Month: March 2012

During a recent trip to the zoo with the family, I noticed this young lady walking in front of me (yes, We ALWAYS have a camera with us and YES, We ALWAYS look at everyone’s gait and YES, we really are that geeky).

Watch the clip a few times and note these points about the gal on the left; keep in mind, she could have hip or muscle pathology as well

  • notice the subtle toeing in (decreased progression angle) of the feet, most likely due to internal tibial torsion
  • notice how she doesn’t have her shoes tied; this would necessitate her clenching or clawing her toes to keep her shoes from falling off. This inhibits the activity of the glutes and causes her to have to extend from the hams and lumbar spine; as a result, note how straight she keeps her legs when ambulating
  • there is little to no ankle rocker; she goes from heel rocker to forefoot rocker
  • premature heel rise
  • due to the lack of hip extension and decreased activity of glute max, note how she “rotates” around each leg
  • how about that cross over gait?

Fixes?

For starters:

  • tie your shoes
  • 1 legged standing exercises, being careful to keep hips level and not have a pelvic shift
  • walk with toes up or slightly extended during all phases except for that brief moment during midstance where you need the toes for balance and ground purchase
  • shuffle exercises to engage glute max
  • never wear pants that are sooooo tight that you cannot generate normal fluid gait

Ivo and Shawn…The Gait Geeks…We leave no gait unanalzed…even at the zoo. Watch it; we may have YOU on film!

Running, Einstein, Gravitational Push and Space. What do they have in common ?

WAIT !  Don’t watch the video just yet !  Read this first paragraph first !

Yes, you read it right. Gravitational PUSH.  Did your physics teachers mislead you ?  There is no such thing as Gravitational “Pull”.  Actually it is most accurate to say atmospheric push. Gravity does not pull us to the ground, space (as in the atmosphere) is pushing down on us. Space and time are curved and adjustable, Einstein proved this. You must be saying, “Oh Gait Guys, you are going way too deep now !”.  No, we are not. And you need to know this if you run or walk. It is simple. Your 5th grader will understand this and so should you !   Watch the video for a very nice explanation of what we are going to discuss today, atmospheric PUSH, start at the 3:30 mark for support for our point today.  If you choose not to watch this video today, it is your loss.  You will be depriving yourself of some of the most important information and logic there has ever existed in science. There is a big difference between pull and push.  Ask anyone who has had a car breakdown and had to push it off the road. Ask any weightlifter as well.

What does this have to do with running, walking and gait ?

Well, it is pretty simple.  This is yet another reason why posture is dependent upon the extensors such as the gluteals, the quadriceps, the cervical spine extensors, the thoracolumbar paraspinals, the abdominals etc.  These muscles must be strong enough to resist the push of Space down upon our bodies. Think of it this way, what muscles would have to work harder and be more isometrically and eccentrically strong and endurance trained if you had to carry a 100 pound person on your shoulders all day ?  It is much the same as if you were carrying a bunch of extra winter fat on your body. You will need more of these extensors otherwise you will begin to break down into compensations. 

With the natural motion of pronation during impact loading we need to dampen the internal spin of the hip, femur and tibia to resists the pronatory forces from space pushing down on us. 

So, our neuromuscular system has evolved to resist this push, and that job lies largely with the antigravity extensor muscles, which keep us upright. The elderly eventually begin to lose this battle as they weaken and posturally decompose. These muscles are powered by a special part of our our brain, largely the cerebellum, assisted by the vestibular apparatus (inner ear). Remember that there are 3 systems that keep us upright; vision, the vestibular system and the proprioceptive system. The interplay of these 3 systems is what Newton was trying to figure out and Einstein was eluding to.

This is one of the reasons orthotics (for the long term) often, but not always of course,  do not make sense.  Space pushing down on us and thus space pushing our body mass down onto our tri-arched foot (what we have come to understand as gravitational pull, which is technically misspeaking of the facts) is a large part what creates the pronation; with the musculature of the lower kinetic chain assisting in slowing it.  Slapping an orthotic under the foot to resist this force is not a permanent solution; it is often a temporary fix to a long term problem. This returns us to the hypothesis of today’s post, gravitational pull or Space push. Which is smarter, pushing up against the downward pressure of Space push (orthotic) or finding a better way of using the body’s anatomy to pull up against it ?  Which makes us stronger and a better human and athlete ? Finding better skill, endurance and strength (there it is again, S. E. S.) in the anti-gravitational muscles if you will, such as the toe extensors, tibialis anterior and posterior and foot intrinsics as well as those muscles above that are not dampening internal spin (medial quads, gluteals, lower abdominals)  is the answer if you really want to fix it.  Often times, a stability shoe is much the same as the orthotic; it provides dampening and slows pronation, or “resists” the push of gravity. It can sometimes be helpful in the short term; creating mechanics that you do not have; but is seldom good for the long term (though in some cases they are necessary, we are not negating their occasional beneficial use). We just ask that you, or at least your orthotist,  use your/their brain when making that decision.

