Podcast 149: A runner's podcast. Many things running and biomechanics.


Links to find the podcast:
Look for us on iTunes, Google Play, Podbean, PlayerFM and more.
Just Google "the gait guys podcast".

Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:
Apple podcasts:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:
https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

Other links:
http://traffic.libsyn.com/thegaitguys/pod_149_-_71319_7.44_AM.mp3
http://thegaitguys.libsyn.com/a-runners-podcast-many-things-running-and-biomechanics
http://directory.libsyn.com/episode/index/id/10506122



Show notes:


Exercise matters
3 months of exercise training reprogrammed the epigenetics of sperm DNA in healthy young men. Exercise silenced genes in sperm DNA involved in schizophrenia, Parkinson's disease, cervical cancer, leukemia, and autism
https://www.ncbi.nlm.nih.gov/pubmed/25864559?dopt=Abstract
Epigenomics. 2015 Aug;7(5):717-31. doi: 10.2217/epi.15.29. Epub 2015 Apr 13.
Genome-wide sperm DNA methylation changes after 3 months of exercise training in humans.
Denham J1, O'Brien BJ2, Harvey JT2, Charchar FJ

Footstrike doesnt matter?
https://www.outsideonline.com/2397214/foot-strike-running-study

Adaptation of Running Biomechanics to Repeated Barefoot Running: A Randomized Controlled Study - Karsten Hollander, Dominik Liebl, Stephanie Meining, Klaus Mattes, Steffen Willwacher, Astrid Zech, 2019
https://journals.sagepub.com/doi/full/10.1177/0363546519849920
Is There an Economical Running Technique? A Review of Modifiable Biomechanical Factors Affecting Running Economy.
Moore IS. Sports Med. 2016.
https://www.ncbi.nlm.nih.gov/m/pubmed/26816209/

Running Technique is an Important Component of Running Economy and Performance.
https://www.ncbi.nlm.nih.gov/m/pubmed/28263283/
Folland JP, et al. Med Sci Sports Exerc. 2017.
https://journals.sagepub.com/doi/full/10.1177/0363546519849920

Important to note though than less vertical oscillation is associated with better economy within groups of distance runners, eg ncbi.nlm.nih.gov/m/pubmed/28263… ; ncbi.nlm.nih.gov/m/pubmed/26816… compliant tendons but greater leg stiffness is the goal for distance runners, correct?

This video shows how end. runners compliance & economy are achieved by greater vertical excursions vs. sprinters who hit hard, get off the ground fast and burn more energy.
https://www.nytimes.com/video/sports/100000004379956/identifying-the-best-way-to-run.html

typically have peak vertical forces of 2.5-3.0 times body weight to offset gravity during contact portion of the stride.
https://www.youtube.com/watch?v=hEnIbklXOiU

Effects of footwear midsole thickness on running biomechanics
Sports Medicine and Biomechanics
Mark H.C. Law, Eric M.F. Choi, Stephanie H.Y. Law, Subrina S.C. Chan , Sonia M.S. Wong, Eric C.K. Ching
https://www.tandfonline.com/doi/abs/10.1080/02640414.2018.1538066?journalCode=rjsp20

Knee muscle forces during walking and running in patellofemoral pain patients and pain-free controls.
Thor F.Besiera, Michael Fredericsona, Garry E.Gold, Gary S.Beaupréd, Scott L.Delp
Journal of Biomechanics Volume 42, Issue 7, 11 May 2009, Pages 898-905
https://www.sciencedirect.com/science/article/abs/pii/S0021929009000396

Podcast 148: A deep dive case study. Plus, Central and Peripheral fatigue explained

tag/key words: gait, gaitproblems, gaitanalysis, forefootrunning, forefootstrike, heelstrike, pronation, central fatigue, peripheral fatigue, fatigue, hip rotation, gait biomechanics, running

Links to find the podcast:
Look for us on iTunes, Google Play, Podbean, PlayerFM, Radio.com and more.
Just Google "the gait guys podcast".

Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:

iTunes page:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:
https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

Direct download URL: http://traffic.libsyn.com/thegaitguys/pod_1488_-_61419final.mp3

Permalink URL: http://thegaitguys.libsyn.com/podcast-a-deep-dive-case-study-plus-central-and-peripheral-fatigue-explained

Libsyn Directory URL: http://directory.libsyn.com/episode/index/id/10151672

1st MTP Pain? The Biomechanics of the Big Toe...

