I saw my ortho doctor a couple weeks ago, still having pain down the front of my thigh, with some minimal issues in my butt and upper hamstring area. These two areas have hurt for a long, long time. It's what I initially went to my current ortho doctor for in the first place. That was almost three years ago. He thought it was my piriformis and my lower back.
He prescribed physical therapy and after about (no running), there seemed to be some improvement. Tried to get back into running and it all came back. Stopped running for a while and tried to start again.. several times... the pain always came back so I went back to the doctor. That was this past December, 2010. Again, they thought it was my lower back; had MRI of my lower back... no, not my lower back.
And that's when they finally thought it might be my hip. MRa of the hip, and lo and behold, the disease had come back (see posts http://www.run2joy.com/search/label/synovial%20chondromatosis), and on top of that I had a labral tear. So, they said the pain down the front of my thigh and the issues in my butt and upper hamstring were from my hip.
Surgery on the hip March 31, followed by four months of physical therapy... hip's doing great! But I was still have pain down the front of my thigh and in my butt and upper hamstring area. So, I had two MRI's, one of my front thigh area and one of the upper hamstring area. Results: front thigh area is okay, but I have a torn hamstring tendon, a partial avulsion. What's funny to me is that it just didn't really hurt. It has not felt "right" for a long time, but has not been painful. I just figured it was strained from the hip issues and would get better as the hip healed. But it didn't.
So, my ortho doc suggested PRP therapy. What is that? PRP stands for platelet rich plasma. The therapy has actually been around since the 90's, used in dental surgery. It only quite recently has been used in sports medicine--for muscle, tendon, and ligament repair. Some high profile athletes have been turning to the therapy with reportedly good results--Tiger Woods, Pittsburg Steelers' Hines Ward, and Alex Rodriquez, to name a few. The theory behind it is that the platelets in the blood contain what they call healing growth factors. If, say a tendon injury has become chronic and won't heal on its own using conventional conservative methods such as rest and physical therapy, an injection (or two) of this PRP could help the body along to heal the injury by providing a concentration of these healing factors to the area.
I had a PRP injection last Friday. They take some blood from your arm, just one small vial, and then put it in a centrifuge to remove the platelets. The doctor then injects this "platelet rich plasma" into the area so that it gets this concentrated infusion in hopes of helping the body heal itself. The injection itself wasn't so bad. After he inserted the needle, he moved it around the area; I guess just "needling" the injury will encourage the body to heal. Afterwards, the area was quite sore, and for several days I really didn't want to walk much. But I did swim the next day, as the doctor said that would be good for it.
The doc said another injection might be needed in six weeks, that is very typical. If six weeks after the second injection there is no improvement, then I am looking at surgical repair of the tendon. But I am very hopeful that this will work.
Here are some videos I found about the procedure:
Thursday, August 4, 2011
Wednesday, July 13, 2011
Criteria for Transitioning into Minimalist Shoe from PT Jay Dicharrry
I follow the running blog Runblogger by Pete Larson. His most recent post (see it here: http://www.runblogger.com/2011/07/criteria-for-safe-transition-to.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+Runblogger+%28Runblogger%29) is about physical therapist Jay Dicharry and his criteria for transitioning into a minimalist or barefoot-style shoe. Dicharry is director of the Speed Lab at the University of Virginia and, as he has tons of experience treating runners and has conducted much research, is an expert in the field of running gait and injuries. Pete summarizes Dicharry's three criteria for the transition in his post and directs you to Dicharry's blog for a full explanation.
As Dicharry explains it, the switch from a "regular" shoe to a more minimalist shoe can be significant... without all the cushioning and the lower heel, your foot will "feel" the ground more, which by the way, is a good thing--your foot and ankle were designed to do this and take more of the shock so that the knee and hip are less impacted. Wearing shoes all our lives weakens our feet, they don't have to do what they were meant to do. Dicharry has found over the course of treating many, many runners, that certain criteria need to be met before successful transitioning can occur.
Dicharry's three criteria are:
1. Mobility - Two things here: You need to be able to dorsiflex your foot toward your shin up about 25 degrees. This requires your Achilles to be flexible and if it isn't, you will need to do some calf stretching to get it to that point before you try the transition. You also need to be able to dorsiflex your big toe about 30 degrees up while your angle is at about 5 degrees toward your shin. This allows you to roll over your toes instead of your forefoot as you run.
