Building A Better Bumblebee

Be sure to get them to burn you CD of the test.  They might be able to upload it, so the doc can see it digitally, but it's nice to have a hard copy in case another doctor wants to see it.  I have found that NO doctor reads a report from another doctor and trusts it implicitly.

Good luck on the results.

Since I don't have my own blog right now (not running much will do that to a guy), I'm going to hijack yours to talk about my injury since that's what all the cool kids are doing.

I got into the PT today and have discovered that I, like you, seem to have an ever moving deficiency that will continue to pester me. It just picks whatever happens to be the weak point at that particular time and once I fix that, it moves onto the next. Hopefully I'll run out of deficiencies soon! This time around it's the tensor fascia latae that's causing the problem after previous episodes with the piriformis and iliopsoas (why do all these things have such tongue twisting names?).

So, I too am sort of sidelined by PT and in a holding pattern, which will likely result in no fall marathon for me this year. All this to say, I know how you feel right now and man do injuries suuuuuuuuuuck!

ounce wrote:Be sure to get them to burn you CD of the test.  They might be able to upload it, so the doc can see it digitally, but it's nice to have a hard copy in case another doctor wants to see it.  I have found that NO doctor reads a report from another doctor and trusts it implicitly.

Good luck on the results.

Interesting idea. Not sure if they do it in my health system, but it can't hurt to ask.

mul21 wrote:Since I don't have my own blog right now (not running much will do that to a guy), I'm going to hijack yours to talk about my injury since that's what all the cool kids are doing.

I got into the PT today and have discovered that I, like you, seem to have an ever moving deficiency that will continue to pester me.  It just picks whatever happens to be the weak point at that particular time and once I fix that, it moves onto the next.  Hopefully I'll run out of deficiencies soon!  This time around it's the tensor fascia latae that's causing the problem after previous episodes with the piriformis and iliopsoas (why do all these things have such tongue twisting names?).

So, I too am sort of sidelined by PT and in a holding pattern, which will likely result in no fall marathon for me this year.  All this to say, I know how you feel right now and man do injuries suuuuuuuuuuck!

Feel free to post away, Jim... but since when did *not running* ever manage to shut me up? As a matter of fact, this is just about the only release available for my chronic case of energy constipation. So bring it on!

As far as your injury (boo!) goes, I hope you have a PT who wants to get to the root of the problem. The problems you're having are just the symptoms of something else that's going on. It might take a while to piece together, but a good PT can do it. (I'd note that core weakness might be one of the possible causes of all of those problems you mention above.) Good luck!

Mark B wrote:

ounce wrote:Be sure to get them to burn you CD of the test.  They might be able to upload it, so the doc can see it digitally, but it's nice to have a hard copy in case another doctor wants to see it.  I have found that NO doctor reads a report from another doctor and trusts it implicitly.

Good luck on the results.

Interesting idea. Not sure if they do it in my health system, but it can't hurt to ask.

mul21 wrote:Since I don't have my own blog right now (not running much will do that to a guy), I'm going to hijack yours to talk about my injury since that's what all the cool kids are doing.

I got into the PT today and have discovered that I, like you, seem to have an ever moving deficiency that will continue to pester me.  It just picks whatever happens to be the weak point at that particular time and once I fix that, it moves onto the next.  Hopefully I'll run out of deficiencies soon!  This time around it's the tensor fascia latae that's causing the problem after previous episodes with the piriformis and iliopsoas (why do all these things have such tongue twisting names?).

So, I too am sort of sidelined by PT and in a holding pattern, which will likely result in no fall marathon for me this year.  All this to say, I know how you feel right now and man do injuries suuuuuuuuuuck!

Feel free to post away, Jim... but since when did *not running* ever manage to shut me up? As a matter of fact, this is just about the only release available for my chronic case of energy constipation. So bring it on!

As far as your injury (boo!) goes, I hope you have a PT who wants to get to the root of the problem. The problems you're having are just the symptoms of something else that's going on. It might take a while to piece together, but a good PT can do it. (I'd note that core weakness might be one of the possible causes of all of those problems you mention above.) Good luck!

maybe we need to create a Core thread?  We all have our own special links for core work and the myriad of you tube links, too.

As far as the CD, Mark, it's part of your medical records that you have access to.  They burn CD's all the time, and since you just had it done, it shouldn't take long to find it in the computer and burn it.  It's really easy.  And it shouldn't cost you a nickel.  Give it a whirl.

