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The role and function of feedback
Published in Andrea Utley, Motor Control, Learning and Development, 2018
Petrofsky (2001) showed that EMG biofeedback was effective in reducing Trendelenburg gait, a disturbance of walking pattern which, during the stance phase of walking, causes the pelvis to tilt down on the opposite side and the limb struggles to clear the ground. It is very important to strengthen the muscles around the hip and in the leg (to prevent pathologies due to altered gait). However, as a therapist spends little time with a patient, they often walk incorrectly when the therapist is not present. Petrofsky (2001) studied two groups of patients with Trendelenburg gait due to incomplete spinal cord injury, receiving therapy (muscle strengthening and gait training) for two hours a day, five days a week in a clinic. Biofeedback was also accomplished for 30 minutes of the training on each patient using EMG. In addition, five patients wore an EMG biofeedback training device at home and thus received continuous biofeedback therapy every time they walked, and not biofeedback limited to only 30 minutes a day. The device provided warning tones giving feedback of improper gait through bilateral assessment of the use of the gluteus medius muscles. Patients undergoing clinical therapy showed about a 50% reduction in hip drop due to therapy. However, the group that used the home training device showed almost normal gait after the two-month period. A full review of biofeedback is provided by Stanton et al. (2011); see Further reading for the full reference.
The Gluteal Region and Posterior Thigh
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
The gluteus medius is an extremely important abductor of the hip, arising broadly from the ilium and inserting upon the greater trochanter. Equally important is the fact that the gluteus medius muscle of one side of the body acts to keep the contralateral side of the pelvis from sagging when the limb of the contralateral side is lifted from the ground. [In other words, the functional origin and insertion can be reversed.] Loss of the gluteus medius causes one to lurch to the injured side, producing a pronounced limp which cannot be disguised, the so-called Trendelenberg sign.
Cryoneurolysis: Principles and Practice
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Clinical Presentation: Neuralgia due to irritation of the SGN is commonly seen after a lifting injury involving the lower back and hip. After exiting the sciatic notch, the SGN passes caudal to the inferior border of the gluteus minimus and penetrates the gluteus medius. Vulnerable as it passes in the fascial plane between the gluteus medius and gluteus minimus musculature, the SGN is injured as a result of shearing between the gluteal musculature with forced external rotation of the leg, and with extension of the hip under mechanical load. Occasionally, this nerve is injured with forced extension of the hip, as might occur in a head-on automobile collision where the foot is pressed against the automobile floorboards with the knee in extension, as the patient anticipates impact. The clinical presentation consists of sharp pain in the lower back, dull pain in the buttock, and vague pain to the popliteal fossa and occasionally down to the foot. Patients generally experience pain with prolonged sitting, leaning forward, or twisting to the contralateral side. Often, patients will describe a “giving away” of the leg. Patients will sit with the weight on the contralateral buttock or cross their legs in such a manner as to minimize pressure on the involved side.61 Clinically, the presentation can be similar to SI pathology, but examination will show the SI tenderness medial to the posterior iliac crest while the SGN is lateral. Diagnostic blocks under fluoroscopy, with nerve stimulation, are critical for accurate diagnosis, as it is easy to confuse this nerve with a piriformis entrapment syndrome or the myofascial pain of the gluteus medius muscle itself.
Using an external focus of attention for gait retraining in runners: A case report
Published in Physiotherapy Theory and Practice, 2023
Sara Skammer, Justin Halvorson, James Becker
The initial examination revealed that all flexibility measures were within normative ranges and the only major difference between limbs was less hip internal rotation and more hip external rotation range of motion on the previously injured left leg (Table 1). The Thomas and Ely’s tests were both negative bilaterally, while Ober’s test was positive bilaterally. Muscle strength values were all within 1 standard deviation of the mean values from our laboratory’s database of 200 runners (Table 1). When evaluating the video of the participant running, it was noted that she displayed substantial hip adduction and medial heel whip during swing (Figure 2a). These were confirmed by biomechanical analysis, which showed abnormally high amounts of hip adduction during the stance phase and hip internal rotation during both the stance and swing phase (Table 2). These values are considered abnormally high and high based on both the laboratory database of runners and reports in the literature, which have targeted these measures in previous gait retraining studies (Noehren, Scholz, and Davis, 2011; Willy and Davis, 2013; Willy, Scholz, and Davis, 2012). Lastly, EMG analysis revealed a delayed onset of the gluteus medius muscle relative to heel strike, an issue that has been targeted for improvement in previous gait retraining studies (Willy and Davis, 2013).
Rehabilitation of a patient with bilateral rectus abdominis full thickness tear sustained in recreational strength training: a case report
Published in Physiotherapy Theory and Practice, 2022
Omer B. Gozubuyuk, Ceylan Koksal, Esin N. Tasdemir
The main goals of this phase were regaining muscle strength and endurance. The patient was able to tolerate quadruped exercises, and the duration was increased steadily. One leg-standing was pain-free and balance exercises were utilized. The intensity was adjusted gradually, beginning with stable and then to unstable platforms. The patient’s gait improved markedly (Video 2). The patient was sleeping without disturbance and his daily life activities improved along with significant improvement in his night pain (Table 3). However, he was still complaining of mild stiffness and episodes of pain in his right-hip region, similar to his symptoms during the initial weeks. We decided to add dry needling at this stage to alleviate increased muscle tension and soreness. The needles (50 mm and 30 mm) were inserted into tender nodules in the muscle identified upon flat palpation. These nodules were located in the middle and anterior portions of the gluteus medius muscle, the proximal region of the right-tensor fascia latae and the proximal portion of the vastus lateralis (Travell and Simons, 1983). An observable twitch response occurred among some, but not all of these points.
Therapists’ cues influence lower limb muscle activation and kinematics during gait training in subacute stroke
Published in Disability and Rehabilitation, 2018
Michelle Ploughman, Jennifer Shears, Susan Quinton, Cordell Flight, Michelle O’brien, Phillip MacCallum, Megan C. Kirkland, Jeannette M. Byrne
We found that a tactile facilitory input targeted over the gluteus maximus and gluteus medius muscles during the stance phase of gait did not affect activity of those muscles suggesting that in our sample at least, the NDT approach to facilitate muscles did not have its intended effects. In fact verbal cues (more than tactile) affected more distal muscles particularly medial gastrocnemius. Verbal cues increased activity of medial gastrocnemius during early swing (toe off to midswing) but without a concomitant increase in ankle plantarflexion suggesting that there was a block to effective propulsion. In fact, the ankle was at or near neutral for most of the gait cycle with or without cues (Figure 3(B, C)) suggesting that there may be excessive cocontraction around the ankle or ankle joint stiffness on the more-affected side. Lamontagne et al. have shown that medial gastrocnemius is specifically impaired on the most-affected side with reduced plantarflexion moment due to excessive coactivation [26,27]. The same group also showed that passive ankle stiffness, likely related to spasticity, limits dorsiflexion during stance and the following propulsive forces required for push-off [28]. Our results suggest that verbal cueing has the potential to at least activate plantarflexors but prolonged activation and muscle tightness are issues to be addressed.