# Tibialis Posterior Pain



## tunafisherman (Aug 8, 2016)

So in laymen's terms the inside of my Right ankle has been killing me.  Had a doctor friend look it over and it's just a bad strain for now he thinks, possible tear or rupture of the Posterior Tendon but that isn't what he expects and would take a MRI to confirm.  All of this stems from my knee injury which has caused my stride in running (phucking cardio) to change--basically my foot turns outward when running, which puts more pressure on the tendon.

Anyway, was wondering if anyone had any experience with this.  It's been going on about a week, and my dumbass has continued to train on it, with some self-imposed limitations.  I still was running on it until a day ago, and will do my best to rest it now.  Was going to have leg day tomorrow, but will probably postpone that as well.

In the mean time, I don't want to stop deadlifting as I've made some great progress the past month or 2.  I have a solid brace, but was also wondering if anyone had done DL in a brace, or if I should just skip it all.


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## PillarofBalance (Aug 8, 2016)

More than likely this is a nerve impingement around the medial malleolus than a tear.  This would be a good time to floss the ankle and try and restore normal ROM.  You should find a good physical therapist to help you strengthen the ankle too.

Deadlifting, if don't correctly should not be a problem as there should be very little flexion of the ankle.


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## tunafisherman (Aug 8, 2016)

PillarofBalance said:


> More than likely this is a nerve impingement around the medial malleolus than a tear.  This would be a good time to floss the ankle and try and restore normal ROM.  You should find a good physical therapist to help you strengthen the ankle too.
> 
> Deadlifting, if don't correctly should not be a problem as there should be very little flexion of the ankle.



Thanks.  I also got an old brace out for the ankle and planned on deadlifting with it.  What do you mean by "floss the ankle"?


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## PillarofBalance (Aug 8, 2016)

https://youtu.be/_u4eObrrmZc

The white compression band you see is what's referred to as floss. It's an occlusion therapy and also provides a tac and stretch like active release therapy.  The bands can be bought at roguefitness.com by searching for voodoo floss. Get the black set. Length doesn't matter unless you are like 300 pounds.

You won't need to do what donnie does with the black bands. You just need someone to grab your foot and just start rotating it.  I keep saying this and it's becoming my mantra. "Motion is restorative." 

Get it moving and get the fluids out.

Nobody in the gym except my team is taking care of their ankles properly and it's one of the most important joints you have.


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## tunafisherman (Aug 8, 2016)

Thanks brother.

I know that the military (at least Marines) agree with the "motion in restorative"  approach.  I had hurt some joints and their standard practice differs significantly from the civilian side--but the more medical papers I've read on the subject more it seems to be catching on, and the RICE method is falling off.


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## PillarofBalance (Aug 8, 2016)

tunafisherman said:


> Thanks brother.
> 
> I know that the military (at least Marines) agree with the "motion in restorative"  approach.  I had hurt some joints and their standard practice differs significantly from the civilian side--but the more medical papers I've read on the subject more it seems to be catching on, and the RICE method is falling off.



Rice is mostly shit yes. Compression I am good with. That's it.


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## Ryand (Aug 8, 2016)

PillarofBalance said:


> Rice is mostly shit yes. Compression I am good with. That's it.



Rice is in fact shit lol. The guy that created it many years ago retracted and even took the 'ice' out of it.


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## Ryand (Aug 8, 2016)

tunafisherman said:


> So in laymen's terms the inside of my Right ankle has been killing me.  Had a doctor friend look it over and it's just a bad strain for now he thinks, possible tear or rupture of the Posterior Tendon but that isn't what he expects and would take a MRI to confirm.  All of this stems from my knee injury which has caused my stride in running (phucking cardio) to change--basically my foot turns outward when running, which puts more pressure on the tendon.
> 
> Anyway, was wondering if anyone had any experience with this.  It's been going on about a week, and my dumbass has continued to train on it, with some self-imposed limitations.  I still was running on it until a day ago, and will do my best to rest it now.  Was going to have leg day tomorrow, but will probably postpone that as well.
> 
> In the mean time, I don't want to stop deadlifting as I've made some great progress the past month or 2.  I have a solid brace, but was also wondering if anyone had done DL in a brace, or if I should just skip it all.



What's your age bro?

I'm not going into detail about what I do, but I work w/ this shit everyday, and I clear this kind of stuff up everyday so hopefully I can give you some direction.

Without it being a spontaneous traumatic injury, I'm going to assume it's not a tendon or a ligament problem (your friend is correct this is a very strong possibility) I just try to save people the $ and hassle of MRIs starting out.

Look up flexor hallicus longus, and flexor digitorum longus muscle origions.







With increased running, and your foot compensating in external rotation, these muscles can become overused and huge problems.

Try to avoid aggravating activities, but keep the ankle mobile. The stuff that POB sent you was great...use the flossing and try to improve ankle mobility. 

