How are your eyes?
Test yourself on this video.
Why does this individual lean to the right during stance phase and have an increased arm swing on the L?
Details Manana!
Part 3: The Problematic Cross-over gait motor pattern. The final piece.
Here Dr. Shawn Allen of The Gait Guys summarizes this gait problem in running form. The Cross-over gait is a product of gluteus medius and abdominal weakness and leaves the runner with much frontal plane hip movement, very little separation of the knees and a “cross over” of the feet, rendering a near “tight rope” running appearance where the feet seem to land on a straight line path. In Part 3, Dr. Allen will discuss a more detailed specific method to fix this. You will see this problem in well over 50% of runners. This problem leads to injury at the hip, knee and foot levels quite frequently. To date we have not met anyone who had a good grasp on this clinical issue or a remedy quite like ours. Help us make this video go viral so we can help more runners with this problem. Forward it to your coaches, your friends, everyone.
Thanks for watching our video
Here Dr. Shawn Allen of The Gait Guys further discusses this gait problem in running form. The Cross-over gait is a product of gluteus medius and abdominal weakness and leaves the runner with much frontal plane hip movement, very little separation of the knees and a “cross over” of the feet, rendering a near “tight rope” running appearance where the feet seem to land on a straight line path. In Part 2, Dr. Allen will discuss a more detailed specific method to fix this. You will see this problem in well over 50% of runners. This problem leads to injury at the hip, knee and foot levels quite frequently. To date we have not met anyone who had a good grasp on this clinical issue or a remedy quite like ours. Help us make this video go viral so we can help more runners with this problem. Forward it to your coaches, your friends, everyone.
Thanks for watching our video
-Shawn and Ivo……The Gait Guys
Funny Nancy Sinatra clip on Zero-drop.com→
/Thanks to our friend, Bill Katovsy on http://zero-drop.com for sharing a classic Nancy Sinatra clip from the The Ed Sullivan Show
Video presentation: The Problematic Cross-Over Gait pattern. Part 1
Here Dr. Shawn Allen of The Gait Guys works with elite athlete Jack Driggs to reduce a power leak in his running form. The Cross-over gait is a product of gluteus medius and abdominal weakness and leaves the runner with much frontal plane hip movement, very little separation of the knees and a “cross over” of the feet, rendering a near “tight rope” running appearance where the feet seem to land on a straight line path. In Part 2, Dr. Allen will discuss a more detailed specific method to fix this. You will see this problem in well over 50% of runners. This problem leads to injury at the hip, knee and foot levels quite frequently. To date we have not met anyone who had a good grasp on this clinical issue or a remedy quite like ours. Help us make this video go viral so we can help more runners with this problem. Forward it to your coaches, your friends, everyone.
Thanks for watching our video, thanks for your time.
-Dr. Shawn Allen, The Gait Guys
The Truth About Treadmills: A Neurological Perspective
Gender differences in walking and running on level and inclined surfaces.
Chumanov ES, Wall-Scheffler C, Heiderscheit BC. Clin Biomech (Bristol, Avon). 2008 Dec;23(10):1260-8. Epub 2008 Sep 6.
What the Gait Guys have to say about this article:
This article highlights some of the differences in gait between males and females on treadmills. Though treadmills don’t necessarily represent real life, they are an approximation. While reading this article, please keep the following in mind:
1. the treadmill pulls the hip into extension and places a pull on the anterior hip musculature, especially the hip flexors including the rectus femoris, iliopsoas and iliacus. This causes a slow stretch of the muscle, activating the muscle spindles (Ia afferents) and causing a mm contraction (ie the stretch reflex). This acts to inhibit the posterior compartment of hip extensors (especially the glute max) through reciprocal inhibition, making it difficult to fire them.
2. Because the deck is moving, the knee is brought into extension, with stretch of the hamstrings, the quads become reciprocally inhibited (same mechanism above).
3. The moving deck also has a tendency to put the ankle in dorsiflexion, initiating a stretch reflex in the tricep surae (gastroc/soleus) facilitating toe off through here and pushing you through the gait cycle, rather than pulling you through (with your hip extensors).
4. the moving deck forces you to flex the thigh forward for the next footstrike (ie footstance), firing the RF, IP and Iliacus, and reciprocally inhibit the g max
If your core isn’t engaged, the pull of the rectus femoris and iliopsoas/iliacus pulls the ilia and pelvis into extension (ie increases the lordosis) and you reciprocally inhibit the erectors and increase reliance on the multifidus and rotatores, which have short lever arms and are supposed to be more proprioceptive in function. Can you say back pain?
