We hope you are standing up while you read this….

A newborn’s brain is only about one-quarter the size of an adult’s. It grows to about 80 percent of adult size by three years of age and 90 percent by age five (see above). This growth is largely due to changes in individual neurons and their connections, or synapses.

The truth is, most of our brain cells are formed at birth, In fact, we actually have MORE neurons BEFORE we are born. It is the formation of synapses, or connections between neurons, that actually accounts for the size change (see 1st picture above). This is largely shaped by experience and interaction with the environment.

Do you think children’s brains are less active than adults? Think again, your 3 year old’s brain is twice as active as yours! It isn’t until later in life that you actually start dialing back on some of those connections and those pathways degenerate or fade away…a process scientists call “pruning”.

How does this apply to gait? Gait depends on proprioception, or body position awareness. Your brain needs to know where your foot is, what it is standing on and so on. Proprioception, as we have discussed in other posts, is subserved by muscle and joint receptors called mechanoreceptors (muscle spindles, golgi tendon organs and type 1-4 joint mechanoreceptors to be exact). This information is fed to 2 main areas of the brain: the cerebral cortex and the cerebellum. These 2 parts of the central nervous system are interconnected on many levels.

The cerebellum is intimately associated with learning. Try this experiment. you will need a tape recorder (guess we are showing our ages, digital recorder), a timer and a moderately difficult book.

Sit down and pick a section of the book to read. start the recorder and timer and read aloud for 2 minutes. Stop reading, stop the recorder and stop the timer.

Stand up, somewhere you won’t get hurt if you fall. Stand on 1 leg (or if available, stand on a BOSU or rocker board). Open the book to a different spot. Start the timer, the recorder and start reading again for 2 minutes.

Sit back down and grab a snack. Listen to the 2 recordings and pay attention to the way you sound when you were reading, the speed, fluency and flow of words. Now think about recall. Which passage do you remember better?

The brain works best at multitasking and balance and coordination activities intimately affect learning. Having children sit in a class room and remain stationary and listen to a lecture is not the best way to learn. We always tel our students to get up and move around…

This article looks at this relationship in a slightly different way.

The Gait Guys….Sorting it out so you don’t have to.

We hope you are still standing : )

Scand J Med Sci Sports. 2011 Oct;21(5):663-9. doi: 10.1111/j.1600-0838.2009.01027.x. Epub 2010 Mar 11

Motor coordination as predictor of physical activity in childhood.

Lopes VP, Rodrigues LP, Maia JA, Malina RM.

Source

Department of Sports Science, Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Bragança, Portugal. vplopes@ipb.pt

Abstract

This study considers relationships among motor coordination (MC), physical fitness (PF) and physical activity (PA) in children followed longitudinally from 6 to 10 years. It is hypothesized that MC is a significant and primary predictor of PA in children. Subjects were 142 girls and 143 boys. Height, weight and skinfolds; PA (Godin-Shephard questionnaire); MC (Körperkoordination Test für Kinder); and PF (five fitness items) were measured. Hierarchical linear modeling with MC and PF as predictors of PA was used. The retained model indicated that PA at baseline differed significantly between boys (48.3 MET/week) and girls (40.0 MET/week). The interaction of MC and 1 mile run/walk had a positive influence on level of PA. The general trend for a decrease in PA level across years was attenuated or amplified depending on initial level of MC. The estimated rate of decline in PA was negligible for children with higher levels of MC at 6 years, but was augmented by 2.58 and 2.47 units each year, respectively, for children with low and average levels of initial MC. In conclusion MC is an important predictor of PA in children 6-10 years of age.

© 2009 John Wiley & Sons A/S.

Cerebellar impairment = Gait Changes = Happy Patient

This is a fairly info dense post with many links. please take the time to explore each one to get the most out of it. 

If you have been with us here on TGG long enough, you know the importance of the cerebellum and gait. Mechanoreceptor information travels north to the cortex via the dorsal (and ventral) spinocerebellar pathways to be interpreted (and interpolated, in the case of the ventral pathway), with the information relaying back to the motor cortex and vestibular nucleii and eventually back down to the alpha (and gamma) motor neurons that proved the thing you call movement and thus gait. (Cool video on spinocerebellar pathways here and here).

This FREE FULL TEXT paper has some cool charts, like this one, that show the parameters of gait that change with cerebellar dysfunction (in this case, disease, although idiopathic means they really don't know. Anatomical or physiological lesions will behave the same, no? Doesn't the end result of a functional short leg look the same as an anatomical one?)

Looking tat this chart, what do we really see? People with cerebellar dysfunction:

• a shorter step length
• a wider base of gait
• decreased velocity
• increased lateral sway
• slower overall gait cycle

Hmmmm...Beginning to sound like a move toward more primitive gait. Just like we talked about in this post on the 5 factors and proprioception here several years ago. We like to call this decomposition of gait. 

