Tag: gait abnormality

Podcast 77: Gait analysis, Forefoot Running & more.

Plus, the 5 neurologic gait compensation expressions.

*Show sponsor: www.newbalancechicago.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_77final.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-77

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:

Google X acquires ‘tremor-canceling spoon’ startup
http://venturebeat.com/2014/09/10/google-x-acquires-tremor-canceling-spoon-startup/

The 5 expressions of neurologic gait decomposition,
Last week we did an online teleseminar … . .
An acoustic startle alters knee joint stiffness and neuromuscular control
http://onlinelibrary.wiley.com/doi/10.1111/sms.12315/abstract
Effectiveness of Off-the-Shelf, Extra-Depth Footwear in Reducing Foot Pain in Older People: A Randomized Controlled Trial
http://biomedgerontology.oxfordjournals.org/content/early/2014/09/08/gerona.glu169.abstract
reader:
I really appreciate learning from you!! I have a bit of a loaded question that I will try to explain clearly to the best of my ability. About 2 years ago, I broke my left shin (hairline-fibula) in a MMA fight. After it healed, a few things have been happening that I assume are connected but can’t quite put my finger on. My ankle mobility on my left ankle is worse than my left. I seem to have permanent turf toe as well. My right glute, ham, and erector are hyperactive.
Additionally, many times when sprinting, pushing a sled, etc, my right quad will become fatigued much more than my left. I believe it’s because I’m not fully extending my left ankle, and relying on my right leg more. Whenever I squat or deadlift, I feel similar too. The right glute and erectors get much more of a “pump” than my left. With all of this, is there anything you would recommend? I truly appreciate it!! It is very frustrating. Thank you again!

Podcast 77: Gait analysis, Forefoot Running & more.

Plus, the 5 neurologic gait compensation expressions.

*Show sponsor: www.newbalancechicago.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_77final.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-77

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:

Google X acquires ‘tremor-canceling spoon’ startup
http://venturebeat.com/2014/09/10/google-x-acquires-tremor-canceling-spoon-startup/

The 5 expressions of neurologic gait decomposition,
Last week we did an online teleseminar … . .
An acoustic startle alters knee joint stiffness and neuromuscular control
http://onlinelibrary.wiley.com/doi/10.1111/sms.12315/abstract
Effectiveness of Off-the-Shelf, Extra-Depth Footwear in Reducing Foot Pain in Older People: A Randomized Controlled Trial
http://biomedgerontology.oxfordjournals.org/content/early/2014/09/08/gerona.glu169.abstract
reader:
I really appreciate learning from you!! I have a bit of a loaded question that I will try to explain clearly to the best of my ability. About 2 years ago, I broke my left shin (hairline-fibula) in a MMA fight. After it healed, a few things have been happening that I assume are connected but can’t quite put my finger on. My ankle mobility on my left ankle is worse than my left. I seem to have permanent turf toe as well. My right glute, ham, and erector are hyperactive.
Additionally, many times when sprinting, pushing a sled, etc, my right quad will become fatigued much more than my left. I believe it’s because I’m not fully extending my left ankle, and relying on my right leg more. Whenever I squat or deadlift, I feel similar too. The right glute and erectors get much more of a “pump” than my left. With all of this, is there anything you would recommend? I truly appreciate it!! It is very frustrating. Thank you again!

Podcast 76: The FMS™ screen and Injuries, Impact Loading & more.

Podcast 76: Association of Functional Movement Screen™ With Injuries, Wool workout gear, landing softly and more !

*Show sponsor: www.newbalancechicago.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_77.1_76final.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-76

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:

 
Last week on our social media sites we posted this article that garnered 9000+ hits:
Runner? LONG DISTANCE runner? Better be careful out there!
http://www.sciencedaily.com/releases/2012/06/120604093108.htm
 
then this news this week:
Well-Regarded Endurance Athlete Chad Denning Dies While Running Appalachian Trail | Valley News
 
Association of Functional Movement Screen™ With Injuries in Division I Athletes
 
from a reader:
Hey guys, great site, sometimes a bit more than I know at this point. Just graduated from massage school in april. I have been diagnosed with tendonosis of the Achilles heel. Also finding that my leg doesn’t fully extend while walking, anything I can do besides hamstring and calf stretches. It really happened after a 30 mile hike with a 40 lb backpack, Help 
Thanks, sincerely Hector
Synthetic Workout Gear Smells Worse Than Cotton Gear
 
 Land Softly And Carry Less Injury Risk

http://running.competitor.com/2014/07/injury-prevention/land-softly-and-carry-less-injury-risk_11174

 
 

Podcast 76: The FMS™ screen and Injuries, Impact Loading & more.

