Category Archives: pain – lower limb

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.

My 10k Journey #01

I’ve never considered myself a ‘proper’ runner, but in my time I have managed to plod my way round a few 10k routes. Plod is very much the right word. Running has never felt effortless or easy, but rather something I’ve managed to just about conquer.

bridge-runner

That was until the 2015 Bristol 10k, where I was in such horrible pain and discomfort that I decided I really wasn’t a runner and so vowed never to run again. At several parts during the run I had to stop running and was reduced to an awful whimpering hobble, all the while clutching at the root of the pain, my left hip. After a little bit of walking the pain would subside enough for me to run another couple of kilometres before having to repeat the same whimper-hobble-hip hold.

To be fair, I really shouldn’t be too harsh on the Bristol 10k. My hip pain wasn’t it’s fault. It had been there though the other 10k events I’d done that year, steadily getting worse with each run, but then all too quickly forgotten in that post-run euphoria. Giving up running seemed to be the most obvious way to eradicate the pain. And it worked! For a while. Over the past six months the pain has returned when I’ve tried everyday things that never caused me any issues previously – walking moderate distances, gardening, even simply sitting sometimes left me with that all too familiar dull ache in my hip.

Determined to face my nemesis once again, I have signed up for the 2017 Bristol 10k and I want to do it without hobbling. In fact, I want to be able to walk, sit or just generally exist without that nagging pain. I’ve decided to be sensible and grown up this time around and rather than taking the ‘doing more exercise will surely make it better’ approach I’ve decided to get the problem sorted properly.

And so it was that I found myself in John’s clinic last week. After a few questions about my general health, activity and mobility he had me skipping with an imaginary rope to see how each of my legs performed. (At this point I should also mention that I purposely went for a very long walk the day before to make my hip bad – though I really needn’t have bothered as John was able to pinpoint the cause of the problem pretty quickly anyway). It came as no great surprise to me that my left leg didn’t feel anywhere near as stable as my right. Onto the couch and again my left leg continued to be the poor relation when it came to mobility and strength. The most fascinating part for me was seeing how much weaker my left big toe was than my right – it was as if I had absolutely no control over it!

As the consultation continued it became clear that the problem was not actually in the hip itself, but rather in my back, which was causing me to compensate through other parts of my body and thus causing the pain in my hip. John then taught me how to stand properly. At 34 years old, I have finally learned how to stand in a way that doesn’t cause my back to ache – how have I never worked this out for myself?! John also did a little bit of cracking of my back, which led to an immediate improvement in the mobility and strength of my left leg. Clever stuff.

My homework for the week was to practise standing properly. Apparently I tend to stand ‘like a ballerina’, which might look great but actually does nothing good for my back and shoulders. So this week I have been learning to stand like a ski-jumper. I’m delighted to say it’s definitely making a difference. My hip hasn’t been achy, and I’m far more aware of how I’m holding myself and definitely feel less tension in my shoulders. I know this is only the first part of correcting a lifetime of bad habits, but I’m already encouraged by the results.

KNEES – RUNNING REBUILT #02

Last week I did Neural Flossing, by the end of the week I was experiencing hip pain in my left hip and stiffness when I stood up after sitting for long periods of time. To combat this, John provided me with a different stretch – putting my legs in a sort of figure of 4 while lying on my back, this stretched my lower hip and upper leg area – after a couple days of doing this the hip pain disappeared. The combining of this and the Neural Flossing is working on increasing the degree of movement in my left leg.

 

physio-neural-flossing-ra physio-neural-flossing-stretched physio-hip-stretch

This week I went on the treadmill to look at how I walk and run; a muscle in my left hip/upper bottom does not engage when I walk, I almost learn back which could be contributing to my back pain, as well as twisting my upper body while walking and even more so when running. While running I bounce up and down a lot and I put my heel out in front of me, which means that I am not exerting energy in the right places while running.

