Got Arm Swing?

We have written many times about arm swing. Click here for some of our posts here on Tumblr.

Here we are again at the beach. Look at the beautiful difference in arm swing from side to side in the guy carrying the bag. Makes you want to tell him to use a backpack, eh?

Never mind what it does to his gait

  • decreased arm swing on the carrying side
  • increased step length on the left side
  • increased thigh flexion of the left side
  • increased body lean and head tilt to right side (Take a look at this paper)

think about the increased metabolic cost. Think about what this  type of input (increased amplitude of movement unilaterally) is doing to your cortex!

keep your movements symmetrical, folks!

The Gait Guys

A profound loss of hip extension…

While sitting on the beach, our mind never rests. Even when on vacation we continue to watch how people move.

Luckily today, I had the gait cam (Dr Allen is holding down the Gait Guys Fort), so live from Sunset Beach, it’s Sunday night. See of you can see what I saw.

Sitting with my wife and watching the kids dig in the sand, this gal with the flexed posture caught my eye.

Why is she so flexed forward? The profound loss of hip extension made it impossible for her to stand up straight! It was difficult to say if she has bilateral hip osteoarthritis, or possible bilateral THR’s (total hip replacements), maybe just really tight hip flexors, painful bunions that do not like toe off, or even all of the above. She may have a leg length discrepancy, as she leans to the left on left stance phase; of course she could have weak hip abductors on the left. It does not appear she has good control of her core.

What do we see?

  • flexion at the waist
  • loss of hip extension
  • body lean to left at left midstance
  • shortened step length
  • loss of ankle rocker
  • premature heel rise
  • decreased arm swing (she is carrying something in her left hand)

No one is safe from the gait cam! Stay tuned for more beach footage this week!

We remain, The Gait Guys, even on vacation.

Podcast 77: Gait analysis, Forefoot Running & more.

Plus, the 5 neurologic gait compensation expressions.

*Show sponsor: www.newbalancechicago.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_77final.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-77

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:

Google X acquires ‘tremor-canceling spoon’ startup
http://venturebeat.com/2014/09/10/google-x-acquires-tremor-canceling-spoon-startup/

The 5 expressions of neurologic gait decomposition,
Last week we did an online teleseminar … . .
An acoustic startle alters knee joint stiffness and neuromuscular control
http://onlinelibrary.wiley.com/doi/10.1111/sms.12315/abstract
Effectiveness of Off-the-Shelf, Extra-Depth Footwear in Reducing Foot Pain in Older People: A Randomized Controlled Trial
http://biomedgerontology.oxfordjournals.org/content/early/2014/09/08/gerona.glu169.abstract
reader:
I really appreciate learning from you!! I have a bit of a loaded question that I will try to explain clearly to the best of my ability. About 2 years ago, I broke my left shin (hairline-fibula) in a MMA fight. After it healed, a few things have been happening that I assume are connected but can’t quite put my finger on. My ankle mobility on my left ankle is worse than my left. I seem to have permanent turf toe as well. My right glute, ham, and erector are hyperactive.
Additionally, many times when sprinting, pushing a sled, etc, my right quad will become fatigued much more than my left. I believe it’s because I’m not fully extending my left ankle, and relying on my right leg more. Whenever I squat or deadlift, I feel similar too. The right glute and erectors get much more of a “pump” than my left. With all of this, is there anything you would recommend? I truly appreciate it!! It is very frustrating. Thank you again!

Podcast 77: Gait analysis, Forefoot Running & more.

Plus, the 5 neurologic gait compensation expressions.

*Show sponsor: www.newbalancechicago.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_77final.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-77

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:

Google X acquires ‘tremor-canceling spoon’ startup
http://venturebeat.com/2014/09/10/google-x-acquires-tremor-canceling-spoon-startup/

The 5 expressions of neurologic gait decomposition,
Last week we did an online teleseminar … . .
An acoustic startle alters knee joint stiffness and neuromuscular control
http://onlinelibrary.wiley.com/doi/10.1111/sms.12315/abstract
Effectiveness of Off-the-Shelf, Extra-Depth Footwear in Reducing Foot Pain in Older People: A Randomized Controlled Trial
http://biomedgerontology.oxfordjournals.org/content/early/2014/09/08/gerona.glu169.abstract
reader:
I really appreciate learning from you!! I have a bit of a loaded question that I will try to explain clearly to the best of my ability. About 2 years ago, I broke my left shin (hairline-fibula) in a MMA fight. After it healed, a few things have been happening that I assume are connected but can’t quite put my finger on. My ankle mobility on my left ankle is worse than my left. I seem to have permanent turf toe as well. My right glute, ham, and erector are hyperactive.
Additionally, many times when sprinting, pushing a sled, etc, my right quad will become fatigued much more than my left. I believe it’s because I’m not fully extending my left ankle, and relying on my right leg more. Whenever I squat or deadlift, I feel similar too. The right glute and erectors get much more of a “pump” than my left. With all of this, is there anything you would recommend? I truly appreciate it!! It is very frustrating. Thank you again!

People tend to forget about the peroneal muscles. This is what it looks like when the brain forgets.

This client came to see us for obvious reasons but the case details are not what we are focusing on today. Gait gets pretty messed up when a critical component or phase is lost or forgotten.  

