Podcast 87: Podcast 87: The Kenyan’s Running Brain & “The” Anterior Compartment.

Plus, Some unknown facts about going minimalism and barefoot. We POUND anterior compartment strength today gang ! Hope you enjoy !

Show sponsors:
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A. Link to our server: 
http://traffic.libsyn.com/thegaitguys/pod_87final.mp3

Direct Download: 
http://thegaitguys.libsyn.com/podcast-87

Other Gait Guys stuff

B. iTunes link:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138

C. Gait Guys online /download store (National Shoe Fit Certification and more !) :
http://store.payloadz.com/results/results.aspx?m=80204

D. other web based Gait Guys lectures:
Monthly lectures at : www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

Show notes:

On high heels and short muscles: A multiscale model for sarcomere loss in the gastrocnemius muscle

http://www.sciencedirect.com/science/article/pii/S0022519314006262

The Brain Needs Oxygen

Maintained cerebral oxygenation during maximal self-paced exercise in elite Kenyan runners.

http://www.runnersworld.com/racing/the-brain-needs-oxygen
http://www.ncbi.nlm.nih.gov/pubmed/25414248
J Appl Physiol (1985). 2014 Nov 20:jap.00909.2014. doi: 10.1152/japplphysiol.00909.2014. [Epub ahead of print]

The texting lane in China
http://www.theguardian.com/world/shortcuts/2014/sep/15/china-mobile-phone-lane-distracted-walking-pedestrians

Dialogue on endurance training,
NeuroRehabilitation. 2006;21(1):43-50. 
http://www.ncbi.nlm.nih.gov/pubmed/16720937

Effects of dorsiflexor endurance exercises on foot drop secondary to multiple sclerosis.  Mount J1, Dacko S.

APOS Therapy
we were asked out opinion on this
http://apostherapy.com/

Foot instrinsic dialogue
Motor Control. 2014 Jul 15. [Epub ahead of print]

Quantifying the Contributions of a Flexor Digitorum Brevis Muscle on Postural Stability.
Okai LA1, Kohn AF.

There are many factors in adults that impair gait. It is not all biomechanical. This is part of our ongoing dialogue on the aging population and why gait impairments and falls are so prevalent.
Acta Bioeng Biomech. 2014;16(1):3-9.
Differences in gait pattern between the elderly and the young during level walking under low illumination.
Choi JS, Kang DW, Shin YH, Tack GR.


According to the CDC, falls are the number one reason for death and injury among people age 65 and older. More than two million older people went to an emergency room in 2010 because of a fall.

From the article “The Science of Trips and Falls” (link)

After a fall, older people often say they tripped or slipped. Researchers at Simon Fraser University, in Burnaby, British Columbia, wanted to observe what really happens. The team outfitted a long-term-care facility with video cameras and recorded residents going about their daily lives. They recorded 227 falls from 130 individuals over about three years. Tripping caused just 1 out of 5 of the incidents. The biggest reason for falling—accounting for 41% of the total—was due to incorrect weight shifting, like leaning over too far, says Stephen Robinovitch, a professor in the biomedical physiology and kinesiology and engineering science departments. Other, less frequent reasons for falling included loss of support with an external object, like a walker, or bumping into something.”

Using Tai Chi in the gait retraining process. Watch the attached video above.

This is particularly useful in reteaching weight transfer in the elderly or in the post operative hip, knee or foot clients. It is most useful in post operative total hip or total knee replacements. Note the slow loading responses which focus on effective weight transfer and loading as well as forcing safe balance challenges because the other foot is always skimming across the floor if  needed. 

Also, note that the transfers are always facilitating ankle dorsiflexion, just make sure you are not teaching this with knee extension lockout because it will cheat the amount of effort and wanted challenge to the anterior compartment.

We use the tai chi transfers as shown in our rehab in specific cases, but if you are dealing with the elderly, this is a great part of a daily program to reduce the fall statistics we listed earlier.  It helps the post operative cases and elderly where exactly are the limits of their safe weight shifting and where the risk zone of excessive weight shift begins.  

If you are looking for a good soft gentle way to:

1- improve balance

2- increase awareness of weight shifts that are not beyond the frontal plane stability of the hip (ie. improve awareness of the gluteus medius and lateral hip stabilizers)

3- improve the awareness of the back leg hip extension and gluteus maximus use during the forward weight transfer

4- improving anterior compartment awareness, skill and strength

5- improve weight bearing ankle rocker motion

… . then the basic tai chi walking weight transfer is an excellent start. I have taught my 80 year old parents this simple daily challenge and I think it will reduce their falls. We have used this in post operative knees and hips and it is a nice gentle start for many clients.  And when done super slow in a deep knee bend the challenges as described by our upper level athletes are surprising to both us and them.  Do tai chi for 30 minutes and learn its secret values. Millions of people around the world all can’t be wrong.

