In celebration of Physical Therapy Month, we invited our patients to submit questions to our expert physical therapists via social media. We're excited to share some of the top questions and our therapists' insights in this blog post. Whether you're rehabbing an injury or working on your fitness, you'll find valuable advice here.
Question: I tore my achilles and had surgery last summer. I still cannot single leg calf raise. I can jump, walk, run, flip, and tumble. I was able to compete in most things in gymnastics but still not 100%. My calf has been the limiting factor in getting all my skills back. What do you recommend?
Clinicians should use mechanical loading, which can be either in the form of eccentric or a heavy load, slow-speed (concentric/eccentric) exercise program, to decrease pain and improve function for patients with midportion Achilles tendinopathy without presumed frailty of the tendon structure.
Brad Dale, PT, OCS, Cert. MDT, Cert. DN
Submaximal Isometric Ankle PF in Shortened Position
Seated Ankle PF Isotonics
Leg Press Ankle PF
Double Leg Calf Raise
Single Leg Supported Calf Raise
Single Leg Calf Raise
Single Leg Calf Raise (off step)
Single Leg Eccentric Calf Raise
Single Leg Eccentric Calf Raise (off step)
Question: What objective testing do you utilize for return to sport testing?
We look for full range of motion (ROM) to return to sport. This involves the following:
- Achieve >90% strength of non-involved ankle strength
- A score of 16 (out of 21) on the FMS™ Assessment Screen, with no pain on any of the 7 fundamental movement patterns
- No statistical asymmetries on the Y-Balance Test™
- Single-leg vertical hop is 90% of non-involved leg
Isokinetic testing:
- Quadriceps (90% or greater) compared to non-injured leg
- Hamstring (100%-110%) compared to non-injured leg
- Hamstring-Quadriceps Ratio (80% or greater)
Brad Dale, PT, OCS, Cert. MDT, Cert. DN and Greg March, PT, Cert. MDT
Question: I'm trying to get into running, but then the muscles in my lower calf "seize up" and get really tight. Do you know what could be causing this and what I can do that may help?
This question leads to broad options for "how to" answer.
Let's start with the obvious … are the shoes the proper fit for the runner's feet and the surfaces being encountered? Visiting a local running store for a running assessment, proper fitting, and shoe recommendation is an excellent start for addressing these issues.
Another possible culprit is decreased ankle range of motion, primarily into dorsiflexion (which is toe/foot up toward the shin). Proper pre-running dynamic stretching for the calf muscles and post-running static stretching can lead to improvements in muscle tightening during the run.
Initiating a running program progression should be facilitated linearly. This means distances or durations of the run are shorter at the beginning of training. And as fitness improves, the distances and/or durations increase. Progressing either of these too quickly can be another factor in muscular-related issues during and/or after the workout. Refer to the 10% rule as it applies to running progression.
You should also consider your water intake, electrolytes, and possible nutritional deficiencies. Speak with your primary care provider and read up on nutritional requirements for runners.
Lastly, the frequency of running can lead to muscular-related issues, including "seizing up". Although there is not a hard-fast rule for running frequency, symptoms during and after running should be the guide for the appropriate frequency.
Brad Dale, PT, OCS, Cert. MDT
References
Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2018 Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and HealthJ Orthop Sports Phys Ther. 2018;48(5): A1-A38
https://www.jospt.org/doi/pdf/10.2519/jospt.2018.0302Rehabilitation and Return to Sports after Achilles Tendon Repair
Marrone W, Andrews R, Reynolds A, Vignona P, Patel S, O'Malley M.
IJSPT. 2024;19(9): 1152-1165.
Running: How to Safely Increase Your Mileage
J Orthop Sports Phys Ther. 2014;44(10): 748
https://www.jospt.org/doi/pdf/10.2519/jospt.2014.0506
Question: What are ways I can be taking care of my joints now, so that my knees are in better shape as I age?
- Maintain a reasonable body weight
- Maintain/increase strength and flexibility through regular directed lower extremity exercise: yoga, weight training, aquatic aerobics
- Engage in regular recreational activities: walks, hiking, cycling
- Never delay seeking medical attention when pain and dysfunction limit the above!
John Koegel, PT, DPT
Question: Are spine wheels (ex: Chirp Wheel) actually good for your back?
I am unaware of any clinical research on them. In my opinion, for patients with thoracic pain and a directional preference for extension, then the Chirp Wheel or similar devices are a good adjunct to exercise and manual therapy.
If an individual is sitting slouched all day, in addition to using a lumbar support to maintain better posture, they can use the spine wheel to help stretch their back in the opposite direction. This would reverse some of the postural stress on their mid-back. Or they could simply interlock their hands behind their neck and lean over the top of a chair several times every few hours and achieve a similar effect if the spine wheel is not easily accessible.
Robert L. Medcalf, PT, Dip MDT
Question: If I've been diagnosed with a grade one spondylolisthesis in the lumbar spine, am I destined for surgery, if not, what options do I have available?
When we look at patients in the research and the clinic, with a diagnosis of Grade I Spondylolisthesis, we see a group of patients who do well with a course of physical therapy. If therapy does not help, we recommend speaking to your doctor to determine if you are a candidate for other treatment options based on your specific clinical picture.
Linnet Kazemi, PT