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 Post subject: Lots of Rehab.
PostPosted: Thu Nov 25, 2010 7:35 am 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
I have been emailing Steve for a while and thought I would start posting on here so that other people can make use of my experiences. (And to stop filling up Steve's inbox!)

I have several conditions I am currently trying to rehab. I am 36 and have spent most of my life working at a computer so blame this lifestyle for causing dysfunctions and injuries. I have always ran, swam and biked but have over the last year tried to do more Crossfit. Some of Steve's documents really make sense to me (Tendonitis and Shoes, Sitting) and that is why I have asked him for advice. Dietwise I pretty much eat Paleo with occasional beer, cheese and milk.

Current problems I am trying to rehab and a short history;

Achilles
History:
I used to run a lot and when this occured I was definately pushing the miles and hills to much. I was not paying any attention to my flexibility. I have had this injury approximatley 5 years. I used to run in support shoes with orthotics.

Current State:
I have tried eccentric work again, worked up to 3x25 heel drops wearing a rucksack. I have had Pose coaching and now wear minimal shoes all the time and racing flats to run in. My PT has said it is ok to try running again. I have been doing 12 mins 2 times a week and now pushed to 19 mins. My Achillies (and around the bony bump at the side of my foot, I suspect this is Peroneals) area feels sore when I pinch it but is not stiff in the morning. Flexibility is a lot better than it was. My Physio says there is no sign of tendonitis and the tendon is not thickened. I am going to see him again next week to see if he still thinks it is ok.

I also have a bone spur on my heel which may be causing this problem, my Orthapedic is not sure (after xray and MRI) and has sent me for a second opinion. My PT does not think this spur is causing the problem.

Elbows
History:
I have had elbow problems for a couple of years, aggravated by talking on a phone, using a desk that is to high and generally having my elbows flexed. Riding my road bike really aggravated them (too much weight on hands I think). My PT suggested adhesions to on my ulnar nerve and gave me some nerve glides which immediately helped and improved my shoulder mobility massively.

Current State:
I still have some aggravation with my elbows but am continuing to do the exercises and have some splints to use at night. I find I cannot help flexing my arms while I sleep and lying on them , the splints prevent me straightening my arms. I belive that this problem can be classed as RSI. I have also started swimming again in an attempt to just improve the general mobility of my upper body.


Wrists
History:
This problem occured approximately 6 years ago while I was studying at university. I used my mouse too much and had furniture that did not encourage good posture. My wrists swelled up and were sore and hurt when I used my computer and wrote.

Current State:
Both still slightly swollen and swelling gets worse when aggravated. Can be aggravated by holding in one position for too long, riding my road bike with too much weight on the bars. I went to see a Rheomatologist (referred by doctor) and she has diagnosed Tenosynovitis (inflammation of the tendon sheath), she thinks this is related to by achllies and could be a genetic problem. She just ordered blood tests and xrays. I disagree and think that overuse has caused the problem. I am going to tighten up on Paleo diet and see if that helps. I am also going to try treating like tendonitis and do some eccentric work. My flexibility (extension mainly) was previously terrible but i have stretched a lot and improved.

Groin:
History:
Had some groin/hip pain for almost 12 months, PT has suggested my hip flexors were short and got me to stretch a lot.

Current State:
Still some hip pain and clicking, stretching and exercises seems to help.

Back:
History:
Back pain for years, sciatica and lower back. MRI confirms L4/L5 disc prolapsed.

Current State:
Mckenzie work and lots of lumbar mobility exercises does help. Keeping mobile and exercise helps. Nerve glides helped sciatica. I plan on crossfitting still and watching my form on with my lumbar curve.


Just one think to add is my experience with tennis elbow. I had this approximately a year ago and cured it with eccentric work and stretching. Progress was slow but it feels back to 100% now.

I think thats it! Big thanks for advice so far Steve and for having this fantastic website.


Later,


Mick


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 Post subject: Re: Lots of Rehab.
PostPosted: Tue Nov 30, 2010 12:57 pm 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
Quick update.

I have recently picked up a shoulder niggle. Its probably caused by starting swimming again (overuse, bad technique?) I think its inflammation of the rotator cuff (had a quick Google), pain occurs in front of shoulder when I raise my arm.

Obviously stopped swimming and overhead work. Any rehab ideas? Do I need to improve my mobilty/strength?

It has started to settle already but I would like to rehab asap and prevent re-occurring.

Cheers,

Mick


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 Post subject: Re: Lots of Rehab.
PostPosted: Tue Nov 30, 2010 5:53 pm 

Joined: Sat Oct 16, 2010 8:56 pm
Posts: 1565
Front of the shoulder with full ROM tends to be biceps tendon aggravation.

If it's some sort of tendonitis then yeah you want to do soft tissue work, ice it if helps, and rest. Mobility may be good.

