not too technical to say the least…….but we are trying to make sure that we accumulate a library of just about everything gait, running, shoes, feet, movement, biomechanics related.
enjoy…….its a fun 3 minutes
Following the Flintstones….
In this next clip, Barneys barefoot technique has only improved marginally. He initiates with a much better forward lean. His ankle rocker is improved, but not enough for him to gain traction. His arm swing is better, but he has a tendency to hunch his shoulders. His leap into the car is a tribute to his gastroc soleus group…
Hey
Check out Barney joing the barefoot craze! We slowed him down a bit to observe his technique a little closer
Not the best barefoot technique we have witnessed. Though he has a some forward lean, he still heel strikes with an extended knee in front of his body (ouch!) and has little to no ankle rocker with premature heel rise. This results in a “bouncing” gait with most likely sore calves!
We hope Betty was a massage therapist…
graphic above by Edward Muybridge
Leg length discrepancies and heel lifts. To lift or not to lift…
The Gait Guys
Leg length discrepancies (LLD’s) are encountered on a daily basis. They are the root of many ankle, knee, hip and spinal problems. The questions the clinician must ask are “How much is significant?”, “How much do I add?” What are some of the signs and symptoms?” “What is the etiology?” and “How do I detect it?” A literature search (2003) provided the following information and answers.
How much is significant?
Most authorities claim that deficiencies of greater than ¼ inch (6mm) are clinically significant (1, 2) though some sources state that differences as little as 4 mm are significant (5). Subotnick (3) states that because of the threefold increase in ground reactive forces with running, lifts should be used with inequalities of greater than 1/8” inch (3mm).
How much do I add?
One of the easiest ways to determine the amount of lift needed is to examine the person in a weight bearing posture and add lifts under the short leg until the pelvis is even or until the lumbar spine is straight. If using off weight bearing measurements, you need to add 1/3 more height than measured because the talus is positioned 1/3 of the way between the calcaneus and metatarsal heads (4, 13). So, a heel lift placed under the calcaneus will only raise the talus 2/3 of that height. Lifts placed under the calcaneus can shorten the tricep surae muscles (4, 6) and apply increased pressure to the metatarsal heads (12); full length sole lifts are more physiological, though not always practical. Due to the supinatory moment of the short leg on heel strike, a lift may cause overcompensation and increased supination, with a tendency to overweight the lateral column and possibly injure the lateral ankle. Careful observation of gait post addition of a lift is in order and a valgus post running at least the length of the 5th metatarsal along with the lift should be considered (8, 9). Heel lifts also cause EMG changes of leg muscles, with decreased recruitment of gastrocnemius and tibialis anterior directly proportional to the height of the heel lift (18, 19). A lift or LLD changes the ground reactive forces associated with gait, increasing vertical force on the longer leg, along with increased joint stresses along the kinetic chain (14, 20).
Generally speaking, lifts greater than 3/8” (9mm) require extrinsic modifications to footwear (4, 6, 8). Find a competent individual to perform this work for you. Large discrepancies should be treated gradually, at a rate of ¼ inch every 4 weeks, less if symptoms do not permit.
What are signs and symptoms associated with LLD’s?
Compensation comes in many forms, depending whether it is acute (recent injury caused an LLD or compensation resulting in one, or long term. The deficiency can cause injury on the short or long legged side (or both).
The long leg moves through a greater arc during all portions of swing phase (7). The person may flex the knee to compensate and shorten the arc. The individual may also maximally pronate and evert the calcaneus an additional 3 degrees or greater on that side in an attempt to lower the navicular to the ground and shorten that leg. This causes an increased amount of internal rotation of the tibia and thigh causing muscular dysfunction (tightness of the hip flexors, strain of the intrinsic external rotators from eccentric deceleration of the thigh), along with medial knee strain (especially with concomitant genu valgus) (4, 6, 8, 9, 10, 11, 21, 22).
