Today on rewind Friday, we salute the glutes! This is in conjunction with this weeks POD topics : )

The gluteus maximus controls:

Flexion / Extension: The Sagittal Plane
- the rate and extent of limb flexion at term swing: this is eccentrically controlled
- hip extension: this is concentrically controlled
- hip flexion rate during loading response (eccentric at foot loading): this will help to control the vertical loading response as the body mass loads the limb there must be enough eccentric strength of the glute maximus to control-stop this loading so that hip extension can occur. This will indirectly assist in control some of knee flexion.

Rotation:
- external rotation of the limb: this is concentrically controlled
- assists in controlling the rate of internal rotation: this is eccentrically controlled

Pelvic Posturing:

- controls rate of Anterior Pelvic Tilt (APT): this is eccentrically controlled (this is relative hip extension as discussed in Part 1 last week)

- assists in Posterior Pelvic Tilt (PPT): this is concentrically driven

- controls sacroiliac joint mobility through FORCE CLOSURE (force closure is a compression of the joint surfaces by the contraction of muscles that cross the joint)

Divisions:

- the sacral division of the gluteus maximus is mostly a pure sagittal plane driver at the hip joint
- the coccygeal division is more of an adductor and internal rotator at the hip joint
- the iliac division is more of an abductor and external rotator at the hip joint

The gluteus maximus also has some fascial attachments into the posterior aspect of the TFL-ITBand. Remember, this TFL-ITB complex is an internal rotator of the limb in the gait cycle. You will recall that internal rotation is a precursor to hip extension. The hip must first, and adequately, internally rotate in the gait cycle before hip extension can occur. This means that for correct and complete gluteus maximus contraction to occur in the second half of the stance phase we must have adequate internal hip rotation. Without it, all of the things we talked about last week in our glut maximus blog post cannot occur properly. Now, back to our attachment disucssion of the gluteus maximus to the ITB-TFL mechanism. This attachment allows the gluteus maximus to produce posterior tension on the ITB-TFL mechanism so that it can be anchored to provide it’s internal rotation function on the limb. So, here we have a powerful hip extensor and external rotator providing assisted effects on an internal rotator of the limb. Isn’t the body a beautiful and amazing thing ! (Well it is. But if you will recall from the detailed layout above that the gluteus maximus in the eccentric phase of contraction functions to control the rate of internal hip rotation you will not be surprised or enlightened. Rather you will enjoy the brilliance of how an anchoring muscle is eccentrically giving up length while an agonist muscle is concentrically taking up length). The gluteus maximus-TFL relationship….. it is beautiful teamwork in helping, not exclusively of course, control limb rotation during loading responses.

Next time you see a client’s knee drift too far inwards during a lunge, or walking or running we hope this whole discussion will spring a light bulb moment for you. You must look at the complex function above in controlling the limb during pronation and supination. Merely inserting an orthotic is not going to fix a proximal deficiency, it could modulate it however. But wouldn’t you want to fix it ? Who wants an orthotic if you don’t need one  ? Some people do, don’t get us wrong, but many do not. And then some just need them temporarily to gain the awareness and skill of posturing and function and once that is achieved the device and be weaned.

Just some more functional anatomy talk on a Friday afternoon…….from us, The Gait Guys

Podcast 62: Foot Strengthening and Lumbar/Glute Endurance

A. Link to our server:

Direct Download: http://traffic.libsyn.com/thegaitguys/pod_62final.mp3

Permalink: 

http://thegaitguys.libsyn.com/podcast-62-foot-strengthening-and-lumbarglute-endurance 

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:

1. Neuromuscular Fatigue Alters Postural Control and Sagittal Plane Hip Biomechanics in Active Females With Anterior Cruciate Ligament Reconstruction

http://sph.sagepub.com/content/early/2014/04/23/1941738114530950.abstract?ct&location1=all&location2=all&row_operator2=and&term_operator1=and&term_operator2=and

2. Will Running Too Much Kill You?

http://www.runnersworld.com/health/will-running-too-much-kill-you

3. Limits of Stability and Adaptation to Wearing Rocker Bottom Shoes
http://fai.sagepub.com/content/early/2014/04/07/1071100714531227.abstract

4. http://lowerextremityreview.com/article/a-three-point-approach-to-testing-running-shoes

5. http://www.facebook.com/l/kAQFXOMnhAQEwqyJQh2dIlhh_I5uOddsQyuFVnBs5PlDOdQ/thegaitguys.tumblr.com/post/23165452918/gait-parameter-ankle-rocker-during-the-squat-as-a

Unilateral heightened toe extensor tone.

