MSK Lower Limb TERM 1

Acetabular Labrum Tear

Symptoms: groin/buttock pain, ant/lat. hip pain, clicking, night pain, limitation in ROM, limping

Diagnosis: FADDIR, FABER, Arthroscopy

Treatment: Unloading, manual therapy, surgery

Risk Factors: Females, athletes, patients with chondropathy

Chondropathy (Pathology to the articular cartilage)

Symptoms: Ant/groin pain, AM stiffness, Clicking/locking/catching, limping

Diagnosis: FADDIR, FABER, arthroscopy

Treatment: Load reduction, increase in physical activity, surgery (similar to labral tear)

Risk Factors: Early sign of OA, synovitis, FAI

Osteoarthritis (deterioration of the joint)

Symptoms: thigh/groin/buttock pain, antalgic gait, stiffness, pain in AM

Diagnosis: Subjective info, FADDIR, FABER, radiograph

Treatment: hemi/arthroplasty, weight loss, manual therapy, exercise

Risk Factors: Female, genetics, trauma, repetitive loading,

Ligament Teres Tear

Symptoms: Ant hip/groin pain, Limitation to ROM, limping, locking/catching/clicking

Diagnosis: Subjective interview, MRI, arthroscopy

Treatment: Surgery, neuromuscular control, and proprioception of stabilising muscles.

Risk Factors: Hyperabduction, forced F/Add/IR/ER

Synovitis (inflammation of the synovium)

Symptoms: constant ant hip/groin pain, night pain, atrophy, limping

Diagnosis: Arthroscopy

Treatment: intra-articular injections, avoid open-packed positions, treat deficits

Risk Factors: Usually coexists with labral tear, FAI or ligamentum teres tear

Hip instability or Hypermobility

Symptoms: Poor balance/neuromuscular control, poor strength, HOF translation

Diagnosis: X-ray

Treatment: Treat the deficits identified

Risk Factors: Athletes with excessive ROM

Femoroacetabular Impingement FAI (femoral neck/acetabular morphological abnormality)

Types: Cam (NOF deformity), Pincer (acetabulum deformity), Combined

Symptoms: Asymptomatic pain, catching/grinding, reduced ROM

Diagnosis: FADDIR, FABER, Arthroscopy, MRI

Treatment: Surgical intervention, avoid impingement positions

Risk Factors: Hip loading during maturation, biological

NOF Stress #

Symptoms: Ant groin pain, thigh/glute pain, pain radiate to knee, “crack” or “pop” if displaced

Diagnosis: Compressive testing (Drop Test), Fulcrum test, X-ray

Treatment: Surgery, rest-reload program

Risk Factors: 16-56 years old, females, causative sports

Traction Apophysitis (bony outgrowth) and/or Avulsion (fracture of bone (still attached to muscle))

Symptoms: Hip/groin pain, weakness, limping

Diagnosis: Apophysitis – palpation, AROM/PROM, Avulsion – weakness/deformity

Treatment: Apophysitis – rest, strengthening, stretching, Avulsion – surgery

Risk Factors: Biological

NOF Fracture

Symptoms: constant pain, swelling, no ROM, inability to WB

Diagnosis: X-ray or MRI, PatientHX,

Treatment: Surgery

Risk Factors: over 50

Avascular Necrosis of NOF (no vascular supply)

Symptoms: NOF# or dislocation, gait disturbances, constant pain,

Diagnosis: MRI or X-ray

Treatment: Surgery, pain relief

Risk Factors: Smoking, IV drug use

Perthes Disease (flattening of femoral head)

Symptoms: Hip/groin dull ache, limp, reduced ABD and IR

Diagnosis: X-ray and MRI

Treatment: Rest, surgery, pain relief

Risk Factors: Age

Slipped Capital Femoral Epiphysis (posteroinferior slip of HOF)

