And the author of a guide for recovery from ankle surgery contacted me after finding my articles. You can read their guide here:
http://blog.garymoller.com/2015/01/first-aid-treatment-for-severe-ankle.html
Showing posts with label ankle pain. Show all posts
Showing posts with label ankle pain. Show all posts
Saturday, March 14, 2015
Progress and exercises following my severe ankle injury
Monday, March 03, 2014
Unexplained swelling of the inside of the ankle explained
This most recent time, I was being barefoot as much as possible for a
week and a half. Then I found your video (your most popular one),
suspecting that it might have some thing to do with a weak tibialis
posterior.
After a couple of days of doing the exercise (as well as being
barefoot), it seems to have resolved itself.
Do you think this is an exercise I should continue to do? Or should I
just keep it up my sleeve if the problem returns.
Cheers Malcolm
Cheers Malcolm
Video: 370,000 views and increasing by the day!
Gary:
Malcolm: What you are describing is most likely caused by a tendonitis of the tibialis posterior tendon where it wraps around the ankle bone on the inside of the foot (refer anatomy diagram above). If the foot is excessively pronating (flattening) during exercises such as walking and running, it is possible that the tendon is being further aggravated by pinching and excessive angulation as the foot flattens.
The exercise in the video is the most effective one you can do to alter foot posture and strengthen the muscles that maintain a strong foot arch. It works but must be practiced several times a week - constantly - even when there is no pain.
You can also support the arch and foot by fitting a pair of heat moulded Formthotics Shock Stop innersoles which are designed to support the foot while not interfering with natural biomechanics (a most common fault of orthotics inserts).
You may also find it beneficial to firmly massage the inner part of the ankle. If you are ever in Wellington, I can show you exactly how best to do this.
Getting about barefoot may be beneficial, especially walking and jogging on grass and sand. However; running barefoot on pavement, even with "barefoot" shoes carries with it an increased risk of injury. Although I personally get about more often barefoot each day than in shoes, and I do have very strong feet, I would never dream of running anything more than a few hundred meters barefoot on pavement. Its just far too harsh on the legs. Stick to grass and sand if barefoot running.
Malcolm: What you are describing is most likely caused by a tendonitis of the tibialis posterior tendon where it wraps around the ankle bone on the inside of the foot (refer anatomy diagram above). If the foot is excessively pronating (flattening) during exercises such as walking and running, it is possible that the tendon is being further aggravated by pinching and excessive angulation as the foot flattens.
The exercise in the video is the most effective one you can do to alter foot posture and strengthen the muscles that maintain a strong foot arch. It works but must be practiced several times a week - constantly - even when there is no pain.
You can also support the arch and foot by fitting a pair of heat moulded Formthotics Shock Stop innersoles which are designed to support the foot while not interfering with natural biomechanics (a most common fault of orthotics inserts).
You may also find it beneficial to firmly massage the inner part of the ankle. If you are ever in Wellington, I can show you exactly how best to do this.
Getting about barefoot may be beneficial, especially walking and jogging on grass and sand. However; running barefoot on pavement, even with "barefoot" shoes carries with it an increased risk of injury. Although I personally get about more often barefoot each day than in shoes, and I do have very strong feet, I would never dream of running anything more than a few hundred meters barefoot on pavement. Its just far too harsh on the legs. Stick to grass and sand if barefoot running.
Thursday, January 03, 2013
The 21 day rule for medical treatments
 |
| Not really relevant to the article; but I do like it! |
The 21 day rule
I often come across people including athletes who have been undergoing a form of medical treatment for months; sometimes longer.
It raises the question:
"How long should one undergo a course of medical treatment before calling it quits?"
As a general rule of thumb, I recommend applying the
"21 day rule"
If you are undergoing any form of treatment or therapy, be it physical therapy or medicine, apply the 21 day rule.
If, after 21 days of consistent application of the therapy, there has not been a significant improvement in your condition and at a rate or level above what would normally be expected if things were left up to Mother Nature herself, then you need to review what is being done.
Far too often, ineffective therapies are continued with long after when their use should have been critically reviewed, modified or ceased altogether. In addition, progress is often erroneously attributed to the treatment or medicine when it is really just the natural healing processes that should be getting the credit.
Many medications (unlike herbs, vitamins and minerals) cease to be effective after a month of regular use. In many cases, the body "habituates" (another term for "addiction") to medicines such as steroids, anti-depressants and pain medications).
Simple methods of monitoring progress, such as using a personal heart rate monitor, are often overlooked, therefore causing a loss of objectivity when assessing progress. Always ask:
Far too often, ineffective therapies are continued with long after when their use should have been critically reviewed, modified or ceased altogether. In addition, progress is often erroneously attributed to the treatment or medicine when it is really just the natural healing processes that should be getting the credit.
Many medications (unlike herbs, vitamins and minerals) cease to be effective after a month of regular use. In many cases, the body "habituates" (another term for "addiction") to medicines such as steroids, anti-depressants and pain medications).
Simple methods of monitoring progress, such as using a personal heart rate monitor, are often overlooked, therefore causing a loss of objectivity when assessing progress. Always ask:
"How is my progress being measured?"
Nutritional and lifestyle strategies, including exercise and deep tissue massage, can be extremely effective. These enhance and support, rather than replace or inhibit normal body physiology. Sometimes no obvious benefit is ever demonstrated by exercise, eating well and supplementing where the need exists, other than looking good and feeling great over the long term. Give these strategies at least 3 months to take effect.
Friday, June 29, 2012
Here's some simple advice to get relief from sore feet
 |
| The Mollers: A collection of strong legs and strong feet! |
Perhaps the most frequent request for assistance I receive is from people suffering from some kind of foot or ankle pain. These are for injuries like neuroma, sesamoiditis, toe pain including hallux rigidus, plantar fasciitis, stress fractures, reflex sympathetic dystrophy syndrome and Achilles pain.
What you may have noticed when reading the list of medical conditions is the heavy wording such as "reflex sympathetic dystrophy syndrome". I immediately have a problem when I see these heavy pieces of professional jargon. The problem is that what often comes with the big words are complex and costly treatments that may fail to see the wood for the trees. Sometimes the solutions are ridiculously simple, like throwing away those expensive sports socks!
These drastic and costly treatments are often unpleasant, uncomfortable, often with unpleasant side-effects and some are one-way streets with no turning back once entered.
For example; that quick-fix cortisone injection into the ankle may result in a catastrophic tendon rupture several months later.
Regardless of your foot problems, there are some simple things you can and probably should try before escalating to more costly and invasive treatments:
Have a daily foot bath
Get an oval plastic bucket that your feet can sit into comfortably, fill it with tepid water and add half to one cup of Epsom Salts (magnesium sulphate). Soak the legs until the water is about blood temperature (about half an hour). The best time to do this is when the feet are achy such as first thing in the morning or after a long day on your feet. It can also be a wonderful prelude to an exercise session.
Fit a pair of Formthotics Shock Stop Inner soles
These are heat moulded to fit the contours of your feet, while not restricting natural foot function. You might have to search around for them. (I have them available for about $55/pair). I have these in all my shoes and just would not be without them nowadays.
Wear thin socks
 |
| Lorraine and Gary Moller Barefoot for most of our lives. Love the fashion! |
Thick sports or tramping socks can prevent the circulation of blood to the sole of the foot, especially when combined with tight shoes and/or overly soft innersoles (innersoles should be quite hard - not spongy). Conditions associated with thick socks and tight shoes include heel pain, forefoot pain, sesamoiditis and neuroma.
Get on the internet and Google search for "How to lace a running shoe" where you will find excellent illustrations of how to lace shoes without restricting the circulation to the feet.
