A look at the Lunge. Are you ready to take the lunge?

Another one of our favorite exercises. Unfortunately, all too often it is executed improperly. Watch carefully, as we cover many points in detail.

Remember the mantra; Skill, Endurance, Strength. In that order. Not every individual is ready for every exercise you may give them. Be sure to build an adequate foundation before proceeding ti the next level.

This excerpt is taken from our video series, available for download here.

The Gait Guys. Join the movement and spread the word. .

The unbalanced athlete, motor pattern, team, joint etc…… is not efficient.

Like him or not, believing he should have lost his last fight (or not), Georges St-Pierre was/is one of the best MMA fighters of all time. He was once quoted as saying, 

“In fighting, in evolution, in life, efficiency is the key,” says St-Pierre. 

 ”It’s not the most powerful animal that survives. It’s the most efficient.

This certainly describes most of Georges fights. There were always bigger, faster, meaner, stronger opponents. However, most of his fights went the distance. Eight of his last nine fights went to a five round decision. Now, there are those who will say that he didn’t have the finishing power or submission skills to close fights in the earlier rounds, and that is debatable for sure.  However, there is no doubt that anyone’s best fighting attributes will diminish as the rounds progress and fatigue sets in.  But, perhaps this is an equalizer when someone doesn’t have one single “golden right hand”, or what have you.  Efficiency can be the great equalizer.

St-Pierre isn’t your typical fighter. He’s arguably the best mixed martial artist in the world, a 5-foot 11-inch, 190-pound destroyer. Up until his most recent fight with Johnny Hendricks, he had not lost a round in more than 3 years, that is pure efficiency ! Arguably, he is faster than other fighters, he is more fit, has a greater range of skills, has better endurance …  in a Darwinian sense, perhaps more efficient ?

Here at the Gait Guys we are always considering efficiency.  As you can see from the slide above, there are many factors that can diminish efficiency.  We strive for as much symmetry as we can because with neuromuscular symmetry efficiency can be maximized.  Keep in mind however, that total symmetry is not always possible. Most people have two different feet, often one is more varus because it sat against the mothers rounded belly in utero.  And, one tibia is often more bowed or torsioned than the other for the same reason.  So, perfect symmetry is not always possible or guaranteed. But, one can do alot to gain as much physical symmetry as possible through detailed study of your client. (Remember, just because things look symmetrical does not mean that they function symmetrically ! This game is not that easy ! But, for some of the uneducated, it may seem to be !)  When physical symmetry is regained often the sensory-motor nervous system becomes functionally more symmetrical.  And, this is a flippable phenomenon, when neuro symmetry is driven often physical symmetry will be driven in time.  

Think about the afferent input to the cortex from the peripheral receptors in the skin (Paccinian corpuscles, Merkels discs, etc); the joint mechanorecpetors (types I-IV) and muscle receptors (spindles and Golgi tendon organs). Generally speaking, they travel up the dorsal columns on the back of the spinal cord to the thalamus and then the cortex; up the dorsal spinocerebelllar tract, to the cerebellar hemispheres; the spino- reticular tract to the reticular formation, or in the case of the upper cervical spine, directly into or flocculonodular lobe of the cerebellum. This information needs to be equal and opposite from each side of the extremity (flexors and extensors) as well as the right and left sides of the body. This “Balance” or “Homeostasis” or what the Chinese called Yin and Yang is key to efficiency.

In your workouts and rehab, strive for symmetry. We like to say “Tailor your exercises to the weaker side”. This helps to create more equality rather than a larger disparity.

The Gait Guys. Making it Real…Each Day….On the Blog…

How well do your boots fit your ride?

Whether you ski, ride, nordic or tele, having the right boot fit can make the difference between a good day and a great day. It can accelerate your learning curve, prevent injuries, keep you warm and make you more comfortable. Not all feet are made the same and neither are ski boots. Good fit requires time and patience (lots of both). Here are a few tips for better fit.  

What kind of a skier/rider are you?  Recreational, competitive, racing, extreme?  How you’ll use the boot will often determine the type of boot that is appropriate for you.  In my opinion, you should get a boot that is a little above your ability (unless you are not interested in improving your skiing and/or riding), so that you will improve and “grow into” the boot.  This will ensure that you’ll continue to improve in your snowriding abilities.  Boots are very high tech these days and a subtle change in stiffness or angles can make a drastic difference in your skiing/riding.

