Category Archives: Knee

My feet are (apparently) broken…

 

 

Went to the VivoBarefoot in London, like I normally do when I am there.  They were a bit slow, so I jumped on the pressure pad, and what did we see?  No toes!IMG_2921

 

Next is a one legged balance – there are some of my toes!

IMG_2922

 

Vivo says this means my feet are broken.  :-)  I don’t disagree — my feet still get sore and tired after 40 or 50 miles of tough trail, even in shoes, while other folks I know do not have that problem.  They gave me some exercises to do, so I’ll give them a whirl.

They also had me run on the treadmill, and said I run from the hip flexors, and barely use my hamstrings to lift…  It looks a bit like a pendulum.   I hope to get a copy of that video and if so I’ll update this post…  They slapped the bottom of my feet while I was running, and it really makes you lift the foot off quickly.  The before and after videos were quite distinct!

 

 

Running year in review…

According to Daily Mile, where I log my work outs, I ran 1024 miles and averaged 23 miles per week.  This might also include miles from other “sports” like mountain biking, hiking, paddling, but since I did almost ZERO of that in 2012 (other than hiking), it should be close enough.

I’m hoping to get into the 35 mpw this year…

Uhwarrie Mountain Run.

I had tried to get into this race the past few years — the 8 miler or the 20, but never registered in time.  The race typically fills up in 20- 30 minutes.  Due to a registration snafu, I got into the 20 miler twice this year.  I wasn’t sure I’d be ready to run 40, and thought 20 would be plenty.  For a while I thought I might give one of the entries to my sister.  But I also was looking for a reason to run the 40, and when she had plans come up, things fell into place.  All of the old Triangle AR guys were in the 40, and I’ve been running pretty well, so I thought why not go for it.  I could just use the ultra-shuffle to go that distance, right?

The trail and race is notoriously rugged.  Here is an elevation profile:

I’ve run some on the northern section (mile 0-5 or so), though not a whole lot on the trail as we were practicing for a Rogaine, and I had backpacked from the southern end solo last year (miles 20 to 5 or so), so I knew what I was getting into.  Lots of steep climbs, stream crossings (many with no bridges), some without stepping stones, etc.

The week prior Kelly and Reece had not been feeling well.  I used Airbornne all week to try and stay healthy, but the night before the race I got a tickle in my throat, my nose started running, and I just didn’t have much energy.  I went to bed at 8:30 but couldn’t really fall asleep until closer to 10:00.  Luckily on race day I awoke not feeling very sick after all.

I woke up at 3:52 a.m., 3 minutes before my alarm was due to go off.  I got up, made coffee, got dressed, forced down some oatmeal (I hate to eat that soon after waking), and I was out the door by 4:20 or so.

The 90 minute drive to Uhwarrie went by quickly as I jammed to some genius play-list, though I can’t for the life of me recall what song I seeded it with.  None-the-less it was good music and kept me awake.

I arrived at the Church shuttle parking lot a few minutes after 6 a.m.  This year, with the amount of rain there has been, the forrest service did not want racers parking at the start, which is really a trail head with very minimal parking anyway.  I went in to the church to use the facilities, gathered up the gear I wanted, threw on some body glide in the appropriate placeds, got in the shuttle bus, and was at the start by 6:30.

After I quick check-in, I attached my race number to my shorts, made some final gear selections, and hung out.  I ran into Charlie and met Sultan, whose blog I have followed for a while… Here is a link to his race report.

A couple minutes after 7:00 we headed to the road to listen to last minute instructions.   Due to the amount of rain and high streams, some of the crossings on the southern section were deemed too dangerous and we were told that at mile 14 we would have to leave the trail and run a gravel road to the turn-around.  This cut 6 miles of difficult trail out and put in 5 miles of relatively easy) road running in, thus shortening the 40 mile run to 38 and making it a bit easier.  We were also told that depending on conditions they may elect to call the run at 20, which would have been a major disappointment!

