I think I broke my ankle while out running! (updated)

I went for a long run in the hills with my brother-in-law 10 days ago. It was very wet, windy and cold. I went over on my ankle. There I lay in the mud, clutching my ankle, screaming every four letter word in the vocab (good pain management technique).

Choosing pain over death from cold, I hobbled my way towards home, even managing to break into a laboured one-legged trot now and then.

The actual damage to the outside of the ankle that was sprained did not seem that serious despite the bleeding and swelling (I have such skinny ankles that swelling never looks that bad). What really hurt the most was the inside of the ankle affecting the base of the tibia bone.

Treatment

Well, first priority was to warm up, so it was straight into a big hot bath of Epsom Salts (And a beer!) for an hour or so as soon as I got home with my ankle propped up (elevation). I did not bother with ice or compression, much preferring elevation as the best means of preventing further bleeding while not compromising circulation and metabolism (Bear in mind that well over an hour had already passed since the sprain so the initial clotting was complete).

You can see in the photos the damage to both sides of the ankle and the associated bleeding and swelling (Photos taken 12 hrs post injury).

Within 12 hours I was walking carefully trying to maintain proper foot mechanics and not allowing the foot to turn outwards. Proper foot posture and normal movement during healing ensures scar tissue is laid down in the right places and in the right direction.

I did not compress or ice the injury at all, preferring to continue the elevation and relying on normal movement to manage any swelling.

At about 36 hours I had my partner, Alofa, commenced very gentle massage on the area to promote circulation and reduce the swelling. This massage became progressively more vigorous as each day passed with the emphasis more on softening up the injured areas.

There has been no change in diet other than to take some glucosamine, chondroitin, Reparen and MSM to help recover from the destructive wrench to the joint and damage to the surrounding tendons and ligaments.

A quite large lump of hard gristle was found behind the Achilles tendon. This was an area that had given some pain over previous years when doing extremes of exercise, so the opportunity has been taken to do deep tissue massage to soften and free this up.

As swelling diminished and pain disappeared it became apparent that I might have fractured the medial maleolus of the ankle. When I went over I think I compression-chipped the margin of the ankle joint and possibly caused a hairline fracture a few mm further up. Still, no worries: 10 days have passed and I am walking without a limp and kind of jogging. My goal was to be running within a week; but that might have to be put back a few weeks.

While I wait for the bone to settle, I can do some house-keeping like dealing with that troublesome lump of gristle.

Questions:

Why didn't I go to the hospital?

• The thought of a hot bath was much more inviting than hanging about for hours in the A&E. If I thought it was more serious than it first appeared I would have been off to the Doc the next day.  
• Going straight to hospital risks sitting about with the ankle blowing up with blood.  Medically there is nothing that can be done other than to x-ray, strap the ankle, give you a pair of crutches and show your the door!  It is better to go home and stabilise the injury, get warm and dry and have a feed.

If you think you fractured your ankle shouldn't it be in plaster?

• Probably, but it is not an unstable fracture as far as I can tell and so long as I am careful it should heal quickly. Besides, I am able to maintain muscle strength and balance thus avoiding the problems of rehab once plaster is removed.

Why did you sprain your ankle?

• Other than the fact I was running down a very muddy, slippery trail, I think it has a lot to do with my shoes. I switched from wearing Asics trail shoes to a similar pair of Nike. I mildly sprained my ankle the first run in the Nike and a further time not long ago. This is despite them being designed for off-road stability. I think I am being sent a message: go back to the Asics!!

(Gary Moller is available for individual consultations about training and injury issues)
For the latest article about this injury go here.

It feels like a deep pinch in my hip that has stopped me running in my tracks

"I have unfortunately pulled up with an injury that has stopped me running in my tracks.

Saturday 25th May (just over a week ago) I warmed up for my 5k race and felt soreness in my left hip. I just ran on because I've had aches like this before in my hips and it just goes away the next day.

It hurt all through last weeks training, and I've stopped all running since last Friday.

It hurts to walk on and do one legged squats. It feels like a deep pinch in my hip, as well as near my medial glute.

I've had my hip flexor worked on and that was tight, but hasn't relieved the pain.

Have also had my back, hamstring, ITB, and glute area worked on without relief.

Going to see my favourite massage guy this Saturday to see if he can help.

Was wondering if you could provide me with some advice?"

_____________________________________

Gary:

Tensor Fascia stabilises the
leg during single-leg squats

The most common cause of the pain you are describing is strain to the small muscle that stabilises the hip during single leg squats, called "Tensor Fascia Latae".  If this is not the case for you, please reply with a photo with the exact spot marked with a felt pen, thanks.

Possible causes:

Unaccustomed running over hilly, uneven terrain; Running drills that involve high leg raises, or changes in direction; Gym exercises such as box jumping, Pilates, aerobics classes.

If this muscle has been damaged, it is most often experienced as a sharp pain in the side of the hip and a feeling like the affected leg may collapse during a single leg squat.  There may be associated spasm and dysfunction felt in the gluteal and there may be pain in the sacroiliac joints and low back.

