Introduction by Marilyn Pink: from time to time EDUCATA has the privilege of hosting guest bloggers on this platform. This series is written and moderated by Susan Banberger, a PT since 1999. Susan is a Diplomate in Mechanical Diagnosis and Therapy and works at Advance Sports and Spine Therapy in Wilsonville, OR. She has contributed to several publications, including the International Journal for Mechanical Diagnosis and Therapy.
The case study examines the experience of a runner who has recently dared long distances and comes to the PT with severe hip pain.Please feel free to participate and comment at the end of the article, as much is learned by all in the process of exchanging ideas.
A runner with hip pain – getting him back in the race
By guest blogger Susan Bamberger
When a runner comes to physical therapy with debilitating hip pain, there are a multitude of treatment options. The accessibility of information from the internet leaves patients confused as to which shoes they should wear, if they should wear shoes at all, if they should stretch, and if so, should they stretch before or after their run, or both? They come to us to help sort out this information and to determine what is best suited for them.
Physical Therapists have the responsibility to create an effective plan for each patient in a reasonable amount of time. Not every treatment works for every patient. Anyone can research stretches, strengthening and shoes on the internet. Our challenge is in proving that we hold unique knowledge and skills to deal with individual problems in this information age. This case study is an example of how skilled physical therapy provided excellent results and gave thisrunner the knowledge and treatment he needed to return to running, pain free.
The patient is a 38 year old male plant manager and new long distance runner presenting with complaints of left anterolateral hip and thigh pain. He was referred to physical therapy from his orthopedist, who diagnosed him with greater trochanteric bursitis.
His onset of symptoms was 6 weeks prior to the initial evaluation, after running a marathon (26.2 miles). By the end of the race, he was in intense, constant pain, rated at a 5/10 that remained constant for 3 days after. His symptoms became intermittent, and have not changed much since that time. His plan was to run 4 marathons in the next year, but he has stopped running completely, as every time he runs the pain comes back to the same intensity it was immediately after the race.
Since becoming symptomatic he has tried many stretches and strengthening exercises he researched on the internet. He has also received advice from his massage therapist. However, the same pain comes back when he runs. He has good shoes, and changes them every 250-300 miles, per industry recommendations. Because of all of his research, he is concerned that this is an issue that is going to keep him from running altogether.
When asked if the patient had any imaging, he replied “only an xray”. Then he said, “Why, do you think I need an MRI?” Sensing fear of life-altering structural damage, the patient was assured that one of the goals of physical therapy is to determine the right place for them. With a careful assessment over 2-3 visits, we should know if further testing is necessary.
Given the history, which structures are you going to examine?
How can we establish functional baselines and how vigorous can we be in our examination?
What examination tests would you use, and why would you use them?
We look forward to your comments!