Pod #100: Hill Running + Cortical Brain Changes in Injuries

Pod #100  Hill Running + Cortical Brain Brain Changes in Injuries, Plus leg length challenges, Sole vs Heel lifts, Varying your Running Surface, Frontal plane biomechanics, Baker Cyst and Popliteal Muscle problems and more !

Show Sponsors:  
topoathletic.com
rocktape.com

Other Gait Guys stuff

A. Podcast links:

direct download URL: http://traffic.libsyn.com/thegaitguys/pod_100f.mp3

permalink URL: http://thegaitguys.libsyn.com/podcast-100-hill-running-cortical-brain-brain-changes-in-injuries

B. iTunes link:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138
C. Gait Guys online /download store (National Shoe Fit Certification & more !)
http://store.payloadz.com/results/results.aspx?m=80204
D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com type in Dr. Waerlop or Dr. Allen, ”Biomechanics”

-Our Book: Pedographs and Gait Analysis and Clinical Case Studies
Electronic copies available here:

-Amazon/Kindle:
http://www.amazon.com/Pedographs-Gait-Analysis-Clinical-Studies-ebook/dp/B00AC18M3E

-Barnes and Noble / Nook Reader:
http://www.barnesandnoble.com/w/pedographs-and-gait-analysis-ivo-waerlop-and-shawn-allen/1112754833?ean=9781466953895

https://itunes.apple.com/us/book/pedographs-and-gait-analysis/id554516085?mt=11

-Hardcopy available from our publisher:
http://bookstore.trafford.com/Products/SKU-000155825/Pedographs-and-Gait-Analysis.aspx

Show Notes:

1 Cortical change in chronic low back pain

http://www.anatomy-physiotherapy.com/articles/other/nervous/1329-cortical-change-in-chronic-low-back-pain
-Chronic low back pain is characterised by a range of structural, functional and neurochemical changes within the brain. Functional changes in individuals with chronic low back pain are reflected in a cortical reorganization, altered cortical activity and altered cortical responsiveness.

2  Lifting weights can change the brain
http://www.techvibes.com/blog/lifting-weights-can-beneficially-change-structure-of-brain-2015-10-27

3  Importance of varying running surfaces
http://triathlon.competitor.com/2015/05/training/importance-varying-running-surfaces_100995

4  Emergence of postural patterns as a function of vision and translation frequency.
http://www.ncbi.nlm.nih.gov/pubmed/10322069
J Neurophysiol. 1999 May;81(5):2325-39.
Our results suggest that visual information was important to maintaining a fixed position of the head and trunk in space, whereas proprioceptive information was sufficient to produce stable coordinative patterns between the support surface and legs.     *The CNS organizes postural patterns in this balance task as a function of available sensory information, biomechanical constraints, and translation frequency.

5  Previous hamstring injury is associated with altered kinematics.
“Previously injured athletes demonstrated significantly reduced biceps femoris muscle activation ratios with respect to ipsilateral gluteus maximus, ipsilateral erector spinae, ipsilateral external oblique, and contralateral rectus femoris in the late swing phase. We also detected sagittal asymmetry in hip flexion, pelvic tilt, and medial rotation of the knee effectively putting the hamstrings in a lengthened position just before heel strike.”

The biomechanics of running in athletes with previous hamstring injury: A case-control study. C. Daly1, U. McCarthy Persson2, R. Twycross-Lewis1, R. C. Woledge1,† andD. Morrissey1,

Achilles tendonitis: Lift the heel, right? It does not appear so.

There was a recent article in one of our favorite journals, Lower Extremity Review which reviewed and expanded upon another study from Medicine and Science in Sports and Exercise titled “Running shoes increase achilles tendon load in walking: an acoustic propagation study.” We discussed some perspectives of this topic in one of our recent podcasts.
The article discusses a new technique (1,2) for looking at tensile loads in the achilles and looks at 12 symptom free individuals on a treadmill barefoot and in a shoe with a 10 mm drop (heel is 10mm higher than the forefoot) and found:

“Footwear resulted in a significant increase in step length, stance duration, and peak vertical ground reaction force compared with barefoot walking. Peak acoustic velocity in the Achilles tendon (P1, P2) was significantly higher with running shoes.”(1)

According to LER: “The researchers also found changes in basic gait parameters associated with walking in running shoes versus barefoot, which the author Wearing said may help explain the increased tendon load with shoes. Shoes increased mean ankle plantar flexion by 4° during quiet stance as measured by electrogoniometry. When walking with shoes, participants adopted a lower step frequency but greater step length, period of double support, peak vertical ground reaction force, and loading rate than when walking barefoot. The researchers also noted that participants’ stance phase was relatively longer (4%) during shod walking than during barefoot walking.” (3)

Of course, our big question is why?