Symptoms: Insidious groin/knee/thigh/hip pain, psoas spasms, Trendelenburg

Diagnosis: Leg shortening, X-ray, resting in ER

Treatment: Surgery

Risk Factors: 12-15 years, males

Greater Trochanteric Pain (glute med/min tendinopathy)

Symptoms: Dull ache, pain down lateral thigh, AM stiffness, weakness of hip abductors

Diagnosis: Palpation, SLS, de-rotation test

Treatment: Activity modification, strengthening, reduce load

Risk Factors: Long distance runners, women over 40

Adductor-related Groin Pain

Symptoms: Medial groin pain, medial thigh radiation

Diagnosis: Pain with palpation, Squeeze test, adductor stretch pain

Treatment: Protection of Tissue (Phase 1), Tissue repair (Phase 2), restore (phase 3), return to sport (Phase 4)

Risk Factors: Soccer/sports

Iliopsoas-related groin pain

Symptoms: Pain in proximal thigh,

Diagnosis: Iliopsoas pain during palpation, resisted hip flexion and stretching

Treatment: Progressive strengthening

Risk Factors: Athletes

Inguinal-related groin pain

Symptoms: Pain/tenderness in inguinal canal region, aggravated by abdominal resistance

Diagnosis: Resisted Sit up

Treatment: Surgery, abdominal exercises

Risk Factors: NIL

Pubic-related groin pain

Symptoms: Pain around pubic symphysis,

Diagnosis: tenderness at pubic symphysis, imaging, resistance exercises

Treatment: unloading, progressive strengthening

Risk Factors: NIL

Inguinal or Femoral Hernia (intestine protuberance)

Symptoms: Pain with intra-abdominal pressure, palpable bulge

Diagnosis: Palpation and visibility

Treatment: Surgical correction

Risk Factors: NIL

Pubic ramus Stress Fracture

Symptoms: Pain in glute/thigh/buttock, pain with passive abduction, focal tenderness

Diagnosis: Positive Hop test,

Treatment: X-ray or bone scan

Risk Factors: long-distance running

Inguinal Lymphadenopathy (swelling of groin lymph nodes)

Symptoms: constant groin pain, functional activity pain

Diagnosis: PatientHx, palpation

Treatment: GP or specialist

Risk Factors: STD, infections

Intra-abdominal Abnormality

Prostatitis: Prostate inflammation

UTI: infection to urinary system

Kidney Stone: solid masses of calcium within urinary tract

Appendicitis: inflammation of the appendix

Diverticulitis; inflammation of large intestine

Quadriceps Muscle Contusion (corked thigh)

Symptoms: Bruising/hematoma, pain when stretching, tenderness

Diagnosis: Strength testing

Treatment: POLICE regimen

Risk Factors: Contact injury

Myositis Ossificans (calcification of a hematoma)

Symptoms: Ongoing pain, AM/PM pain, stiffness and palpable lump

Diagnosis: MRI, ultrasound

Treatment: Electrotherapy or medications

Risk Factors: NIL

Quadriceps Muscle Strain

Symptoms: local pain, pain on stretching, loss of strength, swelling

Diagnosis: Swelling, bruising and loss of function

Treatment: POLICE regimen,

Risk Factors: Sprinting, jumping, kicking

Stress Fracture Femoral Shaft

Symptoms: Dull ache, poorly localised, tenderness, swelling

Diagnosis: Fulcrum test, MRI or bone scan

Treatment: rest, WBAT, possibly surgery

Risk Factors: training errors, hard surfaces, excessive foot pro/sup

Hamstring Muscle Strain

Symptoms: cramping, stretch reduction, local hematoma, negative slump test

Diagnosis: Slump test,

Treatment: Strength exercises

Risk Factors: Athletes, age

Medial Meniscus Tear

MOI: Shear stress with twisting with planted foot

Symptoms: Pain, swelling, restricted ROM, catching/clicking, pain on hyperflexion

