The Latissimus in Gait

Affording itself a large attachment centrally from the T7 to L5 spinouses, laterally to the iliac crest and thoracolumbar fascia, rostrally to the lower 3 or 4 ribs and inferior angle of the scapula, to travel superiorly and laterally to the attach to the medial lip of the intertubercular sulcus, it is perfectly situated to effect both the upper and lower extremities in a large variety of movements.

It is one of the quintessential and often overlooked muscles in gait. It is generally quiet electrophysiologically during walking gait (1,2) until speed increases or you are running (2-4).  The latissimus dorsi is THE functional link between the upper and lower extremity, particularly though its connections with the thoracolumbar fascia (5,6). Latissimus activity, through gait and arm swing seems to profoundly influence and be influenced by gluteal activity, through the posterior oblique sling system (3,4), consisting of the latissimus dorsi, thoracolumbar fascia and contralateral gluteus maximus (7). The posterior oblique sling system provides trunk stability and power delivery to the upper extremity from the contralateral lower extremity and promotes mutual gait patterns between the upper and lower extremities (8), while creating joint contraction in running, turning and walking (9,10). Recent studies conversely show that arm swing can, in turn, effect lower extremity movement as well (3,4). 

Given the importance of the latissimus, it would stand to reason we would want it to function at its best. Dry needling is one modality we seem to be able to use to change its function,not only reducing central sensitization, but reducing local and referred pain, improves range of motion and muscle activation patterns (11-13). There are other modalities, including supportive exercises, that can be used to both activate and rehabilitate the lat as well (14-17)

Here is one method we like to use to needle the latissimus dorsi. Consider adding this to your clinical toolbag. 

references: 

1. Houglum P, Bertoti D in: Brunstrums Clinical Kinesiology 6th Edition, FA Davis 2012 p.558

2. G. Cappellini, Y. P. Ivanenko, R. E. Poppele, F. Lacquaniti Motor Patterns in Human Walking and Running Journal of Neurophysiology Published 1 June 2006 Vol. 95 no. 6, 3426-3437 DOI: 10.1152/jn.00081.2006

3. Shin S, Kim T, Yoo W. Effects of Various Gait Speeds on the Latissimus Dorsi and Gluteus Maximus Muscles Associated with the Posterior Oblique Sling System. Journal of Physical Therapy Science. 2013;25(11):1391-1392. doi:10.1589/jpts.25.1391.

4. Kim T, Yoo W, An D, Oh J, Shin S. The Effects of Different Gait Speeds and Lower Arm Weight on the Activities of the Latissimus Dorsi, Gluteus Medius, and Gluteus Maximus Muscles. Journal of Physical Therapy Science. 2013;25(11):1483-1484. doi:10.1589/jpts.25.1483.

5. Vleeming A, Pool-Goudzwaard AL, Stoeckart R, van Wingerden JP, Snijders CJ. The posterior layer of the thoracolumbar fascia. Its function in load transfer from spine to legs. Spine (Phila Pa 1976). 1995 Apr 1;20(7):753-8.

6. Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. The thoracolumbar fascia:anatomy,  function and clinical considerations. Journal of Anatomy. 2012;221(6):507-536.doi:10.1111/j.1469-7580.2012.01511.x.

7. Mooney V, Pozos R, Vleeming A, Gulick J, Swenski D Exercise treatment for sacroiliac pain. Orthopedics. 2001 Jan; 24(1):29-32.

8. Page P, Frank C, Lardner R: Assessment and treatment of muscle imbalance. Champaign: Human Kinetics Pub, 2010, pp 30–37. 

9. Bergmark A Stability of the lumbar spine. A study in mechanical engineering. Acta Orthop Scand Suppl. 1989; 230():1-54.

10. Collins SH, Adamczyk PG, Ferris DP, Kuo AD A simple method for calibrating force plates and force treadmills using an instrumented pole. Gait Posture. 2009 Jan; 29(1):59-64.

11. Dar G, Hicks GE. The immediate effect of dry needling on multifidus muscles function in healthy individuals. J Back Musculoskelet Rehabil. 2016 Apr 27;29(2):273-278.

12. Ortega-Cebrian S, Luchini N, Whiteley R. Dry needling: Effects on activation and passive mechanical properties of the quadriceps, pain and range during late stage rehabilitation of ACL reconstructed patients.Phys Ther Sport. 2016 Sep;21:57-62. doi: 10.1016/j.ptsp.2016.02.001. Epub 2016 Feb 24.

13. Dommerholt J. Dry needling — peripheral and central considerations. The Journal of Manual & Manipulative Therapy. 2011;19(4):223-227. doi:10.1179/106698111X13129729552065.

