At Rugby Physio, every patient who walks through our doors is unique. This week, we want to share a story of Liz, a 50 year old runner who had dreams of running a marathon, but was limited by recurrent hip and Achilles pain for the last 6 months. This caused both mental and physical impact to her life.
Liz presented to Rugby Physio with:
- Persistent hip tightness
- Recurrent Achilles tendinitis which continued to flare up on attempting running training
- Seen multiple practitioners for treatment and rehab but still struggling to reach goals.
- Mental frustration related to ongoing pain.
Our Initial assessment at Rugby Physio
We began with a thorough assessment which involved in depth history taking focusing on symptoms, frequency, severity and aggravating factors. We then looked beyond the symptoms and focused on understanding her training programme, movement habits, diet, sleep, recovery, mental health, work stress and general lifestyle. We also looked into her past medical history, considering a medical systems review to gather a holistic picture and disclose if there is medical link to the symptoms. This followed a physical examination.
Our key examination findings:
- Stiff hip rotational movements contributing to increased load through the knee and ankle.
- Weakness in hip flexor muscles.
- Tightened and shortened quadriceps muscle.
- Reduced ankle dorsiflexion.
- Achilles tenderness with stiffened Achilles tendon.
- Big toe stiffness.
- Rigid intertarsal foot joints.
- Tightness in lower spinal joints and muscles.
- Increased frustration and catastrophising thoughts.
Previous treatments tried
- Soft tissue therapy
- Acupuncture
Our approach at Rugby Physio and what we did to help
We designed a tailored rehabilitation programme specific to the patient’s assessment findings and the goals of what the patient wanted to achieve. The patient was seen over a period of 4 physio sessions:
- Worked on improving her length and strength in the hip flexors.
- We treated the tight calf and Achilles tightness with acupuncture.
- Achilles tendinopathy exercise was advised to strengthen the Achilles tendon and improve elastic tensile strength.
- Manual manipulation was applied at the hip to improve rotational mobility. A strength programme was then prescribed for the hip to maintain mobility and strength. This would also improve lower limb biomechanics for running rehabilitation.
- The lower spine was manipulated and mobility exercises where applied.
- The big toe was mobilised with manual techniques and intrinsic foot muscles where strengthened.
- We advised her to begin doing some gentle running between physio sessions. Daily increase in cadence and speed during running activities was recommended to decrease load and allow recovery.
- Clear goals where set at the end of each sessions and we worked together to achieve them by the next physio session ensuring progress was made.
The end result
After 4 sessions, she was back to training and running 12-14k. She managed her half marathon with no issues or pain.