the effects of core strengthening on the gait pattern of ...exercises performed by the case patient...

The Effects of Core Strengthening on the Gait Pattern of an Obese

Middle School Child Joanne Mikaiel,,SPT, NSCA-CPT; Ellen Donald, MS, PT; Stephen Black, DSc, PT, ATC, CSCS

College of Health Professions, Florida Gulf Coast University, Ft Myers, FL

Exercises Performed by the Case Patient

REFERENCES The purpose of this case study is to observe the effects

of a core strengthening program on the gait pattern of

an obese thirteen year old female.

This case report details the use of a core

strengthening program on an obese middle school

child with impaired gait mechanics,. Research has

established that obese children ambulate with a

slower walking velocity, longer double leg stance,

wider stance width, and a greater degree of

asymmetry. The child was referred to physical

therapy with an acute low back sprain, treatment was

focus toward improving the low back sprain and gait

abnormality via a core strengthening program. This

case provides an example of how providing a core

strengthening program to an obese child in middle

school can help improve the impaired gait mechanics

found in obese children.

Colne, P., Frelut, M. L., Peres, G., & Thoumie, P. (2008). Postural control in obese adolescents assessed by limits of stability and gait initiation. Gait & Posture, 28(1), 164-169.

D Hondt, E., Deforche, B., De Bourdeaudhuij, I., & Lenoir, M. (2009). Relationship between motor skill and body mass index in 5- to 10-year-old children. Adapted Physical Activity Quarterly : APAQ, 26(1), 21-37.

Dufek, J. S., Currie, R. L., Gouws, P. L., Candela, L., Gutierrez, A. P., Mercer, J. A., et al. (2011). Effects of overweight and obesity on walking characteristics in adolescents. Human Movement Science,

Epstein, L. H., Paluch, R. A., & Raynor, H. A. (2001). Sex differences in obese children and siblings in family-based obesity treatment. Obesity Research, 9(12), 746-753.

McEwen, J. (2006). Obesity: the prevention, identification,. England: Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0041751/pdf/TOC.pdf

McGill, S.M. Low back stability: from formal description to issues for performance and rehabilitation. Exerc. Sport Sci. Rev. 2001.

Olds, T. S., Ferrar, K. E., Schranz, N. K., & Maher, C. A. (2011). Obese adolescents are less active than their normal-weight peers, but wherein lies the difference? The Journal of Adolescent Health : Official Publication of

the Society for Adolescent Medicine, 48(2), 189-195.

Portney, L. G., & Watkins, M. P. (2009). Foundations of clinical research applications to practice. (3 ed., pp. 235-262). Upper Saddle River: Pearson.

Vander Wal, J. S., & Mitchell, E. R. (2011). Psychological complications of pediatric obesity. Pediatric Clinics of North America, 58(6), 1393-1401.

World health organization (WHO). (2011, December 13). Retrieved from http://www.who.int/en/

Wrotniak, B. H., Epstein, L. H., Dorn, J. M., Jones, K. E., & Kondilis, V. A. (2006). The relationship between motor proficiency and physical activity in children. Pediatrics, 118(6), e1758-65.

Background

Abstract

• 13-year-old obese female with a BMI of 30.7

• The patient sustained a low back sprain while assisting her family move.

• The patient referred to physical therapy to strengthen her core stabilizers to

decrease her current low back pain and to prevent a reoccurrence of low back

pain.

• Patient presented with decreased core and hip girdle stabilization strength,

decreased muscle length, decreased balance, impaired gait, impaired posture, and

increased pain.

• Pt required physical therapy 2x/wk for 8 weeks to return patient to prior level

of function.

Case Patient Description

• During the eight week core strengthening program the

case patient demonstrated significant improvement in:

• Single leg stance time

• Core strength

• Bilateral lower extremity strength

• Gait parameters

• Hamstring and gastroc flexibility.

• After the core strengthening program patient gait pattern

demonstrated: increased stability of the trunk, increased

stride length, and increased cadence.

• The patient demonstrated these improvements despite her

weight remaining unchanged.

• This case study suggests that a core strengthening

program should be performed when a goal for therapy

includes improve the gait mechanics of an obese child.

• In the future, the body composition and the child’s self

efficacy in physical activity should be measured.

Conclusion

Purpose

• Obesity is currently the most common disease in

adolescence

• 16.9% of adolescents are considered obese

• Children who are obese are less likely than

normal weight children to participate in physical

activities

• Children who are obese require a higher energy

cost, as compared to normal weight and overweight

children

• The most fundamental and challenging motor

skill that a child develops is ambulation

• Ambulation is an important skill to master

because it is the prerequisite to all of the motor skills

required for physical activity.

• It is believed that if physical therapists make

physical activity enjoyable to children who are obese,

the children will be more inclined continuing their

participation in physical activities

Results Evaluation Discharge

Single Leg Stance R= 3 secs, L= 4 secs. B trendelenburg

and instability R= 35 secs, L= 34 secs with minimal

sway Gait antalgic, increased BOS, Lateral shifting

B, decreased stride length, B hip hike,

ER hips B, decreased heel strike and

push off

increased BOS, ER hips B, increased

cadence, decreased heel strike and

push off

Posture forward flexed trunk, hips in slight ER,

increased lumbar lordosis, B pas planas hips in slight ER, increased lumbar

lordosis, B pas planas

BLE Strength R: hip flexion: 4-/5, hip extension:

2+/5, hip abd: 3-/5, knee flexion: 4/5,

knee extension: 4+/5, dorsiflexion: 4-/5,

plantar flexion: 2+/5 L: hip flexion: 3+/5, hip extension:

2+/5, hip abd: 3/5, knee flexion: 4/5,

knee extension: 4/5, dorsiflexion: 3+/5,

plantar flexion: 2+/5

R: hip flexion: 4/5, hip extension:

3/5, hip abd: 3/5, knee flexion: 5/5,

knee extension: 5/5, dorsiflexion:

4+/5, plantar flexion: 4/5 L: hip flexion: 4/5, hip extension:

3/5, hip abd: 3/5, knee flexion: 5/5,

knee extension: 5/5, dorsiflexion:

4+/5, plantar flexion: 4/5

flexibility: (Hamstrings at

90 deg of hip flex)

R: 76 deg, L: 80 deg Gastroc R: -5 R, L:-2

R: 86 deg, L: 85 deg Gastroc R: 5 R, L:2

Prone plank test 6 secs before she lost the correct posture * Plank assessed on 3rd visit. Plank

was not evaluated on first visit due to

acuity of pain

Plank test: 20 secs before she lost the

correct posture

:

Balance Strengthening Core Stabilization

This table demonstrates a few of the exercises performed by the case patient during

her core strengthening program.