August 13, 2018

How about that arm swing?

August 13, 2018/ The Gait Guys

Do you ever notice that sometimes when people have a problem with one of their lower extremities, there are arm swing changes? Usually on the opposite side? This can be anything from a short leg to lack of ankle dorsiflexion, lack of hip extension or even over pronation.

Many times, gait changes, including arm swing, are an "above down" process. This means it begins in the cortex, affects the pattern generators which subsequently will affect extremities distal to that. Sometimes this is a metabolic problem, sometimes vestibular (which can also be mechanical, causing decreased joint and muscle mechanoreceptor input to the cerebellum and vestibular nucleii), sometimes a combination of both. Throw a figure-of-eight ankle wrap on and walk. Your ROM is decreased (mechanical); this reduces input to your cerebellum which reduces input to your vestibular system. Your ankle dorsiflexion and step length will be diminished on that side; this will often cause an increase in arm swing on the contralateral side, which increases the metabolic "cost".

Arm swing may be coached, but we believe this is not always the correct approach as if it is a vestibular problem with altered cerebellar input (Something with the actual semicircular canals or perhaps input from muscle spindle or Golgi tendon organs), coaching arm swing makes the patient "look better" but does not really "fix" the problem; Which may be something as simple as joint pathomechanics, ligamentous restriction or a lack of skilled/endurance/strength in appropriate musculature. If it is a metabolic issue, sometimes coaching arm swing can improve mechanical efficiency but at the cost of decreasing cortical efficiency, because the brain is such an energy hog.

Arm swing is there for a reason. It tells you something about what is going on or what is not going on. Just because it looks bad does not mean that it is necessarily the problem. Look deeper and keep your eyes, ears and mind open.

We will be talking about the case with this gal. her crossover gait and armswing, alonng with 2 other cases, on our 3rd Wednesdays class on onlince.com: Biomechanics 320 on 8/15/2018

Meyns P, Bruijn SM, Duysens J. The how and why of arm swing during human walking. Gait Posture. 2013 Sep;38(4):555-62. doi: 10.1016/j.gaitpost.2013.02.006. Epub 2013 Mar 13.

Wu Y, Li Y, Liu AM, Xiao F, Wang YZ, Hu F, Chen JL, Dai KR, Gu DY. Effect of active arm swing to local dynamic stability during walking. Hum Mov Sci. 2016 Feb;45:102-9. doi: 10.1016/j.humov.2015.10.005. Epub 2015 Nov 23.

May 16, 2018

Thinking while walking changes arm swing...

May 16, 2018/ The Gait Guys

Maybe we should keep this in mind while "gait retraining" and "rehabbing". You could be inducing the changes you are seeing on a cortical level.

This makes you wonder about walking and thinking about sometime else. Being mindful has its advantages, like less cortical laterality and dominance. Remember, in this study, the arm swing is les on the right, so theoretically, less cortical motor drive from the left side. No wonder your gait changes! Be careful which hand you are texting with : )...Better yet, don't walk and text....

Human arm swing looks and feels highly automated, yet it is increasingly apparent that higher centres, including the cortex, are involved in many aspects of locomotor control. The addition of a cognitive task increases arm swing asymmetry during walking, but the characteristics and mechanism of this asymmetry are unclear. We hypothesized that this effect is lateralized and a Stroop word-colour naming task-primarily involving left hemisphere structures-would reduce right arm swing only. We recorded gait in 83 healthy subjects aged 18-80 walking normally on a treadmill and while performing a congruent and incongruent Stroop task. The primary measure of arm swing asymmetry-an index based on both three-dimensional wrist trajectories in which positive values indicate proportionally smaller movements on the right-increased significantly under dual-task conditions in those aged 40-59 and further still in the over-60s, driven by reduced right arm flexion. Right arm swing attenuation appears to be the norm in humans performing a locomotor-cognitive dual-task, confirming a prominent role of the brain in locomotor behaviour. Women under 60 are surprisingly resistant to this effect, revealing unexpected gender differences atop the hierarchical chain of locomotor control.

