Can your patient's feet even articulate with the floor?

Of course.

You don't often see anyone standing or walking with their foot off of the floor, but how many people can achieve this task without compensation?

The other day in clinic I decided to passively evaluate my patient's feet and ankles moving them into a neutral position to see if their foot could articulate with the floor without compensation.

None of my patient's, age range 18-84 could achieve this motion without mobilization.

Restoring it helped to elicit an improvement in posture as well as function.

Compensations up the kinetic chain for a lack of neutral dorsiflexion in standing include the following:

• Genu recurvatum
• Anterior innominate rotation
• Knee flexion in standing (think of your elderly patients)
• Elevation of the rib cage a sternum
• Forward head rounded shoulders posture
• Thoracic kyphosis
• Rotation of the tib/fib
• Rotation of the femur

To evaluate place the patient in prone or supine and passively move the toes, metatarsals (where most the structural restrictions are), mid tarsals and ankle joint to see if the patient can achieve a neutral position in all.

As you do this look up the kinetic chain as you do this to see if there is movement including, rotation of the lower leg or femur and/or hyperextension or flexion of the knee.

In my classes I always say that I could make the world a better place, physically if I could restore dorsiflexion in my patients.

 See what happens to yours when you take a close look.

Comment on: Improve your Posture Improve your Breath

One of my axioms of Rehab is Alignment Dictates Function. 

This statement is substantiated by the musculoskeletal  principle of the Length Tension Ratio which states that  a muscle will contract with greatest vigor when it is at a particular length. 

Ultimately, my goal in all of my patients is to restore proper alignment as best possible for that individual.

I believe the Alignment Dictates Function principle when dealing with the viscera. The human body is essentially made up of tubes and if there is a kink in the tube, just like a garden hose, things will not flow. 

Recently I read a post called Breathing Right Down to your Bones that illustrates the Alignment Dictates Function principle with breathing.
 http://www.huffingtonpost.com/carla-ardito/breathing-exercises_b_3269076.html

If you have a pulse oximeter available to you, put it on and test your O2 saturation assuming your patient's posture.

Notice some changes?

As therapists we cannot put more calcium in an osteoporotic bone, heal a broken bone,  or undo damaged lung tissue or change a person's age. Alignment/posture is one of the few things that we can change through the use of manual techniques, taping, bracing, and positioning in our patients.

Another one of the axioms that I ascribe to when it come to therapy is taken from the Serenity Prayer;

grant me the serenity 

to accept the things I cannot change; 

courage to change the things I can;

and wisdom to know the difference

The myth of Core Stability

My linkedin account is a buzz about a post written on the Evidence Based Practice Group stating that Core Muscle training shows little affect on lower back pain. 

The author of the comment references a paper called the myth of core stability: The Myth of Core Stability.www.cpdo.net/myth_of_core_stability.doc

There seems to be a lot of misconception by the author surrounding this topic

Myth #1: Core muscles are only found the in the abdomen: Core muscles are deep 1 joint muscles whose primary function is to stabilize a joint to allow its moving muscles to work.Think about the relationship between the supraspinatus and the shoulder. If the supraspinatusis torn the shoulder cannot flex, yet our kinesiology books do not list the supraspinatus as a flexor of the shoulder.  

Myth #2: The abdominal core consists only of the Transversus Abdominus (TA): The author references only the TA when refuting this topic. The abdominal core also consists of fibers of the multifidus, psoas, pelvic floor, obliques, and likely more to be discovered. 

Myth 3: Patients should go around bracing their core in a constant state of contraction. 

The core should function automatically prior to motion. The following is a true story and an example of how the Abdominal core is supposed to function. I was walking down Park Avenue with my rollerblades in one hand and a cup of coffee in another. There was construction being done on a building on the corner of 35th street. There was scaffolding and noise. At the very same time a younger male was walking toward Park Ave up 35th street and neither of us saw the other person coming. We collided and he went flying off of me, my coffee didn't even spill.

He turned to me and asked "Why did you push me?"

I replied: "How could I have pushed you?, my hands are full and I didn't even see you coming". 

I went on to explain that I was a PT and it was my abdominal core bracing that caused him to ricochet off of me. It was a great comeback as he had no reply and ended our confrontation.

The take home being that the Core should fire automatically in a person and if it is not firing it needs to be facilitated and trained to do so rather than consciously be taught. 

What do A-Rod and Lady Gaga Have in Common?

The Answer: They are both still recovering from labral tear surgery they underwent this past winter. 

The labrum is made of cartilage that lines the rim of the acetabulum of the ilium and provides shock absorption, stability, and nutrition to the joint, similar to the labrum of the shoulder. 

This injury is usually caused by abnormal and repeated internal rotation and or flexion of the hip and it is not coincidence that it has impacted hockey goalies Jean-Sebastien Giguere and Vesa Toskala. The tear can occur over time or by a sudden traumatic event. 

Other famous names who have suffered the same fate; Figure Skater Michelle Kwan and Golfer Gregg Norman. 

Why has this injury become so popular? It was often misdiagnosed as a groin pull and advances in MRI technology have helped to diagnose the problem. Symptoms include clicking and locking of the hip. 

It is not always a surgical problem and can be managed by Physical Therapy. 

How can PT help?

A therapist needs to asses the kinematics of the hip with its relationship to the innominate (1 side of the pelvis), sacrum and the spine will need to be addressed as well as the ability of force to be attenuated and dispersed by the lower extremities.