They go on to talk about specific anatomic regions of the cerebellum and potential correlation to specific gait abnormalities, like the intermediate zone and interposed nucleii controlling limb dynamics and rhythmic coordination like hypermetria (overshooting a target), especially when walking in uneven surfaces or when gait is perturbed, like walking into something or changes in surface topography, or the lateral zone of the cerebellum, for voluntary limb control, such as where you place your foot. Definitely gait nerd material.

There aren't any direct tips on rehab, but it would stand to reason that activities that activate the cerebellum and collateral pathways would give you the most clinical gains. Lots of propriosensory exercises like here, here, here and here for a start.

Happy cerebellum = Happy patient

The Gait Guys

Winfried Ilg, Heidrun Golla, Peter Thier, Martin A. Giese; Specific influences of cerebellar dysfunctions on gait. Brain 2007; 130 (3): 786-798. doi: 10.1093/brain/awl376  FREE FULL TEXT

Podcast #115: Brain logging injuries and patterns

We go deep on how injuries get logged deep in the CNS, what to do and how to get around it all.  Join us today !

Show sponsors:
newbalancechicago.com
altrarunning.com

www.thegaitguys.com
That is our website, and it is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

* Podcast Links: 

http://traffic.libsyn.com/thegaitguys/pod_115f.mp3

http://thegaitguys.libsyn.com/podcast-115-brain-logging-injuries-and-patterns

_______________________________________
Show Notes:

Imagining workouts can improve strength
http://globalnews.ca/news/2885514/imagining-a-workout-may-be-almost-as-good-as-the-real-thing/

Your injuries are not forgotten
http://www.medicalnewstoday.com/articles/312665.php

Podcast 103: Effects of Cold on Physiology/Athletes

Using Cold adaptation to your advantage, Walking Rehab “Carries”, Walking and Proprioception.

Show Sponsors:
newbalancechicago.com
Softscience.com

Other Gait Guys stuff

A. Podcast links:

direct download URL: http://traffic.libsyn.com/thegaitguys/pod_103f.mp3

permalink URL: http://thegaitguys.libsyn.com/podcast-103-effects-of-cold-on-physiologyathletes

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:
Cold
Switching on a cold-shock protein may restore lost connections between brain cells & memory function in aging brain.  
http://www.bbc.com/news/health-30812438

-“Connections between brain cells - called synapses - are lost early on in several neurodegenerative conditions, and this exciting study has shown for the first time that switching on a cold-shock protein called RBM3 can prevent these losses.
http://www.pnas.org/content/111/20/7379.abstract

New study in mice in the inaugural issue of Brain Plasticity reports that new brain cell formation is enhanced by running.
http://neurosciencenews.com/neurogenesis-exercise-memory-3165/

Walking changes our mental state, and our mental state changes our walking.  60 sec audio clip.
http://www.scientificamerican.com/podcast/episode/bouncy-gait-improves-mood/

http://www.sciencedaily.com/releases/2015/…/151119122246.htm

Walking. You don’t have to have the pedal to the metal.
"Those who walked an average of seven blocks per day or more had a 36%, 54% and 47% lower risk of CHD, stroke and total CVD, respectively, compared to those who walked up to five blocks per week.”

http://www.sciencedaily.com/releases/2015/…/151119122246.htm
New proprio study:
http://www.nature.com/neuro/journal/v18/n12/abs/nn.4162.html
Piezo2 is the principal mechanotransduction channel for proprioception
Seung-Hyun Woo et al,
Nature Neuroscience 18, 1756–1762 (2015) doi:10.1038/nn.4162Received 14 July 2015 Accepted 13 October 2015 Published online 09 November 2015

Magnesium intake higher than 250 mg/day associated with a 24% increase in leg power & 2.7% increase in muscle mass.
http://onlinelibrary.wiley.com/doi/10.1002/jbmr.2692/full

Dietary Magnesium Is Positively Associated With Skeletal Muscle Power and Indices of Muscle Mass and May Attenuate the Association Between Circulating C-Reactive Protein and Muscle Mass in Women

Ailsa A Welch et al.
http://www.readcube.com/articles/10.1002%2Fjbmr.2692?r3_referer=wol&tracking_action=preview_click&show_checkout=1&purchase_referrer=t.co&purchase_site_license=LICENSE_DENIED

Gray Cook
https://duker2p.wordpress.com/2015/11/16/illuminating-insights-gray-cook-part-1/

Carries, lots of carries
https://www.facebook.com/otpbooks/videos/1004044686323688/

Neuromechanics?  This early in the morning?

It has been a while since we have done a neuromechanics post. While doing some research for one of our PODcasts, We ran across this paper: http://www.ajronline.org/content/184/3/953.full

It’s title?

Midbrain Ataxia: An Introduction to the Mesencephalic Locomotor Region and the Pedunculopontine Nucleus

Yikes! What a mouthful!

What’s the bottom line?

