Category Archives: Physio in Bristol

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!

 

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 – 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

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.

 

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.