Phew...it's just as well I have been watching the baseball, its bad
enough I get lost on some of the conversations on here...! So I add my
bit too, go the red sox...! Let's hope then they perform well on tour!
Following Gareth's comments, glute medius is a stabilizer under load, so
how can it be tested for its effect during gait if it is tested non
weight bearing and non functional, ok, the test you are talking about
does assess the strength of the muscle, but not its strength in a loaded
situation, and especially for the purpose we test as Podiatrists, during
weight bearing and simulating gait.
Briefly, I test this muscle during weight bearing, single leg stance,
single leg with knee flexion and also, on one leg, as in gait, both with
and without knee flexion. Of course the action and flexibility of all
the other muscles that effect gait also are tested and taken into
consideration as part of the assessment.
As for strengthening it, if it is performed correctly and educated to
its purpose, then there is no reason why it does not "fire" correctly.
From my observations on Physio strengthening it is performed non weight
bearing, and non functional. I never strengthen glute medius non weight
bearing, unless it is totally wasted from trauma or an elderly stroke
patient for example.
Here's another thought, how about functional primal tasks? Instead of
just assessing gait, how about the patient who is only assessed on gait
but has hallux pain when squatting to perform daily living tasks? Glute
medius weakness leading to femoral rotation leading to pronation, throw
in a reduced windlass, posterior compartment tightness, and a bit of
FnHL and we got a nice little brew.
I only have my 15 years in the fitness industry as an offering and I can
draw your attention to a couple of articles I found. There are lots out
there, and mainly focusing on the knee, and only small sample sizes.
However, this is an area I want to perform some research in down here in
New Zealand.
Thanking all for their contributes to this subject, I am thrilled to
hear your views, sorry not to be in Boston, and no not for the baseball.
Next year. (Craig, what is the conference you are coming to New Zealand
for? It may have passed me by, busy with finals right now, thanks.)
Mascal et al. Management of Patella femoral pain, targeting hip, pelvis
and trunk muscle function, 2 case reports. Journal of Orthopedic and
Sports Therapy. Volume 33, number 11. November 2003.
Powers, Christopher. The influence of altered lower extremity kinematics
on patella femoral joint dysfunction. A theoretical perspective.
Journal of Orthopedic and Sports Therapy. Volume 33, number 11. November
2003.
Many thanks
Julie
-----Original Message-----
From: A group for the academic discussion of current issues in podiatry
[mailto:[log in to unmask]] On Behalf Of Gareth Milne
Sent: Sunday, October 24, 2004 11:39 PM
To: [log in to unmask]
Subject: Gluteal strength etc
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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