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Fixing a wandering kneecap (and growing half an inch taller!)

I’ve been seeing John to correct issues with a dislocated right knee. I first dislocated it 5 years ago but I still suffer with knee and back ache and weakened muscles in my right leg.

To check how I was progressing with strengthening my right leg John put me through some resistance exercises. Lying on the bed with 2 pillows under my head and my left knee raised John pushed against my upper thigh to try and push my leg down. As this is my weak leg it wasn’t hard for him to push against it. He then pushed onto my shin to try and push my leg into the bed and again my knee bent to the pressure easily. The last two exercises were with my feet, I had to flex my feet towards me and try and resist John bending my little toe and big toe down. My little toe in particular gave up very quickly.

Because so much of the weakness in my knee, and the subsequent lower back pain I experience, can be resolved by strengthening the supporting muscles and working on my posture John taught me the technique to create a ‘spine sandwich’. This allows me to engage my transverse abdominals which wrap around the lower abdomen, taking the pressure off the muscles immediately around my knee and strengthening my core and legs.

Before we began it helped me to roll into a ball and for John to rock me back and forth for a while so that the spine got used to curving that way for a change.

Lying down with 2 pillows under my head and my knees bent with feet on the bed – a neutral starting position I took a deep breath in for 3 seconds expanding ribs sideways. Then breathed out paying attention to my ribs tucking all the way back in.

I placed my hand underneath my spine just above the tailbone in the ‘nook’ where the spine curves and the other hand over my lower abs with my thumb by belly button.

Next I curved my tailbone up slightly (as if pushing bum into the bed) and tightened my pelvic floor muscles to around 20%. I could feel my lower belly area tighten slightly and flatten under my hand.

Finally I needed to engage and stretch the top three vertebrae in my neck. To do this I rolled my eyes down as if looking at my bely button, and then let my head follow suit so that the neck stretched slightly.

Holding this position John then repeated the resistance tests and the difference was amazing. My leg was much stronger and even my toes could resist the force John as putting on them. It’s surprising how much of a difference engaging and tightening my core had on my feet.

We then measured me against the wall and I seemed to have grown 1/2 an inch just from this exercise.

I’d always known that posture was important but the differences in before and after doing this exercise shocked me. I am know conscious of my seating position throughout the day at my desk, as well as the position of my spine neck and head when driving and I’m noticing a real difference in terms of knee and back ache at the end of the day. I can’t wait to start Pilates to continue the work on my core strength and posture.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

.                                   Top view                                                                               Bottom view

 

 

.                                               Side view, upside down from the back

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

Knees – not just getting old? #28 – postscript A: other treatment, workstation revisit

It’s been nearly 3 months since my “final” blog re Physio John’s treatment. Since then I have been seeing an orthotics specialist.  As well as giving me further specific exercises to do to help re-train both my running and walking gaits, he has had me gradually reduce the height of the insole worn in my left shoe for the past 6½ years, down from 11-12 mm to a current height of just 3mm, and which in a few more days can be reduced down to nothing!  This has been aided by learning to use my glutes and piriformis muscles much more properly, and getting them firing better.

There have been almost no “transition” issues as the insole heights were reduced – none in the neck area , where I had a lot of pains for years (before starting to wear the original insoles in 2010), and just some soreness in a muscle in the middle of the shoulder blade of the opposite arm, which might not even have been related to the insoles reductions, as it could have just been that I pulled something. In any case, that has cleared up now also.

Over the course of appointments spaced about 1 month apart, the orthotics specialist has gradually concluded that even though I was turning out to be a model patient, and we were making big advances towards much better walking and running posture, I might still have to wear an orthotic insole. Whereas “normal” insoles are “even” from the left to the right side as you look from behind , orthotic insoles are slanted, either one way or the other.  In my case this needs to have the extra height on the inside of the foot – near the arch etc – and reducing down to nothing on the outside.  I had been wondering several months ago about whether something like this might be needed, when I was having the more serious issues at that time with the knee.  The orthotics specialist made up a “quick and dirty” jury-rigged orthotic lift for me, which I have worn in all footwear since the first week in June, changing it over from one left shoe to another as I did varying activities etc.

On the plus side, both my walking and running gaits have ended up with a much longer stride than before. They were each always unnaturally short, and I didn’t know why until now.  I just wasn’t using my body’s equipment properly.  After resuming full running a few months ago, with the improved techniques and gait, I found that the time it was taking to run the same 4-mile course, came down from about 40 min to just 36 min on the last run taken, which was around the middle of June.

