Movement, can it make us better Humans ?

Human movement, grace and beauty.

This will be the last blog post you read from us …  for 2016. Happy New year wishes to you all !

This is a rehash of some old stuff, and some new, it seems to bring together many good points and thoughts of our work this past year. We hope you agree. If this seems familiar for those who have been with us for the last 7 years, it is our typical year end post, but it is worth your time

We have an amazing video for you today, a testament to how amazing the human frame is and how amazing movement can be.  But first … . it has been an amazing year for both of us here at The Gait Guys. Through this year, we have bridged further chasms. Our podcasts went into high gear and our number continue to grow globally, we were blessed to know our voices spanned the miles into 85 countries. The National Shoe Fit Certification Program continues to bring us deep gratitude emails from all professions. We blogged weekly , added some new videos and have made plans for more. We also made many new friends while learning much on our own end in our relentless research and readings. We appreciate every one of you who has followed us, and we thank you for your friendship.

As we find ourselves here at the end of another year, it is normal to look back and see our path to growth but to look forward to plan for ways to further develop our growth.  Many of you who read our blog are runners, but many of you are in one way or another involved with a sport or activity that incorporates running and gait. Hey, we all walk !  Even in the video above the dancers are seen running and walking. What we mean is that many of you are coaches or trainers or movement experts who develop those who run or move in one way or another in various sports, but many of you are also in the medical field helping those to run and move to get out of pain or improve performance.  And still yet we have discovered that some of you are in the fields of bodywork such as yoga, pilates, dance, martial arts and movement therapies.  It is perhaps these fields that we at The Gait Guys are least experienced at (but are learning) and like many others we find ourselves drawn to that which we are unaware and wish to know more in the hope that it will expand and improve that which we do regularly.  For many of you that is also likely the case.  For example, since a number of you are runners we would bet to say that you have taken up yoga, pilates, lifting or cross training to improve your running and to reduce or manage injuries or limitations in your body. But why stop there ? So, here today, we will try to slowly bring you full circle into other fields of advanced movement. As you can see in this modern dance video above the grace, skill, endurance, strength, flexibility and awareness are amazing and beautiful.  Wouldn’t you like to see them in a sporting event ? Wouldn’t you like to see them run ? Aren’t you at least curious ? Their movements are so effortless. Are yours in your chosen sport ? How would they be at soccer for example ? How would they be at gymnastics ? Martial arts ? Do you know that some of the greatest martial artists were first dancers ? Did you know that Bruce Lee was the Cha Cha Dance Champion of Hong Kong ? He is only one of many. Dance, martial arts, gymnastics …  all some of the most complex body movements that exist. And none of them are simple, some taking decades to master, if that, but most of which none of us can do. In 2017 we will continue to expand your horizons of these advanced movement practices as our horizons expand. We plan to return to dance again to advance our thinking of foot and body movements, incorporating many aspects into our treatment and exercise regimens, and now that we have almost 4 years of jiu jitsu under our belts it is time to consider adding the sport of Parkour and climbing as we have hinted. Why not add this knowledge to your repertoire ?  Many of our athletes do not even know that much of their exercise homework is from basic dance principles, until we tell them at the end of a session.  There is a reason why some of the best athletes in the NBA, NFL and other sports have turned to almost secret study of dance and martial arts because there is huge value in it.  Look at any gymnast, martial artist or dancer. Look at their body, their posture, their grace.  It is as if their bodies know something that ours do not.  And so, in 2017 The Gait Guys will dive even deeper into these professions to learn principles and bring them back to you. After all, everything we do is about movement. Movement is after all what keeps the brain alive and learning. 

Below are excerpts from a great article from Kimerer Lamothe, PhD. She wrote a wonderful article in Psychology Today a few years ago  on her experience with McDougall’s book “Born to Run” and how she translated it into something more.  At some point, take the time to read her whole article.  But do not cut yourself short now, you only have a little more reading below, take the next 2 minutes, it might change something in your life.

We leave you now with our 2017 gratitude for this great growing brethren and community that is unfolding here at The Gait Guys. We have great plans for 2017 so stay with us, grow with us, and continue to learn and improve your own body and those that you work with.  Again, read Kimerer’s most excellent excerpts below, for now, and watch the amazing body demonstrations in the video above. It will be worth it.

Shawn and Ivo, the gait guys

_____________________

Can Running Make us Better Humans ?….. excerpts from the artcle by Kimerer LaMothe.

http://www.psychologytoday.com/blog/what-body-knows/201109/can-running-make-us-better-humans

“The Tarahumara are not only Running People, they are also Dancing People. Like other people who practice endurance running, such as the Kalahari Kung, dancing occupies a central place in Tarahumara culture. Or at least, it has. The Tarahumara dance to pray, to celebrate life passages, to mark seasonal and religious events. They dance outside where Father God and Mother Moon can see, in patterns consisting of steps and shuffles, taps and hops, performed in a line or a circle with others. And they dance the night before a long running race, while the native corn beer, or tesguino flows.

While McDougall notes the irony of “partying” the night before a race, he doesn’t ask the question: might the dancing actually serve the running? Might it be that the Tarahumara dance in order to run—to ensure the success of their run—for themselves and for the community?

At the very least, the fact that the Tarahumara dance when and how they do is evidence that they live in a world where bodily movement matters. They believe that how they move their bodies matters to who they are and to how life happens. They have survived as a people by adapting their traditional method of endurance hunting (running animals to exhaustion) to the challenges of fleeing Spanish invaders, accessing inaccessible wilderness, and staying in touch with one another while scattered throughout its canyons. As McDougall notes, they have kept alive an ancient genetic human heritage: to love running is to love life, for running enables life.

