Limitations: The powers of observation will help you.
Physical examination, FMS, DNS, gait analysis … . . these are all very important tools for the coach, trainer, therapist, clinician.  They will all offer information and lead the “th…

Limitations: The powers of observation will help you.

Physical examination, FMS, DNS, gait analysis … . . these are all very important tools for the coach, trainer, therapist, clinician.  They will all offer information and lead the “therapy giver” in a direction for intervention.  But when something doesn’t match up with the basic standard protocols, you have to go outside the standard box.  We have all been there and today is just a little reminder not to get caught up in the “proceedures” and merely running through protocol without an engaged brain putting the pieces together.  

Here we see 2 classic examples of deviations from the mean, the client on the left has drifted further outside the frontal plane because of tibial varum and a little genu varus.  The client on the right has imploded deep into the frontal plane via rigid pes planus foot collapse and genu valgum.  These will both affect your physical screenings for these clients. And keep in mind, and this is probably the most important point of today’s blog post, either client may have good or bad strategies around their anatomy.  In other words, some clients will have great compensations to limit further functional pathology, and some will have poor compensation strategies, and thus, both will have different physical exam findings, different screenings and different neuromotor patterns embedded deep into their CPGs (central pattern generators).   Put yet another way, all of the scenarios discussed may/will have varying screening assessment outcomes but for different reasons.  If you know the cause of these faults and the impaired neuro-recruitment patterns that are likely, your assessments will make more sense, and so will your exercise/therapy/rehab prescriptions.  If you do not understand the fundamental differences (ie long bone torsions or various femoral-neck shaft angles, foot types such as an uncompensated forefoot valgus etc) , one could prescribe therapies that will not address the underlying problems, rather they might address the compensations and strategies found with these client’s challenges.

It can get sloppy messy.  Wear a bib.

Dig for the roots, don’t mow the grass…… Shawn and Ivo, The Gait Guys

A look at the Lunge. Are you ready to take the lunge?

Another one of our favorite exercises. Unfortunately, all too often it is executed improperly. Watch carefully, as we cover many points in detail.

Remember the mantra; Skill, Endurance, Strength. In that order. Not every individual is ready for every exercise you may give them. Be sure to build an adequate foundation before proceeding ti the next level.

This excerpt is taken from our video series, available for download here.

The Gait Guys. Join the movement and spread the word. .

when spine pain presents the shoulder and pelvic girdle “anti-phase” oscillations (oscillate in opposite rotation) begin to move into a more “in-phase” favor.  Meaning that the differential between the upper torso twist and pelvic twist is reduced. …
  • when spine pain presents the shoulder and pelvic girdle “anti-phase” oscillations (oscillate in opposite rotation) begin to move into a more “in-phase” favor.  Meaning that the differential between the upper torso twist and pelvic twist is reduced. The brain does this to reduce spinal compression. And when we reduce compression shear forces increase.  This is not a good thing.

We are getting the last of the slides together for our www.onlinece.com international teleseminar on Feb 19th, 7pm central.   

You should join us.  This months lecture is on Arm Swing.  

Hope to see you all in 12 days online !  Be sure to sign up ahead of time, we will likely have a large audience.

Happy Friday !

Shawn and Ivo,   The Gait Guys

Treadmill Truths: Because there is alot of Crappy Myths being Laid Down this week on the net.

The Truth About Treadmills: A Neurological Perspective

Gender differences in walking and running on level and inclined surfaces. 

Chumanov ESWall-Scheffler CHeiderscheit BC. Clin Biomech (Bristol, Avon). 2008 Dec;23(10):1260-8. Epub 2008 Sep 6.

What the Gait Guys have to say about this article:

This article highlights some of the differences in gait between males and females on treadmills. Though treadmills don’t necessarily represent real life, they are an approximation. While reading this article, please keep the following in mind:

1. the treadmill pulls the hip into extension and places a pull on the anterior hip musculature, especially the hip flexors including the rectus femoris, iliopsoas and iliacus. This causes a slow stretch of the muscle, activating the muscle spindles (Ia afferents) and causing a mm contraction (ie the stretch reflex). This acts to inhibit the posterior compartment of hip extensors (especially the glute max) through reciprocal inhibition, making it difficult to fire them.

 2. Because the deck is moving, the knee is brought into extension, with stretch of the hamstrings, the quads become reciprocally inhibited (same mechanism above).

 3. The moving deck also has a tendency to put the ankle in dorsiflexion, initiating a stretch reflex in the tricep surae (gastroc/soleus) facilitating toe off through here and pushing you through the gait cycle, rather than pulling you through (with your hip extensors).

 4. the moving deck forces you to flex the thigh forward for the next footstrike (ie footstance), firing the RF, IP and Iliacus, and reciprocally inhibit the g max

If your core isn’t engaged, the pull of the rectus femoris and iliopsoas/iliacus pulls the ilia and pelvis into extension (ie increases the lordosis) and you reciprocally inhibit the erectors and increase reliance on the multifidus and rotatores, which have short lever arms and are supposed to be more proprioceptive in function. Can you say back pain?