Why would an increase in step length result in increased tension?

Perhaps, as the force that the heel would hit the ground would be increased because of a longer acceleration time (F=ma), and it so happens this is what they found. The friction of the heel striking the ground would accelerate anterior translation of the talus, which plantar flexes, everts and abducts, accelerating pronation. The medial gastroc would be called into play to slow calcaneal eversion and this would indeed increase achilles tension.

Or perhaps it’s the fact that

the foot will strike in slight greater plantarflexion

(at least 4 degrees according to the study) and this results in an immediate greater load to the Achilles tendon.  Go ahead and try this while walking even if you’re barefoot. Walk across the floor and strike more on your forefoot. You will notice that you have an increased load in the tricep surae group.

Does this slight plantarflexion of the ankle contribute to greater eccentric load during stance phase?

This would certainly activate 1a afferent muscle spindles which would increase tensile stresses in the achilles tendon.

This seems to fly directly in the face of the findings of Sinclair (4) who investigated knee and ankle loading in barefoot and barefoot inspired footwear and found increased achilles loading in both compared to “conventional shoes”.

Of course this also begs the question of what type of shoes were they wearing? High top or low top shoes and were the shoes tied or not? High top shoes seem to reduce Achilles tension more so than low top shoes, especially if they are tied (5).

Whatever the reason, this questions the use of putting a lift or a higher heeled shoe underneath the foot of people that have Achilles tendinitis.  Once again what seemed to make biomechanical sense is trumped by science.

We think training people to have greater amounts of hip extension as well as ankle dorsiflexion,  as well as appropriate foot and lower extremity biomechanics with the requisite  skill, endurance and strength is a much better way to treat Achilles tendonitis regardless of whether they’re wearing footwear or not.

Dr. Ivo Waerlop, one of The Gait Guys

References:

1. Wearing SC, Reed LF, Hooper SL, et al. Running shoes increase Achilles tendon load in walking: An acoustic propagation study. Med Sci Sports Exerc 2014;46(8):1604-1609.  http://www.ncbi.nlm.nih.gov/pubmed/24500535
2. Reed LF, Urry SR, Wearing SC. Reliability of spatiotemporal and kinetic gait parameters determined by a new instrumented treadmill system. BMC Musculoskelet Disord 2013;14:249.
3. Black, Hank. Achilles oddity: Heeled shoes may boost load during gait. In the Moment:Rehabilitation   LER Sept 2014  http://lermagazine.com/news/in-the-moment-rehabilitation/achilles-oddity-heeled-shoes-may-boost-load-during-gait
4. Sinclair J. Effects of barefoot and barefoot inspired footwear on knee and ankle loading during running. Clin Biomech (Bristol, Avon). 2014 Apr;29(4):395-9. doi: 10.1016/j.clinbiomech.2014.02.004. Epub 2014 Feb 23.
5. Rowson S1, McNally C, Duma SM. Can footwear affect achilles tendon loading? Clin J Sport Med. 2010 Sep;20(5):344-9. doi: 10.1097/JSM.0b013e3181ed7e50.

Podcast 87: Podcast 87: The Kenyan’s Running Brain & “The” Anterior Compartment.

Plus, Some unknown facts about going minimalism and barefoot. We POUND anterior compartment strength today gang ! Hope you enjoy !

