Tibialis Posterior Muscle strain-recurrent

[cadynz]

hi jim,
tib post can be a tricky customer!
in cases like this with a recurring history, i am always inclined to have a look further up the kinetic chain - have any of the PTs you have seen had a look at your biomechanics? if this is the root cause of the problem isolated treatment to the tibialis posterior like you have described won't completely sort you out. it's a bit of an ambulance at the bottom of the cliff scenario - you need to build the fence at the top!
do you do any core work? how are your gluts?
there's a myriad of possibilities - for example, if you have increased valgus at the knee, it puts more strain through the tib post.
it sounds like you have been doing all the right things and that hasn't worked - so you need to change tack a bit.
regarding your questions - i would like to think we can improve the pain rather than you having to work through it - as you are probably aware you don't want to get into a cycle of inflammatory damage.
i'm a little confused what you mean by "Also, it's not clear to me what the stretch for the PT would be: soleus."
i hope this is a little helpful - it is a frustrating condition, but my partner had a similar issue and now he is in the last weeks of training for a marathon next weekend with no worries

cady

[Jim Riley]

Hi Cady, thanks for replying. First, I have worked quite a bit on posterior chain including hams and gluts. My knees are moderately varus. I do use orthotics for pronation. The injury occurred when one day after a strenuous hike, with my leg muscles fatigued, I slipped when stepping onto a wet rock, slid, and forcefully everted my ankle. There was immediate pain, and a few days later some hemorrhage appeared on the medial surface of my calf, around towards the tibia. A few months later I aggravated it again running through packed snow, doing some forcefull eversion in the process. 3 0r 4 times more i have gotten back to normal, but a bit of overuse brings it back. So the issue is how to keep it from recurring--or does it even matter, since the pain is minimal. That's why I asked what is the worse that could happen.

Jim