Shoe Review: The Brooks Pure Project Line.

Ok, we have been meaning to get to this for months but are just getting around to it now. So for those of you who have been hounding us for the data, sorry, but thanks for keeping us on it.  Here are the specs for the EVA midsole thicknesses and ramp numbers. Remember, ramp angle can only be given if the length of the foot is known, so those numbers will not be given here.  What is good to know is that we have another shoe in the category of the Saucony Kinvara, the Brooks Pure Project line.  Below you will see the specs for all 4 in the line up.  All have a 4 mm forefoot to rearfoot rise, in other words……the heel is only 4 mm lifted compared to the plane the forefoot is resting on.  This still changes the biomechanics and neuromechanics that we were all given at birth that would really prefer the rear and forefoot to be on the same plane 1:1 ratio although a 4 mm rise is pretty darn close !  Our man beef with the Saucony Kinvara is that they did not use much black rubber outsole on the shoe other than the small thin layer glued to the traction lugs  throughout the mid and forefoot.  We have found that these shoes barely get 200 miles on them (give or take) and we and all our clients are already into the EVA midsole which wears down as fast as bubble gum might.  This is a serious design flaw in our opinion. We like this shoe and like it for many clients but we are having to explain that they will burn through them in under 350 miles most likely.  So, we are excited for the October Release of the Brooks Pure Project line……in the hopes that they have not made this same design choice.  Remember, if you are new to this line of shoes, the 4mm lift variety, wean down from your old 12-20mm rear-foot lift trainers and try these with your shorter runs until skill, endurance and strength are achieved in this new foot orientation.  It is gonna take some people some time to accomodate.  (remember, there is no substitute for a doctor’s exam and watchful eye to see if you can even entertain this shoe type with your foot type). (Do not be fooled into believing there is going to be much stability provided by these shoes.  They are all pretty neutral. If you have a  forefoot varus, you better look in another direction !)

Here is the data …….

Brooks Pure Connect

lightest and most flexible shoe in the line, the PureConnect puts as little as necessary between the runner and road. 7.2 oz men, 6.5 oz women – 14 mm heel:10 mm forefoot

Brooks Pure Flow

For runners who want to connect with the run without losing the comfort
of dynamic cushioning. 8.7 oz men, 7.5 oz women – 18 mm heel :14 mm forefoot

Brooks Pure Cadence

Runners who need more supportive features can still experience the feel
of a more natural stride. 9.5 oz men, 8.3 oz women – 18 mm heel:14 mm forefoot

Brooks Pure Grit

Trail runners will love the hug-your-foot upper, slim midsole, and pliable
yet protective outsole. 8.9 oz men, 7.6 oz women – 15 mm heel:11mm forefoot

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Good Morning, everyone!

Here is another cool take on Trinity from “The Matrix” that we did for our buds at The Natural Running Center.com and Zero-Drop.com. Click on the photo to be transported……

http://naturalrunningcenter.com/2011/07/24/trinity-outruns-agent-brown-the-matrix-gait-guys-movies/

Deano !

It is Friday here on the Gait Guys and we try to keep things light.  No Antetorsion or forefoot varus stuff here today………. today is Footloose Fridays !

Today we leave it up to good old Dean Martin to bring out the relatives !

Here we see Uncle Leonard doing the wild thing !

have a good weekend everyone.

Photographs of a 6 yr. old.

What do you see ? How does the alignment look ? Are they developing normally ?
At what point should you intervene to ensure proper alignment and
development occurs in this child ? Can we standardize our visual
screen to fit all cases in all children ?  So many questions !

* this case goes very nicely with a prior case on the blog published on July 15th.

Click back and forth between the two photos above on the blog.  Youcan see that in the first photo that when the feet are parallel, the patellae point inward (normal compensation).

In photo 2, we can see that when we put the patellae in the saggittal plane (pointing
forward) the foot progression angle is severely positive (externally postured or out-toed).  

