Monday, May 27, 2013

Amazing Kenyan High School High Jumpers

This is awesome. Filmed at a high school track meet in the Rift Valley of Kenya in the town of Mosoriot. February, 2013.

Here Swedish Hurdler Stefan Holm shows some jumping ability going over super-high hurdles in training.

This film shows the history of the high jump from 1896-1992.

Sunday, May 26, 2013

No (finish) Line On the Horizon: Back to Ground Zero

I am not seeing where anything is going with running, so I am not. I only ran once this week. I did 4 miles (longest run in a month) on Wednesday. Despite feeling really out of shape and breath, I made it past 2 miles without my glutes tightening up, but I did start losing my stride the last mile.

I have lost everything I had built up and am terribly out of shape and I am not feeling capable of any other exercise. I did ride my kickbike 8 miles earlier in the week and that actually felt pretty good, but when I went  to the chiropractor on Wednesday, she didn't think it was a good idea. I am not sure exactly what I should be doing and where I should be heading, it is like there is no line on the horizon and I am just waiting to see what I need to do next.

I did get a huge recommendation that the place I am going for treatment is spot on, but that was in reference to the head chiropractor. The lady I am seeing is doing a good job, but I need to see if I can switch to the head guy by the next appointment. Actually, my left side has felt pretty good since the adjustments and other work on Wednesday. I ran the 4 miles after that, but I just feel like things need time to stick and running may kill things again. After I had my session, the main guy jumped in and while working with another patient directed some weird stuff for my to do. First I had to put on a pair of sunglasses that had blinking lights in the top right corner and bottom left corner. Then I did some stability exercises on a balance board and only on my right foot: 30 seconds with my right foot on each side of the board and my left leg in the air. Then I had to do 3 X 15 strides with my right foot on a cushion and my left leg hooked up to a tension belt. I would lift my left knee up against the resistance and pull the leg back as if I was running, all the while maintaining my balance and trying to get my arms to do their proper motion. This was hard at first. I think somewhere along the line he said my right foot should be in supination. I think this is all some sort of neurological patterning and the lights help do something, but I can't find any information on exactly what the exact idea and therapy is called. I do seem to walk better since then and practice without the blinking lights at home. He said next time he wants to work on my gait.

Friday, I went and had an MRI for my left hip. I am getting pretty good at getting through an MRI. This was an MRI with arthrogram which means they shoot some dye or something directly into my hip joint beforehand. As awful as it sounds, I barely feel the initial shot and then nothing. Then you go lie as still as you can in the MRI tube for 45 minutes. Thankfully, I know just what meds to get prescribed so I don't care about claustrophobia and I can basically enjoy lying down while doing nothing.

Wednesday, I will visit my surgeon to get the results. I am hoping to find a lot of answers concerning my hip. Number one: did I retear my labrum? Number two: do I have some type of impingement from FAI to some other thing that makes it hard for me to lift my leg particularly if I lean forward at the same time like when I put on socks or shoes ( I don't expect a good answer on this from my surgeon and will send the results to another surgeon if nothing else makes sense)? My surgeon does not acknowledge FAI from what I have heard and other patients talk about his temper if it gets brought up, but that is not my experience the two times I have met him, so I will see what happens to me when I bring it up. Then I want to see if my tight adductor inner hip area tightness might be related to athletic pubalgia (sports hernia) or osteitus pubis. These are secondary problems that often come due to muscle imbalances related to labral tears or hip impingements. I hope I am clear on all of these as I really don't want more surgery, but it has been almost two years and my hip is still angry and not right. Then I hope to see if it is a muscular issue with one or more of the muscles surrounding the hip joint whether the glutes, adductors, or psoas. These are constantly tight and the tightness keeps shifting around my hip.

Then if I a clear of all evidence of these problems, I will know it is an imbalance and compensation problem that just needs continued work and the correct therapy. I am really disappointed that it has taken this long and I still can't move and run like I thought I would be doing by now.

