Physical Therapy General #3: Private Practice Edition

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>>41124905
The back of my right ankle has been hurting for about two weeks. Started after running a few miles on the treadmill. Slightly to the left of my achilles, most noticeable pain in the bottom range of a calf raise (see pic related, left side). any ideas / tips?

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right here

>>41124905
My right ankle is always rotated externally and when i squat my heels travel a bit during sets which causes my feet to be pointed >=60 degrees out by the time i finish or i have to readjust every rep.

Ive discovered that the couch stretch and seated piriformis stretch temporarily fix the problem while walking for, say, 5 to 10 minutes.

Any suggestions on how to properly fix this issue?

>>41124905
I tore my Right pec, most likely a rupture at the humeral insertion and got fucked over by my GP/family doctor (telling me you cant repair it) so it happened like 4 years ago. how fucked am i if i want to get it fixed now that i've waited so long?

What would you tell someone who was going to increase from 50km/week to 200km/week?

>>41124905
I got put on metaformin. Is it normal for my hands to shake? I didn't have this problem before I started my diet and got my prescription.

>>41125069

Biking or running?

That's a fairly significant increase - I'd recommend these things:

1. Scale up your km/week, if you're not already doing that.
2. Like increasing the intensity with all exercises, use common sense. If you're experiencing pain after a certain amount of time, drop back to a lower mileage and work up from there.
3. In terms of practical advice, make sure your shoes fit right, that you haven't got any immediate issues with ankles, hips, knees or your lower back, and just keep track of how you're doing.

>>41125059

>how fucked am i if i want to get it fixed now that i've waited so long

It depends on the severity of the tear - if you've had loss of length of the muscle then you might be looking at a poorer clinical outcome. If you've had loss of range of movement and loss of strength then you have a justified reason for going in for a repair, but you're looking at hard rehab to get things up and running again following that. My advice would be to run this idea by whichever doctor you're enquiring by, and see what pathway they recommend

>>41124965

From what you've described, it sounds like a tendon-related injury at the insertion site. The aggravating factor you described is loaded dorsiflexion, which is what happens when you push off of your toes at the end of a running step. My advice would be to stop stretching your Achilles, decrease the intensity of your calf exercises and do a little less running. Monitor it for a week, see how it trends. If it gets better, great, give it another week and then see about returning to regular intensity. If not, go see an IRL PT.

Would you say it's gotten better or worse?
Have you had this kind of issue before?
Did it come on quickly or slowly?
Does the pain happen when you walk as well?

>>41125172
Thanks. It's gotten better (i haven't been doing any running, just a lot of walking at work and some high rep unweighted calf raises to bring some blood to the area). Just that particular ROM is causing some flare up.

I tore my left achilles tumbling in 2011 (gymnast) and was out for 9 months. I tumble very rarely but this came on quick as an obvious result of running. I run in barefoot shoes and on flat ground they're like magic but something about being on a treadmill just fucks with my gait in the worst way.

The pain doesn't happen when I walk, no.

>>41125057

my advice would be to look at piriformis muscle releasing stretches to fix the problem longterm. For that, you'll need to discuss it with your IRL PT to get some hands-on assessment and a proper treatment plan. In the interim, if it's not causing pain or balance issues, keep working through it. Use rest periods to stretch and get everything limber before you get into your squats, and consider taking a look at your shoes that you use for daily walking.

>>41125093

I'm not a pharmacist or a GP so take this cum grano salis, but to my knowledge metaformin / glucophage can result in hand numbness or tingling. It might present as muscular tremor, which is something you'll need to discuss with your doctor. If you're due for review, save it until then, but if it's severe, call in and make an appointment.

>>41125192

> It's gotten better

Good, that means it's healing.

>high rep unweighted calf raises to bring some blood to the area

You can also do light, unresisted stretching in a non-painful range to promote bloodflow. Heat works well too, seeing as you're out of the acute phase.

>something about being on a treadmill just fucks with my gait in the worst way

Treadmill running is ergonomically different to ground running - sure the movement is similar but there are subtle differences in stride characteristics that can rightly bugger your gait. My advice would be to consider getting some proper running shoes if you're game for it and would like a little bit more padding, otherwise stick to track and grass.

