See BamaDave Run (and Lift)

[BamaDave]

Originally Posted by cappuccino

more reason for you to get up the morning of the summit and get your itb to LR! Lots of people will be able to check you out and give advice.

Hmmm - that's a really good spin! I'll have to file that away for use in April.

I still think it's doubtful due to youth soccer season and my coaching. I'm already missing two games due to a gymnastics meet and the Indy Mini Marathon. So missing a third (out of 8 games!) might be pushing it.

[BamaDave]

Kevin,

Thanks again for your offer of help. I'm open to any advice you may have for dealing with this aggravating problem.

The short version is that I have run off and on since I was 12 years old (now 40) -- mostly off, but I have been running at least a few days per week consistently for over 4 years. Never any serious injury problems, and nothing that ever took me out of running for more than a few days (usually a calf strain). Since Fall 2004, I have been running a lot, as I entered my first race ever at that time and then decided I wanted to try a marathon. Mostly smooth sailing, aside from having a lot of hamstring tightness... this really started showing up about one year ago.

This past Fall, I was training for a December marathon. Again, everything was going really well. I had been training in Asics DS Trainer XI's, a lightweight training shoe... which is usually designated as neutral or having a little bit of stability. Since I weighed in the 180's this Fall, I got the idea in my head that I was too heavy for these shoes for everyday training and decided to buy a neutral cushion shoe - Mizuno Wave Creations. I used these for about one week, and after a Sunday long run, I noted tightness and some pain on the outside of my left knee and a general stressed feeling in the leg down into the shin. This was only a couple of weeks out from the marathon. My runs after that seemed to exacerbate the problems, so basically little training in the final two weeks before the marathon. Someone clued me in that it was probably my ITB, so I started stretching it, foam rolling, etc. I got to marathon day feeling reasonably good, but I could feel the tightness at the knee while running it (back in my DS Trainers - not the Mizunos), general stress in that leg, etc. and I wound up gradually slowing down and having a pretty rotten run overall. Post-marathon, knee pain started gradually increasing, and by that evening, I was on crutches and in severe pain with any weight on that leg.

I saw a sports med/orthopedist physician, who prescribed me some PT sessions. However, due to the approaching holiday, it was a few weeks before I actually went. All the PT did was assess my hamstring flexibility, which he said was good for a runner, and then gave me cortisone through an electrode injection for 5 or 6 sessions. He also looked at the wear on my running shoes and felt that my gait was appropriate in the DS Trainers, but that I was overpronating in the new Mizuno Creations I had only used for about 1-1/2 weeks (maybe 60-70 miles on these). I could see the obvious wear pattern differences myself. So, he concluded that the shoe change caused the ITB tendonitis.

Lisa~ scoped out some information for me, and I started doing some dynamic leg warmup exercises in addition to foam rolling... also started following recommendations from this PT article on ITB tendonitis that Lisa~ found.

Unfortunately, I tried running again too soon in December and wound up setting myself back fairly badly. In January, I tried yet again by just doing short fast-paced running segments with walk intervals, since faster-paced running was supposed to be less likely to aggravate the ITB. Meanwhile, I biked and continued weight training, including lower body stuff. Some of this probably continued to slightly aggravate the ITB, although I gradually have improved.

A couple of weeks ago, I had a vasectomy, which got me completely off any exercise for 8 days. During that time, I noted that I finally wasn't sensing any tightness at the knee. Sounds like a big gee duh - if I had just stayed off my legs more at an earlier point, I would probably be over this... but I'm not too good about "behaving." So, last Sunday, I decided to try running again and went out for 4 miles. Went reasonably well, but I did feel some tightness and slight pain, especially after the run. I've been foam rolling A LOT this week... and ran again on Friday morning... this time an attempt at the shorter running spurts with walk breaks. That went reasonably well... again, I could sense some tightness at the knee, but overall not much afterwards yesterday (a little bit of tightness or very slight pain at times). Today, I feel almost completely normal - this is a big contrast to how I felt after doing similar runs in January, where I would have mild pain and tightness for days or even a week afterward!

After Friday's run, my thought was to continue trying to run, but cautiously and with a slow buildup... continue the foam rolling and dynamic leg exercises before running and foam roll afterward. However, I've also decided that if I don't sense this is improving or starts getting worse, then I'm going to have to stop all lower body exercise except for therapeutic stuff for 2-3 weeks... based on the improvement I felt after staying off of it for just 8 days. Overall, I am much improved versus where I was 5 or 6 weeks ago, but I can still sense that there is some aggravation of the problem, and I don't want this hanging over me like a ticking time bomb!

