Since the world did not end, you should probably think twice about those motion control shoes….

WE can all agree that there is a time and a place for motion control shoes. For people with chronic ankle sprains or lateral instability (ie, an incompetent lateral compartment; peroneus longus, brevis or tertius), it is neither the time, nor the place.

The lateral ankle is stabilized by both static (ligaments: above lower left) and dynamic (muscles above, lower right) elements. This is often called “the lateral stabilizing complex” The lateral ankle (ie the lateral malleolus) also projects more inferiorly than the medial. This means that when push comes to shove, the ankle is more likely to invert (or go medially) than evert (or go laterally). What protects it? The static component consist of three main ligaments (seen above) the posterior and anterior talofibular ligaments and the calcaneofibular ligaments. The dynamic components are the peroneii muscles. These muscles not only stabilize but also exert an eversion (brings the bottom of the foot to the outside) force on the ankle.

So what you say?

according to one study we found “Using an in-shoe plantar pressure system, chronic ankle instability subjects had greater plantar pressures and forces in the lateral foot compared to controls during jogging.”

Hmmm. Remember the midsole? (If not click here and here for a review) Motion control shoes are medially posted. That means they provide more support medially or  have a tendency to tip the foot laterally. SO, motion control shoes shift forces laterally.

A person with chronic ankle instability has weakness of either the static, dynamic, or both components of the lateral stabilizing complex.

bottom line? make sure folks have a competent lateral stabilizing complex and if they don’t, you may want to think twice about using a motion control shoe.

Ivo and Shawn. Increasing your shoe geekiness coefficient on daily basis!                                                                                                                                                    

Foot Ankle Int. 2011 Nov;32(11):1075-80. Increased in-shoe lateral plantar pressures with chronic ankle instability. Schmidt H, Sauer LD, Lee SY, Saliba S, Hertel J. Source University of Virginia, 2270 Ivy Road, Box 800232, Charlottesville, VA 22903, USA.

Abstract BACKGROUND:

Previous plantar pressure research found increased loads and slower loading response on the lateral aspect of the foot during gait with chronic ankle instability compared to healthy controls. The studies had subjects walking barefoot over a pressure mat and results have not been confirmed with an in-shoe plantar pressure system. Our purpose was to report in-shoe plantar pressure measures for chronic ankle instability subjects compared to healthy controls.

METHODS:

Forty-nine subjects volunteered (25 healthy controls, 24 chronic ankle instability) for this case-control study. Subjects jogged continuously on a treadmill at 2.68 m/s (6.0 mph) while three trials of ten consecutive steps were recorded. Peak pressure, time-to-peak pressure, pressure-time integral, maximum force, time-to-maximum force, and force-time integral were assessed in nine regions of the foot with the Pedar-x in-shoe plantar pressure system (Novel, Munich, Germany).

RESULTS:

Chronic ankle instability subjects demonstrated a slower loading response in the lateral rearfoot indicated by a longer time-to-peak pressure (16.5% +/- 10.1, p = 0.001) and time-to-maximum force (16.8% +/- 11.3, p = 0.001) compared to controls (6.5% +/- 3.7 and 6.6% +/- 5.5, respectively). In the lateral midfoot, ankle instability subjects demonstrated significantly greater maximum force (318.8 N +/- 174.5, p = 0.008) and peak pressure (211.4 kPa +/- 57.7, p = 0.008) compared to controls (191.6 N +/- 74.5 and 161.3 kPa +/- 54.7). Additionally, ankle instability subjects demonstrated significantly higher force-time integral (44.1 N/s +/- 27.3, p = 0.005) and pressure-time integral (35.0 kPa/s +/- 12.0, p = 0.005) compared to controls (23.3 N/s +/- 10.9 and 24.5 kPa/s +/- 9.5). In the lateral forefoot, ankle instability subjects demonstrated significantly greater maximum force (239.9N +/- 81.2, p = 0.004), force-time integral (37.0 N/s +/- 14.9, p = 0.003), and time-to-peak pressure (51.1% +/- 10.9, p = 0.007) compared to controls (170.6 N +/- 49.3, 24.3 N/s +/- 7.2 and 43.8% +/- 4.3).