2. Single-leg Standing Balance - Standing on one leg with foot flat on the floor, you need to be able to balance for 30 seconds with your upper body still. Dicharry points out that, as the midstance running phase is this "single-leg squat," and that the foot needs to be "pro-active not re-active." This is called proprioception--your perceived sense of where your body is and what its doing.
3. Ability to Isolate the Flexor Hallucis Brevis (big toe flexor) - Stand on both feet and see if you can drive the big toe of one foot into the ground while slightly raising the rest of your toes, keeping your ankle in place. Do not curl your big toe. Then reverse it--drive your other toes into the ground while lifting your big toe. Dicharry explains that one of the ways we differ from other primates is that we have a longitudinal arch, which helps us run.
If you're weak in any of these areas, Dicharry recommends practicing these movements to strengthen and stretch those components before beginning a transition into minimalist or barefoot running. If it's mobility that gives you problems, he recommends a 10 to 12-week stretching program. For balance, improvement comes quickly, in about two weeks, if you practice a lot. And strengthening your foot muscles will take about six to eight weeks. Of course, if you can already perform these three tests with no problem, you're good to go!
To read the original post by Jay Dicharry see: http://uvaendurosport.wordpress.com/2011/07/09/less-from-your-shoes-more-from-your-feet/)
As Dicharry explains it, the switch from a "regular" shoe to a more minimalist shoe can be significant... without all the cushioning and the lower heel, your foot will "feel" the ground more, which by the way, is a good thing--your foot and ankle were designed to do this and take more of the shock so that the knee and hip are less impacted. Wearing shoes all our lives weakens our feet, they don't have to do what they were meant to do. Dicharry has found over the course of treating many, many runners, that certain criteria need to be met before successful transitioning can occur.
Dicharry's three criteria are:
1. Mobility - Two things here: You need to be able to dorsiflex your foot toward your shin up about 25 degrees. This requires your Achilles to be flexible and if it isn't, you will need to do some calf stretching to get it to that point before you try the transition. You also need to be able to dorsiflex your big toe about 30 degrees up while your angle is at about 5 degrees toward your shin. This allows you to roll over your toes instead of your forefoot as you run.
2. Single-leg Standing Balance - Standing on one leg with foot flat on the floor, you need to be able to balance for 30 seconds with your upper body still. Dicharry points out that, as the midstance running phase is this "single-leg squat," and that the foot needs to be "pro-active not re-active." This is called proprioception--your perceived sense of where your body is and what its doing.
3. Ability to Isolate the Flexor Hallucis Brevis (big toe flexor) - Stand on both feet and see if you can drive the big toe of one foot into the ground while slightly raising the rest of your toes, keeping your ankle in place. Do not curl your big toe. Then reverse it--drive your other toes into the ground while lifting your big toe. Dicharry explains that one of the ways we differ from other primates is that we have a longitudinal arch, which helps us run.
If you're weak in any of these areas, Dicharry recommends practicing these movements to strengthen and stretch those components before beginning a transition into minimalist or barefoot running. If it's mobility that gives you problems, he recommends a 10 to 12-week stretching program. For balance, improvement comes quickly, in about two weeks, if you practice a lot. And strengthening your foot muscles will take about six to eight weeks. Of course, if you can already perform these three tests with no problem, you're good to go!
To read the original post by Jay Dicharry see: http://uvaendurosport.wordpress.com/2011/07/09/less-from-your-shoes-more-from-your-feet/)
Wednesday, June 8, 2011
Another Opinion on the ACSM Symposium on Barefoot Running
I found another post about the discussion of barefoot running at the ACSM's annual meeting. This one is from the New York Times Health section, written by Gretchen Reynolds. She brings in a couple other studies done last year on how shoes affect children's gait.
One study (http://www.ncbi.nlm.nih.gov/pubmed/21244647) found that, "with shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity. Shoes reduce foot motion and increase the support phases of the gait cycle. During running, shoes reduce swing phase leg speed, attenuate some shock and encourage a rearfoot strike pattern."
The other study Reynolds mentions is one done by Dr Daniel Lieberman on Kenyan children. He compared children in an urban setting, who typically wore shoes most of the time, to those in a rural setting, in which the children were mostly barefoot (http://www.ncbi.nlm.nih.gov/pubmed/20111000). He found that most of the city kids, when running, landed on their heels resulting in greater impact forces; whereas the barefoot rural kids landed more mid- and forefoot with less impact.
But, as pointed out in Dr Tucker's post in his blog The Science of Sport, that doesn't mean we all should ditch our shoes and run barefoot all the time. According to Allison Gruber, lead author of another study done at the University of Massachusetts showing how impact forces are lesser when footstrike is mid- to forefoot, the “evidence is not concrete for or against barefoot or shod running. If one is not experiencing any injuries, it is probably best to not change what you’re doing.”
