Dear Nikki,
I appreciate your remark regarding rotation accompanying the "end og range
movement". Yes you knew about it because I hope that you have learnt about
P.N.F during your PT training. If your instructor did not highlight the
importance of rotation always associated with ANY movement he or she failed
in instructing properly PNF. According to the very old Mc Connail law every
muscle contraction induces, as a first effect,a rotation of the bony lever
on which this muscle is attached. (I do not use inserted because I am under
the assumption that insertion means distal attachment for muscles in the
USA.(by the way am I right?). If you do not teach any of your movement with
a gradient of rotation you do not ask for a functional movement. Any
movement in the frontal or saggital plan requires a correction of the
spontaneaus rotation which happens in normal function. So, certainly,
consider to include a rotation in any rehabilitative movement. As an
example: you cannot recover a total flexion/extension in the knee and a
functional ambulation as long as the degrees of rotation existing in the knee
have not been recovered. At each step the LE rotates and about 8 degrees
take place in the knee. Who has ever evaluated the knee rotation during a
lower extremity assessment? Physical therapists forcing the extension of a
knee joint on a patient in prone position not only take the risk to injure
the joint but will not recover the full range this way. What is the reaction
of a muscle group when such an insult is imposed to a joint? Contracture, no?
to protect the joint. If the same physical therapist was working on the
rotation of the knee at the early stage of his/her intervention he/she would
recover full range without generating any damage in the knee or any pain for
the patient. When I studied in France failure to evaluate the knee rotation
would have cost you your graduation. Let's be functional. Please offer your
feed back. Thank you. Best regards. AMVNewman
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