Too much potential gait pathology all in one sport ? Racewalking … . 

Do not underestimate this title, you may learn more about normal running form from today’s blog post than you think.

 

For the best clips start watching at the 4:15 mark. 

The sport of race walking is an interesting one to say the least.  We had the pleasure for years of treating and working closely with one of our countries best race walkers and she taught me so much, not only about the sport but about the strange mechanics of the sport and the functional pathologies the sport drives from its unique requirements driving abnormal gait mechanics on each step.

Racewalking is a long-distance event requiring one foot to be in contact with the ground at all times (and a couple of other unique and wacky rules that we will discuss in a moment). Stride length is thus reduced and so to achieve competitive speeds racewalkers must attain cadence rates comparable to those achieved by Olympic 800-meter runners for hours at a time. Most people cannot truly appreciate how fast these folks are going, most folks will have to move into at the very least a gentle run to keep up with these folks.

 

There are really only two rules that govern racewalking:

1-The first rules states that the athlete’s trailing foot’s toe cannot leave the ground until the heel of the leading foot has created contact. The rule violation is known as "loss of contact". 

2-The second rule specifies that the supporting leg must straighten, essentially meaning knee extension (and for some, terminal extension, ie. negative 5-10 degrees !) from the point of contact with the ground and remain straightened until the body passes directly over it. Again, essentially meaning full range knee extension for the entire stance phase of gait (early, mid and late midstance phases). For those who do not study the details of gait, this may not seem like a huge issue, but it is because full lockout really never occurs in either walking or running.  And there is nothing like impacting a joint in full extension lock and heavy heel strike to take away all of the natural shock absorbing mechanisms of the lower limb. (watch the video at the 4:30 mark, Dang ! the dude in the red looks like his knees are going to fold backward there is so my knee extension !) There is some great slow motion technique breakdown at the 6:28 minute mark of the video. 

In getting around these 2 major rules:

- the hips must rotate a tremendous amount, with full pelvis rotation, to prevent the frontal plane pelvis motion which would be a loss of sagittal power. This produces the visually painful waddle that is classic to the sport.

- the arms are used aggressively to generate power and to help the lower limbs move through the cycle because of the unnaturally apropulsive nature of the overall technique. The arms also often move excessively into the frontal plane since they mirror the lower limb

- excessive lateral heel strike quite often ensues help keep the knee extended and in an attempt to keep the foot on the ground longer, to avoid getting red carded. 

- there is plenty of cross over gait and severe lack of ankle dorsiflexion for everyone to observe, both of these components combined with the above characteristics give the “Close to the ground” appearance that is attempted by all racewalkers.

- want to see some seriously gut wrenching biomechanics, forward the video to the 7:55 mark. Tell us that won’t cause problems down the road !

Breaking the Rules:

The rules are entirely subjective and enforced by real-time human eye (not video) judges along the course (3 red card violations render an event disqualification). Interestingly, and we have seen this first hand, athletes quite regularly lose contact (meaning initiating a float phase, which is what dictates the difference between running and racewalking) for a few milliseconds per stride.  This float can be detected on film/video which can be caught on film, but such a short flight phase is said to be undetectable to the human eye. Disqualifications (losing contact or bent knee) are routine at the elite level as evidenced by the famous 2000 Summer Olympic case of Jane Saville who was disqualified on her way to a gold medal.

Racewalking … .  a highly technical sport, more so than running.  If you ever get a chance to see someone do this sport first hand, it is truly engaging to a gait geek. Lots of eye candy, gait geek eye candy that is !

Shawn and Ivo… … the gait guys. 

What do we have here and what type of shoe would be appropriate?

You are looking at a person with a fore foot varus. This means that the fore foot (ie, plane of the metatarsal heads) is inverted with respect to the rear foot (ie, the calcaneus withe the subtalar joint in neutral). Functionally translated, this means that they will have difficulties stabilizing the medial tripod (1st MET head) to the ground making the forefoot and arch unstable and likely rendering the rate and degree of pronation increased.

Having trouble with terminology? check out this post on FF varus.

The incidence of this condition is 8% of 116 female subjects (McPoil et al, 1988) and 86% of 120 male and female subjects (Garbalosa et al, 1994), so it happens more in males.

Fore foot varus occurs in 3 flavors:

• compensated
• uncompensated
• partially compensated

What is meant by compensated, is that the individual is able to get the head of the 1st ray to the ground completely (compensated), partially, or, when not at all, uncompensated.

What this means from a gait perspective ( for partially and uncompensated conditions) is that the person will pronate through the fore foot to get the head of the 1st ray down and make the medial tripod of the foot (ie, they pronate through the subtalar joint to allow the 1st metatarsal to contact the ground). This causes the time from mid-stance to terminal stance to lengthen and will inhibit resupination of the foot. We will have an upcoming additional post on this soon and will put a link here when we do.

Today we are looking at a rigid, uncompensated forefoot varus, most likely from insufficient talar head derotation during fetal development and subsequent post natal development. They will not get to an effective foot tripod. They will collapse the whole foot medially. These people look like severely flat-footed hyperpronators.

