Anterior Oblique subsystem (AOS)

The Anterior Oblique Subsystem (AOS) is comprised of:

External Obliques
Abdominal Fascia/Linea Alba
Contralateral Anterior Adductors
Internal Obliques
Rectus Abdominis

 

Function (Brief):

Stabilization of the anterior kinetic chain Which including the joints of the pubic symphysis, hip, and lumbar spine. It transfer force between lower and upper extremities.

 

Functional Arthrokinetic:

 

The Anterior Oblique Subsystem plays very important for stabilizing anterior kinetic chain. This subsystem has little effect on joint arthrokinematics .

The AOS is responsible for eccentric deceleration of rotation and extension of the lumbar and thoracic spine –  when there is asymmetrical movement pattern that may lead to facet joint and posterior disk compression and has been indicated in lumbar spine injury.

 

The AOS is also involved in eccentric deceleration of an anterior pelvic tilt, especially during standing and pushing motions. As an anterior pelvic tilt includes lumbar spine extension with little sacroiliac joint (SIJ) motion. If you find any change in pelvic rotation and SIJ dysfunction which may involve AOS involvement.

The AOS directly stabilizes the pubic symphysis. There is a most notable relationship in the AOS synergy relative to pubis symphysis joint is the fascial continuity.

 

It provides an optimal function to control of rotation with, superior/inferior glide, and other accessory motions at the pubic symphysis which associated with the normal pelvic torsion during gait.

 

What happen when AOS dysfunction occurs?

There is asymmetrical movement occur in the lumbar and thoracic spine, SI joint and pubic symphysis via rotation of the spine and/or innominate. This dysfunction may present as

 

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Core stability : Local as well as Global musculature

What is core ?

It is a muscular box with the abdominals in the front, paraspinals and gluteals in the rear, the diaphragm at the top,  and the pelvic floor and hip girdle musculature at the bottom. Within the “box” multiple muscles help to stabilize the
spine and pelvis as well as transmit forces through the kinetic chain.

Defination of core stability ?

The core through three subsystems, the passive subsystem, active subsystem, and the neural control subsystem. It was proposed that these subsystems were highly integrated and optimization of all three were necessary for normal biomechanics of the spine. If any one of these subsystems became impaired it could lead to instability of the spinal column predisposing an individual to injury, dysfunction, and pain.

Generally, core stability comprises the lumbopelvic-hip complex and is the capacity to maintain equilibrium of the vertebral column within its physiologic limits by reducing displacement from perturbations and maintaining structural integrity.

Objective of core strengthening:

Strength is defined as the maximum force that a muscle or muscle group can generate at a specific velocity. Power refers to the amount of force that can be generated in a given time period 10 repeatation maximum squat is a measure of absolute strength, where the force of a racket on a ball a  given velocity determines the amount of power that is Imparted to the ball.

The crucial question is how core strength relates to each of these situations.

 

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Plantar fasciitis : proximal instability

Plantar fasciitis (PF) is the most common foot condition treated by health care providers.This painful condition can cause impairment of activity and disability.Patients usually report pain after palpation of the proximal insertion of the plantar fascia and plantar medial heel, and the pain is most noticeable when patients begin walking after a period of inactivity.Clinicians have used many approaches for treating pain and enhancing function.

Weakness in the gluteus region causes instability to your trunk that leads to excessive motion . The gluteus medius and gluteus minimus muscles control the sagittal plane motion of the body.

An anterior pelvic tilt : tight back extensors, weak glutes and hamstrings, weak abdominals, and tight hip flexors all commonly caused by prolonged sitting which activate reciprocal inhibition .  This anterior pelvic tilt leads to your body weight being shifted forward causing higher stress on Achilles’ tendon and plantar fascia.

A muscular imbalance cause a shift of weight but it also causes a misalignment the kinetic chain. Weak glutes and tight hip flexors lead to an internal rotation of the femur, causes a valgus position of the knee, tibial internal rotation, and ultimately excessive pronation which may loads the plantar fascia.

