Dysfunctional tibialis anterior?

[Phaedrus49er]

From one of my recent Running forum posts:

Houston, we have a problem. It started Tuesday, and I didn't respect it. I didn't run again until two days ago for a four-mile race, and I didn't respect it. Today, I headed out for a light five-miler, got a half-mile into it, and it bitch-slapped me and told me to respect it. A not-so-quick rundown:

--Tuesday morning, 6.5 miles at sunrise, form suffered due to several adult beverages the night before (I know, excuses, excuses). Knee fatigue noticeable in both legs, more so in left leg (quick note: my left leg constantly fatigues more quickly than my right regardless of activity yet is slightly larger than the right leg, perhaps because I've driven a stickshift in traffic for five years?). Quiet clicking in both knees (behind top of patella) lasts for several hours when walking.

--Wednesday night, dancing on a very sticky floor, lots of (attempted) twisting and sliding involved. Knee fatigue returns, and I decide to skip running on Thursday with a race coming up on Saturday. Knee clicking continues when walking.

--Saturday morning, cold four-miler, insufficient warm-up. About a mile into the run, my left tibialis anterior decides to stop contracting, meaning my forefoot doesn't lift as high as it should, further meaning my left iliopsoas (and perhaps pectineus as well) has to compensate by lifting my entire left leg higher than normal for my forefoot to clear the ground if I am to continue heel striking. The TA tightness is probably initially due to either a tight rectus femoris (via iliopsoas/pectineus) attempting to compensate for a lagging patella (remember the clicking? doesn't happen while running, just when walking) and thereby stretching the TA too far to be pliable, or due to a tight and equally compensatory gastrocnemius made to work harder since I am having to alternate with running on a forefoot strike as well. When attempting to run on a heel strike, my left leg lands heavily flat-footed with the TA out of commission, further exacerbating the knee issues (yes, significant knee fatigue after the race, yet oddly no swelling through any of this, which they usually like to do).

--Today, planned five-miler, usual warm-up. Only takes a half-mile for my left TA to shut down. Make it another mile before giving up and walking back home.

I should note that my static stretching is practically non-existent as I usually walk a good ten minutes following a run and throw in some light dynamic stretching. I usually play around on a foam roller once a week for about fifteen minutes (full body), though I'm looking to get a rolling pin-like device for more focused work (I'd be more inclined to use that than roll around on the floor).

As for pain, nothing really hurts, though today my entire left leg was a little achy/crampy on the walk back home, but other than that, just some very minor knee discomfort a couple times the past week and nothing else. It's just that certain muscles aren't working. I haven't had any running-related, lower-body issues to speak of since last fall. I should also mention that TA mobility returns an hour or so after distance running (doesn't seem to be an issue during sprint training).

I mentioned the leg strength/hypertrophy imbalance, which is easily noticeable when I'm doing squats and deads as I just feel like I push/pull with the left side more and supplement with the right, even though I make a conscious effort to reverse that; seems like some unilateral right-side emphasis work might be in order. I will say that, obviously, the bottom squat position forces the TA to be shorter, and I haven't squatted in over a week. Perhaps a clue?

Now, all that being said, time is of the essence, as always. I have a 10K in Charleston on March 31, then a half-marathon here in Charlotte on April 14, not to mention my mileage goals for these running challenges. I don't think I can beg and grovel enough for help on this, but I can try Thanks in advance for any help.

[UConnJulie]

How's your ankle mobility/range of motion?

[Phaedrus49er]

Ankle ROM is fine, full-range with no pain or hindrances at any time except when the TA lags during running, and even that's mainly just numbness. Shoes are new and custom fitted. Might do a short run in my old worn-out shoes to see if there's a difference.

Dunno if it makes a difference, but I cannot point my foot all the way down, as in if normal foot position is 90 degrees to the leg, then I can push it to only about 150 degrees, not 180. I've always been that way.

[UConnJulie]

And how much above 90 can you bend it? (into dorsiflexion) Any history of ankle sprain on that side? And this is on the larger side that is less strong?

[Bill Hartman]

First things first. Get your running gait assessed by someone who knows what they're doing. Someone like Zig at Motion DNA or I'm sure there's some running addiction group ( ) that knows who to see.

