Dont forget to assess calf capacity when managing patients with lower limb musculoskeletal pain and injury - it's not always the glutes that "aren't switching on".
Notice the wasting in this patient's RIGHT calf? This patient had equal single leg rise repetitions (20 each leg), yet 50% less single leg heel rise repetitions in his RIGHT calf (due to fatigue, not pain) compared to his LEFT calf. This was no doubt a contributing factor to his presentation of chronic RIGHT achilles tendon pain, LEFT knee cap pain and LEFT calf "tightness".
Delving deeper into his history, it was also discovered that 5yrs ago he spent 8 weeks in a moonboot following a distal RIGHT fibula fracture. His rehab following moonboot removal was pretty average.
Take home message: When dealing with any type of chronic lower limb injury, don't overlook calf capacity. Also make sure you probe into the patient's past injury history.
For more information on injury prevention and injury rehabilitation, read my blogs at www.mickhughes.physio/blog