14. Youdas JW, Coleman KC, Holstad EE, Long SD, Veldkamp NL, Hollman JH. Magnitudes of muscle activation of spine stabilizers in healthy adults during prone on elbow planking exercises with and without a fitness ball. Physiother Theory Pract. 2017 Sep 18:1-11. doi: 10.1080/09593985.2017.1377792. [Epub ahead of print]

15. Crane P, Ladden J, Monica D. Treatment of axillary web syndrome using instrument assisted soft tissue mobilization and thoracic manipulation for associated thoracic rotation dysfunction: A case report. Physiother Theory Pract. 2017 Aug 30:1-5. doi: 10.1080/09593985.2017.1368755. [Epub ahead of print]

16. Massé-Alarie H, Beaulieu LD, Preuss R, Schneider C. Influence of paravertebral muscles training on brain plasticity and postural control in chronic low backpain. Scand J Pain. 2016 Jul;12:74-83. doi: 10.1016/j.sjpain.2016.03.005. Epub 2016 May 11.

17. Snarr RL, Hallmark AV, Casey JC, Esco MR. Electromyographical Comparison of a Traditional, Suspension Device, and Towel Pull-Up. J Hum Kinet. 2017 Aug 1;58:5-13. doi: 10.1515/hukin-2017-0068. eCollection 2017 Sep.

Your Gait Changes when you text....

Does texting alter your gait? It sure seems to slow you down, and according to this study, alter firing patterns of muscles about your ankle. Perhaps you are trying to preserve ankle rocker and maintain stability? It is interesting that ankle dorsiflexion actually increased and plantar flexion decreased.

"Young adults showed, overall, small gait modifications that could be mainly ascribable to gait speed reduction and a modified body posture due to phone handling. We found no significant alterations of ankle and knee kinematics and a slightly delayed activation onset of the left gastrocnemius lateralis. However, we found an increased co-contraction of tibialis anterior and gastrocnemius lateralis, especially during mid-stance. Conversely, we found a reduced co-contraction during terminal stance."

link to FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579642/

Distracted Kids Walk Slower

Do Gait rehab on Kids?

Distracted kids walk slower and spend more time in double leg stance.

We know it can effect adults, usually resulting a mild decomposition of gait, by decreasing step length in many and slowing of gait in older folks (becoming more primitive).

Watch where you do your gait rehab in the younger set; keep them focused and engaged for better outcomes.

"Significant main effects of walking experience groupand visual distraction condition were found. Visual environmental distraction significantly affected gait performance in children regardless of walking experience. Velocity decreased from 110.04 to 97.73 cm/sec (p = 0.003) while double limb stance % of gait cycle increased from 18.29% to 20.39% (p = 0.025)."

Phys Occup Ther Pediatr. 2017 Apr 10:1-10. doi: 10.1080/01942638.2017.1297987. [Epub ahead of print]
The Effect of Visual Environmental Distraction on Gait Performance in Children.
Bizama F, Medley A, Trudelle-Jackson E, Csiza L.

J Neuroeng Rehabil. 2014 Apr 28;11:74. doi: 10.1186/1743-0003-11-74.
Effect of explicit visual feedback distortion on human gait.
Kim SJ, Mugisha D.

Curr Gerontol Geriatr Res. 2011;2011:651718. doi: 10.1155/2011/651718. Epub 2011 Jun 16.
Effects of a Visual Distracter Task on the Gait of Elderly versus Young Persons.
Bock O, Beurskens R.

Slow Your Gait & Shorten Your Stride and Your Brain May Slow

Slow Your Gait & Shorten Your Stride and Your Brain May Slow

Well, you have heard it here before, the receptors drive the brain, and here is another study that backs this up. Remember that receptors, which include not only joint mechanoreceptors, but also muscle mechanoreceptors (muscle spindles and golgi tendon organs) and tactile receptors in the skin (Merkels discs, paccinian corpuscles, etc) feed into the brain cortex (via the dorsal column system) and the cerebellum (via the spino cerebellar system). This afferent (sensory information) input is important for proper coordination as well as cognition and learning.

Remember, your brain is always remodeling. Here, the old adage “if you don’t use it, you will lose it” applies. More input = more synapses = more neuronal growth. So less motion = less input=synaptic atrophy = fewer connections and thus slower brain function.

Increased speed and length of stride stretches receptors more; decreased speed and shorter stride lengths decrease receptor activation. So, take big steps quickly, or you may turn into a zombie ! There is a reason why they walk slowly !

