Archive for the ‘Try This!’ Category
7/14/10 Physical Therapist – “You are a lot stronger!”
Today I had a Physical Therapy appointment with Travis, and when he did the test for strength on the gluteus medius, I was able to resist quite successfully! This is a far cry from how I did on the test in February. Then, he and I got to talking about how it would have been great if we had had actual measurements in February rather than just pictures.
So, we decided to do the measurements today since I am not done, yet. There is more work to be done and more success to be had 🙂
Travis drew a line on the inside of my foot just above the arch, and he explains it below:
“The test where I drew a line on the inside of your foot is called the Feiss Line and with it I check the degree at which your navicular [the bone basically at the top of your arch] changed from a non-weightbearing to a weightbearing position. Â Ideally the navicular should stay very close to this line and if it falls closer to the floor it indicates varying degrees of flat feet. Â The distance on your R [right] foot was unchanged and on the left it was 5 mm (virtually unchanged).”
Right Feiss Line
Left Feiss Line
Woohoo! Did you read that?! My left foot arch was virtually unchanged! I’ll bet that in February it would have been quite different. I cannot help but smile at this 🙂
Next, I had to lay down with my feet hanging off the table so Travis could find subtalar neutral on my feet. He then drew a line on the heel of my foot. This is called measuring the “degree of eversion”, and he explains this below:
“Then I also measured the degree of eversion noted at your subtalar joint while weighbearing and it looked great. Â There was a minimal amount of eversion noted on the left foot and essentially none on the right foot.”
Right Eversion
Left Eversion
OMG – Are you reading what I’m reading? He just said that my right foot is basically “normal” when I am standing! I am standing in a virtually subtalar neutral stance on the right foot, which is as good as it gets. The left is only off by a tiny amount (2 degrees or something).
Now, this does not take into account when I am running, which still has some falling of the arches. So, more work to be done with strengthening the foot. However, standing still with almost normal stance is AWESOME!!
So, today he gave me 6 exercises with the caveat that I may stop the other exercises unless I have symptoms that the exercises correct. Hooray! Less exercises! Oh, wait, these new exercises are not easy….
First, I isolate the gluteus maximus by laying on my stomach and bending one leg at a 90 degree angle at the knee (where else would it bend at a 90 degree angle – duh!). Then, I lift the leg using the glute 10 times for 3 sets.
Next, I do what he calls the “stork”. I stand on one leg leaning against a workout ball. Then, I do one-legged squats (essentially) keeping my hips aligned (not letting one fall). It is harder than it sounds.
Then, he told me that I would be doing a side plank, and I told him that would be too easy. So, he told me to balance my arm on a Bosuâ„¢, then do the side plank. Once in a side plank, I lift up the top leg for 10 reps and 3 sessions. Yeah, that’ll teach me to talk smack.
Another exercise is an oldie, but goodie. I stand on a step on one foot with that foot angled in. I then lift to standing on the toe and lower to slightly below the top of the step and repeat for 10-15 with 3 sets.
Finally, I balance on a very squishy circle with my eyes open for 30 seconds. Try this at home – it is harder than it sounds. When that becomes easy, I close my eyes and when that is easy I close my eyes and then tilt my head. I’m going to look really hot in the gym when I start tilting my head 🙂
Anyway, a very awesome visit, and I hope to document even more cool changes!
Personal Trainer and Super Sets! 7/7/10
On Wednesday of last week, Melissa gave me the beginnings of my first super set, which is when you lift heavy weights quickly with multiple exercises in a row (I think). It is definitely a “big girl” exercise as I was exhausted and sore afterward and the next day.
I was extremely pleased with what I was able to accomplish because I was doing a squat with a press starting at the middle of the up movement with a 12KG (approx. 26 lbs.) kettle bell. I squatted with 26 lbs! That might not sound like a lot, but just five weeks ago I was having a hard time squatting without any weights. Now I not only squat, I press!
I am also down to the second rung on the Smith Machine for my assisted pushups.
I feel stronger, and I think I look stronger. I am still having a hard time riding my bike up the 8th Ave hill, but that will come.
