Training out a crossover gait?

This gal came to see us with right-sided hamstring insertional pain. During gait analysis we noted that she has a crossover gait as seen in the first two sections of this video. In addition to making other changes both biomechanically (manipulation, gluteus medius exercises) and in her running style (“Rounding out her gait” and making her gait more “circular”, running with less impact on foot strike, extending her toes slightly in her shoes) she was told to run with her arms at her sides rather than across her body. You can see the results and the third part of this.

Because of her bilateral gluteus medius weakness that is seen with the dipping and lateral shift of the pelvis on the footstrike side, she moves her arms across her body to move her center of gravity over her feet.

Yes, there is much more work that needs to be done. This is one simple step in the entire process.

“When you run up a hill, most of the cross over gait disappears. Runners will tend toward beautifully stacked lower limb joints.”- Dr. Allen

Are people running up a hill more likely to tend towards a cross over gait style, in other words tend toward a more narrow gait step or a wider gait step ?

Watch people run up hill closely. Even if they are cross over (narrow foot fall) runners, when running up hills a few things will negate much of the narrow foot fall.

1- Running up hill requires more gluteals, more power is needed for all that extra required hip extension to power up the hill. More gluteal max use can, and will, spill over into the posterior fibers of the gluteus medius and this will tend to abduct the leg/hip and reduce some of the cross over tendency.

2- When one runs up a hill, there is a forward pitch of the upper torso, often with a some degree of forward pitch occurring at the hips. More importantly, because one is running up hill, they are stepping up and so more than normal hip flexion is necessary than in normal running. The forward pitch of the body and the greater degree of hip flexion is the culprit here. If the hip/leg is adducted in a cross over style, adding this to a more than normal flexing hip, it will create a scenario for anterior hip impingement and risk of femoral acetabular impingement (FAI) syndromes. Go ahead, test it for yourself. Lie on your back and flex your hip, drawing your knee straight up towards your shoulder.  Pretty good range correct ?  Now, flex the hip drawing your knee towards your navel, adducting it a little across your body. Feel the abrupt range of motion loss and possible pinch in the front of the hip ?  FAI.  This is what would happen if you utilized a cross over gait, narrow foot strike gait. The goes for mountain/sleep hill hikers as well. 

This is why, if you are a narrow foot striker, a near-cross over type of runner, you will see it disappear when you run up hills.  

If you get anterior hip pain running up hills, force a wider step width and reduce the possible impingement at the anterior hip joint. Just make sure you have enough ankle dorsiflexion to tackle the hill in the first place. If not, you may welcome some foot and ankle stuff to the table along with the hip.  

Likely obvious stuff to most of the readers here, but sometimes it is nice to point out the obvious.  Hills, just because they are there, doesn’t mean you have the parts to run them safely.

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: 

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Direct Download: 

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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”

 

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.

Hip muscles and postural control related to ankle function.

Hip exercises boost postural control in individuals with ankle instability
http://lermagazine.com/news/in-the-moment-sports-medicine/hip-exercises-boost-postural-control-in-individuals-with-ankle-instability

-“Four weeks of hip external rotator and abductor strengthening significantly improves postural control in patients with functional ankle instability (FAI) and may be useful for preventing recurrent instability, according to research from Indiana University in Bloom­ington.”

Nothing new here, at least not here on The Gait Guys blog. We have been talking about these kinds of issues for a long time. We  have long discussed the necessary control of the glutes (and their anchoring abdominals) to eccentrically control the loading response during the stance phase of gait, we especially like to discuss the control of the rate of internal rotation (read: eccentric ability of external rotators as a component) of the leg with the glutes. It is why we think it is so important to eccentrically test the glutes and the core stabilizers (all of them !) when the client is table assessed because it is a huge window for us as to what is happening when there is ground interface. Sure one is open chain and the other is closed, but function is necessary in both. 
What this article is again, like others, telling us is that the ability to stack the joints (knee over foot, hip over knee, level stable pelvis over hip) improves postural control, especially when there is a risky environment of ankle functional or anatomical instability. 
And yes, we are talking Cross over gait and frontal plane challenges and faulty patterns here.  Failure to stack the joints usually leads to cross over gait challenges (type in “cross over or cross over gait into our blog SEARCH box). Remember though, you must selectively strengthen the weak muscles and weak motor patterns, if you are not specific you can easily strengthen the neuro-protective tight muscles and their patterns because they have been the only available patterns to your client. If you are not careful, you will help them strategize and compensate deeper, which in itself can lead to injury.  This is a paramount rehab principle, merely activating what appears weak does not mean you are carrying them over to a functional pattern. Just because you can show a change on the table doesn’t mean it carries over to the ground and sport or training. 
Shawn and Ivo, the gait guys

