Calf problems from posture: #01 Open Clinic

I went to the Moti running shop hoping for a recommendation for a physio to assess some problems with my calf. Lucky for me, John walked through the door at that moment and offered me a free assessment. With pause only to make a vital cup of tea, we got to work. John walked me through the issues with my body, step by logical step, gradually revealing a complete picture which I feel he knew practically from the start. Neither of my feet land in a straight line down from the knee. The two legs are different, with the right (where I have the calf issues) worse than the left. My right side is weaker than the left in certain areas: lifting the knee up towards the chest, and pushing down around the big toe. John traced these issues to the L2 and L5 vertebrae in my lumbar spine, and demonstrated that these were more tender than the others. Overall, I’m no longer surprised that I am having problems running! Whilst there is a considerable list of problems with the posture of my body, having them pointed out with such clarity has given me genuine optimism that something can be done about them. I hope that optimism is well founded.

My 10k Journey #01

I’ve never considered myself a ‘proper’ runner, but in my time I have managed to plod my way round a few 10k routes. Plod is very much the right word. Running has never felt effortless or easy, but rather something I’ve managed to just about conquer.

bridge-runner

That was until the 2015 Bristol 10k, where I was in such horrible pain and discomfort that I decided I really wasn’t a runner and so vowed never to run again. At several parts during the run I had to stop running and was reduced to an awful whimpering hobble, all the while clutching at the root of the pain, my left hip. After a little bit of walking the pain would subside enough for me to run another couple of kilometres before having to repeat the same whimper-hobble-hip hold.

To be fair, I really shouldn’t be too harsh on the Bristol 10k. My hip pain wasn’t it’s fault. It had been there though the other 10k events I’d done that year, steadily getting worse with each run, but then all too quickly forgotten in that post-run euphoria. Giving up running seemed to be the most obvious way to eradicate the pain. And it worked! For a while. Over the past six months the pain has returned when I’ve tried everyday things that never caused me any issues previously – walking moderate distances, gardening, even simply sitting sometimes left me with that all too familiar dull ache in my hip.

Determined to face my nemesis once again, I have signed up for the 2017 Bristol 10k and I want to do it without hobbling. In fact, I want to be able to walk, sit or just generally exist without that nagging pain. I’ve decided to be sensible and grown up this time around and rather than taking the ‘doing more exercise will surely make it better’ approach I’ve decided to get the problem sorted properly.

And so it was that I found myself in John’s clinic last week. After a few questions about my general health, activity and mobility he had me skipping with an imaginary rope to see how each of my legs performed. (At this point I should also mention that I purposely went for a very long walk the day before to make my hip bad – though I really needn’t have bothered as John was able to pinpoint the cause of the problem pretty quickly anyway). It came as no great surprise to me that my left leg didn’t feel anywhere near as stable as my right. Onto the couch and again my left leg continued to be the poor relation when it came to mobility and strength. The most fascinating part for me was seeing how much weaker my left big toe was than my right – it was as if I had absolutely no control over it!

As the consultation continued it became clear that the problem was not actually in the hip itself, but rather in my back, which was causing me to compensate through other parts of my body and thus causing the pain in my hip. John then taught me how to stand properly. At 34 years old, I have finally learned how to stand in a way that doesn’t cause my back to ache – how have I never worked this out for myself?! John also did a little bit of cracking of my back, which led to an immediate improvement in the mobility and strength of my left leg. Clever stuff.

My homework for the week was to practise standing properly. Apparently I tend to stand ‘like a ballerina’, which might look great but actually does nothing good for my back and shoulders. So this week I have been learning to stand like a ski-jumper. I’m delighted to say it’s definitely making a difference. My hip hasn’t been achy, and I’m far more aware of how I’m holding myself and definitely feel less tension in my shoulders. I know this is only the first part of correcting a lifetime of bad habits, but I’m already encouraged by the results.

