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Show Notes: The Gait Guys Podcast, Season 1, Episode 6
1- CPR: neurscience story
Correctly performed CPR triples survival rates. The UK Resuscitation Council recommends that the chest should be compressed by 5-6 cm and at a rate of 100-120 compressions per minute. A study published in 2009 showed that using a familiar song as an AID did increase the number of people getting the right rate. But there was a drop in those hitting the correct depth.
3. - EMAIL CASE:
off our FB page, from Lisa
I’m so hoping you can help me out with a patient. He is a military runner (Army) who hope to compete his first full Tri this year. In a nutshell: He has been plagued with peroneus Longus pain on his slightly longer side with running. This now occurs only with running in the combat boots and he uses a Nike Free Boot. I have checked all shoes for manufacturer defects.
Barefoot running, ankle rocker exercises, Glu. med strengthening for cross-over gait have helped his out of boot running experience, but he is frustrated by calf pain in the boots and so am I. I do have a video gait barefoot that I can send you. We have discussed the problem of trying to be a midfoot striker in a boot.
He does the waddle gait w/ theraband, squats with toes up, shuffle gait and moonwalk backwards. As far as i know, the military has banned VFFs for training and maybe all minimalist shoes. Scratching head…
What is thought to happen is that one partner dominates the lead in the gait, just as in dancing, one person is the leader and the other is the follower. The lead partner’s lower limbs determine the movement of their arms, which in turn when holding hands, sets the arm movement pattern in the partner then determining the leg swing and stance phases. Thus, synchrony is achieved.
J Neuroengineering Rehabil. 2007; 4: 28. The sensory feedback mechanisms enabling couples to walk synchronously. An initial investigation. Ari Z Zivotofsky and Jeffrey M Hausdorff Published online 2007 August 8. doi: 10.1186/1743-0003-4-28
- So a bit of background, i am a 28 year old very keen amateur (2.23 marathon) who has a 5 year history of heavy run training (80-120 miles per week) having been a triathlete prior to that and a swimmer from the age of 8. I had no injury history prior to this except, perhaps crucially, in 2006 i twisted my right ankle into supination, several times over the course of 2-4 months, I never had to stop running for more than a day or two at this time but it was very swollen and for at least 6 months was very unstable, but i ran through it.
- so current injury is a 2.5 years of vague right posterolateral gluteal pain which is constantly there but progresses with running to a spasm, over the area i believe to be the glute medius and some mild adductor pain on the same right hand . . i can usually get through easy mileage but the pain is always there and speed work/racing is a no no. I had bilateral sports hernia surgery on the 3rd january in the belief that it would cure the problem , it helped and certainly reduced the abdominal/adductor aspect but i still cant race and I know think the sports hernias were a product of the problem and not the problems route cause.
- I have no problems on the left. my right foot are some callouses on the right on the medial aspect of the arch.just proximal to the 1st MTP
- the navicular is much more prominent on the right.
the foot wear pattern on the right shoe is different, there appears to be a far heavier heel strike on the right lateral side, greater wear under where the right 1st MTP joint would be.
on the left there is far more “toe off” wear on the shoe after periods of inactivity it feels as though the foot needs to warm up before it will pronate sufficiently to allow toe off. like im walking on the outside of the foot.
the right hip has more internal rotation and less external rotation than the left,
flexion and extension at the hip are stiff but within i believe normal limits.
the hallux tests i have found online dont appear to show any restricton although i was initially cheating on the right with foot pronation.
- the podiatrist said I had bilateral forefoot varus with it being worse on the right. he noted my prominent naviculars, he initially thought I had accesory bones but confirmed that i did not. he said that on the right (my bad leg) had a restriction/fixed at the midtarsal joint so the increased required pronation to get the first ray down had to come from sub-talar pronation.
- onto the walking pressure pad analysis,
-on the right (bad leg) i had alot of lateral edge mid foot loading, the right foot was much more externally rotated than the left.-on my left leg the peak force/pressure was very unusally right under the tip if the hallux-on the right the forces were much less throught the heel strike, stance, and push off phaseonto the video analysis.
when you slow down my gait the left (my good, pain free leg) looks incredibly odd.on the “swing through” phase (so when my right was on the floor) my left knee points laterally and appears to circumduct through rather than progress straight in the saggital (?) plane. as the left foot approached foot strike is looks much more supinated than the right.-this is in contrast to my right (painful leg) which swung though perfectly in the saggital plane,-no movement laterally in the frontal plane, no cicumduction, approached foot strike with much less supination and just looked mor normal.
The podiatrist thinks all my problems are coming from my left foot, despite that being my good leg. so he gave me a knocked up orthotic to use in my left shoe which basically pushes me more into supination at the arch and calcaneus, nothing in the forefoot. he thought there was nothing to do in the right foot.he told me to try it for 6 weeks and if it worked he would prepare a more robust permanent version.This is where my questions came from the things I have learnt from the gaitguys, Basically i questioned why if I have a forefoot varus is there nothing in the forefoot to bring the ground up to the first ray. and help attenuate the subtalar pronation on the right and mid tarsal/subtalar joint on the left. he said through years of experience, which is fair enough of an answer as I dont have any experience or qualifications of my own!I enjoyed the assessment and I thought it was enlightening but cant help but feel he mar be very good at detecting/ diagnosing but im not convinced that his remedy is the way forward.Despite the abberent movements of the left leg Im still convinced the right is the problem and what i see in the left in swing though is a product of poor mechanics of the right foot when its on the floor.Thanks again. Nathaniel , United Kingdom