2016-08-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553410049-DS53XBDETL73QO42F603/tumblr_ob9ec4H58g1qhko2so2_540.png Blog Take good look at these gals. The gal on the left (in blue) looks like she has a level pelvis, but look at the upper body. She’s leaning to the left and has a great deal of torso rotation backward. One of the clues is the abduction of her left arm. Also note how her right arm crosses across her body. We wonder how she looks in right foot stance. The gal on the left (in red) has a subtle dip of the right side of her pelvis and also has over rotation of her upper body. Her right on crossing the body is a good reason to believe she will have a crossover gait if viewed from straight on. While both of these gals may have adequate strength, we question how much endurance they have as well as available rotation in the hips and lumbar spine. This is an excellent, referenced review of some of the current literature and controversy of strength and injury risk. A good read and certainly worth your time to get caught up on what’s current. We would love to see you study on endurance and injury risk. “While muscle strength may improve tolerance of loads during running, another reason for inconsistencies in the reported relationships between strength and injury risk may be that strength is typically assessed isometrically. It’s unclear how much of an influence peak isometric strength has on the dynamic task of running, and specifically on prolonged running in the presence of muscular fatigue. Schmitz et al found that, while isometric hip strength values were similar between novice and experienced runners, hip internal rotation motion during running was higher in the novice runners, suggesting isometric strength may not correlate strongly with muscular control and kinematics during running.” http://lermagazine.com/article/lower-extremity-strength-and-injury-risk-in-runners https://www.thegaitguys.com/thedailyblog/and-what-have-we-been-saying-about-loss-of-ankle monthly 0.5 2016-07-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553409653-BR8CR6TW55FIZBSIN4DU/tumblr_oam70ju3Rr1qhko2so1_400.jpg Blog and what have we been saying about loss of ankle rocker and achilles tendon problems for years now? Here is a FREE, FULL TEXT article talking all about it “A more limited ankle Dorsi Flexion ROM as measured in Non Weight Bearing with the knee bent increases the risk of developing Achilles Tendinopathy among military recruits taking part in intensive physical training.” J Foot Ankle Res. 2014 Nov 18;7(1):48. doi: 10.1186/s13047-014-0048-3. eCollection 2014.Limited ankle dorsiflexion increases the risk for mid-portion Achilles tendinopathy in infantry recruits: a prospective cohort study.Rabin A1, Kozol Z, Finestone AS. link to full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243387/ https://www.thegaitguys.com/thedailyblog/do-quarter-squats-transfer-best-to-sprinting-we monthly 0.5 2016-07-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553410033-K3B9BXF5AJ6UJJB2V4U1/tumblr_oam5qwAo6P1qhko2so1_1280.png Blog Do quarter squats transfer best to sprinting? We have always said that exercises are specific as to the type of exercise (isometric, isotonic, isokinetic) as well as the speed of exercise. And this backs that up, with a surprise: Unexpectedly, QUARTER produced superior gains in both vertical jump height and 40-yard sprint running times, compared with both HALF and FULL. give it a read, especially the vertical jump section.. https://www.strengthandconditioningresearch.com/promotions/quarter-squats-transfer-sprinting/ https://www.thegaitguys.com/thedailyblog/those-multifidi-the-multifidi-are-important monthly 0.5 2016-07-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553410579-K6C1KZAA915OS2LPLV99/tumblr_oavfyq8enM1qhko2so1_500.png Blog Those Multifidi The multifidi are important proprioceptive sentinels for the low back, as well as the rest of the body, for virtually every activity you do weight bearing, including gait. They are implicated in many instances of low back pain, especially folks with flexion or extension intolerance, since their fiber orientation and thus mechanical advantage (or disadvantage) is dependent upon whether or not you are maintaining a normal lumbar lordosis. Modalities which boost their function are an excellent adjunct to the rehabilitation process. Since they are not under volitional control (go ahead, try and contract your L2/L3 multifidus), they are innervated by the vestibulospinal tract and we must use proprioceptive work to engage them. Dry Needling is one modality that can help them to become functional again. RESULTS and CONCLUSION: “Significant difference was found in the percentage of change of muscle activation post needling between groups on the right side at level L4-5. A slight increase in the percentage of muscle activity, post procedure was observed in the dry needling group compared with the control group, although not significant in other segments examined. An improvement of back muscle function following dry needling procedure in healthy individuals was found. This implies that dry needling might stimulate motor nerve fibers and as such increase muscle activity.” see also our post here. J Back Musculoskelet Rehabil. 2015 Sep 6. [Epub ahead of print] The immediate effect of dry needling on multifidus muscles’ function in healthy individuals. Dar G1,2, Hicks GE3. https://www.thegaitguys.com/thedailyblog/arm-swing-asymmetry-it-can-be-a-huge-window-of monthly 0.5 2016-07-23 https://www.thegaitguys.com/thedailyblog/why-does-this-gal-have-so-much-limited-external monthly 0.5 2016-07-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553411322-P6JRIPPKLUROSAFV1CDF/tumblr_oa5thqROml1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553412110-ZGEEWPNVZMBA0EUOJH3M/tumblr_oa5thqROml1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553411755-XKOVPYOIJUGE7XBDB165/tumblr_oa5thqROml1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553412112-8E0SAVY6A1S5Q022FQ1O/tumblr_oa5thqROml1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/wow-can-you-figure-out-why-this-person-at-the monthly 0.5 2016-07-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553412418-5MYYCE8VH6GW218W24WF/tumblr_o8tlm8zPXq1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553412717-VR09T0XYUU9BUL0KI5Z7/tumblr_o8tlm8zPXq1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553412990-V4ZPRKBI6BRNDIBFPWKE/tumblr_o8tlm8zPXq1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553413663-NZULH42PP8TEZR2ZMRIO/tumblr_o8tlm8zPXq1qhko2so4_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/yay-for-the-lift-spread-and-reach-exercise-toe monthly 0.5 2016-07-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553414183-WOK7MOCTC84N7FQ6L8PJ/tumblr_oabrvarivX1qhko2so2_1280.jpg Blog Yay for the lift, spread and reach exercise! Toe spreads and squeezes are aimed at strengthening specific intrinsic foot muscles—the dorsal and plantar interrosei, according to Irene S. Davis, PhD, PT, director of the Spaulding National Running Center and a professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School in Boston. Doming or foot shortening exercises contract most of the muscles on the plantar side of the foot, and help to strengthen the abductor hallucis muscle see our post here: https://tmblr.co/ZrRYjx1iuSYMM Goo YM, Heo HJ, An DH. EMG activity of the abductor hallucis muscle during foot arch exercises using different weight bearing postures. J Phys Ther Sci 2014;26(10):1635-1636. https://www.thegaitguys.com/thedailyblog/a-visual-example-of-the-consequences-of-a-leg monthly 0.5 2016-07-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553414374-4BUT1N5HQ1BWVC4BSLZM/tumblr_oa5t63IlXj1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553414862-IV7WLUJKSVZ8HNBU9GG9/tumblr_oa5t63IlXj1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553415158-JFB805CQ7VQOIKLYUE7A/tumblr_oa5t63IlXj1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553415161-75416QP2IDCIH4NAEPI2/tumblr_oa5t63IlXj1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/loss-of-medial-tripod monthly 0.5 2016-07-16 https://www.thegaitguys.com/thedailyblog/leg-length-discrepancies-and-total-joint monthly 0.5 2016-07-14 https://www.thegaitguys.com/thedailyblog/forefoot-strike-running-do-you-have-enough-calf monthly 0.5 2016-07-13 https://www.thegaitguys.com/thedailyblog/how-are-your-hammys-another-tool-for-you-in monthly 0.5 2016-07-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553416510-4BFPS6UUAWFFA7P4XI50/tumblr_oa979sBaxX1qhko2so1_1280.png Blog How are your hammy’s? Another tool for you, in addition to making sure the gluten are on line, to improve ankle rocker and hip extension. “This study concludes that neural mobilization techniques are a useful adjunct to static stretching, without any risk of adverse events or injuries. Athletes or trainers can consider using one or both types of neural mobilization techniques to enhance muscular flexibility. Dosage of the neural mobilization as well as the proposed working mechanism behind the increase in hamstring flexibility can be found in the full text of the article.” http://www.ncbi.nlm.nih.gov/pubmed/26482098 Phys Ther Sport. 2016 Jan;17:30-7. doi: 10.1016/j.ptsp.2015.03.003. Epub 2015 Mar 17. Short term effectiveness of neural sliders and neural tensioners as an adjunct to static stretching of hamstrings on knee extension angle in healthy individuals: A randomized controlled trial. Sharma S, Balthillaya G2, Rao R, Mani R . https://www.thegaitguys.com/thedailyblog/improve-your-running-form-with-a-diy-analysis monthly 0.5 2016-07-12 https://www.thegaitguys.com/thedailyblog/more-on-landing-mechanics-here-is-a-recent monthly 0.5 2016-07-12 https://www.thegaitguys.com/thedailyblog/everything-you-wanted-to-know-about-the monthly 0.5 2016-07-12 https://www.thegaitguys.com/thedailyblog/one-point-and-1-treatment-can-profoundly-influence monthly 0.5 2016-07-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553415307-JPRKHVCE4RAOIKSEKCA7/tumblr_o9vc4xvrkE1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553415516-VWPCM7ZYRUWCO0AMCQXT/tumblr_o9vc4xvrkE1qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/new-research-on-non-motorized-treadmills monthly 0.5 2016-07-06 https://www.thegaitguys.com/thedailyblog/a-clear-cut-case-of-form-follows-function-leave monthly 0.5 2016-07-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553416112-MWQ2XDSQKHICKXOZXFGF/tumblr_ni72j0wHZ11qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553416498-ORA6DTKVA7AGRSIYEDKS/tumblr_ni72j0wHZ11qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553417271-S051TR7UKDF1R4YJ9JEX/tumblr_ni72j0wHZ11qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553417829-5LG7XB4YPZ4GH611U6YR/tumblr_ni72j0wHZ11qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553417983-IUD2VVX7M38NVOBLMG7N/tumblr_ni72j0wHZ11qhko2so5_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/a-marathon-a-day-for-over-120-dayson-one-leg monthly 0.5 2016-06-28 https://www.thegaitguys.com/thedailyblog/global-body-compensations-in-acl-deficient-knees monthly 0.5 2016-06-27 https://www.thegaitguys.com/thedailyblog/feature-arterial-disease-and-cycling monthly 0.5 2016-06-27 https://www.thegaitguys.com/thedailyblog/obesity-and-base-of-support monthly 0.5 2016-06-27 https://www.thegaitguys.com/thedailyblog/kinetic-chain-transfer monthly 0.5 2016-06-27 https://www.thegaitguys.com/thedailyblog/gait-and-autism-spectrum-disorder-asd monthly 0.5 2016-06-27 https://www.thegaitguys.com/thedailyblog/gait-and-the-lower-visual-field monthly 0.5 2016-06-27 https://www.thegaitguys.com/thedailyblog/base-of-support-and-chronic-ankle-sprains monthly 0.5 2016-06-27 https://www.thegaitguys.com/thedailyblog/have-you-seen-one-of-these-it-is-called-the monthly 0.5 2016-06-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553418854-2B2J7DH2SBJBFAWUGJMH/tumblr_o8tlmvwRSF1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553418405-7UVYO7D3VIPN02YAFE1L/tumblr_o8tlmvwRSF1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/holy-leg-length-discrepancy-these-pix-come-to-us monthly 0.5 2016-06-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553419319-022UCDEU8OUZP02ZCYBT/tumblr_o92viq6Er51qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553420269-FAIZRAE0VJIEDPRXERX6/tumblr_o92viq6Er51qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553419278-IZOECIX5MO6HNDAVPO8E/tumblr_o92viq6Er51qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/sounds-like-a-bad-idea-orthotics-can-be-useful monthly 0.5 2016-06-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553421505-XHLDWHWMN10BJO969DDA/tumblr_o8u2ufNbHP1qhko2so1_1280.jpg Blog Sounds like a bad idea Orthotics, can be useful adjunct to care. They can be used to give people biomechanics that they do not have while you were trying to improve them and help to make up for ranges of motion which do not seem attainable. From the gate cycle we know that after initial contact and loading response the calcaneus should start to evert. The calcaneus will continue to evert until it encounters something (like the lateral heel counter of the shoe). At mid stance it should be fully everted and as the opposite leg comes in to swing, begin to invert. The lateral heel counter assists in the inversion/supination process. To our knowledge, flip-flops, even if they have an increased arch, do not have a lateral heel counter and therefore will promote further lateral excursion of the calcaneus while the medial longitudinal arch is collapsing  (i.e.: midfoot pronation). Go ahead and place your foot into inversion and see what happens to your heel. It’s slides laterally. It’s also well-established that flip-flops, through flexion of the distal toes and engagement of the long flexor tendons, inhibits ankle rocker. It is often necessary to engage these muscles to keep the flip-flop from coming off. Lack of ankle rocker usually will inhibit hip extension and that can cause a constellation of problems. Though engagement of the long flexors of the toes will have a partial anti-pronatory effect, this is not enough to counter the excessive heel  eversion which is happening. We generally do not think the flip-flops are a great idea and telling someone that it’s “OK” to wear flip-flops as long as it has appropriate arch support, is silly. https://www.thegaitguys.com/thedailyblog/so-here-is-somewhat-of-a-controversial-subject monthly 0.5 2016-06-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553420154-VLLRQD5V3S4JVXU8RTBB/tumblr_o8vc46KNV71qhko2so1_1280.png Blog So here is somewhat of a controversial subject. Perhaps, though not discussed in this article, activating more axial extensors (vestbulospinal pathways, things like your erector spinae) could be somewhat protective, in that it could, at least theoretically, help to normalize flexor/extensor ratios in the lower extremity.  We see flexor dominance (increased corticospinal activity) in many cases of lower extremity problems causing an imbalance. Perhaps activating extensors the lower extremity (tibialis interior, extensor digitorum longest, etc.) could explain, in part, some of these (controversial) results. We’re not recommending or condoning taking up smoking to preserve your knees. This is merely food for thought in the ever-changing landscape of clinical application. http://lermagazine.com/cover_story/smoking-knee-oa-from-clinical-controversy-to-therapeutic-possibility https://www.thegaitguys.com/thedailyblog/pain-on-the-outside-of-one-leg-inside-of-the monthly 0.5 2016-06-15 https://www.thegaitguys.com/thedailyblog/ankle-sprains-and-the-reorganization-of-the monthly 0.5 2016-06-15 https://www.thegaitguys.com/thedailyblog/can-you-guess-why-this-person-has-left-sided monthly 0.5 2016-06-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553421090-ZMUYLUH1QF3P0E76LIC2/tumblr_o8cr4qQQa21qhko2so1_1280.jpg Blog Can you guess why this person has left-sided plantar fasciitis? This question probably seem somewhat rhetorical. Take a good look at these pedographs which provide us some excellent clues. First of all,  note how much pressure there is over the metatarsal heads. This is usually a clue that people are lacking ankle rocker and pressuring these heads as the leg cantilevers forward.  This person definitely have a difficult time getting the first metatarsal head down to the ground. Notice the overall size of the left foot compared to the right (right one is splayed or longer). This is due to keeping the foot and somewhat of a supinated posture to prevent excessive tension on the plantar fascia. The increase splay of the right foot indicates more mid foot pronation and if you look carefully there is slightly more printing at the medial longitudinal arch. This is contributing to the clawing of the second third and fourth toes on the right. Stand up, overpronate your right foot and notice how your center of gravity (and me) move medially.The toes will often clench in an attempt to create stability. The patient’s pain is mostly at the medial and lateral calcaneal facets, and within the substance of the quadratus plantae with weakness of that muscle and the extensor digitorum longus. She has 5° ankle dorsiflexion left and 10 degrees on the right and hip extension which is similar. The lack of ankle rocker and hip extension or causing her to pronate through her midfoot, Tensioning are plantar fascia at the insertion. The problem is worse on the left and therefore that is where the symptoms are. Pedographs can be useful tool in the diagnostic process and provide clues as to biomechanical faults in the gait cycle. https://www.thegaitguys.com/thedailyblog/shoe-drop-and-its-effects-on-the-shoe-itself-an monthly 0.5 2016-06-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553421184-1PCF36YFW7EDM2WEIB34/tumblr_o84av4iR3i1qhko2so2_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553421411-PAIKTTV7SM8LNW6ZUURX/tumblr_o84av4iR3i1qhko2so1_1280.png Blog https://www.thegaitguys.com/thedailyblog/short-leg-and-mottling-of-the-skin-have-you-ever monthly 0.5 2016-06-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553421566-QWV6DN4KK5MDITVGJN9H/tumblr_o864jbYF2R1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553422222-7CIKA3KE5LMPRCWLKXJS/tumblr_o864jbYF2R1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553422820-AHIJOODVXLZ4B00JWAIL/tumblr_o864jbYF2R1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553423243-M9X793NWMEDOLVZS3ADX/tumblr_o864jbYF2R1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/riding-the-inside-edge-of-the-sandal-mystery monthly 0.5 2016-06-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553423232-MU06K5V0XSOB5WR0HX50/tumblr_ni6lv4HU1v1qhko2so2_r1_250.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553423923-LIY1IJUQTHMEAKR78ZFZ/tumblr_ni6lv4HU1v1qhko2so1_500.jpg Blog https://www.thegaitguys.com/thedailyblog/treadmills-motorized-or-nonmotorized-can-have monthly 0.5 2016-06-01 https://www.thegaitguys.com/thedailyblog/podcast-107-unilateral-training-warping-the monthly 0.5 2016-06-01 https://www.thegaitguys.com/thedailyblog/the-diaphragm-and-chronic-ankle-instability monthly 0.5 2016-05-31 https://www.thegaitguys.com/thedailyblog/do-you-know-where-your-rocker-is-at-1st-pass monthly 0.5 2016-05-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553424252-Y598OM0QVR9MKDRSVF3E/tumblr_o80wf8tU9u1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553424554-7MCA42W3AXX7XBFGRNQD/tumblr_o80wf8tU9u1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/walking-in-sync-makes-enemies-seem-less-scary monthly 0.5 2016-05-28 https://www.thegaitguys.com/thedailyblog/pain-on-the-outside-of-the-leg-could-it-be-your monthly 0.5 2016-05-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553425521-L5YUTNFH1318XVSKXE48/tumblr_o7p469lND91qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553425242-HZC4CZZY44IU2TRSCX5Y/tumblr_o7p469lND91qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553425750-OUII4J82Z1U5A8397L64/tumblr_o7p469lND91qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553425767-7ZBFSHB6ZQBWV77MCZD7/tumblr_o7p469lND91qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553427024-5Z3PZGWQ8D5NIKAVKO3D/tumblr_o7p469lND91qhko2so6_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553427134-NZUV1IQHZ97DBQ7GD5Y7/tumblr_o7p469lND91qhko2so8_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553427456-N7JF4YGP3GV9IF2O9UGI/tumblr_o7p469lND91qhko2so9_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553427554-DEUIZY02DSKZE6ECB96Q/tumblr_o7p469lND91qhko2so5_r1_1280.png Blog https://www.thegaitguys.com/thedailyblog/looking-for-the-subtle-clues-will-help-you-you monthly 0.5 2016-05-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553427699-2EYQXDYKMI6OQ0Q7MS1D/tumblr_niel355Tjv1qhko2so1_1280.png Blog Looking for the subtle clues will help you. You should have hypotheses and work to prove or disprove them.  “Remember, this client is displaying these weight bearing differences side to side for a reason, this is their adaptive strategy. It is your job to prove that this is the cause of their pain, their adaptive strategy to get out of pain, or this is now a failed adaptive strategy causing pain, yet still not the root of the problem.” We used to call this a “windswept” presentation. It is not that it is incorrect, but it is so vague.   Look at these fippy floppers. Look closely at the dark areas, where foot oils and whatnot have played their changes in the leather upper of the flops. The right f.flop displays more lateral heel loading, rear foot inversion if you will. You can even see that there is less big toe pressure on this right side and even some increased lateral forefoot loading. This client appears to be more supinated clearly. You can even see there is more lightness to the arch leather on the right, again, more supination is suggested. The left f.flop suggests the opposite. More medial heel pressures and more over the medial forefoot and arch.  Now this clients f.flops tell a story.  So, this client is being windswept to the right we used to say, appearing to pronate more on the left and supinating more on the right.  Why are they doing this? Is the left leg functionally longer and by pronating they reduce the functional length of the leg (yet, increase internal spin of the limb and the host of naughty things that come with that). Is the right leg shorter, and by supinating they are raising the ankle mortise and arch which helps reduce the length differential ?  MAybe a bit of both, finding common ground for a more symmetrical pelvis ?  Who knows. This is where you need your physical exam, but, now you have some hypotheses to prove or disprove.  “Remember, this client is displaying these weight bearing differences side to side for a reason, this is their adaptive strategy. It is your job to prove that this is the cause of their pain, their adaptive strategy to get out of pain, or this is now a failed adaptive strategy causing pain, yet still not the root of the problem.” Is there some right hip pain from the right frontal pelvis drift creating some aberrant loading on the greater trochanter from ITB tension ? Perhaps a painful right hallux big toe, and they are unloading it to avoid pain? Maybe some knee pain or low back pain ? Who knows? Take your history and start putting the pieces together, it is your job. Just don’t screen them and throw corrective exercises at them, you owe it to them to examine them, take their history, watch them walk, teach them about what you see, and then sit down, spread the puzzle pieces out, look for the straight edges and corner pieces, and begin to build their puzzle.  Clues, they are everywhere, if you look for them. Dr. Shawn Allen, one of the gait guys https://www.thegaitguys.com/thedailyblog/144752937834 monthly 0.5 2016-05-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553427710-QEGI8GH58B00WCN0PNIY/tumblr_o7l0ztuJrv1qhko2so1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/landing-strategies-focusing-on-the-control-of monthly 0.5 2016-05-22 https://www.thegaitguys.com/thedailyblog/does-hill-running-equate-to-biking-when-it-comes monthly 0.5 2016-05-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553428531-Y1BQKNG59IU777NPQ64I/tumblr_o7hjhmbXaM1qhko2so1_1280.png Blog Does hill running equate to biking when it comes to pathomechanics ?Think about it, when  you are hill running, one leg is in extension while the lead leg is in more extremes (compared to road running) of hip flexion reaching up the hill for the next step. Isn’t this similar to biking ? On the bike one is bent over leaning forward, the lead leg is in extremes of flexion while the foot on the bottom crank has that same hip in extension.  So does hill running equate to biking ? Well, no. But then it comes to approximating anterior hip structures, there are some similarities. You cannot deny that there seems to be some similarities to pathomechanics.This was a post from a few weeks ago, but this week in our online teleseminar class we went over these principles.  We talked about some of the same biomechanical principles and vulnerabilities in hill running and when in biking.Might be a good time to revisit this brief blog post and see why we had hill running and biking in the same conversation. Dr. Shawn Allen Here is the hill running blog post where we mentioned a few things. http://thegaitguys.tumblr.com/post/143841190479/when-you-run-up-a-hill-most-of-the-cross-over https://www.thegaitguys.com/thedailyblog/screens-are-valuable-but-only-if-they-screen-all monthly 0.5 2016-05-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553429037-JIZSRJ5IX6N5X5JWI53G/tumblr_o7diqtWepC1qhko2so1_1280.jpg Blog Screens are valuable. But, only if they screen all the pertinent areas, only if the screener knows what to look for, and only if one realizes they are just a screen and not a platform for corrective exercise prescription. Guys like us and Gray Cook have been saying this for years. https://www.thegaitguys.com/thedailyblog/awkward-photosdate-smarter-but-necessarily-walk monthly 0.5 2016-05-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553429406-EF618YA7HU3KO1FJ5RN2/tumblr_o6pr1jnpUf1qhko2so1_1280.jpg Blog Awkward photos…Date smarter but necessarily walk that way… Take a look at this photo from an airplane magazine I was leafing through on my way home from teaching a recent needling seminar. I am not really interested in matchmaking (which this ad is for), but the “awkwardness” of the gait caught my eye (not much on the gait cam this time, sorry). Yes, their feet and legs seem to be in synch (for the most part), but take a look at the arms and hands. First of all, he has his right hand in his pocket, which will restrict its motion during forward movement of his left leg. In the shot, his right leg is forward (as is hers), though they are slightly out of synch. His left arm and hand don’t move forward that much in that he adducts it across his body, so he seems to move his left shoulder up and forward to compensate. She appears to be resisting this motion somewhat with her right arm as her right leg comes forward and she needs to lean her body to the right. Also note the increased abduction of her left arm and forearm as it extends in tandem with her left leg and thigh. Try walking with your right arm moving forward with your right leg. Notice how your right shoulder resists moving forward in tandem with the right hip? This is phasic, as Dr Allen likes to say, and because there is not an opposite force to counteract the forward movement of the hip in the saggital plane, you often lean to move the center of gravity to that side in the coronal plane. Wouldn’t it make slightly more sense, when walking hand in hand to have the opposite legs in synch, rather the same ones? Hmm…Food for thought and fodder. All that from a  little picture : ) https://www.thegaitguys.com/thedailyblog/1st-met-pain-in-an-orthotic-this-patient-came-in monthly 0.5 2016-05-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553429788-02DXY3NH06U9DK77VAHV/tumblr_o7941xdZHo1qhko2so7_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553430991-X898K4UHATBHS3YDOA80/tumblr_o7941xdZHo1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553430826-BQV27805JY7XSSQRA000/tumblr_o7941xdZHo1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553431025-ZTUEMH82IMSGM7A3VHPE/tumblr_o7941xdZHo1qhko2so6_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553431268-SLOYF5K8TC9ABG214D3E/tumblr_o7941xdZHo1qhko2so5_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553431393-O4TX7Z6HAUR2J9SYCJUW/tumblr_o7941xdZHo1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/i-think-one-must-study-hard-every-day-for monthly 0.5 2016-05-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553431394-AYE6XZK7FPKD7SXVQKRT/tumblr_o74d30sMmd1qhko2so1_1280.png Blog I think one must study hard, every day, for decades, just to be even remotely decent. https://www.thegaitguys.com/thedailyblog/training-out-a-crossover-gait-this-gal-came-to monthly 0.5 2016-05-12 https://www.thegaitguys.com/thedailyblog/a-nice-referenced-review-on-a-often-hotly-debated monthly 0.5 2016-05-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553432208-B6GLDZP6PBMEAX8TGJSV/tumblr_o6b0zjxaZs1qhko2so1_1280.png Blog A nice, referenced review on a often hotly debated topic.  “Can you emphasize vastus medialis activation in squats?Reading time:By Chris Beardsley, S&C Research columnistSome strength coaches have suggested that squats with either a narrow stance or with elevated heels can preferentially increase vastus medialis activation. They argue that training the vastus medialis is essential, because they believe it is more important than the other quadriceps at the bottom of the squat.But can we actually emphasize vastus medialis activation in the squat by changing stance width or adding a heel lift?And if we can, is the vastus medialis really more important at the bottom of the squat than the other quadriceps, anyway? Let’s take a look!” link to full text: http://www.strengthandconditioningresearch.com/perspectives/vastus-medialis-squats/ https://www.thegaitguys.com/thedailyblog/arm-and-leg-swing-gait-quiz-today-i-combine monthly 0.5 2016-05-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553432211-IORJ8EWE1X54OXDNI3XG/tumblr_o4mq96RWQc1qhko2so1_1280.jpg Blog Arm and leg swing gait quiz. Today I combine concepts from my previous quizes ! This one may really put you to the test.  Two women walking on a sloped beach. They are arm in arm. Take the principles I have taught you on slope walking, functional leg length differentials to level the pelvis, and arm swing to answer the question. Here is the question: Are these two more likely to walk “in phase or out of phase”?  * Do not mistaken the question for anti-phasic or phasic. These are two different concepts. If you are out of the loop on these 4 terms, just search the blog for them. Then come back here to answer this brain thumper. Make for your case in your head and then scroll down to hear my reasoning for my answer. This is an EXTREMELY difficult mind bender of a question. You will need to understand the concepts of 2 prior blog posts to even get to the starting line of the solution.  These are the questions I will often pose to myself so that I force the mental gymnastics of gait biomechanics, and quicken my “gait mind” so that I can leave room for processing unique factors in someone’s individual gait. If you have to take time to process the basics, you are gonna run out of time during a consultation and your client will notice you scratching your head. This is a maturation process, you must put in the work that Ivo and I have, if you want to solve the really tough cases. Simple cases are a break, a vacation if you will, they are welcome during a clinic day, but it is the tough cases that make you stretch that truly fulfill your day.  When you are in the clinic, you have to think fast, efficiently and effectively. Recently I had a powerlifter drive from out of state to see me. His case problems were unresolved for many years.  The treating clinician was on the right page, doing a great job actually, but there were so many issues going on that it was hard to see the root of the problem so the case was just being more “managed” than solved. His case was much like this one, all of the findings and factors were related but because I had seen this hodge podge of complaints before (right foot, right knee, left hip, low back, pelvis distortion and a classic Olympic lift compensation fail) so I knew quickly how to piece it all together into a logical solution and find the single spot to focus the therapy, at the root of the problem. My point is that I had done the hard “head scratching” work long ago, so I readily was able to dismiss the distractors and recognize this beast for what it was.   Back to the two ladies beach walking, I am basing things on a simple assumption that on most beaches the slope gently levels out at the water line, and that the sand several feet up the beach from the water is on a steeper incline, simple tide erosion principles.  Thus, the woman higher up on the beach will be on a steeper slope, this means more beach side leg knee flexion which means less hip extension, meaning a shorter right step length.  This will impair left arm swing, likely shortening it. Less right hip extension will be met by less left arm extension (posterior arm swing behind the body). This often leads to left arm cross over, arm adduction.  Here is where things get squirrelly. The lady lower on the beach is on a slightly more gentle slope but her issues are the same just muted slightly. So her right beach side leg is in less flexion at the knee and hip, so hip extension is greater and step length will be longer (relative to her friend higher up on the beach). However, she (ocean side lady) is being led by the impaired arm swing, as discussed above, of the lady on the beach side.  That is, if in fact she is being led or if she is the leader. Oy ! There is the brain bender !   One must consider who is the more corrupting force. In this case, the more corrupting forces will likely trump out the cleaner forces. The ocean side lady is clearly going to have a “more normal” gait with more normal arm and leg swing and step lengths, quite simply the slope she must negotiate is less so there is less corrupting forces on her. The lady on the beach side is having to accomodate more to her greater slope. The lady up the beach is working harder to keep her pelvis level, her eyes and vestiular apparati on the horizon, her differing step lengths from pulling her off from a straight line course, to keep her from falling over (the steeper the slope, the greater the balance challenge to fight from falling into the beach or falling down the slope. Laws of physics say that things roll down hill, so she is fighting this battle while trying to walk a straight line down a sloped beach, with a friends arm in tow). So, with all that said, one could logically assume that the gal up the beach is definitely working harder, she has greater differing arm and leg swings from side to side, different step lengths, greater struggles with staying up on the slope when gravity wants her to move down the slope, she has more left arm flexion and adduction to help pair with the struggling and perpetual right hip flexion (and loss of right hip extension), she will have to demonstrate more spinal stiffness to deal with these limb girdle torsional differences side to side and a host of other issues I have outlined in these prior “beach walking” quiz posts. Clearly beach side lady is working harder. Thus, just to maintain her gait posturing up on the slope, she will have to dominate the gait. If she gives in to the signals of her ocean side gal, she will have to soften her slope work strategies and she will move down the slope to easier ground.  Now, back to the question: Are these two more likely to walk “in phase or out of phase”?  Who truly knows is the answer ! However, we know beach lady is working harder and must continue to do so to stay up on the slope, so her left arm will remain dominant and the ocean side gal will have to accommodate to a very jerky yet cyclically synchronous gait. To walk linked together they will have to find some rhythm. Walking slower will be easier for them to find a harmoniously rhythm. However, one could make the case that “out of phase” gait will be easier (mental image to help you, if they tie ocean side lady’s right ankle to beach side ladies left ankle you will create “out of phase” gait. Thus, the ocean side lady will not mirror her beach side friend. Thus, when beach lady has right leg in extension, ocean side lady will have her left leg in extension. Why? Well, the left arm swing , their point of union, is the trouble zone. With beach side lady having the left arm in more flexion and adduction, the ocean side lady has to accommodate and meet that troubling arm swing. This means her right leg will be in extension at the same time beach side lady has her left leg in extension. This will be more accommodative work for ocean side lady, but she will just have to go with it. Failure to do so will pull her friend down off the beach and making life harder for her friend. So there you have it. The person up the slope is working harder to stay here, the person down the slope is working harder to accommodate to a gait that their  lower slope is not requiring. Thus, they are both working hard, but for different reasons. But the winner, the dictator, is the one with the greater slope risk. And thus, she will dictate an “out of phase” gait of her ocean side partner, if they are to still walk embraced.  How did you do ? Can you make a case for “in phase” as the solution ? I can, but I think that “out of phase” is more likely, for the above reasons. Thanks for playing  this tough one. Congratulations to you if you followed things smoothly. IF you did not, go back and play the mental game again, I think these are important fundamentals everyone should have if you are doing gait work. Dr. Shawn Allen https://www.thegaitguys.com/thedailyblog/how-brooks-plans-to-reinvent-the-stride-analysis monthly 0.5 2016-05-10 https://www.thegaitguys.com/thedailyblog/leg-pain-are-you-sure-its-a-disc-gluteus-minimus monthly 0.5 2016-05-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553433431-K0IJW8IR7KHLURFBFE1H/tumblr_o2uunml08W1qhko2so2_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553433994-T4L0YT2EJYX9D1E29QTH/tumblr_o2uunml08W1qhko2so1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/whats-wrong-with-this-picture-besides-the-fact monthly 0.5 2016-05-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553433905-FYJOJVUB7ES4782M7YGD/tumblr_o5bqxvqgrK1qhko2so1_1280.jpg Blog What’s wrong with this picture? (Besides the fact that you probably shouldn’t run with your dog on asphalt)  There’s been a lot of incongruency in the media as of late. This particular gal, with your head rotation to the right is going against the harmony of neurology and physiology. Let me explain…  This particular gal, with her rotated to the right is going against the way the nervous system is designed to work. In a post  in the last week or so (the massage cream one and  incongruent movement) we talked about tonic neck responses. When the head is rotated to one side, that upper and lower extremity should extend while the contralateral side should flex. This poor gal is fighting her own neurology!   Also note that she really doesn’t have that much hip extension on the right and increases her lumbar lordosis to compensate. Gee whizz. You’d a thought they would have done better…  So much for the photo op : -)  https://www.thegaitguys.com/thedailyblog/when-you-run-up-a-hill-most-of-the-cross-over monthly 0.5 2016-05-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553434141-9OWUOTO03YXDC8G2Y39V/tumblr_o4mqvi8TEq1qhko2so1_500.jpg Blog “When you run up a hill, most of the cross over gait disappears. Runners will tend toward beautifully stacked lower limb joints.”- Dr. Allen Are people running up a hill more likely to tend towards a cross over gait style, in other words tend toward a more narrow gait step or a wider gait step ? Watch people run up hill closely. Even if they are cross over (narrow foot fall) runners, when running up hills a few things will negate much of the narrow foot fall. 1- Running up hill requires more gluteals, more power is needed for all that extra required hip extension to power up the hill. More gluteal max use can, and will, spill over into the posterior fibers of the gluteus medius and this will tend to abduct the leg/hip and reduce some of the cross over tendency. 2- When one runs up a hill, there is a forward pitch of the upper torso, often with a some degree of forward pitch occurring at the hips. More importantly, because one is running up hill, they are stepping up and so more than normal hip flexion is necessary than in normal running. The forward pitch of the body and the greater degree of hip flexion is the culprit here. If the hip/leg is adducted in a cross over style, adding this to a more than normal flexing hip, it will create a scenario for anterior hip impingement and risk of femoral acetabular impingement (FAI) syndromes. Go ahead, test it for yourself. Lie on your back and flex your hip, drawing your knee straight up towards your shoulder.  Pretty good range correct ?  Now, flex the hip drawing your knee towards your navel, adducting it a little across your body. Feel the abrupt range of motion loss and possible pinch in the front of the hip ?  FAI.  This is what would happen if you utilized a cross over gait, narrow foot strike gait. The goes for mountain/sleep hill hikers as well.  This is why, if you are a narrow foot striker, a near-cross over type of runner, you will see it disappear when you run up hills.   If you get anterior hip pain running up hills, force a wider step width and reduce the possible impingement at the anterior hip joint. Just make sure you have enough ankle dorsiflexion to tackle the hill in the first place. If not, you may welcome some foot and ankle stuff to the table along with the hip.   Likely obvious stuff to most of the readers here, but sometimes it is nice to point out the obvious.  Hills, just because they are there, doesn’t mean you have the parts to run them safely. Dr. Shawn Allen https://www.thegaitguys.com/thedailyblog/every-foot-has-a-story-this-is-not-your monthly 0.5 2016-05-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553434985-DWVMF8U7FO8XCGOBJ1B8/tumblr_o5bqzkYA0a1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553435753-Y1V1EULOACE5GENBSEPP/tumblr_o5bqzkYA0a1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553435528-9PJHKGDEN2YM4U9ASGJB/tumblr_o5bqzkYA0a1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553435564-THDF27R74PCDV5R7VEKF/tumblr_o5bqzkYA0a1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553435462-CAKLYXR38FK48LLKOK4G/tumblr_o5bqzkYA0a1qhko2so5_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553435969-4XDJG22DUXXJ2MT0PQSA/tumblr_o5bqzkYA0a1qhko2so6_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553436667-EVR2FBSTQI8Z5H58GGFR/tumblr_o5bqzkYA0a1qhko2so7_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553438223-YHV6YYEABAPM0UG09AUS/tumblr_o5bqzkYA0a1qhko2so8_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553436906-DH5GU1J9Q4ZRYHX89S0Z/tumblr_o5bqzkYA0a1qhko2so9_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/143792811654 monthly 0.5 2016-05-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553437718-MDKSLN6YH1VL41HK8XYC/tumblr_o5kso4MKp51qhko2so5_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/one-way-to-correct-an-dysfunctional-extensor monthly 0.5 2016-05-02 https://www.thegaitguys.com/thedailyblog/podcast-106-understanding-tendonopathies monthly 0.5 2016-04-30 https://www.thegaitguys.com/thedailyblog/143607489904 monthly 0.5 2016-04-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553437868-3D09MNY69FM0DWHGRTJ0/tumblr_o6f98atfPj1qhko2so1_500.jpg Blog https://www.thegaitguys.com/thedailyblog/knee-hyperextension-and-delayed-heel-rise-in-an monthly 0.5 2016-04-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553438606-53JOO30Y68MWNWLEGP9K/tumblr_o4moyrepS61qhko2so1_1280.jpg Blog Knee hyperextension and delayed heel rise in an interesting sport, Racewalking. If you have been in practice long enough, you should know by now that in order to truly help an athlete you have to know their sport, the subtleties and the specifics.  You have heard us talk about premature heel rise off an on for years. Today, you must consider the opposite, delayed heel rise and the bizarre loading responses that come into the kinetic chains from such a behavior. Racewalking is a long-distance event requiring one foot to be in contact with the ground at all times. Stride length is thus reduced and so to achieve competitive speeds racewalkers must attain cadence rates comparable to those achieved by Olympic 800-meter runners for hours at a time. Most people cannot truly appreciate how fast these folks are going. There are really only two rules that govern racewalking: 1-The first rules states that the athlete’s trailing foot’s toe cannot leave the ground until the heel of the leading foot has created contact.  2-The second rule specifies that the supporting leg must straighten, essentially meaning knee extension (and for some, terminal extension, ie. negative 5-10 degrees !) from the point of contact with the ground and remain straightened until the body passes directly over it. Again, essentially meaning full range knee extension for the entire stance phase of gait (early, mid and late midstance phases).  Delated heel rise ? Clearly some folks are going to take knee extension a little more literally. Look at the fella in the red and yellow. Can you say knee HYPER extension ? This is right knee anteriormeniscofemoral impingement looming on the horizon, this is an anterior compression overload phenomenon via the quadriceps. This is often met in this sport with the delayed heel rise that the sport seems to often drive. Prolonging the foot ground contact phase, attempting to abide by Rule#2, “the support  leg must straighten”, can lead to knee hyperextension if one is not careful. This will put a longer stretch load into the achilles and posterior compartment mechanism and this prolonged stretch-contract load can eventually lead to local pathology let alone in combination with the anterior knee compression we just eluded to. These folks will also be at risk for more anterior pelvic tilt, distraction of the anterior hip capsule-labral interval, unique hip extension and gluteal integration, and even possibly altered hip extension motor patterning driving abnormal loads into the hamstrings and low back.  Just imagine the changes in the hip flexor strategies in this scenario.  To help your athletes, know their sport, know your normal biomechanics and know the pathologies when the rules of clean biomechanics are broken. Today, on Rewind Friday, we will repost a more in-depth, with video, piece we did a few years ago on Race Walking. You may learn more about normal and abnormal gait than you think, today we translate some of the rules of the sport of race walking into deeper thoughts on gait mechanics. Here is the link to our more in-depth video assessment and dialogue on the fascinating sport of race walking. If you have never truly looked at this sport before, you should enjoy this Rewind Post. (link). - Dr. Shawn Allen https://www.thegaitguys.com/thedailyblog/not-sure-we-agree-this-is-the-best-direction monthly 0.5 2016-04-27 https://www.thegaitguys.com/thedailyblog/143483107278 monthly 0.5 2016-04-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553439074-K3UGDA3SKV3ZXRZGLLYO/tumblr_o5ksm6mAFA1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/got-graft-got-acl-rehabbing-one-this-will-give monthly 0.5 2016-04-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553439212-M3U9QR79WBQ1YBI3O5ZD/tumblr_o5ssji7X3M1qhko2so1_1280.jpg Blog Got Graft? Got ACL? Rehabbing one? This will give you some excellent insight. An excellent read for folks wanting to know more about ACL grafts and outcomes. Bottom line: allografts (your own tissue) seem to fare better than autografts (cadaver tissue) BPTB (bone patellar tendon bone) seem to have more longevity. Read on here https://www.thegaitguys.com/thedailyblog/treat-the-paraspinals-in-addition-to-the monthly 0.5 2016-04-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553439184-19BV5ECJKCEJ6CLG6BBW/tumblr_o66w71RSD61qhko2so1_1280.gif Blog Treat the paraspinals in addition to the peripheral muscle As people who treat a wide variety of gait related disorders we often emphasize needling the paraspinal muscles associated with the segemental innervation of the peripheral muscle you are treating. For example, you may facilitate or needle the L2-L4 paraspinals (ie: femoral nerve distribution) along with the quads, or perhaps the C5-C6 PPD’s along with the shoulder muscles for the deltiods or rotator cuff for arm swiing. We do this to get more temporal and spacial summation at a spinal cord level, to hopefully get better clinical results. White and Panjabi described clinical instability as the loss of the ability of the spine, under physiologic loads, to maintain relationships between vertebrae in such a way that there is neither damage nor subsequent irritation to the spinal cord or nerve roots, and, in addition there is no development of incapacitating deformity or pain due to structural changes. Increased movement between vertebrae (antero or retrolisthesis) of > 3.5 mm (or 25% of the saggital body diameter) during flexion and/or extension suggests clinical instability. This often leads to intersegmental dysfunction and subsequent neurological sequelae which could be explained through the following mechanisms: Recall that the spinal nerve, formed from the union of the ventral (motor) and dorsal (sensory) rami, when exiting the IVF splits into an anterior and posterior division, supplying the structures anterior and posterior to the IVF respectively. The posterior division has 3 branches: a lateral branch that supplies the axial muscles such as the iliocostalis and quadratus; an intermediate branch, which innervates the medial muscles, such as the longissimus, spinalis and semispinalis; and a medial branch, which innervates the segmental muscles, (multifidus and rotatores) as well as the joint capsule. Inappropriate intersegmental motion has 2 probable neurological sequelae: I) alteration of afferentation from that level having segmental (reflexogenic muscle spasm or vasoconstrictive/vasodilatory changes from excitation of primary afferents and gamma motoneurons) and suprasegmental (less cerebellar afferentation, less cortical stimulation) effects and II) compression or traction of the medial branch of the PPD, causing,  over time, demyelination and resultant denervation, of the intrinsic muscles, resulting in impaired motor control both segmentally and suprasegmentally. The segmental effects are directly measurable with needle EMG. This is a form of paraspinal mapping, which has also been explored by Haig et al. So, in short, instability can lead to denervation and denervation can lead to instability. We often see clinically that treating a trigger point (needling, dry needling, acupuncture, manual pressure) can alter the function of the associated muscle . Improvements in muscle strength and changes in proprioception are not uncommon. Needling also seems to increase fibroblastic activty through the local inflammation it causes. Wouldn’t better muscle function and some scar tissue be a beneficial thing to someone with instability? The next time you have a patient with instability, make sure to include the paraspinals in your quest for better outcomes. https://www.thegaitguys.com/thedailyblog/and-what-have-we-been-saying-gait-problems-leave monthly 0.5 2016-04-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553439321-3RSOWUXLMOBJSN774DEG/tumblr_o5ssud9wcm1qhko2so1_400.jpg Blog and what have we been saying? Gait problems leave clues. Asymmetry is a BIG clue “Asymmetrical lower extremity neuromuscular control is predictive of repetitive stress injury in recreational runners, according to findings presented at the Combined Sections Meeting of the American Physical Therapy Association in February in Anaheim.” http://lermagazine.com/issues/march/years-after-achilles-tear-injured-limb-demonstrates-elevated-knee-loading https://www.thegaitguys.com/thedailyblog/do-you-have-enough-in-the-anterior-tank-dr monthly 0.5 2016-04-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553440421-UBCJ6V7PEZASQUJRUBB8/tumblr_o4monaC13a1qhko2so1_1280.jpg Blog Do you have enough in the anterior tank ? Dr. Allen’s quiz question and lesson of the week. One of my favorite sayings to my clients, “Do you have enough anterior strength to achieve and maintain posterior length?”   Translation, do you have enough anterior lower leg compartment strength (tibialis anterior, long toe extensor muscle group, peroneus tertius) to achieve sufficient ankle dorsiflexion in order to achieve posterior compartment length (gastric, soleus, tibialis posterior, long toe flexor muscle) ?  You see, you can either regularly stretch the calf-achilles complex or you can achieve great anterior compartment strength, to drive sufficient ankle dorsiflexion, in effect EARNING the posterior compartment length. This is a grounded principle in our offices. It is the premise of the Shuffle Walk exercise (link) and many others we implement in restoring someones biomechanics. Now on to today’s quiz question. In this photo, both people are just mere moments before heel strike.  1. Who is gonna need to have more eccentric strength in the anterior compartment ? And what if they don’t have it ? Repercussions ?   2. Who is toeing off the lateral forefoot ?  3. Who is crossing over more and thus could have more gluteus medius weakness ? A picture is worth a thousand words. Answers and dialogue below. . . . . . . 1. The lady in the high heeled shoes. If she heel strikes first, the larger longer heel on her shoe will mean she will need more of a prolonged eccentric loading of the anterior compartment to lower the forefoot to the ground. I hope she shortens her strike so she can get close to mid foot strike, it will negate most of this issue.  Repercussions? Forefoot pain, clenching/hammering of her toes from use of the long flexors to dampen loading of the metatarsal heads, and even possibly anterior shin splint like pain. 2. The lady is clearly in more lateral toe off, this is from the intoe’ing we see. This is low gear toe off. She may have limb torsion, internal tibial torsion to be specific, or insufficent external hip rotation control as a possibility. There are several possibilities here. 3. Hard to say, but the man seems to be crossing over more. There is also no arm swing, hands are in the pockets, this is a big hit to gait economy. We have discussed these numbers in previous blog posts, the numbers are significant and real.  Step width is also a real factor, reduced step width leads to joint stacking challenges and is found with weaker hip abductors and changes in the iliotibial band length. A picture can be worth a thousand words. I am a few short of the mark today, but I wanted to keep it short. Dr. Shawn Allen, one of the gait guys https://www.thegaitguys.com/thedailyblog/an-industry-wide-concern-if-you-ask-us-and-the monthly 0.5 2016-04-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553441054-WIUDXAIW1C85JAKBH9JC/tumblr_o5wb9z1bCF1qhko2so1_1280.png Blog … an industry wide concern if you ask us, and the problem with looking to solve your problem on the internet. When was the last time you went on youtube to look for your magic pill exercise ? Come read Dr. Allen’s blog post today and take his Case Quiz question of the week ! Come knock your brain around a bit. Post/Quiz link: http://thegaitguys.tumblr.com/post/142737112319/is-your-client-feeling-better-because-they-are https://www.thegaitguys.com/thedailyblog/143062334819 monthly 0.5 2016-04-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553441579-BO7GNMRN8HRT2RYTKA4S/tumblr_o5kskadcPm1qhko2so1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/deep-neurology-principles monthly 0.5 2016-04-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553441345-V19G2VQQT57MYIBHVAZW/tumblr_o5ky7bXJnz1qhko2so1_500.jpg Blog deep neurology principles :) https://www.thegaitguys.com/thedailyblog/this-is-apparently-a-growing-thing-interval monthly 0.5 2016-04-14 https://www.thegaitguys.com/thedailyblog/podcast-105-adding-strength-to-your-system monthly 0.5 2016-04-13 https://www.thegaitguys.com/thedailyblog/go-ahead-take-the-shot-this-runner-came-in-with monthly 0.5 2016-04-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553443030-898DTDQOFJ7IV4JNEMMI/tumblr_o586ok0qOo1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553442563-7X6RP75RHP0C3JXQL12V/tumblr_o586ok0qOo1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553442296-6BQMQ9ARE5V8GAJD7UF4/tumblr_o586ok0qOo1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/is-your-client-feeling-better-because-they-are monthly 0.5 2016-04-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553442639-JMY3H7PF9P89TM76APK6/tumblr_o5alluXLFv1qhko2so1_500.png Blog “Is your client feeling better because they are truly fixed, or have your prescribed corrective exercises merely raised the capacity and durability of their compensation ?  Welcome to a global industry problem.”  -Dr. Allen Which hip will have troubles extending ? Remember this quiz question from 2 weeks ago ? I talked about how the body will compensate to level the pelvis (and eyes and vestibular apparatus). Lets go further down the rabbit hole.  Here is your question of the week (you may have to go back and review the prior blog post if you are unsure of how the body will cope with the slope.  Here is that first blog post. Question: Which hip will have troubles getting into hip extension and thus terminal glute-hip-pelvis stabilization ? Answer:  scroll down (at least think about it for a second) . . . . . . Answer: The leg on the up slope of the beach, the non-water side leg will have to be in a modest degree of knee flexion to shorten and accommodate to the slope. A Flexed knee is not an extended one and it will be far more difficult to extend the hip and get into the glutes. Propulsion will also be compromised.  For you indoor small track runners this will happen to you on the inside leg on the curves of the track. This is why we see so many hamstring injuries during indoor track.  Think about it ! It is not just bad luck.  Go ahead, tally up  your teams history of hamstring injuries, you should find more on the left leg for track runners. It is simple applied biomechanics.   Also, imagine the altered demand on the quadriceps on that flexed knee (the right knee in the picture above, and the left knee in circle track runners). Furthermore, what is the likelihood that the right pelvis will deviate into an anterior tilted posture ? You bet ya, a greater tendency, and thus a possibly shortened quadriceps/hip flexor mechanism.  Do you think this could inhibit hip extension and gluteal function ? You bet ya.  Oh, and one more thing, if you are true gait nerd, you should have asked yourself one more question, what about ankle rocker ?  Yes, you will need more ankle rocker on the beach side foot (flexed knee side). When the knee flexes, there must be more ankle rocker for this to occur, if not, you may implode into some unwelcome arch collapse, because arch collapse offers more false ankle rocker. What a mess huh !   Now, do not be shocked EVER again when your client’s come back from a sunny beach vacation from walking the beaches for hours every day, and find themselves a stark raving mad mess.  It is not the salty ocean air or the tequila, it is the slope. One could make a case that walking up and down the beach should balance things out, but that is only if we are balanced and symmetrical when we start out. Gravity always wins. One final rant. If you are offering “corrective exercises” to your clients, you had better know at least the basics of movement and biomechanics. And further more, you had better know how to examine for them, and that means hands on assessment of the body, not just looking at how your client moves through a battery of tests. If the prior blog post (here) and today’s blog post principles are not remedial principles of knowledge for you, offering corrective exercises without this knowledge and a physical exam to confirm your assumptions is fraught with disaster, or at least helping your client to build deeper compensations on their prior compensations. Is your client feeling better because they are truly fixed, or have your prescribed corrective exercises merely raised the capacity and durability of their compensation ?  This is the kind of stuff that keeps my new patient scheduling booked at 4-8 weeks out … . .  frustrated clients. This is why we do not offer online consultations like some do. Because, we have not figured out how to obtain the third dimension needed in our gait and movement observation (thank you Oculus Rift, the future is near) but more so, we cannot take that information and put it together with our own physical examination to determine whether if what we are seeing is the actual problem, or a compensation. Here in lies the pot of gold. Another clinical pearl from Dr. Allen https://www.thegaitguys.com/thedailyblog/rock-your-clinical-exam-what-sensation-is monthly 0.5 2016-04-12 https://www.thegaitguys.com/thedailyblog/whats-wrong-with-this-picture-the-model-is monthly 0.5 2016-04-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553443100-8DZUCTRLXYT1FY3W0C5G/tumblr_o586cyqPs41qhko2so1_1280.jpg Blog What’s wrong with this picture?  The model is obviously well sculpted and hopefully will paid for the toll that this exercise will be taking on her nervous system overtime. Take a close look at the picture above on the left. Look carefully and what do you notice? Do you see it? This exercise is neurologically incongruent.  Her right arm is flexed at the same time as her right hip. When does this ever happen in gait?  Do you remember crossed extensor responses or tonic neck reflexes? If not, see here and here. When we walk the right arm and left leg or flexed while the left arm and right leg are extended. During a tonic neck response, and that is rotated to one side the upper and lower extremity (upper greater than lower) should extend on that side with flexion on the contralateral side. During a tonic neck reflex, the head is rotated to one side the upper and lower extremity (upper greater than lower) should extend on that side with flexion on the contralateral side. In the picture above her torso is rotated to the left while looking straight ahead which is effectively right neck rotation and her extremities are flexed on that side.  In the picture above her torso is rotated to the left while looking straight ahead which is effectively right neck rotation and her extremities are flexed on that side. Who thinks of these things? Certainly not folks that are paying attention to appropriate neurology and physiology!  Oh yeah, and the ad was for massage cream. Jeez… https://www.thegaitguys.com/thedailyblog/there-are-few-places-we-will-accept-a-cross-over monthly 0.5 2016-04-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553443990-HUUDC7X6CZ3OPBYNBDRQ/tumblr_o4mot4cmku1qhko2so1_1280.jpg Blog There are few places we will accept a cross over gait as safe and normal, this is one of them. Anyone want to place a bet this person does not have a rigid pes planus ? We are happy to take your money if you bet against this one. (hint: a rigid pes planus, is RIGID, it will not form an arch like this, even from upward pressure, in most people who have it). A rigid pes planus can result from a long standing (years) insufficient tibialis posterior or complete tear of one (again, moon’s ago) resulting in an inability to invert the heel and raise the arch. We saw one this week. https://www.thegaitguys.com/thedailyblog/the-vasti-do-you-treat-runners-do-you-treat-folks monthly 0.5 2016-04-07 https://www.thegaitguys.com/thedailyblog/the-elusive-iliocapsularis-as-with-many-things monthly 0.5 2016-04-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553444288-DFY3GKDDFH9U8VNHKDIZ/tumblr_o52truAnp11qhko2so1_500.png Blog The Elusive Iliocapsularis As with many things, one thing often leads to another. I had a patient with anterior hip pain and what i believed was iliopsoas dysfunction, but I wanted to know EXACTLY which muscles attached to the hip capsule, to make sure I wasn’t missing anything. I turned up some great info, including a nice .pdf lecture, which I am including the link to along with a second paper that began my journey. I had thought the iliopsoas attached to the hip capsule, but it turns out it doesn’t, but the iliocapsularis does along with a host of others, including one of my favs, the gluteus minimus, which was believed to be part of the psoas, but actually is a completely separate muscle.  Did I mention that these are  FREE, FULL TEXT articles? Anyway, I began reading, with great interest, about the iliocapsularis and I found yet another great review paper on it, along with mechanical hip pain. This last paper has some real clinical pearls and I recommend reading it the next opportunity you have a bit of time. I began thinking about when the iliopsoas fires in the gait cycle (terminal stance to mid swing). So, it is firing eccentrically at pre swing (perhaps limiting or attenuating hip extension?), then concentrically through early and mid swing, when it becomes electrically silent. During running gait, the activation pattern is similar. This muscle is also implicated in femoroacetabular impingement (FAI), or more correctly anterior inferior iliac spine subspine impingement (AIIS Impingement) or iliopsoas impingement (IPI). They all can cause anterior hip pain and they should all be considered in your differential. The iliocapsularis muscle has its proximal attachment at the anterior-inferior iliac spine and the anterior hip capsule and does not attach to the labrum . Its distal insertion is just distal to the lesser trochanter. It can sometimes inset into the iliofemoral ligament and/or the trochanteric line of the femur. It is innervated by a branch of the femoral nerve (L2-4). It is believed to act to raise the capsule of the hip and be an accessory stabilizer of the hip.  OK, there you have it. the iliocapsularis. Another muscle you didn’t know you could access. It pays to know your anatomy! https://www.mcjconsulting.com/meetings/2012/asm/ePosters/files/ISHA_Poster_202.pdf  http://pubs.rsna.org/doi/full/10.1148/radiol.12111320 https://www.thegaitguys.com/thedailyblog/dr-allens-quiz-question-of-the-week-see-if-you monthly 0.5 2016-04-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553445536-4728O3FB8C927V5AAWR4/tumblr_o4mpdehMXX1qhko2so1_1280.jpg Blog Dr. Allen’s Quiz question of the week. See if you can get this one. Reference point is the Girl in the middle, big sister. Choose all that apply. Note: there is something deeper than the obvious going on here, it doesn’t make sense. Can you see it ?  a. she (big sister) is out of phase with her little sister  b. she is in phase with her little sister c. she is out of phase with her little brother d. she is in phase with her little brother e.  A and C f.  B and C g. B and D h. A and D i. AC~DC rules Yes, Answer  “i” is always right. otherwise the answer is … . scroll down . . . . . . . . F. she is in phase with her sister to her left and out of phase with her brother (at least if you are referencing her leg swing).  With her little sister, left feet are both forward in swing at the same time. However, there is something deeper and requires some true critical thinking. IF you got the answer correct, congratulations. IF you did not, type in “in phase gait” or “arm swing” into the blog search engine and you will be able to read more about “in phase” and “out of phase” gaits.   Now, look at the picture again. If she is “in phase” with her little sister to the left big sister should technically have her left arm in anterior/forward swing to meet little sister’s right arm swing. But, big sister’s left foot is forward, which technically means her left arm swing should be posterior to match her normal Anti-phasic gait.  But this does not pair with little sister. Can you see that this is a conflict in synchrony ?  In phase and phasic are not the same thing, nor are out of phase and anti-phasic. Search our blog for these differences.   Obviously you should glean by now that “In and out of phase” gait refers to the leg swing. Whereas, phasic and anti phasic gait refers to the synchrony of the upper and lower limbs in an individual.  The lower limb spinal cord motor neuron pools are more dominant than the upper arm pools (except in climbing, which is why I spent so much time last week talking about climbing and crawling here on the blog). Thus the lower legs often run the protocols and thus why arm swing changes should not be primarily or initially coached or amended in an athlete, they are very adaptive and accommodating.  The legs need to run the show, we need our arms free to be able to carry things while walking or running (water bottle, babies, spears, rifle, brief case etc) without disrupting the normal leg swing gait mechanics.   Big sister is “out of phase” with her brother when it comes to the legs, but their arm swings are matching in phase so that there is no conflict. When people walk “out of phase” their arm swings will always match. Thus, it would seem that this is the more harmonious way to walk with a partner.  So how are they all walking together ? Certainly not in harmony. Obviously the little sister is not in sync with big sister. She is much shorter, and thus her step length is going to be different and that is the likely answer. She will have to pick up cadence to keep up and that will mean much of the time she will not synchronize with her big sister. As I mentioned in a prior post on these topics, often the larger or more dominant person’s arm swing will dictate the arm swing pattern of the other partner, and this will in turn, dictate how the lower limbs synchronize to the dominant partner. It would make sense that perfect harmony would bring about “out of phase” leg swing, but it does not always occur. Why? There are many reasons I discussed here today, things like differing arm and leg lengths and step lengths come to mind. * There is one more option, none of them are in anti-phasic gait. Maybe they all have back pain :) Back pain patients tend to shift towards phasic gait to reduce spinal torsion and shear. If they all are anti-phasic then arm and leg swing matter very little in terms of full limb swing propulsive gait. This is quite possible as well, perhaps this is just a still photo representing a very slow strolling gait and thus little need for anti phasic gaits from all 3 of them.  Neat points if you are a true gait nerd. Did you catch it ? A picture is worth a thousand words. Hope this little quiz helped you to put some pieces together. One more thing, here is a clinical pearl. By walking hand in hand with someone, you can help a person learn arm swing and leg swing and how to create a clean cadence, the normal anti-phasic gait, and learn how to dual task as well as add audible, visual and tactile queues to one’s gait. It is a great tool for helping neurologic gait pathologies, post stroke gait training and helping someone who has joint replacements or back pain regain normal anti-phasic gait traits where gait has become phasic and apropulsive.  Dr. Shawn Allen https://www.thegaitguys.com/thedailyblog/manipulation-and-mechanoreceptors-do-you-do-joint monthly 0.5 2016-04-05 https://www.thegaitguys.com/thedailyblog/gait-and-climbing-and-dns-part-2-introducing monthly 0.5 2016-03-31 https://www.thegaitguys.com/thedailyblog/what-are-motion-control-features-anyway-in-this monthly 0.5 2016-03-30 https://www.thegaitguys.com/thedailyblog/softscience-the-terrain-ultra-lyte-shoe-update monthly 0.5 2016-03-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553445182-3A2R5YG8U14JLXOT3IH5/tumblr_o4utm7Ycrt1qhko2so1_500.jpg Blog SoftScience “The Terrain Ultra Lyte” shoe update: Introducing “The Terrain Ultra Lyte”.  Fresh off the UPS truck today and just unboxed ! Uber excited. Wearing them right now. Dang, zero drop with good cush. I could run in these babies ! And I will just to try, even thought that is likely not their intended purpose.  Gorgeous roomy toe box. True to fit. These feel like a favorite pair of worn in favorite leather gloves …  they are soft cotton canvass right out of the box.  I don’t think i even need to wait a few days, they should have a label that says “pre-worn in”. I may have just found yet another new favorite weekend casual shoes, I will save my Altra Everyday’s for work. I can see where the thinking came when the partners brought their wisdom over from Crocs (only the best parts were brought, the materials, from what i can see).   Removable, washable Trileon™ insole, non-marking, slip-resistant outsole Ultra lightweight, a pair in size 10 weighs just 1.6 lbs. (that is per pair !) *Welcome to Soft Science. one of our Podcast sponsors. Because we believe in them. Update one day later: Some have been asking about this shoe. I think they have done something unique here. This shoe is about 6 oz, yes, that is seriously uber light. That means there is no room for stabilizing rigidity factors in this shoe. It appears to be a well thought out “outsole” and a soft cotton canvas upper. That is it. If you need control, this shoe may not be for you. The outsole however offers a nice wide foot print with some flare of the sole out from the foot (look at their website, look at the shoe from behind), and that in itself offers stabilizing over something compared to like a glove type shoe. Now, on to the insole: I know what the website says, a “minimal heal to toe elevation”. I emailed the guru over as Soft Science. I have been told they are zero drop and after wearing i believe they are, and if not, maybe a millimeter ? I have sensitive feet, I wear zero drop all day long at work because I can. Not everyone can and this is important to note. I do not have any info outsole thickness of this particular shoe, the foot does recede somewhat into the outsole that you see, so there is not a tremendous amount of stack height as portrayed in photos, some of that is the outsole lipping up to grab onto the shoe’s upper. TRileon Insole:There is a VERY mild arch contour, not as much as in crocs (as one person asked) but it is present and mild. If you have a flatter arch, you will feel it, but, Trileon is uber cush so it is not offending at all. If you have a normal arch posture, you may not even notice it, it is that subtle. Insole: there feels like a 1-2 degree or 1-2 mm varus forefoot post, i have pretty sensitive feet and can tell these things readily, i may choose to grind this down on the insole, it wouldn’t take much to do this. If you take out the insole and put it on a hard floor and stand on it, you will notice the subtle forefoot varus posting of the foam. And if you put the insole in your hands and pinch finger tips together at the 1st metatarsal head and 5th met. head you will notice the thickness difference. * It is not much, but it is there. Some people can really benefit from it since many feet are have a slight FF varus. Some may not notice it at all. I did notice it because my forefoot is not varus’d at all.  I noted it less so when the insole was in the shoe so it may be off setting a slight depression in the outsole shell. I am not sure, so do not quote me on this. For most folks, this is “princess and the pea” subtle jibber jab talk and is not worthy of noting.  But we are shoe geeks and some of you want to know about peas. To be clear, I like this shoe so far, very much actually. It will be on my feet all week and all weekend……..many weekends.  Soft, uber light, no break in, zero drop, good looks, minimal, wide platform, ….. things i like and things that are important to me. The question is, “is it for you ?” That is up to you.  Nice work Soft Science. -Dr. Allen http://www.softscience.com/mens/the-terrain-ultra-lyte.html https://www.thegaitguys.com/thedailyblog/great-free-full-text-article-on-the-hip-an monthly 0.5 2016-03-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553445839-3BY34XN0ORK7HC6Y417P/tumblr_o4mcx4ZATp1qhko2so1_1280.png Blog Great, FREE FULL TEXT article on the hip. an EXCELLENT review with some great rehab tips at the conclusion like this “Once isolated contraction of the deep external rotator muscles is successfully achieved, progression can be made to the rehabilitation of secondary stabilisers and prime movers of the hip, particularly the gluteus maximus, initially using nonweight bearing exercises and progressing to weight bearing exercises once motor control and strength allows. Pre-activation of the deep external rotators may make these exercises more effective. Deficits in flexibility and proprioception should also be addressed at this stage. Once adequate hip muscle strength and endurance is achieved, functional and sports specific exercises can then be implemented. ” Can local muscles augment stability in the hip?: A narrative literature review T.H. Retchford, K.M. Crossley, A. Grimaldi , J.L. Kemp, S.M. Cowan J Musculoskelet Neuronal Interact 2013; 13(1):1-12 http://www.ismni.org/jmni/pdf/51/01RETCHFORD.pdf image from: https://www.researchgate.net/…/258427127_fig12_Fig-11-Anato… https://www.thegaitguys.com/thedailyblog/a-test-question-from-dr-allen-see-how-you-do monthly 0.5 2016-03-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553445504-FUQCJP4NB2F5IYZ6GOTH/tumblr_o4mpvo50fJ1qhko2so1_540.jpg Blog A test question from Dr. Allen, see how you do with this photo critical thinking. When you walk on the beach you are on a slope. The leg closer to the water naturally drops down to a lower surface.  Here is the game …  to keep the pelvis level on the horizon, one would have to: a. shorten the water side leg b. lengthen the water side leg c. pronate the water side leg d. supinate the water side leg e. lengthen the beach side leg f. shorten the beach side leg g. pronate the beach side leg h. supinate the beach side leg i. externally rotate the water side leg j. internally rotate the water side leg k. externally rotate the beach side leg l. internally rotate the beach side leg m. flex the water side hip n. extend the water side hip o. flex the beach side hip p. extend the beach side hip ******Ok, Stop scrolling right now !!!!!   List all the letters that apply first. You should have many letters.  *** And here is the kicker for bonus points, the letters can be unscrambled to spell the name of one of the most popular of the Beatles. Name that Beatle. . . . don’t look, figure it out before you scroll down further. It is important you try to work through the question and its foundational principles. . . . . . . Answer: B, D, F , G, I ,L , N, O * now, more importantly, make sure you think of these issues in all your clients with leg length discrepancies, both anatomic and function and when the pelvis is not level. This is the most important take away from today’s test question. If you got the answers correct, you have the knowledge to implement. If you did not get the answer correct, you need to hammer down the HOW and WHY of the answer before you start playing with people’s bodies putting in heel lifts (boooo), sole lifts, orthotics, postings etc. If you do not have the foundation to play by the rules, you should not be playing. ok, we were messing with ya on the Beatles thing. Sorry. Dr. Shawn Allen https://www.thegaitguys.com/thedailyblog/the-pitfalls-of-motion-control-features-welcome monthly 0.5 2016-03-28 https://www.thegaitguys.com/thedailyblog/yes-virginia-dizziness-and-vertigo-are-costly-i monthly 0.5 2016-03-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553446158-97UD5YOY4LG7PQCA76BY/tumblr_o4i7e73iIW1qhko2so1_400.jpg Blog Yes, Virginia. Dizziness and Vertigo are costly I had a Parkinson’s pt that came in this morning and had fatigue (more than usual) related to a recent onset of dizziness. He was trying to figure out why and It got me to thinking about the metabolic costs of disequilibrium. A quick pub med search found me having to try multiple search terms and all I was able to turn up was a few papers on the topic. I found that surprising, considering the prevalence of fatigue complaints with dizziness and vertigo. It makes sense to think of as proprioception is impaired (or altered), it would have a greater energy cost to get normal tasks done. I was able to turn up a few full text papers (below), and yes, the short answer is it does cost more to have impairment.  Gait Posture. 2015 Feb;41(2):646-51. doi: 10.1016/j.gaitpost.2015.01.015. Epub 2015 Jan 24.Metabolic cost of lateral stabilization during walking in people with incomplete spinal cord injury.Matsubara JH1, Wu M2, Gordon KE3. Arch Phys Med Rehabil. 2013 Nov;94(11):2255-61. doi: 10.1016/j.apmr.2013.04.022. Epub 2013 May 20.Effect of balance support on the energy cost of walking after stroke.Ijmker T1, Houdijk H, Lamoth CJ, Jarbandhan AV, Rijntjes D, Beek PJ, van der Woude LH. https://www.thegaitguys.com/thedailyblog/dragging-your-tongue-when-the-tongue-of-your monthly 0.5 2016-03-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553446419-49BJGBO5G89IZTX2O78B/tumblr_o4ipa72NHr1qhko2so1_1280.jpg Blog Dragging your tongue ? When the tongue of your shoe keeps getting pulled to the side. Do you know what it means ? It means plenty, if you are sharp. By: Dr. Shawn Allen This one pisses off most people it happens to. Why does it typically happen only on one side, on one shoe ? Look at the photo case above. Look closely to the left foot, the tongue of the shoe is pulled laterally compared to the right, or shall I say, dragged. This is a fairly common phenomenon, and there is a reason for it, several actually. So, no, you do not need to staple the tongue to the shoe upper, or tighten your shoe laces, or stitch the tongue to the medial shoe upper. You need to stop externally spinning your foot in your darn shoe.  What ?! Yes, you very well may be avoiding normal internal rotation progression of the pelvis over the fixated limb. Loss of internal hip rotation is often a common finding clinically. As one passes the swing leg forward, the forward progressing pelvis eventually meets this loss of internal rotation over the fixated leg and femoral head. The swing leg none the less progresses further forward to get to its’ heel strike and the stance phase leg has to externally spin over the ground (I like to give the analogy of putting out a cigarette butt on the ground or squishing a bug (PETA don’t come after me)). This is called an Abductory or Adductory twist (good video demo here) depending on whether your reference point is the forefoot or rear foot. Regardless, the heel is spinning inward, the forefoot is relatively spinning outward. This spin of the foot inside the shoe (this happens minutely just before the shoe spins on the ground) and pulls the tongue laterally with it.   This problem can also come from, and often does, a premature heel rise from things like a:  loss of ankle rocker short calf lack of hip extension hallux rigidus / limitus or even a painful big toe etc There are even several other causes I will not list here today, I could have you waste your whole day on the list and the mental gymnastics of things to consider. Basically, anything that impairs the stance phase mechanics creating a premature heel rise or failure of completing internal hip rotation can cause an Abd/Adductor twist of the foot/heel and drag the tongue laterally. Sure, there are others, but the purpose of my blog post here today was to explain a neat little biomechanical phenomenon that  has huge clinical insight if you know what it means.  You cannot fix this problem if you do not do a physical exam, understand clean and faulty gait biomechanics, and maybe can even find small objects in a dark room.  What I mean is it takes some educated exploration and a curiosity to want to fix things.   There are clues often right in front of you, all you have to do is pay attention and sometimes ask a simple question.  “Mr. Jones, when you stick out your tongue, does it drag laterally ?”   Ok, maybe not that exact question. But, when I see a loss of internal rotation or terminal hip extension in a runner, and when I have time to explain things deeply with a openly receiving client, I might start the conversation with that fun question and then explain what I really meant was the tongue of the shoe on that affected side.  You can’t swallow bandaids to fix things, as much as you wish it was that easy. Sure, you can avoid all of this fun by buying a shoe that has the tongue of the shoe sewn to the medial upper of the shoe, but then you wouldn’t have to fix anything.  Where would you “get your fun on” then ?  Be brave, go all in, fix the problem dammit.   These are the things that keep me up at night. Welcome to my nightmares. Dr. Shawn Allen, one of the gait guys Photo courtesy of this weartested.org link: http://weartested.org/wp-content/uploads/2015/03/altra-superior-2-top-socks.jpg https://www.thegaitguys.com/thedailyblog/why-is-that-muscle-so-tight-we-often-think-of monthly 0.5 2016-03-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553446829-RYAP604VPMA5UWMFX5G6/tumblr_o4f80xNfRo1qhko2so1_1280.jpg Blog Why is that muscle so tight? We often think of neurological reasons (increased facilitation of the agonist, decreased reciprocal inhibition of the antagonist, increase gamma drive, etc), but how about the series elastic element (ie the connective tissue)? Or perhaps the sarcomere (individual contractile unit of the muscle)? How can we fix that? It is easier than you thought! An oldie but a goodie. A great FREE FULL TEXT paper on sarcomere loss and how to prevent it. Yep, would you have guessed static stretching? Yes, this study was on mice and it seems plausible that it would be applicable to humans as well. “When muscle is immobilised in a shortened position there is both a reduction in muscle fibre length due to a loss of serial sarcomeres and a remodelling of the intramuscular connective tissue, leading to increased muscle stiffness. Such changes are likely to produce many of the muscle contractures seen by clinicians, who find that such muscles cannot be passively extended to the full length, which normal joint motion should allow, without the production of muscle pain or injury. …These experiments show that in addition to preventing the remodelling of the intramuscular connective tissue component daily periods of stretch of ½ h or more also prevent the loss ofserial sarcomeres which occurs in mouse soleus muscles immobilised in the shortened position.” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1004076/pdf/annrheumd00439-0044.pdf   link to full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1004076/pdf/annrheumd00439-0044.pdf https://www.thegaitguys.com/thedailyblog/a-great-quick-read-from-one-of-our-favs-dr-tom monthly 0.5 2016-03-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553447194-QI1JO6WX9LFROMYC4HJL/tumblr_o4h1gjsj4Y1qhko2so1_400.png Blog A great, quick read from one of our fav’s: Dr Tom Michaud. Here is my favorite excerpt. I had not thought of imaging the ankle quite this way “Physical examination reveals pinpoint sensitivity over the anteromedial capsule. When the ankle is slightly plantarflexed, the osteophytes on the talus and tibia can be readily palpated. Surprisingly, lateral X-rays only identify approximately 40 percent of the talotibial spurs, because the natural torsion of the distal tibia obstructs direct visualization of the anteromedial tibia. To improve radiographic accuracy, van Dijk, et al., recommend oblique radiographs be taken with a 45-degree craniocaudal angle, with the lower extremity externally rotated 30 degrees. The authors demonstrated that oblique radiographs identify 73 percent of the spurs located on the talus and 85 percent of the spurs located on the distal tibia.” https://www.thegaitguys.com/thedailyblog/gastroc-anyone-an-interesting-and-innovative monthly 0.5 2016-03-23 https://www.thegaitguys.com/thedailyblog/where-your-gait-might-break-down monthly 0.5 2016-03-22 https://www.thegaitguys.com/thedailyblog/low-back-pain-and-quadriceps-compensation-a monthly 0.5 2016-03-19 https://www.thegaitguys.com/thedailyblog/holy-twisted-tibias-batman-what-is-going-here-in monthly 0.5 2016-03-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553447316-S5W7B033K62UBXAJW3CU/tumblr_o471xcV05d1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553447601-WZVBU2SUBOMUOC4HAHDL/tumblr_o471xcV05d1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553448700-A449AR7G3DBRJNW8LET2/tumblr_o471xcV05d1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553449263-J9XVCGP19OWYY2LXZ1SO/tumblr_o471xcV05d1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/141198933557 monthly 0.5 2016-03-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553450442-7JOJBLYAZJOZS6CII2N1/tumblr_o453is9bvu1qhko2so1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/your-clients-strategic-protective-compensation monthly 0.5 2016-03-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553449666-K244E5KQKDUVJDTHDISL/tumblr_o450z3O8rB1qhko2so1_1280.png Blog Your client’s strategic, protective compensation patterns are a power leak and costing them greatly in efficiency and energy. There is a greater cost to compensation other than pain avoidance and protection. The cost is a loss in energy and efficiency as these numbers elude to. Think of how many people walking amongst us are in protective pain patterns causing a deep energy suck on the system. So, do your client and yourself a favor… . if you are instructing your clients on how to fix their arm swing on a local (arm/upper quarter) level, please stop. Please don’t use your gait analysis software to coach out arm swing changes, you are missing the boat if you are doing that. Arm swing aberrancies are quite often a manifestation of a greater global problem. Arm swing is largely a passive pendulum effect. Changes in the pendulum are often a sign of something bigger. This takes deep knowledge. https://www.thegaitguys.com/thedailyblog/the-death-of-meniscal-surgery monthly 0.5 2016-03-16 https://www.thegaitguys.com/thedailyblog/when-was-the-last-time-you-thought-about-the monthly 0.5 2016-03-14 https://www.thegaitguys.com/thedailyblog/those-with-chronic-neck-pain-demonstrated-a monthly 0.5 2016-03-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553450184-4FCLOONX3W7I8ZHJ0QFH/tumblr_o3u6f1rpfF1qhko2so1_500.jpg Blog “those with chronic neck pain demonstrated a narrower step width, a shorter step length and slower gait speed during walking with the head movements and at maximum speed” -  Uthaikhup et al. study: Head movement and Gait Parameters: By now you should have a good grasp of the global impact of gait and how it presents and translates in everything we do. It is how we move through this world, and everything we do, and everything that has happened to us, impacts our gait. And, our gait impacts things in turn, from our mental state to how we think and act.   By now, if you have been with us here on The Gait Guys long enough, you know that with the tremendous proprioceptive impact of the system from the cervical spine, that neck pain can influence sensorimotor function and thus motor function. However, little is known about the effects of head movement and walking speed on gait characteristics in patients with neck pain. From the Uthaikhup et al. study: Patient sample:  20 women aged between 18 and 59 years with chronic neck pain (>3 months) and 20 healthy controls of similar age, weight and height Indexes used: Neck Disability Index and Visual Analogue Pain Scale. “The experiment consisted of two walking sessions. The first session included walking with head straight, head up-down, and head turns from side to side. The second session included walking at comfortable and maximum speeds. Each trial was performed twice. Gait parameters measured using GAITRite walkway system were step length, stride length, step time, stride time, step width, cadence and gait speed.” According to this study, the clients with chronic neck pain showed several changes in how they implemented their gait. They displayed step width narrowing, a reduction in step length and speed of gait, and even an overall reduction in gait speed when neck movements were induced or encouraged or when there was pain.. As Uthaikhup et al. summarized, “The results suggest that patients with chronic neck pain have gait disturbances. This supports the notion that assessment of gait should be addressed in patients with persistent neck pain.” You have to know your gait norms to understand abnormals. We have written about other parameters that affect gait speed, step length and width here on the blog. Here is one more parameter for you to store in your noggin. It is all connected. So, when you goto your gait analysis guru, ask them if they are going to clinically assess your painful neck as part of the gait analysis (be prepared for the “deer in the headlights” look). Dr. Shawn Allen, one of the gait guys Reference: Man Ther. 2014 Apr;19(2):137-41. doi: 10.1016/j.math.2013.09.004. Epub 2013 Sep 27.The effects of head movement and walking speed on gait parameters in patients with chronic neck pain. Uthaikhup S, Sunkarat S, Khamsaen K, Meeyan K, Treleaven J. https://www.thegaitguys.com/thedailyblog/what-are-we-listening-to-this-week-the-physio monthly 0.5 2016-03-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553450274-LCZ164OI8E5PJOCNK894/tumblr_o3tzyelXRy1qhko2so1_1280.png Blog What are we listening to this week?  The Physio edge podcast with David pope. This week they interview Kurt Lisle about anterior knee pain. Here is our synopsis: One of the things they empahasized right off the bat was that patellofemoral pain not only refers about the knee but also below or most importantly posterior to the knee. The fat pad had a tendency to refer more locally where is other structures can refer to other areas. Aggravating factors for patello femoral dysfunctional pain tends to be flexion or activities involving flexion as well as compression of the knee and rest is in alleviating factor. The fat pad pain tends to be to either side of the patellar tendon and sometimes directly under it. This can be aggravated by standing, particularly with the knee and hyperextension, which compresses the fat pad. Patellar tendon pain tends to remain at the inferior pole of the patella on the tendon whereas patellofemoral pain has a tendency to refer more. Physical examination pearls: Patellar tendonopathy alone generally does not have effusion present where as the patellofemoral or fat pad injury may. Is there pain in passive hyperextension? This generally can mean fat pad injury or potential he ligamentous injury. Visually you may palpate a thickened fat pad, particularly in females. Pain with passive motions generally points away from patellar tendon. Dialing in as to where and when they are having their pain is an important part of the functional evaluation. Kurt likes to do a table top examination first to ensure functional integrity of the knee before jumping right to functional tasks. His concerns are (which are valid) is the knee up to the task you’re about to ask it to do? Good advice here. He emphasizes the need to be systematic and consistent in your examination, no matter how you examine them. Develop a routine that you follow each and every time. He recommends passively looking at the knee in extension and 90° flexion. There is a discussion on functional movement about the hip and pelvis, knee, and foot and ankle. Emphasis is made, for example at the knee, as to “is the knee moving medially and laterally or are the femur and tibia rotating mediately or laterally” in which is precipitating the pain? “Catching” of the patella is often due to patellofemoral pathology such as a subchondral defect, slap tear of the chondral surface, or abnormalities of the trochlea of the femur. Advanced imaging strategies are also discussed with a brief overview of some of the things to look for. Finally treatment strategies were discussed. It is emphasized that identifying the specific activity or change activities that’s causing any pain he’s made as well as activity modification. We were happy to hear that footwear and its role in knee as well as hepatology was discussed as well as looking at occupational contributions to the pain. There was emphasis on exercise specificity particularly with respect to if the problem was unilateral not giving “blanket” exercises for both knees but rather concentrating on the symptomatic side. A discussion on the use of EMG and activation patterns was also entertained with some good clinical pearls here. More marked rather than subtle changes and activation side to side seem to be more clinically significant. In other words, with respect training, can they achieve similar levels of activation on each side with a similar activity (for example isometric knee extension with the leg bent 60°). The judicious use of tape from a functional testing standpoint was interesting. Emphasis was made that tape is not a cure and will merely a tool. All in all and informative, concise podcast with some great clinical pearls and a nice review of the knee and patellofemoral pain. link to PODcast: http://physioedge.com.au/pe-029-acute-knee-injuries-with-kurt-lisle/ https://www.thegaitguys.com/thedailyblog/congenital-clubfoot-anyone-this-gentleman-a monthly 0.5 2016-03-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553450239-1T4H1OHCR3B9M82AKFZD/tumblr_nx0apl3SVJ1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553450977-UPC0GO7DTC146Z228B6C/tumblr_nx0apl3SVJ1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553451026-PD9QDI70S12HMSETUJG5/tumblr_nx0apl3SVJ1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553451287-4PGZO2SHDEDAEK0E1C5Z/tumblr_nx0apl3SVJ1qhko2so5_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553452129-O10JFFD6FFIHTPIPOD1D/tumblr_nx0apl3SVJ1qhko2so6_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/which-sports-burn-the-most-calories monthly 0.5 2016-03-08 https://www.thegaitguys.com/thedailyblog/got-big-toe-pain-think-its-gout-think-again monthly 0.5 2016-03-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553452814-USGKC1U0GDOQS01IO11X/tumblr_o39jesCIny1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553453291-M0O9EDBPHYC0SK1P37RS/tumblr_o39jesCIny1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553453573-CXQRZQOFKAEMTVPN8409/tumblr_o39jesCIny1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553454265-54UZKGP5S5T85A1N763M/tumblr_o39jesCIny1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553454255-LUAH0RGLHQX7815TU25Y/tumblr_o39jesCIny1qhko2so5_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-103-effects-of-cold-on monthly 0.5 2016-03-04 https://www.thegaitguys.com/thedailyblog/and-what-have-we-been-saying-parallel-processing monthly 0.5 2016-03-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553454200-RJQMXS5V26R4KCY68LS1/tumblr_o3fqbvEli81qhko2so1_400.png Blog And what have we been saying? parallel processing seems to be OK (balancing and reading), but dual or multitasking has its hazards… decreased speed of movement. not surprising because of the dual tasking increased ankle dorsiflexion (not necessarily a bad thing. This is probably to create a wider and more stable base through pronation reduced cadence decreased stride length we were surprised there was not a increased “base of gait”, as balance requirements increase, gait usually decomposes (see here for a cool post and video we did on this a while ago) “Numerous studies have analyzed the impact of dual tasks—specifically, tasks that cause cognitive distraction—on gait. With regard to texting as a dual task, many studies have consistently found that it does have an effect on gait, and that’s mostly to slow a person down. For instance, Italian researchers in the Journal of NeuroEngineering and Rehabilitation assessed 18 healthy young adults who did not have problems with vision, or neurological or musculoskeletal disorders that could affect their gait.3 Barefoot participants walked a straight path of 15 meters (about 50 feet) for three minutes under two conditions: walking alone and walking while texting. They found that texting while walking differed from walking alone in terms of muscle activation, kinematics, and spatiotemporal variables. Texting was associated with delayed activation of the gastrocnemius lateralis muscle and slightly increased ankle dorsiflexion followed by slightly reduced plantar flexion. It was also associated with a slower gait speed, reduced cadence and stride length, increased flat-foot contact, and decreased push-off. The researchers also found increased co-contraction of the ankle antagonist muscles during what they called the “critical” gait phase—from load response to midstance, corresponding to the transfer of body weight from one leg to the other.” its a short one. Take the time to check it out… link to article: http://lermagazine.com/cover_story/texting-while-walking-gait-adaptations-and-injury-implications https://www.thegaitguys.com/thedailyblog/using-a-boot-to-heal-a-bone-tendon-post-op monthly 0.5 2016-03-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553454815-7XRVK3J17YHFD46M9PO7/tumblr_o3h06uZdj91qhko2so1_1280.png Blog Using a boot to heal a bone, tendon, post-op ?  Think deeper please. Please please, please ! If you are going to put your client in a CAM rocker boot/shoe for a fracture, or post-op can you please try to level out the leg length discrepancy caused by the thickness of the boot’s sole ? Please ? Pretty please with sugar on top? Some boot brands have a huge midsole thickness. This leads to a functionally longer leg length. If they are barefoot much of the day, there will be a huge leg length discrepancy. If in shoes all day, you can offset this with a sole lift in the healthy foot’s shoe or you can add something like this to the outsole. Use common sense. IF someone is in a CAM boot for 6 weeks and thus a longer leg, this is going to promote a knee flexed posture on the boot side (ie. shortens the leg) and/or hyperextension of the healthy leg’s knee, supination of the foot, more forefoot habitus (sustained calf loads) and even frontal plane lurch pelvis gait mechanics (this is why many folks will get opposite hip pain). These embedded gait flaws must be addressed and remedied after they are out of the boot to reset normal gait. We have seen enough problems come to our offices that are suspect as a result of prolonged boot use and failure to reteach normal gait patterns, meaning, to reduce the learned gait behaviors of being in a boot for prolonged periods. Gait retraining is just as important as the rehab post-boot removal.  Of course, this is rarely done.  Using logic is never a bad thing.    Dr. Shawn Allen, one of the gait guys Here is a neat device we found to help.http://www.braceshop.com/procare-evenup-shoe-balancer-walker-system.htm?gdftrk=gdfV28018_a_7c2568_a_7c10961_a_7c32290&gclid=Cj0KEQiA37CnBRChp7e-pM2Mzp0BEiQAlSxQCCeL74AvCkYXbQX_jV1jEP27mfocB87f8pSfbo2PZMIaAsOV8P8HAQ https://www.thegaitguys.com/thedailyblog/medial-longitudinal-arch-age-stablization monthly 0.5 2016-03-01 https://www.thegaitguys.com/thedailyblog/medial-knee-pain-in-a-skier-considering-an monthly 0.5 2016-02-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553455202-2RZBTE231U6MPQLF5YO4/tumblr_o39jnrMvyo1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553455338-GWSJHFSH0A35U7AXNM38/tumblr_o39jnrMvyo1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553456026-D42117TSBAX6JSE4GGIT/tumblr_o39jnrMvyo1qhko2so5_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553457061-J2250DZA1I75JRXYM18L/tumblr_o39jnrMvyo1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553456799-OZN9E9Q0W5QYM2HOPCFA/tumblr_o39jnrMvyo1qhko2so6_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/lower-limb-muscle-strategies-in-low-back-pain monthly 0.5 2016-02-26 https://www.thegaitguys.com/thedailyblog/what-have-we-listened-to-lately-patello-femoral monthly 0.5 2016-02-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553457353-M4WVLMZZMTBVA1VKRNFR/tumblr_o2v7svEbjz1qhko2so2_1280.png Blog What have we listened to lately? Patello Femoral Pain! The David pope Physioedge PODcast with  Dr Micheal Rathleff talking about adolescent patellofemoral knee pain, which has a prevalence of 6 to 7%.  Here is our summary:  Two thirds of the population do sports five times per week and often do the sports with pain. This group (adolescents) has usually been doing one sport their entire life and has had pain on and off. The other third of the population are adolescents who do not play sports at all. This group often are going from primary secondary school and encounter a lot of stairs or increased amounts of activity which is believed to contribute to the condition. So the majority are increased intensity or frequency of load whereas the other one is increased load only. For the first group, playing in identifying with the sport is part of their social network and they would rather play with pain than be excluded. One of the questions was “is there a different treatment protocol for each group”?  The short answer is no. Many times and adolescent in the “overuse” group is given additional exercises. Often this just contributes to increasing load. Education appears to be key in the rehab process. Males with the shortest duration of pain and lowest intensity seem to be the best responders to this program. Females with longest duration and highest intensity of pain seem to respond the least. Not surprisingly, compliance with treatment protocol can be difficult with a teenager. In a recent RCT that they performed, 55% of folks that did their exercises three times per week were recovered in one year whereas those that did less were at 20%.  These statistics are often put on the chart, laminatedand shown to the patients. This seems to improve compliance. Another chart is made with these bullet points:  Low hip strength low quadricep strength different movement pattern.  The anatomy is then shown and explained to the patient and an attempt is made to tie it all together. Differentiation is made between: patellofemoral pain, Osgood-Schlatter’s disease, and patellar tendinopathy. The differentiating factors are with patellofemoral pain, the pain is diffuse; with Osgood-Schlatter’s it’s located over the tibial tuberosity and with patellar tendinopathy it is more at the inferior patellar pole. Differentiation is always made between Sinding-Larsen-Johannsen disease and the others by the fact that this is mostly pain at the inferior patellar pole and relatively rare and adolescent population. Differentiation between patellofemoral pain and Osgood-Schlatter’s disease usually involves the latter having locking in addition to pain. These conditions are usually confirmed with ultrasound or MRI. There don’t appear to be specific reliable tests to rule in patellofemoral pain so the process becomes one of ruling out. Palpation in the diagnostic process of course please large role. Also specific localization by the patient can be helpful. Dimension and “app” that the patient can draw on to show the examiner where the knee pain is. We really like this idea.  Exclusionary tests include the patellar fat pad compression test, but it is emphasize that this is more generalized rather than specific to the Tele femoral pain and a brief discussion as to its anatomy ensues.  Treatment includes 3 main steps patient education as to activity limitations.  Patient refrains from activities a check of the pain for approximately four weeks and then his gradually reintroduce as long as they can keep their VAS scores below three.  Exercise can begin at the four-week timeframe, again depending upon the patient’s symptoms. A gentle progression with pain as a guide is advised with a return to activity previous activity as early as 5 to 6 weeks. Frequency of training is increased first and then duration of training. Exercise initially is confined to the more proximal joints such as the core and hips.  They begin with open chain, theraband exercises (which we do not necessarily agree with). They also do RM testing 10 to 12 reps.some standardization is done with regards to therapy and length and amount of travel. Compliance is discussed as adolescence often have an extensive social network. Exercise in 15 minute intervals is encouraged. Prognostically it shows that patients that can control their loads earlier tend to do better longitudinally. Foot orthoses are discussed but it is pointed out that there is not a lot of data and research on their efficacy in an adolescent population for the telephone real pain. He goes on to talk about how a foot orthoses “takes your brain out of the equation” and can provide some degree of increased compliance albeit, passive. The orthotics are left in until they are “worn out” (they use a great expression:”until the natural mortality of the orthotic runs its course” which we loved ! and then see how the patient does. Hip strengthening is discussed. It appears that adolescents develop weaknesses after patellofemoral joint pain,  not as a result of it.  Other treatment modalities included “fat pad unloading tape”. A “v”  pattern is done with crossing at the tibial tuberosity. The Chris Barstann method is given in a YouTube link is provided. Plane “white tape” can be utilized for adolescents who hyper extend their knees, with the tape running behind the knee a few hours at a time.David talks about an anchor above and below the knee with an X pattern crossing at the middle of the popliteal fossa and having the knee in slight flexion. So after the progression of one activity modification, two taping three therapy and exercises they then move onto hip strengthening with close chain exercises such as squatting and lunches.backpacks with different amount of weight totaling there 10 or 12 RM are then employed. Care is exercised to keep them in a pain-free range. When they can accomplish this then they move onto one legged work Stretching was deemphasized because of the increased compression at the patellofemoral joint. Guidance as to speed, frequency and ranges of motion of exercise are carefully given to each patient. Eight seconds of time under tension for each repetition using a thorough band (three second concentric, two second isometric hold, three second eccentric) adding up to 80 seconds for each 10 repetitions. This allows good proprioceptive control because of the long contraction and increased exercise dose. They often use a “smart phone” to video the exercise for the patient (with the doing this for years and it’s a great way to assist in compliance; a person may lose a sheet of paper or their keys but they will not lose their phone). All in all, an informative PODcast for those who have a deeper interest in treating PFP in the adolescent population. The Gait Guys link to PODcast:  http://physioedge.com.au/physio-edge-039-patellofemoral-pain-adolescents-dr-michael-rathleff/ https://www.thegaitguys.com/thedailyblog/heat-exertion-and-gait-decline monthly 0.5 2016-02-24 https://www.thegaitguys.com/thedailyblog/we-had-a-great-podcast-in-the-studio-last-friday monthly 0.5 2016-02-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553457320-6ZDUAZ3GY1ZVVX7H14HV/tumblr_o2utrwI4fg1qhko2so1_1280.jpg Blog We had a great PODcast in the studio last Friday, talking about tendon vascularity and compression vs tension therapies for tendinopathies. Here is a great FULL TEXT article on tendon vascularity that can serve as a catalyst for designing your treatment programs “Conclusions Neovascularization is critical to tissue repair and wound healing. Therefore, strategies to enhance vascularization to promote regeneration are considered promising treatment modalities, i.e., the use of platelet rich plasma (PRP) to restore functional bone (Zhang et al., 2013) or skin (Kakudo et al., 2011). However, in acute or chronic tendon injuries hypervascularity often does not pave the way to functional recovery of the tissue. Therefore, to overcome the limited intrinsic regeneration capacity of tendon and to achieve scarless healing will most likely require a balanced manipulation of the angiogenic response in tendon tissue. For a variety of treatment methods, such as the use of PRP, the availability of clinical data is limited, due to heterogeneity in application (Khan and Bedi, 2015). In order to develop rational strategies to achieve a well-balanced angiogenic response following tendon injury, we need a thorough understanding of the molecular and cellular networks driving tendon vascularization and regeneration—a challenge for years to come.” image from: http://www.slideshare.net/ShoulderPain/rotator-cuff-repair-23326992 link to full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4650849/ https://www.thegaitguys.com/thedailyblog/ankle-spains-and-hip-abductors monthly 0.5 2016-02-23 https://www.thegaitguys.com/thedailyblog/why-dont-some-folks-pay-attention-to-anatomy monthly 0.5 2016-02-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553457709-TH961CJHMWEO1SN7AAW4/tumblr_o0lgqlWE1s1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553458933-5NPKQ0ANSN8Q6BXM4L1M/tumblr_o0lgqlWE1s1qhko2so2_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/what-are-we-listening-to-lately-we-have-been monthly 0.5 2016-02-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553458372-5GGARUHHL56LO70RBXQG/tumblr_o2igi7gBAC1qhko2so1_1280.png Blog What are we listening to lately? We have been getting into David Pope and the “Physioedge” podcast. This particular title piqued our interest talking all about plantar fasial pain. It is an interview with Michael Rathleff from Denmark. Michael works in the areas of patellofemoral research, plantar fascia research, and exercise.   Approximately 10% of the population from 840 to 60 suffers from some sort of plantar fasciopathy. These people usually have jobs where they are upright and standing on her feet for extended periods of time. Plantar fascial pain seems to respond better to loading-based therapies rather than stretching-based therapies,  due to the similarities between tendons and fascia . He emphasizes not to overlook educating the patient about their condition and taking the time to explain what’s going on. He then goes on to talk about activity modification in the treatment plan. He classifies two major types of people who develop planter for shop: runners and people that are overweight ( repetitive loading versus constant loading). Pain patterning is often threefold:  1. pain during the workday 2. pain when they get home 3. pain after they get up after taking a rest for any length of time.  So, how much can you reduce the loading and, how much does that reduce their symptoms?  With runners it’s a little easier as you can just tell them to reduce their mileage. Some “rules of engagement” are given: runners need to be able to walk a 10K briskly, without pain before during or after or at three time frames when they had pain before. After this baby can begin a running program eight weeks of five k’s of continued running. Ching that yes this can take some time is important and offering the patient alternative means of exercise (cycling, swimming etc.) is important. Running should begin with one minute running, two minute walking and repeating the cycle and a pain-free patch fashion. Pain should never exceed a 3/10 on the analog scale. The distinction is made between plantar fasciopathy and plantar fasciitis with the former being more of a degenerative condition and the latter an inflammatory one. Palpation and thickening of the central portion of the planter fascia is emphasized in fasciopathy. A link to some downloads with handouts, instruction, etc. is also provided within the podcast.  Rehabilitative exercises focus on increasing loads. A simple calf raise with the toes of dorsiflexion using a town introduced. The patient begins with three sets of 12 RM done every other day for a few weeks with increased to an eight RM as they get stronger. Repetitions are three seconds up, hold for two seconds, three seconds down, hold for two seconds. The pros and cons of this exercise are discussed: in short if you need high tensile loads across the plantar fashion then this exercise is key. This would be more for chronic conditions rather than acute ones which would probably require rest rather than loading. Up to six months the high load strengthening exercises seem to be superior to stretching and simple he’ll inserts, but after six months there appeared little difference between the two. Speculation was that most people probably discontinue the exercises because they were feeling better. People that were more active or engaged in sports, at least in this RCT, seem to do better than folks that had the fascia apathy due to having a high BMI. One study they cite looks at intrinsic musculature of the feet and legs as a contributing component to chronic plantar fasciopathy. It’s emphasized that an individualized program be designed for each patient. All in all a nice evidence-based lecture/interview with some great clinical pearls. Consider adding a progressive loading program to your planter fasciopathy patients and perhaps consider adding intrinsic muscle exercises well. http://physioedge.com.au/pe-038-plantar-fasciopathy-loading-programs-michael-rathleff/ https://www.thegaitguys.com/thedailyblog/fatigue-and-exercise monthly 0.5 2016-02-18 https://www.thegaitguys.com/thedailyblog/is-the-short-foot-exercise-dead-dr-allen monthly 0.5 2016-02-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553459187-0U7YXYH6GGLT2K259QRZ/tumblr_o2duniYZow1qhko2so1_r1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553459231-IBJKAJI7IBU1OQXCY0EO/tumblr_o2duniYZow1qhko2so3_r1_540.png Blog https://www.thegaitguys.com/thedailyblog/muscle-contraction-and-antibacterial-soap monthly 0.5 2016-02-16 https://www.thegaitguys.com/thedailyblog/asymmetries-in-limbs monthly 0.5 2016-02-15 https://www.thegaitguys.com/thedailyblog/1st-mtp-pain-it-may-not-be-a-trigger-point-in monthly 0.5 2016-02-15 https://www.thegaitguys.com/thedailyblog/got-motion-control-sometimes-too-much-of-a-good monthly 0.5 2016-02-08 https://www.thegaitguys.com/thedailyblog/the-banana-toe-the-force-has-to-go-somewhere monthly 0.5 2016-02-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553459665-0016QTHA7PY5NGYD7W9D/tumblr_o1y939Qxjn1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553461199-OOOIQK5L2JPMXA5VJ7V7/tumblr_o1y939Qxjn1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553460536-0X2R6ESYCIAXR76G4NHF/tumblr_o1y939Qxjn1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553460790-BNLGPI5HWXR3JU5E3UD7/tumblr_o1y939Qxjn1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/carry-a-backpack-unless-you-are-a-great monthly 0.5 2016-02-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553461207-CF72FFVHN4REB5NAPOMH/tumblr_o1s9unMA0u1qhko2so1_1280.png Blog Carry a backpack? Unless you are a great compensator, like some limb amputees seem to be (see yesterdays post), be prepared for some changes in your gait. During some of our “backpack” research for yesterdays post, we turned up this full text article: “In conclusion, college students currently carry too much weight in their backpacks. The average weight carried by UVU students caused an increase in trunk flexion regardless of age, gender or year in school. The load carried in the backpacks also slowed gait velocity, increased time spent in double support, and with the messenger bags caused a change in the right foot angle implying that the hip was rotated due to the contralateral bag placement. In an effort to avoid such potentially harmful conditions, college students should avoid using messenger bags, should always follow the manufacturer settings for proper bag positioning, and carry less weight in their backpacks.” https://www.western.edu/sites/default/files/page/docs/jensen.et_.al_.spring.2014.pdf https://www.thegaitguys.com/thedailyblog/carry-a-pack-have-a-lld-or-other-gait-altering monthly 0.5 2016-02-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553461288-O7UXUTEISB6CKJ21IRTA/tumblr_o1s9bt2PSF1qhko2so1_500.png Blog Carry a pack?  Have a LLD or other gait altering condition like a lower limb amputation? Carrying a pack may not necessarily change your center of gravity.  Yes, we were surprised as well… “There are many scenarios where it becomes necessary to carry a load, and a back pack is often the most realistic option to carry this load. The additional load is thought to lead to changes in kinematics of the persons movement. This hypothesis, however, is not supported by results of this study. Asymmetry in movement did not significantly alter centre of pressure (COP) parameters for an amputee carrying a loaded backpack.” Abstract Understanding how load carriage affects walking is important for people with a lower extremity amputation who may use different strategies to accommodate to the additional weight. Nine unilateral traumatic transtibial amputees (K4-level) walked over four surfaces (level-ground, uneven ground, incline, decline) with and without a 24.5 kg backpack. Center of pressure (COP) and total force were analyzed from F-Scan insole pressuresensor data. COP parameters were greater on the intact limb than on the prosthetic limb, which was likely a compensation for the loss of ankle control. Double support time (DST) was greater when walking with a backpack. Although longer DST is often considered a strategy to enhance stability and/or reduce loading forces, changes in DST were only moderately correlated with changes in peak force. High functioning transtibialamputees were able to accommodate to a standard backpack load and to maintain COP progression, even when walking over different surfaces. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved. Appl Ergon. 2016 Jan;52:169-76. doi: 10.1016/j.apergo.2015.07.014. Epub 2015 Jul 31.Center of pressure and total force analyses for amputees walking with a backpack load over four surfaces. Sinitski EH, Herbert-Copley AG, et al https://www.thegaitguys.com/thedailyblog/yes-you-are-looking-inside-this-toe-that-is-a monthly 0.5 2016-02-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553461605-UCZV012Y3EL0Y3S9D7C2/tumblr_o1y98nYVX41qhko2so1_500.jpg Blog Yes, you are looking INSIDE this toe. That IS a screw and metal plate in that toe.  What kind of stuff finds its way into your office ? I get all kinds of things it seems, at least once a day something comes in that makes me scratch my head.  This client just wanted my opinion and thoughts on their toe and their gait once they are ambulating again. They have had multiple surgeries to this poor foot. You can see multiple scars over multiple digits and metatarsals.  This is the 3rd surgery to the big toe, the last 2 have been attempts at correcting failed prior surgeries. This is obviously the last straw surgery, total fusion of the metatarsophalangeal joint.  What is interesting in this case is that this plate was taken out about 4 weeks ago, and the skin was stretched back over and the wound closed up (forgot to take update photo for you). I saw it yesterday, and I was amazed at how healed up the area was. They are months post op now, and they can load the toe heavily now, that is always amazing to me. The body’s healing ability is a miracle. Of course, if you have been with us here long enough you will know that my “concern button” immediately got pushed but the client was proactive and asked the question before my oral diarrhea of concerns started. So, they wanted to know about their gait and what to watch out for.  Off the top of your head, without thinking, you should be able to rattle off the following: impaired toe off premature heel rise watchful eye on achilles issues impaired hip extension and gluteal function impaired terminal ankle plantar flexion (because they cannot access the synergists FHL and FHB) impaired terminal ankle dorsi flexion (because they cannot access the synergists EHL and EHB) lateral toe off which will promote ankle and foot inversion, which will challenge the peronei frontal plane hip-pelvis drift because of the lateral toe off and lack of glute function possible low back pain/tightness because of the  frontal plane pelvis drift and from altered hip extension motor patterning (and glute impairment) possible knee pain from tracking challenges because they cannot complete medial tripod loading and thus sufficient pronation to internally spin the limb to get the knee to sagittal loading impaired arm swing, more notable contralaterally There is more, but that is enough for now. You need to know total body mechanics, movement patterns, normal gait cycle events (you have to know normal to know abnormal) and more. You have to know what normal is to understand when you are looking at abnormal. * So, dial this back to something more simple, a “stubbed toe”, a painful sesamoid, painful pronation or a turf toe or hallux limitus.  They will all have the same list of complications that need to be evaluated, considered and addressed. This list should convey the importance that if your client has low back pain, examining the big toe motion is critical. Also, if you are just looking at the foot and toe in these cases, pack your bags … .  you don’t belong here. If you are just adjusting feet and toes and playing with orthotics while the list above does not constantly file back and forth through your brain, again, pack all your bags, grab your cat and leave town (just kidding, try reading more and get to some seminars). If you know the complicated things, then the simple things become … … . . simple. Your local treadmill gait analysis guru should know all of this if they are going to recommend shoes and exercises. Shame on them if there is no physical exam however. The data roadmap from the gait analysis software print out is not going to get you even out of the driveway let alone down the street. The data is going to tell you what you are doing to compensate, not tell you what is wrong. You must know anatomy, biomechanics, neurology, orthopedics and how to apply them to get the recipe right, not just which shoe in a store will unload the medial tripod of the foot or which exercise will lengthen your stride on the left.  … .  