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Hello, I am Dr. Sherrie Betz. And I’ve the privilege of working with Ariadne who’s a gymnast and cheerleader. She does cheer competitions and tumbling. She got here to me for knee ache and he or she additionally has a historical past of 5 ankle sprains on the left ankle. So I believe that is possibly inflicting a number of the bother.
And there is a few issues that we found about her once I went to her health club and watched her tumbling. So I might such as you to see some footage of her tumbling now. So right here, you see that she’s doing a roundoff again tuck. And when she lands, I am gonna sluggish the movement down so you may see the valgus and the pronation of the toes, and the valgus of the knees and the pronation of the toes that occurs. And that is a typical touchdown that Ariadne’s been doing when she’s doing any tumbling or leaping.
So we have been engaged on that and I might like to share a number of the outcomes as a result of she’s been capable of tumble with out ache for the final couple of weeks. And we have solely been working collectively about 4 or 5 occasions within the final month proper earlier than Christmas, after which developing within the final couple of months. So yeah. She is doing significantly better and remembering her alignment significantly better, however she does have some biomechanical asymmetries and a few difficulties along with her ankle mobility which might be feeding into a number of the issues that she has with leaping and touchdown. It is actually not the leaping that is the issue, it is the touchdown that is the issue.
So Ariadne, what I might such as you to do is come up onto the reformer. Now, I’ve all of the springs on, after which I need you to face up on the reformer and face this fashion and soar off. After which I need you to form of simply do it any outdated manner. Do not take into consideration all of the corrections and simply let’s have a look at what occurs. Okay. And right here she goes.
(flooring thuds loudly) Okay. Now, let’s do it another time. After which I need you to land along with your toes barely aside this time. And let’s have a look at. (flooring thuds loudly) Okay.
And what we wanna see is, or here’s a little bit quieter touchdown after which straightening out of the foot. You’ll be able to see that one among her toes truly migrates out to the facet and I am going to clarify why that occurs in only a second, so. Okay. So we’re gonna go on the reformer now, and I might such as you to put down in your again. I am gonna convey the headrest up and I am simply gonna take these off as a result of they have an inclination to jingle, jingle once they’re hanging on there. After which I am wanna have you ever place your toes on the footboard right here, the soar board.
And I am gonna take a number of the springs off. Proper now, all of the springs have been on as a result of we had the reformer carriage lockdown. And I am gonna begin with about two pink springs on there. In order that’s like medium stress. Let’s separate your toes just a bit bit. All proper.
And now, go forward and do a lightweight soar. Mm-hmm. And so what I am on the lookout for is that she retains the ankles in impartial, knees aside, and land softly. So level your toes as you raise after which roll by the foot, toe ball heel. Sure. Good.
And once more, repeat. And simply preserve going. After which I need you to land a bit of softer, a bit of softer. Mm-hmm. That is higher. Roll by your toes. Hold going, couple extra.
Wonderful. So she’s doing a extremely good job of holding the ankles aligned and you may see the shut up footage of her doing this, and it appears to be like actually good. Okay. Now, convey one leg up and we’re gonna let her soar on her proper leg first. So proper leg is the leg that is not as problematic and he or she does not have any ache in the suitable knee. So go forward and push out.
And we’ll see if she will do. Good work. So the suitable foot normally is well-aligned. All proper. Now, we’re gonna swap to the opposite facet. Deliver your proper knee to your chest after which lengthen out, leaping on the left.
Mm-hmm. Significantly better. Sure, that appears nice. Mm-hmm. So there’s a bit of little bit of a bunion on this facet too as a result of she’s actually been spending numerous time in that rolled in place with the arch collapsing and looking out significantly better with that. Okay.
So now, I need you simply put your toes up right here for only a second. And what I need you to see is when she flexes her ankles again, and you’ll normally see that she has rather more flexibility on the suitable ankle than the left. So if I normally do a goniometric measurement, you are gonna see a distinction of her vary of movement. So let me present you what that appears like. So if I put the goniometer on the center of her shin right here, proper on the ankle joint, and I put the opposite a part of the goniometer on the lateral foot, after which pull again, I see that I can get her simply to about 10 levels of dorsiflexion along with her knee straight.
