Pt

Age 40 , Profession, Student full time, was infantry for 9,5 yrs, warehouse worker for 4 yrs,
care worker 1 year, waiter 1 year, security guard 4,5 years (last job static , gained weight )

Lyfestyle Activities:

Now -Active, exercising when has spare time, began intermittent fasting 1 meal/day, working
on his healthy gut bacteria, gym sessions3/7,

Past- Lazy, depressive, anxiety episodes, apathic

Hobbies: Walking daily 12 k, computer games, eating, (bad posture noticed when sitting
down )

PMH:

Obesity, Diabetes, Heart Bypass and lack of nutritional education, unhealthy postural gait
runs in family;

Was hit by a loaded cage while working as a loader in the warehouse 2016 in left Achile ’s
tendon

, at that time palpation indicated part tear of left Achile ’s tendon, now there is visible
presence on scarred tissue;

Complains of lower back pain(2015 lower back stuck while working in the warehouse)

L knee slight discomfort (antero-lateral halfway)moving towards sweet pain when squatting,
after climbing and descent from King Arthur’s Chair in Edinburg Jan 22;

claims he sits comfortably in Sitting Cross-Legged (Indian Style);

Resolve:

Femoral angle retroversion (also known as hip retroversion) is a rotational or torsional

deformity in which the femur (thighbone) twists backward (outward) in relation to the knee.
Because the lower part of the femur is connected to the knee, this also means that the knee
is twisted outward relative to the hip.

Observation :

When Pt is lying in supine position on massage table the straight legs are opening outwards.

When sitting down on chair though Pt is adopting a straight back posture sits with one leg
under the torso, most times the left one and sometimes

Side effects:

Patella femoral syndrome :

Overuse. Running or jumping sports puts repetitive stress on your knee joint, which can
cause irritation under the kneecap.

Muscle imbalances or weaknesses. Patellofemoral pain can occur when the muscles
around your hip and knee don't keep your kneecap properly aligned.

Genu valgus: when Knees twisted outward relative to the hip results in knee valgus or
Knock knock knees when squatting when soles are aligned parallel to the direction Pt facing.

R sole > L sole Eversion

MM Hypertrophy L Gastrocnemius >R Gastrocnemius bad postural habits, hypertrophic

defensive reaction cause of pathology in area

RISK:

Developing Knee Chronic OA, from overuse of one side of patella on both knees, may
develop joint pain and abnormal wear

Flat feet

As flat feet have a short arch height (if any), they get more ‘bulging’ on the insides of the feet
and ankle as they roll in. When looking at this foot type from behind, you may only be able to
see the toes on the outside of the foot. This can create the appearance of out-toeing. 

Fix:

-physical therapy, including a stretching and strengthening programme. 

Hip:

What muscles to stretch? EXT ROTATORS OF HIP

What muscles to strengthen ? INT ROTATORS of hip

Adductors being tight need programme

Knee:

What muscles cause knee valgus?

A common improper movement pattern observed during a squat is knee valgus (knees caving
inward). This is typically the result of strong hip adductor muscles (located on the inner
thigh) overpowering the weak hip abductors (gluteus minimus and gluteus medius)

Ankle:

-shoe inserts (Custom orthotics) that do help control and provide support foot structures.

Orthotics are not a cure but may help in correcting mild out toeing that can be contributed to
laxity of ligaments of the foot and ankle.
Corrective exercise meant to activate hip internal rotation, strength and stalibility.
 Femur Internal Rotation Strengthen - Hip
Corrective Exercise