Get your feet massaged
There is nothing like a firm and loving massage of the feet after a long soak in a tepid Epsom Salts foot bath! Have this done once a week, including the calf and shins.
Get your toes pulled
Toe joints are like any other joint: Designed for movement. If they were not, they would be rigid. Toe pain is often the result of lack of movement and the toes being squashed into restrictive shoes.
Google search the internet for "Gary Moller Youtube toe" and you will see an instructional video about how to mobilise sore toe joints.
Get about barefoot
Use your feet as intended - without footwear. Walk on a sandy beach, on a grassy field and get about barefoot around the house.
Are your feet turning to stone?
 |
| Secondary school. Barefoot other than one boy and the teacher. |
Too much calcium is present in the circulation of 80% of the people I test while magnesium is deficient. When there is an imbalance between calcium and magnesium, the excess calcium will tend to precipitate into the soft tissues, including the joints. This is the process that leads to osteoarthritis and hardening of the arteries (arteriosclerosis). The earliest signs of this calcification and loss of circulation is felt in the feet and sometimes the fingers. Reducing calcium in the diet, while increasing magnesium intake can do wonders over the long term for foot health.
Is your medication hurting your feet?
Many medications, such as those to reduce blood pressure and cholesterol, may be the cause of your foot pain. If you think this may be a possibility, please talk to your doctor. Do not hesitate to seek a second opinion.
_______________________________________
Tuesday, May 22, 2012
Feedback from the runner with the ankle pain
Here is some feedback from a runner with the ankle pain.“I'm great... I've been back runnning for about 7 weeks...
“When you told me to start back , you will probably remember I still had the throbbing scenario - after that the ankle was giving me pain in the first few weeks of running. I've crept up slowly in kms and have had to go at a slower pace than I want ... but it's now not throbbing at all and only the very rare day do I feel familiar scary pains here and there.in the ankle... if that happens I get as much rest before the next session or swap sessions around.
So to answer your question yes your intervention did work for me, I was going backwards for many months (9 in total ) with the rehab exercises which I reckon were aggravating it more.
Before I ate healthily but now am using protein (just after a session which I never did before), calcium, minerals and flax will keep going and will keep the joint powder going for a good while yet.
Yes looked at the blog, and that is a great article, I hope it helps others make the right decision, all you need is a perceptive experienced advisor.You are the only person that I saw that wanted the entire background to my running habits and history.... and thank you ! “
___________________________
Gary Moller comments:
This very fit woman has made a remarkable return to running training. What she shows is the value of looking at the total person, including her health and exercise history, training programme, diet, physique and biomechanics - and let's not underplay the role of her determination to get back into running!
When attempting to understand how such injuries develop in the first place, it is essential to understand the constant balancing act that is going on inside the body between anabolism and catabolism. If an athlete is in a state of chronic catabolism, there is no way that any kind of medical treatment is going to "cure" her.
Although this dedicated runner has made a quick and remarkable recovery, healing and repair should be regarded as a slow and gradual process, taking several months, if not years to fully run their course. Too much therapy is on the basis of a 1/2 dozen visits and, if there is no cure, then more drastic action is recommended like surgery, or cortisone. Of course, these don't work and can leave the athlete with much worse problems over the longterm.
Central to modifying her training and diet and her doing some special exercises, is the moto "Body, heal thyself". This is a phrase all health professionals should constantly mutter away to themselves as a constant reminder that they never heal or cure - it is the patient's body that does that!
______________________________________
If you have a chronic injury or illness that you are getting nowhere with fast, and if you are in Wellington, I run a private clinic in the central city. Get hold of me to arrange a consultation - I really do enjoy the challenge of working with people like you!
Monday, February 28, 2011
A Football Player with Posterior Tibial Tendonitis - Cortisone Injections
Hello Gary,
I watched your video on youtube and it seems that nutrition is very important. I have been suffering for PT for the past 7 months. It started as a minor discomfort which I ignored and continued playing football. and running. It eventually got worse and I haven't been playing any football for the past 6 months. My foot was almost cured 2
weeks ago but still felt very weak. Unfortunately, It went downwards again when I walked a lot last week using my normal shoes. I had to see some clients and could not afford walking in my running shoes.
I went to see my doctor again on friday and he injected some cortisones and said to come back in 5 weeks. I read loads of negative things about it but kinda got fed up having my ankle always inflamed. It has been 3 days now and I do feel better but my ankle seems to have lost muscle and my calf has a pulling sensation. Is that normal ?
I also ice it every couple of hours and make sure I eat well.
Should I start some basic exercises in the coming weeks? I have been resting my ankle for the past 3 days and trying not to walk too much.
Do you think this will ever cure? i am going to be 30 in 5 days and used to very active but I am getting very depressed now ....
Any ideas?
____________________________________
Gary:
The best exercise to do, in addition to walking and gradually resuming running and activities like football is the exercise in the above video. Do about 30 repetitions every 2nd day and gradually build up to about 60-100 continuous reps over a few weeks. Keep doing them as a habit even if your ankle is 100%. You can also take up walking on sand barefoot. Walking and running across a grassy slope, either barefoot, or in a pair of snug running shoes will help strengthen the lateral and medial structures of the ankle. Start very conservatively and never repeat the same exercise/activity on consecutive days - mix things up so that there is a variety of stresses on the legs and never the same the following day.
Nutrition is important. In the case of tendons and ligaments, magnesium, copper, zinc, iodine and pyridoxine are most important. Stress can be from multiple sources, including exercise, work, toxins (eg: smoking), relationships, financial, to name some. Depletion of these nutrients hardens collagen which is the main constituent of tendons and other connective tissue structures. This may be seen as conditions such as "Trigger Finger" or "Dupuytren's contracture". While trigger finger is the most obvious manifestation, I see it often in more subtle forms, such as hard and inflexible leg tendons that are prone to chronic injury. A lengthy period of stress is often the precursor of these injuries.
The best source of these nutrients, in as near to perfect combination is Dr Wilson's Adrenal Fatigue Formulations. These are "Practitioner Only" products that are dispensed by prescription only. Please complete the initial Adrenal Fatigue Assessment here and send me the results and we will go from there.
With regards to the cortisone injections you have had, it is interesting to note that the cortisone injected into the ankle by your doctor is a synthetic version of cortisol which is produced by the adrenal cortex of the adrenal glands. It is fascinating to see how seemingly unrelated health issues (stress - tendons) may, in fact, be related! There is a small but significant risk of future complications such as tendon rupture as long as several months from now. Please read the articles in this search list. Reduce the chances of suffering complications by a gradual buildup in physical capacities over the next three or so months and definitely get onto the adrenal supplements for at least three months.
There is no need to ice the ankle and do not take anti-inflammatory medication. Read the articles in this search.
I watched your video on youtube and it seems that nutrition is very important. I have been suffering for PT for the past 7 months. It started as a minor discomfort which I ignored and continued playing football. and running. It eventually got worse and I haven't been playing any football for the past 6 months. My foot was almost cured 2
weeks ago but still felt very weak. Unfortunately, It went downwards again when I walked a lot last week using my normal shoes. I had to see some clients and could not afford walking in my running shoes.
I went to see my doctor again on friday and he injected some cortisones and said to come back in 5 weeks. I read loads of negative things about it but kinda got fed up having my ankle always inflamed. It has been 3 days now and I do feel better but my ankle seems to have lost muscle and my calf has a pulling sensation. Is that normal ?
I also ice it every couple of hours and make sure I eat well.
Should I start some basic exercises in the coming weeks? I have been resting my ankle for the past 3 days and trying not to walk too much.
Do you think this will ever cure? i am going to be 30 in 5 days and used to very active but I am getting very depressed now ....
