When active clients come to access our services, it is more often than not because they want to get back into training for their chosen sport, which is clearly important to them, but generally speaking, nothing more than a hobby.

However, when one of our team of physiotherapy experts, Terri Coates, saw a patient who not only placed health and fitness as one of her lifestyle priorities, but also made her living from helping to keep others active in her role as a personal trainer (PT), she was aware that the need to get her back up and running pain-free was even more important.

The 40-year old fitness and personal trainer came to see Terri with ‘bilateral foot pain’, in other words, she had pain in the centre and top of both feet, and had been suffering in considerable discomfort for two months.

Her GP had requested an X-ray of the lady’s hip and lumbar spine, but nothing abnormal was detected. She was then referred to orthopaedics for possible injection therapy.

The poor PT felt the pain was considerably aggravated after activity or training, and she also suffered with a disturbed sleep pattern, interrupted with burning pains and a tingling sensation that was being referred into her lower limbs. Nothing she did helped to ease the pain.

Terri explains what happened when she saw the lady for the first time:

“Upon assessment, I noted she had flat feet, and wore insoles when training. In a previous assessment elsewhere six months before, it was noted she had a poor gait pattern, and that she laterally rotated from the hip with no lumbar rotation.”

In other words, the unfortunate personal trainer had a less than ideal running style, and her legs swung inwards from the hip, with no movement in the lower back.

Terri continued with her assessment:

“The pain she described suggested that some neural involvement was possible, with the sleep disturbance supporting this theory, as the pain caused by neural tissue damage is often worse at night, due to a drop in blood pressure, and a reduced oxygen supply.

“Therefore a neurological assessment was performed to screen for any significant findings, and the integrity of the peripheral nervous system - all was intact.”

Terri’s explanation so far shows just how much knowledge and in-depth analysis is required in physiotherapy assessments, as the range of issues presented in clinics can be hugely varied!

Our physiotherapy expert then carried out a ‘straight leg raise’ (SLR) test on both legs, and found that the left leg raise was less complete than the right, and, interestingly, reproduced the lady’s symptoms in her lower lumbar spine.

Terri explained what happened next in this thorough assessment:

“Her lumbar spine movements were surprisingly full, but upon palpation of the L5-S1 disc (in her spine), it unilaterally (on one side) showed resistance mid-range, but with no reproduction of her symptoms.

“I then changed her into a neurodynamic position similar to her main activity.”

To explain this terminology in layman’s terms, Terri performed a neurodynamic assessment to evaluate the length and mobility of various components of the nervous system. This is done by placing progressively more tension on the component of the nervous system that is being tested.

Terri continued:

“With the lady’s straight leg raise in the prone position, I performed manual therapy techniques to her tibia (shin bone) and fibula (calf bone) which reproduced her foot pain perfectly - this was performed on both the left and right lower limb.

“I therefore carried out this treatment in specific grades to both sides in two consecutive sessions, progressing the grade from the previous treatment session. The carryover from the first to the second session was good initially, but then we plateaued.”

Again, Terri’s complex analysis and intricate note-taking highlight the sheer amount of attention to detail and awareness of so many integrated factors involved as the possible cause of this, and every, patient’s issues.

Terri explained what happened next:

“I then decided to also treat the interface of these structures (the surrounding integrated areas), and began further re-assessment of specific segments. I performed manual therapy to her L5 -S1 disc in a neurodynamic position (see explanation of this term above), and this further improved her symptoms.

“The treatment was aimed at improving her segmental movement, and improving the neural glide and integrity of the peripheral nervous system.”

Thus, Terri was aiming to improve the movement around the affected areas, and the effectiveness and smooth working of the nervous system, all of which was integral to the lady’s recovery.

Happily, Terri’s treatment worked, perhaps unsurprisingly considering the amount of detailed assessment and analysis she had performed to ensure the lady’s issue was dealt with in exactly the right manner.

“As a result of her treatment, the lady’s sleep was much improved, with no disturbance and no post-exercise exacerbation.

“When she went for her orthopaedic assessment, she told the consultant about her physiotherapy treatment, and, as a consequence, she was discharged, as treatment was no longer required from him or his team!”

What a fantastic result for this fit and active lady, who relied on her ability to be mobile and pain-free for her business, as well as her own well being.

She now continues to teach and train, and has not had any further concerns to date!

Our five-strong physiotherapy team treat a huge variety of issues, so please contact us if you have any pains or niggles you need us to look at, because, as you will be no doubt aware after reading this article, the depth of detail our experts go into to correctly assess the issue and treat it with the utmost care and attention is second to none.