Wouldn’t want to walk a mile in these shoes….
Read all about it here: http://www.dailymail.co.uk/femail/article-2041188/Top-teen-model-Lindsey-Wixson-takes-tumble-Versace-shoes-blame-her.html
Have a great Friday
Ivo and Shawn
Another Gait variant: The Apropulsive gait style
Here is another important video for all you gait fanatics out there. You will see some of these components in your athletes, patients, family or even yourself if you are paying enough attention.
These animated videos are great because they exaggerate the pathology. Here we see several things:
- excessive forward arm swing: this is attempting to create a forward propulsive action to help them move over the suspected primary biomechanical gait pathology.
- forward head “bobbing”: again, this is attempting to create a forward propulsive action to help them move over the suspected primary biomechanical gait pathology.
- a heavy forward lurching lean: this is attempting to create a forward propulsive action to help them move over the suspected primary biomechanical gait pathology.
- pronounced knee lift-hip flexion: this is attempting to create a forward propulsive action to help them move over the suspected primary biomechanical gait pathology.
So, what is driving all of these attempts to create more than normal forward propulsion ?
If you look down at the feet you see a lack of ankle rocker (dorsiflexion) as evidenced by early heel departure. This fella puts his foot on the ground and then tries to move across his ankle but he hits a restriction at the range limitation. He cannot move forward sufficiently to normalize a sound effective and efficient propulsive gait. At the moment his ankles lock out from hinging further forward he must go into the above strategies to pull his body mass forward past his foot plant and literally pull the foot off the ground and move forward to the next dysfunctional step. Everything he is doing is to try to create forward propulsion sufficient to move across ankles that do not dorsiflex enough.
* IMPORTANT: Remember: premature heel rise typically leads to premature activation of the calf muscles, gastrocsoleus. And when this happens, the gait becomes vertical and bouncy in nature as the calf muscles are being used to lift the body more than to propulse it forward. This can lead to posterior compartment injury. Additionally, this causes a quick premature forefoot loading response which can create increased burden on the METatarsal head and fat pad but it will also create a grip response of the toes and possible hammering which can disable the lumbricals and other foot intrinsic muscles).
And if that isn’t bad enough, on the sagittal views, we see the knees hinging outside the normal forward progression line and if that isn’t bad enough, on the views from behind he clearly is dipping the contralateral hip-pelvis during stance phase (when standing on the right leg, the left pelvis drops) which is a key sign of suspect gluteus medius weakness.
even the simple cases have nice topics for review. Failure to have sufficient components for effortless forward motion in gait will result in compensations to get the job done.
TAKE HOME POINT: identifying and restoring ankle rocker is pretty darn important. And that does not mean simply via stretching the posterior compartment. Frequently the anterior compartment is the weakness driving the pathology, but not always.
Pixar should call us……… Shawn and Ivo
The Guys of all things Gait
John Travolta’s Pathologic Gait “Strut”. One of the most memorable Hollywood gait patterns of all time !
First thing you must notice right away, even from the head shot as he exits the door, is the up and down head bob. We will get back to this most important part in #2 below and keep you in suspense.
Another thing you will see is that he has no arm swing, particularly on the right. He also is over pronated in his upper limbs which is what gives him the “kucxkles forward” primate-type hand position but that is not his fault we would guess, men typically have little skill in higher heeled footwear, in this case a cowboy-style boot (we are trying to give him a manly excuse, the men’s higher heeled nightlife footwear of the 1970’s wasn’t exactly manly in our opinion). Those things are hard enough walking in let alone what Travolta did in them on the dance floor. Our point here, most men are not used to the drop down onto the forefoot that comes from the initial heel strike on a higher heeled shoes. Men are not usually used to walking in such high heeled shoes, and so we do not realize that we have to dampen our instinct to heel strike. In these cases men have difficulty with two things:
1). with each successive step, again stepping back up onto the heeled shoe after just descending down onto the lower forefoot from the previous step is a challenge. In this video we see some of his strategy. If you watch closely you will see that the abnormal “knuckles forward” posturing of his upper limbs allows him to most likely get his pectorals and triceps more in to the posterior propulsive swing phase action in a manner of “pulling himself up and thrusting forward with each step”.