In last weeks teleseminar on www.onlineCE.com we discussed several gait cases. In these cases 5 things kept coming up when it came to looking at (specifically) neurologic gait compensations:

  1. slowing of gait
  2. wider based gait
  3. increased ancillary movements 
  4. utilizing support when needed or available
  5. shorted step length and stride length

In this video, it is clear that this person has some serious neurologic problems engaging the peroneal muscles and controlling ankle and foot function and as a consequence you see evidence of some of the itemized issues above, namely, calculated movements, nearly zero arm swing and step length from left to right is abbreviated. 

It can go both ways. The neurologic problem can affect one’s gait, but one’s resultant gait can then affect cortical function, driving an endless loop. Recently, five studies presented at the Alzheimer’s Association International Conference in Vancouver Canada provided striking evidence that when a person’s walk gets slower or becomes more variable or less controlled, his cognitive function is also suffering.(2)  

A person’s gait and their neurologic function cannot be separated. The stuff just run’s too deep.  This is why we love gait so much, because to fully understanding someone’s clinical problems we must understand how and why they move.  There are clues in everyone’s gait that can help you clinically. The question is, will you notice them ? Do you know what normal gait is to begin with ? Will you understand what you are seeing and realize it is a compensation? Will you fix what you see or look deeper to find the cause of what you see ? 

Shawn and Ivo,

The Gait Guys

Gait Posture. 2013 Jul;38(3):549-51. doi: 10.1016/j.gaitpost.2013.02.008. Epub 2013 Mar 11.

Altered gait termination strategies following a concussion.

Buckley TA1, Munkasy BATapia-Lovler TGWikstrom EA.

2.  http://www.nytimes.com/2012/07/17/health/research/signs-of-cognitive-decline-and-alzheimers-are-seen-in-gait.html?_r=1&

This is part 2 of a 2 part post; with the video from the case previously discussed

please note the following in the video:

  • body lean to left during left stance phase (to clear right longer leg)
  • circumduction of right lower extremity  (to clear right longer leg)
  • lack of arm swing bilaterally (cortical involvement)
  • patient looking down while walking (decomposition of gait)
  • shortened step length (decomposition of gait)
  • increased tibial varum bilaterally

ASSESSMENT:  This patient’s short leg and internal tibial torsion impediments to her full recovery. She has increased tibial varum noted which is complicating the picture. This is causing pathomechanics and an abductory moment not only at the knee but also in the lumbar, thoracic and cervical spines.

WHAT DID WE DO?:                    

  • We attempted to do the one leg standing exercise. She needed to hold on and did not feel stable on the left hip while performing this.  This is probably more of confidence rather than ability issue. 
  • We gave her the stand/sit exercise to try to improve gluteal recruitment.
  • We also gave her the lift/spread/reach exercise to attempt to strengthen her feet.
  • A full-length 5 mm lift was cut for the left shoe  She felt more stable when walking on this.
  • She was treated with IC, PIR and manipulative therapy and neuromuscular stim of the knee as well as left hip area above, below and at the joint line of the knee as well as gluteus medius and minimus.   
  • We may need to consider building a more aggressive orthotic with a forefoot varus post depending upon her progress and response to care  

 The Gait Guys. Making it real, each and every post here on the blog.

special thanks to SZ for allowing us to publish her case, so others can learn

Wow! What would you do?

This is part 1 of a 2 part post. Look for the other one a few minutes after this one with a video up top for the conclusion

PRESENTING PROBLEM: This 54 YO female patient presents with with left sided knee pain.  She had a total knee replacement (TKR) done in 2011.  She’s had a significant amount of discomfort on the medial aspect of the knee since then. She had an MRI of the hip done thinking the problem was there, and found nothing.   She is walking with a bad limp, left leg is half inch shorter than the right.  Pain is worse at night, changes with weather. 

She has knee pain on the lateral aspect (points to tibial plateau and joint line) with swelling that goes down to the ankle left side.  She has been wearing a “Good Feet” OTC orthotic on the left side which she states helps quite a bit.

Generally speaking, stretching and analgesics make the discomfort better.    Ibuprofen 400 mg. b.i.d. can take the edge off  Soft sided brace (neoprene sleeve) makes a difference as well. The hard sided brace gives her difficulty.

WORK HISTORY: She works for a preschool.  Her job involves standing and getting up and down a lot.  

FAMILY HISTORY:  She has left sided lid ptosis, this evidently is familial.  

PHYSICAL EXAM:  She stood 5’ 1” and weighed approx. 150 pounds.

Viewing the knees bi-lat., the left knee is markedly externally rotated.

She does have a left short leg; tibial and femoral.  She has bilateral tibial torsion (look at the tibial tuberosities and drop a line straight down; it should pass through the 2nd metatarsal head) and marked internal tibial torsion on the left side (>60 degrees) with femoral retrotorsion (less than 8 degree angle of femoral head with the shaft) on this side.  There is no rotation of the thigh or leg past zero degrees midline. .  She had 10 degrees of tibial varum on the left hand side.  Her Q-angle is 10 degrees on that side.  There is plantar flexion inversion of the foot.  Left lower extremity has less sensation secondary to the her TKR  surgery.

Gait evaluation reveals a fair amount of midfoot pronation noted on the left hand side in addition to an intoed gait.  She has to lean her body over to the left to get the right leg to clear.

Some mild weakness noted of hip abduction musculature left hand side gluteus medius, middle and anterior fibers. Knee stability tests were negative.

Neurologically, otherwise, she had full integrity with respect to sensation, motor strength and deep tendon reflexes in the upper and lower extremities.

Please see part 2 of this post for additional info including our assessment and what WE did.

 The Gait Guys. Making it real, each and every post here on the blog.

special thanks to SZ for allowing us to publish her case, so others can learn