Welcome to rewind Friday Folks.

Think about all those folks in the Northeast who have been shoveling (OK, the folks in Colorado as well) and their feet being rubber boots!

Here’s an oldie, but a goodie.

Here’s one paper we though had merit (sure, go to Pub Med and search foot odor. There were 119 entries). We think we may try this in the office…

The Gait Guys: Yes, smelly feet are something we have to deal with at the office on a daily basis. One of the pitfalls of being a Foot Geek : )

Make sure to check back later for more on malodorous extremities…                        

 

J Int Soc Sports Nutr. 2007 Jul 13;4:3.

A novel aromatic oil compound inhibits microbial overgrowth on feet: a case study.

Misner BD.

Source

West 1140 Glass Avenue Spokane, Washington, 99205, USA. drbill@omnicast.net.

Abstract

ABSTRACT:

BACKGROUND:

Athlete’s Foot (Tinea pedis) is a form of ringworm associated with highly contagious yeast-fungi colonies, although they look like bacteria. Foot bacteria overgrowth produces a harmless pungent odor, however, uncontrolled proliferation of yeast-fungi produces small vesicles, fissures, scaling, and maceration with eroded areas between the toes and the plantar surface of the foot, resulting in intense itching, blisters, and cracking. Painful microbial foot infection may prevent athletic participation. Keeping the feet clean and dry with the toenails trimmed reduces the incidence of skin disease of the feet. Wearing sandals in locker and shower rooms prevents intimate contact with the infecting organisms and alleviates most foot-sensitive infections. Enclosing feet in socks and shoes generates a moisture-rich environment that stimulates overgrowth of pungent both aerobic bacteria and infectious yeast-fungi. Suppression of microbial growth may be accomplished by exposing the feet to air to enhance evaporation to reduce moistures’ growth-stimulating effect and is often neglected. There is an association between yeast-fungi overgrowths and disabling foot infections. Potent agents virtually exterminate some microbial growth, but the inevitable presence of infection under the nails predicts future infection. Topical antibiotics present a potent approach with the ideal agent being one that removes moisture producing antibacterial-antifungal activity. Severe infection may require costly prescription drugs, salves, and repeated treatment.

METHODS:

A 63-y female volunteered to enclose feet in shoes and socks for 48 hours. Aerobic bacteria and yeast-fungi counts were determined by swab sample incubation technique (1) after 48-hours feet enclosure, (2) after washing feet, and (3) after 8-hours socks-shoes exposure to an aromatic oil powder-compound consisting of arrowroot, baking soda, basil oil, tea tree oil, sage oil, and clove oil.

CONCLUSION:

Application of this novel compound to the external surfaces of feet completely inhibited both aerobic bacteria and yeast-fungi-mold proliferation for 8-hours in spite of being in an enclosed environment compatible to microbial proliferation. Whether topical application of this compound prevents microbial infections in larger populations is not known. This calls for more research collected from subjects exposed to elements that may increase the risk of microbial-induced foot diseases.

The Gait Guys. Bringing you the good, the bad and the smelly….

Another IFGEC Certification granted:

Here’s what Mark Small has to say

“The National Shoe Fit Program is beneficial to many fields/disciplines including, but not limited to, coaches, personal trainers, athletic trainers, physical therapists, podiatrists, and chiropractors (I would say MD’s, but it doesn’t come in a pill), as well as those who sell shoes.  The program offers tools to help us understand individual differences and their effects on gait and performance.  Some of the material includes:
    •    Foot anatomy
    •    Anatomical Landmarks
    •    Foot types
    •    Pathologies
    •    Basic biomechanics
    •    Shoe fit functional testing
    ⁃    Static and dynamic tests to assist fitting
    •    Finally shoe selection
    ⁃    Picking the best shoe for your client/athlete/patient

Some of these topics may be a good review for some of the advanced disciplines listed above. What the program is able to do, even for them, is to link everything together in a methodical, step by step, detailed approach, that applies what we have learned into something predictable and usable. We are often looking for ways to increase performance, decrease pain and get people to move better.  I, for one, believe that much of bad movement, pain and dysfunction have to do with inappropriate footwear, this course is a starting place to help correct that problem.  I am looking forward to Level 2 & 3 certification programs, but more importantly, I am looking forward to applying what I am learning with the people I serve.  I’m not a Gait Guy… more like a gleam in the gait daddy’s eye, but I’m working on it.”

Congratulations, Mark!

The Gait Guys

Thanks for the kudos Coach Smith !

for anyone interested… . . 

1.  Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

2. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

“ I had explosive diarrhea in the middle of a good long run.”

We have always wanted to start a blog post with something dirty like that, but it never seemed like the right thing to do. So, we figured we would save it for on or around the day of our 1000th blog post. We started The Gait Guys blog in 2011 with our first blog post and just a few days ago the trumpets sounded at the 1000th post. How did this happen ? Well, it happened little by little, 3-5 post a week, month after month. It happened just as the gentleman described in the video above on how to make a dry wall, stone after stone.  Our writing has managed to reach into 74 countries with the additional help of our podcasts, teleseminars and social media.  Thus, we wanted to just voice a little thanks to you all for following us, week after week, month after month.  So far this has been a pretty great journey for us and we are happy you have come along for the ride. 

Now back to sphincters and running. 

“ I had explosive diarrhea in the middle of a good long run.”

Think it can’t happen to you ? Here is a true medical literature case study. “A 20-year-old female running the Marine Corps Marathon developed diarrhea at mile 12. After finishing the race she noted that she was covered in bloody stool. A local emergency department suspected ischemic colitis.” This was straight from the Grames study found below. 