I am also continuing my physical therapy exercises for the back and foot. Total it takes about 45 minutes to get through all of them. Thus, I do them approx every other day.
Whew! Still more to do! More success to be had 🙂
Physical Therapist 6/29/10 – MORE PICTURES :-) and an EDIT
This last week has been another bummer. On Friday, I spent the day in the kitchen making tomato sauce (Picture 20lbs of tomatoes, and you’re on the right track.) and baking a Yay-You-Finished-Your-First-Marathon cake for my husband. By the time he got home, my left posterior tibial tendon was crying out for mercy.
Today, at my physical therapy appointment, Travis started me back at what certainly does feel like square one. 🙁
This is just part of the process. I know that my foot is improving because it is USING the posterior tibial tendon, but the tendon is not strong enough (even with all the work I’ve put into getting it stronger), yet.
The Story of Muscle: [Edit – I stand corrected :-)]
Travis Orth, my physical therpist, had a few corrections on my story of muscle.
“So, I think you got the story of muscle close, but not quite right. Â I probably was not as clear as I could have been so here is another explanation. Â With strengthening, if you are actively completing exercises for the first 2 weeks there will not actually be an increase in muscle size, but you may experience a gain in strength. Â This gain in strength is attributed to increased muscle fiber recruitment (of muscle fibers that you already have) from your brain to that muscle group. Â It takes approximately 4 weeks to verify the increase in muscle cross-sectional area, so any strength increases prior to this point are likely attributed to improvements in neuromotor recruitment. Â This is all somewhat flexible and there is likely some actual muscle growth prior to the 4 weeks, but they are the numbers and guidelines that I like to follow. Â So with your feet, there are likely increases in muscle size, that is why you see such a dramatic difference in foot position. Â If you were simply recruiting more muscle fibers of the muscle that you already had I don’t think you would see these changes. Â Furthermore the changes are likely due to increased resting tension on the tendon, tibialis posterior, that is pulling up the arch of your foot and preventing collapse of the foot. Â This increased resting tension is from actual increased muscle size, so congrats you did it! Â However, as you have noted, there are still gains that can be made and the muscles can get even larger and stronger.
A lot of the information that I have provided is from the Shirley Sahrmann book titled “Diagnosis and Treatment of Movement Impairment Syndromes”, and she cites the article:
Moritani H, Devries HA: Neural factors versus hypertrophy in the time course of muscle strength gain. Â Am J Phys Med 58: 115, 1979.”
Travis wrote the above quote in an email after reading the blog. I thought I would share it with all of you fine folks so that you are not misguided by my not as educated guesses on muscles 🙂
——Back to the original post—-
All of this muscle building got me wondering just how my feet may or may not have changed. So, now for the pictures!
Before 2.27.10
After 6/29/10
LOOK!!! I think I can tell that my left ankle is not caving as bad! Yahoo!!!
Before 2.27.10
After 6/29/10
Are those the same feet and ankles? No wonder my posterior tibial tendon is sore. Look at all the work it has been doing! My left ankle is noticeably straighter in this picture. I cannot tell you how very good it feels to have some part of my hard work pay off 🙂
Before 2/27/10
After 6/29/10
After careful scrutiny of these two pictures I have several things of note.
1. I really need to keep the perspectives and lighting the same.
2. In the Before picture the left foot looks like a fan, but in the After picture, it is beginning to look more like a foot. i.e. the left foot getting thicker and straighter from the heel to the toe. 🙂
3. I think I see some muscles that weren’t there on the outside of the left foot!!! Yay!!!
Overall, I am really liking what I see after a mere four months! That is all! And that is a lot. I am looking at a very long time frame. The goal will come. It just might take another year.
Video!!!
Posted by admin in Training (running, cycling, etc.), Try This! on June 25th, 2010
At long last, I am going to share those videos that I have been promising.
Video #1 – Me Running from the side in late May 2010. You will see 5 seconds in my super stiff running shoes and 5 seconds in my Vibram Five Fingers (TM).
