I had the opportunity to work with a 15-year-old, male cross country runner in the fall of 2019 who was experiencing pre-syncope toward the end of his races.
Pre-syncope is the medical diagnosis that means he was on the verge of fainting.
With less than a half mile to go, he described his vision as becoming blurry and tunneled, having difficulty breathing, and losing control of his body. He only experienced these symptoms during competition when going at max effort.
After this happened in a few consecutive cross-country meets his parents had him evaluated by his pediatrician. Thankfully, all his work up for his heart, lungs, and brain came back negative. His pediatrician reached out to me to assess him from a postural and breathing standpoint to see if there was anything physically limiting his performance causing him to feel like he was going to faint.
At his initial evaluation this is what we found:
The results of the above test indicate a common pattern seen in people called the left AIC/R BC pattern (PRI).
The hallmarks of this postural asymmetry are difficulty expanding the right upper chest and left posterior chest, getting into left stance during walking or running gait, and being unable to touch one’s toes because of an inability to retract the ribcage well. This can be caused because the chains of muscles that drive this pattern are either oriented in a chronically lengthened or shortened position. Repetitive activity, such as running, can exacerbate this patterned state. This pattern can lead to limitations of his diaphragm and rib mobility creating impaired airflow; particularly being able to exhale fully on the left.
Recommended Exercise Sequence
At our initial visit, he was given the following three exercises to help inhibit the muscles that were driving this stressful pattern. The initial goal was to help restore his left diaphragm’s ability to fully lengthen to restore the length-tension relationship of his abdominals to be able to perform a full exhale followed by full inhale.
Exercise 1: 90-90 hip lift with a balloon (Postural Restoration Institute©)
Exercise 2: Sidelying Swiss ball with right apical expansion (Postural Restoration Institute©)
Exercise 3: Stair short, seated balloon (Postural Restoration Institute©)
The patient was seen for 3 visits over the course of 5 weeks. His exercises progressed each visit to get him into being comfortable in left stance position, maintaining a good relationship between his pelvis and ribcage, and then being able to breathe while alternating from his left leg to his right leg to mimic the demands of running.
The symptoms that he experienced during cross country meets decreased each subsequent visit and at his last visit he was able to compete 100% symptom-free.
Here are the results of testing at his last visit:
Since he was symptom-free and the season was over he was discharged from physical therapy with a set of exercises to help keep him moving in an alternating and reciprocal fashion while breathing well so that he can continue to improve his running performance.
Exercises from his initial visit can be seen on our YouTube page.
Are You Experiencing Physical Limitations?
Zone Physical Therapy would love to help answer your questions about any limitation you are experiencing and we hope we can get the conversation started on the next steps to help you solve any pain or discomfort and find what is causing you issues.
In our clinic, we work so our patients can enjoy the things they love while pain-free. If you are experiencing pain or noticing any physical limitations, come see us!
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