Speaker A
So what exactly causes a stiff leg and more importantly, and something that's been coming up in the comments recently, is how do you normalize movement in a leg that seems to want to stay locked out all the time.
Learn how to address a stiff leg caused by spasticity or abnormal synergy patterns with targeted gait training exercises.
Key Takeaways
- Stiff leg is often due to spasticity or abnormal extensor synergy patterns after neurologic injury.
- Starting exercises with the knee bent helps prevent involuntary knee locking.
- Hip rotation exercises build foundational stability necessary for walking and mobility.
- Using assistive tools like a ball can facilitate early-stage hip flexion.
- Breaking abnormal synergy patterns is essential for regaining isolated leg movement.
Summary
- Stiff leg after brain or spinal cord damage is mainly caused by spasticity or abnormal synergy patterns.
- Spasticity involves involuntary muscle contractions, especially in muscles that straighten the knee.
- Abnormal synergy patterns, particularly extensor synergy, cause the hip, knee, and foot to move together, making isolated movement difficult.
- Extensor synergy pattern leads to difficulty lifting the leg and knee locking out during movement.
- Exercises should start with the knee bent to avoid the knee locking out and focus on hip internal and external rotation.
- Keeping the foot flat on a firm surface while rotating the hip helps build hip stability and control.
- Early-stage hip flexion exercises can be assisted with a ball to make lifting the leg easier and prevent leg flopping.
- Progression involves combining hip movement with knee bending to break up abnormal synergy patterns.
- Mastering these movements lying down is recommended before attempting standing or walking exercises.
- The goal is to isolate hip, knee, and ankle movements to improve gait and mobility after neurologic injury.
Full Transcript — Download SRT & Markdown
Speaker A
If you're new to this channel, I'm Tara, I'm a Neurologic Physical Therapist, and on this channel we cover anything and everything related to mobility and health in the context of Neurologic Rehabilitation.
Speaker A
With the end goal of empowering you with as many tools as possible to reach whatever level you want to reach after damage to your brain or your spinal cord.
Speaker A
And all that being said, today we are going to talk about a stiff leg. It is something that I've talked about before, but it has come up a couple of times with a couple of you regulars who I know have seen some of my other videos.
Speaker A
So I'm going to approach it at a little bit of a different level and really I would consider this more almost a follow-up to the recent video I did where I broke down gate and walking.
Speaker A
It definitely came up in the comments of that video of some of you having trouble to do certain movements in that video because your leg is stiff.
Speaker A
So, what are the two main reasons that might be causing your leg to feel stiff?
Speaker A
Things I've talked about before, two main culprits after damage to your brain or your spinal cord are spasticity.
Speaker A
So in the case of a stiff leg in the context of not being able to lift your leg, so I've done a ton of videos recently on the standing component of walking and how spasticity interferes with that.
Speaker A
But this is sticking with the lifting component of the leg, what might make it harder to lift your leg or for your leg to feel stiff when you're trying to lift it, and that is spasticity or involuntary muscle contraction in the muscles that straighten the knee out.
Speaker A
And I'll get into why you might be having difficulty with certain movements because of that in the next little section.
Speaker A
The other thing is abnormal synergy patterns.
Speaker A
I've talked a lot about this, there are normal synergy patterns where groups of muscles actually link together or they wire together to perform movements that are wrote or movements that we perform all the time.
Speaker A
It is good to have a few built-in codes so that your brain can just push those codes and groups of muscles will work together again to perform an activity or a movement that you do regularly.
Speaker A
However, there are also abnormal synergy patterns that are extremely common after damage to your brain or your spinal cord, the two main ones are a flexor pattern in the lower extremity and an extensor pattern in the lower extremity.
Speaker A
When the leg feels stiff or you feel like you can't lift that leg, whether you're laying on your back or you're walking and you're trying to swing that leg through.
Speaker A
Most likely that is due to an extensor synergy pattern, so the muscles that have linked up in an extensor synergy pattern are the muscles that extend the hip, straighten the knee and point the foot.
Speaker A
And if you have a strong ingrained extensor synergy pattern, those three movements will happen all together and it's hard to isolate just one component of that without the other two happening.
Speaker A
So that would definitely interfere with you being able to swing your leg forward if every time you try and swing your leg forward or move any direction at the hip, the knee wants to lock out straight.
Speaker A
And whether it's spasticity or an abnormal synergy pattern, it will feel near impossible to bend your knee, whether you're laying down or you're standing and you're trying to walk.
Speaker A
Most likely it's going to be even harder when you're standing up, so it's a good idea to master this movement laying down before going into some of those exercises that I showed in that previous video.
Speaker A
So, all that being said, today we're going to focus on how to address a stiff leg or start doing some drills or training activities to make it easier to bend your knee when you're standing up or how to isolate hip, knee or ankle movement without the other three movements happening.
Speaker A
So breaking up that abnormal synergy pattern, and the first one I would say would be to do movements with the knee already bent.
Speaker A
So you don't have to worry about trying to bend the knee, but somehow figuring out a way to get your knee bent and performing hip movements without the knee being able to straighten out.
Speaker A
This is a beginning exercise for hip internal and external rotation.
Speaker A
Anytime you're recovering from any kind of damage to your neurologic system, we always like to start proximal or closer to the core and kind of work outward, and the rotators are really important to build a foundation to build walking skills, standing skills.
Speaker A
Even getting in and out of bed, all of those things require really good stability around the hip.
Speaker A
So basically, the premise of this exercise, you want to keep your foot on the ground.
Speaker A
A lot of times people want to flex their hip up, so you want to keep the foot on the surface that you're laying on.
Speaker A
A firm surface usually works better, I reference this a lot, but a mat table is a really good investment for all of your foundational activities.
Speaker A
So for this one, you just want to keep that foot flat on the ground and just rotate that hip in and out without lifting the foot up off the surface.
Speaker A
So once again, you're going to lay with the involved leg bent.
Speaker A
And again, just rotating that hip in and out, working those hip rotators, gaining a little bit more control.
Speaker A
Now to build on that, in particular when it comes to being able to lift the leg for walking.
Speaker A
Now you want to try and do any hip movement and bend the knee at the same time, kind of breaking up that extensor synergy pattern, but also if you have spasticity in your quadriceps.
Speaker A
Really being able to perform movements without that involuntary movement of that knee locking out kicking in.
Speaker A
So this is hip flexion in the early stages.
Speaker A
So someone who cannot flex their hip up or lift their leg up at all, what the ball does is just help to make that movement just a little bit easier.
Speaker A
So this is a hip flexion exercise that you would do in the very early stages.
Speaker A
If you're someone that's helping someone with this exercise, you might just want to set someone up for success by stabilizing the ball a little bit and allowing it to just roll in one direction.
Speaker A
So that their leg does not flop out to the side, which is the most common thing that happens if someone is super, super weak and still in the very early stages.
Speaker A
So now the next step would be to instead of starting with your knee bent, start incorporating activities where you're bending that knee at the same time as performing some hip movements.
Topics:gait trainingstiff legspasticityabnormal synergy patternsneurologic rehabilitationhip rotation exercisesknee flexionextensor synergyphysical therapymobility recovery
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