My patient presents with low back pain, B knee pain and B ankle pain from chronic military activity. After going through the main SFMA tests, her results were as follows: functional and non-painful (FN) cervical flexion, cervical rotation and lateral bend, MRE (UE pattern), LRF (UE pattern), L trunk rotation, and single leg stance; dysfunctional and non-painful (DN) cervical extension, multisegmental extension, and R trunk rotation; and dysfunctional and painful (DP) multisegmental flexion and overhead deep squat. I decided to breakout the overhead deep squat (the greatest dysfunctional test) and these were the results: DP hands interlocked behind head squat and assisted squat, and DN 1/2 kneel. Treatment thus included ankle joint mobilization (L talocrural distraction manipulation and B mobilization with movement dorsiflexion with belt) which took away her pain with all squatting however did not improve her squatting motion to functional. At that point in time I picked up her core stabilization exercise, and with transverse abdominis cueing, she was able to start making gains in functional movement, without pain, during squatting. The stabilization level she got to today is what I call Pilates Leg Loading Test III (PLLTiii). Her homework included a 1/2 kneel calf stretch and PLLTiii. My plan is to clear up her overhead deep squat function and then proceed to her multisegmental flexion dysfunction as needed to return this patient to pain free military duty.
PLLTiii: patient is to maintain a neutral spine throughout
the exercise (BP cuff feedback to maintain 40mm Hg
throughout), keep 1 leg in a 90/90 or table top position
as shown, and slide the alternate leg from flexed knee to
extended knee position. Repeat 5 times per side with
consistent 40mm Hg reading before progressing to the
next level.
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