2), this is a continuation of #1 and what we were hinting at first off …… you see a abrupt up and down movement of his head in his initial exit from the doors of the club. This is once again a product of the higher heeled shoes-boots. Travolta is obviously a sufferer of anterior shin splints. After each heel strike he drops abruptly onto the forefoot with each step. This cycle is repeated and is synchronous and it is what gives the up and down head movement. It is what also gives him his “Strut”. He likely suffered with terrible anterior shin splints in this movie as a result of this. This is the type of gait you will see in young ladies new to high heeled shoes.
If one insists on choosing this footwear, this Up and Down oscillation strut can be mediated by:
1) shortening ones step
2) ensuring that the forward foot contact is met with as little difference between heel strike and forefoot load, meaning, that the wearer must move the foot forward in relative plantarflexion essentially always trying to stay on one’s forefoot, essentially trying to avoid heel strike as much as possible. Watch any woman skilled in high heel shoes, you will see this pattern. It is easier to stay plantarflexed and on the forefoot rather than suffer the slings and arrows of outrageous gait misfortune, that being clear heel striking and devastating your anterior compartment shin splint muscles and toe extensors.
Regardless, Travolta is still the man ……. on the dance floor or strutting down the streets of NYC in high heeled shoes or not. Don’t believe us men ? …… then head off to yo momma’s (or wife’s) closet and give it a shot …… we dare ya !
We remain, shockingly knowledgeable about high heels shoe biomechanics……. and pleading the 5th as to how we know this stuff .
…… we are both Staying Alive and Jive Talking, and still the undisputed heavyweight champs of all things gait. We are……
Shawn and Ivo …….. The Gait Guys
Barefoot? Minimalism? I thought barefoot WAS minimalist?
Barefoot fever has really caught on over the last year or so. It seemed to start with the advent of the Vibram 5 fingers several years ago (which Dr Waerlop was a biomechanics and design consultant for) and seems to have blossomed to include many different types of footwear.
In the strictest sense, barefoot means NO SHOES or UNSHOD. There are hygenic and social reasons we cover (or need to cover) our feet, and thus the advent of the many types and styles of footwear we are seeing crop up in stores everywhere. This shoes have minimal amounts of bells and whistles (read support and rigidity) and thus promote a barefoot STYLE of walking or running. These “shoes” also have a low (or no) ramp angle. The ramp angle is how much higher the heel is in elevation than the forefoot. Most traditional running shoes have a 2:1 ratio…..the heel is twice as high as the forefoot. The average might be a net 10-20mm rise in the heel height over the forefoot rendering a ramp angle of approximately 15degrees. So when we say barefoot and include these minimalistic shoes we are referring to shoes with a ramp angle of less than 2-3 degrees and less than 5 mm heel rise.
According the the last two studies published in Nature, by Dr Daniel Lieberman, barefoot or minimalistic activites appear to have many advantages: less stress on the joints, less impact forces on the body and increased proprioception (awareness of your body parts, in this case feet, in space).
The barefoot model is based on the simple fact that the movement of our anatomy for thousands of years has been always been that the heel and ball of our foot rest on the same plane. This is the ground work for the normal workings and biomechanics of the foot. When we take the heel and raise it onto a level above the forefoot (as most running and dress shoes do) the body will have to make biomechanical changes to that very same anatomy that loves level ground. It is now being proven over and over again that this altered positioning and corrupted biomechanics may be what are driving much of the foot and lower limb problems we see out in the world. Whether it is plantar fascitis, shin splints, achilles problem, toe problems, or just general foot or ankle pain, these altered biomechanics are highly suspicious culprits.
This is not to say that everyone can go barefoot or is ready to immediately go barefoot, despite the picture the shoe vendors and media are painting. Some folks have to gradually work their way down into lower ramp angled shoe affording the time and tissue changes that will come with adapting to different heel heights. It can take some time for the calf muscles and achilles to restore their original length or take time to regain the strength of the foot intrinsic muscles so that the foot can no longer depend on the shoe for stability but rather it can learn to depend on the anatomy of ligaments and muscles to provide the support like our shoeless ancestors of centuries past. This is where minimalsitic shoes come in. They provide a transition from where you are to where you want to be. Other folks have anatomic foot types that just cannot cope well with a pure “barefoot technique” and will probably need to remain in some type of transitional shoe.
