Flexor Hallucis Longus Tendinopathy: Part II

If the symptoms from the last post sound familiar, it’s important to seek care to prevent the condition from advancing. The good news is FHL tendinopathy does not require imaging for diagnosis. You can see a PT or AT directly- they’ll evaluate and diagnose your condition, and will refer you to a physician as needed.

After assessing your leg, your clinician will be able to ascertain contributing factors that led to the injury and how to address them with an individualized exercise program including neuromuscular re-education and functional training. Neuromuscular re-education helps reprogram the way you move- focusing on specific muscle activation and timing. This strategy takes the whole kinetic chain into consideration, looking for inefficient habits that may seem unrelated to your injury.

For example, many athletes diagnosed with FHL tendinopathy present with excessive pronation- or arch collapsing- a faulty pattern that can contribute to overloading the FHL in running. Strengthening the hip, pelvis and core muscles, combined with improved running mechanics can reduce this problem for the long term!

If you are able to see a clinician in-person, manual therapy may be beneficial to reduce inflammation, muscular tension, and any joint stiffness.  

Until your appointment, follow these recommendations at home:

1. Rest from the aggravating activity - running, dancing, etc.

2. For pain management, try over the counter NSAIDs (ie Advil, Aleve)

3. Use contrast therapy to reduce inflammation:

   • Submerge foot for 10-15’ total following the pattern below:

     • 2-3’ in ice water

     • 2-3’ warm water

     • 2-3’ ice water

     • 2-3’ warm water

     • 2-3’ ice water

4. Self-massage the outer calf by rolling with a tennis ball or something similar on the floor

5. Perform a seated calf stretch with a towel at the toes, being sure to pull the big toe back with the foot

Lumbar Disc Pathology: Part II

If you’ve experienced a disc injury before, you’ll know immediate care is all about triaging. You need strategies to help you deal with the pain now and a plan to tackle this ASAP! Depending on your symptoms and how you got hurt, we recommend making appointments with both your physician and a rehabilitation specialist.

A physician will be able to write prescriptions, as appropriate, while ATs and PTs will be able to address your pain from a mechanical perspective. There is tons of evidence supporting various treatment modalities for the management of lumbar disc pathologies. The focus is pain resolution, restoration of function and any associated neurologic deficits associated. 

At your appointment, your clinician will perform an in-depth evaluation and establish a treatment plan to address your specific and unique symptoms. This will often include:

• Mobility exercises for muscle, joint, and even nerves

• Stabilization exercises focused on trunk control and strengthening

• Proprioception, coordination, and balance training

• Functional conditioning 

• Phased return to sport / activity program

While you’re waiting for your appointment, there are several strategies you can try to safely mitigate your symptoms. Often, disc-related low back pain is aggravated by prolonged flexion, or bending at the waist.

1. Try to limit time sitting by standing or walking when you can.

2. Modify your work environment to allow for standing, taking seated breaks as needed. Get creative- using books, boxes or other household items to create an make-shift ergonomic solution.

3. When sitting, use a pillow or support behind your low back to limit rounding of the low back, or slumping.

4. Raising your seat height, whether in a desk chair or in the car, can help you avoid a posterior tilt of the pelvis. This position puts stretch through the muscles and nerves of the low back.

5. Rest lying down if unable to tolerate sitting. Try bending your knees, planting your feet on the ground to help maintain a neutral spine.

6. Use heat to help relax muscle spasm or guarding.

7. Avoid intense stretches for now- while they may feel good in the moment, this can increase muscle spasm.

8. Over the counter pain meds such as NSAIDs can help reduce pain. Double check each individual brand for dosage recommendations.