The asymmetry term currently used to be a more appropriate word to mean that we want to (often and mistakenly used to call dysmetria: Findings
incorrect distance movements or muscle acts or extensions thereof . ) is a disease sometimes misdiagnosed and very controversial treatment by different practitioners.
Some professionals argue that in an asymmetry is an aberration increases the use of "offsetting" is a physiological process of the body, which will be recovered (except for injuries and illnesses that have caused this shortening) and the same body that has triggered a accommodation mechanisms must not alter, but could cause damage to other locations.
On the other side are the defenders of treatment, ranging from plantar orthosis simply to avoid excessive movement of the ASA to ups and skirts to create a balance between the two members and prevent overloads that produce symptoms.
For the treatment, you should start trying from 0.5 mm, and increase in peak plantar orthoses 1cm, the rest should be added in footwear.
I am not in favor of long skirts, as these produce a shortening caused by muscle origin of the Achilles tendon and a loss of elasticity of the tendon.
Therefore, as far as possible, should be up subcapital hikes ending at 0 º or thickness tapering to end at 0 ° in the distal interphalangeal.
often misdiagnosed the asymmetries, as in our clinical evaluation, we have no contractures present in the hip and pelvis, and the position of the pelvis in all 3 planes of space, often giving false positives or false negatives.
anterización a
The iliac wing is usually characteristic of a short member, so that the iliac wing movement will rot. internal anteriorization addución and, being the most caudal anterior superior iliac spine to neutral and the most cranial posterior.
In a recent clinical case, a patient with asymmetry, is explored in a supine position with legs extended and ankles at 90 º. Tibial malleolus come and appreciated that where one ends the other begins malleolus. A measurement from the anterior superior iliac spine and from the navel, the difference in length is 1.5 cm.
After performing the appropriate manipulations in the pelvis and hips, the same measurement and joining the malleoli, the difference was non-existent, not seeing any asymmetry, which was subsequently confirmed by teleradiography that no such discrepancy.
The teleradiography is a diagnostic test of questionable value, since the scale at which it is taken, the patient's position, contractures and foot positions, hips and pelvis can alter the outcome.
The truth is that we can discuss whether or not to rally, but the evidence shows that its use significantly improves the symptoms not only at the level of lumbar, hip and lower limb muscles of the athletes but also decreases overload and injury.
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objective information based on various studies:
The discrepancy in length of the lower extremities than 1cm, affecting normal alignment of the body affecting the spine, art. sacroiliac, hip and foot.
Rating:
The classification of length discrepancy between the 2 members may be anatomical or physiological:
Anatomical:
describes a constant anatomical difference difference femur length and / or warm neutral heels (PNCA). The Rx
hip shows the elevation of the head femoral.
Physiological:
Describes an apparent functional difference. The lower limbs are the same length but the alignment of them is functionally different. This may be due to scoliosis, muscular imbalance, or pathomechanics foot.
To begin an effective treatment is vital to distinguish which of the 2 diseases have in mind.
The clinical procedure we do a good biomechanical study to determine to which type are length discrepancy.
This should perform the following tests:
- Measure the members and each member segments (femur, tibia)
- Compare joint range and type of movement of major joints.
- Evaluate the compensation
clinical measurements to determine and quantify the discrepancy may be direct or indirect
.
are direct measurements we made from the anterior iliac spine to the medial malleolus.
As an indirect measurement, we placed the patient standing and look for the iliac crest, measuring the distance from this to the distal hand.
are placed increases, previously measured, under the shorter limb until the distance between iliac crest hands and even in the two members.
We have a 10% margin of error when taking the measurement because the position of the iliac spines, the displacement of the marks on the skin, the clothes he wears (even shorts can be modified 1 cm actual measurement because the tape must overcome the gum).
A person who has had a long time discrepancy has adapted and compensated , changing its posture. Does the treatment would be the same?
Merriman and Tollafield (1995): the gap length between members can be observed in gait analysis:
- tilt to one side shoulders (shoulder top, short legs, but yes, this is a major problem due to other causes)
- Balancing uneven arms
- Pelvic Tilt
- Supination and plantarflexion of the foot on the shorter side
- pronated foot in the tip longer
- Knee flexed limb longer
As we can see, biomechanics should be seen and understood from all around the body not only from the feet or lower limbs.
Whilst Blake and Ferguson (1992): the most common compensation length discrepancy in the lower limbs, is a functional scoliosis or scoliosis attitude.
Lorimer (1997): due to compensation in the shortest member, there is an increased likelihood of a stress fracture occur due to a foot supination and therefore their inability to absorb impacts. On the other band, in the longer limb, the predisposition is to have pain in the medial knee, due to internal rotation caused by pronation of the ASA.
Treatment:
Treatment should be considered individually for each patient as they will have characteristics, morphological, functional and different idiosyncrasies.
The 3 treatment options are:
- to accept and accommodate the asymmetry
- Shorten member long
- lengthen the shorter limb
For anatomical asymmetry, can be treated simply with gains.
asymmetries greater than 1 cm to apply the increase in the sole of the shoe to prevent contractures of Achilles. (There was a study in which he commented that from beginning to occur as shortening, as I recall it was between 0.5 and 0.7 mm. Not confirmed)
addition, if the asymmetry is significant, is advisable to gradually increase in height gradually.
Blake and Ferguson (1992): A physiological dissymmetry requires orthotic treatment, sometimes coupled with increases, if the etiology is related to poor foot mechanics. Pathomechanics precedence treat the foot.
be useful physiotherapy and stretching to get the muscle elasticity to accommodate the new position / alignment of the body.
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Despite various studies, there remains the treatment controversy.
My methodology is to offer treatment to the asymmetries that have symptoms or decreased athletic performance or repeated injuries.
In asymmetries less than 5 or 6 mm pathomechanics just try and control the joint, other relevant physical treatment.
What is important is the continuous monitoring of these patients.
There are many studies demonstrating the efficacy and effectiveness of treatment in asymmetries, so it is a good practice based on evidence.
