Issue link: https://www.massageandbodyworkdigital.com/i/68009
ESSENTIAL SKILLS Photos by Melinda Bruno. Be sure to educate your clients so that as their healing progresses, they take steps to prevent the injury from recurring. RESISTED INVERSION OF THE FOOT With the client lying supine, sit in a chair facing the bottom of the client's foot. If the left foot is injured, place your right hand under the heel and grasp it for support. Then, place your left hand on the inner arch just proximal to the great toe. (If the right foot is injured, reverse those hand positions.) Now ask the client to forcefully push medially as you resist with equal force (Image 2). It's OK for the foot to be slightly fl exed or extended. If the tibialis posterior muscle or tendon is strained, this movement should cause some pain or discomfort. However, if it generally takes a few miles of running for the person to feel sore, you probably will not get a positive reading. In this case, it's best to have the person go out and run until he or she begins to feel some discomfort, and then repeat the test at that moment. PALPATION From the same testing position described above, ask the client to resist slightly so that the tendon is under some tension and protrudes a little. Then, palpate all along the tendon with a few fi rm transverse friction strokes to see whether it is tender. Check the other foot to see if there is any difference. If there is tenderness on both left and right sides, the test is inconclusive. (Some people just have sensitive tendons.) If palpating one side causes no discomfort, but palpating the other side reproduces the client's pain, you can be pretty sure that the posterior tibialis tendon is injured. Remember that there is no referred pain in the foot, so the area that hurts tells you the location of the injury. TREATMENT CHOICES SELF-TREATMENT First, it's important to have the client stop doing things that cause pain. If the person can run, dance, play tennis, or do another sort of exercise for a certain amount of time without pain, it is good for the healing process that he or she continues that activity—so long as the client does not go overboard. However, any exercise that causes pain (either during or immediately after the activity) should be discontinued. Keep in mind that when tendons are warmed up, pain is often masked, so clients should take it slowly at fi rst. If the strain is not too severe, rest combined with the rehabilitation exercises described below may be suffi cient for recovery. Be sure to educate your clients so that as their healing progresses, they take steps to prevent the injury from recurring. This means not returning to full activity too soon, warming up thoroughly before vigorous sports, and, if necessary, correcting poor foot alignment through exercises or orthotic devices. Some clients ask the therapist to teach them how to perform friction therapy on themselves. I do not recommend this. Clients tend to either work too hard and hurt themselves or work too lightly, so the treatment fails. 94 massage & bodywork july/august 2009