What do we have here ? Well, it is obvious. The left foot is showing increased short extensor tone (EDB: extensor digitorum brevis) and heightened long flexor tone (FDL: flexor digitorum longus). This is the classic pairing for hammer toe development.  We also know from this post (link) and from this post (link) that this presentation is closely related with lumbrical weakness and distal fat pad migration.

So, at an assessment took we like to play games. Mental games to be precise. When we see something like this we immediately begin the mental gyrations of “what could have caused this, and what could this in turn be causing”. Remember, what you see is often not the problem, rather your clients compensation around the problem.  In this case, what goes through your mind ?  Without deep thought, our knee jerk thoughts are:

• possible loss of ankle rocker dorsiflexion (the increased EDB tone can be recruited to help drive more ankle dorsiflexion indirectly)
• plantar intrinsic weakness ?
• flip flops or slip on shoes where the heel is riding up and down inside the shoe/sloppy fit ?  (initiating a gripping response from the FDL)
• weak tib anterior (recruiting EDB to help)
• weak peroneus tertius (recruiting EDB again)
• Ankle /foot instability (more FDL gripping will help gain ground purchase)
• lateral ankle instablity (same thing, more gripping)
• Weak gastrosoleus (since the FDL is a posterior compartment neighbor it can kick into high gear and help with posterior comparment function, we have a whole video case based around this issue, check this out ! )
• premature departure off of the good side leg, and thus an abrupt loading response onto this affected side can challenge the frontal plane of the body and thus require more grip response at the foot level.
• how about simple weakness of the lumbricals or FDB , the short flexors. The long flexors will have to make up for it and present like this.  
• the list goes on and on … .

These are just some quick cursory thoughts, and by NO means a complete exhaustive list.  Just some quick thoughts.

But what about hip function ?  if ankle rocker is blocked in terminal stance and the FDL fire like this what will that do to hip extension ? Well, heel rise will be premature because of the limitation and thus hip extension will be abbreviated. Thus glute function will be impaired to a degree.  This can become a viscous cycle, each feeding off of each other.

This diagnostic stuff is a tricky and difficult game. If you think you can diagnose or fix a problem from just changing what you see you are mistaken, unless you like driving compensation patterns and future injuries into your clients.   There must be a hands on examination and assessment with an intact educated brain attached to the process.

Just some mental gymnastics for you today.  

Shawn and Ivo

the gait guys

How much does your Hallux Extend?

Last week, on Mondays post, we introduced potential areas for power leaks.

The common areas for leaks are:

• great toe dorsiflexion
• loss of ankle rocker
• loss of knee flexion/extension
• loss of hip extension
• loss of balance/ proprioception

let’s take a look at a video of the 1st one:

Power leak 1: Great Toe Dorsiflexion

The big toe needs to extend AT LEAST 40 degrees and CLOSER TO 60 degrees for normal walking and running gait. If you do not have that available range of motion, then you will need to “borrow” it from somewhere else.

Common compensations include:

• externally rotating the foot and coming off the inside of the great toe. this often causes a callus at the medial aspect of the toe. This places the foot in more pronation (plantar flexion, eversion and abduction) so it is a poorer lever.

• internally rotating the foot and coming off the outside of the foot. This places the foot in more supination ( dorsiflexion, inversion and adduction) and it is therefore a more rigid lever. This often causes tripping or stumbling because of a lack of adequate dorsiflexion of the foot.

• lifting the foot off the ground and avoiding toe off at terminal stance phase

• abbreviating the step length to accommodate the amount of available great toe dorsiflexion.

Are YOU losing power? Tune in here for more tips on this series in the coming weeks!

The Gait Guys. Increasing your gait literacy with each and every post.