It sounds like you have pretty large kinetic chain issue involving at minimum the hip and trickling downward. the lower extremity fatigue pattern may be the indicator (sounds like you're staying in pronation too long on the affected side)

That said, you may have a bit of a deep peroneal nerve issue (this goes along with hip, ITBand, hamstring, and some other fascial issues). Have someone test your dorsiflexion manually and compare sides. Use a pretty decent level of force to test it and use a sustained force of about 10 seconds or so because it'll take a little time for the fatigue to kick in.

If you test weak or it feels like it takes a whole lot of effort to resist, go see an ART doc for a quick fix. If that doesn't work, follow up with your doc and get it checked.

Bill

[Phaedrus49er]

Originally Posted by UConnJulie

And how much above 90 can you bend it? (into dorsiflexion) Any history of ankle sprain on that side? And this is on the larger side that is less strong?

If a straight toe is 180 and normal position is 90, I can dorsiflex to about 60 (maybe a tad further) using just TA strength, though to hold both feet in that position, I can feel the left TA fatigue slightly within a couple seconds (yet maintain the hold) while the right TA remains unaffected for much much longer. I don't remember an ankle sprain on the left side, only the right, though I've had weak ankles until the last five years or so, and yes, the larger (left) side is where I'm having problems. Also of note, the left knee was slightly hyperextended in 1995 (wrestling) but only resulted in minor pain/discomfort/swelling for about a week.

I'll also throw this out: growing up, I was moderately pigeon-toed, became self-conscious about it, and attempted to correct the issue by turning my feet out to a neutral heading. My feet are now mostly neutral (with the exception of slight in-toeing/pronation following the push-off phase of a running stride), but my patella face about 30 degrees outside of center. While it appears that the knee joints swing neutrally, I think over time (while making that conscious adjustment growing up), the ball joint at the femur and pelvis did the actual compensation, turning both legs slightly outward (noticeable by looking at the upper leg muscle development--quads and hamstrings developed slightly turned out and in, respectively)

Originally Posted by Bill Hartman

First things first. Get your running gait assessed by someone who knows what they're doing. Someone like Zig at Motion DNA or I'm sure there's some running addiction group ( ) that knows who to see.

It sounds like you have pretty large kinetic chain issue involving at minimum the hip and trickling downward. the lower extremity fatigue pattern may be the indicator (sounds like you're staying in pronation too long on the affected side)

That said, you may have a bit of a deep peroneal nerve issue (this goes along with hip, ITBand, hamstring, and some other fascial issues). Have someone test your dorsiflexion manually and compare sides. Use a pretty decent level of force to test it and use a sustained force of about 10 seconds or so because it'll take a little time for the fatigue to kick in.

If you test weak or it feels like it takes a whole lot of effort to resist, go see an ART doc for a quick fix. If that doesn't work, follow up with your doc and get it checked.

Bill

Addiction? I don't HAVE an addiction! Who do you think you're talking to, huh? HUH??? I'll have to dig around for someone in Charlotte who's qualified to do a proper stride analysis. Closest thing I've had here is from a friend who manages one of the major running stores here (noted a very slight end-of-stride pronation but neutral position through the rest of the stride); also had one (sprint-focused) from Mike Mejia via Anthony Galvin back in 2002 (I think).

Oddly, I have an ART guy but no general physician. Might have to remedy that soon, though I'd prefer a doc who's an athlete himself/herself.

[Phaedrus49er]

Didn't even think about it until now, but oddly, one of my MySpace pictures shows a good example of my patella placement as well as the push-off pronation (please disregard the flailing arms ):

[UConnJulie]

I agree with Bill in that it sounds like a nerve thing ... best to get it checked out ...

[Phaedrus49er]

Awesome, thanks folks. Please send bills to:

425 W. Capitol Ave.
29th Floor
Little Rock, AR 72201

[Phaedrus49er]

Quick follow-up from yesterday: I wore a neoprene sleeve on my left knee all day at work (sitting) to keep the joint warm. The knee would pop a couple times when I got up to walk around a little, but nothing out of the ordinary (perhaps even less than it has been). I also spent a good ten minutes per leg on a foam roller doing the lower-body stuff from this article. Hurt in a good way.