So, what do you do and what type of shoe is appropriate? Here’s what we did:

• try and get the 1st ray to descend as much as possible with exercises for the extensor hallucis brevis and short flexors of the toes (see our videos on youtube)
• create more motion in the foot with maniipuulation, massage mobilization to optimize what is available
• strengthen the intrinsic muscles of the feet (particularly the interossei
• increase strength of the gluteus maximus and posterio fibers of the gluteus medius to slow internal rotation of the leg during initial contact to midstance
• put him in a flexible shoe for the 1st part of the day, to exercise the feet and a more supportive, medially posted (ideally fore foot posted) shoe for the latter part of the day as the foot fatigues
• monitor his progress at 3-6 month intervals
• a rigid orthotic will likely not help this client and they will find it terribly uncomfortable because this is a RIGID deformity for the most part (the foot will not accommodate well to a corrective orthotic. Besides, the correction really has to be made at the forefoot anyways. We will talk about medial forefoot postings again at a later date.)

Lost? Having trouble with all these terms and nomenclature? Take our national shoe fit program, available by clicking here.

The Gait Guys. Uber foot geeks. Still bald and good looking. Separating the wheat from the chaff, with each and every post.

Bigfoot Gait. Part 2. The Patterson Video: Human or Gigantopithecus ?

Last week on the blog we discussed some of the unique gait characteristics we saw in the famous Patterson Bigfoot video and how many of them are seen in humans as compensatory strategies. Today we will mention a few more interesting things that will have you think about your human gait assessments a little differently.

Renowned chimpanzee researcher Jane Goodall last year surprised an interviewer from National Public Radio when she said she was sure that large, undiscovered primates, such as the Yeti or Sasquatch, exist.”

Why does Jane believe this ? Well, Gigantopithecus blackiwere, the largest apes that ever lived (10 feet tall, 1000+ lbs), lived as recently as 100,000 years ago. Giganto can be placed in the same time frame and geographical location as several hominin species. Its means of locomotion are uncertain since no pelvis or leg bones have ever been unearthed however the dominant view is that it walks on all fours like modern day gorillas and chimpanzees.  There are those however that believe that Gigantopithicus also walked bipedally just like many of today’s apes do.  There was a fascinating theory brought to light by Grover Krantz who made the bipedal assumption from jaw bones which were U-shaped and widened posteriorly leaving room for the windpipe to be located within the jaw, just like in humans.  This had to translate to bipedal ambulation to afford the skull to squarely sit upright on a completely erect spine as compared to being carried anteriorly (when on all four limbs) as in the great apes and chimpanzees.  It is a fascinating theory, but none the less, there are researchers on either side of the debate and proof may never occur … .  until perhaps one day we find a full skeleton or the real life version. Maybe someday we can get a team of Gait Geeks together and create a “Squatching Team” to head out deep into the Pacific northwest on a discovery mission.

1- Vertical Oscillations:

Today, in the video above, we draw your attention to the lack of vertical oscillations of the head.  Take a moment to watch this in the video once again. You should see that there is very little vertical displacement of the body (focus on the head). This minimal vertical type gait can only occur with a continuous slightly bent knee gait and we could make the case that a midfoot strike will dampen the vertical parameter even further. In humans, and in bigfoot here, limiting terminal hip extension also buffers some of the vertical movement, just as you see in the video.   Humans use a slight degree of knee flexion at foot strike to accomplish the same task, it is partly a strategy to keep the eyes steady on the horizon and some anthropological papers have suggested that this was a necessity in order to be able to run, visually track and accurately launch a spear at prey back in our plains hunting days. 

2. Heel Strike vs Heel Contact

A midfoot strike and heel strike are different.  A midfoot strike is often accompanied by a heel contact phase, which is different than a heel strike. With heel strike, the heel is the first point of contact, whereas heel contact can occur if the entire foot is placed flat all at once or it can occur after a forefoot or midfoot strike occurs (ie. placing the heel down).

By many sources, only great apes exhibit a true heel-strike, other primates present with a heel contact after a midfoot strike first occurs. As determined in this study heel contact is a by-product of an active posterior weight-shift mechanism involving highly protracted hindlimbs at touchdown.

 From the Schmitt study a variety of primates (32 species) were viewed walking on the ground and on simulated arboreal supports at a range of natural speeds.

“The study’s results indicated that Pongo as well as the African apes exhibit a "heel-strike” at the end of swing phase. Ateles and Hylobates make “heel contact” on all supports shortly AFTER mid-foot contact, although spider monkeys do so only at slow or moderate speeds.  No other New or Old World monkey or prosimian in this study made heel contact during quadrupedalism on any substrate. Thus, heel contact occurs in all apes and atelines, but only the great apes exhibit a heel-strike.“

Schmitt also concluded that "although heel contact and heel-strike may have no evolutionary link, it is possible that both patterns are the result of a similar weight shift mechanism. Therefore, the regular occurrence of heel contact in a variety of arboreal primates, and the absence of a true biomechanical link between limb elongation, heel contact, and terrestriality, calls into question the claim that hominid foot posture was necessarily derived from a quadrupedal terrestrial ancestor.”

So, in the Patterson video above, we see a lack of vertical oscillations just as in man. Apes also tend to waddle side to side, much more so than what we see in the Patterson video.  We also see a heel strike, which is know to occur in great apes but also in man.  

So, is this a man or is this a great ape ? It points to a human in an ape suit, unless this is actually Gigantopithicus who over 100,000 years has improved upon the skill and coordination of bipedal gait, just as modern day man has done.

Nothing shocking  here today. This was kind of fragmented a little but we just wanted to bring up the vertical oscillation and heel strike components to human and ape gaits. And then, let you decide for yourself about the Patterson video.

Shawn and Ivo……. when not making crop circles we are just two guys in ape suits……. walking the night forests, keeping folks believing…..

PS: here is an interesting excerpt on vertical oscillations from an old blog post we did. It seems pertinent here.

