Tricks of the trade: Backward walking

image credit: https://pixabay.com/vectors/slide-sliding-falling-stickman-151861/

image credit: https://pixabay.com/vectors/slide-sliding-falling-stickman-151861/

A single event can generate asynchronous sensory cues due to variable encoding, transmission, and processing delays. Robert Peterka talks about this, along with posture compensation and system apportionment when it comes to balance and coordination of the visual, vestibular and proprioceptive systems. We have talked about that here on the blog in the past.

We are often looking for ways to “highlight” pathology and make it more visible in the clinical exam. Having your patient/client walk backwards is one of those tools.

Walking and remaining upright in the gravitational plane requires 3 integrated systems to work in concert with one another: the visual, vestibular and proprioceptive systems. Backwards walking requires a more coordinated effort AND IF there is a “hiccup” or extra demand on the system (the proprioceptive in this case), neurological processing can take a little longer, efforts can be delayed and the end result is a greater compensation is needed; this often makes pathology more evident.

Try having your client walk backwards when you are doing your exam and see what we mean. We think you will be surprised with the results : )

Dr Ivo Waerlop, one of The Gait Guys

Peterka RJStatler KDWrisley DMHorak FB. Postural compensation for unilateral vestibular loss. Front Neurol. 2011 Sep 6;2:57. doi: 10.3389/fneur.2011.00057. eCollection 2011.

temporal Shayman CSSeo JHOh YLewis RFPeterka RJHullar TE.Relationship between vestibular sensitivity and multisensory temporal integration. J Neurophysiol. 2018 Oct 1;120(4):1572-1577. doi: 10.1152/jn.00379.2018. Epub 2018 Jul 18.

Hawkins KABalasubramanian CKVistamehr AConroy CRose DKClark DJFox EJ. Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators. Top Stroke Rehabil. 2019 May 12:1-7. doi: 10.1080/10749357.2019.1609182. [Epub ahead of print]

#backwardwalking #clinicalexam #thegaitguys #gaitpathology #clinicaltricksofthetrade

Increased unilateral foot pronation and its effects upward into the chain.

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.

Posture doesn't matter, until it does.

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Awareness is key. Does this person know they are doing this ?  Do they have pain? If they do not have pain or awareness is it a problem and does it need addressed ? These shoes did not make this person load like this, the person broke the shoes into this pattern.  There is something going on, the question is what drove this ?  Most likely, this is not a footwear problem, this is a person problem in the footwear.

What we see is not the problem most of the time. We are seeing their strategies , coping mechanics and their ultimate failure to load more cleanly most of the time.

There are people out in the fields that are saying posture doesn't matter, that your next posture is your best posture. This is a bit curious to us.  Sure, if you are not in pain then is a given posture a problem? One could argue that, but not with a strong argument, we believe.  Take this foot-shoe posturing for example, is this a problem if it is not painful ?  Do we leave it alone if it is not painful? Or do we "head this one off at the pass" before possible pathology or pain presents itself? There are certainly no guarantees, however, one can use some educated and calculated logic and make some reasonable decisions that things are going to go off the rails at some point (or in this case, the heel is going to actually go off the shoe!).  Same for the anti-posture nazi's out there who say posture is not a factor in people's lives.  We are not going to call out people on there personal beliefs, but for us, that is just too extreme thinking. The concept gets some great social media attention, but if you are slouched 90% of your day in a chair or standing at a job, those postures might carry over into other activities and thus matter in time, carrying into aberrant tissue loading.  In our minds, posture does matter, because movement on postures that foster challenging mechanics, lead to challenging loading responses on tissues, and over time, that means change.  Change can be good or bad, sometimes it is how you drive the bus.  Posture can matter in many cases, dismissing if fully is foolish.

So, are you going to change this person's footwear ? Bring it to their awareness ? Look for problems in there body mechanics locally and globally? Or are you just going to say, "foot posturing doesn't matter". Saying it is not a problem, until it is a problem, seems awfully negligent, doesn't it?

