Key moment during my knee exam:

Key moment during my exam:

Today, a small slice of the Sagittal plane:
Here are just a few of the things going through my mind as i go through the lower limb sagittal plane. Everyone has a different way, this is a piece of mine. . . . .

Do they have sufficient ankle dorsiflexion, active passive?
Are the ankle dorsiflexors strong enough to achieve sufficient ankle dorsi and rocker, and are the ankle plantarflexors long enough, to allow said sufficient ankle dorsiflexion.

And to match with that in terms of gait cycles and loading patterns, do they have sufficient hip extension?
Meaning, are the hip extensors strong enough, and the hip flexor groups (hip flexors and quads of course) long enough, to allow sufficient hip extension.
Are the abdominals strong enough to anchor the pelvis from dropping into uncontrolled or excessive anterior pelvis tilt and paraspinal loading? Because when then do drop into APT, they will convert, likely, into quad dominance and paraspinal dominance (instead of glute-abdom). In otherwords, can they adequately control the hip into the pelvis (acetabulum) and the pelvis into the spine?
When there is a conflict between the foot/ankle and hip in the sagittal plane, problems may occur at these joint levels, and/or above and/or below these joints (ie, low back, knee, or deeper into the foot).
To be clear, none of these joints exclusively work in just the sagittal plane. That many of these joint complexes are multiaxial, and there is always the issues of protective stability in other planes that ensure another planes clean function. This is what makes more deeply explaining how to fix something very difficult on the internet, because it is in fact complex and requires juggling many clinical insights all at once to determine where things have gone wrong in an injured client. And, this was only discussing the sagittal plane today, on the most simple and crudest of levels. What about deeper issues?
And then , of course, how are they doing in frontal and transverse planes? And then how do the 3 planes come together, functionally or dysfunctionally? And, if they cannot control sagittal, are they dumping it into frontal hip or transverse hip ? (ie. see the FB post last week that had a few people all in a butt clench of the runner with the right leg internally rotated/torsional questions).
These are the balls i am juggling when i examine people, slowly building a puzzle from a fresh open box.

Today was just a slice of the pie on lower limb sagittal assessment, just a blip into my mindspace.
And so, if you are not adding an assessment to training or corrective work, and there is a problem that is left unaddressed, then we can be adding strength to dysfunction.

Subtle clues to an LLD?

Leg length discrepancies, whether their functional anatomical, have biomechanical consequences north of the foot. This low back pain patient exhibited 2 signs. Can you tell what they are?

can you see the difference ?

how about now?

compare right to left

compare right to left

can you see the difference in the Q angles?

Look at the first picture and noticed how the left knee is hyper extended compared to the right. Sometimes we see flexion of this extremity. This is to "functionally shorten" that extremity.

Now look at the Q angles. Can you see how the left QL angle is greater than the right? This usually results from a long-term leg length discrepancy where the body is attempting to compensate by increasing the valgus angle of that knee, effectively shortening the extremity.

Dr Ivo Waerlop, one of The Gait Guys

#subtle #clues #LLD #leglengthdiscrepancy #leglengthinequality #thegaitguys #gaitabnormality

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Most likely this is common knowledge for most followers here on The Gait Guys and our podcast (another one will launch this weekend btw).

But reducing the plantar flexion moment in the late stance phase of running and walking can make notable changes in the loading response to the posterior plantarflexor mechanism (the gastroc-soleus-achilles complex). A rocked shoe, according to this study, can reduce the plantarflexor moment without substantial adaptations in triceps surae muscular activity.
This of course brings to mind the HOKA family of shoes that have purposefully added a gentle rocker mechanism to some of their shoe line, some with an early and some with a late stage metarocker built in. Are you a HOKA hater? We were not fans in their early development because of the volume of stack height foam, but they have many more options in their line up now. But do this for us, do not pass judgement until you put one of these metarockered shoes on, and you will understand the function of it, and their place for your chronic posterior compartment clients. Don't reflexively judge until you try them. It is good to have options for your clients, because "stop running" is not an option for runners, for our runners, unless all else has failed.

Shawn Allen, the other Gait Guy

#thegaitguys, #gait, #hoka, #metarocker, #achilles, #tendinitis, #gaitproblems, #gaitanalysis, #calfpain, #running

J Sci Med Sport. 2015 Mar;18(2):133-8. doi: 10.1016/j.jsams.2014.02.008. Epub 2014 Feb 14.

