Cupping with neural glides for the management of peripheral neuropathic plantar foot pain: a case study.

Background/purpose: Plantar foot pain of neural origin is a challenging diagnosis to identify and treat. The purpose of this paper is to illustrate the novel way in which cupping was utilized in conjunction with neural glides to better diagnose and manage a patient who presented with symptoms of peripheral neuropathic plantar foot pain. Case description: A 65-year-old male presented to physical therapy with the diagnosis of plantar fasciitis by an orthopedic surgeon. The presentation included a diffuse area of pain toward the medial border of the foot with a peripheral neuropathic pain description. Cupping was used to identify pain in the saphenous nerve distribution and aided in resolving symptoms with the concomitant use of lower quarter neural glides. Outcome: At discharge and 1-year follow-up, the patient had a full resolution of symptoms and a return to prior level of function. Self-report outcomes included the numeric pain rating scale and the lower extremity functional scale. Discussion: This case is the first to describe the use of cupping combined with neural glides in the diagnosis and management of peripheral neuropathic pain from the saphenous nerve that was previously diagnosed as plantar fasciitis. The proposed mechanisms behind this treatment are also reviewed. Conclusion: In patients that present with symptoms of plantar fasciitis, testing neural glides combined with cupping may be warranted to confirm or refute the presence of a peripheral neuropathic pain source. Further studies are necessary to determine the mechanisms and further utility of the combined interventions in well controlled trials. Level of Evidence: Level IV.

Sex differences in running mechanics and patellofemoral joint kinetics following an exhaustive run.

Patellofemoral joint pain (PFP) is a common running-related injury that is more prevalent in females and thought to be associated with altered running mechanics. Changes in running mechanics have been observed following an exhaustive run but have not been analyzed relative to the sex bias for PFP. The purpose of this study was to test if females demonstrate unique changes in running mechanics associated with PFP following an exhaustive run. For this study, 18 females and 17 males ran to volitional exhaustion. Peak PFJ contact force and stress, PFJ contact force and stress loading rates, hip adduction excursion, and hip and knee joint frontal plane angular impulse were analyzed between females and males using separate 2 factor ANOVAs (2 (male/female)×2 (before/after exhaustion)). We observed similar changes in running mechanics among males and females over the course of the exhaustive run. Specifically, greater peak PFJ contact force loading rate (5%, P=.01), PFJ stress loading rate (5%, P<.01), hip adduction excursion (1.3°, P<.01), hip abduction angular impulse (4%, P<.01), knee abduction angular impulse (5%, P=.03), average vertical ground reaction force loading rate (10%, P<.01) and step length (2.1cm, P=.001) were observed during exhausted running. These small changes in suspected PFP pathomechanical factors may increase a runner׳s propensity for PFP. However, unique changes in female running mechanics due to exhaustion do not appear to contribute to the sex bias for PFP.