In summary, treadmills are not the scourge of humanity, but do have some pitfalls for training, and equal amounts of “backwards” running should be employed (with great caution, mind you)

With that being said, lets look at the results: increased hip internal rotation and adduction, as well as more glute activity for the ladies. Not surprising considering women generally have a larger Q angle (17 +/- 3 degrees for females, 14 +/-3 degrees for males) and greater amounts of hip anteversion (average 14 degrees in females vs 8 in males). The larger Q angle places more stress at the medial knee (compression of the medial femoral condyle and usually increased pronation as the center of gravity over the foot is moved medially) and thus more control needed to slow pronation (from the glutes to control/augment internal rotation). Greater hip anteversion means the angle of the femoral head is greater than 12 degrees to the shaft of the femur. This moves the lower extremity into a more internally rotated position, approximating the origin and insertion of the adductors, making them easier to access. With an increased Q angle and easier access, greater demands are placed on adductors in single leg stance (which is considerably greater in running), This increased adductory moment places more demand on the gluteus medius (and contralateral QL) as well, to stabilize the pelvis and this correlates with speed and incline, also found in the study.

The take home message? Don’t throw away your treadmill! The treadmill can be an excellent diagnostic tool! Gluteal and adductor insufficiencies will be more visible (and probably more prevalent) in females, especially those running or walking on treadmills. The hip extension and ankle dorsiflexion moment created by a treadmillworks against some of the stabilizing mechanisms (glute inhibition, ankle dorsiflexor inhibition) and help to highlight some of the subtle gait abnormailities you may miss otherwise.

Abstract from Article

BACKGROUND: Gender differences in kinematics during running have been speculated to be a contributing factor to the lower extremity injury rate disparity between men and women. Specifically, increased non-sagittal motion of the pelvis and hip has been implicated; however it is not known if this difference exists under a variety of locomotion conditions. The purpose of this study was to characterize gender differences in gait kinematics and muscle activities as a function of speed and surface incline and to determine if lower extremity anthropometrics contribute to these differences.

METHODS: Whole body kinematics of 34 healthy volunteers were recorded along with electromyography of muscles on the right lower limb while each subject walked at 1.2, 1.5, and 1.8m/s and ran at 1.8, 2.7, and 3.6m/s with surface inclinations of 0%, 10%, and 15% grade. Joint angles and muscle activities were compared between genders across each speed-incline condition. Pelvis and lower extremity segment lengths were also measured and compared.

FINDINGS: Females displayed greater peak hip internal rotation and adduction, as well as gluteus maximus activity for all conditions. Significant interactions (speed-gender, incline-gender) were present for the gluteus medius and vastus lateralis. Hip adduction during walking was moderately correlated to the ratio of bi-trochanteric width to leg length.

INTERPRETATION: Our findings indicate females display greater non-sagittal motion. Future studies are needed to better define the relationship of these differences to injury risk.

PMID: 18774631 [PubMed - indexed for MEDLINE]

Yup, we’re gait nerds….Don’t laugh….You are too if you are reading this…..

The Gait Guys: finding other uses for treadmills, other than for hanging the laundry…..

Podcast 53: Debunking Treadmills & Recovery Strategies

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-53-debunking-treadmills-recovery-strategies

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

By this time next year, you could be 3D printing custom comfortable inserts for your shoes
http://gigaom.com/2014/01/26/by-this-time-next-year-you-could-be-3d-printing-custom-comfortable-inserts-for-your-shoes/
_______________

LeBron James, Kevin Durant Help Spearhead NBA Popularity of Legs Recovery System
http://bleacherreport.com/articles/1932257-lebron-james-kevin-durant-help-spearhead-nba-popularity-of-legs-recovery-system#articles/1932257-lebron-james-kevin-durant-help-spearhead-nba-popularity-of-legs-recovery-system

_________________
Mechanism of orthotic therapy for the painful cavus foot deformity
http://www.jfootankleres.com/content/7/½/abstract
___________________

The influence of incline walking on joint mechanics

__________________
_____________
Ice baths:
____________

8:38am Jan 21

Hi guys,

I’m hoping you can help.

I have a severely arthritic 2 MTPJ on my left foot.

It seems to trigger extreme hip flexor tightness which has twisted my whole body, right up to my neck and jaw.

I can’t seem to get any definitive answers as to how to turn off this protective hip flexor tightness. I’m concerned if it goes on much longer I’m going to develop bone spurs throughout my body. This would destroy my life.

Is there any surgery you recommend?

Or any type of Rocker soled shoe? I’ve tried MBT’s but I think the forefoot is stiff enough and my Hipflexor hasn’t calmed down properly.

Thank you so much if you decide to answer this

Richard
____________
Blog reader: moham17
How does subtalar supination/pronation affect plane deviations farther up the chain, specifically at the pelvis? I was going over some notes and found something saying that increased pronation leads to increased frontal plane motion at the pelvis during gait, and increased sup leads to increased transverse plane motion. However, in this video I was watching, the clinician states that increased sup will lead to increased frontal plane motion. Is this not a contradiction? Can both be true? Thanks
______________
Fighting falls with feedback: Virtual reality training improves balance | Lower Extremity Review Magazine
http://lowerextremityreview.com/issues/january/fighting-falls-with-feedbac-virtual-reality-training-improves-balance
_____________

Brooks Transcend and Altra Olympus: Max Cushioning In a Lightweight Package Appears To Be The New Trend in Running Footwear

Stacking of the joints, and something that can go wrong when they don’t stack well.
Here is a short, sweet and simple case to open up some thoughts.  We have read on several occasions  of people making changes to arm swing as a solitary indepe…

Stacking of the joints, and something that can go wrong when they don’t stack well.

