Influence of Sacrum during gait cycle….

Walking is influenced by the ability of the sacrum to torsion left on the left axis and right on the right axis.

Sacral torsional movement is considered to occur around an oblique axis.  the left oblique axis runs from the upper extremity of the left sacroiliac joint to the lower end of the right sacroiliac joint, and the right oblique axis runs from the upper end of the right sacroiliac joint to the lower extremity of the left sacroiliac joint.

Clinical observation of the normal walking cycle demonstrates that sacral side-bending and rotation couple to opposite sides.  This is also known as ‘Type 1 motion’.

‘Type 2 motion’ is coupling to the same side.

left torsion on the left oblique axis, the sacrum rotates left and side-bends right, with the right sacral base moving into anterior nutation.

right torsion on the right oblique axis, the sacrum rotates right and side-bends left, with the left sacral base moving into anterior nutation.

Because the nutational component of this normal walking movement is anterior in direction, left torsion on the left oblique axis  and right torsion on the right oblique axis are described as anterior torsional movements.

The exact biomechanics of the torsional movements of the sacrum are still unknown,  The nutational movement in normal walking is anterior on one sidereturn to neutral, and vice versa.

How sacrum moves during gait cycle?

Right heel strike, the right innominate has rotated in a posterior direction and the left innominate has rotated in an anterior direction. The anterior surface of the sacrum is rotated to the

 

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Understanding Sacroiliac dysfunction or iliosacral dysfunction????

Sacroiliac joint dysfunction (SIJD) is a common cause of LBP occurring in 16–30% of patients with LBP. The sacroiliac joint is a diarthrodial synovial joint comprising an anterior segment, which is a true synovial joint, and the posterior segment, a syndesmosis comprising the gluteus minimus and medius muscle, piriformis muscle, and sacroiliac ligament. As all these muscles are shared with the hip joint, the sacroiliac joint (SIJ) cannot function independently. Furthermore, the ligamentous structures and the muscles influence the stability of the SIJ. The nerve supply for SIJ is mainly by the sacral rami dorsal.

The sacroiliac (SI) joint is formed by the articulation of the pelvis and the sacrum.  Dysfunction of this joint can result from how the pelvis impacts on the sacrum or how the sacrum impacts on the pelvis.  If the pelvis (ilium) is responsible for a fixated (immobile/stuck) SI joint, then it is called ‘iliosacral dysfunction’.  If the sacrum is responsible, it is called ‘sacroiliac dysfunction’.

Recent interest in rehabilitation involving the SI joint may be attributed in large part to the fact that approximately 20-30% of low back pain and referred pain comes from the SI joint itself and/or the surrounding ligaments, muscles and other soft tissues involved in the functioning of the joint  (Maigne et al, 1996, Schwarzer et al, 1995).

The concern in sports medicine relates primarily to the problems caused by the biomechanical changes inherent to the malalignment: specific sports injuries, impaired recovery from injury, and a failure of athletes to realize their full potential (Schamberger, 2002).

Sacral Motion and Dysfunction

When you forward bend, your sacral base moves in a posterior and slightly superior direction.  When you bend backward, your sacral base moves in the opposite direction, anteriorly and inferiorly.  The anterior and posterior movement of the sacral base is called nutation and counternutation, but many practitioners use the terms anterior nutation and posterior nutation.  “Nutation” means “nodding.”

Sacrum are also capable of side-bending and rotating.  If there are no joint fixations, then this is what your sacrum does in walking (or running) as you shift your weight from one leg to the other.  Most experts agree that the sacrum only exhibits ‘Type 1’ motion, meaning that side-bending and rotation are coupled to opposite sides (right rotated and left sidebent is known as ‘right torsioned’, left rotated and right sidebent are known as ‘left torsioned’).

The combination of side bending and rotation is also known as ‘torsion.’ When the sacral base is ‘right rotated’ the right sacral base is posterior in relation the left sacral base, and vice versa.  If during an evaluation, you find that the sacral base is rotated (on either side) when you are in the neutral position (standing on two feet), then it is probably dysfunctional.