Remember the rockers? We have done a series on this in the past. Remember there are three: heel, ankle and forefoot. We are going to concentrate on the forefoot today.

As a reminder, forefoot rocker occurs at the 1st metatarsal phalangeal joint (big toe knuckle) as the tibia progresses over the forefoot during forward movement. You NEED 50 degrees to do this competently; you SHOULD have 65 degrees. When you don’t, you have a condition called hallux limitus. This could be from a number of reasons, from overpronation in the mid foot, to a bunion, to faulty firing patterns of the muscles which help to descend the 1st ray (the extensor hallucinations brevis, the peroneus longs and the short flexors off the toes). Pretty much, ANYTHING that causes a dorsal and posterior shift of the 1st MTP axis will cause limited forefoot rocker.

So, the question is, “Do you know where 1st 1st MTP pain may be coming from? How familiar are you with the mechanics of that joint?”

Take a few minutes to review it in this video with Dr Ivo Waerlop of The Gait Guys.

#gait, #gaitanalysis, #1stmtp, #forefootrocker, #thegaitguys,

Toes Spacers, anyone?

Less pain through better mechanics?

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We have been using toe separators for various foot problems like hallux valgus, hammer toes and flexor dominance/extensor weakness. Our reasoning is that through changing the angle of attachment of the muscle, you alter the mechanical advantage of that muscle and help it to work more efficiently. This seems implied in the literature with respect to foot orthoses (1-3) but we could not find any data regarding toe separators. Toe separators DO seem to reduce pain and increase function (4-6). Perhaps this is through better biomechanics, mechanical deformation, proprioceptive changes, or most likely a combination of all these factors and more.  We think clinical results speak volumes. It is nice to see more data coming out on these easy to implement clinical tools. 

What is you clinical reasoning or rationale for using these devices? We would love to hear and if you have an article for reference you could share, that would be great. 

 

1. Scherer PR, Sanders J, Eldredge DE, Duffy SJ, Lee RY. Effect of functional foot orthoses on first metatarsophalangeal joint dorsiflexion in stance and gait. J Am Podiatr Med Assoc. 2006 Nov-Dec;96(6):474-81.

2. Halstead J, Chapman GJ, Gray JC, Grainger AJ, Brown S, Wilkins RA, Roddy E, Helliwell PS, Keenan AM, Redmond ACFoot orthoses in the treatment of symptomatic midfoot osteoarthritis using clinical and biomechanical outcomes: a randomised feasibility study. Clin Rheumatol. 2016 Apr;35(4):987-96. doi: 10.1007/s10067-015-2946-6. Epub 2015 Apr 28.

3. Bishop C, Arnold JB, May T. Effects of Taping and Orthoses on Foot Biomechanics in Adults with Flat-Arched Feet. Med Sci Sports Exerc. 2016 Apr;48(4):689-96. doi: 10.1249/MSS.0000000000000807.

4. Chadchavalpanichaya N, Prakotmongkol V, Polhan N, Rayothee P, Seng-Iad S. Effectiveness of the custom-mold room temperature vulcanizing silicone toe separator on hallux valgus: A prospective, randomized single-blinded controlled trial. Prosthet Orthot Int. 2017 Mar 1:309364617698518. doi: 10.1177/0309364617698518. [Epub ahead of print]

5. Tehraninasr A, Saeedi H, Forogh B, Bahramizadeh M, Keyhani MR. Effects of insole with toe-separator and night splint on patients with painful hallux valgus: a comparative study. Prosthet Orthot Int. 2008 Mar;32(1):79-83. doi: 10.1080/03093640701669074.

6. Tang SF, Chen CP, Pan JL, Chen JL, Leong CP, Chu NK. The effects of a new foot-toe orthosis in treating painful hallux valgus. Arch Phys Med Rehabil. 2002 Dec;83(12):1792-5. 

 

 

The Knee and Macerating Menisci

Take a good look at the above 2 slides.

Notice that, during pronation, there is a medial rotation of the lower leg and thigh. We remember that, during pronation, the talus plantar flexes, adducts, and everts. This anterior translation and medial rotation of the talus causes the tibia and subsequently the femur to follow. This, if everything is working right, results in medial rotation of the knee.

