Running Diagnosis / Gait Laboratory
Pain in the musculoskeletal system occurs largely due to abnormal physiological movement. Often the dysfunctional movement is painful by itself prompting the patient to seek medical help
. If the pain levels are insufficient to cause the alarm however and movement dysfunction becomes neglected, it will pave the way to a surge of pathological events leading to the morphological changes in the anatomical structures that in turn will inevitably exacerbate the intensity of the existing pain.
With main-stream medical diagnostic procedures, which are based on radiological imaging examinations such as X-Ray, MRI or Diagnostic Ultrasound, pain-generating structural pathology, such as tendinosis, post-traumatic joint inflammation, bursitis and other soft tissue pathologies, can be easily identified and mapped. The imagery obtained through radiological diagnostic procedures is essential for planning of surgeries and other invasive interventions.
The issue however remains that, as effective as they are in revealing conditions, which have already crossed the line of the structural damage, imagery-based diagnostics fail to provide warnings against early stages of the pathology.
Functional pathologies, such as most athletics-related disorders, build up gradually and result from the repetitive aberrant movements. These conditions can be treated more efficiently if identified at an earlier stage, before structural changes in the tissues set in.
The obvious demand for the preventive diagnostic methods has been therefore acknowledged, formulated and addressed.
Functional Diagnosis (FD) has been developed to answer the demand for preventive measures in the treatment of the functional pathologies. FD is a clinical analysis method that utilizes visual, palpatory and electrophysiological examinations that can be conducted with or without aid of the technology.
FD allows the clinician to find the true cause of pathology because it is tailored to find the abusive movement which most of the time is either located in the area away from the symptom site or is very subtle. FD allows detecting the pathology in its microscopic phase when the damage occurring to the tissues is on the cellular level and is not yet diagnosable with the radiological scanning procedures. With early detection method in place the practitioner is able to address the problem at its initial stage when the damage is still minimal.
Movement is a dynamic process, which cannot be evaluated by static radiological means. Because of this the use of conventional (and expensive) image-generating methods is limited in early diagnostics of the developing musculoskeletal pathology. The only radiological modality that somewhat corresponds to dynamic needs of the FD is Diagnostic Ultrasound because it is performed in real time. The body part is observed in motion and structural interactions are visualized during the movement.
The core of FD is a specific clinical examination based on evaluation of the movement and multiple systems and organs that control it. The results need to be supported with an objective analysis. This analysis today comes as a combination of various technologies such as Surface Electromyography, 3D Video Gait Analysis and the Ground Reaction Force Plate. All these methodologies measure different physical qualities of the movement and allow diagnostic precision by objectifying movement data and therefore allowing a clinician to either confirm his diagnosis or make changes based on the data obtained in the course of examination.
Below follow brief descriptions of major components of the FD:
Movement System Impairment (MSI) diagnostic classification is considered the most advanced clinical evaluation method of movement disorders.
MSI is a method of biomechanical correction of the movement impairments, which relies on diagnostic precision of the movement faults. Once faulty movement is identified a specific intervention can be designed to maximize the effect of the treatment. In general, movements opposing the faulty ones become the patient’s exercise.
Analysis of video recordings taken during walking, running (with or without use of AlterG treadmill) or other athletic activities is another important component of the FD.
Digital video motion analysis involves using dual high-speed cameras and powerful software to record and replay the video in slow motion or frame-by-frame. On-screen measurements are taken, multiple views and recordings are compared, and succinct reports with still pictures are produced, revealing form flaws that cause injury and impair performance.
Surface Electromyography (SEMG) allows quantitative measurement of multiple muscles simultaneously on the same and/or opposite limbs. SEMG will show isolated weakness and uncoordinated firing of muscles as they are used in the running motion, graph the function of up to eight different muscles, and record the graph data in sync with the recorded video data. More importantly, when a muscle is found to be impaired in the running motion, SEMG data displayed on a big screen TV in front of the runner gives immediate feedback as the runner works on engaging the impaired muscle while running.
