Welcome to rewind Friday Folks.

Think about all those folks in the Northeast who have been shoveling (OK, the folks in Colorado as well) and their feet being rubber boots!

Here’s an oldie, but a goodie.

Here’s one paper we though had merit (sure, go to Pub Med and search foot odor. There were 119 entries). We think we may try this in the office…

The Gait Guys: Yes, smelly feet are something we have to deal with at the office on a daily basis. One of the pitfalls of being a Foot Geek : )
Make sure to check back later for more on malodorous extremities…                        
 
J Int Soc Sports Nutr. 2007 Jul 13;4:3.

A novel aromatic oil compound inhibits microbial overgrowth on feet: a case study.

Source

West 1140 Glass Avenue Spokane, Washington, 99205, USA. drbill@omnicast.net.

Abstract

ABSTRACT:

BACKGROUND:

Athlete’s Foot (Tinea pedis) is a form of ringworm associated with highly contagious yeast-fungi colonies, although they look like bacteria. Foot bacteria overgrowth produces a harmless pungent odor, however, uncontrolled proliferation of yeast-fungi produces small vesicles, fissures, scaling, and maceration with eroded areas between the toes and the plantar surface of the foot, resulting in intense itching, blisters, and cracking. Painful microbial foot infection may prevent athletic participation. Keeping the feet clean and dry with the toenails trimmed reduces the incidence of skin disease of the feet. Wearing sandals in locker and shower rooms prevents intimate contact with the infecting organisms and alleviates most foot-sensitive infections. Enclosing feet in socks and shoes generates a moisture-rich environment that stimulates overgrowth of pungent both aerobic bacteria and infectious yeast-fungi. Suppression of microbial growth may be accomplished by exposing the feet to air to enhance evaporation to reduce moistures’ growth-stimulating effect and is often neglected. There is an association between yeast-fungi overgrowths and disabling foot infections. Potent agents virtually exterminate some microbial growth, but the inevitable presence of infection under the nails predicts future infection. Topical antibiotics present a potent approach with the ideal agent being one that removes moisture producing antibacterial-antifungal activity. Severe infection may require costly prescription drugs, salves, and repeated treatment.

METHODS:

A 63-y female volunteered to enclose feet in shoes and socks for 48 hours. Aerobic bacteria and yeast-fungi counts were determined by swab sample incubation technique (1) after 48-hours feet enclosure, (2) after washing feet, and (3) after 8-hours socks-shoes exposure to an aromatic oil powder-compound consisting of arrowroot, baking soda, basil oil, tea tree oil, sage oil, and clove oil.

CONCLUSION:

Application of this novel compound to the external surfaces of feet completely inhibited both aerobic bacteria and yeast-fungi-mold proliferation for 8-hours in spite of being in an enclosed environment compatible to microbial proliferation. Whether topical application of this compound prevents microbial infections in larger populations is not known. This calls for more research collected from subjects exposed to elements that may increase the risk of microbial-induced foot diseases.

The Gait Guys. Bringing you the good, the bad and the smelly….

Another IFGEC Certification granted:

Here’s what Mark Small has to say

“The National Shoe Fit Program is beneficial to many fields/disciplines including, but not limited to, coaches, personal trainers, athletic trainers, physical therapists, podiatrists, and chiropractors (I would say MD’s, but it doesn’t come in a pill), as well as those who sell shoes.  The program offers tools to help us understand individual differences and their effects on gait and performance.  Some of the material includes:
    •    Foot anatomy
    •    Anatomical Landmarks
    •    Foot types
    •    Pathologies
    •    Basic biomechanics
    •    Shoe fit functional testing
    ⁃    Static and dynamic tests to assist fitting
    •    Finally shoe selection
    ⁃    Picking the best shoe for your client/athlete/patient

Some of these topics may be a good review for some of the advanced disciplines listed above. What the program is able to do, even for them, is to link everything together in a methodical, step by step, detailed approach, that applies what we have learned into something predictable and usable. We are often looking for ways to increase performance, decrease pain and get people to move better.  I, for one, believe that much of bad movement, pain and dysfunction have to do with inappropriate footwear, this course is a starting place to help correct that problem.  I am looking forward to Level 2 & 3 certification programs, but more importantly, I am looking forward to applying what I am learning with the people I serve.  I’m not a Gait Guy… more like a gleam in the gait daddy’s eye, but I’m working on it.”

