3 things

Its subtle, but hopefully you see these 3 things in this video.

I just LOVE the slow motion feature on my iPhone. It save me from having to drag the video into Quicktime, slow it down and rerecord it.

This gal has a healing left plantar plate lesion under the 2nd and 3rd mets. She has an anatomical leg length deficiency, short on the left, and bilateral internal tibial torsion, with no significant femoral version. Yes, there are plenty of other salient details, but this sketch will help.

  1. 1st if all, do you see how the pelvis on her left dips WAY more when she lands on the right? There is a small amount of coronal plane shift to the right as well. This often happens in gluteus medius insufficiency on the stance phase leg (right in this case), or quadratus lumborum (QL) deficiency on the swing phase leg (left in this case) or both. Yes, there are other things that can cause this and the list is numerous, but lets stick to these 2 for now. In this case it was her left QL driving the bus.

  2. Watch the left and right forefeet. can you see how she strikes more inverted on the left? this is a common finding, as the body often (but not always) tries to supinate the shorter extremity (dorsiflexion, eversion and adduction, remember?) in an attempt to “lengthen” it. Yes, there is usually anterior pelvic tilt accompanying it on the side, because I knew you were going to ask : )

  3. Look how her knees are OUTSIDE the saggital plane and remain there in her running stride. This is commonly seen in folks with internal tibial torsion and is one of the reasons that in our opinion, these folks should not be put medially posted, torsionally rigid, motion control shoes as this usually drive the knees FURTHER outside the saggital plane and can macerate the meniscus.

Yep, lots more we could talk about on this video, but in my opinion, 3 is a good number.

Dr Ivo Waerlop, one of The Gait Guys

#thegaitguys #gaitanalysis #footpain #gaitproblem #internaltibialtorsion #quadratuslumborum #footstrike

https://vimeo.com/329212767

Do her hips get weak, fatigue, or both when she runs?

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“ Both healthy and injured runners demonstrated decreased gluteus medius strength following the run to fatigue (p = 0.01), but there was no interaction between groups (p = 0.78). EMG onset activation timing did not differ between groups for the gluteus medius (P = 0.19) and tensor fascia latae muscles (P = 0.52). Injured runners demonstrated decreased gluteus medius initial median frequency values suggestive of fatigue (P = 0.01). These findings suggest that the gluteus medius muscle of female runners with ITBS does not demonstrate gross strength impairments but does demonstrate less resistance to fatigue. Clinicians should consider implementation of a gluteus medius endurance training regimen into a runner's rehabilitation program. “

Dr Ivo Waerlop, one of The Gait Guys

#gait, #gaitanalysis, #fatigue, #gluteusmedius, #gluteusminimus, ITB, #ITbandsyndrome, #thegaitguys

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

So, what attaches to that hip capsule anyway....

I was trying to figure to which muscles attached to the labrum of the hip, as I see many folks where theres has gone south. I had always wondered if the iliopsoas attached, since many people with labral pathology have hip flexor dysfunction, where they use their psoas and iliacus as hip flexion initiators (or sometimes the rectus femoris, TFL and sartorius), instead of the abdominals. It turns out that NO MUSCLES attach to the labrum, but some attach to the capsule. 

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Have you noticed that many of the muscles on the list below (not the obturator internus) are internal rotators AND work during the 1st part of stance phase? Remember "glide and roll"? With internal rotation of the hip comes posterior translation of the femoral head. If these are dysfunctional, you may get capsular "pinching". Think about it with the next patient with hip joint pain from initial contact to midstance. 

"An updated knowledge of the intricate relationship of the pericapsular and capsular structures is essential in guiding our treatment of the hip. Following dissection the authors were able to discern that the iliocapsularis, indirect head of the rectus, conjoint tendon (of the psoas and iliacus),  obturator externus and gluteus minimus all have consistent capsular contributions whereas the piriformis did not have a capsular attachment."

 

Walters BL, Cooper JH, Rodriguez JA New findings in hip capsular anatomy: dimensions of capsular thickness and pericapsular contributions.
Arthroscopy. 2014 Oct;30(10):1235-45. doi: 10.1016/j.arthro.2014.05.012. Epub 2014 Jul 23.