Whatever happens, I have signed up for two races in advance. Thursday, June 13 I have the Hollis Fast 5k. As of now, I think that it will be a long run for me. And if I crash and burn, it is not like I haven't done that before in this race. The first year they had it, there was a right hand turn at the finish off Depot Road. I took the corner too fast and hard trying to break 18 minutes and slid on some sand tumbling me ingloriously in front of the finish line (they have since taken out the turn and just finish on Depot Road so as to avoid "Hansen's Corner"). The downhill nature of the race may not be the best for my hip, so I think I have to go and just have fun as a jogger. I also am signed up for the Falmouth Road Race in August. Hopefully, I will be back and running by then

Besides the little bit of exercises I have been given, I am steering clear of anything else. The only things I have been doing are basic movement patterns, you know the ones we first explored when we were learning how to move: rock, roll, nod, crawl, and cross crawl. You can find them in the ebook by Tim Anderson and Geoffrey Neupert called Original Strength: Regaining The Body You Were Meant To Have. This is a newer edition of their earlier and simpler ebooks. With everything going on with getting my body back, it shouldn't hurt to go back to ground zero and tear apart what I think I know and start all over again.

"I set about the systematic destruction
Of the world I built up
I set about the sytematic destruction
The deconstruction
From new emotion, a new reaction
A new location, a new vocation
From new destruction comes new creation, a new creation"

David Rudisha wins in New York City

The New York Times has a new article on Kenyan 800 meter superstar, Olympic Champion and World record holder-set in the Olympic final, David Rudisha and his coach Colm O’Connell Improbably, Missionary Trains Stars in Kenya. Yesterday, both men were in New York City, where Rudisha won the Adidas Grand Prix despite windy and rainy conditions. Rising American star Eric Sowinski crashes to the ground near the finish after tanglinig with another runner.

One British Magazine recently ranked Rudisha among the 50 most marketable athletes in the world.

Here is the London 2012 Olympic Final that is always worth watching.

If you have not watched the Eamonn Coghlan documentary on Brother Colm Man on a Mission, you can see my previous post on it and view it here. It is an excellent documentary and includes footage of David Rudisha training.

Saturday, May 25, 2013

Running to the Limits: part 3

Here is the third and final part to the Alex Vero documentary Running to the Limits recently uploaded to youtube..

Part one and part two were previously posted on youtube.

Wednesday, May 15, 2013

Simply Running: I Wish

It's a simple thing. I just want to run. I only did two runs last week: 3 miles on the treadmill and 2 miles around the neighborhood. I did make a lot of phone calls. I have an MRI scheduled next Friday for my hip. Some days I feel good and pretty much balanced and then all of a sudden, I will get like these light burning pains from my toes, to the bottom of my feet, to the back of my knee (these are all only on the left side) to my adductors, to my lower back, and up my back to behind my shoulder. It may last all day and then just disappear. It can't be muscular as I am not really doing anything. I also am tight in the adductors and glutes on my left side and maybe tight in my high hamstring, too. The hip doesn't want to work right.  I have no clue what all this is, but it reminds me of the randomness of things pre hip surgery.

I have a physiatrist visit planned at the beginning of June and the possibility of seeing a new chiropractor who does dry needling, gait analysis, ART, and a functional movement screen. These may be worth a shot.

I went for my fourth weekly visit to the new chiropractors office this morning. I wanted more work on my feet which she had done the first session and had my running well that night and less work on my back. I think the spinal manipulations there may have been too much for me to handle. I like the variety of techniques she uses, but I am not sure what works and what doesn't and she is young and new to the practice and I am well, I guess, complicated..

Typical smile when running these days.
What happened to my smile?
At the end of the session, she had a question about my hip for the head chiropractor, who is well known for his work with amateur and professional athletes and a strange thing happened. The first thing he asked me was about my facial tone. I said, "What? What are you talking about?" a few times, but he caught me with his question, because I have been wondering about the left side of my face. When I look at photos, it droops down, particularly when I am running, but I wasn't sure if that is what he meant.

He did a balance test. I have been doing this at the start of every session where you stand on a foam mat and close your eyes. I always end up leaning to the right with pressure on the outside of my left foot, He did some eye tests: looking at a pencil to the upper right and then down to the lower left and made some comments to the lady who had been treating me. I did  the balance test again and was more balanced that time. Then he  had me sit down and raise a leg one at a time. I had told him about how hard it is to lift my left hip flexor so he gave me a very cool hip flexor strengthening exercise I have never seen before (see below).

