2019 comes to a close, and here is what we want to share.

Movement, can it make us better humans ?

This will be the last blog post you read from us … for 2018. 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 9 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.

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. We are learning, just like you all who join us here weekly, 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.
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 2019 we will continue to expand your horizons of these advanced movement practices as our horizons expand. 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 2018 gratitude for this great growing brethren and community that is unfolding here at The Gait Guys. We have great plans for 2019 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
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Can Running Make us Better Humans ?….. excerpts from the artcle by Kimerer LaMothe.

http://www.psychologytoday.com/…/can-running-make-us-better…

“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/…/can-running-make-us-better…

*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

Internal tibial torsion + femoral retrotorsion + twisting = low back pain

note the internal tibial torsion and lack of internal rotation of the right hip secondary to femoral retroversion

note the internal tibial torsion and lack of internal rotation of the right hip secondary to femoral retroversion

internal rotation of less than 0 on the left hip

internal rotation of less than 0 on the left hip

Here’s one that we’ve talked about before. Think about internal tibial torsion for a moment. You remember when the tibial tuberosity points straightahead and the foot points inward? 

Now combine that with femoral retro torsion. Remember that that’s when the angle of the femoral neck with the shaft is less than 8° which results in a loss of internal rotation of the hip. 

Put those two together and you have a foot that points inward and limited internal rotation of the hip on that same side. 

Stand on your right leg with your foot turned in. Twist your body to the right. Can you see how this is internal rotation of the right hip?

If people have to create internal rotation of the hip, then the motion has to occur somewhere. If it is not available at the hip and the lower extremity is fully internally rotated it has to occur north of the hip which is usually in the lumbar spine. Now think about when people are lifting things. Often times they do not do a hip hinge and reverse or flatten their lumbar lordosis, opening up the facet joints which allows more rotation. Do you remember that rotation of the lumbar spine is limited to about 5° unilaterally? Where do you think that hip rotation is going to occur? Hmmmm... Probably north of the hip. 

Better teach them to spin that weight bearing leg and foot out into some external rotation to create that needed range of motion, increase the amount of internal rotation of that hip or have them keep their shoulders and hips in the same plane when rotating.

Dr Ivo Waerlop, one of The Gait Guys 

#backpain #hipinternalrotation #internaltibialtorsion #retrotorsion #femoralretrotorsion 

The case of the lateral thigh, leg and knee pain

note how the bottom of the heel cup is rounded

note how the bottom of the heel cup is rounded

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This gal  came to see us with pain in the lateral thigh, knee, and lateral lower leg on the left. It has happened recently with skiing and alleviated only temporarily with acupuncture of the vastus lateralis and peroneal groups. She has been skiing with a foot bed (please see picture).

Evaluation reveals mild bilateral external tibial torsion, a right anatomically short  leg tibial, and bilateral medial knee fall (knee is medial of the sagittal plane) L>R during weight-bearing when the feet are pointing straight ahead. There is moderate loss of the medial longitudinal arches bilaterally, greater on the left.

We remember that when a patient has external tibial torsion, when the knees points straight the feet point to the outside. 

Translated to skiing, the feet need to be straightahead which brings the knee(s) inside of the sagittal plane. 

We remember that often times with leg length discrepancy is, the longer leg side will “pronate ” in attempt to shorten extremity and the shorter leg side “supinate”, in an attempt to lengthen the extremity.

Putting this all together:  the patient is pronating bilaterally, left greater than right with medial knee fall. The ski shop put the footbed you see in the picture in both of the patients boots. You can see that it is extremely rounded at the heel and, because orthotics are shank dependent devices, a round heel like this will just roll into pronation as there is more weight on the medial longitudinal arch. This makes the entire foot bed assembly relatively ineffective and increases the valgus moment at the knee, stressing the vastus lateralis as it is trying to pull the knee to midline as well as the peroneal group as it is trying to do the same from a closed chain position as well as supinate the foot. 

We placed a 3 mm sole lift under the right foot and added a post to the bottom the left orthotic to allow it to sit flat. This did not correct the problem completely and we needed to add a Morton’s toe extension (post under the first metatarsal) to invert the foot and bring the knee out into the sagittal plane.

Dr Ivo Waerlop, one of The Gait Guys 

#footbeds #kneepain #orthotics #skibootfit #thighpain #legpain #quadriceps

Two things we hope you see right away when viewing this video.

.

