Monthly Archives: January 2012

My self diagnosed ‘pressure’ knee injury – part 2

Prior to my first ‘full’ appointment with John, I decided to check out some more of his advice and exercises on his website, especially regarding posture at a desk. I realised that I had a tendency to sit very poorly, with a curved spine for hours on end and so already started to make a conscious effort to improve that. I had also started doing some more focused core muscle exercises while at the gym. This small increase in effort over a couple of days resulted in John commenting almost right away that ‘things had improved from last time.’ The muscles in my left leg and lower back were by no means equal in movement with those on the right, but were noticeably less tight.

So John started this session by once again checking the range of movement of my legs, lower back and, a bit more surprisingly, arms. Again, my lower right side performed well, exhibiting good movement and strength, whilst my left side was less flexible and weaker. My arms, however, exhibited largely the same movement as each other, showing that my problems stemmed from my lower back. At this point, through a slightly bizarre mixture of twists, rolls and squeezes, John stretched and ‘cracked’ both my middle and lower back. The improvement in my range of movement was noticeable immediately. I gained roughly 20 degrees of forward rotation in my left leg and a significant increase in strength, I was amazed! After this ‘manipulation’, we focused on exercises and postures that I should adopt to ensure that I strengthened my core and prevented the injuries from reoccurring.

While I always felt like I knew what a good posture entailed, John showed me that I had been slightly mistaken. My ‘good’ posture involved maintaining one single slight curve through my spine, rather than the outwards curve at the top and the inwards curve at the bottom. I was shown that, by raising roughly where the tag on my shorts were, I would achieve this desired ‘S’ bend. Since the appointment I have been trying to adopt this posture whenever possible, but it certainly takes some concentration and getting used to!

John then taught me how to perform a version of a ‘roll back’, a move derived from pilates that, as I understand it, is designed to stretch out your spine and strengthen your core. This involves sitting up, slowly collapsing and rolling back along your spine, before rolling back up to sitting. I was also taught the basis for how to run without bouncing, by maintaining a constant head height – achieved by reimagining how I carried my weight on the pads of my feet.

Alongside these exercises, John provided advice about some further reading, some improvements for my cycling technique and also the kind of desk chair I should consider in the future. It also turns out that John is pro barefoot running and that some of the techniques I was learning may help me achieve this in the future.

I have been instructed to bring my trainers to the next session, so I have high hopes of being able to run again soon!

My self-diagnosed pressure ‘knee’ injury #1

Self Diagnosis
I might have been partially right on the pressure part, but the problems extended a long way past my knee!

image showing problems with left leg allignment
image showing problems with left leg allignment

Background:

Roughly 8 weeks ago I injured my knee during a particularly hard high-gear session on a watt bike. Though running has always been my focus, I have recently turned to triathlons (not least to provide a more interesting training schedule!). I am a competent runner (I think) and was looking to push forwards into more endurance-based events only to find my progress hampered by a knee injury that would tend to flare up roughly 5kms into a run – hardly great news for endurance events. So I booked an appointment for some physio with John.

Diagnosis:

John started with a fairly broad examination of my legs and their respective ranges of movement; from watching my attempts at single leg squats to push and pulling my legs through most axes. It became apparent that my right leg performed fairly ordinarily. Its movement was as expected in most directions (apart from being a bit tight – something I would attribute to my ongoing bike training) and I was able to successfully counter any pressure that John directed. My left leg, however, was a different story. I had previously been told, during a trainer fitting, that my left leg did a lot more of the work when I was running. John believes that this miss-diagnosis is due to its ‘noisy’ range of movement. In a forwards direction from my hip, my left leg has a much smaller range of movement than my right. It also has a tendency to roll outwards at my knee when I am lying down. That being said, my foot structure is apparently fairly good, with all toes engaged when placing pressure on the floor – a nice positive that I can hold on to!

Having tested my range of forward motion and muscle strength in both legs, John proceeded to check my backwards movement range by getting me to lie on my front and lift my foot, first from my knee and then from my hip. Again, my right leg motion was said to be good. Again, my left leg motion somewhat underwhelmed. During this exercise John also tested the tension in various places in my lower back and needless to say the muscle on the right-hand side was much firmer than that on the left.

At this point, John believes that my problems stem from the muscular structure (or lack thereof) of my lower back, which causes recursive problems through my left leg – more specifically, that my movement aggravates the left-hand side of my L2 nerve, which causes a pain that manifests itself in my knee. This has been attributed to poor core stability – likely caused by poor posture throughout my fairly sedentary desk-based studying. My lower left core stability problems cause my left leg to perform inefficiently and engage different muscles in, as I understand it, bizarre manners to try and compensate for reduced range of movement, which, in turn, leads to further hip flexor and lower back problems, further aggravating my knee and so on and so forth.

