Photographs by John Sykes Jr.
Gary Taylor cooperates while Chris Oholendt, rehab therapy manager, applies reflectors to key points on his lower body so he can undergo 3D Gait Analysis at the UAMS Orthopaedics Clinic.
Monday, November 13, 2017
When Gary Taylor sits in an airport and the humans stride past, he can't stop himself: He has to watch how they walk.
His eyes follow the knocking knees, the bowed legs, the pigeon-ing toes.
"Also at the mall," says Dr. Michael Cassat, an assistant professor in the UAMS College of Medicine's Orthopaedic Surgery Department. He shares Taylor's affliction. Where others see a mass of moving bodies, he stares at gait anomalies.
Chris Oholendt, who as an occupational therapist is equally locomotion-obsessed, says watching limpers on the Arkansas River Trail is the worst: "You see these people and want to yell, 'You should not be running like that!'"
Habitual seeing can be an occupational hazard. Oholendt and Cassat work in the new UAMS Orthopaedics Clinic that opened in October at 10815 Colonel Glenn Road, in far west Little Rock. Cassat, 46, is a primary-care sports medicine physician whose specialty is the nonsurgical treatment of athletic injuries. Oholendt, 40, is the clinic's rehabilitation therapy manager.
And Taylor, 54, owns Go! Running in the Heights of Little Rock, which sells myriad models of running shoes that are marketed as gait-correcting devices.
Recently they stood together in the 13,000-square-foot clinic's 1,600-square-foot therapy center, boisterously shaking their heads about not being able not to notice abnormal gaits. But next to them sat something that pays no attention whatsoever to gait or anything else until it's told to, and yet puts all their combined observational skills to shame: a 3D Gait Analysis system.
3D Gait Analysis sounds generic but is actually the brand name of a motion-capture system developed for use in medical clinics by The Running Injury Clinic in Calgary, Alberta. The system is just one of the diagnostic tools employed by doctors and therapists in the new UAMS clinic, but it's a fancy one. Paul Stover, administrator for the Orthopaedic Surgery Department, ballparks its price tag at $20,000 -- not counting the treadmill.
And yet 3D Gait is not the thing that makes this clinic something new for Arkansas. It houses a full-service diagnostic, treatment and rehab clinic -- for running -- open to amateurs and athletes alike.
"It ties in well with the local running community because this is something that they can't go elsewhere and find," Cassat says. "There's not another multi-disciplinary physician-led group" dedicated to runners' injuries.
Walkers can use the Colonel Glenn clinic, too, but it's not a walk-in clinic. Patients need to make appointments, and their insurance might require referrals first. But the running clinic itself doesn't require referrals.
Stover notes that the new facility is the department's third off-the-main-campus orthopaedics clinic in Little Rock, counting one at 600 Autumn Road and another at 2 Shackleford W. Blvd. The Autumn Road location does take walk-ins; but it doesn't have a running-specialty clinic.
Cassat explains the target population for the running clinic includes "injured current runners, yes. Injured past runners, also a focus. People who want to get into running, yes. All of those things."
But not people who have had joints replaced: "We just don't recommend people running with a joint replacement."
He also expects to see a few high-level athletes who want their gait analyzed as a tool for improving performance. "But that's the rarity," he said. "If you look at injury rates in runners, the incidence of injury is somewhere between 50 and 80 percent.
"It's hard to find a runner without an injury."
Care in the clinic would begin with learning the runner's history -- family, medical and also running history: "where you run, how you run. Types of terrain. What shoes you wear. What your mileage has been. How fast you built to that mileage -- all the different variables that can be associated with injury," Cassat says.
Examining the injury comes next, and if necessary, X-rays or MRI scans. The runner could undergo 3D Gait and be evaluated by a physical therapist.
"And then as a team we're going to put together a treatment plan to try to prevent and, if we need to, correct the injury that you brought in now. That is going to be done under a patient's insurance," he says.
Although injury rates are high among runners, he says, runners overall have better health outcomes than sedentary people, and so he aims to keep patients on their feet.
"It helps with heart disease, it helps with weight management, diabetes prevention. And we know that even in runners knees that may typically look worse on X-ray, their pains are much lower. We know it does a lot of good things for the body, other than just the brain part" -- running has been shown to improve mood and ease depression.
"It's a good, healthy way to take care of yourself," he says.
Generic motion capture is not an alien concept for moviegoers who liked the blue aliens in Avatar or the galumphing of Gollum in The Lord of the Rings. We know how actors' bodies are marked with sensors and photographed, and how those images are fed into graphics software to generate lifelike animation.
Also, physical therapists and athletic trainers in Arkansas have used various kinds of motion-capture systems for a decade or more to figure out what's wrong with clients, especially golfers. It's not new. But Gait 3D is an especially powerful system, Stover says.
It uses three high-speed, Vicon Viro infrared-strobe cameras that take 500 pictures a second. Technicians poke 30 sticky little reflective dots onto a runner's lower body parts, some directly onto bare skin, others embedded in blue elastic girdles that wrap about the lower back, thighs and calves.
As the dotted body uses the treadmill, infrared light strobes off the dots; the cameras catch those reflections, and software translates it into data. Instantly.
(Anybody wearing a reflective badge or glasses can't be wandering around the treadmill while the system's calibrating, or it will not start.)
The data come out as a report that's gibberish to an untrained eye; but during the test, an easy-to-appreciate, black-and-white half-skeleton trots on the screen of a computer.
To demonstrate, Taylor borrowed running clothes and stood still while Oholendt attached the little dots to his skin and wrapped the elastic around him. Reflective patches on shoes are masked out, but reflective socks are a no-no. Also, shorts should not be skin-tight spandex: Therapists don't need to see everything.
Gearing up took about five minutes and was painless, Taylor said, no electrodes or oxygen masks involved.
"Once we get everything calibrated we actually take some of the markers off once [the system] knows where the joints are," Cassat says. "Because they will fly off once you start running."
One of Taylor's markers came off while he was running, and his skeleton avatar's left femur vanished from the computer screen.
The runner warms up for several minutes on the treadmill; the test takes about 2 minutes, and then he cools down.
3D Gait "looks at 30 different data points while somebody is walking or running, and then it allows us to look at how the different parts of the body move together," Cassat says. "We can look at the hips, the femurs, the knees, the tibias, the ankles, the feet and then look and see how all that moves in real time -- at 500 frames per second."
The information collected includes not only the paths those bones follow as the body runs but also the angles and velocity of their rotations.
Here's the fanciest part: Therapists compare the runner's data to norms drawn from a massive and growing database of lower-body motion being collected at clinics around the world.
Because 3D Gait provides three-dimensional views of the runner's motion, the therapist can see pelvic tilt and information like whether the speed at which leg bones rotate is much different from that seen in the norms. Abnormal velocity can be associated with injuries, and it could be moderated by strengthening the muscle groups that move the joints, for instance, the hamstrings.
"If you are a far outlier from the norm, we could use that data and build a physical therapy regimen to strengthen that area and see if we can correct it," Cassat says. "But the last thing we want to do ever is treat X-rays on people or treat MRIs on people. We want to treat the patient.
"There are people who run with horrible form, and they do great. And are injury free.
"What we don't want to do is just correct everything that looks funny. What we want to do is really work with the patient and their injury history and work off of that."
And that still means, yes, a skilled observer who watches how people walk and how they run.
"But this is new," Cassat says. "The running clinic is new with this clinic. We didn't have anything like this before."
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