Oh, we know what the root of the problem is. It's a right leg that has decided to grow about a half inch longer than the left, putting an undue amount of stress on my whole hip/glute region. There really is no permanent fix other than addressing the issues as they pop up and trying to strengthen the area enough that it's a bit more resistant to failure.

ounce wrote:Maybe we need to create a Core thread?  We all have our own special links for core work and the myriad of you tube links, too.

As far as the CD, Mark, it's part of your medical records that you have access to.  They burn CD's all the time, and since you just had it done, it shouldn't take long to find it in the computer and burn it.  It's really easy.  And it shouldn't cost you a nickel.  Give it a whirl.

Interesting idea about a core thread. I know there are lots of folks out there who have useful core routines. It might be good to get them all in one spot.

I'll have to ask on the records. Just for my own curiosity, I'd love to see what the scans look like.

mul21 wrote:Oh, we know what the root of the problem is.  It's a right leg that has decided to grow about a half inch longer than the left, putting an undue amount of stress on my whole hip/glute region.  There really is no permanent fix other than addressing the issues as they pop up and trying to strengthen the area enough that it's a bit more resistant to failure.

Oh, yeah. That'd cause problems. It's a structural leg-length discrepancy, not functional, right? Have they ever talked about different shoe stack heights for each leg? The difference isn't so huge that it'd be too weird. Not like, say, a Hoka on one foot and a VFF on the other.   

Back from today's session with the PT, and it's got me more pensive than usual.

The PT had access to the radiologist's report from the MRI. It found signs of a bunch of different things, all related to the peroneal tendon where it wraps around the foot and attaches. The MRI showed signs of inflammation in the sheath around the tendon (tenosynovitis if you like the big word version), some damage to the tendon itself (tendinosis) and some sort of a ganglion, which can't be a good thing.




(I think the swelling was more around the sole of the foot, but I won't know for sure until I get the official report.)

And this was all detected after more than a month of near total rest. Sheesh. How bad was it a month ago?

The upside? No stress fracture, no bone marrow edema or anything like that -- unless you count early indicators of future arthritis in that jumble of bones and joints that are my feet, of course. But that doesn't seem to surprise anybody.

It'll be interesting to get the sport medicine doctor's take on this after she reviews the report, but my PT watched me run down the hallway and is theorizing that I'm landing too far on the outside of my foot and taking a huge load on my peroneal tendons as the rest of my foot rotates down to make ground contact. I asked if she thought this was something that could have developed quickly -- due to the defective shoes, for instance -- or something that had been building up for years... and she said she really couldn't tell.

She's also not sure what to do about it, because it seems so ingrained in my basic biomechanics. She mentioned that maybe she'd suggest something to provide more support, but then backed off that when I mentioned how "support" shoes I've tried before only reinforced that outer edge landing. There's so much motion going on in my feet, it's hard to know what'll help.

I'd be lying if this hasn't made me wonder about what I've been doing for the past few years. Less about the barefoot component, per se, as the whole notion of shifting from a heel-strike to more of a mid- to forefoot landing to save my foot joints. That involves barefooting, zero drops, denser midsoles... pretty much everything I've been doing lately. Correlation? Causality? I just don't know. And she doesn't, either.

She did give me more exercises, after discovering just how weak my calf muscles are. She tried to have me go on my tip-toes on one leg, said "Wait. That's it?" and had me try with both legs, then had me try it while supporting part of my weight on something. "Ah! Okay, so it is possible. You're just weak." Then she had me doing lots and lots of two-legged raises, concentrating on maintaining perfect form from the bottom of my foot all the way up to my abs, before I'll be ready to try it on one foot.

Her idea is, at the very least, strengthening the proper muscles could improve mechanics and avoid injury - and maybe even improve performance.

Finally, she cleared me to begin a  v-e-r-y  slow reintroduction of jogging/walking. As in, starting with 0.1 mile walking, then 0.1 mile jogging. Repeat 10 times. Rest two days. Then, if there's no pain after several cycles of this, increase the jogging portion to 0.2 miles. No more than 2 miles at any time. Not much, to be sure, but at least it's something.

Amazing!

Now you know that folks have sued and won against Vibram - so who knows.

Michele \"1L" Keane wrote:Amazing!

Now you know that folks have sued and won against Vibram - so who knows.