Look up the insertions of those muscle and try to self-release them near the tibia. Or find a chiropractor or physical therapist trained in dry needling, graston, ART ect.

Release the muscle, avoid provocative activity, improve ankle and mid foot mobility -- inflammation and pain should decrease.

POB was right also, all of this could result in a peroneal nerve entrapment leading to more pain.

If this doesn't resolve in 1-6 weeks it may be time for an MRI to rule out more serious issues. Shoot me a PM or ask me anything else that might be in the gray area for you I'm sick if typing on this phone lol.

And judging by all the pictures you post I doubt you can avoid provocative activity you slaying fool lmao.


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## Ryand (Aug 8, 2016)

Also I agree w/ the restorative motion concept.  Keep as active as possible, it is ok to reproduce pain and symptoms, as long as it is not worse afterward -- if it's worse then that was the wrong activity or you over did it. (I.e.. Totally fine to deadlift if it hurts during, but if you are worse in the evening or the morning you need to modify).


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## tunafisherman (Aug 9, 2016)

I don't know who Ryand is, but I like this guy....

other symptoms include loud pops...like it locks up and I know how to get it to "crack," which is generally followed by a bit of pain but massive relief.


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## Beedeezy (Aug 9, 2016)

Broken record...
I have pretty much educated all of my minor care physicians enough that they stopped giving crutches to people for strains and sprains. Unless we really think there is structural damage we don't immobilize joints anymore. I do most of the patient education before discharge and I tell them all "take it easy for a day or two but after that you need to ease into using the (insert injured extremity here). It will only become more stiff and take longer to heal if you stay off it for an extended amount of time.

Unfortunately, many of the older MD/DO still tell people R.I.C.E and include it with discharge instructions. Thankfully the new wave of clinicians are much more open to physical therapy approaches to rehab.
Sorry to ramble but... I was taking a lacrosse ball to a nurses shoulder the other night that was wearing an ace wrap and forearm compress band because her elbow hurt. I was talking about referred pain and how its usually the joint below or above causing the pain not where she was feeling it. Old female MD sighed within ear shot. It was everything I had not to ask if she wanted to speak up. I love the medical model but hate old farts that refuse to get with the times.
/endrant


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## PillarofBalance (Aug 9, 2016)

tunafisherman said:


> I don't know who Ryand is, but I like this guy....
> 
> other symptoms include loud pops...like it locks up and I know how to get it to "crack," which is generally followed by a bit of pain but massive relief.



Maybe that's the talus? Where is the sound coming from exactly?


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## Ryand (Aug 9, 2016)

PillarofBalance said:


> Maybe that's the talus? Where is the sound coming from exactly?



Very possible also w/ all the running. Hard to pick up on X-ray, advanced imaging would rule that out a few weeks down the road tuna.


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## Ryand (Aug 9, 2016)

tunafisherman said:


> I don't know who Ryand is, but I like this guy....
> 
> other symptoms include loud pops...like it locks up and I know how to get it to "crack," which is generally followed by a bit of pain but massive relief.



Happy to try to help bro. Injuries suck, and sometimes the process of figuring out how to get the injury healed is worse.


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## tunafisherman (Aug 10, 2016)

PillarofBalance said:


> Maybe that's the talus? Where is the sound coming from exactly?



I haven't had it happen in the past day, was working on what everyone here said and the pain is still there, but mobility is better.  From what I remember, it was just a loud pop, more from the outside of the ankle bone...reminded me of the sound of a joint being "popped" back in.


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## Ryand (Aug 10, 2016)

^^ that's a great sign so far.

Like POB said might be the talus. If you try all this stuff and you arn't noticing significant improvements in 2-6 weeks, it may be more serious and require the MRI.

Could be damage/fracture to the talus or ligament damage -- MRI will pick up the soft tissue damage, and maybe some findings on the talus. Unfortunately a better way to assess the talus is CT scan.

I can understand not wanting to give up location/city -- but I know great physicians all over the nation.

I suggest professional, conservative treatment first -- ie PT, Chiro, etc.

If self treatment, or professional treatment doesn't work, it's time for the medical model.


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## tunafisherman (Nov 29, 2016)

Reviving this because, after a couple months of feeling fine, it has flared back up, probably a week or so of being sore. This time more swelling and a lot more pain than I remember from the previous time.  I have increased my cardio over the past few weeks as I am trying to keep my 3 mile run time around 20-21 mins (it's the Marine in me that wont die...haha--it's how I measure my endurance for running).  

Anyway, have flossed it and continue to use it, but idk if today I over did it or what.  2 miles into an easy run/jog it started hurting.  2.5 miles I stopped my warm-up run.  Went to deadlift.  Didn't go above 315 because it felt very unstable and painful.  Is it time to get it looked at professionally, or should I just cut back its use and give it a good amount of time to actually heal up?


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