Podcast #140: Running, hallux amputation, building deeper gait concepts.

/

Topics:

hallux amputation, achilles tendon, achilles tendinopathy, rehab achilles, bursae, marathons, vapourfly, shoes, shoe fit, gait, gait problems, gait correction, gait retraining, running, foot strike, heel strike, midfoot strike, rearfoot strike, heel strike, loading responses, gait rehab, muscle strength, isotonics

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

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_140real_-_10618_9.18_AM.mp3


Permalink URL: http://thegaitguys.libsyn.com/podcast-140-running-hallux-amputation-building-running-concepts


Libsyn Directory URL:http://directory.libsyn.com/episode/index/id/7135745


Topics and links:


The tendinopathic Achilles tendon does not remain iso-volumetric upon repeated loading: insights from 3D ultrasound. Nuri L, et al. J Exp Biol. 2017.

https://www.ncbi.nlm.nih.gov/m/pubmed/28620014/

Good tip to decrease loading and help decrease injury risk in runners: See study by Chan et al.:
http://journals.sagepub.com/doi/abs/10.1177/0363546517736277?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&

Vapourfly shoe
https://www.nytimes.com/interactive/2018/07/18/upshot/nike-vaporfly-shoe-strava.html

Men’s marathon:
https://twitter.com/chrisbramah/status/1019481750039343104/photo/1


fun facts:

Foot strike patterns of the World Championships Marathon:
Women’s race:
73% rearfoot, 24% midfoot, 3% forefoot
Men’s race:
67% rearfoot, 30% midfoot, 3% forefoot
pic.twitter.com/iWRzjImQBZ
https://www.iaaf.org/about-iaaf/documents/research#biomechanical-research-projects

Foot structure and stiffness is critical
https://www.nature.com/articles/srep29870

Tendons can change
Progressive calf strength training led to increased achilles stiffness @ 4 weeks & increased tendon cross sectional area @ 8 weeks
https://link.springer.com/article/10.1007/s00421-018-3904-1

Bursae can thicken painlessly as a normal adaption to activity... just like skin calluses!
https://www.ncbi.nlm.nih.gov/pubmed/24907190

Between 63-72% of participants were wearing incorrectly sized footwear. review of the literature here from @LTPodiatry team:
https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-018-0284-z

How Neuroscientists Explain the Mind-Clearing Magic of Running -- from the Science of Us
https://www.huffingtonpost.com/science-of-us/how-neuroscientists-expla_b_9787466.html

You need toe extension, more than you might think.

/
Screen Shot 2018-07-20 at 9.24.08 AM.png

There is a major difference in these 2 photos.One foot is ready for foot loading, the other has one foot over the starting line, and is going to possibly have the risks related to inappropriate loading.

In clients with one of several possible issues related to poor control of the arch during weight bearing loading, it is not all too uncommon for us to bring to their attention that not only do they NOT utilize toe extension appropriately, and at the right time, they just simply have poor strength and endurance of the toe extensors (we will not be bringing up the complicated orchestration of the long and short toe extensors today, lets just keep it loosely as looking at them as a whole for today).

We know we say it an awful lot, that clients need more toe extension endurance and strength. But more often than not, they need more awareness of how little they are actually using their toe extensors during foot loading. This is why we despise flip flops and foot wear without a back strap on them, the flexors have to dominate to keep the footwear on the foot.  And, if you are into your toe flexors, you are definitely not into your toe extensors.

Screen Shot 2018-07-20 at 9.23.54 AM.png

You can easily see in this photo that there is a major difference in the integrity and preparation of the foot arch prior to foot loading in these 2 sample photos. One the toes are up in extension, the other the toes are lazy and neutral.  The toe up photo demonstrates well that when the toes are extended, the Windlass mechanism draws the forefoot and rearfoot together and raises the arch. Go ahead, lift your toes, it will happen on you as well (unless your arch is so collapsed that the first metatarsal actually dorsiflexes during toe extension, in this case, you are a whole different management tier). From this arch raised position, the first metatarsal is adequately plantarflexed, this means the joint complexes proximal and distal to the metatarsals are all in the right position to load and cope with loads. In the toe neutral picture, these components are not prepared, the arch is already getting ready to weight bear load from a half-baked position. One cannot expect the foot complex to load well when it is starting from a position of "half way there". One should start the loading of the foot from the starting line, not 3 steps over the line and not 3 steps before the starting line.  There is no athletic or mechanical endeavor that does well when we start the challenge too soon or too late, timing is everything.

How you choose to prep your foot for contact loading, and yes, there is some conscious choice  here, one is lazy the other is optimal, can determine to a large degree if you or your client is about to fall into the long list of problems related to poorly controlled pronation (too much, too soon, too often, too fast). Any of those bracketed problems lead to improper loading and strains during time under tension.

We will almost always start our clients on our progressing protocol of arch awareness and we will loosely say arch restoration, and attempts at better optimizing the anatomy they have, with toe up awareness.  Many clients will have poor awareness of this component issue, on top of poor endurance and frank weakness. The arch is to a great degree build from a lifting mechanical windlass effect, from the extensors and foot dorslflexors, not from the foot flexors. This is one of our primary beefs with the short foot exercise of Janda, there needs to be a toe extensor component in that exercise (search our blog for why the short foot exercise is dead). The short foot exercise is not actually dead, all exercises have some value when placed and performed properly, but the short foot exercise is based off of the toes being down and utilizing the plantar intrinsics to push the arch up and shorten the foot, this is a retrograde motion and it is not how we load the foot, but, it does have value if you understand this and place it into your clients repertoire appropriately.  This is also why we have some conceptual problems in stuffing an orthotic under someones arch to "lift it up", ie. slow its fall/pronation.  There are times for this, but why not rebuild the proper pathways, patterns and mechanics ?

