Sometimes too much shoe is too much...

Minimalist. Maximalist. Neutral. Sometimes you need to earn your way into a shoe. After all, a shoe is supposed to direct and guide your foot to better (more optimal?) mechanics, not necessarily create more work for it. The literature seems to point to maximalist shoes changing lower extremity kinematics and increasing impact forces. The body needs to have the ability to “attenuate“ these impact forces, otherwise problems could potentially arise.

Take a good look at this gal. She is having a heck of a time trying to control what her mechanics are doing in this maximalist shoe. She demonstrates poor control of the foot, as well as the knee and hip.

By design, the shoe has a thicker outsole and forefoot flare (ie: The front of the shoe is wider at the sole than it is at the interface of the foot with it). This can create accelerated forefoot pronation as you see here with the medial aspect of the foot “slapping“ down on the ground. This creates a large valgus moment at the knee, which is further accentuated by her external tibial torsion, greater on the left. Also notice the pelvic dip on the left on the right foot hits the ground; less so on the right side when the left foot strikes. Looking up the chain and as a whole, you can see that this is poor control and could potentially contribute to at the mechanics at the ankle, knee and hip. Not sure if you can see it but she also has an increase in her lumbar lordosis, diminishing her ability to be able to use her abdominal core to help to stabilize.

If she were to continue to want to utilize the shoe, we would need to work on core strength, hip stability and most likely, forefoot motion (so that she can get her first ray complex to the ground at the first metatarsal phalangeal joint), before she “earns her way” into this shoe.

Dr Ivo Waerlop, one of The Gait Guys

Kulmala JP, Kosonen J, Nurminen J, Avela J.Running in highly cushioned shoes increases leg stiffness and amplifies impact loading. Sci Rep. 2018 Nov 30;8(1):17496. FREE FULL TEXT

Law MHC, Choi EMF, Law SHY, Chan SSC, Wong SMS, Ching ECK, Chan ZYS, Zhang JH, Lam GWK, Lau FOY, Cheung RTH. Effects of footwear midsole thickness on running biomechanics. J Sports Sci. 2019 May;37(9):1004-1010

Chan ZYS, Au IPH, Lau FOY, Ching ECK, Zhang JH, Cheung RTH. Does maximalist footwear lower impact loading during level ground and downhill running? Eur J Sport Sci. 2018 Sep;18(8):1083-1089.

Sinclair J, Richards J, Selfe J, Fau-Goodwin J, Shore H.The Influence of Minimalist and Maximalist Footwear on Patellofemoral Kinetics During Running.J Appl Biomech. 2016 Aug;32(4):359-64. 

Chambon N, Delattre N, Guéguen N, Berton E, Rao G. Is midsole thickness a key parameter for the running pattern? Gait Posture. 2014;40(1):58-63

#runnning #gait #biomechanics #maximalistshoes #midsolethickness #gaitanalysis #thegaitguys

"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

Podcast 87: Podcast 87: The Kenyan's Running Brain & "The" Anterior Compartment.

Plus, Some unknown facts about going minimalism and barefoot. We POUND anterior compartment strength today gang ! Hope you enjoy !

Show sponsors:
www.newbalancechicago.com

A. Link to our server: 
http://traffic.libsyn.com/thegaitguys/pod_87final.mp3

Direct Download: 
http://thegaitguys.libsyn.com/podcast-87

Other Gait Guys stuff

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:
Monthly lectures at : www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

Show notes:

On high heels and short muscles: A multiscale model for sarcomere loss in the gastrocnemius muscle

http://www.sciencedirect.com/science/article/pii/S0022519314006262

The Brain Needs Oxygen

Maintained cerebral oxygenation during maximal self-paced exercise in elite Kenyan runners.

http://www.runnersworld.com/racing/the-brain-needs-oxygen
http://www.ncbi.nlm.nih.gov/pubmed/25414248
J Appl Physiol (1985). 2014 Nov 20:jap.00909.2014. doi: 10.1152/japplphysiol.00909.2014. [Epub ahead of print]

The texting lane in China
http://www.theguardian.com/world/shortcuts/2014/sep/15/china-mobile-phone-lane-distracted-walking-pedestrians

Dialogue on endurance training,
NeuroRehabilitation. 2006;21(1):43-50. 
http://www.ncbi.nlm.nih.gov/pubmed/16720937

Effects of dorsiflexor endurance exercises on foot drop secondary to multiple sclerosis.  Mount J1, Dacko S.