A year ago we produced this short video (link) on how to bring back the EHB (extensor hallucis Brevis muscle). Well, it continues to do its magic on a regular basis. Here is a patient’s foot with clear demonstration of unassisted success of isolated engagement of the EHB while simultaneous release of the EHL (ext. Hallucis long us) while engaging the FHL (flexor hallucis long us).  This patient could not isolate any of the long or short hallux muscles on his own. “I can’t find it, my brain doesn’t know what it is supposed to do or how to do it ! (paraphrased)  But after just 24 hours consisting of a few sessions of the exercise here is the result in the photo above.  Success !  And here were his comments: 

Doc, you were right - the brain is an amazingly plastic thing!

I’ll keep working on it, but happy to see such quick progress!

The client’s problem was some medial mid-rear foot pain from the resultant excessive increased pronation because of a forefoot varus.  Well, it is a bit more complicated than that to be precise. There was some true clinical ankle and rearfoot instability because of a lifetime of ankle sprains as well as some highly suspect lower syndesmosis hypermobility from probable distal anterior tib-femoral ligamentous attenuation/tears but the main point is that these were clinically manifesting themselves because of the apparent forefoot varus and the resultant pronatory foot mechanics to get the 1st metatarsal head (medial tripod) to the ground; a typical phenomenon .  Here is the kicker, he did  not have a fixed forefoot varus, it was a mirage, it was functional. What he had was an inability to descend the first metatarsal (plantarflex the Metatarsal) / medial tripod of the foot.  He could not do this because he could not separate ankle dorsiflexion and hallux dorsiflexion.  There was essentially no hallux dorsiflexion at all because he could not descend the 1st MET (head).  So, we knew it was time to break out the nuclear EBH exercise in the video above !  Big problems require big guns !

The rest is history. We fully expect to see a virtual disappearance of the “so called” forefoot varus (because it was never present in the first place). 

“If you have never seen the beast, you will not recognize it when you see it.”-unknown

Podcast 61: Sweating, Ankle Rocker and Free Radicals & Exercise

A. Link to our server:

Direct Download: 

http://traffic.libsyn.com/thegaitguys/pod_61final.mp3

Permalink: 

http://thegaitguys.libsyn.com/podcast-61-sweating-ankle-rocker

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:

1. Free Radicals, Exercise and Nutritional Supplements

http://www.ncbi.nlm.nih.gov/pubmed/21619928

Free Radic Biol Med. 2011 Jul 15;51(2):327-36. doi: 10.1016/j.freeradbiomed.2011.05.010. Epub 2011 May 14.

Extending life span by increasing oxidative stress.

Ristow M1, Schmeisser S.

 

2. Why Runners Sweat More
http://www.runnersworld.com/hydration-dehydration/why-runners-sweat-more

_____________

3. we thank Will, one of our faithful followers for sending this article

 

http://www.businessweek.com/magazine/the-greatest-running-shoe-never-sold-01122012.html

________

http://medicalxpress.com/news/2014-04-brain-dynamic-neural-fiber-insulation.html

 

 

4. Jack rabbit sports running shoe company in New York !

 

http://www.jackrabbitsports.com/

__________

Gabe 11:03am Apr 21

5. Hello Gait Guys,

My name is Gabriel and I am a former patient of Dr. Ivo. I am also a quasi gait geek in the sense that I have read about 90% of your posts and listened to about 80% of your podcasts. I am messaging you today because I am now employed in the REI shoe Department and I would like to get shoe fit certified. If you could explain the shoe fit certification in more detail to me and testing locations, I would greatly appreciate it.

______________

The neurologist with a right short leg from a lower leg reconstruction , barely 90° right ankle dorsiflexion and severe LEFT OA hip

 

Gave him a right to millimeter sole liftft. He doubled the sole lift without telling me. Came in with a raging hot extensor digitorum dorsal foot pain.

 

6. New Balance fresh foam shoes:

weighs 9.1oz

25mm in heel; 21mm in forefoot w/ 4mm drop

In todays post, Join Dr Ivo as he talks about common “Power Leaks” that occur in runners. It really is as simple as P = W/t !

