Achilles Tendinopathy

Muscle Power Deficits

Patients with varying degrees of achilles tendon pathology making presentation and potential treatment differ slightly; however, they will usually present with fairly localized pain in the achilles tendon and toward the heel!

For more clinical findings click here!

Anatomy

Image via Complete Anatomy by 3D4 Medical

Special Tests

The arc sign is and excellent assessment to help rule in presence of achilles tendon pathology due to it’s high specificity rating!

(Click image to watch 1-2 minute video)

Treatment

Insufficient dorsiflexion can be a contributing factor to achilles irritation. If this motion is limited, the achilles can experience increased loading eventually leading to tissue disruption. The gastrocnemius muscle can be a source of movement restriction and should be addressed! (Soft tissue mobilization can be executed in this position as well)

(Click image to watch 1-2 minute video)

Therapeutic Exercise

The gastrocnemius (also achilles tendon) is subject to the highest (eccentric) torque demand during gait, which is further increased while running! As other impairments are being addressed, you may want to consider improving eccentric loading capacity. (Click image to watch 1-2 minute video)

Posterior Tibialis Tendinopathy

Muscle Power Deficits

Patients with posterior tibialis tendinopathy typically present to clinic with diffuse medial ankle/foot pain often with insidious onset. In more severe cases pain can also radiate into the medial calf region!

For more clinical findings click here!

Anatomy

Image via Complete Anatomy by 3D4 Medical

Midfoot Mobility

Remember, during patient assessment, it is imperative to examine up and down the kinetic chain in order to gain a more well-rounded understanding of the patient’s pathology. That being said, mid foot mobility is still something that should be addressed!

(Click image to watch 1-2 minute video)

Posterior Tibialis Assessment

In order to better rule in the possibility of posterior tibialis tendinopathy, the therapist should elongate, contract, and palpate the muscle belly and tendon looking for reproduction of symptoms. Here is an example of how to properly elongate!   (Click image to watch 1-2 minute video)

Treatment

Often, lack of dorsiflexion range of motion can result in compensatory mechanisms through the midfoot contributing to irritation of the posterior tibialis tendon. A high-velocity low amplitude thrust to the talocrural joint can help improve this range of motion deficit! (Click image to watch 1-2 minute video)

Therapeutic Exercise

Motor coordination both proximally and distally can contribute to excessive pronation. A squat assessment can also double as a therapeutic exercise by cueing the patient to maintain a neutral mid foot position while performing the movement! (Click image to watch 1-2 minute video)

Hamstring Strain

Posterior Thigh Pain with Muscle Power Deficits

If a patients presents to clinic with pain in the buttock or posterior thigh, often related to blunt trauma or sporting activity, you should consider a hamstrings strain as a potential diagnosis! For more clinical findings click here!

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Anatomy

      Image via Complete Anatomy 2018 by 3D4 Medical

Hamstring Dominant Movement

Often times, patients with a history of hamstring strains tend to exhibit hamstring dominance. Checking activation sequence and quality can help the therapist determine if the hamstrings are being over-utilized and the gluteal muscles are being under-utilized. If hamstring dominance is present gluteal activation in the future will be key! (Click image to watch 1-2 minute video)

Range of Motion

To help rule in a strain to the hamstrings group it is helpful to elongate, contract and palpate the muscle noting any reproduction of the patient’s symptoms. Straight leg flexibility is one way to elongate the hamstrings group as well as attain an objective measure! (Click image to watch 1-2 minute video)

Treatment

Treatment of hamstring strains depends on the how acute the strain is and/or the irritability of the patient. Early on, inhibition of the hamstrings group should be priority rather than stretching. As the patient progresses, eccentric loading to the hamstrings (if tendinopathy present) and especially gluteal strengthening should be considered!  (Click the image to watch 1-2 minute video)

Therapeutic Exercise

After pain has been reduced, hamstring length has been restored,  and gluteal activation is progressing it is important to incorporate lower extremity motor control while promoting gluteal dominance vs. hamstring dominance. (Click the image to watch 1-2 minute video)