The Problem
A 28 year old pilates teacher has been experiencing left heel pain for the last 3 months. With a busy schedule of leading 30 classes a week and training 3 - 4 times a week, the patient felt 6/10 pain when standing for long static periods. After receiving 3 sessions of massage and acupuncture at a previous Physiotherapist, the pain persisted.
The image shows the insidious onset with 5 degrees of range of motion before the treatment.
- Left eversion and inversion resisted weakness
- Unstable during left single leg resisted plantar flexion
The Treatment
The session combined 4 different treatment methods including ShockWave Therapy, Soft Tissue Massage, Instrument Assisted Soft Tissue Mobilisation (IASTM) and Eccentric Strengthening.
ShockWave Therapy is a precise deep tissue massage which produces non - invasive mechanical pulses which can be delivered inside the body at varying depths of penetration depending on the injury. Using a 10mm therapy head, 1599 pulsations were performed down the medial achilles towards the insertion. Settings: Frequency (Number of pulses per second): Intensity (Strength of each pulse): of 2 - 3. These will focus on the speed and strength of the signals towards the targeted tissue...
The treatment was then followed by IASTM to further breakdown tightness around the achilles and remove any waste products. The small multi curve (HG4) and the tongue depressor (HG9), were combined to mimic cyriax’s friction technique to the localised area with the tool amplifying tissue abnormalities.
Eccentric Strengthening Exercises:
- Stairs - Plantar flexion with assisted support whilst controlling the return phase in 3-4 seconds to a neutral foot position
- Seated plantar-flexion with theraband, controlling the return phase back to neutral
The Results
After using a combination of soft tissue management tools the pain had reduced dramatically. We then retested the range of movement and the results showed a change from 5 degrees to 30 degrees. 1 week after treatment the patient said:
“My ankle feels great, thank you! I’ve avoided any Pilates demonstrations that would’ve previously triggered the pain and taken it easy this week. I’ve also done the exercises you recommended. Really appreciate your help!”
