Taking the Time to Evaluate
Do you have enough spring in the sacrum? How's YOUR sacral nutation?
Yesterday I spent some time with PT friend Sandy and our "client" PTA friend Carla. Carla asked us to help elucidate some tricky, bothersome knee pain that has been bothering her on the bike lately. You should know that both Sandy and Carla are also kick-ass cyclists! Sandy is ramping up her training right now for a September IronMan triathlon.
I brought my Dartfish setup, as well as my small Sony still camera to get some video and pictures. Part of the evaluation inluded putting Carla on her bike on a trainer and really analyzing her movement--checking R vs L and slowing things down to 1/10 of the speed of normal video.
Sandy did the majority of the standing alignment, back/SI and flexibility assessments. We probably spent about 2 hours really teasing everything out--on and off the bike, but eventually came up with this laundry list of issues that need to be addressed. Sandy is an outstanding PT:
1. SI joint immobility
2. R medial hamstring inflexibility
3. R glute med weakness
4. R psoas weakness
5. B ITB tightness
Will addressing these issues fix the problem? We're not sure, but it is a start. But the main thing I want to emphasize here is the comprehensive nature of our approach to the problem. It took time. And the addition of some special technology allowed us to actually see the deficits we found in the manual evaluation in action on the bike. They were subtle--early heel drop on the downstroke, and very slight R femoral internal rotation between 11 & 3 0'clock in the pedal stroke. We were also able to show Carla the dramatic (to us) difference in her Thomas test position after only a few cues and some initial intervention.
In the typical orthopedic physical therapy practice situation, Carla would NEVER receive this type of careful assessment. In fact, Sandy brought up the fact that a local St. Louis hospital- based PT department is now forcing therapists to see patients every 20 MINUTES! In our minds, this in not only untenable, but unethical.
It's not rocket science, but it is careful attention to detail combined with applied problem-solving. Time and patient listening to all of the information the patient can provide is paramount.