Exploring the Links Between Human Movement, Biomechanics & Gait
Month: June 2016
A marathon a day, for over 120 days…..on one leg, battling cancer.
So you think you are tough ? This guy was tough. A marathon a day for over 120 days…..on one leg, battling cancer.
Rest in Peace Terry. You are not forgotten. You made a mark on my life, thank you for that. Watching you skip on the good leg, giving your prosthetic enough time to swing through mesmerized me, the biomechanics of it all. If i look back, this was the first time I payed attention with great detail to someone’s gait. I was in awe, you moved me, your mission moved me, your heart and spirit moved me. Your life made a difference in mine, so I may help others.Dr. Allen Today, June 28th, every year here on The Gait Guys, I remember Terry Fox. Every year I post a reminder of perhaps one of the toughest dudes who ever lived. Today , this day, 1981 Terry Fox died. I grew up in Canada. I was barely a teenager when Terry began his plight, The Marathon of Hope.
His mission, 26 miles a day, every day, until he had crossed the expanse of Canada to raise awareness for cancer. He made it an amazing 120+ days in a row, 3339 miles, one one leg, before his cancer returned. The whole country stood cheering watching him do something no mortal man would attempt, let along with one leg, and cancer. Today we pay a tribute to this true rockstar. Let this video move you, just in case you think you are having a rough day.
ALERT: Ok, this is big. It is a huge comment on what the brain and reflexive patterns impart on posture and gait when perceived functional instability is present. This study aimed to investigate the gait modification strategies of trunk over right stance phase in patients with right anterior cruciate ligament deficiency. * Here is what you need to ABSOLUTLY keep in mind when you read it. The 3D capture it telling you what they are DOING to strategize, not what is WRONG or what needs CORRECTING (our mantra it seems, sorry to keep beating this concept to death). This again hits home what I have been preaching for quite some time, that arm swing (and you can translate that to trunk movements, thorax, head posture, breathing etc) should not be coached or corrected unless you are absolutely sure there are clean symmetrical lower limb biomechanics (yes, you can easily and correctly argue that you can concurrently work on all parts). IF there is something going awry in a lower limb, compensations will occur above, they have to occur. So be absolutely sure you are not making therapeutic interventions above without making therapeutic corrections below. If you are working on a shoulder/upper quarter problem and are not looking for drivers in the lower limbs or in gait, well … . . good luck making lasting effects. Other than breathing, it can be argued well that gait locomotion is our 2nd most engaged motor pattern that we have driven to subconscious levels , and compensations are abound (but not without a cost), so we can dual++ task. If you want to dive deeper into this, search our blog and look for my articles on Anti-phasic gait. This is essentially what this study was looking at, and confirming, that there is a distortion in the NORMAL opposite phase movements (anti-phasic) of the “shoulder girdle” and “pelvic girdle” when something goes wrong in a lower limb. – Dr. Allen
Findings from Shi et al when there was a chronic right ACL deficiency: -trunk rotation with right shoulder trailing over the right stance phase was lower in all five motion patterns – trunk posterior lean was higher from descending stairs to walking when the knee sagittal plane moment ended – trunk lateral flexion to the left was higher when ascending stairs at the start of right knee coronal plane moment when descending stairs at the maximal knee coronal plane moment and when descending stairs at the end of the knee coronal plane moment – trunk rotation with right shoulder forward was higher at the minimal knee transverse plane moment and when the knee transverse plane moment ended – during walking, trunk rotation with right shoulder trailing was lower at other knee moments during other walking patterns
“That offseason, his symptoms worsened. Before, it might have taken 20 minutes of riding at 400 watts to feel the sensation. Now, if he rode for five minutes at 350, he’d be riding with one good leg and one numb, powerless appendage.”
Iliac artery endofibrosis is a circulatory condition affecting the legs and is sending more and more cyclists under the knife. If you are a bike geek like i am (been watching the Tour de France since i was 15) you may take interest in this. If you are a avid bike rider or triathlete you may take interest in this. But do not stop at the bike when you have symptoms in front of you that sound vascular. If your leg is doing numb on a long walk or run, dead or heavy during exertion, something is going on that needs evaluated. Get evaluated.