Rocker shoes reduce Achilles tendon load in running and walking in patients with chronic Achilles tendinopathy.

Sobhani S1, Zwerver J2, van den Heuvel E3, Postema K4, Dekker R5, Hijmans JM6.

Bone marrow lesions in runners.

"More than half of the lesions (bone marrow edema) (58%; 26/45) fluctuated during the season, with new lesions occurring (20%; 9/45) and old lesions disappearing (22%; 10/45)."

Stuff happens to your bones during a marathon, or on that long weekend training run. Make sure you give yourself time to recover adequately before you pound out that next run.
The incidental finding of bone marrow edema (BME) on MRI in professional runners is not well understood. Bone takes on load, as it should. In this study, it is suggested that many asymptomatic athletes show BME lesions, many of which will come and go with training. It is most like proper and ample recovery that allows athletes to heal and not let these lesions turn into greater stress responses, or stress fractures. It is when the load comes too often, to long, heavy and hard that things might mount.

Methods:
Sixteen athletes (13 men and 3 women; mean age, 22.9 ± 2.7 years) were recruited from the Dutch National Committee middle-distance and long-distance running selection. All athletes had been injury free for the year before the study. Magnetic resonance imaging scans were obtained before the start of the season and at the end of the season.

14 of the 16 athletes had BME lesions before the start of the season (45 BME lesions in total). Most BME lesions (69%; 31/45) were located in the ankle joint and foot. More than half of the lesions (58%; 26/45) fluctuated during the season, with new lesions occurring (20%; 9/45) and old lesions disappearing (22%; 10/45). The few clinical complaints that occurred throughout the season were not related to the presence of BME lesions.

Am J Sports Med. 2014 May;42(5):1242-6. doi: 10.1177/0363546514521990. Epub 2014 Feb 20.
Bone marrow edema lesions in the professional runner.
Kornaat PR1, Van de Velde SK.

Increased unilateral foot pronation can cause cephalad asymmetries.

Increased unilateral foot pronation affects lower limbs and pelvic biomechanics during walking. Nothing earth shaking here, we should all know this as fact. When a foot pronates more excessively, the arch can flatten more, and this can accentuate a leg length differential between the 2 legs. But it is important to note that when pronation is more excessive, it usually carries with it more splay of the medial tripod as the talus also excessively plantarflexes, adducts and medially rotates. This action carries with it a plantar-ward drive of the navicular, medial cuneiforms and medial metatarsals (translation, flattening of the longitudinal arch). These actions force the distal tibia to follow that medially spinning and adducting talus and thus forces the hip to accommodate to these movements. And, where the hip goes, the pelvis must follow . . . . and so much adaptive compensations.
So could a person say that sometimes a temporary therapeutic orthotic might only be warranted on just one foot ? Yes, of course, one could easily reason that out.
-Shawn Allen, one of The Gait Guys

#gait, #gaitanalysis, #gaitproblems, #thegaitguys, #LLD, #leglength, #pronation, #archcollapse, #orthotics, #gaitcompensations, #hippain, #hipbiomechanics

Gait Posture. 2015 Feb;41(2):395-401. doi: 10.1016/j.gaitpost.2014.10.025. Epub 2014 Nov 3.
Increased unilateral foot pronation affects lower limbs and pelvic biomechanics during walking.
Resende RA1, Deluzio KJ2, Kirkwood RN3, Hassan EA4, Fonseca ST5.

ACL rehab considerations you might not know about.

ACL rehab consideration.
Once referred to as "the dark side of the knee" due to the limited understanding of the anatomy and biomechanics, the posterolateral corner (PLC) of the knee still remains off the radar for many clinicians.
Whether surgical repair or not, is your patient not progressing? Did you check for damage to the PLC of the knee?

Injuries to the (PLC) comprise a significant portion of knee ligament injuries. Complete PLC lesions rarely heal with non-operative treatment, and are therefore most often treated surgically. Posterolateral corner injuries are commonly associated with ACL or PCL tears, with only 28% of all PLC injuries occurring in isolation, this means there are likely many of these injuries lurking in your injured knees. Posterolateral rotational instability (PLRI) is a real thing, and it is missed often enough.
This was a nice review article, outlining the primary and secondary restraint anatomy and some guidelines to consider.
We discussed this article in our onlineCE lecture last night. Huge class ! Great to see many of you there !
See you again in 4 weeks !

