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
>
>
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