Arm swing asymmetry: It can be a huge window of education into your client.

Arm swing asymmetry: It can be a huge window of education into your client, if you can get past the dumb stuff we’ve all done (and believed) for decades.
I have beaten you down with arm swing principles over the past few years, sorry about that, but, the beating will continue because it is important to know what arm swing tells you, and what it does not tell you (hint hint for all those improperly coaching arm swing changes). We did an entire tele seminar on the Stage 1 principles of of arm swing (#218) on www.onlinece.com and www.chirocredit.com if you wish to take that archived lecture. Heck $19, how can you lose (see photo).  Arm swing is intimately dependent upon scapular stability, thoracic mobility, breathing, cervical spine function, pelvis stability and clearly ipsilateral and contralateral leg swing not to forget to mention spinal stability. The first signs of spine pain or instability and the counter rotation of the shoulder and pelvic girdles become more phasic, instead of their normal anti phasic nature (moving in opposite directions). This phasic nature reduces spinal shear loads.

Neurologic diseases in their early, middle and late phases can give us a clearer window into how the nervous system is tied together.
Arm swing asymmetry during gait may be a sensitive sign for early Parkinson’s disease.

Here is what this Plate et al study found :
-Arm swing amplitude as well as arm swing asymmetry varied considerably in the healthy subjects.
-Elderly subjects swung their arms more than younger participants. -Only the more demanding mental load caused a significant asymmetry
-In the patient group, asymmetry was considerably higher and even more enhanced by mental loads.
-Evaluation of arm swing asymmetry may be used as part of a test battery for early Parkinson’s disease.

Some facts you should consider:
Parkinson’s Disease will be well advanced before the first signs of motor compromise occurs. So early detection and suspicion should be acted upon early when possible. Reductions or changes in arm swing may be the first signs of neuralgic disease expression and progression. Dual tasking may bring out neurologic signs early, so talk to your clients or have them count backwards to distract the motor programs. Look for one sided arm swing impairment, and when present, be sure to examine all limbs, especially the lower limbs, for impaired function. After all, the arms are like balasts, they can help with postural stability simply by abducting or modifying their swing.  Arm swing changes can include:
– crossing over the body
– more forward sagittal swing and less posterior swing
– more posterior sagittal swing and less anterior swing
– shoulder abduction during swing (and with attributes of the prior two mentioned above)
– less swing with adduction stabilized with torso
– modified through accentuations or dampening of shoulder girdle rotation oscillations, thus less arm swing but more torso swing to protect the glenohumeral and other joints
– and others of course

Arm swing and arm swing symmetry matter. Don’t be a dunce and just train it out or tell your client to do things to change it before you identify the “why” behind it. If it were that simple Ivo and I would have long grown tails and begun eating more bananas. Or maybe we would have already moved to the islands by now. That was random wasn’t it. That’s what Jimmy Buffett said.

“Now he lives in the islands, fishes the pilin’s
And drinks his green label each day
He’s writing his memoirs and losing his hearing
But he don’t care what most people say.
Through eighty-six years of perpetual motion
If he likes you he’ll smile then he’ll say
Jimmy, some of it’s magic, some of it’s tragic
But I had a good life all the way.
And he went to Paris looking for answers
To questions that bother him so.”  -Jimmy Buffett

Hope this helps, now back to that rum.
-Shawn Allen

Gait Posture. 2015 Jan;41(1):13-8. doi: 10.1016/j.gaitpost.2014.07.011. Epub 2014 Aug 8.
Normative data for arm swing asymmetry: how (a)symmetrical are we?  Plate A1, Sedunko D2, Pelykh O3, Schlick C4, Ilmberger JR5, Bötzel K6.
http://www.ncbi.nlm.nih.gov/pubmed/25442669

Kinetic chain transfer.

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

http://lermagazine.com/special-section/pediatric-clinical-news/lower-body-conditioning-may-cut-upper-body-injury-risk-in-softball

Dr. Allen’s Quiz question of the week. See if you can get this one.