sorry for the rant, too much coffee this morning, obviously. Shawn Allen, one of the gait guys https://www.thegaitguys.com/thedailyblog/what-are-we-listening-to-this-week-the-plantaris monthly 0.5 2016-02-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553463303-XTUL77WF5P2DAH66R1JI/tumblr_o1qrkwYLb71qhko2so1_1280.jpg Blog What are we listening to this week? The Plantaris… Thanks to Karly Foster of Twin Bridges Physiotherapy the: Physioedge podcast with David Pope Imagine if you were able to dedicate a large portion of your life to the study of one individual muscle. That’s exactly what the main person interviewed here has done Dr. Kristof Spang from Sweden has done.  a lot of research on Achilles tendon tendinopathy.This podcast looks at the role of the plantaris muscle in mid tendon tendinopathy, with an emphasis on anatomy. This muscle needs to be considered in recalcitrant cases of Achilles tendon apathy which of not respond to conservative means. Dr Spang goes through some of the anatomical variations of attachment of the plantaris, with 10 to 20% attaching into the Achilles tendon. Since there seems to be at least nine different anatomical variations in attachment that can occur; this can often explain the variety of symptoms associated with plantaris issues. The plantaris attaches from the lateral aspect of the femoral condyle downward to its insertion point within deli near its origin at the knee. The area of attachment distally can be between two and 5 mm and this “area attachment” may be part of the source of the pain. Phylogenetically the tendon attaches into the plantar fashia, similar to the palmaris. One theory is due to the small muscle size it may actually act as a proprioceptive sentinel for the knee and ankle. The peritendonous tissue may interfere with the gliding of the tendon in this is believed to be one of the ideologies of this recalcitrant problem. Of the diagnostic imaging available, ultrasound seems to provide the most clues. In the absence of imaging, recalcitrant medial knee tendon Achilles tendon pain seems to also be a good indicator. Our takeaway was that most often the problem seems to be had a conjoined area between the planters and Achilles tendon midcalf lead to most problems. Treatment concentrated in this area may have better results. If this is unsuccessful, surgery (removal of the plantaris, extreme, eh?)  may need to be considered. Regarding specific tests for plantaris involvement, people who pronate seem to be more susceptible than those who supinate. This is not surprising since the tendon runs from lateral to medial it would be under more attention during predatory forces It seems that plantaris tendonopathy  can exist separately from an conjoint tendinopathy and it may be that people of younger age may suffer from plantaris tendinopathy alone. This may indicate that the problem may begin with the plantaris and that the planters is actually stronger and stiffer than the Achilles! It was emphasized that this condition only exists in a small percentage of mid Achilles tendon apathy patients. And that conservative means should always be exhausted first. All in all, an interesting discussion for those who are interested in pathoanatomy. Check out part 2 in this series for more.  link to PODcast: http://physioedge.com.au/physio-edge-041-plantaris-involvement-in-midportion-achilles-tendinopathy/ https://www.thegaitguys.com/thedailyblog/pod-102-thermic-adaptation-gaitrunning monthly 0.5 2016-01-29 https://www.thegaitguys.com/thedailyblog/dry-needling-and-proprioception-what-a-great monthly 0.5 2016-01-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553463054-1CEJFGJ3AC5YUSUZ6EJZ/tumblr_o1lhwjgpOg1qhko2so1_1280.jpg Blog Dry Needling and Proprioception. What a great combination. Since dry needling and proprioception both have such profound effects on muscle tone, why not combine them to treat chronic ankle instability? We do all the time and here is a FREE FULL TEXT article that ties the two together nicely! And what better to muscle to use than the peroneii? These babies help control valgus/varus motions of the foot and influence plantar and dorsiflexion AND the longus descends the 1st ray. We call that a triple win! “This study provides evidence that the inclusion of TrP-DN within the lateral peroneus muscle into a proprioceptive/strengthening exercise program resulted in better outcomes in pain and function 1 month after the end of the therapy in individuals with ankle instability. Our results may anticipate that the benefits of adding TrP-DN in the lateral peroneus muscle for the management of ankle instability are clinically relevant as large between-groups effect sizes were observed in all the outcomes.” link to full text http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430654/ photo from this past weekends Dry Needling Seminar: working on the dorsal interossei https://www.thegaitguys.com/thedailyblog/toe-sardines-what-have-we-done-to-our-feet-note monthly 0.5 2016-01-28 https://www.thegaitguys.com/thedailyblog/what-are-we-listening-to-this-week-therapy monthly 0.5 2016-01-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553462592-YWPO01KWSP21M1TTP39O/tumblr_o1jmkkrF7w1qhko2so2_400.png Blog What are we listening to this week?  Therapy Insiders interview with Stu McGill entitled “the mechanics of a treatment approach with Dr. Stuart McGill"This was an interesting interview with some nice clinical pearls. Anyone who has had the opportunity to see Dr. McGill speak will certainly appreciate his humor and candor. After a lengthy discussion on mustaches, they began to talk about competency of therapists. Dr. McGill then explains some salient points in his three hour evaluation of patients. His goals are to "precisely define The pain triggers to that patient” and then to “remove them”. Pretty simple but effective. We think the keyword here is “precisely”.He then talks about utilizing your clinical knowledge based in the powers of observation.  His assessment begins with a patient interview to determine The character of the patients pain. He’s very careful to listen to “exactly” what the triggers and really are for a patient’s pain. He then goes on to offer some nice clinical diagnostics pearls that we will leave for you to listen to the podcast to glean. He then again emphasizes observing the patients movement and movement habits to establish their stability/mobility continuum. His examination consists of three parts: provocative motions, neural tests, and tissue specific tests. He looks for provocative motions postures and loads.  Once the pain should use identified, he then seeks to find positions postures or movements which will alleviate it. He then does neural tests, looking for things like neural or root tension. Finally he discusses some tissue specific diagnoses. There’s an interesting discussion on pain and pain science. Dr. McGill emphasizes that people need to avoid the movement which causes pain not moving in general. He then goes on to talk about Central sensitization and how, if you can teach people to not invoke their “pain trigger” motion, that they will actually improve and central sensitization will decrease. in other words, don’t move “through” pain but find ways to work around the trigger. There’s been a series of “Twitter” questions that are answered with an interesting discussion on Core stability and superimposed axial movement. All in all a informative interview with some clinical pearls.  you can give it  listen here:  http://updocmedia.com/mediacast/the-mechanics-of-a-treatment-approach-w-dr-stuart-mcgill/ https://www.thegaitguys.com/thedailyblog/hmmmwhats-going-on-here-can-you-see-it monthly 0.5 2016-01-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553463689-M0IEZICYXAT5OAF8E3VX/tumblr_o19wj7jqB71qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553464399-NSRNZ2KENXC5VXHKSFFF/tumblr_o19wj7jqB71qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553464226-1FBPEPDVRI7E84188AZY/tumblr_o19wj7jqB71qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553464948-SWMW2HB93YOZNW449ZTB/tumblr_o19wj7jqB71qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553464906-0MYPH51EUQK4AA6JXTOF/tumblr_o19wj7jqB71qhko2so5_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553465004-2H39JOIXFFEQRAD7SM48/tumblr_o19wj7jqB71qhko2so6_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/children-postural-control-of-balance monthly 0.5 2016-01-23 https://www.thegaitguys.com/thedailyblog/part-2-how-relaxed-or-shall-we-say-sloppy-is monthly 0.5 2016-01-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553465333-9KI7KWV1VJUIZHU4H5XN/tumblr_o1b7433ZEV1qhko2so1_1280.jpg Blog Part 2: How relaxed, or shall we say “sloppy” is your gait ? The Cross over gait /Frontal plane drift gait. In this photo (*credit below) the blurred right swing leg tells you this client has been photographed during gait/running motion. Can you see it ? Have we educating you well ? Human gait is cyclical. A problem on one side will corrupt the other and the cycle begins, and usually continues until the cycle is broken.  We 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 us 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 four in a cohesive antiphasic effort. This would be perfect and clean gait, a gait that would unlikely ever suffer pain or problems. Symmetrical durability wins every time.  This photo demonstrates the cross over gait and we are beating it to a pulp here, again.  In this running gait photo, this momentary snapshot of global movement, it shows this client is engaging movement into the left frontal plane excessively, they have drifted to the left far outside the vertical plumb line from the foot. The question is, it is excessively enough to present as painful pathology or is it a painless problem at this time? We call what you see here a frontal plane drift, but more so, the cross over gait. You can even see suggestion of the left frontal drift as evidenced by the concavity of the lumbar spine curve to the left.  It should be clear that the right pendulum leg will scrape the left calf on its way through its oblique pendulum swing (instead of a pure forward sagittal swing) to a foot strike somewhere near to the line they are closely running on (a theoretical line). This is the cross over gait.  After this left frontal plane drift and right cross over, there will likely be a corresponding right frontal plane drift and left cross over to compensate on the very next step. Thus, the cycle begins, each on feeding and compensating off the other. To prevent it, it means you have to have an extra bit more of lateral line strength in the gluteus medius and lateral abdominal sling to fend off pathology. You have to  have the stability from S.E.S (skill, endurance, strength) to stack the hip, knee and foot over top of each other.  You have to have enough ankle stability and a host of other clean and strong and skilled layers to fend it off to be precise. One must be able to find functional stability in the stacked posture, and this can take some training and time.  Make no mistake, this is a faulty movement pattern, even if there is not pain (yet), this is not efficient motor patterning and something will have to give. Whether that is lateral foot pain from more supination strategizing, more tone in the ITB perhaps causing lateral knee or hip pain, posterior ischeofemoral impingment syndrome, a compensation in arms swing or thoracic spine rotation or head tilt etc … .  something has to give, something has to compensate. To complicate the cyclical scenario, the time usually used to move sagittally will be partially used to move into, and back out of, the frontal plane. This will necessitate some abbreviations in the left stance phase timely mechanical events. Some biomechanical events will have to be abbreviated or sped through and then the right limb will have to adapt to those changes. These are simple gait problems we have talked about over and over again here on the gait guys blog. (Search “arm swing” on our blog and you will find 50+ articles around this topic.) These compensation patterns will include expressed weaknesses in various parts of the human frame as part of the pattern Are you able to find the problem in the never ending loop of compensations of your clients and find a way to unwrinkle their system one logical piece at a time, or will you just chose to strengthen the wrinkled system and hope that the new strength on top of the compensations is adequate for you or your client ? One should not be forever sentenced to daily or weekly rehabilitative sessions or homework to negate and alleviate symptoms, this is a far more durable machine than that. Fix the problem.  Merely addressing things locally can be a crime.  If you are seeing an arm swing change, you would be foolish not to look at the opposite lower limb and foot at the very least, and of course assess spinal rotation, lateral flexion and hinging as well as core mobility and stability.  For you neuro nerds, remember what Dr. Ivo says, that the receptors from the central spine and core fire into the midline vermis of the cerebellum (one of the oldest parts of our brain, called the paleo cerebellum); and these pathways, along with other cerebellar efferents, fire our axial extensor muscles that keep us upright in the gravitational plane and provide balance or homeostasis through stability.  It is why they assessed and addressed.   Or, if this is too much thinking for you, … you can just train harder and get stronger . .  . in all your compensation patterns, after all, it is easier than figuring out why and how a right ankle for example started the whole mess, if in fact that is even the first piece of the puzzle.  No one said this would be easy.  So, how sloppy is your gait ? Dr. Shawn Allen, one of the gait guys ________________________ References and Credits Note: photo linked to this article. Photo credit/property: REUTERS/Eduardo Munoz (Copyright Reuters 2016).   Article: Workouts focused on motor skills may help ease lower back pain  http://www.foxnews.com/health/2016/01/14/workouts-focused-on-motor-skills-may-help-ease-lower-back-pain.html https://www.thegaitguys.com/thedailyblog/the-mighty-quadratus-femoris monthly 0.5 2016-01-20 https://www.thegaitguys.com/thedailyblog/you-mean-a-sauna-can-improve-my-endurance-for monthly 0.5 2016-01-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553465714-908O0XD2V6Y3IHXFZGSY/tumblr_o18ghhVLUJ1qhko2so2_1280.png Blog You mean a sauna can improve my endurance for running? Did you know using a sauna can (in some areas) produce better results than exercise? I didn’t believe it either. What are we listening to this week? For 1, one of Dr Ivo’s new favs: Dr Rhonda Patrick This is an absolutely great, referenced short on some of the benefits of hyperthermic conditioning (ie sauna use). One of the most surprising effects was benefits which exceeded exercising! Here is one small excerpt: Being heat acclimated enhances endurance by the following mechanisms: It increases plasma volume and blood flow to the heart (stroke volume). This results in reduced cardiovascular strain and lowers the heart rate for the same given workload. These cardiovascular improvements have been shown to enhance endurance in highly trained as well as untrained athletes. It increases blood flow to the skeletal muscles, keeping them fueled with glucose, esterified fatty acids, and oxygen. The increased delivery of nutrients to muscles reduces their dependence on glycogen stores. Endurance athletes often hit a “wall” when they have depleted their muscle glycogen stores. Hyperthermic conditioning has been shown to reduce muscle glycogen use by 40%-50% compared to before heat acclimation. This is presumably due to the increased blood flow to the muscles. In addition, lactate accumulation in blood and muscle during exercise is reduced after heat acclimation. It improves thermoregulatory control, which operates by activating the sympathetic nervous system and increasing the blood flow to the skin and, thus the sweat rate. This dissipates some of the core body heat. After acclimation, sweating occurs at a lower core temperature and the sweat rate is maintained for a longer period. waaaayyyyy more in her video. Check it out. I had to listen to it several times to catch all the details. https://www.youtube.com/watch?v=aHOlM-wlNjM&feature=youtu.be https://www.thegaitguys.com/thedailyblog/and-what-have-we-been-saying-for-the-last-several monthly 0.5 2016-01-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553465998-P706HNZRCHFA2WJ1E81I/tumblr_o18gbvvAIY1qhko2so2_400.jpg Blog and what have we been saying for the last several years? “The development of bone marrow edema after transitioning from traditional running shoes to minimalist footwear is associated with small intrinsic foot muscle size, according to research from Brigham Young University in Provo, UT. The findings, epublished in late October by the International Journal of Sports Medicine, suggest that runners with small intrinsic foot muscles may benefit from strengthening exercises prior to attempting the transition to minimalist running. Investigators randomized 37 habitually shod runners to 10 weeks of running in minimalist footwear or their own shoes, and performed magnetic resonance imaging at baseline and after the intervention to detect bone marrow edema and assess intrinsic foot muscle size. Eight of the runners in the minimalist group had developed bone marrow edema at 10 weeks, as well as one in the control group. Those who developed bone marrow edema had significantly smaller intrinsic foot muscles than those who did not. In addition, running in minimalist footwear was associated with a 10.6% increase in abductor hallucis cross-sectional area, a statistically significant change”. Source: Johnson AW, Myrer JW, Mitchell UH, et al. The effects of a transition to minimalist shoe running on intrinsic foot muscle size. Int J Sports Med 2015 Oct 28. [Epub ahead of print] https://www.thegaitguys.com/thedailyblog/yet-another-cause-of-impaired-ankle-rocker-be monthly 0.5 2016-01-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553466433-AC2DV3KXHE4IC4JMAKWF/tumblr_o18g7okVo31qhko2so2_400.jpg Blog yet another cause of impaired ankle rocker. Be sure to do a thorough exam! “Many pathogenic manifestations of equinus occur due to the center of pressure displacement that is seen in diseased states. Typically, the center of pressure on the foot can be measured 6 cm anterior to the ankle during gait, but with equinus, it is shifted distally and laterally. The pull of the Achilles tendon cannot adequately compensate for the new distal and lateral center of pressure and, as a result, an overall pronatory force remains.” http://lermagazine.com/article/equinus-its-surprising-role-in-foot-pathologies https://www.thegaitguys.com/thedailyblog/the-deep-6-and-their-not-so-talked-about-role monthly 0.5 2016-01-20 https://www.thegaitguys.com/thedailyblog/eliminating-the-fake-out-of-ample-ankle-rocker monthly 0.5 2016-01-19 https://www.thegaitguys.com/thedailyblog/how-relaxed-or-shall-we-say-sloppy-is-your-gait monthly 0.5 2016-01-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553467224-VONQE29Z66ERCEG4KP7Z/tumblr_o0yk0oM5Ui1qhko2so1_500.png Blog How relaxed, or shall we say “sloppy” is your gait ? Look at this picture, the blurred left swing leg tells you this client has been photographed during gait motion.  Now, visualize a line up from that right foot through the spine. You will see that it is clearly under the center/middle of the pelvis. But of course, it is easier to stand on one leg (as gait is merely transferring from one single leg stance to the other repeatedly) when your body mass is directly over the foot.  To do this the pelvis has to drift laterally over the stance leg side.  Sadly though, you should be able to have enough gluteal and abdominal cylinder strength to stack the foot and knee over the hip. This would mean that the pelvis plumb line should always fall between the feet, which is clearly not the case here.  This is sloppy weak lazy gait. It is likely an engrained habit in most people, but that does not make it right. It is pathology, in time something will likely have to give.  This is the cross over gait we have beaten to a pulp here at The Gait Guys over and over … . . and over.   This gait this gait, this single photo, means this client is engaging movement into the frontal plane too much, they have drifted to the right. We call it frontal plane drift. To prevent it, it means you have to have an extra bit more of lateral line strength in the gluteus medius and lateral abdominal sling to fend off pathology. You have to be able to find functional stability in the stacked posture, and this can take some training and time.  Make no mistake, this is a faulty movement pattern, even if there is not pain, this is not efficient motor patterning and something will have to give. Whether that is lateral foot pain from more supination strategizing, more tone in the ITB perhaps causing lateral knee or hip pain, a compensation in arms swing or thoracic spine rotation or head tilt  … … something has to give, something has to compensate.  So, how sloppy is your gait ?  Do you kick or scuff the inside of your opposite shoe ? Can you hear your pants rub together ? Just clues. You must test the patterns, make no assumptions, please. Shawn Allen, one of the gait guys https://www.thegaitguys.com/thedailyblog/podcast-101-physics-of-falling-running monthly 0.5 2016-01-13 https://www.thegaitguys.com/thedailyblog/did-you-know-using-a-sauna-can-in-some-areas monthly 0.5 2016-01-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553467169-9LLW7YKQCI9KJL62VEJE/tumblr_o0pmgr9cRY1qhko2so2_1280.png Blog Did you know using a sauna can (in some areas) produce better results than exercise?  I didn’t believe it either. What are we listening to this week? For 1, one of Dr Ivo’s new favs: Dr Rhonda Patrick This is an absolutely great, referenced short on some of the benefits of hyperthermic conditioning (ie sauna use). One of the most surprising effects was benefits which exceeded exercising! Here is one small excerpt: Being heat acclimated enhances endurance by the following mechanisms: It increases plasma volume and blood flow to the heart (stroke volume).  This results in reduced cardiovascular strain and lowers the heart rate for the same given workload.  These cardiovascular improvements have been shown to enhance endurance in highly trained as well as untrained athletes. It increases blood flow to the skeletal muscles, keeping them fueled with glucose, esterified fatty acids, and oxygen. The increased delivery of nutrients to muscles reduces their dependence on glycogen stores. Endurance athletes often hit a “wall” when they have depleted their muscle glycogen stores. Hyperthermic conditioning has been shown to reduce muscle glycogen use by 40%-50% compared to before heat acclimation. This is presumably due to the increased blood flow to the muscles. In addition, lactate accumulation in blood and muscle during exercise is reduced after heat acclimation. It improves thermoregulatory control, which operates by activating the sympathetic nervous system and increasing the blood flow to the skin and, thus the sweat rate. This dissipates some of the core body heat. After acclimation, sweating occurs at a lower core temperature and the sweat rate is maintained for a longer period. waaaayyyyy more in her video. Check it out here. I had to listen to it several times to catch all the details. https://www.thegaitguys.com/thedailyblog/pronating-around-internal-hip-rotation-loss-this monthly 0.5 2016-01-12 https://www.thegaitguys.com/thedailyblog/when-is-a-hamstring-strain-not-a-hamstring-strain monthly 0.5 2016-01-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553467979-EYI45ZP71FA3U3XZNZUB/tumblr_o0pgabVPZJ1qhko2so1_1280.jpg Blog When is a hamstring strain not a hamstring strain? We have always have found the quadratus femoris is one of, if not the, 1st hip muscle to become dysfunctional in hip pain patients. Perhaps it is due to it being the southern most stabilizer of the deep 6. Long known as an adductor, but also external rotator, we find it is employed eccentrically when the foot the planted and people rotate to the same side as weight bearing, or people take a “sudden stumble” while running. It often mimics an insertional hamstring strain with regards to location. We were happy to see it is getting some of the attention it deserves : ) http://www.anatomy-physiotherapy.com/articles/musculoskeletal/lower-extremity/hip/1528-function-of-the-quadratus-femoris-and-obturator-externus https://www.thegaitguys.com/thedailyblog/what-were-they-thinking-oh-they-werent monthly 0.5 2016-01-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553468684-DKBONWYM6TTAE21HJ77F/tumblr_o0pa2hQiOL1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553468946-TVYMRN7WGLEED0Z1GITG/tumblr_o0pa2hQiOL1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553469436-Y6K8B7659H4JJWQTQF0W/tumblr_o0pa2hQiOL1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553469420-GL9PBU91E6N0TR0D11PQ/tumblr_o0pa2hQiOL1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553469697-UCHSEBIKUNZBRTQ94G21/tumblr_o0pa2hQiOL1qhko2so5_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553470349-XTOOC6AVSMYMU5PK8D0J/tumblr_o0pa2hQiOL1qhko2so6_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553470118-HEPFMU2LNH9KR7ZS5FAO/tumblr_o0pa2hQiOL1qhko2so7_r1_250.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553470419-8NTM3EH4771QASB5ER1Z/tumblr_o0pa2hQiOL1qhko2so8_r1_250.jpg Blog https://www.thegaitguys.com/thedailyblog/the-great-toes-effect-on-external-hip-rotation monthly 0.5 2016-01-07 https://www.thegaitguys.com/thedailyblog/httpemedicinemedscapecomarticle1236085-overv monthly 0.5 2016-01-06 https://www.thegaitguys.com/thedailyblog/change-the-foot-change-the-knee-and-vice-versa monthly 0.5 2016-01-05 https://www.thegaitguys.com/thedailyblog/falling-hard-using-supination-to-stop-the-drop monthly 0.5 2016-01-04 https://www.thegaitguys.com/thedailyblog/cold-war-shoe-lace-tying monthly 0.5 2016-01-03 https://www.thegaitguys.com/thedailyblog/salsa-dancing-for-age-related-functional-deficits monthly 0.5 2016-01-02 https://www.thegaitguys.com/thedailyblog/difference-between-adult-and-infant-gait monthly 0.5 2016-01-01 https://www.thegaitguys.com/thedailyblog/hmmmm-the-question-is-is-the-earlier-activation monthly 0.5 2015-12-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553471361-GPQ7OJLZDVOBSW653H7R/tumblr_nzm9pvpmIi1qhko2so2_400.jpg Blog Hmmmm… The question is: “is the earlier activation a good thing”? What do you say? “A study of patients with chronic ankle instability (CAI) suggests the onset of knee and ankle muscle activity occurs significantly earlier when shoes and orthoses are worn than when the patients are barefoot.” http://lermagazine.com/issues/october/shoes-orthoses-improve-muscle-activation-onset-in-unstable-ankles https://www.thegaitguys.com/thedailyblog/eating-up-a-cardinal-plane-simple-post-simple monthly 0.5 2015-12-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553471389-T509670MHMOYGTSZEU4S/tumblr_nka8fnqPlp1qhko2so1_540.jpg Blog Eating up a cardinal plane. Simple post, simple principle today.  We found this case on the web, somewhere. Wish we could remember so we could give credit.  Looks like simple right leg length discrepancy but the point we wanted to make is that any time you deviate into a plane, you eat up length. In this case, the right knee is severely valgus and that has at least in part contributed to a shorter limb and unleveling of the pelvis. And, it is not uncommon that rotation axis are changed when frontal or sagittal planes are compromised. It is easy to see this on the x-rays, if the foot posturing isn’t at least noted, look at the spacing between the tibia and fibula .  .  .  . rotational planes have changed as well. Is it from the femur or tibia? That is the topic of another day.  In the larger photo you will notice that even with the right foot lifted there is still a pelvis unleveling. How can that be, unless it was further unleveled that what we are seeing ?  Well, just because you lift to fix doesn’t mean the lift will not enable further collapsing into the weakness and deformity.  We have described this principle on the topic of EVA shoe foam deformation.  When the foot presses the foam into the deformation, it leaves more room for possibly further and faster deformation loads (perhaps more so than had a new shoe been prescribed). So in some cases, more lift can allow more deformation.  How far, well as in this photo, at least until the right knee slams into the left knee and stops further deformation. So, seeing a plane deficit clues you into possible unleveling of the pelvis and abnormal joint loading responses. It should clue you into looking for another cardinal plane compromise as well. But make no mistake, just adding a lift doesn’t mean the deformation is remedied and not enabling further deformation. It is possible that you can make your client worse if you do not teach them how to find the appropriate motor patterns with the lift so they can learn to protect the parts. Often teaching these types of clients how to control their deformities (when and if possible) is where the gold lies, not in just leveling out the foundation.  One more “beating of the dead  horse”, lift the whole foot, heel and forefoot with a sole lift when you are “lifting and leveling”. Lifting only the heel puts them into ankle plantar flexion and can often facilitated earlier and faster forefoot loading and even earlier knee flexion.  Save the heel lift as a possible consideration when there are posterior compartment contractures or inflammation.  Certainly we could have gone into functional and structural leg length discrepancies, but we have blogged excessively on that topic in the past. Go ahead and search our blog if you want more on those topics. Take home point, “just because you lift, doesn’t mean you are truly lifting, you may enable the opposite”. Shawn Allen, one of the gait guys https://www.thegaitguys.com/thedailyblog/what-types-of-tests-do-you-use-to-assess monthly 0.5 2015-12-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553471870-JZ7KHP8ELZY67O3F9X66/tumblr_nzm9cyOY2X1qhko2so1_250.jpg Blog What types of tests do YOU use to assess lumbopelvic control? We have talked about the multifidus lift test before; here is another “The clinical test of thoracolumbar dissociation was devised into assess a patient’s ability to perform anterior/posterior pelvic tilt in sitting while attempting to maintain a constant position of the thoracolumbar junction. The results demonstrate that the clinical test of thoracolumbar dissociation has acceptable inter-rater reliability when used by trained physiotherapists. This test described here is the first to assess the ability to dissociate movement of the lumbopelvic region from that of the thoracolumbar region.” From: Elgueta-Cancino et al., Manual therapy (2015) 418-424(Epub ahead of print). All rights reserved to Elsevier Ltd. https://www.thegaitguys.com/thedailyblog/welcome-to-monday-and-news-you-can-use-got-arm monthly 0.5 2015-12-28 https://www.thegaitguys.com/thedailyblog/happy-holidays-from-the-gait-guys-twas-the-night monthly 0.5 2015-12-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553472469-SJEDV3TRF6UP68FFYJW0/tumblr_nzvs29P9Nx1qhko2so1_1280.jpg Blog Happy Holidays from The Gait Guys Twas the night before Christmas, and all through the land, and the Gait Guys were there to give St Nick a hand.  This poor fellows knees had been in pain as of late. He had taken up running to help lose some weight.  To his clinician he went, who prescibed an orthotic for pronation, without a look or thought, or a very methodic examination. So across the country, Dillon, Chicago and the nation, He went to see the Gait Guys for a comprehensive evaluation. They watched him run on the treadmill and analyzed his stride and they saw he had a heavy foot strike on one side And his knees fell outside of center, left side more than the right and an adductory twist, from a heel cord wound too tight. They looked at each other and at the same time said they thought that they knew what the problem was with the man who wore red. Then they placed him on the table, with the highest efficiency, they found that he had a left sided leg length deficiency. When his knees were straight, his feet pointed to the middle; internal tibial torsion they thought, and that solves the riddle. An orthotic for internal torsion, without a valgus post is sure to macerate the meniscus, and turn it to toast.  That orthotic they took, from his shoe in a jiffy and knees were more midline, now wasn’t that spiffy and a sole lift for his shoe, to correct the difference, even though it was small, it had a significance… And exercises they gave, to be done three times each day to anchor the medial tripod, and push off through the 1st ray.  “Thanks Gents”, he said, as he took off running with a smile, His knees were much better, even after running a mile.  Shawn and Ivo looked at each other feeling fulfilled, Having helped this poor fellow, and they hope they instilled In each and every reader and follower and student the desire to look closer and do what is prudent Happy Holidays we wish to all our sisters and brothers, We hope we have inspired you to continue to learn and teach one another.  Have a great one : ) https://www.thegaitguys.com/thedailyblog/we-always-like-to-try-and-reproduce-the-problem monthly 0.5 2015-12-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553472482-JJYXDU0UENN98SQ6THWD/tumblr_nzm9i9S8gz1qhko2so2_400.jpg Blog We always like to try and reproduce the problem. We like to say “If we can reproduce the pain, we can probably fix the cause”, which seems to hold true in many cases. This article makes us think about seeing the patient at a point in their training that they feel the discomfort or are having the problem (after 30 minutes, after 20 miles, etc). There may be some value to scheduling their exam later, rather than sooner. A nice fatigue article from one of our favs “LER”. http://lermagazine.com/article/running-in-an-exerted-state-mechanical-effects https://www.thegaitguys.com/thedailyblog/hyperthermic-conditioning-for-hypertrophy monthly 0.5 2015-12-23 https://www.thegaitguys.com/thedailyblog/more-on-the-minimalist-debate-nearly-a-third monthly 0.5 2015-12-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553472570-5T90SLD3M7DFMOAS6V2K/tumblr_nzm9mqUvzY1qhko2so2_400.jpg Blog More on the Minimalist Debate “Nearly a third (29%) of those who had tried minimalist running shoes reported they had experienced an injury or pain while using the shoes. The most common body part involved was the foot. Most (61%) of those reports involved a new injury or pain, 22% involved recurrences of old problems, and 18% were a combination of both old and new musculoskeletal problems. More than two thirds (69%) of those who had tried minimally shod running said they were still using minimalist running shoes at the time of the survey, but nearly half of those who had stopped said they did so because of an injury or pain. The most common sites of pain or injury that caused survey participants to discontinue minimally shod running were the foot (56%) and the leg (44%). While some runners who tried minimalist running shoes suffered some pain and discomfort, a greater percentage (54%) said they had pain that improved after making the switch. The anatomical area most often associated with improvement was the knee. The results were published in the August issue of PM&R.” https://www.thegaitguys.com/thedailyblog/welcome-to-monday-and-news-you-can-use-any-of monthly 0.5 2015-12-21 https://www.thegaitguys.com/thedailyblog/walking-changes-our-mental-state-and-our-mental monthly 0.5 2015-12-17 https://www.thegaitguys.com/thedailyblog/calf-strength-screen-um-maybe-not-specifics monthly 0.5 2015-12-16 https://www.thegaitguys.com/thedailyblog/ever-wonder-why-vladimir-putin-walks-like-that monthly 0.5 2015-12-16 https://www.thegaitguys.com/thedailyblog/gait-retraining-be-careful monthly 0.5 2015-12-14 https://www.thegaitguys.com/thedailyblog/why-cant-i-squat monthly 0.5 2015-12-09 https://www.thegaitguys.com/thedailyblog/gait-stopping monthly 0.5 2015-12-07 https://www.thegaitguys.com/thedailyblog/walking-facts monthly 0.5 2015-12-07 https://www.thegaitguys.com/thedailyblog/foot-posture-and-kinematics monthly 0.5 2015-12-07 https://www.thegaitguys.com/thedailyblog/in-physics-angular-momentum-is-the-rotational monthly 0.5 2015-12-07 https://www.thegaitguys.com/thedailyblog/achilles-tendonitis-lift-the-heel-right-it-does monthly 0.5 2015-12-07 https://www.thegaitguys.com/thedailyblog/welcome-to-news-you-can-use-listen-as-dr-ivo monthly 0.5 2015-12-07 https://www.thegaitguys.com/thedailyblog/welcome-to-monday-folks-and-news-you-can-use-have monthly 0.5 2015-11-30 https://www.thegaitguys.com/thedailyblog/pod-100-hill-running-cortical-brain-changes-in monthly 0.5 2015-11-27 https://www.thegaitguys.com/thedailyblog/have-a-patient-with-weak-hip-abductors-here-is-a monthly 0.5 2015-11-23 https://www.thegaitguys.com/thedailyblog/starting-and-stopping-your-gait-how-we-do-it monthly 0.5 2015-11-23 https://www.thegaitguys.com/thedailyblog/now-theres-some-internal-tibial-torsion-so-this monthly 0.5 2015-11-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553473903-M8AWRD9684BH7C21UK42/tumblr_nxo5gvpjDh1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553473967-P6ZY99C3BK5WE8YIU65V/tumblr_nxo5gvpjDh1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-99-how-foot-placement-the-glutes-and monthly 0.5 2015-11-14 https://www.thegaitguys.com/thedailyblog/the-dodgy-foot-a-uk-runners-dilemma-we-get monthly 0.5 2015-11-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553474918-00SPXRAKVLNKWL3344SL/tumblr_nxnl8o3gv11qhko2so1_500.jpg Blog The “Dodgy Foot”, a UK runner’s dilemma. We get “help me” emails from all over the world on a regular basis. Recently we received this photo from a runner in Oxford, UK,  The runner was frustrated, explaining a “dodgy foot”.  We like the word.  dodg·y    däjē/ -dishonest or unreliable; potentially dangerous; of low quality. We can guarantee you that the solution here to this runner’s form issue is not wholly at the foot which appears “in toed” and slanted and appears ready to kick the back of the right heel, not to mention the knees that are about to brush together.  Thus, merely working on their foot strike would be so remedial and corrupt that it would a crime.  Ivo and I do not take on cases via the internet because we cannot give all the information because we cannot examine the client, many do offer such services but people are not being given the whole story and we pledged long ago not to be part of the problem.  Anyone who recommends exercises from things they see on a video gait analysis are basically doing the same disservice in our opinion. But sometimes, as in this case, their inquiry is simple, there is a photo or video and it allows us to highlight an important component of an individuals gait which can lead them on a road to appropriate discovery. This is one of those cases.  I will not be presenting a solution, because I do not have the examination information I need, but I will propose a solid thought process that further investigation may afford progress towards resolution. This is a non-pathologic cross over gait in my mind until proven otherwise, there may be other sources, causes and components, but when it quacks like a duck you’d be silly not to check for webbed feet. This runner even confirmed upon questioning that the left foot scuffs the inside of the right ankle/shin often, both sides scuff in fact but more left shoe on right shin. No Einsteinian epiphany there.  This means a narrow swing through  (adducting) left limb.  This means stance and swing phase gluteus medius communication problems.  This means swing leg foot targeting problems.  This often suggests right, but sometimes both right and left, frontal plane pelvis sway problems which means pelvis control is challenged which means core lumbar stability control is challenged.  This means adaptive arm swing changes from the clean norm.   This does NOT mean this runner has pain, or pain yet, or maybe never will have pain but there are many determinants of that which I will discuss below.  But, make no mistake, this is flawed gait mechanics. The left swing leg is clearly targeting a more medial placement, meaning limb adduction (active or passive or both is to be determined) and this is a product of the cross over gait (unfamiliar with the cross over gait ? SEARCH our blog for the term, you will need a few hours of free time to get through it all).  Some would call the cross over gait a lazy gait, but I would rather term it an efficient gait taken too far that it has now become a liability, a liability in which they can no longer stabilize frontal plane sway/drift. A wider gait on the other hand, as in most sprinters, is less efficient but may procure more power and the wider base is more stable affording less frontal plane drift. Just go walk around your home and move from a very narrow line walking gait to a wide gait and you will feel a more powerful engagement of the glutes. Mind you, this is not a fix for cross over gaits, gosh, if it was only that simple ! This runner must investigate whether there is right frontal plane drift, and if it is in fact occurring, find the source of the drift.  It can come from many places on either limb. (This client says they are scuffing both inside ankles, which is not atypical and so we likely have drift on both right and left). We have discussed many of them here in various places on the blog over the years. Now as for “Why” the foot looks in toed, well that can also come from many places. Quite simply the adducted limb once it leaves toe off can look like this. But, perhaps it is also a product of insufficient external rotation maintenance occurred during that left stance phase, affording more internal rotation which is being unchecked and observed here during early swing.  Remember though, if this is in fact a cross over gait result, in this gait the limb approaches the ground unstacked (foot is too far inside a left hip joint plumb line) the foot will greet the ground at a far lateral strike and in supination.  Pronation will thus be magnified and accelerated, if there is enough time before toe off. However, and you can try this on your own by walking around your home, put yourself in terminal stance at toe off. Make sure you have the foot inverted so you are toeing off the lateral toes (low gear toe off). Does this foot not look like the one in the photo ? Yes it does, now just lift the foot off the ground and you have reproduced this photo. And when combined with a right pelvis drift, the foot will sneak further medially appearing postured behind the right foot.  Keep this in mind as well, final pronation and efficient hallux (big toe) toe off does often not occur in someone who strikes the ground on a far lateral foot. I am sure this runner will now be aware of how poorly they toe off of the big toe, the hallux.  They will tend to progress towards low gear toe off, off the lesser toes. This leaves the foot inverted and this is what you are seeing in her the photo above. That is a foot that is inverted and supinated and it carried through all the way through toe off and into early swing. It is a frequently component of the cross over gait, look for it, you will find it, often.  Final thoughts, certainly this can be an isolated left swing phase gluteus medius weakness enabling an adducted swing limb thus procuring a faulty medial foot placement, but it is still part of the cross over phenomenon.  Most things when it comes to a linked human frame do not work in isolation.  But i will leave you with a complicating factor and hopefully you will realize that gait analysis truly does require a physical exam, and without it you could be missing the big picture problem.  What if she has a notable fixed anatomic internal tibia torsion on that left side. Yup, it could all be that simple, and that is not something you can fix, you learn to manage that one as a runner.   * Side bar rant: Look at any google search of runners photos and you will see this type of swing limb foot posturing often, far too often.  And yes, you can take the stance that “I do it as well and i have no injuries or problems so what is the big deal?”.  Our response is often “you do have an issue, it may be anatomic or functional, but you do have an asymmetrical gait and you think it is not a problem, YET”. And maybe you will run till you are 6 feet under and not have a problem because you have accomodated over many years and you are a great compensator, yes, some people get lucky. Some people also do not run enough miles that these issues express themselves clinically so lets be fair. But some of these people are reality deniers and spend their life buying the newest brace or gadget, trying a different shoe insert, orthotic or new shoe of the month and shop over and over again for another video gait analysis expert who can actually fix their pain or problem. And then there are those who have a 45 minute home exercise program that they need to do to keep their problems at bay, managing, not fixing anything.  Or, they spend an hour a week on the web reading article after article on what are the top 4 exercises for iliotibial band syndrome for example. They shop for the newest Graston practitioner, the newest kinesio taping pattern, Voodoo bands, breathing patterns, compression socks etc.  And sometimes they are the ones that say they still dont have a problem.You get the drift.  Gosh darn it, find someone who knows what the hell they are doing and can help you fix the issues that are causing the problem.  And yes, some of the above accoutrements may be assistive in that journey.  I have dealt with this unique toe off issue way too many times not to roll my eyes at it any longer. It is to the point that it is an automated evaluation and solution program that begins to run in my head. Once you see something enough times, you learn all of the variations and subtle nuiances that a problem can take on. But, trying to fit everyone into a similar solution model is where the novice coach, trainer or clinician will get into trouble. Trust us, it all starts with an examination, a true clinical physical examination.  If one leaves the investigatory process to a series of screens or functional movement patterns, “activation” attempts, digital gait analysis or strength tests one is juggling chainsaws and the outcome you want is often not likely to occur. There is nothing wrong with making these components part of the investigation process, but on their own, they are not enough to get the honest answer many times.  Of course, Ivo and i were not able to jump the pond and examine this runner with our own eyes and hands so today’s dialogue was merely to offer this runner some food for thought to open their mind to our thought process, in the hopes that they can find someone to help them solve the underlying problem and not merely make the gait look cleaner. Making someone’s walking or running gait look cleaner is not hard, but making it subconsciously competent and clean (without thought or effort) requires a fix to the underlying problem. We can ALMOST guarantee you that the solution here to this runner’s form issue is not wholly at the foot that looks in toed and slanted. Merely working on their foot strike would be so remedial and corrupt that it would a crime. Dr. Shawn Allen, one of the gait guys https://www.thegaitguys.com/thedailyblog/look-at-your-patients-and-clients-shoes-can-you monthly 0.5 2015-11-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553475131-OXWAQWKP7VDH9HZY5M9O/tumblr_nx0af1nwit1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553475192-RNZDFUMMW1I88YEN1HVE/tumblr_nx0af1nwit1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/ivo-and-i-have-a-bunch-of-screens-we-use-to-glean monthly 0.5 2015-11-09 https://www.thegaitguys.com/thedailyblog/sometimes-you-need-to-run-that-valgus-post-clear monthly 0.5 2015-11-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553475597-GP3K8UEV0SDV9GCNXUAV/tumblr_nx0asr7Q1c1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553475401-DYCBD1PKWMVY60SKUNZB/tumblr_nx0asr7Q1c1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553475776-PHOAIDN3PA684TN6GJH1/tumblr_nx0asr7Q1c1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/l-sided-medial-knee-pain-in-a-tkr-patient-so-why monthly 0.5 2015-11-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553476607-K4FUZXIGEQB8IZ87ULDL/tumblr_nwjdvaVDhF1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553476282-6IO88VZJ9YPYOHREJ44S/tumblr_nwjdvaVDhF1qhko2so2_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553477310-4TVK9WH6OBXVELQQGEWO/tumblr_nwjdvaVDhF1qhko2so3_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-98-stability-mobility-and-the-brain monthly 0.5 2015-10-30 https://www.thegaitguys.com/thedailyblog/can-you-believe-they-missed-this-sometimes-you monthly 0.5 2015-10-26 https://www.thegaitguys.com/thedailyblog/effects-of-prior-hamstring-injuries monthly 0.5 2015-10-23 https://www.thegaitguys.com/thedailyblog/en-pointe-demi-pointe-posterior-impingement monthly 0.5 2015-10-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553477508-FYE9BP9T6M5X0YCNQK3W/tumblr_no75l1nCgP1qhko2so1_r1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553477973-LBSSCSPNGXG8FO7HUKZ6/tumblr_no75l1nCgP1qhko2so2_r1_400.jpg Blog https://www.thegaitguys.com/thedailyblog/custom-orthotic-or-sham-for-mid-tendon-achilles monthly 0.5 2015-10-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553478793-Y0XW83AKPZO4ZA7JF551/tumblr_nw6xmimO3Z1qhko2so1_1280.jpg Blog Custom orthotic or Sham for mid tendon achilles tendonopathy? It doesn’t seem to matter. This study prescribed eccentric calf exercises along with either a custom or “sham” foot orthosis for 140 people who were randomized as to which group got the real goods and which one did not.  A Victorian Institute Sports Assessment-Achilles questionairre was given at baseline, 1, 3, 6 and 12 months. No statistically significant difference between the groups. Hmmm.. We wonder just what were the custom and sham like? When we use orthoses, we use full arch contact devices. Perhaps the type of orthosis makes a difference? What has been your experience? Munteanu SE, Scott LA, Bonanno DR, Landorf KB, Pizzari T, Cook JL, Menz HB.  Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Br J Sports Med. 2015 Aug;49(15):989-94. doi: 10.1136/bjsports-2014-093845. Epub 2014 Sep 22. https://www.thegaitguys.com/thedailyblog/national-shoe-fit-certification-course monthly 0.5 2015-10-20 https://www.thegaitguys.com/thedailyblog/psoas-iliacus-hip-flexors monthly 0.5 2015-10-19 https://www.thegaitguys.com/thedailyblog/dr-ivo-talking-about-some-of-the-finer-points-on monthly 0.5 2015-10-19 https://www.thegaitguys.com/thedailyblog/how-quickly-does-your-brain-start-working-when-you monthly 0.5 2015-10-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553478961-BTTS5PJOJ6UY9QVHY3TP/tumblr_nw9zkm0Kse1qhko2so1_1280.jpg Blog How quickly does your brain start working when you start your client evaluation ?   Answer: as quickly as possible. Stepping up to the plate today for the first pitch I see this.   Do you see the ever so slight evidence of “possible” right toe extensor tone ? It is subtle but it is staring you right in the face if you care to embrace the subtle clue.  From this angle you can see more of the fat pad and plantar aspect of the RIGHT forefoot. The very next thing we did was look at the dorsum of the foot, and yup, more prominent extensor tone, short extensors to be specific.  The next question was why was I seeing this ? Short flexors usually pair with long toe flexors, and that means gripping the ground and distal displacement of the fat pad and even sometimes lumbrical inhibition or frank weakness. Possible attempts to gain more foot purchase on the ground ? Hmmmmm, perhaps.  The client had right hip pain and right lateral sesamoid pain.  Time for an examination to find out the “whys” and then fix things. The powers of observation should always get your clinical juices flowing. Even the smallest of things should help guide you or at least clue you in to things. https://www.thegaitguys.com/thedailyblog/notice-the-differences-in-running-top-vs monthly 0.5 2015-10-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553478953-JAW42YDURIST3D2T1N5R/tumblr_nv42pyzoQp1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553479251-NMGYABUW6QOPLCB03QSR/tumblr_nv42pyzoQp1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-97-decomposition-of-human-movement monthly 0.5 2015-10-14 https://www.thegaitguys.com/thedailyblog/medial-or-lateral-foot-placement monthly 0.5 2015-10-13 https://www.thegaitguys.com/thedailyblog/a-cause-of-ishial-pain-how-many-of-us-treat monthly 0.5 2015-10-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553479629-NBXJDAXL3NRT0M5ICI6K/tumblr_nvf79ix42c1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553479875-4I45QE9JEQ1UZH7J610V/tumblr_nvf79ix42c1qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/taking-advantage-of-the-stretch-reflex-and monthly 0.5 2015-10-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553480769-JAHK1T0TJ8S7PDMUO5LD/tumblr_nvqxs9VtjB1qhko2so1_1280.png Blog Taking advantage of the stretch reflex and reciprocal inhibition; or the “reverse stretch” Reciprocal inhibition is a topic we have spoken about before on the blog (see here). The diagram above sums it up nicely. Note the direct connection from the spindle to the alpha motor neuron, which is via a Ia afferent fiber.  When the spindle is stretched, and the pathway is intact, the uscle will contract. What kind of stimulus affects the spindle? A simple “stretch” is all it takes. Remember spindles respond to changes in length. So what happens when you do a nice, slow stretch? You activate the spindle, which activates the alpha motor neuron. If you stretch long enough, you may fatigue the reflex. So why do we give folks long, slow stretches to perform? Certainly not to “relax” the muscle! How can we “use” this reflex? How about to activate a weak or lengthened muscle? Good call. Did you notice the other neuron in the picture? There is an axon collateral coming off the Ia afferent that goes to an inhibitory interneuron, which, in turn, inhibits the antagonist of what you just stretched or activated. So if you acitvate one muscle, you inhibit its antagonist, provided there are not too many other things acting on that inhibitory interneuron that may be inhibiting its activity. Yes, you can inhibit something that inhibits, which means you would essentially be exciting it. This is probably one of the many mechanisms that explain spasticity/hypertonicity How can we use this? How about to inhibit a hypertonic muscle? Lets take a common example: You have hypertonic hip flexors. You are reciprocally inhibiting your glute max. You stretch the hypertonic hip flexors, they become more hypertonic (but it feels so good, doesn’t it?) and subsequently inhibit the glute max more. Hmm. Not the clinical result you were hoping for? How about this: you apply slow stretch to the glutes (ie “reverse stretch”) and apply pressure to the perimeter, both of which activate the spindle and make the glutes contract more. This causes the reciprocal inhibition of the hip flexors. Cool, eh? Now lightly contract the glutes while you are applying a slow stretch to them; even MORE slow stretch; even MORE activation. Double cool, eh? Try this on yourself. Now go try it on your clients and patients. Teach others. Spread the word. https://www.thegaitguys.com/thedailyblog/a-great-free-full-text-on-forward-and-backward monthly 0.5 2015-10-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553481035-JSVIUERANWXI9HD76DV7/tumblr_nv42e3kN0u1qhko2so1_1280.png Blog A great, FREE, full text on forward and backward walking kinematics and a possible link to central pattern generators. “Leg kinematics during backward walking (BW) are very similar to the time-reversed kinematics during forward walking (FW). This suggests that the underlying muscle activation pattern could originate from a simple time reversal, as well… "We concluded that the changes in muscle contributions imply that a simple time reversal would be insufficient to produce BW from FW. We therefore propose that BW utilizes extra elements, presumably supraspinal, in addition to a common spinal drive. These additions are needed for propulsion and require a partial reconfiguration of lower level common networks.” http://jn.physiology.org/content/107/12/3385 Similar muscles contribute to horizontal and vertical acceleration of center of mass in forward and backward walking: implications for neural controlKaren Jansen, Friedl De Groote, Firas Massaad, Pieter Meyns, Jacques Duysens, Ilse JonkersJournal of Neurophysiology Published 15 June 2012 Vol. 107 no. 12, 3385-3396 DOI: 10.1152/jn.01156.2011 https://www.thegaitguys.com/thedailyblog/welcome-to-news-you-can-use-today-dr-ivo-talks monthly 0.5 2015-09-28 https://www.thegaitguys.com/thedailyblog/news-you-can-use-welcome-to-monday-folks-in monthly 0.5 2015-09-28 https://www.thegaitguys.com/thedailyblog/gait-and-climbing-part-1-lucid-dreaming-is-the monthly 0.5 2015-09-23 https://www.thegaitguys.com/thedailyblog/thoughts-on-the-adductor-grouping-to-ponder-i monthly 0.5 2015-09-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553481033-VFOBWIGOL5FSCKD2JYLJ/tumblr_nuu07ezLgX1qhko2so1_400.jpg Blog Thoughts on the adductor grouping to ponder.  I found this while prepping for the dry needling course I am teaching this weekend and thought you may enjoy it. Though the primary actions of the addcutors are well established, secondary actions (whether they are acually internal or external rotators) remains to be elucidated. Here is a nice abstract that supports the dynamic function of them as external rotators (eccentrically) during gait. “Anatomical texts agree on most muscle actions, with a notable exception being the action of the adductors of the hip in the transverse plane. Some texts list an action of the adductor brevis (AB), adductor longus (AL), and/or adductor magnus (AM) as internal rotation, whereas others list an action of external rotation. The purpose of this article is to present a functional model in support of the action of external rotation. Transverse plane motion of the femur at the hip during normal gait is driven by subtalar joint motion during the loading response, terminal stance, and preswing phases. During the loading response, the subtalar joint pronates, and the talus adducts. This talar adduction results in the lower leg, and subsequently the femur, internally rotating. During terminal stance and preswing, the opposite occurs; the subtalar joint supinates as the talus abducts in response to forces generated from the lower extremity and in the forefoot. Electromyographic (EMG) studies indicate varied activity in the AB, AL, and AM during the loading response, terminal stance, and preswing phases of the gait cycle. A careful analysis of EMG activity and kinematics during gait suggests that, in the transverse plane, the adductors may be eccentrically controlling internal rotation of the femur at the hip during the loading response, rather than the previously reported role as concentric internal rotators. In addition, these muscles may also concentrically produce external rotation of the femur at the hip during terminal stance and preswing. Physical therapists should consider this important function of the hip adductors during gait when evaluating a patient and designing an intervention program. Anatomical texts should consider listing the concentric action of external rotation of the femur at the hip as one action of the AB, AL, and AM, particularly when starting from the anatomic position.” Leighton RD. A functional model to describe the action of the adductor muscles at the hip in the transverse plane.Physiother Theory Pract. 2006 Nov;22(5):251-62.Leighton RD. A functional model to describe the action of the adductor muscles at the hip in the transverse plane.Physiother Theory Pract. 2006 Nov;22(5):251-62. https://www.thegaitguys.com/thedailyblog/podcast-96-minimalism-shoes-toe-trauma-meniscal monthly 0.5 2015-09-19 https://www.thegaitguys.com/thedailyblog/does-slowing-gait-increase-gait-stability monthly 0.5 2015-09-17 https://www.thegaitguys.com/thedailyblog/unique-adaptations-to-arm-swing-challenges-the monthly 0.5 2015-09-09 https://www.thegaitguys.com/thedailyblog/dr-ivo-demonstrating-a-dry-needling-technique-for monthly 0.5 2015-09-09 https://www.thegaitguys.com/thedailyblog/dont-deny-it-you-are-curious-and-so-are-we monthly 0.5 2015-09-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553481395-FM3OL4KKA3KE6HEKJJ2X/tumblr_nu5oip7ldy1qhko2so1_400.jpg Blog !!!! Don’t deny it, you are curious, and so are we smile emoticon We are easily distracted by bright shiny things and this one sure has the “wait, what the #$%&@ was that !” factor. Inspired by the oversized tires found on “Fat Bikes”, the Michelin® Wild Gripper outsole welcome to the UnderArmor Fat Tire GTX Trail shoe. 2015 “Outside Gear Of The Show” Winner. Could be a disaster or an ingenious idea. We hope to get a pair to review and let our brethren here know. https://www.underarmour.com/…/mens-ua-fat-tire-g…/pid1262064 https://www.thegaitguys.com/thedailyblog/journal-of-foot-and-ankle-research-full-text monthly 0.5 2015-09-08 https://www.thegaitguys.com/thedailyblog/podcast-95-head-tilt-while-squatting-or-running monthly 0.5 2015-09-02 https://www.thegaitguys.com/thedailyblog/the-minimalist-shoe-rating-scale-and-definition monthly 0.5 2015-09-02 https://www.thegaitguys.com/thedailyblog/will-smiths-new-movie-concussion-terrifies-the monthly 0.5 2015-09-01 https://www.thegaitguys.com/thedailyblog/just-when-do-those-hamstrings-fire-anyway-in-a monthly 0.5 2015-08-27 https://www.thegaitguys.com/thedailyblog/pincher-nails-who-knew-written-by-dr-shawn monthly 0.5 2015-08-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553481795-XS8SR1O5E9LXEMI8XP6Y/tumblr_ntnuoif8Tj1qhko2so1_r1_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553482675-O9N178P6WKYO4C9DY5UP/tumblr_ntnuoif8Tj1qhko2so2_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/hamstring-reverse-engineering-the-biceps-femoris monthly 0.5 2015-08-24 https://www.thegaitguys.com/thedailyblog/what-creates-muscle-tone-anyway-not-for-the monthly 0.5 2015-08-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553482463-HXNQG0SONRWAL4TZE476/tumblr_ntatsiDHt11qhko2so1_250.jpg Blog What creates muscle tone, anyway? Not for the timid, here is an excellent , free, full text article on spasticity. More importantly, it is an excellent review on what creates muscle tone and how it is maintained, starting and the spindle and moving centrally.  Think about this the next time you have a patient with mm spasm and you can se things in a whole new light http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009478/ https://www.thegaitguys.com/thedailyblog/irregular-arm-swing-could-be-early-sign-of-pending monthly 0.5 2015-08-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553482464-0JIJSEO4E510YFOBST58/tumblr_nt3ky1SKmu1qhko2so1_1280.jpg Blog Irregular Arm Swing Could Be Early Sign Of Pending neurological disease. Written by Dr. Shawn Allen We’ve been saying this for quite some time now, the small subtle gait changes are often the first sign of things to come. The attached article suggests that scientific measurement investigating irregular arm swing during gait could help diagnose the Parkinson’s disease earlier, giving greater opportunity to slow brain cell damage and disease progression. In the study below Huang suggests that although we all know that classically the Parkinsonian disease is met with tremors, slow movements, stooped posture, rigid muscles, bradykinesia, speech changes etc, “by the time we diagnose the disease, about 50 to 80 percent of the critical cells called dopamine neurons are already dead,” Previously, here at The Gait Guys, we have gone deep into discussions of arm swing and the phasic and anti-phasic natures of limb action in gait and how the four limbs interact neurologically, both centrally and peripherally. You can click here for just a sampling of our “arm swing” writings,    In the study, because arm swing changes are one of the first gait parameters to diminish and decline, and because the decline is typically asymmetrical due to the fact that the disease is an asymmetrical one, the authors compared arm swing magnitude and asymmetry in patients with and without Parkinson’s as parameters to begin the assessments.  Most research to date has commented on the early loss of arm pendular swing but as they said here, “ but nobody had looked using a scientifically measured approach to see if the loss was asymmetrical or when this asymmetry first showed up,“ explained Huang. What they discovered was that compared to the control group, “the Parkinson’s group showed significantly greater asymmetry in their arm swing (one arm swung significantly less than the other while walking),” and when the subjects walked faster, the arm swing increased but the amount of asymmetry remained unchanged. On a slightly different tangent of thinking, an aside from the Parkinson’s disease disucussion, how truly sensitive is this limb swing thing you might ask ? Here, read this from this piece (How injury and pain reorganize the brain) we wrote a few years ago. “Getting a cast or splint causes the brain to rapidly shift its resources to make righties function better as lefties, researchers found. Right-handed individuals whose dominant arm had to be immobilized after an injury showed a drop in (brain) cortical thickness in the area that controls primary motor and sensory areas for the hand, Nicolas Langer, MSc, of the University of Zurich in Switzerland, and colleagues reported. Over the same two-week period, white and gray matter increased in the areas that controlled the uninjured left hand, suggesting “skill transfer from the right to the left hand,” the group reported in the Jan. 17 issue of Neurology. The findings highlight the plasticity of the brain in rapidly adapting to changing demands, but also hold implications for clinical practice, they noted.” This article highlights the rapid changes in motor programs that occur. It does not take long for the body to begin to develop not only functional adaptations but neurologic changes at the brain level within days and certainly less than 2 weeks. If you know your literature on this topic of arm swing symmetry, you know it is an arguable point.  According to the Lathrop-Lambach study (see link in the article just mentioned above), they mentioned that they feel a 10% baseline asymmetry is the norm.  This symmetry issue is an arguable point that no one is likely to ever win.  We tend to feel, as many others do, that asymmetry can be a major component and predictor to injury, and in today’s topic of discussion a possible determinant of higher level gait disease.  Still think you should retrain arm swing ? Dive into our blog archives here on arm swing, you will find out that perhaps it is not your best first choice. Discover from our old writings who tends to dictate how much arm swing occurs.  Shawn Allen, one of the gait guys References: http://www.medicalnewstoday.com/articles/173680.php “Arm swing magnitude and asymmetry during gait in the early stages of Parkinson’s disease.” Michael D Lewek, Roxanne Poole, Julia Johnson, Omar Halawa, Xuemei Huang Gait & Posture, 2009, In Press, Corrected Proof, Available online 27 November 2009  DOI:10.1016/j.gaitpost.2009.10.013 https://www.thegaitguys.com/thedailyblog/does-gait-retraining-alter-peoples monthly 0.5 2015-08-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553482911-4NJNLNZ0873LPFIX4MLI/tumblr_ntavllYLu91qhko2so1_1280.jpg Blog Does gait (re)training alter peoples biomechanics?  You bet it does! Should we be retraining peoples gait? We like to think, yes. What do you think? “Overall, this systematic review shows that many biomechanical parameters can be altered by running modification training programmes. These interventions result in short term small to large effects on kinetic, kinematic and spatiotemporal outcomes during running. In general, runners tend to employ a distal strategy of gait modification unless given specific cues. The most effective strategy for reducing high-risk factors for running-related injury-such as impact loading-was through real-time feedback of kinetics and/or kinematics.’ Br J Sports Med. 2015 Jun 23. pii: bjsports-2014-094393. doi: 10.1136/bjsports-2014-094393. [Epub ahead of print] Gait modifications to change lower extremity gait biomechanics in runners: a systematic review. Napier C1, Cochrane CK1, Taunton JE2, Hunt MA1. https://www.thegaitguys.com/thedailyblog/development-of-the-arch-functional-implications monthly 0.5 2015-08-18 https://www.thegaitguys.com/thedailyblog/reciprocal-inhibition-anyone-thanks-to-the-manual monthly 0.5 2015-08-18 https://www.thegaitguys.com/thedailyblog/patello-femoral-pain-thinking-weak-vmo-think monthly 0.5 2015-08-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553483431-PHHQ6053CJFQJSXCI6QS/tumblr_ntavai6gJv1qhko2so1_250.jpg Blog Patello femoral pain? Thinking weak VMO? Think again… “Atrophy of all portions of the quadriceps muscles is present in the affected limb of people with unilateral PFP. There wasn’t any atrophy of the quadriceps in individuals with PFP compared to those without pathology. Selective atrophy of the VMO relative to the vastus lateralis wasn’t identified in persons with PFP.” http://www.physiospot.com/research/atrophy-of-the-quadriceps-is-not-isolated-to-the-vastus-medialis-oblique-in-individuals-with-patellofemoral-pain/ https://www.thegaitguys.com/thedailyblog/your-gait-and-peripheral-vision-part-2-there-is monthly 0.5 2015-08-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553485391-W8N3P633EAU1669R00NZ/tumblr_nsvyc7nUuE1qhko2so1_500.gif Blog Your gait and peripheral vision: Part 2. There is more to it than what you do/don’t see. Written by Dr. Shawn Allen Yesterday we did a blog post on the loss of peripheral vision from drooping eye lids leading to the necessity (not vanity based) of a minor surgical procedure called a blepharoplasty.  Here was that blog post (link), it had some important research based points you need to know. Vision is typically the predominant sensory system used for guiding locomotion. Online visual control is critical for adjusting lower limb trajectory and ensuring proper foot placement, including optimal limb/foot crossing velocity, optimal trail-foot horizontal distance and lead-toe clearance. Research suggests that peripheral visual cues play a large role in this online gait control. 1 We have discussed many of these issues, the conscious and subconscious importance of vision on human gait, in many of our blog posts over time.  Namely, blog posts on dual-tasking attention, negotiating stairs, and even in tandem walking holding hands. These all require a degree of peripheral vision function otherwise gait problems, including falls, rise on the risk list. According to Timmis and Buckley (2), “although gaze during adaptive gait involving obstacle crossing is typically directed two or more steps ahead, visual information of the swinging lower-limb and its relative position in the environment (termed visual exproprioception) is available in the lower visual field (lvf).”  Their study determined exactly when lvf exproprioceptive information is utilized to control/update lead-limb swing trajectory during obstacle negotiation.  Their study determined that “when (the) lower visual field (lvf) was occluded, foot-placement distance and toe-clearance became significantly increased; which is consistent with previous work that likewise used continuous lvf occlusion”. Their findings suggest that “ lvf (exproprioceptive) input is typically used in an online manner to control/update final foot-placement, and that without such control, uncertainty regarding foot placement causes toe-clearance to be increased. Also that lvf input is not normally exploited in an online manner to update toe-clearance during crossing: which is contrary to what previous research has suggested.” 2 Elliot and Buckley (3) showed the importance of peripheral visual cues in the control of minimum-foot-clearance during overground locomotion. In their study,  From their abstract: “eleven subjects walked at their natural speed whilst wearing goggles providing four different visual conditions: upper occlusion, lower occlusion, circumferential-peripheral occlusion and full vision. Results showed that under circumferential-peripheral occlusion, subjects were more cautious and increased minimum-foot-clearance and decreased walking speed and step length. The minimum-foot-clearance increase can be interpreted as a motor control strategy aiming to safely clear the ground when online visual exproprioceptive cues from the body are not available. The lack of minimum-foot-clearance increase in lower occlusion suggests that the view of a clear pathway from beyond two steps combined with visual exproprioception and optic flow in the upper field were adequate to guide gait. A suggested accompanying safety strategy of reducing the amount of variability of minimum-foot-clearance under circumferential-peripheral occlusion conditions was not found, likely due to the lack of online visual exproprioceptive cues provided by the peripheral visual field for fine-tuning foot trajectory.” These appear to be important studies on the effects of vision and peripheral vision and proprioceptive cues.  How we move our bodies depends much on visual cues, the ones we know we see, and the ones we are unaware that we “see”. Take this to the next level, imagine how the blind must adapt to gait without these cues. That is gait topic we will save for another time. So, the gait analysis you are doing with your runners, your athletes, your clients takes into consideration their vision right ? Hmmmm, some how we just know that many gait gurus just sat back in their chairs and let out a long exhale. We go even more rogue in podcast 95 when we discuss head tilt and the vestibular system, we know that one is almost always overlooked. Another long exhale we presume. Shawn Allen … .  one of the gait guys References: 1. Exerc Sport Sci Rev. 2008 Jul;36(3):145-51. doi: 10.1097/JES.0b013e31817bff72.Role of peripheral visual cues in online visual guidance of locomotion. Marigold DS1. 2.Gait Posture. 2012 May;36(1):160-2. doi: 10.1016/j.gaitpost.2012.02.008. Epub 2012 Mar 17.Obstacle crossing during locomotion: visual exproprioceptive information is used in an online mode to update foot placement before the obstacle but not swing trajectory over it.Timmis MA1, Buckley JG. 3. Gait Posture. 2009 Oct;30(3):370-4. doi: 10.1016/j.gaitpost.2009.06.011. Epub 2009 Jul 22.Peripheral visual cues affect minimum-foot-clearance during overground locomotion.Graci V1, Elliott DB, Buckley JG. https://www.thegaitguys.com/thedailyblog/i-keep-walking-into-doorframes-a-visual monthly 0.5 2015-08-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553485781-5QH8BF2427SJM0CUQ3S0/tumblr_nsvxm78b011qhko2so1_1280.jpg Blog “I keep walking into doorframes,” : A visual aspect of problematic gait you likely have not considered. Written by Dr. Shawn Allen Recently i had an elderly client come in to see me, we were working on some arthritic knee problems post-total knee arthroplasty. He mentioned to me that he recently had eye surgery because he was having some gait difficulties. My brain immediately when into age related gait decline, you know, balance kind of stuff.  He mentioned that he was banging into door frames because he was not clearing the sides of the door frames and was also banging up his knees, ankles, thighs and toes on many other things.  He said he had been getting anxious about his gait and thought he might be experiencing some kind of neurologic gait problem. He wasn’t trusting his gait, he feared leaving his house. He happened to mention it to his eye doctor a few months ago and here is what he told him .   “Your upper eye lids are drooping so much that they are obliterating your peripheral vision. You can’t avoid banging into things that you cannot see. Your peripheral vision is imperative for normal safe gait.” Drooping eyelids are an inevitable effect of getting older, but the sagging eyelids can impair peripheral vision and magnify gait risks. The procedure known as a blepharoplasty is a simple procedure performed on the upper eyelid when the lid drops down and creates a lateral blind or fold blocking out the lateral eye fields. When looking to the extremes of lateral gaze or depending on peripheral vision this fold blocks the lateral field on the affected eye while the bridge of the nose blocks the same lateral field of the other eye. Effectively, the lateral gaze and peripheral vision becomes progressively narrowed.  Watch the gait of your elderly clients. Observe how they move about your office, around furniture, tables, door frames. Ask if their gait is uncertain. Ask if they are running into things for no apparent reason.  Think about this next time you are walking in close proximity of the elderly, just because you see them in your peripheral vision, does not mean they can see you.  Remember, their balance and stability is likely not what yours is, it might not take much to knock them over for what appears to be little reason at all. From the Graci study:  “However, under CPO conditions (circumferential peripheral visual field occlusion), the doorframe led to a further reduction in crossing velocity and increase in trail-foot horizontal distance and lead-toe clearance, which may have been because of concerns about hitting the doorframe with the head and/or upper body.” From their conclusions, “exteroceptive cues are provided by the central visual field and are used in a feed-forward manner to plan the gait adaptations required to safely negotiate an obstacle, whereas exproprioceptive information is provided by the peripheral visual field and used online to “fine tune” adaptive gait. The loss of the upper and lower peripheral visual fields together had a greater effect on adaptive gait compared with the loss of the lower visual field alone, likely because of the absence of lamellar flow visual cues used to control egomotion.” Shawn Allen, one of the gait guys. 1. Optom Vis Sci. 2010 Jan;87(1):21-7. doi: 10.1097/OPX.0b013e3181c1d547.Utility of peripheral visual cues in planning and controlling adaptive gait.Graci V1, Elliott DB, Buckley JG. 2. http://abcnews.go.com/blogs/health/2013/05/31/eye-lifts-fine-line-between-cosmetic-and-therapeutic/ https://www.thegaitguys.com/thedailyblog/podcast-94-the-shoe-motor-control-podcast monthly 0.5 2015-08-10 https://www.thegaitguys.com/thedailyblog/components-to-be-aware-of-during-the-bouncy monthly 0.5 2015-08-06 https://www.thegaitguys.com/thedailyblog/trunk-control-in-locomotion-what-you-may-be monthly 0.5 2015-08-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553485644-540UF6RVKUF3JHJFTPLU/tumblr_nsm2efEiWH1qhko2so1_1280.png Blog Trunk control in locomotion: What you may be realizing by now, if you have been with us here long enough, is that if you are getting good at the deepest of gait stuff, you are truly looking at your clients completely. You are considering vision, vestibular, cerebellar, postural patterns, sensory and motor aspects, movement patterns, proprioception, coordination, S.E.S., stability, mobility, compensation patterns, dual tasking abilities and so much more. We are working on new presentations and projects, soon for your eyes. Here is a slide from a new presentation to wet your whistle. https://www.thegaitguys.com/thedailyblog/doing-video-gait-analysis-really-are-you monthly 0.5 2015-08-05 https://www.thegaitguys.com/thedailyblog/quadrupedal-gait-and-tree-climbing monthly 0.5 2015-08-05 https://www.thegaitguys.com/thedailyblog/quadruped-facts monthly 0.5 2015-08-05 https://www.thegaitguys.com/thedailyblog/doc-how-many-reps-and-sets-should-i-do monthly 0.5 2015-08-05 https://www.thegaitguys.com/thedailyblog/gait-walkingwhy-movement-matters monthly 0.5 2015-08-05 https://www.thegaitguys.com/thedailyblog/ankle-dorsiflexion-stretching monthly 0.5 2015-08-05 https://www.thegaitguys.com/thedailyblog/walking-strokes-movement monthly 0.5 2015-08-05 https://www.thegaitguys.com/thedailyblog/optimal-walking-speed monthly 0.5 2015-08-05 https://www.thegaitguys.com/thedailyblog/higher-level-gait-disorders monthly 0.5 2015-08-05 https://www.thegaitguys.com/thedailyblog/the-effect-of-lower-extremity-fatigue-on-shock monthly 0.5 2015-08-05 https://www.thegaitguys.com/thedailyblog/the-smell-of-napalm-in-the-morning-your-gait-and monthly 0.5 2015-07-29 https://www.thegaitguys.com/thedailyblog/the-mighty-quadratus-plantae-here-is-a-video monthly 0.5 2015-07-27 https://www.thegaitguys.com/thedailyblog/pod-93-ankle-rocker-sacroiliac-joint-symmetry monthly 0.5 2015-07-25 https://www.thegaitguys.com/thedailyblog/just-because-it-looks-good-doesnt-mean-that-it monthly 0.5 2015-07-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553486029-0CXGKUR0271LOWGKHGGV/tumblr_nry289AZhy1qhko2so1_1280.jpg Blog Just because it looks good, doesn’t mean that it is. We have all had patients with seemingly negative knee x rays and pain, only to develop arthritic changes at a later date. Find and treat the cause! “Our analysis found that incident radiographic knee osteoarthritis is preceded by prodromal symptoms lasting at least 2-3 years. This has potential implications for understanding phasic development and progression of osteoarthritis and for early recognition and management.” Case R, Thomas E, Clarke E, Peat G. Prodromal symptoms in knee osteoarthritis: a nested case-control study using data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2015 Apr 2. [Epub ahead of print] picture from: http://whyfiles.org/…/chronic-pain-understanding-the-roots…/ https://www.thegaitguys.com/thedailyblog/due-to-the-shape-of-the-condyles-and-the-menisci monthly 0.5 2015-07-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553486890-T2RLASMPEM3520P7QM6A/tumblr_nry26dttxO1qhko2so1_500.png Blog “Due to the shape of the condyles and the menisci, and the location of ligaments of and muscles acting on the knee, the joint rotation axis is located medially in the knee joint. This also in part explains why the lateral condyle and meniscus are more mobile. Maximum extension of the knee is caused by these factors and the “screw home” mechanism of the cruciate ligaments. The popliteal muscle is connected with the lateral meniscus and the caput fibulae: it locks the knee joint in and unlocks the knee joint out of its maximum extension. Moreover, it plays an important role for proprioception in the knee joint and is known to cause posterolateral knee pain. ” from: http://www.anatomy-physiotherapy.com/…/94-test-your-knowled… https://www.thegaitguys.com/thedailyblog/forefoot-valgus-a-fixed-structural-defect-in monthly 0.5 2015-07-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553486709-HTWW32FP1VQUBTMQTSKE/tumblr_nry226pOuL1qhko2so1_250.jpg Blog Forefoot valgus: A fixed structural defect in which the plantar aspect of the forefoot is everted on the frontal plane relative to the plantar aspect of the rearfoot; the calcaneum is vertical, the mid tarsal joints are locked and fully pronated Want to know more? Join us Wednesday evening: 5 PST, 6 MST, 7 CST, 8 EST for Biomechanics 309: Focus on the forefoot on onlinece.com. McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc. https://www.thegaitguys.com/thedailyblog/fore-foot-types-differences-between-forefoot monthly 0.5 2015-07-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553487116-26T9TTPXHQUPA16S7OMT/tumblr_nry1ywvvJB1qhko2so1_250.jpg Blog Fore foot types: Differences between forefoot varus and forefoot supinatus. Certainly this can be a contraversial topic. Perhaps this will help clear up some questions. Supination of the forefoot that develops with adult acquired flatfoot is defined as forefoot supinatus. This deformity is an acquired soft tissue adaptation in which the forefoot is inverted on the rearfoot. Forefoot supinatus is a reducible deformity. Forefoot supinatus can mimic, and often be mistaken for, a forefoot varus. A forefoot varus differs from forefoot supinatus in that a forefoot varus is a congenital osseous deformity that induces subtalar joint pronation, whereas forefoot supinatus is acquired and develops because of subtalar joint pronation (1). A Forefoot Varus induces STJ pronation whereas a Forefoot Supinatus is created because of STJ pronation (2). As the foot experiences increased subtalar joint (STJ) pronation moments during weightbearing activities (as in forefoot supinatus) , the medial metatarsal rays will be subjected to increased dorsiflexion moments and the lateral metatarsal rays will be subjected to decreased dorsiflexion moments. Over time, this increase in STJ pronation moments will tend to cause a lengthening of the plantar ligaments and medial fibers of the central component of the plantar aponeurosis and a shortening of the dorsal ligaments in the medial longitudinal arch. As a result, the influence of increased STJ pronation moments occurring over time during weightbearing activities will tend to cause the following (3): 1. An increase in inverted forefoot deformity. 2. A decrease in everted forefoot deformity. 3. A change in everted forefoot deformity to either a perpendicular forefoot to rearfoot relationship or to an inverted forefoot deformity. More on the forefoot tomorrow evening on onlinece.com: Biomechanics 309. Join us! 1. Clin Podiatr Med Surg. 2014 Jul;31(3):405-13. doi: 10.1016/j.cpm.2014.03.009. Forefoot supinatus. Evans EL1, Catanzariti AR2. 2. https://kenva.wordpress.com/…/…/forefoot-varus-or-supinatus/ 3. http://www.podiatry-arena.com/podiatry-forum/showthread.php… https://www.thegaitguys.com/thedailyblog/here-is-another-nice-review-consider-severs-with monthly 0.5 2015-07-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553487546-8VUCXKIVFFTSGXQOZXF4/tumblr_nry1wrduj01qhko2so1_400.jpg Blog Here is another nice review. Consider Sever’s with all your younger heel pain patients We posted on this a few weeks ago. see here:http://thegaitguys.tumblr.com/…/clinical-tidbit-heel-pain-i… https://www.thegaitguys.com/thedailyblog/does-gait-retraining-alter-peoples-biomechanics monthly 0.5 2015-07-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553487287-QGSQCA80EFSR7XHYN49W/tumblr_nry1u03XP11qhko2so1_1280.jpg Blog Does gait (re)training alter peoples biomechanics? You bet it does! Should we be retraining peoples gait? We like to think, yes. What do you think? “Overall, this systematic review shows that many biomechanical parameters can be altered by running modification training programmes. These interventions result in short term small to large effects on kinetic, kinematic and spatiotemporal outcomes during running. In general, runners tend to employ a distal strategy of gait modification unless given specific cues. The most effective strategy for reducing high-risk factors for running-related injury-such as impact loading-was through real-time feedback of kinetics and/or kinematics.’ Br J Sports Med. 2015 Jun 23. pii: bjsports-2014-094393. doi: 10.1136/bjsports-2014-094393. [Epub ahead of print] Gait modifications to change lower extremity gait biomechanics in runners: a systematic review. Napier C1, Cochrane CK1, Taunton JE2, Hunt MA1. https://www.thegaitguys.com/thedailyblog/how-much-dip-in-the-coronal-plane-is-in-your monthly 0.5 2015-07-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553488154-QOVLZN3XMRYYT53LGXCO/tumblr_nry1shu5Nq1qhko2so1_1280.png Blog How much “dip” in the coronal plane is in your single leg squat? “In conclusion, the Single-Leg Squat is a reliable tool to identify patients that would need to improve their hip and trunk muscle weakness and dysfunction (by strengthening and neuromuscular coordination retraining). ” Crossley et al., Am J Sports Med 39 (2011) 866 - 873. Performance on the single-leg squat task indicates hip abductor muscle function. - Anatomy &… Clinical assessment of performance on the single-leg squat task is a reliable tool that may be used to identify people with hip muscle dysfunction.ANATOMY-PHYSIOTHERAPY.COM https://www.thegaitguys.com/thedailyblog/how-many-times-have-you-seen-us-post-and-talk monthly 0.5 2015-07-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553488983-6F0CQP8JUJ63S8PPS370/tumblr_nry1p93N6F1qhko2so1_400.png Blog How many times have you seen us post and talk about the shoulder complex and lower extremity relation? Here is another “Kids grow up thinking that throwing a baseball hard is all about strength in the arm and shoulder, but new evidence suggests that muscle strength and range of motion in the hip affect shoulder function during throwing in youth baseball players.” Lower-body focus could help youth baseball player arms | Lower Extremity Review Magazine https://www.thegaitguys.com/thedailyblog/how-do-your-gluteus-maximus-and-gluteus-medius monthly 0.5 2015-07-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553489361-QQJJ3KFBERCCQ1D9857I/tumblr_nry1l9Sa1q1qhko2so1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553489397-QG589U7EOKUYAYRVPJDW/tumblr_nry1l9Sa1q1qhko2so2_1280.png Blog https://www.thegaitguys.com/thedailyblog/whod-a-thought-can-someone-make-an-app-for monthly 0.5 2015-07-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553489607-GZXJ7JBOU5D1NH0X138U/tumblr_nra7dx0MEV1qhko2so1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553489907-HP76FEALXUBUZSMI8O2P/tumblr_nra7dx0MEV1qhko2so2_1280.png Blog https://www.thegaitguys.com/thedailyblog/folks-with-patellofemoarl-pain-move-differently monthly 0.5 2015-07-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553490354-WJ62DOM4JQVVXZVQN4DP/tumblr_nra7p3D34j1qhko2so1_250.jpg Blog Folks with patellofemoarl pain move differently. But they don’t necessarily engage their trunk differntly. We think we all knew this, but here is a study that looks at it.  “Compared with the control group, the PFP group demonstrated increased ipsilateral trunk lean, hip adduction and knee abduction (p = 0.02-0.04) during single-leg squat accompanied with decreased trunk isometric strength (p = < 0.001-0.009). There was no between-group difference in trunk muscle activation. Only in the control group, ipsilateral trunk lean was significantly correlated with hip adduction (r = -0.66) and knee abduction (r = 0.49); also, the side bridge test correlated with knee abduction (r = -0.51). Differences in trunk, hip and knee biomechanics were found in people with PFP. No relationship among trunk, hip and knee biomechanics was found in the PFP group, suggesting that people with PFP show different movement patterns compared to the control group.” Man Ther. 2015 Feb;20(1):189-93. doi: 10.1016/j.math.2014.08.013. Epub 2014 Sep 9.Trunk biomechanics and its association with hip and knee kinematics in patients with and without patellofemoral pain.Nakagawa TH1, Maciel CD2, Serrão FV3. https://www.thegaitguys.com/thedailyblog/big-toe-woes-one-way-to-learn-to-load-the-head-of monthly 0.5 2015-07-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553490364-P0FMG0PINPB3OUBIKD09/tumblr_nra74f2tsF1qhko2so1_250.jpg Blog Big Toe Woes: One way to learn to load the head of the 1st metatarsal On Thursday morning, while sprinting up a hill on the latter part of a run, I had the fortuosity of catching my big toe on what I beleive was an exposed root and fell sudddenly. Instinctively I rolled to protect my back (as you often do if you have had any history of back injuries). After a few expletives and a bruised ego, I took inventory of my body: back was fine, an abrasion and contusion on my left elbow and a really sore big toe. I got up and decided to run home as I was less than a mile from there. I immediately noticed that my gait would need to be altered if I was going to make it home. I had injured the distal interphalangeal joint and distal phalanyx from the best I could tell; loading them in any way brought excruciating pain, so I was forced into one of my mantra’s: “Keep your toes up”*. I did this for the rest of my run and noticed, probably more than ever, how much this simple technique shifts the weight to the head of the 1st metatarsal and sesamoids. It also made me make my gait more “circular” (rather than pendular, another thing we teach in gait retraining). I made it home and promptly iced. After getting to the office, an X ray confirmed my suspicion of a fracture in the proximal portion of the distal phalanyx. A day later and from my distal to my 1st metatarsal phalangeal joint is sausage like and a beautiful violet color. I am grateful I did not seem to injure the MTP…Oh well, I will either have to run carefully or switch to mountain biking for the next few weeks. Some ipriflavone (to assist in calcium absorption), cucumin and essentail oils (for inflammation) and I was good to go. Yes it throbs a bit, but it is a reminder that I need to push off through the head of the 1st : ) Try “toes up”with your peeps and let us know how it goes. TGG * “Toes up” technique involves conciously firing the anterior compartment muscles, particularly the extensor digitorum longus. It fires more into the extensor pool and assists in firing ALL your extensors through spacial and temporal summation and also heps to shut down flexor tone through reciprocal inhibition. It will also help you to rocker through your stance phase and get more into your hip extensors. https://www.thegaitguys.com/thedailyblog/the-eccentric-aspect-of-the-shuffle-walk-hey monthly 0.5 2015-07-12 https://www.thegaitguys.com/thedailyblog/compression-socks-worth-your-time monthly 0.5 2015-07-08 https://www.thegaitguys.com/thedailyblog/deep-brain-stimulation-and-movement monthly 0.5 2015-07-08 https://www.thegaitguys.com/thedailyblog/corticospinal-axon-regeneration monthly 0.5 2015-07-08 https://www.thegaitguys.com/thedailyblog/it-is-not-your-gait-it-is-where-you-take-it monthly 0.5 2015-07-08 https://www.thegaitguys.com/thedailyblog/xbox-and-gait-analysis monthly 0.5 2015-07-08 https://www.thegaitguys.com/thedailyblog/the-gluteus-medius-and-low-back-pain monthly 0.5 2015-07-08 https://www.thegaitguys.com/thedailyblog/abs-on-the-up-glutes-on-the-down-i-had-the monthly 0.5 2015-07-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553490827-7P6HHVNV50O8QQKP43RT/tumblr_nqx6p7oa9h1qhko2so1_250.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553491023-4WWOQQSXVWNHTWQYRX4V/tumblr_nqx6p7oa9h1qhko2so2_400.png Blog https://www.thegaitguys.com/thedailyblog/abductory-twist-in-your-gait-last-night-on-our monthly 0.5 2015-07-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553492168-7GE1ST94JDJEKAE70XF0/tumblr_nqvkmn5o3d1qhko2so1_500.png Blog Abductory twist in your gait ? Last night on our www.onlinece.com teleseminar we discussed some clinical applications and critical thinking of gait parameters and pathology. We discussed the dynamic gait pedograph below. Possible evidence of Abductory Twist gait pathology (video linkhttps://youtu.be/F3DHRoHrYOs). In this case, client had loss of internal hip rotation, but they sure love external rotation pivot at the ground interface, as the pedo shows here (more details were provided on the teleseminar last night). *Fix the problem, retrain normal gait skills, add endurance and strength to the new gait pattern and you have a solution. Add an orthotic to treat what you see on the pedograph and you have a bandaid (and potentially/probably a problem down the road). You can’t fix a motor pattern compensation by forcing a compensatory fix. Get to the root of the problem, in this case hip and pelvic biomechanics ! It is all about mobility and stability !  https://www.thegaitguys.com/thedailyblog/cross-fit-gray-cooks-thoughts monthly 0.5 2015-07-02 https://www.thegaitguys.com/thedailyblog/gait-changes-on-a-treadmill monthly 0.5 2015-07-02 https://www.thegaitguys.com/thedailyblog/muscle-activity monthly 0.5 2015-07-02 https://www.thegaitguys.com/thedailyblog/muscle-activity-and-movement monthly 0.5 2015-07-02 https://www.thegaitguys.com/thedailyblog/gait-on-slippery-floors monthly 0.5 2015-07-02 https://www.thegaitguys.com/thedailyblog/reteaching-sensory-motor-patterns monthly 0.5 2015-07-02 https://www.thegaitguys.com/thedailyblog/ankle-plantarflexors-as-gait-compensators monthly 0.5 2015-06-22 https://www.thegaitguys.com/thedailyblog/achilles-tendonitis-the-motion-needs-to-occur monthly 0.5 2015-06-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553492214-28B0NPDOARO5EVFZQYQD/tumblr_nqcv8fQm3p1qhko2so1_250.png Blog Achilles Tendonitis The motion needs to occur somewhere…Make sure you look at the whole picture Since the knee was bent, perhaps we should be looking at the soleus? And the talo crural articulation? “A more limited ankle Dorsi Flexion Range Of Motion as measured in Non Weight Bearing with the knee bent increases the risk of developing Achilles Tendonitis among military recruits taking part in intensive physical training.” J Foot Ankle Res. 2014 Nov 18;7(1):48. doi: 10.1186/s13047-014-0048-3. eCollection 2014. Limited ankle dorsiflexion increases the risk for mid-portion Achilles tendinopathy in infantry recruits: a prospective cohort study. Rabin A1, Kozol Z1, Finestone AS2. https://www.thegaitguys.com/thedailyblog/got-glute-meds-want-to-strengthen-that-gluteus monthly 0.5 2015-06-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553492726-VJ37Y06PZ9MQ2Y2659L6/tumblr_nqcv4fIoKt1qhko2so1_1280.png Blog GOT GLUTE MEDS? Want to strengthen that gluteus medius we were talking about Monday? Have you considered walking lunges with dumbbells? These seem to activate the side contralateral to a better extent than split squats. We wonder if you get the same effect with a medicine ball. Anyone out there have some data or experience with that? Stastny P1, Lehnert M, Zaatar Zaki AM, Svoboda Z, Xaverova Z. DOES THE DUMBBELL CARRYING POSITION CHANGE THE MUSCLE ACTIVITY DURING SPLIT SQUATS AND WALKING LUNGES? J Strength Cond Res. 2015 May 8. [Epub ahead of print] https://www.thegaitguys.com/thedailyblog/foot-orthoses-and-patellofemoral-pain-frontal monthly 0.5 2015-06-22 https://www.thegaitguys.com/thedailyblog/lumbar-link-ankle-spinal-pathologies-coexist-in monthly 0.5 2015-06-22 https://www.thegaitguys.com/thedailyblog/forefoot-varus-or-forefoot-supinatus-forefoot monthly 0.5 2015-06-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553493063-AS2FGMQ8SHZVO3DW9RU6/tumblr_nqcuwnd7S61qhko2so1_1280.png Blog Forefoot Varus or Forefoot Supinatus? Forefoot varus is a fixed, frontal plane deformity where the forefoot is inverted with respect to the rearfoot. Forefoot varus is normal in early childhood, but should not persist past 6 years of age (i.e. when developmental valgus rotation of forefoot on rearfoot is complete, and plantar aspects of fore- and rearfoot become parallel to, and on same plane as, one another (1) Forefoot supinatus is the supination of the forefoot that develops with adult acquired flatfoot deformity. This is an acquired soft tissue adaptation in which the forefoot is inverted on the rearfoot. Forefoot supinatus is a reducible deformity. Forefoot supinatus can mimic, and often be mistaken for, a forefoot varus. (2) A forefoot varus differs from forefoot supinatus in that a forefoot varus is a congenital osseous where a forefoot supinatus is acquired and develops because of subtalar joint pronation. “Interestingly, only internal rotation of the hip was increased in subjects with FV – no differences were present in hip adduction and knee abduction between subjects with and without FV. The authors nevertheless conclude that FV causes significant changes in mechanics of proximal segments in the lower extremity and speculate that during high-speed weight-bearing tasks such as running, the effects of FV on proximal segments in the kinetic chain might be more pronounced.” We wonder if the folks in this study had a true forefoot varus, or actually a forefoot supinatus (3). The Gait Guys 1. Illustrated Dictionary of Podiatry and Foot Science by Jean Mooney © 2009 Elsevier Limited. 2. Evans EL1, Catanzariti AR2. Forefoot supinatus. Clin Podiatr Med Surg. 2014 Jul;31(3):405-13. doi: 10.1016/j.cpm.2014.03.009. 3. Scattone Silva R1, Maciel CD2, Serrão FV3. The effects of forefoot varus on hip and knee kinematics during single-leg squat. Man Ther. 2015 Feb;20(1):79-83. doi: 10.1016/j.math.2014.07.001. Epub 2014 Jul 12. https://www.thegaitguys.com/thedailyblog/foam-rolling-a-literature-review-anatomy monthly 0.5 2015-06-22 https://www.thegaitguys.com/thedailyblog/92-your-brain-on-running-ankle-tightness-femur monthly 0.5 2015-06-18 https://www.thegaitguys.com/thedailyblog/high-performance-high-heels monthly 0.5 2015-06-12 https://www.thegaitguys.com/thedailyblog/one-of-our-favorite-and-biggest-brained-people monthly 0.5 2015-06-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553493835-5ZT4XF55D0HVP3BH4S8A/tumblr_noo34m0W5y1qhko2so1_1280.png Blog One of our favorite (and biggest brained) people in the world ! In his own words: “Gait is the most important biomarker for neurological integrity and is considered a quantifiable variable that might serve as a window of disease or functional neurological progression or attenuation.” Prof. Carrick has had almost 4 decades of clinical experience in this gait knowledge area. His knowledge application base in this functional approach to human stance, balance and gait is world renown. He will share his clinical experience so that the learner will be able to gain a fluency in this exciting evidence based clinical area of expertise. Check out this teaser 15" talk on his Amsterdam course coming up in June. http://lp.carrickinstitute.org/advanced-human-gait/ https://www.thegaitguys.com/thedailyblog/increase-glute-medius-activity-with-weighted monthly 0.5 2015-06-12 https://www.thegaitguys.com/thedailyblog/running-yourself-into-thyroid-troubles monthly 0.5 2015-06-09 https://www.thegaitguys.com/thedailyblog/weighted-carries-for-glute-training monthly 0.5 2015-06-09 https://www.thegaitguys.com/thedailyblog/mental-training monthly 0.5 2015-06-09 https://www.thegaitguys.com/thedailyblog/shoes-and-pronation-and-injuries monthly 0.5 2015-06-09 https://www.thegaitguys.com/thedailyblog/fascia-science monthly 0.5 2015-06-09 https://www.thegaitguys.com/thedailyblog/beware-of-research-data monthly 0.5 2015-06-09 https://www.thegaitguys.com/thedailyblog/the-cross-over-gait-and-achilles-pathologies monthly 0.5 2015-06-09 https://www.thegaitguys.com/thedailyblog/post-stroke-spatiotemporal-gait-asymmetries monthly 0.5 2015-06-09 https://www.thegaitguys.com/thedailyblog/walking-meditation monthly 0.5 2015-06-09 https://www.thegaitguys.com/thedailyblog/isometrics-for-patellar-tendonitis-we-are monthly 0.5 2015-06-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553494043-W2C9A9HD5PJII2346H0M/tumblr_np4fgbaRA21qhko2so1_1280.png Blog Isometrics for patellar tendonitis? We are familiar with different modes of exercise: isometric, isotonic and isokinetic. Isometric exercises have a physiological overflow of 10 degrees on each side of the point of application (ie; to do the exercise at 20 degrees flexion, and you have strength gains from 10 to 30 degrees); isotonics and isokinetics, 15 degrees. Taking advantage of physiological overflow often allows us to bypass painful ranges of motion and still strengthen in that range of motion.  In this study, they looked at immediate and 45 minute later pain reduction (not function) comparing isometric (max voluntary quadricep contraction) and isotonic (single leg decline squat) exercises. They also looked at cortical inhibition (via the cortico spinal tract) as a result of the exercises.  Here is what they found: “A single resistance training bout of isometric contractions reduced tendon pain immediately for at least 45 min postintervention and increased MVIC. The reduction in pain was paralleled by a reduction in cortical inhibition, providing insight into potential mechanisms. Isometric contractions can be completed without pain for people with PT. The clinical implications are that isometric muscle contractions may be used to reduce pain in people with PT without a reduction in muscle strength.” These same results were not seen with the isotonic exercise.  Did the decrease in pain result in the decrease in cortical inhibition (muscle contraction is inhibited across an inflamed joint: Rice, McNair 2010; Iles, Stokes 1987)? Was it a play on post isometric inhibition (most likely not, since this usually only lasts seconds to minutes post contraction) ? Or is there another mechanism at play here? There has been one other paper we found here, that shows cortical inhibition of quadriceps post isometric exercise. Time will tell. In the meantime, start using those multiple angle isometrics! The Gait Guys Rio E, Kidgell D, Purdam C, Gaida J, Moseley GL, Pearce AJ, Cook J.Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy Br J Sports Med. 2015 May 15. pii: bjsports-2014-094386. doi: 10.1136/bjsports-2014-094386. [Epub ahead of print] http://www.anatomy-physiotherapy.com/28-systems/musculoskeletal/lower-extremity/knee/1163-isometric-exercises-in-patellar-tendinopathy https://www.thegaitguys.com/thedailyblog/the-mighty-gluteus-medius-in-all-its-glory monthly 0.5 2015-06-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553493748-C3RM7M8S8S7I5LHT1X7X/tumblr_nozmgsVmXF1qhko2so1_250.jpg Blog The mighty Gluteus Medius, in all its glory! Perhaps the delayed action of the gluteus medius allows an adductory moment of the pelvis, moving the center of gravity medially. This could conceivably place additional stress on the achilles tendon  (via the lateral gastroc) to create more eversion of the foot from midstance on “The results of the study demonstrate altered neuromuscular control of the GMED and GMED in runners with Achilles Tendonitis. During running, GMED typically activates before heel strike so as to stabilize the hip and the pelvis. In runners with Achilles Tendonitis, GMED is activated with a delay, which consequently might affect the kinematics of knee and ankle resulting in rear foot inversion. Similarly, GMAX is activated with a delay and for a shorter duration in runners with Achilles Tendonitis. GMAX is the primary hip extensor and via a kinetic chain, a decreased hip extension moment might be compensated by an increased ankle plantarflexion moment which could potentially increase the load on the Achilles tendon.” Franettovich Smith MM1, Honeywill C, Wyndow N, Crossley KM, Creaby MW. : Neuromotor control of gluteal muscles in runners with achilles tendinopathy. Med Sci Sports Exerc. 2014 Mar;46(3):594-9. https://www.thegaitguys.com/thedailyblog/the-mighty-interossei-by-request-of-one-of-our monthly 0.5 2015-06-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553494128-KGYPQYSVFAZ9GWADO2OU/tumblr_np3dt87iAK1qhko2so1_540.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553494407-I222ZLX795UHO236IZB7/tumblr_np3dt87iAK1qhko2so2_540.png Blog https://www.thegaitguys.com/thedailyblog/abdominal-activity-and-gait-we-came-across-this monthly 0.5 2015-05-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553495522-OGOUFRYUUZAVUXGQZMZO/tumblr_nozmzf3ikk1qhko2so1_400.png Blog Abdominal Activity and Gait We came across this cool study today, after a well educated patient asked about abdominal activity during gait. Here is the bottom line: low level activity in the rectus abdominis and external oblique throughout the gait cycle, more concentrated activity of the internal oblique at initial contact/loading response (heel strike). This makes sense, since the external oblique occupies more real estate and has a larger cross sectional area; it most likely has a role in stabilization both in rotational like emoticon planes as well as the saggital plane (Z). Perhaps the action of the internal oblique at initial contact is to assist in external rotation of the pelvis on the stance phase leg, as the the opposite leg goes into swing? “Cluster analysis identified two patterns of activity for the internal oblique, external oblique and rectus abdominis muscles. In the lumbar erector spinae, three patterns of activity were observed. In most instances, the patterns observed for each muscle differed in the magnitude of the activation levels. In rectus abdominis and external oblique muscles, the majority of subjects had low levels of activity (<5.0% of a maximum voluntary contraction) that were relatively constant throughout the stride cycle. In the internal oblique and the erector spinae muscles, more distinct bursts of activity were observed, most often close to foot-strike. The different algorithms used for the cluster analysis yielded similar results and a discriminant function analysis provided further evidence to support the patterns observed” Clin Biomech (Bristol, Avon). 2002 Mar;17(3):177-84. Abdominal and erector spinae muscle activity during gait: the use of cluster analysis to identify patterns of activity. White SG1, McNair PJ. https://www.thegaitguys.com/thedailyblog/forefoot-varus-anyone-forefoot-varus-appears-to monthly 0.5 2015-05-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553496241-Y1WV2ER14VJGGZJPDQXB/tumblr_nozmszGQjm1qhko2so1_540.png Blog Forefoot Varus Anyone? Forefoot varus appears to move the center of gravity medially while walking. Nothing earthshaking here, but nice to see the support of the literature. “The most medial CoP of the row and CoP% detected increased medial CoP deviation in FV ≥ 8°, and may be applied to other clinical conditions where rearfoot angle and CoP of the array after initial heel contact cannot detect significant differences.” We will be talking about foot types this week on onlinece.com; Wednesday 8 EST, 7 CST, 6MST, 5 PST Biomechanics 314. Hope to see you there! J Formos Med Assoc. 2015 May 5. pii: S0929-6646(15)00132-1. doi: 10.1016/j.jfma.2015.03.004. [Epub ahead of print] Analysis of medial deviation of center of pressure after initial heel contact in forefoot varus. picture from: http://forums.teamestrogen.com/showthread.php?t=46901 https://www.thegaitguys.com/thedailyblog/clinical-tidbit-heel-pain-in-kids-and monthly 0.5 2015-05-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553496460-WUQ1QD9RM3O1JNS913UR/tumblr_nozmpqndk41qhko2so1_540.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553496474-TNDOZ8EWM7ZBZKTHQDLB/tumblr_nozmpqndk41qhko2so2_500.png Blog https://www.thegaitguys.com/thedailyblog/ahh-yes-the-lumbricals-one-of-our-favorite monthly 0.5 2015-05-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553497911-TEMSHWFDPLPO1AYDS9KF/tumblr_nozmmaOxAI1qhko2so1_500.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553497280-NI8TK1K5TSOP96B3BP0F/tumblr_nozmmaOxAI1qhko2so2_540.png Blog https://www.thegaitguys.com/thedailyblog/prior-hamstring-injuries monthly 0.5 2015-05-20 https://www.thegaitguys.com/thedailyblog/foot-core-anyone-and-a-good-time-was-had-by monthly 0.5 2015-05-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553498071-9H33ZK0RBCRS8TDRJY39/tumblr_no4aoazAce1qhko2so1_1280.png Blog Foot “core” anyone? And a good time was had by all. Day 1 of the event in Vancouver. Lots of info and a bonus exercise session. Thanks to all who attended and looking forward to another great day tomorrow! We spent a great deal of time talking about muscular firing sequences and the reasoning as to why things fire when. Take a look at the picture and focus on the tib posterior, flexor digitorum longus, and flexor hallucis longus. They fire from loading response and fire through terminal stance. Up to midstance, they act eccentrically to slow pronation and after midstance, they fire concentrically to assist in supination. Note the sequence starts with the tib posterior (more proximal attachments in the foot) and ends with the flexor hallucis longus, more distal attachements (because in “ideal” gait, the hallux is the last to leave the party (or the ground, in this case)). Stability is a priority, so the central or “core” of the foot needs to fire before adding on peripheral (appendicular) muscles. Remember the foot intrinsics fire from midstance to pre swing, further stabilizing the foot “core” The Gait Guys https://www.thegaitguys.com/thedailyblog/attempting-to-regain-a-level-playing-ground-for monthly 0.5 2015-05-07 https://www.thegaitguys.com/thedailyblog/more-muscle-madness-or-weakness-as-the-case-may monthly 0.5 2015-05-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553497613-EP4Y2UMVWDSPNQ1A02YJ/tumblr_nnr8joFuMU1qhko2so1_1280.png Blog More muscle madness (or weakness, as the case may be) In the last post (missed it? click here) , we discussed 3 causes of muscle weakness: local, segmental and cortical. In that post, we emphasized LOCAL causes of muscle weakness, determining that many of these causes related to direct injury, disease processes or neuromuscular endplate disorders. This post will look at segmental causes, which as you have probably guessed, are at the spinal cord level. These are usually “electrical” problems, though in uncommon cases (syrinx, ependyoma, dermoid tumors) thay can be due to pathological processes.  We need to understand that the spinal cord is composed of either tracts or nucleii, that’s pretty much it. The tracts are largely on the outside of the cord. Remember that they are the axons of nerves. Since they are myelinated (insulated), they are white in appearence. They have names like the spinocerebellar tracts, dorsal columns, reticulospinal tracts and corticospinal tracts, just to name a few. The nucleii are largely in the central part of the cord, organized in an “H” pattern that is divided up into layers called lamina. They are unmyelinated, so they are grey in appearance. Interspersed with these nucleii are perhaps one of the most important contributors to muscle weakness, the “interneurons” or “interneuronal pool”. Remember, as impulses travel down from the cortex to control volitional (voluntary)movement, they end here in the internuncial pool and land on, you guessed it, interneurons. To this end, we need to remember that interneurons are 30X more numerous than any of the other cells in the central part of the cord. When a message is on its way down from the cortex, or heading up to it, most of the time, it interacts with an interneuron. In turn, interneurons can be excitatory or inhibitory.  Something you should know about neurons, is that they are all or none. They either fire or they don’t. There is no in between. Same for interneurons. Depending on what they are connected to, the muscles (or autonomics, or other 2nd and 3rd order neurons) fire…or they don’t. There are 2 types of motor neurons that go to muscle: alpha and gamma. Alpha motor neurons go to “extrafusal” muscle, or muscle we can control voluntarily. Gamma motor neurons go to “intrafusal” muscle, or muscle spindles, which monitor the length and rate of change of length of a muscle. As you probably guessed, these motor neurons can be either activated directly (few) or through interneurons (many). These motor neurons connect with sensory neurons that monitor things like length, rate of change of length and tension in muscles. These modalities are subserved by receptors you have heard of: muscle spindles and golgi tendon organs. The alpha and gamma motor neurons also interact with axons of neurons that are descending from higher areas of the brain, like the cortex, cerebellum, vestibular nucleus, just to name a few. It is the interplay of all these inputs and outputs, often referred to as the “central integrated state”, that ultimately determines whether a muscle fires or not, and thus if it is “weak” or “strong”. If excitation wins, then the nerve fires and the muscle contracts; if inhibition wins, then it does not.  What are all the inputs and outputs? Only all the sensory and motor (this includes the autonomics ie sympathetic and parasympathetic) information arriving there from the periphery and central nervous system! Quite a lot! Segmental causes, just another reason a muscle may test week Ivo and Shawn: The Gait Guys https://www.thegaitguys.com/thedailyblog/medial-or-lateral-ankle-swelling-not-a-unicorn monthly 0.5 2015-04-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553497914-TUAVQ8VGKLZN67KTCXJJ/tumblr_nn9u01thxT1qhko2so1_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553498226-TLBJ76X23AMDA9RLHHYH/tumblr_nn9u01thxT1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/can-the-vmo-be-selectively-activated monthly 0.5 2015-04-28 https://www.thegaitguys.com/thedailyblog/more-on-weak-muscles-just-why-are-they-weak-know monthly 0.5 2015-04-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553499309-BVEEZ5BRM6KBTF15SOI1/tumblr_nndwhh7w481qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553499306-M9HX0HI658D73TI8OOA0/tumblr_nndwhh7w481qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553499811-F0PX4H1RI5OE506S92Y2/tumblr_nndwhh7w481qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/last-week-we-ran-an-archived-piece-named-just monthly 0.5 2015-04-22 https://www.thegaitguys.com/thedailyblog/neural-circuits-linking-activity-in-anatomically monthly 0.5 2015-04-21 https://www.thegaitguys.com/thedailyblog/simple-foot-exercises-are-effective-conclusion monthly 0.5 2015-04-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553500009-SXP5PMNY4PCIJ0QHX1YP/tumblr_nn1ca5fx0C1qhko2so1_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553501792-6GMLOIYFLNXZTC0BSLLP/tumblr_nn1ca5fx0C1qhko2so2_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553501079-8V53UGM8LHQV9CA9Z39M/tumblr_nn1ca5fx0C1qhko2so3_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553501938-C7TVIUBSDIDJA4DFIPRA/tumblr_nn1ca5fx0C1qhko2so4_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/gait-and-any-form-of-locomotion-are-highly monthly 0.5 2015-04-15 https://www.thegaitguys.com/thedailyblog/what-ischial-femoral-impingement-might-look-like monthly 0.5 2015-04-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553501846-YLBIAXDU1QLSAV47K02L/tumblr_nmthzgDyh61qhko2so1_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553501782-1RUIMCD4NJK6FL9BF2BW/tumblr_nmthzgDyh61qhko2so2_500.jpg Blog https://www.thegaitguys.com/thedailyblog/the-serratus-and-gait-think-about-the-role-of monthly 0.5 2015-04-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553502033-PFSHADFSFH9MKNMNXH1X/tumblr_nmfyt908iR1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553502826-O2GSJ2ZWKMFS1ZDYR0SA/tumblr_nmfyt908iR1qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/how-well-do-you-understand-stance-phase-mechanics monthly 0.5 2015-04-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553503423-OBO6P0JI9NN8JHNWGABA/tumblr_nm5tkl3rsl1qhko2so1_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553504114-3TSPJ2IV5UGKQU7P2W6P/tumblr_nm5tkl3rsl1qhko2so2_1280.gif Blog https://www.thegaitguys.com/thedailyblog/the-deeper-your-knowledge-and-experiences-the monthly 0.5 2015-03-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553503504-D3ZEJCM95N76TZLKDQSU/tumblr_nlerv2Z5UD1qhko2so1_1280.png Blog The deeper your knowledge and experiences, the more things you will see. As in life, the more experiences you have the wiser you become and the clearer the bigger picture becomes. All these things enrich the experience or observation. These experiences take simple black and white and render an infinite palate of grey tones.  To the untrained observer, these are just two feet. With a little more experience these are two feet of different length. Deeper further, these are two different sized feet with different plantar pressure responses (helped here by increasing the greyscale contrast). Deeper yet, this represents a left foot (viewers right) that has a dysfunctional flexor digitorum longus (FDL) and lateral quadratus plantae muscle. All of these observations allow the skilled and knowledgeable viewer to extrapolate and theorize, with clear thought processes, which leg could be shorter/longer, how the pelvis might be distortioned, step length and stride length variability, foot stability and so much more. The life long student does not need the contrast enhanced picture on the right to heighten the visibility of the plantar pressures, but it helps.  This is what wisdom and experience do, they enable you to look deeper into something and to see it for what it truly is, not what it appears to be. Come listen to our teleseminar tonight (Wednesday March 18th, 2015) on www.onlinece.com at 7pm central. Log in early to get set up. Come listen in while we delve into one of the bigger questions, if the left foot (viewers right) is longer it has likely pronated more over a longer period of time stretching out plantar soft tissues and corrupting joint function in multiple areas. But if this is the case, why then are they presenting with plantar pressures that are more representative of supination standards ?   This is mental gymnastics. It is good stuff to do regularly, even though this is a static presentation, many good theories and thoughts can be brought forth. Getting the answer is not the goal, getting the thought process down is. The more you know, the more truth you will see. See you tonight, we will break this down into a microscopic level that will challenge you all. Shawn and Ivo, the gait guys https://www.thegaitguys.com/thedailyblog/the-all-to-common-case-of-the-wobbling-hexapod monthly 0.5 2015-03-06 https://www.thegaitguys.com/thedailyblog/i-have-been-playing-with-some-of-this-guys-work monthly 0.5 2015-03-05 https://www.thegaitguys.com/thedailyblog/the-partial-truth-about-the-foot-tripod-the monthly 0.5 2015-03-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553505280-R2PL2N5LD66J0SEPV5ML/tumblr_nka9cydN3k1qhko2so3_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553505476-AZ8FIWZ4G9H2M9NYXLAB/tumblr_nka9cydN3k1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553505560-28FSEJCEOT14MQ5Q8BTT/tumblr_nka9cydN3k1qhko2so4_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553506241-DUUNWOXEDA8NF17URZ6U/tumblr_nka9cydN3k1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/some-stuff-you-need-to-know-about-running-spikes monthly 0.5 2015-02-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553506792-XUTYKODLRZKEW8EBSUS5/tumblr_nkfs0eDDpP1qhko2so1_1280.png Blog Some stuff you need to know about running spikes. I see many track runners in my office, from middle school all the way into the USA Masters Division.  A few years ago one of the top USA Masters Milers came to see me on Friday before heading off to a national meet. He showed me some of his spikes (see pics above) and complained the there was something off on the spikes on the left, the Nike Mambas.  The shoe to the right is the Nike Zoom Miler. You need to understand a bit of the physics of running turns to understand what is missing for this runner in this pair of spikes.  Things do change if you are running on a sloped track, but those are only found indoors and are not all that common to run on for most folks so we will stick with the thinking on flat tracks. What you should be able to easily detect is that the Nike Mamba’s are missing the lateral 5th metatarsal forefoot spike on the cleat plate.  And you need to then realize that this is the right shoe, so it is the outside foot/leg on the track. It is the foot that will be pushing off harder from the outside on the turns to keep the centripetal forces of running a curve from allowing the runner to fall off the curve into the outer lanes. This right foot will always be pushing from outside to inside to maintain the body’s progression in the desired lane, when running the curves. Think about it for a minute. In order to run in a circle, or a curve in this situation, the outside foot always has the tendancy to be more inverted to keep foot contact on the ground. This is where a Forefoot varus MIGHT come in handy ! This means the foot will be tipped to the outside a little, because of the curve and because the body will be leaning into the center of the track on the curves. Thus the foot and shoe will be relying on more lateral foot pressures to drive the body mass back into the lane since centripetal forces will always be driving you laterally out of the lane.  Thus, the lateral spikes on the right foot must be accommodating.  In the case of the Mamba shoe. there is only a sheet of black hard plastic over the midshaft-head of the 5th Metatarsal on the lateral foot. It is no wonder the runner was feeling like he was slipping on the turns (the front of the midfoot was not anchored to the ground, only the forefoot due to the spikes in that location). You can see clear evidence of the lateral slipping in the picture. Can you see the orange/brown patch where he was slipping ? A spike there in that area would have been wonderful.  Slipping is a power leak and a risk for injury.  If the foot is trying to gain purchase into/onto the track with the foot inverted there needs to be traction at that lateral foot, what is referred to as the Lateral Column.  You can see why the Nike Zoom Miler was a better choice, there is a nice spike placement under the lateral foot for just this measure, and there is no evidence of slippage wear.  He told me that the Mamba was a steeplechase designed shoe but we still both felt that the issue remained relevant even in that event. The Nike website however states that “the Nike Zoom Mamba Men’s Track and Field Shoe is perfect for the 800-5000m track athlete” so we think they have missed an issue here in our opinion. I could make a better case for the Mambas if  they were for a 100m straight run but I would still like a 5th metatarsal /lateral spike where there isn’t one.  I will occasionally file spikes to get the perfect feel for the athlete.  It is usually the 5th metatarsal and 1st metatarsal spikes I mess with, merely to help hone the athletes feel on the track. The problem is that each track has a different feel so it is less of an occurrence in recent years. It is good to know your shoes, it is good to know your physics. It is great to know them both and melt them together to solve problems.  Not all spikes are created equal, not all tracks are the same, not all events are the same and certainly not all feet and the athlete’s who own them are the same.  And on the topic of Forefoot Foot types, both the forefoot varus and forefoot valgus foot might have a problem with the Mamba’s depending on their strength, skill and strategies for ground purchase.  