Here is a short, sweet and simple case to open up some thoughts.  We have read on several occasions  of people making changes to arm swing as a solitary independent issue.  Arm swing, when aberrant, is quite often a compensatory change to something else. It is quite often a problem in the opposite lower extremity.  We will be doing a 1 hour teleseminar in 2 weeks on www.onlinece.com on the topic of arm swing. Why don’t you come and join us ?

 This photo proves our point. It is clear to anyone that the right arm is far too abducted , yet it should make one question as to whether it is a product of the “failure to stack” the left lower limb. One should easily see that the right hip  has drifted beyond the perpendicular line of the left foot and that we are witnessing somewhat of a Trendelenberg presentation. The left hip should be over the left foot. We classify what we see  here however, as “stance phase” frontal plane sway. It is a POSSIBLE product of many things, but remember that what you see is a compensation around a functional or ablative problem, and not the actual problem most of the time.  One could easily hypothesize that the left gluteus medius is weak or that the left abdominals are frontal plane weak but these are only the two major assumptions most people make. Remember one of our cardinal rules, when the foot is on the ground the glutes are in charge, and when the foot is in the air, the abdominals are in charge. So, do not forget to look at the right sided abdominal component here as well.  How about foot and ankle stability ? Something is causing her frontal plane drift. It is your job to find it and correct it, not the arm swing (unless you determine it as the cause). But it is not your job to guess !  

Is it luck or predictable fact that the left pelvis is left frontal plane deviating and that the right arm is right frontal plane deviating ?  Not in our opinion, she is trying to maintain balance and symmetry during power production.  Balance maintenance comes from many areas.

Because of the neurologically embedded crossed extensor reflex and cross crawl response that permeates all human locomotion, anything that changes one of the limbs, whether it be a direct limb issue or something to do with the stabilization of the limb can impair and change locomotion, motor pattern choices and programming.

So, be careful where you make your demanded changes in your clients and your athletes. If you are guessing you are playing with fire and potential injury. The patterns are centrally generated and not by conscious choice, and hence they should not be completely remedies by the athletes conscious choice.  According to Zehr, “Although the strength of coupling between the legs is stronger than that between the arms, arm and leg movements are similarly regulated by CPG activity and sensory feedback (e.g., reflex control) during locomotion.” (Neuroscientist. 2004 Aug;10(4):347-61. Regulation of arm and leg movement during human locomotion.Zehr EPDuysens JRehabilitation Neuroscience Laboratory, University of Victoria, BC)

There is alot more to this topic, but you will just have to join us in two weeks on www.onlinece.com.  Third Wednesday of every month, 7pm central time, that is where you will find us !

shawn and ivo,

the gait guys

tumblr_mzon5s7yoY1qhko2so1_1280.jpg
tumblr_mzon5s7yoY1qhko2so2_r1_500.png
tumblr_mzon5s7yoY1qhko2so3_r1_1280.png

So you want to do a Gait Analysis: Part 3

This is the third in a multi part series. If you missed part 1, click here. For part 2, click here.

 Again, a quick review of the walking gait cycle components:

There are two phases of gait: stance and swing

Stance consists of:

  • Initial contact
  • Loading response
  • Midstance
  • Terminal stance
  • Pre-swing

Swing consists of:

  • initial (early) swing
  • mid swing
  • terminal (late) swing

today, lets explore Midstance

we remember that midstance is the mid point of the stance phase of the gait cycle. It is when the maximal amount of midfoot pronation should be occurring

Lets look at what is happening here at the major anatomical areas:

Foot

  • Pronation begins: The talus should have slid anteriorly on the calcaneus and it then plantar flexed, everted and adducted to its greatest degree. The subtalar joint should have its axes parallel with the calcaneocuboid joint, essentially “unlocking” the midfoot.  This allows the midfoot to assist in absorbing shock, along with knee flexion, hip flexion and a dip of the contralateral pelvis.
  •  the calcaneus everts to a max of approximately 5-8°
  •  the center of gravity of the foot is lowest at this point, and the ankle mortise its deepest. 
  • The lower leg should be internally rotated (as it follows the talus) 4-6°
  • The thigh should follow the lower leg and should also be internally rotated 4-6°; sometimes to a greater extent due to the shape and size of the medial condyle of the femur (which is larger than the lateral)
  • these actions are (still) attenuated by eccentric action of both the long flexors and extensors of the ankle, as well as the foot intrinsics

Ankle

  • The ankle should be neutral, as it should be at the mid point of ankle rocker

Knee

  • Flexion to 20°. This is attenuated largely by the quadriceps, contracting eccentrically. The popliteus has often concentrically contracting to assist in internal rotation of the thigh up until midstance. It is quiescent at midstance and will begin to contract eccentrically as soon as the knee passes midstance.

Hip

  • The hip is at full flexion at loading response, decreasing as it approached midtsnce and now begins to extend. This is facilitated by a brief contraction of the gluteus maximus (which started at initial contact)

Can you see what is happening? Try and visualize this in your mind. Can you understand why you need to know what is going on at each phase to be able to identify problems? If you don’t know what normal looks like, you will have a tougher time figuring out what is abnormal.