Yet McDougall is also clear: even the Tarahumara are not born knowing how to run. Like all humans, they must learn. Even though human bodies are designed to flourish when subject to the stresses of long distance loping, we still need to learn how to coordinate our limbs to allow that growth to happen. We must learn to run with head up, carriage straight, and toes reaching for the ground. We must land softly and roll inwardly, before snapping our heels behind us. We must learn to glide—easy, light, smooth—uphill and down, breathing through it all. How do we learn?

How do we learn to run? We learn by paying attention to other people, and taking note of the movements they are making. We learn by cultivating a sensory awareness of our own movements, noting the pain and pleasure they produce, and finding ways to adjust. We learn by creating and becoming patterns of movement that release our energy boldly and efficiently across space. We learn, in a word, by dancing.

While dancing, people open up their sensory selves and play with movement possibilities. The rhythm marks a time and space of exploration. Moving with another heightens the energy available for it. Learning and repeating sequences of steps exercises a human’s most fundamental creativity, operating at a sensory level, that enables us to learn to make any movement in any realm of endeavor with precision and grace. Even the movements of love. Dancing, people affirm for themselves and with each other that movement matters.

In this sense, dancing before the night of a running race makes perfect sense. Moving in time with one another, stepping and stretching in proximity to one another, the Tarahumara would affirm what is true for them: they learn from one another how to run.  They learn to run for one another. They run with one another. And when they race, they give each other the chance to learn how to be the best that they each can be, for the good of all.

It may be that the dancing is what gives the running its meaning, and makes it matter.

Yet the link with dance suggests another response as well. In order for running to emerge in human practice as something we are born to do, we need a culture that values movement—that is, we need a general appreciation that and how the bodily movements we make matter. It is an appreciation that our modern western culture lacks. 

Those of us raised in the modern west grow up in human-built worlds. We wake up in static boxes, packed with still, stale air, largely impervious to wind and rain and light. We pride ourselves at being able to sit while others move food, fuel, clothing, and other goods for us. We train ourselves not to move, not to notice movement, and not to want to move. We are so good at recreating the movement patterns we perceive that we grow as stationary as the walls around us (or take drugs to help us).

Yet we are desperate for movement, and seek to calm our agitated senses by turning on the TV, checking email, or twisting the radio dial to get movement in a frame, on demand. It isn’t enough. Without the sensory stimulation provided by the experiences of moving with other people in the infinite motility of the natural world, we lose touch with the movement of our own bodily selves. We forget that we are born to dance and run and run and dance.

The movements that we make make us. We feel the results. Riddled with injury and illness, paralyzed by fears, and dizzy with exhaustion, our bodily selves call us to remember that where, how, and with whom we move matters. We need to remember that how we move our bodies matters to the thoughts we think, the feelings we feel, the futures we can imagine, and the relationships we can create with ourselves, one another, and the earth.

Without this consciousness, we won’t be able to appreciate what the Tarahumara know: that the dancing and the running go hand in hand as mutually enabling expressions of a worldview in which movement matters.”

Thanks for a great article Kimerer. (entire article here)http://www.psychologytoday.com/blog/what-body-knows/201109/can-running-make-us-better-humans

*oh, and want a little more of these performers in the video, check this out……. it will move you.

http://youtu.be/CvQBUccxBr4

Wishing a Happy New Year to you all, from our hearts……. Shawn and Ivo

The Gait Guys

"Stiff person syndrome": A clinical mystery ?


Stiff person syndrome (SPS), first noted in 1956, is a rare neurologic entity of unclear etiology. It is characterized by progressive rigidity and stiffness mainly affecting the axial trunk muscles thought it can affect the limb(s), one or more.  It looks much like a sensory-motor neuropathic gait, and similar to a CIDP (chronic inflammatory demyelinating polyneuropathy) client we have seen. Chronic pain, impaired mobility, and lumbar hyperlordosis are common symptoms. Spasms can be severe and leave the patient very sensitive to touch and sound, which can sometimes trigger spasms. Some studies have noted that patients generally tend to have anti-glutamic acid decarboxylase (GAD) antibodies, anti-amphiphysin, anti-gephyrin, and anti-gamma-aminobutyric acid A receptor-associated protein (GABARAP) antibodies leaving one to assume this is a variation of an autoimmune disorder expressing neurologically. This is complicated by lack of adequate or specific lab tests to pin point the diagnosis though some CSF and EMG tests are helpful. Generally this is a progressive disorder eventually leaving many clients with movement disabilities.  Enough patients tend towards cancer over time that there may be a paraneoplastic underpinning.
This is a bizarre one, what do you think ?  Have you seen it ?

Pract Neurol. 2011 Oct;11(5):272-82. doi: 10.1136/practneurol-2011-000071. Stiff person syndrome. Hadavi S1, Noyce AJ, Leslie RD, Giovannoni G.


Brain Nerve. 2010 Apr;62(4):377-85. [Stiff-person syndrome and other myelopathies constitute paraneoplastic neurological syndromes]. [Article in Japanese] Ishii A1.

Abnormal Forefoot loading creates fatigue ?

How is your medial-lateral foot and ankle stability ? In many injured folks it is an issue and needs to be investigated. Remember, skill, endurance, strength IN THAT ORDER ! Today, Fatigue is the topic du jour !
If you are in a heeled shoe of any degree (greater heels suggests greater risk) , and this likely pertains to increased heel dropped running shoes we would propose, fatigue of the frontal plane is risky business. 
“EMG measurements from habitual high-heeled shoe wearers demonstrated an imbalance of gastrocnemius lateralis versus gastrocnemius medialis activity in fatigue conditions, which correlated with abnormal lateral shifts in the foot-ground or shoe-ground COP of these women.”
Some of this is from the natural foot architecture, a blog post on this very topic is in order we think !
“The results demonstrated accelerated fatigue of the peroneus longus muscle in marching conditions … . EMG analysis further revealed substantial fatigue of the pre-tibial and triceps surae muscles during intensive marching”
Don’t forget to assess fatigue gait brethren ! Motor patterns, skill, strength are all great, but what about fatigue ?! Test for it and you will find it ! 
And, think about this if you are a forefoot strike runner, for obvious reasons, the heels is similarly in a raised posture.