Reference point is the Girl in the middle, big sister. Choose all that apply. Note: there is something deeper than the obvious going on here, it doesn’t make sense. Can you see it ? 

a. she (big sister) is out of phase with her little sister 

b. she is in phase with her little sister

c. she is out of phase with her little brother

d. she is in phase with her little brother

e.  A and C

f.  B and C

g. B and D

h. A and D

i. AC~DC rules

Yes, Answer  “i” is always right.

otherwise the answer is … . scroll down

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F. she is in phase with her sister to her left and out of phase with her brother (at least if you are referencing her leg swing).  With her little sister, left feet are both forward in swing at the same time.

However, there is something deeper and requires some true critical thinking. IF you got the answer correct, congratulations. IF you did not, type in “in phase gait” or “arm swing” into the blog search engine and you will be able to read more about “in phase” and “out of phase” gaits.  

Now, look at the picture again. If she is “in phase” with her little sister to the left big sister should technically have her left arm in anterior/forward swing to meet little sister’s right arm swing. But, big sister’s left foot is forward, which technically means her left arm swing should be posterior to match her normal Anti-phasic gait.  But this does not pair with little sister. Can you see that this is a conflict in synchrony ? 

In phase and phasic are not the same thing, nor are out of phase and anti-phasic. Search our blog for these differences.  

Obviously you should glean by now that “In and out of phase” gait refers to the leg swing. Whereas, phasic and anti phasic gait refers to the synchrony of the upper and lower limbs in an individual.  The lower limb spinal cord motor neuron pools are more dominant than the upper arm pools (except in climbing, which is why I spent so much time last week talking about climbing and crawling here on the blog). Thus the lower legs often run the protocols and thus why arm swing changes should not be primarily or initially coached or amended in an athlete, they are very adaptive and accommodating.  The legs need to run the show, we need our arms free to be able to carry things while walking or running (water bottle, babies, spears, rifle, brief case etc) without disrupting the normal leg swing gait mechanics.  

Big sister is “out of phase” with her brother when it comes to the legs, but their arm swings are matching in phase so that there is no conflict. When people walk “out of phase” their arm swings will always match. Thus, it would seem that this is the more harmonious way to walk with a partner. 

So how are they all walking together ? Certainly not in harmony.

Obviously the little sister is not in sync with big sister. She is much shorter, and thus her step length is going to be different and that is the likely answer. She will have to pick up cadence to keep up and that will mean much of the time she will not synchronize with her big sister. As I mentioned in a prior post on these topics, often the larger or more dominant person’s arm swing will dictate the arm swing pattern of the other partner, and this will in turn, dictate how the lower limbs synchronize to the dominant partner. It would make sense that perfect harmony would bring about “out of phase” leg swing, but it does not always occur. Why? There are many reasons I discussed here today, things like differing arm and leg lengths and step lengths come to mind.

* There is one more option, none of them are in anti-phasic gait. Maybe they all have back pain 🙂 Back pain patients tend to shift towards phasic gait to reduce spinal torsion and shear. If they all are anti-phasic then arm and leg swing matter very little in terms of full limb swing propulsive gait. This is quite possible as well, perhaps this is just a still photo representing a very slow strolling gait and thus little need for anti phasic gaits from all 3 of them. 

Neat points if you are a true gait nerd. Did you catch it ? A picture is worth a thousand words.

Hope this little quiz helped you to put some pieces together.

One more thing, here is a clinical pearl. By walking hand in hand with someone, you can help a person learn arm swing and leg swing and how to create a clean cadence, the normal anti-phasic gait, and learn how to dual task as well as add audible, visual and tactile queues to one’s gait. It is a great tool for helping neurologic gait pathologies, post stroke gait training and helping someone who has joint replacements or back pain regain normal anti-phasic gait traits where gait has become phasic and apropulsive. 

Dr. Shawn Allen

Falling hard; Using supination to stop the drop.