Treatment:

1.  Rest the legs for no longer than about five days.  Any longer is likely to be counterproductive. Use the time out to exercise the rest of the body.
2. Deep tissue massage of all of the muscles about the hips, including backside, low back, hamstrings, ITB and thighs.  But only once a week as per the usual advice found in my many earlier articles about deep tissue massage.  Do both legs.
3. You may be able to self massage the tensor fascia: Sit in a chair; Lean forward so that the point of the elbow can dig into the tensor fascia muscle.  Keeping the elbow firmly on the muscle and using pain to guide you, firmly grind away at the tissue with pressure.  It may be quite uncomfortable at first; but the pain should diminish over the following few minutes.  The muscle may also feel as if it releases and softens.  Do this for several minutes then leave it for a week.  Then repeat weekly for as long as is required for a 100% recovery.
4. Stretch the hips every which way - Gently!  No excessive stretching during this period of healing.
5. Ensure your protein, mineral and vitamin intake is on the high side, especially magnesium which is associated with muscle spasm when deficient.  Exactly what you need to increase, or even reduce, is best determined by a current hair tissue mineral analysis.
6. Gradually reintroduce running from about five days.  Have a rest day between each running workout; but this rest day is best an active day doing vigorous exercise other than running.

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.

Adductor hamstring muscle pain and I have knee pain and feel like it might give way

Rear view of leg: Take careful noted of the red
muscle that runs up the side of the leg

"I have a question for the PGDipRehab PGDipSportMed- department- a year and half ago I got a very bad IT problem that took months of physiotherapy (strengthening, stability and tensioning etc) and eventually a meeting with a Dr who gave me one exercise of straight legged tensioning with foot tilted in.

Now- even though I do a lot of hip flexor stretches, and trying to keep the IT band stretched and stretching in general, I have a sensation of weakness in the ligament or tendon that is attached

from the quad to the top of the knee cap, it does not hurt at all, but sometimes it feels like it could give way. Bearing in mind I have no pain. It feels like it is on the tendon or muscle that the kneecap is attached to - just wondering if you have any suggestions?"

(name withheld)
________________________________

Gary:

This topic continues to be extremely popular with over 100,000 views of this article alone (to May 2013), so I have done a quick update as follows:

Although this injury appears to be affecting a slightly different area to what I am about to describe, the majority of cases that fit this description of persistent niggling knee pain with apparent instability may be due to a condition affecting the tendons of medial hamstring muscles where they slide around the bony inside border of the knee and insert into the tibia and help form the knee joint capsule (Refer diagrams).

You can see from the diagrams how tightness and inflammation of these tendons can indirectly cause pain in the front of the knee, including the kneecap and patella tendon. It is an area that is easily irritated because of the way the tendons wrap around the tibia and easily confused with conditions such chondromalacia and patellar tendonitis - and even cartilage damage. This explains why so much physiotherapy and surgery for knee pain is wasted time and effort. Knee pain of this kind is more common in women than men, possibly because of their having softer collagen and more stretchy ligaments.

It is also worth noting that pain abut the lower leg and knee may not be all that is amiss: If you look at the upper diagram of the rear of the leg, deep, firm palpation of the muscle that is outlined in red may elicit considerable pain.  This will need to be addressed because dysfunction, including spasm of this muscle will directly affect knee function, stability and pain.

Front view of knee

Treatment for this problem is usually a doddle but it does take time: Massage the inside and front of the knee where the affected tendons and fascia slide, insert into the tibia and form the knee joint capsule. Look for areas that are tender and swollen. It is common on women for the insertion point on the tibia to be visibly swollen and may even look like a fluid sack.

Massage each of the affected areas firmly but gently for several minutes using a quality massage wax or oil. It is best that this be done by a trained and experienced massage therapist.

Do not repeat the massage for another 5-7 days. Do not massage, other than very gently in between but exercise as per normal. Repeat the massage at least 4-6 times or more, or for as long as it takes, until there is no pain or residual swelling.

If recovery is poor, or the problem persists, then I recommend that you arrange to consult with me either in person or via Skype.

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A once very fast runner halted by an unexplained case of calf pain

Lorraine Moller winning
London Marathon 1980

"Good morning I am French from Montpellier,I have 53ans today; I am coach himself with the principles of A.LYDIARD since 1984. 


In 1985 I made 15 ' 04 " / 5000m, then 14 ' 40 " in 1986 in 1987 I was hill, in 1988 2h24' ', then 2h21' in 1989. In 1990 j was stopped by a wound the origin of which we have never found I was hardly I gained(won) a competition of very good level and dices the next day I had my left leg very very heavy to the effort; I made of numerous examination and I eventually made(eventually was made,eventually happened,eventually was) 2years after operated for the syndrome of muscles legs but without result); 


I think today that my probleme was purely mechanical but nobody knew how to see; With internet we are lucky magnifical to be able to communicate with people like you which(who) was friend to A.L for which I had a very big admiration. Can be had you a case similar to mine in your knowledge? 


In any case thank you and bravo for your blog. Be you the husband of Lorraine Moller? Has the time(period) in 1984 I had seen her marathon AVON in Paris. remember...... sincerely yours Jeff"
___________________________
Gary:
Jeff, Wow!  You were a fast runner!  You must be very frustrated not being able to run freely anymore.

Jeff: Me be not the husband of Lorraine Moller.  She be my younger sister.

While I do not have a photo of her winning Paris, the photo above is of her winning the London Avon Marathon in 1980.  I have asked her if she has one from the Paris Marathon.

The calf problem you describe is an interesting one that I have encountered many times, mostly in runners, so your inquiry is timely for writing an article.

Blood is returned to the heart almost
exclusively by muscle contraction.

Unexplained calf muscle pain/dysfunction with feelings of heaviness may be due to poor circulation through the muscle.  This may be due to a combination of factors which I will explain as best I can....

