[Prophylaxis]

hey fellas, Im currently doing some travels but should be back end of April. anything urgent pm me

[Gunner]

Bumping this helpful thread.

Last monday I didn't warm up properly and I started doing squats with 50% 1RM. After my workout I felt a little and difuse pain in my knee. The pain aggravated everytime that I'm sitting long times in the computer or that my knee is flexed.

I started reading a lot and it seems like Palleto femoral syndrom (PFPS) the knee pain is not hard or excruciating, just uncomfortable. I decided to use to RICE method and altough the pain has receded I still feel it while sitting (Movie goer symtpom) for long periods of time.

I want to go back to the gym or do cardio but I need my knee, what should I do?

[Prophylaxis]

(06-03-2013 01:02 PM)bars Wrote:  

Bumping this helpful thread.

Last monday I didn't warm up properly and I started doing squats with 50% 1RM. After my workout I felt a little and difuse pain in my knee. The pain aggravated everytime that I'm sitting long times in the computer or that my knee is flexed.

I started reading a lot and it seems like Palleto femoral syndrom (PFPS) the knee pain is not hard or excruciating, just uncomfortable. I decided to use to RICE method and altough the pain has receded I still feel it while sitting (Movie goer symtpom) for long periods of time.

I want to go back to the gym or do cardio but I need my knee, what should I do?

Hey bars,

Sounds like you could be on the money with PFPS. Is there any associated clicking, locking or giving way? Are going down stairs particularly painful?

If it IS PFPS - evidence suggests that the single BEST thing to assist with patellar tracking is pure quad strengthening - this means plenty of knee extensions.

You'd also want to look at what is exactly happening at knees when you go down for a squat -are they buckling in as you get deeper? - you want to generally keep them in line with your 1st/2nd toe.

I'd also advise plenty of hip abduction strengthening - which assists in keeping the knee in good alignment (see below). Many of my clients simply don't have the strength in glut medius - which means the groin muscles work overtime and can wreck havoc on knees!


- feel free to add a resistance band.

As said - also make you warm up with plenty of quad/hip flexor stretching!

[PUA_Rachacha]

Body Chart: Left Trazpezius / Deltoid
Age: 34
Mechanism of injury: I injured it surfing 2.5 years ago (got rolled in a wave, arm got thrust in weird position), then kept surfing for a week after the injury since I was on a surf vacation. Initially my left pectoral was killing me, but after I got back home the pain migrated to my left shoulder/neck, where it remains.
Aggravating factors: Sleeping on left side, sitting for long period at work desk
Easing factors: Physical therapy helped a bit. A number of Egoscue movements, especially the Static Extension Position on Elbows, dull the pain.

The pain is dull, almost achy. Strength is around 80% of right shoulder's strength. Shoulder used to be inflamed 24/7, but the PT and ongoing Egoscue exercises have keep the pain in check.

I work in Finance in NYC. Anyway I can barter my services for yours, please let me know.

[Prophylaxis]

(06-04-2013 01:43 PM)PUA_Rachacha Wrote:  

Body Chart: Left Trazpezius / Deltoid
Age: 34
Mechanism of injury: I injured it surfing 2.5 years ago (got rolled in a wave, arm got thrust in weird position), then kept surfing for a week after the injury since I was on a surf vacation. Initially my left pectoral was killing me, but after I got back home the pain migrated to my left shoulder/neck, where it remains.
Aggravating factors: Sleeping on left side, sitting for long period at work desk
Easing factors: Physical therapy helped a bit. A number of Egoscue movements, especially the Static Extension Position on Elbows, dull the pain.

The pain is dull, almost achy. Strength is around 80% of right shoulder's strength. Shoulder used to be inflamed 24/7, but the PT and ongoing Egoscue exercises have keep the pain in check.

I work in Finance in NYC. Anyway I can barter my services for yours, please let me know.

What did the physical therapist say was the problem?

I'd say given the injury there could be some underlying shoulder instability. Especially with pain in the 'pec' region. Did it feel like the shoulder popped out at the time?

Pain in the traps region is from the neck - not the shoulder. This could be secondary to your initial injury. Is there any pins and needles or numbness radiating down your left arm? When you got dumped, did it put pressure on your neck, or mainly the shoulder?

[PUA_Rachacha]

(06-04-2013 05:31 PM)Prophylaxis Wrote:  

What did the physical therapist say was the problem?

I'd say given the injury there could be some underlying shoulder instability. Especially with pain in the 'pec' region. Did it feel like the shoulder popped out at the time?

Pain in the traps region is from the neck - not the shoulder. This could be secondary to your initial injury. Is there any pins and needles or numbness radiating down your left arm? When you got dumped, did it put pressure on your neck, or mainly the shoulder?

