PHYSIOTHERAPY MANAGEMENT OF A FIVE-YEAR-OLD WORSENING SOCCER INJURY
Dublin Spine and Sports Physiotherapy, Dublin, Ireland
A CASE REPORT
A range of peripheral and central chemical and structural factors appear to contribute to the creation of various clinical presentations that are likely to prove supersensitive to unwanted mechanical perturbation (Zusman, 1998). In managing such an irritable patient it is advised to ‘respect’ the body’s way of self-protection from excessive movement in the case of serious tissue damage (Maitland, 1986). In this case report, a serious sports injury puzzled more than 20 clinicians over a five year period, treatment failed to prevent a continuous regression in her symptoms to a point where she had to give up her profession (teacher) and live with continuous pain.
This female soccer player, then 19 years old, was involved in a forceful fall, landing on her coccygeal area with her spine in a flexed position in March 1996. Among her initial symptoms was loss of sensation dorsally affecting her back and legs. All of her X-rays and MRI scans proved to be without clinical findings. Yet, physical signs and symptoms were widespread, with severe pain spanning from her left low back and buttock, down the posterior left leg to the heel and plantar aspect of the foot, the left inner thigh, the thoracic spine, medial aspect of the left arm, the thoracic and cervical spine.
Her previous treatments included medication, ultrasound, electrical stimulation, heat treatments, acupuncture, chiropractor, 3 facet joint blocks, 2 rhizotomies, massages, hydrotherapy, spinal mobilisations and medical exercise. The majority of the pain relieving treatments only provided short-lived transient pain relief, and all of the movement based therapies caused severe exacerbation of the symptoms.
On examination she complained of continuous pain exacerbated when walking and sitting. Her left hip, lumbar, thoracic and cervical spine and her left shoulder were painful and limited in all movement directions. She had positive neural tissue sensitivity signs, especially her left sciatic and left medial nerve, and a combination of hyperalgesia and allodynia in widespread areas, especially in the left half of the body, the low back and coccygeal areas. She had very poor core stability resulting in her inability to keep a correct posture for any length of time, and an inability to control movements effectively. She had recently decided to take a six-month leave off work, as a day’s work caused very severe symptoms.
The ATM2 was used to self mobilise her coccyx, and provide pain-free mobilisation with movements (Mulligan, 1999) and movements to her left sacroiliac and hip joint while restraining/compressing the pelvis resulted in significant pain relief. These benefits did not last for more than a few hours after the treatment; however, they did demonstrate the mechanical component of this disorder. In this pain free period medical exercises were introduced to maintain the new pain free mobility and initiate pain free core stability muscles activity.
Gradually relieving the pain became quicker, easier, longer lasting and she can now perform more pain free activities, including recently pain free walking on the treadmill – for the first time in five years.
Prior to the ATM2 treatment, all attempted symptomatic pain relief techniques used on this patient either failed or were short lived. All previous movement based therapies were deleterious and had a ‘punishing’ effect on this young lady.
Maitland G. D. Vertebral Manipulation, Butterworths, London, 1986. 352-353
Mulligan B.R. Manual Therapy ‘Nags’, ‘Snags’, ‘Mwms’ etc, Wellington, 1999. 56-58
Zusman M. Manual Therapy 4: 199-204, 1998.