Wednesday, December 28, 2011

Somatics: Pain Relief Through Movement

I graduated from Physical Therapy with Leigh Boyles yesterday. I celebrated with a trip to the YMCA and a treadmill run. I wanted to run harder than I had been going and eventually ended the run at 5 miles at my fastest pace yet. It felt good. Some wobbling on the left side, but things are improving. I also had 4 trigger point injections in my left glutes on Friday. I think they have loosened things up a bit. I have been feeling tightness in my adductors at times and I also feel tight at the front of the left hip. I asked Leigh about this and she said that as the front of my hip loosens up (by pushing back as I run) the adductors should feel better.

 One thing that Leigh has been mentioning all along is that I have to retrain the way my brain works through proprioceptive work. This is something the Gait Guys have mentioned as well as Dr. Michaud in the past weeks. There was the mentioning, but finding out what to do about it is hard to do. Sure, some exercises and taping have helped me, I am running noticeably straighter, but how do you get your brain to change your whole-body movement patterns?

Last summer, right before my hip surgery, I discovered something called somatics through Martha Peterson's blog Pain Relief Through Movement and webpage. Some of her movements helped my hip in the weeks prior to my surgery when I was in Kenya. I received her DVD after I returned from Kenya and started going through it again post-surgery a while back. I have been doing the movements more frequently and then I got her newly published book Move Without Pain this month which has new exercises as well as guides to those on the DVD. It also includes a good overview of somatics.

It is a very simple to understand book to both read and use. The pictures and text structure make it easy to read and follow. While the DVD guides you through the exercises and the speed as to how to do them, the book is easier to pull out and review before doing an exercise. These are not exercises that will leave you stiff and sore like yoga or stretching can often do, but they are exercises that feel good and leave you feeling changed. I am not ready to thoroughly review the book at this time, but I do want to highlight the key ideas of somatics. You can read more here from Martha's blog.

1) Sensory Motor Amnesia- This happens when muscles are so tight that they will not relax. One thing that I found very interesting is something that Martha mentions in her book: what looks like a structural abnormality can be an issue of sensory motor function -tight muscles that won't relax. The point of somatics is that because the brain and nervous system control the muscles you have to engage the brain to unlock muscle patterns.

2) Three Reflex Patterns- In somatics there are full body reflex patterns that people us in reaction to stress. The Green Light Reflex involves an arching of constantly tight back muscles. The Red Light Reflex is another stress related posture with a rounded back due to anxiety or fear or from sitting all day hunched over a computer. The Trauma Reflex is a response to an accident or injury and involves a twist or rotation as a way to avoid injury or pain. This can lead to imbalances as your body gets stuck in this pattern.

3) Pandiculation- This is the somatic alternative to stretching. It works like a reset button. It involves making a tight contraction, followed by a slow release of the contraction to lengthen the muscle, and a complete relaxation at the end.

Somatics uses these ideas to help you rebuild your movement patterns and get rid of chronic pain. I highly recommend Martha's website, DVD (more are promised to come out soon), and her book Move Without Pain. It might just be the method to get you to get out of pain, move better, and to recover your stride.

I have emailed back and forth with Martha and she graciously offered to do a Skype session with me. I won't go into too much specifics, but will write down the things I need to remember before I forget them. It was an awesome experience to have someone so knowledgeable take a look at how I move, perform exercises, and offer me ideas to pursue.

We worked on the side-bend (one of the exercises I had found before going to Kenya that helped my sore hip and back before the labral-tear surgery). I learned some tips on doing this move, but most important, I need to slow down when doing it. Here is an tutorial for the side-bend.

We also worked on the back-lift (directions here) and then she gave me a different exercise for my tight illiopsoas that I don't recall as being in the book or on the first DVD but is found right here.

I was also told to check out this post on 3 common mistakes when doing Somatic exercises and this post on Standing Tall and Walking.

I had a valuable learning time with Martha on Skype (first time I have ever Skyped) and a thank Martha for her time, knowledge, and inspiration.