Show sponsors:
www.newbalancechicago.com

A. Link to our server: 
http://traffic.libsyn.com/thegaitguys/pod_87final.mp3

Direct Download: 
http://thegaitguys.libsyn.com/podcast-87

Other Gait Guys stuff

B. iTunes link:
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:
Monthly lectures at : www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

Show notes:

On high heels and short muscles: A multiscale model for sarcomere loss in the gastrocnemius muscle

http://www.sciencedirect.com/science/article/pii/S0022519314006262

The Brain Needs Oxygen

Maintained cerebral oxygenation during maximal self-paced exercise in elite Kenyan runners.

http://www.runnersworld.com/racing/the-brain-needs-oxygen
http://www.ncbi.nlm.nih.gov/pubmed/25414248
J Appl Physiol (1985). 2014 Nov 20:jap.00909.2014. doi: 10.1152/japplphysiol.00909.2014. [Epub ahead of print]

The texting lane in China
http://www.theguardian.com/world/shortcuts/2014/sep/15/china-mobile-phone-lane-distracted-walking-pedestrians

Dialogue on endurance training,
NeuroRehabilitation. 2006;21(1):43-50. 
http://www.ncbi.nlm.nih.gov/pubmed/16720937

Effects of dorsiflexor endurance exercises on foot drop secondary to multiple sclerosis.  Mount J1, Dacko S.

APOS Therapy
we were asked out opinion on this
http://apostherapy.com/

Foot instrinsic dialogue
Motor Control. 2014 Jul 15. [Epub ahead of print]

Quantifying the Contributions of a Flexor Digitorum Brevis Muscle on Postural Stability.
Okai LA1, Kohn AF.

There are many factors in adults that impair gait. It is not all biomechanical. This is part of our ongoing dialogue on the aging population and why gait impairments and falls are so prevalent.
Acta Bioeng Biomech. 2014;16(1):3-9.
Differences in gait pattern between the elderly and the young during level walking under low illumination.
Choi JS, Kang DW, Shin YH, Tack GR.


Podcast 72: Neuroplasticity, EVA Shoe Foam, and Shoe Trends

Maximalist shoes and the death of Minimalism ? Could this be true ?

*Show sponsor: www.newbalancechicago.com

Lems Shoes.  www.lemsshoes.comMention GAIT15 at check out for a 15% discount through August 31st, 2014.

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_73f.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-72

B. iTunes link:

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”

______________

Today’s Show notes:

1. Neuroplasticity: Your Brain’s Amazing Ability to Form New Habits
new link (does not have the old photo ivo mentioned that he loved)
 
2. Last week we pounded the sand on EVA foam and maximalist shoes. There was alot of attention, emails and good social media discussion on the topic.  
LETS REVIEW IT
file:///Users/admin/Downloads/p142_Heel_shoe_interactions_and_EVA_foam_f_web_150dpi.pdf
 
3. Then there just last week there was an article in LER on “the death of minimalist shoes” ? 
READ THIS: 
The rise and fall of minimalist footwear | Lower Extremity Review Magazine
http://lermagazine.com/cover_story/the-rise-and-fall-of-minimalist-footwear
 

4.  Physical Therapy as Effective as Surgery for Meniscal Tear

Kathleen Louden

March 20, 2013
Torn Meniscus? Thinking about surgery? Think again…


5. Cast study: the broken foot tripod

Podcast 72: Neuroplasticity, EVA Shoe Foam, and Shoe Trends

Maximalist shoes and the death of Minimalism ? Could this be true ?

*Show sponsor: www.newbalancechicago.com

Lems Shoes.  www.lemsshoes.comMention GAIT15 at check out for a 15% discount through August 31st, 2014.

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_73f.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-72

B. iTunes link:

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”

______________

Today’s Show notes:

1. Neuroplasticity: Your Brain’s Amazing Ability to Form New Habits
new link (does not have the old photo ivo mentioned that he loved)
 
2. Last week we pounded the sand on EVA foam and maximalist shoes. There was alot of attention, emails and good social media discussion on the topic.  
LETS REVIEW IT
file:///Users/admin/Downloads/p142_Heel_shoe_interactions_and_EVA_foam_f_web_150dpi.pdf
 
3. Then there just last week there was an article in LER on “the death of minimalist shoes” ? 
READ THIS: 
The rise and fall of minimalist footwear | Lower Extremity Review Magazine
http://lermagazine.com/cover_story/the-rise-and-fall-of-minimalist-footwear
 