“One thing, affects all things. One change necessitates global change. The more you know, the more you will see (and understand).  The more you know, see and understand, the more responsible you will and should feel to get it right and the more global your approach should become. If your head does not spin at times with all the issues that need to be juggled, you are likely not seeing all the issues you should be seeing.” -Dr. Allen (from an upcoming CME course)

This is a case that has been looked at before but today with new video. This is a client with a known anatomic short leg on the right (sock-less foot) from a diseased right hip joint.  

In this video, it is clear to see the subconscious brain attempting to lengthen the right leg by right foot strike laterally (in supination) in an attempt to keep the arch and talus as high as possible.  Supination should raise the arch and thus the resting height of the talus, which will functionally lengthen the leg.  This is great for the early stance phase of gait and help to normalize pelvis symmetry, however, it will certainly result in (as seen in this video) a sudden late stance phase pronation event as they move over to the medial foot for toe off. Pronation will occur abruptly and excessively, which can have its own set of biomechanical compensations all the way up the chain, from metatarsal stress responses and plantar fasciitis to hip rotational pathologies.  It will also result in a sudden plummet downwards back into the anatomic short leg as the functional lengthening strategy is aborted out of necessity to move forward.  

This is a case where use of a full length sole lift is imperative at all times. The closer you get to normalizing the functional length, the less you need to worry about controlling pronation with a controlling orthotic (controlling rate and extent of arch drop in many cases). Do not use a heel lift only in these cases, you can see this client is already rushing quickly into forefoot loading from the issues at hand, the last thing you should be doing is plantarflexing the foot-ankle and helping them get to the forefoot even faster !  This will cause toe hammering and gripping and set the client up for further risk to fat pat displacement, abnormal metatarsal loading, challenges to the lumbricals as well as imbalances in the harmony of the long and short flexors and extensors (ie. hammer toes). 

How much do you lift ?  Be patient, go little by little. Give time for adaptation. Gauge the amount on improved function, not trying to match the right and the left precisely, after all the two hips are not the same to begin with. So go with cleaner function over choosing matching equal leg lengths.  Give time for compensatory adaptation, it is going to take time.  

Finally, do not forget that these types of clients will always need therapy and retraining of normal ankle rocker and hip extension mechanics as well as lumbopelvic stability (because they will be most likely be dumping into anterior pelvic tilt and knee flexion during the sudden forefoot loading in the late midstance phase of gait). So ramp up those lower abdominals (especially on the right) !  

Oh, and do not forget that left arm swing will be all distorted since it pairs with this right limp challenge. Leave those therapeutic issues to the end, they will not change until they see more equal functional leg lengths. This is why we say never (ok, almost never) retrain arm swing until you know you have two closely symmetrical lower limbs. Otherwise you will be teaching them to compensate on an already faulty motor compensation. Remember, to get proper anti-phasic gait, or better put, to slow the tendency towards spinal protective phasic gait, you need the pelvic and shoulder “girdles” to cooperate. When you get it right, opposite arm and leg will swing together in same pendulum direction, and this will be matched and set up by an antiphasic gait.

One last thing, rushing to the right forefoot will force an early departure off that right limb during gait, which will have to be caught by the left quad to dampen the premature load on the left. They will also likely have a left frontal plane pelvis drift which will also have to be addressed at some point or concurrently. This could set up a cross over gait in some folks, so watch for that as well.

“One thing, affects all things. One change necessitates global change. The more you know, the more you will see (and understand).  The more you know, see and understand, the more responsible you will and should feel to get it right and the more global your approach should become. If your head does not spin at times with all the issues that need to be juggled, you are likely not seeing all the issues you should be seeing.” -Dr. Allen (from an upcoming CME course)

Shawn Allen, one of the gait guys.

Unique adaptations to arm swing challenges: the one armed runner.  Welcome to Luke Ericson, an amazing athlete and man.

Written By Dr. Shawn Allen

Human gait is cyclical. For the most part, when one limb is engaged on the ground (stance phase), the other is in swing phase. Before I continue, you should recall that there is a brief double limb support phase in walking gait, that which is absent in running gait. Also, I wish to remind you of our time hammered principle that when the foot is on the ground the glutes are heavily in charge, and when the foot is in the air, the abdominals are heavily in charge.  