Congratulations, Mark!

The Gait Guys

Thanks for the kudos Coach Smith !

for anyone interested… . . 

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

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

2. other web based Gait Guys lectures:

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

” I had explosive diarrhea in the middle of a good long run.”

We have always wanted to start a blog post with something dirty like that, but it never seemed like the right thing to do. So, we figured we would save it for on or around the day of our 1000th blog post. We started The Gait Guys blog in 2011 with our first blog post and just a few days ago the trumpets sounded at the 1000th post. How did this happen ? Well, it happened little by little, 3-5 post a week, month after month. It happened just as the gentleman described in the video above on how to make a dry wall, stone after stone.  Our writing has managed to reach into 74 countries with the additional help of our podcasts, teleseminars and social media.  Thus, we wanted to just voice a little thanks to you all for following us, week after week, month after month.  So far this has been a pretty great journey for us and we are happy you have come along for the ride. 

Now back to sphincters and running. 

” I had explosive diarrhea in the middle of a good long run.”

Think it can’t happen to you ? Here is a true medical literature case study. “A 20-year-old female running the Marine Corps Marathon developed diarrhea at mile 12. After finishing the race she noted that she was covered in bloody stool. A local emergency department suspected ischemic colitis.” This was straight from the Grames study found below. 

Maintenance of the basal tone in the internal anal sphincter is critical for rectoanal continence. Effective evacuation requires a fully functional rectoanal inhibitory reflex-mediated relaxation of the internal anal sphincter via inhibitory neurotransmission.

Ok, What !!!!????

Basically, all that means is that the tone of the anus is pretty complicated and when it works right, we don’t think about it much, and when it shows us signs of things hitting the fan, it prompts an immediate hierarchy of our attention.  However, diarrhea is so much more than what is violently erupting from the opening at the other end of our alimentary tract.

Lower GI complaints such as urgency and diarrhea are not all that uncommon in runners.  Sometimes it is pre-race jitters/nerves, sometimes is too many donuts and coffee before the big sunday team run, sometimes it is electrolyte imbalances or too much beer or Wild Turkey the night before, sometimes it’s aberrant autonomic nervous system stimulation, and in the initial case above sometimes it is ischemia (impaired blood perfusion to the colon).

Possible mechanisms of ischemia in distance runners and others participating in intense exercise may include a combination of splanchnic vasoconstriction, dehydration, and hyperthermia, combined with the mechanical jostling of organs via intense activity. Most of the unfortunate presenting with marathon-running-induced ischemic colitis respond favorably to conservative treatment, but awareness is the first step. However, as in the Cohen et al case referenced below, sometimes the unlucky collapse at the finish line and have other results …  whereafter “computed tomography scanning revealed ischemic colitis of the cecum and ascending colon, which progressed to the development of clinical peritonism after 48 hours. This patient subsequently underwent a laparotomy and right hemicolectomy, with ileostomy formation, on the third day after admission. Operative and histologic findings confirmed ischemic colitis of the cecum and proximal colon.”  

So, there is some anxiety-inducing stuff to think about right before your long run this week ! But lets be realistic. Be smart, watch your diet with a good food diary, think hard about your fluid levels and what those fluids are, be smart about pushing hard during high temperature days, know your usual stool habits, and most of all do not ignore the subtle or obvious signs that things could be going wrong in a race or in training. Unexpected bowel problems in a race may not be only a mere embarrassment, they could be telling you something is seriously wrong. 

In closing, thanks for following our writings for the past 3.5 years, writings amounting to 1000 articles. It has been a fun journey and we have learned right along side of you.  In relation to the video above, our body of work is clearly no novel, but our journey in itself is a story of sorts. A story that has been piecing together all the little nuances of the human frame and its biomechanics, bit by bit. 

(Oh, and for those who feel we should apologize for the video not being about, well, erupting diarrhea in a runner, well, we wanted to make today’s post more about the writing process. If you want THAT video, that is what youtube might be for. Just don’t too much of your day looking for it, try writing a book instead.)

