Category Archives: knee pain

Back to running after 2 years of knee injury #02

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

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

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

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

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

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

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

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

 

Back to running after two years of knee injury #01

Rebuilding my running

runner practicing elbow drive
Elbow Drive Practice

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

Knees – not just getting old? #21 – Before MRI scan

Mon 23 Jan 2017

Since my last blog post on Fri 06 Jan, the knee has improved only slightly.  For much of the time it is still tight in the joint, and it also seems tight around the lower IT Band area when I bend it – even if bending with no weight, i.e. lifting the leg up and bending at the knee.  The rest of the time, it is a bit better than this, but still has what feels like tightness in both of those places.

Lately I have begun to think that the “tightness” in the lower IT Band is not to the ITB muscle itself, but maybe just the sciatic nerve.  Whenever I foam roll, which is 2 or 3 times a day, that lower ITB is no tighter than on the other, healthy leg.

On once occasion I tried a foam roll on the ground and  with the affected knee joint bent, to see whether the ITB would seem to be tight – but this proved to be pretty much impossible to do properly, so I did not get a definitive result from it.

Whatever is up with the ITB, it feels like borderline pain that is sharper than in the knee joint itself.  I can even feel this borderline pain in the ITB if I press on that area with my fingers while the leg is straight and the muscles are not being worked.  This is partly why I suspect it is more to do with the sciatic nerve, than the muscles in that area.  The joint mainly feels tight around the outside, as it has done for some time.

I have done John’s new recommended ankle exercises every day since my last post on 06 Jan.  I cannot tell whether there are having any effect, but am doing them anyway.  If they are working to help the joint stay loose, I think it is only by a little.

I have done no running for 2 months now.  Since my last post on 06 Jan, I have played some table tennis.  This sometimes seems to leave the joint worse off the next day (tighter), but not always – and it does not seem to be related to the length of time I play, more to whether I hold back a bit when going for shots, or take them fully committed.  Unlike the more severe troubles I was having before early December, the joint is not sore on the day after table tennis.

When I bend the knee, even without putting weight on it, it still does not “pop” as much as the other, healthy knee joint.  When it hardly pops at all, these are times when the joint is always tighter.  When I have been working at the computer and get up, I often get a small pop from bending the knee, and the joint and ITB feel a bit less tight.  On days when I am not at the computer and do not do any sitting of that sort, the joint pops less, and is a bit tighter in general.  I find this to be a strange observation, but that’s what’s going on.  Maybe it tells us something about what’s wrong with the knee.

I have been walking most days, for around 1.5 miles or so usually.  Walking down a slope no longer results in that “goofy” gait, and there is no specific pain in the knee joint now, when on a downward slope   – but overall, I am still favouring the affected knee a bit when I walk, and I can almost always feel that something in the joint is not right, as I take each step.  I would not want to do any amount of running or even jogging on it, at this time.

I still cannot use my preferred sleeping position when on my left side.  It continues to give the same pain to the knee joint as it has done since early October last year.

I am having the MRI scan this Thursday 26 Jan.  I have spoken to a technician there, and they have told me that the area the scan will cover should include about a third of the way down the lower leg from the knee joint itself, and a third of the way up the upper leg from the joint.

With the lower IT Band clearly playing some sort of a role in the current state of the knee joint – even if it is just the part of the sciatic nerve that goes across the ITB – I am wondering whether it would be a good idea to ask the technician to aim the MRI scan down a bit lower, so it still includes the whole of the knee joint itself, but also picks up more of the lower ITB.

That is a question I would like to hear from John on, before the appointment for the scan on Thursday.

Thu 26 Jan 2017

The scan took place today.  There were no issues with how the scanning process went.  They told me the results should be with my GP in about 2 weeks.

Knees – not just getting old? #01 – History to start of 2016

I have recently started sessions with John for a knee problem, and have had 2 of them so far.  I decided to start this diary on progress, as I am very  impressed with John’s approach, and his level of knowledge and skill.

This is my first blog ever, of any kind.  I have been around awhile, so there’s a fair bit of history here, with this first blog being about my background, lifestyle and fitness.

I am 60 years old, sit working at the computer for a living these days, but exercise quite a lot for my age and profession.