Can you see it?

Here we are again. We have looked at this picture before; once about head tilt, and another about flip flops and form.

Take a good look at this picture and what is different about the child in blue all the way to the right and all the others with the exception of the boy in pink, that we really cannot see?

Can you see it? No, we don’t mean the flip flops (but if you caught that all the boys were in sneakers and all the girls are in flip flops, you are good!)

How about looking at arm swing? Remember this post on arm swing and crossover gait, with the simple cue for correction? All of the children EXCEPT the boy in blue, are drawing their arms ACROSS their body (ie: flexion, internal rotation and adduction). Take a look at their legs. Yep, crossover gait (flexion, internal rotation and adduction). Little boy blues arms are going relatively straight and going in the saggital plane, where the others are going in the coronal plane.

We are not saying that blue does not have some gait challenges, like his torso shift to the left (or pelvic drift to the right), most likely do to gluteus medius weakness or inappropriate firing of the gluteus medius on the left stance phase leg; or his head tilt to the right, which most likely represents a compensation for the right pelvic drift and left body lean.

Arm swing. A very important clue to the puzzle we call gait and compensation. It is more prevalent than you think, and, in some cases, easily corrected with a simple cue.

The Gait Guys. Making it real and pertinent, in each and every post.

Correcting a cross over gait with arm swing? Is it really THAT easy? Sometimes, yes!

We noticed this patient had a cross over gait while running (1st few seconds of video. need to know more about crossover gait? click here). We noted she was crossing her arms over her body as well. We than had her run her hands and arms straight out. See the crossover disappear? Need to know more about arm swing? click here

We the had her do the same while walking. Easier to see, eh? That’s because it is often easier to “fudge” things when you are moving faster (ie: the basal ganglia of nervous system can interpolate where the body part is supposed to be, and because of momentum, there is less need for precision). When we do things slowly (like the 3 second Test), more precision is needed. Watch this short video clip a few more times.

The arms are essentially adducting when the arms cross over. The arms are reciprocally paired with the contralateral lower extremity. When you make a change in one, you often will make a change in the other.

Subtle. Yes. Easier to see when the task becomes more difficult. Yes. Pay attention, the answer is often right there if you look closely enough.

Providing the clues to help you be smarter, better, faster, stronger; we are The Gait Guys

special thanks to “Q” for allowing us to publish this video : )

Saucony: Line Running and Crossing Over

We are big fans of the Saucony line of shoes. We have recommended them to our novice and serious runners for decades now. Currently one of our favorite shoes for our runners is the Saucony Mirage, a beautiful 4mm ramp shoe with no bells and whistles.  It is as close to a perfect zero drop that  you will find without going zero, in our opinion.  That is not to say there are not other great 4mm shoes out there, the Brooks Cadence and the New balance minimus are other beautiful 4mm’s out there.  The Mirage has never failed a single client of ours.  

This was a photo we screen captured from the Saucony Facebook page (we hope that for the sake of educating all runners and athletes that we can borrow this picture for this blog post, please contact us if you would like us to remove it). It is a good page, you should follow it as well.  This picture shows not only a nice shoe but something that we have been talking about forever.  The cross over; this runner is running in such a line that it could be argued that the feet are crossing the mid line. In this case, is the line queuing the runner to strike the line ? Careful of subconscious queues when you run, lines are like targets for the eyes and brain.  One thing we like to do with our runners is to use the line as training however, a form of behavioral modification.  When you do a track workout, use the line underneath you, but keep the feet on either side of the line so that you learn to create that little bit of limb /hip abduction that helps to facilitate the hip abductor muscles.  This will do several things, (and you can do a search here on our blog for all these things), it will reduce the reflexive tightening of the ITBand (pay attention all you chronic IT band foam rolling addicts !), it will facilitate less frontal plane pelvis sway, optimal stacking of the lower limb joints, cleaner patellofemoral tracking and help to reduce excessive pronation /internal limb spin effects.  

