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

Loss of medial tripod

It is Rewind Friday.
Today, we are reaching back to a brief 2009 lecture I did for the local NSCA chapter on the patterns of kinetic chain compensation that match with loss of medial and lateral foot tripod. (video starts at 49 seconds, for some reason)
https://www.youtube.com/watch?v=yeCBGZkNaeM

Loss of medial tripod

Leg length discrepancies and total joint replacments.

5mm cut off ?  MaybeYou are likely to come across hip and knee arthroplasty clients (total joint replacements). When they take a joint out and replace it with a new one, it can be a true challenge to restore leg lengths to equality side to side. Problems often arise down the road once gait is resumed and rehabilitation is completed. It can take time for the leg length discrepancy (LLD) to begin to create compensatory problems. This article seems to suggest that 5mm is the tipping point where gait changes becoming a problem are founded. Other sources will render different numbers, this article found 5mm. The authors found that both over- and underrestoration of leg length/offset showed similar effects on gait and that Gait analysis was able to assess restoration of biomechanics after hip replacement.  I would chose to use the word “change” over restore, since the gait analysis is merely showing the deployed strategies and compensations, never the problem.  But it is a tool, and gait analysis can be a decent tool to show “change”.*Remember, it is not always a product of true length, it can come from the pelvis posturing and/or from the acetabular orrientation, which can be a postoperative sequella. One cannot over look  acetabular inclination, anteversion and femoral component anteversion/retroversion issues.Just remember, before you start making LLD changes with inserts, cork, orthotics etc be sure that you have restored as best as possible, pelvis-hip-spine mechanics because changes here can reflect as a mere leg length discrepancy. And it goes the other way as well, a LLD can cause those changes above.

* Just use your brain and don’t just lift the heel, give them a full sole lift. Heel lifts for this problem are newbie mistakes. Don’t be a newbie.

– Dr. Shawn Allen

Leg length and offset differences above 5 mm after total hip arthroplasty are associated with altered gait kinematicsTobias Renkawitz, Tim Weber, Silvia Dullien, Michael Woerner, Sebastian Dendorfer, Joachim Grifka,Markus Weber
http://www.gaitposture.com/article/S0966-6362(16)30148-5/abstract?platform=hootsuite

More on landing mechanics.
Here is a recent article on landing mechanics. This article talks about the landing mechanics far past where I feel the first stage of vulnerability is, which is initial forefoot load, as i discuss in the video pertaining to landing from a jump or if sprinting (forefoot loading). IF landing occurs in low gear (lateral half of the forefoot), inversion risks are higher.
The medial foot tripod, high gear toe off (1st and 2nd mets) is where we should be taking off from, and landing initially upon. Anything lateral is vulnerable without the lateral column strength (lateral gastrocsoleus complex, peronei longus/brevis).
This article talks about knee flexion angles and ACL vulnerability, far after this initial loading response. The article some valid conclusions in that phase.

– Dr. Shawn Allen

Posture specific strength and landing mechanics.

http://lermagazine.com/article/posture-specific-strength-and-landing-mechanics

https://www.youtube.com/watch?v=8T9UzOaYxmo

New research on Non-motorized treadmills.

Facts:

•Non-motorised treadmill locomotion creates large reductions in tibial acceleration.
•Non-motorised treadmill locomotion increases lower limb muscular activation.
•Non-motorised treadmill locomotion decreases cycle time/increases step frequency.

Keep these things in mind when you are doing a treadmill gait analysis. We have discussed over and over again of the severe and misleading information gleaned from gait analysis, that it shows strategies around problems, often not the problem at hand. But, this is yet one more factor to keep in mind when you are doing such studies, that changing the surface and how and why any given work is being performed on a given surface/device, that the information can be tainted if you do not know exactly what you are dealing with.   

Few studies are perfect, look at all of the parameters they likely should, and understand the complexity of the model they examine in their entirety. None the less, there is information to glean from most studies that help to debate, refute or clarify working concepts presently proven or unproven. This study provides some conclusions as well, that should be take in, digested and then determined where, when and if appropriate for a client.

Tibial impacts and muscle activation during walking, jogging and running when performed overground, and on motorised and non-motorised treadmills

Montgomery, Dobson, Smith & Ditroilo

http://www.gaitposture.com/article/S0966-6362(16)30116-3/abstract?platform=hootsuite

A clear cut case of Form follows Function.  Leave a deforming force long enough and the body will accommodate. 

When the lateral quadratus plantae (QP) is weak and the flexor digitorum longus pulls unopposed (relying on the QP to properly orient the long flexor pull) for too long the 4th and 5th toes and drift medially and spin inwards toward the midline of the foot (as seen in the photo). Then, as the 4th toe presses down on the fleshy pad of the 5th toe, over time the fleshy pad is pancaked and triangulated. Then, with repeated pressure a corn like hardness becomes of the tip of that triangluted tissue, it resembles a hard callus. A corn is a coalescing of the skin cells into a tighter formation, a reaction to fend off repeated pressure and friction.  Form follows prolonged function.  Shave these things down and they will come back, unless you get to the root source of the problem, which could be all the way up the chain. 

-Dr. Allen

A marathon a day, for over 120 days…..on one leg, battling cancer.

So you think you are tough ? This guy was tough. A marathon a day for over 120 days…..on one leg, battling cancer. 

Rest in Peace Terry. You are not forgotten. You made a mark on my life, thank you for that. Watching you skip on the good leg, giving your prosthetic enough time to swing through mesmerized me, the biomechanics of it all. If i look back, this was the first time I payed attention with great detail to someone’s gait. I was in awe, you moved me, your mission moved me, your heart and spirit moved me. Your life made a difference in mine, so I may help others.Dr. Allen
Today, June 28th, every year here on The Gait Guys, I remember Terry Fox. Every year I post a reminder of perhaps one of the toughest dudes who ever lived. Today , this day, 1981 Terry Fox died. I grew up in Canada. I was barely a teenager when Terry began his plight, The Marathon of Hope. 

His mission, 26 miles a day, every day, until he had crossed the expanse of Canada to raise awareness for cancer. He made it an amazing 120+ days in a row, 3339 miles, one one leg, before his cancer returned. The whole country stood cheering watching him do something no mortal man would attempt, let along with one leg, and cancer. Today we pay a tribute to this true rockstar.
Let this video move you, just in case you think you are having a rough day.

https://www.youtube.com/watch?v=xjgTlCTluPA