What Comes Next

Today was the day for my appointment with the sports medicine doctor.

Or, as I have come to call these sorts of events: the freak show.

I went because my right foot and lower leg is still grumpy after I pushed it too far in defective shoes. I wanted to make sure that I hadn't done bone damage. Sore muscles and tendinitis, I can deal with. A stress fracture? Not so much.

The good news? No bone damage that they can tell. I am, they say, at a pretty low risk for that sort of thing.

One reason might be because...

No, this is not bad news.

It's the weird news.

Not surprised? Yeah, neither am I.

So, anyway, what it might be because is this: I have a new tentative diagnosis/description/whatever for the host of little things that crop up from time to time -- the weird hips, sore ankles, odd gait, extra effort in running, inability to go on my tiptoes, etc. -- are quite possibly because I have joint hypermobility syndrome. Or, at least, that I'm a borderline case.

I was disappointed to find that it is not a fledgling superpower.

It is, apparently, what happens when you have loose ligaments. It gives you wibbly-wobbly joints. That's great if you're a dancer, escape artist or contortionist (I have been known to tie my shoe behind my head, after all), but it means you need to be VERY CAREFUL about keeping your static muscles strong around your joints to make sure they don't go from wibbly-wobbly to, well, dislocated or something.

So, that means cross training. Core training. You know... all the stuff we hate to do.

"Do you do any cross training?" the doctor asked.

"Well, I walk..." I offered, lamely.

"What?! That's not cross training!"

And so it went. I figured I was in for a bad time when the doc caught me sitting cross-legged on the exam table. "Uh, you sit like that all the time?" "Uh, well, kinda..." "Well, I think we can see at least one thing going on."

She tested my core strength. It was pathetic. I kinda got out of the habit...  

And one side effect of that? Yeah. My ITB and TFL were super tight. Makes sense, considering they're probably the only things holding my legs on...

And we haven't even got to my feet yet! That prompted a visit from a second doctor who just had to see what my doctor was talking about. They watched me walk, worked the joints, pondered how they worked, argued with each other about just how hypermobile my foot joints were ("Oh, THAT's what you meant!") made bad suggestions for dealing with them, then realized they were bad suggestions before eventually agreeing what I've been doing seems to have been working pretty well for me. They even saw how barefoot running could help!

She ordered a hip X-ray, just to see what was going on there, and left an MRI of the foot as an option, though she didn't think it'd be a useful diagnostic tool for what's going on right now. She suggested ditching the bad shoes (which I already did), and suggested gingerly getting back to it, letting pain be my guide.

She also ordered PT with a therapist who specializes in sports injuries, in the idea of building core, ankle and foot strength. That could help a lot, so I'm looking forward to that.

Now that I know it's just soreness, I can test things out a bit and see how it goes.

Mark B wrote:Today was the day for my appointment with the sports medicine doctor.

Or, as I have come to call these sorts of events: the freak show.

I went because my right foot and lower leg is still grumpy after I pushed it too far in defective shoes. I wanted to make sure that I hadn't done bone damage. Sore muscles and tendinitis, I can deal with. A stress fracture? Not so much.

The good news? No bone damage that they can tell. I am, they say, at a pretty low risk for that sort of thing.

One reason might be because...

No, this is not bad news.

It's the weird news.

Not surprised? Yeah, neither am I.

So, anyway, what it might be because is this: I have a new tentative diagnosis/description/whatever for the host of little things that crop up from time to time -- the weird hips, sore ankles, odd gait, extra effort in running, inability to go on my tiptoes, etc. -- are quite possibly because I have joint hypermobility syndrome. Or, at least, that I'm a borderline case.

I was disappointed to find that it is not a fledgling superpower.

It is, apparently, what happens when you have loose ligaments. It gives you wibbly-wobbly joints. That's great if you're a dancer, escape artist or contortionist (I have been known to tie my shoe behind my head, after all), but it means you need to be VERY CAREFUL about keeping your static muscles strong around your joints to make sure they don't go from wibbly-wobbly to, well, dislocated or something.

