Upon assessment I found the following:
- During a prone glute assessment that her right side glute was significantly weaker than the right (go figure), however both were very weak.
- A overhead squat test shown a significant asymmetrical weight shifting to the right side, reduced shoulder mobility due to tight lats - she was unable to fully lift the bar over her head, it was stuck out front (confirmed this with the supine lat assessment).
- Active leg raise shown bilateral mobility issues, but more so on the right with excessive lateral rotation of the iliofemoral joint during full knee extension. Upon further investigation, I suspected her piriformis for the increased degree of lateral rotation.
- Client was unable to perform a complete toe touch with a feeling of stiffness in her low back and hamstring area.
- A seated T-spine rotation assessment suggested a severe limitation in her ability to fully rotate to either side (20-25 degrees bilaterally).
Session 1-3
We focused on mobility. She was experiencing a large degree of "stiffness". As such, I wanted to help her feel less restricted. I introduced her to glute and T-spine exercises, focusing on full range of motion and the control of eccentric forces. We wrapped it up with a bit of soft tissue on the hamstrings and latissimus dorsi stretch.
Session 4-8
My focus was on increasing scapulothoracic stability (hitch hikers), continued T-Spine mobility and strength through functional movement (primarily lifting with the glutes and shoulders). However, by the seventh session she became overly fatigued as she was training on alternate days. I suggested a reduction of training intensity and re-assessed her glute strength and T-spine mobility. She was able to activate the right side glute for 36 seconds and her left for 52 seconds. T-spine mobility had improved, but not markedly. By the seventh and eighth day, I introduced more soft tissue and flexibility protocols and less strengthening. I focused on the piriformis, hamstrings, adductors and latissimus dorsi - off and on static/PNF protocols.
Session 9
She came in feeling better and stronger. She stated that she was able to withstand her back pain until well into the afternoon and that she felt less stiff in her pelvic region. I assessed her glute strength and found that she could activate her right side glute for over 1 minute, with her left side following suit - I was pumped! I incorporated a few exercises for her glutes and ST joint, stretched her hamstrings and piriformis (PNF) then sent her on her way.
Awesome!
