The human body is designed so that muscle groups work together. Simplistically, one muscle force may move a joint in one direction and this is opposed by another muscle force pulling the joint in the opposite direction. These are known as agonists and antagonists respectively. When the agonist is overworking or the antagonist is not working enough, muscular imbalance may occur and it generally develops over time and may be a result of poor technique, or overuse. Pain can inhibit muscle activation and this is also a cause of muscular imbalance.
Regardless of the cause, muscular imbalance alters joint mechanics and may lead to postural changes, joint overload, pain and dysfunction. Management generally involves a thorough biomechanical assessment to determine the origin of muscular imbalance followed by techniques to release tight structures and appropriate strengthening and biomechanical retraining.
Postural assessments observe how your body naturally rests, as well as how you use your body functionally. These assessments are integral in identifying areas of weakness, areas of stiffness or reduced flexibility and areas of increased injury risk. Commonly, strengthening exercises, control strategies and stretching are effective in resolving postural issues and these are often used in conjunction with manual therapy.
(Patella, Achilles, Gluteal)
Tendinopathies are a maladaptive response to load within a tendon. This usually happens when there is an increase in training or change in the type of sport or skill set within the same sport.
Managing the load of the tendon is the key – your physiotherapist will guide you through a loading programme specific to your needs. Massage and specific strengthening of the surrounding muscles will also help to unload the tendon. More often than not, biomechanical differences can predispose you to a tendinopathy. Your physiotherapist will assess your biomechanical differences and tailor your rehab to address these appropriately.
Posterior Ankle Impingement
Impingement is caused by structures such as bursas, fat pads or tendons being compressed in an area where movement may decrease the space for these structures (such as near a joint).
Posterior ankle impingement (PIS) occurs at the back of the ankle on actions such as pointing, jumping and rising and may involve irritation of the bursa, fat pads or the tendons and, in some cases, it may be associated with FHL tenosynovitis. Ice is useful in reducing the pain, swelling and irritation behind the ankle. Treatment includes soft tissue work to unload the muscles of the lower leg, ankle mobilisations, strengthening and biomechanical assessment and improvements.
Flexor Hallucis Longus (FHL) Tenosynovitis
The FHL is a muscle of the lower leg whose primary function is to pointe the big toe. The FHL muscle also contributes to plantarflexion (or pointing) of the ankle. The FHL tendon courses to the toe via a bony groove behind the inner part of the ankle and is surrounded by a sheath that assists the tendon to glide smoothly. Tenosynovitis is the inflammation of this sheath that surrounds a tendon, rather than the tendon itself.Particularly in ballet dancers, this muscle is susceptible to high loads with jumping, pointing and dancing en pointe. When overload occurs in this muscle, the tendon rubs excessively in the bony groove which causes an inflammatory response in the tendon sheath (i.e. tenosynovitis).
Signs and symptoms include pain anywhere along the FHL tendon, weakness in pointing/jumping/pointe work; reduce range of pointe and pinching at the back of the ankle. Physiotherapy treatment is key and includes soft tissue work, ankle mobilisation and strengthening.