I don't know if it can always be done and I don't know if I can even correct my own pelvic tilt that I have had since before I was a runner and that goes back to about 45 years ago when I "failed" the junior high scoliosis test and was sent to Boston Children's Hospital to deal with what they called a "leg length discrepancy". Last month the doctor who has given me prolotherapy injections ordered an x-ray and I read the results and I still have a tilted pelvis.
Running in Kenya. The security guard didn't speak English, know how to use
my camera, or to move his finger off the lens!
I am happy riding my ElliptiGO these days, miss running, but not doing anything to hurt my body. Every once in awhile, I try out a run, but the next day my hip is imbalanced and sore. I did a few runs in June, culminating with my longest run in well over a year: 7 miles, but that was just to prove to myself that I could survive a run so that I could get a run in when I went to Kenya in July. I did get a two mile run while I was in Kenya which was pretty cool. I was out in the country at the Joska boarding school and had fun running on the dirt roads and all the Kenyans would wave and cheer me on! One guy riding by on a motorcycle shouted out, "Why in the world are you running?" I retorted, "I'm in Kenya!"
I haven't run since. I feel a creakiness in my hip joint, but it is mostly the the ligaments and muscles around my hip joint that pull everything out of place and leave my whole left leg out of whack the next day after a run and my hip feels jammed up. So I ride my ElliptiGO, which allows me to shift my body around, but I am never fully comfortable in the muscles around my hips. They are rarely feeling balanced.
The good news is that the day after running 7 miles, I returned to my prolotherapist doctor and only after two visits she said my si joint was good and tight. I had a great response to this therapy. Originally, she had said that it might take four visits to even know if it would work for me and she said it would probably take at least six visits in all. I was good after two, which would save me a bunch of money as insurance doesn't cover prolo. So my si joint had improved, but I still feel unbalanced and out of whack three or four days a week. I asked about prolo in the hip joint. She used to do that, but would recommend PRP therapy instead, but that is out of my price range. I was curious about prolo helping the muscles and ligaments surrounding the hip joint. She said it might, but seems cautious about doing anything further, beyond ordering the x-rays. My report says:
STANDING AP PELVIS.
HISTORY: REASON FOR TEST PAIN IN JOINT, PELVIS, THIGH
TEST DETAIL: OSTEOARTHRITIS
COMPARISON: AP pelvis from left hip series 4/25/2013, 9/5/2012.
IMPRESSION:
1. Pelvic tilt with the left superior iliac crest approximately
26 mm more superior compared to the superior right iliac crest.
2. Mild bilateral hip joint space narrowing, acetabular
articular sclerosis and tiny lateral marginal osteophytes, not
significantly changed.
3. Mild bilateral sacroiliac joint. Symphysis degenerative
changes.
4. No visible fracture.
In the past, I have ordered many of Sean Schniederjan's ebooks on the hip and lower back. I have found that he has some good information and alternative exercises which he tells about in a straightforward way. I have found some of his movements helpful at times, but it was hard to pinpoint exactly which or what movement was best for my conditions. I noticed that he recently put out a new ebook Conquer Your uneVEN Hips: Simple Strategies to Regain Balance and Structure In Your Central Joint and decided that would be another good one to try. Sean just doesn't repost the same exercises and movements that are sort of the "recipe" approach that everyone mimics and posts online, he explains things that may be a bit unusual, but that have worked for him. I have done a few of these exercises and they seem to really tire out the muscles around my hip that are always tight and I noticed my hips feeling a bit more stable since doing them. It will be interesting to see how these work over time.
Here is Sean demonstrating some of these exercises:
The beauty of the EllitpiGO is that not only can I move my body around to adjust for instability, but I am also using the handlebars to keep my body stable when not working in perfect posture (of course this can also be a bad thing). I have had a great summer riding. I hit a new PR for distance traveled in a week during August when I put in 350 miles. I led all ElliptiGOer on Strava around the world that week in mileage, just as I did last week although I only put in 215 miles. If you looked at last week's' leader board of over 200 riders, I also had the fastest average speed of all riders 16.2 mph except for one person who did 50 miles. Despite my inefficiencies and lack of stability over my hips, I can still do some great workouts on the ElliptiGO.