 

You won't read this. So send it to a colleague who will.

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Beating a point to near-death. Consider this our Thursday Rant.

Yes, we won't let this go, and, you should not either.

We highlight the word ADAPTIVE below, because it is the key to all of this.

"The observed postural responses could be viewed as an ADAPTIVE process to cope with an unilateral alteration in the hip neuromuscular function induced by the fatiguing exercise for controlling bipedal stance. The increase in CoP displacements observed under the non-fatigued leg in the fatigue condition could reflect enhanced exploratory "testing of the ground" movements with sensors of the non-fatigued leg's feet, providing supplementary somatosensory inputs to the central nervous system to preserve/facilitate postural control in condition of altered neuromuscular function of the dominant leg's hip abductors induced by the fatiguing exercise."-*Vuillerme N1, Sporbert C, Pinsault N.

When one prescribes or chooses a corrective exercise for a client, one based sheerly on what is visualized as an "apparently" faulty movement pattern or aberrant screen, one is making many assumptions. Assumptions that are likely not entirely correct (we are being kind, most assumptions made based on partial fragmented information are incorrect to a high degree).

Here is comes again, . . . . what you SEE and TEST in your client's movement is not what is wrong with them most of the time. What you see is how your client is ADAPTING to the variables they can engage, avoiding the ones that are painful or perceived as unstable, or finding ways around immobility and as the article as quote above suggests. This was a basic tenet of Karel Lewit's and Janda's work to not focusing on the area of pain, rather to seek out the root cause, we are just saying it in a different manner.

Continuing, we also adapt around fatigue which can take place even in everyday tasks and how we move around our world, yes, even in our gait. Yes, you are seeing a client's best attempts, ones that are likely deeply rooted and now their new norm, their baseline to base all other patterns off of. Their attempts can be based off of immobility, instability (true or functional), lack of skill, proprioceptive deficits, fatigue (lack of baseline endurance), lack of strength or power. For some clients, forget challenging screens that really test them, heck, we find some athletes do not even have the requisite baseline endurance or strength in a few primary fundamental patterns of which they have built more robust patterns atop of. We all to often read about "robustness" of a skill and pattern and interpret it as a good thing. Robustness can also be build atop of a bad pattern of movement, atop of poor stability patterns.

Thus, asking a client to change that ADAPTIVE norm, based off of what you visualize, based on the working parts available to them, without rooting out the cause, is asking them to compensate around their new norm base of compensation. When done this way, we are merely giving our client armor to their dysfunction, faulty robustness if you will. We are in fact moving further from the remedy. To correctly play this multi-layered game of helping people, one has to examine the client, not just put them through screens and assessments that show us (and them) what they can and cannot do.

There is an awful lot of armchair doctoring going on out there, thankfully it all comes from a good place in the heart's of many good folk. We have so many people come in to see us who have problems and a list of corrective exercises that have been prescribed to them, exercises that clearly have been based off of correcting what is seen in their screens and movements. We discuss their workout patterns, their activities, and hear about how they are attempting to build up their bodies for the apparent good. But all to often, with a client in front of us in pain, we hear the clues that the problem is being exercised around. Meaning, building robustness on top of a dysfunctional base somewhere in their system. Many of these people have been given these exercises as part of their corrective work and strengthening programs at their place (gym, box, trainer, coach etc). Many times there was no in depth hands on examination coupled with screens and gait to root out the cause of why they are moving the aberrant way that they are. We all must commit ourselves to a complete process for our clients. Screens and tests and exercises are not enough. Please read yesterdays post if you have not already, we make our point once again in a video case.

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To close this post, we fully acknowledge regularly that we are on the same bus to the same temple of higher wisdom as everyone else that reads these kinds of posts. We write to share, but we write to learn, to dive deeper into our thoughts, to challenge our biases and rooted assumptions through thought experiments, challenging thoughts and old ways that get us into troubled automated patterns of approaching all things. Again, we write to learn. And, part of that learning is accepting our limitations and hearing from others who are wiser in other areas than us, so, please comment and add insight below if you wish. Debates are good, for us all.  Pull up a chair, grab a pint, join us around the hearth for some gab.

