Do you know your stuff? Would you correct this child’s gait ? Give them orthotics, exercises, force correction, leave them alone ?
Is he Internal Tibial torsioned ? Is he “pigeon toed” ,if that is the only lingo one knows, :( Does he have femoral torsion ? A pronation problem locally at the foot or an internal spin problem through the entire limb ? Or a combination of the above ?
What’s your solution?
It MUST be based on the knowledge necessary to fix it, not the limits of YOUR knowledge. You can never know what to do for this lad from his gait evaluation, no matter how expensive your digital, multi-sensor, 3D multi-angle, heat sensor, joint angle measuring, beer can opening, gait analysis set up is. You can never know what to do for this lad if you do not know normal gait, normal neuro-developmental windows, normal biomechanics, know about torsions (femoral, tibial, talar etc), foot types etc. It is a long list. You cannot know what to do for this kid if you do not know how to accurately and logically examine them.
Rule number 1. First do no harm.
If your knowledge base is not broad enough, then rule number one can be easily broken ! Hell, if you do not know all of the parameters to check off and evaluate, you might not even know you are breaking rule number one ! If everything looks like a weak muscle, every solution will be to “activate” and strengthen and not look to find the source of that weakness. Muscles do not “shut down” or become inhibited because it is 10 minutes before practice or because it is the 3rd Monday of the month. You are doing your client a huge disservice if you think you are smarter than their brain and activate muscles that their brain has inhibited for a reason. What if it were to prevent joint loading because of a deeper problem ? If every foot looks flat and hyper pronated, and all you know is orthotics or surgery or shoe fit, guess what that client is prescribed ? If all you see is torsions, that is all you will look to treat. If all you see is sloppy “running form” and all you know is “proper running form” forcing your client into that “round peg-square hole” can also lead to injury and stacking of compensation patterns.
One’s lack of awareness and knowledge, are one’s greatest enemies. If you don’t know something exists, because you’ve never studied or learned it, how can you be aware of it ? If you’re not spending enough time examining a client, you might not be aware of an issue even though you may be knowledgeable about the issue.
One must have both awareness and knowledge. One must also be aware that compensations are the way of the body. What you see is not your client’s problem. It is their strategy to cope.
Are you helping your client ? Hurting them ? Adding risk to their activity ? Are you stepping beyond your skill set ?
Rule Number 1: First do no harm.
Shawn and Ivo
PS: we will get to this case another time, we just wanted to make a point today about the bigger problems out in the world.
the gait guys