This is a severe case of FEMORAL ANTETORSION
with compensatory EXTERNAL TIBIAL TORSION.  The external tibial
torsion is an external spin along the long axis of the shaft in a
response to try to correct alignment.  You can see that in this case
there is no happy medium.  The torsion in the long bones is so extreme
that either the knees are positioned inwards when the feet are
normally aligned or the feet are spun outwards when the knees are
properly aligned.  Regardless, there is much abnormal stress on the
hip and knee joints and the labrum of the hip and menisci of the knees
not to mention the challenges into the foot mechanics and gait.

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Taking this into a gait perspective:

Patients with antetorsion are forced to externally rotate the limbs to bring the knee forward to a normal alignment from an internally rotated position.

This takes up some, occasionally all, of the lateral (external) rotation needed for the hips to function normally during gait causing compensatory rotation of the spine during single leg stance; the spine being really the only place the rotation can be achieved.

Normally, during gait the hip rotates laterally from toe off through to heel strike and is present during the initial loading response.

When this rotation does not occur in the hip, it must occur as a compensatory motion somewhere else in the kinetic chain and this is usually the pelvis or lumbar spinal joints.

Furthermore, the abnormal alignment of the femoral head in the acetabulum can repetitively irritate the hip joint and labrum let alone place abnormal torque on the tib-femoral joint (knee).

Antetorsion patients who compensate and realign the feet to a normal progression angle via tibial external torsion will force the femoral head anteriorly into the anterior hip capsule and this is a common source of pain.  It is a “hammocking effect” into the anterior capsule and it can leave the femoral head and it’s cartilage uncovered and uncompressed thus advancing arthritis degeneration. 

This is a similar symptom phenomenon as in “anterior femoral glide syndrome” as described by Shirley Sahrmann.  It is not uncommon to see a sway back lumbar posture in these clients.

These patients may have anterior contractile tissue deficits, namely stretch-weak iliopsoas as described by Kendall.

Remember to check for limb length symmetry in these clients who’s anteversion is not symmetrical. 

Watch for a future series on torsions and versions

We may be twisted, but the last time we looked, we are still …… The Gait Guys

1 + 1 usually = 2

take yesterdays tibialis posterior dialogue……. translate that to the resultant foot structure that can occur when there is complete insufficiency in that muscle (a valgus heel, midfoot collapse and an abducted forefoot) and then understand that this resultant foot will have a first ray complex insufficiency whereby 1st metatarsal head anchoring will be compromised. Now watch todays video by Dr. Waerlop and put the two together.  Yes, tib posterior insufficiency can be a cause of bunion-hallux valgus formation.

1 + 1 = 2   

not only are we foot geeks, but as you can see we missed our calling in mathematics as well !

Shawn and Ivo …….. 

More on Bunions: proof we know what we are talking about→

[Sequential lateral soft-tissue release of the big toe: an anatomic trial].

Z Orthop Unfall. 2007 May-Jun;145(3):322-6. Roth KE, Waldecker U, Meurer A.Source: Abteilung für Orthopädie, Universitätsklinik Mainz. roth@orthopaedie.klinik.uni-mainz.de

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Summary:  Dr. Ivo in his brief video today discussed the altering of the origin/insertion effects on the adductor hallucis and the big toe.  When the first metatarsal is not anchored on the ground the lateral toes cannot be pulled towards the medial foot, instead the lateral foot acts as the anchor and the big toe/hallux is pulled laterally towards the anchor rendering the all famous bunion/hallux valgus.

This surgical study pretty much proves this principle.

This study showed that when the soft tissues (capsule, tendon and ligament) are surgically released, the contractile affects on the joint angle of the bunion/hallux valgus are released and the hallux valgus angle was predominantly and significantly improved.  A significant correction of the intermetatarsal angle did not take place however.

Kind of a radical procedure ultimately destabilizing the joint and medial foot structure…….but hey……whatever floats your surgical boat.  To each his own.  We suppose that on a case by case basis all options need to be considered.

……we’re still the gait guys…….. with no scalpels, but with big oars

Biomechanical and Clinical Factors Related to Stage I Posterior Tibial Tendon Dysfunction.     Rabbito M, Pohl MB, Humble N, Ferber R.

