Are you a Gait Troglodyte ? Are you sure ?

Are you a Gait Troglodyte ? Are you sure ? You might want to read on.

Most of us are all still in a cave and unacquainted with some of the affairs of the world. Some of us may find ourselves behind the times when it comes to GMO foods, social media, computers and the internet, smart phones while others may be behind on world issues and politics. Heck, some of us have never even seen “Ancient Aliens” on the History Channel !  It is hard to keep up with everything in this fast paced changing world. Something has to give for each of us and so we pick our poison and decide what it is that we are going to have to remain behind on when it comes to the learning curves of the world. And this is alright, but you have to first admit your “back of the pack” and “still living in a cave” type status on the issues and take some ribbing when acknowledging your limitations.  Failing to admit these inevitable shortcomings while pretending that you are still running with the pack can be a real problem. Not only are you faking yourself out but you may be deceiving those that you attempt to help.

Understanding gait, truly understanding it, is a monumental undertaking. This is why there are just no vast resources on it unlike other things in healthcare. Try going to PubMed and type in “arm swing”, you will see 318 articles. Try “pronation”, 2900 articles.  Now try “heart”, 1 million+ articles.  You get the point. Research is behind on gait, and thus our understanding of it is also poorly reflected in functional medicine and  human bodywork.  We are collectively gait troglodytes, living in stereotypical caveman times when it comes to gait.  Sure there are some good books like Perry’s text, or Michaud’s landmark work but there is a void on gait work and research. Human locomotion via gait (walking and running) is a small and poorly understood component by many. It is much the reason why we started The Gait Guys and began writing daily for over 600 days on gait issues. Little did we know that the door we had opened would continue to swing so wide and encompass so many other aspects that feed into human gait.

One of the aspects that worries us the most these days is the growing volume of “functional” work that is going on in the world of therapy and training.  There is a very important and critical place for this work and we fully admit that everyone needs to be on board with all of the great work that the leaders are teaching. What worries us is the apparent lack of integration of this work into gait assessment, gait therapy, and flawed gait neuro-biomechanics. Once again gait is not getting the pulpit it deserves. Yes, flaws in the functional screens and assessments need to be brought to light and remedied because they can impact bipedal locomotion but, the pendulum swings both ways. Gait can often be a cause of these functional problems that show up on the screens and assessments. If one fixes the functional pattern problems and the gait pattern is not restored then either the dysfunction will return or a new undesirable pattern will be generated. There needs to be more gait understanding and assessment from us all. Gait needs retraining as well, it is as much of a functional pattern as any other, if not more.  Gait deserves a pulpit as well.  Human assessment is clearly a two way street and it is not always clear who is the chicken and who is the egg. The problem may be that when gait does have its pulpit to speak from, who is the speaker ? A gait troglodyte or an expert ?

There will be folks who say we are over thinking this issue. There will be some who are offended. There will be some who cheer. There are some that will say “it will all come out in the wash” once the functional patterns are corrected elsewhere. They are wrong, it just is not that simple. Next to breathing, gait may be the second most compromised and corrupted functional pattern that humans express thousands of times daily. So, it is time to get busy.  It is time to peel off your Gait Troglodyte cloak and step into a 3 piece suit when it comes to understanding and interpreting gait.  If you are working in the world of human movement, locomotion, training, rehab and human biomechanics this is your next challenge.  Lets face it, we can either continue to walk around with our 10 year old flip phone understanding of gait or we can step up to a smart phone understanding of gait.  It is up to you, but know where you are and know your limitations. So be honest with yourself and your next client the next time you assess their gait. Be sure to ask yourself after seeing something that just doesn’t seem right in their gait, is what you see really what you are seeing ? Is that really what is wrong ? Or is it a compensation ? Do you know enough to see things for what they really are ?

Shawn and Ivo, The Gait Guys. 