Then again, if you do experience a lot of running injuries, you might want to try the minimalist approach. The key, according to all of these experts, is to move into either a less constructed shoe or barefoot gradually. Dr Lieberman suggests you, "remove your shoes for the last mile of your usual run and ease into barefoot running over a period of weeks." It all depends on the individual, how fast or slow they should move into the minimalist shoe or barefoot running, but I would err on the side of caution. Dr Lieberman also mentions form--running with a shorter stride and landing lightly. As I tell all my runners, "run tall, run relaxed, run easy."
One study (http://www.ncbi.nlm.nih.gov/pubmed/21244647) found that, "with shoes, children walk faster by taking longer steps with greater ankle and knee motion and increased tibialis anterior activity. Shoes reduce foot motion and increase the support phases of the gait cycle. During running, shoes reduce swing phase leg speed, attenuate some shock and encourage a rearfoot strike pattern."
The other study Reynolds mentions is one done by Dr Daniel Lieberman on Kenyan children. He compared children in an urban setting, who typically wore shoes most of the time, to those in a rural setting, in which the children were mostly barefoot (http://www.ncbi.nlm.nih.gov/pubmed/20111000). He found that most of the city kids, when running, landed on their heels resulting in greater impact forces; whereas the barefoot rural kids landed more mid- and forefoot with less impact.
But, as pointed out in Dr Tucker's post in his blog The Science of Sport, that doesn't mean we all should ditch our shoes and run barefoot all the time. According to Allison Gruber, lead author of another study done at the University of Massachusetts showing how impact forces are lesser when footstrike is mid- to forefoot, the “evidence is not concrete for or against barefoot or shod running. If one is not experiencing any injuries, it is probably best to not change what you’re doing.”
Then again, if you do experience a lot of running injuries, you might want to try the minimalist approach. The key, according to all of these experts, is to move into either a less constructed shoe or barefoot gradually. Dr Lieberman suggests you, "remove your shoes for the last mile of your usual run and ease into barefoot running over a period of weeks." It all depends on the individual, how fast or slow they should move into the minimalist shoe or barefoot running, but I would err on the side of caution. Dr Lieberman also mentions form--running with a shorter stride and landing lightly. As I tell all my runners, "run tall, run relaxed, run easy."
Tuesday, June 7, 2011
New Research on Barefoot Running vs Shoes
My new runner Tom directed me to this post by Dr Ross Tucker on his blog, The Science of Sport (http://www.sportsscientists.com/2011/06/barefoot-running-shoes-and-born-to-run.html). He writes about a recent meeting of the American College of Sports Medicine (ACSM) where the topic of barefoot running was discussed. Two top scientists in the field, Dr Irene Davis and Dr Daniel Lieberman, presented new research they have done (http://www.ncbi.nlm.nih.gov/pubmed/20111000). For anyone thinking of trying the more "minimalist" approach to running--barefoot, huaraches, minimalist shoes--Dr Tucker's post is a must-read.
Sunday, May 15, 2011
Beginning a Meditation Practice
Six weeks post-op... I am pool walking and moving around better. I still cannot walk for any length of time or be on my feet a whole lot--starts to hurt.. can't believe how much you lose by being partial weight-bearing for five weeks. But my gait, the way I walk, feels more normal than I have felt for a very, very long time. That's great!
I see my surgeon this week; my PT wants to ramp up the intensity of my therapy. I think I will be able to start swimming, maybe pool running.
One of the good things that has come out of my down time these past couple months is that I have had the time to begin a meditation practice, something I have always wanted to do, but couldn't sit still, stay my mind long enough to really get into it. Going for a run was always a lot easier. Well, since I haven't been able to even go for a walk, much less run, or even swim or bike or kayak or workout in the gym or even do yoga... I've had the time. To sit and breathe... and watch my thoughts, and breathe... and calm my mind, be still... and listen, and breathe...
And I'm kind of getting it.. starting to anyway. I am doing some yoga now; my hip joint is still limited in movement, so I can't do a lot of the poses, but I can do some. And then I sit with my eyes closed for 20 minutes, and breathe and be still, and listen...
I see my surgeon this week; my PT wants to ramp up the intensity of my therapy. I think I will be able to start swimming, maybe pool running.
