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Marathon Training & Foot Strike Pattern
September 3, 2010

I've been training for my 3rd marathon testing my theories about foot mechanics by running in Chuck Taylors (Converse) shoes. And no, I'm not sponsored by Converse! I'm up to my 20-mile runs and am feeling very good about my foot strike mechanics (although wish I was a faster runner!). I've had no, foot, knee, hip, or back pain since switching. Previously, I would always have to correct a pelvic rotation which contributed to back and hip pain but no longer. I'm feeling very good about my new theories regarding our walking (running) patterns.

Yesterday saw a woman with bunion problems and we were able to temporarily reduce the size of her bunions by changing how she stood. Now the trick will be to get her to walk better, thereby correcting the mechanical issues, I believe to be behind her foot, hip, and back pain issues. I'm really enjoying experimenting with this as I believe our anatomy supports my theory. Of course, I have a lot to learn, however, to tweak it and make it applicable to everyone.

Holistic Success and Back Pain
August 14, 2010

Earlier this summer I flew out to California to be interviewed about back pain on The Holistic Success Show. I had a wonderful time meeting Dr. Puff, Elizabeth, and the crew. They really made me feel at home. Feel free to check out Episode 38 if you'd like to hear me speak about back pain. Feel free to contact me with your thoughts!

Plantar Fasciitis, Bunions, and Foot Mechanics
May 24, 2010

I've been experimenting with my theories about walking mechanics and chronic pain conditions such as plantar fasciitis, bunions, heel spurs, hammer toes etc. Although it has been simple to remove the pain of bunions through improved gait training, I haven't yet been able to reduce the size of the bunions--until now (I think). The problem is I took pictures of my client's bunions but mistakenly sent them to my trash. She believes (as well as I) they are reduced--dramatically. But I have no proof without those pictures!

The plantar fasciitis has been more difficult to treat. I can make the pain go away with my simple taping technique but getting people to actually alter their gait pattern consistently has been the problem. I'm now also experimenting with a simple knee taping technique to help change their gait mechanics even if they're not thinking about it. This is an interesting mental leap for me as I generally haven't considered the knee affecting the foot. Instead I've always thought of the foot affecting the knee. I think this should help though. We'll see! I'm also understanding that, for those with chronic plantar fasciitis, the foot mechanics are in a "deep hole" of poor function and so taping right off the bat is the right way to go instead of just altering gait patterns.

Ultimately my theory is that we should not need foot orthoses to fix our foot mechanics given the proper guidance.  This, in light of the fact that I cast for foot orthoses, would be a major revelation in the industry. What I am learning, however, is that changing foot strike patterns on a regular basis is more difficult than I expected. For those unable (or unwilling)  to change their patterns, foot orthoses are a good choice--assuming they are casted correctly (which many are not).

Anyway, my experiments continue and I am heartened by my results!

The Pelvis and Sciatic Pain
April 10, 2010

Sciatic pain is almost as ubiquitous as back pain in our culture. As with most chronic pain conditions, I've found sciatic pain to be a problem in people's habits such as sitting or sleeping postures as well as anatomical issues such as tight muscles in the front of the pelvis or weak muscles in the back of the pelvis.

Let's look at the anatomical players first. The sciatic nerve originates in the lumbar spine as nerve roots exiting the spine then coming together to form the sciatic nerve which passes through the back of the pelvis and continues down the leg. Often the pelvis can become tilted forward (anterior pelvic tilt), backward (posterior pelvic tilt), or rotated so that one of the pelvic bones is tilted forward while the other is not. The vast majority of sciatic pain I treat results from either an anteriorly tilted pelvis or one that is rotated.

This happens when the muscles in the front of the pelvis become symmetrically tight as with an anterior pelvic tilt or they can become asymmetrically tight creating a rotated pelvis. Correcting this tightness goes a long way toward correcting sciatic pain.

[caption id="attachment_246" align="alignleft" width="182" caption="Pelvic Asymmetry      Copyright Boone Publishing, LLC. 2009"][/caption]

Usually people with these issues also present with weakened or poorly performing gluteal muscles (the rear-end muscles). These usually turn off as a result of poor standing posture or walking mechanics. Turning these muscles on while walking or running, together with stretching the muscles in the front of the pelvis help restore normal pelvic mechanics which then restores normal spinal mechanics. The spine responds to the pelvis because both are linked so closely together. Fixing the pelvis will help fix the spine.