The first thing you need to do is look at your feet.  Are they feet to the same from side to side (ie. same size and shape)?  These are the platform for the rest of your body.  What happens down there will affect everything else. Take a good look at your feet while you are standing. Are there bunions, calluses, hammertoes (toes curled under), or a Morton’s toe (2nd toe longer than your big toe)?  Do you pronate excessively while standing or walking (this will look like your arches are collapsing)? What is the relationship of the forefoot (front of your foot) to the rear foot (is the ankle sideways when viewed from behind? It should be neutral without your heel turning in (inversion) or turning out (eversion). The forefoot (front of your foot) should be flat on the ground. Does your ankle bend back as far as it should (this is called dorsiflexion). This will have an effect on the forward lean of the boot. Are you bowlegged or knock-kneed? This will cause you to ride on the outside or inside edge of your ski/ snowboard.

If you pronate excessively, have increased or decreased flexibility in the forefoot, rearfoot or big toe, have bunions or hammertoes, or are excessively bowlegged or knock kneed, proper fit and comfort while skiing will probably require a full contact orthotic or footbed. Hard deformities, such as bunions, may require liner and or boot shell modification.

Good socks are next on the list.  Wool or wool blend socks are best. The intertwining fibers of wool create air pockets, which make it both insulating and breathable. Wool absorbs sweat in its vapor state, before it liquefies, keeping you dry. It utilizes your own body heat to evaporate the moisture. This also helps to eliminate odor. No cotton socks, as they hold moisture, often creating blisters and providing a breeding ground for bacteria that cause odor; no multiple pairs, as they make feet cold. Remember, thin is in… let the liner do its job.

Have your foot measured utilizing a Brannocks device in a standing position.  Remember that your arch will flatten as you put weight on it. Remembering that the foot elongates with weight on it, will be useful for the next step.

Next you need to have the right sized ski/snowboard boot shell. This is as important for hard boots as soft boots Take the liner out of the boot and put your foot inside the shell so that your toes are just touching the front of the shell.  There should be approximately ½ – ⅝ of an inch (two crossed fingers thickness) behind the ankle to the back of the shell.  More than ¾ of an inch will cause too much heel rise once the shells are “packed out”.  There should be ¼ – ⅜ of an inch space between the feet and the side shell of the ski boot.

Now comes the liner. The liner should fit snugly.  Very snugly.  There should be no pressure spots anywhere on your foot.  Put in your foot bed or custom orthotic if available, before sizing the shell.  Remember that you’ll gain between ⅛ and ¼ of an inch of space with break-in when the liners “pack out”.

Buckle the boots loosely and flex the boot forward.  This will help to “seat the heel”.  Remember that if the you cannot flex the boot at room temperature, you will not be able to when the plastic is very cold. Now that the heel is seated, buckle the boot more firmly.  They should not be on the last buckle.

Now simulate some ski/ride movements.   If the boot is relatively comfortable, proceed to the next step otherwise repeat with different shell/liner size.

The cant of the boot (cuff alignment) needs to be adjusted next. This needs to be done by someone other than yourself (because you are standing in the boot). A plumb line dropped from the knee should pass between your second and third toe.  This ensures an even transfer of weight from edge to edge. Most boots are built with about 4 degrees of varus (lateral cant).  If you are not able to adequately align the foot, consider orthotics or having the boot shimmed. Remember that boots with higher cuffs will have more of an effect on your stance.  

Most boots provide between 12-16 degrees of forward lean.  If there is less than 12 degrees, consider a heel lift to place your body weight forward.  Remember to consider how much ankle dorsiflexion you have.

Once these adjustments are made, simulate skiing/riding movements in the shop for at least an hour.  Remember that ski/snowboard boots are made for snowriding, not walking. Now remove the boots and socks and look for “hot spots” on the feet that will show up as red marks.  These may represent areas in the boot liner or shell that need to be stretched and/or fitted better.

Well. There you have it. Now you know lots more than you knew when you began this article. As you can see, it is a very time consuming and labor intensive ordeal. Often times, people need professional help with the whole process and often require a foot bed or full arch contact orthotic. Become familiar with your own feet and then become familiar with the people or shops that do good boot fitting (ask around) and consider enlisting their help on your journey to the perfect boot.

