Dear list members,
I would appreciate any help and ideas regarding PT management of the following case:
Patient: Male, 28 years old, works as a personal trainer and is also a very active athlete (martial arts & weightlifting).
History: Diffuse symtoms in thoracic spine and chest for some 4 months. Debut initially after an highly intensive bout of bench pressing/weightlifting (hard training for 8-10 weeks before competition) earlier this spring. Has since then NOT stopped his weightlifting or training routine although low grade pain, but has changed to a routine excluding benchpresses and got temporarily better (not completely pain free though). Got worse after trying another series of benchpress workouts last month and is now seeking help from MD and PT. MD has given diclofenac (Voltaren) for pain and as antiinflammatory agent and is now waiting 14 days to see if medication has effect. Blood status not yet given. No reumatoid factors discovered so far. No current X-ray or other lab test so far. Tietzes syndrome and/or costochondritis is suspected.
Current status and symptoms: Typically inflammatory symptoms with aggrevated pain in the mornings and after periods (>20-30min) of sitting still. Pain is localised bilaterally around upper chest, sternum and anterior rib joints (primarely costae I-III but also IV-V), somewhat more on left side. Also "burning" sensation in middle back (approx T3/4-T8) specially occurs with long standing or sitting at desk writing. Full AROM/PROM all periferal joints and spine except for painful facett joints and spinous processes during provokative testing/palpation of middle T-spine. Generalized triggerpoints/myofascial pain in muscles around shoulder girdle/trapz/rhombs/pecs. Pat also has a vague sense of wanting to caugh ("tickling" in chest area) after sitting still, which the MD told could be normally assiciated with the Tietzes syndrome...
Rx Plan: Let pat continue training and aerobic exercises (he has VERY difficult not to, due to job and personal status) but exclude ALL pressing exercises for next month. NO combat wrestling for 3-4 wks to see if medication has effect. Gentle mobilization of thoracic spine and stretching of muscles to address triggerpoints and affected soft tissues. Give pat specific stretching routines to do at home for chest and shoulder muscles.
QUESTION: Apart from the PT management suggested above and medication, do you know of any other treatment that has been shown useful to directly address costochondritis/Tietzes syndrome. I have searched medical books and internet with little results. Any ideas on: Steroid injections, electrotherapy, other modalities, orthoses etc? Patient is VERY concerned as he feels his body is "his business" so to speak...
Tobias Sundberg, PT
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