Diagnosis: McMurray’s test, Apley’s test, Thessaly’s test

Treatment: Phase 1 Control swelling, Phase 2 Full ROM, Phase 3 Full strength, Phase 4 Return to Sport

Risk Factors: Males, MCL limiting mobility

Anterior Cruciate Ligament injury (ACL)

MOI: cutting maneuver, valgus collapse, quads activation

Symptoms: feeling pop/snap, pain, swelling, loss of ROM, weakness to contract

Diagnosis: Anterior draw test, Lachhmans Test, Pivot Shift Test (higher sp/se when unconscious), MRI

Treatment: Phase 1 Acute Phase goals, Phase 2 Sub-acute/strengthening goals, Phase 3 Limited return to activity goals, Phase 4 Return to Sport

Risk Factors: Males, 70% non-contact injury, skiing/rugby/afl/netball/soccer

Patella Dislocation

Symptoms: traumatic MOI, immediate pain/swelling, “popping out “, weakness to use quad

Diagnosis: Ottawa knee rules, pain on compression/palpation,

Treatment: Phase 1 Control swelling, Phase 2 Full ROM, Phase 3 Full strength, Phase 4 Return to Sport.

Risk Factors: Females, younger

Patella Fracture

MOI: Fall, direct blow to patella, stress fracture

Symptoms: Instant pain, swelling, inability to extend leg, Ottawa knee rules

Diagnosis: X-ray confirmation, Ottawa knee rules

Treatment: If non-displaced → Brace knee immobilizer, period of NWB. If displaced → ORIF

Knee Osteoarthrosis

Symptoms: Pain, stiffness, limited ROM

Diagnosis: X-ray, age, 6MWT, STS

Treatment: 12 non-pharma logical therapies, 8 pharmalogical modalities and 5 surgical modalities

Risk Factors: Idiopathic (older age) or following injury (younger age)

Patellofemoral Pain (PFP)

Symptoms: Ant knee pain, peripatellar pain, pain with prolonged flexion, poor patella tracking, crepitus

Diagnosis: Palpation, compression, eccentric step test

Treatment: Non-operative, surgery should be avoided

Risk Factors: Females, quads weakness, greater hip abductor strength

Patella/Quadriceps Tendinopathy

Symptoms: localized pain on inferior pole of patellar, pain on tendon load, thickening on palpation

Diagnosis: Pain on palpation, site of symptoms

Treatment: Tendon Rehab 4 Stages (Isometrics→ Isotonics→ Energy Storage→ Energy storage and Release)

Risk Factors: younger population,

ITB Friction Syndrome (ITBFS)

MOI: Rubbing of the ITB over the lateral femoral epicondyle

Symptoms: Pain on lateral aspect of knee, tenderness, crepitus, positive Obers test, hip abductor weakness, tibia IR

Diagnosis: Obers test, pain on palpation

Treatment: Foot alignment/orthotics, strength, ITB stretching/strengthening, entire kinetic chain

Risk Factors: Marathon runners, cycling, athletes

Prepatellar and Infrapatellar Bursitis

Symptoms: Prepatellar → Superficial ant knee pain/swelling when kneeling, Infrapatellar → Anterior knee pain

Diagnosis: Bursae inflammation

Treatment: Oral/topical NSAID, corticosteroid

Fat Pad Impingement

“Impingement between tibia and femur”

Symptoms: extreme pain during hyperextension of knee and quad contraction, swelling, deep to patellar tendon

Diagnosis: Imaging if needs, swelling/pain on palpation

Treatment: Activity modification, neuromuscular control of quads, taping, strength and endurance

Risk Factors:

Osgood-Schlatter Disease

Osteochondritis of the growth plate of the tibial tuberosity

Symptoms: Pain during exercise, thickening of tibial tuberosity,

Diagnosis: consider age, enlarged tibial tuberosity.

