In this second installment of applied hip biomechanics, Dr. Allen of The Gait Guys delves deeper into a complex topic and attempts to bring it to a level that everyone can understand and implement. Here he talks about the hip mechanics in relation to pelvic stability and gait.
It is our goal to share as much of our collective 37 years of clinical experience as we can in a medium that is usable, friendly and understandable to all viewers.
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Shawn & Ivo, ....... The Gait Guys ... https://www.youtube.com/watch?v=7nmIcCTR6mw
Want to learn more about this video case ? We have written up the case on our blog. See the write up at www.thegaitguys.com, look up the blog post dated April 17th, 2012 LINK HERE= http://thegaitguys.tumblr.com/private/21216053160/tumblr_m2l0wm00XL1qhko2s.
Video Gait Case: A troubled Youth.
This is a video of a teenage girl with chronic posterior knee pain. What do you see in her gait. Don't cheat yourself. Before you read below see what you can see first and then drop your eyes down to our work below.
Heavy rear foot lateral strike. This is rearfoot inversion at its worst. This is considered rearfoot varus. Lots more on this case in our blog post.
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https://www.youtube.com/watch?v=9B9nhKGq89Y
In this neuromechanics weekly, join Dr Waerlop as he talks about 5 things we need to remember about proprioception when examining gait tha can provide clues to the underlying problem.
See more neuromechanics weekly episodes on our Blog: http://thegaitguys.tumblr.com or on Facebook: The Gait Guys
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https://www.youtube.com/watch?v=_fBjyutWQvU
You have heard us talk time and time again about the importance of the foot tripod. To review, it consists of the center of the calcaneus, the base of the 1st metatarsal and the base of the 5th metatarsal. To see some of the other articles we have written on the foot tripod, including other exercises, look here http://thegaitguys.tumblr.com/search/tripod
This brief video during a patient encounter outlines the basics of part 1 of this exercise.
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https://www.youtube.com/watch?v=_eA1TLb4Zbg
Have you ever wondered why your heart rate goes up when you have pain? Or why your respiratory rate increases? Remember about 10 years ago, when kids were having heart attacks from playing Nintendo? Did you wonder why? Today's neuromechanics post answers those questions. join Dr Waerlop in this fascinating lecture.
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https://www.youtube.com/watch?v=BNN_Gqb9y5Y
Doc Allen explaining how the arch works in the foot.Go to www.thegaitguys.com, www.wannagetfast.com or www.homunculusgroup.com for more info
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https://www.youtube.com/watch?v=EjARB1PT_cs
A video case of a gait impairment. Chronic dorsal foot pain.
This client came to see us recently. They had a current (2 year) history of dorsal foot achey/burning pain and anterior ankle pain, right greater than left. They had been just about everywhere for these complaints and were pretty much resolved that it was not fixable. They also had a chronic history of anterior shin splints.
This is a pretty simple case. It is missed alot of the time. The reason it is missed is because nothing much shows up on examination. However, we used some tricks to bring out their symptoms. There are also some subtle hints on the gait video above but when you cannot pair what you see with what you find on a clinical exam the issues can get lost in the mix, as they did in this case. This is thus a case based much on clinical experience. We have seen this before. A great clinician (who's name we have forgotten) used to have a quote that went something like this:
It is only after you have seen the beast once before that it will serve you well to be able to recognize it the next time. Having never seen the beast previously will leave you with a terrible bloody battle on how to slay it the first go-round."
ln this video above you should basically see 2 things:
1. the easy one to see: the right foot immediately after toe off does not come forward sagitally rather it spins out into abduction in the swing phase to prepare for the next heel strike.
2. the harder one to see: both feet pronate immediately in the rear and mid foot excessively.
This patient has some limitations in normal ankle rocker. More simply put, they cannot get enough adequate tibial progression forward into dorsiflexion over the talar dome. The squat test was really the only positive movement assessment that was confirmatory. As they squatted the ankle met early dorsiflexion restriction and thus the foot had no choice but to pronate early and heavily thus collapsing medially and drawing the knees in medially. Normally the arch should remain unaffected and the tibia should merely pivot cleanly and effortlessly over the talus allowing the knees to come purely forward. Not in this case.
