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.

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Of course this article is not exclusive for sprinters, it pertains to any running sport, even endurance.

Maximum isometric force had increased by 49% and tendon CSA by 17% !
Tendons can change their cross sectional area, if you load them.

Here I show lateral forefoot loading in a heel raise, and a medial forefoot loading in heel raise. This has to be part of the discovery process outlined below. Forefoot types will play into the loading choice, and unequal strength of the medial or lateral calf compartment will also play into the loading choice made. Where do you need to put your strength ? And is the forefoot competent to take that loading challenge ? Meaning, do they have a forefoot valgus? A forefoot supinatus ? These things matter. If you are a sprinter, how you load the forefoot bipod might be a variable of foot type, asymmetrical posterior compartment strength, or foot strike pattern in the frontal plane (search our blog for cross over gait and glute medius targeting strategies for step width) ,or a combination of several or all of the above. These things matter, and why and where you put your strength matters, if you are even aware of where and how you are putting the loads, and why of course. Of course, then there are people like the recent Outside online article that says how you foot strike doesn’t matter, but it does matter. But of course, if you do not know the things we have just mentioned, it is easy to write such an article.

Isometrics are useful, they have their place. In a recent podcast we discussed the place and time to use isometrics, isotonics, eccentrics and concentrics.
One of the goals in a tendinopathy is to restore the tendon stiffness. Isometrics are a safe way to load the muscle tendon complex without engaging a movement that might have to go through a painful arc of movement. With isometrics here is neurologic overspill into the painful arc without having to actually go there.
The key seems to be load. More load seems to get most people further along. Remember, the tendon is often problematic because it is inflammed and cannot provide a stiffness across its expanse. Heavy isometric loading seems to be a huge key for most cases. But, we have to say it here, not everyone fits this mold. Some tendons, in some people, will respond better to eccentrics, and strangely enough, some cases like stretching (perhaps because this is a subset of an eccentric it seems or because there is a range of motion issue in the joint that is a subset of the problem). Now the literature suggests that stretching is foolish, but each case is unique all in its own way, and finding what works for a client is their medicine, regardless of what the literature and research says.
Finding the right load for a given tendon and a right frequency of loading and duraction of loading is also case by case specific. Part of finding the right loading position is a discovery process as well, as noted in the photos above. Finding the fascicles you want to load, and the ones you do not want to load (painful) can be a challenging discovery process for you and your client. Finding the right slice of the pie to load, and the ones not to load takes experimentation. When it is the achilles complex, finding the safe However, if one is looking for a rough template to build from, brief, often, heavy painfree loads is a good template recipe to start with.

Here, in this Geremia et al article, "ultrasound was used to determine Achilles tendon cross-sectional area (CSA), length and elongation as a function of plantar flexion torque during voluntary plantar flexion."
They discovered that, "At the end of the training program, maximum isometric force had increased by 49% and tendon CSA by 17%, but tendon length, maximal tendon elongation and maximal strain were unchanged. Hence, tendon stiffness had increased by 82%, and so had Young’s modulus, by 86%.

Effects of high loading by eccentric triceps surae training on Achilles tendon properties in humans. Jeam Marcel Geremia, Bruno Manfredini Baroni, Maarten Frank Bobbert, Rodrigo Rico Bini, Fabio Juner Lanferdini, Marco Aurélio Vaz
European Journal of Applied Physiology
August 2018, Volume 118, Issue 8, pp 1725–1736

Whole-body coordination patterns may become partitioned in particular ways as a function of task requirements

Just some more thoughts for those who insist on coaching arm swing changes.

"Whole-body coordination patterns may become partitioned in particular ways as a function of task requirements.”

