Injury Rehabilitation

The Final Victory Against My Heel Pain Part I: Addressing the Biomechanics

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I’m really thrilled to be writing this post because it seems I’ve finally truly gotten rid of a chronic heel/Achilles/plantar fasciitis issue that has been with me for a long time. (I’ve said this before and I’ve been wrong, but for the record I’ve been running a lot and my heel hasn’t felt this good for this long in years.)

This thing has been with me for maybe three years. It’s never been enough to really knock me out. It didn’t derail me from my first marathon and subsequent 10-milers and half-marathons. However, several weeks ago I did a long trail run and it felt like a nail had been driven into my heel. I figured it was time to sort this out. The solution has been a mix of biomechanical and running technique adjustments, and a deeper understanding of pain science.

Before I met with anyone I put a green Superfeet insert into my shoes. I’m a minimalist shoe advocate.  I don’t want to rely on a crutch but I’m also very much willing to do whatever is appropriate to solve a problem. A lot of what I’ve read for addressing heel and Achilles problems suggests putting some sort of insert into a shoe. The idea here was to unload some of the muscles and structures that hold up the foot, including the Achilles. I’m still using the inserts on a lot of my runs but I rarely wear them at work and I do some of my runs with without the insert.

I next met with a couple of guys with a lot of great knowledge and experience. Mike Terborg and Nick Studholme were both very instrumental in my progress.  Mike is a performance and injury recovery specialist in Boulder and Nick runs Studholme Chiropractic. Mike is heavily influenced through John Hardy and the principles of FASTER Global which teaches a process of biomechanical reasoning. Nick studied under the innovative physical therapist Gary Gray. Both guys speak much the same language when it comes to movement and movement analysis.

They both have tremendous ability to explain what they see and communicate the changes they thought I should make. They both used a fantastic and powerful video program called Spark Motion which was created by Nick and a group of other guys. This was just an amazing way to record and analyze movement. Spark is a great tool that I need to look into.

The visit with Mike Terborg: Running adjustments

I first visited with Mike in Boulder a few weeks ago. We spent a couple of hours looking at how I moved. The major issue we found was prolonged eversion of my left foot. The foot stayed in contact with the ground for what seemed a long time. Mike explains his observations and thought process:

“Adhering to the Biopsychosocial or BPS model of pain (vs the Postural-Structural-Biomechanical model), we couldn’t say for sure what was causing the pain other than it could be a combination of things including but not limited to biomechanics. You had chronic pain of the plantar fascia, like to run, and wanted to be able to run more without aggravating this injury so we needed to look at your physiological skills and tendencies relative to gait. We cannot say for sure that eversion and dorsiflexion of the subtalar joint caused the injury (because these are natural motions of subtalar joint and thus normal motions for the PF to decelerate), but we can deduce that less loading of the plantar fascia (less dorsi/eversion) might be helpful in reducing the amount of stress on the PF during running. Our hope was that less stress/load during gait may allow you to run pain free for longer. In sum, we can say for sure that we crossed some type of stress threshold (bio, psycho and or social), so we wanted to ask your body what happened if we backed off on the biomechanical load to the pissed off tissue. 

“Your ranges and sequencing in the breakout evaluation all looked good, so we went straight to your running technique. Using Spark Motion for gait analysis, we deduced that it was possible for you to run in a way that reduced the stress to your PF and apparently that helped. The drills were all part of a progression to not only teach your body the skills and sequence of a more rapid gait but to train your ability to sustain that gait for longer periods of time (strength endurance of a skill). Nothing fancy, just following biomechanical reasoning to look for clues and strategies.” 

I really like Mike’s explanation of the process. He puts his explanation in a very honest way. In saying that we don’t know for certain why the pain is there, nor do we understand exactly how or why it might go away, he reflects the current cutting edge of pain science which reveals that pain is in many ways a baffling mystery.

He directed me to several exercise progressions of which here are three:


We changed my running gait along these lines:

  • Put less pressure through the heel into the ground. Let the heel touch the ground but only lightly.
  • Quicken the stride so the foot stays in contact with the ground for less time.
  • Swing the right leg through faster to facilitate less time on the ground of the left foot.
  • Run with a metronome set somewhere between 170-190 bpm.  This quickens the stride rate. Experiment.