Treatment: Activity modification/reduction, stretching, surgery not needed

Risk Factors: Males, high level of physical activity,

Tibial Stress Fracture (Medial/Anterior)

Symptoms: Gradual pain aggravated by exercise, pain with walking, rest or night, local tenderness over tibia

Diagnosis: Palpation over medial tibial border, tuning fork vibrations, foot assessment

Treatment: Medial → Rest, low impact training, Pneumatic brace, Anterior → immediate Pneumatic brace, screening

Risk Factors: high impact sports, increased training loads, amenorrhea,

Tibial Fracture

Symptoms: Pain, swelling, deformity, inability to WB, known MOI

Diagnosis: POP, pain with compression, imaging for confirmation

Treatment: Imaging, pain relief, surgery, rehabilitation, immobilization.

Types: Transverse, Oblique, Spiral, Comminuted, Open

Medial Tibial Stress Syndrome

“Shin Splints“

Symptoms: Pain along medial border, decreases with warm-up, pain after exercise and worse following morning.

Diagnosis: Medial border palpation, potential leg discrepancy

Treatment: RICE, activity modification, taping, braces/footwear, stretching, surgical release

Risk Factors: excessive pronation, runners/dancers, shoe design, surface type, females, training errors

Periosteal Contusion of the Tibia

'“Bone bruising of the tibia“

Symptoms: Pain, swelling, bumps on shin bone, bruising

Diagnosis: POP, pain with compression/WB, deformity

Treatment: POLICE, hydrotherapy, physical activity, ROM

Risk Factors: direct force to the bone/trauma, sports

Chronic Exertional Compartment Syndrome (CECS)

“increased pressure within a closed space, reducing blood flow and tissue perfusion“

Symptoms: Pain with exertion (ant, lateral, deep post, superficial post)

Diagnosis: 5 Ps, compartment pressure testing using the Stryker device, MRI?

Treatment: address contributing factors, dry needling, massage, surgery, (fasciotomy)

Risk Factors: Overuse, subsequent exercise

Deep Vein Thrombosis

“A blood clot (thrombosis) that occurs in the venous system“

Symptoms: Pain/throbbing/cramping, warm skin, red, swelling of the calf/leg

Diagnosis: POP, Wells Clinical Prediction Rule,

Treatment: Anticoagulation medicine, inferior vena cava filter, compression stockings

Risk Factors: Post injury, environmental factors

Gastrocnemius Muscle Strain

Symptoms: Palpable defect, antalgic gait, bruising, swelling painful ROM

Diagnosis: Palpable defect, painful AROM, PROM, and MMT plantarflexion,

Treatment: 4 Stages of Rehab

Risk Factors: sport acceleration, Grade 1 → Stretch injury, Grade 2→ Partial tear, Grade 3→ Complete rupture

3 Vascular Conditions - Claudicant-type Pain

Popliteal Artery entrapment

• Symptoms: Brought on by exercise, pain behind knee

• Diagnosis: Popliteal bruit, MRI, surgical intervention

Atherosclerotic Vessel Disease (deposition of fatty material in the arteries)

• Symptoms: increased with exercise, thigh/calf pain,

• Diagnosis: exam post exercise, ultrasound, Bruit

Endofibrotic Disease (thickening of the endothelium of the artery)

Symptoms: calf pain/thigh pain, no distal pulse

Diagnosis: exam post exercise, ultrasound

Neural Entrapment - Tibial and Sural Nerve

Tibial Nerve

Baker cyst causes tibial nerve entrapment leading to compression

Diagnosis: Paresthesia, muscle atrophy, nerve condution tests, surgery

Sural Nerve

Compression of the sural aponeurosis where the nerve passes through

Diagnosis: Bakers cyst on palpation, Paresthesia, nerve conduction tests, conservative treatments

Lateral Ankle Sprain

Symptoms: pain, swelling, instability, NWB

Diagnosis: Palpation, Ottawa ankle rules, X-ray, Anterior drawer tests, talar tilt test

