Approaching joint assessment from the perspective of “cylinders”.

Our approach to every joint assessment has long been to visualize and assess the joint(s) as a cylinder since the body parts are cylindrical in form. This has been our approach, and they way we teach, for many years. At each number on the clock (cylinder) there is a theoretical muscle that provides stability to the joint in that vector during loading. The most accurate assessment would be one that investigates the ability of each muscle around the clock (cylinder) to see if it has sufficient S.E.S. (Skill, Endurance, Strength) as well as how well that muscle(s) participates with the synergists, antagonists and agonists (ie. motor patterns for stability and mobility).  We do this at each joint along the kinetic chain when assessing someone with a clinical or functional problem.  

When dealing with a frontal plane drift, as in the 3rd photo above where you see the person’s (black shorts) pelvis drift laterally outside the perpendicular foot line, one could naturally assume that the gluteus medius is weak (9 o’clock) but the wise clinician would also look at the other side of that cylinder to see if the adductors were involved (3 o’clock) since that is 180 degrees through the joint axis.  (Note: Runners are sagittal athletes so frontal plane weaknesses are often seen. This is not desirable however, this is a perfect example why runners should cross train more into lateral and angular sports to ensure that the sagittal plane does not dominate.) Obviously the foot and the knee also need a similar cylindrical assessment approach. We have spoken loudly many times  here and on our podcasts over the years that quite often there are multiple flaws in a presentation, typically a focal cause and one if not several compensations as a functional adaptation strategy around that central flaw. In this runner’s case there could be medial knee weakness or foot weaknesses that are affording too much medial drift and spin of the limb resulting in the lateral pelvic drift compensation.  But, just because the gluteus medius shows up weak does not mean that it is the focal point of clinical intervention. If one facilitates the gluteus medius and does not address the causative lower cylinder issues then they are quite possibly empowering the compensation and enabling the aberrant activity to continue. Knowingly or unknowingly layering armor or inappropriate strength to a pathologic compensation pattern at a focal joint level that is not the focal cause should be a clinical crime, but it is done every day by people who do not know better even though their efforts are well intended.

Ok, we got on a bit of a soap box rant there, sorry. Back to the case at hand.  

Your assessment should not stop at the frontal plane in this case. If there is an imbalance in the sagittal plane in this sagittal athlete this can be a causative problem as well, which is why the cylinder approach should not stop at the frontal plane or when you find that first major weakness. In frontal pelvic drift cases, there is quite often an anterior pelvic tilt where the lower abdominals can be weak, the low back is slightly extended and the paraspinals are more active. This is the classic “impaired hip extension pattern” and sets up a Janda/Lewitt style “Layered Syndrome”. Most of the time, resolving this sagittal flaw will show immediate improvement of the frontal plane deficits.  But, do not think it is as simple as re-facilitating these 2 patterns. Remember, neuromotor reprogramming and patterning takes 8-12 weeks by some sources. And remember, the initial strength gains in the first few weeks are from neuroadaptation (ie, skill gains in coordination), these gains are not the true physiological endurance and strength gains that we desire for an athlete.  Those gains take time but they are the ones that we need for sport performance and joint power.

And then there is the rotational or axial component, which we did not even begin to discuss here. We have briefly talked about the frontal and sagittal cylinder aspects, and yes, we have just skimmed the surface as there are multiple patterns and issues which we have had to leave out here so that this doesn’t turn into a full fledged chapter for our next book. This stuff gets complicated and can leave you running in mental circles at times.  But these concepts will help you better understand why you often see neuro-protective tightness 180 degrees on the other side of the cylinder from tightness, and when you address the weakness the other side of the cylinder some of that neuro-protective tone is eased.  But again, it is not nearly this simple because you must remember that if your assessment is static or on a table then your findings will be functionally imprecise.  And, not stopping there, there are multiple joints below the joint you are focusing on, and multiple joint complexes above as well. Plus, there are 3 other limbs that can play into the function and dysfunction of a given limb and its joints. There are breathing patterns, postural patterns and many other issues. This is not an easy game to play, let alone play it well or wisely for your athlete.

