Abdominal Strain Minus the Strain

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[00:01:19] Welcome to Untold Physio Stories Podcast. Your perfect commute resource with Physio failures, successes, interesting cases and more from the physio and rehab world. With your host, Dr. Andrew Rothschild and person, Raleighio Zone. Welcome back to Untold Physio Stories Podcast. I'm a new host, Dr. E with

[00:01:44] Modern Manufacturer, the Edge of the Mobile Assistant and our four month online mentoring program, Modern Rehab Mastery and I'm back finally with my co-host, Andrew Rothschild. Yeah, how's it going Andrew? It's going good, Erson. How are you?

[00:01:59] Good. Andrew has a story today even though it's not one of his but he has something to share with go on. Yeah, it seemed lately all my colleagues are getting the interesting cases so I'm going to have to

[00:02:08] piggyback off of them. So I'll relay it to best I can with the information that I have. So what my colleagues had a new E-val early this week and it was a woman. I think she was in

[00:02:21] her late 50s, early 60s. She presented it with sort of left-sided, primarily abdominal pain but it kind of wrapped around that, you know, sort of lower, lower thoracic region, no mechanism of injury is pretty active. Personally, I'm sure she walks. She does resist training

[00:02:40] that kind of stuff and no mechanism, no incident. She recalled having a similar episode of symptoms like this earlier in the year. Like around May, I think he said, again with that

[00:02:55] situation, there's no sort of specific mechanism and it kind of I think just resolved on its own without any specific treatment. The referral from the physician of course was abdominal strain which, again, is sort of laughable. And he said during the exam, he really could not

[00:03:16] reproduce those symptoms. He had a little bit of sort of lower low back pain with like extension but it's like, you know, it's kind of that pinchy low back pain that's not really pain is like that is a normal kind of sensation and was we not her symptoms.

[00:03:32] You know, side bending, rotation, resistance testing, nothing really reproduced her symptoms. And, you know, with palpation he felt, you know, he can't felt just a few centimeters lateral to the to the umbilicus. He kind of felt a little bit of that sort of post-attile

[00:03:52] thing. Yeah, that was sort of unusual. I think it was a little bit sensitive, a little bit tender and so he was concerned with abdominal aerodomy. He felt like a post-attile. Yeah,

[00:04:08] kind of it's kind of a pulsing throbbing kind of sensation. Um, so he was concerned about a potential abdominal aerotic ineurysm and he ended up recommending that she go to the ER

[00:04:23] and that was sort of the end of the, you know, that was when he was, he was, he was telling me about the consult and then she, I guess, had left a message that that evening that

[00:04:34] she gone the, that gone to the ER and it was, you know, something that had to be taken care but it wasn't like emergent. So I guess, you know, we really still weren't sure what it was until

[00:04:45] the following day. He was able to get in touch with her. Do you have any guesses of what it could be or what did like differential diagnosis on your, on your thought process? Pulse a tile, um, I don't know, on the left side of the umbilicus? Yeah.

[00:05:01] So wait, you're saying you have an answer with them, right? Because, you know, obviously I'm like, I'm treating this as a puzzle. I'm thinking like, oh, is this? When you said left side

[00:05:12] um, you know, thoracic, if I, I was trying to remember when you said left the right and if it was right, I would have said, oh, it's a gallbladder referral. It was left-sided.

[00:05:22] Yeah, I know. So it was left-sided, so like it's not gallbladder referral because gallbladder is right, right, right, right, right. Yeah. Left, I mean there, I would think it's some sort of

[00:05:37] like a you were to something. Yeah. No, no, no, no. And that was in that, I'm glad, you know, he's, he's a new, I should say he's also a new grad therapist if he's only been out for like,

[00:05:47] you know, six months. I didn't know I feel like the differential is a bit better than we do though. Yeah, and it sounds like he's like they had a good day had some good, uh, you know, grilling on in those

[00:05:57] topics. Um, but thankfully it was not that it turned out to be something way more benign. It was severe constipation. Oh, okay. Yeah. I mean, it's just this and it kind of makes

[00:06:13] something that we don't really act about though, right? Exactly exactly. I was like, oh, yeah, okay. Which, which was, you know, again, it makes sense because that, you know, that can refer to the abdominal

[00:06:25] area. Obviously, it could also refer to like the back sometimes. Um, and the fact that it happened a few months earlier, you know, I guess, you know, if you consider that it could have been in a,

