Last time I saw Mrs. Dehath she reported to be, “twisted like a pretzel.” Hopefully this time around we will find some decreases in tissue tension and discomfort as well as increases in energy and strength.
She reports feeling some improvement, both in the level of discomfort and in her ability to move a bit more freely. The referred pain down the leg is gone. No new issues have arisen so I’m going to continue my course of action.
First we follow up from last weeks assessments to see what has improved.
Visual assessment shows the following:
-Bilateral dropped arches with right side a little lower: This has stayed the same
-Common cause: Overactive calves, peroneus longus, tibialis posterior. Inhibitied/weak tibialis anterior and plantar foot intrinsic muscles.
– Externally rotated feet. Right side noticeably worse. This has improved moderately
– Common cause: Overactive external hip rotators. Inhibited/weak hip medial rotators
– Right ASIS inferior and anterior Still off but at least a 50% correction
– Common cause: Overactive right rectus femoris, iliacus, left lumbar ESG, QL.
– Type 1 left curve through lumbar/thoracic spine – Mild improvement
– Likely due to the rotation in the pelvis causing the sacrum to be tilted right. Tight left ESG.
– Elevated/upward rotated left shoulder – Mild Improvement
Common cause: Overactive left upper trap, levator scapula. Inhibited/weak lower trap, rhomboids
– Cranial right shear (usually a righting reflex compensation) – Mild Improvement
-Common cause: Overactive L sub occip, SCM.
Special tests for referred pain
Because she complains of pain going down the leg in a pattern that could indicate the sciatic nerve I perform a sciatic nerve stress test. It is negative which means likely this symptom may be trigger point referral from the gluteus minimus. No more referred leg pain so we skip these.
Overall this seems like solid improvement and hopefully will allow today’s care to reach greater depth.
Today’s session focuses on the same tissues as they all require continual care for further improvement. However the tissues are holding less tension to begin with and release quicker which allows a bit of time to work on the dropped right arch.
Caring for a dropped arches revolves around releasing the hypertonic triceps surae and peroneals. Following the inhibition work to these tissues we utilize spindle stimulation techniques (look at 1:00) to invigorate and wake up the the tibialis anterior.
The abdominals are much less restricted allowing for a modest amount of pressure to be applied to the deep psoas superficial fibers of the iliacus. This is kept mild to ensure we don’t cause any irritation.
The capsular restriction with hip internal rotation is still present but time doesn’t allow for this work to be done today.
Overall there is solid progress. Mrs. Dehath will continue with the previous weeks self care. In addition to that we will add stretches for both the gastrocnemius and soleus and ankle stabilization exercises to begin strengthening and lifting the medial arches.
Follow up again in 1 week and continue balancing her structure.
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