Podcast 76: Association of Functional Movement Screen™ With Injuries, Wool workout gear, landing softly and more !

*Show sponsor: www.newbalancechicago.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_77.1_76final.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-76

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:

 
Last week on our social media sites we posted this article that garnered 9000+ hits:
Runner? LONG DISTANCE runner? Better be careful out there!
http://www.sciencedaily.com/releases/2012/06/120604093108.htm
 
then this news this week:
Well-Regarded Endurance Athlete Chad Denning Dies While Running Appalachian Trail | Valley News
 
Association of Functional Movement Screen™ With Injuries in Division I Athletes
 
from a reader:
Hey guys, great site, sometimes a bit more than I know at this point. Just graduated from massage school in april. I have been diagnosed with tendonosis of the Achilles heel. Also finding that my leg doesn’t fully extend while walking, anything I can do besides hamstring and calf stretches. It really happened after a 30 mile hike with a 40 lb backpack, Help 
Thanks, sincerely Hector
Synthetic Workout Gear Smells Worse Than Cotton Gear
 
 Land Softly And Carry Less Injury Risk

http://running.competitor.com/2014/07/injury-prevention/land-softly-and-carry-less-injury-risk_11174

 
 
Steppage gait ? Or just a runway model ?  Take the thinking farther.
Today we have a short blog post for you. You may take the topic simply on the surface or cogitate over it and find some deeper epiphanies from the well of knowledge we have tried to present here on our blog for the past 4+ years.  
It is clear that in this video that the model has a consciously driven steppage gait. Meaning, she is lifting her limb/foot via exaggerated hip flexion and knee flexion to clear the foot.  This is often seen unilaterally in a foot drop case where the client has a neurologic lesion that for one reason or another has impaired the client’s ability to extend the toes or dorsiflex the ankle sufficiently to clear the foot (so they do not drag toes and trip/fall).  
But, why is she doing this steppage gait ? It is highly unlikely that she has bilateral lesions.  Sure, she was asked to walk this way by her mentor but again, take it further.  Is there a factor making this gait necessary regardless of the coaching ? 
Obviously the answer is yes or we wouldn’t be doing a blog post on this topic.  She is wearing ridiculously high heels. This is forcing her into an extreme plantarflexed foot and ankle posture. IF she were to swing her leg normally during the swing phase she would drive the foot and ankle into dorsiflexion (a normal gait event) and the long pointed heel would be made more prominent as it was driven forward and downward. This would surely catch on the ground, immediately driving the foot into sudden violent forefoot loading and pitch her into a forward fall.  Yes, you have seen this on the run way videos on youtube, and yes we know you laughed too ! You see, when wearing heels this high, one must deploy a certain degree of steppage gait to clear the heel because ankle plantarflexion is fraught with the risk we just discussed above, the heel is too prominent and will catch. How much steppage (knee flexion and hip flexion to clear the foot) is necessary ? Well, to a large degree it depends on how much of a heel is present.  If you are wearing a small heeled shoe, lets say 1 inch, then a small steppage is necessary.
None the less, there is a bigger problem lurking and brewing underneath when heels are a regular occurrence. Slowly and gradually the disuse of the anterior compartment muscles (Extensor dig., Ext. hallucis, peroneus tertius, tibialis anterior) will weaken and the posterior compartment will shorten respectively. IF left too long, it will result in tightness (yes, there is a difference between tightness and shortness, one is a neurlogical protective mechanism, the other is a more permanent change.) We have said this many times here and in our videos, much of posterior compartment problems (ie achilles tendonitis, Sever’s, Hagglunds etc) are related to a degree of anterior compartment weakness, skill deficits or endurance challenges.  Wearing high heels often will often, but not always, increase this risk. 
If you are an athlete, but someone who wears high heels often, you may have to do extra work to keep your anterior compartment competent on several levels.  Eccentric strength is just as important as concentric in this region. Remember, many gait problems come on slowly, a slow simmering smoldering fire. And remember this last point about heeled shoes, your forefoot is always being loaded initially in ankle plantarflexion, this is not normal and in time this will have a cost in many people.  
One last thing. We are not necessarily talking about dress shoes, although they are a greater culprit.  Many running shoes still have accentuated rear foot stack heights where the heel will be many millimeters above the plane of the forefoot.  Do not discount these shoes as a possible contributor of your problem, remember, physiological adaptation takes time to express into a biomechanical symptom creating problem, and it may take quite some time to resolve your compensations and adaptations.
PS: drive that “cross over gait” lady.  Fools.
Shawn and Ivo
the gait guys
(Source: https://www.youtube.com/)

