Optimal walking speed

How fast you should move in order to improve your health?
In many studies, the more intense runners are healthier than those who walk or run more moderately. However, this is not the entire picture, there are studies that say moderation is wiser. Confusingly, and perhaps unfortunately there is literature that will support whatever makes you happy.
From the linked blog:
“This risk of death is lower even with a very minimal energy expenditure. The lowest-energy-expenditure group in each study is walking at about 3 mph for 20 to 40 minutes per day. In other words, a mile or two of walking. In exchange, their risk of death goes down by 10 percent.
"Walking a bit farther — say, 2 to 3 miles at 3 mph — gets you an additional death reduction of about 30 percent. But walking more than that, or more than an hour a day at this speed, is no better.”
“If we take this research at face value, we learn a few things. First, some exercise reduces your risk of death. Second, the optimal walking/jogging exercise is light to moderate jogging. The optimal speed is between 5 and 7 mph, and if you do 25 minutes about three times a week, you’re all set. Nothing in the data suggests that running more — farther, or faster — will do more to lower your risk of death.”

What do you think ? Agree /Disagree?

http://fivethirtyeight.com/features/whats-the-optimal-speed-for-exercise/

Higher Level Gait Disorders

How deep are you willing to take your gait understanding ?

“In conclusion, these data suggest that the gait and balance deficits in higher level gait disorders (HLGD) mainly result from the lesion or dysfunction of the network linking the primary motor cortex and the mesencephalic locomotor region (MLR), brain regions known to be involved in the control of gait and balance, whereas cognitive and ‘appendicular’ hypokinetic-rigid signs mainly result from deep white matter lesions (DWML) that could be responsible for a dysfunction of the frontal cortico-basal ganglia loops.”

http://www.ncbi.nlm.nih.gov/pubmed/24202784
J Neurol. 2014 Jan;261(1):196-206. doi: 10.1007/s00415-013-7174-x. Epub 2013 Nov 8.
High-level gait and balance disorders in the elderly: a midbrain disease?
Demain A

The effect of lower extremity fatigue on shock attenuation during single-leg landing.

Thank goodness the body can compensate. Here is a perfect example of this discussed in this study.
“ … it has been shown that a fatigued muscle decreases the body’s ability to attenuate shock from running. The purpose of the study was to determine the effect of lower extremity fatigue on shock attenuation and joint mechanics during a single-leg drop landing.”
This study suggests that as one part fatigued, the joint and muscle strategies elsewhere in the limb made up for it.
“Hip and knee flexion increased and ankle plantarflexion decreased at touchdown with fatigue. Hip joint work increased and ankle work decreased.” The results suggested that the lower extremity is able to adapt to fatigue though altering kinematics at impact and redistributing work to larger proximal muscles.

The effect of lower extremity fatigue on shock attenuation during single-leg landing. Clin Biomech (Bristol, Avon). 2006 Dec;21(10):1090-7. Epub 2006 Sep 1.
Coventry E1, O'Connor KM, Hart BA, Earl JE, Ebersole KT.
http://www.ncbi.nlm.nih.gov/pubmed/16949185

The smell of napalm in the morning: Your gait and trouser coughs, a clinical entity no one talks about.

Written by Dr. Shawn Allen


This is our very last gait guys blog post. Yes, all good things come to an end, even this trusted blog.
But, keeping in good faith, we will finish on a strong note ……. One of gardenia and lavender.  Thanks for the last 5 years gait brethren, is has been a great ride.  Shawn and Ivo
_______________________________
The technical title of this blog post should have been, “The reactive influence of non-normopressure bowel distention and spontaneous high vapor dissipation on bipedal locomotion.”  but no one but true gait nerds would have read it had we stuck with this pubmed-type title. Yes, we are talking about farts and gait here today folks, buckle up.

One biomechanical principle we will link to this entity of “off-gassing“ is that excessive or sustained ankle plantarflexion could inhibit dorsiflexion and certainly, at the very least, works against it. We have talked about this often here on the blog and how the lack of ample ankle dorsiflexion can impair many of the biomechanical events higher up into the human frame. So, how can someone’s bowel gas translate into gait problems ?