Teach your clients about toe extension awareness. TEach them that they need to relearn the skill that when the toes drop down to the ground that the arch does NOT have to follow them down, that the client can relearn, "toe up, arch up . . . . . then toes down, but keep the arch up".  IT is a mantra in our office, "don't let your arch play follow the leader".  Reteach the proper neurologic disassociation between the toes and arch.

Perhaps the first place you should be starting your clients with foot and ankle issues, is regaining awareness of proper toe extension from the moment of toe off, maintaining it through swing, and then keeping it until the forefoot has purchase on the ground again, and not any time sooner than that ! If their toes are coming down prior to foot contact, it is quite likely their arch is following the leader.

So, if your client comes in with any of the following, to name just a few:  tibialis posterior tendonitis, plantar fascitis, heel pain, forefoot pain, painful bunions, arch pain, hallux limitus, turf toe, . . . . and the list goes on. Perhaps this will help you get your client to the starting line.

Shawn & Ivo, thegaitguys.com

 

The gluteus medius is playing target practice.

/
Screen Shot 2018-02-22 at 1.57.58 PM.png

We think about the gluteus medius often, mostly, during stance phases of locomotion. But, do not forget about the absolutely necessary function of the gluteus medius on the swing limb. Foot placement of that swing leg is in part dictated by how well the pendulum leg receives gluteus medius control to abduct the leg. When it fails to abduct adequately, a more adducted/medial foot placement occurs. An agreeable balance between the abductors and adductors affords a more pure forward sagittal pendulum of the hinging leg. When imbalanced, from insufficient gmedius and the rest of the abductory team, the foot and leg can target a more medial pendulum swing and thus a more medial foot target placement. Thus, the gluteus medius is important in both the stance and swing phases of gait. We discussed this in the webinar last night. Failure to develop the skill, endurance and strength of the gluteus medius and related complex of muscles will often result in frontal plane pelvis drift on the stance limb, and adduction targeting of the foot. What is this called ? We call it the Cross Over gait and we have written oodles of articles about this gait phenomenon, more than anyone else we believe. It is real, it has economical advantages and similar liabilities. Want to learn more, type it into the SEARCH box on our website-blog. Many people this is a normal gait, how we should all run. We think like most things in this world, there is a benefit and a drawback to things, and it is how you use it, as long as you read the instructions. Sadly, we were never given our users manual when we were born. That is, in part, what we are trying to do here at . . . . www.thegaitguys.com

So, what DOES cause a change in strike pattern with barefoot running?

/

We kinda thought so...

"CONCLUSION: Superficial cutaneous sensory receptors are not primarily responsible for the gait changes associated with barefoot running."

So what is? Most likely they play a part, but the joint and muscle mechanoreceptors that we had been talking about here on The Gait Guys for the last several years most likely play a larger role. The cutaneous receptors appear to play a role in general sensation, balance and coordination as well as coordination of upper extremity movements.

Thompson MA, Hoffman KM.Superficial plantar cutaneous sensation does not trigger barefoot running adaptations.Gait Posture. 2017 Jun 27;57:305-309. doi: 10.1016/j.gaitpost.2017.06.269. [Epub ahead of print]

https://www.ncbi.nlm.nih.gov/pubmed/28728130

Podcast 101: Physics of falling & running.

/

Podcast 101: Physics of Falling & Running
Plus: calf strengthening problems, odometer neurons help you find your way, Chi running and more !

Show Sponsors:
newbalancechicago.com
rocktape.com

Other Gait Guys stuff

A. Podcast links:

direct download URL:http://traffic.libsyn.com/thegaitguys/pod_101fmp3.mp3

permalink URL: http://thegaitguys.libsyn.com/podcast-101


B. iTunes link:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138
C. Gait Guys online /download store (National Shoe Fit Certification & more !)
http://store.payloadz.com/results/results.aspx?m=80204
D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”

-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:

-Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E

-Barnes and Noble / Nook Reader:
http://www.barnesandnoble.com/w/pedographs-and-gait-analysis-ivo-waerlop-and-shawn-allen/1112754833?ean=9781466953895

https://itunes.apple.com/us/book/pedographs-and-gait-analysis/id554516085?mt=11

-Hardcopy available from our publisher:
http://bookstore.trafford.com/Products/SKU-000155825/Pedographs-and-Gait-Analysis.aspx


Show Notes:

‘Odometer neurons’ encode distance traveled and elapsed time
http://www.eurekalert.org/pub_releases/2015-11/cp-ne102815.php#.Vj5xCP01e5w.facebook

Snap on shoehttp://www.digitaltrends.com/cool-tech/minimal-shoe-3d-printed-programmable-fabric-snaps-into-shape/

Physics of falling/runninghttps://www.newscientist.com/article/dn28246-physics-of-falling-says-professional-athletes-are-running-wrong/

Foot strike and (pre)positioning ?
http://www.runnersworld.com/sweat-science/where-should-your-feet-land-while-running