He spent only about 10 busy minutes with me, but it was mind boggling. As he was giving me a doctor's name to consult with about my hip, he said I should look up something called  "pyamidal distribution of weakness".  When I got back to school, I did. He had told me not to be frightened by all the stuff I might read on the web, but I got a bit uneasy reading what I could find. It has something to do with a lesion and neuromuscular stuff and some pretty crappy illnesses. I immediately got a massive headache: whether from the eye movements we did or from seeing this new stuff. Really I just want to run, not be a basket case, but I am interested in what he might say. I will have to call and see if he can guide my treatment, instead of the lady chiropractor as he was making asides to her about what we should or shouldn't be doing and I didn't catch it. I had been planning to stop treatments before he worked with me until I found out info from the MRI.

Well, at least I may know some answers after the MRI (and if you know how much I hate MRIs then you know I am serious about getting answers) and who knows what this stuff the chiropractor was mentioning was really about?  A retorn labrum almost sounds nice now. I am hoping they only find some scarring or tendonitis or something that is simple to treat. Another hip patient looked at my recent x-rays and thought she saw slight cam on the hip and some possible pincer (but she is just someone on the internet). Those would be signs of FAI and something my surgeon does not acknowledge and I have found a few other patients of his who had similar problems to be and had to go to another surgeon after their labrum re-tore due to the FAI. FAI is an impingement that the surgeon needs to fix during surgery or it can re-tear the labrum. Let's just hope I aggravated some muscles or tendons and that some rest can fix things up.

Here is some good news about the tightness in my adductors. I have learned to avoid most stretching of my psoas and adductors as I found it aggravates things. I also found that doing glute medius exercises like the clamshell or straight leg lifts tighten things up too much in the glutes like someone hit them with a baseball bat, but I am supposed to do those, right? Fortunately, I started listening to myself and what some other hip surgery patients have said about their muscles getting aggravated by doing these so I am stopping. However, one night this week I found this page called Untying the Four Knots I had bookmarked in the past and decided to do this frog like stretches and movement for both adductors at the same time. A single leg move always throws things off. The day after doing the movements in the video, my muscles were tight, but I noticed I could lift my leg up higher. I waited a couple of days and tried them again. They don't seem to aggrevate me and I can lift my knee even higher. Of course this could also be due to some Graston work on the adductors, or due to the fact that I started taking Advil. I also notice I can lift and rotate my leg to get out of a car seat without using my hand for assistance. So maybe I have found a helpful stretch for those adductors.

Here is the video:

The new hip flexor strengthening move I was given goes like this:

Kneel with the leg knee on a cushioned mat (theirs was 2 " thick or so) with the toes pointed behind.
The left hip and knee are both at 90 degrees like in a typical hip flexor stretch.
Dorsiflex the left foot and lift the foot off the ground by bringing the knee up and down. Repeat.
Then he had me look to the right and hold my right elbow up to shoulder lever with the hand 90 degrees pointing up. Lift the left knee again. I immediately felt it target the hip flexor in a new way.

I don't know what type of movement therapy this is from, but I will give it a try.

I used to blog a lot on teaching on my Simply Teaching blog. I found this one more rewarding and haven't posted there in awhile, but I look forward to the day I can call this blog "Simply Running" because it really shouldn't be this complicated and all I want to do is run.

Sunday, May 12, 2013

"The Day the Big Men Cried": Great article on Andy Hampsten's epic ride in the 1988 Giro d'Italia

With the Giro d'Italia (Tour of Italy) currently underway, Austin Murphy of Sports Illustrated takes a wonderful 25 year peek back to at the 1988 Giro which American Andy Hampsten won in epic fashion. Hampsten's courageous ride on the 14th stage over the Gavia during a blizzard is legendary. Whether you were a fan of cycling, like I was back in 1988, and you who Andy Hampsten was, or you have never heard his name, you should know him as one of the greats of American cycling and his race over the Stevia as one of the greatest rides ever. It did pass my mind back in 1990 when my son was born that the name we gave him, Andy Hansen, sounded very cool and similar to Andy Hampsten! You can read the article here.

Saturday, May 11, 2013

Hip Problems? Labral Tear? FAI? Read this: A Patient's Guide to Hip Impingement

Anna-Lena Thomas of the The Entrepreneurial Patient has written the first (that I know of) book for the labral tear patient who has problems with their hips. The Entrepreneurial Patient: A Patient's Guide to Hip Impingement is a must read for any person (and therapist and doctor) who is curious about hip problems or suffers from a labral tear or femoroacetabular impingement (FAI). I found Anna's blog and this post last week that talked about the multiple and complex issues of the hip joint and helped categorize different layers of diagnoses. It was a very helpful post for myself.