The Gait Guys. Making it real…here….on the blog…with every post…

What can we learn from a trip to the museum and ancient pachyderms?

Lessons from the Denver Museum of Science and the “Mammoths and Mastodons” exhibit.

Leave it to gait nerds to notice stuff like this. These are the things that keep us up at night.


Look carefully at the last 2 pictures, especially the femurs. Besides their grandious size, what do you see. Femoral anterversion! The angle of the femur head with the shaft of the femur is quite large. We remember from our discussion of anteversion previously (see here); that femoral anteversion allows a greater amount of internal rotation of the head of the femur in the acetabulum (ie the ball in the socket).

Now look at the top picture. Besides a cross over gait that Dr Allen was quick to point out. What do you see?  Ok…tremendous glutes : ). What else? Look at the second picture for a hint. You got it! Internal rotation of the legs.

Think about how pachyderms are put together compared to say, reptiles, specifically lizards. The legs are UNDER the body in the former and STICK OUT from the body in the latter. Watch them walk. The latter swing their tails and the former have the legs under their center of mass.

Extrapolate this to human gait (We know, it’s a stretch, but you have a great imagination). Some people have their weight under their body (ie, they have sufficient internal rotation of the hips to allow this; many of these folks have more anteverision than retroversion. also remember that we are speaking versions, NOT torsions here). Think about retroverted folks. Wider stance, wider gait, just like reptiles.

Ok, maybe this was a stretch, but it was cool, no?

The Gait Guys. Comparing pachyderms to humans….reallly.

all material copyright 2013 The Gait Guys/The Homunculus Group. All rights reserved.

So, What’s going on here?

Remember torsions and versions? If not, click here, here, here and here for a review. 

In the top left view, you are seeing the left foot in a neutral posture with the knee in the (relative) midline. Notice how the foot adducts? This person has INTERNAL TIBIAL TORSION. They also have hammer toes and a cavus (high) arch. 

In the top right, the foot is again in a neutral posture and the R foot is adducted EVEN FARTHER. Again, internal tibial torsion along with hammer toes and a cavus foot. For a hint, look at the tibial tuberosity; it should line up with an imaginary line drawn through the 2nd metatarsal. 

In the middle left picture I am fully internally rotating the R leg. Hmm, no internal rotation of the hip (note the knee goes little beyond midline). You need 4 degrees of internal rotation of the hip to walk normally and most folks have 40 degrees. This person has FEMORAL RETROTORSION.

In the middle right picture I am fully internally rotating the L leg. Hmm, no internal rotation of the hip here either; in fact, even less than the right. Again, FEMORAL RETROTORSION. 

In the bottom two pictures, the goniometer is aligned with the ASIS and tibial tuberosity. I am not sure if you can see it, but it is 18 degrees on the left and 20 on the right. Normally the Q angle is between 8 and 12 degrees. This person has developed compensatory GENU VALGUS.

Does it surprise you he has pain on the outside of his feet? How about knee pain?

So what does this mean?

  • he will have a decreased progression angle of the feet
  • he will externally rotate the feet to allow a more normal progression angle and “create” the internal rotation of the hip needed
  • this will place the knee out side the saggital plane and create a potential conflict at the knee
  • he will stress the ligaments at the medial knee secondary to his valgus deformity
  • he will increase the pressure on the lateral condles of the femur and lateral tibial plateau, leading to early degeneration

So what do you do?

  • normalize, to the best of his (and your) abilities, foot and lower extremity mechanics with manipulation, exercise, etc
  • ensure he has an adequate foot tripod with the tripod and EHB exercises
  • In his case, construct an orthotic, which will correct rearfoot pronation and yet not push the knee outside the saggital plane, by having a forefoot valgus post in place
  • educate him about proper footwear with an adequate toe box and not too much torsional rigidity (ie no motion control features)
  • follow him at regular intervals to make sure he doesn’t fall off the turnip truck
The Gait Guys. Making it real, every day, every post, every PODcast.
all material copyright 2013 The Gait Guys/ The Homunculus Group.

