The banana hallux. When the big toe curls upward

Note: over-extension of the hallux and over-flexion of the 2nd toe. How can they both be so different at rest ? read on

This is common, but not commonly addressed. And, it can become a cause of symptoms.
Note how curled up into extension the hallux appears. This is just a representation of hyperextension of the distal phalange at the IP joint (interphalangeal joint).
This often occurs in hallux limitus/rigidus, where there is insufficient extension through the 1st MTP joint (metatarsophalangeal joint). In that condition, they client attempts to toe off, needing extension (dorsiflexion) at that joint, and they do not have it, so the extension can be found through arch collapse (1st metatarsal dorsiflexion) or through extension at the IP joint. Over time, form follows function and you will often see this presentation.

However, we do not need to see impaired ROM function at the 1st MTP joint, as in this case. This foot had full 1st MTP ROMs.
In this case, this toe represented massive imbalance between the long and short flexors and extensors. Specifically, increased use and strength in the EHL (extensor hallucis longus) and weakness and unawareness of how to even engage the short extensor (EHB).
Similarly, the pairing met the one we always see with this, that being weak and even difficulty of awareness to engage the FHL (flexor hallucis longus) and over-activity of the FHB (short flexor-flexor hallucis brevis).
There pairings: weak: EHB and FHL & overactive: EHL and FHB over time will result in this presentation.

In gait, you will note poor compentence and purchase of the hallux on the ground and thus a sharing of that load through overflexion hammering of the 2nd digit through increased FDL activity (note the great evidence of this with the thick obvious callus at the tip of the 2nd toe).
These clients can also often have pain at the plantar aspect of the Metatarsal head because of sesamoid imbalanced loading (sesamoiditis) as well as frank pain at the MTP joint dorsally or plantarward. One will often note a medial pinch callus on these feet medial to the metatarsal head, from a rotational spin toe off. Hallux valgus and bunion formation are also not uncommmon at all in this incompetent hallux presentation.
PS: the solution is so much more complex and involved than just towel-scrunches and marble pick up games. I mean, come on, we can do better that this team !
This requires some serious reteaching of how to use the foot, arch, tripod, windlass and foot-ground engagement skills.

Shawn and Ivo, the gait guys

#gait, #gaitproblems, #gaitcompensatins, #gaitanalysis, #bunions, #halluxvalgus, #sesamoiditis, #turftoe, #halluxlimitus, #pinchcallus, #bananatoe, #metatarsalgia, #thegaitguys, #hammertoe

The rigid flat foot. Why an orthotic may not work well at all.

Just because the foot is flat (arch collapsed) does not mean you have a right to try and lift it !
This is a perfect example of a foot that is troubled. It is a rigid flat foot deformity. This acquired over a long period of time. Sometimes tibialis posterior insufficiency over time finally gives way to an incompetent tib posterior, with eventual arch gradual collapse into a pes planus flat deformity, and then time takes its effect to contracture and shorten tissue and arthritic change makes it permanent.
This arch will no longer lift, it is a rigid pes planus. IT will not tolerate an orthotic, SO DO NOT PRESCRIBE ONE ! Even a mild orthotic lift will feel like a golf ball under this arch.
And, to take this one step further, a rockered shoe is, in part, the right idea, but not when the foot does not sagittally toe off. This foot is permanently locked into a full limb external rotation because of hip arthritic change. The point is that his foot progression angle is 45 degrees++, and the rocker will not work if it cannot rocker in the sagittal plane.
This guy wanted an orthotic, and i would not give it to him, and you shouldn't either. He will wear it for 1 minute and throw it away.

Shawn Allen, the other gait guy

#gait, #anklerocker, #forefootrocker, #footprogression, #archcollapse

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. 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.

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

More on the scourge of Flip Flops. Riding the inside edge of the sandal. Mystery hunting with Dr. Allen.

Tis the season upon us. Riding the inside edge of the sandal.
You can see it in the photo, the heel is a third of the way off the sandal.

You either have it or have seen it. It is frustrating as hell if you have it. Your heel rides on only half of your flip flop or summer sandals. You do not notice it in shoes, only in sandals, typically ones without a back or back strap. This is because the heel has no controlling factors to keep it confined on the rear of the sandal sole. There is no heel counter on open backed shoes and sandals, the counter keeps the heel central on the back of the footwear. There is a reason this inside edge riding happens to some, but not everyone. It is best you read on, this isn’t as simple as it might seem.

These clients may have restricted ankle rocker (dorsiflexion), restricted hip extension and/or adductor twist (if your reference is the direction the heel is moving towards). I could even make a biomechanical case that a hallux limitus could result in the same scenario. So what happens is that as the heel lifts and adducts it does not rise directly vertically off the sandal, it spins off medially from the “adductor twist” event. This event is largely from a torque effect on the limb from the impaired sagittal mechanics as described above, manifesting at the moment of premature heel rise resulting in an slightly externally rotating limb (adducting heel). The sandal eventually departs the ground after the heel has risen, but the sandal will rise posturing slightly more laterally ( you can clearly see this on the swing leg foot in the air, the sandal remains laterally postured). Thus, on the very next step, the sandal is not entirely reoriented with its rear foot under the heel, and the event repeats itself. The sandal is slightly more lateral at the rear foot, but to the wearer, we believe it is our heel that is more medial because that is the way it appears on the rear of the sandal or flip flop. Optical illusion, kind of… . . a resultant biomechanical illusion is more like it.

