Exploring the Links Between Human Movement, Biomechanics & Gait
Why does this gal have so much limited external rotation of her legs?
We have discussed torsions and versions here on the blog many times before. We rarely see femoral antetorsion. She came in to see us with the pain following a total hip replacement on the right.
Note that she has fairly good internal rotation of the hips bilaterally but limited external rotation. This is usually not the case, as most folks lose internal rotation. We need 4 to 6° internal and external rotation to walk normally. This poor gal has very little external rotation available to her.
Have you figured out what’s going on with hips yet? She has a condition called femoral ante torsion. This means that the angle of the femoral neck is in excess of 12°. This will allow her to have a lot of internal rotation but very little external rotation. She will need to either “create” or “borrow” her requisite external rotation from somewhere. In this case she decreases her progression of gait (intoed), and borrows the remainder from her lumbar spine.
So what do we do? We attempt to create more external rotation. We are accomplishing this with exercises that emphasize external rotation, acupuncture/needling of the hip capsule and musculature which would promote external rotation (posterior fibers of gluteus medius, gluteus maximus, vastus medialis, biceps femoris). A few degrees can go a very long way as they have in this patient.
confused? Did you miss our awesome post on femoral torsions: click here to learn more.
an EXCELLENT review with some great rehab tips at the conclusion like this
“Once isolated contraction of the deep external rotator muscles is successfully achieved, progression can be made to the rehabilitation of secondary stabilisers and prime movers of the hip, particularly the gluteus maximus, initially using nonweight bearing exercises and progressing to weight bearing exercises once motor control and strength allows. Pre-activation of the deep external rotators may make these exercises more effective. Deficits in flexibility and proprioception should also be addressed at this stage. Once adequate hip muscle strength and endurance is achieved, functional and sports specific exercises can then be implemented. ”
Can local muscles augment stability in the hip?: A narrative literature review T.H. Retchford, K.M. Crossley, A. Grimaldi , J.L. Kemp, S.M. Cowan J Musculoskelet Neuronal Interact 2013; 13(1):1-12
Welcome to Monday, folks. Today Dr Ivo discusses why not all shoes are created equal and why you need to understand and educate your peeps about shoes!
Internal tibial torsion is when the foot is rotated internally with respect to the tibia. When the foot is straight (like when you are walking, because the brain will not let you walk too internally rotated because you will trip and fall), the knee will rotated OUTSIDE the saggital plane (knee points out). Putting a medially posted shoe on that foot rotates the foot EVEN FURTHER laterally. Since the knee is a hinge joint, this can spell disaster for the meniscus.
need to know more? email us or send us a message about our National Shoe Fit Program.
Got Motion Control? Sometimes too much of a good thing is a bad thing!
Welcome to Monday and News You can Use, Folks.
Today we look at short video showing what someone with internal tibial torsion looks like in a medially posted (ie motion control) running shoe. Note how the amount of internal rotation of the lower leg decreases when the shoe is removed and when he runs. Be careful what shoes you recommend, as a shoe like this is likely to cause damage down the road.
You can follow along listening to Dr Ivo’s commentary. This was filmed at a recent seminar he was teaching.
Too much pressure for the holidays? Take a look at that midsole of yours…
In the vein of last weeks post on plantar pressures, we find that midsoles DO DECREASE plantar pressures, especially across the midfoot (30% less pressure in this study), again dependent on foot type (In this study, low vs high arched individuals). They also INCREASE plantar contact area. Contact area can be useful for helping to influence biomechanics of different foot types (often more contact area = more force attenuation)
We also saw that they increase pressures LATERALLY (see our post here).
Bottom line? You need to look at foot type and remember that “shoes are medicine”. Watch what you are prescribing and think about what you are trying to accomplish. There is no substitute for good biomechanics.
We are The Gait Guys. Bringing you the best of gait, each week.
Research addressing the effect of running shoe type on the low- or high-arched foot during gait is limited. We sought 1) to analyze mean plantar pressure and mean contact area differences between low- and high-arched feet across three test conditions, 2) to determine which regions of the foot (rearfoot, midfoot, and forefoot) contributed to potential differences in mean plantar pressure and mean contact area, and 3) to determine the association between the static arch height index and the dynamic modified arch index.
Plantar pressure distributions for 75 participants (40 low arched and 35 high arched) were analyzed across three conditions (nonshod, motion control running shoes, and cushioning running shoes) during treadmill walking.
