Case Presentation: Patient presents with bilateral epicondylitis after performing crawling during an exercise class.
The right side was worse when we were looking at the bilateral epicondylitis. There was pain onset following a high volume crawling exercise class. Pain present for six weeks prior to the session and was unresponsive to other treatments. The pain occurred straight on arm loading which radiated to a small degree into the… And also was radiated with bicep curls. The findings were, there was pain on finger extension and wrist extension, as well as straight arm, long head biceps loading. There was slight dissymmetry to the left, and as well as into the shoulder.
Dr. Mark Wade presents his thoughts on this case presentation.
As Dr. Brock had mentioned, I would also wanna be evaluating the postures. I’d be specifically looking at posture quadrants one and two for any kind of postural distortion patterns presenting dysfunction in the kinetic chain. Most likely, we’ll find some anterior rolling of the shoulders, as Jeff just put it. As well as forward head posture.
28:35 DW: Now, I would use the spinal push test, and it would let me know if there was any kind of postural instability throughout that spine, that may be altering the structure and the function of the kinetic chain, and potentially the musculature. I would evaluate the ranges of motion of both the elbow, the wrist, and the shoulders, as we’ve mentioned. And most likely with this pain presentation, we are gonna find some restrictions going on there at the elbow. But as Jeff just said, we’re probably gonna need to check the shoulder as well.
29:04 DW: Based on those findings, and the findings presented, I would do some manual therapy, or the CPC treatment to correct any major or minor points of postural instability in the spine to bring that upper spine or the thoracic kyphosis back into postural alignment, and return the forward head posture back to aligned as well. This is gonna help with the anterior shoulder rounding, as we’ve been talking about. And based on any restrictions in the arm, I would clear those out with some manual corrections to ensure that all the ranges of motion are moving as well as possible, or as close to normal function as possible.
29:40 DW: Next, checking in those muscles, like Jessica was saying, I would check for any kind of hybrid tonicity or trigger points, and if there’s anything there, probably going in with some active release technique, or maybe even some PIR in those areas. The next response would be to get the patient out of pain, so I would be applying some K-taping, or posture taping, either using the specific proprioceptive rehabilitation taping technique, or simply some high-tension taping, just to help with that pain, depending on the findings. And then in this case, there is most likely gonna be some hyperactivity or hypertonicity of the musculature.
So I would use an inhibition or negative tension SPRT taping technique, and that’s gonna help calm down some of those inflamed muscles. Just so we can get the patient out of pain while we do some of our other treatments to resolve the actual problem. As Jeff said, this is very well likely a compensatory problem, not the primary issue. Now, if that resolves the pain, then I know it is primarily some muscular irritation from the activity, and I would obviously have the patient refrain from doing the exercises that exacerbated the pain. So that’s kinda how I would handle that case.
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Dr. Mark Wade D.C, PhD, CPE,
Dr. Mark Wade is the founder of the American Posture Institute, creator of the Certified Posture Expert program, board member of the International Posture Association and President of the Council On Human Function. Dr. Mark is considered one of the most “Certified” Posture Experts on the Planet, having obtained more than 45 certifications in posture, neurology, and human function, including a PhD in Public Health. Clinically Dr. Wade has worked with professional athletes and sports teams in every major sports arena and has served as the official Posture Practitioner for the 4 Time National Champions – Parma Panthers. He has become widely known for his ability to help individual athletes and teams perform at their maximum potential having achieved a total of 7 national championships.