Shawn and Ivo, taking gait to new dimensions.

How to properly regain ankle rocker: A Prince of an Exercise

If you have been with us here at The Gait Guys you will know by now that we like to take Fridays and make them a blog post recycle.  This week we have a beauty and it parlays beautifully into our blog posts from the last 2 days on ankle rocker. We did this video about 3 years ago. We can tell because Dr. Allen hasn’t yet shaved his dome and he looks much younger.  Plus he stopped wearing sweater vests !  Ouch !

Today we show a staple in our in-office and home exercise programs. The Shuffle Walk and the Moon Walk.  We have altered these exercises in the last year or so, thus we really need to get that Foot Exercise DVD done that we have been promising for 2 years+.  

Anyhow, STOP passively stretching your calf muscles !!!!!!

Do the Shuffle walk instead.  We have a rule in our offices. If you are going to participate in a running sport, you must do 2 minutes of Shuffle Walks EVERY SINGLE DAY.  

The size of the anterior compartment muscles is much smaller than the bulbous large posterior compartment so the tug of war is always in the favor of the calf to become too dominant.  Drive some SES (Skill, Endurance and Strength) into the anterior compartment and you will see a stronger arch, control pronation better and very likely see shin splints disappear once and for all. 

Watch the video today and learn why some of our teams can be seen Shuffling around the outdoor track. It is pretty amazing to drive by a school and see an entire team shuffling and know that they are doing it because of The Gait Guys. It is comforting that we do not have to see many shin splint cases in our offices anymore because the teams are being proactive. Shin splints are SOOOOO boring and easy to fix.  

Enjoy gang, From the archives……..

Shawn and Ivo

Oval Track Running Injuries, Part 2. The Details.

Last week we did a blog post on the problems that oval track running can set up in terms of injury and promoting asymmetry, LINK).  We wanted to briefly go back to that article to hit some details that many folks did not put together. 

Keep in mind as you read on that the scenario is the typical counterclockwise oval track running.  As it said in the study, “analysis indicated that the left (inside limb) invertors increased in strength significantly more than the right (outside limb) invertors while the right evertors increased in strength significantly more than the left evertors.”

What this means is that someone who runs repeatedly counterclockwise on an oval track will drive skill, endurance and strength (the 3 basic tenets to solidifying a motor pattern) into the inside limb invertor muscles. This means the tibialis posterior, medial gastrocsoleus complex, flexor hallucis longus (likely) as well as some of the medial foot intrinsics. Because they are invertors, they are fighting the pronatory eversion forces on the track surface. These muscles will help to keep the ankle and foot neutral and slow the rate of foot pronation.  When these muscles are weak we see posterior shin splints in the left foot/ankle early in the track season. 

Whereas, the outside limb will be staving off the forces that want to launch the person off of the curves and off the outside of the track. Hence this limb will constantly redirect the forces inwards into the center of the track so that centripetal forces can continue to act to keep the runner on the curve (centripetal force is defined as a force which keeps a body moving with a uniform speed along a circular path and is directed along the radius towards the center). This means that the evertor muscles of the outside leg will be gaining skill, endurance and strength with every lap of training.  Hence, improvements in the peroneal group, the lateral gastrocsoleus namely.  Without these improvements the outside ankle would eventually fail and the forces are synonymous with inversion sprain mechanics.  Remember, here as well, these improvements in these muscle groups are designed to try and hold the ankle in a safe neutral biomechanical position and avoid inversion injury via the imparted forces.

It is also imperative to point out that the inside foot will see more ankle (mortise) dorsiflexion and eversion and the outside ankle will be seeing more (mortise) dorsiflexion and inversion.  We know that there are two heads to the tibialis anterior, one helps create more eversion and one more inversion.  Do we also want to see an imbalance and experience differential there as well ? If you have been with The Gait Guys for the last 4 years you will know that we harp on symmetrical ankle rocker range and function.  How can we expect to stay injury free with all this purposely driven asymmetrical skill, endurance and strength ?

Then one must remember that these muscular chains do not stop locally. If the inside foot invertor muscles are strengthened it is likely that the tonus and capabilities of the inner leg chain will be improved upon let alone the spiral chains as well.  Inner thigh groups including the adductors improve lower abdominal function from what we see in decades of clients. But remember, the outside leg is not seeing this same chain of muscles getting ramped up, rather it is seeing the lateral chain higher up improving which included the right gluteus medius to name just one. Furthermore, and we have talked about this until blue in the face, when  you have asymmetrical lower limb function you have asymmetrical upper limb swing.  We see shoulder and neck imbalances in our track athletes all the time.  And, then think about this, on non-track days what to many track athletes do ? They then go and drive massive strength into these asymmetries by going into the weight room and drive the problem deeper.