Although I am skinny, I have always been quite active, doing various sports when younger – tennis, squash, table tennis, racketball, handball, basketball and so on.  In my mid 20s I did some middle distance running for a while and turned in a creditable 1:31:30 in the Stroud Half Marathon at age 27.  But even that kind of distance was too challenging – I just don’t have the stamina I think.  Also my diet was not that great around that time, I pushed myself too hard, and I knew little about running preparation, post-run “cool down”, or anything like that.  In the end, I stopped running not long after doing the Stroud race.

Through my 30s and early 40s I did more physically-oriented kinds of work, and less sport in my leisure time. By my mid-40s I had settled into working in IT and so was mostly sat at the computer all day. But at age 45 I got a hernia, most likely a legacy from lifting things up onto shelves in other more active jobs before then.

We have a tendency for hernias, down through the male line in my family. Mine was an ‘inguinal’ hernia in the lower left area. I was put onto a 9-month NHS waiting list for the operation, and decided to take up running again, to get more fit so I would recover quicker from the op, when it eventually came up.

As I started this running again at age 45, I took to it much more than I had when younger. I didn’t pay attention to times, just ran at whatever pace was comfortable. I prefer pavements / roads to running off-road, so harder surfaces are where I ran.

By this time in my life, I was eating a much better diet, and was a lot more relaxed about things in general, than I had been when I was younger. Rather than try and improve my fitness through target setting, pushing through barriers, willpower, or anything like that, I just ran for the pleasure of it, and let the simplicity of the exercise itself, take care of the cardiovascular side of being fit.

I quickly found I wanted to run further and further, and within a week or two I was doing 4 miles in a session. I found that a run followed by 2 days rest, then the next run, was best for me – so running every 3rd day became the norm, and 4 miles became the standard distance.

My concentration at work improved. When required, I found I could work more hours in a day than before, and I didn’t get as tired mentally or physically, when doing a normal day’s hours. I got fitter and fitter. My bone strength improved. I am lucky to be blessed with a slight frame without much dead weight – or even much meat – on my bones, and I don’t seem to suffer “wear” as much as people who are bigger. Either way, within a few weeks of starting to run, I was hooked.

I had the hernia op in 2002. They did a great job, and I recovered so quickly that I was able to start running again after just 4 weeks off – not bad for a middle-aged guy!

Between then and the start of this year 2016, I kept up the running almost the whole time, doing 4 miles every 3 days. The only significant break I took was when I had an ankle injury about 5 years ago and had to stop for about 3 months. This means I have run something like 7,000 miles in total, since starting 15 years ago.

I never seem to pick up injuries from normal activities, always something strange or bizarre, and the ankle injury was a case in point: I put my foot down into a gap between 2 cobblestones while hurrying on the way to the cinema in downtown Bristol, jogging along and not paying attention properly. There was no pain, but I damaged some ligaments. I saw a different private physiotherapist practitioner who is based out of town, and he was able to advise and assist with recovery. Despite my fears around this at that time, the injury healed up completely, and has been fine ever since then.

I suffered neck pains on my left side for about 25 years, starting when I was around 30 years old. I never injured it, but it just seemed to hurt all the time. No one seemed to be able to figure out what was going on – not my GP, and none of the various private specialists I saw. Eventually, 6 years ago, I had a recommendation from my usual mechanics since the mid 1980s, a father and son who have to stay fit and healthy to be able to do their work. The physiotherapist they recommended was Polish and had training across multiple disciplines of medicine. Within 5 minutes of seeing him for a 1st appointment, he figured out that my left leg is 8mm shorter than the other one!

I started wearing insoles in all my footwear on that side. The body adjusted in all sorts of ways, and very quickly, the neck pains completely disappeared. Around a year later they had returned again, though not as severe. Another check showed that the leg length discrepancy had increased, and was now 11mm! Apparently this is rare, but not unheard of. I had all the insoles remade to 11mm, and after more adjustments by the body, the neck settled down again, and in the 5 years since that time, it has never given any further trouble.