Hopefully your shoe store and your track and cross country coaches know these issues. You might want to bring this blog post to their attention however, just in case. Dr. Shawn Allen https://www.thegaitguys.com/thedailyblog/tom-purvis-hits-some-strong-points-in-this-video monthly 0.5 2015-02-26 https://www.thegaitguys.com/thedailyblog/rewiring-the-peripheral-and-central-nervous monthly 0.5 2015-02-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553506380-B11EII573SJE59KNN4G0/tumblr_nkc4nqsi4e1qhko2so1_500.jpg Blog Rewiring. The peripheral and central nervous systems are functionally integrated regarding the consequences of a nerve injury: a peripheral nerve lesion always results in profound and long lasting central modifications and reorganization. (Kaas, 1991) Does there need to be a lesion though ? A functional lesion will force changes just like an ablative lesion. Altered gait that persists from a sprained ankle or a painful knee will force central modifications and reorganization. This is why resolution of pain and aberrant function is critical. If you rehab to 80% you leave 20% on the table and that gets rewired into the system as the new norm. Remember, the entire system is watching, learning, adapting and rewiring all the time. This is why you must have a team in place to resolve all, if possible, of your client’s deficits. If you leave 20% of a problem on the table, and add endurance and strength to the “80%resolved:20%remaining”, you reorganize the central nervous system with that as the assumed norm moving forward. From this point forward, this is the architecture that all new patterns and forms are built from.  This sets up for long term rewiring of all of the connected parts, from motor, sensory, visual, gait, proprioceptive, vestibular and the list goes on and on. If you have ever wondered how a client can have so many areas of pain and dysfunction you might want to go back into their history and ask them if there was a single injury or event that occurred after which all their new problems started to stack up.  If you are a gait analysis junkie, remember this principle above. All of the things you see in a person’s gait are not unconnected in many cases.  Much of what you see is a compensation around their problems, not the actual problem.  Remember this principle: the peripheral nervous system attempts to repair by regrowth, the central nervous system attempts to repair by re-routing and reorganizing. Dr. Shawn Allen https://www.thegaitguys.com/thedailyblog/our-neurology-mentor-dr-carrick-discusses-the monthly 0.5 2015-02-25 https://www.thegaitguys.com/thedailyblog/know-this-gait-memorize-it-it-is-not-a monthly 0.5 2015-02-24 https://www.thegaitguys.com/thedailyblog/if-the-software-in-your-brain-does-not monthly 0.5 2015-02-23 https://www.thegaitguys.com/thedailyblog/a-wobble-in-the-system-the-gait-changes-in monthly 0.5 2015-02-23 https://www.thegaitguys.com/thedailyblog/rearfoot-to-hip-pathomechanical-considerations-in monthly 0.5 2015-02-20 https://www.thegaitguys.com/thedailyblog/spinal-interneuronal-networks-linking-the monthly 0.5 2015-02-18 https://www.thegaitguys.com/thedailyblog/gait-sometimes-it-is-about-the-ear-sort-of monthly 0.5 2015-02-12 https://www.thegaitguys.com/thedailyblog/anterior-meniscofemoral-impingement-syndrome monthly 0.5 2015-02-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553506806-E0DDA9WOTFD4PH68QR7E/tumblr_njm9lc6bbA1qhko2so1_1280.png Blog Anterior meniscofemoral impingement syndrome.  Ever heard of it ? Probably not. Here we have a case of a young fellow with knee pain immediately below the patellae. As you can see here there are a few issues, some of which he will likely grow out of and some of which he may not.  Here we obvious see hyperextension of the knees and increased ankle plantarflexion posturing (I chose that word carefully) that obviously goes hand in hand with this retro-postured knees. After a few more questions it was clear that the pain had been around for quite some time and was at a specific pencil eraser sized area above the anterior joint line, slightly medially to center and without question not at the joint line proper but directly on the medial femoral condyle.  There was no swelling or fulness to suggest this was involvement of Hoffa’s fat pad. The patellar tendons were not thick. So, do you know what he has ?  You should always suspect this in knees that hyperextend this far or in athlete that have sustained or repetitive hyperextension stressing: gymnastics kicking sports (martial arts, soccer, swimming etc) postural syndrome folks (like this little fella) who have low core tone, anterior pelvic tilt both of which drive knee hyperextension. any one who has a loss of ankle rocker dorsiflexion range and who then chooses the knee hyperextension option to regain ankle range in an attempt to normalize progressive gait. Frequently flatter feet/hyperpronators will drive more tibial internal spin resulting in hyperextension as well. short quadriceps with a dominant quadriceps strategy to control the hip and knees This fella has several factors here. So, clearly understanding these biomechanical factors and coupling a palpatory tenderness at the correct spot on the medial femoral condyle indicates that he has (the youngest we have ever seen)…….drum roll……. Anterior meniscofemoral impingement syndrome.  Ever heard of it ? Probably not. Why, because it was glazed over in school, and maybe not at all for many doctors to be honest. Go ahead, look it up under Pubmed and see how many referenced papers you find on it.  I see it enough (albeit still rarely) to know that it is frequently diagnosed as a patellar tracking problem but those clients do not have the same risk and anatomy factors that I discussed above. I have had doctor referrals call me back saying they have never even heard of it, most have not to be honest.  Bottom line, if you know your anatomy and your biomechanics you can figure out most things. If you are slim and skinny on either one you might be missing a few things.  I do sometimes as well; we are all students. Summary:  When the knee hyperextends either too much, too long, or for too many repetitions either statically or in dynamic walking, running or in activity the leading upper edge of the medial meniscus can impinge repeatedly and forcefully into the soft medial femoral articular cartilage and over time create a softening of the cartilage (chondromalacia ).  Do it long enough or enough times and you create an inflammatory reaction with a cartilagenous defect. This poor little guy was hating walking.  Interestingly, what do you think happened when we had him crouch walk (knees flexed)……yup…..no pain. He looked up at me in wonderment immediately and of course saw me smiling knowing very well he would be pain free. Solution in a 4 year old.  Slightly flex the knees and place a long strip of tape down the back side of the upper and lower leg.  If he extends the knee he forces the tape taught and is instantly reminded (pseudo biofeedback if you will) that he is approaching the danger zone. As this case and many other find, after a few days the skin gets pretty irritated but that is time to take the tape off and let him go back to his old tricks……. trust us, it is only for a few hours until he will figure it out……meaning….. hyperextension is evil ! Teaching this little guy our now famous “Shuffle walks” (to drive ankle dorsiflexion strength in the tibialis anterior and toe extensors in a posture of knee flexion) was on the menu to improve ankle dorsiflexion and anterior compartment strength and we turned it into a fun game for him to play with mom and dad. Anterior Meniscofemoral Impingement Syndrome.  Say it 3 times fast with a mouthful of organic chunky peanut butter for fun.  Hope you never see it in a little one. if you do, smile and reach for some tape and put on some 70’s music and shuffle to some oldies. Dr. Shawn Allen,  one of the gait guys Arthroscopy. 1996 Dec;12(6):675-9.Meniscal impingement syndrome. McGuire DA, Barber, Hendricks .Plano Orthopedic and Sports Medicine Center, Texas, USA. Abstract The meniscal impingement syndrome consists of three elements: impaction on theanterior medial femoral condyle by the leading edge of the medial meniscus, articular cartilage damage of at least Outerbridge grade 3, and knee hyperextension of at least 5 degrees. This report reviews this condition in a series of seven knees with an average follow-up of 39 months. The time from the onset of symptoms until surgery averaged 45 months. Treatment consisted of a thorough arthroscopic knee evaluation and debridement of the articular cartilage fragmentation and any impinging synovitis. Postoperative rehabilitation includes extension block bracing, hamstring strengthening, and closed-chain exercise. With this regimen, there was improvement in the Tegner scores and a reduction in postoperative knee hyperextension. Identification of this uncommon condition requires a complete evaluation of the medial femoral condyle in patients with knee hyperextension. https://www.thegaitguys.com/thedailyblog/ischial-femoral-impingement-you-have-to-know-what monthly 0.5 2015-02-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553507272-1PBJ0YO2PD5L8ITID4CJ/tumblr_njiuf7bwQX1qhko2so1_400.png Blog Ischial-femoral impingement: you have to know what it is to make the diagnosis and know how to treat it. How many times have you had a client come in with pain high up in the ischial area, often explaining that it feels like a high hamstring pull. Others come in and say they have deep gluteal pain, deep in the buttock near the “sit bones”. Often they do not have a “hamstring-type event” that could be the cause of this injury or pain. I see this “high hamstring” pain often in runners, mostly distance runners but in high velocity cutting sports as well. I see this one often, and it was a difficult fix until I recognized what it truly was and what was generating the pain and problem. Often the problem is at the quadratus femoris muscle. This muscle has an origin off of the ischial tuberosity and inserts into the trochantric interval. The problem arises when the space, the interval, between these bony prominences is closed causing the quadratus femoris to become compressed or pinched in the small space. This can occur from too much frontal plane drift of the pelvis (side shift/drift) and this is almost always met by a relative adduction of the femur. This adduction narrows the space. Frontal plane drift of the pelvis and adduction of the femur, as either genu valgum or a cross over gait, are highly suspicious culprits in getting to the bottom of this clinical entity. Do you know how to test and evaluate the quadratus femoris muscle ? How about the similarly functioning obturator externus, upper vastus medialis or iliac division of the gluteus maximus ? Can you reasonably tease them out on your physical examination? If you know the common motion amongst them all you will know why they all can be a culprit of the pain and impinging mechanism, and why in treating this problem you likely will have to evaluate and treat one or more of them since they all support external rotation of the femur especially in varying degrees of hip flexion, and thus are used eccentrically to a significant degree to control the rate and degree of internal rotation of the lower limb during contact phase of gait. Losing this control and compounding frontal pelvis drift (and thus femur adduction) will close off the interval for the ischium of the pelvis moving past the femur’s lesser trochanter. I know you have seen this problem in your clinics and gyms. Have you missed it and called it a hamstring tendonopathy, or have you nailed it ? It is out there, but you have to know something exists to recognize it, and to fix it. You have to recognize it and understand the pieces of the problem, the anatomy and the pathomechanics and understand what is going on in their gait that could be causing it. This is not a psoas related entity although that should remain on your differential list. This is not to be mistaken for a hamstring tear as I suggested earlier, look at this study’s findings, it is not the same entity, although it is possible to have both simultaneously: “Abnormalities of the quadratus femoris muscle included edema (100%), partial tear (33%), and fatty infiltration (8%). The hamstring tendons of affected subjects showed evidence of edema (50%) and partial tears (25%).” - Torriani (3) I cannot find any research out there correlates weakness of the gluteals and of the lateral chains with weakness of this quadratus femoris muscle and its synergists with femur adduction and cross over gait styles in this clinical impingement phenomenon. These components are closely related and functional in my experience.  Certainly I cannot be the first to entertain this conceptual layered idea with the cross over gait /frontal plane drift predisposers. So, please come forward if you have seen the same things and had similar successes, lets compare notes and share your nuances in caring for it. There is something here though, because my clients progress nicely when the multiple muscles that support this spiral-natured external rotation are cleaned up, active, strong and paired nicely in a motor pattern that stacks the foot, knee, hip and pelvis reducing femoral adduction and in the functional components that reduce frontal plane drift which I have discussed here many times on the gait guys blog (type in “cross over gait” in the blog search box).   Dr. Shawn Allen, the gait guys references: 1. Am J Orthop (Belle Mead NJ). 2014 Dec;43(12):548-51.Ischiofemoral Impingement and the Utility of Full-Range-of-Motion Magnetic Resonance Imaging in Its Detection.Singer A1, Clifford P, Tresley J, Jose J, Subhawong T. 2. Magn Reson Imaging Clin N Am. 2013 Feb;21(1):65-73. doi: 10.1016/j.mric.2012.08.005. Epub 2012 Oct 13.Ischiofemoral impingement.Taneja AK1, Bredella MA, Torriani M. 3. AJR Am J Roentgenol. 2009 Jul;193(1):186-90. doi: 10.2214/AJR.08.2090.Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femorismuscle.Torriani M1, Souto SC, Thomas BJ, Ouellette H, Bredella MA. 4. J Bone Joint Surg Br. 2011 Oct;93(10):1300-2. doi: 10.1302/0301-620X.93B10.26714. Ischiofemoral impingement. Stafford GH1, Villar RN. https://www.thegaitguys.com/thedailyblog/pain-at-toe-off-stopping-big-toe-impingement-with monthly 0.5 2015-02-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553507714-VXZFCBXOMRB6RAJ85Q1R/tumblr_nj93ad9yEM1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553507980-1JPS3N2B5OTVZFIOWJ5S/tumblr_nj93ad9yEM1qhko2so2_r1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553508961-EEU48AEZQDCN31XWPI4B/tumblr_nj93ad9yEM1qhko2so3_r1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553510106-YFTER54SSC89HBOCZ81P/tumblr_nj93ad9yEM1qhko2so4_r1_1280.png Blog https://www.thegaitguys.com/thedailyblog/all-about-toe-break-no-this-is-not-a-post-about monthly 0.5 2015-02-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553510114-U1L8ZGRW7K063AVC3SCZ/tumblr_nj46ukTd3o1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553509708-4J4YL6137VZPJ19MWD2Z/tumblr_nj46ukTd3o1qhko2so2_500.jpg Blog https://www.thegaitguys.com/thedailyblog/vintage-shawn-and-ivo-podcast monthly 0.5 2015-01-31 https://www.thegaitguys.com/thedailyblog/compressing-the-distal-tib-fib-joint-really-if monthly 0.5 2015-01-29 https://www.thegaitguys.com/thedailyblog/podcast-91-gait-vision-some-truths-about-leg monthly 0.5 2015-01-28 https://www.thegaitguys.com/thedailyblog/from-abby-road-to-vivaldi-the-sensory-information monthly 0.5 2015-01-27 https://www.thegaitguys.com/thedailyblog/a-case-of-gait-spasticity monthly 0.5 2015-01-27 https://www.thegaitguys.com/thedailyblog/lets-make-a-resolutionor-not-cool-guy-cool monthly 0.5 2015-01-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553510152-O8FZL6CI1ILU59KMEKQR/tumblr_niosdmj4lf1qhko2so1_1280.jpg Blog Lets make a resolution…Or not… Cool guy, cool picture, cool scenery. Motivational? He is the fitness guru the developed the “Insanity” workout series, amongst others. But looks may be deceiving.   For reference, draw a line from the philitrium, interpec interval, symphisis pubis to area bisected between feet.  Did you notice the following? crossing arms across midline; look how far that left arm is abducted. look at pelvis list to left. If you bring that arm in, you need to compensate somewhere did you notice the hip hike on the left? That may have something to do with the excessive internal rotation of the thigh on the left. Is that because of the pelvis shift to the left (to compensate) or is he making up for limited internal rotation of the right hip? what about the subtle head tilt to the right? is that driving the compensation or is it another compensation? Questions, questions, questions… We are choosing to make a resolution without him for the time being : ) More on this photo another day. https://www.thegaitguys.com/thedailyblog/sometimes-it-is-easy-and-straight-forward monthly 0.5 2015-01-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553510904-6PJZMMG07V82W6TNG1NC/tumblr_ninuje0onw1qhko2so1_1280.jpg Blog Sometimes it is easy and straight forward. HISTORY: A 56 YO 200 # male construction worker presents with pain at the bottom of his right foot, worse in the am, getting better as the day goes on till midday, then getting worse again. Better with rest and ice. More supportive shoes and a heel gel pad offer him some relief. Past history of plantar fascitis.  OBJECTIVE:           Tenderness at medial calcaneal facet right side;  tenderness also in the arch and over the flexor hallucis longus tendon and short flexors of the toes. Ankle dorsiflexion is less than 5 degrees on the right, and 15 on the left.  Hip extension was less than 10 degrees bilaterally. He has mild bi-lat. external tibial torsion. Gait evaluation reveled an increased progression angle right greater than left.  Very limited ankle dorsiflexion noted bi-lat (decreased ankle rocker).  There is weakness of the short flexors (FDB) and long extensors (EDL) of the toes on the right. Poor endurance of the intrinsic musculature of the arch as well as interossei musculature during standing arch test. PEDOGRAPH FINDINGS:  ASSESSMENT:       From history and exam, plantar fascitis. PLAN:           He was given the following exercises:  lift/spread/reach, the one leg balancing, shuffle walks and toes up walking. These were filmed via ipad and sent to him.  We are going to build him a medium heel cup, full length orthotic made out of acrylic.  We will see him again later this week.  We will do some symptomatic treatment utilizing manual stimulation techniques, pulsed ultrasound and additional exercises aimed at improving dorsiflexion as well as hip extension.    https://www.thegaitguys.com/thedailyblog/postures-must-have-integrity-patterns-must-have monthly 0.5 2015-01-22 https://www.thegaitguys.com/thedailyblog/podcast-90-the-brain-a-deeper-look-at-gait-and monthly 0.5 2015-01-21 https://www.thegaitguys.com/thedailyblog/prof-ted-carrick-and-the-eyes-and-some-cursory monthly 0.5 2015-01-20 https://www.thegaitguys.com/thedailyblog/keeping-it-objective-for-clinicians-and-some-die monthly 0.5 2015-01-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553511371-PJH3ZPFJR3VQ4V3H838V/tumblr_nhdevsLYyN1qhko2so3_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553511106-D78BOOLD2EC8EWOTWNZN/tumblr_nhdevsLYyN1qhko2so4_r1_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553511689-LDFRNXCFGAICGFWV65IE/tumblr_nhdevsLYyN1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553512664-5C156GHZMDYVNIZUH2IL/tumblr_nhdevsLYyN1qhko2so2_250.jpg Blog https://www.thegaitguys.com/thedailyblog/to-met-pad-or-not-to-met-pad-that-is-the monthly 0.5 2015-01-19 https://www.thegaitguys.com/thedailyblog/following-up-on-the-peroneal-topic-of-the-week monthly 0.5 2015-01-17 https://www.thegaitguys.com/thedailyblog/the-fudge-factor monthly 0.5 2015-01-17 https://www.thegaitguys.com/thedailyblog/so-you-think-you-are-an-iliotibial-band-syndrome monthly 0.5 2015-01-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553512510-NGDDSE79O3W0GIR3BT6E/tumblr_ni7w3dwmRf1qhko2so1_1280.png Blog So you think you are an iliotibial band syndrome guru ?  This study has some interesting provoking thoughts about the mechanics we have all previously assumed. It is good to challenge established teachings, for it is only through interrogating old ways that we may see the true light of things. The iliotibial band (ITB) syndrome is a common overuse injury that is commonly misunderstood. It has been regarded as a friction syndrome where the ITB rubs against he lateral femoral epicondyle because of its previously assumed variable function, below 30 degrees knee extension it has been though to act as an extensor of the knee, and above 30 degrees (ie more knee flexion) it has been thought to act as flexor.  It is thought to be a culprit (with the biceps femoris) of the shift phenomenon in the “pivot shift test” for posterolateral rotatory instability of the knee (PLRI).  Here is an interesting perspective from a 2006 journal article. “In all cadavers, the ITB was anchored to the distal femur by fibrous strands, associated with a layer of richly innervated and vascularized fat. In no cadaver, volunteer or patient was a bursa seen. The MR scans showed that the ITB was compressed against the epicondyle at 30° of knee flexion as a consequence of tibial internal rotation, but moved laterally in extension. MR signal changes in the patients with ITB syndrome were present in the region occupied by fat, deep to the ITB. The ITB is prevented from rolling over the epicondyle by its femoral anchorage and because it is a part of the fascia lata. We suggest that it creates the illusion of movement, because of changing tension in its anterior and posterior fibres during knee flexion. Thus, on anatomical grounds, ITB overuse injuries may be more likely to be associated with fat compression beneath the tract, rather than with repetitive friction as the knee flexes and extends.” We found this article interesting because it challenges many thoughts about its actual movement, (“it creates an illusion of movement”) because of changing of tension in the anterior and posterior fibres. As this article suggests, it is unlikely that there is any forward and backward motion of the band over the epicondyle during flexion and extension, rather the illusion of movement is from a gradual shifting of load to and from the anterior and posterior fiber bundles during flexion/extension. It is also an interesting article to us because it suggests and challenges that the clinical phenomenon is associated with fat compression rather than friction over the epicondyle.  The authors go into discussion of how the fat beneath the distal ITBand at the knee level is well vascularized and that Pacinian corpuscles can be present in adipose tissue supporting the view that fat compression may have a proprioceptive role and a roll in pain production when the corpuscles undergo hypertrophy in such a clinical setting. Just remember what we have been saying all along when treating what you think are lateral chain problems, the ITBand receives most of the tendon of the gluteus maximus so do not forget to examine the hip and pelvis function, but so not forget the critical contribution that impaired foot and ankle function can have proximally at the knee. This study has some interesting provoking thoughts about the mechanics we have all previously assumed. It is good to challenge established teachings, for it is only through interrogating old ways that we may see the true light of things. If you are looking for more of our thoughts on this topic, we discussed a clinical case in our last podcast (link here).  Shawn and Ivo,  the gait guys Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. Journal of Anatomy 2006;208(3):309-316. doi:10.1111/j.1469-7580.2006.00531.x https://www.thegaitguys.com/thedailyblog/cai-more-on-chronic-ankle-instability monthly 0.5 2015-01-15 https://www.thegaitguys.com/thedailyblog/more-research-on-the-peronei-and-chronic-ankle monthly 0.5 2015-01-14 https://www.thegaitguys.com/thedailyblog/podcast-89-2015-shoe-talk-foot-beds-and-shoe monthly 0.5 2015-01-14 https://www.thegaitguys.com/thedailyblog/vastus-lateralis-closed-chain-internal-rotator-of monthly 0.5 2015-01-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553513462-FTGHNZTLXXRGM8R26NU3/tumblr_nhzes2ccpW1qhko2so1_1280.jpg Blog Vastus lateralis. Closed chain internal rotator of the thigh. Stimulation of this point (ST34) improves gait in elderly individuals (who we assume have compromised mechanoreceptors in the muscles and joints). Think about incorporating this muscle into your rehab protocol, particularly in older folks.  Arch Phys Med Rehabil. 2011 Jan;92(1):7-14. doi: 10.1016/j.apmr.2010.09.023. Stimulation of acupoint ST-34 acutely improves gait performance in geriatric patients during rehabilitation: A randomized controlled trial. Hauer K1, Wendt I, Schwenk M, Rohr C, Oster P, Greten J. “CONCLUSIONS: Study results showed that a 1-time administration of a specific acupoint stimulation regimen statistically significantly improved gait performance during geriatric ward rehabilitation. If sustainability of effects can be documented, acupuncture may prove to be an inexpensive intervention that may mildly improve motor performance in frail geriatric patients.” http://www.ncbi.nlm.nih.gov/pubmed/21187200 Commentary on this topic copied from our social media: Reader: The abstract doesn’t give much away. I suspect using the acupuncture technique DECREASED activity of the VL leading to a more balanced muscular response to gait…kinda like massaging out an overactive muscle - which I don’t like doing but people do… The Gait Guys Could be. We like to think of it as it created homeostasis of the muscular system. The effects of inserting a needle are not just local but global. Reader:Hmm. I am not sure there is evidence to support that statement.  Something changed. Homeostasis was not necessarily achieved. Their gait improved. For how long is unknown. Also, it is unlikely that the people applying the acupuncture were blinded so that is a source of bias. It is interesting for sure, but drawing conclusions is difficult. The Gait Guys agreed. you bring up some good points. The folks doing the acupuncture were not blinded   https://www.thegaitguys.com/thedailyblog/we-think-it-has-to-do-with-reciprocal-inhibition monthly 0.5 2015-01-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553513730-574YE9FPRVTNLZY9S0WU/tumblr_nhzev1gS2M1qhko2so1_250.png Blog We think it has to do with reciprocal inhibition and increased long flexor activity, which was eluded to but not discussed at length in the article.  “As previously mentioned, few studies have investigated the effects of thong style flip-flops on gait dynamics, one of which was the initial study done by the authors at Auburn University in which several gait kinematic and kinetic measures differed between two types of footwear illustrating that walking in flip-flops alters one’s gait when compared to sneakers.” http://lermagazine.com/article/flip-flops-fashionable-but-functionally-flawed Commentary on this article from our social media sites: Reader: It’s great to see a study being done trying to quantify the effects that flip flops may have. Thanks for sharing. The Gait Guys agreed. there are several in the article Reader: Russ Brandt When I had mild shin splints from running I noticed that wearing flip flops inflamed my shins   https://www.thegaitguys.com/thedailyblog/arthrogenic-inhibition monthly 0.5 2015-01-13 https://www.thegaitguys.com/thedailyblog/more-on-clamshells-and-the-gluteus-medius-great monthly 0.5 2015-01-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553514009-CXXX9GXAUM4XYH3MVCTJ/tumblr_nhzeigZZtz1qhko2so1_250.jpg Blog More on Clamshells and the Gluteus medius. Great article written by one of our Facebook followers: Andy Du Bois He talks about specificity of exercise: “In simple terms it says that the strength gained in a particular exercise is only relevant to other exercises that look and feel similar to the original exercise. For example the strength gained in doing a bench press will make you better at push ups but wont improve your ability to throw a cricket ball, or the strength gained in doing small range squats will help skiing but wont help you to kick a ball further. If the body positions, loads, speed of movement and range of movement aren’t similar then the body wont transfer the gains from one exercise to the next.” Nice job and a good, quick read: http://www.mile27.com.au/strengthening-your-gluteus-medius-2/ Reader: Thanks for posting this. So, focusing on GM muscle activation is an incomplete, spot-weld patch. It’s really all about the whole ship. The captain needs to get data on joint position, velocity, speed, and load to integrate glute med into the whole syst… The Gait Guys you now are seeing the whole picture. Perfect! The Gait Guys we are not saying clams have no merit; we are saying the research shows they do not effectively strengthen the g med Reader:  Local and global Stability muscles respond to low load activities not strengthening activities. Also their primary function, especially the global stability muscles, is eccentric control of motion. As a result classic concentric activities are ineffective. These exercises work the global mobilizers reinforcing a already faulty movement pattern. The clam shell is not about gaining glute strength. it is about improving control and then applying that control to more functional exercises. We start with the clam because it allows for activation without substation if done correctly. And that is the key. They most be done correctly with the appropriate focus. The Gait Guys surface EMG can be a valuable tool here, to see what and hhow much you are activating Reader: I am not an expert but what I think this article means is you need to RELATIVELY get the glut med working more than the TFL. Not just get your glut-med to work. You want it to grow stronger than TFL if you have those problems, so dont do exercise that strengthens your TFL as much as glut med  Reader: The issue with EMG is crosstalk and if not placed correctly you will pick up other muscles. An example is picking up levator scap when testing upper trap. Reader:  it is not about leg position:http://www.ncbi.nlm.nih.gov/pubmed/22488226, it is about the muscles the exercise really activates..? (I still agree: it should be more specific also. what about a single leg deadlift?) Hip muscle activity during 3 side-lying hip-strengthening exercises… - PubMed - NCBI  J Athl Train. 2012 Jan-Feb;47(1):15-23. NCBI.NLM.NIH.GOV|BY MCBETH JM , ET AL. The Gait Guys how about a single leg squat with weight? deadlifts tend to create increased shear in the lumbar spine (when performed improperly) and that creates other issues Reader: You cannot lift that much with one leg i think. At least not very soon after starting. Squats with single leg are probably just as good, you cant load too much so easily. With pistol squats, need to take care of technique (pelvic control). Squats for concentric and (romanian, single leg) deadlifts for eccentric strength i would suggest. Those two different types of muscle contractions need different training for optimal performance…   https://www.thegaitguys.com/thedailyblog/look-carefully-at-the-graphs-flip-flops-seem-to monthly 0.5 2015-01-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553513751-NRCR05UT995PS8Y4NWYQ/tumblr_nhzetiQF6h1qhko2so1_250.jpg Blog Look carefully at the graphs. Flip flops seem to allow for less peak dorsiflexion of the foot (plantar flexion needed to hold the flip flop on?) and more inversion and eversion of the foot. Makes sense since there is no heel counter to stopthe calcaneus from inverting or everting.  “The results from this study indicate that barefoot, flip-flops and sandals produced different peak GRF variables and ankle moment compared to shoes while all footwear yield different COP and ankle and knee kinematics compared to barefoot.” J Foot Ankle Res. 2013 Nov 6;6(1):45. doi: 10.1186/1757-1146-6-45. A comparison of gait biomechanics of flip-flops, sandals, barefoot and shoes. Zhang X, Paquette MR, Zhang S1. http://www.ncbi.nlm.nih.gov/pubmed/24196492 https://www.thegaitguys.com/thedailyblog/trying-to-strengthen-the-gluteus-medius-using monthly 0.5 2015-01-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553514891-JDL0CQ16OI1LI6I0ERSQ/tumblr_nhzennyghH1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553514874-IWZX2DI4L6WDFFKCVSGC/tumblr_nhzennyghH1qhko2so2_1280.png Blog https://www.thegaitguys.com/thedailyblog/we-have-talked-about-the-muscles-being-turned monthly 0.5 2015-01-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553514594-0P2TZEETIYW45TVKDJRB/tumblr_nhzeflqglD1qhko2so1_1280.jpg Blog We have talked about the muscles being “turned off” when there is joint effusion or injury. But what happens to the motor system that drives the muscles (ie the cortex)?  It seems the brain actually becomes MORE excited and it contributes little, if any to the “muscle inhibition” that is occurring in the injured or swollen joint (ie; it is a spinal cord segmental reflex).  Take home message?  When a joint is injured, the muscles crossing the joint become “turned off” (or defacilitated/weak) when the joint is swollen  The “turing off” that occurs is a local or spinal segmental (read spinal cord) phenomenon. This is great because we all work with these reflexes on a daily basis The lack of muscle activity appears due to decreased inhibition (which causes increased excitation) of the cortex. So the brain is working hard to figure out a way around the problem! “The results of this study provide no evidence for a supraspinal contribution to quadriceps Arthrogenic Muscle Inhibition. Paradoxically, but consistent with previous observations in patients with chronic knee joint pathology, quadriceps corticomotor excitability increased after experimental knee joint effusion. The increase in quadriceps corticomotor excitability may be at least partly mediated by a decrease in gamma-aminobutyric acid (GABA)-ergic inhibition within the motor cortex.” Arthritis Res Ther. 2014 Dec 10;16(6):502. [Epub ahead of print] Quadriceps arthrogenic muscle inhibition: the effects of experimental knee joint effusion on motor cortex excitability. Rice D, McNair P, Lewis G, Dalbeth N. http://www.ncbi.nlm.nih.gov/pubmed/25497133 https://www.thegaitguys.com/thedailyblog/the-gait-guys-the-national-shoe-fit-certification monthly 0.5 2015-01-13 https://www.thegaitguys.com/thedailyblog/more-on-the-the-peroneus monthly 0.5 2015-01-13 https://www.thegaitguys.com/thedailyblog/thinking-on-your-feet-you-have-less-than-20 monthly 0.5 2015-01-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553515348-7ZEHYR24ESCQ94TLFAN1/tumblr_nhoqkqFCHJ1qhko2so2_r1_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553516396-MONLLW2W8I3ODHA8UEPL/tumblr_nhoqkqFCHJ1qhko2so4_r1_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553516503-YUZFIPLSURJCIPL8MGZ2/tumblr_nhoqkqFCHJ1qhko2so1_r1_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553516760-SDXTIM2YFYJZGXKBB60S/tumblr_nhoqkqFCHJ1qhko2so3_r1_250.png Blog 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https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553521050-300M9UZPKRCR8K5S0FSK/tumblr_nfzg0nM4pC1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553521190-5AFUEKX48SDQMBY126GK/tumblr_nfzg0nM4pC1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553522787-OQFRCNTRCPZQVWJZGPDQ/tumblr_nfzg0nM4pC1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553522268-85EZYBGW2LR066EB84MR/tumblr_nfzg0nM4pC1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553522736-GH82KEE5Q1AA5ODKE0V4/tumblr_nfzg0nM4pC1qhko2so5_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553525014-PLXUIBHIJ4QJZ0DOVD26/tumblr_nfzg0nM4pC1qhko2so6_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/human-gait-changes-following-mastectomy-we monthly 0.5 2014-12-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553523253-HV3S01T26HX9GSE9GPNT/tumblr_ng0hwwN5tM1qhko2so1_1280.jpg Blog Human Gait Changes following mastectomy.  We first wrote about this a year ago after the news of Angelina Jolie’s double mastectomy decision. Research has confirmed that following a mastectomy there are limitations in the efficiency of the upper limb and even changes in the posture of the torso. (1,2,3)  Following mastectomy, whether unilateral or bilateral, restorative measures are necessary, and not just for cosmetic effects either. From a biomechanical perspective, obviously depending on breast size, removing a considerable mass of tissue is going to change the symmetry of the torso particularly if we are dealing with a unilateral mastectomy.  Not only is it 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.  The literature has even shown that post-mastectomy clients display changes in spatiotemporal gait parameter such as step length and gait velocity. Breast tissue moves. It oscillates a various cycles depending on speed of walking or running.  There is a rhythmic cycle that eventually sets up during walking and running and the cycle is intimately and ultimately tied to arm swing.  Thus, it would make sense that removing a sizable mass of tissue, particularly when done unilaterally, will change the tissue and joint rhythmicity. And if you have been here with The Gait Guys for more than a year 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.)  Here are 2 links for more on these topics,Arm Swing: Part 1 and Arm Swing: Part 2, When Phase is Lost. Plus here from our blog search archives, everything we have talked about on Arm Swing.  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 that can either consciously or unconsciously alter arm swing and thus global body kinematics.  (Also, do not forget any changes in opposite leg function secondary to a frozen shoulder (adhesive capsulitis) and the like which can impair arm swing. The bottom line is that because of the neurologically embedded reflexes and reflexive motions and motor patterns, which are things that permeate all human locomotion, anything that changes one of the limbs directly or indirectly can impair and change locomotion, motor pattern choices and programming.  Obviously the degree to which intervention is taken depends on the amount and location of breast tissue removed and intervention will be determined by physical placement of the prosthesis (whether it be external or internal) as well as the prosthesis weight, shape and possibly several other independent factors such as comparative support to the chest wall in comparison to the opposite breast. (There is a plethora of research out that addresses other methods of intervention such as latissimus dorsi relocation to reform the breast mass. This deserves a blog article all on its own because modifying a major shoulder, scapular and spinal stabilizer and prime mover has never made sense to us clinically or biomechanically.) In Hojan’s study (below) they found significant differences in the gait parameters in the younger age groups with and without breast prosthesis however there appeared to be no significant differences in the women of the older study group.  However, it appeared that their study did not take into account all of the intimate issues we talk about in gait here on The Gait Guys blog. None the less, in the younger and likely more active study group, the use of a breast prosthesis brought the gait parameters closer to the healthy control group, as we suspected.  Bottom line, every external and internal parameter that changes affects the human organism and thus affects their gait. Again, here are those links to our other blog writings on arm swing that are paramount to understanding what we are discussing here today. Arm Swing Part 1: The Basics   http://thegaitguys.tumblr.com/post/13869907052/arm-swing-in-gait-and-running-part-1-there-is Arm Swing Part 2: When Phase is Lost   http://thegaitguys.tumblr.com/post/13920283712/arm-swing-part-2-when-phase-is-lost From our blog search   http://thegaitguys.tumblr.com/search/arm+swing Shawn and Ivo, The Gait Guys References: 1.Blomqvist L, Stark B, Engler N, et al. Evaluation of arm and shoulder mobility and strength after modified radical mastectomy and radiother- apy. Acta Oncol. 2004;43(3):280Y283. 2. Rostkowska E, Bak M, Samborski W. Body posture in women after mastectomy and its changes as a result of rehabilitation. Adv Med Sci. 2006;51:287Y297. 3. Crosbie J, Kilbreath SL, Dylke E, et al. Effects of mastectomy on shoulder and spinal kinematics during bilateral upper-limb movement. Phys Ther. 2010;90(5):679Y692. 4. Hojan K, Manikowska F, Molinska-Glura M, Chen PJ, Jozwiak M. Cancer Nurs. 2013 Apr 29. [Epub ahead of print] The Impact of an External Breast Prosthesis on the Gait Parameters of Women After Mastectomy. https://www.thegaitguys.com/thedailyblog/human-gait-is-cyclical-for-the-most-part-when monthly 0.5 2014-12-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553523954-6V0IDW7H0YVGI7R8MDZY/tumblr_ng0mn0tSpy1qhko2so1_500.png Blog 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 we continue, you should recall that there is a brief double limb support phase in walking gait, that which is absent in running gait. Also, we 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 us 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).  For example, when right ankle rocker (dorsiflexion) is impaired, early heel departure will occur and hip extension will be limited. An alteration in right glute function will most likely follow.  One could theorize that the left step length (the length of measure from right heel strike through to left heel strike) would thus be shortened. This would cause a premature load onto the left limb, and could very well force the left frontal plane to be more engaged than is desirable. This could lead to left core and hip frontal plane weakness and compensation patterns to be generated (ie. right arm abduction. One can see all of these components in the photo above, and in this case here). It could also lead to a pelvic distortion pattern which would further throw off the anti-phasic nature of symmetrical and efficient gait.  To complicate the cyclical scenario, the time usually used to move sagittally will be partially used to move into, and back out of, the left frontal plane. This will necessitate some abbreviations in the left stance phase timely mechanical events. Some biomechanical events will have to be abbreviated or sped through and then the right limb will have to adapt to those changes. These are simple gait problems we have talked about over and over again here on the gait guys blog. (Search “arm swing” on our blog and you will find 45 articles around this topic.) These compensation patterns will include expressed weaknesses in various parts of the human frame as part of the pattern, and merely fixing those weaknesses does not address the right ankle rocker problem. Fixing said weaknesses merely encourages the brain to possibly continue to perpetuate necessary tightnesses in other muscles and engrain the compensations (challenges to mobility and stability) further or more complexly.  It is easy to find something weak, it takes a sharp brain to find the sometimes silent sparking event. Are you able to find the problem in this never ending loop of compensations and find a way to unwrinkle the system one logical piece at a time, or will you just chose to strengthen the wrinkled system and hope that the new strength on top of the compensations is adequate for you our your client ? One should not be forever sentenced to daily or weekly rehabilitative sessions/ homework to negate and alleviate symptoms, this is a far more durable machine than that. Fix the problem. Now, lets add another wrinkle to the system.  What if there were problems before any injuries ?  Meaning, what if there were problems during the timely maturation and suppression of the primitive reflexes ? Or problems in the timely appearance or maturation of postural reflexes? A problem in these areas may very well result in a central or peripheral nervous system malfunction and a representation of such in one’s movement and gait.  That is a larger discussion for another time. 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. This is a really tough puzzle and game you are playing. For example, when there is insufficient hip internal rotation unilaterally you can regain some of the loss through increased foot pronation unilaterally, but at a consequence to both the local and global pictures.  Remember, most of the time you are trying to walk in a straight line from A to B and if the parts are not symmetrical you have many options to compensate. It is not as simple as telling your athlete to swing one arm more, or to stop pulling it across their body; they need to do those things, it is called a “compensation”. It is often not as simple as finding an impaired Rolling Pattern and driving it back to symmetry, in doing so, you may have just added strength and skill to a compensation.  Merely addressing things locally can be a crime.  If you are seeing an arm swing change, you would be foolish not to look at the opposite lower limb and foot at the very least, and of course assess spinal rotation, lateral flexion and hinging as well as core mobility and stability.  For your neuro nerds, remember the receptors from the central spine and core fire into the midline vermis of the cerebellum (one of the oldest parts of our brain, called the paleo cerebellum); and these pathways, along with other cerebellar efferents, fire our axial extensor muscles that keep us upright in the gravitational plane and provide balance or homeostasis.  So, those need assessed and addressed as well.   Or, if this is too much thinking for you, … you can just train harder and get stronger . .  . in all your compensation patterns, after all, it is easier than figuring out why and how that right ankle started the whole mess, if in fact that is even the first piece of the puzzle. Welcome to the matrix. shawn and ivo, the gait guys https://www.thegaitguys.com/thedailyblog/more-on-stretching-enough-already-eh-the-last monthly 0.5 2014-12-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553523496-0EE5ECK0I2WM9POHQGZF/tumblr_nfw1xxi7Yt1qhko2so1_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553523941-TU50DNJ36EDV5ECQ9P2S/tumblr_nfw1xxi7Yt1qhko2so2_540.png Blog https://www.thegaitguys.com/thedailyblog/podcast-84-toe-walkers-hip-impingment-olympic monthly 0.5 2014-11-27 https://www.thegaitguys.com/thedailyblog/toe-walking-in-children-do-you-know-what-you-are monthly 0.5 2014-11-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553524466-C7NFIR3L1RKOUL6UWC2H/tumblr_nf35bjnCIj1qhko2so1_1280.jpg Blog Toe Walking in Children. Do you know what you are dealing with ? Part 2 So you have now ruled out possible Autism-spectrum, possible CMT (Charcot-Marie Tooth Disease), CP (Cerebral Palsy), MD (Muscular Dystrophy) in your young toe walking individual.  Now you have been left with the aftermath foggy diagnosis of “Idiopathy Toe Walking”, that doesn’t leave you as a parent or clinician with much to work with or likely to be confident about. Let us try to help make things clearer and give you some other cognitive options to entertain. New research in recent years has brought new light onto the issue and we wanted to use today’s blog post as a platform to share it with you.  In a previous week’s “Part 1” blog post & video (link) you can see in the gait on the video that nothing appears to be terribly abnormal in the foot structure (from what we can tell), the client is merely remaining in the plantarflexed posture and forefoot weight bearing.  This is highly ineffective gait and can be very fatiguing let alone to mention the sustained loading into the posterior compartment and plantarflexor mechanism (gastrosoleus-achilles) not to mention the sustained forefoot loading response on the foot bones and joints. Remember, the tibialis posterior and long toe flexors are close neighbors with capabilities of plantarflexion moments, so there are possible clinical manifestations there as well not to mention the obvious (especially to long-time Gait Guys readers) deficits that will be found in functional ankle dorsiflexion, ankle rocker and S.E.S. (skill, endurance, strength) of the anterior compartment mechanism (tibialis anterior, long toe extensors, peroneus tertius).  Even if this client were to go into normal heel strike and stance phases right now, they would have lots of work to do to restore the anterior-posterior compartment balance, the 3 foot rockers (heel, ankle and forefoot) abd posterior compartment length to avoid functional pathology not to mention the timely coordination of all these events.  Idiopathic toe walking is suggested to be as prevalent as 12%. Toe walking is categorized when there is an absence, or at least a limitation, of heel strike during initial walking gait contact phase. We are not referring to, at all, forefoot running principles. Neuromotor maturation comes about via the suppression of the primitive reflexes/windows and appearance of the postural reflexes and responses. Delays or subtractions of these windows/reflexes may cause challenges in the normal development and maturation of the central and/or peripheral nervous systems.  With toe walking, the clinical window most studies suggest is to begin investigation after 3 years of age when the primitive motor patterns should have solidified and the gait and postural patterns have begun to layer on top of those primitive reflexes.  Remember though, the primitive patterns are not sequentially fixed, meaning that infants move in and out of these reflexes until they become skilled and permanent.  It is not until they are fixed that the postural patterns, which are volitional, can be gradually built. This should bring some deeper thoughts to your mind right now.  Is toe walking behavior a missed primitive window or a non-volitional postural window? These kids are not doing this by choice, anyone who has worked with these types of cases knows this very well, and we have seen our share.  In the literature and clinics a plethora of things have been tried and discussed (ie. serial casting, botulinum toxin, surgical tendon lengthening, gait retraining, orthoses/orthotics, night splints, day splints and the like). Keep in mind that only one of the above is addressing a functional change via cognitive and higher brain center demand, “gait retraining”. The others are passive forced attempts.  But is gait training enough ? And how far back into primitive and postural gait pattern training do you have to go? Gait training certainly does something as eluded to by two research papers we posted on our Facebook page in previous weeks. See those references below. “For both feet, contact time of the heel was increased after the training period, whereas contact time of the forefeet decrease. Also positive changes in the active range of joint motion of the ankle (dorsal extension) were observed in both feet. These positive effects were visible also in the follow–up assessment.” -Pelykh study “Daily intensive gait training may influence the elastic properties of ankle joint muscles and facilitate toe lift and heel strike in children with CP. Intensive gait training may be beneficial in preventing contractures and maintain gait ability in children with CP.” - Willerslev-Olsen study So what else could be going on here ? Is this neurodevelopmental ? Yes, for sure.  But where did things go awry ?  And how do we fix it ? Remember, the development of primitive and postural reflexes is supposed to occur proximal to distal (ie. from core to hand/foot). In a recent study in the Journal of Child Neurology,   “for the first time, motor and sensory challenges presenting in healthy children with an idopathic toe walking gait have been identified.These challenges imply an immaturity or mild impairment at the cerebellum or motor cortex level.” As the article suggested, the research did not render direct cause(s) for the gait pattern, rather some very viable theories on the topic. They found that only the areas of balance, upper body coordination and bilateral coordination were areas found to be problematic in the toe walkers. These 3 components require the integration of the tactile, vestibular and proprioceptive systems as a team. Diving deeper into how these 3 outputs are linked, there is a required “mix of occulomotor control and cues together with subtle and gross postural adjustments” (3). As Williams et al (3) suggested, “they are skills requiring the coordination of movements in which each side of the body moves simultaneously or in sequence”.  Kind of sounds like some topics on Arm Swing/Leg swing and also on the topic of phasic/antiphasic gait we have discussed over and over again here on TGG and in recent podcasts (82) doesn’t it ?  It was proposed that perhaps idiopathic toe walkers negotiate their sensory challenges by unconsciously engaging toe walking behavior to change or challenge these inputs.  Here were some of the proposed thoughts from the Williams study. “The tactile receptors of the skin may be stimulated through pressure at the ball of the foot or lessened by a reduction of surface contact by raising the heel off the ground. Proprioceptive input may be changed at the knee, ankle and even toe joints by unconsciously repositioning of the foot posture.  The vestibular input may be increased by the vertical stimulation of the bouncy type gait that results from toe walking.”(3) Williams It seems clear from the Williams study that these children demonstrate a number of sensory needs that motivate toe walking to alter (increase or decrease) or improve sensory input.  The study also suggests that the toe walking gait is an attempt to modify input on postural stimuli during gait to serve diminished postural and position awareness. The findings of this study are important.  Our most recent blog posts and podcasts (Nov 2014) have discussed some of the components to build, control and coordinate gait on a higher neurologic level. The Williams article seems to support these discussions, that some pathologic gaits are initiated on a neurologic level as opposed to biomechanical at the foot and ankle level.  This sounds like the work offered by “the functional neurologist”, graduates of the Carrick Institute for Graduate Studies ! (carrickinstitute.com) Have a great day gait brethren ! Shawn and Ivo, The Gait Guys References: 1. Eur J Phys Rehabil Med. 2014 Oct 9. [Epub ahead of print] Treatment outcome of visual feedback training in an adult patient with habitual toe walking. Pelykh O1, Klein AM, Feist-Pagenstert I, Schlick C, Ilmberger J. NeuroRehabilitation. 2014 Oct 15. [Epub ahead of print] 2. Gait training reduces ankle joint stiffness and facilitates heel strike in children with Cerebral Palsy. Willerslev-Olsen M1, Lorentzen J1, Nielsen JB2. 3. Is idiopathic toe walking really idiopathic ? The motor skills and sensory processing abilities associated with idiopathic toe walking gait.  J Child Neurol 2014, 29:71 Williams, C. , Curtin, Wakefield and Nielsen https://www.thegaitguys.com/thedailyblog/more-tricks-for-stretching-part-3-we-have-been monthly 0.5 2014-11-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553524798-KU6HBO5F1GCP09HRDZPB/tumblr_nfij40WXFk1qhko2so1_250.jpg Blog More Tricks for stretching, part 3 We have been talking about ways to enhance stretching, talking about taking avvantage of reciprocal inhibition (please see part 1 here) and autogenic  (or post isometric) inhibition (please see part 2 here).  Before we talk about this next one, we need to give you a little background (neurologically speaking).  Take a look at the picture above and note the posturing of the baby in the 2 positions. These neurological reflexes (or postures) are called symmetrical tonic neck reflexes or responses (STNR’s for short) and were described in animals and men by Magnus and de Kleyn in 1912 (1). This work was later studied and reported by by Arthur Simons in 1916  (2) and later by Francis Walshe in 1923 (3). These were later made popular by Berta and Karl Bobath in the 70’s (who studied Walshes work), whom they are often attributed to (4).  You next question is “Do these persist into healthy adulthood”? and the answer is a resounding YES (5). Take a look at the picture above again and note the following:  When the neck is flexed, the fore limbs flex (and the muscles facilitating that, bicep, brachialis, anterior deltoid are contracting) and the hind limbs are extending (relatively), with the glutes maximus, quadriceps, foot dorsiflexors contracting. Note that when the head is extended, the forelimbs are extended and the hind limbs flexed. Think about the muscles involved. Upper extremity tricep, anconeus, posterior deltoid, lower back extensors, hamstrings and foot plantar flexors facilitated. The reflex is based on the mechanoreceptors in the neck articulations and muscles and are frequently used by us and many others in the rehabilitation field. Generally speaking, looking up facilitates things which make you extend above T12, and flex below T12. Looking down facilitates flexion above T12 and extension below.  We would encourage you at this point to “assume” these positions and feel the muscles which are active and at rest. So, how can we take advantage of these while stretching?  Think about your head position:  If you are standing up and hinging at the hips to stretch your hamstrings (notice we did not say “bent at the waist”; there is a BIG difference in shear forces applied to your lumbar spine) you would probably want your neck bent forward, as this would fire your quads which would in turn ALSO inhibit your hamstrings, in addition to the STNR inhibiting the hamstring.  If you were in a hip flexor stretch position, you would want you head up, looking at the ceiling to take advantage of the reflex.  We are confident you can think of many more applications of this reflex and trust that you will, as it can apply to both upper and lower extremity stretches. Just remember that this reflex is symmetrical and will affect BOTH sides. Of course, there are reflexes that only effect things unilaterally, but that is the subject of another post.  The Gait Guys. Helping make you better at what you do for yourself and others and assisting you on using the neurology that God gave you.  http://www.worldneurologyonline.com/article/arthur-simons-tonic-neck-reflexes-hemiplegic-persons/#sthash.6QS3Eat3.dpuf  Simons A (1923) Kopfhaltung and Muskeltonus. Ges.Z. Neurol.Psychiatr. 80: 499-549. Walshe FMR (1923) On certain or postural reflexes in hemiplegia, with special reference to the so-called “associated movements.” Brain 46: 1-37.  Janet M. Howle . Symmetrical Tonic Neck Reflex in Neuro-developmental Treatment Approach: Theoretical Foundations and Principles of Clinical Practice.   NeuroDevelopmental Treatment, 2002  p 341 ISBN 0972461507, 9780972461504 Bruijn SM1, Massaad F, Maclellan MJ, Van Gestel L, Ivanenko YP, Duysens J. Are effects of the symmetric and asymmetric tonic neck reflexes still visible in healthy adults?Neurosci Lett. 2013 Nov 27;556:89-92. doi: 10.1016/j.neulet.2013.10.028. Epub 2013 Oct 21. https://www.thegaitguys.com/thedailyblog/podcast-83-gait-brain-injury-and-compression monthly 0.5 2014-11-20 https://www.thegaitguys.com/thedailyblog/the-bouncy-gait-premature-heel-rise-gait-taking monthly 0.5 2014-11-19 https://www.thegaitguys.com/thedailyblog/more-effective-stretching-part-2-last-week-we monthly 0.5 2014-11-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553525646-B28FM18WZMRYXE30XAUG/tumblr_nf5f7fiyxD1qhko2so1_r1_1280.jpg Blog More effective stretching, Part 2 Last week we looked at one (of many) methods to make stretching more effective, utilizing a neurological reflex called “reciprocal inhibition” If you missed that one, or need a review, click here.  Another way to get muscles to the end range of motion is to utilize a technique called “post isometric relaxation”. Notice I did not say to lengthen the muscle; to actually add sarcomeres to a muscle you would need to use a different technique. Click here to read that post. Contracting a muscle before stretching is believed to take advantage of a post isomteric inhibition (sometimes called autogenic inhibition), where the muscle is temporarily inhibited from contracting for a period immediately following a isometric contraction. This has been popularized by the PNF stretching techniques, such as “contract hold” or “contract relax” . EMG studies do  jot seem to support this and actually show muscle activation remains the same (1, 2) or increased after contraction (3-6). Perhaps it is due to an increased stretch tolerance (7,8).  The technique was 1st described by Mitchell, Morgan and Pruzzo in 1979 (9). These gents felt it was important to utilize a maximal contraction (using 75-100% of contractile force) to get to have the effect. It was later shown by Feland and Marin (10) that a more minimal, submaximal contraction of 20-60% accomplished the same thing.  Lewit felt that a less forceful contraction offers the same results, and combined respiratory assists (inspiration facilitates contraction, expiration facilitates relaxation) with this technique (11). Interestingly, there are bilateral increases in range of motion with this type of stretching, indicating a cross over effect (12). Regardless of the mechanism, the phenomenon happens and we can take advantage of it.  This is how you do it:  Bring the muscle to its end range (maximum length) without stretching, taking up the slack. This should be painless, as this will elicit a different neurological reflex that may actually increase muscle tone.  resist with a minimal isometric contraction (20-60%) and hold for 10 seconds.  You can inspire to enhance the effect. relax and exhale slowly. It is important to wait and feel the relaxation. Stretch through the entire period of the relaxation. You should feel a lengthening of the  muscle. repeat this 3-5 times This technique can also be used with the force of gravity offering isometric resistance. In a hamstring stretch, you could lean forward while maintaining the lumbar lordosis and allowing the weight of the upper body to provide the stretch.  Wasn’t that easy? Now you have another tool in your toolbox for yourself or your clients. The Gait Guys. Giving you useful information and explanations in each and every post. Magnusson SP, Simonsen EB, Aagaard P, Sorensen H, Kjaer M. A mechanism for altered flexibility in human skeletal muscle. J Physiol. Nov 15 1996;497 (Pt 1):291–298 Cornelius WL. Stretch evoked EMG activity by isometric coontraction and submaximal concentric contraction. Athletic Training. 1983;18:106–109 Condon SM, Hutton RS. Soleus muscle electromyographic activity and ankle dorsiflexion range of motion during four stretching procedures. Phys Ther. Jan 1987;67(1):24–30  Mitchell UH, Myrer JW, Hopkins JT, Hunter I, Feland JB, Hilton SC. Neurophysiological reflex mechanisms’ lack of contribution to the success of PNF stretches. J Sport Rehabil. 2009;18:343–357  Youdas JW, Haeflinger KM, Kreun MK, Holloway AM, Kramer CM, Hollman JH. The efficacy of two modified proprioceptive neuromuscular facilitation stretching techniques in subjects with reduced hamstring muscle length. Physiother Theory Pract. May 2010;26(4):240–250  Osternig LR, Robertson R, Troxel R, Hansen P. Muscle activation during proprioceptive neuromuscular facilitation (PNF) stretching techniques. American journal of physical medicine. Oct 1987;66(5):298–307 Mahieu NN, Cools A, De Wilde B, Boon M, Witvrouw E. Effect of proprioceptive neuromuscular facilitation stretching on the plantar flexor muscle-tendon tissue properties. Scandinavian journal of medicine & science in sports. Aug 2009;19(4):553–560  Mitchell UH, Myrer JW, Hopkins JT, Hunter I, Feland JB, Hilton SC. Acute stretch perception alteration contributes to the success of the PNF “contract-relax” stretch. J Sport Rehabil. May 2007;16(2):85–92 Mitchell F Jr., Moran PS, Pruzzo NA: An Evaluation of Osteopathic Muscle Energy Procedures. Pruzzo, Valley Park, 1979.   Feland JB, Marin HN. Effect of submaximal contraction intensity in contract-relax proprioceptive neuromuscular facilitation stretching. Br J Sports Med. Aug 2004;38(4):E18. Lewit K: Postisometric relaxation in combination with other methods of muscular facilitation and inhibition. Man Med, 1986, 2:101-104. Markos PD. Ipsilateral and contralateral effects of proprioceptive neuromuscular facilitation techniques on hip motion and electromyographic activity. Phys Ther. Nov 1979;59(11):1366–1373 https://www.thegaitguys.com/thedailyblog/podcast-82-phasic-vs-antiphasic-gait-cross-over monthly 0.5 2014-11-15 https://www.thegaitguys.com/thedailyblog/this-client-went-phasic-in-their-gait-do-you-know monthly 0.5 2014-11-12 https://www.thegaitguys.com/thedailyblog/making-your-stretching-more-effective-while-i monthly 0.5 2014-11-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553525953-1D0U90X81JK6L4VOFWSL/tumblr_neswgbQW3z1qhko2so1_1280.jpg Blog Making your stretching more effective.  While I was making linguine and clam sauce for my family, one of my favorite foods that I haven’t had in quite some time( and listening to Dream Theater of course) I was thinking about this post.  Then I remembered about voice recognition on my iMac.  Talk about multitasking! What do you agree that stretching is good or not, you or your client still may decide to do so possibly because of the “feel good” component. Make sure to see this post here on “feel good”  part from a few weeks ago.  If you do decide to stretch, make sure you take advantage of you or your clients neurology.  There are many ways to do this. One way we will discuss today is taking advantage of what we call myotatic reflex. The myotatic reflex is a simple reflex arc. The reflex begins at the receptor in the muscle (blue neuron above) : the muscle spindles (nuclear bag or nuclear chain fibers). This sensory (afferent) information then travels up the peripheral nerve to the dorsal horn of the spinal cord where it enters and synapses in the ventral horn on an alpha motor neuron.  The motor neuron (efferent) leaves the ventral horn and travels back down the peripheral nerve to the contractile portion of the myfibrils (muscle fiber) from which the the sensory (afferent) signal came (red neuron above).  This causes the muscle to contract. Think of a simple reflex when somebody taps a reflex hammer on your tendon. This causes the muscle to contract and your limb moves. Nuclear bag and nuclear chain fibers detect length or stretch in a the muscle whereas Golgi Tendon organs tension. We have discussed this in other posts here.   With this in mind, slow stretch of a muscle causes it to contract more, through the muscle spindle mechanism. Another reflex that we should be familiar with is called reciprocal inhibition. It states simply that when one muscle (the agonist) contracts it’s antagonist is inhibited (green neuron above).  You can find more on reciprocal inhibition here. Take advantage of both of these reflexes?   Try this: do a calf stretch like this: put your foot in dorsiflexion, foot resting on the side of the doorframe. Keep your leg straight. Grab the the door frame with your arms and slowly draw your stomach toward the door frame.  Feel the stretch in your calf; this is a slow stretch. Can you feel the increased tension in your calf? You could fatigue this reflex if you stretched long enough. If you did, then the muscle would be difficult to activate. This is one of the reasons stretching seems to inhibit performance.  Now for an added stretch, dorsiflex your toes and try to bring your foot upward.  Did you notice how you can get more stretch your calf and increased length? This is reciprocal inhibition at work! There you have it, one neurological tool of many to give you increased length.The next time you are statically stretching, take  advantage of these reflexes to make it more effective.  The Gait Guys. Teaching you more  about anatomy, physiology, and neurology with each and every post.  image from :www.positivehealth.com https://www.thegaitguys.com/thedailyblog/pronation monthly 0.5 2014-11-06 https://www.thegaitguys.com/thedailyblog/podcast-81-gait-critical-pure-and-essential monthly 0.5 2014-11-05 https://www.thegaitguys.com/thedailyblog/one-way-compensations-develop-we-have-all-had monthly 0.5 2014-11-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553526453-3LXSRLUOTAHJP66S78IV/tumblr_nefq8vTG4k1qhko2so1_400.jpg Blog One way compensations develop We have all had injuries; some acute some chronic. Often times injuries result in damage to the joint or articulation;  when the ligament surrounding a joint becomes injured we call this a “sprain”.  Joints are blessed with four types of mechanoreceptors.  We have covered this in many other posts (see here and here).  These mechanoreceptors apprise the central nervous system of the position (proprioception or kinesthesis) of that body part or joint via the dorsal column system or spinocerebellar tracts. Damage to these receptors can result in a mismatch or inaccuracy of information to the central nervous system (CNS). This can often result in further injury or a new compensation pattern.  Joints have another protective mechanism called arthrogenic inhibition (see diagram above). This protective reflex turns off the muscles which cross the joint. This was described in a few great paper by Iles and Stokes in the late 80’s an early 90’s (vide infra). Not only are the muscles inhibited, but it can also lead to muscle wasting; there does not need to be pain and a small joint effusion can cause the reflex to occur.  If the muscles are inhibited and cannot provide appropriate afferent (sensory) and efferent (motor) information to the CNS, your brain makes other arrangements to have the movement occur, often recruiting muscles that may not be the best choice for the job. We call this a “compensation” or “compensation pattern”. An example would be that if the glute max is inhibited (a 2 joint muscle, with a larger attachment to the IT band and a smaller to the gluteal tuberosity; it is a hip extender, external rotator and adductor of the thigh), you may use your lumbar erectors (multi joint muscles; extensors and lateral rotators of the lumbar spine) or hamstrings (2 joint muscles; hip extenders, knee flexors, internal and external rotators of the thigh)  to extend the hip on that side, resulting in aberrant mechanics often observable in gait, which may manifest itself as a shortened step length, increased vertical displacement of the pelvis, lateral shift of the pelvis or increase in step height, just to name a few. Keep this up for a while and the new “pattern” becomes ingrained in the CNS and that becomes your new default for that motion. Now to fix the problem, you not only need to reactivate the muscle, but you need to retrain the activity. Alas, the importance of doing a thorough exam and thorough rehab to fix the problem. Often times, the fix is much more involved than figuring out what the problem is (or was). Take your time and do a good job. Your clients and patients will appreciate it! Ivo and Shawn, the gait guys Young A, Stokes M, Iles JF : Effects of joint pathology on muscle. Clin Orthop Relat Res. 1987 Jun;(219):21-7 Iles JF, Stokes M, Young A.: Reflex actions of knee joint afferents during contraction of the human quadriceps. Clin Physiol. 1990 Sep;10(5):489-500. image from: http://chiroeco.com/chiro-blog/results-to-referrals/2013/04/03/neurology-based-simplified-musculoskeletal-assessment/ https://www.thegaitguys.com/thedailyblog/podcast-80-muscle-receptors-building-your-gait monthly 0.5 2014-10-31 https://www.thegaitguys.com/thedailyblog/random-thoughts-on-the-symmetry-of-the-gait-cycle monthly 0.5 2014-10-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553526766-QUS3QECRUERGA9R49UPH/tumblr_ne9ultkBKs1qhko2so1_540.png Blog Random thoughts on the Symmetry of the Gait Cycle Human gait is cyclical. For the most part, when one limb is engaged on the ground (stance phase), the other is in swing phase (in walking gait there is a brief period of double limb support), then the limbs switch tasks. For us to move cleanly and efficiently one would assume that the best way to do that would be to ensure that both limbs are capable of doing the exact same things, with the same timing, same skill, same endurance and same strength. For this clean seamless motor function, one must assume that there is complete limb symmetry (length, long bone torsion, the same rate and degree of pronation, supination, ankle dorsiflexion, hip internal/external rotation, same strength, power output etc) and one would hope 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).  For example, when right ankle rocker (dorsiflexion) is impaired, early heel departure will occur and hip extension will be limited. An alteration in right glute function will follow.  One could theorize that the left step length (the length of measure from right heel strike through to left heel strike) would be shortened. This would cause a premature load onto the left limb, and could very well force the left frontal plane to be more engaged than is desirable. This could lead to left core and hip frontal plane weakness and compensation patterns to be generated. To complicate the cyclical scenario, the time usually used to move sagittally will be partially used to move into, and back out of, the left frontal plane. This will necessitate some abbreviations in the left stance phase’s timely mechanical events. Some biomechanical events will have to be abbreviated or sped through and then the right limb will have to adapt to those changes. These are simple gait problems we have talked about over and over again here on the gait guys blog. These compensation patterns will include weaknesses as part of the pattern, and fixing those weaknesses does not address the right ankle rocker problem. Fixing said weaknesses merely encourages the brain to possibly continue to perpetuate necessary tightnesses in other muscles and motor linkages and engrain the compensations further or more complexly.  It is easy to find something weak, it takes a sharp brain to find the sometimes silent sparking event underneath it all. One’s focused task should be, are you able to find the problem in this never ending loop of compensations and find a way to unwrinkle the system one logical piece at a time, or will you just chose to strengthen the wrinkled system and hope that the new strength on top of the compensations is adequate for you our your client ? One should not have to do daily or weekly rehabilitative sessions and homework to negate and alleviate symptoms, this is a far more durable machine than one that needs daily support.  Rather, one that “seems” to need daily supportive homework/rehab is one that likely needs the underlying limitation to be uncovered. However, there are always exceptions. If one has a fixed issue, for example Foot Baller’s Ankle, then regular doses of lower limb anterior compartment work may be necessary to ensure that further ankle dorsiflexion range is not eroded.   Now, lets add another wrinkle to the system.  What if there were problems before any injuries ?  Meaning, what if there were problems during the timely maturation and suppression of the primitive reflexes ? Or problems in the timely appearance or maturation of postural reflexes? A problem in these areas may very well result in a central or peripheral nervous system malfunction and a representation of such in one’s movement and gait.  But, that is a discussion for another time. Shawn and Ivo, the gait guys photo: courtesy of Thomas Michaud, from the excellent textbook, Human Locomotion https://www.thegaitguys.com/thedailyblog/more-thoughts-on-stretching-we-get-a-lot-of monthly 0.5 2014-10-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553526912-F1X69GNHQGP8LHKGX0FK/tumblr_ne2sg64OZ11qhko2so1_400.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553527514-Q0FD8Y5GA9E6F01ED1VA/tumblr_ne2sg64OZ11qhko2so3_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553527506-1O8FRWI6JTR5YAME1A2P/tumblr_ne2sg64OZ11qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/hip-muscles-and-postural-control-related-to-ankle monthly 0.5 2014-10-22 https://www.thegaitguys.com/thedailyblog/why-does-it-feel-so-good-to-stretch-we-are-sure monthly 0.5 2014-10-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553528155-HYZT7BLFZY5PA36YU7WE/tumblr_ndq10qn3oQ1qhko2so1_1280.png Blog Why does it feel so good to stretch?  We are sure you have read many articles, some written by us, about the good the bad and the ugly about stretching.  Regardless of how you slice the cake, we think we can all agree that stretching “feels” good. The question of course is “Why?” Like it or not, it all boils down to neurology. Our good old friends, the Ia afferents are at least partially responsible, along with the tactile receptors, like Pacinian corpuscles, Merkel’s discs, Golgi tendon organs, probably all the joint mechanoreceptors and well as a few free nerve endings. We have some reviews we have written of these found here, and here and here. What do all of these have in common? Besides being peripheral receptors. They all pass through the thalamus at some point (all sensation EXCEPT smell, pass through the thalamus) and the information all ends up somewhere in the cortex (parietal lobe to tell you where you are stretching, frontal lobe to help you to move things, insular lobe to tell you if it feels good, maybe the temporal lobe so you remember it, and hear all those great pops and noises and possibly the occipital lobe, so you can see what you are stretching. The basic (VERY basic) pathways are:Peripheral receptor-peripheral nerve-spinal cord-brainstem-thalamus-cortex; we will call this the “conscious” pathway:  and peripheral receptor-peripheral nerve-spinal cord-brainstem-cerebellum- cortex; we will call this the “unconscious” pathway. Of course, the two BASIC pathways cross paths and communicate with one another, so not only can you “feel” the stretch with the conscious pathway but also know “how much” you are stretching through the unconscious pathway. The emotional component is related through the insular lobe (with relays from the conscious and unconscious pathways along with collaterals from the temporal lobe to compare it with past stretching experiences) to the cingulate gyrus and limbic cortex,  where stretching is “truly appreciated”.  As we can see, there is an interplay between the different pathways and having “all systems go” for us to truly appreciate stretching from all perspectives; dysfunction in one system (due to a problem, compensation, injury, etc) can ruin the “stretching experience”.  Hopefully we have stretched your appreciation (and knowledge base) to understand more about the kinesthetic aspect of stretching. We are not telling you to stretch, or not to stretch, merely offering a reason as to why we seem to like it. The Gait Guys https://www.thegaitguys.com/thedailyblog/podcast-79-tightness-vs-shortness-plantar monthly 0.5 2014-10-16 https://www.thegaitguys.com/thedailyblog/some-fat-on-flat-feet-normal-feet-more-hindfoot monthly 0.5 2014-10-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553528084-BVHTDCCA1J223WZX3WQG/tumblr_ndhu102Wf21qhko2so2_400.jpg Blog Some Fat on Flat Feet Normal feet: more hindfoot dorsiflexion (read ankle rocker) hindfoot more flexible no or different compensation, if any Symptomatic Flat feet: less hindfoot dorsiflexion (read, reduced ankle rocker) hindfoot was more everted, but less flexible. forefoot compensates for reduced motion in rearfoot by increasing motion  hallux hypermobility symptomatic flat feet lacked positive joint energy for propulsion  Asymptomatic flat feet: less hindfoot dorsiflexion (read, reduced ankle rocker) hindfoot was more everted, but less flexible. forefoot compensates for reduced motion in rearfoot by increasing motion  hallux hypermobility asymptomatic flat feet needed to absorb more negative ankle joint energy during loading response. This may risk fatigue and overuse syndrome of anterior shank muscles “Hence, despite a lack of symptoms flatfoot deformity in asymptomatic flat feet affected function. Yet, contrary to what was expected, symptomatic flat feet did not show greater deviations in 3D foot kinematics than asymptomatic. Symptoms may rather depend on tissue wear and subjective pain thresholds.” http://www.ncbi.nlm.nih.gov/pubmed/23796513 https://www.thegaitguys.com/thedailyblog/podcast-78-step-width-gait-training-asymmetries monthly 0.5 2014-10-09 https://www.thegaitguys.com/thedailyblog/part-2-standing-on-glass-static-footpedograph monthly 0.5 2014-10-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553529904-XQBQ1TYFGTMEKWT5AQWH/tumblr_nd32fvOzjx1qhko2so3_r1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553530557-NMBWGRANDK4BYZXSHC5V/tumblr_nd32fvOzjx1qhko2so2_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553530979-FTUV5D04XRBWPKN8ZAJ2/tumblr_nd32fvOzjx1qhko2so1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553530855-DC33OAN6JCXRYL7MSWCA/tumblr_nd32fvOzjx1qhko2so4_r1_500.png Blog https://www.thegaitguys.com/thedailyblog/the-standing-on-glass-static-footpedograph monthly 0.5 2014-10-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553531407-OQRM5NYQMZIICLJOJILA/tumblr_nd2t7q0Bcr1qhko2so1_1280.png Blog The “Standing on Glass” Static Foot/Pedograph Assessment: Part 1 * note: This is a static assessment dialogue. One cannot, and must not, make clinical decisions from a static assessment. As in all assessments, information is taken in, digested and them MUST be confirmed, denied and/or at the very least, folded into a functional and clinically relevant assessment of the client before the findings are accepted, dismissed and acted upon. As we always say, a gait analysis or pedograph-type assessment is never enough to make decisions on treatment to resolve problems and injuries. What is seen and represented on either are the client’s strategies around clinical problems or compensations.  Today’s photo and blog post are an exercise in critical clinical thinking to get the juices flowing and to get the observer thinking about the client’s presentation and to help open up the field to questions the observer should be entertaining.  The big questions should be, “why do i see this, what could be causing these observances ?” * note the right and left sides by the R and L circled in pink. ORANGE lines: The right foot appears to be shorter, or is it that the left is longer (see the lines and arrows drawing your attention to these differences)? A shorter foot could be represented by a supinated foot (if you raise the arch via the windlass mechanism you will shorten the foot distance between the rear and forefoot). A longer foot could be represented by a more pronated foot.  Is that what we have here ? There is no way to know, this is a static presentation of a client standing on glass. What we should remember is that the goal is always to get the pelvis square and level.  If an anatomically or functionally short leg is present, the short leg side MAY supinate to raise the mortise and somewhat lengthen the leg.  In that same client, they may try to meet the process part way by pronating the other foot to functionally “shorten” that leg.  Is that what is happening here ? So, does this client have a shorter right leg ? Longer left ?  Do you see a plunking down heavily onto the right foot in gait ? Remember, what you see is their compensation.  Perhaps the right foot is supinating, and thus working harder at the bottom end of the limb (via more supination), to make up for a weak right glute failing to eccentrically control the internal spin of the leg during stance phase ? OR, perhaps the left foot is pronating more to drive more internal rotation on the left limb because there is a restricted left internal hip rotation from the top ? Is the compensation top-down or bottom up ? These are all viable possibilities and you must have these things flowing freely through your head during the clinical examination as you rule in/rule out your hands-on findings.  Remember, just going by a FMS-type screen to drive prescription exercises from what you see on a movement screen is not going to necessarily fix the problem, it could in fact lead one to drive a deeper compensation pattern. You can be sure that Gray Cook’s turbo charged brain is juggling all of these issues (and more !) when he sees a screen impairment, although we are not speaking for him here. Remember this critical fact.  After an injury or a long standing problem, muscles and motor patterns jobs are to stabilize and manage loads (stability and mobility) for adequate and necessary movement. Injuries leave a mark on the system as a whole because adaptation was necessary during the initial healing phase. This usually spills over during the early movement re-introduction phase, particularly if movement is reintroduced too early or too aggressively.  Plasticity is the culprit. Just because the injury has come and gone does not mean that new patterns of skill, endurance, strength (S.E.S -our favorite mnemonic), stability and mobility were not subsequently built onto the apparently trivial remnants of the injury.  There is nothing trivial if it is abnormal. The forces must, and will, play out somewhere in the body and this is often where pain or injury occurs but it is rarely where the underlying problem lives. Come back tomorrow, where we will open your mind into the yellow, pink, blue and lime markings on the photo. Are the hammering toes (lime) on the left a clue ? How about the width of the feet (yellow) ? The posturing differences of the 5th toe to the lateral foot border ?  What about the static plantar pressure differences from side to side (blue)? Maybe, just maybe, we can bring a logical clinical assumption together and then a few clinical exam methods to confirm or dis-confirm our working diagnostic assumption.  See you tomorrow friends ! Shawn and ivo, the gait guys https://www.thegaitguys.com/thedailyblog/whoa-it-is-amazing-what-the-human-frame-can monthly 0.5 2014-10-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553531655-DASWNSB6F3M8NFP6WB16/tumblr_nc9gscGC521qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553531760-F6DUYFSTZUKTO1BDCMF6/tumblr_nc9gscGC521qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553531803-ZGL4Z6SIVHFUW2F70AA2/tumblr_nc9gscGC521qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553532459-6MSQXWDK3VIBLQYDWTOB/tumblr_nc9gscGC521qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553533352-V8P3Q7BU17HLLIKMMPON/tumblr_nc9gscGC521qhko2so5_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553534063-QQ2XUOHQBNEOUTOWZMZL/tumblr_nc9gscGC521qhko2so6_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/shoe-lacing-problems-things-you-need-to-know monthly 0.5 2014-10-01 https://www.thegaitguys.com/thedailyblog/does-this-guy-have-a-short-leg-or-what-how-good monthly 0.5 2014-10-01 https://www.thegaitguys.com/thedailyblog/got-arm-swing-we-have-written-many-times-about monthly 0.5 2014-09-30 https://www.thegaitguys.com/thedailyblog/a-profound-loss-of-hip-extension-while-sitting monthly 0.5 2014-09-29 https://www.thegaitguys.com/thedailyblog/podcast-77-gait-analysis-forefoot-running monthly 0.5 2014-09-25 https://www.thegaitguys.com/thedailyblog/people-tend-to-forget-about-the-peroneal-muscles monthly 0.5 2014-09-23 https://www.thegaitguys.com/thedailyblog/this-is-part-2-of-a-2-part-post-with-the-video monthly 0.5 2014-09-22 https://www.thegaitguys.com/thedailyblog/wow-what-would-you-do-this-is-part-1-of-a-2 monthly 0.5 2014-09-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553534383-IM0GB67JI2UNEXA9JZID/tumblr_nc9grebaIQ1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553534611-YGF1FN045M03DCJ7N6TH/tumblr_nc9grebaIQ1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553534772-KDDYE001JT9HAMHD6M52/tumblr_nc9grebaIQ1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-76-the-fms-screen-and-injuries-impact monthly 0.5 2014-09-19 https://www.thegaitguys.com/thedailyblog/it-is-marathon-season-in-chicago-time-for-this monthly 0.5 2014-09-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553535098-9U12G3MPDR9EO9UCBH7J/tumblr_nc1x994UP81qhko2so1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553535280-ZCW9R8XTIC4R7LKDK27K/tumblr_nc1x994UP81qhko2so2_1280.png Blog https://www.thegaitguys.com/thedailyblog/remapping-the-cortex-how-rehab-exercise-does-it monthly 0.5 2014-09-18 https://www.thegaitguys.com/thedailyblog/steppage-gait-or-just-a-runway-model-take-the monthly 0.5 2014-09-17 https://www.thegaitguys.com/thedailyblog/subtle-clues-often-provide-the-answers-we-like monthly 0.5 2014-09-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553535663-ATT9PLHT1ESPOG3MXT01/tumblr_nbv71od9Y71qhko2so1_400.jpg Blog Subtle clues often provide the answers. We like yoga as much as anyone else. We saw this picture on the latest cover and couldn’t resist making a few comments on this pose. Yoga has many benefits. Our understanding is that in addition to the cognitive and spiritual effects of yoga, is that it helps to build your core.  At first look you may say that this woman has a few issues: she has a right pelvic shift and a left body lean She has slight head rotation to the right and a slight left head tilt you may have noticed that she appears to have more tone in the musculature on the right side of her face than on the left.   Just look at the nasolabial fold as well as the corner of her mouth any area of wrinkling underneath her left orbit.  You may have also noticed the subtle flexion and lack of external rotation of the right hip.  You may go on and think that she has a week right gluteus medius as well as an overactive quadratus lumborum on the left-hand side which may be causing the pelvic shift. The head tilt may be in compensation for the right side gluteus medius weakness and the subtle rotation may be an attempt to engage a tonic neck response. ( a tonic neck response is  ipsilateral extension of the upper and lower extremity to the side of head rotation with contralateral flexion of the same counterparts.  You may have also noticed that the toes of the right foot are not dorsiflexed and that her hair appears to be flowing on the right side, and this is not the case at all, but rather she is either standing on a sloped surface or on the downward phase of a jump. According to the magazine it is the latter.  If you caught this at first then congratulations: you are sharper than most. If not remember to always look for subtle clues.  Like Sir Topham Hat says in Thomas the Train: “  You didn’t get the whole story. What really happened is what really matters. So why the mild facial ptosis on the left side? She could have had an old Bells palsy, or other form of facial paresis. Note that mostly the lower portions of the (left) face are affected (ie, below the eye). We remember that the upper portions of the face receive bilateral innervation but lower portions of the face unilateral innervation, from the contra lateral facial motor nucleus; this is why it could be a mild upper motor neuron lesion (micro infact, lack of cortical afferent input) and not an lower motor neuron lesion (like Bells Palsy). Why is this germane? Or is it not? Stand in front of a mirror. Jump up in the air trying to assume the same pose as this woman does and what do you see.  Make sure that you jump up from both legs and then bring one leg over and your hands in front of you in the "praying position”. You may want to have a friend take a snapshot of you performing this. You will notice that you have contralateral head rotation,  a pelvic hike on the side opposite the leg that’s extended and a head tilt to the side that is flexed.  You are attempting to stabilize your core as you’re going up and coming down. What we are witnessing is a normal neurological phenomena.  This gal merely seems to have some limited external rotation of her left hip. Now perform the same maneuver again but this time don’t externally rotate your leg as far as this woman does and what do you see. You should’ve seen an increase in the aforementioned body postures. Subtle clues are often the key. Keep your eyes and ears open.  The Gait Guys. Helping the subtle to become everyday for you, with each and every post. https://www.thegaitguys.com/thedailyblog/podcast-75-joint-symmetry-clinical-pearls monthly 0.5 2014-09-12 https://www.thegaitguys.com/thedailyblog/how-injury-and-pain-reorganize-the-brain monthly 0.5 2014-09-10 https://www.thegaitguys.com/thedailyblog/more-on-the-little-guy-we-have-been-following monthly 0.5 2014-09-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553536124-8MRTAEGX3X71KEYPB8QE/tumblr_n9y3v5nRcH1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553536123-C6QFM4J3V47QIURO9DIB/tumblr_n9y3v5nRcH1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553537390-3KNY8126MI1RAS7C5WUD/tumblr_n9y3v5nRcH1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553538473-UK705KD7T0W4PP91C18F/tumblr_n9y3v5nRcH1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553538410-S3V7X76HQKEKC3C31HJ7/tumblr_n9y3v5nRcH1qhko2so5_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-74-cross-fit-more-on-squatting-and-hip monthly 0.5 2014-09-06 https://www.thegaitguys.com/thedailyblog/do-i-really-need-my-pinky-toe-just-the-other monthly 0.5 2014-09-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553538896-36ET1MT5Q77ZEPDOUXL2/tumblr_nbbuav1anA1qhko2so1_1280.png Blog Do I Really Need My Pinky Toe? Just the other day we saw this article in Popular Science written by Sally Zhang.  Sally obviously does not read our blog, but she got a lot of stuff right. “If you’re born without a pinky toe or have an accident and it’s removed, you can completely do everything you wanted to do,” Dr. Anne Holly Johnson, instructor in orthopaedic surgery at Harvard Medical School, says. Above you will see a photo of one of the gait guy’s feet.  It is quite clear from the photo that competent use of the pinky toe is not necessary for adequate, and possibly exceptionally skilled, foot function.  Here, check out this video of our foot in these 2 videos (here and here) for some advanced foot function (sans pinky toe). As you can see in the photo above, this 5th toe has likely never felt the ground, this is a fixed deformity.  Flexor and extensor function of the toe are intact, but it does not reach the ground and so assistance in gaining adequate purchase of the 5th metatarsal on the ground is absent.  This brings us to a deeper question, what about the 5th metatarsal then? Is it necessary ?  Our answer even without deeper research is a solid “yes”. The foot tripod is severely compromised without the 5th metatarsal. The lateral stability of the foot is impaired without the 5th MET.  The natural locking of the calcaneocuboid joint mechanism will be impaired, the peroneal muscles that provide such critical lateral ankle and foot stability will have fascial planes and tendon attachments disengaged, the natural walking gait lateral to medial foot progression would be impaired, propulsion would be impaired and the list goes on and on. And, not even on the local foot/ankle level. Because, if you take out the function and stability of the lateral foot the hip is very likely to suffer lateral (frontal plane) stability deficits. Meaning, the gluteus medius and abdominal obliques will have more difficulty guarding frontal plane drift when in stance phase rendering all of the “cross over gait” risks (link) highly probable.   So, not much exciting stuff here today. The presence of a functioning pinky toe does not appear to be critical but don’t take away its big brother neighbor, the 5th Metatarsal or trouble is just around the corner. Don’t believe us? Just ask anyone with a non-union fracture (Jones fracture) of the 5th metatarsal. The answer goes back to the evolutionary history of humans, explains Dr. Anish Kadakia, assistant professor in orthopaedic surgery at Northwestern University. "Primates use their feet to grab, claw, to climb trees, but humans, we don’t need that function anymore,“ Kadakia says. "Clearly we’re not jumping up and down trees and using our feet to grab. We have toes embryologically, evolutionary for that particular reason because we descended from apes, but we don’t need them as people.” The gait guys, working with 4 toes on each foot, one step ahead of evolution it seems. Shawn and Ivo, The gait guys reference: http://www.popsci.com/science/article/2013-05/fyi-do-i-really-need-my-pinky-toe?dom=tw&src=SOC https://www.thegaitguys.com/thedailyblog/all-that-is-twisted-is-not-tibial-last-week-we monthly 0.5 2014-09-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553539398-UXP2WO0PYFIIBKMP6PV1/tumblr_nb9a9pr6O71qhko2so1_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553539480-3FAQ9FS3BVDLQ9C8DWXL/tumblr_nb9a9pr6O71qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/is-the-normal-foot-normal monthly 0.5 2014-08-30 https://www.thegaitguys.com/thedailyblog/the-abductor-heel-twist-look-carefully-it-is monthly 0.5 2014-08-28 https://www.thegaitguys.com/thedailyblog/podcast-73-cross-fit-and-squatting-knees-out monthly 0.5 2014-08-27 https://www.thegaitguys.com/thedailyblog/how-do-you-measure-tibial-torsion-anyway-with monthly 0.5 2014-08-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553538806-LQHOIIAX6YX7HM1MKQTG/tumblr_n9y3ea9yyg1qhko2so4_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553539285-ONRWZ1SY5KTZLJCC1WHD/tumblr_n9y3ea9yyg1qhko2so3_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553539892-5YJ6SC2TOFGGB2X6DF3K/tumblr_n9y3ea9yyg1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553540530-3MIOUGCYWQAGRZS7CG6B/tumblr_n9y3ea9yyg1qhko2so1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-72-neuroplasticity-eva-shoe-foam-and monthly 0.5 2014-08-22 https://www.thegaitguys.com/thedailyblog/proprioceptive-afferent-inputs-can-control-the monthly 0.5 2014-08-20 https://www.thegaitguys.com/thedailyblog/proprioception-trumps-biomechanics-as-i-sit-here monthly 0.5 2014-08-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553541335-5GGJ4MIXCZ7A5M7SUL5K/tumblr_nahfwdDSeS1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553542172-QNDNRDH5T7L8K57ISELI/tumblr_nahfwdDSeS1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/did-you-see-this-in-our-recent-blog-post-here-a monthly 0.5 2014-08-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553542698-DADILYYAWU93RUC7IXJX/tumblr_n9t3r07m8O1qhko2so5_r1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553542804-F2A3ZTREJ0YNJYRRR5YP/tumblr_n9t3r07m8O1qhko2so1_500.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553542797-50NPPOCAMVXQROAJPML3/tumblr_n9t3r07m8O1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553542632-3NZPTJSFHV8GRUVJ7YNS/tumblr_n9t3r07m8O1qhko2so3_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553543072-ZCNX5HZLF4LBDSA3EA3F/tumblr_n9t3r07m8O1qhko2so4_250.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-71-forefoot-varus-big-toe-problems monthly 0.5 2014-08-13 https://www.thegaitguys.com/thedailyblog/subtle-clues-helping-someone-around-their monthly 0.5 2014-08-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553543429-29CB5OCR4BQZEK73I3OS/tumblr_n9jt5dtWlc1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553544156-NS8LG47B5O6UZ8YXP1NG/tumblr_n9jt5dtWlc1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553545007-B2M29JA1ST2IYM2IVHRG/tumblr_n9jt5dtWlc1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553545984-K0Y8W98DTHY75O5HV777/tumblr_n9jt5dtWlc1qhko2so4_r1_1280.gif Blog https://www.thegaitguys.com/thedailyblog/here-is-a-great-case-from-a-reader-hey-guys monthly 0.5 2014-08-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553545677-ROANRPFTHQAD8465K6B4/tumblr_n46fk0Yklo1qhko2so1_1280.jpg Blog Here is a great case from a reader. “Hey guys, I absolutely love the show, especially as it becomes less and less over my head. Due to your love of gait-altering absurdly thick EVA midsoles, I thought you might like to check out this Hoka incident that occurred at the Marathon des Sable across the Sahara in Morocco, a 6 day 251km event. It was posted by Ian Corless at Talk Ultra Podcast. Apparently the medial side of the midsole collapsed–on DAY 2! This guy finished the race, and as you have to carry 100% of your gear and nutrition, I guess he only had the one pair. It looks like this runner should fly out to CO or IL asap, because if he didn’t have gait issues before, he is sure to have them now.” This brings up some scary thoughts when it comes to the amount of EVA foam and quality of foam (EVA or otherwise) being used in some shoes.  "The more foam there exists, the greater one can break down into their compensation or deforming strategy.“ What do we mean by this ?  Well, two things should be on one’s mind:  1. all foam breaks down into the vector of the deforming forces and 2. most of us do not have perfectly clean biomechanics, thus an abnormal loading vector is most likely present. These aberrant biomechanics are eventually reflected into our shoes as a "wear pattern”.  In this case, the EVA foam had progressively broken down into their rearfoot pronation (and likely mid and forefoot pronation). In this case, even if the person had enough tibialis posterior and other medial pronation-decelerating structure strength at the start, the acceleration of their foot into this issue is now even more abrupt, brisk, excessive etc.  A new pair of shoes would not be broken down into this deformity and so a newer pair of shoes is preventive. This is why we recommend new shoes often, and the cycling in of another pair (or several pair) into the mix so that one is never driving the same shoes into the potentially destructive compensation patterns that most of us  have.  At least with a fresh pair of shoes brought into the mix at the 200 mile wear point, you would only be in the more destructive shoes every other run, giving the body time to recuperate more.  As for this pair of shoes, this runner either has a terrible right foot problem or this was a brutally flawed right shoe from the get go, or both. We can only imaging how painful the medial knee might be at this point.  Furthermore, imagine the abrupt nature of the hip internal rotation mechanics ! IF they do not have hip labrum impingement yet, they will soon !  And with that amount of internal limb spin, can you imagine how inhibited the glutes would be from constantly having to eccentrically control that excessive rotation?  As a whole, are not huge fans of the HOKA shoe family, we just cannot fathom the need for this much foam under the feet. If you have been with us long enough you will have heard on our podcast and blog talk about increased impact forces with increasing EVA foam thickness (want that info, here is the link and references). Just because some EVA foam is good, doesn’t mean more is better.  Remember, to propulse off of a foam infrastructure you must bottom out/compress the foam sufficiently to find a firmness to propulse from. The Hoka’s have plenty of foam making this our concern, and we are not picking on just them. There are other companies doing this “super sizing/super stacking” such as Brooks, Altra, and New Balance to name just a few.  Sure they have added a greater forefoot rocker/toe spring on the front of the shoe to help (they have to because the foam thickness is so great that there is no flexing of the forefoot of the shoes), but is it enough for you? Remember, every biomechanical phase of the gait cycle is necessary and timely to engage the natural joint, ligament, muscle components of joint loading, mobility, stability and movement. If you spend too much time in one phase (perhaps because you are waiting for foam to decompress) you may wait a moment too long and miss the opportunity for another critical phase to begin in the sequence.  This is the root cause of many injuries, aberrant biomechanics leading to aberrant mobility or stability.  So remember these few things: 1. more is not always better for you, it may be for some, but maybe not you. 2. there is a price to pay somewhere in the mechanical system, after all the body is a contained system. What doesn’t happen at one joint often has to be made up at the next proximal or distal joint. 3. Everyone has some aberrant mechanics. No one is perfect. These imperfections will reflect in your shoes, and the longer you are in a pair of shoes the deeper the aberrant mechanics will be reflected in your shoe, thus acting as a steering wheel for the aberrant pattern (the steering is more direct/ more aggressive than in a new pair of shoes). So keep at least 2 pair of shoes rotating in your run cycle, one newer and one half done. We even recommend 3 pairs often.  Trust us, the sudden biomechanical shift from a dead shoe into a new one (even though it is a clean new shoe without bad patterns in it) is still a biomechanical shift and could cause adaptive phase problems, pain or injury. Lots to consider in this game. It is not just about dropping into barefoot and taking off down your street. Not if you want to be doing this for a long time and stay healthy. Shawn and Ivo, the gait guys * next day follow up from our social media pages: Along the lines of EVA and yesterdays post:  “Wear of the EVA consistently increased heel pad stresses, and reduced EVA thickness was the most influential factor, e.g., for a 50% reduction in thickness, peak heel pad stress increased by 19%. ” This study looks at a model; it would be interesting to see this study with a large cohort. Biomed Mater Eng. 2006;16(5):289-99. Role of EVA viscoelastic properties in the protective performance of a sport shoe: computational studies. Even-Tzur N1, Weisz E, Hirsch-Falk Y, Gefen A. http://www.ncbi.nlm.nih.gov/pubmed/17075164 https://www.thegaitguys.com/thedailyblog/ett-and-hip-extension-not-extra-terrestrial monthly 0.5 2014-08-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553546411-KRHHXL9DWNAWFGAOCP4H/tumblr_n9ql3rlqGi1qhko2so2_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553547025-D8FHLIHQ8UAXRJYJVRGH/tumblr_n9ql3rlqGi1qhko2so1_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553547104-A5ERY7VAEIGWZX9TMX2K/tumblr_n9ql3rlqGi1qhko2so3_r1_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553547149-OPDKZQ8NIZ40AO4TOOWS/tumblr_n9ql3rlqGi1qhko2so4_r1_1280.gif Blog https://www.thegaitguys.com/thedailyblog/podcast-70-achilles-solutions-and-foot-cases monthly 0.5 2014-08-03 https://www.thegaitguys.com/thedailyblog/foot-progression-angle-exaggeration-external monthly 0.5 2014-07-30 https://www.thegaitguys.com/thedailyblog/the-calcaneo-cuboid-locking-mechanism-do-you-know monthly 0.5 2014-07-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553547442-J6K62QEPTRBKV6YO9C4W/tumblr_n92uvpRnzv1qhko2so1_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553547910-2LQAN4513VG2GXOICV2M/tumblr_n92uvpRnzv1qhko2so2_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553548125-YI81TXL8345UW0YAXH9B/tumblr_n92uvpRnzv1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553548945-00ZIJZH9A54CVUJCNKYL/tumblr_n92uvpRnzv1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-69-advanced-arm-swing-concepts monthly 0.5 2014-07-24 https://www.thegaitguys.com/thedailyblog/so-you-want-to-do-a-gait-analysis-part-4-this-is monthly 0.5 2014-07-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553550575-TBU5O87W0W93MHZD44LY/tumblr_n92mssK8su1qhko2so2_r1_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553550193-FU26XRNEANLLYA1DHRDH/tumblr_n92mssK8su1qhko2so3_r1_1280.gif Blog https://www.thegaitguys.com/thedailyblog/subtle-clues-to-ankle-rocker-pathology-how-good monthly 0.5 2014-07-21 https://www.thegaitguys.com/thedailyblog/spine-pain-and-arm-swing-do-you-truly-get-this monthly 0.5 2014-07-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553550263-ZP8VXNYKO27NY5C4CO1E/tumblr_n4uooo1jnw1qhko2so1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553550589-ZG111LZ9I298BT1FMIIN/tumblr_n4uooo1jnw1qhko2so2_r1_1280.png Blog https://www.thegaitguys.com/thedailyblog/you-can-only-borrow-so-much-before-you-need-to monthly 0.5 2014-07-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553550484-PKUZOYOI48UASM449H9A/tumblr_n7yjctusWm1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553551283-VJTXWP17DTPZDRN1WF1N/tumblr_n7yjctusWm1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553551335-SA614KJQBYJ2HL30LNUM/tumblr_n7yjctusWm1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553552564-PONBSQAMRRU08Z1XC7ZH/tumblr_n7yjctusWm1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553551728-FXNCTBB22ZE0287CEYKS/tumblr_n7yjctusWm1qhko2so7_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553553086-4ATVAIJA9UW1N49YTBGT/tumblr_n7yjctusWm1qhko2so9_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-68-gait-arm-swing-neuro-developmental monthly 0.5 2014-07-10 https://www.thegaitguys.com/thedailyblog/arm-swing-truths-and-lies-we-have-been-reminded monthly 0.5 2014-07-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553553615-KZYJ86GFBYUIDUKWXKSN/tumblr_n4uopmu8r21qhko2so1_1280.png Blog Arm Swing Truths, and Lies. We have been reminded over and over again in recent weeks how intimately arm swing is tied to leg swing. We have recently had clients in our practices with strokes (ischemic and hemorrhagic), transverse myelitis, inflammatory neurologic disorder and the plethora of biomechanically pain-mediated gait responses affecting the limbs, including the upper limbs which manifest many variations in these people’s normal gait neuro-mechanics. We are even reminded of the recent triathlete who had a right hip weakness that was allowing him to drift into the right frontal plane in running and biking. Upon asking about further symptoms he mentioned left hand tingling on longer bike training rides.  We asked if he recalled sliding/shifting onto the right side of the saddle/seat often to find power in the right leg and he mentioned matter of fact that it is a constant awareness. We then suggested that he was having to over pressure into the left handle grips to keep the bike on a straight line because of the right pelvis-saddle shift. He was wide eyed and shocked that it was what he was in fact aware of.  Moral of the story: even in on the bike opposite arm and leg action are intimately tied together.  After testing and assessment it was clear that a function TOS (thoracic outlet syndrome) was in effect because of shortness and increased tone in the left pectoral chest wall compromising neurovascular bundle compression and generating hand paresthesias (numbness/tingling).  A simple fix if you fix the right pelvic frontal plane drift.  If you try to fix the TOS at the shoulder-neck level resistance to progress is likely. Arm swing is a sneaky thing. There are many variables. We have discussed many of these arm swing variables in 38 previous blog posts (link here) and we have whole lecture here on arm swing (this slide is part of that in depth lecture). In the pubmed article below there is new research delving into passive and active components of arm swing. There are both, clearly. But what a reader needs to take away is that a clinical examination must be part of every assessment to discover the active components (muscular and neuromuscular) that are missing (ie. weak posterior deltoid, lat dorsi etc) and which need fixing and rehabilitation and the passive components that are inhibitory to the big picture (mobility, stability). It should be clear by now, if you have been with us for at least the last year, that what you see in someone’s gait is their compensation, not their problem. Addressing resolution measures to change what you see is a path to deepening the compensation or developing others.  Arm swing is intimately tied to the lower limbs, and powerfully so to the opposite leg. A deficit in the leg will be expressed in some way in the opposite upper limb, which in turn forces a compensatory change in the opposite upper limb and thus down into the “other” opposite lower limb.  One thing affects many. The wrong intervention drives bigger problems, so make sure you know your gait “normal” parameters and be sure a clinical examination is a huge part of your discovery toward the answers for your client. Shawn and Ivo … . .  the gait guys Pubmed abstract link: http://www.ncbi.nlm.nih.gov/pubmed/24865637 Gait Posture. 2014 Jun;40(2):321-6. Epub 2014 May 6. Arm swing in human walking: What is their drive? Goudriaan M, Jonkers I, van Dieen JH, Bruijn SM Abstract The results confirm that passive dynamics are partly responsible for arm swing during walking. However, without muscle activity, passive swing amplitude and relative phase decrease significantly (both p<0.05), the latter inducing a more in-phase swing pattern of the arms. Therefore, we conclude that muscle activity is needed to increase arm swing amplitude and modify relative phase during human walking to obtain an out-phase movement relative to the legs. https://www.thegaitguys.com/thedailyblog/flat-dogs-take-a-look-at-these-pedographs-wow monthly 0.5 2014-07-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553553955-OMKTE1UKDQESZ0X3RIB7/tumblr_n7yjg9vOg61qhko2so1_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553554596-4DKOAWMDC1FLF4UMMRAS/tumblr_n7yjg9vOg61qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553554784-9SI410D1BC94UL0FB85J/tumblr_n7yjg9vOg61qhko2so3_r1_500.gif Blog https://www.thegaitguys.com/thedailyblog/the-weeping-calf-and-the-deconstructed-arm-swing monthly 0.5 2014-07-02 https://www.thegaitguys.com/thedailyblog/90561016949 monthly 0.5 2014-07-02 https://www.thegaitguys.com/thedailyblog/so-a-patient-presents-to-your-office-with-a-recent monthly 0.5 2014-06-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553554989-G0FT57N6KPELTVNCH4JU/tumblr_n7yjq09EgU1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553554949-1DQO24D1XHR0IC8KE3HQ/tumblr_n7yjq09EgU1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553555527-CGYF2CGR6KLVNS5RFNYX/tumblr_n7yjq09EgU1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553555451-7Y604YWLMFUQ95QKNGX5/tumblr_n7yjq09EgU1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553556757-6K6Z4TGWU8PVLFRGVKA1/tumblr_n7yjq09EgU1qhko2so5_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553557533-6PDOBB0A7N2PIZCZ7TBI/tumblr_n7yjq09EgU1qhko2so7_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553557903-HBXFAZJP6ZVMWWL8EBF8/tumblr_n7yjq09EgU1qhko2so9_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553557834-HA2TALSGV14FZ4S54B2U/tumblr_n7yjq09EgU1qhko2so6_r1_500.jpg Blog https://www.thegaitguys.com/thedailyblog/finishing-up-the-week-on-kids-and-gait-here-is-a monthly 0.5 2014-06-27 https://www.thegaitguys.com/thedailyblog/podcast-67-biotech-of-runnings-future monthly 0.5 2014-06-26 https://www.thegaitguys.com/thedailyblog/a-serious-gait-problem-pancompartmental monthly 0.5 2014-06-25 https://www.thegaitguys.com/thedailyblog/another-ifgec-certified-doc-here-is-what-dr-brad monthly 0.5 2014-06-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553558368-MVBD2VZL2Z8S5ZP6GH7Z/tumblr_n7p2wjfwm31qhko2so1_1280.jpg Blog Another IFGEC Certified Doc! Here is what Dr Brad Hochstein has to say about the National Shoe Fit Certification Program. “Taking the National Shoe Fit Certification course has introduced me to many things that I didn’t take into consideration when working with my patients. The depth of information introduced is very helpful and presented more clearly than other courses I have taken in the past. I have studied a lot of the concepts that are introduced through the program in the past but struggled to put everything together. This certification did just that for me. It has helped me to link things together and look “outside the box” more than I had in the past. I am a chiropractor with an extensive functional/biomechanics background and this has added another level of depth to my practice assessment and treatment. I am excited to incorporate the knowledge I have gained through this certification into my practice to give my patients an even better experience!” Is it time to up your knowledge base and separate yourself from other clinicians, coaches, trainers, therapists and retailers? Want to know more? Email us at : thegaitguys@gmail.com https://www.thegaitguys.com/thedailyblog/can-you-see-it-here-we-are-again-we-have-looked monthly 0.5 2014-06-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553558944-FWCC5F73VUQ801DX1E88/tumblr_n2n3x32CQM1qhko2so1_250.jpg Blog Can you see it? Here we are again. We have looked at this picture before; once about head tilt, and another about flip flops and form. Take a good look at this picture and what is different about the child in blue all the way to the right and all the others with the exception of the boy in pink, that we really cannot see? Can you see it? No, we don’t mean the flip flops (but if you caught that all the boys were in sneakers and all the girls are in flip flops, you are good!) How about looking at arm swing? Remember this post on arm swing and crossover gait, with the simple cue for correction? All of the children EXCEPT the boy in blue, are drawing their arms ACROSS their body (ie: flexion, internal rotation and adduction). Take a look at their legs. Yep, crossover gait (flexion, internal rotation and adduction). Little boy blues arms are going relatively straight and going in the saggital plane, where the others are going in the coronal plane. We are not saying that blue does not have some gait challenges, like his torso shift to the left (or pelvic drift to the right), most likely do to gluteus medius weakness or inappropriate firing of the gluteus medius on the left stance phase leg; or his head tilt to the right, which most likely represents a compensation for the right pelvic drift and left body lean. Arm swing. A very important clue to the puzzle we call gait and compensation. It is more prevalent than you think, and, in some cases, easily corrected with a simple cue. The Gait Guys. Making it real and pertinent, in each and every post. https://www.thegaitguys.com/thedailyblog/podcast-66-stem-cells-running-form-dartfish monthly 0.5 2014-06-19 https://www.thegaitguys.com/thedailyblog/correcting-a-cross-over-gait-with-arm-swing-is-it monthly 0.5 2014-06-17 https://www.thegaitguys.com/thedailyblog/the-5-point-turn-in-a-human-do-you-know-this monthly 0.5 2014-06-16 https://www.thegaitguys.com/thedailyblog/spanking-the-orthotic-the-effects-of-hallux monthly 0.5 2014-06-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553558922-IA4M9GYGN262NQMQAEGB/tumblr_n6o2eycOuV1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553559297-PSQWWSOYZAYY382EMITC/tumblr_n6o2eycOuV1qhko2so5_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553559456-F2RZHMBKSD354M33A1XM/tumblr_n6o2eycOuV1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553559851-JWWS2ITPQA3LJ2FAKP31/tumblr_n6o2eycOuV1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553560811-Q0D2WBUZPB4J6MFIIALA/tumblr_n6o2eycOuV1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/whats-up-doc-nothing-like-a-little-monday monthly 0.5 2014-06-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553561258-UB8I531LY4VVSNU35WLC/tumblr_n5yh7cD8kP1qhko2so1_1280.jpg Blog What’s up, Doc? Nothing like a little Monday morning brain stretching and a little Pedograph action. This person had 2nd metatarsal head pain on the left. Can you figure out why? Let’s start at the rear foot: limited calcaneal eversion (pronation) L > R. The teardrop shape is more rounded on the left. This indicates some rigidity here. note the increased pressure at the  medial calcaneal facets on each side with the increased printing very little fat pad displacement overall Now let’s look at the mid foot: decreased mid foot pronation on the L. See how thin the line is going from the rear foot to the forefoot along the lateral column? This indicates a high lateral longitudinal arch Now how about the fore foot? increased printing under the met heads bilaterally; L >> R increased printing of 1st met head L >> R increased printing at medial proximal phalynx of hallux  L >> R increased printing of distal phalanges of all toes L >> R  Figure it out? What would cause increased supination on the L? short leg on L more rigid foot on L increased pronation on the R Did you notice the elongated 2nd metatarsals (ie: Morton’s toe) on each foot? Here is what is going on: there is no appreciable leg length deformity, functional or anatomical The Left foot is more rigid than the Right, thus less rear, mid and fore foot pronation, thus it is in relative supination compared to the right foot do this: stand and make your L foot more rigid than the right; take a step forward with your right foot, what do you notice? Can you feel how when your foot is supinated can you see how difficult it is to have ankle rocker at this point? remember: supination is plantar flexion, inversion and adduction Can you feel the weight of the body shift to the outside of the foot and your toes curl to make the foot more stable, so you do not tip to the left? now, how are you going to get your center of mass forward from here? You need to press off from your big toe (hallux) Wow, does that make sense now? What’s the fix? create a more supple foot with manipulation, massage, muscle work increase ankle rocker by training the anterior compartment (shuffle walks, lift/spread/reach exercise, heel walking, Texas walk exercise, etc) have them walk with their toes slightly elevated we are sure you can think of more ways as well! The Gait Guys. Increasing your gait literacy with each and every post. If you liked this post, tell others and spread the word. If you didn’t like this post, tell us! We value your constructive feedback. https://www.thegaitguys.com/thedailyblog/welcome-to-rewind-friday-folks-we-always-seem-to monthly 0.5 2014-06-06 https://www.thegaitguys.com/thedailyblog/running-ugly-sometimes-wins-marathons-there-are monthly 0.5 2014-06-04 https://www.thegaitguys.com/thedailyblog/more-power-leaks-part-3-good-morning-peoples-a monthly 0.5 2014-06-02 https://www.thegaitguys.com/thedailyblog/podcast-64-baby-walker-risks-achilles-asymmetry monthly 0.5 2014-05-29 https://www.thegaitguys.com/thedailyblog/some-times-there-is-not-an-easy-answer-a-patient monthly 0.5 2014-05-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553561805-1OAXKCESW2QBOB9G67X1/tumblr_n5swv8KbAz1qhko2so1_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553562056-LV5H3GDLK78SNWJDISV7/tumblr_n5swv8KbAz1qhko2so2_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/the-naked-foot-the-soft-neurology-behind monthly 0.5 2014-05-23 https://www.thegaitguys.com/thedailyblog/oh-it-is-just-a-simple-ankle-sprain-it-will-heal monthly 0.5 2014-05-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553561802-TGFKDPVG5F52SD6U67TV/tumblr_n04k3m4RxJ1qhko2so1_250.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553562411-UN2RG3WV0H6KSHTKG8O1/tumblr_n04k3m4RxJ1qhko2so5_r1_250.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553562375-ZGBJHTDNKDNNIQ5G81DN/tumblr_n04k3m4RxJ1qhko2so4_400.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553563122-7AWSENQYBBG6S51XKK42/tumblr_n04k3m4RxJ1qhko2so2_500.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553563419-4GRE8DZGUC7WHXMJSMTN/tumblr_n04k3m4RxJ1qhko2so3_400.png Blog https://www.thegaitguys.com/thedailyblog/saucony-line-running-and-crossing-over-we-are monthly 0.5 2014-05-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553564171-ITB10X55ESGRPOXTELLX/tumblr_n5xkahJmCL1qhko2so1_1280.png Blog Saucony: Line Running and Crossing Over We are big fans of the Saucony line of shoes. We have recommended them to our novice and serious runners for decades now. Currently one of our favorite shoes for our runners is the Saucony Mirage, a beautiful 4mm ramp shoe with no bells and whistles.  It is as close to a perfect zero drop that  you will find without going zero, in our opinion.  That is not to say there are not other great 4mm shoes out there, the Brooks Cadence and the New balance minimus are other beautiful 4mm’s out there.  The Mirage has never failed a single client of ours.   This was a photo we screen captured from the Saucony Facebook page (we hope that for the sake of educating all runners and athletes that we can borrow this picture for this blog post, please contact us if you would like us to remove it). It is a good page, you should follow it as well.  This picture shows not only a nice shoe but something that we have been talking about forever.  The cross over; this runner is running in such a line that it could be argued that the feet are crossing the mid line. In this case, is the line queuing the runner to strike the line ? Careful of subconscious queues when you run, lines are like targets for the eyes and brain.  One thing we like to do with our runners is to use the line as training however, a form of behavioral modification.  When you do a track workout, use the line underneath you, but keep the feet on either side of the line so that you learn to create that little bit of limb /hip abduction that helps to facilitate the hip abductor muscles.  This will do several things, (and you can do a search here on our blog for all these things), it will reduce the reflexive tightening of the ITBand (pay attention all you chronic IT band foam rolling addicts !), it will facilitate less frontal plane pelvis sway, optimal stacking of the lower limb joints, cleaner patellofemoral tracking and help to reduce excessive pronation /internal limb spin effects.   There is really nothing negative about correcting your cross over, IF it truly needs correcting.  That is the key question.  Some people may have anatomic reasons as to why the cross over is their norm, but you have to know  your anatomy, biomechanics and neuromechanics and bring them together into a competent clinical examination to know when the correction will lead to optimal gait and when it will drive suboptimal gait. Just because you see it and think it is bad, does not make it so.   New to this cross over stuff ? Head over to the search box here on our blog and type in “cross over” or “cross over gait” and you will find dozens of articles and some great videos we have done to help you better grasp it.  * you will also note that this runner is in an excessive lateral forefoot strike posturing.  This means that excessive and abrupt prontation will have to follow through the mid-forefoot in order to get the medial foot tripod down and engaged.  The question is however, is what you are seeing a product of the steep limb angle from the cross over, or does this runner have a forefoot varus (functional or anatomic, rigid or flexible)?  Are the peronei muscles weak, making pre-contact foot/ankle eversion less than optimal ? This is an important point, and your clinical examination will define that right away … . . if you know what these things are.  