Maintenance of the basal tone in the internal anal sphincter is critical for rectoanal continence. Effective evacuation requires a fully functional rectoanal inhibitory reflex-mediated relaxation of the internal anal sphincter via inhibitory neurotransmission.

Ok, What !!!!????

Basically, all that means is that the tone of the anus is pretty complicated and when it works right, we don’t think about it much, and when it shows us signs of things hitting the fan, it prompts an immediate hierarchy of our attention.  However, diarrhea is so much more than what is violently erupting from the opening at the other end of our alimentary tract.

Lower GI complaints such as urgency and diarrhea are not all that uncommon in runners.  Sometimes it is pre-race jitters/nerves, sometimes is too many donuts and coffee before the big sunday team run, sometimes it is electrolyte imbalances or too much beer or Wild Turkey the night before, sometimes it’s aberrant autonomic nervous system stimulation, and in the initial case above sometimes it is ischemia (impaired blood perfusion to the colon).

Possible mechanisms of ischemia in distance runners and others participating in intense exercise may include a combination of splanchnic vasoconstriction, dehydration, and hyperthermia, combined with the mechanical jostling of organs via intense activity. Most of the unfortunate presenting with marathon-running-induced ischemic colitis respond favorably to conservative treatment, but awareness is the first step. However, as in the Cohen et al case referenced below, sometimes the unlucky collapse at the finish line and have other results …  whereafter “computed tomography scanning revealed ischemic colitis of the cecum and ascending colon, which progressed to the development of clinical peritonism after 48 hours. This patient subsequently underwent a laparotomy and right hemicolectomy, with ileostomy formation, on the third day after admission. Operative and histologic findings confirmed ischemic colitis of the cecum and proximal colon.”  

So, there is some anxiety-inducing stuff to think about right before your long run this week ! But lets be realistic. Be smart, watch your diet with a good food diary, think hard about your fluid levels and what those fluids are, be smart about pushing hard during high temperature days, know your usual stool habits, and most of all do not ignore the subtle or obvious signs that things could be going wrong in a race or in training. Unexpected bowel problems in a race may not be only a mere embarrassment, they could be telling you something is seriously wrong. 

In closing, thanks for following our writings for the past 3.5 years, writings amounting to 1000 articles. It has been a fun journey and we have learned right along side of you.  In relation to the video above, our body of work is clearly no novel, but our journey in itself is a story of sorts. A story that has been piecing together all the little nuances of the human frame and its biomechanics, bit by bit. 

(Oh, and for those who feel we should apologize for the video not being about, well, erupting diarrhea in a runner, well, we wanted to make today’s post more about the writing process. If you want THAT video, that is what youtube might be for. Just don’t too much of your day looking for it, try writing a book instead.)

Shawn and Ivo,

Two Gait Guys trying to avoid what sometimes hits the fan.

References:

1) Am Fam Physician. 1993 Sep 15;48(4):623-7. Runner’s diarrhea and other intestingal problems of athletes. Butcher JD.

2) Am J Emerg Med. 2009 Feb;27(2):255.e5-7. Marathon-induced ishemic colitis: Why running is not always good for you.  Cohen DC1, Winstanley A, Engledow A, Windsor AC, Skipworth JR.

3) Case Rep Gastrointest Med. 2012;2012:356895. Ischemic Colitis in an endurance runner.  Grames C1, Berry-Cabán CS.

Concepts in Pelvic Stabilization. Do you know what you know?

We made this video several years ago. It is excerpted from our DVD series on core stabilization available here.

It reviews some concepts of the abdominal core and reviews problems with typical sit up and crunch exercises.

The take home message is one of technique and application. The details and little things are often the most important things. Especially when it comes to exercise and rehabilitation.

The Gait Guys

Stopped by yesterday to see my friends and fellow running/shoe geeks at New Balance Chicago, Oakbrook Terrace store. My good friend and shoe genius Mike and Jeff blessed me with a gift. A pair of the New BAlance Fresh Foam. We will definitely be talking this one up on podcast 56 ! 4mm drop, and just over 20mm of stack height, no siping, this one could be a smooth ride ! These guys are so nice, what a store ! New Balance #newbalance#thegaitguys #freshfoam #4mmramp

 (4 photos)

Podcast 55: Cold Joints, Gluten Brain & Toilets

-The Neurophysiology of your Joint Pain and Problems

A. Link to our server:

Direct Download: http://traffic.libsyn.com/thegaitguys/pod_55final.mp3

Permalink: http://thegaitguys.libsyn.com/podcast-55-cold-joints-gluten-brain-toilets

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

________________________________________

* Today’s show notes:

3 neuroscience pieces this week:

Why Does Cold, Damp Weather Make My Old Injuries Hurt?
http://www.outsideonline.com/fitness/bodywork/fitness-coach/Why-cold-damp-weather-makes-old-injuries-hurt.html

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First Tests of Prototype Organic Wires Grown from Seedlings
http://www.technologyreview.com/view/523956/first-tests-of-prototype-organic-wires-grown-from-seedlings/

‘Gluten Brain’: Wheat Cuts Off Blood Flow To Frontal Cortex 

http://www.greenmedinfo.com/blog/research-wheat-cuts-blood-flow-brains-frontal-cortex

Influence of midsole hardness of standard cushioned shoes on running-related injury risk

http://bjsm.bmj.com/content/48/5/371.abstract

__________

http://journals.lww.com/acsm-msse/Abstract/pu

blishahead/Running_Shoes_Increase_Achilles_Tendon_Load_in.98153.aspx

_____________

Case From a blog reader

Hello, 

I’m a swedish elite cross-country skier and newly graduated physio and I find your podcasts very interesting and informative! I have a question about something I’ve never heard you talk about, and which has been a problem for me for the last year.