The resulting new gait felt like I was some sort of prancing fool–La la la la laaaa!!!–dancing through the daisies.  Fortunately the video Mike shot of me indicated that in fact I just looked like I was running with a quicker step. (I could in fact go running in public this way.) Finally, Mike also suggested I visit with Nick so I did.

Analysis from Nick Studholme & fine tuning the lower leg

Nick put me through a muscle testing process and winnowed out some weak and unstable muscles in my lower leg. Specifically, big toe muscles known as flexor hallucis longus, and flexor hallucis brevis weren’t working up to par. The fibularis muscles (aka peroneals) were also a bit off line.

Taken together, when these muscles work they create and control plantar flexion and inversion of the foot as in the push-off of running or walking, and they create/control dorsiflexion and eversion of the foot as when the foot hits the ground.

Of great importance is the ability to anchor the big toe to the ground while the body passes over the foot. I was missing the mark. Nick taped my foot in a way to help facilitate this anchoring and he showed me several exercises to help me feel, create and control better big toe function while running. These exercises were similar in nature to what Mike showed me.

It’s several weeks later and what are the results? The heel and Achilles quickly started feeling better. I did a series of short interval type runs. The quicker pace (around 175-180 bpm) was challenging at first. I didn’t want to become exhausted while running and lose the technique, thus I only ran 1 or 2 minutes at a time. and walked in between. (Running with my dog tends to be a good way to break up the running with walking.)

Some discomfort remained for a couple of weeks in a stubborn way. It wasn’t terrible but it was hanging around like it was ready to pounce. I was worried that there was something we might be missing. This last bit of hanging-around heel trouble would be gone within 48 hrs after I reviewed the current ideas on pain and the brain. I’ll discuss that in the next post.

 

 

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NSCA Endurance Clinic Summary: Day 2 (I forgot to summarize the final presentation.)

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Maybe I was in a rush to post the Day 2 summary, I’m not sure.  I forgot to summarize the final presentation of the day.

Dr. Jeff Matthews: Running Injuries – The Big Picture

  •  DC, CCSP, CCEP, 1996 USAT National Team, high school track coach
  • Primary shock absorber of the body: FOOT PRONATION
    • Pronation isn’t a bad thing–it’s supposed to happen.
    • Posterior tibialis controls pronation via eccentric contraction
  • Secondary shock absorber: knee flexion
  • Aches & pains of the leg, foot and toes
    • Metatarsalgia
      • Pain at the metatarsal phalangeal joint as the heel leaves the ground too early.
        • Causes
        • limited ankle dorsiflexion
        • tight gastrocnemius
        • weak digital plantar flexors
      • Treatment
        • stretch gastroc with straight leg
        • increase distal plantar flexor strength
        • rigid forefoot in shoes
        • decrease stride length & employ heel strike
      • I have off and on metatarsalgia.  I’m going to work the toe flexors, particularly the flexor hallucis brevis.  I’ll use a band.
    • Hallux limitus and rigidus (aka Turf Toe)
      • Dancers and defensive backs get this as a result of doing a lot of stuff on their toes.
      • Loaded dorsiflexion of the big toe should be 42 degrees at toe off.
      • To check: Sit with knees bent at 90 degrees.  Lift toe with finger while foot is flat on the ground.  If it’s less than 30 degrees then you’ve got a problem.
      • Stretch toe flexors: Pull toe back 20-30x/day.
      • Restore joint motion to big toe.  I’ve been playing with this stuff quite a bit lately.  I’ve got a constantly tight left calf.  I’m wondering if restricted toe dorsiflexion is part of the problem.
      • I’m not only working to stretch the FHB, but also to strengthen it so my big toe can grip the ground.
      • Here’s a good big-toe mobility video:

    • Insertional Achilles tendonitis
      • occurs near the base of the AI
      • common in high-arched, stiff feet
      • common with Haglund’s Deformity.
      • Seems I have a bit of this; more along the lines of a bursitis from what I cant tell.
      • Strengthen with eccentrics.
      • He says “Work on the front of the tendon,” as that’s where the blood flow comes from.
    • Achilles Paratendonitis
      • He describes this as occurring with an audible squeak or creak–I’ve had that!
      • An inflammation of the sheath around the tendon
      • Work on the front of the tendon to increase blood flow.
    • Achilles non-insertional tendonosis
      • degenerative non-inflammatory condition from repeated trauma
      • treatment
        • rest
        • muscle work to stimulate fibrolasts to remodel
        • when appropriate, strengthen posterior tibialis and flexor digitorum longus
        • How do we strengthen the FDL?  Here’s one way:

    • Patellofemoral Pain Syndrome aka runner’s knee
      • comes from abnormal femoral movement
      • hip muscle weakness is the cause; increases with fatigue
      • Testing for PFS: 1-leg squat & check for 3 things:
        • leaning toward stance leg to maintain balance
        • knee caving in
        • falling
      • Treatment
        • retro patellar pain: recruit/strengthen the vastus medialis oblique (VMO)
        • stretch hips, foam roll quads, increase hip flexor strength
    • IT Band Syndrome (ITBS)
      • strengthen hip abductors
      • decrease tension on the tendon with soft tissue therapies
      • stretch glute max and TFL
      • may take 6 weeks (Didn’t take me that long to overcome mine.)
      • Check out my post on IT Band issues for more help.
    • Popliteus tendonitis
      • The popliteous unlocks the knee from the extended position.
      • inserts under the IT band and can cause lateral knee pain
      • if weak then knee may stay locked and send shock to the back
    • Treatment
      • Strengthen the popliteous
      • soft tissue therapy
      • control pronation (probably with foot strengthening drills and more importantly, HIP ABDUCTOR exercises)
      • Here’s a video on recruiting and strengthening the popliteous

  • Hamstrings
    • Hamstring strains have the highest recurrence rate and can take 4 months to resolve
    • Semimembranosus protects the medial meniscus during knee flexion
    • long head of biceps femoris helps stabilize SI joint and is most frequently injured in runners because of the long lever arm decelerates knee extension
    • more proximal the injury the harder to treat
    • Treatment
      • increase length, strength and flexibility
      • evaluate pelvis
      • strengthening abs/stabilizing pelvis can position pelvis correctly thus putting hamstrings at proper length
  • Low back pain
    • Pain causes weakness/looseness
    • Internal or external femoral rotation may become problematic.
    • Treat hips
    • A TFL problem = a glute medius problem.  This is huuuuge to me!
    • Seems to me that sitting too much is maybe the main problem here.

 

 

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Where’s Your Weak Link? Using Exercise to Expose Weakness – Part I

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Where's your weak link?

One big concept is on my mind and it’s been expressed by several experts that I look up to. In his book Movement, Gray Cook says “True champions will spend more time bringing up weaknesses than demonstrating strength.” The great powerlifting coach Louie Simmons of Westside Barbell says, “The Westside program is all about finding where you are weak and making it strong. Your weaknesses will hold you back. Kelly Starrett discusses the idea of “making the invisible visible.” With this statement he suggests we can use exercise to expose movement problems. (He talks about this concept here, here and here.)  What does all this mean?

All these guys are telling us that rather than going to the gym and doing fun stuff that we’re already good at and simply making our strengths stronger (taking the easy route, really) rather we should find our weaknesses and work like hell to bring them up to speed.

A slightly different paradigm

I think most of us have an equation in our head regarding exercise.  It might look like this:

I exercise → I get stronger.

(BTW, the word “strong” doesn’t just mean muscular strength.  We can get stronger at swimming, biking, driving a golf ball, carrying bags of mulch, etc. “Stronger” means to improve an ability.)

There might be a few more dots to connect between those statements though. With regard to the earlier statements about weaknesses and making the invisible visible (i.e. make hidden weaknesses visible), we might see the equation thus:

I exercise → I expose weaknesses/pain/poor movement → I correct/improve my weaknesses and poor movement →I get stronger.

What often happens is that we find an exercise that we really like and at which we’re very strong.  We really like that exercise! We do it and we demonstrate to ourselves (and let’s face it, others in the gym) how strong and able we are. Therefore our already well-developed ability gets stronger.

