Podcast 148: A deep dive case study. Plus, Central and Peripheral fatigue explained

tag/key words: gait, gaitproblems, gaitanalysis, forefootrunning, forefootstrike, heelstrike, pronation, central fatigue, peripheral fatigue, fatigue, hip rotation, gait biomechanics, running

Links to find the podcast:
Look for us on iTunes, Google Play, Podbean, PlayerFM, Radio.com 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_1488_-_61419final.mp3

Permalink URL: http://thegaitguys.libsyn.com/podcast-a-deep-dive-case-study-plus-central-and-peripheral-fatigue-explained

Libsyn Directory URL: http://directory.libsyn.com/episode/index/id/10151672

Normal walking and running have a certain degree of vertical oscillation, but we do not want too much

Normal walking and running have a certain degree of vertical oscillation, but we do not want too much, we want the body to move along mostly horizontal path but we do need some dampening of impact loads. We do not want to waste too much energy bouncing up and down. This is mitigated quite a bit by hip and knee flexion, the knee is well positioned to do this the easiest in many cases. Pronation and ankle dorsiflexion do dampen loads as well.

Ivo and I just recorded a class on leg length discrepancies. Here are some factors to keep in mind if there is even the smallest leg length discrepancy, anatomic or functional.

-the short leg may hyperextend at the knee , externally rotate at the hip, as well as supinate the foot (this supination is relative ankle plantarflexion, which can set up increased protective tone in calf complex and reduced strength and exposure to anterior compartment).

-the long leg side may knee flex , internally rotate at the hip, and as well as pronate at the foot (this is relative ankle Dorsiflexion)

Both of these scenarios can be going on at the same time on either leg, or it can be only on one leg. We are not perfectly symmetrical organisms, so these things can set up to help us run and walk more effortlessly, to compensate to get the head and neck properly positioned (normalizing the visual and vestibular centers on the horizon) for balance and movement through the 3 cardinal planes, and to compensate around challenging anatomy or biomechanics.

This is a complex machine, with infinite abilities to compensate and cope. But what we see is the compensation, not the problem. The joint range losses in one joint, the excesses in another, the weakness in one area, the over protection in another, the failure to tolerate loads in another, are all ways of coping and keeping us moving, . . . . . . but sometimes at a cost. . . . . pain.

shawn and ivo, the gait guys

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).

Screen Shot 2019-04-12 at 8.43.42 AM.png

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.

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

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

The Bird Dog rehab exercise is neurologically incorrect. Know what you are asking your client to do, and why..

Screen Shot 2019-02-24 at 9.44.19 AM.png

Runners, athletes . . . Even in your drills, do it correctly !
Is this Bird Dog standing up? No, look more closely.

Photo #1: pull that right swing leg outwards with your abductors/external rotators. Do not let the knee drift inwards, it will lead to that foot targeting the midline. Plus, because of the neurologic links, it will encourage the left arm to cross the mid line (see yesterdays FB blog post). The upper limb movement can shape lower limb movement. An aggressively narrow cross over gait is undesirable in many aspects, it might be more economical, but it has a wallet full of potential liabilities.
IF you train your machine in a lazy manner, it is not unlikely it will perform as such. Get that knee under the shoulder, not under your head.

Aside from that, this is a good drill. It is neurologically correct. Note that:
- the right arm is in extension and the left hip is in extension
- the left arm is in flexion and the left knee is in flexion.
This is neurologically correct cross crawling.

Screen Shot 2019-02-24 at 9.44.31 AM.png

* VERY important point:
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.
When we crawl, we use the following pattern:
- the right arm is in extension and the left hip is in extension
- the left arm is in flexion and the left knee is in flexion.

This is 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.

When runner do you want to be? 2 photos

Screen Shot 2019-02-24 at 9.29.56 AM.png
Screen Shot 2019-02-24 at 9.29.44 AM.png

Who do you want to be ? The guy loading his head over his foot
(narrow step width), or the gal loading the head and COM inside the foot (less narrow step width) ?

