​But Can You Crawl?

Newsletter sent on 1/16/2020

In my quest to learn all the things, I have delved into fundamental movement patterns and explored the impacts of skipping developmental milestones. 

Sure enough, this week I had my first patient of the year who completely reinforces what I’ve been researching. 

My older patient comes into the clinic after a total hip replacement. During the assessment, I realized there is poor control of her ENTIRE leg. Her feet are floppy and weak. Her knees are stiff. Her hips are, of course, weak. I asked her what’s going on. She replied, “I’ve been wearing custom orthotics. I’ve had bad feet forever.” I asked, “ Did you hurt yourself as a kid?” She said, “Actually no, I was strong. I even skipped crawling as a baby. Something must have happened.”

OMG. This is the moment I’ve been waiting for. 

I proceeded to tell her what I knew about the developmental milestones. 

The basic movements that we develop when we're babies -- rolling, crawling, kneeling, squatting, and so on -- are the foundation to movement for the rest of our lives. Proficiency of one of these movements is the foundation to the next movement. From there, the movement patterns build on top on one another. From infancy to the toddler stage and through the rest of childhood, we develop these skills progressively. Studies have shown that skipping a milestone as an infant can lead to movement dysfunction as an adult.

In the case of my patient, she skipped crawling. This means she did not develop good push-off with her foot and toes. Since she didn’t crawl, she also didn’t develop appropriate hip flexion drive and opposing arm/leg coordination. Finally, she didn’t develop adequate spine control since she didn’t experience de-weighting of opposite arm and leg (doesn’t crawling look similar to the bird dog exercise often given for core stabilization?!).

With injury, there’s opportunity for these movement patterns to be disrupted. But unlike infants, as adults, we are strong enough to push through the movement pattern without noticing the compensations. This is how injuries continue.

In the video below, I show how having long term core injury (from falling onto my back) disrupts my ability to move from all fours position into a high kneel.

I had a prior injury on my right side hip/thigh from overuse due to change in mechanics from falling onto my back. Going into a right half kneel position from being on all fours is challenging. Swinging my leg forward feels awkward and not smooth. Poor core and hip stabilization from the fall cause my body to find the stability in my legs. To re-establish core and hip drive, I practiced crawling.

After practicing crawling, going from all fours to a half kneel improved. This is important for running because my body has to develop proper muscle movement strategy to move from a more stable position to one less stable. This happens with each step of running. 

You should have seen the look on my patient’s face when I was able to explain her lifelong foot, hip and back pain.

Kinda Deep! If you have questions please email me at info@3-drunner.com or DM on Instagram @3DRunner

Janet Yiu, PT, DPT, OCS, FAFS

3DRunner.... Run Free from Injury.

Janet Yiu