Transcript Document

Goals
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Identify structural or muscle imbalance anatomy that
might predispose to musculoskeletal problems
Identify movement patterns or postures that suggest
CNS pathology
Offer examination techniques to illustrate important
muscle imbalances that can occur
Offer guidelines for who might benefit from further
musculoskeletal evaluation in referral or testing
Focus Points
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Developmental milestones
Locomotion is most important function
Standing posture probably reflects “lifestyle” postures in
older children & adolescents
The foot is the contact point with the world & first in
kinetic chain of ambulation
We weren’t designed to sit, we should be able to squat
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You may need to play with them 
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Developmental milestones
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Hand dominance emerges 18 mo, matures by 2-3 years
Belly crawl 7-9 mo
Hands & knee creep 9-11 mo
Cruise 11-12 mo
Walk alone 12-14 mo, mature gait by 2.5 yrs
Climb stairs on hands & knees ~15 mo
Run stiffly ~16 mo
Walk down steps, nonreciprocally 20-24 mo
Locomotion milestones cont….
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Alternating steps up stairs 3 yrs
Hop on one foot & broad jump 4 yrs
Skip 5 yrs
One foot balance 20 sec 6-7 yrs
Key anatomy areas
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Foot/ankle mechanics in sagittal plane
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Hip extension in sagittal plane
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Dorsiflexion range in late stance and squatting, forefoot extension in toe
off
Tight heel cords will affect knee, reduce hip extension in late stance since
tibia can’t advance over foot, leg will lift up early
Lateral border of foot should be straight, if convex think tibial torsion
Loss may be postural and hip flexor shortening in older child
Excessive or lordotic gait may be glut maximus loss in MD
Hip stability in frontal plane
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Glut medius strength – Trendelenburg gaits or waddling may occur till 3
yrs
Gait considerations
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Limp = altered gait, often antalgic due to painful
joint, kids won’t admit it.
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Any joint in kinetic chain but hip most common,
hardest to examine.
Anatomy areas….
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Hip rotation, knee flexion, ankle dorsiflexion in
squatting, can they squat and walk?
Hip extension is frequently lost, do they extend
during ambulation in the sagittal plane?
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Supine hip extension range is important and helps
localize tightness
Hip firing patterns are probably very important
to identify, easy ways to check?
Compensations
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Gower’s maneuver = walk up to standing using hands to
make up for weak proximal extensor muscles.
Screening starts with gait
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Sagittal plane mechanics most important, then
frontal plain
Shoes on and off, out in the hall, let them run if
able
Squatting and walking in older children
Are landmarks level?
Uni-pedal balance depends on age
Modified Thomas test
Firing patterns
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Hip abduction: Glut medius >> tensor fascia
lata >> quadratus lumborum
Hip extensors: Glut maximus >> hamstrings
>> spine extensors
Palpate for muscle contraction,
timing and force relative to
movement and other muscles
Abdominal bracing may be the key
to all low back pain
Thank you for your attention