It is not hard to suspect who is gonna be faster and more powerful from these photos. This however does not mean on is more durable, more or less injured, more or less efficient but logical debates and thought experiments can be made here.

The lady is stacking the knee over the foot, the hip over the knee and stabilizing the hip and pelvis sufficiently and durably to keep the pelvis level for the next powerful loading step, and the other is flexion collapsing into the stance phase knee, insufficiently loading the hip and thus dropping the opposite side pelvis. He is not stacking the joints, there is a pending cross over (look at the swing leg knee approaching midline with barely any knee spacing, thus guaranteeing a cross over step or at the very least a very narrow step width.)
Sure, some one is going to say one is a distance runner and the other is a sprinter. Yes, and our point is that the sprinter is not head-over-foot, the one with all the highly suspect flaws is head over foot ! Wider step width means more glutes. Go ahead, walk around right now with a very narrow step width and see how little efficient glute contraction you get, then walk with a notably wider step width, and you will see wider means more glutes. Keep your COM moving forward, not oscillating back and forth sideways over each stance foot, that is a power leak.

The distance runner appears to be demonstrating less optimal in technique, appears is the key word here. Say what you want, but a decent argument might be made as to one of these runners being weak and very likely at greater risk for injury, the other is suspect to be strong and durable, and likely at less risk for injury.
If you ask us, but what do we know . . . . it is all a thought experiment, but based on some pretty decent ideas.
So, again, was ask . . . . which one do you want to be ?

The hip flexors do not cause initial hip flexion.

The hip flexors are not responsible for pulling/flexing the swing leg forward in gait or running. The psoas is a mere swing phase perpetuator, not an initiator.
For about 2 decades we have been saying in our lectures, posts and podcasts that it is the reduction of the obliquity of the pelvis during gait from various other tissues and biomechanical events that causes leg swing, meaning the trail leg is brought forward in swing largely by the abdominal muscle linkage to the pelvis (and other loaded tissues) that is responsible for forward swing of the leg. It is not the hip flexor group that does this hip flexion action. Thus it could be considered foolish to train the hip flexors to be the primary swing drivers. Here is another supporting piece of research.

"These experiments also showed that the trailing leg is brought forward during the swing phase without activity in the flexor muscles about the hip joint. This was verified by the absence of EMG activity in the iliacus muscle measured by intramuscular wire electrodes. Instead the strong ligaments restricting hip joint extension are stretched during the first half of the swing phase thereby storing elastic energy, which is released during the last half of the stance phase and accelerating the leg into the swing phase. This is considered an important energy conserving feature of human walking. "

Dan Med J. 2014 Apr;61(4):B4823.
Contributions to the understanding of gait control.
Simonsen EB1.

https://www.ncbi.nlm.nih.gov/pubmed/24814597?fbclid=IwAR3yZQLb2Z0X1LZSVp2hOFLCt3wefsPt4iWEGveswn7-aGaou5OdDqmj4lA

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".

Adaptations and compensations.

Screen Shot 2018-10-25 at 10.54.01 AM.png

. . . the entire system has to adapt to that deficiency. That means compensation. Now, does adding strength to that asymmetry (compensation) have a consequence. Most likely. Will it lead to injury? That is the question.

We are going to keep pounding sand on this one because we believe this is important.
All too often people are working out and strengthening their systems, and that is good. But, if they are strengthening a system that is asymmetric or strengthening a faulty pattern (clearly, as in too much arch collapse) they are likely overburdening the hierarchical system and a component of the chain of that system.
Now, many are going to argue, and we know who those folks are, they are going to argue that if the movement is not painful, if the posturing of the load is not painful, then it is not a problem. Sure, and that is easy to say, but there is no proof they are right either. And, we are not saying we are stonewalled right either, but we are trying to be logical with what we know and what some of the research says (yes, that fits our bias). But our eyes are open and we hear the arguments from the other side, but those arguments come from a crystal ball in our opinion. Truthfully, no one has that crystal ball and can see into the future to see if one side of this argument has any more "legs" to it.
However, we know that . . .

