1. The Whole is more than the sum of the parts
popularquotessy.tk
Shelly Post, PA-C
Seattle Children's Hospital
Department of Orthopedics
Seattle, Washington

2. Anterior Knee Pain/Patellofemoral syndrome
Typical history/PE
No trauma, vague achy anterior knee pain, worse with activity
No effusion, may not have any tenderness, ligaments stable, tight quads and hamstrings
X-Rays normal
Functional exam: popliteal angles/Ely’s test, squat,
jump and land
single leg hop

3. Make the Patient show you!
**Increases force between patella and femur
fthefreshman15.com283
Functionaltrainingcoach.com
**Increases stress on medial side of knee

4. Anterior Knee Pain/Patellofemoral syndrome
Red Flags: trauma, effusion, painful popping, locking, giving way, night pain, worsening pain or not improving with rest, fever
Look for another cause
Take home: tight hamstrings means quads work harder, poor mechanics increase force on anterior knee and between patellofemoral joint, strong core and hips protect the knee
Make your case stronger by showing patient and family the mechanics

5. Functional/Non-specific Back Pain
Functional Back pain
Typical history/PE: usually teenager, chronic pain, diffuse, pain with flexion, complain of pain with activity but doesn’t prevent activity
X-Rays normal
Red flags:
trauma  must rule out fracture
increased pain with extension  rule out spondylolysis or Bertolotti’s
positive straight leg raise/numbness/weakness/asymmetric reflexes concern for herniated disc or intrathecal pathology
stiffness, night pain, one finger sign  keep looking for
another cause
Fitseats.com
I have 15 out of 10 pain all day, every day.

6. Functional/Non-specific Back Pain
Benign Back pain
Functional exam: feel ropey paraspinals, posture, bird dog, single leg squat, slump test
Bird dog: Look for exaggerated lordosis, tipping of pelvis, uncoordinated movement
munfitnessblog.com290

7. Functional/Non-specific Back Pain
Take home:
Poor posture/weak core  paraspinal muscles get overworked
Tight hamstrings often contribute
Make patient demonstrate mechanics
Refer if red flags are present or the diagnosis is in question
Screening (labs, bone scan, MRI) may be necessary to rule out other pathology if not responding to rest, PT, NSAIDS
**Ear in line with shoulder, shoulder in line with hip

8. Shoulder Pain/Glenohumeral Dysfunction
Shoulder pain/Glenohumeral Dyskinesia
Typical history/PE: no trauma, gradual onset, often dominant side in a throwing/overhead athlete, vague anterior or posterior pain, some impingement, X-Rays normal
Red flags: trauma, apprehension or feelings of instability, numbness or weakness, night pain
Upper trapezius is overpowering, weak rhomboids and lower trapezius, poor scapular control impingement and pain
eastbayhittinginstruction.com

9. Shoulder Pain/Glenohumeral Dysfunction
Functional exam: watch flexion and abduction from behind the patient, watch for elevation superiorly and also elevation off the thorax, watch for asymmetric glide
thesportsphysio.wordpress.com
Mikereinold.com

10. “The whole is more than the sum of the parts.”
Summary
Common theme: All are considered rather benign diagnoses that cause much pain and complaining. Patients/families will continue to look for more answers unless the cause is clearly demonstrated.
“The whole is more than the sum of the parts.”
When to worry:
Night pain, swelling, mechanical symptoms (locking, painful popping, instability), neuro symptoms, fevers, persistent or worsening symptoms especially after rest, pain out of proportion to injury
Refer if red flags are present or the diagnosis is in question