Monday, December 26, 2011

Arms up - Face Forward

A recent article Healthy Running Comes from the Arms and Head Connection over at The Natural Running Center by Jae Gruenke gives two tips to improve your running posture that counter the notion that you tuck your chin in when running and keep your hands low. Her tips are based on the Feldenkrais Method of movement. One is to keep your hands close to your chest, and bring your knuckles to the midpoint of your breastbone on the forward swing as in the photo taken at the World Cross-Country Championships.

 Her other tip is on the face forward head position.
When you run and therefore lean, you still need your eyes and inner ears upright relative to gravity so they work properly for balance and orientation, which means you have to let the distance between your chin and your throat increase in a move we have nicknamed “face forward.” What actually happens is that your skull slides forward on your atlas vertebra (this is the top vertebrae that along with the axis forms the connection to the skull) the same way it does when you kiss someone or when you hunch up at your laptop. But in running you allow this forward movement of your head to cause your whole body to fall forward, rather than just caving in your chest and hunching your shoulders, and it leads you into a beautiful, free, and easy lean.
Jae can be found over at The Balanced Runner. I have enjoyed doing Jae's cds in the past as a method to warm-up for a run or in an attempt to move better. If anyone these cues on a run, let me know how it goes.

Here is a Runners World interview with 3 time Olympian Jenn Rhines who explains her work with Jae  Gruenke and the Feldenkrais Method.

Well, you mentioned earlier in this Chat that there had been some tweaking of your running form. What exactly did you do, and what was the reason a need for that was perceived?
JR: Last year, I was running some decent workouts. I couldn't put anything together in a race and felt like I was really struggling. I felt like my body couldn't do it anymore, so I figured I'm either done or I need to figure out a way to do it differently.  I've been working with Terrence; I also worked with a woman in New York. Her name is Jae Gruenke, doing a thing called Feldenkrais Lessons – basically, teaching your body there's an easier way to do things. Things are starting to stick now. It's starting to come around.

Can you explain a little bit what Feldenkrais Lessons re?
JR: They're called awareness through movement lessons. I was actually doing them with her over Skype. To me, the easiest way to explain it is just that you're doing simple movements and teaching yourself to use different muscles and to do things a little move easily than in the patterns you've been stuck in. For somebody like me who's been running for over 20 years, I was definitely stuck in some bad habits.

One thing I've learned about is how everything interacts together. I'll get a very tight upper body and my arms with be way up high and twisting when I get tired, and now I kind of understand you can't just force yourself to drop them and have it be perfect. I understand more how everything works together.  It's probably still subtle, because I know I don't look dramatically different, but I'm not overstriding quite as much and I'm using my glutes and hamstrings more so I have a little bit higher back kick. It's better for me;  I don't look like a gazelle yet.

Friday, December 23, 2011

Attack Mode

For the last two weeks, I have been on attack mode. I am doing all I can to get myself healed up and it's been enlightening. I have had 4 doctors visits (3 different doctors) as well as 2 PT sessions. I am very hopeful that with all the advice, knowlege, and work that things will start progressing quicker.

First, I had the visit with Dr. Michaud who measured all my angles and joints and gave me somewhat of a confirmation of things that aren't right and what to do to get stronger. A few days after that I went to Dr. Dannenburg and he did manipulations on my knee-popliteus and on a cuboid bone in my foot that was causing my foot to be stuck and not work or move correctly. I also had PT work each week where I am getting graston technique done on my popliteus and surrounding muscles as well as getting taped around my knee as a proprioceptive thing to get my body and mind used to a better positioning of my knee. Today I had 4 trigger point injections into my glute medius. I will go back every two weeks for more for 2 or 3 more times.

My goal 2 weeks ago was to run only a mile or two each day. I got in 7 straight days of running before my glute medius tied up after one run and things fell apart again. The good news this weel was the physiatrist wanted me to stress my glute medius before the injections this morning so I ran 10 miles on the treadmill last night. That was my longest run since August 2010 and if felt good to go that long.