Not sure what's amazing, other than my lack of arse and calf muscles...  

If there was a long-term cause to this problem, I'd say the most likely suspect is my decision a couple of years ago to shift to a more mid foot to forefoot landing. I did it without any specific lower leg conditioning (I thought it'd take care of itself. Bzzt!) that might have helped me not overload my peroneal muscles.

There's another possibility: that maybe my body's peculiar construction can't handle a mid foot or forefoot landing, and that I've been wasting my time for the past two years. That's what I fear, but there are far too many very reasonable (if difficult) things I can do to build the strength to possibly make it work, so I'm not ready to throw in the towel yet.

Now, I never wore VFFs -- I didn't trust them to give the necessary ground feedback to prevent overuse injuries -- but in fairness, I must note that the lawsuit only accused Vibram of making health claims without the studies to back it up. They were NOT sued for causing injury. That's an important distinction, and it's lost on many of the writers/bloggers out there who are all too happy to dog pile on the funny-looking shoe that challenged conventional wisdom.

It would seem to me that Oregon Coast 50K is not in the cards, this year.  But I don't know nuffin'. 

I read your post -- took a break before posting knowing your affinity for barefoot running -- and now I'm back with the comment.

First, the non heretical comment:  when I had PT I had to do calf raises till the cows came home. 

Second, dare I say -- custom orthotics?  -- hey someone had to day it.

Sorry it seems like a long slow slow road back.

ounce wrote:It would seem to me that Oregon Coast 50K is not in the cards, this year.  But I don't know nuffin'. 

I'm not ready to say that yet, Ounce. I guess we'll see when the sports medicine doctor reviews the report and gets back to me. It all depends on just how significant those scary-sounding findings are, how much damage was done, and what it'll take to heal it up properly. It might be only a little. It could be a lot, too, but I'm keeping my fingers crossed.

Dave Wolfe wrote:I read your post -- took a break before posting knowing your affinity for barefoot running -- and now I'm back with the comment.

First, the non heretical comment:  when I had PT I had to do calf raises till the cows came home. 

Second, dare I say -- custom orthotics?  -- hey someone had to day it.

Sorry it seems like a long slow slow road back.

First: I've got chicken legs. I've always known that. It only seemed to limit my vertical in basketball and my running speed, but maybe it's more important than I thought. So I guess these chicken legs will be put to work until the cows come a'knocking.

Second: Heretic! (Kidding!) I actually used to HAVE custom hard-shell orthotics, but they and the "motion control" shoes I tried afterwards tended to cause more problems for me by making me run more on the outside edge of my foot and causing all sorts of problems up the kinetic chain.

Switching away from an engineered solution and trying to strengthen my body instead led to a reduction in injuries and improvement in performance. This may just be the next step in that process. Hope so, anyway.

I guess we'll find out how long and slow this road is. Like I told Ounce, I'm not ready to surrender.

Resolutely, I face the future.

Or, at least, the kitchen counter.

Okay. Feet apart, hip tucked under, abs engaged, butt working, pressure on first and second metatarsal...

Time for the hated calf raise.

... and UP! Remember to *not* twist the heel around! Oop! Keep that foot straight! And is the butt really engaging? How high up are you? Is that it?!

Just about the most dreaded PT exercise.

... and DOWN. Slowly! Keep everything in track.

Okay, that's one. Ow. Now I just need to keep doing them until I can't do them anymore.

Which, this morning, at least, felt like about six of them. Geez. Really? With BOTH legs?

Really. I pressed on, struggling up to 10, then I rested a couple of minutes, did another 10, then repeated the cycle. But I kept catching myself holding my breath while I did them, and I could tell that my heels were a *lot* less high off the ground for those last 10. I'm supposed to do these sets to failure two to three times per day (this time, Ounce, the weightlifting rules apply).

It's shocking to me that my calves could be so weak, and that I was still able to run long-long distances, climb stairs and mountains and otherwise explore the planet without any real trouble. I asked my PT how I was able to manage it, and she said she hadn't the faintest idea, but I clearly did.

Anyway, these #@$! heel lifts -- again, with BOTH legs pushing, not just one -- feel like the lower body equivalent of pull-ups. And the strain/pain wasn't just in my calves (though they felt it a lot) -- it was in my feet, as well, from my toe knuckles on up. I suppose that the foot muscles that work in conjunction with my barely functioning gastroc and soleus would necessarily be weak, too, so it's logical. But still. Ow!