During this recent 6-year period of learning the cause of my long-standing neck troubles, and curing them, I was doing the usual 4-mile runs every 3 days. At the point 5 years ago when re-measurement showed that I would need 3mm more height on all the insoles I was wearing, we examined my running shoes and found that the heel on the shorter-leg shoe was worn down further than on the other shoe. This is apparently quite common, when someone has unequal leg lengths. The experience has led me to believe that if a runner has unequal wear on the heels of their two shoes, it might be a sign that one of their legs is shorter than the other. Either way, I decided it was time for a new pair of running shoes, and I bought Asics. Even though they were more expensive, I am really glad I did, as they are great footwear for middle distance runs.

I began to notice a number of other “spin-offs” of finally curing the neck pains by wearing an insole in all my various left shoes. My upper body gradually rearranged itself in subtle ways, a process that continued for a few years, as far as I can tell. I used to find there was a tendency to get mucous collecting at the top of my right lung, which would not clear properly when I coughed and which, every winter, made me more susceptible to getting a “proper” cough . Not only did this stop happening, the “tone” of my cough changed, and it started to resonate more deeply and seemed to be clearing the lungs better as a result.

My running stride also became more confident, and without trying to, I was running faster. Before starting to wear an insole, whenever I would step onto a slightly uneven surface while running, the body would seem to overreact to it. With the insole in place, this stopped happening. My interpretation of this is that, before using an insole, even though I did not know at the forefront of conscious thought that the body was not balanced – that the legs were unequal in length – the body knew instinctively that something was not right, and so it would overcompensate whenever I stepped on an uneven surface.

Around 3 years ago I took up table tennis again, after not having played for about 15 years or so. I use a style of table tennis bat with a “penholder” grip that most local shops do not stock for, and I had given up trying to play with a homemade version of it, one that had been hurting the thumb a bit when I used it. During that 15 years gap, the internet had become more widely used for marketing and buying all sorts of things, and in the end I decided to take a punt on buying something online, without being able to try it out first. After one attempt at this which I found was not what I needed – a bat with a “Chinese” penholder grip – I found there is a “Japanese” version of the penholder, which turned out to be exactly right for me.

In these last 3 years, I have ended up playing table tennis around twice each week on average, on days I don’t take the usual 4-mile runs. Ping pong is a perfect complimentary form of exercise to the great cardiovascular workout that running provides. It is a high-octane, short-burst activity that is great for muscle tone, and it improves concentration. I happen to love playing a fast, top-spin game, and being a highly strung sort of guy with a relatively high metabolism, means I get great benefit from doing something, on a regular basis, that really gets the adrenaline going a bit.

In the autumn of last year, a little over a year ago, I had some lower back problems, brought on by, among other things, overworking in my job of that time, and by a bit too much travelling for work. I saw that same other private physiotherapist practitioner who had helped me with the ankle injury a few years before, the one who is based out of town. As well him doing “emergency” manipulation to help me to be able to stand up straight again, he gave me some stretch exercises to do on the “glute” muscles, using a tennis ball. They did help, and I have been doing them ever since. The back pains cleared up within a month or so, and since then it is better than it’s been in years.

Knees – Running rebuilt #01

Blogger Name: Philniche

image of Marathon Running Legs only
Marathon Running Legs

I have always struggled with my knees, when I was a child I experienced pain and they felt like they twisted when I ran; that along with being an over weight child I tended to avoid exercise. When I got older I went travelling for 6 months and spent a large amount of that time wearing just flip flops and carrying a heavy bag most days as I moved around; once I returned to England I found that my knees had got considerably worse, they would click and crack when climbing stairs and cycling (it would make me feel sick hearing and feeling it), and when bending or kneeling down my knees would get stuck and I wouldn’t be able to stand back up again.

This all lead me to requesting assistance from an NHS Physio, she didn’t take a lot of time treating me, she just set me exercises to do, and based on my pain and thoughts of the exercises she changed her thoughts about my injury each week. It when from an old hamstring injury, to a flabby core, to you’re overweight and this is why you’re experiencing pain. at 13 & a half stone I wasn’t hugely overweight, but there was definite room for improvement. So after seeing no improvement in my knees and worsening pain in my hips, I felt that I was not getting any benefits from seeing this Physio and I never returned to her. After losing 3 and a half stone I felt great, but my knees had not improved, while training for my first half marathon I was experiencing pain and swelling as well as not being able to bend my knees to climb stairs after long runs – which at 28 should not be hard thing to do. While in the running shop asking about knee supports the guys in there recommended that I have a session with their in house Physio, so I thought why not. After an initial consultation I thought lets give a few sessions a go and see how I feel.

