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.

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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