Think about this …  to squeeze out a right “cheek sneak” (fart) with optimal crowd pleasing pitch and peak vibrato, some elevation and relaxation of the lower and middle gluteus maximus divisions (coccygeal and sacral) seems imperative to optimally control off-gassing . Seemingly, to do this, a significant degree of right ankle plantarflexion may be necessary to lift the right hemipelvis driving a subsequent intentional clockwise pelvic distortion assisting in the relaxation of these gluteal divisions.  This consciously driven right side of the body “lift” via the right ankle plantarflexion can also be met and assisted via ipsitlateral abdominal and contralateral gluteus medius contraction to further enable the optimal right hemipelvis elevation. Go ahead, stand up and mimic the posture and note these biomechanical pieces. Recall our mantra, 

“when the foot is on the ground, the glutes are in charge, when the foot is in the air, the abdominals are in charge”.  

These coordinated motor patterns might be considered dual/multi tasking. This honed series of biomechanical events is one often perfected in frat houses and basement gaming rooms. But make no mistake, there is a biomechanical danger lurking here if this becomes a habitual compensation pattern, one common in large volume legume consumers (beware vegans). Habituation of this motor task, or demonstrating poor technique over time can render right quadratus lumborum shortening and weak lower abdominals rendering an anterior pelvic tilt. This tilt may lead to gluteal inhibition/weakness (because it is difficult to contract the gluteals in an anterior pelvic tilt, go ahead stand up again and try it) which over time can impair stance phase gait mechanics. However, relating to the off-gassing, this physical posturing might optimize low frequency gluteal vibrations that can optimize vibrato during gas dissipation if pressurization is in fact optimal for an “audible”.  It is important to note that conscious variable control of the tonus of the muscular anal sphincter complex plays a big part in the pitch and vibrato. There is always a drawback it seems, it does truly come down to motor control it seems, doesn’t it always ?


This is not to say that avoiding “audibles” through holding “one” in doesn’t have consequences. The exotic gas (nitrogen, carbon dioxide, hydrogen, methane, oxygen) induced gut distention that could only make your collage roommate proud can inhibit the abdominal wall and thus the lower thoracic canister and disable normal breathing mechanics. This could be a serious complication to the coupled events of respiration and thoracic mobility. So, holding that big one in for your friends rather than engaging the compensatory Trendeleburg-type off-gassing posture as described above is also fraught with problems. We know that functional disconnection of the thoracic canister from the pelvic core can disrupt the normal anti-phasic mechanics of the contralateral upper and lower limbs as well as possibly impair the normal spinal cord mediated central pattern generators.

Farts…..Call them what you want, those ear pleasing, nose hair curling, trouser coughs that only a teenage boy can truly relish and recognize as a function of boyhood success.  All joking aside, they truly should be your biggest concern in your gait analysis evaluation, bar none. Ask your patients about their bowels and off-gassing, it should be part of your clinical history intake. Maybe even consider taking out the discomfort of open dialogue, and put it on your intake forms. We found that a stick figure diagram in a good biomechanical squat posture with a mushroom cloud formation hanging overhead eases dialogue tension about this sensitive topic. We even give the young children crayons to they can color the cloud. What fun !


Dare us to write a part two on this topic. “Blue Angels” (unfamilar with this clinical phenomenon? look it up). Go ahead, dare us for a part 2. 

By now, if you haven’t realized that The Gait Guys just punked you, then you likely haven’t had your cup of morning coffee. Yes, we have no clue what we were talking about on this blog post, well, ok maybe, after all we do have that y-chromosome. Yes, we are NOT ending the blog either :) 

Are you now considering us juvenile ? Ok maybe we are a little, but don’t deny it, you thought about some unique and honest body biomechanics for a moment here and it is these mental gymnastics that will take your creative thinking about gait to the next level. If you are upset, so be it. There will be no apologies here in this growing PC world. Off-gassing is a human thing, we all do it. We have been writing serious stuff daily for 5 years here on The Gait Guys. It was time for us to write something a little lighter.  We can only hope that you will think of us and the complexities of the gait cycle the next time you sneak one out while having dinner at the in-laws.  Try not to giggle when you do, but for certain, think about your body mechanics when you do, we can’t be responsible for off-gassing injuries. Think of us.