Treatment: POLICE, crutches, taping/bracing

Risk Factors: Athletes, running/jumping sports, cutting

Osteochondral Fractures of the Talar Bone

Damage to the articular surface of the talus

Symptoms: persistent ankle pain, catching/clicking/locking, reduced ROM

Diagnosis: MRI/CT, arthorscopy

Treatment: Activity modification, cycling, arthroscope 3mths+

Malleoli Fractures

Symptoms: pain, swelling, instability, loss of ROM, pain on palpation

Diagnosis: Imaging/X-ray

Treatment: surgery, physiotherapy

Risk Factors: fall, uneven ground, jumping sports

Tibial plafond/Plion fracture

Symptoms: limited ROM, constant pain during WB,

Diagnosis: Ottawa ankle rules, imaging CT/Bone scan

Treatment: conservative treatment, moon boot, stretching, manual therapy, surgery if displaced

Risk Factors: fall, occur from ankle sprain

Fracture of the 5th Metatarsal

Avulsion fracture of peroneus brevis

Symptoms: Pain on 5th MT, swelling and bruising

Diagnosis: Type 1: narrow fracture line, Type 2: delayed union, Type 3: non-union

Treatment: gradual rehab, surgery, screw fixation

Risk Factors: soccer players,

Dislocated Ankle

Severe lateral ankle sprain

Treatment: immediate referral for relocation (surgery)

Syndesmosis Injury (aka high ankle sprain)

MOI: IR of the tibia on fixed DF foot

Symptoms: pain at DTFJ, other ligaments may be affected

Diagnosis: Squeeze test, Kleigers test, Cotton test

Treatment: 4 Phases of Rehab

Maisonneuve Fracture

injury involving proximal fracture of the fibula, rupture of the MCL and rupture of the AITFL

Treatment: immediate surgery

Chronic Ankle Instability (CAI)

Symptoms: pain on palpation, limited ROM

Diagnosis: ligament laxity tests, imaging/X-ray

Treatment: physical therapy, strength, balance, ankle brace

Risk Factors: laxity of a joint, “giving way“

Ox Trigonum

Extra bone that develops behind the talus

Symptoms: deep ache at back of the ankle, pain with PF

Diagnosis: pain with AROM & PROM during PF

Treatment: activity modification, ice/heat, surgery/injections

Risk Factors: ballet, gymnastics, dancing

Achilles Tendinopathy

Symptoms: Pain, tendon thickening reduced strength, stiffness

Diagnosis: Imaging, ultrasound

Treatment: activity modification, therapeutic exercise, heavy slow resistance, energy storage and release exercises

Risk Factors: associated with physical activity

Sinus Tarsi Syndrome

Symptoms: poorly localized pain, ankle/foot stiffness, IR/ER pain

Diagnosis: fluoroscopy injection

Treatment: rest, mobilization of subtalar joint, corticosteroid, corrective footwear

Risk Factors: overuse, Rheumatoid, repeated forces

Posterior Impingement

Impingement of the tissues between tibia and calcaneus

Diagnosis: pain during active and passive PF, imaging, technique assessment

Treatment: technique modification, manual therapy, cross-training, surgery

Risk Factors: ballet, gymnasts, footy players

Severs Disease

Symptoms: limited dorsiflexion, activity related heel pain, swelling, reduced gastroc strength,

Diagnosis: biomechanical examination,

Treatment: activity modification, heel raise inserted in shoes, doesn’t need surgery, stretching calf

Risk Factors: adolescents,

Plantar Fasciopathy

Symptoms: gradual onset, pain at inferior medial aspect of heel, pain worse in AM, pain decreases with activity but returns with rest