So I have had work on my feet by the podiatrist, on my knees and popliteus through PT, and on my glutes through the trigger point injections. That should cover a lot of things and hopefully everything will play nice together. I have also been doing all my PT work to get my hips strong. I will say that when I run on the treadmill, my hips stay aligned and straight which is very different from how I ran before surgery. Everything from the knee up looks a lot better than before. It is just the left leg rotating out that looks bad. It had appeared to be pointing out about 40 degrees  last month, after seeing Dr. Dannenberg it improved to about 20 degrees, but if I pushed off more on the foot, it got down to about 10 degrees. That tells me I can improve on things.

Despite all that work, I have also written back and forth a bit with Martha Peterson this week and learning more about somatics. I found a few of her videos and postings online a few days before I went to Kenya this summer and some of her exercises helped keep my pain at bay during that trip. I got her DVD, but didn't start working on the movements until recently again as I was letting my hip heal from surgery. She also just published her book Move Without Pain which I have been reading and enjoying very much. Somatics deals with sensory motor training and reteaches the body how to move properly. I enjoy the movements and their effect and they don't "hurt" my body like yoga or stretching often can. I will have more to say on this at a later date, but her book and video are top notch.

Here is a new hip movement from Martha's soon to be released DVD "Pain-Free Legs and Hips" .

Tuesday, December 20, 2011

A story about consistency and durability

Earlier in the year I wrote about the Baker brothers from New York, Brian and Jeff, and their ongoing streak of running (now) 33 straight Falmouth Road Races. I have to congratulate Brain Baker for reaching yet another significant (and magnificent) milestone. Earlier this month on December 10th, he ran the Rehoboth Beach Seashore Marathon and just dipped under 3 hours with a time of 2:59:53. The 7 seconds under 3 hours are very important. Back on December 2 in 1979 Brian first ran a marathon faster than 3 hours when he ran the Jersey Shore Marathon in 2:56:29 . That marks a span of time of 32 years and 8 days between his first and most recent sub 3 hours marathon. Soon Brian's name will appear on  this international list for longest time spans between sub 3 hour marathons. He will be in 25th place and will be keeping fast company with a list of high quality runners, some with national and world class performances. This is the list I want to recover for and try to make some day. It may take awhile, but it is my primary racing goal, if I ever get up and running healthy again. For me it is just a far in the future dream right now, but the competition is getting stiffer to make the list. It is great to see an extremely consistent runner like Brian make this list. Congratulations and well done!

I think this shows how good it must feel to finish and beat your goal! It must have been harrowing the last few miles trying to get under the 3 hour barrier!

Thursday, December 15, 2011

Craig Virgin deserves it!

Craig Virgin is one of America's greatest ever distance runners. He won the World Cross-Country Championships twice (1980-1981). He finished in 2nd place in the 1981 Boston Marathon, qualified for the Olympics 3 times in the 10,000 meters and won the 1979 Falmouth Road Race among other achievements. Earlier this month he was inducted into the National Track and Field Hall of Fame. Here is a video of the incredible finish of the 1980 World Cross-Country Championships. Even if you have seen this multiple times, it is always inspiring.

Craig Virgin certainly deserves such an honor. However, I think what he really deserves is to get himself running again. This recent article tells about the struggles he has overcome and still faces. His body has been through the wringer and he just wishes he could recover his stride enough to run a 10K again some day.

Virgin was badly injured in an auto accident in 1997 and ruptured his right quadriceps during a fall on ice a few years later. He has had 15 surgeries and the most he can run is two miles although he still continues to workout at a gym. He has also three surgeries because of a congenital kidney condition. 
"I'm no longer Craig Virgin the Olympian," he said. "I'm Craig Virgin the middle-age everyman who wants to lose 10 pounds."
and then goes on to say:
"Jimmy Connors still plays tennis. Jay Haas and Hale Irwin still play golf," he said. "Running is something you do because you love it. I still have a passion for it."
You can't take the run out of a runner and for someone who has reached such high levels in the sport of running, it must be incredibly hard to not be able to run. If anyone deserves to get their legs back and be able to recover their stride, I would put in my vote for Craig Virgin. 


I took this photo of Craig Virgin at the 1978 Falmouth Road Race where he placed 3rd.

Sunday, December 11, 2011

So not born to run!

