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Muscle tear or DVT

Muscle tear….or DVT?

I’ve just done my first Parkrun. For those that don’t know anything about Parkrun, it is a free, community-led international event that happens somewhere near you on a Saturday morning. It is a 5kilometre run, which is timed. It felt like hard work, and I got too hot as I had kept my fleece on, which was obviously a mistake.  I’ll let you know what my time was at the end! Parkrun has turned exercise back into what it should be: done by all, easy to access and free. Here is a link to the Abingdon Parkrun

Anyway, after the run I saw one or two participants stretching their calf muscles with rather pained faces. Presumably they had simply pulled a muscle in the leg. A bit of stretching and a mix of exercise and rest, and they’ll be fine. One of the dilemmas that clinicians have is whether leg pain like this is just a pulled muscle or is a DVT, particularly if the patient has not been doing any exercise that might have injured a muscle. I saw one such patient a couple of weeks ago who had pain in his lower leg. He hadn’t done any vigorous exercise and the leg was a bit swollen. I wondered whether he had a deep venous thrombosis (DVT)?

A DVT is a clot of blood (or thrombus)  in one of the veins. The blood clot prevents blood flowing through the vein, hence the swelling. The worry about a DVT is that some of the thrombus can break off and travel through the heart and then get lodged in one of the pulmonary arteries that carry blood to the lungs, called a pulmonary embolism (PE). This is why you don’t want to massage the leg of someone who possibly has a DVT.   PE can cause shortness of breath and chest pain and is a cause of death. So we do need to know if these patients have a DVT or not. If they do then they need to be treated with an anticoagulant, quite typically apixaban (Eliquis).

The way that we can check to see if someone has a DVT is to use an ultrasound scanner to see whether the vein can be squashed. Arteries have tough walls and should not be squashable with compression. Veins have thin walls and should normally be squashable, a bit like a slightly flat bike tyre. If a vein has thrombus in it, it can’t be squashed, a bit like an overinflated tyre. You can see the arteries  in this video. They can’t be squashed. That’s normal. The veins are just above the arteries and in the video you can see that the vein in the right leg can be squashed. The vein in the left leg can’t be squashed because there is thrombus in it. This patient did have a DVT in his left leg.

The GP was very helpful and put him on apixaban and sent him to the Churchill hospital, where the DVT was confirmed. The anticoagulant will minimise the risk of him dying from a pulmonary embolism. Good result!

I hope that the Parkrunners who had calf muscle twinges all recover quickly. I came 222nd out of a field of 316 and did the run in 30mins 39secs. Not at all fast, but I enjoyed it, and will do it again. But if the weather is mild, I’ll leave my fleece off! There was a great sense of community. Maybe I’ll see you there one day?

#calfmuscle, #DVT, #calfstretching, #deepvenousthrombosis, #pulmonaryembolism, #sportsinjury, #chiropractorabingdon, #parkrun, #parkrunabingdon, #chiropractic, #BCA, #BCAfamily, #POCUS

 

