With Cristina's squat, we noticed several things:
-Quite stance is in genu recurvatum and plantar flexion
-Stability deficits as noted by shaking of the knees during descent
-Stability deficits noted by involuntary head motion during descent
-Balance deficits due to the outstretched arms during the squat
-Either stability or mobility issues that inhibit Cristina from completing a full deep squat
-Poor lumbopelvic rhythm as noted by a loss of lumbar lordosis during descent
-"Snapping" of lateral hamstrings, as she passes 90 degrees of knee flexion (look closely and you can actually see the cord-like structure "snap" to a different position as if it's jumping over a structure)
-Pronounced Heel Strike
-Excessive thoracic/ upper torso motion
-Contralateral Pelvic Drop on the Right during Left stance phase
-Mild tibial whip during swing phase on the Left
-Greater pronation on L vs. R during stance phase (it appears as if she pronates too quickly as well. A shoe modification may be able to help with this).
These are the main abnormalities we found. What else do you see? Let us know!
There were several lessons that can be learned from our first movement analysis experiment that can be directly translated to the clinic:
1) Your outcomes will greatly depend on how compliant your patients are with their home exercise program. Unfortunately, Jim performed his HEP less than anticipated. Some changes were noted, but overall performance did change as anticipated. Being able to effectively teach an HEP will be important for your success as a therapist.
2) The ideal movement may not be attainable for all people. Since Jim has a pathological right shoulder, his end-range flexion and abduction will not be the same as his left shoulder. Due to some SC joint problems, the "perfect" movement was not possible for him based on the HEP we prescribed. We did not address the SC impairments specifically. Additionally, it must be considered that he is right handed. As Mike Reinold states, "we are unilateral creatures...and typically function in predominant movement patterns." We must work on proper alignment in addition to solely addressing muscular imbalances.
Some of the things we noted upon follow-up:
1. Increased scapular winging bilaterally (L >R)
2. Increased Upper Trapezius Muscle Activity (L> R)
3. R scapula relatively lower than L scapula
4. Asymmetrical Lateral Trunk Curvatures. It was noted that the asymmetry became worse during end-range flexion and abduction and improved upon return to starting position.
5. L Inferior Scapula border tilted anteriorly
One positive aspect we observed was smoother scapulohumeral eccentric control. Jim attributes this change to being most compliant with his seated theraband scapular retraction intervention & focusing on postural awareness.
What did we miss? Point out other asymmetries you observe & give us your thought process to why it might be occurring!
Finally, we want to apologize for delaying this follow-up post longer than expected. Our next movement analysis will be much more timely!