Gait, Running and Sound. Are you listening to your body ?

A few months ago we tried something new.  We tested your gait auditory skills while listening to a video of a runner on a treadmill. We queued you to listen to the foot falls listening for the one foot to slap or impact harder than the other at foot strike. Most of you got it right, we  got plenty of positive feedback on that piece. Here is that piece (link).

This is something we do during the initial evaluation for each and every patient that comes to see us, no matter what their issue. We ask them to walk. We ask them do they notice anything. The answer is almost always, “no”.  This is because they are accustomed to their walking habit.  The first queue we notice much of the time is that there is either a bilateral heavy heel strike (because heel strike is normal in walking) or it is  heavier on one side. We ask them to hear and feel that heavier strike once we point it out to them. Not only can they feel it, they can hear it. It is something they have rarely been aware of until that moment.  We then do the same for forefoot loading. If the anterior compartment is a little weaker on one side or if they departed abruptly off the opposite leg for some reason (decreased hip extension, tight calf, loss of ankle rocker etc), a heavier forefoot loading response will be felt and heard as well (opposite side of the mentioned issues).  These are great initial gait queues that anyone can use to gain diagnostic information.  It also draws the client into greater body awareness of their habitual patterns of movement. We then draw out the numbers and forces for them so they understand what several thousand cycles of this event can cause into their body and their clinical problems they are presenting with.  This is typically a new skill they will develop and always be aware of and be able to report to you as they progress through their care with you.  Sound and feeling are key biofeedback tools.

Just remember, they are feeling and hearing what they are doing, not what is wrong ! It is your job to take this information and figure out the “Why” it is happening, and the “how” to fix it.  This is the hard part.

Hey Folks

You know we are big Altra Fans. Check out their new commercial!

We are sure your keen eyes have picked up on the midfoot pronation at :17 and forefoot pronation at :28. This brings to mind a question we often get asked: How much pronation is too much pronation?

Some pronation is necessary, as it is one of the 4 shock normal absorbing mechanisms

1. midfoot pronation
2. ankle dorsiflexion
3. knee flexion
4. hip flexion)

We do not believe there is a perfect answer, but rather the ideal is: How much pronation can your (neuro and bio) mechanics control? Too much in one individual may be not enough in another. It has to do with foot structure, muscle competency, neuromuscular control, and a host of other things.

Remember the mantra: Skill, endurance, strength… in that order! Work to control the pronation you have and expand on that range.

The Bald Headed, Good Looking, Bringing you the facts Gait Guys.

all material copyright 2012 The Homunculus Group/The Gait Guys (except the commercial of course, which is property of Altra). If you want to use our stuff, ask nicely : )

Got Hip Pain ? Attention Runners and Athletes with Hip Pain.

Compensatory joint motions are quite often a source of a person’s pain. Shirley Sahrmann named her hip syndromes for the direction of the movement most consistently associated with pain. In a recent CME presentation we did for www.onlineCE.com we discussed the accessory movements found with the hip.

Lets look at the known normal biomechanical facts:

During hip flexion the accessory motion is posterior glide of the femoral head.

Hip extension: accessory motion is anterior glide of the femoral head.

Hip medial (internal) rotation: accessory motion is posterior glide of the femoral head.

Hip lateral (external) rotation: accessory motion is anterior glide of the femoral head.

Hip abduction: accessory motion is inferior glide of the femoral head.

Hip adduction: accessory motion is superior glide.

Impairment, either from joint/bony deformation (ie. torsions) or from functional muscular asymmetry, can lead to impairment of the accessory motions (compensation) that are necessary for clean joint function.  This can lead to pain. 

For you clinicians out there, knowing your hip torsions and versions will impact the amount/degree of these accessory motions. This is why we harp on knowing your fixed anatomic variants.  (You can find discussions on these in our prior blog posts and on previous recorded www.onlineCE.com teleseminar presentations.) For example, reduced medial rotation at the hip (usually met with increased external rotation) is often seen in people with retrotorsion of the femur. Said another way, when your client has impaired medial or lateral hip rotation you must go beyond looking at the muscles at some point and consider whether they have a form of ante or retro torsion.