As we always say, there are so few people who truly understand the neuro-ortho-biomechanics of the human parts going into the shoe that we get  all caught up in the shoe as the solution.  The solution is S. E. S.  , if you still  have the anatomy to get there.

Shawn and Ivo ………. two Uber geeks today.  They are the kind of guys who keep neurology and physics textbooks beside the toliet rather than Sports Illustrated Swimsuit issues.  Hey, we try to keep it simple. We like to pick the low hanging fruit just like everyone else. But it is the higher hanging fruit that are often the gems.  Sure, space pushing down on us all can make it hard to get up that high to the good stuff…….but it is worth it when you get there.  Thanks for tagging along on this journey. If you are a regular reader,  reconsider your bathroom reading material if you haven’t already !

(Source: http://www.youtube.com/)

More on the “Earth” shoe

3.7 degrees. Who (besides maybe Kevin Bacon) would have thought a few degrees could make that much of a difference?

We don not doubt that the shoe helps you to burn more energy. You are walking up hill against your normal biomechanics. Inefficiency usually costs more energy.

Remember our friend “PRONATION”? It consists of dorsiflexion, eversion and abduction. SOME PRONATION is requisite for normal gait. It is one of the 4 shock absorbing mechanisms, along with ankle dorsiflexion, knee and hip flexion. (Midfoot) PRONATION begins from initial contact of the heel with the ground (loading response); friction of the heel on the ground causes the talus to slide anteriorly on the calcaneus and it then plantar flexes, adducts and everts to lower the midfoot. This goes on until MIDSTANCE, when the opposite leg begins to go into swing phase which initiates SUPINATION.

We remember PRONATION makes the foot into a “mobile adaptor” for shock absorbtion; SUPINATION makes the foot into a rigid lever for propulsion. The question is: “Why keep the foot in a position that would decrease biomechanical efficiency for ½ of the gait  cycle?”

We do not refute that the shoe does burn more energy. We agree that it will reduce the lordosis of the low back, which can be beneficial for spinal canal stenosis and a few other conditions which demand less stress on the facet joints. We like the wide (though not anatomic) toe box.

Negative ramp delta? We are not convinced this is great idea.

Ivo and Shawn. Triangular, pointy (but beautifuul and bald) heads (like a delta). Bringing you the facts so you can make better decisions.

(Source: https://www.youtube.com/)

More on the “Earth” shoe

3.7 degrees. Who (besides maybe Kevin Bacon) would have thought a few degrees could make that much of a difference?

We don not doubt that the shoe helps you to burn more energy. You are walking up hill against your normal biomechanics. Inefficiency usually costs more energy.

Remember our friend “PRONATION”? It consists of dorsiflexion, eversion and abduction. SOME PRONATION is requisite for normal gait. It is one of the 4 shock absorbing mechanisms, along with ankle dorsiflexion, knee and hip flexion. (Midfoot) PRONATION begins from initial contact of the heel with the ground (loading response); friction of the heel on the ground causes the talus to slide anteriorly on the calcaneus and it then plantar flexes, adducts and everts to lower the midfoot. This goes on until MIDSTANCE, when the opposite leg begins to go into swing phase which initiates SUPINATION.

We remember PRONATION makes the foot into a “mobile adaptor” for shock absorbtion; SUPINATION makes the foot into a rigid lever for propulsion. The question is: “Why keep the foot in a position that would decrease biomechanical efficiency for 1/2 of the gait  cycle?”

We do not refute that the shoe does burn more energy. We agree that it will reduce the lordosis of the low back, which can be beneficial for spinal canal stenosis and a few other conditions which demand less stress on the facet joints. We like the wide (though not anatomic) toe box.

Negative ramp delta? We are not convinced this is great idea.

Ivo and Shawn. Triangular, pointy (but beautifuul and bald) heads (like a delta). Bringing you the facts so you can make better decisions.

(Source: http://www.youtube.com/)

As a runner: To Cross-Over or not to Cross-Over ?   That is the question. Lets go back and talk about the Cross Over Gait again (yes, again). This is the next level.

*watch this video (link) and notice 2 things: 1. the size of the glutes on these amazing athletes and 2. pay attention to the few seconds at 1:32. No Cross Over gait anywhere.

If you look at any video on the web of ANY sprinter in competition from the front or back (sagittal progression), you will always see the knees and feet falling underneath the hips. Watch video above again and see this. You will never see a sprinter cross over like we see in many distance runners.  Why is that ? Here, look this video (link)  as well, at the 1:30 mark there is a great overhead view of the field, look for one of these fellas crossing over, you will not see it.  Here are starts out of the blocks, clear abduction (link) and no cross over, in fact there is more leg abduction separation coming out of a start to get more glute power (think of a skater, same thing).  Now get on YouTube and watch any distance race and you will have to work at finding non-Cross Over runner or at least someone who is at the tipping point. Everyone does it, but does that make it right ? Does it make it wrong ? Does it make them vulnerable to injury more ?  We think it does.

