Gait ataxia and gluten. Yup, what you eat can affect your running and gait.→

Ok, lets exaggerate things a bit to make our point. But keep this in mind, this is some people, and they do not know it.

Think about how many people didn’t PR at the New York Marathon last week because they carb loaded on pasta and bread (and beer).  How many might have a subtle gluten sensitivity and gluten ataxia ?  Read on … .

Ataxia is a pathological lack of muscle motor coordination. Gait ataxia would be an impairment of the muscles necessary for normal gait.  Here at The Gait Guys we are well aware that there are many other causes of gait disorders other than biomechanical. We have decided to start to add a few of these other metabolic causes of gait problems, just so you are aware.  We will start off here with Gluten ataxia.  And with the plethora of gluten infused foods these days this is one you at least need to be aware of.  Both of The Gait Guys are gluten free in our diets, and because of what we know about gluten and its effects on the body, we encourage our patients to avoid it (yup, beer, pizza, bread, pasta…. anything that seems to satisfy the soul. That doesn’t mean we are soul less……. just at times sole-less…….. oh, that was bad !)

So, if you are concerned you have gluten sensitivity issues, either get tested or just cut it out of your diet.  The University of Maryland study and Annals of Medicine last year stated that since 1974 the rate of autoimmune diseases such as rheumatoid arthritis, lupus and multiple sclerosis has doubled every 15 years and gluten is suspect.

the researchers found that the number of people with blood markers for celiac disease increased steadily from one in 501 in 1974 to one in 219 in 1989. In 2003, a widely cited study conducted by the celiac research center placed the number of people with celiac disease in the U.S. at one in 133.

“You’re not necessarily born with celiac disease,” says Carlo Catassi, M.D., of the Universita Politecnica delle Marche in Italy. Dr. Catassi is the lead author of the paper and co-director of the Center for Celiac Research. “Our findings show that some people develop celiac disease quite late in life.” The trend is supported by clinical data from the center, notes Dr. Catassi, who urges physicians to consider screening their elderly patients.

“Our study shows that environmental factors cause an individual’s immune system to lose tolerance to gluten, given the fact that genetics was not a factor in our study since we followed the same individuals over time." 

The recent findings challenge the common speculation that the loss of gluten tolerance resulting in the disease usually develops in childhood and in fact shows that some people develop celiac disease quite late in life. The gluten related disorders are being seen to increase in those in their 50s and above. The finding contradicts the common wisdom that nothing can be done to prevent autoimmune disease unless the triggers that cause autoimmunity are identified and subtracted. Gluten is one of the triggers for celiac disease. But if individuals can tolerate gluten for many decades before developing celiac disease, some environmental factor or factors other than gluten must be in play, notes Dr. Fasano. What do they say ? your genes load the gun, your environment pulls the trigger ? Something like that.

Defining gluten: That mixture of proteins, including gliadins and glutelins, found in wheat grains, which are not soluble in water and which give wheat dough its elastic texture. Any of the prolamins found in cereal grains, especially the prolamins in wheat, rye, barley, and possibly oats, that cause digestive disorders such as celiac disease.

Sporadic ataxia could be from gluten ataxia. Sporadic ataxia is ataxia that does not have a genetic or other known cause. More often than not, sporadic ataxia turns out to have a link to gluten intolerance and celiac disease.

What is Gluten Ataxia?

Gluten ataxia is an autoimmune disease that is brought on by ingestion of gluten in people who are genetically predisposed. The most common symptoms of gluten ataxia, which is most closely associated with cerebellar ataxia, are:

1. Poor coordination in physical movements and poor control of muscle movement
2. Inability to control the speed or the power of a physical movement
3. Headaches
4. Inability to speak or form words correctly; speech impediments

There are also three general areas of ataxia: cerebellar, sensory and vestibular. The ataxia discussed in this article is essentially caused by damage to the cerebellum. Dr. Ivo has done videos on our youtube channel that discusses the cerebellum as the portion of the brain responsible for motor pattern coordination and balance . Of course there are other causes for ataxia other than gluten sensitivity and are generally ruled out before gluten sensitivity or celiac disease is identified as the origin. So do not go rushing over to your doctors office and start a pilgrimage for gluten testing.  Gluten ataxia is a progressive disease and can cause permanent damage to the cerebellum if not treated promptly.

