Case Presentation for a male who presents with bilateral epicondilitis is as follows.
Subjective Findings & History:
Right elbow worse
Pain onset following a high volume crawling exercise class
Pain present for 6 weeks prior to session and unresponsive to Osteopathic treatment
Pain occurs on straight arm loading which radiates to a small degree and bicep curls
Pain on finger extension/wrist extension/straight arm long head biceps loading
Slight dysmteria to left paravermis CB at the shoulder
Manual muscle test:
Bilateral glut medius weakness
Right teres major – hurts elbow
Right minor weakness teres minor
Bilateral Radial extensors
Bilateral brachialis creates pain
Reduced tone in brachialis bilaterally
Dr. Mark Wade quickly presents his thoughts on this case presentation.
I would evaluate posture quadrants 1 and 2 looking for any postural distortion patterns presenting dysfunction in the kinetic chain. Most likely we will find some anterior rolling of the shoulders as well as forward head posture. The spinal push test would let me know if there is any postural instability throughout the spine that may be altering the structure and function of the kinetic chain, and musculature. I would evaluate the ranges of motion of the elbows, wrists, and shoulders. Most likely with this pain presentation we are going to have some restrictions going on.
Based on those findings I would do a manual therapy CPC treatment to correct the major and minor points of postural instability of the spine, to bring the upper spine back into postural alignment and to return the forward head posture to aligned. This is going to help with the anterior shoulder rounding as well. Based on any restrictions in the arms I would clear those with manual corrections to ensure all ranges of motion are moving properly.
Next checking those muscles for any hyper tonicity or trigger points, I would perform active release technique and possibly PRI for those areas.
The next response will be to get the patient out of pain. So I would apply some k taping or posture taping, either using Specific Proprioceptive Rehabilitation taping technique or a simple High Tension taping. depending on if the findings. In this case there is most likely going to be some hyper active or hyper tonic musculature, so I would use an inhibition or negative tension SPRT taping technique to help calm down those inflamed muscles. If that resolves the pain then I know its primarily muscular irritation from the activity, and I would have the patient refrain from doing the exercise that exacerbated the pain.
To hear the other 6 council members perspectives and discussions on this case presentation refer to Episode 04 on the Council On Human Function Podcast.