For instance, if an SI joint evaluation reveals that (in a neutral position) the sacral base is fixated on the right side, then you must determine whether the right sacral base is fixated in anterior or posterior nutation.  Making the correct diagnosis is essential because you must treat the fix side to correct the dysfunction.  Treating the non-fix side will be meaningless.

Why is this important to know?

In cases of pelvic dysfunction, the side that hurts is often the side of the symptom (pain), but not the side that is fixed.  Most practitioners will try to treat the symptomatic side instead of the fixed side. There is a high probability that they will not be the same, and as stated previously, this work will be relatively meaningless.

Hip (Ilium) Motion and Malalignment

When we walk or run our hips rotate reciprocally in all three planes of motion.  These are the ‘sagittal plane’, the ‘coronal’ plane, and the ‘transverse’ plane.  In the sagittal plane, a type of hip rotation (malalignment) occurs as anterior or posterior rotation.  In the coronal plane, a type of hip rotation occurs as upslip or downslip (this is also known as superior or inferior shear, respectively).  In the transverse plane, a type of hip rotation occurs as inflare or outflare (this is also known as medial or lateral rotation, respectively).

If you discover an iliosacral fixation, at first you will only know the side of the fixation.  You must then determine the type of malignment involvement wheather it is anterior/posterior rotation, inflare/outflare, upslip/downslip.  Occasionally, an individual will present with a single malalignment.  Typically, an individual presents with a combination of two malalignments. A triple combination is possible, but relatively rare.

Remember again, you must treat the fixed side.even if the contralateral side is the symptomatic side.  In the case of a single-type of malalignment, just go ahead and treat according to the appropriate technique.  In the case of a combination of malalignment types, you must treat with the appropriate techniques(s), but also in the correct sequence.  The correct sequence is critical because if your sequence is wrong, your work will be ineffective.

After you release the fixed side, you can treat the symptomatic side (especially if they are not the same side) to speed up the healing process on that side.  This healing process will probably happen on its own but may happen faster with treatment.  Again, the sequence is the key.

EVALUATION AND CORRECTION :

The passive straight leg raising test is most helpful in the evaluation of pain in the low back. Pain down the leg on passive straight leg raising, which is exacerbated by dorsiflexion of the foot, is indicative of sciatic nerve pain. Despite a study to the contrary by Danforth and Wil~on,’~ several researchers have found a relationship between sciatic nerve pain and pain in the sacroiliac joint.When the leg is raised, the pull of the hamstrings on the innominate bone causes a posterior torsion strain on the same side.

If this does not increase the pain in the back or if it eases the pain in the back, anterior dysfunction should be suspected. If passive straight leg raising causes pain or increases the pain on the same side, suspect a posterior or vertical complication.

Rationale:

The use of ‘direct’ techniques in treatment, the more effective the results will be.  The use of indirect techniques, however, usually indicates less than a full grasp of the biomechanical descriptions and how to more precisely locate and treat the joint fixation.

Knowing what you are releasing in a client’s body adds to your clarity of purpose and makes you a more effective therapist. The techniques you apply will be more effective than if you don’t know precisely what you are releasing.

 Knowing and naming what you are working on is an essential part of effective therapy.

Reference :

  1. Maitland, J.  Spinal Manipulation… 2001.  North Atlantic Books, Berkley, California.
  2. Schamberger, W. The Malalignment Syndrome, Implications for Medicine and Sport.  2002.  Elsevier Science Limited.
  3. Maigne J-Y, Aivalikis A, Pfefer S.  Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain.  Spine 1996; 21: 1889-1892.
  4. Schwarzer AC, Aprill CN, Boduk N.  The sacroiliac in chronic low back pain.  Spine 1995; 20:31-37.
  5.  Bernard TN, Jr, Kirkaldy-Willis WH: Recognizing specific characteristics of nonspecific low back painClin Orthop Relat Res, 1987, (217): 266–280.
  6. Erhard R, Bowling R: The recognition and management of the pelvic component of low back and sciatic painJ Am Phys Ther Assoc, 1977, 2: 4–15.
  7. Image coutsey :wikipedia

Warning bells for gluteus inhibition

 

 

What does inhibited mean?