We may not be Gait Troglodytes……. but some accuse us of living in a cave none the less.  However, if you have seen our cave, you will know it looks much like Bruce Wayne’s Batcave.  It isn’t your everyday cave.

Shoes and Shoe fit→

“It was suggested that the most important criteria in the selection of running shoes are fit and comfort. Running shoes that meet these criteria are likely to provide
optimal levels of cushioning and stability.”

www.med.nyu.edu

More evidence that perception is reality; just like one of our other posts about a persons perception of what the shoe will do and what it actually does. Looks like the brain may know best!

The Gait Guys

A piece we put together to celebrate the Olympic challenge.

good luck to all !

Run and Bike Training using Music and Cadence.→

Using music in your training is smart. We have been saying this for over a year in some of our blog articles regarding music and dance and incorporating some of the advantages of brain development and music. Today we have more research to prove our point.

 In The Journal of Sports Medicine and Physical Fitness (link) British researchers concluded that “exercise is more efficient when performed synchronously with music than when musical tempo is slightly slower than the rate of cyclical movement.” Scott Douglas summarized the study nicely:

    The study had cyclists pedal at 65 revolutions per minute (i.e., 130 pedal strokes per minute) while working at 70% of their aerobic max, which in running terms would be between recovery pace and half marathon pace. The cyclists listened to music at three tempi:

• faster than their pedal rate (137 beats per minute),
• synced with their pedal rate (130 beats per minute)
• and slower than their pedal rate (123 beats per minute).

Although the cyclists rated their perceived effort the same in the three conditions, their oxygen cost was greater when they pedaled along to music that was slower than they were riding. Their heart rates were also slightly higher when listening to the slowest of the three music speeds.

Anyone who has frequently run with music knows how a peppy tune can jump start things. This study suggests you’re asking to work a little harder if your playlist includes songs slower than your turnover, which for running purposes ideally means around 170 or more beats per minute.

In one of our favorite Gait Guys blog posts on June 7th, (here is the link)
we mentioned some other great benefits of strategically using music to further your training:

Music provides timing. Music taps into fundamental systems in our brains that are sensitive to melody and beat. And when you are learning a task, timing can access part of the brain to either make it easier, easier to remember, or engrain the learned behavior deeper. When you add music to anything you are exercising other parts of your brain with that task. It is nothing new in the world of music and brain research when it comes to proving that music expands areas of learning and development in the brain. As Dr. Charles Limb, associate professor of otolaryngology and head and neck surgery at Johns Hopkins University states “It (music) allows you to think in a way that you used to not think, and it also trains a lot of other cognitive facilities that have nothing to do with music.”

Several weeks ago we asked you as an athlete, and this pertains to runners and even those walking, to add music to your training. If you are walking, vary the songs in your ipod to express variations in tempo. Use those tempo changes to change your cadence. If you are a runner, once in awhile add ipod training to your workouts and do the same. Your next fartlek (a system of training for distance runners in which the terrain and pace are varied to enhance conditioning) might be a new experience. Perhaps an enjoyable one. Trust us, we have done it. Here at The Gait Guys, with our backgrounds in neurology and biomechanics amongst other things, we are always looking for new ways to learn and to incorporate other areas of brain challenge to our clients. To build a better athlete you have to use training ideas that are often outside the box.

Remember what Dr. Charles Limb said,

“It (music) allows you to think in a way that you used to not think, and it also trains a lot of other cognitive facilities that have nothing to do with music.”

It is nice to see more studies on music. All to often we use music for pleasure, but here we once again show that it can be a useful training tool if you are paying attention and thinking outside of the iPod. 

Shawn and Ivo, The Gait Guys ……… music lovers as well.

BIKE FIT: Case Study

Along the vein of bike fit, to go with Thursday and Friday’s posts last week, here is gentleman with right sided low back pain ONLY when ascending hills on his mountain bike. Can you figure out why?

*Stop, watch the video and think about it before we give you the answer… .