Non-local fatigue
http://www.runnersworld.com/sweat-science/the-mystery-of-nonlocal-fatigue

Chi running, less injuries?http://www.runresearchjunkie.com/chi-running-did-not-lead-to-less-injuries/  

CAlf strength screen?http://thebarbellphysio.com/2015/10/09/calf-strength-assessment/stupid screen 

http://blog.brainfacts.org/2013/08/human-grid-cells/#.Vk-TemSrQ_V

http://www.nature.com/neuro/journal/v16/n9/abs/nn.3466.html

Podcast 67: Biotech of Running's Future, Rothbart's Foot, 100 Ups

/

A. Link to our server:

Direct Download:

http://traffic.libsyn.com/thegaitguys/pod_67finals.mp3

Permalink: http://thegaitguys.libsyn.com/podcast-67

B. iTunes link:

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

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

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

D. other web based Gait Guys lectures:

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

______________

Today’s Show notes:

The cyborg era begins next week at the World Cup
 
The One Exercise That Just Might Change Your Running Forever
 

What Foot Strike Photos From 10K Olympic Trials Say About Barefoot Running by 

More on EVA foam, impact loading behaviors, and adding shoe inserts.

/

A few weeks ago we wrote about some thoughts on the maximalist shoe foam trend and how it is possible that more foam could mean alterations in impact loading behaviors that could lead to problems (note we used the word could, and not will).  If there are pre-existing proprioceptive deficits in a limb these issues most likely will rise to the surface. 

The EVA foam in shoes is primarily used to absorb forces via air flow through interconnected air cells in the EVA during shoe deformation under body-weight. When the shoe has seen a finite number of compressive cycles the air cells collapse and the EVA can compact on itself leaving the shoe with an negatively impacting area of compression to fall into.  Shock absorption may be impacted and possibly lead to injury.

The Robbins study we discussed a few weeks ago (link) suggested that the reduction of impact moderating behaviour is 

Reduction of impact-moderating behavior is a response to loss of stability induced by soft-soled cushioned shoes: Humans reduce impact-moderating behavior in direct relation to increased instability.This is presumably an attempt to achieve equilibrium by obtaining a stable, rigid support base through compression of sole materials. Humans reduce impact-moderating behavior, thereby amplifying impact, when they are convinced that they are well protected by the footwear they are wearing. 

These were important points but we wanted to bring to your awareness of the component of the shoe you may have not thought of to this point, the foam foot bed that comes with the shoe, or ones you might add to the shoe  yourself post-purchase. With what we have just taught you in our last blog post and this blog post, we will let you make the connection we are suggesting you be aware of when it come to more foam, changes in foam as the shoes and inserts degrade and impaired impact loading behaviors.

There are just 3 brief study summaries here, take the time to read them and read between the lines now that we have educated you a little better in how to think about them.

Shawn and Ivo

J Appl Biomech. 2007 May;23(2):119-27.

Effects of insoles and additional shock absorption foam on the cushioning properties of sport shoes.

The purpose of this study was to investigate the effects of insoles and additional shock absorption foam on the cushioning properties of various sport shoes with an impact testing method. 

The results of this study seemed to show that the insole or additional shock absorption foam could perform its shock absorption effect well for the shoes with limited midsole cushioning. 

Further, our findings showed that insoles absorbed more, even up to 24-32% of impact energy under low impact energy. 

It seemed to indicate that insoles play a more important role in cushioning properties of sport shoes under a low impact energy condition.

_______

Biomed Mater Eng. 2006;16(5):289-99.

Role of EVA viscoelastic properties in the protective performance of a sport shoe: computational studies.

 Using lumped system and finite element models, we studied heel pad stresses and strains during heel-strike in running, considering the viscoelastic constitutive behavior of both the heel pad and EVA midsole. In particular, we simulated wear cases of the EVA, manifested in the modeling by reduced foam thickness, increased elastic stiffness, and shorter stress relaxation with respect to new shoe conditions. Simulations showed that heel pad stresses and strains were sensitive to viscous damping of the EVA. Wear of the EVA consistently increased heel pad stresses, and reduced EVA thickness was the most influential factor, e.g., for a 50% reduction in thickness, peak heel pad stress increased by 19%. We conclude that modeling of the heel-shoe interaction should consider the viscoelastic properties of the tissue and shoe components, and the age of the studied shoe.

________________

J Biomech. 2004 Sep;37(9):1379-86.

Heel-shoe interactions and the durability of EVA foam running-shoe midsoles.

A finite element analysis (FEA) was made of the stress distribution in the heelpad and a running shoe midsole, using heelpad properties deduced from published force-deflection data, and measured foam properties. The heelpad has a lower initial shear modulus than the foam (100 vs. 1050 kPa), but a higher bulk modulus. The heelpad is more non-linear, with a higher Ogden strain energy function exponent than the foam (30 vs. 4). Measurements of plantar pressure distribution in running shoes confirmed the FEA. The peak plantar pressure increased on average by 100% after 500 km run. Scanning electron microscopy shows that structural damage (wrinkling of faces and some holes) occurred in the foam after 750 km run. Fatigue of the foamreduces heelstrike cushioning, and is a possible cause of running injuries.