We talked about this woman in yesterday‘s post and, when viewing from the front, we wanted to bring out a few salient points

Notice how her foot progression angle is diminished bilaterally. Normally the foot will “toe out“ somewhere between 12 and 20° when the foot hits the ground and hers are nearly straightahead. This can be due to numerous things such as femoral retro torsion, internal tibial torsion, or subtalar version. All of these things will often have the foot point medially when examining a patient on the table and placing the knee in the sagittal plane. In this particular case, she has internal tibial torsion.

The next thing we would like you to look at is noting how her knee falls “outside“ the sagittal plane. In other words, instead of the knees pointing straight ahead, the point slightly out laterally. This is a cardinal sign of internal tibial torsion, especially in a gait analysis.

So what’s a clinician to do?

In this particular case, there’s nothing really to “fix“ as these are hard deformities that are often congenital. Our job is to help the patient to compensate and the best way possible so that they can remain pain and as injury free as possible. We discussed remediation in the post yesterday, So please refer back to that for what we did


Dr Ivo Waerlop, one of The Gait Guys

#invertedforefoot #forefootsupinatus #forefootvarus #pronation #forefoot #gaitanalysis #decreasedprogressionangle #toeingin

The consequences of an inverted forefoot

A forefoot that is inverted with respect to the rearfoot. Whether it is a forefoot varus, forefoot supinatus or an everted rearfoot ( because the forefoot is still inverted with respect to the rearfoot), what are the biomechanical sequelae?

If we accept the premise that the foot is basically a tripod between the calcaneus, base of the first and base of the fifth metatarsal‘s, we know that all of these parts needs to be on the ground at certain points in the gait cycle. Forces should travel from the calcaneus, up the lateral aspect of the foot, across the metatarsal heads to the first metatarsal head and hopefully out through the hallux.

The foot should hit the ground in slight inversion of the entire foot at initial contact and pronate through the middle of mid stance and then supinate through the remainder of the gait cycle. There’s an intricate balance of biomechanical events that must occur, especially in the latter half of the gait cycle when the rear foot is inverting where the forefoot is everting, so that we can have high gear push off through the distal first ray.

If the forefoot remains inverted then somehow the head of the first metatarsal needs to be brought down to the ground. If there’s not adequate range of motion in the foot, particularly the first ray, then you may pronate through the midfoot, rearfoot or in cases where this is insufficient, bring them immediately over the foot to get it down. This of course shifts center of gravity to midline and the body above must compensate in someway.

Take a look at this video footage and what do you see? She strikes on the outside of her foot but does not have adequate motion in her forefoot and therefore “crashes“ down on the forefoot, forcing a valgus moment into the ankle and the need to shift immediately by the pelvis attempts to dampen it. Notice how this is worse on the right side with more medial knee shift, pelvic shift as well as a lateral bending of the body to the right. Notice also how the upper body twists more to the left than to the right.

So what’s the fix? Well the answer is, “what’s bothering the patient?” We don’t necessarily fix what we see; we correlate what we see with what the patient’s symptoms are because that’s usually why they show up in your office. Yes, we do get people from time to time that come in strictly for “performance enhancement“ but this is pretty rare.

This woman has very little motion and plantar flexion of the first Ray complex so our primary goal was to get her to descend the first ray. We accomplished this by the following:

1. Manipulation in plantar and dorsiflexion of the first ray complex
2. Soft tissue work in the first intermetatarsal interval
3. Exercises of muscles to assist in descending the first ray including the following: extensor hallucis brevis, peroneus longus, flexor digitorum brevis
4. Pelvic stability work to improve the skill, endurance and strength of the gluteus medius complex as well as abdominal endurance work.

Your rehab program should change as the patient has more functional gains, tailoring it to the patient’s deficiencies.


Dr Ivo Waerlop, one of The Gait Guys

#invertedforefoot #forefootsupinatus #forefootvarus #pronation #forefoot #gaitanalysis

Internal tibial torsion puts pressure on the outside of the foot

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Take a look at these pictures. This is also a good reason to always look at the insoles. Take a good look. Can you see the increase printing on the lateral aspect of the right foot?

You’ll note that he has internal tibial torsion on the right side. This often presents with a forefoot supinatus and results in pressuring of the lateral column of the foot and an inability to descend the first ray. Note that the footbed on the right shows increased pressure of the lateral column and a lack of pressure under the head of the first.

Stand up and put the weight on the outside of your right foot. Can you feel how the toes on right side pressing more in an attempt to shift the center of gravity medially while it offloading the toes on the left foot? This is also represented in the foot beds.

