Qualified physio ask me anything

A snowHead

Hey everyone. I'm a physiotherapist. Currently furloughed so thought I should put my time to better use! (Or maybe I have just reached the level of boredom where work doesn't seem so bad!). Anyway feel free to post a message on here or pm me with any medical related questions and I will do my best to answer.

I grew up skiing (lived in in colorado) and have a master's in sports kinesiology so probably a little more sports orientated than your average physio.

A snowHead

Hi Jen, Welcome to snowHeads

My husband two weeks ago had an operation to trim his meniscus. They took away 30%. He is a keen skier and runner. He was told to do anything within his pain threshold during recovery. He can walk without a limp and has been decorating etc which involves bending, with good ROM. The swelling has gone down but he is still icing it as still bigger than the other leg. But it still hurts, why is there still pain and any ideas of specific exercises he could do to help with pain more than anything else? He has strong legs and no muscle wastage. Thank you very much! Smile

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Your husband sounds like he's on track. We usually suggest 4-6 weeks from surgery to returning to sport so still plenty of time left. Continue with rest, ice, compress, elevate. Ibuprofen is also good for pain and to reduce inflammation. You can try contrast showers too.

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Hi Jen. Appreciate your presence.
Our 19 yo son broke his back snowboarding in Feb (T7 & T8 )
He had a body cast (corset) since then.
The consultant says he doesn't really need it now, and our local physio in Morzine has says he can start doing lat-pull downs and light bench presses. (he's been twice now).
Thing is he spends 21 hours a day lying down on his bed, saying the he needs to rest, whenever I encourage him to get up and do something.
I know that teenagers have a genetic propensity for laying in bed all day, but is he right about the rest thing, or just playing me along?
I might cancel Netflix tomorrow and sees if he need less rest then ....

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For a normal spinal fracture it's anywhere between 6-12 weeks recovery time, so I would go with the consultant and physio that he's ok to start light exercise. It may just be being a teenager or it could be that he is apprehensive about reinjury (we see a lot of anxiety in people with injuries returning to sport). Perhaps a solution could be booking a few sessions with a physio? Gives him a fixed time and should relieve any worries having a physio there to guide him through it.

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That's a decent offer @Physiojen, Thank you, and welcome to Snowheads Very Happy

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@Physiojen, got a finger infection last year that proved impossible to budge. By the time I was referred to a specialist the infection had damaged the already arthritic finger and had destroyed the tendon, don't know on ligaments, but it is laterally unstable.
It is the end joint on my left index finger and was treated as a mallet finger. The tendon has fixed but I have about a 20% droop in the finger.
The middle joint now only has 90 degrees of movement and the finger in general is next to useless. I feel like cutting it off some days. Any advice?

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@Physiojen, Thanks Jen.
His prescription is for 15 sessions of physio, so hopefully he'll become more active as it goes along.

And of course, welcome to snowheads

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@Ray Zorro, A cold beer and a catch up wink

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@windofchange sounds like he is in good hands. Maybe have a word with his physio and discuss what he needs to be doing between sessions.

@frostythesnowman sorry, I probably can't help too much. I think you would be best consulting an orthopedic surgeon, who can explain your options. I guess you are joking, but if it is just one finger and you don't mind losing it amputation may be considered.

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Hi Jen. Any tips for runner`s knee? Is it worth getting a support strap? Got some pain from the patella down. Tried resting for a few weeks but it didn`t work.

@Physiojen, Thank you for your offer.

I have moderate to severe osteoarthritis in one knee and mild to severe in the other. It is a marginal decision to go for a replacement. I’ve noticed that I’m having difficulty straightening the right leg when walking and it is starting to cause pain in the opposite hip. To try and improve my gait and prevent further problems I’ve started a programme of trying to force the leg straight, which seems to be working very slowly (along, naturally, with trying to strengthen my quads).

My question is simple at the age of 69 am I wasting my time trying to increase flexibity?

You know it makes sense.