I get to test my summer training over the next three weekends when I do three separate centuries. Tomorrow I do my first 100 miler of the year at the Ride for Angels. The next Sunday, I will be doing the Charles River Wheelman's Fall Century Soughegan River Tour (and if the weather is great I might to another century the day before). In two weeks, I will be returning to the Seacoast Century.
One thing that I have found somewhat helpful over the past few months when my hip gets jammed and my leg goes out of whack is to use a band as a distraction for my hip doing exercises like these. My prolo doctor said these type of hip distractions were fine! The osteapath she has had me go to in the past, just pulls on my leg. I use the green Strong Assisted Pull-up & Resistance Power Stretch Band .
This will be one of the strangest posts I make, particularly if you have read about the different strategies I have tried to recover my stride.
Back in junior high school I was diagnosed with a leg length discrepancy. The doctors followed my growth through high school and even wanted to operate at one point to stop the growth in my left leg to let the right one catch up. They did do this operation to my older brother but not to me!
Now before I get on with today's story, I was talking to my dad the other day on the phone. He enjoys tennis as much as I enjoy running. He likes to play in local tournaments with much younger players. He has remained surprisingly injury free for being over 75 years old and playing tennis for many decades. However the past couple of years he had an Achilles problem, then plantar fasciatis, and now he said he knee is hurting a bit. So he went to a podiatrist (and no, he is not into fixing problems or trying to understanding sports medicine like I do) and he told me that the podiatrist told him he had a leg length discrepancy. He said that was the first he heard of that, but told her that his two sons had that issue and that one even had surgery to correct it. She wanted to know who did the surgery and asked what they did. When he said this was through the Boston Children's Hospital and told her about my brother's surgery, she rolled up her pants leg to show him her scars on either side of her knee. She had had the same surgery my brother had many years ago!
Anyhow my right leg was the one diagnosed as the short leg and it was supposedly almost 1/2 inch shorter than my left leg when last diagnosed back in high school. The past few weeks I have been playing around with a heel lift in that right shoe. At first it felt great. I had almost a week of wonderfully balanced runs, but since that time it has been slowly unraveling. My left leg is doing strange rotations, my hips are rotating without pain but not in the same way on each side and I keep feeling like I need more lift in the right shoe.
Today I went for my longest run of the year. I could not get my legs right. True my left hip was not jamming up, but I was out of balance and fighting myself the whole way. I got halfway into the run and decided to try something radical that I had been thinking about. I took the lift out of my right shoe and put it in my left shoe. All of a sudden I felt more balanced again and my left leg was bending and working better. I wasn't sure how long it would last before I would feel a pain, or something wrong but that didn't happen and I completed my run of a little more than 15 miles. The second half felt so much better than the first. What in the world is going on here?
One thing I have learned is that my body adjusts to all sorts of strange positions and strides. Some people run with perfect form and if one little thing is altered they end up injured. I have horrible form but somehow I adjust to all sorts of imbalances and keep running. Last year I started calling new things I try as I run "distractions" because I will try something new and it will feel good for a day or week and then things will fall apart and it won't work anymore. I think my body gets fooled by distractions and runs better for a while before getting to a place where the distraction does not work. That may be what happened today. My body got distracted by a new running position and it felt good while my body tried to adjust or maybe just maybe.... I have two short legs!!!!!
Actually don't laugh too hard at that because listen to this. Back about 18 years ago (yes I have been fighting this stuff for a long time) I had a doctor x-ray my legs while lying down. I heard this was the only way to truly test a leg length discrepancy and what I was told when I was done was that one leg had a longer femur than the other, and that the other leg had longer lower leg bones. When they did the calculations the both sides together were not off by that much. It wasn't the nearly half-inch that I had been told. However (and I would like to find the results- I think I saved them somewhere) that could mean that when standing my right leg is the short leg (I do feel so much better with the heel lift in my right shoe when standing or walking around). But maybe just maybe my left leg acts as the short leg when running, possibly because when running the dynamics is changed because my knees are bent and the way the differences between lower leg and upper leg lengths are altered in a running stride.