Could be from bad technique or overuse. I don't know your current program or correct swimming technique so I don't know what might be wrong there.

In general, with most shoulder stuff the more mobility you can get will be good as long as you have good strength and muscular balance.

May not be a bad idea to do some RC exercises anyway.



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 Post subject: Re: Lots of Rehab.
PostPosted: Wed Dec 01, 2010 6:10 pm 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
Swimming program is too much too soon.
Technique is awful.

Bicep sounds about right, I never thought that they must attach there.
I will mention to PT when I next go.


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 Post subject: Re: Lots of Rehab.
PostPosted: Fri Jan 07, 2011 4:59 pm 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
Happy New Year!

I reckon its time for an update:

Achillies:
Physio still says no tendinitis, still getting pain which I though was Peroneal but he has pinned it down to a bursar right back at my heel on the outside. Makes sense, this is the exact spot where I get any pain at the moment. He has suggested an injection (cortisone??) might fix this and has written to my Orthopedic consultant who I am seeing in a couple of weeks. What do you think?

Elbows:
Still ulnar nerve symptoms, keeping doing nerve glides and planning on changing my job so I am not desk bound!

Groin:
Started sleeping differently, for years I have slept on my front with 1 leg straight and the right leg (affected hip/groin) bent up in a "h" shape. I have stopped doing this as well as stretching a lot, trying to mature my squat and learning to OHS. Bingo, 99% better!

Wrists:
Still rubbish, worse after using computer too much, new job will help!

Shoulder:
Discussed with Physio, I suggested it was rotator cuff/ bicep swimming overuse. He suggested that as usual my self-diagnosis was wrong. He said its was a symptom of my ulnar nerve problem! I think I agree, I never get any pain when exercising but get bicep (area) pain when I straighten my arm out to the side and tip my head the opposite direction. Any thoughts?

Back:
Pretty good, feels great after OHS work.

Currently I am training as per usual , scaled Crossfit and some Pose. Had more Olly coaching, trying to learn snatch. No pain in workouts or the next day.

.

Later,

Mick


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 Post subject: Re: Lots of Rehab.
PostPosted: Sat Jan 08, 2011 12:18 am 

Joined: Sat Oct 16, 2010 8:56 pm
Posts: 1565
Achilles:

Hmm, cortisone tends to not actually help heal injuries. If no other rehab protocol is working that may be a decent shot though. If it's a bursa it should respond well to massage/ice and some other typical physical therapy protocols.

Shoulder/Elbows/Wrists

Have you been extensively stretching/massaging out the forearm flexors and supinating your forearms as much as you can to loosen that stuff up? Job switch would help a lot definitely... but there is probably more you can be doing besides nerve glides if you aren't already.

Hmmm, as for the shoulder area has the posture gotten any better? That could be an issue as well. I would definitely try to loosen everything else up a lot more including the bicepital area and neck if you can... but definitely not into any type of pain. Just more loosening stuff would be good.

Groin:

Excellent progress. :)

The fact that all the other stuff is improving is a good sign though... hopefully can resolve the rest of it and you're good to go.



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 Post subject: Re: Lots of Rehab.
PostPosted: Mon Jan 10, 2011 6:13 am 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
Thanks Steve.

Ach: Will discuss with Ortho and find out exactly what diagnosis and treatment are.

Wrists, stretched a lot, improved ROM, looks normal to me now was previously restricted. Not massasging, this causes symptons in the wrist I use to massage.

Supination of forearms is painful (at wrist, ulnar side on top) at end of ROM, a slight click is also felt. Supination with arm out to side gives pain at bicep. Should I be training with this? My opinion is that using is better than not using?

Posture IMHO is better, going to work on T spine mobility.

Mick


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 Post subject: Re: Lots of Rehab.
PostPosted: Mon Jan 10, 2011 9:00 am 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
PS
"Should I be training with this?" -- Its not painful during exercise.

After a few Supinations with my arm out to the side it "loosens up" and pain goes away.


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 Post subject: Re: Lots of Rehab.
PostPosted: Mon Jan 10, 2011 9:03 am 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
Forearm extension stretching is also painful in the same place on my wrist.

This has only started happening recently.


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 Post subject: Re: Lots of Rehab.
PostPosted: Mon Jan 10, 2011 10:48 am 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
Is tennis ball massage ok? Must be better that none. Presumably bicep stretching as well?


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 Post subject: Re: Lots of Rehab.
PostPosted: Mon Jan 10, 2011 11:47 pm 

Joined: Sat Oct 16, 2010 8:56 pm
Posts: 1565
Do you have a desk or corner of a surface that is rounded around the edge?

You can place some KY or other lubricant (I personally don't use any) and can mash your forearm into that and use that for massage instead of the tennis ball. It's better at digging into stuff to get some more localized pressure, or you can use your opposite arms elbow.

