Christine,
Pete the physiotherapist here. Some different factors come in to play with single leg stance instability, especially when its one sided. You were right to check with your podiatrist to see if you have different foot structure from one side to the other. It’s not uncommon to have more forefoot ‘varus’ (upward cant of the front of the foot) on one side causing more pronation and instability. This type of structure can also stress the outside of the foot. Metatarsal pads can aide in providing some support to your forefoot.
The ligaments holding your ankle together can also make balancing more difficult. Recommendations for this type of issue is to make sure you wear good stability oriented trainers, as this will help your stability.
Of course, there are other factors. Your hip strength is a key factor in foot stability. the good news is that this can be trained! Starting off with weight bearing exercise into both legs such as deadlifts is a good start. Progress into front and side lunges. The key is making sure your knee stays stacked on top of the foot,and doesn’t collapse in. Monster walks with bands around the knee or ankles are also a good activity.
Hope this gives you some direction to pursue. Best of luck and keep in touch!
Pete
Pete Dickinson MS,PT
Forum Replies Created
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ParticipantPete Dickinson MS,PT on December 6, 2019 at 12:25 am · in reply to: Knee instability doing box step ups, foot issue #33804ParticipantPete Dickinson MS,PT on November 18, 2019 at 1:05 am · in reply to: Knee Tweak during 24 Week Expedition Plan #32138
Max,
I would consider it a positive if you are having patellofemoral symptoms instead of instability symptoms with your running. Give some kinesiotaping around the patella for running a try, and do some soft tissue massage to the medial quad region and posterior hip PRIOR to running to see if this helps with the discomfort. Continue with strength and progress as tolerated. Stop short of flaring up your knee with all your activities. I’m not a ‘backing off’ type of guy if you can work around it without flaring it up with your upcoming goals.
Keep in touch.
PeteParticipantUsing the bar on yourself is a little awkward but doable. I’d pick a lighter bar to start, most gyms have training bars ~15lbs, or 35lb. ones. In a tall kneeling position, with the bar 90* from your leg out to the side, use the thick end and roll it back and forth across your calf and upper achilles. I like to support under the shin and ankle so you don’t force your foot into excessive plantarflexion. Hope this description makes sense.
PeteParticipantPete Dickinson MS,PT on November 10, 2019 at 8:43 am · in reply to: Knee Tweak during 24 Week Expedition Plan #31600Max,
Given your symptoms and injury history, you likely have some knee laxity that rears its head when its inhibited from a ‘tweak’, or acquired weakness. Strength is your friend when it comes to instability so a return to single leg strength exercises will assist in gaining knee stability once two legged strength movements are good. Slow progression into dynamic activities on that side is warranted, gentle side or front lunges with an aggressive return to standing you might try without resistance. The risk with an unstable knee is a meniscus injury.
Best of luck on your trip!
PeteParticipantTodd,
Thanks for reaching out! Some thoughts..
Do not immobilize. We want you maintaining at least what you have, and not go backwards in load tolerance. With your pain level, I would not recommend a boot. I like the met pad.
If your foot structure is fairly normal, chasing orthotic intervention is just one more variable that should best be considered after trying to make some mobility changes.
Metatarsalgia is like plantar fascitis, it can have multiple causes. After a period of overreaching during your goal season, strength can be compromised, as can tissue mobility. Hip strength can affect the forces at the foot. Of most interest, calf/hamstring soft tissue restrictions affect the loading through the forefoot. Roll out the posterior chain with a ‘Stick/rad roller’, or even better with the end of a 45lb. olympic bar.
I like the Hoka’s for attenuating some of the force coming through the shoe.
There you go! Keep us posted.
PeteParticipantPete Dickinson MS,PT on November 1, 2019 at 11:35 am · in reply to: Running on a Knee Replacement #31037Cindy,
Going into surgery, it’s important not to have an inflamed knee, as this contributes to post surgery motion restrictions. The mobility you take into the surgery, is very indicative of how much you will attain post surgery. I emphasize this as it’s not just about the strength you have going into surgery. Full knee extension is key as without this, walking/running at a high level is difficult.
Strength training pre surgery is about working around your limitations. Hip hinges load the knee without requiring as much flexion as squats. You may be able to handle more load with subsequent increased benefit with these movements. Post surgery there are a lot of tricks to progress strength at an optimal rate. This is important as your muscles act as the shock absorber for the joint. The stronger you are , the more the joint can handle. Proper strength activities also stimulate the endocrine system giving us improved healing, recovery, and fatigue tolerance.
