June 13, 2016
Conversations with Shelley and Kim Congenital Muscular Torticollis
A few weeks ago I had occasion to assess a lovely little girl. Her mom had several concerns one of which was her incoordination during running. I noted that there were difficulties with alignment in all positions/activities (pelvis and rib cage tending to stabilize at end range rather than display mid-range control) and this was interfering with her recruitment of the anticipatory core team for central stability as well as several reactive core synergists for movement (for more info, please refer to A New Operating System and You Can’t Have One Without the Other). I also observed during walking that there was slight decreased mid-range control of her femur during both stance and swing; it tended to drift just a little into adduction. As I watched her run, I made some observations and of course, took a video. But it occurred to me that while I know the developmental progression of gait 1-4 and am comfortable assessing it, I was not so sure about the developmental progression of running. Was what I was seeing atypical or just an immature/emerging pattern? I wasn’t actually sure. No worries I thought, I’ll put it out to all my wonderful social media contacts and someone will hook me right up. Alas, this was not to be. I love that so many of you tried but it seemed we were all coming up short on info. So I’m pulling together and sharing what I found with regards to the development of running. Please remember this is just a start, a rough guide, and if you have any more information please share it with us so we can all learn together.
First, let’s state the basic. Running is a forward progression of the body with a flight phase – that is, a phase of no support. This is in contrast to walking, which has a phase of double support. Our little gal in the photo above is probably fast walking, as it doesn’t look like she’s going to get a period of no support. However, it’s interesting to note that Whitall and Getchell 5 indicate that when kids are transitioning to a run it’s hard to tell if there’s a flight phase.
Now on to the developmental progression. Some researchers 1,6 divide the sequences into arms and legs for clarity and I find this helps me.
Step 1. Initially there is minimal flight with short, flat-footed steps. As the leg swings forward, it is somewhat stiff.
Step 2. The pattern progresses to a longer stride with the swing leg flexing to 90°. However, this leg has lateral movements; the leg swings out into abduction and back in during the swing phase. This movement of the swing leg is termed “crossover swing”1.
Step 3. Finally, the child progresses to a long stride, and the swing leg tucks under the body to move forward in the sagittal plane. The legs move directly backwards on takeoff and directly forward for touchdown.
Step 1. Arms are held in high or middle guard position at waist to shoulder level. They move very little during stride and do not participate in the running action.
Step 2. Bilateral arm swing is present with spinal rotation. The arms move forward and backward together however, not in opposition to each other. They frequently move obliquely to the body, with continual balance adjustments, giving them a flailing appearance.
Step 3. The arms now drive forward in an opposition to each other, so one arm is moving forward while the other is moving back (with spinal rotation still being the primary mover). The elbow flexes as it moves forward and extends as it moves back. The arms are also moving forward/backward in concert with the opposite leg. However, the arms often swing across the chest or out to the side, oblique to the plane of movement of the body.
Step 4. The arms now drive forward and back in opposition to each other, independent of spinal rotation. Arm movement is in concert with the opposite leg. Elbow flexion remains at 90°. The arms stay very close to the sagittal plane of movement of the body.
Haywood and Getchell 1 provide a nice observational plan to assist in assessment of the developmental level of running.
I am (not so) secretly obsessed with YouTube. Here are some videos that you might be interested in using to practice your observational assessment.
As the child becomes more proficient in running, there is an increased stride length, with the rear leg fully extended at push off. As the leg swings through, the heel is tucked and the thigh swings forward with increased acceleration. The base of support narrows. Trunk rotation increases and there is a slight forward lean 1,5,6.
A final note – it would appear that the two most important rate limiters for running are balance and strength. Balance is essential as the child must catch themselves on one leg when landing from the air and balance while moving forward. And the child must propel themselves in the air by lifting off the ground, requiring adequate strength 1,5. So if a child is having difficulty running, we can assess balance and strength in order to have a clearer picture of their needs. Oh, and did I mention central stability impacts both strength and balance? 🙂
This may seem totally obvious but take a video of your client, so you can slow down the motion and watch it repeatedly. That way you can assess what the trunk or each arm or leg is doing in relation to each other and you can evaluate whether there is a flight phase.
This information helped me sort out some of the questions I had when I was assessing my young client. As always, if you have anything additional, please post it in the comments so we can all help our clients to run!
1.Haywood KM, Getchell N. Life Span Motor Development. Illinois, Human Kinetics, 2005.
2.Adolph KE, Vereijken B, Shrout PE. What changes in infant walking and why? Child Dev. 2003; 74(2): 475-97.
3.Burnett CN, Johnson EW. Development of gait in childhood. Part I and II. Dev Med Child Neuro. 1971; 13: 196-215.
4.Shumway-Cook A, Woollcott M. Motor Control. Translating research into clinical practice. Philadelphia, Linppincott Williams & Wilkins, 2007.
5.Whitall J, Getchell N. From walking to running: applying dynamical systems approach to the development of motor skills. Child Dev. 1995; 66(5): 1541-53.
6.Masci I, Vannozzi G, Bergamini E, et al. Assessing locomotor skills development in childhood using wearable inertial sensor devices: the running paradigm. Gait Posture. 2013; 37: 570-4.
Photo credits: nameisgrace.blogspot.com, science-all.com, artsconnected.org