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ABSTRACT: Athletes reporting chest pain are challenging to diagnose and equally challenging to treat. The majority of chest pain is musculoskeletal in origin, yet differentiating these from other more serious conditions should be the initial primary focus. The ability to reproduce the patient's symptoms aids in the differential diagnostic process. The purpose of this case report is to illustrate the use of dry needling (DN) to aid in the diagnosis and treatment of focal chest wall pain.
A 22 year-old male military athlete with anterior chest pain, refractory to traditional physical therapy, was evaluated and treated with dry needling.
Favorable results were achieved as demonstrated by clinically meaningful improvements in the Patient Specific Functional Scale, the Global Rating of Change score, and his physical performance which allowed this athlete to return to competition and military training.
Dry needling in the hands of properly trained providers may aid in diagnosis and treatment of focal chest wall syndromes.
Therapy, Level 4.
International journal of sports physical therapy. 06/2012; 7(3):323-32.
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ABSTRACT: Although upper extremity (UE) closed kinetic chain (CKC) exercises have become commonplace in most rehabilitation programs, a clinically meaningful UE CKC functional test of unilateral ability has continued to be elusive.
To examine reliability of the Upper Quarter Y-Balance Test (UQYBT), evaluate the effects of arm dominance on UQYBT performance, and to determine how the UQYBT is related to specific components of the test (trunk rotation, core stability and UE function and performance) in a college-aged population.
A sample of healthy college students performed the UQYBT and a series of 6 additional dynamic tests designed to assess trunk rotation, core stability, and UE performance. The relationship of these tests compared to the UQYBT was assessed. The effect of upper limb dominance for the UQYBT was also explored. Finally, test re-test reliability was established for the UQYBT.
Thirty subjects (24 males, 6 females, mean ages 19.5 6 1.2 and 18.8 6 0.8 years) were assessed during the study. The test re-test reliability was excellent for UQYBT measurements (intraclass correlation coefficient > 0.9). A significant (p <0.05) fair to moderate association was observed between the UQYBT and several core stability and UE functional tests. There was no significant difference in UQYBT performance between dominant and non-dominant limbs.
The UQYBT is a reliable UE CKC test that can be used to assess unilateral UE function in a closed chain manner. The UQYBT appears to be most related to dynamic tests involving core stability and UE performance. Similarity on the UQYBT between dominant and non-dominant limbs indicates that performance on this test using a non-injured UE may serve as a reasonable measure for "normal" when testing an injured UE. Future research is needed to determine the clinical applicability of the UQYBT.
2b.
International journal of sports physical therapy. 04/2012; 7(2):139-47.
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ABSTRACT: Anterior compartment pressures of the leg as well as kinematic and kinetic measures are significantly influenced by running technique. It is unknown whether adopting a forefoot strike technique will decrease the pain and disability associated with chronic exertional compartment syndrome (CECS) in hindfoot strike runners.
For people who have CECS, adopting a forefoot strike running technique will lead to decreased pain and disability associated with this condition.
Case series; Level of evidence, 4.
Ten patients with CECS indicated for surgical release were prospectively enrolled. Resting and postrunning compartment pressures, kinematic and kinetic measurements, and self-report questionnaires were taken for all patients at baseline and after 6 weeks of a forefoot strike running intervention. Run distance and reported pain levels were recorded. A 15-point global rating of change (GROC) scale was used to measure perceived change after the intervention.
After 6 weeks of forefoot run training, mean postrun anterior compartment pressures significantly decreased from 78.4 ± 32.0 mm Hg to 38.4 ± 11.5 mm Hg. Vertical ground-reaction force and impulse values were significantly reduced. Running distance significantly increased from 1.4 ± 0.6 km before intervention to 4.8 ± 0.5 km 6 weeks after intervention, while reported pain while running significantly decreased. The Single Assessment Numeric Evaluation (SANE) significantly increased from 49.9 ± 21.4 to 90.4 ± 10.3, and the Lower Leg Outcome Survey (LLOS) significantly increased from 67.3 ± 13.7 to 91.5 ± 8.5. The GROC scores at 6 weeks after intervention were between 5 and 7 for all patients. One year after the intervention, the SANE and LLOS scores were greater than reported during the 6-week follow-up. Two-mile run times were also significantly faster than preintervention values. No patient required surgery.
In 10 consecutive patients with CECS, a 6-week forefoot strike running intervention led to decreased postrunning lower leg intracompartmental pressures. Pain and disability typically associated with CECS were greatly reduced for up to 1 year after intervention. Surgical intervention was avoided for all patients.
The American journal of sports medicine 03/2012; 40(5):1060-7. · 3.61 Impact Factor
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ABSTRACT: The patient was a 39-year-old man who self-referred to a physical therapist with a chief complaint of right wrist pain after falling backward onto an outstretched right hand the previous day. Based on the suspicion of a fracture, right wrist radiographs (posterior-to-anterior, lateral, and oblique views) were completed, which revealed a comminuted dorsal triquetrum fracture. The patient was referred to an orthopaedic surgeon who recommended nonoperative management.
