Please Note: This is an Example Case Study Not to Be Reproduced, Copied or Shared

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Shana Robinson
6 years ago
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1 Please Note: This is an Example Case Study Not to Be Reproduced, Copied or Shared Your Name Workshops Name and date Case Study For Level 3 FST History: a) Torn labrum R shoulder 2009 Complete rupture/tear R Achilles tendon 2007 Dislocated L pinky finger at the carpal-metacarpal joint 2004 b) R rib contusion Ribs Sore R shoulder Soreness and restriction R hip Migraine headaches at nighttime Symptoms: Client feels pain and severe restriction in the R lower ribs Right shoulder is restricted when performing anything where he is pushing off of with the hands and shoulders i.e. being blocked when blitzing trying to push through offensive lineman as well as lifting bench press. Right groin soreness after games. Right hamstring tightness and soreness as he is warming up for practice/competition also when he is cooled down after strenuous activity. Left hamstrings tight all the time but without soreness or pain. Tightness, soreness and restriction in Right calf and Achilles tendon when powering forward during tackling, jumping, landing and running. Posture and Alignment: Left scalenes locked short Right and left shoulders medially rotated Right shoulder anteriorly rotated and dropped inferiorly and rotation towards the left hip Right arm and hand medially rotated Left arm and hand medially rotated but less than the right Rib cage restricted anteriorly, Right rib cage compressed Right and left os coxas anterior tilt with the left about 2-4 degrees more anterior tilted

2 Left knee slight valgum Right and Left knees both slight hyperextension Right foot laterally rotated approx. 10 degrees more than the left. Left is still laterally rotated but considerably less. Lumbar area of the back exaggerated lordotic curve causing rear end to stick out posteriorly. Right and left scapulas drawn laterally with the right slightly inferiorly as well. Thoracic Spine exaggerated kyphotic curve Head Posture is forward with exaggerated lordotic curve as well. Sport-Specific Movement: (Body Positions) Break down position (slight squat position with arms forwards and hands extended superiorly)- Standing- Glutes and hamstrings strained, Right hip feels unstable, Calves and lower crus tight and restricted especially on the right, Right shoulder tightness/soreness, Low back tightness and restriction, Right hip feels unstable, Right ribs compressed and painful. Upper back at the cervical-thoracic area tight and sore. Low back very sore and tight when standing strait Right shoulder soreness on anterior part of the shoulder Left hip is very tight and tired

3 Sport-Specific Movement: (Dynamic Movement) Upper body twisting (rotation) to the left with head rotation to the left- Right rib cage soreness Right hip instability Right shoulder soreness Left neck (2 nd head traps, scalenes, scm) tight with slight pinching up into the upper left lateral neck. Right medial knee pull with slight pain, left medial knee tightness Upper body twisting (rotation) with head rotation to the right- Right rib cage painful causing restriction Upper left back (mid thoracic region) Soreness Left low back through QL tight/sore Left hip tight and restricted but feels strong Right medial ankle and Achilles tight and unstable with restriction losing ROM through entire movement. Right neck pinching with left neck restriction losing ROM to right head rotation. Right lateral movement (running laterally)- Good power in the left hip knee and ankle some restriction in the left hip but feels good Right ribs strained and painful Right shoulder soreness Right Achilles sore and tight Right low lateral abdominals strained and tight

4 Right mid back tightness Active Range of Motion: General Spine: Flexion degrees Restrictions in right and left hamstrings right more sensitive Mid back both right and left Cervical spine more restriction left more soreness right Extension degrees Right and left lumbar soreness and tight with slight pain Low Rectus abdominus Side Bend (R) degrees Restrictions in Right intercostals Right low ribs Left hip Left Lumbar (QL) Side Bend (L) degrees Restrictions in Right low ribs Right Lateral Abs Right Hip Full Body Rotation (R) 65 degrees Restriction in Left Hip Left calf Right low ribs Full body Rotation (L) 75 degrees Restrictions in right ribs Right Low back Left QL Upper Extremity: (R) Flexion-85 degrees Restrictions in Right ant. Shoulder pinching Right neck (R) Extension- 10 degrees Restriction in Right ant shoulder Right bicepts (R) Abduction- 70 degrees

5 Restrictions in Right delt Right neck (R) Adduction- 35 degrees Restrictions in R rhomboids Right ant shoulder (R) External Rotation- 35 degrees Restrictions in Right mid/low back Ant deltoid (R) Internal Rotation- 75 degrees Restriction in anterior deltoid Right peck major tissue approx. (R) Reach Behind Back- 90 degrees Restriction in Right Ant shoulder Right Ant deltoid (pinch) Right post. Deltoid (Strain) Right Triceps (L) Flexion- 90 degrees Restriction in Left ant shoulder pinching (L) Extension-15 degrees Restriction in Left ant shoulder Left biceps (L) Abduction-80 degrees Restriction in left deltoid (tightness) (L) Adduction-40 degrees Restrictions in left ant shoulder (Pinching) Left post deltoid (tightness) Left rhomboids (tightness) (L) External Rotation- 35 degrees Restrictions in left post shoulder (tissue approx) Left ant shoulder (short head bicep s) tightness (L) Internal Rotation- 90 degrees No restriction (L) Reach Behind Back- 100 degrees Restriction in left post deltoid Left ant shoulder pec major insertion