Posterolateral Corner of the Knee: Current Concepts
Jorge Chahla, MD, Gilbert Moatshe, MD, Chase S. Dean, MD, and Robert F. LaPrade, PhD
Arch Bone Jt Surg. 2016 Apr; 4(2): 97–103

Habituating a gait correction

We tell our patients all the time that the key to acquiring the gait correctives is the number of times a day they show the nervous system the corrective gait patterns. It is not about 2-3 solid episodes of homework a day, rather, it is an hourly 2-3 minute focused episode driving nothing be the cleaned up motor skill we are trying to neurologically "rewrite".
We have 3 tiers in my office, Gold, Silver and Bronze.
Gold medal homework= 2-3 minutes every hour.
Silver medal homework= 2-3 min every 2 hours
Bronze medal homework= 2-3" every 3 hours (that is still a medal, because it is still 6x a day)

We start with one corrective in their gait and homework to set that pattern up. Then next visit we up the difficultly on that skill/pattern, and introduce another new one that is part of the overall gait correction was want to see. Thus, they are juggling 2 balls, one that is more familiar but a little harder, and now a new one that is at the basic level. The next visit, we add a 3rd ball, upping the demands on the other 2.
Rinse and repeat.
This goes for walking and running gait problems.

IF they want this pattern to be come more habitual faster, one has to go for gold, or gold++.

-Shawn Allen, the other gait guy
#gait, #gaitproblems, #gaitcorrections, #gaitretraining, #gaitanalysis, #thegaitguys, #habits, #runningform

"The findings indicate that the amount of practice in the criterion task is more critical than the difficulty and variations of task practice when learning new gait patterns during treadmill walking."

https://www.ncbi.nlm.nih.gov/pubmed/30905405

Got hip extension?

Because she sure could use some...

we have see this gal before… yesterday in fact

• left plantar plate lesion (yes, conformed on ultrasound)

• left sided anatomical leg length discrepany

• bilateral internal tibial torsion

• incompetent L quadratus lumborum

• adequate hip extension and ankle dorsiflexion available to her

• lack of endurance in her abs

yep, lots more, but that is enough for now

note that she has plenty of ankle dorsiflexion, more on the right. this is due to her right leg being anatomically longer and has to travel through a greater range of motion

look at the knee and the hip articulations to assess hip extension. It should match ankle dorsiflexion, no?

Dr Ivo Waerlop, one of The Gait Guys

#gait #gaitguys #thegaitguys #hipextension #LLD #quadratuslumborum #internaltibialtorsion #anklerocker #ankledorsiflexion

Running cadence doesn't matter? Maybe.

Does running cadence matter? Not as much as previously thought (in terms of speed and efficiency, but this is not a comment on altering biomechanics to avoid or manage running through injury. One of the first things we ask of a runner, who insists they will be running with their injury while we attempt to get ahead of it, is to increase their cadence and land with more finesse (if they are a heavy "plunker", which often happens on longer runs when people fatigue).

“Some ran at 160 steps per minutes and others ran at 210 steps per minute, and it wasn’t related at all to how good they were or how fast they were,” Burns said. “Height influenced it a little bit, but even people who were the same height had an enormous amount of variability.”

"Another unexpected finding is that by the end of a race, cadence varied much less per minute, as if the fatigued runner’s body had locked into an optimal steps-per-minute turnover. It’s unclear why, Burns said, but this deserves further study."

https://news.umich.edu/step-it-up-does-running-cadence-matter-not-as-much-as-previously-thought/?fbclid=IwAR07mIPxVEPXlkkXoU-XxyCIQY7MwfpX0HHXW7lxMqrcx69ZHHjLO1SxPXw

3 things

Its subtle, but hopefully you see these 3 things in this video.

I just LOVE the slow motion feature on my iPhone. It save me from having to drag the video into Quicktime, slow it down and rerecord it.

This gal has a healing left plantar plate lesion under the 2nd and 3rd mets. She has an anatomical leg length deficiency, short on the left, and bilateral internal tibial torsion, with no significant femoral version. Yes, there are plenty of other salient details, but this sketch will help.