Podcast 75: Joint Symmetry, Clinical Pearls & Random Thoughts

Lots of good random topics on today’s podcast, including possible causes of leg length discrepancies.

*Show sponsor: www.newbalancechicago.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_true76f.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-75-joint-symmetry-cases-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:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:


Neurons in human skin perform advanced calculations
http://medicalxpress.com/news/2014-09-neurons-human-skin-advanced.html

RunScribe Is A Wearable For Granular Gait Analysis
Free dialogue on leg length discrepancies.

Evidence for joint moment asymmetry in healthy populations during gait.

Gait Posture. 2014 Jul 1. pii: S0966-6362(14)00610-9. doi: 10.1016/j.gaitpost.2014.06.010. [Epub ahead of print]
The contralateral foot in children with unilateral clubfoot, is the unaffected side normal?

http://www.gaitposture.com/article/S0966-6362(14)00523-2/abstract

Gait guys case on Club foot:

http://thegaitguys.tumblr.com/post/23230149195/we-could-have-easily-made-this-a-blog-post-about

Podcast 75: Joint Symmetry, Clinical Pearls & Random Thoughts

Lots of good random topics on today’s podcast, including possible causes of leg length discrepancies.

*Show sponsor: www.newbalancechicago.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_true76f.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-75-joint-symmetry-cases-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:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:


Neurons in human skin perform advanced calculations
http://medicalxpress.com/news/2014-09-neurons-human-skin-advanced.html

RunScribe Is A Wearable For Granular Gait Analysis
Free dialogue on leg length discrepancies.

Evidence for joint moment asymmetry in healthy populations during gait.

Gait Posture. 2014 Jul 1. pii: S0966-6362(14)00610-9. doi: 10.1016/j.gaitpost.2014.06.010. [Epub ahead of print]
The contralateral foot in children with unilateral clubfoot, is the unaffected side normal?

http://www.gaitposture.com/article/S0966-6362(14)00523-2/abstract

Gait guys case on Club foot:

http://thegaitguys.tumblr.com/post/23230149195/we-could-have-easily-made-this-a-blog-post-about

How injury and pain reorganize the brain.

Gait, Arm Swing and Reorganizing the Brain

When we injure a body part there is a price to pay, how expensive it will be is entirely up to you. Upon injury, the brain takes note and typically dives into a backup plan of neurologic inhibition, neuro-protective tightness and alteration of motor patterns to protect that injured area and allow it to heal. Moderating and altering the forces and demands upon said tissues is the goal to enable healing, if we as humans, don’t get in the way first (“I have to get that run in, I am behind in my training with all these injuries !” or “Ah, its still not that bad, the pain wasn’t worse on Tuesday’s run, I will be ok.”). The bigger question for most folks is, will you listen to what your body is asking of you? Heed the warnings and messages, and your injury will come and go in a timely manner, ignore the messages and welcome to a chronic festering problem.

These protective mechanisms need to be in place, we just have to listen to them.  Failure to heed their warnings to dial things back and rest, recover and heal, the brain will make alternative changes out of necessity.