Shawn Allen, . . .  the other gait guy.    www.doctorallen.co    &    www.shawnallen.net

"One of the few ways I can almost be certain I'll understand something is by sitting down and writing about it. Because by forcing yourself to write about it and putting it down in words, you can't avoid having to come to grips with it. You might be wrong, but you have to think about it very intensely to write about it. So I use writing as a learning tool. " - Hunter S. Thompson

*Postural adaptation to unilateral hip muscle fatigue during human bipedal standing.

Gait Posture. 2009 Jul;30(1):122-5. doi: 10.1016/j.gaitpost.2009.03.004. Epub 2009 Apr 28.

Vuillerme N1, Sporbert C, Pinsault N.

How the CNS adapts. Exploratory testing of the ground.

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What is happening at the 150 meter mark in a 200m sprint when that glute starts to fatigue ? What is happening at the 12th mile in a half marathon when stabilzation around that knee starts to falter?
In this article below, the authors discuss postural adaptations to unilateral hip muscle fatigue. This study merely looks at the effects during standing, so imagine what happens during locomotion when things start to fatigue.

Anyone who has sprained an ankle or banged up a knee knows what it is like to have an automated limping gait. The CNS is trying to reduce and shorten the loading response (and time) on the affected limb. This scenario goes on for awhile, days, maybe weeks, until it becomes somewhat more automated.
We just saw a client in the office just yesterday who had a subtle limp from a foot fracture 6 months ago. I mentioned it in passing, "isn't it amazing that your CNS can still be generating that limping adaptive gait even after 6 months, even now that the pain is no longer present?" His response, "What ? I am still limping? No I'm not ! Am I? Really?" I showed him the video, he was shocked. Things get automated, the CNS adapts, and it often doesn't know when to let go of an adaptive pattern even when it is no longer warrented. It is amazing to think that the brain often cannot logically process the incoming data and revert back to the sensory-motor program that was engaged pre-injury. Amazingly, perhaps the brain still knows better, perhaps it knows that things might seem fine, but lurking beneath the surface the sensory receptors are still sending soft warning signs that things still are not kosher.
We say something like this often to our clients, "The CNS makes momentary adaptive choices, but it has no way of foreseeing the consequences of an adaptive measure which is necessary in the moment. It makes these choices based on perceived stability, necessary mobility, economy, and pain avoidance, most of the time. But, it has no way of seeing into the future to see whether its choices have ramifications, it just chooses what makes the most sense in that moment." This is one of the reasons why we get so cranky about people who offer training and corrective exercise queues to people without deep thought, examination, and consideration. There can be ramifications down the road, that, in the present, are unseen and unknown. For example, just because you are running faster because you altered or augmented a client's arm swing, doesn't mean that newly trained pattern, that might even have the positive performance outcomes, won't have consequences that need to be walked back in the future. This is one of the premises of our recent arguments with the HOF (Head over Foot) crowd, who explicitly convey they only care about the clock and a client's speed, not about their well being down the road. There is no free lunch, the piper always gets paid, but just because we are not there to see the payment, it doesn't mean the day of reckoning isn't coming. We have been playing this human mechanic game now collectively for about 50 years, we know the payback is real, we see it often, eventually the tab for that free lunch shows up.

In this article below, the authors discuss postural adaptations to unilateral hip muscle fatigue. We are again looking for that Piper, he wants to get paid, so what is the consequence to the fatigue ? This study merely looks at standing, so imagine what happens during locomotion when things start to fatigue.

"The purpose of the present experiment was designed to address this issue by assessing the effect of unilateral muscle fatigue induced on the hip's abductors of the dominant leg on bipedal standing."