 

Podcast 56: Crawling, Neurodevel. & Foot Strike

/

A. Link to our server:

Direct Download: 

http://traffic.libsyn.com/thegaitguys/pod_57_final.mp3

Permalink: http://thegaitguys.libsyn.com/podcast-56-crawling-neurodevel-foot-strike

B. iTunes link:

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

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

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

D. other web based Gait Guys lectures:

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

________________________________________

* Today’s show notes:

Neuroscience

Human quadrupedalism is not an epiphenomenon caused by neurodevelopmental malformation and ataxia.  

“ a re-emergence of the ancestral diagonal QL, and (3) it may spontaneously emerge in humans with entirely normal brains, by taking advantage of neural networks such as central pattern generators that have been preserved for about 400 million years.”

References:

Front Neurol. 2012 Oct 25;3:154. doi: 10.3389/fneur.2012.00154. eCollection 2012. Karaca S1, Tan M, Tan U. Human quadrupedalism is not an epiphenomenon caused by neurodevelopmental malformation and ataxia.
2)  selectively removing torsions ? bunions ?  
FDA Panel Mulls Technique That Creates Babies Using DNA of 3 People
http://foxnewsinsider.com/2014/02/25/fda-panel-mulls-technique-creates-babies-using-dna-3-people
3) A Crazy Oculus Rift Hack Lets Men and Women Swap Bodies

http://www.wired.com/design/2014/02/crazy-oculus-rift-experiment-lets-men-women-swap-bodies/

“Minimum effective dose: Why less is more” - via Farnam Street blog. True for manual therapy, for sure. Lighten up, hack nervous system instead of trying to force structure to comply.http://www.farnamstreetblog.com/2014/02/the-minimum-effective-dose-why-less-is-more/
6) Unpowered Treadmills

Podcast #25: Bionics, Arm Swing & Footwear

/

Great podcast today, #25. Wide range of topics today: the first truly bionic body part, technical shoe issues, GTO’s and more. 

podcast link: 

http://thegaitguys.libsyn.com/podcast-25-bionics-arm-swing-footwear

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

Gait Guys online /download store:

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

Today’s show notes:

 

1. The First Truly Bionic Hand

http://www.independent.co.uk/life-style/gadgets-and-tech/news/a-sensational-breakthrough-the-first-bionic-hand-that-can-feel-8498622.html
“The first bionic hand that allows an amputee to feel what they are touching will be transplanted later this year in a pioneering operation that could introduce a new generation of artificial limbs with sensory perception.

2. Effects of toning shoes on lower extremity gait biomechanics

http://www.clinbiomech.com/article/S0268-0033%2813%2900010-7/abstract

Clinical Biomechanics, Jan 2013

3. Beware of trendy barefoot running shoes - you could end up with broken bones in your foot

http://www.dailymail.co.uk/health/article-2289725/Beware-trendy-barefoot-running-shoes–end-broken-bones-foot.html?ito=feeds-newsxml

  • Advocates of barefoot running claim it can reduce injuries and back pain
  • ‘Minimalist’ shoes such as these now account for 15% of sales
  • But experts say many people suffer injuries by overdoing it early on
  • Runners should make transition from regular trainers more slowly, they say

4. Foot strike and injury rates in endurance runners: a retrospective study.
Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YA, Lieberman DE.
 Med Sci Sports Exerc. 2012 Jul;44(7):1325-34. doi: 10.1249/MSS.0b013e3182465115.

Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA.

5. Effects of foot strike on low back posture, shock attenuation, and comfort in running.

http://www.ncbi.nlm.nih.gov/m/pubmed/23073217/
Med Sci Sports Exerc. 2013 Mar;45(3):490-6

CONCLUSION: Change in foot strike from RFS to FFS decreased overall ROM in the lumbar spine but did not make a difference in flexion or extension in which the lumbar spine is positioned. Shock attenuation was greater in RFS. RFS was perceived a more comfortable running pattern.

*it seems to becoming a question as to what you are doing with the body parts at impact……..where it be you are RFS or FFS.  Do you have the ability to protect the parts in varying mechanical stressful positions.

6. Hey guys, Dr. Ryan:

I just listened to Pod 23 and Ivo you mentioned sagittal curves not developing until after birth..  There is evidence they begin to develop in-utero.  Here is an article excerpt and link to it.
 
"In many anatomy texts, it is often claimed and/or assumed that the cervical lordosis is a secondary curve and is not present during intra-uterine life. However, as early as 1977, Bagnall et al3 demonstrated that the cervical lordotic curve is formed in intrauterine life (9.5 weeks). In 195 fetuses, Bagnall et al3 found that by 9.5 weeks, 83% of fetuses have a cervical lordosis, 11% have a military configuration, and only 6% of fetuses are in the typically described kyphotic position of the cervical spine. This means that by 9.5 weeks, 94% of the fetuses are starting to use their posterior cervical muscles to pull the cervical curve away from the fetal “C”-shape. Fetuses have a cervical lordosis before birth, however, the lordosis increases during post-natal life at ages 3 months-9 months as the infant raises his/her head and begins to sit up.4”

REFERENCES

  1. Harrison DD, et al. Spine 1996; 21: 667-675.
  2. Harrison DD, et al. Spine 2004; 29:2485-2492.
  3. Bagnall KM, et al. J Anat 1977;124:791-802.
  4. Kure S. J Tokyo Med Collage 1972;30;453-470.
  5. Kasai T, et al. Growth. Spine 1996;21:2067-2073.
  6. Harrison DE, Harrson DD, Haas JW. Evanston, WY: Harrison CBP Seminars, Inc., 2002, ISBN 0-9721314-0-X.
  7. Shatz A, et al. Acta Anat 1994;149:141-145.
  8. McAviney J, et al. J Manipulative Physiol Ther 2005;28:187-193.
  9. Bastecki A, et al. ADHD: A CBP Case Study. J Manipulative Physiol Ther 2004; 27(8):e14.


