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Welcome to Neuromechanics, a regular weekly feature here at The Gait Guys. Join Dr Waerlop on this neurological journey as he discusses the corticospinal system and how flexor dominance occurs and how that leads to many common injuries.

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Welcome to Neuromechanics, a regular weekly feature here at The Gait Guys. Join Dr Waerlop on this neurological journey as he discusses the formation of Bunions.

The Myopathic Gait:

This gait abnormality is sometimes referred to as a waddling gait. The waddle or shift is secondary to proximal pelvic musculature weaknesses.  The client may utilize a limb circumduction strategy to compensate for the weakness in the gluteals or as seen better here displaying an exaggerated alternation of lateral trunk movements with an exaggerated elevation of the hip.  There are some distinct similarities to the Trendelenburg gait pattern.  There are several causes of this gait variant, some of which are temporary and some of which are orthopedic and some neurodegenerative.  For example: pregnancy, hip dysplasia, muscular dystrophy and spinal muscular atrophy. 

Shoes make the man, or in this case, the athlete. This study shows that shoes (much like skis) allow us to perform faster than our brain is able to compensate ( in other words, we lack the skill) and allow us to sometimes stretch our  abilities, often at the cost of an injury. We must remember that technology must keep pace with the rate of neural learning, not the opposite. J Sci Med Sport. 2010 Jul;13(4):382-6. Epub 2010 Mar 15.

The effect of footwear and sports-surface on dynamic neurological screening (click for link)

More garbage on the internet about running myths. We need a Gait Police. Wait ? Maybe that should be us ! This MSNBC article is exactly why we are trying to spread the word.  This article has so many half truths and misleadings that it isn’t even worth reading in our opinion. MAybe next time they will ask us for this kinda stuff. One of the first things you must know the next time you decide to watch your running in a mirror, or get a professional gait analysis done, is that what you see is not the problem…….so carry this main thought with you. * What you, or your gait analysis professional or your running partner behind you, see in that mirror or on that video is often not the problem.  How you are moving is your neuro-musculoskeletal system’s best interpretation to demonstrate a functional gait with the parts that ARE working correctly. In other words, what you are seeing is a best case scenario for the central nervous system to achieve stability most of the time. So, when your coach or therapist or gait “Specialist” tells you that you need to increase your arm swing on the right, or turn your left foot in……to make a correction towards what looks symmetrical to them and to you, please stop them and say “but that is not the problem, that is my strategy to run as best as i can. I am not doing those things because i have nothing better to do when i run!” And, even worse, tell them not to give you exercises to correct those visual flaws ! And educated person in the field of neuromusculoskeletal medicine has to make those recommendations based on the faulty sensory and motor patterns they assess, and the muscular weaknesses that are discovered.  Neuroadaptive changes are for a good reason, even though they may look bad. For example, a right foot might be turning out into the frontal plane for the good reason that your hip stability in the frontal plane is insufficient, and thus the best strategy determined by your central nervous system was to turn out the foot to better engage and protect that plane. It might not however, be logical to us to make the change so far away from the area of problem, but for those of us who do this daily over and over again, it makes pretty decent sense.  The patterns you display are neuromechanical strategies, strategies and compensations to best stabilize the body parts during the activity. It is obvious to the viewer that the pattern is wrong, but the brain has made these changes for a good reason. Don’t think you are smarter than your brain !  (how’s that for a final statement !) We are, The Gait Guys

5 crucial running mistakes ? Really ? Hogwash ! (click on title for the article link)

Part 2: Progressing out of orthotics.

another Facebook Q. Is there a point during, or post treatment when the foot intrinsics perform and maintain their function without the exercises? Is it shuffle gait and moonwalk for life? and…. Are there any foot conditions that require ‘orthotic therapy’ to be maintained long term?

The Gait Guys answer:

Over time (about 3-6 mos avg, sometimes longer in our experience) the neural pattern becomes ingrained through neural adaptation and collateralization. As long as the exercises become a habit and ingrained into the motor pattern, then it is automatic; but think about how many layers of compensation are present and how long the problem took to occur. It takes time to restructure the nervous system and those pathways. The key here is adaptation of a new motor pattern; then life becomes rehab. There are many other exercises as well; keep an eye out for our new site launch and watch for some of them there. We have a DVD on the works as well.

When a person is UNABLE to function normally (ie they lack the ROM, muscle capacity, anatomy, neural drive IOW an anatomical problem) they MAY require an orthotic to make up for those ROM’s or mechanics they lack. An example may be an uncompensated FF varus where they lack the ROM in the 1st ray, or the individual with a loss of ankle rocker due to trauma, an arthrodesis, or some other anomaly.

The key is, if you are doing your job, their prescription should change and become less and less. This is one reason we sometimes use orthotics constructed of EVA, because they are easier to modify.

Believe it or not (LOL), some people won’t do the exercises you prescribe or aren’t willing to make the changes to be independent of them; these individuals will often need to wear them indefinitely.