One of the good things that has come out of my down time these past couple months is that I have had the time to begin a meditation practice, something I have always wanted to do, but couldn't sit still, stay my mind long enough to really get into it. Going for a run was always a lot easier. Well, since I haven't been able to even go for a walk, much less run, or even swim or bike or kayak or workout in the gym or even do yoga... I've had the time. To sit and breathe... and watch my thoughts, and breathe... and calm my mind, be still... and listen, and breathe...
And I'm kind of getting it.. starting to anyway. I am doing some yoga now; my hip joint is still limited in movement, so I can't do a lot of the poses, but I can do some. And then I sit with my eyes closed for 20 minutes, and breathe and be still, and listen...
Thursday, April 28, 2011
One Month Post-Op and Zoe Koplowitz
Four weeks post-op...
Two weeks since I started PT...
One more week with the crutch and brace, says my therapist. Still have to limit time spent on my feet. But, I am seeing some improvement from when I began the therapy.
As I continue to "crutch around" I have had memories pop into my head...
"Have a dream, make a plan, go for it.
You'll get there, I promise."
Said by Zoe Koplowitz, Achilles Track Club member with multiple sclerosis and diabetes, after finishing the 1993 New York City Marathon, on crutches, in over 24 hours. Koplowitz has completed every New York City Marathon since that first one, plus Boston and London, all in over 24 hours, for a total of 22 completed marathons. She continues to be an inspiration to all who hear her story.
New York 1993 was my first marathon. After awakening the next morning, terribly sore but immensely happy, after having my coffee and a big post-marathon breakfast, I remember watching the news on TV in my hotel room in New York, and seeing this incredibly brave woman, Zoe Koplowitz, on crutches, surrounded by the New York City Guardian Angels, slowly, deliberately, walk across the finish line in Central Park. I am sure she too was.. "terribly sore but immensely happy."
Two weeks since I started PT...
One more week with the crutch and brace, says my therapist. Still have to limit time spent on my feet. But, I am seeing some improvement from when I began the therapy.
As I continue to "crutch around" I have had memories pop into my head...
"Have a dream, make a plan, go for it.
You'll get there, I promise."
Said by Zoe Koplowitz, Achilles Track Club member with multiple sclerosis and diabetes, after finishing the 1993 New York City Marathon, on crutches, in over 24 hours. Koplowitz has completed every New York City Marathon since that first one, plus Boston and London, all in over 24 hours, for a total of 22 completed marathons. She continues to be an inspiration to all who hear her story.
Zoe Koplowitz
Tuesday, April 19, 2011
Boston Memories
I pulled out my Boston Marathon book tonight--Hal Higdon's 1995 Boston. It tells the history of the running of Boston, with all the great runners and great races there. I reminisced about the years I ran Boston, and the time I met Boston Marathon great, Johnny A. Kelley.
In early 2002, I ran, and won (women's overall) a 50k over in Sarasota, the Knight Trail 50k. Johnny Kelley and his wife used to winter in Sarasota, and the race directors had persuaded them to join us for the post-race picnic they put on for us. He was there to greet us as we crossed the finish line. His running advise to me? The Finns told him to "start your workout with 300 yards or so of fast walking, then jog at an easy pace and slowly build up to your faster running."
2002 Knight Trail 50k -
Me, Johnny Kelley,
& Men's Winner Danny Ripka
Kelley won Boston twice, in 1935 and 1945; came in second seven times; and placed in the top ten 18 times. He continued to run the full marathon up until 1992 at age 84. Out of 61 Bostons he started, he only dropped out three times, for a total of 58 finishes.
Monday, April 18, 2011
Boston Marathon 2011 - Wow!
Oh my!
Men's world record broken - by Kenyan Geoffrey Mutai in 2:03:02! (old record - 2:03:59)
Women's race - American Desiree Davila back and forth with eventual winner Kenyan Caroline Kilel, 2:22:36 and 2:22:38!
American men's record broken by 40 seconds - by Ryan Hall in 2:04:58!
Wow!
Wish I had been there..
Elite Women's Start
Elite Men
Ryan Hall
Mutai crosses the finish line
Davila and Kilel down the homestretch
Then it's Kilel and Davila
And Kilel wins it!
Men's world record broken - by Kenyan Geoffrey Mutai in 2:03:02! (old record - 2:03:59)
Women's race - American Desiree Davila back and forth with eventual winner Kenyan Caroline Kilel, 2:22:36 and 2:22:38!
American men's record broken by 40 seconds - by Ryan Hall in 2:04:58!
Wow!
Wish I had been there..
Elite Women's Start
And Kilel wins it!
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