Toddlers actively reorganize their whole body coordination to maintain walking stability while carrying an object. Hsu WH1, Miranda DL2, Chistolini TL3, Goldfield EC4. Gait Posture. 2016 Oct;50:75-81

Today we seem to be going back to dual-tasking again, in this case utilizing the arms as balance assistance devices, amongst their other functions. However, we all know that walking with a hand in a pocket, or carrying something alters our ability to maximize their ballast-like function. Balanced walking involves freely swinging the limbs in pendullar motion. Changes in arm swing will change gait economy and efficiency. We have all run with a water bottle or bag/briefcase and know how that changes the symmetry and fluidity of our gait.

Today's research piece discusses toddlers and their function as they carry objects. "children immediately begin to carry objects as soon as they can walk. One possibility for this early skill development is that whole body coordination during walking may be re-organized into loosely coupled collections of body parts, allowing children to use their arms to perform one function, while the legs perform another. Therefore, this study examines: 1) how carrying an object affects the coordination of the arms and legs during walking, and 2) if carrying an object influences stride length and width." -Hsu et al.In this study of 10 toddlers with 3-12 months of walking experience were recruited to walk barefoot while carrying or not carrying a small toy. "Stride length, width, speed, and continuous relative phase (CRP) of the hips and of the shoulders were compared between carrying conditions. While both arms and legs demonstrated destabilization and stabilization throughout the gait cycle, the arms showed a reduction in intra-subject coordination variability in response to carrying an object. Carrying an object may modify the function of the arms from swinging for balance to maintaining hold of an object. The observed period-dependent changes of the inter-limb coordination of the hips and of the shoulders also support this interpretation. Overall, these findings support the view that whole-body coordination patterns may become partitioned in particular ways as a function of task requirements." -Hsu et al.

So once again we will say it, if you are coaching the arm swing YOU want, because you do not like what you see in your client, or if you think you are helping your client get more out of their body in terms of speed, power, efficiency or anything of the sort, know that there is a higher, smarter program running the show. And that program in the client’s CNS is smarter than you when it comes to what they need for whole-body coordination pattern generation.

The “Dodgy Foot”, a UK runner’s dilemma.

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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, often we cannot help, but when there is a story to tell that everyone can learn from, we offer what we can. This runner was frustrated, explaining a “dodgy foot”. We like the word.

dodg·y däjē/

-dishonest or unreliable; potentially dangerous; of low quality.

We can likely 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 offers a opportunity for dialogue. 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 thought process that further investigation may afford progress towards some answers.

This appears like 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. There are many component parts that leave someone with a cross over type gait (ie a narrow based gait, that if taken further, might as well result in running on a line). 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 might mean stance and swing phase gluteus medius communication problems.
This might mean 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. Arm swing to a large degree is driven by the lower limb motor patterns, despite what some people will propose (dive into our archives to find some of those research articles).
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, but that does not translate to injury, speed, outcome or pain. But when they come with those complaints attached, one would be foolish not to at least consider these biomechanics as a source.
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 might 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 (a toe off that is most often a "low gear toe off", meaning not a medial/hallux 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. That does not mean it is normal ! That means, that many people do this, but it cannot mean that it is optimal mechanics. 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 accommodated 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 don't 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 very frequently. Once you see something enough times, you learn all of the variations and subtle nuances 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

#gait, #gaitproblems, #crossovergait, #gaitanalysis, #gluteweakness, #toeoff

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

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

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

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

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

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

Luke Ericson is tough as nails.

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

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

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

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

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

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

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

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

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

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

Dr. Shawn Allen, the other gait guy

Where do you want to load your foot in relation to your center of mass ?

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Who do you want to be ? The guy loading his head over his foot
(narrow step width), or the gal loading the head and COM inside the foot (less narrow step width) ?
It is not hard to guess who is gonna be faster and more powerful from these photos. The lady is stacking the knee over the foot, the hip over the knee and stabilizing the hip and pelvis sufficiently and durably to keep the pelvis level for the next powerful loading step, and the other is flexion collapsing into the stance phase knee, insufficiently loading the hip and thus dropping the opposite side pelvis. He is not stacking the joints, there is a pending cross over (look at the swing leg knee approaching midline with barely any knee spacing, thus guaranteeing a cross over step or at the very least a very narrow step width.)
Sure, some one is going to say one is a distance runner and the other is a sprinter. Yes, and our point is that the sprinter is not head-over-foot, the one with all the highly suspect flaws is head over foot ! Wider step width means more glutes. Go ahead, walk around right now with a very narrow step width and see how little efficient glute contraction you get, then walk with a notably wider step width, and you will see wider means more glutes. Keep your COM moving forward, not oscillating back and forth sideways over each stance foot, that is a power leak.