While visiting her site, I noticed she has recently published a book: The Entrepreneurial Patient: A Patient's Guide to Hip Impingement While I have not been diagnosed with FAI (my surgeon doesn't treat it- I understand) I was curious about what she had to say about hip arthroscopic surgery and the different diagnoses, procedures, and outcomes. Upon downloading the ebook version, I did a real quick read of the book since it was late at night. I went back to reread it all over again this weekend and I wish this book had been written before I had my surgery in 2011. She walks you through her story, explains the mechanics of the hip and different forms of surgery. She uses data from studies and interviews and explains what a patient should know and do before and after surgery.

From my experience, just about everything I have learned about labral tears and arthroscopic surgery, (including my own) has been from my own research which is primarily found on online message boards from other patients. In fact, I believe I would never had been treated or had surgery if I didn't advocate for myself through self-diagnosis. No doctor or therapist ever suggested a labral tear to me as the source of my long-time problems, which started as a lower back problem similar to Anna's experience. I had the resultant back, sacrum, psoas, adductor, and glute problems as well as muscular imbalances long before I felt anything in my hip (although in retrospect the clicking, catching, and giving away in that hip joint should have been a clue that something was wrong with the joint).

Anna gives a solid education regarding the hip and it is good to have it in one place rather than in a bevy of numerous online postings. The book is worth its weight in gold, just because she tells you how to interview and seek out qualified surgeons and therapists. I thought I did lots of work to get my surgeon, but really he was only the second surgeon I called (the first considered me too old at over 50). My surgeon has excellent credentials, but I had heard he doesn't treat FAI and I really should have asked around to see if I have it and I never questioned him on it either. I still don't know if I have FAI.  I also did not meet my surgeon until right before the surgery. If I had researched and asked around, I would have found out how hands-off he is post surgery. I was given a sheet with a few exercises and told to call his office in 10 days, from which I was told I could start running when I felt ready. I waited until three weeks post surgery and I have yet to hear of anyone starting running so quickly! I don't think that was a problem for me, the bigger problem was I didn't know to ask about PT. I asked almost two months later, just to be sure.

If I had this book, I would have been much more prepared to question my surgeon or get second opinions from other surgeons before getting my surgery. Anna also highlight all the things to do pre and post surgery and the types of therapies that can help. She also goes over the many complications that can result from hip surgey: the muscle imbalances and the tight adductors and glutes, things that I am still fighting in my own recovery. One thing I found interesting is that Anna found that stretching the hip flexor was not helpful to her. I have noticed this too. If I stretch the psoas or hip flexor I seem to be worse off than if I leave it alone. Do you want to know how many times I have been told that stretching the psoas would solve my problem? Nope! She also gives advice for dealing with insurance companies.

This was one Kindle book where I constantly highlighted passages throughout my reading so I can go back again and reread. I got a wonderful one-stop education from someone who has done her homework. This should really help out the many patients who are curious about what is wrong with their hips. Message boards are great, but you can spend a significant amount of hours reading them to get the information that you need.

I thought I had done a lot of work researching on my own, but what I learned was only a small amount compared to all the Anna imparts. I am pleased to note that some of the important treatments that I discovered such as MAT are some of the treatments that she thinks are worthwhile. Hip arthroscopic surgery is a relatively new field that continues to grow. I also think that my recent frustrations (and last two posts) dealing with recovery and doctors and therapists mirror what Anna (and others) have discovered. It seems that getting a diagnosis is difficult (the pains of a torn labrum are referred to other areas), in surgery it is important to get the best surgeon that you can, and that recovery seems to be the most difficult part of all due to doctors and therapists not having a protocol or understanding of the needs of the patient after surgery. Muscles imbalances, deactivated muscles, and other problems such as in the psoas. glutes or with the adductors are common. Just like I have found, standard hip PT does not really help. I have some new ideas to pursue and some new ammunition when I talk with doctors and therapist that I did not have before I read the book. I think I was on the right track before, but this book will help me articulate things better and I now now that my hunches and speculations are probably right on, so I need to pursue them and not just trust that things will work out on their own. I can only tell you that if you are curious about your hip or are dealing with hip surgery and its aftermath, this is the one best book you can read and when you are done you can go to the message boards and fill in the gaps with the support and experiences from other patients that are so willingly shared.

