The patient is a 43-year-old man who works in a factory wher…

The patient is a 43-year-old man who works in a factory where he is responsible for operating a drill press and lifting heavy (25kg) cases of metal plates over his head several times throughout the day. He presents with a chief complaint of chronic low back pain that ranges from 3/10 at rest to 9/10 at the end of the day. He denies lower limb pain; he also denies lower limb numbness or muscle weakness. His symptoms began several years ago when he tried to stop a pallet of metal plates from falling off a truck. He felt a tearing sensation in his back and indicates that it has not been “right” since that time. He has had several periods of lost work time due to low back pain and has currently been out of work on a worker’s compensation claim for one month. This patient has had 2 lumbar magnetic resonance imaging examinations that revealed mildly degenerative, bulging disks at L4-5 and L5-S1. His previous physical therapy treatment has been centered on pain control approaches using moist heat and ultrasound. He indicates that he was instructed in the performance of sit-up exercises but stopped doing them after a couple of days because they increased his pain. He has avoided physical activity and exercise since that time.   What components of the patient’s history suggest the presence of yellow flags?

The patient reports, “spraining” his ankle one week ago play…

The patient reports, “spraining” his ankle one week ago playing basketball. Pain is 0/10 at rest, but intermittently increases to 5/10 at end of day. He is unable to run, play basketball, and walk long distances (> 1/2 mile) without some discomfort. He is currently playing in a recreational basketball league and would like to return to play in 2 weeks. The patient is currently wearing a lace up stabilizing brace. Radiographs were taken 2 days after injury and were negative with regard to any fracture. He reports having had multiple episodes of rolling his ankle without traumatic injuries.   Objective examination On initial examination there was mild swelling over the lateral ankle.  The patient complained mild pain pain at the anterior talocrural joint line, the anterior talofibular ligament and, and the distal fibula. Ottawa ankle rules are negative. Range of motion at the ankle which involves combined talocrural and subtalar motion was limited in dorsiflexion and eversion on the involved side. An anterior drawer test was positive. Instability of the subtalar joint was evident upon inversion mobilization testing. Gait was antalgic but the patient was able to bear full weight on the ankle. Strength was limited in dorsiflexion (4/5) and eversion (3+/5). Balance was impaired with inability to single limb stand on the involved side for greater than 10 seconds.   Which of the following is considered the most important clinical finding in determining whether a patient will develop chronic ankle instability?

A 38 y/o male presents to the clinic with a chief complaint…

A 38 y/o male presents to the clinic with a chief complaint of heel cord pain, which worsens with running. He reports onset of symptoms was about 4 months ago around the time he increased his training level for an upcoming marathon he is competing in.  Clinical presentation at initial evaluation reveals the absence of observable increase in swelling, redness, or warmth.  According to the Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopahty Clinical Practice Guidelines:   Which of the following statements is TRUE, in regards to the Tendon changes associated with the pathological process of midsubstance Achilles Tendinopathy?

Your patient is a 25 y/o recreational hockey goalie who was…

Your patient is a 25 y/o recreational hockey goalie who was playing in a men’s league game when he made a save as an opposing player collided into the anterior-medial aspect of his knee and forcing his R knee into hyperextension.  He felt a “pop” and had immediate pain and swelling in the knee.  He went to the ER, where radiographs were obtained and were negative for fx.  He was evaluated by an orthopedist, had MRI (results pending) and was referred to physical therapy.  One week after his injury, he has a primary complaint of 5/10 pain with walking, stairs, and bending.  He also reports intermittent perception of instability during pivoting movements.  Gait pattern is consistent with knee hyperextension thrust (“quadriceps avoidance pattern’) during loading response.  He lacks 15* of active ROM into both flexion and extension as compared to the L side.  Decreased tone and muscle activation was noted with quadriceps setting on the R, and SLR revealed a 10* extension lag.  Anterior-lateral knee pain with a step-down test was reproduced at 30-40** of knee flexion.  R quadriceps maximum voluntary isometric contraction was 900 N as compared to 1200 N on the L.  (The R was 75% of the L)  The dial test, Posterior sag, and posterior drawer test at 90*were all + on the R.  The Lachman’s test, and varus stress test at 30* knee flexion were negative on the R. Trace effusion was noted inferior and lateral to the patella on the R.  The patient’s Knee Outcome Survey was 57% and his LEFS score was 60%. Upon integrating the data from the initial evaluation, your hypothesis about the patient’s problem would be: