Barefoot Versus Running Shoes: Which Is (Surprisingly) More Efficient?→

Many folks extol the virtues of barefoot or minimal running shoes and or styles. We have contended that you often need to “earn the right” to be able to do this through our mantra “skill, endurance, strength”.

Here is an interesting take by Alex Hutchinson from Runner World and his review of Franz, Wierzbinski and Kram’s study published in Medicine and Science in Sports and Exercise, explaining why, metabolically speaking, shod running may be more efficient

The Gait Guys: sifting and surfing so you don’t have to…

For the 1st time ever, the Gait Guys are offering a “celebrity gait instructional series”…

OK, maybe not; but forensically speaking, you will recognize this gait immediately

Have a great Friday

Shawn and Ivo

Plantar Fascitis?  

 

You’ve got plantar fascitis? We’ll try steroid injections. If that does not work, no problem, we’ll just cut it out…. 

 

Ah, yes…..Nothing like cutting one of the main stabilizing influences for the foot (via the windlass mechanism) to accomplish your goals. We sure are glad they used dead feet in this study!                 

And now, here is more evidence that those ligaments play a significant role (along, of course, with competent musculature) in stability of the foot.    

          The conclusion: “The data suggest that operations involving fasciotomy affect arch stability and should not be performed in patients with evidence of concomitant pes planus deformity, because of the likelihood of further deformation.”    

 

                                                                                                                                   The Gait Guys: Just the facts, so you can make more educated decisions..                                                              

                                                                                                                                  Foot Ankle Int. 1997 Jan;18(1):8-15.

Mechanical behavior of the foot and ankle after plantar fascia release in the unstable foot.

Kitaoka HB, Luo ZP, An KN.

Department of Orthopedics, Mayo Clinic, Rochester, Minnesota, USA.

Abstract

The change in position of the bones of the foot was studied in three dimensions after plantar fascia release in intact and destabilized feet. Fifteen fresh-frozen human foot specimens were used. Physiologic loads of 445 newtons were applied axially to simulate standing at ease, and the three-dimensional position of tarsal bones was determined with a magnetic tracking device. The positions were presented in the form of screw axis displacements, quantitating rotation, and axis of rotation orientation. After fasciotomy in the six intact feet, significant differences in rotation were observed at the talotibial and calcaneotalar levels. After fasciotomy in the four unstable feet with three supporting elements sectioned, significant differences in position were observed at the talotibial joint and a significant decrease in arch height was observed. After fasciotomy in the five unstable feet with five supporting elements sectioned, significant differences in rotation were observed at the talotibial joint (mean, 5.5 +/- 1.6 degrees; P = 0.001), calcaneotalar joint (mean, 6.1 +/- 2.1 degrees; P = 0.003), and metatarsotalar level (mean, 9.3 +/- 4.1 degrees; P = 0.007). The average decrease in arch height was 7.4 +/- 4.1 mm (P = 0.015). Displacement of all joints tested occurred after fasciotomy, with rotation about all three axes. These changes in displacement were more pronounced in unstable or destabilized feet. The data suggest that operations involving fasciotomy affect arch stability and should not be performed in patients with evidence of concomitant pes planus deformity, because of the likelihood of further deformation.

http://www.ncbi.nlm.nih.gov/pubmed/9013108

Recognize this one? Gait evaulation of a skunk. Pepe Le Pew. We did this post a year ago. Has it been a year already ? This one is worth looking at again.

The Foot Slap Gait Style:  

This is a funny little video that shows a few important points.

Our purpose here is to help train your eyes to the important things.  There are multiple clues in every gait compensation.  There is head movement (which we will discuss in this case), there is arm swing (is it equal and symmetrical), torso rotation, hip lateral sway in the frontal plane, violations of sagittal knee progression, and then the always difficult multiplanar foot and ankle motions as well as so many other parameters we consider.  So, when one component goes wrong, with enough experience and skill, one can make predictions as to what is wrong.  And, the more flaws (correlative compensations) that are noted, the higher the predictive value of the assumption.  After decades of doing gait analysis, as with anything, a skill is developed and an art in doing it begins to take shape, as we will see here (without stop frame, without foot mapping devices etc).  One begins to form a mental algorithm to the process.  We always start with, “is the head silent in the vertical, frontal and sagital plane?”.  When a person’s gait is off, the head is almost never silent in space.  And arm swing also begins an assymetrical pendulum effect.  This could be called an energy conservation mode (as talked about in the article on the blog entitled, Dynamic Arm Swing in Human Walking, (http://www.ncbi.nlm.nih.gov/pubmed/19640879) where it was determined that normal arm swinging required minimal shoulder torque, while volitionally holding the arms still required 12% more metabolic energy. Among measures of gait mechanics, vertical ground reaction moment was most affected by arm swinging and increased by 63% without it.

