Quest on CCP (common compensatory pattern)?

[Slowtwitch]

I think I may have run out of luck in the States so I thought going global might help.

History and Info.

Male 42 Years, High level athlete competing in marathons, Triathlons, and recently long distance trail running and Backpacking. Work day is unfortunately at a desk.

2 Years back started to have issues with my Right Ankle mostly due to lack of power during running. Continued to compete and 1 year ago started training heavier with weights for 40-50 mile adveture type races.

The symptoms starting from the bottom:

Bilateral Hammer toes
Left Toe crossover problem..just crowding the big toe now.
Right ankle loss of power at toe off and unstable.
Right ankle splayed out
Right Gast/Sole complex atrophy
Left peroneal tendon type nerve pain when cross friction self massage of lower lateral ankle region. Same type of pain and sensations at the fibula head.
Left TFL/VL very tight and muscle mass much greater than right side.
Last Ortho doc measured right leg shorter than left by 1/4 inch but not sure if she knew what she was doing as she did not indicate if functional or antomical.
When running the left leg does not extend out as much as right
Left Rect Fem also has greater mass than right
Right hip restricted internal rotation.
Bilateral hip flexor tightness
Right QL seems to be weak and stretched
Left QL seems to be overactive and tight.
Standing it appears hips and lumbar are rotated to the left. Right hip anterior to left when looking down.

The real pain is in the upper body:

Bilateral Nerve related pain in forearms and hands. Not much weakness in Grip strength. Pain is tolerable upon waking but gets worse as day proceeds at work.
Bad pain in left rotator cuff area very bad as day proceeds.
Left pectoral are larger than right and are overactive
Left arm is more rotated in than the right. Tight right under clavical on left.
Very bad pain in Left Traps and Romboid
Restricted rotation on head to left and some scalene trigger poi

Scans done to date:

Cervical MRI - Normal degen for 40 Year old...but forward head posture and some loss of curve.

MRI- Lumbar - Normal Degen

Right ankle MRI - thickening of the both peroneals

Old procedures done:

ACL reconstruction on Right knee 10 Years ago using patella tendon.

I have been to at least 5 different doctors with no diagnosis, rest has not helped, pain meds don't work.

I have done some research on what is called the common compensitory pattern but it gives very little information on the initial cause, or where to start to get me fixed. This is the only thing that came close to all my symptoms except for TOS, but the lower limb problems.

My theory is that if you have even a small kenetic chain imbalance and then subject the body to hundreds of miles of training, with weighted pack in some cases, that the whole firing pattern of many muscles will be impacted.

Any help would be really appreciated.

Thanks

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[physiobob]

My first thought is to have electromyography (EMG)studies done on the leg to see what is compromised and where. This seems neurological in it's presentation. It might of course have a musculoskeletal cause however we need to find out what is being damaged at the neural level and where. EMG will shed light on whether this is an issue. No point doing MRI's etc until the results of this are known.

[ginger]

