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| http://trialx.com/g/Calf_Pain-1.jpg |
The athlete complained of chronic pain at the
musculotendinous junction of the Achilles tendon that had been recurrent at the
beginning of track season the previous two years. The athlete had a previous
history of turf-toe like symptoms in the ipsilateral great toe.
The athlete first discussed her pain with me because she had
been doing gastrocnemius/soleus stretching/strengthening with another clinician
for the previous 4 weeks with no improvement in symptoms. She was apprehensive
about her progression because the national meet was soon approaching.
I did an assessment of the athlete and found her to have adequate
ROM of the great toe, ankle dorsiflexion and she had full strength of her
gastroc/soleus. I then continued my evaluation up the kinetic chain and
assessed her gait. I discovered significant glute inhibition of the ipsilateral
leg especially compared to the contralateral leg. This was very noticeable in a
single-leg bridge position. With the patient prone and actively performing hip
extension she had overactivity of the hamstring and paraspinal muscles with
poor glute activation again.
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| http://physicaltherapy.about.com/od/strengtheningexercises/ss/Advanced-Hip-Strength-Exercises_2.htm |
I then explained to the athlete that I thought her problems
with her lower leg and toe stemmed from the inhibition of her gluteus maximus. My
reasoning that I gave to her was that if she had diminished contribution to
propelling herself forward to run that she would have to make up for it with over activity of another muscle group. To finish this consultation I gave the
athlete a home exercise program that focused on basic glute max activation
exercises. Many of these exercises were basic bridges with different variations
as well as some single-leg deadlift exercises. I also discussed mental cues for
running and instructed her to cue hip extension and toe-off as a cue during
gait.
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| http://www.runnerscorner.com/images/kenyans.jpg Got Hip Extension? |
The athlete followed up with me about two weeks later and
noted significant improvement in her symptoms and rechecking her single leg
bridge showed much improvement. The athlete went on to win a national championship
in her event at indoor nationals and has set several PRs for herself since
then.
The athlete has been very compliant and has continued her exercises
at home and her symptoms have not returned since. She is currently preparing for her outdoor
national championship meet without any issues.
This case study highlights the need to stop chasing pain and
to stop treating the sight of the symptoms. You HAVE to treat the dysfunction
and not their symptoms. This was an often vocalized and instructed concept but
it is still something that some clinicians seem to struggle with. I don’t think
it is something that clinicians do on purpose but I feel that a lot of
clinicians are great at evaluating the symptoms of an injury but don’t know how
or where to look for the dysfunction. There are exceptions to this with certain
injuries like a contusion or bruise for instance. I am not against treating the
symptoms to alleviate the pain but you have to go above and beyond that to
actually fix the root of the problem.
This Weekend:
Later this week I will be doing a video interview with Dr. Erson Religioso III, DPT, FAAOMPT of www.themanualtherapist.com, and I will upload it here for all to see! Check back this weekend to see it firsthand!
This Weekend:
Later this week I will be doing a video interview with Dr. Erson Religioso III, DPT, FAAOMPT of www.themanualtherapist.com, and I will upload it here for all to see! Check back this weekend to see it firsthand!
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