Monday 18th October 2021
Hours: 4
Patient presentations:
- Calf Strain
- Medial Ankle Pain
- Lateral Hip Pain
Reflection Focus
- Calf Strain
Reflection Model
- Gibbs Reflective Cycle 1988
What Happened?
- 4th visit – signs and symptoms progressively improving.
- Patient has been experience ongoing/reoccurring calf/achilles pain. The most recent episode he reported as a twinge in his calf during running that resulted in an inability to run.
- Prior to treatment the patient did not have any warm up or warm down routines in place. Further to this, as an amateur runner little attention was paid to training volume.
- Reassessed ROM and pain via ROM assessment and palpation. No pain on any ROM, normal end feels, 5/5 strength, proximal achilles tendon PoP reduced from 7/10 > 2/10 over 2 week period.
- Patient adhering to exercises although not been able to attend the gym as often as he would like. Abiding by 10% rule to avoid overloading the calf complex and achilles tendon too quickly. He completed a 5km run pain free a few days before the assessment which he was really pleased with.
What were you thinking and feeling?
- I was really happy to see the progress the participant was making – he was clearly pleased to be back running pain free and he acknowledged that his lack of S&C, warm up, and warm down strategies were likely contributing factors to his injury reoccurrence. Therefore, I felt the patient had not only benefited from the exercises but equally the education.
What was good and bad about the experience?
- Good = patient improvements in pain, ROM and knowledge.
- Needs improvement = clinical judgement on returning to running.
Analysis
- The patient fits the demographic described by Fields and Rigby (2015), in terms of age, recreational runner status and poor conditioning. Therefore, I believe it was correct to introduce condition work for the lower limbs and also educate on loading to avoid injury and enhance performance. Providing eccentrics was popularised by Alfredon, et al. in 1998 and has a strong evidence base for achilles tendinopathy and calf strains (Fields and Rigby, 2015).
- I never really provided goals for the patient to achieve in order to return to running. As a result, the patient returned to running within a month of the injury. The patient did not have a limp and reported no pain when running slowly; however, returning to running too soon may have cause further or re-injury. Fields and Rigby suggest that in addition to running for 30 minutes pain and limp free, runners should also be able to perform 3 x 15 single leg calf raises, both with a straight and bent knee.
Conclusion
- It is common to see recreational runners in clinic and therefore it is important that I have return to sport criteria to aid my clinical judgement and decision making. Therefore, I will use the approach outlines by Fields and Rigby to inform future treatment plans of runners who have sustain and injury to the calf complex.
Revisiting Reflection
References
- Alfredson, H., Pietilä, T., Jonsson, P., & Lorentzon, R. (1998). Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. The American journal of sports medicine, 26(3), 360–366. https://doi.org/10.1177/03635465980260030301
- Fields, Karl B. MD; Rigby, Michael D. DO Muscular Calf Injuries in Runners, Current Sports Medicine Reports: 9/10 2016 – Volume 15 – Issue 5 – p 320-324 doi: 10.1249/JSR.0000000000000292