  So, as  you do this more and more you will develop the skills of observation to improve the art form of assessing one’s gait.  But remember this KEY POINT *** what you see is mere information gathering, it is not always and frequently ever, the problem that you see.  You are seeing their compensation pattern around some neurologic, orthopedic or biomechanical problems…..things that are making a silent pristine gait impossible.  You MUST then, take this information and correlate it to your clinical findings in terms of neuro-orthopedic-biomechanical limitations during your exam.  Things like, joint range limitations, muscle weakness, instabilities and the like….things that you cannot accurately detect just watching or video taping a person’s gait. So, you are trying to take what you see, and what you find, and develop a logical algorithm as to where their problem lies and one that tells a solitary lesion logical mechanical story as to the gait pattern you are seeing.

OK, soap box aside………

lets build on that skill set we are trying to develop, the powers of observation and what they COULD mean.

THE SKUNK FU GAIT:

The first thing we see is, the Sagittal head bob.…..each step there is a propulsive head anterior oscillation and then dropping downwards at the end. This can mean there is an apropulsive problem in midstance such as loss of ankle rocker but that is not so in this case, the ankle rocker is great.  The head drop in this case coincides with successive heel strikes each time.  This in essence means that they are dropping from a height each time.  How can this be ? The little fella is on flat ground ! (more on this in a minute).  This could mean a lack of core maintenance in the late midstance phase of gait (heel rise-toe off) and subsequent movement onto the next heel strike.  This can come from overstriding, as in this case, but it can also come from an aggressive forward lean in a person’s gait style (like walking into a strong head wind).  In this case, we have a more reasonable ASSUMPTION, it comes back to the “falling from a height issue”. In this case, lack of adequate anterior compartment lower limb strength (tibialis anterior and the long and short toe extensors, EDL, EDB, EHL, EHB) allows PEPE to move from heel strike to foot flat in an uncontrolled and abrupt fashion.  When this occurs, pronation (even the normal amount of pronation) occurs fast.  And we know that when a person moves from supination to pronation there is a drop in height of the arch and thus a drop in the body (try this to prove the point, …..stand up straight, look in a mirror and begin raising up your toes and then dropping them.  If you do it right, each rise of the toes should raise the arch (The Windlass Effect), and each fall should drop the arch demonstrated in the mirror by a rise and fall of the head vertically.)  And so here you have the height differential in this case.  So, in a nutshell, PEPE is over-striding (as evidenced by his also aggressive arm swing), and falling hard from  heel strike abruptly into foot flat, a double whammy !  There is basically zero eccentric phase activity of the lower anterior compartment musculature and so the foot accelerated to the ground from its starting peak height at heel strike.  The poor fella probably has a raging anterior shin splint condition because of this but you would be hard to tell from the smile on the little stinkers face.  …………but remember, prove your facts on the table……who knows, maybe he has posterior column spinal cord disease, but an examination will have to be done to confirm your findings and suspicions.  In this case, we highly recommend an upwind exam table and plenty of air fresheners. 

we remain,…  The Gait Guys

Gait, Running, Dance, Martial Arts and the Mirror neurons of the brain. Today The Gait Guys put it all together.  (Why you need to get familiar with mirror neurons).

When was the last time you actually truly “listened” to music and “used it” while you worked out or ran?  Many of us do it, but many of us are not using the music to its optimal advantage. This is something we will talk about at the end as we summarize today’s very important article.

Beautiful human movement is something to behold.  Being able to watch and appreciate beautiful movement does several things within the brain.

According the the Scientific American Article (LINK) by Columbia University neurologist John Krakauer:

“some reward-related areas in the brain are connected with motor areas …  and mounting evidence suggests that we are sensitive and attuned to the movements of others’ bodies, because similar brain regions are activated when certain movements are both made and observed. For example, the motor regions of professional dancers’ brains show more activation when they watch other dancers compared with people who don’t dance.”

Many things stimulate our brains’ reward centers, among them, both the participation in and the observance of coordinated movements thanks to our mirror neurons. Today we show an example of the world famous Slavik Kryklyvyy once again. The combination of the physical capabilities and the artistic rendering of the fluid and complex movements stir something in your brain.  Thanks to the mirror neuron cells in the brain’s cortex, which link the sensory experience from when a person is performing a movement or when watching someone else do it generates a subsequent motor experience in the brain.  Watching someone execute a complex athletic task for example, your brain’s movement areas subconscously activate and mentally plan and predict how the athlete would move based on what you would do. We do this when watching sports all the time. How many times have you watched an athlete and either verbally or mentally said to yourself “Oh man ! That was a dumb move ! I would never have done that ! I would have done ______ !"  Krakauer mentioned, ” the motor regions of professional dancers’ brains show more activation when they watch other dancers compared with people who don’t dance.“  This will be the same for all athletes. This is the same neurologic phenomenon that also allows you to truly appreciate a movement when it is done with amazing skill and precision.  Think of Cirque du Soleil and you will instantly know what we mean.

