KINESIOLOGY SPRING 2015

Movement Analysis Project

[Instructor: Dr. Liss]

Yaniris Cintron

Partner Name: Kyle PizichiliDate:__________________

The information gathered on this form will be used for the evaluation of your current health, previous health, and readiness to create your exercise program. The form is used to give you the safest and most effective guidelines to start a healthy nutrition and exercise plan to meet your individual needs. Please take your time and complete it carefully and thoroughly, try to be as truthful and accurate as possible. This information will be used solely to provide a comprehensive plan of action.

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Medical and Movement History Questionnaire

Personal InformationDate: 2/6/15 Last: Cintron First: YanirisDOB: 5/26/94Gender(Check)

M: F:

Measurements:

Height: 60 inch 153 cm

Weight: 121 lbs 55kg

Body Mass Index:

23.6

1. Have you ever experienced diseases or injuries such as…-Herniated disks…………Y or N-Gait abnormalities…………...Y or N-Knee injuries…………...Y or N-Joint disorders……...Y or N-Multiple sclerosis…………Y or N-Muscular dystrophy…………..Y or N-Thyroid Disease………Y or N-Osteoporosis………....Y or N-Paralysis………Y or N-Sciatica………Y or N-Rotator cuff injuries………Y or N-Rheumatoid Arthritis………Y or N-Sarcoma(bone cancer)………Y or N-Scoliosis………Y or N-Other : Broken Right foot- calcaneus and navicular bone

2. Have high blood pressure Yes No

3. Smoke more than a pack of cigarettes a day Yes No

4. Have bone/joint problems that would be worsened by exercise Yes No

Symptoms:

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-Pain in your chest, shoulder, or arm when doing any physical activity…Y or N-Experience frequent dizziness ……. Y or N-Lose your balance frequently…….. Y or N-Shortness of breath during any physical activity…… Y or N-Pain in joints or specific area of the body when doing physical activity……. Y or N-Trouble with hearing….Y or N-Trouble with vision……Y or N

-If yes, please explain: ________________________________________________________________________________________________________________________________________________

5. Are you on any current medication that can affect physical performance?

YesNo

a. If yes, please list name, use, frequency:i.ii.iii.

6. Have you had any major illnesses or surgeries?Illness/Condition: Date/Age:Broken right foot bones Calcaneus and Navicular

5/26/11/ 17 years old

Family History:

1. Does anyone in your family have/had a history of the following: (Specify who if Yes)

-Carpal tunnel system…………Y or N -Osteoporosis…………Y or N -Marfan syndrome…………Y or N -Sarcoma(bone cancer)…………Y or N -Diabetes…………Y or N (My mom is pre-diabetic and my grandpa is diabetic)-Parkinsons Disease…………Y or N-Fibrodysplasia ossificans progressiva…………Y or N

Questionnaire Part 2: Movement History

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1. Do you have any physical limitations or injuries that could be worsened with exercise?

Yes No-but if I work my legs out a lot, I tend to get some discomfort in my right ankle and in the arch.

-If yes, please clarify:

2. Are you physically active?a. If so please choose one:

How many hours do you exercise a day?__Over 3 hoursX 1-2 hours__less than 1 hour

3. What physical activity do you do, if any? a. I am powerlifting and cross-fit training. I go to the gym 3

days a week for 2 1/2 hours. b. Monday is max lower body effort- deadlifts, gluteham

raises, squat, or another lower body exercise with weights. c. Tuesday is active recovery- cross fit workouts including pull

ups, push-ups, box jumps, sled pushes, situps, etc. d. Wednesday is max upper body- bench, overhead press,

pull-ups, rows4. What does your daily routine consist of?(work, sports, jogging)

If I am not at work, I will be in school. By 8 o’clock at night, I will be at the gym in the beginning of the week from Monday- Wednesday. On Thursdays and Fridays I will be at work and get done around 5pm. I will be making dinner when I get home or doing homework.

