Patient is a 29 year-old female (34 weeks pregnant) complaining of bilateral hip and pubic pain, both of which were more pronounced on the left side. Pain was present during activities of daily living and while sleeping. Patient reported being unable to sleep throughout the night for several weeks secondary to the discomfort. Patient is a devout Crossfit athlete and, with certain modifications, has remained extremely active throughout the pregnancy, her first. Patient’s medical history is otherwise unremarkable.
Hip extension within normal limits bilaterally
Limited hip adduction: positive Ober’s test bilaterally, soft end feel, resistance from posterolateral hip
20 degrees hip internal rotation (left), 40 degrees hip internal rotation (right)
Patient is a 31 year-old male tactical athlete with a history of multiple traumatic right shoulder dislocations currently presenting with anterior shoulder pain and apprehension during overhead activities. Athlete must routinely perform overhead activities to include climbing caving ladders and controlling a parachute canopy during his workday. Patient is likely a surgical candidate but cannot have surgery at this time for a variety of reasons.
Pain at end range passive right shoulder flexion (170 degrees)
50 degrees of passive right shoulder external rotation, soft end feel (guarded)
Symptom exacerbation and perception of instability with passive right shoulder external rotation >50 degrees
Limited right external rotation appears to be protecting a pathological joint. Attempting to passively increase external rotation not indicated despite patient’s ability to achieve greater range of motion with various mobilization techniques.
Assessment also included gross movement analysis with specific orthopedic testing where indicated
Solace New York coach and 63kg Weightlifter Heather Farmer (@olyfarmer) has been working hard to compete this weekend at the 2016 American Open in Orlando. She’s an elite lifter because of her strength, power, and skill, however she had difficulty with executing ideal technique due to some hip mobility limitations.
Here’s a video of Heather and Doug Kechijian going over how Resilient coaches the Glute Ham Raise and why she can benefit from the exercise.
Return to sport is a hot topic in the fields of sports medicine and human performance. Implicit in “return to sport” is an injury that prohibited an athlete from participating in competition. Return to sport guidelines typically warrant the most scrutiny following a surgical procedure like an anterior cruciate or ulnar collateral ligament reconstruction. Essentially, the greater the number of games missed to a particular injury, the more medical and performance professionals fixate on what constitutes physical readiness for specific sporting demands.
Resilient‘s Dr. Doug Kechijian was recently interviewed for the PJ Medcast.
PJ Medcast are the podcasts for PJ MED (Pararescue Medicine). Besides PJs, these podcasts may be useful to other Military, Law Enforcement and Civilian Medical Personnel involved in Tactical and Technical Rescue Medicine, and other facets of Operational Medicine.