[youtube http://www.youtube.com/watch?v=k-ZIvYIvToU&w=560&h=315]
Okay, I tried to get creative with the title and my creative juices just are not flowing today!
This post looks at internal rotation and walking (as if you couldn’t figure that). We have several kiddos that we see that use excessive internal rotation when walking (toes pointing in) and many times parents ask how we can correct that. What we have found for a lot of these kiddos is that while they do have internal rotation, it is not as excessive as it may appear when they are walking. Many kids will use compensatory movements while walking for a variety of reasons. Some of the things we have found that contribute to the appearance of excessive internal rotation are the use of circumduction (swinging the leg around causing an internal rotation like movement), pelvic instability (so because of weak hip abductors they can’t maintain a level pelvis when they take a step and the side of the pelvis that is taking the step will drop down causing the leg to look like it is going further into the center), and initiating swing from the pelvis (so instead of a straight plane step through they are swinging their leg through using the whole pelvis).
We have found that if we can provide stability at the pelvis, or even slow the kiddos down while walking some of these compensations will decrease. When the compensations decrease, you will still have the internal rotation that is already present but you won’t have the illusion of more rotation because they will be using more deliberate actions.
We have also found that when kiddos get AFO’s or other orthotics it will also increase the appearance of internal rotation for some of the same reasons. I’ve mentioned before that when you change one thing you will see changes in other areas. So when a child gets a new foot brace, they may be trying to figure out how to use it and it can alter their swing phase of walking and bring out compensations.
I’m not sure how well you can see it in the video but in the first part the child moves fast and uses their body to lean into the movement and they have poor pelvic stability as well as increased circumduction/use of their pelvis to initiate swing phase. When we changed the walker and gave them some hip stability, as well as used leg cuffs to not let the leg drop into the middle (that can happen when the pelvis drops) the appearance of internal rotation decreases. You can see more deliberate stepping and they aren’t able to use their momentum to keep them moving.
Using a walker isn’t for all kids but for this particular child it was one way to decreased the excessive internal rotation that was happening.
We did not try to correct for his actual internal rotation because of his age and the fact that bony changes have occurred altering the alignment of his femur. By trying to use strapping to make his toes point forward we would have put his hips at risk.
What have you used to help kiddos that walk with this similar pattern?