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

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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

Simulated knee flexion contracture to elucidate knee-spine syndrome

When we have on one side either a:
- fixed knee flexion deficit
- weak quadriceps mechanism
- short quadriceps-hip flexor complex with anterior pelvis predominance

. . . these often present functionally as a short leg on that side. Perhaps better put, these will cause a premature forefoot loading response. This loading response will expedite ankle rocker during the stance phase of gait. This will often result in an overactive calf muscle complex and thus shortness over time, further blunting the ankle rocker during tibial progression over the ankle.
Furthermore, there will be a heavy lurching loading response on that same leg, it will surely look like a short leg, functionally. This is why it is imperative to check for full knee extension, ability to engage the quads with endurance and strength in full extension, and be able to connect that anterior chain with the lower abdominals and hip flexors without dumping into an anterior pelvis posture.
The loads move. They move up and down. There are many other causes of this descriptive mechanical chain problem above. Even a weak anterior shin compartment will cause many of these abrupt forefoot loading responses (that can also functionally resemble a knee flexion contracture) and promote early and excessive knee flexion during early limb loading response, when we rather should be posturing over a more stable and extended knee. They feed off of each other. It is why these syndromes of problems get intermixed and complicated to both diagnose and remedy.

PS: we chose this photo for a reason today, because high heels make us load the forefoot prematurely during the gait cycle, and we have to dampen the loads with the quadriceps.

Take what you will from this study, but it is really the global picture it suggests. That being, everything can affect everything.
PS: we hate the name they put on this study at the end. . . . "Knee-spine syndrome". For what its worth.

"However, the 30 degrees (simulated knee) contracture significantly changed the kinematics in each of the following planes. In the coronal plane, the trunk tilted to the contracture side in standing and walking. In the sagittal plane, posterior inclination of the pelvis in standing significantly increased. In addition, anterior inclination of the trunk and pelvis during walking significantly increased. In the axial plane, trunk rotation to the unaffected side significantly decreased during walking. The vertical knee force in the contracture limb decreased, being accompanied by the increase of the force in the unaffected limb during standing and walking. Results of our study suggest that knee flexion contracture significantly influences three-dimensional trunk kinematics during relaxed standing and level walking, and will lead to spinal imbalance. These facts may explain the onset of the "Knee-Spine Syndrome".

Gait Posture. 2008 Nov;28(4):687-92. doi: 10.1016/j.gaitpost.2008.05.008. Epub 2008 Jun 26.

A gait analysis of simulated knee flexion contracture to elucidate knee-spine syndrome.

Harato K1, Nagura T, Matsumoto H, Otani T, Toyama Y, Suda Y.

The Dumpling Walk !

Its time for Gait Guys Gait Gaffs again ! 

This is one of our all time favorite gait styles. Aside from the atonic arm swing, what we love about this one is the vertical nature of this gait style.  If you look around you will see this one often. These are the bouncy folks.  There is a bucket load of vertical body movement when in fact the head should stay static in gait and in running.

This gait style is caused by a premature heel rise from premature engagement of the gastrosoleus (and sometimes even the long toe flexors, you will see them hammering and curled). The person will never get to full late-midstance of gait and thus never achieve full hip extension nor adequate ankle dorsiflexion / ankle rocker. These are timely events and specific things are supposed to happen during these phases of gait that are omitted and thus passed into other areas for compensation. This gait style is very inefficient in that the gluteals cannot power into hip extension into a forward progression drive, because the calf is prematurely generating vertical movement through ankle plantarflexion.  This strategy is sometimes deployed because the person actually is significantly ankle dorsiflexion (ankle rocker) deficient.  Meaning, they hit the limitations of dorisflexion and in order to progress forward they first have to go vertical. Obviously, the remedy is to find the functional deficit, remove it and retrain the pattern.  We will be going over this pattern quite a bit in our new DVD line when we can get to it, because there are other deficits that could drive this one such as short hip flexors and quads to name one. 

See you again on Gait Guys Gait Gaffs !…….Shawn and Ivo, we are…….The Gait Guys