Dear all on the Podiatry Mailbase
Been following to some extent the gluteal/foot function discusison.
We have some work going on here at Salford which is looking at
the issue of whether the foot controls the hip (limb), or hip controls
the foot, of course with the belief that "control" (if as such it exists)
can change during the cycle. This relates closely to a paper by
Bellchamber and Van der Bogert in J Biomechanics, they term the
phrase distal and proximal "power flow".
http://www.healthcare.salford.ac.uk/crhpr/hip_musculature.htm
Central to this work and the theory proposed by my colleague Dr
Steve Preece is that altered (in some way, not necessarily
strength) gluteal function can allow changes in femoral rotation
(transverse plane) leading to changes in the tibial force driving, or
being driven by, the foot.
Steve is using a previsouly published theory and technique (sorry
not got ref to hand) that allows the recruitment of gluteals and
hamstrings to be quantified. From what I recall, there is a test
using EMG that shows distinct differences between how some
people control their hip, some recruiting gluteals, some recruiting
primarily the hamstrings. Since the moment arms etc for these two
groups are different, the ability of a subject to control the femoral
rotation may be different. Recruitment stratgegy rather than
strength is key to the work.
We have some experimental work underway already, which will
continue until the end of Dec 2005, though results should be
presented late next year. Steve will be undertaking a cross
sectional study of people with different hip muscle recruitment
strategies in terms of comparing their foot biomechanics, and
hopefiully starting a longitudinal study to see if by altering hip
muscle recruitment etc we can alter foot biomechanics.
cheers
chris
> 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
>
> Find local movie times and trailers on Yahoo! Movies.
> http://au.movies.yahoo.com
>
> ----------------------------------------------------------------- This
> message was distributed by the Podiatry JISCmail list server
>
> All opinions and assertions contained in this message are those of the
> original author. The listowner(s) and the JISCmail service take no
> responsibility for the content.
>
> to leave the Podiatry email list send a message containing the text
> leave podiatry to [log in to unmask]
>
> Please visit http://www.jiscmail.ac.uk for any further information
> -----------------------------------------------------------------
>
> ----------------------------------------------------------------- This
> message was distributed by the Podiatry JISCmail list server
>
> All opinions and assertions contained in this message are those of the
> original author. The listowner(s) and the JISCmail service take no
> responsibility for the content.
>
> to leave the Podiatry email list send a message containing the text
> leave podiatry to [log in to unmask]
>
> Please visit http://www.jiscmail.ac.uk for any further information
> -----------------------------------------------------------------
>
Dr Christopher Nester BSc PhD
Senior Research Fellow
Brian Blatchford Building
School of Health Care Professions
Centre for Rehabilitation and Human Performance Research
University of Salford
Salford
M6 6PU
England
http://www.healthcare.salford.ac.uk/crhpr/
http://www.realprof.eu.com
TEL:0161 295 2275
FAX:0161 295 2668
-----------------------------------------------------------------
This message was distributed by the Podiatry JISCmail list server
All opinions and assertions contained in this message are those of
the original author. The listowner(s) and the JISCmail service take
no responsibility for the content.
to leave the Podiatry email list send a message containing the text
leave podiatry
to [log in to unmask]
Please visit http://www.jiscmail.ac.uk for any further information
-----------------------------------------------------------------
|