This study’s findings findings clearly demonstrate that human walkers consume substantially more metabolic energy when they minimize vertical motion.

Anyhow, the summary of this peer reviewed article by Ortega concluded that :

“in flat-trajectory walking, subjects reduced center of mass vertical displacement by an average of 69% but consumed approximately twice as much metabolic energy over a range of speeds . In flat-trajectory walking, passive pendulum-like mechanical energy exchange provided only a small portion of the energy required to accelerate the center of mass because gravitational potential energy fluctuated minimally. Thus, despite the smaller vertical movements in flat-trajectory walking, the net external mechanical work needed to move the center of mass was similar in both types of walking. Subjects walked with more flexed stance limbs in flat-trajectory walking, and the resultant increase in stance limb force generation likely helped cause the doubling in metabolic cost compared with normal walking.Regardless of the cause, these findings clearly demonstrate that human walkers consume substantially more metabolic energy when they minimize vertical motion.”

J Appl Physiol. 2005 Dec;99(6):2099-107. Epub 2005 Jul 28. Minimizing center of mass vertical movement increases metabolic cost in walking. Ortega JD, Farley CT. Source– 

 References:

-http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409101/

-Am J Phys Anthropol. 1995 Jan;96(1):39-50.

-Heel contact as a function of substrate type and speed in primates. Schmitt D, Larson SG.. Department of Anatomical Science, School of Medicine, State University of New York, Stony Brook 11794, USA.

-http://thegaitguys.tumblr.com/post/46851286689/more-on-the-great-debate-does-decreased-step-height

-http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1571309/

To orthotic or not to orthotic, that is the question

A concerned mother of this 3 year old boy came in, wondering if her son should have orthotics. What do you think?

Pros for orthotics:

• will make calcaneii more vertical
• will make feet look better
• will decrease progression angle while walking
• will halt most of the midfoot pronation you see on the single leg standing views
• will make left calcaneal valgus better that we see on the post view

Cons for orthotics:

• may interfere with derotation of the talar head, causing a permanent forefoot varus deformity or Mortons foot (need to more about development? click here)
• will make the child use their intrinsic muscles less, weakening the feet, causing problems later on in life
• will inhibit descent of 1st ray, and peroneus longus function (if you don’t use it, you lose it. More on peroneus here)
• will alter gait and affect motor development

What did we do?

• have the mother have the child walk barefoot more, especially in the sand
• have the child hop on one leg and do tandem gait walking
• have the child balance on one leg at a time
• place the child in flexible shoes
• recheck the child in 6 months to assess progress

Does this mean kids should NEVER be in orthotics? No, certainly not, but we fell this is neither the time or the place. A lot of development (and learning) occurs in the 1stf five 5 years of life. How about we let nature do its thing, try and stay out of the way of normal development and monitor?

The choice is yours

The Gait Guys. Offering firm, but gentle clinical guidance through the maze of gait information out there.

Bigfoot Gait. Yup, taking a look at the “big guy”.  The famous Patterson video.

Man or Ape? That is the question ! Lets see what can be noticed :

1. protracted head, shoulders and a forward and downward drop of the anterior rib cage through probable weak upper abdominals
2. internally rotated upper limbs with excessive forward arm swing (overswing, likely pulling/flexing too much from the pectorals to drive arm swing as opposed to driving normal pendular arm swing from triceps extension)
3. no hip extension during gait, (see #2 above. Without adequate triceps use/posterior arm swing the degree of hip extension/gluteal use cannot be optimized.

These are clearly attributes of a animal that has moved from quadipedal gait to bipedal before they have earned the postural right to do so.

Just like any modern man,  as evidenced by clear observance of said gait in the local mall or airport, most of modern man has difficulties with the degree of motor coordination and postural control necessary to walk with clean upright biomechanics.  Most modern gait exhibits the pathologies we discussed above. So, this must be a man in an ape suit then, right ? The only problem is that this film was from 1967 ! Clearly we know that Bill Gates and Steve Jobs were not doing their thing at that time, and people were not driving that much nor sitting in board rooms as much as they do now. So the question remains, if this is a man how did he get so posturally imploded ? Unless of course, he was trying to walk like a bipedal monkey.  The only problem there is that ape contra-body movements (symmetrical fluid opposite arm-leg swing) are not this clean even though this is pretty poor gait for a human.  So, either this is a non-computer age man trying to walk like an experienced ape, or, this is bigfoot.

There you go, we successfully made no progress in our forensic analysis to help in the mystery of bigfoot.  Then again, no one has.  National Geographic has a something else to say……. read on.

article: Forensic Expert says Bigfoot is real. (click for link)

From the article…..”It’s been the subject of campfire stories for decades. A camera-elusive, grooming-challenged, bipedal ape-man that roams the mountain regions of North America. Some call it Sasquatch. Others know it as Bigfoot.

Chilcutt says one footprint found in 1987 in Walla Walla in Washington State has convinced him that Bigfoot is real.

“The ridge flow pattern and the texture was completely different from anything I’ve ever seen,” he said. “It certainly wasn’t human, and of no known primate that I’ve examined. The print ridges flowed lengthwise along the foot, unlike human prints, which flow across. The texture of the ridges was about twice the thickness of a human, which indicated that this animal has a real thick skin.”

Renowned chimpanzee researcher Jane Goodall last year surprised an interviewer from National Public Radio when she said she was sure that large, undiscovered primates, such as the Yeti or Sasquatch, exist.”

click the link above to read the whole article.

