Building A Better Bumblebee

Ohhh.... the toe-bone's connected to the... foot bone!
The foot bone's connected to the... ankle bone!
The ankle bone's connected to th-...

Uh...

Connected to the...

the...

Damn. What the hell IS it connected to?

***

There is nothing quite like seeing the look in your new physical therapist's eyes when it begins to dawn on her just what she's getting herself into. It's an unmistakable mixture of amusement, curiosity, disbelief and horror. Sort of an, "Oh my God. How is this even possible?" sort of thing.

I've gotten used to the look; I've seen it enough times. But it still cracks me up.

I was back to the PT for the first time in years this morning about a month after I developed an overuse injury in my peroneal tendons that derailed my kinetic chain and left me unable to run - or barely even walk - without notable discomfort. I've accepted the fact that my June ultra is not going to happen, but I would very much like to get back out and run. I was making good progress before this happened.

Today was the evaluation day. The PT took my history, then watched me walk and run up and down the hallway ("Wow. There's so much motion going on there."), worked my foot joints ("I don't know if I've ever seen a foot do this before ... ") and checked my core strength (which was poor), my leg and foot strength (which was good) and whether I was recruiting other muscles (which, of course, I was). That's about when she got that look in her eyes, as she tried to figure out what to do about it.

What she decided to start with were some core-building moves (bridges, leg lifts, modified clamshells) and excruciatingly difficult exercises to activate and strengthen the muscles that invert and evert the ankle. It's excruciatingly difficult because I apparently have long been recruiting other muscles -- the wrong muscles -- to do the job. It takes a LOT of concentration to not pull my toes back and use the tendons in the top of my foot to "help."

The recruiting of improper muscles is one of my body's quirks -- it's not that uncommon, but I'm uncommonly "good" at it -- and it applies to more than just my ankles. She had to coach me through doing a bridge, so I don't cheat and use my quads, or back, or glutes rather than my lower abs. She also warned me that if 20 reps doesn't fatigue me, it means I'm doing it wrong.

We also talked about running. She'd rather I not run for the time being, until we get some muscle activation and strength built. Not so much because of injury, but because I'd likely revert to old habits and overwhelm any beneficial changes with my old compensations. I hate to admit it, but I think she's right.

She also said that I'll be needing more visits, because really, this is just scratching the surface. Again, no surprise there.

You'd think I'd be at least a little upset about this, but I'm really not. I've passed through a transition, and I accept that it's necessary. I've got a goal (stronger core, ankle and feet) and a means to get there. If I can achieve this, and I have no doubt that I can, it'll mean I'll end up stronger and more resilient for many years to come.

That's a very good thing.

Which all probably helps explain the title of this new blog.

So, that whole bumblebee thing. My faithful readers might remember that Flight of the Bumblebee was the title of my blog as I was getting ready for the Eugene Marathon back in 2010. I didn't manage to "Bee-Q" that time, but I set my current PR, so it was a pretty good outing.

One of the reasons for that success was probably all the extra work I'd done on my core in the months leading up to the race. I probably should have been more diligent in keeping my core conditioned in the four years since then, because core weakness is one of the main reasons I'm back with a PT. Oops.

Anyway, my recent encounters with bemused sports medicine docs and PTs reminded me of the seeming improbability of my success as a runner (hypermobile joints, odd foot structure and a tendency to use the wrong muscles to do the job), which naturally brought back memories of our good friend, the bumblebee.



The bumblebee can, of course, fly -- despite the old saying that it's aerodynamically impossible. It's just "surprisingly inefficient," according to this article from the University of Oxford.

Bumblebee flight ‘triumph of power over finesse’

"Our observations show that, instead of the aerodynamic finesse found in most other insects, bumblebees have adopted a brute force approach powered by a huge thorax and fueled by energy-rich nectar. This approach may be due to its particularly wide body shape, or it could have evolved to make bumblebees more maneuverable in the air at the cost of a less efficient flying style."

I'll just merrily skip past all the talk about wide body shapes (though I am rather fond of nectar) and focus on how a strong core (thorax, in the bee's case) powers wings that at first glance seem wholly inadequate to the task. Sound familiar?