____________________________

This gentleman presented with low back pain, only on his mountain bike, only on long ascents.

He measures out with an 83 cm inseam which should put him on a 44 to 45.5 cm frame (measured via our method). His frame has a dropped top tube and measures 55 cm.

He has a knee bend angle of 20 degrees at bottom dead center. Knee is centered well over pedal axis.

His stem falls far in front of his line of sight with respect to his hub. Stem is a 100 mm stem with a 6 degree rise.

There is a 2" drop from the seat to the top of the handlebars.

He has an anatomically short Left leg (tibial)

Here is some additional video of him with a 3 mm lift in the left shoe. Look at the tissue folds at the waist and amount of reach with each leg during the downstroke in this one as well as the last. no changes were made to the seat height, fore/aft position of seat. or handlebars.

The frame, though he is a big dude (6’+), is too big and his stem is too long. He is stretched out too far over the top tube, causing him to have an even more rounded back (and less access to his glutes; glutes should rule the downstroke and abs the upstroke). This gets worse when he pushes back (on his seat) and settles in for a long uphill. Now throw in a leg length discrepancy and asymmetrical biomechanics.

Our recommendations:

• smaller frame (not going to happen)
• lower seat 5-7mm
• shorter stem (60-75mm) with greater than 15 degree rise
• lift in Left shoe

We ARE the Gait Guys, and we do bikes too!

Podcast #3: S1E3 (Season 1, Episode 3)→

The Gait Guys Podcast #3

Here are 2 links for the podcast.

This one will get you to the show player of all of our podcasts.

http://directory.libsyn.com/shows/view/id/thegaitguys

And this link will get you a nicely laid out “show notes”.

http://thegaitguys.libsyn.com/rss

Here is a brief outline of the topics on today’s podcast #3.

- Computer simulation of stress distribution in the metatarsals at different inversion landing angles
- Pencil Skirts: walking in one and how it is troublesome for normal gait.
- an email from a coach
- a youtube video about gravity and its effects on humans
- the Secrets to Running Downhill fast
- Shoe talk: The vivobarefoot
- a case of a sprained my left ankle
- we discuss a case study from a listener in Ireland (rock on Damien! )

___________________________

And, below is a detailed outline of podcast #3.

1. NEWS  OF THE DAY:

Hello:  I recently saw you guys speak at the NSCA clinic at Chicago State University and I am immensely impressed and relieved to find someone able to clearly explain gait in such thorough detail. The Gait Guys blog has been immensely helpful in myself and my running clients. I would like to inquire if “either of you” would be interested in being a guest speaker at the AMA as a part of our Wellness Program’s monthly seminar series.

2. TOPIC:

 Computer simulation of stress distribution in the metatarsals at different inversion landing angles using the finite element method

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903174/

Abstract:  Metatarsal fracture is one of the most common foot injuries and is often associated with landing in inversion. The deformation and stresses of the metatarsals during landing at different inversion angles (normal landing, 10 degree inversion and 20 degree inversion angles) were comparatively studied. The results showed that in the lateral metatarsals stress increased while in the medial metatarsals stress decreased with the angle of inversion. The peak stress point was found to be near the proximal part of the fifth metatarsal, which corresponds with reported clinical observations of metatarsal injuries.Landing in inversion is another factor which potentially could affect the metatarsals leading to deformation and fractures; however, most published studies on landing in inversion have focussed on ankle ligaments and sprains during this abnormal movement

3. TOPIC:

Pencil Skirts: walking in one and how it is troublesome for normal gait

4. EMAIL FROM A COACH:

*( we will be answering most of your questions on these podcasts. It may take a week or 2-3 to get to them. We hope to have a “podcast table of contents for each podcast” on our new website when it gets launched. That way you can search for topic lists and look for your email. We will only use your first name, or whatever name you wish to provide. We will not give out your email. 