CONCLUSION:

Using an in-shoe plantar pressure system, chronic ankle instability subjects had greater plantar pressures and forces in the lateral foot compared to controls during jogging.

CLINICAL RELEVANCE:

These findings may have implications in the etiology and treatment of chronic ankle instability.

 

all material copyright 2012 The Homunculus Group/ The Gait Guys. Don’t rip off our stuff. PLEASE ASK 1st!

Podcast #13: Caffeine, Nicotine & Lance

here is the link for podcast 13

http://thegaitguys.libsyn.com/webpage

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1- Malcolm gladwells piece on drug doping (PEDs) in sports:

“Gladwell argued that we should think about cycling the same way we think about auto racing — where teams should be rewarded for using science and bending the rules to their breaking point to succeed.
“When you look at what Lance is alleged to have done. Basically he was better than everyone else at using PEDs,” Gladwell said. “He was the guy who sat down and was rigorous and focused and thoughtful and intelligent and cutting edge in how to use them, and apply them and make himself better. Like, I don’t know, so is that a bad thing?”

Read more: http://www.businessinsider.com/malcolm-gladwell-lance-armstrong-2012-10#ixzz29QBKJpAJ

2- Caffeine: A PED ?
Mens health online magazine, also found in our Sunday edition Oct 14th, 2012 newspaper:

http://news.menshealth.com/chew-gum-before-races/2012/04/12/

Chew on this: Caffeinated gum can improve your athletic performance—if you start chewing it at the right moment, finds a new study from Kent State University.

NICOTINE: http://www.t-nation.com/free_online_article/most_recent/50_hits_of_nicotine
Nicotine has been used in energy drinks in Japan for years.
stimulates the release of acetylcholine, providing a sense of increased energy. Arnold used to do commercials for them.
Nicotine can improve reaction time.
Nicotine can be addictive, much like caffeine. But addiction to nicotine gum, lozenges, or patches is rare, if not unheard of.
MAYO clinic: http://www.mayoclinic.org/medical-edge-newspaper-2009/apr-24b.html

3- DISCLAIMER:We are not your doctors so anything you hear here should not be taken as medical advice. For that you need to visit YOUR doctors and ask them the questions. We have not examined you, we do not know you, we know very little about your medical status. So, do not hold us responsible for taking our advice when we have just told you not to !  Again, we are NOT your doctors !

4: Maryland Guy Running a marathon in flip flops:

“Some of the rules: It can’t be a heal strap. There can’t be any other means to hold the flip flop on your shoe besides just the normal thing between your toes,” Levasseur said. “I don’t know what happens if I get a blowout.”

Read more: http://www.wbaltv.com/news/sports/Man-to-run-Baltimore-marathon-in-flip-flops/-/9379464/16917220/-/remeou/-/index.html#ixzz29QDIyW4d

5-Managing Ankle Sprains:
http://www.running-physio.com/anklesprain/

6- HIIT
 http://www.the15minutes.info/2012/10/12/what-is-hiit-and-what-can-it-do-for-you/

http://sportsmedicine.about.com/od/anatomyandphysiology/a/Deconditioning.htm
Studies have shown that you can maintain your fitness level even if you need to change or cut back on you exercise for several months. In order to do so, you need to exercise at about 70 percent of your VO2 max at least once per week.

7- EMAIL FROM A Blog follower:

middleagedathlete asked you:
I searched the site and didn’t see anything on bow-leggedness (if that’s a word) and it’s impact on gait. I have mild to moderate bow legs and never even knew it until I started running and it was pointed out to me by a PT I was seeing for knee pain. Is there an optimal (or at a minimum least bad) strategy for running with bow legs? I am 6’0” tall and have a gap of about 2” between my knees when standing with my ankles together and my legs straight. I am curious to hear your thoughts.

8- from the newspaper:
from Barefoot Running University.com
Article: Running up Hill

 http://barefootrunninguniversity.com/2012/10/12/uphill-running-technique/
9- Blog post we liked recently: October 5th, Gait Running and Sound. Are you listening to your body ?
 
