Masaracchio Michael, Kirker Kaitlin, Collins Cristiana Kahl, Hanney William, Liu Xinliang
Long Island University, Brooklyn, NY, USA.
University Central Florida, Orlando, FL, USA.
Int J Sports Phys Ther. 2016 Dec;11(7):1135-1149.
As a result of the anatomical proximity of the thoracic spine to the cervical, lumbar, and shoulder regions, dysfunction in the thoracic spine can influence pain, mobility, and stability across these areas. Currently, a paucity of evidence exists addressing treatment of individuals with primary thoracic pain, especially in young, athletic patients. Furthermore, current research discussing clinical reasoning frameworks focus on the differential diagnostic process. The purpose of this case report was to present a framework that describes the clinical reasoning process for the implementation and sequencing of procedural interventions for the management of a dancer with thoracic pain.
A 21-year-old female dancer presented to physical therapy with a medical diagnosis of thoracic pain. The patient reported exacerbation of left thoracic pain with prolonged sitting, twisting/arching her back during dance, and lifting >15 lbs overhead. Examination revealed hypomobility with positive pain provocation during mobility testing of T1-T3 and the sternocostal junction of ribs 2-4, with associated muscle guarding palpated in the left iliocostalis thoracis and levator scapulae.
Following 10 visits, the patient had no pain, no functional deficits, and a Global Rating of Change (GROC) of + 6. She returned to full competition, and a 3-month follow-up revealed continued success with dancing and a GROC of +7.
This case report described the successful management of a dancer with primary thoracic pain using a clinical reasoning framework for the sequencing of procedural interventions, while incorporating Olson's impairment-based classification system. A combination of manual therapy techniques and neuromuscular control exercises were incorporated to address mobility, stability, mobility on stability, and skill level impairments, which allowed the patient to return to dance activities safely. Future studies should consider the development of further treatment-based clinical reasoning frameworks that illustrate the importance of the sequencing within a session and across the episode of care.
由于胸椎与颈椎、腰椎及肩部区域在解剖位置上相邻，胸椎功能障碍会影响这些区域的疼痛、活动度及稳定性。目前，针对原发性胸痛患者，尤其是年轻的运动员患者，治疗方面的证据匮乏。此外，当前讨论临床推理框架的研究主要集中在鉴别诊断过程。本病例报告的目的是提出一个框架，描述对一名患有胸痛的舞者实施程序性干预措施及安排其顺序的临床推理过程。
一名21岁的女性舞者因胸痛前来接受物理治疗。患者报告称，长时间坐着、跳舞时背部扭转/弯曲以及举过头顶提起超过15磅重物会加重左胸痛。检查发现，在T1 - T3及第2 - 4肋胸肋关节的活动度测试中活动度降低且疼痛激发试验呈阳性，左侧胸髂肋肌和肩胛提肌有相关肌肉紧张。
经过10次就诊后，患者无痛，无功能缺陷，整体变化评分（GROC）为 +6。她恢复了全面比赛，3个月的随访显示舞蹈方面持续成功，GROC为 +7。
本病例报告描述了使用程序性干预措施排序的临床推理框架，同时纳入奥尔森基于损伤的分类系统，成功治疗了一名患有原发性胸痛的舞者。结合了手法治疗技术和神经肌肉控制练习来解决活动度、稳定性、稳定状态下的活动度及技能水平损伤问题，使患者能够安全地恢复舞蹈活动。未来的研究应考虑进一步开发基于治疗的临床推理框架，以阐明在一次治疗过程及整个护理期间排序的重要性。
4级。