A cool paper on taping and reciprocal inhibition.    “Hip extension increased significantly with gluteal taping (p < 0.05) for both walking speeds at late stance phase of walk compared to sham taping and control. The mean absolute difference between gluteal and control conditions for self-selected velocity was 14.2 degrees (95% CI 8.6 to 19.8) whereas the difference between sham and control conditions was 2.0 degrees (95% CI –2.0 to 6.0). Also, for both speeds, step length on the unaffected side increased significantly with gluteal taping compared with either the control or placebo” conditions.     link to full text:  http://www.sciencedirect.com/science/article/pii/S0004951406700629    Aust J Physiother.  2006;52(1):53-6.Gluteal taping improves hip extension during stance phase of walking following stroke. Kilbreath SL ,  Perkins S ,  Crosbie J ,  McConnell J .

A cool paper on taping and reciprocal inhibition. 

“Hip extension increased significantly with gluteal taping (p < 0.05) for both walking speeds at late stance phase of walk compared to sham taping and control. The mean absolute difference between gluteal and control conditions for self-selected velocity was 14.2 degrees (95% CI 8.6 to 19.8) whereas the difference between sham and control conditions was 2.0 degrees (95% CI –2.0 to 6.0). Also, for both speeds, step length on the unaffected side increased significantly with gluteal taping compared with either the control or placebo” conditions. 

link to full text: http://www.sciencedirect.com/science/article/pii/S0004951406700629

Aust J Physiother. 2006;52(1):53-6.Gluteal taping improves hip extension during stance phase of walking following stroke.Kilbreath SL, Perkins S, Crosbie J, McConnell J.

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Leg Pain? Are you SURE its a disc?

Gluteus minimus dysfunction is often present in gait disorders, including stance phase mechanical problems, since it fires from initial contact through pre swing, like it better known counterpart, the gluteus medius. It is interesting that the trigger point referral pattern of the gluteus minimus has a sciatic distribution, whereas the gluteus medius is more in the local area of the hip. 

 There are several, well known effects of dry needling:

decreased central sensitization

increased range of motion

changes in muscle activation

changes in the chemical environment surrounding a trigger point

changes in local and referred pain


and now we can add (not surprisingly), changes in autonomic function. The mechanism probably has something to do with pain and the reticular formation sending information down the cord via the lateral cell column (intermediolateral cell nucleus) or pain (nociceptive) afferents sending a collateral in the spinal cord to the dysfunctional muscle (Dr Ivo talks about these mechanisms in his dry needling and acupuncture lectures). 


Conclusions

The presence of active TrPs within the gluteus minimus muscle among subacute sciatica subjects was confirmed. Every TrPs-positive sciatica patient presented DN related vasodilatation in the area of referred pain. The presence of vasodilatation suggests the involvement of sympathetic nerve activity in myofascial pain pathomechanism.

BMC Complement Altern Med. 2015; 15: 72. Published online 2015 Mar 20. doi:  10.1186/s12906-015-0587-6PMCID: PMC4426539 Intensive vasodilatation in the sciatic pain area after dry needling

link to full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426539/

Have a patient with weak hip abductors? Here is a great closed chain gluteus medius exercise called “"hip airplanes” we utilize all the time. Try it in yourself, then try it on your patients and clients, then teach others : )

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How do your gluteus maximus and gluteus medius exercises stack up?

Looks like side planks (DL=dominant leg) and single leg squats scored big, as did front planks and good old “glute squeezes”

Check out this free full text articlehttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201064/

Yes, we know it was surface emg; yes we know they are not necessarily testing functional movements. The EMG does not lie and offers objective data. Note that the one graph is labelled wrong and is the G max, not medius.

Kristen Boren, DPT,1 Cara Conrey, DPT,1 Jennifer Le Coguic, DPT,1 Lindsey Paprocki, DPT,1 Michael Voight, PT, DHSc, SCS, OCS, ATC, CSCS,1 and T. Kevin Robinson, PT, DSc, OCS1 ELECTROMYOGRAPHIC ANALYSIS OF GLUTEUS MEDIUS AND GLUTEUS MAXIMUS DURING REHABILITATION EXERCISES Int J Sports Phys Ther. 2011 Sep; 6(3): 206–223.

