A thought process for the nagging irritation of the lower leg; many of us have had a client / patient complain of Achilles tendon irritation or irritation in the Achilles region.  Hopefully you first have performed a thorough evaluation of function, specific to the individual and structure (please refer to your Foot  / Ankle manual for specific process).  Through your evaluation you have concluded the soft tissue in the lower leg has been irritated and as a result of the healing process, fibrotic tissue has developed causing the lack of translation amongst the soft tissues in this region.  One of the many strategies you may try is shown below...

FSTT Newsletter January 2012

After this Functional Preparation process, move to Fundamental Movements to stimulate (not aggravate) the tissue region; one example may be a SQUAT starting in XXX progressing to a squat with a pelvic drive to either off load the specific region you structurally emphasized or place more load on the specific region, you will have to decide based on their tissues tolerance.  The goal is to find their threshold TODAY and use this as your new functional stress test.  This form of functional testing can dictate your structural tissue work success as opposed to symptoms alone.  The clients BODY has all the information, the BODY never lies!   Keep in mind during a bilateral squat...a "good" leg can hide a "hurt" leg so your observation of "how well" becomes key!  

Q: Why do you often recommend heat therapy instead of ice with soft tissue injuries? 

 

A: Of course it depends on each unique situation and factors such as severity, region, hypothetical tissues of insult, timing, etc. However, the facts we will share may help solve this "puzzle".  First, research regarding the efficacy of ice / cryotherapy is significantly lacking and rarely talks about much of the newly found fascial research.  In addition, some researchers believe ice and anti-inflammatories may be contraindicated especially in ligamentous injuries.  Since ligaments have a poor blood supply, their nourishment must come from diffusion of nutrients, most likely from the joint itself.   In biology, we learned that cells are temperature sensitive and cells make up our soft tissues!  When you warm cells, their metabolism increases and when you cool cells, their metabolism decreases.  We must also respect that inflammation is a NATURAL process, a protective attempt by the organism to remove the injurious stimuli and initiate the healing process - without inflammation, injuries would never heal, but too much for too long can hinder healing.  So, our goal is to create a stimulus to improve the efficiency of movement in addition ensuring that the tissues are being properly stimulated for efficient healing.  On a practical note, if its already "naturally heated", find an indirect movement that helps to stimulate optimal fiber alignment using no artificial stimuli.  Once the person shows they can accept natural loads in a progressive manner you may decide to facilitate healing by using bouts of Far Infrared Heat applications with intermittent movement.  Allow natural movement to be your guide, not a textbook protocol that emphasizes isolated anatomy.

 

A final thought...inflammation is the basis of all disease, all conditions and all malfunctions.  The intensity and the amount of the inflammation reveal the severity and the spread of the problem.  There are NO accidents in nature.  Everything happens for a reason in the body, it's all linked; changes cannot occur in isolation.  Thinking through this may change the way we view healing!