Limping depends on many factors. It can result from intrinsic causes (congenital malformations, deformities during growth, neurological pathologies), and/or extrinsic causes (intense sports practice leading to anatomical deformities, traumatic or even neurological accidents).
There are many types of lameness documented in the literature. The most frequently observed lameness is... hip rehabilitation, across all types of pathologies, is the one called the Trendelenburg lamenessIt is defined by weakness of the gluteus medius muscle on the weight-bearing side. The signs show a displacement of the pelvis on the ipsilateral side, a lowering of the contralateral hemipelvis, and a compensatory inclination of the trunk towards the weight-bearing side (1). This induces a significant functional change in the entire lower limb (notably hip adduction, valgus and external rotation of the knee accompanied by valgus of the foot) as well as in the rest of the body (activation of other muscles to compensate for this new movement pattern).
In the following diagram we can see that this limp induces a valgus and an external rotation of the knee (a), an adduction of the hip (b) and a lowering of the head (c) (Figure 1) (2).
Most of the time, it is initially caused by an avoidance (or evasive) limp following trauma, joint pain, partial paralysis, etc. The patient experiences a loss of limb function, and therefore a loss of confidence in the affected limb. This is followed by a progressive loss of sensory information, particularly proprioceptive information, throughout the limb. Thus, the limp becomes established, and the patient is no longer able to break free from this compensatory motor pattern. In other words, they have adopted a new neuromuscular circuit.
What is done in rehabilitation
As rehabilitation specialists, our main objective is to improve the patient's mobility so that they can achieve maximum functional gains, ultimately giving them maximum autonomy.
Let us illustrate with a common clinical case example: a case with gluteus medius deficit following a stroke (CVA).
Mr. M. attends rehabilitation twice a week. He performs balance exercises, muscle strengthening exercises (particularly for the gluteus medius), and stretching. He also does exercises at home such as cycling, daily walking, and some muscle strengthening and mobilization exercises every morning that the physiotherapist showed him.
Mr. M. seems to be receiving excellent care. However, he has been working diligently for over six months but sees no significant improvement because he is still unable to walk "like before." He manages it occasionally when he feels well, but it doesn't last. This has led to a decrease in motivation for his exercises, and it is also affecting the rehabilitation therapist, who is reaching the limits of his techniques. The treatment is becoming less focused on recovery and more on maintenance.
What neuromotor reprogramming offers
The neuromotor reprogramming technique, used specifically in the process AllyaneIt comprises three essential sensory elements:
- Mental imagery (visualization of movement)
- Proprioceptive identification associated with movement
- Listening to low-frequency sounds has the effect of placing the cerebral cortex in a precise brain rhythm, the alpha rhythm, where the brain is best able to integrate and anchor these different sensory elements more easily.