The Gait Guys. Breaking it down to understandable terms with each and every post.

The Cheetah man, PART 2: “Bird Dog”, again.

In last week Wednesday’s blog post (link) we discussed the video of this man running amazingly on all 4 limbs at an incredible speed. He was doing it beautifully, most people would have fallen flat on their face after the first leap forward. 

As we discussed on that day, and these 2 screenshot photos will prove, there is ipsilateral interference between the foot and hand in this quadrupedal gait. This is diagonal quadrupedal locomotion (QL); the forward moving lower limb is impaired from further forward progression by the posting up (contact) hand of the same side.  However, in his case, there is such quick removal of the leading hand/limb that he can advance the ipsilateral foot/leg as far forward as he is able without impediment from the same side hand contact. 

As we mentioned in the Bird Dog post last week, (see photo of lady on yoga mat above) the contralateral upper limb will be in the opposite phase of the contralateral lower limb. ie when the left lower limb is in extension, the right upper limb will be in flexion (this is the classic Bird Dog position).

In last weeks blog post (see photos above), the opposite is clearly happening. One can see in the first photo that bird dog is clearly not helping to train a gait pattern, and that is ok, it has other values at times. Rather, in this first photo we see left hip extension and right shoulder extension, just as we see in the baby photo. This contradicts Bird Dog but this does support bipedal gait patterns.  Think about gait. Your right leg and left arm flex until about midstance, when they start to transition into extension; the left leg and right arm are doing the opposite. At no point are the arm and opposite leg opposing one another as in Bird Dog.

As Ivo would say , “if you look at it neurologically, it is a crossed extensor reflex.  It is very similar to a protective reflex called the “flexor reflex” or “flexor reflex afferent”.

The principles remain intact.

More critical thinking today. Hope you enjoyed.

Shawn and Ivo,

The gait guys

This is a slide from a recent teleseminar we delivered on www.onlineCE.com.  You can take any of our dozens of courses/lectures there for a nominal fee.

 

This was an interesting study.  Here the authors seemed to discover that habitually driven sensory-motor patterns (as compared to optimally controlled patterns) are quite resistant to changes in biomechanics. In the study, when the tested model was compromised, the subject merely increased the recruitment of all of the surrounding muscles to stabilize and direct movement. Basically, there was no great and calculated logical strategy, it was an all out, habitually automated response … . a “just get the job done right now kind of response”.  Perhaps a “living in the moment” response?  

We have often said that the paramount task via the central nervous system is an orchestration at the the joint, it must be stabilized and movement controlled at the moment of the joint challenge. But, the problem lies in that the consequences of a suboptimal strategy cannot be determined in the moment, they come in time. And this is likely what builds these aberrant compensation patterns, they happen slowly, subtly over time little by little. 

Just as in life, the cost of our decisions are not often immediately realized.

Shawn and Ivo

The gait guys

The Cheetah man: A new perspective on Cross Crawl and neurologic patterning.

A few months ago we wrote a piece about Uner Tan Syndrome.  Here was a key point from that blog post (blog post link) and it links beautifully to our most recent controversial blog post on the “Bird Dog” rehab exercise (link here):

[In the video presented in that blog post, and in our “Bird Dog” post photo] there is ipsilateral interference between the foot and hand in this quadrupedal gait. In this diagonal quadrupedal locomotion (QL) the forward moving lower limb is impaired from further forward progression by the posting up (contact) hand of the same side. This would not occur if the QL gait was non-diagonal (ie. unilateral), the forward progression of the lower limb would be met with same time forward progression of the upper limb, allowing a larger striding out of both limbs.  This would enable faster locomotion without increasing cadence (which would be the only way of speeding up in the diagonal QL), at the possible limitation of necessitating greater unilateral truncal postural control (which is a typical problem in some of these Uner Tan Syndrome individuals who typically have profound truncal ataxia).  

So, why are we showing you the video above today ?  If you do not know, go read those 2 blog posts again and look more closely at the video above. At exactly 0:21 seconds into the video, at the slow motion section, you can see what we were talking about in the Bird Dog post last week, that being that the quadrupedal pattern that is neurologically substantiated is that when the right lower limb is in flexion, so is the left upper limb. (we will show these 2 photos in tomorrows post).  Where as, “Bird Dog” shows the opposite, that the contralateral upper limb will be in the opposite phase of the contralateral lower limb.