Shawn Allen, remaining here, for the duration.

disclaimer: we cannot be responsible for injuries that might be sustained by improper off-gassing events. We also do not recommend attempts at performing Blue Angels, this is a potentially dangerous activity and could cause great bodily harm (seriously). :)

Pod #93: Ankle Rocker, Sacroiliac Joint symmetry , Landing mechanics

Ankle Rocker, Sacroiliac Joint symmetry , Landing mechanics, Gait Tech, Gray Cook theories, movement and music and so much more !

A. Link to our server:
http://traffic.libsyn.com/thegaitguys/pod_93Final.mp3

Direct Download:  http://thegaitguys.libsyn.com/pod-93-ankle-rocker-sacroiliac-joint-symmetry-landing-mechanics

Sponsor: www.newbalancechicago.com

-Other Gait Guys 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 & more !)
http://store.payloadz.com/results/results.aspx?m=80204
D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”

-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:

-Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E

-Barnes and Noble / Nook Reader:
http://www.barnesandnoble.com/w/pedographs-and-gait-analysis-ivo-waerlop-and-shawn-allen/1112754833?ean=9781466953895

https://itunes.apple.com/us/book/pedographs-and-gait-analysis/id554516085?mt=11

-Hardcopy available from our publisher:
http://bookstore.trafford.com/Products/SKU-000155825/Pedographs-and-Gait-Analysis.aspx

Show notes:

-Landing mechanics
http://www.ncbi.nlm.nih.gov/pubmed/26117159

-Shock absorbing landing loads
J Athl Train. 2015 Jun 11. [Epub ahead of print]
Weight-Bearing Dorsiflexion Range of Motion and Landing Biomechanics in Individuals With Chronic Ankle Instability. Hoch MC1, Farwell KE1, Gaven SL2, Weinhandl JT1.

-Neuroscience:
Trying to reteach your client’s CNS new sensory-motor patterns so they can move better ?
New connections and pathways are fragile and only through repetition and practice and focused attention can those connections be established enough to become habitual or default behaviors.
Neuroscience for Leadership: Harnessing the Brain Gain Advantage (The Neuroscience of Business). Tara Swart

-Does variability in muscle activity reflect a preferred way of moving or just reflect what they’ve always done?
http://esciencenews.com/articles/2014/03/14/motion.and.muscles.dont.always.work.lockstep.researchers.find.surprising.new.study

-Context-dependent changes in motor control and kinematics during locomotion: modulation and decoupling. Foster and Higham
http://www.ncbi.nlm.nih.gov/pubmed/24621949

-gait technology problems :?
http://www.buzzfeed.com/stephaniemlee/who-owns-your-steps#.twn1Bg28P

-Dance video discussed, Alvin Ailey Dance Company
https://vimeo.com/36286106

-SI joint anatomy/rehab piece: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3512279/
more rehab strategies here: http://lermagazine.com/article/music-therapy-and-gait-rehab-to-a-different-beat

-a few minutes on Gray Cook quotes. pick a few we can talk about (pic attached)

movement patterns talk: http://www.anatomy-physiotherapy.com/28-systems/musculoskeletal/lower-extremity/knee/1191-altered-movement-patterns-in-individuals-with-acl-rupture

Just because it looks good, doesn’t mean that it is.We have all had patients with seemingly negative knee x rays and pain, only to develop arthritic changes at a later date. Find and treat the cause!“Our analysis found that incident radi…

Just because it looks good, doesn’t mean that it is.

We have all had patients with seemingly negative knee x rays and pain, only to develop arthritic changes at a later date. Find and treat the cause!

