Physical Therapy General #3: Through Knowledge You are Strong

I have a grade 3 sperated shoulder, right side on my dominant arm with a very nice bump. Happened 3-4 years ago.

I have no pain, full rom, but I want to get into serious lifting. I can do about 20 pushups and I feel a little tiny pain, but nothing more than a 1/2 on the pain scale..

I'm too afraid to try dips, I've tried benching with just the bar and it feels okay but there is a ton of clicking and running going on.

Also when I try to do barbell curls it seems like no matter how much I relax my shoulders and try to lean them back and focus on just the biceps, I can never get consistently reps, like side is always off from the other.

I can do 3 sets of 8 reps military press sitting and it feels fine, but again it's like I can never keep the bar even or straight even though it's only a 30lb barbell

Any general tips / advice? I'm probably not gonna get the surgery but at the same time if I can't bench or do dips or do OHP, what can I do instead? I do bandwork on it everyday and for the most part it feels fine and stable, except compound exercises involving the shoulder. I can move the bone with my hand which isn't a very comfortable feeling...

Do I just need to slowly work on strengthening all the muscles around it?

I'm trying not to get discouraged but I feel like I'll never get swole with this thing, I hate it.

I found this video helpful
youtube.com/watch?v=6uZ_sBMw0qo

It hurts like Id do a leg raise

The pain is specific, like right in the middle at the top, front of my right thigh

Its sharp, yeah

Hard to tell, close to the surface I guess

Slightly worse

I manage it by ignoring it but im scared ill make it worse

I jumped right in I guess, trying to get fit for infantry soon so im worried about it getting worse.

Thanks in advance

>I want to get into serious lifting

Good lad.

>I'm too afraid to try dips

Have you tried doing assisted dips? Taking the weight off for the start can help you acclimatise your joint to loaded movement, and if pain or instability presents it's better to have it happen under low load rather than something that could really hurt you.

>but there is a ton of clicking and running going on

Form check. If you're worried about keeping the bar level, have a buddy spot for you or set up a phone to record yourself for some feedback.

> I can never get consistently reps, like side is always off from the other

My advice would be to vary your exercise. Switch from barbell to dumbell - the different force vector of DB v BB means you'll have to move along different pathways to achieve the same results.

>I can never keep the bar even or straight even though it's only a 30lb barbell

Again, try switching from BB to DB and see what happens - it could be the case that you're getting better recruitment from your non-injured shoulder leading to the bar kinking to one side.

>Any general tips / advice?

1. Practice good load management strategies: You don't want to compensate for your bung shoulder by overloading your healthy shoulder. Maintain good form and good weight path when you're doing your exercises.
2. Move your shoulder through different ranges of motion: not just overhead - work push and pull through all angles.
3. Vary intensity and type of exercise: Again, the above point. Low-intensity work can do wonders for movement reprogramming and pain management.

>what can I do instead? / Do I just need to slowly work on strengthening all the muscles around it?

Keep up with the band work you're doing. Consider getting tougher bands before you move into doing weight, and once you get there, progress conservatively. Most programs have pretty aggressive linear progression models - I'd say progress slower, concentrate on quality of movement and range.

Solid video - I'll add it to the OP when next I post up.

Alright will do. Appreciate the info, thank you.

-Doesn't fully pass for a day or so, but it does lessen within an hour or so.
-Nope.
-Yes, but it doesn't tend to affect me till the end of the workout.

For completionist sake, I have been at this PPL for 4 weeks now. I had been doing SS for a year, and had gotten bored with the routine + had been stalling a lot on the lifts.

Routine for the Pull day is as follows;
4x8 pullups
4x8 barbell rows (this tends to be where it starts)
4x8 lat pulldowns
3x10 db shrugs
3x10 ezbar bicep curls
3x10 hammer curls

Thanks in advance helpful PT user.

Sounds like a rectus femoris muscle pathology: you've strained one of the muscles contributing to your quads. It's not uncommon, in fact it's pretty much expected with kicking and sprinting athletes. I'd rather you swapped from running to swimming for rehab, but if you want to keep running then decrease the intensity.

Your recipe is as follows:

1. Scale back your running: run BELOW the point of pain and/or restriction. As long as the quadriceps feel good, the speed can be increased.

2. Don't run everyday, only every other day. Again, rectus injuries tend to do poorly if overworked day after day. Leave running for every second day, manage the 'tone' the next day and cross train. Overzealous rehabilitation every day will delay the recovery process.

