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