Wednesday, October 13, 2010

What is a Physiatrist???

Today I completed only my 3rd run of the month. I wasn't too happy with a doctor today, so I went for a run. The past two weekends, I dusted off my running shoes and went for one 8 mile run to just see if things are improving in my left hip. I haven't run much since the beginning of September (and have gained about 10 pounds-yikes!) and was hoping for a sign that things were getting better. Both runs started off great. My legs and hip felt fine, without the stiffness that I had in the left hip all summer. I was thinking I might be healed.

But about 1/2 mile into each run, the muscle or bone right on the inside crease of where my leg meets my pelvis would start hurting. The inner thigh muscle then would start tightening up. As I ran, the tightness would spread around the inside and then at about 4 miles my glutes would start tightening up like they did all summer. As I ran things would get tighter and tighter all around my hip. Saturday, I had no choice but to stop just 1/4 mile from my house, not because I was tired, but because it started shutting down on me. The next day, after both runs, I would have to fight all sorts of sore and stiff muscles (not running sore-but out of place sore).

After failing to complete two MRIs, I was to see an orthopedist this morning. I was looking forward to see what the next step would be. So much of my malfunctioning hip sounds like a labral tear (what they wanted to check out on an MRI), but I wasn't ruling out a stress fracture, or some other problem. I was expecting to be sent to Boston for an MRI (where they can put you out!) or maybe get a cortisone shot to see if that would help things.

The new doctor did a few tests of moving my joint around, measured leg lengths and then said that she didn't think I have a labral tear at all. She said she looked at the x-ray (which the previous doctor said showed nothing) and said that I have a little bit of arthritis. I always assumed "arthritis" is the "name" given to something that you are not sure of and that you don't want to treat. I guess that was the easy answer. She said I was good enough to run again. "Hello", I have been trying that and something is still wrong. If I could run every day, I most certainly would.

This was a ridiculous appointment, coupled with the fact that I was her first appointment of the day and it still started over 1/2 hour late. She said she would like to refer me to a Physiatrist. She wrote down 4 local names (which I can't even read it is so poorly written). I asked her if they worked with athletes and she said she wasn't sure, but she said I could research it myself if I wanted to find someone different. I don't know anything about physiatrists. It seems that a physiatist is a medical doctor who focuses in on rehabilitation (rather than surgery). They are like a physical therapist but with more training. They treat the whole body and not the symptoms with a lot of different approaches. It sounds good to me, but where do you find one that specializes in sports injuries and if it worked so good, why do I never hear runners talk about them? I see that they also work with accident victims, amputees, the elderly (almost there), and people with other needs so I am not sure that every one has the training, knowlege, insight, or desire to work with a runner that refuses to stop running. I am sure great ones are out there, but is that person nearby and how do I find him or her? I will be working on it, however. Hopefully, I can find someone real good!

So even though it was a lousy appointment and I think I was just gracefully "shown the door" I can only hope that I find the right physiatrist and find a way to figure out what is wrong with my hip and how to fix it!

I could have bought a nice television or an iPad or something really cool, but I got these instead so I better show them off!

On another note, I picked up my permanent orthotics last night (three weeks after getting them molded for my feet). Not only are they expensive (I think that is the most I have spent on any one item in a long time) but they seem really fragile. That could be good or it could be bad. They are the lightest orthotics I have ever had. I had a pair in the 80s and another in the 90s and they were like boats. The base is reduced in size compared to what I have had in the past and they are incredibly light. They feel like they are made out of chalk and that they could break or dissolve in a few days of use. It has a seemingly flimsy covering with the cutouts for my 1st MPT joint (to treat Functional Hallux Limitis). They are extremely light in my shoes and have a different feel than the generic FHL insoles that I have been using since the summer. I think the cutout for my joint is deeper and my feet roll differently in them.

