Lindsay Tyburski

Movement Analysis Project

Kinesiology

Fall 2012

Dr. Biren

Demographics:

Name: Melanie Wittenberger

Age: 21

Gender: female

Height: 5’2; 157 cm

Weight: 125 lbs; 56 kg

BMI: 22.9

Sports Participated in : soccer

Physical Goals: Hopes to regain full stability and strength from most recent knee surgery which occurred

in December 2012. Plans on working on agility, quadriceps and hamstring strength to limit pain and

increase mobility.

Physical History:

Injuries:

2 right ACL tears

2 right meniscal tears

Left ACL tear

Numerous quadriceps pulls

Numerous hamstring pulls

Umbilical hernia

Orthopedic Surgeries:

2008: left acl reconstruction. Patellar autograft

2010: right acl reconstruction, and meniscal tear. Patellar autograft

2011: right acl reconstruction, and meniscal tear. Cadaver allograft.

Limits: Can no longer compete competitively. Also, has to be extremely careful cutting and running. Pain

limits her activity occasionally.

Summary:

Based on the demographics I found that Melanie is in good physical condition. She has a healthy body

weight for her age and appears to be in good physical shape. She is athletic, but due to injuries she has

had to cut down on the intensity of certain sports and the frequency in which she can participate in

these activities. Melanie has already had three major knee surgeries which already have a negative

impact on her daily life. From these surgeries she has to physically limit herself from performing at her

best. Because she has knee injuries it is possible that there are other injuries which may occur, due to

the kinetic chain. These injuries could affect other body parts and prevent her from reaching her goals if

the pain continues. From what I have learned about her so far, I would say that there are some things

she can begin to do to help reach her goals. She can begin another rehab program to strengthen her

knee muscles. During this program she should focus on her knee range of motion in all three aspects,

active, passive and resistive. Also she should strengthen her hip and ankle muscles to prevent injuries to

the other body parts which could be negatively impacted by the kinetic chain.

Range of Motion:

Cervical spine (sagittal plane & mediolateral axis):

Cervical flexion: 50°

Cervical extension: 75°

Cervical flexion is a little less than normal range

Cervical spine (frontal plane & anteroposterior axis):

Lateral flexion right: 45°

Lateral flexion left: 45°

Normal

Cervical spine (transverse plane & vertical axis):

Cervical rotation right: 80°

Cervical rotation left: 80°

Normal

Shoulder (frontal plane & anteroposterior axis):

Flexion right:150°

Flexion left:145°

75° 50°

45°45°

80° 80°

150° 145°

Both sides are lower than the normal range

Shoulder (sagittal plane & mediolateral axis):

Flexion right: 170°

Flexion left: 170°

Normal

Elbow (transverse plane & vertical axis):

Internal rotation right: 80°

Internal rotation left: 95°

External rotation right: 110°

External rotation left: 100°

Both sides are slightly hypermoble

170° 170°

100°110°

95°80°

Knee (sagittal plane & mediolateral axis):

Extension right: 0°

Extension left: 0°

Normal

Hip (sagittal plane & mediolateral axis):

Flexion right: 80°

Flexion left: 70°

Both sides are slightly under the normal range of motion

Hip (frontal plane & anteroposterior axis):

External rotation right: 45°

External rotation left: 45°

Internal rotation right: 30°

Internal rotation left: 30°

Normal

0°0°

70° 80°

45°45°

30° 30°

Knee (sagittal plane & mediolateral axis):

Flexion right: 130°

Flexion left: 120°

Both sides are slightly under the normal range of motion

Summary:

Melanie for the most part had normal range of motions throughout each segment that

was evaluated during the lab. Where she did have deficits it was usually only lower by 10°,

which isn’t terrible. She has had many injuries in the past and that is most likely why she has some range

of motion issues. By increasing her flexibility and stretching the joints on a regular basis she will be able

to increase her range of motion and get all of them to normal limits. The places where I saw not normal

range of motion was cervical flexion, shoulder flexion on the left and right side on the frontal plane, hip

flexion, and knee flexion. Because of her previous injuries that could explain why she has limits with the

knee and even hip flexion. The other range of motions could be due to lack of flexibility or using the joint

in certain ways. These could easily be improved by focusing on the specific joint and stretching them. I

believe that if she improves this range of motion that she will be able to reach her goals of getting her

knee back to normal conditions since her surgeries and also getting full range of motion in her

quadriceps and hamstrings.