In the medpage today article in the references below, the authors discuss several important things.

“Getting a cast or splint causes the brain to rapidly shift its resources to make righties function better as lefties, researchers found.
Right-handed individuals whose dominant arm had to be immobilized after an injury showed a drop in (brain) cortical thickness in the area that controls primary motor and sensory areas for the hand, Nicolas Langer, MSc, of the University of Zurich in Switzerland, and colleagues reported.
Over the same two-week period, white and gray matter increased in the areas that controlled the uninjured left hand, suggesting “skill transfer from the right to the left hand,” the group reported in the Jan. 17 issue of Neurology.
The findings highlight the plasticity of the brain in rapidly adapting to changing demands, but also hold implications for clinical practice, they noted.”

This article highlights the rapid changes in motor programs that occur. It does not take long for the body to begin to develop not only functional adaptations but neurologic changes at the brain level within days and certainly less than 2 weeks.

So how long have you been in this pain ? If someone has to ask you this question, the process has already begun.

We tell our patients, if pain does not go away fairly quickly, that we need to get on top of the injury quickly. That is not to say you need to reach for the phone every time you have pain but you need to heighten your awareness of the injury’s status and  you need to make sure you are not driving session after session of training into a festering injury. If you do not let something heal and recover, the brain will find a way around it.  And it will imprint that new motor pattern into hard wiring, and into the hard wiring of other patterns, if you do not heed the warning signs.  This new wiring is a compensation pattern. And the longer it is there the more the neurologic pattern becomes embedded by layerings of myelin coating.  Which means that in the future, if you fatigue or injury another local tissue, this old compensation pattern is waiting in the shadows looking for an opening to rear its ugly head for old times sake.

Furthermore, on the topic of asymmetry, the above concept holds strongly true. In our clinics, we recognize asymmetry as a strong clinical finding. Despite the  Lathrop-Lambach study below, mentioning that they feel a 10% baseline asymmetry is the norm, if you do not rehab and correct both an injury and its new neurologic hardwiring changes, you have enabled and welcomed asymmetry. We feel, as many others do, that asymmetry can be a major component and predictor to injury. Logically, restoring as much symmetry as possible, both biomechanically and neurologically, is restorative and protective.

Don’t be a stoic knucklehead. Get your stuff fixed by someone who knows what they are doing. And remember, watching your gait on a treadmill or through some high tech gait analysis software and making recommendations from that information is just plain idiotic. Go see someone smart who can correlated it to examination findings. 

This article pertains to athletes and non-athletes of all walks of life. From 5 to 105 years of age, we are all susceptible to the brain’s overriding mechanisms. 

Shawn and Ivo

references:

1. Broken arm can reorganize the brain.

http://www.medpagetoday.com/Neurology/GeneralNeurology/30686

Gait Posture. 2014 Jul 1. pii: S0966-6362(14)00610-9. doi: 10.1016/j.gaitpost.2014.06.010. [Epub ahead of print]
Evidence for joint moment asymmetry in  healthy populations during gait.
“We found a high amount of asymmetry between the limbs in healthy populations. More than half of our overall population exceeded 10% asymmetry in peak hip and knee flexion and adduction moments. Group medians exceeded 10% asymmetry for all variables in all populations. This may have important implications on gait evaluations, particularly clinical evaluations or research studies where asymmetry is used as an outcome. Additional research is necessary to determine acceptable levels of joint moment asymmetry during gait and to determine whether asymmetrical joint moments influence the development of symptomatic pathology or success of lower extremity rehabilitation.”

Podcast 74: Cross Fit: More on Squatting and Hip Torsions, Part 2

Lots of great hip, squatting and biomechanics in this weeks show !

*Show sponsor: www.newbalancechicago.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_75.f_74.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-74

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:

Diving deeper into crossfit’s squatting, lunges, leg press.