Knees – not just getting old? #28 – postscript A: other treatment, workstation revisit

It’s been nearly 3 months since my “final” blog re Physio John’s treatment. Since then I have been seeing an orthotics specialist.  As well as giving me further specific exercises to do to help re-train both my running and walking gaits, he has had me gradually reduce the height of the insole worn in my left shoe for the past 6½ years, down from 11-12 mm to a current height of just 3mm, and which in a few more days can be reduced down to nothing!  This has been aided by learning to use my glutes and piriformis muscles much more properly, and getting them firing better.

There have been almost no “transition” issues as the insole heights were reduced – none in the neck area , where I had a lot of pains for years (before starting to wear the original insoles in 2010), and just some soreness in a muscle in the middle of the shoulder blade of the opposite arm, which might not even have been related to the insoles reductions, as it could have just been that I pulled something. In any case, that has cleared up now also.

Over the course of appointments spaced about 1 month apart, the orthotics specialist has gradually concluded that even though I was turning out to be a model patient, and we were making big advances towards much better walking and running posture, I might still have to wear an orthotic insole. Whereas “normal” insoles are “even” from the left to the right side as you look from behind , orthotic insoles are slanted, either one way or the other.  In my case this needs to have the extra height on the inside of the foot – near the arch etc – and reducing down to nothing on the outside.  I had been wondering several months ago about whether something like this might be needed, when I was having the more serious issues at that time with the knee.  The orthotics specialist made up a “quick and dirty” jury-rigged orthotic lift for me, which I have worn in all footwear since the first week in June, changing it over from one left shoe to another as I did varying activities etc.

On the plus side, both my walking and running gaits have ended up with a much longer stride than before. They were each always unnaturally short, and I didn’t know why until now.  I just wasn’t using my body’s equipment properly.  After resuming full running a few months ago, with the improved techniques and gait, I found that the time it was taking to run the same 4-mile course, came down from about 40 min to just 36 min on the last run taken, which was around the middle of June.

On the minus side, after that last run, I developed some soreness again in the affected knee later that evening, but it felt a bit different to previously – not as severe as when I had been having major troubles in the Autumn of 2016, which had led me to start seeing Physio John, but serious enough that I realised I would have to stop running again, for an unknown period.

Since then, based on both my own instinct and on the orthotics specialist’s advice, I have only mixed in a few very short runs of 1 min or less, while taking walks.  Even so, over the past few weeks, as well as some pain in the tib-fib joint on the outside of the knee, the main joint feels like it is not quite properly lined up, and that joint can also sometimes give a little pain.  When playing table tennis, which I have continued with the whole time, I am unable to give 100% when going after a shot that requires a full stretch onto that left knee.  Another thing I’ve noticed is that while laying on the couch, such as after a day’s normal activity, if I rest that leg with the knee bent upwards and the foot on the couch, even after a few minutes, the whole knee joint is a little stiff when I next straighten the leg out again.

After that final run, when I next saw the orthotics specialist on 19 June, he concluded that I will definitely need to wear an orthotic insole. In that session he took some film on his mobile phone, of me walking across the floor of his treatment room.  He found that looking from the front as I walked toward him, my knees stay straight as I walk, but from the back, my legs are rotating – both of them.  His conclusion is that this rotation, together with the likelihood that the affected knee has some permanent damage, is why I am having further issues, despite the fact that my walking and running techniques had recently been much more “correct”.  He took imprints of both feet and ordered the orthotic lifts, and I am now waiting for those to arrive with him from the manufacturer – the same firm who had made the original, “unslanted” insoles I had been wearing previously.  His assessment is that wearing an orthotic lift on both feet will gradually help with re-training the body to use my long limbs more naturally and efficiently, without any of the observed, unnecessary rotations to either leg.  Until that has taken place, I will continue to do no further running of any significant distances at all, just a few yards here and there when walking.  This transition to phase out the current rotations, could take some time – so I am being fairly patient.  It’s also not clear whether I will ever be able to resume running the same distance as before.  I must be prepared for any outcome on that.