Shawn and Ivo……. when not making crop circles we are just two guys in ape suits……. walking the night forests, keeping folks believing…..

Holy Late Cretaceous Therapods. Those Veliciraptors were twisted!

The dinosaur made famous by Jurassic Park (We never understood why they put this dinosaur in the movie, the Jurassic period was many millions of years earlier, but that’s another story).

Dr Ivo was able to take some pictures of a rare, preserved skeleton from Mongolia at the dinosaur museum in Fruita, CO, while visiting with his family.

These bad boys (and girls) were fast predators, and one of the things that made them that way, was the fact that they were built for speed!

Take a look at theses hips! Note the extreme retro torsioned angle of the femur heads. We remember that femoral retro torsion limits internal rotation of the hips (OK, so you don’t remember? click here for a review).

Now lets think about this. Externally rotate your thigh and lower leg. What do you notice? Hopefully you notice it puts your foot in more supination. This makes it into a more rigid lever, better for pushing off and better for sprinting!

Have you ever seen a sprinter? do they run on their toes? Is their foot more supinated? Ever see a velociraptor run? Check out this sequence from the “Dinosaur Planet” series. Remember, only their toes are on the ground and the thing that looks like a backwards knee is actually their ankle. 

Since their legs are so close to the body, there is little need for internal rotation, so why not maximize the effect and assist in supination?

Wow! Are you finally convinced that torsions are cool? After all, they appear to have been around for at least the last 75 million years and probably longer. 

The Gait Guys. Quarternary Geeks of the Cenozoic Era. Yes, we study dinosaur gait too…

Subtle clues often tell the story. A case 

A young athlete that wants to be faster (he is a 4:17 miler).

In the 1^st shot we see he has an anatomically short R tibia (and the gait to match it). You will note the right tibial plateau is lower than the left. The 2^nd shot backs this up; look at the malleoli.

The next shot shows a FABER test f the L hip. Compare the range of motion with the right one. Hmmm.  Limited external rotation and abduction on the right.  It should be noted he had normal and relatively symmetrical internal rotation of both hips.

Now come the feet. 1^st the left. A relatively neutral foot. Next the right. What’s different? Note how much more pronounced the right 1^st ray (ie 1^st metatarsal phalangeal joint).

Think about his short side. Most likely, he will be trying to lengthen it, right? How would he accomplish that? By supinating the foot (making it more rigid) and attempting to lengthen that leg, by anterior rotation of the pelvis. If you anteriorly rotate the pelvis (ie the innominate rotates forward, bringing the ASIS forward), what happens to external rotation of the hip? Stand up, edtend your hip on your pelvis and find out. It limits it.

How else might he try to lengthen that leg? If he supinates the foot (ie planytarflexion, adducion and inversion), the foot will be more inverted. He will be trying to get that medial tripod down to the ground. How might he accomplish that? By plantarflexing the 1^st ray!

So how can we make him faster?

• Place sole lift under r foot
• Correct pelvic pathomechanics with manipulation
• Support coorection with appropriate exercise (he had weak R lower external oblique’s)
• Foot mobilization
• R Foot intrinsic exercises to promote rasing of the 1^st ray (extensor hallicus longus  and flexor hallicus brevis exercises)  and lowering of the lesser metatarsal heads (extensor digitorum brevis exercises ).

The answers are often in the details. Be detail oriented. That’s one of the things that makes us foot geeks.

Ivo and Shawn

Happy Friday Folks!

Today, a classic rerun with a take on one of our favorite movies. Sit back and watch Trinity outrun Agent Brown, with full biomechanical explanations!

This was originally run for the Natural running Center in July 2011. Click here for that version.

Our friend Mountain and his new minimalist dress shoes.

Great job pal !

Barefoot Shoes: ThePrimalProfessional.com 
Facebook: facebook.com/thePrimalProfessional

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Standing Propriosensory Exercise Progression

If you have been with us for any length of time, you know how we feel about proprioception. Here are a few samples from some of our posts on this subject. 

Here is an exercise progression we like to use, and we use it often. You are free to use it in your clinic, but please do not “rip it off” or print this copyrighted material without our permission. 

Enjoy, 

Ivo and Shawn

Standing Propriosensory Exercises

©1997 Ivo F. Waerlop DC, DABCN

patient positioning: patient stands in a door way with arms outstretched near door jam (for support if needed).

progression of exercise: when the patient can perform exercise pain free and with appropriate proficiency for 60 seconds, the next exercise is introduced. That exercise receives periodic review by the examiner, and is discontinued in a supervised setting. The patient may continue that exercise at home for 1-3 minutes, 3 times per day.

duration of exercise: each exercise is performed one time for up to 60 seconds or to patient pain threshold, whichever comes first. As the patient improves, time and may be increased up to 3 minutes.

frequency of exercise: exercises are performed daily under supervision until the patient demonstrates proficiency in that exercise. The patient then continues that exercise at home for at least 1 minute, at least 3 times per day.

standing with eyes open:  the patient stands in the door way with both feet together, eyes open, and arms outstretched. The patient should feel stable and confident before progressing.

standing with eyes closed: the patient stands in the door way with both feet together, eyes closed, and arms outstretched.

exercise #1 is repeated while standing on one leg: the non weight bearing leg and thigh are brought to 90E flexion.

exercise #2 is repeated while standing on one leg: the non weight bearing leg and thigh are brought to 90E flexion.

one legged dips/ eyes open: The patient assumes a one legged standing posture (as previously described with arms outstretched  for stability if needed). The patient then lowers their torso as low as possible without losing their balance.

exercise #5 is repeated with the eyes closed

the entire sequence is repeated with the head extended 60 degrees

Do they not only look dumb, but reduce your IQ to your waist size?

