Quick Case! Using Lumbar Repeated Motions to Improve Gait Quality and Pain

Last week I mentored an EIM Fellow in Training in his clinic. One of the cases was a young woman status post right tibial fracture and repair.

Due to the good work done at the clinic prior to my arrival, she already had most of her function and range back in her right ankle, knee, and hip, but she still shifted to the right (ipsilateral side to injury) with each ipsilateral stance phase.

I asked her if she had any back pain, and the answer was no, but she had very "tight" right hip and QL areas. These were the interventions I tried first.

Since she was shifting to the right, I had her hold a 30# kettlebell on the left to see if it was proprioceptive
it wasn't! - this made her shift much worse!
I then looked at lumbar extension in standing, which showed moderate deviation to the right
sidegliding in standing was DN to the left, and FN to the right

both of these tests showed a decrease in ability to load her lumbar spine to the left

palpation revealed tenderness and increased tone in right psoas and QL versus the left
pain free psoas and QL releases were performed to the right side, which improved her right shift during stance phase a bit
next I tried patient generated left lumbar sidegliding against a wall check the video below for the results on day 1 and visit 2 - 2 days later

Lumbar Repeated Motions to Improve Gait Quality

SGIS in standing was prescribed to the left to restore left lumbar loading
she performed them hourly between visits and gait was much improved
her perceptions of tightness in right lower quarter was also gone
she had a new complaint of right tibial pain around her incisions, but after wrapping with EDGE Mobility Band and performing functional mobilization tibial internal rotation, this was abolished and instructed for HEP

Was her gait perfect? By no means, and I am no The Gait Guys, but this was something the fellow candidate was working on for several weeks without change. What's the bottom line? When threat is eliminated, rapid changes may happen as the motor patterns are ingrained in the CNS and they return just as fast as they changed in the first place.