R Soc Open Sci. 2017 Jan 25;4(1):160993. doi: 10.1098/rsos.160993. eCollection 2017 Jan.
Increasing cognitive load attenuates right arm swing in healthy human walking.
Killeen T1, Easthope CS1, Filli L2, Lőrincz L2, Schrafl-Altermatt M1, Brugger P2, Linnebank M3, Curt A1, Zörner B1, Bolliger M1.

free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319362/

May 14, 2018

Arm swing and instability. To train or not to train... Should we do it?

May 14, 2018/ The Gait Guys

We have long talked about arm swing and whether to change it, encourage it or just observe it. It appears to be an indicator of potential instability as well as a portent for more dire neurological problems (Alzheimers, Parkinson's)

This study looks at altered arm swing in kids with CP; how it is an indicator that there is a problem and how it can profoundly effect their gait and stability. Cerebral palsy may be an extreme case, but how does it differ REALLY (other than severity) from someone who has a mild neurological impairment, such as movement patterning disorders, that we see each and every day in our friends, family, clients and patients? Try and think out of the box and investigate the implications.

"Observational research suggests that in children with cerebral palsy, the altered arm swing is linked to instability during walking. Therefore, the current study investigates whether children with cerebral palsy use their arms more than typically developing children, to enhance gait stability. Evidence also suggests an influence of walking speed on gait stability. Moreover, previous research highlighted a link between walking speed and arm swing. Hence, the experiment aimed to explore differences between typically developing children and children with cerebral palsy taking into account the combined influence of restricting arm swing and increasing walking speed on gait stability. Spatiotemporal gait characteristics, trunk movement parameters and margins of stability were obtained using three dimensional gait analysis to assess gait stability of 26 children with cerebral palsy and 24 typically developing children. Four walking conditions were evaluated: (i) free arm swing and preferred walking speed; (ii) restricted arm swing and preferred walking speed; (iii) free arm swing and high walking speed; and (iv) restricted arm swing and high walking speed. Double support time and trunk acceleration variability increased more when arm swing was restricted in children with bilateral cerebral palsy compared to typically developing children and children with unilateral cerebral palsy. Trunk sway velocity increased more when walking speed was increased in children with unilateral cerebral palsy compared to children with bilateral cerebral palsy and typically developing children and in children with bilateral cerebral palsy compared to typically developing children. Trunk sway velocity increased more when both arm swing was restricted and walking speed was increased in children with bilateral cerebral palsy compared to typically developing children. It is proposed that facilitating arm swing during gait rehabilitation can improve gait stability and decrease trunk movements in children with cerebral palsy. The current results thereby partly support the suggestion that facilitating arm swing in specific situations possibly enhances safety and reduces the risk of falling in children with cerebral palsy."

Front Hum Neurosci. 2016 Jul 15;10:354. doi: 10.3389/fnhum.2016.00354. eCollection 2016.
Restricted Arm Swing Affects Gait Stability and Increased Walking Speed Alters Trunk Movements in Children with Cerebral Palsy.
Delabastita T, Desloovere K, Meyns P.

link to FREE FULL TEXT: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4945643/

October 11, 2017

Swing matters, too.

October 11, 2017/ The Gait Guys

We speak often about the 3 foot rockers, with particular attention often to ankle rocker (ankle mortise). But one must not forget about the rear and forefoot rockers, they have their important place as well.
But, we all too often only think of these parameters when the foot is on the ground. The truth is, the swing limb is very important as well. How we swing, how the foot prepares for initial contact is also critical.

Last week Ivo wrote about toe walkers, a topic we have written about several times previously on our blog "The Gait Guys".

In this study, the researchers were appearing to look at plantarflexion posturing of the foot-ankle complex. the noted that"unilateral restricted ankle motion influenced kinematics mainly in the swing phase" as we proposed. Again, swing phase is just as critical as the stance phase of gait. One might recall our mnemonic, "when the foot is on the ground, the glutes are in charge, and when the foot is in the air, the abdominals are in charge". This admittedly is a very loose statement, but it has its place to begin the dialogue. Meaning, there is more to it. Yes, the hip flexors are key, but they have to be active on a precursor, sufficient control of the pelvis, via the abdominals in part. To this point, the researchers noted that, "hip and knee peak flexion in the swing phase were increased on the restricted side". Meaning, that to clear a plantarflexed foot-ankle complex, one might have to accentuate flexion elsewhere. No rocket science here. This is the "foot drop" strategy most of us are all to familiar with. People with foot drop have an inability to dorsiflex the ankle to clear the ground in swing, thus, to avoid tripping, one has to flex the limb higher up the chain, perhaps even hike the pelvis with the opposite leg hip abductors (plus a little frontal plane lean perhaps). This article however discusses restrictions, and not what we just discussed, loss of function.