A bumblebee may not be the most graceful creature, and it may work hard to do it -- but it gets the job done.

Mark love the story at the PT and the whole what is the ankle connected to!!! That put a little smile to my face. I remember the blog "Flight of the Bumblebee". Although I really don't think of you as one that is not "graceful" but I will say that over the years of following your blogs there is no doubt that you work hard to be the best you can. 

You have always been inspiring and your attention to being a student of the sport and your need of wanting to learn and gain more knowledge as always been a great thing for me to move forward with my only learning of the sport.

Here's to the return of the Bumblebee and may he be more graceful than past bees!

I will start my PT this coming week.
It won't be pretty either - at least I know my core is better than average. : )

Schuey wrote:Mark love the story at the PT and the whole what is the ankle connected to!!! That put a little smile to my face. I remember the blog "Flight of the Bumblebee". Although I really don't think of you as one that is not "graceful" but I will say that over the years of following your blogs there is no doubt that you work hard to be the best you can. 

You have always been inspiring and your attention to being a student of the sport and your need of wanting to learn and gain more knowledge as always been a great thing for me to move forward with my only learning of the sport.

Here's to the return of the Bumblebee and may he be more graceful than past bees!

Thanks, Schuey! I've been fascinated by the body and how it works, so I'm looking forward to what I learn this time.

And I guess being "graceful" is a matter of degree. It's not like I run into trees or anything (well, there was that time skiing, but I digress...), but I'm getting the impression that achieving an "effortless" running style might take more effort for me than others. Luckily, I was never gifted with perfect form to start with, so I don't know what I'm missing.

Case in point: When the PT was flexing my midfoot and marveling at how it could sort of flop over on itself like a swim flipper, I said, "You mean, everybody's foot doesn't do that?"

She said, "Uh, no."

Maybe at some point, grace isn't the most important thing. After all, some commentator once said that Emil Zatopek, one of the greatest runners of all time, ran "like a man wrestling with an octopus on a conveyor belt."  My kind of guy.

charles.moman wrote:I will start my PT this coming week.
It won't be pretty either - at least I know my core is better than average. : )

That's the understatement of the year, Charles. Your core earned a five-star (          ) crash rating.

Good luck on the PT. I have no doubt that you'll blow your therapists away with your determination and spirit.

Mark...I love the Bumblebee theme and I do remember your old blog.  That was shortly after I discovered how much help/support was available online.

Your story reminds me that I also need to get back to regular core work.  I feel it was a big part of my success last year and I kept up over the winter but I've really let it slide the last few weeks.  Thanks for the reminder.

Best of luck with your PT and your quest to build a better running you.

I think my Boston race so what a strong core will do for you.  Get on it!!!!

nkrichards wrote:Mark...I love the Bumblebee theme and I do remember your old blog.  That was shortly after I discovered how much help/support was available online.

Your story reminds me that I also need to get back to regular core work.  I feel it was a big part of my success last year and I kept up over the winter but I've really let it slide the last few weeks.  Thanks for the reminder.

Best of luck with your PT and your quest to build a better running you.

Hi, Nancy! I'm glad I can serve as a reminder to all of us that the core doesn't take care of itself. I'd convinced myself that trail running, with all its uneven surfaces, provided a sufficient core workout. Maybe it did help a bit when I was on the trails a lot, but I actually haven't been doing much trail running lately anyway, so... there's that. My sitting posture has gotten horrible. Even at this very moment, I'm all schlumped to one side.   

Michele \"1L" Keane wrote:I think my Boston race so what a strong core will do for you.  Get on it!!!!

Yes, ma'am!

I don't doubt that core strength helped your race in Boston, Michele. You looked strong and fast the whole race this year. It was great to see.

It seems to apply to me, as well. I was surprised when I looked back at my training logs and remembered that I was doing my PT/core work even during the taper week before Eugene 2010. I'd gotten a lot faster during that time, and I gave all the credit to low heart rate training. I'm now starting to realize that there was more to it than that.

Now, if I can just get my hands on Whitney's famous "Hips of Death" workout plan... I'd have more ways to torture myself once I get past the PT-mandated routines, which are more focused now on waking up the right muscles and getting them to work in proper sequence.

