Corrective Exercise

Case Study: 44 Year Old Male Experiencing Runner’s Knee

This client is fairly active, a male, 44 years old, married, children and full time job that requires a large amount of time in front of a computer.  Outside of work he enjoys running on average 3-5 miles 3-4 times per week.  Throughout the years, has experienced increasing pressure on the right knee more specifically, but does complain of knee problems in both knees.  Goes to the gym to engage in weight training a few times per week, weight training routine is pretty standard, using universal style machines for most exercises, also completes free weight exercises such as squats, bench press and deadlifts.  Believes he keeps good form and has not experienced any muscular injury while lifting, other than muscle soreness following the workouts.

Overhead Squat Assessment

Anterior: 

  • Feet turn out: Right and Left
    • Overactive:
      • Soleus
      • Gastrocnemius
      • Biceps Femoris
      • TFL
    • Underactive:
      • Med Gastroc
      • Med Hamstring
      • Gluteus Med/Maximus
      • Gracilis
      • Popliteus
      • Sartorius

 

Lateral:

  • Excessive Forward Lean
    • Overactive:
      • Soleus
      • Gastrocnemius
      • Hip Flexor Complex
      • Piriformis
      • Abdominal Complex
    • Underactive:
      • Anterior Tibialis
      • Gluteus Maximus
      • Erector Spinae
      • Intrinsic Core Stabilizers

Posterior:

  • Foot Flattens
    • Overactive:
      • Peroneals
      • Lat Gastrocnemius
      • Biceps Femoris
      • TFL
    • Underactive:
      • Anterior Tibialis
      • Posterior Tibialis
      • Med Gastrocnemius
      • Gluteus Medius

Now that we have completed a dynamic assessments, we can begin to develop a game plan to properly engage neuromuscular control and limit potential injuries.   The first stage in helping him along the Corrective Exercise Continuum (Clark and Lucett, 2011), would be implement Self Myofascial Release on the muscles that are showing as overactive.  Client is clear of any contraindications, so we can begin a program that involves almost daily, SMR for 1 set and holding on the tender spots for 30 – 90 seconds depending on the intensity of discomfort.    Beginning distally and working up, we will SMR the lateral gastrocnemius, peroneals, TFL, short head of the biceps femoris,  piriformis, adductors, and the vastus lateralis. 

Our second phase on the Corrective Exercise Continuum would be the lengthening techniques which involve static stretching to decrease the activation of the muscle spindles.  To stretch the overactive muscles, Client can perform the static gastrocnemius stretch, static soleus stretch, static standing adductor stretch, static seated ball adductor stretch, static supine hamstring stretch, static supine and standing  bicep femoris stretch, static adductor magnus stretch, static TFL stretch,  static piriformis stretch also with the ball and in addition a prone lying hyperextension stretch for the abdominal complex would be beneficial.  These stretches would be done almost daily for 1-3 repetitions, holding for 20-30 seconds and to the point of mild discomfort.

The next phase in the Corrective Exercise Continuum would be the activation techniques.  These techniques would be done 3-5 days per week, 1-2 sets, 10-15 repetitions, contraction phase followed by a 2 second isometric hold and a 4 second eccentric phase (Clark and Lucett, 2010).  Exercises to strengthen the underactive muscles and begin to integrate excitability and create neurological pathways for the underactive muscles, would be:

  • the isolated anterior tibialis resisted dorsiflexion with slight inversion
  • posterior tibialis with resistance laying on the side taking the foot from eversion and plantar flexion into inversion and dorsiflexion
  • Medial gastrocnemius toe raise, having the foot in a inverted position rising into plantar flexion placing equal pressure on the toes, but not allowing the foot to lower to the point of compensation.
  • Medial Hamstring with resistance into knee flexion with slight external rotation.
  • Standing gluteus medius with the leg in hip flexion and move into abduction
  • Quadruped arm/opposite leg raise
  • Floor cobra
  • Iso-ab (plank)

Lastly, we can incorporate integrated dynamic movements for intermuscular coordination.  Exercises that would benefit the Client would be the ball squat with overhead press, squat to row, step up to overhead press, lunge to overhead press, single leg squat to overhead press and possibly a hop with stabilization.

References:

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

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