In contrast, I think a lot of us have discovered exercises that we really don’t like. The movement pattern feels awkward, painful or somehow asymmetrical or unbalanced. We have a poor ability to execute the exercise.  In other words, we’re weak at this particular movement.  We don’t do it well and we know it. Thus we rarely if ever explore this particular exercise.  What happens?  We probably get weaker and weaker at it.

So while something we’re already fairly good at gets better, a glaring weakness gets weaker.  And what do we know about chains and weak links? At some point that weak link (poor movement pattern) is going to cause us a problem if it isn’t already. We may not even know how strong we could be if we fixed our weakness.

My rule of thumb is: “If it’s really difficult to do and you don’t like doing it, then you probably need to do a whole lot of it.”

My experience

A lot of my clients have movement problems and various aches and pains. Their weaknesses are often rooted in a forgotten ability to move properly and maintain their joints in proper position. We frequently need to dial back the exercise intensity and simply work on slow, proper, mindful movement. Sometimes this requires a frustrating level of concentration. It gets difficult. It isn’t always fun. This frustration may lead a client to say ” I just want to work out!  I don’t want to think!” In other words, he or she want to revert to their hold habits, ignore their movement shortcomings and do what they’re already good at.

This is an important fork in the road. If a client chooses to continue to focus and do the hard work of correcting bad habits–to improve their true weaknesses–then he or she will almost certainly start to see lasting improvement in the near future. This client and I will likely have a long, productive and happy relationship. On the other hand, we have another type of client.  He or she balks at the first sign of difficulty, ignores and avoids weaknesses, and in essence chooses to tread water and only marginally strengthen their limited strengths.  He or she has picked an easy but limited route. In this case, our relationship is thankfully short.

The big picture

I’m going to go into some specifics in the next post, but for now I’d like you to consider the idea that the real way to get stronger is to seek out and wallow in your pathetic weaknesses. If you think you don’t have any, then add weight, reps, range of motion and/or speed to see if things start to come apart. Recognize where you start to fail and dedicate yourself to working on those weaknesses.

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Lower Trap/Scapula Mobility & Strength Process

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I’ve had some on and off right shoulder pain for a while. Along with it has been some wrist and elbow pain.  I’ve worked wrist mobility, elbow mobility and I’ve worked shoulder internal rotation as well as elevation and retraction of the scapula.  Like I said, the pain comes and goes so I figure I’ve been knocking on the door of the issue, but I haven’t yet nailed it.  I’ve employed the following process to very good effect.  I’ve used the same process with several clients and seen some very nice changes in shoulder pain and mobility, and neck pain and mobility.

An elevated shoulder

Recently, I asked my wife to look at my shoulders from the back and see if there were any discrepancies or anything that seemed out of place.  She quickly said my right shoulder was higher than my left.  I took a wild guess and figured I had an elevated scapula and that perhaps my lower fibers of my trapezius muscle weren’t doing their job.

The trapezius

The trapezius (or “trap”) is an interesting muscle.  As the name implies, it is a trapezoid.  From the picture you

The multi-talented trapezius

can see the superior fibers originate from the base of the skull and attaches at the lateral clavicle, acromion process, and the spine of the scapula.  The  middle fibers originate from C7 and T1-3 and attach at the acromion and scapular spine.  The inferior fibers originate from T4-T12 and run upwards to attach to the lower scapular spine.

 

The traps do several things.  Largely, they shrug your shoulders up (elevation), shrug them back (retraction) or shrug them down (depression).  The traps also play a role in rotation, lateral flexion, and extension of the neck.  The traps work closely with lots of other muscles including the lats, the levator scapula, deltoids, rhomboids, the muscles of the rotator cuff and a host of neck muscles.  Consequently, if some part of the traps are too tight, too long or offline in some way, the result may be shoulder pain, neck pain or other issues down the line such as elbow, wrist or possibly jaw pain.

Mobilize & strengthen

To get things feeling and moving correctly, I like to start with soft tissue work via a lacrosse ball, the Stick, a foam roller, or whatever tool you like to use to soften tight tissue.  I’ve found the stick rolled along the upper trap to be quite effective.  An example is below.  Also, I like to pin a lacrosse ball against my shoulder blade and the wall to get at the external rotators, mid traps, rhomboids, etc.  I like to use the lacrosse ball in a similar fashion to work the pecs, but facing the wall instead of backing into the wall.  Then, I’ve been using the following combination of stretches and strength work to put things in working order.

