Abstract
HISTORY: A 28 year old Paralympic track and field athlete presented for physical therapy evaluation. The athlete’s history was positive for a congenital absence of the right fibula, resulting in a below the knee amputation at age two. However, at the time of the evaluation, he was asymptomatic, participated in daily training activities, and regularly competed in meets at the world-class level.
PHYSICAL EXAMINATION: The athlete demonstrated the following postural traits: forward head; forward, internally rotated shoulders bilaterally; decreased thoracic and lumbar curves; and anterior pelvic tilt. He demonstrated decreased active and passive range of motion in many of the muscles in his lower extremities, as well as asymmetries measured between legs. While manual muscle testing was 5/5 throughout, he demonstrated a delayed recruitment of the gluteals/hamstring dominance bilaterally. The athlete was unremarkable in neurological and soft tissue assessment. He demonstrated a “poor” capacity to maintain lower extremity symmetry while squatting to moderate depth, as well as marked asymmetry in numerous measures of single leg athletic function.
DIFFERENTIAL DIAGNOSIS:
1. Musculoskeletal imbalances
TEST AND RESULTS:
1. Abnormalities in lower quarter muscle length and function.
2. Asymmetrical performance in numerous tests of single leg athletic function.
FINAL WORKING DIAGNOSIS: Chronic musculoskeletal imbalances due to congenital deformity and compounded by repetitive athletic activity.
TREATMENT AND OUTCOMES: Many throwing athletes sustain musculoskeletal or nervous injuries due to repetitive microtrauma to these tissues. Paralympic throwers are at greater risk of such injuries, due partly to the chronic effects of asymmetrical biomechanical demands. The physical therapist evaluated this athlete, identifying musculoskeletal imbalances and prescribing therapeutic exercises to address these limitations. The throwing coach integrated these prescribed activities into the athlete’s annual training program so as to foster his power development in an injury-free manner. This case report highlights a cooperative relationship between sports medicine and coaching professionals that assisted a Paralympian in peaking for the 2016 Rio Games.