Just before the start I decided I should ditch my top layer, a mid weight wool shirt, and just keep my even lighter weight wool base shirt on.  As I ran the 30 meters back to my bag I heard “Get Set! Go!”  Uh-oh, here I am starting the race in last place!   No worries though in a 40 miler, in which my goal is to 1st finish, and then finish in under 10 hours.  (The 10 hour goal was before the course modifications had been put in place.)

The first 50 meters or so is on the paved road up to a short double track trail that then climbs a few hundred feet, before you hit the single track.  I passed some folks on the climb up before we hit the single track, and then settled into an easy pace, passing a few people here and there as the trail permitted.  About 3 miles in I dashed past a pack of 6 or so to get some separation so I could do my own thing.

From mile 4 – 9 or so, I ran with Shannon and we talked about a bunch of things, which passed the time.  She had a camera and took a few photos of me, which I’ve included in this post.

Crossing a stream.

Between 4 and 6 miles, snow started to fall and I began to worry about my choice of not wearing any kind of rain/snow shell.  At the last minute I had stuffed it in my turn-around bag, so I had 15 miles or so to go until I could get it, and if the snow turned to rain, I probably would have chilled pretty quickly.   But luckily, the snow stopped and it never rained.  It was beautiful running in the woods with big flakes of snow falling all around.

Shannon had a pretty good fall right after the stream crossing shown here, at about mile 9, and told me to go on.

Just before the aid station at mile 14, the two leaders of the 20 mile run came flyng up behind me – they had started an hour later.  I watched them run off and subsequently tripped and fell pretty hard on my right knee.  Now two days later I don’t know if it is my old patella-femoral syndrome that I feel or the fall!  I lean towards the fall since most of the pain is on the outside of the patella, not underneath, though the PFS is probably contributing a little.

Mile 14 is where we turned on to the 5 mile gravel road instead of continuing on the 6 miles of trail.  Who knows how bad the trail was, but at the end of the day I trust the RD’s.  They put on a great race in not so great conditions, had 8 aid stations well stocked with supplies and volunteers, etc.  And while I would have loved to do the full trail, I still had a great time on the modified course.  Here is the elevation data from the Garmin, which you can compare to the normal course elevation shown above.  Miles 14 – 23 or so are the gravel road…  As you can see pretty level compared to the rest of the course!

The thing with the road, for me, at least, was that I had planned on walking all the steep hills on the trail.  The road, however, only had gradual inclines and declines.  So I ran just about the whole 10 miles, which again, was not really in my race plan and not how I trained.  Watching my average pace on the Garmin showed me go from about a 12:30 minute per mile average down to 11:40 by the turn around, so it was clearly a lot faster.

Only 2 or 3 more twenty milers passed me on the road up to their finish and my turn around.  I was starting to get concerned that maybe the 40 milers were being pulled from the course at the turn, but finally I saw another 40 miler coming back.  And then another, and another, and another… Good, the full race was on!

At the turn around I just put on new socks and grabbed my two extra fuel bottles.  My fueling strategy for this run was to use two 20 oz bottles filled with perpetuem mixed very thickly with water for each half …  One in my hand with water, the other in the pack with just powder, and then drink water at each aid station to dilute it.  I ended up diluting the mix in the bottles by filling them with water at each station.  This strategy worked well and I only had a tiny bit of solid food… About 3/4′s of a bananna at the turn-around; less than one pack of cliff shots, and one hammer gel single serving.  The rest of the run was fueld by my liquid diet of Perpetuem and two or three swallows of Heed the aid stations had.  (About 600 calories per bottle, 4 bottles total, and I never even drank from the 4th bottle!)

Shannon came in to the turn-around and said her leg was fine, and was back out on the road pretty quickly.  After the turn, it was 5 miles back on the gravel road.  I saw many more 20 and 40 milers heading towards the finish/turn, but I could not wait to be back on the trail.  I was really getting sick of the roads!

Sometime around mile 25 or so, a lady in purple came up behind me and we ran together for a while.  She said “that was impressive” when I crossed a stream on high, slipperly log.  I looked back to see her in water up to her thighs, and thought my way was the  better choice.  :-)  After the stream I told her to pass me and she was gone.  She was running some really technical trail like she was a mountain goat — she made it look so easy!  I on the other hand had to walk through some of this section.

