Wed 19 Apr 2017
It’s been a full 8 weeks since I last updated these blog pages. For the first few weeks of that period, I still did not try any proper running, just added a bit of jogging in now and then when out walking, always for quite short distances. These experiments went fine, with no ill effects, but my instincts were still saying to hold off for a bit, so that’s what I did.
During that first month or so of these past 8 weeks, which ran up to the last week of March, I was very busy finishing off a work project that took up a lot of extra time, and I was reluctant to put any extra demands on the body, beyond my usual daily exercises, the walks of around 1.5 miles on most days after having lunch, and fitting in some table tennis, though not as much as normally.
During this time, the knee still seemed to be improving slowly. It was not at full strength yet, but was heading in that direction. Walking felt fine and, as had been the case since the breakthrough events of early December (see blog #14), there continued to be no difference between walking on flat elevations, and walking down- or uphill. As in the recent past before this, the main times I noticed much of anything at all, was when doing squats as part of my daily exercise routines, and also as before, at night I could not use one of my normal sleeping positions on my left side, because the weight of the other, OK leg on top of the affected one, continued to make the knee a bit sore.
I carried on doing the new exercise John had showed me in session 8 (see blog #24), to loosen up the smaller joint between the tibia and the fibula, the “tibiofibular” joint. I have been doing this one at the start of my morning routine of foam rolling and various exercises, which now includes a few things added over the last several months, to target the various causes of the knee issues.
I have noticed one odd thing while doing this new exercise to loosen the tibiofibular joint. The back of the top of the fibula bone on the affected left leg, seems to have a really pronounced “knobby” bit, which is not present in the same place on the other leg. I can only surmise that this is a long-standing difference that was never noticed before I started doing this exercise, as it seems to be very hard bone that I can feel.
I have also added one new exercise in, taken from a web video by a runner, “lunges”, which is helping to give more strength to both knees.
A few days before the end of March, the work project was coming to a close, and I felt freed up to put more focus onto the knee, and on fitness and exercising in general. I first tried a slightly longer bit of jogging while walking to an evening meet-up with friends in central Bristol. This felt fine, both during it and afterwards. I probably jogged a total of 1/8 to 1/4 of a mile.
Even after this, I was overcautious about trying out any proper running. But I did begin to play table tennis for longer periods of time in a given session, and I also added more sessions each week. These changes did not result in any noticeable issues. There were none of the sorenesses afterwards, such as on the day after table tennis, which had been so prevalent just a few months ago.
Around this time I began to notice that I was occasionally having pains in the neck area again, on the left side as before. Historically this has always been due to my left leg being shorter than the other one (see blog #01), and usually it has meant that either the insoles I wear on the footwear of the affected left leg were wearing down, or the shoes themselves were wearing down, or even, as after the first year of using 8mm insoles in 2010, that the leg length discrepancy had changed further. For the last 5 1/2 years I have worn 11mm insoles, and that seems to have been correct since then, although as various pairs of shoes would wear out / down, I have tended to add a few layers of black tape to the insole, to correct for shoe wear etc.
In my 8 sessions with John starting in late October 2016, we have made all sorts of adjustments that could potentially also be having an effect on the neck. The most notable of these is some work John did in session 6 on 19 Dec 2016 (see blog #16), to free up some tensions to the left of the lower spine joints which were giving the upper body a “lean” to the right, when viewed from behind (see photos in blog #16 for specifics).
I began to wonder whether the prolonged period of over 4 months during which I had done virtually no running at all, might also be having an impact on the leg length discrepancy – could it be changing further?
Eventually I decided that one simple way to test this idea, would be to try out some proper running at last. Having put it off for quite some time, I dressed in the usual running gear one day in early April, did the usual foam rolling, stretching and other run-prep exercises, and headed off down my street to see what it felt like. I was prepared for any possibility. If, for example, there was to be any sign of similar issues while running as I had suffered in previous attempts in late November of 2016 and before, I was clear I would have to stop, and probably just walk back home from there.
The first few hundred yards felt just fine. I was going fairly slowly, more of a jog than a run, but everything was working correctly. My running posture was naturally quite good, and my affected leg’s stride appeared even in terms of the foot pointing forwards (no “turn-out” for example). I carried on from there.
It was surprisingly easy to do this. I think my discipline about all the other exercising, and playing more table tennis (including a 3-hour session a few days before this), meant that my general level of fitness had not dropped all that far back from when I had last been running 4 miles every 3 days (up to late September 2016). Either way, I was encouraged by this, and kept going on my usual route.
I paid special attention to any differences in how it felt to run down- and uphill, compared to running on the flat. There were none of these at all, which I took to be a very good sign. This was a world apart from the issues I had been having before the breakthrough events of early December 2016 (see blog #14), before which I would always be running with a noticeable limp on any downhill sections, for example.
I ended up doing the entire previous normal distance of 4 miles on this first run. Then, after a hot bath and another foam roll to cool down, I did not have any of the kinds of soreness that runs or jogs of any distance at all, had been giving in the Autumn months of 2016.