We believe to reduce injury the cross over needs to be corrected. However, in distance running less brute power is needed, we need to conserve energy so we need to dial to a more reasonable and economical and efficient running gear.  In distance athletes and your typical 20+ mile a week runner less gluteal power is needed, but most runners have just gone past that tipping point and get into under use and begin to cross over.  Lets see if we can expand on this theory a little more.

Well, there are no studies on this. As far as we know we are the only ones trying to solve this mystery of the tipping point cross over gait/run style. Go ahead, search on the web, we seem to be on a solitary voyage all on our own, thankfully we have our Gait Guys brethren (you guys !) with us.  It does however bode the question for us,  “Why are we able to get so many of these chronic distance runners over their injuries by addressing their Cross-Over Gait and its frequent weaknesses (gluteus medius/maximus/medial quadriceps), excessive pronation and their tightness’s (IT band etc). Why do our sprinters have an entirely different injury pattern  ?”  Sure the athletes are different and their events are different, that is the simple answer but it is not good enough.  One athlete is built for speed, the other built for distance and endurance. But there is something big here that needs all of our attention.

Here is the fundamental difference.  We get some vocal challenges particularly from distance runners (but less with time as our theory has yet been refuted) that the cross over is more efficient for a distance runner.  (Example of another great cross over here in case you are new to our work on this topic (video link)). We disagree, for now, until research can disprove our theory which has been several years in development.  The Cross Over Running form challenges the normal pendulum effect of the lower limbs and challenges the biomechanics of the hip frontal plane stabilizers, namely the gluteus medius (need a biomechanics refresher? , click here).  Why would you want to change the natural leg pendulum in a runner ? This is not good running economy, although you will have a fight on your hands if you ask a runner to convert to our anti-cross over gait and drag them from their deeply engrained and comfortable cross over running style ! Beware, they are going to tell you it doesn’t feel right, it is too hard, it feels awkward, “it cannot be right !”  Well, so does brushing your teeth with the opposite hand but that doesn’t make it wrong.  Our 3 part series on Cross Over Running is pretty thorough if you want to learn more, but this is not the place. We feel we have been pounding the floor on those issues long enough.

Here is our question, go and do your own observational work as well. 

Look at the glutes of sprinters (watch the main video with this post again), compare size ratio of glutes to quads. Sprinters have bigger glutes, sure they have massive legs but they have glutes to match that power.  Their glutes are in charge of their hip and pelvic mechanics. When there is mismatch there is often injury.

Distance runners have much smaller glutes, their buttocks are small, in some cases you wonder where it has all gone !  But their quadriceps are massive in comparison in many cases. It is clear that in most of the cases the ratio is not the same as in sprinters.  There is a mismatch. We like to say that their quadriceps are in charge of their hip mechanics, and are certainly not suited to do so.  Now, we know the argument that will arise, that being they are different activities and thus they should be different.  Our only argument there is that the quadriceps should not have such a dominance over the gluteal and hip biomechanics.  Watch our two part hip biomechanics videos on YouTube again.

When we put our distance athletes on our Total Gym slide-squat board to do primitive squat isolations the distance runners have a great deal of difficulty “getting themselves out of the quads and into the glutes”.  The sprinters automatically go right into the glutes, or clearly have a better time of finding the correct pattern in controlling hip extension and eccentric hip flexion during the decent of the squat. 

Here is the bottom line. The glutes should always be in charge over the quadriceps when it comes to hip biomechanics. Mess up this ratio and dominance and problems will occur.  This goes for both distance runners and sprinters, actually all human beings no matter what sport. It has become painfully clear that the cross over gait allows the leg pendulum to shift too far medially and this is controlled largely by the gluteus medius and its synergists on a neutral pelvis and stable core controlling it.  Crossing over is poor gait economy, you must block that faulty cross over collapse.  A good distance runner will come right up to the fence, to the tipping point, but not fall off the proverbial fence.  Go too far, and the injury clock starts ticking.  If you are a runner or even a distance walker and you are crossing over even a little, you need to correct this gait pathology in our humble opinion. You are just not using your glutes correctly and effectively.

( By the way, Here is a drill (link) not to do for a sprinter or any runner for that matter in our opinion, it is driving cross over both mentally and physically. If we had our way he would have run with his foot contact drifting to the outer limits of each marker maintaining a nice vertical pendulum of the limbs from the hip axis, we wouldnt have him run down the line.  We ask our runners to run on either sides of the lanes on the track, not between the lines and in the lane. It is a great place to start. It is just enough to get the feel right.  We know of two coaches doing this from our consultations with them, we know they are on a serious journey to championship seasons. And, when we walk onto their fields and we see all the runners running down the lines and not down the middle of the lanes we smile.  We know it looks crazy.  But sometimes crazy is right !

Shawn and Ivo.  Beating our bloody foreheads against the wall each time we see another cross over runner with hip, knee or foot issues.  You gotta fix the neuromotor pattern problem too !!!!!!!!!!  All the in-clinic rehab and physical therapy in the world will not stave off re-injury if the pattern is not corrected !

whew !  (thanks for hanging in there gang…..long post today !)

(Source: http://www.youtube.com/)