Monthly Archives: November 2016

Knees – not just getting old? #13 – From 2 weeks after session 5 with John

Wed 16 November 2016

I started a 10-day trip today, to visit relatives abroad.  To begin with I was travelling for around 24 hours straight.  First I had a 4-hour coach ride, then a 9.5 hour flight, a 2-hour layover, a short 2-hour flight, and a car trip for around 1 hour.

I packed my foam roller for this trip, and did what I could to accommodate the periods when I knew I would be cooped up in a plane or car.  I had to arrive quite early at the airport before my first flight, so after the 4 hours on a coach, I spent around an hour walking around all the gates while wearing a small rucksack which was my carry-on luggage, to give the knee a bit of a workout.  I wore my new @asics running shoes for this, and probably walked 3 miles or so.

That walk proved to be a good move, and helped me cope with the long first plane flight.  There were lots of empty seats next to mine, and I was able to fully stretch out both legs while sitting across 3 seats at once, which was also helpful.

Despite these preparations etc, the knee did get stiff from all the sitting, and each time I would get up to stretch and move around a bit, it was sore.

I arrived at my first destination for this 10-day break, late on the evening of 16 Nov local time, which was a full 24-hour day after I had set off from home.  A quick foam roll on arrival left me feeling quite relaxed, and the knee felt relatively OK.  Compared to other similar trips I have made over the last few years, this one seemed much easier physically, and I put this down to foam rolling, as much as anything.

Thu 17 Nov 2016

On my first full day away, the weather was unexpectedly warm and sunny, so I had 2 walks, one in the morning that was around 1.5 miles, and the other later in the day, at around 3.5 miles.  I resumed the new exercises for the glute muscles (see blog #12), did foam rolling and all my other exercises as usual, and made sure to roll after the longer 3.5 mile walk which, unlike the shorter one, I did at a good pace.  I did not do any jogging or running at all during these walks, feeling that this should probably wait until I was a few days into the trip, after having walked a few more miles etc.

When rolling, I continued to note that the affected left leg IT band just below the knee was still no tighter than on the other leg, and any minor tightness was easily and equally “rolled out” of both legs.  This was a positive sign.

The new glute muscle exercises were working well – I could really feel the gluteus medius getting worked out on each leg, and my core balance gradually improved as I kept including these exercises over the next few days.  The glutes on each leg seemed to be in a very similar state to each other, but I did find that some of the other nearby areas where I had had muscle issues going back to earlier in the year (see blog #02), got more sore on the affected left side of the body.  My instincts had said I might find this, and it was one reason I wanted to do these exercises, as I thought it might help to trace any residual, possibly incomplete healing of those areas, and to address them.

My usual sleeping position while on my left side was still hurting the affected knee joint, and I had to keep using less comfortable positions instead, as over the previous weeks.

The soreness that had come on from the small amount of running we did in session 5 on Monday 14 Nov, had gradually worn off over the days that followed, as it has done on other occasions when I have done any running at all over the last couple of months – which has been rarely.  By the end of this week of 14-18 Nov, that soreness had more or less disappeared as would typically happen, except when I would be sat for any length of time, which again as experienced recently, led to the knee getting stiff.

Sat 19 Nov 2016

Today involved a 500-mile car trip, as a passenger only.  We stopped several times, and at each of those the knee had stiffened up quite a lot, and took some moving around to get it loose again.  Once we arrived at our endpoint – where I was to spend the next 2 days – I rolled and stretched, and the knee felt much better right away.  There was, again, no extra tension in the affected left leg IT band just below the knee joint.

I took a short walk later that afternoon, at a fairly brisk pace.  The knee felt OK.

Sun 20 Nov 2016

Having rested fully from the previous day’s car trip – and having been getting plenty of sleep since arriving a few days before that – I was ready to take a walk and try mixing in some light jogging for short distances.  The knee seemed relatively OK when I started the day with my usual foam rolling and exercises, including those for the glutes.  I had decided that this point, around halfway through my 10 days of break, was the best time to experiment with mixing in some jogging with a significant walk.  If it went well, great, and if not, I still would have a few days to recover before having to travel home at the end of the trip.

Around the middle of the morning I set off walking.  At first I did around a mile, but only at a brisk walking pace.  I then continued and began to do short stints of jogging and slow back to walking after very short distances.  These felt quite fine.  The body seemed to want more of this, so as the walk progressed, I just extended the distances of the jogs each time.  I didn’t track this in any way, just did what felt right.  By the time I had done over half the overall distance, I was jogging lightly for most of the time and only occasionally slowing back down to a walk.  There was no pain at all, and it actually felt really good to be doing this.  It was not as fast as I would have run normally, but that did not matter.

I tried to judge what my running form was like while jogging.  As far as I could tell it was reasonable, but I did find it difficult to really know.  I wondered whether there was any hip drop, but could not confirm this one way or another.  I doubted it.

By the time I finished, I was jogging slowly all the time and was not walking at all.  I probably covered something like 3.5 miles in total.

I had not prepared for this much of a workout, and was not really dressed for sweating, but as it was a nice sunny day, I had broken a light sweat.  I felt pretty good after this though.  I was wearing old clothes, so decided I would do foam rolling in them first, and take a shower afterwards.

Rolling also felt good, and the affected left leg IT band muscles just below the knee joint, again shown no extra tightness, compared to the other leg.  At this point I was thinking that, now that the previous extra IT band tightness had been gone from that left leg for several days, and the body had seemed fine with this first bit of adding in jogging, maybe the knee was finally on the road to proper recovery.

After a shower, I relaxed a the rest of the afternoon.  Within 2 hours or so, the knee had stiffened up and was quite sore.  This persisted throughout the rest of the day.

Mon 21 Nov 2016

I awoke to find the same soreness I had been experiencing on the day after any running done over the past several weeks.  I was limping badly as on previous occasions, and things like going downstairs were especially painful.

I wondered whether I had done too much too soon.  Maybe, but to be honest, I think I would have been sore even from just a small amount jogging.  The main thing was, the knee was clearly not settling down.

This was another travel day, a return trip of the same 500 miles from Fri 19 Nov.  Each time we stopped, the knee was very stiff.  When we arrived at our destination, after foam rolling and my usual stretches and other “later in the day” exercises, I took a walk of around 1.5 miles, going pretty slowly as the knee was quite sore.  The walk did loosen it up a bit, as my instincts had told me it might.

Fri 25 Nov 2016

I did not try any more jogging after Sunday 20 Nov, and took only  brief walks now and then over the several days after that.  The soreness gradually improved each day.  I kept doing the glute exercises as best I could (not at all on Mon 21 Nov, a few on Tue, more on Wed, and so on).

By this day Fri 25 Nov, the general soreness had retreated as usual, but the knee did still get stiff quite easily if I sat down for any length of time.  Also, as I have sometimes found over the past few weeks, I seemed to still have a constant limp when walking, even when the knee was not sore.

I took a more brisk walk during the morning of Fri 25 Nov, during which I was limping a bit for most of it.  As with all my other recent walking, I am fairly sure I was using the more correct gait as John had instructed me in our early sessions at MOTI, and I could feel both legs’ sets of glutes being worked equally, with each step.

By now I was also finding that bending the left knee was giving more marked pain, both on the outside part of the joint (where, since first starting to have these troubles, there has always been some degree of more acute pain than elsewhere in the joint), and even on the inside.  The inside area felt like muscles were being strained or stretched more than they liked, which is different to how the outside area has always hurt.

It’s worth noting that the general soreness that comes on by the next day after any jogging or running, has always been throughout the whole knee joint, and not just near the outside area where the more specific pains have been. That soreness has always felt like I sprained the knee, even though I have not.  But the pains just from bending the knee were there, even once the general soreness had dissipated, which by the end of this week, it had.

Sat 26 Nov 2016

This was my day to travel home.  It included a 1-hour car ride, a 2-hour flight, around 1 hour of layover, an 8-hour longer flight, some lugging around of baggage, then a 2-hour coach ride.  The longer flight was full on this return, and I could not stretch out as I had done on the outbound trip.  The knee continued to get stiff from all the sitting around, and the other pains that had been there over the last couple of days before this, also persisted.

