[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on January 24, 2021 at 7:00 pm · in reply to: Low Grade ACL tear. #49696

Heet,
In treating the knee, look at regaining your full extension of the knee. If motion is full, goblet squats and single leg step ups/downs are a great strengthening exercise you can do at home. Gradually return to running. If you are not running normally due to knee pain, yes, this could irritate the back. Also perform core exercises to strengthen around the back while exercising the knee.
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on January 24, 2021 at 6:56 pm · in reply to: Ankles Ankles Ankles- looking for some RUNNING specific help please :) #49695

Ankles can take some time to tolerate running after a significant sprain. Rehabilitation for this includes inversion/eversion band strengthening, calf stretching to make sure you have full dorsiflexion, and balance/dynamic movement retraining. You will get better, but may need to put some effort into returning normal sport function to the ankle.
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on January 16, 2021 at 7:51 pm · in reply to: Peroneal Tendinopathy (maybe?) questions #49346

You can start some light strength right away, maybe a short week away from running then reintroduce with walk/jog progressions. The concept here is to return to activity ASAP that doesn’t irritate the condition, then gradually reintroduce the more dynamic activity at a reduced level/load/volume. Find a painfree starting point, then very slowly progress. The training error that I see here is your training surfaces are all over the place, I would try to get more consistent/good surfaces to start on.
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on January 14, 2021 at 3:14 pm · in reply to: Achilles tendinitis 20 months #49296

Rich,
Thanks for your thoughts on this! But as I said, focus on eccentrics is so 1990″s. Current research provides continued modifications in our treatment regimens. I certainly am treating differently than I did 5 years ago, as research and clinical experience add to my skill set. There are interesting studies using heavy strength loads that outperform eccentrics as a treatment for tendonitis. There is also a study that shows equivalent benefit. Want you really want to do is nail your functional progressions from a relatively pain free starting point. This will include isometrics/concentrics/eccentrics/dynamic movement/plyometrics….you get the idea. The biggest factor limiting effectiveness of treatment is self inflicted training errors due to OES (Over Enthusiasm Syndrome).
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on January 13, 2021 at 4:11 pm · in reply to: Dupuytren’s Contracture #49264

Uli,
If you are at an early stage in this condition, you might try the enzyme or steroid injections. My patients have had good results with this. A hand specialist is always recommended for this.
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on January 13, 2021 at 4:07 pm · in reply to: Achilles tendinitis 20 months #49263

Tom,
So sorry to hear about your achilles tendonitis. Your experience is very typical with poor response to treatment, ongoing pain with return to significant activity. Eccentric training for this is so 1990’s. So here’s the deal, you have an injured part to the tendon, it really won’t ‘heal’. You have to slowly build up the remaining ‘good’ part to the tendon to take enough load to tolerate training etc. The key is finding a starting point, and progressing from there. Most Uphill Athletes don’t start at a low enough level of activity. The remaining good part of the tendon can’t take the load, so that the ‘bad’ part of the tendon gets involved and becomes painful. I have success with my patients starting with calf raise isometrics, 5x30sec both feet loaded. Really, isometrics. From there it gets increased to single leg, then some more dynamic movements, deadlifts/step downs…and return to sport with a walk/jog program. If you want more personalized progressions, I’m at pete@worldcup.physio. A key ingredient in all this is….patience. It takes time for the physiologic changes to occur, but they can!!
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on January 4, 2021 at 10:23 pm · in reply to: Staying on Track when Injured #48812

Christie,
For individual guidance I recommend a coach or PT to apply an individual approach as you requested. In general, to run you need to…..run. This can be phased in as you work on some of the contributing factors to your development of IT injury. Other activities can help with general fitness, but will have poor transfer to running.
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on December 23, 2020 at 9:44 am · in reply to: Remedy against Posterior Tibial tendonitis symptomes #48508

Trygve,
This is a fairly complicated topic depending on your foot structure and training status. The change in running form can just switch the injuries to different locations. Not that you can’t try this approach, just be aware that there isn’t one best way to do things.
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on December 22, 2020 at 9:54 pm · in reply to: Chronic low back pain #48489

