Joseph Feraco

Joseph Feraco

Exercise Prescription Project

Exercise Prescription

Table of Contents

Demographics: pg 3

Medical and Physical Questionnaire: pg 3-4

Movement Goals and Initial Summary: pg 5

Range of motion: pg 6-10

Postural Assessment: pg 11-12

Overhead Squat: pg 12-13

Sit and reach, Semo Agility test and other tests: pg 13

Correction Exercises: pg 13-15

Demographics of Client

Name: Richard Stapleton

Gender: Male

Height in inches and in centimeters: 71 in. 180 cm.

Weight in pounds and in kilograms: 210 lbs. 95 kg.

Body mass index: 29.3

Resting HR: 64

Resting Blood Pressure: 113/65

Medical and physical history questionnaire

1. Do you exercise on a regular basis? If yes, about how many days per week do you exercise and for how long each day?

Yes. 4-6 days a week for about 1-2 hours each of those days.

2. Do you play any sports or have any hobbies involving physical activity? If so, please list them.

I like to play volleyball recreationally, and parkour is one of my main hobbies. I also spend a lot of time strength training with both weights and bodyweight activities. I spend some time training boxing as well.

3. Do you work a job where you must be sedentary for a large portion of the day, or is there physical activity involved?

My job involves a lot of walking and being on my feet constantly. I spend a lot of time sitting at school and at home however.

4. Are there any other times during your day that you are physically active? For example, riding your bike to work or walking to class.

Walking to class is the only other time I’m active.

5. Have you been diagnosed with hypertension or prehypertension?

No, my blood pressure is in a healthy range.

6. Have you been diagnosed with diabetes or high blood sugar? If yes, please list any medications that you may be taking to control these conditions.

No.

7. Have you ever been diagnosed with a heart condition? If yes, please explain the condition.

No.

8. Do you have asthma?

No.

9. Have you experienced any injuries that impact your ability to move? If so, please describe the injury and the limitations it causes.

I have a few injuries that impact my performance. I injured my elbow while doing front squats and it frequently bothers me during exercises that require elbow extension, especially with the shoulder flexed above 90 degrees. I also had a hip injury than reduced the internal rotation of my left hip. This causes my weight to shift to the side during activities like landing from a jump or squatting which has caused some knee pain. Lastly, I had a back injury several years ago that flares up occasionally. Although lifting has helped reduce the pain,8 it comes back from time to time.

10. Do you experience any other pain while exercising or during your day to day activity? If so, please explain.

No.

11. Do you have any other conditions that may have an effect on the way that you move?

No.

Movement goals for Rich

●Improve straight leg raise range of motion by 15 degrees.

●Restore internal rotation of left hip to the recommended 35 degrees

●Rehabilitate my right knee to eliminate pain

●Rehabilitate my left elbow to eliminate pain

●Perform a pistol squat on each leg on a flat surface

●Hold an unweighted full squat for 30 seconds with no spinal flexion

●Increase hip abduction range of motion by 20 degrees on both sides

Initial summary

Reviewing all of the information there are a few things that stand out to me as areas to address. First of all, he has several nagging injuries that he really needs to take care of if he wants to start moving better. Compensating for these injuries has only resulted in more problems. Most of the injuries he’s currently dealing with seem to either be causing poor mobility (in the case of his hip) or caused by poor mobility (back and elbow). I think that improving his flexibility will be an important part of helping Richard to recover and stay injury free in the future. The next thing that stands out is his weight and BMI. Although he does have a decent amount of muscle which skews his BMI reading slightly, he really should be lighter if he wants to improve at activities like volleyball and parkour. Losing weight would also probably help to mitigate his knee pain since he has to handle a lot of impact when landing from jumps.

There are some things that he’s already doing well. He is highly physically active and already put some work into improving the way that he moves. Rich constantly has to learn new skills and refine his movement simply because of the hobbies that he engages in. This has taught him a lot about his body and given some insight to where his strengths and weaknesses are. For example, he’s learned that he needs to stretch his hamstrings to improve his range of motion in his hips.

Range of motion assessment

The cervical spine was assessed for range of motion in flexion, extension, lateral flexion, and rotation. He was able to achieve about 85 degrees of cervical rotation which is slightly more than the 80 degrees that is expected. There is nothing to worry about as he is not significantly more flexible than he should be while Rich does meet the expected range of motion. Similarly, he had just about 45 degrees of lateral flexion to both the left and right. Because 45 degrees is what should be expected, I do not need to be concerned with this either. Cervical extension should be 75 degrees and he measured about 70 degrees. While this is slightly less than expected, it is not very far off. He needs to stretch his neck to make up for this small deficit, but do not see it as a pressing concern. Overall, he had no problems with his neck and I think that having the correct mobility has helped keep it that way.