CONCLUSION:

The increased foot pronation is hypothesized to place greater strain on the posterior tibialis muscle, which may partially explain the progressive nature of this condition. J Orthop Sports Phys Ther, Epub 12 July 2011. doi:10.2519/jospt.2011.3545.

What the Gait Guys say about this article:

Do these results really surprise us? The Tibialis posterior (TP) is one of the more important extrinsic arch stabilizing muscles. It is a stance phase muscle that fires from the loading response through terminal stance. It ‘s proximal attachments are from the posterior aspect of the tibia, fibula and interosseous membrane and its distal attachments are the undersurface of all the tarsal’s except the talus and the bases of all the metatarsals except the first.

Since the foot is usually planted when it fires, we must look at its closed chain function (how does it function when the foot/insertion is fixed on the ground), which is predominantly maintenance of the medial longitudinal arch, with minor contributions to the transverse metatarsal and lateral longitudinal arches; flexion and adduction of the tarsal’s and metatarsals, eccentric slowing of anterior translation of the tibia during ankle rocker. It is also an external rotator of the lower leg and is the prime muscle which decelerates internal rotation of the tibia and pronation. As the origin and insertion are concentrically brought towards each other during early passive heel lift it becomes a powerful plantarflexor and inverter of the rearfoot.  There is also a  component of ankle stabilization via posterior compression of the tarsal’s and adduction of the tibia and fibula.

Alas, there is soooo much more than the typical open chain function of plantar flexion, adduction and inversion. Perhaps it is some of these other, closed chain functions, that cause the “progressive nature of the condition”?

We remain…The Gait Guys…Going above and beyond basic function and biomechanics.

Ancient Footprints Reveal Earliest Signs of Human-Like Gait→

Recent trails found in Tanzania suggest fully upright walking began 3.7 million years ago.

The footprints they found suggest that the fully upright gait of present day humans existed about 2 million years prior than previously thought !

“The shape of the human foot is probably one of the most obvious differences between us and our nearest living relatives, the great apes. The difference in foot function is thought to be linked to the fact that humans spend all of their time on the ground, but there has been a lot of debate as to when in the fossil record these changes occurred. Our work shows that there is considerably more functional overlap than previously expected,” Bill Sellers, of the University of Manchester’s Faculty of Life Sciences, said in a University of Liverpool news release.

Known as the Laetoli trail, the 11 individual footprints found in Tanzania are the earliest known footprints made by human ancestors. The prints reveal features of a gait with more similarities to the way modern humans walk than the bipedal walking of chimpanzees, orangutans and gorillas.

The study found that instead of the crouched walking posture with mid foot push off of present day apes, the researchers found that these new found foot impressions categorize a bipedal upright walk driven off the front of the foot and largely the big toe highly representative of the  human gait of today.

This study suggested that Australopithecus afarensis had a much different build than that of modern day humans.  Their build had a long torso and short legs.  A reverse of modern man’s physique.  Thus, this studies researchers proposed that this species could only ambulate bipedally for short distances. 

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Click on the title link at the top  for the link to the copywrited article. Excerpts quoted from the article.

So, if you are a believer in evolution (or, have been watching “Ancient Aliens”, the Docu-series on The History Channel   {wry humor}) ……. then this is worthy of longer term memory.

Q.  Why is this article here and why do we deem it important to share with you ? 

A. Because history is full of clues. To be good in this field of gait and motion, we feel that you should have a decent foundation in anatomy, neurology and physiology, store facts, keep an open mind, study the research (both old and new), do not discount historical information merely because it is old, and consider all options and possibilities so that knowledge can follow from more current experiences).

(Fact: such memory items are encoded by your hippocampus, entorhinal cortex, and perirhinal cortex, but consolidated and stored mostly (we think) in your temporal cortex.

Tidbit on memory:

In gait, Procedural memory refers to movements of the body, such as how exactly to use use a phone, walk or ride a bicycle. This type of memory is encoded and probably stored by the cerebellum and the striatum.

have a good week everyone…….. The Gait Aliens……. Shawn and Ivo

null→

Dr Mark puts succinctly what we have been saying all along; it is the rare person that can begin the barefoot or minimalist running journey with out proper education, sufficient skill, muscular endurance or appropriate strength.

