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Lower Extremity
Hip
1) The glutes are internal rotators too…
2) Some great clinical insight on chronic hip flexor strains from Dave Tilly. I love the idea of treating the hip like the shoulder in regards to PNF rhythmic stabilization and wall ball circles.
3) The hip and the back are always related. “The authors concluded that dynamic pelvic orientation significantly influences the functional orientation of the acetabulum. This study also found that people with impingement have reduced trunk control bilaterally, supporting the need to include trunk rehabilitation in treatment. This has implications for therapists rehabilitating patients with symptomatic FAI as not only should the trunk be a strong focus of rehabilitation but pelvic positioning during exercise and ADLS can have an impact on the positioning of the hip and range of movement.”
4) Erson uses the SL Bridge to fire the posterior chain, improve anterior hip ROM, and increase rotary stability.
Knee
5) This study was done on athletes. I wonder if it would be different for a sedentary population with co-morbidities. “Postoperative bracing after ACLR has not beneficial effect on clinical outcomes and the complication rate. Patients who wore the rigid brace had limited flexion early on.”
6) Sometimes there’s a big difference between anatomy and function. “With respect to range of motion, pain, clinical, and radiological outcomes, no clinically relevant differences were found between total knee arthroplasty with retention or sacrifice of the posterior cruciate ligament.”
7) Mark Comerford once said his clinical mantra was, “I love a level pelvis”. Here’s some quick research to back it up, “Increased hip adduction during stance phase of Trendelenburg gait contributes to excessive knee joint loading.”
(source)
Ankle/Foot
8) “Those ankles with more swelling had the most anteriorly positioned fibulae. The fibulae in sub-acutely sprained ankles appear to be positioned more anteriorly compared to the contralateral ankles. This positional fault may be maintained acutely by swelling.” (via Michael Mullin)
9) Are they pronating because they don’t have ankle rocker or because they don’t have forefoot and midfoot stability? “When the foot is unstable, things often switch; the once mobile ankle rocker shifts towards stability attempts.”
10) Tendinopathies aren’t just about load. They’re also about circulation. And what dictates circulation? One of the variables is movement patterns. “the more the eversion excursion observed, the lower the increase in blood flow”
11) Strengthen the feet to improve balance “In the foot-focused training group, increased toe flexor strength was associated with significant improvements in perceived general foot health (based on the Foot Health Status Questionnaire) and single-leg balance time.”
12) The glute max and the abductor hallucis both “supinate” the lower extremity. “The group that performed both gluteus maximus and abductor hallucis strengthening exercises showed smaller values in the height of navicular drop than the group that performed only abductor hallucis strengthening exercises. The muscle activity of the gluteus maximus and the vastus medialis increased during heel-strike in the group that added gluteus maximus exercises, and the muscle activity of the abductor hallucis significantly increased in both groups.”
(source)
13) “The simulations revealed that strong preparatory co-activation of the ankle evertors and invertors prior to ground contact prevented ankle inversion from exceeding injury thresholds by rapidly generating eversion moments after initial contact. Conversely, stretch reflexes were too slow to generate eversion moments before the simulations reached the threshold for inversion injury. These results suggest that training interventions to protect the ankle should focus on stiffening the ankle with muscle co-activation prior to landing.” Good advice, but I wonder how to do this in the clinic without compromising the ability to absorb shock.
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