"Human movement is initiated, controlled and executed in a hierarchical system including the nervous system, muscle and tendon. If a component in the loop loses its integrity, the entire system has to adapt to that deficiency. Achilles tendon, when degenerated, exhibits lower stiffness. This local mechanical deficit may be compensated for by an alteration of motor commands from the CNS. These modulations in motor commands from the CNS may lead to altered activation of the agonist, synergist and antagonist muscles."- Chang and Kulig

So, when we see a pattern of loading that is aberrant, and especially when it is most likely playing into a client's painful presentation, it is an easier sell on the thought-arguments above. We know that the entire system has to adapt to deficiencies. It is how we are synergistically built. We have redundancies build into us that protect us. Compensation is part of the redundancy. So, does adding strength to that asymmetry (compensation) have a consequence? Most likely it does, in our opinion. Why allow an area to undergo more loading than we know it should, (ie. valgus knee loading) even if it is non-painful to a client ? Will it lead to eventual injury or pain? That is the question. But we have picked our side of the story, for now, until proven otherwise, and we work from that side of the line. For now.

"yet" is a powerful looming word.
When adding strength takes someones pain away, it doesn't mean you fixed them. It likely means you helped them adapt and protect and better negotiate the loads. However, it also does not mean that your instruction did not build a layer of initial protective strength that will not have a cost further down the road because it wasn't the right medicine for the problem.
When your cars alignment is off, and it is pulling the car to the right towards the ditch, pulling harder to the left on the steering wheel keeps the alignment aberrancy, and the ditch at bay. But nothing was fixed. You adapted and compensated. The problem is still sitting there. And you will get used to the adapted and compensated pattern of steering wheel pull in time. Until the next thing occurs. Maybe the tire will start to chirp in time, the treads silently wear unevenly, and maybe it will be your left shoulder that chirps at you, and not the car.

The squeaky wheel may get the grease, but the misaligned tire is ignored.

Shawn and Ivo, the gait guys

J Physiol. 2015 Aug 1; 593(Pt 15): 3373–3387.
Published online 2015 Jun 30. doi: 10.1113/JP270220
The neuromechanical adaptations to Achilles tendinosis
Yu-Jen Chang and Kornelia Kulig

#gait, #thegaitguys, #gaitcompensations, #gaitproblems, #compensations, #running, #walking, #genuvalgus, #pronation, #CNS, #synergist

"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

What do the hip flexors have to do with the knee extensors ?


"It is not about your test, it is what your client displays in your test that matters. They will try to find a way. The load has to go somewhere, and they will find a place to put it, they always do. Finding out how your client cheats, compensates, recruits and fails is the value of the assessment."

This is just a small example of how I approach a client through small assessment window.
As best as I am able, knowing the absolute limitations of a supine examinations translation to vertical loading, I will approach a client's ability to stabilize in all 3 planes of movement. Today, i will micro-dissect a thought process.