From that point on there’s not much to report.  I passed a couple runners, and at least one passed me.  I was just marking time to the aid stations and the finish.

Coming down to the finish is a really rocky section… I was trying to push it to finish in under 8 hours, but it was tough to run here!  I finally came down the last steep descent to finish in something like 7:58.  Here I am coming to the line.  I was trying to make sure my race number was showing so I could find the photo later!  :-/

My goal for the original course was to #1 — finish, and if I finished, to break 10 hours.  I think a 9 hour finish on the original course might have been possible, but pretty tight.  We did a little under 38 miles, and about 9 – 10 of that was on roads.  The roads were definitely easier and faster, though by how much is hard to say.  So add 25-30 minutes for the extra distance, and another 25-30 minutes for the added difficulty, and 9 may have been in reach.

There’s always next year to see!  However, I would really like to do the Mt Mitchell challenge which is another 40 mile run from the town of Black Mountain to the top of Mt. Mitchell and back.  But it is a couple of weeks after Uhwarrie, and I can only handle one of these that close together!

Click here to see the Garmin GPS data…

Pose Method of Running

Pictured are both the book and the DVD…  Both are somewhat expensive relative to most books and DVDs, so I would recommend spending a fair amount of time on the web site before purchasing, to make sure they are for you.

The Pose method is similar to Chi Running, which I read and reviewed here, though Pose is much more “scientific.”  Chi is kind of go with the flow, and use nature (gravity) and your body as you feel, while Pose feels and sounds more scientifically grounded.  At the end of the day, both forms are quite similar.  Both utilize a very slight forward lean so that you are working with gravity, not against it.  Both teach you to run without braking, by modifying your form.  (Forward lean is really not the best word or image for what is going on, but it is all we have…)

I’m working on many of the drills in the book and in the video.  I would definitely say the video is a must on some of the drills, as seeing them in action by a real person vs. just reading about them makes a huge difference in understanding exactly what must be done.

One cool thing is about 1/2 way through the book, when you still have not done any running or any drills, he tells you to go to a local race to watch.  Watch the differences between the elite runners and the back of the pack.  How quiet and efficient the fast runners are vs. how loud and clumsy the slow runners are.  Watch the heel strike of the slow runners vs. the ball of foot/mid foot strike of the fast runners.  Watch the amount of time the fast runners foot stays on the ground, which is tremendously minimal vs. the slow runners, which can seem like an eternity.  I happened to go to a race to watch my wife run, and it was amazing to see how accurate all of this was.

Quote: When you understand one thing through and through, you understand everything.  Shunyro Suzuki

(Thus the need for doing the drills over and over…)

I’m still working on the drills, but I would say the form as outlined is sound, and the drills should help you get there.  I especially like his stance on barefoot training (he is fore it)…  And I love jumping rope barefoot.

Knee Update

After the backpacking trip last week, in which we did 75 miles on the AT in just 4 days(18, 18, 19, and 20 miles), my left knee got pretty sore. My right knee, which has given me problems the past several years, held up pretty well. The day after we got off the trail, we walked up to Brasstown Bald, a .6 mile paved path up. That hurt a lot, both up and down. It was all lateral pain. I did a self exam the day after that, and it was definitely sore in the lateral anterior patella and femur — classic signs of patella fermoral syndrom, likely caused by a tight ITB.

So I set up a time to go see my old PT, and he did exams of both knees, as well as my SI joint and R hip, which have also bothered me off and on a bit. I didn’t see him for another 4 days, and most of the discomfort in the R knee was gone, though in some of the exam I could feel it a bit.

I basically need to do much of the same stuff I used to do on the R knee on the left now:

  • ITB foam roller
  • ITB stretches
  • patella stretches, in both the medial and inferior directions

Beyond that, on both legs, I need to work on my hip adductor and abductor strength, stretch my hip flexors, in particular my psoas, stretch my groin, etc.

