The hand walkers: The family that walks on all fours. Part 1
Quadrupedalism and its commentary on human gait. To understand your athlete, your patient, your client, whatever your profession, you need to have a good understanding of neurodevelopment. If your client has some functional movement pattern flaws it could be from a delayed or expedited neurodevelopmental window. Generalized training and rehab will not correct an early or late window issue; often your work must be more specific.
When we began our journey into our daily writings on “The Gait Guys blog” we had no idea of the never ending tangents our writing would take pertaining to gait, human movement and locomotion. It has become plainly obvious over time that this blog will likely exist as long as we choose to continue it.
In 2006 we saw a documentary documentary entitled The Family That Walks On All Fours and the video clip above was from the documentary. It was a fascinating documentary and with our backgrounds in neurology, neurobiology, neuroscience, biomechanics and orthopedics we had more questions than the documentary touched upon. The documentary opened up many thoughts of neuro-development since we all start with a quadrupedal gait. But there had to be more to it than just this aspect because people eventually move through that neurologic window of development into bipedial gait. This has been in the back of our minds for many years now. Today we will touch upon this family and their challenges in moving through life, today we talk about Uner Tan syndrome, Unertan syndrome or UTS.
The original story is about the Ulas family of nineteen from rural southern Turkey. Tan described five members as walking with a quadrupedal gait using their feet and the palms of their hands as seen in this video. The affected family members were also severely mentally retarded and displayed very primitive speech and communication. Since his initial discovery several other families from other remote Turkish villages have also been discovered. In all the affected individuals dynamic balance was impaired during upright walking, and they habitually chose walking on all four extremities. Tan proposed that these are symptoms of Uner Tan syndrome.
UTS is a syndrome proposed by the Turkish evolutionary biologist Uner Tan. Persons affected by this syndrome walk with a quadrupedal locomotion and are afflicted with primitive speech, habitual quadrupedalism, impaired intelligence. Tan postulated that this is a plausible example of “backward evolution”. MRI brain scans showed changes in cerebellar development which you should know after a year of our blog reading means that balance and motor programming might be thus impaired. PET scans showed a decreased glucose metabolic activity in the cerebellum, vermis and, to a lesser extent the cerebral cortex in the majority of the patients. All of the families assessed had consanguineous marriages in their lineage suggesting autosomal recessive transmission. The syndrome was genetically heterogeneous. Since the initial discoveries more cases have been found, and these exhibit facultative quadrupedal locomotion, and in one case, late childhood onset. It has been suggested that the human quadrupedalism may, at least, be a phenotypic example of reverse evolution.
Neurodevelopment of Children:
Children typically go through predictable windows of neurodevelopment. Within a set time frame they should move from supine to rolling over. Then from prone they should learn to press up into a push up type posturing which sets up the spine, core and lower limbs to initiate the leg movements for crawling. Once crawling ensues then eventual standing and cruising follow. In some children, it is rare yet still not neurodevelopmentally abnormal, they move into a “bear crawl” type of locomotion where weight is born on the hands and feet (just as in our video today of UTS). Sometimes this window comes before bipedalism and sometimes afterwards but it should remain a short lived window that is progressed through as bipedalism becomes more skilled.
In studying Uner Tan Syndrome, Nicholas Humphrey, John Skoyles, and Roger Keynes have argued that their gait is due to two rare phenomena coming together.
“First, instead of initially crawling as infants on their knees, they started off learning to move around with a “bear crawl” on their feet.Second, due to their congenital brain impairment, they found balancing on two legs difficult.Because of this, their motor development was channeled into turning their bear crawl into a substitute for bipedalism.”
According to Tan in Open Neurol, 2010
It has been suggested that the human quadrupedalism may, at least, be a phenotypic example of reverse evolution. From the viewpoint of dynamic systems theory, it was concluded there may not be a single factor that predetermines human quadrupedalism in Uner Tan syndrome, but that it may involve self-organization, brain plasticity, and rewiring, from the many decentralized and local interactions among neuronal, genetic, and environmental subsystems.
There is much more we want to talk about on this mysterious syndrome and the tangents and ideas that come from it. We will do so in the coming weeks as we return to this case. We will talk about other aspects of neurodevelopment which should be interesting to you all since most our readers either are having children, will have them, or are watching them move through these neurologic windows. And we know that some of our readers are in the fields of therapy and medicine so this should reignite some thoughts of old and new. In future posts we will talk about cross crawl patterning in the brain, bear crawling, the use of the extensor muscles in upright posture and gait as well as other aspects of neurodevelopment gone wrong. We are not even close to being done with this video and all of its tangents. In the weeks to come we hope you will remain interested and excited to read more about its deep implications into normal and abnormal human gait.
