Physical therapy examination and management of a 20-year-old female with multiple tendinopathies post-traumatic hip fracture: a case report

Background and Purpose: The term “tendinopathy” defines an overuse condition of a tendon that impairs function related to mechanical loading through disrupted healing processes, neovascularization, and collagen structural derangement. 1,2 Common management of this pathology includes progressive loading with particular emphasis of eccentric resistance training4. The purpose of this case report is to present physical therapy examination and management strategies for a patient with multiple synchronous tendinopathies and additional adverse neurodynamics. Case Description: A 20-year-old female service member was referred to physical therapy for right hip fracture. She presents with synchronous right hamstring tendinopathy, adductor tendinopathy, and intra-articular hip pain. PT plan of care was focused on progressing strength and load tolerance utilizing Rate of perceived Exertion (RPE) and Repetitions in Reserve (RIR) scales while simultaneously managing adverse neurodynamics with manual therapy and nerve glides. Outcomes: The patient responded very well to progressive load training despite multiple synchronous pathologies. Repeated reassessment of symptoms at each treatment allowed for adverse neurodynamics and unexpected setbacks to be identified and treated with efficiency. The objective measures in combination with the subjective patient report indicated that the therapy provided was effective in improving her physical symptoms, functional ability, and work participation. Discussion: In conclusion, the constant holistic reassessment of the patient’s condition in combination with intentional, evidence-informed progression of load can improve both a single tendinopathy and multiple synchronous tendinopathies. Additional research into the management of multiple synchronous pathologies could help others in the field improve outcomes for more complex patients