Hello, welcome to the Balanced Body podcast.
I'm Lindy Royer, physical therapist, founder of PacMeta's Pilates and Physical Therapy
in Lone Tree, Colorado, and Balanced Body faculty member.
I'm here today with my friend Krista, who's going to help us look at some of the structures
that influence the knee, particularly when we're going through a rehabilitation program
of a knee patient.
Today we're going to look in a couple of exercises at the difference between gastroc
and soleus complex.
Gastroc obviously is a muscle that inserts above the knee, so has direct influence over
the knee joint.
Soleus, however, influences us, particularly with propulsion, and influences our lower
extremity through the ankle.
So we're going to look at two different exercises that can target these two different muscles
to help us sort out a little better which muscle may or may not be more dominant in
our patient.
So Krista, we're going to do a single leg press here.
I'm going to help Krista get into position by pressing the pedal down.
So we have just one spring here so that we can smoothly transition from one exercise to
the other, and you'll see in a moment that one spring is going to be plenty for the exercises
that we're doing.
So I like to start with the pedal down because it's much more easy for our patients and clients
to get into a balanced pelvis position than if we start in more hip or knee flexion.
So I'm just going to float the pedal up, and it's going to be a lot more challenging for
her to maintain pelvic alignment with the pedal in this position because it's an increase
in hip flexion.
So we're going to start in this position, and then Krista's going to place her hands
just lightly on the handles.
Now we want to have light balance as little as possible, actually, rather than having a
death grip on the handles because then clearly we're not going to be challenging balance
and stability if our patients are relying solely on upper extremity.
I'm going to take my foot off the pedal now, and Krista's now going to maintain her alignment.
We're looking for balanced support through both extremities for right now, understanding
that our left leg is going to be moving.
So starting in this position, Krista's going to ground herself through her right leg.
She's on the ball of her left foot.
As you start to inhale, can you allow the pedal to float up?
So we're just going to let her explore a range of motion of hip and knee flexion on
the left side, and looking to see is she able to maintain stability through the right side.
If we're not able to do this, then we won't obviously proceed on to the next phase of
the exercise.
So now can you bring the leg up about halfway?
So we're going to ask Krista to maintain a position with her left leg, where she's about
halfway between pedal all the way down and all the way at the top of the spring.
And now take another breath in, and what Krista's going to be doing is floating the right heel
up.
As you exhale, she's coming up onto the ball of the foot.
As you inhale, we're looking for control as she lowers her right foot down onto the floor.
Her left foot is maintaining its position.
This is quite challenging.
This is actually a really great core exercise because there's a lot that has to be organized
through the core in order to maintain this.
What I'm looking at here, and I really want to look at her from a variety of angles and
positions, is she able to both concentrically and eccentrically control this position?
And is she also able to maintain alignment through the ball of the foot?
So we're looking at foot mechanics, ankle mechanics, and lower extremity mechanics as
connected to obviously a nice stable torso and well-organized upper extremity.
As Krista gets more comfortable with this, and before she fatigues, I'd like her to
see if she can take her hands off the handles and see if you can do just one or two of these.
Now you'll notice as we start to challenge the balance and stability even more, she's
probably going to have a little bit less range of motion through the foot and the ankle,
which is totally fine.
So this is a really great challenge.
We're really looking at how the gastroc influences the whole lower chain.
Beautiful.
And place your hands back on the handles and let the pedal come up.
And now we're going to continue.
We're going to be working now on the left leg since she's done so much great work.
This is actually an excellent transition.
We're going to come into an Achilles stretch on the left leg.
So Krista's going to lower her hands down onto the chair, lengthening through the back
of the right leg.
So she's actually getting a nice little gastroc stretch here just by getting into position.
We're now going to find that alignment, again, optimal position through the torso.
I'm looking here at whether her pelvis is aligned.
So there's a tendency as we go into this position to really hike up that left hip.
Occasionally she might start to load into the right, but usually what we'll see is more
of a hike on the left hip.
So I'm going to just ask her to lengthen through the left sit bone.
Her right knee, just at the patella, is placed lightly just for tactile cueing on the front
of the chair.
And then you're going to lengthen through the arm.
She's creating support through her shoulder girdle, also through her torso, so she has
that lovely sense of being organized through the center between ribs and pelvis, and then
organized through the shoulder girdle down into the hands.
Take a breath in.
As you exhale, press the pedal down with that left leg.
So now we're looking at dorsiflexion, planiflexion on the left side.
But because the knee is bent, we're focusing more on the soleus complex.
Again, even though the soleus does not attach directly to the knee, it directly influences
the lower leg and is used a huge amount in propulsion.
So we want to have a balanced gastro-soleus complex.
And as we're looking at this exercise, I get I'm looking at, is she able to eccentrically
and concentrically control that soleus?
We use the soleus far more eccentrically functionally than we do concentrically.
So this is a really important part of knee and ankle and foot rehabilitation.
And Chris is going to finish that one.
And again, we can look at alignment and control.
You're going to bring yourself back into standing.
Coming back up into your starting position.
So that is a way to look at gastro-soleus complex using the combo chair in knee and
lower extremity rehabilitation.
Thank you very much, Christa.
Thank you for watching.
