Dear all,

thanks again for the contributions, very helpful and reassuring.

My pt has had 2 weeks off the bike now, basically resting up and allowing any ongoing inflammation/micro trauma to settle.

He's continued with a general stretching regime addressing all lower limb and spine muscles.

Assessed him yesterday and although symptoms have settled and pain is reduced, he still has a focal area of tenderness generally between distal insertion of biceps femoris and posterior distal fibres of ITB. no swelling apparent.

there is an area of fibrous thickening and any attempts to probe beyond superficial layers results in fasciculation of biceps fem.... no trigger points found.

Alophysio, thanks for your valued input, and yes I would say his hams are definitely overactive, He really struggles to relax with assisted stretching and seems 'hypersensitive' almost during palpation of lateral hams and ITB, almost produces a reflex withdrawal response at times !

As for videoing him, yes, done that and his action (before orthotics) was a pronounced 'knee in' in flexion with resulting increase tibial internal rotn. the orthotics have corrected this and his knee and ankle now describe a linear plane of motion.

Not sure about his glutes, muscle strength is good but hes got the smallest 'buns' I've ever seen !!:lol

my plan is: release adhesions around lateral structures, restore length with sstm/stretches, introduce specific glutes strength exercises.

anything else I ought to consider !

thanks for all your comments and advice, I think I'd got to the stage where I couldn't see the wood for the trees 8o

regards