Just a quick recap of the past couple weeks with regards to PT:
- It turns out that the 3:30 leg raises shouldn't go up and back quite as much as I had been doing them. The motion is 90% vertical.
- Weights for the 3:30 and 10:30 leg raises has gone up to 5 lbs, and I've started doing them on both sides.
- The knee spread exercises are called clamshells.
- New balance exercise: the lean forward toe touch. In this exercise, you bend the knees slightly, and raise one foot off the floor, balancing on one foot. While continuing the balance (and making sure to keep the knee from buckling inwards), lean forward while extending the leg back, touch the floor, and then come back up. Three sets of 15.
- New strength exercise - side walking. In this exercise, an exercise band is looped around the ankles (while standing), and the feet are spread just enough to get some tension on the exercise band. Then, walk sideways 10 steps, being sure to keep control of movement and not letting the band snap your feet back together too quickly. Always keep tension on the band. Once you have gone 10 steps, go back the other direction. Repeat 3x.
- New strength exercise - leg press with exercise band. This is a standard leg press on a leg press machine, but with the exercise band just above the knee. The band is supposed to keep some of the hip muscles engaged, but so far I have not really been able to feel anything during this exercise other than on the quads. Since it requires a leg press machine, I am unable to do this one at home.
For about 1.5-2 weeks, I had been doing all the exercises that can be done at home (3:30 leg raises, 10:30 leg raises, clamshells, dips (up to 6" in height), lean forward toe touches, side walking, quad flexor stretching, and a total of around 10 minutes on the foam roller per side) on a daily basis.
Today's PT session had a few new exercises to begin integrating into a rotation of 5-6 exercises per day:
- Leg extensions: 120 lbs (three sets of 10). This is done on an exercise machine.
- Plank hold: 30 seconds x 2 per side. In this exercise, lie on your side, propped by on your elbow. Lift your hips off the ground to maintain a straight body. Hold for 30 seconds, rest, repeat, and do other side.
- Side toe touches. Similar to the lean forward toe touches, but instead of keeping the planted leg fixed in its starting position, bend at the knee to get downward motion. Two sets of five touches on each side. This exercise works the quads a bit.
- Side lunge squats: Step to the side, squat down on the knee, and back up. Two sets of 10 on each side.
- hamstring curls. This one requires a pilates ball (one of those three foot diameter inflatable balls). Lie on your back, legs raised, and the ball placed under your feet - tallest point of the ball about in line with the ankles. Place arms out to the side for stability, raise butt off floor and pull feet toward you, which rolls the ball towards you. This works the hamstrings (surprisingly well), as well as helps with building control and stability in the hip and core muscles. Two sets of 10.
Friday, November 20, 2009
Sunday, November 8, 2009
IT band PT - 11/8/09
Last Thursday was my second PT session for the IT band. It contained the previously mentioned exercises (I wish I knew the real names):
- 10:30 raises w/4 lbs. 3 sets of 15
- 3:30 raises w/4 lbs. 3 sets of 15
- Quad flexor stretch (3 x 30 sec sets)
- Foam roller (5 minutes)
There were also a couple new things. Again, I don't know the real names, but the first one I'll call the heels together knee spread. Lie on your side, with your legs bent - about halfway between totally straight and a full fetal position. With a resistance band looped around the knees, keep the feet together and raise the top knee. Repeat for the other side, 3 sets of 15. I'm not sure whether the muscle worked here is the same muscle as the 3:30 raises - it feels to be in the same general area.
The last new exercise was dips. Standing with the left leg on an aerobic step, dip down and lower the right leg to the ground. The knee should be kept from buckling inward during the dip - so roughly in line with the 2nd toe. Once again, three sets of 15. This one was surprising to me, as my ankle was pretty unstable. Having to balance and stabilize on one ankle while moving around is tough at first. By the end of the third set, my ankle was definately feeling it.
I had a realization over the past couple days. Initially, my thinking was along the lines of 'Hey - so these exercises are supposed to help stabilize my knee, but were talking about 45 iterations of an exercise per day. When I go out and run for an hour and I'm running with a cadence of 90 steps/minute - thats 5400 iterations. How would 45 iterations make any bit of a difference?'
Then I realized that if I'm doing 5400 iterations, and I'm feeling the burn (and in the case of the knee spreads on the right side, feeling sore the next couple days) after 3 sets of 15 of an isolation exercise - then I'm not getting a good workout for that muscle during that run. Plain and simple.
