Physical Therapy General #2

Title related. Ask about sprains, strains, gains and pains.

I don't have clean gym clothes so I'll likely be home all day today.

Keep fucking up my right shoulder (rotator cuff I think). Went to physical therapy for it like 3 years ago, try to keep it strong and stretched out but inevitably hurt it and have to take 2-3 weeks to rehab it.
How do I get off this ride?

>How do I get off this ride

Rotator cuff injuries can recur if you overstress the muscles around the joint. Is this a recurrent problem? If so, identify precursor symptoms: if you don't feel 100% doing exercises, reps or whatever, deload, do drop sets, do wave sets or incorporate resistance band work into your program.

If this is a cyclic recurrent problem, identify the factors that lead up to it, like if you're doing heavy bench. In that case it's best to rotate your exercises to put focus on anterior RC, posterior RC, and your middle delts to ensure you're not overstressing the entire joint.

My questions are:
- what was the injury 3 years ago
- did you need surgery
- what rehab did you do
- has it flared up between then and 2 weeks back
- what happened 2 weeks ago; how did you hurt it
- any other shoulder issues?

Injured was overuse in baseball.
No surgery but about 2 months of rehab.
It started hurting about 2 weeks ago just from lifting. I've stopped lifting and am doing the exercises I did during rehab to strengthen it.

I think I just mildly strained my quad.

How do I tell if it's my rectus femoris or another muscle and what can I do to help recovery.

Sounds like you've got a good read on it. my advice would be to do the exercises at an intesity that's good for you. Monitor the pain, and gradually return to your regular activity. If pain is stopping you from progressing, consider speaking to a GP or another PT about other treatment that may work. If you find you have decreased range of movement or anything like that, consider speaking to a GP or PT about that too. Musculoskeletal injuries take about a week to settle, and then three or four weeks to heal completely, especially in a high-use joint like the shoulder. Rest will do you good, as well.

>How do I tell if it's my rectus femoris or another muscle

The tricky thing is that the quadriceps muscles all do fairly similar actions. The good part about that is that rehab can be fairly uniform regardless of whether it's a VM, VL, VI or RF strain. Just take some weight off, do light exercises, get plenty of rest, and once the pain has passed, transition back into regular exercises.

Any at home stretches/remedies for mild tennis elbow?

If it's mild, the best thing you can do is to rest, avoid aggravating factors, and scale up to small exercises like:

- clenching your fist around a towel
- wringing out a towel, as if you would to get water out of it
- gently extending and flexing your elbow, like you'd do a bicep curl.

Ice if the pain persists

This area right under the bone in my forearm hurts like crazy. usually, when doing preacher curls/barbell curls but I find myself wincing in pain just picking shit up/pushing shit at work.. Been to the chiropractor already and didn't help. Been having this pain for like 3 weeks now :/

I hurt my toe a week ago. I have pain when bending the big toe down and some bruising on the side of the joint. Pretty sure it's turf toe, class 2. I immobilize the toe with tape and wear a walking boot. I am guessing it'll be 2-4 weeks before I can start lower body exercises or cardio again. Should I do some rehab before I start up again, and if so, when should I start with the rehab exercises?

Based on what you've said and the image you've provided, it sounds like golfer's elbow. Depending on how long it's been going on, it may have an acute or chronic nature. If it's recent, manage your pain by avoiding aggravating activities - try to minimise grasping work at the gym and consider alternate lifting strategies at work that won't aggravate your elbow. If you want to take anti-inflammatories, discuss this with a surgeon.

The important thing is to give the structure time to heal.

Another thing you can do for momentary relief is to take a hard ball like a baseball or a green apple, and use that to massage your arm. Start at your wrist, apply slightly firm pressure, and roll the ball up towards your elbow and back down again. Try that and see how you feel.

> If you want to take anti-inflammatories, discuss this with a surgeon

Sorry, discuss with a GP, not a surgeon.

Where you working kenny?

>Should I do some rehab before I start up again

Yes, do some light rehab work before transitioning into regular intensity exercise. Good measures of progress include the level of pain that movements generate, the easiness with which you can move your toe, bear weight and walk, as well as how long it takes to recover.

I would recommend using pain as your guide: if you exercise and the pain keeps building up, consider decreasing your intensity and alternating movements.

>when should I start with the rehab exercises

If you hurt your toe a week ago, begin the rehab exercises two weeks from now. The thing with turf toe is that it is a tendonous injury to a joint that gets pretty mobile, so I prefer to be conservative with return to rehab and return to work. If two weeks is too long, begin light rehab when you can move around pain-free.

Currently off work. I'm starting a private practice with some friends with whom I attended uni.

Also, Kenny's my girlfriend's name. First thing that came to mind when I made the trip, haha.

Thanks for the advice.

What advice do you have for someone interested in becoming a PT?