Wednesday, May 8, 2013

There is no Finish Line

Nike had a famous advertisement that said, "There is no finish line." A crucified Jesus uttered the final words. ""It is finished," before dying on the cross. Minwax promises a long lasting finish to your wood products. While my running problems are nothing close to Biblical in nature, I do feel completely unlike the Nike runner who keeps running because there is no point in finishing up with running when you can enjoy it so much and instead I feel like a runner that may never get his legs back and realizing that as far as running goes, things might just be finished.

I am discouraged and embarrassed that I can't get my hip working and feeling right. The whole point of the blog is to announce that hard work leads to a victory some day over my hip problems so that I can happily go running off into the sunset. Every once in awhile  I get that hope that I am almost there, and then, I can't run again and my faith in my ever getting completely healed is destroyed.

Last week I ran a 2 mile treadmill run after going for my 2nd visit to the new therapist. The next day I had a trigger point injection for a really tricky trigger point deep in my glutes. I thought I would be good to go, for after my first visit to the therapist I had a close to perfect night of running at my first track workout in three years. I waited two days to run and Saturday I could barely make three easy miles. I took another day off and I had the same result on Monday. I have had only one good run in about one and 1/2 months (and it was awesome) and I can barely be encouraged my a couple of short awkward runs each week. My hip isn't working right and I am getting reoccurring  pains from my toe to my knee and up through the hip (adductors and gluteus ) and into my sacrum and lower back. It feels almost  like it did before I had to stop running before my surgery and is nearing the worst it has felt since the surgery.

I have a visit to the therapist tomorrow and if she can't get me back to how I felt after the first visit just two weeks ago, then I will be pursuing an MRI as my surgeon's office could only offer that to me two weeks ago. I really don't want to contemplate a failed surgery or a new surgery, but I am not convinced that my surgeon fixed everything. I learned that he is one of the few surgeons who doesn't believe in FAI (hip impingement due to bony problems) so he doesn't fix the parts of the bone that can create the impingement. It there is a bone problem, it can retear the labrum.

I know I didn't get the best post-surgery care either from my surgeon's office and I was left to pursue things basically on my own. I hope the labrum is still OK and I have a hard time getting answers from someone as to why the pinching feeling feels like nerve pain and then why that pain flares up through my body. I also also can tell my whole hip complex doesn't seem to work or move properly. The other day while trying to run, it felt like the whole hip was completely backwards.

I also realize that at another finish line, people had their legs blown off just  last month and there are so many people with much more pressing medical problems than me and my faulty hip, so I can't really feel too sorry for myself. I am a very lucky guy with the life that I have.  I would just like to know once and for all what is really going on with my hip and what do I need to do to keep running. And if I can't ever get back, then should I just retire the whole thought of ever running competitively again. It has been a good 40 years of running. I just want more.

I am at a loss of words in explaining the complexities to the doctors or therapists so that I can get a knowledgeable and satisfactory answer from them, particularly when it seems they don't get what I am saying. I know I am chasing lots of ideas around as I chase the pain around, but I can't seem to get a medical professional to join alongside me in my quest and my surgeon's office just seems clueless (and I am not the only patient to have questioned this surgeon- I have found many that have had to go to another surgeon for a revision). I don't think and I hope that is not me, but there is definietly something going on in my hip and I would hope that the surgeon's office would have some type of answer or advice.

I did see a wonderful blog post this afternoon that for the first time explains what the medical field should be doing with cases similar to mine where the hip just doesn't seem to cooperate. This type of arthroscopic hip surgery is relatively new (about 10 years), so the doctors don't have all the right answers yet. It is good to see that some doctors are starting to look at things a bit deeper due to patient concerns.