4.  Physical Therapy as Effective as Surgery for Meniscal Tear

Kathleen Louden

March 20, 2013
Torn Meniscus? Thinking about surgery? Think again…


5. Cast study: the broken foot tripod

Podcast 70: Achilles Solutions and Foot Cases

The Achilles and Calf: Achieve Posterior Length via Anterior Strength

A. Link to our server: 

Direct Download: 

http://traffic.libsyn.com/thegaitguys/pod_70final_was71.mp3

Permalink: http://thegaitguys.libsyn.com/podcast-70-0B. 

iTunes link:

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”

______________

Today’s Show notes:

*Show sponsor: Lems Shoes.  www.lemsshoes.com
Mention GAIT15 at check out for a 15% discount through August 31st.
 
1. Achilles tendons, loading, and biomechanical changes with different shoes and heel stack heights.
 
2. Aging adults, falls and keeping them and their gait safe.
 
3. Gait and speed evolution of vertebrates.
 
4. Blaise Dubois et al on Barefoot Running. Shod vs unshod.
 
5. Females, pronation, and back pain. The Framingham foot study.
 
6. Your feet and orienteering.
 
7. A case of calcaneal valgus in a youngster.
 
8. Structural integrity is decreased in both Achilles tendons in people with unilateral Achilles tendinopathy

http://www.jsams.org/article/S1440-2440(14)00115-7/abstract

The Naked Foot: The Soft Neurology behind Barefoot.

The Naked Foot: Thoughts for the Shoe Minimalist

This may be one of the very first articles we ever wrote for The Gait Guys. It must be 7-8 years old now, before the barefoot-minimalist craze ever started. It is a bit dated, but we think that it was time to revisit its contents. You will see that many of our early core principles have not changed and you can see the thought process of where the fads and trends were projected to go.  Wind your mind back a near decade, and read on !

_____________________

If you want to follow the fad craze these days, just look to companies like Vibram and Nike. Vibram is the company that has brought you the soles and treads of many of the shoes you have worn over the years and of course Nike are the people who first brought you the “running shoe” as we know it today. Nike first brought us the waffle bottom trainer, the cross trainer, air pockets, “shocks” and, the Air Jordan and now their barefoot minimalist series, the Nike Free. Now, we are sure not many of you have heard of the “Vibram Five Fingers” barefoot slip-on ‘shoe’ but virtually everyone who runs in some manner has seen and heard about the Nike Free. What initially stymied us when they first came out was the obvious question of “Why would the same people who sell us the shoes, and give us so many varieties and categories to choose from, now be advocating that we train barefoot, or close to it? ” Or are they ?

  • (Addendum:  this article was originally written long ago, at the start of this fad, the fad that has become a trend.  The article traveled fast around the internet and garnered us much attention including a gig with Vibram as consultants.  But that was then, this is now.  We, and the trend have come a long way, and so has the research.  Some supportive for the trend, some disagreements and plenty of controversy.  The remainder of this article has been unedited, hence its tense and outdated verbiage, shoe types and research.  But we thought it was time to review before moving ahead.)

The Nike version they are pushing, first the Nike Free 5 and now down to the Nike Free 3, has a light weight thin flexible sole and thin vamp top cover material whoís purpose is to merely hold the shoe onto the foot. The Vibram device, which is a fascinating yet simple slipper, is even more simplistic but has some brilliance built right into its heart. It is merely a rubber sock with compartments for each individual toe but that is part of its brilliance. So why would Nike and now Vibram go against their own creations and advocate that we begin walking and running barefoot, or at least become more “shoe-minimalists” after decades of building shoe and sole lines that previously were designed for various conditions, foot types and activities ? There appears to be sound moral reasoning if you delve into the research, but you have to look closely and you have to be careful you do not have one of those foot types that could lead to problems with this type of footwear (but that is a topic for another article to come soon, see Part II).

Barefoot theories are nothing new. In 1960 Abebe Bikila, perhaps the greatest barefoot runner of all time, won the first of his consecutive gold medals without shoes setting a world record of 2:15:17. Englandís Bruce Tulloh was setting overseas records into the 1960’s running unshod, skin to the ground. Today Ken Bob Saxton is one of the most visible barefoot marathoners, long beard and all, and is an advocate of the technique.

