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New 'Physio Clinic' Q&A session (Read 173664 times)

HPclinic

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Wow, busy day for these guys tomorrow!

I bruised my right heel about two months ago. I couldn't rest it, so spent a month basically walking on my toes on my right leg. This made my calf ache a bit on long walks. Now I can walk normally again, heel is fine, but my right knee has started having twinges where it briefly feels weak and unstable. I had an arthroscopy on the inside of the knee about eight years ago, to 'tidy up' cartilage (a torn flap was visible on MRI, but the surgeon couldn't find it). Any ideas?

Johnny. Sounds like you compressed your knee as you landed on your heel. Knees don't like compression loads so if you we're having problems before with  the knee is likely to take longer to recover.  Additionally as you limped you will have aggravated the knee further.
If your knee locks or swells excessively you might have a cartilage tear and so you will need to see your GP.  If its not, start to exercise the knee by performing daily step ups, 'sit-to -stand', lunges and modified squats.  Gradually add weight to the exercises and make sure your walking has returned to normal (walking poles are useful to reeducate rotation and forward momentum). If that doesn't help see a recommended Physio.  Thanks Steve.

HPclinic

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Bet you're wishing you'd never asked.....

Tennis elbow for me, diagnosed by a couple of medical types I climb with now and again. It started when I bashed my elbow on a hold, and then got steadily worse. It is worse if I don't climb at all, and I have been surprisingly careful when climbing - stopping if a particular move hurts it and so on.

I'm just wondering if there are other exercises I can be doing to help it clear up - is there a tin of beans thing I should be doing?

Hi LucyB. It's interesting that it is worse if you don't climb.  That makes sense as even painful tendons are usually better when they are loaded.  It is natural to protect the elbow climbing but overprotection can lead to more pain.  I assume its several weeks since the injury so gradually introduce the moves that you have avoided.  Try strengthening the arm and shoulder with shoulder presses (see other posts and Matts rehab for elbow pain coming to the site soon for more training ideas) and don't specifically strengthen the forearm muscles.  Local gentle massage over the lateral forearm muscles might be useful but there is no evidence that deep tissue and 'scar tissue release' helps. Thanks Steve

HPclinic

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Hi Steve

I had what appeared to be an open & shut case of Golfers Elbow (it would feel like a strap was being tightened around my forearm immediately below the elbow when performing tasks like squeezing a plastic bottle or unscrewing a jar lid.  I would also feel a tweak on the inside just below the elbow when straightening or bending the elbow fully).  I tried wrist curls and icing but it hasn't responded to either.

Knowing how you work I looked into other possible causes and I saw both your and Joe Le Sage's video advice on here and subsequently noticed that my right shoulder was much stiffer than my left (maybe 20 degrees difference when performing a Scarf Stretch at that point), also if I dug my fingers into my back/shoulder muscles beneath my scapula I'd experience moderate pain.

I decided to work on my shoulder and started rotator cuff exercises and scarf stretches and both my elbow and shoulder improved, I also did some gentle climbing and the symptoms could disappear almost entirely for a day or two afterwards.  Recently I've been climbing at increasing intensity without pain and managing to do more and more.

This week though the symptoms have returned.  I climbed on Monday, did quite a strenuous swim on Tuesday and today the elbow is tweaky again.  Having fallen out of the habit of doing them, I tried the shoulder exercises again and it is also stiff, a bit crunchy and fingers-in-the-scapula generates pain again.

It appears I have a shoulder problem, does it sound like I have an elbow issue too or is it possible the shoulder is causing the symptoms in the elbow?


Thanks

Ian

Ian
Thanks for the detailed report and I would agree you don't have a local elbow problem.  It could be from the shoulder but from what you are saying with the medial scapular pain you have a neck involvement.  Also the medial pain (golfers elbow) would suggest referred pain into this region.  I assume its your right elbow so check if your right shoulder is low and causing stress on the neck(and shoulder). I would elevate the shoulder up (shoulder shrugs are a good exercise for this) and stretch the right lat dori muscle.  Stop the rotor cuff exercises and stretch your neck if it is stiff.  Do that for a couple of weeks but keep climbing and see if that helps.  See Matts video on elbow rehab coming soon to the site. Tell me how you get on. 
Steve

HPclinic

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Sheesh, reading this thread makes me realise how lucky I am to only have slightly dodgy hamstrings at the moment.

