A primary trigger of gradual and acute onset MSK Pathology

External femoral rotation or EFR is everywhere you look. It’s easy to spot the footprints in the sand or snow, in gait patterns of people walking the street, while standing in line, when sitting, kneeling and lifting. You’ll find it in sports and fitness class, Yoga, Pilates, ballet and dance. Many therapists and fitness gurus unknowingly encourage EFR, intending to alleviate tight hips and back pain, but are in actuality doing the opposite.  EFR has been taken for granted for so long and is so deeply engrained in our movements it is never questioned. Just because we have always done it doesn’t mean it is the best thing for us.  We now have an epidemic of foot and ankle, knee and hip, SIJ and spine, wrist, shoulder, neck and jaw pathologies that can kinetically be traced back to EFR. EFR is literally costing our health care systems billions of dollars globally, not to mention the loss of productivity and increased worker compensation costs to businesses. So an in-depth look at what actually occurs with EFR is long overdue.

EFR acts as an immediate OFF SWITCH to the psoas/iliacus triggering a ripple effect throughout the kinetic chain.  This is due to the distal psoas attachment at the lessor trochanter.  Psoas/iliacus easily stabilizes trunk loads with neutral or internal femoral rotation (NFR/ IFR).  EFR immediately weakens psoas, resulting in unbalanced load transfer to the posterior body and dysfunctional compensation patterns. Weakness in psoas, a significant local and global stabilizer, leads to segmental vertebral shear which can lead to end plate lesions and other pathology.  Without the powerful extensor/flexor/stabilization psoas offers there is combined compressive load with shearing to the thoracolumbar vertebral discs overtaxing facet ligaments. Without adequate stabilization of psoas/iliacus the pelvic and sacral iliac joints and ligaments are compromised leading to pelvic positional dysfunction. Without optimal tension and line of pull from psoas there is unbalanced demand on quadratus lumborum, multifidus, gluteus maximus, piriformis and quadratus femoris. Without the balanced tension of psoas, erect posture is more difficult leading to kyphosis which in turn leads to decreased function in upper quadrant muscle groups tested.   When psoas is dysfunctional, compensation is significant throughout the kinetic chain in upper and lower quadrants with marked load asymmetry.

 

 It’s simple to demonstrate this chain of events. Testing is performed with the subject sitting on a bench or standing while performing perturbation. The objective helps patients kinaesthetically learn the value of NFR. This test demonstrates decreased stabilization, decreased response time, load transfer and compensation patterns.  The test subject is asked to stand with feet in neutral position and notice response to lateral, anterior/posterior perturbation. Then repeat with feet at 45° and notice the change in response. Many people are of the impression they are more stable with EFR and are surprised to find the opposite. Further observations such as load pattern in foot front to back, knee compression, weakness in core, and trunk posture deficits  can be done simultaneously while in both NFR and EFR. 

After performing these tests thousands of times in clinical practice and public demonstrations we enlisted the help of researcher Greg Kawchuck PhD, Canada Research Chair of Spinal Function at the University of Alberta. Early data is consistent with clinical findings. Further studies commence in January 2014. In lab testing we have a subject fitted in a motion capture suit sitting on a robot platform which provides unpredictable perturbation. We are collecting data from the subject in external rotation and internal rotation. We will also be using EMG to show more specific details pertaining to muscle response time.

The positive side to all of this is that EFR is correctable in nearly all patients. Patients generally feel empowered to finally understand the cause of many of their problems. This knowledge is integral to STAMINA patient education and a great asset for therapists to share with patients of all ages and lifestyle. The most powerful injury prevention involves:  Avoid EFR in active or passive situations –sitting, standing, squatting, running, exercising or resting.  The clinical data we collected a few years ago demonstrates that when the psoas drops in function and stabilization, supraspinatus was the second lowest functioning muscle out of 38 key stabilizers measured and graph charted each treatment. When psoas is dysfunctional it influences kyphotic posture. A weakened psoas will increase the chances for injury to everything from the ankles to the neck, from the shoulders to the wrists and is a leading contributor to most MSK pathology.

We are currently seeking other investigators who would be interested in joining us in other aspects of this research. We have seen significant immediate changes in athletic performance NFR and suspect this will decrease injuries in many sports and workplace injuries.

STAMINA® Rehabilitation Therapy or SRT is a full body treatment protocol which restores dynamic equilibrium and joint centration throughout the kinetic chain with neuromotor re-education. SRT restores optimal muscle fibre line of pull for optimal muscle alignment and function. There are many treatment approaches out there that go about this in various ways with varying degrees of effectiveness. SRT restores optimal function to psoas/iliacus benefiting the whole kinetic chain. Courses commence January 2014 California. To host a course in your area contact: academy@staminatherapy.com .

References :

McGill, Stuart, (2007, 2^nd Edition) Low Back Disorders, pg. 61, “In a recent study, we examined a matched cohort of workers-half of whom had a history of disabling low back troubles, while the other half had never missed work. Those who had a history, were asymptomatic at the time of the test, had significant loss of hip extension and hip internal rotation (but more external rotation). This is an interesting observation, given much clinical discussion regarding the “tight” psoas. Even though we do not fully understand the neuromechanics, this muscle as a clinical concern is worth studying further.”

Brunhuber, Kim and Hurko, Marijka, CBC New, Nov. 15, 2013 6 am, Yoga can lead to hip injuries http://www.cbc.ca/player/News/TV+Shows/The+National/About+the+Show/Kim+Brunhuber/ID/2415699721/?sort=MostPopular