In today’s photos we wanted to show you 3 runners. One a distance runner with good joint stacking and one sprinter with amazing joint stacking.  And then the runner in the black shorts, who cannot stack the foot, knee or hips even remotely well.  This runner in the back shorts will have the cross over gait and likely have the medial ankle scuff marks to prove it. But remember, there is one component that we often talk about, one we did not discuss here … . . are there also torsional issues in this runner ? Do they have femoral or tibial torsion(s) ? What is their foot type ? Are they in the right shoe for their foot type ? Are some of these components playing into their visibly flawed mechanics ? 

Below is an article we have put up here on the blog previously.  It is a study where the investigators examined hip abductor strength (watch this video here ) in distance runners with iliotibial band syndrome comparing injured limb strength to the unaffected limb to determine whether correction of the strength deficits in the HAM’s (hip abductor muscles) correlates with successful outcomes.  The study showed the obvious, that runners with ITBS have weaker HAM strength compared to the asymptomatic leg.  

But here is our question, did they just strengthen the compensation for an apparently successful outcome, or did they address the problem ? Only time will tell if you actually fixed something or merely enabled the dysfunctional motor pattern by layering it with more armor for the next battle. If it is fixed the problem and all of its associated problems should go away. But if the runner comes back weeks later with knee complaints, foot pain, back pain or the like … . . then the message should be loud and clear.

Shawn and Ivo, The Gait Guys……today with soap on the bottom of our feet.

References:

Clin J Sport Med. 2000 Jul;10(3):169-75. Hip abductor weakness in distance runners with iliotibial band syndrome. Fredericson MCookingham CLChaudhari AMDowdell BCOestreicher N,Sahrmann SADepartment of Functional Restoration, Stanford University, California 94305-5105, USA.

Podcast 39: Ankle mobilizations, Plyos & Bunions

Risks and Understanding Band assisted Ankle mobilizations, bunion correction, Plyo jumps on inclines and more !

A. Link to our server:

http://thegaitguys.libsyn.com/podcast-39-ankle-mobilizations-plyos-bunions

B. iTunes link:

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

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :

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

D. other web based Gait Guys lectures:

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

* Today’s show notes:

Neuroscience:
1.Emma Adam, a Northwestern professor and an expert on sleep in adolescents and young adults, said , “Sleep has effects on cognition, your attention, your memory, your mood, your metabolism, your appetite — it affects so many different things.”
 
2.  Eye tracking technology:
3. From Mashable: 3 Days With a Posture-Correcting Wearable Gadget
4. Band assisted ankle mobilizations. Do you know what you are doing ?
5.  Why we prefer a low ramp delta shoe, when tolerable
6. From a Blog reader:
I have a patient who is suffering MS… . 
DISCLAIMER !
7.  Bunions
 I am a fitness instructor, and teach mostly barefoot classes…Pilates, yoga, willPower & grace. One of my students came to me originally because she has had bunion surgery, and wanted to regain alignment and strength in her feet. She is doing well with her big toe, but due to compensations made for the bunion, she has this pronounced  protrusion of the lateral edge of the foot by her 5th toe and metatarsal.  It looks larger in person than it does in the photo and is painful for her.  What is the cause and are there specific exercises for her?
Thanks for any insight,
Suzy 

Bloomington, IN
8. From Men’s health magazine: Doing plyo jumps on an incline !?
9. From the field doc: Dr. Rothbart himself !
Dear Dr Allen and Dr Waerlop, … . 

I thought you might be interested in my definition of normal vs abnormal pronation (and supination):

11. 

J Manipulative Physiol Ther. 2013 Jul-Aug;36(6):359-63. doi: 10.1016/j.jmpt.2013.06.002. Epub 2013 Jul 3.

Effect of customized foot orthotics in addition to usual care for the management of chronic low back pain following work-related low back injury.

The findings showed that patients in this study with chronic, nonspecific low back pain following work-related low back injury had greater improvement in short-term outcomes with orthotics and UC than with UC alone.

The Case of the Non Rotating Knee

Here is a runner, wanting to be an ultra runner, who recently developed right sided knee pain while running a 50K. He was pacing another individual and developed pain on the outside (lateral patella and knee) on the right, ascending and especially descending hills. The pain is dull and achy. He is able to “push through” the pain, but if he does, it remains painful for a few days.