Andy. Yes you are 'lucky' with hamstring problems.  I bet you sit at a desk all day and have a tight lower lumbar spine.  The hamstrings are tighten up in response to back pain/stiffness and sitting only compounds this.  This is why stretching the hamstrings doesn't usually give a longterm solution. Try stretching your lumbar spine ad see what happens to your hamstrings.  Thanks Steve

HPclinic

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Fellas,

I'm 48 with shoulder injuries.....lots :(

Some history: SLAP tears in both shoulders, R since 2007(MRI diagnosis - L. Funk), 2nd diagnosis on R Feb 13.
Rotator cuff tears front and back & SLAP on L shoulder.

Still climbing & MTB & wanting to prolong surgery as long as possible. Climbing up to 7c/+ sport & trad E4/5. I climb/train 3 times a week & ride once/twice a week.

From what Funk says the SLAP's probably won't heal without intervention. He also encouraged me to continue until things become unmanageable (I suspect he is saying this not too disappoint). He said he'd always(95%) be able to repair. 
I avoid pull ups, press ups and weights as they all seem to aggravate. However, I'm able to train on circuit boards with not too many problems. Physio is limited to standerd theraband stuff prior to climbing. If I increase the theraband stuff and add in rotator cuff ex with light weight - the ones sitting and rotating shoulder from horizontal to vert + same but lying on side then pain increases. Thus I tend to avoid the last 2.
If I'm careful I manage and I back off/rest if pain increases. The biggest issue is walking in with a heavy trad sac. As you'd expect my L(SLAP & Rot cuff) is far worse than R .

Can you point me towards any exercises that may well repair/ strengthen the rotator cuff other than the light weight(1-1.5KG) ones mentioned. I appreciate I'm asking a lot. Funk mentioned rowing as an option?
Cheers
Thanks Rick.  From your history you either have made a bad decision selecting your parents (we sometimes inherit less than ideal tissues/joints!) or you are using your shoulders in an abnormal way.  I suspect the latter.  Pain when carrying a ruck sac is common (i expect you will also get pain on carrying heavy bags and lifting heavy objects off the floor)  if your shoulders are low or depressed and this will cause you to stress the shoulder joint as you move into rotation or flexion.  If climbing doesn't cause a problem continue and stop the rotator cuff exercises (when your shoulder gets over 120 degrees they work anyway so climbers have stronger rotator cuff muscles than 90% of the general population).
Many climbers have rotator cuff tears that are not painful  ( a recent study of international javelin throwers showed that 40% had rotator cuff tears but NO pain-or 5 years later after the follow up). Do any resistance exercise with shoulders higher(develop a Galic shrug!) and I expect your shoulders to feel much better
Try this and I agree with Prof Funk to avoid surgery. Tell me how you get on.
Cheers Steve




HPclinic

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I have finally finished the replies to this weeks climbing injuries questions and answer session.  See if it makes sense and look out for Matts elbow rehab and exercise ideas video coming to the site soon.  We will be answering more questions next week at 12 noon on Friday (June 21). I'm now going to have a large drink to help my 'warm down'.  :2thumbsup:

nai

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Hi Steve, Many Thanks for your reply, I'll give your suggestions a go.

Quick (hopefully) question referring to swimming:

Doing crawl is good but requires good technique with plenty of rotation - something often missing with climbers!

I only swim while my nipper is having her lesson and the opportunity for 35 minutes exercise is preferable to sitting watching with a group of chit-chatting mummies.  I'm unlikely to have good technique or lots of rotation and my neck usually feels stiff afterwards.  The problem is with my right arm and I always breathe to my left in the water (when I saw you previously you told me I didn't like moving to my right) so my left shoulder moves in a completely different path and I think will be rotating a lot more than my right.  Could this be contributing to, or even the cause of, the symptoms?

Again, many thanks for your reply, enjoy your drink

Cheers

Ian

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  The problem is with my right arm and I always breathe to my left in the water

I breathe every 3rd arm stroke ie alternate sides. Took some getting used to initially but quickly becomes second nature.

HPclinic

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Hi Steve, Many Thanks for your reply, I'll give your suggestions a go.

Quick (hopefully) question referring to swimming:

Doing crawl is good but requires good technique with plenty of rotation - something often missing with climbers!