The Journal of orthopaedic and sports physical therapy. 01/2012; 42(4):380.
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ABSTRACT: Chronic exertional compartment syndrome (CECS) is a condition that occurs almost exclusively with running whereby exercise increases intramuscular pressure compromising circulation, prohibiting muscular function, and causing pain in the lower leg. Currently, a lack of evidence exists for the effective conservative management of CECS. Altering running mechanics by adopting forefoot running as opposed to heel striking may assist in the treatment of CECS, specifically with anterior compartment symptoms.
The purpose of this case series is to describe the outcomes for subjects with CECS through a systematic conservative treatment model focused on forefoot running. Subject one was a 21 y/o female with a 4 year history of CECS and subject two was a 21 y/o male, 7 months status-post two-compartment right leg fasciotomy with a return of symptoms and a new onset of symptoms on the contralateral side.
Both subjects modified their running technique over a period of six weeks. Kinematic and kinetic analysis revealed increased step rate while step length, impulse, and peak vertical ground reaction forces decreased. In addition, leg intracompartmental pressures decreased from pre-training to post-training. Within 6 weeks of intervention subjects increased their running distance and speed absent of symptoms of CECS. Follow-up questionnaires were completed by the subjects at 7 months following intervention; subject one reported running distances up to 12.87 km pain-free and subject two reported running 6.44 km pain-free consistently 3 times a week.
This case series describes a potentially beneficial conservative management approach to CECS in the form of forefoot running instruction. Further research in this area is warranted to further explore the benefits of adopting a forefoot running technique for CECS as well as other musculoskeletal overuse complaints.
International journal of sports physical therapy. 12/2011; 6(4):312-21.
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ABSTRACT: The patient was an 18-year-old male military trainee who presented to a physical therapist with a chief complaint of right ankle pain following a combined plantar flexion-eversion ankle injury 3 days earlier. Based on the suspicion of a fracture, ankle radiographs were ordered by the physical therapist. On the lateral radiographic view, a longitudinal nondisplaced fracture of the posterior aspect of the distal tibia was appreciated. J Orthop Sports Phys Ther 2011;41(8):615. doi:10.2519/jospt.2011.0417.
The Journal of orthopaedic and sports physical therapy. 01/2011; 41(8):615.
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ABSTRACT: Resident's case problem.
A 21-year-old athletic male college student presented to a direct-access physical therapy clinic with complaints of left calf pain 4 days in duration. After initial examination, a working diagnosis of calf strain was formulated. Three days following initial examination, the patient reported 80% improvement in symptoms and was performing activities of daily living pain free. Four weeks later, the patient returned with complaints of reoccurring calf pain. The patient's signs, symptoms, and history at subsequent follow-up no longer presented a consistent clinical picture of calf strain; therefore, a D-dimer assay was ordered to rule out a deep vein thrombosis (DVT).
The D-dimer was elevated so the patient was admitted to the hospital and started on low-molecular-weight heparin. A compression ultrasound revealed an extensive left superficial femoral and popliteal DVT in this otherwise healthy athlete.
Lower extremity DVT is a serious and potentially fatal disorder. Physical therapists need to be diagnostically vigilant for vascular pathology in all patients with extremity pain and swelling. Employing the best current evidenced-based screening tools to rule out vascular pathology, such as deep and superficial vein pathology, should be the goal of every clinician. The Wells score is one such screening tool that has proven to be beneficial in this area. This case report presents a dilemma in diagnosis and illustrates the importance of revisiting differential diagnoses with each patient encounter. Clinicians must consider the possibility of a DVT with every patient seen with posterior leg pain.
Diagnosis, level 4. doi:10.2519/jospt.2011.3823.
The Journal of orthopaedic and sports physical therapy. 01/2011; 41(12):942-7.
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J Parry Gerber
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ABSTRACT: A 19-year-old male presented to a direct access physical therapy clinic with a complaint of left ankle pain after "rolling it" multiple times on uneven terrain. The physical therapist, having imaging privileges, ordered ankle radiographs due to the patient's severe tenderness and difficulty with weight bearing. Except for medial soft tissue swelling, the radiographs were interpreted as normal by the radiologist. The physical therapist, however, observed a radiographic lucency within the talar neck and ordered magnetic resonance imaging to further evaluate the area of concern. Magnetic resonance imaging revealed a 2.3 x 1.1 x 1.4-cm mass on the anterior aspect of the medial talus, producing a well-defined, 8-mm-diameter erosion into the talar neck. The patient was diagnosed with pigmented villonodular synovitis. The patient was referred to an orthopaedic surgeon. Treatment included excision of the mass followed by thorough curettage and treatment of the talar lesion. The patient subsequently returned to full activity. J Orthop Sports Phys Ther 2009;39(4):296. doi:10.2519/jospt.2009.0404.
Journal of Orthopaedic and Sports Physical Therapy 05/2009; 39(4):296. · 3.00 Impact Factor