In July 2012 at the Alzheimer’s Association International Conference in Vancouver, British Columbia Mayo Clinic researchers presented research indicating that walking problems such as a slow gait and short stride are associated with an increased risk of cognitive decline. Computer assessed gait parameters (stride length, cadence and velocity) in study participants at two or more visits roughly 15 months apart. They revealed that participants with lower cadence, velocity and length of stride experienced significantly larger declines in global cognition, memory and executive function.

references:

http://www.aansneurosurgeon.org/2012/08/02/slow-gait-short-stride-linked-to-increased-risk-of-cognitive-decline/

http://www.newswise.com/articles/view/591437/?sc=dwhn

Some Biomechanical Facts on Oscar Pistorius: 400 m London Olympic Games

Following Saturday’s 400m men’s preliminary heats Jere Longman’s wrote an article in the NYTimes entitled “Pistorius Advances to Semifinals”. In it were some interesting facts. Here is the link to the article. 

Ever since Pistorius’s shut out from the Beijing Olympics scientific and legal debate has continued about whether his prosthetic legs gave him an unfair advantage over sprinters using their natural legs. However, as we all knew, this time around would different in London 2012. Competing on carbon-fiber prosthetics called Cheetahs, Pistorius was going to get his chance and in the process further the debate on what is considered able and disabled.

Prior to Beijing the I.A.A.F. said Pistorius’ carbon-fiber blades violated its ban against springs or wheels that gave an athlete a competitive edge over able bodied athletes. The prosthetic legs allowed him to run as fast as elite sprinters while consuming less energy, the governing body concluded. None the less, the debate has continued over the past few years since Beijing pertaining to where to draw the line between fair play and the right to compete. In 2009 in The Journal of Applied Physiology a study concluded that Pistorius could take his strides more rapidly and with more power than a sprinter on biological legs.

An acquantance of ours who we talk to from time to time, Professor Peter Weyand at SMU Locomotor Performance Laboratory in 2009 looked at Oscar Pistorius-type carbon fiber Cheetah blades a little more closely. In his study (referenced below), in the Journal of Applied Physiology, he conducted three tests of functional similarity between an amputee sprinter and competitive male runners with intact limbs: the metabolic cost of running, sprinting endurance, and running mechanics. What he found was:

• the mean gross metabolic cost of transport of the amputee sprint subject was only 3.8% lower than mean values for intact-limb elite distance runners and 6.7% lower than for subelite distance runners but 17% lower than for intact-limb 400-m specialists
• the speeds that the amputee sprinter maintained for six all-out, constant-speed trials to failure were within 2.2 (SD 0.6)% of those predicted for intact-limb sprinters.
• at sprinting speeds of 8.0, 9.0, and 10.0 m/s, the amputee subject had longer foot-ground contact times ,shorter aerial and swing times and lower stance-averaged vertical forces than intact-limb sprinters [top speeds = 10.8 vs. 10.8 (SD 0.6) m/s].

Weyand concluded that running on modern, lower-limb sprinting prostheses appears to be physiologically similar but mechanically different from running with intact limbs.

Longman’s article listed some of the other facts that have come up in recent years, facts that led to the eventual acceptance of Pistorius in London 2012’s Olympic events.  We have not captured these references specifically (yet, but we will) but in the mean time to keep this blog article timely, lets look at some of the other facts that Longman mentioned in his NYTimes article:

• While calf muscles generate about 250 percent energy return with each strike of the track, propelling a runner forward, Pistorius’s carbon-fiber blades generate only 80 percent return, Gailey said.
• Given that Pistorius has no feet or calves, he must generate his power with his hips, working harder than able-bodied athletes who use their ankles, calves and hips, Gailey said.
• And because the blades are narrow and Pistorius essentially runs on his tip toes, he pops straight up out of the blocks instead of driving forward in a low, aerodynamic position for the first 30 or 35 meters, making him more susceptible to wind resistance, Gailey said.
• Compared with runners with biological feet, Pistorius also must work harder against centrifugal force in the curves, and his arms and legs tend to begin flailing more in the homestretch, costing him valuable time, Gailey said. His stride is not longer than other runners, as many presume, Gailey said. “It’s not like he’s bouncing high with a giant spring,” Gailey said.
• The blades “basically allow him to roll over the foot and get a little bounce,” Gailey said, adding: “The human foot operates like a spring, and his feet operate like a spring. But the human foot produces more power than the blades do.”

There is an abundance of interesting information here. We will likely return to some of these topics and facts in the future, but in the meantime we say that everyone has their own demons and deficits. We all have injuries and limitations we have to cope with, in life and in sport. So where the line gets drawn will always be a blurred. This debate on this specific case with Pistorius could go on for years and never reach an agreeable conclusion as to a fair playing field. So, let the games begin and may the best man or woman win, with his or her demons and deficits in tow.  Good work Oscar. Thanks for the inspiration.

Shawn and Ivo, The Gait Guys

____________________________

We found 3 other journal articles on Pubmed on Oscar.

