JJMMEDIC:::::::::::::::::::::
Got Pain?
What’s the
Diagnosis and
What to Do
W
words: Dr. john park
| illustrations: dave palacios
e all know that any serious
injury or painful condition
should be examined by a
healthcare professional.
However, since it is not always
possible to see a doctor right away, this guide will help
you get a better understanding of what might be going
on after an injury. The following tests are designed to
be performed by a healthcare professional, however,
they have been modified to be performed by you or
with the assistance of a training partner. In every case
mentioned hereafter, a fracture is always one of
the differential diagnoses following trauma,
however, it will be excluded from the lists.
This guide is not a substitute for an examination
done by a licensed healthcare provider. A visit
to the doctor or a trip to the emergency room is
always recommended whenever possible.
Neck Pain
01
Neck pain
without trauma:
neck pain in the
absence of trauma can be the
result of osteoarthritis, disc
degeneration or muscular
strain from overuse.
What to do: reduce
activities, try massaging
therapy, seeing a
chiropractor, and using
NSAIDs (Advil, Motrin,
etc.) as needed. X-rays
may be necessary to rule
out other conditions.
02
Neck pain with
trauma: neck pain
resulting from an injury
can be due to a ligamentous
sprain, muscle spasm, or disc
bulge/herniation causing a
pinched nerve
000
www.jiujitsumag.com
Tests
Maximum foraminal encroachment
test: extend head and neck all the way back and
rotate to both sides. Have someone press downwards
on the head from each position. If pain increases in
neck and there is pain referring down the arm or
shoulder blade, or there is increased tingling and
numbness in the hand or fingers, you most likely
have a pinched nerve in the neck resulting from a disc
bulge or herniation.
maximum foraminal
encroachment test
Shoulder depression test: from the seated
position, bend the neck sideways down towards one
shoulder. If pain is present on the opposite side, a
ligament sprain or muscle strain may be present. If
pain is present on the same side with pain, numbness
or tingling going into the shoulder blade, arm, or
hand, a pinched nerve may be present.
What to do: stop activity immediately and see
a doctor. If decreased activity does not improve
symptoms, an MRI may be necessary to determine
if a herniated or bulging disc is present.
shoulder depression test
This is the side bar quote thingy. Text can go here.
Shoulder Pain
01
Shoulder pain
in the absence
of trauma: pain
without injury suggests a
chronic condition such as
tendinitis. Most likely diagnosis
is a Rotator Cuff Impingement
Syndrome.
1
Tests
Shoulder Impingement
Tests: 1. Reach upwards
with the affected side arm fully
extended. Pain in the front of
the shoulder with limited range
of motion is a positive finding.
2. Reach across the body with
the affected arm, bend the
elbow 90 degrees, and rotate
shoulder impingement test
02
Shoulder pain after
trauma: pain and weakness
after an injury can indicate a torn
rotator cuff muscle or cartilage damage.
Shoulder dislocations and separated
shoulders are also possible injuries.
arm down towards the floor.
If pain is reproduced in front
of the shoulder, there is most
likely a biceps or supraspinatus
tendinitis.
What to do: avoid
repetitive overhead
activities, strengthen rotator
cuff muscles, especially the
teres minor/infraspinatus,
and stretch pectoralis
muscles. Retrain muscles so
there is no internal rotation
and forward rolling of the
shoulders. Try physical
therapy if pain persists.
2
empty the can test
Tests
Empty the can test:
Straighten the affected arm with the
thumb pointed down. If you are
unable to lift the arm up from that
position or have to cheat by using the
upper back and shoulder muscle, you
most likely have a rotator cuff tear.
This is the side bar quote thingy. Text can go here.
A
B
May 2013
000
JJMMEDIC::::::::::::::::::::
crank test
Crank test: Lay flat on your back
with affected arm bent. Slide the arm above
your head and have someone rotate the arm
internally and externally while applying
pressure towards the shoulder joint. Sharp
pain with catching and/or locking suggests
a labral (cartilage) tear.