The short leg side will often supinate in an attempt to lengthen and cushion some of the shock of heel strike, since it has a greater vertical distance to travel (14); this often occurs with hyperextension of that knee. This lessens the dampening ability of the knee (since it flexes almost 20 degrees between heel strike and full forefoot load), and speeds the rate of subtalar pronation (since the rear foot is inverted and still must pronate the same amount (4). Many individuals will try and attenuate impact by contracting the contralateral hip abductor muscles and eccentrically lower the shorter extremity (4, 14). This can produce excessive strain of that musculature (trochanteric bursitis) as well as pathomechanical abnormalities of the L4 and L5 motion segments (due to increased body rotation toward the short side and attachments of the iliolumbar ligaments; this can cause degenerative changes if present long term (11, 12)).
What’s the etiology?
LLD’s can be structural (anatomical) or functional (pathomechanics, compensation). LLD’s can be due to foot problems (overpronation/supination, fractures), leg or thigh problems (congenital shortening, deformity, fracture), or pelvic compensation (rotation of ilia, fractures).
So, what is the etiology? A lot can be gleaned from the history. Past trauma is the most obvious so pay close attention. This could result in flattening of the calcaneus or overpronation due to ligamentous laxity; tibial fractures can cause shortening as well as increased or decreased tibial torsion; similar findings can occur in the femur, along with anteversion or retroversion; pelvic trauma can be more subtle and x-ray can often provide the most information (1, 2, 4, 6).
How do you determine a leg length inequality?
There are a number of methods, each with their own merit. X –ray is most accurate, but exposes the patient to ionizing radiation. Weight bearing seems most appropriate, since symptomatology usually presents itself then. Supine measurements are said to be influenced by asymmetrical muscle tension, table pressure on the innominates and hip flexor length (15).
With the patient weight bearing and both feet placed below the trochanters, observe the level of the medial malleoli. Next, compare the heights of the tibial plateaus. Femoral length can be judged by the heights of the greater trochanters, and pelvic alignment judged by the heights of the iliac crests (4, 17).
Alternately, lay the person supine and observe the heels and medial malleoli. If there is noticeable discrepancy, they may have a short leg; if there isn’t, they still may have a discrepancy that they are compensating for. Check the range of motion of the foot and ankle in 6 general directions: plantar flexion (40-45 degrees), dorsiflexion (20-25 degrees, depending on whether the knee is flexed or extended), inversion of the forefoot (3-60 degrees, on average), and eversion of the forefoot (20-45 degrees on average), calcaneal inversion (4-20 degrees) and calcaneal eversion (4-10 degrees). Excessive calcaneal eversion usually means over pronation due to a longer leg on that side; excessive inversion can mean a long leg due to a cavus foot type (2, 4, 6, 8, 9, 12). Lack of flexibility in the posterior compartment of the calf usually causes a greater degree of pronation (16).
Now, perform Allis’s test. Bend both knees to 90 degrees and observe the height of the tibial plateaus. The lower one is usually the side of the discrepancy (which can be in tibial length or due to excessive pronation). Now walk superior to the knees and observe the femurs from more cephalad (4). Is there a discrepancy? If so, the problem may be in the femur length, femoral head angle or pelvis. Extend the knees so that the legs are lying flat on the exam table. Palpate the greater trochanters on both sides. Is one lower than the other? If so, they probably have coxa vara on the short side or coxa valga on the long side. If they are even, you need to look at the pelvis. Does one ASIS palpate more anterior or posterior than the other? This could represent compensation. A posterior or “flexed” ilia, usually causes a short leg on that side; an anterior or extended ilia usually causes a long leg on that side. Now stand the patient up and perform a Gillet Test. Have them stand erect and hold onto something for balance. Palpate the PSIS on one side along with the 2nd sacral tubercle. Have them raise their thigh to 90 degrees on the side you are palpating. The PSIS should nutate backward (flex) and drop .5-1.5 cm on the side of the raised leg. Now have them raise the opposite leg. The sacrum should nutate backward and down. If either of these movements does not occur, consider pelvic pathomechanics and treat accordingly. Recheck for motion as well as leg length when done.
