Stephen Stockhausen recommended this article, written by a good friend of his. Please click on the link below (or copy and paste the url into your browser) to be directed to the original article:
Exactly one year ago I underwent a surgical procedure to alleviate a long standing, and rather severe case, of Illiotibial Band Syndrome, or runners knee. This is a very common injury involving a pathologic tightening of the illiotibial band (ITB) causing sharp pain in the outside of the effected knee, likely due to a hip weakness. The uncommon part of my particular injury was its lack of progress with physical therapy. Ninety five to ninety seven percent of ITB related problems can be solved by conservative measures (skilled physical therapy and/or injections). Being a physical therapist myself, the lack of progress was particularly distressing, and was preventing me from doing the one thing I moved to Durango to do, which was run on the beautiful mountain trails. After nearly 4 1/2 yrs of hard work, I opted to have a procedure called a Z-plasty, performed by one of our local orthopedic surgeons.
Initially after surgery my knee was very stiff and painful, but I was able to walk the next day with only the support of one crutch. Within four days I returned to work at the clinic with only a slight limp, icing between patients and staying late to do my own rehabilitation.
Rehabilitation for this type of procedure is fairly straight forward. In the beginning days/weeks, a priority is placed on knee range of motion (ROM), especially for straightening. From there, making sure the muscles of the quadriceps are firing correctly and improving my walking form were emphasized. Shortly thereafter (2-4 weeks), gentle hip strengthening began, with the focus being placed on the gluteus medius.
The gluteus medius is responsible for abducting the leg, or swinging the leg out sideways. Also, when standing on one leg, it is the muscle responsible for keeping your pelvis level over the standing leg, preventing the hip from kicking out sideways. If this muscle does not work correctly, or is weak for some reason, an assortment of injuries can result. Some research has linked this muscle to injuries of the ankle, knee, hip, and even lumbar spine (low back). It was going to be essential for me to get my gluteus medius as strong as possible if I was going to be able to run again pain free.
By 6 weeks I was permitted to begin jogging again, which was incredibly encouraging for me. It was by no means pain free, but I never had the stabbing pain in the outside of my knee that I had become so accustomed to after 2-3 miles.
With the nearly constant help of Dave, Ellen and my wife (who is also a physical therapist), I made good progress. The greatest challenge, as it is with our patients, is in fact being patient. The body has specific healing times that must be respected in the rehabilitation process. Knowing the appropriate timing and progression during recovery can mean the difference between running for fun a few miles a week, and being able to compete at a high level again. It was with the guidance of other therapists who have the advantage of perspective (It is very difficult to be realistic in expectations when it is your own body in recovery. Even for a PT).
I spent much of the winter and spring of 2013 in the clinic and the Durango Recreation Center weight room strengthening my legs, and most specifically my glutes. By the time June came around I was running pain free and with improved form. I continued to work hard on my therapy, even though I was 7 months post op. All of my hard work began to pay off in big ways. Not only was I running pain free, but I was able to challenge my self again, running my first marathon, then a week later doing the Pikes Peak Ascent and setting a PR. However, these were only stepping stones to my ultimate goal that I have had for nearly 10 years.
On September 28, nearly 11 months after my surgery, I finished my first Ultra-Marathon. Not only did I finish the Devil Mountain 50K, but beat my goal time, and in the process finished 5th overall, which was a completely unexpected result.
It was only with a tremendous amount of hard work and good guided therapy that I was able to finally achieve a goal that I had nearly given up on a year prior. Through this experience I have grown an even greater appreciation for the efforts that our patients give towards their own rehabilitation and training. These are scary times after surgery, but with hard work and the advice of trusted clinicians, a 110% recovery truly is possible.
Stephen Stockhausen, PT, DPT
Nice to see some recognition for physical therapy in the national media. US News discusses the benefits of physical therapy before injections or surgery. The physical therapist is highly skilled in all musculoskeletal conditions, and is ready to get athletes (especially runners) back in action.
Be proactive and get a movement screening before starting a new training regimen to prevent problems before they start!
Stephen Stockhausen PT DPT, @SStockPT
Common Cause of Heel Pain Shown to Improve More with Manual Physical Therapy than Traditional Therapy
By Stephen Stockhausen, Doctor of Physical Therapy
Ever have a stabbing feeling in your heel with your first step out of bed the morning after a long hike down the Colorado Trail? The stabbing pain is the call sign of a condition commonly called plantar fasciitis.
The plantar fascia is a strong fan-like band of stiff connective tissue that stretches from the base of the heel towards the toes. This band supports the bottom of the foot and is essential for transitioning the foot from a “shock absorbing state” (pronation), when the foot initially touches the ground, to a “force producing state” (supination) for final push off when walking or running. Intrinsic muscles within the foot also assist in providing muscular support. When these structures become over worked or stressed they cause a sharp pain usually felt in middle of the heel. Occasionally there may also be a component of heel pain stemming from a low back problem.