Now, when she bends her knee, it is gonna enable the calf to alleviate its affect on the ankle. And so then, I can get the foot a bit of bit extra into dorsiflexion, possibly get one other 5 levels. So she’s obtained about 15 levels there. Now, on this left facet, you may need to take my phrase for it. She has, principally, I can get her to zero levels on this facet.
I can not get her any additional again than zero levels. After which if I push a bit of bit, presumably, I can get about 5 levels of dorsiflexion. So she’s restricted at the very least 10 levels. It would be ultimate if she had about 20 levels of dorsiflexion on this ankle. As a result of she sprained it so many occasions, there’s some limitation there.
So we have been doing numerous ankle mobility work with that. One other factor that’s inflicting her some bother is the, her potential to increase by the nice toe. And it is attention-grabbing. I requested her mom to return along with her someday as a result of I wish to see if this was genetic and it’s. Her mom has the identical toes as she does.
And that is so far as she will lengthen the massive toe, which is about, not even 45 levels. So that basically is troublesome for her in tumbling when, particularly when she’s touchdown from a again handspring or a spherical off, or if she lands quick, that large toe actually will get both jammed into extension or it is actually robust for her to land. And she or he’ll find yourself rolling in by the ankles as a substitute of dorsiflexion by the nice toe. And similar factor on this facet. After which she’s obtained the bunions which might be extra pronounced on the left than the suitable.
And the left facet is the one which has extra bother. However anyway, you’ll see this in only a second with another issues that we’ll be doing. So we do various spring tensions with the leaping. She likes to do it with mild springs so she will fly a bit of bit and that is actually enjoyable. So let’s do one with a lighter spring stress, I simply do a pink and a blue, after which lengthen your proper leg out.
I do know your proper leg can do it. So let’s have a look at what your left leg does. After which go forward and soar. Yeah. So she will get a bit of extra air time and he or she has a bit of bit extra time when she’s simply starting this method to determine the place she’s gonna place her foot, how she’s gonna preserve her heel barely lifted, after which holding her knee in alignment in order that she does not let that knee caving. Wonderful. All proper.
There’s your enjoyable. Okay. So I need you to roll to the facet and are available up after which we’re gonna transfer onto the subsequent train. All proper. So now, we’re gonna perform a little little bit of mat work and simply form of seeing how she strikes in standing. So let’s do a releve and let your, sure, only a pure manner of doing it.
And also you see how her ankles come aside. She sickles outward just a bit bit. And now, attempt it along with your heels collectively. Nice. That appears good. There you go.
Mm-hmm. And you may see how that impacts the knees too. She has a bit of little bit of bowing of the legs, particularly this left one. And she or he has a bit of little bit of inner rotation of this leg as nicely that creates issues for that foot. Okay.
So now, what I need you to do is stand in your proper leg, raise your left knee to a 90 diploma angle and do a heel increase on that facet, and simply preserve going a number of occasions. That is it. Stress’s on. Three and 4, 5, six, seven, eight, 9, and ten. Okay. The opposite facet. I am gonna see if there is a distinction proper to left.
All proper. One, two. Do you see the distinction now she’s rolling out on that left facet? Mm-hmm. Okay. So I need you to cease now and I am gonna offer you a bit of device that can assist you.
So I need you to place this dowel in your left facet right here, after which I am gonna get proper again right here and see what is going on on. All proper. Now, stand in your left leg and stand up and I am going to offer you some cues. Okay. Sure, that is already higher. I need you to place a bit of bit extra weight to the, truly, the within of your foot.
Mm-hmm. Just a bit bit. And stand up. And that is the place we would use a mirror too for her. Sure, that may be good.
That appears nice. So it is not as excessive because it was if you have been rolling outward, proper? That she was dishonest to get the peak of the heel. So that appears actually good. Now, what I need you to do is simply preserve your toes collectively after which bend your knees as a lot as you may. Mm-hmm.
