T Nation

Dr. Ryan -PTime 6/19-6/20

Boogity, Boogity, Boogity, let’s go racing boys.

DR. Ryan-
The past week I have had pain in my ankle area - it is on the inside of my leg( along one of the calf muscles, I forgot which ones are the gastro and the soleus, but the pain is on the one that runs along the side- not directly behind.) running from mid shin level down to my ankle- it was swollen up pretty good and it hurt like hell a couple days ago- but the swelling has gone down and the pain is getting better but it still hurts.
the only thing I can think I did to it would be that I started doing calf raises for the first time in 6 months about 2 weeks ago so mabye I pushed it too hard? I also run every morning, and do squats and deads in my workout/

so what did I do??

andHow should I treat it??

Doc, how can I tell if my lower back pain is due to hip flexor tightness?

Do you know of any good Chiro’s in the Houston area I could see about this?

Thanks

Jeep69,

Sorry to hear about the problem.

From what you have said there was no acute trauma to initiate the inflammation, so you would think it must be related to the accumulated strain/stress from the calf training in addtion to your running. What kind of running volume have you been doing? Has it changed recently? Also, what calf exercises have you been doing and at what freq/intensity/volume?

What kind of warm-up/stretching program do you do?

If it was swollen as much as you indicated, then use ice only for 72 hours and then do some combo heat/ice.

Use heat prior to activity, followed by a mild warm-up and some gentle stretching. Ice following activity.

I would take a few days off of running to give the injured tissue a chance to recover. You could do some cycling or swimming instead. Also, avoid calf training for 7-10 days and then start back with about half the volume/intensity. Do not do any intense stretching right now as you don’t want to further aggravate the problem. After 7-10 days from the initial onset, you can start with some gentle stretching and assess your tolerance.

Let meknow what kind of symptoms you have currently and what kind of activity/movements make it better/worse, and I may be able to give you some additional advice.

If it continues to bother you after you have rested it for 7-10 days, I would see either a chiro/PT/ortho to check it out. I don’t know how old you are or if you have had problems with it before, but you don’t want to develop a more severe problem involving the Achille’s tendon.

Take care,

Ryan

Dave,

Hard to know if the hip flexors are causing the problem versus contributing to it.

You can assess for hip flexor tightness by laying flat on your back with your legs out straight. Then pull one leg in toward your chest (the other leg remains straight). If the straight leg starts to lift up, then your hip flexors are tight.

You can stretch them by getting in a lunge position, performing a pelvic tilt and then gliding your body forward. Do not lean back, just keep your torso straight. To intensify the stretch, raise your arm (on the side of the down leg) overhead and then lean away from the down leg.

Hope that helps.

Take care,

Ryan

Dr Ryan,
I’m an army medic, and train others is first aid on a regular basis. Part of that training is giving and recieving IV sticks (using normal saline or lactate ringer solution). For demonstration purposes, I’m taking in about 1000ml of fluids 2-3 times a week. (Fun stuff)
I am wondering how this will affect my strength training. I have some influence in class schedule. I lift in the evenings. Would it be better to take the fluid earlier in the day so I will shed the excess fluid during the day, or it it better to get my sticks in closer to pre workout time. Increased blood volume will cause an increase in BP, I don’t know how that will affect my lifts. I drink a lot of water and stay pretty well hydrated during the course of the day.
Thank you.

Combatmedic,

First off,I just want to send a sincere thank you all of the military personnel that are looking out for the rest of us.

Now, on to your question. Unfortunately, I don’t have much experience dealing with IV’s, however, I would think that it would be better to do it earlier in the day, further away from your workout time, to avoid any problems due to the fluid overload. Also, it would minimize any complications at the venipuncture site as well.

I know you are using isotonic solutions, however, but I am curious as to whether they contain electrolytes equal to the body’s concentration, or if they just have enough saline to maintain the desired osmotic gradient. Do they monitor your Na/K levels? Also, over what time period do you get the 1000ml?