Can sagging pants lead to cognitive decline? 

There are a number of papers being written about gait changes (step length, frequency, speed)  being indicative of cognitive decline (see here and here for 2 of them).

Wearing sagging, baggy pants has many associated issues (see here for our recent post on that). Can the reverse be true? Can creating a smaller step length cause cognitive decline?

Neurologically, we know that the cerebellum is involved with learning. Balance and coordination tasks improve learning. Yes, it is better to have have your kids banging and climbing on the TV, rather than being passive and watching it.  This is probably due to muscle and joint mechanoreceptors being activated, and that information traveling northward in the spinocerebellr tracts which feed to the flocculo nodular lobe and cerebellar hemispheres. Here they interact with converging input from all the other systems (vision, hearing, and probably smell), as well as descending motor information from your motor cortex. They are processed and then redirected to the areas where they came from, as well as to systems which project that information to many places, including, you guessed it, your temporal lobe (memory), parietal lobe (special integration and discrimination) and frontal lobe (personality and motor activity).

So, what happens when you slow or decrease information to the cerebellum? What happens if we don’t use neurons? They degenerate, or are remodeled into something else as the pathways slowly grow over and are replaced by other information your brain sees as more important.

Could decreasing your step length, altering and/or diminishing proprioception affect cerebellar output? Yes. Could this affect your ability to learn and remember? Yes. Could this lead to cognitive decline? Conceivably…

We think you know  where we stand on this. Think before you sag…while you still can

The Gait Guys.  Definitely NOT saggy : )

What a difference a lift can make.

More from the pedal freaks….

Yes, we watch folks on bikes too. We look at foot and knee position, smoothness of strike, back position, as well as the spandex. Gait and biomechanics are everywhere and no one is safe from “the gait cam”.

Take a look at this gal and her pedal stroke. The first 9 second portion of the clip shows her pedal stroke with an increased medial migration of her L knee. Notice at about 4 seconds when she increases her cadence, it exaggerate the issue (see out post on that here). What sorts of things could cause that? A few causes are:

•  Leg length discrepancy
• Collapsed arch of L foot
• Poor foot intrinsic strength of L foot
• Poor eccentric contraction of L posterior gluteus medius complex
• Weak lower abdominals L > R
• Decreased ankle rocker of L foot
• Cleat positioning on L shoe
• Hip osteoarthritis
• And the list goes on…

In this particular case, she had an anatomically short leg on the LEFT and weak foot intrinsics. Yes, we know, folks tend to pronate heavier on the LONGER leg side, but this is usually with running, not cycling. It tends (but not always) to be opposite with cycling. We believe this is due to the more rigid lasted cycling shoe and more of a “reach” with the foot on the short leg side.

In the second part of the clip, from 10 seconds to end, we place a 3mm lift on the left. THAT’S IT. Wow! What a difference! Still some oscillation of the knee at the top of her stroke (present on both sides, but more pronounced on the left), but much less. Note also that her body oscillation lessens as well and her stroke is smoother.

The Gait Guys. Not only are we watching how you walk, but also how you ride

More proof for the Cross Over Gait for the non-believers and debaters.

For those of you who have been with us for a few years, you are no stranger to our articles and videos on the web for piecing together many aspects of the CROSS OVER GAIT in a manner more comprehensive and more clear.  If you are not familiar with our work on this, please click here.

Today we add a little more “proof to our pudding”.

“Changing step width alters lower extremity biomechanics during running.” Brindle et al.
http://www.gaitposture.com/article/S0966-6362(13)00291-9/abstract

• Step width influences frontal plane biomechanics of all body parts
• Changes in step width affects arm swing symmetry and often creates arm abduction
• Hip and knee biomechanics change from their normal predicted path and mechanics
• Hip adduction, rearfoot eversion and internal tibial spin decrease as step width increases
• Knee adduction/valgus stress decreases as step width increased.
• Increased step width improves cephalad stacking of all lower extremity joints
• The swing limb is a hinging pendulum. Striving for a level pelvis and normal step width promotes a normal sagittal pendulum path and improves the likelihood of a recurring sagittal pendulum swing for the opposite leg. 

As Brinkle et al. say in their paper, “step width is a spatiotemporal parameter that may influence lower extremity biomechanics at the hip and knee joint.”  We would argue that it is even more far reaching than the hip and knee. You have likely learned here at the Gait Guys that arm swing is heavily predicated on the dynamics of contralateral leg function and positioning.

The above video shows a classic cross over gait. The limbs can be seen crossing over the midline thus guaranteeing that the pendulum is moving through an arc and not along a straighter progression. This adduction of the limb virtually guarantees that the foot is striking greater on the lateral heel and forefoot than it should, that the rear foot is going to move through eversion with greater speed and force and internal tibial spin and arch control will need to be controlled better.  And if they are not controlled better, pathology may eventually occur.  Do you want any of this to occur at an accelerated rate as occurs in running ? One doesn’t need to just heel strike to suffer these problems, midfoot strike will still see them if the cross over occurs.

Shawn and Ivo, the Cross Over Guys.

Got Water?

How Much Water should I drink? The basics of hydration…

Water is the elixir of life. Too much (hyper hydration) or not enough (dehydration) can both be detrimental to your performance, but how much is enough?

