ABSTRACT
Non-cardiac chest pain (NCCP) is a very common and functionally limiting pain complaint that vexes patients and medical providers leading to time-consuming and expensive diagnostic work-ups as well as significant disability and lost productivity. Despite extensive debate and research, there is no definitive treatment recommendation or high-level evidence to support a conservative care treatment approach, or interventional management procedures for the diagnosis and alleviation of NCCP. In patients presenting with chest pain, after ruling out life-threatening causes, the diagnosis of NCCP is made. This process is a diagnosis of exclusion rather than a specific etiology with a defined treatment plan. This results in specialty consultation, advanced diagnostic testing, and delayed definitive care. A better triage process may include the incorporation of diagnostic maneuvers at the primary care and emergency room to justify referral to a musculoskeletal specialist in lieu of or during advanced diagnostic work-up. After the diagnosis of NCCP is made in our young and active patient population, we have seen significant success in the application of manipulation and a functional restoration program similar to the presented case. To our knowledge, this treatment approach has not been previously described. While this management strategy may be taught in physiotherapy courses, we provide the case to illustrate a multimodal treatment approach that seems to be unknown or underutilized based on the number of referrals and prevalence of this condition.
ABSTRACT
Musculoskeletal injuries continue to be the most common cause of decreased readiness and loss of productivity in all military environments. In commands with smaller footprints, such as Naval Special Warfare (NSW), every asset is critical for mission success. Studies have shown that early intervention by a medical provider can enhance healing and maintain unit readiness by preventing medical evacuations. Reports are limited with regard to Special Forces commands, especially during deployment. This article describes the injury characteristics and treatment of injuries seen by a physical therapist while deployed at forward operation commands embedded with NSW Group 2 Team 4. Over 4 months, 282 patients were evaluated and treated in southeast Afghanistan. In descending order, the three most common injured body regions were the lumbar/sacral spine (n = 82), shoulder (n = 59), and knee (n = 28). Therapy exercises (n = 461) were the most frequently performed treatment modality, followed by mobilization/manipulation (n = 394) and dry needling (n = 176). No patient evaluated was medically evacuated from the area or sent to an advanced medical site. Our data are similar to other published data reported on deployed units in terms of mechanisms and locations of injuries; thus, Special Forces commands do not appear to have unique injury patterns. These results support continued use of physical therapists in forward operations because of their ability to evaluate injuries and provide treatment modalities that help maintain the integrity of small commands at the site of injury.
