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Jan Sultan

Handouts for Participants in the Foot and Leg Telecourse with Jan Sultan, Advanced Rolfing Faculty

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Please have these pages to refer to while listening to your audiocourse.



The Lower Extremity
© Jan Henry Sultan
v.110401

In order to have a working view of the Lower Extremity, we must include the Ilia, in relation to the sacrum, in our thinking. Remember that the pelvis functions in three primary ways. 1. At the sacroiliac junction the sacrum is supported in its role as part of the spine and interacts with the ilia in locomotion. 2. At the ilio-femoral joint, the ilia interact with the legs in locomotion and weight transmission. 3. As a unit with the sacrum, the pelvis is the lower basin for the internal organs, both supporting and containing the organs and viscera.

A. Ilio sacral movement. 1. In normal walking, the ilia have a characteristic and patterned motion cycle in relation to the sacrum. As each leg moves to the apex of its anterior swing, the corresponding ilium "rotates" posterior. This brings the iliac crest on that side posterior-lateral, and the tuberosity anterior-medial. This pattern is related to the shape of the SI joint, and the triangular shape of the sacrum on which the ilium articulates. Illustration #1

2. As the heel strikes, the ilium retains its posteriority until the leg moves into its weight-bearing phase. At the apex of weight bearing, the ilium starts its counter movement anteriorly, and completes that movement as the leg moves into its push phase. This can be seen as gaining a mechanical advantage to help in propelling the body forward with the push of the leg. It also accelerates the contralateral patterning of the torso and shoulder girdle. Illustration #2

3. These pelvic motions are not large amplitude. The amplitude is determined by the overall body type of the individual, in particular the lateral profile of the sacrum. Flatter sacra move less, and the more curved, the greater the amplitude of the motion. What is important to observe here is that some of the motion restrictions of the ilium that we commonly see will be identified as interruptions of the biomechanics of the ilia in normal walking.

B. Ilio-femoral movement: 4. The ilio femoral joint is a ball in socket configuration. This shape tells us that the joint is multi-axial in function. It is equally functional in walking, running, kicking, and dancing. Most problems with the hip joint originate distal to the joint, either as restrictions of normal movement at the SI joint, or as structural problems in the legs. These problems are usually exaggerations of normal shapes, or the result of maladaptation to injuries. The deterioration of function that occurs at the ilio-femoral joint is usually an outcome of these distal problems, and not originating in the joint itself.

The Leg Patterns: 5. Leg patterns can be understood by looking at the relationships of the segments. Generally the legs can be seen as either varus or valgus in pattern. Within that pattern we see internally rotated thighs in the varus, and externally rotated thighs in the valgus. You can identify the rotation of the thigh by watching your client walk toward you, and seeing which way the knee moves as the leg swings thru its arc. Illustration #3

6. The lower leg can be either internally or externally rotated in relation to the thigh. Thus you can see an everted foot on either an internally or externally rotated thigh. Conversely, you can see an inverted foot on either an internally or externally rotated thigh. Illustration #4

7. Each of these variations can be best understood by knowing the patterns of transmission of weight bearing load, or kinetic energy, for the congruent patterns in which the thigh, lower leg, and foot are all in (more or less) the same degree of rotation.

8. These are soft tissue patterns that form from the function of the structure in walking and standing. In essence we have a trait driven pattern that is reinforced by use. These patterns are expressed as predictable fibrous accretions, or excessive development within the muscles and connective tissues, and can be palpated and observed in the individual. In an attempt to bring the limb into a shape that better supports the weight transmission, and minimizes stress on the joints, it is these soft tissue patterns that can be addressed. As these tissues are released and either sedated or toned thru manipulation, the bones are able to move into better alignment, and bear the load of weight transmission more efficiently.

The CONGRUENT external type: 9. In this pattern (see illustration #3) the adductors are brought forward with the external rotation of the femur, and are recruited with the quadriceps as a flexor of the leg. The rotators are simultaneously and chronically concentrically active, also as a function of the external rotation. This pattern will usually show an "apple shaped" bottom when seen from behind, and has the ilia relatively outflared bilaterally. The femur will also recruit the psoas as a leg flexor, and it will be strong and well developed. The general set of the pelvis will be posterior tilt. In the external type, in walking, the lateral hamstrings dominate the internal hams in extension as they pull the leg thru the PUSH phase of the gait.

10. Due to the lateral orientation of the lower leg, out from under the load bearing line, the medial gastrocnemius head becomes more developed, and shows a typically prominent contour.

11. The foot in this pattern takes the shape of a high, relatively immobile arch. This is due to the general external rotation of the upper and lower segments of the leg, and brings the weight onto the lateral aspect of the foot.

The CONGRUENT internal type: 12. In this pattern (see illustration #3) the adductors are brought posterior with the internal rotation of the femur, and are recruited with the medial hamstrings as an extensor of the leg. The tensor fascia lata and the gluteus medius are concentrically active and recruited with the vastus medialis in flexion of the leg. The pelvis will tend to be anteriorly tilted, and the ilia bilaterally inflared. The bottom will show a "pear" shape. The iliacus will be well developed and act with the quadriceps as a flexor of the leg. Illustration #5

13. Due to the internal orientation of the lower leg, the weight will be taken to the lateral aspect of the leg, and the lateral head of the gastroc will develop accordingly, showing a strong contour on the outer aspect of the leg.

14. The foot will show a long and flexible arch. This reflects the general internal rotation of the leg, with the weight being driven into the inner arch.

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