Shawn and Ivo,

Two Gait Guys trying to avoid what sometimes hits the fan.

References:

1) Am Fam Physician. 1993 Sep 15;48(4):623-7. Runner’s diarrhea and other intestingal problems of athletes. Butcher JD.

2) Am J Emerg Med. 2009 Feb;27(2):255.e5-7. Marathon-induced ishemic colitis: Why running is not always good for you.  Cohen DC1Winstanley AEngledow AWindsor ACSkipworth JR.

3) Case Rep Gastrointest Med. 2012;2012:356895. Ischemic Colitis in an endurance runner.  Grames C1Berry-Cabán CS.

Concepts in Pelvic Stabilization. Do you know what you know?

We made this video several years ago. It is excerpted from our DVD series on core stabilization available here.

It reviews some concepts of the abdominal core and reviews problems with typical sit up and crunch exercises.

The take home message is one of technique and application. The details and little things are often the most important things. Especially when it comes to exercise and rehabilitation.

The Gait Guys

Stopped by yesterday to see my friends and fellow running/shoe geeks at New Balance Chicago, Oakbrook Terrace store. My good friend and shoe genius Mike and Jeff blessed me with a gift. A pair of the New BAlance Fresh Foam. We will definitely be talking this one up on podcast 56 ! 4mm drop, and just over 20mm of stack height, no siping, this one could be a smooth ride ! These guys are so nice, what a store ! New Balance #newbalance#thegaitguys #freshfoam #4mmramp

 (4 photos)

Podcast 55: Cold Joints, Gluten Brain & Toilets

-The Neurophysiology of your Joint Pain and Problems

A. Link to our server:

Direct Download: http://traffic.libsyn.com/thegaitguys/pod_55final.mp3

Permalink: http://thegaitguys.libsyn.com/podcast-55-cold-joints-gluten-brain-toilets

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:

3 neuroscience pieces this week:

___________

‘Gluten Brain’: Wheat Cuts Off Blood Flow To Frontal Cortex 

http://www.greenmedinfo.com/blog/research-wheat-cuts-blood-flow-brains-frontal-cortex

Influence of midsole hardness of standard cushioned shoes on running-related injury risk

__________
blishahead/Running_Shoes_Increase_Achilles_Tendon_Load_in.98153.aspx
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Case From a blog reader
Hello, 

I’m a swedish elite cross-country skier and newly graduated physio and I find your podcasts very interesting and informative! I have a question about something I’ve never heard you talk about, and which has been a problem for me for the last year.
It’s about the IP-joint of the big toe. I’ve had discomfort/pain in the joint for the last year, mostly after my workouts. It’s a bit swollen and there is crepitus to some degree(especially when I manually flex the toe while compressing it and at the same time have a pressure downwards/ventrally of the distal phalanx. I think it may be coming from a trauma I had 4-5 years ago when I stubbed my big toe really hard in a rock in an orienteering competition, which caused me to rest from running for a week or two.
So, my question to you is if you have any suggestion for me or others in my situation? Treatment? Which types of shoes to use? How would a future joint-fusion affect my running?
I’m only 23 years old and I’m really worried that this ache/discomfort will just get worse and worse.. I’ve asked a lot of great physios here in Sweden, but most of them don’t know much about what to do.
I’d be really grateful if you could take the time to give this a thought and share it.
Thanks!
_______________
Another reader case:
 

Good morning. I am a former collegiate runner, I competed at Eastern Michigan University and Grand Valley State University, my father is a Chiropractor in northern Michigan. While in school I was recalled to active duty in the reserves after 9/11 and was unable to finish my eligibility. I am now 32, living in North Carolina, and trying to make a comeback to running and competing in Triathlons. At 6’2” and 170lbs. during college  I was competitive at the collegiate level  but always a step behind the true elites in the distance races in college, probably just because of my size, etc. competing against guys carrying 30 less lbs.

