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Thread: Flexion withdrawal during gait training

  1. #1

    Flexion withdrawal during gait training

    My hip flexors on my "bad" leg are about a 2+/5. This in combination with my inability to dorsiflex my foot on the same leg make it difficult to clear that leg while walking with crutches. Hip flexors have gotten stronger and I have been able to improve their efficiency but I feel like time is working against me. The more I walk with my current gait pattern, the closer I come to blowing out that hip joint or jacking my knee on the other leg.

    During my inpatient stay at rehab hospital, a few days before my discharge, we (my PT and I) started playing with the e-stim unit to elicit the flexion withdrawl in my hip flexor when it was time to swing that leg through. Long story short, the gave me an AFO the day I left and flexion withdrawal was never discussed agan.

    I have brought this up to my current PT as a means of speeding up the process of strengthening my hip flexor and she is strongly against it. I'm really not understanding her reasoning but I trust her 99.9%.

    If anyone has ever used this technique to strengthen the hip flexor (not for functional walking) any experiences or outcomes - positive or negative - would be most helpful to me.



    *** c4/c5 incomplete *** Injured in Summer 2003 ***

  2. #2
    I've stimmed the peroneal nerve, which cause the reflex withdrawl you speak of. I had to use it to "break" the tone in my leg. I had movement in my hip flexor but the extensor spasticity combined with muscle weakness didn't allow me to bend and swing my leg through, I also had no dorsiflexion. I couldn't bend my leg when laying on my back or sitting down. I stimmed about 5-6 days a week for about six months until one day I was able to move the leg on my own. Last year I did the stim again for about 14 weeks 5 days a week in a gait study and my hip flexor felt/feels stronger. I can now move my leg in sitting, standing and laying down so for me its been helpful. Its been my experience that e-stim should always be utilized for weak muscles, you never know until you try is my thinking. Hope this helps.

  3. #3
    I would be curious as to why your PT is against using the e-stim in this manner. In general, e-stim was only thought to help strengthen muscles when the grade was 3 or below, however this mind set is beginning to change especially in regards to SCI. There is an abundance of current literature showing positive benefits from the use of FES (gait quality, spasticity management/control, muscle strength, muscle mass, bone density, increased afferent information…). In my opinion (and assuming no contraindications) there is no reason not to try peroneal nerve stimulation with and without a small ankle weight in various positions (you need to stimulate the hip flexors through out the maximal/full range). It may or may not work but you will not know until you try. I have had success with numerous individuals using this technique. I suggest that you ask for a detailed explanation from your PT why they feel this technique is inappropriate or contraindicated (physiological and all).

    “As the cast of villains in SCI is vast and collaborative, so too must be the chorus of hero's that rise to meet them” Ramer et al 2005

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