Our bodies consist of about 60-70% water at any point in time. Most men have a higher percentage because they have a higher percentage of muscle mass (unfortunately, adipose tissue contains little water!). We generally lose between 1.5 and 2.5 liters of fluid a day through breathing, urinating and general metabolism. The body must keep a balance of water both inside (intracellular) and outside (extra cellular) your cells. Because the body is in equilibrium, if you sweat, breathe, or urinate too much, you will lose water from your extra cellular compartment. The body will then take water from inside your cells and shift it to outside. Likewise, your brain (hopefully) will stimulate you to drink more and urinate less, helping you to fill up the extra cellular compartment again. The water will then diffuse back into the cells and equilibrium is established again. A lot of this movement of water has to do with electrolytes (charged particles in your blood and body fluids) and their movement across cell membranes. The electrolytes that are most important for us are Sodium (Na+) and Potassium (K+).

When you lose too much water, your blood becomes more viscous (remember, you are losing water, not cells. Less water plus same number of cells equals more viscous liquid). This makes your heart have to work harder to push the blood around. This takes more energy and resultantly your heart rate increases, causing a phenomenon called cardiac drift. An example is when you are exercising for a while at the same intensity and your heart rate increases over time. A loss of 2-3% of your body’s water will decrease your performance by 3-7%! The amount you lose will depend on your exercise intensity and duration as well as temperature. A 20 degree increase in temperature can increase your heart rate as much as 10 beats per minute!!

So, it seems if we drink a lot of water, all will be well. Well, yes… and no. Your body can only absorb about 24-28 ounces of water per hour, any more and it just makes you pee more. You can sweat up to 3 liters (that’s more than 96 ounces!) per hour. Hmm. looks like we will probably be in a deficit. How much we absorb depends on whether we can get the water out of our stomach and into our intestines where it can be absorbed. As you can imagine, there are some things which speed gastric emptying and some which slow it down.

Protein and fat are the 2 main things which slow the trip through the stomach down. If too much of these are in your drink or already in your stomach the water will end up sloshing around and probably leave you not feeling too good. Guess that means lots of protein before or during an endurance workout is probably a bad idea, especially if you are trying to stay hydrated! Small amounts of protein, when combined with carbohydrate can be beneficial, but that’s another subject for another day. So much for all that marketing hype!

Small amounts of carbohydrate (up to 60 grams per hour) can enhance water absorption from the intestines and speed emptying of the stomach. The body can’t process any more than this, and it will actually start to slow stuff down if you do too much.

Sodium (50-70 mg, about a pinch) also helps with water absorption. It has the added bonus of stimulating your hypothalamus to tell you to drink more. If you wait until you are thirsty, it will be too late. You need to drink before you are thirsty!

So, what’s a person to do? Here are some tips:

• Drink small amounts often, especially in hot weather. 6 ounces every 15 minutes is a good pace
• Consider adding some sugar to your water sucrose (table sugar) or maltodextrin are a good start. Remember, no more than 60 grams per hour
• If you don’t like sweet drinks while working out, consider using a gel or goo
• A little salt is a good thing. It improves the taste of the water, helps with its absorption, and stimulates the thirst mechanism.
• Research your workout drink. Ask questions. Many claims are marketing hype and not based on science or physiology.
• Consult with your chiropractor, physical therapist, doctor or trainer with questions

The Gait Guys. Quenching your thirst for knowledge and providing answers to you, each and every day.

Hill Running: The Ankles Have to Get it Somewhere.

Get what ? They have to get the dorsiflexion or ankle rocker somewhere. One has to get the ankle dorsiflexion range somewhere and if it is not at the ankle mortise one can snag it from somewhere else, but at a cost.   

Remember, we need a requisite 10 degrees (preferably 15 degrees) of ankle dorsiflexion to walk and run normally (the starting reference point is 90 degrees perpendicular to the ground). You should have 30-35 degrees! (You will tap into most of this with up hill running). This motion needs to be matched with available hip extension. When one (i.e. hip extension or ankle dorsiflexion) is limited, the other is usually impaired as well.

When someone has a limitation in ankle rocker it can be found elsewhere possibly, and often, at a cost. Increased midfoot pronation is a classic strategy. If one collapses the arch enough the talus will drop forward and inwards (we know that the normal talar movement in pronation is Plantarflexion, adduction and medial rotation). These 3 combined motions will also tip the tibia forward and help to achieve the sufficient forward motion of the joint complex to allow sagittal progression of the body. The problem with this is that if the amount of pronation is too much the foot will splay compromising the foot tripod, excessive pronation will occur putting the tibialis posterior and plantar fascia at risk as well as other structures, and when this occurs the tibia will excessively internally spin dragging the knee into a valgus/medial moment thus possibly creating patellar tracking issues and significant strain on the MCL and menisci as well as other components. Increased foot progression angle, with increased forefoot pronation is another classic strategy. This option maintains the normal sagittal knee progression path, but at a cost. Many folks will attempt to mitigate biomechanical limitations when running hills by either knowingly or unknowingly turning the feet outwards. This will also allow for the increased foot pronation, internal tibial spin and valgus knee collapse BUT the turn out (increased foot progression angle) will still keep the forward/sagittal knee progression angle.  So, they are still creating all of the other pathologic compensations but fooling the knee into a forward/sagittal progression. Mind you, this is a mere smoke screen because the same detrimental foot, ankle and knee mechanics are still occuring.  The knee may be hinging forward but it is still doing so through a valgus hinge. 