I've never had my biomechanics assessed aside from the PT looking at the soles of my shoes. I had always assumed that they must be okay since I never seemed to have injury problems and was able to run in lightweight trainer type shoes without issues. The only "issue" I really have noted has been hamstring tightness for about one year. Even when I don't exercise for a stretch of time, like earlier in Feb., I still have tight hammies. I don't know whether these two problems could be related? The tight hams haven't debilitated me, although I did note a slowdown in my paces about the same time that started.

I guess this version isn't exactly "short." Thanks for any input you may have, even as a saboteur from Team One.

[BamaDave]

SAT. 3.3.07
PM WORKOUT

COSGROVE'S UNDULATING PERIODIZATION PROGRAM PHASE II
UPPER BODY - VERTICAL WORKOUT 1
PHASE 2 WEEK 1/ WKT 3

All sets = 3 sets of 12/ 90 sec rest between sets and supersets/ 301

A1. CLOSE GRIP CHINUPS: BW: 12; 10U+2A; 7U+5A (U=unassisted, A= assist with toes on bench)

A2. BB MILITARY PRESS: 100#: 12; 12; 10


B1. WIDE GRIP PULLUP: BW: 5U+7A; 5U+7A; 4U+8A

B2. DB ARNOLD PRESS: 45# e/h: 7; 40# e/h: 10; 9


C1. EZ BAR CURL: 82#: 10; 72#: 12; 12

C2. RUSSIAN TWISTS: 12; 12; 12 ea. side

-- This workout calls for lat pulldowns, but I don't have a pulley system so will have to do chinups and pullups and assist with my feet on a bench when needed. I felt pretty trashed in that second superset! Never could get to 12 reps on the Arnold Shoulder Presses.

I'm planning another running workout in the AM and then a bike ride to get my heart pumpin'...

[Kevin Littler]

The foam roller and stretching are crucial, but if your biomechanics are faulty then you will need very flexible ITB's for it not to flare up. And then, you would only get the problem elsewhere.

During the following, references to figures are from the article Lisa sent you to (as always, great links from Lisa. I'd love to see her browser's list of Bookmarks/favourites).

The reasons why it's so important to get the foot and pelvis right for ITB's:
1. If the foot pronates, the tibia rotates inwards. Of course the iliotibial band attaches to the tibia, so rotation can make the ITB taut, increasing the friction between it and the femoral epicondyles underneath it.
2. The other end of the iliotibial band is attached to the ilium (part of the pelvis). If, when standing on the affected leg (such as during foot strike in running) your pelvis drops down like in figure 11, then your ITB is also in a taut position.
3. No. 2 above happens if you have a weak glute medius. If your glute max is also weak functionally, then in single leg stance your femur may also internally rotate/adduct (ie your knee moves towards the middle of your body). Guess what effect this has on the ITB? Yep, see no. 1 & 2.

I would definitely get these checked. Alternatively, I would be happy to look at some pictures of you doing some movements that would give me a bit more info - if you didn't want to post them I could PM you my email address.

The kind of movements I would be looking at are:
- basic position in standing on one leg
- close up foot&ankle in standing on one leg/during a 1 leg squat
- front view of forward lunge
- picture of figure 2, but from side AND front.

Also, what stretches are you doing? Figures 5 and 6 are typically given, but I usually find these inadequate. The PT for our national track cycling squad showed me what she uses for her athletes, and I have found these to be awesome - I can post pics of these if you need.

If you would prefer to see a PT in person to have your biomechanics checked (I would go see one who specialises in sports, on even a podiatrist - is that what they are called in the US?), then I would be happy to post some questions that would be useful to take with you.

Cheers,
Kev

[BamaDave]

Thanks, Kevin. I'll snap some photos as soon as I can. I appreciate it!

The stretch I have been doing is the one in Fig. 5a -- the typical ITB stretch. If there are some other better ones, I would greatly appreciate seeing pics of those.

I have no plans, yet, to go back to a PT in person, although I certainly would if I can't get the problem to go away completely AND if I can find one locally who is good with this problem. I've had no luck, so far, getting recommendations for a local PT who works with runners.

