Podcast 168: Gait Speed, hip extension, and A New Dawn

Podcast 168: Gait Speed, hip extension, and A New Dawn

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Join at the $40 monthly level and get the masterclass each month, bonus material and the detailed monthly content we only share on Patreon.

The Masterclass is a formal LIVE presentation of slides, videos, demos, deep dives on topics you will not hear anywhere but here ! We hit the gait, biomechanics, neurology and orthopedics of all of the gait topics we present. This is not for the weak and timid, this is the deep dive you have been waiting for. Join us while we turn our normal 50 minute presentations into 3.5 hours on a regular basis ! The 40$ Patreon level will give you the Masterclass and also get you the $20, $10, and 5$ Patreon level content. What a deal ! It will not be here forever so lock in now !

Or, you can get less for your money (why would you do that?) and just buy our Monthly $40 Masterclass at our VIMEO on demand page: https://vimeo.com/ondemand/thegaitmasterclass


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_______________________________________________________________________________
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Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
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shawnallen.net

Our website 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 and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

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Dual decline in gait speed and cognition is associated with future dementia: evidence for a phenotype
Age Ageing. 2020 Oct 23;49(6):995-1002. doi: 10.1093/ageing/afaa106.
Manuel Montero-Odasso et. al


Walking in humans: how much brain function is needed?
Kressig RW.
Age Ageing. 2020 Oct 23;49(6):930-931

Correlations Between Hip Extension Range of Motion, Hip Extension Asymmetry, and Compensatory Lumbar Movement in Patients with Nonspecific Chronic Low Back Pain

Med Sci Monit. 2020 Sep 24;26:e925080. doi: 10.12659/MSM.925080
Won-Deuk Kim 1 , DooChul Shin 2

Prolonged sitting and physical inactivity are associated with limited hip extension: A cross-sectional study
Musculoskelet Sci Pract. 2021 Feb;51:102282. doi: 10.1016/j.msksp.2020.102282. Epub 2020 Oct 28. Abderrahmane Boukabache 1 , Stephen J Preece 1 , Nathan Brookes 2

Independent muscle of extensor hallucis capsularis: a cadaveric case report
Surg Radiol Anat. 2020 Oct 13. doi: 10.1007/s00276-020-02592-7. Online ahead of print.
Jeong-Hyun Park , Yu-Jin Choi, Kwang-Rak Park , Digud Kim , Hyung-Wook Kwon , Mijeong Lee, Jaeho Cho

Sensorimotor and gait training improves proprioception, nerve function, and muscular activation in patients with diabetic peripheral neuropathy: a randomized control trial
J Musculoskelet Neuronal Interact. 2020 Jun 1;20(2):234-248.
Irshad Ahmad , Shalini Verma , Majumi M Noohu , Mohd Yakub Shareef , M Ejaz Hussain

Podcast 165: Chronic ankle problems: A long form discussion on functional neurology and biomechanics.

Chronic Ankle Problems: Neurologic effects in functional ankle instability,

Join at the $40 monthly level and get the masterclass each month, bonus material and the detailed monthly content we only share on Patreon.The Masterclass is a formal LIVE presentation of slides, videos, demos, deep dives on topics you will not hear anywhere but here ! We hit the gait, biomechanics, neurology and orthopedics of all of the gait topics we present. This is not for the weak and timid, this is the deep dive you have been waiting for. Join us while we turn our normal 50 minute presentations into 3.5 hours on a regular basis ! The 40$ Patreon level will give you the Masterclass and also get you the $20, $10, and 5$ Patreon level content. What a deal ! It will not be here forever so lock in now !

Or, you can get less for your money (why would you do that?) and just buy our Monthly $40 Masterclass at our VIMEO on demand page: https://vimeo.com/ondemand/thegaitmasterclass


Links to find the podcast:
Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more.
Just Google "the gait guys podcast".
_______________________________________________________________________________
Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website 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 and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:
Apple podcasts:
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Links for todays show

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Podcast 164: Foot placement challenges, vestibular issues & spatial orientation.

Podcast 164:  Foot placement challenges, vestibular issues & spatial orientation.

This podcast is way more interesting than the title !

join us each month on the Masterclass in Gait

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Join at the $40 monthly level and get the masterclass each month, bonus material and the detailed monthly content we only share on Patreon.