Standing observation often (but not always) reveals overpronation on the long leg side and relative supination on the short leg side. The shoulder is often higher on the short side and the waistline dips to the long side because of posterior rotation of the innominate. The shoulder will dip to the side of the short leg on heel strike during dynamic evaluation (4, 6, 8, 9, 10, 11). Gait observation usually reveals adduction of the pelvis toward the stance phase leg with a lateral sway in excess of 1” during stance phase. The person will seem like they are “stepping into a hole” on the short side.
Conclusion
Leg length inequalities occur due to a variety of anatomical and physiological conditions. Careful analysis and examination can often reveal its etiology. To lift or not to lift is a clinical decision that is left to the clinician and patient, with a careful balance between what is perceived as improved biomechanics and tolerance levels of the patient with regards to their presenting symptomatology.
References available by request
Materials: Do soft soles improve running shoes ?
/BioMechanics
April 1998
Materials:
Do soft soles improve running shoes?
Most athletic shoes advertise injury protectiong through “cushioning,” but real world studies have not shown impact moderation.
By Steven Robbins, MD, Edward Waked, PhD, and Gad Saad, PhD
here are their conclusions word for word:
Please honor the authors and purchase the article for your own use.
Conclusion
“Shoes with cushioning fail to absorb impact when humans run and jump, and amplify force under certain conditions, because soft materials used as interfaces between the foot and support surface elicit a predictable reduction in impact-moderating behavior.5-10,13-17 This behavior is not a response to sensations directly caused by impact because, whereas barefoot humans estimate impact precisely, humans judge it inaccurately when shod.14-17 This situation has recently been made clearer. Reduction of impact-moderating behavior is a response to loss of stability induced by soft-soled cushioned shoes: Humans reduce impact-moderating behavior in direct relation to increased instability.27 This is presumably an attempt to achieve equilibrium by obtaining a stable, rigid support base through compression of sole materials.27
After considering footwear advertising, additional factors appear to influence impact-moderating behavior. Recent reports also indicate that humans reduce impact-moderating behavior, thereby amplifying impact, when they are convinced that they are well protected by the footwear they are wearing. Advertising that suggests good protection results in higher impact, whereas advertising that suggests injury risk attenuates impact.19 Deceptive advertising, suggesting that expensive cushioned footwear offers advanced technology that protects against impact, accounts for the 123% greater frequency of injuries with the most expensive shoes found by Marti.18
Public health could be advanced through truth in advertising of footwear products with cushioned soles. Furthermore, footwear must be required to provide good balance. Current athletic footwear undoubtedly causes falls, since footwear with thick yielding soles destabilizes humans by as much as 300% compared with hard-soled shoes.
Now that the destabilizing nature of cushioned footwear is well established, continued manufacture of these hazardous items without explicit warning labels represents risk for liability claims from users who are injured from falls and ankle sprains while wearing them. In the context of this report, footwear that provides superior balance will probably be effective at attenuating vertical impact. Clearly, highly resilient materials must be removed from shoe soles for many reasons. This move will portend better health through improved stability and fewer injuries from excessive repetitive impact in sports. ”
Run, Carey, Run?
Lets look at this Hitchcock classic “North by Northwest” and check out Cary’s form.
1st of all, what an arm swing! Think of all that energy it is sapping from the rest of his muscular system. He must be hiding something, but what? We can only see him from the waist up, so we may never actually know. Did you notice how he initially only turns to the right? Did you pick up on the flexion at the waist? How about that torso bob from side to side? Not much to his hip abductors now are there?
The only thing he has going for him is he is wearing leather soled shoes, which have been shown to have one of the lowest impact loading on the body (yes, you read that right; increased cushioning INCREASES impact forces, but that’s not what we are here to talk about). Oh yea, he actually impacts the ground at the end of the sequence. I guess if his technique was better, he would have hit even HARDER.
