UNASSIGNED: Lateral ankle sprain the most common injury in physically active populations. Individuals who sustain an acute lateral ankle sprain may not receive timely formal rehabilitation and are at an increased risk to have subsequent sprains which can lead to chronic pain and instability. Attention to essential factors for ligament protection and healing while preserving ankle movement, may result in a more stable yet mobile ankle offering improved outcomes. The purpose of this case series was to describe the methods and observe the outcomes associated with a comprehensive strategy for managing acute first episode grade II lateral ankle sprains.
UNASSIGNED: Prospective case series.
UNASSIGNED: Ten patients (mean age 26.7 years, range 16-51 years, mean 2.3 days from injury) with acute grade II lateral ankle sprain were treated with an approach to protect the injured ligament, prevent impairments to movement, restore strength and proprioception, and progress to full function. Patient outcomes were assessed at four, eight and 12 weeks. Follow-up interviews at six and 12 months assessed injury recurrence.
UNASSIGNED: Patients were treated for an average of eight sessions over a mean of seven weeks. Rapid change in self-reported function, ankle ROM, and pain were observed in the first four weeks of care. Clinically meaningful improvements in function and ankle ROM were also noted at eight weeks and maintained at 12-week follow-ups. All patients returned to desired physical activity with only a single re-sprain event within one year after injury.
UNASSIGNED: The results of this prospective case series suggest that a treatment approach designed to protect the injured ligament, maintain and restore normal ankle motion, and provide a tailored functional pathway to return to run and sport demonstrated resolution of symptoms and improvement in reported functional outcomes in a group of patients following grade II acute primary ankle sprain.
UNASSIGNED: Level IV, Case Series.

This case report describes the physical therapy management and clinical decision-making for a 67-year-old female patient with an initial left-hip sarcoma which subsequently metastasized. The patient had significant physical pain and emotional distress after her surgery and radiation. The patient presented to physical therapy (PT) with left hip pain and pain in the left flank and left shoulder. These issues were significantly affecting her quality of life and activities of daily living. She had undergone a previous bout of outpatient PT that did not resolve her pain. A thorough PT evaluation was completed and conservative management of the patient\'s pain was initiated but she did not experience sustainable pain relief. Later it was discovered that the patient had developed spinal metastatic lesions and the pain was likely caused by a pathological fracture that was not identified upon physical examination or previous imaging. Based on this, the physical therapist chose to conduct physical therapy due to the increasing pain, and then referred her back to the physician for further evaluation of imaging results and reevaluation of the patient\'s symptoms. The initial diagnosis and metastatic spread of the sarcoma had a significant negative influence on the patient\'s quality of life and participation in her activities of daily living. When working with any patient with a history of cancer, metastatic disease should remain high on the differential diagnosis list and should be a focus of any new unexplained pain.

OBJECTIVE: Arthritis resulting from recurrent intra-articular bleeding in individuals with hemophilia can be severely debilitating due to joint pain and stiffness with subsequent loss of mobility and function. Very limited studies have investigated the potential benefits of joint mobilization for this condition. This case series is a preliminary investigation of safety, as well as immediate and short-term clinical benefits, associated with gentle knee and ankle joint mobilization in people with hemophilic arthropathy.
METHODS: A single intervention of joint mobilization was applied to the affected knees and/or ankles of 16 individuals with severe or moderate hemophilia within a public hospital setting. Adverse events, as well as immediate (pain-free passive joint range, Timed Up and Go Test with maximum pain numerical rating scale) and short-term (Lower Extremity Functional Scale) effects of the intervention were evaluated with a repeated measures ANOVA.
RESULTS: There were no adverse events. An immediate significant increase was observed in pain-free passive ankle joint range of motion (p < 0.05) following the joint mobilization intervention.
CONCLUSIONS: The findings of this case series suggest that gentle joint mobilization techniques may be safely considered as part of a multimodal management approach for hemophilic arthropathy.

[Purpose] The purpose of this case study was to identify the effects of joint mobilization using Kaltenborn-Evjenth orthopedic manual therapy (KEOMT) and proprioceptive neuromuscular facilitation (PNF) techniques on a patient with chronic low back pain (CLBP) and a lumbar transitional vertebra. [Methods] The intervention methods were joint mobilization using KEOMT and PNF techniques. The program consisted of 40-min sessions 3 days a week for 4 weeks. The spinal motion (thoracic and lumbar vertebrae), pain, and thickness of the multifidus were measured. [Results] The angle of spinal curvature increased, and the range of motions (ROMs) flexion and extension increased in the thoracic and lumbar vertebrae. The pain score as measured on a visual analogue scale (VAS) and the Oswestry disability index (ODI) score decreased. The thickness of the multifidus (L4) increased on the left and right sides. [Conclusion] These results suggest that joint mobilization using KEOMT and PNF techniques had a positive effect on the spinal motion, pain, and thickness of the multifidus of a patient with chronic low back pain and a lumbar transitional vertebra.