I only swim while my nipper is having her lesson and the opportunity for 35 minutes exercise is preferable to sitting watching with a group of chit-chatting mummies.  I'm unlikely to have good technique or lots of rotation and my neck usually feels stiff afterwards.  The problem is with my right arm and I always breathe to my left in the water (when I saw you previously you told me I didn't like moving to my right) so my left shoulder moves in a completely different path and I think will be rotating a lot more than my right.  Could this be contributing to, or even the cause of, the symptoms?

Again, many thanks for your reply, enjoy your drink

Cheers

Ian

I would stretch before swimming and work on thoracic rotation to either side (sitting in a chair and rotating your upper body around).  Practice breathing to the right and aim to add more variety to your swimming technique.  Do this slowly as changing stresses to a new position can cause soreness. Steve 

nai

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  The problem is with my right arm and I always breathe to my left in the water
I breathe every 3rd arm stroke ie alternate sides. Took some getting used to initially but quickly becomes second nature.

I have tried but there's only so much pool water you can swallow during a session, looks like I'll have to try harder...

I would stretch before swimming and work on thoracic rotation to either side (sitting in a chair and rotating your upper body around).  Practice breathing to the right and aim to add more variety to your swimming technique.  Do this slowly as changing stresses to a new position can cause soreness. Steve 

I'll give this a go, many thanks once again.

Duncan Disorderly

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This is a great idea!

I've been suffering with an elbow issue for the past 6 weeks or so and it's just begining to get to a point where I can climb again but it's not comfortable afterwards! Not sure how it occured but it was after a session on Arch Enemies when I first noticed it (and by noticed I mean -  :furious: ouch! The next day!) so I'm thinking maybe a big move to jug where pretty much everything cut loose? Or the hard top section which involves pulling pretty hard on a pretty poor crack on steep ground - then again it could be throwing a ball for me dog but I'm not convinced tbh!  :doubt:

Basically I've had a sports massure and a physio have a brief look and it appears that it's the brachioradialis that has somehow been torn/pulled etc... Basically I can crimp fine but as soon as I pinch anything it's pretty painful (if I squeeze my hand to a fist it hurts even sat here now!)...

Kinda holding off going to see someone due to funding issues right now but can you tell me if there are any specific things that I need to be doing to sort this out? My physio mate mentioned getting right in there with deep (read: painful) massage  and then ice which I'm happy to do but don't wanna twat it any more.

Properly getting me down now - but on the plus side my running is going well :-\

Thanks,

:D

tomtom

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As boxing has been recommended as a good form of shoulder exercise - maybe we should start a UKB fight club? ;)

nai

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Tennis was also mentioned.

Anyone for Swingball?

HPclinic

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As boxing has been recommended as a good form of shoulder exercise - maybe we should start a UKB fight club? ;)

Good idea-swap tennis elbow for head injuries!  Variety of exercise is important but hitting bags and not people is probably better. Steve

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I bet you sit at a desk all day and have a tight lower lumbar spine. 

Yes indeed.

The hamstrings are tighten up in response to back pain/stiffness and sitting only compounds this.  This is why stretching the hamstrings doesn't usually give a longterm solution. Try stretching your lumbar spine ad see what happens to your hamstrings.  Thanks Steve

I see! Thanks for the advice, I'll get to work on it. The problem originally started when pulling on my right heel in an awkward position but has seemed to spread to my left hamstring as well now! It gets quite painful on long-distance drives and I end up having to use the accelerator with my left foot for a bit to rest my right leg. I'll do some lower back stretches and let you know whether driving to Aberdeen this weekend, back from Aberdeen next, then to Brittany the following weekend hurts or not. (I suspect it will!) Thanks!

Stubbs

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Andi check out Joe's videos, he has a few for lumbar spine stuff http://www.youtube.com/channel/UCob_Fn1Qyjf9-RRNfle_T7w
« Last Edit: June 18, 2013, 11:03:49 am by Stubbs »

andy_e

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Cheers, I just found those on his blog too.

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Thanks for the question.  Eccentric loading of the Achilles tendon has some research to suggest it works but from my clinical practice it makes more sense to remove stress on the overloaded tendon (I rarely prescribe eccentric loading exercises and see many people achilles problems who have not responded to this approach). 

.....
PS
Regarding injections I am not a major fan and I would not have an injection before removing the stress on the tendon as outlined above.  If you do go down the injection route be careful not to have more than three as steroids can weaken the tendon and possibly increase the risk of rupture.  I would stop stretching as there is no evidence it works and it might be traumatising the tendon with repeat loading.  Tell me how you get on.
Steve

Thanks for taking the time to answer. I was dubious about the injection myself.

