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gday all, im not sure if this has been covered before, so if it has my apologies. i was just interested in your opinions on treadmill walking vs "standard" walking, in particular, does the moving surface activate different/or have a different sequence of muscle involvement compared to general walking on a static surface. For example, is the effort required to propel the body less due to an already moving surface, or is there now deceleration and more stabilising required??? Sorry if this sounds vague, i know the question in my head, but its hard to put it in text.....
any ideas?????

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Treadmill versus overground running has been studied and has been found to be very similar to each other kinematically, as long as the subject has had adequate time on the treadmill beforehand to familiarize themselves to the apparatus. I don't know if the same studies have been performed for walking. Here is a good review of the research on treadmill versus overground running.

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thanks kevin, ill check out that review........

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There were several articles that I cited in my chapter on computerized gait analysis in Valmassey's book that came out 10 years ago. Some of the points from thos articles included:

It still takes energy to move the body relative to the moving treadmill just as it takes energy to move the body relative to the stationary earth.

The quality of the treadmill matters. As the foot strikes the treadmill the impact can pinch the belt on the underlying surface and momentarily stop the treadmill, which does alter gait. So a treadmill with a larger (greater moment of inertia) flywheel is less likely to stop when this occurs. Also the length of the treadmill has to be long enough so that the user does not fall off the back of, or step on the stationary part in front of, the belt. There has to be enough extra room to account for variation in stride length. This is one of the things that takes getting used when you start using the treadmill.

There was an emg study comparing ground versus treadmill and only found a difference in the hamstrings that was consistant with the flywheel comment above.

I think there was a little more, but it has been a while. Hope this helps

Eric

From a purely clinical perspective, I have found the treadmill extremely helpful in observing a much more natural gait compared to having a patient walk up and down the long hallway in my practice. I have only recently put a treadmill in my rooms (which was extended late last year to accommodate more Pods and give us more space for a gait lab). I have to say that after a few years of watching patients walk up and down the long hallway, with stopping and turning at each end and the deceleration associated with the anticipation of a turn along with several other factors, there is a marked difference.

I know this doesn' t address the question of different muscle activity when comparing treadmill walking to flat ground walking, however it may be relevant to the discussion.

Patients that have had time to acclimatised to the treadmill often reveal a much more natural gait pattern. They relax into the assessment and after several minutes expose anomalies within their gait that may have otherwise been missed in a flat ground analysis. I especially find that paediatric patients expose habitual anomalies after fatigue sets in. this gives a greater insight into what occurs within their gait when in the playground and during sport.

I'm not sure if this contributes constructively to your enquiry, however often more basic clinical observations are also valid.

Regrds
Trent

Hi

Having not used treadmills for examination I cannot comment on the value of them. That said I do find an aspect of what Trent says interesting:

"..watching patients walk up and down the long hallway, with stopping and turning at each end and the deceleration associated with the anticipation of a turn along with several other factors, there is a marked difference. "

Personally, and I am sure Trent would not dispute this, I find a lot of value in this process, some of which you can probably detect with treadmill walking.

However, I have always found the slowing down and turning process quite informative, often providing insight into the point of gait where:

1. a persons sense of instability manifests itself to them and me
2. the point where a persons tendency, on average terrain, "to go over" on their ankles becomes more evident

Considering that slowing down then speeding up and turning constitute a considerable amount of our walking day, be it in the street or in the office (where alterations in speed and turning occur due to ergonomics of working contexts), such information is surely more important than perhaps we give credit?

Cheers
Ian

I have a 8mm femoral inequality. When walking on the treadmill it was noted that the way I tried to compensate for this appeared to vary from when I walked on the floor.

I would say that the learning curve for treadmills for some is very steep and trying to run on them can be terrifying for some. Walking may not be so bad.
As far as exercise on treadmills goes, I wonder at times, if the totally repetitive patterns of treadmill walking do not allow for recruitment of muscles that one would use outside on sidewalks, streets, roads and trails.

Additionally, getting "locked" into a pattern may not allow a person to slow down when they would ordinarily do so, for many reasosn that you might when walking outside.

Safety for some, especially during the winter is an issue heree in Canada that would suggest that readmill or mall walking might be safer than barving the cold and ice (on such a bitter and absolutely frigid day as we have tday in Halifax NOva Scotia where it is now -12C with a windchill of -20) I digress. ADD happening here....
Best regards.
Freeman Churchill

Ian I agree, I didn't mean to discount the validity of gait assessment carried out on a floor as opposed to the treadmill. I also can see the importance of identifying a weakness in gait and points where a patient may be more susceptible to injury, particularly where there is a history of lateral ankle sprains.

The main point of my comments was to point out the value of a treadmill in certain circumstances. In my practice, we also watch our patient's gait as they trott up the hallway aswell as a treadmill analysis. Indeed I'm sure most experienced clinicians watch their patients walk into their treatment rooms in an attempt to capture their natural gait whilst they are unaware of being observed. Hell I do it when I'm shopping, it's a podiatrist's curse.

Anyway Ian, I have spent a few years using 'the hallway' and have found it very usefull. The treadmill just adds another aspect to the observation process. I'll be keen to look for the "instability" that may "manifest" while a patient is negotiating a turn. Thanks for the tip.

