Guest guest Posted August 8, 2001 Report Share Posted August 8, 2001 Thanks Paolo, I appreciate your input. I think I had better start pedaling on my stationary bicycle! ----- Original Message ----- From: " Paolo Vinci " <p.vinci@...> < > Sent: Wednesday, August 08, 2001 9:44 AM Subject: [] EXERCISE > I COPIED IT FROM THE JOURNAL, IT WAS FREE. > > > Strengthening of the proximal muscles in Charcot-Marie-Tooth disease > Letters to the Editor > > > > -------------------------------------------------------------------------- ------ > Several reports1-3 have suggested that the proximal muscles in Charcot-Marie-Tooth (CMT) disease may be strengthened by resistance exercise. Any conclusion from such studies cannot be extrapolated to distal muscles, which are selectively involved by CMT disease.4 More important, however, in our large CMT1 and CMT2 population, most patients' proximal muscles are strong enough and so do not need strengthening. > > Several of our patients with apparent gluteus maximus weakness, assessed by manual muscle testing, were found to have one of the following problems: (1) foot inversion causing hip flexion-intrarotation and knee flexion, as protective mechanisms aimed at a reduction of foot inversion; (2) plantarflexor failure in patients with residual dorsiflexion range of motion or in patients wearing shoes with excessive heels (which caused knee and hip flexion); (3) plantarflexor contracture or equinus deformity compensated by hip flexion and pelvis antiversion; and (4) quadriceps muscle weakening with the consequent need to keep the trunk bent and to use 1 or 2 canes. > > These patients promptly recovered normal strength in the gluteus maximus after their distal joints had been stabilized by use of proper footwear or an orthotic device and after postural training to promote fully erect stance.5 This result indicates that gluteus maximus weakness did not result from the neuropathy itself; rather, it resulted from an inability to contract fully a muscle that participated in an unused pattern of movement and from resistance caused by hip flexors in contracture. > > Our experience suggests that classical strengthening exercises for the glutei muscles may not be helpful, particularly when the distal alterations causing abnormal posture in stance are not first corrected. > > doi:10.1053/apmr.2001.24085 > > References > 1. Lindeman E, Leffers P, Spaans F, Drukker J, Kerckhoffs M, Koke A. Strength training in patients with myotonic dystrophy and hereditary motor and sensitive neuropathy: a randomized clinical trial. Arch Phys Med Rehabil 1995;76:612-20. MEDLINE > > > 2. Lindeman E, Leffers P, Reulen J, Spaans F, Drukker J. Progressive resistance training in neuromuscular patients. Effects on force and surface EMG. J Electromyogr Kinesiol 1999;9:379-84. MEDLINE > > > 3. Lindeman E, Leffers P, Reulen J, Spaans F, Drukker J. Surface EMG of proximal leg muscles in neuromuscular patients and in healthy controls. Relations to force and fatigue. J Electromyogr Kinesiol 1999;9:299-307. MEDLINE > > > 4. Dyck PJ, Chance PF, Lebo RV, Carney JA. Hereditary motor and sensory neuropathies. In: Dyck PJ, JW, Low PA, Poduslo JF, editors. Peripheral neuropathy. 3rd ed. Philadelphia: WB Saunders; 1993. p 1094-136. > > 5. Vinci P, Perelli SL. Malattia di Charcot-Marie-Tooth: aspetti clinico-riabilitativi. Neurol News 1999;2:3-31. > > > > > Paolo Vinci, MD > Specialized Rehabilitation Hospital L. Spolverini > Ariccia (Rome), Italy > > -------------------------------------------------------------------------- ------ > > > > > Quote Link to comment Share on other sites More sharing options...
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