There are exercises and drills, along with types of manual therapy and muscle activation techniques that can help speed the transition from your current footwear to being a minimalist. Make sure you consult with providers with plenty of experience that are familiar with and competent with these methods.
We are still 2 foot nerds, out there making a difference…The Gait Guys
Hip function and knee pain, again.
/
And once again…… another study validating the fact of weak hip stabilizing muscles in causing knee pain. The study showed that increased activation of the gluteus maximus in individuals with patellofemoral knee pain suggests that these subjects were attempting to recruit a weakened muscle, perhaps in an effort to stabilize the hip joint.
J Orthop Sports Phys Ther. 2009 Jan;39(1):12-9.
J Orthop Sports Phys Ther. 2009 Jan;39(1):12-9.
Differences in hip kinematics, muscle strength, and muscle activation between subjects with and without patellofemoral pain.
Souza RB, Powers CM.Source
Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
Hip rotation and knee pain. What we have been saying.
/We have been pounding the floor on this topic on and off for the last 6 months it seems. Lack of internal hip rotation or too much internal hip rotation ……. both abnormal hip kinematics, is a result of reduced hip-muscle performance as opposed to structural issues of the hip (anteversion, retroversion etc).
If you are not assessing for impaired hip muscle function in your knee patients, you could be missing the boat …….. and it is a big boat…… Titanic in size.
Don’t be like so many others and be tunnel visioned when you have a knee patient, expand your vision, at least to the hip and foot.
We are……. The Gait Guys……. Shawn and Ivo
________________________________________________________________________________
Am J Sports Med. 2009 Mar;37(3):579-87. Epub 2008 Dec 19.
Predictors of hip internal rotation during running: an evaluation of hip strength and femoral structure in women with and without patellofemoral pain.
Hey Check it out! John Wayne has either a Left short leg or a weak left Gluteus medius and a compensatory increased arm swing on the Right ! Watch for the lean to the left on Left stance phase and the arm swing to pull him through. WE guess even the Duke needs a hand sometimes !
The “Dukes” of Gait Shawn and Ivo
Going to try a new pair of shoes at the running store ? You better read this first. Shoe stores, shoe manufacturers, pay attention !
/Stiffness adaptations in shod running.
Source : J Appl Biomech. 2005 Nov;21(4):311-21.
Physiology Laboratory, PPEH Unit, University of Saint-Etiene, France.
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What The Gait Guys have to say about this article:
How long do you run in the shoes at the store before you decide whether they are a good match or feel for you ? This study suggests that if you take less than 4 minutes in a pair, you are not getting the accurate feel of the shoes. Your “running stiffness” takes at least 4 minutes to adapt and alter to a given shoes materials. Each shoe will likely feel different. Don’t be fooled by the EVA’s softness, or the sock liner’s plushness. They might be there to offset what this study found, that being…… shoe stiffness increased significantly during the first 4 minutes but beyond the 4th minute, shoe properties remained stable.
How many stores or shoe companies are telling you this one !?
Well, we are telling you right here and right now…….. first impressions are not always the best ones.
- “We don’t know where our first impressions come from or precisely what they mean, so we don’t always appreciate their fragility." - Malcom Gladwell
- also remember, your perception of how you think the shoe will perform will play a role as well. Remember this post? http://www.tumblr.com/tagged/impact-force
* Read the study’s conclusion below…… and think (and feel) before you buy. Read your favorite internet blogger’s shoe reviews with an educated eye, and an open mind. What they feel and report could very likely be the exact opposite of what you feel because their anatomy and running style could be very different from your own.
We are, without a doubt…… from all angles…….. The Gait Guys
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Abstract
When mechanical parameters of running are measured, runners have to be accustomed to testing conditions. Nevertheless, habituated runners could still show slight evolutions of their patterns at the beginning of each new running bout. This study investigated runners’ stiffness adjustments during shoe and barefoot running and stiffness evolutions of shoes. Twenty-two runners performed two 4-minute bouts at 3.61 m.s-1 shod and barefoot after a 4-min warm-up period. Vertical and leg stiffness decreased during the shoe condition but remained stable in the barefoot condition, p < 0.001. Moreover, an impactor test showed that shoe stiffness increased significantly during the first 4 minutes, p < 0.001. Beyond the 4th minute, shoe properties remained stable. Even if runners were accustomed to the testing condition, as running pattern remained stable during barefoot running, they adjusted their leg and vertical stiffness during shoe running. Moreover, as measurements were taken after a 4-min warm-up period, it could be assumed that shoe properties were stable. Then the stiffness adjustment observed during shoe running might be due to further habituations of the runners to the shod condition. To conclude, it makes sense to run at least 4 minutes before taking measurements in order to avoid runners’ stiffness alteration due to shoe property modifications. However, runners could still adapt to the shoe.
