What rehabilitation consideration should be factored for patients with L4 injury using an AFO?

For patients with an L4 injury using an Ankle-Foot Orthosis (AFO), the consideration of increased risk of falls due to weak hip extensors is crucial. The L4 spinal level corresponds to the innervation of key muscles involved in hip extension, primarily the gluteus maximus. Weakness in these muscles can lead to instability during ambulation, particularly when navigating uneven surfaces, initiating movement, or maintaining balance.

Furthermore, the use of an AFO may help stabilize the ankle and foot, but it does not compensate for instability from the hip extensors. Consequently, patients may find it difficult to control their posture and effectively manage their center of gravity, which can lead to falls. This highlights the importance of addressing hip stability during rehabilitation to reduce fall risk and enhance overall mobility and safety.

While the development of secondary complications, the potential future need for surgery, and high energy costs during activities are relevant considerations in rehabilitation, they do not directly address the immediate risks associated with muscle weakness affecting balance and mobility in patients with L4 injuries.