02/07/2019 (Clinical Hours)

First patient of the day was a 70 year old retired bus driver that has within the last taken mid-distance running as his new hobbie. By the end of his regular 5 mile run he starts to feel a niggle on the lateral malleolus of his left ankle. There is no specific MOI and his prior P1 behind the knee is no longer relevant after full evaluation of the region (Reimam et al 2013). None of the special tests, dermatological or functional tests were positive and his walking gait was unhindred. Following the requested STM on both lower limbs (calf muscles only), we began strengthening the area with specific runner-based conservative exercises: Lateral Band Walks and Single Leg Proprioception (Bennell et al 2015). When he comes back the next time I would like to re-evaluate all of his symptoms along with analyzing his running on the treadmill.

Second patient of the day was a 12 year old footballer complaining of iliotibial knee pain below the patella, around the tibial tuberosity.  In February he had fallen during a game on his left knee (Medial Condyle) which was follwed by immediate swelling and loss of ROM. Within two weeks he was symptom free and slowly started to return to full practice and play. Two and a half weeks ago his symptoms returned, bilaterally. He started having considerable swelling in his knee after football practice, and the pain, bilateral again, had shifted to the tibial tuberosities. After special and functional testing it was evaluated that he was growth spurt and all of his symptoms lead to a differential diagnosis for Osgood Schlatter Disease (Kenyon et al 2016). A very conservative treatment plan was prescribed, consisting of Isometric Quadriceps strengthening, Rectus Femoris Isolated Static Stretching, and 15 minute icing whenever swelling occured post-game (Hughes 2018).

Third patient of the day was a 30 year old office worker that has taken up mid to long-distance running as a hobbie. She felt a niggle on the posterior medial portion of the greater when performing Hip special tests. Her differential diagnosis was early GTPS. Her treatment consisted of reducing her mid-long distance running volume from 6 to 2-3 times per week, along with performing a conservative exercise treatment in a home environment to strengthen her gluteus medius. On her next visit we will re-evaluate her cluster of symptoms along and take a look at her running gait (Keu et al 2018).

Fourth patient was a 41 year old corss-fit enthusiast complaining of inferior knee pain when squatting and lunging. There was no pain on compression or in the special tests. After aisstance from one of the supervisors the given differential diagnosis was confirmed to be Patellar Tendinopathy (Jones et al 2018). Reduced weight volume by 50% was advisd to reduce the inflammation and speed up recovery in the patellar tendon. Isometrics and eccentrics based exercises were prescribed in his recovery process. Rigid taping on the inferior portion of his patella was applied to compression and decrease his pain symptoms during training sessions (Gibbons 2014).

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