Hi Tania continuing from where i left of yesterday.

I said i would look to the sacrum, specifically the Wikipedia reference-linksacroiliac joints on either side of it and ensure there are enabling nutation and counter nutation of the sacrum, i.e. the sacrum is moving equally between the two sacroiliac joints (Wikipedia reference-linkSIJ). The patient should be able to flex forward in standing with equal movement of the SIJ. Please do not get caught up in which way the sacrum is tilted and or moving if the SIJ's of the patient are not moving equally, which i think they are not considering the hypo mobility of one of the SIJ. This i think is due to the tight or shortened musculature you have already identified.

Although suggesting specific muscles i think is not always a good thing as muscles always work in combination with others. But for now looking at piriformis, gluts, tfl, erectae spinae, quadratus lumborum, hamstrings and qaudriceps all on the hypo mobile side of the SIJ would benefit from deep tissue mobilization then PNF stretches (hold relax stretches or muscle energy techniques as they liked to be called now a days).

Try posterior anterior mobilisations to the base and apex of the sacrum, has the nutation counter nutation of the sacrum increased?

Reassess?

Possibly simple rotation mobilization into a grade 4 post the muscle mobs may benefit the patient to?

Check patients leg length discrepancy pre and post treatment.

The tingling and numbness in the groin are symptoms of SIJ syndrome, in combination with the leg length discrepancy and hypomobility of the sij that's the working diagnosis i have come up with considering the information i have read and i have not assessed your patient.

Tania get your hands on this patient, the lower limbs posterior and anterior and the whole of the back musculature need mobilizing and stretching i think desperately i think.

Then see what you have to work on, as i see it,i t could be 1) Achilles tendinopathy 2)partial Achilles rupture 3) leg length discrepancy is that due to SIJ hpomobility 4)hypomobility at sij or SIJ syndrome causing "carriability" issues

If these are the major issues why do you need to prioritise is what i would be thinking.

And Tania we are physiotherapists our skill is in our hands..... please use them more before we loose our specialism.

Thank you in advance if you have read this reply.