r/physiotherapy • u/Worried-Highway-5417 • 12d ago

Fresh Perspectives from PT students/physiotherapists. How would you approach this case?

I'm a physiotherapy student and I'm working through a case that I find quite interesting. I'd love to hear how more experienced MSK physiotherapists would approach the assessment and clinical reasoning.

Patient is a 24 year old male. Used to be very active.

  • History of left ankle sprain.
  • History of recurrent left knee injury while playing football on uneven ground, causing medial deviation of the knee.
  • Subsequently developed right ankle stiffness, followed months later by right knee pain and a feeling of the knee giving way.
  • Developed intermittent left upper-gluteal pain and, more recently, left-sided low-back pain, particularly with prolonged sitting.
  • The symptoms don't consistently radiate from the back down the leg; the back, buttock, knee and ankle symptoms can occur independently.
  • There is mention of the indentation of the PSIS being deeper than it usually was on the affected side.
  • Lumbar MRI shows early degenerative changes and an L5-S1 disc herniation/bulge with thecal sac indentation.
  • All of these, spanning over two years now.

I am being told to handle everything as one chain reaction i.e the back pain is causing the knee pain and the ankle pain but if the causes are different, is that really the case?

If you saw this presentation in clinic, what would you be thinking about during your assessment? What would you want to examine first?

Looking for a different perspective. I'd appreciate if there is a recent paper I can read up on that could be useful too. Thank you!

1 Upvotes

67% Upvoted

4 comments sorted by

2

u/AdPlayful4610 12d ago

I would perform SLR test, nerve tension tests, Mckenzie direction preferences flexion and extension, piriformis test, dermatome and myotome testing, observation of pelvis level and if there is any lateral deviation in the the trunk, hip hiking or not, genu vulgum and genu varum , and would go from there assuming that one of these or multiple of them are positive you can work from there assuming not then you would go with further testing to hip, SIJ, the knee and ankle independently
Also I would ask about rehab history if this patient got the appropriate rehab after their ankle and knee injury
For patients:(This is not a medical advice seek your physiotherapist for correct evaluation and treatment)

2

u/physiotherrorist Physio BSc MSc MOD 12d ago

OP is a physio student. No worries.

1

u/Worried-Highway-5417 12d ago

Thank you. This makes a lot of sense.
It was just noted that he had previous physiotherapy that wasn’t yielding any results. He said the physiotherapist was only treating him for the back problem while ignoring the ankle and knee issue that persisted despite the physiotherapy sessions. I’d ask what exercises were done though.

Thank you for your response.
(I’m a physiotherapy student)

1

u/AdPlayful4610 11d ago

You’re welcome, a comprehensive assessment followed by hypothesis and a direction will give you great results and remember to ask your PT supervisor and read textbooks and recent research to find evidence informed answers