GOT GLUTE MEDS?   Want to strengthen that gluteus medius we were talking about Monday? Have you considered walking lunges with dumbbells? These seem to activate the side contralateral to a better extent than split squats.   We wonder if you get the same effect with a medicine ball. Anyone out there have some data or experience with that?  Stastny P1, Lehnert M, Zaatar Zaki AM, Svoboda Z, Xaverova Z. DOES THE DUMBBELL CARRYING POSITION CHANGE THE MUSCLE ACTIVITY DURING SPLIT SQUATS AND WALKING LUNGES? J Strength Cond Res. 2015 May 8. [Epub ahead of print]

GOT GLUTE MEDS?

Want to strengthen that gluteus medius we were talking about Monday? Have you considered walking lunges with dumbbells? These seem to activate the side contralateral to a better extent than split squats.

We wonder if you get the same effect with a medicine ball. Anyone out there have some data or experience with that?

Stastny P1, Lehnert M, Zaatar Zaki AM, Svoboda Z, Xaverova Z. DOES THE DUMBBELL CARRYING POSITION CHANGE THE MUSCLE ACTIVITY DURING SPLIT SQUATS AND WALKING LUNGES? J Strength Cond Res. 2015 May 8. [Epub ahead of print]

The mighty Gluteus Medius, in all its glory!   Perhaps the delayed action of the gluteus medius allows an adductory moment of the pelvis, moving the center of gravity medially. This could conceivably place additional stress on the achilles tendon  (via the lateral gastroc) to create more eversion of the foot from midstance on   &ldquo;The results of the study demonstrate altered neuromuscular control of the GMED and GMED in runners with Achilles Tendonitis. During running, GMED typically activates before heel strike so as to stabilize the hip and the pelvis. In runners with Achilles Tendonitis, GMED is activated with a delay, which consequently might affect the kinematics of knee and ankle resulting in rear foot inversion. Similarly, GMAX is activated with a delay and for a shorter duration in runners with Achilles Tendonitis. GMAX is the primary hip extensor and via a kinetic chain, a decreased hip extension moment might be compensated by an increased ankle plantarflexion moment which could potentially increase the load on the Achilles tendon.&rdquo;   Franettovich Smith MM1, Honeywill C, Wyndow N, Crossley KM, Creaby MW. : Neuromotor control of gluteal muscles in runners with achilles tendinopathy. Med Sci Sports Exerc. 2014 Mar;46(3):594-9.

The mighty Gluteus Medius, in all its glory!

Perhaps the delayed action of the gluteus medius allows an adductory moment of the pelvis, moving the center of gravity medially. This could conceivably place additional stress on the achilles tendon  (via the lateral gastroc) to create more eversion of the foot from midstance on

“The results of the study demonstrate altered neuromuscular control of the GMED and GMED in runners with Achilles Tendonitis. During running, GMED typically activates before heel strike so as to stabilize the hip and the pelvis. In runners with Achilles Tendonitis, GMED is activated with a delay, which consequently might affect the kinematics of knee and ankle resulting in rear foot inversion. Similarly, GMAX is activated with a delay and for a shorter duration in runners with Achilles Tendonitis. GMAX is the primary hip extensor and via a kinetic chain, a decreased hip extension moment might be compensated by an increased ankle plantarflexion moment which could potentially increase the load on the Achilles tendon.”

Franettovich Smith MM1, Honeywill C, Wyndow N, Crossley KM, Creaby MW. : Neuromotor control of gluteal muscles in runners with achilles tendinopathy.
Med Sci Sports Exerc. 2014 Mar;46(3):594-9.

Does this guy have a short leg or what? How good are your eyes?

One again, we had the gait cam, investigating gait on the east coast. What do we see in this gent?

  • heel strike on out side of left foot with increased progression angle

he appears to be stabilizing the left side during stance phase. notice the upper torso shift to the left during left stance phase

  • abbreviated arm swing on right

note that ankle rocker is adequate on the left

  • body lean to right on right stance phase

gluteus medius weakness on right? short leg on right?

Good.