Physical therapist thought that the traps were compensating for the injured pectoral muscle, and now can't ever relax. I can't really remember what he said though. I had to do neck stretches everyday, plus PT 2x per week.

It didn't feel like my shoulder popped, just the tissue connecting the pec to the shoulder felt pulled at the time of injury. As I said, I kept surfing, i.e., paddling a lot, which didn't make the strained muscle feel any better.

No pains and needles radiating down left arm, but a little numbness does drift into my front shoulder/bicep. Pain is just a dull achy feel, primarily in my traps, like the muscle has been under strain all day. Sort of like performing a shrung workout, but the feeling's there all the time. I've also felt numbness/soreness in my teres minor/major.

[Prophylaxis]

(06-05-2013 09:02 AM)PUA_Rachacha Wrote:  

It didn't feel like my shoulder popped, just the tissue connecting the pec to the shoulder felt pulled at the time of injury. As I said, I kept surfing, i.e., paddling a lot, which didn't make the strained muscle feel any better.

No pains and needles radiating down left arm, but a little numbness does drift into my front shoulder/bicep. Pain is just a dull achy feel, primarily in my traps, like the muscle has been under strain all day. Sort of like performing a shrung workout, but the feeling's there all the time. I've also felt numbness/soreness in my teres minor/major.

Hmmm. I have never heard of a torn pec from a surfing incident. I'd say the pain could be caused by underlying shoulder instability/impingement. Definitely sounds like the traps are overactive as well, possibly secondary to the injury; when we get injured it often puts our shoulder blade movements out of sync when we move the injured arm.

I would focus on scapular stabilisation - i.e resetting the shoulder blade in the ideal position while you move the arm. Here's a general example of how to reset the shoulder blade

while keeping the shoulder blade in this position - try to gentle raise a straight arm forward (don't go above your belly button!) - and repeat this 15 times every 2 hours.

Next I would look at rotator cuff strengthening



(ps if these hurt look at performing them with the elbow by side)

Definitely you'd want to stretch AND strengthen the posterior cuff as well.






To ease with the (upper) traps overactivity, you want to get LOWER traps firing better - here's a sweet exercise I've found work wonders with my clients. Just make sure you don't push it too far with your shoulder.

So in summary:

You want to reset the shoulder blade mechanics
Strengthen/stabilise the shoulder (with minimal delt involvement!)
Stretch posterior cuff
Turn off upper traps

I'd also recommend laying off any heavy incline press/shoulder press until you get the right muscles firing.

Lemme know how you go!

[TheBMan]

Glad this thread came up -

36, in shape, 6'3m 185
Sprained the hell out of my right ankle last week. Playing basketball, jumped up, not sure if i landed on someone elses foot or what happened but I just crumpled when I came down. Almost positive it turned inwards. Stayed down, limped off the court, and it started to feel better but was still obviously painful. Once the shoe came off it swelled up pretty nicely and bruised pretty bad. I was very good about rest, ice, compression, elevation. i was able to walk on it w/a limp the next day. its been 8 days and the bruising is going away and the swelling is going down but its still very stiff at times, especially the morning. Once I start walking its ok but sometimes the first few steps are getting painful. I've been doing some stuff in the pool and it feels okay. At this point what else, if anything should? Compression? Still icing? And how long is it going to take me before I can start playing sports again? Thanks in advance!

[Prophylaxis]

(06-05-2013 07:39 PM)TheBMan Wrote:  

Glad this thread came up -

36, in shape, 6'3m 185
Sprained the hell out of my right ankle last week. Playing basketball, jumped up, not sure if i landed on someone elses foot or what happened but I just crumpled when I came down. Almost positive it turned inwards. Stayed down, limped off the court, and it started to feel better but was still obviously painful. Once the shoe came off it swelled up pretty nicely and bruised pretty bad. I was very good about rest, ice, compression, elevation. i was able to walk on it w/a limp the next day. its been 8 days and the bruising is going away and the swelling is going down but its still very stiff at times, especially the morning. Once I start walking its ok but sometimes the first few steps are getting painful. I've been doing some stuff in the pool and it feels okay. At this point what else, if anything should? Compression? Still icing? And how long is it going to take me before I can start playing sports again? Thanks in advance!

Hey Bman,

Given the fact that you could put weight on your ankle immediately after you sprained it is a good sign.

The fact that bruising is present tells me that would have damaged the anterior capsule of the ankle (quite a sprain!), as well as the lateral ligament complex.

When we sprain ligaments it affects our proprioception (how we know where our joint is in space, without looking at it). But like strength, proprioception can be retrained.

