Russell,
Prognosis depends ‘in part’ with the severity of the injury to the chondral region. It’s amazing the amount of progress you can make in return to function over time. Big injuries in practice take around a year for near-full recovery. If you have ever been in this situation, you’d make a deal with the devil to be that good in a year!! But to get that good, you have to take a true training approach to your rehab employing consistency, the right loads at the right time, and appreciation of attaining small goals along the way, think rehabTFTUA.
On a side note, I’m in Winthrop so if you would like a more individualized approach, just email me or use that chatbot in the lower right.
Cheers,
Pete
Pete Dickinson MS,PT
Forum Replies Created
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ParticipantParticipant
Russell,
I concur that you likely have a chondral injury of some sort. Really, an MRI would help confirm and give a more clear direction to treatment but…. Clearing up the anterior extensor mechanism of pain is a longish process. You will need patience as strength builds slowly in the presence of pain in this area. As strength builds, the stress across this area decreases and you will be able to handle deeper ranges of motion and higher external loads. So yes, there is a treatment, but you aren’t going to enjoy the timelines. You start off with lower loads and manageable ranges of motion (think bike with progression into force tempo work). There are pure strength movements that load the hip (an essential controller of patellar loads), and keep the patelofemoral joint largely out of it (deadlift). Let me know if I can be of help.
Cheers,
PeteParticipantcurriespencer,
Pain on the top of the 5th metatarsal with running can sometimes be caused by upward movement of the outside of the foot. This can happen due to a forefoot varus alignment which causes greater pronation of the forefoot dropping the inside, and pushing the outside up. Of course there is a lot of shoe interplay here either helping or hurting this process. Sometimes a simple metatarsal pad can be used to support the forefoot before getting into more involved orthosis. As always, review your training progressions to look for errors in over-enthusiasm. Rest will help and I hope you are down the road soon!
Cheers,
PeteParticipantPete Dickinson MS,PT on May 9, 2019 at 6:41 pm · in reply to: Knee discomfort vs base period plans #21815kocanez,
With the increase in minutes last week, and the sensations in your knee, I would back off and take it day by day. Don’t get locked into the plan if your body is giving you some pre injury signs. I’m ok with appropriate fatigue as that is part of training, but early season knee symptoms should be listened too. Core and strength can be maintained if your are accommodated to the activities. Hope this helps to tell you that you are right to listen to your body, our intrinsic motivation can sometimes mask our bodies ‘voice’.
Cheers,
PeteParticipantPete Dickinson MS,PT on April 29, 2019 at 7:57 pm · in reply to: Calf discomfort, especially on downhills #21159coryl93,
If you had a greater training block prior to onset of calf pain, then rest should be highly effective at decreasing your pain. Good job listening to this, as this is the exact type of thing that progresses to bigger issues if ignored and trained through. Rolling of the calf on a foam roll, kinesio taping, and switching to other cardio such as the bike are all good things to try in the short term. If you have failure to improve, I would advise seeing a physical therapist, or take advantage of my online therapy service. Other causes of calf pain include the back, ankle/knee/hip/spine mobility restrictions, fascial mobility impairment, leg length inequalities, and muscle tears of the medial gastroc.
Cheers,
PeteParticipantI’ll echo Dan in that this is quite interesting giving rise to a bunch of questions on our part! Medial tibial pain usually can be traced back to training errors, poor footwear, ankle mobility limitations, and too much or too little foot movement. Your previous background would seem to inoculate you to many of the typical causes of shin pain. The kicker is sedentary pain. There may be another component in play here. Pain outside of activity, or with other unusual characteristics might have a neural component. Excessive sitting limiting back mobility can certainly tighten up the posterior chain giving way to increased demands on the foot/shin complex during sport movements. Who knew shin pain could be so complicated!! My general recommendation is to focus on lower extremity strength, and for your volume supplement other aerobic pain free exercises, and progress running only as tolerated.
Cheers,
PeteParticipantPete Dickinson MS,PT on April 15, 2019 at 6:24 pm · in reply to: Exercise Induced Gross Hematuria (blood in urine) #20533Todd,
I have heard of this with impact related activities such as running. Its for sure a cautionary symptom which you should monitor going forward. Good job getting it checked out. With the lack of definitive diagnosis, I would return to training with continued observation of your response.
PeteParticipantPete Dickinson MS,PT on April 5, 2019 at 10:01 pm · in reply to: Referral for Residual High Altitude Issues #20032Frank,
Can you give a little more detail about the ‘situation’. That’s a broad category. There are pulmonary, cardiac, musculoskeletal categories involved. That will impact the referral.
PeteParticipantBeat me to it with the link, that’s the one! Thanks Dan.