 
10- Random topic: Wednesday october 10th Peter larson who runs Runblogger did a review of the following article:

Minimalist Running Results in Fewer Injuries?: Survey Suggests that Traditionally Shod Runners are 3.41 Times More Likely to Get Hurt

we have not gotten through the research article yet but we will, and we will try to address out thoughts on it and pete’s in the next 1-2 podcasts.  We want to make sure our thoughts are heard as well.  We bet Pete did a phenomenal job but we like to see things for ourselves, just like pete does. He is a stickler to details like we are, which is why we like alot of his work.  So, stay tuned !

11- Our dvd’s and efile downloads
Are all on payloadz. Link is in the show notes.
Link: http://store.payloadz.com/results/results.asp?m=80204

Do you have enough Ankle Dorsiflexion to do this ?  Some clues ?

Two guys pulling 40,000 pounds over one mile in just over an hour !

Watch the video above and then check out this link.

http://www.powerropes.com/brtrophy.html

Look at the fellas left foot in the video compared to his right.  Notice the turn out (the increased progression angle as it is referred to as) ?  Now look at the photos from the article link above, again the fella in the red shirt has his left foot turned out again.  Why is he doing this ? 

Because he does not likely have enough ankle dorsiflexion (ankle rocker) to get into this far of a forward lean.  Have you seen this in people or your students doing squats ? Lunges ? Will this present in his normal gait ? Perhaps, but if he has enough for normal gait (~15 degrees past vertical 90 degrees) he shouldn’t need to turn it out.

Turning out the foot will allow you to pronate through the midfoot to gain more dorsiflexion. It is why some people do it.  Look for it.

It is also possible that he has a painful big toe or a hallux rigidus/limitus (ie. turn toe) and thus cannot toe off sagittally like on the other foot or like the other fella.  This turn out will avoid loading that joint as much. 

Regardless, you must examine this fella and figure out why he is using this strategy only on one side.  This is just one theory, but we did not want to pollute this post with a few others. We can do that another time.

Ankle rocker dorsiflexion. It is critical for some activities.

Shawn and Ivo

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from a FAcebook reader:

  • Question:  Most sources allow for a small amount of turnout as “normal” in gait – about 7 degrees on average. Should feet point straight ahead? What is the repercussion of turnout, even a small amount? I think in barefoot societies the feet are pointing straight ahead so I wondered where this belief comes from and if it is correct. Perhaps people are losing dorsiflexion from wearing positive heels and are turning out in response? Thanks.

  • The Gait Guys You are correct. zero degrees progression angle is not considered normal….. 5-20 degrees is more “normal”……but it depends on the source. Keep in mind that femoral torsion and tibial torsion will be big players in this foot angle. The more the foot is turned out the more pronation (more than normal) can sneak in. IT will challenge the foot tripod. Weakness in the glutes, (particlarly g. medius from frontal plane challenges ) may ask the limb and foot to turn out to engage a more stable foot tripod. meaning, if you engage another plane (ie. more frontal plane) via more foot/limb turn out you can gain the help from other muscles such as the quadriceps. Reducing the heel height can force one to adapt to the use of more ankle dorsiflexion, you are correct. Hence why the literature suggests less injuries from more minimialist shoes. Hope this helps.

The Consequences of Overstriding.

Consequences of Over Striding: “Call me Ishmael”.

Have you ever wondered what would happen if you were running and impacted the foot at foot strike at the end range ankle rocker (full dorsiflexion) with the knee extended ? Can you even imagine this ?  It is hard isn’t it.  (Be patient, we are about to show you, but for now just try to imagine it.)
Where would the shock absorption go ?
How could  you progress over the limb other than through hip rotation?  Because there certainly would be no pivot over the ankle joint, like a client with a fused ankle joint. The ankle and lower leg would be like a wooden peg leg, “Call me Ishmael ! “.