Ivo and Shawn. Gait and foot geeks extraordinaire. Helping you to build a better foundation to put all this stuff you are learning on.

Podcast 52: Limb Dominance & Other Cool Stuff

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-52-limb-dominance-other-cool-stuff

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience:

1. The Potential Downside of Wearable Biomechanical Monitoring Devices for Running

http://runblogger.com/2014/01/downside-of-wearable-biomechanical-monitoring-devices-for-running.html

2. Google’s Next Crazy Project: Smart Contact Lenses | Entrepreneur.com
http://www.entrepreneur.com/article/230927
3. How Humans Burn Fewer Calories Than Other Mammals
http://www.runnersworld.com/weight-loss/how-humans-burn-fewer-calories-than-other-mammals
4. Update: I was listening to your podcast and you said Ice Bug was out of business. I sell them in my store in Fairbanks Alaska where we have snow and ice on the ground for 6-7 months a year. The US distributor is Ice Bug USA. I also carry a the Salomon Snow Cross studded shoe.
The effects of limb dominance and fatigue on running biomechanics
http://www.gaitposture.com/article/S0966-6362(13)00702-9/abstract
5. Email case:
Dear Gaitguys,
   I have been on a search since October to determine the cause of my chronic tendonitis in my knees and right hip. Through my search I was told that my femurs are rotated internally and my tibia are externally rotated. This is causing my patella to face inward.
  I was told by one PT that I will never be able to run long distances without developing tendonitis. I want to believe he is wrong because I love running. I came across something called Femoral Anterior Glide in my research and was wondering if you guys believe this is a real condition. Also is there a way a person can know if they have this problem?
Thank you for all of your great posts!
 Kate 
6. Blog reader:

My 11 year old son walks with a very noticeable external tibial torsion. We just recently noticed this and I came upon your site while trying to research it. I also read that many time it has to do with a problem with the patella. Both my husband and daughter have had patella problems but do not have the duck walk like my son. I did ask a a pediatric sports medicine specialist about the problem and he said some kids just walk that way. Where should I bring my son for help with this?

7. Blog reader asks:

About a year ago there was an article posted called: “A case of the non-resolving ankle sprain. Things to think about when the ankle and foot just do not fully come around after a sprain”. I am 15 weeks into an identical problem and I was wondering if there was any way you guys could follow up with “MR” to see if he was ever able to resolve his issue. It is such a unique and frustrating case (being able to walk but not run) and I haven’t found any other instance of it until now. Thank you.

8. Shoe Fit Certification program
Link:Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

9. Second metatarsal osteotomies for metatarsalgia: A robotic cadaveric study of the effect of osteotomy plane and metatarsal shortening on plantar pressure - Trask - 2013 - Journal of Orthopaedic Research - Wiley Online Library

http://onlinelibrary.wiley.com/doi/10.1002/jor.22524/abstract;jsessionid=BCFFA5207512C41214E7F3D601729EFE.f01t01

The unbalanced athlete, motor pattern, team, joint etc…… is not efficient.
Like him or not, believing he should have lost his last fight (or not), Georges St-Pierre was/is one of the best MMA fighters of all time. He was once quoted as…

The unbalanced athlete, motor pattern, team, joint etc…… is not efficient.

Like him or not, believing he should have lost his last fight (or not), Georges St-Pierre was/is one of the best MMA fighters of all time. He was once quoted as saying, 

“In fighting, in evolution, in life, efficiency is the key,” says St-Pierre. 

 "It’s not the most powerful animal that survives. It’s the most efficient.

This certainly describes most of Georges fights. There were always bigger, faster, meaner, stronger opponents. However, most of his fights went the distance. Eight of his last nine fights went to a five round decision. Now, there are those who will say that he didn’t have the finishing power or submission skills to close fights in the earlier rounds, and that is debatable for sure.  However, there is no doubt that anyone’s best fighting attributes will diminish as the rounds progress and fatigue sets in.  But, perhaps this is an equalizer when someone doesn’t have one single "golden right hand”, or what have you.  Efficiency can be the great equalizer.

St-Pierre isn’t your typical fighter. He’s arguably the best mixed martial artist in the world, a 5-foot 11-inch, 190-pound destroyer. Up until his most recent fight with Johnny Hendricks, he had not lost a round in more than 3 years, that is pure efficiency ! Arguably, he is faster than other fighters, he is more fit, has a greater range of skills, has better endurance …  in a Darwinian sense, perhaps more efficient ?

Here at the Gait Guys we are always considering efficiency.  As you can see from the slide above, there are many factors that can diminish efficiency.  We strive for as much symmetry as we can because with neuromuscular symmetry efficiency can be maximized.  Keep in mind however, that total symmetry is not always possible. Most people have two different feet, often one is more varus because it sat against the mothers rounded belly in utero.  And, one tibia is often more bowed or torsioned than the other for the same reason.  So, perfect symmetry is not always possible or guaranteed. But, one can do alot to gain as much physical symmetry as possible through detailed study of your client. (Remember, just because things look symmetrical does not mean that they function symmetrically ! This game is not that easy ! But, for some of the uneducated, it may seem to be !)  When physical symmetry is regained often the sensory-motor nervous system becomes functionally more symmetrical.  And, this is a flippable phenomenon, when neuro symmetry is driven often physical symmetry will be driven in time.  