Sun 27 Nov 2016

I arrived home late on this morning, following the longer flight, which was overnight, and the final coach ride.  I took care of some errands first thing after getting back, and then went to the MOTI store to buy another foam roller, as I had decided to leave behind the one I had taken on the trip, so I would not have to haul one over to there again, for any future trips.  MOTI did not have the same roller in stock, so for the time being I bought the more “advanced” version for a deeper roll – the one with the more uneven surface – until they could get the same, smoother one back in stock from their other branch, later this week.

Mon 28 Nov 2016

The knee continues to be painful when bending, and it gets stiff when I am sitting for any period of time.  Now that I am home again and have a known set of references such as my own stairs and living accommodation layout, it is clear from how it feels as I move around here, that it is in worse shape than before I went away on this trip.

I have decided it’s time to ask my GP if he will send me for an x-ray of this knee.  I don’t know if we may have missed something, and this seems like a prudent thing to do at this point.  The knee does not seem to be responding and is getting worse, and my instinct is that this may be due to structural anomalies of some kind.  They could either be from damage in the joint itself, which in a worst case scenario could even be permanent, or perhaps more likely, it is caused by the other muscle issues I suffered from on the affected left side of the body, going back to the start of 2016 (see blog #02).

If, for example, I still have left rib area and/or vertical fascia (sp) muscle problems around the left part of the waist – which doing the new glutes exercises seem to suggest may be the case – then perhaps these are still pushing my running and walking form towards hip drop, or they are affecting the knee joint more directly, in a similar way to hip drop.  If so, then even walking and running with the correct gaits may not work properly to enable recovery, until those other structural issues are fixed.

One reason I am thinking along these lines, is that experience has taught me that to some extent, the structure of anything determines how it can and will behave – and sometimes, if you just try and change the behaviour without addressing the underlying structure that gave rise to that behaviour, it won’t work.  I don’t know whether that is what’s going on with my knee, but I think we need more information about this.

I am even wondering whether I might have picked up a stress fracture somehow.  If not from the running over the last 15 years, this could conceivably have come about from table tennis, as once in a while I stomp my foot down when making a shot.  I am fairly doubtful about this, but it is one possibility.  I am also concerned about potential bone and/or cartilage wear on the affected knee.  If I have understood x-rays properly, any of this kind of trouble should show up clearly.  I do have a lot of miles in my joints from all that running, and have never had an x-ray of them.

For now I have deferred my upcoming appointment with John, until I have seen my GP on Fri 02 Dec.  I am told my GP is good with knee issues, and in the past I have always been able to work with him in relation to any medical issues, so I believe he will agree that we need to take a look at this using the standard x-ray technology that is available.

Tue 29 Nov 2016

I am now fully rested from my trip.  The knee continues to behave as recently.  I took my usual local walk for the first time in a while, and as well as limping a bit for all of it, doing a usual short, steeper downhill section made me limp more, as it has done for the last few months.

Fri 02 Dec 2016

Today I saw my GP about the affected knee.  I had printed off all these blog pages and handed them in at his health centre the day before, and he was able to scan them prior to our appointment, for background information.  I filled in a bit more details for him, and he did a brief examination.  He agreed with John’s assessment that it does not appear from visual inspection there is any joint wear, but he also agreed with my feeling that we need to do an x-ray on this, so he placed an “order” for that on the NHS system.

Later in the day I went to the BRI and had x-rays taken of the knee, in 3 positions: head-on while standing and with the knee slightly bent, side-on while standing with the knee slightly bent, and lying on my back with the knee bent at 90 degrees from top leg to lower leg, so each part of the leg at 45 degrees from the horizontal.

The NHS specialists will assess the results of these and pass their appraisal to my GP, who will contact me in around 10 days.  In the meantime I must wait.

 

Knees – not just getting old? #12 – After session 5 with John

Tue 15 Nov 2016

Last night I once again could not sleep in my usual position when on my left side, as the knee was too sore, following very short distances of running we did in session 5 yesterday at the MOTI store, along with a little running on the MOTI treadmill beforehand, to check out a new pair of running shoes.

Today the knee continues to be fairly sore.  I am limping due to this soreness, and going downstairs is especially troublesome, as it sometimes has been in the recent past.  It feels like I have sprained it, even though I have not.

Despite this, I am optimistic that this will settle down.  I believe that, having bought a new pair of running shoes which are giving proper support to the inside area of the left foot, the knee joint may now be having to make adjustments to once again being aligned properly and having the correct levels of stress and torque put onto it in all areas, as I move around in those shoes.

We discovered yesterday in session 5, that my old pair of running shoes were giving inadequate support to that left foot inside area, which was the cause of ankle turn-in that we had filmed going back to session 2.  This shoe wear probably developed gradually over the last few months, perhaps driven in part by the various issues I had been having, since the start of 2016, with muscles on the left side of the body – rib muscles, groin, and also a pain just below the waist on that side, all of which had most likely contributed to the gluteus medius muscles on that same left side “going to sleep”, resulting in the originally observed hip drop we also found in session 2.  The hip drop has improved significantly since then, enough that in session 4 around a week ago, it was almost completely gone, in films we took of me on the treadmill.  The fact that the ankle turn-in had remained and still appeared in session 4, had alerted me to the possibility that, as well as me having some physical issues to resolve, something else was up with the shoes themselves.  This has turned out to be exactly correct, which is one reason I bought the new pair of Aasics shoes yesterday at MOTI.

Yesterday evening I finished studying the details from links for various exercises to help recovery of the gluteus medius, and I took a look at the NHS “Couch to 5k” website.  I did not download any of the podcasts offered by Couch to 5k, but read through the outlines of each week of the 9-week recovery programme, to get an idea of what is involved.  It appears to mainly be a gradual increasing of the running portion of a combination of walking and running, from week to week.  For now I filed that information away for possible future use.

To begin with, I knew I needed to start some of the exercises to target waking up the gluteus medius.  I had already been doing one of these for around 3 days, “lateral leg raises” – you lie down on the floor onto one side, line the legs up with each other, and slowly raise and lower the top leg.  I increased the number of iterations and sets of this, to more closely match those recommended.  This is the only exercise that does not involve standing and bending the knee, which for me right now, has an “up” and a “down” side.  The up side is that I can easily do it, even when the affected left knee is so sore, which it certainly is right now.  The down side is that it’s not as effective as the other ones done while standing and bending the knee.  I decided it’s worth doing it anyway, and have kept it as a latest addition to the usual set of various morning exercises that I have been doing for many years.  It does work the target muscles.

I also added two further exercises done while standing on a stair, with a dropoff below it.  For me, I do these standing on the last stair coming down, the first one above the lower floor, and I have to stand side-on to the stairs themselves, to allow room for everything.

The first exercise is called “lateral step ups”, and involves standing with one leg unsupported, and slowly letting the hip drop down on that unsupported, “free-floating” side, then slowly raising it again – and all the while, keeping the gluteus medius muscle active, in the leg you are standing on.

The other standing exercise is “single leg squats” alternating with a “leg lift”, and is more challenging.  From a similar starting position to lateral step ups, you prep for doing a typical squat – you stick your backside out a little and begin to bend the knee – and slowly bend the knee on that leg more and more, while letting the other leg hang off the stair and go lower and lower, which means that foot ends up below the one you are standing on.  This should all be done while keeping the gluteus medius active, and if you are doing it right, the bending knee should remain relatively straight left-to-right, and in particular should not be rotating inwards.  You go down as low as you can while keeping this form, then straighten up again – and once straight, you slowly lift the other, free-floating leg up sideways and let it down slowly, for the 2nd, leg lift phase of the exercise.

The first time I tried these two exercises on the stairs, was yesterday evening.  For many years I have done my usual daily exercises while wearing flip-flops (with socks, so not the ones that go between your toes, more like sandals that go across all of the ball of the foot).  This partly contributed to my balance being all over the place at first, even when doing them on the unaffected right leg, whose knee was not sore at all.

