PM: Lateral Knee/Calf Pain with Standing and Transitional Movements: Patient waiting PT Eval and Treatment (2-4-19)

  • WALKING PROGRESSION
    • Below you will find 2 things:
      • Return to WALKING progression broken into levels of difficulty
        • These levels are a guide, and everyone does not need to start at level 1…BUT the first time you try this, have the mindset of making it too easy versus making it too hard
        • You want to pick a level that is too easy so you at least know a safe zone prior to pushing the limits
      • Soreness Rules:
        • Rules that will guide you as to how much rest and what level you should be training at
    • Return to WALK Levels:
      • 1:  SLOW walk 1 minute, FAST WALK 1 minute for 10 minutes
      • 2: same as above for 15 minutes
      • 3: same as above for 20 minutes
      • 4: SLOW walk 1 min FAST WALK 2 min for 10 min
      • 5: same as above for 15 min
      • 6: same as above for 20 min
      • 7-9: SLOW walk 1 min FAST WALK 3 min (10min, 15min, 20min)
      • 10-12: SLOW walk 1 min FAST WALK 4 min (10min, 15min, 20min)
      • 13-15: SLOW walk 1 min FAST WALK 5 min (10min, 15min, 20min)
      • 16-18: FAST WALK only (10min, 15min, 20min
    • Soreness Rules
      • *These rules are meant to guide your progress through a walking/running program in an effort to allow individuals to progress safely without over training. They are based on the symptoms that you experience during and after workouts. These rules are based on an article in the Journal of Orthopedic & Sports Physical Therapy that set up a program for individuals returning to running following ACL repair.
        1. Soreness during the warm up that continues during the session = 2 days off, drop down a level
        2. Soreness during the warm up that goes away = Stay at that level
        3. Soreness during the warm up that goes away but redevelops during session = 2 days off, drop down a level
        4. Soreness the day after (not muscle soreness) = 1 day off, do not advance program
        5. No Soreness = Advance 1 level once there is no soreness for 3 consecutive attempts at that level
  • Every other day list
    • NEW: SINGLE LEG BALANCE WITH POST OR IN DOOR WAY
    • Band Pull inward in staggered stance
    • NEW: REVERSE LUNGE TOWEL SLIDE: STAY BENT FORWARD AT COUNTER
    • Weighted pullover 2lbs
    • Elevated lunge
  • Hello Phyllis, it was nice to meet you today
  • We discussed some various concepts in regards to the pain you are having
    • Getting in and out chairs: Keep the pressure on your heels and keep knees apart
  • Somethings I noticed from your exam
    • Bending forwards and backwards your upper body shifted to the right
    • sidebending was decreased to the left and and sidebending to the left reproduced mild lateral knee/calf pain
    • Sit to stand with inward collapse of bilateral knees
    • standing on one leg gradually increased the pain in the outside of the L knee
    • Tender to touch more so along the lateral quad/distal IT band
    • Lying Down:
      • Significant limitation in quad flexibility on both sides but increased limitation in quad and hip flexor on the right(which is the side of your problematic hip
      • Felt more tightness in the front/side of the L knee with a bridge when in a deeper knee bend
    • I also noticed in standing you tend to keep the weight more on the outside of the left foot, possibly from the issues with the neuroma
  • What we do:
    • The movements below try to get some muscle activation in and out of a stretch
    • I am also going to include what I call a self myofascial release option for your quad/IT band
    • It is alright to have pulling/ mild discomfort during a movement as long as there is no increase in pain afterwards
    • Ice on the outside of the knee is a good idea, especially after activity which may help reduce pain
    • Try to do the movements below lightly, I will specify some details under each one
    • If you have any pain…try doing just the bridge one day…see how you feel that day and the next day. If that feels fine then do the bridge and add the seated cross leg …add one movement at a time so you can see what caused you the issue
  • NEW: SEATED SLIDE
  • NEW: KNEE TO CHEST ON BACK
  • Movement #1: Bridge
    • Bend knees as much as possible but short of pain.
    • Hold each 3-5seconds and repeat 5-10 reps slowly
    • This can be done 2-3x per day
    • If it hurts when you bend your knees, sometimes you have to start with less knee bend and that will be less painful
  • Movement #2: Seated Cross Leg Stretch/Glute Isometric
    • Hold each 5 sec, repeat 5-10x each leg…Try for 2-3x/day
  • Movement #3: Heelraise at the wall
    • Don’t go too high on toes as it may irritate your neuroma
    • This can also be done at the edge of a step so I included both options below
    • 8-15x, 2-3x per day
    • NEW: ROCK HEEL TO TOE