It’s about the IP-joint of the big toe. I’ve had discomfort/pain in the joint for the last year, mostly after my workouts. It’s a bit swollen and there is crepitus to some degree(especially when I manually flex the toe while compressing it and at the same time have a pressure downwards/ventrally of the distal phalanx. I think it may be coming from a trauma I had 4-5 years ago when I stubbed my big toe really hard in a rock in an orienteering competition, which caused me to rest from running for a week or two.

So, my question to you is if you have any suggestion for me or others in my situation? Treatment? Which types of shoes to use? How would a future joint-fusion affect my running?

I’m only 23 years old and I’m really worried that this ache/discomfort will just get worse and worse.. I’ve asked a lot of great physios here in Sweden, but most of them don’t know much about what to do.

I’d be really grateful if you could take the time to give this a thought and share it.

Thanks!

_______________

Another reader case:

 

Good morning. I am a former collegiate runner, I competed at Eastern Michigan University and Grand Valley State University, my father is a Chiropractor in northern Michigan. While in school I was recalled to active duty in the reserves after 9/11 and was unable to finish my eligibility. I am now 32, living in North Carolina, and trying to make a comeback to running and competing in Triathlons. At 6’2” and 170lbs. during college  I was competitive at the collegiate level  but always a step behind the true elites in the distance races in college, probably just because of my size, etc. competing against guys carrying 30 less lbs.

I train with a team called Without Limits  (iamwithoutlimits.com ) in Wilmington NC. My coach had mentioned that I had a really long loping stride which felt normal to me, but I cannot remember if I ran this way in college or not. When I finally counted, I had a cadence of 140 steps per minute rather then the optimal 180…

Long story short, I got really out of shape, now getting into pretty good form again, but I am having problems with the IT band and pain in the knee on the right leg. I never ever had this in college training at very high levels (90-100 mile weeks in the off and early parts of each season) …so now I have the bike component that I am working on, but being a larger distance runner I am trying to fine tune my gait/stride and see if I can improve my running that way and also figure out what is going on with this IT band issue as I am only running 30-40 miles/week now but on the bike and in the pool a lot. I am back down to 175 and pretty lean but carrying a little extra muscle from biking and swimming.

Would you be interested, if I could send you several high quality videos from different angles, in taking a look at my gait (or even riding the bike on the trainer) and see if you notice anything ? I have been working on improving my cadence since the IT band issues began, and found your videos online while doing research.  I understand this would be better done on a treadmill or in the parking lot at your office where you could watch up close, but if you are interested, please let me know. I look forward to hearing from you.

 Sincerely,

 Tim

__________

The sedentary life affects your neurons !

http://www.outsideonline.com/news-from-the-field/Sitting-Still-Is-Bad-For-Your-Neurons.html

_________

A 3rd case this week, on Dystonia

Do you guys have any recommendations for analysis and treatment of acquired focal and gait dystonia?
It started as a splinting mechanism with a very loose right si and some L5 radiculopathy over 5 years ago.  The dystonia would come and go then eventually stuck all the time.
All the dystonia is on the right side and I don’t have any systemic neurological disease.
Forward walking, stair climbing, running (although barefoot running in grass and in particular undulating surfaces is ok in small amounts, asphalt or treadmill
brings on dystonia within seconds) are all a problem. Can cycle, run in water for 40 minutes or so no problem, so I think Si may still be hypermobile.  Walking backwards no problem.
Dystonia presents as stiff right leg with knee hyperextension, right eccentric weak, right glute medius weak, sticky posterior weight shift, but full and
painless movement through complete range of hip and knee.  I do have some focal dystonia as well mostly knee extension with hip flexion and foot supination and eversion with hip and knee flexed.

There must be someone who deals with this somewhat locally to me, Virginia Beach, VA.  Hoping you all may have some contacts on the east coast.
Thanks,
Sally

Get This: A Smart Toilet That Aims to Correct Poor Posture, and Even Detect Pregnancy and Disease | Entrepreneur.com
http://www.entrepreneur.com/article/231344

Welcome to rewind Friday, Folks. This week we have hammered on arm  swing. This one is from a year ago and seemed germane to this weeks posts.

Arm swing in gait and running. Why it is crucial, and why it must be symmetrical.

It becomes clear that once you get the amazing feats seen in this video out of your head, and begin to watch just the variable use of the arms that you will begin to appreciate the amazing need for arm swing and function in movement.

We have written many articles on arm swing and its vital importance in gait and running. Have you missed all these articles ?  If so, go to our blog main page, type in “arm swing” in the search box and you will have a solid morning of readings at your fingertips.  We are still not done writing about this most commonly forgotten and overlooked aspect of gait and running analysis, and we probably never will be done.  Why is no one else focusing on it ?  We think it is because they do not see or understand its critical importance.

Without the presence and use of the arms in motion things like acceleration, deceleration, directional change, balance and many other critical components of body motion are not possible.