Screen Shot 2018-11-16 at 6.00.11 PM.png

The distance runner is showing sloppy in technique. Say what you want, but one of these runners is weak and very likely at greater risk for injury, the other is strong and durable, and likely at less risk for injury.
If you ask us, but what do we know . . . .
So, again, was ask . . . . which one do you want to be ?

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

Screen Shot 2019-04-08 at 4.20.41 PM.png

You are mostly likely not getting to your big toe at push-off if you are doing this. And, if you have a painful big toe, you will do it as well. Oh, and Head-over-foot related, yup. Read on . . .


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


If you are not closer to stacking the hip over the knee, and knee over the foot (like in the photo "SUI" bib runner) you are not likely getting to much of your big toe at terminal stance loading, when you could be getting more power at push off.
Said another way, if you are attacking the ground with the feet closer together, as if you are running on a line (as in the photo) you are going to be more on the outside of the foot (note the lateral foot contact), show a similar wear/loading pattern as in these shoes, and hardly load the medial foot tripod effectively.
Go ahead, walk around your office or home right now . . . . with a very narrow step width and see how little you can load into the bit toe-medial foot tripod (note how little effective glute engagement you get as well). Then, walk with a wider step width, note the easier more effective big toe-medial tripod loading, and, not the glutes come into play.

Screen Shot 2019-04-08 at 4.20.52 PM.png

Thus, head over foot/cross over gait is foolish for effective gait. You have a big toe, don't you wish to use it ? One has to find that balance between an economical step width that still allows an effective toe off event in walking and running. A very narrow cross over-style gait does not afford us this.
So, should it be any surprise to any of us that someone with pain in the big toe or medial tripod complex will choose a narrow step width to avoid the painful loading ? No, no surprise there at all.
We have been writing about the cross over gait for 10 years, bringing little pieces of research to the forefront to prove our theories on it as the research presents itself. We first brought it to you with our 3 part video series here. Search our blog, type in "cross over gait" into the search box on the site www.thegaitguys.com and get a LARGE coffee before hand, you are going to be reading for several hours.

https://www.youtube.com/watch?v=LG-xLi2m5Rc
https://www.youtube.com/watch?v=WptxNrj2gCo
https://www.youtube.com/watch?v=oJ6ewQ8YUAA

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Screen Shot 2019-04-08 at 4.21.23 PM.png

Look at his guys right leg, the lower leg and foot.

Look at his guys right leg, the lower leg and foot.

This photo was part of an insert in an old Altra shoe box when we got our shoes.

IMG_3850.PNG

Is that internal tibial torsion, a fixed bony issue that is causing what appears to be the intoe? Or is it a drop of the right hemipelvis into anterior tilt, to try to get more hip extension, which often leads to full leg internal rotation from the hip ? Is it from a weak left hip complex, particularly the abductor players? Remember, internal hip rotation and hip extension can be paired events. Internal hip rotation is a precursor event, in gait, to hip extension. But this is beyond the normal hip extension-internal limb rotation pairing.

There is no way to know except to examine him.
Coaching this out is a mistake until you know what it is.
Prescribing a corrective exercise to attempt to correct it is also a huge mistake without examining the person hands on, and determining whether this is a fixed bony issue, or a functional pattern of choice/power/biomechanics.
It could also be a compensation to another issue, such as I eluded to in a possible weak right lower abdominal interval, allowing the pelvis to tip too far forward.
We have to understand anatomy, biomechanics, compensations and we have to examine our clients.
If a coach tries to train this out, because they do not like the way it looks, it is foolish. Just plain foolish. And if a coach notes this, but does nothing about it, and merely adds training and strength to the "potential" dysfunction, do not be surprised if injury arises. It might not, but adding strength, load and training onto faulty mechanics can have a consequence. There will be those who say, " if it is not a problem, don't fix it". Our response is, sure, that might work, and then again it might not work. Just take responsibility and honest self inventory if that athlete might injure. And learn from it. We are all students.
Do not add strength to dysfunction.