Ataxia is the least easily identifiable version of gluten intolerance. Many people with gluten ataxia do not realize they have a sensitivity at all to gluten before diagnosis as they do not have any of the typical symptoms. Generally this form of ataxia is diagnosed after all other types of ataxia are ruled out and then other tests are run to determine whether gluten could be at the foundational problem.

Gluten Ataxia and Celiac Disease

Gluten ataxia is essentially a sister of celiac disease. Celiac disease is an autoimmune disorder that impacts the intestines, specifically the villi or microvilli. When an individual who is predisposed ingests gluten, the autoimmune reaction occurs and causes swelling to the lining of the intestines. Over time this swelling damages the intestines, causing villous atrophy, and makes it difficult for the small intestine to absorb any nutrients. With individuals suffering from gluten ataxia, the cause of the problem is the same: gluten. The difference is that the cerebellum is impacted instead of, or in addition to, the intestines. Both of these differ from a wheat allergy where symptoms would instead be of the histamine reaction variety: sneezing, hives, lip or face swelling.

Bottom line……..why are you taking the chance ? Even if you do not seem to have a problem with gluten, it does not mean you are safe.  The alarming increase in the incidence of the problem in the last decade ( > 1 in 133 and increasing) suggest that far more people are at risk and unknowingly sensitive to gluten than we previously thought.  It seems to be telling us that perhaps humans just do not process it well.  So, what do we say ? We say dump gluten…….. so that you do not have to put yourself at risk, and more so (joking) that you won’t have to worry about falling over with Gluten Ataxia before your race, which will let you run faster because you won’t have symptoms 1 &2,

• Poor coordination in physical movements and poor control of muscle movement
• Inability to control the speed or the power of a physical movement

and as an added benefit, you won’t have symptoms 3 & 4

• Headaches
• Inability to speak or form words correctly; speech impediments

which you might otherwise confuse with having too many beer.  And you will be aware and clear headed enough to ask for a gluten free beer the next time !

Plus, you might just PR your next race because symptoms 1&2 will be absent.

Think about how many people didn’t PR at the New York Marathon last week because they carb loaded on pasta and bread (and beer).  How many might have a subtle gluten sensitivity and gluten ataxia ? We know we may be pushing this issue to the limits of reasonable here, but with the numbers climbing each decade, and the incidence climbing in our private practices, we have to ask the question "are we really pushing the limits of reasonable here ? Or are we just ahead of the inevitable tipping point ?"  You have to decide what is best for you.  A gluten free diet is healthy, probably healthier.  We make our own bread, there is great gluten free beer out there, great gluten free pizza, pasta and bread available everywhere.  It is merely a lifestyle change.  Our patients make it work, so can you.  The first few weeks are the hardest, until you get into the swing of things.  And then, like many of our athletes, you begin to notice the subtle difference in how you feel and then the thinking begins…….. "hey, the odds are decent that the gun is already loaded, I am not going to risk pulling the trigger”.

Thanks for reading our long post today.  Forward it to your running friends, or at least those friends who seem to fall over after a pasta dinner.

Shawn and Ivo…….The Gait Guys, …….. kind of like the two physicists Dr. Sheldon Cooper & Leonard Hofstadtler from the very funny TV show “The Big Bang Theory”.  Ivo is Sheldon, he is way smarter…….. Shawn is more like Leonard, almost as smart (but at least he had a shot at winning the heart of the pretty blonde, Penny !! )………. so, who then is really smarter ?  :-)

The Gait Guys speak. Jan 14th, 2012 →

49th Annual Track and Field Clinic
January 14th, 2012

ITCCCA: The Illinois Track and Cross Country Coaches Association have asked Coach Chris Korfist and Dr. Shawn Allen to present their newest training techniques and philosophies at this years event. Video cases, research materials and insights into the “how and why” of what they do and what has made them an unstoppable team in speed training.  If you are an Illinois coach, we hope to see you there.  If you thought their work last year was good, wait til you see what they have in store this year !

