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June, 2024

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Ask a physical therapist

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SkierPT
Posts: 2177 - Karma: 4,720
Hey NS family,

Dr. Nick here, sports and ortho physical therapist. Winter is coming and I plan to be a hit more active here.


I wanted to make a thread for you guys to ask me about anything in the rehab/ performance world.

I’ll do my best to answer accurately.

Check out my previous news posts for some fun skier interviews and PT content !
Sep 18 2023 6:23PM
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steez_apprentice
Posts: 788 - Karma: 5,415
what's the best way to prepare for the ski season/recover properly between days, and what do you typically suggest for shin pain?
Sep 18 2023 6:27PM
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Dlonetti
Posts: 1517 - Karma: 14,825
This will be my third season post acl surgery, when will my leg get back to the same size as the other/tips to do that. Less of a skiing question more of a gym question cuz the skiing has been fine for two years now
Sep 18 2023 6:50PM
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SkierPT
Posts: 2177 - Karma: 4,720
DlonettiThis will be my third season post acl surgery, when will my leg get back to the same size as the other/tips to do that. Less of a skiing question more of a gym question cuz the skiing has been fine for two years now


Wow, third ACL? That's tough man, you're a tough dude!
That's a hard question to answer. Adding muscle mass normally takes months. Adding 0.5 lb per month is a realistic goal. Train for strength, power and hypertrophy. If you're not sure how, feel free to DM me.

Diet is a huge part of recovery along with hydration. Caloric surplus with high protein intake will help build muscle.

I wish you the best. I'm glad skiing has been good. Please wait a minimum of 9 months before returning to sport!
Sep 18 2023 8:17PM
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SkierPT
Posts: 2177 - Karma: 4,720
steez_apprenticewhat's the best way to prepare for the ski season/recover properly between days, and what do you typically suggest for shin pain?


https://www.newschoolers.com/news/read/Shin-Bang-Manage

Here is a previous post about shinbang!

For preseason rehab, I recommend a full fitness approach. Get stronger, leaner and fast. Train the big 3 lifts (bench, deadlift, squat) with various of dumbell work. Run more, sprint more. Interval train on a bike.

Recovery between days is tough. Icing only for pain, heat is generally better. Hydrate more than you think you need do. High protein intake can help as well.

Modalities like massage, dry needling and such can also help recovery. I hope this helps!
Sep 18 2023 8:20PM
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steez_apprentice
Posts: 788 - Karma: 5,415
SkierPThttps://www.newschoolers.com/news/read/Shin-Bang-Manage

Here is a previous post about shinbang!

For preseason rehab, I recommend a full fitness approach. Get stronger, leaner and fast. Train the big 3 lifts (bench, deadlift, squat) with various of dumbell work. Run more, sprint more. Interval train on a bike.

Recovery between days is tough. Icing only for pain, heat is generally better. Hydrate more than you think you need do. High protein intake can help as well.

Modalities like massage, dry needling and such can also help recovery. I hope this helps!


As a long distance runner during the fall, this definitely helps preparing for the ski season since I often suffer from shin splints and find myself in shin pain before the season even starts. Thanks for the help!
Sep 18 2023 8:25PM
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saucemastrscotty
Posts: 139 - Karma: 783
Last season I separated my shoulder (grade 3), doctors told me it didn't require surgery. It's still not back to 100% (I did it at the start of March), really want it to be better by the start of the season, are there any exercises/anything u recommend doing?
Sep 18 2023 10:07PM
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Dlonetti
Posts: 1517 - Karma: 14,825
SkierPTWow, third ACL? That's tough man, you're a tough dude!
That's a hard question to answer. Adding muscle mass normally takes months. Adding 0.5 lb per month is a realistic goal. Train for strength, power and hypertrophy. If you're not sure how, feel free to DM me.

Diet is a huge part of recovery along with hydration. Caloric surplus with high protein intake will help build muscle.

I wish you the best. I'm glad skiing has been good. Please wait a minimum of 9 months before returning to sport!

Lol no no sorry I meant third season since tearing my acl, only happened once. I just want my legs to be the same size again
Sep 18 2023 10:10PM
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BIIIGZ
Posts: 219 - Karma: 2,131
I’ve read in a few scientific articles/studies that strengthening the neck muscles can mitigate the severity/occurrence of concussions.