I had the privilege to go visit Dr. Thomas Michaud yesterday. It was actually more than a privilege as he emailed me earlier in the week inviting me in, after he saw my blog post and a question I had over at the gait guys Facebook page. He is a busy man and the earliest scheduled appointment I could previosly get was next April, so it was nice of him to offer a time to fit me in. He also wrote the book on gait related disorders called Human Locomotion, so I was an eager patient.

I think he was just as excited to delve into the mysteries of my running stride as it is quite a puzzle as I was to hear what he would say. He spent a long time measuring angles, testing muscles, and watching me run. He was giving me a running commentary of all the specifics (I couldn' t hold them all in my head) and was very much interested in what he found.

Basically, I should not be a runner! These are not muscular problems, but structural. He was able to give me a clear overview of what was going on in my body. I have heard parts of it all before, but this is the first time someone has put it all together for me. Basically, I have tibial torsion. I forget some of the numbers for what is normal, but I think he said my right foot is pointed out 10 degrees. I don't really notice this one, but my left foot is pointed out to the side at about 40 degrees! You can't fix that!

Don't let your kids sit like this or they could get tibial torsion!

Coupled with that, my left hip has femoral anteversion. That means my hip, femur and knee want to rotate inwards (hello knock-knees). So while my upper left leg rotates in,  my lower left rotates out. They both meet at the knee, which collapses down. He said that my body was doing some interesting things on its own, trying to make the whole structural mess work and these things aren't bad, my body just had to find a way to work. He also said my left hip doesn't' rotate out (well it does at about 5 degrees when most people get 60 degrees).

He said I also do have the functional hallux limitis, but actually my right foot has it more than the left. One thing that surprised him when I ran was that my left foot suppinates upon landing (trying to hold everything in line) before pronating sharply over. I wasn't correct in the last post that FHL was my main problem. In fact my orthotics are very good. They were made by Dr. Michaud's brother up in New Hampshire.

Well, there is no easy fix. He gave me some exercises to do and the reasons for doing them. Some are based on very recent research. They are nothing new, but now I know which exercises to do and why. I also bought a copy of his book, which is going to keep me busy for a long time. Flipping through, there are many references to conditions like mine.

I was thrilled with the visit and the time I got to spend with Dr, Michaud. It clarified a lot of things for me. I hope to do his exercises and my goal is to just run a little bit each day (1 mile on the treadmill/day) as I try to strengthen and reeducate my brain into doing better movement patterns. Yes, he confirmed what I had read on the Gait Guys website: the brain's mental map needs to be changed. One key exercise he wants me to do is a dyna-disc lunge. I am to hold the lunge for 3 seconds. They wiggling I will feel as my foot tries to balance and for my knee to provide stability is the way that my brain is to rewire itself.

One final thing: he said my muscles were very strong on all the testing. The popliteus was strong too. I am wondering if it is going into spasm when I have difficulty with it?

I was very overwhelmed after the appointment. I finally found a doctor who could look at the whole picture, explain it to me (although I forgot so much), and be excited to work with my at the same time. I think he found my mechanics very interesting. Unfortunately, as I left, I had to come to the conclusion that there are some things I just can't fix! You can't fix twisted bones that rotate the wrong way. It left me a bit sad that there is no quick and magic fix. I will do what I can to see if I can run how I would like run, but I am stuck with the body that I have. My body did work somewhat decently years ago when I was younger, so I need to reverse a few of the compensations and take things slowly.

I read somewhere this weekend some saying that goes something like this. " Do what you should and not what you can." I am going to take things slowly and see if the exercises work. That is what I should do. I have to get rid of the "can" part. I can run 8 miles, but I probably shouldn't at this point until I get things under better control. That will be hard for me as I like to push things, but it is time to do what I should.

And sadly, biking is not and was not the best thing for to do with a tibial torsion and the femoral anteversion. He confirmed that that is what probably really messed up my hip, although in the 1980s when I did triathlons it was my back that felt the pain. He said that the glutes have a mass five times greater than the back muscles which take over the work when my hip isn't working right (or jammed in the joint) and that is why it could not handle the stress. It is also why I have to keep working on my glutes, particulary the glute medius.

