“When you run up a hill, most of the cross over gait disappears. Runners will tend toward beautifully stacked lower limb joints.”- Dr. Allen

Are people running up a hill more likely to tend towards a cross over gait style, in other words tend toward a more narrow gait step or a wider gait step ?

Watch people run up hill closely. Even if they are cross over (narrow foot fall) runners, when running up hills a few things will negate much of the narrow foot fall.

1- Running up hill requires more gluteals, more power is needed for all that extra required hip extension to power up the hill. More gluteal max use can, and will, spill over into the posterior fibers of the gluteus medius and this will tend to abduct the leg/hip and reduce some of the cross over tendency.

2- When one runs up a hill, there is a forward pitch of the upper torso, often with a some degree of forward pitch occurring at the hips. More importantly, because one is running up hill, they are stepping up and so more than normal hip flexion is necessary than in normal running. The forward pitch of the body and the greater degree of hip flexion is the culprit here. If the hip/leg is adducted in a cross over style, adding this to a more than normal flexing hip, it will create a scenario for anterior hip impingement and risk of femoral acetabular impingement (FAI) syndromes. Go ahead, test it for yourself. Lie on your back and flex your hip, drawing your knee straight up towards your shoulder.  Pretty good range correct ?  Now, flex the hip drawing your knee towards your navel, adducting it a little across your body. Feel the abrupt range of motion loss and possible pinch in the front of the hip ?  FAI.  This is what would happen if you utilized a cross over gait, narrow foot strike gait. The goes for mountain/sleep hill hikers as well. 

This is why, if you are a narrow foot striker, a near-cross over type of runner, you will see it disappear when you run up hills.  

If you get anterior hip pain running up hills, force a wider step width and reduce the possible impingement at the anterior hip joint. Just make sure you have enough ankle dorsiflexion to tackle the hill in the first place. If not, you may welcome some foot and ankle stuff to the table along with the hip.  

Likely obvious stuff to most of the readers here, but sometimes it is nice to point out the obvious.  Hills, just because they are there, doesn’t mean you have the parts to run them safely.

Dr. Shawn Allen

“those with chronic neck pain demonstrated a narrower step width, a shorter step length and slower gait speed during walking with the head movements and at maximum speed” –  Uthaikhup et al. study:

Head movement and Gait Parameters:

By now you should have a good grasp of the global impact of gait and how it presents and translates in everything we do. It is how we move through this world, and everything we do, and everything that has happened to us, impacts our gait. And, our gait impacts things in turn, from our mental state to how we think and act.  

By now, if you have been with us here on The Gait Guys long enough, you know that with the tremendous proprioceptive impact of the system from the cervical spine, that neck pain can influence sensorimotor function and thus motor function. However, little is known about the effects of head movement and walking speed on gait characteristics in patients with neck pain.

From the Uthaikhup et al. study:

Patient sample:  20 women aged between 18 and 59 years with chronic neck pain (>3 months) and 20 healthy controls of similar age, weight and height

Indexes used: Neck Disability Index and Visual Analogue Pain Scale.

“The experiment consisted of two walking sessions. The first session included walking with head straight, head up-down, and head turns from side to side. The second session included walking at comfortable and maximum speeds. Each trial was performed twice. Gait parameters measured using GAITRite walkway system were step length, stride length, step time, stride time, step width, cadence and gait speed.”

According to this study, the clients with chronic neck pain showed several changes in how they implemented their gait. They displayed step width narrowing, a reduction in step length and speed of gait, and even an overall reduction in gait speed when neck movements were induced or encouraged or when there was pain..

As Uthaikhup et al. summarized, “The results suggest that patients with chronic neck pain have gait disturbances. This supports the notion that assessment of gait should be addressed in patients with persistent neck pain.”

You have to know your gait norms to understand abnormals. We have written about other parameters that affect gait speed, step length and width here on the blog. Here is one more parameter for you to store in your noggin. It is all connected. So, when you goto your gait analysis guru, ask them if they are going to clinically assess your painful neck as part of the gait analysis (be prepared for the “deer in the headlights” look).

