Shoulder Case Study and Gymnast Symptoms: A Week in Review
Week in Review: Shoulders, Gymnastics, and the Power of Clinical Fundamentals
In this week’s episode of The FARM: Week in Review, the team dives into three complex yet enlightening clinical cases that highlight the power of objective thinking, clear communication, and sticking to foundational principles in musculoskeletal care. From the psychological weight of surgical conviction to the biomechanical nuance of gymnastics and the diagnostic clarity offered by McKenzie-based evaluation, this episode is a case study in how good clinicians navigate uncertainty with precision and empathy.
Case One: The Shoulder and the Surgical Mindset
The episode opens with a common yet difficult scenario: a patient presenting with shoulder pain who is already convinced they need surgery. Despite relatively minimal findings on exam and imaging, the patient is psychologically anchored to the idea that something inside is “torn” or “damaged beyond repair.” The FARM team walks through how they delicately unspooled this belief using clear communication, functional assessments, and progressive loading strategies. This case reminds clinicians that clinical care often begins not with the body, but with the mind. Reframing the patient’s understanding of pain and guiding them toward active solutions—not passive surgeries—was central to this case's success.
Case Two: Gymnastics and Unusual Bilateral Symptoms
Next, the team discusses a gymnast experiencing strange bilateral lower extremity symptoms that didn’t fit a textbook diagnosis. The case was layered with red flags, possible central sensitization, and questions about neural tension versus mechanical overuse. What stood out was The FARM’s approach: they didn’t rush to conclusions or over-image; instead, they slowed down, looked at movement patterns, and considered the unique demands of the athlete’s sport. They also integrated insights from Dr. Sloan Beard’s deep expertise in gymnastics care, ensuring every piece of the rehab plan was specific to the athlete’s functional context. The key takeaway here: when symptoms are weird, you don’t get weird—you get systematic.
Case Three: The Classic Hip Derangement and the Return of MDT
The final case involved a straightforward yet powerful reminder of how effective the McKenzie Method (MDT) can be when applied with precision. A patient presented with what seemed like a complex hip pathology, but directional preference testing revealed a clear derangement pattern. With careful repeated movement testing, a tailored home exercise strategy, and ongoing audit of progress, the patient made rapid gains without any passive interventions. In a world that often chases high-tech tools or complex imaging, this case was a tribute to the timelessness of a good assessment.
Clinical Threads and Big-Picture Thinking
Throughout the episode, the team weaves in big-picture commentary on modern healthcare: the tendency to over-medicalize pain, the need to build trust in clinical relationships, and the value of returning to fundamentals. Whether treating elite athletes or everyday patients, the same principles apply—listen deeply, assess clearly, and empower patients to participate in their recovery.
This episode is a reminder that excellent care isn't always flashy—it’s consistent, curious, and rooted in human connection.
