Torn arch ligament

[Matt P]

Potential client has been dealing with a torn arch ligament for over a year. His doctor is trying to treat him without surgery but he is still on his feet every day as he can't miss work more than a cpl weeks. He did take 2 weeks off to rest it, but it is still giving him problems. He is on pain meds and has had injections but no massage, or physical therapy. He says in the mornings it is fine, but by 3:00 in the afternoon the pain is excruciating. The doctor has him using a very high arch support to keep weight from his heel and he's taking Naproxin.

Can I do light massage? Do I need doctor's permission?

 

[rose_32008]

Do you know which ligament of the foot is the sprain located? How bad was the tear? Since it's been over a year, it's about time he gets some massage work! Anyway, you can probably feel where the sprain was, especially if it was that bad, you will probably feel it in the tissues. I would work all surrounding areas up into the knee and hip region because a year of limping has really affected his gait by now! The areas of compensation should probably be worked on first before hitting the adhesions of the actual injury.

Once all that has been worked a little, then I would get into that area of the sprain and use dtf followed by stripping and compressions over the specific area. And just do a little at first and there shouldn't be a lot of pain, when it feels painful, then move on. He should come in to see you once or twice a week for a half hour (for the whole leg/hip. On the injury start out with about several minutes progressing to five to ten minutes) until he starts feeling better. If you know any myofascial techniques, that's a great way to start deeper work and also to finish at the end of the session.

Although it's probably out of your scope, he should be wearing a soft arch support and not the hard plastic ones. The hard plastic ones don't provide any give and prevent the injury from full recovery. Some other considerations, what type of work does he do? Also, if the injections were cortocosteroids, those have been shown to break down tissues so that can work against him if he has them too often.

 

[Elizabeth R]

Thanks for your reply!

I don't know any specifics as I saw him limping while in a store and he and his friend were discussing how tired he was of his foot hurting. I introduced myself and we struck up a conversation about it right there. So I have no specifics of exactly what muscle as he didn't remember (only that it was from heel to arch). I don't know what inserts he is using either but if he books an appt. I'll find out more then. Not sure what type of work he does other than he is on his feet all day which isn't productive to healing.

 

[Artemisc]

Just stick to working with his tissues to bring some relief.

Don't openly question his doctor's recommendations regarding the arch support, as you don't know what information his MD is working with. Hard arch supports may well be a better choice depending on specific pathology and seforum.xxxe of recovery. If you suspect that his arch supports are inappropriate, refer him back to his medical pros or suggest getting a second opinion from another qualified medical pro.

I am actually quite surprised he hasn't been to physical therapy, and I'd recommend that he explore the possibility. A good PT could work with him in ways that you don't, and probably speed up his recovery.

For bodywork, I strongly agree with working the whole foot, ankles, knees, legs, hips, etc. He'll have lots of compensatory patterns by now. Go slow and gently in the areas where he has had the most damage. Get as much info on extent and location of the injury as possible.

If you know how, take some time to work with his interossei, both dorsal and plantar, in both feet. Many feet suffering from chronic pain tend to have loads of issues with the interossei.

Check for signs of hypertonic calves too. You may need to do some stretching of gastrocs and soleus. If you can, teach him how to stretch them properly between sessions. Stick to AIS, PNF, or CRAC stretching methods, these are reasonably simple and safe. The old static stretching approach is probably not going to work well for this client, and it would be easy for him to overstretch and cause more harm.

Last, see if you can get this client to provide you with the doctor's contact info, and get permission to make a call. If you can, introduce yourself and let him/her know you're starting to work with this client. Learn all you can about the specifics of the injury and what the physician thinks is going on. This simple step can save you loads of guesswork and may serve to establish a measure of professional courtesy that could turn into referrals later.

Have fun!

 

[CourtneyJo]

Just stick to working with his tissues to bring some relief.

Don't openly question his doctor's recommendations regarding the arch support, as you don't know what information his MD is working with. Hard arch supports may well be a better choice depending on specific pathology and seforum.xxxe of recovery. If you suspect that his arch supports are inappropriate, refer him back to his medical pros or suggest getting a second opinion from another qualified medical pro.

I am actually quite surprised he hasn't been to physical therapy, and I'd recommend that he explore the possibility. A good PT could work with him in ways that you don't, and probably speed up his recovery.

For bodywork, I strongly agree with working the whole foot, ankles, knees, legs, hips, etc. He'll have lots of compensatory patterns by now. Go slow and gently in the areas where he has had the most damage. Get as much info on extent and location of the injury as possible.

If you know how, take some time to work with his interossei, both dorsal and plantar, in both feet. Many feet suffering from chronic pain tend to have loads of issues with the interossei.

Check for signs of hypertonic calves too. You may need to do some stretching of gastrocs and soleus. If you can, teach him how to stretch them properly between sessions. Stick to AIS, PNF, or CRAC stretching methods, these are reasonably simple and safe. The old static stretching approach is probably not going to work well for this client, and it would be easy for him to overstretch and cause more harm.

Last, see if you can get this client to provide you with the doctor's contact info, and get permission to make a call. If you can, introduce yourself and let him/her know you're starting to work with this client. Learn all you can about the specifics of the injury and what the physician thinks is going on. This simple step can save you loads of guesswork and may serve to establish a measure of professional courtesy that could turn into referrals later.

Have fun!

Thanks for all your advice as I will certainly keep it in mind. I couldn't hide my surprise that he hadn't had any physical therapy at all. I did mention that I felt PT could be beneficial to his treatment. He may not even book with me but I wanted to be prepared in case he does. I appreciate the feedback from you and Kathryn. Thanks...

~Sandra