APOS Therapy
we were asked out opinion on this
http://apostherapy.com/

Foot instrinsic dialogue
Motor Control. 2014 Jul 15. [Epub ahead of print]

Quantifying the Contributions of a Flexor Digitorum Brevis Muscle on Postural Stability.
Okai LA1, Kohn AF.

There are many factors in adults that impair gait. It is not all biomechanical. This is part of our ongoing dialogue on the aging population and why gait impairments and falls are so prevalent.
Acta Bioeng Biomech. 2014;16(1):3-9.
Differences in gait pattern between the elderly and the young during level walking under low illumination.
Choi JS, Kang DW, Shin YH, Tack GR.

Midfoot strike in a non-zero drop shoe. Have you thought about this ?

Here is something to think about. As one midfoot strikes the foot during walking or running the individuals body mass is typically directly over the foot.  When this occurs in a zero drop shoe (ie. flat, your rear and forefoot are on the same plane) the tibia-ankle is at the very least, at 90 degrees. Meaning, the tibia is at the very least at 90 degrees and is at the very least perpendicular to the ground and plane that the foot is on.  And with just a little bit of forward body mass movement over the foot the critical and necessary range of 110-115 plus degrees of ankle dorsiflexion (depending on your reference source) is achieved. This means that one does not have to prostitute the foot into greater than normal pronation to drop the arch further to gain the extra amount of ankle rocker (dorsiflexion) that is necessary to pass over the foot.

However, think about this.  What if that same foot is in a stacked heel shoe.  There are plenty of shoes still out there that have a ramp delta that is above zero drop. So, what we have is a shoe that has the heel higher than the forefoot, a sloped shoe.  IF this same foot midfoot strikes what happens now ?

Well, midfoot strike now occurs in a relatively greater plantarflexed posture (ie. heel is raised higher than the forefoot because of the shoe). This means we are not anywhere near the 115 degrees necessary for normal gait, timely heel departure, timely forefoot load, timely hip extension, timely gluteal activation etc. These timely gait events are paramount to normal gait and when they are altered injury and altered tissue loads can occur.  Altered motor recruitment patterns are likely to ensue.  In the scenario proposed, as the body mass moves over the slightly plantarflexed foot we might now only get to 90 degrees of ankle rocker before the body mass is far enough forward to create the passive heel rise during late-midstance phase of gait. And when the body can only get 90 degrees of ankle dorsiflexion/rocker during midstance the extra amount of dorsiflexion range may need to come from some other joint.  It may come from more than normal midfoot pronation, knee hyperextension, knee valgus etc. This is potentially a long list of compensations.

Our point is simple here and at this time it is just a tip of the iceberg article for us.  But we thought we would put this idea out there to share some of the things we think about on a daily basis, and some of the things that get played out in our clinics each and every day. 

Changing your running form involves so much more than just changing your form. If you change to a midfoot or forefoot strike what kinds of biomechanics are you employing ? Do you have the neuromechanics to accompany these running form changes ? Do you have the necessary ranges of motion ? Do you have strength in potential compensation patterns to fend off both subtle and dramatic running form changes ?  If not, you might find out that your initial response is “ I just cannot do a midfoot or forefoot strike running form. I get foot pain, or knee pain, or hip pain.”

Conversely, think about this regarding our postulation above.  If you have been employing a midfoot strike or forefoot strike pattern in stacked heeled shoes and suddenly try a zero drop shoe you better be aware of symptoms such as pain, tightness or other complications.  Is your body able to adapt to a new (possibly increased) ankle-midfoot rocker or the demand of a greater ankle-midfoot with the newly dropped heel? Is your body immediately adaptive enough after going through that stage of gait with the heel higher than the forefoot for years ?  Just because you went to a running form clinic doesn’t mean  you are ready to make that your new form tomorrow. Change takes time, so be patient with your body and let it adapt.

Food for thought, especially for those who say to others. “Hey dude, chuck your ramped shoes and go minimialism or barefoot. Just go for it. I did and I was fine !”

What is fine for one, is not fine for all.

Shawn and Ivo

The Gait Guys