Watching Slavik move in the video above is complex motor tasking at its best. Dancers are amazing athletes, they are not just dancers. They are much like martial artists. Take Capoeira for example. It is a Brazilian martial art that combines elements of dance and music. It was created in Brazil mainly by descendants of African slaves with Brazilian native influences. It is a complex and feared martial art known by quick and complex moves, using mainly power, speed, and leverage for leg sweeps. It is a beautiful art, and a deadly art.

So, why does music make it that much better ? It is the same reason why weddings are less touching without music.  It is why music is used in church. It is why dance is paired with music.  Music stimulates the pleasure and reward areas of the brain, such as the orbitofrontal cortex, the ventral striatum and the cerebellum where timing, coordination and movement planning is performed. The combination of music with the motor task amplifies the reward zone in the brain. It is the task of trying to add timing and rhythm to movement that makes these activities that much harder, but that much more rewarding to the brain.  Runners who run with music, those who truly hear the timing and rhythm of the music and then use it in their workouts get a little something extra out of it. But sadly so many people "just listen” to the music instead of incorporating it into the movement.  A smart runner will vary the music and combine it with a run to vary tempo, cadence, speed etc.  That way the brain will be on fire and dish out rewards at a  new level. Dancers have no choice but to force the issue. We will sometimes use a metronome snapping of our fingers or clapping in the rhythm of a clients gait to help them hear the rhythm of their gait, particularly when it is arrhythmic due to pain or faulty biomechanics. We will do this so that it cues a heightened awareness in them. Seeing, feeling and hearing are all additive when sensory-motor relearning is concerned.

Gait and running are complex movements which we take for granted.  They are so automatized that we really do not realize how complex and amazing they are until something goes wrong or until someone brings the subtle flaws to our attention.  Maybe it is a stroke that compromises it, or maybe a neurologic disease like Parkinsons, or maybe it is as simple as a sprained ankle, a torn knee mensicus, a strained hamstring or a degenerative hip.  But any compromise to this complex sensory-motor task of ambulation immediately brings about a recognition that something is wrong to the skilled and aware observer. As in life, we do not appreciate something until something goes wrong with it.  Getting good at recognizing beautiful clean fluid gait and running is our job, and it is now your job. Now that you know better you cannot ignore gait in your clients, your artists, your athletes. Now that you know better, you must hold yourself to a higher level of expertise. Knowing what beautiful looks like will help you better understand what loss of beauty looks like.  It is what will make you better at understanding gait and human movement and locomotion and better at your chosen craft. It is what will heighten your appreciation of the amazing beauty of the human form and motion, whatever form it might take.

Shawn and Ivo,  the gait guys

The Collective Goal of Natural Running. The Gait Guys Opinion.

Is this minimalist shoe trend a fad or is it truly a trend? What is the truth. (What are you not being told ?)

It appears that over the last few years this question is finding its own answer, for the most part.

We believe this minimalist direction has become entrenched enough now seeing the increased work and attention from most companies. We suspect that this is a firm trend which will not be going anywhere soon, although modifications will be likely. The research papers are convincing that there are benefits. However, we feel the industry is not spending enough time discussing the risks and concerns. And we are finding out that there are two issues here on that topic.

1. That discussing the demerits of a product is not likely good marketing.

2. One must know the underlying problems around the product, and more importantly the foot that is going into the product to understand a product’s drawbacks and risks.

None the less, there are issues not being talked about.

The fact of the matter is that some foot types do not, and never will, have any business being in such minimalistic shoes (ie. a rigid flat foot pes planovalgus or a rigid forefoot varus foot type are just a few examples). We remain concerned about the vague existing dialogue that these types of shoes will make everyone’s feet stronger. For some, they will, but many times strength education must be directed (There is a right way to do a squat, and a wrong way. There is a right strategy for toe off, and a wrong one.). With the wrong strategies employed, one can easily strengthen the incorrect motor patterns. Merely putting on a minimalistic shoe does not mean that the correct patterns and strategies for foot strengthening are being instituted. The shoes do not come with a magic potion guarantee. For those with challenged foot types (FF varus, Rothbart Foot, cavovarus foot, excessive tibial varum and/or tibial torsion etc) these folks will likely trend towards local foot problems or injuries further up the kinetic chain (hip, knee, low back etc). Understandably, these are heavy medical terms and conditions but they are very much out there in the running public and with little attention to the “buyer beware” warning when attempting to add a minimalist shoe to their mix. We know these issues exist, we see them daily in our clinic. As we see it, the problem could be that those providing the education often do not have enough clinical background to know what these issues are let alone recognize them or prescribe the right shoe for the combined presentation . So how can they then draw these issues to the surface in educating the public ? As we say in our lectures, “You first have to know what a platypus is in order to identify it. Otherwise it is just a hedge hog with flippers and a duck bill.” This is the elephant in the room that everyone is missing, everyone except us. We get the folks who are running in these minimalist devices and we get to see those who should never have been in them in the first place.

The good thing is that many companies are setting up educational programs to help folks drop down into “minimalism 2.0”. But still, to date, two problems exists in that arena.