What is perhaps equally important for you to realize, as put forth in:

Huang et al in the Eur Spine Journal, 2011 Mar 20(3) “Gait Adaptations in low back pain patients with lumbar disc herniation: trunk coordination and arm swing.”

is that as spine pain presents, the shoulder and pelvic girdle anti-phase begins to move into a more in-phase favor.  Meaning that the differential between the upper torso twist and pelvic twist is reduced. As spine pain presents, the free flowing pendulum motions of the upper and lower limbs becomes reduced to dampen the torsional “wringing” on the spine. When this anti-phase is reduced then arm swing should be reduced. The central neural processing mechanisms do this to reduce spinal twisting, because with reduced twist means reduced spinal motor unit compression and thus hopefully less pain. (Yes, for you uber biomechanics geeks out there, reduced spine compression means increased shear forces which are favorite topics of many of our prior University instructors, like Dr. Stuart McGill). The consequence to this reduced spinal rotation is reduced limb swing.  And according to

Collins et al Proc Biol Sci, 2009, Oct 22 “Dynamic arm swinging in human walking.”

“normal arm swinging requires minimal shoulder torque, while volitionally holding the arms still requires 12 % more metabolic energy.  Among measures of gait mechanics, vertical ground reactive moments are most affected by arm swinging and increased by 63% without arm swing.”

So, it is all about efficiency and protection. Efficiency comes with fluid unrestricted movements and energy conservation but protection has the cost of wasting energy and reduced mobility through a limb(s) and spine.

In past articles we have carried these thoughts into historical functional needs of man such as carrying spears and of modern day man in carrying briefcases.   Today we show a great high functioning video of another parkour practitioner.  Parkour is a physical discipline and non-competitive sport which focuses on efficient movement around obstacles.  Watch closely the use of the arms. The need for arm use in jumping, in balance, in acceleration etc. It becomes clear that once you get the amazing feats seen in this video out of your head, and begin to watch just the use of the arms that you will begin to appreciate the amazing need for arm swing and function in movement.

There is a reason that in our practices we treat contralateral upper and lower limbs so much.  Because if you are paying attention, these in combination with the unilateral loss of spinal rotation are the things that need attention. 

Yup, we are The Gait Guys….. we have been paying attention to this stuff long before the functional movement assessment programs became popular.  If you just know gait, one of the single most primitive patterns other than crawling and breathing and the like, you will understand why you see altered squats, hip hinges, shoulder ROM screens etc.  You have to have a deep rooted fundamental knowledge of the gait central processing and gait parameters. If you do not, every other screen that you put your athlete or patient through might have limited or false leading meaning. 

Shawn and Ivo …  combining 40 years of orthopedics, neurology, biomechanics and gait studies to get to the bottom of things.

So you do not think arm swing is important huh ?  Read these 2 stats and recalibrate your thinking.  

This was yet another slide from last nights well attended teleseminar. Those that attended learned all of the up to date facts that doctors, trainers, coaches, therapists need to quickly understand what factors to look for when observing someones gait.  Including our favorite, “what you see is not the problem in their gait, rather it is there strategy around the faulty parts, problem or pain.”

If you think that changing arm swing at the local level is not a big deal, just digest the towering facts from this slide.  Arm swing is a big deal ! It is a CPG generated big deal (Central Pattern Generator).  

Sorry we missed you last night.  The teleseminar was recorded and should be up on www.onlinece.com or www.chirocredit.com in a few days for you to enjoy on your own free time (and so are a few dozen of our other lectures !).   

So, if you are coaching or making local-level arm-swing form running or training changes in yourself or your client, you are probably making some big mistakes.  Our lecture brings this all to light for you in one place !

Arm Swing matters…….. more than any of us previously knew !

Shawn and Ivo, The Gait Guys

Faulty Arm Swing provides clues to gait pathology.

Don’t think that just because you see aberrant arm swing that you should “coach” it out of someone.  It is very likely there for a reason. We discuss tonight how the leg swing is more deeply neurologically embedded, more so than arm swing.  So, fixing something you do not like in their arm swing is very possibly the wrong solution and by doing just that you are forcing your client into a new compensatory CPG (central pattern generator) which is essentially a compensation to their compensation.   Fix the problem, go for its roots !

This is one of our slides for tonights lecture.  This is from the European Spine Journal 2011.  More posterior arm swing can help improve impaired hip extension and gluteal function. A nice compensatory fix to reduce spine rotation in a spinal pain patient, more hip extension means that less pelvic obliquity needs to be acquired (less obliquity in the pelvic girdle means less spine rotation and thus less spine compression. This is a brain based phenomenon, the brain is engaging a pain avoidance CPG. 

You gotta know your biomechanics, you gotta know your neurology and you MUST understand and recognize normal and abnormal gait patterns if you choose to work with humans !

Join us tonight on www.onlinece.com for an in-depth hour talking about the biomechanics and neurobiology behind normal and abnormal arm swing.  7pm central Wednesday 19th.

Shawn and Ivo, the gait guys

Have you ever wondered why people who walk together quickly synchronize their gaits ?

From healthy heart cells that synchronize to a single beat, to women in school dormitories or work places who synchronize their menstrual cycles, to fireflies who begin blinking in synchrony when they all perch in the same tree synchronization is something that is abundant in nature.  It is no wonder that we find synchronicity in one of our most primitive and frequent motor patterns, walking together with someone shows the same synchronicity phenomenon.

Hold the hand of your favorite person and go for a walk. Within a few strides your gaits will synchronize. Is it because it is easier ? Is it because when synchronized the arm swings will match thus making it easier and more effortless to hold hands ?  Does the same effect occur if you are not holding hands ? Studies have concluded that although it does not happen all of the time, they found it occurs in almost 50% of the walking trials even among couples who do not usually walk together. This is far too high a percentage to not make it a statistically significant finding.