And if you don’t ? Well, you have found the right blog, one with a SEARCH box. Type in “forefoot varus”, if you want to open up the rabbit hole and climb down it … . . we dare ya ! :-) https://www.thegaitguys.com/thedailyblog/the-case-of-the-focal-alopecia-the-what-a-focal monthly 0.5 2014-05-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553564984-9UXJ7SUBU1M12YYPFNCY/tumblr_n5syo4fmqh1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553565186-XCT7RNAU0FD5EGU435ID/tumblr_n5syo4fmqh1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553565295-YASYWHHNWY0KNONNSL1Z/tumblr_n5syo4fmqh1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553566154-LVW74THQGGK7OEHM7FQ3/tumblr_n5syo4fmqh1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553566044-NACTRL4A2GYA2FXI8E38/tumblr_n5syo4fmqh1qhko2so5_1280.png Blog https://www.thegaitguys.com/thedailyblog/today-on-rewind-friday-we-salute-the-glutes-this monthly 0.5 2014-05-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553566196-C3AZ899TWRDK9MYSZ6RS/tumblr_n5op2wfMWj1qhko2so1_500.gif Blog Today on rewind Friday, we salute the glutes! This is in conjunction with this weeks POD topics : ) The gluteus maximus controls: Flexion / Extension: The Sagittal Plane - the rate and extent of limb flexion at term swing: this is eccentrically controlled - hip extension: this is concentrically controlled - hip flexion rate during loading response (eccentric at foot loading): this will help to control the vertical loading response as the body mass loads the limb there must be enough eccentric strength of the glute maximus to control-stop this loading so that hip extension can occur. This will indirectly assist in control some of knee flexion. Rotation: - external rotation of the limb: this is concentrically controlled - assists in controlling the rate of internal rotation: this is eccentrically controlled Pelvic Posturing: - controls rate of Anterior Pelvic Tilt (APT): this is eccentrically controlled (this is relative hip extension as discussed in Part 1 last week) - assists in Posterior Pelvic Tilt (PPT): this is concentrically driven - controls sacroiliac joint mobility through FORCE CLOSURE (force closure is a compression of the joint surfaces by the contraction of muscles that cross the joint) Divisions: - the sacral division of the gluteus maximus is mostly a pure sagittal plane driver at the hip joint - the coccygeal division is more of an adductor and internal rotator at the hip joint - the iliac division is more of an abductor and external rotator at the hip joint The gluteus maximus also has some fascial attachments into the posterior aspect of the TFL-ITBand. Remember, this TFL-ITB complex is an internal rotator of the limb in the gait cycle. You will recall that internal rotation is a precursor to hip extension. The hip must first, and adequately, internally rotate in the gait cycle before hip extension can occur. This means that for correct and complete gluteus maximus contraction to occur in the second half of the stance phase we must have adequate internal hip rotation. Without it, all of the things we talked about last week in our glut maximus blog post cannot occur properly. Now, back to our attachment disucssion of the gluteus maximus to the ITB-TFL mechanism. This attachment allows the gluteus maximus to produce posterior tension on the ITB-TFL mechanism so that it can be anchored to provide it’s internal rotation function on the limb. So, here we have a powerful hip extensor and external rotator providing assisted effects on an internal rotator of the limb. Isn’t the body a beautiful and amazing thing ! (Well it is. But if you will recall from the detailed layout above that the gluteus maximus in the eccentric phase of contraction functions to control the rate of internal hip rotation you will not be surprised or enlightened. Rather you will enjoy the brilliance of how an anchoring muscle is eccentrically giving up length while an agonist muscle is concentrically taking up length). The gluteus maximus-TFL relationship….. it is beautiful teamwork in helping, not exclusively of course, control limb rotation during loading responses. Next time you see a client’s knee drift too far inwards during a lunge, or walking or running we hope this whole discussion will spring a light bulb moment for you. You must look at the complex function above in controlling the limb during pronation and supination. Merely inserting an orthotic is not going to fix a proximal deficiency, it could modulate it however. But wouldn’t you want to fix it ? Who wants an orthotic if you don’t need one  ? Some people do, don’t get us wrong, but many do not. And then some just need them temporarily to gain the awareness and skill of posturing and function and once that is achieved the device and be weaned. Just some more functional anatomy talk on a Friday afternoon…….from us, The Gait Guys https://www.thegaitguys.com/thedailyblog/podcast-62-foot-strengthening-and-lumbarglute monthly 0.5 2014-05-15 https://www.thegaitguys.com/thedailyblog/unilateral-heightened-toe-extensor-tone-what-do monthly 0.5 2014-05-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553566252-WGLL20VI3HDE7PQDOOLL/tumblr_n4uoniCQds1qhko2so1_1280.png Blog Unilateral heightened toe extensor tone. What do we have here ? Well, it is obvious. The left foot is showing increased short extensor tone (EDB: extensor digitorum brevis) and heightened long flexor tone (FDL: flexor digitorum longus). This is the classic pairing for hammer toe development.  We also know from this post (link) and from this post (link) that this presentation is closely related with lumbrical weakness and distal fat pad migration. So, at an assessment took we like to play games. Mental games to be precise. When we see something like this we immediately begin the mental gyrations of “what could have caused this, and what could this in turn be causing”. Remember, what you see is often not the problem, rather your clients compensation around the problem.  In this case, what goes through your mind ?  Without deep thought, our knee jerk thoughts are: possible loss of ankle rocker dorsiflexion (the increased EDB tone can be recruited to help drive more ankle dorsiflexion indirectly) plantar intrinsic weakness ? flip flops or slip on shoes where the heel is riding up and down inside the shoe/sloppy fit ?  (initiating a gripping response from the FDL) weak tib anterior (recruiting EDB to help) weak peroneus tertius (recruiting EDB again) Ankle /foot instability (more FDL gripping will help gain ground purchase) lateral ankle instablity (same thing, more gripping) Weak gastrosoleus (since the FDL is a posterior compartment neighbor it can kick into high gear and help with posterior comparment function, we have a whole video case based around this issue, check this out ! ) premature departure off of the good side leg, and thus an abrupt loading response onto this affected side can challenge the frontal plane of the body and thus require more grip response at the foot level. how about simple weakness of the lumbricals or FDB , the short flexors. The long flexors will have to make up for it and present like this.   the list goes on and on … . These are just some quick cursory thoughts, and by NO means a complete exhaustive list.  Just some quick thoughts. But what about hip function ?  if ankle rocker is blocked in terminal stance and the FDL fire like this what will that do to hip extension ? Well, heel rise will be premature because of the limitation and thus hip extension will be abbreviated. Thus glute function will be impaired to a degree.  This can become a viscous cycle, each feeding off of each other. This diagnostic stuff is a tricky and difficult game. If you think you can diagnose or fix a problem from just changing what you see you are mistaken, unless you like driving compensation patterns and future injuries into your clients.   There must be a hands on examination and assessment with an intact educated brain attached to the process. Just some mental gymnastics for you today.   Shawn and Ivo the gait guys https://www.thegaitguys.com/thedailyblog/how-much-does-your-hallux-extend-last-week-on monthly 0.5 2014-05-12 https://www.thegaitguys.com/thedailyblog/a-year-ago-we-produced-this-short-video-link-on monthly 0.5 2014-05-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553566861-EDD2C7K7FQSFRSZQOBAR/tumblr_n58e667gzf1qhko2so1_250.jpg Blog A year ago we produced this short video (link) on how to bring back the EHB (extensor hallucis Brevis muscle). Well, it continues to do its magic on a regular basis. Here is a patient’s foot with clear demonstration of unassisted success of isolated engagement of the EHB while simultaneous release of the EHL (ext. Hallucis long us) while engaging the FHL (flexor hallucis long us).  This patient could not isolate any of the long or short hallux muscles on his own. “I can’t find it, my brain doesn’t know what it is supposed to do or how to do it ! (paraphrased)  But after just 24 hours consisting of a few sessions of the exercise here is the result in the photo above.  Success !  And here were his comments:  Doc, you were right - the brain is an amazingly plastic thing! I’ll keep working on it, but happy to see such quick progress! The client’s problem was some medial mid-rear foot pain from the resultant excessive increased pronation because of a forefoot varus.  Well, it is a bit more complicated than that to be precise. There was some true clinical ankle and rearfoot instability because of a lifetime of ankle sprains as well as some highly suspect lower syndesmosis hypermobility from probable distal anterior tib-femoral ligamentous attenuation/tears but the main point is that these were clinically manifesting themselves because of the apparent forefoot varus and the resultant pronatory foot mechanics to get the 1st metatarsal head (medial tripod) to the ground; a typical phenomenon .  Here is the kicker, he did  not have a fixed forefoot varus, it was a mirage, it was functional. What he had was an inability to descend the first metatarsal (plantarflex the Metatarsal) / medial tripod of the foot.  He could not do this because he could not separate ankle dorsiflexion and hallux dorsiflexion.  There was essentially no hallux dorsiflexion at all because he could not descend the 1st MET (head).  So, we knew it was time to break out the nuclear EBH exercise in the video above !  Big problems require big guns ! The rest is history. We fully expect to see a virtual disappearance of the “so called” forefoot varus (because it was never present in the first place).  “If you have never seen the beast, you will not recognize it when you see it.”-unknown https://www.thegaitguys.com/thedailyblog/podcast-61-sweating-ankle-rocker-and-free monthly 0.5 2014-05-07 https://www.thegaitguys.com/thedailyblog/in-todays-post-join-dr-ivo-as-he-talks-about monthly 0.5 2014-05-06 https://www.thegaitguys.com/thedailyblog/the-cheetah-man-part-2-bird-dog-again-in monthly 0.5 2014-05-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553567076-T0MV97B8NK7U24G55HR3/tumblr_n4vfolBwtj1qhko2so2_250.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553568119-ZDLGY75JZ4FG2UDKPRLJ/tumblr_n4vfolBwtj1qhko2so1_400.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553568638-EGWGNKO47DERYKY12MIK/tumblr_n4vfolBwtj1qhko2so3_r1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553569118-QWD0EPJ9PKX4UHKJROWM/tumblr_n4vfolBwtj1qhko2so4_r1_1280.png Blog https://www.thegaitguys.com/thedailyblog/this-is-a-slide-from-a-recent-teleseminar-we monthly 0.5 2014-05-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553569357-DN8ONQVF2LIO3VF12R76/tumblr_n4uorsOybN1qhko2so1_1280.png Blog This is a slide from a recent teleseminar we delivered on www.onlineCE.com.  You can take any of our dozens of courses/lectures there for a nominal fee.   This was an interesting study.  Here the authors seemed to discover that habitually driven sensory-motor patterns (as compared to optimally controlled patterns) are quite resistant to changes in biomechanics. In the study, when the tested model was compromised, the subject merely increased the recruitment of all of the surrounding muscles to stabilize and direct movement. Basically, there was no great and calculated logical strategy, it was an all out, habitually automated response … . a “just get the job done right now kind of response”.  Perhaps a “living in the moment” response?   We have often said that the paramount task via the central nervous system is an orchestration at the the joint, it must be stabilized and movement controlled at the moment of the joint challenge. But, the problem lies in that the consequences of a suboptimal strategy cannot be determined in the moment, they come in time. And this is likely what builds these aberrant compensation patterns, they happen slowly, subtly over time little by little.  Just as in life, the cost of our decisions are not often immediately realized. Shawn and Ivo The gait guys https://www.thegaitguys.com/thedailyblog/the-cheetah-man-a-new-perspective-on-cross-crawl monthly 0.5 2014-04-30 https://www.thegaitguys.com/thedailyblog/the-case-of-the-missing-toes-ok-a-bit-dramatic monthly 0.5 2014-04-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553569915-9QZYW79PTOTCD4X2OZV4/tumblr_n4swdbdmHS1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553570276-ZD3CC21OMJ8VRCZ71JGB/tumblr_n4swdbdmHS1qhko2so1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/this-simple-screening-test-becomes-a-form-of monthly 0.5 2014-04-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553569985-7MN80ED2RPWVU6JZ3FQV/tumblr_n4p3qkoqT81qhko2so1_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553570087-OOQ906E83MAGXCTQJQEW/tumblr_n4p3qkoqT81qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/rewind-double-feature-part-2-for-part-1-click monthly 0.5 2014-04-25 https://www.thegaitguys.com/thedailyblog/rewind-double-feature-part-1-a-first-ever-her-on monthly 0.5 2014-04-25 https://www.thegaitguys.com/thedailyblog/podcast-60-speeding-up-at-the-finish-line monthly 0.5 2014-04-24 https://www.thegaitguys.com/thedailyblog/can-you-see-something-strange-in-this-gait-you monthly 0.5 2014-04-22 https://www.thegaitguys.com/thedailyblog/a-new-twist-on-an-old-exercise-do-you-know-the-the monthly 0.5 2014-04-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553570287-YCYLMS7ZH93CF91VLOYE/tumblr_n4b8plBI1q1qhko2so1_400.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553570424-0PKKKA227S9GJEXR3JCS/tumblr_n4b8plBI1q1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553571813-7MTMY13166JYNH3PQQPH/tumblr_n4b8plBI1q1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553572174-IP6PDTDENJE40T7LH9RJ/tumblr_n4b8plBI1q1qhko2so4_400.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553573101-W15MZW3U9U5IYVLW803W/tumblr_n4b8plBI1q1qhko2so5_500.jpg Blog https://www.thegaitguys.com/thedailyblog/welcome-to-rewind-late-friday-sorry-about-the monthly 0.5 2014-04-19 https://www.thegaitguys.com/thedailyblog/go-ahead-and-try-this-at-home-remember-last monthly 0.5 2014-04-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553573757-RR97GQI3T10YBYC6TH5Q/tumblr_n3zupnft8D1qhko2so1_400.jpg Blog Go ahead and try this at home. remember last mondays post? (if not, click here). Here is one way of telling whether your (or someone else’s) vestibular system is working. It will also give you an idea of how some people compensate. Ready? Stand up (barefoot or shoes does not matter). place your hands resting on the top of your hips with your thumbs to the back (like your Mom used to, when you were in trouble). Your thumbs should be resting on your quadratus lumborum (QL) muscle. tilt your HEAD to the LEFT you should feel the muscle (ie the QL) under your RIGHT thumb contract come back upright repeat, but this time lean your BODY to the LEFT same thing right? Now check the other side. Everything OK? Everything fire as it should? Now lets add another dimension. slide your fingers down so they are just below the crest of the hip, resting above the greater trochanter (the bump on the side of your upper thigh). This should place your fingers on the middle fibers of the gluteus medius. tilt your head (or body ) to the LEFT. You should feel the LEFT gluteus medius and the RIGHT QL contract. These muscles should be paired neurologically. When walking, during stance phase on the LEFT: the LEFT gluteus medius helps to maintain the pelvis level, while the RIGHT QL, assists in hiking the RIGHT side. If everything works OK, then your vestibulospinal spinal system is intact and your QL and gluteus medius seem to be firing and appropriately paired. If not? That is the subject for another post. The Gait Guys. Helping you to understand the concepts of WHY compensations occur. https://www.thegaitguys.com/thedailyblog/welcome-to-rewind-friday-folks-today-we-review monthly 0.5 2014-04-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553573624-CVPLO8AB4IWXD6HYS47Q/tumblr_n3vbw7hW5t1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553573856-TMRB08P77Q99AFFRQ47C/tumblr_n3vbw7hW5t1qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-56-motor-chunking-gait-assessments monthly 0.5 2014-04-10 https://www.thegaitguys.com/thedailyblog/things-may-not-always-be-how-they-appear-what monthly 0.5 2014-04-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553573624-Q5LYVD41QG00V1HY36LE/tumblr_n2n3xcTGG81qhko2so1_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553573987-CG4W6ZWTTT6Q3RLMCFJ3/tumblr_n2n3xcTGG81qhko2so2_r1_250.jpg Blog https://www.thegaitguys.com/thedailyblog/welcome-to-rewind-friday-today-we-review-a-video monthly 0.5 2014-04-04 https://www.thegaitguys.com/thedailyblog/the-turned-out-foot-how-far-ahead-and-how-fast monthly 0.5 2014-04-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553574028-5D57HT88MYKQUGKSZJ33/tumblr_n0lvhfw0Pz1qhko2so1_1280.png Blog The turned out foot. How far ahead (and how fast) can you think ?  There are many causes of the turned out foot. The above slide is just one of many logical and possible chain of events.   There are also reasons above the neck that cannot be ignored in creating the externally rotated foot (and in resolving it). Things are not always biomechanical in origin so remember this when you are continually doing activation and rehab interventions to get more glute or drive more internal limb spin and your results are met with a non-response.   Most of us like a biomechanical line of thinking when it comes to apparent biomechanical aberrancies from the norm.  However, more often than you probably think (go back and listen to podcast 58 on Cortical Brain Mapping of injuries), several more purely neurologic reasons are plausible.  For example, changes in input/output in unilateral activity within the pontomedullary reticular formation (PMRF) of the brain can lead to inhibition of the posterior chain muscles below the T6 spinal level (And anterior muscles above T6. And what is awesome is that there are ways to test this kinda stuff on a physical exam !  However, this blog post is not the place to teach these neurologic examination procedures.  But, if this sounds like Janda’s Upper and Lower Crossed Syndromes you are thinking soundly. Just remember though, if you are fixing what you see, you may not be fixing the problem, fix the cause that drove what you are seeing.  If you know your functional neurology you will know where these things come from, they are a cortical phenomenon).   Of the posterior compartment muscles below T6, the gluteus maximus is probably the largest of this group and when it is inhibited there is loss of control of its ability to stabilize single leg stance.  One strategy around a stability challenge would be to turn the foot/leg into the frontal plane (toe out) via external limb rotation.  Now we can use the remaining muscles in both the sagittal and frontal planes ! We are always more stable when we can engage two or more cardinal planes at the same time. There are  many more reasons for the externally rotated limb/foot, for example vestibular dysfunction, cerebellar dysfunction, core dysfunction, impaired normal arm swing and the list goes on. We have talked about many of these reasons on many of our blog posts and podcasts. Mental gymnastics when it comes to the brain are important, Keep your gait and human movement game sharp, work through scenarios in your head regularly because it is what is necessary when you are working up a client.   Shawn and Ivo the gait guys https://www.thegaitguys.com/thedailyblog/podcast-58-brain-mapping-injuries-muscle monthly 0.5 2014-04-01 https://www.thegaitguys.com/thedailyblog/well-how-convenient-a-fantastic-picture-for monthly 0.5 2014-03-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553574589-3BO59YILR2UGWY4QV87Y/tumblr_n2n3wlqqDJ1qhko2so1_250.jpg Blog Well, how convenient. A fantastic picture for teaching from the cover of one of our favorite magazines. For this post, lets start with the gal on the left in the pink shirt. 1st of all, she is running in flip flops. Since these require so much long flexor activity to keep them on, not the best footwear choice, in our opinion. Check out that exaggerated left sided arm swing. This goes to propel herself forward. Why the extra effort? Check out her right (stance phase leg). What do you see? The knee points outward while the foot is planted. We are looking at either external tibial torsion or a femoral retrotorsion. Did you pick up the compensatory head tilt to the left? The vestibular system has become involved, and the trapezius and levator scapula seem to be it’s target (thus the shoulder hike and ipsilateral rotation), as well as the ipsilateral lateral benders and rotators of the cervical spine, namely the splenius cervicis and capitis (the multifidus/rotatores are contralateral rotators). How about the subtle pelvic shift to the right? and the mild crossover gait (note the adduction of the left knee across midline). It would be great to see a shot of her barefoot to see what changes, as increased long flexor activity has both local (impaired ankle rocker, excessive forefoot inversion, reciprocal inhibition of the anterior compartment muscles of the lower leg) as well as long distance (namely increased flexor drive to the brainstem and cerebellum) implications. We would want to see this (as well as examine her) before making any recommendations other than LOSE THE FLIP FLOPS GIRLFRIEND. Wow, all that and we have only scratched the surface. We remain the geeks of gait: Ivo and Shawn https://www.thegaitguys.com/thedailyblog/activation-cortical-remapping-and-what-you-are monthly 0.5 2014-03-26 https://www.thegaitguys.com/thedailyblog/more-on-eva-foam-impact-loading-behaviors-and monthly 0.5 2014-03-25 https://www.thegaitguys.com/thedailyblog/remember-this-kiddo-we-have-been-following-the monthly 0.5 2014-03-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553575702-UEXY0RE7PTFIILE7GKHO/tumblr_n2ac0gX4j01qhko2so1_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553576777-QTR4PQED9PSQ9OZOQX19/tumblr_n2ac0gX4j01qhko2so2_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553577304-CE33BXAYQAPI9Y4P90RY/tumblr_n2ac0gX4j01qhko2so3_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553577320-383X6EJ1NYWRZYF2E8PD/tumblr_n2ac0gX4j01qhko2so4_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553577781-709N5QYKTZYEW5MPRJN7/tumblr_n2ac0gX4j01qhko2so5_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553577992-T8IX2DD4N5B57QJZT3MX/tumblr_n2ac0gX4j01qhko2so6_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-57-the-brain-ankle-instability-heel monthly 0.5 2014-03-21 https://www.thegaitguys.com/thedailyblog/president-obama-and-mr-biden-go-for-a-run-you monthly 0.5 2014-03-21 https://www.thegaitguys.com/thedailyblog/more-shoe-foam-may-mean-more-problems-last-night monthly 0.5 2014-03-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553578072-4RZLN801GTKSMOMH3SI5/tumblr_n2qfjzn8eo1qhko2so1_1280.png Blog More shoe foam may mean more problems. Last night we had a great online teleseminar (www.onlinece.com). The talk was minimialism. Here was 2 of our take home points: More foam in the shoe is not always good. “Shoes with cushioning fail to absorb impact when humans run and jump, and amplify force under certain conditions, because soft materials used as interfaces between the foot and support surface elicit a predictable reduction in impact-moderating behavior. ” -Robbins Basically barefoot feet, and even shoes with thinner foam/soled shoes, tend to judge impact more precisely because there is less foam to dampen proprioceptive input. The more foam you stack under the foot, the more material that must be deformed before a sufficiently rigid surface can be detected by the foot. Think of this, what do we do in rehab ? We stand people on stacked foam to give them an unstable surface (if they have championed balance challenges on a stable surface first, this is an important first step). When the foot cannot find a firm platform it searches for stability and drowns in the instability. This can be what more foam under the foot provides, inability to reference stable ground surface can negatively impact proprioceptive joint and tissue receptors. 2. Impact loading behaviors. if we know the surface (the shoe or the actual surface/ground) is unstable, we will modify the pending impact loading behavior. In other words, you will jump differently onto a frozen puddle than you would dry ground. Studies have shown that the more foam a shoe has (ie. the more the potential instability from the example above) the greater the reduction of impact moderating behavior. Humans reduce impact-moderating behavior in direct relation to increased instability.- Robbins hope to see you in the next online teleseminar in 4 weeks ! shawn and ivo reference: BioMechanics April 1998 Materials: Do soft soles improve running shoes? Most athletic shoes advertise injury protection through “cushioning,” but real world studies have not shown impact moderation. By Steven Robbins, MD, Edward Waked, PhD, and Gad Saad, PhD https://www.thegaitguys.com/thedailyblog/tonites-the-night-folks-the-research-behind monthly 0.5 2014-03-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553578071-S4QS2BENZNRQB2I79SOM/tumblr_n2k9npEIIY1qhko2so1_1280.png Blog Tonite’s the night folks. The research behind minimalism and minimalsitic footwear; Biomechanics 318. Join us at onlinece.com or chirocredit.com at 5 PCT, 6 MST, 7 CST, 8 EST for all the beef, without the filler. https://www.thegaitguys.com/thedailyblog/tomorrow-we-lecture-on-minimalistic-footwear-and monthly 0.5 2014-03-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553577806-N2YRJHFUJ31XN0GS5Z81/tumblr_n2k9mr2xVp1qhko2so1_1280.png Blog Tomorrow we lecture on Minimalistic Footwear and its impact on runners on onlinece.com and chirocredit.com. Join Us. Biomechaics 318; 8PM Eastern, 7 Central, 6 Mountain, 5 Pacific. All the cool people will be there and if you attend, you will know why barefoot is not the same as minimal https://www.thegaitguys.com/thedailyblog/yep-you-read-it-here-exercise-good-sugarnot-so monthly 0.5 2014-03-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553577925-URVTLPQ491ATRL3JHNIB/tumblr_n2a7mmNb441qhko2so1_1280.jpg Blog Yep, you read it here. Exercise good: Sugar…Not so good for your brain “Thus, BDNF appears to be released from the human brain, and the cerebral output of BDNF is negatively regulated by high plasma glucose levels, but not by high levels of insulin” Let us boil it down to two simple equations for you: Exercise = More BDNF Sugar (Glucose) = Less BDNF So what is BDNF? It stands for “Brain Derived Neurotrophic Factor”. It’s the stuff that makes our brain grow. Neurotrophins are a family of structurally related growth factors, including brain-derived neurotrophic factor (BDNF), which exert many of their effects on neurons in the brain, but also many other metabolic processes in the body. Brain-derived neurotrophic factor has been shown to regulate neuronal development and to modulate synaptic plasticity (ie it is a mind expanding compound; literally). Recent studies show that BDNF is also expressed in non-neurogenic tissues, including skeletal muscle. BDNF has also been identified as a key component of the hypothalamic pathway that controls body weight and energy homeostasis and it appears to be a major player not only in central metabolic pathways,but also as a regulator of metabolism in skeletal muscle. So, before you replenish those glycogen stores with some simple sugars post run or workout; remember that it may be at the expense of your brain function. Are we saying not to replenish? No, we are saying stick to lower glycemic choices, which yes, will fill the glycogen stores slower, but can help preserve your noggin. Glucose IS the preferred fuel of the brain, but it can make it from fats and proteins as well; remember something called gluconeogenesis from physiology class? Some of the latest studies show that ketosis isn’t as bad as we previously thought, but that is the subject of another post… We are The Gait Guys and we are all things gait; even those that are peripherally related. Krabbe KS, Nielsen AR, Krogh-Madsen R, Plomgaard P, Rasmussen P, Erikstrup C, Fischer CP, Lindegaard B, Petersen AM, Taudorf S, Secher NH, Pilegaard H, Bruunsgaard H & Pedersen BK (2007). Brain-derived neurotrophic factor (BDNF) and type 2 diabetes. Diabetologia 50, 431–438. https://www.thegaitguys.com/thedailyblog/join-us-this-wednesday-evening-5pm-western-6-pm monthly 0.5 2014-03-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553579473-HTCTE5CTPUY8PGE7DGDV/tumblr_n2k9n9Msvv1qhko2so1_1280.png Blog Join us this Wednesday evening, 5pm western, 6 PM mountain, 7PM central, 8PM eastern, at:  online CE.com for a lecture on minimalistic footwear and its impact on runners called Biomechanics 318. Drop, motion control features and a host of other subjects will be addressed. https://www.thegaitguys.com/thedailyblog/vintage-nike-niobe-i-best-recall-being-told-that monthly 0.5 2014-03-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553580137-P0Q0OS37BAO314COJPSQ/tumblr_n1ilprdiDo1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553580801-XXBV00WZWFBR4XW2J42W/tumblr_n1ilprdiDo1qhko2so5_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553581223-50TFN962XTADFJW7QUIE/tumblr_n1ilprdiDo1qhko2so6_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553581267-AECMM5OP2B5CKTC3ISCM/tumblr_n1ilprdiDo1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553581394-MCM530N5GM8XV3MCY0D2/tumblr_n1ilprdiDo1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553581680-WO2DPN6ZI9I4YPM1BSJ8/tumblr_n1ilprdiDo1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/we-always-love-a-video-with-cool-foot-action-and monthly 0.5 2014-03-15 https://www.thegaitguys.com/thedailyblog/todays-rewind-includes-an-older-gait-guys-at-the monthly 0.5 2014-03-14 https://www.thegaitguys.com/thedailyblog/holy-hand-grenades-what-kind-of-shoe-do-i-put monthly 0.5 2014-03-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553581863-W31VD8C6UD2LUTU5OEKZ/tumblr_n2aypmQpun1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553581748-DYLJHZB3UAY28ZVLFU0J/tumblr_n2aypmQpun1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553582567-UGP4B89JLTTYNF8O48CJ/tumblr_n2aypmQpun1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553583156-WJJVGAFRKWPWTZD65QMP/tumblr_n2aypmQpun1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-56-crawling-neurodevel-foot-strike monthly 0.5 2014-03-12 https://www.thegaitguys.com/thedailyblog/when-a-stability-shoe-makes-things-worse-look-at monthly 0.5 2014-03-11 https://www.thegaitguys.com/thedailyblog/its-a-dancing-queen-kind-of-friday-here-on-the monthly 0.5 2014-03-07 https://www.thegaitguys.com/thedailyblog/a-theory-for-bipedal-gait-ipsilateral monthly 0.5 2014-03-06 https://www.thegaitguys.com/thedailyblog/if-you-work-in-a-shoe-store-you-better-understand monthly 0.5 2014-03-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553583313-QL22OE3KBNP6Q8IXLL0F/tumblr_n0m10kogss1qhko2so1_1280.jpg Blog If you work in a shoe store, you better understand the real problem behind this frequent shoe breakdown. You have seen it, but do you truly understand it ? Stripping of the heel counter: a naughty problem. (note the foam break down at the inside heel of the shoe in this photo of an almost new pair of shoes) Has the inside of the heel counter of your shoe ever looked like this? Do you know why ? We will tell you why !  * #4 is the lightbulb moment for most people,.  1. you may be lazy and not tie your shoes and try to slip  your foot into/out of your shoe without unlacing and re-lacing. This will often fold the top of the counter over upon its self and start some breakdown. Kids are lazy, but so are some adults. 2. your laces may be laced to loosely and your heel is excessively slipping/riding up and down on the heel counter foam/material.   3.  you have a nasty Halglunds deformity that is just so big it is creating too much friction. 4. However, there is often a better and more logical reason and it just so happens that it is the one that no one thinks of or understands.  Loss of ankle rocker (AKA loss of ankle dorsiflexion.  You see, the heel counters job is to gently create counter pressure against the back of the heel/calcaneus so that when the person moves into terminal stance phase of gait (when the heel begins to rise) the heel rise will pull the heel of the shoe up AT THE SAME TIME !  If there is a differential in this time stamp event, then the heel will rise abruptly against a shoe that has not had time to finish forefoot rockering at toe-off through the normal forefoot siping on the outsole.  In other words, if ankle rocker/dorsiflexion is less than sufficient the restricted range will necessitate that the  heel rise BEFORE it is technically supposed to do so, AND thus, before the shoe will reach its build in rocker that enables the heel rise. The two events  have to occur at the same time ! When a person has impaired ankle rocker and thus goes into premature heel rise, the shoe will essentially still be attempting to get to the forefoot rocker built into the shoe (which will lift the heel of the shoe passively). So, if the heel rise is premature, before the shoe gets to the forefoot rocker, the heel will abruptly, yet subtly, slide up the heel counter and shear the foam on the inside of the heel counter. Keep in  mind that once the heel slide and the shoe heel counter engage together the shoe will be suddenly thrust into its (the shoe’s) forefoot rocker. But, you should understand that this is premature forefoot loading response, and it has a host of clinical problems that go along with it (ie. metatarsal stress fractures, premature or excessive forefoot pronation, toe clenching etc).  * clinical pearl: this problem often presents with the runner having dorsal foot pain across the top of the foot. The runner will naturally think it is the tightly tied shoes, so the natural solution is to lace the shoes looser and looser (or skip lace) until the point they no longer stay on the foot because of the heel counter sliding. Neither one fixes the dorsal foot pain, because the lacing is not the issue. The astute shoe fitter will realize that this dorsal foot pain is directly related to the loss of ankle rocker, but that is a blog post for another time.  It is natural for runners to try to tie their shoes tighter to stop the feeling of the heel slip but this is not the solution.  Ankle strangling is not the solution. Either the shoe is: 1. not fit properly matching the person’s natural forefoot rocker phase to the shoe’s natural rocker or 2. they have a narrow heel (and thus also need a more appropriately fit shoe) 3. need to learn to lace the shoes properly (this does not mean strangle the ankle, any shoe that needs to be tied that tightly to prevent this phenomenon is not the correctly fitted shoe).  Shoe tie tension should be modest, comfortable and not constrictive…… ie hardly noticeable. OR:   the person needs more ankle rocker !  Which does not necessarily mean more calf stretching. It means EARNING posterior length through anterior strength. Watch one of our solution exercises here  .  Earn the changes you need, no one wants to have to performs stretches before every run for the rest of their lives.  Who has that kinda time ?!  Better yet, why not take our National Shoe Fit Certification Program and learn the truths about shoe fit and clean biomechanics.  Or, you can leave the pathology alone and support your friendly neighborhood shoe store and local running injury guru more frequently than usual or than is necessary.  Its your money and your time. Links to the National Shoe Fit certification program: Gait Guys online /download store (National Shoe Fit Certification and more !) : http://store.payloadz.com/results/results.aspx?m=80204 other web based Gait Guys lectures: www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics” Shawn and Ivo, The gait guys Sharing the secrets of gait and walking/running biomechanics that you are not taught elsewhere. https://www.thegaitguys.com/thedailyblog/congrats-to-coach-cameron-our-1st-certification monthly 0.5 2014-03-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553584466-E5KMII03P6MQSPM3CMO8/tumblr_n1tmnxBbA21qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553584490-7Z4Z22V2Q06E3Y8H52FY/tumblr_n1tmnxBbA21qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/the-hand-walkers-part-2-uner-tan-syndrome-the monthly 0.5 2014-03-03 https://www.thegaitguys.com/thedailyblog/welcome-to-rewind-friday-folks-think-about-all monthly 0.5 2014-02-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553584712-I8QF23ERMQZF40NJUUQA/tumblr_n0zr1hWCkf1qhko2so1_1280.jpg Blog Welcome to rewind Friday Folks. Think about all those folks in the Northeast who have been shoveling (OK, the folks in Colorado as well) and their feet being rubber boots! Here’s an oldie, but a goodie. Here’s one paper we though had merit (sure, go to Pub Med and search foot odor. There were 119 entries). We think we may try this in the office… The Gait Guys: Yes, smelly feet are something we have to deal with at the office on a daily basis. One of the pitfalls of being a Foot Geek : ) Make sure to check back later for more on malodorous extremities…                           J Int Soc Sports Nutr. 2007 Jul 13;4:3. A novel aromatic oil compound inhibits microbial overgrowth on feet: a case study. Misner BD. Source West 1140 Glass Avenue Spokane, Washington, 99205, USA. drbill@omnicast.net. Abstract ABSTRACT: BACKGROUND: Athlete’s Foot (Tinea pedis) is a form of ringworm associated with highly contagious yeast-fungi colonies, although they look like bacteria. Foot bacteria overgrowth produces a harmless pungent odor, however, uncontrolled proliferation of yeast-fungi produces small vesicles, fissures, scaling, and maceration with eroded areas between the toes and the plantar surface of the foot, resulting in intense itching, blisters, and cracking. Painful microbial foot infection may prevent athletic participation. Keeping the feet clean and dry with the toenails trimmed reduces the incidence of skin disease of the feet. Wearing sandals in locker and shower rooms prevents intimate contact with the infecting organisms and alleviates most foot-sensitive infections. Enclosing feet in socks and shoes generates a moisture-rich environment that stimulates overgrowth of pungent both aerobic bacteria and infectious yeast-fungi. Suppression of microbial growth may be accomplished by exposing the feet to air to enhance evaporation to reduce moistures’ growth-stimulating effect and is often neglected. There is an association between yeast-fungi overgrowths and disabling foot infections. Potent agents virtually exterminate some microbial growth, but the inevitable presence of infection under the nails predicts future infection. Topical antibiotics present a potent approach with the ideal agent being one that removes moisture producing antibacterial-antifungal activity. Severe infection may require costly prescription drugs, salves, and repeated treatment. METHODS: A 63-y female volunteered to enclose feet in shoes and socks for 48 hours. Aerobic bacteria and yeast-fungi counts were determined by swab sample incubation technique (1) after 48-hours feet enclosure, (2) after washing feet, and (3) after 8-hours socks-shoes exposure to an aromatic oil powder-compound consisting of arrowroot, baking soda, basil oil, tea tree oil, sage oil, and clove oil. CONCLUSION: Application of this novel compound to the external surfaces of feet completely inhibited both aerobic bacteria and yeast-fungi-mold proliferation for 8-hours in spite of being in an enclosed environment compatible to microbial proliferation. Whether topical application of this compound prevents microbial infections in larger populations is not known. This calls for more research collected from subjects exposed to elements that may increase the risk of microbial-induced foot diseases. The Gait Guys. Bringing you the good, the bad and the smelly…. https://www.thegaitguys.com/thedailyblog/another-ifgec-certification-granted-heres-what monthly 0.5 2014-02-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553585346-5ZSKQ45YZWDLBXKBWVFQ/tumblr_n1hhg88os61qhko2so1_1280.jpg Blog Another IFGEC Certification granted: Here’s what Mark Small has to say “The National Shoe Fit Program is beneficial to many fields/disciplines including, but not limited to, coaches, personal trainers, athletic trainers, physical therapists, podiatrists, and chiropractors (I would say MD’s, but it doesn’t come in a pill), as well as those who sell shoes.  The program offers tools to help us understand individual differences and their effects on gait and performance.  Some of the material includes:     •    Foot anatomy     •    Anatomical Landmarks     •    Foot types     •    Pathologies     •    Basic biomechanics     •    Shoe fit functional testing     ⁃    Static and dynamic tests to assist fitting     •    Finally shoe selection     ⁃    Picking the best shoe for your client/athlete/patient Some of these topics may be a good review for some of the advanced disciplines listed above. What the program is able to do, even for them, is to link everything together in a methodical, step by step, detailed approach, that applies what we have learned into something predictable and usable. We are often looking for ways to increase performance, decrease pain and get people to move better.  I, for one, believe that much of bad movement, pain and dysfunction have to do with inappropriate footwear, this course is a starting place to help correct that problem.  I am looking forward to Level 2 & 3 certification programs, but more importantly, I am looking forward to applying what I am learning with the people I serve.  I’m not a Gait Guy… more like a gleam in the gait daddy’s eye, but I’m working on it.” Congratulations, Mark! The Gait Guys https://www.thegaitguys.com/thedailyblog/thanks-for-the-kudos-coach-smith-for-anyone monthly 0.5 2014-02-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553585552-YXFWO5NPH83TXI8RAADA/tumblr_n1lbsvKM0D1qhko2so1_1280.png Blog Thanks for the kudos Coach Smith ! for anyone interested… . .  1.  Gait Guys online /download store (National Shoe Fit Certification and more !) : http://store.payloadz.com/results/results.aspx?m=80204 2. other web based Gait Guys lectures: www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics” https://www.thegaitguys.com/thedailyblog/i-had-explosive-diarrhea-in-the-middle-of-a-good monthly 0.5 2014-02-25 https://www.thegaitguys.com/thedailyblog/concepts-in-pelvic-stabilization-do-you-know-what monthly 0.5 2014-02-24 https://www.thegaitguys.com/thedailyblog/stopped-by-yesterday-to-see-my-friends-and-fellow monthly 0.5 2014-02-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553585757-QTOSI1K0YJIP7OLO7FI2/tumblr_n1gayw5ve61qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553585583-CPZIV2RL7FLF2HO29U8A/tumblr_n1gayw5ve61qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553586279-HM67P8TGT7THO9LJKN8W/tumblr_n1gayw5ve61qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553586752-SXS25BKZ0OVVF18QFQEI/tumblr_n1gayw5ve61qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-55-cold-joints-gluten-brain-toilets monthly 0.5 2014-02-23 https://www.thegaitguys.com/thedailyblog/welcome-to-rewind-friday-folks-this-week-we-have monthly 0.5 2014-02-21 https://www.thegaitguys.com/thedailyblog/so-you-do-not-think-arm-swing-is-important-huh monthly 0.5 2014-02-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553587203-VNBYA9CMFLUNKVVCH093/tumblr_n1b6mhRslp1qhko2so1_1280.png Blog So you do not think arm swing is important huh ?  Read these 2 stats and recalibrate your thinking.   This was yet another slide from last nights well attended teleseminar. Those that attended learned all of the up to date facts that doctors, trainers, coaches, therapists need to quickly understand what factors to look for when observing someones gait.  Including our favorite, “what you see is not the problem in their gait, rather it is there strategy around the faulty parts, problem or pain.” If you think that changing arm swing at the local level is not a big deal, just digest the towering facts from this slide.  Arm swing is a big deal ! It is a CPG generated big deal (Central Pattern Generator).   Sorry we missed you last night.  The teleseminar was recorded and should be up on www.onlinece.com or www.chirocredit.com in a few days for you to enjoy on your own free time (and so are a few dozen of our other lectures !).    So, if you are coaching or making local-level arm-swing form running or training changes in yourself or your client, you are probably making some big mistakes.  Our lecture brings this all to light for you in one place ! Arm Swing matters…….. more than any of us previously knew ! Shawn and Ivo, The Gait Guys https://www.thegaitguys.com/thedailyblog/faulty-arm-swing-provides-clues-to-gait monthly 0.5 2014-02-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553588333-G42HC1D87JP1IYFD4HM8/tumblr_n1929vqkLx1qhko2so1_1280.png Blog Faulty Arm Swing provides clues to gait pathology. Don’t think that just because you see aberrant arm swing that you should “coach” it out of someone.  It is very likely there for a reason. We discuss tonight how the leg swing is more deeply neurologically embedded, more so than arm swing.  So, fixing something you do not like in their arm swing is very possibly the wrong solution and by doing just that you are forcing your client into a new compensatory CPG (central pattern generator) which is essentially a compensation to their compensation.   Fix the problem, go for its roots ! This is one of our slides for tonights lecture.  This is from the European Spine Journal 2011.  More posterior arm swing can help improve impaired hip extension and gluteal function. A nice compensatory fix to reduce spine rotation in a spinal pain patient, more hip extension means that less pelvic obliquity needs to be acquired (less obliquity in the pelvic girdle means less spine rotation and thus less spine compression. This is a brain based phenomenon, the brain is engaging a pain avoidance CPG.  You gotta know your biomechanics, you gotta know your neurology and you MUST understand and recognize normal and abnormal gait patterns if you choose to work with humans ! Join us tonight on www.onlinece.com for an in-depth hour talking about the biomechanics and neurobiology behind normal and abnormal arm swing.  7pm central Wednesday 19th. Shawn and Ivo, the gait guys https://www.thegaitguys.com/thedailyblog/have-you-ever-wondered-why-people-who-walk monthly 0.5 2014-02-18 https://www.thegaitguys.com/thedailyblog/what-do-you-do-with-these-dogs-take-a-good-look monthly 0.5 2014-02-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553587972-7GSZ1DO9WUNDSMQIDICK/tumblr_n06qsgxeEf1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553588409-JAG6VIH5PMR56TDFGX6Q/tumblr_n06qsgxeEf1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553588963-8SCK4PYR9NKQH5TYABER/tumblr_n06qsgxeEf1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/arm-swing-the-straight-up-truth monthly 0.5 2014-02-15 https://www.thegaitguys.com/thedailyblog/limitations-the-powers-of-observation-will-help monthly 0.5 2014-02-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553588950-ADL0L7F3LYN9779OYVB9/tumblr_n0w4ooUbb61qhko2so1_1280.png Blog Limitations: The powers of observation will help you. Physical examination, FMS, DNS, gait analysis … . . these are all very important tools for the coach, trainer, therapist, clinician.  They will all offer information and lead the “therapy giver” in a direction for intervention.  But when something doesn’t match up with the basic standard protocols, you have to go outside the standard box.  We have all been there and today is just a little reminder not to get caught up in the “proceedures” and merely running through protocol without an engaged brain putting the pieces together.   Here we see 2 classic examples of deviations from the mean, the client on the left has drifted further outside the frontal plane because of tibial varum and a little genu varus.  The client on the right has imploded deep into the frontal plane via rigid pes planus foot collapse and genu valgum.  These will both affect your physical screenings for these clients. And keep in mind, and this is probably the most important point of today’s blog post, either client may have good or bad strategies around their anatomy.  In other words, some clients will have great compensations to limit further functional pathology, and some will have poor compensation strategies, and thus, both will have different physical exam findings, different screenings and different neuromotor patterns embedded deep into their CPGs (central pattern generators).   Put yet another way, all of the scenarios discussed may/will have varying screening assessment outcomes but for different reasons.  If you know the cause of these faults and the impaired neuro-recruitment patterns that are likely, your assessments will make more sense, and so will your exercise/therapy/rehab prescriptions.  If you do not understand the fundamental differences (ie long bone torsions or various femoral-neck shaft angles, foot types such as an uncompensated forefoot valgus etc) , one could prescribe therapies that will not address the underlying problems, rather they might address the compensations and strategies found with these client’s challenges. It can get sloppy messy.  Wear a bib. Dig for the roots, don’t mow the grass…… Shawn and Ivo, The Gait Guys https://www.thegaitguys.com/thedailyblog/a-look-at-the-lunge-are-you-ready-to-take-the monthly 0.5 2014-02-10 https://www.thegaitguys.com/thedailyblog/everyone-need-a-good-running-partner-never-would monthly 0.5 2014-02-07 https://www.thegaitguys.com/thedailyblog/when-spine-pain-presents-the-shoulder-and-pelvic monthly 0.5 2014-02-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553588922-Q6XTF8MNBKQS9NWF8FZO/tumblr_n0ly04Zzv41qhko2so1_1280.png Blog when spine pain presents the shoulder and pelvic girdle “anti-phase” oscillations (oscillate in opposite rotation) begin to move into a more “in-phase” favor.  Meaning that the differential between the upper torso twist and pelvic twist is reduced. The brain does this to reduce spinal compression. And when we reduce compression shear forces increase.  This is not a good thing. We are getting the last of the slides together for our www.onlinece.com international teleseminar on Feb 19th, 7pm central.    You should join us.  This months lecture is on Arm Swing.   Hope to see you all in 12 days online !  Be sure to sign up ahead of time, we will likely have a large audience. Happy Friday ! Shawn and Ivo,   The Gait Guys https://www.thegaitguys.com/thedailyblog/treadmill-truths-because-there-is-alot-of-crappy monthly 0.5 2014-02-06 https://www.thegaitguys.com/thedailyblog/podcast-53-debunking-treadmills-recovery monthly 0.5 2014-02-05 https://www.thegaitguys.com/thedailyblog/stacking-of-the-joints-and-something-that-can-go monthly 0.5 2014-02-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553589152-PZ5RFZ989MUKBZVPUJPL/tumblr_n0hjx5g4uv1qhko2so1_1280.png Blog Stacking of the joints, and something that can go wrong when they don’t stack well. Here is a short, sweet and simple case to open up some thoughts.  We have read on several occasions  of people making changes to arm swing as a solitary independent issue.  Arm swing, when aberrant, is quite often a compensatory change to something else. It is quite often a problem in the opposite lower extremity.  We will be doing a 1 hour teleseminar in 2 weeks on www.onlinece.com on the topic of arm swing. Why don’t you come and join us ?  This photo proves our point. It is clear to anyone that the right arm is far too abducted , yet it should make one question as to whether it is a product of the “failure to stack” the left lower limb. One should easily see that the right hip  has drifted beyond the perpendicular line of the left foot and that we are witnessing somewhat of a Trendelenberg presentation. The left hip should be over the left foot. We classify what we see  here however, as “stance phase” frontal plane sway. It is a POSSIBLE product of many things, but remember that what you see is a compensation around a functional or ablative problem, and not the actual problem most of the time.  One could easily hypothesize that the left gluteus medius is weak or that the left abdominals are frontal plane weak but these are only the two major assumptions most people make. Remember one of our cardinal rules, when the foot is on the ground the glutes are in charge, and when the foot is in the air, the abdominals are in charge. So, do not forget to look at the right sided abdominal component here as well.  How about foot and ankle stability ? Something is causing her frontal plane drift. It is your job to find it and correct it, not the arm swing (unless you determine it as the cause). But it is not your job to guess !   Is it luck or predictable fact that the left pelvis is left frontal plane deviating and that the right arm is right frontal plane deviating ?  Not in our opinion, she is trying to maintain balance and symmetry during power production.  Balance maintenance comes from many areas. Because of the neurologically embedded crossed extensor reflex and cross crawl response that permeates all human locomotion, anything that changes one of the limbs, whether it be a direct limb issue or something to do with the stabilization of the limb can impair and change locomotion, motor pattern choices and programming. So, be careful where you make your demanded changes in your clients and your athletes. If you are guessing you are playing with fire and potential injury. The patterns are centrally generated and not by conscious choice, and hence they should not be completely remedies by the athletes conscious choice.  According to Zehr, “Although the strength of coupling between the legs is stronger than that between the arms, arm and leg movements are similarly regulated by CPG activity and sensory feedback (e.g., reflex control) during locomotion.” (Neuroscientist. 2004 Aug;10(4):347-61. Regulation of arm and leg movement during human locomotion.Zehr EP, Duysens J. Rehabilitation Neuroscience Laboratory, University of Victoria, BC) There is alot more to this topic, but you will just have to join us in two weeks on www.onlinece.com.  Third Wednesday of every month, 7pm central time, that is where you will find us ! shawn and ivo, the gait guys https://www.thegaitguys.com/thedailyblog/so-you-want-to-do-a-gait-analysis-part-3-this-is monthly 0.5 2014-02-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553589755-F9NPFY8SO8DDS5Q47M7E/tumblr_mzon5s7yoY1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553590633-5EU2HQDA4FE8S1888T8E/tumblr_mzon5s7yoY1qhko2so2_r1_500.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553590422-0XV1EFWWRTL291U5P2XJ/tumblr_mzon5s7yoY1qhko2so3_r1_1280.png Blog https://www.thegaitguys.com/thedailyblog/it-is-rewind-friday-on-the-blog monthly 0.5 2014-01-31 https://www.thegaitguys.com/thedailyblog/podcast-52-limb-dominance-other-cool-stuff monthly 0.5 2014-01-30 https://www.thegaitguys.com/thedailyblog/the-unbalanced-athlete-motor-pattern-team-joint monthly 0.5 2014-01-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553591332-HDRBGNU0IHRPZPDLJ7GN/tumblr_mzwxrq6UhU1qhko2so1_1280.png Blog The unbalanced athlete, motor pattern, team, joint etc…… is not efficient. Like him or not, believing he should have lost his last fight (or not), Georges St-Pierre was/is one of the best MMA fighters of all time. He was once quoted as saying,  “In fighting, in evolution, in life, efficiency is the key,” says St-Pierre.   "It’s not the most powerful animal that survives. It’s the most efficient.“ This certainly describes most of Georges fights. There were always bigger, faster, meaner, stronger opponents. However, most of his fights went the distance. Eight of his last nine fights went to a five round decision. Now, there are those who will say that he didn’t have the finishing power or submission skills to close fights in the earlier rounds, and that is debatable for sure.  However, there is no doubt that anyone’s best fighting attributes will diminish as the rounds progress and fatigue sets in.  But, perhaps this is an equalizer when someone doesn’t have one single "golden right hand”, or what have you.  Efficiency can be the great equalizer. St-Pierre isn’t your typical fighter. He’s arguably the best mixed martial artist in the world, a 5-foot 11-inch, 190-pound destroyer. Up until his most recent fight with Johnny Hendricks, he had not lost a round in more than 3 years, that is pure efficiency ! Arguably, he is faster than other fighters, he is more fit, has a greater range of skills, has better endurance …  in a Darwinian sense, perhaps more efficient ? Here at the Gait Guys we are always considering efficiency.  As you can see from the slide above, there are many factors that can diminish efficiency.  We strive for as much symmetry as we can because with neuromuscular symmetry efficiency can be maximized.  Keep in mind however, that total symmetry is not always possible. Most people have two different feet, often one is more varus because it sat against the mothers rounded belly in utero.  And, one tibia is often more bowed or torsioned than the other for the same reason.  So, perfect symmetry is not always possible or guaranteed. But, one can do alot to gain as much physical symmetry as possible through detailed study of your client. (Remember, just because things look symmetrical does not mean that they function symmetrically ! This game is not that easy ! But, for some of the uneducated, it may seem to be !)  When physical symmetry is regained often the sensory-motor nervous system becomes functionally more symmetrical.  And, this is a flippable phenomenon, when neuro symmetry is driven often physical symmetry will be driven in time.   Think about the afferent input to the cortex from the peripheral receptors in the skin (Paccinian corpuscles, Merkels discs, etc); the joint mechanorecpetors (types I-IV) and muscle receptors (spindles and Golgi tendon organs). Generally speaking, they travel up the dorsal columns on the back of the spinal cord to the thalamus and then the cortex; up the dorsal spinocerebelllar tract, to the cerebellar hemispheres; the spino- reticular tract to the reticular formation, or in the case of the upper cervical spine, directly into or flocculonodular lobe of the cerebellum. This information needs to be equal and opposite from each side of the extremity (flexors and extensors) as well as the right and left sides of the body. This “Balance” or “Homeostasis” or what the Chinese called Yin and Yang is key to efficiency. In your workouts and rehab, strive for symmetry. We like to say “Tailor your exercises to the weaker side”. This helps to create more equality rather than a larger disparity. The Gait Guys. Making it Real…Each Day….On the Blog… https://www.thegaitguys.com/thedailyblog/how-well-do-your-boots-fit-your-ride-whether-you monthly 0.5 2014-01-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553592026-N6ZZ6KGU3TLYPZ5G6696/tumblr_mzwrchzkCN1qhko2so1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553592003-0ZMYFZ52GY0KOOG9P5UR/tumblr_mzwrchzkCN1qhko2so2_400.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553592007-GKZW5OKMLWN3LWBU89IH/tumblr_mzwrchzkCN1qhko2so3_400.jpg Blog https://www.thegaitguys.com/thedailyblog/gait-is-a-fingerprint-just-because-you-see monthly 0.5 2014-01-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553592592-BCHEDROAXU9UIORTCLZJ/tumblr_mzv9n4suLp1qhko2so1_1280.png Blog Gait is a Fingerprint.   “Just because you see something you do not like, does not mean that it is wrong. ” How many times have you heard us say this ! Yes, we are getting tired of saying it, too. But, it is the honest truth.    The above slide is one that we are using in an upcoming teaching presentation for you folks.  And this slide pretty much tells it like it is.  That being, that gait is a unique and variable fingerprint.  The slide suggests, with references, that gait is so variable, that even people with the same disease process have different presentations miles apart from one another.  This gait analysis thing is not simple. If you are using a piece of analysis software that has you comparing your patients to normative data, be careful. You are very likely not comparing “apple to apples”.  So, do not pigeon-hole your client to normative data. Do your hands on physical examination and find out where THEIR limitations are, not what the normative data says their capacities should be.  This could be one’s first mistake in trying to help a client.   Bottom line, no 2 people’s arms swing, leg swing, pelvic posture, hip extension etc are the same. Even side to side on the same client there may be variability due to degrees of long bone torsion or foot type (we have discusses these embryologic issues previously many times here on our blog). So, just try to improve your clients function and stability and mobility to what their body needs. This is not a templated game. This an art form that takes years to develop. We too are learning and growing, so thanks for being on this journey with us ! Shawn and Ivo, the gait guys https://www.thegaitguys.com/thedailyblog/start-with-the-basics-one-of-our-favorite-core monthly 0.5 2014-01-21 https://www.thegaitguys.com/thedailyblog/the-lumbar-lordosis-and-pelvic-stabilization monthly 0.5 2014-01-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553593102-JU38JD01273751OZNQEC/tumblr_mzoo71gBTf1qhko2so1_r1_540.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553593158-H7PFT4GX5BWJGALT1NYL/tumblr_mzoo71gBTf1qhko2so2_r1_1280.png Blog https://www.thegaitguys.com/thedailyblog/welcome-to-rewind-friday-some-light monthly 0.5 2014-01-17 https://www.thegaitguys.com/thedailyblog/the-cross-over-gait-did-you-miss-our-teleseminar monthly 0.5 2014-01-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553593193-U6BCZ65511X0D09PRSJG/tumblr_mzh26zCMFa1qhko2so1_1280.png Blog The Cross Over Gait Did you miss our teleseminar presentation on this topic last night on www.onlinece.com ? Here is a sample of one of our slides.  The cross over gait is potentially a real problem for some. The question is always, how much cross over (running or walking) is too much for a client ? When does it need corrected ? Does it need corrected ? Leave it alone ?  We answered these hard questions in our teleseminar.   Lucky for you www.onlineCE.com recorded it so you can take the class anytime !  (just give them a few days to process the recording).  As you can see from just this slide here, we looked at many aspects of the cross over. But we also discussed STEP WIDTH, lateral compartment weakness and tightness as coexisting pathology, and so much more.  Stay tuned, we will be recording this program into an extended and more in depth course for you all in a video format with course notes and more and then have it for you on our Payloadz website (which you can access here for our present offerings). In the mean time, consider looking for these “Big 6” and when you see them co-existing you might want to look for a cross over pattern in your client, it just might be there sometimes. - weak gluteus medius - weak TVA and obliques - weak adductors - weak medial quadriceps - weak tibialis posterior - excessive foot pronation Shawn and Ivo, The Gait Guys https://www.thegaitguys.com/thedailyblog/hallux-varus-the-anti-bunion-thinking-of-bunion monthly 0.5 2014-01-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553594920-1HFY13YILW53XJJR8E08/tumblr_mzge6fmmGg1qhko2so1_1280.jpg Blog Hallux Varus: The anti-bunion. Thinking of bunion surgery ? This could be a complication if things go sour. Hallux varus, when the big toe drifts medially, is a real problem. It is typically an acquired problem from a hallux valgus/bunion surgery gone awry.  (This post will not delve into some of the suspected culprits of this problem including Mc Bride, Scarf, Chevron or Akin osteotomy etc but that would be some of the reader’s next steps into diving deeper into this problem. Surgical procedures to the 1st ray was one of the gait guys senior orthopedic residency thesis topics, hence we now hate this topic !).  This deformity can be rigid or flexible.  This case seen in the photo walked into our office recently.  These are not all that common and you won’t see many of them, but you do need to know they exist and where they can come from, how to cope with them and what issues you will need to understand (ie. footwear, talked about below) to assist your client.  Hallux varus can be painful, uncomfortable and even debilitating in some cases.  Sometimes they necessitate fixation to realign the hallux bone along a more reasonable alignment with the shaft of the 1st metatarsal.    Early correction seems critical because the linear and rotational forces at work generating the deformity can eventually lead to a further progressing deformity that can be even more problematic. When left unaddressed more drastic and radical corrective interventions seem necessary, including but not limited to, resection of the base of the proximal phalanx, fusions and tendon transfers. However, newer surgical procedures are coming along proposing things like reconstruction of the lateral stabilising components of the first metatarsophalangeal (MTP) joint.    So here at The Gait Guys we like to ask the big, and sometimes obvious, questions.  What is toe off in walking and running gait going to look like in this hallux varus case ?  Well, one has to consider that the normal linear and rotational forces are now changed.  This means that the normal eccentric axis of the 1st MPT joint involved is going to very likely be changed. This means that the clearance of the base of the phalanx could be impaired and lead to painful binding, grinding or locking of the toe prior to reaching the adequate range of dorsiflexion for normal toe off. Additionally, the toe may act functionally unstable as the rotational forces remain unchecked leading to joint instability. Naturally, the medial foot tripod will be impaired and since the big toe acts in part like a kickstand to help support and fixate the 1st metatarsal (medial tripod), pronation forces can remain unchecked and beyond normal.  Naturally the foot will attempt to shift the tripod stability elsewhere and often this goes to the 2nd metatarsal commonly found with hammering of the digit in an attempt to help with stability through increased long flexor tone (FDL). Pain with a hallux varus can be a bigger complaint than the unsightly surgical outcome.   There is so much more to this topic. We could go on for at least another 50 pages on this topic (as our thesis reminds us) but volume is not the point of today’s task. It was to bring something new to light for our brethren here at The Gait Guys.  In the photo above, you see drift of the lesser toes, seemingly to follow the big toe. What you need to know is that this is not typical, however not impossible one could propose. This client had some other forefoot procedures done that were largely, although not exclusively, related to that lesser digit drift. Regardless, this is a client that is in some amount of foot trouble. They had good mobility of the 1st MTP joint, so full toe off was possible but because of the instability and uncontrollable rotational forces the joint was painful. A simple intervention made her life infinitely more comfortable, moving her into rigid rocker bottomed shoes.  Dansko clogs for work, and ROCS shoes for walking.  This left us with a very happy client. Not bad, all things considered.  In the mean time we will watch for deformity progression even though the patient could not be urged to have another surgery probably even if their life depended upon it.    In summary, being a patient can be difficult. These days, more than ever it seems, one needs to do their homework and be their own advocate.  Prior to surgery several consults should have taken place, risk and rewards should have been discussed, realistic outcomes dialogued and perhaps most of all questioning whether surgery needed to be on the table in the first place. Remember, surgery is most wisely selected in cases of neurologic decline and excessively painful and further detrimental biomechanics (ie. unaddressed ACL deficiency eventually promoting secondary instability with time). If there are ways around either, they should be explored. Cosmetic correction should never be on the table, and in the case of the foot, nor should poor shoe choices that promote problems. https://www.thegaitguys.com/thedailyblog/take-a-look-at-this-gal-why-does-she-have-a monthly 0.5 2014-01-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553594556-MBF7RBEKZRLQTVEB7SCP/tumblr_mzdis2ueOF1qhko2so1_1280.png Blog Take a look at this gal. Why does she have a cross over gait? note how much tibial varum she has (curvature of the tibial in the coronal plane) how much adduction of the right foot there is, potentially indicating a tight posterior compartment, or perhaps a loss of internal rotation of the right thigh the excessive posterior rotation of the left shoulder and upper body the subtle abduction of the right arm compared to the left the slight torso lean to the left The correct answer is we don’t know until we examine her. Maybe is is there out of necessity or perhaps it is a more efficient running style for her. Here are some points: Technical Issues with the crossover gait The cross over gait may be: a more efficient running style a potential pathologic musculoskeletal motor pattern better for long distance runners a challenge to balance because of a narrower base of support It may also be related to: a weak gluteus medius weak adductors excessive foot pronation lower extremity morpholgy (like tibial varum, forefoot varus) a weak vastus medialis a weak tibialis posterior and the list goes on Join us, tomorrow, Wednesday evening, 8pm EST, 7 CST, 6 MST, 5PCT for an hour of crossover gait on chirocredit.com or onlinece.com for Biomechanics 316. We look forward to seeing you there.. The Gait Guys: Shawn and Ivo https://www.thegaitguys.com/thedailyblog/podcast-51-bouncy-gait-stem-cells-plantar monthly 0.5 2014-01-13 https://www.thegaitguys.com/thedailyblog/so-you-want-to-do-a-gait-analysis-part-2-this-is monthly 0.5 2014-01-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553594601-XGYX0GHNFQKPCOHXN41I/tumblr_myy96cASgW1qhko2so1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553595218-L23UKQB1CP4PMZEMZR1W/tumblr_myy96cASgW1qhko2so2_r1_1280.png Blog https://www.thegaitguys.com/thedailyblog/so-you-want-to-do-a-gait-analysis-part-1-from monthly 0.5 2014-01-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553595435-SHU9IEACFKA4C5WGFK4A/tumblr_myy93yimhF1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553595485-4H9J0VTXV3OF6FNQCNEH/tumblr_myy93yimhF1qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/singer-songwriter-jewel-and-her-knee monthly 0.5 2014-01-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553596348-SA0B94ROXUAQO7XTNES1/tumblr_mx3obv5YZW1qhko2so1_1280.jpg Blog Singer Songwriter Jewel and her knee hyperextension. One of our favorite television shows is “Alaska: The Last Frontier”.  What some of you might not know is that the show is about Singer Songwriter Jewel’s family, the Kilchers. Yes, Her name is Jewel Kilcher.  The theme to the show is written and sung by Jewel and her father Atz Kilcher.  The Kilcher’s are tough folk who live off the grid (mostly) and maintain a subsistence living off the land in Alaska.   Use the photo above to help you clearly understand what we are talking about in this video here (link)  where we see Jewel and her dad getting ready to sing the show’s theme. In this video, Jewel is in some insanely high heeled shoes and being the gait geeks that we are we could not help but notice the degree of knee hyperextension she was displaying.   What can we extrapolate from this genu recurvatum / hyper extension knee posturing  ?: We are going to keep it to things from pelvis down or we will be here all day. Anterior pelvis tilt. She appears to be sitting back into her pelvis so to speak, doing so we can see an increased lumbar lordosis pressing the pelvis anterior.  In many cases combine this with suspect weak lower abdominals and the pelvis drops in the front. This position is often met with isometric contraction of the gluteals helping to maintain the forward/anterior shifted pelvis. The above, will create an abnormal (possibly increased) tensile load on the hamstrings since the ischeal tuberosities are being drawn cephalad (up). This can create a net posterior shift of the knee joint since she is in relative hip extension, the pelvis is often also translated forward into the sagittal plane pushing the head of the femur into anterior glide into the front of the acetabulum. The knees are often locked into hyperextension. This will create meniscal tensions and certainly cause increased patellofemoral pressures.  This can also create the rarely diagnosed, but often present, anteriormeniscofemoral impingement syndrome. In this type of presentation the anterior compressive forces are so great compared to what should be balanced forces around the entire joint that the superior leading edge of the anterior mensicus (can affect medial or lateral menisci) begins to become impinged and irritated as the femur rolls and translates too far anterior. You have to know it exists to make the diagnosis. She will be in ankle plantarflexion because of the footwear instead of balancing the tibia neutrally over the talus.  The tibia will rest on the posterior talus. If constant, the plantarflexion means shorter posterior compartment (gastroc-soleus) and usually weak anterior compartment (tibialis anterior and long extensors of toes).  If she is a runner we bet shin splints were on her holiday list of things to resolve.  These are just the sagittal plane flaws we can assume. There are more but this is plenty to think about right now.  Remember, these are just assumptions. Like in video analysis, anything you pic up on film is just a compensation. It does not tell you what you have wrong until you can test them for neuromuscular integrity and motor pattern assessments.  Do not hang your hat on photos or video analysis. Do the extra work that is required.  After all, you know where ASSUMPTIONS get us. The Gait Guys. Shawn and Ivo https://www.thegaitguys.com/thedailyblog/podcast-50-lactate-thresholds-fartleks-more monthly 0.5 2014-01-03 https://www.thegaitguys.com/thedailyblog/orthotics-and-foot-beds-whats-the monthly 0.5 2014-01-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553596060-VPONU67VZ94SQKCUZFWO/tumblr_myg75lluIF1qhko2so1_250.gif Blog Orthotics and Foot beds, What’s the Difference? Welcome to rewind Friday Folks. Here is an oldie but a goodie, with lots of great information. Rememeber; if you use or prescribe orthotics, hopefully you are using exercises as well and hopefully, the prescription is changing over time and you are removing correction from the device! Orthotics and footbeds, they’re the same thing, right? This is a question that is often posed to us.  No, they’re not the same, but oftentimes one or the other can be appropriate. To explain the difference, we need to understand a little bit about foot mechanics. The foot is a biomechanical marvel.  It is composed of 26 bones and 31 articulations or joints.  The bones and joints work together in concert to propel us through the earth’s gravitational field.  It is a dynamic structure that is constantly moving and changing with its environment, whether it is in or out of footwear.  Problems with the bones or joints of the foot, or the forces that pass through them, can interfere with this symbiosis and create problems which we call diagnoses.  They can range from bunions, plantar fasciitis, shin splints, TFL syndrome, abnormal patellar tracking, and lower back pain just to name a few. Before we go any further, we should talk a little bit about gait (ie walking pattern). Normal walking can be divided into 2 phases, stance and swing. Stance is the time that your foot is in contact with the ground. This is when problems usually occur. Swing is the time the opposite, non weight bearing foot is in the air.   The bones of the foot go through a series of movements while we are in stance phase called pronation and supination. Pronation is when your arch collapses slightly, to make your foot more flexible and able to absorb irregularities in the ground; this is supposed to happen right after your heel hits the ground. As your foot pronates, the leg rotates inward, which causes your knee to rotate in, which causes your thigh to rotate in, which causes you spine to flex forward. Supination is when your foot reforms the arch and makes your foot a rigid lever, to help you propel yourself; This is supposed to happen when you are pushing off with your toes to move forward. It is at this time that the entire process reverses itself, and your leg, knee, and thigh rotate outward and your spine extends backward. When these movements don’t occur, or more often, occur too much, is when problems arise. This can be due to many reasons, such as lack of movement between your foot bones (subluxation), muscle tightness, injury, inflammation, and so on. Many people over pronate, due to incompetence of the intrinsic musculature of the lower kinetic chain, genetics, environmental factors or injuries. This means that their arch stays collapsed too long while in stance phase, and they remain pronated while trying to push off. As we discussed, during pronation the foot is a poor lever. This means you need to overwork to propel yourself forward. This can create arch pain, inflammation on the bottom of the foot (plantar fascitis), abnormal pressure on your foot bones (metatarsalgia), knee pain, hip pain and back pain. Lets look at skiing. Skiing is a stance phase sport. While skiing, your foot stays relatively immobile in a ski or snowboard boot (i.e. it is not moving through a gait cycle). A footbed is designed to create a level surface for your feet and keep them in a neutral posture. It accomplishes this by “bringing the ground up to your foot.” They are generally custom designed to an individuals foot through many different methods. They work incredibly well (as long as the foot remains in a static posture) and many people extol the benefits and improvements in their respective sports when using these. Orthotics are always custom made devices. They actually improve the mechanics of your foot (or give you mechanics you didn’t have before) and make it function more efficiently by altering the shape and function of the arch as the foot moves through various activities. They act like a footbed but have the added benefit of functioning while dynamic (i.e. moving) as well. This works as well or better than a footbed, and is usable in other sporting activities, such as Nordic skiing, snow shoeing, hiking, running, or biking. Many people use their orthotic in their everyday shoes, to help prevent some of the problems and symptoms they are experiencing. It should be emphasized that an orthotic IS NOT a substitution for competent musculature. We view them as an aid to assist the rehabilitation process; slowly pulling out correction as the biomechanical competence improves.  We like to call this “Orthotic Therapy”. In summary, a footbed supports the foot in a neutral posture. It is great for activities where your foot is static or held in one position. An orthotic supports the foot in a neutral posture and improves the mechanical function of the foot. It can be used in static or dynamic activities. Remember to always consult with a professional who is well versed with the mechanics of the feet, ankles, knees, hips and back, since footbeds and orthotics have a profound effect on all these structures. Orthotics and footbeds; they can be great assistive devices along the road to foot competence. And they can be great doorstops when you are done using them! We are and remain..The Gait Guys. https://www.thegaitguys.com/thedailyblog/movement-can-it-make-us-better-humans-this monthly 0.5 2014-01-01 https://www.thegaitguys.com/thedailyblog/on-the-subject-of-manual-muscle-workthere-is-more monthly 0.5 2013-12-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553596678-JO6VRI4KC5X7R7AV2X37/tumblr_myl1kjZFFR1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553597217-8ARNTF3412ZUPZDCODXG/tumblr_myl1kjZFFR1qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/muscle-activation-concerns-we-are-concerned-about monthly 0.5 2013-12-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553598386-9TSKNNCCYKIYOV6AJI2N/tumblr_mykyewP4jQ1qhko2so1_400.jpg Blog Muscle Activation Concerns We are concerned about some things that are showing up in our clinics lately. Strange injury patterns we have not seen before. We know you are all very busy, because you are the best what you do, but we hope that by sharing these 2 articles with you we can all further raise this team of practitioners, coaches, physical therapists, trainers, pilates and yoga instructors, surgeons etc and work even more effectively as a team.   This issue is about muscle activation or facilitation. As you are all learning, this game is more than just turning muscles on, and there are risks to turning something on when the central nervous system has decided it is not safe to turn something on. We are all treating people who are slouched over all day either as students or at desk jobs and thus everyone (seeing as they are all dropped into hip, knee and cervical, thoracic and lumbar spine flexion) will have some degree of inhibited glutes (and thus reciprocal neuro-protective hip flexor tightness) that appear to need activated when the truth is that they need more central extension facillitation. Activating the glutes when there is a central flexion inhibition driver overrides the nervous system’s protective inhibition response. Hence the near-epidemic of hamstring and hip flexor/groin/labrum tear problems we are seeing !   There are logical reasons why something is not activated. Sometimes it is a  1. muscle skill pattern (large diameter nerve, all muscle fiber diameters),  2. sometimes it is an endurance problem (large diameter nerve, small muscle fiber diameter), 3.  sometimes it is a strength problem (largest diameter nerve, largest diameter muscle fibers).  Knowing a problem is driven by 2 or 3 will tell the practitioner that activation will not solve the problem and that activation can force a compensation pattern that can lead to a future injury. Also, sometimes it has nothing to do with the muscles motor nerve activity, it may in fact be about the reciprocal inhibitory neurosensory input (see our post on reciprocal inhibition here).  Hence we wanted to share 2 articles we wrote. These articles were spurred by the magnified influx in the last year of injuries that appear compensatory, meaning they seem to have occurred because alternative compensatory motor patterns were encouraged where there appear to be clear signs that they should not have been encouraged.  In other words, sorry to say this, people with a weaker understanding of how and why the nervous system works are using muscular activation as a tool when it is the wrong tool. When you are pounding a nail, using a screwdriver won’t get you good results, and might get you the wrong results. But, if all you have is a screwdriver … . . The blog posts are below. We strongly believe that many of these injuries we are seeing are not necessary. We always ask ourselves when a person who we have been working on says to us “honest doc, I really did not do anything, I was just running comfortably and the hamstring grabbed at me for no apparent reason.”  These stories always make us look in wards and ask “is this injury my fault ?” “Did this occur because I was activating the wrong muscles and wrong patterns thus forcing them into a less worth protective pattern because I thought I knew better than their nervous system did ?” When we want to learn we judge ourselves and our actions  harshly, for we know we make mistakes and we know we are still students. We know that if it appears simple, it might be a good time to step back and think it through a little more.  Don’t just be an muscle “activator”, be a thinker who occasionally activates when it is appropriate.  The nervous system knows better than you do, accept this and try to figure out why it is shutting things down. http://thegaitguys.tumblr.com/post/68785250796/just-because-a-muscle-tests-weak-doesnt-mean-it-needs http://thegaitguys.tumblr.com/post/68879743040/do-you-do-manual-muscle-testing-following-up-on Shawn and Ivo image from : http://www.emeraldinsight.com/books.htm?chapterid=1775219&show=html https://www.thegaitguys.com/thedailyblog/podcast-49-winter-running-biomechanical-problems monthly 0.5 2013-12-27 https://www.thegaitguys.com/thedailyblog/and-what-have-we-here-the-above-is-a-pedograph monthly 0.5 2013-12-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553598106-095AL5YBD2AS0LAM1MME/tumblr_my9vb37Ozy1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553598996-4NQ3LXGWDGUICW8QMILN/tumblr_my9vb37Ozy1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553598752-3UF46XKYA6BQ0Y4F2NC9/tumblr_my9vb37Ozy1qhko2so3_540.png Blog https://www.thegaitguys.com/thedailyblog/and-the-grinch-with-his-grinch-feet-ice-cold-in monthly 0.5 2013-12-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553599404-3ZJ7XEPO4ZW711T92DTK/tumblr_my9ya5NY2U1qhko2so1_1280.jpg Blog “And the Grinch, with his Grinch-feet ice cold in the snow, stood puzzling and puzzling, how could it be so? It came without ribbons. It came without tags. It came without packages, boxes or bags. And he puzzled and puzzled ‘till his puzzler was sore. Then the Grinch thought of something he hadn’t before. What if Christmas, he thought, doesn’t come from a store? What if Christmas, perhaps, means a little bit more?” Wishing you a safe and blessed holiday! Keep your glutes engaged and your toes up! The Gait Guys https://www.thegaitguys.com/thedailyblog/since-he-has-been-the-man-of-our-latest-few-posts monthly 0.5 2013-12-24 https://www.thegaitguys.com/thedailyblog/usain-again-how-good-are-your-powers-of monthly 0.5 2013-12-23 https://www.thegaitguys.com/thedailyblog/podcast-48-running-tech-cadence-and-running monthly 0.5 2013-12-21 https://www.thegaitguys.com/thedailyblog/ankle-dorsiflexion-even-in-sprinters-who-land-on monthly 0.5 2013-12-17 https://www.thegaitguys.com/thedailyblog/making-a-list-and-checking-it-twice-so-you-or monthly 0.5 2013-12-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553599227-XKGYOW2PQ17Z3ALO3HPG/tumblr_mxvsd6hj8x1qhko2so1_1280.jpg Blog Making a list and checking it twice… So you or someone you are treating/coaching/ rehabbing, etc has muscle weakness, either perceived by them or noted by you, by observation or muscle testing. Have you stopped to think what might be causing the weakness? Cross sectional area is directly proportional to strength. With strength, we are talking predominantly about Type II muscle (remember, Type I is predominantly endurance muscle, due to differing histological structure).  Type II muscle fibers are larger, have fewer capillaries, less myoglobin, fewer mitochiondra . They obtain most of their energy by anaerobic glycolysis, rather than aerobic respiration  (ie the Krebs cycle).  All muscles are made of a mixture of Type I and Type II fibers, but most muscles tend to have a predominance of one over the other. Here we are referring to strength. There are many causes of muscle weakness. Here are a few: Injury to the muscle Injury to the joint the muscle crosses Stretch weakness Tight weakness Neurogenic weakness Myopathic weakness Reflexogenic weakness And the list goes on… The 1st one on the list is an easy one to understand. If you break the machine, it doesn’t work. Torn contractile proteins with leaky sarcoplasmic reticulum (calcium reservoirs) do not allow for efficient contractions. The second on the list is a bit more complex. We remember that that the joint capsules are blessed with four types of mechanoreceptors, aptly named Type I, II, III, and IV, which when stimulated physically, chemically, or thermally apprise the nervous system of the forces acting on that joint as well as its position in space. For a great video review of mechanoreceptors, click here Joint pathology or inflammation will often cause distention of its capsule. The effect of the resulting joint effusion on the actions of the muscles crossing that joint have been examined extensively in the literature. Let’s look at one of the studies and its implications. Reflex Actions of Knee Joint Afferents During Contraction of the Human Quadriceps Iles JF, Stokes M, Young A: Clinical Physiology (10) 1990: 489-500 In this paper, the authors infuse hypotonic saline into the knees of eight asymptomatic individuals (including one of the authors) using a 16 gauge needle (ouch!) and studied its effects on the H reflexes and muscle recruitment. An H reflex is like performing a tendon jerk reflex (the involuntary contraction you would check with a neurological hammer) using an electrical stimulus. The onset time (also called the latency) and its amplitude are recorded. Muscle recruitment is the voluntary contraction of that muscle, measured with electromyography (EMG) by having an electrode either over (surface EMG) or within (needle EMG) the muscle and examining how hard the muscle is working based on the amplitude and frequency of the response. First of all, no one in the study experienced any pain (hmmm, not sure about that) , only the sensation of pressure in their knees (which was considered activation of only the proprioceptors of the joint). The authors found that any pressure increase within the joint capsule depressed the H reflex and inhibited the action of the quadriceps. They hypothesize that this may contribute to pathological weakness after joint injury. So how does all this apply to us? As we all know, lots of patients have joint dysfunction. Joint dysfunction leads to cartilage irritation, which leads to joint effusion. This will inhibit the muscles that cross the joint. This causes the person to become unable to stabilize that joint and develop a compensation pattern. Next the stress is transferred to the connective tissue structures surrounding the joint which, if the force is sufficient, will fail. Now we have a sprain and some of the protective reflexes can take over. Abnormal forces can now be translated to the cartilage. This, if it goes on long enough,  can perpetuate degeneration, which causes further joint dysfunction. The cycle repeats and if someone doesn’t intervene and control the effects of inflammation, restore normal joint motion and rehabilitate the surrounding musculature, the patient’s condition will continue its downward spiral, becoming another statistic contributing to the tremendous economic and physical costs of an injury. And that, my friends, is one mechanism as to how joint effusion disturbs the homeostasis of the musculature surrounding a joint. In future posts, we will examine other causes of muscle weakness. For now, make a list of possible causes before assuming it is just injured or “turned off”. Compensations happen for a reason, and if you remove someone’s compensation pattern, you had better make sure you have another one up your sleeve and that their system is ready for a change. The Gait Guys. Giving you the tools so you can be better. Period.  https://www.thegaitguys.com/thedailyblog/welcome-to-friday-follies-today-we-introduce monthly 0.5 2013-12-13 https://www.thegaitguys.com/thedailyblog/podcast-47-the-thigh-gap-medial-tibial-stress monthly 0.5 2013-12-11 https://www.thegaitguys.com/thedailyblog/does-this-foot-look-like-your-foot-there-are-a monthly 0.5 2013-12-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553599397-I9C3RVV5W3AJ35R3HHT6/tumblr_mun51sTFwU1qhko2so1_1280.jpg Blog Does this foot look like your foot ?  There are a few subtle issues here. At first glance this foot looks half-way decent but upon further observation you should note the subtle drift of all of the toes.  In the foot, the toe that delineates abduction and adduction of the toes is the 2nd toe. The 2nd toe is considered the anatomic middle of the digits and forefoot. Any toe or movement that moves away from the 2nd toe is abduction and any movement towards the 2nd toe is adduction. This is obviously different than in the hand where the 3rd digit is the reference digit.   In this foot, look at the shape of the 2nd and even the 3rd digit, they have a curve to them. Remember, form follows function and the dead give away here is that the hallux (the big toe) is drifting into adduction towards the 2nd digit. This is referred to as early hallux valgus and it is accompanied by early evidence of a bunion at the medial foot at the metatarsophalangeal joint.  When the shaft of the hallux is not in line with the shaft of the metatarsal long bone we get the angulation between the two causing the hallux valgus.  This is often from excessive pronation (either rearfoot, midfoot and/or forefoot) that collapses the tripod, splays the distal MET head via its dorsiflexion, and the development of complicated long and short hallux flexor muscle dysfunction as well as abductor hallucis (transverse and oblique head) disfunction further driving the hallux pull medially.  When the distal toes are engaged on the ground and there is still forefoot pronation occurring through the medial tripod support, the toes will be forced into a twist or spin, and in time you will get toes that appear drifted or windswept like these toes appear.  A similar phenomenon occurs at the lateral foot and a Tailor’s bunion begins to occur there as the forefoot begins to widen as the MET heads separate and the toes funnel medially (often provoked to do so by pointed footwear).   We can also see the 4th and 5th toes curl under from the probably weak lateral head of the quadratus plantae thus encouraging unopposed oblique pull of the long flexors of the digits (FDL). See this post here for an explanation of this phenomenon.   This is a fairly typical foot that we see in our practices.  This is not a far-gone foot but one has to catch this foot at this stage or it is rather difficult to resuscitate back to a healthy foot. Like a spinal scoliosis, once a bunion and  hallux valgus gets too far, it becomes an issue of symptom management rather than repair.  Hallux abduction must be retaught, tripod skills must be retaught, intrinsic foot muscle strength must be regained as well as strength and endurance of the tibialis anterior and toe extensors to help raise the arch again and control pronation. Sometimes a temporary orthotic can help the person to passively regain some degree of competent tripod while homework earns the changes. In some cases, an orthotic needs to be a permanent intervention if tripod stability cannot be adequately achieved.  But, we never give up and neither should you or your client, amazing things can happen over long periods of time when correction is forced. There is plenty of life left in this foot, but you have to get to it quickly and get them in lower heeled shoes if tolerable and ones with a wider toe box.  Support the midfoot with an orthotic or built up foot bed, if necessary, but don’t leave it there. It is a crutch, and even crutches are intended to be put aside at some point.  Shawn and Ivo, The gait guys https://www.thegaitguys.com/thedailyblog/take-this-simple-test-want-to-be-faster-better monthly 0.5 2013-12-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553600380-E9527TXF2YZKSIDGRCS9/tumblr_mxi3mgdqCf1qhko2so1_1280.jpg Blog Take this simple test.  Want to be faster? Better incorporate some proprioceptive training into your plan. It is the 1st part of our mantra: Skill, Endurance, and Strength (in that order). Proprioceptive training appears to be more important that strength or endurance training from an injury rehabilitation perspective as well part of an injury prevention program  What is proprioception? It is body position awareness; ie: knowing what your limbs are doing without having to look at them. Take this simple test: Stand in a doorway with your shoes off. Keep your arms up at your sides so that you can brace yourself in case you start to fall. Lift your toes slightly so that only your foot tripod remains on the ground (ie the base of the big toe, the base of the little toe and the center of the heel.). Are you able to balance without difficulty? Good, all 3 systems (vision, vestibular and proprioceptive) are go. Now close your eyes, taking away vision from the 3 systems that keep us upright in the gravitational plane. Are you able to balance for 30 seconds? If so, your vestibular and proprioceptive systems are intact. Now open your eyes and look up at the ceiling. Provided you can balance without falling, now close your eyes. Extending your neck 60 degrees just took out the lateral semicircular canals of the vestibular system (see here for more info). Are you still able to balance for 30 seconds? If so, congrats; your proprioceptive system (the receptors in the joints, ligaments and muscles) is working great. If not, looks like you have some work to do. You can begin with exercises we use every day by clicking here. Proprioception should be the 1st part of any training and/or rehabilitation program. If you don’t have a good framework to hang the rest of your training on, then you are asking for trouble.  The Gait Guys. Your proprioceptive mentors. We want you to succeed! https://www.thegaitguys.com/thedailyblog/is-your-5th-toe-curled-under-what-do-you-do-when monthly 0.5 2013-12-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553599983-A1NSXYONIDP8A9UMMJND/tumblr_mwzu9gTBzS1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553600360-ONG6GFXBGFOI5LM8ICQK/tumblr_mwzu9gTBzS1qhko2so2_400.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553601762-F9EL1FMBMKJUI5XR6XL3/tumblr_mwzu9gTBzS1qhko2so3_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553602017-17SV0YZ9NFQ0R2708J9G/tumblr_mwzu9gTBzS1qhko2so4_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/do-you-do-manual-muscle-testing-following-up-on monthly 0.5 2013-12-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553602257-YR63XOHYD0ZJP8860MUY/tumblr_mvtqrj0cqk1qhko2so1_500.jpg Blog Do you do manual muscle testing? Following up on yesterdays post… We all like to evaluate our patients; hopefully on the table as well as observation while weight bearing. Here is some food for thought. When your patient or client is lying on the table, do you pay attention to where there head is in space (ie the position of their head)? Why should you care? Remember our post on facilitation (if not, click here)? That has something to do with it. Here is the short story. Make sure the head is neutral and midline (lined up between the shoulders), there is good preservation of the cervical curve , with a small pillow supporting the neck, but not altering it’s angle. The long story involves the vestibular system. It is a part of the nervous system that lives between your ears (literally) and monitors position and velocity of movement of the head. There are three hula hoop type structures called “semicircular canals” (see picture above) that monitor rotational and tilt position and angular acceleration, as well as two other structures, the utricle and saccule, which monitor tilt and linear acceleration. I think you can see where this is going…. The vestibular apparatus (the canals and the utricle and saccule) feed into a part of the brain called the floccular nodular lobe of the cerebellum, which as we are sure you can imagine, have something to do with balance and coordination. This area of the cerebellum feeds back to the vestibular system (actually the vestibular nucleii); which then feed back up to the brain as well as (you guessed it) down the spinal cord and to predominantly the extensor muscles. So, what do you think happens if we facilitate (or defaciltate) a neuronal pool? We alter outcomes and don’t see a clear picture. Look at the picture above. Notice the lateral semicicular canals are 30 degrees to the horizontal? If you are lying flat, they are now at 60 degrees. If the head is resting on a pillow and flexed forward 30 degrees, the canals are vertical and rendered inoperable. This could be good (or bad) depending on what muscle groups you are testing. OK. HEAVY CONCEPT APPROACHING So if we defacilitate the extensors, what happens to the flexors? Remember reciprocal inhibition (If not click here)? According to the law of reciprocal innervation, the flexors will be MORE FACILITATED. If the extensors are faciltated, they will appear MORE ACTIVE and the flexors LESS ACTIVE. Wow. All this from head position…The key herer is to know what you are doing, This gait stuff can get pretty complex; but don’t worry. We aren’t going anywhere and are here to teach you. The Gait Guys . Gait Geeks are the new cool…. https://www.thegaitguys.com/thedailyblog/just-because-a-muscle-tests-weak-doesnt-mean-it monthly 0.5 2013-12-02 https://www.thegaitguys.com/thedailyblog/podcast-46-georges-st-pierre-regenokine monthly 0.5 2013-11-27 https://www.thegaitguys.com/thedailyblog/want-more-stability-when-trail-running-try monthly 0.5 2013-11-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553602576-G54T666VBOTGFF2XC6E9/tumblr_mwq1krByrE1qhko2so1_1280.jpg Blog Want more stability when trail running? Try this… While running the other morning through about 6-8” of fresh snow (yes, it is snowing here already at 9000 feet), something occurred to me as I almost fell several times due to the undulating surface beneath my feet and the terrain to match under that. “I need to do something to improve my proprioception, or I am going to fall (again)” I thought (yes, we both think about this stuff while running or exercising! No, I was not listening to music on this run, though cranking up some AC/DC was tempting..). If I were to increase my surface area on the snow, and make myself less top heavy, I would be more stable. How could I accomplish that? Here is what I did, and it worked great! First, I spread my toes. No, I wasn’t barefoot, but in my Altra Lone Peak 1.5’s; why not maximize the real estate available to my feet in these roomy shoes? Next, I widened my stance (or base of gait). My massive 145# spread over a larger surface area would be more stable and provide stability from my weight distributed over a larger surface area. Third, I raised my arms out from my sides (no I didn’t try to fly) to provide more input from my upper extremities to my proprioceptive system (more input from peripheral joint and muscle mechanoreceptors = more input to cerebellum = better balance) Lastly, I slowed down from my blistering 10 min mile pace. Though this did not improve my surface area, it did give my aging nervous system more time to react. It occurred to me that these actions were all “primitive” reactions of the nervous system when learning to walk. We did a post on that when my youngest son was learning to walk a few years ago. Want to have better balance? Spread your toes Widen your stance Raise your arms Slow down Notice I didn’t say this would make you faster. Who is more likely to fall on a corner when being chased by a predator; the tortoise or the hare?   A little practical neurology for you this morning brought to you by the geeks of gait. Ivo and Shawn.   https://www.thegaitguys.com/thedailyblog/allens-rule-is-this-why-the-kenyans-are-better monthly 0.5 2013-11-25 https://www.thegaitguys.com/thedailyblog/podcast-45-spock-ankle-syndesmosis-injuries-and monthly 0.5 2013-11-22 https://www.thegaitguys.com/thedailyblog/heads-up-remember-that-song-hold-your-head-up monthly 0.5 2013-11-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553602764-R5GLZKZ2W8F9SRZOKFND/tumblr_mw4vu62aZ51qhko2so1_400.jpg Blog Heads up! Remember that song “Hold Your Head Up” by the British  band “Argent” in 1972? Ok, maybe not, but the principle is very important to runners and sprinters, so lets talk about it a bit.  We are wired to maintain our visual axes parallel to the horizon. This involves a series of joint and muscle mechanoreceptors in the neck (for a review of joint mechanoreceptors, click here, muscle mechanoreceptors, click here). These muscle and joint mecanoreceptors receptors, through connections in the midbrain (or mesencephalon as we neuro geeks like to call it) and pons, interact with the vestibular system to keep our head (and our bodies) upright, by firing our extensor muscles. Berta Bobath, physiotherapist, wrote a great book in 1965 entitled “Abnormal Postural Reflex Activity Caused By Brain Lesions”. In it she describes, among many things, reflexes involving the cervical spine and correlating them to motor function. One of these is the cervical extensor reflex. To explain this reflex, think of a dog sitting to get a treat. As he looks up while sitting down he has to extend his head, extend his front legs and fires all the axial extensor muscles associated with performing this action. The opposite would also happen, but with the flexors, if he were to bend forward to take a drink; fire front flexors and rear extensors to bend down. There are many more reflexes (tonic neck, cervcio ocular, etc) that could be the subject of another post. As we have learned from the principle of facilitation (see recent post here), when we fire pur extensors, we fire into the extensor pool, and as a result, ALL extensors get to benefit. The advantage of the receptors in the cervial spine is that the upper four fire DIRECTLY into the flocculo nodular lobe of the cerebellum, and thus have a PROFOUND EFFECT on extensor tone in general. So, if you want to go faster, why not hold your head up and FIRE YOUR EXTENSORS MORE? Hmmm….Where have you heard this before? Another magic bullet, courtesy of your built in neurology, we are sharing with you so you and your clients, patients and friends can be better at what they do The Gait Guys. Stretching your neurology on a daily basis. https://www.thegaitguys.com/thedailyblog/master-of-your-own-physiology-you-dont-need monthly 0.5 2013-11-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553602702-JM8YVGIDX8S7J2C9K40R/tumblr_mvcyteqxwg1qhko2so1_1280.png Blog  Master of your own physiology You don’t need perfect mechanics to win. Look at these fine gents and take note. On the left we have Kenensia “Canny” Bekele, world and Olympic 5,000m and 10,000m world record holder, who sat back as Mo Farah and Haile Gebrselassie set the pace for most of the race, and then sprinted at the end and won by 1 second. Note the crossover and lack of space between his thighs. Note also the internal tibial torsion of the left tibia and slight head tilt to the right. In the middle is Mo Farah, the current 10,000 meter Olympic and World champion and 5000 meter Olympic, World and European champion. look at the pelvic dip on the right..and the valgus angle of the left knee…and external tibail torsion of the left tibia…and the differing arm swing (right side abducted). Finally, on the right,  we have Haile Gebrselassie, an Ethiopian like Bekele, who won two Olympic gold medals over 10,000 meters and four Wld Championship titles in the event. He won the Berlin Marathon four times consecutively and also had three straight wins at the Dubai Marathon.  At 40, he is the eldest of the group, with his right lower extremity external tibial torsion and subtle dip of the left pelvis on right sided weight bearing. So What? All these great athletes have mastered their own physiology and overcome any biomechanical faults they may appear to have. Could they be faster? Maybe. We think so. Your body will find a way to compensate. That does not mean you will be slower. It means, like each of these men, that you will probably be injured at some point. In the words of Big Z from Surf’s Up “Winners find a way”. You can too and so can your clients and athletes. Skill, endurance and strength. The big 3. Make sure you an the folks you care for have them. We are The Gait Guys. Teaching you more with each post we write and helping you sort through the sea of information out there. https://www.thegaitguys.com/thedailyblog/the-one-cheek-sneak-and-your-gait-yup-you-know monthly 0.5 2013-11-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553603245-RKFTO6CABZJ1NP5FZZ1Y/tumblr_mwdd90MDUC1qhko2so1_500.jpg Blog The One Cheek Sneak and Your Gait. Yup. You know what we are talking about.  Out gassing. Passing gas. Trouser coughing. Flatulating (is that a word?) Tooting. Farting.. Call it what you like. Exemplified by Shinta Cho’s classic “The Gas We Pass”. The question is, why is it relevant to gait? If you have followed us for any length of time, you know how important we think the glutes are.  We have many posts and blog articles on their importance and exercises to strengthen them.  The problem is, when most people do them, they THINK they are contracting their glutes (and some are) BUT they are ALSO contracting their (external anal) sphincter (for you neuro nerds,  the internal sphincter is not under voluntary control). This results in gas retention, which may cause a stomach ache, or in rare instances, distention of the bowel. Chances are, when  you relax, it will come out then (yes, you fart in your sleep, as your bedfellow for an honest answer !). Try this. Sit down and and contract your glutes and your external sphincter. Now try and contract your external sphincter, ONLY. Contracting the external sphincter also engages the pelvic floor. Not necessarily something you need to do (unless you are treating an incontinence issue but then again that more recently under hot debate, here read our blog post here for some truths and myths on this topic) when running. OK, now just the glutes. You can palpate them (glutes only please) to make sure they are contracting. You are now experiencing isolation of the individual muscles. You should be able to access them individually, as well as together. For an added challenge in your powers of isolation, you can then try this exercise after consuming beans (as you flog your gut with their poisonous lectins) , to test your true abilities. There are other related issues here to consider, one is the Kegal exercise. As we mentioned in another blog post (link here): “A Kegel attempts to strengthen the pelvic floor, but it really only continues to pull the sacrum inward promoting even more weakness, and more PF (pelvic floor) gripping. The muscles that balance out the anterior pull on the sacrum are the glutes. A lack of glutes (having no butt) is what makes this group so much more susceptible to pelvic floor disorder (PFD). Zero lumbar curvature (missing the little curve at the small of the back) is the most [we would chose to say a nicely speculative] telling sign that the pelvic floor is beginning to weaken. An easier way to say this is: Weak glutes + too many Kegels = PFD.”-Nicole Crawford (1) Many exercises are designed to help train your nervous system and create a new motor pattern, in addition to strengthening and or creating endurance in the targeted muscles.  Your external sphincter probably has plenty of strength and endurance. The Gait Guys.  Bringing you the relevance in the seemingly irrelevant. All Gait; All the time…  1. Here is Crawford’s article link. http://breakingmuscle.com/womens-fitness/stop-doing-kegels-real-pelvic-floor-advice-women-and-men All material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved. We have Lee and know how to use him https://www.thegaitguys.com/thedailyblog/podcast-44-new-knee-ligaments-and-ankle-rocker monthly 0.5 2013-11-14 https://www.thegaitguys.com/thedailyblog/soccerfootball-cleats-do-you-know-all-you-should monthly 0.5 2013-11-12 https://www.thegaitguys.com/thedailyblog/knowing-this-will-not-mistakenly-leave-one-with monthly 0.5 2013-11-11 https://www.thegaitguys.com/thedailyblog/pod-43-achilles-problems-neurology-of-watching monthly 0.5 2013-11-07 https://www.thegaitguys.com/thedailyblog/video-case-the-kings-preference-short-and monthly 0.5 2013-11-06 https://www.thegaitguys.com/thedailyblog/podcast-42-rhabdo-bionics-and-turf-toe monthly 0.5 2013-11-05 https://www.thegaitguys.com/thedailyblog/according-to-the-cdc-falls-are-the-number-one monthly 0.5 2013-11-04 https://www.thegaitguys.com/thedailyblog/hip-abduction-moment-this-was-a-great-question monthly 0.5 2013-10-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553603510-P4ZWUUKJCLOIK8185DPV/tumblr_mvcjetUi171qhko2so1_540.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553603676-MT05ORS3PE94AZNHU9KO/tumblr_mvcjetUi171qhko2so2_540.png Blog https://www.thegaitguys.com/thedailyblog/join-us-wednesday-evening monthly 0.5 2013-10-28 https://www.thegaitguys.com/thedailyblog/the-power-of-facilitation-how-to-supercharge-your monthly 0.5 2013-10-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553603785-JEQQNXCU9ZQT5Q530F44/tumblr_mv7i93JhZK1qhko2so1_1280.jpg Blog The Power of Facilitation: How to supercharge your run. While running intervals this crisp, cool 19 degree morning, something dawned on me. My left knee was hurting from some patellar tracking issues, but only on initial contact and toe off. I generally run with a midfoot strike. I began concentrating on my feet, lifted and spread my toes and voila! my knee pain instantly improved. Very cool, and that is why I am writing this today.  Without getting bogged down in the mire of quad/hamstring facilitation patterns, lets look at what happened. I contracted the long extensors of the toes: the extensor digitorum longus and the extensor hallicus longus; the short extensors of my toes: the extensor digitorum brevis, the extensor hallucis brevis: as well as the dorsal interossei.the peroneus longus, brevis and tertius were probably involved as well. Do you note a central theme here? They are all extensors. So what, you say. Hmmm…  Lets think about this from a neurological perspective: In the nervous system, we have 2 principles called convergence and divergence. Convergence is when many neurons synapse on one (or a group of fewer) neuron(s). It takes information and “simplifies” it, making information processing easier or more streamlined. Divergence is the opposite, where one(or a few) neurons synapse on a larger group. It takes information and makes it more complicated, or offers it more options. In the spinal cord, motor neurons are arranged in sections or “pools” as we like to call them in the gray matter of the cord. These pools receive afferent information  and perform segmental processing (all the info coming in at that spinal cord segment) before the information travels up to higher centers (like the cerebellum and cortex). One of these pools fires the extensor muscles and another fires the flexor muscles..  If someone in the movie theater keeps kicking the back of our seat, after a while, you will say (or do) something to try and get them to stop. You have reached the threshold of your patience. Neurons also have a threshold for firing.  If they don’t reach threshold, they don’t fire; to them it is black and white. Stimuli applied to the neuron either takes them closer to or farther from threshold.  When a stimulus takes them closer to firing, we say they are “facilitating” the neuron. If it affects a “pool” of neurons, then that neuronal pool is facilitated. If that pool of neurons happens to fire extensor muscles, then that “extensor pool” is facilitated. When I consciously fired my extensor muscles, two things happened: 1. Through divergence, I sent information from my brain (fewer neurons in the cortico spinal pathway) to the motor neuron pools of my extensor muscles (larger groups of motor neurons) facilitating them and bringing them closer to threshold for firing and 2. When my extensor muscles fired, they sent that information (via muscle spindles, golgi tendon organs, joint mechnoreceptors, etc) back to my cerebellum, brain stem and cortex (convergence) to monitor and modulate the response. When I fired my extensor muscles, I facilitated ALL the neuronal pools of ALL the extensors of the foot and lower kinetic chain. This was enough to create balance between my flexors and extensors and normalize my knee mechanics. If you have followed us for any amount of time, you know that it is often “all about the extensors” and this post exemplifies that fact.  Next time you are running, have a consciousness of your extensors. Think about lifting and spreading our toes, or consciously not clenching them. Attempt to dorsiflex your ankles and engage your glutes. It just may make your knees feel better! The Gait Guys. Facilitating your neuronal pools with each and every post. All material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved. If you rip off our stuff, we will send Lee after you! https://www.thegaitguys.com/thedailyblog/podcast-41-the-ankle-dorsiflexion-podcast monthly 0.5 2013-10-24 https://www.thegaitguys.com/thedailyblog/look-at-these-kids-running-all-but-one-shows monthly 0.5 2013-10-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553605320-VBI7YMXFMXMG8WK42SAU/tumblr_muw8tiOjlr1qhko2so1_1280.png Blog Look at these kids running …  all but one shows poor form, but remember, these kids are still undergoing neurodevelopment and are learning to control their body parts. Remember, the maturation/myelination of the nervous system usually lags behind the development of the musculoskeletal system.  In the photo, lets first focus on the happy lad in the green shirt. He sure looks like he is having fun, which is what running should be about in kids. If you try to make running a chore for kids you just might lose their love of it in the process. But our point here at The Gait Guys is to teach. So here in this photo are some good teaching points. You should see: 1- the stance phase leg (right leg) is spun out into external rotation. Not too much of a big deal because we do not know if he has finished the normal derotation process of the limb, sometimes this can carry into the puberty years even though for most kids the process is largely completed by his predicted age. 2- The pelvis has drifted laterally in the frontal plane past a perpendicular line up from his foot. This could mean alot of things including gluteus medius or abdominal weakness but the point here is that he has broken through the lateral line (frontal plane) of support up through the hip-pelvis-core chain. This is going to set up what the the left knee (swing leg) is doing and will set up #3. 3. Cross over gait is virtually guaranteed because of the lateral pelvis drift as noted in #2. It is virtually guaranteed as well because the swlng leg knee coming inwards is dictating it. IF the knee is coming inwards toward the midline the thing attached to it , the foot, is going to follow. The swing leg is a pendulum, if you shift the pivot point of the pendulum (in this case to his right) the pendulum will swing to the right. This is a self-perpetuating cycle and it will not correct without strengthening, awareness and drilling positive feedback changes. 4. Dr. Allen’s current thought experiment on Ballasts (see podcast 38) is playing out here with the left arm of this fella. If the pelvis drifts far to the right, the arm will move away from the body to move some of the left side body weight outwards to negate the right shift. This is pure balance physics.  Arm swing most of the time cannot be corrected without correcting the thing that causes the aberrant arm swing, and that is often (but not exclusively) aberrant lower limb and pelvis-hip-core or foot mechanics. There are exceptions, but often if you fix the lower limb and pelvis-hip mechanics  you will see an immediate change in the arm swing. If you force changes in arm swing without fixing the problem (and that is not to say there are not local arm swing etiologies) you may be  driving strength into a compensation pattern that you may not want or like. 5. The girl in the pink tights  … . she might have been modelling the boy in the green shirt. Same issues, same concerns. 6. The form we love the most ? The boy in the dark blue shirt and black shorts on the far right. Great form, no major issues here. We bet he didn’t hear the starters gun go off. On a side note, the fella in the green shirt with that form he would be a champion race walker. He already has the hip action right, the cross over that is loved in that sport and the arm swing.  Maybe some exposure to an alternate sport is a better solution here ? Although we are always an advocate for correcting flawed biomechanics. It is often painful for us to watch kids run. We know that much of the things we hate are temporary because of the neuro-developmental process. But sometimes, if kids run too much at a young age, and are pressed into long running miles or cross country at too young an age, these aberrant mechanics can become their new norm. This is the danger of plasticity in the nervous system. Repeated stimulation of a pattern engrains that pattern and the extent of a brain’s plasticity is dependent on the stage of neuro-development and the brain region affected.  When an aberrant running form is allowed to perpetuate into the mid-teenage years, when the majority of the synapses are already formed and neurologic “pruning” and myelination are ramping up, then the repeated exposure to the aberrant pattern can get the myelination. This is the most frustrating thing for us. We would rather see some intervention early on with the creation, strengthening and myelinating of correct motor patterns through skill development training rather than mileage training, rather than discarding the more appropriate synapses that could have, might have, should have, been formed. Our bodies and brain will develop depending on the exposures and demands put upon it. And here is the big key, if you do not clean up someone’s gait aberrancy(s) early on, one should not wonder down the road why they developed flat feet, bunions, early degenerative knees and the like. This is a fairly predictable machine, but you have to try to intervene early to prevent the slings and arrows of outrageous misfortune later on. Both the brain and the body will adapt to their environment, whether that is an optimal one or a compensatory one. It can myelinate either pathway. Which one will you choose for your kids ? Shawn and Ivo, The Gait Guys https://www.thegaitguys.com/thedailyblog/do-you-kick-or-scrape-the-inside-of-your-ankle monthly 0.5 2013-10-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553605373-UC604DDHZ6EA88DPOJEC/tumblr_mun52axd261qhko2so1_500.jpg Blog Do you kick or scrape the inside of your ankle with the other foot ? We are moving into the final throws of cross country season now and we are seeing the pathologies creep in and the miles go up. Some of you who have been with us for 3 years  have seen this picture but we realized we did not have a blog post on the problem represented by this photo.  This young runner had these scuff marks on the inside of the right lower leg and ankle after a cross country meet.  So what is going on here and what does it tell you ? Some runners notice that they repeatedly will scuff in the inside ankle or inner calf with the opposite shoe when running. This can happen on both sides but it is more often present unilaterally than bilaterally.  This problem, typically, but not always represents one of two things: 1- cross over gait (if you are new to our blog in the SEARCH box type in “cross over” and “cross over gait” and be sure to see our 3 part video on the cross over on our youtube channel found here). 2- negative foot progression angle which may or may not be combined with a degree of internal tibial torsion.  Said easier, the runner is “in-toed” or “pigeon toed” but if you have been here with us awhile on The Gait Guys we expect a diagnosis of a higher order so use the former terms, please. Lets discuss both. 1- Cross over.  When the runner is standing on the right leg, right stance phase of gait, the frontal plane is not properly engaged and the pelvis can drift further over the right foot. This drift to the right will drop the pelvis on the left side. This will alter the pendulum movement of the left leg. Since the global pelvis is moving to the right the left swing leg pendulum moves to the right as well and as it swings past the stance leg it strikes a glancing blow to the inside of the right ankle or calf. This is simple biomechanics and physics. To fix this problem, which is clearly inefficient, one has to determine what is causing the right pelvis drift (there are many causes, the most often thought of cause is a weak gluteus medius on the right but if you have been here with us awhile you will know there are other causes) and then fix the drift. Do not assume it is the gluteus medius all the time, for if it is not, and you employ more glute medius exercises you could be ignoring the source and building a deeper compensation pattern.  Fix the problem, not what you see. 2- Negative foot progression angle and/or internal tibial torsion.  In order to fix this you have to know first if you are dealing with a fixed/rigid anatomic tibial or femoral torsion issue which cannot be fixed or if you are dealing with a flexible progression angle issue. Often, “in-toeing” is accompanied with internal tibial torsion, this is because the knee has to progress forward to keep its tracking mechanics clean, if you correct someone’s foot progression back to neutral and they have internal tibial torsion then you have dragged the patellar tracking outside the normal sagittal progression angle, knee pain will ensue. In fact, the foot progression on the ankle is normal, but the tibia or femur are merely torsioned in a manner that drags the foot inwards with the long bone orientation, again, this is driven by a higher order/demand, to normally track the patella sagittally (forward).  