Furthermore, "Walking with unilateral restricted ankle motion had a negative effect on walking velocity, cadence, step time, and step length."

Gait Posture. 2015 Mar;41(3):835-40.
Immediate effects of unilateral restricted ankle motion on gait kinematics in healthy subjects. Romkes J1, Schweizer K2.

https://www.ncbi.nlm.nih.gov/pubmed/25800648

September 19, 2017

How can feet relate to golf swing?

September 19, 2017/ The Gait Guys

This 52 year old right handed gentleman presented with pain at the thoracolumbar junction after playing golf. He noticed he had a limited amount of “back swing” and pain at the end of his “follow through”.

Take a look a these pix and think about why.

Hopefully, in addition to he having hairy and scarred legs (he is a contractor by trade), you noted the following

Top: note the normal internal rotation of the right hip; You need 4 degrees to walk normally and most folks have close to 40 degrees. He also has internal tibial torsion.
second picture: loss of external rotation of the right hip. Again, you need 4 degrees (from neutral) of external rotation of the hip to supinate and walk normally.
third picture: normal internal rotation of the left hip; internal tibial torsion
4th picture: limited external rotation of the left hip, especially with respect ti the amount of internal rotation present; this is to a greater degree than the right
last 2 pictures: note the amount of tibial varum and tibial torsion. Yes, with this much varum, he has a forefoot varus.

The brain is wired so that it will (generally) not allow you to walk with your toes pointing in (pigeon toed), so you rotate them out to somewhat of a normal progression angle. If you have internal tibial torsion, this places the knees outside the saggital plane. (For more on tibial torsion, click here.) If you rotate your extremity outward, and already have a limited amount of range of motion available, you will take up some of that range of motion, making less available for normal physiological function. If the motion cannot occur at the knee or hip, it will usually occur at the next available joint cephalad, in this case the spine.

The lumbar spine has a limited amount of rotation available, ranging from 1.2-1.7 degrees per segment in a normal spine (1). This is generally less in degenerative conditions (2).

Place your feet on the ground with your feet pointing straight ahead. Now simulate a right handed golf swing, bending slightly at the waist androtating your body backward to the right. Now slowly swing and follow through from right to left. Note what happens to your hips: as you wind back to the right, the left hip is externally rotating and the right hip is internally rotating. As you follow through to the left, your right, your hip must externally rotate and your left hip must externally rotate. Can you see how his left hip is inhibiting his back swing and his right hip is limitinghis follow through? Can you see that because of his internal tibial torsion, he has already “used up” some of his external rotation range of motion?

If he does not have enough range of motion in the hip, where will it come from?

he will “borrow it” from a joint more north of the hip, in this case, his spine. More motion will occur at the thoracolumbar junction, since most likely (because of degenerative change) the most is available there; but you can only “borrow” so much before you need to “Pay it back”. In this case, he over rotated and injured the joint.

What did we do?

we treated the injured joint locally, with manipulation of the pathomechanical segments
we reduced inflammation and muscle spasm with acupuncture
we gave him some lumbar and throacolumbar stabilization exercises: founders exercise, extension holds, non tripod, cross crawl, pull ups
we gave him foot exercises to reduce his forefoot varus: tripod standing, EHB, lift-spread-reach
we had him externally rotate both feet (duck) when playing golf

The Gait Guys. Helping you to store up lots “in your bank” of foot and gait literacy, so you can help people when they need to “pay it back”, one case at a time.

(1) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2223353/

(2) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705911/

December 28, 2015 December 28, 2015/ The Gait Guys

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

September 30, 2014 September 30, 2014/ The Gait Guys

Got Arm Swing?

