Monday, November 30, 2009

Taking a Closer Look at the Ankle Joint: Dorsiflexion and Mobility

For over 20 years, I have been looking at my hips and back trying to figure out the pain and imbalance problems that I can't get rid of. My left lower back and my left front hip have always been the two areas that I can never seem to fix. I have been told not to run anymore by many doctors and even physical therapists have said it must be something wrong with my hip. But they are never sure what! I have actually helped my back, this past year, to feel the best that is has since the mid 1980s when triathlons just killed my back (or as I now suspect- a faulty bike set up and fit caused the problems).

I have always looked at my hip for a solution, but what if the hip is just the symptom and the problem can be found somewhere else. I have started looking somewhere else and I think I may be able to pinpoint the problem. Is there a solution? I don't' fully know, but if I could run marathons prior to my excursion into triathlons without the problems I have now, then why can't I get my body back to that point.

About a month ago, after much work with Feldenkrais, I started realizing that my hips and back seemed to work just fine (at least while lying on the ground). My left hip could do the same movements as my right hip. I then wondered if Feldenkrais would work on lower body parts, particularly my left foot and ankle. My left ankle does not work like my right ankle. The foot twists out to the side and the inside half of the foot is higher than the outside part. It is sort of like a twisted foot. If I point my left knee forward, the left foot points to the outside. If I straighten my left foot on the ground, my left knee knocks into the right knee. This has been a long-standing problem. In high school, I was jokingly given an award for being knock-kneed. When I started triathlons and fit myself to my bike, I knew my left foot pointed out, so I locked them into that position with my pedals. I did five intense years of triathlons (including five Ironman distance races) with this toed-out position on my left foot. After one year of triathlons, I was trying to figure out the pain in my back (I didn't do stretching or know anything about chiropractic back in those days 1983-1987). By 1987, I honestly thought I would be in a wheelchair by my mid-thirties as I couldn't do much of anything without trying to relieve the pain by cracking my back every 15 minutes all day long. I was a mess! I have improved a lot since then and have kept myself out of a wheelchair, but I have yet to fully straighten out my body again. I went to get physical therapy for the first time in 1988 right before my marriage, because I wasn’t sure that I could stand up long enough during the ceremony without needing to crack my back! This was less than one year after my fifth and final Ironman distance race.

Here I am back in 1985 winning a triathlon in Lakeville, Ma. The ankle-knee-hip thing isn't so bad. Same with this photo from  the Falmouth Road Race in 2004.

But look at what is happening at this year's Applefest 1/2 Marathon. It is painful to look at. I have to straighten things out starting somewhere.

So I started thinking again! What if the problem isn't my lower back (first problem area) or hips (a later problem)? What if it has to do with my feet. I have experimented with Morton's Foot remedies, but that doesn't fully address my misaligned foot. Could it be that my weird stride is because of my foot? When I run the left foot splays out to the side and then my foot rolls over the arch, sending my left knee in the opposite direction so that it knocks into my right knee. Then my femur sticks up into my hip socket at a weird angle causing the hip, butt, and back problems. My body has learned to compensate by getting all out of alignment and running with all sorts of twists and imbalances that somehow work (but is very ugly). I started wondering if I could fix my foot and ankle, thus creating a fix for my hip and back. I found a Feldenkrais ATM lesson for the ankles and used it the night before the Cape Cod Marathon in October. It was an hour-long practice with the ankle and I noticed something right off the bat, well I already knew this, but never really thought much about it. Part of the lesson was done lying on my belly. From this position, you have to leave your knees on the ground together and lift up your lower legs to a ninety-degree angle, bottoms of the feet pointed to the ceiling. With you feet together, you had to do slow movements: toes out-ankles together, toes together-heels out. I could move my right heel out, but the left would go nowhere. Doing these and other movements I was able after an hour to get my left heel to move less than an inch, but there was some improvement.

I have no idea if my left ankle-foot arrangement is something I was born with or something I developed through misuse or poor movement patterns (or locking myself into an unnatural pedal position). I decided to try to find out more information, and am still looking, and I am not sure it is something I can fully fix, but I am willing to see what I can do to improve my movement patterns. I am no expert, but unless my bones are formed improperly or worn down, (can that happen?) then it might be my muscles and ligaments that are holding things in bad positions and alignment and maybe that can be fixed. There are 26 bones, plus the tibia and fibula, in the lower leg, ankle, and foot so there are many places where "something" can go wrong.