Article link: http://www.ncbi.nlm.nih.gov/pubmed/16498177 , get this article for yourself.
The Saucony Progrid Mirage
Well it has been about a year now and we have seen enough of our Track athletes, Mid distance, Cross Country, Marathon and IronMan athletes (by the way, congrats to our Tom K for a fantastic 8 place IN THE WORLD finish at the China Ironman this month. Guys like you make docs like us look really good !)……back to the post….. we have had enough athletes over the year in many different shoes. Months ago we were speaking somewhat favorably of the Saucony Kinvara, another 4mm rise minimalist shoe. Our only beef with it was that the black outsole burns out real fast and it shortens the life of the shoe. They really need to extend the black harder rubber outsole to the edges of the EVA foam on the sole. Turn a pair over, you will see what we mean.
So, we are now favoring another shoe in this category by this company. We have seen enough to feel that it is a nice alternative, and one you will barely notice the difference. But you should get a bit more life out of the shoe and it does have a small medial arch built into the midsole EVA which should help with some medial collapse if foot strike is not pristine from time to time.
Remember, minimalist shoes are not for everyone. You must have, or earn, a competent foot structure to earn the right to wear them. Walking, not such a big deal, for that we are a fan of this shoe. But for running, if you pronate beyond what is safe, this is not the animal for you.
happy shoe hunting…….. Shawn and Ivo
the gait guys
Circumducting gait.
This is a great video. This is a video we found on the internet. There is another one showing her with a much more pathologic steppage gait, we may bring this one to your attention another time. She may have had a cerebral event or mild stroke from what the other video showed. But we like this one, because it is subtle and much more likely what you are going to see day to day in your world.
We see here on the video a left sided circumducting gait. What this means is that the left limb is not swinging purely through the sagittal plane from heel lift-toe off phase to repeat heel strike again. Instead we see the foot sweep laterally. The foot moves immediately into an increased progression angle (turned out), and it sweeps around a half circular motion to repeat the contact phase again at heel strike.
In this case here it is clearly evident, especially on the lateral side view, that she is blocked out of left ankle rocker (dorsiflexion) for some reason. She does not even get to 90 degrees dorsiflexion range at the ankle mortise. She can no longer allow the treadmill to draw her left foot backwards because she hits this limitation. As the limitation is met, the foot must come forward now (because it cannot go anywhere else, certainly not backwards). But, she does not display enough right gluteus medius use to create hiking of the left hip to create the clearance necessary for this premature forward left leg swing. Thus, she has to spill the left leg out to the side in a circular-circumducting fashion to clear the limb from hitting the ground. She is also likely doing it because if you are not able to dorsiflex the ankle, you will be relatively plantarflexed at the ankle. And if you are plantarflexed, you are much more likely to catch your toe on the treadmill-ground during the swing through phase. This case is a problem of not creating sufficient clearance for the left foot.
Also take note of the subtle foot drop on the left. The foot cannot maintain adequate dorsiflexion, due to weakness of the anterior compartment (possibly from a cerebral event?). Did you see the lack of inversion of the left foot as well. This is usually accomplished by the tibialis anterior and long extensors, especially EHL, neither of which is seen (take a look at the amount of hallux extension on the R on the lateral view and compare it with the left). How about that subtle midfoot collapse as well?
There are other reasons for a circumducting gait. This is just one. Some are functional limitations, some are ablative orthopedic type limitations such as post surgical, some are neurological, and some are a combination. Taking a good history, knowing your gait parameters and assimilating the information will bring you to an answer.
