Welcome to News You Can Use!
Today, Dr Ivo talks about how to test and exercise the long lesser toe extensors to increase skill, endurance and strength.
It will literally take just over a minute of your time. Try it and then go teach others!
News you can use!
Welcome to Monday, folks. In this video, Dr Ivo talks you through The Gait Guys modification of the FIM (foot intrinsic muscle) or what is sometimes called the “short foot” exercise.
Now go do it!
Gait and Climbing: Part 1
Lucid Dreaming is the name of a rock in the Buttermilks of Bishop, California. This is no ordinary rock. It is a V15. Summiting this rock is basically only 3 moves off of 3 holds, from your fingertips. The remainder of the climb is sliced bread. If you can do the 3, you can get to the top. The problem is, only a handful of people in the world can do it. How hard can this be, after all you start sitting down.
Strength, stability, mobility, endurance, skill, experience, movement patterns … . it is all here, today, on The Gait Guys blog.
Author: Dr. Shawn Allen
There are things that other people can do in life that rattle your brain. These are tasks that these individuals make look fairly simple, but in actuality are nearly impossible to the average person. The honest fact is that many of us could do many of these things to a degree if we would dedicate a portion of our day to building the engine to perform these tasks, but the truth is that many of us would rather sit down and be entertained than get up and struggle.
Here on The Gait Guys blog, bipedal and quadrupedal gait has been discussed for over 5 years. Discussions have gone deep into the strange quadrupedal gait of Uner Tan Syndrome and have delved into the critical neurology behind CPG’s (Central Pattern Generators) which are neural networks that produce rhythmic patterned outputs. We have gone on and on about arm swing and how they are coordinated with the legs and opposite limb in a strategic fashion during walking running gaits.
Today I will look briefly at the interconnected arm and leg function in a high functioning human arguably one of the best new hot shots in climbing, Alex Megos. This year the German, as seen in this video link today, managed to summit Lucid Dreaming, a V15 in the Buttermilks of Bishop, California. Hell, you can say that this is just a big boulder, but there are not many V15s in the world like this one. Only a few of the very best in the world have even tried this rock, and you can count even fewer who have reached the summit. So, what does V15 mean to you? “virtually impossible” just about sums it up. Watch the video, this V15 starts from a “sit-start”, many folks wouldn’t even get their butts off the ground to complete the first move, that is how hard this is. Watch the video, if this does not cramp your brain, you perhaps you don’t have one.
Are there possible neurologic differences in climbers such as Megos as compared to other quadruped species? Primarily, there is suspect of an existing shift in the central pattern generators because of the extraordinary demand on pseudo-quadrupedal gait of climbing because of the demand on the upper limbs and their motorneuron pools to mobilize the organism up the mountain. We know these quadrupedal circuits exist. In 2005 Shapiro and Raichien wrote “the present work showed that human QL(quadrupedal locomotion) may spontaneously occur in humans with an unimpaired brain, probably using the ancestral locomotor networks for the diagonal sequence preserved for about the last 400 million years.”
As we all know, the interlimb coordination in climbing and crawling biomechanics shares similar features to other quadrupeds, both primate and non-primate, because of similarities in our central pattern generators (CPG’s). New research has however determined that the spaciotemportal patterns of spinal cord activity that helps to mediate and coordinate arm and leg function both centrally, and on a cord mediated level, significantly differ between the quadruped and bipedal gaits. In correlation to climbers such as Megos however, we need to keep in mind that the quadrupedal demands of a climber (vertical) vastly differ in some respects to those of a non-vertical quadrupedal gait such as in primates, in those with Uner Tan Syndrome and during our “bear crawl” challenges in our gyms. This should be obvious to the observer in the difference in quadrupedal “push-pull” that a climber uses and the center-of-mass (COM) differences. To be more specific, a climber must reduce fall risk by attempting to keep the COM within the 4 limbs while remaining close to the same surface plane as the hands and feet (mountain) while a primate, human or Uner Tan person will choose to “tent up” the pelvis and spine from the surface of contact which narrows the spreading of the 4 contact points. Naturally, this “tenting up” can be reduced, but the exercise becomes infinitely more difficult, to the point that most cannot quadrupedally ambulate more than a very short distance. I will discuss this concept in Part 2 of this series on climbing. If you study childhood development and crawling patterns, you need to be familiar with UTS (search our blog, save yourself the time), the flaws in the neurology behind the "Bird Dog” rehab pattern, and crawling mechanics … and of course, study climbers.
