HA! I Think I have a Double Leg Length Discrepency!

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.

Return of the MP3's

I was the first one I ever knew to have an MP3 player. I got a Sensory Science RaveMP 2000 back in 1999 and I couldn't believe such technology. It could hold 30 minutes of music! I had to explain what an mp3 was to everyone I knew, because no one had heard of or seen such a thing before. I actually liked this player, its hourglass shape meant it fit snugly in my hand.



My next MP3 player, a Creative Nomad 2, held 60 minutes of music. I could also put a media card in it to add songs. Both players fit neatly in the palm of a hand and on long runs I would take both so I could hear a change in music.



Eventually I got an mp3 player with a mini-hard drive that could hold tons of music, The Rio Nitrus. It worked great at first, but like everyone else that had this player it died about 2 days after it 90 day warranty expired.



I had a few other low cost mp3 players through the years, but eventually ended up with my first iPod: a mini. It worked great and held lots of music but I had to use an armband like this to run with it and after a year the battery died. I replaced the battery but that lasted less than a year. It is now plugged into my alarm clock to wake me up to tunes of my own choosing.



Finally I got an iPod shuffle. This mp3 player is perfect for running. I clip it onto my shorts and listen to music without feeling encumbered at all by the mp3 player. It worked great, but unfortunately it disappeared from my stuff while I was in Hawaii in April. I have run tuneless since then until I replaced it this week. I am happy to be back in the music. I have no apologies for running with an mp3 player. It is one of the few times I can listen to music during my day and after running for over 30 years, I need a little diversion. However the important rule about mp3 players is never use one during a race or while training with friends.

I had another good day of running and adjusting to the heel lift. Today I ran 8 miles, yesterday 12 miles, and Thursday 10 miles for 30 miles in 3 days and I felt great when finished with each run. My hips seem balanced side to side. My right hip doesn't dip down and back. My legs feel straighter although they are still adjusting and I am being careful about overdoing it (it doesn't sound like it- but I feel like running more than I have the last 3 days). I have about 1/4 to 3/8 of an inch lift in my right foot so the angles of my feet landing on the ground, my ankle, knees, and hips all have a different angles of motion and supporting my weight as I run. I would guess I would be having all sorts of problems if I wasn't on to something with the lift. I hope my stride keeps on making improvements and adjustments as I feel a new balance as I run.

The Olympic Track Trials in One Workout

I missed four days of running last week due to going to the Olympic Swimming Trails. When I came home Saturday night the heel lifts I had ordered had arrived. My left hip and left shoulder were off the whole time I was away so I was happy to try them out. I adjusted them by taking many layers off and put them in my shoe. I liked the feeling of balance. I woke up and wore them again and the tightness I had were gone. I had a very well balanced 8 mile run and felt good afterwards and the next morning.

Then I went in for a massage. It went well and I got looser. I had a very tight right ITB band and left hamstring. When I was done my hip was tight in a new way. I had lost the balance I had. Still I decided to do the 5k at night. This time I did a 4 mile warmup right to before the start of the race, but I was all off and my hip was not working. I had a horrible race and lumbered to a slow finish.

Then my hip was sore all night. I couldn't sleep and got up a few hours early. All day it was out of whack. I tried rolling the left adductor which was tight. It is hard to do but here are two clips on how to do it:





It helped ease a little tension, but not enough. I did Z-Health drills (no help), used a heating pad on my back (nothing), and although I was dressed to run I decided the hip still hurt so I decided to bike.

I got dressed for biking but then thought I'd go back to an earlier page on my blog where I had placed a web link that I intended to get to later. I decided it was later. I decided to take a closer look at the tibialus posterior tendon as explained here. This muscle can cause a flat pronated foot and knock knees. That is me!

I read it through and tried the strengthening exercises on my left side. That is the side where my knee knocks in. The exercise gave me an idea of what that muscle should be doing and the effect it should have on the functioning of the foot and knee. It lifted the arch up like the orthotics I had tried last month did artificially. I learned to push the knee out and what that felt like (actually like I felt the Z-Health knee circles should be doing-but aren't). I also felt I lot of tightness and work being done on the outside of my hip. After doing the exercises my muscles felt distracted enough that I though I'd try running, so it was back to putting on my running gear.



