couch gait

[spandanphysio]

hello friends what else other than hams. spasticitiy can cause couch gait.can femoral intorsion cause it?

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[estherderu]

dear Spandanphysio,

According to Crenna 1998 & Perry 1992 & Gage 1991 quoted in Motor Control 3rd edition authors: Anne Shumway & Marjorie Woollacott, " it was originally thought that hamstrings overactivity was the result of spasticity. Research has found that after selective dorsal rhizotomy ( sensory nerve roots ), hamstring overactivity had not decreased in children with cerebral palsy. This suggests that the basis for hamstring overactivity is abnormal coordination, not a simple hyperactive reflex.

Crouched gait pattern results from excessive hip and knee flexion in conjunction with excessive ankle plantar flexion and anterior pelic tilt during the stance and swing fase of gait.
Of course ,static or dynamic contractions can limit range of motion in these joints as well.
This flexed position requires additional muscle activity for stability. Waters 1992"

Much more information in this recommendable book.

kind regards
Esther de Ru

[spandanphysio]

hi esterderu i tried to get that book but don't think available here.what about rectus femoris overactivitiy ?can hams weakness cause couch gait?

[estherderu]

dear Spandan,
It is not that easy, there are a number of factors causing the crouch gait. It is often the only way a person can stay upright and it costs a lot of energy. If you can change it??

The book is not available in Spain as wel but you can order it on line and it is sent all over the world. go to Lippincott Williams & Wilkins Home Page It is really worth buying.

kind regards
Esther

[pkkenchan]

by the way, you can try reading muscle testing and function with posture and pain.
there are numbers of factors causing the crouching gait, including the weakness of soleus.

[spandanphysio]

interesting how can weak soleus can cause it?can any1 put link for hams,rectus and calf?

[pkkenchan]

I am sorry I can post out the link about the book, coz I got the book long time ago and i just can't find out the link for you via the internet.

About soleus problem,
during standing, the plantarflexor muscle will reverse its functions, due to reverse origin-insertion relationship, thus normal soleus during wieghtbearing its functions is to shifting the tibia from anterior to posterior directions.
Thus, a weak soleus will allow the tibia to shift forward and result in a proning for the case to have a more knee flexed position.

for the rectus femoris and hamstrings, you should check about the lower-cross syndrome to find out its relationship with pelvic.

Also, its muscle balance is crucial in maintain a upright posture.

[spandanphysio]

hello friends my pt. has also developed quadriceps lenthening.so what to do for it?is it possible by conservative treatment?

[pkkenchan]

haha... I didn't have experience in training a lengthened muscle for a patient.
but a lengthed muscles , in many cases, would accompanied by weakness.

I suggest you try terminal knee extension exercise or isometrics exercise for quadriceps, hope that may help you.

[neuromuscular]

Have you tried a measuring of the Pelvic angles to see if the patient has bilateral posterior rotation of the innominate bones such that the PSIS is inferior to the ASIS? Do the test with hip abduction for the most graphic stress on the innominate bones.

If there is bilateral posterior rotation, it may not be the hamstrings per sae.

It could be the adductor magnus that is in a guarding response or in excess tonus. Try releasing the adductor magnus. Part of the adductor magnus acts like a hamstring. I do not find many hamstring problems but lots of adductor magnus problems.

If only one side is posterior in rotation, then treat the adductor magnus on that side.

Hope that you find this helpful.

Best regards,

Neuromuscular.

[srinig7]

patient have spasam in lower limb bilateraly how to train the gait

[srinig7]

yes consevative mangement for train the patient to frequent knee fletion and holding for few second