Dr. Shawn Allen

Gait Posture. 2002 Feb;15(1):56-63.
Analysis of muscular fatigue and foot stability during high-heeled gait.
Gefen A

Med Biol Eng Comput. 2002 May;40(3):302-10.
Biomechanical analysis of fatigue-related foot injury mechanisms in athletes and recruits during intensive marching.
Gefen A1.

Podcast 117: The glutes in rotation

Key tag words:

running, glutes, climbing, hip rotation, movement patterns, hominids, bone density, gait

Links:

http://traffic.libsyn.com/thegaitguys/pod_117ffinal.mp3

http://thegaitguys.libsyn.com/episode-117

www.thegaitguys.com

That is our website, and it is all you need to remember. Everything you want, need and wish for is right there on the site.

Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

 

Show Notes:

3D printed talus replacement surgery helps patients regain up to 75% normal ankle function
http://www.3ders.org/articles/20160504-3d-printed-talus-replacement-surgery-helps-patients-regain-up-to-normal-ankle-function.html

http://pubs.rsna.org/doi/full/10.1148/rg.2015140156

Stopping Exercise Decreases Brain Blood Flow
http://neurosciencenews.com/exercise-brain-blood-flow-4927/?utm_medium=email&utm_source=flipboard

Babies Who Walk Earlier May Have Stronger Bones in Their Teens
http://news.health.com/2016/06/02/babys-early-walking-may-mean-stronger-bones-as-teen/

NEW EVIDENCE SUGGESTS OUR HOMINID COUSIN LUCY LOVED CLIMBING TREES
http://www.popsci.com/new-evidence-that-our-hominid-cousin-lucy-loved-climbing-trees

Glutes as internal hip rotators
https://www.thegaitguys.com/thedailyblog/2016/12/7/the-glutes-are-in-fact-great-internal-hip-rotators-too-open-your-mind

Retraining movement patterns, mind or muscles or vision ?
http://www.theglobeandmail.com/life/health-and-fitness/fitness/study-suggests-visual-feedback-doesnt-speed-up-learning-of-new-movements-health/article33142789/

Crawling and EMG

With all the talk last week on the blog about the glutes and their functions, especially INTERNAL ROTATION along with crawling, we thought this FREE FULL TEXT article was germane

The following conclusions are drawn from the current study:
1. The highest gait velocity in confined space is achieved with stoopwalking, followed by four-point and two-point crawling. 2. Wearing kneepads did not influence thigh muscle EMG or knee
kinematics during stoopwalking or crawling; however, wearing kneepads in two-point crawling decreased cadence and increased stride length.
3. Compared to upright walking, EMG activity of the thigh muscles during stance in stoopwalking is more prolonged.
4. A variety of interlimb coordination patterns were observed in four-point crawling, including trot-like, pace-like, and no-limb pairing contact patterns.
5. Two-point crawling was unique among the techniques in that the hamstrings exhibited greater activity than the vasti muscles.

 

 

 

https://www.cdc.gov/niosh/mining/UserFiles/works/pdfs/lirsk.pdf

Podcast 116: Running Cadence & Tricks


Key tag words:
running, cadence, form, running form, running tricks, gait, gait analysis, the gait guys, CRISPR, brain implants, spinal regeneration, coordination

Direct download URL:
http://traffic.libsyn.com/thegaitguys/pod_116_final_2.mp3

Permalink URL:
http://thegaitguys.libsyn.com/episode-116

Libsyn directory URL:  http://directory.libsyn.com/episode/index/id/4901265

Key tag words:
running, cadence, form, running form, running tricks, gait, gait analysis, the gait guys, CRISPR, brain implants, spinal regeneration, coordination
 
Show sponsors:
 
www.thegaitguys.com
That is our website, and it is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).
 
Our podcast is on iTunes, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.
 
Show Notes:

Human patient treated with CRISPR gene editing for the first time.
http://www.popsci.com/crispr-tested-in-human-patient-for-first-time

For the First Time, a Wireless Brain Implant Has Enabled Paralysed Primates to Walk Again
http://www.sciencealert.com/for-the-first-time-a-wireless-brain-implant-has-enabled-paralysed-primates-to-walk-again

Scientists May Have Found Protein That Could Help Unlock Spinal Regeneration in Humans
http://futurism.com/scientists-may-have-found-protein-that-could-help-unlock-spinal-regeneration-in-humans/

Cadence:
"Coordination variability decreased with an increase in cadence across all couples and phases of gait. These results suggest examination of coordination and its variability could give insight into the risk of intervention-induced injury."

Hafer JF, Freedman Silvernail J, Hillstrom HJ, Boyer KA. Changes in coordination and its variability with an increase in running cadence. J Sports Sci. 2016 Aug;34(15):1388-95. doi: 10.1080/02640414.2015.1112021. Epub 2015 Nov 20.

http://www.thegaitguys.com/thedailyblog/2016/10/16/music-to-my-earsand-steps-to-my-cadence

http://www.thegaitguys.com/thedailyblog/2016/10/16/step-rate-to-change-foot-strike

http://www.thegaitguys.com/thedailyblog/2016/10/16/cadence
-cadence and running. Increasing it as little as 5% seems to decrease vertical loading rates in the achilles tendon.

The glutes are in fact great internal hip rotators, too. Open your mind.