The paper review a condition called “gait ataxia”. In plain English this means “aberrant or unsteady” gait. Things which usually cause gait ataxia originate in an area of the brain called the cerebellum, which coordinates all muscle activity. If you drink to much alcohol, it affects your cerebellum and you have a “wobbly” gait : ).

This paper looks at another area of the brain called the midbrain. It is the top part of the brainstem and contains an important gait integration and initiation center called the “midbrain locomotor nucleus”. The paper looks at 3 different cases and has some cool MRI images to see, along with alot of fancy neurological words and pathways.

Whenever we see gait ataxia, we think of impaired proprioception (look here for a bunch of posts on that, or at this post specifically).

There are many factors to consider when evaluating ataxic (or wobbly) gait, and this just gives us all one more place to look.

The Gait Guys. Making you smarter every day!

Podcast #15: Brain Size, Gait and Evolution to Bipedalism

Here is the link to the podcast:

http://thegaitguys.libsyn.com/webpage

And it is up on iTunes already.

You don’t want to miss this podcast gang ! Whether you are a runner, walker, trainer, scientist, therapist or just a plain old information junkie, this is a podcast you do not want to miss !

___________________________

Payloadz link for our DVD’s and efile downloads: http://store.payloadz.com/results/results.asp?m=80204

1- The Scars of Evolution: Part 0

http://news.nationalgeographic.com/news/2012/10/121026-human-cooking-evolution-raw-food-health-science/

http://thegaitguys.tumblr.com/post/22193730427/the-upright-walking-and-the-stoned-chimpanzee

http://www.scientificamerican.com/article.cfm?id=raw-veggies-are-healthier

2-  Creatine:

 http://www.foxnews.com/health/2012/10/11/creatine-myths-and-facts/

3- Side effects of Nicotine Gum: A risky performance enhancer ?

4- DISCLAIMER:We are not your doctors so anything you hear here should not be taken as medical advice. For that you need to visit YOUR doctors and ask them the questions. We have not examined you, we do not know you, we know very little about your medical status. So, do not hold us responsible for taking our advice when we have just told you not to !  Again, we are NOT your doctors !

6- EMAIL FROM A Blog follower: 

abnewman10 asked you:

Both my big toes planterflex. My right toe has Morton’s toe and elevates when standing in neutral. My left toe elevates and twists inward when standing in neutral - I think I have Rothbarts toe. I have tried two orthotics that drop my big toes and it caused a lot of pain up through my pelvis and back. What are the treatments for Morton’s toe and Rothbart’s toe for the big toe joint - would you use a Morton’s toe joint pad and/or full Morton’s extension? Thank you, Andrea

Neuromechanics Weekly:

Gait Noise

Think of “Gait Noise” as those things which alter the sum total of all neuronal activity acting at a specific locus. Gait noise is all of the aberrant signals that distort the correct and most functionally desirable signal necessary for a clean gait.  Think of noise as the static found between radio stations, that irritating white noise that blurs out the perfect radio station from coming in clearly.  Gait noise is thus anything that impairs a clear sensory and motor signal to and from the central nervous system required for clean uncompensated gait. These definitions will help you understand where we are going with this.

1. Communication: Anything that interferes with, slows down, or reduces the clarity or accuracy of a communication. Thus, superfluous data or words in a message are noise because they detract from its meaning.

2. Quality control: Variability that may be caused by changes in the ambient conditions, faulty machine performance, or uneven quality of the material or human factor inputs.

3. Telecommunications: Random disturbance introduced into a communication signal, caused by circuit components, electromagnetic interference, or weather conditions. Also called line noise.

Gait noise is therefore very undesirable. It could be interpreted as seeing a foot turned out more than normal, more than the other side. Seeing that compensation is a motor impairment and an undesirable motor pattern, but it also sends aberrant sensory information back into the nervous system. Bad information in, bad information out, and a viscous cycle ensues.  Gait noise can occur from a total knee replacement, from a scar, from a sprain, a broken bone, from the numbness of a diabetic neuropathy etc.  These all cause impairment of the sensory-motor-sensory loop.  Gait Noise theoretically could occur anywhere along the neuraxis (spinal cord and brain-brainstem) or even the peripheral nervous system, but it makes most sense to think of it happening where neurons congregate; most likely at synapses, especially at the spinal cord level. The wiring of the nervous system extends to all tissues, so the noise can occur anywhere for almost any reason.

In the words of Dr Ted Carrick, “Is the lesion at the receptor, the effector, the peripheral nerve, the spinal cord, the brainstem, the thalamus, the cerebellum or cerebrum?”  Where is the problem in otherwords ?  Lets explore how this relates to “Gait Noise”.

Today lets look at the receptor. Receptors are the information gatherers of the nervous system. Think of your 5 senses (vision, smell, taste, sound and touch). These are all subserved by receptors. Vision and touch seem to most affect gait and movement. This post will concentrate on touch.

