Emulation as an Integrating Principle for Cognition

What you think, and what you think about matters…

More fodder for motor planning and other cortical activities. This article talks about what the movie “What the Bleep Do We Know” is all about; what you think can effect the outcome, but this article is focused on you and your actions, rather than the world around us.

This goes for gait retraining, rehab and a host of other things you may be trying to accomplish (even beyond the world of gait, if you can believe such a world exists!)

What you do matters bascially. And when you do it right, there is neurologic reinforcement of those motor behaviours. And when you do it wrong, meaning you cheat or compensate, there is neurologic reinforcement of those motor behaviours as well. 

We often hear it is better to do something right the first time than to have to do it truly properly a second time.  There is far more to it than correcting your ways. Now you have to rewrite another motor pattern, while the old one remains stored waiting for you to cheat or take a short cut the next time. 

If something is worth doing, do it right the first time.  This goes for gait and running form retraining.  This is why running form is such a big business these days, so many have been running incorrectly, emulating improper motor patterns. 

When Nike said “Just do it”…….we think they meant, “Just do it right.”

The Gait Guys

Emulation as an Integrating Principle for Cognition

Front Hum Neurosci. 2011; 5 : 54.

Published online 2011 May 27. doi:  10.3389/fnhum.2011.00054

Abstract

Emulations, defined as ongoing internal representations of potential actions and the futures those actions are expected to produce, play a critical role in directing human bodily activities. Studies of gross motor behavior, perception, allocation of attention, response to errors, interoception, and homeostatic activities, and higher cognitive reasoning suggest that the proper execution of all these functions relies on emulations. Further evidence supports the notion that reinforcement learning in humans is aimed at updating emulations, and that action selection occurs via the advancement of preferred emulations toward realization of their action and environmental prediction. Emulations are hypothesized to exist as distributed active networks of neurons in cortical and sub-cortical structures. This manuscript ties together previously unrelated theories of the role of prediction in different aspects of human information processing to create an integrated framework for cognition.

You have seen the artwork of British Photographer Eadward Muybridge in some of our videos and online education programs (with credit). Here is a Google Doodle based on “The Horse in Motion” you may enjoy. Click on the picture to follow the link.

The Gait Guys

Have a great day!

Supination: the Matrix Way!

Wow, can you believe it’s Monday already? Ready for some entertainment this Monday morning?

We have a special, previously unreleased version of a video we had done, with a surprise ending.

Have an awesome, supinatory kind of day!

Ivo and Shawn

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Curse of the Bunion

Hi Dr. Allen,

My husband was able to stop using his orthotics by utilizing the exercises he learned from The Gait Guys on YouTube so I thought I would send you an email to ask your opinion about my daughter’s foot issues. She is 14 years old and a serious dancer (eight hours of class per week plus up to eight hours of rehearsal). She has developed a bunion which is starting to cause her significant pain in the joint of her big toe. We took her to an Orthopedist who gave her a Cortizone shot in her joint and suggested she will need surgery. Considering she is only 14 and surgery would take her out of dance for at least 3-4 months, we do not view it as a viable option. Is it possible to fix a bunion without surgery and is that something you have had success doing? I know she is not currently a patient of yours but I would be interested to hear your opinion on the issue.

Thanks,  PG

___________________________________

Dear PG

Wow, that is great news for your husband ! Although we do not recommend taking our information as medical advice it is always nice to hear that by simply using our stuff to self educate oneself that people are fixing what therapy was unable to achieve.

I used to treat many in the dance company at the Chicago Joffrey Ballet along side a few other brilliant doctors (who are Gait Guys followers as well !) and we always cringed when a nasty bunion would walk and and cry for help.

Bunions are developmental for the most part. They are found paired with Hallux Valgus. This journal article has a real nice verbiage that we like:

“The first ray is an inherently unstable axial array that relies on a fine balance between its static (capsule, ligaments, and plantar fascia) and dynamic stabilizers (peroneus longus and small muscles of the foot) to maintain its alignment. In some feet, there is a genetic predisposition for a nonlinear osseous alignment or a laxity of the static stabilizers that disrupts this muscle balance.  Many inherent or acquired biomechanical abnormalities are identified in feet with hallux valgus. However, these associations are incomplete and nonlinear. In any patient, a number of factors have to come together to cause the hallux valgus.”

In working with dancers we found plenty that did not have bunions or hallux valgus.  So it is not always the dancing that is the culprit. But it can be a factor if the osseous alignment is suboptimal (the joint line architecture at the metatarsophalangeal joint at the big toe is angled to allow for lateral hallux drift or the intermetatarsal angle is predisposed (wider than optimal)).  

