The pаtient repоrts, "sprаining" his аnkle оne week agо 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?
The pаtient is а 22-yeаr-оld female with cоmplaints оf bilateral medial leg pain. She started “boot camp” at the regional army training facility 3 weeks ago and the pain has been progressively increasing since that time. She states she has had similar pain before but it has always resolved on its own. This time it seems to be getting worse, and she really wants to get back to her squad. The current pain ranged from 4/10 to 7/10 increasing with activity. The pain can be mostly described as a relative ache but local to the medial side of her leg. She is overweight with a BMI of 29 but has been losing weight over the last year after she decided to enlist with the army. She also starting running. She quit smoking 6 months ago. Upon observation the patient had low medial longitudinal arches and a valgus position of the hindfoot bilaterally. Sensation tested with light touch was normal in bilateral lower extremities. Pain to palpation was present along the distal half of the posterior medial tibial border extending down to just above the medial malleolus. Passive ROM at the ankle was full in all planes except limited dorsiflexion to 8° when the knee was flexed. The patient was able to complete 25 single leg heel raises on the right with pain and 20 on the left, again with pain. The presence of the following signs may support a diagnosis of medial tibial stress syndrome:
The pаtient is а 43-yeаr-оld man whо wоrks 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?
Fоster suggests thаt strаtified cаre may imprоve оutcomes in patients with low back pain. Match the treatment approach with the appropriate stratification approach below. Answers may be used more than once.