Dr. Shawn Allen, one of the gait guys

Reference:

Man Ther. 2014 Apr;19(2):137-41. doi: 10.1016/j.math.2013.09.004. Epub 2013 Sep 27.The effects of head movement and walking speed on gait parameters in patients with chronic neck pain. Uthaikhup S, Sunkarat S, Khamsaen K, Meeyan K, Treleaven J.

Heat Exertion and Gait Decline

Changes in gait characteristics are found when exertional heat stress is experienced during prolonged load carriage.  As heat stress increased, step width decreased while percent crossover steps increased. Reduced stance time variability, step width variability, and percent crossover step were observed.  These are frontal plane gait parameters for the most part. 

Think about these things during your long summer run or as you go deeper into those last miles of your long run.  Simple muscular fatigue in the frontal plane hip-pelvis stabilizers are going to render the same results.  This is quite possibly why many problems and injuries crop up in the latter miles of your run. 

Reference:

Gait Posture.

2016 Jan;43:17-23. doi: 10.1016/j.gaitpost.2015.10.010. Epub 2015 Oct 23.Using gait parameters to detect fatigue and responses to ice slurry during prolonged load carriage. Tay CSLee JKTeo YSQ Z Foo PTan PMKong PW

Does slowing gait increase gait stability ?

As this study suggests, it has been difficult to find studies that establish a clear connection between gait stability and gait speed. One can easily assume that slowing down increases stability, we do it on slippery surfaces, we do it when a joint is painful, even the elderly do it naturally everyday. Walking speed, step length, step frequency, step width, local dynamic stability , and margins of stability were measured in this study below. It was found that the subjects did not change walking speed in response to the balance perturbations rather they made shorter, faster, and wider steps with increasing perturbation intensity. They became locally less stable in response to the perturbations but increased their margins of stability in medio-lateral and backward direction. 

So what did they conclude ?  Here are their words,“In conclusion, not a lower walking speed, but a combination of decreased step length and increased step frequency and step width seems to be the strategy of choice to cope with medio-lateral balance perturbations, which increases Margins of Stability (MoS) and thus decreases the risk of falling.”

It is my assumption, and this just seems logical, that if the perturbations were to continue constantly, that one would slow the gait speed to reduce the need for these shorter, faster and wider steps. 

Dr. Shawn Allen

http://www.ncbi.nlm.nih.gov/pubmed/22464635

Gait Posture. 2012 Jun;36(2):260-4. doi: 10.1016/j.gaitpost.2012.03.005. Epub 2012 Mar 29.Speeding up or slowing down?: Gait adaptations to preserve gait stability in response to balance perturbations.Hak L1, Houdijk H, Steenbrink F, Mert A, van der Wurff P, Beek PJ, van Dieën JH.

Texting and Walking.  Your gait will change when you are texting on your phone.
You are going to want to put away your cell phone after you read this, or at least hide your parent’s phones.
*(the video link attached here has likely been blocked by ABC News, you should see a forwarded link to their youtube feed. If not, here it is

So you think you are a multi-tasker do you ?  Do you know how much cerebral cortex real estate is necessary to walk or drive and text ? Just try texting while walking for 5 seconds in an unfamiliar environment and see what happens.  Dual tasking is difficult especially when one task is cognitive and the other is spacial and motor. At some point something has to give, especially if you are on the edge of tapping out the executive function centers in the brain because of early disease or age related mental decline.  This has never been more prevalent than in the elderly and the number of mounting studies proving that dual attention tasks lead to a dramatic increase in age related fall injuries.  If you look into the literature the fall rate increases from anywhere from 11 to 50%, these are strong numbers correlating falls and dual attention tasking in the elderly.  Certainly the numbers are worse in the frail and gait challenged and fewer in healthier elderly folks, but the correlation seems to be strong particularly when there are even early signs of frontal cortex demise. We have talked about this on several recent podcasts (check out podcasts 80-85) and this has been rooted even further from one of our neurology mentors, Dr. Ted Carrick.  