Are you a Gait Troglodyte ? Are you sure ? You might want to read on.
Most of us are all still in a cave and unacquainted with some of the affairs of the world. Some of us may find ourselves behind the times when it comes to GMO foods, social media, computers and the internet, smart phones while others may be behind on world issues and politics. Heck, some of us have never even seen “Ancient Aliens” on the History Channel ! It is hard to keep up with everything in this fast paced changing world. Something has to give for each of us and so we pick our poison and decide what it is that we are going to have to remain behind on when it comes to the learning curves of the world. And this is alright, but you have to first admit your “back of the pack” and “still living in a cave” type status on the issues and take some ribbing when acknowledging your limitations. Failing to admit these inevitable shortcomings while pretending that you are still running with the pack can be a real problem. Not only are you faking yourself out but you may be deceiving those that you attempt to help.
Understanding gait, truly understanding it, is a monumental undertaking. This is why there are just no vast resources on it unlike other things in healthcare. Try going to PubMed and type in “arm swing”, you will see 318 articles. Try “pronation”, 2900 articles. Now try “heart”, 1 million+ articles. You get the point. Research is behind on gait, and thus our understanding of it is also poorly reflected in functional medicine and human bodywork. We are collectively gait troglodytes, living in stereotypical caveman times when it comes to gait. Sure there are some good books like Perry’s text, or Michaud’s landmark work but there is a void on gait work and research. Human locomotion via gait (walking and running) is a small and poorly understood component by many. It is much the reason why we started The Gait Guys and began writing daily for over 600 days on gait issues. Little did we know that the door we had opened would continue to swing so wide and encompass so many other aspects that feed into human gait.
One of the aspects that worries us the most these days is the growing volume of “functional” work that is going on in the world of therapy and training. There is a very important and critical place for this work and we fully admit that everyone needs to be on board with all of the great work that the leaders are teaching. What worries us is the apparent lack of integration of this work into gait assessment, gait therapy, and flawed gait neuro-biomechanics. Once again gait is not getting the pulpit it deserves. Yes, flaws in the functional screens and assessments need to be brought to light and remedied because they can impact bipedal locomotion but, the pendulum swings both ways. Gait can often be a cause of these functional problems that show up on the screens and assessments. If one fixes the functional pattern problems and the gait pattern is not restored then either the dysfunction will return or a new undesirable pattern will be generated. There needs to be more gait understanding and assessment from us all. Gait needs retraining as well, it is as much of a functional pattern as any other, if not more. Gait deserves a pulpit as well. Human assessment is clearly a two way street and it is not always clear who is the chicken and who is the egg. The problem may be that when gait does have its pulpit to speak from, who is the speaker ? A gait troglodyte or an expert ?
There will be folks who say we are over thinking this issue. There will be some who are offended. There will be some who cheer. There are some that will say “it will all come out in the wash” once the functional patterns are corrected elsewhere. They are wrong, it just is not that simple. Next to breathing, gait may be the second most compromised and corrupted functional pattern that humans express thousands of times daily. So, it is time to get busy. It is time to peel off your Gait Troglodyte cloak and step into a 3 piece suit when it comes to understanding and interpreting gait. If you are working in the world of human movement, locomotion, training, rehab and human biomechanics this is your next challenge. Lets face it, we can either continue to walk around with our 10 year old flip phone understanding of gait or we can step up to a smart phone understanding of gait. It is up to you, but know where you are and know your limitations. So be honest with yourself and your next client the next time you assess their gait. Be sure to ask yourself after seeing something that just doesn’t seem right in their gait, is what you see really what you are seeing ? Is that really what is wrong ? Or is it a compensation ? Do you know enough to see things for what they really are ?
Shawn and Ivo, The Gait Guys.
We may not be Gait Troglodytes……. but some accuse us of living in a cave none the less. However, if you have seen our cave, you will know it looks much like Bruce Wayne’s Batcave. It isn’t your everyday cave.
A piece we put together to celebrate the Olympic challenge.
good luck to all !
Podcast #3: S1E3 (Season 1, Episode 3)
The Gait Guys Podcast #3
Here are 2 links for the podcast.
