Mentoring Minutes: Plantar Fasciitis

Welcome to PhysioU’s Mentoring Minutes! Each episode of Mentoring Minutes directly applies a clinical approach with relevant research for effective results.

Did you know Plantar Fasciitis was reported as 15% of all running injuries? Do you know how you would rule in this diagnosis? Based on the research, there are specific diagnostic criteria that you should look at when your next patient presents with heel pain. Watch this episode of Mentoring Minutes with Dr. Marshall Lemoine for strategies to best help these patients long term.

Mentoring Minutes: Femoral Neck Stress Fracture Assessment

Can we catch a break? Femoral neck stress fracture risks factors and clinical assessment. It’s not always the biomechanics at fault with running injuries. Remember our differential diagnoses and to treat the whole patient. 

NOTES & REFERENCE

2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 

• Mary Jane De Souza, PhD, et al.

  - The Female Athlete Triad is a medical condition often observed in physically active girls and women, and involves 3 components: (1) low energy availability with or without disordered eating, (2) menstrual dysfunction, and (3) low bone mineral density. Female athletes often present with 1 or more of the 3 Triad components, and an early intervention is essential to prevent its progression to serious endpoints that include clinical

  - Best tests to rule out femoral neck stress fracture are Pubic Patellar Percussion Tests (PPPT) test and fulcrum test

  Femoral Neck Stress Fracture in a Female Runner.

• Journal of Orthopaedic & Sports Physical Therapy 2018, 48:4, 343-343 

  -1 week history of right groin pain that had progressively worsened while training for a half-marathon; initial image at eval showed no fracture.

  - At Physical therapy Eval, the patient presented with an antalgic gait pattern, difficulty getting up from a chair, severe pain during single-limb stance, and occasional night pain. The lumbar screen was noncontributory, and no red flags were noted. Palpation of the iliopsoas and hip adductors revealed muscle spasm and pain. Hip passive range of motion was not limited, but was painful at end range in all directions. Strength testing showed weak and painful hip flexors and adductors. The hip scour test and the “flexion, adduction, internal rotation” (FAIR) test were negative. Movement observation showed weight shift to the left during double-leg squat and inability to perform right single-leg hop due to pain.
  

Mentoring Minutes: Quadratus Lumborum and Psoas Major Exercises

This week's Mentoring Minutes, Dr Marshall LeMonie talks about Quadratus Lumborum and Psoas major exercises.

These muscles are often given a bad rap when it comes to low back pain, but the Quadratus and Psoas can play an important role in trunk and pelvic strength and stability. Just because they are stiff or tight, doesn’t always mean they are strong. Happy planking!

Source & Notes:

Evaluation of Psoas Major and Quadratus Lumborum Recruitment Using Diffusion-Weighted Imaging Before and After 5 Trunk Exercises

Journal of Orthopaedic & Sports Physical Therapy 2017 47:2, 108-114 

• Nine healthy male participants performed the right side bridge, knee raise, and 3 front bridges, including the hand-knee, elbow-knee, and elbow-toe bridges. Diffusion-weighted imaging was performed before and after each exercise.

• Of the 5 exercises investigated, the elbow-toe bridge and side bridge exercises elicit the greatest recruitment of the PM and QL.

Mentoring Minutes: Drop vertical jump for return to sport

Source and Notes:

Cognitive Demands Influence Lower Extremity Mechanics During a Drop Vertical Jump Task in Female Athletes

Journal of Orthopaedic & Sports Physical Therapy 2018 48:5, 381-387 

• Drop vertical jump task is commonly used to screen for anterior cruciate ligament

  injury risk.

• Purpose: Investigate the influence of additional cognitive demands on lower

  extremity mechanics during execution of the drop vertical jump task (stood on a 31-

  cm-high box, positioned 15.24 cm behind the force plates, with their feet 35 cm

  apart, were required to drop off the box, land with their feet on separate force

  plates, and immediately perform a maximum vertical jump, raising both arms as if

  they were jumping to grab a rebound).

• Methods: - 4 different conditions: (1) without decision making or an overhead goal

  (DVJ), (2) without decision making but with an overhead goal (OG), (3) with

  decision making (jump or no jump) but without an overhead goal (DM), and (4) with

  both decision making and an overhead goal (DM+OG).

• Results: Inclusion of the overhead goal resulted in higher peak vertical ground

  reaction forces and lower peak knee flexion angles in comparison to the standard

  drop vertical jump task. Greater peak knee abduction angles in trials incorporated

  temporal constraints on decision making and/or required participants to attend to

  an overhead goal, in comparison to the standard drop vertical jump task.

• Discussion- Higher vGRFs and lower knee flexion angles are indicative of a relatively

  stiff landing pattern, which may increase forces acting on the ACL.. Collectively,

  these additional cognitive demands appear to have resulted in a landing pattern

  whereby participants relied more on knee motion in the frontal plane to decelerate

  their center of mass.
  

Mentoring Minutes: Chronic Ankle Sprains

The all-to-common inversion ankle sprain. How to assess and treat to improve outcomes and limit them from turning into chronic ankle instability. Research is pretty clear: balance and proprioceptive training until the cows come home, then progress to single leg hopping.

Reference & Notes:

Van Ochten JM et al., Chronic Complaints After Ankle Sprains: A Systematic Review on Effectiveness of Treatments. JOSPT.  2014 Nov, 44:11, 862-71 

• 23,000 ankle injuries daily; up to 34% of ankle sprains continue to have symptoms 6 months later.

• 20 RCT’s included to evaluate most beneficial treatment for decreasing pain and function, and reducing recurrences.

• Initial treatment: POLICE (Protected Optimal Loading, Ice, Compression Elevation;

• Biggest benefit at 4 weeks was following proprioceptive training (use of wobble boards, discs, airex, bosu; progressed from eyes open to closed; static to dynamic training (Lateral and change or direction single limb hoping).