Recently in the Journal of Applied Biomechanics, Parr and associated took 30 young able bodied healthy individuals with experience texting on cellular phones. The study used an 11-camera optical motion capture system on a 8m obstacle-free floor. 
The study showed a reduction in gait velocity in addition to significant changes in spatial and temporal parameters, notably, step width, while the double support phase of the gait cycle increased.  Furthermore, and equally disturbing, toe clearance decreased but luckily step length and cadence decreased. 
Thus, it appears that the attention draining texting task generally forced the brain to slow the gait, reduce step length while improving stability via increasing step width and double support phase of gait, keep in mind that these are young healthy experienced individuals with no early cognitive challenges.  This is not the case in aging adults, or in adults with factors that have either challenged gait stability (degrees of impaired balance, vision, vestibular, proprioception etc) or challenged frontal cortex function where that functionality of the brain is already nearing its tipping point for adequate function.  Sadly, these are all factors in the aging adult and they are why falls are increased and riskier for the elderly. Essentially, what the studies are showing is that dual tasking creates a distraction that can amplify any sensory-motor challenges in the system.  Mind you, there are studies that show that if the dual task is remedial such as talking while walking the effects are more muted, however in those who are at the tipping point capacity of mental executive function, mere talking (cognitive linguistic engagement), can also tip the system into deciding whether to focus on the gait or the talk but not both adequately.  Something will have to give in these folks, safe competent dual tasking is beyond the ability of their system. 
As we have eluded to here, there are many factors and variables that can challenge the system. Visual challenges such as low light vision problems or depth perception challenges can act similarly on the system to dual tasking attempts and thus magnify fall risk. What about sensory challenges from a spinal stenosis or peripheral neuropathy such as in advancing diabetes?  Balance and vestibular challenges, let alone factors such as unfamiliar environments (perhaps magnified by vision challenges) as precursors are a foregone conclusion to increase fall risk in anyone let alone the elderly.
By this point in this article it should be a given that texting while doing anything else is a dual tasking brain challenge that could lead to a fall, an embarrassing spill into the public pool or into a fountain at the mall let alone driving off a cliff or into a crowd of people.  But are all of these unfortunate people showing signs of frontal cortex/executive function impairment? Perhaps not, especially if they are healthy.  One has to keep in mind that texting is a high demanding cognitive attention task, even though we think nothing of it as a healthy adult. Think about it, one has to engage a separate screen other than the environment they are trying to walk through. Additionally, one has to think about what they are trying to text, engage a seperate motor program to type, then there is spelling, choosing text recipients, sending the message, watching and listening for a response, and the list goes on meanwhile the person is still trying to run the gait subprograms.  We take it for granted but texting is highly engaging and adding walking can tip the system into a challenge or failure if we are in a crowd, unfamiliar environment, low light etc.  
So if you have ever wondered why elderly people trip and fall in even the most benign environments, it is likely a compounded result of challenges to situation and spatial awareness and working memory with many possible factor challenges. Again, things like poor lighting, vision limitations, unfamiliar environment, vestibular limitations, numbness in the feet, talking or even if they are simply carrying the afternoon tea to the sun room these things all are dual tasking and some require higher demands from the executive function brain centers.   Any factor(s) which tax the already-reducing executive function centers in the elderly subtract from the most basic elements required for upright posture and gait.  If dual-tasking can impair healthy young individuals, the elderly are a forgone conclusion to have magnified risks.  
There can be a plus to all of this however. If the goal were to only reduce falls and fall risks in the elderly, an astute clinician can work this to their favor and do gait challenges and retraining in the office environment while safely stacking dual task challenges to expand and restore some executive function capabilities.  We are never too old to learn and lay down improved motor and cognitive patterns. So, use this information to your advantage to improve function instead of delivering it as a dark cloud to hang over your clients, whether they are elderly or neurologically challenged. 
In summary, put down the darn phone, trust us, that text can wait.  Rather, enjoy the sunshine, the smiling faces, the trees.  If you are driving or walking, dump the phone and pay attention to traffic and your environment. Stop and wave to a friend. Teach your kids about this texting problem, they are likely already oblivious to many risks in the world, and this one likely hasn’t crossed their mind either. At the very least, help the elderly lady or man cross the street. By now you should understand all that they are consciously and subconsciously trying to calculate to negotiate the street crossing. Their declining executive function is often a mental feat all on its own, but having to actually add the physical act of walking (which is likely already showing aspects of age related biomechanical decline) might just be their tipping point leading to a fall.  So offer your arm, a warm smile, and think everything of it, because someday it will be you at that street corner with sweaty palms and great fear.
 
