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RE: Re: Pose Method runner w/ Hip pain, post meniscus rehab.
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 29, 2008 2:32:06 PM
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bonez
Posts: 171
Joined: August 29, 2007
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I can think of several things to consider but self treatment/assessment at this point is certainly NOT one of them!
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 29, 2008 2:54:50 PM
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rru2s
Posts: 17
Joined: February 7, 2007
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I plan to followup with professionals -- there are many possibilities but looking for direction.
In the absence of constructive advice, merely repeats the old aphorism, "self-help is bad" doesn't provide any advice on the path towards answers.
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 29, 2008 6:03:48 PM
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Tom Reeves DPT ATC
Posts: 388
Joined: March 14, 2006
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rru2s,
for what its worth, it seems to me that you are doing exactly what a sensible person would do. You have sought medical advice that you have discovered to be less than state-of-the-art. You have investigated things on your own so that you could be an informed consumer. You have gone through the channels that you insurance provider demands, and getting insufficient relief are looking for other channels. you have provided this forum with interesting and appropriate (obviously informed) information. I understand that you are not treating yourself.
It is unfortunate that your HMO limits your access to the best possible providers.
I don't understand why some on this forum seem to be somewhat belligerent toward you and your posts.
My two cents: HMOs are cheap because they decide for you who you can see. If you have choices, pick a different provider. Or, pay out of network costs to see the professional you want/need to see. One of the big problems in health care( and there are many) is that the consumer does not get to chose and participate in how they spend their health care dollar. Further, all too many of my patients want a magic wand waved to make their pain go away. You are not that type of person and I commend you for it.
End of sermon.
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 29, 2008 9:31:38 PM
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bonez
Posts: 171
Joined: August 29, 2007
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Tom with all due respect I did reread the entire tree before my post and there is still no actual professional functional/gait analysis. There is all kinds of complaints about hmo etc and self research but I find no actual posted analysis. We both know that an Ortho eval is from a surgical patho direction. While the poster has done much research it is useless to speculate on causation via this format as all it will do is cause more self analysis. I would also suspect from the posts that rru2 is posting on several different forums.
With this problem obviously recurring and at one point progressing to a stress fracture the correct answer is to quit all running activities until it is diagnosed and solved. We have all been involved with people who have stress #ed and continued to play competitvely and re injured til there is never complete healing. It is obvious that running is this persons life so why the buck against skipping on the HMO? The longer we foster this support the longer til rru2 goes out of pocket getting to the bottom of this and gets fixed.
quote:
ORIGINAL: Tom Reeves DPT ATC
rru2s,
for what its worth, it seems to me that you are doing exactly what a sensible person would do. You have sought medical advice that you have discovered to be less than state-of-the-art. You have investigated things on your own so that you could be an informed consumer. You have gone through the channels that you insurance provider demands, and getting insufficient relief are looking for other channels. you have provided this forum with interesting and appropriate (obviously informed) information. I understand that you are not treating yourself.
It is unfortunate that your HMO limits your access to the best possible providers.
I don't understand why some on this forum seem to be somewhat belligerent toward you and your posts.
My two cents: HMOs are cheap because they decide for you who you can see. If you have choices, pick a different provider. Or, pay out of network costs to see the professional you want/need to see. One of the big problems in health care( and there are many) is that the consumer does not get to chose and participate in how they spend their health care dollar. Further, all too many of my patients want a magic wand waved to make their pain go away. You are not that type of person and I commend you for it.
End of sermon.
< Message edited by bonez -- May 29, 2008 9:37:53 PM >
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 30, 2008 7:48:43 AM
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Tom Reeves DPT ATC
Posts: 388
Joined: March 14, 2006
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bonez
Yes, he should get to someone who can watch him run with an educated eye. Most people rru2s included, figure they pay enough for their insurance and don't want to pay outside the policy. when he eventually sees a good PT he will recognize the value of our training. that is the first step toward becoming the provider of choice for these things.
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - June 2, 2008 3:57:11 PM
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rru2s
Posts: 17
Joined: February 7, 2007
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Interesting advice on gait analysis, shoe wear, and LLD. Thanks people.
Plausible reason for a LLD might be because of the 2005 major left knee meniscal damage.
In addition, the knee injury had major influence on restricted ROM for over 8 to 9 months, and even after that, I had a tad bit of knee instability or slight achiness walking on very uneven ground.
So a functional gait analysis might be useful, but I have read cases on other runners forums where one gait analysis is done and claims no problems but a second opinion says there is a gait problem.
So with that in mind, since I only see a problem with heavy exercise with distance running and only then after a couple or 3 months continually, the difference is going to be subtle.
I need specifics on where to find a list of people in my area (Phila) who are qualified to perform a quantitatively meaningful and less subjective rigorous gait analysis.
How do I go about finding someone and somewhere to do the gait analysis properly:
(1) person experienced at analyzing RUNNING gait, not walking gait (walking doesn't give me problems);
(2) organization that is not trying to sell me their personalized coaching method (I've already had Dr. Romanov's online coaching critique my running videos several times and also a board certified orthopedic rehab specialist review video, but both were promoting forefoot running which I gave up).
(3) what equipment and protocols must be followed -- it would seem that the interpretation is subjective unless a computer can trace the path of certain points on the body while stationary running on a treadmill. Anything short of that would be hard to find a very subtle left/right difference.
As far as shoe wear, my forefoot running shoes (Brooks Racer ST3) and the previous 2 pair of ST2's, all with about 300 to 500 miles each, show even wear left vs. right, and not really excessive wear.