Any ideas?
____________________________________
Gary:
The best exercise to do, in addition to walking and gradually resuming running and activities like football is the exercise in the above video. Do about 30 repetitions every 2nd day and gradually build up to about 60-100 continuous reps over a few weeks. Keep doing them as a habit even if your ankle is 100%. You can also take up walking on sand barefoot. Walking and running across a grassy slope, either barefoot, or in a pair of snug running shoes will help strengthen the lateral and medial structures of the ankle. Start very conservatively and never repeat the same exercise/activity on consecutive days - mix things up so that there is a variety of stresses on the legs and never the same the following day.
Nutrition is important. In the case of tendons and ligaments, magnesium, copper, zinc, iodine and pyridoxine are most important. Stress can be from multiple sources, including exercise, work, toxins (eg: smoking), relationships, financial, to name some. Depletion of these nutrients hardens collagen which is the main constituent of tendons and other connective tissue structures. This may be seen as conditions such as "Trigger Finger" or "Dupuytren's contracture". While trigger finger is the most obvious manifestation, I see it often in more subtle forms, such as hard and inflexible leg tendons that are prone to chronic injury. A lengthy period of stress is often the precursor of these injuries.
The best source of these nutrients, in as near to perfect combination is Dr Wilson's Adrenal Fatigue Formulations. These are "Practitioner Only" products that are dispensed by prescription only. Please complete the initial Adrenal Fatigue Assessment here and send me the results and we will go from there.
With regards to the cortisone injections you have had, it is interesting to note that the cortisone injected into the ankle by your doctor is a synthetic version of cortisol which is produced by the adrenal cortex of the adrenal glands. It is fascinating to see how seemingly unrelated health issues (stress - tendons) may, in fact, be related! There is a small but significant risk of future complications such as tendon rupture as long as several months from now. Please read the articles in this search list. Reduce the chances of suffering complications by a gradual buildup in physical capacities over the next three or so months and definitely get onto the adrenal supplements for at least three months.
There is no need to ice the ankle and do not take anti-inflammatory medication. Read the articles in this search.
_______________________________________
About this website
The advice in these articles is given freely without promise or obligation. Its all about giving you and your family the tools and information to take control of your health and fitness. Please give me your support by subscribing to my free email updates. Please shop at my Online Store. Please encourage your family and friends to do the same. While we may not always be able to compete with the big operators on price, we aim to more than compensate through personal service! Thursday, August 19, 2010
Advice for a suspected case of tibialis posterior tendinosis
I've been suffering from medial ankle pain for about 2 to 3 months (since early May). I initially though it was a grade I deltoid ligament sprain (in both ankles) because the pain was delayed and pretty minor. The pain came a few hours after performing lower body exercises (squats, lunges, single-leg balancing) while trying to force my feet into a neutral position, because I am an overpronator. It responded well to ice and compression at first, and after 3 weeks the pain had subsided. I was walking normally and going up and down stairs as if I was never injured, and about 2 weeks later, the pain returned. What also aggravated it probably were the exercises that I attempted to do to rehab it (single leg balancing and directional movements with theraband resistance). I think I was too aggressive with the exercises. Heat and ice both assist in pain management, but now walking will just bring pain back immediately. I have no visible signs of inflammation - no swelling or heat - and stretching seems to help for the short-term. Exercise also isn't that bad (theraband directional movements and calf raises with the knees bent) but a bit after some discomfort will arise. About a week or two ago, I found out that the pain had to be from either my tibialis posterior or another muscle in the shin/ankle (the flexor hallucis longus? I'm not sure) Since the pain usually comes about with standing and walking, and the fact that I overpronate, led me to believe it is more likely my tibialis posterior, since this has a direct link over overpronating and such
Friday, June 18, 2010
Are there safer alternatives to a cortisone injection in the ankle?
 |
| Permanent harm caused by a cortisone injection into an ankle |
The results of the MRI scan show a build up of fluid in the ankle. I have a defect in the cartilage, a hole probably caused by a small loose bone but the doctor does not know what cause the accumulation of this fluid. I understand the injection would take the pain away but is not better working on the cause? What other safe treatment are available? Thanks
_________________________________
Gary:
Despite the resurgence in popularity of the cortisone injection in recent years, nothing has changed with regards to the risks of this therapy. These risks are real and definitely not imagined.
Tuesday, March 30, 2010
Medial ankle pain following a lateral ankle inversion injury
I am from Korea and I used to be college basketball player but recently moved to U.S. I had superior athlete body shape before I injured my ankle last November. It was eversion sprain(deltoid ligament), I usually have multiple inversion sprain during practice or game but this one was pretty severe so I decided to use crutches. I lost noticible muscle on lower leg.
Monday, February 22, 2010
Feedback plus: "I have now developed a very sore point just in front of my right ankle"
Hi Gary
This is just a brief e-mail to say thankyou for the information you have placed on your web site. In particular, I have found the Super Smoothie of incredible value. Approximately 3 years ago, I was training for the Christchurch Marathon and was up around the 18 - 20 K mark each run in training. I ran the Taupo Half as a build up (1hr 36 - stoked) but a week later broke my ankle. It took me 12 months before I could run freely again without pain.Thursday, February 21, 2008
Will glucosamine help my arthritic low back and relieve back pain?
"Hello Gary, I have just come across your website and I must say its bloody fantastic. I am an age group triathlete (41year female) who last year had diskectomy surgery on my lower back and am now suffering from painful degeneration that has caused me to cut my running right down (replacing with crazy fast walking) and I am finding the swimming painful too.
I have just started taking Glucosamine tablets and am trying hard to not take as many panadol as I am sure it cant be good for me. My goal is to NOT go and have fusion surgery but to still be able to race and train comfortably for as long as I can. I was interested in your u tube piece on the various joint supplements but am now a bit confused as to what I should be taking can you help. I have also been reading many online articles about it and some say its not been proven to work and some say its fantastic, what is your opinion?"
"L"
_______________________________________________
Gary Moller comments:
I have been assisting people with low back pain for more years than I care to think about! In many cases, if not most, the pain suffered has only a passing association with the degree of degeneration of the spinal discs. Let me explain what may be going on and why further surgery is a poor option that should only be exercised as an absolute last resort:
OK, you injure your back, irritate it, stir it up for some reason. The immediate protective response is for the muscles about the spine, including the butt, to lock up in spasm. This is a natural casting effect to immobilise the spine while the damage is repaired. Unfortunately, the longer this spasm goes on the greater the possibility of secondary problems developing - chronic muscle weakness, hard gristle and permanent spasm.
When muscles are in spasm, there is little blood flow through them. In order to survive the cells switch to anaerobic mode to cope with the low oxygen environment. This causes a buildup further of toxins in the area which becomes swollen and painful. The toxins cause more spasm, thus setting up a vicious cycle of pain and inflammation that continues well after the original injury has healed (99% of healing is complete within 12 weeks. Exercise may make the pain worse as will sitting and standing without moving. Even sleep may be a problem.
The spine does not like a lack of normal movement and there will be an acceleration of degeneration as a consequence. Not a good look all round!
Let me give an overview of how I help people get over their back pain.
The first step in getting a full recovery is to try to identify any areas of nutritional deficiency because it is a waste of time trying to reduce inflammation, strengthen and mobilise if there is a nutrient deficiency. Exercise will just make the person worse. Each person is different. A person might be deficient in some key minerals. A low fat diet may cause fat soluble vitamin deficiency, the person may be slightly anaemic, etc. Many nutritional factors can contribute to ongoing pain and poor response to exercise. Once these are being dealt with I then introduce deep tissue massage about a week later.