For more information, consult a podiatrist, otherwise keep an eye on symptoms and be sensible.

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>>41125250
Great, thanks. As a reward, here's a funny picture I downloaded off of the internet website 4chan.

>>41125195
Cool thanks. Could you elaborate more on the shoes bit? Im curious now

How fucked am I? I was hoisting my heavy bag after it was rained on, alot heavier than usual but I got it hung up and worked out, felt fine after. The next day I'm stretching and afterwards my upper back on the right side around the trapezius and shoulderblade felt tight and painful. Two days later it still hurts and I get an extra twinge when I breathe. Prognosis?

>>41125223
Thank you doctor man

>>41125378

If you have a particular gait pattern, such as swinging one foot out to the side or landing with your foot rotated inward or outward, you can wear down your shoes in a pattern that reinforces that. This can make your shoes less stable to wear, and can lead to problems down the line. Also, do you squat in shoes or without?

I got hit in the arm with a steel chip. It gouged out a slice about an inch wide and a quarter inch deep. It healed up just fine and I have a scar, however when I poke or massage it my index finger tingles and goes numb for awhile.

What's causing this and will it eventually go away?

>>41125382

>How fucked am I

Not very

>Prognosis

Could be a local muscle spasm that's getting aggravated with thoracic movement. Thoracic movement also happens when you breathe, which explains the twinge. I had something happen like this to me as well when I started doing OHP with strict form. If it's muscular, which is what I reckon it is based on what you've told me, the best thing to do would be to cut out any overhead arm movement and heavy hoisiting until you can move and breathe pain-free. If it's something else, like neurological or bone-based, the symptoms will develop into something different, which will depend on the nature of the injury. But like I said, I doubt it's a break and I doubt you've impinged anything at this point. Just for the sake of thoroughness:

1. About where in your back to you feel the pain? Is it towards the top of your neck or towards your lower back? Also, is it towards your spine or out from your spine?
2. Are there specific postures or movements (aside from breathing) that aggravate it?
3. Anything that makes it better?
4. Has anything like this happened before, and if so, how long did it take to resolve
5. Are you still doing overhead arm movements?
6. Have you taken anything for the pain, eg. painkillers or anti-inflammatory medication
7. Has this disturbed your sleep, and how do you sleep.

>>41125465

Precisely where in the arm did you get hit by the steel chip, how long ago did this happen, and did you get the wound stitched up.

>>41125498
>Precisely where in the arm
On the outside of my forearm about halfway between the wrist and elbow
>how long ago did this happen
About 4 months ago
> did you get the wound stitched up.
Neosporin and gauze my friend.

Is a bulged disc permanent I've been stretching everyday and it's been 6 months I'm about to just quit.

>>41125523

Okay, makes sense. Based on what you've told me, and the fact that I'm not there to see the scar etc, my judgment is this: the development of scar tissue over the injury site may be putting a little pressure on one of the nerves that supply the skin on your hand. This means that rubbing the scar tissue will move the nerve, and this can make your finger go numb. If you want this looked at further, I'd recommend going to an IRL PT and getting some neuro-dynamic and sensation testing done.

Further questions:

- have you noticed a loss of strength in the hand or arm following the injury?
- How long does the numbness take to fade
- Have you noticed a loss of flexibility in the hand or arm following the injury

If it's not causing an issue, no worries, but it could help to get it looked at.

>>41125549

Disc bulges can be reduced with proper stretching and treatment - have you seen a PT about it?

>>41125486
>where in your back to you feel the pain?
Just sort of radiating between my shoulderblade and spine, The pain when breathing feels slightly higher. The muscles in my neck and even on my right ribs feel tender but not in pain.

>postures or movements that aggravate it
My normal stretching brought it on and it feels a little worse when I tense up.

>Anything that makes it better?
Icy Hot didn't do much but a back massaged lessened the ambient pain. Tilting my neck forward while seated almost totally eliminates the breathing pain.