The blog Hip Impingement News by The Entrepreneurial Patient newest post Impingement and the Unraveling of Related Diagnoses explains this recent history and the struggles that certain patients have.  She talks about a recent symposium where some of the top hip surgeons began to address this situation with a layer of diagnoses:
Dr. Kelly presented his process for obtaining “layer diagnoses” for the painful hip as compensatory soft tissue changes are common. He encouraged attempting to identify diagnoses for each layer. He identified Layer 1 as bone and cartilage abnormalities. According to Dr. Kelly, Layer 2 diagnoses are defined by abnormalities affecting the tissues of the hip capsule and labrum, which lack ability to function. Layer 3 diagnoses refer to dysfunction of the muscle (contractile) tissues. Layer 4 diagnoses include processes affecting neural structures, such as nerve entrapment syndromes.
I think that is exactly what I have been trying to articulate to my doctors and therapists, but they don't yet seem to have ears to understand. While I had surgery. It only was a layer 2 correction. How do I get help for layer 3 (what I refer to as the hip not working properly and why I sought help with MAT) and layer 4 (the "pinching nervy problems" that I get). I am now also getting concerned with that Layer 1. I know my hip is abnormal with the femoral anteversion, so I wonder if there is some abnormality (maybe even FAI) that causes the pinching feeling. I wish I didn't have to think of these things, but I do want to know what the end result of all of this is so I can know if I can faster and more ably to more finish line or if that active part of my life is indeed finished.

It was be awesome if the therapist tomorrow can get me back to where I was 2 weeks ago after that first visit.

Things I am thinking about:

A short time post surgery, I started using Schiff Move Free for my hip joint. At first, it felt like it "juiced up" my hip for a short while, then I didn't notice anything in particular. I stopped using it in February right at the time I did a 71 mile week. I didn't notice any loss of hip function, but things started falling apart about two months ago. I also can't tell if the problem is in my hip joint, it feels more like the muscles and ligaments that surround the hip.

I started eating gluten-free at the end of November. Soon after, my running seemed to get better. I was hoping that a gluten-free diet would reduce inflammation. I stopped being real picky about being gluten-free about the time my hip started gradually doing worse. I really was not good at finding and making gluten free food that was enjoyable to eat. Maybe, I need to test out other anti-inflammation diets. I still try to be as gluten-free as possible. I am just not religious about it.

At my first visit to the new therapist, she tested my left TFL as weak. She activated the muscles then had my walk for a short time in my Hoka One One Bondi shoes. Then she retested my TFL and it was weak again. She thought the shoes may not be good for my feet (or maybe it was just getting up and walking). I decided to buy some new Brooks shoes and while I never felt good walking in the Hokas, I felt firmly connected to the ground in the Brooks. However, I haven't had a good run yet in the Brooks shoes and I liked running in the Hokas.

This new book from the author of The Entrepreneurial Patient blog mentioned above is a must read book for anyone with hip problems and is thinking about about arthroscopic hip surgery or has had arthroscopic hip surgery for a labral tear or FAI.

Friday, May 3, 2013

Ten Rules for Therapists and Doctors

I feel like I have seen way to many doctors and therapists (of all kinds) in trying to "recover my stride" and some things hit me today about how some "get it" and some have "no clue". Here is my lists of what can make a therapist or a doctor "stand out" in their field and what makes them look like they really don't care about the patient.

1) If you don't know the answer, ask around for help. Now I don't know what goes on behind the scenes with all therapists and maybe they talk a lot, but I was most impressed with one PT I went to about 15 years ago when my hip got "stuck" right at the tail end of my marathon training season (hint: never run a 25 mile workout in Nike Shox-actually never run in Nike Shox). She worked for a couple of weeks trying to get me running.When she couldn't figure out what was wrong despite all our efforts, she had all the other PTs in the office check out my hip. They couldn't get it working either, so she researched at home. She found a figure four stretch that immediately brought relief to my hip capsule and I was back to running pain-free that afternoon. She was also the PT who said of me, "You were so born to be a runner, and so not born to be a runner." Unfortunately, she moved away, but she set the tone for how awesome a PT person could be.

2) Do hand out written or illustrated handouts for exercises you want done. Better yet, create videos of your instruction. I know therapists are busy, but how hard is it to give a handout. I forget the exact mechanics of a stretch or movement real quickly particularly when I am given more than one thing to remember. The M.A.T. guy I went to last fall, spent a couple of minutes filming the many movements he wanted me to do for my feet and back. I still have to watch the videos to get things right or I would be messing up all over the place. He just handed me the camera and I filmed his demonstrations and explanations. Then he sent me the video. Last month I just took the video on my camera. If you want me to get better and to do things precisely, this is a great idea! Better yet, show your enthusiasm for what you do on a website or blog. After finding this website, I made sure she was my PT pre and post hip surgery. I knew she cared about helping and informing patients.  I drove an hour each way to get to her office. She has since moved to Arizona, which is too far to drive.