So, that means cross training. Core training. You know... all the stuff we hate to do.

"Do you do any cross training?" the doctor asked.

"Well, I walk..." I offered, lamely.

"What?! That's not cross training!"

And so it went. I figured I was in for a bad time when the doc caught me sitting cross-legged on the exam table. "Uh, you sit like that all the time?" "Uh, well, kinda..." "Well, I think we can see at least one thing going on."

She tested my core strength. It was pathetic. I kinda got out of the habit...  

And one side effect of that? Yeah. My ITB and TFL were super tight. Makes sense, considering they're probably the only things holding my legs on...

And we haven't even got to my feet yet! That prompted a visit from a second doctor who just had to see what my doctor was talking about. They watched me walk, worked the joints, pondered how they worked, argued with each other about just how hypermobile my foot joints were ("Oh, THAT's what you meant!") made bad suggestions for dealing with them, then realized they were bad suggestions before eventually agreeing what I've been doing seems to have been working pretty well for me. They even saw how barefoot running could help!

She ordered a hip X-ray, just to see what was going on there, and left an MRI of the foot as an option, though she didn't think it'd be a useful diagnostic tool for what's going on right now. She suggested ditching the bad shoes (which I already did), and suggested gingerly getting back to it, letting pain be my guide.

She also ordered PT with a therapist who specializes in sports injuries, in the idea of building core, ankle and foot strength. That could help a lot, so I'm looking forward to that.

Now that I know it's just soreness, I can test things out a bit and see how it goes.

I don't think Alita would agree that you're a 'borderline' case.

Hopefully, you won't get a PT that thinks triathletes set the moon AND the stars.  Yoga can help all of what you are deficient.  But core exercises are good.


I always thought you were a fledgling superhero, e.g.

ounce wrote:I don't think Alita would agree that you're a 'borderline' case.

Hopefully, you won't get a PT that thinks triathletes set the moon AND the stars.  Yoga can help all of what you are deficient.  But core exercises are good.

I always thought you were a fledgling superhero, e.g.

Ah yes: "Not a bird or plane or even frog, it's little old me, Underdog!" Boy, does that bring back memories.

Alita caught me looking up Plastic Man and Mr. Fantastic and scoffed. I said it could be worse... and then showed her Eugene Victor Tooms from the X-Files.   

Anyway, I have a routine of core/hip exercises from a previous round of PT, so I can get started on that even before I see the new PT. It'll be interesting to see what different approaches they suggest. What complicates it (for them, for me it's totally normal) is that flexibility isn't really an issue for me. Well, it is, but in the opposite way from most people.

Tris aren't in my future. I have been able to ride a bike pretty well, but I swim like a brick. Besides, it's insanely expensive.

One different twist is that this doc wonders if there's something in my hips that's leading to dysfunction lower down the kinetic chain. So I got a pelvis X-ray. I wonder if anything weird will show up there? If not, that might actually be the weird thing.   

I'm planning to try a little activity before work today. I'll start with a few barefoot laps and see what happens.

I guess that is good news and bad news.  I have a friend who is just like you and she had all sorts of knee and hip issues until she started seriously core training.  She has avoided knee and hip replacement surgery so far just because of adding this stuff.  I have been working it hard using all those crazy exercises from Whitney and I know that I am stronger than ever.  Let's hope it helps on Monday.

Michele \"1L" Keane wrote:I guess that is good news and bad news.  I have a friend who is just like you and she had all sorts of knee and hip issues until she started seriously core training.  She has avoided knee and hip replacement surgery so far just because of adding this stuff.  I have been working it hard using all those crazy exercises from Whitney and I know that I am stronger than ever.  Let's hope it helps on Monday.