PeteParticipantPete Dickinson MS,PT on April 2, 2019 at 10:21 pm · in reply to: Training Well While Avoiding Barring Injuries #19740Jacob,
Thanks for reaching out. Tendon and joint pain I would consider on the more concerning side of the ‘injury scale’ compared to muscular pain. The course of treatment tends to be longer. Your progression, and content, of training sets you up for success or failure. A coach can be a huge help in getting the right mix and ramp of training for your project, just saying. Plantar fascia pain needs to be treated locally, and with other causes in mind. Depending on your presentation, I might recommend spine care, hip strengthening, fascial mobility around the foot and medial calf,you get the idea. I would definitely address it with a major project in two months. Resources are 1. A TFTNA coach 2. Local Physical Therapist (a physician won’t really treat this) 3. Chat with Pete.
Cheers,
PeteParticipantPete Dickinson MS,PT on April 1, 2019 at 8:26 pm · in reply to: Straightening leg, pain at knee, tips for recovery? #19698Kyle,
A meniscal injury will give pain to the ‘area’ or side its on. As you surmise, there are other injuries in the mix including an ITB friction syndrome and a lumbar radiculapathy. I once had a patient miss diagnosed with a meniscus injur,y when it was a lumbar nerve injury sending pain to the outside of his knee. If you are shut down from training, its time to get some help with it.
Cheers,
PeteParticipantPete Dickinson MS,PT on March 31, 2019 at 9:08 pm · in reply to: Straightening leg, pain at knee, tips for recovery? #19636I agree with ahole88 that your symptoms may be meniscal. Locking and catching of the knee are significant meniscus indications. Also, a chondral injury can give similar symptoms without the swelling. If it is a meniscus tear, you need to be aware of the ranges you interact with the tear, and try to train around them at first. Deep flexion is usually a problem (deeper squats etc.) uneven ground activities, and even biking can give you a problem. Try to get as strong as possible without pissing it off. If symptoms continue, see an orthopedist, MRI, scope to get back to full activity. Its the fastest rehab of all knee surgeries.
PeteParticipantEccentric training has long been used to load the tendon. The thinking is that the tendon (as opposed to the contractile tissue) sees more load in an eccentric movement, providing more specific stress and ‘recovery’ stimulation. This type of training teases out 1/2 of normal functional movement however. A strong school of thought is to train functional movements, and not try to isolate too much. The world of rehab is full of dead ends from thinking we can isolate structures to rehab (remember VMO training for patellofemoral dysfunction!!).
When bringing a tendon back to a healthier status, you want to progress through a loading sequence from easy to hard without increasing pain the following day. Easy loading would incorporate isometrics, with moderate loading using heavy but slow resistance exercise, with advanced training including plyometrics and movement specific activities. I would still include eccentrics, but focusing on them misses the point of progressing loads gradually, including single limb activities, and climbing the movement complexity ladder. Recent randomized controlled studies have born this out with superior results to heavy slow resistance tendon rehab compared to eccentrics.
I’m probably raising more questions than answers, but that’s what a forum is for!
Cheers,
PeteParticipantTendon injury and recovery is a big topic and worthy of a longer post, but I’ll do a quick primer. The key is to improve the function of the tendon region that is still able to improve. As this region gets stronger, your symptoms improve. Initial therapy starts with 45sec isometrics (calf raise ‘hold’). Progression into other exercises to push the tendon to greater function is quite gradual. Current thinking is moving away from eccentrics, and into higher load isotonics. Patience is the key requirement to improving this injury. Extended periods of tendon pain usually have training errors as a key component.
Pete
ParticipantPete Dickinson MS,PT on March 19, 2019 at 3:00 pm · in reply to: ACL Reconstruction for Skiing #18634Thank you dmburch for your surgeon perspective on this condition! My post exposed my biases gained from the treatment room. Since the patellar tendon autograft is considered a ‘gold standard’ I was able to see countless sport specific outcomes to this choice. While great in cutting sports due to it’s strength, it takes out the middle third of the patellar tendon leading to tendon pain with sports that load that area (think skiing, biking). I remember ski legend Marc Giradelli sitting at the start of many races packing snow on his patellar tendon due to his chronic pain at the end of his career (post ACL).
The “bottom line” might be laxity oriented in D1 Football, but this isn’t the whole story. Laxity was common in post ACL even in B-PT-B due to the demands of sport and training, in my alpine team experience. In light of the graft choices available, the advantages outweigh the disadvantages for the knee extensor loaded sport participant to consider non B-PT-B grafts.
All this being said, pick the surgeon, not the graft. Your surgeon of choice will have what works for him based on his skills and experience.
Respectfully,
Pete