- 10:30 raises w/4 lbs. 3 sets of 15
- 3:30 raises w/4 lbs. 3 sets of 15
- Quad flexor stretch (3 x 30 sec sets)
- Foam roller (5 minutes)
There were also a couple new things. Again, I don't know the real names, but the first one I'll call the heels together knee spread. Lie on your side, with your legs bent - about halfway between totally straight and a full fetal position. With a resistance band looped around the knees, keep the feet together and raise the top knee. Repeat for the other side, 3 sets of 15. I'm not sure whether the muscle worked here is the same muscle as the 3:30 raises - it feels to be in the same general area.
The last new exercise was dips. Standing with the left leg on an aerobic step, dip down and lower the right leg to the ground. The knee should be kept from buckling inward during the dip - so roughly in line with the 2nd toe. Once again, three sets of 15. This one was surprising to me, as my ankle was pretty unstable. Having to balance and stabilize on one ankle while moving around is tough at first. By the end of the third set, my ankle was definately feeling it.
I had a realization over the past couple days. Initially, my thinking was along the lines of 'Hey - so these exercises are supposed to help stabilize my knee, but were talking about 45 iterations of an exercise per day. When I go out and run for an hour and I'm running with a cadence of 90 steps/minute - thats 5400 iterations. How would 45 iterations make any bit of a difference?'
Then I realized that if I'm doing 5400 iterations, and I'm feeling the burn (and in the case of the knee spreads on the right side, feeling sore the next couple days) after 3 sets of 15 of an isolation exercise - then I'm not getting a good workout for that muscle during that run. Plain and simple.
Friday, November 6, 2009
IT Band PT - November 2009
It's been a while since my last post. Thats because things have really slowed down due to the IT band, but here's a quick recap of the past 6-8 weeks:
- I decided to forego the marathon this year. At the time, it was mid-September, and I was still limited to just a few miles. That was six weeks into trying to treat the IT band with rest, and it wasn't helping much - so I didn't see how things would magically get better in the next four.
- I went to the doctor to confirm the diagnosis, and get started on a treatment plan. The doctor was able to isolate and feel the point of irritation/inflammation - which is nice because it was a definitive diagnosis, as opposed to being purely based on symptoms. Also, in feeling the left vs right IT band, she found that the left was definately tighter, although both were generally tight.
- Initial treatment would be going through a course of physical therapy. The doctor said that results can often be seen in 4-6 weeks. There was also the option of an injection at the point of irritation. I'm not sure whether it'd be a cortizone shot or something else - but it was generally agreed upon that the PT course should be tried first. The PT prescription would include a running evaluation in order to determine if there was any imbalance during the running stride, or core strength imbalance that might be a contributing factor.
The first day of PT started out with a massage of the area and general analysis of knee and kneecap operation and movement. The therapist found that my left knee cap does not move laterally inward as much as my right knee cap. Since the knee cap is attached to the IT band, it was another sign that all the connective tissue in that general area is fairly tight.
The first exercise was what I'll refer to as the 10:30 leg raises, where you lay on your back with your left toes pointed to the 10:30 position. With weights on the ankles (3 lbs to start off with), raise and lower the leg vertically about 18". Three sets of 10. I found that it didn't really start to burn at all until mostly through the second set. But at the end of the third set, the muscle was definately fatigued. I believe the purpose of this exercise is to strengthen the muscle that pulls inward on the kneecap.
Next was what I'll refer to as the 3:30 leg raises, where you lay on your unaffected side (in this case, my right side), with the legs stacked and the left toes pointed slightly downwards to the 3:30 position. With weights on the ankles (3 lbs again), raise and lower the leg about 18". However, instead of raising and lowering vertically, raise the leg up and back. Once again, it was at the end of the 3rd set of 10 that I felt the muscle was fatigued. The purpose of this exercise was to strengthen the some of the gluteus muscles that normally don't get isolated during normal activity (and thus it is common for them to be rather weak).
Next was a look at quad flexibility. I've generally been pretty good about stretching my quads, but I found I've been isolating the quad muscle, but not the quad connective tissue that makes up the hip flexor. For this stretch, she had me lay on a table with the left butt cheek hanging off the edge, and just let the left leg hang. Apparently the angle of the lower leg hangs around 70 degrees for most people, and I was closer to 50 degrees. So there is a bit of tightness there. For this stretch, I remained in that position, and with the aid of a loop of rope around the ankle, simply reach for the rope and pull back. Stretch for 30 seconds 3 times.