 

One other development of note has come from the work done with the orthotics specialist, something worth sharing in this blog. In his treatment room/office, he sits on an unusual-looking “sit-to-stand saddle stool”, the kind of stool used in places like hair salons, for example.  He recommended I get one of these – they are dirt cheap on Amazon – to see whether it would help with sitting properly more of the time, as well as not putting the glutes and piriformis to sleep as much as sitting on a conventional chair does.

I bought one of these saddle stools in mid May – the same model he has in his office – and gave it a proper tryout for around 6 weeks. While it was indeed clearly much better for the various muscles on my backside, I did get very sore where the bones of the hip stick downwards – the same place where cyclists get sore, from sitting on their bike saddles.  Also I found that sitting on the stool seemed to aggravate some residual muscle sorenesses I have continued to have up in the rib area on the same left side of the body on which I have had the knee issues (see blog #01).

I did like using this new stool, and as predicted, due to simple physics, they naturally move you into good back posture. But after a couple of weeks to see whether my “underside” would toughen up and I would be able to get used to sitting on it at my home workstation for a total of the typical hours in a working week etc, I had to admit to myself that this was not happening, and that it was just too painful.  So I tried adding a layer of 1-inch foam rubber, of which I had some left over from an unrelated DIY task done in the house.  That helped quite a bit at first, but within a few more weeks, the foam had squashed down, as it was not designed for seating or furniture.

I then tried using proper foam for cushions – 2 inches thickness in total, and much stiffer material that wears out much slower. For this, I had a professional upholsterer add the foam over the top of the existing saddle shape, then finish it off with the same sort of layer of PVC as the stool originally came with, over that foam.  While this felt a bit better at first, after a few days the hip bones that protrude downwards were still getting quite sore, and the aggravation to the rib muscles was still happening.

Here are pics of the various stages of trials of the saddle stool, as described above:

      

Having been through all the above experiments, the continuing pains etc led me to decide it was time to give up on the saddle stool approach altogether. Instead I returned to using the “deep” chair I had bought from Physio John late last year, which was a spare one from his treatment room in the MOTI store.  Sitting on this chair, with an added towel folded into 8 layers as John has recommended (something that helps keep the pelvis a bit higher than the knees as you sit), did not hurt the “underneath” protruding hip bones like the saddle stool did, and the soreness in the rib area was also not bothered as much.  But as I had always found, my glutes get fairly sore after even just ½ an hour on the chair, and also my right hip joint gets sore.  These issues had been what motivated me to try the saddle stool – but compared to the troubles I had with the stool, it turns out that the chair issues are the lesser of 2 sets of evils.

To come up with the best compromise that seemed possible, using all the knowledge gained from trying various things re sitting, and based on what the orthotics specialist and Physio John have each told me, in place of a folded towel – which offers only a little cushioning – I worked out a design for a cushion to use together with John’s chair, one that as it turns out, works reasonably well. It’s made of 2-inch stiff cushion foam, is a square 360mm x 360mm when seen from the top, and starting halfway along it from the back to the front, I had the foam cut at a diagonal angle, so it slopes down to nothing at the knees.

Below is a scan of the drawing I initially made up of this shape, which is intended to provide the required extra height for the hips so that they are a bit higher than the knees, and to do this in a way that should feel comfortable and natural, as you sit on it.  In the past I have tried thicker foam, but it just squashes around too much, so 2 inches seems about right.

Using some excellent cutting machinery in their factory, the foam people were able to produce some pieces to the specification in this drawing.  I then took those to the same upholsterer who did the saddle stool work, along with some nice fabric I had picked out for covers. I had 2 cushions made up, one in green for use at home, and a black one to take out to the workplace.

After trying out the green cushion for a few hours, it was clear it helped with the sore backside, and to some extent, with the sore right hip joint. But one thing I noticed was that with the extra height I was now sitting at above the chair seat, a bony bit of my spine that had previously been lined up with the foam in the chair’s curved backrest, was now up against the top edge of the backrest, where there was no foam.  This was making it sore.

