Fatigue matters. Why a quick treadmill analysis of someone's gait will lie to you.

This is why i think gait analysis, on a treadmill with all the sensors, the visual captures , there are so many lies and fake outs.

Driving to work today and I saw this 40 something lady running. It just might have been the most tortured running i have seen in ages. It made me wonder, when we see our clients at the office and we ask them to run, they are typically in a fresh state, they're going to give us their best running, they are naturally going to put out their best for us, even if we ask them to "just run".

The truth is, they haven't been out there for 10-15 miles slogging it out in the heat and the pain and in the dysfunction. They haven't been out in the elements slowly fatiguing stabilizers, slowly layering neuro-protective tightness and strategies to offset the fatiguing structures. Even if that lady came in to see me tomorrow, i am not going to see what i saw in here on the side of the road. The clues i might see will be the muscular inhibition, the neuro-protective tightness, the compensations, the things on the hands on examination. This is why gait analysis has to have a hands on examination. And if i put her through a screening method, i am going to see her strategies in the screen to get around all that i mentioned above.

This is why i think gait analysis, on a treadmill with all the sensors, the visual captures , there are so many lies and fake outs. That process has significant limitations. Do not get me wrong, everything has value, but do we know what that value is, and what the lies are?

I think my question for my clients needs to be, be honest with me how ugly does your run get in the later miles when you're in pain? But then again, that is an impossible question isn't it !? Self awareness has its limitations. After all, we are human.

When asked to run at my doctors office, i am still gonna put on my best run for them. I will hide my flaws, my weaknesses, my tightness, my soreness, and give them the best run i have. The game is on them. Lets see how good they are.

Good luck today comrades, see what you can find and solve in all those who come begging for help, yet doing their best to hide their worst.

And then there is # 245....

Look at the position of his knee with respect to his foot. Both are pointing outward into external rotation. They are in the same plane so a torsion is unlikely, but he is probably trying to gain some stability as his center of gravity moves across his body.

Now look at his pelvis and see how it is tilted (or dropped) down on the left. We would definitely want to check his right gluteus medius and his left quadratus lumborum.

And what about that arm swing? Is he creating more space on the left (ie abducting his left arm) from his body lean to the right? More than likely, this is to make up for his hip muscle problem. we say this because his head tilt is to the left. Remember that your body will always try to make your visual fields parallel with the ground, so as his body goes to the right, his head will go to the left. There must be a great deal of body rotation going on, as his entire jersey has moved to his right!

Whoa # 2

And what about # 260?

Things are certainly different for this chap compared to # 172. His take off from his right foot looks pretty good. His left foot looks like it is going to cross over with some medial knee fall as it descends to hit the ground. Just before it hits the ground, it should be supinated in some degree of dorsiflexion (he is sprinting, so we expect some plantar flexion because he is sprinting), inversion and adduction. His pelvis is nice and level. His arm swing looks pretty good with only a slight cross over on the right as it is coming through. With form this good, no wonder he is out front!

Whoa!

Whoa! What's wrong with #172?

 Where do we start? Look at all of that tibial and genu varum! Notice how his knee is outside the sagittal plane? This means that he also has internal tibial torsionand he is rotating his foot out to create the requisite 4-6° internal rotation needed to move forward. It also looks like he has limited internal rotation of the thighby the positioning of his body.  This could be due to femoral retroversion as this commonly occurs with internal tibial torsion. Check out the interesting hand posturing bilaterally. Notice the extended thumb and wrist on the left? He may be trying to fire into his extensor pool to help gain more hip extension.  I sure wish we had a Sideview. Thankfully his pelvis is relatively level, isn't it? No, it actually isn't. That's just his shirt. Look closely at the tops of the iliac crests and you will see what I am talking about. Did you catch the slight head tiltto the right? With that much tibial and genu varum his center of gravity is moving to the left and he needs to tilt his head to the right to equalize things out.  What about the posterior rotation of the left shoulder? Again probably this is due to a lack of or failure to use internal rotation of the left hip.

Lots to talk about on this picture and we will do some more next time.