3) Explain what you are doing and why. Explain the reasoning. I love information about how my body works and what you are looking for or trying to do. When I have the M.A.T. work with Greg, I was getting a running commentary of everything he was doing, as he explained each muscle he was testing and how it worked. I can't remember half of what he said, but I could match things up with what I have read or studied and found all this knowledge fascinating. I am trying to be involved, so please don't think I am not interested in your thinking or that I am a dummy. I am your student.

4) Listen to my questions and feedback. Again, I will reference Greg and his M.A.T. work. The first thing he asks me before a session is about what I feel is going on and what do I think needs work. Usually we are on the same page, but is nice to know he is listening and paying attention to my feedback changes the course of his work that day. Now here is an anecdote from today. I went to get trigger-point injections in my glutes Ever since my surgery, I have mentioned to many people including my surgeon's office during last week's appointment about the high up tightness in my adductors. No one seems to address that issue, yet still almost two years post hip surgery, I have a hard time lifting my left leg. I have to "assist" it when getting in and out of a car and some mornings I can barely put my socks and shoes on as well as my pants. The only thing I got out of the surgeon's assistant last week was that I could pursue an MRI at some time if I wanted. I would like to know "why" and what is going on as this seems to happen to many hip surgery patients. It didn't help that while I was waiting in the surgeon's office before the appointment, I was checking a "Arthroscopic Hip Patient" Facebook page that has members from around the world and two patients where not happy with the quality of care of my surgeon and later needed revisions. Oops, not the material you want to read in the waiting room!  Now, I have faith that my surgeon did a good job with me (but maybe the office is avoiding something he missed). Thee adductor thing seems to be a real problem and they seem to not be interested in it. I told them it feels like a bone is stopping my adductor from moving or causing it to quickly weaken.  I had x-rays taken before the appointment that the assistant looked at and I was supposed to bring a copy to my new therapist at her request. I forgot to pick them up and they hadn't been mailed. I saw the therapist yesterday, so I picked them up while getting the trigger-point injections today to bring next week. I saw some notes on the the x-rays that were never explained to me and they were basically the same notes from last fall's x-rays that were also included. These were not explained to me. Nor was my higher left hip. See the images below. it is quite noticeable!

1. Mild left hip osteoarthritis and left hip joint space narrowing.
2. Minimal right hip joint space narrowing.
3. There are pubic symphysis osteophytes. (and I think it was mentioned a narrowing here too on the recent x-ray which I left on my desk at school)
4. There is minimal narrowing of the bilateral sacroiliac joints.

Anyhow, I don't want to spend any time worrying about more things being wrong, but when I read these and typed them into Google, I got a some pages talking about Osteitis Pubis or Sports Hernia and I recall reading pages of these on the running message boards back when I was trying to figure out if I had a labral tear. The interesting thing is the new therapist told me these bones were misaligned last week and we did some Muscle Energy Technique work to realign them. Something is going on, but the surgeon's office just ignored the reports or didn't share them with me. When I look up osteophytes, it sounds like they are bone spurs. Well, I mentioned something felt like bone, was rubbing against my adductors, could that be it? I appreciate doctors not wanting patients to self-diagnose, but I was the one who pursued the labral tear when other doctors didn't even mention it. I am now curious is something else is going on?

5) Don't just treat my as your paycheck. Speaking of labral tears, this reminds me of an chiropractor who did ART (Active Release) work whom I visited during the summer of 2010. I had to stop running due to my hip. When I started seeing him that July, I though he was very knowledgeable, I kept mentioning a labral tear and he said, "No." He kept doing ART that had no real effect. Some days, I felt good, some I didn't, but my hip kept getting progressively worse. Finally at the end of that August, I called to cancel an appointment  because I was convinced it was a labral tear and I couldn't run any more and his work wasn't helping. He said that I should come in anyhow and at the end of that appointment he said that I have two more visits left and he would like to try some new things. I went in and whatever he tried did not work. At the end of the last appointment that my insurance would cover, his last words were, "Maybe, you do have a labral tear after all!" Over one year later, I got a letter from his office that those last three visits were not covered by insurance and I had to pay up the difference from the copay to his full price. He is also the guy, that when I asked for a recommendation for a  massage that summer and I needed someone real good, he recommended his secretary. She was a nice lady, but was the worst massage therapist I have ever had. She barely pressed on my muscles and kept asking if she was working too hard. If you want to  know who not to go to in Manchester, let me know. I'll tell you. This guy was not interested in anything but accumulating as many office visits from patients as he could. I got suckered by another chiropractor many years ago, back when my insurance didn't cover them, he convinced me to come in on his plan for 10 weeks or so where I could come in up to 3 times a week for about $100 a week. I would be fixed, he said. He did so much work and pushing on my back that I was just exploding sometimes after being in his office. My nerves were just completely shot. He got a nice family vacation paid for out of the deal and it fixed nothing for me. I guess this is more of a warning to be aware of the shysters out there!

