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GIM-CASE
STUDY
SCOLIOSIS
| Notes:
We saw significant chest breathing, which indicates
an inhibition of the diaphragm and therefore lack
of intra-abdominal pressure through reduced inner
unit function. This may lead to increased hyper-tonicity
in the accessory respiratory muscles of the neck,
which leads to a forward head carriage and a preference
for mouth breathing which only compounds the situation.
This also leads to the pectoralis minor pulling
the shoulders forward and compressing the brachial
plexus leading to referred sensations or lack
of function in the extremities.
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1 Leg Standing
Notes:
On 1-leg standing we saw a significant
drop in the pelvis on the right side to the stance leg.
This may indicate a weakness in the lateral glutes and
a subsequent over-activity in the left QL.
On 1-leg squatting we
saw more hip adduction and lateral shift on the right.
There was also less ankle movement on the right, which
may be due to the inability to unlock the foot.
Squatting
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Notes:
Edmund was rotated to the right due to restriction
in the right ankle, which can be observed from the
front and rear. In order to achieve this range of
motion Edmund’s ankles over pronate to allow
for increased dorsi-flexion
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Push & Pull
Notes: upon shoulder abduction
we saw a marked elevation of the right shoulder
girdle indicating instability.
This was confirmed on the push assessment by
the exaggerated winging on the right.
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Gait
Notes:
During the stance phase of walking we noticed
significant restriction around the left hip and
an increased need for lateral hip movement on
the right to accommodate for this. On the left
we saw a marked internal rotation of the hip also
coupled with exaggerated lateral movement. This
confirms the lateral glute weakness and Edmunds
inability to control his mass on 1 leg.
During the left swing phase, not only did we
notice and increased need for the right knee to
roll in to load up the glute, but also a external
rotation of the tibia indicating hip flexor (and
hamstring) dominance and again glute weakness.
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TMJ
Notes:
If we take a look at Edmund’s neck and head
position we can see a lateral flexion to the right
coupled with a rotation to the right. The lateral
flexion is a result of a lateral tilt in the left
pelvis and then a subsequent gravitational response
from the upper trapezius to maintain balance.
The rotation may be a result of a anterior rotation
of the left ilia and therefore a reciprocal rotation
from the cervical. This shortness in the left
SCM pulling in the temporal bone, create a muscular
reaction in the temporalis on the right.
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Programme objectives:
Our
initial focus will be to get Edmund activating his diaphragm
in the breathing process. This will not only take the
pressure off of the neck muscles and shoulders it will
help to re-align his pelvis and reduce visceral compression.
I would like to then focus on his 1-legged stability.
I will release his muscles around the right pelvic bone
and then attempt to strengthen the lateral glutes to
resist the pull of the adductors.
Strengthening the glutes and increasing the motion
in the right pelvic bone will take the pressure of off
the left hamstring and pelvic ligaments, which will
alleviate the discomfort experienced during walking.
We will also need to create end-range strength in his
shoulder lateral rotators (especially the right) and
shoulder girdle retractors to help maintain shoulder
alignment and function. This will be achieved by first
reducing the activation of the pec minor and increasing
the involvement of the serratus anterior.
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