You will also see this one all over the map during the winter months in teenagers who swear by their Uggs and other similar footwear, as you can see in the 2nd photo above. This is not an Ugg or flip flop problem though, this is often a biomechanical foot challenge that is not met by a supportive heel counter and may be a product of excessive rear foot eversion as well. This does not translate to a “stable” enough shoe or boot, that is not what this is about. This is about a rearfoot that moves to its biomechanical happy place as a result of poor or unclean limb and foot biomechanics and because the foot wear does not have a firm stable and controlling heel counter. This is not about too much pronation, so do not make that mistake. And orthotic is not the answer. A heel counter is the answer. The heel counter has several functions, it grabs the heel during heel rise so that the shoe goes with the foot, it give the everting rearfoot/heel something to press against, and as we have suggested today, it helps to keep the rearfoot centered over the shoe platform. To be clear however, the necessary overuse and gripping of the long toe flexors to keep flip flops and backless sandals on our feet during the late stance and swing phases of gait, clearly magnifies these biomechanical aberrations that bring on the “half heel on, half heel off” syndrome.

There you have it. Another solution to a mystery in life that plagues millions of folks.

Shawn Allen, the other gait guy

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.

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

the current understanding of how tendons respond to loading, unloading, ageing and injury

A muscle contract, transfers load across the tendon into the attachment to another bone on the other side of a joint, sometimes across 2 joints. There can be a mechanical flaw/injury in the muscle or tendon, or the joint, if inflamed, can neurologically inhibit that muscle-tendon team. The journal abstract has a nice diagram looking at the potential cellular and molecular changes at the tendon interval.
"Here we review the current understanding of how tendons respond to loading, unloading, ageing and injury from cellular, molecular and mechanical points of view. "- S. Peter Magnusson, Michael Kjaer

https://physoc.onlinelibrary.wiley.com/doi/10.1113/JP275450

The opposite upper and lower limbs model each other. Today we discuss adduction. See the photo.

The opposite upper and lower limbs model each other. Today we discuss adduction. See the photo.

This is a discussion we had last March 11 and 12, 2019 on this photo. Today, lets look closer at the photo.

Runners, athletes . . . Even in your drills, do it correctly !
Last week we discussed this and its relation to the Bird Dog exercise. This is no where near the same pattern as Bird Dog, as we discussed, the Bird Dog is neurologically incorrect. Today, Adduction is the topic at hand.

This runner is performing a skill, a proper neurologic skill when it comes to patterning limbs the way we repeatedly move in walking, running, and often (but not always) sports. If you want to know why Bird Dog is an outlier neurologically, go back and find our post last week on the topic.

Today, look at the right knee, he has allowed it to adduct. We discussed why this is a lazy pattern, unless he has a purpose for not abducting the hip (possibly addressing something we are unaware of). Now look at the left arm, it too is adducted towards the midline. When left to its patterned and balanced based ways, the brain will use balance and patterning to model the limbs with their counterpart. This is the neurologic "shaping" we have discussed previously. The upper limb can help to shape the movement of the lower, but we know there is the opposite effect as well. We also know that the lower limb has a higher "leading" affect, it runs the show more. This is why we feel coaching arm swing is not the best way to go about changing someone's gait issues/form.

Try what he is doing, stand up and try it. You will see that the upper limb and lower limb better follow the modeling and shaping when they are both doing the same things (in this case, hip and shoulder flexion, and adduction). Now, keep the right thigh flexed and adducted, and ABduct the arm, you will find a subtle balance challenge and it will feel like there is a slight disassociation, because you have taken one limb away from the midline. Now, instead, adduct the left shoulder, but abduct the right thigh/hip. It is harder to do, again. Not leaps and bounds harder, but you had to think about it, because one limb is moving toward the midline and the other is not , all the while in a static balance position. Now yes, some will argue that this was not hard at all, and this kind of thing happens in sport all the time, agreed. Sometimes balance and proprioception (i.e. the vestibular system) trumps neurological patterning because of the hierarchy in the CNS. BUT don't miss our point, that there are underlying neurologic patterns and principles that dictate limb function when we are not paying attention to it. This is our point, and you will see it in your clients when they walk and run. And you see it in this guys case, because we would bet that he was not doing this left shoulder left hip adduction on purpose. He was doing it because it felt right, felt normal, felt balanced, and it is neurologically sound. But, he could do better, if he abducted the left arm and right hip, he be earning a more pattern as a runner. And, he would reduce the tendency of the cross over gait pattern, because, as you can see here, if that right foot heads to the ground, he is going to be very narrow step width in his gait, and that COULD mean potential problems and power leaks.
One more thing, do not be surprised that the right arm is abducting while it is extending, this is spin off of the adduction of the other limbs we discussed today. If he likely remedies them, the right arm will no longer abduction, likely.
And, these same concepts play out if you are adducting your arms across your body when walking or running, if the arm is pulling hard across the midline, do not be surprised if your step width is narrow. Hence, if you wish to run with more glutes and a wider more powerful gait, reduce the arm adduction and the legs will have to follow from the "shaping" influence of the arms.