"Results of the experimental group showed that unilateral muscle fatigue induced on the hip's abductors of the dominant leg had different effects on the plantar CoP displacements (1) under the non-fatigued and fatigued legs, yielding larger displacements under the non-fatigued leg only, and (2) in the anteroposterior and mediolateral axes, yielding larger displacements along the mediolateral axis only. These observations could not be accounted for by any asymmetrical distribution of the body weight on both legs which were similar for both pre- and post-fatigue conditions. The observed postural responses could be viewed as an adaptive process to cope with an unilateral alteration in the hip neuromuscular function induced by the fatiguing exercise for controlling bipedal stance. The increase in CoP displacements observed under the non-fatigued leg in the fatigue condition could reflect enhanced exploratory "testing of the ground" movements with sensors of the non-fatigued leg's feet, providing supplementary somatosensory inputs to the central nervous system to preserve/facilitate postural control in condition of altered neuromuscular function of the dominant leg's hip abductors induced by the fatiguing exercise." - Vuillerme et at, 2009

We have discussed arm swing many dozens of times over the 9 years of blogging research on the web. You can search our blog for "arm swing" and go down the deep rabbit hole we have dug if you wish to learn how arm swing is not only necessary, but highly adaptive ballasts to help maintain balance and effective and adaptive locomotion. They can be used for improving or changing locomotion of all types. They can be looked at as prime movers or passive followers of the higher order leg swing. They can be coached right and wrong. The have a huge impact on COM (center of mass) and COP (center of pressure). And as a tangential comment of the article above, when the adaptive postural responses of the body are activated from a given fatigue in the body, COM and COP must change and adapt to keep us upright in the gravitational plane. These COM and COP changes are exploratory postural compensations, of which altered arm swing is often one adaptive and assistive measure. In this articles discussions, these compensations provide supplemental somatosensory inputs to the central nervous system to "preserve/facilitate postural control in conditions of altered neuromuscular function" when fatigue sets in somewhere. Bringing this all full circle, changing someone's arm swing, because you do not like how it looks (ie asymmetry, cadence, direction, etc), is foolish. The brain is doing it, because it likely has to do it to help adapt to a problem elsewhere that is altering the brain's perception of a safe COP and COM. Your job is to find out why and correct it, not to teach them a new way, which is very likely a new compensation to their already employed adaptive compensation.
-Shawn Allen, the other gait guy

Postural adaptation to unilateral hip muscle fatigue during human bipedal standing. Vuillerme N1, Sporbert C, Pinsault N. Gait Posture. 2009 Jul;30(1):122-5. doi: 10.1016/j.gaitpost.2009.03.004. Epub 2009 Apr 28.

Vitamin D and Gait?

Vitamin-D.jpg

So, is it the effects on calcium and nerve function (neurotransmitter release), the effects on calcium and muscular contraction, the antioxidants properties, some other function? Supplementing Vitamin D and getting people more sun exposure are easy things to do...

"These findings reveal an important new relationship between parathyroid hormone and gait stability parameters and add to understanding of the role of 25-OHD in motor control of gait and dynamic balance in community-dwelling women across a wide age span."

Bird MLEl Haber NBatchelor FHill KWark JD. Vitamin D and parathyroid hormone are associated with gait instability and poor balance performance in mid-age to older aged women. Gait Posture. 2017 Sep 28;59:71-75. doi: 10.1016/j.gaitpost.2017.09.036. [Epub ahead of print]

 

https://www.ncbi.nlm.nih.gov/pubmed/29017107

Pod #124: Gluteal gripping, Runner's dystonia. Are leg length differences real ?

Key tag words:
running, gait, injuries, kidney, kidneydamage, marathoners, foot, feet, dehydration, heatstroke, elon musk, neural lace, hip pain, crossfit, squats, deadlifts,  LLD, short leg, dystonia, runner's dystonia, posture, 

Summary:  Today we hit some very important topics on how to examine a client and how asymmetries play into gait, running, posture and pathomechanics. We hope you enjoy today's show, it is our first one back in 6 weeks. We are back strong after a brief early summer sabbatical. Back to the "podcast every 2 weeks" again. Thanks for being patient while Ivo recharged for the second half of the year.   Plus, on today's show, we also dive into Runner's kidney, dehydration, gluteal gripping, runner's dystonia, functional leg length differences due to asymmetries, and more !