1. no one is talking about the elephants in the room, those being those foot types that are too risky to be in the shoes and even more specifically, how to strengthen the foot. But who would admit to those risks, that would be stupid advertising.

2. those teaching the courses and those individuals that rep for the companies and act as an intermediary between the shoe company and the store either do not have the fundamental knowledge to educate the shoe stores about the merits and demerits of the products or they find there is too much of a knowledge gap between the parties so things are left unspoken. You have to be able to see the elephant in the room to address it.

It is at the heart of these issues that we feel we can make a difference. A few companies are finally listening to us on these topics. We are getting more calls, emails and inquiries as to how we can help them bring these issues to light and improve upon their products. Sadly, most companies are not doing the same and we feel they will be left behind. Companies are sharing exciting yet difficult challenges and many are struggling to catch up. Some of them are really on board and doing their homework and are coming to the table with really impressive dialogue. We are excited to work closely with these types of companies so that all runners can reap the safe and effective benefits of better products and more knowledgeable intermediaries. These companies, some big, some small, get a big thumbs up from us because the knowledge behind the product is spot on but more so because the product is excellent and does what it says it is supposed to do and goes beyond what the other products seem to be doing at this point. But there is always someone around the corner pushing the guys at the front.

Our one ‘stick in the mud’ issue is that still no one is talking about the elephants. And we believe its mostly because no one can see them. There is a main danger in doing too much barefoot running too soon. We made this clear initially on Vibram’s website when we wrote the part on how to progress out of your running shoe and down into Vibrams. For us it is, and has always been, about “keeping them honest” and putting out the facts. But don’t expect us not to make mistakes, nor to not own up to them. But do expect us to try to “right the wrongs”. From time to time we try to make the calls on the products that have questionable statements and applaud those that stick their neck out to do the right thing. We do not know everything, but we seem to know much more than many when it comes to the biomechanics of what is going in a product and in knowing when there is a giant tusked animal in the room.

If you put 10 different feet in a product, you will get 10 different biomechanical presentations from the shoe, and that is the difficult truth. So, logically, much of what is being missed is the education of that issues and of what is going on in the shoe, and that is our world. It is usually the problems that exist with the thing you are putting into all of these products, a person. A person who likely does not have the classic middle of the road, ‘Average Foot’ these shoes may have been designed and researched around.

To us, the most important thing is to raise the knowledge and awareness to the public, shoe companies, shoe stores and everyone else in between.

At this point, if this minimalist shoe trend is to survive we believe there must be enough companies that extol the virtues of honesty and education to the end user, the shoe company-shoe rep intermediaries, running form clinic presenters and educators. And, that means talking also about the elephants in the room. Our new, soon to launch, Shoe Fit Educational Program will help everyone get on the same page, and the same elephant.

Shawn Allen and Ivo Waerlop……… The Gait Guys

What’s your foot type? : Part 3 of a 5 part series

Forefoot varus.

Here the forefoot is inverted (twisted inward about its long axis) with respect to the rear foot and the big toe side of one of the front legs of the tripod is able to touch the ground without compromising normal mechanics and collapsing medially to bring the foot to the ground.  In doing so, this foot like the rearfoot valgus foot, has to rotate internally more dramatically, forcing pronation (dorsiflexion, eversion and adduction) to occur more violently and for a longer period of time.  This action drags the knee medially and leads to the same hip and pelvic stability and external rotation challenges we discussed in the rearfoot valgus, as well as patellofemoral tracking syndromes.

A little lost? We were too. That’s why we have this blog and have come up with a the only of it’s kind “Shoe Fit Program” . Launching soon with the new website. The Shoe fit functional testing module (also available separately from the 3 part program) discusses foot types in more detail.

WE ARE The Gait Guys: foot and gait literacy for everyone! 

The Gait Guys are Ridiculously Esoteric (apparently)

Any attention to your work is good attention. This one made us truly smile (it means we are doing our job) …. we will take being ridiculously esoteric as a compliment ! If paying attention to details wasn’t important no one would never do it. Take any professional (athlete or otherwise) and ask them not to pay attention to the small details of their craft and see how far they get !

http://www.sherdog.net/forums/f13/gait-guys-1892419/

“Here’s a fine series of videos designed to make you paranoid about walking. Some of the videos on their (The Gait Guys) channel veer into ridiculously esoteric territory of interest only to brain surgeons, but there are also several comprehensible explanations of the workings of the hip, the foot and some great practical assessments…

History Lesson Saturday:  The Shoe Fitting Fluroscope

The following was copied from the following YouTube Channel, LINK here.   Please visit their, “The Historic Workplace & Environmental Health and Safety Films” YouTube page at that link.  This is good historical information. Rather than put it into our own words and risk degrading its thoroughness we quote it here.  It is good to look back at history. Some folks say this because we are told that those who do not know the history of things are destined to repeat them.  However, we have heard it put “History will repeat itself. Knowing history will make us aware of when it is about to repeat itself."  Enjoy this piece of history.

