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| foomiler |
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Tibialperoneal Trunk, Jason Dunn, and others interested, Besides what you're doing right now, try working on your coordination. What I mean is that there's a pattern of muscle firing that should occur each time you walk or run, but for some reason you just cannot access it even after resolving whatever shows up on scans or doctor's opinions, etc. The issue of gluteal strength has to connect with how you activate it during ambulation. If your psoas is strong and flexible, you shd be trying to get it to fire concurrently with yr glutes and low abs each time you take a step. What I mentioned about "hip suck" comes into play here. You've got to fire the psoas at the hip joint region at the same time you get the glutes to contract, meaning the muscles holding the femur from front and rear fire together each time you shift your body weight from one foot to the other. This alone will see the foot being picked off the ground. The TVA and lower abs also contract to hold the pelvis and spine in neutral, while you pick your foot off from the ground. This does not mean you are crunching your stomach as you can contract your abs even when holding your trunk tall. Try to get a feel of the respective muscles firing. This may be tougher with the psoas, but its worth while learning how to "hip suck" because if your psoas do not contract when you perform glute exercises, you may not be strengthening the glutes much at all in all yr exercises, but instead be recruiting the quads/hamstrgs/TFL, thus wasting all those glute workout sessions. When you run you shd try not to lift the thigh and reach the lower leg foward, but simply pick up the lower leg under your hips even as you are consciously activating your psoas/glutes/abs. There shd also be a notable body weight shift each time you take a new stride. If your tendency is to keep your trunk stiff or on one side more than the other you will find that the glutes turn off, and yr stride messes up. A lot of the foot/lower leg nerve problems you experience can come from the misplaced steps due to poor trunk positioning and poor psoas/abs/glutes recruitment. This can happen even if you've got super strong in these respective muscles because you haven't yet learnt how to piece it all together in terms of muscle firing pattern. I can't say the same for those with hip labral tears, but you can try it and see if it helps. For those with purely trouble in activating the glutes, you do need to re-learn how to use the muscles at yr hip and core to effect movement, or having those big strong glutes will count for nothing. |
| TDF |
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foomiler, Have you seen something like this? Would it be something that works on the firing patterns as you suggest? http://boddickerperformance.com/?p=990 or can you point to something similar that "trains your brain" to move with correct patterns with the psoas and glute? |
| fly137 |
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foomiler, You seem to be pretty adamant about restoring normal firing patterns to the glutes. And I don't think you are wrong per se. I certainly have some abnormal firing issues with my glutes and hip flexors. The question is, "Why did this happen?" I don't think my mind decided to shut off one day. Plus, why do I feel sensations in my leg when I am sitting right now and typing. My opinion is that there has to be some sort of underlying issue. Maybe vasuclar, maybe labral tears, maybe pinched or entrapped nerves. Whatever it is, is causing some muscles to become weak or inhibited. Then, being the adaptive, compensatory beings we are, we used other muscles to do the work those weak or inhibited muscles used to do. I have done lots of motor recruiting work. Not just strengthening - but the hip suck you describe and all sorts of exercises where I focused on contracting my glutes and sucking in my lower abs. And they helped. But they didn't fix the problem totally. And the week I stopped - thinking I had basically fixed the problem, the symptoms came on again full tilt. All this leads me to believe that the exercises were countering the effects of a basic underlying issue. Basically the exercises were battling against this problem - labral tear? compartment issue? - for control of my muscles. And the problem won. Which means, as far as I can figure out, that I need to get to the root of it. Then - and only then - can your recruitment exercises really work. |
| milerpt |
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I've been doing some research. I was already looking at pathoanatomy involving compromise of the femoral bundle (artery-vein-nerve)when Tibialperoneal Trunk reported on their vascular findings. While there is not much research on runners, there are other pathologies with similar symptoms. One possible explanation is adaptive shortening of the psoas-iliacus-iliopsoas group. Most know that distance runners do not typically have well developed glutes but have well developed hip flexors. The femoral nerve is susceptible to compression at the distal psoas just prior to crossing the inguinal line/hip joint and merging with the iliacus to form the iliopsoas. The artery and vein run right with the nerve. I would assume, based on anatomy all 3 of these structures would be further susceptible to compression by the iliopsoas. Some call this iliopsoas syndrome. Some on this thread have ID'ed activities such as hill workouts or sit-ups trigger their symptoms. These put the muscle group in shortened positions as does sitting especially for long periods of time. Do an activity enough over a period of years, couple it with an anatomy that is predisposed, and you'll get adaptive shortening. When I've got more time I'll talk about what someone might need to do to get resolution. |