Maybe that explains why pictures of me running show my left side (the one I was told is longer is always collapsed down) and I feel like I always have to hike up the leg to run. It may also explain why my right shoulder is always higher or why I had one massage therapist who used to force my left side's rib cage higher because it was lower than the other side. Then there was the chiropractor a few years ago who took an x-ray of my pelvis with a heel lift under my short leg. When he added height to the heel lift on my right side then the leg length difference seemed even more pronounced. He kept staring at the results and couldn't figure out why a leg lift made that short leg appear even shorter. Finally he abandonded what he was trying to do and just forgot about it because he was too confused!
Or I could just be full of beans, but I do know this: at least for one day it helped me run more smoothly and I made it through my longest run of the year.
Maybe my new strategy should be to alternate which shoe gets the heel lift and just remain distracted and running free.
I went to Boston for my third Active Release (ART) appointment today. I was feeling good since my run on Tuesday, but didn't run yesterday as I spent a couple of hours in a dentist's chair before celebrating 20 years of marriage!
Today the I had a quick treatment on the back of my left hip and my left adductors (I didn't tell him that this was bothering me on Monday). The ART therapy never hurts me and I don't feel a thing but it does do something. He has me check my balance doing lunges and of course my left side is awkward when I do these. He gave me a hamstring strengthening exercise. I am to lie on the floor on my back with me knees at 90 degrees and my heels resting on a bench at knee height. I am to press my heels into the chair and lift my rear off the floor. I am to do this until tired (maybe 50 times), rest a minute, then repeat. I am to do these once per day. He doesn't say anything when I mention I am working on the tibialis posterior.
Here is a video where an Active Release Technique therapist explains the process. The second technique he does for this persons sciatica is similar or the same as one of the hip movements I had done the last two appointments. I do it with straight leg and bent leg as shown.
Here the founder of ART, Dr. Leahy, talks about what ART is and its effectiveness.
This is another video dealing with sciatica and ART. At about 7 minutes into it you will see the ART Psoas release similar to the one that is done on my Psoas muscle.
Today my run was really good. I think the heel lifts are right on. I feel so much more balanced and my hips don't have to do all this work trying to be leveled and balanced. I feel better walking and running and the back of hip pain is subsiding. Today I added an extra loop to my run so I did close to 10 miles. I would do more but I am nervous that the change by using the heel lift could create a new problem from adjusting muscles. I am getting my legs to feel straighter and I could happily train at this level as I don't feel so exhausted from fighting my own body. Although not 100%, I do feel a whole lot smoother and solid as I run.
I am doing the Tibialis Posterior exercises. They are simple and feel so right for what I need to do with my knee and feet. I found another exercise to try for strengthening the tibialis posterior. The accent is from New Zealand and the person, Gary Moller, is the older brother of Olympic Marathon Bronze medalist Lorraine Moller. Here Gary writes more about correcting foot pronation. What I find interesting is that his diagram and the diagram on the Yoga site I listed the other day, both show the inward knee rotation and hip problems that I suffer from.
I am thinking, thinking, and thinking constantly trying to figure out how to even out my stride. I am trying all sorts of ideas: scrapping some and keeping others, but still have not found the "key" that will get me back to a healthy and efficient stride. It probably makes for a boring blog as seem to complain a lot and go off in all sorts of divergent directions. I think many of the things I have tried would be extremely beneficial to many injured runners, but for me they seem to lead me to right back where I keep starting from. Last night the back of my left hip was tight and causing me to limp again. I woke up a few times in the night and tried different stretches, joint mobility drills, ect. and I was just moving on the floor and got myself into a "child's pose" yoga position ( I think that is what it is called. It is where you sit on your knees, and bend forward over them and rest. This time I moved my arms and body to the left over to the side of my left hip. I may have even rotated my knees and legs to the right. All of a sudden things felt loose and free. There was no click or pop or anything like that. Just loose and free. I got up. No more limp. I thought that was strange and walked around and things felt very good. When I woke up things continued to feel good. The pressure on the back hip was gone and I moved much better.