For one to move cleanly and efficiently one would assume that the best way to do that would be to ensure that the lower 2 limbs are capable of doing the exact same things, with the same timing, same skill, same endurance and same strength. This goes for the upper 2 limbs as well, and then of course the synchronizing of the 4 in a cohesive effort. For this clean seamless motor function to occur, one must assume that there would be no injuries that had left a remnant mark on one limb thus encouraging a necessary compensation pattern in that limb (and one that would then have to be negotiated with the opposite limb as well as the contralateral upper or lower limb).  

Removing a considerable mass of tissue anywhere in the body is going to change the symmetry of the body and require compensations. One can clearly see the effects of this on this athletes body in the video above. He even eludes to the fact that he has a scoliosis, no surprise there.  There is such an unequal mass distribution that there is little way the spine had any chance to remain straight.  Not only is this going to change symmetry from a static postural perspective (bulk, weight, fascial plane changes, strength etc) but it will change dynamic postural control, mobility and stability as well as dynamic spinal kinematics.  I have talked about this previously in a blog piece I wrote on post-mastectomy clients display changes in spatiotemporal gait parameter such as step length and gait velocity.

-mastectomy post: http://tmblr.co/ZrRYjx1XB8RhO

If you have been with The Gait Guys for more than a year you will know that impairing an arm swing will show altered biomechanics in the opposite lower limb (and furthermore, if you alter one lower limb, you begin a process of altering the biomechanical function and rhythmicity of the opposite leg as well.) You can search the blog for “arm swing part 1 and part 2″ for those dialogues.

Arm swing impairment is a real issue and it is one that is typically far overlooked and misrepresented. The intrinsic effects of altering the body through subtraction of tissue are not all that dissimilar to extrinsic changes into the system from things like  walking with a handbag/briefcase, walking with a shoulder bag, walking and running with an ipod or water bottle in one hand. And do not forget other intrinsic problems that affect spinal symmetry, for example consider the changes on the system from scoliosis as in this case.  It can cycle back on its own feedback loop into the system, either consciously or unconsciously altering arm swing and thus global body kinematics.  

There is a reason that in my practice I often assess and treat contralateral upper and lower limbs as well as to address remnants from old injuries whether they are symptomatic or not. It all comes together for the organism as a concerted effort in optimal locomotion.

Here on TGG, and in dialogues with Ivo on our podcast, I have long talked about phasic and anti-phasic motions of the arms and shoulder-pelvic blocks during gait and locomotion/sport activity.  I have written several times about the effects of spine pain and how spine pain clients reduce the anti-phasic rotational (axial) nature of the shoulder girdle and pelvic girdle. In the video above, you can see anything but anti-phasic gait, to be clear, this is a classic representation of a phasic gait. The shoulder block and the pelvic block show little if any counter rotation, they are linked together which is not normal gait. Furthermore, if you look carefully, the timing of the right arm swing is variable and cyclically changing in its timing with the left leg. Look carefully, you will see the cyclical success and failure at the beginning of the video.  This is pathologic gait, he must be constantly fighting frontal plane sway because there is no axial anti-phasic motion. He is also constantly fighting the unidirectional rotation that the absence of an entire limb and limb girdle is presenting, you can see him struggle with this if you have looked at enough gait samplings. There is essentially frozen torso movements.  Want to see more of our work on arm swing ? search the gait guys blog.

There is so much more here to discuss, so I will likely return to this video another time to delve into those other things on my mind. Luke is an amazing athlete, he gets much respect from me.

I hope this dialogue helps you to get a deeper grip on gait and gait problems. I have written many articles on the topics of arm swing, phasic and anti-phasic gait, central pattern generators. The are all archived here on the blog. I try to write a new original thought-process article each week for the blog amongst the other “aggregator” type stuff we share from other folks social media. My weekly article serves to go deeper into things, sometimes they are well referenced and in this case, I am basing today’s discussion on the referenced work in the other pieces I have written on arm swing, phasic and anti-phasic gait, central pattern generators etc. So please do your readings there before we begin debate or dialogue, which i always welcome !