120°

130°

Postural Assessment

Frontal View:

Eyes Aligned: Yes

Acromioclavicular Joint Aligned: Yes

Anterior Superior Iliac Spine Aligned: Yes

Patella Height: Even

Patella Forward: Yes

Genu Valgum: No

Genu Varum: No

Feet Face Forward: Yes

Sagittal View:

Head Protruded: No

Protracted Shoulder Girdle: No

Kyphosis: No

Excessive Lordosis: Yes, slight

Reduced Lordosis: No

Genu Recurvatum: No

Posterior View:

Winged Scapula: No

Feet Evert: No

Feet Invert: No

Summary:

Melanie overall has very good posture. From analyzing all of the basic body landmarks

for posture, they all appeared to be in line. This is very beneficial to her, proving that there are

no structural issues that will be presented to increase her chance at injury, the only thing that

could be problematic would be if she has functional issues. She does have a slight excessive

lordosis, but because it is sight, it will not cause her a big problem. Because of her good posture,

it will be easier for her to reach her initial goals of regaining her strength and flexibility of her

knee and increasing her quadriceps and hamstring strength and mobility. The only correction I

would give to her would be to increase her flexibility of her hip flexors which would decrease

her excessive lordosis.

Overhead Squat Assessment

Frontal View:

Knees Align with Foot: Yes

Feet Face Forward: No

o Slight abduction of the right foot

Sagittal View:

Normal Forward Flexion: Yes

Normal Lumbar Lordosis: Excessive lordosis

Arms Remain in Line: Yes

Posterior View:

Feet Evert: No

Heels Rise Off Floor: No

Asymmetrical Shift: No

Summary:

Overall Melanie had very good posture during the overhead squat analysis. During the anterior

view I did notice a slight abduction of her right foot; this could be caused by an over-active soleus or

lateral gastrocnemius muscles or an under-active medial gastrocnemius muscle. Additionally from the

sagittal view I noticed an excessive lordosis. This could be caused by tight hip flexors and a weak inner

core. By saying this, I would conclude that her erector spinae, hip flexors, and latissiumus dorsi are over-

active and her hamstrings and anterior core is under-active. I would recommend her doing calf raises to

strengthen her gastrocnemius muscles. I would say that she should be able to complete her goals she

had set at the beginning of this assignment and should not have any complications due to overhead

squat dysfunctions.

Gait Analysis

Postural View:

Stance Phase:

Hip Position: proper position, goes from flexion into extension during proper time

Knee Position: flexes and extends during proper time

Ankle Position: goes from plantar flexion into dorsiflexion at proper time

Foot Flat:

Hip Position: Flexion

Knee Position: Extension

Ankle Position: Neutral position, flat foot

Mid-Stance:

Hip Position: Slight flexion

Knee Position: Extension

Ankle Position: Neutral Position, flat foot

Heel-Off:

Hip Position: Extension

Knee Position: Extension

Ankle Position: Plantar Flexion

Toe-Off:

Hip Position: Extension

Knee Position: Extension

Ankle Position: Plantar Flexion

Sagittal View:

Swing Phase:

Initial Swing:

Hip Position: Extension

Knee Position: Slight flexion

Ankle Position: Plantar flexion

Mid-Swing:

Hip Position: Extension

Knee Position: Flexion

Ankle Position: Plantar Flexion

Terminal Swing:

Hip Position: Flexion

Knee Position: Flexion

Ankle Position: Plantar Flexion

Summary:

After doing a gait analysis on Melanie I observed she had a very good gait cycle. All of

her joints were doing the correct mechanism during the right stance. Her foot during the initial

heel contact began with supination and then rolls into pronation with her leg externally

rotating. During the midstance her foot moves into pronation and leg into internal rotation

which helps her to have proper movement. Additionally her foot moves into supination and leg

external rotates during toe off allowing her to properly finish her step. Because she has strong

hip flexors the swing phase is easily completed with proper mechanics. I did not notice any

abnormalities within her cycle that would contribute to negatively affect her gait cycle. Because

she has no dysfunctions I feel as if she will be able to reach her initial goals at the beginning of

this assessment.