The synchronization between walking partners is more complex than it seems on the surface.  There are two types of synchronization, in-phase (both person’s right foot move forward at the same time) and out-of-phasesynchronization (where the right foot moves forward with the partners left foot).  You can see in the video above that the couple has subconsciously fallen into an Out-of-Phase synchronization, then after the tide splash that throws them off within just a few steps they fall right back into Out-of-Phase synchronization and hold it in that state.  There are multiple factors and communication mechanisms occurring. There are auditory mechanisms in play such as the sound of the other persons foot fall.  There are even visual mechanisms through peripherally seeing your partners arm swing and foot fall which encourages the imitation synchronization. However, the strongest in-phase synchrony occurred in the presence of tactile feedback meaning hand holding or embracing each others waist from behind, which couples often do when walking more slowly, seem to create a stronger synchrony.  When this tactile component is engaged between two walkers it is plausible that the upper and lower limbs move more freely when paired up, particularly with arm swing.

What is thought to happen is that one partner dominates the lead in the gait, just as in dancing, one person is the leader and the other is the follower. The lead partner’s lower limbs determine the movement of their arms, which in turn when holding hands, sets the arm movement pattern in the partner then determining the leg swing and stance phases. Thus, synchrony is achieved. 

However, it is important to note that many of the studies were clear to mention that even in non-tactile cases, many of the gaits of two people walking together are synchronized. This was likely due to the visual and auditory parameters however height, leg length cadence etc could also play into those successful non-tactile synchrony cases.

These are interesting findings at 50% because it is very unlikely that any two people are of the same height, leg length, cadence, stride and step length.  These are all parameters that are likely to change the likelihood of gait synchrony.  Zivotofsky found that “even in the absence of visual or auditory communication, couples also frequently walked in synchrony while 180 degrees out-of-phase, likely using different feedback mechanisms”. The studies below discuss many issues of this synchrony but it is perhaps most significant in clinical rehabilitation cases or in early or moderately advanced movement impairment disorders and diseases these findings may partially explain how patients can enhance their gait function when they walk with a partner or therapist.  It is in these movement impairment syndromes and diseases where the central processing and Central Pattern Generators (CPG’s) are diseased leaving them with the need for other cues such as those discussed here today, auditory, visual and tactile.  

You may have read our previous blog articles on arm swing and how intimately they are anti-phasically (opposite) paired with lower limb swing.  But today’s blog post article took limb swing to another level.  Stay tuned for more on arm and leg swing in human movement.  If you wish to read our other works on arm and leg swing and their deeper effects on gait, go to our blog www.thegaitguys.tumblr.com and enter the words “arm swing” into the SEARCH box. 

Shawn and Ivo…….. taking gait far beyond what you learned about it in school.
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References used:

J Neuroengineering Rehabil. 2007; 4: 28. The sensory feedback mechanisms enabling couples to walk synchronously. An initial investigation.  Ari Z Zivotofsky and Jeffrey M Hausdorff  Published online 2007 August 8. doi:  10.1186/1743-0003-4-28

Hum Mov Sci. 2012 Jun 22. [Epub ahead of print] Modality-specific communication enabling gait synchronization during over-ground side-by-side walking. Zivotofsky AZ, Gruendlinger L, Hausdorff JM.Gonda Brain Research Center, Bar-Ilan University, Ramat-Gan 52900, Israel.

What do you do with these Dogs?

Take a good look at these feet. Hard to not cringe, we know. In this photo, the gentleman’s feet are relaxed! Imagine what it they will look like with some additional long flexor tone!

So, keeping in mind his tibial varum (bend in the tibia) and uncompensated forefoot varus (inability to get the head of his 1st ray down to the ground), what can we do?

• how about we increase extensor strength? He could do the lift, spread, reach exercise while tripod standing. He could do the toe waving exercise.   He could do shuffle walks.
• teach him to stretch his long toe flexors. Frequently. 20-30 mins minimum; daily
• you could manipulate his feet to ensure better biomechnics
• you could massage his feet to improve mobility and circulation
• you could facilitate his long toe extensor muscles
• you could inhibit his long toe flexor muscles
• you could improve ankle dorsiflexion by showing him how to stretch the calves, 20-30 mins daily
• you could improve ankle dorsiflexion by making sure he has adequate hip extension
• he could wear correct toes, to improve the biomechanical advantage of the long toe extensors
• he could wear shoes with a wider toe box
• he could wear shoes with less ramp delta (or drop)
• he could wear shoes with less torsional rigidity

and the list goes on. There are many simple things you teach a person with feet like this. many of them we have introduced you to here on the blog. Spend some time. Learn some cool stuff. Read the blog. Follow us on Facebook. Attend a Biomechanics class we teach the 3rd Wednesday of each month on onlinece.com . Check out our Youtube Channel. Consider furthering your education and taking the National Shoe Fit Program.

The resources are there. All you need to do is dig a little deeper.

We are The Gait Guys and we are all things gait.

Arm Swing: The Straight up Truth

Are you a Gait Troglodyte ? Are you sure ? You might want to read on.

* On Wednesday of this coming week, Feb 19th at 7pm central on www.onlinece.com we will give an important 1 hour teleseminar on “Arm Swing”. We will discuss all of the current research. If you think you know when, why and how to correct Arm Swing deficits, you are probably lacking the research and honest truth. Today’s blog post will prepare your head for the event.