This morning I decided I would try something new – for the first time ever, I wore shoes while doing all my usual exercises, and including these new ones.  I had been thinking about the old running shoes and their inadequate support on the inside of the left ankle, and had concluded that it might be a good idea to spend as much time as is practical wearing the new running shoes.  The difference in support of that left ankle area in the new running shoes is so marked when compared to how it felt in my old shoes, that I can easily detect it when just walking, or even when standing still.  I think this is quite significant.

Wearing the new shoes helped the body to begin to learn to balance while doing these stair exercises for the gluteus medius, and I was a bit was less wobbly on both legs.  An added benefit of wearing them was that it improved  foam rolling – done before anything else in my usual set of morning exercises.  My elbows had been given a hard time by rolling “shoeless” up to now, but I found the extra weight of wearing shoes acted as a counterbalance, which took some of the weight off my elbows as I rolled.  Also, the same extra weight meant I could get a deeper roll, than with no shoes on.

A couple of my usual exercises were not as effective with shoes on, so I decided that in the future, I would just start everything with doing them, before putting on the shoes.  They are all stretches for the achilles muscles on each leg, one set done while leaning on the top of the table with the hands and then stretching back each leg individually, pivoting the ankle joint back (sometimes it then cracks nicely), and the other set done also one leg at a time, standing flat-footed and then rolling back onto the heel, as far as you can.

That last one is my own invention.  I made it up to try and work the lower achilles a bit, after having had a sore one a few years back.  You can’t really tip back very far, as the body just doesn’t do that, so you won’t ever fall backwards.  But you don’t need to tip back that far anyway.  It’s a simple and quick stretch, and it has strengthened those muscles quite a lot since I started doing it.  I have had no further achilles problems since then, either.

Wearing the new running shoes, I was able to do my usual exercises as well as the new ones, despite the affected left knee being so sore.  I was on the verge of some pain at various points, and the most difficult exercise was one done lying on my back, with the knees up and the feet flat on the ground, and involving swinging both knees together to the left and right as quickly as you can, which is targeted to work the abdominal muscles, without risking the groin area.  Having successfully recovered nearly 15 years ago from a hernia operation, and with a tendency towards hernias running down the male line in my family, I cannot work the abs in standard ways such as situps, and so I was recommended this knee swing exercise as an alternative, by another practitioner I saw a few years ago.  For some reason, this exercise seemed to be especially hard to do today, and the affected knee hurt the most while doing it.

After finishing all these morning exercises, I had definitely worked the gluteus medius muscles on both sides, and could feel them a bit.  There was some other soreness up near where I had the persistent trouble just below the waist earlier this year, and some borderline soreness lower down, on the edge of the groin area.  I am not too concerned about any of these – if anything, they are probably a sign that the target areas are being properly addressed.

My instincts are that the current knee soreness will improve over the next few days.  As outlined above, this may be due to the joint, for the first time in a while, now being more properly lined up as a result of having run a bit in the new shoes, and so on.  But since our session 5 yesterday, I have also noticed two further things that are encouraging.  The first was while doing foam rolling both yesterday evening and this morning.  There has been tightness in the IT band muscles below the affected knee joint, which up to now has been there to some degree since starting to roll a few weeks ago.  They were very tight for the first 2-3 weeks of rolling, and less so since then, but it was still there.  It seems to be completely gone now, for the first time.  The second is that when I bend the affected left knee, it now seems to be cracking more similarly to the OK right knee, and more often – again, this is for the first time in quite a while.  If I am right about this, it may mean that the wear in the old running shoes, and the resulting left ankle turn-in,  has been a bigger factor in my knee troubles than we thought.

Either way, we will have to see how it goes.  I am starting a 10-day break from work tomorrow, and won’t be spending hardly any time at the computer at all.  Instead I plan to be more active than recently, by doing as much walking as I can stand to, and as advised, to mix in a little light jog for a few yards now and then, to start with.  I will be wearing my new running shoes to do this walking, partly as I think it will help the knee joint get “retrained”, for it to get used to having the proper support under that ankle for more of the time, and also because the new shoes are soft enough underneath, that I don’t think it will do any harm to do a few walking miles in them, instead of proper full-on running – which in any case, I believe is still some way off for me right now.

Finally, I took a closer look at my table tennis shoes this morning.  Running has bothered the affected knee the worst out of all of my exercising, resulting in it being quite sore for most or all of the day after a run for example – but table tennis has also been doing this, though not as much as running.  There is no evidence on the inside of the table tennis shoes, of uneven wear that might result in the left ankle turning in, as has been happening with my old running shoes. But there is extra wear on the outside, to the tread in that area.  This extra wear looks like someone sliced a 45 degree angle off the tread for a length of around 3 inches, at the “inside back corner” of the shoe, more or less where the left ankle area is.  I believe this strange wear is caused partly by the way I play table tennis.  It may be due in some indirect way to me being left-handed, for example.  In any case, it’s clearly time to buy a new pair of shoes for table tennis, to go with the ones I got yesterday at MOTI for running.  I will be looking into this after my upcoming break.

Knees – not just getting old? #11 – Session 5 with John – Mon 14 Nov 2016

Having worked out that I might benefit from having a new pair of running shoes, I was able to arrange a last-minute appointment with John for this afternoon.  I arrived early, and the MOTI staff helped me try on a couple of pairs of Aasics shoes, similar to the pair I had run in for the last 5 years.  We filmed me on the treadmill, running in my existing shoes, and in 2 options for a new pair.  Examination of stills from these films confirmed my instincts that the ankle turn-in happening when I plant the affected left leg, was due to my old shoe having worn differently in that area – neither of the two new shoe options showed anywhere near that amount of ankle turn-in, and the new pair that were closest to my existing ones in terms of how soft they were on impact, was the best of these options, regarding ankle turn-in.

I decided it was high time I bought a new pair, and so went ahead and had them.  When John was ready for our appointment for session 5, I was wearing these new shoes.  We examined the stills, and he confirmed our assessment that the ankle turn-in I had been having, was most likely down to shoe wear.

We only had half an hour for this session 5, so we decamped outside for most of it, and John gave me lessons on running technique.  This involved him firstly getting me to stand still and keep the back, legs and head all lined up (which for me in particular, meant tucking in my chin a bit), then leaning forward at the ankles, as though about to fall off a cliff.  Next he had me do some knee movements up and down while in this position.  Later in the session, this morphed into him having me use a “back-kick” motion while running on the spot, to prep for proper leg movement technique, when I would eventually set off.

We also focused on moving the arms.  This involved bending them at the elbows by a bit more than 90 degrees, and some practicing at swinging them back, as counterbalance to raising the knee on the same side of the body.  A few tries of this felt strange, and I had a bit of difficulty with it, but then he had me do a more “normal” running gait for me, which seemed to better incorporate the arm movements we were aiming for, at least at that stage.

We also covered landing more on the balls of the feet rather than doing a heel strike, planting each foot strike more in line with my centre of gravity when seen from the side, keeping my upper body stationary in relation to the rest of the body as I moved along (no up and down or side movements of the torso, for example), and so on.

Although I did find it difficult to put all these elements together at the same time, I felt that I had understood them as shown, and by the time we did a final short distance back to the running shop, I was showing some early signs of being able to do it all simultaneously.

We went back to the treatment room, and John brought up a couple of YouTube videos of runners demonstrating good technique, and sent me their links.  We studied these videos briefly, and a couple of sequences were particularly striking to me, one especially of a world class marathon runner (typical time 2:16) who ran barefoot for the demo – he had a very fluid style which I liked.  John also explained how energy is wasted by a heel strike, but is temporarily stored in the achilles muscles and is then available for re-use, when you plant using the ball of the foot, and then “take off” from it again.

To finish our appointment, I showed John the photo from blog #10 of my revamped workstation setup at home, and we spoke on this briefly.  After a couple of short stints at the computer, it’s already clear that I am spending much more of the time sitting with good posture, using the chair John has passed on.  The extra desk area for resting my wrists and forearms on, is also working well.  I consider it a breakthrough to be able to use that approach for the first time ever, as without any such  support, I previously had to have the top of the desk significantly lower, or my arms would just get tired.  This way, I am able to better accommodate having both long arms and long legs, without needing to do something so ridiculous about the heights of either the chair or the desk, or both, in relation to each other – and also, with more typical heights for everything, my forearms are now parallel to the floor, which is preferred.