“Our analysis found that incident radiographic knee osteoarthritis is preceded by prodromal symptoms lasting at least 2-3 years. This has potential implications for understanding phasic development and progression of osteoarthritis and for early recognition and management.”

Case R, Thomas E, Clarke E, Peat G. Prodromal symptoms in knee osteoarthritis: a nested case-control study using data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2015 Apr 2. [Epub ahead of print]

picture from: http://whyfiles.org/…/chronic-pain-understanding-the-roots…/

“Due to the shape of the condyles and the menisci, and the location of ligaments of and muscles acting on the knee, the joint rotation axis is located medially in the knee joint. This also in part explains why the lateral condyle and meniscus …

“Due to the shape of the condyles and the menisci, and the location of ligaments of and muscles acting on the knee, the joint rotation axis is located medially in the knee joint. This also in part explains why the lateral condyle and meniscus are more mobile. Maximum extension of the knee is caused by these factors and the “screw home” mechanism of the cruciate ligaments. The popliteal muscle is connected with the lateral meniscus and the caput fibulae: it locks the knee joint in and unlocks the knee joint out of its maximum extension. Moreover, it plays an important role for proprioception in the knee joint and is known to cause posterolateral knee pain.

from: http://www.anatomy-physiotherapy.com/…/94-test-your-knowled…

Forefoot valgus: A fixed structural defect in which the plantar aspect of the forefoot is everted on the frontal plane relative to the plantar aspect of the rearfoot; the calcaneum is vertical, the mid tarsal joints are locked and fully pronatedWant…

Forefoot valgus: A fixed structural defect in which the plantar aspect of the forefoot is everted on the frontal plane relative to the plantar aspect of the rearfoot; the calcaneum is vertical, the mid tarsal joints are locked and fully pronated

Want to know more? Join us Wednesday evening: 5 PST, 6 MST, 7 CST, 8 EST for Biomechanics 309: Focus on the forefoot on onlinece.com.

McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

Fore foot types: Differences between forefoot varus and forefoot supinatus.Certainly this can be a contraversial topic. Perhaps this will help clear up some questions.Supination of the forefoot that develops with adult acquired flatfoot is defined a…

Fore foot types: Differences between forefoot varus and forefoot supinatus.

Certainly this can be a contraversial topic. Perhaps this will help clear up some questions.

Supination of the forefoot that develops with adult acquired flatfoot is defined as forefoot supinatus. This deformity is an acquired soft tissue adaptation in which the forefoot is inverted on the rearfoot. Forefoot supinatus is a reducible deformity. Forefoot supinatus can mimic, and often be mistaken for, a forefoot varus. A forefoot varus differs from forefoot supinatus in that a forefoot varus is a congenital osseous deformity that induces subtalar joint pronation, whereas forefoot supinatus is acquired and develops because of subtalar joint pronation (1).

A Forefoot Varus induces STJ pronation whereas a Forefoot Supinatus is created because of STJ pronation (2).

As the foot experiences increased subtalar joint (STJ) pronation moments during weightbearing activities (as in forefoot supinatus) , the medial metatarsal rays will be subjected to increased dorsiflexion moments and the lateral metatarsal rays will be subjected to decreased dorsiflexion moments. Over time, this increase in STJ pronation moments will tend to cause a lengthening of the plantar ligaments and medial fibers of the central component of the plantar aponeurosis and a shortening of the dorsal ligaments in the medial longitudinal arch. As a result, the influence of increased STJ pronation moments occurring over time during weightbearing activities will tend to cause the following (3):

1. An increase in inverted forefoot deformity.
2. A decrease in everted forefoot deformity.
3. A change in everted forefoot deformity to either a perpendicular forefoot to rearfoot relationship or to an inverted forefoot deformity.

More on the forefoot tomorrow evening on onlinece.com: Biomechanics 309. Join us!

1. Clin Podiatr Med Surg. 2014 Jul;31(3):405-13. doi: 10.1016/j.cpm.2014.03.009. Forefoot supinatus. Evans EL1, Catanzariti AR2.

