Monthly Archives: September 2017

Knees – not just getting old? #30 – Session 9 with John

We began this session with a very brief catchup of the key points on where things are with my knee, and with the treatments I have been having with the other practitioner, an orthotic specialist, as per parts of my recent blogs #28 and 29.

Next, using my foam roller, which I had brought to this session 9 appointment with John, I showed him how, when I do a roll for the lower left leg and ITB , there is much clicking of vertebrae in the middle and upper back, but not when I do the same roll for the lower right leg.  John filmed this, and we reviewed the film and discussed it a bit.  John pointed out that my whole upper body is being used in slightly different ways when I roll out each leg – something I had not been aware of, but which was clear from watching the films.  More on this later.

John then had me get on the treadmill, and he filmed me again on there, first walking, then running.  This was done with me wearing a hat he provided, like a baseball cap.  His instruction was to bring the bill of this hat down a little from sighted along the vertical, and then to line up the angle of the head so I was looking at the bill as I walked and ran.  John noticed how much my gaits had improved, and pointed out a few things that he was especially happy with.

Next we went outside, and with me still wearing the hat, he filmed me running up a roughly 5-degree slope, as well as running down the same slope.  We then talked about this.  The key things he brought to my attention were that:

  • the upper body – including the head position – looks much better than how I was running in sessions with John from several months ago;
  • the left knee is now in a better position when I plant that foot;
  • the right knee is perhaps a little too far forward when I plant that foot:
  • both feet plants could do with being more towards the front of the foot and less towards the back; and
  • it would be better to lift the “trailing leg” up higher at the back of each running step, like the Kenyan runners do so well – this would more favourably alter the weight distribution of that leg as a lever, during its “trailing” part of the running stride.

After this we returned to his office, and he found a link to a website with a video of running form tips, which he emailed to me.  He said that he was excited by the improvements in my technique.  I am also very pleased, feeling that walking and running have both been transformed over the last few months, and I said so.

I then showed John the bumpf that the orthotics practitioner had given me, with exercises to wake up the glutes, piriformis and so on.  John said these are remarkably similar to the exercises he had recommended to me, and to others of his patients.  I had felt the same about the orthotics practitioner’s exercises, which is one reason I think my walking and running techniques have improved so much, following the appointments I have had with him.  John agreed with this.  In effect, this means John’s work is in alignment with the approach of the orthotics practitioner, something I had also concluded after my first appointment with that other person, in the spring of this year.

Next John got me on the treatment couch, and he did some fresh range of motion checks.  Compared to the “OK” right leg, the affected left leg did not have as much drop below the vertical as I sat on the edge of the couch and held onto the other knee.  The “OK” right leg went down about 30 degrees below the vertical, and the left only about 5 degrees.  For the range of motion check where he held one leg pointed up towards the ceiling, he couldn’t move the affected left leg as far towards my upper body/head, as with the right leg.  Also he could not move the affected left leg as far towards the other side of the body, as with the right leg.

John concluded from all this, that I need to do some work / exercises / retraining of the angle of the head and use of the upper neck vertebrae, so that my head does not stick out forwards as much as it used to and instead, the chin is tucked in more.  To demonstrate how much this could affect the range of motion of my legs, while I was still laying on the couch in the “pilates” position from the previous check, he got me to position the head/ neck more correctly, and once it was to his liking, he repeated the “leg towards the ceiling” test with the affected left leg.  Even though he had not done any manipulations on me at all, there was a big difference in the available range of motion: he was able to move the left leg an extra 12 inches or so farther towards my head than before, and he could also move that leg much farther towards the other side of the body than before.  I found this quite remarkable.  No treatment, just better head/neck position, resulted in better range of motion, more similar to that of the “OK” leg.  I found this exciting, because it means I can learn this and do it myself.

John then described the key points of how to correctly position the head and neck, using something for support behind it that is around 3-4 inches thick, so that  the upper vertebrae in the neck are “flexed” around 1cm from being straight, as the head points slightly “downwards” towards the lower part of the body.  His description included showing how, by translating the pilates position to standing vertically against a wall – but with both legs on the ground, as you can’t bend them both without falling down – I would be able to figure out just how much thickness will be needed to support the back of the head, where that bit that usually has a little bump sticks out the most.  He said that a book or books could be used for this support.  I always have a few paperback books lying around at home, so once I know how much thickness I need, I will be able to find which ones to use for that support.