Show links:

http://traffic.libsyn.com/thegaitguys/pod_124final.mp3

http://thegaitguys.libsyn.com/pod-124

Our Websites:
www.thegaitguys.com

summitchiroandrehab.com   doctorallen.co     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, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

Kidney Damage in Runners. 82%  !?
http://www.newsweek.com/running-bad-you-marathons-damage-kidneys-runners-bodies-575829
 
Kidney nephropathy in mesoamericans.
http://www.ajkd.org/article/S0272-6386(15)01257-3/fulltext  
 
Elon Musk's Neural Lace.
https://www.scoopwhoop.com/elon-musk-launches-neuralink-which-hopes-to-combine-your-brain-with-artificial-intelligence/
 
Leg length discrepancies,do they really even exist ?
Dystonia ?
The Gluteal gripping phenomenon.

You are just breathing wrong dummy. (Um, maybe not. It is a little more complicated than that.)


There is a paradoxical idea that the fitter someone is, the more likely they will experience respiratory limitations.  This referenced article today suggests that every endurance athlete "has their own limit in endurance training", and that once exceeded it will produce all the possible respiratory disorders discussed in the article.

This article suggests there is a debate in the scientific community as to whether the lung can be defined “overbuilt” or “underbuilt” for facing strenuous exercise. In the ideal scenario,  your athlete will have a respiratory system perfectly tailored to meet their body’s metabolic demands under normal conditions.  However, it is when challenged by demand, whether that be intensity of exertion, environmental challenges or underlying physical pathology where limitations can impact the athletes demand and performance, thus, a pathological response can occur in a seemingly healthy athlete.  
Breathing, how to do it right, how you are doing it wrong. It is all over the internet these days and there are so many "experts" teaching it now. Some are also teaching it and diaphragm "activation" as the answer to every ailment you have, including why you received a "B minus" grade on your 6th grade spelling test. 
Make no mistake, how to breath properly is important. But, like much of the work Ivo and I do, and much of the preaching we do here on The Gait Guys is about getting to the root of the problem. Converting someone to diaphragmatic breathing from a thoracic cage breathing pattern (use whatever nomenclature you wish, we are trying to keep it simple here) is important, but not as important as finding out why someone is doing it. So are you looking deep enough? Are you asking the right questions before you just assume they forgot how to abdominally breathe ?  All to often we have our clients and athletes come in with their newest epiphany from their latest alternative "guru". Lately is it is, "my yoga/pilates/trainer/coach/bodyworker/massage therapist etc showed me how to belly breathe and use my diaphragm properly ! All is going to be ok now ! Everything will now be right in the world !"  However, all to often they fail to realize that all of the things this article delves into, not including the obvious things such as posture, thoracic spine mobility and stability, prehension patterns, workout habits, soft tissue tension/shortness/tightness, muscle weakness, motor pattern aberrancies, etc these are all just a piece of the potential "causes" of the breathing choice and problems. Fixing the problem helps to allow the natural breathing pattern to occur, with some helpful correction and re-education of course. 

There is a paradoxical idea that the fitter someone is, the more likely they will experience respiratory limitations. One's respiratory abilities as an athlete must be built up, just like any other component of their training. The lungs must be trained to satisfy the metabolic demands of the system, however, often their are parameters existing that are outside of the athletes training efforts. Ask any athlete who jumps into altitude training and this becomes painfully apparent. Endurance athletes do die, thankfully not very often, but they do die and it is not always directly from sudden cardiac failure. There is often a reason the endurance athlete dies shortly after the event, not during, when the physical exertion was actually occurring. Think about it. Exercise-induced respiratory disorders do exist in athletes and they are often the limiting factor in excelling physically. Ask any runner who has done a cold weather run, they will often be able to describe the thermal stress of cold air inhalation and dehydration. This is airway cooling followed by rewarming cycle. The coldness triggers a parasympatheic driven brochoconstiction and a vasoconstriction of the brochial venules. Subsequent rewarming follows and the opposite happens, followed by mucosal edema. 

