Monthly Archives: September 2011

Wk1. Learning to run sub 1h40 for the Half

Went to see John who explained the connection between knees and necks (turns out the nerves are all connected and the way I sit and work in my office is probably the reason my knee hurts while I run). John did a thing with my neck and my back which made a horrific sound but made my knees move alot more freely.

As well as reminding me about dynamic sitting (which he’d mentioned last week), John also showed me how to stand so that I’m leaning/arching back less, and my hips and abdomen are tucked in more, while leaning forward a bit over my forefeet. From this position, he showed me how to move my legs and arms correctly for running. We went outside and did some drills, though I think I need a bit more time to process before putting it all together!

Action for this week… join a gym so I can see what my running looks like in the mirror, and do some cross-training too.  Only 8 weeks til the half – and a long way off my target!

Dancing Freely Again – 4

My opinion of orthopaedics (never very high – see my previous post!) has reached an all-time low… but backtracking slightly… I seem to be aquiring injuries faster than John can teach me exercises, so have backed off doing most of them until the pain subsides 🙁

I trashed my knee again, twisting it badly running across a field, and John demonstrated very clearly that my suspicions were correct… cartilage again… and explained that it’s impossible to know how badly without either ‘wait and see’ or a scan. OK, time to do very careful squats to get that synaptic fluid pumping… and wait and see…

… but being unsteady on your feet around a boat is a recipe for disasters of one kind or another, and I just fell off mine, ending up hanging off the side by one arm, feet in the water. (Probably should have just dropped – would have gotten a lot wetter and smellier, but wouldn’t have torn my shoulder!) Anyway… off to A&E the next day, since it denied me much sleep and wouldn’t move much at all by morning.

Aha! Maybe a chance to get scan on the NHS? I had twisted my knee again falling, so I glossed over the ‘repeat’ and let the doc have a look at that too. Despite giving a text-book description of a cartilage injury, he told me it was muscle/tendon and should heal up OK if I rest it. Oh, and the clicking is my kneecap. Oh, and if it still hurts in a week or two, go see my GP (400 miles away).

BU****IT! (Not bluetit, smellier) … Usually if I twist my knee in the night it gives me a warning twinge but, after reluctantly taken painkillers overnight for the shoulder, I slept awkwardly, the knee clicked out, and all day I was practically screaming with pain if I tried to put any weight on it at all. Early evening, “click!” and suddenly it’s OK again and I’m walking almost normally. Two days later I’m dancing. Correct me if I’m wrong, but I’ve NEVER had muscle/tendon damage that did anything quite like that.

However… I am dancing, if very carefully, with a bit of a limp, and with one hand in my pocket cuz of the shoulder… the funny bit was watching a couple of dancing partners unconsciously copying the dance of the one-armed bandit! ‘Dancing more freely’ would be a bit of a stretch though. All this has at least put the original presenting issues in perspective tho, and provoked a sense of gratitude for being vertical, and achievement every time I make it up a flight of stairs without a yelp! 🙂

And for now, with the shoulder slowly improving (I can change a light bulb again, but getting out of a t-shirt is tricker!), my main practice is simple awareness – moving with CARE… and, er, how to confess to John about the shoulder!? … and does anybody wanna buy a narrowboat?! 😉

P.S. The orthopaedic consultant I ranted about in my previous post told me to get a steroid jab for my tennis elbow. Sceptical. Those were already regarded with suspicion in my bodybuilding days, many years ago. Didn’t take me long online to find two recent articles (BMJ and Lancet, one a trial, one a review of pre-existing trial data) indicating that this probably does more harm than good. What are these people ON?!

Sorting head position for Golf Combined effort

Photo of a stream
I usually end up in here - once a week

Started with a Golf Specific Personal Training Session with Andy Wadsworth from MyLife PT in Clifton BS8 3BQ – This lasted 60minutes.

  • The first thing John Stephenson from AAA-Physio asked was:
  • What are the 3 main findings from your assessment with Andy?
  • 1. I said…………Independently rotating my trunk on my pelvis
  • 2. ?
  • 3. ?