| fly137 |
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So, I say back down, specifically in the hip, specifically a labral tear. And, I say glut exercises aren't enough. Essentially, the "seal" if you will, in the hip is broken and it can't properly stabilize. Thus, the muscles around it live in a state of dysfunction. Before I even knew I had a labral tear, I described what I was feeling as my leg feeling like it was a lightbult loose in a socket and it needed to be tightened to work. I don't want to do Foomiler's flipping glut exercises. I've done them... FOR YEARS. And, know I now they are never going to FIX my problem. No amount of strengthening exercises has ever eliminated my symptoms. -----I am about 95% in agreement with this post by Miss Osage County....Just got back from yet another doctor. He was baffled too. And he sent me to see yet another strength expert. BUT the muscles are out of whack for a reason. This is not a garden variety muscle imbalance that happens from compensating alittle too much for a blister or something. The muscles are permanantly going to be that way too. That is, unless the stability in the joint is normalized. Now the million dollar question is can surgery for a labral tear fix this problem? |
| An elite |
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With regards to the above: are people getting checked for a labral tear (~MR arthrogram), or are they assuming it's neuromuscular only (and treating as such)? |
| lizard king |
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Track Dude, I was wondering if you have had any success with your condition after visiting the speed clinic last year. If so could you be more specific on what other types of strengthening and stretching work you have done. I have had this problem for the last 7 months and have seen no improvement. I can notice my leg losing control at all speeds, even walking. I have a very tight feeling im my right tib anterior region, and also tightness in my right glut med, Does anyone else have the tib anterior problems? |
| foomiler |
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If you've read the first and final paragraphs of my previous post carefully you would see that there's no contradiction between what I've proposed and what you've written above. |
| foomiler |
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I would direct you to wannagetfast.com as one way to see what I'm getting at. The author Chris Korfist has written articles on how to get his sprinters to activate their glutes and has made an especial link between the big toe and the glutes. Its nothing as systematic as what you've provided in your link, but what I'm saying is that its basically a total body re-orientation of how to move itself, relying not on muscular force per se, but on astute positioning of one's centre of mass at each intermediate phase of a walk or run in order to get the right muscles to coordinate with each other efficiently. It goes beyond static recruitment exercises and includes being conscious of what you are doing when you run, instead of just switching to zone-out mode, which a lot of runners like to do. Running for me is a skill that you need to learn and practise, and proper technique and posture engages the right working muscles, provided they are strong enough. I'm sure there are others out there who have better links to what you're looking for. |
| Miss Osage County |
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Foomiler, Did/do you have this injury? Have you reduced or eliminated your symptoms with what you talk about in your posts? I'm just curious if you have any first-person results or specifics. You just seem very confident in your knowledge about the ways to "correct" this injury when you post. Yes, flexibility, strength, biomechanical efficiency, maintaining the kinetic chain with proper sequential muscle firing, proper breathing... for *any* runner, injured or not, attention to these areas would be a good thing, and would probably make them a better runner. BUT ultimately, would it be enough to correct the injury? Has it for you? |
| it is what what is it |
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Osage, the contributions by 'foomiler' on this thread are nothing short of OUTSTANDING! What you evidently have yet failed to realize is that there is not just one specific problem, such as a 'torn hip labrum' that, is going to be the defacto injury which manifest all of the physiological symptoms common on this thread. And I wonder whether tears in the hip labrum, at least to some degree, which can now be more accurately imaged with modern methods, can nonetheless be a 'red herring' in diagnosing the root problems; something to consider. |