3. Rectus injuries respond better to short distances of 60 metres. Try 20m acceleration, 20m cruise and 20m deceleration.

4. Gradual re-introduction of skills: If you're doing anything on top of your cardio training, shelve that until your rec fem is good again.

5. Monitor your symptoms: Reassess stretch, strength and muscle tone the next day and decide based on a 24 hour reaction to training.

>Trying to get fit for infantry soon

Hooah.

Thanks for being thorough with your program - the high number of isometric holding exercises towards the end look like the prime culprit behind your forearm pain. Keeping the muscles fully engaged without changing their length is going to aggravate them nastily. My advice would be to do some light stretching inbetween those exercises - resisted palmar flexion and extension, as well as unresisted supination and pronation. Plus clench your fists a little to get the blood flowing.

See if that helps, otherwise post back here in the next PTGen you see, I'll try and keep them running for the foreseeable future.

Currently and for the next 2 months in a cast, broken scaphoid, other than legs what can I do at the gym?
I've been running more but having been in the cast for a month already my arm is practically dead.

Thanks for the advice man, appreciate it

Be patient. Once your arm gets out of that cast you're going to have a lot of work to do to get it back up to par. Don't fuck up your injury management course now by doing upper limb stuff because you want to hold on to your progress.

Once the cast comes off you'll have basic movements to do to get your flexibility that. Then in a few weeks' time you'll have light strength exercises. You will be guided by your case management team, whose interest is in your best outcome. Take it slow.

As for gym based stuff, stick to doing what you can. Focus on legs and core, don't worry about arms right now except for flexibility and range stuff. You'll have plenty of time later to get gains.

Also, digits.

Injured my mcl a week ago.
Imagine sitting on your heels with you knees on the ground but only one leg then getting tackled backwards on the ground.
There was a loud popping sound and instant pain.
I had to walk on it for a few hours because of job but went to the ER that night and they took an X-ray showing lots of fluid but nothing broken.

They gave me crutches and an ACE wrap and told me to RICE until the hospital opens after Easter.

Went to the hospital and they told me to get an MRI and look at it further nd detirmibe if I need an MRI have to go to an appointment with PT.

PT's earliest appointment is in 3 weeks.

Like I said it's been a week since the injury, I've been icing it and kept it wrapped, using crutches to get around and taking Ibuprofen and acetaminophen.

It still hurts to straighten my leg completely, I can't bend it past 90 degrees, still painful to apply weight to that leg, and my knee feels unstable when I move it.

How can I get this shit to heal because by the time I get to PT my shit could be mega fucked up.

fair enough
guess I'll just stick to cycling/running and leg day every other day

also, somewhat related, how much cardio is enough to lose some extra weight? I recently began to run 12km 2-3x per week but thinking maybe just doing that 2x per week and 2-3x of cycling/legs at the gym.. I eat fairly well I've just always struggled to lose those last 5kg regardless.

>Went to the hospital and they told me to get an MRI and look at it further I would have to be examined by physical therapy, and to make an appointment with them.

Yeah this sounds like a nasty MCL injury, maybe GII or GIII. I can't make a proper clinical call because I can't do an assessment on you right away, but my advice would be this:

- If you're comfortable with waiting, wait it out until you can get to your PT. If you want to preserve range, you can do some assisted exercises, which is where you use your good leg to help your sore leg. Try sitting on a chair, hooking your ankle around the other one, and then using your good leg to bend your sore one past 90 and straighten it out. That can help with range.
- If you're not comfortable with waiting, look around at any PT clinics that offer emergency appointments for assessment and if they can offer you a referral for imaging.
- If you can't find anything earlier, try not to load your knee too heavily, avoid painful movements, and try to preserve range as best you can.

Godspeed, kneebro.

quick rundown on behind the neck exercises
been doing standing behind neck press a for months now, they make my shoulders feel comfy

is it an issue if you have good shoulder mobility and adjust grip according to mobility

>how much cardio is enough to lose some extra weight

Enough to create a caloric deficit. The whole TDEE thing is a massive moving target if you're trying to lose weight - there's some good information in the sticky about it, plus some excellent threads on Reddit from actual fitness models whose career depends on their understanding of this information. Unfortunately, I'm not the sharpest tool in the shed when it comes to weightloss. For more information, consult a dietitian, though you're best off shelving the idea of weightloss until your injury is repaired. Focus on getting better, then focus on getting buff.

Hey Kenny

I'd like to see a PT in Edinburgh - how would you go about determining who is worth the time and money?