The day after this first run, I was also not sore at all. The knee felt like it had done some proper work, but that was a different kind of feeling to any soreness. In fact, the whole body felt that way to some degree. The 2nd day after the run I was especially tired, and my hamstrings were fairly sore, despite having rolled them out properly before and after that run. I have heard that sometimes it’s not the 1st day after physical exertion that you feel it, but the 2nd. This was an example of that. But even then, the knee was not sore in the way it had been getting, before the work I did with John in our various sessions as from late October 2016.
Doing one run was one thing. Would there be any adverse effects if I took another one? I waited until 4 days after the first one to try again, an extra day beyond what I usually would leave between runs. The 2nd run felt quite different, but not in any adverse way. It just seemed more difficult overall, and my legs just felt like they had lead weights in them. Still, it was fairly easily able to do the usual distance that time as well.
As with the first run, there was no soreness during or afterwards this time, neither on the 1st or the 2nd day after. I also did not feel any more tired on the 2nd day than the 1st afterwards.
I played table tennis in between these 2 runs, and it was also fine.
Since then I have done a total of 5 runs. The body is returning to full conditioning slowly as a result of this, and there appear to be no issues.
Between runs 3 and 4, I had a major house clean over about 3 days, the middle of which included hoovering the house from top to bottom and then using one of those steam cleaning machines to clean the carpets – something I do each spring. I was quite tired for the 2 days after the carpet cleaning day, and there was some soreness in the knee joint, which first appeared the day after that cleaning and then gradually subsided over the day or so after that. I was down on my knees quite a lot doing the carpets, in all sorts of body positions I normally don’t adopt, so this was understandable. I delayed run 4 for an extra day beyond when I would have otherwise done it, meaning runs 3 and 4 were a total of 5 days apart. If the soreness from carpet cleaning had not improved, I would have waited longer – but early on during the day on which I later took run 4, a short walk showed that the knee was no longer sore at all, and my walking was full of vigour once again, so I was confident enough to have a go at that run, which went fine – no soreness either during or after.
I took run 5 this past Monday, and it felt really good. I am still going slower than before all these troubles from the past year, but that is to be expected. As I never push this anyway, it’s not an issue. It might take some time to get back to the same level of conditioning as before – and it might not even happen. Either way, I am very pleased to be able to run at all, with no apparent adverse effects. I must keep an eye on things, as it’s not certain I can continue like this, but for now it looks very hopeful.
The pains in the neck have remained. Today I got out some spare insoles and measured them up, then phoned the orthotics firm who made them for me, to ask them a couple of technical questions. I also bought a big bag of plastic spacers that carpenters use to level up furniture and cabinet installations, and something hard and flat to put over the tops of these spacers. The point of getting hold of these things is so that they can be used to have my leg length discrepancy re-checked, which I strongly suspect now needs to be done.
The orthotics firm told me one thing I had not known – the insoles tend to be good for 6 to 12 months only. Mine are over 5 years old. Once I knew this, I compared the thicknesses of the spare ones that I have never used yet, against a couple of the ones in my current sets of footwear. Sure enough, the ones from my footwear have compressed a bit and are no long giving the full compensating thickness I require, assuming there have been no changes to my physiology that has resulted in a further shift to the difference between the length of each leg as I stand upright.
It is possible that the knee joint issues have had an impact on the leg discrepancy, but I suspect it’s unlikely. The alignment of the main joint in that knee may now be slightly different to before I starting having all these knee issues around a year ago (something my instincts are saying, based partly on how it feels to do even normal walking), and even though the MRI scan had some comments about “patchy subchromal marrow changes” to the main joint, John and I think this is probably typical of a 60-year-old man, and that, had they also scanned the other, OK knee, the same thing might have showed up on that one. Aside from this, the scan they did on the affected knee showed nothing of particular note in the main joint, only some degeneration to the outer joint where the tibia and fibula meet, the “tibiofibular” joint. If that’s all that’s different in comparison to the other knee, I doubt it has led to the overall leg length discrepancy having changed.
The only way to find out for sure is to measure this. Now that I have the tools to do that – the plastic spacers etc mentioned above – I want to ask John whether he can carry out these checks. It will involve measuring up to see whether, using various thicknesses of extra height added under the affected left foot while standing barefoot, the pelvis is level, until the correct spacers give a level result. I know this is what is now required, because it’s what the therapist who originally diagnosed the discrepancy did, when he first found it 6 1/2 years ago. That therapist no longer takes private patients, and even if he did, given the history of the sessions I have recently had with John, and given John’s expertise in all his work to date, I prefer him to do this, if he is able.
As well as this checking, I will need to have a check done while wearing each pair of current footwear, to see whether the insole worn in the left shoe of each pair, is resulting in the pelvis being level and, if not, how far off this is. My suspicion is that I probably need new insoles made up, just because the current ones are so old and they have suffered some compression in their own right, as the suppliers have suggested by their comments to me today.
Even if I just need the same sizes again, the suppliers require a request be made to them by my physiotherapist, so I would ask John to do one for me, following this checking.
To summarise all the above, I am extremely pleased to have been able to start running again. Although I am still very cautious about it, there don’t seem to be any problems arising. I now need to address the neck pains that have returned, which is usually due to the insoles I use – to compensate for the affected left leg being shorter than the other one when I am in a standing position – and/or the footwear itself, having worn out. This means I need to be re-measured for insoles, and probably then have new ones made up, even if the discrepancy is unchanged. I will ask John whether he can do this measuring.