Part 2: How relaxed, or shall we say “sloppy” is your gait ? The Cross over gait /Frontal plane drift gait.
In this photo (*credit below) the blurred right swing leg tells you this client has been photographed during gait/running motion. Can you see it ? Have we educating you well ?
Human gait is cyclical. A problem on one side will corrupt the other and the cycle begins, and usually continues until the cycle is broken.
We wish to remind you of our time hammered principle that when the foot is on the ground the glutes are heavily in charge, and when the foot is in the air, the abdominals are heavily in charge. For us to move cleanly and efficiently one would assume that the best way to do that would be to ensure that the lower 2 limbs are capable of doing the exact same things, with the same timing, same skill, same endurance and same strength. This goes for the upper 2 limbs as well, and then of course the synchronizing of the four in a cohesive antiphasic effort. This would be perfect and clean gait, a gait that would unlikely ever suffer pain or problems. Symmetrical durability wins every time.
This photo demonstrates the cross over gait and we are beating it to a pulp here, again. In this running gait photo, this momentary snapshot of global movement, it shows this client is engaging movement into the left frontal plane excessively, they have drifted to the left far outside the vertical plumb line from the foot. The question is, it is excessively enough to present as painful pathology or is it a painless problem at this time? We call what you see here a frontal plane drift, but more so, the cross over gait. You can even see suggestion of the left frontal drift as evidenced by the concavity of the lumbar spine curve to the left. It should be clear that the right pendulum leg will scrape the left calf on its way through its oblique pendulum swing (instead of a pure forward sagittal swing) to a foot strike somewhere near to the line they are closely running on (a theoretical line). This is the cross over gait. After this left frontal plane drift and right cross over, there will likely be a corresponding right frontal plane drift and left cross over to compensate on the very next step. Thus, the cycle begins, each on feeding and compensating off the other. To prevent it, it means you have to have an extra bit more of lateral line strength in the gluteus medius and lateral abdominal sling to fend off pathology. You have to have the stability from S.E.S (skill, endurance, strength) to stack the hip, knee and foot over top of each other. You have to have enough ankle stability and a host of other clean and strong and skilled layers to fend it off to be precise. One must be able to find functional stability in the stacked posture, and this can take some training and time. Make no mistake, this is a faulty movement pattern, even if there is not pain (yet), this is not efficient motor patterning and something will have to give. Whether that is lateral foot pain from more supination strategizing, more tone in the ITB perhaps causing lateral knee or hip pain, posterior ischeofemoral impingment syndrome, a compensation in arms swing or thoracic spine rotation or head tilt etc … . something has to give, something has to compensate.
To complicate the cyclical scenario, the time usually used to move sagittally will be partially used to move into, and back out of, the frontal plane. This will necessitate some abbreviations in the left stance phase timely mechanical events. Some biomechanical events will have to be abbreviated or sped through and then the right limb will have to adapt to those changes. These are simple gait problems we have talked about over and over again here on the gait guys blog. (Search “arm swing” on our blog and you will find 50+ articles around this topic.) These compensation patterns will include expressed weaknesses in various parts of the human frame as part of the pattern
Are you able to find the problem in the never ending loop of compensations of your clients and find a way to unwrinkle their system one logical piece at a time, or will you just chose to strengthen the wrinkled system and hope that the new strength on top of the compensations is adequate for you or your client ? One should not be forever sentenced to daily or weekly rehabilitative sessions or homework to negate and alleviate symptoms, this is a far more durable machine than that. Fix the problem. Merely addressing things locally can be a crime. If you are seeing an arm swing change, you would be foolish not to look at the opposite lower limb and foot at the very least, and of course assess spinal rotation, lateral flexion and hinging as well as core mobility and stability.
For you neuro nerds, remember what Dr. Ivo says, that the receptors from the central spine and core fire into the midline vermis of the cerebellum (one of the oldest parts of our brain, called the paleo cerebellum); and these pathways, along with other cerebellar efferents, fire our axial extensor muscles that keep us upright in the gravitational plane and provide balance or homeostasis through stability. It is why they assessed and addressed.
Or, if this is too much thinking for you, … you can just train harder and get stronger . . . in all your compensation patterns, after all, it is easier than figuring out why and how a right ankle for example started the whole mess, if in fact that is even the first piece of the puzzle. No one said this would be easy.
So, how sloppy is your gait ?
Dr. Shawn Allen, one of the gait guys
References and Credits
Note: photo linked to this article. Photo credit/property: REUTERS/Eduardo Munoz (Copyright Reuters 2016).
Article: Workouts focused on motor skills may help ease lower back pain
Just the other day we saw this article in Popular Science written by Sally Zhang. Sally obviously does not read our blog, but she got a lot of stuff right.
“If you’re born without a pinky toe or have an accident and it’s removed, you can completely do everything you wanted to do,” Dr. Anne Holly Johnson, instructor in orthopaedic surgery at Harvard Medical School, says.
Above you will see a photo of one of the gait guy’s feet. It is quite clear from the photo that competent use of the pinky toe is not necessary for adequate, and possibly exceptionally skilled, foot function. Here, check out this video of our foot in these 2 videos (here and here) for some advanced foot function (sans pinky toe). As you can see in the photo above, this 5th toe has likely never felt the ground, this is a fixed deformity. Flexor and extensor function of the toe are intact, but it does not reach the ground and so assistance in gaining adequate purchase of the 5th metatarsal on the ground is absent.
This brings us to a deeper question, what about the 5th metatarsal then? Is it necessary ? Our answer even without deeper research is a solid “yes”. The foot tripod is severely compromised without the 5th metatarsal. The lateral stability of the foot is impaired without the 5th MET. The natural locking of the calcaneocuboid joint mechanism will be impaired, the peroneal muscles that provide such critical lateral ankle and foot stability will have fascial planes and tendon attachments disengaged, the natural walking gait lateral to medial foot progression would be impaired, propulsion would be impaired and the list goes on and on. And, not even on the local foot/ankle level. Because, if you take out the function and stability of the lateral foot the hip is very likely to suffer lateral (frontal plane) stability deficits. Meaning, the gluteus medius and abdominal obliques will have more difficulty guarding frontal plane drift when in stance phase rendering all of the “cross over gait” risks (link) highly probable.
So, not much exciting stuff here today. The presence of a functioning pinky toe does not appear to be critical but don’t take away its big brother neighbor, the 5th Metatarsal or trouble is just around the corner. Don’t believe us? Just ask anyone with a non-union fracture (Jones fracture) of the 5th metatarsal.
The answer goes back to the evolutionary history of humans, explains Dr. Anish Kadakia, assistant professor in orthopaedic surgery at Northwestern University. ”Primates use their feet to grab, claw, to climb trees, but humans, we don’t need that function anymore,” Kadakia says. “Clearly we’re not jumping up and down trees and using our feet to grab. We have toes embryologically, evolutionary for that particular reason because we descended from apes, but we don’t need them as people.”
The gait guys, working with 4 toes on each foot, one step ahead of evolution it seems.
Shawn and Ivo,
The gait guys