7. “Dynamic Arm Swing in Human Walking, (http://www.ncbi.nlm.nih.gov/pubmed/19640879) where it was determined that normal arm swinging required minimal shoulder torque, while volitionally holding the arms still required 12% more metabolic energy. Among measures of gait mechanics, vertical ground reaction moment was most affected by arm swinging and increased by 63% without it.
* brings up issues of shoulder pathology……rot cuff, frozen shoulder, carrying a purse, water bottle etc


8. Winter foot wear:
We like Steger Mukluks…….youtube video   "gait guys mukluks”

9. Versions: one of the more difficult concepts to grasp…………..here is a Q from a FB reader

  • Does retroversion mean this child will automatically grow up with abnormal mechanics - leading to possible knee foot hip back issue etc? Is there a fix to prevent such without an ortho’s bone saw?
     
    10. The role of GTO’s in plyometric exercises.

Step width alters iliotibial band strain during running.

/
More substantiation that “the cross over gait” is a pathologic process.

Did you get to hear podcast #23 yet ?  Here is the link (iTunes).  In podcast #23 we talked at length about the effects of step width in runners.  Reducing ones step width will result in a progression into what we have been referring to for years as “the cross over gait”.  We have been reducing this phenomenon in our runners, and many walkers, for over a decade now to reduce many of the lower limb pathologic processes that ensue when the cross over is left unchecked and worse yet, strength and endurance is loaded upon the faulty pattern.  Everyone’s gait in this realm will differ because of pelvis width, femoral and tibial torsion, genu posturing (knee valgum, varum)  and foot structure and type. All of these factors must be taken into account when deciding upon the degree of step width correction.  Ultimately the goal in a perfect world would be to have the foot and knee stack pristinely under the centrated hip joint proper, but we all know that ideal biomechanics are the unicorn when it comes to humans. Anatomic variation is the known norm and this must not be forgotten, this was pounded into all of our heads in medical school.
As this article from the Nov 2012 J. of Sports Biomechanics clearly states, iliotibial band strain and strain rate is significantly greater in narrow based gait scenarios and that increasing step width during running, particularly in those who tend towards the lazier narrower step width, may be beneficial in not only the treatment but the prevention of future lateral hip and knee biomechanical syndromes such as IT band syndrome.  So, if you are a slave to your foam roller and need your IT band foam roller fix daily, you might want to look a little deeper at your biomechanics and make some changes.  Our videos here will be helpful to you and our writings on the Cross Over gait  and link here will be helpful as well.
In  summary, there is just so much more to good running form than just following the mantra “let my feet fall under my body mass and everything will be just fine”.  We wish it was this easy, but it is not. Unfortunately, too many of the sources on the internet are maintaining that good running form is mostly just that simple. Sadly, we find it our mission to bring the bitter tasting truth to the web when it comes to these things.  One just cannot ignore the factors of pelvis width, femoral and tibial version and torsion, genu posturing (knee valgum, varum) and foot structure and foot type (and we mean so much more than are you a pronator or supinator).  These factors will alter lower limb biomechanics and may drive even the runner with heightened awareness of foot strike and running form into less than optimal foot strike positioning and loading response. Furthermore, one needs to be acutely aware that merely taking the cooked down under-toned postulation of this journal article, that being increasing step width will resolve their IT band problems, may not resolve their problem. In fact, without taking the issues of pelvis width, torsion, version, foot type and the like into account, making these changes could bring about more problems.  Seeking the advise of a knowledgeable physician in this complicated field of human locomotion is paramount to solve your chronic issues.
There is more to clean running than just a midfoot-forefoot strike under the body mass, a good forward lean and high cadence. And we are here to bring those other issues to light, for the sake of every injured and frustrated runner.  Remember, uninjured does not always mean efficient. And efficient does not always mean uninjured.

Shawn and Ivo, The Gait Guys

_______________________________
Sports Biomech. 2012 Nov;11(4):464-72.Meardon SA, Campbell S, Derrick TR.

Step width alters iliotibial band strain during running.

Abstract
excerpted:

“Greater ITB strain and strain rate were found in the narrower step width condition (p < 0.001, p = 0.040). ITB strain was significantly (p < 0.001) greater in the narrow condition than the preferred and wide conditions and it was greater in the preferred condition than the wide condition. ITB strain rate was significantly greater in the narrow condition than the wide condition (p = 0.020). Polynomial contrasts revealed a linear increase in both ITB strain and strain rate with decreasing step width. We conclude that relatively small decreases in step width can substantially increase ITB strain as well as strain rates. Increasing step width during running, especially in persons whose running style is characterized by a narrow step width, may be beneficial in the treatment and prevention of running-related ITB syndrome.”

Podcast #23. Neurology of walking babies, dialogues on step width for runners and so much more !

/

Syndication link:

http://thegaitguys.libsyn.com/podcast-23-walking-babies-step-width-cross-over-running

iTunes link:

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

Podcast #23. Neurology of walking babies, dialogues on step width for runners and so much more !