In response to Freeman's comments, I was having a chat with a fitness trainer a few weeks back and he was expressing concerns with people training purley on a treadmill. He pointed out that due to the tredmill essentially propelling for you, the reduced effort required by the posterior musculature of the leg, most notably the gastroc/soleus and hamstrings, would cause a reduction in strength. This makes sense to me. Has anyone seen any literature on this?

Regards
Trent

gday big trent, thanks for the tips on the treadmill use. i have got one in my clinic but have been reluctant to use it so far. will give it more use i think, even just to add a different dimension to the assessment. out of curiosity, how do you find the older patients with the treadmill?
Paul

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relder patients on treadmill: like a deer on ice

Yeah, lol. I try to treat each patient with individual consideration in terms of their assessment process. It also depends on what you class as elderly.

I have plenty of 60 year old patients who I would have no hesitation in doing a treadmill assessment with, and there are those 60 year olds who find it difficult to negotiate the floor strip at my front door. Each on their own merrit Paul.

Trent

Gender differences in the variability of lower extremity kinematics during treadmill locomotion.
Barrett R, Noordegraaf MV, Morrison S.
J Mot Behav. 2008 Jan;40(1):62-70.

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I have been in a few practices that utilise both methods of assessment. Recently I had an experience of trying to film someone running up and down the street. Their gait was not consistent each lap or even to that of what they would normally do in their general running. And my filming skills were pathetic.

I like the idea of a treadmill if for nothing else that it gives a consistency to gait be it walking or running, and the ability to video accurately, patient after patient and also if you were trying to compare different footwear, or footwear with and without orthoses. Patients seem to adapt well, but again having an assessment that includes both the 'hallway' walk and the treadmill assessment isnt that time consuming and is also very valuable.

I feel that it is a necessity to utilize both modalities. Contrary to Trent, when I first started using treadmill/video analysis I often felt that my pts exhibited a more natural gait when asked to walk up and down my hallway, as opposed to walking on a treadmill. I don’t always utilize the treadmill for every pt during the initial phases of treatment. I do, however, just about always film people on the treadmill as part of my biomechanical assessment. I find it very useful, as I always have something to refer back to after the pt has left the office. By having something on record, also allows me to check that I haven’t missed any vital information.

In addition, when treating runners, I don’t really think you have an option. How do you treat runners without being able to assess there running cycle? I think the best solution is to use the treadmill and then film them. For same reasons as before, I like having a record so that I have something to refer back to.

I did take me a while getting comfortable with using the treadmill, filming pts and mastering how to use the software. What I can tell you now is that I denfinately have no regrets about incorporating this into my practice. I have found it extremely helpful.

Regards,

Daniel

Out of curiosity Daniel, what type of software do you use?

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I use Silicone Coach. There are different programs out there, which, from what I know, pretty much achieve the same thing. I prefer to use silicon coach as this is what I used at Uni. But at then end of the day, it comes down to personal preference.

Daniel,

When I suggested that patients show a more natural gait on a treadmill, I was referring to the gait they exhibit after a few minutes of being on the treadmill. All patients need a couple of minutes to settle into the treadmill assessment, however after a 5 minute period, once they have adapted, I find they show a more natural gait associated with perpetual ambulation. Meaning, patients go through acceleration and a re-stabilising phase after a turn, which is not indicative of their normal gait. When they are walking up and down a 5 meter hallway, they never really reach a typical gait pattern. Given a good session on a treadmill offers them the opportunity to display a more typical gait.

I know I have alluded to this previously in the thread but I just wanted to make this a little clearer.

Trent

Trent:

Even though I believe the use of a treadmill is extremely beneficial, based on my own observations, I don’t agree that every person will display a more coordinated gait on a treadmill, no matter how long they walking on it for. Pts will often display a more consistent gait pattern on a treadmill but this does not necessarily mean it’s normal. This does not apply to every pt that I see, however, it is something that I have thought a lot about since I first began using a treadmill. I will often watch a pt walk up and down my hallway then compare them on the treadmill. I find that this helps me more accurately determine the specific gait pattern related to their problem.

Don’t get me wrong though, I completely agree with you that when assessing pts on a treadmill, pts will always need a few minutes to become accustomed before anything useful can be observed.

Regards,

Daniel

This is a good tactic Daniel. I might make more of an effort to assess patients using both techniques and see for myself the differences.

Trent

Has anyone been exposed to pressure analysis on a treadmill?
Reason for asking is that I have been asked to assess a treadmill with a pressure plate in it and was wondering if there are any major technical issues to be aware of.
Key points may be how it deals with the treadmill material/belt surface, the ground moving, vibration, etc.

Any one any experience with one?

Cheers

Phil

No experience here Phil. Sounds interesting though, I'd be keen to know more about it.

Trent

There are major technical issues. They may be solvable, but the vendor should demonstrate to you that they have been solved. You also have to think about what data is generated by the force plate treadmill combination.

One of the major technical issues is knowing where the force on the treadmill is relative to the foot. If the foot is on a moving belt and the force plate is under the belt then you will have difficulty knowing where the force is relative to the foot. The treadmill/force plate could give you total force applied by the foot to the treadmill, but what do you do with this information?

See the discussions about center of mass excursion and force time curves and how groucho walking will give you a "better" gait than normal upright walking. Although I wrote it over 10 years ago you could look at my computerized gait analysis chapter in Valmassey's textbook. The general information in it is still good.

Cheers,

Eric Fuller