5. Do you have trouble with personal hygiene activities such as-Showering…………Y or N -Getting out of shower…………...Y or N -washing your hair……...Y or N -shaving…………Y or N

6. Do you have trouble with activities including -Getting dressed……Y or N -putting shoes on……Y or N -feeding yourself……Y or N

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-drinking certain drinks……Y or N -swallowing certain foods……Y or N

7. Do you have a trouble with any of these movements-kneeling N -bending down N -picking things up N -pushing N -pull up N -duck walking N

8. Have you tried to lose weight in the past?YesNo 

a. If yes. Check the methods that apply i. Diet(s) (List)___

______________________________________________________ ii. Medications (List)___

______________________________________________________ iii. Other (Describe) X- I started doing cross fit for 4

months of high intensity work outs with weights. 9. How would you rate your health?(Check one that apply)

Excellent Good Fair Poor

Movement Goals : • Establish movement goals to improve the way I do a squat clean and/or snatch. I want to increase my hip flexibility in order to improve my range of motion and exercise movements. A short term goal will be to increase the flexibility in my hip area and the long term goal is to compete in cross fit competition with proper snatches and squat clean form. In order to thrust enough weight I need to get good depth. Doing so can increase my performance. • To be more specific I want to break below parallel in a squat.

- Do an overhead press with full squat depth - Increase hip mobility ->increase speed->fully thrust heavy

weight->breaking under the bar

Initial Summary :

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• My BMI index indicates that I am in a healthy range for my weight and age. I have had success with losing weight and maintaining my weight at 121 lbs. I don’t have any issue currently but I have had an injury that may affect the way I move now. About four years ago I had broken bones in my ankle and if I have a high weight leg work out, I feel discomfort in my right foot. I rated my health Good because I am actively practicing my flexibility but I feel tightness when I do squats or squat cleans. They key area of improvement is my hip as well as my shoulders to get good technique. I am doing well with my deadlift as well as some upper body strength. My bench press needs to be improved as well. I can do more chest opening exercises to increase strength and range of motion. To move towards my goal, I can start stretching my hip and include more hip opening exercises with weights. I can practice bench more in order to increase my upper body strength to hold an overhead squat longer.

Postural Needs Assessment

Frontal ViewEyes Aligned Yes NoAC joint Aligned Yes NoASIS Aligned Yes NoPatella Height Even Yes NoPatella Faces Forward Yes NoGenu Valgum Yes No If yes, which side: BothGenu Varum Yes NoFeet Face Forward Yes No Facing which way? Slight out, normal

Sagittal View

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(Moved arms slightly forward to allow visual representation of excessive lordosis)Head Protruded Yes NoProtracted Shoulder Girdle Yes NoKyphosis Yes NoExcessive Lordosis Yes NoReduced Lordosis Yes NoGenu Recurvatum Yes No If yes, which side: Both

Posterior ViewWinged Scapula Yes NoFeet Evert Yes No If yes, which foot: RightFeet Invert Yes No

Possible causing for postural misalignment: Genu Valgum: Overactive adductor complex; underactive gluteus

medius and piriformiso Possible exercise(s): Hip abduction, may include resistant

bandso May need orthotics o Balance on BOSU without knees moving medially

Head protruded: Overactive SCM, levator scapula, and upper trap; underactive cervical extensors

o Possible exercise(s): Retraction of neck for 25 seconds then relax as if retracting neck against the head of a car seat.

o Levator scapula stretch, gently pull cervical region in between lateral flexion and flexion

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Excessive Lordosis(Increased anterior pelvic tilt): Overactive erector spinae, rectus femoris, and possible iliopsoas; Underactive rectus abdominus, hamstrings, gluteus max/medius

o Possible exercise(s): Hip flexor stretch in supine, lunge stretch exercise across the room and back.

o Bridging with ball between knees lying on your back, squeeze the buttocks and draw in the abdomen muscles. At least 3 inch off the floor lift and pause at top while still contracting, then relax.

o Core strength exercises, include yoga poses as it deals with a lot of core work

o Childs poseo Cat stretch and pelvic tilt to neutral and hold, for tight

erector spinae.o Plan supine while on ball, lie supine to floor with arms at

side have ball underneath the gastrocnemius with flexed feet lift hips off floor while contracting gluteus and engaging abdomen, then slowly lower back.

Genu Recurvatum: more of a structural than functional condition may be due to excessive lordosis hyperextending the knee due to overactive rectus femoris.

o Possible exercise(s): relax knees and correct posture like the anterior pelvic tilt. May want to neutralize pelvis to relieve the stress on the knee.