1. 1st if all, do you see how the pelvis on her left dips WAY more when she lands on the right? There is a small amount of coronal plane shift to the right as well. This often happens in gluteus medius insufficiency on the stance phase leg (right in this case), or quadratus lumborum (QL) deficiency on the swing phase leg (left in this case) or both. Yes, there are other things that can cause this and the list is numerous, but lets stick to these 2 for now. In this case it was her left QL driving the bus.

2. Watch the left and right forefeet. can you see how she strikes more inverted on the left? this is a common finding, as the body often (but not always) tries to supinate the shorter extremity (dorsiflexion, eversion and adduction, remember?) in an attempt to “lengthen” it. Yes, there is usually anterior pelvic tilt accompanying it on the side, because I knew you were going to ask : )

3. Look how her knees are OUTSIDE the saggital plane and remain there in her running stride. This is commonly seen in folks with internal tibial torsion and is one of the reasons that in our opinion, these folks should not be put medially posted, torsionally rigid, motion control shoes as this usually drive the knees FURTHER outside the saggital plane and can macerate the meniscus.

Yep, lots more we could talk about on this video, but in my opinion, 3 is a good number.

Dr Ivo Waerlop, one of The Gait Guys

#thegaitguys #gaitanalysis #footpain #gaitproblem #internaltibialtorsion #quadratuslumborum #footstrike

https://vimeo.com/329212767

Heart disease and changes in gait.

Research is finding some clues. . . . ankle plantarflexion. The calf as a locus of impaired walking capacity.

Dr. Ted Carrick was once heard saying that even in the earliest phases of neuropathology, stages possibly so early that neuropathology is absent from most testing results (incidentally, we discuss this on a recent podcast, 137 or 138 and what tests might help in the discovery when things like EMG/NCV are "normal"), that subtle changes in one's gait might be the first sign(s) of aberrant sensory-motor function when all other methods prove unfruitful in the discovery process.

Reduced walking capacity is a hallmark of chronic heart failure (CHF). Why is this? It is reduced fitness ? It is weakness, stiffness, reduced metabolic capacity ? It could be all of them, and many more.
This interesting study found "over two times greater ankle plantarflexion work during stance and per distance traveled is required for a given triceps surae muscle volume in CHF patients. This, together with a greater reliance on the ankle compared to the hip to power walking in CHF patients, especially at faster speeds, may contribute to the earlier onset of fatigue in CHF patients."

This makes sense to us, after all, the much work (perhaps 50%~?) should be provided by the glutes and core in the propulsion phase of gait. But we know that the elderly, and especially the weak elderly, who walk with shorter steps and strides, who walk slower, who are weaker and more fragile, that their capacity for propulsion is notably diminished in the later years. The later years when CHF is also found. Thus, how do these folks find ways to effectively move forward? This study provides one possible clue, the ankle plantarflexors, the gastrocsoleus-achilles complex.

"This observation also helps explain the high correlation between triceps surae muscle volume and exercise capacity that has previously been reported in CHF. Considering the key role played by the plantarflexors in powering walking and their association with exercise capacity, our findings strongly suggest that exercise-based rehabilitation in CHF should not omit the ankle muscle group."

J Biomech. 2014 Nov 28;47(15):3719-25. doi: 10.1016/j.jbiomech.2014.09.015. Epub 2014 Oct 11.
Gait analysis in chronic heart failure: The calf as a locus of impaired walking capacity.
Panizzolo FA1, Maiorana AJ2, Naylor LH1, Dembo L3, Lloyd DG4, Green DJ5, Rubenson J6.

Patreon video

Last night on Patreon i uploaded a brief exercise and discussion VIDEO on how not to load the hips, core and spine in overhead sports, lacrosse in this case.
Join us on Patreon for the "how to address" problems with corrective work.

https://www.patreon.com/thegaitguys

Toe off: medial or lateral ? The hip matters, and do does forefoot loading.

Toe off.
How we off load can affect the tragectory of the knee sagittal hinging and it can affect the frontal, sagittal and rotational planes at the hip.

We can see here that a nice high gear medial foot toe off will draw the knee in a more sagittal direction (knee over foot, hip over knee) where as a lateral foot toe off, low gear off the lateral metatarsals could easily encourage the knee into the frontal plane, and the hip into the frontal and lateral rotational planes (knee outside the foot, hip outside the knee).