2. https://kenva.wordpress.com/…/…/forefoot-varus-or-supinatus/

3. http://www.podiatry-arena.com/podiatry-forum/showthread.php…

Does gait (re)training alter peoples biomechanics? You bet it does! Should we be retraining peoples gait? We like to think, yes. What do you think?“Overall, this systematic review shows that many biomechanical parameters can be altered by runn…

Does gait (re)training alter peoples biomechanics? You bet it does! Should we be retraining peoples gait? We like to think, yes. What do you think?

“Overall, this systematic review shows that many biomechanical parameters can be altered by running modification training programmes. These interventions result in short term small to large effects on kinetic, kinematic and spatiotemporal outcomes during running. In general, runners tend to employ a distal strategy of gait modification unless given specific cues. The most effective strategy for reducing high-risk factors for running-related injury-such as impact loading-was through real-time feedback of kinetics and/or kinematics.’

Br J Sports Med. 2015 Jun 23. pii: bjsports-2014-094393. doi: 10.1136/bjsports-2014-094393. [Epub ahead of print]
Gait modifications to change lower extremity gait biomechanics in runners: a systematic review.
Napier C1, Cochrane CK1, Taunton JE2, Hunt MA1.

How much “dip” in the coronal plane is in your single leg squat?“In conclusion, the Single-Leg Squat is a reliable tool to identify patients that would need to improve their hip and trunk muscle weakness and dysfunction (by strengt…

How much “dip” in the coronal plane is in your single leg squat?

“In conclusion, the Single-Leg Squat is a reliable tool to identify patients that would need to improve their hip and trunk muscle weakness and dysfunction (by strengthening and neuromuscular coordination retraining). ”

Crossley et al., Am J Sports Med 39 (2011) 866 - 873.

Performance on the single-leg squat task indicates hip abductor muscle function. - Anatomy &…

Clinical assessment of performance on the single-leg squat task is a reliable tool that may be used to identify people with hip muscle dysfunction.ANATOMY-PHYSIOTHERAPY.COM

How many times have you seen us post and talk about the shoulder complex and lower extremity relation? Here is another“Kids grow up thinking that throwing a baseball hard is all about strength in the arm and shoulder, but new evidence suggests…

How many times have you seen us post and talk about the shoulder complex and lower extremity relation? Here is another

“Kids grow up thinking that throwing a baseball hard is all about strength in the arm and shoulder, but new evidence suggests that muscle strength and range of motion in the hip affect shoulder function during throwing in youth baseball players.”

Lower-body focus could help youth baseball player arms | Lower Extremity Review Magazine

tumblr_nry1l9Sa1q1qhko2so1_1280.png
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How do your gluteus maximus and gluteus medius exercises stack up?

Looks like side planks (DL=dominant leg) and single leg squats scored big, as did front planks and good old “glute squeezes”

Check out this free full text articlehttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3201064/

Yes, we know it was surface emg; yes we know they are not necessarily testing functional movements. The EMG does not lie and offers objective data. Note that the one graph is labelled wrong and is the G max, not medius.

Kristen Boren, DPT,1 Cara Conrey, DPT,1 Jennifer Le Coguic, DPT,1 Lindsey Paprocki, DPT,1 Michael Voight, PT, DHSc, SCS, OCS, ATC, CSCS,1 and T. Kevin Robinson, PT, DSc, OCS1 ELECTROMYOGRAPHIC ANALYSIS OF GLUTEUS MEDIUS AND GLUTEUS MAXIMUS DURING REHABILITATION EXERCISES Int J Sports Phys Ther. 2011 Sep; 6(3): 206–223.

tumblr_nra7dx0MEV1qhko2so1_1280.png
tumblr_nra7dx0MEV1qhko2so2_1280.png

Who’d a thought? Can someone make an “app” for that?

Interesting study that we just found out about in the June 15th LER journal titled “Patients with ankle instability respond to auditory feedback by changing gait”

In this study they put a sensor under the head of the 5th metatarsal in 10 folks with chronic ankle instability that would emit a sound in respose to excessive lateral ankle pressure. They were told to “walk quietly” and not let the beeper beep. After a short time, the people in the study were able to walk with decreased pressures in the lateral forefoot, in addition to the midfoot and central forefoot. EMG showed increase in peroneal and medial gastroc activity.