Register for the 49th January Clinic

Saturday January 14th, 2012
Oak Park-River Forest High School

Our most recent article “Making Great Strides” is on the rack as of yesterday in the December issue of Tri Magazine. They have asked for more submissions so get a subscription !  Thx Jene Shaw !!!!! (editor)

Your stride length is the distance covered from the time your foot hits the ground to the time it hits again on the same side, encompassing one complete gait cycle. some variables can compli- cate the stride, such as terrain, power output, stride frequency, footwear and type of workout, and everyone’s indi- vidual anatomy affects stride length.

We talk about lack of ankle rocker, lack of abdominals, lack of hip extension and other good stuff.  It was a short article, but short can be also be sweet.

Ivo and Shawn

Just when you thought it was safe to watch a Neuromechanics Weekly episode, Dr Ivo throws a curveball. Check out the interesting clinical asides about myelopathy (pressure on the spinal cord causing ataxic gait) and the importance of which modality to check 1st, when doing an exam.

Keep these things in mind the next time you are evaluating someone’s gait.

Robotic Exoskeleton: New device helps people with spinal cord injury walk upright

Robotic Exoskeleton: New device helps people with spinal cord injury walk upright

Read more: http://newsok.com/new-device-helps-people-with-spinal-cord-injury-walk-upright/article/3619754#ixzz1cyJBDZFE

article link (click)

 … Now, a robotic exoskeleton has allowed her to take her first independent steps in years. In March, Fejerdy, 36, began participating in a clinical trial of the device — called the ReWalk — in Philadelphia, where she and her husband moved three years ago.

The device allows her to move independently in reality and in her dreams. 

Read more: http://newsok.com/new-device-helps-people-with-spinal-cord-injury-walk-upright/article/3619754#ixzz1cyHdRrC3

http://newsok.com/new-device-helps-people-with-spinal-cord-injury-walk-upright/article/3619754?custom_click=lead_story_title

Population Insights on Hallux Valgus: “When the big toe heads West”.

(thanks to Emily Delzell and LER for their ongoing great work.)

Handicapping Hallux Valgus: Predictive variables include race, age    By Emily Delzell

here are some of the study findings right from the article…….

1. “In nonobese individuals, African Americans were almost two times more likely than whites to have hallux valgus. But in obese participants, prevalence was just as high in whites as in African Americans. This difference seen in the non-obese suggests a real racial difference,” said Golightly, the study’s lead author.
2. Past high heel use increased HV risk by 22%. Investigators defined past use as participants’ self-reported primary shoe type during 10-year periods beginning when individuals were aged 20 years.“We found what we expected, that past—but not current—high heel use was predictive of hallux valgus. Women reported wearing high heels the most when they were aged 20 to 29, and high heel use diminished each decade until people reached 60, when wear really plummeted. It makes sense that people with hallux valgus and foot pain are uncomfortable in heels and are less likely to be current wearers,” Hannan said.

3. The study showed that HV heritability overall was 39% for women and 38% for men (mean age 66 years, age range 39-99 years), but was significantly increased in the subset of participants younger than 60 years (HV heritability, 89%).

   “We know that genes for obesity are also highly heritable and it could be that the gene for hallux valgus is linked to obesity genes,” Hannan said.

Get the full study from LER here (CLICK)

Our new friend, Dr. Mark Cucuzzella. An inspiring story.→

OK, now you have read the article in the NYTimes.  Here was Dr Cucuzella’s blog post following the article.