IN LINE STABILITY Assessment

This scored really well upto 9/10 on both legs. See the Video below.

Then we added the rotation back in. Using a cable pull to the side with minimal weight. To get the rounded action of the golf swing John got me to hug a round stability cushion.

While I was doing this exercise I was concentartiong and thinking this………….
I found out this…….
I struggled with….
We used a scoring system for shoulder position and smoothness of the swing. Imagined hitting with a 7 iron. we had an imaginary ball marked on the floor – I scored this

Physio Investigations – Capsular tightness and cervicogenic pain.
upper limb tight – Neck adjustments more movement

Target for “The Easter Tournament??” H/Cap of 12?

3. Getting ready for Cardiff Half Marathon with AAA physio John

Four weeks today until the race, four trips to the physio under my belt, £1400 in sponsorship lined up and a four miler around Bristol at 6:30am this morning in the rain so all the fours on my mind today!!

I saw John last Monday along with Hannah who is taking over the Monday evening physio slot at Moti Bristol. More analysis took place of my stance and running action before John got to work on trying to alleviate the tension and pressure points in my neck and back. The analysis also showed that my hips are not as aligned as they should be when running which  will be exacerbating my groin pain further.

I also discussed with Hannah the hours I’m currently spending sat at a desk (and at home) hunched over a laptop as my company is currently in the midst of its key trading period. Hannah advised how important it was during the working day to ensure I set reminders to walk around and stretch rather than put unneccessary pressure on my spine. She also offered good advice on my driving position when out on the road in terms of changing it regularly, using cruise control etc so I didn’t get stuck in one position.

Finally, I went on the treadmill in the shop much to the amusement of John who pointed out that I run exactly like a footballer with my head straight down looking at an invisible ball. I pointed out that I’ve been playing football for 37 years and running for 7 months so that wasn’t too surprising really!

I’ve built an acronym to remember what I’ve learnt so far which resolves around my Feet (short steps, straight and quiet), my Abs (lifted high), my hips (straight ahead like headlights), my Torso (leaning slightly forward and well aligned), my arms (away from the midline of my body) and my head (looking down the road with a Superman laser vision and staying tall through my crown).

I’m back up to four miles plus which is great but only a month to go and I can’t shake off the feeling of discomfort. Had a 14 hour working day last Thursday and an 8 hour round trip in the car on Friday which left me struggling badly on Saturday. Better today and another trip to the physio’s on Monday to see how I’m doing!!

 

Physio Help! – One leg longer than the other? Wk.1

Hi John,

Physio John Stephenson Consults about a knee problem
ESP-Physio John Stephenson Consults about Calf and Knee Problem

Over the past 4 weeks I have been having trouble problems with my right calf. I went to the Lake district and did lots of hill running which started it off I think then got back to normal training, while on the track, it completely tightened up and have hardly ran since. It has improved a great deal but what is actually bothering me is that I feel my right leg is longer than left. When going into Moti over the weekend this was picked up, when I run my right leg seems to stay straight while left is in normally running motion. I think my right hip flexor is tight also which probabaly doesn’t help.

Sorry abit complex but they thought maybe you could help?

Best wishes,
Lisa

No1: Hoffas Fat Pad Syndrome – The Consultant Surgeon’s View

Common Causes of Anterior Knee Pain

  • Hoffas Fat Pad Syndrome
  • This is a common cause of anterior knee pain in runners. Thirty percent of runners with this condition are cured by a good physiotherapist. Have a look at the MRI below and you can see…..

MRI lateral view: hoffas impingement
MRI Scan showing Hoffa's Impingement

Presented with this situation, and after six to eight  weeks of appropriate Sports Specialist Physiotherapy, without lasting results you may wish to consider what could be done with latest techniques in key-hole surgery.

My approach is to test with…

Then…

Surgery is….

Risks are……….