I took a closer look at the backrest on the chair, and immediately worked out what to do about this. The height of the backrest needed to be raised up by at least 1 inch.  As well as taking care of this new pain in the spine, I realised that if I raised it a little more, the whole backrest might then work more as intended by the chair’s original design, but for a person like me who has a longer than average torso.  It occurred that I could add a 3rd screw halfway between the existing 2 on each side of the backrest, then move the backrest up by one “set” of these screws, in effect adding around  2 inches to the height of the whole backrest, relative to the seat itself.

I carried out these modifications to the chair, and was even able to get the lowermost pair of screws – one on each side – to get a proper hold in the wood in the very bottom part of the backrest. The end result of this was that as well as being exactly the correct height for me, the backrest was now fastened even more strongly to the rest of the chair, than it originally had been.

The final tweak of note that I have made to the workstation setup in the last few months, was to the height of the desk. I had already raised it a little when trying out the saddle stool for a few weeks, and as it turned out, that height was still correct for sitting on John’s chair again, with the new green cushion.

Below are some pics of John’s chair, showing these mods and the new cushion, as compared to how it looked before they were made. In each pair as aligned, the left pics show the original chair design, and of me sitting on a towel folded into 8 layers as advised by John, for the extra pelvis height – and the right pics show the modified chair, and me sitting on the new cushion with the slanted bit to get my knees lower than the pelvis.

 

    

Finally, here are shots of the modified chair and new green cushion:

 

Sitting on this for the last few days has been much better for the parts of the hip bones that protrude “underneath”, and the rib area soreness has improved also.  Although my glutes are still getting sore, it’s not a bad as with no cushion, and the right hip joint soreness is also reduced, though still there.

I am open to suggestions from anyone reading this, about how this setup might be improved further, to both retain a structural design that will promote sitting properly – as this seems to do – but which might further reduce the sore glutes and right hip joint.  This is the best I have been able to come up with, at this point.

 

How to become a blogger for AAA Physio

  1. Write First Blog Post and email to John Stephenson PHYSIO
  2. You will need to come up with a blogger name- you could use your real name or a creative username. This will also need to be in the email you send to John.
  3. John will then set you up a bloggers account, and email you back with details of how to access this account. Your first blog will have been posted for you by AAA Physio Support.
  4. You are now able to log in, have a look around! (You are also able to change the automatically generated password given to you)
  5. All blog posts from that point forward can be written and posted by you directly onto the website (no need to get it done in one go –  there is a ‘save as draft’ function!). You are also able (and encouraged) to include photos in your posts.
  6. John or AAA Physio support are always on hand if you experience any technical difficulties with the blog.
  7. Write away!

Here is the blog to give you ideas for your own posts! http://www.physiotherapy.co.uk/blog/

Back to running after 2 years of knee injury #02

Since my last session I had been really trying to focus on keeping my head in the right position rather than jutting it forward, keeping my shoulders back and my back straight (so that I resemble less of an S shape overall). However, I had been having a bit of knee pain in the days leading up to seeing John.

When I arrived at my appointment I told John about the knee pain and we went through what I had done that week that may have caused this. I did a 35 mile cycle and a long swim on Sunday – but I have been able to go on 2 cycle tours in France since my injury so it almost definitely wasn’t that – the we realised it was the wedding I had gone to on Saturday in shoes that weren’t totally flat (which are all I’m used to wearing) and standing around and dancing in them for over 10 hours.

I was so relieved that the pain could be easily pinpointed. During this session we practiced my checks for setting my body in the correct position and then practiced the order of drills/exercises to do before ‘falling’ into running (I haven’t tried running properly yet – just the preparation!). The list is as follows:

  • Leaning backwards as if I am standing on the edge of a cliff (weight on my heels)
  • rocking that weight forward onto the widest part of my feet – now in my ‘eddie the eagle’ pose
  • alternate knee pushes (don’t bob up and down!) keeping my core engaged and my head back even as I start to concentrate
  • add elbow drives to my knee pushes without starting to twist my hips
  • stop mid movement – with my knee cocked and my elbow back
  • lean my weight forward until I fall forwards taking the tiniest step possible (this is my first step of a run!)
  • glide off trying to remember the feeling of falling forward, keeping my head back, keeping my core engaged, not twisting my hips…there’s a lot to think about!