Mark Cucuzzella MD
Shepherdstown, WV
November 5th, 2011
9:58 pm

NYT Readers,
I’ve been flattered by the emails from around the globe of runners sharing their stories of recovery and discovery. Here is my story.
“A man’s errors are his portals of discovery” – James Joyce
Twice in the past two years, my running shoe store, Two Rivers Treads, which is in the small town of Shepherdstown, West Virginia, was honored to host and gain wisdom from best-selling author and force of nature Christopher McDougall. Locals came to hear from Chris aka “Mr. Born to Run.”
Chris and I both share a similar pathway in the discovery of better fitness and health through natural running. He is now a world-famous author, and in addition to owning a minimalist shoe store, I am a family physician in a town of 3,000. We both are in our mid 40s, and have trashed our feet and legs along the way, the result of a lifelong addiction to running.
Chris’s bestseller “Born to Run” follows several narrative threads, but it is also his own personal story of “why does my foot hurt?” He discussed the regular trips to the doctors, shoe stores, and orthotic makers. With each escalation in care there was more pain, that is, until he found a different route in the remote Copper Canyon of Mexico where the Tarahumara Indians run in flat-sole tire-tread sandals happily into their 80’s. He also met barefoot runners during his research for the book. He eventually arrived at the conclusion that most conventional running shoes are the cause of running injuries.
I began running barefoot on the beach as a pre-teen and easily covered distances of 10 or more miles. My personal path of pain began in high school and then into a college and post-collegiate running career. I had successes that were often tempered by injury, setbacks, surgery. I had acquired a closet full of arch supports, orthotics, various shoe types. This was always in search of the holy grail of pain- free running.
I pushed through the pain in pursuit of the Olympic Marathon Trials 2:22 standard and came within two minutes on two occasions. When I hit 34 years of age, my first toe joints were fused with arthritis, and I was forced to have surgical procedures to reduce the pain. The prognosis looked bleak for a future in running.
And a lot like Chris’s own trip to Copper Canyon, my journey of discovery began afar: while watching Kenyan runners go barefoot. I applied this natural way of running to my own jogging. I learned how to run softly. Seven months after surgery and with a new efficient and painless running stride, I ran a 2:28 for third place in the 2001 Marine Corps Marathon, only four minutes shy of my best time ever for the distance.
A decade has passed and the learning I gained about natural running only became deeper and broader. You might say that I was being “home-schooled” on all aspects of movement and how the foot interacts with the ground. For example, the Tarahumara Indians run in a style reflective of how we all ran as children; they land lightly on their mid-foot (not the heel), have a slight forward lean, and are completely relaxed and happy. Also, the best shoe was less shoe.
My self-enlightenment about footwear and running was not as immediate as Chris, who experienced it by cultural immersion. Chris and I both agree that it is not about the shoes (or lack thereof), but more about understanding how your body stands and moves, improving strength and function, and then figure out what shoe (if any) to wear. Ten years after the foot surgery and being told not to run, I feel that I’m finally putting all the pieces of the puzzle together. I finished the Boston marathon in 2011 in 2:37:00, practically smiling the whole way. Several months later, I won the Air Force Marathon outright; and back running the day after the race. I love light and flat shoes for road races, trails, casual, and at work to get me secretly close to barefoot at my day job as a physician.
We all have to follow our own path of what works or doesn’t work. Our bodies and past running histories are different. View the resources Natural Running Center, you will have a practical way to make injury-free running a permanent fixture in your own life.
I especially want to thank colleagues for sharing knowledge: Danny Dreyer, Jay Dicharry, Lee Saxby, Danny Abshire, Dr. Ray McClanahan, Dr. Daniel Lieberman, Ian Adamson, Dr. Phil Maffetone, Blaise Dubois, Pete Larson, Dr. Irene Davis, Lorraine Moller, and Nobby Hashizume. And especially Bill Katovsky and Nicholas Pang for helping me create the Natural Running Center.
–Mark Cucuzzella, M.D. mark@freedomsrun.org
http://naturalrunningcenter.com/
https://www.tworiverstreads.com/
For our movie on Barefoot Running Style - enjoy
http://youtu.be/kpnhKcvbsMM

Here is a decent video on how to do the “100 up” and age old running practice technique developed as discussed in a three-page essay from 1908 titled “W. G. George’s Own Account From the 100-Up Exercise.” According to legend, this single drill turned a 16-year-old with almost no running experience into the foremost racer of his day.