Think about the afferent input to the cortex from the peripheral receptors in the skin (Paccinian corpuscles, Merkels discs, etc); the joint mechanorecpetors (types I-IV) and muscle receptors (spindles and Golgi tendon organs). Generally speaking, they travel up the dorsal columns on the back of the spinal cord to the thalamus and then the cortex; up the dorsal spinocerebelllar tract, to the cerebellar hemispheres; the spino- reticular tract to the reticular formation, or in the case of the upper cervical spine, directly into or flocculonodular lobe of the cerebellum. This information needs to be equal and opposite from each side of the extremity (flexors and extensors) as well as the right and left sides of the body. This “Balance” or “Homeostasis” or what the Chinese called Yin and Yang is key to efficiency.

In your workouts and rehab, strive for symmetry. We like to say “Tailor your exercises to the weaker side”. This helps to create more equality rather than a larger disparity.

The Gait Guys. Making it Real…Each Day….On the Blog…

tumblr_mzwrchzkCN1qhko2so1_1280.png
tumblr_mzwrchzkCN1qhko2so2_400.png
tumblr_mzwrchzkCN1qhko2so3_400.jpg

How well do your boots fit your ride?

Whether you ski, ride, nordic or tele, having the right boot fit can make the difference between a good day and a great day. It can accelerate your learning curve, prevent injuries, keep you warm and make you more comfortable. Not all feet are made the same and neither are ski boots. Good fit requires time and patience (lots of both). Here are a few tips for better fit.  

What kind of a skier/rider are you?  Recreational, competitive, racing, extreme?  How you’ll use the boot will often determine the type of boot that is appropriate for you.  In my opinion, you should get a boot that is a little above your ability (unless you are not interested in improving your skiing and/or riding), so that you will improve and “grow into” the boot.  This will ensure that you’ll continue to improve in your snowriding abilities.  Boots are very high tech these days and a subtle change in stiffness or angles can make a drastic difference in your skiing/riding.

The first thing you need to do is look at your feet.  Are they feet to the same from side to side (ie. same size and shape)?  These are the platform for the rest of your body.  What happens down there will affect everything else. Take a good look at your feet while you are standing. Are there bunions, calluses, hammertoes (toes curled under), or a Morton’s toe (2nd toe longer than your big toe)?  Do you pronate excessively while standing or walking (this will look like your arches are collapsing)? What is the relationship of the forefoot (front of your foot) to the rear foot (is the ankle sideways when viewed from behind? It should be neutral without your heel turning in (inversion) or turning out (eversion). The forefoot (front of your foot) should be flat on the ground. Does your ankle bend back as far as it should (this is called dorsiflexion). This will have an effect on the forward lean of the boot. Are you bowlegged or knock-kneed? This will cause you to ride on the outside or inside edge of your ski/ snowboard.

If you pronate excessively, have increased or decreased flexibility in the forefoot, rearfoot or big toe, have bunions or hammertoes, or are excessively bowlegged or knock kneed, proper fit and comfort while skiing will probably require a full contact orthotic or footbed. Hard deformities, such as bunions, may require liner and or boot shell modification.

Good socks are next on the list.  Wool or wool blend socks are best. The intertwining fibers of wool create air pockets, which make it both insulating and breathable. Wool absorbs sweat in its vapor state, before it liquefies, keeping you dry. It utilizes your own body heat to evaporate the moisture. This also helps to eliminate odor. No cotton socks, as they hold moisture, often creating blisters and providing a breeding ground for bacteria that cause odor; no multiple pairs, as they make feet cold. Remember, thin is in… let the liner do its job.

Have your foot measured utilizing a Brannocks device in a standing position.  Remember that your arch will flatten as you put weight on it. Remembering that the foot elongates with weight on it, will be useful for the next step.

Next you need to have the right sized ski/snowboard boot shell. This is as important for hard boots as soft boots Take the liner out of the boot and put your foot inside the shell so that your toes are just touching the front of the shell.  There should be approximately ½ - ⅝ of an inch (two crossed fingers thickness) behind the ankle to the back of the shell.  More than ¾ of an inch will cause too much heel rise once the shells are “packed out”.  There should be ¼ - ⅜ of an inch space between the feet and the side shell of the ski boot.

Now comes the liner. The liner should fit snugly.  Very snugly.  There should be no pressure spots anywhere on your foot.  Put in your foot bed or custom orthotic if available, before sizing the shell.  Remember that you’ll gain between ⅛ and ¼ of an inch of space with break-in when the liners “pack out”.

Buckle the boots loosely and flex the boot forward.  This will help to “seat the heel”.  Remember that if the you cannot flex the boot at room temperature, you will not be able to when the plastic is very cold. Now that the heel is seated, buckle the boot more firmly.  They should not be on the last buckle.

Now simulate some ski/ride movements.   If the boot is relatively comfortable, proceed to the next step otherwise repeat with different shell/liner size.

The cant of the boot (cuff alignment) needs to be adjusted next. This needs to be done by someone other than yourself (because you are standing in the boot). A plumb line dropped from the knee should pass between your second and third toe.  This ensures an even transfer of weight from edge to edge. Most boots are built with about 4 degrees of varus (lateral cant).  If you are not able to adequately align the foot, consider orthotics or having the boot shimmed. Remember that boots with higher cuffs will have more of an effect on your stance.  