| fly137 |
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Though both Miss Osage County and I do have labral tears, labral tears are, by no means, the only reason that muscles develop improper firing patterns. What she has been saying - and I absolutely agree - is that the muscleimbalances are not the likely CAUSE of this problem, but rather the EFFECT of some underlying injury. If this were a case of just plain imbalances, then 2 months worth of the exercises foomiler has been suggesting from the beginning would have probably worked for one of us. I have already said that doing the sorts of exercises he recommends, and which were prescribed for me at the UVA Speed Clinic, did help to some degree. But they did not fix the problem, and the minute I stopped doing them (after about 2.5 months), my symptoms came on again. This result tells me that something besides inactive glutes is the problem. Something is actually causeing the glutes to be inhibited. More and more I am thinking that my adductors and hip flexors are working to stabilize the joint and so they CAN'T really get loosened up to let the glutes work or else the joint will become horribly unstable. The minute the underlying issue is taken care of, then foomiler's exercises will become crucial, but until then the most important thing is finding out the Cause of the imbalances. |
| mlbfan24 |
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I agree that the imbalances are not a cause, but rather an effect in this situation. I'm basically retired from running at this point because of the frustration of this injury, but I still deal with it every day. Even leg exercises at the gym, such as romanian deadlifts, regular deadlifts, squats, etc. affect my leg when I lift at a high percentage of my max. I'll feel my right leg shaking/buckling a bit and my right hamstring and calf seem to be the first muscles to quit on me. In my opinion, it's either rooted somewhere in the back in some form of nerve dysfunction, or as talked about elsewhere on this thread, it could be vascular issue. |
| MUST READ |
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STRENGTHEN THE POPLITEUS MUSCLE of the affected leg. This is a muscle that controls the flexion of the knee. Sit in a chair and put the foot flat on the floor, then practice SLOWLY SLOWLY SLOWLY sliding the foot in towards the midline of the body. Do 10 repetitions. |
| foomiler |
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I suffered from this problem for about 12 years. It was on and off for the first 7 yrs but when I popped my right achilles during the 8th yr I started to fall apart totally. Same symptoms as most people here, most of what you and Fly 137 described too, like numbness/pain even when seated/stationary. Problem left hip seemed to give up in longer runs/races at first, then later even in shorter ones. Am I better now? Yes. But because part of my pathology has to do with my left leg being anatomically shorter, the only permanence in my healing comes from being able to execute correct technique conducive to glute firing, and not relying on equal foot contact on the ground. That means that I can no longer daydream in my runs, but to be technique conscious all the way, like in practising other skill sports, or in Yoga and Pilates, and in weight-lifting. If I fail to fire each glute successfully, but because of fatigue/loss of concentration, turn to the leg muscles primarily for propulsion, trouble's always around the corner. I'm in a state of constantly refining my perception and remodeling my bodily habits, a kind of rehab from the bad movement patterns of the past. Like all ex-smokers or -alcoholics or -drug addicts, I'm always one slip away from reverting to previous self-destructive ways. Kind of a self-imposed "poor coordination anonymous". Personally I do not believe in being prescribed exercises, like being prescribed medication from the pharmacist, in which you simply follow the instructions and ingest the required dosage, and then hocus pocus you get well and never need to do any thing about it ever again. Neuromuscular coordination pops in and out of effectiveness according to changes in our ever changing psychological/emotional/spiritual/physical states. An exceptionally stressful lifestyle in which one becomes a workaholic without sufficient recreation/rest will have as much impact on our physical coordination as overtraining per se. An extremely introspective person, a perfectionist who worries and worries and sweats all the small things, or an overachiever who is consumed in a neverending quest to beat everyone in class/work; all these are very likely candidates for coordination issues because excessive tension tends to shut down certain neuro-functions in favour of others. If you tend to tense up yr shoulders or groin area regularly, you've probably stepped into that unhealthy zone, and tension in the said areas will shut down yr glutes. Some more exercises to consider: One further glute-firing cue to add on to what I've written earlier is BACKWARDS RUNNING. This helped me a lot. If you can reproduce the muscle firing in your body's posterior chain that occurs while running backwards during forward running, chances are, your hip and postural muscles will work in proper tandem. I believe this is because we do