Erik,
You have part of your tendon that’s not going to be healthy, but….you have a large part of the tendon that you can train to take the loads necessary for an uphill athlete. I feel this is a training/rehab issue. You see this a lot in alpine racing athletes that hang on their patellar tendon a lot with high loads. Sticking things into the tendon and filling it up with all sorts of things is kind of missing the point. Progressive load is whats going to create change in the tendon (mechanotransduction). The devil is in the details of how you gradually tease in more strength to the tendon. With time, its amazing the changes you can create.
Pete
Pete Dickinson MS,PT
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Erik,
That is a fairly significant MRI finding, I would be interested in your Orthopedics recommendations. For sure, pain free training is still indicated for the health of the tendon tissue. I would find a ‘baseline’ level of activity that doesn’t cause an increase in symptoms, then explore greater loading activities. Quick, dynamic, eccentric high load activities are the most significant stress to the tendon. If you’re not having significant pain, a reintroduction to strength with lower weights to start, would help the area of tendon that can still be responsive to strain. The same goes for hill climbs, start slow with some modification in grade and load. I usually recommend that you should fail a progressive rehabilitative approach before considering surgery if your symptoms haven’t ‘shut you down’.
PeteParticipantThis is a great discussion. It illustrates the many regions and causes of pain in the posterior chain. The medial gluteus is just below the pelvic crest and a common region for inhibition from neural impingement coming from the spine. Sitting pain can be from tendinosis of the tendons attaching to the ischial tuberosities, and neural impingement of the sciatic/pudendal nerves as they traverses through some narrow regions in the area.
Nerves just don’t get impinged in specific spots, they also get held onto by soft tissue adhesions/restrictions. Rolling for fascial restrictions also helps nerve mobility. Everyone’s glutes/piriforis/quads/hamstrings have some densifications, roll them out!!
One to the most significant causes of pain in the area is improper progression of load. Get a coach!!
Cheers,
PeteParticipantI concur with Scott that after a trauma event and resultant swelling and pain, an xray is a great start. Without clearing for fracture, you can’t get proactive on range of motion and return to activity. I’ve been fooled many times thinking ‘it’s just fine’, when there is an underliying fracture that needs to be protected.
PeteParticipantJohn,
Getting shut down in your running is very frustrating, been there… Mid arch pain can involve a few structures from fascia to muscle. We always like to treat causes to injuries, but sometimes its not your physical imperfections, but your approach to training exceeding the current abilities of your muscles/ligaments/bone/fascia/neural structures (OverEnthusiasmSyndrome). I’m always a big supporter of using coaches for big projects to properly direct your OES. After a rest, return to running is best done with a run/walk progression. Start with 2min run, 1min walk. Seriously, this is where you start!! Progress to 5/1, 10/2, 15/1, then go with 30min blocks. In this way you can let your body adjust to the impacts. Mobility prior to this is essential, I like foot wakers for the arch, and lots of hip rolling. Hip strength helps attenuate the loads at the feet. Progress into single leg strengthening.
Lots to think about!
Cheers,
PeteParticipantPete Dickinson MS,PT on January 16, 2020 at 4:59 pm · in reply to: Surgery after herniated disc #36394Best of luck with your surgery!! Going forward, PATIENCE is the key ingredient to success as you manage the healing process, with your commitment to return back to high level activity. Depending on the amount of bone work done, a walking program is usually started fairly early on. Remember, there is some tissue healing that must occur before being subjected to impact loads. This is the type of situation where a coach can help your volume and intensity progressions. It depends somewhat on your previous training load and experience.
Cheers,
PeteParticipantInternal hip impingement can be treated conservatively with good results early on. You would need to fail conservative care before surgery is considered. Your therapist can guide you in some self ‘gapping’ movements using straps and bands. Relieving the soft tissue tightness around the hip will also aide in improving movement patterns and tolerance of impact (running). We usually use a ball or roller to mobilize the soft tissue ‘densifications’ that conspire to impinge the hip. Activity progressions can span the range from non impact cycling, to progressive impact training with unloading treadmills/elliptical/trail running. The key is progressive training over time to allow for adaptations that don’t feed into your impingement. Strength training is also key, and should be performed after your mobility activities. I would combine both pure strength movements pain free of hip hinges and squats, with some balance control weight bearing training. Progressions from two leg exercise, to single leg exercise will support your running. And lastly, a good core program will support optimal hip function.
Cheers,
PeteParticipantTerry,
I usually lie on my stomach, have the bar 90* to my thigh/hamstring, then I reach back and roll the fat end of the bar up and down my hamstring. Works great!