Most boots provide between 12-16 degrees of forward lean.  If there is less than 12 degrees, consider a heel lift to place your body weight forward.  Remember to consider how much ankle dorsiflexion you have.

Once these adjustments are made, simulate skiing/riding movements in the shop for at least an hour.  Remember that ski/snowboard boots are made for snowriding, not walking. Now remove the boots and socks and look for “hot spots” on the feet that will show up as red marks.  These may represent areas in the boot liner or shell that need to be stretched and/or fitted better.

Well. There you have it. Now you know lots more than you knew when you began this article. As you can see, it is a very time consuming and labor intensive ordeal. Often times, people need professional help with the whole process and often require a foot bed or full arch contact orthotic. Become familiar with your own feet and then become familiar with the people or shops that do good boot fitting (ask around) and consider enlisting their help on your journey to the perfect boot.

The Gait Guys. Making it real…here….on the blog…with every post…

Gait is a Fingerprint.  
“Just because you see something you do not like, does not mean that it is wrong. ”
How many times have you heard us say this ! Yes, we are getting tired of saying it, too. But, it is the honest truth.   
The abov…

Gait is a Fingerprint.  

“Just because you see something you do not like, does not mean that it is wrong. ”

How many times have you heard us say this ! Yes, we are getting tired of saying it, too. But, it is the honest truth.   

The above slide is one that we are using in an upcoming teaching presentation for you folks.  And this slide pretty much tells it like it is.  That being, that gait is a unique and variable fingerprint.  The slide suggests, with references, that gait is so variable, that even people with the same disease process have different presentations miles apart from one another. 

This gait analysis thing is not simple. If you are using a piece of analysis software that has you comparing your patients to normative data, be careful. You are very likely not comparing “apple to apples”.  So, do not pigeon-hole your client to normative data. Do your hands on physical examination and find out where THEIR limitations are, not what the normative data says their capacities should be.  This could be one’s first mistake in trying to help a client.  

Bottom line, no 2 people’s arms swing, leg swing, pelvic posture, hip extension etc are the same. Even side to side on the same client there may be variability due to degrees of long bone torsion or foot type (we have discusses these embryologic issues previously many times here on our blog). So, just try to improve your clients function and stability and mobility to what their body needs.

This is not a templated game. This an art form that takes years to develop. We too are learning and growing, so thanks for being on this journey with us !

Shawn and Ivo, the gait guys

Start with the basics: One of our favorite Core Exercises for the obliques.

Following up on yesterdays post, here is one of our all time favorite exercises for core stability. It focuses on the external obliques, but hits all the major players. This exercise has been adapted and modified from from Shirley Sahrmann’s book “Diagnosis and Treatment of Movement Impairment Disorders”. It is shown here excerpted from our video series, available by clicking here.

Her is a quick summary you are free to reproduce for home or clinic/ shop use (they are copyrighted) but not for resale. Please give us credit if you pass them along!

Non Tripodding Exercise

The purpose of this exercise is to improve the strength of your abdominal muscles.  You will also learn to prevent lower back (lumbar spine) motions associated with leg movement.

STARTING POSITION: Lie on your back on the floor. Bend both knees about 90 degrees with the feet flat on the floor.

Contract your abdomen, do not hold your breath or hollow. 

Lift one foot off the floor slightly and hold it there. Lift the opposite leg until your thigh is vertical. Do not push down with the opposite leg while lifting! Repeat for 5-10 repetitions with good form. Repeat with the opposite leg. Remember not to contract the muscles on the back of your thigh on the leg you have on the floor.

Perform 5 repetitions 2 times per day increasing to 3 sets of 10 repetitions.

The Gait Guys. Showing you how to get it done, each and every post!

tumblr_mzoo71gBTf1qhko2so1_r1_540.png
tumblr_mzoo71gBTf1qhko2so2_r1_1280.png
The Lumbar Lordosis and Pelvic Stabilization Exercises

We had an inquiry regarding maintenance of the lumbar lordosis during exercise: Do you keep the spine flexed or in a “neutral” posture?

Here was our response:
“A decreased lumbar lordosis increases shear forces in the lumbar spine, as the plane of the multifidus and rototores with lumbar flexion become more parallel with the lumbar spine (see above: from McGill). This changes the angle of insertion of the muscles and they cannot stop the forward movement of the vertebrae, creating shear, which can be damaging to the discs. If they are experiencing pain during an exercise with increased flexion, that may indicate discogenic pain, poor stabilization or both.
Placing the spine in too much extension will cause the facet joints to bear too much weight (normally they are to bear approximately 20%: Kirkaldy Willis) resulting in facet irritation. If they are experiencing pain during an exercise with increased extension, that may indicate a facet issue or poor stabilization (or both).
We would emphasize that the patient needs to be in a NEUTRAL spine, not necessarily extension. Exercises should be minimized to a pain free range of motion or removed from their rehab program until they are able to perform the motion competently and in a pain free range.

Sometimes , patients need to “slow down” and though they are anxious to proceed, we must make sure they have adequate stabilization and appropriate technique.”

The Gait Guys. Giving you the facts and the info you need to make great decisions.

Welcome to REWIND FRIDAY.

