Eccentric training for the rehabilitation of a high level wrestler with distal biceps tendinosis: A case report

BACKGROUND AND PURPOSE: Distal biceps brachii tendinosis is a relatively uncommon clinical diagnosis seen by physical therapists. As a result, there is little evidence guiding clinical decisions regarding best practice or effective treatment options to restore individuals to their previous level of function. The purpose of this case report is to describe the use of eccentric training as the primary intervention in the rehabilitation of a patient with distal biceps tendinosis. CASE DESCRIPTION: A 41-year-old male electrician and collegiate wrestling coach presented to a university outpatient physical therapy clinic with a two month duration of pain in the right antecubital space which occurred when the patient was performing close-grip body weight curl ups for the first time. Sharp pain was noted in the right arm during the lowering phase of the exercise. Following the examination, distal biceps tendinosis appeared to be the likely diagnosis. The patient was educated in eccentric exercise principles and was prescribed eccentric loading exercises for the distal biceps brachii tendon in two different positions of elbow flexion. OUTCOMES: The patient was seen in physical therapy for three visits over the course of four weeks. Following eccentric training, the patient reported decreased pain, demonstrated increased right elbow flexion and forearm supination strength, was no longer tender to palpation of the distal biceps tendon and showed clinically significant improvement in QuickDASH scores. DISCUSSION: Given the lack of available research on the rehabilitation of distal biceps tendinosis, eccentric training showing benefits with other upper quarter tendinoses and the positive outcomes in this case, it may be appropriate for physical therapists to employ eccentric training for patients with distal biceps tendinosis. LEVEL OF EVIDENCE: 5 (Single case report

Cervicothoracic junction thrust manipulation in the multimodal management of a patient with temporomandibular disorder.

Temporomandibular disorder (TMD) is a common condition that can be difficult to manage in physical therapy. A number of interventions, such as manual therapy, therapeutic exercise, and patient education have typically been used in some combination. However, the evidence regarding thrust manipulation of not only the local but also adjacent segments is sparse. Specifically, the use of cervicothoracic (CT) junction thrust manipulation has not previously been described in the management of individuals with TMD. In this case report, CT junction thrust manipulation, in addition to locally directed manual therapy, exercise, and postural education, was associated with immediate improvements in neck and jaw symptoms and function in a complex patient with TMD. The patient was seen for seven visits over the course of 2 months and demonstrated clinically significant changes in the neck disability index (NDI), the numeric rating of pain scale (NPRS), and the global rating of change (GROC) scale. The purpose of this report is to describe the successful physical therapy management of a patient with TMD utilizing manual therapy, including CT junction thrust manipulation, education, and exercise

Lumbar manipulation and exercise in the management of anterior knee pain and diminished quadriceps activation following acl reconstruction: a case report.

BACKGROUND AND PURPOSE: Quadriceps weakness is a common finding following knee injuries or surgery, and can be associated with significant functional limitations. This weakness or muscle inhibition may be due to central inhibitory mechanisms, rather than local peripheral dysfunction. Lumbopelvic manipulation has been shown to effect efferent muscle output by altering nociceptive processing. The purpose of this report is to describe the physical therapy management of anterior knee pain and chronic quadriceps weakness utilizing side‐lying rotational lumbar thrust manipulation and therapeutic exercise for an individual eight months status‐post ACL reconstruction CASE DESCRIPTION: A 20 year‐old male presented to physical therapy eight months following anterior cruciate ligament (ACL) reconstruction of the left knee with primary complaints of residual anterior knee pain and quadriceps weakness. The subject was treated with a multimodal approach using side‐lying rotational lumbar thrust manipulation in addition to therapeutic exercise. OUTCOMES: The subject was seen in physical therapy for eight sessions over eight weeks. Lower Extremity Functional Scale (LEFS) scores improved from 58/80 to 72/80, quadriceps force, measured by hand‐held dynamometry (HHD), was improved from 70.6 lbs to 93.5 lbs and the subject was able to return to pain free participation in recreational sports. DISCUSSION: Therapeutic exercises can facilitate improved quadriceps strength, however, in cases where quadriceps weakness persists and there is concurrent pain, other interventions should be considered. In this case, lower quarter stabilization exercise and lumbar thrust manipulation was associated with improved functional outcomes in a subject with anterior knee pain and quadriceps weakness. Side‐lying rotational lumbar thrust manipulation may be a beneficial adjunctive intervention to exercise in subjects with quadriceps weakness. LEVEL OF EVIDENCE: 5, Single case repor

Joint mobilization in the management of persistent insertional achilles tendinopathy: a case report

BACKGROUND & PURPOSE: Insertional Achilles tendinopathy (IAT) can be a challenging condition to manage conservatively. Eccentric exercise is commonly used in the management of chronic tendinopathy; however, it may not be as helpful for insertional tendon problems as compared to mid-portion dysfunction. While current evidence describing the physical therapy management of IAT is developing, gaps still exist in descriptions of best practice. The purpose of this case report is to describe the management of a patient with persistent IAT utilizing impairment-based joint mobilization, self-mobilization, and exercise. CASE DESCRIPTION: A 51-year-old male was seen in physical therapy for complaints of posterior heel pain and reduced running capacity. He was seen by multiple physical therapists previously, but reported continued impairment, and functional restriction. Joint-based non-thrust mobilization and self-mobilization exercise were performed to enhance his ability to run and reduce symptoms. OUTCOMES: The subject was seen for four visits over the course of two months. He made clinically significant improvements on the Foot and Ankle Activity Measure and Victorian Institute of Sport Assessment-Achilles tendon outcomes, was asymptomatic, and participated in numerous marathons. Improvements were maintained at one-year follow-up. DISCUSSION: Mobility deficits can contribute to the development of tendinopathy, and without addressing movement restrictions, symptoms and functional decline related to tendinopathy may persist. Joint-directed manual therapy may be a beneficial intervention in a comprehensive plan of care in allowing patients with chronic tendon changes to optimize function. LEVEL OF EVIDENCE: Therapy, Level 4