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Most likely this is common knowledge for most followers here on The Gait Guys and our podcast (another one will launch this weekend btw).

But reducing the plantar flexion moment in the late stance phase of running and walking can make notable changes in the loading response to the posterior plantarflexor mechanism (the gastroc-soleus-achilles complex). A rocked shoe, according to this study, can reduce the plantarflexor moment without substantial adaptations in triceps surae muscular activity.
This of course brings to mind the HOKA family of shoes that have purposefully added a gentle rocker mechanism to some of their shoe line, some with an early and some with a late stage metarocker built in. Are you a HOKA hater? We were not fans in their early development because of the volume of stack height foam, but they have many more options in their line up now. But do this for us, do not pass judgement until you put one of these metarockered shoes on, and you will understand the function of it, and their place for your chronic posterior compartment clients. Don't reflexively judge until you try them. It is good to have options for your clients, because "stop running" is not an option for runners, for our runners, unless all else has failed.

Shawn Allen, the other Gait Guy

#thegaitguys, #gait, #hoka, #metarocker, #achilles, #tendinitis, #gaitproblems, #gaitanalysis, #calfpain, #running

J Sci Med Sport. 2015 Mar;18(2):133-8. doi: 10.1016/j.jsams.2014.02.008. Epub 2014 Feb 14.

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Sobhani S1, Zwerver J2, van den Heuvel E3, Postema K4, Dekker R5, Hijmans JM6.

Increased unilateral foot pronation can cause cephalad asymmetries.

Increased unilateral foot pronation affects lower limbs and pelvic biomechanics during walking. Nothing earth shaking here, we should all know this as fact. When a foot pronates more excessively, the arch can flatten more, and this can accentuate a leg length differential between the 2 legs. But it is important to note that when pronation is more excessive, it usually carries with it more splay of the medial tripod as the talus also excessively plantarflexes, adducts and medially rotates. This action carries with it a plantar-ward drive of the navicular, medial cuneiforms and medial metatarsals (translation, flattening of the longitudinal arch). These actions force the distal tibia to follow that medially spinning and adducting talus and thus forces the hip to accommodate to these movements. And, where the hip goes, the pelvis must follow . . . . and so much adaptive compensations.
So could a person say that sometimes a temporary therapeutic orthotic might only be warranted on just one foot ? Yes, of course, one could easily reason that out.
-Shawn Allen, one of The Gait Guys

#gait, #gaitanalysis, #gaitproblems, #thegaitguys, #LLD, #leglength, #pronation, #archcollapse, #orthotics, #gaitcompensations, #hippain, #hipbiomechanics

Gait Posture. 2015 Feb;41(2):395-401. doi: 10.1016/j.gaitpost.2014.10.025. Epub 2014 Nov 3.
Increased unilateral foot pronation affects lower limbs and pelvic biomechanics during walking.
Resende RA1, Deluzio KJ2, Kirkwood RN3, Hassan EA4, Fonseca ST5.

Running cadence doesn't matter? Maybe.

Does running cadence matter? Not as much as previously thought (in terms of speed and efficiency, but this is not a comment on altering biomechanics to avoid or manage running through injury. One of the first things we ask of a runner, who insists they will be running with their injury while we attempt to get ahead of it, is to increase their cadence and land with more finesse (if they are a heavy "plunker", which often happens on longer runs when people fatigue).

“Some ran at 160 steps per minutes and others ran at 210 steps per minute, and it wasn’t related at all to how good they were or how fast they were,” Burns said. “Height influenced it a little bit, but even people who were the same height had an enormous amount of variability.”

"Another unexpected finding is that by the end of a race, cadence varied much less per minute, as if the fatigued runner’s body had locked into an optimal steps-per-minute turnover. It’s unclear why, Burns said, but this deserves further study."

https://news.umich.edu/step-it-up-does-running-cadence-matter-not-as-much-as-previously-thought/?fbclid=IwAR07mIPxVEPXlkkXoU-XxyCIQY7MwfpX0HHXW7lxMqrcx69ZHHjLO1SxPXw

Loss of terminal knee extension: How quickly can you process the facts ?