From the slides, it should also be evident that the medial condyle of the femur and a medial tibial plateau are larger than the lateral. This allows for an increased amount of internal and external rotation of the knee. We remember that the meniscus, like a washer, is between the tibia and femur. We if you think about this kinematically, it would make sense that the tibia, during pronation (which occurs from initial contact to mid stance) would have to rotate faster than the femur otherwise the meniscus would be caught "in between". If there is a mismatch in timing, the meniscus is "caught in the middle", which causes undue stress and can cause fraying, degeneration, etc.

Likewise, during supination (from mid stance to pre swing) the femur must externally rotate faster then the tibia, otherwise we see this same "mismatch". This is a scenario we commonly see in folks who over pronate at the mid foot and remain in pronation for too omg a period of time. 

We think of pronation as being initiated from the movement described above by the talus, and it is attenuated by the popliteus muscle as well as some of the deep flexors of the foot, which fire mostly during stance phase. You will notice that the popliteus  is eccentrically contracting at this point.

Supination, initiated by swing phase of the opposite leg and momentum, is assisted by concentric contraction of the popliteus muscle, internal rotation of the pelvis on the stance phase leg, contraction of the vastus medialis, deep flexors of the foot and peroneii.

Taking moment to "wrap your head around" this concept. Now you can see how complicated it can be when we started to throw in femoral and tibial torsions as well as possibly some orthotic therapy. For example, in an individual with internal tibial torsion, if you do not valgus post the forefoot of the orthotic, the knee is placed at outside the sagittal plane in external rotation further by the orthotic and this thwarts the function of his mechanism, leaving the meniscus holding the bag. 

Know your anatomy and know what is supposed to be firing when, your patients and clients knees depend on it!

 

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.

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.

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Proprioception trumps Biomechanics

As I sit here on a rare Friday afternoon, not working (OK, I am writing this, so sort of working) and looking out at the lake (picture above), while on a family camping trip, I think about a walk on the rocks this morning with my kids. I was watching my very skilled 7 year old jump from rock to rock while my 3 ½ year old, that thinks he is seven, tried to follow his older brother.

I had my foot on a rock which lowered the front of my foot in plantar flexion and stood on that leg. I noticed that my balance was not as great as it was when my foot was in dorsiflexion. This made me think about pronation and supination. Yes, it is not uncommon for me to think about such things, especially when I have some spare time. That is one of the things about being a foot and gait nerd; these sorts of things are always on our minds.

So, why was my balance off? Did I need more proprioceptive work? Were my foot intrinsics having issues? No, it was something much more mundane.

Pronation consists of dorsiflexion, eversion and abduction. This places the foot in a  “mobile adaptor” posture, reminiscent of our hunter/gatherer ancestors, who needed to adapt to uneven surfaces while walking over terra firma barefoot. Supination, on the other hand (which is the position my foot was in), consists of plantarflexion, inversion and adduction. It places the foot (particularly the midtarsals) in a locked position for propulsion (think of the foot position during toe off).

So why when my foot was plantar flexed and adducted while standing on this rock so much more unstable in this supposedly more stable, supinated position? I would encourage you, at this point, to try this so you can see what I mean. When I placed my foot in dorsiflexion on the rock, I was much more stable. A most interesting conundrum for a biomechanist.

Experimenting for a few minutes, alternating plantar flexion and dorsi flexion, gave me the answer. When we are walking on the flats, our foot is (usually) not pushed to the extremes of dorsiflexion; with the front of the foot up on a rock, it is much more so. This “extra” upward force on the front of the foot, provides much more sensory input (and thus proprioception) from the ball of the feet. Take a look at the sensory homunculus and you can see how much brain real estate is dedicated to your foot, especially the front portion. With this information, we are able to apply more  force through the posterior compartment of the leg,which is stronger than my anterior compartment (as it is with most folks).

When the front of your foot is in plantar flexion (ie, your heel is on the rock), we have less sensory input to the balls of the feet, and rely more on the anterior compartment (weaker in many folks, including myself) to counterbalance the weight of our body.

Mystery solved: proprioception trumps biomechanics; more proof that the brain is smarter than we are.

The Gait Guys. Solving the worlds great gait questions, one at a time.

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So you want to do a Gait Analysis: Part 3

This is the third in a multi part series. If you missed part 1, click here. For part 2, click here.