The Masterclass is a formal LIVE presentation of slides, videos, demos, deep dives on topics you will not hear anywhere but here ! We hit the gait, biomechanics, neurology and orthopedics of all of the gait topics we present. This is not for the weak and timid, this is the deep dive you have been waiting for. Join us while we turn our normal 50 minute presentations into 3.5 hours on a regular basis ! The 40$ Patreon level will give you the Masterclass and also get you the $20, $10, and 5$ Patreon level content. What a deal ! It will not be here forever so lock in now !

Or, you can get less for your money (why would you do that?) and just buy our Monthly $40 Masterclass at our VIMEO on demand page: https://vimeo.com/ondemand/thegaitmasterclass


Links to find the podcast:
Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more.
Just Google "the gait guys podcast".
_______________________________________________________________________________
Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website 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 and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:
Apple podcasts:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:

https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

https://traffic.libsyn.com/secure/thegaitguys/Pod_164_was_pod_162_May_25_-_81520_6.20_PM.mp3

https://thegaitguys.libsyn.com/foot-placement-challenges-vestibular-issues-spatial-orientation

https://directory.libsyn.com/episode/index/id/15625700

Podcast 163: The hip and foot talk to each other. A research paper.

You cannot miss this mini-podcast. It is an excerpt from our Masterclass program. Come join us monthly on the Masterclass at for the monthly Masterclass installment hour.

https://www.patreon.com/thegaitguys

Formal presentations, slides, videos, demos, deep dives on topics you will not hear anywhere but here ! We hit the gait, biomechanics, neurology and orthopedics of all of the gait topics we present. This is not for the weak and timid, this is the deep dive you have been waiting for. Join us while we turn our normal 50 minute presentations into 3.5 hours on a regular basis ! The 40$ Patreon level will give you 50% off the Masterclass and also get you the $20, $10, and 5$ Patreon level content. What a deal ! It will not be here forever so lock in now !

Or, you can get less for your money (why would you do that?) and just buy our Monthly Masterclass at our VIMEO page: https://vimeo.com/ondemand/thegaitmasterclass


Links to find the podcast:
Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more.
Just Google "the gait guys podcast".
_______________________________________________________________________________
Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website 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 and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:
Apple podcasts:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:

https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

Other locations:

https://traffic.libsyn.com/secure/thegaitguys/163_mini_pod_peronei_-_8120_12.01_PM.mp3

https://thegaitguys.libsyn.com/the-hip-and-foot-talk-to-eachother-really-a-research-paper

https://directory.libsyn.com/episode/index/id/15439292

Today's article link: https://pubmed.ncbi.nlm.nih.gov/32717719/

Podcast 161: Central pattern generators: Why and how movement goes bad

Hello, World!

*The Masterclass in Gait, with the Gait Guys

join us monthly at: https://www.patreon.com/thegaitguys for the monthly Masterclass installment hour. Formal presentations, slides, videos, demos, deep dives on topics you will not hear anywhere but here ! We hit the gait, biomechanics, neurology and orthopedics of all of the gait topics we present. This is not for the weak and timid, this is the deep dive you have been waiting for. Join us while we turn our normal 50 minute presentations into 3.5 hours on a regular basis ! The 40$ Patreon level will give you 50% off the Masterclass and also get you the $20, $10, and 5$ Patreon level content. What a deal ! It will not be here forever so lock in now !

Or, you can get less for your money and just buy our Monthly Masterclass at our VIMEO page: https://vimeo.com/ondemand/thegaitmasterclass

Links to find the podcast:
Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more.
Just Google "the gait guys podcast".
_______________________________________________________________________________
Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website 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 and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:
Apple podcasts:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:
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Links to find today's show:
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https://directory.libsyn.com/episode/index/id/14905823

Lessons in Gait from Autistic Kids

“Additionally, there is the potential for the cerebellum, which receives sensory information and regulates movements, to have a level of dysfunction as well. Viewed collectively, the potential key contributors for gait asymmetry originate in the brain and specifically, the motor-controlling functions of the brain.” 

“While there is still little known regarding gait impairments in children with ASD, our findings illustrate that gait descriptors may provide insight into furthering working knowledge of ASD and may even enable gait-related symptoms to be treatable through therapies and interventions” 

“Alternative hypotheses suggest that children with ASD exhibit dysfunctional segregation of the motor cortex, which may be the key to uncoordinated movements” 

We often say that "gait is a fingerprint". Gait symmetry is often considered a window to neurologic function. We like to think "normal" gait has minimal asymmetries, while pathological gait does not. 