He has an anatomically short leg on the L (tibial). There is no significant tibial torsion (he has normal external version) and not femoral torsion. There are adequate amounts of internal (>15 degrees) and external (>30 degrees) rotation of the hips.

He has 7 degrees ankle dorsiflexion on the right, 10 degrees on the left. On the table (and in the video) he has 0 degrees of hip extension during passive motion, walking and running. He has weakness of the long extensors of the toes, as well as the abductors.

Take a look at his video. Note the following:

·       the right knee has less medial excursion than the left (watch the dots)

·       rearfoot valgus is noted on the L  (ie. calcaneus is everted)

·       subtle lean to Left on L sided stance phase

·       when barefoot, the problem lessens

Why does the right knee rotate less than the left?

When folks have a short leg, we generally expect that leg to remain in supination (thus external rotation) more and the longer leg to internally rotate more, due to excessive pronation. But here, we see the opposite. You will notice he has a rearfoot valgus on the left. This means the midtarsal joint is in a greater amount of pronation on the shorter side. For every action, there is an equal and opposite reaction. In this case, less pronation (or supination) on the longer leg side. Remember, we said generally folks pronate more on the long leg side. This is one of the exceptions.

So, should he throw away his shoes?

The shoes, which have a certain amount of torsional rigidity, are compounding the problem. The Brooks Cascadia is an excellent trail running shoe, he just needs something with less torsional rigidity. the shoe does  not allow his knee to come midline sufficiently. Since he is a Brooks Fan, we suggested the “Grit” in the Pure line. 4mm drop and less rigid torsionally. He could also work his way into a “Drift” (4mm or zero drop, extremely flexible).

Why does he lean to the left on stance phase on the left?

Most likely, to clear the right long leg on swing phase. This is one of the 5 common strategies. For more strategies, click here.

Why is it better when he is barefoot? It must mean he should be a barefoot runner, right?

He is better, because there is less impediment to the foot pronating (ie. the shoe has less torsional rigidity)

The Gait Guys. Making you a better diagnostician, with each and every post.

Lebron James and his funky toes. We have the scoop as to what is going on.

http://bleacherreport.com/articles/1757693-everybody-look-at-lebron-james-toesimage

This is what happens when you get too much short extensor tone and/or strength in the digits of the foot.  Now this is his trailing foot and he has moved into toe off so he should be activating his toe extensors and the tibialis anterior (ie. the anterior compartment) to create clearance for that foot so that he doesn’t catch the toes on the swing through phase of gait.  In this case we do not see alot of ankle dorsiflexion (which we should see at this point) so we are  seeing a compensation of perhaps increased short extensor (of the toes) activity.  

We also see what appears to be a drifting of the big toe (the hallux) underneath the 2nd toe. This often happens when a bunion or hallux valgus is present.  Now we do not see a bunion present here but the viewing angle is not optimal however it does appear that there is a slight drift of the hallux big toe towards the lesser toes . We are not sure if we would qualify this as hallux valgus, and if so it is mild, but none the less we see a slight lateral drift. What is interesting is that despite the obvious activity of the lesser toes short extensor muscle (EDB) we do not see a simultaneous activity of the short extensor of the hallux (EHB, extensor hallucis brevis). Does he need to do our exercise ? See video link here ! 

And so, when the lesser toes are in extension as we see here and the big toe is not moving into extension, and when that is simultaneously combined with even a little hallux valgus tendency, the big toe will drift underneath the lesser toes as we see here, even appearing to push the 2nd toe further into extension.  

As for his little toe, well, Dr. Allen  has one just like it so perhaps he missed his calling in the NBA. Some folks just do not have as plantarward orientation of the 5th toe and so it migrates upward (dorsally) a little. This can be from birth but it can also come from trauma. But in time because the toe is not more plantar oriented, the dorsal muscles (the extensors) become more dominant and the toe just starts to take on this kind of appearance and orientation. It will reduce significantly when the foot is on the ground and the extensors are turned off, but it looks more shocking during the swing phase because of the extensor dominance in that phase.