The straight leg resistance test (SLR):
just a few incomplete thoughts on a SAGITTAL perspective (so as to avoid writing a book).
I will do it looking at **pelvis posture (anterior, posterior, oblique), lumbar spine posture (incr/decr lordosis), if they can keep their knee locked in a position, does the pelvis rotate, do they want to deviate into internal or external rotation at the hip, do they plantar or dorsiflex their ankle or toes. Lots to see here in how a client will recruit, and this is just a small snapshot of things they might do. Yes, head position, arm position were left out , again, to avoid a longer post today.
I will add consistent (as best as possible) resistance in the SLR test , with full locked knee, at hip 30, 45 and then full straight leg SLR (at the client's hamstring tension limit), then again at 45 degree knee lock with partial hip flexion, 90 degree hip and knee. I am changing loading vectors frequently to see if their is a directional loading failure. I am looking for their ability to provide ample resistance, and how they might cheat (see above).
But here is how my mind works through the test on the most basic level, which will give me insight on the above cheats** the client may employ.
* In the MOST SIMPLEST thought of the assessment, can they EFFECTIVELY stabilize the pelvis to the lumbar spine, can they stabilize the femur into the pelvis, can they stabilize the tibia onto the femur? It is how they choose to engage the system that matters, and that might be partly why their "Screen" shows up shoddy and may be a window into their pain.
The question is, if they fail, where are they failing and what tissues are overburdened or over protecting ? Where is the load, and where NOT is the load, going ?

"It is not about your test, it is what your client displays in your test that matters. They will try to find a way. The load has to go somewhere, and they will find a place to put it, they always do. Finding out how your client cheats, compensates, recruits and fails is the value of the assessment. This is how you need to be thinking when you perform many of the mostly useless orthopedic tests in the textbooks.

This is key,
a SLR screen will not show you any of this, it will just show you their range of motion, nothing more, not how they did it, what parts worked harder than other parts, and which parts are weak, injured or inhibited, for example. It is not what a client does, it is how they go about it that has the most value to you in helping them.

Today's article below is what spurred my rant today. It gives light that most already know, that everything is connected. And perhaps we can translate it into deeper thoughts for our clients, namely, what part is not doing its job, and where are they not connecting the parts, and where are they putting the loads ?

From the Ema study:
"Our findings indicate that hip flexion training results in substantial neuromuscular adaptations during knee extensions similar to those induced by knee extension training."-Ema et al.

We need a stable and strong core-spine-pelvis connection to display powerful knee extension, and, we need a stable and strong femur-pelvis connection as well. So, where is your client doing more or less of the work, and is it related to their hip, low back or knee pain? Or are they tossing it into the ankle perhaps? This is the beauty of the game we all play every day, if we are actually paying attention.

Now, remember my discussion last week about "adding strength to dysfunction" ? Where is your client going to put the load?, the answer, where they can/able. And that doesn't exactly mean where they should be putting it. Mindless prescription of corrective exercises is a real problem in my opinion.

Shawn Allen, the other gait guy.

#gait, #gaitproblems, #gaitanalysis, #correctiveexercises, #running, #hipflexors, #kneeextension, #SLR, #corestrength, #thegaitguys

Scand J Med Sci Sports. 2018 Mar;28(3):947-960. doi: 10.1111/sms.13008. Epub 2017 Nov 22.
Neuromuscular adaptations induced by adjacent joint training.
Ema R1,2, Saito I3, Akagi R1,3.

You are wondering: "Does the distance between footfalls make a difference?"

1running-iStock_000017285887Large-copy.jpg

In short, when it comes to stress fractures, IT band syndrome and patellofemoral pain, the literature says yes…

"In conclusion, decreasing stride length has been proposed as a method to treat and prevent running-related musculoskeletal injuries. While not directly examining the effect of stride length, research examining the effect of barefoot running and minimalist shoes indirectly evaluates stride length, as barefoot/minimalist runners tend to adopt a reduced stride length. Evidence suggests that decreasing stride length results in biomechanical changes, including reduced GRFs and joint moments, that can contribute to reduced injury risk. Clinical studies indicate that reducing stride length may help decrease the likelihood of stress fractures, iliotibial band syndrome, and patellofemoral pain."


a good read: https://lermagazine.com/article/implications-of-reduced-stride-length-in-running. ALSO the photo credit


#gait, #thegaitguys, #gaitanalysis, #running, #stridelength


Dr Ivo, one of The Gait Guys

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.

Can running/loading form changes last and translate from treadmill into the outdoor world ?