If the supination helps that's good. Try to loosen it up with that pain first and then do soft tissue work in both supination and pronation.. but moreso in supination as that will take some flexor tension out of the equation.



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 Post subject: Re: Lots of Rehab.
PostPosted: Tue Feb 01, 2011 1:05 pm 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
As I have been massaging around I notice that when I roll my Triceps they are pretty sore, had a quick google and it suggests that pain on extension would be a symton of tricep tendonitis which I am not getting.

I am using a foam roller or cardboard tube to massage with at the moment which is easy to do.

When I hold my arm flexed (on a phone) for a while it is painful.

Any ideas on this? I so far plan to heat/ice/ roll and tricep stretch.

I always thought my elbow pain was caused by my ulnar nerve but this is definately a tricep thing? Unless this is where the nerve runs?

On final thought is that stetching my arms overhead seems to help relieve the pain/stiffness. (like in samson stretch).

Any thoughts?


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 Post subject: Re: Lots of Rehab.
PostPosted: Tue Feb 01, 2011 10:51 pm 

Joined: Sat Oct 16, 2010 8:56 pm
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If the pain is on the tendon, sure. If it's not on the tendon and more muscular or nervous then there you go.

Triceps is innervated by radial nerve and it kinda goes through the back and then laterally to the front of the forearm, so I would be more inclined to think it was that instead unless the pain is all the way medial where the ulnar nerve runs.

Have you been doing radial nerve glides besides the ulnar?



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 Post subject: Re: Lots of Rehab.
PostPosted: Wed Feb 02, 2011 9:01 am 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
24 hours after concentrating on stretching triceps and they a a million times better already. Amazing.

Massaging with two tennis balls in a sock is working well.

Occasionally done those glides but will do more now.

To me this supports your "work on everything surrounding the affected joint". Hopefully this advice will help other people.

Sorting my forearms initially helped a lot, now hitting my triceps has made a huge improvement. You would not believe how less tension there is when I flex now.

I have been reading the trigger point book you recommend and have been trying to hit them. I also bought another sports massage book that suggests that triceps can get shortened easily because they are very rarely in their lengthened position.

I am doing the standard "hand down back" tricep stretch, anything else I can lengthen them with?



Cheers,

Mick


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 Post subject: Re: Lots of Rehab.
PostPosted: Wed Feb 02, 2011 10:32 am 

Joined: Sat Oct 16, 2010 8:56 pm
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Nah, that's the best triceps stretch. Although it would probably be a good idea to stretch our your lats, chest, and teres major beforehand so it can take some of the slack off the shoulder joint. That should give you a better triceps stretch overall.



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 Post subject: Re: Lots of Rehab.
PostPosted: Fri Feb 04, 2011 2:23 pm 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
Right, we are really cooking now. Triceps are a LOT better, not as much fire when I massage, slept better last night that I have for months because elbows not giving me grief.

Just the last layer of the onion to peel back now, my right arm bicep? problem.

Pain is present on the ulnar side of my wrist, near the bony protrusion.
When I suprinate I get a little click (maybe wrist. maybe bicep area?) somewhere and I get pain running down my bicep, with my arm held in front of me palm down the bicep pain is on the top straight down the middle. ( this does not cause the pain, this was the best way to describe the area.)
I get the pain in my bicep when I hold my arm straight in the air and a small click and pain when I bring it down.
Similar bicep? pain is felt when I do "downward dog" to stretch my shouders.

Currently I am stretching:

Triceps (a lot, really helping)
Biceps (aggravates problem)
Shoulders, dislocators and downward dog kind of but stoop up and arms on kitchen surface.
forearms (flex and extend)

Any ideas on this final niggle? Ulnar nerve still?

Cheers,

Mick


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 Post subject: Re: Lots of Rehab.
PostPosted: Fri Feb 04, 2011 10:22 pm 

Joined: Sat Oct 16, 2010 8:56 pm
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Well, don't do biceps stretch if it aggravates it. I assume massage has not worked on this problem?

I'm a bit amiss on where this problem actually is? There's pain in the biceps, but also stuff in the forearm as well? Do these occur at the same time?

If you place your palm on your forearm with the heel of the hand directly on the medial epicondyle, and your pinky pointed at the pinky, and index finger pointed at the thumb you'll be over the 4 superficial muscles that run off of the medial epicondyle.

For ulnar nerve you'd want to massage the where the pinky is e.g. your flexor carpi ulnaris... can do that both in pronation and supinate as well as flexion and extension of the wrist. Helps to try them all and see which ones work best because it will be different to different people sometimes.

Likewise, under the index finger is your pronator teres... I would massage that too with forearm pronated and supinated.

