Firstly I would like to say what a privilege it is to be working with such an amazing team! I have been referring clients to Gayle at Willis Street Physiotherapy now for quite some time and my clients have all had outstanding results when other efforts had failed. She has such a unique set of skills and a holistic approach to health – much like myself, so it’s a great working relationship!
Meeting Helen recently, again I recognise a very similar health and wellness philosophy. I havent yet worked along side a skilled naturopath, so I’m really excited about this oportunity and I’m sure we will learn something from each other along this journey (I have already picked up some pretty amazing recipes!).
Given Helen’s goals and current condition I put together an assessment protocol that involves 3 stages (leaving the really tricky stuff up to the physio’s):
1. Static posture testing
2. Length and strength testing
3. Functional testing
The static posture test – shows me how Helen is holding herself when standing and gives me an insight as to what needs testing in the next two stages.
With the length and strength testing – I complete a quick full body check and focus in on the areas that need to be addressed in relation to her goals and then hone in on any areas that need further investigation.
For the functional testing – I observe how Helen moves through all 7 of the ‘primal pattern’ movements: Squat, lunge, pick up, push, pull, rotate and gait (walking and running gait). Usually this all ties in nicely and the static posture and length and strength testing reflects what is going on in the functional testing, but “usually” isn’t always the case! Normally I would address lifestyle and nutrition also, but Helen has a very firm grip on this already and I couldn’t tell her anything she didn’t already know!
The highlights of the assessment:
The static posture testing revealed:
- Downward rotated right scapula
- Right upper thoracic scoliosis (curvature of the spine)
- Slightly excessive Lumbar lordosis
- Anterior pelvic tilt
- Humeral head well forward of midline
- Head carriage: 4 cm forward
Length/strength test findings:
- Right Levator Scapular
- TFL, ITB RF both sides but more so on right
- Right pec minor
- Right pec major
- Lat doorsi Both sides
- Scapula upward rotation both sides
- Restricted thoracic rotation both sides especially right
- TVA: 20% strength (prone position)
- LA strength: 60% strength
- LA coordination: Poor-fair
- Both Glute med esp right
Functional Testing findings:
There was a right hip shift in the squat, pick-up and lunge patterns along with forward head position. In the push and pull movements I observed a lack of abdominal stabilty with the pelvis dropping into an anterior pelvic tilt and there was no ‘belly button in’ movement. Also observed in the push and pull was a scapular instabilty especially in the eccentric (coming back) phase. The rotation was pretty good technique wise but a little restricted. In gait the only thing I noticed was a right knee medial deviation on foot strike during running, however I think Gayles techniqe adjustments have had a positive effect already!
All of Helens findings in the static and ROM testing were also obvious in functional testing especially around the hip where with an under active R glute med and tight/dominant R TFL & ITB. The weak inner unit (TA, multifidus, Pelvic floor and diaphragm) became obvious in the testing where the pelvis was dropping into excessive anterior tilt and abdominal ‘doming’ was observed. From these findings I will form a daily pre-exercise specific stretch and prep routine to combat over facilitated tight muscles and switch on under facilitated weak muscles allowing easier biomechanical re-training. In relation to Helens goals there will be an ‘isolate to integrate’ approach with the goal to recruit the correct muscles in a standing and gait positions. An emphasis on correct static and dynamic posture is essential especially in regard to head and scapular positioning.
Next time is programming and I look forward to combining what I found with the physio team to come up with a great integrated approach to get helen flying up and down the hills pain free!
For more posts in this series click the ‘Himalayan Dreaming’ category tab.