1987 Cape Cod Endurance Triathlon: It looks like I was trying to keep the foot straight, but the hip then was jammed. This was my fifth and final Ironman distance triathlon.
Dr. Michaud did say that when running and biking I should keep the knees straight ahead and let the foot do its own thing off to the side.

Friday, December 9, 2011

The popliteus muscle and functional hallux limitus

This is just a quick post for myself before I go for a new and welcome appointment tomorrow. I think I have clarified a lot of my thinking lately and I want to see how right I am. The really really good news is that in the last post I wrote about a doctor who I was told I should go see. I got an appointment, but he is so busy that my appointment wasn't going to be until the end of April. Well he found my blog post and emailed me to offer me an appointment this Saturday as he was going to be in the office doing paper work. Well, isn't that the greatest? I also had a running friend email me as he has been a patient and he also says that he is the best and definitely who I should see! I can only say that I am very fortunate to find a doctor who is very eager to fix problems and to make time to see a new patient. That is quite exciting. The rest of this is more boring stuff, and mostly for my reference, but you never know who may read this and offer some insight or get some ideas to help figure out their own biomechanical problems!
So my hip has been fixed and an MRI ruled out a back or nerve problem so what is up? And what is the etiology, or cause, of my messed up mechanics and problems running. I am going to write what I now think and I then want to compare it to what the doctor says tomorrow, but most important for me is what to do about it all and I think I have found the right doctor to do that!

Last week (after a month of feeling my left lower leg was pointing out more to the side and creating instability on my whole left side) I did some massage on the back of the knee and upper calf. It started feeling better and lining up better. I asked my PT about this and she said it is the popliteus muscle and that muscle can rotate the lower leg out. She then did Graston and deep tissue massage on this and the surrounding muscles. My leg felt better than it had in over a month. I also noticed, however, that when I stand or walk, my big toe really doesn't touch the ground and when I walk or run that left foot awkwardly shifts from from the outside to the inside rotating my foot and lower leg out to the side to try to get that toe on the ground. I also noticed that I have no foot tripod on my left foot (I was aware of this before) as when I  pronate forward the 1st MTP joint gives way and collapses without supporting my foot. The joint and toe is there, but it is almost like it is cut-off and doesn't do what is supposed to do and just gives way.There is a name for this phenonena and it is called functional hallux limitis and I do have orthotics for this, but they seem not to work correctly anymore. So I took out the orthotics ( a cutout under the 1st MTP joint is supposed to preload the joint so this doesn't happen) and instead put a wedge under the big toe which is supposed to do the same thing for the toe joint but in a slightly different way. It is called a cluffy wedge and I bought a set before I got the orthotics made, but I never really used them as I had orthotics. I used them and had a great 8 mile run on Saturday (my only run of the week) and my foot felt much better (of course I got sore muscles from going so far with a change in what I had inserted in my shoe and using a regular insole instead of an orthotic).

So I think that my big toe is the source of my problem.s With functional hallux limitis the big toe joint doesn't work and the foot can't propel itself over the toe, so it finds an new way to do this through pronation. Over time the pronation then forced my foot to point out and that created havoc with my knee (the poplietius muscle). This created the inward rotation at my hip which caused the hip not to work correctly which led to the back pain on the left side for the past 25+ year and the labral tear in the hip. In other words I think the problems start in my toe. Now the question is can we finally fix it and retrain my muscles to work properly. I will be most interested to see what the doctor says tomorrow.

I was also supposed to see the podiatrist who is renowned for his work with functional hallux limitis and made my orthotics this week. I somehow got lost and missed the appointment, which is too bad, because I was looking forward to his thoughts and to get the manipulations on my feet. I have an appointment next week if I need it.