Next sequence, we are off to a good start, look at that forward lean to start! This is essential to good technique. He loses that form pretty quickly; we can still see that forward flexion at the waist; certainly costing him energy by not using his core.
Finally, we get a posterior view at the end, but the uneven surface makes it difficult to make an analysis.
We think Cary would certainly give Lola a run for her money. Cary, next time, engage your core and watch your step…
We Remain….The Gait Guys
Chicago Lecture , "World Class Shoe Fit"
/Yesterdays IRRA event (Independant Running Retailers Assoc) lecture in Chicago went 2.5 hours yesterday ! Great group, great feedback. We talked at length about shoe anatomy and the various anatomic foot types and how to evaluate a client or patient for a good shoe match and fit depending on their foot type. Everyone, please welcome aboard another 60 foot/shoe/gait nerds ! The more the merrier !
Passive Arch Stability Anatomy Review→
/Anatomy review: No matter how good the shoe choice is for a client’s/patient’s foot type……if muscular weakness has persisted long enough to compromise one of the big 6 (plantar aponeurosis, long-short plantar ligaments, plantar calcaneonavicular ligament (spring ligament), medial talocalcaneal ligament, talocalcaneal interosseous ligament, and tibionavicular portion of the deltoid ligament) there is likely to be recurrent foot problems.
Foot Ankle Int. 1997 Oct;18(10):644-8.Stability of the arch of the foot.
Kitaoka HB, Ahn TK, Luo ZP, An KN.Source
Department of Orthopedics, Mayo Clinic, Rochester, Minnesota 55905, USA.
What did you notice? Cavus foot? Loss of the transverse arch? Prominence of extensor tendons?
The question is: Why?
It’s about reciprocal inhibition. The concept, though observed in the 19th century, was not fully understood and accepted until it earned a Nobel prize for its creditor, Sir Charles Sherrington, in 1932. Simply put, when a muscle contracts, its antagonist is neurologically inhibited, So when your bicep contracts, your tricep is inhibited. This holds true whether you actively contract the muscle or if the muscle is irritated (causing contraction).
So how does this apply to this foot?
We see prominence of the extensor tendons (particularly the extensor digitorum brevis EDB; the longus would have caused extension at the distal interphalangeal joint). The belly of the muscle is visible, telling us that it is active. It is neurologically linked to the flexor digitorum brevis (FDB). This muscle, in turn, has slips which attach it to the abductor hallucis brevis (AHB) medially and the abductor digiti minimi (ADM) laterally. These muscles together form 2 triangles (to be discussed in another post) on the bottom of the foot, which lend to the stability of the foot and the arches, especially the transverse.
When the EDB fires, it inhibits the FDB, (which, in addition to flexing the MTP’s, assists in maintaining the arch). The EDB has an effect which drops the distal heads of the metatarsals as well (Hmm, think about all the people with met head pain) Now, look at the course of the tendons of the EDB. In a cavus foot, there is also a mild abductory moment, which flattens the arch. Conversely, the FDB in a cavus foot would serve to actually increase the arch, and would have a ,mild adductory moment. Net result? A flattened transverse arch.
Now look at the Flexor digitorum longus, overactive in tbis foot (as evidenced by the flexion of the distal interphalangeal joints, mild adduction of the toes (due to the change of direction of pull in a cavus foot) and lowering of the met heads due to hyperextesnion at the MTP joints ). This mm is reciprocally linked with the extensor digitorum longus. The prominence of the extensor tendons is do to increased activity of the EDB (go ahead, extend all your fingers and look at the tendons in your hand. Now flex the DIP and IP joints and extend the MTP; see how they become more prominent?).
Reciprocal inhibition. It’s not just for dinner anymore…
We are and remain; The Gait Guys
Part 2 of a case study from Northern Ireland. This video discusses the dynamic findings and how they correlate clinically with the history. Treatment recommendations are discussed as well.
Follow up question from a doctor…..
