Mailbase:
Julie wrote: "why we putting an orthotic in to control
late pronation when this patient has no glute strength
to control the femoral rotation that is countering the
late tibial external rotation any way?"
Each time we fit an orthoses we should be mindful of
the fact that the lower limb is a kinetic chain that
involves all muscles and joints all having different
functions to help aid in the what seems effortless
function that is abulating from A to B.
I am sure I am stating the obvious for most if not all
the Mailbase contributors. I, myself, am still in the
early stages of my Podiatry career. I do however find
it helpful to make sure that all other main muscle
groups and joints in the lower limb/lower back are
able to work to their required degrees of motion. If
not there is compensation and change of gait
efficiency. This could be in the form of tight
hamstrings which lead to reduced muscle contraction of
gluteus medius causing increased internal rotation of
the femur/knee increasing STJ pronation moments.
Your question Julie, regarding reduced Gluteal
strength causing increased internal rotation is an
interesting one which I have had many a discussion
with the Physiotherapists and Sports Doctors alike in
the hallways SportsMed.
We find it easy to find weakness in the Gluteal
region, namely Gluteus Medius, via muscle testing
having the patient side lying, abduction and slight
external rotation of the limb and asking for active
contraction from the patient while forcing the limb
into adduction. We can offer a guaranteed strength
programme that will strengthen up the lateral rotator
of the femur (the easy part) but what if the muscle is
still not able to fire in the chosen activity. This
from discussion with other sport medicine
professionals is the hard part. We can have strong
muscles but without the fire power of muscle
contraction during exercise of the specific muscle
group there will be little change to the gait cycle.
I have however seen great results with patients being
taken through a vigorous strengthening programme of
Core stability/Glut med/VMO exercises and with the use
orthoses being discharged pain free (as I'm sure we
all have!).
Whether the force was with these people, I'm not
sure!?
regards,
Gareth
=====
Gareth Milne
PODIATRIST
Sportsmed
156 Bealey Avenue
Christchurch
New Zealand
+64 3 366 0620
+64 21 136 1244
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