He contacted me to let me know about some Posterior Tibialis Tendon Pain
The function of this muscle is to provide support to the medial aspect of your ankle and more specifically the arch of your foot. Excessive pronation can cause pain, but more so the rate of pronation. Every time your foot strikes the ground the muscles of your lower leg two basic functions are to decelerate or absorb the force of your foot striking the ground controlling the transition from your heel initially contacting the ground to the weight transfer through your toes. If there is weakness in the post tib or the calf or some of the others, then they will not effectively control the motion and can have a quick pull on the tendon which can cause pain over time. Their other job, once they have controlled the contact of your foot to the ground, to then propel you forward into your next step or jump or running stride. Once again, if the muscle does not have sufficient strength to complete this, there will be excessive stress on tendon and connective tissue. Just keep in mind, our goal is to get the red meaty part of your muscle stronger without excessively pulling at the tendon, whether that is achilles or his next door neighbor, tib post. One option I do want you to consider because i know that you said your ankle/calf feel very stiff is a night splint (Strasburg night splint sock LINK). This can provide a low intensity, prolonged stretch with light tension over a longer period of time. You can even start out just having it on for a couple hours at night before bed
Stable with slight decrease in pain but remained in the 6-8 range with some days better then others.
This does sound positive and I do believe as your strength improves this will also improve as long as you are careful not to over do it
Strength Exercises: Some are done 3 days/week and some are done 2 days with none of them 2 days in a row
Did the squat pulses 2x and the wall sit clamshell 1x
Heel raises at leg press 2x/week, 1 set 45sec and the other set 1 min
Hip Thrust is too painful for the heel
This sounds good to me. One thing I am always trying to organize is a way to load or challenge the body, while providing sufficient rest so that it can recover before we load it again. It is always a challenge with the lower body, because we are always using it for daily activities, so if you have had a busy day, that may not be a day of rest like it is designed to be. I like the variety of trying to hit each movement at least 2x/week. Your goal should be to challenge your body 2-3x/week for now, avoiding any movement that is painful, and making sure that you respect the fact that your body may be fatigued from a more strenuous day and you may have to take it easy on strengthening if your body is already a little tired or sore
Continues to do the daily sequence with the addition of the spiky ball roll on the bottom of the foot
NOW REMEMBER FOR THIS ONE THAT YOU ONLY DO ONE OF THE OPTIONS…BAND IS THE EASIEST…THEN YOU PICK BETWEEN THE WALL OR THE LEG PRESS AS THE BEST ONE TO LOAD THE ACHILLES WITH THE LEAST AMOUNT OF PAIN
There are a variety of band resistances
Try to start with something that allows you to get through as much ROM as possible
If you have significant pain with any motion, try to start with just an isometric hold for 30sec-2 minutes
If you are able go through as much range as possible with minimal pain, go really slow on the negative 4-5 sec as you slowly load into the stretch
DURING THE STRENGTH SEQUENCE, TRY TO PUSH YOURSELF WITH THE ENDURANCE OF THIS ONCE
LETS TRY TO GET YOU UP TO 3-4 MINUTES BEFORE WE GO BACK TO OTHER LOADING OPTIONS
WHERE ARE WE AT WITH THIS ONE….I WOULD LIKE TO TRY THE LEG PRESS AS A WEIGHT OPTION THAT IS LESS THEN YOUR BODY WEIGHT
Slow and controlled rolling with a thoracolumbar stretch in between each
Tightness in the low back can often contribute to the achilles sensitivity so I like to include some lateral trunk stability which we will start off with in a non-weight bearing position
NEW SUBSTITION
INNER THIGH PROGRESSION ACTIVATING ARCH OF THE FOOT AND ADDUCTORS