My next session with John will be in a little under 3 weeks time, so a bit more gap than recently, between appointments.  Until then I will be starting up on exercises to target the gluteus medius muscles that have been in need of waking up so as to completely cure my hip drop, mixing some very short distances of jogging in with walking, studying the YouTube videos of good running form, and looking into the NHS “couch to 5k” information that John recommended in our previous session 4 last Friday.

I also want to find a new pair of shoes for playing table tennis in, because examination of my existing pair suggests that they may also have worn unevenly, like my running shoes did – and this certainly won’t be helping my knee issues.

Since our session 5 a few hours ago today, in which I did only a few minutes of running, the knee has been a little sore.  I think it shows that I am still a ways off being able to run for extended periods, which we already knew.  It’s one reason John has recommended a gradual approach to getting back to my normal exercise routines.  I fully concur with this.

 

Knees – not just getting old? #10 – Between sessions 4 and 5 with John

Mon 14 Nov 2016

Last night, I was able to resume using my normal sleeping position when on my left side – the one that was making the affected left knee sore over the last few nights.  This is the first time I have been able to do this for over a week.  Yesterday I also walked around downtown Bristol quite a lot while shopping, and after our session 4 last Friday, I also did a bit of extra walking and even mixed in a few light jogs for very short distances, as John had advised during the appointment.  These things are probably not having as much impact as what I will get from doing exercises to target the pelvic muscles, including the gluteus medius.  But I hope to have researched those exercises later today, and should then be able to start them after that.

Following session 4, I had more things to do with my workstation setup.  I took home the chair from his treatment room that John had let me have on sale or return, and began to think about how I might best be able to experiment with adding some extra top-of-desk size, to allow resting the wrists and forearms, while at the computer keyboard.

When I got the chair home, I compared its height to that of my existing chair, the green one with which I had recently been using the green cushion also.  Adding some “risers” I happened to have, under John’s chair so as to get the heights to match, I learned that when sitting on it with no risers, my pelvis would be around 25mm (1 inch) lower, than when sitting on the green chair but without the cushion.

I put my new webcam on, and took a proper look at this from its side-on view, partly to see how different the heights and angles of my legs were.  Having decided to leave out the green cushion from the new arrangement, I had instead already opted for putting a folded-up towel under my pelvis while sitting on this new chair, to get some extra height for that part of the body, above my knees.  With all this in place, I then also checked just how my arms looked in relation to the desk and the computer keyboard.

I had never paid much note of what the arms looked like before, and had always just made height adjustments to chair and desk, based on how they felt as I used a computer keyboard.  What was interesting and unexpected was that my forearms were sloping just slightly downwards, towards the computer and the desk.  This meant that although the arms were close to being at the optimum angle as John had advised me in an earlier session, working at that desk and chair height as I had been doing for some time – with no support for the wrists or forearms –  meant that my arms would get tired more easily.

I realised from this, that it was possible I might find it less tiring on the arms to have support as John had recommended, despite then working with the desk higher than before, relative to my lower body.  I quickly measured up and worked out that I easily could do a simple experiment involving the addition of a piece of wood as an “extension” to the top of the desk, and that I could clamp it to the existing top.  Due to how I already had the various bits of equipment arranged, (laptop sitting on height-adding box, telephone, lamp, and external keyboard and mouse switch), and without having to make any specific adjustments, I would not need a piece of wood that went all the way to the back of the desk’s top area, and instead could have one that was more “shallow” than that.

I measured up, then had cut and bought a piece of 9mm plywood and clamped it into place, and tried using this for a couple of hours or so.  It was less tiring to have the support, and it was clear I might be able get used to this arrangement.  There were some drawbacks.  I had to hike my pullover sleeves up to the elbows, as otherwise they kept getting in the way as I slid my arms about for things like moving the mouse.  Also, even though I had sanded it very smooth, the plywood was not as slick and made moving the mouse harder work, and I also noticed this on my wrists and forearms.  Even so, I was convinced that, with some further finishing touches such as varnishing the wood, this was probably workable.

Here is what my workstation setup now looks like, with John’s chair and with the new plywood support for wrists and forearms, as yet “unvarnished”:

nelson-setup-johns-chair-desk-top-extension-cropped

Since session 4 last Friday, I have had one thought about something we covered during the appointment.  The “turning in” of my left ankle was still noticeable from the films of me doing light jogging in that session, despite the hip drop being much improved.  John had examined my shoes but was not able to draw any firm conclusions about whether there was “uneven” wear between the left and right shoe, which might explain this continuing ankle anomaly.  It had occurred to me that if this turn-in was in fact the result of my running shoes being some 5 years old, we ought to be able to compare this to me doing the same movements while wearing a new pair of MOTI shoes.

I checked John’s availability and found that he still has a slot free early this afternoon, and after speaking to the MOTI staff, decided to book that time with him, and to turn up early so they can help me find a suitable new pair of running shoes for doing this test.

Knees – not just getting old? #09 – Session 4 with John – Fri 11 Nov 2016

We began this session by me getting onto the treadmill, so John could check my walking posture.  Despite my reservations since our earlier sessions about whether I was indeed learning and doing it properly, John’s assessment was that my walking gait was much improved, and he was encouraged by this.  The hip drop was much less and was nearly unnoticeable, and I was using the glutes properly on both sides.  Although I had been thinking I had gotten the hang of doing this, I was doubtful because the knee issues had persisted, so evaluation by John’s independent viewpoint, and with his expertise, was helpful.

After filming me while walking briskly on the machine, John suggested we try to transition this to a light jogging gait, to see how that went.  It seemed I was able to do this reasonably well also, with little or no hip drop.  John filmed this also.

Looking at some of the filming showed that when jogging, my left ankle was still turning in slightly, despite there being less hip drop than before.  We discussed the insole I wear in all my left shoes, to make up for an apparent 11mm discrepancy in my leg lengths.  John examined the standard inserts in each running shoe, the left of which also had the insole attached on top.  He also checked whether there was any evidence of the left shoe having worn differently over time, to the other one.  He did this not just on the underside of the shoe (the “tread”), but also he played about a bit to see whether adding some “torsional rotation” to each shoe (sort of “wringing” out the shoe), suggested any possible difference in internal wear, between left and right.  They seemed about the same as each other, so as a possible cause of my left ankle turning in, the shoes themselves could not be confirmed one way or the other.

Despite this, it is worth nothing that this pair of running shoes are now 5 years old, and even though they seem OK, I might benefit from replacing them with a new pair.  This is something I have filed away for the time being.

After this we relocated to John’s treatment room to continue the session.  The next thing we discussed was the possibility that I could have one of the chairs from his treatment room on a sale or return basis, for my home setup, as John had one to spare.  I immediately said I wanted to do this, so I could at least try it out at home.  We finalised the arrangements on this, and it was agreed I would take the chair away with me when we finished our session.

John also commented that in terms of my home workstation, he thought I would further benefit from adding several inches of “overhang” to the desk, onto which I could then rest my wrists and forearms while at the computer keyboard.  This was something he had brought up in an earlier session.  At that time I did not think too much about it, partly because I was in a relatively inflexible frame of mind about my workstation.  But this time John also said that being able to rest the wrists and forearms would reduce the amount of tension placed onto the head and neck muscles.  I filed this away for further consideration.

We spoke briefly about the website links I had sent John, on hip drop.  He confirmed that I could do any of the exercises outlined in these, to assist recovery of proper muscle function.  We returned to this topic again later.

Next John got me on the treatment couch, where we looked at my “uneven” leg lengths.  With me first lying down fully onto my back, he checked my legs and reported that they were within around 3mm as long as each other.  Although this is quite a lot less than the 11mm of insole height I have been using in all footwear for the last 5 years, I was not surprised.  He then got me to relax and get positioned into the middle of the couch, and then to move to a sitting position, while he held onto each ankle and used his thumbs to mark a similar point vertically on each one.  As I sat up, I could feel that the differential between the two feet changed, with the right one ending up a few mm longer again, than the left.  John also observed and commented on this.  We took this further in the direction of me standing up, and the discrepancy increased again.