This one will get you to the show player of all of our podcasts.
And this link will get you a nicely laid out “show notes”.
Here is a brief outline of the topics on today’s podcast #3.
– Computer simulation of stress distribution in the metatarsals at different inversion landing angles
– Pencil Skirts: walking in one and how it is troublesome for normal gait.
– an email from a coach
– a youtube video about gravity and its effects on humans
– the Secrets to Running Downhill fast
– Shoe talk: The vivobarefoot
– a case of a sprained my left ankle
– we discuss a case study from a listener in Ireland (rock on Damien! )
And, below is a detailed outline of podcast #3.
1. NEWS OF THE DAY:
Hello: I recently saw you guys speak at the NSCA clinic at Chicago State University and I am immensely impressed and relieved to find someone able to clearly explain gait in such thorough detail. The Gait Guys blog has been immensely helpful in myself and my running clients. I would like to inquire if “either of you” would be interested in being a guest speaker at the AMA as a part of our Wellness Program’s monthly seminar series.
Computer simulation of stress distribution in the metatarsals at different inversion landing angles using the finite element method http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903174/ Abstract: Metatarsal fracture is one of the most common foot injuries and is often associated with landing in inversion. The deformation and stresses of the metatarsals during landing at different inversion angles (normal landing, 10 degree inversion and 20 degree inversion angles) were comparatively studied. The results showed that in the lateral metatarsals stress increased while in the medial metatarsals stress decreased with the angle of inversion. The peak stress point was found to be near the proximal part of the fifth metatarsal, which corresponds with reported clinical observations of metatarsal injuries.Landing in inversion is another factor which potentially could affect the metatarsals leading to deformation and fractures; however, most published studies on landing in inversion have focussed on ankle ligaments and sprains during this abnormal movement 3. TOPIC: Pencil Skirts: walking in one and how it is troublesome for normal gait
4. EMAIL FROM A COACH: *( we will be answering most of your questions on these podcasts. It may take a week or 2-3 to get to them. We hope to have a “podcast table of contents for each podcast” on our new website when it gets launched. That way you can search for topic lists and look for your email. We will only use your first name, or whatever name you wish to provide. We will not give out your email.
5. YOUTUBE AUDIO CLIP:
The body’s biomechanics are different running up and down hill, but you are also dealing with gravity differently.
Einstein did these things called “Thought experiments”.
It is a YOUTUBE CLIP , type “albert einstein-2“ into the SEARCH box.
we will start the clip at 4:14 min clip to 8:40
6. REVIEW of our favorite BLOG POST OF THE WEEK:
The Secrets to Running Downhill Fast.Last month we contributed to Jene Shaw’s article in Triathlete Magazine.
Please hit the link here for the entire great article by Jene Shaw. There is lots more here. LINK
Here were some of our Form tips used in Jene’s article for going fast downhill. Hear about them on the podcast.
7. EMAIL CASE
I’ve been going to physio therapists for a while with lower back and posture problems, which I now think are related to how I walk (duck footed). So far the only thing I have really got from this would be a nice massage.
What is the main issue with the “Duck footed” posturing and what kind of professional or practioner should I see about correcting issues like this?
Thanks very much, MIKE
8. SHOE TALK:
9. EMAIL CASE
Hello Gait Guys, In the past, I have sprained my left ankle in which has led me to think that this is the cause for me having a flat foot. This in turn has led me to having problems around the knee and the hip. Are there any exercises I can do to improve my medial arch? If there are videos that you are selling to teach how to deal with this problem, could you link me to it? Sincerely, Zac
response: youtube video: The foot tripod: the importance of the toe extensors in raising the arch. also read our blog post ( February 16th, 2012 blog post for more)
10. EMAIL CASE:
My name is Damien and i am writing you from Ireland. I’ve watched a lot of your videos online on YouTube. They are amazing. Congratulations on such a great and informative service. It’s so refreshing seeing people want to diagnose and fix feet rather than putting insoles or arch supports in place. I have alot of things going on with my body, let me get started … . .
So that is the topic list for this week, podcast 3. We hope you can find time to lend us your ears.
Shawn and Ivo…….. The Gait Guys
BIKE FIT: Case Study
*Stop, watch the video and think about it before we give you the answer… .
This gentleman presented with low back pain, only on his mountain bike, only on long ascents.
He measures out with an 83 cm inseam which should put him on a 44 to 45.5 cm frame (measured via our method). His frame has a dropped top tube and measures 55 cm.