Yet another great reason to not only look at the wear on the outside, but also on the inside of your clients/patients shoes.

Dr Ivo Waerlop, one of The Gait Guys

#footbeds #internaltibialtorsion #lateralfootpressure #insoles

Unilateral increased tibial varum; one reason why...

Take a look at this gent in the picture. Do you notice anything peculiar? Pick a point and start either moving from above down or from the ground up.

From the ground up, the first thing you may notice is that he has a hallux abducto valgus on the right side. This could be for any number of reasons and what it actually tells you is that he is unable to anchor his first ray to the ground and have appropriate function of the adductor hallucis. Your job, during the examination process, is to sort that out.

The second thing you may notice is that he has more midfoot collapse on this same side. You would think that with that much midfoot collapse he would get his first ray to the ground but that’s obviously not the case.

Moving up from there, you may have noticed that he has significantly more tibial varum on the left-hand side. Tibial varum should be about 4-6 degrees and is largely a function of in utero positioning although diseases like osteomalacia and rickets can increase it though this is often more bilaterally symmetrical.

You need to be aware increased tibial varum means that the foot, particularly the forefoot, needs to pronate a greater degree to create a stable foot tripod on the ground. You need to ensure during the examination process that adequate range of motion in the forefoot and 1st ray are available.

You may have noticed that there is prominence of the left medial head of the gastroc which is most likely a combination of positioning as well as increased mechanical advantage secondary to the varum.

Hopefully you noticed that the knees are (relatively) in the sagittal plane and that there’s an increase progression angle on the left-hand side. If you drop a plumbline from the tibial tuberosity you’ll see the falls medial to the second metatarsal shaft indicating external tibial torsion in the lower extremity.

The unilateral increased tibial varum on the left-hand side is secondary to an anatomical leg length discrepancy where the right tibia is shorter. This has been long-standing and in compensation, the left tibia has “bowed“ to compensate for the difference, In an attempt to shorten the left leg.

Dr Ivo Waerlop, one of The Gait Guys

Like this stuff? Come and drink from the fire hydrant. Consider joining us this Wednesday evening on online CE.com for bio mechanics 326, 6 PM Mountain standard time. Likewise, you can become a Patreon supporter and get this kind of information every week.

#tibialvarum #leglengthdiscrepancy #lld #bowedlegs #pronation

A novel way to look at functional internal rotation of the hips

As clinicians (and coaches) we are often trying to figure out different ways to functionally assess internal rotation of the hips. How many times does the patient/client “appear“ to have appropriate internal rotation on the table only to find out that they don’t functionally and vice versa.

Take a look at it this gentleman who is a ski instructor. We are trying to simulate the standard side to side ski motion in a way that would be functionally appropriate. Keep in mind that he has bilateral internal tibial torsion and bilateral femoral retro torsion. When he began care at our office he had 5° external rotation on the right and about 8° external rotation on the left as his FULL AMOUNT OF INTERNAL ROTATION AVAILABLE to him bilaterally.

Treatment consisted largely of hip mobilization, Therapeutic exercises to emphasize internal rotation of the hips such as hip helicopters, airplanes and supine “chairs“ with internal rotation and adduction utilizing a ball between the knees; we also did acupuncture/needling of the hip capsules as well as anterior fibers of the gluteus medius and minimus. He now has about 5° internal rotation on the right now and a little less than 5 on the left. Note how the motion is clearly visualized in this video below.

Do you have other novel ways to test internal rotation of the hips functionally? Leave a comment or drop us a line and let us know

Feel like you want more? Join us this Wednesday evening on onlinece.com for Biomechanics 326: 6 MST

Dr Ivo Waerlop, one of The Gait Guys.

#functionaltesting #functionalmovement #hip #internalrotation #femoralretrotorsion #femoralretroversion #thegaitguys

The Hip "Airplane"

Here’s another great hip strengthening exercise for the gluteus medius, minimus, deep six external rotators as well as proprioceptive components about the hip. It is often used in conjunction with the hip helicopter exercises.

Dr Ivo Waerlop, one of The Gait Guys

#hipairplaneexercise #hippain #deep6extrenalrotators #gaitguys #proprioception #proprioceptiveexercises #thegaitguys


https://vimeo.com/371217385

What does "hip drop" look like?

Watch this gal running on a treadmill at a 1.5% grade at about a 10 minute mile pace. Note that when she is in stance phase on one leg, the contralateral side of the pelvis “drops“. Up to an inch of vertical oscillation of the entire pelvis is expected, but the unilateral “dip” often signals a problem.