I had already known that something like this might be in play, from my assessments by the other physiotherapist who originally discovered my unequal leg lengths 6 years ago (see blog #01).  That other specialist had done a similar check of my arm bones, as I had told him my right arm seemed to have over an inch lower reach than my left one – yet measurement of those arm bones had shown they were within 1mm of each other.

The upshot of all this is that, as least in my case,  it is not the bones themselves that are different, but the combination of bone, muscle, tendon, cartilage and other tissue, taken together with what position the body is taking, at any given time.  For me, this holds true for both my apparent unequal arm lengths, as well as leg lengths.

John commented in our session, that perhaps over time, as my running, walking and sitting posture improves, these discrepancies might improve also.  Even if they do not, it is good to know that for the legs, it is what I might call a “semi-dynamic” discrepancy, in that it changes with different body positions.

I was satisfied for now with knowing this, partly because I had come to believe in my own mind that the hip drop is more likely to be a result of the rib area troubles I had in early 2016 (see blog #02), as opposed to being an outcome of something going on with my insole size and/or the leg discrepancy.

We returned to possible exercises, and to how I might best move forward from this point, with recovery.  John was encouraged enough by my progress to recommend that I could mix a little light jogging in with normal walking.  He suggested I could do this by moving to a jog for short distances such as between two lampposts, then return to walking.  He advised that this is probably better than trying to go back to a full-on run of my usual distance of 4 miles, which I had been feeling was more or less out of the question right now anyway.  He then mentioned an NHS website for me to look into, “Couch to 5k”, which includes a programme of recovery that I might benefit from working to, perhaps starting partway through it as, in his opinion, I am already maybe halfway along that kind of path to being fully recovered.

John was optimistic about where we are and thought I am not that far from being able to do proper running again.  I said I was not so sure, because of the ongoing issue with the knee getting sore in one of my usual sleeping positions, and with how it is feeling generally.  Although I did not mention it at this time in our conversation, or at any point for the rest of our session, my recent experiences with table tennis had also led me to feel that the knee may take awhile to heal up.

We ended this session 4 by me showing John where the rib troubles had taken place around the start of this year, and explaining how I had come to believe that they may have led to me ending up with hip drop, after 14 previous years of running with no issues of that kind at all.  In short, I felt that I might have suffered from a rib muscle tear while coughing deeply and repeatedly in January of this year, after which I began to have pains in the groin area – at random times as well as when coughing or even when sneezing – and eventually after which I also began to suffer from a soreness just below the waist, on the same affected left side of the body, for which I had taken around 4 weeks off from running and had then begun using Kinesiology Therapeutic “KT” tape, which had enabled me to resume running.

I told John my belief is that all of these issues with muscles nearby, may have put extra demands onto the “gluteus medius” muscle on that side, one of the muscles above the hip joint which, when it has “gone to sleep”, leads to hip drop.  I thought that maybe that muscle had lost proper function during walking and running, and was still not recovered from this, even though all of the other problems – rib, sore groin and waist area soreness – had more or less cleared up.

John said that he thought this was fair comment, and this concluded our session.  I arranged to see him again in early December, some 3 weeks on from this session 4.

 

Knees – not just getting old? #08 – Between sessions 3 and 4 with John

Tue 08 Nov 2016

There was much to think about and try out after my 3rd session with John on Fri 04 November, in which we had covered many aspects of how I sit at the computer while working at home.  I had some things to measure up and compare to our 3rd session notes, a photo of me sitting with more ideal posture to try and emulate, and further things to think about concerning the chair, desk and so on.

Since our previous session 2 just a few days before the 3rd one, I had been keeping an eye on how sore the knee joint was feeling, from day to day and following various levels of activity and inactivity.  When I took a walk in late afternoon after session 3, I noticed that there did seem to be some improvement in my tendency to limp more when walking downhill.  This was the first time I could really say it was any better, though just why that was the case at this stage, was not clear.  I thought it might be because I was applying the more correct way of walking, at least in part.  Either way, I decided to play table tennis again that evening of Fri 04 November, to see how that felt in comparison to a relatively short (for me) one-hour playing session I had had a few days before.

Once again I played table tennis for only around an hour.  The knee behaved similarly to how it had when playing a few days earlier, except that movement to the extreme left was not giving as much knee joint pain as in that previous session.  Also I noticed that both before and after playing, foam rolling had one significant difference to recent “rolls”: the IT band muscles just below the affected knee joint, were not as tensed up as they had been.  This was also a first sign of those muscles perhaps settling down at long last.  All the other muscles being targeted by foam rolling, had already loosened up by about a week before this, and most of their knots had also disappeared, with only the affected IT band muscles still holding out, up to this point.  With them now showing signs of finally letting go of their tension, this foam rolling progress was encouraging.

The day after table tennis and my 3rd session with John, was Sat 05 November.  Despite all the encouraging improvements as above, the knee was still sore for all of that day, clearly brought on by the table tennis.  When I took my usual walk that afternoon around part of a local park, to practice the walking techniques covered in session 2 with John, I was not limping perhaps as badly as in the past, but the knee was still sore.

Over the next few days, the soreness improved a bit each day, and walking varied from sometimes including a slight limp,  to being generally better than when it had been at its worst.  The variation in the limp came and went, rather than moving consistently in one direction or the other, but overall I would say the direction of travel was that things were better.  The IT band also continued to be more relaxed each time I would foam roll, than it had been up to 04 Nov.  I usually roll twice a day, or 3 times if running or playing table tennis – but I did not do either of those things after 04 November, so have been rolling 2x daily from then until today 08 Nov.

The one thing that did not seem to improve, was that I continued to have to adopt a different position to normal when sleeping on my left side, as the normal one was still leading to some pain in the affected knee joint.  Also, in general I felt that even though applying the walking techniques was perhaps making some difference to the limp, the knee was still subject to getting sore if I were to do anything too active, and some movements would still bring on pain as they have done for several months, and also, a period of inactivity for any length of time, continued to sometimes result in the knee getting stiff.

My instincts from all this were that I should stay away from running or table tennis for awhile, and give the knee a chance to heal up a bit.  Even though there doesn’t seem to have been a trauma event per se, in some ways it behaves as though there has been one – and it might take a while for the tendency to get sore, to completely clear up.  Until the hip drop is fixed in my running technique, doing that is very likely to make the knee quite sore again.

If anything can be concluded about the knee soreness, the limp, the IT band and the pains when sleeping, at this point I can only say that the relationship between all these things is not a clear-cut one of cause and effect, nor is any of those things fully dependent on any other one.  Rather, they are all connected and related, but they also have some independence from each other.  In other words, the limp can be better on one day than on the previous one, yet at the same time, the knee can be more sore than on the previous day, and so on.

I still have questions about possible key physical structural changes that might have given rise to my “left leg plant hip drop to the right” as filmed in session 2 with John on Mon 31 Oct, and which might thus be the original and potentially continued cause of my knee joint problems.  I still find it hard to believe that I could have run for 14 years with no issues at all, as I did up until the start of 2016, if I had had that hip drop during that time, or even for only the latter period of it, before the start of the year.  This leaves me wondering what has led to that hip drop.

The two possible physical structural changes I am thinking of that might explain it, are summarised by two bullet questions from the list I included at the end of blog #06, a list I left with John at the end of session 3:

  • When I do the “banana” stretch (see blog #02), there is a big difference between how it feels on the left, affected side of the body, and the right side. It feels as though there are less muscles between the waist and the shoulder being stretched on the affected side, than on the other one. Is it possible that the original rib problem from early 2016 (see blog #02), and/or the waist muscle/tendon issue that developed after that – which might have been a result of the rib issue (also blog #02) – has left me with continued, missing muscle support on the left side of the body, between the waist and under the left arm, and that this is causing the hip drop?
  • The insoles to correct the leg length discrepancy, which I wear in the left shoe of all footwear (see blog #01), have so far been made up to be a uniform height from left to right, when looking at them from the back. Could there have been any new, left-to-right change to the leg length discrepancy / structures etc, which now requires addressing through a different type of insole that is not the same height from left to right, for the first time in the 6 years I have worn one?  Could this have anything to do with the hip drop?

