Last entry I spoke about carry over. I recently saw a
patient who I treated 2 years ago for repeated falling. I tell her story in
almost all of my classes as it was one of the first experiences that I had
using Diagnostic Motion Evaluation that amazed me, here it is:
An older woman, who is an avid tennis player, had been
falling on the tennis court. Her multiple falls resulted in an ankle fracture
and pelvis fracture on her left side. As a result she was fearful that she
would have to quit her favorite sport.
When I had seen her, I decided to perform the foot clock
evaluation in the directions of 3-9 o’clock. My rationale was this; she had
been falling only on the tennis court, not during her normal community
ambulation. The motion in tennis that is distinctly different than walking are
the lateral motion. When I had her do this action, I observed that her Right
medial foot came almost completely off of the floor very soon after she began
to shift her weight toward her right side. Bear in mind her injuries were on
her Left and I assumed that her dysfunction would be on the Left side as well.
Based on the principle of Diagnostic Motion Evaluation,
this was a closed chain activity,
therefore, my beginning observation point was just above the knee. Base
on her compensation being with the first few degrees of motion, I realized that
her dysfunction was somewhere at the proximal tibia. I brought her into sitting
and moved her passively to determine if this was a structural or a non
structural dysfunction. The dysfunction was the same and therefore was
determined to be structural.
When I palpated, I found the structural dysfunction to be
at the superior/medial tibia and I treated with ARMS. I re educated by
facilitating her medial foot to stay on the floor as she shifted to the Right
and her home program was foot clocks 3-9 with progression to side stepping and
karaokes.
As I had mentioned earlier, until a few weeks ago, I had not
seen her in over 2 years. I am thrilled to report that since our treatment she
has not fallen on the tennis court and she continues to play consistently.
She did however, mention tripping over a step that she had
not seen, so I decided to evaluate open chain Dorsiflexion and this is what I
saw.
Her initial walking pattern revealed external rotation of
the right foot, narrow base of support, widened arm swing and mild
trendelenberg to the right.
I will post her treatment for her gait and dorsiflexion next
post.