And with me being asked not to run for the next several weeks (probably more like a month), goodness knows I'm going to have plenty of time to really focus on my core.

***

One additional injury-related update. The sports medicine doctor and I had talked about eventually getting an MRI of my right foot -- not necessarily to deal with this injury (she seriously doubts there's any bone issue going on) but to see what's going on in there. The slow pace of healing has me worried that something IS wrong in there, so I asked if we could do it sooner rather than later. She agreed.

The funny thing is, as I've started the ankle exercises, I've noticed a bit less discomfort in my foot. I guess that working to strengthen the tibialis posterior muscle has the effect of gradually stretching out the peroneal muscles, which is the source of my issue.

Pero-what? Tibialawhatsis?

Okay, a quick anatomy guide to what's going on with my leg.

First off, the offended party: the peroneus/fibularis muscles. (Mostly the peroneus longus, but brevis ain't exactly happy, either.)


(Yes, some people call them the peroneal muscles; others call them the fibularis muscles. Potato, po-tah-to.)

They're the muscles that live in that groove between your calf muscles and the main bone in your shin on the lateral side of your lower leg. They're hugely important in plantarflexing your ankle (pushing off, pointing your toes) and everting (pivoting from in to out) your ankle joint. They're a big part of the stability system. And they're mad at me.

The peroneuses' partner in this dance are the tibialis muscles. As best as I understand it, THEY are the ones that are the root of the problem.



The tibialis muscle group has two parts. The first, tibialis anterior, runs down the front of your leg and goes in front of the bony protrusion on the inside of your ankle called the medial malleous. It helps dorsiflex your ankle (lifting up your forefoot) and invert your ankle (pivoting from out to in).

The second part, the tibialis posterior, runs down the back of your leg, behind the medial malleous and connects to the underside of the foot. It also helps invert your ankle but it plantarflexes your foot (extending your forefoot, in opposition to what tibialis anterior does) and as such is critical for arch support and ankle stability. And on me, it's hardly working at all.

Gah! So much terminology.

Here's the difference between eversion and inversion, visually:



And plantarflexion vs. dorsiflexion:



What I tend to do is overuse the tibialis anterior muscle (in the front of my leg)  -- I can tell, because I can see the tendon pop up when I try to invert my ankle -- which makes this first round of PT so challenging, because I have to concentrate enough to isolate a muscle I hardly realized existed until last week! It probably also helps explain why it's so easy to dorsiflex my feet and toes, and so difficult to plantarflex. The system is totally out of balance.

I'm not complaining, though. I've known for a long time that my ankles were weak, but I've never known exactly why. The exercises I've done before never quite did the job -- most likely because I wasn't using all the muscles I needed to make those exercises work. Until now.

A big PT day today, since I can't go out and do a long run.

Here's what they have me doing:

- Modified clamshells to work the glute med. Usually, you do the clamshells with your feet touching. My PT has me raising my foot, too. 20 reps.
- Side leg lifts (from my old PT regimen), working the glute med from a slightly different angle. 20 reps.
- Side leg circles (again, from my old PT regemin), working the glute med and glute min. 20 reps.

By the time I get to the end, I can really feel the burn.

Also:
-Bridges, making sure to squeeze the abs and minimize the distance between the top of my pelvis and ribcase. 20 reps (holding 5 seconds each rep)

Not much of a "burn" for this exercise, though as I sit here, I can feel my abs slightly quivering.

And, of course:
-Theraband work everting and inverting the ankle, using the opposite leg as a fulcrum to hold the band and making sure to note recruit other muscles. 20 reps each way.

No burn on the theraband work (which kind of concerns me), but it takes a lot of concentration to do it right.

I did one session this morning. I'll do another tonight when Alita gets home. She wants to do the core work with me. She also just volunteered to take part in the big Portland to Coast walk this summer (it's part of the Hood to Coast extravaganza) to help out a coworker's team and give her something to work toward as motivation.

No scenic photos at the moment, but I can share what the theraband exercises look like...



The first photo shows the exercise for the peroneal tendons. My goal is to point my foot and then evert it (rotating outward away from my body's midline). It doesn't move much that direction, so it's tricky getting a sense of this move.