One reason I continue to wonder about all this, is that even though the knee soreness is all around the knee joint, the more acute pains sometimes felt, when in extreme positions for example, are always on the outside of that left knee joint.  Also, when I bend down such as when doing “squats”, the right knee joint seems to “crack” normally, but the left one hardly does at all.  Instead – such as if I bend down and stay down – something clicks at bit at a late stage, after I am already fully “bent” at the knee: this is something on the outside of the affected left knee, and I don’t think it is normal.  It has been happening for several months, since I started having all these limping issues which, at first, were very minor and so were hard to identify as being associated specifically with the left leg at all.

I am confident that John will be able to clarify whether there is any relationship between all these other physical things I have noted and the hip drop, and if not, that we can then rule them out and I can forget about them.  For now they remain in mind though.

As for my homework from session 3, I stewed over all the details John and I had covered in that session, on sitting techniques.  I tried out my revised home workstation setup, including the newly upholstered cushion, and I had a good idea about a way to help me learn to sit correctly, which I hope to implement in the next day or so, once a delivery arrives that should be here tomorrow.

After a few days of using it, it is clear that my now-upholstered cushion is not ideal and, among other things, has a little too much play sideways and forwards / backwards, as I sit.  John mentioned in session 3, that he thought the cushion might not be stable enough.  It behaves a little differently with this home setup chair, to how it did on the office chair I sat on, with no issues, for over 10 years.

I have also checked the height measurements of my current home setup, to  see how far away they are with me sitting there, to the ones John had noted down in session 3, once we had arrived at a more ideal sitting position as in the photo of me above, in this blog #08.  The height differential between the pelvis and knee joints is about right as I sit at my home workstation, but with the new footrest in place, I am perhaps now sitting a bit too “low” relative to where my feet are.

I have given some thought to making further modifications to this same chair, to see whether I could come up with any good ideas.  All the things I have thought of involve adding height back in, but also I know I would need to do something about the “front-to-back” depth of the seat, which on this chair is not enough for my long legs.  I have begun leaning more towards seeing whether I can find the same kind of chair as John sits at in his treatment room, the one with the larger, square seat and curved backrest.  Sometimes you cannot fix a structure that is badly designed in the first place, and instead you must use a different structure that is more fit for purpose.  This might be a case in point.

I did have one brainwave about my current setup, which was simple and clear, and which I immediately decided to apply.  I realised that the wooden dowels I have been using to support the weight of the equipment now stored on the small shelf under the top of the desk,  would not be needed, if I were to use quite strong square tube “box section” metal to support the underside of the shelf.  As well as meaning I would not have to keep fiddling with the lengths of these two wooden dowels any more if I made further adjustments to desk and/or chair heights, doing away with the dowels altogether would completely free up all the leg and foot space under the desk!  I really liked this idea, and yesterday Mon 07 Nov, I went ahead and made these changes.

The underside of the shelf now looks like this:

nelson-home-setup-wooden-dowel-supports-for-shelf-replaced-by-box-sections-resized-pic

With no dowel supports in the way of my legs and feet any more, the whole setup now looks as below.  Note that this pic is taken from a bit high up, so both the desk and chair look a bit narrower than they really are, though in truth, the image is not skewed by that much:

nelson-home-setup-after-cushion-ready-and-box-sections-not-dowel-supports-resized-pic

I am fully prepared to abandon this chair in favour of the same kind as John has in his treatment room, if they are still available from somewhere.  John is looking into this, so I await news from him.

Wed 09 Nov 2016

Last night I had to sleep in alternative positions again, when turned onto my left side .  The knee is less sore today though, and during the usual after-lunch walk, I was limping a bit less than yesterday.  This confirms that there seems to be short-term benefit from not doing any running or playing any table tennis right now.

Today some technology arrived – I had ordered a new wide-angle webcam, with which I can now do “live monitoring” of my posture while at the computer, from a side-on view.  By arranging the photo  from session 3 as posted in blog #07, the one of me sitting with fairly good upper body posture,  so that it is right next to the webcam display on my computer screen, I can easily move from whatever normal work I am doing on the computer, to quickly checking my webcam posture against the photo.  With a simple small download app to run the camera, I can do this even while offline.  Below is a sample comparison of the session 3 photo and the webcam view of me a short while ago.  This is a “screen print” of what actually shows on my computer screen, which is what I am looking at, below right.

nelson-session-3-sit-pic-vs-live-webcam-image-at-the-computer-cropped

The webcam is positioned lower than John’s camera when he took the session 3 photo on the left, so my lower legs look comparatively larger in the webcam image.  That image also has some diminishing perspective as you look upwards, and to the right.  But otherwise, the viewing angles of everything in these two images are close enough to each other, to use for comparisons of my posture, in this side view.

One thing immediately emerged from doing this, and from a bit more measuring up.  It was clear that, while sitting on my green chair at home as on the right and while using the cushion, the 27mm of footrest height I had added to the floor area underneath, was not needed – so I removed the footrest and then took the screen print above.

When I am sat as in the webcam image, the height differentials are about what they ideally should be, between the knee joints and the pelvis.  Having been trying out the footrest and cushion for a few days, and then seeing how it all felt for a few hours after removing the footrest today, I reluctantly have to admit that I don’t think the footrest is needed at all, while I sit on this chair.

It also has occurred that, if I do move to using the same type of chair as John has in his treatment room, the extra support it will give my legs at the “front” of its seat, will probably mean that the upper leg angle as above, which I make out to be around 13 degrees from the horizontal, may end up being too much slope, and may put extra pressure onto the backs of my upper legs, at the very front part of the seat.  If I am able to change to that kind of chair – which I am still hopeful can be done – I will just have to experiment with all of that, with heights and so on.

In the meantime, I am now in a position to actively check my posture in this new “external” way using the webcam, which I think will be a big help to being able to re-train myself to sit more correctly, more of the time.

Thu 10 Nov 2016

Today I did some research on the internet, concerning hip drop.  I found 3 good sites that explained what hip area muscle groups are key to addressing hip drop when you have it, and various exercises that can be done to target “waking up” those muscles again, when they have become disengaged and this has led to hip drop.

After learning quite a bit more about all this than I had known beforehand, I became convinced that the original rib problem that had developed in early 2016 (see blog #02), might be much more of a factor in me ending up with hip drop, than I had thought.  Among other things, one cause mentioned by one of the websites for hip drop, is when there is injury trauma and/or muscle tear of the “gluteus medius” muscle, one of the ones above the hip joint.  The original rib issue from early 2016 was to muscles very near to this one, and my feeling was that perhaps the gluteus medius had ended up having to do the work of other nearby muscles, which could have resulted in it struggling with its normal functions during running.  I decided to bring this up with John in our next appointment.

Of the various exercises recommended on these websites, one was very close to a leg lift exercise I have been doing for the last few weeks, which I had come across in a site on how to foam roll.  I decided to modify it to match the version for targeting hip drop.  These links and their information on hip drop seemed really good, and I forwarded them to John so we could discuss them in our upcoming session.

 

 

Knees – not just getting old? #07 – Session 3 with John – Fri 04 Nov 2016

Today we covered many things related to sitting at the computer.

I had picked up the refurbished cushion for my home working chair (see blog #06), just before our appointment.  After some general demonstrating about sitting on various chairs of differing heights in the treatment room, John adjusted the treatment couch until, with me sitting on it and also on the cushion I had brought, the height was about right, based on his assessments and on recommendations for dynamic sitting, from his website.

As the session progressed and he helped me make adjustments to my posture, he took photos.  Also he noted down key height measurements, for me to use for comparison to my home setup afterwards.

The biggest adjustment for me when sitting at the computer, is to get the shoulders back, instead of having “computer hunch”, and probably the next biggest is to straighten up the neck and head, as my head tends to lean forward.  After John’s various tweaks to how I was holding myself, I ended up looking as in the pic below, which is a relatively good result in terms of everything being aligned:

nelson-on-treatment-couch-04-nov-2016-session-3-posture-more-improved-after-js-tweaks-screen-print-try-2-cropped

As well as showing how the more correct posture is more stable, is lined much up better vertically, and means I am naturally distributed more evenly across my centre of gravity when seen side-on, John did a comparison of finger, thumb and arm strength of resistance to him pushing the other direction.  He did this while I was in the more correct posture, once on each arm, and then I returned to my typical, poor posture and he repeated this test.  I was quite strong in both arms and hands when sitting properly, but definitely not, with my more typical posture.  A similar test with him pushing against the side of my head in both postures, gave a similar result.