First are a couple of stretches I stole from Kelly Starrett at MobilityWOD.com.  Both are useful ways to work on internal rotation and tie in some neck mobility.  We often see poor shoulder movement that includes poor internal rotation and tight neck muscles–whether the lower trap is messed up or not.  Working some internal rotation, moving the neck and loosening the tissue in that neighborhood seems to help facilitate good shoulder movement.

Second, I use the prone-Y simply to get a feel for what it feels like to use the lower traps.  It’s nearly impossible to do this one wrong.  Make sure to keep the glutes engaged so the low back doesn’t arch too much.  Put a cushion under the forehead so as not to mash your face into the ground, bench, or table.  I like to go to mild exertion.  This isn’t something to make you grimace.  It’s simply to get you connected to your lower traps.

The face-pull comes next.  Take a staggered stance so as not to lean back.  Keep the upper arms parallel to the ground.  Keep the shoulders down–but don’t let the elbows drop.  This may be a challenging skill for some.  You may find your brain gets a tougher workout than any of the muscles involved.  Again, no need to go to use a lot of weight or go to high exertion.  Technique is #1 here!

Then I go to something I call a shrug-down.  You can do this with a lat pull-down or cables or tubing of any sort positioned overhead.  It can also be done with an assisted pull-up machine or unassisted hanging from a bar.  The important thing is not to go too heavy.  Just like the other exercises, this should feel too easy to start with.  Many people find it quite difficult to shrug the shoulders down without bending the elbows. This is a skill and it may take some time, some steam coming out of your ears, and sticking out your tongue to master it.

Finally, I like going to a full cable pull-down or pull-/chin-up.  Just like the other exercises, I suggest you go light.  Try to separate the scapular depression (the shrug down) from the elbow flexion.  See if you can make it sort of a two-part exercise: shrug down, pull up, lower yourself back down, un-shrug. Let me know if this helps your shoulder and/or neck issues.

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“Body Talk” Lecture Series by Rick Olderman

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If you’re in Denver and you’re either in pain or your a trainer/therapist who’s interested in helping people who are in pain, then I highly suggest you attend one or more of the following lectures from Denver physical therapist and certified personal trainer Rick Olderman.  I’ve mentioned Rick before (here, and here) and his hugely important role in helping me recover from back pain and regain my running ability.  Without question he’s one of the main reasons I was able to resume running and run my first marathon last year.  He’s part of the Body in Balance physical therapy office. The information here will be practical and probably very powerful in helping you or someone you know get out of pain.  And it’s free!

  • Neck Pain & Headaches: Innovative answers you’ve been missing.
    Tuesday, 4/9, 6pm
    Presented by Rick Olderman MSPT, CPT.
  • Trauma, Pain, and the Brain: How to use your brain to fix your pain.
    Saturday, 4/13, 1pm
    Presented by  Rick Olderman MSPT, CPT.
  • 3 Patterns Causing Back Pain and How to Change Them.
    Tuesday, 4/16, 6 pm
    Presented by Rick Olderman MSPT, CPT.
  • Accidents and Chronic Pain: Why you’re not getting better and how can you change your outcome.
    Saturday, 4/20, 1pm
    Presented by Rick Olderman MSPT, CPT.
  • How You Walk Can Fix Your Back, Hip, Knee, and Foot Pain.
    Tuesday, 4/23, 6pm
    Presented by Rick Olderman MSPT, CPT.
  • Stretching: Is there a better way to lengthen muscles?
    Saturday, 4/27, 1pm
    Presented by Rick Olderman MSPT, CPT.
  • Core Performance Versus Core Strength: Common mistakes with abdominal strengthening.
    Tuesday, 4/30, 6pm
    Presented by Rick Olderman MSPT, CPT.
  • How Does Walking Contribute to Chronic Foot and Ankle Pain?
    Saturday, 5/4, 1pm
    Presented by Rick Olderman MSPT, CPT.
  • Carpal Tunnel Syndrome and Thoracic Outlet Syndrome: A unique approach to solving pain.
    Tuesday, 5/7, 6pm
    Presented by Rick Olderman MSPT, CPT.
  • Running Injuries: It’s more than just foot-strike patterns.
    Saturday, 5/11, 1pm
    Presented by Rick Olderman MSPT, CPT.
  • Dry Needling: How is it different than acupuncture and how can it help you?
    Tuesday, 5/14, 5:30pm
    Presented by Aline Thompson PT, MSPT, OCS.
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The Problem(s) With Surgery