This special form of massage can be most unpleasant initially. It is applied to break muscle spasm and to soften hardened gristle and to shift out metabolic toxins of which there can be several liters.
Gentle stretching can be introduced as can gentle exercise. For guidance about safe exercise for a dodgy spine, there is my book about Back Pain.
Where we go from there depends very much on the person.
Glucosamine?
Yes! Most definitely. It works in most cases when taken in accordance with directions of the manufacturer and for at least 3 months. Your spine is a series of fibrous joints and the same principles of joint nutrition for other joints apply. Chondroitin is most important for the spine since it hydrates discs that tend to dry with age and lack of movement. Add MSM (methylsulfonylmethane) which has a natural anti inflammation effect and builds strong collagen (double-click any words for their meaning). There are other important ingredients for joint health, such as vitamin C. The joint care powders that I favour have these added.
I have just started taking Glucosamine tablets and am trying hard to not take as many panadol as I am sure it cant be good for me. My goal is to NOT go and have fusion surgery but to still be able to race and train comfortably for as long as I can. I was interested in your u tube piece on the various joint supplements but am now a bit confused as to what I should be taking can you help. I have also been reading many online articles about it and some say its not been proven to work and some say its fantastic, what is your opinion?"
"L"
_______________________________________________
Gary Moller comments:
I have been assisting people with low back pain for more years than I care to think about! In many cases, if not most, the pain suffered has only a passing association with the degree of degeneration of the spinal discs. Let me explain what may be going on and why further surgery is a poor option that should only be exercised as an absolute last resort:
OK, you injure your back, irritate it, stir it up for some reason. The immediate protective response is for the muscles about the spine, including the butt, to lock up in spasm. This is a natural casting effect to immobilise the spine while the damage is repaired. Unfortunately, the longer this spasm goes on the greater the possibility of secondary problems developing - chronic muscle weakness, hard gristle and permanent spasm.
When muscles are in spasm, there is little blood flow through them. In order to survive the cells switch to anaerobic mode to cope with the low oxygen environment. This causes a buildup further of toxins in the area which becomes swollen and painful. The toxins cause more spasm, thus setting up a vicious cycle of pain and inflammation that continues well after the original injury has healed (99% of healing is complete within 12 weeks. Exercise may make the pain worse as will sitting and standing without moving. Even sleep may be a problem.
The spine does not like a lack of normal movement and there will be an acceleration of degeneration as a consequence. Not a good look all round!
Let me give an overview of how I help people get over their back pain.
The first step in getting a full recovery is to try to identify any areas of nutritional deficiency because it is a waste of time trying to reduce inflammation, strengthen and mobilise if there is a nutrient deficiency. Exercise will just make the person worse. Each person is different. A person might be deficient in some key minerals. A low fat diet may cause fat soluble vitamin deficiency, the person may be slightly anaemic, etc. Many nutritional factors can contribute to ongoing pain and poor response to exercise. Once these are being dealt with I then introduce deep tissue massage about a week later.
This special form of massage can be most unpleasant initially. It is applied to break muscle spasm and to soften hardened gristle and to shift out metabolic toxins of which there can be several liters.
Gentle stretching can be introduced as can gentle exercise. For guidance about safe exercise for a dodgy spine, there is my book about Back Pain.
Where we go from there depends very much on the person.
Glucosamine?
Yes! Most definitely. It works in most cases when taken in accordance with directions of the manufacturer and for at least 3 months. Your spine is a series of fibrous joints and the same principles of joint nutrition for other joints apply. Chondroitin is most important for the spine since it hydrates discs that tend to dry with age and lack of movement. Add MSM (methylsulfonylmethane) which has a natural anti inflammation effect and builds strong collagen (double-click any words for their meaning). There are other important ingredients for joint health, such as vitamin C. The joint care powders that I favour have these added.
Saturday, December 29, 2007
Struggling with pain from an ankle injury
Hi, I am a 30 year old struggling with pain from an ankle sprain injury that has not healed. I sprained my ankle in an inversion type of injury 
in June 2007. There was never any swelling in the ankle at all, and I did not seek treatment. Over the coarse of the next 3 weeks, I noticed a throbbing ache in the outer aspect of my foot toward my outer heel area. I wrapped with an Ace bandage and tried to limit my walking. I also was a runner/could run 4-5 miles 3 times a week until this injury.
Eventually I saw the primary care dr. and he dx me with an ankle sprain and ordered a air cast for my foot. It seemed to help the pain at first and I increased my walking and 5 days later I could not bear weight on the foot.
I had an MRI and a CT scan which showed no torn tendons/ but small tears in my post tib tendon with an accessory navicular bone. Also a tarsal coalition that I never knew I had was dx'd at this time, however my foot looks completely normal. All of my pain is on the outside of my foot. I have done pt for 3 months with ttle improvement. I am doing accupuncture now, but still take a lot of medicine for pain. Ibuporfen/Aleve/tylenol arthritis. I can stand and walk for 1.5 hours on my foot and have a lot of muscle wasting in my calf on my left leg as I continually favor that leg.
My doctor wants me to start on a medicine called Cymbalta which is an antidepressant. Apparently this medicine is also for neuropothy. This pain is real and I can't seem to find any help for my pain. I will try to do your exercises for the calf muscles. do you have any thoughts? I also am doing accupressure massage to my peroneals. Thanks for your time! -Joi
_________________________________________
Gary Moller responds:
Joi,
Therapy to assist recovery following an injury should always focus on assisting the body with healing itself. On occasion, there can be a place for various drugs, surgery and immobilisation. But these should never be at the cost of impairing natural healing processes. Nutrition, some supplements, rest/exercise, massage and Old Man Time should be the mainstays of injury rehabilitation.
Please have a read of my other articles about ankle pain here.
From what you have written, I can see no reason for prescribing Cymbalta for your ankle pain, if that is the reason given. While the injury may be depressing and frustrating, this medication has far too many risky side effects. The best action for feeling depressed about a sore ankle is to deal as best one can with the ankle through positive action. All that anti-depressants can do is dull the brain to the reality of the situation. Avoidance by way of dulling the brain is not positive action. I might add the same cautions about adverse short and long term side effects apply as well to the various pain medications that you are presently relying on to get through the day. Having said this, please discuss your needs with your doctor, including what is advised in this article, thank you.
You should heed my advice here about ankle pain.
In addition, you need to take the accupressure massage a step further. Find a trained therapist who can deeply massage all of the knotted and painful areas of the calf and ankle. This should be done about every 4th or 5th day with rest between to allow healing. The therapist should also be mobilising and tractioning the ankle and the various other joints of the foot. Where you have painful joint margins, the therapist should massage these, applying progressive finger pressure as pain permits. This massage breaks up and softens areas of scar, swelling and toxic buildups. As the massage progresses during a session, the intensity of the pain should diminish. You may feel a little bruised for a few days after. This is to be expected and the bruised gristle will eventually be replaced by healthy, supple tissue that is pain free.
The supplements, including vitamin C referred to in the article here are important when getting this kind of massage therapy. If it is going to work, you will notice a significant improvement in the pain levels after 4-6 sessions. Each session should last about an hour. Above all else, give things time and do not be panicked into radical therapies that can not be reversed.
Please keep in touch and let me know how you get on.
in June 2007. There was never any swelling in the ankle at all, and I did not seek treatment. Over the coarse of the next 3 weeks, I noticed a throbbing ache in the outer aspect of my foot toward my outer heel area. I wrapped with an Ace bandage and tried to limit my walking. I also was a runner/could run 4-5 miles 3 times a week until this injury.Eventually I saw the primary care dr. and he dx me with an ankle sprain and ordered a air cast for my foot. It seemed to help the pain at first and I increased my walking and 5 days later I could not bear weight on the foot.
