Case 1 - Mr X #principles

Mr X is a 46 year old male who is typically quite sedentary in terms of physical activity. He works as an accountant and is married with 2 children (aged 8 and 10). He reports no history of significant injury or pathology. Additionally, he reports good general health, although he is slightly over-weight with a body mass index (BMI) of 27.

Upon presentation to you, he reports and onset of left Achilles tendon pain at the site of insertion which became very painful following a 5km run 2 days ago. It is still quite sore and hurts to now walk. He has been icing the area and avoiding walking due to pain. He is very fearful the tendon might rupture/tear.



When asked about how long the pain has been present, Mr X reports the pain started around 5-6 weeks ago during runs he has been completing while following the couch to 5 km program suggested to him on the NHS choices website to become physically active. Here is a copy of the program:

The tasks to complete related to this case are as follows are outlined on subsequent pages (1 page is allocated per question but you may write as little or as much as you like – this is your course and learning). This is designed to facilitate learning related to the principles section of the website.

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Your questions/tasks

  1. Please summarise the education you will provide Mr X to manage his acute pain/symptoms and why.
  2. Please outline what educational information you will provide Mr X about why he may have developed his Achilles tendon pain, including justification.
  3. When can Mr X return to running with consideration to time and/or other criteria? What is your justification for this
  4. How appropriate do you think the couch to 5 km program is for getting someone to start to run, including whether this follows accepted training load and adaptation principles? What aspects might you change and why? Can you write a better start to run program based on current load management evidence and understanding?
  5. Develop a potential exercise program for Mr X over the next 4 weeks including type of exercise, how often, and how you will progress. How will you progress, and what principles will you use to progress? How does your program align with mechanotherapy principles? If possible, record videos of you doing the exercises and post in the group with the hash tag #case1
  6. Mr X would like to continue to run in the future. Please develop an exercise program with consideration to ensuring performance and return to pain free running beyond for 4 weeks. What will be your criteria for progression and regression of exercises and or running?