Dr. Shawn Allen

Podcast 82: Phasic vs Antiphasic Gait, Cross Over Gait & more.

Show sponsors:

www.newbalancechicago.com

www.lemsshoes.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_82final.mp3

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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”

 

Show notes:

 
Blog posts we reviewed:
 

Muscle Activity Differences in Forefoot and Rearfoot Strikers
http://www.runresearchjunkie.com/muscle-activity-differences-in-forefoot-and-rearfoot-strikers/

www.runnersworld.com/injury-treatment/forward-lean-while-running-might-reduce-knee-pain?cid=social33696857

Weight-Bearing Ankle Dorsiflexion Range of Motion—Can Side-to-Side Symmetry Be Assumed?
http://www.natajournals.com/doi/abs/10.4085/1062-6050-49.3.40

extras for this piece:

and you can use this to substantiate it: http://www.ncbi.nlm.nih.gov/pubmed/23997389

Effect of step width manipulation on tibial stress during running. J Biomech. 2014 Aug 22;47(11):2738-44. doi: 10.1016/j.jbiomech.2014.04.047. Epub 2014 May 21.

This Client went Phasic in their Gait. Do you know what that means ? We do, and so does McGill, Liebenson, Cook and many others.

Long ago on this blog we showed and discussed a video (link) that discussed Stu McGill’s research of the human movements of Georges St-Pierre and David Loiseau. The basic tenets of that video were that the hips and shoulders are used for power production and that the spine-core are used for creating stiffness and stability for the ultimate power transmission through the limb.  He made it clear that if power is generated from the spine, it will suffer. 

Here on TGG we have long talked about phasic and antiphasic motions of the arms and shoulder-pelvic blocks during gait and locomotion/sport activity.  Many of our 1000+ blog writings and 80 podcasts have talked about spine pain and how spine pain clients reduce the antiphasic rotational (axial) nature of the shoulder girdle and pelvic girdle. In the video above, we see anything but antiphasic gait, to be clear, this is a classic representation of a phasic gait. This is pathologic gait, the frontal plane sway is exaggerated and necessary because there is no axial antiphasic motion.  There is essentially frozen arm and torso movements. This client has a long standing history of severe spine trauma and pain, their central pattern generators (CPG) had to make this motor pattern choice in an attempt to avoid pain and negotiate force streams across trauma zones. If you are curious and wish to go deeper down this rabbit hole, read the 30+ articles we have produced more specifically on arm swing and locomotor phasics, just click here.

In these types of cases, the client subconsciously makes the subcortial pattern choice (overrides the normal CPG) to rotate them as a solid unit to reduce spine rotation, axial loading and compression.  We could say that quite often spine pain disables the normal arm-leg pendulums via altering the shoulder-torso and hip-pelvis phasics and the CPG that dictates them. Normally, the spine and core must present sufficient amounts of recruited stiffness, yet mobility where necessary, to enable the locomotive power and velocity generated by movements of the shoulders and hips. These are the two main portals of limb movement off of the spine/core.  These principles holds true in gait and sport. For and interesting example, in human gait the psoas is not entirely a hip flexor initiator when it comes to leg swing, it is a huge hip flexion perpetuator. The initial hip flexion in human gait comes from derotating the obliqued pelvis, via abdominal contraction, on a stiff and stable spine.  Once the pelvis rotation is initiated, the femur can further pendulum forward (via contraction of the psoas and other muscles) on the forward accelerated pelvis in the hip joint proper creating an energy efficient movement (the towel flick/whip effect). This premise holds true in gait, running, kicking etc.  This is a solid principle of effective and efficient human locomotion. This principle also holds true for a punch or throwing an object, the stable torso/spine provides a stable anchor upon which to accelerate the arm in order to create a high velocity limb movement with power.  But here is where we get annoyed much of the time.  (Soap box Tangent coming up) How often do you read articles about tight ITBand, tight psoas, tight piriformis and the like ?  As a “diagnosis” these are weak and they are the “go to diagnosis or cause” of the unseasoned clinician, trainer, coach, therapist. If we all are to be really good at our job, we must go beyond what we see in someone’s gait (since it is the compensation) and go beyond the CNS neuroprotective strategy of tightness/shortness when there is weakness or motor pattern failure.  This does not mean that you cannot, or should not, incorporate restoration methods and principles to restore length-tension relationships in your client, it means you have to resolve ALL of the problems, including the aberrant CPG they have set up as a protective default to avoid injury or further injury. 