Touch encompasses not only physical touch but also proprioception (see here for review of proprioception and receptors). These receptors: Pacinian corpuscles, Merkel discs, end bulbs of Krause, bare nerve endings, joint mechanoreceptors, muscle spindles and Golgi tendon organs are all included here. These sentinels provide the central nervous system (CNS) with mechanical environmental information, for comparison with that same information (there is much redundancy in the CNS) and other environmental information (balance, vision, hearing, etc), so that you can formulate (consciously or subconsciously) a response.

In short, there are multiple systems converging, in this case, on the peripheral receptor. Remember, receptors can be activated in may ways. A touch receptor could be activated not only by touch, but also by heat, cold, pressure, or even chemical (metabolic or toxic) means. Just like you may be a great tennis player, you could probably play racquet ball, handball, or football, even if you never played before. You may not excel, but you could get by. Receptors are no different; they may be BEST activated by touch, but other means could certainly do the job. This inadvertent activation creates receptor bias, as we like to call it “noise”, and that information is sent to the CNS for processing. If a touch receptor is activated, it is activated, and the CNS  sees it as an activation, whether it is intentional or not. These mixed signals are then processed along with everything else, creating “noise”.  And the noise might not be a desired signal. And these signals can be what initiates a gait change, a compensation, whether it be from information mis-processing or a strategy to cope.

Think of the application to your gait analysis, next time you are seeing something that you think you shouldn’t be seeing.  This is the problem with video gait analysis (as we take a moment to pound the wall on this topic ONE MORE TIME !).  What we see on a video analysis is not necessarily the problem, nor does what you see warrant a correction or a specific shoe. What we are seeing on video is their coping strategy after all of the CNS signals (noise and non-noise) have been processed, it is what they can do with what is available to them and with what makes most sense to the brain.  We have said before, as a classic example, that an over pronating foot might be a necessity to compensate for lack of internal hip rotation because the brain deems that functional pathology as more damaging at the hip than the hyperpronation at the foot.  Who are we to deem that the foot needs an orthotic or a stability shoe because of what we see?  Who are we to think that we can outsmart all the sensory-motor calculations of that persons brain without knowing all of the functional limitations of their body ? Perhaps if we take an hour to assess our client, and then see them for another visit or two, we can then correlate the gait video, our findings and our corrective work and then truly qualify a logical reasoning.  But this is a far more difficult game that this simple gait video or foot plantar pressure digital foot mapping nonsense.

Ivo and Shawn; the voices in your head, helping you sift out the noise.

Exercise Training Increases Mitochondrial Biogenesis in the Brain. A Journal of Applied Physiology topic.

We have included an indirectly related video link today. It will add some spice to a bland topic. This is a video of World Champions Slavik Kryklyvyy and Karina Smirnoff (last years Dancing with the Stars Champion). The video shows complex body motions that they make look simple, particularly at the 2:52 minute mark (right when you think the video is over) where we see the best in the word effortlessly solo demonstrate arguably some of the most difficult body movements, “Cuban/latin motion” of the Cha Cha. Even though the rest of the world embraces dance more than America, it isn’t for everyone. But, when some of America’s best athletes try this stuff and flounder repeatedly in front of America TV audiences despite weeks of practice one must trust the complexity of the motion from foot work to body control. We will see how Green Bay Packers NFL wide receiver Donald Driver will do when he trades in his football cleats for dancing shoes in a few weeks on Dancing with the Stars. There is a reason why top level pro athletes have challenged themselves behind closed doors with this stuff, because it makes them a better athlete. Our point? Master complex motions and simple ones become effortless. Here is a little piece of trivia for you…… name one of the best Latin dancers of all time ? Martial Artist Bruce Lee. Yup, Cha Cha Champion of Hong Kong. Looks like balance, flexibility, coordination, strength and speed of limb movement served him well in both ! We are not trying to pull the wool over your eyes gang, If you watch the first 10 seconds of the video again you can easily see how Slavik’s lightening fast, coordinated fluid moves are very much similar to open martial art moves. You cannot even see his footwork from the inside edges it is so fast. There is a reason we study these complex motions, because everything is simple after this stuff !

Now, onto today’s article discussing complex movements and exercise and their effect on brain function.

Exercise and complex movements put a demand on both the body and the brain. There are numerous articles confirming the positive benefits of continue physical activity through our life, even into our senior years. In fact, many peer reviewed articles confirm that for the elderly one of the best activities with low risk and high benefit is dancing. For the aged, dancing improves and positively challenges joint motion, balance and vestibular issues, cardiovascular health and muscle activity (strength and endurance) to name a few. It is well documented that with demands on the muscular system more mitochondrial production occurs in the muscles.

However, in 2011 in the Journal of Applied Physiology the authors sought to prove or disprove changes in mitochondria in the brain from exercise and activity demands.