In the motion control and cushioning shoe conditions, mean plantar contact area increased in the midfoot (28% for low arched and 68% for high arched), whereas mean plantar pressure decreased by approximately 30% relative to the nonshod condition. There was moderate to good negative correlation between the arch height index and the modified arch index.
Cushioning and motion control running shoes tend to increase midfoot mean plantar contact area while decreasing mean plantar pressure across the low- or high-arched foot.
all material copyright 2012 The Gait Guys/ The Homunculus Group. Please ask before using our stuff or Santa will bring you athletes foot this holiday season.
Since the world did not end, you should probably think twice about those motion control shoes….
WE can all agree that there is a time and a place for motion control shoes. For people with chronic ankle sprains or lateral instability (ie, an incompetent lateral compartment; peroneus longus, brevis or tertius), it is neither the time, nor the place.
The lateral ankle is stabilized by both static (ligaments: above lower left) and dynamic (muscles above, lower right) elements. This is often called “the lateral stabilizing complex” The lateral ankle (ie the lateral malleolus) also projects more inferiorly than the medial. This means that when push comes to shove, the ankle is more likely to invert (or go medially) than evert (or go laterally). What protects it? The static component consist of three main ligaments (seen above) the posterior and anterior talofibular ligaments and the calcaneofibular ligaments. The dynamic components are the peroneii muscles. These muscles not only stabilize but also exert an eversion (brings the bottom of the foot to the outside) force on the ankle.
So what you say?
according to one study we found “Using an in-shoe plantar pressure system, chronic ankle instability subjects had greater plantar pressures and forces in the lateral foot compared to controls during jogging.”
Hmmm. Remember the midsole? (If not click here and here for a review) Motion control shoes are medially posted. That means they provide more support medially or have a tendency to tip the foot laterally. SO, motion control shoes shift forces laterally.
A person with chronic ankle instability has weakness of either the static, dynamic, or both components of the lateral stabilizing complex.
bottom line? make sure folks have a competent lateral stabilizing complex and if they don’t, you may want to think twice about using a motion control shoe.
Ivo and Shawn. Increasing your shoe geekiness coefficient on daily basis!
Previous plantar pressure research found increased loads and slower loading response on the lateral aspect of the foot during gait with chronic ankle instability compared to healthy controls. The studies had subjects walking barefoot over a pressure mat and results have not been confirmed with an in-shoe plantar pressure system. Our purpose was to report in-shoe plantar pressure measures for chronic ankle instability subjects compared to healthy controls.
Forty-nine subjects volunteered (25 healthy controls, 24 chronic ankle instability) for this case-control study. Subjects jogged continuously on a treadmill at 2.68 m/s (6.0 mph) while three trials of ten consecutive steps were recorded. Peak pressure, time-to-peak pressure, pressure-time integral, maximum force, time-to-maximum force, and force-time integral were assessed in nine regions of the foot with the Pedar-x in-shoe plantar pressure system (Novel, Munich, Germany).
Chronic ankle instability subjects demonstrated a slower loading response in the lateral rearfoot indicated by a longer time-to-peak pressure (16.5% +/- 10.1, p = 0.001) and time-to-maximum force (16.8% +/- 11.3, p = 0.001) compared to controls (6.5% +/- 3.7 and 6.6% +/- 5.5, respectively). In the lateral midfoot, ankle instability subjects demonstrated significantly greater maximum force (318.8 N +/- 174.5, p = 0.008) and peak pressure (211.4 kPa +/- 57.7, p = 0.008) compared to controls (191.6 N +/- 74.5 and 161.3 kPa +/- 54.7). Additionally, ankle instability subjects demonstrated significantly higher force-time integral (44.1 N/s +/- 27.3, p = 0.005) and pressure-time integral (35.0 kPa/s +/- 12.0, p = 0.005) compared to controls (23.3 N/s +/- 10.9 and 24.5 kPa/s +/- 9.5). In the lateral forefoot, ankle instability subjects demonstrated significantly greater maximum force (239.9N +/- 81.2, p = 0.004), force-time integral (37.0 N/s +/- 14.9, p = 0.003), and time-to-peak pressure (51.1% +/- 10.9, p = 0.007) compared to controls (170.6 N +/- 49.3, 24.3 N/s +/- 7.2 and 43.8% +/- 4.3).
Using an in-shoe plantar pressure system, chronic ankle instability subjects had greater plantar pressures and forces in the lateral foot compared to controls during jogging.
These findings may have implications in the etiology and treatment of chronic ankle instability.
all material copyright 2012 The Homunculus Group/ The Gait Guys. Don’t rip off our stuff. PLEASE ASK 1st!