What are some PT approved ways to strengthen the neck muscles?

Your insta is awesome by the way I have like all of the pre-season prep exercises saved lmao. And your foam roller/stretching/calf exercises rlly helped my shinbang issues🙏

**This post was edited on Sep 18th 2023 at 11:06:37pm
Sep 18 2023 11:02PM
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PartyBullshiit
Posts: 2742 - Karma: 15,636
Do you have any ski specific stretching routines you recommend for day of skiing?
Sep 19 2023 12:07AM
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Loodwik
Posts: 235 - Karma: 309
Any way to reduce ACL related swelling faster after activity? This will be my first winter back after surgery last september.
Sep 19 2023 3:16AM
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SamuelForsgren
Posts: 144 - Karma: 1,461
I almost completly tore the acl in the begining of 2022 its still litle acl left but the doctors said it was hanging in thread so i didnt ski much that season but by the end i skied more and i didnt get surgery because it worked well in the spring and the 2023 season i was skiing very much and it worked well and i feel like my knee is normal now and i dont have any problems. Do you think it will be problems in the future for me because i didnt get surgery?
Sep 19 2023 8:00AM
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asparagus
Posts: 2460 - Karma: 27,957
How to get bulletproof shoulders?
Sep 19 2023 10:17AM
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b0ss
Posts: 781 - Karma: 6,150
do you have any opinion on collagen supplements? Is the body’s natural ability to make/process/idk collagen a use it or lose it thing?

Is it better to stretch in hot or cold room? Hot room means more flexible right a way but does that actually translate to flexibility gains in all temps?

In the 200 days before a season, is it better to train single leg strength and overall output? Single leg then overall power out? Or overall power out then single leg.

For cardio, is it better to train on a bike and make more cardio gains? Or run, make less cardio gains but potentially strengthen joints and ankles? Is the difference even that big? I’ve been skiing hard all year every year now and cant seem to make gains running because I just explode my knees before even sweating. Is this a sign I should run from scratch? Or should I ditch running if joint strength gains are negligible?
Sep 19 2023 12:24PM
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BIIIGZ
Posts: 219 - Karma: 2,131
BTW anyone reading or posting on this thread seeking injury prevention/recovery: HIGHLY recommend you check out this guy’s insta (@SkierPT)

It’s an actual goldmine of information if you want to make your body “bulletproof” and he’s doing a huge service catering to us with professional knowledge and high quality, short form content type vids. Yes strength training can be tedious but if u wanna abuse your body like we do and not sacrifice your whole season over one bad slam it’s worth it.
Sep 19 2023 12:31PM
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Lonely
Posts: 6645 - Karma: 60,281
Where can I get anabolic steroids?
Sep 19 2023 12:45PM
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Liam_j10
Posts: 507 - Karma: 2,441
I tore my ACL this last winter and had surgery the last week of Jan. Rehab was going terrific until May when I was getting back into running. I got too excited and ran way farther than I should have, aggravating my patella tendon (noted in an mri), and probably other things in there. Ever since then progress has been much harder. I wanna work on strengthening my legs for ski season and to help support my knee but a lot of exercises that involve bending do not feel good and def aggravate it (squats, lunges, even cycling). since that injury in may, it also clicks in the front every time I bend it. I'm having success and progress hiking, but I definitely need some more exercises to get back into running and skiing at a high level. RDL's have been good too



Any suggestions on exercises, activities, or treatments that can help that aggravation in the front while still allowing me to build strength and make progress?
Sep 19 2023 1:37PM
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_jam0__
Posts: 102 - Karma: 989
What are your thoughts on knees over toes?
Sep 19 2023 2:02PM
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milo-mcsenderson
Posts: 604 - Karma: 7,664
_jam0__What are your thoughts on knees over toes?


+1 for this question!
Sep 20 2023 1:36PM
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SkierPT
Posts: 2177 - Karma: 4,720
saucemastrscottyLast season I separated my shoulder (grade 3), doctors told me it didn't require surgery. It's still not back to 100% (I did it at the start of March), really want it to be better by the start of the season, are there any exercises/anything u recommend doing?