During my first 45 minute session with John, I saw a massive improvement in my movement and reduction in pain when being stretched in different ways, I was so shocked and couldn’t believe that it was that quick at getting results. We ran through some movements to see what my body did and reacted, then we manipulated my back and cracked it a bit, then my leg and hip was in a much better place flexibility wise. John set me an exercise called Neural Flossing to help increase the movement in my legs (stretch them out), as well as dynamic sitting to support my back and core when sitting at my desk all day.

After 1 week of dynamic sitting, at first it was weird and my back would sometimes go into a spasm, however as the week went on I found I was sitting correctly without even thinking about it. I went from pain and trying to crack my back 3/4 times a day to not at all. I even think about it when I am standing still or walking, and I feel much better inside for it.

Roll on session number 2 to see what further improvements can be had!

My First Physio Experience #02

2nd Appointment  – 45 minute assessment 

Bridge pose - rolling from hips onto shoulders
Bridge pose – rolling from hips onto shoulders

We started the assessment with John redoing similar tests to my first appointment to strengthen his analysis and all the exercises gave the same results.

John used various techniques to determine my flexibility and movement range whilst talking me through everything he did. The best thing was comparing how I was at the beginning of the appointment to how I was after the 45 minutes. I started the appointment with stiffness in my right side with limited flexibility. He located where all the stiffness was in my back and then eased my spine by clicking it and releasing the pressure in several locations. Immediately we tested my leg flexibility and it was absolutely incredible to see the difference. I could move so much more and without pain or feeling weak.

It seems that years of my parents telling me to sit up straight fell on deaf ears as my posture has slumped, this could also be due to having a desk job for so long. John showed me ‘dynamic sitting’ which enables me to focus on how I am sitting at my office chair and adjust myself accordingly. Immediately I feel my core engaged and I feel taller and less slumped. The really helpful advice is to imagine lifting the label in the back of your shorts, it helped me roll my pelvis forwards whereas when I slump it just rolls back.

My homework is to continue with dynamic sitting and trying to think about how I am sitting every 20 minutes at work. Additionally I need to practice laying on my back and rolling back to my shoulders joint by joint into a pilates bridge and back down again. My first couple of attempts are shaky and my balance was all off but hopefully if I do at least 30 of these every evening I will improve.

My First Physio Experience #01

1st Appointment – 20th April 2016 – Open clinic

In this picture; tight muscles and ligaments on the front of the LEFT thigh are forcing the spine to overwork
Running biomechanics causing knee and hip pain

My first ever physio appointment was a real eye opener.

After putting up with sharp right knee pain during running for over 4 years I thought it was finally time to have it assessed. After spending 30 minutes with John he had assessed me and discovered that it is lack of flexibility in my right hip that has caused lower back pain, knee pain and general leg weakness.

I was amazed to see the differences in both legs in terms of strength, flexibility, stiffness and movement. I was very impressed and keen to have my next session as soon as possible to find out more.

 

Knee of little faith #01

It’s happened. After merely a few days of setting my (annual) New Year’s resolution of ‘don’t get injured’, I appear to have fallen at the first hurdle. Not literally thankfully – that could be messy – but I’m certainly not in one happy piece. 2015 is set to be my biggest athletic year to date with, at the very least, 2 marathons, a half Ironman and full Ironman, so, naturally, I panicked that the Ironman dream was over.

I am suffering with, what felt like, a twisted left knee; discomfort around the inside base of the knee, but only whilst I am running. The initial cause is unknown, although it may have had something to do with my last pre-Christmas 35 mile run. Weeks of no running and rest, since then, have yet to alleviate the problem, or my bad mood. However, a miracle, in the form of a friend’s advice, saw me booking an appointment with local physio, John Stephenson.

After performing a few one leg squats on both sides, John identified that there was indeed a difference between my two legs; notably that my hip was dropping on my left, but not my right. He explained that this was due to the nerve paths on my left side, specifically the four lumber spine nerves that innervate muscles in my leg and foot. John individually tested each lumber spin nerve path (L1-4) on both my left and right sides, at various points on the leg, via the application of force manipulations (i.e. pushing against my knee in a particular orientation and telling me to push back), and then assess the corresponding strength of my response. Of course, the strength of my right side passed with flying colours, but John identified that my L2 and L4 responses (namely my knee and toe extension) were very weak on my left hand side, including a very unresponsive duff big toe.