We have written many times about arm swing. Click here for some of our posts here on Tumblr.

Here we are again at the beach. Look at the beautiful difference in arm swing from side to side in the guy carrying the bag. Makes you want to tell him to use a backpack, eh?

Never mind what it does to his gait

decreased arm swing on the carrying side
increased step length on the left side
increased thigh flexion of the left side
increased body lean and head tilt to right side (Take a look at this paper)

think about the increased metabolic cost. Think about what this type of input (increased amplitude of movement unilaterally) is doing to your cortex!

keep your movements symmetrical, folks!

The Gait Guys

July 22, 2014 July 22, 2014/ The Gait Guys

So you want to do a Gait Analysis: Part 4

This is the 4th in a multi part series. If you missed part 1, click here. For part 2, click here, part 3, click here.

These are the basics, folks. We hope this is a review for many.

A quick review of the walking gait cycle components:

There are two phases of gait: stance and swing.

Stance consists of:

Initial contact
Loading response
Midstance
Terminal stance
Pre-swing

Swing consists of:

initial (early) swing
mid swing
terminal (late) swing

today, lets explore Terminal stance

Terminal stance is one of the last stages of stance phase. Following midstance, where maximal pronation should be occurring, the stance phase foot should now begin supinating, initiated by the the opposite foot in swing phase moving forward of the center of gravity.

Lets look at what is happening here at the major anatomical areas:

Foot

Supination begins from the opposite, swing phase leg (see above)

the calcaneus inverts to neutral

the center of gravity of the foot raises from its lowest point at midstance

The lower leg should begin externally rotating (as it follows the talus)

The thigh should follow the lower leg and should also be externally rotating; sometimes to a greater extent due to the shape and size of the medial condyle of the femur (which is larger than the lateral)

these actions are perpetuated by the gluteus maximus and posterior fibers of the gluteus medius, as well as posterior compartment of the lower leg including the flexor digitorum longus, flexor hallucis longus, peroneus longus and tibialis posterior

Ankle

The ankle should be 5 degrees dorsiflexed and in ankle rocker
the calcaneocuboid locking mechanism should be engaging to assist the peroneus longus in getting the head of the 1st metatarsal to the ground

Knee

near or at full extension. This is perpetuated by the quadriceps and biceps femoris, contracting concentrically and attenuated by the semi membranosis and tendonosis. The popliteus contracts eccentrically as soon as the knee passes midstance to keep the rates of external rotation of the tibia and femur in congruence.

Hip

The hip should be extending to 10 degrees.

Can you picture what is happening? Try and visualize these motions in your mind. Can you understand why you need to know what is going on at each phase to be able to identify problems? If you don’t know what normal looks like, you will have a tougher time figuring out what is abnormal.

Ivo and Shawn. Gait and foot geeks extraordinaire. Helping you to build a better foundation to put all this stuff you are learning on.

pictured used with permission from Foot Orthoses and Other Conservative Forms of Foot Care

June 17, 2014 June 17, 2014/ The Gait Guys

Correcting a cross over gait with arm swing? Is it really THAT easy? Sometimes, yes!

We noticed this patient had a cross over gait while running (1st few seconds of video. need to know more about crossover gait? click here). We noted she was crossing her arms over her body as well. We than had her run her hands and arms straight out. See the crossover disappear? Need to know more about arm swing? click here

We the had her do the same while walking. Easier to see, eh? That’s because it is often easier to “fudge” things when you are moving faster (ie: the basal ganglia of nervous system can interpolate where the body part is supposed to be, and because of momentum, there is less need for precision). When we do things slowly (like the 3 second Test), more precision is needed. Watch this short video clip a few more times.

The arms are essentially adducting when the arms cross over. The arms are reciprocally paired with the contralateral lower extremity. When you make a change in one, you often will make a change in the other.

Subtle. Yes. Easier to see when the task becomes more difficult. Yes. Pay attention, the answer is often right there if you look closely enough.

Providing the clues to help you be smarter, better, faster, stronger; we are The Gait Guys

special thanks to “Q” for allowing us to publish this video : )