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Lim, Y.Z., et al., People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. J Physiother, 2019. 65(3): p. 124-135.
Meade, T.W., et al., Low back pain of mechanical origin: randomised comparison of chiropractic and hospital outpatient treatment. BMJ, 1990. 300(6737): p. 1431-7.
Koes, B.W., et al., Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine (Phila Pa 1976), 2001. 26(22): p. 2504-13; discussion 2513-4.
Chou, R., et al., Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med, 2017. 166(7): p. 493-505.
Pengel, L.H., et al., Acute low back pain: systematic review of its prognosis. BMJ, 2003. 327(7410): p. 323.
Croft, P.R., et al., Outcome of low back pain in general practice: a prospective study. BMJ, 1998. 316(7141): p. 1356-9.
Santilli, V., E. Beghi, and S. Finucci, Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J, 2006. 6(2): p. 131-7.
Leemann, S., et al., Outcomes of acute and chronic patients with magnetic resonance imaging-confirmed symptomatic lumbar disc herniations receiving high-velocity, low-amplitude, spinal manipulative therapy: a prospective observational cohort study with one-year follow-up. J Manipulative Physiol Ther, 2014. 37(3): p. 155-63
Morris, C.E., Chiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disk herniation. J Manipulative Physiol Ther, 1999. 22(1): p. 38-44.
Bergmann, T.F. and B.V. Jongeward, Manipulative therapy in lower back pain with leg pain and neurological deficit. J Manipulative Physiol Ther, 1998. 21(4): p. 288-94.
Runge, N., A. Aina, and S. May, The benefits of adding manual therapy to exercise therapy for improving pain and function in patients with knee or hip osteoarthritis - a systematic review with meta-analysis. J Orthop Sports Phys Ther, 2022: p. 1-36.
Anwer, S., et al., Effects of orthopaedic manual therapy in knee osteoarthritis: a systematic review and meta-analysis.Physiotherapy, 2018. 104(3): p. 264-276.
Zhu, L., X. Wei, and S. Wang, Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. Clin Rehabil, 2016. 30(2): p. 145-55.
Wang, Z., et al., Systematic Review and Network Meta-analysis of Acupuncture Combined with Massage in Treating Knee Osteoarthritis. Biomed Res Int, 2022. 2022: p. 4048550.
Tian, H., et al., Acupuncture for Knee Osteoarthritis: A Systematic Review of Randomized Clinical Trials with Meta-Analyses and Trial Sequential Analyses. Biomed Res Int, 2022. 2022: p. 6561633.
Chen, J., et al., Acupuncture for the Treatment of Knee Osteoarthritis: An Overview of Systematic Reviews. Int J Gen Med, 2021. 14: p. 8481-8494.
Araya-Quintanilla, F., I. Cuyúl-Vásquez, and H. Gutiérrez-Espinoza, Does acupuncture provide pain relief in patients with osteoarthritis knee? An overview of systematic reviews. J Bodyw Mov Ther, 2022. 29: p. 117-126.
Katz, J.N., et al., Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA, 2022. 327(17): p. 1688-1699.
Bronfort, G., et al., Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther, 2001. 24(7): p. 457-66.
Vernon, H.T., The effectiveness of chiropractic manipulation in the treatment of headache: an exploration in the literature. J Manipulative Physiol Ther, 1995. 18(9): p. 611-17.
Nilsson, N., H.W. Christensen, and J. Hartvigsen, The effect of spinal manipulation in the treatment of cervicogenic headache.J Manipulative Physiol Ther, 1997. 20(5): p. 326-30.

Boline, P.D., et al., Spinal manipulation vs. medication for the treatment of chronic tension-type headaches: a randomized clinical trial. J Manipulative Physiol Ther, 1995. 18(3): p. 148-54.

