Compensatory FA ER

The other day we received a great question…

In Myokinematic Restoration I understood that the left femur is in flexion, external rotation, and abduction (Left AIC pattern).  I understand this as being positional AF ER.  But I think I learned somewhere that the left leg is oriented in internal rotation and adduction because of the “pull” of the left ilium as it rotates anteriorly in the transverse plane.  When I look at my Impingement and Instability manual I see that the left hip can be oriented in internal rotation and compensatory external rotation. Is external rotation a function of position, compensation, or both?

You are not wrong in identifying that these concepts are presented differently depending on if you go to Myokin or Impingement.  In a Left AIC pattern the femur will be internally oriented and adducted.  This is described in Impingement and Instability.  This is an assessment made through upright / dynamic evaluation.  In Myokinematic Restoration, the femur will be in external rotation and abduction with respect to the acetabular position because of the position you and the table placed them in.  When you place the patient on a table to measure ER/IR values, the patient’s lower extremity is positioned by the table and the examiner, not by the acetabulum.  So theoretically, this is not a compensatory activity, you passively placed them in that position.  Left FA ER is only considered compensatory when it is dynamic.  We can’t go into discussion that the femur is actually in an internally oriented and adducted state in Myokinematic Restoration because the attendees taking this course are learning what PRI means by “neutral” and “position”. 

Posted January 23, 2009 at 6:08PM
Categories: Clinicians


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