However, if this is a pre-puberty individual you have time because the long bone derotation process is still occuring. Give homework to encourage a good foot tripod and work to strengthen the external hip rotators and encourage sagittal knee tracking mechanics. This is a delicate balancing act, but it can be done, but it is a monster of a project for a blog post because each case is different, variable and always changing depending on the client progress. Remember, you can only encourage more appropriate mechanics and hope that the body will embrace some of the change and encourage some of the de-rotation process to occur from the long bone growth plates.  The “inside scuff”, to identify its solution you have to know the cause. After all, if it was as easy a fix as “stop doing that” no one would be doing it and we would be out of a job. Shawn and Ivo …… The Gait Guys  https://www.thegaitguys.com/thedailyblog/podcast-40-trips-falls-and-nfl-shoe-injuries monthly 0.5 2013-10-17 https://www.thegaitguys.com/thedailyblog/the-power-to-bend-bones-what-have-we-here-hmmm monthly 0.5 2013-10-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553605827-WASGS4TXJOI94DZALHNG/tumblr_mumzdeHw9w1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553606293-V4FP4G3LF6EV9URHYJP7/tumblr_mumzdeHw9w1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553606054-4I8M0KWLBX18YG4J7MY1/tumblr_mumzdeHw9w1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553606383-HZDH1I6R3A4F6ZHXUKRL/tumblr_mumzdeHw9w1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553606696-2KJYKJ516X9VV6R7IAXF/tumblr_mumzdeHw9w1qhko2so5_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/you-create-your-own-gait-problems-just-a-simple monthly 0.5 2013-10-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553606802-4HTBH718NTIM0QOMQ2VQ/tumblr_mun4vkY4vF1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553607307-TD3ENGXAP57UIOXHMBB9/tumblr_mun4vkY4vF1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/video-wow-he-just-lifted-232-kg-that-is-511 monthly 0.5 2013-10-10 https://www.thegaitguys.com/thedailyblog/can-you-see-the-problem-in-this-runners-gait monthly 0.5 2013-10-09 https://www.thegaitguys.com/thedailyblog/trade-secret-proper-calf-raise-we-are-selling monthly 0.5 2013-10-07 https://www.thegaitguys.com/thedailyblog/footprints-in-the-sand-what-do-they-tell-us monthly 0.5 2013-10-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553607754-YCD5LIZPZUR4DTAWPHIP/tumblr_mu0ouosKob1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553609046-ZQEFFWCPUJ93V7G2SQVY/tumblr_mu0ouosKob1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553608869-UI4YHSZS29OVZVY0J2EX/tumblr_mu0ouosKob1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553609499-1O9FG8SE7048UPFCC7EG/tumblr_mu0ouosKob1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/if-you-create-it-they-may-not-come monthly 0.5 2013-10-02 https://www.thegaitguys.com/thedailyblog/its-that-time-of-the-year-againbeach monthly 0.5 2013-10-01 https://www.thegaitguys.com/thedailyblog/approaching-joint-assessment-from-the-perspective monthly 0.5 2013-09-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553609411-T3A85OBTZF9S3L38G7H1/tumblr_msx5cpbLpS1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553610165-1UEKM9CT40J2WDDBGTXA/tumblr_msx5cpbLpS1qhko2so2_r1_1280.png Blog https://www.thegaitguys.com/thedailyblog/podcast-39-ankle-mobilizations-plyos-bunions monthly 0.5 2013-09-26 https://www.thegaitguys.com/thedailyblog/the-case-of-the-non-rotating-knee-here-is-a monthly 0.5 2013-09-24 https://www.thegaitguys.com/thedailyblog/lebron-james-and-his-funky-toes-we-have-the-scoop monthly 0.5 2013-09-23 https://www.thegaitguys.com/thedailyblog/podcast-38-usain-bolt-arm-swing-ballasts monthly 0.5 2013-09-19 https://www.thegaitguys.com/thedailyblog/what-does-changing-your-stride-cost-you monthly 0.5 2013-09-17 https://www.thegaitguys.com/thedailyblog/within-months-hundreds-of-the-young-male monthly 0.5 2013-09-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553610619-B3XXP0AHFIC7I2C6DYLK/tumblr_mt74udHZmI1qhko2so1_r1_1280.jpg Blog  “… within months, hundreds of the young male inmates of the camp began limping, and had begun to use sticks as crutches to propel themselves about. In some cases inmates had been rapidly reduced to crawling on their backsides to make their ways through the compound …. Once the inmates had ingested enough of the culprit plant, it was as if a silent fire had been lit within their bodies. There was no turning back from this fire—once kindled, it would burn until the person … would ultimately be crippled …. The more they’d eaten, the worse the consequences—but in any case, once the effects had begun, there was simply no way to reverse them …. ” -insights from Dr. Arthur Kessler, prisoner and doctor within the concentration camp What would you do if you were trapped out in the wilderness and your glutes and legs stopped working ? This is just what happened to Christopher McCandless (aka, Alexander Supertramp) in the wilderness outside Fairbanks Alaska. Neurolathyrism is a toxic myelopathy caused from ingestion of Lathyrus sativus grass pea. It causes paralysis, lack of strength or inability to move the lower limbs and may involve the pyramidal tracts of the spine/CNS producing UMN signs (upper motor neuron signs).  A unique symptoms of lathyrism is apparently the atrophy of the gluteal muscles.    Dear Gait Guys, why are you telling us obscure things about a toxic neuropathy ?   Ok, let us back up. But for you to understand we first need to tell you about a 1940’s Holocaust concentration camp in the Ukraine. Vapniarka is a presently a small town of ~8600 in Vinnytsia, Obllast, Ukraine.  It was during the months of October 1941 through March of 1944 it became the site for the German occupied Holocaust concentration camp imprisoning Romanian Jews.  As most concentration camps go, food, water, sanitation and disease outbreaks were common problems and concerns. Food was so limited that the prisoners were at one point fed barley bread that had 20% straw mix within and a species of pea known as Lathyrus sativus typically used to feed livestock.  It was only a short time later that strange symptoms began to break out amongst the prisoners. At first they became weak but it wasn’t long before they had difficulties ambulating and then became paralyzed with what was diagnosed as Neurolathyrism also known more simply as Lathyrism, a form of spastic paralysis. The culprit was oxalyldiaminopropionic acid (ODAP) from the peas. Some sources say that by 1943 hundreds of prisoners were struck down with Lathyrism and apparently 117 Jews were left permanently paralyzed. We believe we first read about this in early 2013 in an online news article by Ronald Hamilton in a paper entitled “The Silent Fire: ODAP and the Death of Christopher McCandless”. McCandless has been made famous for his story and death deep in the Alaska wilderness in the Jon Krakauer book “Into the Wild”. We were excited to see this paper quoted in Jon Krakauer’s The New Yorker article this month. In his paper Hamilton wrote,   "… within months, hundreds of the young male inmates of the camp began limping, and had begun to use sticks as crutches to propel themselves about. In some cases inmates had been rapidly reduced to crawling on their backsides to make their ways through the compound …. Once the inmates had ingested enough of the culprit plant, it was as if a silent fire had been lit within their bodies. There was no turning back from this fire—once kindled, it would burn until the person who had eaten the grasspea would ultimately be crippled …. The more they’d eaten, the worse the consequences—but in any case, once the effects had begun, there was simply no way to reverse them …. “ In Krakauer’s recent The New Yorker article "How Chris McCandless Died”, he gives an explanatory full-circle synopsis regarding the gripping conclusion in his book “Into the Wild”.  In the article he speaks about Hamilton’s paper, McCandless’s fate and also mentions that in the 20th century more than a hundred thousand other people worldwide have been permanently paralyzed from eating grass pea containing the neurotoxin ODAP. According to Hamilton, the neurotoxin over-stimulates the nerve receptors causing them to burn out. As he explained in his “The Silent Fire” paper, “It isn’t clear why, but the most vulnerable neurons to this catastrophic breakdown are the ones that regulate leg movement…. And when sufficient neurons die, paralysis sets in…. [The condition] never gets better; it always gets worse. The signals get weaker and weaker until they simply cease altogether. The victim experiences “much trouble just to stand up.” Many become rapidly too weak to walk. The only thing left for them to do at that point is to crawl….” You can read the Krakauer / Hamilton account and recent story in the article link found below. In it they both tell the most recent events in the laboratory testing of the seeds that McCandless ate in bulk during his last months/weeks.  The tested seeds were found to be in high enough concentration to cause the symptoms (of Lathyrism) McCandless wrote about in his last weeks of survival when he was more susceptible to the neurotoxin having already been in severe malnutrition and hunger. THE NEW YORKER LINK : http://www.newyorker.com/online/blogs/books/2013/09/how-chris-mccandless-died.html?mbid=social_retweet&mobify=0 We dove a little deeper into this toxic myelopathy and discovered some helpful journal articles. According to Misra et al.  "patients complained of walking difficulty due to weakness and leg stiffness. The gait abnormalities ranged from spastic gait, toe walking and the need of assisted gait devises such as canes. They spoke of the weakness being mild to moderate and less prominent than was spasticity. In 8 of their subjects the physical signs were asymmetrical. Peripheral neuropathy was present in only one patient, but muscle atrophy and widespread fasciculation's were not found. A higher frequency of peripheral neuropathy and lower motor neuron involvement has been reported from Bangladesh and Israel. Severe spasticity in the absence of prominent weakness in lathyrism may be due to the involvement of certain specific groups of corticospinal fibres.“ We are big fans of Krakauer’s writing (and now Hamilton’s paper "The Silent Fire”) and this was a good story to close the Alexander Supertramp chapter hopefully once and for all. “Into the Wild” by Krakauer was a riveting book, one of our favorites.  Sean Penn’s cinematic interpretation of the story was good as well.  But for two gait geeks like us, to finally find out that poor Chris died of something so rare and complex, something that could be traced back as far as the holocaust concentration camps where people’s gait was first seen impaired was pretty fascinating. We are sure there billions of folks who have never looked at our blog and who will never likely read it.  Gait and gait related disorders and diseases do not get many people excited, but for us, this might as well be pornography. We are sure there are millions that are not fascinated by the fact that every organism on this planet locomotes in one manner or another, each with their own characteristic rules and biomechanics. It is sad to us that few really pay attention to how humans locomote and ambulate, at least not until they break a leg, sprain an ankle or come down with some complex motorneuron lesion. Gait is everywhere once you start looking for it. Whether you start to become aware of it at the local shopping mall, in TV commercials, during Sunday night football, during the Olympics, at your grandmama’s house, during your son or daughters walk to the dinner table , or even in the movies… . . gait is everywhere. Sean Penn’s interpretation of Krakauer’s “Into the Wild” is a touching sweeping movie and for us to now find out that the thing that ultimately led to McCandless’s demise was a gait related neurotoxic myelopathic disorder just goes to prove our point, gait is everywhere.  Why more people do not see this is beyond us, but hey, it would be a strange world if everyone was as nerdy as the two of us wouldn’t it !?  Shawn and Ivo, The Gait Guys.     References:   1. Paraplegia. 1993 Apr;31(4):249-54. Clinical aspects of neurolathyrism in Unnao, India. Misra UK, Sharma VP, Singh VP. http://www.ncbi.nlm.nih.gov/pubmed/8493040 2. J Neurol. 2012 Jul;259(7):1263-8. doi: 10.1007/s00415-011-6306-4. Epub 2011 Nov 12. Neurolathyrism: two Ethiopian case reports and review of the literature. Woldeamanuel YW, Hassan A, Zenebe G. http://www.ncbi.nlm.nih.gov/pubmed/22081101 3. Neurobehav Toxicol Teratol. 1983 Nov-Dec;5(6):625-9. Lathyrism: a neurotoxic disease. Spencer PS, Schaumburg HH. http://www.ncbi.nlm.nih.gov/pubmed/6422318 https://www.thegaitguys.com/thedailyblog/podcast-37-anandamide-body-work-3d-printed monthly 0.5 2013-09-12 https://www.thegaitguys.com/thedailyblog/forefoot-valgus-or-plantarflexed-1st monthly 0.5 2013-09-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553610461-IOW9WUIIHBQ0RWNSRDGX/tumblr_ms9szmkxQr1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553611382-R7D925X3CQN66I543O0Q/tumblr_ms9szmkxQr1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553612134-UQ75BTAT19O74OH8YTP5/tumblr_ms9szmkxQr1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553612016-50XA93YDIYNERLMAXFKU/tumblr_ms9szmkxQr1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/this-is-a-follow-up-to-our-last-post-on-forefoot monthly 0.5 2013-09-09 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https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553616548-36MD8KVP8RJCB7OQ8F43/tumblr_mrrb0hsxBX1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553617167-GWVPS4I8EPUHIWAIFU2F/tumblr_mrrb0hsxBX1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553617110-81B4P6TVQUO77WG2QNP7/tumblr_mrrb0hsxBX1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553617262-JPT0QZ7UOTM0JWPEONAA/tumblr_mrrb0hsxBX1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553617571-S5Q027QH2PMOIXJANDOJ/tumblr_mrrb0hsxBX1qhko2so5_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553617642-91X2EN5KRMAZP70EKBXA/tumblr_mrrb0hsxBX1qhko2so6_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/happy-friday-folks-today-a-classic-rerun-with-a monthly 0.5 2013-08-16 https://www.thegaitguys.com/thedailyblog/our-friend-mountain-and-his-new-minimalist-dress monthly 0.5 2013-08-15 https://www.thegaitguys.com/thedailyblog/standing-propriosensory-exercise-progression monthly 0.5 2013-08-15 https://www.thegaitguys.com/thedailyblog/do-they-not-only-look-dumb-but-reduce-your-iq-to monthly 0.5 2013-08-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553617673-L7C3B9267EI4V0TCHWA3/tumblr_mri212TkBE1qhko2so1_400.jpg Blog Do they not only look dumb, but reduce your IQ to your waist size? Can sagging pants lead to cognitive decline?  There are a number of papers being written about gait changes (step length, frequency, speed)  being indicative of cognitive decline (see here and here for 2 of them). Wearing sagging, baggy pants has many associated issues (see here for our recent post on that). Can the reverse be true? Can creating a smaller step length cause cognitive decline? Neurologically, we know that the cerebellum is involved with learning. Balance and coordination tasks improve learning. Yes, it is better to have have your kids banging and climbing on the TV, rather than being passive and watching it.  This is probably due to muscle and joint mechanoreceptors being activated, and that information traveling northward in the spinocerebellr tracts which feed to the flocculo nodular lobe and cerebellar hemispheres. Here they interact with converging input from all the other systems (vision, hearing, and probably smell), as well as descending motor information from your motor cortex. They are processed and then redirected to the areas where they came from, as well as to systems which project that information to many places, including, you guessed it, your temporal lobe (memory), parietal lobe (special integration and discrimination) and frontal lobe (personality and motor activity). So, what happens when you slow or decrease information to the cerebellum? What happens if we don’t use neurons? They degenerate, or are remodeled into something else as the pathways slowly grow over and are replaced by other information your brain sees as more important. Could decreasing your step length, altering and/or diminishing proprioception affect cerebellar output? Yes. Could this affect your ability to learn and remember? Yes. Could this lead to cognitive decline? Conceivably… We think you know  where we stand on this. Think before you sag…while you still can The Gait Guys.  Definitely NOT saggy : ) https://www.thegaitguys.com/thedailyblog/what-a-difference-a-lift-can-make-more-from monthly 0.5 2013-08-13 https://www.thegaitguys.com/thedailyblog/more-proof-for-the-cross-over-gait-for-the monthly 0.5 2013-08-12 https://www.thegaitguys.com/thedailyblog/got-water monthly 0.5 2013-08-08 https://www.thegaitguys.com/thedailyblog/hill-running-the-ankles-have-to-get-it monthly 0.5 2013-08-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553618395-I50UUEGJZT8SNMFX2FNA/tumblr_mqwtcsdR831qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553618717-B64YMBIKQK8173088V0B/tumblr_mqwtcsdR831qhko2so1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/holy-twisted-femurs-batman-what-is-going-on monthly 0.5 2013-08-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553619072-8A5EIYW7NQHAW2YVLV8D/tumblr_mr3b80hz4Y1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553619347-EF2WVCKW34HOO0XHSZKR/tumblr_mr3b80hz4Y1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553619624-8NT4GQQ8WD5X7BQQLI5J/tumblr_mr3b80hz4Y1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553620030-OA1SESRFTHI1NDQJIBVY/tumblr_mr3b80hz4Y1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553620049-TB26F68FSYINWPDKVLBN/tumblr_mr3b80hz4Y1qhko2so5_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/study-shows-saggy-pants-linked-erectile monthly 0.5 2013-08-05 https://www.thegaitguys.com/thedailyblog/sagging-pants-is-about-to-become-a-lot-more monthly 0.5 2013-08-05 https://www.thegaitguys.com/thedailyblog/sagging-pants-a-different-kind-self-inflicted monthly 0.5 2013-08-05 https://www.thegaitguys.com/thedailyblog/mirror-neurons-we-are-gonna-piss-off-alot-of monthly 0.5 2013-07-31 https://www.thegaitguys.com/thedailyblog/sometimes-you-just-need-to-add-a-little monthly 0.5 2013-07-31 https://www.thegaitguys.com/thedailyblog/photo-where-is-your-knee-joint-hinge-point-say monthly 0.5 2013-07-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553620467-JFDLESHOCTWEHMBVT7W6/tumblr_mnkc0u2lyq1qhko2so1_1280.png Blog Photo: Where is your knee joint hinge point ?  Say that 4 times fast. Here is a photo of 4 elite runners. We suspect it is an 800m race  because #100 is Ahmed Bile who is the son of Olympian and world champion Abdi Bile. In this photo you can see that Ahmed #100 has a significantly large foot progression angle (large foot turn out) and this likely represents external tibial torsion or femoral antetorsion while #454 has a neutral foot turn out as does #232.  #46 has a modest foot progression angle. Grossly, #46 also has the patella right over the foot and so tibial torsion is not likely. Now, move up to observe their knee progression. All of them have a forward (sagittally) oriented knee progression. How can that be? Well, it is simple if you know your torsional issues. After all, the knee is a hinge and if you are running forward your knee pretty much should hinge forward as well.  Now, there is much room for conversation here and debate but we are just trying to make and observation and a point. To a large extent the knee rules the roost in the lower limb in terms of sagittal progression because it is the joint with the least number of tolerances. The knee only hinges in flexion and extension where as the hip and ankle/foot have frontal and axial planes they can notably tap into when the sagittal is challenged.  Again, look at #100 and our point is made. Look at the 2 fellas in the middle (454 and 232). they have a internally (medially) postured knee/thigh yet their foot progression angle is mostly neutral and the knees are hinging forward.  Does #454 have internal tibial torsion? It could be (hint, look at his right trailing leg, specifically the patella and foot postures) but the left limb looks cleaner although adducted suggesting he might like the cross-over gait or it is more external tibial torsioned. Where as the 2 outer fellas, 100 and 46, are more neutrally oriented knees/thighs (one could make the case that #100 has a more externally oriented femur) yet increased progression foot progression angle in an environment of a forward hinging knee. So what gives ? Torsions. Yes, we are soapboxing on torsions again. Torsions in the tibia, torsions in the femur. Versions are normal expressed angles, tibial torsions are abnormal. Now, as life would have it, look over the right shoulder of #100. See the fella in the red headband? Ya, that guy losing.  He has the cleanest lines of the bunch. How is that for cruel irony ?  Sometimes it ain’t what you got, it is what you do with what you got.  Unless of course he is actually wincing in pain and trailing behind because he got spiked by #100 and that hideously frontal plane splayed foot ! Lastly, this wouldn’t be an official Gait Guys post if we did not preach to remember that “what you see is not the problem, what you see in a gait analysis is the person’s compensatory strategy around their deficits”. And here we see deficits. Our observations today are merely just that, observations. Now someone has to get them on a table and examine them and confirm our observations, prove them wrong and/or discover the joint, muscular and motor pattern deficits that created these observations.  Or, someone has to confirm that all parts are working and that they were at the end of the line when the straight long bones were first handed out.   Today’s Lesson:  Get in line, and get in line early. (just kidding of course) The Gait Guys.  Calling it they way we see it, but reserving the right to plead the 5th or change our minds after an examination.  We would suggest to everyone, when it counts and when your reputation is on the line, plead the 5th, until you have completed your hands on clinical examination.  "Seeing may be believing" but that still doesn’t always make it so. Want to learn more about these kinds of things, foot beds, foot types, shoe anatomy and shoe function, proper shoe prescription etc ?  Our National Shoe Fit program will help you get smarter about this stuff. email us at : thegaitguys@gmail.com  Gait Guys online /download store:http://store.payloadz.com/results/results.aspx?m=80204 *Photo courtesy of BIG EAST Conference https://www.thegaitguys.com/thedailyblog/bipedal-vs-quadrupedal-a-navy-seal-vs-chimp monthly 0.5 2013-07-26 https://www.thegaitguys.com/thedailyblog/midfoot-striking-monsters-thats-right-a monthly 0.5 2013-07-25 https://www.thegaitguys.com/thedailyblog/trojan-horses-for-knee-menisci-orthotics-and monthly 0.5 2013-07-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553620613-TTDMO6ESSIRCV2BVAA46/tumblr_mqf5re5X3Q1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553620912-YU2E34H276DOXDF7EOTL/tumblr_mqf5re5X3Q1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553622475-SUNRZ7B7OVUN1SA48V0T/tumblr_mqf5re5X3Q1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/what-is-your-gait-filter-this-blog-post-may-be monthly 0.5 2013-07-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553621305-AZ8NFBOZSF88UMOWTUVT/tumblr_mq9eegdtJ31qhko2so1_500.jpg Blog What is your gait filter ? This blog post may be the most important one we have ever written. Are you a biomechanist ? A high school or college coach ? A physical therapist ? Chiropractor ? Self-proclaimed running guru ? Running shoe store shoe fitter ? Researcher ? We all are going to approach gait and gait analysis through our biased filter. There is no way you can avoid it. And the more diverse your background, the deeper your education levels and the deeper your experience level in practicing your trade the better your filter will be.  But in many ways this article is more than just about your gait analysis filter, it is about your life filters, your outlook and opinions that have shaped your life. Are you assessing your client’s gait ? Maybe you think you are. Maybe you are doing a great job and are seeing things that are truly there, and maybe you are making them up.  Is your filter clogged ? And, if you are doing gait analysis and your gait knowledge is thin, then you are also limiting and possibly biasing the information of one of the most deeply repetitive and engrained motor and movement patterns that a human will do on a daily basis. If you are not looking for honest gait pathomechanics, and if you are giving exercises to your client without cleaning up those pathomechanics (*not what you see but what has caused what you see) you are further driving your clients neurologic faulty motor patterns deeper into a rut.  This can lead to injury locally and possibly globally. Just remember, in gait analysis and in life, if you disagree with someone it is likely because of the detail and depth of the filter you or they are observing things through.  Once your education stops, formal or experiential, your filter will no longer change and life and gait will be judged based on that stagnant filter (and we all know a “rigid in their ways” parent or grandparent who is stuck in their ways).  And, when it comes to progress or lack there of,  so does the potential benefit to every client you help from this day forward. Keep refining that filter, keep making it deeper and more pristine. Keep cleaning it out regularly and look for ways to improve upon it.  The more you know the better your filter, the better you will filter out the assumed, the lies and the fake outs from the truth.   Ivo and I have have filters too. And when it comes to gait, our individual filters force us to see other sides but these filters we each bring to the table create conflicts at times.  We do not always see a case the same way and sometimes we argue from one side of the fence, until we realize to put on the other guys filtered glasses. Ivo has a strong neurological, rehab, acupuncture/Eastern medicine filter. These are weak filters for me and I will always default to him on these issues. Likewise, I have an orthopedic, sports med, muscle activation filter and they too can be a blessing and curse. But when we come together and layer our filters we get a clearer extract from what is being pressed through our filters. And, when we play nicely with each other, putting our two brains together and let a case filter down through the filters of neurology, orthopedics, acupuncture, rehab, sports medicine, movement pattern systems, muscle activation/inhibition techniques and the like we often get a pure and honest extract at the other end. Our filters help us remove the biases in a case that inexperience or a lack of expertise or knowledge on a particular disorder will cloud. There is much to this filter theory. As we eluded to earlier, filters dictate how we see the world. Whether it be gait analysis or how we raise our kids filters affect how we see our world and the actions we take based on that filtered information.  Gait analysis is no different than anything else in our lives. When it comes to rearing children for example we often act subconsciously and reactively on many of the filters handed to us by our parents, from our life experiences, from our religous views, political views and many others. These actions and reactions do not mean your filter is always right either. Learning about another side or perspective through some else’s filter can help clear or solidify yours. Gait analysis is no different and it is subject to the biases passed down to you from all that you have learned or experienced. Are you keeping your clinical and gait filters pure and unbiased? We question this all the time about our work to keep us honest. If all someone does is look at something through the same filter you can get lost at seeing the world only through that filter. Be careful if all you do is go to the same seminars and follow the same people around because they are the top chef guru right now. Every theory has holes and limits, just ask Einstein. It’s when we try to press a square peg into a round hole based on “the guru or theory of the moment” perspective that we get ourselves into the problems of a clogged filter. We have all done it, yes all of us. We get stuck in our ways as well. We are creatures of habit. We have all been to a great seminar only to return the next Monday into our routines of old slowly drifting back to ways of old in a few weeks. It’s easy to settle back in to a narrow clogged filter because change asks something more of us. It’s easier to slide down that hill of comfort and familiarity, but it asks something more and something bigger of us when we have to trudge up that steep hill that is cursed with questions, unfamiliarity and discomfort. But, that’s where the gold is found.  So, what are your filters ? Are there enough of them and are they deep enough ? Are they based on good guided and mentored experience or are they based on your self-taught and thus biased experiences ? Our filters here at The Gait Guys have a combined 24+ years of formal medical and medical-related education and 40+ years of clinical experience (and more importantly, failure) with patients. We think our filters run pretty deep but they admittedly have holes that have been stitched with experience and humility, and they likely still have unseen gaping holes and leaks that we struggle to find to this day. But we try to show up everyday in our clinics and here on The Gait Guys blog with an honesty and humbleness in an attempt to learn that which we don’t know and to honestly face that which we think we know, but actually don’t, because our filters are also subject to clogging. And finally remember one of our biggest catch phrases. “What you see in someone’s gait is not their problem, but rather their strategic compensation around the problem”.  Don’t make it worse but trying to filter what you see through a clogged or shallow filter.  And if you do not mind us finishing with a broader brush, it is more than just about GAIT filters, rather it is about every filter through which we approach life and the people in our lives. Whether it be politics, religion, the media, research, guns, war, abortion, gay rights, marriage, our spouses, child rearing and the like, if we just step back from every opinion we have and become aware of our thoughts, feelings and emotions and realize that they are a product of the filters we apply, maybe, just maybe … . . the world will be a better place in that moment. (And if Ivo and I can dream big, maybe a world where everyone walks and runs without pathologic compensations.) Shawn and Ivo, The Gait Guys.  Getting a little armchair philosophical on you today. https://www.thegaitguys.com/thedailyblog/more-foot-rocker-pathology-clues-is-ankle-rocker monthly 0.5 2013-07-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553622626-YCV9J4RSSNPUWTAUVX5W/tumblr_mq9e3zZ0dE1qhko2so1_1280.jpg Blog More Foot Rocker pathology Clues. Is ankle rocker normal and adequate or is it limited ?  Is it limited in early midstance or late midstance ? How about at Toe off?  Is it even possible to distinguish this ? Well, we are splitting hairs now but we do think that it is possible. It is important to understand the pathologies on either end of the foot that can impact premature ankle rocker.  Look at the photo above. You can see the clinical hint in the toe wear that this runner may have a premature heel rise. However, this is not solid evidence that every time you see this you must assume pathologic ankle rocker. The question is obviously, what is the cause. Considerations: 1- weak anterior compartment, which is quite often paired with the evil neuroprotective tight calf-achilles posterior complex to offer the necessary sagittal protection at the ankle mortise.  This will cause premature heel rise from a posterior foot aspect. 2- rigid acquired blocked ankle rocker from something like “Footballer’s ankle”. This will also cause premature heel rise from a relatively posterior foot aspect. 3- there are multiple reasons for late midstance ankle rocker pathology. The client could completely avoid the normal pronation/supination phase of gait because of pain anywhere in the foot. For example, they could have plantar fascial pain, sesamoiditis, a weak first ray complex from hallux vaglus, they could have a painful bunion, they could be avoiding the collapse of a forefoot varus. There are many reasons but any of them can impair the timely pronation-supination phase in attempting to gain a rigid lever foot to toe off the big toe-medial column in “high gear” fashion. And when this happens the preparatory late midstance phase of gait can be delayed or rushed causing them to move into premature heel rise for any one of several reasons.  Rolling off to the outside and off of the lesser toes creates premature heel rise.   4- And now for one anterior aspect cause of premature heel rise. This is obviously past the midstance phase but it can also cause premature heel rise. Turf toe, Hallux rigidus/limitus or even the dreaded fake out, the often mysterious Functional Hallux limitus (FnHL) can cause the heel to come up just a little early if the client cannot get to the full big toe dorsiflexion range.   We could go on and on and include other issues such as altered Hip Extension Patterning, loss of hip extension range of motion, weak glutes, or even loss of terminal knee extension (from things like an incompleted ACL rehab, Osteoarthritis etc) but these are things for another time. Lets stay in the foot today. All of these causes, with their premature heel rise component, will rush the foot to the forefoot and likely create Metatarsal head plantar loading and could cause forces appropriate enough to create stress responses to the bone. This abrupt forefoot loading thrust will often cause a reactive hammer toe effect.  Quite often just looking at the resting nature of a clients toes while they are lying down will show the underlying increase in neuro-protective hammering pattern (increased long toe flexor and short toe extensor activity paired with shortness of the opposing pairs which we review here in this short video link).  The astute observer will also note the EVA foam compressing of the shoe’s foot bed, and will also note the distal displacement of the MET head fat pad rendering the MET head pressures even greater osseously.  Premature ankle rocker and heel rise can occur for many reasons. It can occur from problems with the shoe, posterior foot, anterior foot, toe off, ankle mortise, knee, hip or even arm swing pathomechanics.   When premature heel rise and impaired ankle rocker rushes us to the front of the foot we drive the front half of the shoe into the ground as the foot plantarflexion is imparted into the shoe.  The timing of the normal biomechanical events is off and the pressures are altered.  instead of rolling over the forefoot and front half of the shoe after our body has moved past the foot these forces are occurring more so as our body mass is still over the foot. And the shoe can show us clues as to the torture it has sustained, just like in this photo case. You must know the normal biomechanical gait events if you are going to put together the clues of each runner’s clinical mystery.  If you do not know normal how will you know abnormal when you see it ? If all you know is what you know, how will you know when you see something you don’t know ? Shawn and Ivo, The Gait Guys … .  stomping out the world’s pathologic gait mechanics one person at a time.  https://www.thegaitguys.com/thedailyblog/why-alignment-of-the-big-toe-is-so-critical-to monthly 0.5 2013-07-19 https://www.thegaitguys.com/thedailyblog/action-expresses-priorities-gandhi monthly 0.5 2013-07-17 https://www.thegaitguys.com/thedailyblog/a-study-supporting-much-of-what-we-have-been monthly 0.5 2013-07-17 https://www.thegaitguys.com/thedailyblog/lateral-foot-pain-well-then-why-does-this-young monthly 0.5 2013-07-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553622321-KRUPCEKFR6Q4MT8RMKM8/tumblr_mpszmkCmVP1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553622611-3IMPI4C2FXD72X38FLY4/tumblr_mpszmkCmVP1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553622591-69SZ9I7E738L4E3Y2ZMG/tumblr_mpszmkCmVP1qhko2so3_1280.jpg Blog 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I was in my Muscle Activation Class (MAT) here in Chicago and somewhere during the course of the class the topic came up about problems with the big toe. This really nice fella spoke up about a major injury to his thumb (the photo is not of him but here is a link to this fella’s story) and how doctors then proceeded to amputate his big toe to replace the thumb. Gosh, with my brain knowing all that it does about gait as well as hand function, thoughts began to swim in every direction. What would I do if I were presented with the same scenario?  Without my thumb my work as a manual medicine physician would definitely be changed. But, heck, my gait would forever be changed too! I would be sentenced to a life of never ending gait compensations that could never be treated. My mind swirled around impaired hip extension and gluteal dysfunction, not to mention: foot tripod incompetence pronation and supination dysfunction guaranteed virtually guaranteed hammer toe formation metatarsal stress impacts inappropriate loads on the medial column stabilizers such as the tibialis posterior now that the medial foot tripod was impaired let along the new absence of the long and short toe flexors that often provide compensatory activity to help an insufficient medial tripod. impaired ipsilateral and contralateral arm swing impaired shoulder function core and hip impairments and asymmetry the list goes on and on……. perhaps for hours !  We could do a whole 1-2 hour lecture just on the gait compensations and the subsequent motor impairment patterns that would ensue. Seeing this photo and reading this fella’s story brought my mind back to the swirling thoughts I had while sitting in that lecture hall that day. And now some 8+ years later i am still brought to the same uncertain conclusion.  Would I go for the switcheroo ?   The transplant isn’t guaranteed successful, if it was that might sway things a little. But the gait impairments are guaranteed.  What would  you do ?  We hope you ( and us here at The Gait Guys) never are confronted with this most difficult presentation.  However, in just a few years, with the advent of 3D printers the anxiety of this issue is likely going to become a non-issue. Just some food for thought today.  Or maybe we should have said “Foot for thought.” Shawn and Ivo https://www.thegaitguys.com/thedailyblog/orthotics-and-footbeds-whats-the-difference monthly 0.5 2013-04-29 https://www.thegaitguys.com/thedailyblog/podcast-30-running-your-heart-out monthly 0.5 2013-04-25 https://www.thegaitguys.com/thedailyblog/on-the-topic-of-endurance-training monthly 0.5 2013-04-24 https://www.thegaitguys.com/thedailyblog/how-we-keep-our-head-steady-while-we-run monthly 0.5 2013-04-23 https://www.thegaitguys.com/thedailyblog/unstable-shoes-provide-more-activation-of-selected monthly 0.5 2013-04-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553636285-9LPS6OQYEXDLHBO54Q6N/tumblr_ml861yy80o1qhko2so1_400.jpg Blog Unstable shoes provide more activation of selected lower extremity muscles and increased postural sway WHILE STANDING. Does this really surprise us?  “ …it was shown that standing in the unstable shoe increased activity of the flexor digitorum longus, peroneal (PR) and anterior compartment (AC) muscles of the lower leg. No activity differences for the larger soleus (SOL) were identified between the stable and unstable shoe conditions.”. In English that means the muscles on the front, back and outside of your lower leg. It goes on to say “Postural sway was greater while standing in the unstable shoe compared to barefoot and the stable control shoe.” and “Postural sway while standing in the unstable MBT shoe also decreased over the 6-week accommodation period.” Postural sway is one way of measuring proprioception or body position awareness.  The key words here are “WHILE STANDING”. It DOES NOT SAY WALKING. We have talked about rockered shoes in numerous previous posts and we have always maintained that in the right circumstances, it can be a good thing, but not necessarily something you should go do your grocery shopping or gym workout in. Gait Posture. 2010 Jun;32(2):215-9. doi: 10.1016/j.gaitpost.2010.04.018. Epub 2010 May 23. Standing in an unstable shoe increases postural sway and muscle activity of selected smaller extrinsic foot muscles. Landry SC, Nigg BM, Tecante KE. Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Drive N.W., Calgary, Alberta, Canada T2N 1N4. scott.landry@acadiau.ca Inactivity or the under-utilization of lower limb muscles can lead to strength and functional deficits and potential injury. Traditional shoes with stability and support features can overprotect the foot and potentially contribute to the deterioration of the smaller extrinsic foot muscles. Healthy subjects (n=28) stood in an unstable MBT (Masai Barefoot Technology) shoe during their work day for a 6-week accommodation period. A two-way repeated measures ANOVA was used to determine (i) if unstable shoe wear increased electromyographic (EMG) activity of selected extrinsic foot muscles and increased postural sway compared to standing barefoot and in a stable control shoe and (ii) if postural sway and muscle activity across footwear conditions differed between a pre- and post-accommodation testing visit. Using an EMG circumferential linear array, it was shown that standing in the unstable shoe increased activity of the flexor digitorum longus, peroneal (PR) and anterior compartment (AC) muscles of the lower leg. No activity differences for the larger soleus (SOL) were identified between the stable and unstable shoe conditions. Postural sway was greater while standing in the unstable shoe compared to barefoot and the stable control shoe. These findings suggest that standing in the unstable MBT shoe effectively activates selected extrinsic foot muscles and could have implications for strengthening and conditioning these muscles. Postural sway while standing in the unstable MBT shoe also decreased over the 6-week accommodation period. Copyright 2010 Elsevier B.V. All rights reserved. https://www.thegaitguys.com/thedailyblog/one-simple-hip-screen-that-gives-you-lots-of monthly 0.5 2013-04-18 https://www.thegaitguys.com/thedailyblog/the-naked-foot-thoughts-for-the-shoe-minimalist monthly 0.5 2013-04-17 https://www.thegaitguys.com/thedailyblog/podcast-29-darpa-robots-cartilage-in-runners monthly 0.5 2013-04-15 https://www.thegaitguys.com/thedailyblog/a-scientific-look-at-heeled-shoes-a-nice-follow monthly 0.5 2013-04-12 https://www.thegaitguys.com/thedailyblog/zero-drop-think-before-you-drop-more-to-think monthly 0.5 2013-04-11 https://www.thegaitguys.com/thedailyblog/podcast-28-nanotech-athletes-barefoot monthly 0.5 2013-04-11 https://www.thegaitguys.com/thedailyblog/midfoot-strike-in-a-non-zero-drop-shoe-have-you monthly 0.5 2013-04-09 https://www.thegaitguys.com/thedailyblog/another-ifgec-certification-granted-with-more monthly 0.5 2013-04-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553636582-3M08D71FUFB1Y564N0DW/tumblr_mkwbhbytKY1qhko2so1_1280.jpg Blog Another IFGEC Certification Granted “With more than 2 decades in the fitness industry, and a MS in Exercise Physiology, I’ve learned that there is so little that I really know.  I am constantly looking to improve what I can do to help the triathletes and runners that I see.   As an endurance coach and clinician that focuses on preventing injuries, optimizing performance, and avoiding reoccurring injuries, the IFGEC Shoe Fit Certification is going to be a keystone (much like the Navicular Bone) to my screening process of athletes and clients.  Making sure they are fitted properly in shoes, working with their movement patterns, teaching them running form skills, and then building on all aspects from there.  What I have learned from "The Gait Guys” has already made an impact on what I do, but it’s at a whole new level now.  This is not just a “online course”  this is real education that stays with you for life.  This is a true Ground Up approach to helping and is something that every running shoe store, coach, and medical professional that deals with runners and triathletes needs to learn.“ Ryan Smith, MS is owner of the Personal Impact, LLC and The Runners’ Clinic in the Cincinnati, Ohio area.  He is a USATF Level 1 Coach, Newton Natural Running Form Coach, & ACSM-CPT that works with runners and triathletes helping to prevent and recover from injuries that athletes deal with.  More information on Ryan Smith, visit his site at.  http://ryansmithfitness.com Want to get certified or learn more? 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https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553640893-RTAIHRW6MMAE51R20VOO/tumblr_mikhnpR8V81qhko2so1_250.jpg Blog http://thegaitguys.tumblr.com/post/21713480315/the-chef-another-abnormal-gait-pattern-in Last night we caught a DVR’d season show of Bourdain’s new show “the Layover” on the Travel Channel.  Great new show, we love his diatribes, rants and command of the English language. It reminded us of this post we did last year where we looked in depth at his unique gait flaw, the circumducting foot. Join us again for this great gait dissection, see the link at the top. Even if you have been with us for over a year and still somewhat remember this gait pattern and our explanation of it, you will likely pick up another layer of  understanding after our last year of teaching  here on The Gait Guys blog. Shawn and Ivo, The Gait Guys https://www.thegaitguys.com/thedailyblog/yes-we-are-all-twisted-part-3-continued-if monthly 0.5 2013-02-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553641377-5HXMAUF984TB544RN59N/tumblr_miivgh6NpC1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553641803-0NINJ83VW30CUBL6I7JT/tumblr_miivgh6NpC1qhko2so2_1280.png Blog https://www.thegaitguys.com/thedailyblog/yes-we-are-all-twisted-part-3-in-the-last-2 monthly 0.5 2013-02-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553642266-Q41HDXKK4J0LOKY9Z8LM/tumblr_mic2p8EQnN1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553642258-AY7OBEUAN6PLBG67CXRU/tumblr_mic2p8EQnN1qhko2so2_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553644337-75O8TGK46CL9UUT4LX4C/tumblr_mic2p8EQnN1qhko2so3_1280.gif Blog https://www.thegaitguys.com/thedailyblog/podcast-23-neurology-of-walking-babies monthly 0.5 2013-02-18 https://www.thegaitguys.com/thedailyblog/walking-what-you-need-to-know-and-why-here monthly 0.5 2013-02-15 https://www.thegaitguys.com/thedailyblog/how-did-you-do-on-yesterdays-photo-of-3-foot monthly 0.5 2013-02-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553642948-G7JQ1GHYC0JPVH6OJ48Z/tumblr_mi9lkzyTOr1qhko2so1_1280.jpg Blog How did you do on yesterday’s photo of 3 foot strikes ? Now, look at the women ! Almost pristine ! Still a little evidence of cross over gait in each of them, but pretty darn good ! The feet are falling under the body mass, not good for sprinting, but utilized more in endurance athletes. If you have enough abdominal and hip frontal stabilzers (ie. G. Medius et al) you can play safely with the efficiency factor. If you do not have the strength, you sacrifice efficiency and risk injury at multiple sites in the lower limb. The more cross over you have, the more the foot will strike in inversion (more lateral foot strike), then you much hope you have enough gluteus medius strength at the hip, medial knee stability strength and ankle/arch strength in muscles like the tibialis posterior.  Kara Goucher and Shalane Flanagan, right, shown here leading the 2012 Olympic Trials Marathon, Photo: Kurt Hoy/Competitor https://www.thegaitguys.com/thedailyblog/a-visual-demonstration-of-3-different-foot-strike monthly 0.5 2013-02-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553643269-AMZWY6C4PGS310SS588O/tumblr_mi16zzIL4w1qhko2so1_1280.png Blog A visual demonstration of 3 different foot strike patterns. Lets test some of what you have learned here at The Gait Guys over the last few months. On the readers left, blue shirt Bib 232:  The left leg appears to have all joints stacked at this viewer angle (knee is vertically over the foot, hip is over the knee). What we love here is that the foot profile (look at the black sole of the shoe) is parallel to the ground, it is hard to believe that it won’t strike as such. The medial and lateral aspects of the foot should strike flush and simultaneously. This is a neutral foot and is very likely without valgus or varus forefoot typing.  The tibia looks pristine and straight without any torsion, at least from this limited perspective. He also looks to be striding nicely, it seems to appear (albeit this is reaching from this head on view) that the foot will strike below the body mass, this may be because he subtly appears to be leaning forward, again hard to see on this view. Middle runner, white shirt:  We see some problems here.  First of all, it appears (and again, this is reaching from a front on view) that this runner is striding out with the foot beyond the body mass and will likely heel strike, he also seems to be in more backward lean that the Blue Bib Man but again hard to tell on a frontal view. We also see that the foot is pitched in inversion (note the outward tip of his foot compared to the man in Blue) quite aggressively which will facilitate a strong excessive lateral heel and/or forefoot strike pattern.  You can also see that drawing a line through the length of the long bones (tibia and femur) that they are in alignment, they are even in alignment with the 90 degree perpendicular to the forefoot inverted angulation.  This clearly represents our classic “cross over gait” which was first brought to you and the internet by yours truly a few years ago (here on Youtube link).  It is easy to see that the projected foot landing will be on a virtual line and thus appear to run on a line or even cross the feet over the line indicating that this client is not stacking the foot, knee and hips vertically and thus challenging the gluteus medius and hip stability into the frontal plane (video link here). This client will be wasting energy and efficiency in the frontal plane (side to side movement) and challenging the core, risking knee tracking issues and excessive foot pronation forces beyond the safe and normal.   Running on the readers right, green shirt #8:  There appears to be a strong stance phase leg collapse, the hip is lateral to the foot and the knee is perhaps on its way to medial from a vertical line from the foot. This can be, and often is, from the issues of cross over described in the middle runner above but it can also be simply found in someone who is striking with the foot/knee/hip joints stacked but does not have sufficient gluteus medius strength to keep the pelvis level on the horizon (thus drift laterally). When this happens the downward collapse of the opposite side pelvis is often, but not always, see as a valgus collapse at the knee since the femur is allowed to drift medially from insufficient strength, skill or endurance pairing of the gluteus medius/maximus pairing and the medial quadriceps. This client is  likely a cross over victim as well and this would give good reason to the aforementioned.  Again, this is all theoretical from a static picture but knowing these patterns like we do, we know these typical patterns of breakdown. This is also suspect because of the foot more positioned under the midline of the body instead of under the knee and hip vertically stacked and the obvious proximity of the knees to one another.  These clients often kick or brush the foot or shoe against the stance phase lower leg as they swing the foot through.  Who is going to win this race ? One cannot tell. But if they were the same on all levels of endurance, training, VO2 max and equal on every parameter except what was mentioned above, well then our man in Blue, # 232 would be the most efficient and likely the least injured. Photo from an Outside Magazine article. We Would reference it, and would be happy to do so, but we cannot find the net article anywhere now. Please send it our way if you happen across it ! Shawn and Ivo, The Gait Guys … .  followed in 51 countries and counting. https://www.thegaitguys.com/thedailyblog/yes-we-are-all-twisted-part-2-last-time-we monthly 0.5 2013-02-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553643490-XWCCORBR9YVYONZ3FP7Y/tumblr_mhnym1twha1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553643824-KYICZWCBXR7K7HIMQ0Z6/tumblr_mhnym1twha1qhko2so2_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553645383-LIB0FGHQGSHQKIWURGH2/tumblr_mhnym1twha1qhko2so3_r1_1280.gif Blog https://www.thegaitguys.com/thedailyblog/treat-your-children-well-we-think-crosby monthly 0.5 2013-02-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553644767-7KOSFD7K2GNSTW2KF7NQ/tumblr_mguue7a0sE1qhko2so1_1280.jpg Blog Treat your children well. We think Crosby, Stills, Nash and Young had it right… look at this conclusion: “Shoes affect the gait of children. With shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity. Shoes reduce foot motion and increase the support phases of the gait cycle. During running, shoes reduce swing phase leg speed, attenuate some shock and encourage a rearfoot strike pattern."                                                                    let’s break that down a bit: "Shoes affect the gait of children.” Shoes effect EVERYONE’S gait, not just kids. They alter the ground reactive forces, limit some ranges of motion and thus can promote a compensation or mechanics that you may not have seen previously. Take off one of your shoes. Lift your toes up slightly so you are centered on your tripod. Stand on your “barefoot” leg with your eyes closed. See how long you can stand without faltering. Now repeat that with your shod foot. Some difference, eh? I thought shoes dampened proprioception…They do. But they also give you more support and mechanics that you didn’t have previously, so the foot doesn’t have to work as hard.  “With shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity.”Remember we are talking about kids here. Longer steps because with a shoe we promote heel rocker and because of the added support, more stability (or at least more perceived stability). This means more confidence. Greater knee and ankle motion because of the increased stride length. Greater tibialis anterior activity because of greater dorsiflexion of the foot because of the increased weight (the shoe adds ounces and this muscle must work harder to attenuate the foot as it approached midstance) and increased heel and ankle rocker. “Shoes reduce foot motion and increase the support phases of the gait cycle.” Shoes constrain the foot and reduce available ranges of motion (yes, even non motion control shoes). Less motion (and thus proprioception) means less feedback to the brain about muscles length and tension (via muscle spindles and golgi tendon organs). The brain will need to have the foot have more contact with the ground to know where it is in space.  “During running, shoes reduce swing phase leg speed,probably due to the increased weight so it takes more to start the process of initial (early) swing …attenuate some shock we know shoes attenuate at least initial ground reactive forces …and encourage a rearfoot strike pattern.” most likely due to the cushioning (remember from the recent Kenyan study about barefoot heel strikers? (click here if you need a reminder) They were more likely to heel strike on softer surfaces) AND the increased stride length (which would require more ankle dorsiflexion).  Wow. Shoes really do make the, er….kid. The Gait Guys. Making it real and increasing your shoe and gait IQ with each post.                                                                                  J Foot Ankle Res. 2011 Jan 18;4:3. doi: 10.1186/1757-1146-4-3. Effect of children’s shoes on gait: a systematic review and meta-analysis. Wegener C, Hunt AE, Vanwanseele B, Burns J, Smith RM. Source Discipline of Exercise and Sports Science, Faculty of Health Sciences, The University of Sydney, Cumberland Campus, PO Box 170, Lidcombe, 1825, NSW, Australia. cweg6974@uni.sydney.edu.au. Abstract BACKGROUND: The effect of footwear on the gait of children is poorly understood. This systematic review synthesises the evidence of the biomechanical effects of shoes on children during walking and running. METHODS: Study inclusion criteria were: barefoot and shod conditions; healthy children aged ≤ 16 years; sample size of n > 1. Novelty footwear was excluded. Studies were located by online database-searching, hand-searching and contact with experts. Two authors selected studies and assessed study methodology using the Quality Index. Meta-analysis of continuous variables for homogeneous studies was undertaken using the inverse variance approach. Significance level was set at P < 0.05. Heterogeneity was measured by I2. Where I2 > 25%, a random-effects model analysis was used and where I2 < 25%, a fixed-effects model was used. RESULTS: Eleven studies were included. Sample size ranged from 4-898. Median Quality Index was 20/32 (range 11-27). Five studies randomised shoe order, six studies standardised footwear. Shod walking increased: velocity, step length, step time, base of support, double-support time, stance time, time to toe-off, sagittal tibia-rearfoot range of motion (ROM), sagittal tibia-foot ROM, ankle max-plantarflexion, Ankle ROM, foot lift to max-plantarflexion, ‘subtalar’ rotation ROM, knee sagittal ROM and tibialis anterior activity. Shod walking decreased: cadence, single-support time, ankle max-dorsiflexion, ankle at foot-lift, hallux ROM, arch length change, foot torsion, forefoot supination, forefoot width and midfoot ROM in all planes. Shod running decreased: long axis maximum tibial-acceleration, shock-wave transmission as a ratio of maximum tibial-acceleration, ankle plantarflexion at foot strike, knee angular velocity and tibial swing velocity. No variables increased during shod running. CONCLUSIONS: Shoes affect the gait of children. With shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity. Shoes reduce foot motion and increase the support phases of the gait cycle. During running, shoes reduce swing phase leg speed, attenuate some shock and encourage a rearfoot strike pattern. The long-term effect of these changes on growth and development are currently unknown. The impact of footwear on gait should be considered when assessing the paediatric patient and evaluating the effect of shoe or in-shoe interventions. http://www.ncbi.nlm.nih.gov/pubmed/21244647 all material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved. Yea, that means ask before you touch! https://www.thegaitguys.com/thedailyblog/pod-22-primates-limb-synchrony-motor-patterns monthly 0.5 2013-02-11 https://www.thegaitguys.com/thedailyblog/hey-star-wars-fans-check-out-these-coolio-kicks monthly 0.5 2013-02-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553645084-85XZS55IG2PFCU9V7HYX/tumblr_mhtgtu6hR41qhko2so1_500.png Blog Hey Star Wars fans. Check out these coolio kicks! We especially love the “roller heel” option. Takes “Wheelies” to a whole new level. You know our stance on high heels. They are great, as long as you don’t walk in them. Have a great Friday Ivo and Shawn https://www.thegaitguys.com/thedailyblog/chronic-ankle-instability-alters-central monthly 0.5 2013-02-08 https://www.thegaitguys.com/thedailyblog/an-alternate-view-of-crawling-and-quadrupedal monthly 0.5 2013-02-06 https://www.thegaitguys.com/thedailyblog/yes-we-are-all-twisted-part-1 monthly 0.5 2013-02-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553645616-FD0X0AHHA76AZEU5N3IJ/tumblr_mhnkjc4Mdl1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553645981-ZGT3KHA18P60YVW6HXGV/tumblr_mhnkjc4Mdl1qhko2so2_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553645961-17ZY0JY1NT9ZABGX2BDK/tumblr_mhnkjc4Mdl1qhko2so3_400.gif Blog https://www.thegaitguys.com/thedailyblog/podcast-21-you-cannot-beat-the-brain-show monthly 0.5 2013-02-04 https://www.thegaitguys.com/thedailyblog/the-case-of-the-apropulsive-cyborg-gait-can-you monthly 0.5 2013-02-01 https://www.thegaitguys.com/thedailyblog/lateral-forefoot-loading-why-do-we-see-so-many monthly 0.5 2013-01-31 https://www.thegaitguys.com/thedailyblog/the-gait-guys-talk-more-about-the-myths-and-truths monthly 0.5 2013-01-29 https://www.thegaitguys.com/thedailyblog/podcast-20-foot-strike-truths-part-2 monthly 0.5 2013-01-28 https://www.thegaitguys.com/thedailyblog/a-very-cool-video-comprises-this-post-today-it monthly 0.5 2013-01-25 https://www.thegaitguys.com/thedailyblog/though-you-weigh-less-when-naked-it-doesnt-mean monthly 0.5 2013-01-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553646317-CGJR1CN6059HYF1YDIXV/tumblr_mguu6dnSax1qhko2so1_100.gif Blog Though you weigh less when naked, it doesn’t mean you are more efficient… “Running barefoot offers no metabolic advantage over running in lightweight, cushioned shoes.” This study looked at VO2 max (ie. the bodies ability to utilize oxygen, or more precisely, the maximal oxygen uptake or the maximum volume of oxygen that can be utilized in one minute during maximal or exhaustive exercise. It is measured as milliliters of oxygen used in one minute per kilogram of body weight ). The study found that VO2 increased as weight was added to the foot, whether or not ehy were wearing shoes AND there was not significant difference. “V˙O(2) increased by approximately 1% for each 100 g added per foot, whether barefoot or shod (P < 0.001). However, barefoot and shod running did not significantly differ in V˙O(2) or metabolic power. A consequence of these two findings was that for footwear conditions of equal mass, shod running had ∼3%-4% lower V˙O(2) and metabolic power demand than barefoot running (P < 0.05).” An interesting finding was that VO2 was actually 3-4% less for shod running than barefoot, indicating increased metabolic efficiency (albeit small) for shoes. Why? Our theory is increased biomechanical efficiency with shoes. Shoes, creating less pronatory force and accessory motion (due to cushioning and constraints of the shoe; ie it takes some of the complexity out of the motion) created a more rigid lever with better force transduction. The Gait Guys. Asking the hard questions and giving you the facts with each post.        Med Sci Sports Exerc. 2012 Aug;44(8):1519-25. doi: 10.1249/MSS.0b013e3182514a88. Metabolic cost of running barefoot versus shod: is lighter better? Franz JR, Wierzbinski CM, Kram R. Source Locomotion Lab, Department of Integrative Physiology, University of Colorado, Boulder, CO, USA. jason.franz@colorado.edu Abstract PURPOSE: Based on mass alone, one might intuit that running barefoot would exact a lower metabolic cost than running in shoes. Numerous studies have shown that adding mass to shoes increases submaximal oxygen uptake (V˙O(2)) by approximately 1% per 100 g per shoe. However, only two of the seven studies on the topic have found a statistically significant difference in V˙O(2) between barefoot and shod running. The lack of difference found in these studies suggests that factors other than shoe mass (e.g., barefoot running experience, foot strike pattern, shoe construction) may play important roles in determining the metabolic cost of barefoot versus shod running. Our goal was to quantify the metabolic effects of adding mass to the feet and compare oxygen uptake and metabolic power during barefoot versus shod running while controlling for barefoot running experience, foot strike pattern, and footwear. METHODS: Twelve males with substantial barefoot running experience ran at 3.35 m·s with a midfoot strike pattern on a motorized treadmill, both barefoot and in lightweight cushioned shoes (∼150 g per shoe). In additional trials, we attached small lead strips to each foot/shoe (∼150, ∼300, and ∼450 g). For each condition, we measured the subjects’ rates of oxygen consumption and carbon dioxide production and calculated metabolic power. RESULTS: V˙O(2) increased by approximately 1% for each 100 g added per foot, whether barefoot or shod (P < 0.001). However, barefoot and shod running did not significantly differ in V˙O(2) or metabolic power. A consequence of these two findings was that for footwear conditions of equal mass, shod running had ∼3%-4% lower V˙O(2) and metabolic power demand than barefoot running (P < 0.05). CONCLUSIONS: Running barefoot offers no metabolic advantage over running in lightweight, cushioned shoes. PMID: 22367745 http://www.ncbi.nlm.nih.gov/pubmed/22367745 all material copyright 2013 The Gait Guys/The Homunculus Group. https://www.thegaitguys.com/thedailyblog/the-debate-continues-more-support-for-mid-and monthly 0.5 2013-01-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553646824-PWE4ET65358SN4F7P323/tumblr_mguu2f76dN1qhko2so1_100.gif Blog The debate continues. More support for mid and forefoot strikers.… “Forefoot and midfoot strikers had significantly shorter ground contact times than heel strikers. Forefoot and midfoot strikers had significantly faster average race speed than heel strikers.” We are not saying “better”, but according to this study “faster”! What is the ideal?  We wish we knew…Biomechanics seem to point to less impact is better, but what is actually best for the individual is probably due to genetics, training, practice, running surface and that individuals neuromuscular competence and ability to compensate. The Gait Guys. bringing you the facts, even if you or we don’t like them…                                                                                                                                       J Sports Sci. 2012;30(12):1275-83. doi: 10.1080/02640414.2012.707326. Epub 2012 Aug 2. Foot strike patterns and ground contact times during high-calibre middle-distance races. Hayes P, Caplan N. Source Department of Sport and Exercise Sciences, School of Life Sciences, Northumbria University, Newcastle-upon-Tyne NE1 8ST, UK. phil.hayes@northumbria.ac.uk Abstract The aims of this study were to examine ground contact characteristics, their relationship with race performance, and the time course of any changes in ground contact time during competitive 800 m and 1500 m races. Twenty-two seeded, single-sex middle-distance races totaling 181 runners were filmed at a competitive athletics meeting. Races were filmed at 100 Hz. Ground contact time was recorded one step for each athlete, on each lap of their race. Forefoot and midfoot strikers had significantly shorter ground contact times than heel strikers. Forefoot and midfoot strikers had significantly faster average race speed than heel strikers. There were strong large correlations between ground contact time and average race speed for the women’s events and men’s 1500 m (r = -0.521 to -0.623; P < 0.05), whereas the men’s 800 m displayed only a moderate relationship (r = -0.361; P = 0.002). For each event, ground contact time for the first lap was significantly shorter than for the last lap, which might reflect runners becoming fatigued. PMID:22857152[PubMed - indexed for MEDLINE] http://www.ncbi.nlm.nih.gov/pubmed/22857152 https://www.thegaitguys.com/thedailyblog/podcast-19-of-fish-footstrike-and-facts-about monthly 0.5 2013-01-21 https://www.thegaitguys.com/thedailyblog/support-for-a-midfoot-strike-running-with-a monthly 0.5 2013-01-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553647385-A25K4ZYLU6COHFZ5U2K1/tumblr_mgiuqzcBUr1qhko2so1_1280.jpg Blog Support for a midfoot strike? “Running with a midfoot strike pattern resulted in a significant increase in gastrocnemius lateralis pre-activation (208 ± 97.4 %, P < 0.05) and in a significant decrease in tibialis anterior EMG activity (56.2 ± 15.5 %, P < 0.05) averaged over the entire stride cycle. The acute attenuation of foot-ground impact seems to be mostly related to the use of a midfoot strike pattern and to a higher pre-activation of the gastrocnemius lateralis. ” Do these results surprise you? They didn’t really surprise us. The lateral head of the gastroc is a midstance to preswing stabilizer and works synergistic with the medial head, with the medial head firing earlier. Sutherland talks about these muscles not being propulsive in nature, but rather maintainers of forward progression, step length and gait symmetry. Thinking this through in a closed chain (foot up) fashion, this would counter the inversion moment created by the medial gastroc for supination in the second half of contact phase. If the foot is already partially supinated (as we believe it would be in a midfoot strike), it would have to pre activate. A decrease in tibialis anterior activity? Sure. If the foot is striking more parallel to the ground, the anterior compartment (including the tibialis anterior, extensor hallucis longus, and extensor digitorum longus) would not have to eccentrically contract to decelerate the lowering of the foot to the ground. Better? Maybe, maybe not. We are seeing more and more literature about foot strike (if you missed our last few posts, click here, here, here and here), We still maintain that you need a competent lower kinetic chain, including the foot and an intact nervous system to drive the boat. We remain, handsome, bald and nerdy…Ivo and Shawn                                                                                                                                  Eur J Appl Physiol. 2012 Aug 9. [Epub ahead of print] Impact reduction during running: efficiency of simple acute interventions in recreational runners. Giandolini M, Arnal PJ, Millet GY, Peyrot N, Samozino P, Dubois B, Morin JB. Source University of Lyon, 42023, Saint-Etienne, France. Abstract Running-related stress fractures have been associated with the overall impact intensity, which has recently been described through the loading rate (LR). Our purpose was to evaluate the effects of four acute interventions with specific focus on LR: wearing racing shoes (RACE), increasing step frequency by 10 % (FREQ), adopting a midfoot strike pattern (MIDFOOT) and combining these three interventions (COMBI). Nine rearfoot-strike subjects performed five 5-min trials during which running kinetics, kinematics and spring-mass behavior were measured for ten consecutive steps on an instrumented treadmill. Electromyographic activity of gastrocnemius lateralis, tibialis anterior, biceps femoris and vastus lateralis muscles was quantified over different phases of the stride cycle. LR was significantly and similarly reduced in MIDFOOT (37.4 ± 7.20 BW s(-1), -56.9 ± 50.0 %) and COMBI (36.8 ± 7.15 BW s(-1), -55.6 ± 29.2 %) conditions compared to NORM (56.3 ± 11.5 BW s(-1), both P < 0.001). RACE (51.1 ± 9.81 BW s(-1)) and FREQ (52.7 ± 11.0 BW s(-1)) conditions had no significant effects on LR. Running with a midfoot strike pattern resulted in a significant increase in gastrocnemius lateralis pre-activation (208 ± 97.4 %, P < 0.05) and in a significant decrease in tibialis anterior EMG activity (56.2 ± 15.5 %, P < 0.05) averaged over the entire stride cycle. The acute attenuation of foot-ground impact seems to be mostly related to the use of a midfoot strike pattern and to a higher pre-activation of the gastrocnemius lateralis. Further studies are needed to test these results in prolonged running exercises and in the long term. PMID:22875194 [PubMed - as supplied by publisher] All material copyright 2013 The Gait Guys/The Homunculus Group, yada, yada, yada… https://www.thegaitguys.com/thedailyblog/gait-guys-can-i-wear-my-racing-flats-during monthly 0.5 2013-01-17 https://www.thegaitguys.com/thedailyblog/looks-like-newbies-are-heel-strikers-nearly-all monthly 0.5 2013-01-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553647346-Q550ANK2W2SLU716HDS6/tumblr_mghvxx07091qhko2so1_r1_400.jpg Blog Looks like Newbies are heel strikers “Nearly all novice runners utilize a rearfoot strike when taking up running in a conventional running shoe. Hereby, the footstrike patterns among novice runners deviate from footstrike patterns among elite and sub-elite runners.” please take some time to explore the links we put in, as they are germane to the post The question begs, “Why?” do they believe running is merely an extension of walking, and just “speed up” the process? are they afraid of going too fast and are using the heel strike to “brake”? do they learn to strike differently with more experience? at least one paper eludes to “yes” is it “more comfortable” as this paper says it may be? If there is a rear foot strike, the foot is poised to be able to pronate to a greater degree. This theoretically means it (ie, the foot) can absorb more shock through this mechanism, although this seemingly contradicts the Lieberman study This paper certainly had a nice cohort size (> 900 runners) so we can state, at least for this group, that this is not by chance.  When there is a fore foot strike, the foot is more supinated and makes a seemingly “rigid lever”, does this mean there is less shock (perceived or actual) with this foot posture? Lots of questions. This is only 1 part of the puzzle. The Gait Guys. Sifting through the literature and giving you the beef              Gait Posture. 2012 Dec 29. pii: S0966-6362(12)00448-1. doi: 10.1016/j.gaitpost.2012.11.022. [Epub ahead of print] Footstrike patterns among novice runners wearing a conventional, neutral running shoe. Bertelsen ML, Jensen JF, Nielsen MH, Nielsen RO, Rasmussen S. Aarhus University Hospital, Aalborg Hospital, Orthopaedic Surgery Research Unit, Science and Innovation Center, Aalborg DK-9000, Denmark. Electronic address: miclejber@gmail.com. Abstract INTRODUCTION: It has been suggested that striking on the midfoot or forefoot, rather than the rearfoot, may lessen injury risk in the feet and lower limb. In previous studies, a disparity in distribution in footstrike patterns was found among elite-, sub-elite, and recreational runners. PURPOSE: The purpose of this study was to investigate the footstrike patterns among novice runners. METHODS: All runners were equipped with the same conventional running shoe. Participants were video filmed at 300 frames per second and the footstrike patterns were evaluated by two observers. The footstrike was classified as rearfoot, midfoot, forefoot, or asymmetrical. RESULTS: A total of 903 persons were evaluated. The percentages of rearfoot-, midfoot-, forefoot-, and asymmetrical footstrike among men were 96.9%, 0.4%, 0.9%, and 1.8%, respectively. Among women the percentages were 99.3%, 0%, 0%, and 0.7%, respectively. CONCLUSION: Nearly all novice runners utilize a rearfoot strike when taking up running in a conventional running shoe. Hereby, the footstrike patterns among novice runners deviate from footstrike patterns among elite and sub-elite runners. Copyright © 2012 Elsevier B.V. All rights reserved. PMID: 23280125 [PubMed - as supplied by publisher] all material copyright 2013 The Gait Guys/The Homunculus group. Please don’t lift our stuff without asking and giving credit. https://www.thegaitguys.com/thedailyblog/a-return-to-the-solitary-externally-rotated-foot monthly 0.5 2013-01-15 https://www.thegaitguys.com/thedailyblog/functional-ankle-instability-and-the-peroneals monthly 0.5 2013-01-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553647984-OYI4N59PQOIVHBUXSU71/tumblr_mgcawrDlDn1qhko2so1_400.jpg Blog Functional Ankle Instability and the Peroneals  Lots of links available here with today’s blog post. please make sure to take your time and check out each one (underlined below)  As you remember, the peroneii (3 heads) are on the outside of the lower leg (in a nice, easy to remember order of longus, brevis and tertius, from top to bottom) and help to stabilize the lateral ankle. The peroneus brevis and tertius dorsiflex and evert the foot while the peroneus longus plantarflexes and everts the foot. We discuss the peroneii more in depth here in this post. It then is probably no surprise to you that people with ankle issues, probably have some degree of peroneal dysfunction. Over the years the literature has supported notable peroneal dysfunction following even a single inversion sprain event.  Functional ankle instability (FAI) is defined as “ the subjective feeling of ankle instability or recurrent, symptomatic ankle sprains (or both) due to proprioceptive and neuromuscular deficits."  Arthrogenic muscle inhibition (AMI) is a neurological phenomenon where the muscles crossing a joint become "inhibited”, sometimes due to effusion (swelling) of the joint (as seen here) and that may or may not be the case with the ankle (see here), or it could be due to nociceptive input altering spindle output or possibly higher centers causing the decreased muscle activity.  This paper (see abstract below) merely exemplifies both the peroneals and FAI as well as AMI. Take home message? Keep the peroneals strong with lots of balance work! The Gait Guys: bringing you the meat, without the filler!                                                                          Am J Sports Med. 2009 May;37(5):982-8. doi: 10.1177/0363546508330147. Epub 2009 Mar 6. Peroneal activation deficits in persons with functional ankle instability. Palmieri-Smith RM, Hopkins JT, Brown TN. Source School of Kinesiology, University of Michigan, 401 Washtenaw Avenue, Ann Arbor, MI 48109, USA. riannp@umich.edu Abstract BACKGROUND: Functional ankle instability (FAI) may be prevalent in as many as 40% of patients after acute lateral ankle sprain. Altered afference resulting from damaged mechanoreceptors after an ankle sprain may lead to reflex inhibition of surrounding joint musculature. This activation deficit, referred to as arthrogenic muscle inhibition (AMI), may be the underlying cause of FAI. Incomplete activation could prevent adequate control of the ankle joint, leading to repeated episodes of instability. HYPOTHESIS: Arthrogenic muscle inhibition is present in the peroneal musculature of functionally unstable ankles and is related to dynamic peroneal muscle activity. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Twenty-one (18 female, 3 male) patients with unilateral FAI and 21 (18 female, 3 male) uninjured, matched controls participated in this study. Peroneal maximum H-reflexes and M-waves were recorded bilaterally to establish the presence or absence of AMI, while electromyography (EMG) recorded as patients underwent a sudden ankle inversion perturbation during walking was used to quantify dynamic activation. The H:M ratio and average EMG amplitudes were calculated and used in data analyses. Two-way analyses of variance were used to compare limbs and groups. A regression analysis was conducted to examine the association between the H:M ratio and the EMG amplitudes. RESULTS: The FAI patients had larger peroneal H:M ratios in their nonpathological ankle (0.399 +/- 0.185) than in their pathological ankle (0.323 +/- 0.161) (P = .036), while no differences were noted between the ankles of the controls (0.442 +/- 0.176 and 0.425 +/- 0.180). The FAI patients also exhibited lower EMG after inversion perturbation in their pathological ankle (1.7 +/- 1.3) than in their uninjured ankle (EMG, 3.3 +/- 3.1) (P < .001), while no differences between legs were noted for controls (P > .05). No significant relationship was found between the peroneal H:M ratio and peroneal EMG (P > .05). CONCLUSION: Arthrogenic muscle inhibition is present in the peroneal musculature of persons with FAI but is not related to dynamic muscle activation as measured by peroneal EMG amplitude. Reversing AMI may not assist in protecting the ankle from further episodes of instability; however dynamic muscle activation (as measured by peroneal EMG amplitude) should be restored to maximize ankle stabilization. Dynamic peroneal activity is impaired in functionally unstable ankles, which may contribute to recurrent joint instability and may leave the ankle vulnerable to injurious loads. all material (except for the study); copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved. Please ask before you lift our stuff. If you are nice and give us credit, we will probably let you use it! https://www.thegaitguys.com/thedailyblog/new-study-finds-group-of-heel-striking-barefoot monthly 0.5 2013-01-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553648099-CXAMWF9T42U63SH8BH4M/tumblr_mgfeotpPga1qhko2so1_250.gif Blog New Study Finds Group of Heel Striking Barefoot Kenyan Runners. Not all that is barefoot is necessarily forefoot… You may have seen our tweet yesterday and have read this article. Or maybe, because you are a foot geek, you have seen it already. Here’s the summary: “Jan. 9, 2013 — A recently published paper by two George Washington University researchers shows that the running foot strike patterns vary among habitually barefoot people in Kenya due to speed and other factors such as running habits and the hardness of the ground. These results are counter to the belief that barefoot people prefer one specific style of running.” The study reported a 72 percent rearfoot landing when running barefoot at endurance pace speeds supporting the notion that speed affects landing choice (faster speeds transitioned  the runners into more midfoot / forefoot landing).  Lieberman’s Harvard study which brought much of the forefoot strike principle to the western world was often based off of sub 5 mile paced runs. It raises the question “ If barefoot IS better, and forefoot impact IS BETTER, then, what gives?” We think the better response is: there are many variables (genetics, surface, speed, etc) that can influence foot strike patterns and this paper exemplifies that. Fore foot striking in runners does lessen impact forces. Forefoot striking does appear to accentuate any forefoot abnormality (ie: varus/valgus) that may be present (something we will continue to say until someone proves it otherwise). forefoot striking loads the posterior compartment of the lower leg (tricep surae (gastroc soleus complex)) to a greater degree We like a mid foot strike, not because it is the middle road, but because it supports the notion in distance running that the entire foot tripod (which is more stable) engages the ground reducing solitary forefoot and rearfoot loading issues which each have their risks and challenges and allows for a more stable contact point for the body to negotiate over.  We have pounded sand on forefoot types, and the inherent risks of forefoot strike running with each of them, from our inception.  But, when it comes to midfoot strike there doesn’t appear to be much, if any literature out there to support our opinion.  Maybe now that the forefoot and rearfoot studies are out there maybe someone will find a tribe of midfoot strikers to support our rants. We think the key is not necessarily strike position, but rather where the foot is hitting the ground relative to the body AND MORE IMPORTANTLY, having a competent foot and lower kinetic chain and core, along with the body’s ABILITY to absorb or attenuate those forces, no matter where the foot is striking the ground. This is no doubt the 1st in a series of papers looking at this. It will be interesting to see where it goes from here. Ivo and Shawn…  The Gait Guys here is the link: http://www.sciencedaily.com/releases/2013/01/130109185856.htm all material copyright 2013 The Homunculus Group/ The Gait Guys. Please ask to use our stuff and reference it appropriately. We know a guy named BamBam who helps people play nice. https://www.thegaitguys.com/thedailyblog/gait-guys-what-is-the-truth-when-it-comes-time-to monthly 0.5 2013-01-09 https://www.thegaitguys.com/thedailyblog/a-little-neuro-anyone-welcome-to-monday-and monthly 0.5 2013-01-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553648393-9I2S4HM9RCG7A64DW3Q4/tumblr_mg6a1wNO4i1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553649020-D72YV8ZCWADCXYYVFELG/tumblr_mg6a1wNO4i1qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/previously-unreleased-video-available-for monthly 0.5 2013-01-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553650350-T03ZMID15RO4S41OCHIZ/tumblr_mfz2vgcl521qhko2so1_1280.jpg Blog Previously unreleased Video Available for download “Performance Theories: Dialogues on Training Concepts” How about some one on one with Shawn and Ivo? Hear our thoughts on: • What is the definition of the core and what does it entail ? • Physiologic overflow of muscles with respect to joint motion • Isotonic Exercise concepts • Physiologic characteristics of muscle types • Strength Training: Neural Adaptation • Motor Pattern Muscle Compensation Concepts • Exercise Prescription Concepts • Hip Extension Motor Pattern: A discussion on compensations • Neurologic Reciprocal Inhibition: Principles of joint movement and stability • The Concept of Tight and Short Muscles: They are different • Stretching: Good or Bad? We tackle the tough questions and provide real world answers.  An hour packed with hours worth of information! Download your copy here from Payloadz. all material copyright 2009 The Homunculus Group/ The Gait Guys. All rights reserved. https://www.thegaitguys.com/thedailyblog/acupuncture-and-muscle-strength monthly 0.5 2013-01-03 https://www.thegaitguys.com/thedailyblog/back-and-better-than-ever-more-on-the-core monthly 0.5 2013-01-02 https://www.thegaitguys.com/thedailyblog/high-heels-and-orthotics-what-better-way-to monthly 0.5 2013-01-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553649781-CK8EHWDV1U8R2SHNXOLI/tumblr_mftbzfYnqO1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553650266-ZHSWHWE0WKDD2G48D3LY/tumblr_mftbzfYnqO1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553650308-ORSY9B73PEABACE8YHV6/tumblr_mftbzfYnqO1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/we-want-to-thank-all-of-you-for-putting-up-with-us monthly 0.5 2012-12-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553650924-MWKZFZONXONUM0FSC3JE/tumblr_mftcrkXC9b1qhko2so1_1280.jpg Blog We want to thank all of you for putting up with us this past year. Thanks for reading, thanks for responding, thanks for listening and thanks for your support. We are looking forward to a great 2013! The Gait Guys, Shawn and Ivo (In case you didn’t know, Shawn is the taller. better looking, younger member of the team : ) ) https://www.thegaitguys.com/thedailyblog/can-running-can-movement-make-us-better monthly 0.5 2012-12-31 https://www.thegaitguys.com/thedailyblog/classic-shawn-and-ivo-from-our-archives-training monthly 0.5 2012-12-27 https://www.thegaitguys.com/thedailyblog/so-what-do-these-dogs-tell-us-these-are monthly 0.5 2012-12-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553651398-J3VSHUBJ0GHBUEJ0OG9T/tumblr_mfmh22NLm01qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553651562-6CVSKPA1IJBB5KDQTUVE/tumblr_mfmh22NLm01qhko2so2_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553652432-4FPPF0XFMVK80R230Z9L/tumblr_mfmh22NLm01qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/what-lies-behind-us-and-what-lies-before-us-are monthly 0.5 2012-12-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553652186-6KG9RO75FQRBVSEFMDIO/tumblr_mfkiypU6wN1qhko2so1_1280.jpg Blog What lies behind us and what lies before us are tiny matters compared to what lies within us. Ralph Waldo Emerson Happy Holidays. Ivo and Shawn https://www.thegaitguys.com/thedailyblog/too-much-pressure-for-the-holidays-take-a-look-at monthly 0.5 2012-12-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553653656-HTTYOTTBT68YG02OA4RX/tumblr_mfjhywerr21qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553653200-JY8HWYXDP9K58O84121G/tumblr_mfjhywerr21qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/since-the-world-did-not-end-you-should-probably monthly 0.5 2012-12-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553653092-TKDWSW19EK5K6JMC3RAW/tumblr_mfc6225TaT1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553653892-ZA8AR9PU1P9ICARJONIG/tumblr_mfc6225TaT1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553653545-AY9JDT5WX4NZJWM6MA7J/tumblr_mfc6225TaT1qhko2so3_r1_250.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553654411-P0Y1I0GXNWRCUQ4YUS0K/tumblr_mfc6225TaT1qhko2so4_r1_400.jpg Blog https://www.thegaitguys.com/thedailyblog/ill-plead-the-1st-more-foot-geek-stuff monthly 0.5 2012-12-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553654666-LHRAAVH8VCL18QGUOOYR/tumblr_mee0ffpHp51qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553654718-I7CLAJP0TJHRL6CBAF7Z/tumblr_mee0ffpHp51qhko2so2_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553655475-BUJRXWEP801AILBHYPPK/tumblr_mee0ffpHp51qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553655464-Z9D5XBDLQ8RYSULQTJW2/tumblr_mee0ffpHp51qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/excessive-supination-in-a-marathoner-shoe-photos monthly 0.5 2012-12-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553656032-P70BFJZQWRDEXN0VQ8MF/tumblr_mez09uCjqF1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553657155-3RN1TED2BYNTYTP79RGF/tumblr_mez09uCjqF1qhko2so5_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/podcast-18-treadmills-shrooms-santa monthly 0.5 2012-12-12 https://www.thegaitguys.com/thedailyblog/shoe-news-you-can-use-the-heel-counter-the-back monthly 0.5 2012-12-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553656532-FVEOGBZCY8YE5SYF0M5R/tumblr_mee1niiIs01qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553657251-D8S4PFL0R2Y80GWW0V1N/tumblr_mee1niiIs01qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553657375-STL6KYT0SA6246NC3POQ/tumblr_mee1niiIs01qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/are-old-running-shoes-detrimental-to-your-feet monthly 0.5 2012-12-06 https://www.thegaitguys.com/thedailyblog/the-great-myth-of-rotating-your-shoes-here-are monthly 0.5 2012-12-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553657507-8QN00NDWP76VQAAQUWAV/tumblr_mekfl3JSiq1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553657774-ZZQT82AUDOIB2CY2V195/tumblr_mekfl3JSiq1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/gait-forensics-why-the-government-and-their monthly 0.5 2012-12-04 https://www.thegaitguys.com/thedailyblog/more-to-say-about-the-national-shoe-fit monthly 0.5 2012-12-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553657831-VDIUTOTEVN2SJJECLNW4/tumblr_me6dovQycn1qhko2so1_1280.jpg Blog More to say about the National Shoe Fit Certification Program… “I found the course to be the perfect blend between science and retail practices, making it an essential tool for any specialty running store. Immediately after finishing the video I was able to recognize specific issues in my customer’s feet and their reaction to my knowledge couldn’t have been more positive. As a result of becoming certified I will have happier and healthier customers and will know when to refer particular foot and gait issues to my partner doctors and physical therapists. The video will be a resource long after becoming certified.” Ben Nelson is the manager of Goldstream Running, the farthest north run specialty shop in North America (and maybe the world!), located in the Goldstream Valley outside of Fairbanks, Alaska. He also coaches high school cross country and track and field. Want to know more about getting certified? drop us an email: thegaitguys@gmail.com https://www.thegaitguys.com/thedailyblog/podcast-17-gait-and-magic-and-much-more monthly 0.5 2012-11-30 https://www.thegaitguys.com/thedailyblog/neuromechanics-this-early-in-the-morning-it monthly 0.5 2012-11-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553658597-L1UOEZLGTYUJC2HK226X/tumblr_me99vfgimt1qhko2so1_400.jpg Blog Neuromechanics?  This early in the morning? It has been a while since we have done a neuromechanics post. While doing some research for one of our PODcasts, We ran across this paper: http://www.ajronline.org/content/184/3/953.full It’s title? Midbrain Ataxia: An Introduction to the Mesencephalic Locomotor Region and the Pedunculopontine Nucleus Yikes! What a mouthful! What’s the bottom line? The paper review a condition called “gait ataxia”. In plain English this means “aberrant or unsteady” gait. Things which usually cause gait ataxia originate in an area of the brain called the cerebellum, which coordinates all muscle activity. If you drink to much alcohol, it affects your cerebellum and you have a “wobbly” gait : ). This paper looks at another area of the brain called the midbrain. It is the top part of the brainstem and contains an important gait integration and initiation center called the “midbrain locomotor nucleus”. The paper looks at 3 different cases and has some cool MRI images to see, along with alot of fancy neurological words and pathways. Whenever we see gait ataxia, we think of impaired proprioception (look here for a bunch of posts on that, or at this post specifically). There are many factors to consider when evaluating ataxic (or wobbly) gait, and this just gives us all one more place to look. The Gait Guys. Making you smarter every day! https://www.thegaitguys.com/thedailyblog/shoesday-tuesday-shoe-news-you-can-use-the monthly 0.5 2012-11-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553658472-ZT93EHFMZVPZBJD0SH2V/tumblr_mdycul6PpX1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553659195-6NHN7WP78X5E0E9RRBUL/tumblr_mdycul6PpX1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/turkey-training-a-spooked-turkey-can-run-at monthly 0.5 2012-11-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553659656-VH4I0V78B64CIHN08BEC/tumblr_mdwjbyQjv21qhko2so1_1280.jpg Blog Turkey Training: “A spooked turkey can run at speeds up to 20 miles per hour. They can also burst into flight approaching speeds between 50-55 mph in a matter of seconds.” http://thanksgiving.aristotle.net/turkey-facts The Gait Guys Response: Well of course they can. Look at hat hip extension! Wow, they must have some Creatine Phosphate stores! Have a great bird, everyone! Ivo and Shawn https://www.thegaitguys.com/thedailyblog/all-walking-is-discovery-on-foot-we-take-the monthly 0.5 2012-11-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553660637-Q4AOIN2XKH4AD9MVV5C1/tumblr_mdvjdk5PsP1qhko2so1_1280.jpg Blog “All walking is discovery. On foot we take the time to see things whole.” Hal Borland Have a happy and healthy Thanksgiving! Ivo and Shawn https://www.thegaitguys.com/thedailyblog/the-dual-density-foam-running-shoe-this-goes monthly 0.5 2012-11-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553660084-66O34D05FBLR4HDM6GLJ/tumblr_mdsxt2WcFd1qhko2so1_1280.jpg Blog The Dual Density Foam Running Shoe. This goes along nicely with yesterdays post. Note the photo attached. This is a great example of something we all see everyday. A laterally tipped foot in a stability shoe.  Clearly a shoe that has been mis-prescribed for the wrong reason. Or has it ? This client is clearly tipped laterally in the shoe, forcing supination.  Did this client self fit the shoe themselves in a discount store ? Were they fitted in a retail running store ? Where did things go wrong ? Or did they ?  The initial knee jerk reaction is to say this is the wrong shoe for this client.  Lets go a little deeper and ask some harder questions and see if you are considering some alternatives. The assumption is frequently one of, “you are a hyperpronator so you need a stability shoe”. In this case is this person a hyperpronator ?  There is no way to know, not in the shoe.  On initial knee jerk observation this looks like a supinator in a stability shoe, a poor match.  But read on … 1. What if this person has significant flat feet, pes planus with severe pronation problems, but they find the stability they need by standing on the outer edge of the foot in the mechanically locked out position (supination).  Perhaps this is a less fatiguing posture, perhaps a less painful posture. This is often a comfort thing for hyperpronators to display.  What you see is not always what you get because there are two types of feet, those that drop or collapse into the weakness and those that fight the collapse and weakness the whole way via an alternative compensation.  You cannot tell by looking, certainly not from this picture of someone in a shoe. There must be a functional assessment and some gait evaluation.  2. There exists the high arched flexible foot that pronates excessively, quickly and for a long time (this is the flexible cavus foot) and then there is the high arched rigid foot (the equinovarus foot).  The first described foot may need support from a stability shoe even though they have a high arch on presentation/examination and the later described foot can often go right into a neutral non-supportive shoe.  Can you tell either of these from this picture ? No you cannot. 3. Maybe the person in the photo has tibial varum (bowed lower leg) combined with a rearfoot varus and forefoot varus. This could mean they pronate heavily through the midfoot-forefoot and less so through the rearfoot-midfoot. In this case they are still a heavy pronator but not through what is typically noted or detected by significant medial arch collapse.  In this case the dual density shoe is not going to help all that much because the pronation is occurring mostly after the bulk of the shoe’s dual density stability foam has been passed through by the foot. Can this be detected by this photo ? Again the answer is no. The shoe fitter needs to be clinically aware that this type of client needs a forefoot varus posted shoe to help post up that medial tripod (1st metatarsal head). 4. Maybe, just maybe this is a typical rearfoot-midfoot pronating client, excessive mind you, and all they need is some foot and gait retraining to break their old compensation pattern of lateral weight bearing (standing or walking) and with this correct shoe they can then engage a healthier motor pattern.  Which is it ? Do you know how to navigate your way through these issues to make the right decision ?  There is no way to know here without seeing the foot naked and moving across the floor, and with a clinical examination to boot. You can get all these things through our National Shoe Fit Certification program found here. LINK:  http://store.payloadz.com/results/results.aspx?advsearch=1&m=80204 Email us and we will share the necessary info to get you started.  thegaitguys@gmail.com Shawn and Ivo, The Gait Guys https://www.thegaitguys.com/thedailyblog/shoe-news-you-can-use-the-midsole-last-time-we monthly 0.5 2012-11-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553660859-BC6Q3QDF4PT4OO1E3JMA/tumblr_mdroefnw051qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553660619-RXS8BMVDPVF58VW0RA86/tumblr_mdroefnw051qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553660859-906KF02H7GQNO403INCW/tumblr_mdroefnw051qhko2so5_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/certification-see-what-your-peers-are-saying monthly 0.5 2012-11-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553660797-E3G3GTP1DFU2XUJ7KVVG/tumblr_mcx3q2Wjlc1qhko2so1_250.jpg Blog Certification. See what your peers are saying…. “The shoe fit certification program is a must for anyone who wants to take their knowledge base of shoes, foot types and how they interact to the next level. The program is detailed, thorough, and the test will make sure you know this cutting edge material.  If you are a doctor or therapist that treats foot or other lower extremities disorders, this information will help ensure the patients you treat are in the right shoe to assist them in their healing process and help prevent future problems.  If you are a shoe retailer, it will give you the confidence you are putting the right shoes on your customer’s feet to minimize complaints and unwanted returns.  The retail practice of simply looking at a customer’s feet while standing, asking them their shoe size, and pulling a shoe off the shelf has gone by the wayside in light of this new information. If your profession involves shoes or feet, the information contained in this program is priceless!”     Ryan D. Hamm, D.C. Corrective Chiropractic Center 612 E. Golf Road Arlington Heights, IL 60005 847.718.0071 www.correctivechiropracticcenter.com Specializing in the Conservative Treatment of Musculoskeletal Disorders of the Spine and Extremities https://www.thegaitguys.com/thedailyblog/podcast-16-monkeys-newton-shoes-gait-vision monthly 0.5 2012-11-16 https://www.thegaitguys.com/thedailyblog/foot-types-and-shoe-selection-anyone-join-dr monthly 0.5 2012-11-15 https://www.thegaitguys.com/thedailyblog/hip-biomechanics-part-6-of-6-the-conclusion-for monthly 0.5 2012-11-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553662123-H6U0AYP3K1I5LUR1FXAT/tumblr_m7fb3sydAv1qhko2so1_r1_400.jpg Blog Hip Biomechanics: Part 6 of 6, The Conclusion (for now) A Piece of the Functional Puzzle: Hip Rotation As we have already mentioned, stabilization of the hip is complicated in its own right, but when we ask it to participate in balanced single limb movement and stability in the frontal/coronal, sagittal and axial planes all at once, the delicate balancing act of of these components is sheer genius. Through our collective clinical experiences it has become apparent over time that vertical and horizontal gravity dependent postural examination can open insight into a deeper functional disturbance in patients.  For example, an externally rotated right lower limb as evidenced by an accentuated external foot flare should initiate the thought process that there is either an anatomically short right limb (external rotation increases leg length), tight right posterior hip capsule, short gluteals or other posterior hip musculature (piriformis, obterators, gemelli), weak internal hip rotators, weak stabilizers of this internal hip rotation, or possibly an over-pronating right foot which shortens the limb and hence the need for the externally rotated and lengthened right limb (ie. failed compensattion).  What we mean by this last component is that there are really two basic types of presentations, those that are compensations to an underlying problem and those that are failed compensations. In consideration of all scenarios, our traditional thinking has directed us to believe we are dealing with a limb posture that has occurred to lengthen the limb in question.  However, perhaps the compensation is deeper in its root cause.  For example, the traditional thinking in alignment restoration of this postural deviation is to stretch the piriformis, glutes and iliopsoas and perform deep soft tissue work such as myofascial release methods, stripping, post-isometric release and mobilization or manipulation to the affected tissues and associated joints to ensure normal function.  These efforts are meant to restore the limbs rotational anomaly and hopefully the cause of the leg length compensation. However, many clinicians will attest to the fact that these methods are frequently unsuccessful or at least limited in their short or long term effectiveness towards complete symptom and postural deficit resolution.  Frequently our patients enter into the cyclical office visits several times a year to address symptoms associated with the root cause.  Thus, we must delve deeper into the source of the problem, perhaps those above methods are focused at resolving the neuroprotective compensation and not the lack of strength or stability of internal hip rotation.  This approach will require the therapist to investigate the open and closed kinetic chain functions of these external and internal hip rotators and look further and more deeply for the source. In the open kinetic chain (swing phase of gait) the primary and secondary external rotators turn the lower limb outwards in relation to a fixed pelvis established by a sound core; this is late swing phase. This external rotation is, at this point, largely assistive in driving foot supination to gain a rigid foot lever to toe off from.  In the closed kinetic chain scenario, with the foot engaged with the ground, the activation of these same muscles will cause the same movement at the hip-pelvis interface but in this case the pelvis/torso will rotate.  For example, in observance of a closed chain right lower limb, upon activation of the glutes, piriformis and accessory external hip rotators the client’s pelvis and thus torso will rotate to the left (counterclockwise rotation) along the vertical body axis about the fixed right limb.  With this functional thinking we must now embrace the fact that our traditional perspectives of body function assessment in the frontal and sagittal planes must be largely discarded.  It is a rare occurrence that we move in a single plane of motion without any component of rotation.  This being accepted, we must return to our client’s left pelvis rotation and understand that torso rotation must occur in the opposite direction if gait is to be normal with proper arm swing and propulsion.  This rotation can occur from activation of not only component muscles at the hip-pelvis interval but also from the abdominal obliques, thoracic spine and rib cage.  Therefore, one could hypothesize that a client’s external rotation of the right lower limb in stance or gait might not be a primary problem with the piriformis, glutes or accessory muscles rather it could be a compensation for either a one sided over-active or  weak abdominal oblique system/sling/chain or abnormal thoracic rotation, or a combination of both.  Assessment of a patient’s passive and active torso and thoracic/rib rotation might open a window into one of a range-driven deficit or weakness/inhibition. Shoulder mobility assessment is going to be necessary as well because it can and will effect torso/rib cage mobility, arm swing is a huge predictor and indicator in faulty gait assessment and it is one frequently overlooked (type in “arm swing” into our blog SEARCH box and you will be excited to read the research on arm swing in gait). The practitioner must always embrace the thought that the client’s core might not only present as weak but to a higher level that of imbalanced, which is a combination of weakness, stretch weakness, strength, over-activation, inhibition and impaired movement patterns (including breathing).  This imbalance can come from such parameters as pain, handed dominance activities, lower limb dominance issues, occupational demands or others as discussed below. What we continue to find as our clinical experiences expand is that many deficits in the body are driven by a functional core weakness/imbalance or forces not dampened across a weak core and from impaired gait biomechanics.  In this case, the absence of balanced core abdominal strength and torso rotation renders a weaker or inhibited core rotation/lateral bend on one side and it is this deficit that is often compensated in the pelvis as a tight hip/pelvis soft tissues unilaterally (expressed perhaps as the unilateral externally rotated limb). This will often alter function, strength and mobility in single leg stance during the gait cycle and enable a compensatory cheat into one or several of the cardinal planes of motion. This is of course but just one scenario. Taking the example above, a right externally rotated lower limb with associated tight and/or painful right piriformis muscle, we frequently (but yes, not always) see a loss of rotation range or strength into left torso rotation.  This can be seen on supine rolling patterns looking for upper or lower limb driver deficits. This scenario might be showing little to no progress with therapy but may do so with focused work on supine rolling patterns.  Therapeutically facilitating oblique abdominal strength to improve range and strength into left thoracic/rib cage rotation over time may reflexively reduce the piriformis spasm and rotational deficit in the right lower limb without even applying much direct therapy to this area.  In other words, our experience shows that improving the thoracic rotation into the side of limitation can have some neurologic response of inhibition/relaxation on the tight posterior hip compartment.  We would be remiss if we were to neglect that this oblique abdominal weakness could coincide with a slight anterior pelvic tilt in the sagittal plane on that side (which promotes weakness of the internal hip rotators since the lower abdominals help anchor them).  We would see a slight bellowing of the left abdominal group and a slight increased anterior pelvic tilt on the same side.  This asymmetrical pelvis posture would load the superior aspect of the right piriformis and force it into spasm due to the sustained pelvic obliquity and slight drop in the anterior direction.  This spasm can inhibit the gluteal group and further complicate the problem.  Keep in mind that a weak left oblique abdominal system would facilitate a tendency towards a sway back position, stretch weak left iliopsoas, and the anterior femoral glide syndrome of the hip (not to mention weak internal hip rotators).  As previously touched upon, activities of daily living such as sleep, stance and sit positions, driving style, handedness, respiration,  functional and anatomical leg length differences, unidirectional floor transfers and simply imbalances in the hip rotators can all cause this imbalance and thus piriformis dysfunction.  In summary, the key to the body in the above scenario is in its ability to create and control rotation.  The ribs, thoracic spine, foot and hips are the most important rotators of the body and their relationship is well established.  Even something as simple as respiration mechanics can be dysfunctional as a result of excessive computer use, reading, driving, sedentary lifestyle and sporting history (one sided dominant sports).  For these reasons, most individuals will be unable to rotate effectively and without compensation patterns so the rotational deficits frequently are expressed either upwards into the thoracic spine, ribs and shoulders (one way to see these problems is to look at shoulder posture and arm swing during gait) or they are expressed caudally into the pelvis at the hips.  We are sure there is more in us on hip biomechanics but for now this 6 part series will have to suffice. We are putting it aside for now and will move back to some other issues on gait and  human movement so we do not get stale.  We hope you enjoyed our 6 part series. Shawn and Ivo  (not just your average gait analysis doctors) https://www.thegaitguys.com/thedailyblog/yet-another-ifgec-certification-here-is-what monthly 0.5 2012-11-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553661911-RGBSCMT964TZRHS2XZ1V/tumblr_mcbuhmke0o1qhko2so1_1280.jpg Blog Yet another IFGEC certification Here is what Diana Keh has to say “The Gait Guys have really helped me learn more about foot anatomy and biomechanics and how they relate to fitting customers properly for shoes.  I had followed their blog posts in the past but it was the course that helped solidify those concepts and put them into practice.” Check her out at:  www.fitgeeksports.com   (408) 418-5888 The Gait Guys. Bringing the world of gait geeks together, one shop at a time. https://www.thegaitguys.com/thedailyblog/join-dr-ivo-as-he-talks-about-pronation-and monthly 0.5 2012-11-09 https://www.thegaitguys.com/thedailyblog/hip-biomechanics-part-5-of-6-sagittal-plane monthly 0.5 2012-11-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553662345-4BHXEFTPOZWQ008H2N7S/tumblr_m7fb24SE6G1qhko2so1_400.jpg Blog Hip Biomechanics: Part 5 of 6 Sagittal Plane Functional Biomechanics Thus far we have discussed the hip biomechanics mostly in the frontal plane.  The sagittal plane mechanics are much less complex since the axis of movement is in the frontal plane (the axis is directed horizontally through the femoral heads and pelvis) and the body weight for the most part rests on this same plane (unlike the frontal plane mechanics where the body weight is a moment arm away from the center of the hip rotation).  One of the main reasons the mechanics are a little less complicated for the most part is due to the fact that even with the pelvic obliquity that occurs during gait cycles of swing and stance, the body weight still remains largely over this trans-femoral head axis.  In the sagittal plane the prime movers are the abdominas and gluteals (flexion and extension of the hip respectively) with some help from the ilopsoas for hip flexion perpetuation. The calf compartment is also  helpful as is arm swing.  The hip flexor synergistic muscles are the quadriceps and abdominals while the hip extensor synergist is mainly the hamstring group.  This is certainly simplified since transaxial rotation through a vertical oriented axis does occur as a coupled motion and thus we cannot talk about sagittal plane movements, or even frontal plane movements for that matter, without at least considering the effects of movement generation or stabilization by the hip intrinsics (gemelli, oburators, quadratus femoris, piriformis).  The greatest body function in the sagittal plane is gait and many of the body’s compensations and conditions stem from alterations in hip joint function through this movement negotiation through the sagittal space.  For the therapist, clinician or trainer the greatest problem can be the body’s numerous back-up systems which compensate and share normal or abnormal loading. The basis of gait evaluation needs to be based from a holistic perspective.  Gait cannot be evaluated without consideration of the entire organism. A minor functional limitation in the first metatarsophalangeal (MTP) joint can significantly impact hip, pelvic and spinal biomechanics.  The best and simplest example of this is the clinical scenario of hallux limitus.  We will entertain the equally devastating functional hallux limitus later on in the chapter but the point to note here is that a minor loss of the last few degrees of the normal MTP joint dorsiflexion (45-60 degrees is necessary, patient specific) can be devastating to sagittal plane motion of the body.  Even a loss of the last 5 degrees of this normal range, although appearing relatively normal on an examination and possibly without symptoms (ie. early stages of progression into a more noticable hallux limitus), can impact normal and efficient toe off.  If toe off is early, even to a small degree, then the stance phase will be abbreviated via early heel rise.  If heel rise is early this creates a functional change in the kinetic chain, both open chain and closed chain.  There are many closed chain changes that will occur. One such change might be toe off propulsion forces being imparted through a more flexed tibiofemoral joint (knee) which will impart both translatory shear forces in the sagittal plane and torsional forces through the joint, both causing potential maceration effects on the menisci.  However, perhaps the easiest functional changes to understand are the changes at the hip.  It is well known on EMG studies that hip flexion is both an active and passive motion during gait.  The active flexion of the hip is generated largely by iliopsoas concentric contraction.  However, this is not the first mechanism to generate hip flexion.  In fact, hip flexion is first generated passively through engagement of the kinetic chain.  The first movement of the swing phase is rotational or torsional activation of the oblique pelvis through core activiation of the abdominal muscle group.  Through activation of the internal and external abdominal obliques and transversus abdominus, in addition to activation of their synergists and cocontration of their antagonistic stabilizers, the obliqued pelvis is rotated.  Better said, the trailing leg’s lagging pelvis is moved forward by contract of the synergistic oblique activation.  This forward movement generates a sagittal momentum and movement of the toe off leg.  Once movement is generated then the iliopsoas activates concentrically to perpetuate hip flexion.  In other words, the ilopsoas is not an initiator of hip flexion, rather, a perpetuator.  When hallux limitus limits the stride length via early generation of heel rise the pelvic obliquity is limited.  As a result, the degree of initial swing phase leg movement is less from the generation of pelvis de-rotation via abdominal activation and more through ill-directed iliopsoas hip flexion.  Thus, as hip flexion still needs to occur, the iliopsoas is called upon to compensate; it now becomes a hip flexion initiator as well as its previous function of hip flexion perpetuator.  This demand is minimal but with repetitive demand thousands of steps per day, the iliopsoas eventually looses its ability to continue these compensations, as does its now over burdened synergists.  The result is either hypertrophy, inhibition, hypertonicity, spasm, shortening, insertional tendonitis, origin tendonitis or a combination thereof but make no mistake, such burden will eventually cause dysfunction within the muscle itself or within its synergists or antagonistic pair.  The scenario may result in either joint dysfunction at the lumbar spine near the muscle’s origin, at the sacroiliac joint over which it crosses, or at the hip joint proper.  The ensuing joint derangement or dysfunction is complex and creates numerous compensation patterns locally and globally since the main function of the muscle is to create hip flexion, external rotation, and abduction in the open kinetic chain and trunk flexion and trunk internal rotation in the closed kinetic chain. In a nutshell, the loss of dorsiflexion of the hallux, even to a minor degree, must be made up somewhere in the sagittal plane.  If it is not immediately made up for at the more proximal joints (1st metatarsal-midfoot joint, talo-navicular, ankle mortise-tibiotalar, or knee) the hip will undoubtedly change its function as described above to compensate, it is well suited to do so.  Keep in mind that such compensations may be better suited at the ankle, knee or hip depending on the degree of hip ante/retrotorsion or tibial internal/external torsion if present but none the less these compensations have consequences to changes in function of muscles either eccentrically, isometrically or concentrically or by recruiting assistance from synergists or antagonistic groups.  Additionally, a person with a very flexible midtarsal joint may stop the more proximal compensations via restoration of the necessary first ray (first toe) complex dorsiflexion at that more immediately proximal joint complex.  Shawn and Ivo (yup, that is Dr. Allen thinking he is a bad ass in the picture above, clay pigeon shooting and a cubano……. thinks he is Clint Eastwood or something. Regardless, don’t mess with The Gait Guys !). https://www.thegaitguys.com/thedailyblog/shoe-facts-the-outsole-also-called-the-sole monthly 0.5 2012-11-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553662780-U2D4HAVGR31MYUX29IS8/tumblr_mcy05kknUm1qhko2so1_1280.jpg Blog Shoe Facts: The Outsole (also called the “sole”) This is the part of the shoe that comes in contact with the ground. It is often made of rubber and provides for traction and some degree of shock absorption. It can be sewn, cemented or integrated with the midsole. Remember that the heel strikes the ground at approximately a 16° angle, lateral from the center of the heel.  The force is then transmitted from the sole of the shoe, up the lateral column of the foot and across to the first metatarsal for propulsion (add link see mondays post here for more on progressional forces).  This can be assisted by a “rocker” which is a “drop” put into the front portion of a shoe, to ease walking and assist in toe off (more on this in  another post).  A flare to the sole of the shoe (usually at the rear, medial or lateral), can be important for stability on uneven surfaces, by providing a bigger “footprint” or surface area contacting the ground (much like Dr Allen’s new Dodge truck).  A lateral flare provides extra stability upon heel strike by preventing too much inversion of the heel, but it speeds up the rate of pronation.  A medial flare would slow pronation (not great for a supinator though, or folks who keep weight on the outside of the foot for extended periods of time). This flare’s placement (whether medial or lateral) will profoundly affect forces at the mid tarsal joint as the foot comes through mid stance.  The Gait Guys. Making you more “shoeliterate” each day! Want to know more? Email us at thegaitguys@gmail.com for information about our National Shoe Fit Certification course. copyright 2012 The Homunculus Group/ The Gait Guys. All rights reserved. DON’T RIP OFF OUR STUFF. https://www.thegaitguys.com/thedailyblog/podcast-15-brain-size-gait-and-evolution-to monthly 0.5 2012-11-07 https://www.thegaitguys.com/thedailyblog/the-importance-of-the-toe-box-in-this-brief monthly 0.5 2012-11-06 https://www.thegaitguys.com/thedailyblog/another-ifgec-certification-granted-my-name-is monthly 0.5 2012-11-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553663023-BO9H6SGF72JEGN4H8NY5/tumblr_mbpn8gPfKd1qhko2so1_r1_1280.jpg Blog Another IFGEC Certification Granted! “My name is Eric Johnson.  I’m a runner and triathlete, and manage a running store called Ultramax Sports in Springfield, MO.  I am a self-confessed exercise physiology nerd but don’t have an advanced degree in exercise science.  As a result, I’m always reading and trying to learn more.  My fascination with running, shoes, and injuries also stems from an extended bout of lower leg problems stemming from attempting to run through an injury in the early 2000’s.  I came across the Gait Guys’ tumblr blog one day and was instantly fascinated by the detailed descriptions of human gait abnormalities they wrote about but also how easy it was to apply to myself and my customers. At our store, we pride ourselves on doing very thorough fittings, including detailed athlete history, foot and leg observations, video gait analysis, and trying on lots of shoes with close customer care.  We’ve been doing this fitting process since we opened in the late 2000’s and have built a very solid following based upon customer care and attention to detail.  We try to avoid the fads and base our process on scientifically valid methods.  Through my explorations over the past couple of years, it became apparent that some of the things we were doing were right and some were wrong.  I had the opportunity to watch Shawn and Ivo speak at the 2011 IRRA conference and was very excited when they announced the upcoming release of a shoe fitting certification.  It took a bit longer than expected, but it was well worth it.  The three Level I videos were very clear and easy to understand, and it was an easy shift to apply the concepts to our fitting process.  I took and passed the Level I exam today in fact, and am working on the first wave of changes our store will be implementing on our shoe fitting process.  My understanding of the anatomy and physiology of human gait is incredibly better now.  In fact, I was able to apply concepts from the videos to a customer the other day whom I would not have served as completely without that knowledge.  She had been fit at our store in the past, but commented that our level of knowledge really seemed to grow in the interim.  She loved learning about why her feet her and why certain shoes felt better.  She was also very grateful to learn exercises to help her particular condition. This certification has the potential to greatly impact the running industry in a very positive way.  I wholeheartedly recommend all of you run specialty managers/owners/staff who want to provide a more complete and accurate experience for your customers to pursue this certification.  Customers will be more impressed with your level of knowledge and your returns will reduce.” Gait Guys. Certified! Get the edge! https://www.thegaitguys.com/thedailyblog/what-were-they-thinking-you-have-heard-us-talk monthly 0.5 2012-11-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553663257-87F6TKJ1YOS9453HVP52/tumblr_mcxyteSpsV1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553663729-D24LY91EQOCU34K35PMB/tumblr_mcxyteSpsV1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/dr-ivo-would-like-to-thank-everyone-who monthly 0.5 2012-11-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553663480-22O46630BAWBN416JFIW/tumblr_mctjs97kFC1qhko2so1_1280.jpg Blog Dr Ivo would like to thank Everyone who participated in our “Foot Fest” Tuesday evening at the office. Good Info, Good Food (provided by “Toosie’s Gluten Free”) and Good times. We gave away some great stuff and people went away informed. Here is a follow up article you may enjoy! http://www.runnersworld.com/article/0,7120,s6-238-267-268-8210-0,00.html https://www.thegaitguys.com/thedailyblog/hip-biomechanics-part-4-of-6-this-diagram monthly 0.5 2012-11-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553664154-AQKZVKSANGAA2WKE5WDU/tumblr_m7fb0nNtGJ1qhko2so1_r1_1280.jpg Blog Hip Biomechanics: Part 4 of 6 This diagram (Figure 4) also shows a balanced equation; HAM x D1 = D2 x BW.  (where HAM=hip abductor/g.medius, D1 and D1 are lever arms, BW= body weight). This is not exactly a desirable scenario or strategy to obtain when it comes to joint compression mechanics however it is close to representing what is accurate in the human hip.  Since the gluteus medius muscle is the primary joint compressor in the frontal plane (it applies two thirds of the compressive forces across the joint) we would ideally never want such a large HAM force.  Typically the internal to external moment arm ration is 2:1 thus this model would require a HAM force twice the body weight to maintain a balanced system.  None the less, we would want to offset these forces somehow.  The only way to offset the large HAM would be to move the pivot point closer to the BW thereby increasing the D1 (increase D1 and you can reduce HAM and thus joint compression load).  In a physical person the pivot point, the joint axis of movement, is fixed so there is no real strategy to improve the situation without surgery.  