PTH 645 Grace Blankenhagen

Strength Training Assessment: SOAP Note 01/28/2016

Subjective

Patient: Abbey Thornock. Gender: Female. Age: 23 Birthday: 05/14/1992 Height: 60

Weight: 138 lbs

Current Complaint: General weakness in upper back. States possibly contributing to

rounded shoulders and poor posture. Patient goal: Increase upper back strength to
improve posture. Social Hx: Lives with husband and 17 month old daughter.
Employment status: Student. Living Environment: Ground level apartment. No stairs.
Health Status: No current illness. Social/Health Habits: No alcohol/ no smoking/
moderately active in daily activities, but does not work out regularly. Diet is generally
healthy and balanced. Functional status/ Activity Level: Independent. Medical/Sx Hx:
Wisdom teeth removed (2010), L. Inguinal Heria repair (2015), One pregnancy with no
complications; Vaginal delivery. Medications: IUD. Patient Comments: Poor posture is
habitual, starting in childhood or early adolescence.

Objective

Systems Review

Cardiovascular/Pulmonary: HR: 70bpm. RR: 11 breaths/min. BP: 106/68 mmHg.

Integumentary: Pink. Warm. Unimpaired. Musculoskeletal: Extension at upper cervical
spine with flexion in lower cervical spine. Slight winging in scapulae bilaterally. Kyphosis
in thoracic spine slightly exaggerated. Shoulders internally rotated. Gross symmetry
appears equal in tone and ROM. Strength varied, with overall upper extremity deficits
noted in the left upper extremity and scapular stabilizers. Height: 60. Weight: 138 lbs.
Neuromuscular: Gait, balance, locomotion unimpaired. Communication: Unimpaired.
Affect: Emotional/behavioral responses unimpaired. Cognition: LOC x3. Learning
Barriers: None. Learning Styles: Learns by visual example, verbal cuing, and doing.
Education Needs: Exercise progression and HEP.

Tests and Measures

MMT:

Middle Lower Upper Serratus Biceps Triceps

Rhomboids Traps Traps Traps Anterior Brachii Brachii
L 5 3+ 3+ 4 5 5 4
R 4 4 4 5 4 5 4
PTH 645 Grace Blankenhagen
Strength Training Assessment: SOAP Note 01/28/2016
One Repetition Max (1RM)

1. Standing T: Performed 14 reps at 5.8 lbs (blue Thera Band) with 100%
elongation. 1RM= 9.10 lbs.
2. Wall Sit W-Y: Performed 3 reps with 5 lb dumbbells. 1RM= 5.30 lbs.
3. Triceps Pull Down: Performed 16 reps at 10.2 lbs (silver Thera Band) at 100%
elongation. 1RM= 17.5 lbs.
4. 3-Point Triceps: Performed 7 reps with 10 lbs on left and 13 reps at 10 lbs on
right. Left 1RM= 12.0 lbs. Right 1RM= 19.5 lbs.
5. Compound Row: Performed 12 reps at 75 lbs. 1RM= 108 lbs.
6. Triceps Dips: Performed 13 reps at 20 lbs. 1RM= 30.0 lbs.

1RM determined by trial-and-error and calculated using Hetherington equation.

Assessment

Patient exhibits weakness in middle and lower trapezius on the left side of the body.
Patient has strong elbow flexors and scapular protractors. Weakness noted in elbow
extensors bilaterally. Tolerated initial 1RM session well. Exhibited fatigue but was able
to continue with adequate rest between exercises. Needed verbal cuing to hold correct
posture during exercises, may need reminders in order to prevent muscle substitution.
Lives busy life with husband, school, and child. She prefers to do exercises at home
because getting to the gym is difficult for her, so she will be sent home with Thera Band
and instructions for creating her own weights for most of the exercises. Patient is
motivated to get stronger so adherence appears promising.

Plan

Patient will be able to demonstrate increased strength, determined by MMT, in scapular

retractors and triceps in 6 weeks. Patient is instructed to perform all exercises except
W-Y, at 60% 1RM for 3 sets of 10 reps once every other day. Instructed to perform W-Y
at 60% 1RM for 3 sets of 6 reps every other day. Instructed to progress to compound
row and triceps dips once other exercises can be performed at 20 reps at once of their
respected %1RM (except W-Y; 12 reps at prescribed %1RM). Patient goals are to
increase strength. Reps and resistance weight prescribed with that in mind, Thera Band
chosen to promote controlled motion and prevent injury as re-introduction to exercise.
1RM and MMT grade will be re-evaluated at 3 weeks, and again at 6 weeks at end of
program.

Goals

o Increase strength in scapular retractors and triceps.

o Adherence to exercise program to promote healthy exercise habits.
PTH 645 Grace Blankenhagen
Strength Training Assessment: SOAP Note 01/28/2016
Exercises Prescribed

1. Standing T (targets middle traps)

a. Patient stands with Thera Band wrapped around stationary object at
shoulder height. Assumes athletic stance with shoulders abducted to 90
degrees and externally rotated (thumbs pointing back). Contracts scapular
retractors to pinch scapulae together. 3x10 reps with blue Thera band
(5.8 lbs) every other day.

2. Wall Sit W-Y (targets lower traps)

a. Patient assumes wall sit position with back flat against surface. Shoulders
abducted 30 degrees, elbows flexed 100 degrees and forearm pronated
(W). Lateral epicondyles of elbows and dorsum of hand remain in
contact with surface as patient abducts shoulders further up wall until
contact is lost or back arches. Attempt to make Y with upper extremities.
3x6 reps with 3 lb weight (or full 32oz water bottle) every other day.

3. Triceps Pull Down (targets triceps)

a. Anchor Thera Band on surface above head. Stand in athletic stance with
elbows fully flexed and forearm supinated holding Thera Band. Extend
elbows through full range. Come back to start with slow controlled motion.
3x10 reps with silver Thera Band (10.2 lbs) every other day.
PTH 645 Grace Blankenhagen
Strength Training Assessment: SOAP Note 01/28/2016
4. 3-Point Triceps (targets triceps)
a. Patient rests ipsilateral foot on ground, kneeling supported by contralateral
lower and upper extremity. Ipsilateral extremity shoulder is adducted and
elbow fully flexed with forearm neutral holding weight. Patient extends
elbow through full range and comes back to start with slow controlled
motion. Switch sides and repeat 3x10 reps with 8 lb weight (or sack of
potatoes) every other day in both arms.

Progression Exercises

Patient is instructed to begin these when more than 20 reps (except W-Y with 12 reps)
at 60% 1RM can be completed easily with other exercises.

1. Compound Row (targets middle traps)

a. Patient seated in compound row machine with chest unsupported. Patient
retracts (pinches) scapulae together as she pulls the handles toward her,
forearms neutral 2x10 reps at 45 lbs every other day.

2. Triceps Dips (targets triceps)

a. Patient supports bodyweight on bench with upper extremities and lower
extremities on floor. Dumbbell or ankle weight rests on thighs. Elbows and
shoulders extended with palms on bench and fingers facing forward.
Patient lowers body straight down and flexes elbows while keeping
shoulders adducted. 2x10 reps with 12 lb weight every other day.