These are two landmark studies of gait in children with autism spectrum disorder. There were significant kinetic and kinematic differences in gait patterns in the 3 cardinal planes (saggital, coronal and transverse)  in ankle, knee and hip mechanics: The "pattern" is that there is no pattern, only changes. If you have a little time, check out this free, full text article here.

What this article says to us is that

• We should be looking more carefully at gait asymmetries realizing that
  • These asymmetries are most likely cortical/cerebellar phenomena implying
• Gait dysfunction equals cortical/cerebellar dysfunction

As clinician's, we should be thinking of altered gait as a window to what is going on north of the feet, knees, hip and pelvis. We remember that the joint and muscle mechanoreceptors feedback to the cerebellum and cortex via the spinocerebellar and dorsal column pathways which feed forward to the lower extremities via the anterior spinous cerebellar pathway as well as cortical spinal, rubrospinal had vestibula spinal pathways. The cortex, particularly the motor portion, has the capacity to alter gait just as abnormal mechanoreception has the capacity to alter cortical and cerebellar function. The two are interrelated and inseparable. Changes over time will altered pathways due to neural plasticity and adaptations will occur.

We need to be prudent and examined people fully and be very careful as to the modalities and exercises that we utilize and prescribed as ultimately they will shape that patients neural architecture.

Eggleston JD, Harry JR, Hickman R, Dufek JS. Analysis of gait symmetry during overground walking in children with autism spectrum disorder. Gait Posture 2017;55:162-166. 

Dufek JS, Eggleston JD, Harry JR, Hickman R. A comparative evaluation of gait between children with autism and typically developing matched controls. Med Sci 2017;5:1.  link to free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635776/

Better gait AFTER rhizotomies?

Nothing surprised me more than reading this paper and finding out that folks that have had rhizotomies, which removes the afferent input from the dorsal horn and sensory information from the reflex loops in the cord, actually had better gait. Of course these children had severe spastic diplegia, which means they have lost descending inhibition from higher center's and most likely had increased flexor tone in the lower extremities. 

image credit: http://realtyconnect.me/spinal-cord-cross-section-tracts/background-information-musculoskeletal-key-within-spinal-cord-cross-section-tracts/

Remember that the fibers entering the dorsal horn not only go to the dorsal columns but also to the spinocerebellar pathways. When someone has spasticity, the feedback loops are skewed and flexor drive coming from the rostral reticular formation generally is increased are often kept in check by the cerebellar and vestibular feedback loops. Perhaps the interruption of this feedback loop and lack of information from type IA and II afferents of the muscle spindles as well as Ib afferents from the globe tendon organs modulated the tone sufficiently to improve gait. This study did a selective dorsal rhizotomy which means only a portion of it was ablated. 

The somatotopic organization  of the dorsal horn of the spinal cord (i.e.: certain areas of the dorsal horn correspond to certain body parts) is well documented in humans; It would make sense that the dorsal root itself (i.e.: the afferent fibers in the nerve going into the dorsal horn) would be as well, as they are that way in murines (2) and felines (3). 

So, how does this apply to gait? People with strokes, cortical lesions, diseases like cerebral palsy and even possibly increased flexor tone, may benefit from altered input into the dorsal horn. It would have been really cool to see if they increased extensor activity in this individuals, if they would be benefited further. 

Abstract

OBJECTIVE: To identify factors associated with long-term improvement in gait in children after selective dorsal rhizotomy (SDR).

DESIGN: Retrospective cohort study SETTING: University medical center PARTICIPANTS: 36 children (age 4-13y) with spastic diplegia (gross motor classification system level I (n=14), II (n=15) and III (n=7) were included retrospectively from the database of our hospital. Children underwent selective dorsal rhizotomy (SDR) between January 1999 and May 2011. Patients were included if they received clinical gait analysis before and five years post-SDR, age >4 years at time of SDR and if brain MRI-scan was available.

INTERVENTION: Selective dorsal rhizotomy MAIN OUTCOME MEASURES: Overall gait quality was assessed with Edinburgh visual gait score (EVGS), before and five years after SDR. In addition, knee and ankle angles at initial contact and midstance were evaluated. To identify predictors for gait improvement, several factors were evaluated including: functional mobility level (GMFCS), presence of white matter abnormalities on brain-MRI, and selective motor control during gait (synergy analysis).

RESULTS: Overall gait quality improved after SDR, with a large variation between patients. Multiple linear regression analysis revealed that worse score on EVGS and better GMFCS were independently related to gait improvement. Gait improved more in children with GMFCS I & II compared to III. No differences were observed between children with or without white matter abnormalities on brain MRI. Selective motor control during gait was predictive for improvement of knee angle at initial contact and midstance, but not for EVGS.

