About 8 years ago (?) I was in my Muscle Activation Class (MAT) here in Chicago and somewhere during the course of the class the topic came up about problems with the big toe. This really nice fella spoke up about a major injury to his thumb (the photo is not of him but here is a link to this fella’s story) and how doctors then proceeded to amputate his big toe to replace the thumb.

Gosh, with my brain knowing all that it does about gait as well as hand function, thoughts began to swim in every direction. What would I do if I were presented with the same scenario?  Without my thumb my work as a manual medicine physician would definitely be changed. But, heck, my gait would forever be changed too! I would be sentenced to a life of never ending gait compensations that could never be treated. My mind swirled around impaired hip extension and gluteal dysfunction, not to mention:

  • foot tripod incompetence
  • pronation and supination dysfunction guaranteed
  • virtually guaranteed hammer toe formation
  • metatarsal stress impacts
  • inappropriate loads on the medial column stabilizers such as the tibialis posterior now that the medial foot tripod was impaired let along the new absence of the long and short toe flexors that often provide compensatory activity to help an insufficient medial tripod.
  • impaired ipsilateral and contralateral arm swing
  • impaired shoulder function
  • core and hip impairments and asymmetry
  • the list goes on and on……. perhaps for hours !  We could do a whole 1-2 hour lecture just on the gait compensations and the subsequent motor impairment patterns that would ensue.

Seeing this photo and reading this fella’s story brought my mind back to the swirling thoughts I had while sitting in that lecture hall that day. And now some 8+ years later i am still brought to the same uncertain conclusion.  Would I go for the switcheroo ?   The transplant isn’t guaranteed successful, if it was that might sway things a little. But the gait impairments are guaranteed. 

What would  you do ? 

We hope you ( and us here at The Gait Guys) never are confronted with this most difficult presentation.  However, in just a few years, with the advent of 3D printers the anxiety of this issue is likely going to become a non-issue.

Just some food for thought today.  Or maybe we should have said “Foot for thought.”

Shawn and Ivo

Orthotics and Footbeds. What’s the difference?

Orthotics and footbeds, they’re the same thing, right? This is a question that is posed to us all the time.  No, they’re not the same, but oftentimes one or the other can be appropriate. To explain the difference, we need to understand a little bit about foot mechanics.

The foot is a biomechanical marvel.  It is composed of 26 bones and 31 articulations or joints.  The bones and joints work together in concert to propel us through the earth’s gravitational field.  It is a dynamic structure that is constantly moving and changing with its environment, whether it is in or out of footwear.  Problems with the bones or joints of the foot, or the forces that pass through them, can interfere with this symbiosis and create problems which we call diagnoses.  They can range from bunions, plantar fasciitis, shin splints, TFL syndrome, abnormal patellar tracking, and lower back pain just to name a few.

Before we go any further, we should talk a little bit about gait (ie walking pattern). Normal walking can be divided into 2 phases, stance and swing. Stance is the time that your foot is in contact with the ground. This is when problems usually occur. Swing is the time the opposite, non weight bearing foot is in the air.

 

The bones of the foot go through a series of movements while we are in stance phase called pronation and supination. Pronation is when your arch collapses slightly, to make your foot more flexible and able to absorb irregularities in the ground; this is supposed to happen right after your heel hits the ground. As your foot pronates, the leg rotates inward, which causes your knee to rotate in, which causes your thigh to rotate in, which causes you spine to flex forward. Supination is when your foot reforms the arch and makes your foot a rigid lever, to help you propel yourself; This is supposed to happen when you are pushing off with your toes to move forward. It is at this time that the entire process reverses itself, and your leg, knee, and thigh rotate outward and your spine extends backward. When these movements don’t occur, or more often, occur too much, is when problems arise. This can be due to many reasons, such as lack of movement between your foot bones (subluxation), muscle tightness, injury, inflammation, and so on.

 

Many people overpronate. This means that their arch stays collapsed too long while in stance phase, and they remain pronated while trying to push off. As we discussed, during pronation the foot is a poor lever. This means you need to overwork to propel yourself forward. This can create arch pain, inflammation on the bottom of the foot (plantar fascitis), abnormal pressure on your foot bones (metatarsalgia), knee pain, hip pain and back pain.

 

Skiing is a stance phase sport. While skiing, your foot stays relatively immobile in a ski or snowboard boot (i.e. it is not moving through a gait cycle). A footbed is designed to create a level surface for your feet and keep them in a neutral posture. It accomplishes this by “bringing the ground up to your foot.” They are generally custom designed to an individuals foot through many different methods. They work incredibly well (as long as the foot remains in a static posture) and many people extol the benefits and improvements in their snow sports when using these.