In summary, treadmills are not the scourge of humanity, but do have some pitfalls for training, and equal amounts of “backwards” running should be employed (with great caution, mind you)
With that being said, lets look at the results: increased hip internal rotation and adduction, as well as more glute activity for the ladies. Not surprising considering women generally have a larger Q angle (17 +/- 3 degrees for females, 14 +/-3 degrees for males) and greater amounts of hip anteversion (average 14 degrees in females vs 8 in males). The larger Q angle places more stress at the medial knee (compression of the medial femoral condyle and usually increased pronation as the center of gravity over the foot is moved medially) and thus more control needed to slow pronation (from the glutes to control/augment internal rotation). Greater hip anteversion means the angle of the femoral head is greater than 12 degrees to the shaft of the femur. This moves the lower extremity into a more internally rotated position, approximating the origin and insertion of the adductors, making them easier to access. With an increased Q angle and easier access, greater demands are placed on adductors in single leg stance (which is considerably greater in running), This increased adductory moment places more demand on the gluteus medius (and contralateral QL) as well, to stabilize the pelvis and this correlates with speed and incline, also found in the study.
The take home message? Don’t throw away your treadmill! The treadmill can be an excellent diagnostic tool! Gluteal and adductor insufficiencies will be more visible (and probably more prevalent) in females, especially those running or walking on treadmills. The hip extension and ankle dorsiflexion moment created by a treadmill works against some of the stabilizing mechanisms (glute inhibition, ankle dorsiflexor inhibition) and help to highlight some of the subtle gait abnormailities you may miss otherwise.
Abstract from Article
BACKGROUND: Gender differences in kinematics during running have been speculated to be a contributing factor to the lower extremity injury rate disparity between men and women. Specifically, increased non-sagittal motion of the pelvis and hip has been implicated; however it is not known if this difference exists under a variety of locomotion conditions. The purpose of this study was to characterize gender differences in gait kinematics and muscle activities as a function of speed and surface incline and to determine if lower extremity anthropometrics contribute to these differences.
METHODS: Whole body kinematics of 34 healthy volunteers were recorded along with electromyography of muscles on the right lower limb while each subject walked at 1.2, 1.5, and 1.8m/s and ran at 1.8, 2.7, and 3.6m/s with surface inclinations of 0%, 10%, and 15% grade. Joint angles and muscle activities were compared between genders across each speed-incline condition. Pelvis and lower extremity segment lengths were also measured and compared.
FINDINGS: Females displayed greater peak hip internal rotation and adduction, as well as gluteus maximus activity for all conditions. Significant interactions (speed-gender, incline-gender) were present for the gluteus medius and vastus lateralis. Hip adduction during walking was moderately correlated to the ratio of bi-trochanteric width to leg length.
INTERPRETATION: Our findings indicate females display greater non-sagittal motion. Future studies are needed to better define the relationship of these differences to injury risk.
PMID: 18774631 [PubMed - indexed for MEDLINE]
Yup, we’re gait nerds….Don’t laugh….You are too if you are reading this…..
The Gait Guys: finding other uses for treadmills, other than for hanging the laundry…..
DVD's we have made, for sale.
/Here is a list of what we currently have available on DVD:
Item Name:
The Performance Core
Item #:
Performance I
Price/ea:
$39.95
• The Neuro Core: Abdominal neurological connection and control
• Purpose of the DVD in Core Training
• The Problems with Crunches and Sit Ups
• Bracing and Hollowing:
• Breathing and the Core
• Exercise: Bicycles- Right and Wrong
• Problems with Leg Lifts
• Exercise: The Non-Tripod Core Exercise for Oblique Activation
• Core Progression Order: …. Pathologic motor pattern compensations
• Exercise: Tripod with a Ball
• Exercise: the Abdominal “Chairs”
• Exercise: “Chairs” progressions continued…….. getting harder !
• Exercise: The Glute and Core Combine
• Exercise: The Hip Extension Pattern- Assessment and Progression
• Exercise: Hip Extension progressions continued…….getting harder
• Exercise: Bridges and Planks. The Right and Wrong and progressions
• Exercise: Motor Pattern Setting……The Sit to Stand Core
Item Name:
The Performance Squat
Item #:
Performance III
Price/ea:
$39.95
The Performance Squat – First phase development exercises and concepts
DVD Running time: 46 minutes
• The Reason for the Squat: Problems
• Where the Squat Begins: The Foot Tripod Concept
• The 3 Rockers of Movement in Gait and the Squat
• How the Foot Works: The Basics of what you need to know right now
• Another Look at the Foot: Foot types and Shoe Types
• The Foot and Pelvis Position: Its Impact on Movements and Squats
• Video Case Study of a Sprinter: Issues of Foot and Limb Positions
• A Brief (Very Brief) Discussion on Shoes and their issues with the Squat
• Exercise: The Texas Walk- A skill for early squat preparation and performance
• Exercise: The Potty Squat- The proper motor sequence
• Exercise: The Ball Squat- With Breathing concepts intertwined (critical neuro training)
• Exercise: The Hip Hike
• Exercise: Iso (Isometric) Drops Done Right (“Box Drops and Depth Drops”)
• Video Case Study: Drop Assessment frame-by-frame stop motion analysis
Item Name:
The Performance Theories
Item #:
Performance II
Price/ea:
$39.95
The Performance concepts: Dialogues on Training Concepts
DVD running time: 65 mintues
• What is the definition of the core and what does it entail ?