Let's look at sitting and sleeping postures that relate to sciatic pain now. When sitting, most often I find the knees are resting too low in relationship to the hips or the legs are too close together. This creates an anterior pelvic tilt and consequent spinal extension (arching) which can create sciatic pain. Another problem would be sitting asymmetrically so one leg is loaded more than the other. This can create a rotated pelvis also contributing to asymmetrical stress to the spinal nerve roots.

Standing habits involve locking out the knees and allowing one or both leg bones (femurs) to rotate inward too much. Both of these habits also create varying degrees of anterior pelvic tilt either symmetrical or asymmetrical.

Typically people with sciatic pain sleep on their sides which allows spinal sidebending and rotation to occur. Sleeping presents one of the hardest stresses on the spine because you are in this position for 6-9 hours each night. This can cause damage if care isn't taken to pay attention to your body. Often what I find helpful is folding a bath towel lengthwise and placing it under the waist. This removes sidebending and rotation stresses to the spine regardless of which side you are lying on. Consequently it helps sciatic pain.

These tips and others can be found in my book, Fixing You: Back Pain.

Tennis Elbow Anyone?
April 5, 2010

Tennis and golf season is upon us which means those sleeping injuries re-awaken after a winter of rest. One of the most pervasive and lingering aches is tennis elbow or golfers’ elbow. These are felt in the outer (in the case of tennis elbow) or inner (in the case of golfers’ elbow) elbow joint and affect just about everything you do that requires gripping. The medical terms are lateral epicondylitis (tennis elbow) or medial epicondylitis (golfers’ elbow) which basically mean that something is irritated on the outer or inner elbow. These terms don’t actually explain what is irritated or why. There are many approaches to dealing with these injuries including forearm cuffs, painful trigger point release, or even surgery. However fixing the underlying roots of the problem resolves pain quickly and permanently.

Know Your Anatomy

The first place to start is the shoulder. Problems here affect how tennis elbow or golfers’ elbow develop. The most common issue is that the shoulder blades sit too low on the trunk and too far out to the side (I've mentioned this in previous posts). This sets up a domino effect whereby the upper arm bone to rotates inward which then causes the forearm to rotate as well. This is when tennis elbow or golfers’ elbow emerges.

This commonly happens in people who spend a lot of time at a computer. But, frankly, I see it in athletes or blue-collar workers as well. The muscles of the shoulder and forearm then adapt to this posture causing deep forearm rotator muscles to become lengthened or weakened while others become shortened (Figure 1.).

[caption id="attachment_239" align="alignleft" width="269" caption="Figure 1. Deep Forearm Rotators        (Copyright Boone Publishing. 2010)"][/caption]

Treatment is usually delivered to the muscles lying on top of these deep rotators. Mostly because it is in these muscles most people feel pain. These superficial muscles are merely reacting to deeper problems in the muscles lying against the elbow bones (pictured). Treatment of the superficial muscles requires multiple visits for painful therapy which delivers marginal results at best. The real problem is that the shoulder blade is not resting or moving correctly which sets up the elbow joint for problems which then leads to tennis elbow or golfers’ elbow.

The Fix

The solution? There’s good and bad news: The good news is that fixing tennis elbow or golfers’ elbow can happen quickly. The bad news is it’s not simple. You must first correct the shoulder blade issue which is feeding the recurring elbow pain. Then address the deep forearm rotators that have altered to accommodate the shoulder and arm position as well. Doing one without other can’t correct the problem for the reasons mentioned above.

However, I’ve made it as simple as possible in my new book, Fixing You: Shoulder & Elbow Pain. In it I present the problem and solution so anyone can understand the roots of their pain and fix them. So, if you’re tired of wearing that forearm strap, endless visits to a therapist for treatment, or icing your elbows after work or a game of tennis or golf, then do yourself a favor and get to the root of the problem. It’s time to fix your elbow pain!

Rick Olderman is a sports and orthopedic physical therapist, personal trainer, Pilates instructor and speaker. He is the author of Fixing You: Back Pain, available at www.FixingYou.net. Email Rick at Rick@FixingYou.net or call 303-477-4212.

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