Category Archives: Physio Sports Injury Blog

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 – 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.

First Physio Appointment – Jes

I went in apprehensive at what to expect as having a physio beforehand and not seeing much improvement had made me this way. We started off by analysing how far each of my legs could stretch and my natural posture. John immediately recognised what my problem was and after clicking my backs joints a few times my flexibility was automatically increased.

He then went into detail on how to sit properly and it resonated. After the first session i walked out feeling like a different person and am looking forward to the next session to learn more.aid65704-728px-Sit-at-a-Computer-Step-1-Version-2

 

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.

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.

OUCH! Hip pain. Week two of not being able to run….

OUCH! HIP PAIN
Week two of not being able to run and after a pain-filled weekend trying to juggle a two year old who refuses to walk down the stairs, I hastily book a second appointment with John at his AAA-Physio Clinic in Bristol BS8. As I hobble (very much a left leg limp) the short distance from my office to Moti, I am aware that every step is pinching my left hip and is a struggle.

DEBRIEF
And so the debrief, I have managed to spin and row in the week since I first saw John, but the pain I’m experiencing hasn’t eased at all. In fact, if anything it’s much worse. Carrying said two-year-old halfway across the Downs to the circus certainly didn’t help.

GP
I’ve been to the doctors (usual anti-inflammatory prescription and inconclusive x-ray) to no avail and am told it could be six weeks before I can run again…

PHYSIO
After a brief look at the extension on my left hip (or lack of it) John sets to work on my back. I’m shocked at how painful my lower back is. Ten years post-surgery, I am somewhat used to niggling there but as John works his way around my lower spine, I feel sharp shooting pains that actually make me scream. And so, the initial diagnosis is reiterated. In my inability to stabilise my core, I’m causing myself all kinds of problems in my neck, arms and, most painfully, my hip.

BACK TO RUNNING
I think it’s going to be a slow road back to stability and running, but leaving the clinic, into the driving Bristol rain, I’m already feeling a bit stronger and if I really put my mind to it, can see how strong core (deep breath in relax into the stomach) does help ease the pain. Another challenge…and one I’m determined to win.

Standing

Photo showing: Testing off road shoes with AAA-Physio @ Moti BS8. 14kmph : foot contact slightly ahead of body centre of gravity
Testing off road shoes with AAA-Physio @ Moti BS8. 14kmph : foot contact slightly ahead of body centre of gravity

Problem
Top of right glute painful, John has identified that my right foot veers left just at the end of my stride, meaning my hip twists probably causing the pain. It’s only in the last month.

Question is what causes it; shoes, stance or what?
Solutions
1. New tyres – popped in to Moti and the attentive chaps spent 45 mins sorting that in line with John’s instructions. Very different but comfy, hope an old foot injury in my foot isn’t aggravated as it always casts a shadow over new shoes.
2. Posture – while standing – ‘peering over cliff’, this is the one I’ve been concentrating on, feet, knees, pelvis and head, oh and chest and shoulders if a man can concentrate on more than 4 things at once! While sitting – pelvis, shoulders and head (superman eyes)
3. Running style – shorter stride landing on ball of foot not so heavily on heel, pelvis, elbows (pushing back and not too far forward), and the head, again. Needs working on at the next session.
Thoughts
I really should stretch more.
Been running and out on MTB, neither very good. Torn between resting and pain of getting fit again once John has worked his magic vs glute and back pain of continuing exercise.

Why no magic button John can crunch?

Pre-Iron man injury

FOOT OVERLOAD!
Having done a long distance run in training for my Iron distance I managed to injure my foot. I have been unable to weight bear for the last 6 days.

Triathlete Helen Jenkins running 2013
Triathlete Helen Jenkins 2013 – Also suffred from overuse injuries prior to the Olympics 2012 & had to pull out of the Commonwelath Games in 2014.

WHAT THE PHYSIO SAID….
Interestingly instead of being due to the camber in the road it was due to a total misalignment of my left side. I have a tight ITB, and weak glut medius. This combination makes me rotate my entire pelvis, valgus knee position which results in me placing all my weight and pressure on my lateral 1-2 toes….. And injuring my self!

THE PLAN
The plan this week is to do lots of swimming to allow my foot to heal, with core stability working on my gluts, stretch my piriformis muscle and ITB and try and run in line! Not much hey! Let’s see what happens……