Meet me where I am

[BB]

Hello,

I liked Servaas' outlook on "meet them where they are"

I thought about this and "where I am"

I think solidifying ideas through examples helps a lot and probably others too. (Clinical Reasoning is a great expansion! Good job Emad and Bernard!)

My father in-law has been having anterior knee pain when we hike...especially with the downhill.

He does not have any excessive rotational movement during his gait. Foot placement is pretty good.

His hamstring remains very contracted throughout stance and swing phase. I think that his quadricep does not have good eccentric control (does not lengthen smoothly) because of the contracting hamstring. This puts excessive force through the patella....

I gave him some things to think about while hiking which have helped (he is able to complete the hikes, but gets sore later that night now) as have taping.

What thoughts do you have in facilitating the smooth lengthening, and making it the 1st person experience?

Servaas: When is your next retreat so that more of us can meet you where you are?

Cory

[emad]

Hi cory :

Is thus the right /eft lower limb?

but i think it is thr right .

cheers
emad

[Green Hornet]

Cory,
I would check where he is in:
1) Ability to breathe diaphragmatically and to expand the abdomen
2) Ability to curl and arch in the entire spine
3) Ability to fold/elongate the waist laterally
4) Ability to organically twist the neck and trunk
5) Ability to move the scapula in 3 dimentions

Any limitation in the above and lack of organic pattern will be facilitated by pandiculation. That would be my start for him, then I will go peripherally. Don't forget to check the opposite side.

Without restoring natural movement patterns in the core (core intelligence), his hamstrings and quads won't fire and relax when they need to.

[emad]

Hi takao:

Really, a good idea to assess the effect of the central on the perpherial.

But do u think if the scapula movements is affected , thus will affect the gait .

cheers
emad

[Green Hornet]

Emad,
Yes. Scapulae are important in 4 dignities of mankind: lying, sitting, standing, and walking. And it is not just scapulae that are important.

Another check points are the regions controlled by cranial nerves and subcranial (C1-4) nerves. The nerves are very dominant in motor function and stress responses.

[emad]

Hi Takao:

Yes , you are right all affect each other, yes all affect the gait .

But the case we are already discuss is ( may be ) soft tissue injury of the quadriceps muscle , so if the patient for example has limitation in the scapulae/cervical motions , thus will affect gait /limping ?


Oh , also the patient may have some pathological patterns of movement , but do u think those movement patterns may extend to include trunk and cervical , beside upper limbs.

cheers
emad

[BB]

Hi Emad and Takao,

It is his left knee Emad. I'm curious why you thought it would be his right?

This will have to be a theoretical example now because my father in law left for alaska this week.

Takoa
How do you move on linking the scapula to the leg during gait? I would also say that in cases where there is significant tension, pain, and fear of movement I have began with work in the upper body and worked my way down. But, he does not have fear of movement, does not have full body tension in the manner that I was speaking about before. Also, I didn't see a gait pattern suggesting lat over recruitment during trunk and arm motions. But he way over recruits his hamstring. It is the "stand out" finding.

Cory

[emad]

Hi Cory :

Sorry yes , it must be the left , i reviewed what you have written in your first post , you said he has pain in walking hilldown ( this like down-stairs ).

Because the Quadriceps is contracting in the righr LL during climbing stairs ( like hill climbing ) , but is contracting eccentrically in the left LL during down-stairs .

So , as physiotherapists he might has quadriecps strain ( any injury ) ?OA changes .

Please teast resisted contraction of that quadriceps .

Yes , Cory Takao is right
IF we treat as somatic stretchs as we deal her on our forums , it is good to perform stretchs with full attention/awarness/feel/.

The patients needs education about how to deal with his knee, avoid vigrous exercises,to move smoothly , simply.....so o n.

cheers
emad

[Servaas]

Hi Cory,

Sounds like you are on the right track !

Your dad's knee is not able to absorb the forces appropriately. What that tells me is that his main 'shockabsorbers' (the muscles in his waist) are not doing the job right and sabotage the ability to have circular movements in the pelvis and shoulder areas during gait.

Takao's recipe is excellent, with an emphasis on the 3rd point: free ability to contract & release the lateral side of the body (on both sides!!)

This will instantly help his knee extension to become easier with less effort and less friction of the patella.

The following link will show you some photoos of a hands-on pandiculation to improve the function in the waist that might help you:
http://www.somatichealthcenter.com/html/testimony.html


Next workshop:
Not planned yet. We are being comsumed every minute of the day with the construction of our new office.

Cory, where are you located ?

I hope that helps! Feel free to ask

Servaas Mes
www.somatichealthcenter.com

[BB]

Hello Emad and Servaas,
Emad- His quad strength in the standard position is strong. But I think that eccentrically it is not, which makes me think probably not a quadricep injury but probably more pain correlated. Since his hamstring does not release smoothly the quad doesn't pull the patella up sufficiently. Result is pain and probably some muscle shut down. I agree with you that he probably does have arthritis because he has probably been moving this way for quite awhile. However, my personal belief is that arthritis mostly causes problems when it happens along with the problem motion. If movement is improved then jt. stress on the arthritis should decrease.

Servaas,
thanks for the info and the link. I cannot try this on my father in law because he is headed to alaska. I am in Vancouver, Washington (The other Vancouver!). Maybe he should swing by Diane's on the way through! I do have a patient that I will try this on tomorrow. He has the same issues, only more severe.

Thanks!
Cory

[Green Hornet]

Cory,
Careful to identify somatic or sensory motor amnesia (SMA), even if he does not have a fear to move. Often times, I need to tweak to identify SMA. In a normal functional movement, it could be tough (could be not) to identify SMA. Use open chain motion with controlled number of freedom of motions. Too bad for you to have him take off to Alaska.

I don't think that his hamstrings are hyper in isolation. Hyper always results from reacting to something else and you got to find a pattern. Until you identify that something else, he may keep suffering from the knee pain and tight hams.

[BB]

Hi Takao,
I agree!
Cory

[Green Hornet]

Servaas,
I think that Cory will benefit from improving core intelligence himself because of his big belly from beer drinking and chocolate abuse.

[BB]

I told you all that Takoa was the one to watch out for!

Well green hornet, it appears that for exposing my identity (takao's nickname for me is big belly-BB) I will have to give you a tai chi beating. It will be very slow strikes, but effective. You are lucky my friend that I have eaten so much chocolate in my life. The love-mimicking response of the chocolate I think has been triggered enough times to make me a pacifist. Otherwise, you may have gotten a sneak tai chi attack earlier!

Cory