Research is here to inform us, give us concepts to guide protocols, clinical decision making, to make better choices for the patient right in front of us with their own unique set of variables (environment, choices, age, skills, strength, endurance, sport, history of injuries etc).

This is a study that makes us raise our eyebrows.
We sense that, as any reasonable clinician would, that a 8-session training protocol is not enough. You cannot win over old ingrained loading patterns that are well rooted in a mere 8 sessions.
The message we chose to take is that if changes were possible, if adaptations are possible, then time is the variable and patience must prevail. It can take months to make a new pattern unconsciously competent. It takes time.

The authors of this study said , "SIGNIFICANCE: Our findings indicated that a newly learned gait pattern may not fully translate to running outside of the laboratory environment."
We say, "it may not fully translate in 8 training sessions. Keep at it."

Can runners maintain a newly learned gait pattern outside a laboratory environment following gait retraining?Janet H Zhang, Zoe Y S Chan, Ivan P H Au, Winko W An, Roy T H Cheung

https://www.readbyqxmd.com/read/30658313/can-runners-maintain-a-newly-learned-gait-pattern-outside-a-laboratory-environment-following-gait-retraining

Muscle activation and gait: EMG studies that differentiate!

image credit:  Cappellini G ,  Ivanenko YP ,  Poppele RE ,  Lacquaniti F . Motor patterns in human walking and running.  J Neurophysiol.  2006 Jun;95(6):3426-37. Epub 2006 Mar 22.

image credit: Cappellini G, Ivanenko YP, Poppele RE, Lacquaniti F. Motor patterns in human walking and running. J Neurophysiol. 2006 Jun;95(6):3426-37. Epub 2006 Mar 22.

Got Muscle activation? Looking for some EMG data on what fires when in walking vs running gait? The conclusion and point of the study are good, but the EMG data and diagrams are awesome for those of you seeking a greater understanding of what goes on when

“The major difference between walking and running was that one temporal component, occurring during stance, was shifted to an earlier phase in the step cycle during running. These muscle activation differences between gaits did not simply depend on locomotion speed as shown by recordings during each gait over the same range of speeds (5–9 km/h). The results are consistent with an organization of locomotion motor programs having two parts, one that organizes muscle activation during swing and another during stance and the transition to swing. The timing shift between walking and running reflects therefore the difference in the relative duration of the stance phase in the two gaits.”

A great read and FREE FULL TEXT

Dr Ivo, one of The Gait Guys

Cappellini G, Ivanenko YP, Poppele RE, Lacquaniti F. Motor patterns in human walking and running. J Neurophysiol. 2006 Jun;95(6):3426-37. Epub 2006 Mar 22. link to free full text: http://jn.physiology.org/content/95/6/3426

#gait, #gaitanalysis, #thegaitguys, #gaitabnormality, #EMGgait, #muscleactivation, #musclerecruitmentpattern

Podcast 143: Future of movement, Running Cadence. Plus: gait rehab, eye control, plantar fascia talk

Topics:


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_143_146old_-_11919_11.11_AM.mp3

Permalink URL: http://thegaitguys.libsyn.com/podcast-143-future-of-movement-running-cadence-and-more

Libsyn Directory URL: http://directory.libsyn.com/episode/index/id/8316341

Show notes:

The future of human movement control ?
https://www.zerohedge.com/news/2019-01-01/zuckerberg-funds-wireless-mind-control-using-game-changing-brain-implants

Really interesting study: in-race cadence data from world 100K champs. Fatigue matters less than expected;
https://www.outsideonline.com/2377976/stop-overthinking-your-running-cadence?utm_medium=social&utm_source=twitter&utm_campaign=onsiteshare

A new study shows a majority (82%) of adolescent patients presenting with FAI syndrome can be managed nonoperatively, with significant improvements in outcome scores at a mean follow-up of two years: ow.ly/GXtC30n49nc pic.twitter.com/dyr4f6pEOU