Thanks for the post. Interesting case study. Are most hernias at this point a result of overactive hip flexors? What would be your exercise dosage/prescription of the exercises mentioned in part 2?
The Gait Guys In our experience, most inguinal hernias are due to weakness of the lower abdominal wall, in this case, the external obliques, not being able to fire appropriately to guard against the load. Exercise would most likely progress along the lin…es of skill 1st (can he perform the exercise appropriately), endurance 2nd (increased reps to increase capillarization, myoglobin content, mitochondrial content; beginning with 8-12 reps and increasing to 5-10 sets daily) and strength last (low reps, high weight; dependent on progress)
When the Short Toe Extensors Try to Rule the World !
A case of a runner with forefoot pain.
This is a runner of ours, one of the fastest young men in the state of illinois, top 10 in the country in mid-distance, top 20 in the USA in cross country.
He came in with left forefoot plantar pain. He explained (in a matter of words) that he was having pain at full forefoot loading at heel rise /push off.
We watched him walk, saw this visual problem present itself in dynamic motion (yup, no stop frame video on this one, not when you see it about 10 times a month !) and noted a subtle left lateral hip/pelvis shift past what would be considered normal for frontal plane mechanics.
On the table this is a photo of his feet. What do you see ?
We see a suspected (which you will try to confirm on examination) increase in short extensor (EDB, extensor digitorum brevis) muscle tone. Increased long extensor (EDL, extensor dig. longus muscle) tone would have represented itself with the distal toes also extended but here we see a relative dominance of the long flexors (FDL, Flexor dig. longus) with the heightened short flexor increase.
We also see more confirmation of heightened long flexor tone (FDL) by the degree of heavy callus formation on the very tip of the 2nd toe (it was on all 4 lateral toes but the photo is not clear enough to demonstrate). You can also see supporting evidence of heightened long flexor dominance by the subungual hematoma (bleeding under the 2nd toe nail). (How does this correlate ? Well, in most runners with excessive long flexor tone/use not only do they flex and claw so much in the shoes that the callus is on the tip of the toes but the nail also begins to lift as the nail is caught on the sock liner of the shoe as the toe flexes, slowly, mile by mile pulling the toe nail from the nail bed thus bleeding underneath it). Yes, it is NOT from the toes hitting the front end of the shoe !
Our examination confirmed weakness of all lumbrical muscles and of the flexor digitorum brevis and lateral quadratus plantae. The patient could feel the strength/engagement difference as compared to testing on the right foot of the same muscle groups (we always compare side to side, for us and for the patient’s awareness). The extensor digitorum brevis muscle mass on the lateral dorsum of the foot was tender as were the tendons along their course. There was also weakness higher up in the kinetic chain at the lower division of the transversus abdominus and internal abdominal oblique, and frontal plane hip stabilizers (gluteus medius; anterior-middle-and posterior divisions).The 2nd and 3rd metatarsal heads were remarkably tender to palpation and it was obvious that the metatarsal fat pads had migrated distally from the lumbrical muscle weakness.
Sometimes a grasp response by the long flexors can represent a propioceptive /balance deficit during single leg stance phase so be sure to test those centers as well (cerebellar, vision, joint position sense, inner ear-vestibular apparatus).
So, what is the take away for the non-medical person, the runner next door if you will ? Lets just say, symmetry wins and when asymmetry is apparent, bring it up to the people that do your body work. Hopefully, what you and they see will be assessed in a clinical light, and as a team you can get to the bottom of what is not working…….and in this case…..what was causing not only the plantar foot pain, but the left lateral hip sway outside the frontal plane.
———we are, The Gait Guys……Shawn and Ivo
The Quadratus plantae (Flexor accessorius) muscle. Do you have foot pain ?
(*There are two pictures here on the blog. Move your cursor over to the side of the photo and you will see that you can toggle between the photo and anatomy pic).
