KP Skills Corner

Welcome to KP skills Corner, where we combine our vast experience in performance, injury management, and post-operative rehabilitation to educate. We aim to empower new graduates and fellow physiotherapists with our "spice" and strategies to tackle the varied cases you may see on a daily bases. Join us as we share valuable insights to enhance your clinical skills and improve athlete care.

Step Down Task

The Step Down Task is an exercise we use to prepare athletes for the demands of running and landing from a jump. This exercise addresses:

Stability of the lumbo-pelvic system, the knee and ankle/foot complex
Force absorption
Deceleration

Weight bearing and energy storing tendons such as the Patella tendon and Achilles tendon, clinically, I found has to be trained to absorb force even though the athlete has good strength in the muscles of these tendons.

At this point we have ticked the required criteria to execute this task such as the dynamic stability of the pelvis, knee and foot complex, ensuring we have good recruitment of the Gluteus Medius, VMO recruitment and optimal Quad strength for this phase and of cause recruitment of the FHL and Tibialis Posterior for optimal control of the ankle and foot complex during ground contact, to avoid things like over pronation of the foot.

Once that has all been covered in the early stages we can progress to the step down task.

In the Initial stages of doing this, there is a psychological component that needs to be addressed, whether it is the fear of dropping down onto the affected leg or lack of confidence in the leg, so be patient with the athlete and help guide them through this process. Our cues are to lift the back leg before we strike the ground with the front foot. Landing with a soft knee, and athletic posture and maintaining good form, avoiding over pronation of the foot, pelvic drop or knee collapse. My go to thought for the athlete is “big toe Glut Med”. Remember quality over quantity, correct one thing at a time and building until the athlete can execute the task confidently and autonomously.

Gluteus Medius Strength TEST

Every athlete needs good Lumbo-Pelvic control. A major player in having optimal Lumbo-Pelvic control is the Gluteus Medius. This muscle gives the system dynamic stability.

So it’s important to test how well it recruits. We use the standard Gluteus Medius strength test.if this was just to measure strength, we don’t guess we test, so using a handheld dynamometer would be the go to. However personally I like to use this test to see how well the Glut Med recruits using tactile sensation, watching how the athlete compensates as well as feedback from the athlete.

Can I feel the Glut Med contract under my thumb when I place the leg in the starting position
Does the athlete rotate their trunk or flex their hip
Which area of the body does the athlete feel is being used to hold their leg up.

Understanding these factors can assist you in understanding why a certain pathophysiology is present and how an athlete may be compensating while in an athletic position.

Being able to spot these things comes with practice and gaining experience through using this test in practice.

But being able to identify these factors can be an invaluable asset in the management of your athlete

Scapula setting

Scapular dyskinesis or poor scapular control can result in things like subacromial impingement.

A few points on how we feel at Kerspuy Physiotherapy:

- Perfect posture is overated
We don’t place too much emphasis on static posture. We are more interested in dynamic stability of the scapular when there is movement of the shoulder

- Trying to be symmetrical is not always optimal, we are either right or left handed and one side will be more developed, most sports are unilateral inclined

- We focus on what muscles are designed to do and not aesthetics: big movers move and stabilisers stabilise

If you are not to sure on what I mean by this please feel free to ask your questions in the comments.

When you are told to set your scapula, you might of heard to either, “pinch your shoulders together” or go “round and down”

What I usually see when I ask someone to set their scapula, I see the use of the upper traps, rhomboids, lats and tricep.

What we actually want to see is a posterior tilt of the scapula.
Once the athlete is able to master this, we can then progress, by adding GHJ movement or setting the scapula while arm is situated in different positions.

Remember having a good foundation is key to progress to the more exciting exercises. This one may be boring and tedious, but I have found that it makes a big difference in the road ahead. It’s not sexy, but it’s necessary.

#Physio #Rehab #Shoulder #Scapula