We will answer this in podcast 19
should launch this week !
thanks for your great question
The Gait Guys
We will answer this in podcast 19
should launch this week !
thanks for your great question
The Gait Guys
Classic Crossover Gait Case.
Here is a client with a uncompensated forefoot varus (ie: the forefoot is inverted with respect to the rearfoot) and a cross over gait, secondary to incompetence of the medial tripod of the foot (he cannot descend the head of his 1st metatarsal to form the medial tripod due to the uncompensated forefoot varus) and weak right lower abdominal external obliques which we discovered on examination (perhaps you can detect a subtle sag of the right side during stance phase on that side).
Note how he circumducts the lower extremities around each other. This takes the cross over to another level and it can occur when a client is pronating through the medial tripod such as in this forefoot varus case (we know this from the examination, it cannot be detected for sure from the video with the foot in the shoe, that would be an assumption).
How do you fix this?
The Gait Guys. Bringing you the meat, without the fat.
all material copyright 2012 The Gait Guys/ The Homunculus Group: all rights reserved
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).
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” : )
The Cross Over Running Technique (again): A New Quick Case Study
Walk on a piece of string or along a seam in the concrete or walk on the lane dividing lines on your local high school or college track. What happens ? If you walk on a single line you will find yourself more unstable as compared to walking with a foot fall directly under your hips and knees the way it is supposed to occur. The limbs are a pendulum and economy and biomechanical efficiency as well as injury reduction will occur when the parts operate in the most effective manner.
We have all of our cross over runners, as you see her doing in the first half of this video before she corrects to anti-cross over (ie. natural), first walk on a line. In our case we use the metal drainage grate outside our office that you see in the video for just that purpose, they walk the grate. Then they run the grate. We ask them to feel how unstable they are in the frontal plane walking the grate. Then we have them walk with their feet only touching the outer edges of the grate, now not crossing over. They can feel the difference, the increased stability. They all say it is easier to walk with the thighs, knees and feet all barely scuffing past one another but after they feel the other most will comment that they can see and feel how lazy their gait and running gait have become. They can feel the better posture, more gluteals and more power that an anti-cross over gait affords them. Then they run the grate again. Then they run the edges of the grate. You see this skill builder in the video above.
In this video clip, after 60 seconds of coaching, this top NCAA distance track athlete (often injured) was able to make the change immediately. You can see after just a few strides the immediate and dramatic change in her gait. We then had her drift back and forth between lazy cross over and the corrected anti-cross over gait. We do this so that on her long runs, when she notices the inside shoes scuff past one another, when they notice the feet begin to run on a line, when the thighs begin brushing past each other that she can immediately make the correction. It will happen often during the beginning stages of developing the new neurologic skill pattern. Motor pattern learning takes up to 12 weeks before the neuroplasticity becomes more worthy of the dominant pattern of choice.
We have all of our athletes head over to the oval track and run not in the lanes, but on the line. To be precise, they run with their feet on either side of the line, making sure they have that visual feedback for the correction. They run over the line. We drove past a local high school the other day and saw the entire girls cross country team on the track running not in the lanes, but over the lines. We smiled big, and long. We know the coach, he follows our stuff, and he will prevent so many injuries this year in his runners. They have a 15 minute pre-run warm up and skill building for their runners. They will be competitive at the State level once again because they will show up with everyone healthy and free of injury, we can only hope. They will have a better chance than others who keep doing what they did last year, and the year before that, and the year before that.
If you are doing what you did last year in your training, expect last years results.
Have you watched the cross over series we put together on youtube ? The 3 part video series ? It is worth your time to watch it.
Shawn and Ivo……… still pounding the floor on eradicating the modern day plague in running…… The Cross Over Gait. You don’t want to catch this illness !
Retail/Coach/Trainer Focus: When a stability shoe does not stop gait or running pronation.
This video is unlisted. You will need this link to view it if it does not show up in the player above this blog post: http://youtu.be/Lt6RbEtALUY
This is a higher end stability shoe. We know what shoe it is and you can see the significant amount of dual density mid sole foam in the shoe, represented by the darker grey foam in the medial mid sole. The point here is not to pick on the shoe or the brand. The point here is to:
1. not prescribe a shoe entirely on the appearance of the foot architecture
2. not to prescribe a shoe merely because a person is a pronator
3. not to assume that a stability shoe will prevent pronation
4. not to assume that technique does not play a part in shoe prescription
5. not to assume that all pronation occurs at the mid foot (which is the traditional thinking by the majority of the population, including shoe store sales people)
There you go, plenty of negatives. But there are positives here. Knowing the answers and responses to the above 5 detractors will make you a better athlete, better coach, better shoe sales person, a safer runner, a more educated doctor or therapist and a wiser person when it comes to human locomotion.