This is a great, but highly overlooked, muscle. The QP acts to assist in flexing the 2nd to 5th toes. Equally important is its effect of offsetting the oblique pull of the long toe flexor group (flexor digitorum longus). It has two heads, medial and lateral. The medial head is attached to the calcaneus, while the lateral head originates from the lateral border of the calcaneus, in front of the lateral process of the calcaneal tuberosity and the long plantar ligament.
The fact that we just love, and one that we believe is often overlooked is the acute angle at which the muscle heads attach into the tendons of the flexor digitorum longus (see picture) and has a rather dramatic alignment effect on the lateral 3 digits (since the line of pull on the long flexor tendons to these 3 digits is most dramatically changed by the purely posterior pull of the Quadratus Plantae. As you can see in this stripped down anatomy picture, without the QP pulling on the tendons of the FDL to these 3 lateral toes, those toes will have to curl medially and gently flex (*see the photo, a classic presentation!) By having a competent and active QP that oblique line of pull of the FDL /long flexors is rearranged to be more of a pure posterior pull and you will not see this classic lateral 3 digit curl and medial drift. This action is accentuated in a cavus foot type, where the pull of the FDL will be accentuated, due to the mechanical advantage afforded it and relative adduction of the forefoot with respect to the rear foot.
In the photo you can see a classic representation of a deficient Quadratus Plantae, in this case the patients lateral head was dramatically weaker than the medial, but both were weak. So, summary time….if you know your anatomy, know your biomechanics, and if you can test the muscle bundles specifically……..then you can see why form follows function (and in this case, why form has followed dysfunction). As we always say, “ya gotta know your stuff”, and you have to test what you suspect……there are other things that could also do this……so, let your eyes gain info, let your brain process and prove or disprove the information.
we are…….the gait guys !
Audio Podcast: The Gait Guys, Barefoot Concepts
This is a blast from the past from our parent company, The Homunuculus Group ! Our podcast from 2008 ! Still solid info several years later. Just trying to get you all up to speed before we start up the podcasts here in a month or so.
Here we talk about the foot, intrinsic foot musculature, Nike Free, Vibram 5Fingers and some of Dr. Ivo’s always brilliant neuromechanical discussions.
Enjoy !
Research to support that we are on target !
CONCLUSIONS AND CLINICAL RELEVANCE:
The abductor hallucis muscle acts as a dynamic elevator of the arch. Understanding this mechanism may change the way we understand and treat pes planus, posterior tibial tendon dysfunction, hallux valgus, and Charcot neuroarthropathy. (see our video attached, it is much of what we talked about in this video just a few months ago).
*From the article: “Most studies of degenerative flatfoot have focused on the posterior tibial muscle, an extrinsic muscle of the foot. However, there is evidence that the intrinsic muscles, in particular the abductor hallucis (ABH), are active during late stance and toe-off phases of gait.
RESULTS:
All eight specimens showed an origin from the posteromedial calcaneus and an insertion at the tibial sesamoid. All specimens also demonstrated a fascial sling in the hindfoot, lifting the abductor hallucis muscle to give it an inverted ‘V’ shaped configuration. Simulated contraction of the abductor hallucis muscle caused flexion and supination of the first metatarsal, inversion of the calcaneus, and external rotation of the tibia, consistent with elevation of the arch.
http://www.ncbi.nlm.nih.gov/pubmed/17559771
Foot Ankle Int. 2007 May;28(5):617-20.
Influence of the abductor hallucis muscle on the medial arch of the foot: a kinematic and anatomical cadaver study.
Wong YS. Island Sports Medicine & Surgery, Island Orthopaedic Group, #02-16 Gleneagles Medical Centre, 6 Napier Road, Singapore, 258499, Singapore. yueshuen@yahoo.com
A question from a doctor on the topic of limb alignment development.
/The following question was forwarded to us from an internist on the USA east coast.
Question:
“I have a large number of female patients, many of them elderly. I have noted that women in our society tend to progress to valgus knee deformity with age, and that TKR (total knee replacement) doesn’t seem to correct that deformity. Men tend more to the varus in our society. I had formerly chalked that up to inherit gender difference.
