Tibialis Posterior injury

[bluecat]

Hi there,

I seem to have pain at my tibialis posterior and I think it's from running too much too fast (I jumped in training schedule from about 6/7 km every few days to 13km every day). It now hurts to walk but if I warm it up its okay and doesn't hurt.

I am a physio student, can someone clarify with me the following?

It hurts mostly when it goes into pronation because the tib post is supposed to control this movement eccentrically and tib post is probably weak? Does this mean I should include eccentric exercises into my rehab program so that it strengthens tib post the most ? (should I prescribe these after a few days of concentric exercises for tib post? (I was thinking inversion exercises with a elastic resistance band).

I have a flat/sway back for a postural assessment potentially indicating tight calf muscles.. could this also be contributing? Should I prescribe myself some gastroc and soleus stretches? I'm thinking of addressing my core stability (I have weak lower abs) too..

I'm desperately in love with running, I want to get back into as soon as I can. If I tape my foot into a neutral position (using the basket weave.. or even if I tape it into a position of supination?) could I run on it faster?

Is it a good idea to tape my foot into this position while wandering around my day?

I noticed the pain badly yesterday, but I have a feeling its been creeping up for a few weeks (cos thats when I increased my training).

Does this all sound fair? I have had 1 day off so far and its killing me. I was thinking of getting myself to have 4 days off at least. But I don't want to make it worse. I have a running race on on the 22/3 and also a really good one on on the 28/3 ... I guess I will have to do some hardcore taping??

What do you guys think??

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[Judith Mollet]

Hi there! Tough about the problem/injury as you seem quite a running junky. You are a student physio therefore must have information about/access to experienced sport physiotherapists.
I think the "hardcore" approach is important BUT hardcore THINKING about what you did wrong to mess up your chances of running in these races. Then THINKING about preventing more damage. You upped your training and expected to get away with it. Your lower leg is saying woah! Before doing more training to try and make better something you got by doing too much too fast for the state of your body as it was, go for assessment and advice. Even physio students aren't super human and your body is not a machine. Imagine you are the physio, someone comes to you for advice and treatment!! It's not a car being taken to the garage for a quick fix. If your observations about posture are correct a re-think of training including style of running etc may well be indicated. And it takes time.
And yeah, I was probably just the same years ago....been there...seen it... felt it...ouch!

[Fisiomarc]

Slow down, bluecat. You need a pair of insoles specificaly designed for you for correcting your pronation or you could always suffer from these. Your tibialis are weak because they are exhausted!! You don't need to strenghten them. You have to relax them!! They hurt because they can´t follow you . Try with several massages, a lot of stretching and rest. I have had some experiencies like yours and if you keep running with pain it could became chronic. Don´t let it happen.

[physiobob]

In general I agree with both posts above. On the one hand you have increased the training. Have you also changed shoes recently?

Maybe the additional km's are also contributing to a gait cycle that has slightly excessive pronation (hence the orthotics comment). That might be a "bandaid" of course if the pronation is due to more proximal issues about the hip joint (stability, fatigue resistance, ability to extend and recruit glutes and hamstrings etc etc).

As you're a physio student now is a great time to get looking at the body. Get a friend to video you running towards the end of a run when things are perhaps falling apart slightly. This might provide more insights into the issues.

Oh and don't forget to eat well

[specialisedsofttissue]

am I stating the obvious here or are we already talking about a pretty classic case of shin splints, I know shin splints is an big umbrella term used to describe almost any lower leg/tibia pain so differentiating between tibial periostitis, exertional compartment syndrome, tib post tendinopathy or perhaps some form of neural component is paramount to success in effectively treating this condition. A recent paper i read suggested that soleus was the primary cause of medial tibial stress, and tib. post. secondary, might be something to think about/assess. I guess like the others have said rest is definately on the cards either way, if just walking flares it up then maybe ice it down for a while afterwards and soft tissue massage.
Additional Comment I forgot:
also a friend of mine who does a lot of sprints swears by dry needling, he had them for years on and off, a few treatments with DN and the problem was solved.

[physiobob]

am I stating the obvious here or are we already talking about a pretty classic case of shin splints, I know shin splints is an big umbrella term used to describe almost any lower leg/tibia pain so differentiating between tibial periostitis, exertional compartment syndrome, tib post tendinopathy or perhaps some form of neural component is paramount to success in effectively treating this condition. A recent paper i read suggested that soleus was the primary cause of medial tibial stress, and tib. post. secondary, might be something to think about/assess. I guess like the others have said rest is definately on the cards either way, if just walking flares it up then maybe ice it down for a while afterwards and soft tissue massage.
Additional Comment I forgot:
also a friend of mine who does a lot of sprints swears by dry needling, he had them for years on and off, a few treatments with DN and the problem was solved.

In a sense perhaps, more like a tenoperiostitis in something like the tibialis posterior origin or peroneals.