These patients are unlucky and have no strategies to improve their high compression forces unless they loose weight; due to the fact of the 2:1 ratio, for every pound of body weight loss there is a 2 pound force decrease in the HAM.  Obesity is going to wreak havoc on our populations hips. As mentioned previously, the model presented is very much incomplete.  Muscular forces surround the joint, movement occurs in every cardinal plane and there is acceleration of body segments which requires even greater muscular contraction isometrically, concentrically and eccentrically.  These factors all considered, it has been calculated that the total hip force crossing the joint can reach 3 times the body weight during walking.   This force is welcomed for maintaining joint stability but it can be an unwelcome force in a degenerative arthritic joint where the cartilage is less pliable and flexible.  The loading forces in an arthritic joint rhythmically pass into the acetabulum and femoral head as a result of the compromised cartilage necessitating increased bone mass and sclerosis within them.  This compromised arthritic joint will have some minor laxity due to the loss of the cartilage bulk and thinning of the acetabular labrum.  Thus the joint will have a slight increase in translatory/accessory movement and require greater muscular contraction to minimize/stabilize these movements.  These increased forces will be unwelcomed as they will generate more pain.  Additionally, the increased movements and degenerative debris within the joint will cause irritation and inflammation of the joint capsule and synovial lining causing further pain.  This entire scenario will cause the patient to investigate conscious and subconscious gait strategies to reduce the compression across the joint, in other words, they will essentially seek gait strategies that will reduce HAM (gluteus medius contraction) and increase the D1 internal moment arm.  These strategies will reduce the perpendicular joint compression forces that likely will be causing pain but if performed well they will be devastating to the normal frontal plane equilibrium since the gluteus medius muscle will be essentially shut down and inhibited.  Thus, the patient’s gait strategy will give us the compensated Trendelenburg gait pattern.  The uncompensated Trendelenburg gait will show a dropping of the contralateral hemipelvis on the swing side during gait, this is the pathologic gait pattern we see when the patient has not implemented strategies to reduce their pain but it is more likely seen when the patient is not yet at the painful stage in which they need to implore strategies to avoid the movement.  Comparatively, compensated Trendelenburg gait pattern will display a lifting of the contralateral hemipelvis.  This strategy is not implemented by activation of the gluteus medius on the side in question, rather it is a compensation move performed by shifting the patient’s body weight over the pathologic hip thus causing the hip that is dropping to be passively raised into a more normal range in the frontal plane.  This passive frontal plane move by the patient over the painful hip is at first difficult to embrace logically as one does not expect to want to load their body weight further over top of the painful hip.  However, upon investigation of the mathematical equation one will see that the shift of body weight (BW) over the affected hip will significantly reduce the D2 external moment arm, significantly increase the D1 internal moment arm and thus deliver us the desirable significant reduction in the HAM gluteus medius compressive contraction across the painful hip.  Thus, the pathologic compensation gait pattern in the frontal plane will markedly reduce the patient’s hip pain.  From a kinetic chain perspective however, there is always a price to pay.  This implemented strategy of ipsilateral trunk lateral flexion is performed by utilization of the thoracolumbar paraspinals and quadratus lumborum on the painful hip side. The resulting abnormal muscular and joint strategies now imparted on the lumbar spine and pelvis interface frequently begins a cascade of muscular and joint pain in the low back and abnormal loading of the lumbar discs.  The strategy also begins an unwelcome increased loading of the non-painful hip as the patient is loading the hip greater than normal due to the height from which the hip and pelvis drop from the compensated Trendelenburg position.  In other words, by protecting the painful arthritic hip from increased loads we sacrifice the healthy hip for a period of years until the forced finally amount to enough damage that pain begins here as well.  Fortunately, we have the ability to mediate some of these dramatic movements and forces by using logic and a cane.  By placing a walking cane in the hand opposite to the painful hip and by asking the patient to contact the cane with the ground when they initiate contact with the painful limb we can offset some of the excessive compensations and forces.  When the cane contacts the ground the patient is to apply a mild to moderate downward force through the cane via arm contraction.  This downward force will afford us a resultant upward ground reactive force through the cane delivering us a lifting effect on the dropped hemipelvis side (dipping hip side/non-painful side).  This strategy will allow us a more passive shifting of the body weight (BW) over the painful hip side without having to lift or pull the body weight (BW) over the painful hip with the hip abductor muscles (HAM).  These passive forces (which can be more than  half of those normally needed to be generated by the HAM) will help to markedly reduce the muscular forces needed by the spinal and quadratus muscles while also rendering the desired marked reduction in HAM compressive forces across the painful joint.  It is interesting to note that the further the cane is placed from the body, the longer its moment arm and thus the less downward force necessary by the patient’s arm.  It is quite possible, that if used correctly, a cane can almost completely offset the required contralateral HAM force.  Another passive strategy would be to carry objects (purses, books, grocery bags, etc) on the affected hip side.  This action will also balance the teeter-totter  in favor and thus reduce the muscular forced necessary to perform the same task.  It must be noted however that increasing any body load is undesirable and should be avoided not so much because of issues pertaining to the painful degenerative hip but because of the increased load on the healthier hip. Shawn and Ivo, The Gait Guys All materials are copywrited. Don’t rip our stuff off ! Just ask nicely if you can link or reference. Play nice, play fair. https://www.thegaitguys.com/thedailyblog/podcast-14-forefoot-strike-evolution monthly 0.5 2012-11-01 https://www.thegaitguys.com/thedailyblog/the-national-shoe-fit-certification-program monthly 0.5 2012-10-31 https://www.thegaitguys.com/thedailyblog/the-national-shoe-fit-certification-program-is monthly 0.5 2012-10-29 https://www.thegaitguys.com/thedailyblog/hmmm-orthotic-not-reallyfunny-yup monthly 0.5 2012-10-26 https://www.thegaitguys.com/thedailyblog/the-foot-tripod-part-2-here-we-go-more-stuff monthly 0.5 2012-10-26 https://www.thegaitguys.com/thedailyblog/here-is-an-oldie-but-a-goodie-the-flash-a monthly 0.5 2012-10-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553664005-BMTTZSYP1UVDUW8J5SY6/tumblr_mcg5rhY8VT1qhko2so1_1280.jpg Blog Here is an oldie but a goodie. The Flash !  A return to concepts of heel strike, hamstrings and abdominals.  This was from our first steps into blogging. Enjoy. http://thegaitguys.tumblr.com/post/3902070321/more-gait-guy-gait-gaffs-what-it-would-look-like https://www.thegaitguys.com/thedailyblog/podcast-13-caffeine-nicotine-lance monthly 0.5 2012-10-24 https://www.thegaitguys.com/thedailyblog/food-alert-gluten-and-your-thyroid-what-you monthly 0.5 2012-10-22 https://www.thegaitguys.com/thedailyblog/another-ifgec-certified-eric-is-our-1st-non monthly 0.5 2012-10-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553665024-KYMID58TK8HZ7NUJ5NA3/tumblr_mb8vdsFudm1qhko2so1_1280.jpg Blog Another IFGEC Certified! Eric is our 1st non retail individual to pass the exam! Some comments on the course an exam from Eric: “ I was impressed by the depth of the material and your abilities to keep a highly complex subject like foot/ankle mechanics and shoe fit to only 3 hours. I have been to a full weekend course on the foot/ankle and didn’t leave with as much practical knowledge!  As for the exam, I noticed that some questions had a couple of layers to them that really ensured that the material presented needed to be understood by the participant.  I haven’t taken a test before where I received immediate feedback on whether I was right or wrong.  At times, I got a little too excited at knowing I was wrong, but for the most part that may help people take extra time to think their answers through.  As for studying, everyone is different.  I watched the video three times, took detailed notes and studied them.  Also, I’ve been an avid follower of the blog, facebook page and now podcast since I saw Dr. Allen present for the NSCA earlier this year at Chicago State University. I am the manager for an outpatient orthopedic facility in Flossmoor, IL (southern suburb of Chicago).  The overwhelming majority of referrals are worker comp physical therapy and work conditioning patients.  I primarily took the course to answer my and my patient’s questions on proper shoe choice and since I’m not a runner, I really didn’t put much thought into shoes beyond "whatever feels comfortable."  I have much more confidence on what recommendations need to be made following this course.” The Gait Guys. Stepping toward foot, gait and shoe competency, one individual at a time https://www.thegaitguys.com/thedailyblog/welcome-to-friday-follies-folks-amidst-one-of monthly 0.5 2012-10-19 https://www.thegaitguys.com/thedailyblog/do-you-have-enough-ankle-dorsiflexion-to-do-this monthly 0.5 2012-10-19 https://www.thegaitguys.com/thedailyblog/notice-to-our-blog-followers monthly 0.5 2012-10-17 https://www.thegaitguys.com/thedailyblog/hip-biomechanics-frontal-plane-part-3-this monthly 0.5 2012-10-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553665941-4WEQZT7F4QT13ST71ENM/tumblr_m7fazaHYZ61qhko2so1_r1_1280.jpg Blog Hip Biomechanics: Frontal Plane Part 3 This diagram (Figure 3)  also shows a balanced HAM x D1 = D2 x BW equation.  The BW is larger than the HAM but this is offset in the rules of the teeter-totter.  Shifting the pivot point towards the larger mass is offset by the smaller D2 and larger D1 moment arms.  This is a typical compensatory mechanism used by obese patients to ambulate effectively.  It does render significant frontal plane movement of the pelvis instead of the more desirable silent frontal plane pelvis.  In this compensation, even large body weights can be somewhat offset by the degree of contralateral hip hiking to reduce the D2 moment arm and increase the D1 moment arm however this compensation has its limits.  When the limits of alteration of moment arm length are reached the body’s only compensation at that point is to increase the HAM forces which increases joint compression and thus cartilage wear since the cyclical loading and unloading of the cartilage is much less.  This is also the same mechanism used by patients with a osteoarthritic painful hip joint.  We are not referring to increasing BW, rather we are suggesting that to reduce pain the patient will want less joint compression and thus a reduced HAM.  To do this we want to increase the D1 moment arm. The only way other than surgery to achieve this increase in D1 is to take the existing body weight and shift it closer to the pivot point. Ideally you would want to lean so far over the affected painful hip as to get your body weight (BW) immediately over the pivot point. This is what is done with a walking cane in the opposite hand of the stance leg, to help lift the swing phase leg and pelvis and to push the body mass over the hip WITHOUT using more HAM (glute medius contraction generated compression, which would generate pain). This would effectively reduce D2 to nil and significantly increase D1 thus allowing HAM to be minimal; thus reducing painful joint compression.  (In teeter-totter verbiage, put the small child on the long part of the teeter-totter arm and you can move large forces with little effort at the pivot point.)  https://www.thegaitguys.com/thedailyblog/get-certified-our-2nd-nationally-certified monthly 0.5 2012-10-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553665934-ASKTHRCN8VRPJEO0CP51/tumblr_m61dz28XJs1qhko2so1_250.jpg Blog Get Certified! Our 2nd Nationally Certified Individual! Congratulations to Marianne Fitzgerald, LMT.   Marianne is the coordinator of “ all things shoes and sox” @ Summit Chiropractic  Rehabilitation, PC in Dillon, Colorado ( Dr Ivo’s office). “The course was super informative and well structured.  It was great to be able to watch the videos online at my own pace and on my schedule.  I learn by repetition so I was able to watch each one a couple of times. .  The exam was challenging but no trick questions.  I wish I had taken better notes because I know that all the information on the test was in the video.  Now when I’m working with someone to try on shoes and hopefully buy them, I feel more confident and actually sound like I know what I’m talking about.” The Gait Guys: spreading gait, foot and shoe competency, one pair at a time… https://www.thegaitguys.com/thedailyblog/a-tale-of-two-footies-time-for-a-pedograph monthly 0.5 2012-10-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553665370-R9N09PL9C1X69JZ2TLEH/tumblr_mbrdtqf3wj1qhko2so1_1280.jpg Blog A Tale of Two Footies Time for a pedograph, folks. What do we have here? Look at the last analysis here. To review : Let’s divide the foot into 3 sections: the rear foot, the mid foot and the fore foot. First of all, are they symmetrical? Look carefully at the fore foot on each side. NO! the right foot looks different than the left, so we are looking at asymmetrical pathology. Let’s start at the rear foot: The heel teardrop is elongated on both sides, slightly more on the right; this means incraesed calcaneal eversion (or rearfoot pronation) bilaterally, R > L. The right heel shows increased pressure (more ink = more pressure). Next up, the mid foot. Similar shapes, more pressure and printing on the left. Did you notice the “tail” of the 5th metatarsal printing, giving it a wider print? This person is staying on the outside of their foot longer than normal, right (more ink) more than left. How about the fore foot? Lots going on there. Lets start on the left Notice the mild increased printing of the 5th and 4th metatarsal heads. Force should be traveling from lateral to medial here, as the foot goes into supination. A relatively normal amount of pressure on the head of the 1st metatarsal. Now look at the toes. Notice that space between the 2nd and 3rd? This gal had an old fracture and has an increased space between them. Now how about the right? Increased pressure on most of the heads with a concentration on the 1st metatarsal. Hmmm…what would cause that? this is typical of someone who has a 1st ray (cunieform and metatarsal) that is hypomobile, such as with someone with a forefoot valgus (as this person does) or a dropped 1st metatarsal head (which is usually rigid, as is NOT the case here). Did you see that rpinting at the medial aspect of the proximal phalanyx of the hallux (ie. big toe)? This gal externally rotates the lower extremity to push off the big toe to propel herself forward. This is because the 1st metatarsal head hits the ground BEFORE the 5th (as we would normally expect to see, like in the left foot), and because the weight is now on the outside of the foot, she need to push off SOMETHING. Getting better at this? We hope so. Keep reading the blog and look at some of our past pedograph posts here. The Gait Guys. Teaching you about the importance of gait, each and every day! https://www.thegaitguys.com/thedailyblog/podcast-12-ice-spikes-and-exercise monthly 0.5 2012-10-12 https://www.thegaitguys.com/thedailyblog/hip-biomechanics-part-2-figure-1-shows-the monthly 0.5 2012-10-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553666200-HTKJVSF5VLKZ0U5J9G8D/tumblr_m7fawbnFUL1qhko2so1_r1_1280.jpg Blog Hip Biomechanics Part 2 Figure 1 shows the condensed version of the parameters (forces and moment arms) affecting movement and stability of the femur-acetabulum complex in the frontal plane during the closed kinetic chain.  (A moment arm such as D1 and D2 is defined as the length of a line that extends from the axis of rotation to a point of right angle intersection with a respective force, in this case HAM or BW.) In Figure 1 above we see several parameters.  HAM represents the Hip Abductor Muscles, D1 represents the internal moment arm, D2 represents the external moment arm and BW represents the Body Weight of the individual.  These factors all come into play when considering the frontal plane equilibrium of the hip joint.  The equation representing the interaction of all of these parameters is HAM x D1 = D2 x BW.  Both sides of this equation must be equal and balanced in order for the pelvis to remain stable and without movement when in the closed chain stance phase of gait. In this diagram, if the left side of the equation is greater than the right the net effect will be a counterclockwise hip moment and the patient will move their torso over the hip creating a hiking or lifting of the contralateral hip.  This net movement will create abduction at the hip joint.  If the right side of the equation is greater than the left the net effect will be a clockwise hip moment and the patient will move their torso away from the hip creating a dropping of the contralateral hip.  This net movement will create adduction at the hip joint seen here and thus the classic Trendelenberg gait.  We need to keep in mind that this is not a perfect model presented here since we are ignoring acceleration of the body in the forward sagittal plane and rotational planes.  Investigating the equation further should bring the reader to further realization that if the body weight (BW) were to increase, mathematically the D2 external moment arm could decrease to keep the equation balanced.  However, since the length of this D2 moment arm is rather fixed (unless the pelvis were to go through a counterclockwise  rotation which would draw the body weight center closer to the hip joint center effectually abducting the stance hip, thus reducing the D2 moment arm) this is not a more likely scenario. Rather, the response would be to attempt to increase the left side of the mathematical equation thus increasing the HAM forces to attempt to keep the pelvis level and the equation from changing.  In other words, when body weight increases we must increase the gain or contraction in the HAM group during each step to keep the pelvis level and balanced.  Unfortunately the HAM strength has its limits of maximal contraction, sometimes far below any major increases in body weight.  One must keep in mind that with increased HAM contraction there is a corresponding increase in joint compression across the hip articular surfaces which at reasonable levels is well embraced but at unreasonable levels can damage articular cartilage.  One should thus conclude that maintaining a reasonable body weight for one’s bone structure keeps the right and left sides of the mathematical equation at tolerable levels, both for movement, stability and cartilage longevity.  Fortunately the equation has a built in safety mechanism for these counterclockwise hip moments, one that is beneficial.  In such scenarios, as the body is brought over the hip thus decreasing the D2 moment arm, the D1-internal moment arm increases in length and since the equation must be balanced the HAM force can decrease.  Thus, the magnitude of the HAM force is inversely proportional to the length of the D1-internal moment arm.  The whole equation can better be visualized and conceptualized by a teeter totter diagram with a sliding pivot point. Shawn and Ivo,  The Gait (and biomechanics) Guys https://www.thegaitguys.com/thedailyblog/fundamental-hip-biomechanics-part-1 monthly 0.5 2012-10-10 https://www.thegaitguys.com/thedailyblog/the-almighty-foot-tripod-you-have-heard-us-talk monthly 0.5 2012-10-09 https://www.thegaitguys.com/thedailyblog/get-certified-in-my-experience-the-foot-wear monthly 0.5 2012-10-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553666722-9LEDXRKCI5IT5SC8R2EZ/tumblr_m5wbknF0Bg1qhko2so1_250.jpg Blog Get Certified! “In my experience, the Foot Wear Certification Series, is what is most needed by anyone in the position of helping an individual receive a more satisfying shoe fit experience.  Whether that is a simpler issue of finding the best athletic shoe to enhance their individual health goals, or to assess ones foot anatomy and the problem areas that can be hindering an individuals comfort and ability to function, the videos are informative and deeply educational.  The combined experience and knowledge of Drs. Ivo and Shawn Allen is so extensive, that it is the tool I would recommend for those of us in the industry.” Our 1st IFGEC (International Foot & Gait Education Council) Certified Sales Associate. Congratulations to Julie Meyers; the nations 1st to be certified. Julie works for Dr Waerlop at Summit Chiropractic & Rehabilitation, PC in Dillon, Colorado. She is especially fond of Lemming shoes! When asked about the exam, she said “Wow, it was really hard!” Want to get certified? Stay tuned as the program is ramping up! The Gait Guys. Making gait and foot competency viral! https://www.thegaitguys.com/thedailyblog/hey-guys-check-out-these-groovy-shoes-we-wonder monthly 0.5 2012-10-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553666482-QG0SJIV3U6PLTBGT9U6Z/tumblr_mbf9esACAE1qhko2so1_500.jpg Blog Hey Guys Check out these groovy shoes! We wonder if they are carnivorous! Have a great weekend Ivo and Shawn https://www.thegaitguys.com/thedailyblog/gait-running-and-sound-are-you-listening-to monthly 0.5 2012-10-05 https://www.thegaitguys.com/thedailyblog/hey-folks-you-know-we-are-big-altra-fans-check monthly 0.5 2012-10-05 https://www.thegaitguys.com/thedailyblog/got-hip-pain-attention-runners-and-athletes-with monthly 0.5 2012-10-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553667545-Z2HS4G1JWTJCJPU8RK17/tumblr_m99x8e4Nt71qhko2so1_250.jpg Blog Got Hip Pain ? Attention Runners and Athletes with Hip Pain. Compensatory joint motions are quite often a source of a person’s pain. Shirley Sahrmann named her hip syndromes for the direction of the movement most consistently associated with pain. In a recent CME presentation we did for www.onlineCE.com we discussed the accessory movements found with the hip. Lets look at the known normal biomechanical facts: During hip flexion the accessory motion is posterior glide of the femoral head. Hip extension: accessory motion is anterior glide of the femoral head. Hip medial (internal) rotation: accessory motion is posterior glide of the femoral head. Hip lateral (external) rotation: accessory motion is anterior glide of the femoral head. Hip abduction: accessory motion is inferior glide of the femoral head. Hip adduction: accessory motion is superior glide. Impairment, either from joint/bony deformation (ie. torsions) or from functional muscular asymmetry, can lead to impairment of the accessory motions (compensation) that are necessary for clean joint function.  This can lead to pain.  For you clinicians out there, knowing your hip torsions and versions will impact the amount/degree of these accessory motions. This is why we harp on knowing your fixed anatomic variants.  (You can find discussions on these in our prior blog posts and on previous recorded www.onlineCE.com teleseminar presentations.) For example, reduced medial rotation at the hip (usually met with increased external rotation) is often seen in people with retrotorsion of the femur. Said another way, when your client has impaired medial or lateral hip rotation you must go beyond looking at the muscles at some point and consider whether they have a form of ante or retro torsion. Hip extension is a critical part of normal human ambulation, whether you are walking or running.  Normally the hip, when moving into extension during the final propulsive phase of ambulation, allows for the femoral head of the hip to glide anterior in the socket (acetabulum). This reduces labral RIM pinch (RIM Syndromes) and allows for greater safe extension range. If hip extension range is impaired then this accessory motion of anterior glide can be impaired and lead to compensation and pain. Think about this: What if the quadriceps are tight ? What If the Glutes are weak ? What if rotational muscles are short ? What if ankle rocker (dorsiflexion) is impaired ? What if there is neuro-inhibition from joint pain (ie. osteoarthritis or joint mal-centration etc) ? What if there is imbalance and weaknesses about the hip ? What if there are other faulty movement patterns ? What if there is one of the femoral torsions present ? Much of this is “chicken or the egg”, who came first ?  These “what ifs” are what make practicing medicine difficult and a real challenge. Some of these issues can be found during functional movement assessments, but some of them will be missed if that is all you are doing. These issues may be what separates the good clinician, therapist, coach or trainer from the “not so good”. Knowing if a person has an impaired rolling pattern (see here http://youtu.be/dqnR0EcW2YY) is great to know, but knowing if the lower limb driver is off because the hip cannot internally rotate is even greater. Merely giving the person the homework of practicing and repeating the rolls on the impaired driver side without assessing all of the parts (for example some of the issues above) may cause you to miss the boat, or to engrain a new faulty motor pattern.  Knowledge is prince, application of knowledge is king. Next week we will begin a blog post a week on the biomechanics of the hip. We hope you will join us. Shawn and Ivo Here are some of our prior blog posts to add and deepen this dialogue: http://thegaitguys.tumblr.com/post/7493909435/the-hip-part-1-hip-labral-tears-the-rim-syndromes http://thegaitguys.tumblr.com/post/7533986761/ars-acetabular-rim-syndromes-hip-pain-some http://thegaitguys.tumblr.com/post/7573791535/the-hip-part-3-more-on-hip-rim-syndromes-and-labral https://www.thegaitguys.com/thedailyblog/podcast-11-walking-and-ozzy monthly 0.5 2012-10-03 https://www.thegaitguys.com/thedailyblog/what-do-you-think-of-when-you-watch-zsa-zsa-gabor monthly 0.5 2012-10-01 https://www.thegaitguys.com/thedailyblog/policing-gait-on-the-web-there-is-some-decent monthly 0.5 2012-10-01 https://www.thegaitguys.com/thedailyblog/is-your-foot-tripod-stable-enough-to-walk-or-run monthly 0.5 2012-09-28 https://www.thegaitguys.com/thedailyblog/ready-a-little-beach-forensics-anyone-as-far monthly 0.5 2012-09-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553666904-7HEF5Y0388VIS3B68I4J/tumblr_maxa50hbk21qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553668036-MMEN4M9HFVK4TZ4YWEQP/tumblr_maxa50hbk21qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553669156-5UNV0FIAN81KSQT1ME10/tumblr_maxa50hbk21qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553668616-N05X6FZ5S8GQRQ1HHFC5/tumblr_maxa50hbk21qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553669562-ROMP6L5LQ6VI927KHK4O/tumblr_maxa50hbk21qhko2so6_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/abnormal-wear-pattern-on-a-newton-shoe monthly 0.5 2012-09-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553668816-UBIFQV97IQS8U0O4G1EB/tumblr_mapnurHtGl1qhko2so1_1280.jpg Blog Abnormal wear pattern on a Newton Shoe Understanding what went wrong in this runner to cause unilateral Right shoe “toe off” wear pattern is important.  It happens alot.  Many times it doesn’t get this far but there is evidence on a shoe, more on one side, none the less.  It is quite often “What is wrong with the part/person that goes into a shoe”, than “the shoe itself”. It wasn’t the Newton Shoe in this case (it is almost never a shoe material issue), it was the limb attached to it. The shoes are the window to the gait cycle! This is one of our running clients.  They presented with some right hamstring soreness and pain after longer runs.  There were no foot complaints, the shoe wear pattern was just something that we felt was interesting to share as it made sense with their clinical presentation.  Client clinically demonstrated: inhibited right glute max tight right quadriceps weak right lower abdominals Summary: Subsequent to #1-3 above there was a loss of right hip extension, thus shortened right stride. When hip extension is limited the heel rise is premature and the calf engagement can be premature. When premature the calf is asked to lift the person during midstance instead of forward propulsion and its other activities during late midstance. Premature heel rise, premature calf muscle engagement, premature foot plantarflexion all lead to greater pressure at the forefoot and thus through toe off……plus some hamstrings complaining as well ! Knowing your gait cycles, knowing which muscles should fire at a given time in the gait cycle, and knowing why they fire and what joints they stabilize is a valuable tool in diagnosis of a runners issues.  Of course, it would be very simple to say “hey, you are toeing off real hard on that right side”.  “BRILLIANT SHERLOCK ! ” would be our first response, there is nothing like stating the obvious.  But the how and why is where the brain actually needs to be engaged, and when it is, things can get very interesting and fun in figuring out what is going on in athletes and patients. Knowing how and why things happen allows you to fix the problem.  And in this case if you are attempting to fix this person at the level of the foot you are missing the true problem originating at the hip.  And when you know the origin of the problem in this case, you also get a new shoe wear pattern for the next shoes and best of all, you conquer a chronic  hamstring problem as well. Shawn and Ivo………. Pipe smoking English sleuths…….. (OK, we are good at the board game CLUE and nothing more, who are we kidding !) https://www.thegaitguys.com/thedailyblog/what-do-you-see-a-pedograph-analysis-you-have monthly 0.5 2012-09-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553669269-H8E0LZR6LSUZ9MNIWN2G/tumblr_mavtgyFcvj1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553669493-4FQTDKXID4NFV4R9GI4C/tumblr_mavtgyFcvj1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/foot-talk-its-all-about-communication-in-this monthly 0.5 2012-09-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553669861-TB7RG65EQ8J1XBPTLXWQ/tumblr_mau352bxll1qhko2so1_540.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553669671-LTOGSWTIHCXHRRGTNUHN/tumblr_mau352bxll1qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/welcome-to-friday-fellow-foot-aficionados monthly 0.5 2012-09-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553669978-CFUB82UOR28MQ1JAJNUN/tumblr_ma9tmyz6KX1qhko2so1_500.jpg Blog Welcome to Friday, Fellow Foot Aficionado’s Beware of Geeks wearing lifts! Have a great weekend! Ivo and Shawn https://www.thegaitguys.com/thedailyblog/supination-anyone-the-importance-of-the monthly 0.5 2012-09-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553670898-4DBH83ZIHH3JGI84TKQC/tumblr_m9t1opQS931qhko2so1_1280.gif Blog Supination, anyone? The importance of the calcaneocuboid locking mechanism. Pronation gets all the press; but what about its yin counterpart, supination? There could not be one without the other. Pronation is dorsiflexion, eversion and abduction of the foot. It provides shock absorption. Supination is plantar flexion, inversion and adduction. It make the foot into a rigid lever so we can GO (Like in Theo Selig’s “Go Dig Go”. OK, I have been reading that to my kids alot lately…) Locking of the lateral column of the foot (4th and 5th metatarsal, cuboid and calcaneus) is a necessary prerequisite for normal force transmission through the foot and ultimately placing weight on the head of the 1st metatarsal for proper toe off. Locking of the lateral column minimizes muscular strain as the musculature (soleus, peroneus longus and brevis, EHL, EDL, FDL and FHL) is usually not strong enough to perform the job on its own. The peroneus longus tendon wraps around the cuboid (and the brevis attaches to the base of the 1st metatarsal) on its way to insert onto the base of the 1st metatarsal. When it contracts, it dorsiflexes and everts the cuboid, which, along with the soleus (which plantar flexes and inverts the subtalar joint) allows dorsiflexion of 4th and 5th metatarsals and “locks” the lateral column.  Without this mechanism, there is no locking. Without locking, there is no supination. Without supination, there is little rigidity and inefficient propulsion. The calcaneo cuboid locking mechanism. Another cool thing you learned about gait today from The Gait Guys. all material copyright 2012 The Homunculus Group/The Gait Guys. All rights reserved. If you use our stuff without asking us, we will find you and put valgus wedges in all your shoes. https://www.thegaitguys.com/thedailyblog/podcast-10-in-the-running monthly 0.5 2012-09-20 https://www.thegaitguys.com/thedailyblog/so-what-can-you-tell-us-about-this-foot-hmmm monthly 0.5 2012-09-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553672114-GZTRZ63L4DKVWZIDAHKK/tumblr_m9t1jht6891qhko2so1_1280.jpg Blog So what can you tell us about this foot? Hmmm. Pedograph again….You guys must think this is important, eh? You bet!  The best $150 dollars you will spend and one of the best education (and sales) tool you can buy. So, back to the foot. Lets divide it into 3 sections; the rearfoot, the midfoot and the forefoot. What do we see in the rearfoot? plenty of pronation, that’s for sure. How do you know? Look at the width of the print and the elongation of the heel print medially; ideally it is shaped like a teardrop. You would expect to see the calcaneus tipped into valgus (eversion) wile standing. What else? A heavy heel strike; look at all that ink! Next, the midfoot; Lots of printing here = lots of midfoot pronation. Look at how the 2nd and 3rd cunieforms and cuboid print. This much ink under the cuboid means that the peroneus is having a hard time everting and assisting in supination  of the foot. The forefoot? We see ink under met heads 2, 3 and 5, but not under 1.Looks like they can’t get the head of the 1st metatarsal down. This would lead us to believe they have an uncompensated forefoot varus (forefoot inverted with respect to the rearfoot). What about the toes? looks like overactivity of the long flexors to us, including the flexor hallucis longus (the brevis would only print more proximally; see our post here). This activity is probably to try desperately to stabilize the obviously unstable foot. Where do you begin? Lots of diligent work on the clients behalf, maybe consider an orthotic that you can slowly pull the correction out of as they improve, to give them mechanics they don’t have. How about the tripod? Increase mobility of that 1st ray and get the 1st met head down and help to keep it there. Mobilization/manipulation, toe waving, tripod standing are a good start. Next tone down some of that long flexor tone. How about some more tripod standing, toes up walking and some shuffle walks. The intrinsics are next, and so on. Yes, you should own a pedograph.  Need one? One of our friends (Another Shawn) can get you one. contact him at: 303 567 2271 You be able to interpret a pedograph. It provides a window to the gait cycle unlike any you have seen. Need help? Search our blog here with hundreds of examples, go to our Youtube channel and watch some of our great, free videos. Thirsty for more? We have THE ONLY book published (as far as we know) on them exclusively and you can get it by clicking here. We are told by our publisher that it is being converted to e-book format, but have not been given a conversion date. Ivo and Shawn. Articulate. In your face. Pushing your limits daily. Changing the way the world looks at the feet and gait. all material copyright 2012 The Homunculus Group/The Gait Guys. All rights reserved. If you use our stuff without asking us, we WILL find you and and send Toelio to deal with you. https://www.thegaitguys.com/thedailyblog/minimalism-is-there-a-formula-on-one-of-our monthly 0.5 2012-09-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553671539-KFZORTBKL1IS452ND0BB/tumblr_ma5zi4zGBc1qhko2so1_1280.jpg Blog Minimalism: Is there a formula? On one of our many forays into cyberspace, we ran across this easy to understand formula, from one of our friends Blaise Dubois. After we contacted him, he allowed us to reprint it here, for your enjoyment. Thank You Blaise! In his words: “What is the relationship between the FiveFingers, Brooks’ Pure Connect, the Nike Free 4.0 and the Adizero Hagio from Adidas? All are considered “minimalist” running shoes. However, their drop ranges from 0 to 12 mm, their thickness is between 3 and 23 mm while their respective weight and flexibility vary considerably. In my own opinion, the best definition for minimalism bears a qualitative connotation: “The least amount of shoes you can safely wear now.” Given its qualitative nature, we are bound to define tighter parameters in order to quantify the minimalist definition for running shoes. Up until now, I would have suggested the following set of characteristics for a clear definition of minimalist running shoes: a drop that was less than 5 mm (heel to toe height differential), a 15 mm stack (thickness at the heel) and a weight lower than 7 oz. (200 g). On the other hand, maximalism would have been defined based on the following: a 7 mm drop, a 20 mm stack along with a weight exceeding 9 oz. (250 g). Today, we propose a new formula so that you can rate your running shoes on a scale from 1 to 100 (100 being “extremely minimalist” -bare feet- and 1 “extremely maximalist”). The range of variation of your final rating will be more or less 5 points regardless of the comfort criteria, which is subjective. The only thing you need to do is to choose a language, then select the tab of your country at the bottom of the formula page, rate your shoes on the 6 criteria set out and there you go! Please note that we have used average values for criteria to which you don’t have the information. The multiple formats of the formula for every country are represented in accordance with their measuring system, currency and the average selling price of a running shoe for each of these countries. As for health professionals and scientists, you will see that weighting factors have been applied to all criteria as a function of their importance, which is their effect on the body (biomechanics, tissue adaptation, etc.) Here’s the formula translated in 3 languages (click on the selected language to access) : English French Spanish You can now rate your running shoes based upon The Running Clinic’s “TRC Rating” methodology!” The Gait Guys. Bringing you the meat, the whole meat and nothing but the meat! from: http://www.therunningclinic.ca/blog/2012/09/definition-du-minimalisme-defining-minimalism/  used with permission from the author https://www.thegaitguys.com/thedailyblog/understanding-neuroreceptors-movement-concepts monthly 0.5 2012-09-18 https://www.thegaitguys.com/thedailyblog/so-what-do-we-see-here-a-limp-on-the-left-a monthly 0.5 2012-09-17 https://www.thegaitguys.com/thedailyblog/its-foot-fungus-friday monthly 0.5 2012-09-14 https://www.thegaitguys.com/thedailyblog/the-toe-waving-exercise-part-3-the-lumbricals monthly 0.5 2012-09-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553672005-L5OJ8POAJ148WXISQ8LP/tumblr_m9sytjXhaA1qhko2so1_540.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553672566-VR94U7S12CV9BI7UBXXW/tumblr_m9sytjXhaA1qhko2so2_540.png Blog https://www.thegaitguys.com/thedailyblog/the-windmill-pitch-fastpitch-softball-more-proof monthly 0.5 2012-09-13 https://www.thegaitguys.com/thedailyblog/the-gait-guys-podcast-9-the-essex-swagger-the monthly 0.5 2012-09-12 https://www.thegaitguys.com/thedailyblog/the-consequences-of-overstriding monthly 0.5 2012-09-11 https://www.thegaitguys.com/thedailyblog/we-have-an-interesting-gait-video-case-for-you monthly 0.5 2012-09-10 https://www.thegaitguys.com/thedailyblog/sleep-leads-to-performance monthly 0.5 2012-09-09 https://www.thegaitguys.com/thedailyblog/leg-length-discrepancies-and-shoe-lifts monthly 0.5 2012-09-08 https://www.thegaitguys.com/thedailyblog/its-friday-andits-raining-shoes-have-a-great monthly 0.5 2012-09-07 https://www.thegaitguys.com/thedailyblog/the-toe-waving-exercise-part-2-in-part-one-of monthly 0.5 2012-09-07 https://www.thegaitguys.com/thedailyblog/somnambulation-sleepwalking-gait-and monthly 0.5 2012-09-06 https://www.thegaitguys.com/thedailyblog/season-1-podcast-8-of-the-gait-guys-experience monthly 0.5 2012-09-05 https://www.thegaitguys.com/thedailyblog/the-mighty-extensor-digitorum-longus-edl-a monthly 0.5 2012-09-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553672790-PATZNZ4JE54YOGE9PGUR/tumblr_m9t1byPpdc1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553674645-PO5SRPG0JD80EJ487I1S/tumblr_m9t1byPpdc1qhko2so2_1280.gif Blog https://www.thegaitguys.com/thedailyblog/torsions-this-gentleman-has-2-excellent-examples monthly 0.5 2012-09-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553672971-YVVZ0XK08IXOF9SGS48Q/tumblr_m9lptl1vea1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553673110-NLQJF0M7W708RJINI3ON/tumblr_m9lptl1vea1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553672899-JXKMGJSA54RD62GOSDMT/tumblr_m9lptl1vea1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553674462-OKRFALYAZKSC67MHWG6G/tumblr_m9lptl1vea1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553674761-ERMA3JO966HZN0SGVJRS/tumblr_m9lptl1vea1qhko2so5_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/the-toe-waving-exercise-part-1-welcome-to monthly 0.5 2012-08-31 https://www.thegaitguys.com/thedailyblog/using-a-pedograph-to-get-dynamic-answers-to-foot monthly 0.5 2012-08-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553675225-MDJCH5NGCAEP8WAMFXHK/tumblr_m9ixmrYRIO1qhko2so1_1280.jpg Blog Using a Pedograph to get Dynamic Answers to Foot Dysfunction: Pedograph topic: One quick topic here. Note the hot spot (ink concentration) at the big toe and note that the ink is proximal on the toe pad. We would like to see the pressure point at the center of the pad. This spot means this person walked across the Harris Ink mat with increased FHB (flexor hallucis brevis) use and not enough FHL (flexor hallucis longus);  too much short flexor, not enough long flexor. There is loss of synergy between the two. This will likely mean there is something going on in the extensors as well, something abnormal. Need a review? Look at Monday’s video again on the EHB (extensor hallucis brevis) where we discuss all of the toes muscles. Clinically this patient had a hallux limitus/rigidus (could not dorsiflex great toe) which complicated the mechanics at the joint and forward into the great toe, sadly also at the foot’s medial tripod as well. You cannot get an accurate read from a static (standing only) pressure mapping. Don’t rely on them for dynamic info ! Too much FHB with not enough FHL means EHB (as well as long extensors of the lesser toes) is going to be impaired. Impair the EHB and you ask the EHL  to work differently as well.  Here’s a hint, look at all the printing under the lesser digits distally, there is too much flexor activity here as indicated by intense inking from toe clenching / hammering.  They are likely doing this to add more stability since the great toe cannot from what we discussed above. There are problems that come from these issues as well but we want to stay focused on the big toe today. Now, go back and review Mondays blog video post (here is the link). Treatment: In a case where there is some loss of the 1st MPJ range of motion (metatarsaphalangeal joint) (depending on the source, 45 degrees is typically needed) there will be impairment of the long and short toe flexor/extensor pairing and synergy.  In this case above there is highly suspected increased short flexor (FHB) activity (hence the ink at the proximal big toe) and this means that the long flexor is usually submissive.  And, when the long flexor (FHL) is submissive the long extensor is dominant. When the long extensor is dominant the short extensor is submissive. Can you now see the beautiful symphony and harmony we need here. This is why we loosely say that the FHB and the EHL are paired and the FHL and EHB are paired.  It is not exactly the case but hopefully you catch our drift.  So, in this case, with a hallux limitus/rigidus when the 45 degrees of dorsiflexion is lost these pairing can be challenges and the synergy is lost.  The symphony of these muscles is “off tune”.  This can further provoke the 1st MPJ and it can also be the slow brewing initiation of the problem. It can be a vicious cycle when it gets going. And, when the 1st MPJ is limited the dorsiflexion that is supposed to occur at the joint can be shunted proximally into the midfoot or ankle and cause pain/pathology there.  It can also impair the normal pronation-supination cycles. The big toe when it goes sour makes the whole orchestra angry and play off tune. Doing your best to normalize and maximize muscle harmony and function many times will dampen the pathology and pain and get the person going again.  Of course the problem is still lurking under the surface.  Test the muscles, try to isolate them but remember that your muscle tests need to be as specific as you can. Nothing is isolated in the body, but do your best. Of course there are many other scenarios but this is the one we chose to teach today from this pedographing of the big toe. We will explore other options and challenges another time. Shawn and Ivo.    Gait geeks promoting gait literacy and competency everywhere we can get an open ear. https://www.thegaitguys.com/thedailyblog/ehb-extensor-hallucis-brevis monthly 0.5 2012-08-30 https://www.thegaitguys.com/thedailyblog/the-gait-guys-podcast-7-s1e7 monthly 0.5 2012-08-29 https://www.thegaitguys.com/thedailyblog/the-gait-guys-wwwonlinececom-courses monthly 0.5 2012-08-28 https://www.thegaitguys.com/thedailyblog/runners-on-your-mark-ready-setswim monthly 0.5 2012-08-28 https://www.thegaitguys.com/thedailyblog/did-you-know-that-the-ehb-extensor-hallucis monthly 0.5 2012-08-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553675398-LCYZZEABZHVQ0MXVR0OC/tumblr_m9f5miqoIJ1qhko2so1_250.jpg Blog Did you know that the EHB (extensor hallucis brevis) the topic of today’s video tutorial, originates off of the forepart of the medial aspect of calcaneus & lateral talocalcaneal ligament. It is just above the bulk origin of the EDB (extens or digitorum brevis). It is frequently torn/strained in ankle inversion sprains and frequently goes undiagnosed. It can be torn/avulsed from the bone if the inversion sprain is focused below the lateral ankle joint. This occurs mostly when the foot is more plantarflexed before the inversion event. A foot cannot afford to have an impaired big toe ! Don’t miss this one ! https://www.thegaitguys.com/thedailyblog/part-2-of-the-ehb-bringing-the-extensor-hallucis monthly 0.5 2012-08-27 https://www.thegaitguys.com/thedailyblog/welcome-to-friday-follies-folks-a-funny-fila monthly 0.5 2012-08-24 https://www.thegaitguys.com/thedailyblog/classic-crossover-gait-case-here-is-a-client monthly 0.5 2012-08-24 https://www.thegaitguys.com/thedailyblog/ready-the-gait-guys-case-of-the-week-what-do-you monthly 0.5 2012-08-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553675628-CBN4SQQ2OVNGFZLXJCFP/tumblr_m96vfsCBSV1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553675588-K26GEEG9JMJPMGQNF97B/tumblr_m96vfsCBSV1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553676148-RA71CYFP3L3UWMEH21LJ/tumblr_m96vfsCBSV1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553675981-QE3ENSPSLTIPOLAKM8OB/tumblr_m96vfsCBSV1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/the-gait-guys-podcast-6-s1e6 monthly 0.5 2012-08-22 https://www.thegaitguys.com/thedailyblog/gait-analysis-case-study-a-runner-with-achilles monthly 0.5 2012-08-21 https://www.thegaitguys.com/thedailyblog/big-toe-exercise-regaining-control-of-the monthly 0.5 2012-08-20 https://www.thegaitguys.com/thedailyblog/welcome-to-friday-folks-here-is-a-funny monthly 0.5 2012-08-17 https://www.thegaitguys.com/thedailyblog/proprioceptive-effects-of-aging-its-all-in-the monthly 0.5 2012-08-17 https://www.thegaitguys.com/thedailyblog/doing-squats-lunges-as-well-as-walking-and monthly 0.5 2012-08-16 https://www.thegaitguys.com/thedailyblog/the-cross-over-running-technique-again-a-new monthly 0.5 2012-08-15 https://www.thegaitguys.com/thedailyblog/slow-your-gait-shorten-your-stride-and-your monthly 0.5 2012-08-14 https://www.thegaitguys.com/thedailyblog/welcome-to-friday-follies-here-is-a-funny monthly 0.5 2012-08-10 https://www.thegaitguys.com/thedailyblog/gait-problem-but-where-is-the-problem-a-case monthly 0.5 2012-08-10 https://www.thegaitguys.com/thedailyblog/retailcoachtrainer-focus-when-a-stability-shoe monthly 0.5 2012-08-09 https://www.thegaitguys.com/thedailyblog/midfoot-strike-5-year-old-running-barefoot-in monthly 0.5 2012-08-08 https://www.thegaitguys.com/thedailyblog/the-gait-guys-podcast-5-s1e5 monthly 0.5 2012-08-07 https://www.thegaitguys.com/thedailyblog/some-biomechanical-facts-on-oscar-pistorius-400-m monthly 0.5 2012-08-06 https://www.thegaitguys.com/thedailyblog/welcome-to-friday-follies-folks-a-fun-adidas monthly 0.5 2012-08-03 https://www.thegaitguys.com/thedailyblog/the-essex-swagger-are-gait-walking-and-running monthly 0.5 2012-08-03 https://www.thegaitguys.com/thedailyblog/more-on-leg-length-discrepancies monthly 0.5 2012-08-02 https://www.thegaitguys.com/thedailyblog/speed-matters-brief-thoughts-on-gait-and-running monthly 0.5 2012-08-01 https://www.thegaitguys.com/thedailyblog/the-gait-guys-podcast-4-s1e4 monthly 0.5 2012-07-31 https://www.thegaitguys.com/thedailyblog/the-hand-walkers-the-family-that-walks-on-all monthly 0.5 2012-07-30 https://www.thegaitguys.com/thedailyblog/are-you-a-gait-troglodyte-are-you-sure monthly 0.5 2012-07-27 https://www.thegaitguys.com/thedailyblog/shoes-and-shoe-fit monthly 0.5 2012-07-27 https://www.thegaitguys.com/thedailyblog/a-piece-we-put-together-to-celebrate-the-olympic monthly 0.5 2012-07-27 https://www.thegaitguys.com/thedailyblog/run-and-bike-training-using-music-and-cadence monthly 0.5 2012-07-27 https://www.thegaitguys.com/thedailyblog/bike-fit-case-study-along-the-vein-of-bike-fit monthly 0.5 2012-07-25 https://www.thegaitguys.com/thedailyblog/podcast-3-s1e3-season-1-episode-3 monthly 0.5 2012-07-24 https://www.thegaitguys.com/thedailyblog/running-technique-video-with-complications-here monthly 0.5 2012-07-23 https://www.thegaitguys.com/thedailyblog/do-or-do-not-there-is-no-try-yoda monthly 0.5 2012-07-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553677250-FLMF4FEXGXCTHENXSECK/tumblr_m6362kTEMe1qhko2so1_500.jpg Blog “Do or do not; there is no try.” Yoda https://www.thegaitguys.com/thedailyblog/muscle-coordination-is-habitual-rather-than monthly 0.5 2012-07-21 https://www.thegaitguys.com/thedailyblog/we-can-always-appreciate-a-great-gait-check-out monthly 0.5 2012-07-20 https://www.thegaitguys.com/thedailyblog/proper-bike-fit-highlights-from-the-clinic-at monthly 0.5 2012-07-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553677542-R0IVM0BWKI9FJBQIR7M0/tumblr_m7c8s3Owfj1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553677840-OEUZDWKMAGMD1JG4ZK7D/tumblr_m7c8s3Owfj1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553678625-U1W3QB9CY1XXXME9G0VL/tumblr_m7c8s3Owfj1qhko2so3_400.gif Blog https://www.thegaitguys.com/thedailyblog/httpdirectorylibsyncomshowsviewidthegaitgu monthly 0.5 2012-07-19 https://www.thegaitguys.com/thedailyblog/bike-fit-clinic-tonite-drs-waerlop-and-asthalter monthly 0.5 2012-07-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553678838-R3KGTACV2U7E7CPHYTIF/tumblr_m7c84x8wJV1qhko2so1_1280.gif Blog Bike Fit Clinic Tonite Drs Waerlop and Asthalter (Dr Ivo’s office) will be holding their annual bike fit clinic this evening from 6-7:30 at at Summit Chiropractic & Rehabilitation, PC in Dillon, Colorado. frame sizing, seat height, fore and aft positioning, and handlebar height will be discussed, with common dysfunctions resulting from improper fit. The event is usually a sell out, and we expect nothing less this year. Highlights to follow on the blog! https://www.thegaitguys.com/thedailyblog/compensations-for-short-legsfinal-installment-in monthly 0.5 2012-07-18 https://www.thegaitguys.com/thedailyblog/podcast-2-the-gait-guys-podcast-experience monthly 0.5 2012-07-17 https://www.thegaitguys.com/thedailyblog/tight-ankles-here-we-do-a-short-little-video-for monthly 0.5 2012-07-16 https://www.thegaitguys.com/thedailyblog/yesterday-is-history-tomorrow-is-a-mystery-but monthly 0.5 2012-07-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553679336-S19TMAW0DT8CMA5DXVE5/tumblr_m636dtWko51qhko2so1_500.jpg Blog “…yesterday is history, tomorrow is a mystery, but today is a gift. That is why it is called the "present.” Master Oogway: Kung Fu Panda (2008) https://www.thegaitguys.com/thedailyblog/along-the-lines-of-friday-follies-and-our-earlier monthly 0.5 2012-07-13 https://www.thegaitguys.com/thedailyblog/a-great-reference-text-biomedical-acupuncture monthly 0.5 2012-07-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553679699-T7H90TKTLIQRHZO32AWN/tumblr_m72w8bsnBi1qhko2so1_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553679981-VVS944JPUB6HBX8VGL6K/tumblr_m72w8bsnBi1qhko2so2_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553680935-BC8YD4DO5EEHV9SOOLYL/tumblr_m72w8bsnBi1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/acupuncture-can-be-effective-for-many-types-of monthly 0.5 2012-07-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553680937-U3Y9RJ8JGBQEPAU9Y53V/tumblr_m72x93WA2n1qhko2so1_400.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553681862-LX84LD0HI7EGD3ZDVIC7/tumblr_m72x93WA2n1qhko2so2_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553682064-B6GUZPB88GPKAI3TPCJ3/tumblr_m72x93WA2n1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/why-do-we-have-difficulty-with-our-gait-when-we monthly 0.5 2012-07-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553681985-25U4OXOC05RM6VQ6IRPY/tumblr_m5skii4Dmy1qhko2so1_250.jpg Blog Why do we have difficulty with our gait when we drink too much alcohol ? It is not unlike the disturbed sense of balance we experience when we have an inner ear problem such as an infection. Alcohol affects one’s balance by changing the viscosity of the endolymph within the otolithic membrane, the fluid inside the semicircular canals inside the ear. The endolymph surrounds the cupula which contains hair cells within the semicircular canals. When the head is tilted, the endolymph flows and moves the cupula. The hair cells then bend and send signals to the brain indicating the direction in which the head is tilted. By changing the viscosity of the endolymph to become less dense when alcohol enters the system, the hair cells can move more easily within the ear, which sends the signal to the brain and results in exaggerated and overcompensated movements of body. This can also result in vertigo, or “the spins."  Many of us have experienced this event in one shape or another and we know what it feels like.  The unsteadiness of our gait is disturbing and uncorrectable until the problem is solved or the alcohol’s effect wear off.  In chronic alcoholism however, the problem is different and more lasting. Disturbed gait and balance are among the most consistent sequelae of chronic alcoholism. Research studies have shown evidence that partial recovery of gait and balance functions in alcoholics may be achieved with abstinence. This study ( http://www.ncbi.nlm.nih.gov/pubmed/21919921)  showed that alcoholics’ gait and balance can continue to recover with long abstinence from alcohol, but that deficits persist, especially in eyes-closed standing balance. http://www.sciencedaily.com/releases/2011/09/110915163519.htm Chronic alcohol abuse consistently damages the cerebellum. The cerebellum has multiple functions, including control of balance and coordination and even motor pattern generation. Alcohol also damages subcortical white matter, the myelinated fiber tracts that connect different parts of the cortex, and other central nervous systems. Long-term alcohol dependence also results in impaired dopamine transmission in the striatum, an important area for motor control. The next time you are the designated driver, spend some time appreciating the subtle nuances and changes in people’s gait. Not only is it amusing, but fascinating as well. Studies quoted in this blog post. (Smith and Fein, 2011, Alcohol Clin Exp Res 35:2184–2192) http://www.ncbi.nlm.nih.gov/pubmed/22691134 Gait and Balance Deficits in Chronic Alcoholics: No Improvement from 10 Weeks Through 1 Year Abstinence https://www.thegaitguys.com/thedailyblog/teleseminar-on-gait monthly 0.5 2012-07-11 https://www.thegaitguys.com/thedailyblog/neurocognitive-control-in-movement-perception-and monthly 0.5 2012-07-11 https://www.thegaitguys.com/thedailyblog/gait-pathomechanics-walking-in-a-pencil-skirt monthly 0.5 2012-07-10 https://www.thegaitguys.com/thedailyblog/podcast-1-s1e1-season-1-episode-1 monthly 0.5 2012-07-09 https://www.thegaitguys.com/thedailyblog/more-silly-walks-here-we-have-some-peculiar-walks monthly 0.5 2012-07-06 https://www.thegaitguys.com/thedailyblog/welcome-to-silly-walks-friday-hmmmm-an-entire monthly 0.5 2012-07-06 https://www.thegaitguys.com/thedailyblog/is-barefoot-more-economical monthly 0.5 2012-07-06 https://www.thegaitguys.com/thedailyblog/yet-more-compensations-for-short-legs-we monthly 0.5 2012-07-05 https://www.thegaitguys.com/thedailyblog/more-research-on-forefoot-running-forefoot-varus monthly 0.5 2012-07-02 https://www.thegaitguys.com/thedailyblog/put-your-hand-on-a-hot-stove-for-a-minute-and-it monthly 0.5 2012-07-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553682109-OJGT9ISPCGHE3WNN1U1J/tumblr_m635u6Ls6X1qhko2so1_1280.jpg Blog “Put your hand on a hot stove for a minute, and it seems like an hour. Sit with a pretty girl for an hour, and it seems like a minute. That’s relativity.”  Albert Einstein https://www.thegaitguys.com/thedailyblog/foot-strike-of-women-for-the-olympic-time-trials monthly 0.5 2012-06-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553682403-SY9HVQPHR2YTVIQ3K2YP/tumblr_m6dqp5sG9g1qhko2so1_540.jpg Blog Foot Strike of Women for the Olympic Time Trials: This picture comes from Iain Hunter at BYU: http://biomechanics.byu.edu/. We found it on Peter Larson’s Blog: Runblogger.com http://www.runblogger.com/2012/06/foot-strike-patterns-of-men-and-women.html Here are some of our thoughts: It would have been nice to see each of these in turn on video for further analysis; What this shows are a few things; People who are at this level and run fast have different foot strike patterns, this type of foot strike does not always equal the fastest times (though the top 3 were mid foot strikers, something we work with our athletes to achieve) 7 (and 1 DNF) were midfoot strikers 4 were forefoot strikers 11 were heel strikers many runners has asymmetrical strikes, depending on side (4) 4 of these runners seem to have a significant varus in either their fore foot or rear foot. However this is difficult to truly tell from such small single snapshot pictures.  And just because it appears to be a varus landing does not mean that it is true on examination, a foot that has reduced peroneal activity can appear to have a  varus strike, but that does not truly then comment on a true forefoot varus. Also, remember from our previous posts, if a runners is employing a notable degree of cross over gait technique the approach of the foot to the ground and at the ground can appear to be forefoot varus. * These are critical points, because what you see is not necessarily what you truly have.  There are possibly many variables playing out. shoes which have green on them are more popular (7) Neither Shawn nor Ivo could run a 10K and have a chance against any of these folks  Have a great Saturday Ivo and Shawn https://www.thegaitguys.com/thedailyblog/happy-friday-everyone-have-a-great-weekend-ivo monthly 0.5 2012-06-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553682178-6OQNRTLKRKTMMJ01URD6/tumblr_m6b3wf9N4P1qhko2so1_1280.jpg Blog Happy Friday Everyone! Have a great weekend Ivo and Shawn https://www.thegaitguys.com/thedailyblog/continuing-on-our-theme-of-foot-odor-friday monthly 0.5 2012-06-29 https://www.thegaitguys.com/thedailyblog/a-cure-for-smelly-feet-welcome-to-foot-odor monthly 0.5 2012-06-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553682678-UA3E15C95ODUOL12RZ5O/tumblr_m6bzzi0LRh1qhko2so1_400.jpg Blog A Cure for Smelly Feet? Welcome to foot odor Friday. Today’s Theme: You guessed it! Here’s one paper we though had merit (sure, go to Pub Med and search foot odor. There were 119 entries). We think we may try this in the office… The Gait Guys: Yes, smelly feet are something we have to deal with at the office on a daily basis. One of the pitfalls of being a Foot Geek : ) Make sure to check back later for more on malodorous extremities…                         J Int Soc Sports Nutr. 2007 Jul 13;4:3. A novel aromatic oil compound inhibits microbial overgrowth on feet: a case study. Misner BD. Source West 1140 Glass Avenue Spokane, Washington, 99205, USA. drbill@omnicast.net. Abstract ABSTRACT: BACKGROUND: Athlete’s Foot (Tinea pedis) is a form of ringworm associated with highly contagious yeast-fungi colonies, although they look like bacteria. Foot bacteria overgrowth produces a harmless pungent odor, however, uncontrolled proliferation of yeast-fungi produces small vesicles, fissures, scaling, and maceration with eroded areas between the toes and the plantar surface of the foot, resulting in intense itching, blisters, and cracking. Painful microbial foot infection may prevent athletic participation. Keeping the feet clean and dry with the toenails trimmed reduces the incidence of skin disease of the feet. Wearing sandals in locker and shower rooms prevents intimate contact with the infecting organisms and alleviates most foot-sensitive infections. Enclosing feet in socks and shoes generates a moisture-rich environment that stimulates overgrowth of pungent both aerobic bacteria and infectious yeast-fungi. Suppression of microbial growth may be accomplished by exposing the feet to air to enhance evaporation to reduce moistures’ growth-stimulating effect and is often neglected. There is an association between yeast-fungi overgrowths and disabling foot infections. Potent agents virtually exterminate some microbial growth, but the inevitable presence of infection under the nails predicts future infection. Topical antibiotics present a potent approach with the ideal agent being one that removes moisture producing antibacterial-antifungal activity. Severe infection may require costly prescription drugs, salves, and repeated treatment. METHODS: A 63-y female volunteered to enclose feet in shoes and socks for 48 hours. Aerobic bacteria and yeast-fungi counts were determined by swab sample incubation technique (1) after 48-hours feet enclosure, (2) after washing feet, and (3) after 8-hours socks-shoes exposure to an aromatic oil powder-compound consisting of arrowroot, baking soda, basil oil, tea tree oil, sage oil, and clove oil. CONCLUSION: Application of this novel compound to the external surfaces of feet completely inhibited both aerobic bacteria and yeast-fungi-mold proliferation for 8-hours in spite of being in an enclosed environment compatible to microbial proliferation. Whether topical application of this compound prevents microbial infections in larger populations is not known. This calls for more research collected from subjects exposed to elements that may increase the risk of microbial-induced foot diseases. https://www.thegaitguys.com/thedailyblog/more-compensations-for-short-legs-we-remember monthly 0.5 2012-06-28 https://www.thegaitguys.com/thedailyblog/neuromechanics-weekly-how-does-appropriate monthly 0.5 2012-06-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553683250-SOVAZC9WEXMXU8XZ8JXR/tumblr_m69aylFcmg1qhko2so1_500.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553683765-6UYLZAGR5AIM6LG27VEH/tumblr_m69aylFcmg1qhko2so2_500.gif Blog https://www.thegaitguys.com/thedailyblog/case-of-the-week-rib-pain-while-running-part-2 monthly 0.5 2012-06-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553684190-L0FF4BS3LZWSPEWFF3OT/tumblr_m61uqg0Fv11qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553684885-EGKMXVDQDABBE4JIEFRF/tumblr_m61uqg0Fv11qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553684872-T3EGF6IR983SLOSSZO36/tumblr_m61uqg0Fv11qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553684889-LQUNK0OW0GWWZJQQ4MII/tumblr_m61uqg0Fv11qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/case-of-the-week-rib-pain-while-running-part-1 monthly 0.5 2012-06-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553684969-872U7ZT0C5O2W8FXEP2F/tumblr_m61up0396B1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553685549-1BJ1893Y0EDL3H8IY90L/tumblr_m61up0396B1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553685649-7JDZF6ZE6WTRN1X87V72/tumblr_m61up0396B1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553685755-OIIDHB0U4KY4JILS3M7G/tumblr_m61up0396B1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/a-small-boy-was-walking-along-a-beach-at-low-tide monthly 0.5 2012-06-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553686324-GI9SV4AVS9JZIB7BRYIE/tumblr_m5fm8jW5G11qhko2so1_1280.jpg Blog A small boy was walking along a beach at low tide, where countless thousands of small sea creatures, having been washed up, were stranded and doomed to perish. A man watched as the boy picked up individual creatures and took them back into the water. “I can see you’re being very kind,” said the watching man, “But there must be a million of them; it can’t possibly make any difference.” Returning from the water’s edge, the boy said, “It will for that one.” We seek to make a difference, no matter how small. The Gait Guys https://www.thegaitguys.com/thedailyblog/injury-and-repair-it-appears-injury-and monthly 0.5 2012-06-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553687390-944JW10ZL7UPLKA0SMJ2/tumblr_m61vo8p5U91qhko2so1_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553687124-KM1ZA4JPPVFEXG6MSD2X/tumblr_m61vo8p5U91qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/the-coffee-walkers-a-tangent-article-on-gait-concepts monthly 0.5 2012-06-22 https://www.thegaitguys.com/thedailyblog/remember-by-clicking-on-the-youtube-logo-in-the monthly 0.5 2012-06-21 https://www.thegaitguys.com/thedailyblog/neuromechanics-weekly-proprioceptive-clues-in monthly 0.5 2012-06-20 https://www.thegaitguys.com/thedailyblog/biomechanist-challenges-idea-that-forefoot-strike monthly 0.5 2012-06-19 https://www.thegaitguys.com/thedailyblog/dear-dr-lieberman-some-vital-facts-on-forefoot monthly 0.5 2012-06-19 https://www.thegaitguys.com/thedailyblog/clearing-that-long-leg-even-more-on-short monthly 0.5 2012-06-18 https://www.thegaitguys.com/thedailyblog/a-brief-story-by-ack-simon-dedman-a-lecturer-at monthly 0.5 2012-06-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553687581-HYU514HOR5B8F8IB2PL1/tumblr_m5fmm0sZzJ1qhko2so1_1280.jpg Blog A brief story by Ack Simon Dedman: A lecturer at a university is giving a pre-exam lecture on time management. On his desk is a bag of sand, a bag of pebbles, some big rocks and bucket. He asks for a volunteer to put all three grades of stone into the bucket, and a keen student duly steps up to carry out the task, starting with the sand, then the pebbles, then the rocks, which do not all fit in the bucket. “The is an analogy of poor time management,” trills the lecturer, “If you’d have put the rocks in first, then the pebbles, then the sand, all three would have fit. This is much like time management, in that by completing your biggest tasks first, you leave room to complete your medium tasks, then your smaller ones. By completing your smallest tasks first you spend so much time on them you leave yourself unable to complete either medium of large tasks satisfactorily. Let me show you..” And the lecturer re-fills the bucket, big rocks first, then pebbles, then sand, shaking the bucket between each so that everything fits. “But Sir,” says one student, slouched at the back of the theatre, “You’ve forgotten one thing..” At which the student approaches the bucket, produces a can of lager, opens it and pours into the bucket. “No matter how busy you are,” quips the student with a smile, “There’s always time for a quick beer.” One of our goals is to make you think outside the box to solve clinical problems, and to fill your “bucket”. We also hope you have a good time while doing it : ) The Gait Guys https://www.thegaitguys.com/thedailyblog/what-is-driving-our-patterned-movements-such-as monthly 0.5 2012-06-16 https://www.thegaitguys.com/thedailyblog/welcome-to-friday-today-we-have-a-particularly monthly 0.5 2012-06-15 https://www.thegaitguys.com/thedailyblog/foot-maturation-in-children-is-reached-by-5-years monthly 0.5 2012-06-15 https://www.thegaitguys.com/thedailyblog/retail-focus-the-midsole-the-midsole-is-the-area monthly 0.5 2012-06-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553687750-RZ5TTM2XSQKK8DAWJKLV/tumblr_m5dro4UxTL1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553687915-88PNVXF6Z838FH78H0HT/tumblr_m5dro4UxTL1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553688207-P0BVSJXMJQ95K6LGCVRO/tumblr_m5dro4UxTL1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/video-gait-case-it-is-neuromechanics-wednesday monthly 0.5 2012-06-13 https://www.thegaitguys.com/thedailyblog/lean-on-me-more-on-short-legs-we-remember-from monthly 0.5 2012-06-12 https://www.thegaitguys.com/thedailyblog/educations-purpose-is-to-replace-an-empty-mind monthly 0.5 2012-06-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553689220-8G0OX5HLMMI9LY95BTG5/tumblr_m50ujkdY6u1qhko2so1_r1_1280.jpg Blog Education’s purpose is to replace an empty mind with an open one. Malcolm S. Forbes https://www.thegaitguys.com/thedailyblog/more-on-childrens-foot-maturation monthly 0.5 2012-06-09 https://www.thegaitguys.com/thedailyblog/a-fun-little-video-for-all-you-foot-fanatics-out monthly 0.5 2012-06-08 https://www.thegaitguys.com/thedailyblog/more-on-gluten-what-we-have-been-recommending-all monthly 0.5 2012-06-08 https://www.thegaitguys.com/thedailyblog/ok-friday-follies-are-upon-us-heres-a-not-so monthly 0.5 2012-06-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553689155-BI81N57F9IZYBB8ESZ52/tumblr_m50tz6rzKP1qhko2so1_400.jpg Blog OK, Friday Follies are upon us. Here’s a not so funny one. Funny Gait May Cause Back Pain. Gee, imagine that! : ) We don’t necessarily agree with the Journal of the American Podiatric Association that orthotics are the answer, but the we like the premise. Have a great Friday! Ivo and Shawn photo from: http://www.fatfiction.co.uk/society/funny-walks-of-the-20th-century/ https://www.thegaitguys.com/thedailyblog/is-that-dry-skin-on-your-feet-lotions-not monthly 0.5 2012-06-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553689110-S16V54KAFC5OPCNQAIUK/tumblr_lon1fg28MN1qhko2so1_1280.jpg Blog Is that dry skin on your feet ? Lotions not working ? It is a yeast infection ! How many times will you smash your forehead into a wall before you realize that the bleeding suggests it might not be a good idea to continue ? Similarly, how many times are you going to put lotion on your feet, or pumice off the dry skin and callouses before you ask “maybe this isn’t dry skin after all !” ? Do your feet have something similar as to what is seen in the photo above ? Do your heels look like this ? Do they have the deep fissured cracks ? Do you have similar powdery white appearing stuff on your feet ? Are lotions not taking care of all this “apparently dry” skin ? Candida albicans is a yeast that lives in harmony in and on our body until something throws off the delicate balance, causing the fungus to proliferate wildly. When Candida is allowed to build up in the body, over time a wide variety of severe symptoms can occur. Without proper treatment, the yeast overgrowth can be extremely dangerous. Candida buildup in any one place in or on the body indicates that a balancing act is off when it comes to normal body system regulation. Candida overgrowth can cause cognitive problems, genitourinary, gastrointestinal, allergic and even (as we see here) dermatological problems. The skin is the body’s largest organ and it is also susceptible to problems. Sometimes referred to as Athletes foot, in this case a fungus, it spreads easily through contact. Exposure to the fungus does not guarantee its growth and conditions must be right for the fungus to spread. Athletes foot is a fungal infection of the skin of the feet, which can also involve reactions by the feet and skin to toxins produced by candida/fungus overgrowth. Red and/or pale skin. Mild to intense itchiness, mostly in between the toes. Burning and inflammation. Cracked or blistered skin. Skin patches and scaling of the skin. Skin fissures (small cracks). Toenails may become affected as athlete’s foot progresses causing thick yellowish nails that are malformed, thickened and crumbly, called onychomycosis. Fingernails can also become affected just like toenails. Fungus on the feet can also develop into or enable other opportunistic issues such as calluses, corns, warts, and horny growths, or keratotic tissue (hardened horny growths or build-up). Active growth of the fungus is also supported by nutrients contained in such horny growths. Now do not dismiss this apparently benign problem. We have had patients experience bleeding from these deep fissures and cracking and we even had one client have one of these bleeding fissures get infected with Staph Aureus and almost lose their entire leg from the “flesh eating bacteria”. So we do not take this apparently benign infection lightly and we suggest you not either. Find a doctor that will properly diagnose the problem and then look deeper for signs and symptoms that indicate where in the body the imbalance is located. We have found it is usually a GI (gastrointestinal) tract problem, one of dysbiosis (normal flora imbalance) in the bowels. Yeast and fungal infection, they are definitely not just for athletes alone.  If you have it, it is in all of your shoes, on your shower floor, and anywhere it can harbor growth. But do not freak out. Just take care of the problem and move on. It is a mere several weeks to months to remedy. Just get the right solution for the job.  When it comes to yeast we suggest 2% miconazole cream (yes, vaginal yeast cream) be trialed, but it isn’t a fix if that is not the problem.  See someone who knows. Sadly the yeast problem is missed by most in the field, we have no idea why but it is. Shawn and Ivo…….not just your regular foot geeks.  Read more: Signs & Symptoms of Candida Buildup in the Human Body | eHow.com http://www.ehow.com/list_5929515_signs-candida-buildup-human-body.html#ixzz1voZ6mLOw https://www.thegaitguys.com/thedailyblog/gait-and-biomechanics-and-love-potion-9-the monthly 0.5 2012-06-07 https://www.thegaitguys.com/thedailyblog/there-is-more-than-one-way-around-a-long-leg monthly 0.5 2012-06-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553690038-WZIAHMRGTNUOSVNSZ5N8/tumblr_m50tmwg3GQ1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553690593-FGBZGF11IQW1AJERYWG0/tumblr_m50tmwg3GQ1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553691612-6XZLLWCLP1RS2X5C2LZK/tumblr_m50tmwg3GQ1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/phidippides-cardiomyopathy-a-condition-caused-by monthly 0.5 2012-06-05 https://www.thegaitguys.com/thedailyblog/gait-and-ovulationa-sexier-saunter-welcome-to monthly 0.5 2012-06-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553690851-9YTSSW9FFZ6CV182T8J3/tumblr_m4va9hEFD81qhko2so1_500.jpg Blog Gait and Ovulation…A sexier saunter… Welcome to Monday morning folks. Here’s something to get you going for the week. Nope, not a post about orangutans, but even BETTER! Remember, you probably saw it here 1st. You always wondered (at least we did) why women walk differently around the time of ovulation (yes, they REALLY do) , and now here’s the proof. A recent article in Gait and Posture confirms that women walk slower and with what is judged to be a “sexier” gait around ovulation (Go Zsa Zsa Gabor!), which is believed to reinforce their attractiveness and make them more likely to be noticed and attract a partner. We knew there was a reason we liked gait so much….. Ivo and Shawn. Bald. Middle aged…Good looking…The Gait Guys https://www.thegaitguys.com/thedailyblog/if-you-know-recognize-that-you-know-if-you monthly 0.5 2012-06-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553691253-EISJYGR5L9DYAC9217S0/tumblr_m3u7imIaAZ1qhko2so1_500.jpg Blog If you know, recognize that you know, If you don’t know, then realize that you don’t know: That is knowledge. Confucius  True knowledge is when one knows the limitations of one’s knowledge. https://www.thegaitguys.com/thedailyblog/neuromechanics-on-saturday-we-have-long-been monthly 0.5 2012-06-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553691405-9XAXE1QGB0AVK72K7RTL/tumblr_m4yzt0mG6V1qhko2so1_400.jpg Blog Neuromechanics on Saturday? We have long been talking about the importance of the cerebellum in gait and motor activity (see here). Here is a study (Non-Invasive Brain Stimulation Shown to Impact Walking Patterns) that looks at a new technique for using electrical stimulation of the brain’s cerebellum (trans cranial direct current stimulation to be exact) to change gait on a split belt treadmill (a double treadmill where each leg moves a slightly different speed). The study found that during the electrical stimulation the anode (negative charge) seems to speed up the learning process (our theory: more electrons, possibly creating a temporary electrical gradient which depolarizes (excites) the cells to a greater degree). And the cathode seemed to slow things down (our theory, it hyperpolarizes the cell and makes it less excitable). Take home message? There are new neurologic studies and experiments that may be proving helpful in retraining gait function.  Stimulating the brain’s cerebellum seems to speed up learning or slow it down, depending on your client’s needs. We are sure we will be seeing more of this kind of stuff at technology advances.  Maybe Larry Niven wasn’t that far off. (We loved the story “The Long Arm of Gil Hamilton”).  This could be a great, non invasive tool for rehab (or maybe improving performance!) The Gait Guys…taking you deeper down the rabbit hole… https://www.thegaitguys.com/thedailyblog/a-silent-parody-of-something-we-see-in-our-offices monthly 0.5 2012-06-01 https://www.thegaitguys.com/thedailyblog/arm-swing-in-gait-and-running-why-it-is-crucial monthly 0.5 2012-06-01 https://www.thegaitguys.com/thedailyblog/external-tibial-torsion-as-expressed-during-gait monthly 0.5 2012-05-31 https://www.thegaitguys.com/thedailyblog/foot-landing-mechanics-part-2-of-2-gait-and monthly 0.5 2012-05-30 https://www.thegaitguys.com/thedailyblog/whats-your-foot-type-part-5-and-finally-the monthly 0.5 2012-05-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553691398-GY4HMIXFYPNXU3QKACQF/tumblr_m2qko2JVG71qhko2so1_250.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553692062-1FHOYFN4B4N9G2BKPWI7/tumblr_m2qko2JVG71qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/httpcheilectomycom monthly 0.5 2012-05-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553692143-M0KFAET4T65S25BM3D5Y/tumblr_m4hbvgZi731qhko2so2_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553692668-7NYJVTHCHCUHIXFZLX6R/tumblr_m4hbvgZi731qhko2so1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/we-have-talked-alot-of-gait-this-week-especially monthly 0.5 2012-05-25 https://www.thegaitguys.com/thedailyblog/the-secrets-to-running-downhill-fast monthly 0.5 2012-05-25 https://www.thegaitguys.com/thedailyblog/external-tibial-torsion-a-video-showing-the monthly 0.5 2012-05-24 https://www.thegaitguys.com/thedailyblog/case-quiz-part-2-the-questions-here-was-our monthly 0.5 2012-05-23 https://www.thegaitguys.com/thedailyblog/case-quiz-part-1-here-is-a-case-submitted-by-a monthly 0.5 2012-05-23 https://www.thegaitguys.com/thedailyblog/a-case-of-the-non-resolving-ankle-sprain-things monthly 0.5 2012-05-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553692698-J6BJ5EGHE0136Q2B1XXH/tumblr_lzenjilcv61qhko2so1_400.jpg Blog A case of the non-resolving ankle sprain.  Things to think about when the ankle and foot just do not fully come around after a sprain. Gait Guys, A while back I had a severe ankle sprain while trail running.  As I stepped on a rock my toes pointed downward, my ankle was rolled in and I felt a pop. This was follow by a lot of swelling and bruising both on the inside and outside of my ankle.  Being experienced with ankle sprains, I jumped on the initial treatment immediately. The reduction in swelling and bruising lead me to believe that I was in for a 4-5 week recovery, then I would be back at what I love doing. I was proven wrong:   1.       Initial treatment consisted of immobilization, icing, and a very high dose of Ibuprofen (3 days only). After a couple weeks of this I began stretching, massage and trying to get into some modified activities as the pain allowed me to. I was able to  do some hiking but running was too painful. 2.       After 6 weeks, I was still having pain in the posterior tibial tendon area as well as the deltoid ligament area. I tried running but, I was met with severe pain beginning in the middle of the gait cycle through  the push off. I saw a PA at this time and was told to give it more rest. For the next few weeks I wore a soft brace and spent most of my time in a chair. 3.       By week 9, there was no improvement. I could walk fine but, I had the same pain when I tried to run. I visited the PA again and was put in a walking cast and had an MRI. The MRI should a low grade deltoid and ATFL sprain as well as a bruised bone. I spent 2 weeks in the walking cast then returned to the soft cast for another week. During this time I did nothing besides give it rest. 4.       At week 11, I did not see a noticeable improvement. I still had a sharp pain in my posterior tibial tendon area and deltoid area during the middle of my gait (when trying to run). At this time, I had another visit with the PA. After looking at my MRI more closely, he saw fluid buildup behind my talus. He thinks that I had an impact injury to my Os Trigonum. He also noticed that I had very limited dorsiflexion.  He has advised me to stretch and give it a few more weeks. If it’s not going in a positive direction he recommended a cortisone shot. As it stands today at week 12, in a dorsiflexion position, I have a sharp pain in what feels like my Achilles tendon and posterior tibial tendon area (the MRI shows these are intact). I also have a lot of tenderness in the deltoid area. Walking, I am almost pain free but as soon as I begin to run, the pain starts in the areas described above. This is the first injury I have ever had where I haven’t seen a steady improvement when recovering (maybe I am just getting old). The pain I am having now when trying to running is the same as it was at week 4. This really concerns me. I guess my question is, where do I go from here? Do I keep doing what I am doing? Should I seek a second opinion?  Any help or guidance you could provide would be greatly appreciated. On a side note, your blog has helped me to get though the last 12 run-less weeks without losing my mind or falling into a deep depression.  You guys do some great stuff.  Keep up the good work! Best Regards, MR ____________________ Dear MR: Somehow we missed this email. Sorry about that. Whenever things are not resolving with reasonable intervention one must think of two things: either the injury was severe or the diagnosis is incorrect. Without seeing you we are unable to determine either. But here are our thoughts. The Os Trigonum syndrome is a good thought. It seems to be in the correct area of your complaint. These “Os” bones can be embedded in tendon or soft tissue and they can be fixed to the posterior talus by either bone or a cartilagenous bridge. It is possible for this to be your problem if the inversion event was severe enough although it is not that common in this described mechanism. One must also be suspect of osseous compression of the medial talus against the medial calcaneus, which will bring thoughts of a posterior subtalar facet fracture. We pulled up an article we read a few years ago on this issue (click here), the article is entitled, “Pseudo os trigonum sign: missed posteromedial talar facet fracture”. Obviously this needs to be considered in your case since there are similar components in area and symptom of your complaints. Posteromedial talar facet fracture (PMTFF) is a rare injury, sparsely reported in the literature and it must be chased as a diagnosis of suspicion when all other clinical presentations have not panned out. Damage to the sustentaculum tali must also be assessed, as this too can be fractured.  Osteochondral defects are also always on the list in violent inversion events; they are classically seen anteromedially and posteriolaterally at the ankle mortise joint. Something else that is often missed in ankle inversion sprains is avulsion or rupture of the extensor digitorum brevis on the lateral foot. As the rearfoot inverts and forefoot plantarflexes the EDB is tensioned to the point of tearing. Although you seem to have no symptoms in this area it can never be overlooked. These are easy to discern from the lateral ligamentous structure damage because the areas are clearly separate from eachother.  Look for tenderness down into the top of the metatarsals into the forefoot. Also test for weakness and pain of toe extension. So, lots to consider here in this case. When things to not resolve you have to start looking for less common problems and damage.  We would love to hear how you are doing MR. Drop us a line. Shawn and Ivo……. also geeks of orthopedics.  We paid the piper long ago. https://www.thegaitguys.com/thedailyblog/forefoot-balance-and-forefoot-variants-are-you-a monthly 0.5 2012-05-21 https://www.thegaitguys.com/thedailyblog/learn-without-thinking-begets-ignorance-think monthly 0.5 2012-05-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553693384-YCBC231WFD2KG58VSFV1/tumblr_m3u7lewfzD1qhko2so1_400.jpg Blog Learn without thinking begets ignorance. Think without learning is dangerous. Confucius - Lun Yu Chap. 2 https://www.thegaitguys.com/thedailyblog/saturday-quickie-hmmm-rearfoot-valgus-make monthly 0.5 2012-05-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553694028-CM5LAOOELNNA5IM5JVVH/tumblr_m491hiJaBd1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553694388-RFNNH8RZ1QQH8SDSEHYY/tumblr_m491hiJaBd1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553694530-UVD8ADGWNNGYP75ZY7F4/tumblr_m491hiJaBd1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553694905-P8HKIBH96HJFEB4VHEZZ/tumblr_m491hiJaBd1qhko2so6_r1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/well-it-is-comforting-to-know-that-there-are monthly 0.5 2012-05-18 https://www.thegaitguys.com/thedailyblog/ok-something-different-this-friday-we-admit monthly 0.5 2012-05-18 https://www.thegaitguys.com/thedailyblog/we-could-have-easily-made-this-a-blog-post-about monthly 0.5 2012-05-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553694598-OKQ3M72JL3OZB3VC77X4/tumblr_lyq5shvUL91qhko2so1_1280.jpg Blog We could have easily made this a blog post about shoe sizes or how to use the Brannock device. And maybe we will in time. But this picture, if you are really thinking, can give you more insight into the entire biomechanical flaw of a client. If you read our post today we bet you will forever look and compare the size of both feet of your clients … forever ! This is a picture of one of our patients. This person had a congenital “club foot” at birth also know as congenital talipes equinovarus (CTEV). It is a congenital deformity involving one or both feet. In this case it affected on the right foot (the smaller one). Multiple surgeries were performed at an infant to correct, and the correction is beautiful as these things go. TEV is classified into 2 groups: Postural TEV or Structural TEV. That all aside, we have a smaller shorter right foot. Where are we going with this ? Foot size is often measured with the Brannock device in shoe stores, you know, the weird looking thing with the slider that measures foot length and width. In this case, the right heel:ball ratio, the length from the heel to the first metatarsal head, is shorter. The heel:toe length is also shorter, nothing like stating the obvious ! IF they are shorter then the plantar fascia is shorter, the bones are shorter, the muscles are smaller etc. So, taking yesterday’s blog post in tow here (LINK to that posting), the maximal height of the arch on the right when the foot is fully supinated is less than that of the left side when also fully supinated (ie. during the second half of the stance phase of gait). Even with maximal strength of the toe extensors which we spoke of yesterday will not sufficiently raise the arch on the right to the degree of the left. Thus, this client is very likely to have a structural short leg. Certainly you must confirm it but you will likely see it in their gait if you look close enough. Also, you must remember that the shorter foot will also spend fractionally less time on the ground and will reach toe off quicker than the left. This may also play into a subtle limp. This client may have a mal-fitting shoe, the right foot will swim a little in a shoe that fits correctly on the left. You may be easily able to remedy all issues with a cork full length sole insert lifting both the heel and forefoot. This can negate the shoe size differential, change the toe off timing and remedy much of the short leg issue. * IMPORTANT: keep in mind, if you know your shoe anatomy (and you will if you get on board with our very soon to release “Shoe Fit Course”) you will know that the right foot at the metatarsal-phalangeal joint bending line will not be flexing where the shoe flexes on that right foot. The Right foot will be trying to bend proximal to the siping line where the shoe is supposed to naturally bend. This will place more stress into that foot. This brings up the rule for shoe fit: never size a persons shoe by pinching the toebox to see if there is ample room, the shoe should be fit to meet the great toe bend point to the flex point of the shoe. Strength of muscles is directly proportional to the cross sectional area of the muscle. With smaller muscles, this right limb is very likely to be underpowered when compared to the left. All of these issues can cause a failure of symmetrical hip rotation and pelvic distortion patterning. Altered arm swing (most likely on the contralateral side) is very likely to accommodate to the smaller weaker right lower limb. Do not be surprised to hear about low back pain or tightness or neck/shoulder issues. A shorter right leg, due to the issues we have discussed above, will place more impact load into the right hip ( from stepping down into the shorter leg) and more compressive load into the left hip (due to more demand on the left gluteus medius to attempt to lift the shorter leg during the right leg swing phase). This will also challenge the pelvic symmetry and can cause some minor frontal plane lumbar spine architecture changes (structural or functional scoliosis…… if you want to drop such a heavy term on it). Gait plays deeply into everything. Never underestimate any asymmetry in the body. Some part as to take up the slack or take the hit. Shawn and Ivo…….. far from symmetrical lads. https://www.thegaitguys.com/thedailyblog/gait-parameter-ankle-rocker-during-the-squat-as-a monthly 0.5 2012-05-16 https://www.thegaitguys.com/thedailyblog/retail-focus-last-no-not-the-last-retail-focus monthly 0.5 2012-05-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553695156-8SKBP0292CDKHT3ICM9J/tumblr_m412cwgDcg1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553695486-4DNEBFIY0MZ7V6NOW8WH/tumblr_m412cwgDcg1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/whats-your-foot-type-part-4-forefoot-valgus monthly 0.5 2012-05-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553696225-EP99UZHHZV7RB9SILS6C/tumblr_m2qkjw6pid1qhko2so1_100.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553695788-I4Q9WAV2BUOTUCBT4Y89/tumblr_m2qkjw6pid1qhko2so2_250.jpg Blog https://www.thegaitguys.com/thedailyblog/we-are-here-to-teach-you-ivo-and-shawn monthly 0.5 2012-05-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553696096-86OFYODPJYHS9EKNO3EL/tumblr_m3u7nbSrxy1qhko2so1_250.jpg Blog We are here to teach you… Ivo and Shawn https://www.thegaitguys.com/thedailyblog/barefoot-versus-running-shoes-which-is monthly 0.5 2012-05-12 https://www.thegaitguys.com/thedailyblog/for-the-1st-time-ever-the-gait-guys-are-offering monthly 0.5 2012-05-11 https://www.thegaitguys.com/thedailyblog/plantar-fascitis-youve-got-plantar monthly 0.5 2012-05-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553697607-KX83PY67JL2PB097HZ70/tumblr_m3twiqKxiS1qhko2so1_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553697303-6GSC3IA3YUQ0R0LMIF3V/tumblr_m3twiqKxiS1qhko2so2_500.jpg Blog https://www.thegaitguys.com/thedailyblog/recognize-this-one-gait-evaulation-of-a-skunk monthly 0.5 2012-05-10 https://www.thegaitguys.com/thedailyblog/gait-running-dance-martial-arts-and-the-mirror monthly 0.5 2012-05-09 https://www.thegaitguys.com/thedailyblog/the-collective-goal-of-natural-running-the-gait-guys monthly 0.5 2012-05-08 https://www.thegaitguys.com/thedailyblog/whats-your-foot-type-part-3-of-a-5-part-series monthly 0.5 2012-05-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553697979-65LMA23HTOICJKAPRATX/tumblr_m2qkgbFugc1qhko2so1_100.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553698010-3LYL1JM7GWR2IMG9LP5Q/tumblr_m2qkgbFugc1qhko2so2_400.gif Blog https://www.thegaitguys.com/thedailyblog/the-gait-guys-are-ridiculously-esoteric monthly 0.5 2012-05-06 https://www.thegaitguys.com/thedailyblog/history-lesson-saturday-the-shoe-fitting monthly 0.5 2012-05-05 https://www.thegaitguys.com/thedailyblog/does-your-yoga-tree-suck-yoga-tree-for-runners monthly 0.5 2012-05-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553698366-1GJ1Z05LNN9VT9XN3HUF/tumblr_m3ese6zh8Y1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553698722-SM724Y7X8A2GFA55D5QL/tumblr_m3ese6zh8Y1qhko2so2_500.jpg Blog https://www.thegaitguys.com/thedailyblog/retail-focusreally-the-vamp-what-you-need-to monthly 0.5 2012-05-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553698399-TGQ0O5OTJYBRZGGLBZ4O/tumblr_m33mf9VxLt1qhko2so3_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553698865-G4PR4QO76G9FVX1V3JDZ/tumblr_m33mf9VxLt1qhko2so1_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553699006-B7LVMYJTPRTIXDBWZXFL/tumblr_m33mf9VxLt1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/mbt-revisited-perhaps-you-have-read-our monthly 0.5 2012-05-02 https://www.thegaitguys.com/thedailyblog/the-upright-walking-and-the-stoned-chimpanzee monthly 0.5 2012-05-01 https://www.thegaitguys.com/thedailyblog/whats-your-foot-type-part-2-welcome-to monthly 0.5 2012-04-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553699527-YBDQ5106RH7XKUYKZXCT/tumblr_m2qk8kUlFh1qhko2so1_250.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553700185-SINIPX88UT7A4T2V8AIP/tumblr_m2qk8kUlFh1qhko2so2_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553700442-107PVLEVLENTAG0P3G86/tumblr_m2qk8kUlFh1qhko2so5_r1_100.gif Blog https://www.thegaitguys.com/thedailyblog/gait-arm-swing-and-reorganizing-the-brain monthly 0.5 2012-04-28 https://www.thegaitguys.com/thedailyblog/email-from-a-reader-chronic-it-band-and-plantar monthly 0.5 2012-04-27 https://www.thegaitguys.com/thedailyblog/a-runner-with-an-inverted-heel-and-functional monthly 0.5 2012-04-26 https://www.thegaitguys.com/thedailyblog/neuromechanics-weekly-gait-noise-think-of-gait monthly 0.5 2012-04-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553700615-WEGMO1GKDWERDCKD3Q1Q/tumblr_m2p6ifBnAW1qhko2so1_1280.jpg Blog Neuromechanics Weekly: Gait Noise Think of “Gait Noise” as those things which alter the sum total of all neuronal activity acting at a specific locus. Gait noise is all of the aberrant signals that distort the correct and most functionally desirable signal necessary for a clean gait.  Think of noise as the static found between radio stations, that irritating white noise that blurs out the perfect radio station from coming in clearly.  Gait noise is thus anything that impairs a clear sensory and motor signal to and from the central nervous system required for clean uncompensated gait. These definitions will help you understand where we are going with this. 1. Communication: Anything that interferes with, slows down, or reduces the clarity or accuracy of a communication. Thus, superfluous data or words in a message are noise because they detract from its meaning. 2. Quality control: Variability that may be caused by changes in the ambient conditions, faulty machine performance, or uneven quality of the material or human factor inputs. 3. Telecommunications: Random disturbance introduced into a communication signal, caused by circuit components, electromagnetic interference, or weather conditions. Also called line noise. Gait noise is therefore very undesirable. It could be interpreted as seeing a foot turned out more than normal, more than the other side. Seeing that compensation is a motor impairment and an undesirable motor pattern, but it also sends aberrant sensory information back into the nervous system. Bad information in, bad information out, and a viscous cycle ensues.  Gait noise can occur from a total knee replacement, from a scar, from a sprain, a broken bone, from the numbness of a diabetic neuropathy etc.  These all cause impairment of the sensory-motor-sensory loop.  Gait Noise theoretically could occur anywhere along the neuraxis (spinal cord and brain-brainstem) or even the peripheral nervous system, but it makes most sense to think of it happening where neurons congregate; most likely at synapses, especially at the spinal cord level. The wiring of the nervous system extends to all tissues, so the noise can occur anywhere for almost any reason. In the words of Dr Ted Carrick, “Is the lesion at the receptor, the effector, the peripheral nerve, the spinal cord, the brainstem, the thalamus, the cerebellum or cerebrum?”  Where is the problem in otherwords ?  Lets explore how this relates to “Gait Noise”. Today lets look at the receptor. Receptors are the information gatherers of the nervous system. Think of your 5 senses (vision, smell, taste, sound and touch). These are all subserved by receptors. Vision and touch seem to most affect gait and movement. This post will concentrate on touch. Touch encompasses not only physical touch but also proprioception (see here for review of proprioception and receptors). These receptors: Pacinian corpuscles, Merkel discs, end bulbs of Krause, bare nerve endings, joint mechanoreceptors, muscle spindles and Golgi tendon organs are all included here. These sentinels provide the central nervous system (CNS) with mechanical environmental information, for comparison with that same information (there is much redundancy in the CNS) and other environmental information (balance, vision, hearing, etc), so that you can formulate (consciously or subconsciously) a response. In short, there are multiple systems converging, in this case, on the peripheral receptor. Remember, receptors can be activated in may ways. A touch receptor could be activated not only by touch, but also by heat, cold, pressure, or even chemical (metabolic or toxic) means. Just like you may be a great tennis player, you could probably play racquet ball, handball, or football, even if you never played before. You may not excel, but you could get by. Receptors are no different; they may be BEST activated by touch, but other means could certainly do the job. This inadvertent activation creates receptor bias, as we like to call it “noise”, and that information is sent to the CNS for processing. If a touch receptor is activated, it is activated, and the CNS  sees it as an activation, whether it is intentional or not. These mixed signals are then processed along with everything else, creating “noise”.  And the noise might not be a desired signal. And these signals can be what initiates a gait change, a compensation, whether it be from information mis-processing or a strategy to cope. Think of the application to your gait analysis, next time you are seeing something that you think you shouldn’t be seeing.  This is the problem with video gait analysis (as we take a moment to pound the wall on this topic ONE MORE TIME !).  What we see on a video analysis is not necessarily the problem, nor does what you see warrant a correction or a specific shoe. What we are seeing on video is their coping strategy after all of the CNS signals (noise and non-noise) have been processed, it is what they can do with what is available to them and with what makes most sense to the brain.  We have said before, as a classic example, that an over pronating foot might be a necessity to compensate for lack of internal hip rotation because the brain deems that functional pathology as more damaging at the hip than the hyperpronation at the foot.  Who are we to deem that the foot needs an orthotic or a stability shoe because of what we see?  Who are we to think that we can outsmart all the sensory-motor calculations of that persons brain without knowing all of the functional limitations of their body ? Perhaps if we take an hour to assess our client, and then see them for another visit or two, we can then correlate the gait video, our findings and our corrective work and then truly qualify a logical reasoning.  But this is a far more difficult game that this simple gait video or foot plantar pressure digital foot mapping nonsense. Ivo and Shawn; the voices in your head, helping you sift out the noise. https://www.thegaitguys.com/thedailyblog/the-chef-another-abnormal-gait-pattern-in monthly 0.5 2012-04-24 https://www.thegaitguys.com/thedailyblog/whats-your-foot-type-part-1-ready-for-monday monthly 0.5 2012-04-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553700705-ZSILYSZCUZ2WXDG0ALR6/tumblr_m2qk5abtbe1qhko2so1_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553701041-1LPWIPQIH37IL5DVQSI5/tumblr_m2qk5abtbe1qhko2so2_400.gif Blog https://www.thegaitguys.com/thedailyblog/keep-digging-we-are-often-asked-by-coaches monthly 0.5 2012-04-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553701636-7G73RWS004YC7IGJEGT2/tumblr_m2p6bbz4Rp1qhko2so1_400.jpg Blog Keep Digging We are often asked by coaches, trainers, runners, therapists or folks on the internet sending us video clips “What is wrong with this gait?” or “Why do I have pain?”. Sometimes, we are able to provide an explanation which seems too simple, but is often correct. Things usually are more simple than one makes them out to be.  It often corrects the immediate problem, only to have another crop up a few weeks later. Why? To paraphrase from the words of SHREK; peoples compensations are like onions; they have layers. It is not that you were incorrect, not at all.  You may have been correct for “that” issue.  But, uncovering and remedying one problem often leads us to the next weakest link in the chain. We still have fond memories of Dr Ted Carrick grilling us in the post graduate neurology program “What is the longitudinal level of the lesion? Most pathologies occur at one locus; if you diagnose more than one, it is usually due to metastasis, multiple vascular occlusions, or clinical incompetence. Is the lesion at the receptor, the effector, the peripheral nerve, the spinal cord, the brainstem, the thalamus, the cerebellum or cerebrum”. The information to glean here is that often we need to establish and limit our focus to ONE area where the problem could be, and sort out that issue first. This necessitates us thinking through the problem and coming up with ONE problem which could cause all the problems you are seeing. This applies to gait and motion assessment as well. Think of the patient with right sided knee pain caused by patellar tracking issues. Is the retro patellar inflammation the cause? Not usually (unless there has been direct trauma), it is often the symptom (or compensation). Maybe the cause is a forefoot varus deformity causing abnormal knee mechanics because they cannot descend the 1st ray adequately. Maybe this is due to insufficient extensor hallicus brevis function, or is it the peroneus longus? Maybe it is due to a congenital deformity of the foot. Maybe it is due to a functional (or anatomical) leg length discrepancy. Or maybe it is a problem with the left shoulder affecting tandem arm swing with that leg ? … you get the idea. Keep looking and digging until you have found the 1 THING that can explain what is going on. Maybe it’s the individual; maybe it’s their footwear. maybe it is remnants of unresolved factors from an old ankle sprain, old fracture maybe something else. Maybe a c-section scar disabling the abdominal wall and reducing the anchoring capacity of the abdominals into the hip thus impairing the quadriceps and thus knee tracking ? The possibilities are endless. If you can’t explain it by a single problem or fault, maybe it is time to run some blood work, send them for a vascular flow analysis, or more often than not; expand our knowledge base. We are The Gait Guys… Two guys digging deeper and looking for the cause. https://www.thegaitguys.com/thedailyblog/welcome-to-friday-follies-or-should-we-say-friday monthly 0.5 2012-04-20 https://www.thegaitguys.com/thedailyblog/retail-focus-thursday-the-lateral-flare-we-recall monthly 0.5 2012-04-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553701648-VTSDO5M9C62XQQH2N5SP/tumblr_m26k4jbWrG1qhko2so1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553701964-HN8L6UIMGSAT2YH7JG9N/tumblr_m26k4jbWrG1qhko2so2_500.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553702940-ZQDBJE0ZE1Z2R4VB8W4J/tumblr_m26k4jbWrG1qhko2so3_250.jpg Blog https://www.thegaitguys.com/thedailyblog/neuromechanics-weekly-part-2-stretching monthly 0.5 2012-04-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553702953-50J7ZQ2QJU7VAUTYSFB9/tumblr_m2j60zuBR31qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553703265-L00KYNUK39IL2M22PT1M/tumblr_m2j60zuBR31qhko2so2_r2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/neuromechanics-weekly-part-1-stretching monthly 0.5 2012-04-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553703487-EHYB5RC5L4GOLSY6FR75/tumblr_m2j5t6IDzZ1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553703842-61FTWUBKXZ90QNXNTHUY/tumblr_m2j5t6IDzZ1qhko2so2_r1_400.gif Blog https://www.thegaitguys.com/thedailyblog/video-gait-case-a-troubled-youth-this-is-a monthly 0.5 2012-04-17 https://www.thegaitguys.com/thedailyblog/a-brief-look-at-the-effect-of-shoe-drop-on monthly 0.5 2012-04-16 https://www.thegaitguys.com/thedailyblog/when-gait-is-lost-new-developments-in-mobility monthly 0.5 2012-04-14 https://www.thegaitguys.com/thedailyblog/we-found-this-while-searching-for-another-image monthly 0.5 2012-04-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553704103-W0OPKL552IUT5V75LO73/tumblr_m0jsr9NT8E1qhko2so1_500.jpg Blog We found this while searching for another image and thought it fitting for a Friday: “May you walk barefoot in joy and empathy, or shod with the shoes of your choice (or your charity), and may your path be the one that takes you where you need to go” Have a great Friday Ivo and Shawn source: http://kathleenkirkpoetry.blogspot.com/2011_03_01_archive.html https://www.thegaitguys.com/thedailyblog/are-you-running-yourself-into-hormonal-trouble monthly 0.5 2012-04-13 https://www.thegaitguys.com/thedailyblog/retail-focus-thursday-the-heel-counter-heel monthly 0.5 2012-04-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553703805-8N98FSDLF9TO5S77T106/tumblr_m26jhzklTc1qhko2so2_400.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553704810-9OXNGCKCECPICFF1LX5Y/tumblr_m26jhzklTc1qhko2so3_1280.png Blog https://www.thegaitguys.com/thedailyblog/the-boston-marathon-black-bloody-toe-nail monthly 0.5 2012-04-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553705180-9W0RKLD7TPXEPPECPGSL/tumblr_m2ajsv00qa1qhko2so1_400.jpg Blog The Boston Marathon Black & Bloody Toe nail epidemic. (want the truth, read on) Just in time for all those black bloody toenails at the Boston Marathon. We are going to try to repost this blog post (last June 2011) every year around the Boston Marathon. We need to kill the myth of “ I lost my toe nails because my shoes were too short”.  How stupid is that theory ! Our next statement is always “well, if you bought shoes that short you deserve it. But we doubt that is the case."  Here is likely why you got a black toenail or lost your nail in the marathon. ” The Gait Guys have it figured out for you.  This just makes more sense gang. It makes sense because it is the answer.  Click the link below. http://thegaitguys.tumblr.com/post/6355488304/the-black-plague-ok-kinda-sort-of-subungal https://www.thegaitguys.com/thedailyblog/neuromechanics-weekly-bad-posture-is monthly 0.5 2012-04-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553705055-KWWG0RTACKI0RJ64FQ7S/tumblr_m1h0nfVgBC1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553705584-YJX78P48BTPMR716K64L/tumblr_m1h0nfVgBC1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/emulation-as-an-integrating-principle-for monthly 0.5 2012-04-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553706061-7OPIFXWQOXVAW29Q1LFV/tumblr_m29nd6oMXq1qhko2so1_500.jpg Blog Emulation as an Integrating Principle for Cognition What you think, and what you think about matters… More fodder for motor planning and other cortical activities. This article talks about what the movie “What the Bleep Do We Know” is all about; what you think can effect the outcome, but this article is focused on you and your actions, rather than the world around us. This goes for gait retraining, rehab and a host of other things you may be trying to accomplish (even beyond the world of gait, if you can believe such a world exists!) What you do matters bascially. And when you do it right, there is neurologic reinforcement of those motor behaviours. And when you do it wrong, meaning you cheat or compensate, there is neurologic reinforcement of those motor behaviours as well.  We often hear it is better to do something right the first time than to have to do it truly properly a second time.  There is far more to it than correcting your ways. Now you have to rewrite another motor pattern, while the old one remains stored waiting for you to cheat or take a short cut the next time.  If something is worth doing, do it right the first time.  This goes for gait and running form retraining.  This is why running form is such a big business these days, so many have been running incorrectly, emulating improper motor patterns.  When Nike said “Just do it”…….we think they meant, “Just do it right.” The Gait Guys Emulation as an Integrating Principle for Cognition Front Hum Neurosci. 2011; 5 : 54. Published online 2011 May 27. doi:  10.3389/fnhum.2011.00054 Abstract Emulations, defined as ongoing internal representations of potential actions and the futures those actions are expected to produce, play a critical role in directing human bodily activities. Studies of gross motor behavior, perception, allocation of attention, response to errors, interoception, and homeostatic activities, and higher cognitive reasoning suggest that the proper execution of all these functions relies on emulations. Further evidence supports the notion that reinforcement learning in humans is aimed at updating emulations, and that action selection occurs via the advancement of preferred emulations toward realization of their action and environmental prediction. Emulations are hypothesized to exist as distributed active networks of neurons in cortical and sub-cortical structures. This manuscript ties together previously unrelated theories of the role of prediction in different aspects of human information processing to create an integrated framework for cognition. https://www.thegaitguys.com/thedailyblog/you-have-seen-the-artwork-of-british-photographer monthly 0.5 2012-04-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553705877-KR4H4KZYWUBG12IBWWKI/tumblr_m28s6fBgFt1qhko2so1_500.jpg Blog You have seen the artwork of British Photographer Eadward Muybridge in some of our videos and online education programs (with credit). Here is a Google Doodle based on “The Horse in Motion” you may enjoy. Click on the picture to follow the link. The Gait Guys Have a great day! https://www.thegaitguys.com/thedailyblog/supination-the-matrix-way-wow-can-you-believe monthly 0.5 2012-04-09 https://www.thegaitguys.com/thedailyblog/curse-of-the-bunion-hi-dr-allen-my-husband-was monthly 0.5 2012-04-07 https://www.thegaitguys.com/thedailyblog/friday-follies-going-through-our-archived monthly 0.5 2012-04-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553706556-BAHGDA3VVX698YWYV4VY/tumblr_m20o6kBIYx1qhko2so1_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553706453-H5IUTM1RODVH75IM81AS/tumblr_m20o6kBIYx1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553706516-IE9OXK6U0DQNLOWJCDSI/tumblr_m20o6kBIYx1qhko2so3_400.jpg Blog https://www.thegaitguys.com/thedailyblog/muscle-tightness-vs-muscle-shortness-there-is-a monthly 0.5 2012-04-06 https://www.thegaitguys.com/thedailyblog/shoe-retail-thursday-today-we-have-a-client-in monthly 0.5 2012-04-05 https://www.thegaitguys.com/thedailyblog/neuromechanics-weekly-gait-and-running-and-the monthly 0.5 2012-04-04 https://www.thegaitguys.com/thedailyblog/more-on-micah-and-the-future-of-ultra-marathoning monthly 0.5 2012-04-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553707138-CDB3S1WTSH1M12P1U8ZB/tumblr_m1vucnb5eU1qhko2so1_400.jpg Blog More on Micah and the future of ultra marathoning: click for AP article link https://www.thegaitguys.com/thedailyblog/quiz-lets-see-how-your-blog-reading-has-been monthly 0.5 2012-04-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553707972-YFKOZP7K31RRZPXLI88O/tumblr_m1h0g09NlZ1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553707842-FXPL8IF2K5DZSBU7D6G7/tumblr_m1h0g09NlZ1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553707983-AEX6KX52KNTWWDXJMHNR/tumblr_m1h0g09NlZ1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553708753-TNKSQ45Y94U4Z1QZFRES/tumblr_m1h0g09NlZ1qhko2so4_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553708740-5PY5ZY0I7YUWO4E04DJI/tumblr_m1h0g09NlZ1qhko2so5_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/ultrarunning-running-has-lost-one-of-its-best monthly 0.5 2012-04-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553708624-5UJLSJDJ8KGSY5FFY97P/tumblr_m1ut1w3HuG1qhko2so1_250.jpg Blog Ultrarunning Running has lost one of it’s best, the 58 year old from Boulder Colorado, Micah True. Full story of what we know here: http://abcnews.go.com/US/micah-true-ultrarunners-body-found-mexicos-wilderness/story?id=16048218#.T3j03e3Da20 https://www.thegaitguys.com/thedailyblog/often-times-we-find-ourselves-in-a-difficult monthly 0.5 2012-04-01 https://www.thegaitguys.com/thedailyblog/bunions monthly 0.5 2012-03-31 https://www.thegaitguys.com/thedailyblog/do-you-know-someone-like-one-of-these-people-some monthly 0.5 2012-03-30 https://www.thegaitguys.com/thedailyblog/think-about-what-you-are-doing monthly 0.5 2012-03-30 https://www.thegaitguys.com/thedailyblog/another-day-at-the-zoo-what-do-you-see-fashion monthly 0.5 2012-03-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553709117-2AV3C0MJVREKKJ95JT9E/tumblr_m141z6jKC81qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553709141-P68SP7M2V2BWXD06P265/tumblr_m141z6jKC81qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553709364-CDGSUMCC28IZIGHMC5GF/tumblr_m141z6jKC81qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/its-hard-to-follow-sandra-bullock-in-high-heels monthly 0.5 2012-03-28 https://www.thegaitguys.com/thedailyblog/research-support-for-dynamic-warm-up-rather-than monthly 0.5 2012-03-28 https://www.thegaitguys.com/thedailyblog/why-you-should-have-a-picture-similar-to-this-of monthly 0.5 2012-03-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553710052-FTPI32F3JBVZAX16JEQV/tumblr_lz6jrc1Q5H1qhko2so1_r1_400.jpg Blog Why you should have a picture similar to this of Sandra Bullock in your shoe store….  Because of the story it tells to all runners (and walkers)….. we guess that means everyone then doesn’t it ? Note what the lovely Sandra is wearing. Your eyes may be first drawn to the accentuation of her buttocks and calf as well as her lifted chest.  In actual fact, that is what high heel shoes are designed to do. What you might not see because you are drunk on her beauty and figure is the cost on her body from those illusion driving high heel shoes. Here is what they are doing behind the scenes: creating a perpetually plantarflexed foot with excessive and unnatural forefoot loading and likely increased use of long toe flexors sustaining tension in her quadriceps because she is purchased forward on the balls of her feet hyperextension loading the knees with increased lumbar lordosis which is making it a challenge to maintain adequate abdominal tone, in fact, likely inhibiting the abdominals.   Who cares right ? It all frame her glutes nicely and accentuates her bosom right ?  Blame it on Sex and the City or blame it on men who like to see women in high heels, but there is blame to dish out. Put Sandra in some Newtons or Altra’s ……or some other zero-drop minimalist shoes and watch: Her heels drop redistributing normal rear : forefoot loading  Foot intrinsic muscles begin to re-engage as the long toe flexors settle down now that she is off the forefoot Achilles and calf muscles lengthen to their normal state Tone normalizes in anterior shin compartment and toe extensors The foot mechanics we were born with are restored because they are in the environment we were born with…… that being that the forefoot and rearfoot are both on the same plane (flat on the ground) and thus the mechanics they were designed to engage are once again available and possible.  (But it will take time to restore the lost function. Even men’s every day shoes, including traditional running shoe trainers have a ramp-delta heel lift.) Lumbar spine lordosis reduces, abdominals engage easier Psoas returns to normal length from its shortened state Cervical spine returns to neutral patellofemoral joints compressively unloads making for some happy knees Gluteals re-engage and take the extension from the lumbar spine and put it back into the hips where it is supposed to be achieved. And that my friends, is why you need a picture of Sandra Bullock in your shoe store now that you know what heeled shoes are doing in the background of your body mechanics. Bammmmm…….. The Gait Guys…….. critics of even the most beautiful actresses in Hollywood.  Ivo and Shawn…….risking it all, even a dinner date with Sandra, to bring you the facts.  Our only question now is, “Why Jessie James? Why ?” Shawn and Ivo https://www.thegaitguys.com/thedailyblog/how-robust-is-human-gait-to-muscle-weakness monthly 0.5 2012-03-26 https://www.thegaitguys.com/thedailyblog/tibialis-posterior monthly 0.5 2012-03-25 https://www.thegaitguys.com/thedailyblog/in-this-great-little-slow-mo-video-we-see-some monthly 0.5 2012-03-24 https://www.thegaitguys.com/thedailyblog/friday-follies-time-to-revisit-george-costanzas monthly 0.5 2012-03-23 https://www.thegaitguys.com/thedailyblog/during-a-recent-trip-to-the-zoo-with-the-family-i monthly 0.5 2012-03-23 https://www.thegaitguys.com/thedailyblog/retail-focus-the-toe-box-3-photos-today-hover monthly 0.5 2012-03-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553710488-PQY7HVZ9TAMGFRLVR0JM/tumblr_m143w7QGkN1qhko2so1_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553711174-QJGYR0ECW5LWXXFZ73SW/tumblr_m143w7QGkN1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553711298-K67SVW2L6VIKISC1MCWY/tumblr_m143w7QGkN1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/under-armor-mouth-guards-neuromechanics monthly 0.5 2012-03-21 https://www.thegaitguys.com/thedailyblog/running-einstein-gravitational-push-and-space monthly 0.5 2012-03-20 https://www.thegaitguys.com/thedailyblog/more-on-the-earth-shoe-37-degrees-who monthly 0.5 2012-03-19 https://www.thegaitguys.com/thedailyblog/in-our-series-of-questions-we-get-dear-gait monthly 0.5 2012-03-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553711487-EFVKMU4KEVKOVCJJBQ97/tumblr_m0zz1puREf1qhko2so1_500.png Blog In our series of questions we get… Dear Gait Guys I was reading an article the other day about the foot and intrisic muscles to gain more insight into the function and how to re-train these muscles. I am having a difficult time trying to give patients exercises for intrisic muscles when everyone seems to say something different. The most recent I have read is that the best way to retrain the lumbricals is stand on your toes and walk up steps. I can see some logic in this but also seems a very generic exercise and would encompass alot more flexor driven muscles that are likely already strong. I was wondering if you have a more specific exercise that would be simple and easy for patients to do? Dear Lumbricals We would have to agree with you that the exercise is very generic and would cause overuse of the flexors, though it would stimulate lumbrical function. As you are aware, the lumbricals attach proximally to the sides of adjacent tendons of the flexor digitorum longus (with the exception of the 1st, which only attaches to the medial side) and attach distally to the medial aspect of the head of the proximal phalynx and continue on to the extensor hoods in toes 2-5 . Their typical function is described as flexion of the proximal phalynx and extension of the proximal and distal interphalangeal joints. They have the unique ability to compress the metatarsal-phalangeal and inerpahlangeal joints. There is also a small adductory moment to counteract abductory shear, due to the tendon passing medial to the metatarsal-phalangeal joints (michaud). These are open chain functions. Unless you are in the habit of waving to people with your toes, they often are used quite differently. But this brings upa good point and excellent exercise we call “waving the toes”. They are performed by holding the great toe in dorsiflexion (hopefully, without assistance) and flexing the other toes at the MTP joint, while keeping the PIP and DIP in extension. This requires and intact and functional EDL (with good motor control!) Another exercise is sitting with the foot relaxed and concentrating on flexing the toes (2-5) without clawing (similar to above, without the Hallux extended. Remember they work from mid to terminal stance, but you need to develop skill before endurance or strength. We hope this helps,  The Gait Guys https://www.thegaitguys.com/thedailyblog/as-a-runner-to-cross-over-or-not-to-cross-over monthly 0.5 2012-03-17 https://www.thegaitguys.com/thedailyblog/hip-dancing-gets-this-runner-to-the-olympics monthly 0.5 2012-03-16 https://www.thegaitguys.com/thedailyblog/it-wouldnt-be-st-pattys-day-with-out-a-little monthly 0.5 2012-03-16 https://www.thegaitguys.com/thedailyblog/from-traditional-trainers-to-minimalism-so-what monthly 0.5 2012-03-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553711526-6SXFW8Y12YJCWUZU1CZ6/tumblr_m0wl9mzOKY1qhko2so1_250.jpg Blog From Traditional trainers to minimalism…… so, what is the “earth shoe” then ? Will the fad return ? Will we see running shoes go this far ? Afterall, we are at zero drop now ? So, we all have seen the trend……. minimalism is here and it is not a fad, it is a trend and it is here to stay. It is here to stay because it is not a fad like this shoe above.  The Earth shoe has made 2 resurgences in the last 4 decades. We are likely to see another very soon since this minimalism trend has occurred. Make no mistake though, the minimalism is not a fad, it is a trend and it will be staying.  So, what is wrong with this shoe ? Minimalism will remain because we are finally restoring the normal rear foot : forefoot parameters to what we were born with. We were born with the rear and forefoot on the same plane, flat on the ground.  This even playing field, or at least a return to it for many shoe manufacturers, allows the anatomy (both bone and soft tissues such as muscles) to again operate in the fashion it was designed.  Sure the “running form” changes everyone is promoting is important. It is critical to get into good form. But unless the foot’s parts are normalized to the optimal mechanics we were born with even running form changes will not correct 100% of a person’s mechanical issues.  The minimalism is allowing the rear foot to drop down to the same level of the forefoot, the same operating plane.  This necessitates length in the posterior compartment (calf and achillies mechanism) which will enable the anterior compartment (tibialis anterior and toe extensors) to see more function and thus gain more strength.  This plays well into our long standing theories that stretching of the calf, albeit sometimes necessary to a point, is not the answer for tightness in the calf…..rather putting the foot in a posture to enable the anterior compartment will earn length in the posterior compartment.  Here comes another mantra we use in our offices……. “Gain Anterior strength to achieve Posterior Length”.  Merely stretching the posterior compartment to gain length does not afford anterior strength.  So, it depends if you want a temporary bandaid or a long term fix.  We opt for the fix which is why it is a rarity that you ever hear from us “Mrs. Jones, you need to stretch your calf”.  Instead we teach the solution. What else comes to mind about minimalism.  Well, again take the shoe above to give an extreme example of what dropping the heel will do.  