1- Newborn babies walk the walk | Body & Brain
http://www.sciencenews.org/view/generic/id/348262/description/Newborn_babies_walk_the_walk

2- 3D printing with stem cells could lead to printable organs - CNET Mobile
http://m.cnet.com/news/3d-printing-with-stem-cells-could-lead-to-printable-organs/57567789

3- our payloadz e-file download site.  http://store.payloadz.com/results/results.aspx?m=80204

4- www.onlineCE.com  

Great TeleSeminar Wed Feb 20th, 2013 8:00 PM Eastern Time Chiropractic TeleSeminar Biomechanics 302 Location: 1 hr by telephone Instructor: Waerlop/Allen, DC Price: 19.00

5- J Biomech. 2004 Jun;37(6):935-8.Owings TM, Grabiner MD.  Step width variability … .

Brach JS.    J Neuroeng Rehabil. 2005 Jul 26;2:21.  Step width variability … .

Sports Biomech. 2012 Nov;11(4):464-72.  IT Band strain and step width … .

6. Rethinking Ice Baths And Ibuprofen pulse.me/s/isg3t Inflammation IS part of the healing process!

7. Bringing the Foot Back To Life: Restoring the Extensor Hallucis Brevis Muscle.

http://youtu.be/1iZg_e4veWk

/
How did you do on yesterday&rsquo;s photo of 3 foot strikes ? Now, look at the women ! Almost pristine ! Still a little evidence of cross over gait in each of them, but pretty darn good ! The feet are falling under the body mass, not good for sprint…

How did you do on yesterday’s photo of 3 foot strikes ?
Now, look at the women ! Almost pristine ! Still a little evidence of cross over gait in each of them, but pretty darn good ! The feet are falling under the body mass, not good for sprinting, but utilized more in endurance athletes. If you have enough abdominal and hip frontal stabilzers (ie. G. Medius et al) you can play safely with the efficiency factor. If you do not have the strength, you sacrifice efficiency and risk injury at multiple sites in the lower limb. The more cross over you have, the more the foot will strike in inversion (more lateral foot strike), then you much hope you have enough gluteus medius strength at the hip, medial knee stability strength and ankle/arch strength in muscles like the tibialis posterior. 

Kara Goucher and Shalane Flanagan, right, shown here leading the 2012 Olympic Trials Marathon,
Photo: Kurt Hoy/Competitor

/
A visual demonstration of 3 different foot strike patterns. Lets test some of what you have learned here at The Gait Guys over the last few months. On the readers left, blue shirt Bib 232: The left leg appears to have all joints stacked at this view…

A visual demonstration of 3 different foot strike patterns. Lets test some of what you have learned here at The Gait Guys over the last few months.

On the readers left, blue shirt Bib 232:
 The left leg appears to have all joints stacked at this viewer angle (knee is vertically over the foot, hip is over the knee). What we love here is that the foot profile (look at the black sole of the shoe) is parallel to the ground, it is hard to believe that it won’t strike as such. The medial and lateral aspects of the foot should strike flush and simultaneously. This is a neutral foot and is very likely without valgus or varus forefoot typing.  The tibia looks pristine and straight without any torsion, at least from this limited perspective. He also looks to be striding nicely, it seems to appear (albeit this is reaching from this head on view) that the foot will strike below the body mass, this may be because he subtly appears to be leaning forward, again hard to see on this view.

Middle runner, white shirt:  We see some problems here.  First of all, it appears (and again, this is reaching from a front on view) that this runner is striding out with the foot beyond the body mass and will likely heel strike, he also seems to be in more backward lean that the Blue Bib Man but again hard to tell on a frontal view. We also see that the foot is pitched in inversion (note the outward tip of his foot compared to the man in Blue) quite aggressively which will facilitate a strong excessive lateral heel and/or forefoot strike pattern.  You can also see that drawing a line through the length of the long bones (tibia and femur) that they are in alignment, they are even in alignment with the 90 degree perpendicular to the forefoot inverted angulation.  This clearly represents our classic “cross over gait” which was first brought to you and the internet by yours truly a few years ago (here on Youtube link).  It is easy to see that the projected foot landing will be on a virtual line and thus appear to run on a line or even cross the feet over the line indicating that this client is not stacking the foot, knee and hips vertically and thus challenging the gluteus medius and hip stability into the frontal plane (video link here). This client will be wasting energy and efficiency in the frontal plane (side to side movement) and challenging the core, risking knee tracking issues and excessive foot pronation forces beyond the safe and normal.  

Running on the readers right, green shirt #8:  There appears to be a strong stance phase leg collapse, the hip is lateral to the foot and the knee is perhaps on its way to medial from a vertical line from the foot. This can be, and often is, from the issues of cross over described in the middle runner above but it can also be simply found in someone who is striking with the foot/knee/hip joints stacked but does not have sufficient gluteus medius strength to keep the pelvis level on the horizon (thus drift laterally). When this happens the downward collapse of the opposite side pelvis is often, but not always, see as a valgus collapse at the knee since the femur is allowed to drift medially from insufficient strength, skill or endurance pairing of the gluteus medius/maximus pairing and the medial quadriceps. This client is  likely a cross over victim as well and this would give good reason to the aforementioned.  Again, this is all theoretical from a static picture but knowing these patterns like we do, we know these typical patterns of breakdown. This is also suspect because of the foot more positioned under the midline of the body instead of under the knee and hip vertically stacked and the obvious proximity of the knees to one another.  These clients often kick or brush the foot or shoe against the stance phase lower leg as they swing the foot through. 