CONCLUSION: Functional mobility level and baseline gait quality are both important factors to predict gait outcomes after SDR. If candidates are well selected, SDR can be a successful intervention to improve gait both in children with brain MRI abnormalities as well as other causes of spastic diplegia.

1. Oudenhoven LM, van der Krogt MM, Romei M, van Schie PEM, van de Pol LA, van Ouwerkerk WJR, Harlaar Prof J, Buizer AI. Factors associated with long-term improvement of gait after selective dorsal rhizotomy. Arch Phys Med Rehabil. 2018 Jul 4. pii: S0003-9993(18)30442-8. doi: 10.1016/j.apmr.2018.06.016. [Epub ahead of print]

2. Wessels WJ1, Marani E. A rostrocaudal somatotopic organization in the brachial dorsal root ganglia of neonatal rats. Clin Neurol Neurosurg. 1993;95 Suppl:S3-11.

3. Koerber HR, Brown PB. Somatotopic organization of hindlimb cutaneous nerve projections to cat dorsal horn. J Neurophysiol. 1982 Aug;48(2):481-9.

The Power of Facilitation: How to supercharge your run.

While running intervalsone morning, something dawned on me. My left knee was hurting from some patellar tracking issues, but only on initial contact and toe off. I generally run with a midfoot strike. I began concentrating on my feet, lifted and spread my toes and voila! my knee pain instantly improved. Very cool, and that is why I am writing this today. 

Without getting bogged down in the mire of quad/hamstring facilitation patterns, lets look at what happened.

I contracted the long extensors of the toes: the extensor digitorum longus and the extensor hallicus longus; the short extensors of my toes: the extensor digitorum brevis, the extensor hallucis brevis: as well as the dorsal interossei.the peroneus longus, brevis and tertius were probably involved as well.

Do you note a central theme here? They are all extensors. So what, you say. Hmmm… 

Lets think about this from a neurological perspective:

In the nervous system, we have 2 principles called convergence and divergence. Convergence is when many neurons synapse on one (or a group of fewer) neuron(s). It takes information and “simplifies” it, making information processing easier or more streamlined. Divergence is the opposite, where one(or a few) neurons synapse on a larger group. It takes information and makes it more complicated, or offers it more options.

In the spinal cord, motor neurons are arranged in sections or “pools” as we like to call them in the gray matter of the cord. These pools receive afferent information  and perform segmental processing (all the info coming in at that spinal cord segment) before the information travels up to higher centers (like the cerebellum and cortex). One of these pools fires the extensor muscles and another fires the flexor muscles.. 

If someone in the movie theater keeps kicking the back of our seat, after a while, you will say (or do) something to try and get them to stop. You have reached the threshold of your patience. Neurons also have a threshold for firing.  If they don’t reach threshold, they don’t fire; to them it is black and white. Stimuli applied to the neuron either takes them closer to or farther from threshold.  When a stimulus takes them closer to firing, we say they are “facilitating” the neuron. If it affects a “pool” of neurons, then that neuronal pool is facilitated. If that pool of neurons happens to fire extensor muscles, then that “extensor pool” is facilitated.

When I consciously fired my extensor muscles, two things happened: 1. Through divergence, I sent information from my brain (fewer neurons in the cortico spinal pathway) to the motor neuron pools of my extensor muscles (larger groups of motor neurons) facilitating them and bringing them closer to threshold for firing and 2. When my extensor muscles fired, they sent that information (via muscle spindles, golgi tendon organs, joint mechnoreceptors, etc) back to my cerebellum, brain stem and cortex (convergence) to monitor and modulate the response.

When I fired my extensor muscles, I facilitated ALL the neuronal pools of ALL the extensors of the foot and lower kinetic chain. This was enough to create balance between my flexors and extensors and normalize my knee mechanics.

If you have followed us for any amount of time, you know that it is often “all about the extensors” and this post exemplifies that fact.

 Next time you are running, have a consciousness of your extensors. Think about lifting and spreading our toes, or consciously not clenching them. Attempt to dorsiflex your ankles and engage your glutes. It just may make your knees feel better!

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.

We hope you are still standing : )

 Lopes VP, Rodrigues LP, Maia JA, Malina RM.Motor coordination as predictor of physical activity in childhood. Scand J Med Sci Sports. 2011 Oct;21(5):663-9. doi: 10.1111/j.1600-0838.2009.01027.x. Epub 2010 Mar 11

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.