More on the Great Debate: Does decreased step height (resulting in less vertical oscillation) increase running economy

There continues to be a plethora of conflicting data out there on the web. Yes, shocking realization !

This study looks at 16 triathletes; 8 folks trained in the “pose method” of running for 12 weeks, versus the 8 folks who just kept running in their usual fashion (ie. the control group perhaps also known as the “beer and Doritos group”  : )  ). They measured changes in stride length (decreased in posers), vertical oscillation (decreased in posers) and oxygen cost (increased in posers).

According to the study’s conclusion

“The global change in running mechanics associated with 12 weeks of instruction in the pose method resulted in a decrease in stride length, a reduced vertical oscillation in comparison with the control group and a decrease of running economy in triathletes”

Why the changes? Perhaps it takes longer to train appropriately in this method and to become efficient at the method. Perhaps when you lose the “pendulum effect” we spoke about last Thursday on the blog, you become less efficient, or maybe there is another factor. MAYBE “pose running” just isn’t more efficient. Time and more studies will tell.

The Gait Guys. Telling it like it is and bringing you the meat….without the filler

all material copyright 2013 The Gait Guys/ The Homunculus Group. Please ask before lifting our stuff.

J Sports Sci. 2005 Jul;23(7):757-64.

Effect of a global alteration of running technique on kinematics and economy.

Source

Department of Exercise Science, Health Promotion and Recreation, Colorado State University – Pueblo, Pueblo, CO, USA. george.dallam@colostate-pueblo.edu

Abstract

In this study, we examined the consequences of a global alteration in running technique on running kinematics and running economy in triathletes. Sixteen sub-elite triathletes were pre and post tested for running economy and running kinematics at 215 and 250 m.min-1. The members of the treatment group (n=8) were exposed to 12 weeks of instruction in the “pose method” of running, while the members of the control group (n=8) maintained their usual running technique. After the treatment period, the experimental group demonstrated a significant decrease in mean stride length (from 137.25+/-7.63 cm to 129.19+/-7.43 cm; P<0.05), a post-treatment difference in vertical oscillation compared with the control group (6.92+/-1.00 vs. 8.44+/-1.00 cm; P<0.05) and a mean increase in submaximal absolute oxygen cost (from 3.28+/-0.36 l.min-1 to 3.53+/-0.43 l.min-1; P<0.01). The control group exhibited no significant changes in either running kinematics or oxygen cost. The global change in running mechanics associated with 12 weeks of instruction in the pose method resulted in a decrease in stride length, a reduced vertical oscillation in comparison with the control group and a decrease of running economy in triathletes.

PMID:16195026 [PubMed – indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/16195026

More on the Great Debate: Does decreased step height (resulting in less vertical oscillation) increase running economy

There continues to be a plethora of conflicting data out there on the web. Yes, shocking realization !

This study looks at 16 triathletes; 8 folks trained in the “pose method” of running for 12 weeks, versus the 8 folks who just kept running in their usual fashion (ie. the control group perhaps also known as the “beer and Doritos group”  : )  ). They measured changes in stride length (decreased in posers), vertical oscillation (decreased in posers) and oxygen cost (increased in posers).

According to the study’s conclusion

“The global change in running mechanics associated with 12 weeks of instruction in the pose method resulted in a decrease in stride length, a reduced vertical oscillation in comparison with the control group and a decrease of running economy in triathletes”

Why the changes? Perhaps it takes longer to train appropriately in this method and to become efficient at the method. Perhaps when you lose the “pendulum effect” we spoke about last Thursday on the blog, you become less efficient, or maybe there is another factor. MAYBE “pose running” just isn’t more efficient. Time and more studies will tell.

The Gait Guys. Telling it like it is and bringing you the meat….without the filler

all material copyright 2013 The Gait Guys/ The Homunculus Group. Please ask before lifting our stuff.

J Sports Sci. 2005 Jul;23(7):757-64.

Effect of a global alteration of running technique on kinematics and economy.

