Case History

-56 year old male
-Persistent left heel pain for 6 weeks aggravated by running and causing patient to stop running
-Running 4-5 times per week 30+ miles. Has been running for 30+ years
-Similar pain 5 years ago, resolved by orthodics and physical therapy
-Has had a neuroma surgery followed by staph infection on right foot.
-Has had previous chiropractic care for left hip pain
-Pain levels low without running
-Not taking medications

EXAM FINDINGS
-Tightness and tenderness throughout the upper back and lower back, left hip and thigh more so than the right. Bilateral leg muscles with more so on left calf and right tibialis and peroneal muscles (front and outside of right leg and back of left leg [out of balance])
-Joint dysfunction upper and lower back, pelvis, hips and feet.
-Posture compensated in a forward position with increased flexion and outward rotation of lower body more so on right and upper body is flexed with inward rotation of shoulder and arms.
-Gait favors propelling his body with right side and pivots with left non-dominant side.

DISCUSSION
-Patient has a repetitive strain injury to left Achilles complicated by asymmetries in whole body mechanics legs, thighs, pelvis, spine and shoulders. Asymmetries result form general stressors of side dominance, forward focus of ADLs, lower body favoring for walking and compensation for previous injuries.

TREATMENT PLAN
-Treat acute injury of left heel
-Treat surrounding areas to reduce stress on acute areas. Improve whole body mechanics to lessen repetitive strain on acute injury and allow gradual return to running while strengthening the function of the whole body as it re-integrates into fluid whole body efficient movement.
Goal complete injury recovery with less chances of recurrency and hopefully improved performance and greater longevity.

RESPONSE TO CARE
-First Month 10 visits adjusting feet, hips, upper back, lower back and pelvis. US/EMS for acute soft tissue injury to left heel 6 visits.
-Local exercise leg, foot, ankle, stretch and strength
-Progression to posture exercise emphasis spinal mobility strength and stability
-Gait exercises that focus on body symmetry and whole body functional integration.
-Post-first month treatment taper frequency of treatment to 1 time per 3 week and continued to taper while maintaining and improving function gradual increasing in running with initially frequent stops and stretching.
-Progression of exercise: to functional hip exercises to improve force transmission from lower to upper body and back again with the ultimate goal of improving performance and lessen foot/ankle demand.
-Backwards running to counteract forward running demands and build eccentric muscle contraction endurance strength.

Patient is back to 30 mile run week and continue functional recovery and improvement treatments currently at a one time per 2 to 3 week basis.