[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on March 14, 2019 at 2:52 pm · in reply to: Mountaineering trip after calcaneal fracture #18370

It sounds like you are well on your way to your June trip. You’ve survived the immobilization/boney healing phase, and the initial ramp back up to some activity. Indications you are not tolerating the training load will be swelling and loss of motion. It will be important that you address single leg strengthening, as this is your greatest limiter on the road back to full function. EVERYTHING gets weak on that side after immobilization: tendons, ligaments, joint surfaces, soft tissue. Impact tolerance will be the last thing to improve after a period of strength load. Skiing should be one of the better tolerated activities. The transition to hiking/running will be the most difficult. Hope this gives you some overview.
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on March 9, 2019 at 3:55 pm · in reply to: Lyme disease #17870

Steve,
Thanks so much for sharing this. There are some conditions and injuries that we just can’t avoid. Finding your proper starting point for activity was key. It can be very difficult at times to be truthful with where to start, or how quick to progress.
Happy to hear you are able to return to activity.
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on March 7, 2019 at 8:30 pm · in reply to: ACL Reconstruction for Skiing #17760

Sorry to hear about your recent injury and ACL/MCL involvement. Ligament instability of the knee starts to become a safety issue in the backcountry as movement limiting incidents can then occur. My time rehabbing our US Ski Team Downhillers has given me some background with this injury. Graft selection is an important consideration, but the main issue is picking the right surgeon and trusting his judgement. I never recommend pushing for a surgery that the surgeon’s experience doesn’t favor. That said, the autograft patellar tendon compromises your quad, not a good outcome for a ski athlete. Dealing with subsequent chronic patellar tendonitis is no fun. The hamstring autograft is a great option, as is the allograft donor tissue. You have been getting some odd advice as the hamstring graft has nice outcomes for all patients. Speed of rehabilitation is individual, all the ACL surgeries need to respect the graft fixation time limitations, then its a matter of gradually progressing without getting into trouble with yanking on the graft with the wrong activities (ie: skiing, early running). I also agree that you need 3 months between surgeries to have a good leg to stand on for the 2nd surgery.
Best,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on March 7, 2019 at 8:11 pm · in reply to: Shin pain from maximum strength box step ups #17757

I recommend using a weight you can successfully do with your left leg to accommodate for the strength differential. Don’t worry that you can do more with the right. The most important thing is to correct the strength imbalance on the left. Make sure you keep a strength focus with the step down, if balance is an issue, use a ski pole to stabilize the movement. 4 sets of 8-10 to start,then 5×5 with appropriate load for strength.
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on March 3, 2019 at 1:13 pm · in reply to: Shin pain from maximum strength box step ups #17332

Great to hear about your improvement! Now that you have a way of doing step ups, start moving your back foot in closer to the box ~1-2inches a week to begin approximating what you are doing on your non-painful side. This will help you build strength in the movement gradually. For the heel touch exercise, try loading your stance foot at the heel as you lower down, don’t let the weight shift to the ball of the foot.
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on February 28, 2019 at 3:32 pm · in reply to: Shin pain from maximum strength box step ups #17157

Cool machine but I don’t think it’s a weakness issue. When you explore different positions for the step up, try making the hip angle greater to start with, and actively power through the hip into extension as you stand up. This will get greater contribution for the movement from the hip, taking some load off the front of the leg (quad/shin). Post a pic of your start position on the step, and that will show your relative femur/tibia lengths. Having shin pain is just unacceptable!! We gotta figure this out.
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on February 25, 2019 at 1:12 pm · in reply to: Shin pain from maximum strength box step ups #16993

Interesting response to step ups! Great job doing your single leg strengthening as this is an important component of any outdoor sport plan. I’ll assume here that you aren’t getting a ‘shin splints’ response to running that is showing up in your step ups. Shin strain during a fixed closed chain movement can occur due to your unique structure. We see this in squats and deadlifts as well. The relative length of your tibia compared to your femur affects the angle of the ankle/knee/hip during the step up. This can really load the anterior lower leg causing your shin to wig out.

Try observing how far your knee moves over the ankle during the movement. It might help to treat it more as a hip hinge movement causing a more vertical shin as you step up. For you, there might be a sweet spot between doing the movement as a squat vs deadlift (hip hinge). We would love to have it replicate steep uphill hiking with weight for best carry over, but keeping your pain under control is most important. You should be able to tell a difference as you explore the different positions if this is a helpful modification.

Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on February 22, 2019 at 2:44 pm · in reply to: Shoulder issues #16939

Shoulder impingement, the compression and inflammation of the space under your acromion, can have multiple causes and treatment paths. Since I try to have experienced all of the injuries my patients have, I know this condition well! When the traditional rotator cuff strengthening approach you have tried doesn’t yield results, a different approach is warranted.

Soft tissue fascial restrictions can affect the path of shoulder movement pushing you into an impingement. One of my ‘go to’ treatments is to roll out the posterior capsule of the shoulder. For strengthening I like to challenge the cuff in diagonal vectors with tubing resistance. Of course, the classic kettlebell overhead press is a fantastic shoulder strengthening movement that has nice postural effects, and is the key to a powerful pull up.

For those that have difficulty finding a local therapist that doesn’t tell you to sit on your butt, the chat link on the lower right gets you talking to me and directed to my online treatment practice if appropriate. If I’m with a patient you can email me at pete@worldcup.physio, or visit my website at http://www.worldcup.physio.

Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on February 21, 2019 at 10:52 pm · in reply to: Plantar Fasciitis – workouts & recovery tips? #16917

Pete here, really excited to contribute to this community! I share the need to get back to effective training as quick as possible while dealing with injury.

Good news/Bad news here! If you can intervene when it first starts, your success rate goes way up. I often deal with plantar fascitis that has gone on for MONTHS, that can be a different story. You first start with treating locally: arch support, change in footwear to more supportive, deep massage to the arch surfaces, kinesio taping or traditional athletic tape for support, and activity modification…ugh. Cycling with stiff shoes is usually well tolerated. Low rpm or standing intervals will address muscular endurance work. Deep water running in the pool would be better than swimming.

If you dig a little deeper to the origins, you can avoid it in the future. Training errors are the usual cause, poor progression in volume/intensity/terrain/equipment (Shoes)! Have a plan, a coach, and follow the path.

Calf and hamstring stiffness will create more restriction through the fascia, exacerbating heel pain. Dig a little deeper, and if your are over `30-40 the spine comes in to play as the cause of calf/hamstring tightness giving heel/foot pain. Of course every therapist will tell you the hip is ‘weak’ which increases the amount of work the foot has to do to control movement. One of my Olympians felt that getting really glut strong helped, but this does not work for everyone.

Whew, a lot of ground to cover here. As you can see, there can be several causes and therefore people have success with different treatments and approaches. Start working on the calf mobility, arch soft tissue support, and have your therapist run down what is the cause of your plantar fascitis.

Pete