METHODS: Case report.
BACKGROUND: Although there is a growing body of literature on both surgical intervention and postsurgical rehabilitation of acetabular labral repairs and femoroacetabular impingement, there is a paucity of information on how to manage individuals who show a lack of progress postsurgery.
METHODS: A 30-year-old woman underwent surgical labral repair with femoroacetabular impingement osteochondroplasty. Postsurgery, she was initially treated with an exercise-based approach, but experienced an increase in hip pain and further decline in function. Her primary functional deficits were difficulty standing and pain (6/10) with ambulation. A combination of soft tissue mobilization and trigger point dry needling was used to address perceived muscle dysfunction, and nonthrust manipulation was used to address perceived hip joint hypomobility.
RESULTS: Following 12 therapy sessions over 120 days, the patient returned to her demanding occupation with minimal residual symptoms. By the end of the period of care, the patient\'s Harris hip score had improved from 56 to 96 and her Lower Extremity Functional Scale score had improved from 26 to 70.
CONCLUSIONS: This case describes a multimodal manual therapy approach and the health outcomes of a patient following labral repair with femoroacetabular impingement decompression who did not respond to an initial exercise-based postsurgical rehabilitation approach. Level of Evidence Therapy, level 4.

Manual therapy is an important tool for the treatment of musculoskeletal disorders of mechanical origin. Since the hip is an important structure for weight bearing as well as static and dynamic balance, it is suggested that hip impairments may affect weight distribution. Both static and dynamic balance are dependent on adequate joint mobility which in the presence of any kind of alteration can lead to modifications of plantar pressure distribution patterns which, in turn, can be detected by computerized baropodometry. The aim of this study was to verify clinical and baropodometric immediate effects of a single session of hip mobilization in a patient with chronic anterior hip pain. A physically active 21-year old patient underwent a pre-intervention assessment which included pain rating, active and passive range of movement, passive accessory movement as well as static and dynamic barodometry. The intervention consisted of an anteroposterior grade III + mobilization of the right hip, which was conducted with patient in left side-lying with the right hip flexed at approximately 45°. After the intervention, the patient\'s pain was reduced and there was an improvement in the active movement related to the pain generation. Baropodometric assessment showed plantar peak pressures shift on both feet, from forefoot to rear foot, and there was also reduction in anteroposterior center of pressure displacement on static recording.

Dorsal wrist pain frequently occurs in weight bearing through the hand in patients with distal radius stress injuries, scaphoid impaction syndrome, and dorsal impingement. To improve the wrist extension motion, joint mobilization has been used. However, there is no report on the effects of mobilization on the range of motion (ROM) and pain onset in patients with dorsal wrist pain when weight bearing through the hand. This study determined the effects of self-mobilization with a strap (SMWS) while weight bearing through the hand on the ROM and force generated at the onset of pain (FGOP) and intensity in the wrist joints of patients with dorsal wrist pain. Fifteen patients (six men, nine women) with dorsal wrist pain during weight bearing through the hand were recruited from a workplace-based work-conditioning center. SMWS was applied during five visits for a 1-week period. Both passive and active wrist extension ROM, FGOP, and pain intensity (PI) while pushing down through the hand were measured before and after SMWS. Passive and active ROM of wrist extension and FGOP increased significantly after the five sessions over 1 week of SMWS (p < 0.05). PI decreased significantly after the five sessions of SMWS (p < 0.05). These results suggest that SMWS can be used to increase wrist extension ROM and decrease wrist pain in patients with dorsal wrist pain during weight bearing through the hand.

Rib injuries are common in collegiate rowing. The purpose of this case report is to provide insight into examination, evaluation, and treatment of persistent costochondritis in an elite athlete as well as propose an explanation for chronic dysfunction. The case involved a 21 year old female collegiate rower with multiple episodes of costochondritis over a 1-year period of time. Symptoms were localized to the left third costosternal junction and bilaterally at the fourth costosternal junction with moderate swelling. Initial interventions were directed at the costosternal joint, but only mild, temporary relief of symptoms was attained. Reexamination findings included hypomobility of the upper thoracic spine, costovertebral joints, and lateral ribs. Interventions included postural exercises and manual therapies directed at the lateral and posterior rib structures to improve rib and thoracic spine mobility. Over a 3-week time period pain experienced throughout the day had subsided (visual analog scale - VAS 0/10). She was able to resume running and elliptical aerobic training with minimal discomfort (VAS 2/10) and began to reintegrate into collegiate rowing. Examination of the lateral ribs, cervical and thoracic spine should be part of the comprehensive evaluation of costochondritis. Addressing posterior hypomobility may have allowed for a more thorough recovery in this case study.