Lack of strength or awareness or endurance on a long run to endure the "more normal" medial toe off could lead to some knee tracking challenges and pathomechanical set up at the knee and hip, or elsewhere for that matter.
It is the clinicians job to find out if this is a factor, whether it is anatomic (torsion of long bones), weakness, lake of proprio/awareness or a combination of them.
Sometimes the smallest of details in how your client moves can get you the answers you need as to why your client may be in pain.

running gait: the contralateral pelvis drop

Great visual here, Nice work @ylmsportscience !
This is from the AJSM 2018 article Bramah et al.

Nothing new here for our Gait brethren, we have been talking about this contralateral pelvis drop for a long time. Our soap box rant on many of our podcasts and teaching courses of, "when the foot is on the ground the glutes are in charge, and when the foot is in the air, the abdominals are in charge" comes to this article as well. Sure, that is a loose quote, filled with caveats and many other components, but it is globally valid and runners get it when it is kept in simplest terms. Just do not forget that this process can be a top down problem, a bottom up problem from poor foot control, or both (which it often is).
None the less, this is a good article to keep in mind, and a great info-graphic by @ylmsportscience. Thank you to both !

https://www.ncbi.nlm.nih.gov/pubmed/30193080

"found injured runners to run with greater peak CPD (contralateral pelvic drop) and trunk forward lean as well as an extended knee and dorsiflexed ankle at initial contact. CPD appears to be the variable most strongly associated with common running-related injuries."

https://ylmsportscience.com/2018/12/03/is-there-a-pathological-gait-associated-with-common-soft-tissue-running-injuries/?fbclid=IwAR0vR51_13m-xs3q8ucurKmZvzbCagBCZ_WJkVNUW0qGFq8focLTRd3zm8k

#gait, #gaitprobems, #gaitcompensation, #hippain, #gluteweakness, #hipdrop, #archcollapse, #pronation

The case of the sneaky aberrant heel rise.

If you are not careful, as shown in this video case on Patreon, you can easily miss this aberrant heel rise clue.

This has been a challenging case. Without the patience of someone with a strong heart that really wants to get back to running, sometimes things do not get fixed because they are so deeply layered. This has been a rough case, but i have learned to be patient in unlayering things when things are not changing. I think for this great lady and great runner, teamwork and communication regularly was the key to getting to what i feel is the tipping point. come hell or high water, i will get her running again. Enjoy the long talk and steps into our head on this one.

Join us on Patreon (and soon another platform) for deeper gait insight and complex case "Work throughs". You might call these, "exercises in clinical gymnastics".

https://www.patreon.com/thegaitguys

Loss of terminal knee extension: How quickly can you process the facts ?

Some quick thoughts that must go through your mind on your examination. These thoughts must be ingrained, so that you can quickly juggle the other issues you client is coming in with that may very likely be related to the loss of left knee terminal extension.

more knee flexion may likely mean more ankle dorsiflexion , and that means more more anterior shin compartment strength is necessary to stop a quick progression to the forefoot (consider their clinical symptoms), this may mean pronation occurs more quickly (consider their clinical symptoms), it may mean more abrupt quadriceps loading since the loading does not start in more reasonable knee extension which means the quad is short now and that means increased patellofemoral compression possibilities (consider their clinical symptoms), this may mean more hip flexion on initiation of stance phase (consider their clinical symptoms), this may lead to more anterior pelvis tilt posturing and thus increased lordosis (consider their clinical symptoms), this flexed knee means that the leg is shorter which will through off pelvis symmetry (consider their clinical symptoms), this may mean more work for the contralateral hip abductors (consider their clinical symptoms), this may mean more frontal plane pelvis drift to the short leg side (consider their clinical symptoms), it will also mean 2 different step lengths which means 2 different hip extension patterns which means 2 different heel rises, and it will likely mean altered arm swing on both sides which can create changes into thoracic rotation (and of course the cervical spine sits on top of that) etc etc etc, so consider their clinical symptoms . . .

just wanted to quickly rattle off how fast your brain must juggle things, otherwise your exam is going to be knee-centered and tunnel visioned. Keep in mind, your client may not even have knee complaints, perhaps one or more of the above. But this is a perfect example of why you must examine the WHOLE client.

Perhaps this gives you even deeper understanding (combined with yesterdays "parallax binocular vision 2D post" as to why we will not give online corrective homework or consultations. There is just no way all of these things can be considered over video, Skype, Zoom or anything of the sort. Gait analysis must be done in person and encompass a hands on exam, if you do not want to miss something possible critically important, in our opinion, for what that is worth.

