Corrective ExerciseMuscular Impairments

Case Study: 38 Year Old Teacher and Baseball Coach

Client is a 38 year old teacher and part time baseball coach who experiences bilateral calf tightness and plantar fasciitis.  Client engages in running several times per week and likes to enter and complete local 5k and 10k runs.  Client has had 2 right shoulder surgeries to repair his rotator cuff.  He has also had to cortisone shots in his foot.   Client has been cleared by his physician and no other contraindications present.

Anterior View:

  • Compensations: During Clients virtual overhead squat, he showed compensations on the right side of his foot turning outward and his knee also moving outward.  On his left side, his foot flattened and turned outward and there was a slight outward movement of his left knee.
  • Overactive Muscles: On Clients right side, overactive muscles would be the soleus, lateral gastrocnemius, short head of the bicep femoris and his tensor fascia latae.  Contributing to the outward knee movement would be his piriformis, bicep femoris, TFL, and gluteus minimus.  On his left side, overactive muscles would be the peroneal complex, lateral gastrocnemius, bicep femoris, and TFL.  Even though it was slight, there still might be overactivity of the piriformis, bicep femoris, TFL, and gluteus minimus contributing to the knee moving outward.
  • Underactive Muscles: On his right side, possible underactive muscles would be medial gastrocnemius, medial hamstring, gluteus medius and maximus, Gracilis, Popliteus, and Sartorius.  Also underactive would be adductor complex, medial hamstring and gluteus maximus for the outward movement of the knee.  On his left side, underactive muscles would be anterior and posterior tibialis, medial gastrocnemius, and gluteus medius.

Lateral View:

  • Compensations:  demonstrated an excessive forward lean  with his arms falling forward.  His shoulder surgery demonstrated the excessive arms falling forward on the right side.
  • Overactive Muscles: Overactive muscles would be the soleus, gastrocnemius, hip flexor complex, piriformis, rectus abdominus, and external obliques.  Possible overactive causing arms to fall forward would be latissimus dorsi, pectoralis major and minor, coracobrachialis, and teres major.
  • Underactive Muscles: anterior tibialis, gluteus maximus, erector spinae, transverse abdominus, multifidus, transversospinalis, internal oblique, pelvic floor muscles. Also the mid and lower trapezius, rhomboids, posterior deltoid, and the rotator cuff muscles.

Posterior View:

  • Compensations: Left foot flattens.
  • Overactive Muscles: Peroneal complex, lateral gastrocnemius, bicep femoris(short head), and the TFL.
  • Underactive Muscles: Anterior and posterior tibialis, medial gastrocnemius, and gluteus medius.

References: (Case Study Exrx Doc)

Clark, Micheal, and Scott Lucett. NASM Essentials of Corrective Exercise Training. Philadelphia, PA: Lippincott Williams & Wilkins, 2010. Pr

 

Sahrmann, S. (2002). Diagnosis and Treatment of Movement Impairment Syndromes. St. Louis, MO: Mosby, Inc.

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