Gait Rehab
https://academic.oup.com/ptj/article/88/12/1460/2742171
" Rehabilitation of gait in PSP should also include oculomotor training because the ability to control eye movements is directly related to the control of gait and safe ambulation. Vision plays a critical role in the control of locomotion because it provides input for anticipatory reactions of the body in response to constraints of the environment. Anticipatory saccades occur normally in situations that involve changing the direction of walking17 or avoiding obstacles.18 When downward saccades are not frequently generated during obstacle avoidance tasks, there is an increase in the risk for falling. Di Fabio et al19 reported that elderly people at a high risk for falling generated fewer saccades than their low-risk counterparts during activities involving stepping over obstacles. In addition, foot clearance trajectories were asymmetric in the high-risk group, with the lag foot trajectory being significantly lower than the lead foot trajectory. Similar behavior has been observed in patients with PSP during stair-climbing activities. Di Fabio et al20 recently reported that patients with severe oculomotor limitations had a lower lag foot trajectory than those with mild oculomotor limitations. "

Eye movements:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4932064/
" The content of the eye movement program was as follows: First, a picture card was shown to the patient, and then mixed with 20 other cards and spread face up on the desk. The patient was instructed to find that one card. This task was repeated approximately 20 times. Second, the therapist moved a baton slowly while drawing curves and the patient was instructed to keep his or her gaze fixed on the tip of the baton. In this task, the distance between the baton and the patient was maintained at approximately 1 m and the task was performed for approximately five minutes. Third, the patient was instructed to shake his or her head laterally as quickly as possible and a letter card with letters written upside down was presented to the patient to read. This task was repeated approximately 10 times. Fourth, the therapist moved a baton slowly from a point approximately 5 cm away from the patient to a point approximately 50 cm away and the patient was instructed to keep his or her eyes on the baton. This task was performed for approximately five minutes. The experimental group underwent eye movement training while the control group underwent gait training for 20 minutes per session, five times per week for six months in total."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259492/

Plantar fascia loads higher when forefoot striking . . . .
https://www.sciencedirect.com/science/article/pii/S0021929018308959
Foot arch deformation and plantar fascia loading during running with rearfoot strike and forefoot strike: A dynamic finite element analysis
Tony Lin-WeiChen et al


High pronation was associated with 20-fold higher odds of injury than neutral foot posture
Association between the Foot Posture Index and running related injuries: A case-control study
AitorPérez-Morcillo et al
https://www.sciencedirect.com/science/article/pii/S0268003318304303

movement, gait, thegaitguys, running, cadence, step length, stride length, eye movements, rehab, gait analysis, gait problems, pronation, plantar fascia,

Barefoot running is Barefoot running. There is no substitute

umage source: https://commons.wikimedia.org/wiki/File:06patriotsrun5.jpg

umage source: https://commons.wikimedia.org/wiki/File:06patriotsrun5.jpg

There is nothing quite like running barefoot .. literally ..

There are few studies which examined barefoot versus simulated barefoot versus shod running and this is one of them (1). The forefoot strike pattern and shorter stride length (or increased cadence, provided velocity is constant) often associated with barefoot running, as well as simulated barefoot running seems, to decrease vertical impact loading rates, depending upon the angle of the foot on landing and seem desirable for decreasing injury risk (2-4).

Running barefoot has the greatest amount of ankle dorsiflexion, plantar flexion and thus total range of motion with the knee flexion angle being the least when comparing it to shod and stimulated barefoot running. stride length was shorter and cadence increased, as was suspected and has been reported in many other studies. It is surprising that and stimulated barefoot running, the forefoot strike was there however cadence and stride length did not really change.

In short, the runners were able to simulate some elements of barefoot running, but they did not completely mimic it.