I train with a team called Without Limits  (iamwithoutlimits.com ) in Wilmington NC. My coach had mentioned that I had a really long loping stride which felt normal to me, but I cannot remember if I ran this way in college or not. When I finally counted, I had a cadence of 140 steps per minute rather then the optimal 180…

Long story short, I got really out of shape, now getting into pretty good form again, but I am having problems with the IT band and pain in the knee on the right leg. I never ever had this in college training at very high levels (90-100 mile weeks in the off and early parts of each season) …so now I have the bike component that I am working on, but being a larger distance runner I am trying to fine tune my gait/stride and see if I can improve my running that way and also figure out what is going on with this IT band issue as I am only running 30-40 miles/week now but on the bike and in the pool a lot. I am back down to 175 and pretty lean but carrying a little extra muscle from biking and swimming.

Would you be interested, if I could send you several high quality videos from different angles, in taking a look at my gait (or even riding the bike on the trainer) and see if you notice anything ? I have been working on improving my cadence since the IT band issues began, and found your videos online while doing research.  I understand this would be better done on a treadmill or in the parking lot at your office where you could watch up close, but if you are interested, please let me know. I look forward to hearing from you.

 Sincerely,

 Tim

__________

The sedentary life affects your neurons !

http://www.outsideonline.com/news-from-the-field/Sitting-Still-Is-Bad-For-Your-Neurons.html

_________

A 3rd case this week, on Dystonia

Do you guys have any recommendations for analysis and treatment of acquired focal and gait dystonia?
It started as a splinting mechanism with a very loose right si and some L5 radiculopathy over 5 years ago.  The dystonia would come and go then eventually stuck all the time.
All the dystonia is on the right side and I don’t have any systemic neurological disease.
Forward walking, stair climbing, running (although barefoot running in grass and in particular undulating surfaces is ok in small amounts, asphalt or treadmill
brings on dystonia within seconds) are all a problem. Can cycle, run in water for 40 minutes or so no problem, so I think Si may still be hypermobile.  Walking backwards no problem.
Dystonia presents as stiff right leg with knee hyperextension, right eccentric weak, right glute medius weak, sticky posterior weight shift, but full and
painless movement through complete range of hip and knee.  I do have some focal dystonia as well mostly knee extension with hip flexion and foot supination and eversion with hip and knee flexed.

There must be someone who deals with this somewhat locally to me, Virginia Beach, VA.  Hoping you all may have some contacts on the east coast.
Thanks,
Sally

Get This: A Smart Toilet That Aims to Correct Poor Posture, and Even Detect Pregnancy and Disease | Entrepreneur.com
http://www.entrepreneur.com/article/231344

Welcome to rewind Friday, Folks. This week we have hammered on arm  swing. This one is from a year ago and seemed germane to this weeks posts.

Arm swing in gait and running. Why it is crucial, and why it must be symmetrical.

It becomes clear that once you get the amazing feats seen in this video out of your head, and begin to watch just the variable use of the arms that you will begin to appreciate the amazing need for arm swing and function in movement.

We have written many articles on arm swing and its vital importance in gait and running. Have you missed all these articles ?  If so, go to our blog main page, type in “arm swing” in the search box and you will have a solid morning of readings at your fingertips.  We are still not done writing about this most commonly forgotten and overlooked aspect of gait and running analysis, and we probably never will be done.  Why is no one else focusing on it ?  We think it is because they do not see or understand its critical importance.

Without the presence and use of the arms in motion things like acceleration, deceleration, directional change, balance and many other critical components of body motion are not possible.

What is perhaps equally important for you to realize, as put forth in:

Huang et al in the Eur Spine Journal, 2011 Mar 20(3) “Gait Adaptations in low back pain patients with lumbar disc herniation: trunk coordination and arm swing.”

is that as spine pain presents, the shoulder and pelvic girdle anti-phase begins to move into a more in-phase favor.  Meaning that the differential between the upper torso twist and pelvic twist is reduced. As spine pain presents, the free flowing pendulum motions of the upper and lower limbs becomes reduced to dampen the torsional “wringing” on the spine. When this anti-phase is reduced then arm swing should be reduced. The central neural processing mechanisms do this to reduce spinal twisting, because with reduced twist means reduced spinal motor unit compression and thus hopefully less pain. (Yes, for you uber biomechanics geeks out there, reduced spine compression means increased shear forces which are favorite topics of many of our prior University instructors, like Dr. Stuart McGill). The consequence to this reduced spinal rotation is reduced limb swing.  And according to

Collins et al Proc Biol Sci, 2009, Oct 22 “Dynamic arm swinging in human walking.”