Hip extension is a critical part of normal human ambulation, whether you are walking or running.  Normally the hip, when moving into extension during the final propulsive phase of ambulation, allows for the femoral head of the hip to glide anterior in the socket (acetabulum). This reduces labral RIM pinch (RIM Syndromes) and allows for greater safe extension range. If hip extension range is impaired then this accessory motion of anterior glide can be impaired and lead to compensation and pain.

Think about this:

What if the quadriceps are tight ?

What If the Glutes are weak ?

What if rotational muscles are short ?

What if ankle rocker (dorsiflexion) is impaired ?

What if there is neuro-inhibition from joint pain (ie. osteoarthritis or joint mal-centration etc) ?

What if there is imbalance and weaknesses about the hip ?

What if there are other faulty movement patterns ?

What if there is one of the femoral torsions present ?

Much of this is “chicken or the egg”, who came first ?  These “what ifs” are what make practicing medicine difficult and a real challenge. Some of these issues can be found during functional movement assessments, but some of them will be missed if that is all you are doing. These issues may be what separates the good clinician, therapist, coach or trainer from the “not so good”. Knowing if a person has an impaired rolling pattern (see here http://youtu.be/dqnR0EcW2YY) is great to know, but knowing if the lower limb driver is off because the hip cannot internally rotate is even greater. Merely giving the person the homework of practicing and repeating the rolls on the impaired driver side without assessing all of the parts (for example some of the issues above) may cause you to miss the boat, or to engrain a new faulty motor pattern. 

Knowledge is prince, application of knowledge is king.

Next week we will begin a blog post a week on the biomechanics of the hip. We hope you will join us.

Shawn and Ivo

Here are some of our prior blog posts to add and deepen this dialogue:

• http://thegaitguys.tumblr.com/post/7493909435/the-hip-part-1-hip-labral-tears-the-rim-syndromes
• http://thegaitguys.tumblr.com/post/7533986761/ars-acetabular-rim-syndromes-hip-pain-some
• http://thegaitguys.tumblr.com/post/7573791535/the-hip-part-3-more-on-hip-rim-syndromes-and-labral

Podcast #11: Walking and Ozzy

http://thegaitguys.libsyn.com/podcast-11-walking-and-ozzy

Topics and Show Notes:

- Flips Flops, Walking Biomechanics, Minimalism Shoe Formula

Payloadz link for our DVD’s and efile downloads: http://store.payloadz.com/results/results.asp?m=80204

1- NEUROSCIENCE PIECE: Walking Statistics

2- Email from a Facebook Follower:
Hey guys, I was wondering if you had any links to articles about the effects of open back shoes on gait?  All I can seem to find are articles about flip flops, which I know have the similar effect, however some of my collegues don’t agree with that, so I was hoping to help inform them on the effects of the open back shoes/sandals on gait function.
 Thanks for your time,Tyler

http://www.ncbi.nlm.nih.gov/pubmed/22185067
http://www.webmd.com/healthy-beauty/features/worst-shoes-for-your-feet?page=3

3- DISCLAIMER:
We are not your doctors so anything you hear here should not be taken as medical advice. For that you need to visit YOUR doctors and ask them the questions. We have not examined you, we do not know you, we know very little about your medical status. So, do not hold us responsible for taking our advice when we have just told you not to !  Again, we are NOT your doctors !

4-  Updates and Sponsor talk:

A-  more lectures available  on www.onlineCE.com   Go there and look up our lectures

B- In January we will be taking on sponsors for our podcast.  We have had some interest already but we wanted to work out the quality control issues first. Early in means savings.

Contact us if you would like to be a sponsor……If we believe your product has value to this listener community we will give you a professional and personalized company or product plug and advertisment.  From our lips to our listeners ears ! 
We will basically expose your product to our international fan base.
The sponsors will help make our mission possible, defray costs and time to put out this podcast and blog. These things take is away from our practices a little.  Each week we will have 2 center-Stage sponsors . Your sponsorship can run as long as you want.

5-  Mail from an International Follower of our Blog:

Hi Dr’s,
Im here again. Just a quick question about functional LLD’s again. As you said before, most people who have a LLD are functional, but what causes such an apparent problem? What muscles are affected? Also, what exercises do you do to start to fix a functional LLD?