not rely as much on the leg muscles to push our bodies backwards as we do on re-positioning our centre of mass with each succeeding backward stride. We also tend to pick up our feet more than pushing them off the ground, which sort of 'hooks up' the butt from behind, not allowing the hip to over-extend which leads to overstriding and injury (in particular to hip flexors). You also learn better balance on each foot and how to re-distribute yr body weight as you shift from one foot to the other such that you do not emphasise one side over the other, which can also lead to misalignment and injury. Other activities like backwards skipping & backwards bounding up and downhill, hurdle mobility drills also teach the body to utilise the glutes together with the psoas while challenging the core to hold up an optimal posture. My healing also accelerated when I realised the need to be more athletic in all planes of motion, and not just the sagittal. I realised that if a runner can get stronger and more coordinated in the transverse, lateral and frontal planes then she/he will experience a re-proportioning of skeleto-muscular structure which relieves tightness that comes from imbalances. There's a very strong need to make a runner's true base to consist not only of more aerobic mileage, but also of developing agility, basic speed, physical strength, mobility, flexibility, eye-hand coordination, etc. or the runner will soon find her/himself unable to fire certain muscles in a coordinated way, even in something as apparently simple as running itself. I can only say that I hope all this will be sufficient to correct this coordination problem, which I do not necessarily label as an "injury" per se, but more of a "condition". Every person who comes onto this discussion may have vastly different needs which may or may not apply to what I've written, but still I share with hopes that those who do have compatible issues will find something to work towards. I have insufficient knowledge of how to conclusively treat the hip labral tears which you Miss Osage County and Fly 137 believe you have. But I believe that even if these exercise do not heal the result of the tears, you still need strong and functional glutes anyway. Can you imagine that when you eventually resolve yr underlying injury, you find yourself with hip muscles too weak to support yr pelvis? Won't that leave the hip joint extremely vulnerable? If you only start yr strengthening/muscle recruitment work then, won't healing take that much longer? Also, being strong now will prevent overstraining yr hip area in the meantime, such that you can last till a proper diagnosis/procedure can be prescribed for you. But that's just my point of view. |
| foomiler |
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Something else to check: Your trunk may be rotated more to your left, and you may be having some tension in your right shoulder. This could be due to improper carriage of your head/neck, or your left trunk muscles are way stronger than yr right, or its subconsciously habitual for some reason. Another thing to consider is your lower leg muscles may differ in strength and recruitment, esp the peroneals on the outside and the posterior tibialis. Your right psoas may be too weak and tight. |
| fly137 |
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foomiler, Your last post changes my conception of what you have been saying. Previously I thought you were like all my other doctors who think this is a plain muscle imbalance. And it is not. But you have added a cause to this imbalance - stress or tension. Very plausible. I can say that these symptoms first came on for me during a stressful time and that I am extremely competitive. I am not convinced this is the answer, but it is definitely possible. I have a few questions: How did you figure this out (I'm assuming you had some sort of stress in your life to which you can attribute this "condition.")? Are there any objective measurements that can help diagnose this: neurological tests, brain chemical tests, etc? If so, couldn't anti-depresants fix this problem? I ask my last question because, as I see it, this isn't a strength issue per se. This is a brain/neuro issue. And the problem is more likely at the brain-end of things than the muscle end. I have no strength issue with my glutes. They are strong; they just don't fire. |
| lizard king |
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Did everyone's problems get worse over time, or was it a sudden on coming. Mine started at mile 20 of a marathon last fall. I couldn't say that stress played a part in my issue, but I imagine it can slow down the healing process. Has anyone aside from foomiler tried backwards running? It seems like an interesting idea that would place a greater emphasis on the glutes and hamstrings. |
| mlbfan24 |