To combat these habits John gave me the following exercises to work on over the week:

  • 5-5: Setting the treadmill on 5 incline & 5 speed, where I need to engage my core and lean forward to promote me walking on the front of my foot rather than leaning back on the heel.  While doing this I put my hands on my hips/upper bottom to make sure my muscle was engaging.
  • Use the treadmill to lean forward like a ski jumper, and using one leg at a time to practice my leg movement where my foot will land in line with my body (rather than out in front), this is through pretending I was on a scooter with an angry horse leg that goes up, round and down. Then using the treadmill to pretend that I was bump starting a car – this was to help me with leaning forward, bouncing less while running, and running with my feet landing below me not out in front of me.
  • Arm Swing – stationary – this is engaging my core and standing like a person about to skip – moving my arms forwards and backwards close to my body in an exaggerated running movement, but not allowing my body to twist as I moved. Then doing this while on the balls of my feet – this I found a lot harder due to my inability to balance.
  • John also sent me a video clip that provided tips on running and form to improve over stepping – it focused on bum kicks, skipping and running barefoot.

arm-swing

This week took a lot of thought as I had to concentrate on a lot of different areas of my body at once, but it’s crazy what difference engaging your core can do.

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 Hip Fracture Recovery #01

“A physio with experience working with dancers”

I originally saw John for a free consultation a few months after breaking my left hip in a bike accident. I had an emergency operation at the time of the  accident fixing the break with 3 screws. My greatest passion in life is dancing so I was very keen to give myself the best chance for a full recovery and John was recommended to me as a physio with experience working with dancers. I decided to see John for a full consultation as I was having some discomfort and
pain when working my left quad in some movements, which didn’t seem to be improving over time.

John first asked me to do a simple test which involved jumping as if skipping on both legs, then my right leg and then my left. He showed me in the mirror how when hopping on my left leg I was leaning over to that side with my upper torso whereas when hopping on my right leg my spine remained vertical. This test immediately showed us that I was not trusting in my gluteus medius doing the work of stabilising my hip in a horizontal position. John performed a number of strength tests (asking me to push my leg against his hand) which showed that my left quad was lacking in power. They also showed him that this wasn’t due to a lack of muscle strength but a problem with the power supply which is provided via a nerve radiating from the L5 vertebrae.

John was curious about testing my upper body, rather than assuming the problem was just localised at around my hip. He performed some tests involving the abduction of my arms which  showed that I had stiffness on my left side going up into L3 and my thoracic region. Also, he found that my neck vertebrae were not so springy on my left side. As I fell fully on my left side it might well explain the ongoing stiffness. John treated my upper spine with some manipulation which released some tension and resulted in my left arm abducting more freely. He also found that this resulted in improved quad strength and leg abduction when re-testing.

We then looked at the glute strength exercises I had been given by my NHS physio and found that my technique was poor. The exercise involved me lying on my side, extending my uppermost leg back  and lifting it upwards. We spent quite a bit of time correcting my technique: he corrected the alignment of my head and neck so that I was keeping my neck long and in line with my spine; he talked about ‘shutting the door’ (activating my transverseabdominal muscles), correcting my hip position and using my fingers to make sure my glutes are working.  We looked at my single leg squat exercise which I had been having a lot of difficulty with and which hadn’t been improving. John also identified my poor technique and I worked on making sure I wasn’t allowing my knee to go too far forward of my knee and that I was folding my hip in the same way as when doing the exercise on my left leg, which felt easy.

Finally we looked at my standing posture and looked at ‘shutting the door’ and ‘scapula setting’ to address the position of my shoulders which are habitually rolled forward. We also looked at John’s exercise sheets relating to ‘dynamic sitting’ and he suggested I work with those over the next few days if possible. John suggested we meet again the next week to see what difference doing the same exercises with my increased understanding has made.

