Friday, September 22, 2017

"Buy-In" for the Tripod Foot Position

After being exposed to the Movement Links  approach to the tripod foot position, I began applying it in the clinic to patients who would benefit from getting better foot centration and stability  during their home exercise program (HEP), as well as in their daily activities.

As with all programming, some patients will readily accept anything you say while others might be more hesitant.  This blogpost serves to give you some strategies that I have found helpful with the latter population.

After introducing and setting up the patient for the foot tripod position (see video below), here are some options that reinforce its functionality to get the buy-in so that the patient is more likely to carry over the training at home.

Tripod Foot Training

Standing Isometric Contractions
The patient begins in standing, I then ask for a near maximal quadriceps contraction, and direct the patient’s attention to the quality and intensity of the contraction.  After ensuring a good foot tripod, I will ask for a second maximal quadriceps contraction, and ask if there's a difference.

I will repeat the position, but this time with gluteal activation.

Step Up
The patient will perform a 12" step-up, both with and without the tripod in place.  I will direct the patient to compare the effort it takes and the power perceived in the legs between the step up with and without the tripod position of the foot.

The patient performs a forward lunge, with attention to the lead knee and thigh.  Should the movement result in a dynamic valgus (excessive pronation leading to tibial internal rotation distally concurrent with hip adduction and internal rotation proximally), cue the foot into a tripod position.  This centration tripod position should mitigate this dynamic valgus significantly.

I won't necessarily use all three strategies.  I will pick and choose based on what the patient has issues with and what I think will get the most buy-in.

Blogpost by Locatelli Rao, DPT
Movement Links Certified Clinician
Pasadena Physical Therapy