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?