This is my podiatrist showing one of his manipulations for the popliteus:

soft tissue treatment of the popliteus

more on the popliteus and its role as a knee rotator- also ways to strengthen the popliteus

how the cluffy wedge works

My current orthotic works like this with a first ray cutout:

Here is my PT showing a big toe mobilization that I have started doing:

Here is a TRX guy showing some toe joint manipulations:

Here is his explanations for the big toe joint and if I am right explains a lot of the compensations my body has created over the years:
Often overlooked, the big toe is not a big joint (metatarsophalangeal joint) but vital for performance and non dysfunctional movements. Mobility is key in locomotion and reciprocal patterns with the feet like the lunges in all planes of motion. Compensations will happen when motion can't occur in this part, which can give other dysfunctions higher up in the chain, muscle or joints or both. Proper gait pattern requires ability to flex the knee to 40 degrees, the dorsiflex the ankle at minimum of 20 degrees, and to be able to extend the first MTP joint to a minimum of 65 degrees (Oatis, 2004). The inability to extend the first MTP joint due to joint degeneration, structural change, or general restriction is commonly known as hallux limitus and is often seen in running athletes who wear traditional running shoes (not all but many of them). This range of motion is very important in the grand scheme of the "Windlass Mechanism" , which is a passive loading mechanism that occurs as the calcaneus clears the ground in late stance and the weight transfers over the heads of the metatarsals. Combined, these motions load the plantar fascia and intrinsics of the foot that help to transform the foot into a stable lever off of which to push (Fuller, 2000). As demonstrated by Carlson, there seems to be an incremental, linear relationship between hallux dorsiflexion and increased tensile strength of the plantar fascia (Carlson, 2000). As you know, the plantar fascia and Medial Longitudinal Arch are capable of producing a great deal of elastic return in running, so imagine the detrimental effects when this mechanism cannot function well. Those with reduced hallux extension and pronated feet often have diminished effects of this mechanism and ultimately less efficient (Dananberg, 1986). When the big toe does not extend well during late stance, plantar flexion torque decreases and occurs in a delayed fashion (Hall, 2004), knee flexion increases (potentially as a result of tension from the distal end as the calcaneus raises early), and hip extension decreases. To compenstate, there must be an increased drive of the hip flexors to advance the leg. When the foot is fixed upon the ground, this contraction creates potential for lumbar rotation and lateral flexion can occur stressing the intervetebral disks and potentially leading to low back pain and dysfunction (Kapandji, 1974). Add to that the possibility of the body compensating with an anterior tilt to facilitate hip flexion and you have a gamut of issues that sounds a lot like the makings of Janda's lower crossed syndrome with excessively toned hip flexors, inadequate gluteal strength, and possibly an increased full body anterior tilt placing the plantar flexors under excessive load. It is very common in the running world. Additionally, the early knee joint flexion and limited extension of the hips can beget a loss of transverse plane stability possibly as a result of ineffective use of the "screw home mechanism" at the tibiofemoral joint and ineffective activation of the hip extensors. Put all of the above together and you have a recipe for increased forces at the PFJ, shearing across the iliotibial band, potentially increased contact pressures at the anterior hip capsule, excessive activation of the deep hip rotators forcing the hip into a hyperextended position causing decreased sacral rotation during gait, low back pain, and SIJ instability. Clearly, limited hallux extension/flexion/abduction is not something to be ignored.

Sunday, December 4, 2011

Jay Johnston's General Strength Progression

Coach Jay Johnston has 5 videos online which detail his general strength progression for runners. They originally appeared in Running Times magazine. Jay says, "The General Strength progression below is the content that I most frequently forward when answering questions on how to improve your running." You can find his post with all 5 videos here. The Colorado mountains in the background are just magnificent. Here is the first routine

These directions are pretty simple and I wish I knew and practiced this stuff years ago. The short routines that Jay presents are certainly worth the effiort and he suggests doing them post run. I have worked through the first routine a couple of times now. His lunge matrix is another valuable routine that I hope to be able to start again soon with my hip. Jay recommends doing these before running or any other work.

Coach Jay also put together two DVDs in his Building a Better Runner series. I did a little bit of proofreading work for Jay on them, so I hope you don't find any spelling or grammar mistakes if you watch them! Here I reviewed the DVD a bit. I found that the DVD had tons of good information, but knowing what to do and sorting through the DVD to figure it out was too much for me. If you want to work on your building yourself up using Jay's methods, the general strength progression posted above is an excellent way to start. He has posted a lot of other worthy stuff online. I would recommend the DVDs to a coach, a trainer, or to an athlete how wants to dig a bit deeper into building up their body for running so that they can keep injuries at bay and fun faster.