I recently got a message from a colleague questioning as to how in the world, that when the hip is in flexion, the glutes and piriformis become internal rotators.  This is again another example of lack of functional anatomy knowledge.  It took me awhile to find a picture to help explain this, but I finally found one reasonable to do so. Many readers who are stuck on this concept are just too stuck on the anatomy as presented in the image to the right, neutral stance-like.  This article today will be all about internal and external moment arms, here, this lecture will help a little, it is on glute medius internal moment arms in stance phase however, so there is little carry over but it will at least get you understanding moment arms more clearly. 

We tend to just think of the glute max as a hip stabilizer and extensor, for the most part. It also decelerates flexion in terminal swing.  The glute medius is mostly thought of as a lateral hip stabilizer and abductor, either of the femur (open chain) or of the pelvis in stance position (closed chain), meaning zero degrees or neutral plus or minus the trivial degrees of engaged hip flexion and extension used in normal gait.

No one I know consciously trains the glutes as an internal rotator, but there are many actions where we need this function, such as in crawling and many high functioning activities such as martial arts grappling and kicking for example. Gymnasts should also know that the glutes are powerful internal hip rotators.  If you are doing quadruped crawling work you also need to know this as your client approaches 90 degrees of hip flexion. No one ever seems to check this critical gluteal function, at least I see it missed all the time from my referring doctors and therapists for unresolving hip pain cases. Patients with hip pain, anterior, lateral or posterior, with lack of internal hip rotation need the glutes checked just as much as the other known internal hip rotators we all seem to know (though some still do not understand how powerful the vastus lateralis is as an internal rotator, but again, those are folks who just have not spend the time in a mental 3D space looking at functional anatomy. I live mentally in that 3D space all day long when working with patients, you should too.) Let me be more clear, the anterior bundle, the iliac bundle of the glute max, is an internal rotator in flexion, the sacral and coccyxgeal divisions are not, they are external hip rotators in flexion. The gluteus medius and minimus are internal hip rotators closing in on 90 degrees hip flexion.  Hence, you must be able to tease out these divisions in your muscle testing, one cannot just test the glutes as external rotators or extensors, you are doing a really sloppy job if that is all you are doing. Nor should someone just train the glutes as hip stabilizers, external hip rotators and extensors (which is probably 90% of the trainers and coaches out there I might assume?). IF one knows the origin and insertions (see the blue and green arrows) and moves those points towards each other in a fashion of concentric contraction (purple arrows) one should be able to easily see that this will orient the femur to spin into internal rotation in the acetabulum (follow the arc of the black arrows). The same goes for eccentric contractions, it is the same game.  If you are doing DNS and crawling work, you should know this stuff cold gang. When you close chain the hip in sitting, or are moving from tall kneeling into flexed kneeling chops, performing high knees in sprint training,  or especially in crawling and climbing type actions, you must understand the mechanisms of internal rotation creation and stabilization -- if the glutes are not present and trained and useful in flexion, you are missing a chunk of something big. Amongst many other things, your client must be capable, stable, strong and skilled in moving from supine to quadruped all in one turning-over motion to teach how to stabilize the hip in the quadruped action and then progress into crawling.  This is a reflexive action learned in the early motor developmental phase of locomotion.  So take your client back through this motor pattern if they have some of the hip problems with internal rotation, it is a small piece of the gluteal puzzle.

I am sure this will show up in someone's seminar at some point, hopefully it is in many already, it has always been in my lectures when going down the rabbit hole of all things glutes. And to be fair, I haven't been to seminars in years as I get too frustrated, so this concept may be everywhere for all I know (lets hope).  But that is something I have to get over, I am sure I still have much to learn.  

To give credit where credit is due, which we always insist upon here at The Gait Guys, this was refreshed in my mind by Greg Lehman in a Facebook post forwarded to me by the inquiring doctor.   Link here  and from the article that spurred him to discuss it, an old article I read long ago just after completing my residency, the article is by Delp et al.  It is worth your time.  Thanks Greg for bringing this back into the dialogue, it is critical base knowledge everyone should already know. 

Variation of rotation moment arms with hip flexion.  Scott L. Delp,*, William E. Hess, David S. Hungerford, Lynne C. Jones  J. of Biomechanics 32, (1999)

-Dr. Shawn Allen, the other Gait Guy

Ankle Sprains...A nice review here

A nice FREE FULL TEXT literature review about the biomechanics, diagnosis, grading and treatment (conservative and non conservative) of acute ankle sprains. There is an interesting section at the end for prevention. Consider this a staple for your library to refer to when needed.

 "This paper summarizes the current understanding on acute ankle sprain injury, which is the most common acute sport trauma, accounting for about 14% of all sport-related injuries. Among, 80% are ligamentous sprains caused by explosive inversion or supination. The injury motion often happens at the subtalar joint and tears the anterior talofibular ligament (ATFL) which possesses the lowest ultimate load among the lateral ligaments at the ankle. "

Fong DT, Chan Y-Y, Mok K-M, Yung PS, Chan K-M. Understanding acute ankle ligamentous sprain injury in sports. Sports Medicine, Arthroscopy, Rehabilitation, Therapy, and Technology : SMARTT. 2009;1:14. doi:10.1186/1758-2555-1-14.

link to full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724472/

 

Podcast: "Run to the Top" with Guests Ivo and Shawn, The Gait Guys


Show link:  https://runnersconnect.net/running-interviews/gait-guys/

We recently shared the mic for an hour with Tina Muir over at RunnersConnect.net.
It was a great open conversation and I think our gang here and elsewhere will really find some hearty information here. Some of the topics you have heard before if you have been with us at The Gait Guys Podcast previously, however, we take some unanticipated paths that lead us to some deeper conversations and some insights you may have not heard from us before.  The ability to facilitate this in a first time discussion with two strangers is the gift of a great interviewer, and Tina shined brightly in teasing these things from us.  We hope you will put your favorite ear cans on and go for a run or walk and give this lively discussion an hour of your time, we do not think you will be disappointed.  Tina laid out a beautiful show, and has gorgeous show notes and time stamp break downs for your OCD folks !  Bravo.  