 

Running, hiking and cycling are more dynamic. Sports like these demand a device that changes the biomechanics, so here an orthotic would be most appropriate.

 

Orthotics are always custom made devices. They actually improve the mechanics of your foot and make it function more efficiently by altering the shape and function of the arch as the foot moves through various activities. They act like a footbed but have the added benefit of functioning while dynamic (i.e. moving) as well. This works as well or better than a footbed, and is usable in other sporting activities, such as running, biking, hiking, skiing or snowbaording. Many people use their orthotic in their everyday shoes, to help prevent some of the problems and symptoms they are experiencing.

 

In summary, a footbed supports the foot in a neutral posture. It is great for activities where your foot is static or held in one position. An orthotic supports the foot in a neutral posture and improves the mechanical function of the foot. It can be used in static or dynamic activities. Remember to always consult with a professional who is well versed with the mechanics of the feet, ankles, knees, hips and back, since footbeds and orthotics have a profound effect on all these structures.

The Gait Guys. Bring you info you can use, each and every day.

All material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved.

Podcast #30: Running your heart out ?

podcast link: 

http://thegaitguys.libsyn.com/podcast-30-running-your-heart-out

iTunes link:

https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

Gait Guys online /download store:

http://store.payloadz.com/results/results.aspx?m=80204

other web based Gait Guys lectures:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen  Biomechanics

Today’s show notes:

Neuroscience Piece:

1. Nanosponges could soak up deadly infections like MRSA from your bloodstream
http://www.theverge.com/2013/4/15/4225834/nanosponges-kill-deadly-bacteria-mrsa-clinical-trial

2. iPhone-controlled bionic hands allow father to hold daughter’s hand for first time since accident
http://9to5mac.com/2013/04/15/iphone-controlled-bionic-hands-allow-father-to-hold-daughters-hand-for-first-time-since-accident/

3. The science behind Obama’s BRAIN project.
http://blog.brainfacts.org/2013/04/the-science-behind-obamas-brain-project/#.UXQraILeb8g

4. Blog reader asks:
I’ve noticed that I’m developing some calluses – on the outside of my big toes. They don’t hurt normally but if I walk for awhile or run a few miles, those (I’m assuming) calluses really starts to ache. Any suggestions for what I can do to help with that?

5. FACEBOOK readers asks:
Hello, I am new to “The Gait Guys,” and was wondering if you have done any blogs about Morton’s Neuromas and bunion treatments. I’m looking for ways other than surgery to fix this ailment. I would love to be able to run and exercise again. Thank you.
Jared

6. What Cardiologists Tell Their Friends

http://shine.yahoo.com/healthy-living/cardiologists-tell-friends-134500478.html
“Go easy with the exercise”
http://www.ncbi.nlm.nih.gov/pubmed/22953596

Mo Med. 2012 Jul-Aug;109(4):312-21.

Cardiovascular damage resulting from chronic excessive endurance exercise.

7. Brisk Walking Equals Running for Heart Health: Study

http://www.medicinenet.com/script/main/art.asp?articlekey=168974
By Steven Reinberg

8. Shoes:

9. Runners Can Improve Health and Performance With Less Training, Study Shows

http://www.sciencedaily.com/releases/2012/05/120531102205.htm

10. A Lesson in Neurology from Jimi Hendrix

by ;luke barnes
letterstonature.wordpress.com/2007/11/30/a-lesson-in-neurology-from-jimi-hendrix

On the topic of endurance training…..

On the topic of endurance training (which we discussed on this weeks PODcast, forthcoming in the next day or so; we have both been extraordinarily busy in our clinics); if you are a well trained athlete (ie endurance junkie), how might this effect your running gait?

So, you run 103 miles with an elevation change of over 31,000 feet, how do you think you would fare? These folks were tested pre and 3 hours post race on a 22 foot long pressure walkway at about 7.5 miles per hour. Here’s how this group of 18 folks did:

  1. increased step frequency
  2. decreased “aerial” time
  3. no change in contact time
  4. decrease in downward displacement of the center of mass
  5. decrease in peak vertical ground reactive force
  6. increased vertical oscillation
  7. leg stiffness remained unchanged

So what does this tell us?

  • wow, that is a lot of vertical
  • holy smokes, that is really far
  • don’t know how I would do with a race like that
  • they are fatigued (1, 2, 6)
  • they are trying to attenuate impact forces (2, 3, 4, 5, 7)

The system is trying to adapt the best it can. If you were to do a standard hip screen test (like we spoke about here)  you would probably see increased horizontal drift due to proprioceptive fatigue. Remember that proprioception (our bodies ability to sense its position in space) makes the world go round. Proprioception is dependent on an intact visual system (see our post yesterday) , an intact vestibular system and muscle and joint mechanoreceptors functioning appropriately). We would add here that central nervous system fatigue (ie central processing both at the cord and in the cortex) would probably play a role as well.

