Physical Therapy

I love to be surprised, to have my expectations surpassed. I went to my gait analysis and first physical therapy (PT) appointment this week with low expectations, an attitude of annoyance that I was being asked to participate in something that would probably be useless, and was immediately infused with hope and confidence that my knee issue would be resolved. I instantly loved the energy of my PT, Mary. Her voice is pressured with enthusiasm and eagerness to solve the mechanical problems of the body. I'd provided a detailed written history of my current knee problems, as well as a history of my past injuries and treatments. Mary was thrilled by this and absorbed the information quickly (in contrast, Dr. Noon, quickly scanned this same history, spending little time on it). She is a quick thinker, an avid listener, and a primo problem solver. From this picture you might imagine a new, younger therapist, fresh on the job, wanting to do her best, but your revised picture should be of a tall, comfortable woman in her late 40's, who has not lost her passion for helping runners. Runners are her specialty, though she sees all types of patients.

We had a great exchange of information, me easily talking about my body, she spewing out knowledge of physiolsogy and how mine in particular must be working to cause me problems. She thought her hypotheses out loud, I could give immediate feedback, and it was a true coming together of two minds to try solving the riddle of my woes. Of course she put me through various movements, strength tests, etc. to further gauge her hypothesis of what needs to be strengthened, and then she got me on the treadmill for my gait analysis. The analysis reinforced what she suspects the problem is and from there a therapy plan was born.

What She Found:

• My core is super strong - it does not need strengthening, BUT for some reason it is not being engaged enough when I run, which causes hip instability, which in turn calls on my hamstring to stabilize my leg.  The hamstring is not meant to do this job - the hip is - so my hamstring is not getting the break it needs. We think of the hamstring as higher up on the back of the thigh, but it actually comes all the way to the back of your knee. Mine is so tight there, that it is pulling on the IT Band attachment point on the outer lower left side of my knee. This issue is confounded by a weak calf.
• My gait analysis (a camera records you running, then the recording is played back on a TV in slow mo so every aspect of your movement can be scrutinized) shows a near perfect gait, except that when my back leg extends for push off, my knee is slightly bent when it should be straight. This is likely due to weak calf muscles, as well as my core not fully controlling my hip movement. Confirmation of my weak calves, mainly my left calf, was found by a simple exercise (now one of my PT exercises to complete daily) that you can try at home: calf raises. Face a wall, standing far enough away so just your finger tips can touch it. Wearing sneakers, stand on one leg, and do 30-40 calf raises. Then do the other side. She asked me to do 30. I did 30 on my right side, but boy was my leg cramping up by the end! The left side? I could hardly do 19 before my leg felt weak and near failure. This shows that my left leg is at a 30% deficit compared to the right.

Her Theory:

• Mary believes my problems are emanating from my 2008 L4-L5 disc herniation. This resonates. I believe it 100%. After I herniated that disc I limped with a cane for several weeks. I lost some sensation in my left rear thigh (which has not returned), my left hamstring could not fire at all for a couple months (eventually Ben, who was rehab training me at the time, got it firing again), my left calf atrophied noticeably (to this day, it's about 1/2" smaller than my right calf), and the underside of my 3rd and 4th toes on the left foot grew numb and tingly (they remain that way now). So, there is this general left sided weakness, and for some reason, my core does not activate well on the left side for hip stabilization when I run. I've gotten by with this imbalance for the past few years, but running downhill for 13 miles in March's Canyonlands race proved too much for my hip to handle, my hamstring tried it's best to help me, but eventually got pissed off at having to do all the work, and revolted, tugging at my IT band and knee.

Her Plan:

• Strengthen my calves, my hips and train my core to engage my hips when I run. I need to do exercises that will keep me on my toes (literally) to develop strength in an extended leg position. I am super strong and stable in a bent knee position (thanks to Aaron and all his squats and lunges), but need to work the "triple extension" now (plantar flexion, knee extension and hip extension). She's given me 5 simple yet very difficult exercises to do 1-2x/day, including those single legged calf raises. She says I will build the strength within in 2 weeks, which is when she'll see me again. She says I will be fine to run the Summerfest 1/2 Marathon in 7 weeks, and does not advise me against running now, even with the knee tweaking. For my part, you know I will work the PT hard - I want a full recovery. Mary also encourages my use of Vibram Five Fingers as they will strengthen my lower legs.

And now for Joe's PT Update:

• LEFT SHOULDER: Dr. Nelson (spine doctor) is pretty sure that there is a C6 nerve narrowing issue due to degeneration of the disc, so doing anything further to investigate (like an MRI) would not likely change the course of treatment, unless a cortisone shot was ultimately determined to be appropriate, in which case it would need to be preceded by an MRI. The current plan is to continue traction using Dr. Jackie (our chiropractor) to see if it actually helps and, if so, then consider buying a home traction unit. Joe will also continue with exercises, etc., but no further PT is scheduled .

• RIGHT SHOULDER: Dr. Nelson thinks Joe has a right shoulder impingement and bicipital tendinitis. He’s given him requisition for PT for ROM/stretching/strengthening, which he will use at Aurora Sports Medicine (same place I'm going). Dr. Nelson  also put in prescription for a topical anti-inflammatory to apply a few times a day to the area, along with icing and ROM.