I'd say, research the profession and the different specialities. You'll have to do a few years of work after you finish uni before you get really comfortable with the things you're doing, and even then there's always things to learn. Be active with your education, be sincere with your patients, and be serious about your decision to do this job. It doesn't pay as well as accounting, it doesn't have the prestige of medicine, it's not as sexy as engineering. But you'll teach people to walk again, and I can't think of any accountant who can do that.

I was doing in and outs and leg raises and my left hip kept popping.
I had done heavy squats and lunges today so was it just an improperly stretched hip? I stretched it afterwards and now I've got a heating pad on it.

I also experience clicking in my shoulders when passing through the top range of motion, where you would position them for OHP. Could this be due to weak rotator cuffs?

What uni did you go to for DPT?

I did my bachelor's and master's in Australia. I had the opportunity to do my postgrad in England but I liked clinical work too much, so I stayed here and sort of bummed around in hospitals and clinics.

Best advice for turf toe?
Been dealing with it off and on for almost 7 years now

interesting, does a masters in Australia still hold plenty of merit for PT certification? In the USA the masters programs are pretty much gone and everything is 3 year DPT programs now. Any new PT has to come from a DPT program but there are still plenty of already practicing PT's with the masters.

>was it just an improperly stretched hip

Could have been, or it could have been a momentary thing due to doing the leg raises. There might have been some muscular or ligamentous tension - when you say "popping, do you mean that you felt your hip crack like you might crack your knuckles, or was it something else?

>Could this be due to weak rotator cuffs

Loads of people, myself included, have clicky shoulders. My advice for you would be to make sure you're working everything proportionally, taking care to work on end-range movement especially. If you feel pain, scale back and try something different.

>does a masters in Australia still hold plenty of merit for PT certification

Not sure - I'm working in Aus atm and going back to uni for premedicine, seeing as my mother keeps badgering me about becoming a doctor like the rest of the family. If I do move to the states, I'd need to sit equivalency exams, but I'd be able to cite my clinical experience as a means of credit, I think.

It was everytime I brought my leg in, on the extension my hip popped like something was sliding over something. Wasn't painful but was uncomfortable. Just weird.

Thanks for the tips on shoulders. I'm about to move to a new city so I've been considering switching to a new routine focused a lot more on bodyweight and gymnastic style flexibility routines, so shoukders and range of motion are a big priority.

I'm one week out from surgery to repair a torn achilles' tendon. What can I do in the meantime to keep my gains, and what advice can you give for when i start rehab on my leg?

Thanks brah

Hmm, given it's been so long, if you're looking for injury minimisation I'd recommend speaking to a doctor about getting a referral for some insoles or something like that. As far as activity modification goes, do plenty of light movement, try not to aggravate the old injury, and make sure to warm up sensibly before getting into activity.

>sliding over something

Might have been tendonous movement, which isn't anything to worry about unless it's causing pain. See how you do, and post back in the thread if anything happens - I'll do my best to be around semi-regularly into the future

Breh PT student here and everyone teaches RICE but the new research that I find interesting is stay away from ice and elevation except in chronic injury. If acute, don't you want more blood flow and inflammation to promote faster healing as long as there isn't massive amounts of edema?

>What can I do in the meantime to keep my gains

Right now, don't worry about gains. Gains come after your body is healthy and repaired, so let the surgeons do their thing, follow their instructions and don't do anything reckless in the leadup to the surgery. If you've been given pre-hab instructions, follow those. If you've been given a care pathway, you'll be following that.

>advice can you give for when i start rehab on my leg

Follow the instructions of your rehab therapists, do your exercises and stick to your routine. It's just like following a normal exercise routine except this time it's to restore baseline function instead of to increase your functional capacity. Do your work, and you'll be fine.

Thanks Kenny, you PTs are great. Pretty always bro teir.

> If acute, don't you want more blood flow and inflammation to promote faster healing as long as there isn't massive amounts of edema?

That's the case - recent research is looking away from icing. I agree with what's being said, but you've got to remember that ice is really good at minimising pain as well, and that's often the biggest problem in an acute injury. Otherwise, the swelling and increased bloodflow for healing are expected and pysiologically normal.

Whether or not you ice will depend on the context and what patients you treat - if you have a soccer player go down, you'll want to ice it for pain relief. In less dynamic cases, you can forgo the ice, but you should always include education about icing so that if the client wants to do it, they can do it safely.

Also, could you link me the articles you've read? I always like seeing new research

My shoulder is incredibly complicated so I won't jump into any big details. My most recent MRI showed a SLAP tear with some biceps tendonitis and my ortho immediately jumped to the bicep tenodesis conclusion. The thing is that my shoulder responds really well to heat as far as ROM and pain goes, much better than ice. Would heat really improve a labral tear? I am not convinced that my labral tear is actually my biggest problem.

