Ok, he has low back pain. But i can also see that high gear (1st toe off) is impaired from loss of terminal dorisflexion at that 1st MTP joint.
Ok , so this means heel rise will be premature and when it does happen the toe off will be towards the lesser toes, low gear toe off.
This means the knee will be carried laterally as opposed to the more desirable sagittal tracking/hinging.
And, if heel rise is premature, this means the knee will likely flex and hinge sagittally just a little, when it should actually be extending and coupling with the gastroc and glute to produce propulsion.
And, when the knee flexes, I know the hip flexes, when we should again be moving into hip extension for propulsion.
And when the knee and hip flex, the vertical length of the leg is shorter functionally, which means a subtle lateral pelvis dip and compensatory thoracolumbar lateral bend to the other side to compensate. This leads to imbalance in the lumbar spine musculature and more work in some areas, and less in others.
So, doc, are you telling me my low back pain is from my big toe? It could be Sir. Lets get into it and find out.
Game . . . .
One has to be able to quickly juggle normal known gait biomechanics with pathologic biomechanics. You don't have all day with your patient. Play these games in your head, often.
Example: So, if the knee doesn't terminally extend, what could this mean to the rest of the system ?
Stop treating the area of pain, is might not be the problem.
Shawn Allen, one of the gait guys.
#gait, #thegaitguys, #gaitproblems, #gaitcompensations, #halluxlimitus, #turftoe, #hipextension, #prematureheelrise