This article proposes: "the question is precisely to understand if there is a limit in terms of intensity and/or in terms of duration in years to endurance training, before respiratory disorders can appear, and if we can apply any preventive strategies. To be an endurance champion, this inevitably means accepting all the labors of strong training but also enduring all possible health problems caused by the same."

There are many factors to consider, asthma, exercise induced asthma, temperature intolerance to cold or warm weather, a sensitive bronchial tree, long time smoker, prior smoker, medications, bronchospasms, reduced ventilation abilities, pulmonary edema, allergies . . .  the list goes on an on, read the article.

One must consider all of those cardio-respiratory limiting pathologies, but, do not forget posture, faulty breathing technique, tight scalenes and pectorals, weak abdominals, poor thoracic rotation and extension, faulty arm swing, protracted shoulders and the list goes on. And, even more so, think of all the things we do when we started getting "winded" as an athlete, we move into more chest wall breathing, tap into the accessory respiratory muscles and all the pathologic patterns that go with it. We begin to struggle, first subtly, then more profoundly until we must stop. Now, do that several times a week and see what happens to your breathing habits. Respiration in the sedentary and in the athlete is a real issue, but it is multifactorial and complex.  It is more than, "Mr. Jones, please lie down. I am now going to teach you to abdominal breath and use your diaphragm correctly (because I just went to a seminar) and all of the stars will align and your next born child will become the next Michael Jordan."  Don't be that guy/gal. 

Breath deep my friends.

Have a read of the referenced article , it should open up your world as to how complex this machine truly is.


-Dr. Shawn Allen, the other gait guy


Reference:
Respiratory disorders in endurance athletes – how much do they really have to endure?

Maurizio Bussotti, Silvia Di Marco, and Giovanni Marchese
Open Access J Sports Med. 2014; 5: 47–63.
Published online 2014 Apr 2. doi:  10.2147/OAJSM.S57828
 

Do novice runners really have weak hips and poor running form ?

Folks are ramping up mileage here in Chicago-land for the October marathon. Lots of first timers trying to fill the bucket list, and lots of hip and knee stuff coming into the office. This older article reminded us of the paramount need to slowly build up safe durability. So many folks just follow the ledgers, "This week is 16 miles, 2 more than last sunday, this will keep you on track to get to your taper week". We get all that. But this recipe doesn't work for everyone. Some bodies are so weak and out of shape that their recipe is drastically different than the "average joe or jane". Many need their marathon program time frame doubled so they can build their durability. Yes, novice runners often have functionally unstable/weak hips (amongst other things), and some have bad running form, and many have BOTH ! We remind folks that 26 miles is something to endure for most, and that means preparation, probably preparation before the running training started. So it is about educating them for next time, if there is a next time for them ! Don't forget, running is a sagittal game, one is moving forward. The frontal and axial (rotational) stability is often neglected, and here lies the hole in the bucket that leads to unjuries. Even if you are half way there to your marathon date and doing fine, it is never too soon to start frontal and axial plane durability work, just in case the 18 miler is just beyond what you can endure to protect those joints.

http://www.physiospot.com/research/do-novice-runners-have-weak-hips-and-bad-running-form/

 

 

 

 

The Skill of walking

The Skill of Walking:
We enjoy most of what goes up on #BreakingMuscle. This one brings up a point we use in the clinic all the time, Mimicry.
We use to to help our patients "see" what we see them doing in their gait or movements. We mimic what we see in their gait while we explain the "what" and "why" of their dysfunctional gait. 
Sometimes we are so wrong when it comes to understanding exactly what we are doing. Think your posture is good ? Check it next time you walk pasta mirror, it is possible it is not as pristine as you think it is. We have mirrors up all over our clinic so people can see what they look like and what they are doing. We encourage them to check on their posture in the mirrors when they walk down to the treatment rooms (and, it is not just for the patients! !). Mirrors can be a real asset when it comes to feedback. 
Mimicry of our clients movements helps them to understand, in 3 dimensions, in many respects better than 2D video what they are actually doing (we discuss this more in podcast 112 launching in a few weeks). Virtual reality is going to clean up many problems we have teaching in the clinic.