What’s wrong with this picture? (Besides the fact that you probably shouldn’t run with your dog on asphalt) 

There’s been a lot of incongruency in the media as of late. This particular gal, with your head rotation to the right is going against the harmony of neurology and physiology. Let me explain…

 This particular gal, with her rotated to the right is going against the way the nervous system is designed to work.

In a post  in the last week or so (the massage cream one and  incongruent movement) we talked about tonic neck responses. When the head is rotated to one side, that upper and lower extremity should extend while the contralateral side should flex. This poor gal is fighting her own neurology! 

 Also note that she really doesn’t have that much hip extension on the right and increases her lumbar lordosis to compensate. Gee whizz. You’d a thought they would have done better…

 So much for the photo op : -) 

Rock your clinical exam!

What sensation is probably the most important to test and why?

Manipulation and Mechanoreceptors

Do YOU do joint manipulations or mobilizations? Could you explain how they are working and accomplishing what you think (or say) they are accomplishing?

All of this information applies to ANY articulation, not just the spine. This is essential information that all folks performing manipulations or mobilizations should know.

What ARE the different types of mechanoreceptors and how do they work? How does that relate to manipulation and its effects? How can mechanoreceptors inhibit pain and influence muscle tone? Dr Ivo answers these questions and more in this video, excerpted from a recent seminar. 

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/

Welcome to Monday and News You Can Use. Got Arm swing? This exercise, borrowed from Shirley Saurmann can be a great adjunct to your rehab program, dispensed with some muscle physiology : )

Do it on your self
Try it on a client
Teach someone else

More on Stretching? Enough already, eh?

The last few weeks , we have been talking about techniques to improve your (or your clients) stretching experience. 1st, we talked about reciprocal inhibition here. Next we talked about post isometric inhibition here. The we spoke about the symmetrical tonic neck reflex (response) here. If there is a symmetrical tonic neck reflex, then there must be an asymmetrical one as well, eh? That is the topic of todays discussion. 

The asymmetrical tonic neck reflex was 1st described by Magnus and de Kleyn in 1912 (1). Like in the pictures above, when the head is rotated to one side, there is ipsilateral extension of the upper and lower extremity on that side, and flexion of the contralateral (the side AWAY from where you are rotating) upper and lower extremity. Take a few minutes to see the subtleness of the reflex in the pictures above. Now think about how this occurs in your clients/patients.  The reflex is everywhere!

The reflex persists into adulthood (2) and is modulated by both eye movement and muscular activity (3). When there is neurological compromise, the reflex can be more prevalent, and it seems to arise from the joint mechanoreceptors in the neck and its connection to the reticular formation of the brainstem (4). It may modulate blood flow and cardiovascular activity as well (5). 

So, how can we take advantage of this? We could follow in the footsteps of Berta Bobath (6) and incorporate these into our rehabilitation programs, which we have done, quite successfully. But rather than read a whole book, lets talk about how you could incorporate this into your stretching program. 

Let’s say you want to stretch the right hamstring:

• actively rotating the head to the right (see reference 3) facilitates the right tricep and right quadricep AND facilitates the left bicep and left hamstring
• through reciprocal inhibition, this would inhibit the right bicep and hamstring AND left tricep and left quadricep
• To get a little more out of the stretch, you could actively contract the right tricep and quadricep (MORE reciprocal inhibition), amplifying the effect

We encourage you to try this, both on yourself and your clients. It really works!

Wow, isn’t neurology cool? And you thought it was only for geeks!

The Gait Guys. Giving you info you can use in a practical manner, each and every post. Be a geek. Spread the word. 

1. http://www.worldneurologyonline.com/article/arthur-simons-tonic-neck-reflexes-hemiplegic-persons/#sthash.6QS3Eat3.dpuf 

2. Bruijn SM¹, Massaad F, Maclellan MJ, Van Gestel L, Ivanenko YP, Duysens J. Are effects of the symmetric and asymmetric tonic neck reflexes still visible in healthy adults?Neurosci Lett. 2013 Nov 27;556:89-92. doi: 10.1016/j.neulet.2013.10.028. Epub 2013 Oct

3. Le Pellec A¹, Maton B. Influence of tonic neck reflexes on the upper limb stretch reflex in man. J Electromyogr Kinesiol. 1996 Jun;6(2):73-82.