This kind of presentation if left unchecked can lead to hammer toes, plantar fat pad migration distally exposing the metatarsal heads to more plantar forces without protection and a host of other problems.  Lebron needs to do our Shuffle Walk Exercise to get more ankle rocker (dorsiflexion) and also work to increase his long toe extensors (EDL) and lumbricals.  This will flatten his toes and improve mechanical leverage.  Remember, if you gait better foot function with increased ankle dorsiflexion you will get more hip extension and more glute function.  But does the big fella really need to jump any higher? We are sure he would accept being faster though … .  who wouldn’t ?

Fee for today’s long distance consult: …  Lebron, lets say 10,000$ and we will call it even.  Sound good ?  But a lifetime of prettier, stronger and more functional toes……priceless. Have  your people contact our people.  (Ok, we don’t have people, but we do have an email address here on our blog !).

Shawn and Ivo, The Gait Guys.  Even helping the elite, little by little.

Lebron James and his funky toes. We have the scoop as to what is going on.

http://bleacherreport.com/articles/1757693-everybody-look-at-lebron-james-toesimage

This is what happens when you get too much short extensor tone and/or strength in the digits of the foot.  Now this is his trailing foot and he has moved into toe off so he should be activating his toe extensors and the tibialis anterior (ie. the anterior compartment) to create clearance for that foot so that he doesn’t catch the toes on the swing through phase of gait.  In this case we do not see alot of ankle dorsiflexion (which we should see at this point) so we are  seeing a compensation of perhaps increased short extensor (of the toes) activity.  

We also see what appears to be a drifting of the big toe (the hallux) underneath the 2nd toe. This often happens when a bunion or hallux valgus is present.  Now we do not see a bunion present here but the viewing angle is not optimal however it does appear that there is a slight drift of the hallux big toe towards the lesser toes . We are not sure if we would qualify this as hallux valgus, and if so it is mild, but none the less we see a slight lateral drift. What is interesting is that despite the obvious activity of the lesser toes short extensor muscle (EDB) we do not see a simultaneous activity of the short extensor of the hallux (EHB, extensor hallucis brevis). Does he need to do our exercise ? See video link here ! 

And so, when the lesser toes are in extension as we see here and the big toe is not moving into extension, and when that is simultaneously combined with even a little hallux valgus tendency, the big toe will drift underneath the lesser toes as we see here, even appearing to push the 2nd toe further into extension.  

As for his little toe, well, Dr. Allen  has one just like it so perhaps he missed his calling in the NBA. Some folks just do not have as plantarward orientation of the 5th toe and so it migrates upward (dorsally) a little. This can be from birth but it can also come from trauma. But in time because the toe is not more plantar oriented, the dorsal muscles (the extensors) become more dominant and the toe just starts to take on this kind of appearance and orientation. It will reduce significantly when the foot is on the ground and the extensors are turned off, but it looks more shocking during the swing phase because of the extensor dominance in that phase.

This kind of presentation if left unchecked can lead to hammer toes, plantar fat pad migration distally exposing the metatarsal heads to more plantar forces without protection and a host of other problems.  Lebron needs to do our Shuffle Walk Exercise to get more ankle rocker (dorsiflexion) and also work to increase his long toe extensors (EDL) and lumbricals.  This will flatten his toes and improve mechanical leverage.  Remember, if you gait better foot function with increased ankle dorsiflexion you will get more hip extension and more glute function.  But does the big fella really need to jump any higher? We are sure he would accept being faster though … .  who wouldn’t ?

Fee for today’s long distance consult: …  Lebron, lets say 10,000$ and we will call it even.  Sound good ?  But a lifetime of prettier, stronger and more functional toes……priceless. Have  your people contact our people.  (Ok, we don’t have people, but we do have an email address here on our blog !).

Shawn and Ivo, The Gait Guys.  Even helping the elite, little by little.

Podcast 38: Usain Bolt, Arm Swing, Ballasts, & Running “Stuff”

Our show notes should interest you today. We have another great podcast ready for you !