6 Lower Extremity: (R) Standing Hip Flexion- 85 degrees Restriction in Right low abs (strain) Right ant superior thigh (pinch) Left ant hip Left glute soreness (R) Standing Hip Extension- 10 degrees Restriction in right quads (rectus femoris) Right low back (QL) (R) Standing Hip Abduction- 25 degrees Restriction Right lateral hip (pinch) Left lateral quad soreness Right low back (QL) (R) Standing Hip Adduction- 10 degrees Restriction in Right lateral hip (tightness) Right hamstrings (R) Standing Hip Lateral Rotation- 45 degrees Restriction in lateral hip (pinch) Right adductors (tightness) Left Glute sore/tight (L) Standing Hip Flexion-90 degrees Restriction Left hamstrings Left QL (L) Standing Hip Extension- 15 degrees Restriction in Left Ql Left quads Left hip flexors (L) Standing Hip Abduction- 35 degrees Restriction in Left lateral hip (pinch) Strain in Left adductors Left Lateral Hamstring (pinch) Left QL (L) Standing Hip Adduction- 10 degrees Restriction in Left adductors (tissue approx)

7 Left Low back (SI jt strain) (L) Standing Lateral Hip Rotation degrees Restriction in Left glute and lateral hip Combination Movements: Spine- Turning Left The first restriction I noticed was in the right occipital region; there was tension and strain. The right post neck, second head of traps and rhomboids on the right were strained as well. As the movement progressed the right low ribs were showing pain and it intensified as the rotation continued. At the same time that the Right ribs began to hurt there was a significant pinch in the Left QL as well as a strain in the left lower abdominal region. Further into the movement the Right Ant hip began to strain as well as right lateral quad. Near the end of ROM there was a significant strain in the right med knee, and some pain in the right lateral ankle (pinching sensation) the medial right ankle felt weak and unstable. Spine- Turning Right There was left neck tightness but no pain or strain. Left QL restriction and pain. Right low abdomen soreness and right ribs began to become painful and the body wanted to constrict more to the Right ribs. There was left hip strain, left lateral quad strain and tissue restriction as the movement got to the end of ROM. Left hip flexors were tight as well. With both movements there was still more ROM available turning to the right and much less painful through the movement. Upper Extremity- During upper extremity movement the ROM was fairly good with no real restrictions until the final part with the hands over the head. The left arm was still good with 90 degrees on each part. A bit of strain in the pectoral area but overall the angles were on point and there was no pain. The right arm was a bit different, there was a bit of pinching in the ant shoulder with the hands up in the air. The right lower arm wanted to move laterally and the angle degreased to about degrees. The ant shoulder was rotated anteriorly as well as some pinching in the ant deltoid area as well as triceps were not allowing the elbow into full flexion. Lower Extremity- Squat position In the squat position the left knee wants to move laterally which can suggest tight hip rotators while the right foot wants to move laterally suggesting tightness along the lateral side of the lower leg. Weight shifted from left to right with a right hip medial rotation within the first 25 degrees of the squat. Torso wanted to fall forward when descending into the squat position as well as the back bowed the deeper in to the movement they went. Due to other assessments throughout the process I would say that the hip flexors are very bound and tight. The right knee moves medially and then laterally from beginning

8 of the movement into the final part of ROM. Right arch drops into the full squat again supporting the tight lateral lower leg. Trigger Points: TPs In right Levator attachment of the right superior angle of the scapula. Both Pec major with a significant TP on the musculotendonous jct of the right pec major. Both lateral quad with more than on the left lateralis as well as the rectus femoris attachment at the AIIS. R tib post Left glute med

9 I have found that in the beginning of the treatment the R LL is short and pulling the right shoulder inferiorly as well as the L SPL (starting at the left occipital) is short and dragging the right shoulder across the body into the left hip. Right serratus anterior the main restriction here. Rhomboids are in an eccentrically contracted and weak state on the right with some on the left as well. Left lateral quads are concentrically short and tight with serious trigger points near the prepatellar tendon. The DFL is tight through the hip flexors especially the right side. Post crus including tibialis posterior are locked in the short position and causing continuous strain on the tibialis anterior tissue. The hip flexors were extremely locked short so we did more work here than anywhere on the body. With a solid release of the the HF s we have been able to get the glutes involved again and the hamstrings have stopped feeling strained as well a significant changes in the low back tightness and pain. Both right and left QL have shown great improvement and have stopped causing issues on and off the field. We started the treatment with a basic great 8 plus some extras. Neck work focused on the opening the L neck, scalenes, traps and SCM. I did 3-1 on the R LL through traps and QL stretching all centered to the R LL. Further I used some tissue release techniques to release the med rotators of the right shoulder especially subscap and pec minor to release adhesions before I continued on with the stretching protocols. We focused on the L SPL and lateral L quads with some TP techniques within rectus femoris on the left as well. The med knee pain on the right knee has been resolved through the work on the R LL. Along with heavy deep work on the deep hip rotators of the left side. The right hip has released due to the sacrum not being pulled on by the left deep hip rotators. Weight distribution has been corrected from the left at about 10 lbs more in the beginning to almost even. There was a serious contusion from a helmet to the ribs in training camp, which over time developed into a ball of scar tissue, and heavy restriction in the lower ribs. Through deep work under the rib cage and the diaphragm I have been able to release all of the adhesion and restored all ROM in the the rib cage which also helped correct the shoulder impingements of the right shoulder not t mention increased breathing capability. Once these were resolved at about session 5 we have been able to keep his body at a very efficient posture to where I can work his body as maintenance while in season. Using FST and CST on the skull and surrounding tissues we have gotten the headaches to stop. He no longer has them, which were apparent after the first session, and continued sessions have relieved them completely.

10 Dynamically the client has seen more than significant changes in the way his body functions on the field and he is showing great performance gains and strength due to postural corrections and continued weekly therapy. My goals for this client are to continue to keep him at peak for the rest of the season and have planned for an off-season treatment plan that is will relieve all other issues from the rest of the season. Continued training and treatment to see where we can take his game. Overall this client is a success and will continue to be persistent with self-stretching and keeping his body where it needs to be.

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