Screen Shot 2016-07-12 at 11.09.54

Heel Fracture

HEEL FRACTURE

No impact Aqua Running - Loan Belts available
No impact Aqua Running – Loan Belts available

‘I suffered a severely fractured Calaneum (heel) bone during a stag do in Berlin in the summer of 2014. It resulted in open reductive surgery where a plate and screws were fitted and I was unable to weight bear for 3 months.

Once able to weight bear I was limping and in quite a lot of discomfort. I would get easily fatigued after periods of standing and after a day on my feet at work would need to spend the entire evening recovering. If I did socialise out after work I would pay for it the following day or sometimes days with further stiffness and pain.
I received hydrotherapy and physiotherapy sessions soon after fully weight bearing and although this helped to a degree it was still painful to walk. I still had a limp, some days were worse than others and I got to a stage where my physiotherapist expressed doubt about his ability to help me any further as I was unable to perform a heel raise on the one foot, usually doable by this stage.

John was recommended to me by a work colleague who had had a running injury. I was feeling mentally defeated at this point as it had been a year since my injury and I still couldn’t walk without some degree of discomfort. I had recently been to a wedding reception after a day at work and as a result the 2 weeks that followed had been more uncomfortable than usual. I was having severe doubts about ever being able to walk properly again.

PHYSIO ASSESSMENT
After explaining my situation to John he worked the surrounding areas of my foot and manipulated areas in my back. I physically saw a change in my flexibility between the beginning and end of this first session. I could now move my right foot back as far as my left which I was unable to do before and it was noticeably easier walking up and down hills as I didn’t have this flexibility before. I’m now also able to perform a heel raise on the right foot and can hold this position for around 30 seconds. My confidence has improved considerably and I’m optimistic that I may even be able to resume more physical activities in the near future.’

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.

Update on my running – Highlander Mountain Marathon.

Here is an update on how I’ve been getting on since my last treatment session with you back in December.  I’ve delayed sending this as I wanted to include an update of the Highlander Mountain Marathon.

grapho showing weekly running milage after physio
weekly running miilage after physio

When I came to Physio in December I had been suffering with a strained adductor muscle (since August) and recurrent problems with my calf and ankle muscles which you’d diagnosed were caused by poor upper body posture from working at a laptop all day.  I was keen to get these problems sorted out so I could be fit enough to start training in earnest in the New Year for the Highlander Mountain Marathon at the end of April.  My training runs prior to seeing you had been very irregular, at the most consisting of a long weekend run and one other 10k run per week.

Your physio sessions got me back running again and the advice you gave me about my posture and running form chimed with advice I’d been given by Susie Baker, my Alexander Technique teacher, in the past.

New leaf in 2015
I decided to turn over a new leaf in 2015 and set myself a target of running or walking at least 5km every day.  I’m pleased to say this is something that I am still doing and I usually only have a walking instead of running day once a fortnight or so.

Running every day
Contrary to fears that running every day was going to exacerbate the calf and ankle problems I had been suffering with, I found that the aches and pains lessened and then disappeared completely.  Running every day gave me the opportunity to concentrate on my posture more and to practice running with good form.  Knowing that I have to do 5km every day means that as soon as I get any pains or niggles I treat them straight away with either stretching, wobble board or foam roller as appropriate.  I have even had a couple of sports massages from Katherine Golik to treat tired legs.  I’m going to continue with running every day for the foreseeable future: I’m used to it now and it’s become a habit.  The only thing I would add is more core exercises to enable me to maintain good form over longer distances.

Highlander Mountain Marathon and Butcombe Trail
As well as the Highlander Mountain Marathon in April (running 32 miles with 3,890m of ascent over a weekend with a backpack containing food, clothes, sleeping bag and tent), I ran the length of the Butcombe Trail during one long day in March: an unsupported solo run of 48 miles in 11 hours (which included time for map reading and stopping in several pubs on the way round for tea, coffee and extra water).

Man v Horse marathon
My next challenge is the Man v Horse marathon in June followed by a 50+ mile ultra in September.