The neural input to a muscle is lowered .The muscle still works but it’s not as efficient to generate power.  To generate power during movement. Therefore it appears weak!! The body finds balance to complete movement task but unfortunately it finds another way for muscle in the movement pattern to do more. Therefore movers become stabilizer for the joint.

What’s the role of the glutes: They are the powerhouse of the lower limb.

The glutes action…

• Extend the hip
• Laterally rotate the hip
• Abduct the hip
• Adduct the hip
• Posterior tilt the pelvis
• Hips are designed for thrusting

1) Hip mobility :

When hip mobility is decrease think of glutes. . If the glutes are inhibited you aren’t stable. There will be difficulty in doing squat in many cases after surgery of lower limb if flutes are inhibited.

2) You find Low back pain without any     reason :

When you lose hip mobility your lumbar spine takes role of mobility,hence there may be more movement from the lower back. Lose movement in one place and you move more in another. To help your lower back from crying  activate your glutes.

3) Knee pain. :

The knee movement depend on what the foot say and the hip can control. To remember , traumatic knee injuries will inhibit the glutes. So always start Gluteus rehabilitation as part of knee injury

4) chronic ankle sprains. :

Poor hip control leads to vulnerability in proprioception and gait. When you find loss of ankle rocker during gait cycle , there is always restriction of hip extension. The main function of glutes  is hip extension. Unlock your ankle by improving ankle rocker .Problem solve and you wins.

5) Plantar fasciitis.:

oh it’s very common condition we face in our daily clinical practice. We have already discussed in our previous blog click on plantar fasciitis due proximal joint instability  Any problem in the feet check your glutes.

6) Shoulder decreased motion or pain. :

This is very tricky for you to think . You have question how it possible . See, The glutes connect to shoulder via the Posterior Oblique Sling. When glutes are inhibited the fascia becomes tight and shoulder range of motion is restricted. If you can’t generate force from the ground up . Many times and  lattismus dorsi is also inhibited. Hence forward when you see a patient of shoulder pain check his posterior oblique sling.

7) Tight psoas muscle :

The psoas is a functional opposite of the glutes. The psoas flexes the hip and glutes extend it. The psoas anterior tilts your pelvis and the glutes posterior tilt it. If the glutes are inhibited the lumbar spine becomes more unstable and the psoas turns into overactive to stabilize the lower back. When you find anterior pelvic tilt  think for the Gluteus.

8) Groin or hamstring pulls:

The hamstrings take over the primary work of the glutes to extend the hip. That extra work causes strain. The most common groin muscles to pull and get injured are (pectineus, adductor longus/brevis). They act as hip flexors, antagonist to the glutes. They are hip adductors, synergistic to the glutes.

 

Finally , activate them and wins the situation.

 

Thank you you for reading notes .any dought raise questions.

Selective exercise for cycling : What evidence say

It ’s ability of the trunk, lower back, pelvis, and hip region to generate effective and efficient generate power when external load act on it.

The ideal cycling position is one of a comfortable flexion with the pelvis supported by the saddle and arms supported by the handlebars. Moreover, cycling is non-weight bearing sports. Don’t think too much? how  “core stability” is important in cycling? Here we explain how it’s important.

During the pedal, stoke movement occurs in 3 planes; flexion-extension, lateral flexion, and rotation.

What does the evidence say?

Cyclists reporting lower back pain have been found to have an increase in lumbo-pelvic flexion and rotation (Burnett et al 2008). An inability to control the movement and position of the pelvis, especially excessive lumbar flexion, may cause undue strain on the lower back and pelvis which turns into pain and pathology (Burnett et al 2008).

It is very interesting that the cyclists with lower back pain had greater flexion in all cycling positions and their posture does not change from start to finish. Cyclist started in more a flexed position and stayed.Here the author gives a suggestion that the cause of back pain was due to positioning error rather than fatigue in the ‘core’ (Van Hoof et al (2012).