• Physiologic overflow of muscles with respect to joint motion
• Isotonic Exercise concepts
• Physiologic characteristics of muscle types
• Strength Training: Neural Adaptation
• Motor Pattern Muscle Compensation Concepts
• Exercise Prescription Concepts
• Hip Extension Motor Pattern: A discussion on compensations
• Neurologic Reciprocal Inhibition: Principles of joint movement and stability
• The Concept of Tight and Short Muscles: They are different
• Stretching: Good or Bad
Item Name:
Performance Series: Advanced Core
Item #:
Performance Series: Advanced Core
Price/ea:
$39.95
This DVD will take viewers into the next step of the Core. Doctor Allen and Doctor Waerlop will cover the always favorite exercise the sit-up. They will show the many ways athletes misuse the exercise and show a perfect sit-up. They will also demonstrate and explain other exercise to take athletes to the next level with their core development, including proper technique for lat pulls
Item Name:
Performance Series. Advanced Squat
Item #:
Advanced squat
Price/ea:
$39.95
This DVD will take viewers into the next step of the squat: the traditional squat. Doctor Allen and Doctor Waerlop will cover the perfect technique needed to develop the glutes instead of the quads in “the king of all exercises”. They will also cover fixing some errors as well as the lunge. Every body part from the foot to head placement will be covered.
Item Name:
Power block- Glute development
Item #:
Power block- Glute development
Price/ea:
$29.95
This DVD was filmed in Chris Korfist’s garage on a nice Sunday afternoon. Dr. Allen and Chris were developing a better way to do the glute power block and they decided to film their discussion. They discuss proper technique on many exercises which serve the purpose of developing explosive glutes and making sure the foot and glute are connected. Now your glute power can be more than “all show and no go.
Performance Core Trio: $99
Advanced Series Trio: $99
All 6 DVD’s: $179.95
We also have the following download available on Payloadz:
Foot Function and the Effects on the Core and Body Dynamics http://store.payloadz.com/go/?id=914689
email us at …… thegaitguys@gmail.com
Oh Pippa ! For God’s sake (or at least the Queen’s) start using your gluteus medius for crying out loud ! That opposite hip drop isn’t winning Dr. Allen over. !
(internal tibial torsion, knees approximating (due to the lack of left g. medius use, high ramp angle shoe……..mon dieu !……. great dress, bad shoe though ! )
Gluteus medius avoidance and blood pudding, apparently it’s what’s for brunch these days !
The Gait Guys
Gluteal Asymmetry: it means something !
Two photos above, toggle the red bar on the right. What do you see ?
Here is a case of a young football star we saw last night. He came in with a fresh right mid-belly quadriceps strain. This is a simple case if you know what the visuals are telling you. Just be sure you test your visuals (which are ASSUMPTIONS !), in other words, prove or disprove your hunches. What you SEE is not always what is present as the problem.
You can see clearly that in a prone position this chap has significant right gluteal underdevelopment compared to his left. This is a “quick peak” method of screening that i do on every patient when they turn over prone on the table as he is positioned.
There are many nuiances to this case, but here is what i was thinking the moment he told me about the injury…. “Doc, we were doing short 40 sprints, and my right quad just seized up?”.
I thought, hummmm….. i wonder if he was anchoring his thigh into his glutes and abdominals. Lets test his glutes first. If the glute is weak then i can assume he is quadriceps dominant and not anchoring the limb into the pelvis and core correctly. If he is gluteal inhibited, that means he will have underdeveloped glute if it has been there long enough. And if so, the glute cannot power hip extension so that range will be deficient. Sagittal extension will occur the next level above (lumbar spine) and inhibit the lower abdominals on the right. The hamstrings can also be called in to drive hip extension (welcome to the world of chronic hamstring issues in athletes). And if hip extension is limited, then internal rotation is likely somewhat limited. And if internal hip rotation and hip extension are limited then ankle dorsiflexion (“ankle rocker”) will be impaired and limited during midstance thus creating early heel rise during push off thus forcing the calf muscles to create more body mass lift than forward propulsion.
