Hello again and thank you for visiting the ThreeSpiresPhysiotherapy blog, this time I thought we could take a break from looking at the physiotherapy services we offer around Lichfield and instead have a look at an interesting case study and recent example of our home visit physiotherapy service and how it has helped one of our patients. The patient has given permission to use his real name and has recently written some fantastic feedback for us (to see this check out our twitter feed or facebook page) and so I thought it would be good to go over the details of the case - especially as it is one of those cases where what at first glance seemed to be a simple running injury with a localised pain in the leg and calf turns out to be more complex and originating from another area!

 

 Mike is a fit and healthy runner in his early 40s who contacted us in late November about an old running injury in his calf muscles that had flared up again and was stopping him running. On visiting him and conducting a an assessment Mike gave us more detail and explained that he had left sided low back pain, pain in the back of his thigh and a severe cramping and pain in his calf. His symptoms could occasionally be both sided but today they were on the left and in general the left was always the more severe. He explained that sitting long periods and running were the main problems and that he desperately wanted to get back to running. As our discussion continued it became clear that Mike had suffered from this problem several times before and that it had a habit of returning when he thought it had resolved. He explained that his calf muscles in the past would often cramp up severely whilst running and often make him stop running and that his current symptoms had developed 3-6mths earlier and had been worsening. During his last run one week earlier he ran approximately 2 miles and then experienced severe cramp and pain in his left calf and leg and had needed to stop. At this point in the assessment I had in my mind two potential causes of his pain, firstly an old hamstring and calf injury that had never been rehabbed properly and was causing problems with his back as well and secondly that the structures in his low back might be causing the pain in his leg and that in fact the pain he was experiencing in his leg was referred neural pain.  

So with two potential diagnoses in mind we began a physical assessment to determine which was the true cause of his pain and what the best strategies in terms of manual therapy and exercise would be in order to get him back to running as quickly as possible. Mike's physical assessment showed good movement through his low back and lower limbs with no obvious restrictions or lack of strength in either his hamstrings or calf muscles, there was also no real discomfort on touch of his calf or the back of his thigh. Overall these findings made an old hamstring or calf strain much less likely to be the culprit of his problems. When we began to assess how easily the nerves of his lower limb moved and any symptoms from these it was evident that Mike had severe neural tension and irritation of his sciatic nerve. He was also very sore to touch in his low back and his left buttock (approximately at the location of a muscle called piriformis). With these physical findings I made a provisional working diagnosis of sciatic nerve irritation caused by irritation of his lumbar disc and possible piriformis spasm. 

I then used manual therapy in the session to alleviate the tenderness in his low back and relieve some of the spasm in his left piriformis. Mike was then given a programme of exercises to do to reduce the nerve tension and alleviate his piriformis spasm, we then agreed to review things in 3 weeks time.

At the next session Mike had already improved significantly, he had nil leg pain but did still have some mild discomfort in his low back and left glute but even these were much improved. Overall a great result after only one session!! Further physical assessment in that session showed some residual piriformis tenderness, a slight lack of global stability and a need for some general stretching of the low back to improve overall mobility. Manual therapy in the session was targeted at reducing the symptoms in the back and glute and a further programme of exercises were prescribed to aid recovery and Mike was advised to slowly return to running and let symptoms guide his rehab. We again agreed to meet up but this time in 4-6 weeks time to let the recovery programme and return to running settle down.

Fortunately over the next 4 weeks Mike improved so much that he no longer needed the third session and in fact by our last email conversation he was back to running 8kms with nil pain and was hoping to slowly build back up to a half marathon distance again!!!! Overall, this has been a fantastic result and is a testament to how hard Mike has worked with his rehab and how receptive he has been to the physiotherapy. For me on a personal note, these are the cases I most enjoy - the ones where the diagnosis is not obvious but by some good clinical reasoning, manual therapy and a programme of personalised rehabilitation I can get my patients back to their chosen sport quickly. As ever the best judge of any physiotherapy service is provided by the users of that service, so I have copied below Mike's testimonial and feedback:   

 "I contacted Dave at ThreeSpiresPhysiotherapy after months of severe pain and cramp like symptoms in my calf muscles. This was coupled with chronic and acute pains in my lower back and glutes. Dave came, assessed me at home and did some mobility tests. I was both fascinated and amazed at how some simple movements with my foot helped identify and relieve the issues. After two visits and a programme of exercises my condition has improved significantly enough to allow me to get back t running again. In between treatments Dave has been helpful and taken the time to respond to questions on the phone or via email. Dave is a very knowledgeable and helpful physio who I would use again and highly recommend to anyone looking for a physio."

I hope you have enjoyed this blog post and found it to be of some help, if you want any further information or would like to book an appointment the please get in touch: you can call us on 07884281623, email us at enquiries@threespiresphysiotherapy.co.uk or use the contact from on the main menu.