ADOLESCENT HIP & LOW BACK PAIN CASE STUDY
History Of Presenting Symptoms
‘John Doe’ is a 14 year old boy with 5 weeks of left flank, low back and hip pain that originated during a sporting event. While performing a bowling action in cricket the client felt a sharp pain at the end of their twisting phase. Due to the amount of pain and discomfort John could not continue the game and had to leave early. Post the initial incident of the injury John had incorporated a number of at home remedies as well as rest to alleviate the pain, with little to no change from onset. Despite the pain John has continued playing cricket throughout this time frame, however has not been able to perform their usual duties of pace bowling and opening the batting for his team.
Aggravating Factors
John has been struggling with many of his daily activities due to the discomfort and pain. The biggest concern for John himself is his inability to bat for long periods as well as his ability to bowl at full pace. These were second to pain present during rotation and flexion of the Thoracic and Lumbar spine, pain walking up or down stairs and stiffness, pain present during running or sitting motions. At this current point John mental health had taken a decline due to stress and anxiety as he was in the process of being selected for a representative team and was afraid of missing his ‘shot’.
Assessment
During the assessment, John’s squat motion was observed to be sub optimal, primarily due to weakness in the stabilising phase. This was accompanied by a notable external rotation and buckle like motion of the right knee. Gait analysis revealed an anterior rotation of the left hip and a shortened stride length. Additionally, there was significant weakness in active resisted hip abduction and external rotation, with the left side being more affected than the right. Notably, no pain was reported during passive mobilisation of the thoracic, lumbar and hips joints.
Treatment
The treatment commenced with a thorough discussion of the patient’s goals and expectations, which were subsequently aligned with a realistic time frame. Manual therapy interventions, including soft tissue manipulation, active mobilisation, myofascial release, and electro dry needling, were administered, resulting in notable improvements compared to the initial assessment. Following the initial treatment, a rehabilitation program was prescribed, focusing on strengthening identified weaknesses and enhancing the patient’s ability to handle explosive kinetic loads in short, repetitive bursts. Additionally, various stretching exercises were incorporated to facilitate improved mobility. The patient attended fortnightly sessions over an eight-week period for regular manual therapy aimed at alleviating symptoms and making necessary adjustments to the rehabilitation program. At the conclusion of the eight weeks, the patient successfully returned to sport without any restrictions.