  • Did you also notice the loss of ankle rocker on the right, compared to the left? This results in less hip extension on that side as well.
  • He flexes his right thigh less than his right during pre swing and swing

external obliques should be firing to initiate hip flexion, perpetuated by the psoas, iliacus and rectus femoris. This does not appear to be happening.

All of this is great BUT nothing like being able to actually examine your patients is there? You can see how gait analysis can tell us many things, but they need to be confirmed by a physical exam.

The Gait Guys. Educating (and hopefully enlightening) with each post. Keep your eyes open and your thinking from the ground up : )

Subtle clues often provide the answers.  
 We like yoga as much as anyone else. We saw this picture on the latest cover and couldn&rsquo;t resist making a few comments on this pose. 
 Yoga has many benefits. Our understanding is that in addition to the cognitive and spiritual effects of yoga, is that it helps to build your core. 
  At first look you may say that this woman has a few issues: 
  she has a right pelvic shift and a left body lean 
 She has slight head rotation to the right and a slight left head tilt 
 you may have noticed that she appears to have more tone in the musculature on the right side of her face than on the left.   Just look at the nasolabial fold as well as the corner of her mouth any area of wrinkling underneath her left orbit. 
  You may have also noticed the subtle flexion and lack of external rotation of the right hip. 
   You may go on and think that she has a week right gluteus medius as well as an overactive quadratus lumborum on the left-hand side which may be causing the pelvic shift. The head tilt may be in compensation for the right side gluteus medius weakness and the subtle rotation may be an attempt to engage a tonic neck response. ( a tonic neck response is  ipsilateral extension of the upper and lower extremity to the side of head rotation with contralateral flexion of the same counterparts. 
   You may have also noticed  that the toes of the right foot are not dorsiflexed and that her hair appears to be flowing on the right side, and this is not the case at all, but rather she is either standing on a sloped surface or on the downward phase of a jump. According to the magazine it is the latter.  If you caught this at first then  congratulations:   you are sharper than most . If not remember to always look for subtle clues. 
  Like Sir Topham Hat says in Thomas the Train: &ldquo;  You didn&rsquo;t get the whole story. What really happened is what really matters. 
  So why the mild facial ptosis on the left side? She could have had an old Bells palsy, or other form of facial paresis. Note that mostly the lower portions of the (left) face are affected (ie, below the eye). We remember that the upper portions of the face receive bilateral innervation but lower portions of the face unilateral innervation, from the contra lateral facial motor nucleus; this is why it could be a mild upper motor neuron lesion (micro infact, lack of cortical afferent input) and not an lower motor neuron lesion (like Bells Palsy). Why is this germane? Or is it not?  
 Stand in front of a mirror. Jump up in the air trying to assume the same pose as this woman does and what do you see.  Make sure that you jump up from both legs and then bring one leg over and your hands in front of you in the &quot;praying position&rdquo;. You may want to have a friend take a snapshot of you performing this. You will notice that you have contralateral head rotation,  a pelvic hike on the side opposite the leg that&rsquo;s extended and a head tilt to the side that is flexed.  You are attempting to stabilize your core as you&rsquo;re going up and coming down. 
 What we are witnessing is a normal neurological phenomena.  This gal merely seems to have some limited external rotation of her left hip. Now perform the same maneuver again but this time don&rsquo;t externally rotate your leg as far as this woman does and what do you see. You should&rsquo;ve seen an increase in the aforementioned body postures. 
 Subtle clues are often the key. Keep your eyes and ears open.  
  The Gait Guys. Helping the subtle to become everyday for you, with each and every post.

Subtle clues often provide the answers.

We like yoga as much as anyone else. We saw this picture on the latest cover and couldn’t resist making a few comments on this pose.

Yoga has many benefits. Our understanding is that in addition to the cognitive and spiritual effects of yoga, is that it helps to build your core.

 At first look you may say that this woman has a few issues:

  • she has a right pelvic shift and a left body lean
  • She has slight head rotation to the right and a slight left head tilt
  • you may have noticed that she appears to have more tone in the musculature on the right side of her face than on the left.   Just look at the nasolabial fold as well as the corner of her mouth any area of wrinkling underneath her left orbit.
  •  You may have also noticed the subtle flexion and lack of external rotation of the right hip.