Right Foot Evert: Overactive peroneals; underactive tibialis anterior and posterior

o Possible exercise(s): Stretching lateral side of foot for a couple seconds and relaxing.

o May need orthotics to support arch

Overhead Squat Assessment (Chapter 6)Anterior View:Knees align with foot Yes or No If no, which one R L Both

which way Valgus VarusFeet Face Forward Yes or No If no, which one R L Both

which way abductadductFor the Anterior View, there were key points to look out for at the

foot and knee. At the feet, they turn outward. At the feet, here were

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overactive muscles included soleus, gastroc, bicep femoris, and possibly TFL. There were also underactive muscles including medial gastroc, medial hamstring, and possibly gluteus. At the knees, they move outward. The femur is abducted and externally rotated. The overactive muscle is the piriformis and bicep femoris and the under active muscle weak adductors and gluteus max.

Sagittal View:Normal Forward Flexion Yes or No Excessive forward leanNormal Lumbar Lordosis Yes or No Excessive ReducedArms remain in line Yes or No, arms fall forward

For the Sagittal view, the checkpoints were forward flexion, arms falling, low back arch and lower back rounds. Everything seemed to line up correctly, there may be a slight forward lean but not excessive. My arms didn't fall forward which can indicate, for example my Latissimus Dorsi were not overactive and my middle/lower traps were not under active. The slight forward lean could indicated an overactive hip flexor or rectus abdominis and an under active erector spinae. There was no lower back arching or rounding.

Posterior View:Feet Evert Yes or NoHeels rise off floor Yes or NoAsymmetrical Shift Yes or No If yes, which side R L

For the posterior view, the checkpoints here are at the feet and the LPHC (lumbo-pelvic-hip-complex.) At the feet, they everted and were flattened. Flatten feet can be an over active peroneal and an underactive tibialis anterior and tibialis posterior. There was so asymmetrical shift that could indicate overactive adductors to the side of the shift and an underactive glute medius to that side of shit.

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Gait Analysis

Heel strike: Hips level with slight left ankle pronation. Hip is flexed 25 degrees, knee is at very slight flexion but mostly extended. Since I notice a slight drop in right shoulder, this may be a

Foot flat: Genu recurvatum at knee joint can be caused by ligamentous laxity. Hip will move toward extension but remain in flexion. Knee, hip, ankle aligned with hyperextension at knee joint causing excessive

Max mid stance to heel off: leveled hip, right leg over pronated; right knee is also genu valgus. Hip will move into a slight extended position up to 10 degrees. Remains extended for 1-5

Heel off: normal stance; slight external rotation at right leg. Hip is continuing to move into extension about 10 degrees, the knee is about 10 degrees of flexion and the ankle is reaching max dorsiflexion up

Walking: Right Leg Gait Cycle

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compensation to increase step length due to tight hamstrings. To correct it, may want to stretch the hamstrings properly before walk.

lumbar lordosis. Try to correct by practicing correct posture like tilting the pelvis posteriorly so it can level the excessive anterior tilt.

degrees. Ankle will move to plantar flexion to foot flat from its 5 degree at mid stance. To correct avoid full end point of extension to the unstable hyperextended joint.

to 20 degrees.

Toe off: slight supination occurring at right foot’ slight external rotation at knee joint. Hip is still in slight extended position where knee is reaching up to 70 degrees of flexion. Try to work on abductor group strengthen exercises like lateral walks with resistance.

Initial swing: Slight pelvic drop to the right- weak abductors on opposite side; appearance of genu valgus shows. The knee will start to reach max flexion as it proceeds to mid swing. Lateral walks with resistance can help as well as medicine ball between legs to decrease valgus force.

Terminal swing: normal stance left leg shows at knee joint slight genu valgus. Hip will be flexed about 25 degrees but knee will remain in slight extension. Ankle shows slight movement to plantar flexion. There seems to be a slight external rotation by the tibia.

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Corrective Exercise Program

#1 Excessive Lumbar Lordosis

Stance: Weak abductors shown with drop at right hip. Genu valgus occurs at left knee joint and there is over pronation at left ankle. Need to work on abductor strength to reduce pelvic drop and focus on pushing knees out. This can reduce over compensation in other areas such as right side.

Float: Hamstrings working to fully flex knee and there is no double limb support. Looks like a short distance of stride may be due to Iliopsoas tightness which may cause less hip flexion towards swing phase. Can work out the hip flexors use a stretch like kneeling position in front of something that you can use to hold your foot up. Your back knee should be completely flexed, bring heel is as close as possible to your butt. Make sure to avoid compensation by tilting pelvic anteriorly.