One thing that I hope is that they may help my hip. I have wondered is if the "off the shelf" insoles might be helping my FLM, but at the same time hurting my hip. An angle or balancing point may shift my foot, leg, and eventually hip into a position that stresses my hip. While many things got better for me in my foot through the use of the insoles all summer, my hip seemed to get worse and worse.

As I ran in them today, I liked the feel of them in my shoes and apppreciated the lightness of them. I noticed my foot working a bit differently and I noticed that as I ran the tightness went from the inside of my hip to the front outside of my hip joint and that was new, as if I was using the joint in a different way. I have decided that I will try to run more, but for smaller distances (I ran 4 miles today) to keep my glutes from acting up and tightening. Maybe things will improve.

I will be on the starting line of the Bay State Marthon on Sunday. I would like to see how far I can go before  the tightness sets in. Maybe I'll only get a few miles in. Maybe I will get a 1/2 marathon in. Who knows, maybe the orthotics will work and I can jog the whole 26.2 mile thing. I don't give it much of a chance, but if the hip doesn't hurt, it would be interesting to do a marathon after barely running the past month and a half! At least, I can cheer on my teammates out on the course once I do stop.

On a final note, I have used many different types of foam rollers, but I think I have found that best foam roller ever made. I have been using this for two weeks and it is quite a monster and can hit muscles in ways that a traditional foam roller cannot and it feels better than it looks as it can really isolate tight spots and trigger points.

I also got this book today. I am going to need something for my abs after all the weight I have gained after shifting from my favorite pastime (running) to my second favorite (eating ice cream). Actually, I have an opportunity to talk with the author, Jonathan Ross, on the phone next week and I want to be ready. He is one of the countries top trainers and I look forward to asking him about the use of the TRX as well as what insights he might have to fix my imbalances. Here is his website for his book "Abs Revealed".




First a thanks,
After coming across your website I saw the link to trigger point Performance.
I followed there workouts and have seen a big improvement in my sciatic problem and greatly improved my posture!
Ok, I think you need to see a Chiropractor, they can really help.
Also maybe you should try running without any inserts in your shoes,does this produce less pain?
also maybe try a pair of neutral shoes with a flat heel to toe profile.
Also get someone to video tape you running, side on, head on etc.
you will then be able to look for any problems you have with posture etc.
Check out this link too;

John Sifferman said...

Hi Jim,

Just discovered your blog from your comment on Matt Metzgar's site. I think I've visited once before awhile ago, but can't remember.

I just wanted to say to hang in there with the running injuries. I developed a long list of injuries from running back in 2003. I spent three years in weekly PT sessions, and was told by two different docs that I would never be able to run again (a sports med specialist and an orthopedist) - that my problems were too severe. In 2006 my health insurance stopped paying for my visits, and I had to "go it alone" to cure the problem and heal the damage. No more twice-weekly visits with my PT.

Today, I run as often and as far as I'd like. I've made quite a bit of changes to my running hobby, but I now run completely pain and injury-free. It's truly remarkable considering I couldn't run more than a few hundred meters before having to stop because of the pain. I've literally gone from debilitated to liberated.

This might sound obvious, even outrageous, but have you tried incrementally working up to running barefoot? I see that you have custom orthotics (yep, had those too!), but have you tried barefoot walking or running in the past?

It's not a cure-all by any stretch, but it does provide you with valuable feedback about how you're running. Generally, if you cannot run barefoot, then you're not running correctly, as was the case in my situation. This was a small part of how I came back to running - among other various interventions.

If I were you, and you have NOT tried the barefoot method, then I would spend this whole winter strengthening your feet in preparation for the warmer months. Walk around the house barefoot, exercise barefoot if you can. Do foot, and ankle strengthening exercises all winter long so that when the snow melts, you have a whole season to start walking, then slowly progressing to running barefoot.

I think it can be done by anyone who hasn't had intrusive surgery that would otherwise prevent the transition, but it absolutely must be a gradual one. If your feet have been in shoes your whole life (mine had), then it's going to take months, maybe even years before you're ready to run fully barefoot. That's why I recommend spending a whole winter preparing the muscles, joints, and connective tissues in advance. The more prepared, the better.

