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Dear owen, excellent response. ONe of the most interesting and possibly helpful I've read on here in a long time. Please forward to me details re: craigs test, and femoral anteversion / retroversion in sitting and lying as you suggest. Also please explain your looking at IR/ER in the thomas test. Thirdly, if it was a lesser troch stress #, what biomechanically and anatomically would have caused this. Lastly, please let me know by personal e-mail what diagnosis you are thinking if it's not too much trouble. Thanks. Scott Epsley Physiotherapist. Brisbane, Australia. -- On Fri, 11 Feb 2000 19:49:18 Owen Moore wrote: >Hi Paul, >Interesting and problematic patient...sounds like the last 13 clients I have >been collating some data on. >I am in agreement with Charlie that you may need to consider stress >fracture...in particular of the lesser trochanter. >Here are some parallels with my clients: >- Long distance running such as triathletes, road runners, 1 gymnast and >3 martial atrists >- Pain in the groin is greater than hamstring but the ischial tuberosity >thing is also very familiar >- Pain increased with stretching hip flexors (hence the problem swimming >me thinks) >- These folks, possibly yours also, have a running style that "pulls" >the centre of gravity forward rather than leaning forward and "chase" >it. Check for poor heel raise performance. >- The pain in the antero-lateral groin is significant I >think....antero-medial is something else. > >Now...can you tell me if your client ALSO possesses the following movement >impairments: > - client stands in hip extension with poor gluteal tone & dominant >hamstrings (hyperext. knees) > - short rectus abdominis (sternum depressed + poss. limited deep breath >when arms above head in supine) > - long iliopsoas - unable to perform inner range hip flexion in sitting >(feet off floor) and Thomas Test demonstrates effortless extension WITH >abduction +/- external rotation. Check for tibial lateral rotation while you >are there! > - SLR in supine - active - greater trochanter moves anteriorly and >medially > - SLR in supine - passive - affected leg seems to have NO resistance >PLUS it reproduces the groin pain > - On all fours (Quadraped) - lumbar spine & hip in flexion > - You MUST rule out femoral anteversion & retroversion via sitting & >prone hip rotation and the Craig's test. I can send you the protocol and >references gleaned from my interest in this field. > >So...if you do all that and all bits are positive...let me know..I'll tell >you the diagnosis rather than bias your testing just yet!!! >From a "Newbie" to the mailbase...hope I don't mess up the reply thing > >Mr Owen Moore BPhysio(Hons)B'ham Adv.Cert. in PT in OH MCSP SRP >Nottingham >-----Original Message----- >From: Paul Sumner <[log in to unmask]> >To: [log in to unmask] <[log in to unmask]> >Date: 09 February 2000 19:38 >Subject: problem patient > > >>Here is the history of a very fit athlete running over 26 miles a week + >swimming/cycling >> >>In November he began to get a cramp whilst running in the proximal >musculo-tendinous junction of the medial hamstring.which eventually >prohibited further running and Partial Weight Bearing only >> >>3 weeks rest all pain had gone and he started swimming again with no >increase in symptoms, but then he began to develop pain in the >antero-lateral groin area and the ischeal tuberosity area. >> >>Past tissue based treatments have helped, but on return to his swimming an >increases in pain is experienced. >> >>Objectively there is nothing specific. He has full range of hip mov't L/sp >mov't full muscle power of hip musculature and stretch. Neural tensioning is >full as is L/sp palpation. His pubic bone is okay to palpation. I think he >has a hyperalgesic area due to returning to swimming to early. Any ideas or >tests. >> >>Many thanks >>paul sumner cornwall uk >> >> > > MailCity. Secure Email Anywhere, Anytime! http://www.mailcity.com %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%