Swing: Quadriceps working eccentrically then concentrically to get back to stance phase.

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There is an excessive anterior pelvic tilt. In order to teach myself to control motion at the pelvis, I can go through progression exercises. I would stretch the tight muscles and strengthen the weak muscles, and then I would start with pelvic exercises.

Tight Muscles: The muscles that need to be stretched are the erector spinae and the Illiopsoas also known as the hip flexor muscle.

Stretch: Performing the “Cow Pose” o To stretch the erector spinae, get on all fours in table

top position-hands under shoulders and knees under hips

o You would do a sequence of arching your lower back and then rounding your back like a cat.

o Hold for more than 20s and do 3 sets while maintaining your breathing.

Stretch: “Childs Pose”o To stretch the erector spinae, start on your hands

and knees table positiono Lean back so that your buttocks sits on your heels

while reaching out your arms in front of you as far as you can reaching a nice long back.

o With your head looking down to the floor, you will hold for more than 20s and then relax. Do this for 3-4 sets

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Stretch: “Lunge”o To stretch the Illiopsoas, start on your kneeso Bring one leg forward while knee is bent 90 degrees o Your other leg will be back lengthened behind you

maintaining aligned position and faced forwardo The stretch is in the front of your hip and you will

hold for 25s for 3 setsWeak Muscles : The muscles that need to be strengthened are

the abdominal muscles like the rectus abdominus and transverse abdominus. Another muscle that is weak is the gluteus maximus.

Strength: “Single leg deadlift”o To strength the gluteus max, you will stand up

straight with one foot slightly bent at the kneeo Keep spine neutral! You will reach with the opposite

hand to the floor and return to upright positiono You can use a kettle bell or weighted ball with handle

to grab off floor when coming back to neutral position

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Strength: “Chair Squats”o To strengthen the gluteus max, stand with back to a

chair o Remember to maintain neutral spine, feet should be

shoulder width apart, feet should not turn out more than 5 degrees

o Without arching your back, lower as if sitting on the chair with hands out in front of you.

o To make it harder you can add a barbell on your back and lower without touching the chair

Strength: “Plank”o To strengthen the core, perform a planko Lie face down, on your toes with feet together and

lifting onto your forearms o Hold this position with neutral spine while engaging

your core for 45s and do the exercise 2-3 timeso For a more challenging workout place a weight on

your back while maintain the neutral spine to work the core more

#2 Excessive external rotations at the hip and knee

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I will need to train the hip abductors and external rotators to isometrically stabilize the knee during any sagittal plane movements while eccentrically control hip adduction and internal rotation.

Tight muscles: The muscles that are overactive and need to be stretched are the piriformis and bicep femoris.

Stretch: “External rotation”o Lying spine with knees bento Bring one knee up 90 degrees and bring opposite leg

across into a figure 4 positiono Pull hamstring on the knee that is 90 degrees

towards chest o Hold for about 25s and repeat on other leg.

Stretch: “Pigeon Pose”o Kneel to the ground, bend your left knee so that left

foot is near pelvic bone and stretch right leg behind you

o Use your hands as an anchor to hold you up. o Hold for 25s on both leg

Weak Muscles: The under active muscle are weak adductors and gluteus medius and IT band that need to be strengthened.

Strength: “Cable cuff Pulls”

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o Secure a cuff around your left ankle and attach it to a low pulley

o Stand with your left side facing pulley with your left leg out to your left side

o Keeping your leg straight, draw your left leg inward until it touches your right

o Pause for 10s then continue repetitions with or without weights added 

Strength: “Side Leg Raises”o Stand next to a chair, which you may hold onto as a

support, stand on one leg. o Keeping your leg straight, raise it as far out to the

side as possible, and swing it back down, allowing it to cross the opposite leg.

o Repeat this swinging motion 5-10 times, increasing the range of motion with or without resistance

Range of Motion

1. Seated with good posture head facing straight forward (neutral position), have your subject bend their head forward so their chin moves toward their chest as far as possible. Then moving back to the neutral position have them look up to the ceiling as far as possible. Make sure only motion occurs by the head. Assess degrees of movement for both positions. The assessors should use a sagittal view to determine each motion. Use the alignment between the nose and the ear as your reference point.