Upside of this, of course, is what might result from all the hard work to come. Maybe my peroneals have been overworked because they was being recruited to do what the calf muscles normally do. Maybe getting strong down there -- from the sole of my foot to the meat of my calves -- will let me bound, gazelle-like, over hill and dale, skipping off the tops of boulders and the like. Well, whether it does or not, it's an image I can keep in my head as I slowly grind away, up and down.

Mark, when I used to lift weights I could never get the form right for calf raises. The only thing that ever helped build calf strength for me was running. Go figure. You are on the right track and as you keep doing them the difficulty of doing them with 2 legs will become but a memory.

Love Dave's comment - orthotics.  I must say that I have always said that I don't want to mess with my natural stride and the only thing that I do is wear orthotics but I have also wore arch supports in my street shoes (all but dressy or sandals) since I was in my early 20s and had to spend a lot of time in the day on my feet (I worked as a plant engineer then).  What I have noticed with core strength and exercise (lifting, core exercises, etc.) over the last few years is that my stride is much more efficient than it was and I do not throw out my right lower leg like I did for years.  I also do squats without my knees collapsing in like it is no problem.  As for calf raises, I guess I've done them for years and never realized how much I was helping myself!

Jim Lentz wrote:Mark, when I used to lift weights I could never get the form right for calf raises. The only thing that ever helped build calf strength for me was running. Go figure. You are on the right track and as you keep doing them the difficulty of doing them with 2 legs will become but a memory.

Thanks, Jim! It's amazing how tricky this can be, but I guess it makes sense if the habits of my body have always put minimal stress on those calf muscles. When I try to fire 'em up, all the other structures of the body are left going, "Huh? What?" It's a little alarming. It'll be nice to be able to look back at this transition period and chuckle at my initial reactions.

Michele \"1L" Keane wrote:Love Dave's comment - orthotics.  I must say that I have always said that I don't want to mess with my natural stride and the only thing that I do is wear orthotics but I have also wore arch supports in my street shoes (all but dressy or sandals) since I was in my early 20s and had to spend a lot of time in the day on my feet (I worked as a plant engineer then).  What I have noticed with core strength and exercise (lifting, core exercises, etc.) over the last few years is that my stride is much more efficient than it was and I do not throw out my right lower leg like I did for years.  I also do squats without my knees collapsing in like it is no problem.  As for calf raises, I guess I've done them for years and never realized how much I was helping myself!

Hey, Michele! I don't want to give the impression that I think orthotics are the devil's tool, or that they aren't incredibly important for some people. They can be incredibly helpful. If people need orthotics, they need them. Goodness knows, they sure haven't had a negative impact on your success as a runner. As for me, it's less clear. I've had docs, podiatrists and PTs initially consider the thought of some sort of extra support, only to back off after getting a closer look at how my foot moves.

Even so, it is interesting to me that you mention how important it is for you to keep your natural stride and only using orthotics, because my perception of orthotics is of something that fundamentally changes your natural stride -- imposing a certain path of movement through artificial means. To me, it seems preferable to teach the body to find its optimum stride -- more refining your natural stride than changing it. That may not always be possible, and it may not be possible for me, either. I guess time will tell.

One thing that clearly seems to help is the strength work. Who knows what this body of mine will do when it has fully functioning calves, stable hips and strong ankles and feet? I'm sure it'll be quite confused, and probably irritated that it took me so long to get a clue.

Interesting - all my orthotics do is provide arch support and that is it.  I pronate and have worn an arch support in my regular shoes forever.  I think I started wearing them back in high school when I was first diagnosed with scoliosis (I also have one hip that is slightly higher).  I just found that controlling the pronation was the trick for me.  When I run barefoot now (on the treadmill), I find that my stride isn't really any different from when I put on my running shoes with the orthotics (have been videoed both ways).  Now - I think that has a lot to do with all the strengthening that I have been doing for the past few years and my final commitment to it as a part of my running life.  I also have not had any real injuries in the last few years related to the areas that I have strengthened.  Now I have some lower back issue and hamstring tightening like the rest of them, but I now know how to catch it when things are tight and how to "fix" - at least for now.  

I was referring primarily to changing foot strike which I have not done and is no different whether I am barefoot or with shoes and orthotics on.

