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.


Michael said...

Hey Jim - I hope you didn't pay that guy a lot of money to tell you that your left foot kicks out at a weird angle. I could have told you that - for free! Best of luck with your recovery. Seems like you're on the right track. Michael

Jim Hansen said...

Now I know what is actually going on and what can't be changed. I can't see myself run (which is probably a good thing)or I probably would have quit years ago. I was hoping to get back to things quicker, but oh well! The good news is that Dr. Michaud said I will need to have my running friends check to see if my knees are going straight! That means I need you to run behind me to do that. Let's see if we can make that happen some day (during a race)!

Bry said...

Kind of a bummer to hear all that! It sounds as if you'll be able to run, just at lower mileage?

Jim Hansen said...

Well, I hope it is just lower mileage at the beginning. I think there is a lot of strength work to be done without trying to push the mileage as well as proprioceptive work. Interestingly, my PT (who is excellent) taped around my knee last night: not for the muscles but more for the bones to "learn a new feel" with the knee straighter.

Unknown said...

Hi Jim,

I know this post is rather old, but came across your story while doing a google search on femoral anteversion and runners.

I'm just realizing my hip issues are more than likely from femoral anteversion. Just curious how everything ended up for you! I did enjoy your words of wisdom from this post.


Jim Hansen said...

Hi Danielle,
Well I ran hard on my hip for nearly 40 years. I could feel the difference in my hip and my knees knocking running in hs and college, but cycling and triathlons in the 1980s messed up things so that I had a lot of back pain and imbalances which ultimately led to hip surgery in 2011 for a torn labrum. I can run, but have sort of retired until I can get the imbalances fixed (and get rid of post run pain). I ride an ElliptiGO with no problems because it doesn't stress the hip joint as much. That is one problem with femoral anteversion. It can lead to hip problems like a torn labrum in the hip, but realize that I put tons of mileage on that hip before surgery. I would suppose that having matching antevesions on both hips would balance things off better. I just have it in one hip so things are never symmetrical.

Unknown said...

Hi Jim,

Sorry I just saw your response to my above questions. Thanks so much for the reply! Yes, I have asymmetrical femoral anteversion as well. What a disaster-ha!

Keep up the great blog. I'm a fan :)


Jim Hansen said...

Thanks Danielle,
Best wishes solving things!

Michelle said...

This blog was a few years ago so I don't know if you will get this but I have the same thing as you. Been running for six years and have had the whole range of problems ... I have to wear metatarsal pads so my toes don't go numb, I have had plantar fascitis (sp?) and IT band syndrome and now Achilles tendinitis which is proofing to be my "Achilles heel." . Don't feel like anything is going to help my Achilles troubles. And the more I think about it I believe my structural issues are probably contributing to all of it. Running is linear and I am NOT linear from the waist down. I love half marathon but don't think they are doing me any favors.... your "do what you should not what you can" is really resonating with me. It makes me sad though... why did I get started on this path if I wasn't going to be able to complete it. I would be happy now with running a healthy 5K but I have doubts even that will happen. And I feel like it is hard for me to find help online because stretches and strengthening exercises are going to explained for others, not me and I don't know how to modify. Thank you for this blog and I hope you are doing well.

Jim Hansen said...

Hi Michelle,
It is a lot of work to try to figure out and I am not there yet. I don't run anymore, well I can but I pay for it the next day. I do ride an ElliptiGO vigorously. I love it. It is running without the injury or joint pains. It is a great replacement for running and I have put over 11,000 miles on it in less than 2 years! I hope to run pain free some day and am currently trying Prolotherapy in my si joint and lower back and so far I am impressed, but I have only had one set of injections, but it started tightening up the loose ligaments and that seems to be resolving some of the other issues right down to my feet. Only more time can tell if it works enough to get me running. Like you, I would be happy with a 5k. Keep learning and trying new things. I always figure if you could run as a kid, you should be able to run as an adult. Best wishes to finding a resolution!