And if the forces were moving up from the ground through the locked ankle mortise (which is again,terminal dorsiflexion) and a locked knee (again, in full extension) the forces through the hip would follow from the ground upwards. Creating a vaulting phenomenon. “Call me Ishmael”.
Can you picture this ?
If not, here is the video piece (VIDEO LINK) today very nicely depicting this awful biomechanical event.
You see, if you know your biomechanics, this stuff can virtually be created in your brain……. but it is always nice to see an athlete try it out.  That is why they get the big bucks !  Did you watch the video link yet ? He sure put the ACL and PCL in the octagon on that one !

Shawn and Ivo, the Biomechanics nerds……. as strange as Ishmael in the Octagon.

http://sports.yahoo.com/blogs/mlb-big-league-stew/houston-marwin-gonzalez-turns-most-spectacular-injury-season-144210692—mlb.html

Gait analysis case study: A runner with achilles pain.

Please watch this clip a few times and pay special attention to the lateral views. This client had persistent Left Achilles pain which has improved with care and foot exercise, but is developing Left soleus pain.

Lets try something new. Lets test your gait auditory skills. Run the video and listen. Listen to the foot falls. Can you hear one foot slap harder than the other on strike ? Can you hear the right forefoot slap harder than the left ?  It is there, it is subtle, keep re-running the video until you are convinced. The left foot just lands softer. Take your gait assessment to the next level, listen to your clients gait. Use all your senses. This finding should ask you to assess the anterior compartment of the right lower limb (tibialis anterior and toe extensors).  And if they are not weak then you should begin to ask yourself why they may be loading the right foot abruptly. Perhaps it is because they are departing off of the left prematurely, in this case possibly because of a short leg that has a shorter stride length. 

From clinical examination he has a 10mm anatomically short left leg (not worn in these videos), bilateral uncompensated forefoot varus deformities, bilateral internal tibial torsion and tibial varum ( 10 degrees Left, less on Right).

Exam reveals:

  • weakness of the fourth and fifth lumbricals (small intrinsic foot muscles to the 4th and 5th toes) left greater than right. This will afford some lateral foot weakness during stance phase.
  • weakness of all long toe extensors bilaterally (their weakness will allow dominance of toe flexors)
  • weakness of the extensor hallucis brevis bilaterally
  • weak left iliacus (a hip flexor muscle)
  • slight pelvic shift to the left when testing the right abdominal external obliques
  • weakness bilaterally of the quadratus femoris (a deep hip stabilizing muscle)
  • weakness superior and inferior gemelli left, superior right (again, more deep hip stabilzer muscles)

So, what gives?

Did you pick up the nice ankle rocker present?  There is good ankle dorsiflexion. What is missing? Look carefully at the hip (in the lateral/ side video views). There is not much hip extension going on there. So, the question is how does he get the ankle rocker he is achieving ? Look at the knees. He is getting it through knee flexion! It would be more effective and economical to achieve this kind of ankle dorsiflexion from a nice hip extension and utilize the glutes for all they can provide.

Remember, he has an uncompensated forefoot varus. This means he has trouble making the medial part of his foot tripod get to the ground. This means that the foot tripod will be challenged when the foot is grounded and when combined with the clinical foot weaknesses we noted on examination this is a foregone conclusion.  With all that knee flexion which muscle will be called upon to control the foot? The soleus  (which DOES NOT cross the knee).

The answer to helping this chap ? Achieve more hip extension! How? Gluteal activation through some means (acupuncuture, dry needling, MAT, K tape, rehab and motor skill patterns etc), conscious dorsiflexion of the toes, conscious activation of the glutes and anything else you might find useful from your skill set. Gain more from the hips and  you will gain more control from that area and ask for the soleus to do just its small job.

Subtle? Maybe. Now that you know what you are looking at it is pretty easy isn’t it ? It’s like the “invisible gorilla in the room” we talked about in our previous Podcast.  Unless someone brings it to your attention your focus will be on what you are accustomed to looking for and what you have seen before. Sometimes we just need someone to direct our vision.  There is a difference between seeing something and recognizing something. In order to recognize something you have to go beyond seeing it, the brain must be engaged to process the vision.

The Gait Guys. Let us be your Peter Frampton and “Show you the Way” : )