Week 6

            This week I learned the process of evaluating a patient when they first start at Synergy. I will show the process by describing Vincent’s thinking process for a patient named Allan.

            Allan walked in with a slight limp. He said he hurt his left calf walking uphill about a week ago. He described it as a sharp pain. Then, last Friday, he was busy with a lot of activities. After that day he told us his pain level was at an 8 out of 10. A day or two before coming in, his right knee began to hurt too. Overall, he only starts to feel pain at the beginning of activities, but can still get through them.

            After hearing his story, we measured his range of joints to get some more clues. First, we tested his ankle joint. In a motion called dorsiflexion, which is moving the ankle to point the toes upwards, he only had 1 degree of motion, both active and passive, whereas most people should have around 10-15 degrees. This stiffness is usually due to low fluid levels. But the takeaway from this discovery is that his calves were probably trying to move his ankle join when the ankle joint couldn’t adjust to the uphill climb, given that the calves pull the ankles into dorsiflexion.

            When we were trying to move his legs in all different directions, he revealed all kinds of compensation methods, like rotating his legs, so long as he didn’t have to use his calves. He also couldn’t stand on his tiptoes. This proved the stiffness in his calves and Achilles was due to them being so weak. The right knee pain that began later was probably due to him compensating on the other leg and bearing too much weight on that side.

            The final conclusion based on that information was that he had a tear in his calf. It couldn’t have been a bone injury because he only feels the pain after activity. We also concluded that it was an interstitial tear, one that goes between strands of calf muscle, breaking them apart, but not actually breaking any strands themselves. If it was a tear that went across strands, then we would’ve noticed a bump in his skin from where the muscle would have snapped and coiled up. Also, he wouldn’t have been able to walk.

            In order to treat Allan, we can’t just break down the calves and build up the strength again. We have to solve the original, underlying problem that caused the calf to tear. And that was the stiffness in the ankle. It is always important to not just treat the injury, but the cause of the injury. And it’s usually not obvious. We taught him stretches for his lower leg to begin loosening up muscle. Later on we will tear the scar tissue. Then we will build up necessary strength. We will also move the ankle joint in all directions forcefully to allow more fluid to enter the joint. When he has range in his joints and strength in the supporting muscles, then we can discharge him.