Pt is a 26 yo recreational runner who presents with an 3-wee…

Pt is a 26 yo recreational runner who presents with an 3-week hx of R lateral ankle and foot discomfort.  Onset of R lateral foot and ankle occurred 3 weeks ago when running, coming off a curb and ‘landing funny’ on the R foot.  The patient denies swelling and completed the remainder of the run with mild soreness on the lateral side of the R ankle/foot. There was a noted increase in pain and stiffness of the foot the next morning but it did not prevent the patient from walking. The patient indicates a history of ‘a few’ ankle sprains when playing intramural basketball while in college that required a few days rest but the patient reports recovering ‘just fine’ from them without intervention.  Otherwise PMH is unremarkable.  The patient took 2 ibuprofen 2 or 3 times but it did not help so they stopped. Current symptoms: there is persistent low level pain (3/10) in the lateral ankle/foot region The patient presents to physical therapy via direct access as they would like to continue training for a 1/2 marathon that is in 8 weeks.   What additional subjective information do you want to know? Why?

A 16 yo ♀ competitive volleyball player with a 2-yr h/o inte…

A 16 yo ♀ competitive volleyball player with a 2-yr h/o intermittent anterior R knee pain and swelling is referred to PT for evaluation and management.  6 wks ago, she had a fat pad debridement surgery and has been going to PT sessions since then at another PT clinic.  Each time she returns to volleyball, her pain and swelling returns.  The activities required for volleyball include running, cutting, jumping, and pivoting; each of these increases her pain.  During the 2 yr prior to surgery, her pain was in the medial aspect of her knee.  However since surgery, she experiences pain on both the medial and lateral sides of the knee.  In the last 4 weeks, she has been experiencing pain and swelling similar to what she had prior to surgery.  With either an increase in practice or game frequency, the anterior knee pain increases to an 8/10 from a baseline of 1/10 on VAS.  With 2-3 days rest, her pain and swelling are eliminated.  She has tried multiple interventions, e.g. ice, heat, compression, OTC NSAIDs, which provide short duration symptomatic relief and are only effective if she is not playing volleyball.  Although she has been in ‘formal’ PT for the last 6 wks, her sx have not been reduced.  Her goal is to return to volleyball symptom-free, now that the season has started.  Her MD (ortho) has not placed any restrictions on her activity.   Generate 3 differential hypotheses stating specifically the information that was listed in the subjective that led you toward this hypothesis?

Pt is a 26 yo recreational runner who presents with an 3-wee…

Pt is a 26 yo recreational runner who presents with an 3-week hx of R lateral ankle and foot discomfort.  Onset of R lateral foot and ankle occurred 3 weeks ago when running, coming off a curb and ‘landing funny’ on the R foot.  The patient denies swelling and completed the remainder of the run with mild soreness on the lateral side of the R ankle/foot. There was a noted increase in pain and stiffness of the foot the next morning but it did not prevent the patient from walking. The patient indicates a history of ‘a few’ ankle sprains when playing intramural basketball while in college that required a few days rest but the patient reports recovering ‘just fine’ from them without intervention.  Otherwise PMH is unremarkable.  The patient took 2 ibuprofen 2 or 3 times but it did not help so they stopped. Current symptoms: there is persistent low level pain (3/10) in the lateral ankle/foot region The patient presents to physical therapy via direct access as they would like to continue training for a 1/2 marathon that is in 8 weeks.   Generate 2-3 prioritized, differential hypotheses (at least 1 each from the lower leg/shin and the foot/ankle region) stating specifically the information that was listed that led you toward each hypothesis?

A 16 yo ♀ competitive volleyball player with a 2-yr h/o inte…

A 16 yo ♀ competitive volleyball player with a 2-yr h/o intermittent anterior R knee pain and swelling is referred to PT for evaluation and management.  6 wks ago, she had a fat pad debridement surgery and has been going to PT sessions since then at another PT clinic.  Each time she returns to volleyball, her pain and swelling returns.  The activities required for volleyball include running, cutting, jumping, and pivoting; each of these increases her pain.  During the 2 yr prior to surgery, her pain was in the medial aspect of her knee.  However since surgery, she experiences pain on both the medial and lateral sides of the knee.  In the last 4 weeks, she has been experiencing pain and swelling similar to what she had prior to surgery.  With either an increase in practice or game frequency, the anterior knee pain increases to an 8/10 from a baseline of 1/10 on VAS.  With 2-3 days rest, her pain and swelling are eliminated.  She has tried multiple interventions, e.g. ice, heat, compression, OTC NSAIDs, which provide short duration symptomatic relief and are only effective if she is not playing volleyball.  Although she has been in ‘formal’ PT for the last 6 wks, her sx have not been reduced.  Her goal is to return to volleyball symptom-free, now that the season has started.  Her MD (ortho) has not placed any restrictions on her activity.   What criteria would you consider prior to allowing her to return to sport?  Why?

A 55 yo female presents with LBP.  She has been an active ru…

A 55 yo female presents with LBP.  She has been an active runner since college.  Occasionally, she has participated in aerobic classes.  Her hx is unremarkable.  She has 3 grown children and had no c/o back pain related to her pregnancies. Current sx:  intermittent periods of pain extending from mid-lumbar spine, through the R buttock and posterior thigh.  The pain begins 15 min into her running and progresses to an 8/10 by 25-30 min.  She also c/o increased stiffness after sitting > 1 hour, standing > 15 min, as well as when waking in the morning and getting out of bed.  She is a middle school teacher and track coach for a girl’s HS team. Key Findings: Lordotic posture Movement testing: Forward bending of the spine increased tension in low back Repeated backward bending and prone press-ups increase buttock pain Side bending is decreased 25% with some discomfort with overpressure into R side bending Ms Length: tight low back, B hip flexors and TFL Ms Performance: lower abdominals 4/5 What is your initial hypothesis and how would you r/i or r/o your hypothesis?