On the minus side, after that last run, I developed some soreness again in the affected knee later that evening, but it felt a bit different to previously – not as severe as when I had been having major troubles in the Autumn of 2016, which had led me to start seeing Physio John, but serious enough that I realised I would have to stop running again, for an unknown period.

Since then, based on both my own instinct and on the orthotics specialist’s advice, I have only mixed in a few very short runs of 1 min or less, while taking walks.  Even so, over the past few weeks, as well as some pain in the tib-fib joint on the outside of the knee, the main joint feels like it is not quite properly lined up, and that joint can also sometimes give a little pain.  When playing table tennis, which I have continued with the whole time, I am unable to give 100% when going after a shot that requires a full stretch onto that left knee.  Another thing I’ve noticed is that while laying on the couch, such as after a day’s normal activity, if I rest that leg with the knee bent upwards and the foot on the couch, even after a few minutes, the whole knee joint is a little stiff when I next straighten the leg out again.

After that final run, when I next saw the orthotics specialist on 19 June, he concluded that I will definitely need to wear an orthotic insole. In that session he took some film on his mobile phone, of me walking across the floor of his treatment room.  He found that looking from the front as I walked toward him, my knees stay straight as I walk, but from the back, my legs are rotating – both of them.  His conclusion is that this rotation, together with the likelihood that the affected knee has some permanent damage, is why I am having further issues, despite the fact that my walking and running techniques had recently been much more “correct”.  He took imprints of both feet and ordered the orthotic lifts, and I am now waiting for those to arrive with him from the manufacturer – the same firm who had made the original, “unslanted” insoles I had been wearing previously.  His assessment is that wearing an orthotic lift on both feet will gradually help with re-training the body to use my long limbs more naturally and efficiently, without any of the observed, unnecessary rotations to either leg.  Until that has taken place, I will continue to do no further running of any significant distances at all, just a few yards here and there when walking.  This transition to phase out the current rotations, could take some time – so I am being fairly patient.  It’s also not clear whether I will ever be able to resume running the same distance as before.  I must be prepared for any outcome on that.

 

One other development of note has come from the work done with the orthotics specialist, something worth sharing in this blog. In his treatment room/office, he sits on an unusual-looking “sit-to-stand saddle stool”, the kind of stool used in places like hair salons, for example.  He recommended I get one of these – they are dirt cheap on Amazon – to see whether it would help with sitting properly more of the time, as well as not putting the glutes and piriformis to sleep as much as sitting on a conventional chair does.

I bought one of these saddle stools in mid May – the same model he has in his office – and gave it a proper tryout for around 6 weeks. While it was indeed clearly much better for the various muscles on my backside, I did get very sore where the bones of the hip stick downwards – the same place where cyclists get sore, from sitting on their bike saddles.  Also I found that sitting on the stool seemed to aggravate some residual muscle sorenesses I have continued to have up in the rib area on the same left side of the body on which I have had the knee issues (see blog #01).

I did like using this new stool, and as predicted, due to simple physics, they naturally move you into good back posture. But after a couple of weeks to see whether my “underside” would toughen up and I would be able to get used to sitting on it at my home workstation for a total of the typical hours in a working week etc, I had to admit to myself that this was not happening, and that it was just too painful.  So I tried adding a layer of 1-inch foam rubber, of which I had some left over from an unrelated DIY task done in the house.  That helped quite a bit at first, but within a few more weeks, the foam had squashed down, as it was not designed for seating or furniture.

I then tried using proper foam for cushions – 2 inches thickness in total, and much stiffer material that wears out much slower. For this, I had a professional upholsterer add the foam over the top of the existing saddle shape, then finish it off with the same sort of layer of PVC as the stool originally came with, over that foam.  While this felt a bit better at first, after a few days the hip bones that protrude downwards were still getting quite sore, and the aggravation to the rib muscles was still happening.