3 or 4 years ago, I had occasion to spend a lot of time waiting outside the main Tokyo train station and observed a large number of people coming and going. I observed the following:
1. Young women had legs that were either straight or varus.
2. Young women tended toward toeing in.
3. They did all this in ridiculous high heels.
After some thought, I tend to attribute it to prolonged sitting in sesa (knees folded under), though being barefoot or in slippers while inside may also contribute. Women in our society sit with their legs crossed. Additionally, extensive shoe wearing leads to foot pronation.
So, could you direct me to someone who might have an interest in this observation and can refer me to any research that might have been done in this area? I’ve had the dickens of a time trying to find anything on it, or even a specialized area of study that cares about such things.”
The GAIT GUYS RESPONSE:
Thanks for your confidence in us. Here are some thoughts:
Frontal plane deformities (or development) is twofold: genetic (and X linked) and developmental. Children usually go through a varus to straight to valgus to straight development (Ron Valmassey talks about this in his text Clinical Biomechanics of the Lower Extremities). Women generally have larger Q angles (from birth) and this angulation often causes assymetrical epiphyseal development (increased pressure on the lateral malleolus/tibial plateau stunts growth) with overgrowth of the medial femoral condyle. Developmental changes are secondary to weight (obesity causes increase in valgus angle) and posture/muscular devlopment. The increased genu valgus places weight medial to the midline (2nd met) of the foot and the foot accomodates by pronating (often excessively, as noted by both of you). This causes medial rotation of the lower leg and thigh, resulting in lengthening of the glutes (esp G max) resulting in stretch weakness and subsequent over reliance on the gastroc/soleus group for propulsion (remember this group tries to invert the heel in an attempt to cause supination once you go past midstance. Weak intrinsics (as pointed out by Dr Mark) further fuels this cycle. “W” sitting (sometimes a cultural development, as pointed out by Dr Birgit) plays in as well.
As for “toeing in”; may women have the combination of genu valgus with internal tibial torsion (often with femoral retroversion) which makes the condition difficult to treat (the rearfoot needs to be supported, but the forefoot needs to be valgus posted) otherwise the knee is placed outside the saggital plane and the meniscus becomes macerated due to conflicting biomechanics at the knee (Thus the short term fix with orthotics with a return of the pain later).
Yes, high heels and open back shoes are evil as are open backed shoes (we spoke at a convention in Chicago a few years back on this, before some of the research was out).
Thanks for allowing us to participate. below are some references for you.
-The GAIT GUYS…….Ivo and Shawn
______________________________________________________________
J Orthop Sports Phys Ther. 2008 Mar;38(3):137-49.
Differences in lower extremity anatomical and postural characteristics in males and females between maturation groups.
Shultz SJ, Nguyen AD, Schmitz RJ.Source
Applied Neuromechanics Research Laboratory, Department of Exercise and Sport Science, University of North Carolina at Greensboro, 1408 Walker Ave., Greensboro, NC 27402, USA. sjshultz@uncg.edu
RESULTS:
When comparing maturation groups, limb length, pelvic angle, and tibial torsion increased with maturation, and anterior knee laxity, genu recurvatum, tibiofemoral angle, and foot pronation decreased with maturation. Females had greater general joint laxity, hip anteversion, and tibiofemoral angles, and shorter femur and tibial lengths than males, regardless of maturation group. Maturational changes in knee laxity and quadriceps angles were sex dependent.
CONCLUSIONS:
We observed a general change of posture with maturation that began with greater knee valgus, knee recurvatum, and foot pronation in MatGrp1, then moved toward a relative straightening and external rotation of the knee, and supination of the foot in later maturation groups. While the majority of the measures changed similarly in males and females across maturation groups, decreases in quadriceps angles and anterior knee laxity were greater in males compared to females, and females were observed to have a more inwardly rotated hip and valgus knee posture, compared to males, particularly in later maturation groups.