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“In America the scalpel reigns supreme. Some patients accept that surgery isn’t for them and gladly follow the non surgical recommendations, but others go from surgeon to surgeon until they get the surgery they think they need.”
– Dr. Jennifer Gunter MD, FRCS(C), FACOG, DABPM

I just read a very enlightening post from an MD regarding surgery vs physical therapy.  In To cut isn’t always to cure: knee surgery, health care, and our love affair with the scalpel Dr. Jen Gunter hits several nails very squarely on the head.  First, she discusses research comparing physical therapy alone vs arthroscopic surgery for treatment of knee miniscus repair and osteoarthritis.  What did the study find?  Dr. Gunter says,

“Patients over 45 with OA and a meniscus tear were randomized to typical arthroscopic surgery (which included post operative physical therapy) or physical therapy (PT). They were allowed to cross over to the other group if they so desired. At 6 months and at 12 months those who had surgery were no better off pain or function wise than those who stuck with the physical therapy regimen (30% of people decided to switch from PT to surgery).”

She goes on to discuss our view of surgery, and that we often view surgery as the ultimate best solution for pain.  Couple that view with our widely available yet very expensive MRI technology and we are a society hungering for surgery even when it’s clearly a questionable solution in many cases.  More from Dr. Gunter:

“A lot of people have arthritis of the knee (we know this because of all the knee MRIs that we do in this country at $1200 or so a pop). According to the NEJM study, 9 million Americans have osteoarthritis of the knee confirmed by x-ray or MRI and 35% of people over the age of 50 will have a meniscus tear on MRI. A torn meniscus itself doesn’t necessarily identify the cause of the pain because 2/3 of meniscus tears are totally asymptomatic. MRIs are so sensitive they identify tons of things that are not causative as far as pain is concerned.

Because we have an aging population, because we MRI everyone, because we have a problem with obesity (a major co-factor in osteoarthritis), and because surgery is highly reimbursed almost 500,000 people get their partially torn meniscus trimmed by a minimally invasive surgery called arthroscopy (using a surgical telescope) each year in the United States.

However, recent studies have called into question the value of arthroscopic knee surgery. For example, we know that arthroscopic surgery for osteoarthritis (OA) alone is no better than sham surgery. Yup. Put a patient to sleep, nick the skin with a scalpel. squirt water on his leg or stick a telescope into it and fix what you think needs to be fixed… the outcomes are identical.”

Dr. Gunter makes a great point regarding treatment of arthritis and by addressing obesity via lifestyle:

“And what about diet and lifestyle? Obesity is a major co-factor in osteoarthritis of the knee. Not only because the knee is load bearing, but the fat pad in the knee is metabolically active like the fat around the belly and contributes to the inflammatory changes of arthritis. The average body mass index in the NEJM study was 30. That means that obesity was the norm.”

I’m very pleased to see an MD making these kinds of observations.  The big message is that surgery isn’t always the best solution is tremendously valuable.  We love to think American medical care is wonderful but in so many cases it’s just incredibly wasteful.  We spend the most of any 1st world country on medical care yet our outcomes are questionable when compared to other modern countries.  We spend too much on things we don’t need when there are practical ways to reduce costs and maintain a high quality of care.

I would add that surgery often only treats a symptom rather than the cause of something like arthritis.  Osteoarthritis is typically related to poor movement patterns.  If we can use our muscles to correctly control our joints then we have sloppy movement.  The result is friction within the joint and thus a buildup of bone–arthritis.  The process is similar to the formation of a callous on the skin.  If we only clean up the arthritis and we do nothing to correct movement, then we should expect to continue to have pain.  Surgery doesn’t correct movement.  That’s what physical therapy and similar modalities are for.