6) Let me know you care. First off, today I was able to see my physiatrist when I realized that I had developed another trigger-point in my glutes. Earlier in the week, I was told by her office that she was going on maternity leave and wouldn't be able to see me, but they would see if someone else could do it. Later, the office called back said that she wanted to see me today, even though it was her last day of work until August. That was very helpful as she knew where to look for the trigger points and my history with them. She found a large trigger point very deep in my glutes and hopefully the shot will help it relax. Also, if you take the time to research something or report back to me later on a question after you thought about it, then I know you are a top-notch and caring professional. This doesn't happen often, but I want to feel like you care about my condition as much as you care about an elite athletes injuries. I can't recall this ever happening with my injuries, but I know a pediatrician in Nashua that my kids have had, who has called at times out of the blue to check on the condition of my kids and if they were doing better after a sickness or an injury. Good guy! Take the ART chiropractor above, who earned a lot of money off of me and the (at least) two runners who went to him that summer at my recommendation, before I realized his treatments weren't working and his focus was on getting me in to the office as often as he could. After telling me, "Well, maybe it is a labral tear," they guy never called to ask what eventually happened with me. He could have learned a lot about labral tears from me, and maybe saved another athlete from going to countless ART sessions without fixing the problem. Oh wait a minute, that might interrupt the flow of money going into his pockets. You would think, that after so much time and effort treating someone, he might want to find out what eventually happened.

7) Do not treat me, just like you did the last guy. I hate the cookie-cutter approach where everyone gets the same menu of exercises. I had a guy like this for PT last year and at other times in the past. They act like they know everything, and don't listen or belittle any questions or thoughts you have. And they certainly don't see the whole picture of how the body works as a unit.

8) Don't rush me through my visit. I can tell when you aren't paying attention or trying to get to the next patient as quickly as possible.

9) Are you up to date on your reading for your profession. Many times I ask a doctor or therapist about something I have read and I might name a prominent person in the field of therapy or muscle movement and they have no clue what I am talking about. I also might mention things like Postural Restoration. M.A.T., ART, or other newer techniques and the therapist has never heard of these. They can't know everything, but if it is your profession and if you don't know the newer and more cutting edge techniques then maybe all you know is your cookie cutter exercises. On the other hand, I am currently at my present therapist, because my chiropractor in Nashua mentioned something new called ARPwave that might be helpful and I found this place in Woburn that does it as well as M.A.T., M.E.T., and other new and interesting techniques.

10) Never be this guy! One of my most top ten read posts through the years on this blog deals with the Egoscue therapist who admitted to me during my first expensive session, that he was doing Egoscue because his friend told him it was good money! According to my stats on Blogger that is nearly 30,000 hits about my negative experience (and lots of negative publicity for Egoscue). I want to know how much you love what you are doing, not how much money you can get out of me!

Anyhow here are some images of my hips. I hope my new therapist can tell me more.

Sep. 2012 Notice the tilt and higher left hip.
I am standing straight in these x-rays.

April 2013 same tilt. Talk about consistency!
That is one thing my new therapist said we are working on (the up-down of the hip)
Can this really be changed? and no wonder I have hip problems.
I had a chiropractor about 15 years ago take x-rays and when he put heel lifts under
my right foot and took new x-rays the left hip went up even higher.
He was completely baffled and just gave up.
Left hip joint April 2013.

This new book from the author of The Entrepreneurial Patient blog is a must read book for anyone with hip problems and is thinking about about arthroscopic hip surgery or has had arthroscopic hip surgery for a labral tear or FAI.