Okay, completely tore my acl and had a reconstruction the following year.
It's been about 18 years and in that time I've never been able to get full extension. Ever.
As for full flexion. I have about a 8 inch difference between each leg. And if I try to get some flexion it feels like it's trying to pull through something and I feel a strong pain.

I should be feeling some form of OA right now but I don't feel anything.

Oh and my knee is significantly more swolen then the other and I can see two knots in my leg I think that's where the screws that are tying everything together is.

I've not had any problem exercising on it, it's just takes a bit more concentration to activate the muscles and move through my repaired leg and to use it fully.

My question is. How can I get full flexion and extension or at least increase it. And how long do I have before arthritis essentially cripples my leg.

>Would heat really improve a labral tear

What you're feeling is pain relief from the heat. This is the easiest way to explain it: if you stimulate an area that's painful, that extra stimulation can minimise the sensation of pain. Adding heat is adding an extra sensation to the painful area, and so you're feeling less pain. There's more that can be said, and if you're interested, google "pain gating" and "multimodal therapy for pain relief"

A SLAP tear is structural damage to the shoulder, and the biceps tendonitis may be from local area inflammation, compensatory movement of the biceps, or altered movement pattern. The most effective way to address that structural damage conclusively may be through surgery, which is why your ortho is suggesting it.

I have a mild pain (more like a discomfort) on my left knee, located on the right side of my knee bone (patella?). I got it when I was running and now it's interfering with my lift (specially with quats). I tried to lower the weight on my lifts for a week and I spent another one just swimming and the discomfort doesn't go away.

Help me bros, what type of recovery can I do for my knee? Thanks

>How can I get full flexion and extension or at least increase it

Some ideas come to mind:
- try doing the exercises in water, or at least immersed. Taking the weight off can do interesting things with the joint and could help you a good deal.
- try assisting the flexion or extension - if you're lying down, hook a towel over your shin and use it to draw your leg up to your chest. Google "auto-assisted knee rehab exercises" for more information. Be mindful of pain and don't push it too hard.
- Speak to a PT, explain your problem and get some exercises off them. They'll be able to assess you IRL and they'll give much more specific advice than I could over the internet.

>how long do I have before arthritis essentially cripples my leg

Itshappening.tiff

Arthritis is a slow process - the most you can do is preserve function. It advances differently in people, based on their state of health and their past history of activity. I'd reiterate my advice to speak to a PT about it. Sooner you get on the books and start a pathway of care, the better.

Good luck, stranger.

I have a clicky shoulder. It doesn't hurt at all but it just clicks. Is it a problem?

Can you tell me a bit more about it:
- what makes it worse
- what makes it better
- is it worse in the morning or evening
- are there any postures that make it better
- Has it gotten better or worse since it happened
- Has something like this happened previously?

Naw. If it starts hurting, post back. I'll be here.

Thanks bro.

>what makes it worse
When I run (treadmill) or do some squats. I don't have problems with biking, rowing or swimming. I do all these stuff on a commercial gym.
Also I feel it when Im walking and I stumble with something or when I make a bad move.

>it is worse in the morning or evening
I don't know actually but I have felt the discomfort at different hours. I train in the morning though... After waking up at 7 AM.

>are there any postures that make it better
Besides the situations that I described above I don't feel the discomfort.

> Has it gotten better or worse since it happened
Hard to say. I think its the same. After one week of swimming I tried to squat again and the discomfort was still there. I stopped immediately.

>Has something like this happened previously?
Yeah, But usually the pain goes away after a few days.

Thanks for your time mate.

can you tell me about schooling/what got you into physical therapy/whats involved?
been thinking about getting into it

>schooling
University here was four years, but I took six months break to do research, plus six months' break after that. The first two years of university were campus-based, where I learned anatomy, pharmacology, clinical patient management and other subjects. The other two years were hospital-based, where I completed month-long rotations at different campuses and working with different patients. If you take the same path I did, you'll get exposed to lots of different patient populations this way.

>what got you into physical therapy

I didn't know what I wanted to do when I left school. I graduated in the top 2% of the nation, I was good at science, good at art, good with my hands, and the physio course was 80% girls. So I picked physio.

>whats involved

It's basically a gutted medical degree. What you won't learn about pharmacology, organ physiology, reproduction and other medical-related stuff, you will learn about anatomy, neurology, respiratory physiology, rehabilitation, and all manner of other things. There are hospital placements and so on, but those are pretty self-explanatory.

I'd say it's best if you speak to an IRL PT about this. I want you to be able to rule out structural damage to the joint, and good testing will help you with that.

Thanks. I wasn't sure if I should go to a PT since is not severe.

If I bend my arm back in a position suitable to hold a squat bar my bicep hurts like hell.

I have no issues doing anything like a bench press or curl where I actually use that muscle but don't push it back that way.

I had a three week holiday and expected the time off would resolve it.. but it didn't. What the hell is going on?