About 35 years ago, I read a book on Alexander Technique, and tried to “self-apply” the principles in an office job I was doing at that time.  I had found it difficult to get the hang of, and never fully made the transition to better posture.  Even so, I still remember what it felt like.  John’s way of sitting as he taught me in this session, was very close to that from the Alexander principles.

We talked about optimum chair heights, “depths” (chair length from front to back), keeping the hip joint a little higher than the knee joint, and so on.  He showed how the simple addition of a folded-up towel under the seat just by the backrest in a chair, with the towel folded into 8 towel “layers”, can end up making it more comfortable to sit on, and will also promote better posture.

As well as recognising the value of sitting as in the photo above, the most significant thing I took away from this session was that the chair John usually sits in in his treatment room, one with a larger, “square” seat shape and a curved backrest that only comes up around 10 inches off the seat, felt more “right” and significantly more comfortable when I tried it out, than the one I currently sit on when working at home.  I think this was because the extra “depth” from the front of John’s seat to the back, meant that my relatively long upper legs were supported for more of their overall length, than when sitting in a normal chair.

My homework from this session was to have a go at learning to sit more correctly, more of the time while working at the computer.

Knees – not just getting old? #06 – Between sessions 2 and 3 with John

Wed 02 Nov 2016

After just 2 days, I think I have the hang of walking more correctly as shown.  It does feel different, and the glute muscles on each side seem to be getting worked the same amount as each other.

I decided to play table tennis yesterday evening, the first time for awhile, partly to see how the knee felt during and after it, and also because I have not been getting enough exercise recently.  An hour’s playing was enough.  Movement was restricted.  Today the knee is more sore, but maybe not as bad as after previous table tennis sessions – although that could be due to me having a shorter session at it than usual.

As I began working at the computer yesterday, after all the mods made to  that setup from the last few days, my glutes quickly got sore.  I emailed John and he suggested looking at Gaby’s blog and her seat alterations (http://www.physiotherapy.co.uk/blog/?author=857).  She has added a pillow under her seat, as well as one behind her, and that 2nd one means  she is now sitting up more upright than before.

Today I decided to follow Gaby’s lead and further tweak my chair to have a go at the glutes trouble, by adjusting the backrest angle so it’s more vertical, instead of sloping back.  This just needed 10 washers adding, 5 on each side, to the top pair of bolts on the back of the chair – total cost 40p.  I have done a full days’ work today after this change, and the glutes are definitely less sore than before.  Why this simple adjustment makes so much difference, I cannot say, but it does.  Here’s the difference in the angle of the backrest, before and after this change.  Doesn’t look like much, does it?

nelson-chair-backrest-angle-before-tweaks-cropped  nelson-chair-backrest-angle-after-tweaks-cropped-final

Before I started working from home at the beginning of this year, I had been sitting in the same chair at work in various offices for about 10 years, with no sore glutes troubles of this kind.  I still have a 2-inch thick foam pillow I used to sit on, and I might try adding it to this seat in my home setup, as I think it might improve things with that issue even more.  After all the other mods,  I am now sat a little low for the keyboard height anyway, and the pillow would help with that also.  It might mean I end up needing some footrest height added onto the floor to prevent the legs from having more pressure put on them due to sitting a bit higher off the floor again, but as outlined above, some footrest height is something I have been considering anyway.  This seems like an ongoing process, but it is definitely going somewhere!

Fri 04 Nov 2016

Yesterday I decided to go ahead with adding a seat cushion to my chair and desk setup, and to add some footrest height underneath the desk as well.

I got out the seat cushion I had been using for years up until starting to work from home this last January.  Until the last few days, I had forgotten about using that cushion all  those years.  I had never had sore glutes while using it, but this key point had gotten lost in the transition to working at home.  I realised that it was time to put it to use again.

The pillow cover was pretty worn out.  I had some material left over from having my home chair upholstered, and was able to arrange for the upholsterer to do me a new cover from that, which should be ready later today.  In the meantime I bought a new piece of foam of the same thickness, supposedly also the same softness.  When I tried sitting on it, the new piece of foam was did not go down as much as the old one.  I had bought the same size new foam as the old one, so this difference in softness is actually helpful, because now I will have the option to swop or keep the old foam, once the new cushion cover is ready.

Before leaving the old cushion with the upholsterer, I did a rough measurement while sitting, to see how much height would be added to my sitting posture by including the cushion, compared to not using it.  This was around 20mm, so I decided to raise the desk height again by that amount, in order to keep the computer keyboard at the same height relative to my arms, once I am sitting with the cushion.

I had concluded also from the last few days, that it was time to experiment with some footrest height, to try and get the lower legs more parallel with the ground when sitting down, and to thus take a bit more pressure off the hamstrings.  As I was about to add 20mm of sitting height to the chair via the cushion, I knew I needed to add a minimum of that amount in a footrest in any case, or else I would end up with the seat too high again, though not by as much as it had been before all  these modifications of the last week or so.  In the end I opted for using a 27mm thick piece of solid pine for the footrest.  I measured everything up and did a scale drawing of a “trapezoid” shape for the footrest, that would do two  things at the same time:

  • give my feet adequate lift off the floor in most sitting positions I would be likely to adopt; and
  • allow pushing the chair up under the desk by the same amount as it can currently go, without any footrest under there.

I already had some thin wooden dowel “supports” under the desk, taking the weight of the shelf that hangs under the top of the desk.  With the footrest in place, I measured up and then chopped these dowels down to the  new correct height, drilled through both footrest and each dowel, added a screw from underneath for extra strength, and taped up the tops of the dowels for strength up there.

I’m not a keen DIY person, but am fairly proud of the results of all this.  Having tried it all out using, for now, the new foam as a cushion, I find from sitting at the desk this morning, that this is very close to being just right.  My glutes are not getting sore at all, either.

Here is a photo of what it all looks like now.  The “softer” cushion, with the same nice green material as the seat and backrest cover, should be ready later in the day:

nelson-home-setup-after-desk-raised-again-and-new-footrest-resized-pic

So after all these mods, my workstation is much closer to what I think it needs to be, to allow comfortable working that hopefully won’t contribute any further, to the various physical issues.

Here are the questions I am bringing to session 3 with John later today.  The first couple cannot be verified, but are included as I think they are pertinent:

  • How long have I had the “hip drop” when planting the left foot while running ? (this question cannot be answered for certain, as there is no film or photos of me running, until the 31 Oct ones from our first appointment)
  • What did my running look like at the start of 2016? (this question cannot be answered for certain, as there is no film or photos of me running, until 31 Oct ones from our first appointment)
  • I ran for 14 years between autumn 2002 and the end of 2015, without any of my current problems. Does that suggest I did not have the hip drop then?
  • If I didn’t have the hip drop before the start of 2016, what has led to it – what has caused it? What structural or other changes have taken place, that have resulted in this? Do they need to be addressed?
  • When I do the “banana” stretch, there is a big difference between how it feels on the left, affected side of the body, and the right side. It feels as if there are less muscles between the waist and the shoulder being stretched on the affected side, than the other one. Is it possible that the original rib problem from early 2016 (see my blog #02), and/or the waist muscle/tendon issue that developed after that – which might have been a result of the rib issue (also blog #02) – has left me with missing muscle support on the left side, and that this is causing the hip drop?
  • Over the last few days, I have had a return of some minor neck pains (see blog #01), usually later in the day and not noticeable when starting the day. This is the first time in quite a while, and they have always been associated with issues regarding my legs being different lengths (blog #01).  After 1 year of wearing 8mm insoles starting in 2010, the leg discrepancy had shifted to 11mm, and I had to change all my footwear insoles to that height. Could there now be more change happening? Is John able to measure me up to check whether the discrepancy has changed again?
  • The insoles to correct the leg length discrepancy, which I wear in the left shoe of all footwear, have so far been made up to be a uniform height from left to right, when looking from the back. Could there have been any new, left-to-right change, which now requires addressing also, for the first time in the 6 years I have worn an insole?
  • Is it possible that doing very much less running than usual, almost none for the last few weeks, is affecting my body in such a way that is giving me these neck pains, by impacting on the leg discrepancy etc?
  • For the last few days, I have been finding I cannot use one of my normal sleeping positions – on the left side, knees bent, right leg on the affected left leg and offset so the bony parts nestle into the spaces – without the affected knee joint starting to hurt. This happened before, when I had been quite sore for 1 to 2 days after one of my last runs, in early October (see blog #02). For the last few days the knee has not been not as sore as it was at that point, but this pain in that sleeping position is significant enough that, as during that period, I have to adopt less comfortable positions to sleep in. Is the knee getting worse, even though all I have done for vigorous exercise in the last few days, is an hour of table tennis?

