RE: problem patients AND the need for an
international database on movement impairments!
Dear Nigel,
I attended the course titled "Diagnosis & Treatment of Movement
Impairment Syndromes" with Prof.Shirley A Sahrmann (
http://www.apta.org/pt_journal/Nov98/sahrmann.htm)
whereupon I was reliably informed that 15 degrees appears to the accepted
threshold for detection of ante- & retro-version. My own clients who have
had an MRI against my Craigs Test application has also confirmed this. Indeed
studies by Ruwe(1992) and Gelbermann (1987) + the classic textbooks Hoppenfeld
& Magee also detail the procedure for those with an interest in the topic of
structural impairments. Others include tibial torsion, tibial varus (sagittal
& coronal), congenital pes cavus, coxa vara, coxa valga.
Some colleagues have levelled the criticism that these things do not direct
my treatment and that all I am doing by requesting an MRI is just wasting NHS
monies and being too academic. So for those of you out there who think checking
for structural change does not matter.....
...get Magee out from your local library, look at the anteverted hip images
within and tell me how an anteverted hip is supposed to run foot forward like
the norm??!!!! If we all ASSUME that the lower limb osteokinematics are normal,
then you make an ASS out of U and ME. We have to look to see these impairments
and not just continue blindly dishing out exercises hoping time will help.
In those clients I have had to unravel years of LL pains down to an
anteversion what becomes plainly obvious is the bit that hurts is the bit that
is moving due to Compensatory Relative Flexibility (CRF). That is...if an
anteverted hip cannot extend the expected 10 degrees when the foot is forward
(which it wont do!!) then the kinetic chain is going to compensate elesewhere.
Usually it will be lumbar rotation (check for short/stiff quad lumborum - if
GMax can't be recruited, QL will lift the LL!)), knee hyperextension (long
semimembranosus, lax ACL) and overpronation.
Here are some of my fundamental practice beliefs:
- If it was enough to be just fit & exercise willy-nilly, why are
athletes amongst those injured most frequently?
- I believe that precision movements have an effect on longevity of our
rotating body parts (read hip, knee, shoulder etc)
- I do not believe osteoarthritis is an inevitable consequence of being
alive and being older than 45. OA is just a cluster of signs and symptoms
with no real causative virus/bacterial/genetic explanation. Have we all, as
a worldwide professional body, REALLY looked at the common trends in human
movements and documented the trends that may CAUSE wear and tear
- Back pain shares the same laws of mechanics that knees do. Why then do
some people believe that back stiffness equates to pain = push the client
into more extension. IF this was the case...why do surgeons perform
Girdlestones, fusions etc. for segmental pain problems? Probably because
they realised that faulty movements/postures CAUSE the pain at a segment
moving incorrectly! Think about upper trapezius pain.....is it a LATENT
trigger point (why latent?...has the neurone been on holiday until you
pushed it) or is the observation that this muscle is subject to overstrain
as it lacks the osseus restriction that say, the biceps brachii does? In
this case if you shorten the upper traps when it is painful @ 4 kgs of
pressure (tape, hold it up by manual force) and push again, it will not hurt
anymore (you'll need a pressure algometer!) Why? Depends what you know
about......
- stiffness?
- strain?
- atrophy?
- hypertrophy?
- DOMS?
- Lets get rid of pseudoscience (read trigger point theory) and apply our
clinical science (read muscle strain...injurous tension applied to the
musculotendinous unit)
Looking forward to replies....last time I looked the Cranial Sutures had no
anatomical links to my spleen and my foot last saw a connection to the bowel
when I was in utero!
Mr Owen DR Moore BPhysio(Hons)B'ham Adv.Cert. in PT in OH
MCSP SRP
Nottingham
England
>Owen,
>
Many thanks for the information on structural hip deformities.
>I seem to
recall being told on a muscle imbalance course that a 10 degree
>increase
in medial rotation compared with lateral rotation[in prone] could
>be due
to anteversion.A larger amount would indicate a muscle imbalance,ie
>long
gluts,short
TFL/ITB.
> I'd
be interested in listmembers' views on differentiating
>between a
structural deformity and a muscle
imbalance.
>
Nigel Biggs
>