 Again, a quick review of the walking gait cycle components:

There are two phases of gait: stance and swing

Stance consists of:

  • Initial contact
  • Loading response
  • Midstance
  • Terminal stance
  • Pre-swing

Swing consists of:

  • initial (early) swing
  • mid swing
  • terminal (late) swing

today, lets explore Midstance

we remember that midstance is the mid point of the stance phase of the gait cycle. It is when the maximal amount of midfoot pronation should be occurring

Lets look at what is happening here at the major anatomical areas:

Foot

  • Pronation begins: The talus should have slid anteriorly on the calcaneus and it then plantar flexed, everted and adducted to its greatest degree. The subtalar joint should have its axes parallel with the calcaneocuboid joint, essentially “unlocking” the midfoot.  This allows the midfoot to assist in absorbing shock, along with knee flexion, hip flexion and a dip of the contralateral pelvis.
  •  the calcaneus everts to a max of approximately 5-8°
  •  the center of gravity of the foot is lowest at this point, and the ankle mortise its deepest. 
  • The lower leg should be internally rotated (as it follows the talus) 4-6°
  • The thigh should follow the lower leg and should also be internally rotated 4-6°; sometimes to a greater extent due to the shape and size of the medial condyle of the femur (which is larger than the lateral)
  • these actions are (still) attenuated by eccentric action of both the long flexors and extensors of the ankle, as well as the foot intrinsics

Ankle

  • The ankle should be neutral, as it should be at the mid point of ankle rocker

Knee

  • Flexion to 20°. This is attenuated largely by the quadriceps, contracting eccentrically. The popliteus has often concentrically contracting to assist in internal rotation of the thigh up until midstance. It is quiescent at midstance and will begin to contract eccentrically as soon as the knee passes midstance.

Hip

  • The hip is at full flexion at loading response, decreasing as it approached midtsnce and now begins to extend. This is facilitated by a brief contraction of the gluteus maximus (which started at initial contact)

Can you see what is happening? Try and visualize this in your mind. Can you understand why you need to know what is going on at each phase to be able to identify problems? If you don’t know what normal looks like, you will have a tougher time figuring out what is abnormal.

Ivo and Shawn. Gait and foot geeks extraordinaire. Helping you to build a better foundation to put all this stuff you are learning on.

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

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

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So you want to do a Gait Analysis: Part 2

This is the second in a multi part series. If you missed part 1, click here.

We have been exploring the gait cycle, one step (literally) at a time. A quick review of the walking gait cycle components:

There are two phases of gait: stance and swing

Stance consists of:

  • Initial contact
  • Loading response
  • Midstance
  • Terminal stance
  • Pre-swing

Swing phase:

  • initial (early) swing
  • mid swing
  • terminal (late) swing

today, lets explore Loading Response

we remember that Loading response occurs when there is eight bearing on the loaded extremity from initial contact. This continues until the opposite foot is lifted for swing.

Lets look at what is happening here at the major anatomical areas:

Foot

  • Pronation begins: This is when the proverbial “rubber hits the road” occurs. Hopefully the coefficient of friction of the heel with the ground is great enough that pronation of the midfoot begins. As the calcaneus slows, the talus slides anteriorly and plantar flexes, adducts and everts, unlocking the subtalar joint and (hopefully) moving toward making its axis parallel with the calcaneo cuboid joint at midstance (more of that next time).
  • because of this motion, the calcaneus everts approximately 5°
  • both of these motions serve to lower the center of gravity of the leg, deepening the ankle mortise to provide more stability to the ankle
  • Both of these motions (especially adduction of the talus) initiate internal rotation of tibia and lower leg
  • these actions are attenuated by eccentric action of both the long flexors and extensors of the ankle, as well as the foot intrinsics

Ankle

  • The ankle plantar flexes 5-10 °. This motion is attenuated by eccentric action of the anterior compartment muscles of the lower leg
  • this serves to absorb shock (remember pronation is a shock absorber? if not, see here)
  • Ankle rocker occurs (click here for a review of the rockers of the foot)

Knee

  • Flexion to 20°. This is attenuated largely by the quadriceps, contracting eccentrically

Hip

  • The hip is at full flexion at loading response and now begins to extend. This is facilitated by a brief contraction of the gluteus maximus (which started at initial contact)

Starting to see what is happening? Can you understand why you need to know what is going on at each phase to be able to identify problems?