Having written all this up, I am ready for session 3 with John later today.

Knees – not just getting old? #05 – Session 2 with John – Mon 31 Oct 2016

As advised, I turned up at this appointment wearing my running gear.  We started out with John giving me a “Patient-Specific Functional Scale” form to fill in, where I entered 3 targets I wanted to achieve from our treatment, and scored where I currently am in relation to each one, with 0 meaning it has been achieved, and 10 meaning I cannot do it at all, etc.  I was easily able to come up with these, and to score them:

  • to be able to run and play table tennis as normal, without being sore the next day (score 10);
  • to be able to walk without a limp (score 6 to 7); and
  • to be able to work at the computer at home comfortably for extended periods (score around 8).

We discussed the last of these a bit.  It did not mean I wanted to be able to do long sessions without getting up at all – neither did John recommend this, nor I did not have in mind when I wrote it.  Instead I meant that I want it to be possible to comfortably do a full day’s work at the computer, with no accumulation of soreness that persists from one day to the next.  Although I wasn’t able to put this into words properly during the appointment, we both more or less knew what I meant by it.

After dong this paperwork, we got onto the treadmill at MOTI and took a look at my walking and running gaits, filming with the store video equipment, which is really excellent.  It was the first time I have ever been on a treadmill, so it was pretty weird to start out with, but I got the hang of it.

We did walking first.  John immediately picked up on the fact that when using my affected leg, my left glute muscle is underused, doing almost nothing – and also he noted that seen from the side on, I am a bit hunched over and have the head and neck a bit forward, typical “at the computer” posture, as in the pic below (I wonder where that posture came from…).

nelson-walking-original-cropped

We spent some time getting me to straighten up, pull the shoulders and head back, breathe better, and so on.  After a few minutes I was able to walk more correctly, and then I could feel the glutes working more equally on both sides.

We moved onto running.  Once I got comfortable with using the machine at that pace, the most significant thing John commented on was that, although my right, “OK” leg plant is pretty good and everything lines as it should when seen from the back, the left leg swings around in a slightly funny way before planting,  the ankle turns in a bit as the leg plants, and the hip ends up slanted down to the right quite a lot.  The photos are very different from one leg to the other, as you can see below.

nelson-running-left-leg-plant-rotated  nelson-running-right-leg-plant-rotated 

We looked at the video of this immediately afterwards, stopping it for John to take stills with his tablet.  Seeing how “offline” my left leg was in these films and stills, it is no wonder I end up sore the next day, after taking a run.  Whatever the cause of the knee issue is, running in this way definitely doesn’t help it.

My homework until our next session in 4 days, was to use this more correct way of walking whenever possible, and in particular to use it when doing my usual after-lunch walk route, but to do the route in reverse order to normal.

Knees – not just getting old? #04 – Between sessions 1 and 2 with John

I did my homework as requested from the first session.  I took a run that same day, and a couple of days later sent John photos of me sat at the computer at home.

On the recommended run, I felt that my natural running stance when viewed from side-on, seemed already more or less correct in relation to the proper arm swing posture – I did not make any adjustments from doing the exercise correctly just before setting off, and it seemed to be the same as how I always run.  This was despite having poor side-view posture when standing still, as had been demonstrated in our first appointment – posture that is more like the incorrect arm swing one, with the curved back for example.  I concluded that seen from the side, I don’t hold the body the same when running, than as when standing still.  But I realised that I cannot say for sure, since I am inside it during these activities.

The run itself was slow, the knee was sore before, during and after it, and the next day it was really sore, more than after any previous run.

Having paid special attention to posture during that run and compared it to the arm swing exercise, I felt strongly that the source of my knee troubles might be from something other than running.  I focused on the chair and desk setup I have used while working at home since the start of the year.  After a neighbour helped take photos of  me sitting there and I sent them to John, I studied them, and this led me to decide to immediately change a few things.

To begin with, I moved away a printer that I had put under the left side of the desk area, which had meant I didn’t have much left leg room and could not extend that leg fully under the desk.  I had been sitting with the chair to pointed the left, to compensate for this lack of space on that side (see photo).  As you can see, I use a laptop, but with an external, “classical layout” keyboard and with a traditional mouse, and the chair is taller than normal.  If I sit too low in a chair at typical height, I have to have my arms slanted upwards to get them onto the keys, which is both uncomfortable and tiring.  So instead:

nelson-home-computer-setup-before-any-changes-at-all

Even though I had never been satisfied with this arrangement with the printer under the desk, the available space in the room is limited, and up until the start of the year, I also had other equipment taking up possible alternative places for that printer – so a better solution had not occurred until I studied the photos, and realised that with a few desk mods, the printer would fit onto a now-vacant small shelf under the top of the desk (see next 2 pics, before and after).

nelson-home-computer-setup-before-any-changes-desk-only

nelson-home-computer-setup-after-moving-printer-desk-only

Having made that change, I then experimented with sitting more properly, with both legs extended, and with the chair 90 degrees on to the desk, as would be normal.  I quickly realised a few things.

Firstly, since the start of the year and up to then, as I worked from this home setup, I had been spending most of the time sat forward near the front of the seat , instead of sitting back onto the backrest.  After making the proper legroom, I was now naturally tending to sit back into the chair most of the time.

Secondly, my left knee had often been getting uncomfortable, because I could not extend it as much as the other leg, and this had led me to getting up off the chair frequently – not a bad thing in itself, but with the reason for it being a definite sign of something wrong.

Thirdly, now that I was sat back in the chair more of the time, it was clear that the legs were too high.  I had originally had extensions made up for this chair when I first turned my attention to the home computer setup around 18 months ago, to try and get my arms level with the computer keyboard,  with the desk set at the same height as in the various offices I used to work in, a standard height for office desks, I had assumed.  I have long arms and legs, and this has always made it difficult to get everything into the right positions.  There just isn’t enough room for it all, without some unusual adjustments to heights somewhere.  It was now obvious that, when I was sat back properly onto the backrest, there was significant pressure on the backs of my legs, on the hamstrings.

After a quick bit of research on the internet, where I found a simple “fingers under the legs” test for correct chair height and carried it out, I became convinced that I needed to drop the chair down a bit.  The desk would adjust down as much as 45mm, so first I made that change, then doctored the chair leg extensions, chopping off the right amounts to drop its height by the same 45mm from vertical, so that my arm reach to the keyboard, would remain more or less the same vertically.  Here is what all these height changes looked like after making them, with me sitting there:

nelson-home-computer-setup-after-moves-and-chairand-desk-height-adjusts

I then tried this set of alterations out for a couple of days, as my next appointment with John approached.  By that appointment, I felt that the chair seat height was now closer to being right, but might still be a bit tight on the backs of the legs.  But I also noticed that my glute muscles – the ones on your backside – were now getting sore quite quickly, when sitting back properly.  I filed this away for the time being.

Another idea occurred about the chair and desk setup.  If I needed more clearance between my legs and the chair seat, I could get it without altering either the desk or the chair heights any further, if I added some “footrest height” onto the floor under the desk.  For the time being I reserved judgement on this, but thought I might need to try it out at some point.

Even though it was not clear whether there is a cause and effect relationship at play, having done all these mods to the chair and desk setup, I felt that it was now less likely to be further contributing to my knee troubles when I sit there and do a day’s work each workday, than before.  I was ready to see John again.