A shoe prescription does not always make things better. You have heard it here and we will say it again. What you see is not necessarily what you get. This case is a classic example of how everything done for the right reasons when so very wrong for this young runner.
What do you see ?
Pronation can occur at:
So, in this case you might assume that the stability shoe that is designed to prevent rear and midfoot pronation is:
However, the keen eye can clearly see that this is a case of heavy forefoot pronation but there are also mechanical flaws in technique (driven by weaknesses, hence just working on her running form will not solve her issues, it will merely force her to adopt a new set of strategies around those weaknesses !). The problems must be resolved before a new technique is forced. This is perhaps the number one mistake runners make that drives new injuries. They tend to blame the injury on new shoes, old shoes, increased miles, the fartlek they did the other day, the weather, their mom, there spouse, their kids…….runners come up with some great theories. Heck, all of our athletes do ! It keeps things amusing for us and we get to joke around with our athletes and throw out funny responses like, “I disagree, it was more likely the coming precession of the equinox that caused this injury !”.
Although his individual does not have a fore foot varus deformity (because we have examined her) it needs to be ruled out because it is big driver of what you see in many folks. In FF varus the forefoot is inverted with respect to the rear foot. This can be rigid (cannot descend the 1st ray and medial side of the tripod) or plastic (has the range of motion, but it hasn’t been developed).
We, as clinicians, like to assume that MOST FEET have a range of motion that folks are not using, which may be due to muscle weakness, ligamentous tightness, pathomechanics, joint fixation, etc. Our 1st job is to examine test the feet and make sure they are competent. Then and only then, after a trial of therapy and exercise, would you consider any type of more permanent “shoe prescription”.
If the individual has a rigid deformity, then you MAY consider a shoe that “brings the ground up” to the foot. Often time we find, with diligent effort on your and the individuals part, that a shoe with motion control features is not needed.
Sometimes the individual is not willing to do their homework and put in the work necessary to make things happen. This would also be a case where an orthotic or shoe can assist in giving the person mechanics that they do not have.
We have not seen many (or any) shoes that correct specifically for a fore foot varus (ie a shoe with fore foot motion control ONLY). The Altra Provision/Provisioness has a full length varus post which may help, but may over correct the mid foot as well. Be careful of what you prescribe.
Yes, we have been studying, blogging, videoing and talking about this stuff for a long time. Yes, much of it is often subtle and takes a trained eye to see. It is also the stuff that goes the “extra mile” and separates good results from great ones.
We are The Gait Guys. Watch for some seminars on some of our analysis and treatment techniques this fall and winter, and some pretty cool video, soon to be released.
Part 3: The Problematic Cross-over gait motor pattern. The final piece.
Here Dr. Shawn Allen of The Gait Guys summarizes this gait problem in running form. The Cross-over gait is a product of gluteus medius and abdominal weakness and leaves the runner with much frontal plane hip movement, very little separation of the knees and a “cross over” of the feet, rendering a near “tight rope” running appearance where the feet seem to land on a straight line path. In Part 3, Dr. Allen will discuss a more detailed specific method to fix this. You will see this problem in well over 50% of runners. This problem leads to injury at the hip, knee and foot levels quite frequently. To date we have not met anyone who had a good grasp on this clinical issue or a remedy quite like ours. Help us make this video go viral so we can help more runners with this problem. Forward it to your coaches, your friends, everyone.
Thanks for watching our video
Here Dr. Shawn Allen of The Gait Guys further discusses this gait problem in running form. The Cross-over gait is a product of gluteus medius and abdominal weakness and leaves the runner with much frontal plane hip movement, very little separation of the knees and a “cross over” of the feet, rendering a near “tight rope” running appearance where the feet seem to land on a straight line path. In Part 2, Dr. Allen will discuss a more detailed specific method to fix this. You will see this problem in well over 50% of runners. This problem leads to injury at the hip, knee and foot levels quite frequently. To date we have not met anyone who had a good grasp on this clinical issue or a remedy quite like ours. Help us make this video go viral so we can help more runners with this problem. Forward it to your coaches, your friends, everyone.
Thanks for watching our video
-Shawn and Ivo……The Gait Guys