There is really nothing negative about correcting your cross over, IF it truly needs correcting.  That is the key question.  Some people may have anatomic reasons as to why the cross over is their norm, but you have to know  your anatomy, biomechanics and neuromechanics and bring them together into a competent clinical examination to know when the correction will lead to optimal gait and when it will drive suboptimal gait. Just because you see it and think it is bad, does not make it so.  

New to this cross over stuff ? Head over to the search box here on our blog and type in “cross over” or “cross over gait” and you will find dozens of articles and some great videos we have done to help you better grasp it. 

* you will also note that this runner is in an excessive lateral forefoot strike posturing.  This means that excessive and abrupt prontation will have to follow through the mid-forefoot in order to get the medial foot tripod down and engaged.  The question is however, is what you are seeing a product of the steep limb angle from the cross over, or does this runner have a forefoot varus (functional or anatomic, rigid or flexible)?  Are the peronei muscles weak, making pre-contact foot/ankle eversion less than optimal ? This is an important point, and your clinical examination will define that right away … . . if you know what these things are.  And if you don’t ? Well, you have found the right blog, one with a SEARCH box. Type in “forefoot varus”, if you want to open up the rabbit hole and climb down it … . . we dare ya ! 🙂

The Cross Over Gait

Did you miss our teleseminar presentation on this topic last night on www.onlinece.com ?

Here is a sample of one of our slides.  The cross over gait is potentially a real problem for some. The question is always, how much cross over (running or walking) is too much for a client ? When does it need corrected ? Does it need corrected ? Leave it alone ?  We answered these hard questions in our teleseminar.  

Lucky for you www.onlineCE.com recorded it so you can take the class anytime !  (just give them a few days to process the recording). 

As you can see from just this slide here, we looked at many aspects of the cross over. But we also discussed STEP WIDTH, lateral compartment weakness and tightness as coexisting pathology, and so much more.  Stay tuned, we will be recording this program into an extended and more in depth course for you all in a video format with course notes and more and then have it for you on our Payloadz website (which you can access here for our present offerings).

In the mean time, consider looking for these “Big 6” and when you see them co-existing you might want to look for a cross over pattern in your client, it just might be there sometimes.

– weak gluteus medius

– weak TVA and obliques

– weak adductors

– weak medial quadriceps

– weak tibialis posterior

– excessive foot pronation

Shawn and Ivo, The Gait Guys

Take a look at this gal.

Why does she have a cross over gait?

  • note how much tibial varum she has (curvature of the tibial in the coronal plane)
  • how much adduction of the right foot there is, potentially indicating a tight posterior compartment, or perhaps a loss of internal rotation of the right thigh
  • the excessive posterior rotation of the left shoulder and upper body
  • the subtle abduction of the right arm compared to the left
  • the slight torso lean to the left

The correct answer is we don’t know until we examine her. Maybe is is there out of necessity or perhaps it is a more efficient running style for her. Here are some points:

Technical Issues with the crossover gait

The cross over gait may be:

  • a more efficient running style
  • a potential pathologic musculoskeletal motor pattern
  • better for long distance runners
  • a challenge to balance because of a narrower base of support

It may also be related to:

  • a weak gluteus medius
  • weak adductors
  • excessive foot pronation
  • lower extremity morpholgy (like tibial varum, forefoot varus)
  • a weak vastus medialis
  • a weak tibialis posterior
  • and the list goes on

Join us, tomorrow, Wednesday evening, 8pm EST, 7 CST, 6 MST, 5PCT for an hour of crossover gait on chirocredit.com or onlinece.com for Biomechanics 316. We look forward to seeing you there..