 \5. YOUTUBE AUDIO CLIP:

The body’s biomechanics are different running up and down hill,  but you are also dealing with gravity differently.

  Einstein did these things called “Thought experiments”.
 It is a YOUTUBE CLIP , type “albert einstein-2"  into the SEARCH box.
we will start the clip at 4:14 min clip  to 8:40
   http://www.youtube.com/watch?v=x2vx_UOaiRY&list=FL0L4QWkefZUvID-3XGsAEJg&index=12&feature=plpp_video

6. REVIEW of our favorite BLOG POST OF THE WEEK:

The Secrets to Running Downhill Fast.Last month we contributed to Jene Shaw’s article in Triathlete Magazine.

Please hit the link here for the entire great article by Jene Shaw. There is lots more here. LINK

http://triathlon.competitor.com/2012/05/training/the-secrets-to-running-downhill-fast_54031

Here were some of our Form tips used in Jene’s article for going fast downhill. Hear about them on the podcast.

7. EMAIL CASE
Hi there
I’ve been going to physio therapists for a while with lower back and posture problems, which I now think are related to how I walk (duck footed). So far the only thing I have really got from this would be a nice massage.
What is the main issue with the "Duck footed” posturing and what kind of professional or practioner should I see about correcting issues like this?
Thanks very much, MIKE

8. SHOE TALK:

The vivobarefoot

9. EMAIL CASE

Hello Gait Guys,

In the past, I have sprained my left ankle in which has led me to think that this is the cause for me having a flat foot.

This in turn has led me to having problems around the knee and the hip.

Are there any exercises I can do to improve my medial arch? 

If there are videos that you are selling to teach how to deal with this problem, could you link me to it?

Sincerely, Zac

response:   youtube video:  The foot tripod: the importance of the toe extensors in raising the arch.  also read our blog post ( February 16th, 2012 blog post for more)

10. EMAIL CASE:

Hi There,

My name is Damien and i am writing you from Ireland. I’ve watched a lot of your videos online on YouTube. They are amazing. Congratulations on such a great and informative service. It’s so refreshing seeing people want to diagnose and fix feet rather than putting insoles or arch supports in place. I have alot of things going on with my body, let me get started … . .

______

So that is the topic list for this week, podcast 3. We hope you can find time to lend  us your ears.

Shawn and Ivo…….. The Gait Guys

Running Technique Video with Complications:

Here we have a good running video with a nice teaching component to it.

We found this on the web on some random site.  Nice to see others are helping to spread our good word.  Here is what the website said, and below that are our comments.

FROM:http://paraganek.blogspot.com/2011/08/stride-analysis-video.htmlNathanAugust 30, 2011 11:18 AM

Daniel,
You should send your video to The Gait Guys:
http://www.facebook.com/pages/The-Gait-Guys/169366033103080

Actually, they did a 3 part video on crossover gait recently. I looks like you’ve got a bit of crossover going on (hips are swinging side to side). Most people do some crossover. Another thing The Gait Guys always say is that what you can see in the video is usually not the problem (the right foot turning out), it is usually the compensation you are seeing…the problem is somewhere else.

@Nathan:
Thank you Nate. I will see what The Gait Guys say.

*What The Gait Guys have to say:

The most obvious thing we see is that the right foot is spun out (this is more evident on the video clips running away from the camera). This is referred to as the “foot progression angle” and here it is increased.  Depending on the source you reference, the upper limit of normal can be 25degrees. But, it is more important to do a case by case comparison.  Without the advantages of a hands on exam this case seems to indicate that the right foot progression is increased beyond the left, assuming the left is normal.  (yes, it is possible that the right is this chaps normal and that the left foot progression angle is decreased. But the usual presentation is that of increased, usually.)