"The shoe fitting fluoroscope was a common fixture in shoe stores during the 1930s, 1940s and 1950s. The first fluoroscopic device for x-raying feet may have been created during World War I to eliminating the need for patients to remove their boots, to speed up the processing of the large number of injured military personnel who were seeking help. After the war the device was modified the device for shoe-fitting and showed it for the first time at a shoe retailers convention in Boston in 1920. The X-ray Shoe Fitter Corporation of Milwaukee Wisconsin and the Pedoscope Company of St. Albans in the U.K, were the two largest manufacturers of shoe fitting fluoroscopes. In the early 1950s, estimates placed the number of operating units in the United States, the United Kingdom and Canada at 10,000, 3,000 and 1,000 respectively. After WWII, the manufacturers of shoe fitting fluoroscopes became concerned that their products would have to meet a myriad of standards that varied from location to location, and they asked the American Conference of Governmental Industrial Hygienists (ACGIH) to recommend a uniform set of standards. The ACGIH did so and issued their guidance in 1950, an event that allowed the manufacturers to advertise that they met the ACGIH standards. By the early 1950s, a number of professional organizations had issued warnings about the continued use of shoe-fitting fluoroscopes, A few years later, Massachusetts passed regulations requiring that the machines be operated by a licensed physician. In 1957 the State of Pennsylvania became the first jurisdiction to ban the use of shoe fitting fluoroscopes. Attempts to impose regulatory restrictions on the use of shoe fitting fluoroscopes seem to have been limited to the United States . These machines continued to be used in Canada and the UK to a limited extent, at least until 1970. Many shoe salespersons put their hands into the x-ray beam to squeeze the shoe during the fitting. As a result, one saleswoman who had operated a shoe fitting fluoroscope 10 to 20 times each day over a ten year period developed dermatitis of the hands. One of the more serious injuries linked to the operation of these machines involved a shoe model who received such a serious radiation burn that her leg had to be amputated. For more on the history and use of these devices, go to: http://www.orau.org/ptp/collection/shoefittingfluor/shoe.htm . This clip is from the 1920s silent film, General Personal Hygiene, available on the Internet Archives.”

Does your Yoga Tree Suck ? Yoga tree for runners.

Look at the 2 photos above. Click on the lady in the blue shorts so you can see her full photo and then toggle back and forth between the 2 photos. Both show a lady doing the Yoga Tree pose.  There are alot of ways to do this post.  Which one is right ? Which one is best ? Is one wrong ? How can a runner, and all of us for that matter, take advantage of the Tree pose ?

This blog post is all about PROPERLY improving strength and PROPER motor programs of the stance phase leg so that the opposite pendulum swing leg works through the simplest freely swinging swing phase.  A correct swing phase will result from good stance phase biomechanics on the stance side.  So what you do on well on one side will render safe mechanics on that side and show good results on the opposite side or it if what you do it poor mechanics, it risks both sides for functional pathology and injury.

In the 2 photos we see two different levels of the two pelvi. One waist line is horizontal and the other is on an angle.  Do you know which one is more correct ? Draw a vertical line in your mind from the foot up through the body on both ladies.  Can you see that the lady in the black leggings has far more body mass lateral to the line ? Look at the dramatic angle of attack of the leg into the ground (draw a mental line from the hip joint to the foot on both, the line is much more vertical in the lady with the blue shorts.) The lady on the left in the blue shorts shows good gluteus medius use. The stance phase leg is more vertical, the pelvis is elevated on the swing leg (the bent knee side in this case) and with that same vertical line reference there is little more than the lateral hip outside/lateral to the line. Shorts-lady shows opposite pelvis elevation acquired by good stance leg gluteus medius and abdominal core use.  This stance limb is in the concentric-isometric gluteus medius phase.  The lady on the right has a lower pelvis and a laterally shifted pelvis.  The body mass is over the hip joint (for you detailed fact “sticklers”, yes she could be moving the non-stance phase pelvis down through the hip frontal plane via an eccentric exercise if she is doing a dynamic tree pose).  None the less, this lady’s static posture requires very little gluteus medius use because she has most of her body mass over her hip joint axis.  The gluteus medius under needle EMG would show very little activity. This is an easier Tree pose and this client is not getting all she can out of the pose.  It would ask more of her gluteus medius and core as well as more lower limb and foot strength, skill and balance to do what the lady on the left is doing.  Try it yourself. Are you getting as much as you should out of your tree ? IS your balance really as good as you think it is if you are doing the pose right ?  The lady on the left will have to work harder but will get far more out of the pose.

The lady on the left in the blue shorts also has her hands above her body, extending actively reaching for the ceiling. This will lift the rib cage from the pelvis and make it more difficult for the abominals to stabilize the core. This is a level-up challenge. Plus the arms when not out to the sides cannot act as balance stabilizers.  The lady in the shorts is getting far more out of her pose and is working for that smile. 

