Jessica Kane’s Body Assessment: Page |1
Jessica Kane’s Body Assessment: Page |2
T a ble of Con t en t s
2
H ea lt h Qu est ion a ir e
3
Ra n g e of Mot ion (ROM), ROM 1
4
ROM 2 , 3
5
ROM 4 , 5
6
ROM 7 , 6 A
7
ROM 6 B, 8
8
ROM 1 0 , 9 A
9
ROM 9 B
10
Post u r a l A ssessm en t (POS) Fr on t a l
11
POS Sa g it t a l
12
POS Post er ior
13
Ov er h ea d Squ a t A ssessm en t (OH SA )
Fr on t a l
14
OH SA Sa g it t a l
15
OH SA Post er ior
16
OH SA Feedba ck
1 7 -1 8
G a it A n a ly sis (G A ) Pa r t A : Sa g it t a l
19
G A Pa r t A Ex pla n a t ion
2 0 -2 1
G A Pa r t B: Post er ior
22
G A Pa r t B Ex pla n a t ion
2 3 -2 4
Corrective Exercises
25-30
Table of
Contents
:
Jessica Kane’s Body Assessment: Page |3
Health History Questionaire
La st Na m e: Ka n e
Fir st Na m e: Jessi ca
A ddr ess: 123 Ch er r y T r ee La n e
Cit y : Gl a ssbor o
Pr im a r y Ph on e: (856)256-5555
Em a il: ka n ej76@ st u den t s.r owa n .edu
Best w a y t o con t a ct y ou : Ph on e - Em a i l - Bot h
Heig h t : 5'6
W eig h t : 128l bs
DOB: 4/12/91
M.I: M
St a t e: NJ
Gen der : F
Personal Medical History
Ph y sicia n : Dr . Pr i ce
La st ch eck -u p (X X /X X X X ): 12/2011
A r e y ou cu r r en t ly u n der a ph y sicia n 's ca r e? Yes - No
If y es, ex pla in : Un der gen er a l ph y si ci a n ca r e on a n eed-t o-go ba si s
Plea se list a n y oper a t ion s/su r g er ies a n d w h en per for m ed:
1
2
Plea se list a n y m edica t ion t a k en r eg u la r y a n d t h e r ea son for t a k in g it :
1
2
Current Medical History
Do y ou dr in k ? Y es - No
Do y ou sm ok e? Y es - No
Do y ou h a v e a n y pr eex ist in g con dit ion s? Y es - No
If y es, ex pla in :
Do y ou h a v e a n y ch r on ic/r eoccu r in g con dit ion s? Y es - No
If y es, ex pla in :
Lifestyle
Ra t e y ou r cu r r en t a ct iv it y lev el: Low - Moder a t e - A ct iv e
How oft en do y ou per for m ca r diov a scu la r ex er cise: Nev er - 1 -2 t im es/w k - 3-4 t i m es/wk - 5 + t im es/w k
How oft en do y ou per for m st r en g t h t r a in in g : Nev er - 1-2 t i m es/wk - 3 -4 t im es/w k - 5 + t im es/w k
How oft en do y ou st r et ch : Nev er - 1 -2 t im es/w k - 3-4 t i m es/wk - 5 + t im es/w k
Do y ou ex per ien ce t h e follow in g du r in g a ct iv it y : Ch est pa in s - Gen er a l fa t ig u e/t ir edn ess - Dizzin ess Pr essu r e ov er t h e h ea r t - Sh or t n ess of br ea t h e - Bla ck in g ou t
List a n y ot h er sy m pt om s/a ilm en t s r elev en t w h en pa r t icipa t in g in ph y sica l a ct iv it y :
1 A st h m a
2
Ra n k y ou r fit n ess g oa ls fr om 1 t o 1 0 (1 bein g t h e m ost im por t a n t t o y ou ):
(1) In cr ea se en er g y
(9) Ga in w eig h t
(6) En joy m en t
(2) Resh a pe/r et on e body
(5) Redu ce body fa t
(7) Im pr ov e flex ibilit y
(3) Ca r diov a scu la r fit n ess
(8) In cr ea se st r en g t h
(4) Lose w eig h t
In y ou r ow n w or ds, w h a t is y ou r fit n ess g oa l/in it ia t iv e: T o m a i n t a i n a h ea l t h y l i fest y l e speci fi ca l l y
t o decr ea se t h e r i sk of fu t u r e i n ju r y or di sea se.