What we do like is the great form his is displaying. Great natural barefoot technique. Pure barefoot technique does not allow heel strike to occur. Do not believe us? Go try it yourself, just don’t email or call us afterwards and complain !  His strike is midfoot, cadence is high, and body posture is clean and upright.  There is a minor cross over gait here. The readers were right.  Good eyes, good call !

The increased right foot progression angle will often accelerate pronation and increase its degree. This can also increase and accelerate the rate of internal spin of the tibia and limb, all the way into the hip and pelvis.  This can challenge the eccentric capabilities of the gluteals and other external hip rotator muscles and in time this can represent itself and mechanical hip joint pain or low back/Sacroiliac joint symptoms.  The increased pronation amount and rate can challenge other structures at the foot, namely the posterior tibial tendon, abductor hallucis muscle and the first ray stabilizers such as long and short hallux muscles (EHL, EHB, FHL, FHB) and thus loss of longitudinal arch capabilities and stabilizers. 

We also see, if you look closely particularly on the running away from camera views, that the left arm seems to cross the body more than the right. We always look for this in the opposite upper limb to try and help confirm or suggest which of the lower limbs is the problem.  Since the left upper arm is crossing the body, it is neurologically matched up with the right limb during swing and stance.  It can act like a ballast. This fella would most likely have some pelvic asymmetry because of this cross body deficit. 

PS: the issue can be reversed.  We have had plenty of frozen shoulder clients present with biomechanical deficits in the opposite lower limb so beware of the total body complexities and compensations.  We have also have had runners who always carry a water bottle in the same hand showing changes in the opposite lower limb. Our treatment success with one runner did not occur until we convinced this ultra trail runner to go with a camel back water supply.

Nice little case. Wish we had more information on the runner and what is bothering him.

Maybe in time we will hear from him and update him.

To get the most out of this case you should watch the 3 part cross over gait series on our youtube channel. Just type in thegaitguys and it will be right there.  You should also goto the search box in our tumblr blog and type in “arm swing” and read some of our writings on this topic.  We think it is fascinating stuff.

Shawn and Ivo……….. world wide web gait geeks……. and victims of radical hackers everywhere…… ok, just in Algeria.

“Do or do not; there is no try.”

Yoda

Muscle coordination is habitual rather than optimal.→

The nervous system often takes the path of least resistance. Gait compensations are similar. What you are sometimes are seeing is the “least common denominator” with regards to compensation and conservation of energy.  Here is an article that exemplifies this finding.

Abstract

When sharing load among multiple muscles, humans appear to select an optimal pattern of activation that minimizes costs such as the effort or variability of movement. How the nervous system achieves this behavior, however, is unknown. Here we show that contrary to predictions from optimal control theory, habitual muscle activation patterns are surprisingly robust to changes in limb biomechanics. We first developed a method to simulate joint forces in real time from electromyographic recordings of the wrist muscles. When the model was altered to simulate the effects of paralyzing a muscle, the subjects simply increased the recruitment of all muscles to accomplish the task, rather than recruiting only the useful muscles. When the model was altered to make the force output of one muscle unusually noisy, the subjects again persisted in recruiting all muscles rather than eliminating the noisy one. Such habitual coordination patterns were also unaffected by real modifications of biomechanics produced by selectively damaging a muscle without affecting sensory feedback. Subjects naturally use different patterns of muscle contraction to produce the same forces in different pronation-supination postures, but when the simulation was based on a posture different from the actual posture, the recruitment patterns tended to agree with the actual rather than the simulated posture. The results appear inconsistent with computation of motor programs by an optimal controller in the brain. Rather, the brain may learn and recall command programs that result in muscle coordination patterns generated by lower sensorimotor circuitry that are functionally “good-enough.”

J Neurosci. 2012 May 23;32(21):7384-91.

We can always appreciate a great gait. Check out this slick gait.  He is taking that one all the way to the bank !

Lovin’ it……… until that right knee begins to complain from all of that hyperextension and until the leg quadriceps start screaming at him from all of those mini lunges onto that leg.