Wouldn't mind hitting up anconeus and try to get supinator which will be under the extensors off of the lateral epicondyle (need to really dig in).

That would be if the clicking is causing any pain... maybe sticky radioulnar joints if that's where the clicking is coming from?

Otherwise, for the biceps I'm not sure if that's a connected problem or not so we'll have to see. Biceps et al is innervated by musculocutaneous of the lateral cord... while ulnar and median are off the medial cord. You have been having trouble with posterior cord radial nerve possibly (although the triceps stretching/loosening is helping so it may not have been radial nerve at all).

I'm not quite sure what to make of it at this point whether it's just an ulnar nerve issue + tight muscles from computer posture stuff or you actually have issues with brachial plexus causing a lot of the hypertonicity and such. Meh.



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 Post subject: Re: Lots of Rehab.
PostPosted: Tue Feb 08, 2011 5:10 pm 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
Cheers Steve,

Had a bit of a Tricep relapse but its getting better again now.

Wrist issue seems to be fading.

I am going to keep stretching and massaging everything a while longer and see how I get on. (Its taken years to cause so I am not expecting to be pain free immediately)

General mobility feels a lot better.

When I hang from my pullup bar I can feel something tight in the front of my shoulders so I am doing this alot. Not sure If it is anterior deltoid? Similar feeling doing downward dog.


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 Post subject: Re: Lots of Rehab.
PostPosted: Tue Feb 08, 2011 10:14 pm 

Joined: Sat Oct 16, 2010 8:56 pm
Posts: 1565
That's a big vague I can't deduce anything from that



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 Post subject: Re: Lots of Rehab.
PostPosted: Fri Feb 11, 2011 8:48 am 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
Sorry for the vagueness.

I guess it doesn't matter what name we have given the muscle, if I find somwehere that feels sore ( and I suspect a trigger point) I am going to massage and stretch it.

Everything still seems to be improving.


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 Post subject: Re: Lots of Rehab.
PostPosted: Mon Feb 28, 2011 4:12 pm 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
Hi Steve,

Finally managed to get some Lacrosse balls (dont they play it in the uk?).

Should I :

1 go up and down the tendon/muscle?
2 milk it like the Trigger Point methods suggest
3 side to side like cross friction
4 everything

Found a new therapist and he is much more "hands on" and cheaper!

He found all the "knots" in my triceps that I had and some more in my upper back/shoulder muscles.

I am going to get him to look at my calves tomorrow (re Pose niggles), all posing stopped at the moment because skiing in 3 weeks!.

Hip is niggling again and he is sure it is psoas, I am just stretching and rolling a bit at the moment.

All in all not going too bad, upper body mobility feeling a LOT better.

Cheers,

Mick


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 Post subject: Re: Lots of Rehab.
PostPosted: Mon Feb 28, 2011 5:01 pm 

Joined: Sat Oct 16, 2010 8:56 pm
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For massage see what works best.

I find that cross friction tends to work better if the muscles are knotted up in certain spots, and feels better in general.

If the muscles are tight across the whole thing then myofascial type massage (length-wise along the muscles) tends to work well.

Trigger points obviously work well with constant pressure.

Play around with it... you'll find different areas will respond a bit differently than other areas of the body so you can't say this one technique will always work here or in this spot.



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 Post subject: Re: Lots of Rehab.
PostPosted: Tue Apr 05, 2011 7:57 am 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
Hey Steve,

Still feeling ok ish.

My therapist has been working on a Piriformis Trigger Point and I have been hitting it hard with a Lacrosse ball, he thinks it may be causing my PSOAS pain but I am not sure. I read the chapter in the trigger point therapy workbook and it sounds to me more like I also have PSOAS triggers. (Pain in crease of hip at front and sensitivity).

I will discuss with him next week but want to do some self massage asap. I have read how to find my PSOAS and poked around but am struggling. Any advice? I guess fingers is the only way to get in there?

Cheers,

Mick


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 Post subject: Re: Lots of Rehab.
PostPosted: Tue Apr 05, 2011 9:01 am 

Joined: Sat Oct 16, 2010 8:56 pm
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Yeah, it's hard to poke at especially by yourself.

You can try some PNF stretching techniques on it though and see if that helps.



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 Post subject: Re: Lots of Rehab.
PostPosted: Fri Apr 08, 2011 7:40 am 

Joined: Wed Nov 24, 2010 3:29 pm
Posts: 42
I am doing this mainly:

Image

Its definately hitting the right spot. Its not as painful when I drive and I feel like I am walking better.

I am doing some a mix of 6 x 10 secs, 30 seconds and some contract (5 secs) release (10 secs)

Piriformis trigger is getting better IMHO. Therapist booked for next week so will see what he feels. I am using a lacrosse ball against a wall for 2 minutes on the same painfull spot.

Cheers,

Mick


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