Sorry to hear about that, a separation is a nasty one. Because its usually just ligament damage, it can take a longggg time to heal.

Here are a few higher level exercises on my Instagram to check out.

https://www.instagram.com/reel/CvD1xiMNqQ-/?utm_source=ig_web_button_share_sheet&igshid=MzRlODBiNWFlZA==
Sep 20 2023 8:22PM
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SkierPT
Posts: 2177 - Karma: 4,720
BIIIGZI’ve read in a few scientific articles/studies that strengthening the neck muscles can mitigate the severity/occurrence of concussions.

What are some PT approved ways to strengthen the neck muscles?

Your insta is awesome by the way I have like all of the pre-season prep exercises saved lmao. And your foam roller/stretching/calf exercises rlly helped my shinbang issues🙏

**This post was edited on Sep 18th 2023 at 11:06:37pm


Thank you for the kind words!

Generally any type of plank, row and press will help strength the area around the neck.
Neck isometrics is a good choice for the smaller neck muscles. I will be making a post soon about this.

Here is an example of a row workout to help strengthen the base of the neck:

https://www.instagram.com/p/CZN5X3Dlhlh/?utm_source=ig_web_copy_link&igshid=MzRlODBiNWFlZA==
Sep 20 2023 8:25PM
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SkierPT
Posts: 2177 - Karma: 4,720
PartyBullshiitDo you have any ski specific stretching routines you recommend for day of skiing?


DYNAMIC WARMUPS >>

Here is a quick routine:
https://www.instagram.com/p/Bv7hO3iFslN/?utm_source=ig_web_copy_link&igshid=MzRlODBiNWFlZA==
Sep 20 2023 8:26PM
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SkierPT
Posts: 2177 - Karma: 4,720
LoodwikAny way to reduce ACL related swelling faster after activity? This will be my first winter back after surgery last september.


Good job taking your time to come back. Sorry to hear about the injury. Listen to your body, it will tell you when you're over doing it. Progress slowly and build up that swagger.

Ice for pain.
Heat for recovery (if there isn't much swelling).

Don't over ice.
Advil is fine to take the edge off.

Doing light movement, walking, stretching after a day can help along with massage.

Goodluck! Feel free to reach out.
Sep 20 2023 8:31PM
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SkierPT
Posts: 2177 - Karma: 4,720
SamuelForsgrenI almost completly tore the acl in the begining of 2022 its still litle acl left but the doctors said it was hanging in thread so i didnt ski much that season but by the end i skied more and i didnt get surgery because it worked well in the spring and the 2023 season i was skiing very much and it worked well and i feel like my knee is normal now and i dont have any problems. Do you think it will be problems in the future for me because i didnt get surgery?


There has been a lot of new research that surgery isnt always needed for full or partial ACL tears.
MRI will be the only way to determine structural integrity of the ligament.

Try to find a good sports PT in your area and have them go through high level return to sports testing.
If you can't find one or want my assistance, feel free to DM me.
Sep 20 2023 8:36PM
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SkierPT
Posts: 2177 - Karma: 4,720
asparagusHow to get bulletproof shoulders?


Knew this one was coming.
Check these out:

https://www.instagram.com/p/B8uUBsZlall/?utm_source=ig_web_copy_link&igshid=MzRlODBiNWFlZA==

https://www.instagram.com/p/B82XOVAl2Tl/?utm_source=ig_web_copy_link&igshid=MzRlODBiNWFlZA==

https://www.instagram.com/p/B9P4At1BQca/?utm_source=ig_web_copy_link&igshid=MzRlODBiNWFlZA==

I have newer posts up as well for shoulders. Hope these help!
Sep 20 2023 8:38PM
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saucemastrscotty
Posts: 139 - Karma: 783
SkierPTSorry to hear about that, a separation is a nasty one. Because its usually just ligament damage, it can take a longggg time to heal.

