Or, why making your client’s symptoms worse might be a good thing
I like it when my therapeutic interventions make things worse. Is that surprising? Here’s an example to illustrate why it can be such a good thing.
My client came in complaining of a few things: some urgency incontinence and some foot pain in both feet.
The postural assessment revealed a navicular drop on both sides, but slightly worse on the right than the left. When the issue presents on both sides, it’s often caused by something midline – a core issue. We already knew that there was a pelvic floor problem because of the incontinence, so we quickly tracked the issue there. When standing, if the client did a firm keagal, the right ankle would adjust into a less dysfunctional position. So … treat the pelvic floor and the feet should get better, easy-peasy, right??
Not to be.
After releasing the pelvic floor issue and correcting a misalignment of the pubic bone using Neurokinetic Therapy, a trigger point release and some remedial exercises, the right foot was in even worse shape!!
Now that’s interesting. Want to know what happened? We undid a pelvic floor compensation pattern that was partially correcting the ankle issue at the midfoot. Without it, the midfoot, which was aggressively being pulled medially from the adhesions in the forefoot, dropped into even deeper pronation. We had undone a compensation pattern that made the real issue even more apparent. Nothing to be upset about! What a win – now we could see where the real problem lay.
So I started to question the history around the right foot. Turns out that the client had dropped something on that foot a decade ago (right before the first pregnancy) and had a pretty bad bruise, possibly with a small undiagnosed fracture. (Not listed in the history because it was considered “minor” – and this is why I insist EVERYTHING be put into the injury history).
After that it truly was easy. Palpation in the foot showed scar tissue and adhesions between the first and second metatarsal, causing the forefoot to stay in passive pronation and preventing the rest of the foot from being in a functional position without the help of the pelvic floor!
A few minutes later, after some deep work on the intermet, the client’s adductors relaxed and the ankle was able to settle into a much more functional position. The pelvic floor didn’t need to compensate anymore. I sent the client home with a small ball to do their own releases with and some exercises to improve active pronation. One step back, two steps forward, and no pain at all in the feet.