The take home message? The human machine is a neuro mechanical marvel and much more complex than having the right shoe or the right running technique. Training often makes us more competent and efficient, but everything has it limits.

The Gait Guys. Making it real with each and every post.

all material copyright 2013 The Gait Guys/ The Homunculus Group

J Biomech. 2011 Apr 7;44(6):1104-7. doi: 10.1016/j.jbiomech.2011.01.028. Epub 2011 Feb 20.

Changes in running mechanics and spring-mass behavior induced by a mountain ultra-marathon race.

Source

Université de Lyon, F-42023 Saint-Etienne, France. jean.benoit.morin@univ-st-etienne.fr

Abstract

Changes in running mechanics and spring-mass behavior due to fatigue induced by a mountain ultra-marathon race (MUM, 166km, total positive and negative elevation of 9500m) were studied in 18 ultra-marathon runners. Mechanical measurements were undertaken pre- and 3h post-MUM at 12km h(-1) on a 7m long pressure walkway: contact (t(c)), aerial (t(a)) times, step frequency (f), and running velocity (v) were sampled and averaged over 5-8 steps. From these variables, spring-mass parameters of peak vertical ground reaction force (F(max)), vertical downward displacement of the center of mass (Δz), leg length change (ΔL), vertical (k(vert)) and leg (k(leg)) stiffness were computed. After the MUM, there was a significant increase in f (5.9±5.5%; P<0.001) associated with reduced t(a) (-18.5±17.4%; P<0.001) with no change in t(c), and a significant decrease in both Δz and F(max) (-11.6±10.5 and -6.3±7.3%, respectively; P<0.001). k(vert) increased by 5.6±11.7% (P=0.053), and k(leg) remained unchanged. These results show that 3h post-MUM, subjects ran with a reduced vertical oscillation of their spring-mass system. This is consistent with (i) previous studies concerning muscular structure/function impairment in running and (ii) the hypothesis that these changes in the running pattern could be associated with lower overall impact (especially during the braking phase) supported by the locomotor system at each step, potentially leading to reduced pain during running.

Copyright © 2011 Elsevier Ltd. All rights reserved.

http://www.ncbi.nlm.nih.gov/pubmed/21342691

How we keep our head steady while we run.

Evolved to run: How we keep our noodle steady while we run.

Have you ever given thought to your head movements during running or walking ? Ever wonder why the world doesn’t seem to bound around as we move ? Wonder why things look different through your eyes when you yourself are running as compared to when you are watching the nauseating jerky video of someone wearing a camera on their head ?
Bryce Vickmark for The New York Times interviewed Dr. Lieberman of the Harvard Nature study…. here is a quote from that interview.
“We (Lieberman) realized that there were special features in the human neck that enable us to keep our heads still. That gives us an evolutionary advantage because it helps us avoid falls and injuries. And this seemed like evidence of natural selection in our ability to run, an important factor in how we became hunters rather than just foragers and got access to richer foods, which fueled the evolution of our big brains.”

__________________________________________________

Gait Guys say this….. “The ability to see clearly while moving / running / hunting is a well rooted primitive neurologic function in man. The visual-motor system (oculomotor system) is capable of assimilating the visual information and making calculations for the small head displacements that occur with movement via neural mechanisms that control three-dimensional head posture while coordinating three-dimensional eye orientation. The body’s movements as a whole (eye, head and body) are part of a coordinated series of sensory-motor events that are used to voluntarily reorient the axis of gaze between objects.  Body movements themselves can make a predictable contribution to gaze shifts and one study (link) has shown that single neurons (yes, one small neuron all by itself) can code motor commands to move the body as well as the head and eyes.  It is a finely tuned system, an amazing system.  One we rarely appreciate anymore since running during a hunt for food no longer occurs in urban America.  Of course this function is seamlessly tested everyday in athletes, unless of course you are a football or other impact sport athlete, and have accelerated your noggin one too many times.  Ask any aging boxer or ex-football player how their visual-motor system is doing ! (On a slight tangent since there is so much info in the media on concussive syndromes these days, here is support for those dropped endzone passes in the concussed wide receivers...LINK and. LINK)

NY Times link: for the Lieberman article.

We are The Gait Guys…….. running and hunting outside the box everyday, looking for answers.

Unstable shoes provide more activation of selected lower extremity muscles and increased postural sway WHILE STANDING. Does this really surprise us?