Motion: Flexion 60° Segment: Cervical Spine Plane: Sagittal Axis: Mediolateral Extension 75° Cervical Spine Sagittal Mediolateral

Degrees:60 Motion 1: Flexion Normal Y or N Degrees: 70 Motion 2: Extension Normal Y or N Potential Affect if Abnormal: Can decrease ROM in neck and compress the cervical spine area if you are hyperextending the neck. Can also result in poor posture if neck is protruded and flexed/ not in neutral position, tight sternocleidomastoid.

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2. In the same neutral position, have your subject bend their head to the right side as if bringing their ear to their shoulder as far as possible. Make sure only motion occurs by the head. Determine degrees of movement. Then perform on the left. The assessors should use a frontal view to determine each motion. Use the nose as your reference point.

Motion: Lateral Flexion 45° Segment: Cervical Spine Plane: Frontal Axis: Anterioposterior

Degrees: Right: 38 Normal Y or N Left: 30 Normal Y or N

Potential Affect if Abnormal: Can result in upper trap or levator scapula tightness. Can affect people who sit on the computer and cause aching pain and decreased proper posture. Can also affect driving or daily activity involving movement of upper extremity.

3. In the same neutral position, have the subject turn their head to the right side as if looking over their shoulder. Make sure only motion occurs by the head and attempt to determine the degrees of movement. Then perform over the left shoulder. The assessors should use a transverse view to determine each motion. Use the nose as your reference point.

Motion: Rotation 80° Segment: Cervical Spine Plane: Transverse Axis: Vertical

Degrees: 80 Normal Y or N Potential Affect if Abnormal: Reduced neck rotation can cause neck stiffness and degenerative disc disease. Can also cause radiating pain from neck to thoracic region, this can reduced mobility and movement for driving or communication. ___________________________________________________________________________________________________________

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For the next 3 motions (4, 5, 6) have your subject stand against a wall with their heels, pelvis, scapula & head against the wall. This will create a slight lordosis b/t wall and low back. Have them keep the abdominals tight to prevent over arching of the lower back. (This is essential to monitor so slide your hand behind the subjects lower back to make sure they are not arching their back).

4. In the anatomical position (neutral 0°), raise the right arm straight out to the side (palm up) as high as possible. Make sure the elbow and wrist stay in complete extension. The assessors should use a frontal view to determine the motion. Determine the degrees hey are able to raise their arm. Then perform on left arm. Watch for compensations.

Motion: Abduction 170° Segment: Shoulder Plane: Frontal Axis: Anterioposterior

Degrees: Right 160 Normal Y or N Left: 140 Normal Y or N

Potential Affect if Abnormal: This could interfere with daily living if reduced for actions such as showering and lifting things. Can increase risk of injury. Over compensation can result in injury of rotator cuff___________________________________________________________________________________________________________Perform the activity again but this time with the palm facing down. Is there a difference in how far you can raise the arm? If so why might this be? There was a big difference when trying to keep the palm face down because it causes a rotation in the shoulder to rotate forward and limit ROM. May be due to a change in neutral position.

5. From the above neutral position, have them raise their arm straight in front (forearm mid-supinated) as high as possible. Make sure the elbow stays in complete extension. The assessors should use a sagittal view to determine the motion. Determine the degrees they are able to raise their arm; then perform on the left arm. Make sure the only motion occurs by the shoulder joint.

Motion: Flexion 170° Segment: Shoulder Plane: Sagittal Axis: Mediolateral

Degrees: Right 170 Normal Y or N Left: 175 Normal Y or N

Potential Affect if Abnormal: If abnormal this can result in shoulder impingement. This can reduce overhead mobility in a daily lifestyle like picking things up overhead or as little as putting groceries away.___________________________________________________________________________________________________________

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6. From the above neutral position, have them abduct one arm to (90) & flex the elbow to 90 degrees. With palms facing down, rotate your shoulder joint as far down as possible and hold. The assessors should use a sagittal view to determine the motion. Determine the degrees they are able to move. Then have them rotate their shoulder as far back as possible and assess. DO NOT allow movement at the shoulder girdle.