1. Enhancing disabilities: transhumanism under the veil of inclusion? Van Hilvoorde I, Landeweerd L.   Disabil Rehabil. 2010;32(26):2222-7.

2. Oscar Pistorius, enhancement and post-humans. Camporesi S. J Med Ethics. 2008 Sep;34(9):639.

3. By designing ‘blades’ for Oscar Pistorius are prosthetists creating an unfair advantage for Pistorius and an uneven playing field? Chockalingam N, Thomas NB, Smith A, Dunning D. Prosthet Orthot Int. 2011 Dec;35(4):482-3.

4. J Appl Physiol. 2009 Sep;107(3):903-11. Epub 2009 Jun 18.

   The fastest runner on artificial legs: different limbs, similar function?

   Weyand PG, Bundle MW, McGowan CP, Grabowski A, Brown MB, Kram R, Herr H. LINK   http://www.ncbi.nlm.nih.gov/pubmed?term=2009%20journal%20of%20applied%20physiology%20weyand

Speed Matters: Brief Thoughts on Gait and Running.

The journal article below sparked a few thoughts for a blog post today.

Have you ever tried to walk slower than your normal pace ? How about running slower than your normal pace (  you know, running with that person who is clearly a minute slower pace) ? Why are both so uncomfortable and labor intensive ? Why does your balance, energy and stability become challenged ? After all, slower should be easier right ?!
There are many reasons and this study hints at a few issues but the bottom line is that speed matters.  Have you ever been driving down the road and you see a big pot hole in the road that you just cannot get around because it is either too big or you do not have time to steer around it ?  What is your first reaction ?  Many will press down on the gas pedal. Why is that ? Well, logic for many is that speeding up will possibly enable you to launch across the void and reduce the impact issues of dropping down into the void.  Men will rationalize the “launch across the pothole” theory, and in some respects they are not wrong.

Running and walking slowly sort of bring out some of the same issues.  When we move slowly the body is more likely to drift into the frontal/coronal (side to side) plane.  Moving more quickly ensures that the dominant path is forward. Slowing down does not ensure that forward will occur. side to side sway enters the picture. And when side to side sway enters as an option we have to spend more time and strategies negotiating the side sway.  This is why we see all kinds of corrections with the limbs and core when we attempt to stand on one foot, but we do not see these issues when we walk or run.  When running we are mostly trying to get the next foot underneath our body so that we do not fall forward flat on our face. Locomotion is a strategy of nothing more than trying to stay upright.  When we run the predominant motion is forward. But when we slow down and reduce the advantage of speed to blur out these issues the challenges begin and other planes of movement become an option and thus planes we need to control. It is much why the elderly have more difficulty moving about, because they have to negotiate and control so many other planes of movement.
So, if you want to bring out some faulty motor patterns, move more slowly and see where your deficits lie. One of our assessments for patients and athletes is to have them walk at a 3second pace meaning each foot fall must be held for 3 seconds before the next step can be initiated. This means stance and swing must be slowed to 3 seconds.  Amazing things will show up if you just slow things down and allow weaknesses to percolate to the surface.  Speed blurs them and keeps them suppressed. It is really a form of cheating and compensation.
So, like in your car, speed matters.
Think about this next time you have to walk or run with a slower person. It may be one of the issues, but there are others and we will eventually get to them.


Gait and Speed on Child Development

J Biomech. 2008;41(8):1639-50. Epub 2008 May 7. The effect of walking speed on the gait of typically developing children. Schwartz MH, Rozumalski A, Trost JP. Abstract

Many gait studies include subjects walking well below or above typical self-selected comfortable (free) speed. For this reason, a descriptive study examining the effect of walking speed on gait was conducted. The purpose of the study was to create a single-source, readily accessible repository of comprehensive gait data for a large group of children walking at a wide variety of speeds. Three-dimensional lower extremity joint kinematics, joint kinetics, surface electromyographic (EMG), and spatio-temporal data were collected on 83 typically developing children (ages 4-17) walking at speeds ranging from very slow (>3 standard deviations below mean free speed) to very fast (>3 standard deviations above mean free speed). The resulting data show that speed has a significant influence on many measures of interest, such as kinematic parameters in the sagittal, coronal, and transverse planes. The same was true for kinetic data (ground reaction force, moment, and power), normalized EMG signals, and spatio-temporal parameters. Examples of parameters with linear and various nonlinear speed dependencies are provided. The data from this study, including an extensive electronic addendum, can be used as a reference for both basic biomechanical and clinical gait studies.

Something lighter for Friday Follies. 

It just goes to show. You don’t need to be the fastest, just faster than the the slowest guy. Enjoy your Friday!

Ivo and Shawn