With the introduction of the Nike Free, the interest in barefoot running resurfaced at the turn of the century. An article by Michael Warburton, published as an internet paper on barefoot theories, seemed to spark some of the resurgence of the method of running. In his brilliant paper he had some interesting thoughts and pointed out some noteworthy facts. He indicated that research showed that an extra mass of 100 grams attached to the foot diminished the economy of running by one percent. Thus, two 10 ounce shoes (the weight of a lightweight training shoe) could compoundingly cripple you by more than five percent in efficiency. In tangible terms that could be more than six minutes tacked onto a world class marathoner, taking a world record time to a mere first group finishing time. So, it is a question of weight and time, or is there something more ?

To get started with some hard and simple research facts, current research has been conducted showing that plantar (bottom of the foot) sensory feedback plays a central role in safe and effective locomotion, that more shoe cushioning can lead to higher impact forces on the joints and higher risk of injury, that unshod (without shoes) lowers contact time versus shod running, that there are higher braking and pushing impulses in shod versus unshod running, that unshod running presents a reduction of impact peak force that would reduce the high mechanical stress that occurs during repetitive running and that the unshod foot induces a neural-mechanical adaptation which could enhance the storage and restitution of elastic energy at ankle extensor level. These are only some of the research findings but they are some of the more significant ones. These issues will not only support injury management benefits for the unshod runner but increase speed, force and power output.

Stepping backwards in time a little, in the caveman days things were different. The foot was unshod (without shoes) from the moment of the first step until one’s dying day, and thus the foot developed and looked different. The sole of the foot was thicker and callused due to the constant contact with rough and offending surfaces thus preventing skin penetration, the foot proper was more muscular and it may have been wider in the forefoot and the toes were likely slightly separated due to the demands of gripping which would obviously necessitate increase muscular strength and bulk to the foot intrinsic muscles. It was the constant input of uneven and offending surfaces such as rocks, twigs, mud, foliage and debris that stimulated the bottom of the foot, and thus the intrinsic muscles, sensing joint positions and relaying those variations to the brain for corresponding descending motor changes and adaptations to maintain protection and balance. The foot simply worked different, it worked better, it worked more like the engineering marvel that it truly is. The foot was uncovered and the surfaces we walked on were uneven and challenging. However, as time went on, man decided to mess with a good thing. He took a foot that was highly sensitive, a virtual sensory organ with a significant sensory and motor representation in the brain (only the hands and face have more brain representation as represented by the sensory and motor homunculus of the brain) and he not only covered it up with a slab of leather or rubber but he then flattened and then paved not only his world, but also his home, with black hard top, cement, wood or tile thus completing the total sensory information deprivation of the entire foot. Thus, not only did he take away critical adaptive skills from himself and generations to follow, but he began the deprivation of the brain of critical information from which the central nervous system would need to develop and continue to function effectively. It is not unlikely that the man of pre-shod time had a strong competent foot arch (perhaps somewhat flat to increase surface area contact for adaptation), but one that did not need orthotics, stability shoes or rigid shanks and inserts. In other words, the foot and its lower limb muscles were strong with exceptional skills and endurance. But in today’s day and time things are now different. We now affix a shoe to the child’s foot even before he can walk and then when he does, all propriosensory information necessary for the development of critical spinal and central nervous system reflexes is ensured to be virtually absent. Is it any wonder why there are so many people in chronic pain from postural disorders related to central core weakness and inhibition ? Is it any wonder why so many people seem to have flat incompetent feet and arches? Man has done it to himself, but thankfully man has proven that what he can do, he can undo. Thankfully we see modern medical research that has delved into this realm of thought and has uncovered the woes of our ways and to follow, companies like those mentioned earlier are imagining and developing devices that will allow us some protection from modern day offenses such as glass, plastics and metal and thus allow us the slow and gradual return to our healthier foot days, all fashion sense aside.

 Shawn and Ivo, The Gait Guys

Two fellas that were here at the beginning, and two fellas that will be here for the duration.