How do you know ? In this case, one has to get educated on osseous torsions and versions, anatomy, biomechanics, to start. Listen, read, learn. We do these things all the time, every day here on The Gait Guys.

Shawn Allen, one of the gait guys

#gait, #gaitproblems, #gaitcompensations, #tibialtorsion, #internaltibialtorsion, #intoed, #running, #sprinting, #thegaitguys, #hipextension, #powerleak

Running paths and the cross over gait and narrow step width.

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This is a walking/running path. Do the runners on this path only have one foot? No, of course not, they are running on a line. Yes, we cannot get away from this cross over gait, a terribly narrow based gait pattern.
Is it economical? Likely.
Risky ? Possibly.
Do we know that this angled attack of the foot towards the mid-line asks more from the frontal plane stabililzers in the hip and core ? Yes, research has shown this.
Do we know that the gluteus medius helps with foot targeting? Yes, research again shows this, and thus a weak gluteus medius will enable a more medial targeting. Lesson: the gluteus medius helps with foot targeting on the swing leg, and hip stability on the stance leg.
With a Cross Over gait, Do we know that we need better control of internal spin of the limb, better foot pronation durability and many other durable abilities that we might not need so much of if we were better stacking the joint? Again, yes.

We confirmed with the reader who sent the photo that this is not a bike path (at this location this path is for walking folks, the bike path is adjacent to the parking lot).
The reader (Terry B. (thank you Terry)) astutely mentioned that people are walking on a line. If they had some spacing, step width, there would be 2 trails and a tiny patch of grass between them.

But, now, this line, the line is a queue for others to "walk the line" and join the cross-over nation.
We have written gobs of articles on this cross over topic, the few benefits, the teeter-totter "risk / reward" factor, the drawbacks and injury susceptibility factor and we have spoken about it on our podcast probably 100x. IF you wish to entertain that rabbit hole of knowledge, just goto our website and type it into the "search" box. "cross over gait"

When you run Do you kick or scrape the inside of your ankle with the other foot ?

Do you kick or scrape the inside of your ankle with the other foot ?

Runner's pathologies creep in as the miles go up, fatigue can be a variable in biomechanical breakdown. Some of you who have been with us for years have seen this picture. 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 ?

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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

#gait, #gaitanalysis, #gaitproblems, #thegaitguys, #gaitcompensations, #hippain, #hipbiomechanics, #crossovergait, #narrowstepwidth, #calfscuff

When runner do you want to be? 2 photos

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Who do you want to be ? The guy loading his head over his foot
(narrow step width), or the gal loading the head and COM inside the foot (less narrow step width) ?

It is not hard to suspect who is gonna be faster and more powerful from these photos. This however does not mean on is more durable, more or less injured, more or less efficient but logical debates and thought experiments can be made here.

The lady is stacking the knee over the foot, the hip over the knee and stabilizing the hip and pelvis sufficiently and durably to keep the pelvis level for the next powerful loading step, and the other is flexion collapsing into the stance phase knee, insufficiently loading the hip and thus dropping the opposite side pelvis. He is not stacking the joints, there is a pending cross over (look at the swing leg knee approaching midline with barely any knee spacing, thus guaranteeing a cross over step or at the very least a very narrow step width.)
Sure, some one is going to say one is a distance runner and the other is a sprinter. Yes, and our point is that the sprinter is not head-over-foot, the one with all the highly suspect flaws is head over foot ! Wider step width means more glutes. Go ahead, walk around right now with a very narrow step width and see how little efficient glute contraction you get, then walk with a notably wider step width, and you will see wider means more glutes. Keep your COM moving forward, not oscillating back and forth sideways over each stance foot, that is a power leak.