Sulcus sign test: Sitting up,
have someone pull downward on the
affected arm holding at the elbow. If
there is excessive movement downward,
and a “step defect” appears on the top
of the shoulder, a shoulder separation
is the most likely diagnosis.
What to do: activity should be
discontinued, immediately followed
by examination by a doctor. Serious
shoulder injuries, including full
thickness rotator cuff tears, significant
labral tears or ligamentous damage
may need to be managed surgically.
MRI will be necessary to see what
structures are damaged.
sulcus sign test
JJMMEDIC::::::::::::::::::::
back Pain
01
Back pain without trauma:
back pain without injury is most
likely the result of muscular strain,
osteoarthritis, disc degeneration, or
excessive wearing of the joints.
What to do: chronic lower back
pain can be effectively managed with
exercises and a stretching program.
Physical therapy, chiropractic
treatments and massage are also
effective ways to treat non-traumatic
back pain. X-rays can be useful to help
determine the cause of back pain and
general condition of the spine.
02
Back pain resulting from
trauma: sharp lower back pain
with pain radiating into the hips, or
back pain with sciatica (pain radiating down
the back of the thigh and leg) is often the
result of a bulging or herniated disc.
Tests
Straight leg raise: lay flat on
your back with both legs straightened out.
Have someone lift one leg slowly. If pain is
present in the lower back, with increased
pain referring into the hip, thigh, or leg,
it can be indicative of a disc pressing on a
nerve root. Increased tingling, numbness,
or a burning sensation in the legs or feet are
also positive findings.
Standing Kemp’s Test
Standing Kemp’s test: from the
standing position, lean backwards, and
rotate to one side followed by the other. If
there is only lower back pain present, there
may be an injury to the facet joints in the
spine. If lower back pain is present, along
with pain referring into the hips and thighs,
or there is sciatica, tingling, and numbness
in the lower extremity, a disc bulge or
herniation may be present.
What to do: vigorous physical
activity should be stopped immediately.
An MRI can be performed to visualize
the discs and whether or not there is
a pinched nerve. Prolonged sitting
should also be avoided, since most
disc injuries are made worse with
seated postures. Frequent breaks
from sitting and short walks, as
tolerated, can be beneficial.
Straight leg raise
000
www.jiujitsumag.com
This is the side bar quote thingy. Text can go here.
JJMMEDIC::::::::::::::::::::
knee Pain
01
Knee pain without injury is most likely from
osteoarthritis and gradual wearing away
of the cartilage. Improper tracking of the
kneecap can also cause chronic knee pain.
squat test
What to do: X-rays can provide good
information about joint health in the knees.
Cross training along with exercises to
strengthen the vastus medialis oblique muscle
can help stabilize the knee. Bracing and
Kinesiotaping can also be beneficial to help
manage chronic knee pain.
02
Knee pain following trauma: damage to the
cartilage that cushions the knee joint and
ligaments that stabilize the knee are common
following acute traumas
Tests
Squat test: stand with the feet shoulder width
apart and attempt to squat down slowly. If there is
sharp pain with clicking or locking and inability to
apply full pressure on the affected side, there may be
a meniscus tear present.
anterior drawer test
Anterior drawer test: lay flat on your back
with your hip and knee flexed. Have someone pull
on the leg away from you, towards them keeping the
knee in a flexed position. If there is excessive forward
translation of the leg, an ACL injury may be present.
Valgus stress test: with the affected knee
slightly flexed an examiner should press on the
outside of the affected knee inwards while pulling
the lower leg outwards. Pain with excessive flaring
of the leg is a positive finding indicating a possible
MCL sprain.
Varus stress test: with the injured knee
slightly flexed an examiner should press on the inside
of the knee outward, while applying pressure on the
lower leg from the outside inward. Pain on the outside
of the knee, with excessive gapping in the knee joint, is
a positive finding for a possible LCL sprain.
valgus stress test
varus stress test
What to do: activity should be stopped
following any serious injury that limits
range of motion or feels unstable. An
MRI should be performed after physical
examination by a doctor to rule out any
tears that may need surgery.
000
www.jiujitsumag.com
This is the side bar quote thingy. Text can go here.