That was a good start to the day. But over the years I have had moments where I do certain movement, or put pressure on a certain points, and that eases the discomfort I have been feeling but I can never replicate the movement and get the same results again. It's bizarre but that is sometimes the way my body works. Anyhow I decided to ride one of my bikes. It was actually the first time I got a real bike ride in on this bike. It is a K2 Mach 1 bike like the one on the top of this page except it is black. I found it on clearance in L.L.Bean over a year ago. It is a $650 bike but I saw a clearance price on it for $200 something and then I saw there was another clearance of 30% off. I did some quick math and realized I could buy this bike for less than $200. But my wife wasn't there to OK the purchase and so I walked around the store for awhile doing the math and holding the bike because two other customers realized it was a good deal when I asked a salesman if I could really get it for that price and they were following me around seeing if I would put it down. Now I really didn't "need" a new bike. I have a 1985 Centurion bike (although the frame was made in Italy by Cinelli). That one took me through many a triathlon and bike race. Here is my Centurion with me aboard catching up to the pack in a race that went around a motor speedway in New Hampshire. It must be around 1992.
I also have a Cannondale aluminum (talk about a harsh ride) triathlon bike that I bought off a friend awhile back. Plus I have my kickbike which I like more than regular cycling.
Anyhow this K2 bike which I did buy has not been very accommodating. I realized it was a clearance bike because something was wrong with the back tire. I first pumped up the tires when I got it and rode it around the block a few times (it was winter). The next day I noticed it had a flat. Last summer I went to fix it. I found that the tire was really tight on the wheel. To get it on and later to put it back on took lots of effort. It was hard to move that bead over the rim. It would take 15-20 minutes. I fixed it once, pumped it up and heard air escaping. I fixed it again and again. No spokes were poking through so I figured it kept getting pinch flats. I gave up and tried again a couple of weeks ago. I got 2 miles down the road and saw I had a flat again. I finally bought I new tire. It still fits tight but it holds the air. So anyhow I took this bike out for a spin today. I went 10 miles and kept it easy. It felt nice. I remembered the wonderful feeling of riding a bike on a hot day and feeling the wind on my face as I ride. I'll have to do this more often.
Anyhow one thing that felt good was the inserts I had found at Goodale's Bike Shop when I was buying the tire. They are made by Specialized and are called Body Geometry High Performance Footbeds. They have shims you can put in them to alter the forefoot angle within the shoe. It adds height to the inside of my feet. Despite all my running problems I had even worse problems with cycling. My left leg would never be comfortable when riding bikes. I even used to play around trying to make shims on the bottom of my cleats to try to even out that foot. Particularly when starting up a cycling program the bottom of my left foot would always be sore as all the pressure was on the side of the little toe. If I tried to hold that leg flat and even in the shoe my knee would pop into the bar on my bike and my knee would not go up and down, when peddling, but around in circles (in and out). It was always uncomfortable and that is why I used to adjust my saddle some to point to the left side a bit. None of this was good for my back. When I cycled today the bottom of my foot felt fine and the knee was going up and down not around and around. Of course my butt still hurt sitting in the saddle. I did enjoy the ride even though it was a short ride. I was just glad the tire didn't go flat again!
My hip still felt good after the bike and later in the day I went out for my run. Again my hips turned wobbly and as the run progressed it never loosened up and just got worse. So I resorted to thinking things through again.
I am waiting to get the Sacral Aligner in the mail to try that, but something else is definitely wrong in the world of my biomechanics. I am having a harder time then ever trying to run and I am putting more effort than ever in trying to strengthen and mobilize my joints for running. I feel better sitting and walking than in past years, but when I run things start to get worse. So I started evaluating what it going on.
I think that as I have been strengthening and doing joint mobility work I am starting to get my legs into a more normal position. I think my left knee is not knocking in as much and my left leg is straighter. However as I do so I "wonder" if in straightening out the leg I am getting rid of the "compensations" that my body has resorted to over the years to run injury free despite an actual or functional leg length discrepancy. Possibly what my body has done (due to a longer left leg?) is to roll that leg in and knock the knee in so that the hip is lowered. A PT said last year that that hip does drop down as I walk. Maybe that is what kept me running and although not pretty and definitely not pain free that is how my body accommodates the leg length difference.
