T Nation

Help with Troubled Leg

Hi there

Im a 30 years old female Physiotherapist from Denmark. For the past 10 years I have had some set´veer problems in my left leg. I have tried all treatments available in Denmark. Unfortunately the physical therapy are years behind in Denmark so now I’m reaching out. Hopefully someone is able to help me on my journey to regain my functionality. As a side note should I mention that I intend to travel overseas in february/march to consult a qualified practitioner.

History of injuries:

  • Repeated sprained ancles

  • Traumatic fracture 7 cm distalt caput fibula and double sprain in ancle from 2002

  • Lack of dynamic stability in lower back

  • Generel hypermobile

  • L2-4 derangement - dosen´t respond on McKenzie or manuel therapy

Training experience:

  • Competition swimmer during my teenage years from my 11th to 18th year.

  • From 18th to 28th year commercial gym training, running, spinning

  • Crossfit and weightlifting for the past two years.

Sympthoms in left leg:

-Reduced weight bearing - standing and during gait

-Mired forefoot. I don’t use any kind of sole

  • Laxity talucrural + caput fibula

  • Whole left leg constantly feels inflamed and thickened/pressed

  • Reduced sensibility and at the same time allodyni in the L5 dermatome

  • Lack of force and activity in m. tib. ant.

  • Lack of posterior chain activation during squats and deadlifts. Activation is normal when KB swings is performed.

  • The left gluteal region is very sore and there is active trigger points in both gluts inclusive TFL and QL.

  • Lack of mobility in the left hip extension/tight psoas

  • Increased tension in the right hip adductor and reduced external rotation.

  • Left medial knee pain when performing back squats and walking upstairs downstairs - due to lack of activation of VMO even though the muscle is very prominent

-Constant sharp pain in left heel. Xray has verified that there is no calcfication

  • Generel lack of control, coordination and balance in the left leg

-EMG in left feet showed sprouting (neuroma). Surgery hasn’t been suggested

Sympthoms increases when i don’t sleep enough, eat sugar or gluten, all moderat aerobe physical activity during time - especially walking in slow speed

Symthoms decreases when i get enough sleep, deadlifting/dynamic high load strengthtraining of the erector spinae, pelvic floor mobilization, inactivity, or anaerobe physical activity

I have already tried McKenzie, Manual Therapy, acupuncture, osteopathic, dynamic stability of the lower back, time without working/relax, painkillers (NSAID, paracetamol). I haven’t responded to any of that.

For the last 9 weeks I haven’t been weightlifting at all. But on daily basics mobilized my iliopsoas, the posterior myofasciel chain, the external hip rotator, mobilized the hip and pelvic with a muscle driver. I’ve trained core stability, KB swings and just a little cardio (rowing and powerwalking). Besides I have stabilized my scapula and neck.
I’ve just started back squatting again. The result is instantly left knee pain and lack of coordination. I gave it a try for one week, and now I’m only doing the KB swings once again.
The mobilization is helping my mobility, but it hasn’t had any influence of my symptoms - yet!

None in Denmark has been able to locate the problem. I cross my fingers and hope that someone out there can help me to regain my functionality.

Best regards Annika.

If I had to hazard a guess I would bet your transverse abdominus and superficial and deep multifidus aren’t working and your global (superficial) back muscles have taken over, leading to poor segmental control of your vertebrae.

You may already have looked, but check out Stewart McGill’s techniques and research. I’d regress all exercise except walking until your Transverse abdominus and multifidus have been proven to be activating in the right order, and then progress through back and abdominal exercises only as your control of those two allows.

Apologies if any of that sounds condescending, I realise you’re a practitioner.