Results are good to excellent in 75% cases nationally see: The Knee Surgeon 2010:06 pp123-45 Hardy.J et al

  • What to expect at your first knee consultant visit
  • Surgical approaches to the problem
  • After Care
  • Recommended Exercises
  • Other Common Causes of Knee Pain

 

Dancing Freely Again – 3

OK, I’m getting the long slog feeling now. I always nag friends with injuries to keep up the physio, now I’m getting a taste of my own – having the discipline to keep going and do the exercises night and morning is challenging me. Perversely(?), when I’m feeling good it’s easier – when I’m feeling crap I just want to go to bed/get on with the day and it’s a struggle. John gave me some good exercises to start straightening my spine again (now I remember why I didn’t like pilates!) and they ARE making some difference already… so plugging away.

Incidentally, I also had another experience recently that reminded me how much better it is to work with therapists like John who work WITH you and actually listen to what you say and ask interesting and relevant questions. I had to see a senior hospital consultant (not my choice) and came away seething. It’s a while since I’ve felt so belittled, unheard and undermined, and he seemed to dismiss any suggestion that, for example, an ankle problem might have anything at all to do with your back! I was amused by some unexamined assumptions in his report though – my past back pain obviously wasn’t much, as there was nothing in my notes about it… like I’d go to my GP with back pain anyway?!? 😉

Dancing all this weekend, hten back to twice a week from next week so I’ll report back! 🙂

2. Getting ready for Cardiff Half Marathon with AAA Physio John (part 2)

Encouraged by my ability to jog half a mile after my last visit to John on September 1st, and having practised my dynamic sitting and potential new running style, I returned on the evening of Monday the 5th to the most excellent Moti shop on the Whiteladies Road for
my third session of Physio.

Initial diagnosis was carried out via the Thomas hip test which clearly demonstrated that my left leg is in perfect working order and my right leg isn’t!! Basically, the exercise culminates in how many of your toes are pushing into John’s hand – my left leg scored a maximum but my right leg recorded a measly 2 out of 5. I did find the silver lining to that particular cloud though which was that was a 100% improvement on my score the previous week!

John then worked on both legs and during this demonstrated that the hip rotation was very smooth on my left leg (rotating almost as a spoon would when stirring a cup of tea) whilst my right side was far more resistant and inflexible.

John manipulated my back (my problem starts at L2 level of my spine and then impinges on my hip and particularly my groin) and then showed me how my current running style is exacerbating the problem with my pelvis and lower torso turning inwards to counteract and correct the poor posture and performance of my right leg. We then discussed in detail my job and the fact I spend long hours sat in my office and at home working on a small laptop. John demonstrated the “dynamic sitting” position again to ensure that I have got it right because this is clearly having a massive impact upon my spine and torso alignment.

This showed me that my breathing (the wide breath in and then out with the ribs folding down) does not come easy to me and I had to really relax my mind to get it right. Another example of how we forget to look after ourselves properly whilst dashing around so frantically in this day and age.

Following this,  John explained to me about the four different levels that I am (or at least should be) going through. These are as follows;

“Unconscious Incompetence” – I don’t realise that I’m doing things wrong and damaging myself both in my approach to running and everyday life;

“Conscious Incompetence” – I understand what I’m doing wrong but I’m still using bad
habits;

“Conscious Competence” – I am making an effort to correct myself at all times;

“Unconscious Competence” – the ultimate aim where I am sitting, standing and running correctly without even realising.
A little way to go yet to Stage 4!

Finally, John worked on my neck which had a remarkable effect on how far I could lift my right leg in the air whilst lying on my back and, again, demonstrated to me just how amazing the human body is. Before first visiting John I would have been incredulous that treating my neck was going to have an impact on my groin injury!!

Five weeks this Sunday until the Cardiff half marathon and my
determination to run it to raise money for the National Autistic Society (£1300
committed so far). I went out after work on Tuesday the 6th to try
and put some of the new techniques into practice and check the state of the injury
and managed a gentle two mile jog with a pain level of only 2/10. No problems in
terms of pain the following morning either. Back to see John on Monday the 12th
with a current surge of optimism that this problem isn’t going to stop me from
having a crack in October at my first half marathon!