As a runner this is a GREAT exercise. We have our patients do this one for homework to teach, learn and master the use of the gluteus medius and core musculature.  Afterall, you need these muscles to be optimal during each stance phase when you are running.  Each landing is nothing more than a rushed single leg stance, and you can do it right and stay injury free or you can do it wrong and risk some down time.

* key point= make sure you keep your pelvis in the frontal plane, many folks will let the pelvis spin (the non-stance leg) can drift backwards. Thus you are spinning your pelvis on the stance leg. Most unknowing people will let it spin until they find the point where they have good strength and balance.  What is the point in doing that !!! ????  Do the pose where it is challenging, not where it is easy ! 

* Now for your test: Based on what we have talked about here today, watch this very short video of 2 gentlemen doing the pose and see if you can see which of the 2 needs more gluteus medius work, or at least which of the 2 needs to work on abducting the hip better ?  One of the 2 is more stable in the frontal plane, and does not drift laterally.  Ready ? Go ! VIDEO LINK

Cross train to stay injury free.

Cross train smarter, not harder or longer.  Get the most out of what you do. 

Shawn and Ivo.  Just 2 trees in a very large forest.  And using the optimal view of the forest that we have had for so very long (40+ years of clinical practice) to help other trees to grow up straight and strong.

Retail Focus…Really…

The Vamp: What you need to know… (3 pics here today)

Vamp may refer to anything from a Norwegian folk band, a repeating musical figure in a song, a femme fatale, a vampire, a movie, action figure or comic character. It can also be part of a shoe. 

For our intents and purposes, though these are all interesting topics, we are going to limit our discussion to shoes…

Every shoe has an upper part that helps hold the shoe onto the foot. The “vamp” refers to the upper at can cover anywhere on the top part of the foot between where the toes and the legs connect to the foot.

In styles that don’t offer a lot of coverage on top of the foot, the part that covers the tops of the toes might also be referred to as the vamp. Closed footwear, such as boots, trainers and most men’s shoes, will have a more complex upper. This part is often decorated or is made in a certain style to look attractive.

The vamp has a medial and lateral part. The medial vamp (located on the inside or big toe side of the shoe) often gives support to the medial longitudinal arch of the foot (since most shoes offer little if any arch support in and of themselves). Likewise, the lateral vamp can (but often does not) offer support to the lateral longitudinal arch.

Most folks like shoes with a larger, snug medial vamp, because it “feels” better and that’s what they are used to. Then again, most people wear shoes that are too tight for their feet anyway. More on this in a post on the Brannock’s Device.

The Vamp. An athletic supporter for your feet : )

Ivo and Shawn. Definitely Foot geeks, but not shoe vamps.

MBT Revisited:

Perhaps you have read our previous thoughts on the MBT shoe. If not, click here, or listen to an old podcast here.

This is a video from their website which has a few redeeming qualities and teaching value.

1st of all, we notice that the shoe is rockered in the saggital (:02-:05 and :49-:54) AND coronal (:55-:59) planes. Rockers in the saggital plane are a Godsend for folks with hallux limitus and functional hallux limitus (limited ablility to dorsiflex the great toe, aka Turf Toe). Rockers in the coronal plane (the side to side motion plane) promote medial/lateral instability. This can be therapeutic, but ONLY if you have earned the right (through skill, endurance, strength) to be able to handle that instability. Challenges to the coronal plane, sometimes referred to as the lateral plane, are helpful in rehabilitating things like ankle sprains. Rockers, in general, have a higher metabolic cost and require greater proprioception and skill to handle, thus the “increased muscle activation” (1:12-1:23).

A saggital rocker can decrease stress on the knees and hips (1:27-1:30) because it limits the amount of ankle dorsiflexion needed and the “rolling” motion assists in knee and hip flexion. This increased motion comes at a cost of increased hamstring activation (1:15-1:17) and a smaller increase in gluteal activation (1:18-1:20). Do we really want to promote the hamstring dominance when the gluteus medius-maximus team is supposed to help carry us through the gait cycle? Remember, the Gluteus Maximus is only supposed to contract up to the moment before midstance, with a burst at toe off.

It would be interesting to see what effect (positive or negative), or if any, they have on foot intrinsic activity. With a rigid last (you cannot bend these shoes because of the rigid built-in rocker) the foot may be pretty silent since the shoe merely passively rocks you forward into each step.

On a positive note, they do promote a more upright posture (:18-:27) compared to a traditional heeled shoe which purchases the user forward as noted in the video.  The shoes also have a decreased amplitude of vertical oscillation (:19-:22).