Who cares right ?  Well, it matters.  In the video above, this could be a problem because if the right leg is in flexion that means that the right arm will be moving into extension. This means that the knee and the hand will be running into each other (look at the baby photo here). As we discussed in the Uner Tan article this will impair faster quadrupedal locomotion. It is also one of the theories as to what may have pushed us to become bipedal and allow faster ambulation (there are many theories of course).  So, how then does this guy in the video move like a cheetah ? How is he going so fast with the quadrupedal pattern we have clearly outlined here ?

Within days a blog reader (Micheal L, thanks Michael) messaged us and said this:

• As a person who likes what’s going on at MoveNat, this type of quadrupedal movement is referred to by them as contralateral movement and is how they teach people to crawl at their seminars. In CrossFit workouts, we also do bear crawls as an exercise, and I always try to maintain a contralateral gait. i.e. Right arm moves forward as left foot comes forwards and vice versa. 
  So, in other words, in the Uner Tan Syndrome (UTS) the gait is cumbersome and inefficient. In the video above and at MoveNat seminars, it’s a technique/skill.
  Did you guys intend for this comparison, or am I out in the cornfield on this?

  Here was Dr. Uner Tan  himself chiming in on the dialogue:
• Üner Tan It is not the same type of locomotion, i.e., not “the diagonal-sequence quadrupedal locomotion”, which is also used by non-human primates.. .

  Michael: The guy runs so fast it’s hard for me to see it well. Okay, so with UTS the lower limb runs into the upper limb. In this video, his upper limb quickly gets out of the way, giving room for the lower limb (to further flex forward increasing swing phase forward step length). It’s just really hard to see it without slow motion. Thank you for clarifying.

As we said in last weeks post on all of this:

“Think about gait. Your right leg and left arm flex until about midstance, when they start to extend; the left leg and right arm are doing the opposite. At no point are the arm and opposite leg opposing one another. 
If you look at it neurologically, it is a crossed extensor reflex.  It is very similar to a protective reflex called the “flexor reflex” or “flexor reflex afferent”. 

In this video case today, it appeared on the surface because of the speed of this fella, that all that we have been talking about had been left in the dust. But, after looking at things closer and more slowly, the principles remain intact.  For now.

Just a little open thinking digging today. Hope you enjoyed.

Shawn and Ivo,

The gait guys

The case of the missing toes.

OK, a bit dramatic but as you can see in the plantar view above, all you can see is the toe pads, the rest of the digit shafts are hidden.  

This is a classic example of a foot imbalance. We have talked about this many times before but the attached video link here  ( http://youtu.be/IIyg7ejYNOg ) shows it very well.  Read on.

There is shortness and increased resting tone in the short toe extensors (EDB, extensor digitorum brevis) and long toe flexors (FDL=flexor dig. longus) with insufficiency in the short flexors and long extensors. This pairing creates a hammer toe effect.  In the video, you can see that these toes are showing early hammering characteristics, but not yet rigid ones. The key word there is, “yet” so this is still a correctable phenomenon at this point.  You can also clearly see the distal migration of the metatarsal fat pad. The fat pad has migrated forward of the MET heads and is being pulled forward by the excess tension in the long toe flexors. As this imbalance in the toe flexors and extensors develops, the forefoot mechanics get impaired and the lumbricals (which anchor off off the FDL) become challenged. Their contributory biomechanics, amongst other things, help to keep the fat pad in place under the metatarsal heads. You can see in this video link above that by proximally migrating (towards the heel) just the fat pad back under the MET heads the resting mechanics of the toes changes, for the better.  

Remember the other functions of the lumbricals ?  their other major functions, namely: thinking from a distal to proximal orientation (a closed chain mode of thinking), they actually plantarflex the metatarsal on the fixed phalynx, assist in dorsiflexion of the ankle, and help to keep the toes from clawing from over recruitment of the flexor digitorum longus.

