Rehabilitation as an Integrated Approach



Multi-Axial Rehabilitation

A health care professional’s expertise in resolving musculoskeletal conditions is at the heart of any rehabilitation program designed to restore movement and balance to the body.

Clinicians rely primarily on different forms of supervised therapeutic exercises which focus exclusively on the area of complaint.

However, it is also helpful to understand the benefits of including an assessment of foot biomechanics to repair the overall mechanical efficiency of the system.

The feet are the very foundation of the entire musculoskeletal system, supporting the weight of the body and propelling the kinetic chain to work in the right direction.

Any interference from this pedal foundation ultimately affects supporting joints above the foot/ankle complex, causing a multitude of compensatory abnormalities in the rest of the system.

Chief amongst these abnormalities, are postural changes produced by rotatory stress.

A hyperpronated foot induces excessive medial femoral rotation in the lower extremity leading to massive changes in the pelvis, spine and sacroiliac joints.

As a consequence of this, the iliopsoas shortens and the spinal column rotates contra laterally, increasing the sacral base angle and lumbar lordosis. These contribute to the development of subluxations in the joints.

Dysfunctional articulations within the joint complex also affect the body’s proprioceptive capabilities, distorting coordination and balance throughout the spine and pelvis.

The plantar surface of the feet contains nerve endings which supply sensory feedback to the central nervous system, playing a critical role in postural regulation. 

With any alterations brought about to this feedback due to stretched or damaged ligaments, inaccurate neurological information is sent to the spinal cord, cerebellum and brain by the position receptors.

The result is a negative effect on gait and movement.

Excessive pronation can also result in functional leg length discrepancy. Asymmetrical complications arising from this condition cause pelvic and spinal subluxations, mainly because of the anterior rotation of the pelvis on the shorter side.

A study by Rothbart and Estabrook was able to ascertain the correlation factor between asymmetrical pronators and static pelvic lists to be 0.97**.

Functional scoliosis can also be a possible consequence of the resultant vertebral rotation and recurrent subluxation.

In order to develop more effective neuro-rehabilitation programs which improve the overall well-being of the patient, it thus becomes essential to use an integrated approach to craft combinational therapies, focusing on both, the multiple impairments in the body and the lower limbs.

The “hands on” approach often employed by clinicians in their treatments culminates from an extensive examination of the particular needs of the patients, which may include all or any of the following – assessing flexibility in the joints, balance and coordination, range of motion, motor performance, postural alignment, etc.

All are important considerations in the study of lower limb mobility.

Moreover, since a patient’s recovery is not limited to their time in the clinic alone, a clinician’s plan of care is comprehensive in nature and also takes into account their ability to perform daily activities with much ease and agility.

Orthotic intervention speeds up the recovery process and also helps prevent any future injuries by improving foot function and reducing the stress that is placed on the kinetic chain in total.
Related Links

References:

    1. Brian A. Rothbart and Lew Estabrook (1988) Excessive Pronation: A Major Biomechanical Determinant in the Development of Chondromalacia and Pelvic Lists. Journal of Manipulative and Physiological Therapeutics: October 1988, Vol. 11, No. 5, pp. 373-379
    2. Kim Christensen (2007) Spinal Biomechanics: What Role Do The Feet Play? Dynamic Chiropractic: November 2007, Vol. 34, No. 11

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