Most of us are all still in a cave and unacquainted with some of the affairs of the world. Some of us may find ourselves behind the times when it comes to GMO foods, social media, computers and the internet, smart phones while others may be behind on world issues and politics. Heck, some of us have never even seen “Ancient Aliens” on the History Channel !  It is hard to keep up with everything in this fast paced changing world. Something has to give for each of us and so we pick our poison and decide what it is that we are going to have to remain behind on when it comes to the learning curves of the world. And this is alright, but you have to first admit your “back of the pack” and “still living in a cave” type status on the issues and take some ribbing when acknowledging your limitations.  Failing to admit these inevitable shortcomings while pretending that you are still running with the pack can be a real problem. Not only are you faking yourself out but you may be deceiving those that you attempt to help.

Understanding gait, truly understanding it, is a monumental undertaking. This is why there are just no vast resources on it unlike other things in healthcare. Try going to PubMed and type in “arm swing”, you will see 318 articles. Try “pronation”, 2900 articles.  Now try “heart”, 1 million+ articles.  You get the point. Research is behind on gait, and thus our understanding of it is also poorly reflected in functional medicine and  human bodywork.  We are collectively gait troglodytes, living in stereotypical caveman times when it comes to gait.  Sure there are some good books like Perry’s text, or Michaud’s landmark work but there is a void on gait work and research. Human locomotion via gait (walking and running) is a small and poorly understood component by many. It is much the reason why we started The Gait Guys and began writing daily for over 600 days on gait issues. Little did we know that the door we had opened would continue to swing so wide and encompass so many other aspects that feed into human gait.

One of the aspects that worries us the most these days is the growing volume of “functional” work that is going on in the world of therapy and training.  There is a very important and critical place for this work and we fully admit that everyone needs to be on board with all of the great work that the leaders are teaching. What worries us is the apparent lack of integration of this work into gait assessment, gait therapy, and flawed gait neuro-biomechanics. Once again gait is not getting the pulpit it deserves. Yes, flaws in the functional screens and assessments need to be brought to light and remedied because they can impact bipedal locomotion but, the pendulum swings both ways. Gait can often be a cause of these functional problems that show up on the screens and assessments. If one fixes the functional pattern problems and the gait pattern is not restored then either the dysfunction will return or a new undesirable pattern will be generated. There needs to be more gait understanding and assessment from us all. Gait needs retraining as well, it is as much of a functional pattern as any other, if not more.  Gait deserves a pulpit as well.  Human assessment is clearly a two way street and it is not always clear who is the chicken and who is the egg. The problem may be that when gait does have its pulpit to speak from, who is the speaker ? A gait troglodyte or an expert ?

There will be folks who say we are over thinking this issue. There will be some who are offended. There will be some who cheer. There are some that will say “it will all come out in the wash” once the functional patterns are corrected elsewhere. They are wrong, it just is not that simple. Next to breathing, gait may be the second most compromised and corrupted functional pattern that humans express thousands of times daily. So, it is time to get busy.  It is time to peel off your Gait Troglodyte cloak and step into a 3 piece suit when it comes to understanding and interpreting gait.  If you are working in the world of human movement, locomotion, training, rehab and human biomechanics this is your next challenge.  Lets face it, we can either continue to walk around with our 10 year old flip phone understanding of gait or we can step up to a smart phone understanding of gait.  It is up to you, but know where you are and know your limitations. So be honest with yourself and your next client the next time you assess their gait. Be sure to ask yourself after seeing something that just doesn’t seem right in their gait, is what you see really what you are seeing ? Is that really what is wrong ? Or is it a compensation ? Do you know enough to see things for what they really are ?

Shawn and Ivo, The Gait Guys.  

We may not be Gait Troglodytes……. but some accuse us of living in a cave none the less.  However, if you have seen our cave, you will know it looks much like Bruce Wayne’s Batcave.  It isn’t your everyday cave.

Limitations: The powers of observation will help you.

Physical examination, FMS, DNS, gait analysis … . . these are all very important tools for the coach, trainer, therapist, clinician.  They will all offer information and lead the “therapy giver” in a direction for intervention.  But when something doesn’t match up with the basic standard protocols, you have to go outside the standard box.  We have all been there and today is just a little reminder not to get caught up in the “proceedures” and merely running through protocol without an engaged brain putting the pieces together.  

Here we see 2 classic examples of deviations from the mean, the client on the left has drifted further outside the frontal plane because of tibial varum and a little genu varus.  The client on the right has imploded deep into the frontal plane via rigid pes planus foot collapse and genu valgum.  These will both affect your physical screenings for these clients. And keep in mind, and this is probably the most important point of today’s blog post, either client may have good or bad strategies around their anatomy.  In other words, some clients will have great compensations to limit further functional pathology, and some will have poor compensation strategies, and thus, both will have different physical exam findings, different screenings and different neuromotor patterns embedded deep into their CPGs (central pattern generators).   Put yet another way, all of the scenarios discussed may/will have varying screening assessment outcomes but for different reasons.  If you know the cause of these faults and the impaired neuro-recruitment patterns that are likely, your assessments will make more sense, and so will your exercise/therapy/rehab prescriptions.  If you do not understand the fundamental differences (ie long bone torsions or various femoral-neck shaft angles, foot types such as an uncompensated forefoot valgus etc) , one could prescribe therapies that will not address the underlying problems, rather they might address the compensations and strategies found with these client’s challenges.

It can get sloppy messy.  Wear a bib.

Dig for the roots, don’t mow the grass…… Shawn and Ivo, The Gait Guys

A look at the Lunge. Are you ready to take the lunge?

Another one of our favorite exercises. Unfortunately, all too often it is executed improperly. Watch carefully, as we cover many points in detail.

Remember the mantra; Skill, Endurance, Strength. In that order. Not every individual is ready for every exercise you may give them. Be sure to build an adequate foundation before proceeding ti the next level.

This excerpt is taken from our video series, available for download here.