He next suggested I could try to do an exercise along the lines of one of these leg “range of motion” tests.  Using the correct thickness of support behind the head,  it would be the check we had done with one leg pointing at the ceiling while in that same pilates position.  He told me to hold a belt “over” the upturned arch of the foot pointed skywards, then pull the belt down with my hands while trying to resist / oppose that motion using the leg muscles, all the while aiming to keep the head and neck correctly positioned.  I will give this a go as part of my usual morning exercise routine.

As if the effect of a better head and neck position on the range of motion for the legs wasn’t startling enough, he then showed how having good head/neck placement can even affect how far my arms can be moved.  He first did a “before head/neck is right” test with each arm – which showed that the left arm has noticeably less range of motion than the right one.  Next he got me to position the head and neck better, after which he repeated that test again with the left arm – and that time he was able to move that left arm just as freely as the right arm.  Nothing more than better head and neck positioning had made another very noticeable difference to some further range of motion.

John’s first comment on all this was that a whole bunch of nerves and other things are funneled down from the head, through the neck and to the rest of the body – which is why cranial osteopaths spend so much time working on the head and neck.  He also said that the importance of having good head and neck position cannot be underestimated, and he felt that this was the best thing for me to work on next.

He then did one more demonstration to help me grasp what we are aiming for with head and neck positioning.  He got me to sit as properly as I could, with my legs off the edge of the treatment couch as though sitting in a chair, then helped me to position the head/neck correctly, after which he tried to push against the side of my head, to see what would happen.  When he did this, my whole upper body moved, “as one” with the head and neck.  He then had me adopt a more “typical” posture for me, in which my head and neck were not correct, and when he repeated pushing on the head, it bent over by itself, and my upper body did not bend.

This illustrated his point so clearly that I immediately got what we were aiming for.  I said, “so what we are really trying to do here, is to get my head connected up to the rest of my body.”  This was what he had wanting me understand, so it was “high 5s” all around on that.

As we got near the end of the appointment, I asked John if he thought the clicking of middle and upper back vertebrae that takes place only when I foam roll the lower left leg, but not the right one, might be due to possible tensions to the right of the vertebrae,  something we had found in an earlier session, but which we had not had time for John to check this time.  He said it might be a good idea to try holding the head and neck more correctly as I do that foam roll, and see what happens with all the clicking etc.  I thought this was a really good idea, and said I would try it.  I look forward to having a go at this.

We finished the session by John finding some YouTube clips of neck strengthening and neck flexor exercises, which he emailed to me.  I will be adding these into my usual daily morning set of tennis ball work, foam rolling, exercises and stretches – which at this point now usually takes around 50 minutes.

I look forward to using these videos to learn firsthand how to target the head and neck for better positioning etc.  I had commented during the appointment that this is probably important for both walking and running, as well as when sitting at the computer, and John had agreed with this.

I also look forward to trying out some short running stints now, mixed with walking.  After seeing John, I believe it should be OK to have a go at this, keeping the head and neck positioning in particular in mind, as well as all the other points John made about my running technique.

Knees – not just getting old? #29 – Before session 9 with John, including recent summary

It’s been 7 1/2 weeks since my last blog update #28 on 22 July.  I have just made a further appointment with John for later this afternoon.  At the end of this blog page I will outline what I would like us to cover in that appointment, but first below is a summary of the key events since blog 28.

On 28 July I saw the other practitioner, an orthotics specialist, for what will, for the immediate future, probably be the last time.  My new orthotic insoles were ready – one for each foot – and as well as trying them out in various pairs of shoes to ensure they fit fine, he got me onto the treadmill and filmed me running, to see whether they had any effect on the rotations noted at the back of each leg, especially the affected left leg, whose knee had been giving the long-standing problems in the tibio-fibular joint, which I originally first came to see John about in October of 2016.

This 28 July appointment also coincided with the day I could remove the final 3mm from the original, “non-slanted/non-orthotic” insole I had been wearing only in the left shoe (see blog #28), taking me down to having nothing at all, rendering my posture completely “unassisted”.  The transition “down to nothing” had been made over the previous 3 months, and as this other practitioner had predicted and hoped, I had been having minimal issues with the neck pains during this transition.  Those neck pains were what had led me to try a”normal” insole, on the recommendation of a different physiotherapist altogether, someone I had seen many years ago (see blog #01).