This condition has been referred to as an “itis,” meaning inflammation, but recent research has reported little evidence of true inflammation. Physical changes in the tissues of the plantar fascia are found instead.
Patients are often treated with orthotic devices, corticosteroid injections, night splints, stretching, and a referral to physical therapy.
Traditional physical therapy interventions have included stretching the Achilles tendon and plantar fascia, ultrasound, iontophoresis, and orthotic devices. However, these interventions are often only effective for short term.
A recent study by Cleland et al. in the Journal of Orthopaedic and Sports Physical Therapy showed manual, or ‘hands on’, physical therapy, in which specific techniques were applied to mobilize the joints of the foot, ankle, knee and hip, as well as to the soft tissue of the plantar fascia to be more effective than a traditional physical therapy approach for the treatment of plantar fasciitis. Not only was manual physical therapy shown to have excellent short-term effects, but the benefits lasted at least 5 months after the final treatment was completed.
When you first feel the symptom of Plantar Fasciitis, you should begin self-treatment. A simple and effective technique to do at home is to massage along the bottom of the foot. Push deep and firmly into the soft tissues of the foot, gliding back towards the heel, feeling for any lumps or bumps along the way. These bumps may be painful, but working them out will be worth a few minutes of discomfort. Rolling your foot on a tennis ball or a frozen water bottle are also other ways to do this. Then begin stretching your calf and your hamstring.
So, next time you find yourself limping your way to work Monday morning after a long weekend out on the trails, be sure to give these techniques a try and if symptoms are not resolving, make your way to the nearest manual physical therapist for faster and more permanent results.
Chi running is a technique for running involving landing on the mid-foot with an erect posture, a forward lean from the ankles and a more rapid stride cadence. Running like this was recently compared to heel striking in the Journal of Orthopedic & Sports Physical Therapy “A Comparison of Negative Joint Work and Vertical Ground Reaction Force Loading Rates in Chi Runners and Rearfoot-Striking Runners.” The research found that Chi Running reduces vertical loading rates and quadriceps work, but increases calf muscle work slightly. These findings may allow some runners to run more painlessly with the Chi Technique.
I’ll be volunteering at the Durango Double Runs this weekend. Making it to the start line of these races is an accomplishment, as they are long enough to require significant preparation. If you have a pain that came up recently in your preparation, we at Rakita Tomsic Physical Therapy can help you make it to the start line feeling better; sometimes with simple treatment that can be continued at home, with certain exercises. Even during the race, you can continue feeling better without risk.
I just finished a trip to Fort Collins for my nieces’ wedding, and I was reminded of how important sitting posture is for back pain prevention. Most of us must use support for the low back to maintain its arch while on a long trip. Keeping the knees lower than the hips facilitates maintaining the arch(lordosis). When I did, I had no pain, but without a lumbar roll my buttock, and then leg pain, started.
It’s a beautiful fall day and you’re out on an awesome bike ride. Suddenly, there is this big rock and it
messes with you. You find yourself on the ground, and now your shoulder hurts. Or perhaps you are on a hike or a trial run, and that same rock shows up and you roll your ankle. These are the harsh realities we face in Durango! 🙂
In the world of Sports Medicine, we want to get you back to your activity as fast as possible. Did you know that you can come directly to physical therapy without needing to see a physician? We can evaluate your injury immediately and get you started on a rehabilitation program right away.
If we feel therapy is not appropriate for you at this time, or that you require further testing, such as x-rays, before starting therapy, we will assist you with getting to the right place to meet your needs.
Don’t delay your recovery by waiting to get started. Call the Board Certified Specialists at Rakita Tomsic
Physical Therapy, we’ll help you get back on track and back to the trails that we in the Four Corners love.
Plantar fasciitis (bottom of the foot or heel pain)is always a very painful condition, and patients have a hard time figuring out how to ease their symptoms. They read something on the Web, or talk to their friend who suggests a technique or product that ‘cured’ them. They try it and it doesn’t work for them. This is because plantar fasciitis is a broad diagnostic term, and doesn’t address the underlying mechanical problem that causes the pain.
Not all plantar fasciitis’ are the same.
I currently have two patients, each with this diagnosis. Each has a completely different treatment program and both are improving. You need to consult with an advanced trained physical therapist to assess the underlying mechanics of the problem and create a treatment program tailored for you.
After a short break from school I am back in for my second semester. It was very refreshing to not get up at 5 a.am to study every day, but to sleep in to 6 a.m.! I spent a little bit of time in the garden, which has been left on it’s own all summer, and playing with my dogs, Sadie and Sprocket. They remembered me and really appreciated it.
This semester, my course work is focusing on Pharmacology, Leadership, Business Management, and Clinical Case Studies. I am looking forward to more in depth learning of these subjects to be a more effective physical therapist and business owner.