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.
Remember, we're not stopping here! Continue submitting your PT questions throughout October on social media - our experts are ready to help you on your journey to better health and mobility.
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.
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)
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.
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