Some light, entertaining gait candy for you to see. This one is from May 2011; an oldie but a goodie. Enjoy!

Lets look at this Hitchcock classic “North by Northwest” and check out Cary’s form.

1st of all, what an arm swing! Think of all that energy it is sapping from the rest of his muscular system. He must be hiding something, but what? We can only see him from the waist up, so we may never actually know. Did you notice how he initially only turns to the right? Did you pick up on the flexion at the waist? How about that torso bob from side to side? Not much to his hip abductors now are there?

The only thing he has going for him is he is wearing leather soled shoes, which have been shown to have one of the lowest impact loading on the body (yes, you read that right; increased cushioning INCREASES impact forces, but that’s not what we are here to talk about). Oh yea, he actually impacts the ground at the end of the sequence. I guess if his technique was better, he would have hit even HARDER.

Next sequence, we are off to a good start, look at that forward lean to start! This is essential to good technique. He loses that form pretty quickly; we can still see that forward flexion at the waist; certainly costing him energy by not using his core.

Finally, we get a posterior view at the end, but the uneven surface makes it difficult to make an analysis.

We think Cary would certainly give Lola a run for her money. Cary, next time, engage your core and watch your step…

We Remain….The Gait Guys

The Cross Over Gait
Did you miss our teleseminar presentation on this topic last night on www.onlinece.com ?
Here is a sample of one of our slides.  The cross over gait is potentially a real problem for some. The question is always, how much cross o…

The Cross Over Gait

Did you miss our teleseminar presentation on this topic last night on www.onlinece.com ?

Here is a sample of one of our slides.  The cross over gait is potentially a real problem for some. The question is always, how much cross over (running or walking) is too much for a client ? When does it need corrected ? Does it need corrected ? Leave it alone ?  We answered these hard questions in our teleseminar.  

Lucky for you www.onlineCE.com recorded it so you can take the class anytime !  (just give them a few days to process the recording). 

As you can see from just this slide here, we looked at many aspects of the cross over. But we also discussed STEP WIDTH, lateral compartment weakness and tightness as coexisting pathology, and so much more.  Stay tuned, we will be recording this program into an extended and more in depth course for you all in a video format with course notes and more and then have it for you on our Payloadz website (which you can access here for our present offerings).

In the mean time, consider looking for these “Big 6” and when you see them co-existing you might want to look for a cross over pattern in your client, it just might be there sometimes.

- weak gluteus medius

- weak TVA and obliques

- weak adductors

- weak medial quadriceps

- weak tibialis posterior

- excessive foot pronation

Shawn and Ivo, The Gait Guys

Hallux Varus: The anti-bunion. Thinking of bunion surgery ? This could be a complication if things go sour.
Hallux varus, when the big toe drifts medially, is a real problem. It is typically an acquired problem from a hallux valgus/bunion surgery go…

Hallux Varus: The anti-bunion. Thinking of bunion surgery ? This could be a complication if things go sour.

Hallux varus, when the big toe drifts medially, is a real problem. It is typically an acquired problem from a hallux valgus/bunion surgery gone awry.  (This post will not delve into some of the suspected culprits of this problem including Mc Bride, Scarf, Chevron or Akin osteotomy etc but that would be some of the reader’s next steps into diving deeper into this problem. Surgical procedures to the 1st ray was one of the gait guys senior orthopedic residency thesis topics, hence we now hate this topic !). 
This deformity can be rigid or flexible.  This case seen in the photo walked into our office recently.  These are not all that common and you won’t see many of them, but you do need to know they exist and where they can come from, how to cope with them and what issues you will need to understand (ie. footwear, talked about below) to assist your client. 
Hallux varus can be painful, uncomfortable and even debilitating in some cases.  Sometimes they necessitate fixation to realign the hallux bone along a more reasonable alignment with the shaft of the 1st metatarsal. 
 
Early correction seems critical because the linear and rotational forces at work generating the deformity can eventually lead to a further progressing deformity that can be even more problematic. When left unaddressed more drastic and radical corrective interventions seem necessary, including but not limited to, resection of the base of the proximal phalanx, fusions and tendon transfers. However, newer surgical procedures are coming along proposing things like reconstruction of the lateral stabilising components of the first metatarsophalangeal (MTP) joint. 
 
So here at The Gait Guys we like to ask the big, and sometimes obvious, questions.  What is toe off in walking and running gait going to look like in this hallux varus case ?  Well, one has to consider that the normal linear and rotational forces are now changed.  This means that the normal eccentric axis of the 1st MPT joint involved is going to very likely be changed. This means that the clearance of the base of the phalanx could be impaired and lead to painful binding, grinding or locking of the toe prior to reaching the adequate range of dorsiflexion for normal toe off. Additionally, the toe may act functionally unstable as the rotational forces remain unchecked leading to joint instability. Naturally, the medial foot tripod will be impaired and since the big toe acts in part like a kickstand to help support and fixate the 1st metatarsal (medial tripod), pronation forces can remain unchecked and beyond normal.  Naturally the foot will attempt to shift the tripod stability elsewhere and often this goes to the 2nd metatarsal commonly found with hammering of the digit in an attempt to help with stability through increased long flexor tone (FDL). Pain with a hallux varus can be a bigger complaint than the unsightly surgical outcome.
 