>anything like this happen before
I have mild back pain now and then while doing cardio or just standing awhile but it goes away quickly. I chalk it up to the fact that I had really bad posture as a kid.

>Are you still doing overhead arm movements?
Nope, in fact I'm doing the bare minimum to stay active atm.

>taken anything
Just the Icy Hot I mentioned before.

>Has this disturbed your sleep
Just a little bit, I usually sleep on my right side, switched to my left the past few nights. The pain and stiffness are worst when I just woke up.

>>41125591
It's not causing me any problem, but it's a little concerning

I have a pain on my front right delt when I bench. I even have it when I arch my back slightly and retract my scapulas. It's come to the point where I have to have a liftoff everytime I bench for it to be painless. The unracking and the locking out part is when it hurts. Any ideas?

>>41125632

Based on what you've said, I'm going to say this is a muscular spasm, most likely of a muscle deep to the trapezius, likely one of the rhomboids. It could also be spasm of one of the levator muscles in your neck, close to the attachment site.

Your pattern of symptoms is consistent with muscle pain, which has an expected time of resolution of approx three weeks. This might be worth considering within the context of your history of back pain, which may also be muscular based on its postural nature. Continue with your rest and monitor your pain, if it flares up, get it checked out. If it stays the same, see if it declines and if it doesn't, get it checked out. If it gets better, take it slow and ease back into exercise.

>>41125645

>but it's a little concerning

I dig. If you want closure, go check it out with an IRL health professional.

>>41125652

Have you tried dropping the weight and doing DB bench for a bit, just to get some extra ROM?

When I back or bodyweight squat I get pain underneath the top of my kneecap, especially when I activate the muscles to get out of the hole.

I can front squat pain free though, even with higher weight.

I saw a doctor because I was worried about getting some sort of jumpers knee or tendinitis from heavy squats while peaking for a meet.

Why can I front squat without discomfort though?

>>41124905
Hi Kenny,

I have had two meniscus arthroscopy operations on my right knee. I have laxity in my joints which complicates things as squats, lunges etc are bad for my knee and i have been advised they should be avoided. I also have moderate arthirtis in right knee. It can get very tender.

I currently do knee extensions stating at about a 30 degree angle do avoid joint strain. I do small step ups with weights as well. I cycle in the gym too (outdoor cycling is difficult as i have to avoid hills because of laxity).
Do you have any recommendations as to what i can do to safely build muscle on my legs, or shall i keep doing as i have been? Any other advice would be great.

Thanks,

Sean.

(last op was 9 months ago)

>>41125678
Thanks alot for the back pain advice. Other people have just been yelling DOMS at me.

About 1 1/2 years ago I was deadlifting and my back rounded, heard and felt a crack in my lower back. To this day I cant bend all the way over or be in certain positions without some pain and stiffness. Also I have APT, not sure if its from the injury.

Anyways, I got an x ray and nothing was broken so my question is how can I make my back as close to 100% again?

>>41125714

the short answer is that front and back squatting have different ergonomics, and so they're generating different force vectors over your knees. This means that the movements can aggravate your knees differently, in spite of the fact that front squatting uses the quads more than back squatting. The long answer would involve me looking at your squat form to make an assessment, but so long as you're seeing a doctor and you're in a care pathway, that's good.

>Any other advice would be great

Sounds like you've got it on lock, and that you're doing a good job of monitoring your pain and joint issues. If you want to try something new, err on the side of conservatism and scale up slow. Make sure to review with your PT or GP regularly, and check any correspondence from your surgeon to make sure their instructions are being followed.

>>41125737

Other people aren't as good as me :)

>>41125754

There might be residual muscle hyperactivity, but at this point I'd say you've adopted a shitty movement pattern and you need to re-learn how to move out of it. Start with basic compound movements like bending and stretching, maybe even see a PT about it.

>>41125723
>>Any other advice would be great

Sorry, That part was for you.

>>41125810

Any specific stretches you would recommend for my situation? Also how many sets and time holding the stretch?

Thank you

My mother (very ambitious doc) and brother (studied PT @ fresenius) both claim that I should not worry too much about the pain I have in my knees from squatting.