Here is another blog post we did on a similar presentation.http://thegaitguys.tumblr.com/post/14766494068/a-case-of-plantar-foot-pain-during-gait-this

Proper balance of the toe flexors and extensors, and their harmony with lumbricals and fat pad amongst other things will give healthy long flat toes that can help the proximal biomechanics of the foot.  If you have neuromas, metatarsalgia, hammer toes, claw toes, migrating toes, bunions or hallux valgus amongst many other things, this might be a good place to start.   

There are exercises that can help this presentation, but understanding “the why” is the first step.

Shawn and Ivo

The Gait Guys

This simple screening test becomes a form of exercise.

Last week we explored the “Lean” test to see how your QL and gluteus medius were paired. Today we look at a simple CNS screen for your “central pattern generators” or “CPG’s”. If you do not pass, then the exercise becomes the rehab exercise. If you (or your client) does not have good coordination between the upper and lower extremity, then they will not be that efficient, physiologically or metabolically.

The “cross crawl” or “step test” looks at upper and lower extremity coordination, rather than muscular strength. If performed for a few minutes, it becomes a test that can look at endurance as well.

It is based on the “crossed extensor” response, we looked at last week. That is, when one lower limb flexes, the other extends; the contralateral upper limb also flexes and the ipsilateral upper limb extends. It mimics the way things should move when walking or running.

• Stand (or have your client stand) in a place where you will not run into anything.
• Begin marching in place.
• Observe for a few seconds. When you (or your client) are flexing the right thigh, the left arm should flex as well; then the left thigh and right arm. Are your (their) arms moving? Are they coordinated with the lower extremity?
• What happens after a few minutes? Is motion good at 1st and then breaks down?
• Now speed up. What happens? Is the movement smooth and coordinated? Choppy? Discoordinated?
• now slow back down and try it with your (their) eyes closed

If  movement is smooth and coordinated, you (they) pass

If movement is choppy or discoordinated, there can be many causes, from simple (muscle not firing, injury) to complex (physical or physiological lesion in the CNS).

• If movement is not smooth and coordinated, try doing the exercise for a few minutes a day. You can even start sitting down, if you (they) cannot perform it standing. If it improves, great; you were able to help “reprogram” the system. If not, then you (they) should seek out a qualified individual for some assistance and to get to the root of the problem.

The Gait Guys. Giving you information you can use and taking you a little deeper down the rabbit hole with each post.

Rewind double feature! Part 2

(for part 1, click here)

In conjunction with the latest PODcast talking about efferent copy, we thought it appropriate to talk about the cerebellum here. In this capsule we talk about the efferent pathways

Enjoy! and have a nice weekend (not that we are telling you what to do…)

Ivo and Shawn

Rewind double feature! Part 1

A first ever her on TGG. With the latest PODcast talking about efferent copy, we thought it appropriate to talk about the cerebellum here.

Enjoy! and have a nice weekend (not that we are telling you what to do…)

Ivo and Shawn

Podcast 60: Speeding up at the finish line & Efferent Copy

A. Link to our server:

Direct Download: 

http://traffic.libsyn.com/thegaitguys/pod_60final.mp3

Permalink: 

http://thegaitguys.libsyn.com/podcast-60-speeding-up-at-the-finish-line-efferent-copy

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:

1.  Move Your Body, Grow Your Brain

http://www.edutopia.org/blog/move-body-grow-brain-donna-wilson

2. http://www.runnersworld.com/health/the-importance-of-breaks-in-sedentary-time

3. Why are elite athletes able to speed up when they see the finish line?

http://www.theglobeandmail.com/life/health-and-fitness/fitness/why-are-elite-athletes-able-to-speed-up-when-they-see-the-finish-line/article16747880/

4. How Your Thoughts Affect Your Running Efficiency 

http://www.runnersworld.com/sports-psychology/how-your-thoughts-affect-your-running-efficiency

5. How Alcohol Affects Muscle-Building

http://www.runnersworld.com/nutrition-for-runners/how-alcohol-affects-muscle-building

6. Blog reader: Hey again, I personally compete in this uphill/ downhill running race in 2 months. The slops are really steep(incline/ decline).I’m just looking for some useful tips on running biomechanics, cadence etc. Any hints on what things I should be doing and of course avoid doings that will lead to injury? An international podcast fun!