Jessica Kane’s Body Assessment: Page |4
Range of Motion Assessment Results
1) Cervical Flexion/Extension
Fl exi on
Ext en si on
Pla n e: Sa g it t a l
A x is: Mediola t er a l
Deg r ees: 4 5 ᶱ
Deg r ees: 6 5 ᶱ
A v g . ROM: 6 0 ᶱ
A v g . ROM: 7 5 ᶱ
A n y a bn or m a lit ies: Flex ion of cer v ica l spin e is a bn or m a l (1 5 ᶱ < t h a n a v g . ROM), ex t en sion of cer v ica l
spin e is slig h t ly a bn or m a l (1 0 ᶱ < t h a n a v g . ROM)
If y es, ex pla in pot en t ia l a ffect :
Jessica Kane’s Body Assessment: Page |5
2) Lateral Cervical Flexion (Right/Left)
Ri gh t
Left
Pla n e: Fr on t a l
A x is: A n t er opost er ior
Deg r ees: 4 5 ᶱ
Deg r ees: 4 5 ᶱ
A v g . ROM: 4 5 ᶱ
A v g . ROM: 4 5 ᶱ
A n y a bn or m a lit ies: NONE
If y es, ex pla in pot en t ia l a ffect : NONE
3) Rotation of Cervical Vertebrae (Right/Left)
Ri gh t
Left
Pla n e: T r a n sv er se
A x is: V er t ica l
Deg r ees: 7 5 ᶱ
Deg r ees: 8 0 ᶱ
A v g . ROM: 8 0 ᶱ
A v g . ROM: 8 0 ᶱ
A n y a bn or m a lit ies: Cer v ica l r ot a t ion t o t h e r ig h t side h a s a slig h t a bn or m a lit y (5 ᶱ < t h a n a v g . ROM)
If y es, ex pla in pot en t ia l a ffect :
Jessica Kane’s Body Assessment: Page |6
4) Abduction of the Glenohumeral Joint (Right/Left)
Ri gh t
Left
Pla n e: Fr on t a l
A x is: A n t er opost er ior
Deg r ees: 1 9 0 ᶱ
Deg r ees: 1 9 5 ᶱ
A v g . ROM: 1 7 0 ᶱ
A v g . ROM: 1 7 0 ᶱ
A n y a bn or m a lit ies: A bdu ct ion of t h e g len oh u m er a l join t is a bn or m a l in bot h t h e r ig h t a n d left a r m (2 0 ᶱ >
t h a n a v g . ROM in r ig h t a n d 2 5 > t h a n a v g . ROM in left )
If y es, ex pla in pot en t ia l a ffect :
5) Flexion of the Glenohumeral Joint
Ri gh t
Left
Pla n e: Sa g it t a l
A x is: Mediola t er a l
Deg r ees: 1 7 5 °
Deg r ees: 1 8 0 °
A v g . ROM: 1 8 0 °
A v g . ROM: 1 8 0 °
A n y a bn or m a lit ies: Flex ion of t h e g len oh u m er a l join t is slig h t ly a bn or m a l t h e r ig h t a r m ( 5 ᶱ > t h a n t h e
a v g . ROM)
If y es, ex pla in pot en t ia l a ffect :
Jessica Kane’s Body Assessment: Page |7
7) Extension of the Acetabulofemural Joint (Right/Left)
Ri gh t
Left
Pla n e: Sa g it t a l
A x is: Mediola t er a l
Deg r ees: 0 ᶱ
Deg r ees: 0 ᶱ
A v g . ROM: 0 ᶱ
A v g . ROM: 0 ᶱ
A n y a bn or m a lit ies:
If y es, ex pla in pot en t ia l a ffect :
6A) Internal Rotation of the Glenohumeral Joint (Right/Left)
Ri gh t
Left
Pla n e: Sa g it t a l
A x is: Mediola t er a l
Deg r ees: 7 0 ᶱ
Deg r ees: 7 0 ᶱ
A v g . ROM: 7 0 ᶱ
A v g . ROM: 7 0 ᶱ
A n y a bn or m a lit ies: NONE
If y es, ex pla in pot en t ia l a ffect : NONE
Jessica Kane’s Body Assessment: Page |8
