Addressing lateral rotation of leg

[MissMooMoo]

I'm hoping some of you more structurally oriented folks can help me out here... a number of my clients have some sort of lateral rotation going on with one or both legs.

Especially when it's only one leg I notice the feet while prone... one foot will be toes up in the air, and the other will be fifth toe nearly touching the table.

Most of them seem to have issues with the hip rotators, as well as peroneus.

Besides working on these, what else could I be doing?

 

[christina62310]

Client needs to follow up with strengthening the medial rotators so that the loosened laterals won't just tighten back up again due to habitual posture.

Fascia needs loosening, especially through glutes, and through lateral hams (biceps femoris). Make sure there are no restrictions on medial rotators, such as fascial adhesions of anterior hip/TFL, or binding of ITB. If ITB is really tight, you need to release TFL as well as glute max before working on the ITB.

Also take a look at the femurs, then the tibia to make sure that the whole leg is actually rotated and not just the tibia. If the tibia rotates laterally, you will need to release the lower leg muscles and client will need to strengthen whatever is weak to maintain progress.

 

[Chasity]

When the client's leg is as you describe (you mean supine?) that is usually a sign the piriformis on that side is tight.

 

[Malia]

When the client's leg is as you describe (you mean supine?) that is usually a sign the piriformis on that side is tight.

HT piriformis doesn't exist in a vacuum. If piriformis is tight, you have to release glut max/med, lateral hams, deep six also. Leg rotating out could also happen because of other pelvic imbalance, and also that pesky tibial rotation.

 

[reynwater]

Muscular imbalance never occurs in a vacuum.

You can see if the client's tibia is laterally rotated while they are standing, it is also known as knock-knees. If this is the case, it would be best to refer your client to someone who is trained in structural bodywork and the client will also need to re-learn postural habits.

The piriformis is a postural muscle and when it is tight in the lower crossed syndrome model then the gluts and the peroneus brevis and longus will be generally overstretched and/or weak. Other muscles that are usually tight (in the crossed syndrome model) would be the TFL, psoas, semitendinosus, semimembranosus, adductors, gastrocs and soleus. It is the thought of some researchers that the piriformis and sacro-iliac joint dysfunction are closely related and until you lengthen the shortened piriformis it will be difficult to stabilize the SI joint.

It's important to lengthen the shortened muscles first, after which you can strengthen the weakened overstretched muscles. If you know MET and use it on the shortened muscles, this in itself will help to tone the overstretched aneforum.xxxonists. When the shortened muscles have loosened, I would refer to someone who knows these types of exercises or recommend them yourself if your massage laws allow and you know about them.

It would be difficult to determine what is going on with your client without more information. It's easy enough to generalize but some other things to take into consideration are client postural habits, daily routines, past injuries, etc.

If the structural problems are something they are seeing you for, then it may be helpful if you get training in this area or refer out. If they are seeing you and enjoy your work and you would like to see these issues worked on you can refer to someone as an adjunctive therapy to the work you are doing.

 

[Shelby J]

Forgot to add..

To see if your client exhibits the lower crossed syndrome, look at them from the side and their hips will be anteriorly rotated and their abdominal area will pouch out. Usually this goes with the upper crossed syndrome where they will exhibit rounded shoulders and forward neck.

You can check for fascial restrictions by observing your client in underwear or give them a pair of short shorts (if they are uncomfortable standing in their underwear. Look at them face forward, side standing and also with their backs to you. It is easiest to start with the feet and move up the body--you may find fascial restrictions are even more apparent when you are looking at their posterior side.

Fascial restrictions will show as bones turned out, are the knees even, iliac crests even--or is one higher?,check the space between the arm and the hips--one side may be shorter, one arm may seem longer, a shoulder may be elevated, or a scapula may seem drawn in the midline of the body. These are only a couple examples but can help determine why your client's piriformis is tight and what needs to be done.