Podcast 152: Michael Lucchesi : Head Coach, Second City Track Club

/
IMG_2446.JPG

Michael Lucchesi : Head Coach, Second City Track Club
An insightful interview with a great coach, he is one to watch.

Links to find the podcast:
Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more.
Just Google "the gait guys podcast".

Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:
Apple podcasts:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:
https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

other links for today's show:

http://directory.libsyn.com/episode/index/id/11417267

Direct download: http://traffic.libsyn.com/thegaitguys/WOC3_mikeL_-_92719_5.06_AM.mp3

http://thegaitguys.libsyn.com/michael-lucchesi-head-coach-second-city-track-club


Find Michael at,

Secondcitytc.com

https://www.instagram.com/secondcitytc/

https://www.instagram.com/sctcelite/

https://www.facebook.com/secondcitytc/


The effects of aging on the proprioceptive system

/

When the nervous system breaks down, there are predictable patterns that we can see. Aging isn't that much different in the grand scale of things than some neurological disorders. Here is a brief video of a gentleman that presented to us with neck discomfort and limited range of motion. Step through it several times before proceeding.

Hopefully, you noted the following:

  • Increased arm swing on the right (or, decreased on Left)

  • Pelvic shift to the left on Left stance phase

  • Decreased step length on the left

  • Hip hike on Left during Right stance phase


The patient DOES NOT have a leg length deficiency.

We remember that there are 3 systems that keep us upright in the gravitational plane:

1. vision
2. vestibular system

3. proprioceptive system

We also remember that as one of these systems become impaired, the others will usually increase their function to help maintain homeostasis. All these systems are known to decline in function with aging. So we have 3 systems breaking down simultaneously.

Did you also note the head forward posture, to move the center of gravity forward? How about the subtle head tilt to the right and “bobble” right and left? Motions which have to do with the head are functions of the vestibular system. He is attempting to increase the input to these areas (by exaggerating movements) to increase input.

How about the glasses? Presbyopia (hardening of the lens) makes it more difficult to focus. Movement (detected largely by rods in the eyes have a much higher density than cones, which are for visual acuity). By moving the head, he provides more input to the visual (and thus nervous system)

Amplified extremity movements provide greater input to the proprioceptive system (muscle spindles and golgi tendon organs (GTO’s), as well as joint mechanoreceptors).

Think of the cortical implications (and effects on the cerebellum, the queen of motor activity and important component for learning). You are witnessing the cognitive effects of aging playing out on the ability to ambulate and its effect on gait.


So what do we do?

  • Improve quality of joint motion, whether that is mobilization or manual methods to improve motion where motion is lost. Perhaps acupuncture to help establish homeostasis and improve muscular function. There are many options.

  • Postural advice and exercises

  • Core work

  • Proprioceptive exercises (like head repositioning accuracy, heel to toe and heel to shin)

  • Gait retraining


You get the idea. Providing some of that increased input for him and helping the system to better process the information will be the key to improving his function and helping to counteract and maybe slow the effects of aging on the locomotor system.

We are the Gait Guys; giving you the info so we can all make a difference, every day


We will be talking about some principals of proprioceptive rehabilitation along with 2 cases of neurological disorders Wednesday evening for our "3rd Wednesdays" talk on online.com: Biomechanics 321. 5 PST, 6MST, 7CST, 8EST

Special thanks to RM, who allowed us to use this video for this discussion.

When the nervous system breaks down, gait becomes more primitive.

/

Whether we are looking at an injury or a neurological disorder, when something goes awry, we can almost always predict that the gait pattern will start to decompose. We can learn a lot about gait from watching this kiddo walk. An immature nervous system is very similar to one which is compensating meaning there will often "cheat" around a more proper and desirable movement pattern; we often resort to a more primitive state when challenges beyond our ability are presented. This is very common when we lose some aspect of proprioception, particularly from some peripheral joint or muscle, which in turn, leads to a loss of cerebellar input (and thus cerebellar function). Remember, the cerebellum along with the upper brainstem is a temporal pattern generating center so a loss of cerebellar sensory input leads to poor pattern generation output.

Watch this clip several times and then try and note each of the following:

  • Wide based gait; this is because proprioception is still developing (joint and muscle mechanoreceptors and of course, the spino cerebellar pathways and motor cortex)

  • increased progression angle of the feet: this again is to try and retain stability. External rotation allows them to access a greater portion of the glute max and the frontal plane (engaging an additional plane is always more stable).

  • Shortened step length: this keeps the center of gravity close to the body and makes corrections for errors that much easier This immature DEVELOPING system is very much like a mature system that is REGRESSING. This is a paramount learning point !)

  • Decreased speed of movement; this allows more time to process proprioceptive clues, creating accuracy of motion

  • Sometimes we see increased arm and accessory movements, again to try and increase proprioceptive input and provide additional stability.


Proprioceptive clues are an important aspect of gait analysis, in both the young and old, especially since we tend to revert back to an earlier phase of development when we have an injury or dysfunction.

We will be talking about these principals along with 2 cases of neurological disorders and more this Wednesday evening for our "3rd Wednesdays" talk on online.com: Biomechanics 321. 5 PST, 6MST, 7CST, 8EST


Dr Ivo Waerlop, one of The Gait Guys

#gaitanalysis #decompositionofgait #proprioception #neurologicaldisorder #thegaitguys






What a difference a few months makes

/

Take a look at the pre-and post videos of this gal with a forefoot supinatus and impaired motor control of her feet and core. Shuffle walks, foot intrinsic exercises, core work and gait retraining can go a long way! The important thing to remember here is that the patient was very motivated and did what was required to make things happen. A testament to tenacity and dedication

Dr Ivo Waerlop, one of The Gait Guys

#beforeandafter #gaitretraining #gaitanalysis #forefootsupinatus

Yep, these shoes stink for this gal...