In a well-written article called The Ankle Paradox: Building Indestructible Ankles for, Jimmy Smith writes:

Some of my colleagues may want to slap me around a bit, but I'm convinced that the ankle is the primary cause of abnormal gait.... Pain or improper movement will cause the individual to compensate for the dysfunction.

I never have pain in that ankle, but I certainly have dysfunction and an "abnormal gait." So maybe the ankle is where I really should be looking and it looks like a very complicated joint complex. Here is a wonderful video of how the ankle joint complex works:

I still don't know how or if I can fix things. I do know this. Once I start running forward and put weight on my left foot rather than moving straight ahead over my foot, it feels "stuck" as my leg moves over my ankle (that part right in front of the angle-sort of like the vertex where the foot and leg meet).. Rather than move straight over the foot, the front of my ankle rolls to the inside, everting the foot out to the side, and rolling down towards the arch. Could this movement be throwing off my stride? Could this habit be the cause of my funky left foot positioning?

What if I could roll forward over my ankle in a straight line?There are many ankle mobilization videos that show how to test and work on this dorsiflexion. Bill Hartman shows how it is done in this video, as well as a tennis ball trick to work on the soleus muscle, calf muscle, and plantar muscles. I have been working on this mobility work to see if I can get a better sense of moving properly and gaining better dorsiflexion.

Here are other videos that take the ankle mobilizations further into a kneeling position. It helps you line up the knee and ankle with a long dowel or broomstick. The blurb for the first video states
Great warm up for walkers and runners, especially if you have suffered from a previous ankle sprain. Improves ankle and opposite hip flexibility, but more importantly helps to re-wire the front knee on how it is supposed to move and keep it from caving in during walking and running.

Here is another take on that mobilization:

I was also wondering a bit about something that chiropractor, Brian Bigelow, told me many years ago. He mentioned something about my tibia or fibula being out of position. I really didn't realize that these bones move in a small way as your ankle flexes. Bill Hartman shows a technique he developed to mobilize the ankle when the fibula is stuck in the forward position. I used a regular belt when I tried this and it seemed to do something the first time I did it. This stopped some of the pressure I was feeling in my left peroneals and knee. I used it again twice more in the following week when I had the same pressure. It seems to do something positive with my leg, so it is something I am trying to learn more about.

Bill Hartman together with Eric Cressey (I have a couple of his books, plus the Magnificent Mobility DVD), and Mike Robertson have recently come out with a new DVD called "Assess and Correct". I do not have this yet, but it looks very interesting. I am wondering if it gives any more information on ankle mobility techniques.

Here is an article with more videos called Alleviating Ailing Ankles by Carson Boddicker with many exercises to increase dorsiflexion. Carson writes:

All the issues can be both joint mobility restrictions and muscular tightness; achieving proper dorsiflexion should be addressed with a multifaceted approach including altering tissue lengths, joint mobility, and other modifiable lifestyle factors.
Here is a good blog post. It is for frisbee player, but they run too!
I am also looking again at the joint mobility work through the Z-Health exercises. I am paying proper attention to foot placements when doing them.

Many ankle mobility mobilizations require an expert to evaluate and practice. Here is an overview and then some other more complicated videos that I just want to keep track of.

Who knows if doing the simple mobilizations will improve my stride. I am willing to try. Like anything, I assume it will take some time to alter the tightness and alignment issues and then to let the body adjust.

My foot seems a bit better in alignment and as it straightens out. I notice more arch in my left foot. Mywhole foot seems to do its own wiggling and rotations that are not normal. I assume this is also a neurological problem and hope that if things fix in my foot, I can retrain the brain for proper movement patterns. Like everything else I try, I never know if it will work, but I think it is another step on the way to recovering my stride.

Yesterday was another warm and beautiful November day for running. I was stiff, particularly in the hamstrings, as I spent most of the week doing lots of additional things, Z-Health, resistance stretching, yoga, and a return to kettlebells. I think the kettlebell swings tightened up my hamstrings, but I wanted to get back to a consistent use of the kettlebells.

