Saturday, May 16, 2009

My Proud Little Soldier Alex


Alex came to VOI in September of 2008 referred by her MD for physical therapy for tendonitis on both Achilles tendons. She is a Level 7 gymnast and had not participated in gymnastics since July of 2008. Before she stopped due to pain, Alex was practicing an average of 4 hours per day 5-6 days per week.

She was seen by Shane, a licensed physical therapist in VOI and she spent the next 7 weeks working with Shane on getting her inflammation eliminated and was then passed onto myself for a Functional Movement Screen to determine her readiness to return to gymnastics.

I met with Alex and her mother and took her through the functional movement screen. Here were her results: (0=pain, 1=unable to perform, 2=movement performed but with asymmetry, 3=movement performed with required technique)

Test
-Overhead Squat=2
Total Score=0
Pain in R hip
-Hurdle Step L leg over=2
-Hurdle Step R leg over=2
Total score=2


-Inline Lunge L foot forward=0
-Inline Lunge R foot forward=0
Total Score=0
Pain in both knees with movement

-Shoulder mobility, L arm behind
head, R arm behind back=2
-Shoulder mobility R arm up, L
arm behind=3
Total Score=0
due to L Sh pain with clearing test

-Active Straight Leg Raise L=3
-Active Straight Leg Raise R=3
Total Score=3

-Trunk Stability Push Up=3

-Rotary Stability Test L=2
-Rotary Stability Test R=2
Total Score=2
Total Overall Score 7/21

Alex had pain with the squat, lunge, and shoulder mobility. The funny thing was that she had no present pain in either of her Achilles but had hip, knee and shoulder pain during the screen. What was found during the screen was Alex demonstrated that she needed to improve on her thoracic spine mobility as well as her dynamic stability of all her joints.

In plain English, Alex just lost the ability to fire her stabilizing muscles at the correct times when she performed dynamic movements. Thus the load was taken in other areas including her joints and tendons. A rule with the functional movement screen is to work on mobility before stability. So the scores were reviewed with her mother and they both decided to meet with me one time per week for 4-5 weeks and then rescreen. She was asked not to return to gymnastics until she can perform the screen pain free and with no scores of 0 or 1.

Then we performed 4 total 60 minute workout sessions with exercises designed for her to improve on thoracic mobility and then practice using the stabilizers of her hips, trunk and shoulders to work in unison to perform the movement properly and pain free. Every week she was given new “homework” which meant stretches and exercises that would help her to progress to the next level.

Every session came with a quick assessment of her mobility followed by a chat on how her exercises were going and if she had any questions. Her first “aha!” moment came in the second session when she tried to perform a lunge and felt pain in her knees. Then we practiced with a band that required core activation which was pain free. After that set, I asked her to perform the lunge again but to pretend that she was still pulling on the band. Guess what! She had no pain with the movement and her lunge looked much better.

He continued with this aspect over the next few weeks and then had her come in for her follow up FMS in January after the holidays were all done and finished. This is how she scored.

Test

-Overhead Squat=2
Total Score=2 (pain free)
-Hurdle Step L leg over =2
-Hurdle Step R leg over =2
Total Score=2

-Inline Lunge L foot forward =2
-Inline Lunge R foot forward =2
Total score=2 (pain free)

-Shoulder mobility, L arm behind
head, R arm behind back =3
-Shoulder mobility R arm up, L
arm behind =3
Total Score=3

-Active Straight Leg Raise L 3
-Active Straight Leg Raise R 3
Total Score=3

-Trunk Stability Push Up=3

-Rotary Stability Test L =2
-Rotary Stability Test R =2
Total score=2
Total Score 17/21
Not only was she able to move pain free with all tests, but she moved so much better than she did 6 weeks prior. She was now allowed to work back into gymnastics as tolerated and given a final worksheet of things to continually work on to keep her healthy.

I was just recently informed by Alex’s mother that she performed her first meet on 2/28 after 6 months of no gymnastics and finished 4th in the all around, the next two meets in March she finished first in the all around. And finally, at the state meet she won 1st place on floor and vault, third place on bar, ninth place on bean and fifth all around for level 7 in the state of Tennessee! Way to go Alex!

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