Dealing with low back pain is a common occurrence for the Uphill Athlete. Traveling on uneven ground, big loads through the hips going into the back, loaded posturally challenging positions with packs, all conspire to challenge the lower back. In my travels with our Olympic athletes on the World Cup, 70% of my time is spent treating the lower back. Here are some general thoughts for caring for the lower back:
1. Technique. With skiing, your pelvic position can cause a significant increase in shear loads to the lower back. Maintaining a stabilized neutral pelvis during pole plant/push, and leg action is essential.
2. Strength. Core can be done daily 15min. In season, strength 2x week is common, 3x week when trying to advance strength and you can have sufficient recovery with your other activities. Strength movements include bilateral and unilateral movements of the lower extremities, overhead movements for their significant core challenge, and one speed movement such as a snatch/clean/swing/bounding. Dynamic control during various bounding movements in the sagital/frontal plane are also helpful for the advanced athlete.
3. Mobility. Soft tissue rolling with balls/foam rolls keep the tissue flexible and able to transfer loads effectively through the lower back. I also like a lot of thoracic spine mobility work with various windmill movements to stiffness here isn’t added to the lower back.
Big topic here but I thought I would throw some things out there.
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on December 22, 2020 at 7:42 pm · in reply to: Extremely tight hamstrings #48486

I agree with Scott on doing DL’s more frequently with less resistance to see if that helps with your soreness, it won’t be such a ‘new’ exercise for your body to adapt to.
I also agree with Rachel about foam rolling being more effective than stretching for hamstring mobility. Placing the hamstring on a prolonged straight leg stretch can irritate the sciatic nerve which can cause tightness and soreness chronically in the hamstring…..so….how is your back?
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on December 22, 2020 at 7:37 pm · in reply to: Remedy against Posterior Tibial tendonitis symptomes #48485

Thanks for covering for me Scott as I’m just now back from the World Cup….in a pandemic….story for another time.
Trygve: Burning/tingling symptoms might speak to a nerve traction of the tibial nerve in the tarsal tunnel just behind the medial malleolus. Tight calf muscles create greater loads throughout this region, and should be addressed with both straight and bent knee calf stretching. Many lower leg injuries are caused by training errors, too quick progression of loading. This is a great reason to use one of the great Uphill Athlete Coaches!!!

Rachel: Again, training errors are more responsible for calf injuries than most anything else. Along these lines, most athletes don’t have sufficient strength and stiffness in their lower extremities to handle running, which basically is bounding from leg to leg. Back to basics with deadlifts, single leg step downs/dead lifts, single leg calf raise isometrics go a long way to less pain in the lower leg…..Gizmodo….talking to you:)

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on October 23, 2020 at 3:52 pm · in reply to: One injury and one chronic condition…looking for advice #46201

Dan,
You’re moving in the right direction making sure you’re not getting a form of compartment syndrome with the tight cuff on the boots. There is a nerve that goes to your arch that can cause pain coming out of the tarsal tunnel. Orthotic intervention, proper boot fitting are good places to start. I would also mobilize the calf soft tissue with the rad roller or ‘stick’. You want to reduce restrictions on the nerve that goes to the arch, before it gets there. Standing knee touch on wall with foot several inches away till its difficult is also a good ankle stretch.
Just some additional ideas.
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on October 12, 2020 at 3:20 pm · in reply to: Training around injury #45937

This article is well done and repeats the drum we’ve been beating about tendinopathy….exercise is the most evidence-based intervention. Progressing into heavy loaded strength, with evolution to dynamic and sport movements in a gradual fashion, using the 10% rule where applicable. Tendon is helped by good fascial mobility as well. PRP and other injections/interventions are missing the boat on how the tendon evolves out of injury.
Cheers,
Pete

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on September 26, 2020 at 8:08 am · in reply to: Hiking/mountaineering recovery for partial ACL tear #45430

I use my regular road bike on a Tacx neo smart trainer. There are many software/web programs that offer great training for this method. For a large flywheel stand alone bike with power meter, you’re looking at more money.

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on September 24, 2020 at 9:56 pm · in reply to: Hiking/mountaineering recovery for partial ACL tear #45403

Yes, keep your sanity!! A spin bike is fine, the heavier flywheel is just something you have to be aware of when decelerating after an effort or with stopping. I use my regular bike on a smart trainer, no way I’ll outgrow it:) The chondral injury takes a LOT of time to heal, and the bike with low loads is a great way to help ‘polish’ the surface. To really load aerobically, the ski erg or deep water running is the way to go.
Cheers,
Pete