TASTM for posterior tibial tendinitis | Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

TASTM for posterior tibial tendinitis

Interesting case. Pt is a 30 yo Triathlete known to me. See on and off for ITB friction syndrome, arthroscopic repair of L shoulder, various wear and tear issues secondary to his active lifestyle.

A few years ago I was treating him for anterior tibial tendinitis when I had to refer him for B compartment syndrome, which was released surgically. While healing, he developed infections of both areas. He eventually got back to running.

Recently, while training for a triathlon, he came to me with posterior tibial pain. I improved his core stability, used tool assisted soft tissue manipulation (TASTM) with the EDGE to his ITB, and calf, which also improved his dorsiflexion, which was limited.

The posterior tibial medial bony contours were slightly restricted, but not like I expected. I performed a lot of aggressive transverse or perpendicular calf release, which helped, but the effect was transient. He was compliant with his HEP.

After a few Tx sessions, I decided to use the smallest convexity of my tool and just dig about 1/4" in, which immediately reproduced his pain. I found quite a bit of scar tissue and probably spent 10 minutes releasing it. He was then able to run for the next two days nearly pain free. I learned sometimes, you have to go much deeper than you feel comfortable. You can see in the picture how deep I had to press. After two more treatments, his progressively worsening posterior tibial tendinitis was gone and he was back to running pain free.

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