The glenohumeral joint was assessed for flexion, abduction, and internal and external rotation. On both sides of his body he was able to reach 180 degrees of shoulder flexion. This is about 10 degrees more than expected which is somewhat significant. It is important for him to have that range of motion because he does a lot of handstands and overhead pressing exercises. Without that full range of motion, he would have to make compensatory motions in the lower back which would increase his risk of injury. Rich also had 180 degrees of abduction at the shoulder which exceeded the norm by 10 degrees as well. Once again, this range of motion is important for him to perform several exercises safely and correctly so he works to maintain it. On both sides he had about 50 degrees of internal rotation at the shoulder. This is fairly below where it should be as 70 degrees would be more optimal. He may need to increase this range of motion to keep his shoulders healthy, and it may even reduce some of the strain being placed on his elbows. His external rotation in both shoulders was much better, measuring 90 degrees which is considered optimal. The Apley Scratch test was also used to assess shoulder range of motion. A good rule of thumb for this test is that the hands should be within an inch of each other. He was able to touch his hands together on both sides meaning he does not have a restriction according to that test. While his shoulders feel good as a whole, he is now aware that internal rotation is something he may benefit from improving. It is likely to help prevent injury in the future.

Finally, the hip joint was assessed for internal and external rotation and flexion. On the right side of his body, Rich had about 30 degrees of internal rotation at the hip. This is slightly lower than the 35 degrees that he should have. Interestingly, his left hip only achieved about 15 degrees of internal rotation. He injured his left hip in the past and it has bothered him occasionally ever since. It’s interesting to see that the injury had such a huge impact on his ability to move. This lack of internal rotation in his left hip causes him to shift his weight oddly in some activities which may be related to some knee pain that he experiences. For this reason it’s probably very important that I address the internal rotation of his left hip, while also adding a few more degrees to his right hip. As far as external rotation is concerned, his left hip reached 45 degrees whereas his right hip only reached 35 when it should also be able to rotate 45 degrees. This sheds some more light on the impact that his injured left hip has had. He likely reduced external rotation in his contralateral hip because that hip spends more time internally rotated to make up for the left hip being forced into slight external rotation. This adds another component of flexibility that he needs to target to fix his movement patterns. His hip flexion with 90 degrees of knee flexion measured at 110 degrees on both sides. Compared to the recommended 90 degrees he has more than enough range of motion. Despite that, I would still like to increase his hip flexion to allow Rich to squat deeper and safely. In contrast to this, he was only able to achieve about 45 degrees of hip flexion in the straight leg raise assessment on both legs. This is only half of what he should be able to achieve and indicates very tight hamstrings. This is corroborated by the results of his sit and reach assessment. He was several inches away from even being able to reach his feet which would be considered the appropriate range of motion. This probably has a lot to do with his back pain and is certainly restricting his movement in several areas. Improving this range of motion should improve his performance, reduce his back pain, and diminish his potential for further injury. Lastly, he had a negative Thomas test on his left hip meaning that his left hip flexors are not tight. He had a positive Thomas test on his right hip indicating that his rip iliopsoas may be tight. He will need to work more on lunge stretches in order to even out the sides. Overall, his hips are probably the biggest problem joint in his body. He has multiple restricted ranges of motion, some of which cause pain and noticeable impairments to his movement. It is very clear that improvements need to be made in several areas in order to facilitate proper movement patterns.

Postural assessment

Frontal view Sagittal view Posterior view

Posture was assessed in order to identify any dysfunctions that may exist. Frontal, sagittal, and posterior views were all utilized to provide as much information as possible.

Starting with a frontal view, several joints were examined for bilateral symmetry. A lack of symmetry is a postural abnormality that may be indicative of structural or functional issues. Starting with the eyes, his were evenly aligned. This means that none of his sternocleidomastoids or scalenes are over active. Moving down, his acromioclavicular joints were also the same height. Uneven AC joints could be the result of an injury to the area, scoliosis, or over-active upper trapezius. His anterior superior iliac spines were also the same height. This means that there is not a discrepancy in his leg lengths, no scoliosis, and no over activity of the quadratus lumborum or under activity of the gluteus medius. Both of his patellas face forward which shows that there is no internal or external rotation at the hip. Similarly, there are no signs of genu valgum or genu varum which means there is no adduction or abduction happening at the hip joint. Lastly, both of his feet face forward. This means that there is no over activity in his lateral gastrocnemius or under activity in the medial gastrocnemius.