Then you have to figure out what to do. In this case, we do not know, because we do not know what parameter is causing the compensation you see here. This is a good case of “what you see is not what is wrong, you are just seeing what they are doing while working around limitations and finding parts to use and cheat with” to still be able to more forward.
We are The Gait Guys, —- Ivo and Shawn
Why Runners need to take a page out of their automobile maintenance manual when it comes to running injury prevention.
Tissues have limits. They are like a tire, they only have so much tread on them before they show pathology. But like a tire, it takes time for a wear pattern to show up enough to make the tire wobble or the axle to pull the car mildly towards the ditch. Take a spinal disc, it has a certain number of compression and load cycles before it begins to desiccate, especially in the higher load / transition zones of the spine. Cartilage has a certain number of cycles before it begins to desiccate and crack/fissure and flake. Osteoarthritis then begins its slow sneaky onset. Tendons and ligaments have the same “limited lifespan” especially if loaded imperfectly with strained joint loads. Just because someone is pain free doesn’t mean they are safe. The abnormal load on an ITB band doesn’t begin the moment that pain presents itself. The problem brews in the background long before there is pain. Pain and injury represent a failure point in the mechanism. At this point it is too late. Being in medicine, we would be just like all the others if we crisis managed every athlete that walks in the door. So, we are in the game of prevention. We know our biomechanics, we know our orthopedics, physiology and neurology as good as the best out there. And so , we are well positioned on the front lines to identify problems before they ensue, and pick up on that aberrant wear pattern on the proverbial “tire” long before the pattern of wear is so bad that an injury is immanent and a foregone conclusion. So, this bodes the bigger question, just because you are injury free for many marathons and decades, doesn’t mean you shouldn’t take your car in , have its tires rotated, lug nuts snugged up, and alignment tweaked so that your car’s life will be maximized. Remember, unlike a car, we get one set of tires. We cannot replace bolts, we cannot remove the rust or put in a new oil or air filter. All we can do it make sure our “car” , our body, is working as best it can with the anatomical parts it has.
We do not think anyone would disagree that leaving alone and ignoring a 99% stenosed artery in the heart’s “widow maker” artery is a good idea just because someone hasn’t had a heart attack yet. Checking the body for malfunction early can prevent some unpleasant problems down the road. Pain or tightness is the dashboard’s “check engine” light. Regular check ups should keep that light off and reduce the sudden anxiety that comes when it turns on.
In summary, we take our cars in for tune up maintenance 2-3 times a year. And usually we drive away without the car driving too much different. But, we are at ease knowing it is in tip top shape and can go another 6000 miles before it might show signs of wear. We should do the same with our body and our gait mechanics and fix and change the little things that are sneaking up on us that could trigger that “check engine” light. By the time it comes on, it could be too late and require major repairs which just might keep your “car” off the road for awhile while repairs are made. No one likes to hear from the mechanic, “well Mr. Jones…….if we had checked up on this earlier before it was a big problem, we could have prevented this expensive set back on the sidelines.”
Our bottom line, even if your running is pain and injury free for years on end (which would make you a rare bird as runners go), it should make sense to you that improving biomechanical deficiencies isn’t likely a bad thing for the long term. Rather, it is probably the smartest of choices to keep you on your journey down the road, around the next bend, one efficient step after another.
“An ounce of prevention is worth a pound of cure”. -Ben Franklin
In this PART 2 installment of Applied Hip Gait Biomechanics, Dr. Allen delves deeper into a complex topic and attempts to bring it to a level that everyone can understand and implement. Here he talks about the hip mechanics in relation to pelvic stability and gait.
It is our goal to share as much of our collective 37 years of clinical experience as we can in a medium that is usable, friendly and understandable to all viewers.
Thanks for taking time out of your busy lives to care about watching our videos.
Shawn & Ivo, ……. The Gait Guys
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The New Brooks Pure Project line. 4 models in the line.