We are The Gait Guys. Two geeks spreading the word. WE appreciate your help doing the same.

 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.

 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.

Orthotics and Footbeds. What's the difference?

Orthotics and footbeds, they’re the same thing, right? This is a question that is posed to us all the time.  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 overpronate. 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.

 

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 snow sports when using these.

 

Running, hiking and cycling are more dynamic. Sports like these demand a device that changes the biomechanics, so here an orthotic would be most appropriate.

 

Orthotics are always custom made devices. They actually improve the mechanics of your foot 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 running, biking, hiking, skiing or snowbaording. Many people use their orthotic in their everyday shoes, to help prevent some of the problems and symptoms they are experiencing.

 

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.

The Gait Guys. Bring you info you can use, each and every day.

All material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved.

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“I’ll plead the 1st … ."   More foot geek stuff from The Gait Guys.

The 1st Ray that is!

The "1st ray” consists of the 1st metatarsal and the medial cunieform, essentially the long bones associated with the big toe. It is a functional unit we often refer to when discussing foot biomechanics.

You have heard us speak of the 1st ray needing to descend to form the medial tripod of the foot (tripod review: head of 1st metatarsal, head of 5th metetarsal, center of calcaneus). This action depends to some degree on the competency of the peroneus longus, which attaches from the upper lateral fibula and the associates interosseous membrane; curves around the lateral malleolus, crosses under the foot and attaches to the base of the 1st metatarsal and medial cunieform. The tibialis posterior is supportive to this action. This action is opposed (or modulated, for every Yin there is a Yang; it’s all about balance) is the tibialis anterior, which attaches to the top of the base of the 1st metatarsal and 1st cunieform.

As a result, 1st rays can be elevated or depressed. (here is a latin term to impress your friends with: Metatarsus Primus Elevatus, or elevation/dorsiflexion of the 1st ray/metatarsal). Clinically, we see more that are elevated, resulting in a faulty (collapsing) medial tripod of the foot. The important thing is isn’t necessarily its position, but rather its flexibility. The inflexible ones (isn’t it always?) are the problem children, because they result in altered (notice I didn’t say bad) biomechanics. The further we move from ideal, the closer we seem to move to some compensation pattern. The flexible ones are still a problem but we can control and dampen their rate of flexible collapse.

Generally speaking, a plantar flexed 1st ray that is rigid, has a tendency to throw your center of gravity (an often your knee) to the outside of the foot tripod (think of a rigid cavus foot) and a dorsiflexed to the inside of the foot tripod. Sure, there are LOTS of other factors, but we are talking in generalities here.

Look carefully at the images above and note the position of the 1st metatarsal heads. In the top set, the 1st is depressed (or plantarflexed). In the bottom set they are elevated (or dorsiflexed). Cool, eh? 

NOTE: please refrain from using the term “dropped metatarsal”. Nothing gets dropped, it is correctly stated as plantarflexed (rigid or flexible).

Be on the look out for these on your clinical exam.

Ivo and Shawn. Bringing you one step closer to foot geekdom each day!

copyright 2012 The Homunculus Group/The Gait Guys. All rights reserved. If you rip off our stuff, you will be plagued with the curse of Toelio…..

What do you think of when you watch Zsa Zsa Gabor walk , or a woman like “Madeline” describes in this post?

Hip swing.

Yup, like it or leave it. It is here to stay. And evidently. It makes women more attractive to men (or more likely to attract a mate, click here to read our post on that).

So the question is, Why?

Besides the aesthetically pleasing aspect of this, it is most likely biomechanics. Women (generally) have

a. wider hips,

b. more femoral anteversion (or ante torsion) and

c. an increased Q angle.

This means more:

a. lateral displacement of the pelvis,

b. more internal and less external hip rotation available and

c. more lateral displacement again, with increased demand on the gluteus medius, due to the anatomical attachments.

Yup, there usually is a reason and it is often biomechanical, not aesthetics.

The Gait Guys. Ivo and Shawn. Gait Geeks to the core!


Gait Differences between men and women

J Womens Health Gend Based Med. 2002 Jun;11(5):453-8. Gender differences in pelvic motions and center of mass displacement during walking: stereotypes quantified. Smith LK, Lelas JL, Kerrigan DC. Source

Center for Rehabilitation Science, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.