And overall, I could really work on my core strength, both front and back, to help stabalize the SI joint. And work on step downs.

I certainly can’t complain about the right knee and how well it did. It is certainly not 100%, and probably never will be back to where it was when I did the really long races. And I still wonder if there is a little scare tissue under the portal from my last surgery…

Here are the measurements:

Left Knee Right Knee
top of patella 13 3/4 13 3/4
2″ above 14 1/2 14
4″ above 17 16 1/4
6″ above 19 18 3/8
8″ above 19 3/8 19

So this shows size-wise, I still have some work to do. I don’t feel that it is weaker, and on my compex electro-stim unit (yes, I still need to blog about that)!, the milliamps I am sending in to the quads to get similar contractions are almost even… I’m only 1 or 2 ma below on the L side (meaning it is stronger). But when I do exercises like the step-downs, it is clear that the R side is not as stable. That may be supporting muscle weakness more so than quad weakness.

Here is a post with a similar table from September of 2005.

And to compare the two side by side:

April 2008 Sept 2005
Left Right Left Right
top of patella 13 3/4 13 3/4 13 1/2 14
2″ above 14 1/2 14 14 1/2 14 1/4
4″ above 17 16 1/4 17 15 3/4
6″ above 19 18 3/8 19 18
8″ above 19 3/8 19 21 1/2 19 3/4

So this shows some progress on evening things out…. (I’m thinking that 21.5 number on the L side in 2005 is not right!)

Treat Your Own Knees. Jim Johnson, PT.

knees.jpg

I read this on a quick plane trip to Boston, and it had some decent points. It is of course very very hard, if not impossible, to diagnose knee problems without an extensive in-person evaluation wth an O.S, D.O, or P.T. And even then, as in my case, it can be impossible to determine a true root cause. :-/

At any rate, Johnson has years of experience in treating knee problems, and has found four main areas that patients can work on to improve the pain level of knees and increase knee functionality:

  1. Strength
  2. Flexibility
  3. Proprioception
  4. Endurance

He gives simple exercises for each one — sometimes too simple depending on where you are with your knee and treatment and pain level. For example, on Strength, he uses the very simple “quad press” in which you lie or sit mostly reclined, and press down with extended leg onto a towel. Hold for a few seconds, release, and repeat up to 30 times. Johnson does site research that clearly shows such a simple exercise will increase quad strength over time, so it is a good exercise. But is it enough? That of course depends on where you are…

For flexibility, he lists the tried and true quad stretch, which is one I still use all the time, to try to give my knee cavity more space. I also supplement this with Yoga’s Hero pose. But I think other stretches, beyond just the quad, may be called for depending on your root cause of knee pain. For example, I have a tight ITB (just one of several bio-mechanical problems I have!), so ITB stretches are also part of my routine.

Proprioception is the abilty of your mind to know where and how your leg is placed. Standing on one leg and balancing is the exercise he uses to improve this ability. And if you can do that, try closing your eyes and counting to 30! I have been doing this one for a while, and I do believe it is beneficial. I also supplement it with Yoga’s Tree position. In Tree, you can look at a point in front of you (easier), or look at your finger tips (harder!)

The final item is endurance, and he suggests walking. Walking on a road, on a treadmill, in the water, wherever. I agree with this and have been walking more, though I do miss running. :-/ (I am running once or twice a week, up to 30 minutes, but I am so slow compared to before!)

I would add to both strength and endurance by stating that an Electro-stim unit such as the Compex or Globus are beneficial. I just realized I never blogged on my Compex unit, so I will try to do that soon. Briefly, the compex allows me to work on muscle strength and endurance without joint movement. For me, many of the strength exercises proscribed by my PT would irritate my knee. So I’ve been running the strength program on my quads and hams to build up the supporting muscles of the knee, in an effort to help solve some of my knee issues. I have not used the endurance program that often, but I have, and do believe it does help with muscular endurance as well.

Overall this is a quick read, and if you have been dealing with knee pain for some time, and have been trying to solve the problem by working with doctors, PT’s, or on you own, there probably isn’t that much new information here. But it does not hurt to read it, and perhaps incorporate some of his suggestions into your daily routine if you have strayed from any of them.