Promoting gait literacy…..We ARE the Gait Guys….

Imagine having to walk like this AND wear a kilt!

nothing like consciously creating pathologic gait cycles………. as if we don’t have anything better to do. 

In the spirit of traditional medicine…….. “if it hurts when you do this, then don’t do it !”

Have a great Friday

Shawn and Ivo………. two fellas marching on to our own beat

The Mighty Quadratus: Part 2  The Quadratus and Gait

Acting unilaterally without the ipsilateral foot fixed on the ground, it can raise the ilia on the side of contraction (as in a pull up or side bend on a Roman chair). The quadratus lumborum was more active than other muscles during isometric side support postures where the body is held horizontally almost parallel to the floor as the subjects supported themselves on one elbow on the floor together with both feet. 

It is active during single limb support during stance phase of gait on the contralateral side (along with the external oblique) to elevate the ilium. This is coupled with the ipsilateral anterior fibers of the gluteus medius and minimus pulling the iliac crest toward the stable femur.

Sahrmann states “the QL is optimally situated to provide control of lateral flexion to the opposite side via its eccentric contraction to provide control of the return from lateral flexion via its concentric contraction. The muscle is also positioned to play a role in the rotation that occurs between the pelvis and spine during walking”. This makes you really think about the interplay of this muscle, and another stance phase stabilizer, the psoas major, which attaches opposite the QL on the anterior aspect of the vertebral body, IN FRONT of the transverse process.

Acting bilaterally, it extends the lumbar spine, deepening the lordosis and acting to limit anterior shear of the vertebral bodies.

It is able to stabilize the 12^th rib during forced expiration, thus acting as an accessory muscle of respiration. This fixation is important when we need to superimpose pelvic movements upon it. Furthermore, it increased activation in response to increasing compression in static upright standing postures.

Bottom Line?:

Think of the QL, especially during gait abnormalities or recalcitrant low back pain. The more it is stressed, the more it is activated. If someone had mild weakness of the stance leg gluteus medius, it may be called into play to pick up some of the slack. Expect to see increased activity paraspinally, with particular attention paid to the 12 rib attachments.

In our flexor dominant society, the QL may play a role in generating unilateral shear forces on the lumbar spine (along with the ipsilateral psoas), especially in individuals with poor ankle rocker or decreased hip extension.

The QL: it’s not only for breakfast anymore…..

We still are…The Gait guys

do you know we are on FACEBOOK and TWitter ?→

Do you know we are on facebook and twitter as well ?

sometimes things that are slightly less worthy, but still helpful, are put on our FACEBOOK PAGE…….see links here

feel free to LIKE us so you get the daily feeds and notices immediately so that you do not have to constantly check back to the blog here for updates.  All updates are immediately notified on FAcebook so you will get notification immediately there.

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http://www.facebook.com/pages/The-Gait-Guys/169366033103080

The Mighty Quadratus: Part 1

Today we explore the Quadratus lumborum and its functional anatomy.

It is useful to think of the QL as having two divisions. Though they can’t act independently, it helps when thinking about it from a functional standpoint. The first, or lower division arises from the medial portion of the iliac crest and adjacent iliolumbar ligament, inserting onto the transverse processes of the lumbar vertebrae, running in the coronal plane from lateral to medial and posterior to anterior in the saggital plane. The second, or upper division arises from the lumbar transverse processes of the upper 4 lumbar vertebrae at their upper and lower corners and insert into the inferior border of the 12th rib, running in the coronal plane from medial to lateral and in the saggital plane from anterior to posterir. Approximately half of the fascicles of this second division act on the twelfth rib; the rest act on the lumbar spine.