Here are pics of the various stages of trials of the saddle stool, as described above:

      

Having been through all the above experiments, the continuing pains etc led me to decide it was time to give up on the saddle stool approach altogether. Instead I returned to using the “deep” chair I had bought from Physio John late last year, which was a spare one from his treatment room in the MOTI store.  Sitting on this chair, with an added towel folded into 8 layers as John has recommended (something that helps keep the pelvis a bit higher than the knees as you sit), did not hurt the “underneath” protruding hip bones like the saddle stool did, and the soreness in the rib area was also not bothered as much.  But as I had always found, my glutes get fairly sore after even just ½ an hour on the chair, and also my right hip joint gets sore.  These issues had been what motivated me to try the saddle stool – but compared to the troubles I had with the stool, it turns out that the chair issues are the lesser of 2 sets of evils.

To come up with the best compromise that seemed possible, using all the knowledge gained from trying various things re sitting, and based on what the orthotics specialist and Physio John have each told me, in place of a folded towel – which offers only a little cushioning – I worked out a design for a cushion to use together with John’s chair, one that as it turns out, works reasonably well. It’s made of 2-inch stiff cushion foam, is a square 360mm x 360mm when seen from the top, and starting halfway along it from the back to the front, I had the foam cut at a diagonal angle, so it slopes down to nothing at the knees.

Below is a scan of the drawing I initially made up of this shape, which is intended to provide the required extra height for the hips so that they are a bit higher than the knees, and to do this in a way that should feel comfortable and natural, as you sit on it.  In the past I have tried thicker foam, but it just squashes around too much, so 2 inches seems about right.

Using some excellent cutting machinery in their factory, the foam people were able to produce some pieces to the specification in this drawing.  I then took those to the same upholsterer who did the saddle stool work, along with some nice fabric I had picked out for covers. I had 2 cushions made up, one in green for use at home, and a black one to take out to the workplace.

After trying out the green cushion for a few hours, it was clear it helped with the sore backside, and to some extent, with the sore right hip joint. But one thing I noticed was that with the extra height I was now sitting at above the chair seat, a bony bit of my spine that had previously been lined up with the foam in the chair’s curved backrest, was now up against the top edge of the backrest, where there was no foam.  This was making it sore.

I took a closer look at the backrest on the chair, and immediately worked out what to do about this. The height of the backrest needed to be raised up by at least 1 inch.  As well as taking care of this new pain in the spine, I realised that if I raised it a little more, the whole backrest might then work more as intended by the chair’s original design, but for a person like me who has a longer than average torso.  It occurred that I could add a 3rd screw halfway between the existing 2 on each side of the backrest, then move the backrest up by one “set” of these screws, in effect adding around  2 inches to the height of the whole backrest, relative to the seat itself.

I carried out these modifications to the chair, and was even able to get the lowermost pair of screws – one on each side – to get a proper hold in the wood in the very bottom part of the backrest. The end result of this was that as well as being exactly the correct height for me, the backrest was now fastened even more strongly to the rest of the chair, than it originally had been.

The final tweak of note that I have made to the workstation setup in the last few months, was to the height of the desk. I had already raised it a little when trying out the saddle stool for a few weeks, and as it turned out, that height was still correct for sitting on John’s chair again, with the new green cushion.

Below are some pics of John’s chair, showing these mods and the new cushion, as compared to how it looked before they were made. In each pair as aligned, the left pics show the original chair design, and of me sitting on a towel folded into 8 layers as advised by John, for the extra pelvis height – and the right pics show the modified chair, and me sitting on the new cushion with the slanted bit to get my knees lower than the pelvis.

 

    

Finally, here are shots of the modified chair and new green cushion:

 

Sitting on this for the last few days has been much better for the parts of the hip bones that protrude “underneath”, and the rib area soreness has improved also.  Although my glutes are still getting sore, it’s not a bad as with no cushion, and the right hip joint soreness is also reduced, though still there.

I am open to suggestions from anyone reading this, about how this setup might be improved further, to both retain a structural design that will promote sitting properly – as this seems to do – but which might further reduce the sore glutes and right hip joint.  This is the best I have been able to come up with, at this point.

 

How to become a blogger for AAA Physio

  1. Write First Blog Post and email to John Stephenson PHYSIO
  2. You will need to come up with a blogger name- you could use your real name or a creative username. This will also need to be in the email you send to John.
  3. John will then set you up a bloggers account, and email you back with details of how to access this account. Your first blog will have been posted for you by AAA Physio Support.
  4. You are now able to log in, have a look around! (You are also able to change the automatically generated password given to you)
  5. All blog posts from that point forward can be written and posted by you directly onto the website (no need to get it done in one go –  there is a ‘save as draft’ function!). You are also able (and encouraged) to include photos in your posts.
  6. John or AAA Physio support are always on hand if you experience any technical difficulties with the blog.
  7. Write away!

