|
GIM-CASE
STUDY
KNEE PROBLEMS
| Notes:
We saw significant chest breathing, which indicates
an inhibition of the diaphragm and therefore lack
of intra-abdominal pressure through reduced abdominal
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 in the arms
and hands. Sam’s lack of inner unit function,
which is initiated by the downward thrust of the
diaphragm, leads to a permanent compression of
the abdominal viscera in an attempt to establish
some core stability. This in Sam’s case
seems to be achieved through over-activity in
the superficial posterior muscles like the hamstrings
and calves.
|
|
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.
|
|
1 Leg Squats
|
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.
|
1 Leg Reaches
|
Notes:
Notes:
Again on the left we see a higher degree of stability
and control than on the right.
The right knee is placed in a most uncomfortable
position due to lack of control at the hips –
coupled with ankle restriction. The knee is being
beat up by both its older and younger brothers.
|
|
Squats
Notes: There was a reduced range
of motion in the squat. Due to the external rotation
of the feet during squatting I suspected a restriction
in the ankles which was confirmed by the increase
in range when Sam squatted with her heels raised.
Notes:
The pelvic suspicions were confirmed when Sam’s
squat improved with her left foot raised. Indicating
a rotation in the pelvis that results in a shortening
of the left leg and a lengthening of the right.
|
|
|
Gait
Notes:
As Sam was walking at a fairly low speed (4-5km/h)
it already was evident that Sam did not have the
strength or stability to control her hips on one
leg. The pelvis drops excessively whenever she
is on one leg indicating a decreased sensitivity
to disruptions in length of the lateral glutes.
The inward rotation of the heel also indicates
a lack of hip extension and ankle dorsi flexion.
It is a little harder to see as the speed picks
up, however, there is still some obvious instability.
During the right stance phase (left leg swing)
the knee rolls in, and during the left stance
phase (right leg swing) there is a significant
weight shift (weak lateral glutes) and the right
heel whip is exaggerated.
|
Programme objectives:
Our initial focus will be
to get Sam activating her 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.
We will also need to improve Sam’s stability
on 1 leg by reducing the restriction around the right
pelvis and ankle and then by strengthening her lateral
glutes. Due to the flat nature of her feet we will not
rule out the possibility of applying progressive orthotics
to re-establish a loading platform at the ankles.
Once we have achieved this we can start to move Sam
to a more 3-dimensional and movement-based environment
in pursuit of her toning and sporting objectives.
There were a few issues that were highlighted on the
nutritional questionnaire, which we can discuss at a
later date.
|