Here are a few higher level exercises on my Instagram to check out.

https://www.instagram.com/reel/CvD1xiMNqQ-/?utm_source=ig_web_button_share_sheet&igshid=MzRlODBiNWFlZA==


Thanks so much! Will definitely be trying these! Also good to know, no one gave me any sort of timeline on it
Sep 20 2023 11:02PM
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-eREKTion-
Posts: 1534 - Karma: 10,018
I’m about 4 months into recovery from an ankle avulsion fracture. PT has not been going that well, I can walk and jog but haven’t regained a ton of strength or mobility yet. Stick with PT? Or seek out a second opinion because I feel like I might need surgery?
Sep 20 2023 11:24PM
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No-Skill-Phil
Posts: 45 - Karma: 186
What to do about long-term (maybe 1.5-2 years) sharp pain located on the top of the patella, but felt inside the knee?

Fully flexing the left knee results in a massive sharp pain and leg goes limp for a bit. Landing backseat SUCKS and cannot sit-ski anymore haha

A general physio said it was most likely quad tendinitis, so now I do unweighted leg lifts every third day or so, and try to foam it quads most days but I forget all the time.
It’s still hanging around though ¯\_(ツ)_/¯

pro tips?
Sep 22 2023 10:38AM
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SkierPT
Posts: 2177 - Karma: 4,720
_jam0__What are your thoughts on knees over toes?


He is very good at marketing and is making a lot of money selling.

What he preaches makes sense. I use a lot of similar exercises for patients. For skiers, ankle mobility and anterior tibialis strength is MASSIVE for function. I'm a fan of KOT guy, just know he has no formal education from what I can tell.
Sep 22 2023 9:15PM
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SkierPT
Posts: 2177 - Karma: 4,720
Liam_j10I tore my ACL this last winter and had surgery the last week of Jan. Rehab was going terrific until May when I was getting back into running. I got too excited and ran way farther than I should have, aggravating my patella tendon (noted in an mri), and probably other things in there. Ever since then progress has been much harder. I wanna work on strengthening my legs for ski season and to help support my knee but a lot of exercises that involve bending do not feel good and def aggravate it (squats, lunges, even cycling). since that injury in may, it also clicks in the front every time I bend it. I'm having success and progress hiking, but I definitely need some more exercises to get back into running and skiing at a high level. RDL's have been good too



Any suggestions on exercises, activities, or treatments that can help that aggravation in the front while still allowing me to build strength and make progress?


Have you tried aquatics/ swimming? Biking? Both lower impact options. In the pool you can squat, lunge, etc with less impact.
Pilates is also a good option for lower impact. I dish out pilates to my patients with heavy arthritis with good results usually.



Goodluck!
Sep 22 2023 9:17PM
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SkierPT
Posts: 2177 - Karma: 4,720
b0ssdo you have any opinion on collagen supplements? Is the body’s natural ability to make/process/idk collagen a use it or lose it thing?

Is it better to stretch in hot or cold room? Hot room means more flexible right a way but does that actually translate to flexibility gains in all temps?

In the 200 days before a season, is it better to train single leg strength and overall output? Single leg then overall power out? Or overall power out then single leg.

For cardio, is it better to train on a bike and make more cardio gains? Or run, make less cardio gains but potentially strengthen joints and ankles? Is the difference even that big? I’ve been skiing hard all year every year now and cant seem to make gains running because I just explode my knees before even sweating. Is this a sign I should run from scratch? Or should I ditch running if joint strength gains are negligible?


Research on collegen is mixed. If you can afford to try it, it likely won't make things worse!

Stretching is stretching. IMO just stretch. Idt any version is "better". Dynamic stretching is best for warm up injury reduction.

Off season train strength and power. Lower reps for single and double leg. During season, higher reps lower weight to maintain some strength.

if you are running during the season and knees are hurting, choose a different method of cardio. IMO long cardio is overrated for skiers. We don't ski at a high heart rate for a long long time. Its interval, ski a run, get a break on the lift. Maximize interval trianing for cardio on bike for example. I hope this helps.
Sep 22 2023 9:21PM
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SkierPT
Posts: 2177 - Karma: 4,720
-eREKTion-I’m about 4 months into recovery from an ankle avulsion fracture. PT has not been going that well, I can walk and jog but haven’t regained a ton of strength or mobility yet. Stick with PT? Or seek out a second opinion because I feel like I might need surgery?


Seek another opinion. You might benefit from some aquatic therapy and exercise. Lower impact but still allows squats, lunges, etc etc
Sep 22 2023 9:23PM
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SkierPT
Posts: 2177 - Karma: 4,720
No-Skill-PhilWhat to do about long-term (maybe 1.5-2 years) sharp pain located on the top of the patella, but felt inside the knee?

