No significant improvement during climbing. Again, no actual pain with special tests (STs), manual muscle tests (MMTs) or joint integrity tests (JITs).
I actually went onto the wall before doing anything else and watched the patient climb – good movement generally but a noticeable tendency to stick out their bum. Significantly on the dead hand they ‘flared’ i.e. their anterior pelvis caused them to hang with their legs behind them as though flying.
A tight Latissimus Dorsi was the problem and on clinical testing in supine this was not readily apparent but more so if I tilted their pelvis to neutral before testing.
Treatment consisted of 4 sessions of myo-fascial release in side-lying with the lat on stretch and soft tissue massage.
Not to mention a simple home exercise programme (HEP).
Within 2 weeks the situation was resolved and on follow up 1 year later no further issues.