Sometimes too much shoe is too much...

Minimalist. Maximalist. Neutral. Sometimes you need to earn your way into a shoe. After all, a shoe is supposed to direct and guide your foot to better (more optimal?) mechanics, not necessarily create more work for it. The literature seems to point to maximalist shoes changing lower extremity kinematics and increasing impact forces. The body needs to have the ability to “attenuate“ these impact forces, otherwise problems could potentially arise.

Take a good look at this gal. She is having a heck of a time trying to control what her mechanics are doing in this maximalist shoe. She demonstrates poor control of the foot, as well as the knee and hip.

By design, the shoe has a thicker outsole and forefoot flare (ie: The front of the shoe is wider at the sole than it is at the interface of the foot with it). This can create accelerated forefoot pronation as you see here with the medial aspect of the foot “slapping“ down on the ground. This creates a large valgus moment at the knee, which is further accentuated by her external tibial torsion, greater on the left. Also notice the pelvic dip on the left on the right foot hits the ground; less so on the right side when the left foot strikes. Looking up the chain and as a whole, you can see that this is poor control and could potentially contribute to at the mechanics at the ankle, knee and hip. Not sure if you can see it but she also has an increase in her lumbar lordosis, diminishing her ability to be able to use her abdominal core to help to stabilize.

If she were to continue to want to utilize the shoe, we would need to work on core strength, hip stability and most likely, forefoot motion (so that she can get her first ray complex to the ground at the first metatarsal phalangeal joint), before she “earns her way” into this shoe.

Dr Ivo Waerlop, one of The Gait Guys

Kulmala JP, Kosonen J, Nurminen J, Avela J.Running in highly cushioned shoes increases leg stiffness and amplifies impact loading. Sci Rep. 2018 Nov 30;8(1):17496. FREE FULL TEXT

Law MHC, Choi EMF, Law SHY, Chan SSC, Wong SMS, Ching ECK, Chan ZYS, Zhang JH, Lam GWK, Lau FOY, Cheung RTH. Effects of footwear midsole thickness on running biomechanics. J Sports Sci. 2019 May;37(9):1004-1010

Chan ZYS, Au IPH, Lau FOY, Ching ECK, Zhang JH, Cheung RTH. Does maximalist footwear lower impact loading during level ground and downhill running? Eur J Sport Sci. 2018 Sep;18(8):1083-1089.

Sinclair J, Richards J, Selfe J, Fau-Goodwin J, Shore H.The Influence of Minimalist and Maximalist Footwear on Patellofemoral Kinetics During Running.J Appl Biomech. 2016 Aug;32(4):359-64. 

Chambon N, Delattre N, Guéguen N, Berton E, Rao G. Is midsole thickness a key parameter for the running pattern? Gait Posture. 2014;40(1):58-63

#runnning #gait #biomechanics #maximalistshoes #midsolethickness #gaitanalysis #thegaitguys

Arm swing asymmetry: It can be a huge window of education into your client.

Arm swing asymmetry: It can be a huge window of education into your client, if you can get past the dumb stuff we’ve all done (and believed) for decades.
I have beaten you down with arm swing principles over the past few years, sorry about that, but, the beating will continue because it is important to know what arm swing tells you, and what it does not tell you (hint hint for all those improperly coaching arm swing changes). We did an entire tele seminar on the Stage 1 principles of of arm swing (#218) on www.onlinece.com and www.chirocredit.com if you wish to take that archived lecture. Heck $19, how can you lose (see photo).  Arm swing is intimately dependent upon scapular stability, thoracic mobility, breathing, cervical spine function, pelvis stability and clearly ipsilateral and contralateral leg swing not to forget to mention spinal stability. The first signs of spine pain or instability and the counter rotation of the shoulder and pelvic girdles become more phasic, instead of their normal anti phasic nature (moving in opposite directions). This phasic nature reduces spinal shear loads.

Neurologic diseases in their early, middle and late phases can give us a clearer window into how the nervous system is tied together.
Arm swing asymmetry during gait may be a sensitive sign for early Parkinson’s disease.

Here is what this Plate et al study found :
-Arm swing amplitude as well as arm swing asymmetry varied considerably in the healthy subjects.
-Elderly subjects swung their arms more than younger participants. -Only the more demanding mental load caused a significant asymmetry
-In the patient group, asymmetry was considerably higher and even more enhanced by mental loads.
-Evaluation of arm swing asymmetry may be used as part of a test battery for early Parkinson’s disease.

Some facts you should consider:
Parkinson’s Disease will be well advanced before the first signs of motor compromise occurs. So early detection and suspicion should be acted upon early when possible. Reductions or changes in arm swing may be the first signs of neuralgic disease expression and progression. Dual tasking may bring out neurologic signs early, so talk to your clients or have them count backwards to distract the motor programs. Look for one sided arm swing impairment, and when present, be sure to examine all limbs, especially the lower limbs, for impaired function. After all, the arms are like balasts, they can help with postural stability simply by abducting or modifying their swing.  Arm swing changes can include:
- crossing over the body
- more forward sagittal swing and less posterior swing
- more posterior sagittal swing and less anterior swing
- shoulder abduction during swing (and with attributes of the prior two mentioned above)
- less swing with adduction stabilized with torso
- modified through accentuations or dampening of shoulder girdle rotation oscillations, thus less arm swing but more torso swing to protect the glenohumeral and other joints
- and others of course

Arm swing and arm swing symmetry matter. Don’t be a dunce and just train it out or tell your client to do things to change it before you identify the “why” behind it. If it were that simple Ivo and I would have long grown tails and begun eating more bananas. Or maybe we would have already moved to the islands by now. That was random wasn’t it. That’s what Jimmy Buffett said.

“Now he lives in the islands, fishes the pilin’s
And drinks his green label each day
He’s writing his memoirs and losing his hearing
But he don’t care what most people say.
Through eighty-six years of perpetual motion
If he likes you he’ll smile then he’ll say
Jimmy, some of it’s magic, some of it’s tragic
But I had a good life all the way.
And he went to Paris looking for answers
To questions that bother him so.”  -Jimmy Buffett

Hope this helps, now back to that rum.
-Shawn Allen

Gait Posture. 2015 Jan;41(1):13-8. doi: 10.1016/j.gaitpost.2014.07.011. Epub 2014 Aug 8.
Normative data for arm swing asymmetry: how (a)symmetrical are we?  Plate A1, Sedunko D2, Pelykh O3, Schlick C4, Ilmberger JR5, Bötzel K6.
http://www.ncbi.nlm.nih.gov/pubmed/25442669