Abstract OBJECTIVES:

A general perception that women and men walk differently has yet to be supported by quantitative walking (gait) studies, which have found more similarities than differences. Never previously examined, however, are pelvic and center of mass (COM) motions. We hypothesize the presence of gender differences in both pelvic obliquity (motion of the pelvis in the coronal plane) and vertical COM displacement. Quantifiable differences may have clinical as well as biomechanical importance.

METHODS:

We tested 120 subjects separated into four groups by age and gender. Pelvic motions and COM displacements were recorded using a 3-D motion analysis system and averaged over three walking trials at comfortable walking speed. Data were plotted, and temporal values, pelvic angle ranges, and COM displacements normalized for leg length were quantitatively compared among groups.

RESULTS:

Comparing all women to all men, women exhibited significantly more pelvic obliquity range (mean ISD): 9.4 +/- 3.5 degrees for women and 7.4 +/- 3.4 degrees for men (p = 0.0024), and less vertical COM displacement: 3.7 +/- 0.8% of leg length for women and 3.3 +/- 0.9% for men (p = 0.0056).

CONCLUSIONS:

Stereotypically based gender differences were documented with greater pelvic obliquity and less vertical COM displacement in women compared with men. It is unclear if these differences are the intrinsic result of gender vs. social or cultural effects. It is possible that women use greater pelvic motion in the coronal plane to reduce their vertical COM displacement and, thus, conserve energy during walking. An increase in pelvic obliquity motion may be advantageous from an energy standpoint, but it is also associated with increased lumbosacral motion, which may be maladaptive with respect to the etiology and progression of low back pain.

Gait analysis case study: A runner with achilles pain.

Please watch this clip a few times and pay special attention to the lateral views. This client had persistent Left Achilles pain which has improved with care and foot exercise, but is developing Left soleus pain.

Lets try something new. Lets test your gait auditory skills. Run the video and listen. Listen to the foot falls. Can you hear one foot slap harder than the other on strike ? Can you hear the right forefoot slap harder than the left ?  It is there, it is subtle, keep re-running the video until you are convinced. The left foot just lands softer. Take your gait assessment to the next level, listen to your clients gait. Use all your senses. This finding should ask you to assess the anterior compartment of the right lower limb (tibialis anterior and toe extensors).  And if they are not weak then you should begin to ask yourself why they may be loading the right foot abruptly. Perhaps it is because they are departing off of the left prematurely, in this case possibly because of a short leg that has a shorter stride length. 

From clinical examination he has a 10mm anatomically short left leg (not worn in these videos), bilateral uncompensated forefoot varus deformities, bilateral internal tibial torsion and tibial varum ( 10 degrees Left, less on Right).

Exam reveals:

  • weakness of the fourth and fifth lumbricals (small intrinsic foot muscles to the 4th and 5th toes) left greater than right. This will afford some lateral foot weakness during stance phase.
  • weakness of all long toe extensors bilaterally (their weakness will allow dominance of toe flexors)
  • weakness of the extensor hallucis brevis bilaterally
  • weak left iliacus (a hip flexor muscle)
  • slight pelvic shift to the left when testing the right abdominal external obliques
  • weakness bilaterally of the quadratus femoris (a deep hip stabilizing muscle)
  • weakness superior and inferior gemelli left, superior right (again, more deep hip stabilzer muscles)

So, what gives?

Did you pick up the nice ankle rocker present?  There is good ankle dorsiflexion. What is missing? Look carefully at the hip (in the lateral/ side video views). There is not much hip extension going on there. So, the question is how does he get the ankle rocker he is achieving ? Look at the knees. He is getting it through knee flexion! It would be more effective and economical to achieve this kind of ankle dorsiflexion from a nice hip extension and utilize the glutes for all they can provide.

Remember, he has an uncompensated forefoot varus. This means he has trouble making the medial part of his foot tripod get to the ground. This means that the foot tripod will be challenged when the foot is grounded and when combined with the clinical foot weaknesses we noted on examination this is a foregone conclusion.  With all that knee flexion which muscle will be called upon to control the foot? The soleus  (which DOES NOT cross the knee).

The answer to helping this chap ? Achieve more hip extension! How? Gluteal activation through some means (acupuncuture, dry needling, MAT, K tape, rehab and motor skill patterns etc), conscious dorsiflexion of the toes, conscious activation of the glutes and anything else you might find useful from your skill set. Gain more from the hips and  you will gain more control from that area and ask for the soleus to do just its small job.