Hello Slowtwitch, I'm quite happy to outline the nature of your problem on the basis of what is the most likely, and logical. In doing so I am aware of some limitations in the logistics of any solution I suggest. That being , there are some fundamental differences in the training and orientation between Aussie physios and US trained Physical Therapists. It does appear that US Pt's are more likely to offer exercise as the primary intervention, while Aussies are more likely to put hands on you to deal with the movement issues that are indicated by your list of signs/symptoms.
Your problems are all entirely explained by spinal protective behaviour. The end result of which has been to create an assortment of altered sensations and patterns of recruitment associated with nerve irritation. Note the predominant left sided aspect of the tightness and apparent hypertrophy.
Without going into the full detail of what spinal protective behaviour is , at a physiological level , it is normal , instinctive and potentially long term . Your spine will initiate a cascade of muscle tone increases to limit spinal movements when a threat is detected. The most common of which is sitting down.
The result of this protective behaviour is minor inflammatory events of joints and nerves. These nerves will then behave in a disorderly way , at the effect of focal irritations at or near the facet joints. leading to pain. muscle tightness and altered patterns of recruitment , often associated with weakness.
The problem in seeking help for this , is that these constructs are generally not well understood by doctors of medicine. It is my own observation that many PT's and physios are also not alert to spinal problems as cause, rather seeing aspects of altered muscle behaviour as primary , rather than a consequence of facet hypomobility.
So, what to do.
I suggest you stop looking for a pathological/medical answer or solution . Unfortunately returning to the doctors may well lead you to undergo improper attentions by those who ought to stand back. I speak here of surgeons. Remember , when you go to a used car yard , what do you get?, not hamburger. When you attend a surgeon , he or she will attempt to provide a surgical answer, that's what they DO.
Rather I suggests you make a list of local PT's ( assuming you are not fortunate enough to have an Aussie physio at hand ) and call them up. Ask specifically about their success and interest in manual treatments for spinal hypomobility. Avoid the ones who focus just on exercise, also those who will treat you for less than thirty minutes, also those who will not guarantee they will be with you and only you for the whole thirty minutes. Next eliminate those who have only been practicing for less than ten years. Also those who regularly use electrotherapies ( otherwise known as modalities ) as a primary treatment tool.
If there are any left on the list , make a booking, explain you want to have your spine considered and treated with manual therapies, in particular facet joint mobilisation.
Your problem begins with the Left > right L4 and L5. It is the protective behaviour around these joints that has given rise to neuralgic/neural events at you ankle/foot (feet). By restoring normal movements there , you will quickly find relief from the majority of the pain and altered behaviours of TFL, lateral thigh, peroneals and ankle. results will be within ten minutes , provided your chosen therapist is up to the task. Tyese results will be permanent , provided that normal unprotected spinal movement are restored. If not don't get trapped in an arrangement with no future. Be an assertive consumer. Keep looking till you find a manual therapist who leaves your legs ( and shoulders )alone and treats the cause of your spinal problems.
Best of luck

[Slowtwitch]

Ginger,

I really appreciate your insight in my problem, this is not a path I have explored yet. A few follow-ups if you have the time.

Would you please explain how such adjustments could be so quick to work with a problem I have had for so long. I guess I was thinking that my nervious system would need a little more time to learn again. I'm just a little into the science....

Would you know if it is PT's that are trained in Facet Joint Mobilisation in the USA and if this requires some time of additional schooling and certification. I have had some really bad experiences with people who said they were trained ,but not so sure, since I seemed to know more.

Could you briefly explain what i should expect as to the treatment if I find someone qualified?.

What you refered to about Aussie physios being different for US is something I have noticed reading a journal called the injury bulletin, which has many articles from your way. Very much more centered on getting athletes back in the action.

I really appreciate the response

[ginger]

Slowtwitch,

"Would you please explain how such adjustments could be so quick to work with a problem I have had for so long"

These are not " adjustments ", the intention is to restore normal movement characteristics to facet joints, not to shift their position . The construct that goes with "adjustment " is a chiro one and not part of the reasoning that goes with a model where movement is the primary issue. As is true for spinal joints. When tone is reduced around protected facet joints with mobilisation, the effect is to allow normal movement to occur. In doing so focal irritations to adjacent structures ( nerve ) are commonly reduced/ eliminated. The effect may take as little as two minutes, long term effectiveness relies on the normal facet movements being fuly restored, thus eliminating inflammatory events responsible for neural changes.

"I guess I was thinking that my nervious system would need a little more time to learn again."

Your nervous system doesn't need to learn anything in this case , simply needs to have irritations removed in order to function normally again.

"Would you know if it is PT's that are trained in Facet Joint Mobilisation in the USA"

I believe most PT's would have some level of undergrad training in Mobilisation. Further advanced training is certainly of value and available , though few things in this area of skillfullness count more than a combination of good hands and experience.

"I have had some really bad experiences with people who said they were trained ,but not so sure, since I seemed to know more."

Tell me about it, haven't we all LOL.

"Could you briefly explain what i should expect as to the treatment if I find someone qualified?. "

* individual attention
*a willingness , indeed enthusiasm , to approach your problem at the spine first.
* inspection/analysis/pre-treatment fuss and bother should take no more than five minutes tops.
* hands on treatment should be the primary focus of the treatment, time spent using hot packs, electrotherapies, or humming and ha ing should be zero.
*use of or time spent ordering expensive computer aided investigations such as MRI or CAT scans suggest a failure to understand your problem on a basic level.
An experienced manual therapist who understands the effect of skillfull mobilisation and it's relationship to your pain and other symptoms should be able to achieve a reduced pain / altered behaviour effect within ten to fifteen minutes of first applying his/her hands TO YOUR LOWER SPINE.

Good luck with the ring around.
Cheers
G

[Slowtwitch]

ginger

Searching for a qualified phsio now. I really appreciate all your help