Shawn Allen, the other gait guy

#kneeextension, #gait, #gaitanalysis, #gaitproblems, #gaitanalysis, #gaitcompensations, #correctiveexercises, #thegaitguys

Why we have a problem with web-based gait analysis recommendations. What is Visual Parallax and how does it affect gait analysis?

Is your video gait analysis really telling you what you think it is telling you ?

We recently were asked by a student at a physical therapy school to help with a teaching case. They asked us to look at a gait video to assist in outlining some things in the case. Here was our response.
“Hello Jane Doe
We are happy to look at the video for you so you and others can learn.
Just please know, as we say all the time here on the Gait Guys, that without an examination that what we are all seeing is not the problem rather the persons compensatory strategy around the dysfunctional parts.
Plus, video negates binocular and parallax viewing so things that would stand out in in a exam where we are physically present will be masked quite a bit in/on video or on a computer screen. We try to minimize these visual losses by getting multiplanar gait video views (sagittal from front and back and coronal from left and right sides) but even these will not fill the visual gap from transferring data from 3D to 2D and then trying to interpret a 3D answer from the 2D. But it is the best one can do with our technology today unless you use a body suit sensor system, and then you still have the limitations of "what you see is not the problem, its their compensation” so one still needs the physical exam to put the puzzle together.
Here…….. read this if you are wondering what we mean.
*This blog article below which we wrote 6 years ago is the heart of what we wanted you to read today. Visual parallax and binocular vision both need to be understood so that you can better understand why what you see on your gait analysis video might not be what you think you are seeing. Seeing is one thing, knowing what you are seeing is another, knowing the limitations and the “why” of what you are seeing is yet another.

So, we can tell you what we see………but without an exam we cannot tell you with great accuracy why you are seeing what we see. Does that make sense ?“

Read on . . . .

What is Visual Parallax and how does it affect gait analysis? : Is your video gait analysis really telling you what you think it is telling you ?

Have you ever watched someone’s gait, only to reach for your camera to capture a gait deficit digitally, and then later re-watch the video and have a difficult time seeing the same deficit? There is a logical answer.

Vision exists with both eyes open (binocular), or with only one open eye (monocular). Our visual system uses all available depth cues to determine distances between objects, called physiological cues (actual or perceived differences), and psychological cues (experiential; or derived from past experience, or logical deduction).

Our 2 eyes see the world from slightly different locations (or different lines of sight), so the images transmitted to the visual cortex (in the occipital lobe) by the eyes are slightly different (see left picture above, compliments of Wikipedia). This difference in the perceived images is called binocular parallax. The amount or angle can be measured by the angle or semi-angle of inclination between those two lines. The term is derived from the Greek parallaxis, meaning “alteration”.

Our visual system is very sensitive to these “differences”, and binocular parallax is the most important depth cue for medium viewing distances (see right picture above, compliments of www.cns.nyu.edu). The sense of depth can be achieved using binocular parallax even if all other depth cues are removed.

Nearby objects have a larger parallax than more distant objects when observed from different positions, so parallax can be used to determine distances. Usually video provides us with confirmation of we are actually seeing in 3D. Beware, visual parallax may be playing tricks with you, as there is a discrepancy when translating 3D to 2D (cameras have one lens and are therefor monocular). Yes, binocular effect is lost in video; there is little depth perception with 2D and everything on the web, at this point, is 2D. A different vantage point (ie multiple camera angles: front, back and side) often offer a different perspective which is why we always suggest 3 views, but that too, is having 3 videos which are all 2D !

So this is why when you watch someone’s gait, even when LIVE on Skype or FACETIME, you have a difficult time seeing the same deficit that you might have seen had you been there in person enabling the components of binocular and parallax to come into play. Trust us, we are astonished all the time when we see something in a client's gait, and we reach for our phone or ipad, only to have it be barely present on the video because of the 2D capture limitations.

Remember, what you see (actually or on video) IS their compensation, NOT the problem, but it can often lead you to the problem. Pelvic drift to right during stance often means weak Gluteus medius on that side. Is that the problem? Maybe. However, “Why” is the bigger question. Is it from the foot? The Knee? the hip? Or maybe central and involving the vestibular apparatus? We examine, try to make a change, and see if it sticks.