The gluteus medius is also known as the “deltoid“ of the hip. It is active pretty much from the time the foot hits the ground until it leaves the ground ( all of stance phase). It is paired anatomically and neurologically with the contralateral quadratus lumborum. Together this pair helps to keep the pelvis level when walking with the gluteus medius pulling the pelvis up from the opposite side and the contralateral quadratus lumborum on the swing leg side lifting the pelvis up.

When you see the pelvis “dip”on the swing leg side or “cruise“ to the stance leg side, this generally means that there is some weakness of pelvic abduction. This can be due to a weakened gluteus medius on the stance leg side, weak quadratus lumborum on the swing leg side, both, or sometimes as a compensation for a leg length discrepancy.

Remediation would include closed chain exercises like hip helicopters and airplanes as well as penguin walks along with gait retraining of the stance leg gluteus medius and swing leg quadratus lumborum. We’ve had success utilizing K tape as well with an inverted triangle over the gluteus medium and an “X” pattern with a vertical strip on the lateral aspect for the quadratus.

Dr. Ivo Waerlop, one of The Gait Guys

#pelvicdip #gluteusmediusweakness #quadratuslumborum #hipdrop

The “ banana foot”

IMG_7018.jpg

So, you see at foot that looks like this and what do you think? What are some of the biomechanical characteristics of people with the foot that when, you bisect the calcaneus, the line passing forward passes lateral to the second metatarsal or a line between the second and third?

This condition can be congenital, in conditions like forefoot adductus or compensatory.

The first thing that springs to mind when we see deformities like this is “things usually occur in threes“. So we would expect to see other anatomical and/or genetic abnormalities. An adducted forefoot, like you see here, often occurs as the result of lack of internal rotation of the hip on that side so therefore will often be present with conditions like internal tibial torsion and femoral retrotorsion, which we often, but not always, see together. Because of the increased gait and foot progression angle in these individuals, the forefoot compensates and adducts to bring the center of gravity more to midline.

Feet like this are often, but not always, cavus and rigid. If it remains in relative supination (plantarflexion, abduction and inversion) it is an excellent level but poor shock absorber.

Forefoot adduction can also be a compensation pattern if an individual is unable to get the head of their first ray completely down to the ground. It could be a true forefoot varus or more commonly, a forefoot supinatus; either results in an inability to get the first ray down. This often causes the foot to adduct in compensation, and, due to the tarsal articulations, often raises the base of the first metatarsal increasing the inclination angle of the first ray. This frequently leads to limited dorsiflexion of the first metatarsophalangeal articulation.

So what is a clinician to do?

Ensure that the mechanics of the foot are clean through manipulation and mobilization

Make sure there are appropriate flexors/extensor ratios of skill, endurance, and strength of the foot musculature both intrinsically and extrinsically. This means making sure that the long flexors and extensors are in some degree of balance.

Work on balance and coordination of the lower extremity. This can be impeded if they’re unable to get ahead of the first right down to the ground. Exercises for the peroneus longus, extensor hallucis brevis and short flexors of the foot will often help with this.

“Banana foot”. Coming to your clinic, or a clinic near you. Maybe today…

Dr. Ivo Waerlop, one of The Gait Guys.

#forefootadductus #bananafoot #supination #thegaitguys

Unilateral calcaneal valgus: what can it mean?

right calcaneal valgus

right calcaneal valgus

Take a good look at this picture and what do you see? Do you see the calcaneal valgus on the right side. What runs through your mind?

Possibilities for causing this condition, as well as the clinical implications are numerous.

The short list should include:

  • A shorter leg on the contralateral side: often times we will pronate more on the longer leg side to compensate for a short leg on the opposite

  • Increased rear foot and/or fore foot pronation on the valgus side. Laxity of the spring ligament or incompetency of the musculature which helps to maintain your arch (tibialis posterior, foot intrinsics, tibialis anterior to name a few) often causes more collapse on the effected side

  • A lack of available rearfoot eversion on the contralateral side. It may be that the increase calcaneovalgus is normal and the opposite side is more rigid.

  • If you were seeing this in the middle of the gait cycle it could be that that is their strategy to get around a loss of hip extension or ankle rocker

  • External tibial torsion on that side. Go ahead, stand up and spin your right foot into external rotation and keep your left foot with a normal progression angle. Can you see how your arch collapses to a greater degree on the side with the external torsion? Remember that pronation is dorsiflexion, eversion and abduction.