I haven't gone into much detail about the specific process I followed, but there is some information on my site about running, and quite a bit about going barefoot. Feel free to check it out, but definitely hit me up with an email if you have more questions.

I spent a year trying to slowly adjust into going barefoot, and it's now been 2 years of pain-free and injury-free running. Hang in there, Jim!

Jim Hansen said...

The trigger point tools and workouts are pretty good. I probably don't use them enough. Working on the soleus seems to be a key one, I enjoy! DO you their dvds or just the stuff on the web?

I did a great chiropractor (ART- active release) for about 15 visits this summer- but it didn't work and I got worse. He did notice my Functional Hallulx Limitus in my big toe joint and that is why I am using the inserts (from another doctor). They make sense, but they change things up a bit up the line so I have to give them time. I wore minimalistic shoes for many years and let my feet do their thing. I think that meant the arch collapsed on contact because the 1st MPT joint collapsed (FHL) and my foot pronated and rolled wrong. Back when I learned this I sent a video of my running to some guys called The Gait Guys and they noticed stuff including tibial torsion (which can't be corrected) and is probably the original source of my hip and back problems. If you are curious it is here: > I'll have to check out those links. If I get no where with this doctor, I might try gait analysis but it is expensive.

Jim Hansen said...

Hi John,
Yes, I remember you writing before. That is inspiring that going barefoot works for you. I am not against it. I got close as I have been doing minimalistic shoes for years (Puma H Streets and lightweight racing shoes) for all training and racing. I tried the 5 fingers last year, but never got into them. I have been wearing Vivo Barefoot shoes all day for almost two years (until this summer). My new inserts fit into them nicely so I can wear them again, yeah! I do feel good when I do barefoot strides, but don't do them enough.

None of that is really barefooting it, though. I have to give the inserts some time (they were expensive) and make sense for FHL (see above). The new ones I have are quite miminalistic. They are super lightweight and very flexible in the forefoot. There is a cutout under the first MPT joint and that is supposed to be the key for me. The heel is lower and as light as can be, but my joints and body are still getting used to them. I hope they do something good soon.

Maybe I should try running barefoot or in socks a bit on the treadmill to see how that feels, particularly to find form and strengthen things. Is that OK for barefoot running. I know Matt keeps telling me to go barefoot and I tried walking around after runs a bit in the summer barefoot, but again I didn't do it enough.

Thanks fot the encouragement. Maybe I'll try a short distance on the treadmill tonight!


So far I'm just following the TPP video's on their websie.
Had really good results.
i spend 20 mins doing the workouts before each run.
check out that link I sent you on fixing broken runners, really good!
Have you tried starting with run walk breaks, ie run 1 min - walk 1 min and build up?

Jim Hansen said...

I had seen part one of that and now watched part 2. I was looking at gait analysis a week ago, but want to see where this doctor does first. There is a gait anaysis place for runners down in Boston, about an hour away.
I don't think I am ready to start back up running yet, but I should take it slow like that.

Running Fool said...

If you do decide to try a gait analysis, in addition to researching the boston gait lab that you have mentioned, also do some research on the Univ. of Virginia's lab.
Running Times magazine has 2 episodes already posted about the UVA lab helping a runner with an achilles problem and the gait analysis looks very sophisticated and high tech and it maybe helpful to your situation.
Here's the link to episode 1:
Here's the link to episode 2:
Here's a link to the UVA pricing page:
I have no affiliation with the UVA lab (I live out in California) and have no personal experience with the UVA lab but am just giving you this information to help you "recover your stride."

Jim Hansen said...

I have been watching those videos and that is where I got the idea. I think they had an article in Running Times too. No matter how good the lab, it it the person interpreting the results and giving the guidance to correct things that matter most. They sound like they know what they are doing down there in Virginia. I am mulling over a few options of what I would like to do and unfortunately they do involve some money so I really want to make a right choice.