Of note: First, I run like an old lady, meaning that I have a very short and inefficient stride. This indicates that I have tight hip flexors, which has been backed up by both my PT and my Chiropractor.
Second, in my running shoes, my stride is really short, while in my barefoot shoes I extend my back leg a little more.
I find this video very eye-opening. No wonder I run a slow mile!!! I am completely wasting energy and holding myself back with my stride.
Video #2 – Me Walking heel view late May 2010. The only video I have from the heel view is of me walking/running in my running shoes.
Erin Walking Posterior May 2010
Of note: First 5 seconds are walking where the problems of the left foot arch falling are not evident. Second 5 seconds are running where several issues are quite evident. First, my left arch does fall, which means many bad alignment issues further up my leg. Plus, the major pressure is on the posterior tibial tendon to keep that arch up. Last, my right foot is turned slightly out, which causes a torque in the right knee, which I have evidence of my body feeling in that my right knee is the one that had “patellular tendonitis” (i.e. your knee hurts, therefore you have an -itis). Someday I will figure out how to get a video of me in my barefoot shoes up here, which really shows the left foot caving in.
These videos brought to you courtesy of many long hours of working with the video editor by my Physical Therapist, Travis Orth.
I also want to say that iMovie made it possible for the clips to be short and provided the ability to play cool songs rather than the foot slapping soundtrack the videos came with 🙂
Personal Trainer – Wonderful and Creative 6/3/10
So, after all that Physical Therapy/Chiropractor/Massage day, I found out no flexion, meaning very few of my old workout moves could be done. For example, no sit-ups, no dead lifts, no twisting movements (for good measure) and no lunges (also for good measure). What was I going to do for a workout?
I let Melissa, my personal trainer, know of these restrictions in advance so that she could have ample time to figure things out. Well, she was quite ready, and she told me that she has clients who have back problems all the time. So, no biggie!
Plus, despite the restrictions, this was no easy workout! She said that without lunges, that pretty much leaves squats, but it is not a problem because there are tons of those 😉
Well, good.
I can also do plank, which she took advantage of by adding the side plank. Whew, I tell you, it is really a workout, now.
I am starting to really feel stronger in every day life, and I can see the changes in my body. Finally!
Now, to get all this cleared up so I can run!
Physical Therapist, Chiropractor and Massage Therapist – Oh My! 6/2/10
So, the trifecta hits in one day! I must say that I truly do have some of the BEST doctors here in Seattle working for me and my high maintenance body.
This morning I went to Travis Orth, my awesome physical therapist, to report on my exercises. Lo and behold it is NOT my piriformis muscles because all that piriformis work did not do a whole lot. He said that he really thought it was my back, which was fortunate because I had a chiropractor appointment this evening. So, I have a whole new set of exercises to work on the multifidus muscles, which function to move the spine as a whole.
Fun Fact: according to Dr. Larry, my chiropractor, the multifidus muscles are unique in that each section works independently of the other sections both up and down the spine as well as the left and right. This means that the right lower multifidus can fire independently of the upper or left multifidus. Cool, huh!
Back to Travis, since it is my back, I am no longer allowed to do any exercises with flexion (meaning bending over). So, the dead lifts are out; the balancing bends, out; lunges, out (for good measure; biking, out (sitting in flexion); etc. However, I can walk (on treadmill or outside) and use the elliptical machine.I also have to sit in the neutral spine position at all times.
Fun Fact: To find neutral spine, lay on your back with your feet on the floor and knees bent. First lift your lower back in as high of an arch as possible. Then, press your lower back down as much as possible. Neutral spine is the position in between these two positions. Thanks, Travis!
So, I then head over to Dr. Larry’s office where he says that he thought he was my back all along 🙂 Anyway, the L5 adjustment was just the same as my lower back adjustment, but more focused on the specific vertebrae. I also requested a set up on the shoulder, which did the trick, and he pulled my left hip and ankle to pop them both. It was a fantastic adjustment day.