4. Michael D. Ellis, Justin Drogos, Carolina Carmona, Thierry Keller, Julius P. A. Dewal Neck rotation modulates flexion synergy torques, indicating an ipsilateral reticulospinal source for impairment in stroke Journal of NeurophysiologyDec 2012,108(11)3096-3104;DOI: 10.1152/jn.01030.2011

5. Hervé Normand, Olivier Etard and Pierre Denise Otolithic and tonic neck receptors control of limb blood flow in humans J Appl Physiol  82:1734-1738, 1997.

6. Berta Bobath, Chartered Society of Physiotherapy (Great Britain)  Abnormal postural reflex activity caused by brain lesions Aspen Systems Corp. Rockville, MD, 1985 -

More Tricks for stretching, part 3

We have been talking about ways to enhance stretching, talking about taking avvantage of reciprocal inhibition (please see part 1 here) and autogenic  (or post isometric) inhibition (please see part 2 here). 

Before we talk about this next one, we need to give you a little background (neurologically speaking). 

Take a look at the picture above and note the posturing of the baby in the 2 positions. These neurological reflexes (or postures) are called symmetrical tonic neck reflexes or responses (STNR’s for short) and were described in animals and men by Magnus and de Kleyn in 1912 (1). This work was later studied and reported by by Arthur Simons in 1916  (2) and later by Francis Walshe in 1923 (3). These were later made popular by Berta and Karl Bobath in the 70’s (who studied Walshes work), whom they are often attributed to (4). 

You next question is “Do these persist into healthy adulthood”? and the answer is a resounding YES (5).

Take a look at the picture above again and note the following: 

• When the neck is flexed, the fore limbs flex (and the muscles facilitating that, bicep, brachialis, anterior deltoid are contracting) and the hind limbs are extending (relatively), with the glutes maximus, quadriceps, foot dorsiflexors contracting.

• Note that when the head is extended, the forelimbs are extended and the hind limbs flexed. Think about the muscles involved. Upper extremity tricep, anconeus, posterior deltoid, lower back extensors, hamstrings and foot plantar flexors facilitated.

The reflex is based on the mechanoreceptors in the neck articulations and muscles and are frequently used by us and many others in the rehabilitation field. Generally speaking, looking up facilitates things which make you extend above T12, and flex below T12. Looking down facilitates flexion above T12 and extension below. 

We would encourage you at this point to “assume” these positions and feel the muscles which are active and at rest.

So, how can we take advantage of these while stretching? 

Think about your head position:

•  If you are standing up and hinging at the hips to stretch your hamstrings (notice we did not say “bent at the waist”; there is a BIG difference in shear forces applied to your lumbar spine) you would probably want your neck bent forward, as this would fire your quads which would in turn ALSO inhibit your hamstrings, in addition to the STNR inhibiting the hamstring. 

• If you were in a hip flexor stretch position, you would want you head up, looking at the ceiling to take advantage of the reflex. 

We are confident you can think of many more applications of this reflex and trust that you will, as it can apply to both upper and lower extremity stretches. Just remember that this reflex is symmetrical and will affect BOTH sides. Of course, there are reflexes that only effect things unilaterally, but that is the subject of another post. 

The Gait Guys. Helping make you better at what you do for yourself and others and assisting you on using the neurology that God gave you. 

1. http://www.worldneurologyonline.com/article/arthur-simons-tonic-neck-reflexes-hemiplegic-persons/#sthash.6QS3Eat3.dpuf 
2. Simons A (1923) Kopfhaltung and Muskeltonus. Ges.Z. Neurol.Psychiatr. 80: 499-549.
3. Walshe FMR (1923) On certain or postural reflexes in hemiplegia, with special reference to the so-called “associated movements.” Brain 46: 1-37. 
4. Janet M. Howle . Symmetrical Tonic Neck Reflex in Neuro-developmental Treatment Approach: Theoretical Foundations and Principles of Clinical Practice.   NeuroDevelopmental Treatment, 2002  p 341 ISBN 0972461507, 9780972461504
5. Bruijn SM¹, Massaad F, Maclellan MJ, Van Gestel L, Ivanenko YP, Duysens J. Are effects of the symmetric and asymmetric tonic neck reflexes still visible in healthy adults?Neurosci Lett. 2013 Nov 27;556:89-92. doi: 10.1016/j.neulet.2013.10.028. Epub 2013 Oct 21.

Making your stretching more effective. 

While I was making linguine and clam sauce for my family, one of my favorite foods that I haven’t had in quite some time( and listening to Dream Theater of course) I was thinking about this post.  Then I remembered about voice recognition on my iMac.  Talk about multitasking!

