Sunday, July 20, 2008

Personal Worsts are Never Fun!

Here are a couple of pictures by Steve Wolfe of the Gate City Striders Ultimate Runner night.

My right leg looked OK with the heel lift in it.

But my left leg still is all the wrong angles. It is depressing to keep seeing this! Even my face in the photo show me concentrating on form and not doing a good job of it!

This looks like it is going to be a year of PW's (Personal Worsts) with my running. I ran my first road race of the year (not counting the 5k trail races) at the Bill Luti 5 miler in Concord, NH. It is not my of my favorite races to begin with as there is a hill after 5 miles and it is run on the wrong side (left) of the road for me. Last year I had a lousy race and ran 32:07. My hips were very much off that race and I ran my one and only race in a pair of Newton running shoes. I figured I could do better this year. I felt energetic even though I ran some good mileage running up to this years race. I even took Friday off from running.

The day was very hot. I went out slower than normal in this race (about 6:10) and went up the hill OK but then the wheels fell off. I was hot. My legs were going in different directions. My hips weren't working correctly. I struggled all the way in watching runner after runner pass me. I finished in a 5 mile PW of 34:28. I was disgusted!

Anyhow I saw John V. of Kickbike fame (moderator of the KickbikeUSA Yahoo Group) at the Concord race. Not feeling pleasant after that race- the heel lift that had seemed to help my stride- didn't appear to be working the same way anymore. My hip was tightening up again and my left leg was all messed up. I decided to ride my kickbike in the afternoon and even found that hard to do. My legs didn't seem to be moving correctly. Strangely enough I seem to get more push off my left leg, but as I paid attention to what my feet were doing on the ground I noticed my right foot seem to track straight off the ground (as the footbed of my kickbike rolled forward past the leg on the ground). My left foot contacted the ground and the leg and foot rolled like this ). The leg doesn't track straight but curves in and then back out as it rolls over my foot. The kickbike ride wasn't smooth at but it felt good to get out and exercise some frustrations out.

Yesterday and today my hips and leg refuse to work right. They are back to the right hip angling in and the left leg rotating out. I am very uncomfortable. I saw a question on the Runners World forums about a rotated tibia and chimed in a question about stuck or rotated joints. A physical therapist, Damien Howell, wrote back after reading a what I wrote and looking at my running pictures at this blog. It is not a diagnosis but just some ideas (or a possibility) based on the limited information he saw. But he wrote:

"marathonnh this is a very interesting series of stillphotos. Your long history and the still photos do suggest the possibility that either the pelvic bone (acetabulum) has an odd shape; the femoral alignment having excessive femoral internal torsion; excessive tibiial external torsion; or a combination of the above mal-alignments.

I believe a CT scan would be required to definitively rule in or rule out anti-version of the hip, excessive femoral internal torsion, or excessive tibial external torsion. A CT scan could also quantify the degree of torsion. An Orthopedic Surgeon could order and interpret a CT scan of both lower extremities, and transverse plane measurements should be compared to the uninvolved side.

The fact that you have had a remarkable career in competitive running, and if you have permanent bony mal-alignment from childhood, you are an example of the remarkable ability of the humans to compensate and accommodate for short comings in order to achieve remarkable successes.

I found the description at your blog site remarkably insightful and analytical "If I position my left knee pointing forward, the left ankle points correctly, but the foot rotates or splays to the left and tilts up on the inside. If I place my left foot straight on the ground, the left knee is rotated to the inside. If I try to force that knee straight the inside of the foot rotates up. I can't even get that knee into proper alignment with whatever force I use. I still can't tell if it is a knee rotation, or a foot or hip problem. It just won't line up".

You should recognize that Orthopedic Surgeons order this kind of a CT scan measurement in order to plan surgery, the surgery involves breaking the bone rotating the bone and fixing the parts together. It is a extensive procedure and for some one who is functioning as well as you are the Surgeon is likely to think you are a bit odd for requesting such a diagnostic image test.

Good luck

Damien Howell MS, PT, OCS"

It is not pleasant to think that the only way to resolve my issues would be to cut my femur apart and then put it back together. Of course, I could never do that- but it does point to the real possibility that what I am really dealing with it a faulty skeletal problem and whatever I try I can never fix that!

I had a PT tell me before that it may be hip problem that I was born with before. I remember her telling me, "Jim, You are someone who is so made for running, but you are also someone who is not so made for running." She was a young PT that couldn't figure out a problem in that left hip. It was so jammed I couldn't run. The PT work and exercises she tried didn't help. She enlisted all the other PT's in the office to look and talk about the problem (some had helped me in other years). No one could figure out why my hip (or where the femur inserts into the hip) was jammed up. She kept researching and found a hip capsule stretch (sort of a figure 4 stretch) that moved the hip into a new position and I all of a sudden I could run again. I went back to that PT place last year but that therapist was no longer there.

So I am back to dealing with the same issues all over again and maybe it will never be resolved. Everything I try works for awhile and then it stops working. Maybe it is a skeletal problem that will never ever be fixed!

I saw an ad in New England Runner Magazine for something called Structural Management. I was checking it out today and the website says all the right things that I would want to hear from a therapy. The out of balance skeleton on the home page looks like my posture and it talks about structural imbalances and all the things that I observe about my mechanics. They give you a "structural fingerprint" exam. Here they are giving one to Bill Rodgers. Then they give you a conditioning program to get you back to health. It sounds like everything is integrated into one and they look at the whole body (something most therapists I have encountered do not do). It involves orthotics (possibly), leg length determinations, joint mobility work, and a lot of other things that I have been looking at own my own. The website says,
"The key is to restore normal motion back to all joints, increase flexibility, improve balance with muscle strengths and leg lengths, correct pelvic angle defects and gravity line defects. These changes make a dramatic difference in injury frequency, intensity and duration. Without the biomechanical influence, injuries will continue to exist and active participation will continue to decline."

It all sounds so very good and if I was a involved with sports medicine ( I really wish I was) this is how I would market and run a clinic (if I had the answers!). It just looks like it may be very expensive and the nearest person may be a couple of hours away. I will look into some more to see if it could be a possibility and if I could at least "know" what my biomechanical problems are.

Anyhow being in Kickbike mode I started putting up some YouTube videos of portions of an introductory tape to Kickbikes I got when I first purchased my kickbike. Here is what is up so far! Enjoy! Maybe someone will get motivated to try a Kickbike!


Jessica said...

Hi! I actually started the rotated tibia discussion on the RW forum and came across your blog. After reading all the posts, I do not think that my tibia is severe enough to worry about. I kick my leg up a little like in your pictures, but not quite as much. Anyway, I wish you all the luck in the world. Your dedication to running is apparent. Great blog! Feel free to check mine out too, if you have time:

Jim Hansen said...

Hi Jessica,
Thanks for stopping by.
I was in for a massage and talked to the therapist about rotated bones and the discussions on RW. She says she has always had a rotated tibia and can see it in photos from when she was a child too. She is a runner and in my running club. Anyhow she said she had a client come in who said they had that operation that Damian was alluding to: cutting the tibia and turning it. The client said it was the worst thing they had ever done and wishes they had never done such a thing! Ouch!

I checked out your site. Lots of nice photos of food that were making me very hungry! I also saw you use the TP Massage tools. During my run yesterday I remember telling myself to use them again. Seeing you post made me remember that and I should do that before today's run.

Good luck with the running. Realize that I ran inury free for years with whatever problem I had and I would still like to get to that point again.