It took a few miles to warm up, but I ended up doing 11 miles and my stride was shifting after a while to a different position as I tried to keep the left foot straight. It really affects the rotations in both hips and the imbalances in my back. By the end of the run (which went very well), I was very stiff over my entire back. I will just take that as a sign that my balance is shifting and my body is readjusting. After a month, I can now rotate my left heel out about two inches when I do the Feldenkrais exercise I wrote about earlier.

The ankle joint is something I have to learn a whole lot more about. I would really like to know if it is possible to get that left foot to rotate back into position. If it is doable then I may really be onto something!

Saturday, November 28, 2009

One Half Running Geek: Running with a Compression Sleeve

World Class runners like Paula Radcliffe can be seen racing in them, triathletes (Joe Friel's blog) wear them with all their fancy triathlete attire, and they look like the old ankle covering tube socks that we use to run with in the 1970's. Compression socks are what I am talking about. According to this Running Times article they are:

aimed at improving oxygen delivery to muscles, speeding lactic acid removal and stabilizing the lower leg for greater muscle efficiency

Running Times also reports that:

The primary rationale behind wearing compression socks in a race is that they may enhance venous return to the heart through a more efficient calf muscle pump, leading to increased endurance capacity. And there is the notion that because muscles are kept more compact, balance and proprioception are improved and muscle fatigue is minimized.

However the article states that:

at the 2007 American College of Sports Medicine annual meeting in New Orleans suggested there were no statistically significant differences in maximal oxygen consumption, heart rate or minute ventilation between treadmill runners who wore compression socks and those who did not. According to the study, conducted at Stellenbosch University in South Africa, subjects did, however, show a faster lactate recovery rate after exercise when wearing the compression socks, suggesting that compression socks might speed recovery after a strenuous workout or a race.

So wear them in a race if it suits you, but definitely wear them after the race.

That is all fine with me and I would be happy to laugh at the geekiness of fellow compressioned socked runners, except that for the past few years I keep getting calf injuries two or three times a year which keep me out of running for a week or two each time.

I have talked to a few other 50+ runners who started using compression socks for this very reason. They felt they could run when the calf still had the strain. By the way, these calf strains seem to be a very common problem for us older guys who continue running.

I decided to try out a pair after my recent (3rd time this year) calf issue. I ordered what I thought was a good deal on, the Zensah Ultra Calf and Shin Sleeve. The claims for this sleeve (not sock) were that :

Zensah Ultra Calf and Shin Sleeve... just the solution to build circulation and ease muscle strain This super soft, ultra-breathable sleeve is uniquely designed with ribbing on the front and back for 360 degrees of support to the calf and shin. Pinpoint weaving creates upward gradient compression, which helps increase blood circulation, getting oxygen to the muscles faster. Latex-free Zensah Fabric® is renowned for its thermo-regulating ability to help keep the lower leg at the right temperature-warm or cool-when relief is needed. Also aids in locking out moisture and bacteria. Recommended for those with shin pain, poor leg circulation or muscle strains. Caution: Not recommended for those with diabetes.

It all sounded good so bought the black color (why hide geekiness) and waited for the order to come from Footsmart (through Amazon). I was suprised when my $19.99 order came (plus $4.99 shipping) and there was only one sock (or sleeve). I always thought socks came in pairs, but there was only on sleeve shown in the photograph and sleeve is singular (foolish me). However they have another sleeve on Amazon that shows two sleeves and the title is singular so I was easily confused. I wasn't sure what to do with only one sleeve and I certainly don't want to order another and pay the outrageous shipping for one sock (it seems like the shipping is to pay more for the catalog they threw in with the sock). To return the sock it looks like they will charge me $6.99 plus lose the shipping I already paid!

I decided to try the sock today while I wait for a company response. I will pay for another sock, but not the shipping. If I had bought two in the first place the shipping would have been free. I ran on the treadmill for an hour, and switched the sock to the other leg halfway through. I can't say that it did anything for me, but it wasn't uncomfortable. It also got sweaty quick. If I buy a second one, the winter would be a good time to try them out. If I get another calf strain, then that is when I plan to see if the sock is really helpful. If I don't get another one and use this when injured, does that make me 1/2 of a running geek or a double running geek?