What do you agree that stretching is good or not, you or your client still may decide to do so possibly because of the “feel good” component. Make sure to see this post here on “feel good”  part from a few weeks ago. 

If you do decide to stretch, make sure you take advantage of you or your clients neurology.  There are many ways to do this. One way we will discuss today is taking advantage of what we call myotatic reflex.

The myotatic reflex is a simple reflex arc. The reflex begins at the receptor in the muscle (blue neuron above) : the muscle spindles (nuclear bag or nuclear chain fibers). This sensory (afferent) information then travels up the peripheral nerve to the dorsal horn of the spinal cord where it enters and synapses in the ventral horn on an alpha motor neuron.  The motor neuron (efferent) leaves the ventral horn and travels back down the peripheral nerve to the contractile portion of the myfibrils (muscle fiber) from which the the sensory (afferent) signal came (red neuron above).  This causes the muscle to contract. Think of a simple reflex when somebody taps a reflex hammer on your tendon. This causes the muscle to contract and your limb moves.

Nuclear bag and nuclear chain fibers detect length or stretch in a the muscle whereas Golgi Tendon organs tension. We have discussed this in other posts here.   With this in mind, slow stretch of a muscle causes it to contract more, through the muscle spindle mechanism.

Another reflex that we should be familiar with is called reciprocal inhibition. It states simply that when one muscle (the agonist) contracts it’s antagonist is inhibited (green neuron above).  You can find more on reciprocal inhibition here.

Take advantage of both of these reflexes?   Try this:

• do a calf stretch like this: put your foot in dorsiflexion, foot resting on the side of the doorframe.
• Keep your leg straight.
• Grab the the door frame with your arms and slowly draw your stomach toward the door frame. 
• Feel the stretch in your calf; this is a slow stretch. Can you feel the increased tension in your calf? You could fatigue this reflex if you stretched long enough. If you did, then the muscle would be difficult to activate. This is one of the reasons stretching seems to inhibit performance. 
• Now for an added stretch, dorsiflex your toes and try to bring your foot upward.  Did you notice how you can get more stretch your calf and increased length? This is reciprocal inhibition at work!

There you have it, one neurological tool of many to give you increased length.The next time you are statically stretching, take  advantage of these reflexes to make it more effective.

 The Gait Guys. Teaching you more  about anatomy, physiology, and neurology with each and every post. 

image from :www.positivehealth.com

Why does it feel so good to stretch? 

We are sure you have read many articles, some written by us, about the good the bad and the ugly about stretching.  Regardless of how you slice the cake, we think we can all agree that stretching “feels” good. The question of course is “Why?”

Like it or not, it all boils down to neurology. Our good old friends, the Ia afferents are at least partially responsible, along with the tactile receptors, like Pacinian corpuscles, Merkel’s discs, Golgi tendon organs, probably all the joint mechanoreceptors and well as a few free nerve endings. We have some reviews we have written of these found here, and here and here.

What do all of these have in common? Besides being peripheral receptors. They all pass through the thalamus at some point (all sensation EXCEPT smell, pass through the thalamus) and the information all ends up somewhere in the cortex (parietal lobe to tell you where you are stretching, frontal lobe to help you to move things, insular lobe to tell you if it feels good, maybe the temporal lobe so you remember it, and hear all those great pops and noises and possibly the occipital lobe, so you can see what you are stretching.

The basic (VERY basic) pathways are:Peripheral receptor-peripheral nerve-spinal cord-brainstem-thalamus-cortex; we will call this the “conscious” pathway:  and peripheral receptor-peripheral nerve-spinal cord-brainstem-cerebellum- cortex; we will call this the “unconscious” pathway.

Of course, the two BASIC pathways cross paths and communicate with one another, so not only can you “feel” the stretch with the conscious pathway but also know “how much” you are stretching through the unconscious pathway. The emotional component is related through the insular lobe (with relays from the conscious and unconscious pathways along with collaterals from the temporal lobe to compare it with past stretching experiences) to the cingulate gyrus and limbic cortex,  where stretching is “truly appreciated”. 

As we can see, there is an interplay between the different pathways and having “all systems go” for us to truly appreciate stretching from all perspectives; dysfunction in one system (due to a problem, compensation, injury, etc) can ruin the “stretching experience”. 

Hopefully we have stretched your appreciation (and knowledge base) to understand more about the kinesthetic aspect of stretching. We are not telling you to stretch, or not to stretch, merely offering a reason as to why we seem to like it.