[00:06:35] and maybe it was a bit of a, it also happened a few months earlier. Yeah. Make it so good that had been an aneurysm that was not so severe that was that was like about to burst but was just

[00:06:45] a lot of costumes and then settled down. Um, yeah. I mean, maybe they had, they maybe they were doing like, uh, like, they'll solve us or something. Yeah. Yeah. Yeah. But um, the fact, you know, that was very proud

[00:06:57] that he, you know, told me, you know, the whole point of, you know, that's one of the main purposes of a thorough exam is really to rule out serious pathology and make sure that what we're

[00:07:07] seeing is a musculoskeletal, especially with the referral of abdominal strain when there was absolutely zero mechanism that would make sense for that. Oh, right. When you can't everything's everything's a strain. I know, you know, like how many times more strain, I've never seen

[00:07:21] how moved back strain. You know, like, somebody times you prescribe low back strain, you all have like a ridicule off at the ear, something in the foot drop and it's like, is this really a strain? Like how many times have you strained an erector? Right. It's like

[00:07:33] I'll never in my life, you know, wrong voice strain. Like maybe if somebody dove and grabbed somebody from following out of a helicopter, you know, maybe do a little rhomboy strain. But it's not outside of that. There's not, it's not something that really occurs. Oh, man, I just

[00:07:48] watched the last episode of Reacher. Did you know, phenomenal? You know, with though, I feel like I feel because he said that. I was like, there's no way he did just watch that. I don't know,

[00:07:59] not to get off the topic, because I know that in my old podcast, Gina and I used to talk about Star Wars all the time. But I kind of feel like they jumped the shark a little bit. I mean,

[00:08:07] like how many times can you catch someone falling out of a helicopter? He's not Steve Rogers, even though he actually looks like he's strong with a camera. He's been listening to this and

[00:08:16] hasn't seen the finale yet. I'm sorry. Maybe I'll publish this one in another two or three weeks. But yeah, it was a little bit. It was a little bit, I give them a little bit benefit of

[00:08:27] the little things dispension of disbelief. But yeah, so it was a little bit more so than in the previous season. But also she climbed out. She should have stabbed in the arm and

[00:08:37] and she's with a stabbed arm, she unbuckled herself and then climbed up the thing. It's called a red and then Erson. These stuff happened. Oh, I guess so. Yeah. Yeah, adrenaline. You told me

[00:08:47] forget about that arm wound. You're bad at that. You should bad at these things. Right. Right. Let me know for all. It was a great season. And I love you. But let me tell you what,

[00:08:56] Robert Patrick, he really let himself go. He doesn't look like he's a turtle anymore. I said the exact same thing to my wife because she was watching. I guess he's in a

[00:09:04] there's an old show that was on, but he was also in that she's been watching old episodes. And it wasn't that long ago though. And he was like, wow, he really kind of lost his hair.

[00:09:14] But yeah, I know he did. He was a pretty good bad guy though. I mean, he was a hateable bad guy for sure. Oh, yeah, he did great. Yeah. Yeah. All right. Yeah. So,

[00:09:24] just a guess. Yeah, just a guess. Just a guess. Just a guess. Just a guess. Constable, he's a hate. This is, yeah, it's just, you know, wild. Like, yeah, that's kind of makes you think like yeah,

[00:09:33] be some of those, there's more actually we think that's I am thinking. Yes, I am thinking actually to ask this because how many times? Yeah. I mean, we never ask this. We all have to ask about a loss.

[00:09:45] Right now. And then I remember my wife back when she used to do women's health, she would say, you know, I don't ask about a loss of bowel bladder control. I ask about increased frequency

[00:09:57] urgency because like people always think that a loss is like, you know, they're like, pegan pooping themselves and they have to like, depends on the adult or something. But she's like,

[00:10:06] even if frequency and urgency is a question that we should really be asking. But not not not a lot. You know, not like a no, or you haven't been moving your bowel there or anything. That's

[00:10:18] super interesting. Yeah. Yeah. All right. Well, that is a great story. All right. Well, if you guys have any interesting cases or big physiophilias, make sure to reach out to Andrew and get on the podcast and welcome back on told Physiostores. We've been taking a break.

[00:10:37] I took a break from the podcast for about three weeks since for the holidays and everything and then I was stranded in Idaho and whatever. So because of all the snow. So we're back

[00:10:45] and kind of release regular episodes again. So make sure to read us five stars and hit that subscribe button. And again, please leave us more especially ratings on iTunes or Apple podcasts and Spotify. And as always, you guys have a great day.