Diagnosis: stretching of plantar fascia via DF of hallux,

Treatment: 3 Phases → Short ter, medium term and long term

Risk Factors: overuse, runners, varus knees, cavus foot posture

Fat Pad Contusion

Bruising of the fat pad on the heel

Symptoms: heel pain during WB, pain felt laterally

Diagnosis: imaging if necessary, tender on palpation of posterolateral heel

Treatment: activity modification, appropriate footwear, heel lock taping

Risk Factors: running, jumping, overuse, fall onto heel

Calcaneal Stress Fracture

Symptoms: insidious onset heel pain, aggravation on WB activities

Diagnosis: tenderness medially and laterally, squeeze test, X-ray/MRI

Treatment: activity modification, gel heel pad, footwear alterations, stretching/strengthening

Risk Factors: running, jumping athletes, ballet

Tarsal Tunnel Syndrome

Symptoms: poorly defined burning, tingling, numbness plantar aspect of foot, altered sensation

Diagnosis: tarsal tunnel tenderness, MRI, ultrasound,

Treatment: activity modification, pronation involvement → taping, stretching, surgery

Navicular Stress Fracture

Symptoms: Insidious onset, poorly localized midfoot pain, pain along medial arch

Diagnosis: pain on N-spot, X-ray, palpation

Treatment: moonboot, strengthening/stretching

Risk Factors: sprinters, jumpers, hurdling

Lisfranc Joint Sprain

Symptoms: midfoot pain, difficulty WB, pain by the forefoot WB

Diagnosis: pain with eversion and abduction of forefoot with calcaneus held still

Treatment: NWB 6 weeks, surgery, orthoses, moonboot

Risk Factors: athletes, direct force “simple crush injury“

Tarsal Collation

Symptoms: Pain, limited ROM, altered Biomechanics

Diagnosis: Limited ROM with PAM, altered biomechanics, imaging, X-rays and CT

Treatment: Activity modification, paracetamol, orthotics, surgery if needed

Risk Factors: Adolescent population, previous injury,

Turf Toe (sprain of the 1st MTP)

Symptoms: Localized pain to the 1st MTP, tenderness of palpation, PROM painful, pain on WB, swelling/bruising

Diagnosis: Grade 1: Mild, Grade 2: partial plantar capsule rupture, Grade 3: complete plantar capsule rupture

Treatment: dependent on injury grade, activity modification, moonboot, taping/bracing, Grade 3=surgery

Risk Factors: hyperflexion

Hallux Limitus → Hallux Rigidus

Loss of 1st MTP ROM

Symptoms: pain, aggravated by walking, dorsal pain, forefoot WB pain

Diagnosis: X-ray, signs of OA

Treatment: Activity modification, medication, orthoses, surgery

Risk Factors: post traumatic, rheumatoid, gout

Moreeto’s Neuroma

Swelling of nerve + scar tissue from compression of the interdigital nerve

Symptoms: pain radiating into toes, P&N, pain increases with WB and tight shoes

Diagnosis:

Treatment: ice, padding, corticosteroid, intrinsic and extrinsic muscle strengthening, orthoses

Risk Factors: excessive pronation, MT hypermobility

Hallux Valgus

Symptoms: deformity, tenderness, blistering, inflamed bursa medially

Diagnosis: pain on palpation, clinical reasoning

Treatment: padding, footwear, foot function correction, bracing, surgery

Risk Factors: trauma, degenerative, congruous/pathological/causative

Serious Pathology - Malignancies/Tumour

Symptoms: pain, muscle weakness, loss of sensation, numbness, incontinence/retention, paralysis

Risk Factors: Previous history of cancer

Cauda Equina Syndrome

Symptoms: bladder/bowel dysfunction, saddle anaesthesia, sexual dysfunction, leg pain, sensory loss

Diagnosis: loss of function to 2+ of the 18 nerve roots that make up CE

Treatment: decompression within 24-48 hours

Systemic Inflammatory Disorders - Axial Spondyloarthropathy

Symptoms: AM stiffness, night pain, alternating buttock pain, wide-base gait, eases with exercise,