The Gait Guys

Proprioception trumps Biomechanics

As I sit here on a rare Friday afternoon, not working (OK, I am writing this, so sort of working) and looking out at the lake (picture above), while on a family camping trip, I think about a walk on the rocks this morning with my kids. I was watching my very skilled 7 year old jump from rock to rock while my 3 ½ year old, that thinks he is seven, tried to follow his older brother.

I had my foot on a rock which lowered the front of my foot in plantar flexion and stood on that leg. I noticed that my balance was not as great as it was when my foot was in dorsiflexion. This made me think about pronation and supination. Yes, it is not uncommon for me to think about such things, especially when I have some spare time. That is one of the things about being a foot and gait nerd; these sorts of things are always on our minds.

So, why was my balance off? Did I need more proprioceptive work? Were my foot intrinsics having issues? No, it was something much more mundane.

Pronation consists of dorsiflexion, eversion and abduction. This places the foot in a  “mobile adaptor” posture, reminiscent of our hunter/gatherer ancestors, who needed to adapt to uneven surfaces while walking over terra firma barefoot. Supination, on the other hand (which is the position my foot was in), consists of plantarflexion, inversion and adduction. It places the foot (particularly the midtarsals) in a locked position for propulsion (think of the foot position during toe off).

So why when my foot was plantar flexed and adducted while standing on this rock so much more unstable in this supposedly more stable, supinated position? I would encourage you, at this point, to try this so you can see what I mean. When I placed my foot in dorsiflexion on the rock, I was much more stable. A most interesting conundrum for a biomechanist.

Experimenting for a few minutes, alternating plantar flexion and dorsi flexion, gave me the answer. When we are walking on the flats, our foot is (usually) not pushed to the extremes of dorsiflexion; with the front of the foot up on a rock, it is much more so. This “extra” upward force on the front of the foot, provides much more sensory input (and thus proprioception) from the ball of the feet. Take a look at the sensory homunculus and you can see how much brain real estate is dedicated to your foot, especially the front portion. With this information, we are able to apply more  force through the posterior compartment of the leg,which is stronger than my anterior compartment (as it is with most folks).

When the front of your foot is in plantar flexion (ie, your heel is on the rock), we have less sensory input to the balls of the feet, and rely more on the anterior compartment (weaker in many folks, including myself) to counterbalance the weight of our body.

Mystery solved: proprioception trumps biomechanics; more proof that the brain is smarter than we are.

The Gait Guys. Solving the worlds great gait questions, one at a time.

Heads up!

Remember that song “Hold Your Head Up” by the British  band “Argent” in 1972? Ok, maybe not, but the principle is very important to runners and sprinters, so lets talk about it a bit. 

We are wired to maintain our visual axes parallel to the horizon. This involves a series of joint and muscle mechanoreceptors in the neck (for a review of joint mechanoreceptors, click here, muscle mechanoreceptors, click here). These muscle and joint mecanoreceptors receptors, through connections in the midbrain (or mesencephalon as we neuro geeks like to call it) and pons, interact with the vestibular system to keep our head (and our bodies) upright, by firing our extensor muscles.

Berta Bobath, physiotherapist, wrote a great book in 1965 entitled “Abnormal Postural Reflex Activity Caused By Brain Lesions”. In it she describes, among many things, reflexes involving the cervical spine and correlating them to motor function. One of these is the cervical extensor reflex.

To explain this reflex, think of a dog sitting to get a treat. As he looks up while sitting down he has to extend his head, extend his front legs and fires all the axial extensor muscles associated with performing this action. The opposite would also happen, but with the flexors, if he were to bend forward to take a drink; fire front flexors and rear extensors to bend down. There are many more reflexes (tonic neck, cervcio ocular, etc) that could be the subject of another post.

As we have learned from the principle of facilitation (see recent post here), when we fire pur extensors, we fire into the extensor pool, and as a result, ALL extensors get to benefit. The advantage of the receptors in the cervial spine is that the upper four fire DIRECTLY into the flocculo nodular lobe of the cerebellum, and thus have a PROFOUND EFFECT on extensor tone in general.

So, if you want to go faster, why not hold your head up and FIRE YOUR EXTENSORS MORE? Hmmm….Where have you heard this before?

Another magic bullet, courtesy of your built in neurology, we are sharing with you so you and your clients, patients and friends can be better at what they do

The Gait Guys. Stretching your neurology on a daily basis.