RETURN TO ADVANCED STRENGTH TRAINING AND WEIGHTLIFTING IN AN ATHLETE POST-LUMBAR DISCECTOMY UTILIZING PAIN NEUROSCIENCE EDUCATION AND PROPER PROGRESSION: RESIDENT'S CASE REPORT.

STUDY DESIGN: Case Report. BACKGROUND AND PURPOSE: The use of pain neuroscience education (PNE) is indicated when there are psychosocial contributions to a person's pain experience. The scientific literature has established the efficacy of the use of PNE in a population with chronic pain but there is a paucity of evidence to support the use of PNE in athletic populations. The purpose of this case report is to describe the use of PNE and graded exposure exercises specific to an athlete returning to Olympic weightlifting. CASE DESCRIPTION: The patient underwent an L5-S1 discectomy to resolve paresthesia in his leg, completed a bout of post-operative rehabilitation but returned 15 months after the surgery. He presented with the chief complaint of low back tightness and fear of lumbar flexion. When asked to touch his toes during the lumbar flexion range of motion examination, he demonstrated aberrant lumbar movement by hinging at the hips with a straight back due to fear that flexing would damage his lumbar spine. The patient was seen for four weeks with a focus on PNE and graded exposure to weightlifting activities. OUTCOMES: The patient returned to Olympic weightlifting and decreased his Fear Avoidance Behavior Questionnaire (FABQ) score from 22 to 4 during the course of physical therapy. His Tampa Scale of Kinesiophobia (TSK) score also decreased from 55 to 31. By discharge, he was able to bend at the lumbar spine with full flexion and no longer believed the motion to cause damage. DISCUSSION: The case is unique because it describes the implementation of PNE in an athlete returning to weightlifting, and the scientific literature for use of PNE in this population is lacking. The identification of kinesiophobia and implementation of PNE and graded exposure exercises lead to an optimal outcome for this patient. LEVEL OF EVIDENCE: Level 4.

Differential examination, diagnosis and management for tingling in toes: fellow's case problem.

BACKGROUND: The diagnosis of chronic exertional compartment syndrome can be challenging as other pathologies involving bone, muscle, nerve and vascular structures can mimic the syndrome. The purpose of this Fellow's Case Problem is to describe the clinical decision-making and physical therapy differential diagnosis regarding a 25-year-old patient with un-resolved neurovascular complaints following chronic exertional compartment syndrome surgical release. DIAGNOSIS: After surgery, the patient's previous complaint of numbness and tingling in the plantar surfaces of her first and second toes of right foot was still present. The patient's concordant symptoms in toes were reproduced proximally in the lumbar spine and distally in the tarsal tunnel. DISCUSSION: The lumbar spine can refer symptoms to the lower extremities and needs to be ruled out as the source of the patient's complaint whenever neurovascular symptoms such as numbness and tingling are present. The discovery of the relationship of the lumbar spine with the tingling in the toes addressed one of the patient's primary concerns that was not resolved from the surgery. LEVEL OF EVIDENCE: 4.