6B) External Rotation of the Glenohumeral Joint (Right/Left)
Ri gh t
Left
Pla n e: Sa g it t a l
A x is: Mediola t er a l
Deg r ees: 8 5 ᶱ
Deg r ees: 7 5 ᶱ
A v g . ROM: 9 0 ᶱ
A v g . ROM: 9 0 ᶱ
A n y a bn or m a lit ies: Ex t er n a l r ot a t ion of t h e g len oh u m er a l join t is slig h t ly a bn or m a l in t h e r ig h t a r m (5 ᶱ <
t h a n t h e a v g . ROM), a n d is a bn or m a l in t h e left a r m (1 5 ᶱ < t h a n a v g . ROM)
If y es, ex pla in pot en t ia l a ffect :
8) Flexion of the Acetabulofemural Joint (Right/Left)
Ri gh t
Left
Pla n e: Sa g it t a l
A x is: Mediola t er a l
Deg r ees: 8 5 ᶱ
Deg r ees: 8 0 ᶱ
A v g . ROM: 3 0 ᶱ
A v g . ROM: 3 0 ᶱ
A n y a bn or m a lit ies: Flex ion of t h e a cet a bu lofem u r a l join t is a bn or m a l in bot h t h e r ig h t a n d left leg (5 5 ᶱ >
a v g . ROM in r ig h t , a n d 5 0 ᶱ > t h a n a v g . ROM in left )
If y es, ex pla in pot en t ia l a ffect :
Jessica Kane’s Body Assessment: Page |9
10) Flexion of the Tibiofemural Joint (Right/Left)
Ri gh t
Left
Pla n e: Sa g it t a l
A x is: Mediola t er a l
Deg r ees: 1 4 5 ᶱ
Deg r ees: 1 4 5 ᶱ
A v g . ROM: 1 4 5 ᶱ
A v g . ROM: 1 4 5 ᶱ
A n y a bn or m a lit ies: NONE
If y es, ex pla in pot en t ia l a ffect : NONE
9A) Internal Rotation of the Acetabulofemural Joint (Right/Left)
Ri gh t
Left
Pla n e: Fr on t a l
A x is: A n t er opost er ior
Deg r ees: 3 5 ᶱ
Deg r ees: 4 0 ᶱ
A v g . ROM: 3 5 ᶱ
A v g . ROM: 3 5 ᶱ
A n y a bn or m a lit ies: In t er n a l r ot a t ion of t h e a cet a bu lofem u r a l join t is slig h t ly a bn or m a l in t h e left leg (5 ᶱ >
t h a n a v g . ROM)
If y es, ex pla in pot en t ia l a ffect :
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 10
9B) External Rotation of the Acetabulofemural Joint (Right/Left)
Ri gh t
Left
Pla n e: Fr on t a l
A x is: A n t er opost er ior
Deg r ees: 4 0 ᶱ
Deg r ees: 3 5 ᶱ
A v g . ROM: 4 5 ᶱ
A v g . ROM: 4 5 ᶱ
A n y a bn or m a lit ies: Ex t er n a l r ot a t ion of t h e a cet a bu lofem u r a l join t is slig h t ly a bn or m a l in bot h t h e r ig h t a n d left leg
If y es, ex pla in pot en t ia l a ffect :
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 11
Postural Assessment Results
Frontal View
A r ea
A ssessed
Y/N
If Y/N…
R/L/Bot h ,
In /Ou t
Ey es a llig n ed
Y
If n o, w h ich side is
h ig h er ?
/
A SIS a llig n ed
Y
If n o, w h ich side is
h ig h er ?
/
Pa t ella h eig h t
ev en
N
If n o, w h ich side is
h ig h er ?
Left
Pa t ella fa ces
for w a r d
Y
If n o, fa cin g
w h ich w a y ?
/
Gen u v a lg u m
Y
If y es, w h ich side?
Left
Gen u v a r u m
N
If y es, w h ich side?
/
Feet fa ce
for w a r d
N
If n o, w h ich foot
fa ces w h ich w a y ?
