Screen the Spine for Extremity Pain

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[00:01:19] Welcome back to Untold Physio Stories Podcast and when you host Dr. E with

[00:01:22] Modern Manual Therapy, Edge Mobility System, and our four-month online mentoring program Modern Rehab Mastery.

[00:01:28] In this solo cast I just want to talk about two youth athletes that I've seen in the past month.

[00:01:33] The first is a cervical patient but she had shoulder complaints.

[00:01:38] She was being seen currently by another physical therapist who was mostly working on

[00:01:43] strengthening her rotator cuff. Her main complaints were shoulder pain with swimming and a crawl

[00:01:49] but she was currently off season for that and she was finishing up her volleyball season.

[00:01:54] The only thing that reproduced her shoulder pain was serving. She was able to do everything else,

[00:01:59] setting and all the other kind of moves you do in volleyball.

[00:02:04] So she had pain with serving. The relevant findings for shoulder mobility were limitation,

[00:02:09] hard end feel on the right side compared to the left in elevation, abduction, scaption,

[00:02:15] internal rotation, and extension. So pretty much fitting like a shoulder impingement pattern.

[00:02:21] When I checked her with the Actifor she had less than 10% difference in flexion, abduction,

[00:02:26] and external rotation strength probably because the last PT had already been working on all of

[00:02:31] those muscle groups. However she did have a significant limitation in cervical retraction

[00:02:35] and side bending to the right which fits the clinical practice patterns I teach in my

[00:02:40] modern manual therapy courses. So I decided to do some ISTM in supine on her right upper trap,

[00:02:46] right upper cervical spine then I did traction retraction and side bending

[00:02:50] to improve that loading to the ipsilateral side. I was able to get her ear to actually

[00:02:56] touch her shoulder after two sets of 10 of that we retested shoulder mobility.

[00:03:01] It was full pain free went from DP inflection and abduction to FN inflection

[00:03:10] internal rotation, extension, and abduction. Because I didn't have a volleyball and she didn't

[00:03:15] bring a volleyball and neither did her mom we actually went outside my office and she served

[00:03:21] the huge 65 size Swiss or Thera ball that I sit on for work. She was able to actually hit

[00:03:31] that thing with minimal to no pain. Here's really surprised and really happy. So the

[00:03:36] only thing I gave her for recovery plan day one was cervical retraction and side bending to the

[00:03:41] right along with frequent changes of position and getting extra sleep. Her mom reported that

[00:03:46] she was able to finish out the season with minimal to no pain. On visit two a couple weeks

[00:03:51] later I tested with the active force two end range flexion elevation and that still had a

[00:03:59] 25% difference. So in you know with the arm at the side she had no significant differences

[00:04:08] in abduction and arm at 90 degrees she had no significant differences of less than 10% difference

[00:04:14] in flexion strength but however end range flexion still had 25% difference and that was more

[00:04:21] where she actually had those that pain with crawling and especially serving in volleyball.

[00:04:28] So the thing I gave her was overhead carries to be done prior to her workouts and if you

[00:04:35] imagine an anchor with a Thera band anchored in front of you end range flexion oscillations

[00:04:41] to be done to fatigue reps to fatigue comparing how many can do on the left versus

[00:04:47] how many can do on the right twice a day. I didn't really think she needed to follow up

[00:04:51] after that as she was actually able to play her sport without any pain and her mom would

[00:04:59] actually contact me if she had any issues with swimming. So that was the first case. The second

[00:05:04] case was a young black belt that I had seen he was again also being seen in physical therapy

[00:05:12] with just mainly hip strengthening. The only thing that really hurt him was chambering and

[00:05:18] side kicking. He was able to do inside out kicks, axe kicks, wheel kicks, everything else,

[00:05:23] front kicks, back kicks but side kicks hurt. He did have full hip range of motion on the involved

[00:05:31] side compared to the uninvolved side. The only thing that was significantly limited was

[00:05:38] anterior tilt and side bending to that side and with lumbar extension he deviated away from

[00:05:44] the involved side so he deviated to the left. Both of these fit my clinical practice patterns

[00:05:49] with side gliding and standing against the wall loading the right side he was able to

[00:05:54] chamber and side kick no problem. That's the only thing I gave him and he reported being

[00:05:59] able to spar you know a couple weeks later with verbal follow-up he was able to spar,

[00:06:06] kick, do everything with no pain. He also said running was now pain free. He didn't

[00:06:10] tell me that running was painful before because I think his main concern as a martial artist was

[00:06:16] that he was able to spar and do side kicks. So both of these kind of illustrates what McKenzie

[00:06:24] had found with the ex-paw study that a high percentage of shoulder issues can be treated

[00:06:30] with cervical repeated loading and a high percentage of hip issues can be treated with

[00:06:34] lumbar repeated loading. My main question for the audience is if you are not screening the spine

[00:06:40] for extremity problems especially the cervical spine for the shoulder and lumbar spine for the

[00:06:46] hip then what are you doing and you are definitely I feel like you're missing out on

[00:06:52] some potentially very simple solutions for chronic complaints. If you have any questions

[00:06:58] comments or similar cases always make sure to reach out to me or Andrew on social media,

[00:07:04] make sure to rate Untold Physio Stories five stars wherever you listen to podcasts,

[00:07:08] and as always you guys have a great day.