lower leg problem, need ideas

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Greybeard

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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
 
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.
 
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
 
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
 
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.
 
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
 
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?
 
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
 
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
 
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    GOLDEN FS โ€“ 8380 Kennedy Rd ๐Ÿ“ž 905-258-0777 / 416-688-6886 ๐Ÿ‡ป๐Ÿ‡ณ AMY, ๐Ÿ‡ป๐Ÿ‡ณ JULIE, ๐Ÿ‡ญ๐Ÿ‡ฐ JOJO (9PMโ€“2AM), ๐Ÿ‡ธ๐Ÿ‡ฌ CANDY, ๐Ÿ‡จ๐Ÿ‡ด MEGAN ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookinggoldenlove
  38. FLOWER Spa - BLUEXADO | Thornhill | VAUGHAN:
    BLUEXADO FS โ€“ #06-1102 Centre St ๐Ÿ“ž 416-357-9797 / 416-678-8668 ๐Ÿ‡ต๐Ÿ‡ญ๐Ÿ‡ป๐Ÿ‡ณ LUXY, ๐Ÿ‡ป๐Ÿ‡ณ๐Ÿ‡ญ๐Ÿ‡ฐ CICI, ๐Ÿ‡ป๐Ÿ‡ณ SHERRY ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookingbluexadolove
  39. FLOWER Spa โ€“ PINK | Scarborough | TORONTO:
    PINK FS โ€“ 3300 McNicoll Ave ๐Ÿ“ž 416-299-5515 / 416-817-3839 ๐Ÿ‡ฎ๐Ÿ‡ท ELINA (Iran), ๐Ÿ‡ญ๐Ÿ‡บ VANESSA (Hungary), ๐Ÿ‡ญ๐Ÿ‡ฐ JOJO (Hong Kong), ๐Ÿ‡จ๐Ÿ‡ด MEGAN (Colombia) ๐Ÿ”Ž View Schedule: bit.ly/flowers_schedule ๐Ÿ›Ž๏ธ Booking Now: bit.ly/bookingpinklove
  40. Annie Spa:
    ๐ŸŽ‰๐Ÿ’ANNIE SPA๐ŸŽ‰๐Ÿ’ โœ…7-1001 SANDHURST CIRCLEโœ… ๐Ÿ‘ŒSCARBOROUGH ON M1V 1Z6๐Ÿ‘Œ โ˜Ž๏ธ (647) 891-9688โ˜Ž๏ธ โ˜Ž๏ธ (416) 291-8879โ˜Ž๏ธ (FINCH & MCCOWAN) OPEN 9:30am to 9pm MONDAY to SUNDAY ๐Ÿ”ฅโœ…NEW MANAGEMENT๐Ÿ’ฏNEW GIRLS๐Ÿ”ฅ๐Ÿ”ฅ ๐Ÿ”ฅGORGEOUS NEW YOUNG ASIAN GIRLS - TODAYโ€™s ROSTER INCLUDES: ๐Ÿ”ฅ Feifei๐Ÿ˜˜Our new Japanese beauty Feifei specializes in creating an intimate and deeply relaxing massage experience tailored to your desires. Her soft, skilled hands glide effortlessly, easing tension and awakening your senses
  41. AliceSpa:
    WEDNESDAY at ๐—”๐—Ÿ๐—œ๐—–๐—˜ ๐—ฆ๐—ฃ๐—” 416-298-0898, 4915 Steeles Ave. E, Scarborough 3 very nice girls here today. Open 10am to 9pm: APPLE (11am-9pm): from Hong Kong, very small body, 5' 100Lbs, petite with natural C Cups, small waist, pretty baby face, smooth skin, very clean. Shaved tight Pu**y, strong professional massage. Available FS bbbj cim cof rim. CLOUDIA (10am-9pm): is Vietnamese, young
  42. HolidaySpa:
    Wednesday at ๐ŸŒด๐Ÿ˜Ž๐ŸŒ…๐“—๐“ธ๐“ต๐“ฒ๐“ญ๐“ช๐”‚ ๐“ข๐“น๐“ช๐ŸŒ…๐Ÿ˜Ž๐ŸŒด3517 Kennedy Rd, Unit 4, Scarborough โ˜Ž๏ธ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฎ๐Ÿฐ๐Ÿณ-๐Ÿญ๐Ÿญ๐Ÿต๐Ÿตโ˜Ž๏ธ: FIONA, KIKI & CINDY. FIONA is a slim hottie with long dark hair, great melons and ass, and nice services. Kiki is very attractive, young, about 5โ€™4โ€ and 110 Lbs., slim with a banging body. Kiki is very popular for her great attitude and services. CINDY is slim & incredibly sexy
  43. SugarLoveSpa:
