My new client had a lumbar laminectomy about 16 years ago, prior to which (and following) he had acute postural problems (e.g., "walking on toes," excessive pronation of feet), which have been much improved by physio and sports massage. He continues to see a physio, chiropractor and sports masseur for ongoing treatment and does triathlon as a hobby (is a keen swimmer and cyclist). However, he still has limited flexibility and pain, most notably in the calf region (the gastroc/soleus junction), and his hamstrings are being overly recruited to substitute for an absence of glute strength. He has no joint pain (knee/ankle) and hasn't had any achilles tendon problems in conjunction with the calf issue. We did an assessment last night, and following this, I feel he should be focusing initially on improving neuromuscular stabilization and core stabilization, but I'm unclear what to do about his calves and why these are so tight. He has sharp pain simply from standing still longer than five to 10 minutes and discomfort from doing stabilization exercises (e.g., hop with stabilization). His key objective is to be able to start running again. Can you help?!
In response to your questions, I have a couple of my own.
- Is your client’s gait normal? Is there a firm heel strike and roll through the foot to toe-off? The propulsion that comes from the plantarflexors is crucial in good running and walking patterns.
- Has your client been investigated and/or treated for compartment syndrome?
I suspect your client has a myofascial restriction in the gastroc/soleus group. It could be compressing the tissue and causing his pain. His pain could be a sign of compartment syndrome, but if it is early enough, he could avoid the surgery and instead have hands-on treatment using myofascial release (for more on this, please click here or search the Content Library under keyword "Self Myofascial Release.")
Regarding lack of glute strength, do this test: in prone lying, when lifting the whole leg into hip extension (ASIS remains on the mat), your client should have full recruitment of hamstrings and gluteus maximus (simultaneously). If the recruitment is poor, I suggest you test all of the hip flexors for tightness and stretch any that show less than normal ROM (i.e., rectus femoris, tensor fasciae latae and iliopsoas group). Their tightness could be inhibiting use of the gluteus maximus.