Some research has determined is that in quadrupeds the lower limbs displayed reduced orientation yet increased ranges of kinematic coordination in alternative patterns such as diagonal and lateral coordination. This was clearly different to the typical kinematics that are employed in upright bipedal locomotion. Furthermore, in skilled mountain climbers, these lateral and diagonal patterns are clearly more developed than in study controls largely due to repeated challenges and subsequent adaptive changes to these lateral and diagonal patterns. What this seems to suggest is that there is a different demand and tax on the CPG’s and cord mediated neuromechanics moving from bipedal to quadrupedal locomotion. There seemed to be both advantages and disadvantages to both locomotion styles. Moving towards a more upright bipedal style of locomotion shows an increase in the lower spine (sacral motor pool) activity because of the increased and different demands on the musculature however at the potential cost to losing some of the skills and advantages of the lateral and diagonal quadrupedal skills. Naturally, different CPG reorganization is necessary moving towards bipedalism because of these different weight bearing demands on the lower limbs but also due to the change from weight bearing upper limbs to more mobile upper limbs free to not only optimize the speed of bipedalism but also to enable the function of carrying objects during locomotion.
The take home seems to suggest that gait retraining is necessary as is the development of proper early crawling and progressive quadruped locomotor patterns. Both will tax different motor pools within the spine and thus different central pattern generators (CPG). A orchestration of both seems to possibly offer the highest rewards and thus not only should crawling be a part of rehab and training but so should forward, lateral and diagonal pattern quadrupedal movements, on varying inclines for optimal benefits. Certainly I need to do more work on this topic, the research is out there, but correlating the quad and bipedal is limited. I will keep you posted. Be sure to read my 3 part series on Uner Tan Syndrome, here on The Gait Guys blog. Some of today’s blog is rehash of my older writings, naturally I am setting the stage for “Part 2″ of Climbing.
- Dr. Shawn Allen
References:
Shapiro L. J., Raichien D. A. (2005). Lateral sequence walking in infant papio cynocephalus: implications for the evolution of diagonal sequence walking in primates. Am. J. Phys. Anthropol.126, 205–213 10.1002/ajpa.20049
Scand J Med Sci Sports. 2011 Oct;21(5):688-99. Idiosyncratic control of the center of mass in expert climbers. Zampagni ML , Brigadoi S, Schena F, Tosi P, Ivanenko YP
J Neurophysiol. 2012 Jan;107(1):114-25. Features of hand-foot crawling behavior in human adults. Maclellan MJ, Ivanenko YP, Cappellini G, Sylos Labini F, Lacquaniti F.
Thoughts on the adductor grouping to ponder.
I found this while prepping for the dry needling course I am teaching this weekend and thought you may enjoy it. Though the primary actions of the addcutors are well established, secondary actions (whether they are acually internal or external rotators) remains to be elucidated.
Here is a nice abstract that supports the dynamic function of them as external rotators (eccentrically) during gait.
“Anatomical texts agree on most muscle actions, with a notable exception being the action of the adductors of the hip in the transverse plane. Some texts list an action of the adductor brevis (AB), adductor longus (AL), and/or adductor magnus (AM) as internal rotation, whereas others list an action of external rotation. The purpose of this article is to present a functional model in support of the action of external rotation. Transverse plane motion of the femur at the hip during normal gait is driven by subtalar joint motion during the loading response, terminal stance, and preswing phases. During the loading response, the subtalar joint pronates, and the talus adducts. This talar adduction results in the lower leg, and subsequently the femur, internally rotating. During terminal stance and preswing, the opposite occurs; the subtalar joint supinates as the talus abducts in response to forces generated from the lower extremity and in the forefoot. Electromyographic (EMG) studies indicate varied activity in the AB, AL, and AM during the loading response, terminal stance, and preswing phases of the gait cycle. A careful analysis of EMG activity and kinematics during gait suggests that, in the transverse plane, the adductors may be eccentrically controlling internal rotation of the femur at the hip during the loading response, rather than the previously reported role as concentric internal rotators. In addition, these muscles may also concentrically produce external rotation of the femur at the hip during terminal stance and preswing. Physical therapists should consider this important function of the hip adductors during gait when evaluating a patient and designing an intervention program. Anatomical texts should consider listing the concentric action of external rotation of the femur at the hip as one action of the AB, AL, and AM, particularly when starting from the anatomic position.”