So include gluteus assessment in your plantar fascia patient . It’s not always plantar fasciitis is due to hip problem , but 70% cases it affect. Proper clinical reasoning give you better idea.

 

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pic coutsey: Wikipedia.org

 

A sophisticated approach for plantar fasciitis

 

Plantar Fascia is a broad, dense band originating from anterior aspect of calcaneal tuberosity in form of 3 bands namely medial, central and lateral and inserting after dividing into 5 digital bands at metatarsophalangeal joints. It plays vital role in supporting the arch of foot and act as a shock absorber.

Plantar Fasciitis is an inflammation of the plantar fascia specifically at the insertion on calcaneal tuberosity.
• This commonly occurs due to overuse injury among those who stand for prolonged period of time or whose activities require maximal plantar flexion of ankle and simultaneous dorsiflexion of MTP joints and long distance runners.
• It even happens among individuals who have pes planus, tight tendo-achilles, weak foot muscles- tibialis posterior, poor shoe support and obesity or sudden weight gain. This typically can happen in absence of windlass mechanism.

 

Symptoms & signs:

• Swelling at the insertion site
• Temperature rise and redness
• Tenderness at calcaneal tuberosity
• Heel pain that is worse in the morning with     the first few steps and exacerbate with climbing stairs. At times it becomes difficult to rest the foot on the floor in the morning. With progression, pain may start interfering with activities of daily living.

Biomechanical alterations due to plantar fasciitis :

• Individuals with flat feet or pronated feet are more prone to develop plantar fasciitis.

• Chronic long standing cases of plantar fasciitis disturbs the windlass mechanism and so individuals with normal arch also start losing flexibility and shock absorbing capacity of foot and it results into collapsing of medial longitudinal arch. This ultimately causes flattening of arch and thereby disturbance in metatarsal break.

• Body being a kinematic chain, any alteration at one joint result into alterations/ compensations at other joints.

• Flattening of medial longitudinal arch causes pronation of the foot, which is combination of talocrural dorsiflexion, calcaneal eversion & forefoot abduction. Following this, to have body in one alignment, there results into talar adduction & plantar flexion, compensatory internal rotation of tibia & femur.

• These internal rotatory forces cause positional mal-tracking of patella which causes lateral gliding of patella. The ilio-tibial band, tensor fascia lata & lateral retinaculum gets tight. This results gradual development of patellofemoral dysfunction & thereby knee pain.

• Tight ilio-tibial band, internal rotation of femur causes imbalance of pelvis and causes pelvic-femoral and sacroiliac dysfunction which results into back pain. This may progress to change biomechanics till cervical region and even atlanto occipital joint.

• Thus in a nutshell foot pain can alter entire biomechanical chain- foot pain can result pain in knee, back and even neck.

How to approach ?

• Rest- till pain subsides in acute cases. Avoid prolonged walking, running and jumping.
• Before initiating weight bearing in morning, patient can be asked to move toes in warm water to lessen the pain.
• Cryotherapy can help reduce pain- 5-10minutes massage or ice pack application for 15-20 minutes; 3-4times daily.
• Needling , myofascial release and deep friction massage over the plantar fascia.
• Plantar Fascia stretching- can be done in different positions- patient/ therapist’s hold the heel of the affected foot with one hand and other hand’s fingers pulling the toes of affected foot into extension at MTP joint.

Proactive , plantar fasciitis treatment , massage

Woodstown massage:

• Stretching of the tendoachilles- gastrocnemius and soleus with the help of towel or theraband- ankle dorsiflexion with knee in extension for gastrocnemius and ankle dorsiflexion with knee in flexion for soleus. It should be gentle, slow, static & can be done in long sitting or standing- hold time 30-60 secs, 5 reps, 3 times/day.

