A Step Ahead

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A new study researches how chiropractic manipulation of the ankle affects walking performance
Turning over, sitting up unassisted, crawling, standing upright, and taking first steps are developmental milestones every parent anxiously looks for in a child’s first year of life. The complexity of walking is almost incomprehensible, so it comes as no surprise that those first steps are wobbly and subject to frequent tumbles. But barring complications, a child quickly masters a steady gait, learning to pick up speed and go longer and longer distances unassisted.

Walking involves a kinetic chain that engages the feet, ankles, knees, hips, and so on. Add to that the phenomenon of the ankle’s instantaneous axis of rotation, which in turn affects knee and hip movement and it’s easy to see that the process is multifaceted. The mechanics of just lifting one foot are a highly complex series of tasks involving 26 bones and 40 muscles. And with each step, numerous additional bones and muscles are involved since walking is a function of the entire human body, not just an isolated limb. Runners and other sports enthusiasts are probably more familiar with these biomechanics, but most of us take walking for granted because the ambulatory process is in large part subconscious.

Does ankle manipulation improve your gait, and does that improvement have measurable characteristics? — Stephen Perle

Whether you are an Olympic hopeful, marathon runner, or just walk for exercise, Perle is interested in the biomechanics of your gait. Specifically, he seeks to answer the questions, “does ankle manipulation improve your gait, and does that improvement have measurable characteristics?” His interest in research is one of the reasons he left behind a private practice in Manhattan for academia, when he became one of the first two chiropractors hired as full-time faculty for the University of Bridgeport College of Chiropractic in 1992.

Perle’s current clinical trial is an exploratory stage study on a specific chiropractic manipulation of the ankle. He anticipates that the manipulated ankle will be able to bend better, which in turn should more equally distribute the walking process between the two limbs and improve walking speed. Study subjects walk on a treadmill equipped with Microgate’s Optojump, a device that measures the timing of feet walking or running on the treadmill. In the process of walking, both feet are on the ground approximately 40 percent of the time. Perle expects the manipulation to produce change in step to step differences and side to side differences in the two feet, known as variability. While a certain amount of variability is good, other amounts are bad, but researchers have not yet identified thresholds for optimal side to side or step to step variability in walking. If the manipulation in this study does improve gait and improves the variability, then the Optojump could be used to find people who would benefit from manipulation.

Perle himself is a man on the move. In addition to teaching full time at UB, he also has adjunct appointments at Murdoch University in Australia and in the French chiropractic program, is a speakers’ bureau member of NCMIC Group, is a post-graduate instructor for New York Chiropractic College, serves as associate editor for Chiropractic & Manual Therapies, and is an editorial board member for seven scholarly publications. Perle has received numerous awards, including the Presidential Leadership Award from the American Chiropractic Association, The Connecticut Chiropractic Association’s Malcolm Doyle Back Bone Award, and is a Fellow of the International College of Chiropractors.

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