Oscar Pistorius' Gait Deviation

Many critics have claimed unfair advantage to South African runner Oscar Pistorius as he uses Cheetah Blades as a prosthetic for is double leg amputation

Watching his gait in running, I noticed that he is likely not getting the full benefit from his high performance, carbon fiber prosthetic.

As seen in this picture, his left lower extremity is in external rotation. Given the energy storing capabilities of the Cheetah, he is not gaining the full recoiling properties. To gain improvement in his mechanics we need figure out the cause of the left lower extremity external rotation. When evaluating patients, my bias is to attribute external rotation to a lack of dorsiflexion, for this individual it is clearly not the cause. 

Since there is no foot and hasn’t been one before ambulation began for Oscar (he was 11 months old at the time of amputation). The cause is likely a limitation at the femur, hip, innominate or sacrum causing him to compensate with femoral external rotation due to a lack of extension at the hip on push off. When you watch him walk he does not externally rotate on the left, this is why I do not think there is a limitation in hip or innominate internal rotation.

To test I would look at the following:

1.     Open Chain knee flexion- To rule out rotation at stump.

2.     Femoral extension: Should be 10 degrees without compensation above or below

3.     Innominate extension: With the femur should total 20 degrees without compensation above or below.

4.     Sacral Extension: With the femur and innominate should total 30 degrees without compensation above or below.

5.     Pelvic depression- He may lack range in pelvic depression causing him to compensate with external rotation at the hip.

To learn more about evaluating and treating gait dysfunction check out our course;

Restoring Efficient Balance and Gait Through Targeted Evaluation and Treatment Strategies

Greenville, SC September 15th and 16th, 2012

http://www.sigproed.com/live_seminars.html

Tennis player treatment with a surprise result

This patient, whom I had treated in the past for chronic falling (See post July 26, 2012) had now reported that she experienced a fall from tripping.

http://ptsperspective.blogspot.com/2012/07/carryover-2-years-after-treatment-for.html 

In my Balance Enhancement and Fall Prevention Course, I teach that when a person experiences tripping one should evaluate Ankle Dorsiflexion with the knee extended and pelvic elevation. If neither of those show any dysfunction, then look at the push off phase of gait as that is the predecessor to the swing phase of gait where tripping occurs.

When I observed her gait pattern, I noticed that she externally rotated the right lower extremity (often an indicator of a lack of dorsiflexion, presented with a narrow base of support, adducting her right leg toward her left, and abducted her arms with her arm swing.

See video: http://www.youtube.com/watch?v=c0jS6EXihe4

When I evaluated open chain active range of motion dorsiflexion with her knees extended this is what I observed. Please also note the alignment at her Bilateral femurs and patella.

http://www.youtube.com/watch?v=0o0F8S8Gjqo

During my evaluation of Passive Range of Motion her primary restriction was noted to be at the metatarsals, I also noticed callusing of the metetarsals on the soles of her feet as well (a telltale sign that there are restrictions in the metatarsals).  Using the ARMS technique for about 5 minutes, treating both of her feet, her Active Range of Motion Dorsiflexion and it had increased within normal limits.

See video: http://www.youtube.com/watch?v=0lUo0x-KpMg

In spite of this treatment I did not observe a significant change in her gait pattern, she was less externally rotated but there was still a narrow base of support that I noted. What appears most remarkable is the change in alignment at the patella and femur as a result of release to the foot.

At this point I evaluated her pelvis and began to work on that.

Post Treatment Gait: http://www.youtube.com/watch?v=5enNTcOWeqQ

At the completion of the treatment there was a mild improvement in her gait. She presented with a normalized arm swing and decrease hip external rotation. I was surprised and impressed by the improved alignment at the patella and femur with work solely to the metatarsals (excuse the pun).

As noted above open chain dorsiflexion was restored, home program is ankle pumps with toes in flexion.

Given her history of falls, I am concerned about her narrow base of support as falling occurs when our center of gravity moves beyond our base of support. As noted there is still mild rotation of the right femur and patella which may be contributing to her adducting her right leg during swing, and compensating with foot external rotation.

Next visit I will address the rotation of the femur and patella.

Come to a live class to learn how to perform this type of Gait evaluation and myofasical treatments at: http://www.sigproed.com/live_seminars.html

For additional Before and After Patient Results: http://www.sigproed.com/res_before_after.html