Fully flexing the left knee results in a massive sharp pain and leg goes limp for a bit. Landing backseat SUCKS and cannot sit-ski anymore haha

A general physio said it was most likely quad tendinitis, so now I do unweighted leg lifts every third day or so, and try to foam it quads most days but I forget all the time.
It’s still hanging around though ¯\_(ツ)_/¯

pro tips?


Sounds like chronic tendonosis, which can be a degrading tendon. You need to load that sucker over a few months to make it stronger. Its like a scale. You put too much force into a weak tendon and it'll give. You need to make the tendon much stronger over time to balance the force scale.

Here is my post with some exercises.

https://www.instagram.com/reel/Cb5gR0KFNQA/?utm_source=ig_web_copy_link&igshid=MzRlODBiNWFlZA==
Sep 22 2023 9:26PM
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SkierPT
Posts: 2177 - Karma: 4,720
What else y’all got for me?
Oct 2 2023 9:18PM
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ajbski
Posts: 1263 - Karma: 5,065
I’m two months into a meniscus tear I picked up on closing day at mammoth.

I haven’t treated it properly and continued regular activity hoping it would get better. climbed several mountains, couple days of whis bike park, rock climbing etc…

now most recently, I was changing the shocks on my truck and was squatted for about 6 hrs straight. Now I can’t bend my knee fully without medium pain. With weight or no weight. No pain otherwise.

should I rest it for a couple of months before ski season or should I just keep up with activity with a focus on strengthening muscles in that leg?
Oct 2 2023 11:31PM
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SkierPT
Posts: 2177 - Karma: 4,720
ajbskiI’m two months into a meniscus tear I picked up on closing day at mammoth.

I haven’t treated it properly and continued regular activity hoping it would get better. climbed several mountains, couple days of whis bike park, rock climbing etc…

now most recently, I was changing the shocks on my truck and was squatted for about 6 hrs straight. Now I can’t bend my knee fully without medium pain. With weight or no weight. No pain otherwise.

should I rest it for a couple of months before ski season or should I just keep up with activity with a focus on strengthening muscles in that leg?


How’s it going after a few days since this post?

absolute rest is generally the worse thing you want, even with injury!
Oct 7 2023 3:25PM
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AlwaysGrabBlunt
Posts: 156 - Karma: 738
Hey man, I've bruised both of my calcaneus' two times now in the last couple seasons. Is there anything I can do to help prevent this from happening?? (Aside from not landing flat)
Oct 7 2023 3:42PM
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SkierPT
Posts: 2177 - Karma: 4,720
AlwaysGrabBluntHey man, I've bruised both of my calcaneus' two times now in the last couple seasons. Is there anything I can do to help prevent this from happening?? (Aside from not landing flat)


Do you use custom footbeds/ heel lifts in your boots?
Oct 7 2023 3:48PM
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AlwaysGrabBlunt
Posts: 156 - Karma: 738
I just have boot doc inserts. Nothing custom
Oct 7 2023 3:53PM
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SkierPT
Posts: 2177 - Karma: 4,720
AlwaysGrabBluntI just have boot doc inserts. Nothing custom


I’d go to a boot fitter if possible. Spend some $$ to create the best fitting boot.

also check your ankle mobility and strength !
Oct 7 2023 3:54PM
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AlwaysGrabBlunt
Posts: 156 - Karma: 738
SkierPTI’d go to a boot fitter if possible. Spend some $$ to create the best fitting boot.

also check your ankle mobility and strength !

Thanks man!
Oct 7 2023 3:56PM
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Loodwik
Posts: 235 - Karma: 309
AlwaysGrabBluntI just have boot doc inserts. Nothing custom


Had this issue a few years back. Have you tried switching to softer boot boards?
Oct 8 2023 6:57AM
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ajbski
Posts: 1263 - Karma: 5,065
SkierPTHow’s it going after a few days since this post?

absolute rest is generally the worse thing you want, even with injury!


I’m still just riceing it for now and keeping mobility and circulation in a hot tub. Very conservative. It’s really not that bad, but my fears are favouring my other leg or the injury flaring up in the winter. I think my big mistake before was not letting it get past that acute stage and just toughing out the pain. Made the injury worse.