The Gait Guys. Join the movement and spread the word. .

Everyone need a good running partner! Never would have thought of taking our duck with us….

Have a great Friday Folks..

• when spine pain presents the shoulder and pelvic girdle “anti-phase” oscillations (oscillate in opposite rotation) begin to move into a more “in-phase” favor.  Meaning that the differential between the upper torso twist and pelvic twist is reduced. The brain does this to reduce spinal compression. And when we reduce compression shear forces increase.  This is not a good thing.

We are getting the last of the slides together for our www.onlinece.com international teleseminar on Feb 19th, 7pm central.   

You should join us.  This months lecture is on Arm Swing.  

Hope to see you all in 12 days online !  Be sure to sign up ahead of time, we will likely have a large audience.

Happy Friday !

Shawn and Ivo,   The Gait Guys

Treadmill Truths: Because there is alot of Crappy Myths being Laid Down this week on the net.

The Truth About Treadmills: A Neurological Perspective

Gender differences in walking and running on level and inclined surfaces. 

Chumanov ES, Wall-Scheffler C, Heiderscheit BC. Clin Biomech (Bristol, Avon). 2008 Dec;23(10):1260-8. Epub 2008 Sep 6.

What the Gait Guys have to say about this article:

This article highlights some of the differences in gait between males and females on treadmills. Though treadmills don’t necessarily represent real life, they are an approximation. While reading this article, please keep the following in mind:

1. the treadmill pulls the hip into extension and places a pull on the anterior hip musculature, especially the hip flexors including the rectus femoris, iliopsoas and iliacus. This causes a slow stretch of the muscle, activating the muscle spindles (Ia afferents) and causing a mm contraction (ie the stretch reflex). This acts to inhibit the posterior compartment of hip extensors (especially the glute max) through reciprocal inhibition, making it difficult to fire them.

 2. Because the deck is moving, the knee is brought into extension, with stretch of the hamstrings, the quads become reciprocally inhibited (same mechanism above).

 3. The moving deck also has a tendency to put the ankle in dorsiflexion, initiating a stretch reflex in the tricep surae (gastroc/soleus) facilitating toe off through here and pushing you through the gait cycle, rather than pulling you through (with your hip extensors).

 4. the moving deck forces you to flex the thigh forward for the next footstrike (ie footstance), firing the RF, IP and Iliacus, and reciprocally inhibit the g max

If your core isn’t engaged, the pull of the rectus femoris and iliopsoas/iliacus pulls the ilia and pelvis into extension (ie increases the lordosis) and you reciprocally inhibit the erectors and increase reliance on the multifidus and rotatores, which have short lever arms and are supposed to be more proprioceptive in function. Can you say back pain?

In summary, treadmills are not the scourge of humanity, but do have some pitfalls for training, and equal amounts of “backwards” running should be employed (with great caution, mind you)

With that being said, lets look at the results: increased hip internal rotation and adduction, as well as more glute activity for the ladies. Not surprising considering women generally have a larger Q angle (17 +/- 3 degrees for females, 14 +/-3 degrees for males) and greater amounts of hip anteversion (average 14 degrees in females vs 8 in males). The larger Q angle places more stress at the medial knee (compression of the medial femoral condyle and usually increased pronation as the center of gravity over the foot is moved medially) and thus more control needed to slow pronation (from the glutes to control/augment internal rotation). Greater hip anteversion means the angle of the femoral head is greater than 12 degrees to the shaft of the femur. This moves the lower extremity into a more internally rotated position, approximating the origin and insertion of the adductors, making them easier to access. With an increased Q angle and easier access, greater demands are placed on adductors in single leg stance (which is considerably greater in running), This increased adductory moment places more demand on the gluteus medius (and contralateral QL) as well, to stabilize the pelvis and this correlates with speed and incline, also found in the study.

The take home message? Don’t throw away your treadmill! The treadmill can be an excellent diagnostic tool! Gluteal and adductor insufficiencies will be more visible (and probably more prevalent) in females, especially those running or walking on treadmills. The hip extension and ankle dorsiflexion moment created by a treadmillworks against some of the stabilizing mechanisms (glute inhibition, ankle dorsiflexor inhibition) and help to highlight some of the subtle gait abnormailities you may miss otherwise.

Abstract from Article

BACKGROUND: Gender differences in kinematics during running have been speculated to be a contributing factor to the lower extremity injury rate disparity between men and women. Specifically, increased non-sagittal motion of the pelvis and hip has been implicated; however it is not known if this difference exists under a variety of locomotion conditions. The purpose of this study was to characterize gender differences in gait kinematics and muscle activities as a function of speed and surface incline and to determine if lower extremity anthropometrics contribute to these differences.

METHODS: Whole body kinematics of 34 healthy volunteers were recorded along with electromyography of muscles on the right lower limb while each subject walked at 1.2, 1.5, and 1.8m/s and ran at 1.8, 2.7, and 3.6m/s with surface inclinations of 0%, 10%, and 15% grade. Joint angles and muscle activities were compared between genders across each speed-incline condition. Pelvis and lower extremity segment lengths were also measured and compared.

FINDINGS: Females displayed greater peak hip internal rotation and adduction, as well as gluteus maximus activity for all conditions. Significant interactions (speed-gender, incline-gender) were present for the gluteus medius and vastus lateralis. Hip adduction during walking was moderately correlated to the ratio of bi-trochanteric width to leg length.

INTERPRETATION: Our findings indicate females display greater non-sagittal motion. Future studies are needed to better define the relationship of these differences to injury risk.