To set your understanding level for the entire video…… at the start he says the first shoe has a 14-10 offset. That means 10mm of foam under the forefoot, and 14 under the heel, almost a 1:1 heel rise:forefoot rise meaning that the heel is only raised 4 mm compared to the forefoot. This leaves a ramp angle probably well below 5 degrees, depending on your foot length. As he discusses the other 3 shoes, he will mention different offsets…… like 15-11 for the Pure Grit. Notice the net change is still 4mm offset. So they all have the same 4 mm heel rise. The 14-10 Pure Connect as the least amount of EVA foam under the foot, so you supposedly will “feel” the ground more. With less foam, you need to be a better shock absorber with your body. The Pure Flow is 18-14 offset, meaning more EVA foam for more cushion and shock absorption. Remember…. transitioning to minimalistic shoe wear like this means that your heel will be suddenly ~10 lower than it is used to in shoes. Your “trainers” , your older style shoes, have raised the heel and allowed for a slight shortening of the calf and achilles complex, let alone monkey’d around with the normal biomechanics that should have been occurring. So, suddenly dropping 10mm may take some time. Play it safe, start with every other short run, wean into them.
We have been waiting for this shoe line. We hope it holds up to our standards, and prior Brooks Standards.
The Gait Guys
Kicking gait?
/And now… A question from a reader….
Dr Allen- There are a few questions troubling me. The first one concerns the loss of the ankle rocker phase of gait which can have implications further up the kinetic chain. It concerns the interplay of gastroc and soleus. Is it possible for gastrocnemius to work as a knee extensor when the foot is in the closed chain position - especially if the bodies centre of mass has advanced in front of the knee joint ? Thanks - RB
Hi RB_____,
yes it is possible…….it is a retrograde movement as you have described.
it is not commonly seen, but can be, and usually manifests itself, in one of 2 ways.
Typically the client is more ligamentously lax than others……..and they tend to have a “kicking” type gait, where they thrust the leg out in front, like kicking a ball, with each step forward. This causes a heavy heel strike and locks the knee in preparation for midstance, and then follows your thinking. By the way, this client also seems to like standing in a hyperextended knee position at rest.
We remember that the gastroc soleus group begins to fire in the first 10% of stance phase (it is acting as a knee extensor here); to promote eccentric deceleration of the forward moving tibia, and continues to fire until terminal swing. It is believed the soleus provides much of the deceleration force and the gastroc assists in inverting the ankle at midstance and primarily flexes the knee at pre swing, just prior to toe off (Nordin, Frankel 2001). If the gastroc /soleus group fires prematurely, or excessively, particularly in prior to midstance, then we see the action you describe, and it manifests itself as premature heel rise and loss of ankle rocker.
A sudden hyperextesion at midstance or later, in a neurologically competent individual, is unlikely, as he force is too abrupt at this point and there is too much of a mechanical disadvantage.
We hope this helps explain things a bit. Please email us back if it doesn’t!
Uber Geeks, Shawn and Ivo
Listening to music while you run. Research shows there is something to it.
/J Sci Med Sport. 2011 Jul 29. [Epub ahead of print]
Effects of synchronous music on treadmill running among elite triathletes.
Terry PC, Karageorghis CI, Saha AM, D'Auria S.
Source
Department of Psychology, University of Southern Queensland, Australia; Centre of Excellence for Applied Sport Science Research, Queensland Academy of Sport, Australia.
Abstract
Music can provide ergogenic, psychological and psychophysical benefits during physical activity, especially when movements are performed synchronously with music. The present study developed the train of research on synchronous music and extended it to elite athletes using a repeated-measures laboratory experiment. Elite triathletes (n=11) ran in time to self-selected motivational music, a neutral equivalent and a no-music control during submaximal and exhaustive treadmill running. Measured variables were time-to-exhaustion, mood responses, feeling states, RPE, blood lactate concentration, oxygen consumption and running economy. Time-to-exhaustion was 18.1% and 19.7% longer, respectively, when running in time to motivational and neutral music, compared to no music. Mood responses and feeling states were more positive with motivational music compared to either neutral music or no music. RPE was the lowest for neutral music and highest for the no-music control. Blood lactate concentrations were lowest for motivational music. Oxygen consumption was lower with music by 1.0-2.7%. Both music conditions were associated with better running economy than the no-music control. Although neutral music did not produce the same level of psychological benefits as motivational music, it proved equally beneficial in terms of time-to-exhaustion and oxygen consumption. In functional terms, the motivational qualities of music may be less important than the prominence of its beat and the degree to which participants are able to synchronise their movements to its tempo. Music provided ergogenic, psychological and physiological benefits in a laboratory study and its judicious use during triathlon training should be considered.
