Tuesday, March 24, 2015

Self-treat your body with techniques similar to Graston and ASTYM

I have met all sorts of therapies in my quest to recover my stride. I have found out that a lot of my muscle type problems result from far deeper problems in hip/pelvis/si joint area and my own peculiar body: femoral anteversion, mild dysplasia, and tibial torsion (all strangely on the left side of my body). Because these problems throw my body into its own method or sorting out a running stride added together with years and years of running, I have dealt with all sorts of tight muscles due to the compensations my body created..

I became a interested in all sorts of foam rollers, massage balls, and other techniques to try to get my body back out of pain, tightness, imbalances and distortions. I have more rollers and other devices than many PT offices that I have been in. I think a few corners and closets in my house protect the huddled masses of all sorts of these implements and tools.

I had a few PT sessions with therapists who performed Graston or ASTYM therapy. The real basics are that they use speciallly made tools to scrape over your muscle tissue, tendons, or ligaments to address scar tissue and fascial restrictions. I have had it on my lower legs and feet as well as the hip area and back of the knee. The therapist rubs over the tissue. By the end of a treatment, you can be a bit sore and the tissue can be red and inflamed, but it does loosen things up quite effectively. One major reservation I have with these sessions is that it is usually limited to just one spot on your body. I would think that they would look over your whole body to find tightness and try to resolve them like a massage therapist would.

I often wondered if this was a treatment you could do at home (like foam rolling). Late last fall, I ordered a product called the Mobility Star to try it out. I would caution against doing anything close to attempting what a trained therapist does, but I was curious about working on my own muscles. The Mobility Star is similar in some ways to the professional tools, but I do think the corners and edge surfaces are much rounder and more gentler on your body tissues. When researching before trying this out, I also found this inexpensive Kindle book, An Introduction to Instrument Assisted Soft Tissue Mobilization, which gives some excellent guidelines and directions if you want to try self-treatments. It goes over what to do for various muscles and I would consider it a must-have book if you are so inclined to try this.

In fairness, I have not really gotten deep into this as I am in a do-no-harm phase of just trying to keep my body pain-free. I do keep the Mobility Star handy for when a muscle feels tight. I find it much easier to use than a roller or a massage ball on tight muscles around my legs (like a strong thumb), particularly around my shins. It can get directly into any tight tissue that bothers me and it gives much better leverage. When I am slightly bothered by something that is tight, I just pull it out, work on the muscle for a few minutes, and usually I feel much better. I haven't used it much as the book suggests as a way to do ASTYM, but when I have, I do it very lightly as the book suggests. It is not about how deep you can go. One interesting thing to note is that you learn to feel the vibration of you tissues as the tool helps you find what needs to be treated.

I have also found similar and cheaper versions of this tool, like the EDGEility Tool, the Myofascial Releaser - MICRO Tool for IASTM, as well as Gua Sha Scraping Massage Tools . You can also find more expensive (and probably more precise tools).

Here is an introduction to the Mobility Star:



This video shows some techniques for using the Mobility Star:


Here are some more tips and techniques:


Good luck, if you try doing this. I think that someday, these or similar tools will replace the foam rollers and massage type balls that have become very popular today. 

Thursday, March 12, 2015

Spinning Students Learn Self-Regulation

There is something special about exercise! As a running fanatic for all of my life, I have always tried to share my enthusiasm with others, particularly my students. It is not just the movement of running that I enjoy, nor the health benefits, but there is something else that makes it special. I used to get terrible headaches when I was a kid. They interrupted my life throughout childhood, until I started running cross-country in ninth grade. The headaches went away and upon reflection, I am quite sure they were related to stress. When I am out on a run or riding my ElliptiGO, I can solve problems, think creatively, and keep my whole world in working order. This is a guest blog post by myself. It comes from my teacher's blog and reflects something cool that I am doing in my classroom. I recently added a classroom spin bike to my fifth grade class. It is not really for fitness, but for something called self-regulation. As my class cycles through 5 minute spins on the bike throughout the day, I hope they are learning the benefits of movement to relieve stress, help with focus and attention, deal with anxiety, and to calm down when overwhelmed.  The bike is a huge success with my students and is gaining attention throughout my school. Already there is talk of other teachers at my school getting spin bikes in their own classrooms.