After going through this, John worked on the back of my neck, which has got used to years of me holding my head forward. We realised this may be one of the causes of the many headaches I get around the base of my skull/neck. After he had given me a treatment my head felt really light for the rest of the day.

At the end of my appointment we talked about my October 10k goal, and John said that he thought we should have a closer goal to work towards. We agreed on a 5k at the end of July/beginning of August.

That afternoon once I was back at work, John sent me a couch to 5k podcast programme which he recommended I start this week. He gave me some bits of advice over text – how to do the walking sections, how long to leave in between each run or other ‘bouncing’ exercise and to start on week 2.

I tried my first run/walk yesterday and am overjoyed to report that it was pain free! It consisted of 2 mins brisk walking followed by 90 seconds running for a total of 20 minutes. Before each run section I would reset (as per my list above) and fall into my 90 seconds of running. At 2 points – once on a downhill and once on an uphill – I got a small twinge in my bad knee but neither time did it persist and my knee has felt fine since (it’s now 24 hours later). I am looking forward to doing it all again tomorrow!

 

Back to running after two years of knee injury #01

Rebuilding my running

runner practicing elbow drive
Elbow Drive Practice

I was recommended a visit to John by a colleague after living with a knee injury for the past 2 years. John and I are currently working towards getting me back running which is something I have really missed since my injury. In my first 3 sessions, John has taken a really holistic approach to my injury and has identified different links and factors that haven’t been highlighted to me before, but which make a lot of sense. Now we are working on the way I sit and stand in normal life (which leaves a lot to be desired especially as my job is largely desk based) as a starting point to work towards running. I’m not having to do loads of exercises every day but rather I am trying to think about and be aware of how I’m holding myself (or try not to think too much as this seems to be the problem!) and to re-programme old habits. I have booked a 10k race in October so this is what we are working towards, fingers crossed!

Dr Mark Porter: Stiff knees may be a sign of arthritis, but exercise can help

Here is a link to a very interesting article by Dr Mark Porter on how physiotherapy and exercise can reduce the affects of arthritis…

https://www.thetimes.co.uk/article/dr-mark-porter-stiff-knees-may-not-be-a-sign-of-arthritis-just-that-you-need-to-do-some-exercise-xzj9fkvn3

cycling-bicycle-riding-sport-38296 small

For those with arthritis here’s a useful link to Arthritis Research UK for some excersises to help manage knee pain…

http://www.arthritisresearchuk.org/arthritis-information/conditions/osteoarthritis-of-the-knee/knee-pain-exercises.aspx

London Marathon Success!

We would like to congratulate all runners who took part in the London marathon on 23rd of April. A special congratulations to Annie and Rob Dixon who completed the marathon in 3:58:12 and 2:51:43 and also to Richard Edwards in 5:02:00 (who was still looking full of energy despite already completing 25 miles!) and all of whom completed it with no injuries!

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http://www.marathonfoto.com/Catalog/List/285322548?PIN=V54972&LastName=EDWARDS

Knees – not just getting old? #27 – Last entry (for now), including summary

A couple of days after posting my previous blog , I spoke to John about the possibility of him measuring me up for my insoles, as it seemed they now needed replacing (see blog #26).  He felt it would be best for him to pass on doing this, as it’s a little outside his realm of experience and his qualifications.  So I contacted the company that make the insoles I have worn for the last 6 1/2 years, to see who they might recommend instead.  They put me onto a highly qualified orthotics practitioner they have worked closely with for the last 2 years or so, to jointly develop a new kind of long-lasting insole which that practitioner has designed.  I saw this other person a few days ago, on 26 April, and the appointment ended up going in what I would describe as an unexpected direction, though a highly positive one.  But that is another story…

Looking back at the work that physio John and I have done together since I first came to see him in late October 2016,  it has been highly fruitful, to say the least.  When we started treatment at that time, running or playing table tennis – even for just a few minutes – made my left knee joint quite sore, the knee would get quite stiff when I sat down even for short periods, and my walking gait had somehow developed a strange limp on that leg, one that was most pronounced when walking downhill.  In effect I was unable to run, and I was especially worried that I might have to abandon running permanently.

