Exploring Pain Science: Low Back Pain, Radiculopathy, and 'Gymnast Wrist'
On this episode of Week in Review, The FARM clinical team dives into three distinctly different, yet incredibly insightful cases that showcase the blend of art and science we strive to bring to every patient encounter. From navigating the layered reality of chronic low back pain to diagnosing overuse injuries in young athletes and uncovering less obvious sources of upper extremity symptoms, this episode is a powerful look into the diagnostic process, critical thinking, and movement-based rehab strategies that define The FARM approach.
We begin with a classic example of pain neuroscience in action. The patient presents with chronic low back pain, but the tissue damage narrative doesn’t hold up under scrutiny. Imaging was clean, no red flags, and provocative orthopedic testing yielded inconsistent results. What stood out instead were the patient’s beliefs, fear-avoidance behaviors, and a decade-long history of escalating interventions—from MRIs to injections—without lasting relief. This was a case where the nervous system, not the tissues, was driving the pain experience. We discuss the critical importance of educating patients on the difference between pain and injury, using graded exposure through movement, and creating a therapeutic alliance that focuses on function over fear. It’s a reminder that sometimes the most powerful tool we have isn’t a modality—it’s communication.
Next up, we shift to a young gymnast presenting with wrist pain—a textbook case of gymnast wrist. This overuse condition, technically known as distal radial epiphysitis, is a common presentation in pediatric athletes involved in high-impact, weight-bearing sports on the upper limbs. We walk through the biomechanics that contribute to this injury, from repetitive dorsiflexion under load to poor scapular control that shifts forces distally. While imaging confirmed the diagnosis, our team emphasizes how movement screening and load management—not rest alone—are key to recovery and long-term injury prevention. Dr. Sloan Beard highlights specific strength and neuromuscular control drills for the scapular stabilizers and wrist extensors that serve both rehab and performance ends.
Finally, we break down a stealthy case of cervical spine radiculopathy that initially presented as medial scapular pain and tingling in the forearm. The patient's symptoms had been attributed to a “rhomboid strain” and later “carpal tunnel,” but careful assessment revealed a positive Spurling’s test and weakness in wrist extension—a clear sign of C6/C7 root involvement. This case was a strong reminder of how easily radiculopathies can fly under the radar when they masquerade as local soft tissue complaints. We discuss how dermatomal and myotomal testing, coupled with functional movement screening and spinal loading patterns, can quickly differentiate the source and direct treatment.
This episode encapsulates the diversity and depth of clinical reasoning needed to navigate today’s musculoskeletal landscape. Whether it’s pain driven by the nervous system, overuse syndromes in youth athletes, or sneaky neurogenic symptoms, the key lies in looking beyond the surface, treating the individual, and trusting the process. Tune in to learn how we apply principles—not protocols—in our patient care at The FARM.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3325636/
