November 5th 2013
Subjective: Patient presented to Sandhills Sports Performance with an undiagnosed pain in his right upper quadrant. The reports that the pain began approximately in August of 2013 when he would experience sharp shooting pains in his right upper quadrant underneath his ribcage. He notified his physician who ordered several tests to rule out organ involvement, cancer and other medical conditions. The pain episodes would last several seconds up to a minute and would occur up to twenty times per day. The specialists suggested that he be placed on gabapentin and to possibly perform exploratory surgery. The patient is an avid golfer who has been unable to play at times due to the frequency of abdominal pain.
Objective: Postural Restoration Assessment
|Neg||neg||Extension Drop Test|
|neg||pos||Passive abduction Raise|
|50||47||Seated hip IR/MMT|
|40||38||Seated hip ER/MMT|
|1/5||1/5||Hruska Abduction lift Test|
|Hruska Abduction lift Test|
|Squat Test||Level 2|
|Standing Reach Test||10 inches from floor|
|pos||neg||Pelvic Ascension Drop Test|
Assessment: Patient demonstrated that he is in a pathologic PEC pattern meaning that both innominate’s are anterior tipped with ligamentous laxity in his anterior hip ligaments. This PEC pattern is coupled with a pelvic floor that is descended and as a compensatory pattern the patients ribcage is externally rotated bilaterally. This places the diaphragm muscle in a disadvantageous position to function as a muscle of respiration but rather as a postural stabilizer.
Plan: To reposition the patients pelvis by facilitating the hamstrings to posteriorly tilt the pelvis. Instruct the patient how to flex his thorax to restore a neutral ribcage position on top of a neutral pelvis. Improve strength of his left gluteus medius and ischial condylar adductor to provide better stability in left stance activities. Strengthen Right Glute max and inhibit right adductor to allow for alternating and reciprocal gait.
The exercises below were part of the patients treatment program:
Over the course of the next 4 weeks the patient was seen 2x/week. His pain first decreased in severity and at 4 weeks disappeared for good. The patients treatment program progressed from the floor exercises shown above to upright upright supported activities to encourage proper diaphragm zone of apposition with alternating and reciprocal movements in his thorax similar to the exercises shown below. At 4 weeks he was pain free and has not had a reoccurrence since following the postural restoration program.