I had an MRI and a CT scan which showed no torn tendons/ but small tears in my post tib tendon with an accessory navicular bone. Also a tarsal coalition that I never knew I had was dx'd at this time, however my foot looks completely normal. All of my pain is on the outside of my foot. I have done pt for 3 months with ttle improvement. I am doing accupuncture now, but still take a lot of medicine for pain. Ibuporfen/Aleve/tylenol arthritis. I can stand and walk for 1.5 hours on my foot and have a lot of muscle wasting in my calf on my left leg as I continually favor that leg.
My doctor wants me to start on a medicine called Cymbalta which is an antidepressant. Apparently this medicine is also for neuropothy. This pain is real and I can't seem to find any help for my pain. I will try to do your exercises for the calf muscles. do you have any thoughts? I also am doing accupressure massage to my peroneals. Thanks for your time! -Joi
_________________________________________
Gary Moller responds:
Joi,
Therapy to assist recovery following an injury should always focus on assisting the body with healing itself. On occasion, there can be a place for various drugs, surgery and immobilisation. But these should never be at the cost of impairing natural healing processes. Nutrition, some supplements, rest/exercise, massage and Old Man Time should be the mainstays of injury rehabilitation.
Please have a read of my other articles about ankle pain here.
From what you have written, I can see no reason for prescribing Cymbalta for your ankle pain, if that is the reason given. While the injury may be depressing and frustrating, this medication has far too many risky side effects. The best action for feeling depressed about a sore ankle is to deal as best one can with the ankle through positive action. All that anti-depressants can do is dull the brain to the reality of the situation. Avoidance by way of dulling the brain is not positive action. I might add the same cautions about adverse short and long term side effects apply as well to the various pain medications that you are presently relying on to get through the day. Having said this, please discuss your needs with your doctor, including what is advised in this article, thank you.
You should heed my advice here about ankle pain.
In addition, you need to take the accupressure massage a step further. Find a trained therapist who can deeply massage all of the knotted and painful areas of the calf and ankle. This should be done about every 4th or 5th day with rest between to allow healing. The therapist should also be mobilising and tractioning the ankle and the various other joints of the foot. Where you have painful joint margins, the therapist should massage these, applying progressive finger pressure as pain permits. This massage breaks up and softens areas of scar, swelling and toxic buildups. As the massage progresses during a session, the intensity of the pain should diminish. You may feel a little bruised for a few days after. This is to be expected and the bruised gristle will eventually be replaced by healthy, supple tissue that is pain free.
The supplements, including vitamin C referred to in the article here are important when getting this kind of massage therapy. If it is going to work, you will notice a significant improvement in the pain levels after 4-6 sessions. Each session should last about an hour. Above all else, give things time and do not be panicked into radical therapies that can not be reversed.
Please keep in touch and let me know how you get on.
Friday, December 14, 2007
Ankle and foot pain - arthritic talonavicular joint
"I suffer from what has been described as loss of cartilage or wear of the talonavicular joint in my
right foot.
This seriously impairs my enjoyment of walking, tramping, golf and other pursuits.
I am seventy years of age and take Voltarin from time to time, when I can tolerate some, but take one tablet of Panadol (500 mg) every four hours to ease the discomfort.
I am also consulting a podiatrist and have been fitted with appropriate orthotic insoles.
I also take 1,500 mg of glucosamine and chondroitin powder every day in a glass of water.
Have you any advice?
John
_______________________________________
right foot.This seriously impairs my enjoyment of walking, tramping, golf and other pursuits.
I am seventy years of age and take Voltarin from time to time, when I can tolerate some, but take one tablet of Panadol (500 mg) every four hours to ease the discomfort.
I am also consulting a podiatrist and have been fitted with appropriate orthotic insoles.
I also take 1,500 mg of glucosamine and chondroitin powder every day in a glass of water.
Have you any advice?
John
_______________________________________
Gary Moller replies:
John, I appreciate that you are in a difficult position with your ankle pain and, to a degree, age is not on your side. However; there are several things you can do that might help alleviate the pain while enabling you to continue to enjoy activities like walking and golf.
The talonavicualr joint allows the foot to articulate to allow adduction (toe-in) and abduction (toe-out) movements of the ankle as are needed during the heel strike phase of walking/running for shock absorbing.
While mild arthritic changes may be reversed, anything more tends to be progressive and the treatment goal becomes long term management more than seeking cure.
Pain medication
While nobody has ever died from a sore ankle, many have become seriously ill and some die from the long term effects of taking pain killers of the kind you are taking. Common they might be; but this does not belie the seriousness of the possible side effects which are numerous, ranging from digestive upset to liver disease. Digestive upset may appear to be minor; but can lead to serious malnutrition and diseases of the digestive tract. Sub-clinical malnutrition is widespread among the elderly. So, a primary goal with any interventions is to reduce your need for pain medication.
Get alkaline
Ill health, including arthritis and inflamed, tender tissues tend to be closely associated with an acidic body, principally by leaching essential minerals like calcium and magnesium from your body. A healthy person has a PH of about 7.4 which is slightly alkaline and definitely not acidic. The first step is to measure your saliva PH. If your body is less than 7.0 PH then you need to take measures to alkalise your body. These center mostly about reducing acidic foods from your diet and increasing alkaline foods. You can get a PH testing kit off my website (www.GaryMoller.com)
Manipulate and massage the feet
Find a strong massage therapist or podiatrist who can spend an hour twice a week massaging the feet and lower legs. This should include gapping the joints of the foot and ankle and repetitively moving the joints back and forth in gliding, twisting and rolling movements. You need a therapist with strong hands for this. While there may be some pain, it should not be excessive and within pain tolerances. Joints thrive on movement. Gapping and moving arthritic joints encourages the flow of nutritious synovial fluid within the joints and stretching excessively taut ligaments and any scar may relieve some of the constant pressure on the joint surfaces.
Walking barefoot on the beach and in the shallows is wonderful foot exercise; but go carefully and progressively so as not to overdo it any time.
Keep the legs warm
As we age, circulation to the feet declines, as can be seen in the deteriorating state of our toenails which become thickened and gnarly like an old bush that is starved of nutrients. Warm blood flows better, so keep the legs warm. Exercise such as hydrotherapy in a warm spa pool is wonderful for circulation, as is a soak in a warm Epsom Salts bath.
Improve circulation and nutrients through diet
Fish oil, flax oil, olive oil, evening primrose oil, vitamin E and vitamin C are nutrients that are beneficial for the joints, circulation and for health in general. These may also assist with pain management, with healing and with maintaining good health in general. As we get older our requirements for vitamins, minerals and proteins increases, so everything that enters the mouth should be chosen for it delicious nutritious qualities. Sugar, cake and cookies are reserved for rare special occasions and should be eliminated from the daily diet.
Natural pain management
In addition to fish oil, vitamin C and other nutrients, it could be well worthwhile taking quite large daily doses of MSM (methylsulfonylmethane). This is a safe anti-inflammatory that occurs naturally in the body. MSM is essential for healthy collagen, including joint cartilage.
Continue with the glucosamine and chondroitin; but take much more and spread it through the day. Continue for three months and see if there is any relief.
A long hot Epsom Salts bath, with a glass of wine and your favourite music in the background is both relaxing and beneficial for circulation and healing.
Bad pain - Good pain
While exercise and movement are important for the management of joint arthritis, avoid activities that make the condition worse by causing more wear. A general rule of thumb is to avoid activities that cause the pain to get worse as the activity progresses, or which makes the pain worse long after you stop. Activities that may be painful initially; but which diminishes as activity continues, can be assumed to be beneficial. Of course, one would cease the activity if the pain were to increase later as the activity continues.
