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Mini-Case: Groin Strain?

1/26/2016

2 Comments

 
I've written before about the potential need to address "muscle strains" with a neural perspective. Earlier this week one of my co-workers was doing a single-leg squat when he immediately felt intense and sharp upper inner thigh and upper posterior thigh pain. As a result, he displayed a significant antalgic gait pattern. I was busy that day, so I didn't get to look at him, but I, of course, suspected the potential spinal contribution.

The next day my co-worker came to me and told me when he tried doing a lunge the previous day his pain switched sides! If that doesn't tell you to look at the spine, I don't know what should. While he was feeling and walking a little better, my co-worker asked me to take a look at him at lunch.
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Objective
Multisegmental Flexion: Slightly Dysfunctional Nonpainful
Multisegmental Extension: Significantly Dysfunctional Nonpainful
Multisegmental Rotation: Dysfunctional Nonpainful bilat
Deep Squat: Dysfunctional Painful

Sideglides in Standing: No significant asymmetry noted

HS Flexibility: WNL

Mild loss of hip flexion mobility bilaterally with reports of "tightness" in posterior hip

Hip IR/ER ROM: WNL

At this point, the most significant findings are the loss of lumbar extension and hip flexion. While I could have tried tensioning either the obturator or sciatic nerves, I was pretty certain the pain would respond to lumbar treatment. I had my co-worker perform a deep squat as his asterisk sign. My co-worker then performed 20 repetitions of prone press-ups with manual overpressure to the lumbar spine, followed by a reassessment of the deep squat. He reported a significant reduction in pain. Following an additional 20 repetitions, he had no pain with a deep squat and it became functional. I reassessed his lumbar extension and hip flexion mobility and some limitation remained. At that point, I did a lumbar manipulation bilaterally and hip distraction manipulation bilaterally to help normalize his lumbar and hip motion. His HEP was repeated press-ups and hip flexion.

There are a couple take-away points from this one. Always always always check spine. With "weird" symptoms, like switching sides, something neural is likely suspected, even if there is no lumbar pain. Also, in all our patients coming in with "muscle strains," perhaps we should be checking for neural components and trying to treat the spine as well. Both muscles strains and neural tension can present with a sharp and acute pain, so we must be sure to differentiate and treat appropriately.

-Chris

If you are looking to improve upon your clinical skills and orthopaedic knowledge, consider joining OPTIM's COMT program. With OPTIM, you can expect a residency-like learning experience without breaking the bank, all while learning from highly skilled physical therapists. Check out optimfellowship.com for more information!
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Like this post? Then check out the Insider Access Page for advanced content! And check out similar posts below!
Mini Case: The Questionable Calf Strain
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Neural Tension vs. Muscle Strain
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2 Comments
Steve G
1/26/2016 03:20:50 pm

Nice work!

Reply
Chad
1/27/2016 01:08:52 pm

Great point about neurodynamics! I always find it very exciting and interesting when patient's respond to lumbar treatment & their distal symptoms either reduce or are abolished.

I recently had a pt with "bilat plantar fasciitis" <-- -osis -opathy, -etc.. Simply put I gave her lumbar extension & we have targeted only her L-spine & she is reporting less pain. Keep up the good work, Cheers!
-Chad Shafer

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  • Home
  • About Us
  • TSPT Academy
  • Resources
    • Newsletter
    • Orthopedic Blog
    • Featured Articles
    • Research Articles
    • Residency Corner
  • Special Tests
    • Cervical Spine >
      • Alar Ligament Test
      • Bakody's Sign
      • Cervical Distraction Test
      • Cervical Rotation Lateral Flexion Test
      • Craniocervical Flexion Test (CCFT)
      • Deep Neck Flexor Endurance Test
      • Posterior-Anterior Segmental Mobility
      • Segmental Mobility
      • Sharp-Purser Test
      • Spurling's Maneuver
      • Transverse Ligament Test
      • ULNT - Median
      • ULNT - Radial
      • ULNT - Ulnar
      • Vertebral Artery Test
    • Thoracic Spine >
      • Adam's Forward Bend Test
      • Passive Neck Flexion Test
      • Thoracic Compression Test
      • Thoracic Distraction Test
      • Thoracic Foraminal Closure Test
    • Lumbar Spine/Sacroiliac Joint >
      • Active Sit-Up Test
      • Alternate Gillet Test
      • Crossed Straight Leg Raise Test
      • Extensor Endurance Test
      • FABER Test
      • Fortin's Sign
      • Gaenslen Test
      • Gillet Test
      • Gower's Sign
      • Lumbar Quadrant Test
      • POSH Test
      • Posteroanterior Mobility
      • Prone Knee Bend Test
      • Prone Instability Test
      • Resisted Abduction Test
      • Sacral Clearing Test
      • Seated Forward Flexion Test
      • SIJ Compression/Distraction Test
      • Slump Test
      • Sphinx Test
      • Spine Rotators & Multifidus Test
      • Squish Test
      • Standing Forward Flexion Test
      • Straight Leg Raise Test
      • Supine to Long Sit Test
    • Shoulder >
      • Active Compression Test
      • Anterior Apprehension
      • Biceps Load Test II
      • Drop Arm Sign
      • External Rotation Lag Sign
      • Hawkins-Kennedy Impingement Sign
      • Horizontal Adduction Test
      • Internal Rotation Lag Sign
      • Jobe Test
      • Ludington's Test
      • Neer Test
      • Painful Arc Sign
      • Pronated Load Test
      • Resisted Supination External Rotation Test
      • Speed's Test
      • Posterior Apprehension
      • Sulcus Sign
      • Thoracic Outlet Tests >
        • Adson's Test
        • Costoclavicular Brace
        • Hyperabduction Test
        • Roos (EAST)
      • Yergason's Test
    • Elbow >
      • Biceps Squeeze Test
      • Chair Sign
      • Cozen's Test
      • Elbow Extension Test
      • Medial Epicondylalgia Test
      • Mill's Test
      • Moving Valgus Stress Test
      • Push-up Sign
      • Ulnar Nerve Compression Test
      • Valgus Stress Test
      • Varus Stress Test
    • Wrist/Hand >
      • Allen's Test
      • Carpal Compression Test
      • Finkelstein Test
      • Phalen's Test
      • Reverse Phalen's Test
    • Hip >
      • Craig's Test
      • Dial Test
      • FABER Test
      • FAIR Test
      • Fitzgerald's Test
      • Hip Quadrant Test
      • Hop Test
      • Labral Anterior Impingement Test
      • Labral Posterior Impingement Test
      • Long-Axis Femoral Distraction Test
      • Noble Compression Test
      • Percussion Test
      • Sign of the Buttock
      • Trendelenburg Test
    • Knee >
      • Anterior Drawer Test
      • Dial Test (Tibial Rotation Test)
      • Joint Line Tenderness
      • Lachman Test
      • McMurray Test
      • Noble Compression Test
      • Pivot-Shift Test
      • Posterior Drawer Test
      • Posterior Sag Sign
      • Quad Active Test
      • Thessaly Test
      • Valgus Stress Test
      • Varus Stress Test
    • Foot/Ankle >
      • Anterior Drawer
      • Calf Squeeze Test
      • External Rotation Test
      • Fracture Screening Tests
      • Impingement Sign
      • Navicular Drop Test
      • Squeeze Test
      • Talar Tilt
      • Tarsal Tunnel Syndrome Test
      • Test for Interdigital Neuroma
      • Windlass Test