 

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Good Core Strength Artice

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“I have a section called, ‘Stop doing crunches,'” said Westfahl. “If your core routine mainly consists of crunches, you are training for bad posture.”
– Alison Westfall personal trainer, Boulder

Briefly, if you’re an athlete (particularly a cyclist), a fitness enthusiast and/or interested in addressing back pain, you should check out a recent article from the Denver Post titled, Tom Danielson, Tour de France cyclist from Boulder, focuses on core strength, writes book to address back pain. The article covers former pro cyclist Tom Danielson and his trainer Alison Westfall and their approach to addressing Danielson’s back pain.  The two teamed to write a book called Core Advantage: Core Strength for Cycling’s Winning Edge.

Five clients mentioned this article to me and it definitely has some useful information in it.  The admonition to quit doing crunches is the first good piece of advice.  The second is the inclusion of the glutes as part of the core:

“Pain in Danielson’s spine compelled him to see Westfahl, who found his problem wasn’t rooted in his back, but in his glutes. She had him stop doing crunches — his primary core workout — and switch to other exercises, ones that, among other things, would persuade his glutes to start working properly when he rode.”

There’s more good information in the article including descriptions of three core exercises.  Have a look.  The book sounds interesting to me as well.  Probably need to put it on my wish list.

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Chronic Pain Lecture at Cherry Creek Athletic Club, Denver

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For anyone who’s interested in learning more about chronic pain and how to use the Z-Health Performance System to start overcoming chronic pain, I’m giving two lectures next week at the Cherry Creek Athletic Club in Denver.  Both members and non-members are welcome.  The lecture is free.  Dates and times are:

  • 5:45 pm, Tuesday, December 6th
  • 9:30 am, Thursday, December 8th

This is an interactive lecture so you will be moving around.  It’s not a full-on workout by any means but please wear clothing that will allow you to move comfortably.

For more information call the Cherry Creek Club at 303-399-3050 or you may email me at DenverFitnessJournal@Gmail.com.

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The Limited Value of MRIs

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The pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. James Andrews, sports medicine orthopedist from Gulf Breeze Florida says.

Sports Medicine Said to Overuse M.R.I.s is a very valuable article from the New York Times Health section.  It deals with the widespread use and misuse of magnetic resonance imaging (MRI).  As you may know, these images can reveal all sorts of interesting information from inside our bodies.  Fractures, frayed tendons, fluid around a joint and tumors are just a few things that can we can see via an MRI scan.  The thing is, these images don’t always tell us why we’re in pain.

The quote at the top is from a study by Dr. Andrews in which he scanned the shoulders of a bunch of uninjured baseball pitchers.  Though they weren’t in pain, nearly all the scans revealed “abnormalities.”  The results are similar to a similar study of hockey players in which MRIs showed that 70% of the subjects show “abnormalities” in their hips.  The thing is none of the hockey players were injured or in pain.

The Times article discusses the profit motive behind both MRI scans:

“The price, which medical facilities are reluctant to reveal, depends on where the scan is done and what is being scanned. One academic medical center charges $1,721 for an M.R.I. of the knee to look for a torn ligament. The doctor who interprets the scan gets $244. Doctors who own their own M.R.I. machines — and many do — can pocket both fees. Insurers pay less than the charges — an average of $150 to the doctor and $960 to the facility.”

The article goes on to discuss a skier who was prescribed surgery for a torn knee ligament.  This prescription was based on an MRI and the tear was confirmed by a second opinion.  It was a third opinion and MRI however that showed that the ligament was not torn and surgery was not needed.  In this case, the third doctor noticed that the first and second assessments of the torn ligament did not match the symptoms of the man’s injury.  It seems the prior opinions relied only on what the MRI showed and not on a carefully considered history of the injury.

The overall message here is that MRIs can give us a lot of information but they may not tell us the whole story.  An MRI is not a perfect, magic tool that tells us exactly how to address our pain.  It seems the best doctors recognize this and are very careful to order MRIs only when truly needed.  Don’t be afraid to get multiple opinions on your injury.  If your doctor seems to be relying only on an MRI, keep looking around for more help.

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It’s the Cycling Stupid?