Be creative - modify your lifestyle
As much as I detest them, you might use a golf cart when playing golf. Rather than hike, get a good bike and ride safe trails and routes. Get a kayak and paddle about interesting places. If you are not highly skilled, or are a bit rusty, hire a professional instructor to give you some lessons before you take to a bike or canoe. Do not fall off or drown.
Mix it all up
Ride a little, walk a little, paddle the bay, aqua jog, swim, golf a little and get those massages and Epsom Salts baths in. Your body loves variety! Give it plenty and in doing so, you avoid repetitive stress on your joints.
Experiment with footwear
There are numerous styles of walking and hiking shoes available nowadays. You might find that one of the modern lightweight hiking shoes or boots will give your foot the support it needs during the day and when doing more vigorous activities like golf. Shop around and try all styles. You may be surprised and delighted at the dramatic benefits of finding the right footwear for you. All of your shoes should have Formthotics moulded innersoles fitted, if not your custom orthotics. Try using a pair of Nordic Walking poles for stability and to reduce the load on the legs just that little bit and always travel light. Get another person to carry the back pack for you.
The surgical option
If you are unable to get sufficient pain relief from conservative measures to be able to cut down on the Panadol and Voltarin, then you should probably consult an orthopaedic surgeon. The surgeon may recommend a procedure like fusing the joint. Bearing in mind that all surgery carries risk, this is an option that may still be worth considering and the outcome should enable you to continue most activities, if not a little truncated.
Note: all of the products recommended in this article are available from www.GaryMoller.com
Monday, May 07, 2007
Sprained ankle while adventure racing
Hi Gary,
I sprained my ankle just over four weeks ago during an adventure race and continued to race for a further 2 hours to finish with my team.
I have not been able to run on the ankle but have been back on the bike quite a bit since then. The ankle is still a little swollen and is tender to walk on first thing in the morning. Does a sprained ankle require any specialist intervention or will it heal just as well without? I guess I am saying “should I get it looked at”
Also are there any good exercises that I can employ to aid recovery and strength?
Wayne
I sprained my ankle just over four weeks ago during an adventure race and continued to race for a further 2 hours to finish with my team.
I have not been able to run on the ankle but have been back on the bike quite a bit since then. The ankle is still a little swollen and is tender to walk on first thing in the morning. Does a sprained ankle require any specialist intervention or will it heal just as well without? I guess I am saying “should I get it looked at”
Also are there any good exercises that I can employ to aid recovery and strength?
Wayne
Wednesday, May 02, 2007
Cortisone Injections - pain relief at what cost? (Updated)
Let me present the case of a very fit woman who, by anybody's terms, completely overdid the exercise for a few months towards the end of last year. She developed left ankle pain that would not resolve. She was referred to a sports medicine physician who injected the spot with hydrocortisone. Being a sports physician, he would have been well aware of the risks associated with these injections and would have exercised due care with the procedure.
The relief was immediate and she was able to resume normal activities several days later.
About 6 months later, she developed diffuse ankle joint pain when running. It refused to respond to treatment, including rest. The ankle would throb while sitting. Running out of options, she came to see me.
 |
| Photo One shows the left ankle appearing to be less meaty in appearance as compared to the right. |
 |
| Photo Two shows a hollow towards the front margins of the ankle bone |
 |
| Photo Three shows a marked hollow where there should normally be fat and ligaments |
So, what is going on here?
What hydrocortisone does
Hydrocortisone is a means of doing a "chemical exision". In other words, it is a way of removing tissue without the need to cut. The chemical literally dissolves tissue. This is very effective at removing spots of persistent pain - it makes the problem literally disappear!
The problem
While it removes the pain, it invariably leaves the structure weakened. Furthermore, wherever the fluid leaks, tissue is killed off. In this case, healthy tissue - including shock absorbing fat and gristle and protective ligaments were damaged and even disappeared altogether!
It would also appear that some cortisone leaked into the joint itself, causing arthritic changes that now show as diffuse pain throughout the ankle joint, including the other side and general throbbing.
These complications are common. The first instance I can recall was of a running mate who was just on the heels of elite milers like Dixon, Quax and Walker. He developed plantar fasciitis of the foot and had a cortisone injection that fixed the problem. A few months later, he was out for a training run when he felt something snap in his foot. The plantar fascia had completely detached from the heel bone. His foot catastrophically collapsed. When I examined his foot, the arch was absent, he had knee pain due to altered foot mechanics and there was no fatty pad under the skin of his heel - it had been completely dissolved! That was the end of his running career.
Once the tissue is gone, it aint ever coming back.
I have seen plenty of cases of delayed complications. Possibly the most common is cortisone injections to relieve tennis elbow types of pain. This can result in complete avulsion of the wrist extensor muscle where it attaches at the elbow.
In these kinds of cases where there is a delayed complication, the treating doctor may forever remain blissfully unaware and will have chalked the case up as a treatment success.
Sometimes, the cure can be much worse than the ailment itself.
Sunday, November 05, 2006
Ankle pain in older runners
Gary
I have been running since I was a boy; I won my first school title when I was 10, and since then I have run ever since. In April this year I turned 40, so have been running for 30 years, reasonably consistently.
Whilst I've had my share of reasonably serious injuries (many self-inflicted, but a number being managed as I get older), my biggest concern is after a 1 hour plus run on hard surfaces, my feet and/or ankles just hate it, and I spend the whole run, waiting until it's over. I did a easy 75 min flat run with my mates yesterday, and I just couldn't wait until it was over. In terms of shoes, I wear Asics 2110 at home and work, so a reasonable shoe.
I am actually worried for the first time ever about how this might affect my running. Any suggestions of what I can do? Likely treatment or supplements?
Regards
"B"
I have been running since I was a boy; I won my first school title when I was 10, and since then I have run ever since. In April this year I turned 40, so have been running for 30 years, reasonably consistently.
Whilst I've had my share of reasonably serious injuries (many self-inflicted, but a number being managed as I get older), my biggest concern is after a 1 hour plus run on hard surfaces, my feet and/or ankles just hate it, and I spend the whole run, waiting until it's over. I did a easy 75 min flat run with my mates yesterday, and I just couldn't wait until it was over. In terms of shoes, I wear Asics 2110 at home and work, so a reasonable shoe.
I am actually worried for the first time ever about how this might affect my running. Any suggestions of what I can do? Likely treatment or supplements?
Regards
"B"
Photo: sometimes, foot and ankle problems are easy to spot; more often, the trouble is not so obvious and, unfortunately, there are no single, quick-fix solutions.
___________________________
Gary Moller comments:
Thanks, "B", for consenting for this going onto the web: The problem you describe is one of the most pressing faced by "ageing" runners. If not resolved, the runner may be forced into giving running away and we can't have that happening, can we?
___________________________
Gary Moller comments:
Thanks, "B", for consenting for this going onto the web: The problem you describe is one of the most pressing faced by "ageing" runners. If not resolved, the runner may be forced into giving running away and we can't have that happening, can we?
The best approach to dealing with foot and ankle pain is to tackle the problem from several different angles and hope that one, or a combination of the following suggestions have a beneficial effect:
- Run, step and bound barefeet weekly in sand. This is what the great coaches of old, like Percy Cerutty, always had their athletes do as part of their training. When Otago athletes of the 1970's were at their height of national prominence, coaches like Alastair McMurran had regular bounding sessions up the massive sand dunes of the Otago Peninsula (I had the dubious pleasure of doing a couple). This type of training helped develop and maintain strong, flexible feet and ankles. This type of training is all but forgotten nowadays and much to the detriment of runners. This type of training is all the more important as we get into our 40's and older. Joints, muscles and tendons thrive on being flexed and extended through their full range of movement. On the other hand, repetitive and restrictive movement, such as running on pavement is not good for feet and ankle joints.