In George’s words: “By its constant practice and regular use alone, I have myself established many records on the running path and won more amateur track-championships than any other individual.” And it was safe, George said: the 100-Up is “incapable of harm when practiced discreetly.”

comments from a follower of the gait guys.

From a reader …..

“From what I’ve gathered from your posts/videos, I have some major issues with my foot function… ie weak Tib Anterior and Extensors.  You have one video up where you demonstrate that a competent foot should be able to keep a solid arch and lower your big toe without losing arch integrity.  I come no where close to this.  In fact, I think it’s pretty amazing at what the foot is supposed to do which is demonstrated by you.  When looking at what Dr. Allen’s foot does and looks like compared to most everyone else’s his seems much more muscular and solid unlike the case studies you put up.  I almost liken most peoples feet to looking like a skeleton with very little muscle mass and function.”

Dr. Allen’s response…….

It has taken me quite a bit of time to get my foot to function this well.  I am lucky in that i know what it is supposed to do and what exercises to implement to get it there.  We have some exercises that we do which we are compiling and will eventually put in DVD format.  We are completing our 3 part shoe fit and foot function DVD for the December Austin Texas IRRA program launch and the completed package should be available end of  January 2012.  Yes, finally they will be done ! There is another reason my foot functions as well as it does……. and we will be sharing some thoughts on this in several weeks once we can compile the information. Hint, awareness and encouraging skill is a big key.  It all starts with Skill……. then build Endurance, and then Strength.  S. E. S. as we say. 

The Once and Future way to run. NewYorkTimes→

excerpt from the article……….

“Martyn Shorten, the former director of the Nike Sports Research Lab who now conducts tests on shoes up for review in Runner’s World, followed him (Cucuzzella) to the microphone. “A physician talking about biomechanics — I guess I should talk about how to perform an appendectomy,” Shorten said. He then challenged Cucuzzella’s belief that cushioned shoes do more harm than good.

________________________________

As Steve Jobs might say to this………. "yes, there are bozos amongst us”

We know Dr. Mark Cucuzzella. We talk with him often over long conference calls. Dr Ivo was on the discussion panel with him at the Newton Running Retail Conference this year. We are becoming pretty good friends.  We feel quite comfortable in saying that Mark has every right to talk about biomechanics, he has earned our respect.

The mind is like a parachute…It works best when open….

Shawn & Ivo, we are…….The Gait Guys  (and hoping that we are someday challenged by guys like Shorten…we like bozos : ) ).

So how did they get the skunk into the shoe?

Have a great Friday

Ivo and Shawn

Today, something a little different.  I worked for the world famous Joffrey Ballet Dance company on an off for a few years treating the dancers before shows and productions.  These folks always had the most amazing strength (try this one ! bet you cannot do it……in fact, don’t try it…..you will probably dislocate your MTP (metatarsophalangeal joint; the big knuckle joint) of the big toe.)

These folks also had many problems with their hips, knees and spine mechanics from the demands of turn out, jumping, overuse and the demands of things like en pointe.  This is an example of what is referred to as “en pointe” which means “on the tip”.  There is “demi pointe” which means on the ball of the foot which is much safer and we will do another video on that another time to explain some critical components to it right, there is more to it than just getting up on the ball of your foot.

En Pointe is a  terrible challenge in our opinion. So if you are thinking of putting your darling children in ballet…… just beware of the facts and do some logical thinking on your own.