The distance runner appears to be demonstrating less optimal in technique, appears is the key word here. Say what you want, but a decent argument might be made as to one of these runners being weak and very likely at greater risk for injury, the other is suspect to be strong and durable, and likely at less risk for injury.
If you ask us, but what do we know . . . . it is all a thought experiment, but based on some pretty decent ideas.
So, again, was ask . . . . which one do you want to be ?

Gluteal tendinopathy and the Cross Over gait pattern.

Gluteal tendinopathy, often lateral hip pain at or around the region of the greater trochanter. (note: the pain referral of this problem can dispurse far and wide, from low back and even into groin or to the knee). It is not gluteal bursitis, the research barely supports that. You'd be better off using the term "greater trochanteric pain syndrome" (yes, its an ICD10 code).


The problem often involves the abductors, the gluteus medius and/or gluteus minimus tendons as weakness or poor co-contraction stabilization patterning creates a compressive adduction of the tendons and gr.trochanter. But, know this, mere strengthening is not the entire answer, and it is not supported as the cause or cure, it is just part of the solution. As with most problems, resolution is about load, how we load, load over time, tolerance to load, time under tension, loads we can manage, loads we are unprepared for. These are variables certainly pertinent to novice runners and athletes (though for some everyday folk even walking can be vulnerable) but also high level athletes who either mal-adapt, compensate, over protect or under-recover.
About 10 years ago I began my dive into something I was seeing often, something that did not seem to have a name from what I was able to determine, but one that was fraught with mechanical loading issues that was part of my athletes' symptom collage. I referred to it by what it appeared to be, a "cross over gait", and since then have written a few dozen pieces, at least, that go into the problem, pathomechanics, and correction for my athletes and patients. I have often referred this to as a "failure to stack the lower limb joints", but that is so remedial and non-descript. Almost a decade ago I did the 3 part video series (part 1 is below) and it brought a lot of light to gait problems in runners and a huge variable in unresponsive gluteal tendonopathies, amongst others. One can strengthen the glutes all they want, but if the pattern of pathologic loading is not amended, altered, improved, then the model will fail.
And here is another factor that is interesting brought forth at a recent conference,
"@Bill_Vicenzino Imaging over-estimates compared to clinical presentation - MRI positive for Gluteal Tendinopathy in 77% of cases but clinical presentation only positive in 52%"

Watch my 3 part series, starting with the video below. Get to understand the cross over gait variables and you will get better at remedying gluteal tendonopathy. It is more than just prescribing half a dozen glute exercises.

Shawn Allen, the other gait guy.

#gait, #thegaitguys, #gaitproblems, #gaitanalysis, #glutealtendinopathy, #hippain, #crossovergait, #hipadductors, #hipabduction, #greatertrochanter, #hipbursitis

Hip Abductor Strength In Individuals With Gluteal Tendinopathy: A Cross-sectional Study. Kim Allison et al.
https://bjsm.bmj.com/content/48/Suppl_2/A6.2

Don't coach arm swing.

We often say that arm swing should not be coached.
Here are some of our deeper thoughts as to why we stand firm on this.

Look at this photo, there are lots of different arm swings in every group of runners. These differences are not choices for the most part, the arms are just doing what they must, based off of many parameters in a runner, things that are working right, and not so right.

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To be more clear, aberrant arm swing is often a compensation to cope with other flawed mechanics elsewhere, things such as a weak core on one side, loss of thoracic lateral bend or rotation, altered limb stability patterns, hip stability challenges etc. Thus, it is almost foolish to change an arm swing that you do not like in you or your client, because often that is not the problem. Arm swing is a power producer, but it is also a huge ballast like appendage that is used to help maintain balance changes. So, look for all possible causes of what you so, that which looked aberrant, and fix those mechanical flaws first.