Rig h t fa cin g
slig h t ly
ou t w a r d
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 12
Sagittal View
A r ea A ssessed
Y/N
If Y/N…
R/L/Bot h
H ea d pr ot r u ded
Y
/
/
Pr ot r a ct ed sh ou lder g ir t le
N
/
/
Ky ph osis
N
/
/
Ex cessiv e lor dosis
N
/
/
Redu ced lor dosis
Y
/
/
G en u r ecu r v a t u m
N
If y es, w h ich side?
/
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 13
Posterior View
A r ea
A ssessed
Y/N
W in g ed sca pu la Y
If Y/N…
R/L/Bot h
If y es, w h ich side?
Left
Feet ev er t ed
Y
If y es, w h ich foot ?
Left
Feet in v er t ed
N
If y es, w h ich foot ?
/
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 14
Overhead Squat Assessment Results:
Anterior View
A r ea
A ssessed
Y/N
If Y/N…
R/L, Wh i ch
wa y
Kn ees a lig n
w it h foot
N
If n o, w h ich
on e/w h ich w a y ?
Rig h t , v a lg u s
Feet fa ce
for w a r d
N
If n o, w h ich
on e/w h ich w a y ?
Rig h t , a bdu ct
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 15
Sagittal View
A r ea A ssessed
Y/N
If Y/N…
Resu l t
Nor m a l for w a r d flex ion
Y
/
/
Nor m a l lu m ba r lor dosis
N
If n o is it ex cessiv e or
r edu ced?
/
A r m s r em a in in lin e
Y
/
/
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 16
Posterior View
A r ea
A ssessed
Y/N
If Y/N…
R/L
Feet ev er t ed
Y
/
/
H eels r ise off
floor
N
/
/
A sy m m er t r ic
a l sh ift
N
If y es, w h ich side?
/
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 17
Above are the results and observations taken from my evaluation on Jessica doing an
overhead squat assessment. Non-excessive misalignments were identified that are very
common in the human aesthetic, but can still lead to potential injuries if not corrected.
Beginning by analyzing her overhead squat assessment from the anterior view, I noticed
during her five repetitions that Jessica’s right leg buckled in slightly each time she bent
into position. When looking at her photograph, her right foot is abducted to the side,
stemming from her patella being slightly externally rotated at the patellofemral joint.
Because of this rotation I was able to identify a petty valgus forced applied to her right
leg.
I can confidently conclude that Jessica’s right hip is externally rotating, which is causing
the entire leg to face slightly outward. Her piriformis, quadratus femoris, obturator
externus and other external rotator muscles are tight and over active. I would advise
Jessica to do exercises like the wall squat/ball squeeze (press your head, shoulders and
back against a wall, slide down and lower your hips to the ground until the back of your
legs are parallel to the ground, place ball between your thighs and squeeze, maintaining
the tension in your thighs.) This will strengthen her hip adductors to pull and rotate her
thighs and hips inward and reinforce proper knee alignment. Along with strengthening
theses muscles, I would recommended stretches like the lying hip abductor stretch to
target the gluteus minimus muscles (lie on your back with your shoulders pressed into
the floor, cross your left leg on top of your right, twist your hips to the left and lower
your right knee to the floor to your left.) This outward rotation in her leg is normal, but
can cause potential problems, like medial knee pain, possible meniscus tearing and
ligament damage.
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 18
Jessica’s overhead squat sagittal view revealed an excess lordosis of the lumbar spine.
Excess lordosis is a hyperextension of the lumbar spine, caused by an anterior pelvic tilt
of the lumbo-pevlic hip complex. Muscles such as the superficial erector spinae, tensor
fasciae latea, and hip flexor muscles iliopsoas (iliacus, psoas major, psoas minor) and
rectus femoris are tight and over active. This indicates the under activity of the
transverse abdominals, deep erector spinae, and gluteus maximus and medius. We have
to strengthen these weak muscles and stretch the tight ones to evenly distribute muscle
activeness to improve her posture, before her lordosis leads to hamstring strains and
lower back pain. A basic lunge stretch can open up and stretch tight hip flexors, and
sitting in a cat stretch (child’s pose) will allow a concave deep stretch of the superficial
erector spinae. Core training is essential to help pull your lumbo-pelvic hip complex
forward (posteriorly rotate back into neutral anatomical position.) Benefits of good core
strength include reduced back pain, improved athletic performance, and improved
postural imbalances; all these characteristics are affected by an excess lordosis. A list of
core strengthening exercises include: the basic push up, v-sits, oblique twists, planks on
balance ball, and many more.