Subtle? Maybe. Now that you know what you are looking at it is pretty easy isn’t it ? It’s like the “invisible gorilla in the room” we talked about in our previous Podcast.  Unless someone brings it to your attention your focus will be on what you are accustomed to looking for and what you have seen before. Sometimes we just need someone to direct our vision.  There is a difference between seeing something and recognizing something. In order to recognize something you have to go beyond seeing it, the brain must be engaged to process the vision.

The Gait Guys. Let us be your Peter Frampton and “Show you the Way” : )

BIKE FIT: Case Study

Along the vein of bike fit, to go with Thursday and Friday’s posts last week, here is gentleman with right sided low back pain ONLY when ascending hills on his mountain bike. Can you figure out why?

*Stop, watch the video and think about it before we give you the answer… .

____________________________

This gentleman presented with low back pain, only on his mountain bike, only on long ascents.

He measures out with an 83 cm inseam which should put him on a 44 to 45.5 cm frame (measured via our method). His frame has a dropped top tube and measures 55 cm.

He has a knee bend angle of 20 degrees at bottom dead center. Knee is centered well over pedal axis.

His stem falls far in front of his line of sight with respect to his hub. Stem is a 100 mm stem with a 6 degree rise.

There is a 2" drop from the seat to the top of the handlebars.

He has an anatomically short Left leg (tibial)

Here is some additional video of him with a 3 mm lift in the left shoe. Look at the tissue folds at the waist and amount of reach with each leg during the downstroke in this one as well as the last. no changes were made to the seat height, fore/aft position of seat. or handlebars.

The frame, though he is a big dude (6’+), is too big and his stem is too long. He is stretched out too far over the top tube, causing him to have an even more rounded back (and less access to his glutes; glutes should rule the downstroke and abs the upstroke). This gets worse when he pushes back (on his seat) and settles in for a long uphill. Now throw in a leg length discrepancy and asymmetrical biomechanics.

Our recommendations:

  • smaller frame (not going to happen)
  • lower seat 5-7mm
  • shorter stem (60-75mm) with greater than 15 degree rise
  • lift in Left shoe


We ARE the Gait Guys, and we do bikes too!

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Proper bike fit: Highlights from the Clinic at Summit Chiropractic and Rehabilitation: Part 2

Picking up from yesterdays post, here are some more thoughts.

Saddle/seat fore/aft position: There are two ways to make this measurement:

1) When you’re legs are at 90 degrees in your power stroke (cranks are horizontal), drop a plumb line from the tibial tuberosity (the bump on the leg just below the kneecap, where your quadriceps attaches).  This line should intersect the pedal axis or be slightly behind it.

2) if you like to ride with the seat a little back, drop the plumb line from the front of the kneecap.  It should intersect or fall slightly behind the pedal axis.

The a general rule of thumb is that cyclists in spinning classes, or those who like to push lower gears, tend to sit slightly forward.  Those who push higher gears and spin slower, sit a little further back.

If your seat is too far back it can cause lower back pain because of the increased flexion occurring in the trunk.  Cyclists will often feel pain just below the waist where the gluteal muscles attach or in the middle of the lower back, where the hip flexors attach.  If the seat is too far forward, cyclists usually experience knee pain.

Handlebar Height & Width: Handlebars should be approximately shoulder width and be 0-2 inches below saddle height. The wider they are, the more they open up your chest and allow better breathing, but this is at the expense of aerodynamics. The higher they are, the less stress on your back and neck. With your hands in your most common riding position (on the grips,hoods, or in the drops) you should be able to look down at the center of the stem/handlebar intersection and not be able to see the front axle. If the bar is in front, you may have trouble with descents, if behind, you way be doing wheelies up hill! Problems can often be remedied with a change of stem with a different length, pitch or both.

Handle bar reach: This is the “softest” and factors.  And old standby method used to measure the distance from your elbow to the tip of your middle finger from the tip of your saddle to the center of the handle bar stem.  This measurement will vary, depending upon whether your torso is long or short.  Riding style will also be a determining factor; overall, comfort is the rule.  You may need to buy a shorter for longer stem to make yourself more comfortable.