Best of luck!
PeteParticipantPete Dickinson MS,PT on October 19, 2019 at 8:51 pm · in reply to: Maintain Fitness during Treatment #30545Great to hear surgery is behind you! Abdominal surgery can be surprisingly rough to recover from, so listen to what your body is telling you, you’ll get there!! Keep any increases in load/intensity to 10% of current abilities, we want you to adapt, not react to the progressions in training.
PeteParticipantMike,
There is a bursae on the end/tip of your elbow that is likely the cause of the ‘golf ball’. The main concern is whether an infection is causing the inflammation. It can be drained, injected with cortisone, as well as removed depending on the severity. I’d get it checked out.
PeteParticipantPete Dickinson MS,PT on October 13, 2019 at 6:09 pm · in reply to: Achilles Tendonitis – Running substitute #30209Derek,
Sorry to hear about your achilles, its so frustrating when this gets in the way of your training. Continued pain with running tells me the good part of your tendon isn’t yet strong enough to handle the load of running. A proper focus and progression into loaded calf raise holds 5x45sec. will start the long process of strengthening. Some temporary increase in pain is expected 2/10, but you should be able to gradually progress loads into single leg work, then more dynamic strength.Pete
ParticipantIzzy,
A couple things come to mind in this situation. I might question your efficiency of gait that slowly loads the hamstrings more on flat, repetitive terrain. Increasing frequency of foot strike might help decrease the load on the hamstrings. I’ll leave it to Alison for more suggestions. A stronger hamstring will make it more fatigue resistant so deadlifts, single deadlifts at 8rm would move you in a better direction. Downhill and flat terrain increase the impact forces at the lumbar spine possibly causing a radiculapathy leading to burning pain in the hamstrings. For this you would want a more neutral spine at foot strike avoiding a lordotic curve, and extensive core strengthening.
Whew!! a lot of thoughts scatter shooting here. Hope this gets you thinking.
Cheers,
PeteParticipantAlec,
Great question really. After an initial injury, range of motion and tissue mobility can be started as tolerated. We always try to avoid the negative consequences of immobilization. As the injured tissue calms down from the initial stages of inflammation, you can start having some greater success loading the tissue. You want the tissue to adapt to the load, not react to the load. Some discomfort is fine, but be truthful about how the tissue responded to the exercise. If I’m pretty sore the next day, or had a significant increase in pain after the exercise, I probably did too much. You will have better success not initially focusing on the specific muscle which can easily be overloaded, but training the large functional movements of press/pull/horizontal/vertical/diagoanal with strict form and light resistance.
Cheers,
PeteParticipantPete Dickinson MS,PT on August 20, 2019 at 9:49 am · in reply to: Peroneal Nerve Issue, full knee flexion/extension #27008Great news on your improvement. It will be interesting to see the response to load. The meniscus doesn’t have much blood supply to in (only the outer rim) so that ‘healing’ isn’t really the mechanism of improvement. Small tears you can grind a bit smoother with repeat cycles of movement, but its not really ‘healing’.
Cheers,
PeteParticipantI would look at performing the single leg work without much pain if possible to start building strength. Work into 3×10 at a load that isn’t painful. If you can, try to migrate to 5×5 at a heavier load. Failing to take load without pain isn’t the end of the world. You can develop pain free movement gradually using lower loads. Depending on you patellofemoral joint health, doing low rpm (40-50) bike work at just below aerobic threshold is helpful for gaining knee extensor strength in a less stressful way. You could supplement this with deadlifts for hip strength that your knee should tolerate. Hope this gives you some ideas!
Cheers,
PeteParticipantPete Dickinson MS,PT on August 14, 2019 at 2:00 pm · in reply to: Knee pain – meniscus? Treatment? #26787Terry,
Might not be meniscus as surface issues can give similar symptoms. Irregardless, you can train your musculoskeletal system to better support the knee in those positions. On a tall bench, practice a step up/down without pushing off on your ‘down’ leg. Load as tolerated. I like to cock my foot up and just touch my heel down, then power back up. Pause briefly at the point of maximum flexion. For joint relief, cycling is a great activity to clear inflammation and ‘polish’ the chondral surfaces.
Cheers,
PeteParticipantPete Dickinson MS,PT on August 10, 2019 at 11:02 pm · in reply to: Hip flexor / Musculus sartorius pain #26622Keep us posted Thomas!
Pete