Ask Coach E
Episode 10

Welcome message from Coach E 

I am recovering from plantar fasciitis and have been relying on squishy foam slippers for my recovery. My pain is greatly improved and I’m easing my way through the Foot and Ankle Solution for real recovery. I know reliance on orthotics is not good, but I’m looking for advice on how to transition off them. Straight to barefoot? Transition to a different shoe type? How can I ease away from these without shocking my feet.

I am an active 72 year old eg: 2x/week strength training, 2-3 mile walks a few times a week, pilates, yoga, recreational biking, ball room dancing. My body likes movement.

The past 3 years I have had greater trocanter pain syndrome; no trauma to area. Pain level a 6 of 10. Went to a physiatrist/sports med/non surgical ortho doc 3 years ago who diagnosed it as trocanter bursitis. Had 2 rounds of cortisone shots that lasted about 5 mos each. Been doing gluteal Maximus, medius, minimus exercises since this pain started to strengthen the gluteals. This summer I decided I needed to figure out what was causing the pain vs the cortisone shot since I still had the pain. My pain was a 6 of 10. The pain hindered my exercise routine & life & I wondered if I was aggravating the trocanter with the gluteal exercise so I backed off. Did PT, saw a chiro. Their manipulations worked for 7-10 days and then the pain started again.

In September, did a hip MRI that indicated:
-gluteus medius mild tendinosis & peritendinitis to the greater trocanter. Similar findings to a lesser degree noted for the gluteus minimus
-nondisplaced under surface tear of the anterior labrum
-intact hip joint. No acute or stress fracture or AVN.

I saw a different physiatrist/sports med/non surgical ortho doc since the MRI. She suggested shock therapy to heal the trocanter tendon insertion point for a minimum of 3 sessions, possibly 5 sessions. Also suggested PRP if the shock therapy did not work. And do PT.

So, my question is what do you recommend for me to do going forward? What exercises do you recommend? Other?

Thx

What do you recommend for “creaky” knees. I am 68 years old and have been doing ROM exercises and routines for about three years. I admit - I am not consistent with follow-through and finishing. I won’t be surprised if your advice is to stick with KPS consistently and thoroughly.

For example, I have the Knee Pain Solution but have not stuck with it — however, I use it to remedy knee pain (in the 4-5 range) going up and down stairs, with success (lowering pain to 0-1). I have used other routines (hip, warmup, neck, FML, strong for life). (Hip routines erased constant pain in the 6 range.) But the thing that always stops me on certain exercises is my CREAKY knees. They don’t grind, but creak loudly. And, yes, they hurt (4-5 range). Anything that involves lunges or squats is out of my reach. I tried the Squat 1 (I think that’s the name of it) and gave up due to the creaky pain. But it’s the LOUD creaking that really alarms me and makes me wonder if I should be pushing through or backing off. I really want to be able to do lunges and squats.

For background: When I was young (25) I was diagnosed with chondromlacia resulting from about 10 years of extreme running. At the doctor’s recommendation, I quit running. I have stayed pretty active (walking, Zumba) but not running.

GO JAYS!!!! I remember being a kid in elementary school in 92/93 and going bonkers. Doing the same with my own kids now is so cool.

Thanks for sharing your advice on the shoes! I had actually submitted a coach E question a month or so ago asking that very thing - what is your opinion on more minimal/barefoot inspired shoes - but I think I sent it through the wrong channels. I've been transitioning to minimal footwear for running and everyday use for over 6 months now and the difference in my foot strength and running form is incredible. I found I had a lot of tenderness in my intrinsic muscles and a bit of soreness in my achilles at the start. After completing the Strong Feet I, and II routines in ROM those issues have been dealt with. I never realized how previously unstable I was due to my high arches but weak foot muscles. I am feeling so springy and light on my feet for my runs, and no trace of the runner's knee I had after a half marathon in March. Calf strength is still a bit of an issue (see below) so I am avoiding long runs until I build up the strength. I am using the Altra Escalante Racer shoe for road running. I think it also checks all of the boxes you shared in your email.

Note: I still can't find where to submit the Ask Coach E questions. I must be missing something obvious, sorry.

I have a couple questions here, one that relates to above: I've been doing one-leg calf raises (heel drop off a step) several times a week recently, and maybe at least once weekly for months. However, I am not seeing much improvement. Still tiring out after 15 reps, and some soreness returns after long runs (in my left calf - could it be weak hip stabilizers?). I also use the foam roller. Any advice here? FYI I had strained my calves running in bad shoes before as well.

My other question is on strengthening the rotator cuff, specifically infraspinatus. I am working to correct posture issues, an overactive upper trap, and some limited range of motion in my shoulder (example: touching hands behind back). I've been doing the Upper Posture ROM routines, as well as the exercises in a youtube video you had for upper trap tension. However, wondering what routine or individual exercises might help with the rotator cuff specifically. So far I am trying horizontal external rotation against resistance with a band.

Thanks for any help you can give!

Andrew Galbraith

I am currently working on your Shoulder Resilience 3 exercises as I try to make a comeback from Rotator Cuff tendon tears. For the most part, I'm doing well trying to gain strength and range of motion. I have very limited external rotation and I can't do a pushup from my feet or from my knees. I can do pushups using rings attached to a door by adjusting my distance from the door. I don't think I'll ever do a Superman from a pushup position, so I do them from my knees. My right forearm never touches the wall on a Standing Robot or a Reverse Wall Slide but I get it as close as I can. I basically modify or do the best I can. I'm wondering what the next step would be after Resilience 3. I feel like I need to strengthen all the muscles around the torn ones in order to throw a baseball or swing a golf club. I included the results from my MRI. The doctors tell me it's too late to repair the cut tendons. Surprisingly, I have pretty good range of motion outside of external rotation. They say I'd probably have less range of motion with a shoulder replacement. After looking at the MRI results, I'm wondering if you have any suggestions.

Thank You!


COMPARISON: Right shoulder radiographs dated 02/22/2024.

RESULT:

TENDONS:
Rotator cuff tendons:
There are complete supraspinatus and infraspinatus tendon tears with tendon retraction to the glenoid neck.
There is subscapularis tendinosis without high-grade tear. The teres minor tendon is intact.
Biceps (Long head) Tendon: The intra-articular tendon is not well seen and likely chronically torn. The proximal extra-articular tendon is perched on the lesser tuberosity.

MUSCLES:
Rotator cuff muscles:
There is mild supraspinatus and moderate infraspinatus muscle fatty atrophy.

JOINTS:
Glenohumeral Joint:
-Labrum: Degeneration and tearing in the inferior labrum
-Cartilage: Diffuse tow-grade chondral thinning.
-Joint Fluid: There is a small joint effusion decompressing into the
bursa.
Acromioclavicular Joint: Moderate hypertrophic degenerative changes

BONES AND MARROW: No evidence of fracture or suspicious bone marrow replacing process
Localizer images: No additional findings.