Source

Department of Exercise Science, Health Promotion and Recreation, Colorado State University – Pueblo, Pueblo, CO, USA. george.dallam@colostate-pueblo.edu

Abstract

In this study, we examined the consequences of a global alteration in running technique on running kinematics and running economy in triathletes. Sixteen sub-elite triathletes were pre and post tested for running economy and running kinematics at 215 and 250 m.min-1. The members of the treatment group (n=8) were exposed to 12 weeks of instruction in the “pose method” of running, while the members of the control group (n=8) maintained their usual running technique. After the treatment period, the experimental group demonstrated a significant decrease in mean stride length (from 137.25+/-7.63 cm to 129.19+/-7.43 cm; P<0.05), a post-treatment difference in vertical oscillation compared with the control group (6.92+/-1.00 vs. 8.44+/-1.00 cm; P<0.05) and a mean increase in submaximal absolute oxygen cost (from 3.28+/-0.36 l.min-1 to 3.53+/-0.43 l.min-1; P<0.01). The control group exhibited no significant changes in either running kinematics or oxygen cost. The global change in running mechanics associated with 12 weeks of instruction in the pose method resulted in a decrease in stride length, a reduced vertical oscillation in comparison with the control group and a decrease of running economy in triathletes.

PMID:16195026 [PubMed – indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/16195026

Yes, we are all twisted. Part 3 continued.

If you missed yesterdays post, this one will make more sense if you go back and read it.Today we talk about compensations for tibial torsions.

As discussed in previous posts, there are at least 3 reasons we need to understand  tibial torsions and versions:

1. They will often alter the progression angle of gait.  In internal tibial torsion, there will often be a decreased progression angle of the foot and with external, an increased angle of progression. A decreased progression angle is often associated with a decreased step width whereas an increased angle is often associated with an increased step width.

2. They affect available ranges of motion (ROM) of the limb. We remember that the lower leg needs to internally rotate the requisite 4-6 degrees from initial contact to midstance:

ROM changes that may occur with internal tibial torsion

  • If it is already fully internally rotated (as it may be with internal tibial torsion), that range of motion must be created or compensated for elsewhere.
  • This can result in external rotation of the affected lower limb to create the range of motion neede
  • Circumduction of the lower limb, because the foot is already in a supinated posture, and the decreased range of motion of the foot needs to be compensated for.
  • A shortened step length, due to increased compressive forces at the medial knee
  • And alteration of vertical and medial lateral ground reactive forces
  • A rolling off the lateral aspect of the foot, due to it being in a more supinated posture

ROM changes that may occur with external tibial torsion          

  • external tibial torsion often results in the increased midfoot pronation, through the deformity, because more range of motion is possible both at the hip and foot at the subtalar joint

3. They often can effect the coronal plane orientation of the lower limb.

In internal tibial torsion, due to the foot being more rigid and the deformity often being accompanied by increased tibial varum, the knee often falls outside the plane of the foot (rather than being “stacked”), resulting in a decreased step width and often a cross over gait pattern (click here for more info on crossover)

In external tibial torsion, the foot is often more pliable. This often results in an increased step width and well as the knee falling inside (or medially) to the plane of the foot. Because of the increased hip and foot ranges of motion available,  the foot is not an adequate lever, shortening step length and sometimes requiring increased pelvic motion to “get around” the stance phase leg.

Whew! This stuff can be tough, Thanks for hanging in there! Next stop: Femoral Torsions and Versions!

Ivo and Shawn; your torsioned friends : )

 

All material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved.  Ask before you lift our stuff, Lee is watching……

Yes, we are all twisted; Part 3

 

In the last 2 posts we discussed the differences between torsions and versions, as well as talar version and torsion, 1 of the 3 major versional events that occur during normal development (missed out? Click here and here to re read them).

In this post we discuss tibial versions and torsions.

The tibia and femur are more prone to torsional defects, as they are longer lamellar (layered) bones as opposed to the cancellous bone that makes up the talus. These often present as an “in toeing” or “out toeing” of the foot with respect to the leg; changing the progression angle of gait (click here for more on progression angles).

Tibial versions and torsions can be measured by the “thigh foot angle” (the angulation of the foot to the thigh with the leg bent 90 degrees: above right) or the “transmalleolar angle” (the angle that a line drawn between the medial and lateral malleoli of the ankle makes with the tibial plateau: above left). 

