Case Study of Chronic Calf Pain
Posted by Ove Indergaard on December 20, 2015 . 0 Comments
I thought I’d share a case study regarding a recent patient of mine that I have just discharged. He is a 79 year old man who uses walking as the main method of maintaining his fitness and managing his weight as he also has diabetes.
He was referred to me from a colleague who he had seen in a different part of the country, after 3 years of suffering with this calf pain. Other than the calf pain he is in great shape, and has been checked out with Doppler US, MRI and had several consultant referrals over this time. Any neuro involvement was also ruled out. He was also having acupuncture which gave him some short term relief.
Functionally on the first assessment he was walking with an antalgic gait patter, and was unwilling to put weight through his left leg even on standing. He had reduced dorsiflexion on the left ankle, pain on resisted plantarflexion and very tender to any direct palpation of the medial aspect of his L gastrocnemius and the pain was even worse on palpating the medial fibres of the soleus muscle.
I then went on to examine his soft tissues in his foot, as in my experience there are few calf problems that does not have an involvement of some kind in the foot. Since starting using Instrument assisted Soft tissue massage I have found the best way to do this is using the Edge tool scanning the soft tissues to find any restrictions within the fascia on the medial aspect of the foot as well as the plantar fascia. Most of this patients restrictions were on the medial aspect of the 1st tarsometatarsal joint.
Over the next 3 weeks, I treated him with Instrument assisted soft tissue massage, and even from the first session there were immediate pain relief that helped to normalise his gait pattern, and by the 3rd session we had him starting to strengthen his calf muscles. Throughout his treatment he reported being able to tolerate longer and longer walks painfree. At the 4th session he reported to have been completely pain free for the last 2 weeks and was back walking 4 miles, longer than he did 3 years ago, before the onset of his pain. He even gave me a card and a nice bottle of wine as a thank you.
I guess the fact that I was able to affect his chronic, hypersensitive calf muscles by treating away from the pain was a bonus as it enabled me to progress his treatment quite quickly with minimum discomfort for the patient too. The mechanism of this cannot be attributed to causing an increase in the healing response locally as no treatment was administered at the site at the site of pain and my opinion it is more likely a stimulation of mechanoreceptors within the plantar/crural fascia which the foot and the calf muscles share that brought about such immediate improvements as suggested by Schliep (2003).
Anyway, below is a little video demonstrating the technique I utilised with my patient. Enjoy, any comments would be appreciated.