But in order to reduce impact shock I might try going back to higher-heel ASIC Kayanos since all stress fractures/hip overuse events have occurred SINCE switching to lighter, thinner shoes.
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - June 2, 2008 5:26:02 PM
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Tom Reeves DPT ATC
Posts: 388
Joined: March 14, 2006
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I would contact an elite running club in Philly and ask them who their elite runners see for over use injuries. Minnesota here so I don't have any names for you in PA.
Not to be a negativist, but maybe your body is telling you that you are simply running too much?
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - June 2, 2008 5:39:40 PM
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rru2s
Posts: 17
Joined: February 7, 2007
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Thanks, Tom...it will take me a while, but I will start with the clubs that I am aware of and ask around where the elite clubs are and move up the chain until I hit the elite clubs and get the names of the gait analysis folks around here.
Don't worry about being labeled a negativist. Everything in terms of overuse or tolerance to exercise is all relative to the individual, so you have a point worth keeping in mind.
If one looks at the age-group graded lists of finishing times at the various racing events of any distance (3 miles up to the marathon), you can see that there are MANY people in the 50 to 60 year old age bracket that I am in who still run, still compete with good overall pace, and this demographic makes up a quite sizable percentage of finishers in every race. Therefore, there are a LOT of healthy distance runners in the middle-age bracket out there, and even a few hardy souls in their 70s at almost every event that draws at least a couple hundred people.
BUT -- Here is the big caveat -- a body is only as good as it's weakest link, and the nature of what defines the weakest link is highly individual and varies as a person ages.
So while I could easily run injury-free 10 to 12 miles EVERY SINGLE RUN, 3 times a week, from age 20 through age 47, after the rather traumatic knee cartilage tear, I seem to have a *new* weakest link, that being the opposing leg's hip. It may or may not be possible to run at the volume I used to...So far there appears to be a new overuse issue that began abruptly about 1.5 years after the knee injury when I finally was getting my mileage back up again. But it is a challenge worth investigating and medically and physiologically looking for a root cause, since most certainly my heart and lungs and leg muscles are nearly as fit as they were 5 years ago when I could run marathons with ease.
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - June 3, 2008 8:38:22 AM
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orthotherapist
Posts: 201
Joined: February 6, 2007
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Look at the various universities in Philly to see if they have a biomechanics lab - perhaps someone in the area does research and you could get an analysis there
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - June 3, 2008 3:51:20 PM
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rru2s
Posts: 17
Joined: February 7, 2007
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I contacted U of Delaware's Biomechanics Lab. They have a running clinic and have a person there who has been doing gait analysis for 25 years. They have published quite a few papers about gait analysis and various running issues.
Does anyone have experience with these folks as to whether they are able to do a thorough and objective assessment? I like the fact that a University is a non-profit and isn't out to sell me a complete coaching program. However, I'll likely have to bite the bullet and pay the entire cost out of pocket, so I'm going to ask for the guts of the assessment -- the analysis itself, not a bunch of coaching or therapy sessions. My overall gait is safe enough that the problem takes several months to surface, and having been an injury free runner for 27 years whatever abnormalities they identify are probably quite subtle, so a thorough computer analysis with motion trajectory and force plate is probably needed. However, they might do theirs on a static plate that you run across for 75 feet, which is different than a treadmill analysis, I don't know which method is better.
But I'll have to wait at least a month to do the analysis since I don't want to provoke the early warning signs into becoming a full stress reaction in the hip that requires another 8 month layoff.
If gait analysis looks OK, then we are down to 3 possibilities (1) too thin shoes compared to my historical shoes for 25 years; (2) I did too much speedwork too soon after the last relapse (adequate healing is all that is needed); or (3) there is an actual acquired weakness in part of my hips that means I can never go back to substantial mileage again, the cause of which is complex and may never be fully understood -- possibly a permanent injury to the lesser trochanter after trying to change biomechanics and run forefoot and do very impact-intensive drills my hip could not handle...the insertion area of the iliopsoas tendon runs into the bone in that location and if there is abnormal brittleness or fibrous pattern to the insertion area then the lesser trochanter may never have the same strength as before.
Here is an interesting article about the latter:
Shea, J.E., et.al, 2001. Evidence of a hypermineralised calcified fibrocartilage on the human femoral neck and lesser trochanter. Journal of Anatomy, vol. 198, pp. 153-162.
Quote: “Recent investigations have identified a hypermineralised tissue on the neck of the femur and trochanteric region that increases in fractional area with advancing age in both males and females… Regions of hypermineralised tissue correlate with the regions of calcified fibrocartilage from tendon and capsular insertions. The hypermineralised tissue and calcified fibrocartilage had similar morphological features such as the interdigitations of the calcified fibrocartilage into the bone, lacunar spaces, and distinctly shaped pores adjacent to the 2 tissues… The lesser trochanter exhibited regional differences in the fractional area of hypermineralised calcified fibrocartilage and cortical bone but not porosity of the cortical bone. The effects of calcified fibrocartilage on femoral neck periosteal expansion, repair, and mechanics are unknown, but may play a role in osteoporotic fractures and intracapsular fracture healing… The calcified fibrocartilage regions contained more cracks than the underlying bone, as was found in previous studies. Although many of the cracks observed in the present study may be the result of processing artifacts, it does suggest that differences in tissue properties exist. Previous research indicates that highly mineralised bone is more susceptible to microcrack formation.”
< Message edited by rru2s -- June 3, 2008 4:14:35 PM >
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