From a sagittal view the primary area of focus is the position of the spine. A common postural dysfunction at the cervical spine is a forward or protruded head. This would be caused by tightness in both sternoclediomastoids as well as under activity in the cervical extensors. Rich’s head does not protrude so these issues are not a concern. Next, there is not an excessive protraction of his scapula or kyphosis of his thoracic spine. Protraction of the scapula would be caused primary by over activity of the pectoralis minor and under activity of the rhomboids and middle trapezius. Excessive kyphosis would be caused by an over active anterior longitudinal ligament and under active thoracic extensor spinae. Although there is some lordosis at his lumbar spine, it is not excessive. This could be the result of tight hip flexors, weak abdominals, tight erector spinae, and weak hamstrings. Stretching out his hip flexors and strengthening his anterior core will probably help to mitigate the risk of injury. As he has a slight lordosis, he does not have a reduced lordosis. This would be caused by tight and over active hamstrings and abdominals, along with weak and under active hip flexors and erector spinae. Lastly, there is no visual evidence of gen recurvatum in his legs.

From a posterior view the first thing that was assessed was the scapula. There was no winging of his scapula which means that his serratus anterior is functioning properly. Looking at the feet, there does appear to be some degree of eversion occurring. This may point to over activity of the peroneals and under activity of the tibialis anterior. This is an issue that he has been working to address because it may be causing compensations along the kinetic chain that are contributing to knee pain that he has been experiencing. This eversion also increases his risk of ankle sprains so fixing it in a timely matter is especially important.

Overhead squat assessment

Anterior view Sagittal view Posterior view

During the overhead squat his feet face straight forward. This means that his soleus and lateral gastrocnemius are working appropriately with the medial gastrocnemius. His knees are either in line with my toes or slightly outside of them. This means that abduction and external rotation is occurring at the hip joint. This may indicate and over active piriformis, however in his case I believe it is more due to technique than due to tightness or over activity. He was taught to keep his knees out during a squat in order to prevent a valgus collapse, so he intentionally externally rotate his hip.

He demonstrated a normal degree of forward lean during the overhead squat. This means that there is no imbalance between the rectus abdominus and the erector spinae. He may have a somewhat reduced lordosis. This indicates an over active rectus abdominus and hamstrings and under active erector spinae. Although it is currently not severe, allowing his back to round further would put him at an increased risk of injuring his spinal discs. Correcting this dysfunction may help to avoid back pain in the future. Lastly, his arms remain in line above his head. If they were to fall it would indicate tight and overactive latissimus dorsi and pectorals and weak, underactive posterior deltoids and middle and lower trapezius.

Other Tests

His vertical jump test was measured at 24 inches. This measurement is above the average that is set at 16-20 inches. This shows that he has great power in his quadriceps and hamstrings to help push him upward. The Semo agility test was administered and his results came out to 11.17 seconds. This measurement is a good score reaching the ranges from 11.49 seconds to 10.7 seconds. This shows that his calves, ankles, quadriceps, and hamstrings are working to together for a good score. The way to get an even better score is to stretch out his hips so that he can make his turns quicker and more explosive. For his 1RM max bench press, I had him do 12 reps with 185 pounds. I then calculated his 1RM by taking the weight his lifted and multiplied it by his 12 reps then multiplied by .03 and then added the 185 to get his estimated 1RM of 250 pounds. During the sit and reach test he measured at 12 inches. This measurement is a poor score compared to the average. This can be a sign that the flexibility in the hamstrings is not where it should be. A T-test was performed to determine the quickness and agility. The results showed that Rich’s time was 10.8 seconds. This is an average score for men. If he wants to get a lower time, he needs to stretch his hamstrings and hip muscles for quick movement on all planes (forward, backward, side to side).

Corrective exercises

Throughout the course of this analysis, I have come across several dysfunctions and restricted ranges of motion that I would like to correct. The movement dysfunctions that I would like to correct include eversion of the foot and a tendency to move into lordosis, especially during his overhead exercises. The ranges of motion that I would like for him to improve include straight leg hip flexion, hip extension, and shoulder internal rotation.

Eversion of the foot is most likely caused by an underactive tibialis anterior. I plan to address this dysfunction by strengthening his tibialis anterior along with stretching his calves. I will use duck walks, band resisted ankle dorsiflexion, and a wall calf stretch to correct his dysfunction.