Interesting implications and also some questions.

This study shows that auditory feedback can alter behavior and gait. Is this a good thing? We suppose this depends on what you are trying to accomplish and does it ultimately benefit the patient?

this sensor could be made into an “app” that has some cool rehabilitation implications. Imagine a moveable sensor or multiple sensors that could track patterns over time and plot them for you? The auditory could be used to discourage some bevaiors/characteristics of gait and the “tracking” feature could provide progress information. Or maybe is it hooked up to some of your favorite music and it stops playing when you are not weighting appropriately. Wondering if your patient is loading the head of the 1st metatarsal? This could provide some feedback.

Check it out:

Donovan l, Hart JM, Saliba S et al. Effects of an auditory feedback device on plantar pressure in participants with chronic ankle instability. Med Sci Sports Exerc 2015; 46(5 suppl); S104

Folks with patellofemoarl pain move differently. But they don’t necessarily engage their trunk differntly. We think we all knew this, but here is a study that looks at it. “Compared with the control group, the PFP group demonstrated increased ipsila…

Folks with patellofemoarl pain move differently. But they don’t necessarily engage their trunk differntly. We think we all knew this, but here is a study that looks at it. 


“Compared with the control group, the PFP group demonstrated increased ipsilateral trunk lean, hip adduction and knee abduction (p = 0.02-0.04) during single-leg squat accompanied with decreased trunk isometric strength (p = < 0.001-0.009). There was no between-group difference in trunk muscle activation. Only in the control group, ipsilateral trunk lean was significantly correlated with hip adduction (r = -0.66) and knee abduction (r = 0.49); also, the side bridge test correlated with knee abduction (r = -0.51). Differences in trunk, hip and knee biomechanics were found in people with PFP. No relationship among trunk, hip and knee biomechanics was found in the PFP group, suggesting that people with PFP show different movement patterns compared to the control group.”


Man Ther. 2015 Feb;20(1):189-93. doi: 10.1016/j.math.2014.08.013. Epub 2014 Sep 9.Trunk biomechanics and its association with hip and knee kinematics in patients with and without patellofemoral pain.Nakagawa TH1, Maciel CD2, Serrão FV3.

Big Toe Woes: One way to learn to load the head of the 1st metatarsalOn Thursday morning, while sprinting up a hill on the latter part of a run, I had the fortuosity of catching my big toe on what I beleive was an exposed root and fell sudddenly. In…

Big Toe Woes: One way to learn to load the head of the 1st metatarsal

On Thursday morning, while sprinting up a hill on the latter part of a run, I had the fortuosity of catching my big toe on what I beleive was an exposed root and fell sudddenly. Instinctively I rolled to protect my back (as you often do if you have had any history of back injuries). After a few expletives and a bruised ego, I took inventory of my body: back was fine, an abrasion and contusion on my left elbow and a really sore big toe. I got up and decided to run home as I was less than a mile from there.

I immediately noticed that my gait would need to be altered if I was going to make it home. I had injured the distal interphalangeal joint and distal phalanyx from the best I could tell; loading them in any way brought excruciating pain, so I was forced into one of my mantra’s: “Keep your toes up”*. I did this for the rest of my run and noticed, probably more than ever, how much this simple technique shifts the weight to the head of the 1st metatarsal and sesamoids. It also made me make my gait more “circular” (rather than pendular, another thing we teach in gait retraining).

I made it home and promptly iced. After getting to the office, an X ray confirmed my suspicion of a fracture in the proximal portion of the distal phalanyx. A day later and from my distal to my 1st metatarsal phalangeal joint is sausage like and a beautiful violet color. I am grateful I did not seem to injure the MTP…Oh well, I will either have to run carefully or switch to mountain biking for the next few weeks. Some ipriflavone (to assist in calcium absorption), cucumin and essentail oils (for inflammation) and I was good to go. Yes it throbs a bit, but it is a reminder that I need to push off through the head of the 1st : )

Try “toes up”with your peeps and let us know how it goes.