I bet it's going to help a LOT on Monday. I remember the photos of you from late in the race last year. I bet you're going to look a lot stronger this time, thanks to the "Hips of Death" exercises. I should probably get my hands on those...

I'm kind of embarrassed that I stopped doing my hip work, but it's easy to let them slip once the original problems go away. Apparently, that's not quite what you're supposed to do. Oops.

One thing the doc did yesterday was a little surprising. She had me lay flat on the table and raise each leg, first by myself, then with her compressing the sides of my hips. She asked if my legs felt heavy without the compression - they felt like they always do - then asked if it felt easier when she compressed the sides of my hips. It did. Apparently, I wasn't using the right muscles to do the work. Hm.

Such a common problem, Mark.  When I had my hamstring issues a few years back and finally went to PT, I found I was not using my glutes at all, jsut my hamstrings.  I couldn't even isolate my glute muscles and she taught me how.  My hamstrings have not bothered me since.

Michele \"1L" Keane wrote:I guess that is good news and bad news.  I have a friend who is just like you and she had all sorts of knee and hip issues until she started seriously core training.  She has avoided knee and hip replacement surgery so far just because of adding this stuff.  I have been working it hard using all those crazy exercises from Whitney and I know that I am stronger than ever.  Let's hope it helps on Monday.

Michele,
Pardon me for getting on you a bit but, race your training and Stay Smart.  Your Boston Madness is getting the upper hand.  

Mark B wrote:

ounce wrote:I don't think Alita would agree that you're a 'borderline' case.

Hopefully, you won't get a PT that thinks triathletes set the moon AND the stars.  Yoga can help all of what you are deficient.  But core exercises are good.

I always thought you were a fledgling superhero, e.g.

Ah yes: "Not a bird or plane or even frog, it's little old me, Underdog!" Boy, does that bring back memories.

Alita caught me looking up Plastic Man and Mr. Fantastic and scoffed. I said it could be worse... and then showed her Eugene Victor Tooms from the X-Files.   

Anyway, I have a routine of core/hip exercises from a previous round of PT, so I can get started on that even before I see the new PT. It'll be interesting to see what different approaches they suggest. What complicates it (for them, for me it's totally normal) is that flexibility isn't really an issue for me. Well, it is, but in the opposite way from most people.

Tris aren't in my future. I have been able to ride a bike pretty well, but I swim like a brick. Besides, it's insanely expensive.

One different twist is that this doc wonders if there's something in my hips that's leading to dysfunction lower down the kinetic chain. So I got a pelvis X-ray. I wonder if anything weird will show up there? If not, that might actually be the weird thing.   

I'm planning to try a little activity before work today. I'll start with a few barefoot laps and see what happens.

My personal favorite was Robert Patrick "Pusher" Modell from season 3.

Well, the PT loved them because they do cross training all the time, whereas we runners just.  run.  And.  nothing.  else.

Michele \"1L" Keane wrote:Such a common problem, Mark.  When I had my hamstring issues a few years back and finally went to PT, I found I was not using my glutes at all, jsut my hamstrings.  I couldn't even isolate my glute muscles and she taught me how.  My hamstrings have not bothered me since.

Oh, it's definitely a common problem. I'd be willing to bet that, if there's a checklist docs use for evaluating runners, the first item relates to the glutes.

ounce wrote:

Michele \"1L" Keane wrote:I guess that is good news and bad news.  I have a friend who is just like you and she had all sorts of knee and hip issues until she started seriously core training.  She has avoided knee and hip replacement surgery so far just because of adding this stuff.  I have been working it hard using all those crazy exercises from Whitney and I know that I am stronger than ever.  Let's hope it helps on Monday.

Michele,
Pardon me for getting on you a bit but, race your training and Stay Smart.  Your Boston Madness is getting the upper hand.  

Hey, it's taper. If Michele wasn't worried, I think WE would be worried! Not that she needs to be worried, though. She's going to rock it.

ounce wrote:

Mark B wrote:My personal favorite was Robert Patrick "Pusher" Modell from season 3.

