Thursday, February 8, 2018

Running Rehab: Ankle Irritation, Lower Leg Pain, and Pronation - Part II

I resolved to rehab my ankle last week. I said I'd check in, and here I am, still not a doctor! Over the past week I've been doing 3 things:

1. Massage -
Self-massage with a small glass bottle, plus these delicious $5 (150 baht) foot-and-leg massages here in Chiang Mai, Thailand. (Sorry for even mentioning it!)
It hurts so good! I can feel my progress because my soreness is abating.

2. Stretching -
Rotating my ankles qigong style, and focusing/pushing hard on the medial portion of each roll
While sitting on a chair, keeping ankle alignment and slowly going through palmar and plantar flexion, limiting my range by my ability to hold alignment.
keeping good ankle posture through forward fold, downward dog.
Can you feel that stretch? I can, though if I overdo it, that feeling might turn into clicks instead.

3. Practicing posture -
In addition to daily focused practice "penny-pen" style, keeping posture in daily life. This has included engaging my right abductor to keep my knee over my ankle, especially while going down stairs.
I'll get more into that below.*

When combined with stretching and massage, the progression of exercises goes signaling, strengthening, movement, and integration:

1. Focused signaling: practice of "short foot posture."

This is a neurological learning process. Gains can be made through attentive repetition; attending to and trying different things, feeling the difference, correcting, and trying again. Honing the signal from the brain to the foot includes both what to flex and what not to flex; differentiating the signal to flex the arch and medial ankle from the signal to flex the toes or the ball of the foot.

2. Strengthening

Through that same focused repetition, I was strengthening my arch. While I got more specific with my movement, I noticed I became less motivated to do the work, because it was no longer a puzzle and a challenge. I've got to keep at it though! Only over the long term am I going to combat lanky tendons (I hear those don't shrink) and really refine that alignment.

3. Movement Variation

Keeping this posture, I'll ask the foot to absorb shifts in weight. I've used this very light exercise. For my hips, I already use a yoga bridge, keeping my hips aligned and shifting my weight from one ankle to the other. However, I'm noticing as I ask my ankle to load differently, my legs respond differently as well. I'll similarly do some slow squats.

4. Integrating the new posture with everyday movement

I'm already constantly working on and observing this during my daily activities, e.g. while standing, walking, jogging, climbing stairs, and riding a motorcycle. I'm learning a ton as I watch changes in my weight distribution and the angles of my ankle, knee, hip, and even shoulders. I should take it easy and not push or geek out too hard because I don't want to get burned out. (On a hike, I was being very attentive to my desired posture, and found I had made noticable change for the downhill muscle groups to adapt to on the return trip! *That's a where the abductor came in especially handy.) Overall, it's starting to form a nice habit.

Changes:
Engagement of outer calf muscle while walking, esp,. stairs.
Less external rotation of leg when lying down.
Less "clenching" and fatigue of right adductor.
While stretching ankle joint, or in forward fold, less general soreness.
While receiving massage, less soreness in the ankle and sole.
While running, a noticeable lateral shift in right foot load pattern.
Still got to keep the ball of the big toe down!

Still more changes to be seen. For the first week, this is more than I hoped for.

Further resources:
Overpronation diagnostics rant
Diagnostic trick, advice
Some badass doing something pretty intense. I'm not yet, but you can if you want.
And another badass doing some fun things.

Wednesday, January 31, 2018

Running Rehab: Ankle Irritation, Lower Leg Pain, and Pronation

Hey everybody: I'm no doctor and I'm not offering medical advice!!

I started running consistently for the past month or two. For the last week, after longer runs, my lower legs were in increasing discomfort! Resting didn't reset how they felt, so maybe I was building the wrong kind of tissue, and headed toward an overuse injury? Yikes! I tried a flip-flop walk. (Not on purpose; I'm not that smart.) I noted lateral rotation in my left foot, and ended up with acute irritation on a lateral ligament. Yay, feedback!

Something I started with before running regularly: Overpronation in the right foot. For years I experienced knee pain in that same leg if running or hiking, and tension in that adductor if sedentary. When I lie down, my whole right leg externally rotates, so my right foot flops to the right about 15 degrees more than my left, with a bit more plantar flexion as well.* I assumed it was part of a hip issue, but for now I'll take this as a symptom of lower leg tension often accompanying overpronation, and see if I can make headway there. Reevaluation ftw!

Short-term goal: Rehab strained lateral ligament on left foot, relieve pain and get back to a stable gait.
Actions taken:
  • RICE! Rest, ice, compress, elevate
  • Self-massage of sole with body weight and small glass bottle
  • Self-massage of ankle with hands, elbows in sukhasana or var.
  • Penny-pen exercise; press down on ball of foot, engage arch
  • This exercise also helped me find that "arch" muscle group.

Long-term goal: Strengthen and stretch for healthier lower legs, and get back to running!
Actions taken:
  • More self-massage!
  • Uttanasana/Adhomuka svanasana focus: Soften knees, drive ball of the foot while engaging the arch (using penny-pen skill above). Keeping these layers, add flexion stretch to heels, and isometric lateral rotation to hips. So doing, I feel this stretch all through my legs, in my problem muscles, in subtle but deep ways which I hope will have a positive impact.
  • This stuff feels weird in my knees, but I'll do it once in a while to check my progress.
I updated after one week. Check my progress.


* "Fifteen degrees?? Big deal!" you might say. I don't have clinical hip dysplasia. For those that do, may God's love and a great PT be with you.


Disclaimer: Everyone is different. I have a weird situation. (Don't we all!) My hips sit at different angles, my left leg is longer than my right. This is probably exactly like your body... but we still might have a lot in common. Bipedalism, for example!