When performing an evaluation on a client complaining of leg pain of the hip, knee, ankle or foot, many factors are taken into consideration to determine what is wrong and how to fix it.
First, the patient’s standing posture is assessed. The client stands naturally where most comfortable and balanced and the clinician looks for asymmetry. Is one foot more forward or turned out then the other, or carrying more of the weight?
Secondly, their pelvic alignment is observed for levelness. An untreated leg problem usually has a component of pelvic obliquity; one side will be higher than the other. The symptomatic side does not necessarily correspond with higher side.
The third item to look for is differences between the client’s muscle tone on the two sides. If the injury is acute, swelling and increased muscle spasm of the surrounding tissues on the same side may be seen. However, most clients are seen here in the sub-acute or chronic phase. These clients show compensatory tightness of the opposite side muscles. The muscles often find tighter are the gluteus maximus, tensor fascia latae, iliotibial band, lateral hamstring and lateral gastrocnemius. In fact, the tighter these opposite muscles are gives an indication of the length of the problem.
Fourth, it is important to evaluate the knee and foot alignment. Looking from behind the client, one can check for pes planus or flat-footedness, loss of the medial arch. This is usually coupled with genu valgum, aka a knocked-kneed posture, which may be found on both sides, typically more pronounced on the symptomatic side.
The fifth item evaluated is a client’s range-of-motion and strength. Often the involved side is weaker but this is not always the case!
Additional testing specific for the area of concern is performed. This includes assessing joint mobility for laxity or restriction then noting any areas of specific tenderness, fascial tightness, and temperature or color changes which could indicate a vascular issue. A difference in sensation between sides may indicate a nerve problem. More specific evaluation to a joint is performed to check for hip labral tears, osteoarthritis or impingement. Specific tests for the knee may show ligamentous or meniscal strains.
Lastly the client’s walk is observed and any deviations noted, yielding information about movement strategies and compensations. How is the body working as a unit?
From the list of findings, a comprehensive treatment plan is formulated specific to that client’s needs, their living arrangement, work situation and recreational goals.
Michele S Jang, PT is a physical therapist who likes to look outside the box. A physical therapist for over 22 years she has extensive training in manual therapy or the use of hands to help rehabilitate the body. Her clinic Spirit Winds offers Free Consults on Tuesday afternoons and has a team of therapists who offer expertise in many areas to treat problems, increase awareness and encourage healing. Spirit Winds can be reached at 805 543-5100 or firstname.lastname@example.org