I tried running with some of the cues from the exercises I had done and it was tough but I was able to get a better alignment and feel. However since I only did the exercises on the left side, I found it hard to use the cues on the right side. After about 3 miles I started cuing in the right side and things were falling into place a bit. I was running and my stride was changing. I felt I was bearing the running load on the outside of the hip rather than on the inside like I normally do. I am sure I was only making minor movements toward straightening my knee-leg out. It started getting easier and flowing and I realized a good mental image would be to picture Gabe Jennings running the 1500 at the Olympic Trials. There is not a whole lot I care to emulate about Gabe Jennings and in particular his running style, but I put the image of his almost bow-legged running stride in my mind and used it to help keep my knees straight and because of that they were not buckling in.


It was all going well until all of a sudden I felt a sharp twinge at the inside bottom of my left heel. Bam I had to quickly adjust my stride, I felt like Tyson Gay pulling a muscle. Of course he was going fast when his hamstring went and he veered all over the track trying to stop. I was going slow and veered about 5 inches as I tried to adjust my stride and stop. I walked for a few minutes and got back to running but without such an effort to adjust that foot! Fortunately the pain did not reappear.



In the end I feel like Alan Webb. Last year he was fast and set the American record in the mile. This year he looks lost and confused without the stride he used to have. Of course Alan's worst day is still 5th best in the USA. I can't get my body working correctly and it too is confusing. The 5K's I am running are pathetic and I can't move my body properly. Sooner or later I hope to hit on the right combination of strategies and recover my stride. I will continue with the heel lifts and work more on those posterior tibialis strengthening exercises.

I hope you like the pictures of Gabe, Tyson, and Alan running in the Olympic Trials, because pictures of me trying to straighten my knees out, hobbling with a pain on the bottom of my foot, or racing last night would have been really horrible to look at!

More on Tibialis Posterior Dysfunction:
"The tibialis posterior tendon is the primary dynamic stabiliser of the medial longitudinal arch,6 and its contraction results in inversion and plantar flexion of the foot and serves to elevate the medial longitudinal arch, which locks the mid-tarsal bones, making the hindfoot and midfoot rigid.7 This later action allows the gastrocnemius muscle to act with much greater efficiency during gait. Without the tibialis posterior, the other ligaments and joint capsules gradually become weak, and thus flatfoot develops. Furthermore, without the tibialis posterior the gastrocnemius is unable to act efficiently, and therefore gait and balance are seriously affected." (from here)



Here is another look at the same exercise I did today from a Yoga perspective:
It says, "If you have a tendency toward flat feet and knock-knees, use an elastic exercise band to create the resistance...Even if you don’t have flat feet, this exercise will help you learn and practice good action in the feet. The essence of the exercise is to learn how to keep the inner heel and ball of the big toe grounded while lifting the arch, and not throw all of the weight to the outer edge of the foot.


Then the article describes a "wide-legged standing forward bend" that uses the same lifting of the arches by strengthening and lengthening the tibialis posterior. It says, that this stretch "is obviously a stretch to the hamstrings, but a big part of the stiffness that holds us back from fully expressing the pose comes from tight adductors. These inner thigh muscles pull the thighbones toward each other, tightening and even locking the hip joints. And you will find that what goes hand in hand with tight adductors is the inability of the tibialis posterior to keep the arches of the feet lifted." What I find interesting is I do have that tighntess of the adductors (particularly the left side) and this is the side where I have the most trouble with the knocked-knee and fallen arch and it was the first thing I thought of treating today!

Of the many sites I visited, these two suggest a stengthening of this tendon. The other doctor related sites suggest surgery, orthotics, or arch supports. This quote from the last site suggests why this is not the best strategy, "In the orthopedic world, what is often offered as a solution for fallen arches—particularly when they cause a knock-kneed condition—is support in the form of a lift or orthotics in the shoe. The artificial arch takes over the job of the tibialis posterior—and certainly the support is appreciated over the course of a long day as our feet get tired. Yet when the tibialis posterior is not working properly, a host of postural misalignments ensue, and some of them are not rectified by arch supports. With arch supports, changes do happen in the lower leg: the arch is lifted, and the shinbone of the lower leg (i.e., the tibia) rotates out from its base at the ankle, as it should. But not much changes in the thighbone: it remains inwardly rotated and, in the case of knock knees, adducted. This means that while the shin is now rotating out, the inner thigh muscles remain tight and pull the femur in toward the midline of the body, causing a twisting and grinding in the knee. It’s not enough to shore up the arches. This simply shifts the problem up the leg to the knee, where the twisting can damage the knee ligaments and cartilage. The solution, beginning with the tibialis posterior, has to involve the whole leg."