PeteParticipantPete Dickinson MS,PT on January 13, 2020 at 9:39 pm · in reply to: Pre Knee Replacement Suggestions #36235Chet,
You’ll love not having the pain you have now, that limits activity!!
1. Do NOT go in to surgery with an inflamed knee. It really sets you back motion wise, and that is the name of the game early on. No…I think I’ll just trash it since I’m just about to get it replaced….
2. Do strengthen to your tolerance as indicated by pain and inflammation. If bike works then do intervals, strength with higher power/low rpm, short 15sec speeds etc.
3. Passive extension is the most important part of your range of motion to have going into surgery. If you have stiffened up in extension, spend some time with isometric quad exercises pushing into extension to improve it.
4. Classic skiing can sometimes be not too bad with an arthritic knee, if it works, its time on snow!
5. Basically, do what you can within No. 1 above.
Cheers,
PeteParticipantWow, not much fun to have your running so limited! As usual, there can be multiple causes for medial glut pain. One factor is your training load and progressions, this is where a coach comes in to keep your OES (OverEnthusiasmSyndrome) in check. Fascial tightness through the hamstring/hip/back region can conspire to create asymmetric loads through the region. Fascial rolling can be helpful in this instance. Nerve compression as they exit the spine can send pain to the medial glutes. This then gets into spine mobility, fascial mobility, force attenuation through footwear, and core strengthening for treatment. I see this in ultra runners….a lot! Feel free to use the chat button or email directly for more specifics.
Cheers,
PeteParticipantDane,
Good job on being so proactive with dealing with this injury. Lateral hip/knee pain is a neural pathway associated with a pinched nerve coming out of the spine so that needs to be considered. I see this with increasing running impact, travel, long seated work days… If its a local issue then controlling the forces across the lower extremity becomes important. Lateral and posterior hip strength movements with DL’s and other strength can be helpful, especially to the knee. I’m a big fan of rolling out the lateral and posterior glutes, hamstrings, quads. Using the end of a 45lb. bar is especially helpful to the hamstring and hip. I like to just prone roll on a foam roll for my quads.
Best.
PeteParticipantPete Dickinson MS,PT on December 31, 2019 at 7:27 am · in reply to: Upper Hamstring Tendinopathy #35222Eccentric lowering from tall kneeling is a hamstring loading exercise. It’s quite robust and I would do it when you are out of an acute stage as you are able to be more active with the injury. Perform the movement by going to your knees and assuming a vertical upright position with the rest of your body, have someone behind you anchor your calves to the floor by grasping above the ankles and not allowing your feet to lift off the floor. Cross your hands on your chest, and lower your body to the floor without breaking at the waist. Repeat x5 and perform 3-5 sets. As with all exercise addressing an injury, start off slow and observe response.
PeteParticipantPete Dickinson MS,PT on December 27, 2019 at 4:22 pm · in reply to: Upper Hamstring Tendinopathy #35070Glad to hear you are getting better with the PT and modifications! I recommend normalizing your gait during running, and finessing the return to running activities with a gradual ramp of run time as you allow your structure to adapt to the loads of dynamic activity. An initial walk/jog program can gradually give way to longer run blocks. Terrain can be progressed from flat/rolling/uphill etc. We just had one of our world cup skiers perform this progression with a nice return to the final sprint heat after being unable to complete a race. Strength should still be pursued, but with care with aggravating movements. The single leg deadlift is the end point of loading activities, you would probable tolerate double leg loaded strength first with bridges, squats, DL’s, with progression into single leg loaded bridges, and eccentric lowering from tall kneeling.
Hope this gives you some ideas.
PeteParticipantI concur with Bruno that deep core/abdominal contraction leading to pain and a bulge in the groin region would indicate concerns for a hernia. Depending on severity this can ‘hide’ behind rest but become more evident with activity. As Scott mentioned, abdominal muscles attaching to the pubic bone in that very same region can confuse the treatment paradigm. A physical exam by a physician can help sort this out to see if you have a bulge in the inguinal canal, or a muscle strain evident on resisted abdominal flexion.
PeteParticipantYou likely traumatized the back of your achilles from repeated heel cup overpressure into the achilles with the downhill running. Does your achilles ‘squeak’? Treatment would be to punch out the shoe contact area at the achilles, ice massage, and tendon strengthening. Avoiding activity does a good job of weakening the area. I like to try to find what is pain free, and progress from there. You might want to try 5x 30-45sec calf raise holds, if this isn’t too painful. This is a classic case of Early Season Over Enthusiasm Syndrome (ESOES)…..
Cheers,
Pete