7. Blog reader:

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

Can you see something strange in this gait ? You gotta look closely, there are several things that should bother you.

Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)

Not every gait problem is related to faulty shoes, bad feet or impaired arm swing.  

This is a case of CIDP that walked (terribly) into our clinic.  We did not initially know what this was but as you can see from this gait, if you look closely enough, something is just missing and wrong.

Arm swing is very problematic and there is no anti-phasic shoulder/pelvic girdle motions.  There are subtle demonstrations of both wide based gait steps and cross-overs. The gait is syncopated, sort of.  We had to shorten the clip for patient ID preservation, we wish we could have shown you more, it is really quite obvious that there is a systemic neurologic coordination problem in this patient.  With demyelinating polyneuropathies as the peripheral receptors become more and more impaired the brain eventually starts to lose more and more signals from the peripheral joints as to where the body parts are in space. IF the brain cannot find the parts, it cannot control them. If the brain just gets some of the signal the cerebellum cannot use its EFFERENT copy of the motor program, which is send out into the limbs, to orchestrate smooth coordinated tasks.  Go watch the video again, look at the global feel of the video, it is ratchety and syncopated.

CIDP is an acquired immune-mediated inflammatory disorder of the peripheral nervous system. The myelin sheath is slowly destroyed in this disease so nerve conduction is gradually lost. Some sources compare this disease to Guillian Barre disease. 

From wikipedia: 

Chronic inflammatory demyelinating polyneuropathy^[3] is believed to be due to immune cells, cells which normally protect the body from foreign infection, but here begin incorrectly attacking the nerves in the body instead. As a result, the affected nerves fail to respond, or respond only weakly, to stimuli, causing numbing, tingling, pain, progressive muscle weakness, loss of deep tendon reflexes (areflexia), fatigue, and abnormal sensations. The likelihood of progression of the disease is high.

After seeing the client a few times, it was clear that there were several fixed neurologic parameters which could not be mediated and the client was sent an EMG/NCV and the specific diagnosis was made. The client was put on a monthly immunogloblulin IV drip and has remarkably stabilized.

Not all gaits are from a bad ankle, a slumbering cerebellum or cruddy arm swing.  Trust your clinical judgement, if it doesn’t feel right, refer up or laterally.  

Shawn and Ivo

A new twist on an old exercise

Do you know the the “Bird Dog” exercise? It looks like the picture above. The upper and contralateral lower extremities are extended, the the opposite ones are flexed. Seems to make make sense, unless you think about gait and neurology (yes, as you can see, those things seem to always be intertwined).

Think about gait. Your right leg and left arm flex until about midstance, when they start to extend; the left leg and right arm are doing the opposite. At no point are the arm and opposite leg opposing one another. Hmmm.

If you look at it neurologically, it is a crossed extensor reflex (see above); again, flexion of the lower extremity is paired with flexion of the opposite upper extremity. It is very similar to a protective reflex called the “flexor reflex” or “flexor reflex afferent”.

Wouldn’t it make more sense to do a cross crawl pattern? Or maybe like the babies shown above? Seems like if that’s the way the system was programmed, maybe we should try and emulate that. Don’t we want to send the appropriate messages to our nervous system for neurological re patterning? If you are doing the classic “opposite” pattern, what is your reasoning? Can you provide a sound neurological or physiological reason?

Think before you act. Know what you are doing.

The Gait Guys. Bridging the gap between neurology and gait, so you can do a better job.

Welcome to rewind (Late) Friday. Sorry about the late entry, folks.

Along the vein of bike fit, to go with our lecture on onlinece.com this week, here is gentleman with right sided low back pain ONLY when ascending hills on his mountain bike. Can you figure out why?

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

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

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

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

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

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

He has an anatomically short Left leg (tibial)

Look at the tissue folds at the waist and amount of reach with each leg during the downstroke.

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

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

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

Go ahead and try this at home.

remember last mondays post? (if not, click here). Here is one way of telling whether your (or someone else’s) vestibular system is working. It will also give you an idea of how some people compensate.