 You may go on and think that she has a week right gluteus medius as well as an overactive quadratus lumborum on the left-hand side which may be causing the pelvic shift. The head tilt may be in compensation for the right side gluteus medius weakness and the subtle rotation may be an attempt to engage a tonic neck response. ( a tonic neck response is  ipsilateral extension of the upper and lower extremity to the side of head rotation with contralateral flexion of the same counterparts.

 You may have also noticed that the toes of the right foot are not dorsiflexed and that her hair appears to be flowing on the right side, and this is not the case at all, but rather she is either standing on a sloped surface or on the downward phase of a jump. According to the magazine it is the latter.  If you caught this at first then congratulations: you are sharper than most. If not remember to always look for subtle clues.

 Like Sir Topham Hat says in Thomas the Train: “  You didn’t get the whole story. What really happened is what really matters.

So why the mild facial ptosis on the left side? She could have had an old Bells palsy, or other form of facial paresis. Note that mostly the lower portions of the (left) face are affected (ie, below the eye). We remember that the upper portions of the face receive bilateral innervation but lower portions of the face unilateral innervation, from the contra lateral facial motor nucleus; this is why it could be a mild upper motor neuron lesion (micro infact, lack of cortical afferent input) and not an lower motor neuron lesion (like Bells Palsy). Why is this germane? Or is it not?

Stand in front of a mirror. Jump up in the air trying to assume the same pose as this woman does and what do you see.  Make sure that you jump up from both legs and then bring one leg over and your hands in front of you in the "praying position”. You may want to have a friend take a snapshot of you performing this. You will notice that you have contralateral head rotation,  a pelvic hike on the side opposite the leg that’s extended and a head tilt to the side that is flexed.  You are attempting to stabilize your core as you’re going up and coming down.

What we are witnessing is a normal neurological phenomena.  This gal merely seems to have some limited external rotation of her left hip. Now perform the same maneuver again but this time don’t externally rotate your leg as far as this woman does and what do you see. You should’ve seen an increase in the aforementioned body postures.

Subtle clues are often the key. Keep your eyes and ears open. 

The Gait Guys. Helping the subtle to become everyday for you, with each and every post.

Go ahead and try this at home.   remember last mondays post? (if not, click  here ). Here is one way of telling whether your (or someone else’s) vestibular system is working. It will also give you an idea of how some people compensate.     Ready?     
  Stand up (barefoot or shoes does not matter). 
   place your hands resting on the top of your hips with your thumbs to the back (like your Mom used to, when you were in trouble). Your thumbs should be resting on your quadratus lumborum (QL) muscle.  
   tilt your HEAD to the LEFT 
   you should feel the muscle (ie the QL) under your RIGHT thumb contract 
   come back upright 
     repeat, but this time lean your BODY to the LEFT     
  same thing right? Now check the other side. 
    Everything OK? Everything fire as it should?   Now lets add another dimension. 
  slide your fingers down so they are just below the crest of the hip, resting above the greater trochanter (the bump on the side of your upper thigh). This should place your fingers on the middle fibers of the gluteus medius. 
   tilt your head (or body ) to the LEFT. 
   You should feel the LEFT gluteus medius and the RIGHT QL contract. These muscles should be paired neurologically. When walking, during stance phase on the LEFT: the LEFT gluteus medius helps to maintain the pelvis level, while the RIGHT QL, assists in hiking the RIGHT side. 
   If everything works OK, then your vestibulospinal spinal system is intact and your QL and gluteus medius seem to be firing and appropriately paired. If not? That is the subject for another post.     The Gait Guys. Helping you to understand the concepts of WHY compensations occur.

Go ahead and try this at home.

remember last mondays post? (if not, click here). Here is one way of telling whether your (or someone else’s) vestibular system is working. It will also give you an idea of how some people compensate.

Ready?

  • Stand up (barefoot or shoes does not matter).
  • place your hands resting on the top of your hips with your thumbs to the back (like your Mom used to, when you were in trouble). Your thumbs should be resting on your quadratus lumborum (QL) muscle.
  • tilt your HEAD to the LEFT
  • you should feel the muscle (ie the QL) under your RIGHT thumb contract
  • come back upright


repeat, but this time lean your BODY to the LEFT

  • same thing right? Now check the other side.


