Clinical Clues

A recent 34-year-old patient with plantar fasciitis who was training for 6.2-mile race experienced symptoms anytime she ran more than 4 miles. Her race was in two weeks, and her schedule permitted only one 30-minute evaluation and one 30-minute treatment prior to the race.

Stepping in a sprinkler hole this summer while jogging gave me an unexpected opportunity to experience my own response to a variety of current treatment approaches for lateral ankle sprain to determine their efficacy.

Recently a podiatrist requested a sample of the Push Ankle Foot Orthosis (AFO) for a patient with posterior tibial tendon dysfunction (PTTD) (1). Before sending the sample, we explained this brace is designed for patients with foot drop. The podiatrist understood this, but after studying the Push AFO design, he thought it could benefit his patients with PTTD.

Because half of ankle sprains occur during sports play and 40% of those ankle sprains lead to re-injury or chronic instability, clinicians often treat athletes more than once for the same ankle injury. When treating the same patient again, reviewing relevant evidence to update the treatment plan may be efficacious.

Any clinician benefits from knowing how to modify a functional activity so it creates varied challenges for your patient. The farmer’s walk exercise, designed to simulate the functional activity of carrying heavy loads (groceries or luggage), can easily be modified to challenge different impairments.

Current social distancing encourages and supports telemedicine but requires therapists to modify many common procedures—such as hands-on joint measurements with a goniometer. How can you evaluate shoulder flexion if you are unable to use a goniometer?

Most patients with shoulder pain have difficulty stabilizing the scapula during external rotation strengthening exercises. How many times have you carefully explained this exercise to a patient only to discover at the follow-up visit they have been doing the exercises improperly? How can you set up your patients for success?

In last month’s Clinical Pearl, we discussed the importance of the hand-mind connection in upper extremity rehabilitation. Early joint motion and functional task training is just as important for a lower extremity injury to keep patients from becoming deconditioned and from developing dysfunctional compensatory movement patterns.

Recently, J.S., a 16-year-old female soccer player treated 8 months ago for a non-contact grade II right lateral ankle sprain, sought treatment after reinjuring her ankle.

In the clinic sometimes testing maneuvers are also used as treatment maneuvers; muscle tightness testing and stretching is a classic example. Is this also true of neural tension testing and nerve gliding treatment?