In their mouse study (yes, there are human gene correlations with mice studies) where a treadmill to fatigue (8 weeks of treadmill running for 1 hr/d, 6 d/wk at 25m/min and a 5% incline) demand was executed followed up with specimen sacrifice. Twenty-four hours after the last training bout a subgroup of mice were sacrificed and brain (brainstem, cerebellum, cortex, frontal lobe, hippocampus, hypothalamus, and midbrain), and muscle (soleus) tissues were isolated for analysis of mRNA expression of several markers including mitochondrial DNA (mtDNA).

All specimens showed improved Run-to-fatigue (RTF) but the study findings also suggested “that exercise training increases brain mitochondrial biogenesis which may have important implications, not only with regard to fatigue, but also with respect to various central nervous system diseases and age-related dementia that are often characterized by mitochondrial dysfunction.” - Steiner et al.

In the recent issue of Scientific American (link) Feb 29, 2012 the author Stephani Sutherland summarized their article by quoting one of the study’s authors,

“The finding(s) could help scientists understand how exercise staves off age- and disease-related declines in brain function, because neurons naturally lose mito­chondria as we age, Davis explains. Although past research has shown that exercise encourages the growth of new neurons in certain regions, the widespread expansion of the energy supply could underlie the benefits of exercise to more general brain functions such as mood regulation and dementia pre­vention. “The evidence is accumulating rapidly that exercise keeps the brain younger,” Davis says.

* Remember……. the cells in your body, whether in your lungs, your heart or your quadriceps, do not know if you are on a treadmill, in the water, on the dance floor or on the bike. All they know of is the neuro-endocrine/physiological demands that are placed on it by any given activity. This is the premise and value of cross training the body, to expand its challenges and experiences and to reduce repetitive strain type injuries. It is the act of being active that makes the cellular changes, not the activity of choice.

Shawn and Ivo……… keeping up with the research (and keeping it interesting), so you do not have to. We are…… The Gait Guys

_________________

J Appl Physiol. 2011 Aug 4. [Epub ahead of print]

Exercise Training Increases Mitochondrial Biogenesis in the Brain.

Steiner JL, Murphy EA, McClellan JL, Carmichael MD, Davis JM.

Source : University of South Carolina.

Abstract (abstract link)

Increased muscle mitochondria are largely responsible for the increased resistance to fatigue and health benefits ascribed to exercise training. However, very little attention has been given to the likely benefits of increased brain mitochondria in this regard. We examined the effects of exercise training on markers of both brain and muscle mitochondrial biogenesis in relation to endurance capacity assessed by a treadmill run to fatigue (RTF) in mice. Male ICR mice were assigned to exercise (EX) or sedentary (SED) conditions (n=16-19/gr). EX mice performed 8 weeks of treadmill running for 1 hr/d, 6 d/wk at 25m/min and a 5% incline. Twenty-four hours after the last training bout a subgroup of mice (n=9-11/gr) were sacrificed and brain (brainstem, cerebellum, cortex, frontal lobe, hippocampus, hypothalamus, and midbrain), and muscle (soleus) tissues were isolated for analysis of mRNA expression of peroxisome proliferator-activated receptor gamma coactivator-1-alpha (PGC-1α), Silent Information Regulator T1 (SIRT1), citrate synthase (CS), and mitochondrial DNA (mtDNA) using RT-PCR. A different sub-group of EX and SED mice (n=7-8/gr), performed a treadmill RTF test. Exercise training increased PGC-1α, SIRT1 and CS mRNA and mtDNA, in most brain regions in addition to the soleus (P<0.05). Mean treadmill RTF increased from 74.0±9.6 min to 126.5±16.1 min following training (P<0.05). These findings suggest that exercise training increases brain mitochondrial biogenesis which may have important implications, not only with regard to fatigue, but also with respect to various central nervous system diseases and age-related dementia that are often characterized by mitochondrial dysfunction.

Neuromechanics Weekly: Third Installment

FEEL THE PAIN: PART 3

The Pain Pathway

Pain is the emotional response to adequate activation of the nociceptive afferent system.

What?

Pain is an emotional response. We feel (or experience) it in the cingulate gyrus (the gyrus right above the corpus callosum, that thing they cut in “One Flew Over the Cukoo’s Nest, see the 1st picture above). Your pain is different than your patients/clients pain. Like John Travolta said in Swordfish "It’s all about perception…”

Pain is subjective. Men usually have lower tolerance for physical pain than women (We think this has to do with their wiring, as it is all connected for them, and we males have our little boxes we keep everything in (see here if you don’t understand).

We know what “adequate activation” is. Enough stimulus to elicit a response. Like when someone keeps pestering you and finally you let them have it!