It will shift your weight bearing posture posteriorly. Go ahead…..stand on the ball of your feet….. your body mass shifts forwards, your low back might arch if you do not have enough abdominals.  IF you then drop the heel you will feel your body posture shift backward and you will feel more glute and more abdominal and neutral pelvis-core posturing. You will also feel a more balanced weightbearing between the forefoot and rearfoot. This is good. These are just some of the things that minimialism does.  There is alot more.  But those are for another time. In the meantime. The earth shoe. It drops you into rearfoot negative. The rearfoot is lower than your forefoot.  Remind you of anything ? Yup, walking in the sand. The heel sinks more if you load it first.  This will create a drastic change in length-tension relationships between the calf and anterior compartment. It will load the anterior ankle (mortise joint) and can really challenge the shin muscles.  Ever get shin splints or soreness the next day after a long beach walk ?  There is your reason.  So, the Earth Shoe. It is not natural. It puts your rearfoot and forefoot on two separate planes of operation. Or think of it this way…..it raises your forefoot onto a higher plane.  Walk around on your heels with the ball of your foot off the ground.  Feel your anterior muscles challenge ? You might even feel the posterior compartment stretch load a little. And we know that when you put a stretch through a loaded muscle the golgi tendon organ fires to inhibit that muscle….. yup, right when you are about to need it to push off.  Pretty messed up huh ? If you want to see some messed up mechanics buy your favorite enemy some earth shoes. Look for the knees to hyperextend backwards a little, look for a bouncy vertical gait, look for toe gripping/hammer toe development among other things.  They can be a sneaky vengeful gift.  Shawn and Ivo….. rediscovering the old groovy trends and hoping everyone stops at zero-drop.  Otherwise watch out for our vengence …   “V” is for Vendetta !  https://www.thegaitguys.com/thedailyblog/stretching-out-plantar-fasciitis monthly 0.5 2012-03-14 https://www.thegaitguys.com/thedailyblog/proof-that-women-are-not-unstable-at-the-time-of monthly 0.5 2012-03-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553712031-FSJK6U30ZBOCDC7W2VJI/tumblr_lzyzyzIISF1qhko2so1_1280.jpg Blog Proof that women are not unstable at the time of menstruation. On the subject of proprioception, here is something we found interesting while on a quest for another article. 1st, we had found an article in the NY Times blog, talking about training considerations of women during their monthly cycle. They state: “There may, however, still be reasons a woman to consider her period when planning training. A study published this year by scientists at the University of Melbourne in Australia, for instance, found that when women’s estrogen levels were at their highest, around the time of ovulation, they landed subtly differently while hopping than at other times of the month. Their feet splayed, the arch collapsing just a little bit more than it did when their estrogen levels were lower. The women also seemed, to a small degree, wobblier. “We contend that the changes in foot biomechanics may be due to the effects of estrogen on soft tissue and/or the brain,” said Adam Leigh Bryant, a senior lecturer at the University of Melbourne and lead author of the study.” This says, in a nutshell, that women are not unstable around the time of menstruation (dispelling many common myths to the contrary) but rather, they are unstable around the time of their ovulation (proprioceptively speaking, of course). Women on monophasic contraceptives showed less variability (greater stability) and therefore may be more less injury prone. Of course we pulled the study (abstract below). We found it interesting that it may actually be a neurological/cortical phenomenon, rather that muscle estrogen receptor based. What is the advantage of less proprioceptive awareness with increased estrogen levels? Maybe (in a bit of a stretch), it was for propagation of the species. If the women can’t get away, then they are more likely to be caught (or less likely to be able to run…) The Gait Guys….Sifting through the literature and sometimes poking a little fun at it. Ivo and Shawn.   http://www.ncbi.nlm.nih.gov/pubmed/20857138 Eur J Appl Physiol. 2011 Feb;111(2):245-52. Epub 2010 Sep 21. Estrogen-induced effects on the neuro-mechanics of hopping in humans. Bryant AL, Crossley KM, Bartold S, Hohmann E, Clark RA. Source Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, 3010, Australia. albryant@unimelb.edu.au Abstract Estrogen receptors in skeletal muscle suggest a tissue-based mechanism for influencing neuromuscular control. This has important physiological implications for both eumenorrheic women with fluctuating estrogen levels and those with constant and attenuated estrogen levels, i.e., women using the monophasic oral contraceptive pill (MOCP). This study examined the effects of endogenous plasma estrogen levels on leg stiffness (K (LEG)) and foot center of pressure (COP) during hopping. Nineteen females (Age = 28.0 ± 4.2 years, Ht = 1.67 ± 0.07 m, Mass = 61.6 ± 6.8 kg) who had been using the MOCP for at least 12 months together with 19 matched, female, non-MOCP users (Age = 31.9 ± 7.3 years, Ht = 1.63 ± 0.05 m, Mass = 62.5 ± 5.9 kg) participated. Non-MOCP users were tested at the time of lowest (menstruation) and highest (≈ ovulation) estrogen whilst MOCP users were tested at Day 1 and Day 14 of their cycle. At each test session, K (LEG) (N m(-1) kg(-1)) and foot COP path length (mm) and path velocity (mm s(-1)) were determined from ground reaction force data as participants hopped at 2.2 Hz on a force plate. Statistical analysis revealed no significant (p < 0.05) differences for K (LEG). In contrast, significantly higher COP path length (30%) and COP path velocity (25%) were identified at ≈ ovulation compared to menstruation in the non-MOCP users. Whilst there was no evidence of an estrogen-induced effect on K (LEG); significantly elevated estrogen at ≈ ovulation presumably increased extensibility of connective tissue and/or diminished neuromuscular control. Consistent lower limb dynamics of MOCP users demands less reliance on acutely modified neuromuscular control strategies during dynamic tasks and may explain the lower rate of lower limb musculoskeletal injuries in this population compared to non-MOCP users. “There may, however, still be reasons a woman to consider her period when planning training. A study published this year by scientists at the University of Melbourne in Australia, for instance, found that when women’s estrogen levels were at their highest, around the time of ovulation, they landed subtly differently while hopping than at other times of the month. Their feet splayed, the arch collapsing just a little bit more than it did when their estrogen levels were lower. The women also seemed, to a small degree, wobblier. “We contend that the changes in foot biomechanics may be due to the effects of estrogen on soft tissue and/or the brain,” said Adam Leigh Bryant, a senior lecturer at the University of Melbourne and lead author of the study.” https://www.thegaitguys.com/thedailyblog/last-week-an-article-popped-up-on-mens-health monthly 0.5 2012-03-12 https://www.thegaitguys.com/thedailyblog/the-confusion-of-shoe-science-part-5-of-5 monthly 0.5 2012-03-12 https://www.thegaitguys.com/thedailyblog/thinking-about-throwing-away-those-old-running monthly 0.5 2012-03-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553711714-PXA454Y8CWU6Z4FE89D2/tumblr_m0nih3Zcnv1qhko2so1_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553711981-KP4JNLBM8O2RM4ZZXDO9/tumblr_m0nih3Zcnv1qhko2so2_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553712472-B6PYJGPUJMUAZUSUM3MQ/tumblr_m0nih3Zcnv1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/the-confusion-of-shoe-science-part-4-of-5 monthly 0.5 2012-03-11 https://www.thegaitguys.com/thedailyblog/the-sole-truth-and-nothing-but-the-truth-thicker monthly 0.5 2012-03-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553713306-GWGUBJGAGOX9W9RVQ9CW/tumblr_m0lqunwlic1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553713517-E8FXODZ1EEIDSAQ6L5UV/tumblr_m0lqunwlic1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/the-confusion-of-shoe-science-part-3-of-5 monthly 0.5 2012-03-10 https://www.thegaitguys.com/thedailyblog/the-confusion-of-shoe-science-part-2-of-5 monthly 0.5 2012-03-09 https://www.thegaitguys.com/thedailyblog/boots-make-the-man-or-the-woman-if-you-had-any monthly 0.5 2012-03-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553714578-6KHQ2U77P6B748XLHWS9/tumblr_m0jshuyehE1qhko2so1_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553714286-QHUIKUJOH2CXDAOZB2V6/tumblr_m0jshuyehE1qhko2so2_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553714254-PYJ7YSYHPKDC6O88N50R/tumblr_m0jshuyehE1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/shoe-news-you-can-use-pronation-is-dorsiflexion monthly 0.5 2012-03-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553714748-DB8JRDPB8T3A5P9QVN6N/tumblr_m0jrg50UgG1qhko2so1_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553714857-8AMXTQBKZW1LDHG2UNS2/tumblr_m0jrg50UgG1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/the-confusion-of-shoe-science-part-1-of-5 monthly 0.5 2012-03-08 https://www.thegaitguys.com/thedailyblog/a-beautiful-and-informative-video-on-natural monthly 0.5 2012-03-07 https://www.thegaitguys.com/thedailyblog/neuromechanics-weekly-pain-matters-we-know monthly 0.5 2012-03-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553715064-CEYFLRIGG4YIU95OJ49Y/tumblr_m0iunls24K1qhko2so1_400.jpg Blog Neuromechanics Weekly: Pain Matters We know that joint swelling (and thus inflammation) inhibits the contraction of the muscle which crosses the joint from the landmark work of Iles and Stokes back in the late 80’s. Now here is a paper stating that pain does the same thing.  This tells us that there is an axon collateral from the primary pain neuron (the “C” fiber) that somehow inhibits the alpha moto neuron, similar to a flexor reflex, as pictured. his is most likely through affecting the gamma moto neuron (which goes to the spindles) rather than the alpha motoneuron; so the “sensitivity” of the muscle is changed (remember, spindles detect length changes, golgi’s tension). So what does this mean to us and gait? It tells us that pain will inhibit the activity (voluntary and involuntary) of the ability for one to use their muscles, especially those crossing the joint in questions. Be aware of inflammation (painful or non painful) or the painful joint, which can contribute to a compensation pattern. Ivo and Shawn…The Gait Guys. Making your life less painful and more functional…. Muscle Nerve. 2000 Aug;23(8):1219-26. Inhibition of motor unit firing during experimental muscle pain in humans. Sohn MK, Graven-Nielsen T, Arendt-Nielsen L, Svensson P. Source Center for Sensory-Motor Interaction, Orofacial Pain Laboratory, Aalborg University, Denmark. Abstract Electromyographic activity was recorded in the masseter muscle to investigate whether the firing characteristics of single motor units (SMUs) were affected by muscle pain. Capsaicin was injected into the masseter to induce pain. The interspike interval (ISI) and recruitment threshold of SMUs were measured while subjects performed isometric contractions at 5, 7.5, 10, 15, and 20% of maximum voluntary contraction. All subjects were able to maintain a stable isometric force during pain, but the mean ISI was significantly increased without changing the recruitment threshold. In all the experimental conditions, the firing frequency increased with increasing force, and SMUs recruited at low force fired at higher rates for all force levels. These results suggest that acute stimulation of nociceptive muscle afferents inhibits SMU activity without changing recruitment order in the homonymous muscle. Copyright 2000 John Wiley & Sons, Inc. https://www.thegaitguys.com/thedailyblog/sorry-for-the-late-post-folkswe-both-had-pretty monthly 0.5 2012-03-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553715300-DALXVFAJ3KBR81KUSXZU/tumblr_lzyzzkHecF1qhko2so1_1280.jpg Blog Sorry for the late post, folks…We both had pretty crazy days at our clinics… Yup, you saw it here 1st. We couldn’t believe it either. Look what we found in the Harvard archives. Sport féminin : saut sur échasses. Korean women on stilts jumping hurdles in a chase, for fun. Advert for Liebig’s Extract of Meat Company. 1904. Via Harvard U. What does meat extract have to do with women on stilts, jumping hurdles? We could use some help on this one. Anyone have any suggestions? The Gait Guys. Not on stilts, but teetering while jumping hurdles sometimes…. https://www.thegaitguys.com/thedailyblog/a-case-of-severe-mechanical-gait-challenges monthly 0.5 2012-03-05 https://www.thegaitguys.com/thedailyblog/see-the-previous-blog-post-for-the-lower-body monthly 0.5 2012-03-04 https://www.thegaitguys.com/thedailyblog/rolling-patterns-and-their-use-in-body monthly 0.5 2012-03-04 https://www.thegaitguys.com/thedailyblog/the-roll-of-breathing-and-diaphragm-control-in monthly 0.5 2012-03-03 https://www.thegaitguys.com/thedailyblog/it-is-friday-follies-you-may-remember-this-video monthly 0.5 2012-03-02 https://www.thegaitguys.com/thedailyblog/exercise-training-increases-mitochondrial monthly 0.5 2012-03-01 https://www.thegaitguys.com/thedailyblog/the-whole-is-greater-than-the-sum-of-its-parts monthly 0.5 2012-02-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553715526-AKO5FNMM5NHGA9U1PGWM/tumblr_m04zhrgWv81qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553716755-J05G43BI9U9ID7ZKDDQQ/tumblr_m04zhrgWv81qhko2so2_250.jpg Blog https://www.thegaitguys.com/thedailyblog/when-the-toe-extensors-become-short-or-tight monthly 0.5 2012-02-28 https://www.thegaitguys.com/thedailyblog/forefoot-valgus-what-you-need-to-know-hi-shawn monthly 0.5 2012-02-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553716924-QDDYCO8261GQBELFYP74/tumblr_lzyyrkWvry1qhko2so1_250.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553717174-0H8Y8ZARY6FRFPM92AU4/tumblr_lzyyrkWvry1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/the-perfect-forefoot-bipod-the-ostrich-is monthly 0.5 2012-02-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553717368-5MKZPBVT9H9JJMVEAQA5/tumblr_lznt71sLxl1qhko2so1_400.jpg Blog The Perfect Forefoot Bipod The ostrich is distinctive in its appearance, with a long neck and legs and the ability to run at maximum speeds of about 70 kilometres per hour (43 mph)[3], the top land speed of any bird. he bird has just two toes on each foot (most birds have four), with the nail on the larger, inner toe resembling a hoof. The outer toe has no nail.[14] The reduced number of toes is an adaptation that appears to aid in running. Ostriches can run at over 70 kilometres per hour (43 mph) for up to 30 minutes. Although this bird cannot fly, it can run faster than the swiftest horse.their primary means of locomotion is running, so the feet have developed into feet fit for frequent, and very fast running especially to escape preditors. If it would keep on in a straight line no animal could overtake it; but it is sometimes so foolish as to run around in a circle, and then, after a long chase, it may perhaps be caught. A traveller speaking of the ostrich, says, “She sets off at a hard gallop; but she afterwards spreads her wings as if to catch the wind, and goes so rapidly that she seems not to touch the ground.” This explains what is meant by the verse, “When she lifteth up herself on high she scorneth the horse and his rider.” It is a good thing that ostrich’s do not wear shoes. Over time their feet would have weakened and flattened and they would need orthotics.  Some animals are just smarter than humans. :-) https://www.thegaitguys.com/thedailyblog/in-our-ever-popular-ask-the-docs-here-is-another monthly 0.5 2012-02-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553717289-6QWSJG7IMWS1C0GZ3FU8/tumblr_lzxj0gFuZ71qhko2so1_400.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553717550-50PRDHUP3NJPWITHL6F0/tumblr_lzxj0gFuZ71qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/an-entertaining-song-that-sums-up-how-we-feel monthly 0.5 2012-02-25 https://www.thegaitguys.com/thedailyblog/the-importance-of-the-foot-function-and-posturing monthly 0.5 2012-02-24 https://www.thegaitguys.com/thedailyblog/the-foot-tripod-the-importance-of-the-toe monthly 0.5 2012-02-23 https://www.thegaitguys.com/thedailyblog/feel-the-pain-part-4-pain-modulation-in monthly 0.5 2012-02-22 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What is the real issue and solution ? We get dozens of emails daily, and we try to anonymously post a good case weekly. Dear Drs. Waerlop and Allen:   I am hoping that you will be able to help me, by referring me to the right professionals.   I am a 45 year old woman who has been plagued by what doctors have told me is Iliotibial  band friction syndrome for the past three years.   When my injury first occurred, I was running approximately 4 miles three to four times per week.  Most of the time, I ran in the woods, but I also ran in the street.    When it first occurred, I walked home and rested my legs for two weeks.  After resting it, I learned that if I wore compression pants, I was able to run for 3 miles with no pain.  So, I cut back on my running and endured that distance for a while.  Eventually, it became so bad that I could not run two miles, so I decided to go to the doctors.    The first doctor I went to for the problem told me to stretch my Iliotibial band and strengthen it by doing the four way leg exercise.  I did exactly as I was told, but to no avail.  I went back to the doctor and he could not understand why I was not getting better.  Since it became apparent to me that seeing him was fruitless, I did not go back a third time.  He told me that the problem would resolve itself within time.   For the next year, I self-treated.  I stretched, strengthened my hips and iced my knee.  At times, I could run 3 to 4 miles in the woods wearing a brace.  As soon as I felt any pain, I stopped running, and walked to my destination.  I would rest my leg again for a few weeks, and start back to running gradually, i.e. .5 miles every other day.  I took spin class two or three days per week to keep my cardio level up.  Interestingly, biking has never bothered my knee.   Last summer, it became so bad that I could not run .2 of a mile.  In September, I walked about 4 miles in Philadelphia in flip flops (I can hear you gasping now), and my knee began to hurt (you are probably saying no wonder!).  That was the first time my knee hurt while walking.  It was so sore for the next few days that the pain woke me up at night.  Shortly thereafter, I was walking and my back started to hurt so I went to another doctor.   The second doctor I went to told me to do a single leg squat and said you have Iliotibial band friction syndrome.  He prescribed physical therapy.  I have been going to physical therapy since the beginning of October.  I returned to running slowly and eventually I was able to run 20 minutes on the treadmill at a level between 7.4 and 7.6.  I ran three days per week.   I have also endured the Graston Technique and ART twice a week since November.  My physical therapist feels that it was successful in breaking up my scar tissue.   I can foam roll my Iliotibial band with both legs in the air without any pain.    Yesterday, I tried running outside.  I ran on the flattest road I could find, but was unable to make it a mile.  I stopped running as soon as I felt the pain (similar to a throbbing pain) on the outside of my knee and walked home.  I iced it and took Advil.  I went to physical therapy today, and she cannot understand why I cannot run for one mile outside.  She believes I need to see another doctor for another opinion.    Do you know of anyone in the Philadelphia area who would provide me the type of care that you provide to your patients?  I found you on Facebook  (I am Nellie Eplin) and find you fascinating.    I really want to get this fixed.  I want to run for the rest of my life. It makes me a better person.     I appreciate all of the help that you are able to provide.     Best regards,    E.L. _______________________________________________ Response from The Gait Guys: Dear E.L. : ITB problems usually, but not always, occur from Weak gluteal support or from factors that allow or promote too much internal spin of the limb.  Sadly the typical response people get are the same as you heard, stretch the ITB out and foam roll. There is a reason this is frequently fruitless to resolve your issues. The ITB mechanism can shorten because there is weakness somewhere in the limb and internal spin and frontal plane stability is lost.  The internal spin issues can come from flat feet, hyper pronating, tibial torsion issues and valgus knees to name a few let alone general eccentric and isometric weakness of the muscles controlling internal spin rate (glutes and medial quads for example) . The TFL-ITB are internal rotators, provide stability through limb rotation and provide some lateral stability. When the gluteals get weak you lose some of the lateral plane stability (mostly gluteus medius) and you lose some of the ability of the gluteals (iliac div. of g. maximus and posterior g. medius) to control rotation (eccentrically control the rate of internal spin).  A few weeks back we did a several part series on the functions of the gluteal, here is the link of the first one & the second one and their effect on the IT Band-TFL mechanism. We would start with reading these 2 blog posts and then go back to the 3 part series on the Cross Over Gait which you can find here on our Youtube channel. Without an examination we are guessing but perhaps the 2 blog posts and investigating these 3 videos we did will help you to look at Cross over gait issues which can be a big component of excessive internal spin. Within the videos you will see some exercise skills that might help you.  Good luck,  We are in Chicago and Colorado. We do not know of anyone that does our kind of work in your town. Sorry Good luck and keep in touch with us regarding your progress and discoveries, in the mean time investigating our ideas above rethinking the stretching - foam roller approach for the brief time might help you. Shawn and Ivo, The Gait Guys …. helping solve one unresolved case at a time. * (in all case discussions our disclaimer applies, available on our website).   https://www.thegaitguys.com/thedailyblog/17428704829 monthly 0.5 2012-02-11 https://www.thegaitguys.com/thedailyblog/113-marathons-in-one-year-what monthly 0.5 2012-02-10 https://www.thegaitguys.com/thedailyblog/it-is-friday-follies-on-the-gait-guys-and-we-have monthly 0.5 2012-02-10 https://www.thegaitguys.com/thedailyblog/need-more-muscle-activation-how-about-a-crouched monthly 0.5 2012-02-09 https://www.thegaitguys.com/thedailyblog/neuromechanics-weekly-installment-2-now-arent monthly 0.5 2012-02-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553724198-VLU2H7PTT8O3BN5QB280/tumblr_lyydo1N4Q31qhko2so1_400.jpg Blog Neuromechanics Weekly: Installment 2 (Now aren’t you lucky to have so much neuro in 1 week!) FEEL THE PAIN: PART 2 The Character of Pain In today’s post we hope to help you better understand your pain or the pain that someone else describes to you. The character of the pain can tell you much about what tissues are involved and what might be going on behind the scenes. Understanding the anatomy and physiology of the parts is critical.  Thus, this post is going to be a little latin/medical word heavy for some of you….. but trust us, if you spend just a few extra minutes championing these words and owning the concepts below you will forever be better at what you do. Or at the very least, better understand your own pain. In prior post in this series we talked about the pain producing tissues being derived from one of the primordial tissues, the endoderm, ectoderm or mesoderm. And if it is from  the mesoderm, from which of the 3 layers of the somite is it originating ? The sclerotome, the dermatome or myotome? (The mesoderm is the middle embryonic germ layer from which connective tissue, muscle, bone, and the urogenital and circulatory systems develop.) As we discussed yesterday, pain usually has one of four qualities: burning, aching/throbbing, sharp/stabbing, or electric/shooting. Each one tells us something about where it is coming from. Remember the Krebs cycle? How about glycolysis? What was one of the end products of glycolysis? Lactic acid. Your ability to recycle it and make it into oxaloacetic acid and stuff it back into the Krebs cycle determines your aerobic capacity. When lactic acid builds up, we get muscular inefficiency due to the drop in pH (initially this helps, but too much of a good thing creates a problem), The result? Burning pain. Burning pain is the burn of glycolysis, or muscular overuse. Aching/ throbbing pain is that deep, boring pain, like a toothache in a bone. It is the pain of the mesoderm, or what is often called sclerotogenous pain. Aching/Throbbing pain is the pain of connective tissue dysfunction (remember that connective tissue is bone, cartilage and collagenous structures like ligaments and tendons). Throbbing pain can sometimes be vascular in origin, as the connective tissue elements of the vessels (the tunica adventitia to be exact) is stretched (which contains a perineural plexus; think about the pain of a migraine headache). Shooting/electric pain is the pain of the ectoderm. Think about when you hit your ulnar or peroneal nerves and get that “electric shock” sensation. If you ever have had a herniated disc, you know this pain first hand; sharp and shock like. This pain often travels in the distribution of a nerve root or peripheral nerve.  Sharp/ stabbing pain is the pain of acute tissue damage to one of the 3 layers of the somite (the dermatome, sclerotome or myotome). Think of a sprain (sclerotome) or strain (myotome), or the pain of a shingles outbreak (dermatome). Sharp/stabbing pain is the pain of acute tissue damage. Keep in mind there is often overlap of pain types, which mean that there is more than one tissue crying out for help (the burning pain in the left hip from gluteus medius insufficiency, combined with the dull, achy pain in the medial knee, from poor control of internal rotation of the thigh). Pay attention to the character of pain, as it often provides clues to the tissue of origin. The Gait Guys. Explaining it so you can understand it, one pain free stride length at a time. Ivo and Shawn https://www.thegaitguys.com/thedailyblog/neuromechanics-weekly-feel-the-pain-part-1 monthly 0.5 2012-02-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553725022-NI9239KEJC3NJ8HDRI3T/tumblr_lyydjbvOCl1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553725764-1H158V3GL2JGWTX5HRBO/tumblr_lyydjbvOCl1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553725177-BSXPQZ1HJE1JFK9KBKZH/tumblr_lyydjbvOCl1qhko2so3_250.gif Blog https://www.thegaitguys.com/thedailyblog/how-do-you-know-if-your-orthotic-is-working-foot monthly 0.5 2012-02-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553725971-IVDV5ZIKFCZ90CC2AMOK/tumblr_lys2pgVvuw1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553725877-CDD4JJXA6DRDT4VHNO1Q/tumblr_lys2pgVvuw1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/textured-insoleswhats-your-take monthly 0.5 2012-02-05 https://www.thegaitguys.com/thedailyblog/gait-issues-when-proprioception-is-lost-what-we monthly 0.5 2012-02-04 https://www.thegaitguys.com/thedailyblog/extensor-hallucis-brevis-case-treatment monthly 0.5 2012-02-03 https://www.thegaitguys.com/thedailyblog/it-is-fun-friday-follies-time-enjoy-a-great monthly 0.5 2012-02-03 https://www.thegaitguys.com/thedailyblog/gait-running-injury-misdiagnosed-big-toe monthly 0.5 2012-02-02 https://www.thegaitguys.com/thedailyblog/of-gait-running-and-waffles-no-we-are-not monthly 0.5 2012-02-01 https://www.thegaitguys.com/thedailyblog/more-on-gait-and-vision-along-the-lines-of monthly 0.5 2012-01-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553726219-IFK0035X35THX56JTFYM/tumblr_lykurut7jf1qhko2so1_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553726769-GGX0VPFB8KN30QY3QWZO/tumblr_lykurut7jf1qhko2so2_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553726808-YRHRC21V2IY3RG15F6S7/tumblr_lykurut7jf1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/left-foot-pain-in-a-30-year-runner monthly 0.5 2012-01-29 https://www.thegaitguys.com/thedailyblog/just-going-over-our-facebook-stats-today-did monthly 0.5 2012-01-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553728428-SIHJNPVT7UVTPBYZ9E3U/tumblr_lyifwjdpXY1qhko2so1_250.jpg Blog Just going over our FaceBook stats today:  Did you know a significant part of our readership is international? Current readership= UK, Canada, Australia, Sweden, Brazil, Singapore, Germany, Mexico, Netherlands, India, Ireland, Israel, Pakistan, France, Denmark, United Arab Emirates, Argentina, Spain, USA !!!!!!!!  The Gait Guys, moving towards global gait domination ! www.thegaitguys.tumblr.com  Just wait for the website to launch ! 2 more weeks we hope ! Have a great weekend brethren ! Shawn and Ivo https://www.thegaitguys.com/thedailyblog/gait-running-talk-functional-hallux-limitus monthly 0.5 2012-01-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553728505-4O5Q9GXOQAU6H10JR1KH/tumblr_lygittRkpW1qhko2so1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553729569-NL4FUYQIGCNZYF3KFBBE/tumblr_lygittRkpW1qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/welcome-to-friday-follies-here-we-see-people monthly 0.5 2012-01-27 https://www.thegaitguys.com/thedailyblog/the-extensor-hallucis-brevis-revisitedoraxes-of monthly 0.5 2012-01-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553729237-R28R15CCZIUH9VEXAKJ3/tumblr_lyaaroAiVM1qhko2so1_250.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553730095-BHOCUDPR16133E00E1UJ/tumblr_lyaaroAiVM1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553729859-UYVCDHA6LULMSK16OPB0/tumblr_lyaaroAiVM1qhko2so3_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553730165-JWTXQPEJ47G3OGITFGK7/tumblr_lyaaroAiVM1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/gait-running-problems-with-big-toe-pain-or monthly 0.5 2012-01-26 https://www.thegaitguys.com/thedailyblog/gait-topic-the-mighty-ehb-the-short-extensor-of monthly 0.5 2012-01-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553730858-C4Z9Y897ZJB6EHZ22Q28/tumblr_lya8qjIfnu1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553731652-5KC4FRJQIVKYTBYGWOUD/tumblr_lya8qjIfnu1qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/this-week-for-neuromechanics-something-a-little monthly 0.5 2012-01-25 https://www.thegaitguys.com/thedailyblog/weve-got-an-angle-the-progression-angle-1st monthly 0.5 2012-01-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553731313-96D6KS0W82TCJI71IEFT/tumblr_ly4rklWVgC1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553731561-KX3QS6TDGZS1AY39GEKT/tumblr_ly4rklWVgC1qhko2so3_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553732071-BM3QJFE9GHK42X5Q7G8M/tumblr_ly4rklWVgC1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/the-gluteus-maximus-part-2-more-talk-on-gluteal monthly 0.5 2012-01-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553732112-F8BT3KPO7PZF0AVK7HRY/tumblr_ly3m9a91v21qhko2so1_250.gif Blog The Gluteus Maximus: Part 2. More talk on gluteal function & its place in the gait and running cycle. The gluteus maximus controls: Flexion / Extension: The Sagittal Plane - the rate and extent of limb flexion at term swing: this is eccentrically controlled - hip extension: this is concentrically controlled - hip flexion rate during loading response (eccentric at foot loading): this will help to control the vertical loading response as the body mass loads the limb there must be enough eccentric strength of the glute maximus to control-stop this loading so that hip extension can occur. This will indirectly assist in control some of knee flexion. Rotation: - external rotation of the limb: this is concentrically controlled - assists in controlling the rate of internal rotation: this is eccentrically controlled Pelvic Posturing: - controls rate of Anterior Pelvic Tilt (APT): this is eccentrically controlled (this is relative hip extension as discussed in Part 1 last week) - assists in Posterior Pelvic Tilt (PPT): this is concentrically driven - controls sacroiliac joint mobility through FORCE CLOSURE (force closure is a compression of the joint surfaces by the contraction of muscles that cross the joint) Divisions: - the sacral division of the gluteus maximus is mostly a pure sagittal plane driver at the hip joint - the coccygeal division is more of an adductor and internal rotator at the hip joint - the iliac division is more of an abductor and external rotator at the hip joint The gluteus maximus also has some fascial attachments into the posterior aspect of the TFL-ITBand. Remember, this TFL-ITB complex is an internal rotator of the limb in the gait cycle. You will recall that internal rotation is a precursor to hip extension. The hip must first, and adequately, internally rotate in the gait cycle before hip extension can occur. This means that for correct and complete gluteus maximus contraction to occur in the second half of the stance phase we must have adequate internal hip rotation. Without it, all of the things we talked about last week in our glut maximus blog post cannot occur properly. Now, back to our attachment disucssion of the gluteus maximus to the ITB-TFL mechanism. This attachment allows the gluteus maximus to produce posterior tension on the ITB-TFL mechanism so that it can be anchored to provide it’s internal rotation function on the limb. So, here we have a powerful hip extensor and external rotator providing assisted effects on an internal rotator of the limb. Isn’t the body a beautiful and amazing thing ! (Well it is. But if you will recall from the detailed layout above that the gluteus maximus in the eccentric phase of contraction functions to control the rate of internal hip rotation you will not be surprised or enlightened. Rather you will enjoy the brilliance of how an anchoring muscle is eccentrically giving up length while an agonist muscle is concentrically taking up length). The gluteus maximus-TFL relationship….. it is beautiful teamwork in helping, not exclusively of course, control limb rotation during loading responses. Next time you see a client’s knee drift too far inwards during a lunge, or walking or running we hope this whole discussion will spring a light bulb moment for you. You must look at the complex function above in controlling the limb during pronation and supination. Merely inserting an orthotic is not going to fix a proximal deficiency, it could modulate it however. But wouldn’t you want to fix it ? Who wants an orthotic if you don’t need one ? Some people do, don’t get us wrong, but many do not. And then some just need them temporarily to gain the awareness and skill of posturing and function and once that is achieved the device and be weaned. Just some more functional anatomy talk on a Monday morning…….from us, The Gait Guys Shawn & Ivo https://www.thegaitguys.com/thedailyblog/gait-and-foot-pain-in-a-30-year-runner-a-possible monthly 0.5 2012-01-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553734347-OS8TCRGDC03WYN98MZK8/tumblr_ly7m4zXVkF1qhko2so1_400.jpg Blog Gait and Foot pain in a 30 year runner. A possible Forefoot varus. Hi Gait Guys: I could use some help. I’ve been running/cycling for 30 years. Three years ago, I had surgery on my left knee that realigned my patella (lateral release.) Until recently, I lived in custom orthotics and motion control shoes. I’ve been reading chi-running and natural running and bought a pair of shoes for which I’m transitioning a little a day. My left foot is the problem: it severly overpronates and I have a neuroma. I’ve been walking barefoot and in five-fingers for a while and my feet a definitely getting much better. The natural running style feels much better on my ankles,knees and hips, which used to hurt a lot. Also, cycling hurts only when I get off my bike, my knee is killing me for a while. My left forefront seems to move too much even with this new style of walking/running. I’m wondering if I have forefront varus that could be helped with a wedge. My real problem is that I currently live in Las Cruces, NM, where there is no running store and no experts on this stuff. Most podiatrists do the same, generic thing for all patients. Is there a little wedge I could try without having it inserted into a custom orthotic? Is there a place to go to analyze my gait/running that would be worth my time and expense to visit? Any advice would be gratefully received. Thanks for your time, …. AT _____________________________________ Thanks for the note AT. We are glad that the natural style running is helping. remember to go slowly and follow the rules of Skill, Endurance, Strength as you progress into less supportive shoes. The forefoot motion you are sensing MAY indeed be a forefoot varus; we would need to see and examine your foot to know for sure. The fact that you have had a neuroma and needed a lateral release are suspect for a forefoot varus.  With that 1st metatarsal head (the medial tripod) unstable and allowing more forefoot pronation your control of internal rotation of that limb is going to be difficult and drag patellar tracking off line. If it is a rigid deformity, it may never totally be gone, though you may be able to increase the range of motion of your foot sufficiently to compensate elsewhere. We have attached a photo of a prefabricated forefoot varus post (note its thickness on the outside edge and tapering as it moves inwards to the pre-fab it is attached to. It is a wedge.). In our in-house labs we make them custom to the client to get perfect control. We make them out of thermo-rubber-infused cork so we can grind them down as clients earn better ability to anchor the metatarsal tripod with intrinsic muscle strength through our specific exercise programs. It is also used for Rothbart Foot types which has some similarities to a forefoot varus. Make sure you do not have a Rothbart variant. We did a blog post on Rothbart many years ago. Search for in the search box from our archives. Getting a thorough evaluation is paramount. We are not aware of any gait labs in Las Cruces, but Jaqueline Perry’s Pathokinesiology lab is in Rancho Los Amigos (click here for more info). Dr Waerlop is located about 70 miles west of Denver and Dr Allen is in the Chicago suburbs. Only after an evaluation, could exercise suggestions or an orthotic or other device recommendation could be made. Thanks for your inquiry Ivo and Shawn https://www.thegaitguys.com/thedailyblog/redoing-your-gait-analysis monthly 0.5 2012-01-22 https://www.thegaitguys.com/thedailyblog/ready-great-gait-you-dont-see-this-that-often monthly 0.5 2012-01-21 https://www.thegaitguys.com/thedailyblog/a-little-something-for-our-triathletes-today-on monthly 0.5 2012-01-20 https://www.thegaitguys.com/thedailyblog/the-gait-guys-rss-feed monthly 0.5 2012-01-20 https://www.thegaitguys.com/thedailyblog/gait-when-is-the-last-time-you-used-the-swear monthly 0.5 2012-01-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553733106-CMWCBR882PFVSV4N0BJU/tumblr_ly3l260LmR1qhko2so1_250.gif Blog Gait: When is the last time you used the swear words “closed kinetic chain” ? How well do you understand your Gluteus Maximus ? These are just some fragmented, early morning, mental ramblings about the genius of the body. We are sure to follow up with more glute talk in time. When the foot is engaged with the ground one of the major functions of the gluteus maximus is to draw the pelvis into posterior rotation (with some assistance of some other regional muscles of course). The pelvis is extending on the femur through the hip joint axis. If the foot is off the ground one would call this hip extension. But when the foot is on the ground, it is still hip extension, however our mental reference must change. This motion we have described, when the foot has purchase on the ground, is what happens when we return upwards from a squatted position (see ! it is still hip extension). You may find it a brain twister to look at the qluteus maximus also as a rotator of the pelvis away from your foot progression direction. Meaning, we think of the gluteus maximus also as an external rotation generator but when the foot is ground engaged contraction of the G. Max spins our pelvis (and connected torso) away. Go ahead, stand on your right foot and contract your glute maximus. Which way does your body rotate ? So, when contracted, if the right foot is on the ground the body pelvis-torso will spin to the left. So, how do we use our glutes to help us move forward ? Well, this is a complicated chain of events and this was not the purpose of our ramblings today. This muscle does not work in isolation. Might we just say that there is an opposite swing leg moving forward into flexion which helps to redirect that spin into a sagital progression. Go ahead, stand on that right foot again, contract the glute maximus and note the left rotation, but now add the left forward hip flexion placing the left foot into forward progression. Do you feel that torque and compression through the right hip, core and spine ? Do you have enough core strength to not prostitute the pelvic neutral posturing ? Did you drop into an anterior pelvis tilt (APT) ? Go ahead now, add the anti-phasic motion of contralateral arm swing just to add some more complex rotation to the picture. Are bells and whistles going off about some of your clients problems ? You might want to go back and re-read our work on Arm-Leg swing now. (click here). We plan to build on these concepts in the very near future ….. keep up with us, be ready ! There was alot going on here in what we just did. More on this another day, time to go put this gait stuff to our Friday patients. That is right, we just don’t talk about this stuff, we live it. Remember, unless your patients, clients and athletes wheeled themselves into your facility …… they walked in via the gait cycle. Know your stuff. Have a great weekend peeps Shawn & Ivo https://www.thegaitguys.com/thedailyblog/learn-a-clean-motor-skill-slowly-add-endurance-to monthly 0.5 2012-01-19 https://www.thegaitguys.com/thedailyblog/form-is-dictated-by-function monthly 0.5 2012-01-19 https://www.thegaitguys.com/thedailyblog/gait-guys-are-blacked-out-today-re-sopa-pipa monthly 0.5 2012-01-18 https://www.thegaitguys.com/thedailyblog/watch-this-girl-walk-what-is-the-most-striking monthly 0.5 2012-01-17 https://www.thegaitguys.com/thedailyblog/more-constructive-dialogue-on-the-cross-over-gait monthly 0.5 2012-01-16 https://www.thegaitguys.com/thedailyblog/foot-strength-some-clinical-q-a monthly 0.5 2012-01-15 https://www.thegaitguys.com/thedailyblog/robotic-gait-retraining monthly 0.5 2012-01-14 https://www.thegaitguys.com/thedailyblog/yup-we-thought-we-had-seen-it-all-make-sure-to monthly 0.5 2012-01-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553733069-08HZ32BIRO0F3J11K7WG/tumblr_lxq31aMIEP1qhko2so1_1280.jpg Blog Yup. We thought we had seen it all. Make sure to wear your evening formal neoprene. Coming soon: Underwater Gait Analysis. Have a great Friday Ivo and Shawn photo credit: xcitefun.net https://www.thegaitguys.com/thedailyblog/foot-landing-mechanics monthly 0.5 2012-01-13 https://www.thegaitguys.com/thedailyblog/a-30-second-workout-has-similar-results-as-a-90-minute monthly 0.5 2012-01-12 https://www.thegaitguys.com/thedailyblog/does-stretching-make-a-difference-does-it-enhance monthly 0.5 2012-01-11 https://www.thegaitguys.com/thedailyblog/a-few-minutes-in-our-brains monthly 0.5 2012-01-10 https://www.thegaitguys.com/thedailyblog/the-gait-guys-two-weeks-ago-you-talked-about-a monthly 0.5 2012-01-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553733761-Y5SGXP0J0PQ146TBWAEV/tumblr_lxhyvdH5M91qhko2so1_1280.png Blog The Gait Guys. Two weeks ago you talked about a dog’s gait, now cockroaches ? Yup, watching nature at work fosters much insight into gait principles. Biomimetics, also known as Bionics, is another name for engineering systems that copy principles found in nature. If you are real gait geeks you have probably seen some of the cool robots inspired after  the insect world. Many of these robots are called hexapods (six legged robots), just like insects. With 6 legs alternating limbs on opposite sides of their exoskeleton (see diagram above) it can provide an inherently stable tripod mechanism that is effective and efficient in when it comes to locomotion. Insects are great models because they have an extremely stable and efficient model of locomotion through something called a tripod gait. We have a video link demonstrating this a little further down.  At any time, cockroaches for example have 3 limbs in contact with a surface.   This tripod structure makes them very stable and mobile. The stability of the hexapod comes from its ability to establish this gait pattern in which at least three legs are on the ground at any time. Just like the 3 legs of a tripod, when they are firmly planted, the platform is very stable.  You will notice from our year of blogging that we continue to talk about the foot tripod, consisting of stability points at the head of the 1st and 5th metatarsals and the heel. These 3 points of stability of the foot are necessary to make up the longitudinal and transverse arches of the foot. Without the ability to anchor these 3 points effectively on the ground the foot becomes unstable and compromised. Hence why we see bunions, hallux valgus, metatarsalgia, abnormal plantar callus patterns as well as various presentations of foot pain in feet that have lost the tripod ability. The key however is then to place, and maintain, the body mass within the confines or borders of the triangle made by joining these 3 tripod points (see the colored area in the diagram above). In humans, if your body mass deviates towards the outside of the tripod, in other words approaching or violating an imaginary line drawn from your 5th metatarsal to the heel (ie. approaching supination), you tip the foot laterally and begin to compromise the anchoring of the medial foot tripod (under the 1st metatarsal) and risk formation of bunions and hallux valgus among other functional pathologies of excessive or constant supination. On the other hand, If your body mass approaches or exceeds the arbitrary medial border of the triangle delineated by a line drawn from the head of the metatarsal to the heel  you are considered a possible hyperpronator and all of the functional pathologies that accompany it (ie. plantar fasciitis etc).  Bottom line … a tripod is stable, just stay withing the colored lines. Note in this cool video (click here) how clear the 3 pronged tripod engages and how the body mass of the robot stays within the borders of the tripod limbs. In other words, keep your ankle and more specifically the force vector, over your foot tripod (the colored lines),  and most pathology issues will be absent. The closer you get to tipping the tripod, the closer  you are getting to developing biomechanical pathology in the lower limb.  Put another way, by increasing weaknesses in the foot intrinsic and extrinsic muscles and possibly the other stabilizers of the lower limb and pelvis, the closer your body mass will fall towards the edges/limits of the tripod triangle borders. And the closer you are to the risk of gait pathology and pain. ( In the diagram above, for you hexapod insect loving gait fans, the most basic hexapod walking pattern is called the alternating tripod gait. Taken from this site, in this gait, the six legs are treated in two groups of three. Either group of three is a tripod formed by the front and rear legs of one side, and the middle leg of the opposite side. The three component legs of each tripod are moved as a unit. As one tripod is lifted, the other tripod pushes forward. In this gait it can be helpful to think of each tripod as a foot and compare it to your own bipedal walking where as one foot is lifted the other foot pushes forward.) And you still thought we were just your average Gait Guys, didn’t you ?! If it walks, trots, gallops, canters, jumps, runs, jogs or whatever….. we are on top of it.  Yes, even if that means cockroaches ! We are here to stay gang, in 2012 we will begin to execute our plan for intergalactic dominance, gait related only of course. Nerd Shawn & Geek Ivo https://www.thegaitguys.com/thedailyblog/a-coach-with-anterior-knee-pain-about-as-common monthly 0.5 2012-01-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553734295-YYV2BBOA4CVOZN0008DO/tumblr_lxhkfrQyN41qhko2so1_400.jpg Blog A Coach with Anterior knee pain:  About as common a problem as finding dirt on a child. We get emails like this all the time. Here is one from a coach with a problem. Hi Gait Guys, I was just found your blog visiting one of the running sites I like coachjayjohnson.com. I’m a high school xc/track coach and a former runner myself. I say former because I dug a nice hole in my cartilage in the lateral trochlear groove about 4 years ago from running. This actually happened 3 months after I stopped wearing the custom orthotics i had been wearing for about 8 years. What a mistake that was, but the biggest mistake might have been getting them in the first place. Anyways, 3 months ago I had a procedure done to regrow the cartilage. this was done at the stone clinic in San Francisco. The doctor said I should wait a year before I attempt to run again. I’m fine with that but sometime next year once my knee is feeling good enough I’d like to come see you guys before I start running again so that you can help analyze everything and get me out there running again with good form and in the correct shoes etc. Where are you guys located? Also, are you going to come out with some new DVDs? Thanks, (name removed) __________________________________________________ What The Gait Guys have to say … Dear Coach: (Links in our discussion have been embedded for you and other readers and we have included a picture above so everyone else will know where your problem was.) Anterior knee pain in runners is about as common a problem as finding dirt on a child. You have described the all to common, osteochondral defect. IT is a defect of bone and cartilage quite often from blunt or repetitive trauma. Knee joint anterior malalignment is multivariably associated with patellofemoral osteoarthritis (study). Alignment issues at the knee can be driven by variations of the optimal anatomy (versions and torsions, see a post on this from ~3 weeks ago) but in our opinion they are often driven from other factors most notably improper biomechanics driven by muscle weaknesses-tighness. However, other factors can come into play to complicate the scenario, such as poorly selected footwear for a foot type. Alignment at the knee is subservient to the mechanics at the hip and foot. Both the hip and foot are multiaxial  joints, whereas the knee in its healthy state and most basic description, a sagittal hinge joint (sure, miniscule rotation). When the hip or foot are prostituted and some of the availability of their normal motion is lost or changed (as is possibly the case of an orthotic as you eluded to, however in the hands of a skilled practictioner the orthotic can help positively restore compromised function, if they understand and assess whole limb kinetic function) the knee joint can often find itself in the middle of altered biomechanical force streams. This all to often can lead to anterior knee pain, compromised function of the patellofemoral joint.  This, as in your suspected case, can lead to abnormal cartilage wear at the interface of the two bones. In one article it was proposed that physical activity may modify the association between joint incongruity and cartilage loss, and can be further affected by subject characteristics such as gender. It must be part of the thought process that rather than it being the activity, is more likely to suspect altered biomechanics during said activity as being the culprit.  Understanding these complex interactions will help optimize strategies to maintain patellofemoral joint health. However, this study found that for every one-degree increase in the proximal trochlear groove angle at baseline, there was an associated 1.12 mm  increase in the annual rate of patella cartilage volume loss. This brings a person’s given anatomy, perhaps suboptimal anatomy, into play and thus adds one’s risk factors. There was a trend for this effect to occur for males, as well as people participating in vigorous physical activity. Males who exercised vigorously were more adversely affected. In conclusion, this study showed that in vivo engineered cartilage was remodeled when implanted; however, its extent to maturity varied with cultivation period. The results showed that the more matured the engineered cartilage was, the better repaired the osteochondral defect was, highlighting the importance of the in vitro cultivation period. There are many surgical interventions out there for anterior knee pain, such as tuberosity transfers, retinacular releases, injections, and God forbid patellectomies among others (yes, we have clients who decades ago had this done, imagine that! Thankfully this radical move is no longer done !). Most people simply need a well versed biomechanist who understands the whole kinetic chain, understands the force streams, can assess for the limitations and reduce them to restore the previous normal mechanics.  Sadly, sometimes interventions are not optimal or precise and folks end up like you coach. And then surgery is your only option.  Thanks for sharing your story and reaching out to us. Sharing your anonymous story may help others avoid your painful journey. We would be happy to see you, we are getting more and more letters like yours both here in the home land and internationally. Hopefully, our mission will help reduce these problems, if at least just a little. (PS: yes, our 3 part Shoe Fit / Biomechanics & Functional Anatomy DVD and online program should launch in February. Information about the launch will be right about the time phase 2 of the website will lauch www.thegaitguys.com). Best to you. Shawn and Ivo, The Gait Guys https://www.thegaitguys.com/thedailyblog/genu-valgum-in-kids-what-you-need-to-know-we-have monthly 0.5 2012-01-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553734503-MKORS18O6X4RD6CC276L/tumblr_lxeuq7JYjB1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553735100-BZR0MMF8WJLBSX49ZD33/tumblr_lxeuq7JYjB1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553735518-M01SADJ55M6TVCUH7KCP/tumblr_lxeuq7JYjB1qhko2so3_500.jpg Blog https://www.thegaitguys.com/thedailyblog/we-are-not-generally-fans-of-nike-but-they-do monthly 0.5 2012-01-06 https://www.thegaitguys.com/thedailyblog/gait-ischemia-blood-flow-affecting-performance monthly 0.5 2012-01-06 https://www.thegaitguys.com/thedailyblog/gait-does-minimizing-center-of-mass-vertical monthly 0.5 2012-01-05 https://www.thegaitguys.com/thedailyblog/you-have-heard-us-talk-about-weakness-short-weak monthly 0.5 2012-01-04 https://www.thegaitguys.com/thedailyblog/on-and-on-goes-the-barefoot-debate-there-is-no monthly 0.5 2012-01-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553735265-9NNDNT78DC3AB536SI1C/tumblr_lx7bj6hPTZ1qhko2so1_500.jpg Blog On and on goes the barefoot debate.  There is no single right answer, so use your head. article link, click here We have been saying what this article talks about all along, even years before the Vibram 5’s hit the market, back when Vibram came to us to ask us for our thoughts on the early versions.  You will see our soapbox rant on this topic over and over again in our blog posts and it is the modus operandi behind our new 2012 Shoe Fit program that will likely launch February 1st in several forms for several professions to meet everyone’s needs. That modus operandi being that not everyone has a foot type, anatomy or biomechanics to get into minimalist shoes, without a possible cost that is. In this nicely written article by Cynthia Billhartz Gregorian “Barefoot running: Sales grow, but so does debate about benefits, safety” at the link above she lightly covers some of the aspects of the debate.  We have read just about every piece that has come out on the barefoot-minimalist trend. Sadly, some of the blogs are mere opinion and it is rare that the honest truth comes out.  That truth being our mention above that some folks just do not have the skill, endurance, strength or anatomy to delve into footwear that does not support or protect their physical limitations.  Lets be honest, at 5'9’’ I have to come to the realization that no matter how much i practice to be in the NBA I am not going to make it. I just do not have the physical anatomy to be an NBA star.  And some people, no matter how much they want to run barefoot or minimalist, just do not have the anatomy to allow it. Someone with a history of foot pain who has a rigid forefoot varus really is not going to do well in minimalist shoes. There are articles written out there that just tell people to bite the bullet and go 100% into their new minimalist shoes, into the natural way they were supposed to run from the very start and force the body to adapt, that the new form they adopt will take care of any problems. Well, in our experienced and educated opinion, that is just not smart. Someone who has a shortened posterior compartment (calf-achilles) after being in heel shoes for years is going to have several flaws biomechanically going to minimalist shoes right off the bat. One example, just one for now, is that the person is going to have premature heel rise and thus premature forefoot loading response around a compromised ankle rocker mechanism. And there are many others of course. Here is the bottom line as we see it. No shoe company is going to run a commercial or add on their product with the warnings on the cover or in the fine print. We are not talking about cigarettes here.  Admitting that some people should not be in their product would be admitting that the product has limitations and risks.  What kind of advertising add would that be ? Besides, admitting to limitations or mentioning warnings is a mere step away from liability cases.  We are pretty sure of this, after all, look what happened to the Shape Up Shoe in the courts. Here is what we say to the naysayers, look at the research and use logic.  If you are new to the game, leave the extremist blog sites for those that are looking for radical opinions. Because we do not have any openings in our clinics for the next several weeks if you throw caution to the wind. Good running to you all in 2012, use your head, for the sake of your feet. Shawn and Ivo https://www.thegaitguys.com/thedailyblog/ataxic-gait-we-hope-you-have-begun-the-new-year monthly 0.5 2012-01-02 https://www.thegaitguys.com/thedailyblog/proof-that-the-contralateral-limbs-are-programmed monthly 0.5 2011-12-30 https://www.thegaitguys.com/thedailyblog/not-another-cross-over-runner-yup-and-some-new monthly 0.5 2011-12-29 https://www.thegaitguys.com/thedailyblog/part-2-not-another-cross-over-gait-runner-read monthly 0.5 2011-12-29 https://www.thegaitguys.com/thedailyblog/here-is-some-classic-shawn-and-ivo-talking-about monthly 0.5 2011-12-28 https://www.thegaitguys.com/thedailyblog/the-gait-guys-on-movement-physiologic-overflow monthly 0.5 2011-12-28 https://www.thegaitguys.com/thedailyblog/scary-gait-of-the-week-ok-so-we-do-not-even monthly 0.5 2011-12-27 https://www.thegaitguys.com/thedailyblog/a-young-lady-with-knee-recurvatum-even-at-the monthly 0.5 2011-12-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553735693-IXAWXED25YV1E8J4JEXW/tumblr_lwtcjcBOrN1qhko2so1_r1_1280.png Blog A young lady with knee recurvatum. Even at the airport you are not safe from The Gait Guys ! Standing waiting for my parents luggage I had to do a double take when i saw this excessive genu recurvatum of the knees. Of course it was much worse in person because of the added dimension that a photo cannot give.  This poor gal probably doesn’t even know she needs us.  What do we see here and what assumptions can we extrapolate (assumptions from mere standing of course)  ?: We are going to keep it to things from pelvis down or we will be here all day. Anterior pelvis tilt. She appears to be sitting back into her pelvis so to speak, doing so we can see an increased lumbar lordosis pressing the pelvis anterior.  Combine this with suspect weak lower abdominals and the pelvis drops in the front. This position is often met with isometric contraction of the gluteals helping to maintain the forward/anterior shifted pelvis. The above, will create an abnormal (possibly increased) tensile load on the hamstrings since the ischeal tuberosities are being drawn cephalad (up). This can create a net posterior shift of the knee joint since she is in relative hip extennsion. The knees are likely locked into hyperextension. This will create meniscal tensions and certainly cause increased patellofemoral pressures.  This can also create the rarely diagnosed, but often present, anteriormeniscofemoral impingement syndrome. In this type of presentation the anterior compressive forces are so great compared to what should be balanced forces around the entire joint that the superior leading edge of the anterior mensicus (can affect medial or lateral menisci) begins to become impinged and irritated as the femur rolls and translates too far anterior. You have to know it exists to make the diagnosis. She will be in relative ankle plantarflexion instead of balancing the tibia neutrally over the talus.  Relative constant plantarflexion means shorter posterior compartment (gastroc-soleus) and usually weak anterior compartment (tibialis anterior and long extensors of toes).  If she is a runner we bet shin splints were on her holiday list of things to resolve. This gal will likely have problems controlling pronation we suspect because of such assumed imbalances. These are just the sagittal plane flaws we can assume. There are more but this is plenty to think about right now. I was going to walk behind to take a pic so we could make some assumptions about the frontal plane, but people all around were already getting suspicious of me snap photos of so many of them.  Remember, these are just assumptions from a single static photo. Like in video analysis, anything you pic up on film is just a compensation. It does not tell you what you have wrong until you can test them for neuromuscular integrity and motor pattern assessments.  Do not hang your hat on photos or video analysis. Do the extra work that is required.  After all, you know where ASSUMPTIONS get us. Oh, and we must not forget to once again thank Mr. UGG boot for helping add another dimension of challenge to this lovely lady ! Although this assumption would be better made off of a frontal plane photo. Beware of geeks in the airport and shopping malls snapping photos and video. It is likely us, The Gait Guys. Shawn and Ivo https://www.thegaitguys.com/thedailyblog/at-this-time-of-year-we-are-thankful-for-people monthly 0.5 2011-12-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553736308-KTSQLOAF1XF7VC589RRQ/tumblr_lwqwgdr9hf1qhko2so1_1280.jpg Blog At this time of year, we are thankful for people like you and appreciate the trust you put in us.   In the words of Helen Keller: The best and most beautiful things in the world cannot be seen or even touched. They must be felt with the heart. Wishing you Happiness, Health and Prosperity (and excellent gait mechanics).   Ivo and Shawn https://www.thegaitguys.com/thedailyblog/a-case-of-plantar-foot-pain-during-gait-this monthly 0.5 2011-12-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553736396-F6ZV5JVPQL8CGFH367BK/tumblr_lwrl7odklO1qhko2so1_1280.jpg Blog A case of plantar foot pain during gait. This client came to see us after a surgical proceedure to remove a dead (osteonecrosis) medial sesamoid under the 1st metatarsal head and a later surgery to fix a progressing hammer toe of the 2nd digit. What we really want you to see is the huge divot/depression under the 2-3 metatarsal heads. Also note the accumulation and relocation of the normal MET head fat pad now located distal to the MET heads.  It is as if the fat pad is trying to hitch a ride on the toes now ! This is a case of Metatarsalgia secondary to fat pad displacement (displaced from the divot area to the flexor crease) secondary to surgical sequelae.  What is additionally cool in this case is the fact that this client has an almost complete webbing of the 2-3 toes so many of the normal independent muscular functions are no longer independent. After the surgeries this person presents with tremendous loss of flexor and extensor function of the 2-3 toes.  Lumbrical testing was most obviously impaired, completely absent in fact, in these 2-3 toes. On the ground the patient was also unable to achieve any flexion-press of the toes into the ground, he was able to flexion/hammer curl which will obviously put them at risk for hammer toes in the future.  But what is important here is that without the ability to PRESS the toes into the ground particularly while in stance phase the lumbricals will not help to hold the fat pad in its normal location under the MET heads. Nor will they be able to to perform their other major functions, namely: thinking from a distal to proximal orientation (a closed chain mode of thinking), they actually plantarflex the metatarsal on the fixed phalynx, assist in dorsiflexion of the ankle, and help to keep the toes from clawing from over recruitment of the flexor digitorum longus. This client’s MET head pain is obviously caused by lack of cushioning of the head since the fat pad is displaced. There are plenty of other biomechanical abberancies now, the Windlass mechanism will never be the same becuase it is without one of the sesamoids, the hallux short flexor (FHB) is impaired on the medial head without the sesamoid so hallux flexion will become a problem.  Do we really want to see such compromise of the medial tripod ? Heck no, we need sesamoid implants ! There is a novel idea ! When a sesamoid is taken out we need to replace it ! Think about it ! There is so much more to this case, but we will stop here. It’s Christmas after all ! This poor lady was told to wish from Santa for a medial sesamoid implant under the tree and a sudden spontaneous activation of the lumbricals to retract the fat pad back under the MET head so as to reduce her pain.  Hey, wishing can’t hurt ! Merry Christmas and Happy Holidays to you all gang, whatever your faith we wish you well, from Shawn and Ivo…… The Gait Guys (PS: we included below more from the body of the article we wrote long ago called “The Lost Lumbricals”.  So for those of you who wish to geek out more on Christmas, read on … ______________ EXCERPTS FROM “THE LOST LUMBRICALS” The lumbricals of the foot attach proximally to the sides of adjacent  tendons of the flexor digitorum longus (with the exception of the 1st, which only attaches to the medial side) and attach distally to the medial aspect of the head of the proximal phalynx and continue on to the extensor hoods in toes 2 through 5. Their typical function is described as flexion of the proximal phalynx and extension of the proximal and distal interphalangeal joints. They have the unique ability to compress the metatarsal-phalangeal and interphalangeal joints. These are “open chain” functions as described, unless you are in the habit of waving to people with your toes, they often are used quite differently in the gait cycle with the foot affixed to the ground. The lumbricals are most active from midstance to preswing. That means they act predominantly in the closed chain. The lumbricals, along with the other intrinsic muscles of the foot, play a role in maintaining the medial longitudinal arch of the foot.  Along with the interossei, they play a role in stabilization of the forefoot during stance phase and rearfoot during preswing. One author has proposed that overpronation is due to a lack of neuromuscular control of the intrinsic foot muscles to stabilize the tarsal and metatarsal bones and therefore modulate the speed of pronation. Thinking from a distal to proximal orientation (a closed chain mode of thinking), they actually plantarflex the metatarsal on the fixed phalynx, assist in dorsiflexion of the ankle, and help to keep the toes from clawing from over recruitment of the flexor digitorum longus. Clawing toes during gait, which are considered abnormal, are defined as extension of the metatarsophalangeal articulation, and flexion of the proximal and distal interphalangeal joints result from a foot attempting to stabilize itself during the terminal stance and preswing phases of gait.  This is an attempt to help propel the body forward, often accompanied by overactivity of the flexor digitorum longus, tibialis posterior, flexor pollicus longus, and gastroc soleus groups. Overactivity of these groups causes reciprocal inhibition of the long toe extensors and ankle dorsiflexors (tibialis anterior for example), causing the toes to buckle further and a loss of ankle dorsiflexion; in short, diminished ankle rocker. Now think about the changes in the gait cycle in the above scenario. There will be a resultant shortened step length, diminished ankle rocker, increased forefoot rocker and premature heel rise. This will necessitate an increased extension at the metatarsophalangeal joints, shifting the tendon of the lumbricals upward and behind the transverse metatarsal joint axis, causing even more extension now at this joint. Chronically over time, this causes displacement of the fat pads anteriorly from under the metatarsal heads and is one of the main reasons metatarsal head pain (metatarsalgia). In the past have you made the apparent simple diagnoses of metatarsalgia, shin splints, stress fractures or Morton’s neuroma without knowing a more plausible cause ?  Do you now feel you have better answers to these clinical phenomena ? Now think about changes up the kinetic chain and the potential musculoskeletal implications of muscle inhibition, overfacilitation and joint dysfunction, often with neurological sequelae. With lumbrical dysfunction (weakness) and the resultant lack of ankle dorsiflexion, you have less hip extension.  So, you borrow some from the lumbar spine, with increased compressive forces there and an increase in the lordosis, which causes an increase in the thoracic kyphosis and cervical lordosis. We still need to get this leg up and forward to continue our progression ahead, so now we fire our hip flexors instead of the abdominal obliques. And because there needs to be cooperation of the abdominals and hamstrings to maintain pelvis neutrality, this further fuels inhibition of the gluteals thus further compounding the loss of hip extension. Now how about a little increased shoulder flexion on the contralateral side to assist getting that leg forward? Don’t forget that we have altered the thoracic kyphosis and thus changed scapulo humeral mechanics. Now neck/shoulder pain all from bad feet?  Maybe. These muscles developed and exist for a good reason, do your best not to dismiss them and their function the next time you see a tortured foot. When patients have continued dysfunction, consider the base and where it all begins. Consider function in the context of where it occurs. Proper evaluation of the feet and gait can provide valuable clues as to the etiology or manifestation of continued problems. Important? You decide. https://www.thegaitguys.com/thedailyblog/are-aging-runners-less-economical monthly 0.5 2011-12-24 https://www.thegaitguys.com/thedailyblog/just-a-fun-foot-commercial-to-brighten-your monthly 0.5 2011-12-23 https://www.thegaitguys.com/thedailyblog/this-video-pretty-much-sums-up-our-entire monthly 0.5 2011-12-23 https://www.thegaitguys.com/thedailyblog/the-documentary-investigates-kenyan-runners-and monthly 0.5 2011-12-22 https://www.thegaitguys.com/thedailyblog/gait-running-or-biomechanical-problems-today-we monthly 0.5 2011-12-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553736872-K3SRSCOCRCG2VIACZ63H/tumblr_lwhhql2IHi1qhko2so1_1280.jpg Blog Gait, Running or Biomechanical problems ? Today we talk of Torsions and Versions…. (excerpted from the forthcoming second edition of our book) We’ve all heard of, and probably have used, the terms torsion or version especially in the vernacular of antetorsion or anteversion and retrotorsion and retroversion. We (including authors and researchers) often like to use these terms interchangeably. Technically speaking, we have all been wrong. Believe it or not, there was actually a group of folks in 1979 called the Subcommittee on Torsional Deformity and Pediatric Orthopedic Society whose mission was to set people straight on the differences between torsion and version. Version is actually the normal difference in angulation of the proximal and distal portions of a long bone. Torsion is said to be present when this measurement falls outside 2 standard deviations of the normal version. Versions are present in utero and are considered part of the developmental process. For example, the femur has approximately 30 degrees of anteversion at birth (ie the femoral condyles are rotated 30 degrees medial to the plane of the femur head). During the normal developmental process, the femur “untwists” at a rate as slow as 1-3 degrees per year to approximately a 20 degree by age 6, leading to a “normal” angle of 8-12 degrees of anteversion. Of course this can occur slower or faster or to a greater or lesser degree as well resulting in a torsion, which may or may not have symptomatic sequela later in life. Regardless, these torsions are very important transverse plane deformities from a gait biomechanists point of view in regards to resultant compensations which occur in the lower kinetic chain and more proximally. These versions and torsions can affect any long bone, but most important to us, the femur and tibia. Of interesting note, there is a 2:1 preponderance of left sided deformities believed to be due to most babies being carried on their backs on the left side of the mother in utero, causing the left leg to overlie the right in an externally rotated and abducted position. Now maybe you will think twice about the position of the feet of a newborn when placing them on their stomach, as this posturing will effect their development over time and potentially contribute to adult torsional deformity! How’s the sleeping position of your child? Do they consistently sleep on one side? Is their thigh drawn up and internally rotated with a compensatory external rotation of the foot relative to the tibia? Wow, and you thought as long as you fed them well and didn’t let them watch too much TV that all would be OK! Torsions and Versions…. They are not just for breakfast anymore… Yes, we ARE a little twisted……Ivo and Shawn https://www.thegaitguys.com/thedailyblog/we-are-giving-up-one-of-our-deep-secrets-today monthly 0.5 2011-12-22 https://www.thegaitguys.com/thedailyblog/gait-running-and-muscle-fiber-types-why-you monthly 0.5 2011-12-21 https://www.thegaitguys.com/thedailyblog/functional-screens-will-not-always-give-you-the monthly 0.5 2011-12-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553737739-5UI04UMN4M88C4EKH1OL/tumblr_lwgab0gdCc1qhko2so1_250.jpg Blog Functional screens will not always give you the answer, the screen might only show you another level of compensation. Only the keen at that game will get it right. What do we mean by this ? Well, lets take muscle testing and motor pattern assessments for example. When we started with muscle testing we used to look for the weakness of the muscle or pattern we were isolating. But now, with more experience and wisdom, our keen eyes are now focused on the clients attempts to “cheat” around the assessment rather than basing our assessment entirely on the isolated tests. Many athletes will quickly figure out how and where to get more strength in a given muscle test, often because they are used to compensating for a weak muscle…..studies even show that clenching your teeth, or squeezing another muscle (often called a Jendrassik Maneuver) can affect the outcome of a muscle test.  So, you have to watch for your client’s attempts to “cheat” through your assessments.  Just one more thing to think about!  In the screen above, would you know if the person had internal or external tibial torsion?  How about femoral retro or ante torsion ? In doing a screen, only the astute assessor will know what the screen is telling them.  For example, is the foot turned out because the person has external tibial torsion, or is the knee going inwards because they neutralized the foot progression angle before the test and now the knee is drifting inwards ….. it is still external tibial torsion in both cases.  What about internal tibial torsion, where is the foot, where is the knee? (More on Torsions and Versions in Thursday’s post) The squat can give you information but you might want to think about this.  Really how useful is a squat in relation to the most fundamental pattern we use the most, gait ? Well, it is not. 62% of normal gait is stance phase and of that, 51% of that is on one foot (38% of a total gait cycle). We still vividly remember when Professor Janda visited our residency program back in the 90’s for a week.   He spoke of many things but one that stuck with us was a discussion about the need for stable single leg stance function, that it was a key motor skill easily cheated.  That is not to say that the squat test is not a valuable assessment, there are just better ones in our humble opinion. You see, a functional screen does give information, but it is only the person who understands the parameters of normal and abnormal function and anatomy who can glean what the screen is telling you. Guys like Gray Cook  who are big into this stuff are going to be awesome at this because they have the background to know what the test is telling them and know the anatomical parameters that can skew the test.  What we are saying, is that it is not the test that is the gem, it is the knowledge to understand the results of the test that is the key. Oy vey, why can’t anything be simple,  huh ?! It’s Tuesday, we are The Gait Guys…….. and so much more. Shawn and Ivo https://www.thegaitguys.com/thedailyblog/the-solitary-turned-out-right-foot-in-a-barefoot monthly 0.5 2011-12-19 https://www.thegaitguys.com/thedailyblog/arm-swing-part-3-running-downhill-on-uneven monthly 0.5 2011-12-18 https://www.thegaitguys.com/thedailyblog/gait-video-case-of-the-day-the-frontal-plane monthly 0.5 2011-12-17 https://www.thegaitguys.com/thedailyblog/shoes-really-do-make-the-man-have-a-great monthly 0.5 2011-12-16 https://www.thegaitguys.com/thedailyblog/some-thoughts-on-gait-and-foot-pronation-it-is monthly 0.5 2011-12-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553738415-AIOKYNNNRDKS9C1SMF1K/tumblr_lwa3g5px5b1qhko2so2_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553738026-HPD2ALVPV50734WPJZ1X/tumblr_lwa3g5px5b1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/gait-problem-the-solitary-externally-rotated monthly 0.5 2011-12-15 https://www.thegaitguys.com/thedailyblog/how-long-does-it-take-for-training-improvements-to monthly 0.5 2011-12-14 https://www.thegaitguys.com/thedailyblog/power-leaks-asafa-powell-we-all-know-asafa-the monthly 0.5 2011-12-13 https://www.thegaitguys.com/thedailyblog/power-of-splay-new-and-improved-this-time-with monthly 0.5 2011-12-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553738104-XHV0GLW3JI81416NQL1F/tumblr_lw3vg4e9qc1qhko2so1_400.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553738583-IIWE7E1KQDEQ4CG8PZKQ/tumblr_lw3vg4e9qc1qhko2so2_540.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553738788-EPKL0FNKBPLM2X41LIAD/tumblr_lw3vg4e9qc1qhko2so3_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553739535-ANF8SB4SU7F354PBH6FP/tumblr_lw3vg4e9qc1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/the-power-of-splay-watch-the-awesome-power-of-the monthly 0.5 2011-12-12 https://www.thegaitguys.com/thedailyblog/some-inspiration-for-a-sunday-this-is-one-of-our monthly 0.5 2011-12-11 https://www.thegaitguys.com/thedailyblog/keep-digging-we-are-often-asked-what-is-wrong monthly 0.5 2011-12-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553739717-M6Q5XX7YNMTGQSYMNDSE/tumblr_lvyxi2M4LX1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553740104-7HQBYMSYUWXEKQKGPI2O/tumblr_lvyxi2M4LX1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/gait-guysirra-running-event-recap-well-it-was-a monthly 0.5 2011-12-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553740256-RGAUZ0R6VXWJL04LKVNX/tumblr_lvxxlelORd1qhko2so1_1280.jpg Blog Gait Guys/IRRA Running Event Recap Well, it was a fast a furious 2 days for us. We arrived Tuesday evening and put the finishing touches on the presentation for Wednesday morning. We were up and lecturing, 8AM Texas time and were very well received with many interesting questions. This was one one smart group of retailers! We then had a photo session and whisked off to the Austin School of Film (Thank You Anna, KIrk and Brian!) to finish filming the rest of the Shoe Fit Certification Program (Excerpts to be posted soon!). A few hours later we were back at the event and met up with Dr Mark Cucuzella (a good friend and colleague of ours; you have seen his videos here on the blog) and David Jonson from Sole Running. We were then off to a mixer and out to dinner with Dick Beardsley (yes, THE Dick Beardsley from the 1982 Boston Marathon with Salazar), his wife, Curt Munson and Daren DeCavitte from Playmakers, and Dr Mark. Thursday morning was filled with meetings, including a Magazine interview with Max Lockwood of the Georgetown Running Company. Then we were off to the airport by 2PM and away we went. We have full days at the clinic today and are looking forward to some much needed rest (and a lot of film editing!) this weekend! Thanks again for all your support. Ivo and Shawn https://www.thegaitguys.com/thedailyblog/the-krebs-cycle-rap monthly 0.5 2011-12-09 https://www.thegaitguys.com/thedailyblog/arm-swing-part-2-when-phase-is-lost monthly 0.5 2011-12-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553740905-2MROX882X4ZM87U1D8EK/tumblr_lvtl4rB6VD1qhko2so1_500.gif Blog “Arm Swing Part 2. “When Phase is Lost”. * Important: (this is a continuation of yesterday’s post, December 7th. You must read Part 1 from yesterday to have any chance to make sense to today’s post.) So, we are back to looking at limb swing again. It is important for you to realize, as put forth in Huang et al in the Eur Spine Journal, 2011 Mar 20(3) “Gait Adaptations in low back pain patients with lumbar disc herniation: trunk coordination and arm swing.” that as spine pain presents, the shoulder and pelvic girdle anti-phase (as in drawing above) begins to move into a more “in-phase” favor.  Meaning that, the differential between the upper torso twist and pelvic twist is reduced (in the drawing above the lines will laterally converge). IF this anti-phase is reduced then arm swing should be reduced (half truth, this is a topic for anther time). The central processing mechanisms do this to reduce spinal twisting, because reduced twist means reduced spinal motor unit compression and this hopefully leads to less pain.  This also means reduced thoracic mobility unfortunately (think about this the next time a shoulder assessment test directs you to the thoracic spine and rib cage mobility). The consequence to this reduced spinal rotation is reduced limb swing.  Think about this next time you see someone, a runner patient or athlete, with reduced arm swing especially on one side. Furthermore, according to Collins et al Proc Biol Sci, 2009, Oct 22 “Dynamic arm swinging in human walking.” normal arm swinging requires minimal shoulder torque, while volitionally holding the arms motionless requires 12 % more metabolic energy, proving that there are both active and passive components to arm swing.  Collins also discovered that among measures of gait mechanics, vertical ground reactive moments are most affected by arm swinging and increased by 63% without it. Wow, 63% ! So, it is all about efficiency and protection. Efficiency comes with fluid unrestricted movements and energy conservation but protection has the cost of wasting energy and reduced mobility through a limb(s) and spine. Now, digest all of this and we will talk about primitive and modern day man next time…….. think about it…. carrying spears and briefcases, or runners carrying a water bottle for that matter.   There is more to this arm swing thing than we are letting on here, but you have to digest this first. Please, take the time to re-read this and yesterday’s post and really “get it” because this is going to likely get a bit complicated.  But if you take the time to digest this you will never look at an athlete or patient the same again. Your patient assessments will grow deeper and have more clarity. There is a reason that in our practices we often assess and treat contralateral upper and lower limbs. If you are paying attention, these in combination with the unilateral loss of spinal rotation or lateral flexion are the things that need attention.  And for those out there that do not think that the foot is important (we can think of at least one industry guru who thinks it is a “non-factor”), think about this:  When there is insufficient hip rotation unilaterally you can regain some of the loss through increased foot pronation unilaterally.  The problem with this is that you compromise the swing phase on the contralateral side when you do that and quire often create an abductory foot twist on the hyperpronated side (due to firing of the medial head of the gastroc to invert the foot and assist in supination). However, if you are trying to walk in a straight line from A to B, you also have yet another option, a subconscious option of putting a axial spin through the whole body, some call this pelvic distortion patterning or pelvic obliquity. OK, that should keep your heads swimming for awhile until the next post on arm swing.  It is not as simple as telling your athlete to swing one arm more, or to stop pulling it across their body; they need to do those things, it is called a “compensation”.  Merely addressing that locally is such a crime.  If you are seeing an arm swing change, you would be foolish not to look at the opposite lower limb and foot at the very least, and of course assess spinal rotation, thoracic extension and lateral bend, …..all spinal functions for that matter.  For your neuro nerds, remember the receptors from the central spine and core fire into the midline vermis of the cerebellum (one of the oldest parts of our brain, called the paleo cerebellum); and these pathways, along with other cerebellar efferents, fire our axial extensor muscles that keep us upright in the gravitational plane and provide balance or homeostasis which the ancient Chinese called Yin and Yang. Simple log-rolling type patterns on the floor or the spine assessment pattern of your preference will likely show a difficulty or asymmetry unilaterally.  Think of the neurological implications of long term unilateral asymmetry, altering neuronal plasticity, and altering our movement patterns (and thus our compensations). Make sure to  couple this with specific muscle testing to be as clear as you can. Too many folks rely solely on movement assessments but that can catch you in a lie quite often because you could be seeing a compensation. Yup, we are The Gait Guys….. we have been paying attention to this stuff long before the functional movement assessment programs became popular.  If you just know gait well enough, one of the single most primitive patterns other than crawling and breathing and the like, you will understand why you see altered squats, hip hinges, shoulder ROM screens etc.  You must have a deep rooted fundamental knowledge of the gait central processing and gait parameters. If you do not, every other screen that you put your athlete or patient through might have limited or false leading meaning.  Shawn and Ivo …  combining almost 40 years of orthopedics, neurology, biomechanics and gait studies to get to the bottom of things. https://www.thegaitguys.com/thedailyblog/the-perfect-running-shoe monthly 0.5 2011-12-07 https://www.thegaitguys.com/thedailyblog/arm-swing-in-gait-and-running-part-1-there-is monthly 0.5 2011-12-07 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553741493-PU1KSQQVGIQJEBAH20MG/tumblr_lvpj10VkZe1qhko2so1_1280.gif Blog Arm swing in gait and running:  Part 1. There is so much more to it than you could ever have believed ! Here are some of the facts in NORMAL gait: ipsilateral arm and leg swing are in anti-phase (out of phase) meaning that in the picture above the left leg is in flexion and external rotation while the left arm is in internal rotation and extension. (You cannot tell that the left leg is in external rotation but we know that normal gait parameters dictate a lateral heel strike and external rotation.) contralaterally the left leg and right arm are in-phase. the shoulder girdle and pelvic girdle are in anti-phase as well. See the arrows overlaying the drawing. This means that, as in the picture above, as the left pelvic girdle (left hemi-pelvis) is anterior (since it moves anterior with the same side leg flexion) the left shoulder girdle is posterior. These anti-phasic motions should be equal and symmetrical bilaterally, if gait is normal. * so if you are paying very close attention you will note that:  the left leg is in flexion and external rotation just like the right arm (flexion and external rotation/supination). thus, the right leg is in hip extension and internal rotation just like the left arm. This drives the oblique posterior muscular sling from right gluteus to left latissimus/lower-middle trapezius via the multi compartmentalized thoracolumbar fascia. Long ago this was coined the Back Force Transmission System. It was discussed in detail in the Second Interdisciplinary World Congress on Low Back Pain, 1995 (link) which all gait geeks have likely read a few times. Now, many of you who are in the fields of manual and movement therapies are going to say, “guys, tell us something new and fresh, please ! This is old info going all the way back to Serge Gracovetsky’s "Spinal Engine” 1989 book.“  Yes, we know this stuff is old hat. Gracovetsky’s book was a great read, we just wish it had been longer in pages.  But, did you know what these works were asking you to extrapolate from them ? Perhaps they were reminding us of things like: Internal hip rotation is a precursor to hip extension.  In other words, the hip must pass through the internal rotation phase before it starts into hip extension.  This means that the opposite shoulder must do the same thing. Go ahead, get up and walk and you will note it yourself.  But what you must realize is that if shoulder internal rotation range is lost or limited then the posterior sling will be insufficient and hip extension cannot be achieved as effectively. It works both ways gang ! Remember, it is not only a mechanical phenomenon, it is a centrally mediated neurological phenomenon as well.  So, if you are thinking outside of the box you might realize that a frozen shoulder (adhesive capulitis) perhaps cannot be treated effectively or completely if contralateral hip extension or internal rotation are limited.  They feed forward and feed backwards between each other as well; functional hip pathology can drive shoulder functional pathology.  And so if you try to treat a frozen shoulder without paying attention to the gait neurologic central processing patterns then you can sometimes get the slow progress that is seen by many.  Think about this the next time you look at a functional shoulder assessment pattern ! We look at the contralateral hip and gait patterns first and correlate ! Treat the person, not the symptom.  And gait is part of how they move and integrate the parts. Tomorrow we well talk more about arm swing, in "Arm Swing Part 2. "When Phase is Lost”. Shawn and Ivo …  combining almost 40 years of orthopedics, neurology, biomechanics and gait experience to get to the bottom of things  …  and put it into a digestible form for you.  (and sharing some of this in Austin Texas today as speakers at The Running Event…. the nations largest running event.) https://www.thegaitguys.com/thedailyblog/using-kinect-for-xbox-360-and-computer-vision-to monthly 0.5 2011-12-06 https://www.thegaitguys.com/thedailyblog/the-gait-guys-toe-box-sizing-talk-and-case monthly 0.5 2011-12-06 https://www.thegaitguys.com/thedailyblog/intelligent-design monthly 0.5 2011-12-05 https://www.thegaitguys.com/thedailyblog/speaking-of-lactate-heres-the-bottom-line-from monthly 0.5 2011-12-03 https://www.thegaitguys.com/thedailyblog/we-tried-to-link-this-from-our-friend-peters monthly 0.5 2011-12-03 https://www.thegaitguys.com/thedailyblog/evidently-we-are-not-the-only-people-who-find monthly 0.5 2011-12-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553741777-IXPOVK82L9ZX9DZU1S0P/tumblr_ltuzrtDCtO1qhko2so1_400.jpg Blog Evidently, we are not the only people who find feet sexy. http://ngm.nationalgeographic.com/ngm/0609/feature2/online_extra05.html Here is an interesting National Geo Article contrasting and comparing the shoe and the foot: which is sexier? You decide for yourself. Two guys, usually liking feet more than shoes….The Gait guys https://www.thegaitguys.com/thedailyblog/something-lighter-for-friday-follies-it-just monthly 0.5 2011-12-02 https://www.thegaitguys.com/thedailyblog/100-ups monthly 0.5 2011-12-01 https://www.thegaitguys.com/thedailyblog/the-physics-of-heeled-shoes-or-using-newtons monthly 0.5 2011-12-01 https://www.thegaitguys.com/thedailyblog/gait-arm-swing-more-on-dr-carrick-and-sid monthly 0.5 2011-11-30 https://www.thegaitguys.com/thedailyblog/neuromechanics-weekly-what-does-the-reticular monthly 0.5 2011-11-30 https://www.thegaitguys.com/thedailyblog/the-awkward-runner-gait-ataxia-another-cause monthly 0.5 2011-11-29 https://www.thegaitguys.com/thedailyblog/the-week-in-gait-newsletter monthly 0.5 2011-11-28 https://www.thegaitguys.com/thedailyblog/lauren-fleshman-on-her-injuries-biomechanics-you monthly 0.5 2011-11-28 https://www.thegaitguys.com/thedailyblog/foot-scan-a-case-study-what-can-we-glean-about monthly 0.5 2011-11-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553741704-35JYA6PRECO5JB4BGZ1L/tumblr_lv7rglZnxs1qhko2so1_400.jpg Blog Foot Scan: A Case Study. What can we glean about this person from this pressure sensitive foot scan ? Remember, no examination possible here so lets see what we can assume is happening.  These kinds of mental aerobics help keep us clinically sharp and help us pick out subtle patterns in someone gait when we do gait assessments …. so that we can prove them or disprove them on the table during our exam. Remember, for this case, the person is standing, not moving through the gait cycle like in a normal pedograph mapping or F-Scan (hence making an orthotic or true and accurate assumptions from this type of static scan would be really silly …  but alot of people and companies do it ! Sadly.) We are presenting this case for the means of mental stimulation and observation only. Increased foot pressures on the lateral aspect of the right foot. One possibility here is that there could be a short right leg here (anatomic or functional) and the person is supinating to lengthen the limb.  Remember, supination creates a lift in the talus height because the foot is in relative plantarflexion, adduction and inversion and the limb is moving into external rotation, this will all increase the length from foot to pelvis. In contrast the flat foot has internally spun the limb and the foot is dorsiflexed, abducted and everted. Both feet  have reduced medial plantar pressures but remember this is a person standing and not moving through the gait cycle so do not make too many functional assumptions.  Some people who have weaker feet and slightly incompetent arches will often stand on the outsides of the feet because the foot is more supinated and rigid, hence more stable from a joint “lock out” perspective.  People with weakness will always opt for FORM closure (closed packed joint) over FORCE closure (muscular joint compression stabilized joint). Increased flexor hallucis brevis and longus (FHL and FHB) use of the big toe on the right. This appears to be balanced.  If FHB dominated the red would be more proximal on the digit. If FHL were more dominant, the red would only be at the tip.  This imbalance is easy to pick out on a pedograph and in callus patterns on the big toe (do not mistake this callus pattern we are talking about with a medial pinch callus on the inner edge of the big toe, this is from something different …  that is another post another day). In contrast, this person has little left FHL or FHB use.  This doesn’t bother us too much, but the increased right lateral foot pressures and the increased forward forefoot pressures (more RED on more of the toes on the right) tells us this person is supinating the foot and increasing overall plantar grip-type pressures.  Remember Newtons 3rd Law…… for every force there is an equal and opposite reactive force, so more plantar pressure means more upward force into the limb. This could possibly be to help increase more gluteal activity. This leads us to #4. Newton’s 3rd Law. The increased right plantar and supinatory pressures are going to likely activate more gluteal function.  Get up from your chair and take a few steps.  And when you do, push your right foot into the ground more firmly than normal. Do you feel the glute function increase ? You should. Especially note the gluteus medius drive the pelvis medially (this is one of our tricks to help people arrest the frontal plane drift and reduce cross over gait in running).  We would have normally said that the increased right toe pressures (RED) would have meant more forefoot loading in this stance but we do not see a reduced heel pressure so that means they are actively using more flexor dominated strategy. Increased digit flexion will help to drive the arch upwards from the bottom (as opposed driving the arch up from lift (tibialis anterior & posterior). Otherwise this is a pretty normal looking foot.  IF you measure the width of the foot at the narrowest part of the waist you will see that the right is a little wider (and there is more blue). This could mean that this foot is a little weaker intrinsically and could be one that pronates more in gait or is just a little more pronated here (hence the supination evidence as layed out above).  Thus, this could give us good reason to assume the right RED plantar increases …  meaning, this person is working harder on the right to work out and avoid pronating.  Everything we said above seems to fit this ASSUMPTION.  Hope this was a nice little exercise in observation and mental juggling. By the way, Juggling is a great mental exercise….. A Princeton researcher, Les Fehme suggested we can optimize our overall performance in life by broadening our focus. Juggling is one excellent way to do that. He claims most people have a narrow focus, a lack of awareness of their own body sensations or emotions. A recent CNN report suggested juggling increases the amount of grey matter in areas of the brain that process and store visual information, proving what was not thought possible – that new stimuli can alter the brain’s structure. A comparison of brain-imaging scans of non-jugglers and other volunteers before they learned to juggle and three months later, revealed an increase in grey matter in certain areas of the newly trained jugglers’ brains. And so … thanks for juggling with us today.  We hope you did not choose to use chainsaws or Ron Popeil knives (“Wait, there’s more! We’re going to double your order!”). Wanna get a little crazy driving more brain grey matter integration ? Try running while juggling, if you dare ! We recently heard of a guy that broke a record running a recent marathon juggling 3 balls the entire time.  Who has time for this shenanigans ?! We have troubles getting our laundry done. Ivo and Shawn ….. your jugging court jesters. Jester, hmmmm …  perhaps a good label for us.  Sounds like it was a fun job. (define: A jester, joker, jokester, fool, wit-cracker, prankster, or buffoon was a person employed to tell jokes and provide general entertainment. Jesters are stereotypically thought to have worn brightly colored clothes and eccentric hats in a motley pattern. Other things distinctive about the jester were his laughter and his mock sceptre, known as a bauble or marotte.) https://www.thegaitguys.com/thedailyblog/oscar-pistoriushere-on-inspirational-sundays monthly 0.5 2011-11-27 https://www.thegaitguys.com/thedailyblog/feet-suffer-for-high-heel-fashion monthly 0.5 2011-11-26 https://www.thegaitguys.com/thedailyblog/friday-follies-not-exactly-gait-related-not monthly 0.5 2011-11-25 https://www.thegaitguys.com/thedailyblog/cross-over-line-running-one-easy-fix-trick-the monthly 0.5 2011-11-25 https://www.thegaitguys.com/thedailyblog/how-a-really-fast-runner-could-potentially-be monthly 0.5 2011-11-25 https://www.thegaitguys.com/thedailyblog/shoe-fitting-is-about-to-get-smarter-here-is monthly 0.5 2011-11-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553741917-ZN0S3HDT8HW4KGFSSBDR/tumblr_luvyl8wFfU1qhko2so1_400.jpg Blog Shoe Fitting is about to get smarter. Here is some news on our new shoe fit program for 2012. Go ahead. Click on the picture. You know you want to : ) https://www.thegaitguys.com/thedailyblog/ramblings-that-go-on-inside-the-heads-of-the-gait monthly 0.5 2011-11-24 https://www.thegaitguys.com/thedailyblog/is-this-the-perfect-running-shoe monthly 0.5 2011-11-23 https://www.thegaitguys.com/thedailyblog/dont-let-the-title-scare-you-while-watching-this monthly 0.5 2011-11-23 https://www.thegaitguys.com/thedailyblog/gait-video-analysis-olympian-carl-lewis-carl monthly 0.5 2011-11-23 https://www.thegaitguys.com/thedailyblog/the-cross-over-gait-in-a-professional-runner monthly 0.5 2011-11-22 https://www.thegaitguys.com/thedailyblog/gait-analysis-of-lead-pack-at-2011-new-york-city monthly 0.5 2011-11-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553742418-NV3N13ZJBZMNKY0XZWFZ/tumblr_luvxivQs001qhko2so1_1280.png Blog Gait Analysis of Lead Pack at 2011 New York City Marathon Here is a piece (link here)   we did for the great guys over at The Natural Running Center. The Natural Running Center asked us — The Gait Guys – to comment on this striking photo of the lead male pack that was taken at the recent NYC Marathon (with the beautiful Manhattan skyline in the background). We, as always, were glad to oblige. Please keep in mind, we were sent a still photograph that was taken only from the side, and had no video to analyze so there is much information missing; thus some assumptions are a given.  To simplify matters for readers, we dispensed with names. Let’s start with Mr. Hat at the rear of the pack.  He appears to be at the toe off phase of running gait, the late stance phase of gait. Fatigue may be setting in. He appears to have insufficient hip extension, as the thigh is flexed (as is the knee) and he is leaning back at the upper torso and is in neck extension. This could be from fatigued abdominals, but he could be trying to expand his ribs and chest wall to get more oxygen. This is not a good strategy but who are we to pick on a guy who can keep up with gazelles. The angle of his swing or float phase thigh is also a little low, again a possible product of fatiguing abdominals, but it could be merely because he is just beginning forward swing.  Remember, this is a snapshot in time, these ranges may improve at a 100th second subsequent frame.  You also get a peek at his left calf (medial gastroc, actually, behind the right foot) and it looks pretty contracted. Judging from his great toe extension, he is using that torso extension to pull him through the stride. Next we have Mr. Blue Shorts I, immediately in front of Mr Hat. He looks like a heel striker in this frame with that limb out in front of his body. Note that right shoulder coming forward and torso twist to propel him through. He even flexes his neck and rounds his shoulders; probably to try and ventilate for all that ATP expenditure. Form is often loss with fatigue; we all know that. Now onto Mr. Black Shorts, the shortest runner in the lead pack.  He appears to have some really nice hip extension happening, or is it? Actually, if you look carefully, the extension is occurring at his lumbar spine, and his hip extension is close to 0 degrees…far from the 15-30 we would like to see. The shadow on the back of his shirt makes this hard to see.  Check out that  right shoulder. See how far it is cocked into extension behind  him? Driving a strong posterior arm swing will help extend the opposite hip, an attempt to make up for any power leaks in hip extension.  He appears to be another heel striker as well. Next up is Mr. Orange Singlet in his orange Nikes. This gentleman, and pack leader Mr. Red (yes, it’s a Mutai, but not the one who won!)) seem to have the most promise and cleanest strides in this still photo. Mr. Orange Singlet has good forward lean, nice thigh flexion and adequate hip extension; his body is lined up during toe off from the foot to the top of the head. He is using that medial gastroc muscle on the left. He also appears to be the most relaxed of the bunch. Mr. Red appears to be a forefoot striker, and he may hit at or just in front of his center of mass. He has good hip extension as well (maybe he is copying Mr. Orange, or is it the other way around? They do appear to be looking at one another). He has some torso rotation to the right (look at that shoulder), and has a cross body arm swing but that could also be from the neurologic reflex of turning the head to the right to check out the competition. It would be great to see some video of these gents to see if our hypotheses were correct. Good biomechanics and form do not necessarily equate to winning, but they do improve efficiency and we like to think they prevent (or minimize) injuries.  Don’t get us wrong, these guys are the pros.  These are the guys we all strive (and dream) to become as runners. Their apparent “snapshot” flaws are either minor for them given their physical capacities, a product of fatigue in a race where they are running each mile faster than many  can ride a bike, or they have simply grooved their dysfunctional patterns.  That does not mean that what we have talked about are not power leaks for these guys; elite runners can almost always improve some aspect of their form.  But hey, we would settle any day for 26 miles at a sub-5 minute pace. Do not ever forget that running is a skill and an art form.  The more miles you do, the more video you watch, the more you practice the fundamental skills as you build endurance and strength, the better you can tap into optimal biomechanics. Simply running without constant mindfulness on every step often yields faltering mechanics into your weaknesses and habits. Sure, we would all love to look like these guys when we run, but not many of us do. But then again, how many of us amateur runners  are putting in the miles and time that they do?  According to Malcolm Gladwells book, “Outliers” and Daniel Coyle’s book, ‘The Talent Code”,  most of us have not done the 10,000-15,000+ hours necessary to become masters at this craft. Respectfully, we are The Gait Guys. Two aging bald foot geeks, helping humanity, one gait cycle at a time. Pictured in the photo: 3     Geoffrey Mutai    2:05:06           Kenya KEN 2     Emmanuel Mutai    2:06:28           Kenya KEN 4     Tsegaye Kebede    2:07:14           Ethiopia    ETH 1     Gebre Gebremariam 2:08:00           Ethiopia    ETH 6     Jaouad Gharib     2:08:26           Morocco     MAR 14    Abdellah Falil    2:10:35           Morocco     MAR https://www.thegaitguys.com/thedailyblog/why-i-run monthly 0.5 2011-11-20 https://www.thegaitguys.com/thedailyblog/running-is-the-new-currency-not-the-us-dollar monthly 0.5 2011-11-19 https://www.thegaitguys.com/thedailyblog/shift-happens-from-the-gait-guys-perspective monthly 0.5 2011-11-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553742774-5O0CCAI8QY6MEG6T134P/tumblr_luvywf1LqH1qhko2so1_400.jpg Blog Shift Happens: From The Gait Guys perspective: Rebuilding Sidney Crosby’s Brain. As we have discussed before, three systems keep us upright in the gravitational plane so that we can walk, run, skate (in Sidney’s case) and ambulate correctly and efficiently: The vestibular system (inner ear) vision and our proprioceptive system (joint and muscle mechanoreceptors).             and our proprioceptive system (joint and muscle mechanoreceptors) When one of these systems fails or is impaired, the delicate balance between these 3 systems is interrupted and shift happens; our balance and coordination fail and we fall. This stresses the point that gait and locomotion are as much a central nervous system phenomenon as a peripheral one. The processes really cannot be separated.  Thankfully, we and in this case Sidney Crosby and many others, have physicians like Dr Carrick to assist people in correcting these imbalances. Dr Ivo and Dr Allen were fortunate enough to study under Dr Carrick and his programs.  We try to slip in some of this information on a weekly basis into The Gait Guys blogs, to help you understand the human machine a little better and to also allow you to appreciate the complexity, precision and essential requirements of human movement such as walking gait, running and yes, even skating. Enjoy the full article link (HERE) about the fascinating and ongoing rehabilitation of Sidney Crosby of the NHL. Ivo and Shawn…….. two guys pretty crummy on two steel blades (even though one grew up in Canada). full article:  http://www2.macleans.ca/2011/11/03/rebuilding-crosbys-brain/ https://www.thegaitguys.com/thedailyblog/quote-of-the-month monthly 0.5 2011-11-18 https://www.thegaitguys.com/thedailyblog/smart-shoes-well-we-thought-we-had-seen-it-all monthly 0.5 2011-11-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553743309-8ZMXAJUKG59K6M3F9GTJ/tumblr_luh6ejzqA51qhko2so1_1280.jpg Blog Smart Shoes? Well, we thought we had seen it all. Imagine a shoe that tells you what the competition is doing. Next, it tells you how you are doing in comparison to them? Sounds like the future? Guess again… Enter the Adidias Brainy Boot. The latest in the stealth weaponry in the competition for being the worlds greatest soccer shoe for 2 huge giants, Nike and Adidas. REad all about it on Bloomberg…. adidas brainy boot messi Now if they could just design a shoe that gave you the biomechanics you needed…. Ivo and Shawn…The Gait Guys Hoping to see these puppies at the Austin event.. https://www.thegaitguys.com/thedailyblog/running-technique-the-batton-hand-off-and-donut monthly 0.5 2011-11-18 https://www.thegaitguys.com/thedailyblog/the-gait-guys-and-shoe-fit-coming-to-your monthly 0.5 2011-11-17 https://www.thegaitguys.com/thedailyblog/neurodevelopment-of-the-barefoot-brain-or-what monthly 0.5 2011-11-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553743579-BZJ8NMCYDRK304PALKDD/tumblr_lukbf9axNj1qhko2so1_1280.jpg Blog Neurodevelopment of the barefoot brain: or What would happen to our hand function if we wore OVEN MITTS all day long ? and so then, what about the effect of shoes on feet ?  Cody Lundin … perhaps the best known barefoot dude you will ever meet. If you have seen his TV show Dual Survival on Discovery Channel with Dave Canterberry you will know that he has been in the snows of Alaska, on the hot sand deserts, swamps etc you name it, barefoot on each. Take a good look at the photo of his strong healthy feet, no hammer toes, no bunions, no undercurling of the 4-5th toes (lateral quadratus plantae weakness) etc.  He is … Cody Lundin, Aboriginal Living Skills School, LLC _________________ Brief dialogue from Cody…..(yes, those are his feet in the picture) “Feets… I have received many comments over the years - positive and negative - about going barefoot. The reasons I do so are varied, and for those who know me, they know I have no agenda wishing that others would walk barefoot too. Its worthy to note that hundreds of thousands of people around the world - from toddlers to grandmothers - walk barefoot, and certainly, even though primitive foot wear was common, all of our ancestors got their start sans footwear. Foot wear certainly has its place to protect from environmental extremes, yet often its a conformist sign of class, status, or culture. I have traveled to many places in the world barefoot, and the reactions have been interesting; from getting kicked out of the airport in Peru, to boarding several airplanes in Laos where i wasn’t given a second glance. To each their own! cody ” _________________________ What The Gait Guys have to say: Stepping backwards in time a little, in the caveman days things were different. The foot was unshod (without shoes) from the moment of the first step until one’s dying day, and thus the foot developed and looked different. The sole of the foot was thicker and callused due to the constant contact with rough and offending surfaces thus preventing skin penetration, the foot proper was more muscular and it may have been wider in the forefoot and the toes were likely slightly separated due to the demands of gripping which would obviously necessitate increase muscular strength and bulk to the foot intrinsic muscles. It was the constant input of uneven and offending surfaces such as rocks, twigs, mud, foliage and debris that stimulated the bottom of the foot, and thus the intrinsic muscles, sensing joint positions and relaying those variations to the brain for corresponding descending motor changes and adaptations to maintain protection and balance. The foot simply worked different, it worked better, it worked more like the engineering marvel that it truly is. The foot was uncovered and the surfaces we walked on were uneven and challenging. However, as time went on, man decided to mess with a good thing. He took a foot that was highly sensitive, a virtual sensory organ with a significant sensory and motor representation in the brain (only the hands, genitals and face have more brain representation as represented by the sensory and motor homunculus of the brain) and he not only covered it up with a slab of leather or rubber but he then flattened and then paved not only his world, but also his home, with black hard top, cement, wood or tile thus completing the total sensory information deprivation of the entire foot. Thus, not only did he take away critical adaptive skills from himself and generations to follow, but he began the deprivation of the brain of critical information from which the central nervous system would need to develop and continue to function effectively. It is not unlikely that the man of pre-shod time had a strong competent foot arch (perhaps somewhat flat to increase surface area contact for adaptation), but one that did not need orthotics, stability shoes or rigid shanks and inserts. In other words, the foot and its lower limb muscles were strong with exceptional skills and endurance. But in todayís day and time things are now different. We now affix a shoe to the childís foot even before he can walk and then when he does, all propriosensory information necessary for the development of critical spinal and central nervous system reflexes is ensured to be virtually absent. Is it any wonder why there are so many people in chronic pain from postural disorders related to central core weakness and inhibition ? Is it any wonder why so many people seem to have flat incompetent feet and arches? Man has done it to himself, but thankfully man has proven that what he can do, he can undo. Thankfully we see modern medical research that has delved into this realm of thought and has uncovered the woes of our ways and to follow, companies like those mentioned earlier are imagining and developing devices that will allow us some protection from modern day offenses such as glass, plastics and metal and thus allow us the slow and gradual return to our healthier foot days, all fashion sense aside. *Some hard and simple research facts, current research has been conducted showing that plantar (bottom of the foot) sensory feedback plays a central role in safe and effective locomotion, that more shoe cushioning can lead to higher impact forces on the joints and higher risk of injury, that unshod (without shoes) lowers contact time versus shod running, that there are higher braking and pushing impulses in shod versus unshod running, that unshod running presents a reduction of impact peak force that would reduce the high mechanical stress that occurs during repetitive running and that the unshod foot induces a neural-mechanical adaptation which could enhance the storage and restitution of elastic energy at ankle extensor level. These are only some of the research findings but they are some of the more significant ones. These issues will not only support injury management benefits for the unshod runner but increase speed, force and power output. Shawn and Ivo……. The Gait Guys https://www.thegaitguys.com/thedailyblog/today-working-negative-splits-these-are-great monthly 0.5 2011-11-16 https://www.thegaitguys.com/thedailyblog/foot-edge-work-dancer-marquese-scott-this monthly 0.5 2011-11-16 https://www.thegaitguys.com/thedailyblog/speechless monthly 0.5 2011-11-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553743929-ATLJGVOT9R9MV5W27HU3/tumblr_lum3herRwJ1qhko2so1_500.jpg Blog Speechless. https://www.thegaitguys.com/thedailyblog/we-hope-you-are-standing-up-while-you-read-this monthly 0.5 2011-11-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553744628-XVAMEQ85ET1JQS98YZIS/tumblr_luh7t7zoZU1qhko2so1_500.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553745081-56CGNHPZDD50BP18OXR8/tumblr_luh7t7zoZU1qhko2so2_500.gif Blog https://www.thegaitguys.com/thedailyblog/some-gorgeous-running-styles-here-in-this-clip monthly 0.5 2011-11-14 https://www.thegaitguys.com/thedailyblog/nutrition-training-tip-glycemic-index-glycemic monthly 0.5 2011-11-14 https://www.thegaitguys.com/thedailyblog/running-at-the-border monthly 0.5 2011-11-14 https://www.thegaitguys.com/thedailyblog/the-brain-is-for-movement-yes-that-means-running monthly 0.5 2011-11-13 https://www.thegaitguys.com/thedailyblog/running-barefoot-saving-money-or-spending-it-on monthly 0.5 2011-11-12 https://www.thegaitguys.com/thedailyblog/the-200-yard-rule-for-running monthly 0.5 2011-11-11 https://www.thegaitguys.com/thedailyblog/zainabs-discount-shoes-iraqs-1-footwear monthly 0.5 2011-11-11 https://www.thegaitguys.com/thedailyblog/gait-ataxia-and-gluten-yup-what-you-eat-can monthly 0.5 2011-11-10 https://www.thegaitguys.com/thedailyblog/the-gait-guys-speak-jan-14th-2012 monthly 0.5 2011-11-09 https://www.thegaitguys.com/thedailyblog/our-most-recent-article-making-great-strides-is monthly 0.5 2011-11-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553745249-Y4NYSC4KVGD664ZMJN34/tumblr_lueiizFkmu1qhko2so1_250.jpg Blog Our most recent article “Making Great Strides” is on the rack as of yesterday in the December issue of Tri Magazine. They have asked for more submissions so get a subscription !  Thx Jene Shaw !!!!! (editor) Your stride length is the distance covered from the time your foot hits the ground to the time it hits again on the same side, encompassing one complete gait cycle. some variables can compli- cate the stride, such as terrain, power output, stride frequency, footwear and type of workout, and everyone’s indi- vidual anatomy affects stride length. We talk about lack of ankle rocker, lack of abdominals, lack of hip extension and other good stuff.  It was a short article, but short can be also be sweet. Ivo and Shawn https://www.thegaitguys.com/thedailyblog/just-when-you-thought-it-was-safe-to-watch-a monthly 0.5 2011-11-09 https://www.thegaitguys.com/thedailyblog/robotic-exoskeleton-new-device-helps-people-with monthly 0.5 2011-11-08 https://www.thegaitguys.com/thedailyblog/population-insights-on-hallux-valgus-when-the monthly 0.5 2011-11-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553745445-HMRJKDHP93FAJF3FZJSS/tumblr_lqsnc1ywf21qhko2so1_r1_250.jpg Blog Population Insights on Hallux Valgus: “When the big toe heads West”. (thanks to Emily Delzell and LER for their ongoing great work.) Handicapping Hallux Valgus: Predictive variables include race, age    By Emily Delzell here are some of the study findings right from the article……. “In nonobese individuals, African Americans were almost two times more likely than whites to have hallux valgus. But in obese participants, prevalence was just as high in whites as in African Americans. This difference seen in the non-obese suggests a real racial difference,” said Golightly, the study’s lead author. Past high heel use increased HV risk by 22%. Investigators defined past use as participants’ self-reported primary shoe type during 10-year periods beginning when individuals were aged 20 years.“We found what we expected, that past—but not current—high heel use was predictive of hallux valgus. Women reported wearing high heels the most when they were aged 20 to 29, and high heel use diminished each decade until people reached 60, when wear really plummeted. It makes sense that people with hallux valgus and foot pain are uncomfortable in heels and are less likely to be current wearers,” Hannan said. The study showed that HV heritability overall was 39% for women and 38% for men (mean age 66 years, age range 39-99 years), but was significantly increased in the subset of participants younger than 60 years (HV heritability, 89%). “We know that genes for obesity are also highly heritable and it could be that the gene for hallux valgus is linked to obesity genes,” Hannan said. Get the full study from LER here (CLICK) https://www.thegaitguys.com/thedailyblog/our-new-friend-dr-mark-cucuzzella-an-inspiring monthly 0.5 2011-11-07 https://www.thegaitguys.com/thedailyblog/here-is-a-decent-video-on-how-to-do-the-100-up monthly 0.5 2011-11-07 https://www.thegaitguys.com/thedailyblog/comments-from-a-follower-of-the-gait-guys monthly 0.5 2011-11-06 https://www.thegaitguys.com/thedailyblog/the-once-and-future-way-to-run-newyorktimes monthly 0.5 2011-11-04 https://www.thegaitguys.com/thedailyblog/so-how-did-they-get-the-skunk-into-the-shoe-have monthly 0.5 2011-11-04 https://www.thegaitguys.com/thedailyblog/today-something-a-little-different-i-worked-for monthly 0.5 2011-11-03 https://www.thegaitguys.com/thedailyblog/today-on-neuromechanics-weekly-we-explain-how-the monthly 0.5 2011-11-02 https://www.thegaitguys.com/thedailyblog/splay-watch-this-video-a-few-times-through-did monthly 0.5 2011-11-01 https://www.thegaitguys.com/thedailyblog/its-a-great-day-to-be-a-neuro-geek-so-if-the monthly 0.5 2011-10-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553745324-IGNCCTO0MF68B9X6FGW4/tumblr_ltlpf1kXVh1qhko2so1_400.png Blog Its a great day to be a neuro geek So if the receptors on the bottom of the foot aren’t involved aren’t involved in 2 joint muscles staying coordinated (like the hamstring and rectus femoris in this study), how do we determine the appropriate muscle length and ratios? How about our built in muscle length receptors? Lets hear it for muscle spindles! Hooray for Ia and type II afferents! Sifting through the science so you don’t have to. We are The Gait Guys… Exp Brain Res. 1998 Jun;120(4):479-86. Coordination of two-joint rectus femoris and hamstrings during the swing phase of human walking and running. Prilutsky BI, Gregor RJ, Ryan MM. Source Department of Health and Performance Sciences, Center for Human Movement Studies, The Georgia Institute of Technology, Atlanta 30332-0110, USA. Abstract It has been hypothesized previously that because a strong correlation was found between the difference in electromyographic activity (EMG) of rectus femoris (RF) and hamstrings (HA; EMG(RF)-EMG(HA)) and the difference in the resultant moments at the knee and hip (Mk-Mh) during exertion of external forces on the ground by the leg, input from skin receptors of the foot may play an important role in the control of the distribution of the resultant moments between the knee and hip by modulating activation of the two-joint RF and HA. In the present study, we examined the coordination of RF and HA during the swing phase of walking and running at different speeds, where activity of foot mechanoreceptors is not modulated by an external force. Four subjects walked at speeds of 1.8 m/s and 2.7 m/s and ran at speeds of 2.7 m/s and 3.6 m/s on a motor-driven treadmill. Surface EMG of RF, semimembranosus (SM), and long head of biceps femoris (BF) and coordinates of the four leg joints were recorded. An inverse dynamics analysis was used to calculate the resultant moments at the ankle, knee, and hip during the swing phase. EMG signals were rectified and low-pass filtered to obtain linear envelopes and then shifted in time to account for electromechanical delay between EMG and joint moments. During walking and running at all studied speeds, mean EMG envelope values of RF were statistically (P<0.05) higher in the first half of the swing (or at hip flexion/knee extension combinations of joint moments) than in the second half (or at hip extension/knee flexion combinations of joint moments). Mean EMG values of BF and SM were higher (P<0.05) in the second half of the swing than in the first half. EMG and joint moment peaks were substantially higher (P<0.05) in the swing phase of walking at 2.7 m/s than during the swing phase of running at the same speed. Correlation coefficients calculated between the differences (EMG(RF)-EMG(HA)) and (Mk-Mh), taken every 1% of the swing phase, were higher than 0.90 for all speeds of walking and running. Since the close relationship between EMG and joint moments was obtained in the absence of an external force applied to the foot, it was suggested that the observed coordination of RF and HA can be regulated without a stance-specific modulation of cutaneous afferent input from the foot. The functional role of the observed coordination of RF and HA was suggested to reduce muscle fatigue. https://www.thegaitguys.com/thedailyblog/those-are-some-pretty-big-shoes-this-gentleman monthly 0.5 2011-10-29 https://www.thegaitguys.com/thedailyblog/what-are-correct-toes-and-do-they-work-correct monthly 0.5 2011-10-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553746256-PVN2OAEUC5YTMSL7604B/tumblr_ltlnahcpkF1qhko2so1_250.jpg Blog What are correct toes and do they work? correct toes:https://nwfootankle.com/correct-toes We are quite familiar with them. Do they work? That is the question! They are pretty bulky but that could be a good thing, for some though they are just too bulky we have found. Some people are running in them……We think our friend Dr. Mark Cucuzzella does (naturalrunningcenter.com) . We use them with clients to walk around the house barefoot and get used to engaging toes with a flat press (not gripping…like those silly, flexor dominant promoting towel scrunch exercises !) So they MIGHT help someone retrain some muscles if used in this fashion but just wearing them does not produce magical results without some awareness use.  