En pointe or classical point ballet it typically done in point shoes or slippers which have a reinforced toe box that allows a more squared off stable surface to stand in pointe position.  It does not however allow a reduction in the axial loading that you see in this video and it certainly does not help with proper angulation of the big toe, if anything the slipper will gently corral the toes together rendering abductor hallucis muscle function nearly obsolete.   The box will also not stop the valgus loading that typically occurs at the joint as you see occurring here in her right foot if your joint line has a more aggressive angulation (genetics).  You can already see the deforming force that is creating a valgus toe position here. Despite what the studies say, this is one we would watch carefully.  Now, there are studies out there that do not support hallux valgus and bunion formation in dancers (see ** at end of this post).  However, we are just asking you to use common sense.  If you see a bunion forming, if the toe is getting chronically swollen, if the toe is drifting off line then one must use common sense and assume that the load is exceeding joint integrity.  Prolonged and excessive loading of any joint cartilage is likely to create a risky environment to crack, fissure, wear down or damage the cartilage or the bony surface underneath (subchondral bone).  So, if you think that loading your entire body mass axially on the small joint surface of the big toe is a great idea, that is fine, just do not bring your kids to our office and expect to get a happy face sticker at the check out counter.  We are going to read you the risks that are born from logical thinking.  This is not meant in any way to take away from the amazing feat that this is for dancers, but it just is not a smart thing to do if you want a healthy first joint (MPJ - metatarsophalangeal joint) and foot for that matter. After all, if you screw up this joint, toe off will be impaired and thus the windlass effect at the joint will be impaired thus leading to a multitude of other dysfunctional foot issues.

Now, back to the “en pointe” position.  Did you try it yet ? Heed our warning ! Just trust us, this is bloody hard.  Since serious foot deformities can result from starting pointe too early, pre-professional students do not usually begin dancing en pointe until after the age of 10 or so , remember, the adolescent foot has not completed its bone ossification and the bone growth plates have not closed.  Thus, damage and deformity are to be expected if done at too young an age.  If you asked our opinion on this, we would say to wait until at least the mid-teenage years……. but by that point in the dance world a prodigy would miss her or his opportunity.  Thus, we see the problems from going “en pointe” too early in many. In the dance world, there are other qualifications for dancers before En Pointe is begun, things like holding turnout, combining center combinations, secure and stable releve etc. 

Achieving en pointe is a process.  There is a progression to get to it.  Every teacher has their own methods but it is not a “just get up on your toes” kind of thing. 

Shawn & Ivo……. Dreaming of Sugar Plum fairies…….. (ok, maybe not)  but knowing your biomechanics of the foot and gait are an integral part of dance as well.

* and after watching this video, if your next thought was……“ I wonder what the incidence of posterior ankle impingement injures occur in dancers” or if you said under your breath……. “hey, extreme plantarflexion at the ankle loads the Lisfranc joint pathomechanically ….. I wonder if that joint is ever an issue in dancers……. ?"   then you will clearly be on the route to becoming one of……… The Gait Guys

____________________________________________________________

** Hallux Valgus in Dancers. A Myth ? 

Abstract: Among dancers it is widely believed that ballet dancing induces hallux valgus. Revision of radiographs of 63 active and 38 retired dancers of both sexes showed no increase in the valgus angulation of the hallux compared with that of nondancers.

Today on Neuromechanics Weekly, we explain how the autonomic nervous system is linked to brain activity, particularly the cerebellum, which we all know is intimately linked to gait, walking and running. Now you will understand why you get dizzy when you have pain or why your heart beats faster or harder (they are different sides of the brain). Join Dr Waerlop in this fascinating lecture.

The Gait Guys…Providing explanations and making the complex easier to understand

 Splay

Watch this video a few times through. Did you catch the subtle abduction moment of the Hallux (big toe) on impact? Did you see the collapse of the transverse metatarsal arch? No?  Watch it until you do.

What gives? We thought toes were supposed to be stable when they hit the ground (and in fact they are).  Read on…

Think of the adductor hallucis. It has 2 heads. The oblique head arises from the proximal shafts of metatarsals 2-4 and inserts on the MEDIAL aspect of the proximal phalynx of the hallux (along with medial fibers of the flexor hallucis brevis); the transverse head arises from the metatarsophalangeal ligaments of  digits 3-5, and the transverse metatarsal ligament and inserts blending with the oblique head on the proximal phalynx of the hallux.

The action of the adductor hallucis mirrors that of the abductor hallucis (which inserts on the LATERAL side of the proximal phalynx. Together, they act to keep the hallux straight and provide a compressive force which stabilizes the big toe WHEN IT IS ON THE GROUND.