/
IMG_6882.jpg

Look at the left shoe and compare it to the right. See how the upper is canted on the outsole? This “varus cant” can create lots of problems or could actually be beneficial, believe it or not, depending upon the pathology.

In this particular persons story, it was NOT a good thing. They have an anatomical short leg on the left-hand side. If you remember from following us here in the past, generally speaking, the shorter leg tide tends to be more supinated and the forefoot tends to be in more varus. This means more of a “reach” with that foot during the contact phase of gait, Whether that’s running or walking. This generally means that the forefoot will pronate more on the long leg side.

This shoe “defect“ may actually be benefit for someone who has too much rear or mid foot pronation as it would “delay” pronation by starting to rearfoot in an inverted position at heel strike.

The Fix?

You could grind the sole into varus an equal amount to equal the varus cant. In our opinion, not a good idea.

You could return the shoe (that’s what this person is doing) and get another one

In addition, you could…

Give the person a 3 mm sole lift to correct for the leg length discrepancy

Make sure they have adequate range of motion in the first ray on the short leg side to be be able to plantar flex the 1st ray and reach the ground

Make sure they have adequate control of the core musculature as well as foot intrinsic musculature during stance phase.

Dr Ivo Waerlop, one of The Gait Guys

#badshoes #theshoeistheproblem #forefootvarus #leglengthdifference
#gaitproblem

Podcast 151: Gait and neurology of movement, including, Tightness? shortness? What’s the difference? It's the Neurology.

/

Truths about Stretching, a case of sesamoiditis, plus exercised induced muscle damage and impaired motor learning, central fatigue, POSE and Chi running and injuries. This is a good one gang, do not miss it !

Links to find the podcast:
Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more.
Just Google "the gait guys podcast".

Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).

Our podcast is on iTunes and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:
Apple podcasts:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:
https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

Other links for today's show:

http://traffic.libsyn.com/thegaitguys/pod_151final.mp3

http://thegaitguys.libsyn.com/gait-and-neurology-of-movement-including-tightness-shortness-whats-the-difference-its-the-neurology

http://directory.libsyn.com/episode/index/id/11168369

Show notes and links:

We lose muscular Strength as we age.
Changes in supra-spinal activation play a significant role in the age-related changes in strength.
This motor system impairment can be improved by heavy resistance training
https://www.ncbi.nlm.nih.gov/pubmed/25940749

Age (Dordr). 2015 Jun;37(3):9784. doi: 10.1007/s11357-015-9784-y. Epub 2015 May 5.
Strength training-induced responses in older adults: attenuation of descending neural drive with age. Unhjem R1, Lundestad R, Fimland MS, Mosti MP, Wang E.

Osteoarthritis and running
https://journals.lww.com/acsm-csmr/Abstract/2019/06000/Running_Dose_and_Risk_of_Developing.5.aspx
Recent literature adds to a growing body of evidence suggesting that lower-dose running may be protective against the development of osteoarthritis, whereas higher-dose running may increase one's risk of developing lower-extremity osteoarthritis. However, running dose remains challenging to define, leading to difficulty in providing firm recommendations to patients regarding the degree of running which may be safe.

Can even experienced orthopaedic surgeons predict who will benefit from surgery when patients present with degenerative meniscal tears? A survey of 194 orthopaedic surgeons who made 3880 predictions
Non-surgical management is appropriate as first-line therapy in middle-aged patients with symptomatic non-obstructive meniscal tears.
https://bjsm.bmj.com/content/early/2019/08/12/bjsports-2019-100567

Sports Biomech. 2019 Jul 31:1-16. doi: 10.1080/14763141.2019.1624812. [Epub ahead of print]
Running biomechanics before and after Pose® method gait retraining in distance runners.
Wei RX1, Au IPH1, Lau FOY1, Zhang JH1, Chan ZYS1, MacPhail AJC1, Mangubat AL1, Pun G1, Cheung RTH1.

Plantar Plate Gait

/

This girl has a (healing) plantar plate lesion on the left hand side at the head of the second met. She also has an anatomical short leg on the same side. Her second metatarsal of both feet or longer than the first

A few things I hope you notice about the video:

  • Can you see how she “reaches“ to get to the ground with her left foot?

  • Can you see how her left foot is more inverted that strikes in the right, creating a greater amount of forefoot pronation that needs to be controlled?

  • Can you see how poor her motion control is of her pronation on the left foot with the sudden “crash” at impact?

  • Have you noticed her “crossover“ gait?


Does it make sense that because of her anatomy and running style, that the constant reach, increased forefoot inversion and lack of pronation control (which causes more abduction of the forefoot at toe off); this drives the force to the second metatarsal head which is longer and more prominent and is more than likely what led to her plantar plate lesion in the first place?


Remediation?

  • A 3 mm full length sole lift for the left foot

  • Foot intrinsic strengthening exercises

  • Hip abduction strengthening exercises/drills

  • Moving her more to a “midfoot strike” running gait with toes extended to engage the windlass


Dr Ivo Waerlop, one of The Gait Guys


#plantarplate #gaitanalysis #crossovergait #leglengthdifference #thegaitguys