So, we have a client that has impaired sagittal mechanics. They cannot move through ankle rocker effectively and thus they cannot pronate in a timely manner. As the right foot leaves the ground at toe off they need to have sufficient ankle dorsiflexion to carry the foot cleanly forward to prepare for heel strike (this looks pretty good on the left in the video) but the right side is met with ankle range loss. If they did not circumduct the right foot like you see here they would drag their toes on the ground and likely trip. So, foot abduction is the strategy to avoid this issue. Howeve
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https://www.youtube.com/watch?v=uAtrftqaBrk
Key Tagwords: usain bolt, gait, gait asymmetry, isometrics, isotonics, RF ablation, COOLIEF, OA, deafferentation, knee arthritis, ibuprofin, kidney damage, NSAIDS, heel drop, achilles, tendonitis, heel pain, Our Websites: www.thegaitguys.com summitchiroandrehab.com doctorallen.co 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, Soundcloud, and just about every other podcast harbor site, just google "the gait guys podcast", you will find us. Show Notes:
Healing Tech in Neuroscience: New device can heal with a single touch https://www.usatoday.com/story/news/nation-now/2017/08/07/miracle-device-can-heal-single-touch-and-even-repair-brain-injuries/537326001/ Cool radiofrequency ablation http://www.nbcnews.com/health/health-news/cool-new-knee-procedure-eases-arthritis-pain-without-surgery-n771221 Updates on Ibuprofin in runners http://womensrunning.competitor.com/2017/07/news/ibuprofen-risks-endurance-runners_78580#EyIoMyAdkPW9UBpP.97 PeerJ. 2017 Jul 19;5:e3592. doi: 10.7717/peerj.3592. eCollection 2017. Sonographic evaluation of the immediate effects of eccentric heel drop exercise on Achilles tendon and gastrocnemius muscle stiffness using shear wave elastography. Leung WKC1, Chu KL1, Lai C1. Front Physiol. 2017 Feb 28;8:91. doi: 10.3389/fphys.2017.00091. eCollection 2017. Quantification of Internal Stress-Strain Fields in Human Tendon: Unraveling the Mechanisms that Underlie Regional Tendon Adaptations and Mal-Adaptations to Mechanical Loading and the Effectiveness of Therapeutic Eccentric Exercise. Maganaris CN1, Chatzistergos P2, Reeves ND3, Narici MV4. Oman Med J. 2010 Jul; 25(3): 155–1661. An Overview of Clinical Pharmacology of Ibuprofen Rabia Bushra* and Nousheen Aslam https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191627/ Pharm Biol. 2014 Feb;52(2):182-6. doi: 10.3109/13880209.2013.821665. Epub 2013 Sep 30. Zizyphus jujuba protects against ibuprofen-induced nephrotoxicity in rats. Awad DS1, Ali RM, Mhaidat NM, Shotar AM. https://www.ncbi.nlm.nih.gov/pubmed/24074058
Gait asymmetry ? https://www.ncbi.nlm.nih.gov/pubmed/28759127 Scand J Med Sci Sports. 2017 Jul 31. doi: 10.1111/sms.12953. [Epub ahead of print] Kinematic stride cycle asymmetry is not associated
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https://www.youtube.com/watch?v=LlTbbQ3imHo
This client has an obvious problem stabilizing the foot tripod during single leg stance as seen here. There is also evidence of long term tripod problems by the degree of redness and size (although difficult to see on this plane of view) of the medial metatarsophalangeal (MTP) joint (the MPJ or big knuckle joint) just proximal to the big toe. This is the area of the METatarsal head, the medial aspect of the foot tripod.
As this client moves slowly from stance into a mild single leg squat knee bend the challenges to the foot's stability, the tripod, become obvious. Stability is under duress. There is much frontal plane "Checking" or shifting and the tibial and body mass is rocking back and forth on a microscopic level as evidenced by the dancing tibialis tendon at the ankle level. The medial foot tripod is loading and unloading multiple times a second.
Is it any shock to you that this person has chronic foot problems which are exacerbated by running ? Every time this foot hits the ground the foot is trying to find stability. The medial tripod fails and the big knuckle joint (the 1st MPJ or big toe joint) is enlarging from inflammation and early cartilage wear and decay, not to mention the knee falling medially as well! Hallux limitus (turf toe) is subclinical at this time, but it is on the menu for a later date. A dorsal crown of osteophytes (the turf toe ridge on the top of the foot) is developing steadily, soon to block out the range necessary for adequate toe off in this client. And that means a limitation in hip extension sometime down the road (and premature heel rise....... did you read Wednesday's blog post on that topic ?).
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https://www.youtube.com/watch?v=9EIQmKVOGJg
Have stability problems in your ankles ? Lots of people do !
Here is a brief video of a simple, but difficult, functional exercise to strengthen the peroneal muscles in full plantar flexion (we will give more detailed tricks and techniques away on the Foot-Ankle DVD exercise series, once we get some time to get to it !). The key here is to not let the heel drop during single fore-foot loading and to keep the ankle pressing inwards as if to try and touch the ankles together medially .....if you feel the heel drop on the single foot loaded side (or you can feel the calf is weaker or if you feel strain to keep the inward press of the ankle) then it might be more than the peronei, it could be the combined peroneal-gastrocsoleus complex. The key to the assessment and home work is to make sure that the heel always stays in "top-end" heel rise plantarflexion. But you have to strongly consider the peronei just as seriously. Studies show that even single event sprains let alone chronic ankle sprains create serious incompetence of the peronei. Most people do not notice this because they never assess the ability to hold the foot in full heel rise (plantarflexion) while creating a valgus load (created by the peronei mostly, a less amount from the lateral calf) at the ankle. This is why repetitive sprains occur. The true key to recovery is to be able to walk on the foot in this heel-up "top-end" position while in ankle eversion (ankles squeezed together) as you see in this video. This is something we do with all of our basketball and jumping sports athletes and it is critical in our dancers of all kinds. And if they cannot do the walking skill or if they feel weakness then we keep it static and put a densely rolled towel or a small air filled ball between the ankles and have them do slow calf raises and descents while squeezing the towel-ball with all their ability. This will create a nice burn in the peroneal muscles after just a few repetitions. The user will also quickly become acutely aware of their old tendency to roll to the outside of the foot and ankle because of this lack of awareness and strength of those laterally placed ankle evertors - the peronei. It is critical to note that If you return to the ground from a jump and cannot FIRST load the forefoot squarely and then, and only then, control the rate of ankle inversion and neutral heel drop (ankle dorsiflexion) then you should not be shocked at chronic repetitive ankle sprains. Remember, the metatarsals and toes are shorter as we move away from the big toe, so there is already a huge risk and tendency to roll to the outside of the foot through ankle inversion. Hence why ankle sprains are so common. We call this "top end" peroneal strength but for it to be effectively implemented one must hav
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https://www.youtube.com/watch?v=8T9UzOaYxmo