Guest guest Posted March 1, 2004 Report Share Posted March 1, 2004 I am not a PT, so I am not familiar with your bible, and I would not try to offer a diagnosis or prescription to the patient... especially not in this context. Your case study continues to convolute comparative analysis to normative models with simple observation of the actual problem that I was arguing against. In fact, you didn't get to the actual performance problem until the last few words. It doesn't seem like any of your analyses have anything to do with, say, watching the person actually run. From my perspective, virtually all of your basic assumptions and overall mode of operation is upside down and backwards, so I would not follow the trail you have set up to reach that conclusion. Even if I arrived at a conclusion that the person had leg and midsection weaknesses, it's likely that I would not go along with the prescription of isolation exercises, but rather favor complex, compound and full body movements trained at the level of the weak link, and coaching/retraining of the skills involved in the problematic activity itself... the body knows of movements not muscles. Strengthening isolated muscles via exercises that are functionally irrelevant to the target activity is unlikely to have any effect at all. Wilbanks ville, FL > , > > Thanks for your response. I truly value your critique and > input. > > Here is one model I am working with. See if you can assist. A > forty year old runner with plantars neuromas (recently aquired), long > weak hamstrings. Long, according to Kendalls Muscles, Testing and > Function text. I know you are familiar with this P.T.'s bible. Weak, > according to strength test done in as much isolation as can be done > without E.M.G. equipment. Increased anterior pelvic tilt and very > weak lower abs as is shown in simple lower ab isolation tests. Tight > hip flexors as is shown in her inability to roll pelvis posteriorly > without compensatory moves. Her entire body is almost always in a > near metatarsal reflex state and as result her gait has shortened > and she can no longer run as long without tiring much sooner than > usual. > > Given this information can she or can she not benefit from > lower ab isolation movements and hamstring isolation? > > Respectfully > Kanady > Houston Texas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2004 Report Share Posted March 5, 2004 From what you have given I would say you can't start the Lower ab ex. soon enough. There seems to be some missing info to make a good determination about the Hamstrings though. What is her glute and quad strength? If her glutes are not strong the lower abs will also tire quickly and she will fall right back into that anterior tilt. Also with proper glute strengthening you might not even need to lengthen the Hip flexors, as the glutes might do that for you. Jerimiah Childress Tulsa, OK > , > > Thanks for your response. I truly value your critique and > input. > > Here is one model I am working with. See if you can assist. A > forty year old runner with plantars neuromas (recently aquired), long > weak hamstrings. Long, according to Kendalls Muscles, Testing and > Function text. I know you are familiar with this P.T.'s bible. Weak, > according to strength test done in as much isolation as can be done > without E.M.G. equipment. Increased anterior pelvic tilt and very > weak lower abs as is shown in simple lower ab isolation tests. Tight > hip flexors as is shown in her inability to roll pelvis posteriorly > without compensatory moves. Her entire body is almost always in a > near metatarsal reflex state and as result her gait has shortened > and she can no longer run as long without tiring much sooner than > usual. > > Given this information can she or can she not benefit from > lower ab isolation movements and hamstring isolation? > > Respectfully > Kanady > Houston Texas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 5, 2004 Report Share Posted March 5, 2004 From what you have given I would say you can't start the Lower ab ex. soon enough. There seems to be some missing info to make a good determination about the Hamstrings though. What is her glute and quad strength? If her glutes are not strong the lower abs will also tire quickly and she will fall right back into that anterior tilt. Also with proper glute strengthening you might not even need to lengthen the Hip flexors, as the glutes might do that for you. Jerimiah Childress Tulsa, OK > , > > Thanks for your response. I truly value your critique and > input. > > Here is one model I am working with. See if you can assist. A > forty year old runner with plantars neuromas (recently aquired), long > weak hamstrings. Long, according to Kendalls Muscles, Testing and > Function text. I know you are familiar with this P.T.'s bible. Weak, > according to strength test done in as much isolation as can be done > without E.M.G. equipment. Increased anterior pelvic tilt and very > weak lower abs as is shown in simple lower ab isolation tests. Tight > hip flexors as is shown in her inability to roll pelvis posteriorly > without compensatory moves. Her entire body is almost always in a > near metatarsal reflex state and as result her gait has shortened > and she can no longer run as long without tiring much sooner than > usual. > > Given this information can she or can she not benefit from > lower ab isolation movements and hamstring isolation? > > Respectfully > Kanady > Houston Texas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 14, 2004 Report Share Posted March 14, 2004 and , Here are the issues as I see them: , when you say she has " weak " hamstrings, what exactly do you mean? Weak neuroproprioceptively, or unable to maintain position during a " break " test? Was the weakness bilateral, if so, the problem could potentially be a spinal issue, or that you are simply testing too hard (as an aside, we now have much more specific manual tests for most muscles that are slightly different from Kendall's tests and EMG's are pretty poor at testing for strength or weakness). Just because she can't perform a posterior pelvic tilt does not mean her hip flexors are tight and lower abs are weak. There are too many other muscle imbalances and structures to consider. Depending on how the isolation movements are done, they might be a good option. Isometrics would most likely be the route that I would take if the weaknesses are neuroproprioceptive, because that is one of the best ways to stimulate the Gamma motor neuron to help regulate spindle tension to enable a muscle to perform optimally again. , I don't know that full body movements are the way to go. You are correct in saying that " the body knows movements not muscles " , but the part you are missing is that muscles create movement. If any muscle isn't doing its job properly, the whole movement will be disrupted. Practicing a movement may get you better at that movement, but if you don't do specific muscle testing to determine which part of the chain is malfunctioning, you will never know if you just got better at compensation, or if you corrected the problem. Most rehab " experts " agree that " functional exercise " rarely corrects problems, just masks them temporarily through compensation, and then other problems show up later as a result of the compensation. Also, everyone in our industry, no matter who you are, should be familiar with Kendall's book Muscles Testing and Function, I wouldn't consider it a bible, but definitely a great reference, kind of like Netter's Anatomy. ph DeAntonis Pittsburgh, PA > > , > > > > Thanks for your response. I truly value your critique and > > input. > > > > Here is one model I am working with. See if you can assist. A > > forty year old runner with plantars neuromas (recently aquired), > long > > weak hamstrings. Long, according to Kendalls Muscles, Testing and > > Function text. I know you are familiar with this P.T.'s bible. > Weak, > > according to strength test done in as much isolation as can be > done > > without E.M.G. equipment. Increased anterior pelvic tilt and very > > weak lower abs as is shown in simple lower ab isolation tests. > Tight > > hip flexors as is shown in her inability to roll pelvis > posteriorly > > without compensatory moves. Her entire body is almost always in a > > near metatarsal reflex state and as result her gait has shortened > > and she can no longer run as long without tiring much sooner than > > usual. > > > > Given this information can she or can she not benefit from > > lower ab isolation movements and hamstring isolation? > > > > Respectfully > > Kanady > > Houston Texas Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.