Although the anatomical explanations involved are rather confusing, one target of John’s fix is to remove the tightness in the muscles at the base of my back, where these nerve paths originate. This will then hopefully begin to remove the tendency of my knee to bend in during my runs. For now, my homework is a simple exercise (split squats), as well as booking up a few follow-up physio treatments.

Safe to say, I am feeling much more confident, after hearing John’s diagnosis and expertise, that the future won’t be limited to deep heat and ‘rest’. More importantly, Operation Ironman is still very much go-go-go. Consider my resolution reaffirmed.

Physio for knee problem #02

KNEE CAUSE AND EFFECT
I returned to John for my third physio session this week and we continued to explore the causes and effects of my postural imbalance.

In the week I had been returning to the gym and found that, whilst there have been dramatic and notable improvements in my squat, which had been fairly reduced before, I was still having difficulty at the very extremes of my movement. I found that, when rowing for example, I was able to achieve a very “tucked up’ position only after easing my knee into the posture over a period of about 30 seconds.

ON YER BIKE!
I had also been biking, partly on John’s recommendation, as this allows fluid to flow around the knee and promotes recovery. I am finding cycling to be fine, with no real discomfort except upon extreme hills – which I am still avoiding for this reason. Occasionally I experience stiffness the next day but this is only equivalent to what I experience when sat stationary for an hour or two.
MANIPULATION
Once again John performed some manipulations, this time on my neck. This was both an alarming and enjoyable procedure; I’ve never heard my neck make so many cracks before, yet I felt as though a lot of built up tension had been released. This too had a remarkable and instantaneous effect upon my flexibility.

ILIO-TIBIAL BAND
Towards the end of the session we practised walking and running. It seems that, due to the muscular imbalance in my body, I over-rely upon my IT band for walking and thus my hip rotates forwards. I was shown how to become aware of this and told to practise on an ergo-rower, treadmill or when walking and running.

Physio for Knee Problem #01

KNEE DAMAGE
I first came to see John three weeks ago after damaging my knee. The injury was caused, about a fortnight beforehand, by performing the (slightly ridiculous) task of standing up with a friend on my shoulders whilst on the side of a fairly steep slope; as I stood up I felt something lock and, as soon as I had put my friend back onto the floor, I felt a painful ‘ping’ inside my knee.

The day after I had sustained my injury I could barely walk, I limped up and down stairs and generally avoided putting any weight onto the leg. The knee had swollen and was fairly painful to the touch, causing movements or weight-bearing to be difficult. Thankfully, at first, the swelling seemed to reduce with each passing day and the pain involved in using the joint subsided with it. This lasted for around a week at which point my recovery seemed to stall and I contacted John.

PHYSIO
My first physio session was mainly focused on determining the cause of the pain and swelling: John spent a long time testing my flexibility and movement range, along with probing my knee for ligament damage. He said that, at first, he had suspected my ACL had been damaged due to the injury being caused whilst facing downhill on a slope, luckily this was not the case. By the end of the session John believe the cause was likely to be a twisting within the kneecap caused by muscle imbalance that had caused the fat pad to become upset and possibly to catch.

We ended the session by discussing “dynamic sitting”, a method of adjusting seated posture to relieve muscle tightness and fatigue that will hopefully correct my postural imbalances. I feel that this is particularly important to me as my job involves a large degree of “screen time”.

During my second session with John we continued to discuss my postural imbalances and to try and work through some of their causes, along with trying to mitigate against their effects. We worked through some tests to determine neural strength and found that, in many places, the muscle on the left side of my body had decreased mobility with respect to the right: particularly those associated with the L5 nerve root. John performed some manipulations on my back that seemed to immediately have a positive effect on these areas – I was able to raise my left leg an additional 10° from my attempt before the manipulation!

PLANS
At the end of my second session we discussed dynamic sitting some more. I have now purchased a standalone keyboard and mouse that I am using to correct my posture whilst at a computer and it seems to be having a positive effect. We also discusses ” neural flossing ” and John set me some homework to investigate and try this.