http://breakingmuscle.com/natural-move…/the-skill-of-walking

Children: Postural control of balance

From the study:

“From these indexes it was established that the postural capacity needed just to control balance with the leg muscles was not attained before 4-5 years of independent walking, i.e., at about 5-6 years of age.” -Breniere

reference link:

Exp Brain Res. 1998 Aug;121(3):255-62.Development of postural control of gravity forces in children during the first 5 years of walking.Brenière Y1, Bril B.

http://www.ncbi.nlm.nih.gov/pubmed/9746131/

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Things may not always be how they appear.

What can you notice about all these kids that you may not have noticed before?

Look north for a moment. What do you notice about all the kids with a head tilt? We are talking about girl in pink on viewers left, gentleman in red 2nd from left, blue shirt all the way on viewers right. Notice how the posture of the 2 on the left are very similar and the one on the right is the mirror image?

What can be said about the rest of their body posture? Can you see how the body is trying to move so that the eyes can be parallel with the horizon? This is part of a vestibulo cerebellar reflex. The system is designed to try and keep the eyes parallel with the horizon. The semicircular canals (see above), located medial to your ears, sense linear and angular acceleration. These structures feed head position information to the cerebellum which then forwards it to the vestibular nucleii, which sends messages down the vestibulo spinal tract and up the medial longitudinal fasiculus to adjust the body position and eye position accordingly. 

Can you see how when we add another parameter to the postural position (in this case, running; yes, it may be staged, but the reflex persists despite that. Neurology does not lie), that there can be a compensation that you may not have expected?

What if one of these 3 (or all three) kids had neck pain. Can you see how it may not be coming from the neck. What do you think happens with cortical (re)mapping over many years of a compensation like this? Hmmm. Makes you think, eh?

Ivo and Shawn. The Gait Guys. Taking you a little further down the rabbit hole, each and every post.

Podcast 49: Winter Running Biomechanical Problems

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-49-winter-running-biomechanical-problems

B. iTunes link:

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

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

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

D. other web based Gait Guys lectures:

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

________________________________________

* Today’s show notes:

Neuroscience 

1. Skulpt Aim: World’s First Device to Measure Muscle Fitness with One Touch | Indiegogo

http://www.indiegogo.com/projects/skulpt-aim-world-s-first-device-to-measure-muscle-fitness-with-one-touch/

3. Something to consider when it comes to injuries, whether they are closed injuries and certainly when they are open injuries !
 
Bacteria directly activate sensory nerves
http://www.bodyinmind.org/bacteria-directly-activate-sensory-nerves/
Gait Talk:
4. walking on ice vs on slipper hardwood floors with socks.
what are the gait changes that need to be adapted
are their neurologic effects ?
5. The Pros and Cons of Stride Variability
Our Disclaimer !  
6. From a blog reader:
Hi Gait Guys - amazing wealth of info you’ve provided! I’ve been suffering from severe foot pain (peroneal tendonitis and general top/side foot pain) for about a year now which has turned me from very active to completely sedentary since I can hardly walk. My ortho gave up on me after 9 months of treatment incl. countless oral and injected steroids and 2 months in a boot. Then this morning I found your site - and the “The Gaits of Hell” video. That’s my walk!! Is it really all in my back?
7. From a blog reader
Question: when my feet point straight my knees point outward from my body. I’ve heard it called external femoral torsion …
8 . Effects of Nonslip Socks on the Gait Patterns of Older People When Walking on a Slippery Surface
9 . National Shoe Fit Program
10. Running Form: Recognizing Patterns and Posture
http://www.engagingmuscles.com/2013/12/03/running-form-recognizing-patterns-and-posture/