Accelerometers measure limb speed and impact, with data recorded in sync with video, SEMG, and goniometry data, and can also be used for real-time feedback to help runners alter their stride to achieve a more efficient and less injurious pattern.
AlterG treadmill was originally designed as effective exercise regimens for NASA’s astronauts. Differential Air Pressure (DAP) technology has been adapted by AlterG for use in training and rehabilitation. Cleared by the FDA in 2008, the AlterG Anti-Gravity Treadmill is a medical device that can be used for rehabilitation of lower extremity injuries, treatment of neurological conditions, weight reduction, aerobic conditioning and general training to allay the diseases of aging.
Unweighting is achieved in the AlterG by using air in a pressure-controlled chamber to gently lift the user. Clinical studies show that AlterG can provide protection of healing tissues, encourage range of motion, prevent disuse atrophy and encourages rapid return of the motor control.
Case in Point: Functional Diagnosis of Foot and Ankle Complex
The Functional Diagnosis of the foot/ankle complex (FAC) is more difficult task than evaluation of the hip or a knee simply because visual inspection of this relatively static area can only reveal deformed structures that may stem from a variety of causes.
The dynamic behavior of the foot can be best observed during the visual examination, which often reveals the reason for particular foot deformity or a subtle dysfunction which can cause pain during walking or running. Therefore the best way to examine true muscle performance of the FAC is a combination of the Functional test with SEMG monitoring and the video gait or running analysis.
The complexity of the FAC movement stems from the necessity of it being simultaneously a shock absorber and a rigid lever to transfer bodyweight in space. The most common movement impairment of FAC function is due to inability of the foot to be both rigid and flexible at different phases of the gait cycle. When dysfunction of timing of these regimes occurs the foot will fall into either extreme of being too flexible (overpronation) or too rigid (supinated – cavus foot).
These dysfunctions do not always cause immediate foot pain. They may first adversely affect the mechanics and neuromuscular coordination of the knee, hip and pelvic joints. Depending on spinal stability, tissue resilience, body’s ability to adapt and a variety of other factors, these averted dysfunctions can persist for years without directly causing pain at the foot. Instead they often result in deformities and pain syndromes in the compensating body’s regions, most notably at the knee and hip due to close biomechanical relations.
FAC dysfunctions can also result in back, neck and head pain via neurophysiological mechanisms related to body’s balance, proprioception and distant coordination of the spinal musculature.
At Dynamic Neuromuscular Rehabilitation we use the multifaceted approach to treatment of gait and running disorders resulting in ankle, foot, knee and hip pain.
The difference of our approach is in diagnostic precision of all aspects of these disorders.
We use Diagnostic Ultrasound to identify structural impairment of muscles, tendons, bursas and other soft tissue structures.
We use Movement System Impairment diagnostic classification – the most advanced clinical evaluation method of movement disorders.
We use video and surface muscle electromyographic analyses during walking, running and other athletic activities.
We also use video analysis of gait and running with loading reduced by removing gravity utilizing new revolutionary technology – AlterG treadmill.
In our experience, due to complexity of the musculoskeletal system and interdependency of its components, the combination of different curative approaches provides the best results.
We use ESWT treatment to biologically speed up healing of the degenerated or inflamed tendons and muscles with trigger points.
We use patient-specific comprehensive home exercise programs based on the Movement System Impairment Diagnosis. This not only decreases pain and corrects the mechanics but also allows the patient to be in control, which is very important in preventing chronicity. The system also allows patient to avoid daily activities that lead or contribute to the existing pain syndrome.
We use foot orthotics and various taping techniques to prevent aberrant motion and decrease irritation of affected tissues during the daily activities.
We use variety of soft tissue and manipulation techniques to restore joint mobility and mobility of muscles and fascias.
We use Sensory motor stimulation to restore balance and proprioception.
We use DNS method to restore neural drive, motor control and sensory awareness of the affected region.
Finally we use the AlterG treadmill to train muscles and increase blood supply while removing loading of the joints and tendons in gravity-regulated chambered treadmill.