What a difference a few months makes

Take a look at the pre-and post videos of this gal with a forefoot supinatus and impaired motor control of her feet and core. Shuffle walks, foot intrinsic exercises, core work and gait retraining can go a long way! The important thing to remember here is that the patient was very motivated and did what was required to make things happen. A testament to tenacity and dedication

Dr Ivo Waerlop, one of The Gait Guys

#beforeandafter #gaitretraining #gaitanalysis #forefootsupinatus

Is there a need for "Gait Retraining'?...We think so

photo source: https://commons.wikimedia.org/wiki/File:Severe_(Tönnis_grade_3)_osteoarthritis_of_the_hip.jpg

There seems to be some controversy with regards to gait retraining. Some folks seem to believe that it should be “left to itself” and they are fully compensated already (1). Perhaps this is true…or not. We have not seen any studies that compare gait retraining vs non gait retraining as a whole, but there seems to be plenty for specific conditions (2). We all see folks AFTER THE FACT and seek to correct the problems and reverse, halt or slow the progression of further pathology. That seems to be what many of us do.

This recent study (3) looks ate altered loads and muscle recruitment patterns in patients with osteoarthritis. they conclude:

“This study documents alterations in hip kinematics and kinetics resulting in decreased hip loading in patients with hip OA. The results suggested that patients altered their gait to increase medio-lateral stability, thereby decreasing demand on the hip abductors. These findings support discharge of abductor muscles that may bear clinical relevance of tailored rehabilitation targeting hip abductor muscles strengthening and gait retraining.”

There is substantial evidence that hip pathomechanics lead to osteoarthritis (4, 5). Wouldn’t it make sense to assist in altering motor patterns and correct those biomechanical faults before it becomes a problem? Lets change our focus (if we haven’t already) and concentrate on skill, endurance and strength, in that order for the betterment of ourselves, our patients and humanity.

1. Nigg BM, Baltich J, Hoerzer S, Enders H. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: “preferred movement path” and “comfort filter” Br J Sports Med. 2015 Jul; doi: 10.1136/bjsports-2015-095054. bjsports - 2015-095054. 

2. Davis IS, Futrell E. Gait Retraining: Altering the Fingerprint of Gait. Physical medicine and rehabilitation clinics of North America. 2016;27(1):339-355. doi:10.1016/j.pmr.2015.09.002. FREE FULL TEXT

3. Meyer CAG, Wesseling M, Corten K, Nieuwenhuys A, Monari D5, Simon JP, Jonkers I, Desloovere K. Hip movement pathomechanics of patients with hip osteoarthritis aim at reducing hip joint loading on the osteoarthritic side. Gait Posture. 2018 Jan;59:11-17. doi: 10.1016/j.gaitpost.2017.09.020. Epub 2017 Sep 22.

4. Christian Egloff, Thomas Hügle, Victor Valderrabano: Biomechanics and pathomechanisms of osteoarthritis Swiss Med Wkly. 2012;142:w13583 FREE FULL TEXT

5. https://www.the-rheumatologist.org/article/get-out-of-your-oa-box/?singlepage=1&theme=print-friendly

Where do you do YOUR gait retraining?

It may seem like we are stating the obvious, but visual contrast seems to matter more than visual acuity. When we look at light contrast in lower frequencies (red ranges), we start to see some decomposition of gait with regards to step length, but not necessarily cadence or speed in this study of over 4,000 folks over 50 (hey, that’s us!). What are your patients wearing on their feet? What color is your floor? How about the walls?

Do your gait retraining in a well lit area with lots of contrast between the floor and your patients shoes, as well as the surroundings.

Duggan E, Donoghue O, Kenny RA, Cronin H, Loughman J, Finucane C. Time to Refocus Assessment of Vision in Older Adults? Contrast Sensitivity but Not Visual Acuity Is Associated With Gait in Older Adults. J Gerontol A Biol Sci Med Sci. 2017 Feb 28. doi: 10.1093/gerona/glx021. [Epub ahead of print]

Does gait (re)training alter peoples biomechanics? 

You bet it does! Should we be retraining peoples gait? We like to think, yes. What do you think?

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

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

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

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

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