Mitch Altamura

Case Study #2

July 9, 2017
Case History

the subject of this case study is a 22-year-old male. He has been coming to Overtime

Sports for over 2 years now. Before he started his exercise journey he was not familiar with

exercising. Now he can say he has become comfortable with exercising as he has been receiving

personal training 4 days a week for the past 2 years. When he first started, his goals were to:

increase strength and power, as well as increase his overall muscle mass. Standing at 510, he

started his journey at 150 pounds and now weighs 180 pounds. He is very happy with his

progress so far, but his goals are far from met. He has set a new list of goals: eat healthy, lose

body fat and build upon his lean muscle. In order to reach these goals, the trainer has created a

regimen that includes high intensity and high repetition exercises; as well as heavy load, low

repetition Olympic lifts such as: bench press, squats and deadlifts.

Exercising has not always come easy for this client. He has lived with a condition called

Pectus Excavatum his whole life. Pectus Excavatum, commonly known as funnel chest, is a

condition in which several ribs and the sternum develop abnormally and produce a caved in

appearance of the anterior chest wall. This condition is diagnosed at birth and the deformity

becomes more apparent as the individual grows. In this clients case, the condition led to

frequent right lung collapses, poor flexibility, and low self-esteem due to his body image

perception. The only fix for this condition for the client has been a long list of surgeries, six to

be exact. As a result of these many surgeries, the client has since fixed the problem

cosmetically and does not experience collapses of the lungs, but he now deals with permanent

nerve damage. He lives with numbness in his right triceps and the right side of his back. This

has in turn created difficulties with exercise as it makes it difficult for him to properly complete
lifts. He also still suffers from a severe lack of flexibility. He claims to foam roll for 20 minutes

each night to try and help with the problem, but it is still visible that he does not reach the full

range of motion in many of his joints. This became prominent when watching him squat and

deadlift, since those lifts require movements through a multitude of joints.

As an exercise physiologist, I will continue working with his personal trainer in order to

make sure he reaches his next set of goals. I also want to create a safe environment so that

exercise will not worsen or provoke any issues with his condition that may set him back a few

steps. Having such low flexibility creates a high chance of injury so he will be watched carefully

to make sure he is pushing himself just the right amount without any negative side effects. The

trainer and Is goals are to make sure he is working at his full potential safely.

Preliminary/Diagnostic Evaluation

Since this client has been coming to Overtime Sports for over 2 years, I do not have

access to his preliminary evaluation. The only data recorded are his 1 Repetition Maxes and

some other maxes. First is his barbell bench, which he lifted 250 pounds. For his inclined

barbell bench, he lifted 200 pounds. His lower back squat was 300 pounds. Lastly, his front

squat was 250 pounds. Other tests that were performed were a 3 repetition max of his box

squats in which he did 225 pounds. He also completed a pull up max in which he was able to do

12 pull ups.

All of these tests have been previously recorded in other trials and his progress has been

checked through these maxes. He completes these tests at the start of every month to see how
much progress he has made. In all lifts, the lack of flexibility was present. This was especially

prevalent in any of his squats. You can see that he is nowhere near what an average deep squat

would be considered. Although he lacks flexibility, he is very diligent about his form, which he

has worked hard on in order to decrease risk of injury.

Behavioral Modification/Intervention

This client has already gone through the hardest part of exercising: finding the

motivation to adhere to an exercise program. Since he already has the commitment to training,

no real behavioral modification is needed. He is fully aware of the limits of his condition and is

careful about not over-pushing himself. He has already seen the gratification he gets from

meeting his goals since he has already met his first set of goals and has already made his second

set. The client admits to not participating in as much physical activity outside of Overtime

Sports besides some recreational sports in his downtime. He makes coming to his personal

training session a high priority and he is always on time for his scheduled session and he is

willing work even after his session has ended if he has not completed his routine. His normal

sessions usually last about an hour and a half.

He completes his own warm up before every session. It includes different types of

banded walks and different dynamic stretches. This takes him a good amount of time because

he wants to focus on being loose before he starts so that his condition does not limit him from

completing his routine effectively. His current prescribed exercises are listed in a table below:
Exercise Sets x Reps
Power
Squat 4x8
Deadlift 4x8
Chest Press 4x8
Plate Push on Turf 30 yds x 4
Prowler Push 30 yds x 4
Strength
Front Squat 4x8
Lat pull down 3 x 10
Weighted Lunges 3 x 10 ea
Hammercurls 3 x 10
Reverse Flys 3 x 10
Triceps Pushdown 3 x 10
Technique/Balance
Bosu Goblet Squat 3 x 12
SL Romanian Deadlifts 3 x 10 ea
Box Jumps 4x6
Flexibility
Post Capsule Stretch 15 x 5
ER Doorway Stretch 15 x 5
Side Bend Stretch 15 x 5
Seated Hamstring Stretch 30 x 3
Butterfly Stretch 30 x 3
Hip Flexor Stretch 20 x 5
Wedged calf stretch 30 x 5

This is not the same routine the client has been doing for the past two years. Every

couple of months the trainer switches around the exercises he is doing in order to help develop

different movement patterns to work the same muscles. Each of his exercises are broken up

into categories to help develop different areas. These areas are: power, strength,

technique/balance, and flexibility. The client does his own conditioning training. He likes to run
and go for bike rides around his area. He would rather use his personal training time to

dedicate to lifting rather than conditioning.

The power portion of his routine is to help build his explosiveness. It is also a great way

to track his progression because some of these exercises are used in his monthly progress lift

tests. Lifts such as squats and deadlifts are a multi-joint lifts and help him test his flexibility

while also recruiting many different types of muscles. Exercises like his plate and prowler

pushes are more dynamic and even though they do not focus on flexibility, they are helpful in

cross training different muscles to work in unison to complete the exercise.

The clients strength portion is meant to cover a full body exercise regimen. Most

muscle groups are hit within this section and any other muscle groups not included are worked

in the other sections. Most of these exercises were tailored towards his condition; specifically,

the ones dealing with the nerve damage in his right back and right triceps. To help keep

bilateral balance when exercising these muscles, the trainer tries to use lifts that work both

muscles at once, such as the lat pull down and rope triceps pushdown. This ensures that the

weight is evenly distributed between both sides and does not create an imbalance between the

right and left side of the body.

The client also showed small signs of trouble with balance since he does suffer nerve

damage. Luckily the nerve damage is in the upper body so it is not drastic, but since it is in his

back, exercises that require back stabilization are difficult. To help this, exercises like goblet

squats on the bosu ball were prescribed. Other exercises like single leg Romanian deadlifts and

box jumps also help reaffirm with back stabilization and maintaining balance.
 Lastly, a flexibility portion is incorporated into the ending of his workout. This is the best

time for him to try and increase his range of motion, while his muscles are warmed up and

fatigued. This portion is meant to just hit the main muscle groups directly after working out.

Hitting the leg and hip muscles will help him sit deeper in his squat. Keep in mind, these

flexibility exercises are also partnered with 20 minutes of foam rolling and stretching whatever

muscles he feels may be tight at the end of the night.

In conclusion, the client shows great motivation and potential to meet his goals. He has

a satisfactory understanding of exercising and has a great attitude every time he comes to his

sessions. It can be concurred that he will do very well with his exercising endeavors.