There is so much more to this topic. We could go on for at least another 50 pages on this topic (as our thesis reminds us) but volume is not the point of today’s task. It was to bring something new to light for our brethren here at The Gait Guys.  In the photo above, you see drift of the lesser toes, seemingly to follow the big toe. What you need to know is that this is not typical, however not impossible one could propose. This client had some other forefoot procedures done that were largely, although not exclusively, related to that lesser digit drift. Regardless, this is a client that is in some amount of foot trouble. They had good mobility of the 1st MTP joint, so full toe off was possible but because of the instability and uncontrollable rotational forces the joint was painful. A simple intervention made her life infinitely more comfortable, moving her into rigid rocker bottomed shoes.  Dansko clogs for work, and ROCS shoes for walking.  This left us with a very happy client. Not bad, all things considered.  In the mean time we will watch for deformity progression even though the patient could not be urged to have another surgery probably even if their life depended upon it. 
 
In summary, being a patient can be difficult. These days, more than ever it seems, one needs to do their homework and be their own advocate.  Prior to surgery several consults should have taken place, risk and rewards should have been discussed, realistic outcomes dialogued and perhaps most of all questioning whether surgery needed to be on the table in the first place. Remember, surgery is most wisely selected in cases of neurologic decline and excessively painful and further detrimental biomechanics (ie. unaddressed ACL deficiency eventually promoting secondary instability with time). If there are ways around either, they should be explored. Cosmetic correction should never be on the table, and in the case of the foot, nor should poor shoe choices that promote problems.
Take a look at this gal.
Why does she have a cross over gait?
note how much tibial varum she has (curvature of the tibial in the coronal plane)
how much adduction of the right foot there is, potentially indicating a tight posterior compartment, or p…

Take a look at this gal.

Why does she have a cross over gait?

  • note how much tibial varum she has (curvature of the tibial in the coronal plane)
  • how much adduction of the right foot there is, potentially indicating a tight posterior compartment, or perhaps a loss of internal rotation of the right thigh
  • the excessive posterior rotation of the left shoulder and upper body
  • the subtle abduction of the right arm compared to the left
  • the slight torso lean to the left

The correct answer is we don’t know until we examine her. Maybe is is there out of necessity or perhaps it is a more efficient running style for her. Here are some points:

Technical Issues with the crossover gait

The cross over gait may be:

  • a more efficient running style
  • a potential pathologic musculoskeletal motor pattern
  • better for long distance runners
  • a challenge to balance because of a narrower base of support

It may also be related to:

  • a weak gluteus medius
  • weak adductors
  • excessive foot pronation
  • lower extremity morpholgy (like tibial varum, forefoot varus)
  • a weak vastus medialis
  • a weak tibialis posterior
  • and the list goes on

Join us, tomorrow, Wednesday evening, 8pm EST, 7 CST, 6 MST, 5PCT for an hour of crossover gait on chirocredit.com or onlinece.com for Biomechanics 316. We look forward to seeing you there..

The Gait Guys: Shawn and Ivo

Podcast 51: Bouncy Gait, Stem Cells & Plantar fasciitis,

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-51-bouncy-gait-stem-cells-plantar-fasciitis

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

Neuroscience:

1. Stem cells and plantar fasciitis.
2. Study finds axon regeneration after Schwann cell graft to injured spinal cord
http://www.medicalnewstoday.com/releases/270623.php
3.Future Tiny Robots Will Communicate Using Only Molecules
http://www.fastcoexist.com/3020657/futurist-forum/future-tiny-robots-will-communicate-using-only-molecules?partner=rss
Correction:
a. I was listening to pod 49, great job. I am sending a personal message to point out an error regarding body composition. Under water weighing is considered the 2 compartment “Gold Standard” however caliper testing is used more due to cost and ability to be used in the field. Loved the learning stuff I sent some stuff similar to what you were talking about to the school administration but it went no where.
Thanks guys, Mark
b. Mark wrote: “I can see widening base of support to increase stability when one is weak but to widen base of support when one has decreased traction may increase slipping depending on width of stance couldn’t it. If decreased traction is a issue wouldn’t a better statagy”
Blog reader:
Not very infrequently the foot tripod has been discussed. Especially the importance of the medial tripod (MT) has been of great benefit to me. Some kind of a peroneus paralysis was probably the cause of weak MT of the right foot. With a weak anterior muscle group or compartment. But what about the lateral tripod, ie the 5th distal end of the fifth metatarsal. Which muscles are most responsible for the foot stability here and what kind of exercises might be of therapeutic value? Thank you.

Disclaimer
Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204 

Dear Gait Guys,                                
I’ve had a problem for a while where my lower left leg whips across the midline of my body at the start of the swing phase. This happens immediately after my left foot leaves the ground and before my right foot makes contact. My left knee seems to be angled outward, and I think this is due to some sort of external rotation of the hip or femur during the the early part of my swing phase. I attached a picture to illustrate this problem in my gait. I recently came across a blog post you guys wrote (http://thegaitguys.tumblr.com/post/14262793786/gait-problem-the-solitary-externally-rotated) and under the possibilities as to why there isn’t enough internal rotation, the second option describes exactly what happens when I run. So my question is, what can be done to correct this improper gait pattern? Thank you very much for taking the time to read this.
Sincerely,
Matthew
Between a quarter and a third of everything on the web is copied from somewhere else