Link to our server:

 http://thegaitguys.libsyn.com/podcast-38-usain-bolt-arm-swing-ballasts-running-stuff

iTunes link:

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

Gait Guys online /download store (National Shoe Fit Certification and more !) :

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:

2. Running and walking gadget:
Mashable (@mashable)
9/10/13 4:53 AM
This Clip-On Device Lets You Read Your Tablet While You Runon.mash.to/1akqMaK
4. Arm Swing:
– The Ballast Theory 
5. Off the web: Children’s Shoes
6. Off the MEdical Journal:
7.  Clinical Case Questions from a Reader:
Hello there, I’ve been following your stuff for a while now after searching far and wide for solutions to issues I have with my feet/ankles … . .
Chris 
8. Topic: Bartold on heelstrike
9. From the Medical Journal:
Neuroscientist. 2004 Aug;10(4):347-61.
Regulation of arm and leg movement during human locomotion.

Zehr EPDuysens J.

Rehabilitation Neuroscience Laboratory, University of Victoria, BC, Canada. pzehr@uvic.ca

Abstract: Walking can be a very automated process, and it is likely that central pattern generators (CPGs) play a role in the coordination of the limbs. Recent evidence suggests that both the arms and legs are regulated by CPGs and that sensory feedback also regulates the CPG activity and assists in mediating interlimb coordination. Although the strength of coupling between the legs is stronger than that between the arms, arm and leg movements are similarly regulated by CPG activity and sensory feedback (e.g., reflex control) during locomotion

10. Off pubmed: 
J Am Podiatr Med Assoc. 2012 Sep-Oct;102(5):390-5.

Anatomical origin of forefoot varus malalignment.

Lufler RSHoagland TMNiu JGross KD.

Forefoot varus malalignment is clinically defined as a nonweightbearing inversion of the metatarsal heads relative to a vertical bisection of the calcaneus in subtalar joint neutral. Although often targeted for treatment with foot orthoses, the etiology of forefoot varus malalignment has been debated and may involve an unalterable bony torsion of the talus. There was no association between forefoot alignment and talar torsion (r = 0.18; 95% confidence interval, -0.11 to 0.44; P = .22).These findings may have implications for the treatment of forefoot varus since they suggest that the source of forefoot varus malalignment may be found in an alterable soft-tissue deformity rather than in an unalterable bony torsion of the talus.

Podcast 38: Usain Bolt, Arm Swing, Ballasts, & Running “Stuff”

Our show notes should interest you today. We have another great podcast ready for you !

Link to our server:

 http://thegaitguys.libsyn.com/podcast-38-usain-bolt-arm-swing-ballasts-running-stuff

iTunes link:

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

Gait Guys online /download store (National Shoe Fit Certification and more !) :

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:

2. Running and walking gadget:
Mashable (@mashable)
9/10/13 4:53 AM
This Clip-On Device Lets You Read Your Tablet While You Runon.mash.to/1akqMaK
4. Arm Swing:
– The Ballast Theory 
5. Off the web: Children’s Shoes
6. Off the MEdical Journal:
7.  Clinical Case Questions from a Reader:
Hello there, I’ve been following your stuff for a while now after searching far and wide for solutions to issues I have with my feet/ankles … . .
Chris 
8. Topic: Bartold on heelstrike
9. From the Medical Journal:
Neuroscientist. 2004 Aug;10(4):347-61.
Regulation of arm and leg movement during human locomotion.

Zehr EPDuysens J.

Rehabilitation Neuroscience Laboratory, University of Victoria, BC, Canada. pzehr@uvic.ca

Abstract: Walking can be a very automated process, and it is likely that central pattern generators (CPGs) play a role in the coordination of the limbs. Recent evidence suggests that both the arms and legs are regulated by CPGs and that sensory feedback also regulates the CPG activity and assists in mediating interlimb coordination. Although the strength of coupling between the legs is stronger than that between the arms, arm and leg movements are similarly regulated by CPG activity and sensory feedback (e.g., reflex control) during locomotion

10. Off pubmed: 
J Am Podiatr Med Assoc. 2012 Sep-Oct;102(5):390-5.

Anatomical origin of forefoot varus malalignment.

Lufler RSHoagland TMNiu JGross KD.