HPclinic

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I bet you sit at a desk all day and have a tight lower lumbar spine. 

Yes indeed.

The hamstrings are tighten up in response to back pain/stiffness and sitting only compounds this.  This is why stretching the hamstrings doesn't usually give a longterm solution. Try stretching your lumbar spine ad see what happens to your hamstrings.  Thanks Steve

I see! Thanks for the advice, I'll get to work on it. The problem originally started when pulling on my right heel in an awkward position but has seemed to spread to my left hamstring as well now! It gets quite painful on long-distance drives and I end up having to use the accelerator with my left foot for a bit to rest my right leg. I'll do some lower back stretches and let you know whether driving to Aberdeen this weekend, back from Aberdeen next, then to Brittany the following weekend hurts or not. (I suspect it will!) Thanks!

Andy
If you have a stiff/painful back and heel pain with hamstring pain you might be getting a mild form of sciatica.  When you drive for long journeys the sciatic nerve is often irritated by sitting with your leg stretched out.  Try moving the seat forward slightly to take the stress of the nerve and try some lumbar support  (an old rolled up towel is fine).  Steve 

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Cheers, I'll try that. No heel pain thankfully! Problem now is that when I move the seat forward I tend to drive faster for some reason...

HPclinic

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Deidre we will be answering any questions you have on climbing injuries on Friday (21 June) at midday.  Thanks

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Great idea, thanks guys!

I have minor golfers elbow on my right elbow. Can't pinpoint a defining moment which caused it but it's definitely from climbing.

I have had it for a few months, but it's never been painful enough to stop me climbing and I very rarely feel pain while climbing unless I do a really deep lock off or pull up with that arm. It only seems to ache/hurt afterwards when I've warmed down. More niggling pain than anything.

I've tried all the usual things for shifting it, stretching, icing, weights etc. but it always seems to linger. I've now give up on all of the above due to no results, probably not the best idea.

Do you recommend I just need to perserve with the stretching etc or something else?

Also any advice on preventing reoccurance would be great.

Many thanks,

I assume you are right handed?

You've tried the local things which dont work so it is probably referred from the shouder/neck area maybe from overuse of a mouse at work??

Worth trying swapping hands on the mouse and get your arm above your head during the working day and report back.

We are producing a video on elbow rehab and you may get some ideas from that.

HTH

Thanks for the reply.

Yeah i'm right handed, I do work in an office on a computer all day. Will try swapping the mouse around.

If it's possibly coming from the shoulder/neck area I'm guessing I would benefit from stretching these throughout the day?

Thanks,

Luke


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Hi Matt and Steve thank you for giving your time and expertise generously in this way.

I'm middle aged, climbing for decades but in recent years not very frequently. The last twelve months I have been able  to climb more (2-3 times weekly) and have been mixing doing routes, power/stamina training and bouldering with good progress and no injuries.

This week I have tightness and some pain around the right medial epicondyle.  What do you recommend?

Should I avoid strenuous climbing if it's tight/sore at the start of a session?

Thanks again.

Jon

( I teach so mostly stood up at work, some use of computer in evenings).

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HPclinic

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Hi Matt and Steve thank you for giving your time and expertise generously in this way.

I'm middle aged, climbing for decades but in recent years not very frequently. The last twelve months I have been able  to climb more (2-3 times weekly) and have been mixing doing routes, power/stamina training and bouldering with good progress and no injuries.

This week I have tightness and some pain around the right medial epicondyle.  What do you recommend?

Should I avoid strenuous climbing if it's tight/sore at the start of a session?

Thanks again.

Jon

( I teach so mostly stood up at work, some use of computer in evenings).



Thanks for the question Jon.  It sounds like you have increased your climbing sensibly so not sure why the local elbow pain have occured.  As a teacher, have you been sitting and marking more ?  If so, check if your right shoulder is dropping down when on the computer/laptop.  If the right shoulder drops and this is common in climbers with tight lats (latissimus dorsi muscle), stretch the right arm often above your head.  Back off the grades until symptoms settle and then slowly increase again.  Most medial elbow problems are a result of many factors as the tendon is overloaded (and joint/nerve/ muscle etc).   
Hope that helps
Steve &  Matt


 

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