26 Aug Do you suffer with recurrent Right Calf tightness or Right Achilles tendon pain ?
MANAGEMENT OF A TRIATHLETE WITH CHRONIC RIGHT ACHILLES TENDINOPATHY.
A NEUROLOGICAL APPROACH.
Do you suffer with recurrent Right Calf tightness or Right Achilles tendon pain ?
This 49 year old patient had suffered with chronic right achilles tendinopathy and right calf tightness for over 14 years. She had tried numerous physiotherapy interventions during this time including eccentric calf strengthening, taping, acupuncture, massage, dry needling, foam rolling, stretching, custom made orthotics and electrotherapy. She had also undergone a course of extracorporeal shockwave therapy which did not improve her symptoms.
Recurrent right calf tightness, right calf tears and right achilles tendon pain are the most common injuries I see in my clinic. It does not matter if you are an international athlete or a recreational runner the same principle of treatment still applies, the right calf is over working because the body is in the incorrect position.
The calf is overactive as it compensates for the glute max which can not be recruited due to its incorrect position.
From my clinical experience the right calf is one of the most overactive and overused muscles in the body. The reason it becomes tight/overactive is not because of weakness but because it is over compensating for muscles that are in the incorrect position and are underactive higher up in the kinetic chain. The reason that programmes designed to remedy right calf pain/tightness/tears or achilles tendon pain often fail with these athletes, is because the exercises usually aim to further strengthen the right calf. Strengthening exercises will actually compound the issue of the muscle already being overworked.
For the human body to function in an upright position, to maintain balance and generate torque for physical activity, athletes must be able to maintain equilibrium and ability to shift between position of pelvis and thorax (ribcage). Patients who present with right calf pain / right calf tenderness / right calf tear or achilles tendon pain have lost the ability to shift their pelvis and thorax to both sides of the body.
Commonly these athletes lose the ability to utilise the right gluteus maximus muscle in a certain plane (transverse plane) to produce counter clockwise rotation at the pelvis. The right calf complex compensates for the lack of right gluteal muscle firing, resulting in an overactive calf muscle.
My initial goal with this patient was to shift her centre of mass further back so that she could sense her heels (calcaneal bones). I removed the custom made orthotics as they were causing supination at both sub talar joints. I placed the patient in a pair of Asics Foundation running trainers so that the heel was better supported. With the new footwear in place the patient felt much more grounded and could sense her heels and arches.
Once the patient had a new positional sense from the ground I used very specific exercises developed by the Postural Restoration Institute to improve her pelvis/ribcage position, reposition and strengthen her glute max, and improve the athletes ability to shift into both hips. The patient was very compliant with her exercise regime and was running pain free within weeks. She was able to complete an iron man event with no problems 2 months later.
Clinically the key to solving these recurrent right calf/achilles problems is to find out why the pelvis and thorax is out of position and what is driving the position.
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