Through conducting a series of postural assessments, you’ve identified that your
ID: 3517994 • Letter: T
Question
Through conducting a series of postural assessments, you’ve identified that your client has pronation distortion syndrome. Using concepts of agonist/antagonist, length-tension relationships, force-couple relationships, and altered joint arthrokinematics, please describe the muscles involved in this syndrome and how they’re impacting movement in the lower extremities. Next, explain the four phases of the corrective exercise continuum and identify an exercise for each phase that would help correct pronation distortion syndrome.
Explanation / Answer
ANSWER:
PRONATION DISTORTION SYNDROME:In this the knees are approximated with increased valgus deformity(increase in the angle of the knee joint medially) and the ankle is everted with outward rotation and presents with flat foot (pes planus)
This syndrome disturbs the patients gait with more weight bearing on the medial aspect of the knee joint.Distribution of weight is not equal at the knee, ankle and foot as compared with medial and lateral aspects.
The description of motion of a segment without regard to the forces that cause the movement of a joint is called Arthrokinematics.
Agonist are the prime movers whose role is to produce a desired motion at a joint and Antagonists are the opposing muscle group to agonists,The desired motion is not opposed by the antagonists ,but these muscles have the potential to oppose the action.
The coordination of agonists and antagonists at the knee ,ankle and foot are altered and there is muscular imbalance affecting the patients gait.The antagonists -hamstrings at knee,plantar flexors with evertors at ankle and foot dominate the agonists and deviate the knee and ankle leading to typical gait.
Length-Tension relationship:The length of the vastus medialis and semimembranosus is more at the knee joint and the tension in the vastus lateralis and semitendinosus is more compared to the other muscles as they are in continuous contracted position.
At the ankle joint the length of the tibialis anterior ,medial gastrocnemius is more and the tension is more in the peroneal muscles due to shortened position.
On the whole these derivatives affect the patients overall posture leading to knock knees , adduction deformity at the hip, evertion and outward rotation at ankle and foot leading to difficulty in maintaining the proper gait and it also creates pain in the agonist muscle group leading to severe stiffness and contractures.
Treatment and corrective exercise:
If the deformity is more severe surgical correction with varus ostetomy where valgus deformity is corrected is advised.
Physiotherapy:Considering the patients deformed posture , abnormal gait and altered joints
Phase 1:In phase one active exercises of the lower extremities with stretches on the stiff lateral side is given.Posture guidance and gait training also given.
Phase 2:In phase two active exercises with increased repititions and stetches are given.
Phase 3:Resisted exercises of the lower extrimity with minimal weights or body weight is given.
Phase 4:Progressive resisted exercises by slowly increasing the weights and repitition is advised.
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