Want to know more? Join us this Wednesday on onlinece.com: Biomechanics 303 for a lively discussion of barefoot running and more. 8 EST, 7 CST, 6 MST, 5PST

  1. Leblanc M, Ferkranus H. Lower Extremity Joint Kinematics of Shod, Barefoot, and Simulated Barefoot Treadmill Running. Int J Exerc Sci. 2018;11(1):717-729.

    link to FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033505/#b31-ijes-11-1-717

  2. Shih Y, Lin KL, Shiang TY. Is the foot striking pattern more important than barefoot or shod conditions in running? Gait Posture. 2013;88(4):116–120. [PubMed]

  3. Hobara H, Sato T, Sakaguchi M, Nakazawa K. Step frequency and lower extremity loading during running. Int J Sports Med. 2012;2012;33:310–313. [PubMed]

  4. Thompson MA, Lee SS, Seegmiller J, McGowan CP. Kinematic and kinetic comparison of barefoot and shod running in mid/forefoot and rearfoot strike runners. Gait Posture. 2015;41:957–959. [PubMed]

Barefoot vs Shoes...It's about the strike pattern


Footnotes 7 - Black and Red.jpg

“The influence of strike patterns on running is more significant than shoe conditions, which was observed in plantar pressure characteristics. Heel-toe running caused a significant impact force on the heel, but cushioned shoes significantly reduced the maximum loading rate. Meanwhile, although forefoot running can prevent impact, peak plantar pressure was centered at the forefoot for a long period, inducing a potential risk of injury in the metatarsus/phalanx. Plantar pressure on the forefoot with RFS was lesser and push-off force was greater when cushioned shoes were used than when running barefoot.”


takeaways from the study?

  • forefoot strike reduces heel impact

  • rear foot strike reduces forefoot impact

  • forefoot strike increases and prolongs pressures (in shoes) on the forefoot which could potentially cause forefoot problems

  • cushioned shoes do not really change impact force but change (reduce) the rate of loading

  • in a forefoot strike, pressures are shifted more to the mid foot

want to know more? Join us this Wednesday, December 19th on online.com: Biomechanics 303







Sun XYang YWang LZhang XFu W. Do Strike Patterns or Shoe Conditions have a Predominant Influence on Foot Loading? J Hum Kinet. 2018 Oct 15;64:13-23. doi: 10.1515/hukin-2017-0205. eCollection 2018 Sep.

link to FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231350/





Podcast 142: Running in Circles? How your brain manipulates the body parts to get us to run straight.

Visual targeting during running. How we manage to run in a straight line (when we clearly should be running in circles).

Topics:
gait, running, eyes, visual queues, gait problems, gait analysis, running in circles, head tilt, Vaporfly, foot mechanics

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_143final_121418.mp3

Permalink URL: http://thegaitguys.libsyn.com/podcast-142

Libsyn Directory URL: http://directory.libsyn.com/episode/index/id/7927373


1. How exercise reprograms the brain:
https://www.the-scientist.com/features/this-is-your-brain-on-exercise-64934

2. The influence of prolonged running and footwear on lower extremity biomechanics

Gillian Weir , Carl Jewell, Hannah Wyatt , Matthieu B. Trudeau, Eric Rohr, Gert-Peter Brüggemann & show all
Received 20 Aug 2018, Accepted 18 Oct 2018, Published online: 20 Nov 2018

https://www.tandfonline.com/doi/abs/10.1080/19424280.2018.1539127?tokenDomain=eprints&tokenAccess=mWfmhgSBXzETDAAhnAbk&forwardService=showFullText&doi=10.1080%2F19424280.2018.1539127&doi=10.1080%2F19424280.2018.1539127&journalCode=tfws20

3. New study: the thick foam midsole in Nike's Vaporfly 4% shoe stores and returns ~45 times more energy per stride than the bending of the carbon fiber plate.
https://www.outsideonline.com/2367961/how-do-nikes-vaporfly-4-shoes-actually-work?utm_medium=social&utm_source=twitter&utm_campaign=onsiteshare