Again, here is the link to her site, and the show.

Show link:  https://runnersconnect.net/running-interviews/gait-guys/

Offer her hard work some support and like her on all social media and give her other guest podcast shows a try. 

-Shawn and Ivo (and Tina, this time around !)

Screen Shot 2016-11-23 at 5.56.54 AM.png

medial to lateral stability....in older folks...

  • "older adults prioritized medial to lateral control over forward progression during adaptive walking challenges."

Did you know this? It makes sense, if you have been reading along with us and think about decomposition of movement when we get injured or as we age. 

Bottom line?

Older folks would rather move side to side and seem more concerned with lateral movement (i.e. coronal plane stability, possibly to avoid falling?) and will shorten their step length to adjust for moving forward, if needed.

"Simultaneous control of lower limb stepping movements and trunk motion is important for skilled walking; adapting gait to environmental constraints requires frequent alternations in stepping and trunk motion. These alterations provide a window into the locomotor strategies adopted by the walker. The authors examined gait strategies in young and healthy older adults when manipulating step width. Anteroposterior (AP) and mediolateral (ML) smoothness (quantified by harmonic ratios) and stepping consistency (quantified by gait variability) were analyzed during narrow and wide walking while controlling cadence to preferred pace. Results indicated older adults preserved ML smoothness at the expense of AP smoothness, shortened their steps, and exhibited reduced stepping consistency. The authors conclude that older adults prioritized ML control over forward progression during adaptive walking challenges."

J Mot Behav. 2016 Nov 21:1-6. [Epub ahead of print]
Age-Related Differences in Locomotor Strategies During Adaptive Walking.
Lowry KA, Sebastian K, Perera S, Van Swearingen J, Smiley-Oyen AL.

Who’s driving the compensation, anyway?

We often look at folks gait and see a pelvic drift or lean to the weak side and think “I should help them strengthen their gluteus medius”, which is often needed, but we need to think of what is driving that compensation.

Take a look at this gent that presented to the office with low back pain and watch his gait. 

Some things we hope you see are:

  • lean to the right during right stance phase
  • increased arm swing on the left
  • increased progression angle of the foot on the left
  • increased arm abduction on the left, adduction on the right
  • increased finger flexion on the left
  • slight head tilt to the left
  • tibial varum
  • crossover gait

Perhaps you are thinking, in the same order as above:

  • weak glute medius on left or QL on right or compensating for LLD on L
  • using L arm to try and help propel himself forward
  • increased balance requirements on the left so the “kickstand” foot
  • moving center of gravity the left
  • increased flexor tone to try and compensate for a weakness
  • moving center of gravity to the left, the brain needs to help keep the eyes parallel to the horizon
  • tibial varum and perhaps a more supinated foot posture, or increased forefoot pronation requirements
  • crossover

..or maybe you are thinking of something else?

The truth of the matter is that what is driving the largest part of his compensation is in fact a disc herniation, but not for what you may be thinking. The herniation is on the LEFT SIDE and at L3-L4. Take a look at the MRI Image. Yes, there is also a small herniation that L5-S1 but it DOES NOT occlude the foarmen nor hit the individual nerve roots and is on the LEFT (which you are hopefully thinking would cause left sided weakness)

Hmmm...

So what is driving his compensation is actually a LEFT SIDED quad/adductor weakness (the femoral and obturator nerves are from L2-4). Go back and watch the video again. Can you see it?

Someone needs to be driving the bus. Don’t be too quick to jump on it until you know who is driving it and where it is going. 

Podcast #115: Brain logging injuries and patterns

We go deep on how injuries get logged deep in the CNS, what to do and how to get around it all.  Join us today !


Show sponsors:
newbalancechicago.com
altrarunning.com

www.thegaitguys.com
That is our website, and it is all you need to remember. Everything you want, need and wish for is right there on the site.
Interested in our stuff ? Want to buy some of our lectures or our National Shoe Fit program? Click here (thegaitguys.com or thegaitguys.tumblr.com) and you will come to our websites. In the tabs, you will find tabs for STORE, SEMINARS, BOOK etc. We also lecture every 3rd Wednesday of the month on onlineCE.com. We have an extensive catalogued library of our courses there, you can take them any time for a nominal fee (~$20).
 
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* Podcast Links: 

http://traffic.libsyn.com/thegaitguys/pod_115f.mp3


http://thegaitguys.libsyn.com/podcast-115-brain-logging-injuries-and-patterns

_______________________________________
Show Notes:

Imagining workouts can improve strength
http://globalnews.ca/news/2885514/imagining-a-workout-may-be-almost-as-good-as-the-real-thing/

Your injuries are not forgotten
http://www.medicalnewstoday.com/articles/312665.php

Sending a V16, with tears of joy. More neurology of movement: Climbing impossible stuff.

This badass just did a V16 here in this video, translation, the Mount Everest of bouldering. He deserved to cry.

Spin this picture 180 and he is crawling, finding points of “fixation”. What is neat about climbing is that you can have one, two, three or four points of fixation, unlike walking (one or two points) and crawling (two, three or four points of fixation). The difference in climbing is that gravity is a bear, wearing you down, little by little. A deep similarity in climbing to any variety of crawling is that both involve pulling and pushing, compressing and extending over fixation points. Other common principles are those of fixation, stability, mobility and neurologic crawling patterns in order to progress.
Some research has determined that in quadrupeds the lower limbs displayed reduced orientation yet increased ranges of kinematic coordination in alternative patterns such as diagonal and lateral coordination.  