From the first session John and I had together, my objectives for our work included eventually being able to resume running again, to my usual distance of 4 miles and to be done once every 3 days, and to be able to play table tennis – all with no soreness issues either during or after a run / table tennis – and to be able to walk without any limp, including up- and downhill as well as on the flat.  We have more than achieved these targets, and I am 100% satisfied with the outcomes.

Along the way during the treatment period, I had 8 sessions with John.  We covered and addressed a wide range of potential causes of the knee joint issues that I had been suffering from since before first seeing him.  With hindsight, it is now clear that many of these potential causes were making at least some contribution to the knee problems, so it was down to much more than there being just a single thing behind it.  Had any of these causes not been addressed, I don’t think I would have been successful in the attempt to resume running again.

In summary of all of my previous blog pages #01 through #26, the things we/I did as part of our work together, and as a result of it, include the following:

  • A] John carried out various “range of motion” checks, on each leg for comparison, as well as other checks.  We did this in various of our sessions, and the results indicated eventual improvements and progress along the way.  Examining me freshly was invaluable in assessing direction of travel, expected durations of recovery, and so on.
  • B] I bought a MOTI foam roller, to replace an inferior one I had previously bought from a high street “chain” sports store.
  • C] We looked at my posture for sitting at the computer, in some depth.  John showed me how to sit properly, and once he had arranged my posture so it was “correct”, he photographed the result.  This photo became a benchmark I could refer to in other tasks we carried out, and as I sat working at the computer at home.  I even used this photo to measure the angle of my upper legs from the horizontal, using nothing more sophisticated than Microsoft Word and some simple geometry.
  • D] I undertook doing a major overhaul of my home computer workstation setup, where I have been making a living as a freelance Microsoft Excel spreadsheet developer for the last 18 months.  We both strongly suspected that this setup was a major culprit in my knee issues, which had only started up since I began working from home and sitting at it for a total of the usual sorts of working hours each day, sometimes more hours than that, etc.  Before that switch to home working, I had been running the same 4 miles every 3 days for some 14 years, with no problems of any kind – so even though we did not discount the usual things like poor running form etc as possible reasons for these knee issues showing up after all that time, we were on the lookout for other causes as well.  Altogether, the overhaul to my home workstation involved:
    • i) a shift from not having enough room to stretch out both legs underneath the desk and thus sitting at it at a “skewed” angle, to clearing away some IT equipment that had been stored under the desk, by adding strength to an existing shelf found out of the way and under the desk, making more room on that shelf, and putting the IT equipment on it;
    • ii) lowering the height of the desk so it was closer to a standard desk height in most offices;
    • iii) adding a “top of desk extension” so there was now enough desk “depth” and room to rest my elbows on it while using the computer keyboard (resting the elbows is an approach that was a completely new experience for me);
    • iv) replacing the old chair I had originally had leg extensions made up for – to accommodate my previous sitting position, which was quite high – with a spare chair from John’s  MOTI treatment room that he offered to sell to me, a chair which:
      • a} has more “depth” front to back and so provides better support for my long legs;
      • b} is of a more standard height as in most offices, and which;
      • c} when sat in properly following all these changes to the workstation setup – including v) below – results in my lower arms naturally resting in the perfect horizontal position, while I work;
    • v) adding a towel folded into 8 layers to the chair, positioned so the pelvis ends up a bit higher than the knees.
  • E] We took film of my walking and running gaits in the MOTI store – in more than 1 of our various sessions – and we worked on improving my general posture for both walking and running.
  • F] We fixed some ankle turn-in on the affected left leg, which had showed up on the films of me running.  In the end this appears to mostly have been from using running shoes that were quite worn out, as they were over 5 years old.  I bought a new pair at MOTI, and when we filmed me running in those, the ankle turn-in was gone.
  • G] John showed me various exercises, including some to target the glute muscles and get them working more properly.  I have incorporated all of these as shown, into my usual daily routine of morning exercises, and am still doing them today.
