Ask a physical therapist

SkierPT

SkierPT

Active member
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 !
 
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
 
14552181:Dlonetti said:
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
Click to expand...

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!
 
14552174:steez_apprentice said:
what's the best way to prepare for the ski season/recover properly between days, and what do you typically suggest for shin pain?
Click to expand...

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!
 
14552201:SkierPT said:
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!
Click to expand...

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!
 
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?
 
14552198:SkierPT said:
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!
Click to expand...

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
 
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
 
Any way to reduce ACL related swelling faster after activity? This will be my first winter back after surgery last september.
 
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?
 
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?
 
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.
 
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?
 
14552223:saucemastrscotty said:
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?
Click to expand...

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==
 
14552235:BIIIGZ said:
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
Click to expand...

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==
 
14552260:Loodwik said:
Any way to reduce ACL related swelling faster after activity? This will be my first winter back after surgery last september.
Click to expand...

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.
 
14552262:SamuelForsgren said:
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?
Click to expand...

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.
 
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?
 
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?
 
14552330:_jam0__ said:
What are your thoughts on knees over toes?
Click to expand...

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.
 
14552321:Liam_j10 said:
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?
Click to expand...

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!
 
14552311:b0ss said:
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?
Click to expand...

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.
 
14552824:-eREKTion- said:
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?
Click to expand...

Seek another opinion. You might benefit from some aquatic therapy and exercise. Lower impact but still allows squats, lunges, etc etc
 
14553183:No-Skill-Phil said:
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?
Click to expand...

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==
 
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?
 
14555251:ajbski said:
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?
Click to expand...

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

absolute rest is generally the worse thing you want, even with injury!
 
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)
 
14556156:AlwaysGrabBlunt said:
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)
Click to expand...

Do you use custom footbeds/ heel lifts in your boots?
 
14556160:AlwaysGrabBlunt said:
I just have boot doc inserts. Nothing custom
Click to expand...

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

also check your ankle mobility and strength !
 
14556151:SkierPT said:
How’s it going after a few days since this post?

absolute rest is generally the worse thing you want, even with injury!
Click to expand...

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.
 
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.
 
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.
 
14556729:Amnolan4 said:
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.
Click to expand...

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.
 
14556732:Getshifty said:
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.
Click to expand...

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.
 
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.
 
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
 
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