With the weather being sunny and in the mid-70s today, I decided to test my theory about my TA issues affecting only my distance running. Sure enough, the theory held, and I blew threw my usual sprint session a little more easily than normal, perhaps because of the foam roller work, perhaps because I kept the sleeve on the left knee, perhaps both. In fact, I felt so good that I came home and did five continuous rounds of 1000m rowing and 10 pushups (nothing much, just something to offset the upper-body horizontal pull).

Now that I've narrowed down the offending exercise, tomorrow I'm setting up appointments with a new doctor (Burroughs worked on my girlfriend's running issues with positive results) ASAP (hopefully before my scheduled 9.5-mile run on Friday afternoon) and with my ART guy (Duffy fixed my rotator cuff injuries a couple years ago) sometime before Charleston next weekend, and perhaps follow-ups with one or both within the two weeks after Charleston in preparation for the half-marathon. Man, I love having health insurance

[Phaedrus49er]

Had doctor visit #1 today. Y'all were right on with your diagnoses from afar. After some poking and prodding (including Bill's suggestion of resisted dorsiflexion as well as a lot of comparative sensitivity checks all over my left lower leg and foot), the doctor suggested two causes for the significant relative weakness in the left TA:

1) anterior compartment syndrome (anterior shin splints), for which he prescribed me a week's worth of small doses of prednisone (basically a steroid) to see if some swelling would subside

2) peroneal nerve issues somewhere between the knee and ankle (another Bill-ism).

Considering the proximity of two lengthy (for me) races--this coming Saturday and two weeks following that--he agreed to do some patchwork on me (hence the prednisone) until after the April 14 race (I have a follow-up appointment on April 16). Aside from the 10K this Saturday, I'm not to run at all until the following Saturday (the one before the April 14 half-marathon). That'll put me off running for two weeks minus the 10K, giving me a week to get some light running in before the HM, after which I'll return to see if any strength improvements developed. If not, he suggested the possibility of basically hooking me up to an "Operation"-type probe and manually firing the peroneal nerve between various points until a misfire occurs. I also have a "very tight IT band." Guess I'll be stretching more, too.

Thanks again for everything, folks, and I'll update as updates are updated.

[RedLefty]

Originally Posted by Phaedrus49er

I also have a "very tight IT band." Guess I'll be stretching more, too.

Although there are some stretches for the IT band, foam rolling has been much more beneficial for me than stretching ever was. It will hurt, but it builds character.

[Phaedrus49er]

Originally Posted by RedLefty

Although there are some stretches for the IT band, foam rolling has been much more beneficial for me than stretching ever was. It will hurt, but it builds character.

Yeah, I come close to tears foam rolling a couple areas, namely that and my lats, but as a saying goes, pain is just weakness leaving the body. That's what I tell myself, anyway.

[Phaedrus49er]

Had my follow-up with the doc today. Since my last visit three weeks ago:

Sun Mar 25 - 9.5mi run
Mon Mar 26 - doctor's visit, prescribed decreasing doses of prednisone for 8 days, no running for 2 weeks (except the Charleston 10K)
Sat Mar 31 - Cooper River Bridge 10K
Fri Apr 6 - 5K run with 25lb backpack (yes, stupid, I know)
Tue Apr 10 - 6.5mi run
Sat Apr 14 - half-marathon

After going through my running performances, reaction to the drugs, and various mobility ranges, it was decided that I simply have an overly tight IT band, which I believe after some of the stretches he put me through (something about two years of external rotation without proper stretching) He said there was no need to schedule another follow-up unless I started experiencing similar issues again, which hopefully I shouldn't if I, oh I dunno, stretch and foam roll like I should

Thanks again for the help, folks.

[Phaedrus49er]

Thought I'd throw in a first-performance post before ending my rambling on this thread. After two days of the beginnings of properly stretching my IT band, and after a great visualization tip from the doctor on proper efficient running form (think of running ON a tightrope, not on either side of it), I couldn't run slowly at all on my 6.5 miles today, and the only fatigue I had at the end was muscular (in the right places). Knees are fine, a