Boy, wishin we could parallel park a car like that !

Happy Friday Follies gang, have a great weekend !

Proper bike fit: Highlights from the Clinic at Summit Chiropractic and Rehabilitation: Part 2

Picking up from yesterdays post, here are some more thoughts.

Saddle/seat fore/aft position: There are two ways to make this measurement:

1) When you’re legs are at 90 degrees in your power stroke (cranks are horizontal), drop a plumb line from the tibial tuberosity (the bump on the leg just below the kneecap, where your quadriceps attaches).  This line should intersect the pedal axis or be slightly behind it.

2) if you like to ride with the seat a little back, drop the plumb line from the front of the kneecap.  It should intersect or fall slightly behind the pedal axis.

The a general rule of thumb is that cyclists in spinning classes, or those who like to push lower gears, tend to sit slightly forward.  Those who push higher gears and spin slower, sit a little further back.

If your seat is too far back it can cause lower back pain because of the increased flexion occurring in the trunk.  Cyclists will often feel pain just below the waist where the gluteal muscles attach or in the middle of the lower back, where the hip flexors attach.  If the seat is too far forward, cyclists usually experience knee pain.

Handlebar Height & Width: Handlebars should be approximately shoulder width and be 0-2 inches below saddle height. The wider they are, the more they open up your chest and allow better breathing, but this is at the expense of aerodynamics. The higher they are, the less stress on your back and neck. With your hands in your most common riding position (on the grips,hoods, or in the drops) you should be able to look down at the center of the stem/handlebar intersection and not be able to see the front axle. If the bar is in front, you may have trouble with descents, if behind, you way be doing wheelies up hill! Problems can often be remedied with a change of stem with a different length, pitch or both.

Handle bar reach: This is the “softest” and factors.  And old standby method used to measure the distance from your elbow to the tip of your middle finger from the tip of your saddle to the center of the handle bar stem.  This measurement will vary, depending upon whether your torso is long or short.  Riding style will also be a determining factor; overall, comfort is the rule.  You may need to buy a shorter for longer stem to make yourself more comfortable.

Bike Fit. The Gait Guys. Yup, we do that too

http://directory.libsyn.com/shows/view/id/thegaitguys

the link above provides the location where you will find all of the podcasts. Podcast #3 is coming in just 4 days, try to catch up if you are able.

best

shawn and ivo

Bike Fit Clinic Tonite

Drs Waerlop and Asthalter (Dr Ivo’s office) will be holding their annual bike fit clinic this evening from 6-7:30 at at Summit Chiropractic & Rehabilitation, PC in Dillon, Colorado. frame sizing, seat height, fore and aft positioning, and handlebar height will be discussed, with common dysfunctions resulting from improper fit.

The event is usually a sell out, and we expect nothing less this year. Highlights to follow on the blog!

Compensations for short legs…Final installment in this series, but not our last word on this subject

We remember from from the last few weeks, there at least SIX common compensations for a short leg(week 1, week 2, week 3, week 4, week 5). Last time we looked at increased knee flexion on the long leg side. Here is the list, in case you needed a reminder:

• hip hike on long leg side (seen as contraction of hip abductors, obliques and quadratus  lumborum on short leg side)
• excessive knee bend on the long leg side
•  pronation of the longer side, supination of the shorter
• leaning to he shorter leg side
• circumduction of the longer leg around the shorter
• excessive ankle plantar flexion on short side

This time we will look at excessive ankle plantar flexion on short side. Normally the ankle plantar flexes about 10 degrees at initial contact/loading response, and about 20 degrees at pre swing to create “clearance”.

Watch this gentleman’s increased plantar flexion of the L calf to clear the right foot, Yes, he has an S1 nerve root lesion affecting plantar flexion of the R foot. The body needs a strategy to move around the longer leg.

Remember here is that what you are seeing is the compensation, not necessarily the problem. When one leg is shorter, something must be done to get the longer leg through swing phase.