This was clearly different to the typical kinematics that are employed in upright bipedal locomotion. Furthermore, in skilled mountain climbers, these lateral and diagonal patterns are clearly more developed than in study controls largely due to repeated challenges and subsequent adaptive changes to these lateral and diagonal patterns.  What this seems to suggest is that there is a different demand and tax on the CPG’s (central pattern generators) and cord mediated neuromechanics moving from bipedal to quadrupedal locomotion. There seemed to be both advantages and disadvantages to both locomotion styles. Moving towards a more upright bipedal style of locomotion shows an increase in the lower spine (sacral motor pool) activity because of the increased and different demands on the musculature however at the potential cost to losing some of the skills and advantages of the lateral and diagonal quadrupedal skills. Naturally, different CPG reorganization is necessary moving towards bipedalism because of these different weight bearing demands on the lower limbs but also due to the change from weight bearing upper limbs to more mobile upper limbs free to not only optimize the speed of bipedalism but also to enable the function of carrying objects during locomotion. 

This brief excerpt was taken from one of the many articles I have written on the complex biomechanics and neurology of climbing and movement. Search for it all on our blog, thegatiguys.com

-Dr. Shawn Allen, the other gait guy
 

Chris Sharma free climbs a giant Redwood Tree

Chris is a legend, one of the best. He climbs routes and routes without ropes that others do not even consider possible. This time, he takes on a giant Redwood tree.


"In climbing there is suspicion of a shift in the central pattern generators because of the extraordinary demand by pseudo-quadrupedal gait climbing due to the demand on the upper limbs and their motorneuron pools to mobilize the organism up the mountain.  We know these quadrupedal circuits exist. In 2005 Shapiro and Raichien wrote “the present work showed that human QL (quadrupedal locomotion) may spontaneously occur in humans with an unimpaired brain, probably using the ancestral locomotor networks for the diagonal sequence preserved for about the last 400 million years.”
I have written several articles on the complex neurology and biomechanics of climbing.  You can search for them on our blog.  - Dr. Allen
 

Pathologic Ankle Rocker: Part 2. “Passing the Buck Proximally”

This was an unexpected follow up blog post from yesterday’s piece we did on the rigid flat foot. We were purging some files from an old computer and came across these 2 videos. We are not even sure where they came from. They were AVI files from probably 2 decades gone by;  they reminded us how long we have been at this gait game and how many great patients have taught us along the way.
Yesterday we learned that if the ankle rocker (dorsiflexion) was impaired that we could ask for the motion to be passed into the midfoot via hyperpronation in order to get the tibia to progress past vertical to enable the body to pass by the rigid ankle mortise rocker.  (Remember from our previous teachings that there are 3 rockers in the foot. First there is heel rocker, then ankle rocker, then forefoot rocker. Each is essential for normal gait. You must understand the 3 rockers to understand gait and to recognize gait pathologies when they present.)
So, yesterday we saw a strategy of pronating excessively through the midfoot to artificially trick us into thinking we have more ankle rocker then we actually truly did. So this was a “pass the buck” into the foot. Today however we are going to show you a very atypical compensatory choice. Today this client shows that with a rigid and/or strong enough arch that the arch doesn’t always need to be the part that gives in to enable more rocker. Today this client chose a vertical strategy.
You are going to have to study these videos closely several times, this is a critical learning and teaching point today. The problem is the left ankle in the video.

This client has chosen to goVERTICAL when they hit the ankle rocker limitation. Once they achieve their terminal range at the ankle mortise joint (the tibio-talar joint ) their brain realized that moving forward at the ankle was impossible. Since the midfoot did not collapse and give in, as in yesterday’s case, they had no choice but to “pass the buck” proximally into the kinetic chain. In this case we see that the knee was the next vertical joint. Now, they have 2 choices, either hyperextend the knee to enable a forward lurch of the body mass past the ankle rocker axis or “go vertical”. In this case you can see the early heel rise (we refer to is as premature heel rise). Frequently a premature heel rise can force knee flexion but in this case the rise just kept going vertical and forcing them into the use of the gastrocsoleus group and thus forcing a lift of the entire body. If you look hard you can see a greater development of the calf muscles on this side from doing this for years. (Oh, wait, memory data dump here…..we are recalling this case, it was the result of an old motorcycle accident. A student sent us this video back in the 1990’s when we were teaching at the university.)
What is interesting here is that if you think hard, and this will be a new thought process for many readers, that when he goes into heel rise he buys himself more ankle range again. You see, he first met the end range limitation of ankle rocker which appears to be about 90 degrees and then he hits the bony block. If he goes vertical into the calf he is moving back into plantarflexion. This means that even though he is on the forefoot now, he has bought himself more ankle dorsiflexion range again. Now he has the option of holding the posture on the forefoot as rigid and then re-utilizing the new-found extra degrees of ankle dorsiflexion to progress forward OR, he can just move into FOREFOOT ROCKER (the 3rd of the rockers we meantioned earlier).  This client is likely doing a bit of both, perhaps a little more of the forefoot rocker strategy.
You can also kind of see that this slightly shortens the time in the stance phase on this left side and causes an early dumping onto the right limb (which causes a frontal plane pelvis distortion compensation). This gives the appearance of a slight limp.
So, this was a nice follow up from yesterday’s principle of “passing the buck”. You can either ask for the motion from the next distal joint in the kinetic chain, oryou can back up the kinetic chain and dump it into the proximal joint from the pathologic one (the knee in this case). Which one would you want, if you had to choose?  It is a tough choice, luckily the body decides for us.  IF you consider that luck !