  • H] When the knee did not seem to be responding much to our early work from the first few weeks of treatment, I saw my GP.  To his credit, was willing to send me for an x-ray on the knee.  When this eventually did not show anything abnormal, my GP did not hesitate to send me for an MRC scan on it as well.  This proved to be very helpful in my treatment work with John, and it also demonstrated that it is possible for the NHS and a private practitioner to co-operate and work together to the benefit of the patient.
  • I] Between the x-ray and the MRI scan as outlined in the previous item, a “breakthrough” event took place in early December 2016 (see blog #14), after which the limp I had had when walking, which was most apparent when walking downhill , completely disappeared.  Although John and I were left a bit puzzled as to just what had taken place, and why, it was very good news, and as well as never seeing the limp again since then, the knee has also been improving ever since.  When the MRI scan results finally came in and I next saw John, he gave me new exercises to target the smaller joint on the outside of the knee, the “tibiofibular joint”, an area the scan had indicated was involved in the ongoing issues.  The scan suggested the main joint was more or less fine, despite showing what John and I felt were typical signs of me now being over 60 years old.  He felt I should have a good chance to make a recovery that might mean I could eventually get back to some amount of full running again, something my GP had also said after he saw the scan results.
  • J] In the first session with John after the “breakthrough” event as outlined in the previous item above, but still some time before the MRI scan results had arrived as also described in the previous item, John found a further possible cause of the knee issues – some tensions to the left of the joints in the lower spine.  He took a “before” photo of my back that showed my upper body was leaning to the right by a significant amount (around 1.5 inches at the neck), then he got me on the treatment couch and worked out these tensions, and then he took an “after” photo, which showed that I was now standing straight.  He was convinced this and the resulting “lockup” of several of the joints of the lower spine, was also a major contributor to my knee issues.  The knee did improve after his work manipulating the lower back, confirming what he had said.  That work also resulted in my upper body becoming more “evenly” aligned – joints were “popping” evenly on the left and right sides when I did the usual morning stretches and exercises, and so on.  Over the weeks following his manipulation work, I took 2 further photos of my back at home, using a delayed 10 second timer on my camera so I could get into position.  After using the computer to make adjustments to these photos to correct for perspective, they confirmed what I had been feeling – I was still standing up straight, so John’s work seemed to have “stuck” and was permanent.  A recent view of my back has also confirmed that it is still straight.
  • K] After the session outlined in the previous item above, we had a further, “penultimate” one on  02 Jan 2017, in which we had a review of all work so far, John re-checked for range of motion, and so on.  The MRI scan results were not in yet, but it seemed a good idea to take a fresh look at everything we had undertaken, up to that point.  As a result of these fresh checks, John carried out further manipulations on the remainder of my spine, all the way from the lowest joints he had addressed in the previous session, to the neck at the top.  There were no further significant tensions that he felt might be causing or contributing to the knee issues, but he did find some other, more minor tight spots, which he was able to “undo”.
  • L] By the time of our final session together, which was on 20 Feb 2017, the MRI scan results had arrived.  We discussed the results, John repeated the checks from 7 weeks ago, he showed me a new exercise for the “tibiofibular joint” as indicated by the scan, and we talked about recovery and about the physiology of the leg joint in general, and about my affected joint.  John felt I could start experimenting with short distances of running, keeping a close eye on how this felt, both during and afterwards, backing off if there were any issues, etc.
  • M] For a few weeks after that final session, I was reluctant to push the knee and so kept away from any running, just tried a little jogging for a few hundred yards now and then, which seemed fine.  I was going on instinct, and eventually took a proper run around the end of March.  By then the joint had gradually improved enough that there were no problems on that run, and since then I have been able to quickly get the distance all the way back up to my previous 4 miles on any given run.  I have lost a fair bit of runner’s conditioning, but it looks like this may return relatively quickly as well, perhaps due to me having continued the usual morning exercises throughout the treatment period in my work with John, as well as having kept playing at least some table tennis for most of that period, recently adding more of this , and averaging more duration in each table tennis session recently as well.