Well, the PT loved them because they do cross training all the time, whereas we runners just.  run.  And.  nothing.  else.

Oh yeah. Pusher was a great, scary villain. Not as creepy as Mr. "Squeeze", but he'll do.

I can see why PTs would love trifolk. They have to be insanely fit in so many disciplines. They end up looking like Tarzan. Runners? Not so much.

Barefoot Run: 3.1 miles on asphalt

Weather: Rainy. 55 degrees. Gear: Bare feet, shorts, T, jacket, hat.

Now that I have some confidence that the pain in my foot is *not* bone damage, I've decided to start easing back into more activity and see how it goes.

My first test was, of course, a barefoot run. That may sound nuts, but I know I need to run as gently and with as perfect a form as possible. The only way to achieve that for me is to go without shoes.

I was pretty creaky on my first .33 mile lap -- no surprise there, after 2+ weeks of inactivity -- but I didn't have any real discomfort coming from the peroneal tendons or where they attached. My hip and lower back popped a couple of times as my hips started flexing, but that actually felt pretty good.

I kept the effort level low and was content to ease along through the rain at a relaxed pace. It felt fine all the way to my predetermined limit of 3.1 miles, when I shut it down. Everything feels pretty good so far, so I'm hopeful.

Average HR for entire run: 137

I was kinda creaky this morning, so I've been thinking that it's probably not a good idea to take another test run today. Pushing my leg too hard at this point would be foolish. (Though, I must admit, it's seriously temping.)

I made my first PT appointment, but it's not until two weeks from today. And of course, they don't want to suggest exercises until they've done a full work-up on you, so... I'm left dusting off my old PT instructions and trying to remember other core exercises.

I actually tried a few of them this morning, and wow: it used to be a LOT easier to do these.  

Here's what I did:

Standard plank: ~60 seconds, could have gone a little longer. Felt like I had something heavy on my back pushing me down, down, down.

Side plank: ~40 seconds each side, holding to near-failure. Ow.

Bridge/both legs: ~60 seconds, could have gone a little longer. I may have been overusing my quads. I probably was.

Bridge/one leg extended: ~60 seconds with each leg, but I was trembling before I was done. Holding up the left leg seemed more difficult than holding the right. That might have been because it was the last exercise, or not.

Ugh. Intensity. Not a big fan of it. I wonder why?

One other interesting thing to note: Through these appointments and PT scheduling, they're giving more attention to the SI joint popping/soreness than my peroneal muscle tantrum. I guess they think it's a bigger deal over the long term than pulled muscles.

Still fighting the urge to go run, btw.

Have to chime in just to help with the core exercises - I've finally found a routine I really like, and it hits everything running-specific pretty well.  Picked it up from an ongoing job I've got for a high school track team:

V-ups (opposite hand to opposite foot, or both hands to foot, alternating left/right)
Swimmers (or Supermans, or static Superman hold)
Bicycles
Push-ups (just to break up the ab work)
Russian Twists
Plank

Start with 2x 20 reps (45-60sec for the plank) and go straight through the list.  Rest 2-3min between sets.  Increase reps/sets as you improve.

Mike MacLellan wrote:Have to chime in just to help with the core exercises - I've finally found a routine I really like, and it hits everything running-specific pretty well.  Picked it up from an ongoing job I've got for a high school track team:

V-ups (opposite hand to opposite foot, or both hands to foot, alternating left/right)
Swimmers (or Supermans, or static Superman hold)
Bicycles
Push-ups (just to break up the ab work)
Russian Twists
Plank

Start with 2x 20 reps (45-60sec for the plank) and go straight through the list.  Rest 2-3min between sets.  Increase reps/sets as you improve.

Looks interesting, Mike. Thanks. Russian twists? Does that involve White Russians by any chance?

Bahaha, they may help get rid of them!  