All proper. Flip to the facet and do that very same factor. Okay. And watch. And you may see the distinction between how a lot her knees bend and the way a lot my knees bend. So you may see that is a level of dorsiflexion. In case your trunk is vertical and also you bend, truly your ankles are what will restrict you from descending all the best way down.
Proper. So coming again up. Now, stand on simply your left leg and raise your proper knee. And I need you to bend once more. Mm-hmm. And, yeah. In order that’s, you barely obtained any, proper?
It is just a bit bit. Do it once more just a bit bit. Nice. That appears good. Uh-huh. All proper.
So we all know that the limitation is ankle dorsiflexion. So I am gonna have you ever go over right here to the door, and I need you to place your palms up on the door and put your left foot up towards the door. Mm-hmm. And so now, you are gonna stretch the massive toe again and attempt to get the ball of your foot towards the door. Mm-hmm.
After which I need you to bend your knee. That is it. So she’s stretching each the nice toe and the ankle right here, simply the tail curl joint. And good. Sure, that is it. In order that’s a fantastic stretch for her to do as a result of it does not actually contain the calf and it will get each of her points at one time.
That appears actually good. Wonderful. Okay. Now, come again and stand right here. And I need you to place your dowel in the suitable hand. Step ahead along with your proper foot.
And I need you to step about 36 inches or so, three toes or so. There you go. Slightly bit additional. Okay. Now, holding this again foot parallel, stand up in your tip toe. Mm-hmm. After which what I am gonna present you in only a second is that, that ankle’s rolling out fairly a bit as a result of she’s restricted in that nice toe dorsiflexion.
So I am gonna have you ever come again to heart now. That is nice. And put it again down. Okay. Now, come collectively and switch and face the digital camera in order that the parents at house can see this. Put your proper foot straight forward. Okay. And now, stand up on that toe and that is it.
And the best way you probably did it earlier than was like that, turning it out and kinda letting that ankle roll out. In order that’s the rationale that she’s had these ankle sprains is as a result of not as a result of her ankle just isn’t as cell, however her nice toe requires her to roll out as a result of she will’t stand up excessive on that foot. So if we are able to preserve that foot level straight forward after which raise up and actually get her to maintain the heel centered over the second and third toes and stretch that nice toe dorsiflexion, then go forward and bend down right into a lunge so far as you may. There you go. And simply, do not go all the best way down.
As a result of as quickly as she goes all the best way down, she’s gotta tilt her trunk ahead as a way to get that toe to increase. Okay. Come again up. Wonderful. All proper. Step collectively. So you may form of see a number of the points and why she’s having bother with the touchdown.
All proper. Now, we have now introduced the step stools out and I am gonna present you a extremely attention-grabbing manner to take a look at how dorsiflexion impacts the knee bending right here. Okay. So we’re gonna step onto the stool proper within the heart of it, flex the foot, after which I need you to bend your knee till your heel touches the bottom. So you may attain your arms out if you want to. And I need you to attempt to preserve your torso vertical, and you’ll see that I am holding my pelvis fairly degree. I’ve sufficient dorsiflexion to get there.
And for her, she has to bend ahead as a way to get there. Attempt to preserve your foot flex so that you simply contact her heel to the bottom. And so you may see how she has to bend her trunk ahead as a way to get her heel to the bottom. Proper. So let’s do that. We’ll give her two blocks.
After which attempt once more. Sure, that is nice. Now, she will do this as a result of she has sufficient dorsiflexion to get there and she will keep vertical. Nice job. So actually easy little demonstration.
Now, flip round. After which I am gonna have you ever do it in your left facet, and we’ll put the blocks on this facet and let’s have a look at the distinction. Okay. So, all proper. Pull the foot up and contact your heel to the bottom.
So that is her left foot on the stool. And also you see the compensation. She will’t get there with this facet. So there’s a lot much less dorsiflexion of that left ankle that she finally ends up tilting ahead and arching the again and dropping the pelvis to get down there. Okay, good. Let’s work on that.
Stepping down. All proper. And we’ll convey the chair in now to have her do some work on the Combo Chair. All proper. Now, we’re gonna have Ariadne work on the Combo Chair doing the ahead and sideward lunge. So go forward and step in entrance of the platform right here, place your palms on the handles, after which as you place your foot on the pedal, be conscious of how your posture is.