- Try different shoes and fit semi-orthotic inner soles. Although I prefer Asics myself, an obvious measure is to try a few different makes and models. The change can be remarkable when it comes to ankle pain. I have 4 different pairs that I rotate, including a pair of Asics designed for off-road running. The semi-orthotics I recommend are Formthotics Active which can be purchased here. A measure as simple as an inner sole change can give relief.
- Do your ankle and foot exercises. If your feet tire as a long run progresses, the arches begin to drop, shock absorption diminishes and the outer borders of the ankle joints may be bruised which you may really feel upon getting out of bed the next morning! Here is the link to the E-Pub on the subject. Of course, these do not replace sand dune running!
- Get your leg pulled! Yes, get a strong massage therapist to get stuck into your feet and ankles, working on mobilising all of those tight sinews and joints, including the main ankle joint. Manipulate a child's supple feet and the contrast with a typical runner's feet will shock you. So get into it and don't neglect the sand running which flexes the feet better than any masseur.
- Take Glucosamine, Chondroitin and magnesium daily. Joint food preparations help guard against arthritis and may even help reverse the process. If the feet and calf muscles are tiring prematurely and cramping, this may be partly due to magnesium depletion which is a near universal problem with older runners. If the muscles tire, then the feet cease doing their stability and shock-absorbing work, thus throwing abnormal strain on the structures of the ankles and feet.
- Run off-road. Buy a pair of shoes designed for trail running and do all of the long runs on trails. The soft surface and constant adjusting of foot and ankle placement is what those feet were designed for and they love it! Take care at first: your lack of flexibility and dulled reflexes from all that road running means you need to take care initially not to stumble or trip. The foot and ankle pain may be stirred up initially; but should diminish and disappear as the feet and ankles strengthen and regain flexibility with regular trail running.
- Do cross training. Aqua-Jogging done properly and cycling are my favourites. These enable the ageing runner to continue to develop a huge cardiovascular reserve while sparing muscles and joints that have already given more than a lifetime of faithful service!
(For more about this topic, type "ankle" into the search box to the upper left of this page and search this blog.)
Wednesday, October 18, 2006
Does glucosamine and chondroitin work for runners?
Glucosamine assists the repair of worn or damaged cartilage while chondroitin assists the hydration of cartilage, thus improving shock absorption and reducing wear and risk of injury. Their actions are supported by a growing body of research and the experiences of clinicians, including vets.These substances are best taken with various other nutritional co-factors, including MSM, copper and vitamin C which are beneficial to joint health. Many formulations, including the two listed here have these additional nutrients in them.
The benefits may be noticed within days, but it is usual to undergo a course of supplementation taking the maximum dose daily over a 3 month period before easing off. As with most nutritional strategies to maintain health and to be inury free, the effects are subtle to the point of being impossible to measure. In answer to queries about benefits for connective tissue other than joints: the answer is "Yes". they are beneficial for tendons and even the skin, nails and hair.
Should a runner take them? My recommendation is to do so if you are over the age of 35, or have had a history of joint problems or injury, a family history of arthritis, if you are in a job that is stressful on your joints or if you are doing particularly heavy training or intense competition - or all of these!
The benefits may be noticed within days, but it is usual to undergo a course of supplementation taking the maximum dose daily over a 3 month period before easing off. As with most nutritional strategies to maintain health and to be inury free, the effects are subtle to the point of being impossible to measure. In answer to queries about benefits for connective tissue other than joints: the answer is "Yes". they are beneficial for tendons and even the skin, nails and hair.
Should a runner take them? My recommendation is to do so if you are over the age of 35, or have had a history of joint problems or injury, a family history of arthritis, if you are in a job that is stressful on your joints or if you are doing particularly heavy training or intense competition - or all of these!
Sunday, September 03, 2006
Chronic Pain Syndromes
"Dear Gary,
I was sorry I missed hearing you speak... I have had polymyalgia for 2 years and am on Prednisone 11mg daily, but it is barely keeping it under control and I will probably have to increase it. Can you please send some information that might help?"
"M"
__________________________
Gary Moller comments:
I have been dealing with chronic pain syndromes for the last 30 years. These conditions present in various forms including polymyalgia, RSD, RSI and fibromyalgia.
These are characterised by disabling painful and inflamed muscles, tendons and joints that do not readily resolve despite medications, remedial exercise or rest. An episode of ill health or an injury might have been the precurser for the condition that may continues on with a life of its own.
These aliments are more common in women than men. There would appear to be an association in some cases with menopause. There are no known cures as such - just mangement and it runs its course, be that months or even years. I have been taking a renewed interest in these conditions, partly because I have had so many inquiries about them lately.
It is still early days; but I am highly suspiscious of two factors at play which, if properly dealt with, may asssist a healthy resolution.
Vitamin D deficiencyVitamin D has a growing list of health benefits, and "D" deficiency is associated with muscle and joint pain as well as immune system dysfunction. The people commonly afflicted by fibromyalgia and similar conditions tend to be office workers, women in their 50's and others who may have gone for long periods of deprivation of sunlight. An episode of illness, including hospitalisation sees to that.
Recent investigations of clients with "myalgic" conditions have returned positive blood test results for serious vitamin D deficiency. All that must be seen now is what happens over a year or so with deliberate boosting of vitamin D levels.
Mineral and vitamin DeficienciesMuscles and circulation do not function properly if minerals, especially magnesium and calcium are deficient. From work with athletes, I am aware of how common this health problem is and how easily a person can become deficient. Poor circulation, fluctuating blood pressure, aching muscles and joints eventuate. This may be accentuated by deficiencies in vitamins, the B Group in particular. It is too early to tell, but supplemetning with vitamins and minerals along with boositing vitamin D levels may be of benefit as would adding omega 3 oils like Evening primrose, flax seed or fish oil to the diet.
Menopause
If the sufferer is a woman 50 years old or so, strategies to alleviate menopausal symptoms is an obvious action.
What about exercise?
Exercise, other than gentle and preferably done in a pool is of little benefit if the body's anabolic processes are faulty. Attention to diet, vitamin D levels and some supplementation will eventually have the body in a position to build its strength and vitality in response to exercise.
With all good things, these natural approaches require time and patience - several months or more for any lasting benefits to show. These "healthy measures" are complementary to medical treatment and which one should continue and be subject to ongoing review.
Prednisone and other medicines
Should you keep taking Predisone or any other prescribed medicines for chronic pain syndromes? The answer is "Yes!" if you already are. Some medicines like Prednisone, especially if you have been taking a lot of it for more than a few months, should never be stopped suddenly. If you are wanting to reduce your medication, get started by getting on a regime of vitamin and mineral supplementation, get your vitamin D levels measured via your doctor, take measures to boost your "D" if needed and give these time to take effect - then talk to your doctor about the possibility of a gradual cessation.
Discuss with your doctor before starting.
I was sorry I missed hearing you speak... I have had polymyalgia for 2 years and am on Prednisone 11mg daily, but it is barely keeping it under control and I will probably have to increase it. Can you please send some information that might help?"
"M"
__________________________
Gary Moller comments:
I have been dealing with chronic pain syndromes for the last 30 years. These conditions present in various forms including polymyalgia, RSD, RSI and fibromyalgia.
These are characterised by disabling painful and inflamed muscles, tendons and joints that do not readily resolve despite medications, remedial exercise or rest. An episode of ill health or an injury might have been the precurser for the condition that may continues on with a life of its own.