There is a precedent for thinking about this theory. Back in Junior High when they did a scoliosis test, both my brother and I were picked out as needing a second look. Eventually we both ended up many times at the Boston Children's Hospital as they studied our legs and and determined their growth rates. One year my brother went in for surgery and they took out a portion of his femur (near the knee) and reversed it when putting it back. This was to stop the leg from growing so his other leg would catch up. Except for stitch marks on his leg it may have worked. He is an academic and does not do sports however. When they wanted to do surgery on me in high school they said I would not grow taller than 5'8" tall. I was a tiny high schooler. See here I am (the short guy out front) in tenth grade.
However I was away at a prep school and when I came home that year I was already 5'10" so my parents decided not to follow up on that. I would not have allowed the surgery anyhow I was running cross-country and felt no pain so what was the point? By the way I grew to 6'0". If I had that surgery I would have a leg maybe 4 inches shorter now!
I have played around with lifts in my right foot before. The last time when I got a pair of orthotics about 10 years ago. I was told the leg was a little short. When I wore the orthotics the imbalance "seemed" greater (could that be because the left leg was straighter?) . So I added a lift, then more lift. It felt real good when I got up to about 1/2 of lift in the right foot. Strangely enough a chiropractor x-rayed my hips. As I put lifts under the right foot the right leg appeared to get shorter and shorter. Maybe the hip was moving up. He puzzled over that and then dropped any discussion because he could not figure it out! I thought things were going OK. The hips and legs felt more balanced but my back was taking a beating. I was running the Cape Cod Marathon that Fall and just holding my right back stiff for mile after mile because I could feel something was wrong. I hit a water stop at 16 miles and leg go of using my muscles to hold my back in place and it went into an impossible spasm. It took about 10 minutes to grab a tree and ease down to the ground. I had to wait for the bus to pick up the stragglers and then they drove all the way back to the last runners on the course to pick up any other stragglers before getting me to a medical tent for ice and treatment. That spasm was no fun and I think that is when I put an end to orthotics and ditched the heel lifts forever (I promised!).
So now I am wondering if the ceaseless nature of fixing my biomechanics may really be do to that leg length difference. The Children's Hospital was saying it was close to a 1/2 inch difference back when I was growing up. Or I think it may possibly be a functional difference, possibly due to the way my left leg works. Because that knee knocks in and the foot everts out, that leg does not bend as much as my right leg. What if it "acts taller" because it bends at a smaller angular degree pushing that hip higher into the pelvis and throwing everything off?
Well that is what I thought about as I ran today and things got stiffer as I lumbered rather than run. Could improved leg strength and mechanics of the left leg be causing more pelvic imbalances and the pains in my hip? Does a lack of compensation in its movement patterns mean it is harder to run? I really don't know but massages, chiropractic visits, ART visits, stretching, strength work, mobility work, and everything else I am documenting here are not working to make it easier to run. In fact it is getting worse and if I had a normal mind I feel like I should just quit, but I don't want to give up on figuring this out.
As I was finishing up the run today. I had pains in my hip. It rotates all wrong and doesn't even feel like the leg is in the hip socket correctly. I guess that leaves me to wonder about leg lengths. It felt good to wear a lift last week for a couple of days. Maybe I will order these lifts and slowly see if adding a little bit of height in my right leg can balance things out. I really don't know what else to try and this is starting to make sense. I will certainly give it a try at this point because nothing else is working and it may be time to revisit this and see if this is the root of my problems.
Here is a wall hip mobility drill I saw posted on Youtube. It sort of reminds me of riding a kickbike. Anyhow I like the range of motion by kicking the leg out to the side and then across the back of the other leg.
The same person has a hip circle drill that is another way to mobilize the hip, but a bit different than the Z-Health version.
Also I noticed and ankle mobility drill that is also somthing like a Z-Health drill. These may be good ways to introduce yourself to mobility work.
There are some other drill and exercises posted by the same person. Or you can go to the listed website http://www.prodigyperformancetraining.com. There you can find more warmup and mobility drills in the exercise library.
ebooks on the hip and lower back. I have found that he has some good information and alternative exercises which he tells about in a straightforward way. I have found some of his movements helpful at times, but it was hard to pinpoint exactly which or what movement was best for my conditions. I noticed that he recently put out a new ebook Conquer Your uneVEN Hips: Simple Strategies to Regain Balance and Structure In Your Central Joint
.