Corrective Exercise Program

Improve Range of Motion:

Cervical Flexion

o Neck Rolls: standing with feet shoulder width apart begin by putting neck into

flexion, then put back into the neutral position and begin rotating your neck in

slow circles progressively making the circles larger

By doing these daily, it will help to use the neck muscles which then will

help stretch and strengthen them. By strengthening her sternoclavoid

mastoid it will increase her range of motion. This will improve the flexion

range of motion and hopefully get Melanie back to normal range of

motion of her neck

Shoulder Flexion on Frontal Plane

o Shoulder Flexion Stretch: standing I doorway flex shoulder joint by placing

extended elbow on door frame, move truck forward to position shoulder joint as

close to 180 degrees of flexion, then flex the elbow and attempt to externally

rotate shoulder joint.

This will increase her latissiumus dorsi muscle which is a big contributor

to the shoulder in means of flexion. It will also stretch her

inferior/posterior capsule. By incorporating this exercise into her daily

routine, it will slowly improve her range of motion because if these

muscles are strengthened it will allow for her range of motion to return

to its normal positioning. By focusing on these three specific aspects

during shoulder flexion it will allow her to have greater flexibility in her

shoulder joint.

Hip Flexion

o Straight Leg Raise: Laying supine on table, slowly raise leg 45°and hold to 2

seconds then bring back to table

This exercise focuses on strengthening the hip flexors which are essential

in flexing the hip

Once Melanie stretches her hip flexors it will increase her flexibility of her

hip which in turn will positively affect her range of motion. If she focuses

on exercises similar to this, she will be able to increase her hip flexor

strength.

Knee Flexion

o Single Leg Dead Lifts: standing on one foot with the knee slightly flexed, flex the

hip and reach downward to the floor and return, focus on keeping the knee in

proper alignment

This stretch will train the proprioceptors to maintain the proper knee

position. It also focuses on hamstrings which will help with her ACL

strengthening. Additionally, if she stretches her quadriceps and core it

will help her increase her knee flexion. Because she did have an injury to

her knee, if she does this exercise it will help to increase her strength of

her knee and hamstrings which in turn will improve her range of motion

of her knee.

Improve Posture:

Excessive Lordosis

o Lunge Stretch: Stand with feet shoulder width apart then step as far forward

with one leg as possible shifting weight to that leg keeping the foot flat on the

floor. Place hands on knee and bend knee further to the floor.

This will help to increase flexibility of the hip flexors which will allow the

hip to be in proper alignment decreasing the anterior tilt of the pelvis.

When the hip flexor is tight it pulls the pelvis forward. The hip flexor is a

huge contributor to excessive lordosis; because when the hip is

anteriorally tilted it is a sign that hip flexors are tight. So if she can

improve her hip flexor strength it will help to decrease the pelvic tilt

which will eliminate her excessive lordosis.

o Pelvis Tilt: Lying on back with knees bent and feet flat place hands under your

lower back, squeeze abs tight and roll pelvis backward as if trying to flatten your

lower back

This will help to stretch the erector spinae which if tight causes an arch in

the lower back. This also will strengthen her core which is necessary to

improve her proper lordosis. During excessive lordosis it is common that

the core is weak, so if she does this exercise it will improve her core

strength which will allow for her pelvis to be in correct alignment, which

will eliminate her excessive lordosis.

Improve Overhead Squat:

Foot Abduction

o Standing Wall Calf Stretch: Stand toward the wall with foot on the wall at a

slight angle, keeping heel on the floor turn that foot so toes are pointing inward,

lean towards the hip to the side and forward until feel a stretch

This exercise focuses on stretching the medial gastrocnemius which when

under-active causes abduction of the foot. If this muscle is stronger then

it will reduce her foot abduction when squatting. It will allow her foot to

stay in a neutral position if her medial gastoc is strengthened.

Excessive Lordosis

o 90/90 Stretch: Flex the hip to 90° then slowly extend the knee making sure

contra lateral leg is flat on the floor with the knee in extension. Extend the knee

until end range making sure the hip stays at 90°.

o If she stretches her hamstring it will help to keep the pelvis in line and will

eliminate any lordosis of her back. It will increase the strength of the hamstring

which will allow for a normal pull of the muscle which will eliminate lordosis

issues.

o Plank: Place elbows on the floor underneath shoulder and toes on the floor with

legs shoulder width apart. While keeping back straight lift body off the floor and

pull in stomach toward spine.

o By strengthening her core it will help keep her spine in a neutral position. The

core plays a major role in the position of the spine and if she can strengthen her

core it will pull her spine forward and in line which will eventually eliminate any

lordosis problems.