Podcast 78: Step Width Gait, Training Asymmetries & more

Show sponsors: 

www.newbalancechicago.com

www.lemsshoes.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_78ff.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-78

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

24-year-old woman missing entire cerebellum exemplifies the amazing power of brain plasticity

Brain scans reveal ‘gray matter’ differences in media multitaskers

Who are we: Ivo talk a bit about yourself and your educational history and what is your website ?
Shawn…..do the same
and……lets keep each interesting but to just a few minutes
Effect of step width manipulation on tibial stress during running
Does Limited Internal Femoral Rotation Increase Peak Anterior Cruciate Ligament Strain During a Simulated Pivot Landing?
http://ajs.sagepub.com/content/early/2014/09/22/0363546514549446.abstract
Quadriceps Muscle Function After Exercise in Men and Women With a History of Anterior Cruciate Ligament Reconstruction
http://natajournals.com/doi/abs/10.4085/1062-6050-49.3.46

Podcast 76: The FMS™ screen and Injuries, Impact Loading & more.

Podcast 76: Association of Functional Movement Screen™ With Injuries, Wool workout gear, landing softly and more !

*Show sponsor: www.newbalancechicago.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_77.1_76final.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-76

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

 
Last week on our social media sites we posted this article that garnered 9000+ hits:
Runner? LONG DISTANCE runner? Better be careful out there!
http://www.sciencedaily.com/releases/2012/06/120604093108.htm
 
then this news this week:
Well-Regarded Endurance Athlete Chad Denning Dies While Running Appalachian Trail | Valley News
 
Association of Functional Movement Screen™ With Injuries in Division I Athletes
 
from a reader:
Hey guys, great site, sometimes a bit more than I know at this point. Just graduated from massage school in april. I have been diagnosed with tendonosis of the Achilles heel. Also finding that my leg doesn’t fully extend while walking, anything I can do besides hamstring and calf stretches. It really happened after a 30 mile hike with a 40 lb backpack, Help 
Thanks, sincerely Hector
Synthetic Workout Gear Smells Worse Than Cotton Gear
 
 Land Softly And Carry Less Injury Risk

http://running.competitor.com/2014/07/injury-prevention/land-softly-and-carry-less-injury-risk_11174

 
 
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

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

Gait Problem ? But where is the problem ? A case of failed single leg stance in a runner during the “3 Second Gait Challenge”.

Remember, what you see is not the problem most of the time.
You have heard it from us over and over again. What you are seeing in someone’s gait or running, the thing that does not look right, is their strategy to cope with the body parts that are dysfunctional. You are quite often not seeing what is wrong.
For example, here during our “3 Second Gait Challenge” this gentleman shows a solid left stance phase of gait. At times it is so solid and calm that it looks like we still-framed the video. The right side is another matter. During right stance there is excessive “checking” of the frontal plane (side to side) at the ankle. You also clearly see him using the right arm as a ballast moving it out to the right during right stance phase to help offset and dampen the frontal plane challenges.
Now going back to our initial thesis (“Remember, what you see is not the problem most of the time.”) surely you will agree that what you are seeing that right arm doing is probably not the problem here. Correct ? 
Now, this is a patient of ours, so we know what is wrong with him.  But from an outsider looking in, the problem in this case is more likely in the right lower limb, but you cannot see what is wrong with it. So remember, what you see is frequently not the problem, rather it is a compensation strategy. This gentleman’s problem is coming from his right lower abdominal functional impairment (specificially the lower transverse abdominus and internal abdominal oblique functional weaknesses, we know because we  clinically muscle assessed him for strength, skill, and motor patterns in our office.) These muscles were clearly neurologically inhibited and weak and the motor pattern he has laid down is many years in the making, driving a deeply seated compensation pattern.  Basically, he cannot stabilize his torso on the pelvis-hip during single leg stance. This lets the pelvis drift to the right. In this case it was not gluteus medius weakness allowing for the drift, which is more common. The torso is weak on the right side making it difficult to stabilize right lateral torso movement so he cheats by moving his torso to the left (which you can see) but does so ineffectively and thus needs to use the right arm to “check” the poor strategy.  His Rolling patterns were clearly disfuctional however even after correcting them he still had the gait neurologic pattern as his default,  hence gait retraining is necessary in this and all cases. We do many other functional assessments, methods we have developed and they all clearly directed and confirmed the diagnosis.  Just remember, if you fix a person’s movement patterns but then do not fix the repetitive gait pattern they have been using then their gait is cycling the problems right back into the person and you are wasting your, and their, time. 

Additionally, It would be easy to say that this gentleman has a proprioceptive deficit and that he needs to do some balance work on a Bosu ball or  tilt board.  But that is “so last year” thinking. If someone is having troubles standing and balancing on a stable concrete floor why in the world would you make his stance surface training even more unstable ?  This again is just not wise thinking. You don’t first learn to drive on the freeway, you start in a parking lot or back street where you can learn skills at a slow speed first. Conquer stability on a stable surface, then progress them to a more unstable surface.

Today we showed you a small diamond in our assessments. The “3 second gait challenge”.  This one is a keeper for us.  As we always say “Speed kills”. And in gait speed also is a disguise, it blends and blurs the deficits and challenges.  Slow your clients done to 3-4 seconds and watch what jumps out at you !  (did you read our blog post on Speed and Gait deficits ? Here is the link.) Speed is the devil when it comes to gait. At a normal walking pace and running pace these deficits were not perceptible, because speed in the sagittal plane (moving forward) reduced the lateral challenges. Speed blurs, speed blends and speed kills.

We continue to ask “Of all the functional movement courses being offered out there now, why do they not get into functional gait screening?"  We think we have the answer.  It is likely because this stuff is difficult, it is because it takes a deep knowledge base of whole body biomechanics/functional anatomy (from arm swing to big toe function) and it is because what you see in someone’s gait is very often not the problem.  A deep and broad understanding of human gait is not something you can pick up in a single weekend seminar nor can it be something done simply by a "check off” sheet.  This is complicated stuff, our 700+ blog posts with 230 in the draft folder plus 90 YouTube videos proves that there is great depth to gait and proves how complex it can be. But, if you have been with us for awhile and continue to work at this stuff you are likely getting better and better at this gait stuff. Do not give up. This is a worthwhile journey.

We are The Gait Guys. Shawn and Ivo.

Providing a stable surface for your knowledge base!