    Wednesday at โค๏ธ๐Ÿ’™ ๐Ÿ’œโŽ๐—ฆ๐—จ๐—š๐—”๐—ฅ ๐—Ÿ๐—ข๐—ฉ๐—˜ ๐—ฆ๐—ฃ๐—”โŽ ๐Ÿ’–๐Ÿ’—๐Ÿ’˜: ELLA, NANCY, SUSAN & TIFFANY. 1270 Finch Ave W (at Keele St), Unit 18. North York, ON โ˜Ž ๐Ÿฐ๐Ÿฏ๐Ÿณ-๐Ÿฏ๐Ÿฒ๐Ÿฑ-๐Ÿฎ๐Ÿฒ๐Ÿด๐Ÿด โ˜Ž ELLA is a lovely Thai sweetheart, 5โ€™1โ€ with C Cups, smooth skin and a very pleasing attitude. NANCY is a curvy and very friendly Spanish girl, who has all the versatile skills you need. SUSAN is a small, slim & sexy Latina girl
  44. bnwellness_wilson:
    We have 4 young girls are working today, young sweet Mia 25โ€™s with curve body and sexy Coco, pretty Ella and flirty GFE Lina are providing deep tissue massage, pls call 4163985777 book appointment and walk in always welcome,back entrance and parking available, 350 Wilson Ave North York
  45. luckywellness:
    Lucky Wellness Center 4379721888 295 Eglinton Ave E,Unit 7,Mississauga We had two girls working today. Niko and Kiki. They are both young, pretty and cute. The massage and back walking were very good.
  46. Lulu1980:
    Phoenix Blossom Spa ๐ŸŒน๐ŸŒน๐ŸŒน2 girls ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ5124 Dundas St W Etobicokeโ˜Ž๏ธ416-817-3366๐Ÿ‘ Table Shower Sea Salt Bath Body Scrub๐Ÿ˜˜ Japanese girl Nina โค๏ธ Natural Big Boobs 38 DD ๐Ÿ˜˜Pink Mini Nipples Hot body slide, super enjoyable๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜ very provocative service๐Ÿ˜˜๐Ÿ˜˜๐Ÿ˜˜, professional super Luna deep tissue massage, has therapeutic effect to loosen bones and relieve muscle pressure and will bring you unexpected service effects, she will bring you a little surprise๐Ÿ˜๐Ÿ˜๐Ÿ˜๐Ÿ˜โค๏ธYou are welcome to make an appoint
  47. Lulu_Villa_Spa:
    Sami is a gorgeous model type Vietnamese Girl Aiko Mixed Chinese/Japanese Girl Sasa friendly Vietnamese girl Bella She is Mexican Gorgeous face Natalie she is CBC/filipina mixed Petite girl โ˜Ž๏ธ647- 446-0886
  48. DareDevil:
    Blackpink Wellness โ™ฅ๏ธโ™ฅ๏ธ90 Marycroft Ave. Unit #2, Vaughan, ๐Ÿญ๐ŸฌON L4L 5Y1 (647) 395-3188. BEAUTIFUL AND SEXY GIRLS TODAY: Angela, Bonnie, Indian Girl Radika and Beautiful Tiffany on duty๐ŸŒน.
  49. DareDevil:
    ARIA WELLNESS โ™ฅ๏ธโ™ฅ๏ธADDRESS: 360 HWY 7, UNIT #6, RICHMOND HILL,647-222-5683 โ™ฅ๏ธโ™ฅ๏ธ(PHONES CALL ONLY, NO TEXT'N AVAILABLE) โ™ฅ๏ธTODAY'S Schedule!โ™ฅ๏ธ Loaded lineup with Beautiful Girls : New Girl Deep Tissue Lily, Fun Girl Apple, Young RMT Student Helen, Magical Mia and Work out๐Ÿ‹๐Ÿšด๐Ÿ’ช Babe Amy! SPECIAL PROMO 30 MINS 2 GIRLS $70 ๐ŸŒน๐ŸŒน**TODAY'S PICK OF THE DAY IS ๐Ÿญ๐ŸฌHELEN AND APPLE๐Ÿฌ๐Ÿญ**
  50. wonderspa:
    ๐ŸŒบWonder spa,(9421Jane st unit127)call416-5000-800โ˜Ž๏ธbest massage in vaughan,Wednesday RMT available,๐Ÿ’„sexy face young girl Joey natural c cup,very good looking nice body slide,really popular ๐ŸŽlong hair Q Lucy good strong to relax oil massage, Relieve pain and remove stress,more experience,๐ŸŒนyoung friendly new CiCi, back walk,deep to relax,open mind,amazing ending๐Ÿ”ฅ,bring you warm comfortable timeโค๏ธ๐ŸŽˆ
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