So lifting up and putting the foot on the pedal. Press the pedal down along with your heel lifted. Solely watching how she places weight by that foot. After which I need you to step your left foot up right here all the best way to the again of the platform. Mm-hmm. Good.
All proper. After which the pedal’s gonna allow you to come up. So let it enable the pedal that can assist you come up and get up all the best way precisely. So we’re simply trying to see what is that this foot doing? So I am principally watching that left foot after which go forward and step down. Uh-huh.
After which watching to see what occurs there. And you may see there that she’s, most of her weight is on the within of that foot. And so what I need you to consider is that you just preserve your knee aiming in the direction of your fourth and fifth toe and your arch lifted. All proper. So let’s attempt it once more. Rising up.
Mm-hmm. Higher. Makes it tougher, does not it? So now, her pelvis dropped a bit of bit on that facet, so that appears good although. After which typically they do not have sufficient dorsiflexion to have the ability to do this. So the cue I am gonna give her is to push into my hand along with her left knee.
So go forward, urgent up, preserve that stress on my left. Sure, that is proper. Good. All proper. After which take it again down and I am gonna have you ever cease if you’re on the high of the motion. This time, you do not have to go all the best way up.
Breathe in. Breathe out to take it up, urgent up. Nice. That appears good. Hold urgent into my palms. She’s letting that knee roll in a bit of bit.
That is it. And press into my hand as you come down. Wonderful. That is it. So we’re actually getting that gluteus medius to work, after which possibly even raise your large toe on this facet. Attempt lifting that large toe after which let’s attempt it once more and cease when the pedal is on the high and you do not have to return all the best way off of it this time. Simply cease on the high.
There you go. Hold urgent into my hand. That is it. Nice. Okay. Now, come midway down after which I need you to simply pump this ankle. So that you’re gonna bend that knee and simply pump in place.
Nice. And preserve that stress on my hand. There you go. 4 and 5, six, seven, eight, 9, and ten. Wonderful. Now, go all the best way as much as standing. Mm-hmm. Hold that stress on my hand.
Then step all the best way up onto the platform. And now, what I need you to do is put your left foot right here. So discover that I am holding her left foot and weight bearing and switch and face that manner. Mm-hmm. And also you’re gonna put it on the diagonal like that, similar to that.
Okay. Now, this foot is gonna come proper previous the break up within the pedal. Mm-hmm, similar to that. After which, mm-hmm, and switch the foot outward just a bit bit in order that if you come down, it’s going to match on there a bit of bit higher. Nice.
Okay. Now, let’s get you arrange for achievement. We’re gonna take the physique upright. That is good. Okay. Now, I want that knee to return out a bit of bit. I am gonna put my hand right here within the again right here and press towards the surface of her knee in order that she will get that cue to carry that knee out.
And this gluteus medius is already shaking. Okay. Proper? Okay. Now, come down. Let the pedal go all the best way to the bottom.
Shift your weight over a bit of bit. Okay. And attempt to preserve, now, regulate your foot on this pedal so it does not really feel prefer it’s slipping after which stand up on the releve place, lifting up, turning the foot out. Just a bit bit extra. There you go. Like that.
Now, see should you can preserve your pelvis and your physique going through the entrance. Mm-hmm. Right here you go. Now, stand up. Take it up. That appears good. Sure, significantly better. Deliver this rib cage again and your shoulders again.
That is it. Attempt to keep vertical, press into my hand right here. Sure, I am like an octopus right here. After which take it down. Wonderful. That is nice, Ariadne. Higher.
After which press it up, actually reaching up. Wonderful. Okay. Hold that knee pushing out into my hand. Mm-hmm. Good.
Sure, that exterior rotator of the hip is actually useful in controlling the knee route over the toe. Nice job. That appears good. Now, see her heel developing. When the heel comes up like that, she’s operating out of vary of movement and power. Okay. So I am gonna allow you to flip round.
She’s fatigued now. It did not take a lot, proper? Step again onto the pedal. Uh-huh. After which come all the best way down. Nice job.