I then head into my massage therapist, Linda this week (“Where’s my jello?”). So, I’m explaining the sciatic and how it’s not piriformis, etc. Somehow I tell her my hip flexor (the ilopsoas) is really tight on my right side. She says that it is connected to the L5 vertebrae, and that she has to go in from the front to get to it since it is a deep muscle. Wow!!! I had never had anything like that done. Plus, if the hip flexor is pulling the vertebrae to the right, then no wonder it is the left sciatic nerve with issues.
This is getting better and better! I’m feeling like we’re about to figure some major stuff out.
Well, this massage was simply wonderful and very needed. I had knots in my right and especially my left quadriceps and my left hamstring was really, really sensitive. Linda said that my IT bands felt way better because they were moving rather than just stuck together! Yay!!! That is awesome because I have been working on them for a very long time, and, finally, I have confirmation of progress! Yippee!!!
Also, she worked on the left and right ankles. Well, that left ankle hurt me and apparently her as well because it was so tight. Then, she moved to the really weird iliopsoas muscles. She basically pushed down through the hip bone to the back where she just kind of pushed on the hip flexor. My left side was super easy, but my right side (the tight one) was incredibly painful.
I also asked Dr. Larry if I needed to sleep a certain way, and he said no. Just sleeping on different sides is good enough, and my husband confirmed that I am definitely sleeping on multiple sides with the fact that I always end up with the covers on my side or wrapped around me as proof. Dr. Larry also said that if my hip flexor was tight he would do some activation on it next time.
So, in summary, no running and no exercises with flexion until I have had a chance to further strengthen my back and get the sciatic inflammation down. Still a work in progress….
Physical Therapy Visit 5/26/10
It really does take a Village!
Today, I went into Travis after having an increase in the “pulling” sensation in my left hamstring and sometimes my upper calf muscle. I showed him where my problem was, and he said that he did not think it was my hamstring. After several tests, he hypothesized that the sciatic nerve is being irritated by the piriformis muscle (this is a muscle that wraps around your hip bone from the tail bone to the top of the femur or big leg bone).
HA! Once again the symptom is not really anywhere near the problem! The idea is that the sciatic nerve runs under the piriformis. Thus, when the piriformis is tight (mine is), then it places pressure on the sciatic. Pressure on the sciatic equals irritation further down the leg.
So, if this sciatic nerve hypothesis is correct, then it explains why glute exercises irritate it. When I work out my glutes, then I am definitely tightening the piriformis muscle, thereby irritating the sciatic – VOILA! My hamstring feels like it’s “pulling” or doing all the work.
Wow, if this is correct, I am going to advertise for real for my physical therapist!
The exercises:
I am to do a slumped stretch where I slump over as much as possible with my hands completely limp and resting on the chair behind me while I lift my leg just enough to stretch but not irritate the sciatic nerve.
Then, a “press-up” where I lay on my stomach and press up with my arms. This is to help relieve any pressure that might be coming from misalignment in my back (I’ll get back to that as I am now going to call my chiropractor to consult him).
Next, a bridge to specifically use my lower back.
Finally, a stretch for the piriformis.
Oh, I’m also supposed to foam roll the piriformis when I foam roll the IT Band.
So, I have a plan. I have a new diagnosis that is much more plausible. However, this is still a hypothesis.
As for how my chiropractor fits in: Travis said that when folks have sciatic nerve problems a lot of time it starts when the vertebrae put pressure on a disc. So, there could be a possibility of my having a disc out of place or something, but my symptoms are so mild that it is probably not that severe. I am going to call Dr. Larry tomorrow to talk about it.
Anyway, several things fell into place if the sciatic nerve and the piriformis are to blame. First, I have not had problems with the sciatic in a very long time – maybe a year, and that includes all the running I did at the start of this project. The one thing that is true for that point in time is that I was getting a back adjustment and an hour-long therapeutic massage every two weeks. It has been over 5 weeks since my last massage, and I had not had an adjustment in 4 weeks when I saw Dr. Larry last Friday.
Put that all together and my piriformis has had the chance to really get tight, and my back could have gotten all kinds of out of whack. Plus, when you are not getting regular adjustments, your body tends to not hold them as well. I know all this seems to point to the fact that once you start chiropracti you never stop.