 ” …it was shown that standing in the unstable shoe increased activity of the flexor digitorum longus, peroneal (PR) and anterior compartment (AC) muscles of the lower leg. No activity differences for the larger soleus (SOL) were identified between the stable and unstable shoe conditions.”. In English that means the muscles on the front, back and outside of your lower leg.

It goes on to say “Postural sway was greater while standing in the unstable shoe compared to barefoot and the stable control shoe.” and “Postural sway while standing in the unstable MBT shoe also decreased over the 6-week accommodation period.” Postural sway is one way of measuring proprioception or body position awareness. 

The key words here are “WHILE STANDING”. It DOES NOT SAY WALKING. We have talked about rockered shoes in numerous previous posts and we have always maintained that in the right circumstances, it can be a good thing, but not necessarily something you should go do your grocery shopping or gym workout in.

Gait Posture. 2010 Jun;32(2):215-9. doi: 10.1016/j.gaitpost.2010.04.018. Epub
2010 May 23.

Standing in an unstable shoe increases postural sway and muscle activity of
selected smaller extrinsic foot muscles.

Landry SC, Nigg BM, Tecante KE.

Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500
University Drive N.W., Calgary, Alberta, Canada T2N 1N4. scott.landry@acadiau.ca

Inactivity or the under-utilization of lower limb muscles can lead to strength
and functional deficits and potential injury. Traditional shoes with stability
and support features can overprotect the foot and potentially contribute to the
deterioration of the smaller extrinsic foot muscles. Healthy subjects (n=28)
stood in an unstable MBT (Masai Barefoot Technology) shoe during their work day
for a 6-week accommodation period. A two-way repeated measures ANOVA was used to 
determine (i) if unstable shoe wear increased electromyographic (EMG) activity of
selected extrinsic foot muscles and increased postural sway compared to standing 
barefoot and in a stable control shoe and (ii) if postural sway and muscle
activity across footwear conditions differed between a pre- and
post-accommodation testing visit. Using an EMG circumferential linear array, it
was shown that standing in the unstable shoe increased activity of the flexor
digitorum longus, peroneal (PR) and anterior compartment (AC) muscles of the
lower leg. No activity differences for the larger soleus (SOL) were identified
between the stable and unstable shoe conditions. Postural sway was greater while 
standing in the unstable shoe compared to barefoot and the stable control shoe.
These findings suggest that standing in the unstable MBT shoe effectively
activates selected extrinsic foot muscles and could have implications for
strengthening and conditioning these muscles. Postural sway while standing in the
unstable MBT shoe also decreased over the 6-week accommodation period.

Copyright 2010 Elsevier B.V. All rights reserved.

One simple hip screen that gives you lots of information.

This is the one leg standing test. We use it as a hip function (abduction) screen(as well as an exercise), to see if a person’s gluteus medius is working in a functional situation (as opposed to manual muscle testing).

As you may remember (don’t remember? Click here), the gluteus medius fires throughout stance phase (ie; when the foot is on the ground). It keeps the pelvis level while the foot is on the ground and works in conjunction with the opposite quadratus lumborum muscle (if you have not read up on this, please see our groundbreaking work on the problematic cross over gait, found here, here and here).

The test is simple; try it on yourself while watching yourself in a mirror. Stand on one leg on your foot tripod (the heel, base of big toe and base of little toe). Raise the opposite foot off the ground by flexing the thigh. Observe.

You should see the pelvis remaining level with no shift of the torso or hips. 

Watch for:

  • ·      Pelvic drift to the side you are standing on
  • ·      Pelvis drop on the side opposite you are standing on
  • ·      Body lean to the side you are standing on
  • ·      Excessive hiking of the opposite, non weight bearing hip
  • ·      Any combination of the above

 

Seeing any (or all) of these means the gluteus medius is probably having some trouble.  The reason we say probably is that a person with a hip problem (like arthritis) or an anatomically short leg may do some of these things in compensation.

The question you are hopefully asking is why do they drift, lean, hike, etc? Not everything you see is muscle weakness per se.

  • ·      Maybe they have a balance issue
  • ·      Maybe they have a disc injury
  • ·      Maybe they have injury to the nerve going to the gluteus medius
  • ·      Maybe they have a knee/ankle/foot issue
  • ·      And the list goes on…

So, if it were a muscle weakness, how could you fix it? Determine the cause. Begin at the bottom with foot exercises: tripod standing, lift/spead/reach with the toes etc. Then have them repeat the exercise IN A MIRROR, maintaining a level pelvis. Yes, it is that simple. Now see if they can translate that to their gait cycle. If so, great. If not, start again and repeat till they can.

The Gait Guys. Making it real, each and every day.

all material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved. Please ask before using!