This document contains assessment findings and proposed training program for a 25-year old client with anterior pelvic tilt, leg length discrepancy, foot hyperpronation, and limited range of motion. Static and functional assessments identified impairments including excessive foot pronation, weak gluteal muscles, and anterior pelvic tilt. The proposed training focuses on self-myofascial release, static stretching, isolated strengthening, and integration exercises for the feet, hips, and core to address imbalances and improve posture. Regular participation in the program was limited by the client's work commitments.

1. Jacek Kondracki

2. Client Introduction
 Name: Kadra
 Age: 25
 Occupation Type: desk job
 S&C/CEx Training Age: none
 Leg Length Discrepancy 15mm
difference between left and right
 Feet Hyperpronation
 Orthoses
 Anterior Pelvic Tilt

3. Postural Assessments
 Static Assessment-Anterior, Lateral and
Posterior Views
 Functional Testing: OHS and SLS
 ROM
 MMS
 Performance Test

4. Static Assessment, Anterior
View

5. Static Assessment-Lateral View

6. Static Assessment-Posterior
View

7. Feet Pronation

8. Functional Testing-OHS

9. Functional Testing-OHS Hands
Down

10. Functional Testing-OHS Heels
Elevated

11. Functional Testing-SLS

12. OHS-Anterior

13. OHS-Lateral

14. OHS-Posterior

15. Assessments Findings
 OHS, SLS
 ROM
 MMS

16. Findings-OHS

17. Findings-SLS

18. Range of Motion

19. Dorsiflexion

20. Knee extension

21. Hip Extension

22. Hip Internal Rotation

23. Shoulder Flexion

24. Manual Muscle Testing

25. Dorsiflexion

26. Medial Hamstring

27. Gluteus Medius

28. Gluteus Maximus

29. Performance Tests
 Star Excursion
 Press-ups
 Overhead Press
 Cable Pull
 Walking

30. Star Excursion Test

31. Star Balance Excursion Test

32. Press-up Test

33. Press-Up Test

34. Overhead Press Test

35. Overhead Press Test

36. Overhead Press Test

37. Rowing Test

38. Rowing Test

39. Shoulder Flexion Test

40. Upper Extremity Transitional
Assessment

41. Walking Test

42. Walking Test

43. Walking Test

44. Consequences of feet
pronation-Reasons for
Choosing STJ Significance of STJ (Fallat 1998)
 Excessive foot pronation alters movement
patterns and leads to malalignments further
in kinetic chain:
 Feet, ankles (Tiberio 1988, Morrison 2007)
 Knees and PFP syndrome (Hertel 2005,
Powers 2003)
 LPHC and lower back pain (Betsch 2011,
Khamis 2006, Pinto 2008)
 And affect special populations: runners
(Wiliams 2001), older adults (Gross 2012)

45. Foot & Ankle
 Abnormal Foot Mechanics cause STJ to
compensate (Tiberio 1988):

46. Foot & Ankle
 Forefoot varus (Pronated Feet) results
in:
 Increased foot mobility (Cornwall 2011)
 Stress on the noncontractile tissues
(Tibero 1988)
 Increased risk of injury in soft tissue and
knee (Williams 2001)

47. Knee Impairment
 Hyperpronantion of STJ
causes excessive shank
medial rotation (Nester
2000, Tiberio 1988)
 This causes changes in
the Q-angle patella
alignment and soft tissue
stress (Powers 2003)!!
 Which produces
patellofemoral symptoms
(Tiberio 1987)
 Development of chronic
knee pain and cartilage
damage in older adults
(Gross 2011)

48. LPHC & Lower Back Pain
 Lower extremity internal
rotation is linked with
pelvis anterior tilt (approx
4-10 degrees (Khamis
2006)
 Internal femur rotation may
lead to pelvis anterior tilt
(Betsch 2011)
 Foot alignment alters EMG
activity in ES and GMedius
muscles (Bird 2003)
 Weak G Medius muscles
may deepen
malalginments (Hertel
2005)

49. Training Program Rationale-
SMR
 SMR:
 effectiveness in pain relief (Hanten
2000, Hou 2002, Aguilera 2009)

50. Training Program Rationale-
Lengthen
 Lengthening:
 effectiveness in increasing ROM and
decreasing muscle stiffness in ankle
(Guissard 2004) and knee over a period
of 6 weeks (Reid 2004)
 affects viscosity (Kubo 2002)
 duration: optimum 30s (Ford 2005,
Bandy 1997, 1998)

51. Training Program Rationale-
Integration
 Integration exercises:
 Sensimotor training and postural stabilisation
(Bruhn 2004)
 Gluteus medius importance (Hollman 2006,
Dadashpoor 2013) and training method
(Simenz 2012)
 Gluteus Maximus activation(Caterisano 2001)
 Execution, order and amount of repetitions
influences increase in CSA (Roig 2009) and
force generation (Colliander 1990, Kaminski
1998)

52. Training Program-Inhibition,
Lengthen, Isolated
Strengthening

53. Training Program-
Integration

54. OHS, ROM, MMS

55. Functional Testing-Retest OHS
Anterior View

56. Functional Testing-Retest OHS
Lateral View

57. Functional Testing-Retest OHS
Posterior View

58. Retest-Rom

59. Retest-MMS

60. Summation & Conclusion
 Due to work commitments training
frequency was limited to one session a
week.
 Progress was noticeable however
optimal results could have been
achieved if the program was applied 3
times a week.
 Other factor inhibiting progress:
extended amount of time spent at the
desk, not wearing the orthoses regularly.

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