First Time for Everything: PT

Hokas have been my shoe for 2 years. Lookout Mountain 50, #1 Master’s Female, December 2016. Ball of foot pain. Sport’s Doctor. Metatarsalgia in my left foot. I decided on Altras, wide toe box, zero drop, toes won’t cram together, less toe spring. Posterior Tibial Tendon irritation.  Back to Doctor. Back to Hokas. I decided KT taping for toe and tendon. I maintained my 45-60 mile weeks and dealt with the irritation. It was not crippling, just annoying and not going away. Gotta get relief. I decided to take 8 days off of running to ease my symptoms.  I decided to see a PT.

True confessions, my entire 14 years of running life (10 years on the road, 4 years on the trails):

1. I have had a massage, only twice in the past 2 years.
2. I have never “rolled” anything.
3. I have never visited a Physical Therapist (PT).
4. I am 44. (my readers know by now that I LOVE being this age, but that is a long time to go without the above)

My friend recommended Leah Sawyer  to me. Check out her creds:

• Stanford University- BA in Human Biology 2003-2007
• Duke University- Doctorate of Physical Therapy 2009-2012
• Certified Lymphedema Therapist (CLT)- certified since 2015
• CSCS (Certified Strength and Conditioning Specialist)- certified since 2009
• Trigger Point Dry Needling (basic and advanced levels)- certified since 2010
• Functional Movement Systems (FMS)- certified since 2012
• Astym Provider- certified since 2014

I had my first appointment last Wednesday. I arrived and Leah and I talked for a bit about the history of my injuries. She asked me to do several movements, i.e.. heel raises, squats, single leg squats, lunges, etc. She looked at my foot/tendon and asked some more questions. She took some measurements. Then, she went to work on my calf muscle, close the my Posterior Tibial Tendon. She performed Astym on the muscle of my calf. She also did Astym on the bottom of my left foot.

Astym treatment is a physical therapy treatment that regenerates healthy soft tissues (muscles, tendons, etc.), and eliminates or reduces unwanted scar tissue that may be causing pain or movement restrictions.

“What is Astym?”

“We use the analogy of spaghetti to explain the problem,” says Macias. “There are fibers in the muscle tissue that should be parallel to each other like spaghetti in a box so they all fit together and work together. When the muscles are overworked and injured, the body lays down scar tissue so the fibers lay down more haphazardly like cooked spaghetti and interrupt how the tissue can glide.”

-Nancy Maes, “Astym Treatment Heals Pain For The Active and Overweight”

A Few Questions for Leah:

1. How do you decide what treatment to give your patient (s)? Do you start with one therapy and progress to another, based on response? Or do specific injuries generally have a treatment they respond to best?

Treatment is completely individual, so I take into account a number of factors including the patient’s athletic goals, lifestyle goals, their whole body posture, flexibility, strength, etc. The severity and duration of the injury matter too. It’s a complicated algorithm and definitely a bit of a science and an art!

2. What is the easiest injury to treat? Quickest to heal?

No injury is necessarily “easy”. Everyone’s injury is important and significant to them, so I don’t necessary compare on injury to another. That being said, it is really fun to treat young athletes because they heal sooooo quickly and respond to exercise so rapidly. They are like little starfish! 

3. What is the hardest injury to treat? Longest to heal?

High hamstring injuries can be really nagging, take a lot of patience (for both the therapist AND the patient), and require very specific but incremental treatment. I’ve dealt with this myself, so I enjoy helping patients overcome hamstring issues but also know how frustrating it can be. 

4. Hardest ‘type’ of athlete to treat? Easiest athlete to treat?

I am a runner, I’ve been a runner my whole life, but we can be so stubborn and act as our own worse enemy! That being said, I truly enjoy treating runners. As a stereotype though, we can be difficult 🙂 Cross fitters can also be difficult as they tend to not want to rest. 

Easiest athlete…hard to say. Any athlete that prioritizes their long term performance and health over short term goals will do well. I can’t say this is specific to a sport, but to a personality type. I’ve had to learn to think this way myself over the years. 

5. As an athlete ages, does it take longer to heal? Do you change the form of treatment based on age?

It does, absolutely. I hate to admit it but our connective tissue changes with age and the time we take to heal, recover, strengthen, etc changes as well. They have done studies showing this with stretching specifically. Knowledge is power though- as long as one knowns what to expect, he or she can plan and modify accordingly. 

I always say that age is NOT a diagnosis! People don’t get injured because they are “old”. They don’t stay injured because they are “old”. The get or stay injured because they haven’t altered their training or recovery as needed. They can still reach very high goals, but need to go about it in a different way. 

6. Do men’s bodies and women’s bodies heal differently? Faster? Slower? (Does Testosterone influence how fast a person heals?)

It certainly can, but I’m not sure that I’ve seen this as an obvious contributor to recovery times. That being said, I tend to see certain injuries in men vs women. I think this is more a function of how we learn to move and/or what muscles we tend to strengthen. This predisposes us to certain injuries, but I don’t think that hormonal differences are the main component for these differences. 

7. Do you see a lot of athletes who over train? Can you tell?

Oh yeah. And I can tell. As a physical therapist, there are certain things that I KNOW should work and reduce a person’s symptoms. Even though I cannot predict that specific rate of improvement, I should be able to predict a round about recovery time. If a patient is performing their home exercises, coming to their appointments, and their symptoms are still not changing or they are getting worse, something else is going on. More often than not, it’s overtraining. 

Usually I can tell if a patient is an “overtrainer” or not right away. As physical therapists we treat the whole person, not just the body part, so I definitely alter my treatment and exercise prescription based on this.