Recently we have been speaking and writing about “base of support” and how a narrow base of support will render a small comfort and control zone of balance in single leg tasking (walking, running, sports etc). We do not notice these things if we are standing on both feet or when walking or running per se, but all one needs to do is test a 30 second single leg stance to see how crappy one’s single limb base of support actually is. Most people will drift the pelvis laterally to get the single foot under the center of the body mass. This is a false support, it is a demonstration of weak support, unless you like to walk on a line/cross over gait. We should not have our knees rubbing together, scuffing our ankles or shoes together. If you do, you have a narrow base of support, have engrained a lazy style of locomotion, and you will wish and attempt to put the center of your body mass over the foot at all times. This is good if you are walking on ice, but that is about it. This is an epidemic, hence the prevalence of cross over gait out in the world. Increasing balance ability will help to increase base of support and hence help with reducing cross over gait (narrow step width gait and running) tendencies. Obesity seems to make this worse. Obesity in our world is wrecking our people, especially our kids.
“Alterations were detected in the intermittent postural control in obese children. According to the results obtained, active anticipatory control produces higher center of pressure displacement responses in obese children and the periods during which balance is maintained by passive control and reflex mechanisms are of shorter duration.” “Differences in intermittent postural control between normal-weight and obese children ” Israel Villarrasa-Sapiña, Xavier García-Massó
Anyone would be silly to disagree with this. We go into some deeper reasoning back in this older blog post (https://tmblr.co/ZrRYjxTJ6zw9) looking at arm swing and leg swing and pairing of pelvis and shoulder posturing and how clean pelvis function parlays into upper body function in softball pitching.
“Proper utilization of the kinetic chain allows for efficient kinetic energy transfer from the proximal segments to the distal segments. Dysfunction at a proximal segment may lead to altered energy transfer and dysfunction at more distal segments,”
Lower body conditioning may cut upper body injury risk in softball. -Hank Black
Gait and autism spectrum disorder (ASD): “ … overall findings of the studies conducted in the area are inconclusive … however, some results suggest an emerging pattern. The current perspective on gait patterns in children with ASD is that there are a number of deviations present in terms of temporospatial, kinematic, and kinetic parameters and that gait, along with other movement pattern changes, may be used to allow for earlier diagnosis of ASD. There is, however, some consensus regarding the involvement of the cerebellum and basal ganglia in children with ASD and the relationship with observed motor deficits. ” – Kindregan et al
Gait and the eyes. We forget about the eyes. If you have vision issues, your gait may change. Gaze during adaptive gait involving obstacle crossing is typically directed two or more steps ahead where as visual information of the “in the moment” swinging lower-limb and its relative position during the task is available in the lower visual field. This study determined exactly when visual information is utilised to control/update lead-limb swing trajectory during obstacle negotiation. In this study, when the lower visual field was blocked out the foot-placement distance and toe-clearance became significantly increased, suggesting the brain overcorrecting for safety. A logical assumption. “These findings suggest that lower visual field input is typically used in an online manner to control/update final foot-placement, and that without such control, uncertainty regarding foot placement causes toe-clearance to be increased.”
We spoke at length about “base of support” and how if you have a narrow base of support, you have a small comfort zone of balance in single leg tasking (walking, running, sports etc). If you have a narrow base of support, you will wish and attempt to put the center of your body mass over the foot at all times…….hence the cross over gait often times. Increasing balance ability will help to increase base of support and hence help with reducing cross over gait (narrow step width gait and running) tendencies. * This study here showed that a SINGLE episode of single 30-minute training session involving kicking a ball while standing on 1 foot promoted changes in postural-control strategies in individuals with chronic ankle instabilty(CAI). Does this translate to the assumption that “CAI clients will have a narrow step width, narrow base of support, and a cross over gait”? No, but if you are thinking that way, we want you on our team.
Changes in Postural Control After a Ball-Kicking Balance Exercise in Individuals With Chronic Ankle Instability. Marcio Jose dos Santos PhD, Josilene Conceição PT, MSc, Felipe Gustavo Schaefer de Araújo, Gilmar Moraes SantosPhD, John Keighley PhD
These pix come to us from one of our brethren, Dr Scott Tesoro in Carbondale of a 73 yr old golfer with mild LBP and a L knee replacement three yrs ago. He has a VERY short R leg (close to an inch).
What you are seeing is he ultimate compensation for a short leg. Note how he takes the shorter side and supinates it (to the max!). You can see the external rotation of the lower leg and thigh to go along with it. If you look carefully and extrapolate how his left leg would look “neutral”, you can see he has internal tibial torsion on this (right) side as well. He has some increased midfoot pronation on the right compared to the left, but not an excessive amount.
A full length sole lift would probably be in order, as well as potentially addressing some of his compensations. Wow, what a great set of pictures !