A friend of the miner on a bike ride with me, and after about an hour, began to experience severe pain in my knee. After checking her lower limbs, I found that her knees were knocking. The clinical term for “knees” is Genu Valgum. The opposite would be the “swamp” or Gena Varum. Since Genu Varum is not usually associated with pain or problems, we will focus on my friend with Genu Valgum. However, both of these conditions are the result of a Q-angle.
The Q-angle is determined in the frontal plane, stretching the line from the anterior superior spine of the Ilium to the middle of the patella, and the second line from the middle of the patella to the tibial tubercle. The normal Q-angle for the quadriceps function is usually 10–14 degrees for men and 15–17 degrees for women.
Anyway, back to my friend ...
Evaluating the lower limb, you must “go out of the window,” say Ruben Salinas PT, OCS. Ruben is the clinical director of the Physical Therapy Clinic in Arcadia, California. “Don't just focus where the pain lies, looking at the whole picture. Remember that the lower limb is a closed circuit, especially in cycling. "
Usually associated with Genu Valgum, you can find pronation or flat legs, tight gastronemia, and in some cases vertex bursitis.
Let's look one at a time:
On the ankle, the body will try to compensate for the stress of the valgus in the knee (tensile forces on the medial side of the knee, compressive forces on the side) by pronation. In walking, you must dorsiflex on one ankle to swing with the other foot.
If your customers gastroc tight, they will not be able to doriflex, which will lead to a pedestrian. This will really affect the knee, and then the hip. To lengthen the gastrotok, ask your client to stretch. Be careful that their legs are not sung while they are stretching. If necessary, support the inside of your foot with a wooden block so that their foot does not penetrate.
For the back of the tibialis (which is an inverter and crosses the ankle), your client performs “wipers”. By strengthening the inverters (see diagram), you will force your foot to drop, which is the opposite of pronation.
Here's how:
Put light weight on the towel. When their feet are flat on the floor, the person slides a weighted towel inward towards the other leg. There are other ways to help get your foot out, but this is a completely different article.
My friend did not complain about her legs, although the pain was on the side or the outer part of her knee.
So let's look at the knee:
Due to the excess Q-angle on the side there will be more compressive forces and more tensile or distracting forces on the medial side of the knee. So how do you fix this?
“This is a big gray area in the world of physical therapy,” says Ruben Salinas. He is an expert on his knees. Lack of WMO or inability to fire has been proposed as the culprit of the patella - femur dysfunction. Experts still can not agree. Of course it's worth a try. To increase VMO activity, try ATVs in all directions, or have your client place a small ball or folded tug between their legs when doing leg extensions. Ask them to squeeze tightly or adduct to the top of the extension.
Another method proposed by Ruben is bio-feedback. Ask the client to put his hand on both Vastus lateralis and Vastus Medialis, and then they have a contract for the leg. Through their fingers, they should be able to feel which side is initially compressed. Try and ask them to “shoot” inside first (vastus medialis). It would be nice if you had some kind of superficial EMG, but hey, we are just coaches!
On the hips you often find weak external rotators. It is almost as if the head of the hip moved forward and inward. When this happens, the greater spit begins to fly apart against the bursa, which can eventually lead to bursitis.
The main ones here are the outer rotators of your thigh. Focus on gluteus maxims, not gluteus medius. Remember that the medium is an internal rotator. Do not forget about external external rotators. Performing external rotation with a cable or tube attached around the ankle, you strengthen pyriform, upper and lower hemllus, external obturator and internus, as well as the quadrupole thigh. This will help stabilize the hip joint so as not to destroy the bone from the bone.
Keep in mind that some customers may be disgusted. This is the angle of the femoral neck in the frontal plane. (see diagram). Anteversion will turn the finger inward, increase the mechanical advantage of the gluteal maxims as an external rotator, increase the Q-angle and cause greater pronation at the foot. Anteversion is structural, so you cannot repair it without a scalpel and chainsaw.
In conclusion, I hope you will see that in the case of the lower limb, you must take a holistic approach. Ask a lot of questions. How did they do it? Is the condition acute or chronic? Is it congenital? Is it structural or muscular? Examine their gait.
If you experience pain while performing these exercises, consult them and get a medical report.
I hope this helps you and your customers, and I sincerely hope that you will appreciate their position before you load someone with weight.
By the way, after a small RICE (rest, ice, compression, elevation), my friend was able to walk again. Now she only needs one of you to train her.
