Dear Dr. Sood,

If the feet cannot touch the buttocks, the rectus femoris is shortened, not
the iliopsoas. The iliopsoas causes a limited hip hyperextension, and/or a
pulling forward of the lumbar vertebras, in standing.

Your other questions:

>>If Iliopsoas is short then EIL should also be limited?
FC: Not necessarily. They in fact would have to be severely shortened before
it would result in a ROM-limited Extension In Lying.

>>Test  to differentiate between both is little confusing
FC: Have the patient lie on the couch in supine, with the lower legs hanging
over the couch, at the short end. Have him take one leg, fully pulling the
knee to the chest. While he does this, assess the other leg: if the upper
leg does not lie on, or at least touch the couch, the ilipsoas is shortened.
If the lower leg does not hang close to vertically, the rectus femoris is
shortened (a 15 degree angle with the vertical is normal). In case there
still is confusion, Kendall and Kendall's "Muscles, Testing and Function"
has some very clear pictures.

>>Why pelvis is seen rising in one person who is not able to touch heels to
buttock ,but not in others.
FC: Other variables, such as knee problems? Also, it depends on the effort
made by the patient. All patients with (significantly) shortened RFs will
show a pelvic tilt if the feet-to-buttocks movement is continued passively
by the therapist.

>>Why it is not possible to for quadriceps to   undergo adaptive shortening?
FC: It is possible, as e.g. in case of continued knee casting, but it almost
never happens without such a casting. The reason is that the VI, VL and VM
are monoarticular muscles, only stretching out over the knee. People
generally make a full knee flexion once a day or once per two days, thus
keeping them at length. The RF however needs a specific stretching, which is
not a very natural movement.

>>Meanwhile I have continued checking this test  in all of my back pain and
knee patients.I have observed  from my experience a clear pattern emerge in
these cases responses.the pain is felt as following
a) a group of  patients feel a short sudden severe pain in hamstring area
,even some jump out of examination table and shake the limb to shed this
spasm like pain .Reason....
b) some patient  feel a stretch like pain in anterior thigh
c) Some patient feel pain in  anterior knee.....paelofemoral  area.
FC: Sorry, but this is far too difficult to explain by e-mail. I'd have to
see what it is exactly that you're doing, or having the patient done, in
what kind of patient with what kind of complaints, etc. etc.

R.,
Frank



----- Original Message -----
From: "Dr. S.C. Sood" <[log in to unmask]>
To: <[log in to unmask]>
Sent: woensdag 12 december 2001 4:45
Subject: interpretation & test


Dear Frank,
                       As always I am thankful to you for your help  ,by
sharing your views with us and providing someindepth information.
Please let us know
1)Why the  patients not able to touch  his/her heels to buttocks . Is it
rectus femoris and the iliopsoas as you have suggested.If Iliopsoas is short
then EIL should also be limited?Test  to differentiate between both is
little confusing  ,as I gather first the patient is standing and then supine
with knee &hip flexed  ,if the other knee is does not reach 90 degrees  that
means is not parallel to the bed the patients is lying  the rectus femoris
is (relatively) shortened.and if the flexed leg is not able to touch abdomin
as you say"If the upper leg does not liehorizontally, the iliopsoas is
(relatively) shortened" .Please let me know if I have correctly read
interoperated this,also let me know of another test for same purpose.
2) Now coming back to my original question'
Why pelvis is seen rising in one person who is not able to touch heels to
buttock ,but not in others.
Why it is not possible to for quadriceps to   undergo adaptive shortening?
Meanwhile I have continued checking this test  in all of my back pain and
knee patients.I have observed  from my experience a clear pattern emerge in
these cases responses.the pain is felt as following
a) a group of  patients feel a short sudden severe pain in hamstring area
,even some jump out of examination table and shake the limb to shed this
spasm like pain .Reason....
b) some patient  feel a stretch like pain in anterior thigh
c) Some patient feel pain in  anterior knee.....paelofemoral  area.
Please let me know why these patients behave so differently.
Thanking you
Dr.Sarveshwar Sood,
Director,ICCS,
Institute of Conservative Care Of Spine.
Orthopaedic Surgeon & Head Department of Physical
Medicine & Rehabilitation,
Member American Academy Of Pain Management.
S.B.L.S.Hospital
812/1,Housing Board Colony
Model Town,Jalandhar city
Punjab State.India
E-mail [log in to unmask]
http://personal.vsnl.com/sarveshwar