Forefoot varus malalignment is clinically defined as a nonweightbearing inversion of the metatarsal heads relative to a vertical bisection of the calcaneus in subtalar joint neutral. Although often targeted for treatment with foot orthoses, the etiology of forefoot varus malalignment has been debated and may involve an unalterable bony torsion of the talus. There was no association between forefoot alignment and talar torsion (r = 0.18; 95% confidence interval, -0.11 to 0.44; P = .22).These findings may have implications for the treatment of forefoot varus since they suggest that the source of forefoot varus malalignment may be found in an alterable soft-tissue deformity rather than in an unalterable bony torsion of the talus.

What Does Changing your Stride Cost You?

http://running.competitor.com/2013/09/training/study-changing-running-stride-does-more-harm-than-good_41136

A recent study cited in Competitor Magazine, talked about common stride “improvements” actually may reduce running economy. They looked at stride rate (cadence) and vertical displacement. One would think, with all the hoopla out there, that more steps per minute and less vertical displacement would be more efficient. The actual study concluded “Alterations led to an increase in metabolic cost in most cases, measured as VO2 uptake per minute and kg body mass,” Another study which had similar results can be found here.

Even though the study had a small sample size (16 participants), If you think about this, it makes sense.   Volitional effort usually has a metabolic cost. It does not make it right or wrong; they are just the facts. The nervous system will take time to integrate new (motor) patterns. Each person has a optimal (homestatic) stride “style” which includes vertical displacement as well as stride length, among other factors (lateral sway, ankle dorsi pantar flexion, knee flexion, thigh flexion, etc).

The study itself also concluded ““Mid- and long-term effects of altering … technique should also be studied.” we concur, we have not seen any long term studies that look at economy over time, but would love to read them if any of our readers run across them.

The Gait Guys.  Bringing you the facts without the bling.

 “… within months, hundreds of the young male inmates of the camp began limping, and had begun to use sticks as crutches to propel themselves about. In some cases inmates had been rapidly reduced to crawling on their backsides to make their ways through the compound …. Once the inmates had ingested enough of the culprit plant, it was as if a silent fire had been lit within their bodies. There was no turning back from this fire—once kindled, it would burn until the person … would ultimately be crippled …. The more they’d eaten, the worse the consequences—but in any case, once the effects had begun, there was simply no way to reverse them …. ” -insights from Dr. Arthur Kessler, prisoner and doctor within the concentration camp

What would you do if you were trapped out in the wilderness and your glutes and legs stopped working ? This is just what happened to Christopher McCandless (aka, Alexander Supertramp) in the wilderness outside Fairbanks Alaska.

Neurolathyrism is a toxic myelopathy caused from ingestion of Lathyrus sativus grass pea. It causes paralysis, lack of strength or inability to move the lower limbs and may involve the pyramidal tracts of the spine/CNS producing UMN signs (upper motor neuron signs).  A unique symptoms of lathyrism is apparently the atrophy of the gluteal muscles. 

 

Dear Gait Guys, why are you telling us obscure things about a toxic neuropathy ?

 

Ok, let us back up. But for you to understand we first need to tell you about a 1940’s Holocaust concentration camp in the Ukraine.

Vapniarka is a presently a small town of ~8600 in Vinnytsia, Obllast, Ukraine.  It was during the months of October 1941 through March of 1944 it became the site for the German occupied Holocaust concentration camp imprisoning Romanian Jews.  As most concentration camps go, food, water, sanitation and disease outbreaks were common problems and concerns. Food was so limited that the prisoners were at one point fed barley bread that had 20% straw mix within and a species of pea known as Lathyrus sativus typically used to feed livestock.  It was only a short time later that strange symptoms began to break out amongst the prisoners. At first they became weak but it wasn’t long before they had difficulties ambulating and then became paralyzed with what was diagnosed as Neurolathyrism also known more simply as Lathyrism, a form of spastic paralysis. The culprit was oxalyldiaminopropionic acid (ODAP) from the peas. Some sources say that by 1943 hundreds of prisoners were struck down with Lathyrism and apparently 117 Jews were left permanently paralyzed.