The “nociceptive afferent system” is the pain pathway. You remember: the C fibers (or pain fibers) in the periphery get activated (adequately, of course), the impulse travels up the peripheral nerve to the dorsal horn of the spinal cord, synapses in lamina 2-5 (the key here is that it synapses; proprioceptive and other sensory stimuli DO NOT synapse, but travel higher up the chain. The synapse allows modulation of the signal, the subject for the next in this series’s post). The next neuron in the pathway (remember, we are still in the cord, right after the 1st synapse) crosses (or decussates) the cord and travels up the ever famous lateral spinothalamic pathway (see middle picture above). We would think this pathway (from the name) goes an synapses at the thalamus next (THE central relay for ALL sensory stimuli EXCEPT SMELL); in reality only about 27% of the fibers synapse here, and then go to the parietal lobe. to tell you WHERE the pain is.

What about the other 73%? They go to the reticular formation ( a loosely organized group of nuclei in the brainstem) to cause the autonomic concomitants of pain (increased heart rate, increased breathing, nausea, urge to urinate, etc).

So, the next time someone has pain in their knee or foot, or _______, not only will you be able to tell what tissue is causing the pain, but now can trace the pathway north to the brain. Why is this important? Because of the modulation that YOU can influence with your therapy. More on that in  the next neuromechanics.

The Gait Guys. Eliciting a response in your cingulate gyrus. Hopefully, you are storing this in your inferior temporal gyrus (memory area) for future use.

This week for neuromechanics, something a little different. A fun video by Mark Gungor about the differences between male and female brains. Sit back, relax and prepare to laugh!

Of interesting historical note; he describes the differences between the male and female brains perfectly as the contrast to early neuronal theory out forth by Ramon Satiago Cajal: Prior to the 1800’s it was thought the nervous system was continuous (much like the female brain wiring) however he (Ramon) proved it was contiguous (ie. there were synapses).

The Gait Guys….Thinking outside the box, even though we have a special “gait box” in our brains.

Ivo and Shawn

A few minutes in our Brains.

We were over at a book store on the weekend and picked up a book called Incognito written by neuroscientist David Eagleman.

The gist of the book was that the majority of brain activity is largely subconscious. That the brain is continuously processing information and working algorithms to questions and problems that we have inquired about either consciously or subconsciously. A conscious example might be pondering which new computer to buy, factoring in price, model, manufacturer, specs, hard drive size, peripherals desired, etc. Over a period of minutes, hours or days you bounce around the issues until you rationalize a best decision for your needs and wallet. On the other end, a subconscious example might be learning a new motor skill in your gait pattern. For example perhaps, a pathologic pattern is the one being learned. In one case the brain may be subconsciously learning to reduce gluteus medius muscle in an attempt reduce hip joint compression forces and thus hip pain due to a degenerative joint cartilage surface (see Dr. Allen’s recent video, Applied Hip Gait Biomechanics, Sept 15). In this scenario the brain was working out the algorithm to solve for the pain. The brain is continuously subconsciously processing to solve these problems, it is always working in the background, in sleep or in a wakeful state. We have all had these epiphany moments where the solution to a problem comes to you seemingly out of the blue. However, it is not the case. The brain had been at it for some time.

Eagleman describes the conscious brain as a CEO who is handed a final product that has been worked on by hundreds of employees for weeks, those employees being the subconscious brain parts. The CEO is the last to know, they only get to see the end success of hundreds of hours of work by the employees, and they often take full credit because they are the CEO afterall. It is a long process to achieve solutions to complicated problems. Afterall, do you really think Steve Jobs made the iPad all by himself ? Some might.

Where are we going with this ?

Unconscious incompetence: you do not know the right foot has turned out during gait.

Conscious Incompetence : someone has brought it to your attention.

Conscious Competence: you find a reasonable motor pattern to turn the foot in, but you must stay conscious of this pattern for the correction to be maintained.

Unconscious Competence: eventually unknowingly achieving the foot alignment correction. Give the brain the correct information … then give it time and the correct supportive exercise and let the brain figure it out. It will bring that foot inline eventually as long as there are not other impeding factors. The key is making sure that the pattern you teach your client , or that you institute yourself, is not a compensation. That’s the hard part ! You have to know what is right before you know what is wrong. Pick the wrong pattern and you find yourself down a fork in the road that is full of potholes and problems. Don’t guess. See someone who KNOWS. We had a guy fly in to see us yesterday and this was exactly the case. Therapy has been prescribed in-part off of a video gait analysis and incorrect physical evaluation. You can’t guess at this stuff. You gotta study!

Coming directly from our temporal lobes, we are…The Gait Guys

We hope you are standing up while you read this….

A newborn’s brain is only about one-quarter the size of an adult’s. It grows to about 80 percent of adult size by three years of age and 90 percent by age five (see above). This growth is largely due to changes in individual neurons and their connections, or synapses.

The truth is, most of our brain cells are formed at birth, In fact, we actually have MORE neurons BEFORE we are born. It is the formation of synapses, or connections between neurons, that actually accounts for the size change (see 1st picture above). This is largely shaped by experience and interaction with the environment.