@deedee for treatment: rest, ice, compress, elevate,and Ibuprofen.

Runners knee is quite a general term covering a few possible things. If it is patella tendonitis (not uncommon) a strap can alleviate a lot of the tension. In my experience the best strap is an old shoelace tied around the leg just below the kneecap. Shoelace actually works best as it is so easy to adjust the tension , you want it firm but not really tight.

In terms of fixing the problem in the long term:
- if overweight try and lose some weight.
- stretch IT band, hamstrings, quads, and calfs
- get a good pair of running shoes and if necessary insoles. Also try to avoid any kind of footwear with no cushioning or arch support (you would be amazed at how many people get a lower extremity injury each summer which ends up being caused by them switching from their regular shoes that support the arches to flip flops!).
- strengthen glutes and glute med.
- up weekly running mileage slowly, and every couple of weeks have a deload week with less mileage. Think about swapping some running workouts for lower impact activities e.g.swimming, rowing, cycling.

Otherwise you'll just go on seeing the one name:

A snowHead

Thanks Jen, I agree his progress seems good. I guess we just didn't expect pain to continue like it has now the tear is gone. Sounds like patience is key

A snowHead

@Physiojen, Smile

I was just hoping if you could grant some advice. I have been skiing ever since I was seventeen, along with running long distance marathons. Now I am 36 years old and living in Mississauga, Ontario. I had an ACL tear on my right knee last August, after which I had ACL reconstruction about four months ago; I feel much better.
I have no diabetes, no history of high blood pressure, no medications, or no osteoporosis. I have no Hx of cancer, or no account of cancer in my family, no unexplained weight loss, or no bowel/bladder problems. I have been doing specific exercises in the last couple of months, as recommended by my physiotherapist, and taking enough rest.
In the past few weeks, I have this strong urge to start running again. Not that I am a keen runner, but been running 5km once or twice a week on the pavement, gravel or woodland, and progressing with every run. Even though my knee is somewhat rigid, it hasn't given me any pain; I wouldn't resume if it had! I wondered if I was doing too much too soon, considering the surgery was less than four months ago, or am on the right course? I am not consulting my physiotherapist since the lockdown, and have been searching all over the internet for guidance. I am hoping to get back into sports around September. So please, help!
Thanks! Smile

Well, the person's real but it's just a made up name, see?

@OnaClark
4 months after ACL reconstruction should be fine for jogging and light running. Just take it easy, stop if you feel any pain or instability. Avoid uneven and/or slippy trails. Strength exercises and flexibility are the most important things to work on at the minute so don't neglect them for running.

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Hi physioJen, my foot stepped unevenly and I fractured my lateral malleolus, (from the X-ray looks like a tiny bit chipped off at the bottom). I have leg in boot and on crutches. Wonder if I would maybe be back skiing next February. I am determined to keep fit while immobile with body exercises I can do with the boot on. I am 47. Any advice would be so welcome please!!, thanks. I gave nhs fracture team calling me tmrw about the plan, but am looking for some tips info today anyway

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Hi PhysioJen
Both my son and I suffer from limited ankle flexibility, which in his case could cause problems for his future skiing ambitions. Doing the test where you touch your knee to the wall, whilst seeing how far you can get your toes away from it whilst keeping your heel on the floor, we can both only manage 1-2 cms.

Can you recommend any stretches/exercises to try and improve things, he’s only 10 btw. Neither of us have had any injuries etc. Thanks in advance.

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@Physiojen, I'd just like to say thanks for starting this thread - really cool thing to do Cool

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Hi @Physiojen

I have had right knee problems for a number of years, and now constantly have a dull ache around the front of it under the Patella area. I'm told I have a very tight ITB and unballanced knee muscles. I'm now stretching most days for 20-30 minutes, and riding into work trying to focus on my quads evenly applying pressure. I haven't noticed that much improvement in 4-5months. Do you have any suggestions for how to address the dull ache?