The main problem however in dancers is multifactorial:

• the “turn out” predisposes the foot to more pronation which can easily destabilize the medial foot tripod anchoring of the 1st metatarsal to the ground.  This will change the pull of the adductor hallucis causing the hallux to drift laterally and the 1st metatarsal to drift medially widening the gap between the 1st and 2nd metatarsals (ie. the intermetatarsal angle).
• dancers also axially load the hallux. This is called “en pointe”.  Please read our prior blog post on “en pointe” (click here). As you can see in the video above, the angle at the big toe (the 1st metatarsophalangeal joint) immediately begins to drift into hallux valgus.  Continuing to do this will render this poor gal a nasty bunion in time we highly suspect.  These are the challenges that dancers put into the foot. Once the hallux drifts laterally the first metatarsal loses more anchoring capacity at the medial foot tripod and the viscous cycle continues. 
• Remember, a bunion is a soft tissue adventitious mal-development.  It is often erroneously confused as a bony proliferation at the medial joint, the knuckle area.  This is not the case.  Hallux valgus drives the metatarsal head medially and exposes the head of the bone medially giving the appearance of a bump (the “bunion”). In fact, the bunion is an inflamed or adventitious bursal sac combined with the prominence of the MET head and angry inflammed skin, ligaments, joint capsule etc

To “fix the bunion” is a loaded issue.  Once these begin to develop they frequently progress in degree and pain.  They are very hard to correct conservatively but you have to give it a chance, surgery has to be the last road. Unfortunately if this is going to happen it must be determined if dance is a provoking factor, which is very likely.  Being in En Pointe will make this a quick trip into a nasty bunion we fear.  Use caution and logic on this one PG.  Your daughter has to live with these feet for many decades at the very least, and there is nothing like walking on painful incompetent feet for the rest of your life.  Further correction possibilities may come from determining if she can adequately form a good foot tripod and achieve competent strength in the muscles that stabilize the joint (FHL, FHB, EHL, EHB, ABD H., ADD H., tib posterior and anterior …… to name most of them).  A strong competent foot with excellent medial tripod anchoring ability will rarely develop into a bunion or hallux valgus. But you have to catch the incompetencies early and correct them before things get out of  hand. 

Good luck to you and  your daughter PG.  Find someone good at these things.  Find your local “Gait Guy or Gait Gal” and you will be in good hands (or should we say “good feet”).

The government needs to start a “Just say no to bunions” grassroots program. Although on second thought, maybe that is not a good idea. It would only get caught up in congress and the senate for years.

Warm regards,

Shawn and Ivo

Friday Follies:

Going through our archived pictures, we ran across this shot of Dr Ivo with Frank Shorter (Center) at last years Newton Conference that The Gait Guys were invited to speak at.

Knowing that Dr Ivo plays the bass, and is a former rock star, we are always searching for posts which may include a musical reference (even if peripheral). We closely compared some pictures of Alice Cooper (Left and Right) with Frank Shorter.

Hmmm…. Could Frank be Alice? The similarities are uncanny….This is an Uber compliment if you ask us !

Arnold Palmer, Gait & The difference between Muscle Tightness vs Muscle Shortness.

Arnold Palmer did not exactly have the prettiest golf swing but we doubt too many are going to argue that in the height of his uber successful professional career he should mess with it.

One of the gait guys used to date (eons ago) a gal who’s father used to be on the PGA tour. (Although it was not the case, Go ahead and accuse us of using her to get to him ! We have no shame. LOL). We got to golf with him once a week. Needless to say there were deep lessons each time they went out. Some days it was “today we will play with a 7 iron and a putter and nothing more”. But one lesson that really stuck out was …. “Don’t be afraid to bet against the golfer with a beautiful swing who can golf well most days…… be afraid to bet against the golfer with a butt-ugly swing that always hits the middle of the green in 2 strokes every single time.”

Now, this may be a confusing point. What this meant in the golf world was that if you do something enough times, no matter how bad it looks, you will get really consistent and accurate with it. You can bet on it. Now this does not mean there is not a better way, a smarter way, a more economical way. Ask any golfer who cannot hit a driver but can groove a 3 wood and they will tell you they will pick out the 3 wood every time in friendly competition over the risk of driving the ball off the Tee with the driver at the risk of entering the woods or deep rough. That does not mean that picking up the driver at the range and getting some lessons would have a better and wiser outcome in time.

Our point here today is that many times there is a better way, our bodies just cannot always find that better way on the working body parts available. Hitting the driver is just a different skill set and needs some different skills and work to harness its benefits. When we cannot find a “better way”, because of muscle inhibition from an injury or from challenged anatomy (ie. forefoot varus) or for some other reason, the body will attempt a reasonable strategy. It will be a strategy to protect the involved joints, to maximize ranges of motion and over all limb function, as best as possible. Sometimes this works for a short while, sometimes for months or years. But it is usually inevitable that the compensation will fail or the repetitive nature of the tasks will tax the tissues and end in pain or injury.