So that’s really about it in terms of my work with John.  I would highly recommend him, based on everything we have done together over the last 6 months.  He has succeeded in helping me to get back to running again, and the things he and I have done as outlined above, mean I have a good chance of being able to keep running for some time to come.

Calf problems from posture: #04 Twenty six days to twenty six miles

Twenty six days to go and it hasn’t escaped my attention that there is one day left for every mile I will have to run. I feel that this is somehow apt – the marathon is not only run over the 26 miles on the day, but over the many more miles run over the days and months leading up to it. This miniature mountain of time and distance (and hills) already covered is what makes my sensations heighten as the event draws nearer – I have put in so much effort to get this far that I don’t want to miss out due to injury or illness at this late point.
The exercises John has recommended have adjusted my posture to the point that the right calf is much less problematic, although this adjustment does seem to have ignited soreness in the left achilles. I am working on my gait to push right through to the toes on the trailing leg, increasing speed and reducing effort in the legs. This weekend will be my last truly long run before the marathon. As long as that goes well it will be all about keeping the legs ticking over for a few weeks and giving absolutely everything on the big day.

To see Tim’s personal blog see: http://edenprojectmarathon.blogspot.co.uk/2015/01/twenty-six-days-to-twenty-six-miles.html

Calf problems from posture: #03 Whales and Marlins

I feel it is no coincidence that this Christmas I was given two books which are undoubtedly related: Hemingway’s ‘The Old Man and the Sea’, and Melville’s ‘Moby Dick’. Both describe the immense efforts of people to overcome multifarious obstacles in order to capture a monster far bigger than themselves (although I haven’t read Moby Dick yet). It may be over-dramatic, but in some way this is how the marathon has become for me. Particularly since the calf problems, it has been a daily struggle to stay on top and build the mileage back up enough to make the marathon plausible. I put in calf-strengthening exercises daily, I now also slot in postural exercises and some ‘neural flossing’ as recommended by John. I am careful to warm up and down thoroughly around each run. I run three times per week, unsure each time whether the calf will fail again, but monitoring and adapting my runs accordingly. Add to this that I will not be satisfied purely with finishing the marathon, but I would like to run a reasonable time. My running is currently limited not by my fitness but by the leg, which sometimes does not allow me to run further. This is concerning given that my longest mileage since the injury is 15 miles. Still, I believe that my approach is giving me the best chance possible. It combines patience, determination, and discipline. Keep doing the exercises even though you may be bored. Keep training even though the weather may be terrible. Keep believing even though other people may not hide their doubt. There is never a guarantee of success, but you can always put in your best effort possible.

BEFORE:

AFTER:

Calf problems from posture: #02 A two pillow sleeper

On my second appointment with John, he once again demonstrated to me the flaws in my posture. With me standing casually, a quick profile photo showed that my pelvis and nose stuck out in front of the rest of my body. I am curving my lower spine backwards and then my neck and head are pushing too far forwards from my shoulders (see photo); as John rightly pointed out, I am a two-pillow sleeper. These extra curves in my skeletal frame mean that the nerves strung over that frame have further to travel than they should, and therefore have less give in them. My first prescription was to sort out my posture during the many hours I use a computer (at the office and particularly when using my laptop at home, for which my posture is really pretty terrible).


Following this, we tried some little hops as if skipping, first on both legs then switching to one leg, showing that this was much worse on my right side. Similarly, when balancing on one leg, I would lean my upper body much further to the side on the right leg than when balancing on the left. It seems I am literally a lazy arse, at least on the right side, where the upper glute muscles do not want to work to keep me balanced. Prescription two was the sitting-to-standing posture exercise from the physiotherapy.co.uk website to wake these muscles up. You or I may well ask what all this has to do with my calf injury? I believe John’s answer might be that you treat the body and not the symptoms of injury, and the rest follows…there is a logic to this, and as a scientist I see that you can only test this theory by following the advice, so fingers crossed and here goes…