These aliments are more common in women than men. There would appear to be an association in some cases with menopause. There are no known cures as such - just mangement and it runs its course, be that months or even years. I have been taking a renewed interest in these conditions, partly because I have had so many inquiries about them lately.
It is still early days; but I am highly suspiscious of two factors at play which, if properly dealt with, may asssist a healthy resolution.
Vitamin D deficiencyVitamin D has a growing list of health benefits, and "D" deficiency is associated with muscle and joint pain as well as immune system dysfunction. The people commonly afflicted by fibromyalgia and similar conditions tend to be office workers, women in their 50's and others who may have gone for long periods of deprivation of sunlight. An episode of illness, including hospitalisation sees to that.
Recent investigations of clients with "myalgic" conditions have returned positive blood test results for serious vitamin D deficiency. All that must be seen now is what happens over a year or so with deliberate boosting of vitamin D levels.
Mineral and vitamin DeficienciesMuscles and circulation do not function properly if minerals, especially magnesium and calcium are deficient. From work with athletes, I am aware of how common this health problem is and how easily a person can become deficient. Poor circulation, fluctuating blood pressure, aching muscles and joints eventuate. This may be accentuated by deficiencies in vitamins, the B Group in particular. It is too early to tell, but supplemetning with vitamins and minerals along with boositing vitamin D levels may be of benefit as would adding omega 3 oils like Evening primrose, flax seed or fish oil to the diet.
Menopause
If the sufferer is a woman 50 years old or so, strategies to alleviate menopausal symptoms is an obvious action.
What about exercise?
Exercise, other than gentle and preferably done in a pool is of little benefit if the body's anabolic processes are faulty. Attention to diet, vitamin D levels and some supplementation will eventually have the body in a position to build its strength and vitality in response to exercise.
With all good things, these natural approaches require time and patience - several months or more for any lasting benefits to show. These "healthy measures" are complementary to medical treatment and which one should continue and be subject to ongoing review.
Prednisone and other medicines
Should you keep taking Predisone or any other prescribed medicines for chronic pain syndromes? The answer is "Yes!" if you already are. Some medicines like Prednisone, especially if you have been taking a lot of it for more than a few months, should never be stopped suddenly. If you are wanting to reduce your medication, get started by getting on a regime of vitamin and mineral supplementation, get your vitamin D levels measured via your doctor, take measures to boost your "D" if needed and give these time to take effect - then talk to your doctor about the possibility of a gradual cessation.
Discuss with your doctor before starting.
Wednesday, August 02, 2006
Ankle pain
What's your advice for an ankle that's sore when running that doesn't get better with several weeks of rest?
"W"
________________________________
Gary Moller comments:
First of all, as I understand it, the person suffering the ankle pain is quite a large person for a runner. My general rule of thumb is that runners over about 75kg are much more prone to injury than their lighter compatriots. They must ensure that their shoes have plenty of shock absorption; whereas a light-footed 60kg runner can pretty much get away wearing slippers!
I encourage injury-prone heavier runners to run just 3 times a week (of the short and high quality kind) and to do other forms of exercise in between, like aqua-jogging and cycling. Cycling can become the principal form of endurance training and the running is fartlek, running drills, including hill-bounding and short races as examples. Hill-bounding and stepping and striding up sand dunes is one of the best ways to build dynamic strength and stability of the ankles.
The heavier the runner, the more critical it is that they have as near to perfect biomechanics and pounding the pavements does little for good mechanics. The most common fault by far is pronating feet and this is much more common nowadays since fewer people are raised bare foot. Read my e-pub about weak, pronating feet. In it I show how to strengthen the feet. Bear in mind that the feet and calf muscles must forcefully contract thousands of times during a run, so you must be diligent and give these exercises months and months to steadily build sufficient strength to resist collapse. It may be beneficial to replace your shoe innersoles with Formthotics Active which are semi orthotics.
If the feet tend to collapse upon foot impact with the ground, the outside borders of the ankle joint can literally be crushed by the pincer action of the bones as they come together. This will cause swharp/dull and generally agonising joint margin pain with little in the way of swelling. A runner will notice the consequences most of all the next morning and it will tend to settle as the day goes by.
Even if your feet are healthy and pain-free, you might like to give those hard-working joint surfaces a little relief:
Get down on the ground and brace yourself (refer to photo). Get someone with strong arms and hands to grasp the foot and heel. Relax the leg and feet muscles as the foot is pulled, so that you feel the ankle joint gapping. This may take some grunt by the puller and you have to concentrate on relaxing the leg and not resisting. Once the joint is gapped, the "puller" can slowly twist, rotate and glide the ankle joint back and forth. There should be little pain since the joint surfaces are being pulled apart and therefore should not be grinding.
This gapping, gliding and rotating in all directions will stretch any tight scar or other tissue about the joint and will even break down any roughening of the joint margins. It will encourage the healing processes by stimulating circulation to the areas that are being excessively compressed most of the day.
A further therapy is to have a firm foot massage, concentrating on the tender areas, wherever they might be.
The foot exercises, stretches and the massages should happen without fail about every 3rd day until complete relief is had. In conjunction with this should be a course of glucosamine and chondroitin to help ensure healthy joint tissue and healing.
"W"
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Gary Moller comments:
First of all, as I understand it, the person suffering the ankle pain is quite a large person for a runner. My general rule of thumb is that runners over about 75kg are much more prone to injury than their lighter compatriots. They must ensure that their shoes have plenty of shock absorption; whereas a light-footed 60kg runner can pretty much get away wearing slippers!
I encourage injury-prone heavier runners to run just 3 times a week (of the short and high quality kind) and to do other forms of exercise in between, like aqua-jogging and cycling. Cycling can become the principal form of endurance training and the running is fartlek, running drills, including hill-bounding and short races as examples. Hill-bounding and stepping and striding up sand dunes is one of the best ways to build dynamic strength and stability of the ankles.
The heavier the runner, the more critical it is that they have as near to perfect biomechanics and pounding the pavements does little for good mechanics. The most common fault by far is pronating feet and this is much more common nowadays since fewer people are raised bare foot. Read my e-pub about weak, pronating feet. In it I show how to strengthen the feet. Bear in mind that the feet and calf muscles must forcefully contract thousands of times during a run, so you must be diligent and give these exercises months and months to steadily build sufficient strength to resist collapse. It may be beneficial to replace your shoe innersoles with Formthotics Active which are semi orthotics.
If the feet tend to collapse upon foot impact with the ground, the outside borders of the ankle joint can literally be crushed by the pincer action of the bones as they come together. This will cause swharp/dull and generally agonising joint margin pain with little in the way of swelling. A runner will notice the consequences most of all the next morning and it will tend to settle as the day goes by.
Even if your feet are healthy and pain-free, you might like to give those hard-working joint surfaces a little relief:
Get down on the ground and brace yourself (refer to photo). Get someone with strong arms and hands to grasp the foot and heel. Relax the leg and feet muscles as the foot is pulled, so that you feel the ankle joint gapping. This may take some grunt by the puller and you have to concentrate on relaxing the leg and not resisting. Once the joint is gapped, the "puller" can slowly twist, rotate and glide the ankle joint back and forth. There should be little pain since the joint surfaces are being pulled apart and therefore should not be grinding.
This gapping, gliding and rotating in all directions will stretch any tight scar or other tissue about the joint and will even break down any roughening of the joint margins. It will encourage the healing processes by stimulating circulation to the areas that are being excessively compressed most of the day.
A further therapy is to have a firm foot massage, concentrating on the tender areas, wherever they might be.
The foot exercises, stretches and the massages should happen without fail about every 3rd day until complete relief is had. In conjunction with this should be a course of glucosamine and chondroitin to help ensure healthy joint tissue and healing.
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