23-year-old female patient with R knee medial collapse in gait and knee is neutral

when standing. The patient reports she has a torn partial R meniscus in her knee about 7

weeks ago, this is her only serious injury in her life. Patient still walks with a slight limp she

also reports she has no pain but her knee always locks on her and she has to remain in that

position until her knee unlocks. patient favorite shoes to wear are converses and vans she

also works in these type shoes she reports no foot pain these are most comfortable. Patient

also reports she never has time to do much activity with work and school besides walking. In

her free time patients likes to clean her apartment, it makes her feel more relaxed having a

clean home. The patient is a server at long horn steak house.

The patient presented with slight increase lumbar lordosis which causes anterior tilt.

Her R shoulder is more elevated while her L shoulder is more depressed. Her R shoulder is

also showing protraction while her L shoulder is in downward rotation. Patient R hip is also

elevated in the anterior view in posterior view her L hip is elevated. Patient feet is also

showing signs of pronation the R foot more than the L foot.

When in gait the patient head is tilted downward and to left in the posterior view the

patient trunk slightly sway to the right. She also has increased lordosis and R hip drop and IR

with adduction when in gait the L hip is also elevated. The patient hip drop could be a result

to her torn meniscus, if not the patient hip ABD and ER are weak and need strengthening her

Q angle can also play a part in her valgus collapse. The patient also walks with valgus

collapse, no foot slap present patient ankle is in neutral patient foot is still pronated when in

gait overly pronating the foot can indicate flat feet.

 To fix her posture start with fixing her uneven shoulders start with stretching her R

levator scapulae, traps and rhomboids while strengthening her R latissimus dorsi, serratus

anterior, and the pecs. To improve the lumbar lordosis, I will stretch the hip flexors and back

extensors but strengthening the abdominals and hip extensors.

When in the gait to fix the valgus collapse at the R knee we can work on strengthening

the HIP Abductors and External Rotators such as the gluteus Medius, TFL, and Piriformis. And

since the patient has a torn meniscus strengthening the quadriceps along with reeducation on

good quadriceps control is another way to improve her issues at the knee.

1. Interview:

How old are you?

Have you had any previous injuries?

What do you like to do in your free time when you’re not working?

Is your knee still bothering you, do you have any pain?

What type of shoes do you like to wear?

Where do you work?

Did you play any sports in high school?

What is your daily activity like?

2.
Postural Analysis Form

Lateral View Anterior View Posterior View

Head  Neutral  Straight  Straight
Forward Tilted R L Tilted R. L
Retracted Rotation R L Rotation R L
Cervical  Normal Extension  Straight
Spine Increased Extension Lateral rotation R. L
Flat Flat
Shoulders  Neutral Level Level
Internally Rotated  R Higher  Elevated R. L
Externally Rotated L Higher  Depressed R L
Scapulae Normal
 Protracted R.
L
Retracted R L
Elevated R L
Depressed R L
Upward Rotation R L
 Downward Rotation R
L
Winging R L
Thoracic Normal Straight
Spine Increased Kyphosis Convex toward R
 Flat Convex toward L
Lumbar Normal  Straight
Spine  Increased Lordosis Convex toward R
Flat Convex toward L
Pelvis Neutral Level Hips Level PSIS
 Anterior Pelvic Tilt  R Higher Lateral Tilt
Posterior Pelvic Tilt L Higher  L Higher
Rotated clockwise R Higher
Rotated Counter-
clockwise
Knee  Neutral  Neutral Femurs
Hyperextended R L Genu Valgum  Neutral
Flexed R L Genu Varum Internally Rotated R L
Externally Rotated R L
Patella  Even/Neutral
Elevated R L
Lateral Tracking R
L
Medial Tracking R
L
Ankle  Neutral
Plantarflexed R L
Dorsiflexed R L
Foot Normal Neutral Neutral
 Pes Planus R L  Pronated R  Pronated R L
Pes Cavus R L L Supinated R L
Supinated R L
 Dynamic Gait Analysis