We believe we first read about this in early 2013 in an online news article by Ronald Hamilton in a paper entitled “The Silent Fire: ODAP and the Death of Christopher McCandless”. McCandless has been made famous for his story and death deep in the Alaska wilderness in the Jon Krakauer book “Into the Wild”. We were excited to see this paper quoted in Jon Krakauer’s The New Yorker article this month. In his paper Hamilton wrote, 

 ”… within months, hundreds of the young male inmates of the camp began limping, and had begun to use sticks as crutches to propel themselves about. In some cases inmates had been rapidly reduced to crawling on their backsides to make their ways through the compound …. Once the inmates had ingested enough of the culprit plant, it was as if a silent fire had been lit within their bodies. There was no turning back from this fire—once kindled, it would burn until the person who had eaten the grasspea would ultimately be crippled …. The more they’d eaten, the worse the consequences—but in any case, once the effects had begun, there was simply no way to reverse them …. “
In Krakauer’s recent The New Yorker article “How Chris McCandless Died”, he gives an explanatory full-circle synopsis regarding the gripping conclusion in his book “Into the Wild”.  In the article he speaks about Hamilton’s paper, McCandless’s fate and also mentions that in the 20th century more than a hundred thousand other people worldwide have been permanently paralyzed from eating grass pea containing the neurotoxin ODAP. According to Hamilton, the neurotoxin over-stimulates the nerve receptors causing them to burn out. As he explained in his “The Silent Fire” paper,
“It isn’t clear why, but the most vulnerable neurons to this catastrophic breakdown are the ones that regulate leg movement…. And when sufficient neurons die, paralysis sets in…. [The condition] never gets better; it always gets worse. The signals get weaker and weaker until they simply cease altogether. The victim experiences “much trouble just to stand up.” Many become rapidly too weak to walk. The only thing left for them to do at that point is to crawl….”
You can read the Krakauer / Hamilton account and recent story in the article link found below. In it they both tell the most recent events in the laboratory testing of the seeds that McCandless ate in bulk during his last months/weeks.  The tested seeds were found to be in high enough concentration to cause the symptoms (of Lathyrism) McCandless wrote about in his last weeks of survival when he was more susceptible to the neurotoxin having already been in severe malnutrition and hunger.

We dove a little deeper into this toxic myelopathy and discovered some helpful journal articles. According to Misra et al.  ”patients complained of walking difficulty due to weakness and leg stiffness. The gait abnormalities ranged from spastic gait, toe walking and the need of assisted gait devises such as canes. They spoke of the weakness being mild to moderate and less prominent than was spasticity. In 8 of their subjects the physical signs were asymmetrical. Peripheral neuropathy was present in only one patient, but muscle atrophy and widespread fasciculation’s were not found. A higher frequency of peripheral neuropathy and lower motor neuron involvement has been reported from Bangladesh and Israel. Severe spasticity in the absence of prominent weakness in lathyrism may be due to the involvement of certain specific groups of corticospinal fibres.”

We are big fans of Krakauer’s writing (and now Hamilton’s paper “The Silent Fire”) and this was a good story to close the Alexander Supertramp chapter hopefully once and for all. “Into the Wild” by Krakauer was a riveting book, one of our favorites.  Sean Penn’s cinematic interpretation of the story was good as well.  But for two gait geeks like us, to finally find out that poor Chris died of something so rare and complex, something that could be traced back as far as the holocaust concentration camps where people’s gait was first seen impaired was pretty fascinating. We are sure there billions of folks who have never looked at our blog and who will never likely read it.  Gait and gait related disorders and diseases do not get many people excited, but for us, this might as well be pornography. We are sure there are millions that are not fascinated by the fact that every organism on this planet locomotes in one manner or another, each with their own characteristic rules and biomechanics. It is sad to us that few really pay attention to how humans locomote and ambulate, at least not until they break a leg, sprain an ankle or come down with some complex motorneuron lesion. Gait is everywhere once you start looking for it. Whether you start to become aware of it at the local shopping mall, in TV commercials, during Sunday night football, during the Olympics, at your grandmama’s house, during your son or daughters walk to the dinner table , or even in the movies… . . gait is everywhere. Sean Penn’s interpretation of Krakauer’s “Into the Wild” is a touching sweeping movie and for us to now find out that the thing that ultimately led to McCandless’s demise was a gait related neurotoxic myelopathic disorder just goes to prove our point, gait is everywhere.  Why more people do not see this is beyond us, but hey, it would be a strange world if everyone was as nerdy as the two of us wouldn’t it !? 
Shawn and Ivo, The Gait Guys.  
 
