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Notice the symmetry in the gait of the normal subject between right and left sides in the stance (62%) and swing (38%) phases; the asymmetry in those phases in the gaits of the two patients 4mg medrol visa, who spend less time bearing weight on their involved (painful) sides; and the increased cycle time for the two patients compared to that of the normal subject. Normal man Left 62% 38% Stance 38% 62% Swing Right Patient with avascular necrosis, left hip Painful limb Figure 2. Patient with osteoarthritis, left hip Painful limb Adapted from Murray & Gore (1981). Traditionally the gait cycle has been divided into eight events or periods, five during stance phase and three during swing. The names of these events are self-descriptive and are based on the movement of the foot, as seen in Figure 2. Heel strike initiates the gait cycle and represents the point at which the bodys centre of gravity is at its lowest position. Midstance occurs when the swinging (contralateral) foot passes the stance foot and the bodys centre of gravity is at its highest position. Heel-off occurs as the heel loses contact with the ground and pushoff is initiated via the triceps surae muscles, which plantar flex the ankle. Toe-off terminates the stance phase as the foot leaves the ground (Cochran, 1982). Acceleration begins as soon as the foot leaves the ground and the subject activates the hip flexor muscles to accelerate the leg forward. Midswing occurs when the foot passes directly beneath the THE THREE DIMENSIONAL & CYCLIC NATURE OF GAIT 11 body, coincidental with midstance for the other foot. Deceleration describes the action of the muscles as they slow the leg and stabilize the foot in preparation for the next heel strike. Midstance Acceleration Heel-off Toe-off The traditional nomenclature best describes the gait of normal subjects. How- ever, there are a number of patients with pathologies, such as ankle equinus sec- ondary to spastic cerebral palsy, whose gait cannot be described using this ap- proach. An alternative nomenclature, developed by Perry and her associates at Rancho Los Amigos Hospital in California (Cochran, 1982), is shown in the lower part of Figure 2. Here, too, there are eight events, but these are sufficiently general to be applied to any type of gait: 1.
Thus discount medrol 4 mg mastercard, the practical utility of a particular study in the ma- trix of clinical evaluation and subsequent surgical planning is of cru- cial importance. Appropriate patient selection and education about ex- pected outcomes are vital to identify patients who will have a successful surgical outcome. Ideally, the indications and expectations should be identical in the minds of the diagnostician and the surgeon. Finally, in many instances, more rigorous study of both diagnostic and surgical procedures is required. It is perhaps the greatest tempta- tion of the clinician scientist to utilize promising techniques or proce- dures in an effort to alleviate patients’ suffering for apparent problems before the techniques have been completely evaluated. Thus the exer- cise of compassionate restraint may be the greatest challenge facing cli- nicians today. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. The rates of false 64 Chapter 4 The Surgeon’s Perspective: Image-Guided Therapy positive lumbar discography in selected patients without low back symp- toms. False-positive findings on lumbar discography reliability of subjective concordance assessment during provocative disc injection. Specificity of lumbar me- dial branch and L5 dorsal ramus blocks: a computed tomography study. Changes in MMPI profile levels of chronic low-back-pain patients following successful treatment. Comparison of two modes of stress measurement: daily hassles and uplifts versus major life events. A relative value of lumbar roentgenograms, metrizamide myelography, and discography in the as- sessment of patients with chronic low back syndrome.
Professor Van Mow provided me with generous resources during my sabbatical at Columbia University where I prepared most of the text purchase medrol 16mg mastercard. Bülent Atabek of The Catholic University of Amer- ica for his careful reading of the manuscript. Professor Atabek corrected Preface xi countless equations and figures and provided valuable input to the con- tents of the manuscript. DiMaggio of Columbia University, also spent considerable time reviewing the manuscript. Rukmini Rao Mirotznik enriched the text with her beautiful sketches and sublime figures. Chernow and her associates contributed to the book with careful editing and out- standing production. The abbreviations kg, m, N, and s stand, respectively, for kilogram, meter, Newton, and second. For simplicity, we omit the superscript when the reference frame is one that is fixed on Earth. Frequently, we omit this superscript when the text clearly indicates which point or body is being referred to. The biggest part of the human body is the trunk; comprising on the average 43% of total body weight. The thighs, lower legs, and feet constitute the remaining 37% of the total body weight. The frame of the human body is a tree of bones that are linked together by ligaments in joints called articulations. Unlike the frames of human-made structures such as that of skyscrap- ers or bridges, the skeleton would collapse under the action of gravity if it were not pulled on by skeletal muscles.