From Canton: "Current research has yet to determine how passive dynamics and active neural control contribute to upper limb swing during human locomotion. The present study aimed to investigate these contributions by restricting pelvis motion during walking, thereby altering the upward energy transfer from the swinging lower limbs."

Here at The Gait Guys we have discussed for years the principles of the antiphasic nature between the pelvis "girdle" and shoulder "girdles" in that they should move in opposite rotational planes, and yet be equal in their amplitude, and that when this occurs, arm and leg swings are mostly symmetrical, equal in amplitude and symmetrical in their swing planes. This study found that when the pelvis was restricted, that the ranges of motion of the shoulder and trunk, as well as the vertical trunk center of mass movement, were also reduced, as we have said many times in our writings and in quoting the research over the years. This study also supported our long standing position that arm swing is more of a passive phenomenon, yet with complex coupling of the upper and lower limb neural networks, but also strongly taking its queues from the trunk, pelvis and leg swing.

One final thought from us, coaches, especially sprint coaches, are still going to coach arm swing and force arm swing drills, the ones they want to see, to achieve more power. . . . sigh (we get it, speed is important, but there could be a cost to making the body do what is it naturally struggling to do cleanly). So, if you are going to employ these arm swing sprint drills, get someone to fix the aberrant patterns first, if you want to see fewer injuries. Otherwise, don't be surprised if you see in your runners more thoracic lean to one side, a head tilt to one side, athletes complaining of mid or low back or neck pain, tightness, shoulder pain and the list goes on. Forcing your desired coached arm swing pattern on a clients already compensated physiology may have some unwanted costs.
-Dr. Allen (of the gait guys)

From the -Canton and MacLellan paper:
"Relating shoulder muscle activities to upper limb kinematics suggested these muscles mainly acted eccentrically, providing evidence that passive elements are a significant factor in arm swing control. However, the conserved muscle activity patterns and temporal coupling of limb movements when pelvis motion was reduced are suggestive of an underlying active maintenance of the locomotor pattern via linked upper and lower limb neural networks."

Active and passive contributions to arm swing: Implications of the restriction of pelvis motion during human locomotion.Canton S1, MacLellan MJ2. Hum Mov Sci. 2018 Feb;57:314-323. doi: 10.1016/j.humov.2017.09.009. Epub 2017 Sep 25.

Loaded Carry, Addendum idea

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Recently, Jan 13th, 2018, we posted 2 photos of the Farmer's carry, in that specific case how to use it to drive more load into the hip stabilizers as opposed to the lateral abdominals. Here is how we progress someone from wide step walking corrections, we add the step up. The next progression is to be sure they do not lose the hip hike as they try to return the foot to the ground, which you do not see here. Note the kettlebell in the LEFT hand. They will have to do that (return the RIGHTfoot to the ground) through a knee bent knee mini-squat-lunge, to keep the gmedius on. Or, they can just do a controlled eccentric, but that is even more attention. Most people just let the RIGHT glutes go entirely to get the LEFT swing leg back to the ground, no bueno ! This is not normal gait, but it is what most people do because they do not have command of the glutes in the 3 phasese: early, mid and late stance. In fact, most people fail through all 3 phases, but certainly the Early and Late phases are the toughest, with the Late phase being the most challenging. The glutes should remain active through the next foot contact phase.

Details matter in a Loaded Carry.


Last night I lectured on the Cross over gait. I discussed at one point using one sided carries, a heavy farmer's carry, to stimulate more activity on the stance leg , particularly focusing on driving more hip stability. But, it matters how you do it.

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The photos i have attached are both technically a farmers carry unilaterally. One I am working my gluteus medius and hip stabilizers more, and the other i am using my lateral abdominal chain more (more of a compensated Trendeleberg type gait, and we know that hip pain patients lean in a Trendeleberg gait to reduce the activity of the glute medius to reduce compression across the joint (2/3 reduction)). If you are trying to help your client reduce their cross over gait with more hip stability building, one of them is going to hit the mark far better than the other.
So, if your clients are walking a line in their Farmer's carry, think about what you/they are actually doing (likely less hip stability stimulation).
The exercise should fit your goal. Have them walk feet on either side of a wider balance beam to get more stance phase glute activity (try it yourself, the wider your step width the more hip loading you get), or, have them walk a line and lean more into the frontal plane to get more abdominal. It is not a perfect science, but you do get a different feel from how you do it.