Our family runs retropatellarthrosis, grandfather had it, mother has it, brother has it, I have it. And I got to feel it when I took my squat to 4 pl8.
Examined the fuck out of knee travel and everything for a straight year, didn't help.

They claim however that this condition will never get better but also never really worse as it causes no structural damage to the knee joint.

I don't know what to do. I want to squat so badly but I feel like it might me risky.


Stretching quads after lifting helps the pain a lot.

>>41124905
My girlfriend did ballerina as a child for multiple years and has lordosis as an adult from the posture they forced her to do. Will deadlifting/squatting fuck her shit up. also, if she forced her spine into a less curved position would that now be an "unneutral" spine because it adapted the curve with growing up with it.

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I fucked up my knees somehow when squatting, mostly my right knee. I have always had a problem with my right knee traveling too far in during heavy load. Basically raised my lifts faster than I could perform good form.

Did squats one day that week, and felt a slight pain in the two days following, then didn't think much of it. Day after my rest day I did squats again and it started hurting to the point I couldn't support the weight on my right knee, and when not lifting had to limp. It hurt when the knee was fully extended and locked, but most of all when the knee was rotated or twisted out of the straight position at all. "Around" the knee cap.

I didn't do any leg work for a month and a week, and have now started squatting again. The whole month it's hurt a bit, but it was still slightly better. I deloaded a lot, and now the pain is there, but so small I usually don't even notice it.

What do I do? I can't afford to go to a doctor, do I keep lifting if it doesn't get worse, or is it snapped for life and the only reason it's not hurting as much is because I cut down my squat weight so much?

How to rehabilitate if possible?

>>41126148
is the pain stinging just below the knee cap on the inside of the leg?

>>41126167
It's like... Around the knee, except for the outer top right. Mostly on the lower part, but one spot on the inner side, just above. Some "deeper" pain inside the knee, but less noticable. (Feels like that might just be... The other pain "bleeding" over maybe, iunno)

It's like weird to sleep with. It feels uncomfortable in most positions. Sleeping on the back makes it "too extended", but on the side sort of twists it out of straight alignment and that also feels bad. I've tried having a pillow under to lift it up and that seems to help slightly.

I'm bad at describing this.

>>41126237
hm, that sound different from my last injury, thought i could maybe give you tips. For me it happened while tracking the knee too far in and forward during a front-squat and afterwards i couldn't load the knee anymore when it was straight.

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>>41126278
It's like this, sort of.
That does sound like what I did as well though, when injuring it, except it was a lowbar back squat.
Is yours better now? What did you do? Or didn't do, maybe.

>>41126341
i stopped all leg workouts for 1-2weeks and tried to keep it mobile by biking in a low gear
now after 3 weeks its better but not completely gone, lunges are still a bit of a problem, especially jumping lunges.
I am not a docotor, but low intensity movement with a high range of movement seemed to help for me better than complete rest. (although i raised my leg on another chair at work for the first week because keeping it bent would make the pain worse after an hour or so)

>>41125652
>>41125678
I have not tried dropping the weight and doing DB flat bench yet. How would increased ROM help in this situation?

My chest day consists of:
Flat BB bench
Incline DB bench
Weighted dips
Decline Hammer Strength™ bench

My shoulders have started clicking all the time. Left shoulder is worse. Movements like "goalpost" or "cactus" stretches get consistent, but not painful grinding and popping. Lowering my arms, when extended laterally, gets an audible, and usually painful click, around when my humerus is parallel to the ground. Attempting to raise my arms laterally while pressing against something, like a wall or counter, is painful, but is not associated with any click or pop . I can get my left shoulder to consistently pop by depressing then retracting it.

I just wanna lift, but my shoulders are starting to hurt my bench and OHP, and general arm work.

When I run, especially sprinting, my left foot turns out- as in my toes point more out to the side and my heel comes in. I think this is leading to some hip/knee pain I get after a lot of running/sprinting (I play a lot of sport). What could this be caused by, and how do I fix it?

