Lower back and calf issues (again!)

[ml14ml14]

I am posting this thread hoping for some advice regardingwho to consult on my various issues with my legs.
Around 10 years ago I developed a back problem it was diagnosed that 2 of myfacet joints in the lower back were too close together and rubbing.

I received physiotherapy and wore a corrective brace for best part of a year.My condition did improve but there was always a weakness so I learnt how muchpressure I could put through it without causing a reaction.

I have always been fairly active, playing various sports. Around 5 years ago inthe winter I tried to get really fit for the summer's cricket season. This ismy problems began again. I developed sore shins and had a weakness in my calveswhich led to my feet slapping down on the treadmill and shooting pains throughmy heals. In order to treat these symptoms I had went to a private podiatristwho treated my calves and gave exercises to strengthen. However this developedan issue with a tendon next to my ankle, I can't remember its name. Also I havecustom orthotics to correct a slight over pronation.

I did finally get on top on these issues to an extent but I have now startingdoing a weekly 5k run. At first I had no real issues due to the lack of speed Iwas running at, however as I gradually got quicker still going slowly at around29 mins I've now developed various issues again. Whilst running I feel lots ofpressure on my lower back and tight painful gluets, tight hamstrings and very verytight calf muscles.

I am working on my calf exercises to again try and increase the strength andflexibility, and doing plenty of stretching before and after my runs, and I'verecently started to use a foam roller to try and iron out the knots in my calves.

I really want to identify what is causing these issues because running a 30 min5k should not break me!
I want to seek further professional help but am unsure where to go, apodiatrist may just focus on my calfs which my instinct tells me will not cureall my issues.

Any advice gratefully received!

Many thanks


Matt

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[nmarman]

Hi Matt,

You are in luck I run the London foot pain Clinic and am also a Chiropractor, this has lead me to get a unique insight into how the foot pain and lower pain play a pivotal role.

Some years ago you had a condition called facet syndrome from the lower back. The past management sounds like it only focused short term pain, the brace no doubt cause quite bad atrophy of core muscles due to length of time worn.

The best treatment for facet compression is facet release which can be done by manipulation. Physiotherapist only learn this post grad, if at all, and while some are good it can take years to master. For this i would tend to go to a osteopath or a Chiropractor. This technique has also been recommended by national institute for clinical excellence for chronic lower back pain.

Manipulation will reduce the pain quickerly normally within 3 visits but then you must follow a course of rehab exercise to strengthen backs resolve, through stability issues.

Although I haven't seen you - many people that suffer through chronic lower back pain start to posteriorly tilt pelvic - This would lead to excessive glut tightness and SI joint strain. foam roller on gluts (glut med and piriformis muscle) and SI manipulation combined works exceptionally well here.

The calves very rarely play a role in heel pain at the bottom of heel. and most certainly do not cause pain in front of shin. no doubt you have MTSS combined with some plantar facitis.

The MTSS can be helped with a ankle strap during runs/ long walks combined with daily icing of inside of ankle.

The Plantar Fasciitis or pain on underside of heel is generally caused by over pronation (flat feet). We you assessed for this with a running assessment? e.g. slow mo camera.

frequently we see the slight over pronation on standing assessment with extreme over pronation during running gait. this would cause the P fascia to over stress. This leads to thickening - which once chronic only shock wave therapy has been proved to be successful in release. That been said you can find some free exercises at my website: click here.

Does that help?

[ml14ml14]

Many thanks for taking the time to read and reply.
I am currently working hard on band work and calf exercises to manage any plantar fasciitis / MTSS. Although occasionally sore my heals and ankle tendons are not so much an issue currently.

I understand it is very difficult to diagnose remotely but I am trying to determine if the extreme tightness in my calves and my tight hamstrings are a result of my facet syndrome?
In my head I am trying to decide if I should seek a osteopath to work on my back or should I look to work hard to improve strengthen and improve flexibility myself in hamstrings / calves treating the problems but perhaps not the underlying issue.

thanks again

[nmarman]

Long and short - the calves and hamstrings don't generate pain to the back.

The biggest pain generators are the SI joint and the lumbar facets with the ql muscle and gluts including piriformis slowing recovery because of tension.

Be careful choosing a osteopath some don't seem to manipulate, don't ask me why, because they are taught it undergrad level.

If you see a chiropractor they are trained in musculoskeletal radiology and might take x rays on site to determine state of back curve, joints and disc. But check they have x ray machine it means a smoother ride.

Essentially do your research on practice which everyone you choose and pick a practitioner with at least 3 years of experience.

[Need2Run]

Have you had a biomechanics expert look at your running form? (not a self-appointed 'expert' with a camera, but a medical pro - Roehampton Uni will do it for around £150, for example). If you're over-straightening your leg when landing (most runners 'overstride' btw) that will put all kinds of pressure on your glutes, hams, back and calves.

Remember that your feet should strike the ground at least 180 times a minute. Any less than this and your feet will be on the ground for an unhealthy amount of time (studies have shown 180 is a healthy minimum - elite runners will strike at 190+ Try running with a metronome, pretending the ground is hot coals or egg shells)

Also - are you a healthy weight? Your feet will hit the ground several thousand times during a run, so every extra pound can have an effect.

BTW - I'm not a physio, just an avid runner with 10 yrs experience.