Who is going to win this race ? One cannot tell. But if they were the same on all levels of endurance, training, VO2 max and equal on every parameter except what was mentioned above, well then our man in Blue, # 232 would be the most efficient and likely the least injured.

Photo from an Outside Magazine article. We Would reference it, and would be happy to do so, but we cannot find the net article anywhere now. Please send it our way if you happen across it !

Shawn and Ivo, The Gait Guys … .  followed in 51 countries and counting.

Lateral Forefoot loading. Why do we see so many runners laterally strike on the forefoot ?

/

This was from a reader on our Facebook PAGE. It was a great observation and a great topic to continue on our dialogue here on the blog and on our last 2 podcasts. We discussed this on the last podcast but we feel that there needs to be further clarification. (FB link) and (Pod link)

I think Runblogger or someone like that showed video clips of footstrike at an elite (or pro) level race…virtually all the elites (or pros) were first contacting the ground on the outside of their forefoot and rolling to the inside.

The Gait Guys response:

For some people, their anatomy “works” or can tolerate the forefoot contact better than others. Remember, the natural walking gait foot progression is heel, lateral forefoot, medial forefoot. The natural running foot strike is under greater debate as you all know if you have been following the materials here on our blog, facebook, twitter and podcasts. Our last two podcasts (#19 and #20) have gone into this in greater depth.

What you likely are seeing (the more lateral forefoot loading pattern) for these elite pro runners in the video you spoke of is normal clean biomechanics (for them), but for many people, you are not seeing that (by the way, we saw plenty of nice squared off forefoot loading responses as well in other pics and videos); rather you are seeing a coping compensation or just simply poor biomechanics that will lead them to injury. The question is when does it become excessive for a person via poor running form choice, forefoot varus foot type or internal tibial torsion etc ? Perhaps a more important question is whether the person has a flexible mid foot and fore foot that will allow the drop of the first metatarsal (medial tripod) to the ground to complete the foot tripod without having to over pronate through the midfoot or forefoot ? That is the key ! 

And these are valid concerns. Many of people have this, the elites you saw obviously have tolerant anatomy and tolerant biomechanics, for them. For them, they orchestrate all of the parts, perfect or imperfect, into a symphony. This is not as common as many of us would wish. Sure a more (not 100%) squared off forefoot strike is more perfect but not many people have perfect anatomy, in fact we are taught in med school that anatomic variance is the norm. And besides, what is perfect for any given person ?  Perfect and clean biomechanics for a given person could arguably be debated as that which enables them to be most efficient without injury long term. Meaning that which may not look pristine but that which acts as such over the long term.

Classically, a brief, controlled, and non-excessive lateral strike may be  normal, and with a normal and progressive transition to the medial side of the foot however, many people have a rigidity-flexibility issue between the forefoot and rearfoot (ie. rigid or uncompensated forefoot varus for example) and these people often become patients as runners.  This was what we were referring to in podcast #20 which spurred the readers inquiry.  These folks cannot adequately, safely and efficiently drop the medial tripod down (1st metatarsal head) without having to so much of the movement more grossly through the midfoot and excessive pronation.  Many people try to fix this with shoes or orthotics but it is a bit more complicated than that, although on the surface it seems logical and simple.

Obviously those pros that were viewed do not have these issues, hence why they are pros, meaning optimal mechanics, rarely injured for long combined and with gifted cardio fitness. To be a pro you need all of the pieces, just wanting to run fast or simply training hard is often just not enough to become elite. The pros are a small percent of the population. Many others are not in that category and thus remain at risk injury or become statistics. We have had plenty of elite runners in our offices who had the cardio and the will but not the anatomy and biomechanics to stay out of our offices long term (injury free) to compound the necessary training.  Many of these folks were converted to triathletes and have been able to compete at world class levels because we found a way for them to dampen the impact miles on tortured running anatomy. 

Sometimes a person’s will is not enough, sometimes you have to have the complete package. And that means competent anatomy and a tolerance system to aberrant biomechanics.  In our opinion our dialogue here is critical in runners, unfortunately there are some big gaps from the medical and biomechanics side in  many of the dialogues on the internet.  But that is were we find our niche, and it is where we are best positioned to help the masses. 

Join us weekly on our podcasts,  here on our blog, or our other social media sites. Join the Gait Guys brethren !
Shawn and Ivo

The Gait Guys

all material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved. Please ask before lifting our stuff!

More research on Forefoot Running: Forefoot Varus and the toe extensor muscles.

/

Lately we have all seen much in the news about the forefoot strike loading in runners and many of the proposals and rebuttals regarding injury rates.  Our dialogue less than 2 weeks ago on some of Lieberman’s recent comments (our blog article “Dear Dr. Lieberman”, click here) seem to be ringing true again. Here are just two more insightful and important studies when it comes to looking at some of the proposed ideas and causes of forefoot varus. Naturally, a thinking mind would wonder if some of these weaknesses in anterior and posterior tibialis muscles as well as extensor toe musculature, as proposed in just these 2 articles, are causal to the forefoot injuries that seem inevitable as Lieberman seems to suggest (again, see our blog post). Naturally, weaknesses and poor motor patterns of some or all of these muscles is going to create and insufficient and possibly inefficient and pathologic forefoot loads because of the forefoot varus foot type these muscular imbalances can functionally produce.  We have been pounding sand on this issue for years but still no one listens.  The medial research, as evidenced here is supportive of our theories and everyday clinical findings.

