Titre du mémoire :
SIGNE DE TRENDELENBURG POSTURAL ET SEMELLES DE POSTURE : TRAITEMENT DE CHOIX DANS LA STABILITE PODO-PELVIENNE ET LE TONUS RACHIDIEN
Dirigé par Pierre-Olivier Morin.
JURY : Christian Chotar Vasseur, François-Xavier Grandjean, Thierry Mulliez, Philippe Villeneuve
Le but de cette étude est de confirmer la présence de synergie neuromusculaire podo- pelvienne. Soit de démontrer que le traitement par semelles de posture a non-seulement une action locale en augmentant le temps d’appui unipodal, mais aussi des actions plus étendues avec l’amélioration de la stabilité pelvienne en unipodal et la modification de la cinématique spinale.
Improvement of pelvic stability by neurosensory insoles
Background and aim
In podiatric practice, pelvic instability and its consequences are one of the most common reasons for consultations. Low back pain (Nadler et al, 2000), knee injuries (Ireland et al, 2003) and ankle instability (Friel et al, 2006) have all been reported to be related to pelvic instability.
The aim of this study is to confirm the presence of pelvic-foot neuromuscular synergy and to demonstrate that postural treatment with neurosensory insoles improves pelvic stability, increases the duration of unipodale stance and changes spinal kinematics.
26 participants with unilateral pelvic instability and an ankle strategy were evaluated after 8 weeks of treatment. 12 additional participants served as a control group.
Results were recorded from three randomized tests:
The single leg stance test evaluates stability. The test timed and stopped after 45 consecutive seconds. It was repeated up to three times in the event of a fail test.
The clinical posturodynamic test evaluates the quality of postural response to a lateral spinal late ral flexion. Four spinal segments were controlled (cervical, thoracic, lumbar, and pelvis) for the right and left sides of the body. The test was repeated on foam to assess the role of the plantar exteroception.
The unipodal test of pelvic stability is a monopodal stance used to test for functional disorder of the hip abductors.
The location of the plantar inserts on the insoles was determined by the practicing podiatrist following clinical examination of the patient. The inserts did not exceed 3 millimeters in thickness.
Degrees of pelvic instability varied following treatment with Khi² test results of p < 0.001.
After treatment, there was a significant increase of the time of the monopodal task (p=0.001), on both limbs.
Results of the clinical posturodynamic test also showed changes after use of neurosensory insoles (p=0.008).
The results indicate that neurosensory insoles contribute to increased unipodal stability, improve pelvic stability and a change in spinal kinematics in the frontal plane.
This study suggests that neurosensory soles affect not only the foot-ankle complex but also, due to this pelvis-foot neuromuscular synergy, the stability of the pelvis and spinal kinematics.
This is supportive of the presence of a neuromuscular synergy between the pelvis and foot.
Further prospective studies should evaluate the impact of the single leg stance test and the unipodal test of pelvic stability in the development of limb injury and low back pain in athletes.
Keywords: pelvic stability, ankle instability, neurosensory insoles.