Everything OK? Everything fire as it should?

Now lets add another dimension.

  • slide your fingers down so they are just below the crest of the hip, resting above the greater trochanter (the bump on the side of your upper thigh). This should place your fingers on the middle fibers of the gluteus medius.
  • tilt your head (or body ) to the LEFT.
  • You should feel the LEFT gluteus medius and the RIGHT QL contract. These muscles should be paired neurologically. When walking, during stance phase on the LEFT: the LEFT gluteus medius helps to maintain the pelvis level, while the RIGHT QL, assists in hiking the RIGHT side.


If everything works OK, then your vestibulospinal spinal system is intact and your QL and gluteus medius seem to be firing and appropriately paired. If not? That is the subject for another post.

The Gait Guys. Helping you to understand the concepts of WHY compensations occur.

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A Window into the Glutes: Anatomy lesson for the day.

 

A rather literal statement for a rather literal picture. Taken from the Human Body Exhibit at the Denver Museum of Science, this picture offers us a glimpse into, or in this case through, one of our favorite muscle groups. This group that we see here, is probably our second favorite group. They are often called the “deep six” and are the deep hip external rotators. If you count, you will notice there are only five….one remains unseen the obturator internus. More on that later.

 

See the linear white lines on the right of the window? That’ s the two portions of the sciatic nerve. Notice how it runs under the muscle at the top and over the others? The muscle it runs under is the famous piriformis. When this muscle gets tight, it can impinge the sciatic nerve, causing pain down the leg (known as sciatica). This represents one of many causes of pain radiating down the leg.

 

The next muscle south is the gemelli superior, then the obturator externus, gemelli inferior, and quadratus femoris. The sixth of the deep six is the obturator internus, which runs from the inside of the pelvis on the obtrobturator foramen (those huge “eyes” you see in an x ray when looking at a pelvis from the front) to a similar place on the femur.

 

A few observations you should make.

 

  • when someone chews your butt off, or chews you a new one, this picture gives it a whole new meaning

  • the sciatic nerve runs under the piriformis
  • The top (superior) five muscles have a tendonous insertion to the femur that you can see as a whitish area on the left

  • the last (or most inferior muscle) has a muscular insertion to the femur (which is a reddish area on the left)
  • the positioning of these muscles allows them to be external rotators of the femur when the foot is in the air

  • when the foot is planted, they become external rotators of the pelvis or can act to slow internal rotation of the femur during stance phase
  • as you proceed caudally, the muscles become stronger adductors of the thigh

 

We will see this post as a reference for some future posts on this most fascinating muscle groups. Until then, study up!

 

The Gait Guys. Uber Foot Geeks. Join us in our mission to educate the world on the importance of understanding human motion and its impact on translating us forward in the gravitational plane.

 

 

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

One simple hip screen that gives you lots of information.

This is the one leg standing test. We use it as a hip function (abduction) screen(as well as an exercise), to see if a person’s gluteus medius is working in a functional situation (as opposed to manual muscle testing).

As you may remember (don’t remember? Click here), the gluteus medius fires throughout stance phase (ie; when the foot is on the ground). It keeps the pelvis level while the foot is on the ground and works in conjunction with the opposite quadratus lumborum muscle (if you have not read up on this, please see our groundbreaking work on the problematic cross over gait, found here, here and here).

The test is simple; try it on yourself while watching yourself in a mirror. Stand on one leg on your foot tripod (the heel, base of big toe and base of little toe). Raise the opposite foot off the ground by flexing the thigh. Observe.

You should see the pelvis remaining level with no shift of the torso or hips. 

Watch for:

  • ·      Pelvic drift to the side you are standing on
  • ·      Pelvis drop on the side opposite you are standing on
  • ·      Body lean to the side you are standing on
  • ·      Excessive hiking of the opposite, non weight bearing hip
  • ·      Any combination of the above

 

Seeing any (or all) of these means the gluteus medius is probably having some trouble.  The reason we say probably is that a person with a hip problem (like arthritis) or an anatomically short leg may do some of these things in compensation.