I put him on the table……saw the atrophied right gluteal……and proceeded to confirm all of the above. Treatment is based on figuring out who started this whole mess and reversing the functional pathologies in the pattern that makes sense to that patient’s neurologic system. It can be different for each person. You cannot “cook book” good manual medicine.
Prove or disprove your differential diagnoses or hunches……. make sure your direction is the right one. We all know what ASSUMING lead us to ……. it makes a donkey out of all of us.
We are….. The Gait Guys……. just a couple of donkeys.
Factors that adversely effect the natural history of the pronated foot.→
/“Risk Factors that may adversely modify the natural history of the pediatric pronated foot." Clin Podiatr Med Surg. 2000 Jul;17(3):397-417. Napolitano C, Walsh S, Mahoney L, McCrea J.Department of Orthopaedic Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
This article is a nice follow up to the video post from yesterday. The article talks about the flexible and rigid flat foot. In yesterday’s video example we are dealing with a flexible flat foot deformity. When he was non-weightbearing (which wasn’t seen in the video) he formed an arch. As you can see in the video upon weightbearing the arch disappears but you can see that with the correct patterning employed, he can find an arch. This is what we term a flexible flat foot deformity. These types of feet have potential if there is sufficient muscular ability and if hyperlaxity in the ligamentous system can be overcome by neuromuscular support. If not, an orthotic may need to be utilized and be assistive. The rigid flat foot, is one that does not form a competent arch, ever. These feet are what they are, flat. But, keep in mind…… some genetics do render a competent flatter foot. Some of the strongest feet we have seen are on very low arched people / runners. So, flatter does not always mean weak, be careful. What you see is not necessarily what you get, even a rusted out Ford Pinto might have a Ferrari engine in it……. you just don’t know by looking, you have to test the competency of the foot (another example, look at Arnold Palmer’s golf swing, it isn’t the prettiest swing by any means…… but you probably wouldn’t bet a penny against him even these days, if you get our drift.)
As the abstract says. "Normally developing infants have a flexible flatfoot and gradually develop a normal arch during the first decade of life." The key word is NORMALLY. You must consider risk factors that may affect the foot in its overall development. The risk factors include ligamentous laxity, obesity, rotational deformities, tibial influence, pathological tibia varum, equinus, presence of an os tibiale externum, and tarsal coalitions.
Again, this is a nice follow up to our video from yesterday and brings home some additional good points to cogitate over. We knew we had a flexible flat foot with potential. Knowing what you are starting with it vital for your success in treating the problem, and vital in determining long term success.
We are, The Gait Guys ………. and even a bit geeky in neurodevelopmental physiology. (Yes, we have no life.)
Shawn and Ivo
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Abstract of the Journal Article……. the link to the article is at the top of the blog post if you wish to obtain the article for further study.
Here is their abstract:
"Flatfoot is one of the most common conditions seen in pediatric podiatry practice. There is no universally accepted definition for flatfoot. Flatfoot is a term used to describe a recognizable clinical deformity created by malalignment at several adjacent joints. Clinically, a flatfoot is one that has a low or absent longitudinal arch. Determining flexibility (physiologic) or rigidity (pathologic) is the first step in management. A flexible flat foot will have an arch that is present in open kinetic chain (off weight-bearing) and lost in closed kinetic chain (weight-bearing). A rigid flatfoot has loss of the longitudinal arch height in open and closed kinetic chain. According to Mosca, "The anatomic characteristics of a flatfoot are excessive eversion of the subtalar complex during weight-bearing with plantarflexion of the talus, plantarflexion of the calcaneus in relation to the tibia, a dorsiflexed and abducted navicular and a supinated forefoot.” Normally developing infants have a flexible flatfoot and gradually develop a normal arch during the first decade of life. When evaluating an infant for a pronated condition, the examiner must also consider other risk factors that may affect the foot in its overall development. These contributing factors will play a role in the development of a treatment plan. The risk factors include ligamentous laxity, obesity, rotational deformities, tibial influence, pathological tibia varum, equinus, presence of an os tibiale externum, and tarsal coalitions. The authors realize other less significant factors exist but are not as detrimental to the foot as the primary ones discussed in depth. The primary risk factors that affect the pronated foot have been outlined. The clinician should always examine for these conditions when presented with a child exhibiting pronatory changes. A thorough explanation to the parents as to the consequential effects of these risk factors and their effects on the pediatric pronated foot is paramount to providing an acceptable comprehensive treatment program. Children often are noncompliant with such treatments as stretching and orthotic maintenance. The support of the parents is crucial to maintaining an effective treatment program continued at home.“