At a gestational age of 5 months, the fetus has approximately 20° of internal tibial torsion. As the fetus matures, The tibia then rotates externally, and most newborns have an average of 0- 4° of internal tibial torsion. At birth, there should be little to no torsion of the tibia; the proximal and distal portions of the bone have little angular difference (see above: top). Postnatally, the tibia should twist outward (externally) a total of 15 degrees until adult values are reached between ages 8 and 10 years of 23° of external tibial torsion (range, 0° to 40°). 

Sometimes the rotation at birth is excessive. This is called a torsion. Five in 10,000 children born will have rotational deformities of the legs. The most common cause is position and pressure (on the lower legs) in the uterus (an unstretched uterus in a first pregnancy causes greater pressuremaking the first-born child more prone to rotational deformities. Growth of the  unborn child accelerates during the last 10 weeks and the compression from the uterus thus increases. As you would guess, premature infants have less rotational deformities than full-term infants. This is probably due to decreased pressure in the uterus. Twins take up more space in the uterus and are more likely to have rotational deformities. 

Of interesting note, there is a 2:1 preponderance of left sided deformities believed to be due to most babies being carried on their backs on the left side of the mother in utero, causing the left leg to overlie the right in an externally rotated and abducted position.

Normal ranges of versions and torsions are highly variable (see chart above: right). Ranges less than the values are considered internal tibial torsion and greater external tibial torsion.

Internal tibial torsion (ITT) usually corrects 1 to 2 years after physiological bowing of the tibia (ie tibial varum) resolves. External tibial torsion (TT) is less common in infancy than ITT but is more likely to persist in later childhood and NOT resolve with growth because the natural progression of development is toward increasing external torsion.

Males and females seem to be affected equally, with about two thirds of patients are affected bilaterally and the differences in normal tibial version values are often expected to be cultural, lifestyle and posture related.

 The ability to compensate for a tibial torsion depends on the amount of inversion and eversion present in the foot and on the amount of rotation possible at the hip. Internal torsion causes the foot to adduct, and the patient tries to compensate by everting the foot and/or by externally rotating at the hip. Similarly, persons with external tibial torsion invert at the foot and internally rotate at the hip. Both can decrease walking agility and speed if severe. With an external tibial torsion deformity of 30 degrees , the capacities of soleus, posterior gluteus medius, and gluteus maximus to extend both the hip and knee were all reduced by over 10%.

Well, that was probably more than you wanted to know about tibial torsions, and we could go on for many more pages and perhaps cure any insomnia you may have. Take a while to digest this, as it is important to gait, shoe selection, and rehabilitation. Torsions are an acquired taste and we hope we have whetted your appetite! Tomorrow we talk about compensations!

 

Ivo and Shawn; two twisted guys!

 

 

 

 

All material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved.  Ask before you lift our stuff, Lee is watching……

Yes, we are all twisted: Part 1

Developmentally speaking, that is.  Version and Torsion are the words we need to know. There are 3 normal versional changes that take place in the lower extremity development from infant to adult: rotation of the talar head/neck, tibial rotation, and femoral rotation  (see above). 

So, what is the difference between a torsion and version?

A version is a normal variation in the “twistedness” of a limb (longitudinally speaking) between its proximal and distal portions, representing a normal range of development (see femur above) .  An example is the head and neck of the femur has an angle of 8-12 degrees with respect the femoral condyles.

A torsion is the same condition with the amount of twist 1 to 2 standard deviations greater. An example is when the angle of the femoral neck and greater than 15 degrees, the condition of femoral ante torsion exists (see photo above).

There are at least 3 reasons you need to understand about developmental torsions and versions that occur with growth:

  1. Since they occur in the transverse (horizontal) plane, they affect the progression angle of the foot and thus gait
  2. They affect available ranges of motion of a limb (ex the femur needs to internally rotate 4-6 degrees for normal gait) and can cause pain and/or gait alterations
  3. They can affect the coronal (frontal) plane orientation of the lower limb, which can affect gait and shoe choices. A Rothbart foot type with an elevated 1st metatarsal head will often result in a varus (or inverted) position of the forefoot with respect to the rear foot.

In this series, we will explore these 3 major versional changes, one at a time.

The Gait Guys. Bald? Yes! Good looking? You bet! Yes, we are a little more twisted than most folks : )

All material copyright 2013 The Gait Guys/ The Homunculus Group. All rights reserved.  Please ask before recycling our stuff!