Limitations: The powers of observation will help you.
Physical examination, FMS, DNS, gait analysis … . . these are all very important tools for the coach, trainer, therapist, clinician. They will all offer information and lead the “therapy giver” in a direction for intervention. But when something doesn’t match up with the basic standard protocols, you have to go outside the standard box. We have all been there and today is just a little reminder not to get caught up in the “proceedures” and merely running through protocol without an engaged brain putting the pieces together.
Here we see 2 classic examples of deviations from the mean, the client on the left has drifted further outside the frontal plane because of tibial varum and a little genu varus. The client on the right has imploded deep into the frontal plane via rigid pes planus foot collapse and genu valgum. These will both affect your physical screenings for these clients. And keep in mind, and this is probably the most important point of today’s blog post, either client may have good or bad strategies around their anatomy. In other words, some clients will have great compensations to limit further functional pathology, and some will have poor compensation strategies, and thus, both will have different physical exam findings, different screenings and different neuromotor patterns embedded deep into their CPGs (central pattern generators). Put yet another way, all of the scenarios discussed may/will have varying screening assessment outcomes but for different reasons. If you know the cause of these faults and the impaired neuro-recruitment patterns that are likely, your assessments will make more sense, and so will your exercise/therapy/rehab prescriptions. If you do not understand the fundamental differences (ie long bone torsions or various femoral-neck shaft angles, foot types such as an uncompensated forefoot valgus etc) , one could prescribe therapies that will not address the underlying problems, rather they might address the compensations and strategies found with these client’s challenges.
It can get sloppy messy. Wear a bib.
Dig for the roots, don’t mow the grass…… Shawn and Ivo, The Gait Guys