Our point here is that we are driving massive asymmetry into the human track machine. As as with any machine, loosen one bolt on one side and tighten the same bold on the other side and there will be a price to pay in the function of the machine. In the short term it will be one of performance, in the slightly longer term it will be one of injury.  As this study suggested, ” a high incidence of lower extremity injury (68%) occurred in this sample of runners, corresponding to an injury rate of 0.75 injuries per 100 person-hours of sport exposure. Although sample size was limited, secondary analysis indicated that strength changes were not significantly different for injured (n = 17) and uninjured (n = 8) runners (p > 0.05)”. Our response to the later statement is “give it time!”.  If you are one of these track athletes and are not injured, we like to say that you are likely lucky……. for now.

If you are a coach or an athlete, for the sake of your feet and legs……. use your head.
Shawn & Ivo
details, details, details……… because details matter.
______________________

Clin J Sport Med. 2000 Oct;10(4):245-50.

Asymmetrical strength changes and injuries in athletes training on a small radius curve indoor track.

Beukeboom C, Birmingham TB, Forwell L, Ohrling D.

Abstract

OBJECTIVES:

1) To evaluate strength changes in the hindfoot invertor and evertor muscle groups of athletes training and competing primarily in the counterclockwise direction on an indoor, unbanked track, and 2) to observe injuries occurring in these same runners over the course of an indoor season.

DESIGN:

Prospective observational study.

SETTING:

Fowler-Kennedy Sport Medicine Clinic, The University of Western Ontario, London, Ontario.

PARTICIPANTS:

A convenience sample of 25 intercollegiate, long sprinters (200-600 m) and middle distance runners (800-3,000 m) competing and training with the 1995-1996 University of Western Ontario Track and Field team.

MAIN OUTCOME MEASURES:

A standardized protocol using the Cybex 6000 isokinetic dynamometer was used to measure peak torques of the hindfoot invertor and evertor muscle groups of both limbs using concentric and eccentric contractions performed at angular velocities of 60, 120, and 300 degrees/sec. Changes in peak torques between the preseason and postseason values were calculated and compared using a repeated measures analysis of variance test. Injury reports were collected by student athletic trainers and in the Sport Medicine and Physiotherapy clinic.

RESULTS:

Primary analysis indicated that the left (inside limb) invertors increased in strength significantly more than the right (outside limb) invertors (p = 0.01), while the right evertors increased in strength significantly more than the left evertors (p = 0.04). A high incidence of lower extremity injury (68%) occurred in this sample of runners, corresponding to an injury rate of 0.75 injuries per 100 person-hours of sport exposure. Although sample size was limited, secondary analysis indicated that strength changes were not significantly different for injured (n = 17) and uninjured (n = 8) runners (p > 0.05).

CONCLUSIONS:

The observed small, but statistically significant, asymmetrical changes in strength of the hindfoot invertor and evertor muscle groups can best be described as a training effect. Altered biomechanics proposed to occur in the stance foot while running on the curve of the track are discussed in relation to the observed strength imbalance. A causal link between strength changes and lower extremity injuries cannot be inferred from this study, but suggestions for further research are made.

Gait Gaff Time.

(Gaff: verb tr. (to stand or take the gaff) To receive severe criticism; to endure hardship.

The Foot Slap Gait Style:  

This is a funny little video that shows a few important points.

Remember, our purpose here is to help train your eyes to the important things.  We used to use slow/stop frame digital gait software programs to slow down the person to look for particular components of failure in the gait or running cycle. After many years of doing this, we found more and more that even before we could fire up the video camera and software that we had trained our eye to see these deficits.  This is because, there are multiple clues in every gait compensation.  There is head movement (which we will discuss in this case), there is arm swing (is it equal and symmetrical, topics we have posted research articles on in the last 48 hours on this blog), torso rotation, hip lateral sway in the frontal plane, violations of sagittal knee progression, and then the always difficult multiplanar foot and ankle motions as well as so many other parameters we consider.  So, when one component goes wrong, with enough experience and skill, one can make predictions as to what is wrong.  And, the more flaws (correlative compensations) that are noted, the higher the predictive value of the assumption.  Now, many will say to us that there is no way one can do this, and that is ok.  To each his/her own.  But, after decades of doing this, as with anything, a skill is developed and an art to doing it begins to take shape, as we will see here (without stop frame, without foot mapping devices etc).  One begins to form a mental algorithm to the process.  We always start with, “is the head silent in the vertical, frontal and sagital plane?”.  When a person’s gait is off, the head is almost never silent in space.  And arm swing also begins an assymetrical pendulum effect.  This could be called an energy conservation mode (as talked about in the article on the blog entitled, Dynamic Arm Swing in Human Walking, (http://www.ncbi.nlm.nih.gov/pubmed/19640879) where it was determined that normal arm swinging required minimal shoulder torque, while volitionally holding the arms still required 12% more metabolic energy. Among measures of gait mechanics, vertical ground reaction moment was most affected by arm swinging and increased by 63% without it.