Shawn and Ivo, “the gait guys”
References :
1. Eur J Neurol. 2009 Jul;16(7):786-95. doi: 10.1111/j.1468-1331.2009.02612.x. Epub 2009 Mar 31.
Stops walking when talking: a predictor of falls in older adults?Beauchet O1Annweiler CDubost VAllali GKressig RWBridenbaugh SBerrut GAssal FHerrmann FR.
2. J Appl Biomech. 2014 Dec;30(6):685-8. doi: 10.1123/jab.2014-0017. Epub 2014 Jul 9. Cellular Phone Texting Impairs Gait in Able-bodied Young Adults. Parr ND1, Hass CJTillman MD.
3. Gait Posture. 2014 Aug 20. pii: S0966-6362(14)00671-7. doi: 10.1016/j.gaitpost.2014.08.007. [Epub ahead of print]  Texting and walking: effects of environmental setting and task prioritization on dual task interference in healthy young adults. Plumer, Apple, Dowd, Keith.
4. Gait Posture. 2012 Apr;35(4):688-90. doi: 10.1016/j.gaitpost.2011.12.005. Epub 2012 Jan 5.  Cell Phones change the way we walk.  Lamberg, Muratori
5. Int J Speech Lang Pathol. 2010 Oct;12(5):455-9. doi: 10.3109/17549507.2010.486446.  Talking while walking: Cognitive loading and injurious falls in Parkinson;s disease. LaPointe LL1, Stierwalt JAMaitland CG.

 

Podcast 82: Phasic vs Antiphasic Gait, Cross Over Gait & more.

Show sponsors:

www.newbalancechicago.com

www.lemsshoes.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_82final.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-82-phasic-vs-antiphasic-gait-cross-over-gait-more

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:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

 

Show notes:

 
Blog posts we reviewed:
 

Muscle Activity Differences in Forefoot and Rearfoot Strikers
http://www.runresearchjunkie.com/muscle-activity-differences-in-forefoot-and-rearfoot-strikers/

www.runnersworld.com/injury-treatment/forward-lean-while-running-might-reduce-knee-pain?cid=social33696857

Weight-Bearing Ankle Dorsiflexion Range of Motion—Can Side-to-Side Symmetry Be Assumed?
http://www.natajournals.com/doi/abs/10.4085/1062-6050-49.3.40

extras for this piece:

and you can use this to substantiate it: http://www.ncbi.nlm.nih.gov/pubmed/23997389

Effect of step width manipulation on tibial stress during running. J Biomech. 2014 Aug 22;47(11):2738-44. doi: 10.1016/j.jbiomech.2014.04.047. Epub 2014 May 21.

Podcast 78: Step Width Gait, Training Asymmetries & more

Show sponsors: 

www.newbalancechicago.com

www.lemsshoes.com

A. Link to our server: 

http://traffic.libsyn.com/thegaitguys/pod_78ff.mp3

Direct Download: 

http://thegaitguys.libsyn.com/podcast-78

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:

www.onlinece.com   type in Dr. Waerlop or Dr. Allen,  ”Biomechanics”

______________

Today’s Show notes:

24-year-old woman missing entire cerebellum exemplifies the amazing power of brain plasticity

Brain scans reveal ‘gray matter’ differences in media multitaskers

Who are we: Ivo talk a bit about yourself and your educational history and what is your website ?
Shawn…..do the same
and……lets keep each interesting but to just a few minutes
Effect of step width manipulation on tibial stress during running
Does Limited Internal Femoral Rotation Increase Peak Anterior Cruciate Ligament Strain During a Simulated Pivot Landing?
http://ajs.sagepub.com/content/early/2014/09/22/0363546514549446.abstract
Quadriceps Muscle Function After Exercise in Men and Women With a History of Anterior Cruciate Ligament Reconstruction
http://natajournals.com/doi/abs/10.4085/1062-6050-49.3.46