[BamaDave]

SUN. 3.4.07
AM DUATHLON

RUN:

DISTANCE: 1.7 miles
TIME: 16:18

-- Foam rolled and did dynamic leg warmup before running (foam rolled after biking as well). Same run as on Friday, except I extended the running segments a little bit, so that all were 45 seconds with a few at 1 minute. 30 sec. walk intervals. This was my most comfortable running so far, although I could still feel mild irritation at the knee.

BIKE RIDE:

DISTANCE: 13.75 miles
TIME: 1:16:57
AVE. SPEED: 10.7 mph

-- Windy and cold for awhile, but it started feeling pretty good toward the end. I felt like I was a little sluggish on the long climbs, but my ave. speed on this route was pretty similar to what I was doing before my "break."

[BamaDave]

Kevin, here are a bunch of photos. Just let me know if I need to reshoot something. I wasn't sure whether to take the shots in my running shoes or not, so most of them are in the shoes. I did take off my shoe for a closeup of the foot/ankle when standing on one leg or in a single-leg squat. Also, for the "Figure 2" pictures, I wasn't sure whether you wanted me just to mimic that photo in the article (which is what I did), or whether you wanted photographs of someone performing the tests described in the figure legend. Thanks again for your help! BTW - the cat wants to know if you see anything wrong with her.

STANDING ON INJURED LEG:



STANDING ON INJURED LEG WITH SHOES:



STANDING ON INJURED LEG WITH NO SHOES:



SINGLE LEG SQUAT ON INJURED LEG:



SINGLE LEG SQUAT - SHOES:



SINLE-LEG SQUAT - NO SHOES:



LUNGE:



"FIGURE 2" SIDE VIEW:



"FIGURE 2" FRONT VIEW:



Thanks, Kevin! By the way, single-leg squatting caused more pain on the affected leg than running... if that means anything.

[Kevin Littler]

Wow Dave, good photos. I should have mentioned that the photos, especially of the foot, I needed to see the foot (ie no socks) - sorry I goofed. I will take some photos tonight of the stretches and some things of the foot that are important. In the meantime, here is my initial analysis:
1. Your distal ITB (ie the part near the knee) looks tight, evidenced by your lunge photo (the 'divot' to the outside and just above your kneecap - is this near your pain?), and figure 2 front view (see how your leg deviates to the outside - your knee should be directly in line with your hip. Also, the divot is back).
2. The foot position is a bit hard to tell in the photos, so I will post pics showing what to look for.
3. Similiarly difficult with pelvic control. Admittedly, this is much easier to assess in motion. However, your lunge and single leg standing indicates a possible weakness. Referring back to the ITB article, how many of figure 11 can you do before fatiguing/form breaks down?
4. Cute cat - does yours like to rub against your leg during single leg squats/BSS's like mine?

Might not be able to post the pic's up until tomorrow.
BTW, I'm happy to help, as long as you recognise the difficulty with intercontinental consultations . If we find ourselves going around in circles, you can always search for PTs with particular interests on the APTA website.

K.

[BamaDave]

Thanks, Kevin! I'll retake the photos.

The divot does not appear to be where my pain is occuring. The pain is down lower on the side of the knee, near the base (see arrow for approx location):



As far as the "lying down" picture - should I reshoot that one on a table instead of a narrow weight bench? Could that have altered the alignment of my knee with the hip?

I was doing a lot of those Figure 11 pelvic drops without form breakdown as far as I could tell. I think I was doing sets of 30. I actually haven't done those in awhile and should add them in with the dynamic leg routine. Those are even in the Magnificient Mobility warmup exercises.

The cat drives me semi-crazy during workouts. LOL. I generally make her stay away from me as much as possible. She is 17 years old and refuses to come out of the basement ever since we brought home two miniature dachshund puppies last May.

Thanks again!