When I was researching compression socks I came across the SmoothToe Compression Sock, but didn't buy it because of the marketing gimick. It looks like a better deal now because you get both socks for $35 plus shipping. If you download "Free Report" you are promised a free pair of compression socks. But they also send two other socks for you to purchase and then you are on a plan to keep getting more socks.

Long time Gate City Striders may recognize that these socks sponsor former GCS runner David O'Meara who is the spokesman for the socks. David most recently completed his self-titled New England Marathon where he raced miles one at a time throughout New England at under 5 minute/mile pace:

On 8/30/09, David accomplished his 61-day, 2009 challenge as he completed the "SmoothToe® New England Marathon...One Mile at a Time” in 2 hours, 7 minutes, 9 seconds and 14 one-hundredths... beating his sub-5 minute mile target of 2:11.

Here you can see him doing the Bigelow Chiropractic Mile in Hollis, NH with chiropractor Brian Bigelow. Brian is a long time friend, Strider, fast runner, and the chirpractor I go to for tune-ups. Brian explains his techniques with David in this video.

Brian turns 50 this year and I am encouraging him to get back into running (he ran a sub 2:50 marathon in Chicago about 10 years ago) when he was more of a runner than a Cyclist.

Friday, November 27, 2009

What to do about that Pain in your Butt: Piriformis or Gluteus Medius?

There are so many things to be thankful for at Thanksgiving time. One thing that I am thankful for this year is that my back and hips have probably felt the best that they have felt in about 25 years. I can stand, sit, walk around, and go through my day without the pains that I have had since the mid 1980s. My daily life feels so much better. When I stop running for a few days it feels really good. At this point however, once I start running and particularly when I try to run fast it doesn't work so well. I seem to have lost a lot of the little bit of speed I had over the past two years.

When I do try to run fast my imbalances take over and the success I have had during the sedentary part of my day hasn't been accomplished yet. I am learning how to get out of the pain and tightness I have had in the past where once I get stuck or imblanced and my body would go through a week or two week cycle where I couldn't fix it. Now I can usually fix things in a day or two. That is all great and I feel I am on the right path to regaining some running success. One thing I have noticed this year is that after most track workouts or races my left gluteal muscles tighten up and I end up limping for a few hours or days before it calms down.

I had the same thing after yesterday's Thanksgiving 5K race at Nashua South High School. The gluteal and lower back region tightened up during the race and by the end I was limping and unable to even run a warm down. I am guessing that I get this due to my poor biomechanics and running with imbalances which leaves to a stress on the muscles. It comes when I run fast and demand more from my body in power and more specifically range of motion. So what to do?

First is a nerve flossing stretch that I really like. I previously wrote about nerve flossing here. I am working on things in my left foot and ankle that seem promising (haven't reported here yet) and that will give me more balance and effecient movement. As I make positive changes it does change the stress on the gluteal muscles (everything is connected) as I straighten up my stride. I have been trying a few new stretches and exercises for these muscles and thought I'd share them here. I am paying more attention to the piriformis nerve flossing stretch that I linked to in that post. For some reason, this time when I followed the video and did the stretch 20 times it worked a whole lot better. It seemed to be targeting exactly where I was tight so I will continue duing this one. Here is the video again:

Here is another stretch for the hip rotators and piriformis that I have never seen before. This one felt good too.

Finally, not knowing which muscle of mine is really being irritated: the piriformis, the gluteus minimus, or some other neighboring butt muscle, here is a good video explanation showing how to use a tennis ball to work on the gulteus minimus. You can use a tennis ball, a TPMassage ball, or a hard rubber ball. I use all three at different times.

Here is a good article on the anatomy of the hips and back and it shows how to use the TP Massage balls and rollers to loosen tightnesses and imblances.You could also use a tennis ball or a foam roller to do the same thing. I have had the TP Massage products for a couple of years and am learning how to responsibly use them (rather than beat myself up with them) through two of their DVD's that I recently bought. I got the Hip and Lower Back DVD and the Foot and Lower Leg DVD. Previously I had just used the Ultimate 6 book that they sold, but I work better when I see a video then read it in a book as I don't always pick up the subtle nuances and tend to do things to quick and too hard.