Thanks again for your reply and the attachment. It would be great if you could put it on a future podcast, I am keeping up with them. I’m a little sad as the first thing I check on facebook each day is what you guys have put on. The seminar over here is still a possibility, I was thinking about coming out to you guys first if that’s a possibility to learn direct? Have you thought about trying to do the fitness conventions? Experts like paul chek, Charles Poliquin, Gary Gray amongst others have been very successful and made a lot of money doing this. Gary Gray has done a huge dvd educational series and offers an internship out of his house, which he does once per year and is always full. I personally know 12 people from this country that have done it. Regarding your comment on facebook, I find the case studies more educational than anything else you put on there as it directly relates to my clients, but I have to keep watching them to fully appreciate what your saying. I can imagine most trainers just want quick fixes and new exercises they can give their clients as they are easy to understand. What are your sales of case studies on the onlice CEC compared to your performance downloads?  I can imagine not as many?   Kind Regards,   Luke

6- EMAIL FROM A Blog follower: 
Dear GaitGuys, on the video “Doing Squats, Lunges as well as Walking and Running using the Big Toe Ineffectively.”, I would like your opinion on the participation of the intrinsic (lumbricals) muscles, in stabilizing the proximal phalanx when we activate the FHL. I would consider it important, would be pleased to hear your opinion on it. Thanks, keep up the good work! Regards,  - Claudio

7- Blog READER EMAIL:
 field100 asked you:
Hi I wondered whether you could point me to the best exercises to increase strength and arch in the foot - I am flat footed. Also would you recommend the use of vivobarefoot shoes or the like to increase overall strength in the foot and ankle. thanks

 8- Blog post we liked recently
Minimalism: Is there a formula?
On one of our many forays into cyberspace, we ran across this easy to understand formula, from one of our friends Blaise Dubois. After we contacted him, he allowed us to reprint it here, for your enjoyment. Thank You Blaise!

Today, we propose a new formula so that you can rate your running shoes on a scale from 1 to 100 (100 being “extremely minimalist” -bare feet- and 1 “extremely maximalist”). The range of variation of your final rating will be more or less 5 points regardless of the comfort criteria, which is subjective. The only thing you need to do is to choose a language, then select the tab of your country at the bottom of the formula page, rate your shoes on the 6 criteria set out and there you go! Please note that we have used average values for criteria to which you don’t have the information. The multiple formats of the formula for every country are represented in accordance with their measuring system, currency and the average selling price of a running shoe for each of these countries.

As for health professionals and scientists, you will see that weighting factors have been applied to all criteria as a function of their importance, which is their effect on the body (biomechanics, tissue adaptation, etc.)
You can now rate your running shoes based upon The Running Clinic’s “TRC Rating” methodology!

12 - Email from a Blog Reader

hoblingoblin asked you:
I have a very strange gait problem that has caused me a great deal of problems in my everyday life. I get a painful, loud snap somewhere in my tarsal tunnel (Post tib, FDL, or something) as I try to control my foot descent from heel strike to midstance and also sometimes as I try to plantar flex at toe off. My ankle also feels kinda loose. I’ve seen multiple ankle specialists who don’t really have answers for me. Any thoughts?        

Category
Educational

What do you think of when you watch Zsa Zsa Gabor walk , or a woman like “Madeline” describes in this post?

Hip swing.

Yup, like it or leave it. It is here to stay. And evidently. It makes women more attractive to men (or more likely to attract a mate, click here to read our post on that).

So the question is, Why?

Besides the aesthetically pleasing aspect of this, it is most likely biomechanics. Women (generally) have

a. wider hips,

b. more femoral anteversion (or ante torsion) and

c. an increased Q angle.

This means more:

a. lateral displacement of the pelvis,

b. more internal and less external hip rotation available and

c. more lateral displacement again, with increased demand on the gluteus medius, due to the anatomical attachments.

Yup, there usually is a reason and it is often biomechanical, not aesthetics.

The Gait Guys. Ivo and Shawn. Gait Geeks to the core!

Gait Differences between men and women

J Womens Health Gend Based Med. 2002 Jun;11(5):453-8. Gender differences in pelvic motions and center of mass displacement during walking: stereotypes quantified. Smith LK, Lelas JL, Kerrigan DC. Source

Center for Rehabilitation Science, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.