Sometimes we find a better way on our own, sometimes we need help to find a better way around problems. Heck, we all need crutches for a sprained ankle from time to time, but after the first few weeks we do not continue to use the crutches. Eventually function must be restored. Either the pristine biomechanically correct function, or a compensation pattern. One is optimal with little consequences, the other is suboptimal. The real trick is knowing if you have the optimal pattern or if you are adding strength and putting miles on the compensation pattern. Sometimes it is hard to tell.

We will choose conscious incompetence any day over unconscious incompetence. We would rather know we are doing something wrong so we can correct it, or at least be able to monitor it.

So, next time you are foam rolling your “tight” IT Band or stretching out your tight calf……. we hope you will ask the question, “am I bandaiding the problem or am I fixing the problem?” Remember, tightness and shortness are not the same beast. One is a neuro-protective phenomenon and the other is just plain vanilla shortness. One needs stretched and the other craves the strength around the joint to afford the protective tightness (the heightened tone) some resolve.

Athough we love Arnold Palmer, we bet had someone caught him early enough in his young career he would have opted for the optimal swing as opposed to what we all grew to know.

Now, go watch the Masters on TV !

Four !

Shawn and Ivo

Shoe Retail Thursday: Today we have a client in some shoes that appear to be a good match, until you look more closely.  See if you can see it.

“ Just because the shoe fits, doesn’t mean you should wear it ! ”

- The Gait Guys

First of all, we apologize for the crummy video. But we were scouring through some old stuff while working on our long awaited “Shoe Fit” program and this video just had to be shown. This is a short video, you might get some  vertigo from the nasty camera work. Sorry about that. 

Initially this client looks great from behind. The rear foot looks neutral, no valgus heel collapse into rearfoot pronation and no over burdening of the lateral crash zone (lateral/outside tipping of the shoe into supination).  If anything could be said, they look like there could be a subtle rearfoot supination from the initial shot before they start to walk. 

We are also not sure what shoe this is, we do however know it is a New Balance stability shoe from the video.  This client had purchased these shoes 1-2 weeks prior in a trusted high end specialty running store.  As the client walks away from us everything looks pretty good. We could point out some subtleties but those are not the point of our talk today.  It is not until they come walking back that something is clearly wrong.  Did you see it ?  The LEFT foot is drastically supinating displaying a lateral weight bearing shift all the way through toe off.

Now, on the surface this is a simple case.  (We just shot a concept video last night to take this blog post today to the next level. We will present it next week once we get it edited.) But the points we need you to understand today are :

1. Just because someone has a flat foot standing in front of you does not mean they need a stability shoe.  We see plenty of folks who are serious walkers, runners all the way up to professional athletes who have flatter, or flattened, medial longitudinal arches but still have very strong competent feet.  There are ethnic groupings that have flat feet.  So just because a foot looks flat does not mean one should reach for a stability shoe or an orthotic or additional foot bed insert.  This client had flatter arches but had competent feet.  They also had some issues of tibial torsion that negated some of the challenges of flatter feet.  So, our point here is what you see is not always what you get, nor what you should fix either for that matter. 
2. What should happen in a shoe does not always truly happen.  This means you have missed some calculations or you simply do not have enough experiential wisdom to predict the oddities in certain situations or with the given anatomy of a given athlete.  This comes in time, with experience.
3. Sometimes supination is not really supination. This client has a flatter foot. Flatter feet do not supinate well. Ok, better put they run out of time to supinate the foot because they have spent too much time into the pronation phase. However, they also could have weakness in the supinatory mechanisms to drive it adequately. Remember, some clients will fall into their weaknesses and some will strategize to avoid the weaknesses if they have enough body awareness and strength to do so.  They just do not seem to have the skills to find the more appropriate pattern to correct the underlying issues. But there is certainly something positive to be said to knowing you have a problem and that you are cheating around it rather than being oblivious.

This case was possibly, maybe even likely, one of several problems:

1. wrong shoe for the foot type
2. possibly a faulty shoe fabrication
3. poor strategy to make for a rigid foot structure

This case also draws clinical inquiry into:

• whether there is weakness of the ankle and forefoot everting muscles namely the peronei and extensor digitorum longus and brevis. * This the topic of the video we are producing because these muscles have huge implications in the cross over gait (which we have senselessly beat you all with in previous blog posts) at the lower end of the limb.

Who are we ? The Gait Guys…… Shawn and Ivo.  The dynamic duo of all things gait.