Diagnosis: medical imaging NSAIDs, physical therapy

Risk Factors: <40 years, 1 in 200 adults

Spinal VB Fractures

Symptoms: back pain, deformity, loss of height

Diagnosis: pain, tenderness, neurological deficits

Treatment: immobilisation and medical management

Risk Factors: excessive compression/distraction/rotation of the spinal column, accidents, falling

Spondylolysis - Pars Defect

Symptoms: pain, muscle spasms, worse with activity

Diagnosis: Imaging

Risk Factors: single event macrotrauma or repetitive microtrauma, males, Ext+Rotation movements

Spondylolysis - PI Stress #

Symptoms: pain with extension, localised LBP, pain early in activity

Diagnosis: bone scan

Treatment: modify activity, rest, address deficits

Risk Factors: “fatigue failure,” young athletes, repeated stress, males, change in training load,

Spondylolisthesis

“One vertebral body is displaced anteriorly in relation to level below.“

Symptoms: don’t like extension activities, pain

Diagnosis: palpable dip may be present (sail sign), Ext+Rot usually positive,

Treatment: rest, mobilise, address deficits, surgery

Risk Factors: degenerative (older population, L4/5)& spondylolytic (younger population, L5/S1)

IVD Prolapse

Symptoms: severe LBP and leg pain, weakness, reduced sensation, reduced tendon reflex, antalgic posture, lateral shift

Diagnosis: agg. lumbar flexion,

Risk Factors: 20-50 years, males, primary cause of radiculopathy

Acute Radiculopathy

“Pathology to the nerve root“

Symptoms: leg pain/radicular, agg. flexion, sitting, eases lying down, extension

Diagnosis: muscle spasm, adaptive posture, listed often away from side of pain

Treatment: activity modification, McKenzie method, manual therapy

Risk Factors: disc pathology, one-off event

Chronic Radiculopathy

Symptoms: leg pain, LBP, long standing pain, pain even after compression is removed

Treatment: activity modification, McKenzie method, manual therapy, self management

Risk Factors: standing, 60+ years, labourers, neurological deficit,

Central OR Transverse Stenosis

“Narrowing of the spinal canal“

Symptoms: leg pain, weakness, sensory changes, bowel/bladder symptoms

Treatment:

Risk Factors: older patients

Diagnosis: can be either Central or Transverse

Central (degenerative, congenital or developmental)

Transverse (Neurogenic/vascular claudication)

Lumbar Spinal Stenosis (LSS)

“Narrowing of the spinal canal“

Symptoms: leg pain, LBP, numbness, weakness, agg by walking, eased by sitting or flexion

Diagnosis: effect of posture of symptoms→ “stooping,” radiculopathy

Treatment: flexion-based treatment techniques, mobilisations, strength training, surgery

Risk Factors: 50 years, males,

NSLBP: Facet joint as a source of pain

Symptoms: no pain with cough, agg by standing or walking, PM worse

Diagnosis: look for patterns to suggest facet

Treatment: PPIVMs/PAIVMs, self-mobilisation, tape/bracing

Risk Factors: repeated extension, torsion, OA, 65+ years

NSLBP: IVD as a source of pain

Symptoms: somatic pain, agg by sitting/eased by walking, AM worse, worse with increased intra-abdominal pressure

Treatment: activity modification, education

Risk Factors: degeneration, microtrauma

“Clinical Instability” of Lumbar Spine

Symptoms: altered motor control, “giving out/way,” LBP, manipulations,

Diagnosis: greater flexibility,

Treatment: spinal stabilisation, reducing hip flexion,

Risk Factors: <40 years

Myofascial Pain

Symptoms: localized pain in the lower back or buttock

Diagnosis: MOI - overload, training error, pain in AROM, no pain on PROM, palpation, positive Trendelenburg

Treatment: POLICE, STT, muscle strengthening

Risk Factors: sporting injuries, agg. by activity, overlaoded, poor training technique, altered biomechanics