All proper, go forward and step all the best way down. Swish dismount. Let the pedal come up. All proper. Now, I’ve turned the chair sideways so to see what I am doing once I’m correcting her knee. I wished you to see the cues that I am utilizing to assist her right the knee and ankle alignment. So should you can face the chair, place your palms on the handles, after which place one foot on the pedal and push it down.
Conserving the heel lifted of the leg that you just’re utilizing to push the pedal down. That appears actually good. After which step up along with your left foot onto the platform on the finish. So, particularly since she has restricted ankle dorsiflexion, I want her foot to be all the best way on the finish of the platform so far as ahead as it could go. And that manner, she does not need to have as a lot dorsiflexion to get all the best way to the highest.
So now, take your self up with a pelvis impartial place. So pelvic headlight straight forward, collarbone headlight straight forward. Attempt to be vertical in your trunk and go straight up. Okay. After which, sure, that is good. And you may shift ahead a bit of bit.
Mm-hmm. After which recover from that standing leg. Okay. So what she tends to do is roll that knee inward. And I am gonna come to the entrance right here and the arch is flat just a bit bit. So when she bends to return down, and go forward and step down.
I am gonna push into that left knee, and I need you to push into my hand. So I am simply utilizing a lightweight stress on the surface of her left knee after which urgent up. Okay. Press up, stand up. Sure. Wonderful. Mm-hmm. After which I am gonna a have you ever step onto the platform along with your proper foot and transfer this foot straight forward.
It is form of twisting out just a bit bit. And now, go forward and step again. That appears good. After which push into my hand. ‘Trigger when she pushes into the hand and he or she controls the knee utilizing her hip muscle groups that do not have any accidents and doing rather well, she retains the arch lifted and the foot pointed straight forward.
So let’s do this once more, urgent out and stand up. Wonderful. That appears nice. All proper. Another, coming all the best way down. Oh, she needs to twist that foot once more. (laughs) Gotta preserve that foot straight forward. There you go. Wonderful. Okay.
Go forward and step down, and are available all the best way down and let the pedal come up. Effectively carried out you. All proper. Now, we’re gonna see the outcomes of our labor, our fruits of our labor, and see how she does with leaping. Now, we’re gonna convey Ariadne again to the place we began, taking a look at her leaping off of the field right here.
We did soar off the reformer at first, however we had the springs locked down. The field is sort of the identical top because the reformer. And we are able to use that very simply for her to leap off of to check her talents. Go forward and step up onto the field, after which stand along with your toes about parallel. Sure. Hip width the aside.
After which let’s do your soar and see the way you do, okay? So do your greatest holding the knees aside. (flooring thuds softly) Uh-huh. She’s touchdown extra quietly and with higher alignment. That left foot nonetheless needs to prove just a bit bit. So go forward and do it once more and let’s have a look at what you bought.
I am gonna get myself so I can see a bit of bit higher in entrance of her right here. And now, go forward. (flooring thuds softly) Sure. Good. That appears so significantly better. Actually, actually good.
All proper. So what I wished to say about Ariadne’s scenario is that I wanna preserve her tumbling, doing the issues she loves, doing her cheer competitions, with the ability to tumble, and really feel that she’s having a good time and that she’s not anxious concerning the knee ache. I need that to get to be a pure motion for her, that she is aware of the way to place her foot. And so we apply in lots of, many various positions, actually establishing these motor patterns in her mind. However the different cause I believe that is so necessary is that that is the principle time that youngsters construct bone density.
So between age 10 and age 20 is the principle window for what we name the magic window for bone constructing in youngsters. So what she does as a baby or as a younger grownup right here will serve her rather well sooner or later. As a result of what we are saying about osteoporosis is that it is a pediatric situation with geriatric manifestations. So if she will’t run and soar and tumble, that’s going to be a detriment for her bone well being sooner or later. So thanks for letting me work with you.
That is actually enjoyable. Hope you do nicely in your cheer competitions, and sit up for seeing you subsequent week. Thanks. Thanks for becoming a member of us. I hope you loved the tutorial.