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Mine happened suddenly without warning 7 miles into a 10 mile tempo run while in college, but got worse over time in the sense that it started happening more frequently, then earlier into runs, and eventually I felt completely off even while standing or walking around. foomiler- you're right about my right shoulder being tight. I never noticed it as a runner since I never lifted weights, but it is chronically tight now and I can see a visible difference in my shoulder muscles. My right psoas is definitely tight and probably inhibited, but no amount of psoas stretches or foam rolling has ever been able to loosen it up. When I run, it's very difficult for me to fire my right glute, so it feels as though I am running with the side of my hip. The left leg feels much smoother. Strangely though, both quads seem to fatigue really easily when I'm running at a slow pace, but if I push it I don't notice it as much. Also in my right foot, I have the sensation that my shoe is too tight even though it isn't. I'm sure it's all connected in some way, but what that is, I don't know. The other issue that has always had me wondering is why I am able to run much more comfortably, and for a longer duration, on grass. As soon as I hit the roads, I have problems quick. I was able to somewhat get around this while in college by switching to a forefoot strike. My heel would never touch the ground, even during one half marathon I ran. I'm not sure why this lessened my symptoms, but it also didn't completely eliminate them. As for the psychological aspect, I definitely experience stress and anxiety as soon as the loss of coordination occurs. I've always figured it's just draining on me both physically and mentally to try to force my body to continue running through it, but maybe there is more to it than that. |
| quailrider |
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After lurking for the last 9 months (and having read everything from page 1) I thought I'd contribute my particulars and a few points I've figured out. Like others, my loss of coordination came on suddenly. For me it was mile 49 of the 2007 Firetrails 50 race. Most of it's trail but the first and last mile are paved bike path. Out of nowhere my right knee lost a lot of responsiveness and my foot went tingly then started to slap the ground. When I walked for a bit it went away, but it came back twice more in that last mile. I didn't think much of it as it did not reoccur in the following weeks. That is, until a long run 6 weeks later. After that it got steadily worse (occurred more and more frequently). Now nearly 3 years later I'm at the point where (after the first 10 minutes of running) it occurs every quarter mile. Argh. The best diagnosis I've gotten: "tight calf muscles." Not too helpful. (Which is why I was glad to find this forum!) The symptoms I experience might be explained by a pinched nerve, but no pain. Or sciatica - but no back pain. I don't think it's a torn labrum since I don't have any of those symptoms. Sometimes my foot feels like it's gone to sleep: perhaps this is due to decreased blood flow so it's a vascular problem ? * Like others have reported here, resting has no positive effect, sometimes negative. * I've done (and continue to do) glute exercises: they're stronger but that's it. * Sometimes my quads are really tired. (Haven't been able to correlate this with anything.) * To a lesser extent it also happens when I'm on a recumbent bike for 90 minutes or more. Stopping and walking around for a few minutes cures it. One of my symptoms - which no else seems to have mentioned - is that this problem rarely occurs when I'm going uphill. Conversely, downhill really aggravates it. And as others have said flats, especially streets, bring it on while uneven surfaces (grass, dirt areas) seem to help. Experimenting ------------- Since I've continued to run (ultra runners may be nuts but we're persistent nuts :-) I've been experimenting. Early on I found that stopping to stretch helped temporarily brought relief. Specifically: bend over and touch toes for 5 seconds, then squat down for 5 seconds, then raise butt back up and touch toes again. (While it felt great to return to normal form, it was needless to say a frustrating solution.) I started getting better when I switched to extra cushioned shoes (NB 1063's) but that only lasted for a few weeks. Not too long ago I found that using different muscles helped to relieve the symptoms when they occurred. When my foot starts to feel "tight" or "wrong" switching to "sideways skipping" or sideways walking (left foot in front of right, cross over right foot in front of left, etc) for a minute works. So does walking backwards. Contrast this with just slowing from running to walking: it lessens somewhat - but doesn't relieve - the "tightness", etc. None of this cures the problem. My theory is that whatever muscles / tendons / ligaments / nerves are involved in the problem continue to be engaged when switching from running to walking (since it's essentially the same motion). But going sideways or backwards changes to different muscles / etc and allows the problem muscles / etc to temporarily recover. If this is true then it would seem that using different muscles / etc most of the time would effectively bypass the problem and allow me to run well for a much longer distance. With that in mind I'm trying Vibram FiveFingers (KSO). These minimal shoes require a completely different running form and thus use different muscles / etc. My first little forays have been very positive. But of course the real question is what happens over a longer term. (Note: to avoid aching calf muscles you need to take it really, really slow. That's what everyone says. Take it from me: it's true. :-() |