Proximal/high Hamstring Tendinopathy

Symptoms: pain at lower gluteal region/ischial tuberosity, compression of hamstrings insertion during hip flexion

Diagnosis: compression of ischial tuberosity, stretch straight leg raise, modified knee bent stretch, Puranen-Ovara stretch, palpation

Treatment: avoid stretching in acute rehab, medication, ice, progressive loading, isometrics/isotonics

Risk Factors: overuse, increase in load, long distance runners/sprinters

SIJ Dysfunction

Symptoms: deep unilateral buttock pain, referred groin PA pain, tenderness over sacral sulcus

Diagnosis: AROM, forward flexion, Gillets test, Cluster of Laslett/Cluster of Van de Wurff

Treatment: Pain relief, manual therapy, bracing, hydrotherapy, force closure, surgery

Risk Factors: Hyper/hypomobility, # with falls, childbirth (hypo), rotational stress, childbearing (hyper)

Piriformis Syndrome

AKA Deep Gluteal Syndrome Compression of sciatic nerve between pelvic and piriformis OR compression of verve penetrating piriformis

Symptoms: deep pain in hip/buttock, posterior thigh pain, altered sensation, aggravated by sitting or passive stretch

Diagnosis: exclude more common causes, MMTs, resisted tests, neurological assessment

Treatment: Activity modification, soft tissue therapy/stretching, injections, buttock strengthening, surgery

Risk Factors: cycling, dancing, gymnastics

Ischiofemoral Impingement

QF impingement between lesser trochanter and ischial tuberosity

Symptoms: deep groin/buttock pain w/ movement, painful popping/clicking, potential neural symptoms

Diagnosis: reproduce painful movements, MRI required to confirm QF oedema

Treatment: activity modification, manual therapy, strengthening, surgery- lesser trochanter resection

Risk Factors: hip ext, add, ER, weakness of hip abductors (Tendelly), female

Proximal Hamstring Rupture AND Avulsion Fracture

Symptoms: sudden severe pain in high thigh/low buttock, popping, inability to WB, bruising/swelling, weakness,

Diagnosis: confirmation with MRI/radiograph

Treatment: Activity modification, gait aid to offload hammys, strengthening, rupture=most require surgery, avulsion=usually conservative

Risk Factors: high impact sports, rugby, skiing, gymnastics, sudden hip flex with knee ext.

Inflammatory Joint Disorders

Ankylosing Spondylitis, Sporiatic Arthritis, Reactive Arthritis

Symptoms: Joint pain, AM stiffness, joint swelling, skin rash, Uvitis, IBS issues, Fever

Diagnosis: C-reactive protein, Human Leukocyte Antigen B27, blood panel work,

Treatment: Steroids, pain relief, reduce muscle spasm, injections, surgery if needed

Risk Factors: Family history, history of psoriasis

Sacral Stress Fracture

Symptoms: LBP, buttock and post. thigh pain

Diagnosis: SLS on affected side, hop test, focal tenderness of ischial tuberosity, radiograph, bone scan

Treatment: activity modification, reduce WB force, supplementation (eg calcium), strengthening, footwear adjustments

Risk Factors: MOI repetitive force through pelvis, joggers/long-distance runners, marathoners

Dermatomes for light touch sensation assessment indicated by the black dots

• use a cotton swab or tissue

• base response, for example→ cheek

• patients’ eyes must be shut and supine

• stroke skin across all dermatomes

• investigate abnormal sensation

What are the corresponding Levels for LL muscle power testing?

Deep peroneal nerve lesion (L4-S2)

Symptoms: P&N and Nb in web space between 1st and 2nd toes, not influenced by movement of lumbar spine, agg. by repeated ankle DF or tight fitting shoes

Neurological Examination: normal patella and Achilles tendon reflexes, weakness in ankle DF/Inversion and toe extension, reduced sensation between digits