Sep 24, 2012

Quick COTW or A Typical Maintenance Follow Up Visit


I love runners! Not only are the motivated, they also make for great "come back if you need a tune up" patients! Here is a recent follow up I performed just last week.

My typical follow up sessions are 30 minutes of assessment and manual. He had just run twenty miles over the weekend, and previous complaints of right hamstring pain, alternating plantarfasciitis, lower back pain, were all better. His current complaints were slight posterior tibialis "tightness" on the left.

His SFMA - I picked and chose what I thought was most relevant to his current condition. He is a pretty high functioning individual who scored a 19 on his FMS even when he was in active treatment, so very little asymmetries. That may also indicate more of a motor control issue because he has DNs in the following areas, he is working on his rolling patterns and a few other corrective exercises at home.

  • MSR - DN to the left
    • breakout - DN with hip IR and tibial IR on the left
  • MSE - DN
    • breakout - FN with left hip flexed
    • DN with hip extension in prone
    • DN half kneeling ankle df test (this will be a topic of Wednesday's post) - or how to make a treatment and HEP out of this test/breakout

So what does this tell us? His hip extension is limited on the left, possibly causing over striding on that side from an excessive flexion moment during swing phase. The lack of tibial IR could also be limiting knee flexion.

Treatments: IASTM to the lateral upper and lower LE patterns (ITB and bony contours of lateral tibia), posterior upper and lower LE pattern (hamstring/gluteal junctional areas, proximal/superior/lateral gastroc). Functional release to his left psoas and diaphragm.

Instructed on prone swims (previous tests had rolling DN prone to supine lower left to right). These are alternating contralateral UE and LE extensions) to help with rolling as a regression. He was also instructed on the half kneeling ankle dorsiflexion test (knee to the wall with foot 5" away) and a standing dynamic psoas stretch. All of these were to be performed repeatedly throughout the day.

After Tx, MSR and MSE were both FN. He has a few more weeks of training until race day. It's been 4-5 weeks since I last saw him. This is a typical "maintenance" visit. Patients often go to private pay for these as they aren't medically necessary in the eyes of private insurance. It's direct access at it's best. This all takes me about 30 minutes, and is entirely possible to assess, treat, and prescribe exercise for homework within that time. What are some of your typical follow up or maintenance sessions like?

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