He has a knee bend angle of 20 degrees at bottom dead center. Knee is centered well over pedal axis.
His stem falls far in front of his line of sight with respect to his hub. Stem is a 100 mm stem with a 6 degree rise.
There is a 2” drop from the seat to the top of the handlebars.
He has an anatomically short Left leg (tibial)
Here is some additional video of him with a 3 mm lift in the left shoe. Look at the tissue folds at the waist and amount of reach with each leg during the downstroke in this one as well as the last. no changes were made to the seat height, fore/aft position of seat. or handlebars.
The frame, though he is a big dude (6’+), is too big and his stem is too long. He is stretched out too far over the top tube, causing him to have an even more rounded back (and less access to his glutes; glutes should rule the downstroke and abs the upstroke). This gets worse when he pushes back (on his seat) and settles in for a long uphill. Now throw in a leg length discrepancy and asymmetrical biomechanics.
- smaller frame (not going to happen)
- lower seat 5-7mm
- shorter stem (60-75mm) with greater than 15 degree rise
- lift in Left shoe
We ARE the Gait Guys, and we do bikes too!
Running Technique Video with Complications:
Here we have a good running video with a nice teaching component to it.
We found this on the web on some random site. Nice to see others are helping to spread our good word. Here is what the website said, and below that are our comments.
You should send your video to The Gait Guys:
Actually, they did a 3 part video on crossover gait recently. I looks like you’ve got a bit of crossover going on (hips are swinging side to side). Most people do some crossover. Another thing The Gait Guys always say is that what you can see in the video is usually not the problem (the right foot turning out), it is usually the compensation you are seeing…the problem is somewhere else.
Thank you Nate. I will see what The Gait Guys say.
*What The Gait Guys have to say:
The most obvious thing we see is that the right foot is spun out (this is more evident on the video clips running away from the camera). This is referred to as the “foot progression angle” and here it is increased. Depending on the source you reference, the upper limit of normal can be 25degrees. But, it is more important to do a case by case comparison. Without the advantages of a hands on exam this case seems to indicate that the right foot progression is increased beyond the left, assuming the left is normal. (yes, it is possible that the right is this chaps normal and that the left foot progression angle is decreased. But the usual presentation is that of increased, usually.)
What we do like is the great form his is displaying. Great natural barefoot technique. Pure barefoot technique does not allow heel strike to occur. Do not believe us? Go try it yourself, just don’t email or call us afterwards and complain ! His strike is midfoot, cadence is high, and body posture is clean and upright. There is a minor cross over gait here. The readers were right. Good eyes, good call !
The increased right foot progression angle will often accelerate pronation and increase its degree. This can also increase and accelerate the rate of internal spin of the tibia and limb, all the way into the hip and pelvis. This can challenge the eccentric capabilities of the gluteals and other external hip rotator muscles and in time this can represent itself and mechanical hip joint pain or low back/Sacroiliac joint symptoms. The increased pronation amount and rate can challenge other structures at the foot, namely the posterior tibial tendon, abductor hallucis muscle and the first ray stabilizers such as long and short hallux muscles (EHL, EHB, FHL, FHB) and thus loss of longitudinal arch capabilities and stabilizers.
We also see, if you look closely particularly on the running away from camera views, that the left arm seems to cross the body more than the right. We always look for this in the opposite upper limb to try and help confirm or suggest which of the lower limbs is the problem. Since the left upper arm is crossing the body, it is neurologically matched up with the right limb during swing and stance. It can act like a ballast. This fella would most likely have some pelvic asymmetry because of this cross body deficit.
PS: the issue can be reversed. We have had plenty of frozen shoulder clients present with biomechanical deficits in the opposite lower limb so beware of the total body complexities and compensations. We have also have had runners who always carry a water bottle in the same hand showing changes in the opposite lower limb. Our treatment success with one runner did not occur until we convinced this ultra trail runner to go with a camel back water supply.
Nice little case. Wish we had more information on the runner and what is bothering him.
Maybe in time we will hear from him and update him.
To get the most out of this case you should watch the 3 part cross over gait series on our youtube channel. Just type in thegaitguys and it will be right there. You should also goto the search box in our tumblr blog and type in “arm swing” and read some of our writings on this topic. We think it is fascinating stuff.
Shawn and Ivo……….. world wide web gait geeks……. and victims of radical hackers everywhere…… ok, just in Algeria.