Gait Analysis Narrative

Head  Head is tilted downward
Is the head neutral?  Head is tilted toward the left
Do you see increased forward,
backward, or lateral head movement?
Shoulders  R shoulder elevated, L shoulder depressed
Are the shoulders level throughout the  R shoulder IR. L shoulder ER
gait cycle?  R shoulder protracted shoulder downward rotation
Are the shoulders internally rotated?
Are the shoulders elevated or
depressed?
Trunk  Trunk is in neutral anteriorly
Is the trunk neutral?  Posteriorly trunk sway to the right slightly
Is the increased lateral sway?  Slight trunk flexion
Is there increased forward flexion or
backward extension?
Is there trunk rotation?
Pelvis  Increased anterior tilt
Is the pelvis neutral?  R hip drops when walking slightly, L hip is elevated
Is there hiking of the pelvis?
Is there an increased
anterior/posterior tilt?
Is there a lack of excess forward or
backward rotation?
Contralateral hip drop?
Hip  R hip seems to be IR/Adducting
Does the hip have adequate ROM?
Is the hip overally internally or
externally rotated?
Is the hip overally abducted or
adducted?
Knee  When walking the R knee is IR/medial collapse??
Does the knee have adequate ROM?
Is knee hyperextension present?
Is Varus/valgus present?
Is there knee buckling present?

Ankle  No foot slap present

Is foot slap present?  Heel toe pattern
Is there a heel-toe pattern?
Is there excessive or inadequate
dorsiflexion or plantarflexion?
Foot/Toe  Both feet are pronated the R foot has more pronation than
Is there overpronation or over the left foot
supination present?  No foot deformities
Is there enough toe extension?

Is the patient overly extended at 1st

MTP?
Toe deformities present: hallux valgus,
claw foot, hammer toes?

3. Test and measure:

 Perform MMT on the R hip ABD/ER, the patient has a R hip drop when
in gait this will help confirm if the hip abduction and ER are weak.
 The Ober test: the tightness of the TFL and IT band this can also be the
cause of the patient’s hip drop and medial/ valgus collapse at the R
knee.
4. Interventions:
1. This exercise will help with the patient’s lumbar lordosis strengthening the
rectus abdominis, gluteus maximums, and the erector spinae.

Sitting pelvic tilt on ball: have the patient sit on a ball with feet
wider than the hips knees at 90 degree of flexion, shoulders back
and spine in neutral. Patient should tilt the hips and round the
lower back using the abdominals hold for 3 seconds. Patient
should then tilt hips in opposite direction and arch the back hold
for 3 seconds. Repeat 10 times. Complete 3 sets.
2. This exercise will hip strengthen the hip Abductors which will help correct the
hip drop.
Standing hip Abduction: Have the patient start in standing using
chair for balance and not support. Place a medium resistance
band around the ankle, Have the patient bring involved leg away
from the body Keeping head straight and trunk upright. Repeat
10 times. Complete 3 sets. Then switch legs.

3. This exercise will hip strengthen the hip Abductors which will help correct the
hip drop.
Side Plank: Start the patient on their side with feet together and
one forearm right below the shoulder. Contract the core and
raise hips until the patient body is in a straight line. Hold this
position without letting your hips drops, hold for 10 secs. Repeat
times. Complete 3 sets. Then switch legs.

4. This exercise is to help strengthen the hip external rotators while patient is in a
comfortable position, this will help fix the Hip drop.
 Position patient in prone using a medium resistance TheraBand
or resistance band tie one end to a chair or table and the other
end put around the patient’s ankle. bend the knee to 90
degrees. Have patient bring their medial malleolus to the
opposite leg then back up to starting position. Repeat 10 times.
Complete 3 sets. Then switch legs.

5. This exercise is to help strengthen the hip external rotators this will help fix the
Hip drop.
Began with patient on all fours, bend legs to 90 degrees, lean
your trunk forward and squeeze the core, lift leg to 45 degrees
without moving the rest of the body bring leg back to starting
position. Repeat 10 times. complete 3 sets. Then switch legs.

6. this exercise is to fix the valgus/medial collapse at the R knee (quad re-
education)
Have the patient start in standing with band around the ankles
Legs shoulder width apart toes straight ahead spine is straight.
Proceed into a squat keeping weight in the heels of the feet to
advance the squat patient can do a squat and then move into
hip Abd when standing. Repeat 10 times. Complete 3 sets. Then
switch legs.