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Hi Physiojen
I have problems with knee pain - patellofemoral syndrome - but since lockdown have been experiencing pain at the back of the knee. It is almost as if the tendons are very tight. At night having slept with straight legs if I turn over & want to bend my knees I experience excruciating pain doing so. Any ideas as to what it is & any exercises which might help? Normally I do 3-4 hours aquafit per week which seems to keep the knees in check and manage to ski wearing SkiMojos. PS I am not exactly in the first flush of youth....!

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Hi @Physiojen I broke my little toe 5 weeks ago & taped to next one at present. rolling eyes

Not able to wear trainers yet so worried that ski boots could be an issue early season. Should I do any flex exercises to help? Thank you

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That seems a really long time for a broken toe to heal. I have broke several toes over the years and been back to normal in a couple of weeks. In any case, it should certainly not pose any problem for ski boots as should be totally healed very soon.

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Thank you

Enough trouble looking after knees to keep me skiing without other injuries!

@Physiojen, after making a great offer, seems to have dropped off the radar

You know it makes sense.

@MissElectra, I have raced with a broken toe, it was less painful in a ski boot than in normal footwear, wasn't the little toe though.

Otherwise you'll just go on seeing the one name:

@rjs Thank you - will probably just be a matter of time

A snowHead

A snowHead

@NickyJ, good point

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Hi PhysioJen
As per my post nearby, I've broken my T9 vertebrae 5 days ago. It's a stable fracture caused by traumatic compression to the top of my head. Will I be able to start physio immediately after being given the all clear? Are there any questions that I should ask. Thanks very much, I'm keen to plan at least. Time is short at 55!

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@Physiojen, Not entirely skiing related. I always seem to be having trouble with my lower back. I have been told by a doctor that my back is relatively flat (I don't really have much of an arc or curvature around my lower back). I think I'm born with a flatter back than most but my posture probably doesn't help. I tried to correct it whenever I'm aware I'm slouching but my lower back get tired after a while. Are there any workouts I could do to help?

I work out quite a bit and do most of the compound exercises e.g. deadlifts, squats, bench presses. I think deadlifts help but I tend to get most of my lower back injuries from just one incorrect posture. The chiropractor I saw did say the shape of my back probably mean I'm more prone to injuries than others.

Thanks!

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@euanovsky, if there is no serious injury and it it just muscle pain then using a back stretcher might help. (these are fairly cheap online) Also you can use microwaveable wheat bags to give it some heat, or use some deep heat spray or cream.

After all it is free

@Physiojen is probably back at work full-time.

My advice for lower back pain is pilates and core exercises. I mix these with strength exercises although I no longer do deadlifts as even with good technique have caused back pain with resultant loss of earnings.

Exercising the lower back will cause muscle pain if the muscles are weak and old. Muscle pain is the body repairing muscles which have torn due to exercise. Repeated tearing of muscles will make the muscle bigger and stronger, but the pain will come for a few days (or more) after the exercise. This is what body builders do. (no pain no gain)

Resting the muscles allow the pain to ease, as will heat and stretching. In a more serious strain of a muscle you should apply RICE immediately. (rest, ice, compression, elevation)

Provided the pain is just a niggle, and it is a few days since the exercise which caused the pain, then stretching the muscle and heat will allow the muscle to relax better. Sitting down can often be the cause, especially if the muscle is sore after exercise.

A bath or a sauna can help provided you have had a sufficient rest since the initial cause of the pain. (eg. bending over too much doing something such as cleaning the floor, weeding, painting floors etc)

Walking is said to be the great long term cure, as it is blood flow which heals. Walking is a gentle exercise for the lower back (unlike jogging or cycling). It stimulates blood flow, and this is key to clearing the blood clots in the muscles.

Proper nutrition can aid muscle relaxation, particularly ensuring adequate magnesium and vitamin B5 in your diet. (peanut butter is good for magnesium, breakfast cereals for b5)

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Qualified physio ask me anything

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