The Gait Guys: Shawn and Ivo

Look at these kids running …  all but one shows poor form, but remember, these kids are still undergoing neurodevelopment and are learning to control their body parts. Remember, the maturation/myelination of the nervous system usually lags behind the development of the musculoskeletal system. 

In the photo, lets first focus on the happy lad in the green shirt. He sure looks like he is having fun, which is what running should be about in kids. If you try to make running a chore for kids you just might lose their love of it in the process. But our point here at The Gait Guys is to teach. So here in this photo are some good teaching points. You should see:

1- the stance phase leg (right leg) is spun out into external rotation. Not too much of a big deal because we do not know if he has finished the normal derotation process of the limb, sometimes this can carry into the puberty years even though for most kids the process is largely completed by his predicted age.

2- The pelvis has drifted laterally in the frontal plane past a perpendicular line up from his foot. This could mean alot of things including gluteus medius or abdominal weakness but the point here is that he has broken through the lateral line (frontal plane) of support up through the hip-pelvis-core chain. This is going to set up what the the left knee (swing leg) is doing and will set up #3.

3. Cross over gait is virtually guaranteed because of the lateral pelvis drift as noted in #2. It is virtually guaranteed as well because the swlng leg knee coming inwards is dictating it. IF the knee is coming inwards toward the midline the thing attached to it , the foot, is going to follow. The swing leg is a pendulum, if you shift the pivot point of the pendulum (in this case to his right) the pendulum will swing to the right. This is a self-perpetuating cycle and it will not correct without strengthening, awareness and drilling positive feedback changes.

4. Dr. Allen’s current thought experiment on Ballasts (see podcast 38) is playing out here with the left arm of this fella. If the pelvis drifts far to the right, the arm will move away from the body to move some of the left side body weight outwards to negate the right shift. This is pure balance physics.  Arm swing most of the time cannot be corrected without correcting the thing that causes the aberrant arm swing, and that is often (but not exclusively) aberrant lower limb and pelvis-hip-core or foot mechanics. There are exceptions, but often if you fix the lower limb and pelvis-hip mechanics  you will see an immediate change in the arm swing. If you force changes in arm swing without fixing the problem (and that is not to say there are not local arm swing etiologies) you may be  driving strength into a compensation pattern that you may not want or like.

5. The girl in the pink tights  … . she might have been modelling the boy in the green shirt. Same issues, same concerns.

6. The form we love the most ? The boy in the dark blue shirt and black shorts on the far right. Great form, no major issues here. We bet he didn’t hear the starters gun go off.

On a side note, the fella in the green shirt with that form he would be a champion race walker. He already has the hip action right, the cross over that is loved in that sport and the arm swing.  Maybe some exposure to an alternate sport is a better solution here ? Although we are always an advocate for correcting flawed biomechanics.

It is often painful for us to watch kids run. We know that much of the things we hate are temporary because of the neuro-developmental process. But sometimes, if kids run too much at a young age, and are pressed into long running miles or cross country at too young an age, these aberrant mechanics can become their new norm. This is the danger of plasticity in the nervous system. Repeated stimulation of a pattern engrains that pattern and the extent of a brain’s plasticity is dependent on the stage of neuro-development and the brain region affected.  When an aberrant running form is allowed to perpetuate into the mid-teenage years, when the majority of the synapses are already formed and neurologic “pruning” and myelination are ramping up, then the repeated exposure to the aberrant pattern can get the myelination. This is the most frustrating thing for us. We would rather see some intervention early on with the creation, strengthening and myelinating of correct motor patterns through skill development training rather than mileage training, rather than discarding the more appropriate synapses that could have, might have, should have, been formed. Our bodies and brain will develop depending on the exposures and demands put upon it. And here is the big key, if you do not clean up someone’s gait aberrancy(s) early on, one should not wonder down the road why they developed flat feet, bunions, early degenerative knees and the like. This is a fairly predictable machine, but you have to try to intervene early to prevent the slings and arrows of outrageous misfortune later on.

Both the brain and the body will adapt to their environment, whether that is an optimal one or a compensatory one. It can myelinate either pathway. Which one will you choose for your kids ?

Shawn and Ivo, The Gait Guys