Regardless, one has to stand in awe that the body will find a way to get the range elsewhere when it cannot find it in the primary motor pattern.  And when the range has to be gained elsewhere, the muscular function has to change as well and prostitute the normal kinetic chain motor patterns. 

Here is a tougher question for you. Would you want this phenomenon on one side and be unilaterally compromising (and thus have to compensate on the opposite side) the kinetic chain or bilaterally and have the asymmetry on both sides ?  That is a tough one. There is no good choice however.

*Please do not try to help this client by putting a heel wedge in their shoe. You are just going to rush heel rocker into that bony block sooner and faster and speed up his pathologic stance phase. You will see his vertical strategy come even faster and thus pass the buck into the opposite right hip even stronger. It is a fleeting good initial thought because you are merely trying to help his poor calf muscles get to that heel rise easier, until you think about it for a minute.

When it comes to the feet, use your head.  And, consider the Gait Guys, National Shoe Fit DVD program.  Email us at : thegaitguys@gmail.com

Part 2: The Turning: The thoracic spine in connecting the kinetic chain

Yesterday I provided a blog post on this photo here. Today I want to pose a rabbit hole for you to ponder, in the hopes that  you see how  much deeper this process is at looking at gait and locomotion  . . . . . thoracic rotation.
Below you will find yesterdays post, if you read it yesterday you can scroll down to the *** down below and read what I ask you to ponder today (but its always nice to review :)

From yesterday's blog post:


"It should be simple and clear in the photo that I am turning my neck and thoracic spine strongly to the left.  The left rotation has forced me to find stability over the lateral left foot while driving the rotation with the right foot.  Left foot had to supinate, right had to pronate. No rocket science here.

Earlier in the week I posted a brief discussion on the neck and proprioception and the upper and lower limb. I caught some questions on challenging the strength of the neurological linkages to the lower limb, so I promised a simple picture to solidify my point.
Where is what i wrote earlier this week.
"From the study: "Limb proprioception is an awareness by the central nervous system (CNS) of the location of a limb in three-dimensional space and is essential for movement and postural control. The CNS uses the position of the head and neck when interpreting the position of the upper limb, and altered input from neck muscles may affect the sensory inputs to the CNS and consequently may impair the awareness of upper limb joint position."

We say it is not just the upper limb however, the neck and head posture is used in interpreting the position of the lower limb as well. And similarly altered head/neck muscle input can impair awareness of the lower limb posture as well. Think about it, we are trying to stay upright in the gravitational plane while keeping the eyes and vestibular centers on the horizon. Gait is nothing more than a single leg balancing act repeated over and over. Faulty info on where our center of pressure is from a visual or vestibular aspect will alter where we put our foot in space. Just look at how many neurologic diseases end up with a wider based gait, because our proprioceptive centers no longer trust our base of support. It is all connected."

Exp Brain Res. 2015 May;233(5):1663-75. doi: 10.1007/s00221-015-4240-x. Epub 2015 Mar 13.Neck muscle fatigue alters upper limb proprioception. Zabihhosseinian M1, Holmes MW, Murphy B.

As in this study, and putting it together with my photo and discussion at the start here today, limb proprioception is an awareness by the CNS of the location of the limb and is essential for proper movement and postural control. If I had rotated to the left and had my CNS not known where the foot was in space and in relation to the rest of my body, I may have fallen over to the left. Instead, my CNS sensed the weight shift to the left from the neck and torso rotation, and moved my foot weight bearing into supination (affording a slightly greater lateral weight bearing on the foot) to accommodate the shift in my center of pressure and mass laterally.  So, the CNS used the position of the head and neck, and the weight shift, in interpreting the appropriate positioning of the lower limbs. Sometimes moving the foot into supination to accommodate the lateral load is not enough, and we need to actually step laterally to maintain upright.  Altered input from my neck muscles might affect the sensory inputs to the CNS and consequently may impair the awareness of my limb joint positioning in space. This happens often in vestibular challenged clients and in client of aging decline where the system is losing proprioception. If we do not know where a body part is in space, we don't know how to use it or how to load it (think about chronic ankle sprains).

As i said earlier this week, think about it, we are trying to stay upright in the gravitational plane while keeping the eyes and vestibular centers on the horizon. Gait is nothing more than a single leg balancing act repeated over and over. Faulty info on where our center of pressure is from a visual or vestibular aspect will alter where we put our foot in space. Just look at how many neurologic diseases end up with a wider based gait, because our proprioceptive centers no longer trust our base of support. It is all connected.

Think about how amazing this system is when it works right, we can run on a track leaning into the curve, we can ride a bike and lean into turns, we can run forward and yet turn to look behind us, all without falling over -- thanks to our CNS and joint proprioception.

*** Today, to build on the above principles, adding the concept of thoracic rotation and even more, scapular stability, breathing, rib cage and thoracic spine mobility and stability, specifically thoracic rotation is critical.  What if any of these movements are lost in this client's turning attempt ?  Let's keep it simple, what if thoracic rotation is lost, specifically what if the client has lost left thoracic rotation? What happens then to the left foot in this scenario ? Can they achieve enough left foot supination to achieve enough left lateral weight shift to make up for the loss of left thoracic rotation ? Can they achieve enough of these movements without exceeding the tipping point at the ankle creating an inversion sprain?  For the task to be completed, the motion is going to occur somewhere, the question is, will the place it occurs be a safe place ?

