I have been keeping a diary of treatment on a patient in Twickeham and thought I would share it with the City crowd, so here goes!
This starts with a long and painful history!
Duncan was a regular runner, but, in 2005 he created the perfect storm for a running injury. With no training until a week before a half marathon and no pre-race warm up, understandably, he quickly felt his calves tighten, which then became pain, but, instead of stopping, he pushed through and finished the race.
After resting for a week, he experienced severe pain in the shin area when running, which was diagnosed as a stress fracture in both tibia (shins). This marked the start of a long and varied period of tests and treatment between 2005 and 2008, including 2 podiatrists, 2 sets of orthotics and an Osteopath who told him to dump the orthotics. Thankfully the Osteo treatment worked and from 2008 to 2011, Duncan manged to complete 3 Olympic length triathlons, no mean feat! However, after a 6 week lay off, pain returned with a vengeance, this time in his right calf. Between 2011-13 he saw 2 physios, a sports injury specialist, had an MRI and gait analysis, was diagnosed with hypermobility of the ankles, weak gluts and a weak soleaus (the deep muscle of the calf). Strengthening exercises were prescribed and he went for regular sports massages, however, he still was unable to run for more than 10 mins.
When I examined Duncan, he had pronounced flat feet, however, that is his norm. The ankle was very mobile in side to side movement, but front and back movement was very restricted. The lateral head of the right gastrocnemius (the superficial calf muscle) was chronically contracted, possibly with scar tissue, hamstrings were extremely tight as was the tibialis anterior (muscle next to the shin bone). On watching his gait, he over supinated his right foot when walking, which seems to be a habitual thing rather than due to muscle imbalances, but, I suspect could also be related to the limitation in the forward/backward movement of his ankle.
So, during the first treatment, I worked on the tibialis anterior, hamstrings and the calf, using deep soft tissue massage (which cause a lot of groans of pain) and dry needling. I then articulated his solid ankle (which cause lots of groans of exertion from myself!). I applied Kinesio tape to the gastrocnemius to relax the lateral muscle spasm, prescribed hamstring stretches and to start a gentle intermittent running programme.
Next week, we shall see what changes have taken place……Share