You definitely want to load through the ankle, specifically regain proprioception - think lots of single leg balance stuff - trying to hold your balance throughout the day. I usually tell my clients while they are making a coffee to try and stand on that one leg.



Here's a nice little self mobilisation you can do to the ankle to loosen it up a bit

I would also include gentle calf raises throughout the day to encourage joint movement and alleviate swelling.

You will definitely need to be strapped when you return (even to training), but usually a sprain like yours should only take 3 weeks to return.

Before you can return you must be able to perform jumping, hoping and changing direction without pain.

Summary:

Single leg balance drills (start off simple first) - your most important
Self mobilisations of ankle
Calf Raises

Lemme know how you go

[TheBMan]

Thanks, appreciate the advice. Its a bad sprain - far and away the worst one I've ever had. Its been 9 days and still swollen. It is miserable first thing in the morning - stiff and painful to put weight on, but as it loosens up it gets better and I can walk w/o a noticeable limp. Check out the pic - this is approximately day 3

[TheBMan]

one more question - whats the best type of brace to use? a lace up?

[Prophylaxis]

Hey BMan,

Definitely looks like a solid sprain - don't let all that bruising scare you though. I've had clients with ankles similar to that - who were back playing football after 2 weeks!

Work on the exercises and let me know how you go. I would actually advise getting someone to strap your ankle up with rigid tape - this is most effective (albeit more expensive - but provides much better support). I would still advise seeing a physical therapist before your return to basketball though - even if it's for a couple times. Would be great if I could do my physical examination/hands on treatment over the internet HA!

Cheers,

Prophylaxis

[PUA_Rachacha]

(06-05-2013 06:31 PM)Prophylaxis Wrote:  

So in summary:

You want to reset the shoulder blade mechanics
Strengthen/stabilise the shoulder (with minimal delt involvement!)
Stretch posterior cuff
Turn off upper traps

I'd also recommend laying off any heavy incline press/shoulder press until you get the right muscles firing.

Lemme know how you go!

Funny enough these were a lot of the exercises that my physical therapist was having me do. Combined with shoulder and neck stretching.

I have been doing incline bench and shoulder presses for a while. I'll lay off the those, do decline bench press and the rotator cuff exercises. I'll do everything else you recommend too.

Thank you, and I'll report back in a few months.

[dog24]

Broke fibula and ankle two months ago ill be able to step again on monday but not put my full weight on it yet, still with crutches. Had a rod with screws on it. I have another month to go with crutches, when do you think ill be able to squat and do boxing... Will i be able to go heavy on squats ever again? Like 405+ thanks in advance

[TheBMan]

(06-07-2013 09:12 PM)dog24 Wrote:  

Broke fibula and ankle two months ago ill be able to step again on monday but not put my full weight on it yet, still with crutches. Had a rod with screws on it. I have another month to go with crutches, when do you think ill be able to squat and do boxing... Will i be able to go heavy on squats ever again? Like 405+ thanks in advance

ouch - how'd you do that?

[Teedub]

Hey P. Still have the back issues. Its Sciatica from a 'disc bulge' I think. I have started to get slight numbness in my right shin, is this worrying?

I started getting it this week AFTER seeing an NHS physio who gave me a list of stretches to do.

[Prophylaxis]

(06-07-2013 09:12 PM)dog24 Wrote:  

Broke fibula and ankle two months ago ill be able to step again on monday but not put my full weight on it yet, still with crutches. Had a rod with screws on it. I have another month to go with crutches, when do you think ill be able to squat and do boxing... Will i be able to go heavy on squats ever again? Like 405+ thanks in advance

When you say 'broken ankle' was there any other bones fractured, or just the fibula?

The fibula is typically a non-weightbearing bone of the lower limb, so it should be fine getting back to squats/boxing (maybe not heavy,end of range squats or lunges though, as your ability to point your toes up/dorsiflex will be restricted due to the surgery). This is a question to ask your surgeon, but generally I'd advise 6-9 months.

[Prophylaxis]

(06-08-2013 01:24 PM)Teedub Wrote:  

Hey P. Still have the back issues. Its Sciatica from a 'disc bulge' I think. I have started to get slight numbness in my right shin, is this worrying?

I started getting it this week AFTER seeing an NHS physio who gave me a list of stretches to do.

Hey Teedub,

Sorry to hear man! The numbness in the shin is characteristic of an L5 nerve root radiculopathy (nerve pinched in the back). What exercises have you been given? Is the physio you were seeing aware of this?

Definitely stop any exercises which you find bring on the numbness!

