Once recovered and pain free with bounding, you can progress into this activity at a slower rate to address the issue of bone tissue stress. Of course you want to make sure that you have sufficient leg/hip strength to attenuate the loads of bounding. I would start off with 25% of time or distance of the bounding activity, also cut the repetitions in 1/2 to start off. After 2-3 weeks without negative response, go to 50%, then 75% etc. Your response to the activity shows you had an overreach situation occur, with some possible predisposing factors. Going at the activity at a slower pace, may allow for you to keep this training in your repertoire.
Cheers,
Pete
Pete Dickinson MS,PT
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ParticipantParticipant
Running takes a lot of strength to attenuate the loads going into your pelvis. Your adductors are the second most powerful hip extensors, so hip hinge work will activate this region. Start off with two legged strength movements, then gradually progress to single leg work. Once you can do some single leg step up/downs with resistance, add more dynamic movements and consider a walk/jog program. Take it gradual and listen to your symptoms. It will take a while (months) to return back to higher level activity, but you’ll get there!!
Cheers,
PeteParticipantPete Dickinson MS,PT on May 31, 2020 at 9:56 pm · in reply to: Pete! What's wrong with my butt? #42259Well, your butt looks fine to me:) OK, excellent question. This is an interesting area, the sit bone, perineal, hamstring region. We have to differentiate between a soft tissue tendinous injury, or local nerve involvement, proximal spinal referral, training error, or a musculofascial consideration. Lots going on. Your discomfort can give us some indication, do you have pain sitting, driving? I would take you through some neural tension tests to see if one side is tighter than the other. Hows your gross strength on a single leg step down left compared to right? Is your fascial tissue mobile through the glut med/posterior hip/ischial tuberosity/hamstring (posterior line)? Zoomie sessions are helpful to sort this out!! Its all treatable with some combination of fascical mobilization, single leg strength, neural mobilization, spinal mobility.
Cheers,
Pete
pete@worldcup.physioParticipantPete Dickinson MS,PT on May 21, 2020 at 6:54 pm · in reply to: Now 3 mo after knee replacement ?! #41961Chet,
So excited for you!! Sounds like you have a good result post op and are ready to ease back into it. The range of motion is critical, so its nice to have full extension and appropriate flexion (should gradually improve a bit more). Strength going forward should involve general movements that are loaded to tolerance, maybe 12-15rm loads. Functional movements to uphill activity should be weaved in at a low level, progressing to higher difficulty. For sure you should be able to do bench squats, step ups/down, deadlifts, pullups etc. You can modify and do most with minimal equipment. Hike/walk/bike/terrain needs to be progressed and periodized within what the knee is tolerating. I’m happy to work with you, just contact me through pete@worldcup.physio. I can also work with one of the coaches concurrently as you work toward next season with the fantastic snow we are sure to get:)
Cheers,
Pete
pete@worldcup.physioParticipantThe big picture on this is it’s an overreaching event. Take a look at the lead up to this injury, did you increase your volume or intensity at too quick a pace? You might like some kinesiotape support early on. I agree that complete rest is not advised, but listen to your pain levels as you return to activity. Water rehab, and bike might be avenues for activity early on.
Cheers,
PeteParticipantAndy,
Pool work can be a great way to get in some similar running movement patterns without the load. For a start to return to running I would do a walk/jog program, 2min walk/1min jog. Do this for 15min, see how you respond, if little pain or swelling, you can increase the program.
Cheers,
PeteParticipantPete Dickinson MS,PT on April 22, 2020 at 2:42 pm · in reply to: Part-time Glute Pain, Piriformis? #40743Kyle,
With that level of pain, you likely have a nerve injury somewhere. They can be pinched at several exit points from the spine. Flexion exacerbation of pain might indicate a disc, side bending and extension might indicate the foraminal exits. I recommend pillow support of your back in sidelying while sleeping to keep your spine supported in a more neutral position, pillows under the knees while on the back might be another thing to try. I would recommend shortening your run, even to the point of doing a walk/run program. Find a running duration that you can tolerate, then you can consider increasing from there. (10% a week). You have to decrease inflammation around the nerve by minimizing irritating activities, and supplement this with improving core strength to limit shear and strain across the region.