Some quick thoughts that must go through your mind on your examination. These thoughts must be ingrained, so that you can quickly juggle the other issues you client is coming in with that may very likely be related to the loss of left knee terminal extension.

more knee flexion may likely mean more ankle dorsiflexion , and that means more more anterior shin compartment strength is necessary to stop a quick progression to the forefoot (consider their clinical symptoms), this may mean pronation occurs more quickly (consider their clinical symptoms), it may mean more abrupt quadriceps loading since the loading does not start in more reasonable knee extension which means the quad is short now and that means increased patellofemoral compression possibilities (consider their clinical symptoms), this may mean more hip flexion on initiation of stance phase (consider their clinical symptoms), this may lead to more anterior pelvis tilt posturing and thus increased lordosis (consider their clinical symptoms), this flexed knee means that the leg is shorter which will through off pelvis symmetry (consider their clinical symptoms), this may mean more work for the contralateral hip abductors (consider their clinical symptoms), this may mean more frontal plane pelvis drift to the short leg side (consider their clinical symptoms), it will also mean 2 different step lengths which means 2 different hip extension patterns which means 2 different heel rises, and it will likely mean altered arm swing on both sides which can create changes into thoracic rotation (and of course the cervical spine sits on top of that) etc etc etc, so consider their clinical symptoms . . .

just wanted to quickly rattle off how fast your brain must juggle things, otherwise your exam is going to be knee-centered and tunnel visioned. Keep in mind, your client may not even have knee complaints, perhaps one or more of the above. But this is a perfect example of why you must examine the WHOLE client.

Perhaps this gives you even deeper understanding (combined with yesterdays "parallax binocular vision 2D post" as to why we will not give online corrective homework or consultations. There is just no way all of these things can be considered over video, Skype, Zoom or anything of the sort. Gait analysis must be done in person and encompass a hands on exam, if you do not want to miss something possible critically important, in our opinion, for what that is worth.

Shawn Allen, the other gait guy

#kneeextension, #gait, #gaitanalysis, #gaitproblems, #gaitanalysis, #gaitcompensations, #correctiveexercises, #thegaitguys

Podcast 145: Tendons, Heel Drop and their impacts on the posterior chain,

Heel lifts, Sole lifts and their impact on the EMG of the posterior chain.

Keywords: gait, gait analysis, gait problems, running, ankle, tendinopathy, heel lifts, sole lifts, EMG, paraspinal activity, gluteal inhibition, posterior chain, anterior pelvic tilt, tight quads, diagnostic ultrasound

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

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

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

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

Where to find us, the podcast Links:

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_149raw_-_31619.mp3

Permalink URL: http://thegaitguys.libsyn.com/podcast-tendons-heel-drop-and-their-impacts-on-the-posterior-chain

Libsyn Directory URL: http://directory.libsyn.com/episode/index/id/9027890

Show notes:

Current trends in tendinopathy management
Tanusha B.Cardosoa, TaniaPizzarib, RitaKinsellab, DanielleHopec, Jill L.Cook
https://www.sciencedirect.com/science/article/pii/S1521694219300233

https://www.jospt.org/doi/full/10.2519/jospt.2015.5880

Insightful paper on how tendon adapts to loading and unloading. Discusses a lack of evidence supporting eccentric training as the treatment of choice for injury and notes that tendon response to loading is not normalized until ~6-12 months after injury
https://physoc.onlinelibrary.wiley.com/doi/10.1113/JP275450
The impact of loading, unloading, ageing and injury on the human tendon
S. Peter Magnusson, Michael Kjaer

Effects of heel lifts on lower limb biomechanics and muscle function: A systematic review
Chantel L.Rabusinac, Hylton B.MenzacJodie A.McClellandbcJade M.TanacGlen A.WhittakeracAngela M.EvansaShannon E.Munteanuac
https://www.sciencedirect.com/science/article/pii/S0966636218310075?dgcid=coauthor

The influence of high and low heeled shoes on EMG timing characteristics of the lumbar and hip extensor complex during trunk forward flexion and return task
AnnaMikaa, Brian C.ClarkbcŁukaszOleksy
https://www.sciencedirect.com/science/article/abs/pii/S1356689X13000428

The effect of heel lifts on trunk muscle activation during gait: A study of young healthy females
Christian J.Bartonac, Julia A.CoyleaPaulTinley
https://www.sciencedirect.com/science/article/pii/S1050641108000424

A Systematic Review and Meta-Analysis of Crossover Studies Comparing Physiological, Perceptual and Performance Measures Between Treadmill and Overground Running
https://link.springer.com/article/10.1007/s40279-019-01087-9

Plantarflexor strength and endurance deficits associated with mid-portion Achilles tendinopathy: The role of soleus - ScienceDirect
https://www.sciencedirect.com/science/article/pii/S1466853X18305017

Crawling patterns and the Bird Dog look alike, but they are clearly not. Do you understand this ?

Crawling and Bird Dog, a subtle but important difference.

Can you see it ?
When we crawl, as in the photo, we use the following pattern:
- the right shoulder is in extension (but it is fixed on the ground, it is the body that is moving forward/extending over this fixated point, it is approximating the flexing right hip as the knee moves up towards the hand)
- the left hip is in extension, pairing appropriately with the right shoulder extension.
- similarly, the left shoulder is in flexion (it is over head in this photo, just like in the other photo of the runner similarly doing the same patterning but standing up, meanwhile the right hip is in flexion.
* take the photo of the runner in the green shirt, and put him in a quadruped crawling pattern as you will see that it is the same pattern as the one of me in the crawling posture.
* This is not bird dog, as seen in the photo, do not confuse them.