So, in the future, keep in mind some of these limitations of what you are diagnosing off of video analysis because what you are seeing is a monocular interpretation of the real thing. Some information has been lost in the process of monocular motion capture. We are sure that in time video analysis will reach the 3D realm, and solve this problem.

Binocular Parallax. 2 different views of the same thing. Kind of like us…The Gait Guys…Ivo and Shawn

Things seem to come in 3's...

Things tend to occur in threes. This includes congenital abnormalities. Take a look this gentleman who came in to see us with lower back pain.

Highlights with pictures below:

• bilateral femoral retrotorsion

• bilateral internal tibial torsion

• forefoot (metatarsus) adductus

So why LBP? Our theory is the lack of internal rotation of the lower extremities forces that motion to occur somewhere; the next mobile area just north is the lumbar spine, where there is limited rotation available, usually about 5 degrees.

Dr Ivo Waerlop, one of The Gait Guys.

#tibialtorsion #femoraltorsion #femoralretrotorsion #lowbackpain #thegaitguys #gaitproblem

this is his left hip in full internal rotation. note that he does go past zero.

full internal rotation of the right hip; note he does not go past zero

note the internal tibial torsion. a line dropped from the tibial tuberosity should go through the 2nd metatarsal or between the 2nd and 3rd.

ditto for the keft

a line bisecting the calcaneus should pass between the 2nd and 3rd metatarsal shafts. If talar tosion was present, the rearfoot would appear more adducted

less adductus but still present

look at that long flexor response in compensation. What can you say about the quadratus plantae? NO bueno…

Ditto!

The smell of napalm in the morning: Your gait and trouser coughs, a clinical entity no one talks about.

Written by Dr. Shawn Allen

This is our very last gait guys blog post. Yes, all good things come to an end, even this trusted blog.
But, keeping in good faith, we will finish on a strong note ……. One of gardenia and lavender. Thanks for the last 10 years our dear gait brethren, is has been a great ride. Shawn and Ivo
_______________________________
The technical title of this blog post should have been, “The reactive influence of non-normopressure bowel distention and spontaneous high vapor dissipation on bipedal locomotion.” but no one but true gait nerds would have read it had we stuck with this pubmed-type title. Yes, we are talking about farts and gait here today folks, buckle up.

One biomechanical principle we will link to this entity of “off-gassing“ is that excessive or sustained ankle plantarflexion could inhibit dorsiflexion and certainly, at the very least, works against it. We have talked about this often here on the blog and how the lack of ample ankle dorsiflexion can impair many of the biomechanical events higher up into the human frame. So, how can someone’s bowel gas translate into gait problems ?

Think about this … to squeeze out a right “cheek sneak” (fart) with optimal crowd pleasing pitch and peak vibrato, some elevation and relaxation of the lower and middle gluteus maximus divisions (coccygeal and sacral) seems imperative to optimally control off-gassing . Seemingly, to do this, a significant degree of right ankle plantarflexion may be necessary to lift the right hemipelvis driving a subsequent intentional clockwise pelvic distortion assisting in the relaxation of these gluteal divisions. This consciously driven right side of the body “lift” via the right ankle plantarflexion can also be met and assisted via ipsitlateral abdominal and contralateral gluteus medius contraction to further enable the optimal right hemipelvis elevation. Go ahead, stand up and mimic the posture and note these biomechanical pieces. Recall our mantra,

“when the foot is on the ground, the glutes are in charge, when the foot is in the air, the abdominals are in charge”.

These coordinated motor patterns might be considered dual/multi tasking. This honed series of biomechanical events is one often perfected in frat houses and basement gaming rooms. But make no mistake, there is a biomechanical danger lurking here if this becomes a habitual compensation pattern, one common in large volume legume consumers (beware vegans). Habituation of this motor task, or demonstrating poor technique over time can render right quadratus lumborum shortening and weak lower abdominals rendering an anterior pelvic tilt. This tilt may lead to gluteal inhibition/weakness (because it is difficult to contract the gluteals in an anterior pelvic tilt, go ahead stand up again and try it) which over time can impair stance phase gait mechanics. However, relating to the off-gassing, this physical posturing might optimize low frequency gluteal vibrations that can optimize vibrato during gas dissipation if pressurization is in fact optimal for an “audible”. It is important to note that conscious variable control of the tonus of the muscular anal sphincter complex plays a big part in the pitch and vibrato. There is always a drawback it seems, it does truly come down to motor control it seems, doesn’t it always ?