Excessive ankle plantar flexion. Another compensation to look out for when evaluating leg length deficiencies. 

Ivo and Shawn. …still bald…still good looking…still geeky…… The Gait Guys

Podcast #2: The Gait Guys Podcast Experience→

CLICK THE LINK ABOVE OR HERE

Description

PODCAST #2: Topic list and Listener Questions:

1. ARTICLE OF THE DAY:

Nantel J, Brochu M, Prince F    Locomotor strategies in obese and non obese children  Obesity (Silver Spring). 2006 Oct;14(10):1789-94.

We are constantly talking about abnormal gluteal firing patterns. Compensatory patterns can begin in childhood.  “This led obese children to significantly decrease the mechanical work done by the hip extensors during weight acceptance and significantly increase the mechanical work done by the hip flexors compared with non-obese children.”
Compensation patterns start early. Central pattern generators (CPG’s) for locomotion most likely exist in the lower thoracic or lumbar cord and are adaptable to sensory input. They receive input from the brainstem (where there are many relay nuclei, like the inferior olive) and the environment to keep the network regulated. Like any neural network, repetition of a particular pathway leads to axon collateralization and neural learning (much like beating a path from walking through a field), with facilitation (or preferential use) of that pathway in future similar experiences.
We have alot more to say about this, tune into the podcast !


2. On the blog you have seen a recent weekly topic trend on foot types. We are preparing you for the release of our 3 part DVD program to help you all. We have a physicians program we are working on as well.
Understanding where these foot type issues origninated from will help you get better at this game.

3. EMAIL FROM A COACH:

Hi Guys:
Now that i have been following your work on the web for a year i have become very aware of a small twist in the rear foot of many of my runners.  It occurs immediately at heel rise/heel lift when the run. I can even see it when they walk.  Instead of the heel rising purely off the ground progressing nicely to the forefoot loading phase it is as if they spin on the ball of the foot turning it out and thus forcing the heel to spin inwards/medially.  I have heard you loosely call this “putting out a cigarette butt” foot motion which is a great visual descriptor. 
My question……… what insight do you have on this problem ? My runners whom i draw their attention to it suddenly realize it.  Any suggestions ? I know it is not normal, i know it is wasting economy and time which is not good for any runner and i know most people do it. I walk through the malls and see it everywhere.  Maybe it is normal ? 

4. Topic: We talk about S. E. S. today. Developing Skill, Endurance, Strength.  And why they must occur in this order.

5. EMAIL CASE

 This one comes from Lisa in Fresno, California

 I am desperately need the help of a gait expert.   A little over a year ago I started an exercise program and began walking on the treadmill.  Within a month I had developed what I thought was plantar fasciitis.  I thought it might go away on its own, but it didn’t.  By June I had consulted a podiatrist.  He tried rest strapping and a couple steroid injections but nothing helped.  I have custom made orthotics, but wearing them was torture and … .

 

6. EMAIL CASE
I’ve been going to physio therapists for a while with lower back and posture problems, which I now think are related to how I walk (duck footed). So far the only thing I have really got from this would be a nice massage.
What kind of professional or practioner should I see about correcting issues like this?
Thanks very much, MIKE

7. EMAIL CASE
Hello Gait Guys,

In the past, I have sprained my left ankle in which has led me to think that this is the cause for me having a flat foot.

This in turn has led me to having problems around the knee and the hip.

Are there any exercises I can do to improve my medial arch? 

If there are videos that you are selling to teach how to deal with this problem, could you link me to it?

Sincerely, Zachary

 

8. Today we discuss the youtube video: 

The foot tripod: the importance of the toe extensors in raising the arch.Also read our blog post ( February 16th, 2012 blog post for more).