Bryans, R., et al., Evidence-based guidelines for the chiropractic treatment of adults with headache. J Manipulative Physiol Ther, 2011. 34(5): p. 274-89.
Varatharajan, S., et al., Are non-invasive interventions effective for the management of headaches associated with neck pain? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur Spine J, 2016. 25(7): p. 1971-99.
Côté, P., et al., Non-pharmacological management of persistent headaches associated with neck pain: A clinical practice guideline from the Ontario protocol for traffic injury management (OPTIMa) collaboration. Eur J Pain, 2019. 23(6): p. 1051-1070.
Chu, E.C.P. and M. Ng, Long-term relief from tension-type headache and major depression following chiropractic treatment. J Family Med Prim Care, 2018. 7(3): p. 629-631.
West, J. and R.B. Phillips, Chiropractic management of a patient with persistent headache. J Chiropr Med, 2013. 12(4): p. 281-7.
Haas, M., et al., Dose response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study. J Manipulative Physiol Ther, 2004. 27(9): p. 547-53.
Pribicevic, M. and H. Pollard, Rotator cuff impingement. J Manipulative Physiol Ther, 2004. 27(9): p. 580-90.
Pribicevic, M., H. Pollard, and R. Bonello, An epidemiologic survey of shoulder pain in chiropractic practice in australia. J Manipulative Physiol Ther, 2009. 32(2): p. 107-17.
Liu, M., et al., Effects of massage and acupuncture on the range of motion and daily living ability of patients with frozen shoulder complicated with cervical spondylosis. Am J Transl Res, 2021. 13(4): p. 2804-2812.
Kim, Y.J., Acupuncture management for the acute frozen shoulder: A case report. Clin Case Rep, 2021. 9(11): p. e05055.
Ben-Arie, E., et al., The Effectiveness of Acupuncture in the Treatment of Frozen Shoulder: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med, 2020. 2020: p. 9790470.
Rueda Garrido, J.C., J. Vas, and D.R. Lopez, Acupuncture treatment of shoulder impingement syndrome: A randomized controlled trial. Complement Ther Med, 2016. 25: p. 92-7.
Pribicevic, M. and H. Pollard, A multi-modal treatment approach for the shoulder: a 4 patient case series. Chiropr Osteopat, 2005. 13: p. 20.
Russell, S., et al., A blinded, randomized, controlled trial assessing conservative management strategies for frozen shoulder. J Shoulder Elbow Surg, 2014. 23(4): p. 500-7.
Brantingham, J.W., et al., Manipulative therapy for shoulder pain and disorders: expansion of a systematic review. J Manipulative Physiol Ther, 2011. 34(5): p. 314-46.

Pribicevic, M., et al., A systematic review of manipulative therapy for the treatment of shoulder pain. J Manipulative Physiol Ther, 2010. 33(9): p. 679-89.

Page, M.J., et al., Manual therapy and exercise for rotator cuff disease. Cochrane Database Syst Rev, 2016(6): p. CD012224.
Page, M.J., et al., Manual therapy and exercise for adhesive capsulitis (frozen shoulder). Cochrane Database Syst Rev, 2014(8): p. CD011275.
de Sire, A., et al., Non-Surgical and Rehabilitative Interventions in Patients with Frozen Shoulder: Umbrella Review of Systematic Reviews. J Pain Res, 2022. 15: p. 2449-2464.
Murray, C.J., et al., The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA, 2013. 310(6): p. 591-608.
Croft, P.R., et al., Risk factors for neck pain: a longitudinal study in the general population. Pain, 2001. 93(3): p. 317-325.
Nilsen, T.I., A. Holtermann, and P.J. Mork, Physical exercise, body mass index, and risk of chronic pain in the low back and neck/shoulders: longitudinal data from the Nord-Trondelag Health Study. Am J Epidemiol, 2011. 174(3): p. 267-73.
Kääriä, S., et al., Risk factors of chronic neck pain: a prospective study among middle-aged employees. Eur J Pain, 2012. 16(6): p. 911-20.
Linton, S.J., A review of psychological risk factors in back and neck pain. Spine (Phila Pa 1976), 2000. 25(9): p. 1148-56.
Côté, P., et al., The burden and determinants of neck pain in workers: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. J Manipulative Physiol Ther, 2009. 32(2 Suppl): p. S70-86.
Bryans, R., et al., Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther, 2014. 37(1): p. 42-63.
Zhu, L., X. Wei, and S. Wang, Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. Clin Rehabil, 2016. 30(2): p. 145-55.
Gross, A., et al., Manipulation or mobilisation for neck pain: a Cochrane Review. Man Ther, 2010. 15(4): p. 315-33.
Cohen, S.P., Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc, 2015. 90(2): p. 284-99.
Peterson, C., J. Bolton, and B.K. Humphreys, Predictors of outcome in neck pain patients undergoing chiropractic care: comparison of acute and chronic patients. Chiropr Man Therap, 2012. 20(1): p. 27.