This is not to say that avoiding “audibles” through holding “one” in doesn’t have consequences. The exotic gas (nitrogen, carbon dioxide, hydrogen, methane, oxygen) induced gut distention that could only make your collage roommate proud can inhibit the abdominal wall and thus the lower thoracic canister and disable normal breathing mechanics. This could be a serious complication to the coupled events of respiration and thoracic mobility. So, holding that big one in for your friends rather than engaging the compensatory Trendeleburg-type off-gassing posture as described above is also fraught with problems. We know that functional disconnection of the thoracic canister from the pelvic core can disrupt the normal anti-phasic mechanics of the contralateral upper and lower limbs as well as possibly impair the normal spinal cord mediated central pattern generators.

Farts…..Call them what you want, those ear pleasing, nose hair curling, trouser coughs that only a teenage boy can truly relish and recognize as a function of boyhood success. All joking aside, they truly should be your biggest concern in your gait analysis evaluation, bar none. Ask your patients about their bowels and off-gassing, it should be part of your clinical history intake. Maybe even consider taking out the discomfort of open dialogue, and put it on your intake forms. We found that a stick figure diagram in a good biomechanical squat posture with a mushroom cloud formation hanging overhead eases dialogue tension about this sensitive topic. We even give the young children crayons to they can color the cloud. What fun !

Dare us to write a part two on this topic. “Blue Angels” (unfamiliar with this clinical phenomenon? look it up). Go ahead, dare us for a part 2.

By now, if you haven’t realized that The Gait Guys just punked you (happy April Fools day) , then you likely haven’t had your cup of morning coffee. Yes, we have no clue what we were talking about on this blog post, well, ok maybe, after all we do have that y-chromosome. Yes, we are NOT ending the blog either :)

Are you now considering us juvenile ? Ok maybe we are a little, but don’t deny it, you thought about some unique and honest body biomechanics for a moment here and it is these mental gymnastics that will take your creative thinking about gait to the next level. If you are upset, so be it. There will be no apologies here in this growing PC world. "Off-gassing" is a human thing, we all do it. We have been writing serious stuff daily for 5 years here on The Gait Guys. It was time for us to write something a little lighter. We can only hope that you will think of us and the complexities of the gait cycle the next time you sneak one out while having dinner at the in-laws or before you blame the dog for any "something wicked this way comes" gaseous event. Try not to giggle when you do, but for certain, think about your body mechanics when you do, we can’t be responsible for off-gassing injuries.

Think of us, 2 juveniles at times, when the world needs us the most.

Shawn and Ivo, remaining here, for the duration.

disclaimer: we cannot be responsible for injuries that might be sustained by improper off-gassing events. Keep your work area a no smoking or vaping zone please when off-gasing. We also do not recommend attempts at performing Blue Angels, this is a potentially dangerous activity and could cause great bodily harm (seriously). :)

Running paths and the cross over gait and narrow step width.

This is a walking/running path. Do the runners on this path only have one foot? No, of course not, they are running on a line. Yes, we cannot get away from this cross over gait, a terribly narrow based gait pattern.
Is it economical? Likely.
Risky ? Possibly.
Do we know that this angled attack of the foot towards the mid-line asks more from the frontal plane stabililzers in the hip and core ? Yes, research has shown this.
Do we know that the gluteus medius helps with foot targeting? Yes, research again shows this, and thus a weak gluteus medius will enable a more medial targeting. Lesson: the gluteus medius helps with foot targeting on the swing leg, and hip stability on the stance leg.
With a Cross Over gait, Do we know that we need better control of internal spin of the limb, better foot pronation durability and many other durable abilities that we might not need so much of if we were better stacking the joint? Again, yes.

We confirmed with the reader who sent the photo that this is not a bike path (at this location this path is for walking folks, the bike path is adjacent to the parking lot).
The reader (Terry B. (thank you Terry)) astutely mentioned that people are walking on a line. If they had some spacing, step width, there would be 2 trails and a tiny patch of grass between them.

But, now, this line, the line is a queue for others to "walk the line" and join the cross-over nation.
We have written gobs of articles on this cross over topic, the few benefits, the teeter-totter "risk / reward" factor, the drawbacks and injury susceptibility factor and we have spoken about it on our podcast probably 100x. IF you wish to entertain that rabbit hole of knowledge, just goto our website and type it into the "search" box. "cross over gait"