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J Can Chiropr Assoc. 2009 Mar;53(1):23-31.

Conservative treatment of a tibialis posterior strain in a novice triathlete: a case report.

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  • 1Assistant Professor, Clinical Education, Canadian Memorial Chiropractic College, 6100 Leslie St., Toronto, Ontario M2H 3J1. ext. 395, , Email: showitt@cmcc.ca.



To detail the progress of a novice triathlete with an unusual mechanism of a tibialis posterior strain who underwent successful conservative treatment and rehabilitation. Tibialis posterior tendon dysfunction will be discussed as it relates to the case.


The clinical features of tibialis posterior dysfunction are swelling and edema posterior to the medial malleolus with pain and an inability to weight bear. This injury may occur in endurance athletes such as triathletes, most often occurring during running.


The conservative treatment approach used in this case consisted of medical acupuncture with electrical stimulation, Graston Technique((c)) a soft tissue instrument assisted mobilization technique, Active Release Technique((R)), ultrasound therapy with Traumeel, and rehabilitation. Gait analysis and orthotic prescription was completed when the patient was ready to return to play. Outcome measures included subjective pain rating and return to pre-injury activities. Objective measures included swelling and manual muscle testing.


A novice triathlete with a grade I tibialis posterior strain was quickly relieved of his symptoms and able to return to his triathlon training with conservative treatment. Practitioners treating this type of injury could consider including the soft tissue techniques, modalities and rehabilitation employed in our case for other patients with lower leg strains and/or tibialis posterior dysfunction.


Active Release Technique®; Graston Technique©; tibialis posterior strain; triathlete

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