Do you think children’s brains are less active than adults? Think again, your 3 year old’s brain is twice as active as yours! It isn’t until later in life that you actually start dialing back on some of those connections and those pathways degenerate or fade away…a process scientists call “pruning”.

How does this apply to gait? Gait depends on proprioception, or body position awareness. Your brain needs to know where your foot is, what it is standing on and so on. Proprioception, as we have discussed in other posts, is subserved by muscle and joint receptors called mechanoreceptors (muscle spindles, golgi tendon organs and type 1-4 joint mechanoreceptors to be exact). This information is fed to 2 main areas of the brain: the cerebral cortex and the cerebellum. These 2 parts of the central nervous system are interconnected on many levels.

The cerebellum is intimately associated with learning. Try this experiment. you will need a tape recorder (guess we are showing our ages, digital recorder), a timer and a moderately difficult book.

Sit down and pick a section of the book to read. start the recorder and timer and read aloud for 2 minutes. Stop reading, stop the recorder and stop the timer.

Stand up, somewhere you won’t get hurt if you fall. Stand on 1 leg (or if available, stand on a BOSU or rocker board). Open the book to a different spot. Start the timer, the recorder and start reading again for 2 minutes.

Sit back down and grab a snack. Listen to the 2 recordings and pay attention to the way you sound when you were reading, the speed, fluency and flow of words. Now think about recall. Which passage do you remember better?

The brain works best at multitasking and balance and coordination activities intimately affect learning. Having children sit in a class room and remain stationary and listen to a lecture is not the best way to learn. We always tel our students to get up and move around…

This article looks at this relationship in a slightly different way.

The Gait Guys….Sorting it out so you don’t have to.

We hope you are still standing : )

 Scand J Med Sci Sports. 2011 Oct;21(5):663-9. doi: 10.1111/j.1600-0838.2009.01027.x. Epub 2010 Mar 11

Motor coordination as predictor of physical activity in childhood.

Lopes VP, Rodrigues LP, Maia JA, Malina RM.

Source

Department of Sports Science, Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Bragança, Portugal. vplopes@ipb.pt

Abstract

This study considers relationships among motor coordination (MC), physical fitness (PF) and physical activity (PA) in children followed longitudinally from 6 to 10 years. It is hypothesized that MC is a significant and primary predictor of PA in children. Subjects were 142 girls and 143 boys. Height, weight and skinfolds; PA (Godin-Shephard questionnaire); MC (Körperkoordination Test für Kinder); and PF (five fitness items) were measured. Hierarchical linear modeling with MC and PF as predictors of PA was used. The retained model indicated that PA at baseline differed significantly between boys (48.3 MET/week) and girls (40.0 MET/week). The interaction of MC and 1 mile run/walk had a positive influence on level of PA. The general trend for a decrease in PA level across years was attenuated or amplified depending on initial level of MC. The estimated rate of decline in PA was negligible for children with higher levels of MC at 6 years, but was augmented by 2.58 and 2.47 units each year, respectively, for children with low and average levels of initial MC. In conclusion MC is an important predictor of PA in children 6-10 years of age.

© 2009 John Wiley & Sons A/S.

The Gait to Happiness (or, What do you mean I walk & run wrong !? )→

Walking and running are a skill, and for the silent majority they are subconscious skills.

Somehow, for some reason, we just assumed and expected that nature would lead us to a proper gait as we moved from the crib, to crawling, to walking and eventually to running. But, with 36+ years combined experience, my partner in crime, Dr. Waerlop and I are certain of one thing, that nature left most of us with the parts to ambulate properly but with no rule book or users manual on how to use the parts correctly or most efficiently. We basically assumed that the neurological developmental windows or landmarks that we achieve from each developmental stage as an infant and young child would be learned on time, correctly, and with proper assimilation with the prior developmental landmarks.

Unfortunately, this is quite often not the case. We see evidence of these gait related neurological developmental delays or premature landmark achievements every day. Even our experienced patients who have been re-learning under our corrective eye for some time find they cannot go to a mall or airport or local cross country meet and not be amazed by the number of truly tortured gaits that are moving amongst us.

Our experienced patients admit they do not know what is wrong with what they have seen, but they most definitely know that what they have seen is not normal or optimal. They express wonder as to why no one addressed their own gait aberrancies sooner. We like to tell them that “no one gave us the Users Manual at a young age.” Truth be told, even if a “users manual” for the body was present, it would have to be pre-assembled and specific for their body type and specific body parts (ie. bowed legs), and then there would be the issue of being able to understand the complexity of such a manual at the necessary young age of required reading, not to mention the adolescent perspective of “Why do i have to pay attention to this manual? I already have enough reading homework, I am moving about just fine, I have no pain, I do not walk in circles and I run fast. Sure I might run funny, but look at everyone else, they do it too !”.

