Introduction

 Client Overview

The subject of this case study is a 26-year-old man with a sedentary job who spends a significant number of hours per week stationary. Since June 2022, he has complained of lower back pain as a consequence of his sedentary occupation. In addition to his sedentary job, the client engages in recreational football twice per week and resistance training three times per week.

Sedentary jobs that involve sitting during prolonged hours can led to several physical changes in the body including knee pain (Collings et al., 2016; Lee et al., 2015). Moreover, prolonged sitting can cause tightness in the hip flexors, glutes, and hamstrings muscles, which are essential for knee stability and support during running (Ghulam et al., 2017). Lee et al. (2015) discovered that knee pain was significantly higher in individuals with prolonged sedentary times (p<0.02) and was associated with sedentary times over 10 hours/day incidence (OR= 1.28; CI= 1.02–1.60; p<0.03). In contrast, those with greater physical activity had less chronic knee discomfort (OR= 0.78; CI= 0.67–0.95; p<0.001).

Additionally, desk jobs increase the problematic with hip flexors as the more time they remain shortened, the more difficult it will be for them to return to their optimal length (Muscolino et al., 2017). Furthermore, hip extensors and core stabilizers will be reciprocally inhibited, placing the lower back in extension and pelvis anterior tilted  (Winters et al., 2004).

Consequently, it would be essential to investigate the underlying cause of the discomfort and administer the proper treatment. Doing so will reduce pain and muscle fatigue while increasing ROM (Range of motion) and lowering the risk of future injuries (Clark et al., 2014).
The client was asked to complete the Fear Avoidance Beliefs Questionnaire (FABQ) (Waddell et al., (1993) and The Roland-Morris Questionnaire (RMQ) (Roland & Morris, 1983). These questionnaires will help determine the pain intensity, severity of the client's back pain and quality of life; and provide the most appropriate protocol intervention (See Appendix). The client scored 3 in the RMQ (meaning no disability) and 20 in the (FABQ). The English version of RMQ shows it is a valid test, however if a client fills the same questionnaire on two different occasions, variabilities are expected (Stratford et al., 2000). Stradford et at., (2000) found excellent test-retest reliability of 0.81, ICC= 0.62-0.91. Furthermore, Waddell et al., (1983) found a internal consistency in test-retest reproducibility of 0.88- 0.77 in the FABQ.

This case study will include an appropriate corrective exercise assessment to the client needs. These will  include the following:

1. Static postural assessment

2. Gait Analysis

3. Lateral Scapular test

4. Overhead squat assessment (modified squat assessment)

5. Single leg squat

6. Weight-Bearing wall lunge

7. Ankle dorsiflexion goniometer

8. Leg length

9. Adam’s Bend Forward Test

10.  Trendelenburg-test

11.  Thomas test

References:

Collins, N.J., Vicenzino, B., Van der Heijden, R.A. and Van Middelkoop, M., (2016) ‘Pain during prolonged sitting is a common problem in persons with patellofemoral pain.’  Journal of Orthopaedic and Sports Physical Therapy, 46(8), pp.658-663.

Lee, S.H., Son, C., Yeo, S., and Ha, I.H.(2019) ‘Cross-sectional analysis of self-reported sedentary behaviors and chronic knee pain among South Korean adults over 50 years of age in KNHANES 2013-2015.’ BMC Public Health,19, pp. 1375.

Muscolino, J. E., Myers, T., Gaines, S., and Charmoz, A. (2017)  ‘Kinesiology: The skeletal system and muscle function.’ Louis, MO: Elsevier, Inc.

Stratford, P. W., Binkley, J. M., and Riddle, D. L. (2000). 'Development and Initial Validation of the Back Pain Functional Scale.' Spine, 25(16), pp.2095–2102. 

Winters, M. V., Blake, C. G., Trost, J. S., Marcello-Brinker, T. B., Lowe, L., Garber, M. B, and Wainner, R. S. (2004) ‘Passive versus active stretching of hip flexor muscles in subjects with limited hip extension: A randomized clinical trial.’ Physical Therapy, 84(9), pp. 800-806.

Appendix:

1. Fear-Avoidance Beliefs Questionnaire (FABQ).

2. The Roland-Morris Disability Questionnaire.