The Bird Dog exercise is not neurologically correct for the reason of training the proper crossed patterning from a neuro perspective. Note that in the 2nd photo, the bird dog, the same left arm is in flexion, but his left leg is in EXTENSION ! If you want to use the bird dog to teach core engagement, that is one thing, but do not think you are coordinating normal gait patterns or the proper crossed response. This is why we do not use the Bird Dog with our patients, it goes against training fundamental gait patterns.

This first photo of me in the black shirt is normal, natural, neurologically correct, cross crawling. Don't believe us ? Get on the floor and crawl like an infant, it is no where near the bird dog exercise, in crawling the coupled crossed extension and flexion responses are NOT conflicting. So, just because the Bird Dog "sort of looks like crawling" do not get it confused with crawling, because it is not. It is a mere balance exercise, some use it for the core stability, but it is one based on UN-fundamental neurologic patterning we use every day.......something called gait, and running, things we do in our sports. So understand what message you are sending to the CNS.
We are not saying the Bird Dog does not have value, not at all, but if you are not thinking about what it actually is doing, you might be driving patterns you do not want.

Pigeon holed into a particular running form. Some thoughts.

We should not pigeon hole everyone into one of the major (often discussed) "running forms". Every person's running form has some unique parameters that work for them (and perhaps some components that do not work for them and lead to injury), and asking their body to do something else that you "deem" better for them because it looks right/better can at times lead to new issues or complications in resolving their complaints. Work with their system, their anatomy. Help them correct mechanical flaws related to their problems/complaints/injuries. Do not try to get everyone into one of the classically pristine and magazine cover running forms. As Allan on our FB page said, "gait correction requires work". And may we say this . . . . that prescribing corrective exercises does not mean they will spill over into their gait with positive changes. There must be teachable time that is hands on to help them blend over the corrective work into new gait patterns. This is a skill that takes a long time to learn and figure out, and each client is different and each client requires different cues and different exercises to tap into the desirable cues for them. This is why internet/youtube corrective exercise prescribed homework (ie. do this exercise to correct your iliotibial band syndrome) often does not work and sometimes creates new problems down the road. Why? . . . because there are holes missing when there is not a hands on exam to ensure the corrective work is the right work, and, just as importantly, it takes time and skill to show, demo, and translate how and why the homework will take over into a new gait pattern. Translation, corrective exercises do not guarantee a new gait pattern or new running form. There are so many bad examples we could use, "just going to the mechanic does not guarantee they will fix your car", "changing your tires does not necessarily make you a safer driver", "watching some youtube videos on learning to drive does not mean you actually know how to sit in a car and drive".

"You do not have a shoe problem, you have a "thing in the shoe problem", meaning, it is you."

We say this so often in our offices.
"You do not have a shoe problem, you have a "thing in the shoe problem", meaning, it is you."
Translation: compromised mechanics leading to tissue overloading.
But we all have to strongly consider that injury is a result of the loading you have not trained gradually into, failure to adapt and accommodate, excessive mileage without adequate tissue recovery,

From the article:
"So Napier and co-author Richard Willy from the University of Montana reviewed the highest-quality research featuring randomized controlled trials and systematic reviews.
"What we see is that there's really no high-level evidence that any running shoe design can prevent injuries," Napier said."

Now, to be honest, in our (the gait guys) opinion, there are times we do recommend a change in the foot wear for a client, and it is often because it appears to be working against someone mechanics and is a contributory factor in their injury or complaint. And sometimes that shoe recommendation is a temporary one, and sometimes a permanent one. We can use a shoe to help us get to a better/faster end point. After all, when we sprain an ankle sometime a brace or crutches are helpful and protective, of temporary value. A wisely chosen shoe can act the same if we are dealing with an acute achilles tendinopathy or a painful bunion for example. And in those cases we might recommend a shoe that can give us an assist. Sometime, when appropriate perhaps it is a shoe with a stronger medial post, perhaps one with a higher or lower heel drop/delta, or more or less stack height, or perhaps a mid/forefoot rocker built into the shoe. The truth is, people come in with functional or "fixed" pathology and sometimes pairing up a shoe to help us around some conflicting biomechanics can be temporarily, and sometimes permanently, helpful. But, the shoe is never the only answer, a wise clinician has many things they can utilize, all the way up the kinetic chain sometimes.
The more you know, the better you can assist someone.

Shawn Allen, one of the gait guys

#Nigg, #barefoot, #shoes, #stackheight, #heeldrop, #achillestendinitis, #bunion, #pronation, #supination, #running, #gait, #thegaitguys, #gaitanalysis, #gaitproblems, #gaitcompensation

Can the design of a running shoe help prevent injury? A B.C. researcher says he has the answer

Kelly Crowe · CBC News · Posted: Dec 15, 2018 9:00 AM ET

https://www.cbc.ca/news/health/running-shoe-injury-prevention-second-opinion-1.4947408?fbclid=IwAR3XaGPdgfQ68wj2N0tHqIamDdpYuxTIIL2LeudUd-doYN8YqQrIZI9-s9E

Adding strength to dysfunction ?

