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27
Feb

Blocking

Sometimes the muscle you want to contract isn’t the one that contracts when you try to perform a movement.  This goes for both orthopedic stuff and neurologic stuff.  Way the hell more with neurologic stuff though.  I’m working with someone right now and one of my goals is to get her quadriceps muscle stronger.  The thigh muscle.  An exercise that I ask this person to do, I kind of made it up so it doesn’t really have a name, is to – seated – start with the leg bent and try to straighten it as much as possible.  She is only able to straighten her leg about 15-20 degrees forward.  So the leg is kicked forward from about 100 degrees of flexion to like 80 degrees of flexion.  It’s this exercise but the leg is not straightened…….

Hip-Knee -Sitting- Long Arc Quads

Anyway, when she attempts this movement, she recruits her hip flexor muscle and her knee raises up slightly.  In order to work the quadriceps muscle, sometimes I have to hold down her knee down and block it from raising up so that the quad is working more, not the hip flexor.  I allow the incorrect movement some though.  In a few weeks of performing this movement, the incorrect movement has significantly decreased, a sign that the correct muscle, the quad, is gaining strength and control.  I wonder how NDT therapists would deal with an issue like this.  In NDT therapy, the goal is to inhibit all the bad, incorrect movements.  That is so very strange to me.

 

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20
Feb

Control

Hi everyone.  🙂  Long time no talk.  My plan was to take a break from blogging for a month or 2 as I build back up a semi-normal life but Dean f’ed up my plan by e-mailing me and asking me a question that I kinda thought was brilliant so I had to write a post about it.  I asked Dean for his permission to share this so HIPPA police stay away from me.  He asked about a foot issue that he is having, that it’s landing wrong during the gait cycle.  Then he asked for exercises that would further increase the offending motion and in my orthopedic PT brain I thought “uhh why would he want to do that?”  He told me that “I want to work on both inward and outward motion because I think doing both will cause neuroplasticity to take place faster.”

Brilliant!

Yes, I totally agree.  Oh man.  So Dean’s issue is that when he walks his foots lands wrong and turns outward.  For an orthopedic issue – well let’s just get the opposite muscle really strong and fix the motion.  For a neuro issue, can’t think like that.  It makes so much sense what Dean proposed – to work on the motion that’s bad and causing the issue and gain more control over it.  Gain more control, and then….well you’ll be able to control it better and in turn hopefully decrease the problem.  So, the motion that’s causing him the issue is that due to his spasticity, his left foot hits the ground in a position of eversion.  It doesn’t land straight forward like a good foot should.

inversion-of-the-ankle-4

So he asked me for exercises that would further force it to turn outward, and I was thinking, “whaaaaa?”  And then a few seconds later I thought it was genius of him to come up with that.