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Video case: The King’s Preference: Short and Sweet. A quick and easy case demonstrating the patellar tracking struggles with external tibial torsion.

Our favorite functional evaluation piece of equipment as well as our favorite piece of therapy equipment is the Total Gym.  Here we clearly demonstrate, to us and the client, in partial weight bearing load, the effects of external tibial torsion.  

Remember, the knee is sort of the King of all joints when it comes to the lower extremity.  The knee is a sagittal plane hinge, and so all it wants to do is hinge forward, freely without binding from deficits at the hip or knee. But we cannot ignore the simple fact that pre-pubescent kids the long bone derotation process is still undergoing, and in adults the process may have been corrupted or insufficient.  

In this case it should be obvious that the knee is sagittal and free to hinge when the foot is at a large foot progression angle.  This allows the knee to hinge cleanly. But when the foot is corrected to the sagittal plane, as you see in the second half of the video, the knee tracks inward and this can cause patellofemoral pain syndromes, swelling, challenges to the menisci (and possible eventual tears) and challenges to the ACL and other accessory restraints.  Additionally, this medial drift is a longer and more difficult challenge to the eccentric phase external rotators such as the gluteus maximius not to mention many of the other muscles and their optimal function.  

So, the next time you see a large foot progression angle in a client or in their walk (duck footed if you will) try to resist the natural urge to tell them to corrrect the foot angle. They are likely doing it to keep the King happy.  And furthermore, be careful on your coaching recommendations during squats, olympic lifts, lunges and running.  Just because you do not like the way the foot looks doesn’t mean you should antagonize the King of joints.  

External tibial torsion, its not something you want to see, but when you do see it, you have to know its degree, its effects at the knee, hip and foot as well as how it might impact hip extension, pelvic neutrality, foot strike, foot type, toe off and so many other aspects.

Whoever said gait analysis was easy was a liar. And if all they use is a video camera and fancy analysis software they have show up with only part of the team. And if they said they were an expert  in gait only a few years into practice, you had better also look for a jester’s hat somewhere hiding in the corner. After all, the King would want to know !

Shawn and Ivo, your court jesters for the last 3+ years.  Maybe we will get a promotion from the King someday soon !

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Gait Video Analysis: Olympian Carl Lewis.

Carl Lewis: arguably one of the great runners of the 20th century, especially in form.

Today we are going to use this video to look at a few specific components.

First, lets compare his front on technique to Lauren’s from yesterday.  Notice the total lack of limb cross over? Lauren showed almost a “running on a line” where as Carl is running on two lines. This requires more gluteal strength, and if you can get to a position to train it you can make it stronger.  You will also notice that with Carl’s reduced cross over the tibia are vertical and the degree of foot pronation is minimized thus affording less time in the dampening pronation contact phase in comparison to Lauren. 

Now lets talk about the gluteus maximus for a minute.  The function of the G.Maximus is multifactorial. The G.Max is mostly silent at low activity levels such as level and uphill walking, but it increases substantially in activity and alters its timing with respect to speed during running.

The G.Max controls trunk flexion on the stance-side and it contracts in the late swing phase (when the leg is finishing it’s swing in front of our body) through early stance phase to decelerate hip flexion and initiate hip extension. There is lessening gluteal contraction at toe off but the medial bundle (more sacral divisions) offer a brief burst of force. So, if you look at its activity levels and the timing of them, you will get the distinct sense that the gluteus maximus function is to pull the leg through hip extension. The key word here is PULL.  Remember, the foot is fixed to the ground in the stance phase. So as the glute fires in the early half of stance phase, when the hip is still in relative flexion, it pulls us through the stance phase thus driving us forward. Mind you, the core must be strong enough to hold the pelvis static so that the extension can occur through the hip and not travel upwards to create lumbar extension. You can get a great sense of this in Carl Lewis’ video above.  Many people see the G.Max as a push off muscle but this is not true. It is more of a pull muscle, pulling us forward on the ground as opposed to pushing us forward .

Want to do some precision work to focus on the feeling of the glutes “pulling you through”, then try some hip-glute extension pull throughs (click) with a cable crossover on the bottom setting or heavy kettlebell or sandbag swings (click). Best of all to get the feel of what the glute max does …… grab a skateboard and plant one foot on the board and begin pulling yourself through the stance phase with the leg…..after all that is what you are doing, pulling yourself through.  Of course form is everything, so be careful and focus on slow movements that are clean and precise. Just do one thing when you do either of these.  Feel the foot contact and imagine the hips and glutes driving forward on a stiff protected core while you feel the posterior drive through the foot.  This is likely the feeling Carl would be aware of in his feet at the 10-15 second mark in the video. 

Some readers will jump at the opportunity to say “hey, Carl is a sprinter, Lauren is a distance runner…… you cannot compare apples and oranges !”  Our response here is , yes that is correct.  But they are not that different, look at the kick in the end of close a distance race…..are they really that much different ?”  But what we really need to say here on that question is, “That was not the point of this exercise. We are looking at flaws here.”  If we asked Lauren to sprint, we would see the same pattern as in her video here.

Shawn and Ivo………. just a couple of nerds always wondering why everyone else is in the box and we are standing outside of it.  It’s not fair.

(Source: http://www.youtube.com/)