The question you are hopefully asking is why do they drift, lean, hike, etc? Not everything you see is muscle weakness per se.

  • ·      Maybe they have a balance issue
  • ·      Maybe they have a disc injury
  • ·      Maybe they have injury to the nerve going to the gluteus medius
  • ·      Maybe they have a knee/ankle/foot issue
  • ·      And the list goes on…

So, if it were a muscle weakness, how could you fix it? Determine the cause. Begin at the bottom with foot exercises: tripod standing, lift/spead/reach with the toes etc. Then have them repeat the exercise IN A MIRROR, maintaining a level pelvis. Yes, it is that simple. Now see if they can translate that to their gait cycle. If so, great. If not, start again and repeat till they can.

The Gait Guys. Making it real, each and every day.

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

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Gender differences in walking and running on level and inclined surfaces. 

Chumanov ES, Wall-Scheffler C, Heiderscheit BC. Clin Biomech (Bristol, Avon). 2008 Dec;23(10):1260-8. Epub 2008 Sep 6.

 

What the Gait Guys have to say about this article:

 

This article highlights some of the differences in gait between males and females on treadmills. Though treadmills don’t necessarily represent real life, they are an approximation. While reading this article, please keep the following in mind:

1. the treadmill pulls the hip into extension and places a pull on the anterior hip musculature, especially the hip flexors including the rectus femoris, iliopsoas and iliacus. This causes a slow stretch of the muscle, activating the muscle spindles (Ia afferents) and causing a mm contraction (ie the stretch reflex). This acts to inhibit the posterior compartment of hip extensors (especially the glute max) through reciprocal inhibition, making it difficult to fire them.

 

2. Because the deck is moving, the knee is brought into extension, with stretch of the hamstrings, the quads become reciprocally inhibited (same mechanism above).

 

3. The moving deck also has a tendency to put the ankle in dorsiflexion, initiating a stretch reflex in the tricep surae (gastroc/soleus) facilitating toe off through here and pushing you through the gait cycle, rather than pulling you through (with your hip extensors).

 

4. the moving deck forces you to flex the thigh forward for the next footstrike (ie footstance), firing the RF, IP and Iliacus, and reciprocally inhibit the g max

 

If your core isn’t engaged, the pull of the rectus femoris and iliopsoas/iliacus pulls the ilia and pelvis into extension (ie increases the lordosis) and you reciprocally inhibit the erectors and increase reliance on the multifidus and rotatores, which have short lever arms and are supposed to be more proprioceptive in function. Can you say back pain?

 

In summary, treadmills are not the scourge of humanity, but do have some pitfalls for training, and equal amounts of “backwards” running should be employed (with great caution, mind you)

 

With that being said, lets look at the results: increased hip internal rotation and adduction, as well as more glute activity for the ladies. Not surprising considering women generally have a larger Q angle (17 +/- 3 degrees for females, 14 +/-3 degrees for males) and greater amounts of hip anteversion (average 14 degrees in females vs 8 in males). The larger Q angle places more stress at the medial knee (compression of the medial femoral condyle and usually increased pronation as the center of gravity over the foot is moved medially) and thus more control needed to slow pronation (from the glutes to control/augment internal rotation). Greater hip anteversion means the angle of the femoral head is greater than 12 degrees to the shaft of the femur. This moves the lower extremity into a more internally rotated position, approximating the origin and insertion of the adductors, making them easier to access. With an increased Q angle and easier access, greater demands are placed on adductors in single leg stance (which is considerably greater in running), This increased adductory moment places more demand on the gluteus medius (and contralateral QL) as well, to stabilize the pelvis and this correlates with speed and incline, also found in the study.

 

The take home message? Don’t throw away your treadmill! The treadmill can be an excellent diagnostic tool! Gluteal and adductor insufficiencies will be more visible (and probably more prevalent) in females, especially those running or walking on treadmills. The hip extension and ankle dorsiflexion moment created by a treadmill works against some of the stabilizing mechanisms (glute inhibition, ankle dorsiflexor inhibition) and help to highlight some of the subtle gait abnormailities you may miss otherwise.

we remain….The Gait Guys