I am usually a technophobe but I am trying to conquer this. I know what I like and I like what I know and it aint usually computer stuff!!!
I wanted to start off my new blog by talking about a client/patient I was referred this week by a lovely Osteopath Andrea. Andrea called me (we had never previously met or talked!!) and asked me to take a look at her patient Paul.
Paul had some right hip and knee pain. The hip pain like nearly all mystery pains decided that it wanted to move around to confuse the people trying to sort it. Paul definitely was a little thrown by my methods! I first wanted to look at Paul move. Instantly it became obvious that he was pronating when he should be supinating, when his right leg was the back leg. This set the alarm bells ringing and I wanted to check this out further.
I first had Paul just stand on weight-bearing and it was obvious that his right foot was much flatter than the left. He also had the classic pump bump (Haglunds deformity) on the rear of the right foot. I thought I would get him off weight-bearing and have a better look!!
Off weight-bearing I was able to check Paul's callous pattern. It was pretty obvious he was spending a lot of time on the medial side of the foot. He displayed large callouses under the 5th and 1st met heads. I went back to the rear foot and confirmed my suspicion he had a small rear foot varus. This was compounded by the smallish forefoot varus he also displayed. Individually small but together have a much more significant impact on flattening the foot.
During some gait tweaks Paul struggled on the right when we internally rotated the leg. I followed up with a balance reach that confirmed this. Right rotation was only 30-35 degrees versus almost 50 degrees on the left.
Hypothesis time. I think what was happening was as the foot supinates it should come onto the lateral side. Paul's foot was already structurally on the outside due to the pair of varuses and is inherantely unstable. This means it wants to get the medial side back to the ground for stability. Paul's foot was able to compensate through the STJ to do this, the STJ pronates instead of or late in supination. This was having a profound impact on Paul's knee. The tibia and femur want to rotate together, helping supinate the foot. Now the femur is rotating externally and the tibia is being pulled back in by the pronation of the foot. The patella is now stuck in the middle with no place to go and complains about it!!!!
The hip will sense this and close down motion. This is because it maybe sensing the opposite motions from both the proximal and distal ends. Together they create a much larger ROM than can be tolerated. The capsule playing a big part in this. The internal rotation on the back leg being a major victim.
Many of the muscles of the hip will be irritated if they cannot go through the IR they need. Hence the moving pain from the medial and lateral sides. This may also be an indication of a capsular pain pattern from the tight capsule.
I will follow up on this blog later in the week with some treatment strategies that I used. Thankfully both Paul and Andrea were happy with the resolution. You are always under pressure when being referred people.