 Walking in sync makes enemies seem less scary

 
 

The Next Big Thing In Sports Data: Predicting (And Avoiding) Injuries

http://m.fastcompany.com/3034655/healthware/the-next-big-thing-in-sports-data-predicting-and-avoiding-injuries

“LER editor’s pick: Hip internal and external rotation are associated with shoulder mechanics in collegiate baseball pitchers. http://ow.ly/zULpO”

Michael August 27 at 7:49pm I’m curious to hear some thoughts on this, too. I listened to the podcast and read the blog post by the Gait Guys. I’ve coached CrossFit since 2009 and have owned my own affiliate for the last three years and follow Starrett closely. The cue “knees out” originated in powerlifting and the purpose is to keep people from ending up compensating with a valgus knee position during a squat, which is the most common compensation. Also, CrossFit did a special “Offline Episode” with Starrett, Kilgore, Russel Berger (he represented CrossFit) and two other coaches in which the sole topic was the “knees out” cue. It’s very illuminating for this topic. One interesting thing is that CrossFit does not tell people who go through the level 1 to tell others as a law, knees out. It’s merely a cue to fix a common compensation.

You can only “borrow” so much before you need to “pay it back”

How can feet relate to golf swing?

This 52 year old right handed gentleman presented with pain at the thoracolumbar junction after playing golf. He noticed he had a limited amount of “back swing” and pain at the end of his “follow through”.

Take a look a these pix and think about why.

Hopefully, in addition to he having hairy and scarred legs (he is a contractor by trade), you noted the following

  • Top left: note the normal internal rotation of the right hip; You need 4 degrees to walk normally and most folks have close to 40 degrees. He also has internal tibial torsion.
  • Top right: loss of external rotation of the right hip. Again, you need 4 degrees (from neutral) of external rotation of the hip to supinate and walk normally.
  • Top center:normal internal rotation of the left hip; internal tibial torsion
  • 3rd photo down: limited external rotation of the left hip, especially with respect ti the amount of internal rotation present; this is to a greater degree than the right
  • 4th and 5th photos down: note the amount of tibial varum and tibial torsion. Yes, with this much varum, he has a forefoot varus.

The brain is wired so that it will (generally) not allow you to walk with your toes pointing in (pigeon toed), so you rotate them out to somewhat of a normal progression angle (for more on progression angles, click here). If you have internal tibial torsion, this places the knees outside the saggital plane. (For more on tibial torsion, click here.) If you rotate your extremity outward, and already have a limited amount of range of motion available, you will take up some of that range of motion, making less available for normal physiological function. If the motion cannot occur at the knee or hip, it will usually occur at the next available joint cephalad, in this case the spine.

The lumbar spine has a limited amount of rotation available, ranging from 1.2-1.7 degrees per segment in a normal spine (1). This is generally less in degenerative conditions (2).

Place your feet on the ground with your feet pointing straight ahead. Now simulate a right handed golf swing, bending slightly at the waist and  rotating your body backward to the right. Now slowly swing and follow through from right to left. Note what happens to your hips: as you wind back to the right, the left hip is externally rotating and the right hip is internally rotating. As you follow through to the left, your right, your hip must externally rotate and your left hip must externally rotate. Can you see how his left hip is inhibiting his back swing and his right hip is limiting  his follow through? Can you see that because of his internal tibial torsion, he has already “used up” some of his external rotation range of motion?

If he does not have enough range of motion in the hip, where will it come from?

he will “borrow it” from a joint more north of the hip, in this case, his spine. More motion will occur at the thoracolumbar junction, since most likely (because of degenerative change) the most is available there; but you can only “borrow” so much before you need to “Pay it back”. In this case, he over rotated and injured the joint.

What did we do?

  • we treated the injured joint locally, with manipulation of the pathomechanical segments
  • we reduced inflammation and muscle spasm with acupuncture
  • we gave him some lumbar and throacolumbar stabilization exercises: founders exercise, extension holds, non tripod, cross crawl, pull ups
  • we gave him foot exercises to reduce his forefoot varus: tripod standing, EHB, lift-spread-reach
  • we had him externally rotate both feet (duck) when playing golf

The Gait Guys. Helping you to store up lots “in your bank” of foot and gait literacy, so you can help people when they need to “pay it back”, one case at a time.

(1) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2223353/

(2) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705911/