The rehabilitation program to address the biomechanical SI dysfunction, muscle weakness and myofascial therapy to the proximal hamstring has been implemented. The patient has made good progress in a short period of time. He reports less intense pain at the initiation of the run and experiences no spasms. He denies any pain after the run or at night. Subsequent SI examinations reveal that he has improved motion, however, not yet reciprocal.
More work is needed in functional flexibility.
Aggressive mobilization and stabilization of the pelvis and functional flexibility exercises will be continued until he is realigned and pain free. Once pain free, his running mileage will be increased weekly as tolerated and he will be transitioned to a home or gym based exercise program. Meanwhile, we are awaiting completion of the construction and addition of medial forefoot accommodative posts to his orthotics. If treatment had been ineffective and certainly if his condition worsened, we would consider further investigation. This would include MRI of the pelvis to investigate the possibility of ischial stress response or chronic hamstring scar tissue from recurrent strain and repetitive stress from the SI dysfunction.