Clinical Clues

Joint mobilization of the elbow has been shown to decrease pain and improve functional grip in patients with lateral elbow pain. (1) Although there are many treatment approaches for lateral tendinopathy,  we are focusing on some preferred elbow joint mobilization techniques which we have found helpful. Only therapists with appropriate training should perform manual mobilization techniques.

In Clinical Clue 16, why did I recommend using heavy weights when describing Farmer’s Walk (Figure 1)? The answer is simple: patients performing exercises at higher resistance levels impact their nervous system more than doing the same exercise at lower resistance levels.

Asking a patient to return one year after discharge may seem strange but could prove to be a valuable learning experience. I started this approach early in my career and it has allowed me to better recognize how the body changes over time, and to understand that the result at discharge is not the final result.

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?