The QL is primarily a coronal plane stabilizer. Acting unilaterally with the lower body fixed and feet on the ground, it laterally bends the lumbar spine. Normally, with lateral bending of the lumbar spine while in a lordotic posture, we see what is called type I coupled motion, or deviation of the spinous process to the side of lateral bending. The QL would oppose (or perhaps more correctly attenuate) this motion, having a moment of moving the spinous process to the opposite side of contraction. Perhaps it is when the QL become dysfunctional, pulling the ipsilateral transverse process outward (and thus moving the spinous to the opposite side) that we see aberrant (or Type II) motion in the lumbar spine. It is interesting that when the lumbar spine is flexed (as in sitting or forward bending) type II motion is normal, and now the QL becomes prime mover. Due to the angle of attachment here, it can create shear and potentially contribute to injury.

Whew!! Stay tuned for the QL and gait tomorrow!

Yup, if you are reading this, you are a gait geek too!!

Shawn and Ivo

A brief gait review from a youtube clip we found:

at :03 notice the shrugged shoulders and trapezius activation, forcing respirations to the upper lung fields. This also facilitates the scalene muscles in the neck (which is probably one of the reasons they flex their neck). Breathing from here is shallow and inefficient. This action (shrugging the shoulders) activates the upper trap and deactivates the lats (which are the functional link between the upper and lower extremities)

at 05: they begin to flex the lumbar spine

at :06 they flex at the waist as well as the neck. This rounds the spine and puts the glutes at a mechanical disadvantage for extending the hips and limiting some of the driving power. They then become hamstring dependent, which isn’t as efficient. Dropping the head defacilitates the extensor muscles neurologically, so they will have some power loss (as well as stiffness loss) as well. They keep their neck flexed till :07, where they really begin to pick up more speed. The torso remains flexed at the waist through most of the footage.

it appears at :07 that the left foot strikes the ground in eversion bottom of foot pointing away from camera) indicating some degree of forefoot pronation. A shot from behind would be helpful to confirm this

The arm swing appears asymmetrical from left to right, right being greater both forward and especially backward. I would wonder what they are hiding (biomechanically) there (so are they increased on the right or less on the left?. Here is where foot age from behind would be instructional).

Ok folks. Hope you enjoyed the ride!

we still are….The Gait Guys…..

The Risks for Forefoot Strike running. YOU NEED TO READ THIS ! YES, YOU !→

OK, we are going to go on a rant here…… it is time.

We have been talking about problems of forefoot strike for some time now. We like a midfoot strike, and we have research-based, well founded logic to our opinion.  A Forefoot strike reduces the amount of pronation possible for shock absorption because  when the foot is plantarflexed it is in a supinated state which is reserved for a rigid propulsive mechanism.  At impact some degree of pronation is necessary otherwise force attenuation must occur elsewhere in the kinetic chain otherwise it creates bone, joint or soft tissue pathology/injury somewhere in the chain.  However, one of the major issues we have been pounding our fists on the table about, for years, are forefoot orientation anomalies.  A significant portion of the population have forefoot types of varus or valgus, some flexible and some more rigid, some compensated and some uncompenated (yes, this is difficult stuff……but if you are going to make orthotics or if you are going to be a runner or sell or make shoes or coach or even speak about running form styles…… you had better know this stuff or we will call you out on it). 

No one is talking about this stuff except The Gait Guys. 

Is this because no one knows about it ? Maybe.

It is because those in the running fields do not understand it well ? Likely. 

It is because it creates fear and anxiety about selling shoes ? Probably.

Is it because it complicates shoe fabrication? Likely. 

Does that make it right to just ignore it all together ? No ! 

With a forefoot strike into one of these “pathologic” forefoot types the anatomical variance is accentuated.  In this scenario, a varus foot type that lands and subsequently has not choice but to drive hyperpronation strain not only suffers from the increased pronatory collapse but they are unable to acquire a subsequent rigid toe off which in itself can drive further pathology.  And a valgus forefoot strike is even more rigid than a neutral forefoot strike impact and they are also at risk for inversion strain on the lateral foot.  A midfoot strike can reduce some of these consequences by setting the foot up for a preparatory transition. We know this, we see this everyday, it is what we do. These runners need to be categorized and educated as to why their injury is present or chronically persists, and why we insist a program to reteach a midfoot strike. 

As always, if the doctor knows what anatomy presents itself with the client, and adequately educates the athlete……..then a good relationship and outcome will ensue. Additionally, a change in shoe is not  uncommon when their strike mechanics change.