Here is the blog to give you ideas for your own posts! http://www.physiotherapy.co.uk/blog/

Dr Mark Porter: Stiff knees may be a sign of arthritis, but exercise can help

Here is a link to a very interesting article by Dr Mark Porter on how physiotherapy and exercise can reduce the affects of arthritis…

https://www.thetimes.co.uk/article/dr-mark-porter-stiff-knees-may-not-be-a-sign-of-arthritis-just-that-you-need-to-do-some-exercise-xzj9fkvn3

cycling-bicycle-riding-sport-38296 small

For those with arthritis here’s a useful link to Arthritis Research UK for some excersises to help manage knee pain…

http://www.arthritisresearchuk.org/arthritis-information/conditions/osteoarthritis-of-the-knee/knee-pain-exercises.aspx

London Marathon Success!

We would like to congratulate all runners who took part in the London marathon on 23rd of April. A special congratulations to Annie and Rob Dixon who completed the marathon in 3:58:12 and 2:51:43 and also to Richard Edwards in 5:02:00 (who was still looking full of energy despite already completing 25 miles!) and all of whom completed it with no injuries!

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http://www.marathonfoto.com/Catalog/List/285322548?PIN=V54972&LastName=EDWARDS

Knees – not just getting old? #27 – Last entry (for now), including summary

A couple of days after posting my previous blog , I spoke to John about the possibility of him measuring me up for my insoles, as it seemed they now needed replacing (see blog #26).  He felt it would be best for him to pass on doing this, as it’s a little outside his realm of experience and his qualifications.  So I contacted the company that make the insoles I have worn for the last 6 1/2 years, to see who they might recommend instead.  They put me onto a highly qualified orthotics practitioner they have worked closely with for the last 2 years or so, to jointly develop a new kind of long-lasting insole which that practitioner has designed.  I saw this other person a few days ago, on 26 April, and the appointment ended up going in what I would describe as an unexpected direction, though a highly positive one.  But that is another story…

Looking back at the work that physio John and I have done together since I first came to see him in late October 2016,  it has been highly fruitful, to say the least.  When we started treatment at that time, running or playing table tennis – even for just a few minutes – made my left knee joint quite sore, the knee would get quite stiff when I sat down even for short periods, and my walking gait had somehow developed a strange limp on that leg, one that was most pronounced when walking downhill.  In effect I was unable to run, and I was especially worried that I might have to abandon running permanently.

From the first session John and I had together, my objectives for our work included eventually being able to resume running again, to my usual distance of 4 miles and to be done once every 3 days, and to be able to play table tennis – all with no soreness issues either during or after a run / table tennis – and to be able to walk without any limp, including up- and downhill as well as on the flat.  We have more than achieved these targets, and I am 100% satisfied with the outcomes.

Along the way during the treatment period, I had 8 sessions with John.  We covered and addressed a wide range of potential causes of the knee joint issues that I had been suffering from since before first seeing him.  With hindsight, it is now clear that many of these potential causes were making at least some contribution to the knee problems, so it was down to much more than there being just a single thing behind it.  Had any of these causes not been addressed, I don’t think I would have been successful in the attempt to resume running again.

In summary of all of my previous blog pages #01 through #26, the things we/I did as part of our work together, and as a result of it, include the following:

  • A] John carried out various “range of motion” checks, on each leg for comparison, as well as other checks.  We did this in various of our sessions, and the results indicated eventual improvements and progress along the way.  Examining me freshly was invaluable in assessing direction of travel, expected durations of recovery, and so on.
  • B] I bought a MOTI foam roller, to replace an inferior one I had previously bought from a high street “chain” sports store.
  • C] We looked at my posture for sitting at the computer, in some depth.  John showed me how to sit properly, and once he had arranged my posture so it was “correct”, he photographed the result.  This photo became a benchmark I could refer to in other tasks we carried out, and as I sat working at the computer at home.  I even used this photo to measure the angle of my upper legs from the horizontal, using nothing more sophisticated than Microsoft Word and some simple geometry.
  • D] I undertook doing a major overhaul of my home computer workstation setup, where I have been making a living as a freelance Microsoft Excel spreadsheet developer for the last 18 months.  We both strongly suspected that this setup was a major culprit in my knee issues, which had only started up since I began working from home and sitting at it for a total of the usual sorts of working hours each day, sometimes more hours than that, etc.  Before that switch to home working, I had been running the same 4 miles every 3 days for some 14 years, with no problems of any kind – so even though we did not discount the usual things like poor running form etc as possible reasons for these knee issues showing up after all that time, we were on the lookout for other causes as well.  Altogether, the overhaul to my home workstation involved:
    • i) a shift from not having enough room to stretch out both legs underneath the desk and thus sitting at it at a “skewed” angle, to clearing away some IT equipment that had been stored under the desk, by adding strength to an existing shelf found out of the way and under the desk, making more room on that shelf, and putting the IT equipment on it;
    • ii) lowering the height of the desk so it was closer to a standard desk height in most offices;
    • iii) adding a “top of desk extension” so there was now enough desk “depth” and room to rest my elbows on it while using the computer keyboard (resting the elbows is an approach that was a completely new experience for me);
    • iv) replacing the old chair I had originally had leg extensions made up for – to accommodate my previous sitting position, which was quite high – with a spare chair from John’s  MOTI treatment room that he offered to sell to me, a chair which:
      • a} has more “depth” front to back and so provides better support for my long legs;
      • b} is of a more standard height as in most offices, and which;
      • c} when sat in properly following all these changes to the workstation setup – including v) below – results in my lower arms naturally resting in the perfect horizontal position, while I work;
    • v) adding a towel folded into 8 layers to the chair, positioned so the pelvis ends up a bit higher than the knees.
  • E] We took film of my walking and running gaits in the MOTI store – in more than 1 of our various sessions – and we worked on improving my general posture for both walking and running.
  • F] We fixed some ankle turn-in on the affected left leg, which had showed up on the films of me running.  In the end this appears to mostly have been from using running shoes that were quite worn out, as they were over 5 years old.  I bought a new pair at MOTI, and when we filmed me running in those, the ankle turn-in was gone.
  • G] John showed me various exercises, including some to target the glute muscles and get them working more properly.  I have incorporated all of these as shown, into my usual daily routine of morning exercises, and am still doing them today.
  • H] When the knee did not seem to be responding much to our early work from the first few weeks of treatment, I saw my GP.  To his credit, was willing to send me for an x-ray on the knee.  When this eventually did not show anything abnormal, my GP did not hesitate to send me for an MRC scan on it as well.  This proved to be very helpful in my treatment work with John, and it also demonstrated that it is possible for the NHS and a private practitioner to co-operate and work together to the benefit of the patient.
  • I] Between the x-ray and the MRI scan as outlined in the previous item, a “breakthrough” event took place in early December 2016 (see blog #14), after which the limp I had had when walking, which was most apparent when walking downhill , completely disappeared.  Although John and I were left a bit puzzled as to just what had taken place, and why, it was very good news, and as well as never seeing the limp again since then, the knee has also been improving ever since.  When the MRI scan results finally came in and I next saw John, he gave me new exercises to target the smaller joint on the outside of the knee, the “tibiofibular joint”, an area the scan had indicated was involved in the ongoing issues.  The scan suggested the main joint was more or less fine, despite showing what John and I felt were typical signs of me now being over 60 years old.  He felt I should have a good chance to make a recovery that might mean I could eventually get back to some amount of full running again, something my GP had also said after he saw the scan results.
  • J] In the first session with John after the “breakthrough” event as outlined in the previous item above, but still some time before the MRI scan results had arrived as also described in the previous item, John found a further possible cause of the knee issues – some tensions to the left of the joints in the lower spine.  He took a “before” photo of my back that showed my upper body was leaning to the right by a significant amount (around 1.5 inches at the neck), then he got me on the treatment couch and worked out these tensions, and then he took an “after” photo, which showed that I was now standing straight.  He was convinced this and the resulting “lockup” of several of the joints of the lower spine, was also a major contributor to my knee issues.  The knee did improve after his work manipulating the lower back, confirming what he had said.  That work also resulted in my upper body becoming more “evenly” aligned – joints were “popping” evenly on the left and right sides when I did the usual morning stretches and exercises, and so on.  Over the weeks following his manipulation work, I took 2 further photos of my back at home, using a delayed 10 second timer on my camera so I could get into position.  After using the computer to make adjustments to these photos to correct for perspective, they confirmed what I had been feeling – I was still standing up straight, so John’s work seemed to have “stuck” and was permanent.  A recent view of my back has also confirmed that it is still straight.
  • K] After the session outlined in the previous item above, we had a further, “penultimate” one on  02 Jan 2017, in which we had a review of all work so far, John re-checked for range of motion, and so on.  The MRI scan results were not in yet, but it seemed a good idea to take a fresh look at everything we had undertaken, up to that point.  As a result of these fresh checks, John carried out further manipulations on the remainder of my spine, all the way from the lowest joints he had addressed in the previous session, to the neck at the top.  There were no further significant tensions that he felt might be causing or contributing to the knee issues, but he did find some other, more minor tight spots, which he was able to “undo”.
  • L] By the time of our final session together, which was on 20 Feb 2017, the MRI scan results had arrived.  We discussed the results, John repeated the checks from 7 weeks ago, he showed me a new exercise for the “tibiofibular joint” as indicated by the scan, and we talked about recovery and about the physiology of the leg joint in general, and about my affected joint.  John felt I could start experimenting with short distances of running, keeping a close eye on how this felt, both during and afterwards, backing off if there were any issues, etc.
  • M] For a few weeks after that final session, I was reluctant to push the knee and so kept away from any running, just tried a little jogging for a few hundred yards now and then, which seemed fine.  I was going on instinct, and eventually took a proper run around the end of March.  By then the joint had gradually improved enough that there were no problems on that run, and since then I have been able to quickly get the distance all the way back up to my previous 4 miles on any given run.  I have lost a fair bit of runner’s conditioning, but it looks like this may return relatively quickly as well, perhaps due to me having continued the usual morning exercises throughout the treatment period in my work with John, as well as having kept playing at least some table tennis for most of that period, recently adding more of this , and averaging more duration in each table tennis session recently as well.