In the case above, returning the discussion to arm and leg swing, one must understand clearly that faulty arm swing patterns and lack of antiphasic torso and pelvis oscillation is a product of surgery,  trauma and more so, pain. The client is avoiding the antiphasic presentation (hence, he is phasic) for a reason and coaching more arm swing would be just about the dumbest intervention, so don’t be “that guy”. We know this is an altered motor pattern choice, not a new fixed set point. We know this because on clinical examination the range is available, we know because we examined for it, it is just not being used.  In an example of this same principle, in this case talking hip ranges of motion, McGill discusses the same in his paper*:

“Despite the large increases in passive hip ROM, there was no evidence of increased hip ROM used during functional movement testing. Similarly, the only significant change in lumbar motion was a reduction in lumbar rotation during the active hip extension maneuver (p < 0.05). These results indicate that changes in passive ROM or core endurance do not automatically transfer to changes in functional movement patterns. This implies that training and rehabilitation programs may benefit from an additional focus on grooving new motor patterns if newfound movement range is to be used.”

Think about that next time you stretch, or are stretched by someone. As we have said before, just because you increase someone’s range of motion, does not mean they will be able to incorporate that range of motion into a movement pattern, or compensation pattern for that matter. It is only ¼ of the equation: Range of Motion,  Skill (or proprioception),  Endurance (or the proportion of slow twitch muscle) and Strength (the proportion of fast twitch muscle). There is our S.E.S. mnemonic again.

In this video case, lack of NORMAL antiphasic spinal motion (torso and pelvis moving opposite one another) is noted. Without the obliqued pelvis the swing and stance phases will be impaired. The psoas may have to become more of a hip flexor initiator, AS WELL AS the perpetuator of limb swing, because there is no pelvic obliquity from the antiphasic principles to drive it from. And so, when you see this fella in your office with bilateral tight psoas/hip flexor complex and tight quadriceps mechanisms with resultant impaired glutes and hip extension, please do not begin lengthening them as your point of initiation.  They are that way because he has gone phasic in his gait.  Change the motor patterns that drive this as best as possible, restore any weaknesses that are contributory to, or initiate, these motor patterns and then, if needed, encourage some progressive new length-tension in these muscle groups as improved motor patterning evolve to allow for it.  You are likely going to have to go back and reteach and restore primitive and postural sensory motor windows in these cases, so be patient, be kind, be wise. Oh, and do not forget that with impaired hip function, there will most likely be impaired ankle rocker,  you are going to need a wide angled lens to see, capture and remedy this lads problems.

On another note, can you imagine what this client’s video gait analysis would show and interpret ? Let alone the diagnostics and recommendations that could come from it?  What about the appearance of their foot pressures across a dynamic foot pressure plate (or God forbid a static one !), surely what is seen at the foot is this client’s problem (not !) And forgive those poor fools who recommend a shoe for this client based off of just those mediums alone.  Without a complete hands-on clinical examination to correlate gait cycle observances, any recommendations for this case will be traumatic on many levels. 

Today’s bottom line……. read, learn, think, stay hungry, be wise.

Shawn and Ivo, The Gait Guys

* Improvements in hip flexibility do not transfer to mobility in functional movement patterns.  Moreside, Janice: McGill, Stuart

link: http://journals.lww.com/nsca-jscr/Fulltext/2013/10000/Improvements_in_Hip_Flexibility_Do_Not_Transfer_to.1.aspx