Full Transcript for Case Study: Fixing Achilles Pain By Addressing The Hip ⎹ Ep 144

fun. 00:04:34.319 --> 00:04:38.399 But with this patient, he is training for a 100-mile error in October. 00:04:38.560 --> 00:04:50.079 He came to me with Achilles pain, and he had had this Achilles pain for two years, which I just feel like, you know, I my heart, I I feel for you when you've had pain for a long period of time. 00:04:50.319 --> 00:05:12.319 Because as you know, if you've had pain, like it not only affects your running, like, yes, the goal is to get back to pain-free running, but it's affecting everything in your life because if you can't run, you can't do the things you want to do that maybe help you mentally relieve stress, it improves your physical health, like you're just potentially a different person, and potentially, you know, it's affecting your mindset. 00:05:12.560 --> 00:05:14.639 So I totally feel for this person. 00:05:14.879 --> 00:05:26.079 And when I came to working with him, he said he saw a PT, and this is no shade to PT, you know, as a PT out of school, we are trained to reduce pain. 00:05:26.240 --> 00:05:39.120 But the problem is, and this is the problem with a lot of PTs, is that reducing pain and then getting back to high impact endurance running are really like two different things. 00:05:39.279 --> 00:05:51.439 Like it's okay if you know, PT, you see a PT reduce your pain and you might feel a little bit better going through exercises, but once you start increasing your mileage and the pain comes back, that can be really, really frustrating. 00:05:51.600 --> 00:06:01.279 And that's when those running specific rehab exercises can really come into play because you have to prepare your body and rehab to the demands of running. 00:06:01.439 --> 00:06:02.000 You have to. 00:06:02.160 --> 00:06:02.639 You have to. 00:06:02.720 --> 00:06:04.639 If you're an endurance runner, you have to. 00:06:04.800 --> 00:06:16.160 Otherwise, you're gonna keep going into this cycle of okay, I do my exercises, I rest from running a little bit, I feel better, and then I increase my endurance, and then I'm back in that cycle. 00:06:16.319 --> 00:06:19.920 And that cycle, it can be really hard to escape that cycle. 00:06:20.240 --> 00:06:24.160 So this patient was doing a ton of calf raises. 00:06:24.480 --> 00:06:25.199 Oh my gosh. 00:06:25.360 --> 00:06:28.639 Like, probably more calf raises than most of us could do in a row. 00:06:28.800 --> 00:06:30.000 Weighted calf raises. 00:06:30.160 --> 00:06:35.920 I mean, his calves were strong, and I was like, all right, let's just like lay it all out on the table. 00:06:36.000 --> 00:06:43.279 And I said, I'm just gonna tell you, I don't think that you need to keep strengthening your calves to reduce your pain. 00:06:43.439 --> 00:06:49.680 Now, there is nothing, you know, continue strengthening your calves because you need strong calves, especially with the 100 miler. 00:06:49.839 --> 00:06:58.160 But let's go a different route and let's, you know, stop blaming calf weakness on your pain, because clearly that is not the issue. 00:06:58.319 --> 00:07:10.079 Now, when I did his assessment, I looked at his running form, it was pretty uh like I would say pretty obvious to me that something was happening at the low back and the hip. 00:07:10.240 --> 00:07:16.639 And this is where Achilles tendoninus, Achilles tendinopathy can get a little tricky to treat. 00:07:16.800 --> 00:07:23.120 Now, I will say, like, your first route, if you have Achilles pain, should be addressing the Achilles. 00:07:23.199 --> 00:07:26.639 It should be addressing like calf strength, pliometrics. 00:07:26.800 --> 00:07:44.079 Your Achilles is a spring when you're running, so you really want to work on how you absorb shock, how you uh the power that comes from your Achilles, like there is nothing wrong with treating that as your first, I guess, like plan, your first like idea of what to focus on. 00:07:44.399 --> 00:07:54.720 But when you've gone through that, and then you don't see any relief with that type of plan, it's like, all right, let's do something different. 00:07:55.040 --> 00:08:00.319 Because as my mom always says, insanity, what did she used to say? 00:08:00.560 --> 00:08:05.519 The definition of insanity is doing the same thing over and over again and expecting different results. 00:08:05.680 --> 00:08:08.399 And I kind of felt like that's where he was at. 00:08:08.720 --> 00:08:15.680 So when I looked at his running form, I did his assessment, I really saw something going on with the low back in the hip. 00:08:15.839 --> 00:08:22.720 And just to summarize exactly what I saw, less hip mobility into extension. 00:08:22.800 --> 00:08:28.879 So as he was pushing off the ground, it was very evident that his hip was super tight on that side. 00:08:29.040 --> 00:08:32.639 Now he had Achilles pain on both sides, it was just worse on one side. 00:08:32.799 --> 00:08:46.639 So both hips were like really tight, and because of this, and the way I can see this with the running form is really from the side view, I'm looking at how far back the knee is in relationship to the hip. 00:08:46.799 --> 00:08:52.080 So ideally, when you have really good hip extension, then the knee is behind the hip. 00:08:52.240 --> 00:09:00.480 And the other caveat to this is that the low back or the lumbar spine is stabilizing really well in a neutral position. 00:09:00.879 --> 00:09:23.919 Now, when the hip is really tight and maybe the knee isn't as far back, or it looks like it's far back, but the low back is now into this excessive anterior pelvic tilt or hyperextension position, it's almost like the think of it as like the low back is making up for that lack of movement at the hip. 00:09:24.159 --> 00:09:36.320 And when this happens, all of this, you know, like all of this to say the glutes, the glute contraction and a hip extension, and the hamstring contraction and a hip extension are not gonna be as strong. 00:09:36.559 --> 00:09:41.360 And when that happens too, it's