Type these words into the seach box on YOUTUBE:  "gait guys foot tripod"

9.  EMAIL CASE:

Hi There,

My name is Damien and i am writing you from Ireland. I’ve watched a lot of your videos online on YouTube. They are amazing. Congratulations on such a great and informative service. It’s so refreshing seeing people want to diagnose and fix feet rather than putting insoles or arch supports in place.

 Reason for Writing·         The reason I’m writing is that I have a problem with my left foot. Specifically, I have a corn under the outside ball of my left foot (basically about 1 inch back from my baby toe). I had the corn removed twice in the last 4 months, but the area is still pretty sore when I run/cycl

·         I seem to have very poor control of my toes also (based on your video Foot Hallux - Big Toe & Extensors). See pictures above of my toes fully flexed up. I guess I’m getting up about 20 to 30 degrees, whereas in your video you are getting up about 70 or 80 degrees. So I can barely get the long extensor up, and I can’t really get to the short extensor at all.

·         I’m not sure if I suffer from ankle rocker (I think I have a tight calf-posterior compartment). It’s hard for me to diagnose this scientifically at home. Or is it a problem with weakness of my metatarsals, or a weak arch/tripod, or a combination of all of the above.

Thank you for your time.

 Best Regards,

Damien

Tight ankles ? Here we do a short little video for mom.

Gain strength in the anterior compartment to achieve posterior compartment length. Stretching calf is not enough when the calf is tight due to increased neurologic protective tone, possibly an attempt to protect the ankle mortise joint.
So, if stretching is not the solution, look to increase facilitation and strength of the weaknesses in the other compartments.  You just might feel the tightness melt away without stretching at all !

Spindle responses and golgi tendon organ responses. The more you know about the nervous system the smarter your treatments will be.

The Gait Guys, using the functioning of the  nervous system to get the responses we want.

“…yesterday is history, tomorrow is a mystery, but today is a gift. That is why it is called the "present.”

Master Oogway: Kung Fu Panda (2008)

Along the lines of Friday Follies and our earlier post, here a funny acupuncture commercial for you.

Have a great weekend

Ivo and Shawn

A Great Reference Text:

Biomedical Acupuncture for Sports and Trauma Rehabilitation
Dry Needling Techniques,
Yun-tao Ma, Elsevier, 2010

Both Dr Allen and Dr Waerlop have studied under Dr Ma and Dr Waerlop has had the privilege of teaching with Dr Ma (Dr Waerlop is one of the leading acupuncture instructors in the US and one of the few Dry Needling Instructors)

This book is a follow up to Dr Ma’s 1st book: Biomedical Acupuncture for Pain Management.

They are both great resources for the Western approach to needling for pain management and dry needling, explaining the physiological mechanisms behind both.

Dr Waerlop uses acupuncture extensively for muscle stimulation and facilitation in many gait related disorders, and finds it a valuable adjunct to therapeutic exercise.

The Gait Guys

You can download many lectures on acupuncture by Dr Waerlop and many videos by Drs Allen and Waerlop on rehabilitation and gait, as well as basic science here.

Acupuncture can be effective for many types of sports injuries and rehabilitation of gait related disorders. One such study can be found here.

The effect of needling is though to be 3 fold: local, segmental and cortical.

The local effect of needling occurs at the site of the needle insertion. Local tissue damage causes cytokines to be released and this stimulates both the inflammatory and healing process, as well as increasing local circulation.

The segmental affect is thought to be at the spinal cord level (the dermatome or sclerotome) where inhibition of pain impulses occur (pre synaptic inhibition for you neuro nerds out there)

The cortical or “long loop” effect is thought to be due to activation of higher brain centers which cause descending inhibition of pain and activation of the hypothalamic-pituitary axis (which appears to be one of the reasons acupuncture can be effective for colds and other problems).

You can view many of our posts on pain and its physiology here to gain a better understanding of the pain pathway and pain modulation.

The Gait Guys: yes, sometimes we are a pain, but we offer solutions to help and give you the research to back it up