  • Internal tibial torsion on the contralateral side. Internal tibial torsion puts the foot into supination which makes it into more of a rigid lever rather than mobile adapter.

    And the list goes on…

    Next time you see a unilateral deformity like this, hopefully some of these things run through your mind and will help you to pinpoint where the problem actually is.

    Dr Ivo Waerlop, one of The Gait Guys

    #calcanealeversion #rearfootvalgus
    #lowerextremitydeformities

Foot Types? Do they really matter?

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The answer is " yes, often times".

Did you miss our 3rd Wednesdays presentation last week on foot types and obligate biomechanics (and pathomechanic) that ensue? Here is the video feed that you can watch and get ce credits for:

https://www.chirocredit.com/course/Chiropractic_Doctor/Biomechanics_214

#foottypes #biomechanics #thegaitguys

Asymmetries can make all the difference…

Take a good look at these pictures of this gentleman’s feet. Can you see any differences from side to side?

If you look closely, you’ll notice that his right foot is in and abducted position (4 foot adductus) and relatively normal. Asymmetries can make all the difference…

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Take a good look at these pictures of this gentleman‘s feet. Can you see any differences from side to side?

If you look closely, you will notice that his right foot is in an adducted position (forefoot adductus) and the left one relatively normal. If you bisect the heel, it should pass through the second or between the second and third metatarsal in his clearly falls laterally.

So what you say?

Well, putting a foot in relative supination with respect to the other causes certain biomechanical sequela. This forefoot adductus often leads to a forefoot supinatus, so he’s unable to get the head of his first ray down to the ground. Think that might make a difference in his gait cycle?

Think about all the extra internal rotation that will have to occur in that lower extremity during a normal gait cycle. Now combine that with something like external tibial torsion or a leg length discrepancy and things can really stack up and make a big difference.

Lastly, think about the asymmetrical mechanoreceptor input from the joint mechanoreceptors and muscle spindles traveling up the neuraxis. Do you think over time that that may cause some cortical remodeling and ultimately change the way he activates muscles?

Look for asymmetries, they really do matter

Dr Ivo Waerlop, one of The Gait Guys

#asymmetriesmatter #gaitanalysis #thegaitguys #forefootadductus

Obligate Pathomechanics

Much of what we see in gait analysis is secondary to the anatomical and physiological constraints exhibited by a patient. Take a look at this gentleman running. At first glance, you may be saying “yup, crossover gait, strengthen the gluteus medius complex“.

Now let’s talk about his physical exam. He has “windswept biomechanics“, With external tibial torsion on the right and internal table torsion on the left. There is no significant difference or increase in his Q angles bilaterally. He has a forefoot supinatus on the right side (I.e his forefoot is inverted with respect to his rear foot). He has limited plantar flexion of the first Ray complex on the right.

Now watch the video again with this in mind. Can you understand that if he’s unable to get his first ray to the ground he’s going to have any sort of hike your push off, in order to get it to the Ground he’ll need to mediately rotate his lower extremity and increase the valgus angle on that side. External tibial torsion (when you drop a plum line from the tibial tuberosity, it passes medial to a line passing to the long axis of the second metatarsal) compounds this. Stand up, rotate your right foot to the outside, keep it there and walk forward. Do you see how your knee has to go to the inside to push off your big toe?

Yes, he has a crossover gait but it is obligate and a direct function of his inability to descend the first ray, at least partly due to his forefoot supinatus and his external tibial torsion on the right.

Obligate pathomechanics. Coming to a patient in your office or one of the folks you are coaching soon.

We will be talking about foot types and pathomechanics tonite, October 16th, 2019, on our 3rd Wednesday’s teleseminar on onlinece.com: Biomechanics 314

5 pacific, 6 mountain, 7 central, 8 eastern

Dr Ivo Waerlop, one of The Gait Guys

Determining foot types...In a nutshell

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We talked yesterday about how foot types (i.e., the forefoot to rear foot relationship) can often produce predictable pathomechanics. Here's How to do it. Pretty basic, eh? Its the characteristics, along with the other anatomical goodies they may have that helps to clinch the diagnosis and dictate treatment.