The second photo (using my uninjured foot as an example), shows how I'm supposed to work my tibialis posterior, by inverting my ankle (rotating inward toward my body's midline) while keeping my foot pointed. That's tricky, but it's getting a little easier.

What makes it a bit more complicated is using the opposite foot as a fulcrum on the theraband. It's a nice challenge for my coordination.

Mark B wrote:No scenic photos at the moment, but I can share what the theraband exercises look like...



The first photo shows the exercise for the peroneal tendons. My goal is to point my foot and then evert it. It doesn't move much that direction, so it's tricky getting a sense of this move.




The second photo (using my uninjured foot as an example), shows how I'm supposed to work my tibialis posterior, by inverting my ankle while keeping my foot pointed. That's tricky, but it's getting a little easier.

What makes it a bit more complicated is using the opposite foot as a fulcrum on the theraband. It's a nice challenge for my coordination.

I was doing those, plus others, last Fall.  So, I guess I'm faster than you right now.   

ounce wrote:

Mark B wrote:No scenic photos at the moment, but I can share what the theraband exercises look like...



The first photo shows the exercise for the peroneal tendons. My goal is to point my foot and then evert it. It doesn't move much that direction, so it's tricky getting a sense of this move.




The second photo (using my uninjured foot as an example), shows how I'm supposed to work my tibialis posterior, by inverting my ankle while keeping my foot pointed. That's tricky, but it's getting a little easier.

What makes it a bit more complicated is using the opposite foot as a fulcrum on the theraband. It's a nice challenge for my coordination.

I was doing those, plus others, last Fall.  So, I guess I'm faster than you right now.   

Yes, and stronger, too! At least, I hope so. Did you notice a difference?

It's one of those things that you don't see an improvement because the muscles are so small, so you hope the sum total of the exercises does accomplish something.  I can say that I haven't had a sprained ankle since 2005, when I sprained it and got some PT for it.  I've been working on balance (most consistently with just lifting one foot and balancing) and I still do a few of the exercises during meetings, under the table, that I was doing last Fall.

ounce wrote:It's one of those things that you don't see an improvement because the muscles are so small, so you hope the sum total of the exercises does accomplish something.  I can say that I haven't had a sprained ankle since 2005, when I sprained it and got some PT for it.  I've been working on balance (most consistently with just lifting one foot and balancing) and I still do a few of the exercises during meetings, under the table, that I was doing last Fall.

I could imagine how working those muscles is more a matter of control than power. Still, that counts for a lot. The proper support from these secondary muscles can improve balance and reduce the risk of ankle sprains, but it may also help put your joints in the right position to get the greatest oomph out of your stronger muscles. Sort of like hitting the sweet spot. I'd be totally up for that.

Just be careful during those meetings, lest somebody think you're playing footsie down there.

Hey Mark, I am glad to see that you brought the bumblebee analogy back. I like it!! I also think that you are going about this the right way, in making sure that old habits are broke and everything is right before going back to running. You are seeking out and fixing the root of the issue instead of just patching things to keep going. Before you know it you will be back to running and be better for it. You'll be a brand new Mark

Nick Morris wrote:Hey Mark, I am glad to see that you brought the bumblebee analogy back.  I like it!!  I also think that you are going about this the right way, in making sure that old habits are broke and everything is right before going back to running.  You are seeking out and fixing the root of the issue instead of just patching things to keep going.  Before you know it you will be back to running and be better for it.  You'll be a brand new Mark

But can we handle that???     

Nick Morris wrote:Hey Mark, I am glad to see that you brought the bumblebee analogy back.  I like it!!  I also think that you are going about this the right way, in making sure that old habits are broke and everything is right before going back to running.  You are seeking out and fixing the root of the issue instead of just patching things to keep going.  Before you know it you will be back to running and be better for it.  You'll be a brand new Mark

Thanks, Nick! I sure hope you're right. Over the years, it has seemed to me that there was a stronger, smoother (and sure, faster) runner trying to get out of me, but I was never able to find the key. Maybe this is it? That'd be very cool.

ounce wrote:

Nick Morris wrote:Hey Mark, I am glad to see that you brought the bumblebee analogy back.  I like it!!  I also think that you are going about this the right way, in making sure that old habits are broke and everything is right before going back to running.  You are seeking out and fixing the root of the issue instead of just patching things to keep going.  Before you know it you will be back to running and be better for it.  You'll be a brand new Mark

But can we handle that???     