Using a Classroom Spin Bike to Learn Self-Regulation 
I have always liked to exercise and have been a long time competitive runner ever since running  cross-country during high school. I have competed in about 50 marathons and 5 Ironman distance triathlons among hundreds of other races, so I love the challenge and the competition, but there is something more that I gain from exercise. A daily workout of an hour or more helps me solve problems, think creatively, and deal with the stresses and pressure of daily life (particularly when teaching). That appreciation for movement is something I have always wanted to add to my classroom environment, but how do you get your students to understand the benefits of movement and exercise?
You can read my entire post here: Using a Classroom Spin Bike to Learn Self-Regulation

Tuesday, March 3, 2015

What the Osteopath said!

The doctor that will be doing prolotherapy on my si joint the first week of April (if I elect to do this) wanted me to get my joints realigned by an osteopath before I come in and just so happened to recommend one that has office hours three miles from my house. So I went today, did the quick history thing again, and she did the maneuvers that got some pops out of my joints so that I am hopefully realigned. However in checking me over she wasn't so sure my si joint is the cause of my problems since when she pushed on it I didn't feel pain. She said that because of my funky left leg mechanics, when I run it puts a lot of torque  on my body and pelvis and when I was younger I could compensate more easily, but now that I am older my body can't handle it. In other words, I am an old man! I agree with that the torque causing problems, but I am still not sure the prolotherapy couldn't help. I asked her and she said it is like "fusing" the si joint together and it may improve things. Well, that is the point! I will see if the adjustment helps over the next two weeks before I go back again (unless I get a call to come in for the prolotherapy as I am on the wait list if someone cancels). Well, I guess I am officially an old man!


Is this what the doctor's see when I go in for appointments?

Sunday, March 1, 2015

More on Prolotherapy and PRP Injections for the SI Joint



I went to see a doctor about my si joint and getting prolotherapy to see if it can help stabilize everything around my hips and low back. I went to a doctor who specializes in this at the same clinic where I had my hip arthroscopic surgery in 2011. She is a physicist who specializes in prolotherapy and other regenerative techniques. I was waiting for an appointment at the end of the month, but got a call to come in this week. The only problem was that it was an early morning appointment and I had to get up at 5:00 (on my vacation week) to make it through traffic and get their on time.

She went through my history and did an evaluation. What I liked is that she doesn't just focus on one body part. It all works together. On the other hand, that means she can't pinpoint the actual problem for me. She says the si joint and hip joint all work together. She said she would have like to have seen me 10 years ago and that she would have done injection in my hip back then.

She explained that using prolotherapy on my si joint would be a good idea, but with the bit of arthritis found in my hip, it may mean that later, she might need to suggest PRP therapy in my hip joint. I read enough and I am ready to give it a try. The part I don't like is that insurance does not cover prolotherapy and I will have to pay for each visit (around $350) and she suggests that patients commit to coming in once a month for five to six months. She said we would know by the third visit if it is working. I would also have to not ride my ElliptiGO (at least at the intensity that I do) after the injections for a few days or longer. Then after she has worked on my si joint, the hip issue comes into play. I am quite sure PRP therapy is a lot more expensive and I am not sure I could go there, unless I was 100% sure for a positive outcome.

Meanwhile, everything around my left lower back, si joint, and left hip are somewhat troubling every day. I feel OK, but can't do the things I would like to do on a daily basis as everything keeps going out of balance and pinching or pulling all over the place. I started using my Serola Sacroiliac Belt and that gives me more freedom and stability, but I sure would like my body to do the work without resorting to a belt.

Anyway this gives me a bit of hope, even if not for running, just to get rid of the constant imbalances origination in my hips and si joint. She also wants me to work with an osteopath to get myself realigned before the injections. She knew a ostepathic physiatrist up in New Hampshire and gave me her information. It turns out that she has some office hours at one office just 3 miles up the road so I have an appointment next week. This is good as I was searching for a local osteopath last month, but gave up after the first office I called wanted to make it very difficult to even set up an appointment. I decided to skip it at that point. With my current insurance, I am at the point where I don't have to pay for office visit or even copays anymore, so I should take advantage of seeing specialists that may help.