But, it matters how you do it.

Changing step width alters lower extremity biomechanics during running.

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The Cross over gait. We have been talking about this for years, our theories have been supported by the available research and years of patient care.
Here is another study that goes with our ideas, which gives it deeper clinical relevance.

Changing step width alters lower extremity biomechanics during running. Brindle RA1, Milner CE, Zhang S, Fitzhugh EC. Gait Posture. 2014

"Step width is a spatiotemporal parameter that may influence lower extremity biomechanics at the hip and knee joint. Peak hip adduction and rearfoot eversion angles decreased as step width increased from narrow to wide."
Step width influences lower extremity biomechanics in healthy runners. "When step width increased from narrow to wide, peak values of frontal plane variables decreased.

The Fredericson paper (Hip Abductor weakness in distance runners with iliotibial band syndrome) is also supportive. That paper found that increasing step width reduced the strain on the iliotibial band during running. Greater ITB strain and strain rate were found in the narrower step width condition.

We have said it, and will say it again, because someone will post here, "maybe, but all the pros when you watch then and see photos of them, they all have a very narrow step width, basically qualifying for what you guys call a Cross Over gait. So how can you make such bold statements?"
Our response would be, "every attempt at squeezing out more economy in ones gait, walking that fine line of riskier gait mechanics, is a game of playing ECONOMY vs. LIABILITY. And if you have built enough durability and conditioning into your system that you can nudge right up to that fence of RISK, you can play with those liabilities and squeeze out the economy of your gait (like the pros) with that narrower step width. Just be aware and careful, that when you are losing control, as the runs lengthen, that the LIABILITIES are increasing and thus so is the RISK for injury. Just remember, you are likely not a pro, and have not spend the time building a safe zone of durability on your system to endure narrow step width for 26 miles.

A good runner will train the frontal and rotational planes regularly as they engage in their sagittal sport of running. So that as fatigue sets in and the step width begins to narrow, they have some durability of the lower limb to sustain the risky mechanics of the narrow step width. There is a limit for everyone, when the well goes dry.

The Cross Over Running Technique: A Quick Case Study

Walk on a piece of string or along a seam in the concrete or walk on the lane dividing lines on your local high school or college track. What happens ? If you walk on a single line you will find yourself more unstable as compared to walking with a foot fall directly under your hips and knees the way it is supposed to occur. The limbs are a pendulum and economy and biomechanical efficiency as well as injury reduction will occur when the parts operate in the most effective manner.

We have all of our cross over runners, as you see her doing in the first half of this video before she corrects to anti-cross over (ie. natural), first walk on a line. In our case we use the metal drainage grate outside our office that you see in the video for just that purpose, they walk the grate. Then they run the grate. We ask them to feel how unstable they are in the frontal plane walking the grate. Then we have them walk with their feet only touching the outer edges of the grate, now not crossing over. They can feel the difference, the increased stability. They all say it is easier to walk with the thighs, knees and feet all barely scuffing past one another but after they feel the other most will comment that they can see and feel how lazy their gait and running gait have become. They can feel the better posture, more gluteals and more power that an anti-cross over gait affords them. Then they run the grate again. Then they run the edges of the grate. You see this skill builder in the video above.

In this video clip, after 60 seconds of coaching, this top NCAA distance track athlete (often injured) was able to make the change immediately. You can see after just a few strides the immediate and dramatic change in her gait. We then had her drift back and forth between lazy cross over and the corrected anti-cross over gait. We do this so that on her long runs, when she notices the inside shoes scuff past one another, when they notice the feet begin to run on a line, when the thighs begin brushing past each other that she can immediately make the correction. It will happen often during the beginning stages of developing the new neurologic skill pattern. Motor pattern learning takes up to 12 weeks before the neuroplasticity becomes more worthy of the dominant pattern of choice.