Leighton RD. A functional model to describe the action of the adductor muscles at the hip in the transverse plane.Physiother Theory Pract. 2006 Nov;22(5):251-62.Leighton RD. A functional model to describe the action of the adductor muscles at the hip in the transverse plane.Physiother Theory Pract. 2006 Nov;22(5):251-62.
The Minimalist Shoe Index, Pincer toe nails, toe problems, anteromeniscofemoral impingement syndrome and much more on today’s show !
A. Link to our server: http://traffic.libsyn.com/thegaitguys/pod_96f.mp3
Direct Download: http://thegaitguys.libsyn.com/podcast-96
Other Gait Guys stuff
B. iTunes link:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138
C. Gait Guys online /download store (National Shoe Fit Certification & more !)
http://store.payloadz.com/results/results.aspx?m=80204
D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”
-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:
-Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E
-Barnes and Noble / Nook Reader:
http://www.barnesandnoble.com/w/pedographs-and-gait-analysis-ivo-waerlop-and-shawn-allen/1112754833?ean=9781466953895
https://itunes.apple.com/us/book/pedographs-and-gait-analysis/id554516085?mt=11
-Hardcopy available from our publisher:
http://bookstore.trafford.com/Products/SKU-000155825/Pedographs-and-Gait-Analysis.aspx
Show notes:
1. New Cameras In Japan Can Detect Drunks At Train Stations
http://www.popsci.com/cameras-japan-detect-drunks-train-stations
2. It takes a lot of nerve: Scientists make cells to aid peripheral nerve repair
http://www.medicalnewstoday.com/releases/297854.php
-Scientists at the University of Newcastle, UK, have used a combination of small molecules to turn cells isolated from human skin into Schwann cells
3. The Minimalist Shoe Definition study
http://www.jfootankleres.com/content/8/1/42
A consensus definition and rating scale for minimalist shoes
Jean-Francois Esculier123, Blaise Dubois13, Clermont E. Dionne14, Jean Leblond2 andJean-Sébastien Roy12* http://www.jfootankleres.com/content/8/1/42
modified Delphi study, 42 experts from 11 countries
http://www.jfootankleres.com/content/supplementary/s13047-015-0094-5-s1.pdf
-Results
The following definition of minimalist shoes was agreed upon by 95 % of participants: “Footwear providing minimal interference with the natural movement of the foot due to its high flexibility, low heel to toe drop, weight and stack height, and the absence of motion control and stability devices”. Characteristics to be included in MI were weight, flexibility, heel to toe drop, stack height and motion control/stability devices, each subscale carrying equal weighing (20 %) on final score.
4. CASE:
Ivo: broken toe, prioprioception
this: http://www.ncbi.nlm.nih.gov/pubmed/2245598
and this http://www.ncbi.nlm.nih.gov/pubmed/19955289
5. CASE: anterior meniscofemoral impingment syndrome
http://tmblr.co/ZrRYjx1d8503W
http://thegaitguys.tumblr.com/post/17713779565/anterior-knee-pain-in-a-young-marathon-hopeful
6. Pincer Toe nails:
http://thegaitguys.tumblr.com/post/127638788139/pincher-nails-who-knew-note-there-are-two–
As this study suggests, it has been difficult to find studies that establish a clear connection between gait stability and gait speed. One can easily assume that slowing down increases stability, we do it on slippery surfaces, we do it when a joint is painful, even the elderly do it naturally everyday. Walking speed, step length, step frequency, step width, local dynamic stability , and margins of stability were measured in this study below. It was found that the subjects did not change walking speed in response to the balance perturbations rather they made shorter, faster, and wider steps with increasing perturbation intensity. They became locally less stable in response to the perturbations but increased their margins of stability in medio-lateral and backward direction.
So what did they conclude ? Here are their words,“In conclusion, not a lower walking speed, but a combination of decreased step length and increased step frequency and step width seems to be the strategy of choice to cope with medio-lateral balance perturbations, which increases Margins of Stability (MoS) and thus decreases the risk of falling.”