Take care,

Ryan

Hi Dr.Ryan i recently went in for medial meniscus repair and microfracture, i cant run (6 weeks post op) but can walk normally and cant lift weights, i can technically jog short distances but it hurts after. Doc says stick to swimming and biking and i may never jog, which is BS im very pissed about that i dont know how he can say that i could run fine before, also i am a scholarship fball player so wtf… he tells me microfractures are a 12 week recovery time as well and even after that i still wont run…

from what i read on the net i hear nothing but horror stories regarding this operation, i really need to be fully functional, hence why i got the surgery done, how can i never jog again?

Dr. Ryan…

I’ve got one that is probably WAY off the scope…

Any tips for snoring?!

Hi:

I’m 45, have been working out about 2 years - seriously for 6 months or so.

A few weeks ago, I went out sprinting (one of many sessions) - 8 x 10-second sets, with about 1-2 mins rest between. After, I noticed my right glute felt stiff (pain when tensed) - I was all but limping for a day or two back then. It’s a lot better, but to this day, it’s still “stiff” and slightly painful when stretched. If I give my legs extensive stretches (hams/glutes), and massage it like hell, it eases up, but the following day (or later same day), it stiffens up again.

Also, maybe of no relation, my right knee “clicks” some times - no pain, just an occasional click.

I do squats / lunges / stepups / all-kinds of leg exercises, including some jumps.

I have stopped my running this month (first time for about 2 years) - I used to run 5-mile sessions at 6-7.5mph, sometimes 5 times / week.

Any ideas on the glute pain and/or knee clicks? Any suggestions on what I might try to minimize future issues?

Thanks in anticipation. :slight_smile:

WiZ

Dr Ryan,

I have noticed when I tape my ankles my shin splints don’t bother nearly as fast or at all. In addition, I feel I can cut harder for longer than without tapped ankles. Why do you suppose my shins, ankles, and lower legs feels soo much better as opposed to not taping them before practice or games? When I take the tape off my ankles I feel pretty darn great. I went through spring without taping the ankles to see how I felt and I was miserable with shin splints after I took my shoes off my ankles were swollen around the pivotal point. Why does it work so well to tape than not tape??? I have never had any ankle injuries or anything but have noticed this. I wonder if taking my fingers between the joints would help them stop getting broken and dislocated as well. Some people even tape their wrists.

I guess I am curious to why taping can be such a benefit?

-Get Lifted

Split,

Sorry to hear about your injury. Did they repair the damage or remove a piece of the meniscus. If they removed a large piece, then the area that is now not covered by the meniscus will be exposed to greater impact forces and be more prone to develop wear and tear arthrits in the future.

If they repaired the meniscus, then you activities will have to be limited for long enough to allow healing in the area where they tacked the injured tissue back down.

I usually don’t recommend jogging because it is biomechanically inefficient. I usually have people do a run/walk instead. It seems odd to me that the doc would say you wouldn’t be able to run again, as many athletes have similar or worse injuries and return to competition.

Don’t get discouraged. Also, you can perform upper body and core weight training while you recover.

Tell Mike Robertson, that I suggested you contact him about a rehab program. Mike just had his knee scoped due to a meniscus injury. I’m sure he has researched every aspect of rehab from such a procedure and he would be a great person to help you further.

Best of luck! Where do you play football?

Take care,

Ryan

TriGWU,

Try sleeping on your side or a modified stomach posture.

This is assuming of course that you only have the problem while sleeping on your back. If not, let me know.

Sometimes using a good memory foam cervical pillow that doesn’t allow your head to extend as much can help.

Take care,

Ryan

Thanks Dr. Ryan.

I only have the problem laying on my back.

Unfortunately, I start out sleeping on my side and then roll over onto my back.

I sure as hell don’t mind snoring but my bastard roomate knocks on my door until I wake up. I guess I probably deserve it though hehe.