kind of it's just like a cascade of events. 00:09:41.600 --> 00:09:46.720 When that happens, you are more likely to be pushing off the ground through your low back. 00:09:46.799 --> 00:09:53.039 So maybe you can imagine that where you're almost like sticking your belly and your chest out and kind of like pushing through your low back. 00:09:53.120 --> 00:10:02.000 And now it looks like you're into more hip extension because your brain is really smart and it can find a way to compensate without you even realizing it. 00:10:02.320 --> 00:10:08.799 And when you're pushing through your low back, as you're pushing off the ground, you're more likely to over stride. 00:10:08.879 --> 00:10:16.639 And when you're more likely to overstride, it increases the force through your lower extremity, which can definitely contribute to this Achilles pain. 00:10:16.799 --> 00:10:35.360 Now, it's also in the research to definitely check on hip extension when you're running because lack of hip extension, lack of hip extension strength, so mobility, stability, and strength can put more force into or load into that Achilles tenon. 00:10:35.440 --> 00:10:42.879 Because at the end of the day, really like all these overuse injuries, the tendinitis, the tendinopathies, it's a game of load. 00:10:42.960 --> 00:10:49.600 And I tell my one-on-one clients this all the time where it's okay, why is there more load going into this area? 00:10:49.919 --> 00:10:51.679 Is it because the calf is weak? 00:10:51.840 --> 00:10:52.639 Well, clearly not. 00:10:52.799 --> 00:10:53.840 We can kind of check that off. 00:10:53.919 --> 00:10:56.080 He was doing like a hundred calf raises in a row. 00:10:56.320 --> 00:10:57.279 Is it okay? 00:10:57.360 --> 00:11:01.039 Let's look like elsewhere outside of the foot and ankle. 00:11:01.440 --> 00:11:17.360 Is it because of lack of hip extension, pushing through the low back, leading into an overstride, plus his trunk positions off, his pelvis positions off, and that's gonna change the center of mass when he's running, and therefore the load into the Achilles tendon when he's running. 00:11:17.519 --> 00:11:29.679 And yeah, I saw that and I was like, all right, you know, a lot of like the the plan the PT takes, as much as you know, if you're listening to this, hopefully you like my approach. 00:11:29.919 --> 00:11:35.679 But a lot of the plan that a PT takes is it's a guess, it's a it's trial and error. 00:11:35.840 --> 00:11:50.480 Let's let's go down this path because I've seen this pattern before, and I've been able to address this pattern before with someone that had the same exact, you know, type of pain that you've had, and they responded well to this. 00:11:50.559 --> 00:11:51.759 So let's try it again. 00:11:51.919 --> 00:12:04.080 So I'm basing my plan off of experience and research, and but I'm telling him, hey, I really want to address this because I think this could be why you're having a lot of pain. 00:12:04.320 --> 00:12:06.879 And it's really like, let's give it two weeks. 00:12:07.039 --> 00:12:14.960 I'm not expecting him to be pain-free in two weeks, but let's give it two weeks of really like addressing the hip, addressing the low back. 00:12:15.200 --> 00:12:20.879 So what his rehab plan looked like was I worked on stabilizing through the low back. 00:12:21.120 --> 00:12:37.440 So a lot of like um, I hate to say like stability exercises, but focusing on like rotational work, focusing on anti-rotational work, focusing on maintaining a neutral spine while his hip worked into hip extension, because that's pretty much where he lacked. 00:12:37.600 --> 00:12:46.240 Because again, he was like chucking his pelvis forward into this like excessive anterior pelvic tilt anytime his hip looked like it was going into hip extension. 00:12:46.399 --> 00:12:47.440 So we worked a lot on that. 00:12:47.519 --> 00:12:55.919 We worked on opening up the hip into hip extension, we worked on getting those glutes firing through this new range of motion because we worked on the mobility of the hip. 00:12:56.159 --> 00:12:59.440 And after two weeks, he was like, Yeah, I'm starting to feel a lot better. 00:12:59.600 --> 00:13:04.559 Like it was, and again, I was like, listen, you're not gonna be pain-free in two weeks. 00:13:04.720 --> 00:13:11.679 I just want to make sure that we are seeing some sort of small win with your rehab and your pain. 00:13:11.759 --> 00:13:21.840 And that could mean, okay, like my pain would only come on for two minutes at the start of the run, and then I felt good because before it was like 10 minutes. 