Lastly, there was the foam roller stretch. I had done my own version of this a few times using a piece of 4" PVC tube (her reaction was one of 'ouch! That must hurt!'), but I quickly found out that I need to do a LOT more of this stretch. When I was doing this on my own, I'd spend maybe a minute rolling it up and down the leg - she had me start with 5 minutes, specifically concentrating on areas that felt sore and tight as the roller moved along. I asked about the idea of using a hand-held roller, but she indicated that for this, you really want to get the body weight to help and get a good stretch. Speaking of body weight, I started off supporting a good portion my weight with my other leg - but I won't be surprised if by the end of things the stretch will be done with the legs stacked and for a longer period of time, like 10-15 minutes.
Since this was just the first PT session, things weren't turned up to 11 in terms of intensity. The therapist said that they introduce exercises gradually so that if there is lingering soreness or a problem, it can be more easily tracked down to a specific action, as opposed to throwing everything out all at once.
All of these exercises were assigned to be done at home, once per day. Actually, there was an additional one assigned - the standing leg crossover ITB stretch. That was to be done for 30 seconds 3 times per day.
- I decided to forego the marathon this year. At the time, it was mid-September, and I was still limited to just a few miles. That was six weeks into trying to treat the IT band with rest, and it wasn't helping much - so I didn't see how things would magically get better in the next four.
- I went to the doctor to confirm the diagnosis, and get started on a treatment plan. The doctor was able to isolate and feel the point of irritation/inflammation - which is nice because it was a definitive diagnosis, as opposed to being purely based on symptoms. Also, in feeling the left vs right IT band, she found that the left was definately tighter, although both were generally tight.
- Initial treatment would be going through a course of physical therapy. The doctor said that results can often be seen in 4-6 weeks. There was also the option of an injection at the point of irritation. I'm not sure whether it'd be a cortizone shot or something else - but it was generally agreed upon that the PT course should be tried first. The PT prescription would include a running evaluation in order to determine if there was any imbalance during the running stride, or core strength imbalance that might be a contributing factor.
The first day of PT started out with a massage of the area and general analysis of knee and kneecap operation and movement. The therapist found that my left knee cap does not move laterally inward as much as my right knee cap. Since the knee cap is attached to the IT band, it was another sign that all the connective tissue in that general area is fairly tight.
The first exercise was what I'll refer to as the 10:30 leg raises, where you lay on your back with your left toes pointed to the 10:30 position. With weights on the ankles (3 lbs to start off with), raise and lower the leg vertically about 18". Three sets of 10. I found that it didn't really start to burn at all until mostly through the second set. But at the end of the third set, the muscle was definately fatigued. I believe the purpose of this exercise is to strengthen the muscle that pulls inward on the kneecap.
Next was what I'll refer to as the 3:30 leg raises, where you lay on your unaffected side (in this case, my right side), with the legs stacked and the left toes pointed slightly downwards to the 3:30 position. With weights on the ankles (3 lbs again), raise and lower the leg about 18". However, instead of raising and lowering vertically, raise the leg up and back. Once again, it was at the end of the 3rd set of 10 that I felt the muscle was fatigued. The purpose of this exercise was to strengthen the some of the gluteus muscles that normally don't get isolated during normal activity (and thus it is common for them to be rather weak).
Next was a look at quad flexibility. I've generally been pretty good about stretching my quads, but I found I've been isolating the quad muscle, but not the quad connective tissue that makes up the hip flexor. For this stretch, she had me lay on a table with the left butt cheek hanging off the edge, and just let the left leg hang. Apparently the angle of the lower leg hangs around 70 degrees for most people, and I was closer to 50 degrees. So there is a bit of tightness there. For this stretch, I remained in that position, and with the aid of a loop of rope around the ankle, simply reach for the rope and pull back. Stretch for 30 seconds 3 times.
Lastly, there was the foam roller stretch. I had done my own version of this a few times using a piece of 4" PVC tube (her reaction was one of 'ouch! That must hurt!'), but I quickly found out that I need to do a LOT more of this stretch. When I was doing this on my own, I'd spend maybe a minute rolling it up and down the leg - she had me start with 5 minutes, specifically concentrating on areas that felt sore and tight as the roller moved along. I asked about the idea of using a hand-held roller, but she indicated that for this, you really want to get the body weight to help and get a good stretch. Speaking of body weight, I started off supporting a good portion my weight with my other leg - but I won't be surprised if by the end of things the stretch will be done with the legs stacked and for a longer period of time, like 10-15 minutes.
Since this was just the first PT session, things weren't turned up to 11 in terms of intensity. The therapist said that they introduce exercises gradually so that if there is lingering soreness or a problem, it can be more easily tracked down to a specific action, as opposed to throwing everything out all at once.
All of these exercises were assigned to be done at home, once per day. Actually, there was an additional one assigned - the standing leg crossover ITB stretch. That was to be done for 30 seconds 3 times per day.
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