Here is what spurred our soapbox rant today…….. thanks Lower Extremity Review for bringing the June ASCM to light early !!!
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from LER, Link is above:

“The frequency content of vertical ground reaction forces generated during running differ among forefoot strikers and rearfoot strikers, and this may have implications for injury risk, according to findings from the University of Massachusetts presented in June at the ACSM meeting.

Researchers assessed frequency amplitude and power in 10 natural rearfoot strikers and 10 natural forefoot strikers as they ran across a force platform.

At frequencies above 9 Hz, rearfoot strikers’ amplitude exceeded that of forefoot strikers. Similarly, above 22 Hz, power was significantly greater in rearfoot strikers. This is consistent with previous reports that only rearfoot strikers have an impact peak, which occurs between 10 Hz and 20 Hz.

But between 4 Hz and 7 Hz, amplitudes were higher in forefoot strikers. And for frequencies less than 6 Hz and between 9 Hz and 11 Hz, power was greater in forefoot strikers.

Because the body attenuates shock differently at different frequencies, the findings could suggest that even forefoot strikers (including most barefoot runners) may be at risk for certain injuries despite lacking an impact peak.”

Time for a quick pedograph case:

This person presented with arch pain and occasional forefoot pain.

Note the increased size (length) of the heel print with blunting at the anterior most aspect. The midfoot impression is  increased, revealing collapsing medial longitudinal arches. The forefoot print has increased pressures over the 2^nd metatarsal heads bilaterally, and the 1^st on the left. She claws with toes 2-4 bilaterally.

This demonstrates poor intrinsic stability of the foot (as evidenced by the increased heel impression and midfoot collapse) and well as decreased ankle rocker (as evidenced by the increased forefoot pressures).

We also see increased ink under the distal second digit (esp on the right). This suggests some possible incompetence of the first ray complex and big toe, which is represented by the medial ink presentation under the great toe (suggesting a pinch callus, which is seen when there is spin of the foot and insufficient great toe anchoring and push off).  When the great toe function is compromised, we tend to see increased activity of the 2nd digit long flexors, represented well here by increased ink under the 2nd toe.

The pedograph truly does provide a window to the gait cycle!

We remain: Gait Geeks

Another Gait Guys remake for our buds at The Natural Running Center (www.naturalrunningcenter.com) and zero-drop.com! Check out what we have to say about Cary Grant’s gait!

Shawn and Ivo

Even cadaver feet speak volumes...→

We hope you are thinking about muscles in a CLOSED CHAIN fashion, rather than open chain. In other words, when the foot is on the ground, it becomes the fixed point and the more proximal portion is the moveable portion. This paper shows (as Dr Allen did in his most excellent youtube video about foot function   http://youtu.be/TyRE9dReVTE  ) that the abductor hallicus is a dynamic elevator of the arch, in addition to being a great toe dorsiflexor and rear foot inverter!

Yup..we are definitely Gait Nerds….

A brief note on internal hip rotation from a cyclists perspective.

Today is Stage 14 in the Tour De France. We are big fans and we treat tons of Triathletes. So, it seemed perfect to do a little bike fit and mechanics today.

On the subject of cyclists, we have noted many have these 3 anatomical traits: femoral retoversion (see recent blog posts this week), tibial varum, forefoot varus. If you look at these closely, they all tend to supinate the foot foot more and make it a better lever. These folks are way better cyclists than runners.

With a FF varus, they often compensate on the down stroke to make the foot flat on the pedal (to use the 1st MTP); if they are retroverted, they have limited hip internal rotation to begin with and now you are asking them to internally rotate more, which leads to hip pain and at times, labral injuries.

Look at the attached clip, R leg; note how it comes closer to the center bar and the position of the knee; also look at the forefoot.

Yup…The Gait Guys…We do bikes too!

Redemption ! …..lots of midfoot strike………. !!!!

The Gait Guys are now on their way to the BAR, from the BEACH, from the BOAT.

we can retire (at least for the weekend !…….thx for the great video Runblogger !