00:13:22.080 --> 00:13:31.279 So any sort of like small reduction in pain, or you're starting to feel like you have more control of this area, that can be a small win too. 00:13:31.360 --> 00:13:40.639 And I really encourage like anyone who's going through an injury, look for those small wins because it's kind of like seeing the light at the end of the tunnel. 00:13:40.799 --> 00:13:43.840 You're starting to see just a glimpse of hope. 00:13:44.000 --> 00:13:50.320 You're starting to get a little bit stronger, you're starting to feel like you're addressing the source of the pain. 00:13:50.559 --> 00:13:56.000 And when you can start to see that, your mindset starts to shift. 00:13:56.080 --> 00:14:00.159 Like, okay, I'm starting to realize like I'm feeling a little bit better. 00:14:00.399 --> 00:14:06.879 And I I that's like a huge mindset shift versus, oh, well, I still can't run 10 miles in a row. 00:14:07.039 --> 00:14:16.559 And it's like, okay, you can probably see the difference in like the attitude from okay, I'm starting to like feel a little bit better and like a little bit more optimistic. 00:14:16.879 --> 00:14:23.039 Or, you know, I've I've also dealt with the runner who's like, well, I still I'm I'm not at my 40 mile week. 00:14:23.200 --> 00:14:29.759 And it's like, all right, I got let's reframe mentally where we're at because I'm kind of going off on a

tangent. 00:14:29.919 --> 00:14:45.919 But like if you're not able to change your mindset around rehab and your injury when you start to get on the right plan, when you're starting to see some sort of progress, then you're just gonna continue to be disappointed and it's just gonna continue to affect your mental health. 00:14:46.080 --> 00:14:53.919 And I think it's really important too because it's also gonna delay your healing because a lot of rehab is like what is happening in your brain too. 00:14:54.080 --> 00:14:56.480 But, anyways, back on track. 00:14:56.720 --> 00:14:58.639 We worked a lot on the hip extension. 00:14:58.720 --> 00:15:04.399 I also worked a lot on his pronation, being able to control pronation, being able to control supination. 00:15:04.720 --> 00:15:10.559 And the way I explained it was hey, like your soleus is strong, your your gastroc is strong, clearly. 00:15:10.720 --> 00:15:14.320 Like you're doing way more calf raises than like any other runner I know. 00:15:14.960 --> 00:15:29.200 But if he is not able to control pronation and supination, so as his foot, and those are essential pieces of the gait cycle, absorbing the shock, pushing off you know, the ground. 00:15:29.360 --> 00:15:31.679 We need to pronate, we need to supinate. 00:15:31.840 --> 00:15:42.960 If he's not able to do that, whether he's stuck into supination or he is excessively rolling into over pronation, I want you to think of it, and I gave him this analogy. 00:15:43.279 --> 00:15:48.879 I want you to think of it as you're shooting a cannon off of a canoe. 00:15:49.039 --> 00:15:57.440 So you can probably imagine I have all this load, I have all this power, and I'm trying to propel myself forward. 00:15:57.759 --> 00:16:08.720 But as you imagine shooting a cannon off of a canoe, I shoot it off, and all of a sudden that canoe is rocking excessively left and right. 00:16:08.879 --> 00:16:10.159 And it's the same idea. 00:16:10.240 --> 00:16:16.559 If you don't have that foot and ankle stability, then it doesn't really matter how strong your calves are. 00:16:16.720 --> 00:16:18.080 So we worked on that as well. 00:16:18.159 --> 00:16:23.679 So I don't want you thinking we only I neglected the foot and ankle and we only worked on the hip. 00:16:24.000 --> 00:16:24.480 Nope. 00:16:24.639 --> 00:16:30.399 We worked on, you know, a lot of things that I thought were contributing to his Achilles pain. 00:16:30.559 --> 00:16:37.279 So we are six weeks into rehab, one-on-one rehab, and he is not having any pain. 00:16:37.600 --> 00:16:43.759 He is actually about to run next week a 50 miler, and then he's running a hundred miler next month. 00:16:43.919 --> 00:16:44.799 So pretty cool. 00:16:44.879 --> 00:16:54.559 So it's all to say we when you're in rehab, you've rehabbed something, you feel like you're just gonna be stuck with this pain forever, you've addressed the area that is painful. 00:16:54.799 --> 00:16:56.000 One, do not give up. 00:16:56.159 --> 00:16:58.639 You might just need a second opinion into what's going on. 00:16:58.799 --> 00:17:07.759 You might need someone to look at the whole picture versus just the one little piece or one little part of the body that's injured. 00:17:08.000 --> 00:17:12.400 Um, and just don't think you have to live with this pain forever. 00:17:12.559 --> 00:17:15.599 All right, that concludes today today's episode. 00:17:15.839 --> 00:17:21.920 I don't want you to forget about the Labor Day sale because again, this is like the biggest sale I've had and will have this year. 00:17:22.079 --> 00:17:26.480 So$30 off any of my signature programs from Friday to Monday. 00:17:26.640 --> 00:17:29.599 So after Monday, it's done. 00:17:29.680 --> 00:17:34.400 So make sure you jump on that if you are interested in any of my programs, and I'll talk to you soon. 00:17:34.480 --> 00:17:34.880 Bye.