Physiotherapist:I.F.
Martina, 47-year-old office worker. Rides a racing bike 4 x week.
Presents with 6-month history of right hip pain that refers to her right knee. No history of hip trauma. NRS at rest is 3 but it increases to 5 when she changes position (e.g. sit to stand after prolonged sitting), prolonged standing, walking and sitting.
Concomitant pain: pain in the right Achilles tendon for 4 months. Exacerbated by walking and, above all, by running.
Previous traumas: L1 somatic fracture 10 years ago (fall from bicycle), treated by kyphoplasty (denies any current low back pain). 20 years ago: rt medial meniscectomy via arthroscopy following lesion to the meniscus cause by a sprain. More than 20 years: numerous ankle sprains bilaterally. No other pathologies. No medication.
In summary:
SiPa Cx-ge la rt 6m ? NRS 3-5
Pa Conc Ta-re rt 4m ? NRS 0-3
Traumas Lu-re bi 10y (L1 fracture)
Ge-me rt 20y (lesion to meniscus)
Ta-la bi >20y (sprains)
Hypothesis:
Outcomes of repetitive ankle sprains with compensation ascending to the pv-cx. Possible role of vertebral fracture.
MoVe: Evaluated CX and TA. Pain during movements of the right hip, in particular, during extrarotation. ROM of ER is limited. Achilles tendon pain when walking, in particular, on heels and on tiptoes.
The MoVe confirms my hypothesis.
PaVe: palpation of the coxa and talus segments highlights the horizontal plane.
Treatment:
1st session: er-cx bi, er-ta rt, ir-cx lt, ir-ge rt, an-me-cx rt.
At the end of treatment, pain is slightly reduced. Movement of the right hip is smoother.
2nd session: reports that the first session gave only a temporary improvement – pain returned to previous level after one week.
I choose to change planes after PaVe highlights a frontal plane. Treatment: la-pv bi, me-cx bi, la-cx rt, me-ta rt. Marked reduction in pain post-treatment.
Follow-up by telephone after 10 days: very good, no hip pain at rest. Pain appears at end-range of ER CX (NRS 2), while Achilles tendon pain has regressed.