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Written by: Sam Torontour B.Sc., C.S.C.S.
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A good way to implement
stabilization here is to get your client to perform
unilateral, closed-chain leg exercises in bare feet.
Working in bare feet will enable the client to increase
the amount of sensory information and neural feedback
going to and from the brain. This will improve |
neuromuscular coordination in lots of the smaller muscles
of the foot as well as the gastrocnemius/soleus, the anterior
tibialis and especially the peroneals.
A good beginner exercise can be to have your client stand
up from a seated position (you can use a chair or a bench)
by using only one leg. The other leg can be held off the
ground while the individual stands up. The client may
have a tendancy to want to swing themselves or rock into
the movement. This is allowable in the beginning, but
eventually the client should be cued to avoid swinging
and creating momentum since it decreases the degree of
stabilization required by the involved joints.
Make sure that the client pushes off using the entire
foot (not just the front or back part of the foot). In
closed kinetic chain movements like a squat or a step-up,
there is an involvement by the muscles of the lower back,
hip and knee.
At the knee, extension is performed by the quadriceps
group, at the hip extension is performed by the glutes
and hamstrings and at the lower back extension is performed
by the lower back extensors. It is important that the
relative contribution of each of these three areas be
adequate so that one area does not become dominant in
handling the loads of the movement. Often times an individual
may display a 'quadriceps dominant' movement. This can
be observed in individuals who tend to place the load
of a squatting type movement into the front of the foot
(ie. pushing with the ball of the foot and toes and slightly
elevating the heel), and can be indicative of a weakness
in the muscles that extend the hip. An effort should be
made to cue the client to maintain contact on the pushing
surface with both the rear and fore foot. Observe closely
to see if the client has a tendancy to lift the heel and
push with the forefoot.
Also pay close attention to their hip/knee/ankle alignment
during the movement since one of the purposes of improving
stability in the lower limb is to improve alignment and
one of the ways you can help the client do this is by
cueing proper alignment during all lower limb closed kinetic
chain pushing movements. Good movement control, both up
and down, is also very important for any movement designed
to improve stabilization. The client should not collapse
back onto the seat, as mastering the eccentric component
of the movement (ie.lowering back into the seat) is crucial
in developping useful stability.
A couple of more intermediate exercises which can be performed
in bare feet include the front and lateral step-up. When
using the step-up, proper alignment and good movement
control, both up and down, are of course crucial. The
platform height should always be chosen with these key
guidelines in mind. There is no point in performing movements
without good alignment and good movement control. Eventually,
the platform height can be increased (by 2 inch increments)
once the client displays movement mastery at a given height.
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