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Lower-Limb Pain Differentiation by a Physical Therapist in an Amateur Cyclist: A Case Report

PainSci » bibliography » Brindisino et al 2021
Tags: etiology, case, diagnosis, pro

One article on PainSci cites Brindisino 2021: 35 Surprising Causes of Pain

PainSci commentary on Brindisino 2021: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Cyclists get plenty of overuse injuries and are usually referred to physical therapists for any persistent pain that doesn’t have an obvious medical cause. In this case, a 57-year-old recreational amateur cyclist had been suffering thigh and leg pain for two months. The patient failed a couple basic tests for endurance of the leg muscles — painful and weak — and had a reduced blood pressure in the lower limb. A blockage in a leg artery was identified and repaired by a surgeon, and the patient fully recovered within three months.

“Clinicians should consider vascular conditions, even in endurance sports.”

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

Background: Cycling is one of the most popular sports worldwide, and cycling-related injuries often involve overuse of the musculoskeletal system. However, cyclists who have been referred to a physical therapist may also present with nonmusculoskeletal conditions.

Case Presentation: A 57-year-old recreational amateur cyclist presented with a 2-month history of thigh and leg pain. At the clinical examination, a positive pedal plantar flexion test, a reduced 6-minute walk test, and a reduced ankle brachial index confirmed a vascular impairment. Therefore, the patient was referred to a vascular surgeon, and his symptoms were resolved with angioplasty.

Outcome and Follow-Up: After 3 months of physical therapy treatment, all screening tests showed normal values. The ankle brachial index value for the left lower extremity was normal. The Medical Outcomes Study 36-Item Short-Form Health Survey and the Vascular Quality of Life questionnaire showed large improvements in all domains.

Discussion: Clinicians should consider vascular conditions, even in endurance sports, to differentiate between musculoskeletal and nonmusculoskeletal conditions and refer patients to the appropriate health care professional.

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