Having returned from my first appointment, I checked out a variety of other blog posts made on John’s website and it seems I am not the only one with these problems. It also seems that John manages to fix everyone else – so all I can say is ‘bring it on!’

Pain in my lower leg #2

After my second session John advised to continue with the excersises recommended in my first session, but now also to begin looking at my running posture itself. He anaylised my running and suggested i try atleast initially a smaller stride technique to help soften the impact on my lower leg and to help harmonise the movement of my arms with my legs.

Pain in my Lower Leg #1

Pain in my lower left leg

I have not been running now for about 2 months…….

I have been un able to due to a pain in my lower left leg.

PHYSIO
After my first session with Physio John Stephenson, I immediately felt more re assured as he quickly established by “foot scoring” of my feet, that my leg injury was due to an inbalance in my feet.

Learn to Run with AAA-Physio
Learn to Run with AAA-Physio

Coming away from the session he gave me several homework techniques i could fit around my work, which included a neural flossing, roll and leg kick, and also a toe fold to help me strengthen my left leg.

AAA-Physio Meets Olympic Gold & Bronze Medallist – Martin Cross @ RACE Blokes (Big!) Breakfast Event – Bristol

olympian-martin-cross-meets-physio-john-stephenson-300x275
Gold Medal Olympian Rower Martin Cross Meets John Stephenson from AAA-Physio at RACE

Dougie from R.A.C.E. Organised the first “Meet an Olympian – Blokes Breakfast Event” in Bristol – This event ran smooth – Like Triathlete Dougie’s swim stoke!! See him in action at the Lido Bristol or United Reformed Church Bristol BS8!

The Q&A Session with Martin Cross was a real insight in what its like, to sustain this level of performance,  over two successful Olympic campaigns – Gold and Bronze

The next R.A.C.E. Event in the Olympic build up, will be held in March 2012
for more information contact  Douglas Burnett United Reformed Church Bristol BS8

Pain behind the knee when running #4

Did a 30 minute run last Tuesday, a 60 minute run on Wednesday, then a 50 mile run (9.5hrs) on Friday.

I experienced mild pain behind the knee at about 10 miles on the Friday run. Flossing, stretching and 5 minutes of walking sorted it out. The remaining 40 miles were completely pain free.

I have been flossing and stretching all week, usually twice a day.

No running since Friday, but planning to do 90 minutes before my appointment with John tommorow.

Nerve irritation in the Lower back due to poor core stability

Fourth session, last post Dec 15th, 2011

I saw John for the 4th time just before Christmas, initially with right leg knee pain from running. This was diagnosed as nerve irritation in the lumbar area caused by poor stability in the core muscles.

In our physio sessions I feel John is teaching me how I should be moving – from the core / powerhouse and not with my automotive muscles (legs and arms) as I do normally. He has observed that not only is my right knee “dodgey” but I also have poor movement in my neck and hold my right arm oddly – all due to poor stability as I have a poor base to build on and thus compensate with other muscles. This will add strains, which become more of a problem over time and with more strenuous exercise. For me I need to change the way I’m using my muscles all the time and so the Physio experience has been very holistic. I have tried to see myself as a whole and work on my posture all the time.

Since starting with John in October I’ve taken to Pilates and I’m becoming more aware of the number of muscles in the stomach area and feel that I’m “waking them up”. I’ve run a lot over the Christmas period and feel much stronger and like my stomach area is more of a power house, supporting and powering the rest of my body. I borrowed a book Brook Siler, “The Pilates Body”, which I would recommend and noticed that an exercise video followed very similar exercises.

For homework I’ve been considering how my “glutes are firing”. John noticed that I tilt my hips slightly when I walk and so my right glute is not responding properly (putting stress on other leg muscles). To correct for this I’ve been walking up slight inclines and focusing on how I’m walking. This reinforces an awareness of how I’m moving overall and all the time. I’ve been working on “Rolling to Shoulder” where I’m trying to get more movement in my back/spine. As I roll up from flat on my back to a shoulder bridge. Slowing moving through the lower part of my back, taking each vertebrae individually; thus stretching, strengthening and using muscles that I don’t normally.

Learn to Run with AAA-Physio – 10km in Sub 40′

left-hip-drop-before-AAA-14km 

50% reduction in left-hip-drop-after-AAA-14km
50% reduction in left-hip-drop-after-AAA-14km
14km/hr – Spot the Left hip drop