I ran the Great Gobbler 5k on Thanksgiving on limited mileage and no speed work and it showed. The course is a bit long (I see it is listed as a 5.25 K in the race results) and I ran 20:46 for 31st place and 2nd out of 47 in the 50-59 age group. It is a low key race so I don't think the splits and finish time are too accurate but at the one mile mark I was 6:07 and I was 12:10 at the two mile mark. Then I started passing people who had passed me in the first two miles. I was placed real well for the first 1/4 mile until Steve Wolfe bumped me at the corner around the purple shed and ruined my chance to run better and allowed 20-30 people to pass for a while! Anyhow that is 36 seconds slower than last year. It is also much worse than my 18:09 time in 2007 (shorter course) and my 18:16 in 2006. Did I really slow down that much in such a short time?

Thursday, November 19, 2009

A Taste of Heaven

Today I got outside to run for the first time in a couple of weeks after a calf injury kept me from running. I got back to training two days ago, but I only had time for treadmill runs the previous two days. Today I rushed home from school, got the gear on, and headed out the door, and ran. It had turned dark before I finished, but it was still a bit like heaven, running again, outside, on a warm November day.

As I person of faith, I believe that someday I will be up in heaven. When I get there, I am holding God accountable for that "getting a new body" thing that He promised. I intend to get in line for the lean, fast, and powerful body type and I am going to make doubly sure it has perfect biomechanics. Then one of the first things I am going to do is run like the wind on those "streets of gold". I intend to run a sub four minute mile and then go off and run a sub 2:10 marathon and because there is no pain up there, I am going to turn around and do it again just for fun. I want to "feel" how if must feel to run so fast and perfectly. When I am done, I will then know I am in heaven and will sit on my cloud and play my harp. And while I am getting a new body, I am sure it could not hurt to get a better looking one too! Then on my harp, maybe I will start playing "Where the Streets have no Name." When "I go there...I want to run... where the streets have no name." Now that is one of the all time great songs. I have not seen this video for years!

Here on planet Earth, where I have to continue to run with my messsed up biomechanics, I am putting together a hodge-podge "best of" plan to get my body working better and it is good to get things rolling again. I like the Feldenkrais, but I had limited myself to just that and running since August and I need to put back into my routine the other things that may work best for me in the right combination. So I have a mix of Feldenkrais, Z-Health, Yoga, trigger-point work, and Kettlebells that I am doing with a few additional strengthening and stretching routines that target certain muscle groups. It sounds busy, but I have "faith" that I can still improve on my running mechanics. My plan is to continue targeting my hips and back with the Feldenkrais and use what I have learned through Feldenkrais to better inform my movement patterns using the other methodologies. Some of the work I have done has really helped me understand movement patterns and while far from perfect, I feel so much better and in control as I reorganize the way my body works and moves.

I am not sure if it will make me any faster, but at least I want the running to be more enjoyable. However, if you hear of me running these outstanding world class times any day soon then it "must be a mistake" because "Heaven Can Wait"! Remember this old Warren Beatty movie?

Wasn't Beatty a football player in the movie? Did he die while running? I can't remember. I saw this film years ago with the Wheaton College Cross Country team during a preseason running camp in the Northern Woods of Wisconsin. We geeky runners loved it, and like any college age group of guys we used lines from the movie as jokes all that year. We really thought that "I'm just memorizing your face" would be a great line to use with the girls!

I wonder if any of my teammates ever tried that line. Here we are trying to be a bit more macho! I am 3rd from the right and I know I never did!

Monday, November 16, 2009

Bone Rhythm: An Interesting Way of Looking at Movement

I have been thinking about the skeleton a bit in terms of my posture and mechanics. Is it my bones and skeleton that produce my imbalances or is it the muscles, tendons, fascia, or even the neurological way I have wired myself for movement that create the imbalances? As I relearn movement patterns through Feldenkrais lessons, I have been applying some of the movements and pacing to joint mobility work through Z-Health. I have found that I understand and can use the Z-Health joint mobility work much more successfully and in a more targeted way than I could previously. I recalled some interesting lessons from the more advanced Z-Health S-Phase DVD I got earlier this year. I basically watched it from a curiousity standpoint as much of the DVD was too advanced for my body. If I was a young athlete I would find it very useful particularly if I was playing sports with lots of athletic moves. I am not young and just want to run straight ahead so I just keep it in my collection. I did find one concept very interesting and that was something called "bone rhythm". It is an interesting way of looking at the skeleton when performing movements like lunges and squats. The idea of bone rhythm is to get the timing of the joints down so that they work together. You don't concentrate on the muscles, but on the movement at the end of the bones.