In these photos we see a huge steep hill incline represented by the Merrell loop.  The inclination at foot strike is quite significant and so this represents in many ways a steep hill climb.  There are 2 photos here so be sure to click to see both. The first one (white shirt) shows just how much ankle dorsiflexion is necessary to run on this “hill” (we wonder if Merrell knows they are asking their runners to hill run at the ankle/foot level?).  It is hard to tell in the second picture but one might hallucinate that the stance foot is heavily pronating and collapsing inward.  None the less, she is still cranking out a huge ankle dorsiflexion/ankle rocker range of motion.  IF you do not have enough ankle dorsiflexion/rocker, as we discussed today, you may have to ask for it somewhere else and that could be a problem in time.

Hills and happy knees, Hills and unhappy feet, knees and hips.  It is up to you, if you are paying attention.  So many people do not.

Shawn and Ivo, The Gait Guys.  Life is an uphill struggle, manage it well and you will have happy biomechanics your golden years.

Holy Twisted Femurs, Batman. What is going on here?

So, this is what femoral antetorsion looks like!

Remember that ante torsion occurs during development and is when the neck of the femur makes greater than a 12 degree angle with the shaft. We did a great post on this a while ago, click here to read it.

If you remember that the femur heads point anteriorly in a standing position, this would accentuate that, so they stand with an increased progression angle (ie feet toed out; see 1st picture).

With the increased femoral neck angle, these folks have a greater range of internal rotation of the femur, and decreased external rotation. Can you see this in the pictures above? We have rotated her legs fully internally and externally.

A few questions for you:

if you look carefully at the 1st picture, you will note she has external tibial torsion. Why?

• this condition can develop in utero, but more commonly occurs postnatally with"W" sitting (sitting with knees together and legs abducted, with buttocks between the legs or feet. Think about that constant internal force on the femurs and external rotatory force on the lower tibia! Have your kids sit differently!

What type of shoe should this person be in?

• The condition itself does not dictate the type of shoe thay should be in. This individual has a rigid, cavus foot BUT has an uncompensated forefoot varus with a great deal of forefoot pronation. In addition to exercises to strengthen the external rotators of the thigh, and inverters of the foot, a shoe with some motion control features is indicated in this instance

The Gait Guys…..Twisted? Yes! And still bald, middle aged and geeky as well.

A bit confused? Dig into our blog more, or watch our youtube channel. Maybe it’s time to push your knowledge base to the next level and take the National Shoe Fit Program. email us at thegaitguys@gmail.com

Study Shows Saggy Pants Linked Erectile Dsyfunction & Other Health IssuesThi→

Think before you sag…..

Sagging pants is about to become a lot more expensive.

We were thinking of doing this as a fundraiser for The Gait Guys…..

“Sagging Pants”: A different kind Self-Inflicted of Gait Pathology.

We have been absolutely dying to do a blog post on “sagging” pants for years but we just couldn’t find video that sufficiently provided the visuals we required to go into depth on the pathology it drives into one’s gait. Both of us at The Gait Guys knew we would never live it down if we actually did this walk ourselves (plus we realized we didn’t have the required jeans) so we waited for the perfect video(s).  Well folks, today is your lucky day because we found what we are looking for (there is a second video link down below but please read on before you look at it so you can understand what you are seeing).

Today we start this blog post with a classic video example of what “sagging pants” gait looks like. This poor fella is either having some real difficulties or he is taking it to the next level (and if so, good on him !) You know what we are referring to, the culturally proclaimed cool style of wearing your pants down around your upper thighs with your junk barely kept in the trunk.  But there is more to this gait than you might think and there is a reason why we have wanted to so badly present this gait to you. The reason is because, well, it is darn right entertaining to watch, but more so because it creates a very unique variant of the classic Abductor gait.  in order to keep one’s pants up, and from falling down to one’s ankles, one must abduct the thighs and legs to push out into the waist of the pants to keep the pressure constant and keep the pants up.  But wait, there is soooo much more than just that.  This gait throws off:

• the normal stance and swing phases
• impairs the normal gait rhythm
• clearly impairs arm swing (and this video above is interesting because it so very nicely shows in the video that the more the legs abduct the more the arms abduct on the contralateral side. More proof to all you runners out there who are trying to coach a new arm swing, you must realize that a huge part of arm swing is predicated on what is happening in the contralateral lower limb.  Perhaps a unique addition to the “crossed extensor response” for all you neuro geeks out there !).  So before you try to change a runner’s arm swing you better assess the lower limbs, they likely have reasons as to why they are doing what they are doing. Once again, proof that what you see is not the problem and what you see is not necessarily what needs corrected.
• causes and abduction of the feet and legs (perhaps this should be mandatory therapy to reduce all runner “cross over gaits” ?  Can we bill insurance for that ?). This is one reason why we love “monster walks” with an ankle theraband loop as ONE way to train less cross over neuropatterning. This is not to be confused with the more medically classic “abduction gait” pathologic gait pattern.
• lessens the normal pelvic obliquity of the pelvis (ie. when the right leg is behind and in full hip extension just prior to push off phase of gait, the pelvis is obliqued posteriorly).  Remember that the initiation of the swing phase is initially brought on by the reduction of the obliquity by abdominal contraction to pull the pelvis forward (during opposite leg stance/support phase) and then the psoas (ipsilaterally/swing side) becomes a swing phase perpetuator. The psoas is not a swing phase initiator, it is a perpetuator.
• impairs hip extension, and thus will cause gluteal atrophy in time (oh gosh, combined pathology now!)
• impairs terminal swing phase of gait
• recruits pathologic gait patterns
• impairs one’s ability to run from the cops, your girlfriend’s father who might have a shotgun, a guard dog, a nasty bout of diarrhea and finding a toilet, or if you are late to catch the morning bus)

This may be the silliest, self-chosen, and self-consciously acquired, pathologic gait pattern ever.  But it is none the less really entertaining to watch as the main video shows. 