Keep in mind……forcing something doesn’t make it so……… spreading the toes with an object such as these doesn’t make them automatically go where they are supposed to. Most people need to relearn toe separation (actually abduction)…we do alot of that in our offices….and then learn to bring the whole toe flat to the ground with a good, firm toe press……..no grip/scrunch/hyperflexion.  The last thing we would ever want to do is overfacilitate the long toe flexors (flexor digitorum longus) because when we do, we inhibit other foot intrinsic muscles (ie. lumbricals). The Gait Guys…promoting foot and gait literacy and helping you wade through the uncertainty. https://www.thegaitguys.com/thedailyblog/liquid-mountaineering-yup-we-thought-we-had monthly 0.5 2011-10-28 https://www.thegaitguys.com/thedailyblog/oxygen-cost-of-running-barefoot-vs-running-shod monthly 0.5 2011-10-27 https://www.thegaitguys.com/thedailyblog/in-this-neuromechanics-weekly-dr-waerlop monthly 0.5 2011-10-26 https://www.thegaitguys.com/thedailyblog/the-gait-to-happiness-or-what-do-you-mean-i-walk monthly 0.5 2011-10-25 https://www.thegaitguys.com/thedailyblog/you-evidently-cant-have-your-cake-and-eat-it monthly 0.5 2011-10-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553746197-L8HL0NCQVW47RRUL1R2Z/tumblr_lt8q4sHFGs1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553746707-QGVQ27QDHKM8YXM6JWYA/tumblr_lt8q4sHFGs1qhko2so2_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553747624-NYW1FOMRPLUM1P7XTZZH/tumblr_lt8q4sHFGs1qhko2so3_400.jpg Blog https://www.thegaitguys.com/thedailyblog/effects-of-childrens-shoes-on-their-gait monthly 0.5 2011-10-22 https://www.thegaitguys.com/thedailyblog/shoe-insanity-highlights-from-the-2011-paris monthly 0.5 2011-10-21 https://www.thegaitguys.com/thedailyblog/as-promised-the-info-you-need-to-make-an-educated monthly 0.5 2011-10-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553747683-ZY2WHRULZZK6S85DVAJ0/tumblr_lsf2l7s0Gq1qhko2so1_250.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553748159-S3X5DN0XZEYITPWPBJ54/tumblr_lsf2l7s0Gq1qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/the-information-you-have-been-waiting-for-how-do monthly 0.5 2011-10-20 https://www.thegaitguys.com/thedailyblog/the-role-of-executive-function-and-attention-in monthly 0.5 2011-10-19 https://www.thegaitguys.com/thedailyblog/the-2011-running-event-austin-texas-gait-guys monthly 0.5 2011-10-19 https://www.thegaitguys.com/thedailyblog/lets-take-another-look-at-yesterdays-post-the monthly 0.5 2011-10-18 https://www.thegaitguys.com/thedailyblog/how-to-and-how-not-to-do-a-single-leg-squat monthly 0.5 2011-10-17 https://www.thegaitguys.com/thedailyblog/what-we-think-we-look-like-when-we-run-is-not monthly 0.5 2011-10-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553748976-NCIAU7OUOUFXHWI0UPX2/tumblr_lt2h22uG0U1qhko2so1_500.jpg Blog what we think we look like  when we run is not always the case.  Pictures are worth a thousand words ! https://www.thegaitguys.com/thedailyblog/more-on-gait-forensics-soon-to-be-in-airports monthly 0.5 2011-10-16 https://www.thegaitguys.com/thedailyblog/speachless-brilliant monthly 0.5 2011-10-15 https://www.thegaitguys.com/thedailyblog/worlds-oldest-marathoner monthly 0.5 2011-10-15 https://www.thegaitguys.com/thedailyblog/shawn-ivo-the-gait-guys-maybe-just-a monthly 0.5 2011-10-15 https://www.thegaitguys.com/thedailyblog/training-tip-ditch-the-flip-flops-our-mention-in monthly 0.5 2011-10-14 https://www.thegaitguys.com/thedailyblog/we-dont-dig-the-music-but-lots-of-shoes-and monthly 0.5 2011-10-14 https://www.thegaitguys.com/thedailyblog/this-is-a-nice-study-looking-at-lateral-gastroc monthly 0.5 2011-10-13 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553748784-UZLA4LA9AGCEHTKMG5AJ/tumblr_lsnysoMyli1qhko2so1_500.gif Blog This is a nice study looking at lateral gastroc activity and changing firing patterns with speed of movement. It also melds nicely with yesterdays Neuromechanics post… Those darn Ia afferents…. You remember them, large diameter afferent (sensory) fibers coming from muscle spindles and appraising the nervous system of vital information like length and rate of change of length of muscle fibers, so we can be coordinated. They act like volume controls for muscle sensitivity. Turn them up and the muscle becomes more sensitive to ANY input, especially stretch (so they become touchy…maybe like you get if you are hungry and tired and someone asks you to do something); turn them down and they become less or unresponsive. Their excitability is governed by the sum total (excitatory and inhibitory) of all neurons (like interneuron’s) acting on them (their cell bodies reside in the anterior horn of the spinal cord). If we slow things down, the rate of change of length slows as well and excitability decreases, like we see in this study (3-6% slower). We also notice that the length of contraction increases; hmmm, why doesn’t it decrease? Remember these folks are on a treadmill. The treadmill is constantly moving, opposite the direction of travel. With the foot on the ground, this provides a constant rate of change of length of the gastroc/soleus (ie, it is putting it through a slow stretch); so , once the muscle is activated, it contracts for a longer period of time because of the treadmill putting a slow stretch on the gastroc (and soleus). This article also talks about people with upper motor neuron lesions. An important set of inhibitory neurons come from higher centers of the brain, in the motor cortex. These tend to attenuate the signals affecting the Ia afferents, and keep us stable. When we have an upper motor neuron lesion (like a brain lesion or stroke), we lose this “attenuation” and the stretch reflexes (and muscle tone) becomes much more active (actually hyperactive), making the muscle more sensitive to stretch. This loss of attenuation, along with differing firing patterns of the gastroc are important to remember in gait rehab. The soleus and medial gastroc begin firing in the first 10% of the gait cycle (at the beginning of loading response) and fire continuously until pre swing (peaking just after midstance). The lateral head begins firing at midstance; both leads (along with soleus) decelerate the forward momentum of the tibia, flex the knee at midstance, and the medial head assists in adducting the calcaneus to assist in supination. We remain, inexplicably….The Gait Guys   Effects of treadmill walking speed on lateral gastrocnemius muscle firing. by Edward A Clancy, Kevin D Cairns, Patrick O Riley, Melvin Meister, D Casey Kerrigan American journal of physical medicine rehabilitation Association of Academic Physiatrists (2004) Volume: 83, Issue: 7, Pages: 507-51 PubMed: 15213474 Abstract OBJECTIVE: To study the electromyographic profile-including ON, OFF, and peak timing locations-of the lateral gastrocnemius muscle over a wide range of walking speeds (0.5-2.1 m/sec) in healthy young adults. DESIGN: We studied gastrocnemius muscle-firing patterns using an electromyographic surface electrode in 15 healthy subjects ambulating on a treadmill at their normal walking speed and at three paced walking speeds (0.5, 1.8, and 2.1 m/sec). Initial heel contact was determined from a force-sensitive switch secured to the skin over the calcaneous. RESULTS: For all speeds, the gastrocnemius firing pattern was characterized by a main peak, occurring 40-45% into the gait cycle, that increased in amplitude with walking speed. Speeds of > or =1.3 m/sec produced a common electromyographic timing profile, when the profile is expressed relative to the stride duration. However, at 0.5 m/sec (a speed typical of individuals with upper-motor neuron lesions), the onset of gastrocnemius firing was significantly delayed by 3-6% of the gait cycle and was prolonged by 8-11% of the gait cycle. CONCLUSION: Many patients with upper motor neuron lesions (e.g., stroke and traumatic brain injury) walk at speeds much slower than those commonly described in the literature for normal gait. At the slow walking speed of 0.5 m/sec, we have measured noticeable changes in the electromyographic timing profile of the gastrocnemius muscle. Given the importance of appropriate plantar flexor firing patterns to maximize walking efficiency, understanding the speed-related changes in gastrocnemius firing patterns may be essential to gait restoration. https://www.thegaitguys.com/thedailyblog/this-week-on-neuromechanics-dr-waerlop-discusses monthly 0.5 2011-10-12 https://www.thegaitguys.com/thedailyblog/more-lactate-before-we-talk-about-determining monthly 0.5 2011-10-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553749201-R18B4MEAU8HDZIS64U3K/tumblr_lsd6oth5xj1qhko2so1_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553749086-LHPJWL7UK9CGOKZKQU4P/tumblr_lsd6oth5xj1qhko2so2_250.jpg Blog https://www.thegaitguys.com/thedailyblog/the-ankle-foot-orthosis-another-option-for-foot monthly 0.5 2011-10-10 https://www.thegaitguys.com/thedailyblog/parkour-running-taking-gait-and-running-to monthly 0.5 2011-10-09 https://www.thegaitguys.com/thedailyblog/pants-around-your-thighs-we-have-this-gangster monthly 0.5 2011-10-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553749380-YJ8R3D696UNIRAIPROL0/tumblr_lslot4q1rs1qhko2so1_400.jpg Blog Pants around your thighs.  We have this gangster gait on our list of things to do. https://www.thegaitguys.com/thedailyblog/the-gait-guys-indirect-link-to-sidney-crosby-of monthly 0.5 2011-10-08 https://www.thegaitguys.com/thedailyblog/more-on-dr-carrick-dr-ivos-mentor-and-the monthly 0.5 2011-10-08 https://www.thegaitguys.com/thedailyblog/reebok-international-ltd-has-agreed-to-pay-25 monthly 0.5 2011-10-07 https://www.thegaitguys.com/thedailyblog/lifes-the-same-except-for-the-shoes-ric monthly 0.5 2011-10-07 https://www.thegaitguys.com/thedailyblog/gait-forensics-gait-recognition-software monthly 0.5 2011-10-06 https://www.thegaitguys.com/thedailyblog/in-this-weeks-neuromechanics-dr-waerlop-discusses monthly 0.5 2011-10-05 https://www.thegaitguys.com/thedailyblog/are-barefoot-shoes-really-better-newyorktimes monthly 0.5 2011-10-04 https://www.thegaitguys.com/thedailyblog/green-bodies-lactic-acid-as-a-fuel-source monthly 0.5 2011-10-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553749852-Y7G7GIBGUU58YS4Y8IPS/tumblr_lsf3ni1bzF1qhko2so1_500.jpg Blog Green bodies: Lactic acid as a fuel source? Your body can be greener? We don’t mean being a leprechaun. We mean being a better recycler. Read on… For years, we’ve been told that lactic acid is a waste product that burns and shuts down muscles. It’s something athletes and fitness exercisers are urged to avoid. You’re told to work out just below your lactate threshold, where lactic acid begins to accumulate. Well, some of that is correct, but it seems, most of it is wrong.  The aerobic and anaerobic energy systems have long been thought to operate as separate and distinct systems. Lactic acid was considered the enemy of aerobic metabolism, with the power in sufficient accumulations to bring it to a halt. But we are smarter than that now…  UC Berkley integrative biology professor George A. Brooks,  has been studying lactic acid since doing his doctoral dissertation on the subject in the ‘70s. Brooks says the idea that lactic acid is bad and to be avoided “was one of the classic mistakes in the history of science.” “The understanding now is that muscle cells convert glucose to lactic acid,” Brooks explains. “The lactic acid is taken up and used as a fuel by mitochondria, the energy factories in muscle cells. Mitochondria even have a special transporter protein to move the substance into them.” So, your ability to recycle lactic acid into the Krebs (or Citric Acid Cycle) reflects a great deal about your aerobic performance and capacity. Aerobic metabolism and anaerobic metabolism, in fact, operate side by side in the mitochondria. The heart, slow-twitch muscle fibers, and breathing muscles actually prefer lactate as a fuel during exercise. In short, lactic acid is a significant energy source, actually a good thing. Hinting, or perhaps suggesting, how athletes can and are using this revelation, Professor Brooks said in a recent press release: “The world’s best athletes stay competitive by interval training. The intense exercise generates big lactate loads, and the body adapts by building up mitochondria to clear lactic acid quickly. If you use it up [as an energy source], it doesn’t accumulate.” Too much lactic acid is still bad, however. It causes distress and fatigue during exercise, altering the local pH of the tissues and changing chemical reactions.  In extreme circumstances it can damage muscle cells. So how can you learn to use lactic acid to your advantage? Stay tuned for the next lactate installment, coming to a Gait Guys Tumblr Blog near you…. Ivo and Shawn https://www.thegaitguys.com/thedailyblog/now-here-is-something-a-little-different-check monthly 0.5 2011-10-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553750435-7HTB317IU0KESDZ1FN0O/tumblr_ls8j3gOq0o1qhko2so1_r1_400.gif Blog Now here is something a little different. Check out this PhD Thesis submission. What you do DOES make a difference! as we have been saying: it is a cortical phenomenon. http://www.graduate.technion.ac.il/heb/StudentsLec/amir%20haim/abstract.htm Plasticity of Locomotor Patterns & Gait Conditioning via Controlled Biomechanical intervention   Amir Haim, MD (Ph.D candidate) Supervisor: Dr. Alon Wolf Biorobotics and Biomechanics Lab,  Faculty of Mechanical Engineering   Overall, the task of walking is attained by a proper kinematic trajectory command conveyed by the nervous system to its skeleto-muscular instruments which generate the appropriate kinetics. Extensive evidence indicates that motor program adaptations can compensate for losses in mechanical integrity through altered movement and muscle activation patterns. Further more, non surgical biomechanical manipulations, have been shown influence kinetic and kinematic parameters and to generate “active”-neuromuscular re-education.  In the present study we hypothesized that specific biomechanical challenges will stimulate matching biomechanical responses trough out the musculoskeletal kinematic chain. We further hypothesized that repetitive exposure to a biomechanical stimulus would generate  a process of motor learning thus conveying  plasticity of existing  locomotor patterns and gait strategies. To test our hypothesis; we examined two cohorts - healthy young male adults and subjects suffering from knee Osteoarthritis (OA). All participants underwent gait analysis comprising kinematic kinetic and ellcetromygragic patterns during gait. We modeled the direct locomotor response to controlled footwear-generated biomechanical manipulations utilizing a novel biomechanical apparatus comprising four modular elements . Further more we prospectively examined (via gait analysis and valid questioners) patients with abnormal gait patterns (due to knee osteoarthritis) who were subjected to extended biomechanical intervention. Study results confirmed our hypothesis; A direct association was found between specific biomechnical challenges and  direct kinetic and kinematic response in both healthy and OA subjects. Like wise, OA participants who where exposed to long term biomechanical interventions exhibited normalization of cartelistic gait patterns and had a favorable subjective outcome.  http://www.oandp.org/jpo/library/1993_02_039.asp http://emedicine.medscape.com/article/320160-overview http://books.google.com/books?id=S2YVKbu77uQC&pg=PA123&lpg=PA123&dq=altered+motor+patterns+and+gait&source=bl&ots=xY7jGQDXA4&sig=6HmLZRimLVjoc_iFjuWaWTjZdUo&hl=en&ei=iFqWS6yrB4vysgOx1LzCAQ&sa=X&oi=book_result&ct=result&resnum=6&ved=0CCMQ6AEwBTgK#v=onepage&q=altered%20motor%20patterns%20and%20gait&f=false http://jn.physiology.org/cgi/content/full/80/4/1868 http://uppercervicaldr.com/wordpress/?p=58 https://www.thegaitguys.com/thedailyblog/amazing-video-example-of-human-movement-taking monthly 0.5 2011-10-02 https://www.thegaitguys.com/thedailyblog/shoes-are-like-oven-mits-for-your-feet-railing monthly 0.5 2011-10-01 https://www.thegaitguys.com/thedailyblog/neuromechanics-weekly-no-video-this-week-but monthly 0.5 2011-10-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553751581-9PNX8JJ4PDZ9P2ZFK3E4/tumblr_lrmtsbN44d1qhko2so1_250.png Blog Neuromechanics Weekly: No video this week, but check this out…. a little neuro that is, at least, peripherally related to running, for this beautiful Saturday Morning… A question from one of our readers. Dr Ivo I am a runner and often get fatigued and tired, even after a short run. I have had a complete blood work up which was negative, as was my physical exam. My Dr prescribed Zanaflex for muscle spasms and I take ibuprofen prn The short answer: Stop taking Zanaflex (Tizanidine) The long answer… Hmmm. Let’s see. Tizanidine ( mm relaxant ) is a alpha 2 adrenergic agonist (ie they promote activity of alpha 2 receptors). This means it acts on adrenergic receptors (ones that respond to epinephrine and norepinephrine) as opposed to cholinergic receptors (which use acetylcholine as a neurotransmitter). Adrenergic agents usually causes a sympathetic response, like pupil dilation, or increased heart rate. Adrenergic receptors are usually either alpha or beta subtypes. Alpha receptors usually cause vasoconstriction of arteries to the heart, vasoconstriction of veins, and slowing of the GI tract. There are 2 classes of alpha adrenergic agonists, alpha 1: Alpha-1 adrenergic agonists stimulate alpha-1 receptors coupled to G proteins and phospholipase C. They cause vasoconstriction (contraction of blood vessels) and mydriasis; they are used as vasopressors, nasal decongestants and in eye exams. They can be classified in two groups: those which do not cross the blood-brain barrier and have peripheral effects and those which penetrate into the brain and have mainly central effects. alpha 2: inhibit adenylyl cyclase activity.  alpha 2 adrenoceptors are often located on the sympathetic nerve terminals that inhibit the release of norepinephrine and therefore act as a feedback mechanism for modulating the release of norepinephrine. In other words , they inhibit release of epinephrine and norepinephrine (or slow sympathetic activity). Sympathetic activity (like increased heart rate with exercise and vasodilation of capillaries in muscle, to provide more oxygen supply and remove metabolites) is necessary for us to function during exercise performance. Tizanidine falls into this category. Aren’t you glad you asked? We remain, undisputedly, Gait AND Neuro Geeks…The Gait Guys https://www.thegaitguys.com/thedailyblog/wouldnt-want-to-walk-a-mile-in-these-shoes monthly 0.5 2011-09-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553751166-FDGYGOS8VGFI3A28VJKW/tumblr_ls28z046aB1qhko2so1_400.jpg Blog Wouldn’t want to walk a mile in these shoes…. Read all about it here: http://www.dailymail.co.uk/femail/article-2041188/Top-teen-model-Lindsey-Wixson-takes-tumble-Versace-shoes-blame-her.html Have a great Friday Ivo and Shawn https://www.thegaitguys.com/thedailyblog/another-gait-variant-the-apropulsive-gait-style monthly 0.5 2011-09-29 https://www.thegaitguys.com/thedailyblog/john-travoltas-pathologic-gait-strut-one-of monthly 0.5 2011-09-28 https://www.thegaitguys.com/thedailyblog/barefoot-minimalism-i-thought-barefoot-was monthly 0.5 2011-09-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553752099-T6VYSDWITP5KU7CIC9MA/tumblr_ls295xQCn21qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553752189-A1A16D8L5UOHN1NZVA34/tumblr_ls295xQCn21qhko2so2_250.jpg Blog https://www.thegaitguys.com/thedailyblog/hip-function-and-knee-pain-again monthly 0.5 2011-09-26 https://www.thegaitguys.com/thedailyblog/hip-rotation-and-knee-pain-what-we-have-been monthly 0.5 2011-09-26 https://www.thegaitguys.com/thedailyblog/hey-check-it-out-john-wayne-has-either-a-left monthly 0.5 2011-09-26 https://www.thegaitguys.com/thedailyblog/going-to-try-a-new-pair-of-shoes-at-the-running monthly 0.5 2011-09-24 https://www.thegaitguys.com/thedailyblog/the-saucony-progrid-mirage-well-it-has-been-about monthly 0.5 2011-09-23 https://www.thegaitguys.com/thedailyblog/shoes-make-the-man-many-of-our-readers-may-not monthly 0.5 2011-09-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553752246-IUDW81B66KG3SYGUBSKJ/tumblr_lrmatuNuWQ1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553752940-57EKO3SUVCZXGLCF0RX0/tumblr_lrmatuNuWQ1qhko2so2_500.jpg Blog https://www.thegaitguys.com/thedailyblog/congrats-to-our-good-friend-and-colleague-dr-mark monthly 0.5 2011-09-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553753225-MBQ8W75TN6ERIZQDPD5U/tumblr_lrwnbz086c1qhko2so1_400.png Blog Congrats to our good friend and colleague, Dr Mark Cucuzella, just won ANOTHER Air Force marathon. Congrats to you, Mark . Read all about it here: http://naturalrunningcenter.com/2011/09/18/winning-air-force-marathon-natural-running-centers-dr-mark-cucuzzella-44-238/ https://www.thegaitguys.com/thedailyblog/circumducting-gait-this-is-a-great-video-this monthly 0.5 2011-09-22 https://www.thegaitguys.com/thedailyblog/this-week-dr-ivo-talks-about-interneurons-and monthly 0.5 2011-09-21 https://www.thegaitguys.com/thedailyblog/why-runners-need-to-take-a-page-out-of-their monthly 0.5 2011-09-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553752952-TRXRKSP9YFVTHPDUBX3A/tumblr_lpya9fk2Kb1qhko2so1_250.jpg Blog Why Runners need to take a page out of their automobile maintenance manual when it comes to running injury prevention. Tissues have limits. They are like a tire, they only have so much tread on them before they show pathology. But like a tire, it takes time for a wear pattern to show up enough to make the tire wobble or the axle to pull the car mildly towards the ditch.  Take a spinal disc, it has a certain number of compression and load cycles before it begins to desiccate, especially in the higher load / transition zones of the spine.  Cartilage has a certain number of cycles before it begins to desiccate and crack/fissure and flake.  Osteoarthritis then begins its slow sneaky onset.  Tendons and ligaments have the same “limited lifespan” especially if loaded imperfectly with strained joint loads.  Just because someone is pain free doesn’t mean they are safe. The abnormal load on an ITB band doesn’t begin the moment that pain presents itself.  The problem brews in the background long before there is pain. Pain and injury represent a failure point in the mechanism.  At this point it is too late.  Being in medicine, we would be just like all the others if we crisis managed every athlete that walks in the door.  So, we are in the game of prevention. We know our biomechanics, we know our orthopedics, physiology and neurology as good as the best out there. And so , we are well positioned on the front lines to identify problems before they ensue, and pick up on that aberrant wear pattern on the proverbial “tire” long before the pattern of wear is so bad that an injury is immanent and a foregone conclusion.  So, this bodes the bigger question, just because you are injury free for many marathons and decades, doesn’t mean you shouldn’t take your car in , have its tires rotated, lug nuts snugged up, and alignment tweaked so that  your car’s life will be maximized.  Remember, unlike a car, we get one set of tires. We cannot replace bolts, we cannot remove the rust or put in a new oil or air filter. All we can do it make sure our “car” , our body, is working as best it can with the anatomical parts it has.  We do not think anyone would disagree that leaving alone and ignoring a 99% stenosed artery in the heart’s “widow maker” artery is a good idea just because someone hasn’t had a heart attack yet.  Checking the body for malfunction early can prevent some unpleasant problems down the road.  Pain or tightness is the dashboard’s “check engine” light.  Regular check ups should keep that light off and reduce the sudden anxiety that comes when it turns on.  In summary, we take our cars in for tune up maintenance 2-3 times a year. And usually we drive away without the car driving too much different.  But, we are at ease knowing it is in tip top shape and can go another 6000 miles before it might show signs of wear.  We should do the same with our body and our gait mechanics and fix and change the little things that are sneaking up on us that could trigger that “check engine” light.  By the time it comes on, it could be too late and require major repairs which just might keep your “car” off the road for awhile while repairs are made.  No one likes to hear from the mechanic, “well Mr. Jones…….if we had checked up on this earlier before it was a big problem, we could have prevented this expensive set back on the sidelines.” Our bottom line,  even if your running is pain and injury free for years on end (which would make you a rare bird as runners go), it should make sense to you that improving biomechanical deficiencies isn’t likely a bad thing for the long term. Rather, it is probably the smartest of choices to keep you on your journey down the road, around the next bend, one efficient step after another. “An ounce of prevention is worth a pound of cure”. -Ben Franklin https://www.thegaitguys.com/thedailyblog/in-this-part-2-installment-of-applied-hip-gait monthly 0.5 2011-09-19 https://www.thegaitguys.com/thedailyblog/the-worlds-oldest-marathoner monthly 0.5 2011-09-18 https://www.thegaitguys.com/thedailyblog/the-new-brooks-pure-project-line-4-models-in-the monthly 0.5 2011-09-17 https://www.thegaitguys.com/thedailyblog/kicking-gait monthly 0.5 2011-09-17 https://www.thegaitguys.com/thedailyblog/listening-to-music-while-you-run-research-shows monthly 0.5 2011-09-16 https://www.thegaitguys.com/thedailyblog/well-they-say-shoes-make-the-manor-in-this-case monthly 0.5 2011-09-16 https://www.thegaitguys.com/thedailyblog/dr-shawn-allen-discusses-gait-biomechanics-again monthly 0.5 2011-09-15 https://www.thegaitguys.com/thedailyblog/today-in-neuromechanics-weekly-dr-waerlop-talks monthly 0.5 2011-09-14 https://www.thegaitguys.com/thedailyblog/well-in-some-ways-barefoot-is-better-in-those monthly 0.5 2011-09-13 https://www.thegaitguys.com/thedailyblog/forefoot-stiffness-its-all-in-the-supination monthly 0.5 2011-09-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553754480-N7MTXW2JAQSTZ8E8ICK7/tumblr_lr9wv9mBId1qhko2so1_1280.gif Blog Forefoot stiffness. It’s all in the supination… Remember a month ago when we talked about the basics of gait? If not, please see posts the week of 6/27 for a in depth discussion Suffice it to say, in stance phase (about 60% of the walking and 40% of the running gait cycles) we have 2 motions occurring: pronation and supination. In pronation (which begins as soon as the foot hits the ground and should end at midstance) the foot is becoming a mobile adaptor, so it can adapt to irregular surfaces and act as a shock absorber.  In supination (which begins at midstance and ends at preswing) the foot is becoming a rigid lever, to assist in transferring muscular forces to the lower limb to propel us forward. The picture above shows supination nicely. Remember that when one foot is in midstance, the opposite leg (in swing phase) assists in supination. This study (IOHO) demonstrates the principle of supination nicely and demonstrates the (major) role the foot plays in forefoot stiffness. J Biomech. 2005 Sep;38(9):1886-94. A comparison of forefoot stiffness in running and running shoe bending stiffness. Oleson M, Adler D, Goldsmith P. Source http://www.ncbi.nlm.nih.gov/pubmed/16023477 Department of Mechanical and Manufacturing Engineering, University of Calgary, 2500 University Drive, N.W. Calgary, Alberta, Canada T2N 1N4. Abstract This study characterizes the stiffness of the human forefoot during running. The forefoot stiffness, defined as the ratio of ground reaction moment to angular deflection of the metatarsophalangeal joint, is measured for subjects running barefoot. The joint deflection is obtained from video data, while the ground reaction moment is obtained from force plate and video data. The experiments show that during push-off, the forefoot stiffness rises sharply and then decreases steadily, showing that the forefoot behaves not as a simple spring, but rather as an active mechanism that exhibits a highly time-dependent stiffness. The forefoot stiffness is compared with the bending stiffness of running shoes. For each of four shoes tested, the shoe stiffness is relatively constant and generally much lower than the mean human forefoot stiffness. Since forefoot stiffness and shoe bending stiffness act in parallel (i.e., are additive), the total forefoot stiffness of the shod foot is dominated by that of the human foot. The Geeks of Gait: Ivo and Shawn https://www.thegaitguys.com/thedailyblog/born-to-run-perhaps-we-really-were-born-to-run monthly 0.5 2011-09-12 https://www.thegaitguys.com/thedailyblog/we-always-think-of-ourselves-as-the-csi-or-ncis monthly 0.5 2011-09-11 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553753891-X2WZ5LJZ85KJV2STSJT5/tumblr_lr7jng2XNw1qhko2so1_540.jpg Blog We always think of ourselves as the CSI or NCIS geeks of gait. We were aware of forensic analysis of footprints and this article is just the icing on the cake! article source: http://www.google.com/hostednews/afp/article/ALeqM5jhIh9jpQmYAgl6Rv0uBjNQgT1ItQ?docId=CNG.4ecd62b490d0f49529b2cfb2c331d332.481 Security first: When a footstep is like a fingerprint (AFP) – 1 day ago    PARIS — How a bare foot strikes the ground as one walks reveals your identity almost as well as a fingerprint, according to a study released Wednesday. The discovery means that one day retinal scans, voice recognition and old-fashioned mugshots may be joined by foot-pressure patterns as a means of confirming ID, it suggests. Previous research has shown that everyone has a unique stride. Computers can determine “gait patterns” – the way a person walks, saunters, swaggers or sashays – with up to 90-percent accuracy. Scientists led by Todd Pataky at Shinshu University in Tokida, Japan, looked at enhancing this finding by measuring how the foot hits and leaves the ground during walking. They used 3-D image processing and a technique called image extraction to analyse the heel strike, roll-to-forefoot and push-off by the toes among 104 volunteers. Footstep patterns were matched to the individual with 99.6 percent accuracy, according to their paper, published on Wednesday in Britain’s Journal of the Royal Society Interface. The study is “proof of concept,” meaning that it was carried out in experimental conditions among volunteers who were barefoot to see whether the theory was sound. In an email exchange with AFP, said the technology would be useful in security checks. But it would only work in situations where an individual wants to be recognised, “since anyone can modify their gait,” he explained. “Automated airport security checks, ATM security, controlled building access – in all these cases, an individual could walk normally to be positively identified.” Further work is needed to see whether feet that are shod throw up similar telltale patterns. “We have some pilot data for walking with shoes, but have not yet conducted systematic testing,” Pataky said. Too cool, eh? Ivo and Shawn https://www.thegaitguys.com/thedailyblog/evolved-to-run-how-we-keep-our-noodle-steady monthly 0.5 2011-09-09 https://www.thegaitguys.com/thedailyblog/we-thought-this-was-pretty-funny-the-moral-of-the monthly 0.5 2011-09-09 https://www.thegaitguys.com/thedailyblog/so-does-the-angle-your-foot-strikes-the-ground monthly 0.5 2011-09-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553754661-C4ZF7CF1HU97Y87W9UFN/tumblr_lqswpav8361qhko2so1_250.gif Blog So, does the angle your foot strikes the ground really matter? With all the talk about minimalistic training and striking under the body being less stress on the human frame and more efficient, you would think so. Here is one study that seems to support that premise. from the studies conclusion: “Our results indicate that individuals with a larger knee angle (i.e., greater extension) 50 ms prior to initial contact (IC) experience a higher ROL  (Rate of loading) during gait and have poorer proprioceptive scores.” Proprioception, gait kinematics, and rate of loading during walking: are they related? Riskowski JL, Mikesky AE, Bahamonde RE, Alvey TV 3rd, Burr DB. J Musculoskelet Neuronal Interact. 2005 Oct-Dec;5(4):379-87. http://www.ncbi.nlm.nih.gov/pubmed/16340143 Helping to promote gait literacy…We are…The Gait guys https://www.thegaitguys.com/thedailyblog/something-a-little-lighter-borrowed-from-one monthly 0.5 2011-09-07 https://www.thegaitguys.com/thedailyblog/this-week-on-neuromechanics-weekly-the-necessary monthly 0.5 2011-09-07 https://www.thegaitguys.com/thedailyblog/here-are-some-excerpts-from-a-talk-we-did-earlier monthly 0.5 2011-09-06 https://www.thegaitguys.com/thedailyblog/httpnaturalrunningcentercom20110822apolo-oh monthly 0.5 2011-09-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553754997-ZP9TI2DHH6L8W30HFX2M/tumblr_lqrw7faAwA1qhko2so1_500.jpg Blog http://naturalrunningcenter.com/2011/08/22/apolo-ohno-plans-run-york-city-marathon-gait-guys-check-form/ Check out another fun video we did for our friends at thenaturalrunningcenter.com and zero-drop.com featuring Apolo Ohno. photo credit: taminator’s photostream https://www.thegaitguys.com/thedailyblog/defective-running-shoes-as-a-contributing-factor monthly 0.5 2011-09-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553756283-0ZSUIGH3K6UWK6LVDIJ7/tumblr_lqrt8idnc91qhko2so1_100.gif Blog Defective Running Shoes as a contributing Factor in Plantar Fascitis in a Triathlete Wilk B, Fisher K, Guitierrez W: JOSPT 2000;30(1):21-31 http://www.jospt.org/issues/articleID.407/article_detail.asp Overview: Case study of 40 yo male triathlete who developed R sided plantar fascitis after completing a half ironman (2K swim, 90K bike, 21K run). The study describes the factors contributing to the injury, the rehab process, and shoe construction along with the symptoms of plantar fascitis. Authors Conclusion: A running shoe manufacturing defect was found that possibly contributed to the development of plantar fascitis. Assessing athletic shoe construction may prevent lower extremity overuse syndromes. What The Gait Guys Say: Plantar fascitis is something we see clinically many times in our practices. It is often due to overpronation of the midtarsal joint (talo-navicular and calcaneo-cuboid) in midstance, with insufficient supination from late midstance through preswing.  Thus, this over pronation causing overloading of the plantar fascia and windlass mechanism, resulting in increased torsional forces and micro-tearing at it’s proximal calcaneal (and sometimes distal) attachments. This causes local pain, swelling and inflammation, particularly at the calcaneal attachment site, which is alleviated by rest, ice and analgesics. As we have shared many times now, this over pronation does not have to be a local cause, it could be necessary from insufficient internal rotation of the hip or from other factors. In this study, the Right shoe upper was canted medially on the midsoles, believed due to it not being glued perpendicularly (as we often see inspecting a shoe from behind, especially Asics Kayano’s in our experience). The authors state they felt this contributed to excessive inward rolling of the right foot, contributing to overpronation. The authors make the following recommendations about shoe inspection: The shoe should be glued together securely The upper should be glued straight (perpendicular) onto the midsole. The shoe, viewed from behind should have a horizontal heel counter and vertical upper The sole of the shoe should be level to the surface on which it is resting (ie no medial to lateral motion should be present) You can test this by attempting to “rock” the shoe from side to side The shoes should not roll excessively inward or outward when resting on a level surface (ie when rolling from P to A) You can test this by rocking the shoe from A to P Air and gel pockets should be inflated evenly. This can be tested manually by pressing into them and checking for uniformity. A nice rehab protocol is also outlined over a 4 week period. Bottom Line: It pays to be shoe nerd. Shoes can help or hurt. We see manufacturers defects in shoes every day and tell clients to return the shoe; in fact some we collect  to use to show people. A rearfoot varus in a shoe will help to slow pronation. This may actually be beneficial for overpronators but detrimental for supinators. Some defects can be helpful but try and find defect free shoes. Stay away from “2nds” at cheapie stores and online specials. There is usually a reason they are being sold so cheaply. EVA’s have a shelf life and will break down over time. You must be able to not only recommend the appropriate shoe for your patient, based on their evaluation and gait analysis, but you need to inspect their footwear carefully and teach them to do the same. The original shoe nerds….Shawn and Ivo https://www.thegaitguys.com/thedailyblog/and-now-some-light-reading-for-a-saturday monthly 0.5 2011-09-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553755511-035S34Q7B27KEXD7LROX/tumblr_lqrsr8mark1qhko2so1_250.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553755914-TK6MBIEMPE199457BTS3/tumblr_lqrsr8mark1qhko2so2_250.gif Blog https://www.thegaitguys.com/thedailyblog/ah-yes-the-ia-and-type-ii-afferents-one-of-our monthly 0.5 2011-09-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553756738-7Y59VXJQHD5F4F1965RX/tumblr_lqq4mwhPBY1qhko2so1_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553756418-E8OUEKMII5II95IEIB2E/tumblr_lqq4mwhPBY1qhko2so2_500.gif Blog https://www.thegaitguys.com/thedailyblog/you-have-heard-of-minimalist-shoes-be-scared-be monthly 0.5 2011-09-02 https://www.thegaitguys.com/thedailyblog/shod-vs-unshod-what-the-lieberman-harvard-study monthly 0.5 2011-09-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553756903-1LZ3P8LB7N743GM6UCN6/tumblr_lqq0z0MWUs1qhko2so1_500.jpg Blog Shod vs. Unshod : What the Lieberman-Harvard study really said. Shod vs. Unshod : What the Lieberman-Harvard study really said. Thanks to OwenAnderson of  Educatedrunner.com for this excellent article. http://educatedrunner.com/Blog/tabid/633/articleType/ArticleView/articleId/797/BAREFOOT-RUNNING-WHAT-THE-HARVARD-STUDY-REALLY-SAID.aspx If you are paying attention to everything that is going on, you want to read this well thought out article.  The Gait Guys are digesting this article and we will render our thoughts and opinions shortly.  But, differing points of view, when laid out logically and with sound reason, deserve consideration. This is how the truth is eventually discovered. Give this article a productive and attentive read.  We will get back to you shortly. Summary statement seems to be this….. (quoted word from word from the article). _____________________________________________________ “Ironically, the popular press has been using the Harvard study as a launching pad for the idea that barefoot running is healthier than shod ambling, even though Lieberman’s paper provided no data at all to test the idea that barefoot running lowers the risk of running injuries!   Here’s what Lieberman et al actually found:   (A) Habitually shod runners (groups 1 and 5 from above) who grew up wearing shoes are usually rear-foot strikers (RFS), meaning that their heels make the first impacts with the ground during running, right at the beginning of the stance phase of gait. This is not new information. The strong link between running in shoes and heel-striking has been known for many years.   (B) Runners who grew up running barefooted or who switched to running barefooted (groups 2, 3, and 4) are generally fore-foot strikers (FFS), meaning that they tend to land initially on the balls of their feet while running, after which their heels drop down to make contact with the ground. Again, this is nothing new – the tight connection between barefoot running and FFS (and also MFS, mid-foot striking) has been general knowledge for years.   © Impact forces transmitted through the foot, ankle, and leg immediately after impact with the ground are about three times greater in shod runners using RFS, compared with barefoot runners with FFS. Some – but not all - previous studies have shown this same relationship, with RFS producing greater impact force during the first portion of stance, compared with MFS and FFS. The sudden rise in force with RFS, immediately after ground contact, is known as the “impact transient.” The disparity in impact transient between barefoot and shod running represents a “foundation” for the belief that barefoot running is “safer” and less injury producing. While this appears to be logical thinking, it is important to know that no study has ever shown that greater impact forces during the first portion of stance magnify the risk of running injury.   (D) Rates of loading of impact force are actually quite similar between shod RFS runners and barefoot FFS athletes (Figure 2b from the Nature paper). The rate at which impact force is loaded into the leg has also been suggested to be a risk factor for injury, although convincing proof of this notion does not exist.   (E) During the early stance phase of barefoot FFS running, there is greater knee flexion, greater dorsi-flexion at the ankle, and a 74-percent-greater drop in the center of mass, compared with shod RFS running. “Vertical compliance” is defined as the drop in the runner’s center of mass relative to the vertical force during the impact period of stance, and it is obviously greater in barefoot FFS running, compared with shod RFS. Vertical compliance varies as a function of running-surface hardness, and this is why force-loading rates are similar for barefoot FFS runners over a wide array of running surfaces (the runners adjust compliance according to surface). This is not novel information, however.   (F) During barefoot FFS ambling, the ground reaction force torques the foot around the ankle (and therefore increases the amount of work carried out by the ankle, compared with shod RFS running). With shod RFS running, the ankle converts little impact energy into rotational energy. Potentially, this could spike the rate of ankle-area injuries (for example in the Achilles tendon and calf) for barefoot runners, although this hypothesis has not been tested.   And that was pretty much it! The Nature investigation did disclose some interesting information about the effective mass of the foot and shank (which we won’t discuss here), but it offered no other information about the potential links between barefoot running and either injury or performance.   And that’s why it’s too early for you to consider changing from shod to barefoot running, unless such a shift would be a lot of fun for you.  There’s just no proof that barefoot running will reduce your risk of injury or make you faster.   In fact, it’s important to remember that most injuries in running are caused by an imbalance between the strain and micro-damage experienced by a muscle or connective tissue during training and the tissue’s ability to recover from such stress. This imbalance can occur when training is conducted shod – or barefooted! A weak or overly tight hamstring muscle which has been undone by excessive mileage won’t care if its owner was running barefooted or wearing shoes – it will still feel the pain. ” - Owen Andersson, http://educatedrunner.com/Blog/tabid/633/articleType/ArticleView/articleId/797/BAREFOOT-RUNNING-WHAT-THE-HARVARD-STUDY-REALLY-SAID.aspx https://www.thegaitguys.com/thedailyblog/in-this-weeks-neuromechanics-weekly-dr-waerlop monthly 0.5 2011-08-31 https://www.thegaitguys.com/thedailyblog/so-the-question-you-need-to-ask-is-why-they-cut monthly 0.5 2011-08-30 https://www.thegaitguys.com/thedailyblog/here-dr-allen-of-the-gait-guys-introduces-some-of monthly 0.5 2011-08-29 https://www.thegaitguys.com/thedailyblog/ivo-and-shawn-what-we-do-while-you-are monthly 0.5 2011-08-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553757465-P4Q7QKSH6O681C3IET39/tumblr_lql7hhmNcK1qhko2so1_400.jpg Blog Ivo and Shawn …. what we do while you are sleeping. our version of crop circles ! watch for signs of our presence at your local beach or wheat field near you ! you are not alone……. photo from . http://nakedonsharppointystuff.blogspot.com/ https://www.thegaitguys.com/thedailyblog/so-how-did-you-do-as-you-can-see-this monthly 0.5 2011-08-27 https://www.thegaitguys.com/thedailyblog/oh-look-it-appears-but-a-little-hard-to-tell monthly 0.5 2011-08-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553757913-TL07RZBKR3YM070LY5C6/tumblr_lqhuwiPJho1qhko2so1_1280.jpg Blog oh look, it appears (but a little hard to tell) ……but it appears we have a casualty ! here is what her ankle is saying ….. “oh no, we do not have enough ankle dorsiflexion to be on this bad boy…….so, who wants to take it guys…….. how about you hyperpronate Mr. Arch, and to help we will drive Mr. Knee medially."  ? https://www.thegaitguys.com/thedailyblog/better-have-enough-ankle-dorsiflexion-if-you-are monthly 0.5 2011-08-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553758172-9SGXZOAI67R5BRBJHDQL/tumblr_lqhum6HGWl1qhko2so1_1280.jpg Blog better have enough ankle dorsiflexion if you are gonna play with this monster ! https://www.thegaitguys.com/thedailyblog/how-are-your-eyes-test-yourself-on-this-video monthly 0.5 2011-08-26 https://www.thegaitguys.com/thedailyblog/welcome-to-friday-ummm-what-can-we-say-make monthly 0.5 2011-08-26 https://www.thegaitguys.com/thedailyblog/part-3-the-problematic-cross-over-gait-motor monthly 0.5 2011-08-25 https://www.thegaitguys.com/thedailyblog/here-dr-shawn-allen-of-the-gait-guys-further monthly 0.5 2011-08-25 https://www.thegaitguys.com/thedailyblog/funny-nancy-sinatra-clip-on-zero-dropcom monthly 0.5 2011-08-24 https://www.thegaitguys.com/thedailyblog/video-presentation-the-problematic-cross-over monthly 0.5 2011-08-24 https://www.thegaitguys.com/thedailyblog/welcome-to-neuromechanics-weeekly-this-week-dr monthly 0.5 2011-08-23 https://www.thegaitguys.com/thedailyblog/the-truth-about-treadmills-a-neurological monthly 0.5 2011-08-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553758681-CAVA80F8H00VTX6L6IRI/tumblr_lq7m4hUHRb1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553758861-EK8HXFT4A34NDYER7JT9/tumblr_lq7m4hUHRb1qhko2so2_500.jpg Blog https://www.thegaitguys.com/thedailyblog/dvds-we-have-made-for-sale monthly 0.5 2011-08-21 https://www.thegaitguys.com/thedailyblog/9166382872 monthly 0.5 2011-08-20 https://www.thegaitguys.com/thedailyblog/part-8-conclusion-dr-ivo-waerlop-of-the-gait monthly 0.5 2011-08-20 https://www.thegaitguys.com/thedailyblog/oh-pippa-for-gods-sake-or-at-least-the monthly 0.5 2011-08-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553759445-882U5EN3KAXH9BXBXUL5/tumblr_lpvlljrYO01qhko2so1_400.png Blog Oh Pippa ! For God’s sake (or at least the Queen’s) start using your gluteus medius for crying out loud ! That opposite hip drop isn’t winning Dr. Allen over. ! (internal tibial torsion, knees approximating (due to the lack of left g. medius use, high ramp angle shoe……..mon dieu !……. great dress, bad shoe though ! ) Gluteus medius avoidance and blood pudding, apparently it’s what’s for brunch these days ! The Gait Guys https://www.thegaitguys.com/thedailyblog/now-these-are-our-kinda-geeks-the-gait-guys monthly 0.5 2011-08-19 https://www.thegaitguys.com/thedailyblog/part-7-dr-ivo-waerlop-of-the-gait-guys-natural monthly 0.5 2011-08-19 https://www.thegaitguys.com/thedailyblog/gluteal-asymmetry-it-means-something-two monthly 0.5 2011-08-18 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553759526-MK4SSMZROUHZ78D3FXLL/tumblr_lq4ztex8wN1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553759854-0SIWYBHFIXXRS5JXH6NF/tumblr_lq4ztex8wN1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/part-6-dr-ivo-waerlop-of-the-gait-guys-on-the monthly 0.5 2011-08-18 https://www.thegaitguys.com/thedailyblog/part-5-the-gait-guys-on-the-experts-panel monthly 0.5 2011-08-17 https://www.thegaitguys.com/thedailyblog/this-week-we-conclude-the-mechanoreceptor monthly 0.5 2011-08-17 https://www.thegaitguys.com/thedailyblog/so-is-this-foot-a-flexible-flat-foot-or-is-it-a monthly 0.5 2011-08-16 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553760329-RTCIS9ZKDUUQALKF75P3/tumblr_lq17gaw5B21qhko2so1_1280.jpg Blog So, is this foot a flexible flat foot or is it a rigid flat foot ? You need to know. today’s blog post should help you in some thinking. https://www.thegaitguys.com/thedailyblog/factors-that-adversely-effect-the-natural-history monthly 0.5 2011-08-16 https://www.thegaitguys.com/thedailyblog/part-4-dr-ivo-waerlop-on-the-panel-of-experts monthly 0.5 2011-08-16 https://www.thegaitguys.com/thedailyblog/online-barefoot-lecture-by-the-gait-guys monthly 0.5 2011-08-16 https://www.thegaitguys.com/thedailyblog/part-3-dr-waerlop-newton-natural-running monthly 0.5 2011-08-15 https://www.thegaitguys.com/thedailyblog/stage-1-of-correcting-a-flat-foot-video monthly 0.5 2011-08-15 https://www.thegaitguys.com/thedailyblog/part-2-dr-waerlop-on-the-panel-at-the-2011 monthly 0.5 2011-08-14 https://www.thegaitguys.com/thedailyblog/dr-ivo-on-the-experts-panel-for-this-years-2011 monthly 0.5 2011-08-13 https://www.thegaitguys.com/thedailyblog/2011-newton-natural-running-symposium-experts monthly 0.5 2011-08-13 https://www.thegaitguys.com/thedailyblog/the-london-looters-getaway-stride-gait-analysis monthly 0.5 2011-08-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553760207-3Q2UHRVDJXHWNY9VFWSH/tumblr_lps0ypSK8i1qhko2so1_500.jpg Blog The London Looter’s Getaway Stride: Gait analysis by The Gait Guys We did this one yesterday in collaboration with our good friends at Zero-drop.com on their awesome blog.  Check out their stuff. The images coming out of England of young hoodie-wearing hoodlums rioting, stealing, smashing store windows, torching cars, and causing all-out mayhem in London and elsewhere is unsettling for several reasons. What exactly are these lawless yobs protesting? Are these race-induced riots? Public outcry over political and social injustice? Or are these roaming gangs of hooligans more interested in something else–like getting their hands on free stuff such as 46-inch flat-screen high-definition televisions and Nike sneakers. In the photo here, it appears as though a young lad has just swiped a bottle of something lip smacking  from a Manchester food store. It seems that he dressed for the occasion –Adidas track suit and running shoes–  to facilitate a quick, speed getaway. He’s much too young to be hitting the bottle. Plus, one can easily assume that he didn’t expect to make the front page of the U.K. Daily Mail where this photo first appeared. (He’s probably sitting right now in juvie detention.) In any case, Zero Drop asked the Gait Guys to look at his running stride. Here’s their expert analysis: __________________________________________________________________________ This chap looks a bit young to be drinking, and we doubt he is a courier. Let’s see if he will make a clean getaway, shall we? Beginning from the bottom, we see his left foot is turned in and his knee appears straight, He does appear to be banking a left turn, but we would expect him to probably have his toe out a bit for stability since he is really banking heavily into the frontal plane (he must have a great right gluteus medius because he is holding a fairly decent pelvic line into the bank), so our guess is he has a bit of internal tibial torsion (i.e., his foot points in when his knee is straight ahead. This is usually a condition from birth). Folks with internal tibial torsion tend to have their feet in supination more, so they are excellent levers, but it usually means they lack some shock absorption (so maybe we find a forefoot valgus in that shoe, who knows). Because his knee is not in line with his line of forward progression, there will be a conflict there, which could potentially hurt his knee, besides cutting down on his mechanical efficiency (the knee is like a door hinge, and works best when moving in one direction). His lean to the left nicely complements his probable forefoot varus (or inversion of the forefoot), so at least he has that working for him. There is a little hip sag on the left, indicating a weak gluteus medius on the right; which further cuts down his mechanical efficiency; it is moving to the right as he is cutting to the left. Holding that bottle sure cuts down on his arm swing, and he looks a bit tense, as his left shoulder is higher than the right. Like he is trying to hide something. Finally, his head posture looks forward. This facilitates his flexors and inhibits his extensors, taking away from power to drive him forward. We could go on and on, and we have. Guess we told you how to build a clock and you only wanted to know what time it is. In short, whether he gets caught depends on the biomechanics of his pursuer. We hope he doesn’t have internet access to our blog, we would hate for him to recognize his problems and improve upon them.  We would be contributing to improved “get-aways” in the future.  That wouldn’t be good, unless someone was chasing him with a .22 , then we might feel ok with it. Hooch for the youngers, it’s not just for the back alley’s anymore ! - the gait guys https://www.thegaitguys.com/thedailyblog/a-different-kind-of-marathon-so-you-think-you-are monthly 0.5 2011-08-12 https://www.thegaitguys.com/thedailyblog/a-brief-gait-analysis-of-a-pretty-famous monthly 0.5 2011-08-11 https://www.thegaitguys.com/thedailyblog/join-dr-ivo-as-he-explores-the-world-of-joint monthly 0.5 2011-08-10 https://www.thegaitguys.com/thedailyblog/facebook monthly 0.5 2011-08-09 https://www.thegaitguys.com/thedailyblog/yesterdays-video-case-the-gaits-of-hell-we-have monthly 0.5 2011-08-09 https://www.thegaitguys.com/thedailyblog/new-feature-the-gaits-of-hell-heavens monthly 0.5 2011-08-08 https://www.thegaitguys.com/thedailyblog/hot-hot-hot-cute-newbalance-minimus-add-for monthly 0.5 2011-08-05 https://www.thegaitguys.com/thedailyblog/the-windlass-mechanism-of-the-plantar-fascia-what monthly 0.5 2011-08-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553760977-SMP6ZRFSILXOKQBWDHSF/tumblr_lpd1tl6hV11qhko2so1_r1_1280.jpg Blog The Windlass Mechanism of the Plantar fascia. What is a Windlass anyway? After yesterdays post, we thought we might provide more insight to the Windlass mechanism and low and behold; we found AN ENTIRE PAPER on it! Wow, were we thrilled since there is not a ton of decent stuff out on this topic (yes, we are a little geeky, but then again so are you if you are reading this !). A Windlass is the tightening of a rope or cable around a pivot point. The plantar fascia acts like a cable between the calcaneus and its distal insertion into the proximal phalanyx at the metatarsal phalangeal joints. When the toes are dorsiflexed (as in forefoot rocker from yesterdays post, see bottom diagram above), the heel and toes SHOULD become approximated, as the plantar fascia shortens from its winding around the metatarsal head, contributing to supination of the foot. To be accurate, this concept of the Windlass mechanism is quite complex because the dorsiflexion of the great toe also shortens the length of the flexor hallucis brevis.  And we know that the sesamoid bones under the big toe are embedded in its tendon. Their repositioning as the Windlass engages will drive the sesamoids under the metatarsal, elevating it, and shift this joints eccentric axis.  But this is a complex story and post better left for another day.  Simply put, this is a complex joint, do not let anyone fool you otherwise.  Don’t beleive us ? Ask any bunion (or God forbid a fusion) surgery patient how they are doing.  You will get the point then.  Here’s the link to the article (we know you want to read it ! ) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC385265/ The Windlass Mechanism. Just another fascinating foot fact from The Gait Guys. https://www.thegaitguys.com/thedailyblog/forefoot-rocker-and-premature-heel monthly 0.5 2011-08-04 https://www.thegaitguys.com/thedailyblog/welcome-to-neuromechanics-a-regular-weekly monthly 0.5 2011-08-03 https://www.thegaitguys.com/thedailyblog/the-cross-over-gait-slow-motion-barefoot-video monthly 0.5 2011-08-02 https://www.thegaitguys.com/thedailyblog/a-case-of-hip-pain-in-a-young-runner-perthes monthly 0.5 2011-08-01 https://www.thegaitguys.com/thedailyblog/shoe-review-the-brooks-pure-project-line-ok-we monthly 0.5 2011-07-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553761733-EFWBETCWB8BC9NAV6F4V/tumblr_lp05mux9ef1qhko2so1_500.jpg Blog Shoe Review: The Brooks Pure Project Line. Ok, we have been meaning to get to this for months but are just getting around to it now. So for those of you who have been hounding us for the data, sorry, but thanks for keeping us on it.  Here are the specs for the EVA midsole thicknesses and ramp numbers. Remember, ramp angle can only be given if the length of the foot is known, so those numbers will not be given here.  What is good to know is that we have another shoe in the category of the Saucony Kinvara, the Brooks Pure Project line.  Below you will see the specs for all 4 in the line up.  All have a 4 mm forefoot to rearfoot rise, in other words……the heel is only 4 mm lifted compared to the plane the forefoot is resting on.  This still changes the biomechanics and neuromechanics that we were all given at birth that would really prefer the rear and forefoot to be on the same plane 1:1 ratio although a 4 mm rise is pretty darn close !  Our man beef with the Saucony Kinvara is that they did not use much black rubber outsole on the shoe other than the small thin layer glued to the traction lugs  throughout the mid and forefoot.  We have found that these shoes barely get 200 miles on them (give or take) and we and all our clients are already into the EVA midsole which wears down as fast as bubble gum might.  This is a serious design flaw in our opinion. We like this shoe and like it for many clients but we are having to explain that they will burn through them in under 350 miles most likely.  So, we are excited for the October Release of the Brooks Pure Project line……in the hopes that they have not made this same design choice.  Remember, if you are new to this line of shoes, the 4mm lift variety, wean down from your old 12-20mm rear-foot lift trainers and try these with your shorter runs until skill, endurance and strength are achieved in this new foot orientation.  It is gonna take some people some time to accomodate.  (remember, there is no substitute for a doctor’s exam and watchful eye to see if you can even entertain this shoe type with your foot type). (Do not be fooled into believing there is going to be much stability provided by these shoes.  They are all pretty neutral. If you have a  forefoot varus, you better look in another direction !) Here is the data ……. Brooks Pure Connect lightest and most flexible shoe in the line, the PureConnect puts as little as necessary between the runner and road. 7.2 oz men, 6.5 oz women – 14 mm heel:10 mm forefoot Brooks Pure Flow For runners who want to connect with the run without losing the comfort of dynamic cushioning. 8.7 oz men, 7.5 oz women – 18 mm heel :14 mm forefoot Brooks Pure Cadence Runners who need more supportive features can still experience the feel of a more natural stride. 9.5 oz men, 8.3 oz women – 18 mm heel:14 mm forefoot Brooks Pure Grit Trail runners will love the hug-your-foot upper, slim midsole, and pliable yet protective outsole. 8.9 oz men, 7.6 oz women – 15 mm heel:11mm forefoot __________ https://www.thegaitguys.com/thedailyblog/good-morning-everyone-here-is-another-cool-take monthly 0.5 2011-07-29 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553761634-YR24MLW7LPX4XLMKTIGV/tumblr_low4s7u8RI1qhko2so1_400.gif Blog Good Morning, everyone! Here is another cool take on Trinity from “The Matrix” that we did for our buds at The Natural Running Center.com and Zero-Drop.com. Click on the photo to be transported…… http://naturalrunningcenter.com/2011/07/24/trinity-outruns-agent-brown-the-matrix-gait-guys-movies/ https://www.thegaitguys.com/thedailyblog/deano-it-is-friday-here-on-the-gait-guys-and-we monthly 0.5 2011-07-29 https://www.thegaitguys.com/thedailyblog/photographs-of-a-6-yr-old-what-do-you-see-how monthly 0.5 2011-07-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553762001-SPLB89F3CXDWPJX8WJQT/tumblr_loa5ivO33C1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553762994-O8VCM0F1L1EJ52OECB2B/tumblr_loa5ivO33C1qhko2so2_400.jpg Blog https://www.thegaitguys.com/thedailyblog/1-1-usually-2 monthly 0.5 2011-07-27 https://www.thegaitguys.com/thedailyblog/more-on-bunions-proof-we-know-what-we-are-talking monthly 0.5 2011-07-27 https://www.thegaitguys.com/thedailyblog/biomechanical-and-clinical-factors-related-to monthly 0.5 2011-07-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553763130-XDC7QU06KWB4P0GU634U/tumblr_louwzePPmE1qhko2so2_1280.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553763220-B76TO9JTB6HALP4KTALX/tumblr_louwzePPmE1qhko2so5_r1_250.jpg Blog https://www.thegaitguys.com/thedailyblog/ancient-footprints-reveal-earliest-signs-of monthly 0.5 2011-07-25 https://www.thegaitguys.com/thedailyblog/dr-mark-puts-succinctly-what-we-have-been-saying monthly 0.5 2011-07-23 https://www.thegaitguys.com/thedailyblog/imagine-having-to-walk-like-this-and-wear-a-kilt monthly 0.5 2011-07-22 https://www.thegaitguys.com/thedailyblog/the-mighty-quadratus-part-2-the-quadratus-and monthly 0.5 2011-07-22 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553763354-CSX4VLTPSLI5DFKSBP9S/tumblr_lohzpbv2Zj1qhko2so1_500.png Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553763694-JHR7IMC48BMNWJOLKP4V/tumblr_lohzpbv2Zj1qhko2so2_250.jpg Blog https://www.thegaitguys.com/thedailyblog/do-you-know-we-are-on-facebook-and-twitter monthly 0.5 2011-07-21 https://www.thegaitguys.com/thedailyblog/the-mighty-quadratus-part-1-today-we-explore-the monthly 0.5 2011-07-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553764622-F7YOWGN8ZKX037ZAMNNZ/tumblr_lohzj4iyha1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553764377-F90O8D15LOGKXI0XMOA5/tumblr_lohzj4iyha1qhko2so2_250.jpg Blog https://www.thegaitguys.com/thedailyblog/a-brief-gait-review-from-a-youtube-clip-we-found monthly 0.5 2011-07-20 https://www.thegaitguys.com/thedailyblog/the-risks-for-forefoot-strike-running-you-need-to monthly 0.5 2011-07-20 https://www.thegaitguys.com/thedailyblog/time-for-a-quick-pedograph-case-this-person monthly 0.5 2011-07-19 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553765041-U4FP0MCJYZI9609QV161/tumblr_lo77y0LOcc1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553765346-9XIR5UJ60OQY0CVTCOZ0/tumblr_lo77y0LOcc1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/another-gait-guys-remake-for-our-buds-at-the monthly 0.5 2011-07-18 https://www.thegaitguys.com/thedailyblog/even-cadaver-feet-speak-volumes monthly 0.5 2011-07-17 https://www.thegaitguys.com/thedailyblog/a-brief-note-on-internal-hip-rotation-from-a monthly 0.5 2011-07-16 https://www.thegaitguys.com/thedailyblog/redemption-lots-of-midfoot-strike monthly 0.5 2011-07-15 https://www.thegaitguys.com/thedailyblog/grab-a-beer-and-watch-this-heel-strike-flick monthly 0.5 2011-07-15 https://www.thegaitguys.com/thedailyblog/even-though-it-isnt-winter-we-could-resist monthly 0.5 2011-07-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553765693-Q71FO77OXV67HI9FNQMR/tumblr_lnzt1cx0Z31qhko2so1_500.jpg Blog Even though it isn’t winter, we could resist showing you these “toasty” slippers… Have a fun Friday, Ivo and Shawn https://www.thegaitguys.com/thedailyblog/the-hip-part-4putting-it-all-together monthly 0.5 2011-07-14 https://www.thegaitguys.com/thedailyblog/so-many-foot-types monthly 0.5 2011-07-13 https://www.thegaitguys.com/thedailyblog/the-hip-part-3-more-on-hip-rim-syndromes-and monthly 0.5 2011-07-13 https://www.thegaitguys.com/thedailyblog/ars-acetabular-rim-syndromes-hip-pain-some monthly 0.5 2011-07-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553767144-UE6Z2JLWK3DECPG38VYO/tumblr_lo77mjbUTM1qhko2so1_250.jpg Blog ARS: Acetabular Rim Syndromes.  Hip Pain.  Some examples of MOI’s (Mechanism of Injury) -An athlete complains of a gradual onset of pain deep within his or her anterior groin. -Forceful kicking a ball with the medial border of the foot may cause a sharp pain with a catching sensation. -A case involving a ballerina with 10 months of left hip pain originated during a high kick in the abducted position; she felt a sudden catching sensation in the anterior left groin. -A car accident with knee dashboard impact forcing femur posteriorly. -A wrestler in a quadruped position forced back onto heels (buttock to heels) Labral lesions have a strong correlation with  anterior inguinal pain painful clicking transient locking giving way of the hip Pain may be reproduced with flexion and internal rotation of the hip An audible click may also be present The patient history usually does not reveal significant trauma The onset of pain may be related to sports and may involve a mild twisting or slipping injury Radiographs in patients with labral tears are typically unremarkable. If early osteoarthritic disease is present, the pain is out of proportion to the radiographic changes. While the pain is usually in the groin, it could also be in the trochanteric and buttock region. A significant trauma is not necessary to disrupt the labrum - twisting or falling may be causative. The injury is usually caused by the hip joint being stressed in rotation. The pain could be acute or insidious. The most common complaint is discrete episodes of sharp pain precipitated by pivoting or twisting. Clicking or catching is common but not always present. Activities that involve forced adduction of the hip joint in association with rotation in either direction tend to aggravate. The majority of labral tears (up to two-thirds) are located anteriorly. Their hip pain is often nonspecific regarding symptoms. Radiological findings may be negative. It is important to rule out early any possibility of fractures, infections, inflammation or ischemic necrosis; laboratory tests of blood, urine and at times synovial fluid may be necessary. Acetabular dysplasia, considered pre-osteoarthritic by some, is a valid clinical entity that must be considered.  Some references are calling this disorder dysplastic acetabular rim syndrome (DARS). Early symptoms will occur due to overload of the acetabular rim caused by hip motions such as a combination of flexion, adduction and internal rotation. Getting out of a car or doing the breast stroke are examples of this type of movement stress.  Snapping, locking and clicking are common in ARS, causing the clinician to think of problems related to the labrum or a painless snapping iliopsoas. Snapping hip complaints must be discriminated from functional hip problems such as anterior femoral glide syndrome and IT Band syndrome. Symptoms due to hip instability may be related to ARS. The patient may suffer unexplained falls or the feeling that his or her hip may give way. With acetabular dysplasia, there may be excessive anteversion of the femoral neck, causing an increase in hip internal rotation on examination. The capsular pattern of the hip that indicates osteoarthritis is almost always a decrease in hip internal rotation. Therefore, as soon as osteoarthritis appears, decreased hip internal rotation will also appear. We are going to leave things here for today…….we wanted to leave you with 3 words for the day……..INTERNAL HIP ROTATION.  Keep these 3 words in your clinical hat for the day, look for its loss and start thinking about your runners, your patients.  Look for this loss when the patient is supine and in the straight leg position.  Test the hip rotation from spinning the hip (from an ankle contact point) into internal rotation, compare side to side.  More tomorrow ……but remember, sometimes it is not the part……but the anchor for the part….. hence why we will be talking about the lower abdominals as the week goes on. The amount of Internal hip rotation available is only as much as the abdominal wall can support or anchor (ie. a weak abdominal wall cannot support much functional internal hip rotation…….. why ? tune in tomorrow ! as we bring this full circle.) ……….. we are more than…….Just The Gait Guys https://www.thegaitguys.com/thedailyblog/the-hip-part-1-hip-labral-tears-the-rim monthly 0.5 2011-07-11 https://www.thegaitguys.com/thedailyblog/check-out-our-take-on-this-classic-that-we monthly 0.5 2011-07-10 https://www.thegaitguys.com/thedailyblog/gender-differences-in-walking-and-running-on-level monthly 0.5 2011-07-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553766744-5FWIPHISQR0IKKF7QDMV/tumblr_lo0othGbtL1qhko2so1_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553767513-I3GK7V9EXUAU996C2NAB/tumblr_lo0othGbtL1qhko2so2_500.jpg Blog https://www.thegaitguys.com/thedailyblog/more-silly-gaits-a-take-off-on-the-monty-python monthly 0.5 2011-07-08 https://www.thegaitguys.com/thedailyblog/lombards-paradox monthly 0.5 2011-07-08 https://www.thegaitguys.com/thedailyblog/here-is-some-more-vintage-shawn-and-ivo-from-09 monthly 0.5 2011-07-07 https://www.thegaitguys.com/thedailyblog/follow-up-post-on-yesterdays-foot-tripod-video monthly 0.5 2011-07-06 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553768377-634KY6Y5FEH23GVEW4HJ/tumblr_lnx4bkwGq11qhko2so1_250.jpg Blog Follow up post on yesterdays FOOT TRIPOD VIDEO Good Day Fellow foot geeks ! Yesterday we posted a quick video of a young  teenager who came to us for orthotic prescription.  As you can see in the early part of the video he had a flat foot posturing and increased foot progression angle (feet pointing too much east and west).  The increased foot progression posturing can be a problem, and accentuate pronation strategies,  particularly if it is outside the normative values of 5-15 degrees. This is because during midstance the limb is internally rotating.  If the foot progression angle is increased as the limb internal rotation occurs while the body mass is progressing over the foot in midstance, the positioning of the medial tripod of the foot is far off the forward/sagittal progression line (the direction of walk). When the tibia and femur internally rotate on such a foot posturing the degree of pronation is accelerated and accentuated. In another way of explaining it, the subtalar joint is almost falling medially outside of the tripod boundaries and thus cannot be controlled by the tripod. It would be like placing a camera directly on the letter “c” in the triangle diagram above, where the points of the triangle represent the positions of the camera tripod legs. The camera is at risk of tipping over because the mass of the cameral is not within the solid boundaries of the triangle.  In the foot, these tripod leg points would be represented by the 1st and 5th Metatarsal heads and the heel forming a triangle.  The goal is to stabilize the tripod on level ground and place the camera  (foot) in the middle of the tripod for maximal stability.  But, when the foot progression angle is increased, the triangle and foot position take on the triangle appearance above, risking pronation excesses. The problem is that many folks do not know they have developed this problem posturing until symptoms occur.  This young lad was brought into our offices by an aware mom who had heard of similar successes we have had with other children and adults.  It took all of 10 minutes to retrain his awareness of the foot tripod and posturing of the feet underneath the body (where he noticed that he could not pronate as much as seen at the end of the video clip).  HE did awesome as you can see.  For the first time in his life he saw an arch and knew how to correct his foot posturing. He became aware of the use and need for good toe extension to raise the arch (a phenomenon known as The Windlass Mechanism of Hicks).  The last stage would be to help  him retrain these strategies in gait and various movements.  We will see if we can find that video somewhere. Bottom line, …….did this kid need an orthotic……. NO !  It would have kept absent the strength development of the muscles needed to make the correction you see in the video.  This kid now has a fighting chance to develop normally. Hope this helps to explain what was going on in yesterdays video. We are………foot nerds……. Shawn and Ivo https://www.thegaitguys.com/thedailyblog/this-is-a-video-follow-up-to-last-weeks-rockers monthly 0.5 2011-07-06 https://www.thegaitguys.com/thedailyblog/the-tripod-correction-and-your-arches-in-follow monthly 0.5 2011-07-05 https://www.thegaitguys.com/thedailyblog/dr-ivo-waerlop monthly 0.5 2011-07-05 https://www.thegaitguys.com/thedailyblog/foot-arch-question-sent-in-from-one-of-our monthly 0.5 2011-07-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553768068-6OY5JKGN8LICH4SN4BHU/tumblr_lnrp8vNdSz1qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553768469-674O2B8H0M9P8TEU20F8/tumblr_lnrp8vNdSz1qhko2so2_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553768912-G97WXB6ZH7E0O6VRQCZP/tumblr_lnrp8vNdSz1qhko2so3_540.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553769170-F3H5NOY70NLUA5CQ0HY6/tumblr_lnrp8vNdSz1qhko2so4_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/and-now-for-something-totally-random-how-much monthly 0.5 2011-07-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553769525-ACKW38QM0YPY6PSUIR8G/tumblr_lnronsK9zQ1qhko2so1_250.jpg Blog And now for something totally random…. How Much Water should I drink? The basics of hydration We see many athletes and weekend warriors and are often posed this question; so here you go… Water is the elixir of life. Too much (hyper hydration) or not enough (dehydration) can both be detrimental to your performance, but how much is enough? Our bodies consist of about 60-70% water at any point in time. Most men have a higher percentage because they have a higher percentage of muscle mass (unfortunately, adipose tissue contains little water!). We generally lose between 1.5 and 2.5 liters of fluid a day through breathing, urinating and general metabolism. The body must keep a balance of water both inside (intracellular) and outside (extra cellular) your cells. Because the body is in equilibrium, if you sweat, breathe, or urinate too much, you will lose water from your extra cellular compartment. The body will then take water from inside your cells and shift it to outside. Likewise, your brain (hopefully) will stimulate you to drink more and urinate less, helping you to fill up the extra cellular compartment again. The water will then diffuse back into the cells and equilibrium is established again. A lot of this movement of water has to do with electrolytes (charged particles in your blood and body fluids) and their movement across cell membranes. The electrolytes that are most important for us are Sodium (Na+) and Potassium (K+). When you lose too much water, your blood becomes more viscous (remember, you are losing water, not cells. Less water plus same number of cells equals more viscous liquid). This makes your heart have to work harder to push the blood around. This takes more energy and resultantly your heart rate increases, causing a phenomenon called cardiac drift. An example is when you are exercising for a while at the same intensity and your heart rate increases over time. A loss of 2-3% of your body’s water will decrease your performance by 3-7%! The amount you lose will depend on your exercise intensity and duration as well as temperature. A 20 degree increase in temperature can increase your heart rate as much as 10 beats per minute!! So, it seems if we drink a lot of water, all will be well. Well, yes… and no. Your body can only absorb about 24-28 ounces of water per hour, any more and it just makes you pee more. You can sweat up to 3 liters (that’s more than 96 ounces!) per hour. Hmm. looks like we will probably be in a deficit. How much we absorb depends on whether we can get the water out of our stomach and into our intestines where it can be absorbed. As you can imagine, there are some things which speed gastric emptying and some which slow it down. Protein and fat are the 2 main things which slow the trip through the stomach down. If too much of these are in your drink or already in your stomach the water will end up sloshing around and probably leave you not feeling too good. Guess that means lots of protein before or during an endurance workout is probably a bad idea, especially if you are trying to stay hydrated! Small amounts of protein, when combined with carbohydrate can be beneficial, but that’s another subject for another day. So much for all that marketing hype! Small amounts of carbohydrate (up to 60 grams per hour) can enhance water absorption from the intestines and speed emptying of the stomach. The body can’t process any more than this, and it will actually start to slow stuff down if you do too much. Sodium (50-70 mg, about a pinch) also helps with water absorption. It has the added bonus of stimulating your hypothalamus to tell you to drink more. If you wait until you are thirsty, it will be too late. You need to drink before you are thirsty! So, what’s a person to do? Here are some tips: Drink small amounts often, especially in hot weather. 6 ounces every 15 minutes is a good pace Consider adding some sugar to your water sucrose (table sugar) or maltodextrin are a good start. Remember, no more than 60 grams per hour If you don’t like sweet drinks while working out, consider using a gel or goo A little salt is a good thing. It improves the taste of the water, helps with its absorption, and stimulates the thirst mechanism. Research your workout drink. Ask questions. Many claims are marketing hype and not based on science or physiology. Consult with your chiropractor, physical therapist, doctor or trainer with questions                                                                                                                                                                                                               The Gait Guys…telling it like it is https://www.thegaitguys.com/thedailyblog/gait-cycle-basics-part-5-swing-phase-our-final monthly 0.5 2011-07-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553769887-08YRH9R8Q2INN3962KZZ/tumblr_lnbs3a8SJ71qhko2so1_1280.gif Blog Gait Cycle Basics: Part 5 Swing Phase Our final chapter in this series…. Swing phase is less variable in its classification. It begins at toe off and ends at heel strike. It comprises 38% of the gait cycle.There must be adequate dorsiflexion of the ankle, and flexion of the knee and hip to allow forward progression.   The following classification is most commonly used: Early swing: occurring immediately after toe off. There is contraction of the dorsiflexors of the ankle, and flexors of the knee and hip   Midswing: halfway through the swing cycle, when the swing phase leg is passing the midstance phase extremity. Acceleration of the extremity has occurred up to this point.   Late swing: deceleration of the extremity in preparation for heel strike. There is contraction of the extenders of the thigh and knee, as well as dorsiflexors of the ankle.   Perry defines the phases as: Initial swing: the 1st third of swing phase, when the foot leaves the round until it is opposite the stance foot. Mid swing: the time from when the swing foot is opposite the stance foot until the swinging limb is anterior to the stance phase tibia Terminal swing: from the end of midswing, until heel strike And there you have it. A nice review of the gait cycle. Probably more than you wanted to know, but we want to give you the facts. Telling it like it is. We are…The Gait guys https://www.thegaitguys.com/thedailyblog/does-calf-stretching-increase-ankle-dorsiflexion monthly 0.5 2011-07-01 https://www.thegaitguys.com/thedailyblog/just-in-time-for-friday-we-want-to-thank-bill-at monthly 0.5 2011-07-01 https://www.thegaitguys.com/thedailyblog/gait-cycle-basics-part-4-pronation-as-a-shock monthly 0.5 2011-06-30 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553773278-IAC4OJYKWKZ56GTEEOQA/tumblr_lnbrrwYyfx1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553773254-SHY4CDFVLLEQKLPUQBU6/tumblr_lnbrrwYyfx1qhko2so2_r1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553771337-9L9803Y00UWZ3H951MA5/tumblr_lnbrrwYyfx1qhko2so6_r2_1280.gif Blog https://www.thegaitguys.com/thedailyblog/gait-cycle-basics-part-3-as-promised-the monthly 0.5 2011-06-29 https://www.thegaitguys.com/thedailyblog/gait-cycle-basics-part-2-gait-cycle-components monthly 0.5 2011-06-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553772039-0G3PDXKOKIW95CQO0E4V/tumblr_lnbr4hUO7T1qhko2so1_75sq.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553771750-M3FLE0BUSO2BO8KP6RJV/tumblr_lnbr4hUO7T1qhko2so2_1280.gif Blog https://www.thegaitguys.com/thedailyblog/this-week-we-will-focus-on-the-basics-of-gait-and monthly 0.5 2011-06-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553772170-VRBE7JOJXW4IZUOW9QLE/tumblr_lnbqpkFRMQ1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553773509-E2E7G0J3PHYP5VCOLOKZ/tumblr_lnbqpkFRMQ1qhko2so2_1280.gif Blog https://www.thegaitguys.com/thedailyblog/the-pedograph-as-a-window-to-the-gait-cycle-have monthly 0.5 2011-06-26 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553772573-VHU62WR065H0SIRV4SYL/tumblr_ln9y34wTAk1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553773076-BQL2DA4TOU9B7PSJAPWF/tumblr_ln9y34wTAk1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553773768-VCGK0JMZ2AC450L8MM3R/tumblr_ln9y34wTAk1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/how-do-i-know-if-my-orthotic-is-working-foot monthly 0.5 2011-06-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553774556-P5AKIN4PA75XA8UCJNNP/tumblr_ln9xmwxJjt1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553774707-ND3X4R4JUTB3XC9H4Z21/tumblr_ln9xmwxJjt1qhko2so2_250.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553775060-YYTKK6I8BBNO5QUT8V3R/tumblr_ln9xmwxJjt1qhko2so3_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/we-have-been-trying-to-classify-some-of-these monthly 0.5 2011-06-24 https://www.thegaitguys.com/thedailyblog/the-gait-guys-at-the-movies-terminator-2 monthly 0.5 2011-06-23 https://www.thegaitguys.com/thedailyblog/vintage-shawn-and-ivo-one-of-our-early-podcasts monthly 0.5 2011-06-23 https://www.thegaitguys.com/thedailyblog/is-it-possible-to-take-3-minutes-off-your-half monthly 0.5 2011-06-22 https://www.thegaitguys.com/thedailyblog/pronation-primer-part-2-the-problem-with monthly 0.5 2011-06-21 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553775168-Y6LAOYDPEMMBB23XKVXY/tumblr_ln0prfHfEA1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553775858-M8LIPN0EGV1VNXOVVFRH/tumblr_ln0prfHfEA1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/advanced-gait-and-running-topics-biomechanics monthly 0.5 2011-06-20 https://www.thegaitguys.com/thedailyblog/pronation-primer-part-1-a-lot-of-folks-seem-to monthly 0.5 2011-06-20 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553776479-2VEZR2M7EW0GZCHL4KPM/tumblr_ln0pdrpC1J1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553776652-URTGHZOHYHF7EECFL6NJ/tumblr_ln0pdrpC1J1qhko2so2_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553776861-OF2FOHD5YKAE3SWDJIZ0/tumblr_ln0pdrpC1J1qhko2so3_1280.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553776972-N1NMHI08WW86QDUKVO8L/tumblr_ln0pdrpC1J1qhko2so4_1280.gif Blog https://www.thegaitguys.com/thedailyblog/the-gait-guys-biomechanics-202-foot-function-and monthly 0.5 2011-06-19 https://www.thegaitguys.com/thedailyblog/the-tarahumara-and-masai-part-3-from-our monthly 0.5 2011-06-18 https://www.thegaitguys.com/thedailyblog/the-gait-guys-proper-shoe-selection-and-foot monthly 0.5 2011-06-18 https://www.thegaitguys.com/thedailyblog/gum-shoe-def-noungumshoe-1-a-sneaker-or monthly 0.5 2011-06-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553777733-SSKFSI8R3J27UK93U4L4/tumblr_lmsbnhqu7t1qhko2so1_400.jpg Blog Gum Shoe…. def. Noun….gumshoe 1. a sneaker or rubber overshoe 2. (slang) A detective or private eye But in this case……. it quite literally looks like a shoe with gum stuck to the heel and ground ! This pair of pumps is gonna get looks. Pretty amazing what some people think of. Probably courtesy of the guy in the cubical beside you who’s supposed to be doing your mothers taxes but instead is photo-shopping stuff like this to serve his shoe fetish. None the less……a creative mind. We cannot remember where we found this pic……. we would love to give credit to the innovator if he or she is out there…..drop us a line ! By the words of the legendary Rock band Boston………Walk on….. “Take a look around and tell me what you can see I guess that all depend on exactly what you want it to be Is your cup half-full? Is your cup half-empty? How can you get what you need in the land of plenty? Everybody gets carried away Everybody’s trying everyday to remind you Leave it behind you What’s it take to see? What’s it take to believe right from wrong? Never knowing where you belong Walk On Walk On ” https://www.thegaitguys.com/thedailyblog/the-tarhumara-and-masai-part-2-setting monthly 0.5 2011-06-17 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553778530-YTAJDUXFY0YZ268SAV4P/tumblr_lmso80Z8701qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553778143-TQSIYK591EKQ1X8G6CZQ/tumblr_lmso80Z8701qhko2so2_1280.gif Blog https://www.thegaitguys.com/thedailyblog/the-tarahumara-and-masai-part-1-were monthly 0.5 2011-06-16 https://www.thegaitguys.com/thedailyblog/here-is-the-same-video-of-the-cyborg-gait-slowed monthly 0.5 2011-06-15 https://www.thegaitguys.com/thedailyblog/continuing-education-courses-we-have-on-the-web monthly 0.5 2011-06-14 https://www.thegaitguys.com/thedailyblog/dr-waerlop-of-the-gait-guys-discusses-the-often monthly 0.5 2011-06-14 https://www.thegaitguys.com/thedailyblog/give-us-your-tired-your-poor-your monthly 0.5 2011-06-12 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553780626-5OCUVC7AMX941T4ENVFI/tumblr_lmnotz9ZGM1qhko2so2_500.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553780324-3M7ATMUJPV6GHCJY3M50/tumblr_lmnotz9ZGM1qhko2so1_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/gait-lecture monthly 0.5 2011-06-11 https://www.thegaitguys.com/thedailyblog/not-all-that-glitters-is-gold-or-the-black-plague monthly 0.5 2011-06-10 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553780444-WL33RYCTDQF6GWY80KCG/tumblr_lmi5avwrGD1qhko2so1_500.jpg Blog Not all that glitters is gold… Or The Black Plague Revisited Yesterdays post discussed our subungual/friction differential of the phalanyx and sock liner theory.  A word of caution is warranted, as there is a small chance that the lesion could be something more serious. It turns out that a small percentage represent malignant lesions. http://www.ncbi.nlm.nih.gov/pubmed/21554050. Know the ABC(DEF)’s of a melanoma. Age (50-70), Black or Brown lesion with 3mm or greater breadth, Change (or lack of) in nail or nail bed despite treatment, Digit most involved, Extension of pigment into the lateral nail fold, Family or personal history. Don’t believe us, read it here: http://www.ncbi.nlm.nih.gov/pubmed/10642684. Yup, Black Plague or not, we remain The Gait Guys, https://www.thegaitguys.com/thedailyblog/the-black-plague-ok-kinda-sort-ofsubungal monthly 0.5 2011-06-09 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553781084-5MFR7RYIVRG2PUWNIJSM/tumblr_lmhxd0QsI51qhko2so1_400.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553781833-FC8RUKS7JDDIFZFKYTGW/tumblr_lmhxd0QsI51qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/do-you-know-how-you-run-if-the-answer-is-yes monthly 0.5 2011-06-08 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553782062-26QWEYRTLFTIARDY5J9Z/tumblr_lmegobnf6K1qhko2so1_100.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553783039-55LE6D0XCTLDYE3EDBRB/tumblr_lmegobnf6K1qhko2so2_250.gif Blog https://www.thegaitguys.com/thedailyblog/beautiful-glutes-part-3-here-is-the-part-you-have monthly 0.5 2011-06-03 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553783693-GIXNU6O5ERJYI5WN2WL0/tumblr_lm3ehtXahO1qhko2so1_400.jpg Blog Beautiful Glutes: Part 3 Here is the part you have been waiting for… Functional Perspectives It would logically follow that the gluteus medius is important for generating both forward progression and support, especially during single-limb stance suggesting that walking dynamics are influenced by non-sagittal muscles, such as the gluteus medius, even though walking is primarily a sagittal-plane task. After midstance, but before contralateral preswing, support is generated primarily by gluteus maximus, vasti, and posterior gluteus medius/minimus; these muscles are responsible for the first peak seen in the vertical ground-reaction force. The majority of support in midstance was provided by gluteus medius/minimus, with gravity assisting significantly as well. Seemingly, the gluteals appear important for extension of the thigh during gait. One of the most common scenarios appears to be a loss of ankle rocker and resultant weakness of the gluteals (personal observations). Lets look at an example. Have you ever sat at the airport and watched people walk? We all travel a great deal and often find ourselves passing the time by observing others gait. It provides clues to a plethora of biomechanical faults in the lower kinetic chain, like a loss of ankle rocker with people who wear flip flops or any other open backed shoes. What is ankle rocker, anyway? According to Jaqueline Perry (THE Matriarch of Gait Analysis) during normal gait, the stance phase (weight bearing) foot depends on 3 functional rockers (pivots or fulcrums) for forward progression. · heel rocker: at heel strike, the calacaneus acts as the fulcrum as the foot rolls about the heel into plantar flexion of about 10 degrees . The pretibial muscles must contract eccentrically to slowly lower the foot and help, along with forward momentum, pull the tibia forward · ankle rocker: next, the ankle acts as at fulcrum and the tibia rolls forward due to forward momentum, with a maximum excursion of approximately 15 degrees. The gastroc and soleus should eccentrically contract to decelerate the forward progression of the lower leg. · forefoot rocker: the metatarso-phalangeal joints act at the final fulcrum in the stance phase of gait. Note that the 1st metatrso-phalangeal joint must dorsiflex 65 degrees for normal forward progression, otherwise the individual will usually roll off he inside of the great toe. Tibial progression continues forward and the gastroc/soleus groups concentrically contract to decelerate the rate of forward limb movement. This, along with passive tension in the posterior compartment muscles, forward momentum , and the windlass effect of the plantar fascia result in heel lift. Now watch someone walking in flip flops or open back shoes. There is no pivot past 90 degrees at the ankle (i.e. the tibia never goes beyond 90 degrees vertical). At this point the heel comes up (premature heel rise) and the motion must occur at the metatarso-phalalgeal joint. The only problem is that this joint usually has a maximum of 65 degrees extension. Since more is now needed, the body borrows from an adjacent joints, namely the knee (which increases flexion) and the interphalangeal joints (which should be remaining flat and now must claw to “create” more available extension at the middle joint, as the proximal is nearly fully extended, through overactivity of the flexor digitorum longus. The tibialis posterior, flexor hallicus longus, and gastroc soleus groups also contract in an attempt to help stabilize the foot . Overactivity of these groups causes reciprocal inhibition of the long toe extensors and ankle dorsiflexors (tibialis anterior for example), causing the toes to buckle further and a loss of ankle dorsiflexion; in short, diminished ankle rocker function. So there you have it. Glutes. They are a beautiful thing! Isn’t it great to be a gait nerd? We remain..Gait Nerds and ….The Gait Guys…. https://www.thegaitguys.com/thedailyblog/beautiful-glutes-part-2-we-are-going-to-get-a monthly 0.5 2011-06-02 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553784084-R5NLECQZ41XEJQ08ODZC/tumblr_lm3e4r0HhB1qhko2so1_500.jpg Blog Beautiful Glutes: Part 2 We are going to get a little techie here. Hang in there! EMG data There are a paucity of studies on gluteal function during gait, but here is what is out there. The upper and lower portions of the glute max shows activity at initial contact and near the end of swing phase, the middle portion additionally just before and after pre-swing.  The glute max does not appear to be a postural control muscle, nor is it utilized in static one leg standing, except when a large load is imposed  When the center of gravity of the whole body is grossly shifted, the gluteus maximus becomes engaged. The glute max, along with the vasti also assist in deceleration of the body during the first half of stance. The gluteus medius and minimus appear to play a much more substantial role in propulsion and stabilization during normal gait, contracting from terminal swing to preswing, maximally during early midstance, to prevent contralateral drop of the pelvis. The anterior fibers of both appear important for gait, as they assist the external obliques in forward progression of the pelvis on the side oppposite the stance phase leg, in addition to supplying coronal plane stabilization. A brief burst of activity in midswing assists in medial rotation of the thigh. Gluteus maximus fuction can be affected by  altered biomechanics and the g luteus medius commonly affected by postural faults. Wow, betcha didn’t know that! Stay tuned for part 3! We remain…The Gait Guys. https://www.thegaitguys.com/thedailyblog/beautiful-glutes-part-1-place-your-hands-on monthly 0.5 2011-06-01 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553783904-PS7J7NLKK6EUU4TA08SP/tumblr_lm3dn7nM6w1qhko2so1_1280.jpg Blog Beautiful Glutes!     Part 1 Place your hands on your buttocks and stand up from a seated position. Did you feel them fire? Now walk with your hands in your back pockets. Do you feel them active at the end of your stride? No? Maybe you should be in rehab. You should! The glutes have been the fascination of many, including Michaelangelo (Ever seen the sculpture of David?). Perhaps if you have a patient with recalcitrant back or hip problems, you should consider looking closer at their gluteal group. anatomical perspectives The gluteus maximus, the most superficial of the 3 gluteii, is the largest, coarsest fibered muscle in the body. It attaches proximally on the ilia, sacrum, coccyx and sacrotuberous ligament and slopes 45 degrees inferolaterally to attach distally, predominantly to the iliotibial tract with a smaller contribution attaching to the gluteal tuberosity of the femur. In open chain, it is an extender and lateral rotator of the thigh, as well as the upper fibers acting as abductors and lower fibers adductors of the hip. The superior fibers of the gluteus maximus are part of the lateral line of musculature (as described by Myers in “Anatomy Trains”) as it diverges at the hip, along with the gluteus medius and tenor fascia lata. This lateral line helps provide stabilization in the saggital plane, beginning at the peroneus longus and traveling ultimately to the splenius and sternocleidomastoid. From this perspective, we can view gluteal function during gait (ie closed chain) as rotators and abductors/adductors of the pelvis and an extensor of the torso The gluteus medius and minimus attach proximally between the anterior and posterior gluteal lines and distally at the lateral surface of the greater trochanter for the former and anteriorly for the latter . They act as abductors and medial rotators of the thigh in open chain, and abductors and external rotators of the pelvis in closed chain,  the anterior fibers of the minimus and medius probably assisting in forward motion of he contralateral pelvis. Sahrmann states “the posterior portions of the medius act as abductors, external rotator and extenders of the thigh, with the anterior portion also assisting in hip flexion”. The Glutes; they’re more than just another pretty muscle…. We are…The Gait Guys https://www.thegaitguys.com/thedailyblog/there-are-2-photos-here-move-your-cursor-over-to monthly 0.5 2011-05-31 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553784611-VYDU2XRR0UHBXWKDGRLU/tumblr_lm2pqrc0fP1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553784814-6LA0UA4H33QJ50J35DWP/tumblr_lm2pqrc0fP1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/good-form-video-from-newton monthly 0.5 2011-05-31 https://www.thegaitguys.com/thedailyblog/short-discussion-on-the-toe-extensor-muscles monthly 0.5 2011-05-31 https://www.thegaitguys.com/thedailyblog/shoe-anatomy-101-if-you-are-truly-to-be-a-shoe monthly 0.5 2011-05-28 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553785520-1HU51REMNHNSJ59AMOLD/tumblr_llu784oY6o1qhko2so1_400.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553786737-OGEY5K0M22IDTOC6GWVM/tumblr_llu784oY6o1qhko2so2_400.gif Blog https://www.thegaitguys.com/thedailyblog/horse-walk-trot-canter-gallop-man monthly 0.5 2011-05-27 https://www.thegaitguys.com/thedailyblog/why-i-runamazing-video monthly 0.5 2011-05-27 https://www.thegaitguys.com/thedailyblog/todays-post-is-a-very-nice-follow-up-to-the-one monthly 0.5 2011-05-27 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553787165-IOHBCHAH9LJHMQNAQPVH/tumblr_llt5akcND81qhko2so1_r1_400.gif Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553786927-DORQ41FJJELU5XUH19TQ/tumblr_llt5akcND81qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/shuffle-gait-dvd monthly 0.5 2011-05-26 https://www.thegaitguys.com/thedailyblog/muscle-contributions-to-support-and-progression monthly 0.5 2011-05-26 https://www.thegaitguys.com/thedailyblog/ted-how-to-tie-your-shoes monthly 0.5 2011-05-26 https://www.thegaitguys.com/thedailyblog/following-the-flintstones-in-this-next-clip monthly 0.5 2011-05-25 https://www.thegaitguys.com/thedailyblog/hey-check-out-barney-joing-the-barefoot-craze-we monthly 0.5 2011-05-24 https://www.thegaitguys.com/thedailyblog/graphic-above-by-edward-muybridge-leg-length monthly 0.5 2011-05-24 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553787564-O3AT46ZZJBL820AWNELK/tumblr_llojynmwBA1qhko2so1_100.gif Blog graphic above by Edward Muybridge Leg length discrepancies and heel lifts. To lift or not to lift… The Gait Guys Leg length discrepancies (LLD’s) are encountered on a daily basis. They are the root of many ankle, knee, hip and spinal problems. The questions the clinician must ask are “How much is significant?”, “How much do I add?” What are some of the signs and symptoms?” “What is the etiology?” and “How do I detect it?” A literature search (2003) provided the following information and answers. How much is significant? Most authorities claim that deficiencies of greater than ¼ inch (6mm) are clinically significant (1, 2) though some sources state that differences as little as 4 mm are significant (5). Subotnick (3) states that because of the threefold increase in ground reactive forces with running, lifts should be used with inequalities of greater than 1/8” inch (3mm). How much do I add? One of the easiest ways to determine the amount of lift needed is to examine the person in a weight bearing posture and add lifts under the short leg until the pelvis is even or until the lumbar spine is straight. If using off weight bearing measurements, you need to add 1/3 more height than measured because the talus is positioned 1/3 of the way between the calcaneus and metatarsal heads (4, 13). So, a heel lift placed under the calcaneus will only raise the talus 2/3 of that height. Lifts placed under the calcaneus can shorten the tricep surae muscles (4, 6) and apply increased pressure to the metatarsal heads (12); full length sole lifts are more physiological, though not always practical. Due to the supinatory moment of the short leg on heel strike, a lift may cause overcompensation and increased supination, with a tendency to overweight the lateral column and possibly injure the lateral ankle. Careful observation of gait post addition of a lift is in order and a valgus post running at least the length of the 5th metatarsal along with the lift should be considered (8, 9). Heel lifts also cause EMG changes of leg muscles, with decreased recruitment of gastrocnemius and tibialis anterior directly proportional to the height of the heel lift (18, 19). A lift or LLD changes the ground reactive forces associated with gait, increasing vertical force on the longer leg, along with increased joint stresses along the kinetic chain (14, 20). Generally speaking, lifts greater than 3/8” (9mm) require extrinsic modifications to footwear (4, 6, 8). Find a competent individual to perform this work for you. Large discrepancies should be treated gradually, at a rate of ¼ inch every 4 weeks, less if symptoms do not permit. What are signs and symptoms associated with LLD’s? Compensation comes in many forms, depending whether it is acute (recent injury caused an LLD or compensation resulting in one, or long term. The deficiency can cause injury on the short or long legged side (or both). The long leg moves through a greater arc during all portions of swing phase (7). The person may flex the knee to compensate and shorten the arc. The individual may also maximally pronate and evert the calcaneus an additional 3 degrees or greater on that side in an attempt to lower the navicular to the ground and shorten that leg. This causes an increased amount of internal rotation of the tibia and thigh causing muscular dysfunction (tightness of the hip flexors, strain of the intrinsic external rotators from eccentric deceleration of the thigh), along with medial knee strain (especially with concomitant genu valgus) (4, 6, 8, 9, 10, 11, 21, 22). The short leg side will often supinate in an attempt to lengthen and cushion some of the shock of heel strike, since it has a greater vertical distance to travel (14); this often occurs with hyperextension of that knee. This lessens the dampening ability of the knee (since it flexes almost 20 degrees between heel strike and full forefoot load), and speeds the rate of subtalar pronation (since the rear foot is inverted and still must pronate the same amount (4). Many individuals will try and attenuate impact by contracting the contralateral hip abductor muscles and eccentrically lower the shorter extremity (4, 14). This can produce excessive strain of that musculature (trochanteric bursitis) as well as pathomechanical abnormalities of the L4 and L5 motion segments (due to increased body rotation toward the short side and attachments of the iliolumbar ligaments; this can cause degenerative changes if present long term (11, 12)). What’s the etiology? LLD’s can be structural (anatomical) or functional (pathomechanics, compensation). LLD’s can be due to foot problems (overpronation/supination, fractures), leg or thigh problems (congenital shortening, deformity, fracture), or pelvic compensation (rotation of ilia, fractures).   So, what is the etiology? A lot can be gleaned from the history. Past trauma is the most obvious so pay close attention. This could result in flattening of the calcaneus or overpronation due to ligamentous laxity; tibial fractures can cause shortening as well as increased or decreased tibial torsion; similar findings can occur in the femur, along with anteversion or retroversion; pelvic trauma can be more subtle and x-ray can often provide the most information (1, 2, 4, 6). How do you determine a leg length inequality? There are a number of methods, each with their own merit. X –ray is most accurate, but exposes the patient to ionizing radiation. Weight bearing seems most appropriate, since symptomatology usually presents itself then. Supine measurements are said to be influenced by asymmetrical muscle tension, table pressure on the innominates and hip flexor length (15). With the patient weight bearing and both feet placed below the trochanters, observe the level of the medial malleoli. Next, compare the heights of the tibial plateaus. Femoral length can be judged by the heights of the greater trochanters, and pelvic alignment judged by the heights of the iliac crests (4, 17). Alternately, lay the person supine and observe the heels and medial malleoli. If there is noticeable discrepancy, they may have a short leg; if there isn’t, they still may have a discrepancy that they are compensating for. Check the range of motion of the foot and ankle in 6 general directions: plantar flexion (40-45 degrees), dorsiflexion (20-25 degrees, depending on whether the knee is flexed or extended), inversion of the forefoot (3-60 degrees, on average), and eversion of the forefoot (20-45 degrees on average), calcaneal inversion (4-20 degrees) and calcaneal eversion (4-10 degrees). Excessive calcaneal eversion usually means over pronation due to a longer leg on that side; excessive inversion can mean a long leg due to a cavus foot type (2, 4, 6, 8, 9, 12). Lack of flexibility in the posterior compartment of the calf usually causes a greater degree of pronation (16). Now, perform Allis’s test. Bend both knees to 90 degrees and observe the height of the tibial plateaus. The lower one is usually the side of the discrepancy (which can be in tibial length or due to excessive pronation). Now walk superior to the knees and observe the femurs from more cephalad (4). Is there a discrepancy? If so, the problem may be in the femur length, femoral head angle or pelvis. Extend the knees so that the legs are lying flat on the exam table. Palpate the greater trochanters on both sides. Is one lower than the other? If so, they probably have coxa vara on the short side or coxa valga on the long side. If they are even, you need to look at the pelvis. Does one ASIS palpate more anterior or posterior than the other? This could represent compensation. A posterior or “flexed” ilia, usually causes a short leg on that side; an anterior or extended ilia usually causes a long leg on that side. Now stand the patient up and perform a Gillet Test. Have them stand erect and hold onto something for balance. Palpate the PSIS on one side along with the 2nd sacral tubercle. Have them raise their thigh to 90 degrees on the side you are palpating. The PSIS should nutate backward (flex) and drop .5-1.5 cm on the side of the raised leg. Now have them raise the opposite leg. The sacrum should nutate backward and down. If either of these movements does not occur, consider pelvic pathomechanics and treat accordingly. Recheck for motion as well as leg length when done. Standing observation often (but not always) reveals overpronation on the long leg side and relative supination on the short leg side. The shoulder is often higher on the short side and the waistline dips to the long side because of posterior rotation of the innominate. The shoulder will dip to the side of the short leg on heel strike during dynamic evaluation (4, 6, 8, 9, 10, 11). Gait observation usually reveals adduction of the pelvis toward the stance phase leg with a lateral sway in excess of 1” during stance phase. The person will seem like they are “stepping into a hole” on the short side. Conclusion Leg length inequalities occur due to a variety of anatomical and physiological conditions. Careful analysis and examination can often reveal its etiology. To lift or not to lift is a clinical decision that is left to the clinician and patient, with a careful balance between what is perceived as improved biomechanics and tolerance levels of the patient with regards to their presenting symptomatology. References available by request https://www.thegaitguys.com/thedailyblog/materials-do-soft-soles-improve-running-shoes monthly 0.5 2011-05-23 https://www.thegaitguys.com/thedailyblog/run-carey-run-lets-look-at-this-hitchcock monthly 0.5 2011-05-20 https://www.thegaitguys.com/thedailyblog/chicago-lecture-world-class-shoe-fit monthly 0.5 2011-05-19 https://www.thegaitguys.com/thedailyblog/passive-arch-stability-anatomy-review monthly 0.5 2011-05-19 https://www.thegaitguys.com/thedailyblog/what-did-you-notice-cavus-foot-loss-of-the monthly 0.5 2011-05-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553787389-OO1RSC6JUSYYZTCW3UZ4/tumblr_ll7x9gTvYb1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553787672-X0C953F9UKN1PKTVSL6D/tumblr_ll7x9gTvYb1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/what-do-you-see-here-and-how-does-it-relate-to monthly 0.5 2011-05-15 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553788054-A6TS4Z7LE5JNME9LLZ8T/tumblr_ll7wuwsnTv1qhko2so1_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553788148-JBHV8B4M3HZGBXYQOCIG/tumblr_ll7wuwsnTv1qhko2so2_1280.jpg Blog https://www.thegaitguys.com/thedailyblog/part-2-of-a-case-study-from-northern-ireland-this monthly 0.5 2011-05-11 https://www.thegaitguys.com/thedailyblog/a-case-sent-to-us-all-the-way-from-northern monthly 0.5 2011-05-10 https://www.thegaitguys.com/thedailyblog/when-the-short-toe-extensors-try-to-rule-the-world monthly 0.5 2011-05-05 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553788913-QLKSMKPIUGR97VXI69HL/tumblr_lkp3ob00xk1qhko2so1_1280.jpg Blog When the Short Toe Extensors Try to Rule the World ! A case of a runner with forefoot pain. This is a runner of ours, one of the fastest young men in the state of illinois, top 10 in the country in mid-distance, top 20 in the USA in cross country. He came in with left forefoot plantar pain.  He explained (in a matter of words) that he was having pain at full forefoot loading at heel rise /push off. We watched him walk, saw this visual problem present itself in dynamic motion (yup, no stop frame video on this one, not when you see it about 10 times a month !) and noted a subtle left lateral hip/pelvis shift past what would be considered normal for frontal plane mechanics. On the table this is a photo of his feet.  What do you see ? We see a suspected (which you will try to confirm on examination) increase in short extensor (EDB, extensor digitorum brevis) muscle tone.  Increased long extensor (EDL, extensor dig. longus muscle) tone would have represented itself with the distal toes also extended but here we see a relative dominance of the long flexors (FDL, Flexor dig. longus) with the heightened short flexor increase. We also see more confirmation of heightened long flexor tone (FDL) by the degree of heavy callus formation on the very tip of the 2nd toe (it was on all 4 lateral toes but the photo is not clear enough to demonstrate).  You can also see supporting evidence of heightened long flexor dominance by the subungual hematoma (bleeding under the 2nd toe nail). (How does this correlate ? Well, in most runners with excessive long flexor tone/use not only do they flex and claw so much in the shoes that the callus is on the tip of the toes but the nail also begins to lift as the  nail is caught on the sock liner of the shoe as the toe flexes, slowly, mile by mile pulling the toe nail from the nail bed thus bleeding underneath it).  Yes, it is NOT from the toes hitting the front end of the shoe ! Our examination confirmed weakness of all lumbrical muscles and of the flexor digitorum brevis and lateral quadratus plantae.  The patient could feel the strength/engagement difference as compared to testing on the right foot of the same muscle groups (we always compare side to side, for us and for the patient’s awareness).  The extensor digitorum brevis muscle mass on the lateral dorsum of the foot was tender as were the tendons along their course.  There was also weakness higher up in the kinetic chain at the lower division of the transversus abdominus and internal abdominal oblique, and frontal plane hip stabilizers (gluteus medius; anterior-middle-and posterior divisions).The 2nd and 3rd metatarsal heads were remarkably tender to palpation and it was obvious that the metatarsal fat pads had migrated distally from the lumbrical muscle weakness. Sometimes a grasp response by the long flexors can represent a propioceptive /balance deficit during single leg stance phase so be sure to test those centers as well (cerebellar, vision, joint position sense, inner ear-vestibular apparatus).  So, what is the take away for the non-medical person, the runner next door if you will ?  Lets just say, symmetry wins and when asymmetry is apparent, bring it up to the people that do your body work.  Hopefully, what you and they see will be assessed in a clinical light, and as a team you can get to the bottom of what is not working…….and in this case…..what was causing not only the plantar foot pain, but the left lateral hip sway outside the frontal plane. ———we are, The Gait Guys……Shawn and Ivo https://www.thegaitguys.com/thedailyblog/the-quadratus-plantae-flexor-accessorius-muscle monthly 0.5 2011-05-04 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553789148-W6H0YZJ8MDLJNX2MBDLC/tumblr_lkowdng74B1qhko2so2_1280.jpg Blog https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553790521-WGXG7XVHBXQ3TRELZ4ZA/tumblr_lkowdng74B1qhko2so1_540.png Blog https://www.thegaitguys.com/thedailyblog/audio-podcast-the-gait-guys-barefoot-concepts monthly 0.5 2011-05-04 https://www.thegaitguys.com/thedailyblog/research-to-support-that-we-are-on-target monthly 0.5 2011-05-03 https://www.thegaitguys.com/thedailyblog/gluteal-deficiency-and-hip-extenion-5-minute monthly 0.5 2011-05-02 https://www.thegaitguys.com/thedailyblog/a-question-from-a-doctor-on-the-topic-of-limb monthly 0.5 2011-05-02 https://www.thegaitguys.com/thedailyblog/the-psoas-muscle-in-a-runner-an-endurance-savy monthly 0.5 2011-04-29 https://www.thegaitguys.com/thedailyblog/tissue-vibration-in-prolonged-running monthly 0.5 2011-04-28 https://www.thegaitguys.com/thedailyblog/gait-gaff-time-gaff-verb-tr-to-stand-or-take monthly 0.5 2011-04-28 https://www.thegaitguys.com/thedailyblog/hip-internal-rotation monthly 0.5 2011-04-27 https://www.thegaitguys.com/thedailyblog/arm-swing-privides-clues-to-gait-pathology monthly 0.5 2011-04-27 https://www.thegaitguys.com/thedailyblog/arm-swing-matters monthly 0.5 2011-04-27 https://www.thegaitguys.com/thedailyblog/where-to-find-us monthly 0.5 2011-04-26 https://www.thegaitguys.com/thedailyblog/dynamic-arm-swinging-in-human-walking monthly 0.5 2011-04-26 https://www.thegaitguys.com/thedailyblog/dr-lieberman-himself monthly 0.5 2011-04-24 https://www.thegaitguys.com/thedailyblog/near-flawless-running-techniqueit-would-have-to monthly 0.5 2011-04-24 https://www.thegaitguys.com/thedailyblog/we-came-across-this-video-on-youtube-look-at-the monthly 0.5 2011-04-21 https://www.thegaitguys.com/thedailyblog/dr-waerlop-talks-about-pronation-and-supination monthly 0.5 2011-04-20 https://www.thegaitguys.com/thedailyblog/dr-ivo-waerlop-of-the-gait-guys-discusses-rear monthly 0.5 2011-04-18 https://www.thegaitguys.com/thedailyblog/running-gait-analysis-by-dr-ivo-waerlop-of-the monthly 0.5 2011-04-15 https://www.thegaitguys.com/thedailyblog/the-hokaone-hoka-or-hokey monthly 0.5 2011-04-14 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553790511-O4F3PGVPZ1CBAGLIA6JV/tumblr_ljnnwbZGID1qhko2so1_1280.jpg Blog The Hokaone: Hoka or Hokey? http://www.hokaoneone.com/en/technology.html We have been off the grid for a week amassing new research for the website and looking into new products that have come online recently. But we are back now with new stuff.  Lets start today on this shoe, the Hoka. From their website “ By using an EVA 30% softer and increasing its total volume to 2.5 times that of a typical trail running shoe, we allow for more cushioning than any other shoe on the market today, dissipating up to 80% of the shock associated with heel striking when running. Allowing for as much as 20mm of compression in the heel, with a low ramp angle allows for tremendous confidence running downhill, as runners can now engage their gluteus and lower back as opposed to isolating their quads, relaxing the body and making running downhill fun and comfortable.”  What we like: 1-A low ramp angle definitely helps one to engage their glutes more. 2- light weight is often a good thing What we don’t like: There have been enough papers published that show increased cushioning decreases impact at heel strike, but increases overall impact forces sustained by the body. A thickened sole decreases the amount of proprioception and requires the body to work harder by compressing more of the EVA foam, and with this shoe, that will be quite a bit of body work. A little sole rocker off the front endcan be a good thing, especially with people who lack great toe dorsiflexion, but enough to take up 50% of the sole length and 4 cm high? Wow ! This would decrease the amount of forefoot rocker and subtract from the 3 rockers that the foot was normally designed to work with (heel, ankle and forefoot). The research (which at least we have read) shows that rockered shoes increase knee flexion during the first part of the stance phase of ambulation, and less in swing phase. More significantly, ankle plantarflexion is increased at heelstrike through terminal stance, thus delaying pronation (plantar flexion, inversion and adduction are components of supination); this would dampen the shock absobtion afforded from pronaion and lowering of the ankle mortise. Interestingly, this increases the impact force at heel strike significantly as well. “With 50% more surface area than the typical trail running shoe, and 35% more rubber crampons, you’ve never run as confidently as you will in a pair of Hoka’s.” Hmm. Doesn’t a larger footprint, especially at the midfoot, hamper the natural dampening mechanism of pronation? What about the increased mechanical requirements to move the extra sole? Sure, it will be more stable, but at the cost of mechanical efficiency. Take a look at the break points on the undersole; Why put a break directly under the calcaneus and then one immediately anterior (under the sustantaculum tali) at a 90 angle to the plane of the joint? The ones across the transverse metatarsal arch proximally are in an arc OPPOSITE the plane  of  the articulations; it seems to us that this would cause mechanical conflict at the metatarsophalangeal joints; the distal ones seem more appropriate, but the ones anterior to that serve to abduct the phalanges. Summary: In a nutshell ? We are sure this is a supercomfy foot spa that feels like walking on marshmallows but we question the science behind the design and would welcome the opportunity to review their research or even to trial a pair. We think you will find that what we  have addressed here merit some attention by everyone.  As we always say though, every product has some uses and purpose, but also some drawbacks.  Do your own homework though, go to their website…… http://www.hokaoneone.com/en/technology.html Once again, We are and remain,…… The Gait Guys https://www.thegaitguys.com/thedailyblog/clinical-video-case-study-tibial-varum-with-added monthly 0.5 2011-04-09 https://www.thegaitguys.com/thedailyblog/in-this-f-scan-film-we-see-increased-pressure-on monthly 0.5 2011-04-06 https://www.thegaitguys.com/thedailyblog/this-is-a-case-of-internal-tibial-torsion-in monthly 0.5 2011-04-06 https://www.thegaitguys.com/thedailyblog/the-first-biodegradable-shoe monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/peter-weyand-phd-smu-locomotor-performance monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/harvard-lieberman-studies-on-heel-strike monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/shoes-and-cushioning monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/saucony-kinvara monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/rearfoot-forefoot-slope-ratio monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/the-gait-guys-youtube-video-on-tight-calf monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/stress-fracture-factors-guide-orthotic-choices monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/the-truth-about-barefoot-running-its-complicated monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/the-amazing-persistence-hunt-running-all-day monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/immediate-effects-of-acupuncture-on-gait-patterns monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/new-changes-around-mizunos-2011-running-footwear monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/orthotic-shoe-inserts-may-work-but-its-not-clear monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/the-right-fit-matters-shoe-studies-suggest monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/the-gait-guys-youtube-channel monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/the-men-who-live-forever monthly 0.5 2011-03-30 https://www.thegaitguys.com/thedailyblog/shod-landing-provides-enhanced-energy-dissipation monthly 0.5 2011-03-29 https://www.thegaitguys.com/thedailyblog/barefoot-shoe-companies-please-take-note monthly 0.5 2011-03-29 https://www.thegaitguys.com/thedailyblog/the-effect-of-footwear-and-sports-surface-on monthly 0.5 2011-03-28 https://www.thegaitguys.com/thedailyblog/the-ecco-biom-the-human-foot-it-makes-up-to-175 monthly 0.5 2011-03-26 https://www.thegaitguys.com/thedailyblog/footballers-ankle-follow-up-on-the-iwalk monthly 0.5 2011-03-25 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553790881-9I87R3G4T0EFZ4XZ1U0S/tumblr_limtim4GRI1qhko2so1_1280.jpg Blog Footballer’s Ankle (follow up on the iWalk Powerfoot): This is clinical condition which is most often present in those who have engaged in kicking sports for a number of years. As in soccer, the striking of the ball forcefully in a plantarflexed position can generate a traction apophysis (bony tubercle) from the repeated traction stress put on the anterior ankle capsule and ligaments.  This tubercle can form a spur that can act like a door stop impeding any further ankle dorsiflexion (rocker). Footballers ankle manifests itself with pain at the front part of the ankle joint. Soft tissue can become trapped at this anterior joint aspect and produce localized pain. IT will look like a normal degenerative spur, but the clients age and activity will help clarify the diagnosis and pathogenesis.  https://www.thegaitguys.com/thedailyblog/iwalk-powerfoot-video-army-here-in-this-video-our monthly 0.5 2011-03-25 https://www.thegaitguys.com/thedailyblog/iwalk-powerfoot-gait-animation-check-out-this-3 monthly 0.5 2011-03-25 https://www.thegaitguys.com/thedailyblog/fabricating-a-shoe-last-the-last-word-a-few monthly 0.5 2011-03-24 https://www.thegaitguys.com/thedailyblog/the-dumpling-walk-its-time-for-gait-guys-gait monthly 0.5 2011-03-24 https://www.thegaitguys.com/thedailyblog/a-pedograph-mapping-case-everyone-wants-to-use monthly 0.5 2011-03-23 https://images.squarespace-cdn.com/content/v1/57d483ff414fb51a88b0053e/1473553790955-IV1AMXRBTEQ3DVGQN8XA/tumblr_lij2fpDyPd1qhko2so1_1280.jpg Blog A Pedograph mapping case.  Everyone wants to use the high tech stuff, we say you dont need it most of the time.  What do you see in this case ? Answers: Increased heel pressure, Uncompensated forefoot varus (as evidenced by a lack of ink under the first metatarsals (you could even put a Rothbart foot-type on your DDx list), increased clawing of the 2nd-3rd digits on the right, and bilateral Morton’s second toes.  If you look carefully at the big toe ink presentation you can see a “pinch” callus on the left foot at the medial aspect of the hallux. This might also represent some increased pressure being exerted by the short big toe flexor (flexor hallucis brevis), the longus (FHL) would give a more distinct distal pressure and ink response at or near the tip of the toe. What you want to see is a nice ink spot that is well blended throughout the entire pad of the hallux.  There is also similar hint of more use of the short flexor on the right and less of the long flexor. Overall the toes are bunched together in a group, there is not much separation, we sometimes take this as a global representation of a weaker foot. Q: What could this transfer to as a clinical presentation (what kinds of things might you be suspicious of as you conduct your examination ?: Answer: Obviously heel pain has to be on the list.  There is a fair amount of heel pressure going on here.  With a forefoot varus or, simply put, incompetence of the medial foot tripod stability structure the person is more likely to generate more medial rotation of legs.  This, if not met will good pelvic and core resistance, can lead to lumbopelvic functional instability and thus low back pain. Typically, Forefoot varus clients either pronate very heavily, sometimes late (as in this case) as evidenced by lack of heavy ink printing through the arch area, or they tend to compensate and try to walk on the outsides of their feet. Anyone who delays or rushes the 3 rockers of the foot (rear, mid or forefoot rockers) is going to see compensations to the compromised the ankle rocker movement.  This obviously has its complications as well.  There is no good compensation.  As we say, if something is not working right……..someone has to pay, eventually. https://www.thegaitguys.com/thedailyblog/hallux-rigidus-turf-toe-a-case-of-back-pain monthly 0.5 2011-03-22 https://www.thegaitguys.com/thedailyblog/the-gait-guys-some-strategies-in-controlling-the monthly 0.5 2011-03-20 https://www.thegaitguys.com/thedailyblog/barefoot-winter-footwear-the-mukluk-in-this monthly 0.5 2011-03-19 https://www.thegaitguys.com/thedailyblog/5-crucial-running-mistakes-really-hogwash monthly 0.5 2011-03-18 https://www.thegaitguys.com/thedailyblog/asics-gel-speedstar-5-we-were-asked-today-to-give monthly 0.5 2011-03-17 https://www.thegaitguys.com/thedailyblog/rothbarts-foot-type-a-case-discussion monthly 0.5 2011-03-16 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