Confused with these patients...

Case 1: Female patient approx 22 years old. Active and in good health (plays soccer). Presented about a month ago with apparent hip flexor tendonitis. Upon treatment (soft tissue manipulation followed with ice and occasional IFC) patient experienced increased pain. Pain has been unresolved for 2 weeks. Pain mostly present with weight bearing during step in gait. Patient finds relieft with hip flexor stretch and groin stretch but very difficult because if taken into too much range, pain is experienced.

SIJ is negative. No LBP. No hernia...any other ideas of what may be causing this pain and how to treat??

Case 2: Female 22 year old post arthroscopy of knee post medial meniscus injury. Patient was completing therapy well and advancing steadily and attempting to challenge weight bearing activities to return to functional level (ie light running, cross trainer etc). Was progressing well until experienced an episode of strep throat. Was in bed for a day and experienced increased knee pain that day and for the last 2 weeks. Throat infection is unresolved and she has started a new course of antibiotics. Knee since first throat infection (it's been 2-3 weeks now) has been minimally swollen, range of motion has not decreased but function has and pain has increased well above what is was previously. At this time, patient prefers only ultrasound and has been refered back to her doctor. I am very confused as to what has happened since nothing other than the throat infection seems to have interfered with recovery. Could this somehow be related?

Case 3: 62 year old woman who experienced shingles 2 years ago. Since has experienced LBP "discomfort" and complains of burning sensation in low back (not really pain). 6 months ago, patient was diagnosed with RA and has been on meds since to control progress. LBP is pretty regular and patient experiences "Cracking" while moving into flexion. Burn occasionally present with prolonged standing/sitting. Any ideas what could be causing this "Burn"??

Thanks so much for brainstorming everyone! :)

Thanks!

My reply may not be of great use but would like to do some brainstorming at the very least...

Case1:
I'm making an assumption that she has pain and/or weakness with hip flexion....what are the results of the rest (ROM, muscle testing...)?
When she gets the pain during stepping, is it anterior hip pain? Is it any worse (or better for that matter) during running or quick stop / start in soccer?
Does she get any clicking / popping in the hip?

Case 2:
Could it be that she just had her leg in a sustained position for too long while in bed that day and just flared everything up? (i.e. either sustained extension if lying on her back / sustained valgus position if she as on her side)
Probably not that simple but just a thought.....

Case 3:
Has the burning gotten any worse in that last 6 months or is the same discomfort she's had for 2 years? Is it a fairly diffuse area across the low back or can it be localized? Can you reproduce the burning with any testing? What are the results from your assessment?
Is the burning a "nervey" / "zingy" kind of burning? Or is it more like a muscle fatigue kind of burning? (I know that may be tough since it's not your pain...)

re: patient no.1 22 yo soccer player.... insidious onset or sudden from an event? have you checked adductor tendons and tested for osteitis pubis or derivatives thereof? is hip quadrant test negative (full compression + flexion + adduction through ROM) which will test the integrity of the joint itself. What is player's core strength like (ie. is she reliant on iliopsoas and power muscles for pelvic girdle stability rather than TA and core and especially glut med.)? is the pelvic list/tilt/rotation equal on step length between the legs. also what would you expect to achieve with interferential other than masking pain? one other thing, clear the knee as anterior hip pain can be and up-referral from the knee, and ensure ITB/TFL is not contributing to poor biomechanics.

Re: Case 2: a generalised inflammatory condition or acute infection such as strep throat will increase global inflammatory markers and inhibit healing tissues. once the throat infection is sorted the knee should come good again.

re: case 3: is the pain the same as shingles pain and in the same location? this can be ongoing for many years post acute infection of shingles. if not shingles pain then do full Lx assessment as you would for a degenerated disc/ OA spine etc. as the LBP may not necessarily be directly related to the shingles. full list of aggs/eases, treatment to date, pain type: intensity, duration , severity, irritablilty, physical Ax. If you're really stuck, diagnose by elimination: define your list of potential issues in order of priority then treat one thing only per session with only one modality/method and reassess.

good luck :)