Now, here (link) is a better video showing the pathologic problems we itemized above.  Look closely in this video you will see that in order for this gait style to “Work” (if that is what you call it) the pants have to be riding up higher in the front around the front of the thighs.  And to do this one has to tip into a slight posterior pelvic tilt most likely driven by the glutes and create a slight constant flexion of the knees (which also further impairs hip extension and gluteal recruitment). This will cause overactivity of the glutes and eventual shortening of them. We wonder how many of these fellas have developed piriformis syndrome radiculopathy ? 

http://youtu.be/KcvDr-bys2A

http://youtu.be/OvPpewa86yI

For the love of all things sane and wise…….. please pull up your pants if you are doing this…….we can’t fix everyone’s gait on the face of the earth but we certainly do not need folks intentionally screwing up their gait just to show off your hot underwear ? Wouldn’t it be more proper just to ask someone if they want to see your hot new Calvin Klein’s ?.  On a positive note, showing off your undies in this Sagging Pants manner will improve hygiene, if you know what we mean.

Shawn and Ivo, Sagging our pants regularly, but only in the privacy of our own homes, and we suggest you keep it there as well.

Mirror Neurons: We are gonna piss off ALOT of people today with this post.  

How closely do your kids watch you? If you are a guy, how closely did you study the sporting greats like Michael Jordan, Joe Thiesman, Magic Johnson, Nolan Ryan, Carl Lewis, etc ? And ladies, who did you mirror yourself after?  When we are young we idolize, mimic and mirror that which we are surrounded by or that which we aspire to.  Every kid in my neighborhood had a Kareem Addul Jabar Sky-hook.  Heck, why not ?!

When it comes to gait, we model there too. In our practice we have seen, enough times to know it is not coincidence, a father walk into the office and his son have the same limp and swagger.  Kids pay attention, they just don’t model our 4 letter words.  Actions speak loudly and imitation is a strong method of learning and communication.

Humans have always observed other humans.  Observation, modeling and imitation are a form of survival.  If we want to socially understand, interact and survive we have to understand the actions of others and learn to assimilate, interact and react to others. Mirror neurons and the mirror-neuron mechanism are fundamentally human and necessary to complete these tasks of social interaction.

To this end, it is imperative to understand the gait cycle, both the walking and running cycles. The observer must know the normal cycles in order to identify the abnormal components of someone’s gait cycle. Once this can be identified one must know how to determine the cause of what is observed and know how to remedy the cause of the abnormality, not the remedy of the observed abnormality.  And just as importantly, the observer must help the client see and feel the pathologic pattern, correlate the causitive factor and help model a cleaner motor pattern. We find it very helpful to be able to mimic the client’s pathology to help them see and recognize it outside of their own body and then help them better feel their pathology (which is often an epiphany to them), model a remedy, and help them remedy the problem fitting the new pattern into a new non-pathologic gait pattern.  Once a client sees their problem, recognizes it, feels it in their own gait, feels the cleaner remedied pattern then they can cycle in a new neurologic pattern.  Then the clock begins to tick, and a new pattern will develop in 10+ weeks once a new myelinated pattern is engrained with conscious practice.  

* But one thing is clear, if you do not identify the source or cause of the abnormal gait pattern first (with remedy to follow), and you skip this critical diagnostic first step, deciding to go directly into showing your client how they SHOULD walk or run then you merely have helped them to develop a new gait cycle on top of the faulty old gait pattern which was a compensatory strategy to begin with around the underlying neuromechanical pathology (ie. immobility, hypermobility, instability, weakness etc). Whew ! That was mouthful.

Go for the root level of the problem, forget about the grass level appearance of the problem. Dig deep, don’t be a shallow digger. Be part of the solution, not part of the problem.  Think about all of this the next time you goto a running clinic that is teaching what is supposed to be “better form”. First of all, better form for whom ? The elite running? The upper quartile athlete?  The mean? The median? Or, the first timer amateur ?  Telling people how running should look and feel, rather than looking for the cause as to why someone runs less than optimally is a big mistake.  The body doesn’t decide to run poorly and inefficiently, it chooses to do so because some of the parts are either twisted (ie. osseous torsions), there are remnants of old injuries unresolved completely, they are in the wrong shoes for their foot type, they have physical limitations from underlying weakness (which then predicate the development of tightness or altered patterns to compensate) or lack of body awareness. Think about all this the next time you start to ponder form running clinics and treadmill gait analysis at your local store or therapists office.

Examine your client, test their motor patterns, test their muscle strength, find the cause of that gimpy gait or running technique.

Shawn and Ivo, The Gait Guys…….. likely pissing off a whole lot of people today with science, logic and neuro-mechanical principles. And, not intentionally pissing folks off, just suspecting that a bunch of people just had a light bulb moment and are pissed at the messenger.

Another video link:   http://youtu.be/6s1ON7ZZQxQ   Family Performance by Warren & Kristi Boyce - Glenn Richard Boyce & Kayleigh Andrews @ 3rd Surabaya International Dancesport Championship 2013 (8th June 2013)

Reference Links:

http://www.ncbi.nlm.nih.gov/pubmed/15217330

http://www.ncbi.nlm.nih.gov/pubmed/19129788