Bike Fit. The Gait Guys. Yup, we do that too

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Case of the Week: Rib Pain while Running: Part 1

This 39 year old woman presents with with rib pain, pointing to right ribs. First time it “went out” 1 ½ year ago, second time a year ago and recently two weeks ago. It is usually related to running with pain the day of and day after it is acute; it hurts to lie on her back or roll onto that side or breathe deep. She seems to do best when she is semiflexed on her knees.  Stretching can take the edge off.  When she has an acute episode, it usually lasts about a day.

She is very physically active and works out almost everyday. She runs triathlons and Ironman’s (or Ironwoman’s in this case), and generally is in good shape.

Above is what you see physically (hover mouse over each picture) and here are her exam findings:

She is 5’ and weighs approx. 105 pounds. BP 100/72 left, pulse ox 94, pulse 52. Lungs auscultate clearly, normal heart sounds, abdomen non tender and normal to percussion and auscultation.

Viewed from posterior in a standing position, she had increased tibial varum bi-lat., right greater than left, right hip had posterior rotation, less space between iliac crest and rib margin right hand side. No tenderness noted over the obliques or lower ribs left hand side. She had a loss of lateral bending to the left L2 through L4 negative theta-z stress.

She has a L  left short leg (tibial) 5 mm, bi-lat. external tibial torsion left greater than right. There is weakness of the abdominal internal and external obliques bi-lat. as well as iliopsoas, R > L. There was point tenderness at the R lesser trochanter; active and passive hip extensoin was 10 degrees right, 15 degrees left.

Question: What is your assessment and what are you going to do?

a. do not know, go have a beer

b. do not know, go have 2 beers

c. do not know, do not drink beer, have a double latte after reading Fridays post and try not to spill it

d. reply to this post,  think about it and check back later to see what The Gait Guys have to say

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What’s your Foot Type?: Part 1

Ready for Monday Morning? This is the 1st of a 5 part series to get your week going and help get you in a “Gait Guys” frame of mind

Rearfoot varus

What if many of your nagging and seemingly un resolvable injuries as an athlete were from an undiagnosed foot type? What if every shoe, insert and orthotic you implemented in an attempt to help manage these problems was not the solution, but rather a means of “band aiding” the problem because your anatomy was compromised from the start? 

Wouldn’t it be nice to have some answers to all the questions you have as to why your interventions were less than optimal? Wouldn’t life be better if you knew that your anatomy was slightly left of center and that this was the true cause?  Life as an athlete sure would be more tolerable and perhaps, just perhaps, a life with fewer nagging injuries.

The main issue is that the majority of humans have less than perfect feet. The “perfect” neutral foot is one in which the rearfoot and the forefoot lie on the same plane, meaning that the forefoot and the rearfoot lie square on the ground when ankle and subtalar joint mechanics are neutral.  This insures the tripod of the foot (the base of the big toe, the base of the little toe and the center of the heel) remain on equal footing, creating a balance of power between the muscles and articulations.

There are many reasons at to why we do not all have perfect feet with pristine mechanics to run and walk on.  Some are genetic, some congenital, and some developmental. Regardless, as the saying goes “You have what you have, so why not make the best of it?”

In a nutshell, there are 5 basic foot types; two involving challenges to the forefoot, and two challenging the rear foot. These can be rigid and non adapting, flexible and adapting, or somewhere in between. The fifth type is the ideal of what we all hope to have. This 5 part series will help you to understand each and the biomechanics associated with the anatomical variant.

Rearfoot varus.

The rear foot varus is a foot that has the heel inverted, almost appearing as though the ankle is about to roll, like a common ankle sprain. Here the rear of the tripod is compromised. Because of this lateral shift of weight through the contact phase of walking or running, the foot is over supinated  (plantar flexed, inverted and adducted) at toe off.  The owner of this foot type usually has excessive use of the peroneal muscle group to fight this supinated tendency and prevent ankle sprains.  The 4th and 5th metatarsals typically take on more stress, and are often painful. Loading the lateral aspect of the limb shifts the center of gravity and challenges stability in the frontal plane, often leading to hip problems, such as trochanteric bursitits and IT band friction type syndromes and knee/patellar tracking issues.

Confused? Have no fear. Our shoe fit program is almost here! The Shoe fit functional testing module (also available separately from the 3 part program) discusses foot types in more detail. Watch here on Mondays for a different foot type each week!

The Gait Guys: promoting foot and gait competency everywhere!