What is this injury, and what do I do about it? Extreme tibial tendon and calf tightness + piriformis pain

I'm thinking posterior tibial tendonitis?

Talking about your piriformis, sciatic nerve, and posterior tibial tendon is pure guess work unless you have have had imaging done. You need to go see a doctor. Could be something relatively minor, but you could just be treating it wrong

Doc will just refer to ortho who would be the one to order an MRI. You’d be out of time by then.

Stay conservative. Try to find a PT that does dry needling.

So, I did in fact see multiple doctors, and no one can seem to figure out what's up.

I went to two PTs, both of whom did active release on my piriformis and lower legs. It's still excruciating, although the lower leg pain has seemingly migrated to my lower soleus. The PTT isn't as painful any more, although the tightness in the calf and shin still makes it so that I can barely take a normal step, let alone run.

The piriformis has gotten slightly better with plenty of rolling, glute work, and stretching, but it's still there. Both PTs recommended that I look into a cortisone shot now that it's been 3+ weeks. Meanwhile, my knee on that side is feeling super stiff and weak, which I imagine is a symptom of it compensating more everything else.

Finally, I saw an ortho, who ruled out SI nerve issues and diagnosed me with piriformis syndrome. That was a less than useful $35 copay. I've pretty much given up on the marathon, and at this point, just want to run again.

Based on some research I was doing yesterday, I'm starting to think that I strained the soleus and possibly the rest of the calf. Does anyone have experience with effective treatment modalities for calf strains? I'm seeing my PT again on Friday but am always interested in the experience of the hivemind here.

Have you had an MRI of your lumbar spine?

Banana Nut Crunch Fan wrote:

Have you had an MRI of your lumbar spine?

No, but I did have an X-ray; what would those be looking for? SI Joint issues?

I had this exact constellation of injury issues on and off for years. You need to firstly calm down and reset your training load expectations. Taking time off will not heal you, but continuing what you're doing will make it worse. If the PTT pain is more in your foot than already moving up your calf you have more hope though.

For some immediate relief tie your shoes tighter and try out some aggressive KT taping. Also you can try insoles with very very high arches, but this will likely just move the pain up your shin. Try to get graston from someone who really knows what they're doing. Typically a good graston session focused on my soleus would get rid of the PTT pain for a week or so. From there depending on location I highly highly recommend positional release technique (NOT ART). Google search that phrase and go to the institutes website and see if any of the faculty are located near you.

Now for long term fixes, let me start off with making some guesses. I'm assuming you have pretty weak glutes? Flat feet? Probably posterior pelvic tilt? All of my former teammates who also had these symptoms had 2/3 of the above. Things you should try:

- Glute strengthening - squats likely wont help someone with your mechanics so try weighted single leg RDLs (put a small plate under the inside of your bad foot to get proper engagement), weighted standing lunges, and box step ups

- More barefoot strides and maybe a couple barefoot turf laps at the end of a run

- Lighter shoes - still want something cushioned IMO but lighter weight so hokas, nikes seem to work well

- Toe separators an hour or so per day

Best of luck

beentherebefore wrote:

Now for long term fixes, let me start off with making some guesses. I'm assuming you have pretty weak glutes? Flat feet? Probably posterior pelvic tilt? All of my former teammates who also had these symptoms had 2/3 of the above.

This is scarily accurate; I have a history of extremely week glutes, and my feet are flat and malformed. Regarding this injury pattern, did you have the knee stiffness and focal point of pain at the tibial tuberosity, too?

So, Graston and the PRT were usually enough to get rid of this for you? I'm really worried because it's seemingly migrated from mostly PTT to a deep pain and weakness in my calf. Is it likely that I strained my calf, or could it just be a side effect of the other issues?

I'm frustrated because the majority of my doctor / PT visits have been pretty much useless at this point; so, I very much value the lived experience of folks like yourself. Thanks!

Ortho just scheduled me for a cortisone shot later this week to at least kill the piriformis part of the issue. Fingers crossed that helps with the rest of it.

(not bumping to bump, just keeping a record for my own future reference.)

I got an MRI today, with results to come in a couple days. The orthopedist who ordered it was pretty stumped; she was thinking it could be some sort of sciatic pain from the piriformis manifesting itself throughout the leg. The pain is excruciating, but it comes and goes and is generally worse in the morning than towards the end of the day.

Well, folks, the results are in:

It's a pretty nasty stress fracture of the posterior tibia, about five inches below the knee.

The pain became extremely sharp this past weekend, but in the past few weeks leading up to that, I would have never suspected a stress fracture. I've had tibial sfxs before, and this really did NOT feel like those. I suppose a lot of that is due to the one's unusual location on the rear of the bone, which made it mimic soft-tissue pain and make me think that running was still doable.

The ortho told me that I should be fine after 6-8 total weeks off, and as of today, I've already been out for 3 weeks. I'm also allowed to crosstrain as much as I want, so I'm trying to remain optimistic.

This thread is exactly what I'm dealing with too though not quite as fast as you are. If I don't have a stress fracture I wonder if the toe separators and single leg RDLs would work quite as well?