But touch the floor on either side (you can bend your arms to do this).

Mike MacLellan wrote:Bahaha, they may help get rid of them!  

But touch the floor on either side (you can bend your arms to do this).

Oof! Looks kinda tough. But I'll give it a shot. I'm wondering if I can figure out how to rig up a wobble board, too. Those things are expensive!

Low HR Run/Walk: 4.65 miles

Weather: Partly cloudy, cool. 41 degrees. Gear: NEW Altras, shorts, T, jacket. Fuel: Grape Nuts and coffee before.

Met up with my training partner at the local high school track to see how my leg would handle running in shoes. I've been wearing my new (and hopefully improved) Altras casually for a couple of days, and I can feel the tension in my lower leg and foot slowly starting to dissipate. I though the track was a good idea, because I could quit at any time and not be left hanging on an out-and-back route if something started hurting.

It went pretty well. My partner hasn't been running much either, so he was a little creaky and fine with going slow. We went a while at an easy pace, paused a couple of times to walk, then ended up just walking a few more laps until we decided we'd done enough. It was a good conversation, and a good very low intensity effort. Just what I need right now.

One funny bit from my core work on Friday: I was so SORE, and in the weirdest places. As in, my hamstrings? Huh? The tight hips I get, but hamstrings? I think that suggests I'm recruiting muscles other than my core to do this work. Even if the leg resolves itself before my PT visit, I'm thinking I'll need their help getting my core back online. And maybe (dare I dream?) build my ankle strength? That'd be helpful.

Walked first 5, last... several laps. Average HR for entire run: 115

Bonus!

Walk: 2 miles

Weather: Party cloudy and gorgeous. 62 degrees.

An after-dinner walk with Alita, enjoying the evening. My foot complained a bit when we pushed the pace a little, but it didn't get worse as I went. So that's a good thing. We'll see how I feel tomorrow. That'll determine what, if anything, I do on my normal trail/long run day.

I think I found you some new shoes:

http://gearup.active.com/Product.aspx?l=00011314166500000000&p=SAZ01231&et=lls&sc=00011314166505640000

mul21 wrote:I think I found you some new shoes:

http://gearup.active.com/Product.aspx?l=00011314166500000000&p=SAZ01231&et=lls&sc=00011314166505640000

Ha! Those are pretty cool looking, but could you imagine having a sandal strap between EVERY toe? Yipes!   

Glad to see that you are getting back out on your feet/foot/calf...Looks like the barefoot thing is going to have to be sidelined for a while, but take it slow and easy so that you can make it to your event in June.

Nick Morris wrote:Glad to see that you are getting back out on your feet/foot/calf...Looks like the barefoot thing is going to have to be sidelined for a while, but take it slow and easy so that you can make it to your event in June.

  

Ah, Nick. You crack me up. I read your post standing in the street immediately after completing a ...

Barefoot Run: 5.2 miles

Weather:  Sunny. 58-62 degrees. Gear: Bare feet, shorts, T. Fuel: Mid-morning snack before, nothing during.

Surfaces: Asphalt, concrete, chip seal, crushed gravel (ow!), grass, permeable pavement...

If I were still following a training plan, I think I was supposed to do insane miles in the woods today. Well, that clearly isn't happening, so I decided to make the most of the situation and head out barefoot.

No, really. Barefoot. It's easier on my body than shoes, if only because my body tells me faster when it's stressed while barefoot than when my senses are benumbed by footwear. It's much more difficult to overdo it barefoot. It also forces me into my best possible form, which means a lot less stress caused by sloppy running.

I decided against laps around the block and instead headed out on a route I've done before, angling toward some local trails. It's been a fun route. Alas, helpful public works crews have covered up what was a moderate asphalt surface on part of my route with chip seal pavement - which is essentially crushed gravel glued on to the roadbed.


Hmm. Which would YOU rather run on?


Still not sure? Here's a closer look. Oh, well. At least it helps teach a light landing, right?