Post to the Yahoo CM group

I posted this to the Yahoo CM group and thought I should include it here as well:

> Here is my last question: with grade 4 CMP in the right knee and
> grade 3 CMP in the left knee, and 3 knee surgeries, I have come to
> accept the fact that my running days are over (I am a 31 year old
> triathlete and marathoner…no longer I guess). What do I do now???

I know how you feel, and for many on this board that were not competitive athletes, it is hard for them to understand where we come from. Adventure racing was a huge part of my life before my knee went south, and some advice you will receive will be just happy to be walking. And I actually agree that at some point, you may have to accept that.

Personally, I have not yet given up on getting back to racing, though I am getting closer to that every month. :-( The type of racing I did was 2 to 3 day races, in which we would run/trek 40-60 miles, mountain bike 100+ miles, paddle 20-50 miles, do rope skills, etc. So it was pretty extreme. Now, post surgery, it has taken a long time to get back to running 30 minutes, and even then I have minor discomfort in the knee the next day. But I have learned not to push so hard, to take it easy, and see how the knee reacts. Rest, ice, and sometimes NSAIDs, but I do try to limit that.

If I can’t get back to racing competitively, my next goal is to race for fun. If not 2 to 3 day races, short ones like 3 or 4 hours. If that is not to be, then I hope to be able to do some short mountain bike races, or do short orienteering events (which I have been pretty successful at the last few months). But if that is not to be, I hope to be able to do a weekend back pack trip. And if I can’t even do that, then I hope to be able to play with my kids — kick a soccer ball, or play tag, etc. And finally, if none of that is to be, then I hope to just walk around normally, pain free.

But, finally, I have to move. For some reason exercise is just ingrained in me. So if I can’t run or hike or walk or bike, then I will do other things, like an elliptical, or swim, or yoga, or lift weights, or do physically demanding work around my house.

Good luck!

Quick Knee Update

Just wanted to post a quick update that I ran for 30 minutes on the treadmill today. I have been slowly building up towards that. I have been doing the long (60 -120) minute orienteering events, in which I do run a lot, and those have been pretty good to my knee. While it would get sore back in September when I 1st started them, it has not been bad at all in the last couple events– even with Riley on my back. But the treadmill has been a little different. I may be a little tender later, but hopefully not. Granted, I am very slow. At 8:30 min/mile pace, my heart was pushing 170! I used to be able to run 6:30′s at that rate. And I only ran at that pace a minute or two. I averaged about 10 min/mile, though that includes both a 5 minute warm up and cool down at walking pace.

Beyond running, I have not done much biking the past couple of months other than one sping class. I do elliptical now and then, but maybe just once a month. I have been doing PT type strengthening and stretching one or two times a month, and I have been getting back into Yoga — but still just once a week or so. I have been mixing in more yoga to the PT routines, though.

Yoga for Healthy Knees. Sandy Blaine.

 knees.gif

I have to admit that when I first skimmed this book, and looked at the poses, I thought there wasn’t much to them. They were all fairly basic, and things that I use in my practice all the time. However, when I took the time to go through each one, reading exactly what she wrote to do and what to think about, I changed my mind. There is a lot of good information, and what I thought were easy poses were actually sometimes quite challenging.

The list of poses is somewhat short so I’ll go through them all here:

  • Staff Pose/Dandasana
  • Not much to say on this one, other than that holding a contracted quad without pressing down on the back of the knee for 60 seconds is not as easy as it sounds. I’ve done this a lot for a few seconds at a time, especially right after surgery, or right after the injury got so bad I could barely walk, but never for 60 seconds.

  • Comfortable Seated Cross-legged pose/sukhasana
  • I did both comfortable seated, and half lotus variations. Before surgery I could do full lotus, but not any more. One hip is obviously tighter.

  • Cross-legged, forward bend
  • Same comments as above. One side definitely needs to be evened out with the other!

