Bullet-Proof Exam Process, Bowel Obstruction, Nerve Traction: The FARM Week in Review
Week in Review: Exam Mastery, Bowel Obstruction Red Flags, and Fibular Nerve Injuries in Elite Athletes
In this Week in Review episode, The FARM clinical team dives into three seemingly disparate but clinically significant topics: refining the physical exam process, identifying signs of bowel obstruction, and diagnosing fibular nerve injuries in elite athletes. As always, the conversation blends case-based learning with big-picture takeaways to elevate clinical reasoning and encourage a systems-based approach to musculoskeletal and functional health.
The discussion opens with an audit of clinical examination fundamentals. The team reflects on how easy it is, even for experienced clinicians, to drift from a structured exam process. They revisit the importance of intentional sequencing—starting with observation, layering in functional movement, palpation, and then targeted orthopedic or neuro tests. The clinicians challenge listeners to see the exam not as a checklist, but as an evolving dialogue with the patient’s body. The takeaway: great clinicians don’t just gather data—they synthesize it in real time to guide better outcomes.
From there, the conversation takes an unexpected but important turn into the visceral domain. A recent case involved vague abdominal pain that had previously been chalked up to IBS or muscular referral. However, subtle changes in bowel pattern and palpable distention triggered a deeper look—eventually leading to the discovery of a partial bowel obstruction. This part of the discussion is a reminder that musculoskeletal clinicians must be fluent in visceral red flags. The FARM team shares practical signs to watch for—changes in bowel habits, unexplained bloating, pain that’s positional but doesn’t behave like MSK tissue, and systemic symptoms like night sweats or unexplained fatigue. As they point out, it’s not about memorizing every red flag—it’s about staying curious and expanding your differential when things don’t add up.
The episode wraps with a fascinating look at fibular (peroneal) nerve injuries, especially in elite-level runners and field athletes. The crew walks through a recent case involving a high-level athlete who presented with subtle foot drop and lateral calf atrophy that had been missed in previous assessments. What seemed like a basic lateral ankle complaint turned out to be a high fibular nerve compression at the fibular head. The discussion underscores how biomechanics, footwear, previous ankle sprains, and even deep squatting postures can create chronic tension or irritation around the nerve. The clinicians stress the value of combining neurodynamic testing with palpation and gait analysis to catch early signs before they cascade into performance loss or permanent nerve damage.
Throughout the episode, the theme is consistent: great clinical care demands both depth and flexibility. Whether you're refining your physical exam, expanding your awareness of visceral red flags, or diving deeper into neuro-musculoskeletal junctions, it’s the willingness to investigate beyond the obvious that sets expert clinicians apart.
This episode is a call to action for movement-minded providers—don’t settle for treating the diagnosis, treat the story. Every symptom has a context, and every exam is an opportunity to uncover what others miss.