We again caution that need to “earn” you way into this shoe, and though it can be a  rehab tool, we do not feel it is a great shoe for day to day activities or running in.  One of our greatest concerns, other than what the shoe can be doing to the normal function of the foot muscles and joints, is the extremely soft crash-entry zone at the rear 1/3rd of the shoe (depicted here in red in the video).  The EVA  foam is so soft that a heel strike cannot be achieved. Heel strike is part of  normal gait. However, as we have coined, there is a difference between heel strike/impact and heel contact.  We recommend the thought of the heel “kissing” the ground and smoothly transitioning to midfoot strike, no matter what shoe is used in walking.  Certainly running is a different matter, we prefer midfoot strike, where the foot type is accomodating so such a strike.  Not everyone has a foot type that will respond to a forefoot strike (ie. forefoot varus) without eventual pathology or injury.  If heel strike were to occur in the MBT the risk of knee hyperextension would be on the table and retrograde knee motion is never good and never helpful when progression forward is desired.

Almost every shoe has a perk and a drawback. You just need to understand the engineering of the shoe  and understand the foot and body that is going into the shoe, to decide how it might help you.  We do use this shoe for some foot types, mostly as a therapeutic device to help someone heal or improve skills to achieve performance success.  But as a day to day shoe, this is not a shoe we ever recommend. This shoe alters normal biomechanical events, a compensated gait if you will. 

The Gait Guys: just the facts, so you can make more educated decisions.

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Upright bipedal walking and the stoned chimpanzee.

How different is our human gait to the chimpanzee gait ? Months ago we did a blog post on the Sasquatch aka Bigfoot. You can find our blog post here (click). Bipedal walking is evident in the earliest hominins [Zollikofer CPE, Ponce de Leon MS, Lieberman DE, Guy F, Pilbeam D, et al. (2005) Nature 434:755–759], but still today the true reason as to why our unique two-legged gait evolved remains unknown for certain. Scientists 7 years ago found fossil evidence in Ethiopia that showed human ancestors walked on two legs as early as 5.2 million years ago. The fossils were of the earliest hominid known, and dated from close to the time when human ancestors are believed to have split off from the chimpanzees on the first steps of their evolutionary trip to modern Homo sapiens.

Our point here today is just to briefly discuss a few of the biomechanical characteristics of the chimpanzee gait and to correlate them to problems we see in human gait. Our point however is not to bring up issues of evolution, creation or anything of the sort that might offend anyone’s beliefs (however at the end of this piece we do have some creative “outside the box” fun thinking and offer some challenging possibilities in correlating them to theories of how man’s brain might have grown so suddenly and possibly where the advancement of complex motor patterns evolved).

This time we look at the chimpanzee. How does the chimpanzee differ from the gorilla in quadrupedal ambulation ? Both walk with a knuckle-type weight bearing but chimpanzees ambulate quadruped with bend wrists, their carpal bones have ridges and grooves like humans that allow for end range lockout while gorillas quadruped via straight arm and neutral wrist knuckle weight bearing.

But what about humans and these hairy precursors ? Are there similarities ? Differences ? Well, the main question we wanted to ask since apes were not far enough evolutionarily to walk effectively upright is, “are there similarities to pathologic gait problems that lead to injury and these hairy ancestors ?”. We believe the answer is yes.

1. posteriorly tilted pelvis
2. small weakended glutes
3. quadriceps dominant
4. lack of knee extension
5. lack of hip extension and gluteal development

There are many interesting thoughts here. Including the question that the documentary video above poses in part 2 found on youtube. Can two species with 99% of the same DNA have similar problems? Should they? The numbers are in favor of this theory. It also bodes the question that recurs in the video series on Oliver the chimp, if he is even closer to human DNA than his siblings then is this why he walked upright like us humans ?

article link: http://www.pnas.org/content/104/30/12265.full

In this article link above, the authors support the possible hypothesis that energetics played an important role in the evolution of bipedalism. Unfortunately there still remains an evidence gap archaeologically to fully support this hypothesis that locomotor economy provided the initial evolutionary advantage for hominin bipedalism. The study above indicated that

“the biomechanical analysis of adult chimpanzee costs, coupled with previous analyses of early hominin pelvic and hindlimb morphology, suggest that improved locomotor economy may have accrued very early within the hominin lineage. Future fossil discoveries from the earliest hominins will resolve whether this energetic advantage was in fact the key factor in the evolution of hominin bipedalism.”

Similar to this study, some sources discuss that moving to an upright gait is what caused our brains to suddenly expand in size and thus begin to cerebrally dominate all other creatures on earth. This does however remain a hotly debated topic. Our recent interests on these topics have brought us far and wide. Topics on brain expansion have included the strategizing of carrying infants, food and weapons for distances to hunt for food to being able to run distances more efficiently to hunt. Language (complex communication verbally and with symbols), art (cave wall paintings), religion, spiritual belief development and developing the manual dexterity and complex thinking to build and use tools for specific tasks are just some of the other reasons as to what spurred the massive growth of the human brain roughly 50,000 years ago (Google search “brain expansion 50,000 years ago”).