Are you adding strength to dysfunction? Will you be apologizing?
We have been saying this for at least a decade now, glad Michael Boyle feels the same way (see his tweet below).
See ? we are not alone and crazy ! Other smart people are thinking the same things. This is just logic to us and seems Mike feels the same way. We do not fully understand the nay-sayers and push back on this topic.
And so, if you are not examining your client, rather just "movement screening" them and then making corrective exercise prescriptions based off of mere screen outcomes, you are likely, in our strong opinion, risking merely building strength on top of how they already are moving, which is quite possibly dysfunction.
Now, many will argue, a more durable pattern, even if it is dysfunctional, is less likely to be injured. And we can agree with that. But, if you are going to spend all that time, why not just fix the darn problem and then add durability on top of that sound loading pattern in the first place?

Are you going to leave that spare tire on the car just because it drives fine? There is a reason you don't tow a trailer with a spare tire on, and there is a reason you do not drive it at 100mph either. Get the original tire fixed darnit ! Do not settle with, "hey it works fine right now! Leave it alone!" (doh !)

Adding compensations to compensations can have ramifications down the road.
Do you want to be apologizing down the road? Scratching your head asking, "is this a result of what i recommended?"

hmmmmm
It should make you think more about what you are doing, everyday. It sure keeps us in line, everyday.
Makes you ask the hard question of why you are recommending something.
Sorry for the continuous 10 year rant on this. But it is nice to know we are not alone.

shawn allen, one of the gait guys.

#gait, #gaitcompensations, #gaitproblems, #dysfunction, #compensations, #strengthfirst

A flexed leg is a shorter leg: When loss of knee extension really matters.

A flexed knee is a shorter leg, period.
A knee with any loss of terminal extension, is more bent knee, and thus a shorter leg, period.

Stand up, bend one knee 10 degrees, you have shortened the global top to bottom length of that leg.
So when walking, you will plunk down onto that shorter leg, and there will be a cost.

This is old hat for our long time readers, but it is a good reminder to look for loss of terminal knee extension.

I just saw a lady with a uni-knee replacement of 5 months. Failing some aspects of rehab, they are stuck. There is hip,knee and ankle pain on walking.
She had a loss of terminal knee extension, thus a short leg, true shortness.
I placed a 2mm full sole length rubber-cork lift in the shoe (*DO NOT USE JUST A HEEL LIFT, please, for the love of God and all that is beautiful on this earth stop using just heel lifts and causing plantarflexion at the ankle. Heel lifts are specific unicorns you only use when you are trying to get more plantarflexion at the ankle, or want to rush someone to the forefoot, or want a shorter posterior compartment (amongst other stupid things you probably do not want in your client mechanics)).
She put the shoe back on with the 2mm sole lift in the shoe and walked 20 steps and started to tear up. No pain.

Sometimes things are simple. We more closely restored the leg length by adding more vertical height. Yes, the problem still exists, but its global effects are somewhat muted. She stopped premature heel rise, could feel her glutes, stopped the abrupt plunk onto the leg, *stopped the sudden abrupt knee flexion loading that was crippling her.

I then took it out, "shoe'd" her up again, and she was dumbfounded, all the pain returned as did her awareness of what she was coping with.

Now, sent her away with the sole lift to accommodate for 2 weeks, and we will restart the rehab once things have time to get used to the "new norm". Now the rehab will work, we think. Time will tell

One thing is for sure, and now yesterdays post rings more clear and true, if you build strength on compensation, you earn and own that compensation.

The Gait Guys

#gait, #gaitproblems, #gaitcompensations, #strength, #heellift, #solelift, #TKA, #hippain, #shortleg

Photo courtesy of Pixabay, beautiful photo isn't it !?

Pod 144: Grounded running, Glute fatigue & Stress Fractures

Topics: Grounded running, Glute fatigue, Stress Fractures, Duty Factor, Ankle stiffness & Gait and Concussions

Keywords: gait, gait analysis, gait problems, running, ankle, band, concussions, fatigue, fracture, gait, glutes, grounded, gait guys, glute medius, problems, stiffness, stress, syndrome, time under tension

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

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

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

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

Where to find us, the podcast Links:

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_147_raw_-_21619_11.08_AM.mp3

Permalink URL: http://thegaitguys.libsyn.com/pod-144-grounded-running-glute-fatigue-stress-fractures

Libsyn Directory URL: http://directory.libsyn.com/episode/index/id/8666903

Show notes:

Hip muscle response to a fatiguing run in females with iliotibial band syndrome.
Brown AM1, Zifchock RA2, Lenhoff M3, Song J4, Hillstrom HJ3.
Hum Mov Sci. 2019 Feb 8;64:181-190. doi: 10.1016/j.humov.2019.02.002. [Epub ahead of print]