As for the posterior view of the overhead squat assessment, there isn’t photographic
evidence of any imperfections. The only imperfection was that during her squat there
was a slight “bump” in her rhythm of her lowering into position; this could be seen by all
views, but was especially clear when watching her from the back.
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 19
Gait Analysis Results:
Picture: Sagittal
View
PART A
Heel St r i k e
Foot Fl a t
Mi d-st a n ce
Heel -off
T oe-off
Hi p
Posi t i on
Flex ion
Flex ion
Neu t r a l
Ex t en sion
Ex t en sion
Kn ee
Posi t i on
Ex t en sion
Ex t en sion
Ex t en sion
Ex t en sion
Flex ion
A n kle
Posi t i on
Dor siflex ion
Dor siflex ion
Dor siflex ion
Pla n t a r flex ion
Pla n t a r flex ion
In i t i a l Swi n g
Mi d-swi n g
T er m i n a l Swi n g
Ex t en sion
Flex ion
Flex ion
Flex ion
Flex ion
Ex t en sion
Picture: Sagittal
View
St a n ce
Ph a se
Swi n g
Ph a se
Hi p
Posi t i on
Kn ee
Posi t i on
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 20
A gait cycle is the rhythmic alternating movements of the two lower extremities which
result in the forward movement of the body. Simply stated, it is the manner in which we
walk. The cycle is divided into two phases, stance and swing; the stance phase
completing the first 60 percent of the cycle. In Jessica’s analysis above, her left leg is
moving through every position of gait.
In the stance phase, the heel strike is the initial movement that makes contact to the
ground. Your foot should be inverted while having your tibia externally rotated. If the
foot strikes everted, a driving force gets sent up the kinetic chain of the body. Also, if
your working foot supinates too much, it can lead to a potentially rolled ankle.
The following three positions are what consist of the mid-stance motion. First, in
loading response, your foot should be flat on the ground with your center of gravity
slightly behind you. Mid-stance is when your center of gravity directly over your foot.
Terminal stance is when your working foot is now behind you and your center of gravity
is slightly in front. The working foot should pronate with the tibia internally rotated; the
result of over-supinating the foot at this point in the gait cycle is commonly known as
shin splints. Throughout this action, the hip position transitions from flexion to
extension and the foot from dorsiflexion to plantar flexion. The knee joint generally
remains extended, unless you are evaluating a gait cycle while jogging, therefore your
knees may be in slight flexion, easing up the amount of pressure and force affecting the
kinetic chain all the way up to the ASIS.
This engages the pre-swing, where the foot loses contact with the ground first from the
heels and then the toes to be in a ready position to start the swing phase. This motion is
what propels you forward. Similar to the mid-stance motion, the swing phase has its
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 21
own 3-step mid-swing motion that initiates in a foot swing to switch over to the opposite
leg. After toe-off, Jessica’s left foot begins in the initial swing, requiring your hip flexor
muscles to be activated. Mid-swing is when your center of gravity once again is directly
over your foot. Terminal swing is the stepping forward action that subsequently begins
the cycle all, starting with the heel strike. The force exerted throughout these three
phases first accelerates then decelerate by the end. The hip positioning regresses from
extension back into flexion, so does the foot from plantar flexion to dorsiflexion. The
knee is in flexion during the swing movement to be in position to then extend forward
and being the cycle again.
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 22
Picture: (Posterior
View)
PART B
St a n ce
Ph a se
Heel st r i k e
Fl a t foot
Mi d-st a n ce
Heel -off
T oe-off
Foot
Posi t i on
Su pin a t ion
Su pin a t ion
Neu t r a l
Pr on a t ion
Pr on a t ion
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 23
I was able to assess Jessica posteriorly to determine any abnormalities with her foot
mechanics that may lead to potential injury. The work leg I have focused on in the above
chart is the left leg.
Jessica’s foot during her initial heel strike to make contact with the ground is slightly
supinated, which is the correct positioning of walking. You can see that her patellars
however are facing outward rather than forward. This means that the external rotation
action is being fulfilled and developed by the hip instead of the tibia. To correct this,
Jessica can strengthen her hip adductor muscles that will potentially reposition the
direction the front of the leg is facing.