At rest, the circulation of blood through muscle and back to the heart is from the action of the heart.  As activity begins and increases, the rhythmic contraction and relaxation of the muscles progressively takes over the role of returning blood back to the heart.  So, when an athlete is exercising at maximum heart rate, one can presume that that muscles are almost exclusively responsible for flow back to the heart, while the heart is responsible for the flow from the heart to the muscles.

An athlete with healthy blood vessels and pliable muscles will find their heart revs quickly in response to exercise.

With repeated extreme exercise that may span over many years, the muscles become hard and scarred.  This is in marked contrast to the soft and pliable muscles of a well-conditioned young person.  A soft, pliable muscle will be engorged with oxygen rich arterial blood when in the relaxation phase of exercise.  When it contracts, the blood will be forcefully and fully ejected towards the heart.

Muscle that is hardened and scarred will be increasingly resistant to filling with fresh arterial blood.  This may be seen as an increase in systolic blood pressure during rest and as exercise intensity increases. The heart must contract with excess force to get the blood into the muscle.  When the muscle contracts only a small amount of blood is ejected.  The heart will be slower to respond to exercise stress.

This may partly explain why an older athlete's heart is slower to respond to exercise demands.  What typically happens when the gun goes off is the young runners take off like bullets, while the older runners tend to gradually wind into the race and, hopefully, mow down the youngsters as the race progresses.

A further factor in the loss of circulation, heaviness and pain may be the gradual process of blockage of the blood vessels that carry blood to and from the legs.  This may occur at the groin or the back of the legs.  This may include tearing and scarring.  Please refer here: http://blog.garymoller.com/2012/06/kiwi-women-are-dying-of-broken-hearts.html.  Zinc deficiency is as good as universal in athletes.

Jeff, I am assuming that the surgery you had was decompression of the calf muscle.  Here's an article about this syndrome that I wrote in 2007: http://blog.garymoller.com/2007/11/tibial-compartment-syndrome-in-running.html  While surgery may have given temporary relief, I am not surprised it has been of no long term benefit.  


This problem may typically occur after an intense run in a pair of unfamiliar shoes, such as switching to spikes or racing flats, doing hill-bounding, track work or a road race.  Something like this may have set off the first episode of feeling very, very heavy in the calf muscle.  That earlier run causes acute spam of the calf, and consequent muscle damage with consequent swelling and, therefore an increase in pressure within the muscle.  The restricted blood flow that results will cause the leg to feel very heavy and non-functional when trying to run the next day.

The remedy for your calf muscle dysfunction may be quite simple really!

Here's the action I recommend:

Get a weekly deep tissue massage of the calf muscles

This is painful for the first 3-4 sessions but this should ease dramatically with regular sessions.  Each session will last about an hour with attention focusing on any areas that feel hard or deformed within the muscle belly.  The muscle will quickly soften and, with each session, blood flow through it will improve.

Get these essential nutrients into your body

The muscles need massive amounts of magnesium and co-factors in order to function properly, including to relax and contract.  You may also need vitamin C and zinc.  A Hair Tissue Analysis removes the guessing as to what nutrients an athlete needs.

Question: Should you wear compression stockings or tights?

No! In my opinion - unless you have bad varicose veins.  Tight stockings do not allow the calf muscles to fully engorge with oxygen-rich arterial blood, due to the compression effect of the stockings during the relaxation phase of contraction.

If there was a survival advantage from having tight skin, then natural selection would have it that all creatures that require the combination of speed and endurance for survival, including Human Beings, would have natural, inbuilt compression tissues in their skin - The fact is they don't and the reason is clear - tight enclosures of muscle compromises circulation.

_______________________________________

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.

My right hip flexor is really sore

"My right hip flexor is really sore.  Its been playing up for the last few weeks when i go for a run.  Its not over-use though because im only running about 3 times a week.  But its noticeably worse when i run uphill.  and then when i stop running it really hurts just when walking or when i commence running again.  

Do you think it could be due to doing hard runs when unconditioned?  and perhaps straining my muscles when uphill running due to working hard?  Hard to stretch it out aswell....it doesnt really seem to feel like it is doing anything.  Could it also be due to the surrounding muscles being weak or tight? perhaps my quads?"

Mary
___________________________________________
Gary:
The problem is unlikely to be due to weakness but there certainly could be a problem with tightness.  The most likely muscles to be affected are the iliacus and psoas major muscles which can go into spasm from the combination of exercise plus long periods spent sitting (Mary is a student, so spends many hours sitting).  The other muscles most often suspect are the tensor fascia, or any of the thigh muscles that attach to the front of the pelvis, or the gluteus medius, all of which detest long periods of sitting following exercise.

The solution is a combination of regular exercise, stretching to give a break from sitting and deep tissue massage about once a week.  The massage will be particularly effective.  Massage not only the area that is most effective, but also the entire musculature about the hips and thighs right down to the knee and as high as the lower back.

The two problems with getting deep tissue massage is finding a decent therapist who knows what they are doing and then being able to afford it once a week.  A good therapist may go for about $120 per hour or more.

Here are two sets of exercises that can be done daily and to break up sitting far too long!

Running Stretches 2012 Mobility Exercises 2012

_______________________________________

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.

Finally - A win in the PNP Mountain Bike Finals!

No 57 hammering down the Aratahi Track, Makara Peak

It's been a long time coming - like just 20 years of mountain bike racing.  I won!

I am riding at about the same pace, or faster than I was in 1980 when competing as a Roadie with the PNP Club.  That's two age group wins in a row over the last few weeks.  Not bad for a 57 year old, if you don't mind me saying.