Neuromechanics Weekly: Gait and Running and the Crossed Extensor Responses

This week we discuss why upper and lower limbs are paired in gait, and the neuronal wiring that is involved.

Yup, this is pretty geeky stuff, but geez…isn’t it nice to know WHY something works? Think of the implications if YOU DON’T see the upper and lower limb pairing. Think of the implications during rehab. One limb SHOULD be doing the opposite of the other AND always look at the upper limbs and arm swing. Yes, the central  nervous system is involved. It is more than just biomechanics, perhaps this is why this stuff comes easier to us because of our deeper neurology background. The whole is greater than the sum of the parts….

Ivo and Shawn

More on Micah and the future of ultra marathoning: click for AP article link

Quiz: Let’s see how your blog reading has been going. 

These 5 photos are of a 2.5 year old child brought into your office for evaluation by his father. They have been seen by another practitioner who has given him orthotics with full length varus posts to wear.

• What do you see?
• What is your assessment?
• What do you tell the parent?

In the standing views, what stands out?

1. a moderate rearfoot (calcaneal) valgus (ie. rear foot medial  heel collapse)
2. the flattened medial longitudinal arches of the foot ( ie. a little flat footed)
3. the genu valgus (ie. knees are a little “knock knee’d”)
4. he bears weight separately on each lower extremity as you can see from the pictures.  He never bears weight on both limb symmetrically, there is much weight bearing shifting meaning there is always a dominant limb bearing most of the weight.
5. the knees face inward in the standing position
6. the feet point outward (with the knees straight) in the supine position

did you see all of these?

What is your assessment?

1, 2)  pes planus and hyperpronation are the norm for children under 6 years of age

3) genu valgus is not abnormal in children, with many presenting maximally at age 3, and usually resolving by age 9 (see our post here)

4) he bears weight separately on each lower extremity (L>R from rear, R>L from front) so there probably is not a leg length discrepancy.  This is often a hip-core stability issue and as fatigue sets in weight bearing shift is automatized. 

5,6) This child has external tibial torsion. As seen in the supine photo, when the knees face forward, the feet have an increased progression angle (they turn out). We are born with some degree / or little to none, tibial torsion and the in-toeing of infants is due to the angle of the talar neck (30 degrees) and femoral anteversion (the angle of the neck of the femur and the distal end is 35 degrees).  The lower limbs rotate outward at a rate of approximately 1.5 degrees per year to reach a final angle of 22 degrees….. that is of course if the normal derotation that a child’s lower limbs go through occurs timely and completely.

What do you tell the parent?

1,2)  Although research shows that wearing arch supports (navicular wedge or “cookie”, not a full varus wedge as was the case here) can speed development of the the arches, they will in fact most often develop regardless of supportive footwear or support.  Many studies show that footwear impairs muscular development of the foot. One study showed that arch supports in children prevent derotation of the talar head and promote development of a Rothbart Foot Type. How about some flexible shoes (or no shoes) for the boy?  (need to review the Rothbart foot type ? click here for one of our very first blog posts on the topic)

3. We will measure the genu valgus and track it every 6 months to make sure it is regressing. If it persists or becomes worse, we may address it then. How about having your kid walk barefoot?

4. no worries, he is resting each side as the other fatigues. Endurance development takes time, just like marathon training. For gosh sake, the kid is 2.5 years old. Give him a break !

5,6) We will measure his progression angle and degree of torsion every 6 months (along with the genu valgus). This is normal up to reaching skeletal maturity.

Well, how did you do?

Corrective exercises are always nice, but when is too soon? Can their immature nervous system handle it ?  CAn they comprehend the exercise ? Sometimes turning them into a game and taking what you can get is good enough to help promote healthy limb derotation.  Walking with the toes up helps develop arch independence and helps to teach the brain about the foot tripod. But at 2.5 years old, good luck expecting more than that.  

The Gait Guys: two handsome bald guys (one by genetics, and one by aspiring choice) aging gracefully and promoting foot and gait literacy, one case at a time.

Ultrarunning Running has lost one of it’s best, the 58 year old from Boulder Colorado, Micah True. Full story of what we know here: http://abcnews.go.com/US/micah-true-ultrarunners-body-found-mexicos-wilderness/story?id=16048218#.T3j03e3Da20

Often times, we find ourselves in a difficult place, often because we made a bad decision. Sometimes, we are in a difficult place because someone decides for us. We must remember that only you have the power to change. If you do not know things are supposed to be different, then they don’t have to be.

Confucius once said “It does not matter how slowly you go so long as you do not stop.”

On your quest, don’t stop

Have a great Sunday

Ivo and Shawn