PMID: 18774631 [PubMed - indexed for MEDLINE]

Yup, we’re gait nerds….Don’t laugh….You are too if you are reading this…..

The Gait Guys: finding other uses for treadmills, other than for hanging the laundry…..

Podcast 53: Debunking Treadmills & Recovery Strategies

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-53-debunking-treadmills-recovery-strategies

B. iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

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* Today’s show notes:

By this time next year, you could be 3D printing custom comfortable inserts for your shoes
http://gigaom.com/2014/01/26/by-this-time-next-year-you-could-be-3d-printing-custom-comfortable-inserts-for-your-shoes/

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LeBron James, Kevin Durant Help Spearhead NBA Popularity of Legs Recovery System
http://bleacherreport.com/articles/1932257-lebron-james-kevin-durant-help-spearhead-nba-popularity-of-legs-recovery-system#articles/1932257-lebron-james-kevin-durant-help-spearhead-nba-popularity-of-legs-recovery-system

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Mechanism of orthotic therapy for the painful cavus foot deformity
http://www.jfootankleres.com/content/7/½/abstract

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The influence of incline walking on joint mechanics

http://www.gaitposture.com/article/S0966-6362(14)00002-2/abstract

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Biomechanics Expert Debunks Treadmill-Running Myths
http://www.runnersworld.com/treadmills/biomechanics-expert-debunks-treadmill-running-myths

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Ice baths:

http://www.theactivetimes.com/cold-hard-truth-about-ice-baths

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8:38am Jan 21

Hi guys,

I’m hoping you can help.

I have a severely arthritic 2 MTPJ on my left foot.

It seems to trigger extreme hip flexor tightness which has twisted my whole body, right up to my neck and jaw.

I can’t seem to get any definitive answers as to how to turn off this protective hip flexor tightness. I’m concerned if it goes on much longer I’m going to develop bone spurs throughout my body. This would destroy my life.

Is there any surgery you recommend?

Or any type of Rocker soled shoe? I’ve tried MBT’s but I think the forefoot is stiff enough and my Hipflexor hasn’t calmed down properly.

Thank you so much if you decide to answer this

Richard

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Blog reader: moham17

How does subtalar supination/pronation affect plane deviations farther up the chain, specifically at the pelvis? I was going over some notes and found something saying that increased pronation leads to increased frontal plane motion at the pelvis during gait, and increased sup leads to increased transverse plane motion. However, in this video I was watching, the clinician states that increased sup will lead to increased frontal plane motion. Is this not a contradiction? Can both be true? Thanks

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Fighting falls with feedback: Virtual reality training improves balance | Lower Extremity Review Magazine
http://lowerextremityreview.com/issues/january/fighting-falls-with-feedbac-virtual-reality-training-improves-balance

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Brooks Transcend and Altra Olympus: Max Cushioning In a Lightweight Package Appears To Be The New Trend in Running Footwear

http://runblogger.com/2013/08/brooks-transcend-and-altra-olympus-max.html

Stacking of the joints, and something that can go wrong when they don’t stack well.

Here is a short, sweet and simple case to open up some thoughts.  We have read on several occasions  of people making changes to arm swing as a solitary independent issue.  Arm swing, when aberrant, is quite often a compensatory change to something else. It is quite often a problem in the opposite lower extremity.  We will be doing a 1 hour teleseminar in 2 weeks on www.onlinece.com on the topic of arm swing. Why don’t you come and join us ?

 This photo proves our point. It is clear to anyone that the right arm is far too abducted , yet it should make one question as to whether it is a product of the “failure to stack” the left lower limb. One should easily see that the right hip  has drifted beyond the perpendicular line of the left foot and that we are witnessing somewhat of a Trendelenberg presentation. The left hip should be over the left foot. We classify what we see  here however, as “stance phase” frontal plane sway. It is a POSSIBLE product of many things, but remember that what you see is a compensation around a functional or ablative problem, and not the actual problem most of the time.  One could easily hypothesize that the left gluteus medius is weak or that the left abdominals are frontal plane weak but these are only the two major assumptions most people make. Remember one of our cardinal rules, 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. So, do not forget to look at the right sided abdominal component here as well.  How about foot and ankle stability ? Something is causing her frontal plane drift. It is your job to find it and correct it, not the arm swing (unless you determine it as the cause). But it is not your job to guess !  

Is it luck or predictable fact that the left pelvis is left frontal plane deviating and that the right arm is right frontal plane deviating ?  Not in our opinion, she is trying to maintain balance and symmetry during power production.  Balance maintenance comes from many areas.

Because of the neurologically embedded crossed extensor reflex and cross crawl response that permeates all human locomotion, anything that changes one of the limbs, whether it be a direct limb issue or something to do with the stabilization of the limb can impair and change locomotion, motor pattern choices and programming.

So, be careful where you make your demanded changes in your clients and your athletes. If you are guessing you are playing with fire and potential injury. The patterns are centrally generated and not by conscious choice, and hence they should not be completely remedies by the athletes conscious choice.  According to Zehr, “Although the strength of coupling between the legs is stronger than that between the arms, arm and leg movements are similarly regulated by CPG activity and sensory feedback (e.g., reflex control) during locomotion.” (Neuroscientist. 2004 Aug;10(4):347-61. Regulation of arm and leg movement during human locomotion.Zehr EP, Duysens J. Rehabilitation Neuroscience Laboratory, University of Victoria, BC)

There is alot more to this topic, but you will just have to join us in two weeks on www.onlinece.com.  Third Wednesday of every month, 7pm central time, that is where you will find us !

shawn and ivo,

the gait guys