Marco Renalli, Gary Moller,
Ant Bradshaw

This is affirmation that the combination of deep tissue massage to restore punished and damaged muscles; plus nutrition as guided by the Hair Tissue Mineral Analysis works and can give spectacular results.  And these sporting achievements are happening with less training than ever.

However; this process of restoring health and vitality takes time.  I have been plugging away at restoring my own health and getting the legs back into good working order for a good five years with this combination of therapies.  It has only been this year that it feels like the brakes are finally disengaging.  There is still more to be gained.

So, to all my clients who are following similar programmes, the message is this:  "Hang in there!"

_______________________________________

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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!


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I am training for the 2010m Oxfam Trailwalker and feel like I have strained my Achilles Tendon

Hi Gary
I am training for the Oxfam Trailwalker and have experienced some discomfort and tightness in my left Achilles’ heel which is worrying me. This is my second year for the Trailwalker, and am relatively fit and active all year round (running and walking) – but never felt this time of thing before. Its more discomfort than pain, but came about quite suddenly on a short/hilly run on Tuesday night. I have good shoes and orthotics and stretch before and after every training session plus take a yoga class once a week. I am up to about 60kms training over about 4 days (Thursday – Sun) and have been going strong. But I actually had to stop my run on Tues because of the pain/discomfort. Wednesday it was still sore, and I couldn’t

Study finds: Sham Acupuncture is just as Effective as "Real" Acupuncture for Back Pain Relief

May 20, 2009 — Actual or simulated acupuncture therapy appears to be more effective than usual care for chronic low back pain, according to the results of a randomized controlled trial reported in the May 11 issue of the Archives of Internal Medicine.

"Acupuncture is a popular complementary and alternative treatment for chronic back pain," write Daniel C. Cherkin, PhD, from the Center for Health Studies in Seattle, Washington, and colleagues. "Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain."

"Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits," the study authors write. "These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide [sic] physiologically important stimulation or represent [sic] placebo or nonspecific effects."
_______________________________
Gary comments:
Currently New Zealand's Accident Compensation scheme (ACC) is suffering unsustainable cost blowouts. It is appropriate to review all areas of cost. One area that receives insufficient attention for review is the effectiveness of treatments such as orthotics, anti inflammatory medication, ultrasound and acupuncture. Under the bright lights of critical analysis, I am of the opinion that these therapies can not be justified in most cases of injury rehabilitation; yet they constitute the principal forms of therapy (and clinic income) for many health practitioners.

I am now into thirty years working in the fitness and rehabilitation business and have yet to see any convincing evidence that therapies like acupuncture really works beyond that of the Placebo Effect.

While I have only seen the summary of this study about acupuncture, the findings support my own impression that acupuncture is an ineffective treament for chronic pain conditions such as low back pain.

That this study found simulated and sham acupuncture to be more effective than "usual care" indicates just how poorly back patients are served by modern medicine!

Needling does little more than exert a strong placebo effect plus a couple of incidental side benefits that give temporary relief to pain. These are: 15-30 minutes of enforced rest (The neeedles ensure this!) during the middle of the day (If you have low back pain, lying down and daydreaming during the middle of the day is so relieving).

The other benefit is possible reduction of muscle spasm caused by a carefully placed needle inhibiting the contraction and stimulating the release of endorphins. But this will only be a passing benefit, since the needling does not deal with the complex underlying causes of chronic muscle and joint pain. The benefit may be better for acute pain as opposed to chronic pain.

If acupuncture is mostly ineffective for chronic pain, why do so many therapists use it?

What I am about to say is sure to generate shrill, emotive protestations from those who practice acupuncture; but I am going to write this anyway because it needs to be said (I am always happy to participate in informed debate, btw).

Time pressures
Many, if not most therapists who practice acupuncture have, on average, just 15 minutes patient (sorry - "client") contact time. This is the way medical and allied therapies fees are structured in New Zealand, so the pressure goes on clinics to pump the patients through the door just to survive, let alone afford that luxurious house in Khandallah, the flash Alfa Romeo and private schooling for the children. This time pressure makes other therapies that really do work, like massage impractical because these take an hour to do.

With acupuncture, the therapist inserts the needles, then leaves the client for ten minutes and goes and deals with the other clients lying in the other cubicles or gets on with the ACC paperwork. With five minutes to go, the therapist returns, removes the needles, rubs the areas quickly with Antiflamme (It has a big whiff of menthol for dramatic effect) while making positive suggestions about feeling better. It has to be working! And that's it - easy money! It reminds me of painting by numbers which was popular when I was a child.

Not too much effort please!
The most effective therapy (not on its own, mind you!) for chronic pain is massage; but massage is hard work very few allied medical therapists know how to massage properly and few can do this day in and day out without themselves requiring serious therapy! Good massage, not of the tickle and rub kind, is tough on the knuckles, wrists and elbows and best reserved for the hardy therapist with big hands and strong arms.

Medicine and Rehabilitation are businesses for Profit first - Health last
Medicine has aligned with big Pharma so that it can profitably process about one client per doctor every 10 minutes, relying on computer generated prescriptions for drugs that are approved and funded by Pharmac (using your tax dollars - of course!).

With the current financial model driving the sytem, modern medicine has little choice but to remain in bed with Big Pharma. This explains why a doctor will only ever give lip service to natural health alternatives and seldom, if ever prescribe a nutrient supplement and only if it is a Big Pharma product - Bauer's Elevit for pregnant women is one of these rare exceptions. To prescribe, or even acknowledge a natural alternative is dealing with the enemy. But I am beginning to digress.....