_______________________________________________________________________
J Bone Joint Surg Br. 1995 Sep;77(5):729-32.
Development of the clinical tibiofemoral angle in normal adolescents. A study of 427 normal subjects from 10 to 16 years of age.
Cahuzac JP, Vardon D, Sales de Gauzy J.
Source
Centre Hospitalier Universitaire de Toulouse-Purpan, France.
Abstract
We measured the clinical tibiofemoral (TF) angle and the intercondylar (IC) or intermalleolar (IM) distance in 427 normal European children (212 male and 215 female) aged from 10 to 16 years. In our study, girls had a constant valgus (5.5 degrees) and displayed an IM distance of < 8 cm or an IC distance of < 4 cm. By contrast, boys had a varus evolution (4.4 degrees) during the last two years of growth and displayed an IM distance of < 4 cm or an IC distance of < 5 cm. Values above these for genu varum or genu valgum may require careful follow-up and evaluation.
The Psoas Muscle in a Runner: An Endurance Savy Muscle ?
/We received a question yesterday from a doctor. We felt it was worthy of sharing. Here it is, followed by our response.
Doctor: I do have a question about one of my athletes in particular. He is a fairly good (All-State in IL) high school track distance runner that has some left sided femoral acetabular impingement. He gets some capsular hip pain that also will ‘tighten up’ his low back during speed endurance/threshold running only. Moderate and easy distance runs cause no problem and neither do track/speed workouts. Only during speed endurance does he have issues. Upon evaluation after these sessions he does seem to have some low back QL tightness, but joint mobility is fairly good in his lumbar spine. He does show marked hypertonicity through his left hip joint. I’m not quite sure the mechanism here- why he would only flare up with speed endurance running- any insights?
Thanks a bunch and I look forward to hearing from you!
The Gait Guys response:
You state “only during speed endurance” does he have issues. We will assume you mean a long, hard anaerobic workout, which would tax type II b fibers. You also mention he has hypertonicity through his hip joint. Since the psoas crosses this joint it should be considered in sprinting and long, hard endurance activities, especially if the patient is flexor dominant. The psoas major muscle is composed of type I, IIA and IIX muscle fibers. It has a predominance of type IIA muscle fibers. The fiber type composition of the psoas major muscle was different between levels of its origin starting from the first lumbar to the fourth lumbar vertebra. The psoas major muscle has dynamic and postural functions, which supports the fact that it is the main flexor of the hip joint (dynamic function) and stabilizer of the lumbar spine, sacroiliac and hip joints (postural function). The cranial part of the psoas major muscle has a primarily postural role, whereas the caudal part of the muscle has a dynamic role. This is all very much supported in this journal article here (link) (http://www.ncbi.nlm.nih.gov/pubmed/19930517) and making it work in an endurance capacity would certainly cause issues. Flexor dominance is a common scenario we see clinically, due to insufficient extensor activity (and decreased vestibulo and reticulo spinal drive to extensors) and increased cortico spinal drive (to the flexors, including the iliopsoas). This would fuel the “bail out” (lack of stability) of the lower abs. The anterior tippage of the pelvis would drive the femur posteriorly, binding the joint (the opposite of an anterior femoral glide).
Video footage and some pix of your athlete would provide more insight for us to help.
we are……The Gait Guys
Tissue vibration in prolonged running.→
/The impact force in heel-toe running initiates vibrations of soft-tissue compartments of the leg that are heavily dampened by muscle activity. ….Relative to heel-strike, the maximum vibration intensity occurred significantly later in the fatigued condition. Thus, the protective mechanism of muscle tuning seems to be reduced in a fatigued muscle and the risk of potential harm to the tissue may increase.
J Biomech. 2011 Jan 4;44(1):116-20. Epub 2010 Sep 16.Order this article from Elsevier Ltd !!!!Tissue vibration in prolonged running.
Friesenbichler B, Stirling LM, Federolf P, Nigg BM.Source
Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, Alberta, Canada. berndf@kin.ucalgary.ca