Motion: Internal Rotation 70° Segment: Shoulder Plane: Sagittal Axis: Mediolateral

External Rotation 90° Shoulder Sagittal Mediolateral

Degrees- Motion 1:Internal Rotation: Right 55 Left 42 normal Y or N

Motion 2: External Rotation: Right 80 Left 77 normal Y or N Potential Affect if Abnormal: If abnormal, can result in tendonitis as well as decreased function. Can have rotator cuff problems and shoulder joint impingement. Can effect any movement needed to reach behind you like drying off with a towel.___________________________________________________________________________________________________________

7. 90-90: Lying on their back with both knees completely extended, have your subject interlock their hands behind their right knee and the flex hip to 90. Have them attempt to extend their knee as far as possible until they feel a strong stretch in their hamstrings. Make sure the left leg remains completely extended and watch for compensations. The assessors should use a sagittal view to determine the motion. If they can straighten the knee fully this is 0° anything less score a (–) degrees. Then perform on the left leg.

Motion: Flexion Segment: Femur and Tibia Plane: Sagittal Axis: Mediolateral

Degree that knee is in extension: right 20 Normal Y or N left: 0 Normal Y or N

Potential Affect if Abnormal: Tight hamstrings can affect the flexibility in that area and not allowing full extension. Can increase back pain and poor posture___________________________________________________________________________________________________________

8. Straight Leg Raise: In the position described above, have one partner passively raise the leg of the subject as high as possible keeping the knee in extension. Make sure the opposite leg remains flat on the floor. The assessors should use a sagittal view to

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determine the motion. Estimate the number of degrees the hip is flexed. If they can maintain complete knee extension and bring their leg so that it is perpendicular to the ground then they would be at 90°.Motion: Flexion Segment: Femur Plane: Sagittal

Axis: Mediolateral

Degree that knee is in extension: right 90 Normal Y or N left: 93 Normal Y or N

Potential Affect if Abnormal: If abnormal you would have tight bicep femoris, can result in bicep femoris tendinitis. Can also result in back and knee pain. This can decrease proper posture.___________________________________________________________________________________________________________

9. Have your subject lie prone. One partner will passively bend the subject’s knee (heel to butt) until either the subject says stop or the partner senses restriction. Once full range of motion has been achieved, assess the degrees that the knee has bent. 0⁰ is when the knee is straight. The assessors should use a sagittal view to determine the motion. Perform on opposite legMotion: Knee Flexion 145° Segment: Knee Plane: Sagittal

Axis: Mediolateral

Degree that knee is in extension: right 130 Normal Y or N left: 145 Normal Y or N

Potential Affect if Abnormal: If not in normal range, tightness in the bicep femoris may be affecting flexibility.___________________________________________________________________________________________________________

10. Sitting on a bench with knees bent hanging over and the tibia straight up and down perpendicular to the floor (neutral 0°), have your subject rotate their right hip outward (this will move their lower leg inward). The assessors should use a frontal view to determine the motion. By looking at how far the tibia moved from the baseline attempt to determine the number of degrees it moved. Do not allow the buttocks to lift off the table. Watch for compensatory movements. Move back to the neutral position and then rotate your hip inward (this will move your lower leg outward) and estimate the degrees of movement. Do the same for the left leg. Motion: Internal Rotation 35° Segment: Femur Plane: Transverse

Axis: Vertical External Rotation 45°

Degrees: Motion 1 Internal Rotation: Right 30 Left 35 Normal (Y or N) Motion 2 External Rotation: Right 36 Left 38 Normal (Y or N)

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Possible Affect if Abnormal: If abnormal can have hip joint pain and abnormal gait, which can result in misalignment of pelvis and knees.____________________________________________________________________________________________________________

11. Have your subject stand close enough to a wall to hold on for balance. With good posture have them lift their leg up as high as they can in front of them allowing the knee to flex (do not attempt to keep the knee straight). 0⁰ is when the foot is on the floor. The assessors should use a sagittal view to determine the motion. Determine the number of degrees they are able to lift the leg. Do the same for the opposite leg.Motion: Hip flexion Segment: femur Plane: sagittal

Axis: mediolateral Hip Extension

Degrees: Motion 1 Flexion : Right 30 Left 16 Motion 2 Extension: Right 20 Left 18

Affect if Abnormal: Can be weak illiopsoas and rectus femoris. This could cause an imbalance in posture or decrease in flexibility due to abductor muscles. Resulting in lordosis if abnormal.