If over-supination occurs in the foot at this time during the cycle, there is an increased
chance of a rolled ankle injury. Excessive inversion is one of the most common
mechanisms of injury. (The words supination and inversion are often interchanged, but
provide different functions.)
The video of her posterior gait assessment showed that her weight seemed to be
transferring from side to side instead of remaining level. This is formally identified as a
lateral pelvic shift, where your weight and center moves about 1-2 inches outside the
base support. Sub sequentially this can lead to your tibia internally rotating, flattening
your arch and pronating the foot. This is an interesting discovery in Jessica’s
assessment, because this observation taken from the video of her gait does not reflect
the one cycle pictured in the chart above.
What we cannot see because of the footwear warn by Jessica is if there are any
abnormalities with her tibialis posterior which runs down the back of the tibia and
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 24
attaches at the foot, acting as an anti-pronator. Pronation is caused by abduction and
dorsiflexion, while supination is cause by adduction and plantar flexion of the foot. We
can identify that the tibilalis posterior is weak when over-pronation occurs. And if it
does, shin splints may occur.
The loading, mid-stance, and terminal motions the leg travels through to accomplish a
successful step forces the foot's to transition from pronation into supination. This is due
to the amount of force driven down into the foot and where that weight is transferred on
what part of the foot. During the beginning of the mid-stance movement from flat foot
to mid-stance, the foot positioning remains in supination after the heel strike. When the
body is aligned vertically and the weight is distributed directly over the working foot, we
see a neutral positioning in Jessica’s foot. Heel-off and toe-off is when the foot slips into
pronation, while the leg remains externally rotated.
J e s s i c a K a n e ’ s B o d y A s s e s s m e n t : P a g e | 25
Corrective Exercise Program:
After completing Jessica Kane’s body assessment, I can now knowledgably create and
workout outline to correct and improve her bodies dysfunctions. She had expressed in
her health questionnaire that her main fitness goal is “to maintain a healthy lifestyle
specifically to decrease the risk of future injury or disease.” I’ve developed an exercise
program for her to follow to attain this goal. I looked at specifically what body
dysfunctions could potentially lead to an injury/impair her physically ability if injured,
and presented exercises to improve them.
Before discussing and teaching Jessica any exercises or stretches specific for her body
ailments, I will first emphasize the importance and teach her how to properly execute
the pelvic tilt. All exercises focus on maintaining the neutral spine position, which is
what we obtain during this exercise; this is because without proper spine alignment you
run the risk of increased chance of injury and performing the exercise without the
anticipated results. First, I would lie Jessica
PELVIC TILT EXERCISE:
down on her back with her knees bent and
feet flat in a parallel position on the floor.
Next I would ask her to slide her hands in
between the area of where her spine does
not hit the floor and she should feel a slight
arch in the lumbar area (slight lordosis). At
this point I would ask her to first squeeze her abdominals and bring her belly button to
her spine, trying to lower her entire back on the floor (posterior tilt of the pelvis). After
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holding for ten seconds, I would move her to the opposite position of arching her back
off the floor (excessive lordosis). By repeating these positions Jessica should be able to
tell the difference in the placement of her hips. Right in between both is her neutral
spine position that she should practice obtaining in every exercise I prescribe to her.
Beginning with Jessica’s range of motion assessment, it was confirmed that there was a
slight abnormality while abducting at the glenohumeral joint in both of her arms; they
exceeded the average range of motion by 5ᶱ on her right, and 10ᶱ on her left. That leads
me to believe that the muscle whose primary purpose is to stabilize and restrict the joint
from exerting itself in an excess range of motion is weakened. These muscles are known
as the rotator cuff muscles (supraspinatus, subscapularis, infraspinatus, teres minor)
and serve the function of pulling the head of the humerus into the glenoid fossa to
stabilize the glenohumeral joint. If we don’t strengthen these muscles it could
potentially lead to tearing of the rotator cuff, pectorals major or anterior deltoid
muscles.
