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Visceral; cardiac;or MSK
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Visceral; cardiac;or MSK - September 1, 2006 1:08:00 AM
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proud
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29 year old female complains of back pain( T10-L1) and "stomach" pain but only when she runs greater than 25 mins.
No pain with deep inspiration/expiration. Neurological exam clear.
Otherwise unable to elicit the symtoms in clinic. I have not placed her on the treadmill yet to see what the symtoms present like.
People on here always have good differential diagnosis skills...looking for possible NON msk causes for this presentation...
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Re: Visceral; cardiac;or MSK - September 1, 2006 1:26:00 AM
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Jon Newman
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From: Amherst, WI
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How quickly does she recover from her pain?
Do other cardio intensive exercises produce her symptoms?
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Visceral; cardiac;or MSK - September 1, 2006 1:30:00 AM
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proud
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About an hour.
She only runs as a form of cardio so I am not sure.
Thanks Jon
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Re: Visceral; cardiac;or MSK - September 1, 2006 5:02:00 AM
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PHSPT
Posts: 119
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From: Oklahoma
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Where in the stomach?? RUQ, LUQ in terms of quadrants? If no significant red/yellow flags ill proceed to clear spine.
Sounds like neurogenic referral to me, which is brought on by high impacting activities:, "running 25 mins"
Id thoroughly assess thoracic, lumbopelvic, SI to r/o any true involvement.
Asses for any over pronation/supination and thorough biomechanics of LE's varus vs valgus, and any gait abnormalities.
Similar case thread in another forum, check it out.
http://blog.evidenceinmotion.com/evidence/2006/08/clinical_consul_5.html
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Re: Visceral; cardiac;or MSK - September 1, 2006 5:12:00 AM
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dfjpt
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[QUOTE]29 year old female complains of back pain( T10-L1) and "stomach" pain but only when she runs greater than 25 mins.[/QUOTE]I would check, clear, rule out possible entrapment of the iliohypogastric nerve, which comes from that level, but would also check for and clear any abdominal nerve entrapment, especially if she has done any significant amount of ab training in the past.
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Re: Visceral; cardiac;or MSK - September 1, 2006 5:55:00 AM
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proud
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Dfjpt,
Br J sports Med 2004. Reported an analysis of the literature relating to abdominal pain in long distance runners. Pretty good read.
But my question is this: How would you check for abdominal nerve entrapment?
PHSPT: Actually central, sometimes on the right, rarely on the left.
This young patient has been to her family physician who told her she had irritable bowel syndrome. She has been to an osteopath who "placed his hands" on her stomach and told her she had some blood flow problems...She saw a manipulative PT who told her she had restrictions at T4 and reduced costotransverse joint play. She recived manipulation and postural taping over 6 sessions.
One year later, she still has the problem and has become frustrated. Of course this may not be a completely MSK issue, but I thought with contributions from here I might be able to help her find a solution.
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Re: Visceral; cardiac;or MSK - September 1, 2006 6:12:00 AM
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Jeep
Posts: 353
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From: USA
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I'd explore gynecological aspects
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Re: Visceral; cardiac;or MSK - September 1, 2006 6:43:00 AM
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Shill
Posts: 1107
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From: Madison WI USA
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Here are a few ideas from the literature. I would add that I would do what you seem to have already planned, have her run to the clinic for her next visit, from 25 minutes away, or get her on the treadmill for 25 minutes at the visit, then do your eval again.
Heres the lit.
J Sci Med Sport. 2005 Jun;8 number2:152-62. Epidemlology of exercise-related transient abdominal pain at the Sydney City to Surf community run.Morton DP, Richards D, Callister R.
Avondale Centre for Exercise Sciences, Faculty of Lifestyle Education, Avondale College, Cooranbong, New South Wales, Australia.
A questionnaire was administered to 848 participants 76% runners, 24% walkers at the conclusion of the 14 km City to Surf community run in order to investigate their experience of exercise-related transient abdominal pain ETAP. Twenty-seven percent of respondents reported experiencing ETAP during the event, with the condition reported more frequently p< 0.01 by runners 30% than walkers 16%. ETAP was mostly described as well-localised 88% and of an aching 25%, sharp 22% or cramping 22% sensation. The most commonly-reported sites of the pain were the right 46% and left lumbar 23% regions of the abdomen. Forty-two percent of the respondents who experienced ETAP reported that the pain was detrimental to their performance. Reports of ETAP decreased with age r= -0.23, p< 0.01 but were unrelated to gender, body mass index or the time taken to complete the event. Among respondents who ran, those who consumed a large mass of food relative to body weight in the time interval 1-2 hr before the event were more likely to develop symptoms of ETAP p < 0.05. The nutritional content of the pre-event meal did not influence the experience of ETAP. Sufferers of ETAP were more likely to experience nausea r = 0.12, p< 0.01 and report shoulder tip pain r= 0.14, p< 0.01. The results indicate that ETAP is a commonly experienced problem and provide insights into the cause of the complaint.
Whoops.
Abstract removed because I obviously highlighted the wrong one. Im no longer at work, so cant get it back. If you want it, let me know and I will get it on Tuesday. I simply did a quick pubmed search on abdominal pain runners.
and another
Scand J Gastroenterol. 2004 Dec;39 12:1310-3. Links
Exercise-related abdominal pain as a manifestation of the median arcuate ligament syndrome.Desmond CP, Roberts SK.
Dept of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia.
Abdominal pain related to exercise, often loosely referred to as 'stitch', is not uncommon, particularly among participants in sports that involve running. The cause of this typically transient pain is poorly understood with several aetiologies proposed including diaphragmatic ischaemia 1, 2. Other gastrointestinal symptoms that are common during prolonged or high-intensity exercise include nausea, diarrhoea and gastrointestinal bleeding 3, 4. These symptoms are also usually transient and are thought to protect against critical organ damage by promoting cessation of exercise. Decreased gastrointestinal blood flow, increased motility and altered neuroendocrine modulation are postulated disease mechanisms 3. We report here a case of an elite runner with exercise-related severe abdominal pain and diarrhoea related to compression of the coeliac axis by the median arcuate ligament. Complete symptom relief was achieved with surgical division of the constricting ligament. The clinical characteristics and pathogenesis of coeliac axis compression syndrome are discussed
So there are a few thoughts.
Have a good long weekend.
Steve
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Steve Hill PT
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Re: Visceral; cardiac;or MSK - September 1, 2006 8:59:00 AM
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yarringtonpt
Posts: 112
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From: Waynesville, NC
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proud:
How long has she been a runner?
What is her pre-run hydration / eating like?
Anything else bring on the symptoms?
Any other non MSK symptoms on a regular basis?
Eric
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Eric Yarrington, PT, MPT, OCS
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Re: Visceral; cardiac;or MSK - September 1, 2006 1:39:00 PM
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rwillcott
Posts: 455
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From: Canada
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How about Maigne's Syndrome (Thoracolumbar Spinal Pain Syndrome)?
The T10 and T11 ventral rami are intercostal nerves. They run under the ribs and end in the abdominal wall. T12 and L1 ventral rami are the subcostal and iliohypograstric nerves respectivley (Maigne et al., 1989).
Here decribes a posterior iliac crestal point and skin roll test.
Here is a link to an article:
http://www.sofmmoo.com/english_section/4_thoracolumbar_junction/thoracolumbar_junction_australie.htm
I know you were looking for non-msk reasons but I thought this may be of interest.
I would also look at her running posture. Also determine what type of diet she is eating before she runs. High protein versus carb as well as the amount of time she waits before running.
Rob
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