At 09:20 01/07/98 +0100, you wrote:
>On Wed, 1 Jul 1998, Matthew Mollica wrote:
>
>> His symptoms can be so severe that it
>> hurts to pull pants on over his calves, or touch the skin
>> over soleus.
>
>The above seem to indicate some kind of nerve pathology, since, given his
>level of fitness, cannot justify thinking of delayed onset muscle soreness.
I would agree to a degree, but considering the unusual presentation, may
have to consider that this may be pathological muscle. 48 hours is about
the latency for maximal CK blood levels in DOMS from my memory of recent
literature, I would agree with your suggestion of blood tests, biopsy to
rule out muscle pathology. Will be interested in follow up as well.>
>> Calf stretching at this time is excruciating.
>
>again, if we consider that strech receptors are activated with that kind
>of activity, pain should not be normally felt. perhaps the same kind of
>pathology as that indicated above is possible.
>
>> Symptoms remit over days three and four post-gym. He has been
>> told that the fascia around his calves is way too tight, and
>> has seen masseurs for fascial release / deep tissue massage.
>
>this was to be expected. Had he a compartment syndrome, pain would be
>worse during the course of his activity, not two days after!
>
>
>> This has provided little relief. I have no answers as to the
>> cause of his calf pains, or plans for further treatment.
>
>On the other hand the delayed nature of his symptoms may indicate some
>kind of myopathy for which we have not enough evidence to evaluate.
>Perhaps if you could provide information about:
>- atrophy. Are the calf muscles well developed?
>- strength. Does he experience weakness during or after activity or
>indeed whilst the tenderness and pain are present?
>- enzymes. Has he undergone any other medical investigation, such as
>blood tests (for Creatine kinase or myoglobin) or even considered a
>muscle biopsy?
Also if you are considering nerve as a source of pain, could do SLR/slump
variations to assess neural mobility. Does he have parasthesia? Any
neurological signs?
>- response to common analgesics. Is he receiving any type of medication
>and if yes which one and what is the response of his symptoms?
>a better picture may be available for evaluation.
>This is my two pence.
>
>This is truly perplexing and I for one, would really appreciate if you
>could continue to report the progress of this patient.
Ditto
Matt McEwan
Parkside Sports Physiotherapy
ENGADINE
Sydney, Australia
>Cheers,
>
>Panos Barlas, BSc(Hons)PDD, DPhil, MCSP, SRP, LicAc
>Lecturer
>Department of Physiotherapy
>School of Health and Social Sciences,
>Coventry University,
>Priory Street,Coventry, CV1 5FB
>Tel: +44- (0)1203- 838980
>Fax: +44- (0)1203- 838020
>E-mail: [log in to unmask]
>
>
>
>
>
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