Sorry to hear about your knee. There are a lot of variables in these cases, and there is no substitute for getting a good PT to assess you thoroughly. There are some points of advice I can give you, but please understand they are quite limited in their specificity. An uncomplicated LCL strain (i.e. no other tissues were injured like meniscus, joint cartilage, or other ligaments) will typically be healing well at the 3 week mark, and at 6-8 weeks should be functioning pretty well. Exercise and activity will help it heal and prevent on-going problems. A common sense approach would be to ease into activity and progress it at a pace that your body can adjust to. With a hinge brace on, performing activity without any twisting or cutting should be pretty safe. If your knee is swollen in the joint, it’s a sign that you shouldn’t be performing a lot of weight bearing exercise, and you should get it checked out.
The bike and stair stepper are where you should start. Running on even ground is more impactful, but if you do well at the other activities and ease your way into it, you should be good. Be sure to avoid uneven, slippery or too soft ground. Come into this gradually. You may want to knock out 45 minutes or more to get a good cardio workout, but you should establish your knee tolerance to exercise first.
It will pay to gradually blend in some agility and wean off the brace through the 4-8 week timeframe. Like I touched on, having a PT guide and oversee this will be your best bet to returning to normal activity.
We do not have any therapists specifically trained in NDT. However, our therapists are highly trained and likely would still be able to help you, depending on your specific concerns. Because your injury was so long ago, you may have more orthopedic centered things for which a Results PT would be best for you, especially if it is pain in your ankle or foot. You are welcome to schedule a free 15-20 minute screening at one of our clinics to see if the therapists think it is something they could handle with their extensive orthopedic training or if you are still in need of seeing a neuro specialist.
Your question is quite simple of the face of it, but a clear answer can be quite elusive. Some key questions would involve the circumstances around the injury. Would an emergency relocation be considered ‘physical therapy’, what is the best clinical pathway to take to help/ protect the patient, and what are the risks to the physical therapist?
When it comes to practicing PT in an emergency situation, most state practice acts have a provision for being able to treat a person without a referral.
In terms of the clinical decision to relocate, this is a judgment call based on the training and experience of the PT and what other emergent care is available. Someone who has been trained as a first responder or an ATC may have a better understanding of the risks. A PT who has been trained in sports coverage could be an excellent source for emergency injury management. The key clinical decision is do I attempt to relocate, or do I wait for an ambulance/ ER physician perhaps with the benefit of an X-ray. The concern can be a Hills-Sachs lesion, other fractures, neural or vascular injury, etc.
In terms of the legal risk, some states have a ‘good samaritan’ law where if you are trying to help someone in good faith (and are not getting paid for your services), it helps protect you from malpractice/ damages claims.
I suppose it comes down to weighing up your skills and experience with what help is available and the needs of the injured person.
With back braces, the commonality amongst them is that they bind around your lower trunk, provide some mechanical support, and provide some feedback for the joints and tissue of your back. There may be some with lighter and more breathable material, but each of them will likely get pretty sweaty if you’re active in the heat.
From a physical therapy perspective, back braces can be helpful in an interim basis but will not be a solution for your lower back pain. What will be more likely to resolve your pain and spasms will be to get your back moving better. When you have had an episode of pain in your back, your body has a strategy of bracing and limiting movement. Often, this strategy continues even after the pain eases, and it typically will make the pain and spasm more likely to occur going forward. It can be quite disabling, even when the underlying issues in the back are not serious.
I feel my best advice for you is to seek out a good PT with orthopedic or manual therapy specialization and credentials. They should be able to mobilize your back, get your muscles working more appropriately around your spine, and above all, give you fluidity and confidence with movement. It may be that something like a brace or strapping may be helpful on an interim basis while you are learning to move better or if you are especially more active than normal. The goal of anything that limits or restricts movement should always be to progress out of it when the body is ready.
It may take some work on your behalf to get there. It may feel like putting on a brace is an easy solution, but good PT is very likely the best way moving forward for you to manage your back.
I have to include the caveat that without doing a detailed assessment of your back, it is difficult to give clear and accurate direction and advice. I have seen many patients with a similar situation that have done great with PT. If you look up ‘find a PT’ on apta.org you may be able to connect with a good physical therapist.