Well, I don’t think it’s like fast food where you become addicted, I think it is something that your body actually needs on a regular basis. I also think that everyone should get a massage at least once per month. With our sedentary lifestyles, our bodies do not get the constant movement that they were made to do. So, they get all “stove up” or tight and run down. The chiropracti puts everything back into alignment, while the massage relaxes the muscles and helps the body to hold the correct postion, especially when supplemented further by strengthening and exercise.
However, I must bid you good bye as it is time for me to ice my butt. Have a great evening!
My Chiropractor = Awesome! 5/21/10
Yes, The Village is the bomb diggety. Yesterday, I had an adjustment. It had been a month – way too long (I will be moving the adjustments to two or three weeks increments). I could tell that my right shoulder was not quite right, my right hip was definitely in a bad way, and my left ankle needed to be popped. So, Dr. Larry got to work, and I gotta say that I feel much better today!
My body has really been adjusting much better since starting a regular workout routine. I find that I am not as tight through my shoulders and back, which makes the mid-back adjustment much more effective. My hips are also much more responsive.
As for my right shoulder, I cannot say how much Dr. Larry has helped it. When I first moved to Seattle, I could not do some yoga moves or raise my right arm over my head without a lot of pain. Now, I can do anything with my right arm! Dr. Larry is really good at, nay, I think I could say he is a specialist at shoulder adjustments.
Thank you, Dr. Larry!
Shameless Plug:
Dr. Larry Thomas Capital Hill Chiropractic 123 Boylston Ave. E, Suite B Seattle, WA 98102 206-623-5202Tell Rob I said, “Hi!”
Continued Workouts!
So, I am very happy to say that I have been taking myself to the gym on days when I don’t have an appointment with Melissa! I have also realized that I need a good 1.5 to 2 hours to complete each workout she has given me (this would also include 20-30 min cardio). So far, I have only managed to get up early enough to do one hour before I must leave to get ready for work. This will not do. I think I might need to go back to afternoon workouts because I am really not willing to get up at the requisite 5:00am that getting a whole workout in before work would require.
Anyway, I have been getting through 2/3 of Melissa’s workout with my new favorite exercise being the “Smith Machine Push-up”. It is really much better for me than the traditional push-up in that you are standing at the Smith Machine (the assisted squat bar) with the bar set just above your waist. You lean down to grab the bar with your body in a straight plank leaning about 45 degrees. Then, you do a push-up with the FULL range of motion. This is the part that is fantastic because you really use your pectoral muscles as well as stretch them at the same time. I am very tight in the shoulders and pectorals, and this exercise gets into the muscles and your small muscles in your back. LOVE IT! I can do three sets of 18!!! Woohoo!
Notable improvements:
I can deadlift 45 lbs. (up from 35 lbs three weeks ago).
I can do 3 sets of 18 Smith Machine Push-ups.
I increased my ability to hold the plank from 1 minute to 1.5 minutes!
I can do 3 sets of 15 prisoner lunges (so difficult for me because I am so wobbly and week in the legs).
Overall, my body feels stronger and much more agile. I do not favor certain muscles when walking or climbing stairs, which I did not realize I was doing until I wasn’t doing it anymore 🙂
My final thought – go to the gym and do something!!! You will be amazed how much better you feel.
Personal Training #3: 5/3/10
The butt kicking continues! After a really awesome weekend, which truly circumvented any working out, I jumped on the opportunity to have an appointment today, Monday, to start my week off right.
After having dragged myself out of bed too late to do actual gym work, I was elated to discover I could have Melissa driving me to work super hard this afternoon! She is really fantastic.
Today, we concentrated on my back muscles. I have a new way to do pushups. I’m up to 45lbs on dead lifts! Hooray! I started at 35 lbs three or so weeks ago. We also did some balance moves and more core work. I am really excited as my list of exercises continues to grow!
I also did not feel nearly as wobbly during the workout. Of course that might have been because we were not really doing my legs 😉
Anyway, all continues to go well. I am happily icing and then I plan to be up and at ’em for an early start in the morning to continue my physical therapy and personal training exercises! So much to do!