The problem here, is that the base of the Hallux is NOT anchored to the ground. This person has a faulty tripod (most likely an uncompensated forefoot varus) and cannot anchor the big toe, there fore the adductor cannot do it’s job. Is is weak (from lack of use) and we see the result: an abducting big toe AND collapse of the transverse metatarsal arch (which the transverse head of the adductor, under normal conditions maintains).

Looks like this guy needs some exercises to descend the head of the 1st metatarsal and make an adequate tripod. Flexing the distal phalynx of the hallux while extending the metatarsophalangeal joint would be a good start. (see Dr Allen demonstrate this here: http://www.youtube.com/user/TheGaitGuys?feature=grec_index#p/u/11/TyRE9dReVTE )

The Gait Guys…promoting foot literacy here and everywhere.

Its a great day to be a neuro geek

So if the receptors on the bottom of the foot aren’t involved aren’t involved in 2 joint muscles staying coordinated (like the hamstring and rectus femoris in this study), how do we determine the appropriate muscle length and ratios? How about our built in muscle length receptors? Lets hear it for muscle spindles! Hooray for Ia and type II afferents!

Sifting through the science so you don’t have to. We are The Gait Guys…

Exp Brain Res. 1998 Jun;120(4):479-86.

Coordination of two-joint rectus femoris and hamstrings during the swing phase of human walking and running.

Prilutsky BI, Gregor RJ, Ryan MM.

Source

Department of Health and Performance Sciences, Center for Human Movement Studies, The Georgia Institute of Technology, Atlanta 30332-0110, USA.

Abstract

It has been hypothesized previously that because a strong correlation was found between the difference in electromyographic activity (EMG) of rectus femoris (RF) and hamstrings (HA; EMG(RF)-EMG(HA)) and the difference in the resultant moments at the knee and hip (Mk-Mh) during exertion of external forces on the ground by the leg, input from skin receptors of the foot may play an important role in the control of the distribution of the resultant moments between the knee and hip by modulating activation of the two-joint RF and HA. In the present study, we examined the coordination of RF and HA during the swing phase of walking and running at different speeds, where activity of foot mechanoreceptors is not modulated by an external force. Four subjects walked at speeds of 1.8 m/s and 2.7 m/s and ran at speeds of 2.7 m/s and 3.6 m/s on a motor-driven treadmill. Surface EMG of RF, semimembranosus (SM), and long head of biceps femoris (BF) and coordinates of the four leg joints were recorded. An inverse dynamics analysis was used to calculate the resultant moments at the ankle, knee, and hip during the swing phase. EMG signals were rectified and low-pass filtered to obtain linear envelopes and then shifted in time to account for electromechanical delay between EMG and joint moments. During walking and running at all studied speeds, mean EMG envelope values of RF were statistically (P<0.05) higher in the first half of the swing (or at hip flexion/knee extension combinations of joint moments) than in the second half (or at hip extension/knee flexion combinations of joint moments). Mean EMG values of BF and SM were higher (P<0.05) in the second half of the swing than in the first half. EMG and joint moment peaks were substantially higher (P<0.05) in the swing phase of walking at 2.7 m/s than during the swing phase of running at the same speed. Correlation coefficients calculated between the differences (EMG(RF)-EMG(HA)) and (Mk-Mh), taken every 1% of the swing phase, were higher than 0.90 for all speeds of walking and running. Since the close relationship between EMG and joint moments was obtained in the absence of an external force applied to the foot, it was suggested that the observed coordination of RF and HA can be regulated without a stance-specific modulation of cutaneous afferent input from the foot. The functional role of the observed coordination of RF and HA was suggested to reduce muscle fatigue.

Those are some pretty big shoes!

This gentleman actually looks like he has acromegaly. Watch his movements and note his facial features throughout the video.

Acromegaly is a condition where excess growth hormone is produced after puberty and the bones steadily increase in girth. Abraham Lincoln was thought to be a acromegalic.

