Hearing From The Pros

I’m both envious of and sympathetic to people in the medical professions these days.  I’m envious because I bet their work is fascinating – because the human body is fascinating.  As I learn more about the body it becomes even more mysterious.  How we can do what we do is mind boggling to me.  I’m sympathetic to medical professionals because they must lead incredibly hectic lives.  I can only imagine what their daily schedules must be like.

It’s because of this last point (how busy they are) that I’m so appreciative of a seminar Rebound Sports & Physical Therapy (Loveland, CO) recently put on about running injuries.  (This isn’t an advertisement.  I’m a very satisfied patient of Brad Ott – the president of Rebound.)  Additionally, the seminar included a great local podiatrist, Dr. Tom Hecker.  (This isn’t an advertisement for Dr. Hecker either. I’m a very satisfied patient of his as well.)  Both of these folks have gotten me through a variety of issues.  How cool was this?!  Two medical professionals who know running and running injuries really well, who are both incredibly busy, taking the time to talk to a group of runners for a couple of hours. There are four medical professionals I’d do almost anything for – and two of them were going to be in the room at the same time sharing their knowledge.  Suh-WHEET!

As you can imagine – quite a number of things were covered in the 2 hours.  These are the things I found most interesting:

• Asymmetry In The Body.  If we find asymmetry in our bodies that might be an indication of either the cause of an existing injury or an impending injury.  The lack of symmetry (comparing a capability on one side of the body to the other) might show itself in a variety of ways.  Differences might exist in strength, range of motion, balance, etc.  These imbalances can cause compensatory behaviors that, when multiplied over multiple thousands of repetitions, can cause an injury. 
• Left-side Issues.  Frequently when issues do arise it’s on the left side of the body.  Why?  Our abdominal anatomy is  a bit different on the left side.  This can encourage the pelvis to be in a sub-optimum position which can impact hip function.  Proper hip function is critical because……..
• The Hips.  The hips, while they’re at the top of the chain physically, are the foundation on which all the leg function is based.  So just like in your house – if you have a bad foundation – all sorts of bad things can happen.  Knee.  Ankle.  Foot.  They all can get messed up due to bad hips.
• Orthotics.  In this article I wrote a while ago about orthotics the doctor referenced is Dr. Hecker.  He’s one of the few docs I’ve heard of that recommend orthotics as a temporary solution; something to provide support so that the tissues can heal.  However once the healing is done – get out of them.  Let the limb move and get strong. That’s what is supposed to happen with any body part that is immobilized to help it heal.
• Stretching.  This one really blew my mind.  Part of the event involved bringing a volunteer up to the front of the room  and doing some muscle testing.  The right side was strong and firing well.  The left side – well – not so much.  The topic of stretching came up and it was mentioned that stretching can be a muscle inhibitor – something which shuts the muscle down.  Brad had the subject hold a gluteal stretch and, after stretching, the strong-sided muscle, which had previously been doing well, had shut down.  Amazing.  A number of stories were told that described how performance suffered and injury rates increased following stretching. 

It’s so cool to see a doctor and PT collaborating closely in their treatment plans.  Additionally, these two folks look at us injured folks holistically – and treat the root cause of the injury – not just the symptom itself.  If you’re in the Northern CO area I highly recommend them.

Jim

Post Script:  The seminar I describe above was recorded and the video for much of it is on YouTube.  Have a look if you’re interested:

• Running Injuries – Part 1
• Running injuries – Part 2

[Addendum:  I said I’d do almost anything for four medical professionals, but I only mentioned two.  The other ones?  Dr. Stephen Yemm for Sports Medicine and Dr. Tim Podhajsky for a Primary Care physician.  Great folks.]

The Doc Continues To Surprise……….

In January I tried out a local health club to see if I could get into a swimming routine.  The trial went well enough I decided to join.  I didn’t fully understand the depths of my mental state until I was exercising again.  It feels so good to be doing stuff – even if it’s not yet the activity I really love – running.  Moving.  Getting winded.  Feeling tired afterward.  Feeling like you weren’t a lazy you-know-what.  Looking forward to doing it again.  All of these things pulled me from my bad mental state and helped me have a much more positive attitude.

The routine, in addition to helping my mind, has seemed to have helped my heel.  Overall the discomfort is improving, although as I describe to my PT, it’s happening at “glacier speed”.  As I paid close attention to the pain pattern (When do I get pain?  After what activities?  What makes it feel better?  What seems to make it worse?) I noticed something that seemed very odd:  In some situations I would have pain upon contraction of the calf.  There were a few times the heel wouldn’t hurt when I got in the pool, but it did hurt when I got out.  How weird is that?!?!  My very deeply-held mental model has been that the pain is caused by pounding and shock.  Swimming is the epitome of non-impact.  Why would it hurt as a result of swimming?  I concluded it was primarily a weakness and tightness thing – that the calf was pulling on the heel bone and making it hurt.  So I focused a lot on stretching and strengthening and just sort of went with the flow.  I swam 3-4x/wk.  I also started doing spin classes and a little elliptical. 

Even though I was doing stuff, my heel was improving, and my mental attitude was phenomenally better, I recently hit my frustration limit.  So I call the doc’s office and make an appointment.  The only thing that had changed was my frustration level, and I knew I needed to do something.  The last time I’d seen him (my podiatrist) was in November.  At that time I had a bone bruise and he was recommending a syringe filled with cortisone to help get it calmed down.  I did a polite “Thanks but no thanks.” and went on my way.  I claimed I didn’t want that chemical in me.  Truth be told I was more concerned about the process of delivering the chemical to where it needed to be.  (i.e the shot)

So Monday I’m in his office and and pokes and prods and then he lays his diagnosis on me and I about roll out of the chair:  “You’ve got an irritated nerve.  Some muscles are tense and pinching it.  We need to get those muscles relaxed and the nerve calmed down.”  Holy smokes – I was figuring I’d need to fend off the cortisone again.  Nope – the bone bruise is heeled.  He now thinks this is something different.  All the calf stretching and massage is just what the doctor ordered.  He said sometimes those nerves can get gunked up in the calf, but we feel it in the foot.

So the plan is Voltaren gel (a topical anti-inflammatory cream) for a couple of weeks.  If that doesn’t do the trick there is another topical that has muscle relaxers and such in it that we’ll try.  If that fails apparently there is an infrared treatment that works well on nerves.

Lastly, as I’m leaving the exam room, I ask if continued elliptical and spinning is OK.  He replies “Heck – you can go run if you want.”  EXCUSE ME?  Did I hear you correctly?  It turns out I did hear him correctly.  That doesn’t mean running makes my heel feel very good.   I certainly don’t feel compelled to go out and run a whole bunch.  But I was pleasantly surprised to hear he thinks I can do some running and not make things terribly worse. 

Here’s to calm nerves – both in my head and in my foot.

Jim