What you are describing sounds consistent with ‘Runner’s knee’, although that description includes a lot of different tissues and prognoses. A thorough PT exam would clarify much about what you’re dealing with, and it would help chart a pathway to recovery for you.
From what you have described, the fact that you have pain just after running and that it goes away, this indicates that on the scale of severity of an overuse injury, you are on the lower end. This is good. It can give you more leeway in keeping active during your recovery. I would strongly encourage you to seek a good physical therapist, ideally one with qualifications and a specialty in manual therapy, musculo-skeletal, or orthopedic PT. A PT who specializes in runners may also be good to seek out.
Common sources for anterior knee pain are your patellar tendon, your infra-patellar fat pad, one or more of the many bursae around the knee being inflamed, soft tissue around the knee, and quite a few more. Quite often, the specific tissue causing the pain may be unclear, but the underlying causes come down to a few factors:
The good news is that especially if you’ve caught it early enough, anterior knee pain usually responds quite well to good PT. X-rays, other imaging, and specialist physician visits are typically not recommended as a front-line intervention. I would love to set you up in one of our clinics.
It sounds like what you are experiencing is related to the nerve control of your leg muscles. Normally, there is a constant stream of nerve messages going to and from your muscles, and your central nervous system is able to adjust and react to physical demands without you needing to be consciously aware of the process. Sometimes, there can be a change in the quality of this process. Having an injury and being in acute pain are some of the things that may cause this.
What you have experienced doesn’t seem to be an overt injury, but being really sore for a week could be enough to set this in motion.
The good news is that you can regain normal position awareness in your legs. Working on your balance is a good idea, such as heel to toe walking, grapevine walking, 1-leg balancing, etc. Be sure to take care that you don’t hurt yourself. Start slow and deliberate. Easing into exercising more gradually will be sensible as well.
Keep in mind, I am quite limited in my ability to offer clear advice without performing a thorough evaluation. If I’m right about this, you should improve quite quickly. If this persists or worsens, I urge you to get medically evaluated.
I have to express first that without taking a detailed look at you, it is hard to sift through all of the potential variables and contributors to your symptoms. Any advice I give you is limited by this fact. There is no substitute for having a skilled physiotherapist look at you. It is possible your big toe pain is referred down from your anterior tibialis muscle, or even a nerve (like your deep peroneal nerve). I suspect it is more likely that it is the MTP joint (or the knuckle joint) of your toe. The stretch you’re describing puts a lot of pressure on that joint, perhaps a lot more than when you manually push on it.
If it is the 1st MTP joint, it would often be a big thickened around the joint line (a bit swollen and perhaps the bones being a bit more prominent), a bit tender around the joint line, and perhaps bent in towards your 2nd toe. If you have none of these things, it doesn’t rule out a MTP problem, but it may indicate something else happening.
A problem like gout can’t be ruled out either, although the flare ups are often more related to eating and drinking habits.
You are on the right track to work on the mobility of your ankle and leg. There may be a few more factors involved, like the strength and control of the muscles that operate around your foot- especially your ‘intrinsic’ muscles of your foot and the muscles that twist your foot in and out. Physiotherapy prevailing wisdom has moved on a little from looking at foot posture (as in flat foot vs. high arch) as the key to foot problems. Many people with high and low arches have no problems. With all that, if you have a high arch, it may make it more likely for your mid-foot to be stiff, for your big toe to have mobility forced upon it, and for you to get tight down the outside of your lower leg. You can’t change your posture, but the right combination of working on your whole leg strength and control, using strategies like appropriate rest, footwear, strapping or taping of your foot, or orthotics to even the load through your foot could give you some relief. Very often, you compensate due to the pain and that asymmetry with your movement can perpetuate the problem.
I would suggest you seek a physiotherapist out to work out what you need. There is a good chance you can get this settled down and return to normal activity.
I have to recognize that I’m quite limited in my ability to give helpful feedback through this kind of forum because of all of the complexities and variables that exist within each individual’s circumstance. If I had the benefit of a thorough evaluation, it would be much easier to give you specific help based on your needs. I will do my best to apply some general principles that may help.
Firstly, great work in your drive to help yourself. It’s frustrating that you have experienced this setback with your back pain. It is likely that fatigue of your extensors is playing a strong part in your symptoms, but it may not be as simple as getting them strong. It is possible that your extensors are overactive due to excessive strain where continued weight loss will be very helpful. In the short term, if your hips and trunk are more stable (gluteal and abdominal strength), and if your back isn’t fighting against stiffness in your hips and thoracic spine, your extensors may be able to relax and function more normally.
