Sesamoid Bone problems

Question from a Strength Coach in Australia working for a professional basketball team……………

Recently I’ve had 2 athletes having foot problems.  Both have a sesamoid problem. 1 has a crumbling sesamoid and out for 8 weeks.  The other one has it on going for 1.5yrs and chose to play through it.  I believe one of the ligaments on the sesamoid has snapped. What’s your experience with this as far as management goes? And is there anything we can do to prevent this?  Thanks

Management here is very basic to start with rest and potentially some unloading mechanisms of an orthotic if rest is mitigated.

The key here is to understand that this is a result of a terrible forward weight shift and dominating pronation.  The prevention is good training to limit what brings these guys forward.  Please refer to my training basketball players post and interview.  http://charlieweingroff.com/2010/06/new-basketball-interview/http://charlieweingroff.com/2010/05/training-basketball-players/

The sesamoid bone problems are the reaction.  Elsewhere is the cause.

Locally, you have your traditional modalities, of which the Class IV Laser seems to be the most promising.  You can also utilize aggressive soft tissue manual therapy through the plantar aspects of the foot along with joint techniques for the toe and 1st ray.
Regionally, continue with joint manual therapy if the subtalar joint is not mobile enough along with heel cord attention.
Interregionally, this type of condition can live anywhere, flexion, extension, rotation.  Find the weakest link and go to work there.

Training wise, keep everything on the knees.  Don’t make it worse.


  • June 20, 2010

Leave a Reply 2 comments

Travis Hansen Reply

Charlie,
Great little piece. Only part where I was a little lost was at the interregional statement. Is interregional everything proximal to the subtalar joint? And keep everything on the knees? Thanks.

Charlie Reply

Typically, you can follow this paradigm to qualify tracking down the pain, the source, and the cause.

Local is exactly where the pain is and where a local inflammatory response is taking place. Sometimes in areas of true radiating or referred pain, the local problem can be considered where the pain is felt, but also where it is eminating from @ a nerve root, disc, trigger point, etc.

Regional is based on the immediately surrounding joints of the local pain. This is the kinesiological or biomechanical cause of why the local region is bearing excessive stress.

Interregional is based on the particular movement pattern(s) that are yielding the aberrant mechanics. Proper regional training will almost be guaranteed if you start the attack with a movement-based apporach.

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