We have all of our athletes head over to the oval track and run not in the lanes, but on the line. To be precise, they run with their feet on either side of the line, making sure they have that visual feedback for the correction. They run over the line. We drove past a local high school the other day and saw the entire girls cross country team on the track running not in the lanes, but over the lines. We smiled big, and long. We know the coach, he follows our stuff, and he will prevent so many injuries this year in his runners. They have a 15 minute pre-run warm up and skill building for their runners. They will be competitive at the State level once again because they will show up with everyone healthy and free of injury, we can only hope. They will have a better chance than others who keep doing what they did last year, and the year before that, and the year before that.

If you are doing what you did last year in your training, expect last years results.

Want to know more? Join Dr Allen this Wednesday evening on onlineCE.com, Biomechanics 316

Your center of mass in relation to foot strike position.

For those arm swing/pulsers/ COM and head over foot folks consider some more research below.
Let the CNS drive the show, it is what it is there for . . . The leg motor patterns are dominant, the arms are passive and "shape" and influence the leg swing as a balance and ballast effect. As we discuss in an upcoming podcast, to cross the arms in a pumping motion across the midline of the body means one has to have compromised scapular mechanics (mostly protraction) to afford that much humeral adduction. This means we are forcing thoracic rotation as well. This means we are reversing what we know is more true, that "arm motion is driven passively by rotation of the thorax (Pontzer et al., 2009), an idea which is supported by shoulder muscle EMG data" (and not thoracic rotation by arm swing). Why would we try to create more unnatural axial spin through the spine when we are actually trying to move forward in the sagittal plane? Why would we try to force more rotation through the spine when the function of the thoracopelvic canister (ie. the core) is to stabilize rotational /angluar momentum? Hmmmm, things to ponder.

"Previous modelling studies have clearly shown that motion of the arms effectively counterbalances the angular momentum of the lower extremities during running (Hamner & Delp, 2013; Hamner et al., 2010). It has further been suggested that arm motion is driven passively by rotation of the thorax (Pontzer et al., 2009), an idea which is supported by shoulder muscle EMG data, consistent with the shoulders as spring-like linkages (Ballesteros, Buchthal, & Rosenfalck, 1965). Our data are con- sistent with this idea, showing motion of the thorax to be in the opposite direction to that of the swinging leg. Pontzer et al. (2009) also suggested that motion of the thorax is driven passively by motion of the pelvis. However, our data shows that the thorax reaches its peak angular velocity earlier than the pelvis, indicating that thorax motion is not completely passively driven by pelvic movements."

-S.J. Preece et al. / Human Movement Science 45 (2016) 110–118

Pod 136: Part 2: Head over Foot? Where should we put our COM (center of mass)?


This podcast (135) and its soon to launch follow up podcast (136), as the intro explains, comes at the tail end of a series of thought debates between Shawn and Ivo with some folks who have a different view point.  While the debate is unsettled because there is not sufficient research to support one side, we feel the research leans towards our side of things.  However, as the debates went on, it became clear to us that both parties were approaching the debate from a different metric to gauge each party's beliefs.  We outline this in the introduction and then more forward into our dialogue.  We hope you find this a productive thought experiment.

Key words: cross over gait, head over foot, HOF, gait, gait analysis, COM, COP, center of mass, center of pressure, step width, sprinting, symmetry, running injuries

Links to find the podcast:

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

Direct Download: http://traffic.libsyn.com/thegaitguys/pod_136final.mp3

Permalink URL: http://thegaitguys.libsyn.com/pod-136-part-2-head-over-foot-where-should-we-put-our-com-center-of-mass

Libsyn URL:http://directory.libsyn.com/episode/index/id/6586622


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summitchiroandrehab.com doctorallen.co shawnallen.net

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