Balance and Gait Alternations Observed More than 2 Weeks after Concussion: A Systematic Review and Meta-analysis.
Wood TA1, Hsieh KL1, An R1, Ballard RA2, Sonoff JJ1.
Am J Phys Med Rehabil. 2019 Feb 5. doi: 10.1097/PHM.0000000000001152. [Epub ahead of print]

Does Running Faster Put You at Greater Risk of a Stress Fracture?
New research finds that speed might not cause as much strain on the shins as we thought
By Hailey Middlebrook
Feb 12, 2019
https://www.runnersworld.com/health-injuries/a26221848/stress-fracture-speed-study/

Fast Running Does Not Contribute More to Cumulative Load than Slow Running\
Hunter, Jessica G.1; Garcia, Gina L.1; Shim, Jae Kun1,2,3; Miller, Ross H.1,2
Medicine & Science in Sports & Exercise: January 25, 2019

https://journals.lww.com/acsm-msse/Pages/articleviewer.aspx?year=9000&issue=00000&article=96699&type=Abstract

Grounded running Reduces Musculoskeletal Loading.
https://www.ncbi.nlm.nih.gov/pubmed/30480615
Med Sci Sports Exerc. 2018 Nov 21
Bonnaerens S1, Fiers P1, Galle S1, Aerts P1,2, Frederick EC3, Kaneko Y4, Derave W1, De Clercq D1.

Duty factor:
duty-factor. The duration of a gait cycle where each foot is on the ground
https://www.researchgate.net/figure/Illustration-of-the-duty-factor-The-duration-of-a-gait-cycle-where-each-foot-is-on-the_fig2_221908232

Ankle intrinsic stiffness changes with postural sway
PouyaAmiri, Robert E.Kearney
https://www.sciencedirect.com/science/article/pii/S0021929019300387

Approaching hip pain differently.

You might have fewer struggles with your hip pain clients if you start approaching the hip joint as the intersection of a long pole (the leg) with a ball on the end (the femoral head) and the pelvis' acetabulm/labrum sitting/balancing on top of the ball.
The game is to get the stick (the leg) stable and stiff enough that you can control the positioning of the frontal, sagittal and rotational planes of that ball on the end, and achieve enough control/skill, strength, stability, endurance of the interface of the pelvis socket (the pelvis' acetablum/labrum) on top of this ball. The key to success in this area is the understand that the pelvis, and the body mass above it, is terribly disadvantaged to find controlled equilibrium on top of the ball (femoral head). Thus, achieving sufficient skill of the muscles bridging the two, adequate endurance in them to last the duration of the challenges, and certainly sufficient strength of those muscles to control shear, compression, stability and controlled mobility are key components to successful and pain free hip function.
One has to think of things in a closed chain, one's limb is fixed on the ground, and one needs to see that the game is to control the pelvis and the massive entire torso mass on top of this small ball in a controlled fashion, while we are moving and changing position.
This is the game.

*This is why single leg lifts and rehab are so key in the success of a client. Remember, gait and running and most sports are for the majority of the time, spent in single leg loading.

Shawn Allen, the other #gaitguys

#gait, #thegaitguys, #gaitproblems, #gaitcompensations, #gaitanalysis, #hippain, #hipbiomechanics, #Singlelegloads, #unilateraldeadlifts, #stancephase,

photo, courtesy of pixabay.com

https://pixabay.com/en/soccer-football-soccer-players-kick-1457988/?fbclid=IwAR13Laep8KM-w4KaVl8Ip9vyz7Svk6BXbGgEE_UkSYU-3eoAV1suHtsbi80

Gait and Climbing: Part 1

Lucid Dreaming is the name of a rock in the Buttermilks of Bishop, California. This is no ordinary rock. It is a V15. Summiting this rock is basically only 3 moves off of 3 holds, from your fingertips. The remainder of the climb is sliced bread. If you can do the 3, you can get to the top. The problem is, only a handful of people in the world can do it. How hard can this be, after all you start sitting down.

Strength, stability, mobility, endurance, skill, experience, movement patterns … . it is all here, today, on The Gait Guys blog.

Author: Dr. Shawn Allen

There are things that other people can do in life that rattle your brain. These are tasks that these individuals make look fairly simple, but in actuality are nearly impossible to the average person. The honest fact is that many of us could do many of these things to a degree if we would dedicate a portion of our day to building the engine to perform these tasks, but the truth is that many of us would rather sit down and be entertained than get up and struggle.

Here on The Gait Guys blog, bipedal and quadrupedal gait has been discussed for over 5 years. Discussions have gone deep into the strange quadrupedal gait of Uner Tan Syndrome and have delved into the critical neurology behind CPG’s (Central Pattern Generators) which are neural networks that produce rhythmic patterned outputs. We have gone on and on about arm swing and how they are coordinated with the legs and opposite limb in a strategic fashion during walking running gaits.

