When assessing a movement dysfunction, many people will dive into the site of pain to try and bring relief. If an area hurts they will massage it, stretch it or strengthen it to try and bring relief. This is great for short term relief, but to bring lasting change we need to understand how the problem came to be there in the first place.
A runner presented with chronic Achilles Pain and tightness on both sides. Our client was Female and mid 40s. On assessment we found the Soleus and Gastrocnemius muscles to be Hypertonic, or having an inability to relax. Hypertonic muscles will not respond to relaxation techniques because the Hypertonicity, or high tone, is driven by the brain in order to reduce a dysfunction.
So rather than go straight to the calves we looked around for movements associated with ankle extension during gait.
Knee extension was normal but Hip Extension was weak, or inhibited, or both sides.
When we used an Anti Stim technique to temporarily reduce dysfunction in the hips, the ankles became normal and relaxed. This tells us that the hip dysfunction is a higher priority than the ankle dysfunction.
Now we knew that the hip dysfunction was our focus, we searched for what type of dysfunction it may be.
Is it a muscle issue?
Is it a ligament?
Is it a nociceptor, or danger, issue?
We found a small nociceptive dysfunction on a small point around the Lumbosacral Junction. On closer inspection we found this to be an injection site. By looking at the clients history we worked out that this was the site of an Epidural Injection, which had been administered during the birth of her first child.
Nocieption is the sensory nervous system's response to harmful stimulus. It reports to the brain via the Spinothalamic Tract, that harm is occurring and then the body initiates a reaction. In this case, when the client was stimulating the area around the Lumbosacral junction by creating hip extension, the body was sensing this activity as dangerous and then preventing strength from being applied to the action.
We found that if we were to correct this dysfunction, we would normalise hip extension and normalise ankle extension.
The hypertonic or "overactive" ankle extension is only an adaptation to the original issue.
Using the PDTR protocol, we applied treatment to the Injection Site and then rechecked the other areas and found vast improvement in strength, muscle and tone and range of motion. The client also exhibited improved hip extension mechanics on her running assessment.
As homework the client will have to continue to strengthen hip extension whilst maintaining a stable pelvis.
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