On a related note, I went to visit a podiatrist again at the office where I had my orthotics made back in 2011. The world renowned podiatrist that used to work there is now retired, I had to pay out of pocket to see him a few years ago, but now my new insurance pays for the visit. Let's just say this new guy does the minimal  that I ask of him and shows no interest in me as a patient at all (something I notice a lot in the health care field). I visited him a month ago for the first time and he did what I asked: looked at my left foot and adjusted the cuboid bone and also the poplitius. That foot has felt fine since then, but the right foot felt out of whack. I asked him about that and he checked and adjusted something with the ankle, looked at my left foot and readjusted the cuboid and then he was basically done and out of the room before I could ask about anything I could do to help myself with stretches or something. I glad I didn't have to pay out of my own pocket for less than 5 minutes of his time. I mentioned that I was hoping to get some prolotherapy done and he said he had never heard of it. I find that interesting as a few people I know let me know that had it used on their ankle and feet with great results. I am often amazed at how little doctors know or are even curious about new or different therapies than what they were taught. I would think they would read up on everything they can about how to better service their patients (I read everything I can about teaching to improve how I teach). I guess I call that going through the motions and it is quite obvious that this is what this guy is doing.

Here is an article on Prolotherapy and PRP written 5 years ago concerning research at Harvard by the doctor I will be treated by and Dr. Hauser, who is the most visible prolotherapist in the country. Prolotherapy and Platelet Rich Plasma Research at Harvard: Interview with Joanne Borg-Stein, MD

This article is old, but this was interesting about PRP therapy (use you own blood plasma rather than a sugar solution) and labral tears: RH:

One condition you mention there was hip or labral issues. Do you find that is a condition that responds to regenerative injection therapy?
JBS: I don’t know yet. The hip girdle is complicated. Often times labral tears are incidental radiographic finding and not the proximate cause of pain. I think we need to be diligent and careful in our physical examination and assessment of the hip girdle: anteriorly, laterally and posteriorly. I don’t think there is any data yet, and certainly no radiographic data and pre- and post- studies, looking at what happens to the torn labrum if one gets regenerative injections.
Here is a Wall Street Journal acticle (again it is 5 years old):  A Pinch of Sugar for Pain concerning prolotherapy. Here Dr Borg-Stein is again quoted on the effectiveness of prolotherapy (I believe I am one of those carefully selected patients as I don't think she would waste my time otherwise). I do have back pain, but that is related to the si joint and the second doctor talks about how this responds well to prolotherapy.

The strongest evidence in the scientific literature is for chronic tendon problems such as tennis elbow, says Joanne Borg-Stein, medical director of the Spaulding Wellesley Rehabilitation Center in Wellesley Mass. Some studies suggest it can work for thumb and finger arthritis, she adds. The evidence for back pain is conflicting, but Dr. Borg-Stein says she finds it effective in carefully selected patients. 
One type of back pain, caused by looseness of the ligaments around the sacroiliac joint—near the hip—responds very well to prolotherapy, says Michael Osborne, assistant professor of physical medicine and rehabilitation at the Mayo Clinic in Jacksonville, Fla.
Here is a video of prolotherapy performed on the low back by Dr. Hauser. It is not for the squeamish or for those who dislike needles and but cracks:



Wednesday, February 18, 2015

Awesome 4 Week Postural Realignment Therapy Program: Online Videos and Instructions

These videos make up a 4 week/ 4 video postural realignment program that is found on Breaking Muscle and contributed by Maryann Berry. Maryann is someone who has fully recovered from the chronic hip pain in her twenties which put her in a wheelchair. She uses an exercise technique called Posture Alignment Therapy, These exercises remind me sometimes of Egoscue. I started this program on week one, but stopped doing it because my si joint was real sore. I got a Serola Sacroiliac Belt last week and it is feeling better, so I am ready to start the program again. There is a video for each week of the program and you can find more directions for each week's exercises here. I have been following the videos each week as Maryann makes them available online and it looks like a well-thought out program.