It is my assumption, and this just seems logical, that if the perturbations were to continue constantly, that one would slow the gait speed to reduce the need for these shorter, faster and wider steps.
Dr. Shawn Allen
http://www.ncbi.nlm.nih.gov/pubmed/22464635
Gait Posture. 2012 Jun;36(2):260-4. doi: 10.1016/j.gaitpost.2012.03.005. Epub 2012 Mar 29.Speeding up or slowing down?: Gait adaptations to preserve gait stability in response to balance perturbations.Hak L1, Houdijk H, Steenbrink F, Mert A, van der Wurff P, Beek PJ, van Dieën JH.
Unique adaptations to arm swing challenges: the one armed runner. Welcome to Luke Ericson, an amazing athlete and man.
Written By Dr. Shawn Allen
Human gait is cyclical. For the most part, when one limb is engaged on the ground (stance phase), the other is in swing phase. Before I continue, you should recall that there is a brief double limb support phase in walking gait, that which is absent in running gait. Also, I wish to remind you of our time hammered principle that when the foot is on the ground the glutes are heavily in charge, and when the foot is in the air, the abdominals are heavily in charge.
For one to move cleanly and efficiently one would assume that the best way to do that would be to ensure that the lower 2 limbs are capable of doing the exact same things, with the same timing, same skill, same endurance and same strength. This goes for the upper 2 limbs as well, and then of course the synchronizing of the 4 in a cohesive effort. For this clean seamless motor function to occur, one must assume that there would be no injuries that had left a remnant mark on one limb thus encouraging a necessary compensation pattern in that limb (and one that would then have to be negotiated with the opposite limb as well as the contralateral upper or lower limb).
Removing a considerable mass of tissue anywhere in the body is going to change the symmetry of the body and require compensations. One can clearly see the effects of this on this athletes body in the video above. He even eludes to the fact that he has a scoliosis, no surprise there. There is such an unequal mass distribution that there is little way the spine had any chance to remain straight. Not only is this going to change symmetry from a static postural perspective (bulk, weight, fascial plane changes, strength etc) but it will change dynamic postural control, mobility and stability as well as dynamic spinal kinematics. I have talked about this previously in a blog piece I wrote on post-mastectomy clients display changes in spatiotemporal gait parameter such as step length and gait velocity.
-mastectomy post: http://tmblr.co/ZrRYjx1XB8RhO
If you have been with The Gait Guys for more than a year you will know that impairing an arm swing will show altered biomechanics in the opposite lower limb (and furthermore, if you alter one lower limb, you begin a process of altering the biomechanical function and rhythmicity of the opposite leg as well.) You can search the blog for “arm swing part 1 and part 2″ for those dialogues.
Arm swing impairment is a real issue and it is one that is typically far overlooked and misrepresented. The intrinsic effects of altering the body through subtraction of tissue are not all that dissimilar to extrinsic changes into the system from things like walking with a handbag/briefcase, walking with a shoulder bag, walking and running with an ipod or water bottle in one hand. And do not forget other intrinsic problems that affect spinal symmetry, for example consider the changes on the system from scoliosis as in this case. It can cycle back on its own feedback loop into the system, either consciously or unconsciously altering arm swing and thus global body kinematics.
There is a reason that in my practice I often assess and treat contralateral upper and lower limbs as well as to address remnants from old injuries whether they are symptomatic or not. It all comes together for the organism as a concerted effort in optimal locomotion.
Here on TGG, and in dialogues with Ivo on our podcast, I have long talked about phasic and anti-phasic motions of the arms and shoulder-pelvic blocks during gait and locomotion/sport activity. I have written several times about the effects of spine pain and how spine pain clients reduce the anti-phasic rotational (axial) nature of the shoulder girdle and pelvic girdle. In the video above, you can see anything but anti-phasic gait, to be clear, this is a classic representation of a phasic gait. The shoulder block and the pelvic block show little if any counter rotation, they are linked together which is not normal gait. Furthermore, if you look carefully, the timing of the right arm swing is variable and cyclically changing in its timing with the left leg. Look carefully, you will see the cyclical success and failure at the beginning of the video. This is pathologic gait, he must be constantly fighting frontal plane sway because there is no axial anti-phasic motion. He is also constantly fighting the unidirectional rotation that the absence of an entire limb and limb girdle is presenting, you can see him struggle with this if you have looked at enough gait samplings. There is essentially frozen torso movements. Want to see more of our work on arm swing ? search the gait guys blog.