[dog24]

Just fibula, but i had internal stitches on ankle ligaments... Yeah doc said at least 6 months before training but didnt specify what type of training... So you mean ATG squats are out of the question? Even with oly shoes?

[Prophylaxis]

(06-08-2013 07:46 PM)dog24 Wrote:  

Just fibula, but i had internal stitches on ankle ligaments... Yeah doc said at least 6 months before training but didnt specify what type of training... So you mean ATG squats are out of the question? Even with oly shoes?

Just that you won't physically be able to bring your knee too far over your toes. Shoes with a bit of a heel raise will make it easier, but will compromise your form (loading through forefoot).

Just have to find ways to tweak your technique and squat without having excessive 'dorsiflexion' in weight-bearing (see below)

[Teedub]

(06-08-2013 07:30 PM)Prophylaxis Wrote:  

Hey Teedub,

Sorry to hear man! The numbness in the shin is characteristic of an L5 nerve root radiculopathy (nerve pinched in the back). What exercises have you been given? Is the physio you were seeing aware of this?

Definitely stop any exercises which you find bring on the numbness!

I'm not sure the exercises are causing it, but it just seems a bit too coincidental in my opinion. They're just stretches though, like hamstring stretch, certain rotational twists etc.

Do you have any exercises or tips to get rid of this bulge, which I guess is what is pinching the nerve. Is the pinched nerve the cause for all the tightness in my legs too? Does it sound like sciatica to you?

Also, would you recommend seeing a physio regularly, or a chiropractor etc? The physio I was referring to earlier is National Health Service one, and I only go once a month. A proper physio (as in one I'd go to once a week) is about £35 a time, and I wasn't prepared to do that last time we spoke, however this is becoming a joke and is not going away so perhaps I need to commit to it.

I've also read that taking Ibuprofen several times a day for a week could help, is there any sense to this?

[Ensam]

I've recently started having some pain around my peroneus brevis tendon and lateral malleolus. It started out feeling almost like a bruise and would only hurt when I touched it. Now it hurts more consistently and sometimes burns. The pain isn't associated with any specific motion.

Any suggestions?

[Prophylaxis]

(06-09-2013 07:10 AM)Teedub Wrote:  

I'm not sure the exercises are causing it, but it just seems a bit too coincidental in my opinion. They're just stretches though, like hamstring stretch, certain rotational twists etc.

Do you have any exercises or tips to get rid of this bulge, which I guess is what is pinching the nerve. Is the pinched nerve the cause for all the tightness in my legs too? Does it sound like sciatica to you?

Also, would you recommend seeing a physio regularly, or a chiropractor etc? The physio I was referring to earlier is National Health Service one, and I only go once a month. A proper physio (as in one I'd go to once a week) is about £35 a time, and I wasn't prepared to do that last time we spoke, however this is becoming a joke and is not going away so perhaps I need to commit to it.

I've also read that taking Ibuprofen several times a day for a week could help, is there any sense to this?

Jesus!! Good physio's WON'T give hamy stretches for back pain! it's probably one of the worst exercises you could do, as it pulls on the nerve.

Basically nerves being pinched are either caused by:
1)disc bulge
2)facet joint impaction (basically the side back joints compressing the nerve)

I would strongly advise paying money for a good musculoskeletal physio - no point settling when it comes to your health TeeDub. You want to resolve the numbness in your shin asap and alleviate the pressure off your back. Unfortunately, it sounds a little too complex for me to help over the web (I'd need a full assessment and manual therapy to fix something like this).

Basically shop around for a good physio, who gives you a solid gameplan, who tells you WHAT is causing your backpain and how long (roughly) it will take to resolve. If they can't offer you this, and just tell you 'see me once a week' - then scrap them.

[Prophylaxis]

(06-09-2013 10:03 AM)Ensam Wrote:  

I've recently started having some pain around my peroneus brevis tendon and lateral malleolus. It started out feeling almost like a bruise and would only hurt when I touched it. Now it hurts more consistently and sometimes burns. The pain isn't associated with any specific motion.

Any suggestions?

Hey Ensam,

A couple questions;

Do you have any back pain, or pain shooting down the leg? Any pins and needles or numbness?

Did you do anything specific to bring this on? e.g. roll your ankle?

Is there considerable pain in the morning, or pain when you roll your ankle 'in'?

[Ensam]

Nope, just started gradually. I only noticed it by accidentally bumping the sore spot then realized it hurt when I pressed on it. Thought I must have bruised it and not noticed and didn't think about it again. Then after a few months it got worse. No pain associated with any motion. No back pain or pins and needles. It did get worse after I started squatting heavy and doing deadlifts again. It doesn't hurt specifically when I squats/deadlifts but gets more noticeable a day or two afterwards.