Quite often there are strong elements of excessive and unconscious guarding of the extensors. We see this with people who have fear and anxiety built up around their back, and through no fault of their own, their back muscles remain locked up. Such people often hold their breath when they move, and they don’t trust their spine. Many of them have been given information on degeneration, and arthritis that makes them feel their spine is fragile. This can be the key thing that drives someone’s pain.
In your circumstance, it is very likely a combination of these factors. My best advice is to have a good physical therapist assess and understand all of these variables and map out a road to recovery for you. Slowly working on progressing your standing and walking endurance is a good idea. Not pushing past your endurance too much, but challenging yourself is a good premise. It sounds to me like it is more complex than gaining endurance with your back muscles. Like I touched on before, if your hip mobility and thoracic mobility (particularly the ability to stand up straight) are limited, your hips and pelvis rock and tip a lot while walking, and your muscles don’t control the position of your spine very well, this will cause a lot of load on your back muscles.
Your pain is unlikely to be a warning of significant damage in your spine. The symptoms you feel don’t sound like classic DOMS, as you don’t have normal muscle activity and tone there.
To understand the interplay between all these variables and to have a staged program of exercise and intervention, you will likely need some expert help. I would expect any such program would include continued weight management, gluteal strengthening, developing control of pelvic ‘tilt’, and perhaps some manual therapy to help unlock these muscles.
Most people take a while to recover from ACL reconstruction, but what you’ve gone through is not normal. That’s not to say that you can’t recover good function with your knee. The longer you deal with pain and a lack of mobility, the more complex it is to recover from it. However, I’ve seen several examples of great outcomes without having to get more surgery.
One thing is definite- to have a good outcome, you will have to go through a process of regaining mobility, strength, and good movement patterns, with or without surgery.
If you are getting a lot of swelling at the times when it stiffens, that tends to indicate there is something inside the joint (meniscus lesion, a cartilage problem) that is affecting you. A lot of other things like the knee cap, tendons, fat pad, bursae, hip and ankle mobility, and soft tissue flexibility have big influences on knee pain and mobility. Knees often respond great to conservative treatment. Even cartilage and meniscal problems are not one-way-tickets to the operating room. The fact that you have near full mobility at times is a good sign.
What I would suggest is a thorough PT exam to clarify if it seems like scar tissue or a meniscal problem, or if there are other joint or muscular issues influencing your knee. It is wise to have a genuine trial of conservative treatment (as in skilled PT) before considering something invasive like further surgery.
Pain in that area could be from a number of things, and I’d have to do a detailed exam to clarify this. One of the more common reasons for these symptoms is plantar fasciitis. Depending on age, health, activity level and a whole host of other variables, heel pad syndrome, stress fractures, referred pain from the lumbar spine, nerve entrapment syndromes, and referred pain from muscles in the foot and calf are all possibilities too.
If it is plantar fasciitis, and if it has been present for a while, it can be a very stubborn thing. I would strongly suggest getting a physical therapist to take a look at your family member. I would love to direct you into one of our clinics. I’m not sure precisely how far you (or your family member) would be from one, but it would be worth the trip if at all possible.
Not all PT is the same. Having someone with specialist credentials in manual therapy, orthopedics, or a fellowship will be preferable. At Results, we have mandatory training in diagnosis, manual therapy, and injury management. You can seek out good PT’s through the apta.org website “find a PT”, if you are too far from us. Here is a link to our clinics: https://resultspt.com/north-carolina
In the meantime, there are a lot of things that can be helpful. Unfortunately, there is so much difference in foot type that there is no recipe for recovery. Some examples of what could help: calf and ankle stretching, wearing supportive and well-fitting shoes, performing foot strengthening exercises (‘short foot’ or ‘toe yoga’ are examples), night-time stretching boots, ice massage (rolling a frozen water bottle under the foot), weight loss (is pretty hard to exercise for weight loss with a sore foot, but if weight is a problem, it is very likely involved), massage to the calf and arch, supportive strapping (hard to do if you haven’t been trained), and more. The tough part is that you get into bad habits with limping that reinforce the problem.