lower leg problem, need ideas

[Greybeard]

your thoughts please

just treated a distance runner for the second time this week. Complaining of calf problems and is saying he was unable to run, has had the problem for over 2 months maybe 3??

He couldn't describe the pain, but no shooting, burning, or sharp pains. Painful going up and down stair, but ok walking, cycling.

Soleus was positive pain on testing, Gastrocnemius was neg. Treated Soleus and sent client on his way very happen, saying it felt much better, he ran to work the next day, 5 miles, and all was fine no probs, he said he felt he was running better and quicker. When he tried to run home at the end of the day, he was unable as the calf had tightened up, he couldn't run on it at all. He has done a 15+ mile bike ride today with no probs.

I saw him today for an other treatment, Soleus felt a little tight but nothing like before, and softened up quickly with massage.

Here is my question/problem. Palpating along his tib i could feel a bump about a quarter of the way down, it was very hard and very painful to the client even with a gentle touch. Checked other leg small bump is there also but not as big and not painful at all. I am wondering f his problem and pain is stemming from this bump/lump. its around the origin of the Flex Dig Longus but slightly more medial

any ideas

 

[efzeplzl]

nobody have any ideas nobody?????

 

[Colofooniah]

Hi, I am having trouble with my own injury at the moment, on seeing a doctor who had a feel around the leg within this area I have a small but hard lump that was uncomfortable on touch, it isn't necessarily where my injury is as it is lower. However, the doc did say that this 'lump' was supposed to be there (sorry at the vagueness I have a complete blank on what he said it was but something along the lines of nerves etc), I can feel it on both legs but my injured leg it is more painful.

In terms of your guy this could be inflamed or uncomfortable due to injury but this may not necessarily be the 'epi centre'.

Another thought I had from what you have explained is shin splints - (again...I apologise for what may seem very vague but I still have holiday brain) I know from my own personal injury experience this has led to deep calf issues at times.

Not sure if this is much help but thought I would add some thoughts.

 

[lktahmsa]

Are you seeking a possible cause of the symptoms or a possible cause of the problem ?

Sorry but it is almost impossible to give useful input with this sort of info
A painful "bump" could be anything from
calcification (from chronic / untreated tenoperiostitis / #)
scar tissue or
(probably most likely from your symptoms) adipose tissue which can be extremely painful to the touch when inflammed and in close proximity to bone

is pain localised (ie : does he indicate where it is by a) pointing or b) rubbing area concerned)?

list of possible causes is almost endless and could only be short listed with face to face consultation with client since each answer they give will inevitably end up with tangental questions (although gimmie's would of course be overload / recent changes)


sorry to be of next to no help (which is why I haven't replied sooner)

Just wanted you to know you are not being ignored

 

[bon-gart]

Hi Richard

I would assess and treat the affected leg for biomechanical failure in the foot/ankle scar tissue/knee probs. I have found the foot is most likely cause.

What you are palpating on the tib is chronic inflamation of the muscle attachment ( in some people it's the start of ossification !!)

V carefully and gently work along all the medial border of the tib gradually increasing the pressure. To avoid over treating interspace treatment by working elsewhere.

Release chronic inflamation/hypertonic muscle attachment with compression, ice after treatment and ask client to rest for 48hrs.

The nature of this type of pain is very intense and worrying for the client, a confident calming approach is essential.

Regards steve

 

[naik A.B.]

Hi Beagle,

I would agree with what Steve has said, and i would approach it in a similiar way.

When his treatment and rehabilitation is complete, perhaps checking his gait, also his running shoes too.
It is amazing how many runners run in shoes which should have been binned long time ago.

 

[wnvczoqr]

most thanks to all, have treated client as steve said (before i had his reply by the way) but sound advice it was. the problem i believe is coming from the foot.

but as has been said there is an endless list so any more suggestions could help others looking at the same problems,

just spoken to client after two week and he has said it has improved since my treatment

plus i feel a lot better after being on holiday for two week, bonus its the best therapy

 

[Mike Windsor]

I'm interested in the clinical reasoning behind icing a chronic injury- does anyone know of any recent findings that support this method? Thing is, I did some very recent training with a well respected sports therapist/physio/acupuncturist that suggested heat for chronic problems, and icing only on acute ones (upto 36 hours after initial injury).

This fits my classical acupuncture training, that views "cold" as pathogenic, slowing blood supply and stiffening tissues. Chronic inflammation is viewed as "stagnation", for which the standard programme would be to warm and massage the area, followed with acupuncture to promote healing and pain relief. I use this method in my own clinic, with great results.

Any ideas?

 

[starrcod]

Chronic injury can be painful, Ice is analgesic, sometimes we need to "break the cycle" of learned behaviour. As pain is a form of learned behaviour, to break the cycle I would sometimes use Ice. However in general terms I use heat on a chrinic injury.

just one persons opinion
regards BGFL

 

[tracky]

imho
I would normally only ice an injury in the chronic stage following a treatment which involved soft tissue mobilisation techniques (eg frictions. str/ myofr , ct) since these normally elicit an inflammatory response

doesnt ice slow metabolism (and therefore healing)? ....discuss