PeteParticipantAndi,
I concur with Thomas….about the whiskey! I agree that prolonged healing response would indicate ligamentous or chondral involvement in the injury. This would necessitate a slow and steady rehab approach, and expectation of improvement. Change your exercise method to keep up your volume, and listen to your ankle’s response to load/impact. If you don’t progress, some investigations are reccomended to make sure there isn’t more of an injury than was initially indicated.
PeteParticipantSpencer,
I have seen good results from surgery for this when patients have failed conservative care. Treatments usually focus on joint mobility through mobilization, soft tissue work to the posterior hip structures to improve mobility and minimize load transfer on the anterior structures, and progressive strengthening. I often see symptoms shift to the other side as it takes on more of the load due to pain. Now is a good time to shift methods to less irritating movements, and pursue other avenues of fitness that will also help this…..core, core, core. I’m sorry you have to deal with this, as it is sure to frustrate goals and plans. I hear many stories of postponed elective procedures that couldn’t come at a worse time.
PeteParticipantIzzy,
No fun having this pain crop up without a real reason! Sounds like you’re doing a lot of things right with periodizing volume/terrain etc. When I see this situation in one of my athletes, I also look at the miles in their shoes, sometimes you are at the end of life in them. When the easy stuff doesn’t work, it really comes down to…..wait for it….strength. It takes an inordinate amount of strength to attenuate the repeated impacts traveling up your leg into your back. A 6 week block of true strength loads involving squats/deadlifts/single leg step up-down will help take the stress off the SI/Lumbar spine. Muscles are your shock absorbers for these crucial structures. True strength training is also core training. Learning how to create tension through your core, helps you pick up heavy things with your legs. It’s not a quick fix, but will make you more resilient to the repeated cycles of movement with uphill athlete activities.
Cheers,
PeteParticipantPete Dickinson MS,PT on April 7, 2020 at 7:19 pm · in reply to: Part-time Glute Pain, Piriformis? #40304Yes, shifting pain in the area from glutes/leg to back is indicative of nerve involvement. Great job trialing lumbar stabilization, you are ready to add back mobility to the treatment mix. Manipulation is certainly great for short term relief of pain in the region, but the ‘fix’ is accomplished from doing the hard, long, slog of strengthening the core, and gaining greater mobility through the area. Its a biological system, so 4-6 weeks of training will yield robust results, and give the added benefit of improving all your uphill athlete activities.
Cheers,
PeteParticipantPete Dickinson MS,PT on April 1, 2020 at 4:49 pm · in reply to: Part-time Glute Pain, Piriformis? #40064This sort of condition is certainly frustrating! Pain with walking, then with supine positioning would certainly lead me to consider spine involvement. The lumbar region loves to send pain to the glut and piriformis region. You could try doing an abdominal ‘set’ while getting out of bed etc. and see if that removes the pain by stabilizing the spine. When doing any step activity, make sure your hips don’t rock and stay in the same horizontal plane. Try actively performing a core contraction during these activities and see if that helps. Putting more training time into core strength and stabilization is always worthwhile.
Cheers,
PeteParticipantPete Dickinson MS,PT on March 31, 2020 at 6:13 pm · in reply to: Anterior Tibialis Tendonitis Treatment, injury #40048I would start with calf raise holds, progressing up to 45sec. That way, you’re not stressing the sheath interface as much. Progress to the calf raises and eccentrics, with more triplanar/lateral work to follow. General calf dorsiflexion stretches are fine as well.
PeteParticipantPete Dickinson MS,PT on March 31, 2020 at 8:37 am · in reply to: Metacarpal-trapezoid joint issue? #40019I’m open in my telehealth practice, just email me at pete@worldcup.physio.
PeteParticipantPete Dickinson MS,PT on March 31, 2020 at 8:35 am · in reply to: Anterior Tibialis Tendonitis Treatment, injury #40018Ah, quarantinitis! You likely have inflamation in the sheath around the tendon due to the loaded eccentric activity from the treadmill work. I would continue with your current plan of icing, and gradually return to unloaded walking before trying the vest again. If you have a bike, that should work fine in the interim.
Cheers,
Pete