References:
 
1. Paraplegia. 1993 Apr;31(4):249-54.

Clinical aspects of neurolathyrism in Unnao, India.

2. J Neurol. 2012 Jul;259(7):1263-8. doi: 10.1007/s00415-011-6306-4. Epub 2011 Nov 12.

Neurolathyrism: two Ethiopian case reports and review of the literature.

3. Neurobehav Toxicol Teratol. 1983 Nov-Dec;5(6):625-9.

Lathyrism: a neurotoxic disease.

Podcast 37: Anandamide & Body Work, 3D Printed Shoes and Case Studies

Our show notes should interest you today. We have another great podcast ready for you today !

Link to our server:

http://thegaitguys.libsyn.com/podcast-37-anandamide-body-work-3d-printed-shoes-and-case-studies

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:

McPartland et al (2005) measured Anandamide (AEA) levels pre- and post, Myofascial Release, Muscle Energy Technique, High velocity manipulation all of which load fascia patients experienced analgesic/euphoric cannabimimetic effects, which correlated with an increase in serum AEA levels (more than double pre-treatment evels). 
Neither cannabimimetic effects, nor changes in AEA levels, occurred in control subjects.

McPartland, J et al 2005.. Jnl. American Osteopathic Association 105, 283–291 
http://leonchaitow.com/2008/01/30/bodywork-high

2. Vibrating shoes could be the future of navigation and wearable tech

http://www.wired.co.uk/magazine/archive/2013/09/start/vibrating-shoes-the-new-navigation-tool

3. Tim Ferriss (@tferriss)

9/2/13 9:25 PM
Malcolm Gladwell: “Man and Superman” The New Yorker buff.ly/174jruO Drugs, genetics, and the fallacy of a level playing field.

 
4.FB reader sent us a message:

Hi Guys: Not quite sure how I came across your podcasts but really enjoying them, even if I’m only slowly starting to understanding them. I was catching up on some old ones during my marathon training and the ones on evolution reminded me of some of my musing on the arch in the foot (well I guess correctly that should be the medial longitudinal arch). I though you might be able to give me the answers or point me in the right direction

Are we only species with this?
What is the advantage?
When and how does it develop and why isn’t it formed in utero?
Are flat feet then a genetic or developmental issue and why?
Thanks 
Alex
5. off the web:
The imprecise art of foot orthoses
6. off the web:
3D-Printed Shoes Mean You’ll Never Need to Buy Another Pair
http://mashable.com/2013/08/20/3d-printed-shoes/
7. Another TUMBLR reader asks question about:
Hi Gait Guys,

I am currently a third year podiatry student needing some biomechanics and orthotic-making training. I enjoy your youtube videos but was wondering if you offer or could recommend a dvd that I could purchase to further my education. The way the information is presented it in class is not as good as the way you do it! I am also interested in the biomechanics of shoes… I am having trouble finding information about how walking in a cushioned/plantarflexed sneaker effects function (Does is help us get to forefoot running or hinder us?). I enjoyed your blog on different curved lasts as well. How would I be able to apply the way the shoe is lasted to a patient? For example, if the patient is rigid and I want them to be wearing a shoe that is lasted like a slipper how do I guide them into buying a shoe constructed as such? Do I just tell them to go for a shoe made with a straight toe box? Is there such a thing as a toe box curved laterally? 

One last question- do you recommend a medial FF post for a patient that has a mobile RF varus that causes a FF supinatus? I was told a post like this would limit PF of the first ray and DF of the hallux which would limit toe off and cause other problems. 
Thank you. I appreciate any advice you may have. I am out of my element with biomechanics and really want to improve at it.

8.Another off tumblr: 
sign-life-away asked you:
Is forefoot walking bad for you? Everyone says I walk awkwardly, as if i have something up my bum. I have been trying to walk “naturally” (heel-toe) but I go back to forefoot strike. Does this contribute to why my legs have always been muscular?