Acupuncture, like ultrasound, cupping and orthotics, is Rehabilitation's equivalent to medical prescriptions - Perfect for the business that is pressured to process many injured clients in quick succession over a long working day. These additional procedures usually brings in a nice to have surcharge fee that is paid either by the recipient or the health scheme - or both.

So, what do you do if you are prescribed acupuncture?
Save the country, your insurer and yourself a lot of money by challenging it. Ask to be shown the scientific evidence proving that it is a valid therapy for your condition. Are there other therapies that better suit your injury? Be sceptical and wary of single therapy solutions.

You could start by putting your legs up and reading the free articles about injury management that you can find here on my website. Read my advice about massage for chronic pain and do not overlook the powerful contribution nutrition has to play in addressing the underlying causes of chronic pain. If it is back pain that you suffer from, you could get a copy of my Back Pain Book.

Is your pain due to medication side effects? Talk to your doctor. If you are unsure you can even write to me and I will help you sort through your medication to identify possible contributors, either individually or through interactions.

In most cases, the solution to your pain lies within yourself and there are usually several related factors at work which helps explain why single therapy solutions are usually very disappointing. The first step is to carry out a series of investigations, including blood tests and a hair tissue mineral analysis in addition to the usual physical ones. The next step is to work up a list of factors that can be worked on and to prioritise these in terms of difficulty and treatability. An intervention plan is devised which targets just some of these factors and away we go!

An incremental multifactoral approach slowly, but surely chips away at the problem. Relief from chronic pain can be surprisingly rapid in many cases, sometimes within three weeks or so; but patience is required in most cases, sometimes several months or even a year or so. Please read my articles here about client feedback to get an idea of how well this patient, multifactoral approach works.

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I have a pain in the right leg, deep inside the leg

"Although I'm in the USA and you are in NZ, maybe you have some I deas that could help me.
I have a pain in the right leg, deep inside the leg, back and to the right of the knee (but not in the joint).
The pain starts after about 5-10 minutes of walking (used to walk 3 miles every day, can't do that anymore).
Sometimes it's so intense I can't continue walking, sometimes I can walk it off.
The pain started about 3 years ago, then went (almost away) for close to a year, and now is back with a vengeance.
I've had the following tests done:
Ultrasound of the leg.
X rays of the leg
Neurology test
MRI
Chiropractor
Naturopath
No one can find the cause.
I'm a 70 year (in December) male, in good health and shape, and really don't relish the idea of becoming a couch potato.
Now there is a suggestion of injections of novocaine or cortisone.
What do you think?
Any advice.suggestions would be greatly appreciated."

Les
___________________________

Gary:

Les, There is always the possibility of a blood clot in the back of the leg; but the tests you have had more or less eliminate that.  That is good news.

The most obvious possibility, going from the description you have given, is a tendonitis/bursitis of the the iliotibial band.  It is very common in walkers and runners.  Here is what you do:

• Go to an experienced sports massage therapist and get a thorough massage of the iliotibial band, including the hamstrings, backside and front thigh muscles.  It is likely that there will be a tight, painful and possibly slightly swollen area at the point of discomfort felt when walking.  You will probably discover that you have painful knotts in the backside muscles.  You will need at least three thorough massages weekly and maybe several more for a lasting benefit.
• Complete the Active Elements Assessment to work out your mineral salts needs.  If the injury is what i suspect, then there is a strong association with depletion of calcium fluoride and silica salts which give connective tissues their strength and pliability.
• Get some flax and fish oil supplements into your body daily.  These improve the health of collagen as well as having a natural anti-inflammatory effect.

Please read my previous articles and advice about cortisone injections and you will be able to jusdge for yourself my opinion about these.

Please let us know how you get on Les.

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Where can I find someone to massage and manipulate my sore toe joint?

"Hi Gary,
I saw your video and writings about this condition. I was recently diagnosed with this condition after an x-ray. The doctor told me he didn't seen much, if any, arthritis, but he said I have developed some bone spurring around the MTP joint. I agreed to try a cortisone shot. It helped for about 1.5 months and now the joint is becoming more painful again. He said that the spurring could continue to worsen if I don't get it taken care of surgically.

My question is whether you would agree, or would the manipulation technique you talk about help even with the presence of spurring? If you believe that manipulation would help, how would I go about finding a professional that knows this technique?

Thank you."
Mark
_________________________
Gary Moller replies:
Mark, your experience of coritisone injections is pretty typical of many active people: fast relief that does not last. Please read my growing list of articles here about the shortfalls of this kind of treatment.

The best way to deal with your kind of toe problem is as follows:

• Deep tissue massage and mobilisation of the affected joint and all the joints above and below as well as the rest of the foot and the lower leg. Do the other leg as well. This takes about an hour and should be repeated weekly for at least 6 sessions and probably ongoing.
• Replacement of tissue salts that strengthen the ligaments, joints and bones (CaFl, SiO2, CaPO4) - Active Elements 4.3
• Do a course of glucosamine and chondroitin with MSM taking the maximum dose on the label for 3 months and then reduce to an ongoing maintenance dose.
• Walk often barefoot on soft grass, in sand and in mud to flex, extend and strengthen the structures of the feet.
• Wear shoes that do not slam the toe box against the toes. This means lacing the shoes tight at the top and quite loose at the toe box part. If the feet slide about, change to a better pair of shoes. You could experiment with open shoes and sandals.
• Do alternative exercise to ones that slam the feet and toes - swimming, aquajogging, cycling, kayaking for example.