  • Half downward facing dog
  • I thought this would be silly since I do full down dog all the time, and really love the stretch it can give on the back of the R knee, especially when bending the left. But this variation, in which the hands are on a wall and you are standing, is really quite good. Just gives different sensations than normal.

  • Seat of Power Pose / Utkatasana
  • This is basically a wall squat — using a wall to support your back. But the number of things to think about with your feet and knees is a lot, and holding it for 60 seconds or more is quite challenging.

  • Tree Pose
  • Not much to say. Standard Tree Pose. I didn’t feel much different than I normally do.

  • challenging balance: eyes closed
  • This is much harder than it sounds. You stand on both feet, hands on hips, close the eyes, and lift one foot slightly. Hold for 10 breaths. She says this is great for overall lower leg support, and I believe it. You can really feel al the little muscles that hold things together firing. 10 breaths is hard!

  • extended triangle/utthita trikonasana
  • Standard Triangle.

  • Warrior II
  • Standard warrior II. But when you take the time to work on all the little things, I can certainly see why the legs/knees will become much stronger and more stable.

  • Warrior I
  • Standard warrior I. Same comments as for Warrior II.

  • Half Frog
  • A simple quad stretch, but I really feel like this is a great knee opener for me post surgery. Sometimes after surgery, the patella tendon can “shrink” or pull in, and I feel like that has happened to mine, since most of my soreness is now under the patella tendon area, on the infrapatellar fat pad.

  • Hero / virasana
  • This is pretty hard for me post surgery. Definitely need a pillow/bolster to sit on. But again, it feels like a great opener on the R knee which is where I had surgery.

  • Downward Facing Dog
  • Just the standard pose, but this is one of my favorites for my knees. It really allows me to see my bio-mechanical deficiensies — the R femur rotating in, the R foot flaying out. I really can work on bringing those back into alignment — at least as much as possible doing soft-tissue work like this.

  • Thread the needle I and II
  • Just a simple hip opener. I’m definitely tight here, and even though these are the basic poses and I often do the more advanced ones like pigeon and 1/2 pigeon, I can tell these are still working for me. And I can again see how much tighter one side is!

  • Reclining Twist Pose
  • Feels great on the lower back to twist at the end of practice, but in this one, you wrap one leg over/around the other, so you get a slight ITB twist.

  • Relaxation Pose / Savasana
  • A time to rest and relax, but also to mentally probe your body to see what sensations you have and what has changed during the practice. :-)

For < $10 off Amazon, this is a good book for anyone suffering knee pain that wants to explore yoga, and for even somewhat experience practitioners that want to learn more about how to use and modify these poses for knee issues, and how they can help your knees.

Knee update

I was just looking back and realized I haven’t had a knee specific update since September. I know I’ve posted on Adventure Racing and Orienteering, so there’s been a little info, but I thought I’d write a quick post just about the knee.

I did the AR back on 9/24. It was supposed to be an 8 hour race, of both biking and orienteering (plus a short swim), but it turned into a 7 hour bike for me, and my knee got quite sore after that. Before the race, I was able to ride pain free for more than an hour, and running was the problem. After the race, it was somewhat the opposite. I was running better, but riding was out. In fact, I had to cut short a couple of rides, and even had to get up and walk out of a spin class. So I cut out riding totally for 4 or 5 weeks.

Over November and December, and into January, I’ve done a lot more strengthening and stretching (though not as much as I should!). I really feel I need to be doing a lot more yoga, but it has been hard to find the motivation to do tapes at home, and going to a studio is not easy as there are none close by that do the type of yoga I want to do. I did try the YMCA one night, and it was ok, but not great.

The knee has been much better the past few weeks. I have now run 23 minutes (albeit slow!), and even made it through spin class ok. I could tell I had pushed it when in one 3 day span I ran 20 minutes, did some leg strengthening excercises, did spin class, and went to a 90 minute yoga class (in Cambridge), but overall it handled it pretty well. I also walked with a pack on a lot, and even ran an O-event with Riley in a pack (~ 40 minutes).

So it is getting better — very slowly. But I still don’t have confidence that I can get back to doing the really long endurance stuff I used to do. :-(