Michele \"1L" Keane wrote:Interesting - all my orthotics do is provide arch support and that is it.  I pronate and have worn an arch support in my regular shoes forever.  I think I started wearing them back in high school when I was first diagnosed with scoliosis (I also have one hip that is slightly higher).  I just found that controlling the pronation was the trick for me.  When I run barefoot now (on the treadmill), I find that my stride isn't really any different from when I put on my running shoes with the orthotics (have been videoed both ways).  Now - I think that has a lot to do with all the strengthening that I have been doing for the past few years and my final commitment to it as a part of my running life.  I also have not had any real injuries in the last few years related to the areas that I have strengthened.  Now I have some lower back issue and hamstring tightening like the rest of them, but I now know how to catch it when things are tight and how to "fix" - at least for now.  

I was referring primarily to changing foot strike which I have not done and is no different whether I am barefoot or with shoes and orthotics on.

Ah. I can see why they prescribed orthotics for you back in the day. The rest of your mechanics must have been fantastic, given how well you've done as a runner. It doesn't surprise me that you don't notice a stride difference in and out of shoes now, either. With all the strength work you've done, they might be less important than they were a long time ago. Not that I'm suggesting you give them up. I'm not. No need messing with a system that works!

I've experimented with form because I have never been particularly coordinated, and I never had the chance to learn optimum form. My system never really worked. I could move, but my legs moved a lot like eggbeaters, and my heel-to-toe energy movement was more a zig-zag than a direct line. I'd put so much torque on my shoes with my foot motion that I've actually torn the heel off the midsole.   

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Speaking of calf weakness... you want to know just how weak they are? Here's an example. Once the PT saw I could actually go up on my toes using both feet and with my weight supported slightly, she had me try standing facing the wall, raised up on both legs. Then, she had me lift up my left foot -- with the idea that I'd slowly lower myself down on the right foot, building eccentric strength.

What actually happened?

Thunk.

The right foot collapsed in a fraction of a second. I could barely slow it down.

"Wow. Really?" she said.

Yeah. Really.

I'm right there with "Wow - really" - Really????  I do single leg calf raises all the time.

And I've not given up the orthotics for fear of giving up something that works.

Michele \"1L" Keane wrote:I'm right there with "Wow - really" - Really????  I do single leg calf raises all the time.

And I've not given up the orthotics for fear of giving up something that works.

Amazing, huh? Well, it's normal for me. Try to imagine running without using your calf muscles. (Just don't try it; you'll hurt yourself.) I asked the PT how I've been able to run this way for so long, and she got this mystified look on her face. Clearly, I've done it, but how is a bit of a mystery. The best she could say is that, once I get these calf muscles built up, I'll likely put less strain on these smaller support muscles like the peroneals -- and maybe even be able to run faster than before. I could live with that.

I can see why you've kept the orthotics. If I were in your place, I would, too. If it ain't broke, don't fix it.

Here's something I never thought I'd recommend since I absolutely despise them, but here goes. I hopped on an elliptical the other night since I'm kind of limited running wise and my calves have been sore ever since. That might be a good way of getting them strengthened without overworking anything else since it's such low impact.

mul21 wrote:Here's something I never thought I'd recommend since I absolutely despise them, but here goes.  I hopped on an elliptical the other night since I'm kind of limited running wise and my calves have been sore ever since.  That might be a good way of getting them strengthened without overworking anything else since it's such low impact.

Wow, that is an evil thought, Jim! I'm thinking my PT would not like the elliptical at this point due to the repetitive stresses it'd place on the peroneal tendons. That's why I can't give in and jump on my bike, either. (At least I have access to a bike. An elliptical? Not so much.)

Interesting/unsettling note: After my first session of heel-ups this morning, my left knee is kinda sore.  

row machine?  (I guess box jumps are out.   )

So I've been chastised twice this week, first by my PT and then by the massage therapist, for how tight my leg muscles are.  I think I may have to incorporate some sort of stretching into my routine.  She was trying to stretch my TFL and as my right leg dangled off the end of the table, I got the somewhat incredulous "You're fully relaxed?" since apparently my leg should have dropped about twice as far as it did.  Oops.  You're not the only weirdo around here!

Oh, and it's a structural issue and not functional at all.  The leg length difference has caused all the issues I've had over the last several years.  And I wear a 1/4" lift in all of my left running shoes to help.