WiZlon,

Well I would want to eval. the area to see if it is in the glute versus the hamstring insertion at the ischial tuberosity.

Sprinting requires a greater degree of functional or dynamic flexibility than regular distance running. Also, the force and speed of muscle contraction is much greater. This can lead to muscle strains or tendon injuries, especially if the volume or intensity of the sessions is increased to quickly.

I would find a good sports med chiro or PT in your area. They should be able to evaluate you and provide you some treatment, in addition to giving you a good home program to perform.

The program should focus not on static or passive flexibility but on dynamic flexibility.

Also, check out the Get Your Butt in Gear article series by Mike and Eric. Some posterior chain exercises would benefit you greatly.

Regarding the clicking in the knee, it could be several different things, but the important thing is that it is intermittent and non-painful. Has it been doing it for a long time or is it a relatively new problem? If it is a chronic thing that has not gotten progressively worse, it really isn’t much to worry about. Is it related to any cetain movement/postion or activity?

Take care,

Ryan

Dr. Ryan

I have experienced back pain most of my life. However, it is always in the middle of my back, just above the arch, as opposed to the arch itself as most people seem to deal with. I’ve always blamed this on a bad fall down a long flight of stairs that happened when I was a child, mostly because that injured my back more than anything else, and because I don’t recall experiencing any pain previous to that incident. When I started training seriously, I’d hoped simply strengthening my back would take care of it, but it hasn’t. This isn’t a debilitating pain, but it is still an annoyance as well as a minor hindrance.

I’m considering seeking chiropractic help, but I wanted to lobby you for advice first.

Thank you.

Get Lifted,

The tape provides support and stability to the ankle and foot.

During the running stride there is a complex series of events that takes place from heel strike to toe off. These events occur throughout the foot/ankle/lower leg/knee/hip etc. Now, how efficently these activities are controlled are important not only to performance but also injury prevention.

If the ligamentous and fascia are competent and the musculotendinous tissues have good strength/endurance and function with neuromuscular efficiency, then less energy is lost from heel strike to toe off and therefore, less energy has to be generated for the next stride. If less energy is required, then the muscles don’t have to work as hard and therefore they don’t fatigue or become injured as quickly.

Basically, the tape is enhancing stiffness of the lig/fascia,and helps with elastic recoil. This decreases the amount of muscular effort needed during the activity.

I would suggest that you do some lower leg/ankle stability exercises in addition to the taping. The exercises will only help to improve neuromuscular efficiency.

Some people argue that taping alters muscle recruitment patterns and over time can result in increased injury if the athlete competes in an untaped state. You might want to ask Eric Cressey his take on this and what philosophy they used on the athletes at UConn.

Take care,

Ryan

leon79,

Did you get evaluated at the time when you fell down the stairs. If so, what was the diagnosis? Did they do any X-rays or diagnostic testing?

Ryan

Dr. Ryan,

Just wanted to say excellent reply. One of the best I have ever had.

:wink:

Let’s ack eric now. :wink:

-Get Lifted

[quote]Dr. Ryan wrote:
WiZlon,

I would find a good sports med chiro or PT in your area. They should be able to evaluate you and provide you some treatment, in addition to giving you a good home program to perform.[/quote]

I’ll do that. I tried “Accupuncture” following a recommendation. No difference. I’ll look for a sport med chiro - thanks! :slight_smile:

Started last year, probably around the fall or so. I was somewhat into my distance running then (all on a treadmill - to cushion the blows). I was not doing any strength training at the time - I was trying to lose about 20-30 LB of lard. It was about then that I noticed a “click”. No better, no worse since. After extensive stretching I think it clicks somewhat less, but it’s hard to say really.

If I stand up and turn to the left (with foot on floor) then it is more likely to click than if I stand without turning. The same knee also squeeks and scrunches a little when I squat down, but again, no pain whatsoever.

I sincerely appreciate your feedback, and I will go find a sport med chiro to check me out.

Thanks again!

WiZ