If you’re looking for a bit of free CPD head on over to EDUCATA where they have posted a case study of a runner with hip pain. The case study examines the experience of a runner who has recently dared long distances and comes to physiotherapy with severe hip pain. The case study is written and moderated by Susan Banberger, a Physical Therapist and Diplomate in Mechanical Diagnosis and Therapy and works at Advance Sports and Spine Therapy in Wilsonville, USA. The forum on this case study is quite active so please feel free to participate and comment in at the end of the article, as much is learned by all in the process of exchanging ideas.
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?