This year, I had a patient who completed the 2012 Boston marathon in 2hrs 55 min. A personal record in the crazy heat!
Unfortunately, as a result of the marathon he suffered an injury to the right foot. It felt to him like a swelling to the top of the foot on the outer part.
The patient tried conventional physical therapy prior to seeking my help. They used ultrasound on the inflicted area, electric stimulus, massage techniques and prescribed strength exercises to target the area of the foot where it hurt ….all of which seemed to be of no help at all. In the end, his pain worsened. He could still run on it but he began to get lower back pain.
A MRI was performed by his orthopedist and came back normal. He was again given a script for physical therapy. Eventually though, his triathlon coach gave him my contact info.
Three months after his injury, the client came to see me and what I found out during his history was that before the race, he was so afraid of his shoes coming loose that he tied his laces WAY too tight and even triple knotted them to assure they wouldn’t loosen. He tied them so tight that he compressed the extensor tendons of his foot where they cross the ankle.
Unfortunately, he gave himself tendonitis… but where?
I challenged the muscle on his shin which reproduced the foot pain. The problem wasn’t in the foot at all….it was located in the outer shin. As soon as I located the correct spot it reproduced a “click ” in the shin and the pain in the foot .
Basically, as a result of tying his shoe laces THAT tight he “choked” the tendons as they crossed the joint creating tremendous friction. Fortunately, tendons are so strong that they rarely tear (except at the hamstring and shoulder). However, he still overused and suffered a strain to the belly of the muscles above the ankle.
For three months, all that previous therapy was wasted on the pain spot…not the functional injured spot.
My Diagnosis: Extensor digitorum longus tendonosis
In the area where he “choked” the tendons by tying his shoes too tight, I manipulated the ankle joint, performed Graston Technique to the muscle belly and applied Active Release Technique to the ankle to help the tissues “glide” smoothly again.
Additionally, because of his foot pain, he altered his walking/running gait and “threw” his pelvis off. I also had to manipulate the lower spine back into alignment. After prescribing a stretch specific to the tendon and strength exercises to the arch of his foot, two treatments later…he was all fixed.
A happy ending overall. So you ask, what are the morals of the story?
1) Pain in one area DOES NOT mean that’s where the problem is.
2) Most importantly….NEVER tie your shoe laces too tight! =)
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