I required orthotics as a child for high arches & overpronation, was told to stretch my gastrucs and do calf raises (of course I never did them)

Now I'm doing lots of cycling and occasionally light weight squats, I'm getting pain in my knees (medial joint line) and also ankles posterior-inferior to the m. malleolus.

Inb4 see a doctor - I am one and wouldn't trust them with anything biomechanics related and am happy to pay.

Currently I'm doing the exercises the Ortho doctor advised when I was 13, wearing cheap moulded Orthotics, looking to buy weightlifting shoes as heel elevation has helped, only squatting lightweight and working on my abductors.

>Please advise how to choose a good PT
>Please advise if I can do anything else to improve this pain
>Thanks

>quick rundown

INB4 bogpill

>is it an issue if you have good shoulder mobility and adjust grip according to mobility

The problem with behind-the-neck exercises is that it loads the shoulder in that joint's most vulnerable position. When your shoulder is raised to the side and externally rotated, the ligaments holding the joint together are under maximum stress. At that point, all your muscles are doing is moving the joint, while the ligament holds it in position. This can also be a problem if the kinematics of the shoulder joint aren't up to par - you can get a lot of grinding if you've got a worn down shoulder.

Generally I tell my clients to stay away from behind the neck exercises unless they're experienced strength training athletes. Progress conservatively, stop at the first sign of pain or instability, and if any discomfort persists over a long period of time, get on it sooner rather than later.

follow up question:
>When your shoulder is raised to the side and externally rotated, the ligaments holding the joint together are under maximum stress
you always hear about internally rotation being an issue (lat raises)
is external rotation in this case an issue because of the raised shoulder or is it generally not adviced?

I've got mobility problem. My lower body mobility is horrendous considering the amount of time I spend stretching.
The reason for this is APT from sitting too much.
Having said that I am also very active. I work out body-weight and stretch in my room every day (for a few years now) and go to the gym a few days a week.

My left hamstring is seriously lagging behind my right now. My right hip-flexor is lagging behind my left one.
I can't get enough hip extension, I'm perma stuck in apt with very small improvement over the years.

I have very small range of motion when kicking.

How do I fix all of this?

I've started going hard core on front splits (isometric/pnf). Progress is still slow but I believe getting comfortable in front splits will fix my mobility issues.

> how would you go about determining who is worth the time and money

It depends what you're going for - different PTs have different specialisations, or they can be generalists like me because they're deadshits who didn't listen when their supervisors told them to spec. You generally want to go to someone who is a preferred provider for a few private health funds, as well as someone with the qualifications to deal with your particular issue. Look at professional registries and talk to your GP about who to see specifically - you don't want to see some skub who won't treat you good like I treat you.

>(of course I never did them)

You are a fool.

>pain in my knees (medial joint line) and also ankles posterior-inferior to the m. malleolus

Keep up your stretching regime and do your squats with different foot positions. Feet pointing forward, outward, close together, shoulder-width apart. Make sure to keep focusing your adductors, triceps surae (remember to do the stretches with bent knee (focus on soleus) and straight leg (focus on gastrocs.)) You're working against a life-long kinematic derangement so you're going to have to work hard and progress slowly with a close eye on your pain. In the meantime, swimming works wonders and it'll help with your physical capacity overall. Plus the pool is a great place to meet qt swimmers.

>Inb4 see a doctor - I am one

Grats on making it through med, brah.

>is external rotation in this case an issue because of the raised shoulder or is it generally not adviced?

For me, it's generally not advised because the regular Joe Blow off the street is going to do his behind the neck exercises with shit form and with shit progression. For trained people, it's different. The raised shoulder in this case is really your humerus being rotated into its least stable position where the ligament gets stretched and a brisk push in the wrong direction can snap it.

To conclude, I'm going to cop out massively and say it's different for different people, and to monitor your own progress and move forward or back accordingly.

...

Thank you based Kenny.

I will follow your advise and report back in 1 month.

My suggestion to you is this - work from your hips out to your toes. Your first priority should be dealing with your APT before anything else because problems with your hips will prevent proper gains from being made elsewhere. Don't worry about symmetry until you've dealt with your tilt.

Some common exercises for APT include:

1. Lunge stretch. If you want to make it harder lift your arms up alongside your head and twist towards the leading leg. 4 sets in total, 2 on each leg, 15 seconds hold at the deepest point of the stretch.