Lets complicate things further, and ask about hip rotation, what if the left hip has impaired internal rotation, after all it is part of the left turning pattern.  At the terminal end range of thoracic rotation in this case, any further rotation needs will come from hip internal rotation typically (once the pelvis stops spinning leftward with the spine rotation).  What if that hip rotation end range is impaired or limited ?  Something has to give, the turning goal is defined, the question remains does the client have the working parts to get the turning done without overloading any single area causing pathology ?  Furthermore, the right foot must be able to perform the requisite pronation and external hip rotation for similar reasons during the turning. Sharp directional change cutting sports like soccer, basketball and football all require this kind of motion, namely the discussed cervical rotation, thoracic rotation, hip rotation and ability to stabilize safely on a supinated foot at times.  For example, try running downfield at a full clip and suddenly look and turn back over your left shoulder to catch a football pass, these are the component parts I just outlined above. If any of them are limited or missing we can see injury, whether its a torn ACL, hip impingement, sprained ankle, neck or shoulder strain etc.  Everything i have outlined in the last 3 blog posts has to be clean and with safe sensory-motor patterning.  The problem is, we teach people to run and catch, but we often do not look at these component parts as I have discussed looking for limitations, potential places were these glitches harbor.  These are the component things and frameworks of thinking and problem solving that I do in my office.  I hope you do think the same way as well, we can be friends then :)

The next time your client comes in with an ankle inversion sprain, or hip pain, or shoulder or thoracic pain just as examples, try asking them about what they were doing at the time of the event.  Work backwards from there and see if they had the component parts or if one was missing that could be the culprit.

 I had a client just this past week during the NYC marathon invert his ankle when he looked back to snap  a selfie with the crowd behind him.  What i discussed today was the likely mechanism -- his thoracic rotation to that side sucked when I examined him and he had loss of internal hip rotation on that side.  The motion had to go somewhere , sadly it was one degree of ankle supination too much this time.  Many injuries do not occur in a vacuum, there is a reason if you know how to think it through and examine the parts -- go beyond your movement screenings though, it is just a piece of the pie. Oh, one more thing, if this was your client and all you did was begin managing his ankle sprain and nothing else, well, you are just a technician, and you are better than that.  Your job is to find the problems within the system, not the compensations which often only show up in movement screens,  you must examine your client. You must see if they are neurologically intact, determine if there are weaknesses, compensations, shortness, tightness, endurance issues, skill issues, joint range limitations, aberrant movement patterns amongst other things.  You must find these things, then you must figure out why they are there, then you must begin to remedy them. 

Dr. Shawn Allen, the other gait guy

Turning: Connecting the kinetic chain

Look at the photo, which way am I turning my head ? How hard am I turning ? Perhaps I am turning hard through my neck and thoracic spine to look over my shoulder.  The point is, you can see it in my feet and if you know your biomechanics you should easily know which way I am turned.

 It should be simple and clear that I am turning my neck and thoracic spine strongly to the left.  The left rotation has forced me to find stability over the lateral left foot while driving the rotation with the right foot.  Left foot had to supinate, right had to pronate. No rocket science here.
Earlier in the week I posted a brief discussion on the neck and proprioception and the upper and lower limb. I caught some questions on challenging the strength of the neurological linkages to the lower limb, so I promised a simple picture to solidify my point.
Where is what i wrote earlier this week.
"From the study: "Limb proprioception is an awareness by the central nervous system (CNS) of the location of a limb in three-dimensional space and is essential for movement and postural control. The CNS uses the position of the head and neck when interpreting the position of the upper limb, and altered input from neck muscles may affect the sensory inputs to the CNS and consequently may impair the awareness of upper limb joint position."

We say it is not just the upper limb however, the neck and head posture is used in interpreting the position of the lower limb as well. And similarly altered head/neck muscle input can impair awareness of the lower limb posture as well. Think about it, we are trying to stay upright in the gravitational plane while keeping the eyes and vestibular centers on the horizon. Gait is nothing more than a single leg balancing act repeated over and over. Faulty info on where our center of pressure is from a visual or vestibular aspect will alter where we put our foot in space. Just look at how many neurologic diseases end up with a wider based gait, because our proprioceptive centers no longer trust our base of support. It is all connected."

Exp Brain Res. 2015 May;233(5):1663-75. doi: 10.1007/s00221-015-4240-x. Epub 2015 Mar 13.

Neck muscle fatigue alters upper limb proprioception.

Zabihhosseinian M1, Holmes MW, Murphy B.
 

As in this study, and putting it together with my photo and discussion at the start here today, limb proprioception is an awareness by the CNS of the location of the limb and is essential for proper movement and postural control. If I had rotated to the left and had my CNS not known where the foot was in space and in relation to the rest of my body, I may have fallen over to the left. Instead, my CNS sensed the weight shift to the left from the neck and torso rotation, and moved my foot weight bearing into supination (affording a slightly greater lateral weight bearing on the foot) to accommodate the shift in my center of pressure and mass laterally.  So, the CNS used the position of the head and neck, and the weight shift, in interpreting the appropriate positioning of the lower limbs. Sometimes moving the foot into supination to accommodate the lateral load is not enough, and we need to actually step laterally to maintain upright.  Altered input from my neck muscles might affect the sensory inputs to the CNS and consequently may impair the awareness of my limb joint positioning in space. This happens often in vestibular challenged clients and in client of aging decline where the system is losing proprioception. If we do not know where a body part is in space, we don't know how to use it or how to load it (think about chronic ankle sprains).

As i said earlier this week, think about it, we are trying to stay upright in the gravitational plane while keeping the eyes and vestibular centers on the horizon. Gait is nothing more than a single leg balancing act repeated over and over. Faulty info on where our center of pressure is from a visual or vestibular aspect will alter where we put our foot in space. Just look at how many neurologic diseases end up with a wider based gait, because our proprioceptive centers no longer trust our base of support. It is all connected.

Think about how amazing this system is when it works right, we can run on a track leaning into the curve, we can ride a bike and lean into turns, we can run forward and yet turn to look behind us, all without falling over -- thanks to our CNS and joint proprioception.

Dr. Shawn Allen, the other gait guy