Here can see a quick video off the Z-Health DVD that explains bone rhythm with squatting that focuses in on the femur.

This video shows bone a rhythm variation using the lunge. Bone rhythm can be used with other joints.

I don't know how or if it will improve your running, but it gives an alternative way of thinking about movement when exercising. If you start out with Z-Health you should start with the R-Phase DVD unless you try the Quick Start DVD which is an introduction. This is the only DVD I don't have so I don't know what four exercises are highlighted. I have had the Z-Health R Phase DVD for almost two years now and still find it useful as I refine my use of the drills.

Friday, November 13, 2009

1978 Falmouth Road Race: When Bill Rodgers was King

I recently found an old Kenny Moore Sport's Illustrated article on the 1978 Falmouth Road Race which you can read here. Not only was Kenny Moore a great American runner (fourth behind Frank Shorter in the 1972 Olympic Marathon) but he is also one of best writers when it comes to the sport. This was one of the many Falmouth road races that I raced and I found a few pictures of the race from my old Kodak 110 camera. This race is notorious for the heat that felled a young Alberto Salazar. He was famously read his last rights after suffering heat exhaustion. He survived and went on to suffer in the heat again at the 1982 Boston Marathon (a race I also ran as it was my first Boston Marathon). In the article, Kenny Moore laments the rapid growth of running:

Last week the Cape, or that 7.1-mile length of its triceps from Woods Hole to Falmouth Heights, resounded to the footsteps of some 4,000 overheated runners celebrating the sixth renewal of the Falmouth Road Race. Afterward, the bended arms hoisted no-deposit, no-return bottles, solitude was unavailable and thoughtful distance runners were forced to conclude that their sport is rapidly outgrowing its Thoreauvian roots.

and ends with a note about what "spectacles" these running events had become with their "masses of runners" and "exploitive" entry fees.

There are runners now, usually those who have run for years, who no longer come to the big races, who feel them to be perverted simply by the crush, the leveling of numbers. "It's headed toward sin," said one New England runner who chose an obscure race in Maine over Falmouth. The New York City Marathon now has closed its lists with more than 10,000 entries, and Chicago expects as many, even with an exploitative $10 entry fee. So we may see the stream divide, one small branch slipping off into the forest. "The simple satisfaction of a good training run," said Bill Norris, "is now more enjoyable for me than one of these spectacles."

It sounds more like the "good old days" to me!

Here is a brief summary of the race from the Falmouth Road Race site.

1978 — Four thousand runners, and this year the race was called "the best road race ever in the United States at any distance." The list of runners read like a "Who's Who," with only Frank Shorter, coming off heel surgery, missing among the world's elite. Sports Illustrated's Kenny Moore called the 1978 race "the best organized race of this size I've ever been in." Bill Rodgers, in the midst of a streak which saw him win 16 races in two years, including two Boston marathons, two New York City marathons and a pair at Falmouth, was at the top of his game. He outran the star-studded competition and shaved two seconds off his course record (32:21). Salazar made news again, but this time for collapsing with heat exhaustion at the finish and being rushed to the hospital in critical condition. He recovered and would have his day in the sun in a couple of years. For the first year, the woman's record stayed intact, as Joan Benoit won, but couldn't eclipse Kim Merritt's 1977 mark. Records would come later for Benoit.


2nd place finisher Mike Roche near the 6 mile mark

3rd place finisher Craig Virgin

my high school teammate Bill Hobbs came from New York to run (with 78 BAA marathon champion Gayle Barron)

Gayle Barron finished in 6th place
me getting an autograph

71 year old Johnny Kelley

Here are the results. I came in 435th place in 45:47. I was a little over one minute slower this year 31 years later in the 2009 version of the race.

Runner's World did a cover story feature on the race.

For the Letsrunners who are identifying the runners at the start of the race. Here is an article that explains the race time discrepencies.

And you thought the first photo was tough. Try naming these runners!!

More on the timing problems in 1978 and other interesting logistics

A bit deeper results