Hip extension mobility and anterior chain extensibility are assessments that should often be considered in patients with ankle/foot pain. Often, we see that ankle DF and hip ext ROM are limited simultaneously in patients and one can impact the other. When we are assessing gait, a patient will have difficulty with terminal stance phase due to either of these issues. The ankle and hip must each achieve 10-20 deg of DF and ext accordingly. A limitation in either of these may lead to compensation: early heel rise, excessive lumbar extension, shorter stride length, etc.
In the case of Lumbar Extension or Extension-Rotation Movement Impairment Syndromes (MIS), typically we see loss of hip extension mobility leading to excessive lumbar extension motion in standing, walking, or supine positioning. Anything that requires the hip to move into extension will instead move in the lumbar spine, due to flexibility deficits. Over time, this may lead to a painful state. Increasing hip extension mobility may help the local motion, but if the functional pattern (gait) and associated impairments aren’t address as well, the patient may continue to have difficulty with an activity like walking. A patient may have gained enough hip extension mobility to achieve normal terminal stance positioning; however, the restricted ankle DF motion must be also be improved to see the change in gait.
So how do we make sure that we don’t miss these impairments in our exam? The answer is simple: make sure you do a thorough exam that is efficient and a standardized procedure. My exam sequence for strength and mobility looks identical in >95% of my lower quarter patients (minus adding/subtracting a few special tests each time). If you make it a habit, you will be much less likely to miss it. So make sure in your foot/ankle patients, you are assessing hip ext mobility as well looking at ankle DF mobility for your low back/hip patients.
Dr. Chris Fox, DPT, OCS
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