• Tight fascia can be released by rolling the fascia over a tennis ball or bottle filled with cold water.

Ahmedabad India , treatment

Podantics podiatry

• Once the flexibility is gained and its painfree, strengthening exercises of calf and intrinsic foot muscles should be started, as this can prevent reoccurrence and can provide muscular support for weakened plantar fascia.

✓ Toe curling/ towel scrunching exercises: strengthens the intrinsic muscles of foot. Patient in sitting position with foot flat on the floor with towel placed underneath. Patient is asked to curl the toes to try to lift & pull the towel off the floor with the heel in contact with the floor throughout the exercise- done for 1-2minutes.

✓ Calf raises –unilateral & bilateral- 3 times/day for 20 rep in each session.

✓ Short foot exercises/ arch lifts- strengthen the muscles that support the medial longitudinal arch. The patient is asked to draw the metatarsal heads towards the calcaneus without flexing the toes or lifting the ball of great toe & foot, heel off the floor. Hold for 5 secs and relax- 1 minute. Initially done by sitting on chair with foot flat on floor and the gradually progressed in standing. It will require good amount of practice to master.

 

✓ Toe band exercises for toe muscles strengthening- elastic band is wrapped around all 5 toes. It should be fit yet comfortable. Instruction is given to move the toes apart pulling against the band- 3-5secs hold & relax-10-2-times.


✓ Toe squeezes for toe muscles strengthening- small sponges are placed between each toe. Instruction is given to squeeze the sponge with the toes- 3-5secs hold & relax-10-2-times.

✓ Mobilization can be given- talocrural posterior glide, subtalar lateral glide, anterior & posterior glide of 1st tarsometatarsal joint.

✓ Calcaneal taping may help in temporary reducing pain & function by distributing force away from stressed plantar fascia.

✓ Proper foot wear during daily activities and sports provides good support and prevents plantar fasciitis.

✓ Orthotic devices like Insoles can be used which acts as a soft cushion for heel-12-15mm higher than sole or well molded Achilles pad or heel cuffs or medial longitudinal arch support.

With proper care & physiotherapy, plantar fasciitis patients can become painfree and return to normal activities.

 

Next Friday post will be on how proximal joint dysfunction can cause plantar fasciitis

Stay tune!!!!

pic courtesy: Wikipedia.org

Proactivephysiotherapy, hamstring, assesment, lower limb

Hamstring strain due to Glute max late firing : Part 2

 

Read part 1 if you have missed…….

What can be the different diagnosis?

1 )Sciatic nerve entrapment
2)Gluteus trigger point
3) Trochetric bursitis
4) Piriformis syndrome

Here we have explained about trochentric bursitis between gluteal nerve affection relationships:

When a patient preset a complaint of pain while lying on one side , the therapist should suspect trochanteric bursitis. However , if the pain frequency is altered in the absence of hip movement, one should suspect superior gluteal nerve problems in SI joint dysfunction.

Inferior gluteal nerve pain is one of the most common incorrectly assessed in pain practices. When usually SI problems the inferior gluteal nerve refers pain into the gluteus maximus. The reason for this , gluteal nerve locates anterior side of sacrum . This irritation is commonly treated as piriformis syndrome. Beating on the piriformis, particularly the muscle belly, will cause even greater irritation of the inferior gluteal nerve.

Frequently, this type of arthrokinetic dysfunction is so intense that it excites alpha and gamma gain in surrounding muscles causing sympathetic spasm and involuntary tightness in all the hip extensors and abductors. The spasm deep into the SI and lumbar joint capsules . This is associate with hip and back muscles. Which become inflamed and are subjected to increased accumulations of waste products at the injured site.

Hence , The brain continues to cover the area with spasmodic tissue to protect sensitive nerve structures. This process only serves to further shorten the lumbopelvic connective tissues which often creating tissue micro-tearing and increased inflammation.

The brain attempts to prevent excessive movement by forming

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