[BamaDave]

MON. 3.5.07
PM WORKOUT

COSGROVE'S UNDULATING PERIODIZATION PROGRAM PHASE II
UPPER BODY - HORIZONTAL WORKOUT 2
PHASE WEEK 2/ WKT 1

A-C = 2 sets of 25; 201 tempo; 30 sec rest between sets and supersets
D= 3 sets of 12/321/60 sec rest

A1. REVERSE GRIP BENT OVER ROWS: 100#: 2x25

A2. BENCH PRESS: 90#: 2x25


B1. DB ROWS/ ELBOW OUT: 25#: 2x25 each side

B2. INCLINE DB PRESS/ PALMS IN: 30# e/h: 2x25


C. EZ BAR LYING TRICEPS EXTENSION: 42#: 10; 32#: 25


D. DB SWISS BALL CRUNCHES: +80#: 3x12

-- This may be the first time I have ever done 25-rep sets. I went a little conservative for the loads, and I was able to get 25 reps for almost everything. I screwed up when loading the bar for the triceps extensions and had intended to use 32# for both sets. I did seem to have the load right for the Incline DB Presses as part of that second superset, but I should be able to up the loads on the others next time.

[Kevin Littler]

Originally Posted by BamaDave

You always crack me up.

Your ITB is certainly near the arrow, but so is your lateral collateral ligament - unlikely, but possible.
Don't worry about the lying down photo. I think you're tight there, although if the ITB was really tight you would see a big tight band down the outside of the leg (see my photo).
Your glutes look alright (1 leg stand and lunge photos), and the ease you have with the pelvic movement support this.
I have attached some photos of what to look for at the foot and ankle (the 'model' isn't perfect, but I'll not highlight my imperfections ).

I haven't worked out how to add photos apart from as attachments. The following descriptions are what I was trying to convey in the photos:
Foot_Ankle Position: should be able to maintain the arch of the foot without the big tibialis anterior tendon at the front of the ankle showing (see 'Undesirable Foot Ankle' for this tendon. It shouldn't even flicker. You will probably need to put a mirror on the ground to see this in an upright position). Flat foot is also no good.

ITB Stretch 1 instructions (photo shows for right leg): lie on the edge of couch/bed, close to left hand side. Lift L leg and move R leg towards L, dropping it off the couch. Place L leg on R knee to keep the knee across and down. You want to keep a 'posterior pelvic tilt' throughout. To understand this, imagine what a dog does when it brings it's tail between it's legs - it's the same pelvic movement. You will be tightening your lower abs and glutes together when doing this correctly.

ITB Stretch 2: Picture shows stretch for L ITB. Lay on R side and reach back for left ankle with R hand (like a quad stretch). Place R foot on front/outside of L knee to keep knee pushed back and down to the floor. See where my L finger is pointing? This area of the trunk should remain in contact with the floor - it will tend to lift as you push the knee towards the floor if your ITB is tight. Also, I would hope you can get the knee much lower than the inflexible dork in the photo can . You should also maintain a posterior pelvic tilt throughout this one as well.

These are both awkward stretches, but they are (almost) the only ones where I can feel the end of my ITB being stretched. I took a photo of another one, but my form was really bad (knowing where and how my joints move I often just get into a position by feel, but this photo was not adequate for teaching purposes!).

Geez, this assessment/exercise prescription thing is hard over the internet, but we'll do our best. Have a try of the stretches and see of you can hold your arch up without tibialis anterior and let me know.

PS you might see the cat behind my leg in the standing exercises - this is the bugger that tries to knock me over. He is so enthusiastic with his smooches that his skull making contact with my shin bone actually makes an audible clunk!

[Mahler]

[quote=BamaDave]

quote]

You put your right foot in.
You put your right foot out.
You put your right foot in,
And you shake it all about.
You do the hokey pokey
And you turn yourself around.
That's what it's all about.

[BamaDave]

Kevin,

Thanks for taking the time to write all of this stuff out and take the pics. It's a big help to me. I'll work on the stretches tonight and check out my feet/ankles as well. One thing I have noticed with the running shoes that I have been using successfully for a couple of years is that I tend to break down the heels first, and the breakdown occurs on the inside of the heel. But I didn't know whether that really inidicated heel pronation, or whether I was just wearing out the shoes. This is the same shoe style for which the wear pattern of the sole looked good according to the PT I saw. I have high arches, which is usually not associated with overpronation from what I understand, but now I am wondering given that I overpronated in that neutral cushion shoe from Mizuno. Thanks again!!

John,

The next time I do the Hokey Pokey, I'll try not to have such a zombiefied expression on my face!

[BamaDave]

TUES. 3.6.07
AM BIKE RIDE

DISTANCE: 8.3 miles
TIME: 45:40
AVE. SPEED: 10.9 mph

-- Great morning for biking. I wanted to go longer but was already running late. I wish I could go mountain biking on some trails again -- I have to be much better prepared after road biking the hills around my place.