Today I will look briefly at the interconnected arm and leg function in a high functioning human arguably one of the best new hot shots in climbing, Alex Megos. This year the German, as seen in this video link today, managed to summit Lucid Dreaming, a V15 in the Buttermilks of Bishop, California. Hell, you can say that this is just a big boulder, but there are not many V15s in the world like this one. Only a few of the very best in the world have even tried this rock, and you can count even fewer who have reached the summit. So, what does V15 mean to you? “virtually impossible” just about sums it up. Watch the video, this V15 starts from a “sit-start”, many folks wouldn’t even get their butts off the ground to complete the first move, that is how hard this is. Watch the video, if this does not cramp your brain, you perhaps you don’t have one.

Are there possible neurologic differences in climbers such as Megos as compared to other quadruped species? Primarily, there is suspect of an existing shift in the central pattern generators because of the extraordinary demand on pseudo-quadrupedal gait of climbing because of the demand on the upper limbs and their motorneuron pools to mobilize the organism up the mountain. We know these quadrupedal circuits exist. In 2005 Shapiro and Raichien wrote “the present work showed that human QL(quadrupedal locomotion) may spontaneously occur in humans with an unimpaired brain, probably using the ancestral locomotor networks for the diagonal sequence preserved for about the last 400 million years.”

As we all know, the interlimb coordination in climbing and crawling biomechanics shares similar features to other quadrupeds, both primate and non-primate, because of similarities in our central pattern generators (CPG’s). New research has however determined that the spaciotemportal patterns of spinal cord activity that helps to mediate and coordinate arm and leg function both centrally, and on a cord mediated level, significantly differ between the quadruped and bipedal gaits. In correlation to climbers such as Megos however, we need to keep in mind that the quadrupedal demands of a climber (vertical) vastly differ in some respects to those of a non-vertical quadrupedal gait such as in primates, in those with Uner Tan Syndrome and during our “bear crawl” challenges in our gyms. This should be obvious to the observer in the difference in quadrupedal “push-pull” that a climber uses and the center-of-mass (COM) differences. To be more specific, a climber must reduce fall risk by attempting to keep the COM within the 4 limbs while remaining close to the same surface plane as the hands and feet (mountain) while a primate, human or Uner Tan person will choose to “tent up” the pelvis and spine from the surface of contact which narrows the spreading of the 4 contact points. Naturally, this “tenting up” can be reduced, but the exercise becomes infinitely more difficult, to the point that most cannot quadrupedally ambulate more than a very short distance. I will discuss this concept in Part 2 of this series on climbing. If you study childhood development and crawling patterns, you need to be familiar with UTS (search our blog, save yourself the time), the flaws in the neurology behind the "Bird Dog” rehab pattern, and crawling mechanics … and of course, study climbers.

Some research has determined is that in quadrupeds the lower limbs displayed reduced orientation yet increased ranges of kinematic coordination in alternative patterns such as diagonal and lateral coordination. This was clearly different to the typical kinematics that are employed in upright bipedal locomotion. Furthermore, in skilled mountain climbers, these lateral and diagonal patterns are clearly more developed than in study controls largely due to repeated challenges and subsequent adaptive changes to these lateral and diagonal patterns. What this seems to suggest is that there is a different demand and tax on the CPG’s and cord mediated neuromechanics moving from bipedal to quadrupedal locomotion. There seemed to be both advantages and disadvantages to both locomotion styles. Moving towards a more upright bipedal style of locomotion shows an increase in the lower spine (sacral motor pool) activity because of the increased and different demands on the musculature however at the potential cost to losing some of the skills and advantages of the lateral and diagonal quadrupedal skills. Naturally, different CPG reorganization is necessary moving towards bipedalism because of these different weight bearing demands on the lower limbs but also due to the change from weight bearing upper limbs to more mobile upper limbs free to not only optimize the speed of bipedalism but also to enable the function of carrying objects during locomotion.

The take home seems to suggest that gait retraining is necessary as is the development of proper early crawling and progressive quadruped locomotor patterns. Both will tax different motor pools within the spine and thus different central pattern generators (CPG). A orchestration of both seems to possibly offer the highest rewards and thus not only should crawling be a part of rehab and training but so should forward, lateral and diagonal pattern quadrupedal movements, on varying inclines for optimal benefits. Certainly I need to do more work on this topic, the research is out there, but correlating the quad and bipedal is limited. I will keep you posted. Be sure to read my 3 part series on Uner Tan Syndrome, here on The Gait Guys blog. Some of today’s blog is rehash of my older writings, naturally I am setting the stage for “Part 2″ of Climbing.

- Dr. Shawn Allen

References:

Shapiro L. J., Raichien D. A. (2005). Lateral sequence walking in infant papio cynocephalus: implications for the evolution of diagonal sequence walking in primates. Am. J. Phys. Anthropol.126, 205–213 10.1002/ajpa.20049

Scand J Med Sci Sports. 2011 Oct;21(5):688-99. Idiosyncratic control of the center of mass in expert climbers. Zampagni ML , Brigadoi S, Schena F, Tosi P, Ivanenko YP

J Neurophysiol. 2012 Jan;107(1):114-25. Features of hand-foot crawling behavior in human adults. Maclellan MJ, Ivanenko YP, Cappellini G, Sylos Labini F, Lacquaniti F.