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Despite what I said in my last post about feeling great, a number of my years-old aches and pains have returned–and it frustrates the hell out of me!!  I can spend several weeks feeling great.  I can run, lift and bike however much I want and everything feels top-notch.  Then the symptoms come back.  My left heel and Achilles starts to ache.  My left glute feels weak.  Parts of my left hamstring often hurt.  (Maybe I should amputate my left side?)  And I’m right back where I’ve been for way too long.  It’s all of these things that have led me to continue to investigate pain, injury, nervous system dysfunction, and how to overcome these issues. 

Giving up is not an option!

Cycling-related issues

Bicycling has been one of the constants over the course of my pain.  It’s been one activity that I’ve largely been able to do pain free.  But now I’m wondering if the bicycling is setting me up for the pain and dysfunction I’ve been experiencing.  Beyond that, it may be sitting in general that’s an issue for me.

It’s probably no surprise to you that spending a lot of time on a bike saddle isn’t always the healthiest thing a man can do.  Various nerves and blood vessels can be mashed which can result in a variety of problems including erectile dysfunction, numbness, prostate issues.  Here’s a decent rundown of potential men’s health issues related to cycling.

Cycling may also have implications beyond that most sensitive of areas.  If we look at the hip flexion and extension in cycling vs. hip flexion/extension in running, then we see that that cycling keeps the hips in a very closed type of position.  We go from lots of flexion to slightly less flexion as we pedal.  We never get full hip extension.  Thus we may create glutes that are overly stretched out and weak while simultaneously restricting various other nerves in the low back and pelvis.  Add this to the fact that we all wind up sitting a lot during the day no matter how active we are, and you might see how we can quickly create problems in the hips that may filter out to other areas of the body.

Nerve flossing

This is your wiring.

Something else I’ve started recently is a bit of nerve flossing. “What?!” you say? If you look at the chart on right, you’ll notice that the nerves run out from the spinal cord and out through the limbs all the way out to the fingers and toes.  Along the way they travel through various passages.  As we move our nerves must move too–at least they should move.  They should slide back and forth smoothly as we bend, reach, sit, stand, twist, etc. But sometimes these nerves sort of become stuck.  As you might guess, nerves are somewhat sensitive.  They don’t much like being stuck, squished, pinched or otherwise messed with. We can end up with what’s known as nerve impingement or nerve entrapment.  Nerve entrapment can cause pain, numbness, weakness and/or pins-and-needles in any number of places. Someone can have an entrapped nerve for instance in their knee and they may feel symptoms down in the ankle or up in the hip.  Fortunately we can mobilize these nerves though and un-stick them. Watch the nerve flossing videos to see how.

(These are drills which we’re taught in Z-Health T-Phase.  I haven’t attended T-Phase yet but I’m dying to go.  Nerve flossing isn’t exclusive to Z-Health. It comes from the world of neurodynamics.  Good resources for neurodynamics are the NOI Group and Neurodynamic Solutions.)

I started doing some of these last week and felt better immediately.  I’m doing a lot of them every day and I’m sort of playing around with different angles and different amounts of tension as I do them.  My theory is that if I free up the nerves several good things should happen.  First, I expect reduced pain right off the bat. Second, I expect better movement as the nerves should conduct impulses from the brain out to my working parts and back again. Better movement should help resolve any deformities in soft or hard tissue.  (For more on this concept read about Wolff’s Law and Davis’ Law.  These laws describe how tissue remodels along the lines of stress. Further, these laws govern such things such as bone density, arthritis, and callouses.  Arthritis is reversible by the way! Don’t let a doctor tell you otherwise.)

So the plan is this: As much as it “pains” me, I’m laying off the bike for several weeks.  How long?  I’m not sure.  It’s the one part of the equation that I really haven’t changed so I need to investigate it.  Further, I’m going to continue with the nerve flossing and lots of to see what happens.

Further, my idea is that running is something humans have done since before the start of forever.  Bicycling meanwhile is quite a different activity from anything our ancient ancestors did, and it’s a very new activity relative to how long homo sapiens have been on earth.  Thus it may be the sort of activity that causes some weird stuff to happen to us–or me specifically. So my hope and my expectation is by reducing the cycling I’ll resolve some of these issues, and this will allow me to run.  I will eventually return to cycling and see how I feel.  This whole process, should it work, should enhance my cycling ability as well.

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