Ready?

• Stand up (barefoot or shoes does not matter).

• place your hands resting on the top of your hips with your thumbs to the back (like your Mom used to, when you were in trouble). Your thumbs should be resting on your quadratus lumborum (QL) muscle.

• tilt your HEAD to the LEFT

• you should feel the muscle (ie the QL) under your RIGHT thumb contract

• come back upright

repeat, but this time lean your BODY to the LEFT

• same thing right? Now check the other side.

Everything OK? Everything fire as it should?

Now lets add another dimension.

• slide your fingers down so they are just below the crest of the hip, resting above the greater trochanter (the bump on the side of your upper thigh). This should place your fingers on the middle fibers of the gluteus medius.

• tilt your head (or body ) to the LEFT.

• You should feel the LEFT gluteus medius and the RIGHT QL contract. These muscles should be paired neurologically. When walking, during stance phase on the LEFT: the LEFT gluteus medius helps to maintain the pelvis level, while the RIGHT QL, assists in hiking the RIGHT side.

If everything works OK, then your vestibulospinal spinal system is intact and your QL and gluteus medius seem to be firing and appropriately paired. If not? That is the subject for another post.

The Gait Guys. Helping you to understand the concepts of WHY compensations occur.

Welcome to Rewind Friday, Folks. Today we review the importance of the great toe extensor. Enjoy!

Gait Topic: The Mighty EHB (The Short extensor of the big toe, do not dismiss it !)

Look at this beautiful muscle in a foot that has not yet been exposed to hard planar surfaces and shoes that limit or alter motion! (2 pics above, toggle back and forth)

The Extensor Hallicus Brevis, or EHB as we fondly call it (beautifully pictured above causing the  extension (dorsiflexion) of the child’s proximal big toe) is an important muscle for descending the distal aspect of the 1st ray complex (1st metatarsal and medial cunieform) as well as extending the 1st metatarsophalangeal joint. It is in part responsible for affixing the medial tripod of the foot to the ground.  Its motion is generally triplanar, with the position being 45 degrees from the saggital (midline) plane and 45 degrees from the frontal (coronal) plane, angled medially, which places it almost parallel with the transverse plane. With pronation, it is believed to favor adduction (reference). Did you ever watch our video from 2 years ago ? If not, here it is, you will see good EHB demo and function in this video. click here

It arises from the anterior calcaneus and inserts on the dorsal aspect of the proximal phalynx. It is that quarter dollar sized fleshy protruding, mass on the lateral aspect of the dorsal foot.  The EHB is the upper part of that mass. It is innervated by the lateral portion of one of the terminal branches of the deep peronel nerve (S1, S2), which happens to be the same as the extensor digitorum brevis (EDB), which is why some sources believe it is actually the medial part of that muscle. It appears to fire from loading response to nearly toe off, just like the EDB; another reason it may phylogenetically represent an extension of the same muscle.

*The EDB and EHB are quite frequently damaged during inversion sprains but few seem to ever look to assess it, largely out of ignorance. We had a young runner this past year who had clearly torn just the EHB and could not engage it at all. He was being treated for lateral ankle ligament injury when clearly the problem was the EHB, the lateral ligamentous system had healed fine and this residual was his chief problem.  Thankfully we got the case on film so we will present this one soon for you !  In chronic cases we have been known to take xrays on a non-standard tangential view (local radiographic clinics hate us, but learn alot from our creativity) to demonstrate small bony avulsion fragments proving its damage in unresolving chronic ankle sprains not to mention small myositis ossificans deposits within the muscle mass proper.

Because the tendon travels behind the axis of rotation of the 1st metatarsal phalangeal joint, in addition to providing extension of the proximal phalynx of the hallux (as seen in the child above), it can also provide a downward moment on the distal 1st metatarsal (when properly coupled to and temporally sequenced with the flexor hallicus brevis and longus), assisting in formation of the foot tripod we have all come to love (the head of the 1st met, the head of the 5th met and the calcaneus).

Wow, all that from a little muscle on the dorsum of the foot.

The Gait Guys. Definitive Foot Geeks. We are the kind of people your podiatrist warned you about…