To summarize, ONCE AGAIN, not everyone is suited or possibly ready for forefoot load/contact/strike running.  And if you have injury or problems in doing so, don’t blame your minimalist shoe……. it is either a foot type that needs functional repair or a foot type that is fixed an must opt for midfoot strike.

There is SO MUCH MORE to this game than just strap on some minimalist shoes and start forefoot loading your way on your next run.  Buyer beware !

Shawn and Ivo…….. the gait guys……..two guys who are “Gandhi’d” regularly. 

“First they ignore you, then they laugh at you, then they fight you, then you win.”

- Mahatma Gandhi

______________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/20307453

Foot (Edinb). 2009 Jun;19(2):69-74. Epub 2008 Dec 31.

Foot varus in stroke patients: muscular activity of extensor digitorum longus during the swing phase of gait.

Reynard F, Dériaz O, Bergeau J.

Clinique romande de réadaptation, SUVA Care, Av. Gd-Champsec 90, Sion, Switzerland. fabienne.reynard@crr-suva.ch

Abstract

CONCLUSIONS: The activity of extensor digitorum longus muscle during the swing phase of gait is important to balance the foot in the frontal plane. The activation of that muscle should be included in rehabilitation programs.

_______________

http://www.ncbi.nlm.nih.gov/pubmed/16882899

J Bone Joint Surg Am. 2006 Aug;88(8):1764-8.

The contributions of anterior and posterior tibialis dysfunction to varus foot deformity in patients with cerebral palsy.

Michlitsch MG, Rethlefsen SA, Kay RM.

Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.

Abstract

RESULTS: The muscular contributor to varus deformity was the anterior tibialis in thirty feet, the posterior tibialis in twenty-nine feet, both the anterior tibialis and the posterior tibialis in twenty-seven feet, and another contributor in two feet. Seventy feet had varus deformity during both stance phase and swing phase. Of these seventy feet, twenty-five exhibited dysfunction of the anterior tibialis, twenty exhibited dysfunction of the posterior tibialis, and twenty-three exhibited dysfunction of both muscles. Therefore, the timing of varus was not predictive of the contributing muscle or muscles.

CONCLUSIONS: The current study demonstrated a higher prevalence of anterior tibialis dysfunction, both alone and in combination with posterior tibialis dysfunction, as a contributor to pes varus in patients with pes varus and cerebral palsy than had been reported previously. Dynamic electromyography provides clinically useful information for the assessment of such patients.

/
Foot Strike of Women for the Olympic Time Trials: This picture comes from Iain Hunter at BYU: http://biomechanics.byu.edu/. We found it on Peter Larson&rsquo;s Blog: Runblogger.com http://www.runblogger.com/2012/06/foot-strike-patterns-of-men-and-wo…

Foot Strike of Women for the Olympic Time Trials:

This picture comes from Iain Hunter at BYU: http://biomechanics.byu.edu/. We found it on Peter Larson’s Blog: Runblogger.com http://www.runblogger.com/2012/06/foot-strike-patterns-of-men-and-women.html

Here are some of our thoughts:

It would have been nice to see each of these in turn on video for further analysis; What this shows are a few things;

  • People who are at this level and run fast have different foot strike patterns, this type of foot strike does not always equal the fastest times (though the top 3 were mid foot strikers, something we work with our athletes to achieve)
  • 7 (and 1 DNF) were midfoot strikers
  • 4 were forefoot strikers
  • 11 were heel strikers
  • many runners has asymmetrical strikes, depending on side (4)
  • 4 of these runners seem to have a significant varus in either their fore foot or rear foot. However this is difficult to truly tell from such small single snapshot pictures.  And just because it appears to be a varus landing does not mean that it is true on examination, a foot that has reduced peroneal activity can appear to have a  varus strike, but that does not truly then comment on a true forefoot varus. Also, remember from our previous posts, if a runners is employing a notable degree of cross over gait technique the approach of the foot to the ground and at the ground can appear to be forefoot varus. * These are critical points, because what you see is not necessarily what you truly have.  There are possibly many variables playing out.
  • shoes which have green on them are more popular (7)
  • Neither Shawn nor Ivo could run a 10K and have a chance against any of these folks 

Have a great Saturday

Ivo and Shawn

/
So, does the angle your foot strikes the ground really matter? With all the talk about minimalistic training and striking under the body being less stress on the human frame and more efficient, you would think so. Here is one study that seems to su…

So, does the angle your foot strikes the ground really matter? With all the talk about minimalistic training and striking under the body being less stress on the human frame and more efficient, you would think so. Here is one study that seems to support that premise.

from the studies conclusion: “Our results indicate that individuals with a larger knee angle (i.e., greater extension) 50 ms prior to initial contact (IC) experience a higher ROL  (Rate of loading) during gait and have poorer proprioceptive scores.”

Proprioception, gait kinematics, and rate of loading during walking: are they related? Riskowski JL, Mikesky AE, Bahamonde RE, Alvey TV 3rd, Burr DB.

J Musculoskelet Neuronal Interact. 2005 Oct-Dec;5(4):379-87.

http://www.ncbi.nlm.nih.gov/pubmed/16340143

Helping to promote gait literacy…We are…The Gait guys