Everything gait. we are…The Gait Guys

What are correct toes and do they work?

correct toes:https://nwfootankle.com/correct-toes

We are quite familiar with them. Do they work? That is the question!

They are pretty bulky but that could be a good thing, for some though they are just too bulky we have found.
Some people are running in them……We think our friend Dr. Mark Cucuzzella does (naturalrunningcenter.com) .
We use them with clients to walk around the house barefoot and get used to engaging toes with a flat press (not gripping…like those silly, flexor dominant promoting towel scrunch exercises !)

So they MIGHT help someone retrain some muscles if used in this fashion but just wearing them does not produce magical results without some awareness use. 

Keep in mind……forcing something doesn’t make it so……… spreading the toes with an object such as these doesn’t make them automatically go where they are supposed to.

Most people need to relearn toe separation (actually abduction)…we do alot of that in our offices….and then learn to bring the whole toe flat to the ground with a good, firm toe press……..no grip/scrunch/hyperflexion.  The last thing we would ever want to do is overfacilitate the long toe flexors (flexor digitorum longus) because when we do, we inhibit other foot intrinsic muscles (ie. lumbricals).

The Gait Guys…promoting foot and gait literacy and helping you wade through the uncertainty.

Liquid Mountaineering.

Yup, we thought we had seen it all…And they appear to be serious about this. It takes all kinds to make the world go around, but who are we to judge.  It is our guess that that lake was pretty shallow for those first 10 steps or so.  You be the judge.  Even Wallace Spearman Jr. could not reproduce this feat on Mythbusters (until they made an underwater floating bridge !).

Have a good Friday!

Ivo and Shawn

Oxygen cost of running barefoot vs. running Shod.

This study concluded that at 70% of vVO (2)max pace, barefoot running is more economical than running shod, both overground and on a treadmill.  So, if you have a competent enough foot to run barefoot or in minimalistic footwear, and it is important to note that some people are not purely from an anatomical perspective, you can improve your economy of running and use your energy sources efficiently. But if you are one of those unfortunate ones that has excessive pronation or other functional foot challenges, you will have to settle for the less economical shod running.  That does not mean you will not have as good a workout, it just means that you will be protecting your foot doing so.  Sure, you might not be the fastest one on the track, but you will be able to show up every day having not compromised  your feet.

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Int J Sports Med. 2011 Jun;32(6):401-6. Epub 2011 Apr 6.

Oxygen cost of running barefoot vs. running Shod.

Hanson NJ, Berg K, Deka P, Meendering JR, Ryan C.

Source

Health, Physical Education and Recreation, University of Nebraska at Omaha, United States. njhanson@gmail.com

Abstract

The purpose of this study was to investigate the oxygen cost of running barefoot vs. running shod on the treadmill as well as overground. 10 healthy recreational runners, 5 male and 5 female, whose mean age was 23.8±3.39 volunteered to participate in the study. Subjects participated in 4 experimental conditions: 1) barefoot on treadmill, 2) shod on treadmill, 3) barefoot overground, and 4) shod overground. For each condition, subjects ran for 6 min at 70% vVO (2)max pace while VO (2), heart rate (HR), and rating of perceived exertion (RPE) were assessed. A 2 × 2 (shoe condition x surface) repeated measures ANOVA revealed that running with shoes showed significantly higher VO (2) values on both the treadmill and the overground track (p<0.05). HR and RPE were significantly higher in the shod condition as well (p<0.02 and p<0.01, respectively). For the overground and treadmill conditions, recorded VO (2) while running shod was 5.7% and 2.0% higher than running barefoot. It was concluded that at 70% of vVO (2)max pace, barefoot running is more economical than running shod, both overground and on a treadmill.

In this Neuromechanics weekly, Dr Waerlop Introduces the cerebellum and talks about its importance clinically, since it contains more than ½ of the neurons in the brain! It’s anatomy and inputs from the periphery are discussed. The take home message is the cerebellum is the key to understanding and directing movement, since it receives feedback from most ascending and descending pathways.