RESUMO
Patellofemoral pain syndrome (PFPS) is often effectively managed with appropriate exercise prescription, yet in many cases PFPS related symptoms can become persistent and result in reduced daily, functional and sport-related activity levels. Patellofemoral mobilizations may be incorporated to minimize the impact of mobility deficits, and are frequently performed in the patellofemoral joint's open-packed position of knee extension. However, many individuals with PFPS have pain during weight-bearing activities requiring knee flexion such as stairs, squatting, or running. Therefore, it seems reasonable that utilizing joint mobilizations in more symptomatic functional positions may enhance treatment plans. The purpose of this clinical suggestion is to present patellofemoral joint mobilization options in positions more closely replicating positions of symptom provocation, in an effort to offer clinicians different intervention strategies for the challenging condition of PFPS. LEVEL OF EVIDENCE: 5.
RESUMO
BACKGROUND AND PURPOSE: Distal biceps brachii tendinopathy is an uncommon diagnosis. Various exercise prescriptions have demonstrated efficacy in the management of tendinopathy, although studies frequently focus on the effects of a specific type of muscular contraction (i.e., concentric, isometric, or eccentric). Currently, there is limited research guiding the conservative management of distal biceps tendinopathy, particularly with overhead athletes, and even less evidence reporting a multifaceted exercise prescription for individuals with tendinopathy. The purpose of this case report is to describe the integration of various modes of therapeutic exercise into a rehabilitation program for an overhead athlete with suspected distal biceps brachii tendinopathy. CASE DESCRIPTION: A 19-year-old male collegiate baseball pitcher presented to an outpatient physical therapy clinic via direct access for left antecubital pain, which began 6 weeks prior to the evaluation while pitching during try-outs. Following physical examination, distal biceps tendinopathy was the likely clinical diagnosis. Interventions focused on early eccentric exercise eventually progressing to concentric and plyometric activity for return to sport. OUTCOMES: The patient was seen five times over the course of 4 weeks. He had significant improvements of pain, patient-reported functional outcomes, global rating of change, strength, tenderness, and provocation testing. The patient was able to return to an off-season pitching program. DISCUSSION: An impairment-based and task-specific exercise prescription was effective for this patient with distal biceps tendinopathy. Understanding the biomechanical demands of an individual's functional limitation, in this case baseball pitching, may assist the decision-making process and optimize outcomes. Additional research into the most effective exercise prescriptions for individuals with uncommon tendinopathies is warranted.