2. Butterfly stretch. 30 seconds for one set at the deepest point of the stretch.

3. Sit in a full squat. Keep on your heels and sit into a full squat. You can allow your back to round forwards a little as your have no weight on you, thus releasing some of the tension in your lower back.

4. Planking with glute contraction.

If you're still having issues, see an IRL PT or Ex Phys and manage it through them - it sounds like a simple but fairly involved problem which would benefit from some eyes on management.

Good luck all the same - my girlfriend had a nasty case of APT which was a bit of a devil to manage, but once it's done, it's done.

My left calf had a pain on the upper outside that I can only really feel when I'm crouched down. If I put weight on my toes while crouched it can be beyond painful to stand back up. Used to get pain while squatting too. Recently been driving my knees out more and shoving my ass out more which had made squatting a painless endeavor now. Still,if I crotch down the wrong way I get pain. Better to lay off completely until I get no pain regardless or am I good to keep squatting as long as it never hurts? Keep in mind this is the only time my calves hurt, calf raises don't feel the least bit uncomfortable and no other exercise other than squatting down causes pain.

>Better to lay off completely until I get no pain regardless or am I good to keep squatting as long as it never hurts

The fact that there's pain means that there's something that can't tolerate that range of movement. I'd say switch from squatting to other exercises, and maybe even different kinds of squats. The fact that it's the only time your calves hurt isn't important, the fact that there's pain means something's up. Can you go into more detail about the problem?

- How long has this been going on
- Did it happen all of a sudden or come on slowly
- Can you describe the pain
- What kind of squat are you doing
- Does the pain stay in one area or does it spread
- Does it persist or does it dissipate quickly?

Also, if anyone from previous threads had their questions unanswered, let me know and I'll do my best to get to you now.

- How long has this been going on

Few months.

- Did it happen all of a sudden or come on slowly

Slowly, first noticed it when I would be standing up during squats. Never had enough pain to make me stop because the squat moron is so fast. Longer I'm crouched down with weight on the front of my feet (like sitting on your toes with the backs of your feet off the ground) more it hurts to stand up quickly.

- Can you describe the pain

Just a kind of burning pain on my calf when standing up. The slower I do it the easier the pain is to manage so I've assumed it has something to do with the muscle stretching out.

- What kind of squat are you doing

Low bar.

- Does the pain stay in one area or does it spread

One spot, just that calf too.

- Does it persist or does it dissipate quickly?

Dissipates quickly though sometimes my calf will be pretty tight afterwards or when I wake up in the morning.

Is a peanut better than a foam roller for stuff like calves and quads?

Sounds like a chronic muscle/tendon sprain. My advice would be to lay off the squats for a while and work on mobility around your knee joint, focusing on really stretching into end-range of motion. If you're still keen on squatting, deload and switch to different squat forms, see if that minimises the pain and if you can keep going in spite of that.

Otherwise, be safe, be sensible, and monitor your symptoms

Hi based OP

I have a lower back pain und right hip/upper glute pain since about 1 1/5 year. I believe it's L4/L5 injury, maybe from bad form with deads and squat and maybe sitting too much.

The pain is most in the right hip/glute, like a dull, tight muscle injury. Sometimes I feel it like a pierce in the right side of my spine.
I already tried a chiropracticor and learned a stretch (twisting the leg and upperbody in opposite) that helped with the pain but now makes it worse.
I realised as well that squats makes it worse, so I stoped squating. Deads are ok.
Sitting on a swiss ball makes it better as well.
The general pain is better after I learned to strech and fix my postur, but the pain remains. With the numerical pain scala I have most 2-4, 6 at worst.

Pls help

I've never seen this kind of question before and I have no idea how to answer it. Try it yourself and see how you do, unless you are allergic to peanuts. If you are allergic to peanuts, consider switching to another legume like chickpea or soybean as they have a similar shape. Ensure to rotate your legumes regularly to ensure best results.

My advice to you is to go and see an IRL PT for it. Not a chiropractor, but a physical therapist or a doctor. Get your spine MRI'd, get your problem noted down and get onto a care pathway.

Sorry I couldn't have been of more help, but lower back issues that have been going on for that long are best managed by someone IRL and close to you.

Godspeed, user.

Thanks m8. The problem is I'm a studend and don't have the money at the moment, and to be honest I don't trust physicians that easy, than I fear they would rather just give some analgetica or even consider that I stop lifting. Till now I could achieve results by myself but I know I should check it up with good specialists someday.

t. Nurse student that worked in a orthopedic station

Are you still here good fellow ?