This coinciding was helpful, as it was now time to try out the new orthotic insoles, which look fairly strange and have slanting down from the inside to the outside of each foot, near the heel.  Here is what these new ones look like.

.                                   Top view                                                                               Bottom view

 

 

.                                               Side view, upside down from the back

There is around 3mm more extra height added to the one for the left leg, the one I have been having the knee issues with.  This was deliberate and was at the discretion of this other practitioner.  They are a bit weird looking, but they do work: his observation of me running on the treadmill during that final appointment with him on 28 July, was that there was no more rotation in the left leg – the insole had apparently worked as expected – and there was just a little rotation in the right leg.  He commented that the causes of the rotations in each leg are different to each other.  I did not follow up with him on this.

Up to that appointment, I had not been doing any full running since the middle of June, as not just the tib-fib but also main the joint itself had been feeling not quite properly aligned, and had been giving some pains (see previous blog #28).  Instead I had been mixing in a few very short runs of 1 min or less, while taking walks.  So when I ran on the treadmill in the 28 July appointment with the other practitioner, it was the first time I had done that much in several weeks.  In the end he had me going for over 7 minutes, and he told me that was equivalent to around 3/4 of a mile.  With my much better running technique, I had found this “short” treadmill run to be really easy, and was amazed I had run that far so easily.  Afterwards I did not have any soreness, either.

The other practitioner’s assessment was that I could now start to gradually increase the time I was taking when mixing the running in, while walking.  That was the conclusion of the appointment with him.

Also around the end of July – starting a few days before that 28 July appointment – I had made an interesting and helpful discovery.  Due to the continuing pains in the other, right leg’s hip joint from sitting at the computer while working, I had decided to experiment more with how I was using the tennis ball to stretch out the glutes and piriformis muscles (see blog #28).

When that other practitioner first brought the importance of the piriformis to my attention in the spring of this year, I had started to use the tennis ball on that area, as well as on the glute max and glute medius muscles.  What I realised in late July, was that I was only using the tennis ball around the middle area of each of these muscle sets.  I figured this out because the first time I tried moving it around to cover much more of these muscles groups’ areas, I found huge amounts of muscle knotting, especially around the [quite large/”long”] edges of each group.

As with other places in the body where I have found knotting, I went after this with a vengeance, and within a couple weeks, it was completely gone.  But even just after the very first time I worked the tennis ball all the way around the glute medius and piriformis, I was amazed at how much better all those muscles felt, and I noted especially that it seemed like I was now able to get a proper “transfer” of power into my backside muscles and get them to do what I really wanted them to.  It was as if they had not been getting fully engaged before this, and now, when walking, doing the other practitioner’s recommended exercises for the backside, and even just standing and clenching the butt muscles a bit, they were working “to full design specification”.

Since then, any time I walk anywhere, the backside really feels like it is working as it should, and this has made it a more enjoyable activity.  Table tennis has also been impacted by this, in a very good way.  I am getting a lot more power into my shots than before.

By around the start of the second week in August, I had experimented that much more with the tennis ball, and had discovered more muscle knotting right around the hip joints, especially the other, right leg hip.  Within a couple of days of including working all this out with the tennis ball, in both hip joints, I found that the long-standing pains I had been having in that right hip joint from sitting at the computer, had improved dramatically.  Since then, this had hardly troubled me at all , and I have concluded that knotting was the cause of this, and that using the tennis ball has cured it, provided I keep doing that.  Horray!

Using the tennis ball, around this time I was also able to partly address some long-standing pains around the middle of the affected left side’s waist area, where the ITB muscle turns into a tendon at the waist, and in the muscle around the ribs at the front of the body on that same left side – another issue perhaps related to the poor sitting posture I had until I came to see John and we eventually sorted out my workstation setup etc.  These waist and rib sorenesses have improved markedly as a result of targeting them with the tennis ball.

Also around the start of the second week in August, I woke up one morning with soreness deep inside and under the right shoulder blade (scapula).  It felt like I had pulled a muscle in there, perhaps while shifting around during sleep.  I had a very old injury around there from my late 20s (over 35 years ago), and wondered whether this mild recurrence of trouble in that area, might be related to the changes in the body taking place since wearing the new insoles.  In any case, it took around 2 weeks for this to get back to normal.