Where do you find a suitable massage therapist? If you live in Wellington I might be able to help. If not, then you have to shop around. You need a person with strong hands; but with the training and experience not to hurt you. I recommend, as a first start in your search, that you contact:

• Any Government accredited massage training institutions and ask for a recommendation of somebody in your area.
• If you have a professional or semi-professional sports team in your area, speak to the coaching staff and ask their recommendations. Ask top athletes you know of for their recommendations.
• Ask friends and workmates.

like any other kind of hands-on therapist, just how good a massage therapist is , is very much to do with your personal taste, their experience and style. You need to shop around and be prepared to stop and move on if it is obvious that it is not for you.

Effective deep tissue massage can be intense and painful at times and may leave you feeling quite sore for a few days after; but there is a difference between this kind of robust treatment and outright hurting you - this is a fine line that you and your therapist need to negotiate with care and skill.

As far as the spurring is concerned, the mobilisation involves pulling the joint surfaces apart and then gliding, rotating and bending the joint. The bone spurs which are at the very margins of the joints may get "ground" a bit and this can be agonising; but no damage is being done to the all-important articular surfaces of the joint. After several sessions, there should be a noticeable reduction in pain when this procedure is carried out. Not doing this, painful process risks the joint becoming completely immobile.

If surgery is finally required, nothing has been lost and much gained by having stronger, healthier feet going into surgery and the peace of mind of knowing you did your best with less drastic measures.



Do you have a question?
Email Gary: gary at myotec.co.nz (Replace the "at" with @ and remove spaces). Please include any relevant background information to your question.

Running can be a real pain in the butt!

Long distance runners don't retire - they just slowly grind to a halt. One of the most common causes of this painfully slow grind to a halt is buttock pain and sciatic pain that radiates down the back of the leg.

The cause of this pain may be the piriformis muscle which is located deep in the buttock. When this muscle locks up, so does the whole hip and the underlying sciatic nerve can be impinged, thus causing pain that radiates down the leg. An inflamed piriformis is often associated with a previous or current back injury. An experienced therapist is able to palpate this muscle and determine if it is in spam.

Once a muscle is in spasm, it will tend to stay that way. In fact, it will begin to adapt to that condition so that spasm becomes its norm. The environment of a muscle in spasm is toxic due to the very poor blood flow through it. Over time, the muscle becomes hard, gristle-like, crunchy, swollen and very tender to press. It is weak and prone to cramping.

The usual treatment is trigger point therapy in the form of acupuncture, acupressure and maybe deep tissue massage. Stretching the gluteals and piriformis are mainstays for prevention and treatment.

In my experience, the most effective remedy is deep tissue massage of the affected muscle and all of the associated muscle groups. It works; but it must be given time: An hour per session and repeated at least 6-8 times every 4-5 days until pain free. This must be supported by nutritional strategies to ensure that there is maximum healing between sessions. In most cases, there must be measures to reduce body acidity because the body may be overwhelmed by the sudden influx of metabolic toxins that are being squeegied out of swollen muscles. It is not unusual for a person, such affected, to feel ill for a few days following this kind of massage.

Once full function and health is restored to the affected muscles it is a good preventive measure to have weekly massages to keep the body in good health. This is of increasing importance as we get older.

I am getting headaches when riding my mountain bike

Hello,
I have recently come across your blog and I am impressed. In the world of misinformation you are providing real world advice. Thank you.

I am a mountain biker that has been riding for a couple of years and am getting to a point where my longer rides are taking 2 to 4 hours long. These are generally adventures in some back country somewhere but not always. My problem is that I am getting headaches on these long rides which last the rest of the day. I do not notice them if I am moving but I notice them when I stop.

I used to be a competitive swimmer (which I gave up 8 years ago and got fat till starting mtb again) and was training for 2 to 3 hrs 10 times a week and never experienced this. It seems to happen more when climbing hills (maybe because I am overheating, or sweating more, or exerting more). I have had shorter rides in the heat where it has happened as well. However it doesn't seem to matter how much water I have they still happen.

Could it be that I am not getting enough sodium or electrolytes? I am going to start experimenting with good endurance drinks to see if that makes a difference, however the ride yesterday it didn't stop the headache (but it did stop my usual bonk around 3 hrs). I had a Horleys made up drink 750mls and a new mizone (higher carb one) and 2 litres of water over a 3 hr trip time but 5 hrs ride time. My head was buggared and very tired by the end and got progressively worse during the evening. It got better after I had some meatballs, bread and panadol, but my head was very tired, and still is today.

I am about 183cm high and 96kg. I don't drink much caffeine as it makes me jittery and ruins my sleeping pattern, however a cup or two of Dilma english breakfast tea a day has been nice. Usually in the mornings or afternoon though. I have to admit sometimes I have had lots of caffeine though, however I have not noticed a correlation to these rides. Maybe though.

No neck or shoulder injury ever.

The two rides that I remember were on the weekend. My head ache disappeared after the food and the panadol, however my head was still very tired. I was probably dehydrated but on other times I haven't been able to keep up enough fluid to stop these headaches. I feel like drinking coffee after it to make my head feel better. It feels like when I get the flu sometimes, when you get a headache and a fuzzy tired head.

The other recent time I got this was up in hanmer for 2 days. The first day I got a headache for the rest of the day and no matter how much water I had (I was up all night peeing!!) I could not get rid of it. I did not have any panadol then though so I had to live with it. The next day I was fine. Over night sleeps seem to get rid of it. The next day we rode and I didn't seem to get it, which is curious as we were out for longer. The only difference was that I had a normal Mizone that day and we went on a track that was more climbing than mtb. We were literally pushing our bikes for hours.

