[Open Mind]

Hi I've often read various threads but am slow typist so this is the first time I've posted anything.

I have an elite swimmer with posterior ankle impingement. They have previously had a corticosteroid injection (1 yr ago on the os I believe) & was asymptomatic for approx 9 months.

Pain is main symptom but is generally intermittant and only with higher sets & with fins. Reproducing symptoms clincally has also been intermittant (even poolside!).

Initial clinical problems at the time, lost about 20% WB DF - accessory loss was mainly TC & tibfib with some f/footsome, PF was full, neural differences with SLR & Slump bias' (but not reproduction of sx) R vs L, palpation tenderness was intermittant & not they think site of orignial problem or injection site. Is also tender (again intermittantly) around posterior fibula / sural nerve.

L/s, SIJ testing is normal (to me anyway!). Has just finished a 14 day NSAIDs course (surgeons suggestion). Has seen team physician who was happy with what approach & are reviewing with surgeon in a few days.

Athlete isotherwise fit & healthy with no medical conditions.

Have treated it based on what you read above, restored DF, some neural stuff & is probably getting along at about 90-95% - which as you would expect is not enough function for level of athlete.

Have worked with other top athletes with similar issues (although not swimmers) & have generally speaking got them through, this one is proving a little tougher!

Just wanting to get thoughts / ideas of other therapists who may have dealt with similar things & or elite type swimming problems.
Thanks