So that’s really about it in terms of my work with John.  I would highly recommend him, based on everything we have done together over the last 6 months.  He has succeeded in helping me to get back to running again, and the things he and I have done as outlined above, mean I have a good chance of being able to keep running for some time to come.

Calf problems from posture: #04 Twenty six days to twenty six miles

Twenty six days to go and it hasn’t escaped my attention that there is one day left for every mile I will have to run. I feel that this is somehow apt – the marathon is not only run over the 26 miles on the day, but over the many more miles run over the days and months leading up to it. This miniature mountain of time and distance (and hills) already covered is what makes my sensations heighten as the event draws nearer – I have put in so much effort to get this far that I don’t want to miss out due to injury or illness at this late point.
The exercises John has recommended have adjusted my posture to the point that the right calf is much less problematic, although this adjustment does seem to have ignited soreness in the left achilles. I am working on my gait to push right through to the toes on the trailing leg, increasing speed and reducing effort in the legs. This weekend will be my last truly long run before the marathon. As long as that goes well it will be all about keeping the legs ticking over for a few weeks and giving absolutely everything on the big day.

To see Tim’s personal blog see: http://edenprojectmarathon.blogspot.co.uk/2015/01/twenty-six-days-to-twenty-six-miles.html

Calf problems from posture: #02 A two pillow sleeper

On my second appointment with John, he once again demonstrated to me the flaws in my posture. With me standing casually, a quick profile photo showed that my pelvis and nose stuck out in front of the rest of my body. I am curving my lower spine backwards and then my neck and head are pushing too far forwards from my shoulders (see photo); as John rightly pointed out, I am a two-pillow sleeper. These extra curves in my skeletal frame mean that the nerves strung over that frame have further to travel than they should, and therefore have less give in them. My first prescription was to sort out my posture during the many hours I use a computer (at the office and particularly when using my laptop at home, for which my posture is really pretty terrible).


Following this, we tried some little hops as if skipping, first on both legs then switching to one leg, showing that this was much worse on my right side. Similarly, when balancing on one leg, I would lean my upper body much further to the side on the right leg than when balancing on the left. It seems I am literally a lazy arse, at least on the right side, where the upper glute muscles do not want to work to keep me balanced. Prescription two was the sitting-to-standing posture exercise from the physiotherapy.co.uk website to wake these muscles up. You or I may well ask what all this has to do with my calf injury? I believe John’s answer might be that you treat the body and not the symptoms of injury, and the rest follows…there is a logic to this, and as a scientist I see that you can only test this theory by following the advice, so fingers crossed and here goes…