Wednesday, February 11, 2015

Meb Keflezighi relives the 2004 Athens Olympic Marathon video






Here is a new video where Meb recounts the Olympic Marathon in which he won the silver medal in Athens. While watching this video, I noticed for the first time the number that Vanderlei de Lima was wearing when he was attacked by psycho man as he was leading the race. Let me now reemphasize something that I found out, just like Venderlei did: 1234 is not a lucky number.



Monday, February 2, 2015

New Pathways back to Running: si joint dysfunction and Prolotherapy?

I have given up on running. I have never been able to figure out what is going on with my hip post labral tear surgery. Last year I only ran a total of 88 miles (most of those during snowshoe races). I did not run an actual running race for the first time since I started running in 1973 and decided it was not worth it to do more snowshoe racing this year knowing that after each race, I would spend a few days with my hip area all beat up and uncomfortable. I have read everything, tried everything, and have found nothing really helps that hip area: strengthening, mobilizing, or rolling things out, PT, doctor, and injections have not been helpful either. I say my hip is sore, but it really is not the hip socket, but everything connected to the hips within and without.

I have even been feeling uncomfortable riding my ElliptiGO. I am getting my rides in indoors this winter, but my hips always feel rotated or off level. Before Thanksgiving I was really off and sore in the sacrum area. I again researched ways to fix a stuck si joint. I worked on some self mobilazations,I found that were way beyond my flexibility, but low and behold a heard a pop and then everything calmed down for me.

I started getting more discomfort in the si joint after a few weeks and kept trying to work through it. I decided to research more and it hit me quite clearly that what I have been fighting is an si joint problem. The more I read, the more it made sense and everything I read about the symptoms matched me totally. There are methods that can pop a stuck si joint back into positions,, but the problem that people have is that the ligaments connected to the si joint get stretched and don't stretch back, thus chiropractic adjustments can make things worse.

One method that claims to fix this is something called Prolotherapy. I certainly have read about this before and found comments I made (TDF) on running message boards about this from back before my hip surgery. I had ignored it, because it considered experimental and insurance does not cover it. Basically, they inject a sugar type solution into the ligaments and that is supposed to stimulate recovery. It seems to work well with the si joint and tightens up the ligaments and making the joint strong again.

I am in the process of trying to get an appointment with a doctor for this and then I will have to see if it is for me and if it is even something I can afford.

Update: I have an appointment at the end of March with a doctor that specializes in this at the same clinic that I had my hip arthroscopic surgery. Surprised that the doctors, physiatrists, and PT people that I saw there didn't mention this, but maybe they were just focusing in on the hip.

Here is how it makes sense to me. I always had an awkward running stride, but I made it through high school and college running with no problems except my knock knees and  weird stride (due to femoral anteversion). Then two years post college, I got into triathlons. Six months and after only two races, I completed my first Ironman distance triathlon. There was no such thing as bike fit back then and I had problems with my left weird leg getting comfortable right from the start and jamming up my hip-lower back. That winter, my back was already sore, so someone recommended I see an osteopath. He did manipulations on my si joint and I would feel good for a day or two and then it would hurt, so I started lying down an pressing on that si joint myself until it clicked and I felt better. By the end of my my fifth season doing triathlons I could barely stand comfortably and was clicking my back 10-30 times per day. I had my first PT to try to figure it out in 1988 right before my wedding because I didn't think I could stand comfortably through the ceremony. I was told to never run again.

I now know that was the si joint and if the ligaments remained stretched, then I have been fighting that unstable joint for over 30 years (and yes, that is what it always feels like even if I am riding my ElliptiGO). I think once I run and put all the weight on that one joint, my body tries to compensate and that is why everything falls apart when I run. It literally feels like it needs to be stitched back together.

This video even shows how an si joint dysfunction is a cause of a hip labral tear (particularly someone with a long standing dysfunction). Well if I have run for over 30 years with this (I have never been comfortable since 1983- but have controlled it better at times) then that may be a real good reason why I developed a labral tear.



Another video explains the symptoms of si joint dysfunction. Instead of saying, "You can have pain.." she could have said, "Jim has pain..." as it describes my last 30+ years quite accurately.



I will be curious about the Prolotherapy or anything else I learn along the way. So far, the best appointment I can get is in July! If anyone reads this and has comments or has had good or bad results from prolotherapy, I would be interested in hearing them.