You see the dilemma here. The key word missing from that whole diatribe is the magical word, “Yet”. They are not yet in pain, not yet the slowest person on the field. Their gait patterns are not yet aberrant enough or have not been present long enough to create inflammation at a joint or generate sufficient dysfunction within enough muscles to present conscious problems. But, they are there, brewing beneath the conscious awareness; waiting, lurking.

The problems are there, waiting for that wrong step off the porch when you turn your ankle “for no reason”, when the knee suddenly buckles “for no apparent reason” when you are carrying the grocery bags up the stairs or when your knee suddenly begins aching at mile 5 “for no apparent reason” when on yesterday’s 15 mile run it was just fine. Like in the stealth of night, our body finally reaches that magical pinnacle moment, “I have had enough, I cannot compensate any longer”. It is as if the body is trying to say, “Look buddy, we have been dealing with this problem for months at a subconscious level, trying to figure this out. We have been cheating around your sad pathetic gait patterns long enough. Heck we even tried turning out that right foot. Nothing is helping anymore. We have had a meeting of ‘The Parts’, and we have decided we cannot go on like this any longer. It is time to let you know. We had to hit The Pain Button and bring this to your conscious attention once and for all.”

Almost everyone can walk and run, but few can walk or run correctly and efficiently. Lack of efficiency or essential skill are what lead to pain, compromise of the body parts (joints, muscles, neurology) and complex compensation patterns. The difficulty however is that most of those walking among us, do not know that they are walking or running incorrectly until the “parts” start complaining. And by then, the body has been compensating around the problems for some time. Sometimes months, sometimes years. It is not until enough inflammation or tissue compromise has occurred that pain presents itself, and by then, most of us are far into a well engrained motor compensation pattern. Before we know it, someone is asking us why we are limping unbeknown to us. Before we know it, someone is asking us how long we have been turning out that right foot ?

As we like to say, “the brain will find a way”. What we mean by that is this; the brain has a task and goal at hand, whether that is to climb a tree, walk to the store, cut the lawn or run a marathon. The brain will inventory all the parts and players of the body and get busy with the task in the most efficient manner with the parts available. And if some parts are a bit rusty and degenerated, short or weak etc the body will begin to detour from the “standard protocol” use of the parts and initiate a compensation pattern that uses the parts differently, tap into others to assist, or move the anatomy into another plane to find an alternate strategy to avoid pain or achieve better force, power or efficiency (ie. turning out the foot to better engage the gluteus medius to avoid pain at a degenerative hip or knee). This is a subtle unconscious process that occurs under the veil of conscious awareness, the brain knows that pain is a deterrent to efficiency because pain is inhibitory to muscles and thus renders joints functionally unstable. So, like we said, “the body will find a way”, or better put “the brain will find a way”.

So, what is one to do with this information ?

Well, it is a difficult sales job to convince someone to take their body in for an evaluation of their gait and running, especially if there are no problems apparent or they don’t have any outward signs or symptoms that are obvious to them. But, we do this regularly for our cholesterol levels, we do it twice a year with our automobiles and we do it with our home furnace every so often. Why would it be so strange to do it with how we move ?

We don’t know why someone would not do it. We would rather have something evaluated and drawn to our attention while we can still make a difference rather than wait until the muscles are so tight or weak from compensating that it takes months of physical therapy to fix, or a joint replacement to amend, or God forbid daily pain medications to cope. Regardless, it still remains a rare occasion when a person will come into see us and ask us to just “look under the hood” and kick the tires and make sure things are working right and that they are walking and running properly. Sadly, the case is usually one of, “My knee has been killing me on my long runs for 5 weeks now, but nothing happened, I promise !”. It would be nice if they followed that sentence with, “However, I did sprain my ankle 3 months ago, I have had a hernia repair on that side two years prior, and my parents proudly told me that I barely crawled rather, I walked quite early on in life. Maybe we should talk about these things or at the very least look at my ankle rocker and hip extension ranges of motion because they feel a little off on the right, left internal hip rotation feels limited and I think I am into premature heel rise on the right.”

Heck, lets be honest, I would probably swallow my brain, a split second before I face plant on the floor in an all out neurosuppressive faint.

There is a saying that crops up from time to time in our lectures, one that has some great truth, “You cannot beat the brain.”

_______

Sometimes wonderful things come to us when we have a day off from patients, when we get to enjoy a warm cup of joe while staring out the window at a beautiful sunrise on a spectacular Fall morning. I think I will go for a run now, it is still early so no one will be out to see my right foot turn out as i subconsciously compensate down my leaf covered road. - Dr. Allen

The effect of footwear and sports-surface on dynamic neurological screening (click for link)→

Shoes make the man, or in this case, the athlete. This study shows that shoes (much like skis) allow us to perform faster than our brain is able to compensate ( in other words, we lack the skill) and allow us to sometimes stretch our  abilities, often at the cost of an injury. We must remember that technology must keep pace with the rate of neural learning, not the opposite.

J Sci Med Sport. 2010 Jul;13(4):382-6. Epub 2010 Mar 15.