There is so much more here to discuss, so I will likely return to this video another time to delve into those other things on my mind. Luke is an amazing athlete, he gets much respect from me.
I hope this dialogue helps you to get a deeper grip on gait and gait problems. I have written many articles on the topics of arm swing, phasic and anti-phasic gait, central pattern generators. The are all archived here on the blog. I try to write a new original thought-process article each week for the blog amongst the other “aggregator” type stuff we share from other folks social media. My weekly article serves to go deeper into things, sometimes they are well referenced and in this case, I am basing today’s discussion on the referenced work in the other pieces I have written on arm swing, phasic and anti-phasic gait, central pattern generators etc. So please do your readings there before we begin debate or dialogue, which i always welcome !
Dr. Shawn Allen
Dr Ivo demonstrating a dry needling technique for the abductor hallucis brevis
!!!! Don’t deny it, you are curious, and so are we smile emoticon We are easily distracted by bright shiny things and this one sure has the “wait, what the #$%&@ was that !” factor.
Inspired by the oversized tires found on “Fat Bikes”, the Michelin® Wild Gripper outsole welcome to the UnderArmor Fat Tire GTX Trail shoe.
2015 “Outside Gear Of The Show” Winner.
Could be a disaster or an ingenious idea. We hope to get a pair to review and let our brethren here know.
https://www.underarmour.com/…/mens-ua-fat-tire-g…/pid1262064
Chronic achilles-problem clients, slow or non-responders ?
This study suggested that , “Degenerative arthritic changes of the posterior calcaneal wall cartilage characterize patients with IAT (insertional achilles tendonotpathy) and the severity of such changes is directly correlated to the degree of functional impairment.”
Read up… . .
We have a strong show for you today. Ankle instability from a neurologic perspective, shoe wear, head tilt and the neurologic and functional complications… we also talk about Efferent Copy and motor learning.
A. Link to our server:
http://traffic.libsyn.com/thegaitguys/pod_95final.mp3
Direct Download: http://thegaitguys.libsyn.com/pod-95
-Other Gait Guys stuff
B. iTunes link:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138
C. Gait Guys online /download store (National Shoe Fit Certification & more !)
http://store.payloadz.com/results/results.aspx?m=80204
D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”
-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:
-Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E
-Barnes and Noble / Nook Reader:
http://www.barnesandnoble.com/w/pedographs-and-gait-analysis-ivo-waerlop-and-shawn-allen/1112754833?ean=9781466953895
https://itunes.apple.com/us/book/pedographs-and-gait-analysis/id554516085?mt=11
-Hardcopy available from our publisher:
http://bookstore.trafford.com/Products/SKU-000155825/Pedographs-and-Gait-Analysis.aspx
Show notes:
Human exoskeletons: The Ekso
http://www.thedailybeast.com/articles/2015/08/03/the-mechanical-exoskeleton-shaping-the-future-of-health-care.html
Ankle muscle strength influence on muscle activation during dynamic and static ankle training modalities
http://www.tandfonline.com/doi/abs/10.1080/02640414.2015.1072640?rfr_id=ori%3Arid%3Acrossref.org&url_ver=Z39.88-2003&rfr_dat=cr_pub%3Dpubmed&#.VcYWR-1VhBc
Chronic ankle instability:
http://tmblr.co/ZrRYjx1akudcm
http://tmblr.co/ZrRYjx1ah6ThV
http://thegaitguys.tumblr.com/post/68785250796/just-because-a-muscle-tests-weak-doesnt-mean-it
http://thegaitguys.tumblr.com/post/117109093439/last-week-we-ran-an-archived-piece-named-just
the future of footwear and orthotics ?
http://lermagazine.com/special-section/conference-coverage/the-future-of-footwear-and-orthoses-is-here-now-what
squats- head posture-gait vision-gravity
http://thegaitguys.tumblr.com/search/vision
Music: brain rhythm
http://www.kurzweilai.net/the-brains-got-rhythm
Last year we were two of 42 experts worldwide from 11 countries asked to participate and offer our thoughts in an investigation whose goal it was to come up with a rating scale and definition for minimalist shoes.