Oh, stop. You're making me blush.

Mark B wrote:

ounce wrote:It's one of those things that you don't see an improvement because the muscles are so small, so you hope the sum total of the exercises does accomplish something.  I can say that I haven't had a sprained ankle since 2005, when I sprained it and got some PT for it.  I've been working on balance (most consistently with just lifting one foot and balancing) and I still do a few of the exercises during meetings, under the table, that I was doing last Fall.

I could imagine how working those muscles is more a matter of control than power. Still, that counts for a lot. The proper support from these secondary muscles can improve balance and reduce the risk of ankle sprains, but it may also help put your joints in the right position to get the greatest oomph out of your stronger muscles. Sort of like hitting the sweet spot. I'd be totally up for that.

Just be careful during those meetings, lest somebody think you're playing footsie down there.

Well, but it's just not the secondary muscles of the lower leg, it's the adductors, abductors, core, glutes, the balance in the quads vs hamstrings, neck, etc.  I would guess a metaphor would be that a full orchestra sounds better than a couple of pieces and can play longer.

ounce wrote:

Nick Morris wrote:Hey Mark, I am glad to see that you brought the bumblebee analogy back.  I like it!!  I also think that you are going about this the right way, in making sure that old habits are broke and everything is right before going back to running.  You are seeking out and fixing the root of the issue instead of just patching things to keep going.  Before you know it you will be back to running and be better for it.  You'll be a brand new Mark

But can we handle that???     

Good question!!

Nick Morris wrote:

ounce wrote:

Nick Morris wrote:Hey Mark, I am glad to see that you brought the bumblebee analogy back.  I like it!!  I also think that you are going about this the right way, in making sure that old habits are broke and everything is right before going back to running.  You are seeking out and fixing the root of the issue instead of just patching things to keep going.  Before you know it you will be back to running and be better for it.  You'll be a brand new Mark

But can we handle that???     

Good question!!

Well, remember, no matter how much you restore the suspension and tighten up all those rattly connections in the chassis, we're still dealing with something more like a '63 Falcon than a '63 Corvette Sting Ray.

So I think you're safe.

ounce wrote:

Mark B wrote:

ounce wrote:It's one of those things that you don't see an improvement because the muscles are so small, so you hope the sum total of the exercises does accomplish something.  I can say that I haven't had a sprained ankle since 2005, when I sprained it and got some PT for it.  I've been working on balance (most consistently with just lifting one foot and balancing) and I still do a few of the exercises during meetings, under the table, that I was doing last Fall.

I could imagine how working those muscles is more a matter of control than power. Still, that counts for a lot. The proper support from these secondary muscles can improve balance and reduce the risk of ankle sprains, but it may also help put your joints in the right position to get the greatest oomph out of your stronger muscles. Sort of like hitting the sweet spot. I'd be totally up for that.

Just be careful during those meetings, lest somebody think you're playing footsie down there.

Well, but it's just not the secondary muscles of the lower leg, it's the adductors, abductors, core, glutes, the balance in the quads vs hamstrings, neck, etc.  I would guess a metaphor would be that a full orchestra sounds better than a couple of pieces and can play longer.

And that the orchestra always sounds 100 percent better if the oboe player ever finds itself in the same key as the rest of the ensemble. One small piece can make a big difference, (Warning: Metaphor switch-up!) like those lug nuts that keep the wheels from falling off...

Mark B wrote:

ounce wrote:

Mark B wrote:

ounce wrote:It's one of those things that you don't see an improvement because the muscles are so small, so you hope the sum total of the exercises does accomplish something.  I can say that I haven't had a sprained ankle since 2005, when I sprained it and got some PT for it.  I've been working on balance (most consistently with just lifting one foot and balancing) and I still do a few of the exercises during meetings, under the table, that I was doing last Fall.

