In 2011, in our infancy here at The Gait Guys, we were at the airport. And we saw this . . . .
What do you see here in this young lady ? What you should see here matters. They are just visual things, and lead to visual hypotheses, but it is your job to prove or disprove them. If you like to play these kinds of mental gymnastic games, this is valuable work. This is the work that sets you up to move skillfully, quickly and confidently in the exam and treatment room.
Join us for a rewind, back to 2011.
A young lady with knee recurvatum. Even at the airport you are not safe from The Gait Guys !
Standing waiting for my parents luggage I had to do a double take when i saw this excessive genu recurvatum of the knees. Of course it was much worse in person because of the added dimension that a photo cannot give. This poor gal probably doesn’t even know she needs us.
What do we see here and what assumptions can we extrapolate (assumptions from mere standing of course) ?:
We are going to keep it to things from pelvis down or we will be here all day.
- Anterior pelvis tilt. She appears to be sitting back into her pelvis so to speak, doing so we can see an increased lumbar lordosis pressing the pelvis anterior. Combine this with suspect weak lower abdominals and the pelvis drops in the front. This position is often met with isometric contraction of the gluteals helping to maintain the forward/anterior shifted pelvis.
- The above, will create an abnormal (possibly increased) tensile load on the hamstrings since the ischeal tuberosities are being drawn cephalad (up). This can create a net posterior shift of the knee joint since she is in relative hip extennsion.
- The knees are likely locked into hyperextension. This will create meniscal tensions and certainly cause increased patellofemoral pressures. This can also create the rarely diagnosed, but often present, anteriormeniscofemoral impingement syndrome. In this type of presentation the anterior compressive forces are so great compared to what should be balanced forces around the entire joint that the superior leading edge of the anterior mensicus (can affect medial or lateral menisci) begins to become impinged and irritated as the femur rolls and translates too far anterior. You have to know it exists to make the diagnosis.
- She will be in relative ankle plantarflexion instead of balancing the tibia neutrally over the talus. Relative constant plantarflexion means shorter posterior compartment (gastroc-soleus) and usually weak anterior compartment (tibialis anterior and long extensors of toes). If she is a runner we bet shin splints were on her holiday list of things to resolve. This gal will likely have problems controlling pronation we suspect because of such assumed imbalances.
These are just the sagittal plane flaws we can assume. There are more but this is plenty to think about right now. I was going to walk behind to take a pic so we could make some assumptions about the frontal plane, but people all around were already getting suspicious of me snap photos of so many of them.
Remember, these are just assumptions from a single static photo. Like in video analysis, anything you pic up on film is just a compensation. It does not tell you what you have wrong until you can test them for neuromuscular integrity and motor pattern assessments. Do not hang your hat on photos or video analysis. Do the extra work that is required. After all, you know where ASSUMPTIONS get us.
Oh, and we must not forget to once again thank Mr. UGG boot for helping add another dimension of challenge to this lovely lady ! Although this assumption would be better made off of a frontal plane photo.
Beware of geeks in the airport and shopping malls snapping photos and video. It is likely us, The Gait Guys.
Shawn and Ivo