To find out about how to apply your newfound knowledge, join us tomorrow night on our 3rd Wednesdays tele seminar: Biomechanics 314 on online.com

5 PST, 6MST, 7CST, 8EST

Foot types: do they really matter?

forefoot varus: note how the forefoot is inverted with respect to the rear foot

forefoot varus: note how the forefoot is inverted with respect to the rear foot

Foot type. You know what we are talking about. The relation in anatomically and in space of the rear foot to the forefoot. We believe that this anatomical relationship holds key clinical insights to predictable biomechanics in that particular foot type.

Simply put, the rear foot can be either inverted, everted or neutral; Same with the forefoot. If the rear foot is inverted we call that a rearfoot varus. If the foot is inverted we call that a forefoot varus. If the rear foot is everted we call that a rear foot valgus and if the forefoot is inverted we call that a forefoot valgus.

Now think about the simple motions of pronation and supination. Pronation is dorsiflexion, eversion and abduction; supination is plantar flexion, inversion and adduction. If it remains in eversion, we say that it is in vslgus and that means they will be qualities of pronation occurring in that foot while it is on the ground. If the foot is inverted, it will have qualities of supination.

We think of pronation as making the foot into a mobile adapter and supination is making the foot into a rigid lever.

During a typical gait cycle the foot is moving from supination at initial contact/loading response to full pronation at mid stance and then into supination from mid stance to terminal stance/pre-swing. I know that if the foot remains and pronation past mid stance that it is a poor lever and if it remains in supination prior to mid stance it will be a poor shock absorbers. Foot type plays into this displaying or amplifying the characteristics of that particular foot type during the gait cycle: if this occurs at a time other than when it supposed to occur, then we can see predictable biomechanics such as too much pronation resulting in increased rear foot eversion, midfoot collapse, abduction of the forefoot and internal rotation of the knee with most often medial knee fall. Now, consider these mechanics along with any torsions or versions in the lower extremity that the patient may have.

This Wednesday night we will be discussing foot types and their biomechanics. Join us on onlinece .com for Biomechanics 314 6:00 MST

Dr Ivo Waerlop, one of The Gait Guys

3 clues that someone has internal tibial torsion

Watch this video a few times through and see what you notice. There are three clues that this patient has internal tibial torsion, can you find them?

He presented with right sided knee pain, medial aspect of the patella and medial joint line as well as tenderness over the medial joint line and pes anserine. Lower extremity musculature test strong and 5/5 save for his semi tendinosis on the right which tested 4/5.He has diminished endurance bilaterally in the external obliques

1. Note how his knees, right greater than left, fall outside the sagittal plane

2. Note the decreased progression angle of both feet during forward motion

3. Note how he toes off in supination, right greater than left.

This patient’s knee pain is coming from irritation of the pes anserine, particularly semitendinosus and his inability to recruit his abdominals sufficiently so, instead of the usual pattern of recruiting iliopsoas or rectus femoris, he chooses his sartorius, gracious and semi tendinosis.

Pay attention to how the new tracks, the progression angle as well as if they tow off in pronation, neutral, or supination in that can offer subtle clues to internal tibial torsion.

Dr Ivo Waerlop, one of The Gait Guys

#internaltibialtorsion #gaitanalysis #thegaitguys

https://vimeo.com/365342814

Podcast 152: Michael Lucchesi : Head Coach, Second City Track Club

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Michael Lucchesi : Head Coach, Second City Track Club
An insightful interview with a great coach, he is one to watch.

Links to find the podcast:
Look for us on Apple Podcasts, Google Play, Podbean, PlayerFM, RADIO and more.
Just Google "the gait guys podcast".

Our Websites:
www.thegaitguys.com
Find Exclusive content at: https://www.patreon.com/thegaitguys
doctorallen.co
summitchiroandrehab.com
shawnallen.net

Our website 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 and just about every other podcast harbor site, just google "the gait guys podcast", you will find us.

Where to find us, the podcast Links:
Apple podcasts:
https://itunes.apple.com/us/podcast/the-gait-guys-podcast/id559864138?mt=2

Google Play:
https://play.google.com/music/m/Icdfyphojzy3drj2tsxaxuadiue?t=The_Gait_Guys_Podcast

other links for today's show:

http://directory.libsyn.com/episode/index/id/11417267

Direct download: http://traffic.libsyn.com/thegaitguys/WOC3_mikeL_-_92719_5.06_AM.mp3

http://thegaitguys.libsyn.com/michael-lucchesi-head-coach-second-city-track-club


Find Michael at,


Secondcitytc.com

https://www.instagram.com/secondcitytc/

https://www.instagram.com/sctcelite/

https://www.facebook.com/secondcitytc/