I could imagine how working those muscles is more a matter of control than power. Still, that counts for a lot. The proper support from these secondary muscles can improve balance and reduce the risk of ankle sprains, but it may also help put your joints in the right position to get the greatest oomph out of your stronger muscles. Sort of like hitting the sweet spot. I'd be totally up for that.

Just be careful during those meetings, lest somebody think you're playing footsie down there.

Well, but it's just not the secondary muscles of the lower leg, it's the adductors, abductors, core, glutes, the balance in the quads vs hamstrings, neck, etc.  I would guess a metaphor would be that a full orchestra sounds better than a couple of pieces and can play longer.

And that the orchestra always sounds 100 percent better if the oboe player ever finds itself in the same key as the rest of the ensemble. One small piece can make a big difference, (Warning: Metaphor switch-up!) like those lug nuts that keep the wheels from falling off...

Oh, I can come up with a million car-related metaphors like, a wheel lacking a 1 ounce wheel weight can make the whole car shutter.

Mark B wrote:

Nick Morris wrote:

ounce wrote:

Nick Morris wrote:Hey Mark, I am glad to see that you brought the bumblebee analogy back.  I like it!!  I also think that you are going about this the right way, in making sure that old habits are broke and everything is right before going back to running.  You are seeking out and fixing the root of the issue instead of just patching things to keep going.  Before you know it you will be back to running and be better for it.  You'll be a brand new Mark

But can we handle that???     

Good question!!

Well, remember, no matter how much you restore the suspension and tighten up all those rattly connections in the chassis, we're still dealing with something more like a '63 Falcon than a '63 Corvette Sting Ray.

So I think you're safe.

I always like the Chevy Nova...which translates in spanish to "It doesn't go"

ounce wrote:

Mark B wrote:

ounce wrote:

Mark B wrote:

ounce wrote:It's one of those things that you don't see an improvement because the muscles are so small, so you hope the sum total of the exercises does accomplish something.  I can say that I haven't had a sprained ankle since 2005, when I sprained it and got some PT for it.  I've been working on balance (most consistently with just lifting one foot and balancing) and I still do a few of the exercises during meetings, under the table, that I was doing last Fall.

I could imagine how working those muscles is more a matter of control than power. Still, that counts for a lot. The proper support from these secondary muscles can improve balance and reduce the risk of ankle sprains, but it may also help put your joints in the right position to get the greatest oomph out of your stronger muscles. Sort of like hitting the sweet spot. I'd be totally up for that.

Just be careful during those meetings, lest somebody think you're playing footsie down there.

Well, but it's just not the secondary muscles of the lower leg, it's the adductors, abductors, core, glutes, the balance in the quads vs hamstrings, neck, etc.  I would guess a metaphor would be that a full orchestra sounds better than a couple of pieces and can play longer.

And that the orchestra always sounds 100 percent better if the oboe player ever finds itself in the same key as the rest of the ensemble. One small piece can make a big difference, (Warning: Metaphor switch-up!) like those lug nuts that keep the wheels from falling off...

Oh, I can come up with a million car-related metaphors like, a wheel lacking a 1 ounce wheel weight can make the whole car shutter.

And that's a pretty good way to describe it. Small issue has a big impact.

Nick Morris wrote:

Mark B wrote:

Nick Morris wrote:

ounce wrote:

Nick Morris wrote:Hey Mark, I am glad to see that you brought the bumblebee analogy back.  I like it!!  I also think that you are going about this the right way, in making sure that old habits are broke and everything is right before going back to running.  You are seeking out and fixing the root of the issue instead of just patching things to keep going.  Before you know it you will be back to running and be better for it.  You'll be a brand new Mark

But can we handle that???     

Good question!!

Well, remember, no matter how much you restore the suspension and tighten up all those rattly connections in the chassis, we're still dealing with something more like a '63 Falcon than a '63 Corvette Sting Ray.

So I think you're safe.

I always like the Chevy Nova... which translates in Spanish to "It doesn't go"

As much as I love that story, I am sorry to say that it apparently isn't actually, you know, factual.

(Thanks to those pesky killjoys at Snopes.com.)