That slowed me down! Thankfully, it was only a few hundred yards before it transitioned back to butter-soft asphalt. (Well, that's how it felt at the time!) I kept going to the trail head, where helpful volunteers had replaced the first 200 yard stretch from the road to where the dirt trails begin with very fresh crushed gravel. Running became careful walking. Then standing, just trying to relax my feet into all the edges underfoot. I went 100 yards or so downhill before the soles of my feet decided they'd been stimulated enough. The smaller chunks were almost manageable walking, but I kept getting zinged by the bigger sharp-edged gravel chunks. That got old fast.


Feet to brain: "We're sufficiently stimulated, thank you. Can we go back to chip seal, please?"

I never made it to the actual trails. I'm irked that my best path to dirt from my house is significantly more difficult to navigate without shoes, but maybe it'll be good for me. There's no better teacher of light running form than freshly crushed gravel and bare feet.

I worked my way back up the street, navigated the chip seal section, then enjoyed some silky smooth concrete sidewalks. I could have turned and headed home, but I decided to keep going. I made a big loop, rambling along at an easy pace, sometimes swerving onto grassy areas to mix up the surfaces underfoot, as I proceeded along concrete, asphalt of various roughness and permeable pavement, which is pretty stimulating. Quite the sensory diet for my feet. It was fun.

I even got to see a pig! This was a first for me. I'm used to seeing cows, sheep, llamas, aplacas (alpaci?), chickens and farmers... but no pigs, until now.


"Dude! Where are your hooves?!"

This ended up being one of my longer barefoot runs in a while. The soles of my feet are nicely stimulated, and the run bothered my lower leg pretty much not at all -- going barefoot forces you to relax your lower legs -- and it seems happy now.

To be fair, my HR was a bit elevated compared with my normal laps around the block, but it was also warmer and I didn't take any fluids. Even so, it suggests I'd better not push it too hard, too soon, at this point.

Average HR for entire run: 140

---

A follow-up on the last part of Nick's note, regarding June's event. I hadn't registered yet, so I'm not committed to it. They do have a 15-mile option, so I could possibly run that instead of a full 50K. If the goal is to have fun, it's probably fit the bill. We'll see. (And thanks for the note, Nick!)

Barefoot adventure follow-up: A rock bruise or two (no surprise there) and a bit fatigued, but that was at least due to trying two days of running in a row while still rehabbing. I'm glad I went barefoot yesterday; it was so nice, I'd have been tempted to go farther had I been wearing shoes. That 5-mile effort was enough for now.

Tuesday is always a rest or easy walking day, so it'll be pure recovery. Well, except for a few core exercises.

Mark B wrote:Barefoot adventure follow-up: A rock bruise or two (no surprise there) and a bit fatigued, but that was at least due to trying two days of running in a row while still rehabbing. I'm glad I went barefoot yesterday; it was so nice, I'd have been tempted to go farther had I been wearing shoes. That 5-mile effort was enough for now.

Tuesday is always a rest or easy walking day, so it'll be pure recovery. Well, except for a few core exercises.

Crazy barefooter...you wouldn't have gotten those bruises if you were wearing shoes.

Nick Morris wrote:

Mark B wrote:Barefoot adventure follow-up: A rock bruise or two (no surprise there) and a bit fatigued, but that was at least due to trying two days of running in a row while still rehabbing. I'm glad I went barefoot yesterday; it was so nice, I'd have been tempted to go farther had I been wearing shoes. That 5-mile effort was enough for now.

Tuesday is always a rest or easy walking day, so it'll be pure recovery. Well, except for a few core exercises.

Crazy barefooter...you wouldn't have gotten those bruises if you were wearing shoes.

True... But if I was wearing shoes, I probably would have run farther than my body could handle. Naked feet keep me honest.   

Great to see that you're out running again but I have to agree with Nick on the "crazy" part...I guess it's a good kind of crazy.