But, if you really want to challenge your beliefs on the topic of brain size expansion and the development of complex neurologic patterning read some of the fascinating work by Graham Hancock or Terrance McKenna on ayahuasca (yes, The Gait Guys are about to talk about mind expanding hallucinogenic drugs). From Wikipedia,

Ayahuasca (ayawaska pronounced [ajaˈwaska] in the Quechua language) is any of various psychoactive infusions or decoctions prepared from the Banisteriopsis spp. vine, usually mixed with the leaves of dimethyltryptamine (DMT)-containing species of shrubs from the genus Psychotria. The brew, first described academically in the early 1950s by Harvard ethnobotanist Richard Evans Schultes, who found it employed for divinatory and healing purposes by the native peoples of Amazonian Colombia, is known by a number of different names (see below). It has been reported that some effects can be had from consuming the caapi vine alone, but that DMT-containing plants (such as Psychotria) remain inactive when drunk as a brew without a source of monoamine oxidase inhibitor (MAOI) such as B. caapi. “

You may find it interesting that some new age theories by gentlemen such as mentioned above propose that it was the use of these hallucinogenics containing DMT as well as Psilocybin (aka magic mushrooms) as possible mechanisms for the massive growth of the human brain and subsequent abilities to tackle more complex motor tasks, especially those that incorporated ambulation.

Think that we, and these men, are a bit crazy ? That is ok, probably many folks already think that. But heck, even in some sources that discuss what was present in the Garden of Eden show possible evidence of this wild theorizing because according to several sources the "potential forbidden fruits of the Garden of Eden include the apple, pomegranate,the fig, the carob, the etrog or citron, the pear, and, more recently, the datura (a hallucinogenic) ( were all present). And, "A fresco in the 13th-century Plaincourault Abbey in France depicts Adam and Eve in the Garden of Eden, flanking a Tree of Knowledge that has the appearance of a gigantic Amanita muscaria, a poisonous and psychoactive mushroom”, was also possibly present. Now, do not put words in our mouths, we are not saying by any stretch of the imagination that Adam and Eve were stoners. McKenna and Hancock and many others merely theorize (with logical inquiry) that at some point in history, they believe around 50,000 years ago, that mind expanding drugs may have helped force the brain to develop by experiencing cerebral alternative phenomena that the real world was not able to offer. And it is postulated that this brain expansion is what has allowed higher function and higher cognition. And if you think we are crazy to even bring this up as a possibility you might consider doing your own investigations looking into the minds of some brilliant and educated people in science today. You will find that some of them will not dismiss this seemingly radical topic as the reason for the massive and sudden expansion in brain size. Yes, like some of these researchers we are pushing the limits here, but who are we to say that we know the truth any better ? None the less, this blog is not the place to discuss mind expanding hallucinogenics, although we are happy to offer it as just one of the theories of wiser men and women to wet your curiosity to wilder ideas ! Heck, something made our brains suddenly expand some 50,000 years ago. We had millions of years for it to happen, so why was it right around 50,000 years ago ? Because that was the first documented evidence of mind altering natural (yes, organic) herbals? Professor Davis Lewis Williams apparently thinks so. It certainly would have been easier to reach down and grab some leaves and vines or mushrooms wouldn’t it ? Take today’s post with a grin, a pinch of salt, and a pinch of curiosity !

And to further tease your mind to open up, do you wanna guess who else might have done a little substance experimenting ? Search the web for “Einstein and drugs”. One source claims that Einstien’s blood was tested after his death with the autopsy apparently showing traces of LSD as well as Dimethyl-triptimene (DMT). Still wondering how he got so smart ? Hmmm. Now, if you do your homework you will find that DMT is a natural chemical in the body as well as in many plant types, it is a chemical possibly involved with the pineal gland. Many theorize that the dream state we experience every night is from the natural low levels of DMT in our brain, it is possibly why our dreams are so wild and wonderful. But DMT is found in many foods as well, we just break it down with MAO (mono amine oxidase). This is why the psychadelic trips with DMT require a MAO inhibitor to the drug can do its thing. Anyhow, enough drug and brain education for today………

Einstein and many others…….. smart, big brained, world changing folks, many dabbling in mind expanding substances. Heck, how else does one come up with String Theory, Dark Matter, Black holes, Space-Time continuum etc ? Maybe you have to be thinking outside the box and possibly tapping into another dimension to come up with such broad thoughts. Who knows ? Kinda makes you wonder what you might have missed out on in college doesn’t it … if in fact you missed out on it.

The “Stoned Ape Theory” tangent. It is a very radical extreme theory for brain size expansion 50,000 years ago. But radical theories are cool, they make you stretch your thinking and comfort zone. And they just might be true , who knows ? If we can for a moment put aside preconceived biases, old education and embedded religious beliefs and open our mind and thinking we just might see things that expand our wisdom. That’s the hard work. It doesn’t mean we have to accept them. Challenging radical ideas can do that if you can open your curiosity. Regardless, paleo brain or neo brain , we ambulated with both. Brain expansion changed gait, because it changed what we do while we ambulate. And then we changed it all further by adding shoes and paving the surfaces of our world.

Shawn and Ivo…… more than just gait geeks but certainly not Stoned Apes. Maybe just two guys here to further expand the brains of 21st century man with theories on gait and biomechanics.