TGG

* “Toes up” technique involves conciously firing the anterior compartment muscles, particularly the extensor digitorum longus. It fires more into the extensor pool and assists in firing ALL your extensors through spacial and temporal summation and also heps to shut down flexor tone through reciprocal inhibition. It will also help you to rocker through your stance phase and get more into your hip extensors.

The eccentric aspect of the shuffle walk

Hey guys, I’m an Osteopath from Australia and am a keen follower of your work. I just had a quick question about your tib ant training via the shuffle gait. I am comfortable with the theory behind it, my only issue is that clinically, tib ants role as an eccentric controller of pronation is significant. Therefore, shouldn’t we develop an exercise which trains it in an eccentric fashion? perhaps there is some controlled pronation in the shuffle gait that I have missed, but i’m interested to hear your thoughts as they are thoughts I respect! Thanks very much for all your work, it’s great to see practitioners using evidence based practice in a creative and practical way. Cheers, D

________

our response:

Hi D. Good question and it is a major point.. If you think about the exercise, you are slowly putting the ball of the foot back on the ground AND maintaining the arch as best as possible. In essence, the arch will drop a bit as your weight is born on the foot, so it will pronate, but you are trying to hold it up, so in a manner of speaking you are controlling the arch descent, so you are eccentrically focusing on the activity. If we were to reshoot the video, this would be part of teh dialogue, because we do have our clients focus on this.  Remember, we are giving this exercise to many folks who have pronation control issues (yes, and ankle rocker issues) so we are kinda hitting the aspect you are questioning.  How this helps a bit.  As they get better, they take bigger steps in the shuffle walk, so that means more acceleration of the prontation, so they will have to try to maintain the arch under greater loads…….hence, more eccentric focus.  That is the way we see it anyways.  

Compression socks. Worth your time ?

“if putting strawberry bubble gum in your right ear on Tuesday mornings helps to alleviate your left hip pain, who am I to say to "don’t do it”.
Preamble: When patients ask me if XYZ might help their problem/pain I sometimes have been heard to jokingly tell my patients that the placebo effect has been shown as high as 40% in some studies. i say that different things work for different people, so if there is no harm in trying something “fringe” and as of yet unproven, I tell them to feel free to try it. I often jokingly end the conversation with this statement “if putting strawberry bubble gum in your right ear on Tuesday mornings helps to alleviate your left hip pain, who am I to say to "don’t do it”.
My mom wears compression stockings for minor swelling in her lower legs. These socks are rated at a graduated 20-30mmHg. Most athletic compression socks are rated far lower, but we have seen some that are rated that high.
Originally developed for the treatment of deep vein thrombosis (DVT), some compression socks are now marketed as a tool to improve venous return, thus believed to improve both performance and recovery in athletes. Some feel that the socks during training are directed to help the skeletal muscle pump, increase deep venous velocity, and/or decrease blood pooling in the calf veins. Some even claim they will alleviate delayed-onset muscle soreness (DOMS).

Alex Hutchinson (link below) does another nice job reviewing compression socks. His conclusion is the same as ours; 

“So the overall picture is quite mixed. The fact that pre-existing beliefs have a big effect on how well compression socks work definitely seems to suggest that some of the benefits are "all in your head.” But it’s worth remembering that the same is probably true of any kind of intervention, including “real” ones.“


Below is a study that suggests no measurable benefits. But as always, you can find any study to support what you want to believe. So perhaps it comes down to, how suggestive is your brain, and what seems to work for you ?

So, compression socks or strawberry bubble gum ? Choices choices choices. 

Eur J Appl Physiol. 2014 Mar;114(3):587-95. doi: 10.1007/s00421-013-2789-2. Epub 2013 Dec 13.
Compression stockings do not improve muscular performance during a half-ironman triathlon race.
Del Coso J.

http://www.runnersworld.com/sweat-science/do-you-believe-in-compression-socks