“normal arm swinging requires minimal shoulder torque, while volitionally holding the arms still requires 12 % more metabolic energy.  Among measures of gait mechanics, vertical ground reactive moments are most affected by arm swinging and increased by 63% without arm swing.”

So, it is all about efficiency and protection. Efficiency comes with fluid unrestricted movements and energy conservation but protection has the cost of wasting energy and reduced mobility through a limb(s) and spine.

In past articles we have carried these thoughts into historical functional needs of man such as carrying spears and of modern day man in carrying briefcases.   Today we show a great high functioning video of another parkour practitioner.  Parkour is a physical discipline and non-competitive sport which focuses on efficient movement around obstacles.  Watch closely the use of the arms. The need for arm use in jumping, in balance, in acceleration etc. It becomes clear that once you get the amazing feats seen in this video out of your head, and begin to watch just the use of the arms that you will begin to appreciate the amazing need for arm swing and function in movement.

There is a reason that in our practices we treat contralateral upper and lower limbs so much.  Because if you are paying attention, these in combination with the unilateral loss of spinal rotation are the things that need attention. 

Yup, we are The Gait Guys….. we have been paying attention to this stuff long before the functional movement assessment programs became popular.  If you just know gait, one of the single most primitive patterns other than crawling and breathing and the like, you will understand why you see altered squats, hip hinges, shoulder ROM screens etc.  You have to have a deep rooted fundamental knowledge of the gait central processing and gait parameters. If you do not, every other screen that you put your athlete or patient through might have limited or false leading meaning. 

Shawn and Ivo …  combining 40 years of orthopedics, neurology, biomechanics and gait studies to get to the bottom of things.

So you do not think arm swing is important huh ?  Read these 2 stats and recalibrate your thinking.  

This was yet another slide from last nights well attended teleseminar. Those that attended learned all of the up to date facts that doctors, trainers, coaches, therapists need to quickly understand what factors to look for when observing someones gait.  Including our favorite, “what you see is not the problem in their gait, rather it is there strategy around the faulty parts, problem or pain.”

If you think that changing arm swing at the local level is not a big deal, just digest the towering facts from this slide.  Arm swing is a big deal ! It is a CPG generated big deal (Central Pattern Generator).  

Sorry we missed you last night.  The teleseminar was recorded and should be up on www.onlinece.com or www.chirocredit.com in a few days for you to enjoy on your own free time (and so are a few dozen of our other lectures !).   

So, if you are coaching or making local-level arm-swing form running or training changes in yourself or your client, you are probably making some big mistakes.  Our lecture brings this all to light for you in one place !

Arm Swing matters…….. more than any of us previously knew !

Shawn and Ivo, The Gait Guys

Faulty Arm Swing provides clues to gait pathology.

Don’t think that just because you see aberrant arm swing that you should “coach” it out of someone.  It is very likely there for a reason. We discuss tonight how the leg swing is more deeply neurologically embedded, more so than arm swing.  So, fixing something you do not like in their arm swing is very possibly the wrong solution and by doing just that you are forcing your client into a new compensatory CPG (central pattern generator) which is essentially a compensation to their compensation.   Fix the problem, go for its roots !

This is one of our slides for tonights lecture.  This is from the European Spine Journal 2011.  More posterior arm swing can help improve impaired hip extension and gluteal function. A nice compensatory fix to reduce spine rotation in a spinal pain patient, more hip extension means that less pelvic obliquity needs to be acquired (less obliquity in the pelvic girdle means less spine rotation and thus less spine compression. This is a brain based phenomenon, the brain is engaging a pain avoidance CPG. 

You gotta know your biomechanics, you gotta know your neurology and you MUST understand and recognize normal and abnormal gait patterns if you choose to work with humans !

Join us tonight on www.onlinece.com for an in-depth hour talking about the biomechanics and neurobiology behind normal and abnormal arm swing.  7pm central Wednesday 19th.

Shawn and Ivo, the gait guys