In 2007 study by Abt JP1Smoliga JM,  investigated the link between “core stability” and cycling. 15 highly trained cyclists were cycled to exhaustion before and after a core-fatiguing workout. The motion of both the knee and ankle increased following the core fatiguing workout. Unfortunately, Total frontal plane knee motion , sagittal plane knee motion , and sagittal plane ankle motion  increased after the core fatigue protocol. Only knee and ankle motion were measured so it difficult to know in the reduction of control movement in the lower limb. In addition to that whether it was due to reduced control and stability in the proximal joint. However, it does suggest that reduced control of lower limb movement was due to poor proximal stability and force transfer from the truck and pelvic region.

From the referances, we conclude the below exercise that is essential for cyclist.

Unlock Core”

The list of ‘core’ exercises is endless. We would recommend choosing few exercises that challenge trunk-pelvic-hip control and stability through different ranges.

Proactive physiotherapyProactive physiotherapyProactive physiotheray,Ahmedabad

Improvements in ‘core stability’ could promote greater trunk stability leading to improved force transmission to the pedals which helps in the maintenance of core stability. Improved core stability and endurance could promote greater alignment of the lower extremity when riding for extended durations as the core is more resistant to fatigue.

 

Referances :

 

  1. Comparing lower lumbar kinematics in cyclists with low back pain (flexion pattern) versus asymptomatic controls – field study using a wireless posture monitoring system . Wannes Van Hoof a,*, Koen Volkaerts a Manual Therapy 17 (2012)
  2. Lower lumbar spine axial rotation is reduced in end range sagittal posture as compare to neutral spine posture. Burnett A1, O’Sullivan P, Ankarberg L, Gooding M, Nelis R, Offermann F, Persson J.Man Ther. 2008 Aug;13(4):
  3. Relationship between cycling mechanics and core stability. J Strength Cond Res. 2007 Nov;21(4):
Posterio oblique subsytem, AHmedbad, Lattismus dorsi

Posterior Oblique Subsystem (POS)

Before reading this article click on introduction to core subsystem 

 

Structures are involved :

  • Latissimus dorsi,
  • Thoracolumbar fascia,
  • Gluteus maximus
  • Superior portion or gluteus medius.

 

Function (Brief):

IT stabilize the posterior kinetic chain Which including lumbar spine and sacroiliac joint. It transfers the force between us upper extremity and lower extremities eventually, integrated pulling movement of a body.

  • Eccentric deceleration of total body
  • Transference of force between lower and upper extremities
  • Maintaining alignment of the lumbosacral joints
  • Maintaining femoral alignment during legs with pull

 

Functional Arthrokinematics:

This subsystem is an important stabilizer of the posterior kinetic chain.  The fiber arrangement in such a way i.e subsystem indicate a special role in sacroiliac joint (SIJ) arthrokinematics, and lumbo-sacral function.

The fibers of each side run perpendicular which crossing from the gluteus maximus and associated it’s respective fascia which  traversing the SIJ, through the nearly continuous thoracolumbar fascia, across the lumbar spine, to the latissimus dorsi and associated fascia on the opposite side.

During the swing phase of gait cycle, the eccentric control of leg and contralateral arm pulls the thoracolumbar fascia tight.  Concurrently, the contralateral Posterior oblique subsystem concentrically contracts throughout the gait cycle , which in turn pulls the contralateral side of the thoracolumbar fascia.

Optimal function of POS is to stabilize posture.

 

Motor Behavior:

The POS could be underactive termed in upper body dysfunction, Lumbo Pelvic hip complex dysfunction, sacroiliac joint dysfunction , and lower leg dysfunction. Commonly, the under-activity of the POS is paired with a synergistic dominance of the deep longitudinal subsystem (DLS – publish soon).

 

How to find  POS underactive?

AOS may be dominance seen in upper body dysfunction and who present lower leg dysfunction that results in excessive forward lean during the overhead squat assessment. It indicates POS is

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