I was also thinking that I get light headed when standing up (at random times, not when biking) when I have been doing a lot of biking at the moment. My doctor wasn't worried and thinks its just typical low blood pressure or something that people get when training a lot.

So my question is, do you know of any other athlete who is having similar problems? What the solution might be, if its a quick fix or do I need to go get a check up by somebody (maybe bloody work, blood pressure etc).
Jono
_____________________

Gary Moller comments:
Jono: There are several possible things going on here and without seeing you in the flesh, we are reduced to making some educated guesses. The advice that follows needs to be applied with a touch of common sense and try to consult the various experts in your area who might be able to help you apply this advice. No harm should come from any of this advice. In fact, you should become fitter and healthier even if some of the measures suggested end up having nothing to do with the head aches!

Mountain Biking is hard on the neck
Prolonged hill climbing is inherent in the sport and this can cause a kink in the neck, cramping the neck and shoulder muscles and jamming the nerves. This can cause migraine-like headaches. This is exacerbated by the seat and stem and handle bar setup on your bike not being quite right. Even a few mm of adjustment can make a world of difference. Cross-country bikes are a compromise between design for climbing and design for descending and it is a real art to get the adjustment right for different body types, sizes and riding ability. Being a full suspension bike, you might find even the slight sag in the tail while hill climbing has your seat position such that you are having to pull excessively with the arms and shoulders. With your body weight, the sag could be very significant. Try locking out the rear suspension when doing long climbs and see if there is a difference.

When climbing all but the steepest hills, you should be able to lean forward on the handlebars with the palms resting relaxed without the hands having to grip the bars. If you can't do this then look at your climbing technique and get a bike setup expert to adjust your setup, including set post, seat angle and handle bar stem length. I do this for cyclists in Wellington.

After climbing and kinking the neck and straining the shoulders while climbing there is usually a period of high speed slamming your way downhill. The tired neck muscles have to work very hard holding that heavy bowling ball on your shoulders steady so that you can see where you are going! As you can imagine, the neck and shoulders can become cramped and exhausted from all of this punishment and it is hardly surprising that you develop headaches a few hours into a ride. Other than checking the softness of your front and rear suspension to smooth the big hits, there is little to be done with the bike. Read on.

Low Blood Pressure (Postural Hypotension)
It is common in athletes to suffer semi-blackouts when standing up quickly. This is most often attributed to dehydration. I disagree in most cases. This condition is most often associated with an irregular pulse and aching muscles or muscles that have painful knots in them. This can be indicative of mineral depletion, principally magnesium which is essential for cellular function, including muscles and nerves.

Low magnesium shows up as weak muscles, muscles that are painful to press and prone to cramping and aching. Low magnesium is a factor with irregular heart rate and low blood pressure. It is likely that adrenal function is low. An associated factor is vitamin D deficiency which is a certainty among student cyclists living down South. Vitamin D supplementation is cheap and safe.

Drinking lots of water, even if it has some electrolyte in it, may add to the problem by flushing out mineral salts from the body.
Try a course of mineral supplementation with added magnesium with a complementary quality B Group vitamin supplementation. The benefits, if any should be obvious within a few weeks.

Go easy on the sugars and refined carbohydrates
I would go very easy on the sugary drinks as well because they are shocking for teeth and gums. Your athlete diet should be low in sugars and refined carbohydrates and high in quality whole natural foods.

Read my e-books on endurance training and train your body to run on its reserves. You should be able to ride three hours on pure water only with no need for sugary stuff. If you are a junk food addict then you could be suffering killer sugar lows as the ride progresses despite the sugar drinks. As blood sugar plummets, you will ache terribly, including the neck muscles and may develop headaches. You will feel weak and concentration and decision-making will suffer.

Drinking far too much
When riding up a hill you may quickly become drenched in sweat. This is partly because of the extra hard work, but also because there is little or no airflow to evaporate the sweat. You may get the impression that you are losing sweat by the gallon; whereas the truth is it may be just a a few cups worth during the climb.

If you drink too much water before, during and after a ride then you may be placing your health at risk. That you described having to get up several times in the night to pee is a sure clue that you might be drinking too much.

Excess fluid flushes critical minerals and other nutrients, like the water soluble vitamins, out of your body. More dangerously, you risk developing hyponatraemia (I call it soggy body syndrome or SBS). One of the symptoms of hyponatraemia SBS is headache and the other "heady" symptoms that you describe.

Drink only what you need to stay hydrated and no more. Ignore the experts and the sports water companies who advise you to mimic a fish. Learn to go by thirst (I know this advice will cause howls of protest in some quarters; but let's be sensible for once!). Hyponatraemia SBS kills healthy athletes, so it is irresponsible to give the impression that guzzling endless gallons of water is essential for sport and a cure-all for everything.

You might like to get a gauge of fluid loss during a ride by weighing yourself before and immediately after a ride. After deducting a Kg for each liter drunk during the ride, you can tell exactly what your fluid requirements are. You might be surprised at how little water you actually need during a ride. A 2-4% overall weight loss during a ride is fine and your body will get used to it with time.

Caffeine withdrawal
As with bottled water, sports drinks and carbo gels for athletes, do not believe everything that is churned out by the commercially driven research! Caffeine is not all peach and cream. It is a highly addictive drug and you might be hooked!