Here is that study:
A consensus definition and rating scale for minimalist shoes. Jean-Francois Esculier123, Blaise Dubois13, Clermont E. Dionne14, Jean Leblond2 andJean-Sébastien Roy. Journal of Foot and Ankle Research 2015, 8:42
here is a link for that study: http://www.jfootankleres.com/content/8/1/42
This study was performed by very capable and respected folks so you should pay attention.
Here was their background statement:
“While minimalist running shoes may have an influence on running biomechanics and on the incidence of overuse injuries, the term “minimalist” is currently used without standardisation. The objectives of this study were to reach a consensus on a standard definition of minimalist running shoes, and to develop and validate a rating scale that could be used to determine the degree of minimalism of running shoes, the Minimalist Index (MI).”
We might not do the study justice if we paraphrased the conclusions, so here they are as written,
“The following definition of minimalist shoes was agreed upon by 95 % of participants: “Footwear providing minimal interference with the natural movement of the foot due to its high flexibility, low heel to toe drop, weight and stack height, and the absence of motion control and stability devices”. Characteristics to be included in MI were weight, flexibility, heel to toe drop, stack height and motion control/stability devices, each subscale carrying equal weighing (20 %) on final score.”
So why is this study important ? Well, it creates a common term, a standardized definition, we can all agree upon which is paramount for clear communication amongst professionals in fields (shoe fitters, shoe fabricators, clinicians and researchers) who are dealing with these types of shoes. This study also create a rating scale that will be meaningful to all users in all related fields, again allowing a common dialogue with standardized meaning. From this study they wisely recommended “the shoe industry use such standardised ratings to orientate the running community when selecting their running shoes”.
This is an important study, it should be part of your knowledge and vocabulary. You should familiarize yourself to the rating scale.
Shawn and Ivo, the gait guys
Gait and Concussions.
The big movie trailer just came out yesterday, click on the link above to watch the trailer for “Concussion” with Will Smith, slated for theater release in December 2015. Hopefully this will raise even more awareness to TBI (traumatic brain injury), and remember, minimal TBI falls into these categories and discussions.
Here is just a small sampling of some of the complications of concussions on human gait. Head injuries are no joke, their effects on dynamic motor control and sensory-motor integration are potentially serious issues. From the first 4 references that came up on the pubmed search this is what was mentioned:
- “the ability to control and maintain stability in the frontal plane during walking is diminished under divided attention” (1)
- “Adolescents with concussion displayed increased center-of-mass medial/lateral displacement and velocity during dual-task walking after RTA (return to activity), suggesting a regression of recovery in gait balance control. This study reinforces the need for a multifaceted approach to concussion management and continued monitoring beyond the point of clinical recovery.” (2)
- “concussion may have long-term observable and measurable effects on the control of gait stability”(3)
- “persons with a history of concussion adopt a more conservative gait strategy”.(4)
Do you see something strange on your client’s gait analysis ? Have you asked them about previous concussions and head injuries? Perhaps you should. Take mTBI seriously, this is not a trivial matter.
Dr. Shawn Allen, one of the gait guys
References:
1. Clin Biomech (Bristol, Avon). 2005 May;20(4):389-95. Epub 2005 Jan 28.The effect of divided attention on gait stability following concussion.Parker TM1, Osternig LR, Lee HJ, Donkelaar Pv, Chou LS.
2. Med Sci Sports Exerc. 2015 Apr;47(4):673-80. doi: 10.1249/MSS.0000000000000462.Return to activity after concussion affects dual-task gait balance control recovery.Howell DR1, Osternig LR, Chou LS.
3.Med Sci Sports Exerc. 2006 Jun;38(6):1032-40.Gait stability following concussion.Parker TM1, Osternig LR, VAN Donkelaar P, Chou LS.
4. Arch Phys Med Rehabil. 2011 Apr;92(4):585-9. doi: 10.1016/j.apmr.2010.11.029.The chronic effects of concussion on gait.Martini DN1, Sabin MJ, DePesa SA, Leal EW, Negrete TN, Sosnoff JJ, Broglio SP.
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