I’m planning out the exercise schedule now. I think aquatic and spin will be the best to keep weight off. But I’m not a professional, I’ll gladly take any advice or insight. Thanks for being a part of ns and doing this kind of outreach.
Oct 8 2023 1:43PM
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Amnolan4
Posts: 10 - Karma: 55
Any good exercises or stretches you recommend for IT Band Syndrome? I see things all over the internet but nothing necessarily geared towards skiing or single leg workouts.
Oct 10 2023 3:40PM
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Getshifty
Posts: 343 - Karma: 2,116
Hey I've been dealing with Patellar tendinopathy since July, didn't get serious about it until late August. Saw improvement but regressed recently because I tried to go into plyometrics / sport to early. I've moved back to heavy isometrics twice a day that target quads, hamstring, and soleus calf to strengthen the muscles around the tendon and introduce load without high rate of movement. I've been following Jake Tuuras Jumpers Knee Protocol not sure if you know it, its a 4 stage processes of high weight isos, then lifting, then store and release (plyometrics), and finally return to sport. Thoughts on this program? Going to go back to lifting in a week when the daily pain goes down to 1/10, currently around 3-4/10.
Oct 10 2023 3:48PM
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AlwaysGrabBlunt
Posts: 156 - Karma: 738
LoodwikHad this issue a few years back. Have you tried switching to softer boot boards?

No I have not.
Oct 25 2023 4:17PM
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AlwaysGrabBlunt
Posts: 156 - Karma: 738
LoodwikHad this issue a few years back. Have you tried switching to softer boot boards?

No I have not.
Oct 25 2023 5:26PM
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SkierPT
Posts: 2177 - Karma: 4,720
Amnolan4Any good exercises or stretches you recommend for IT Band Syndrome? I see things all over the internet but nothing necessarily geared towards skiing or single leg workouts.


This one is tough. I am currently battling it when running. Strengthening hip abductors and groins. Work on hip mobility and ankle mobility. May have to adjust running technique.
Oct 25 2023 9:22PM
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SkierPT
Posts: 2177 - Karma: 4,720
GetshiftyHey I've been dealing with Patellar tendinopathy since July, didn't get serious about it until late August. Saw improvement but regressed recently because I tried to go into plyometrics / sport to early. I've moved back to heavy isometrics twice a day that target quads, hamstring, and soleus calf to strengthen the muscles around the tendon and introduce load without high rate of movement. I've been following Jake Tuuras Jumpers Knee Protocol not sure if you know it, its a 4 stage processes of high weight isos, then lifting, then store and release (plyometrics), and finally return to sport. Thoughts on this program? Going to go back to lifting in a week when the daily pain goes down to 1/10, currently around 3-4/10.


Tendinopathies are tricky. Load it, without flaring it up too much. That program looks solid, I preach similar stuff for my patients. Keep pain below a 4/10 during and after loading and you're golden.
Oct 25 2023 9:24PM
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K2Hellbentfan
Posts: 19 - Karma: 188
I’ve been dealing with pain in my left shoulder for years, mri last summer shows no visible tear but radiology said there might be a small pinhole tear, I’ve been doing pt trying to strengthen scapular muscles and work on mobility and also fix my posture so my shoulders don’t slump forward, my shoulder still pops and grinds if I move it wrong and almost any reasonable exertion still makes my shoulder tender for days, any advice would be greatly appreciated.
Oct 26 2023 11:20AM
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CowboySkibop
Posts: 3512 - Karma: 28,230
I hardcore popped my ankle and sprained it inside my boot early last season and kept skiing on it after taking like 2 days off. it felt a lil better after that and would only really hurt when I would take my boots on and off and didn't impede my skiing so I just said whatever and kept skiing for the whole season. I had a pretty strict daily regimen of tiger balm, stretching, and a hot/cold soak like once or twice a week which I think helped a lot, but that pain still lasted till like late spring and was kinda a little tweaky for the beginning of my mtb season but all the pain subsided around that time and I had full range again. we all good now and my ankle is back to full normal

is that fucked? what do you think happened?

inb4, I know im a fuckin idiot for not going in at all for this
Oct 26 2023 11:37AM
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