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.

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