I then had a similar thing happen under the other shoulder blade, but not as bad.  For prevention of this in the future, I decided maybe it was time to branch out the foam rolling I had been doing on the lower body for nearly a year now, to include the back as well.  On the internet I found some simple rolls for lower, middle and upper back, and even one for the scapula area – just where I wanted to target, among the other places.

As with other parts of the body, when I did a first foam roll of all these bits of the back, it showed there was significant knotting, and it also felt really good.  I was immediately hooked, and since them have included them in my usual daily morning and late afternoon exercises.   Table tennis especially has benefitted from this rolling of the back, but also in general I feel much better in my upper body, and this includes my breathing, which I think is using more of the upper part of the lungs now, something I was weak on before.

Also around the start of the second week in August, I had increased the duration of 4 short stints of running mixed in with walks, up to around 3 minutes each – so 12 minutes of running within a walk, done every third day.  But I had started to feel some pains in the main knee joint again, but slightly different to anything felt before, and more related to the main joint.

I decided that the body was probably still adjusting to me wearing the new orthotic insoles, and that at least for the time being, I would have to stop doing any running at all.  So I packed it in and just played table tennis, which didn’t seem to bother these main joint pains as much, although I could still feel them, and my table tennis game was definitely hampered by them.

After another 1 1/2 weeks, in late August, these main knee joint pains were a bit better, and then one day as I was doing the hoovering around the house, the joint gave a nice “snap” at one point, and after that the main joint felt much better.  Since then it has not been an issue, provided I am able to get in walks and/or table tennis on a regular basis.  My conclusion from this is that I was right in thinking that the body was adjusting to the new orthotic insoles.

By late August I had decided I could start freshly with mixing in short runs with walks, to begin with just 4 stints of 1 minute each, i.e. “back to square 1”.  I was just at the point where I was ready to do this, but then came down with a nasty infection in the bursa of my left elbow, partly due to both elbows being sore from using them to prop up while foam rolling, and partly because I have eczema which makes the ends of the elbows itchy, and I had scratched this open on the left one, then put some aloe vera lotion on it, which led to the infection.

The elbow swelled up a lot with excess fluid and was also quite painful, and I couldn’t do anything much at all without it hurting.  Also the whole elbow joint was out of alignment from all the fluid.  I saw an NHS doctor who prescribed antibiotics and rest for the elbow.  After the full 5 days of antibiotics were done, there was still pain and swelling, and they recommended I take anti-inflammatory painkillers for a few days.

Eventually this was all fine again, but of course I had not resumed any running, and still have not done so.  I have played a fair amount of table tennis over the past week, and as well as the elbow being fine from this, the knee is feeling really good, so I am at the point where I think I can start adding in running to walks again.  But I wanted to see John again first, to go through a few things with him.  Here is a list of what I would like us to cover when I see him later this afternoon:

  • Now that I don’t wear the “normal” insole only on the left leg and wear slanted, orthotic insoles on both feet, the height difference between left and right is that the left one is around 3mm higher than the right.  Following the 3 months of transition down from the original, “normal” insole of 11-12mm on the left side only, to where things are now, there have definitely been some adjustments made in various places, including the upper body, and the left knee itself.  Let’s have John take a look at my “left to right” posture and photograph my back again, to compare with pics he tool in earlier sessions I had with him, and perhaps to examine me for range of motion in each leg, as he has done in previous sessions.
  • When foam rolling, recently I have become aware that one roll I do, always makes the vertebrae click a lot when I roll on my left side, but not at all when I roll on my right side.  I suspect this might mean I still have some residual knotting in my right side, just to the right of the spine itself.  John found some of this in an earlier session and worked on that area, which helped at that time.  Let’s repeat the examination for this and, if he thinks it’s knotted up again, have him work on it again.  I think the fact that my body weight etc is now closer to being more evenly distributed left and right of the spine, might mean this treatment would “stick” better now, than the last time he did it.  I will bring my rolling foam along to demonstrate this strange, “one side only” clicking I have noticed.
  • I want to show John the bumpf the other practitioner gave me of the exercises he has recommended I do for the backside muscles.  They have really helped to wake up the muscles on my backside, which has completely transformed both my walking and running gaits – they each had a quite short stride for one thing, which is no longer the case.  I will bring these bits of bumpf along.
  • Let’s get me on the treadmill and film me running, so we can compare my form to the films we took in previous sessions.