One reason headaches and migraines and generally feeling rotten happens more often during weekends is because the routine of caffeine ingestion is interrupted. While the amount of caffeine is a factor, so is the regularity of ingestion. If you take a even small amount of caffeine daily, then your physiology adjusts to that. If you then get up early for a long ride without your scheduled caffeine shots, it is possible that you will start to suffer the aches and pains, headaches and loss of energy and concentration that is part of drug withdrawal.

Please read my articles about caffeine, including the guidelines for assessing your possible addiction to caffeine and follow the advice for getting yourself free of caffeine's grip on your physiology.

Possible neck and shoulder problems
I have worked with a number of top swimmers over the years and shoulder and neck problems abound. While flexible and loose is beneficial and common, this does not mean that a swimmer is not without painful knots and inflammation. These do not disappear with rest and can bother an ex-swimmer years later with neck and shoulder pain. This pain can be in the form of tension headaches due to irritation of the nerves that supply the forehead and scalp.

Jono: Being a student, sitting for long periods, staring at a screen all day, just adds to the tension. As does slamming and rattling the skull for several hours on a mountain bike and kinking the neck during steep hill climbs!

The solution is all of the above, plus a course of deep tissue massage of the shoulders and neck. Generally, you need three sessions per week each lasting about an hour for a few weeks. This can then reduce to about twice a week for a few more by which time the muscles (assuming they need working on) will be in fantastic condition. If in Wellington, I provide this service. I am not sure of who you can see down South. Look for an experienced massage therapist with suitable qualifications. You need a person with strong hands who is prepared to spend the time and effort without hurting you. A brief tickle and rub might feel great; but will do nothing of lasting benefit.

So, Jono, now you have much to work on. It is a bit like playing detective with your body. Please let me know how you get on and let our readers know what works and what does not.

Advice sought about post-exercise muscle cramp

"I enjoy hillwalking and a few months ago did the most arduous walk yet. Next day my thighs were tight for a day and next day fine.

However on this second day a knot started in my right calf and progressed to almost crippling status and remained for 3-4 weeks before suddenly disapearing. Whilst there I took anti inflam , asprin and ibufrofen gels without much relief.

I went on almost as hard a walk 3 weeks ago and although filled with trepidation, nothing untoward occurred. I was on holiday this week and played a round of golf and carried my bag. Now 2 days later the cramp has re-ocurred.
Help? Whats going on?"Gary Moller comments:
This 41 year old male appears to be in reasonable shape; but definitely overdid things by doing a hike that appears to have been partially unplanned, turning into a 16 mile hike over and around a couple of mountain peaks. It is understandable that he suffered a quite severe calf strain/cramp that has not resolved.

It may never completely resolve unless dealt with properly.

Here are some observations and advice:

Should one take anti-inflammatories?
In most instances, the answer is "No!"This is because anti-inflammatories may interfere with the processes that lay down healthy collagen scar tissue. If this process is interfered with, the resultant healing may be weak and prone to further injury. Inflammation is healthy: it is the body's mechanism for bringing blood, nutrients and other resources to the injury site. It makes no sense to suppress this mechanism with drugs. These drugs can also interfere with digestion and therefore your nutritional status. While it may have the injured limb back in action sooner (this is questionable anyway) this may be a fool's gain.

The only "anti-inflammatories" that might help are natural ones. Kordel's MSM is one as are Omega oils like fish oil, flaxseed oil and olive oil. Evening Primrose oil is very beneficial. These enhance the healing process rather than interfere with them.

Re-mineralise the body
I doubt there is a 40+ year old male or female who leads an active and stressful life that is not deficient in minerals, principally magnesium. Exhausting exercise chews through magnesium and may result in disabling muscle cramps and failure to recover. In conjunction with the minerals is the need for rich supplies of the B group of vitamins.

So, my advice is to top up with a magnesium supplement and a B group supplement. You can also add a lengthy soak in an Epsom Salts bath which relaxes the muscles while supplying sulphur and magnesium through the skin.

Minerals can be obtained from a bone broth that is consumed daily and this is additional to a course of magnesium supplementation.

Take the guessswork out of supplementation and improve your health by ordering a hair tissue mineral analysis. Although $225 it is well worth the cost.

Massage the injured limb
It is highly likely, if not inevitable that there are still painful knots within the calf muscle that was injured. The uninjured limb may be similarly affected but to a lesser degree. As long as these knots remain there will be ongoing pain and limitations on ability to exert oneself. The risk of further injury is great and rest alone is never the solution. Deep tissue massage is the solution but only commence this 2-3 weeks after the dietary measures have had time to kick in.

Deep tissue massage causes damage to the unhealthy tissue that forms the knot within the muscle. The damage is in carefully controlled doses, stimulating the body's natural healing processes to lay down new healthy tissue to replace that unhealthy tissue. It is painful but highly effective - but only if your nutritional status is healthy.

Deep tissue massage the calf muscle to break down and soften any hard knots and injury-prone spots within the body of the calf. This requires about 30 days to have a lasting effect done every 3-4 days. Get this done by an experienced therapist. If in Wellington I can do this for you.

Do a steady buildup in fitness next time
Recovery includes a steady increase in fitness over about three months and then maintaining a high level of fitness indefinitely through consistent weekly exercise and good nutrition.

Think specificity: If your most challenging past time is hiking mountains, even if only a couple of times per year, then the bulk of your weekly fitness training should be geared towards preparing for these hikes. That means getting outside and doing a lot of walking over tracks and trails. Training in a gym on a treadmill, elliptical and lifting weights are beneficial; but should not be the principal fitness training for hiking. Hiking each week is best.