Abstract OBJECTIVES:

A general perception that women and men walk differently has yet to be supported by quantitative walking (gait) studies, which have found more similarities than differences. Never previously examined, however, are pelvic and center of mass (COM) motions. We hypothesize the presence of gender differences in both pelvic obliquity (motion of the pelvis in the coronal plane) and vertical COM displacement. Quantifiable differences may have clinical as well as biomechanical importance.

METHODS:

We tested 120 subjects separated into four groups by age and gender. Pelvic motions and COM displacements were recorded using a 3-D motion analysis system and averaged over three walking trials at comfortable walking speed. Data were plotted, and temporal values, pelvic angle ranges, and COM displacements normalized for leg length were quantitatively compared among groups.

RESULTS:

Comparing all women to all men, women exhibited significantly more pelvic obliquity range (mean ISD): 9.4 +/- 3.5 degrees for women and 7.4 +/- 3.4 degrees for men (p = 0.0024), and less vertical COM displacement: 3.7 +/- 0.8% of leg length for women and 3.3 +/- 0.9% for men (p = 0.0056).

CONCLUSIONS:

Stereotypically based gender differences were documented with greater pelvic obliquity and less vertical COM displacement in women compared with men. It is unclear if these differences are the intrinsic result of gender vs. social or cultural effects. It is possible that women use greater pelvic motion in the coronal plane to reduce their vertical COM displacement and, thus, conserve energy during walking. An increase in pelvic obliquity motion may be advantageous from an energy standpoint, but it is also associated with increased lumbosacral motion, which may be maladaptive with respect to the etiology and progression of low back pain.

Policing Gait on the Web

There is some decent information here but we do have some issues with this video. We were asked on our Facebook PAGE to talk about our thoughts on this piece.  We are not trying to criticize anyone, merely helping to keep the information accurate on the web:

1. They are promoting external rotation of the limb into the ground. They refer to this as “screwing” (as they put it) the foot into the ground. The issues here are that the foot supinates when you do this and when you do this too far you weight bear on the lateral foot and disengage the medial foot tripod. They do refer to limits on this but we need to heighten the awareness here. Someone with a forefoot valgus will go to far most likely, and someone with a forefoot varus will disengage the medial tripod quickly.  Most people will also disengage the FHB (flexor hallucis brevis) quickly during this “screwing” technique.  Furthermore, people can also become too dependent on their glutes to hold the “screwed” or supinated position and this is not a safe and reasonable way to support the limb and pelvic posturing. We see this as a very detrimental strategy when sustained PPT (Posterior Pelvic Tilt) is maintained during gait and stance.  There needs to be help from the lower abdominals and adductors as well.   Their “20%” torque is a nice mention and may help many to keep this moderate but this is really dependent on foot type and tibial torsion issues which are not discussed here. As always, not everything fixes everyone, and some things go against an admirable intention.  No digs against these nice fellas, we are just stating what we feel are critical facts not discussed. We watched part 2 and 3 in the hopes of hearing about these issues above, but they were not discussed. We wanted to comment on the videos but they have disabled the comments on youtube.

2. This posturing promotes knee hyperextension which is never good. Go ahead, try it yourself.  You cannot employ a whole lot of this external screwing during gait without changing the knee biomechanics into the hyperextension direction.  It is another reason we mention a caveat here.  If you try it, just pay close attention to what you are doing. You may try to get around the hyperextenion by dropping the pelvis anterior, disengaging your abdominals and changing hip and low back function. 

3. Merely doing what they propose here does not necessarily ramp up the intrinsic muscles of the feet (4:00 mark).  They can remain silent in this maneuver.  Keeping the toes pressed might be more productive to this end.

We watched part 2 and 3 of their Rebuilding the Foot youtube videos and frankly they just scare us a little (go ahead have a look yourself) so we will not comment on anything there. Although we strongly do not advise many of their recommendations in either part 2 or 3 for our clients you may find some stuff you like here … . . heck, who are we to say what you will be willing to try !

To each his own. We give these guys mad props for putting themselves on the net and trying to share their info.  It takes guts to put your stuff on the web, we hope they will enable the comments section so productive dialogues can ensue there in the future.

Shawn and Ivo