The supraspinatus muscle is the main agonist for abduction during the first 10ᶱ-15ᶱ of
motion before the deltoid muscle engages the rest of the movement. When the
supraspinatus is weakened, it indicates an increased risk of shoulder injury. This runs
hand in hand with common body deformity that develops as a result of this weakness
known as a “winged scapula”, where the shoulder blade protrudes out of the back rather
than lying against the back of the chest wall. We need this muscle to engage in the full
range of motion for it to be strengthened, but if it is injured it must be rested and not
exerted in order for it to recover.
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FRONTAL/LATERAL DUMBBELL RAISE:
A corrective exercise I would instruct Jessica
to do to strengthen this muscle is a frontal
and lateral dumbbell raise. I will have Jessica
begin
by
grasping
onto
light
weight
dumbbells to perform this exercise (because
we are training smaller muscles, so heavier
weights aren’t necessary). I’ll guide her to raise her arms out in front with a slight bend
in the elbow to reach her shoulder height, then lower back down slowly. A high number
of reps and slow control of this exercise will make it most effective. I can also have
Jessica engage in the same exercise but raise her arms laterally, following the same rep
guidelines. She should be inhaling during the concentric contraction (rising of the arms)
and exhaling during the eccentric contraction (lowering of the arms).
A second dysfunction I noticed during Jessica’s range of motion analysis in both of her
glenohumeral joints while engaging in flexion. She has a limited range in motion during
this action (170ᶱ compared to the average of 180ᶱ). You can notice in her photos that
both her elbows were slightly flexed. We also see that her back is arched (more so in left
photo), and her head is slightly protracted (more so in right). These factors lead me to
conclude that her latissimus dorsi is too tight (causing excess lordosis) and that the
anterior deltoids, pectoralis major, and long and short head of the biceps brachii are
underactive and need to be strengthened.
Because these impairments are minor and generally do not effect daily living situations,
clients may question why we need to work on adjusting these issues. What is the
difference between flexion the joint completely at 180ᶱ and having the angle lower? Why
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is it important? Reiterating Jessica’s fitness goal, she wishes to prevent any chance of
future injury or illness. An incident may occur where she falls down on an outstretched
arm. If her glenohumeral joint has the inability to motion through the complete range of
motion, then she may tear rotator cuff muscles and the anterior deltoid if it is forced
past its __ point. Even the kinetic chain of the fall will be broken and more force will be
exerted, thrusting the head of the humerus in an improper position, possibly causing
impingement or dislocation of the shoulder. We have to think ahead and prepare for the
possibility of injury occurrence.
The pectoralis major muscle is indirectly responsible for
DOORWAY STRETCH:
this lack of range by contributing to the protraction of the
shoulder girdle, by grabbing onto the humerus and
bringing it anteriorly.
Its muscle fibers pull from the
clavicular and sternal head, and insert bicipital groove of
the humerus and crest of the greater tubercle. Due to the
under activeness of this muscle, I would recommend the
doorway stretch for Jessica. I will have her stand in a doorway facing perpendicular to
the wall. Placing the working arm on the posterior side of the wall, she can turn body
away from the arm and hold the stretch for 20-30 seconds then repeat with the opposite
side.
Impingement is the shoulder is a common injury that causes shoulder and upper
extremity pain. This occurs often because when not trained properly, the humerus can
be forced in an inappropriate position that causes injury. The supraspinatus is a rotator
cuff muscle occupies the sub-acromial space between the acromion and humerus. The
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other three rotator cuff muscles depress the humerus downward to prevent jamming of
the supraspinatus into the acromion. Now, between 70ᶱ and 120ᶱ of motion is when the
humerus is not externally rotated, and holds the
highest chance of injury. I would recommend that
Jessica engages in rotator cuff strengthen exercises
to stabilize the glenohumeral joint so injuries such
as this will not occur. The corrective exercise I
would show her is the internal and external
rotation exercise using a resistance band. I will
have her stand about 3 feet away from the wall with
the anchored band, grasping the light weight band with her elbow flushed against her
side at a 90ᶱ pointing forward. I will instruct her to bring the weight out laterally
without loosing placement of the elbow, and then through the middle position medially
to around 45ᶱ. She can repeat this 10-12 reps with 2-3 sets on each side. Throughout this
entire exercise I will have her focus in on engaging the core and maintaining the neutral
spine position with her knees slightly bent for some give.
Moving on to the overhead squat assessment, Jessica’s right foot and knee were facing
outward.