I have splayed my ankle at the end of february.
By april i was back on my feet again, and despite the pain, i had to walk 5-10 km a day (school and work). By now, the pain is gone, unless i try to squat, but it still looks swollen, and can't squat deeper than halfway.

At this point, should i let it rest for a bit longer, or should i keep stretching it?

>>41124905
My spine is fucked up. About halfway down my back I sometimes get pain when putting torsion on my back from manual labor job. I can feel where the vertebra have a gap and don't quite line up. At the base one my spine the tailbone(?) sits out so far from my spine that I cannot even fell where they meet, its like a cliff, only painful. is there stretching or something to help this? I have been avoiding lifting out of fear of snap city. Any advice would be appreciated.

>>41125433
I have squat shoes (oly shoes) that i squat in

>>41124905
I'm 78kg at 5'10 and recently started pullups. At the bottom position I feel a weird tug at my left rear deltoid
I can't do more than 2 or 3 pullups

Is my form wrong or am I just fat

>>41124905
I have piriformis syndrome (upper portion of the left side of my ass hurts a lot) what can I do to deal with this? I've tried some basic stretches and rolling with a a lacrosse ball, but it only helps for a short period of time.

It will randomly get aggravated sometimes during work (office job and sit all day). It sometimes also gets tight and acts up during my OHP

chiropractor?

lol another PT

How do you go about billing your clients as much as possible and how do you stop yourself from laughing at 99% of the PT industry doing "functional" training as physical therapy?

>>41125678
Id also recommend rib subluxation tests because that sounds like a rib pop

>>41125754
you need to double down on your flexability and mobility, because if you arent stretching 2x/day with static holds longer than 2 minutes then you haven't tried your hardest to gain ROM

>>41126388
knees tracking forward and where the pain is located, and jumping lunges fucking with it, I'd put my money on some ligament or tendon damage. Nothing serious if the pain subsides but you should probably stop all high speed jumping exercises or any movement that causes it pain.

Try a low bar vs high bar squat and tell me which one feels worse. 10 bucks on the high bar feeling worse

My pelvis has rotated to point left, naturally it causes my whole upper body to turn left slightly as well. This makes squats, deadlifting, pretty much anything that loads lower back impossible to do without causing major straining. Running also feels pretty unbalanced, since my body isn't aimed straight forward

How does someone go about fixing this? I suspect my broken right leg 12 years ago caused it (broken shin bone). It healed, and I can walk and run and I *think* my pelvis has been normal before I started lifting (around a year ago), which then through some bad movement patterns with squats and deadlifts caused this whole shit

My right shoulder is also slightly higher than left, which again I suspect is because of my pelvis

Hopefully you can help me out ok this one. I rock climb and lift, and it seems as though rock climbing has caused this problem and it's affecting my lifts. It's a pain I feel in my elbow (near my bicep) and my shoulder, but it seems to almost radiate from my shoulder. It's an ache when I'm inactive, but almost a sharp pain when I'm actually doing something which involves my shoulders and bicep. Any quick movements that involve extending my arm above my head seem to trigger it. What is it and what would you recommend I do? Thanks!

OP halp pls, I've been to a shitload of physiotherapists and they just give me ibuprofen and some rest.

Three years ago in bootcamp I sprained my ankle, went to medical and they gave me a bottle of fucking water and told me to fuck off.
In bootcamp we're jogging literally all day (even while having our 3 hour sleep at night) , and I was limping on my sprained ankle all of bootcamp, second week of bootcamp I started having sciatica symptoms, really fucking painful Sciatic symptoms. Went to medical again and they gave me a smaller bottle of water.

Basically I was limping with sciatica symptoms for all of bootcamp.
Cam out, and continued limping in daily life.

Today the pain is less, but I still have really tight right hip, pain on the inside of right knee, pain in feet, pain around the right glute, and an AC joint inflammation on the right shoulder, also I've been trying to increase my squat for a whole year, only increased 20lb in a whole fucking year because of shitty hip mobility and movement.

OP I'll literally suck your dick if you fix my shit.
Stretching the piriformis doesn't do anything btw.