  So, as  you do this more and more you will develop the skills of observation to improve the art form of assessing one’s gait.  But remember this KEY POINT *** what you see is mere information gathering, it is not always and frequently ever, the problem that you see.  You are seeing their compensation pattern around some neurologic, orthopedic or biomechanical problems…..things that are making a silent pristine gait impossible.  You MUST then, take this information and correlate it to your clinical findings in terms of neuro-orthopedic-biomechanical limitations during your exam.  Things like, joint range limitations, muscle weakness, instabilities and the like. So, you are trying to take what you see, and what you find, and develop a logical algorithm as to where their problem lies and one that tells a logical mechanical story as to the gait pattern you are seeing.  For example, a person comes to see you with a lurching forward of their body mass onto the right leg, abruptly skipping over the heel strike phase of gait on the right causing a slap of the right forefoot onto the ground.  One option of thought COULD be a deficit in the right tibialis anterior, that being eccentrically weak in that muscle thus delivering an abrupt right foot drop type gait.  But your examination on the table, your CLINICAL examination, shows a LEFT hallux limitus with dorsiflexion range shy of the key 45 degrees needed for normal toe off.  You then have a clinical epiphany that they are leaving the left foot quickly and prematurely because THEY HAVE NO OTHER CHOICE because it hurts to load that first MTP joint on the left.  You then go down, determine the joint is limited in range, it is painful, there is a pinch callus on the medial hallux and the extensor hallucis longus and brevis are weak.  Gait analysis is done. What you saw, was not the problem, it was their compensation.  Now, you have to try and fix the problem and the compensations…….and treatment begins.

OK, soap box aside………

lets build on that skill set we are trying to develop, the powers of observation and what they COULD mean.

THE SKUNK FU GAIT:

The first thing we see is, the Sagittal head bob.…..each step there is a propulsive head anterior oscillation and then dropping downwards at the end. This can mean there is an apropulsive problem in midstance such as loss of ankle rocker but that is not so in this case, the ankle rocker is great.  The head drop in this case coincides with successive heel strikes each time.  This in essence means that they are dropping from a height each time.  How can this be ? The little fella is on flat ground ! (more on this in a minute).  This could mean a lack of core maintenance in the late midstance phase of gait (heel rise-toe off) and subsequent movement onto the next heel strike.  This can come from overstriding, as in this case, but it can also come from an aggressive forward lean in a person’s gait style (like walking into a strong head wind).  In this case, we have a more reasonable ASSUMPTION, it comes back to the “falling from a height issue”. In this case, lack of adequate anterior compartment lower limb strength (tibialis anterior and the long and short toe extensors, EDL, EDB, EHL, EHB) allows PEPE to move from heel strike to foot flat in an uncontrolled and abrupt fashion.  When this occurs, pronation (even the normal amount of pronation) occurs fast.  And we know that when a person moves from supination to pronation there is a drop in height of the arch and thus a drop in the body (try this to prove the point, …..stand up straight, look in a mirror and begin raising up your toes and then dropping them.  If you do it right, each rise of the toes should raise the arch (The Windlass Effect), and each fall should drop the arch demonstrated in the mirror by a rise and fall of the head vertically.)  And so here you have the height differential in this case.  So, in a nutshell, PEPE is over-striding (as evidenced by his also aggressive arm swing), and falling hard from  heel strike abruptly into foot flat, a double whammy !  There is basically zero eccentric phase activity of the lower anterior compartment musculature and so the foot accelerated to the ground from its starting peak height at heel strike.  The poor fella probably has a raging anterior shin splint condition because of this but you would be hard to tell from the smile on the little stinkers face.  …………but remember, prove your facts on the table……who knows, maybe he has posterior column spinal cord disease, but an examination will have to be done to confirm your findings and suspicions.  In this case, we highly recommend an upwind exam table and plenty of air fresheners. 

we remain,…  The Gait Guys