Monday, May 25, 2015

SRM WEEK 7 OF 20: Another piece in the puzzle of my busted right leg.

Can I just say, this man is kind of my hero.
If you've been reading for a while now, you've probably heard me rant/complain at some point about the chronic problems I have with my upper right leg. It started a little over two years ago, when I was about 6 weeks out from Mountains 2 Beach Marathon, as adductor pain & tightness, which then moved around to my quad, and then during the race itself I actually ended up tearing a muscle in my quad & being on crutches for a month. SUPER FUN.

It's never quite been that bad since, but I also haven't really been able to train solidly for anything since then. It'll be totally fine for a while, then pop up out of nowhere & require anywhere from a few days to a week off, and it seems to be particularly aggravated by fast running (whether speed work or trying to race). And the really strange thing to me has always been how it's not particularly localized: it might be my hip flexor one day, my hamstring the next, or my adductor, or my quads.

Regular massages help a lot with the symptoms, but it's always been incredibly frustrating to me that after 11 months in PT, all kinds of medical imaging, and hundreds of dollars' worth of gait analysis, no one has ever been able to tell me what the actual problem is or how to get rid of it permanently. Recently, though, I feel like I *may* have stumbled onto a potential clue. I'm wary of getting too excited about it, because I've felt like I was on the verge of an answer too many times before, but this time a lot of the pieces certainly do seem to fit.

So! Let's talk internet reading (which I see you are into).

I know I can't be the only person who constantly clicks on interesting links as I peruse social media & think to myself, "I'll just keep that open in a tab to read when I magically find myself with oodles of extra time get around to it." And then one day I open my computer to find forty tabs open staring forlornly at me, with even odds as to whether I just give a little shriek of terror & immediately close them all.

For the last couple of weeks, I've had a tab open to an article from called Elite Feet: Strong Strides Start At The Foot, by ultra-runner/coach/PT Joe Uhan. The reason I clicked on it initially is because it was posted by A.T., the woman I've been doing strength training with once a month or so, with a note about how in her circle of runner-oriented PTs/trainers/coaches/etc., foot mechanics had been a hot topic lately. Basically it sounds like the tendency is to ignore feet unless there's actually an acute problem like plantar fasciitis/collapsed arches/etc., when in fact foot mechanics can have all kinds of effects (including injuries) up & down the body.

Last weekend I was getting fed up with the number of tabs open in my browser & finally decided to slog through this & a bunch of others so I could finally close them. The main topic was foot strength & stability, particularly in the crucial arch/inner toes/ball of foot area.

    "While our feet are designed for many motions and actions, with locomotion–-walking and running-–the most powerful and important power-generating structure is the medial arch. As such, I call it, ‘The Power Ray.’ Through this structure is where we should do all our weightbearing, footstrike, and push-off in both walking and running. [The rest of the foot] is designed more for balance and for cushioning at initial contact. Normal gait involves initially contacting on the outside, then quickly transitioning to The Power Ray engagement."

I found the foot stuff interesting enough, because not rolling through onto my arch is a problem I had pretty severely on both sides for a long time. (Probably because prior to that I had some really bad medial shin splints & dramatically "under-pronating" was the only way I could get any relief.)

The next part got into how engaging "The Power Ray" correctly is what lets us load up our most powerful running muscles effectively:

    "When the foot is loaded through The Power Ray...this action creates an automatic, full-blast activation of the gluteal muscles: both the gluteus medius–-the main leg and pelvic stabilizer–-as well as the gluteus maximus, the most powerful muscle in our body. Proper foot and leg alignment allows ground-reaction force to flow up the leg through the activated hip muscles, creating a powerful, effortless, and automatic push-off."

Sounds kind of important, right?

Then he got into the consequences of not loading up The Power Ray correctly. Of course, most of us are familiar with the whole arch/leg/knee collapsing inward situation (usually referred to by the catch-all term "over-pronation") that tends to cause all kinds of yucky hip/knee/IT band overuse issues.

What caught my attention, though, was his discussion of the opposite problem:

    "The converse condition is where the runner lands only on the outside of the foot. They ram down on the lateral aspect of the foot, avoiding The Power Ray entirely, either by conscious ‘fear of pronation’ or unconscious instability avoidance. In this strategy, runners over-use the lateral foot, as if the brain doesn’t trust the medial arch (or, if for some reason the arch is sore, weak, or unstable). While they might be avoiding collapse stress, the consequence is the same: the foot and lower leg are improperly aligned, and the hip muscles fail to activate."

While it's nowhere NEAR as bad now as it's been in the past, that was still sounding uncomfortably familiar.

And then, discussion of the most common compensatory injuries:

    "If the leg is not pushing off as powerfully as the other side, the opposite leg has to over-reach in order to make up the deficit. This is the primary cause of landing-stress injuries, such plantar foot pain, shin pain, IT-band pain, and many others...If the hip muscles are not fully activated, the other leg muscles have to take up the slack. If that lightning bolt cannot travel up to the hips, then the lower leg muscles–-the quads, hamstrings, and calves-–do the bulk of the propulsion."

This is where my brain really started to sit up & take notice.

    "Very often, runners and sports-medicine professionals alike tend to hyper-focus on the symptomatic landing leg. They will focus their treatment on stretching, massaging, or strengthening the [problematic] leg and hip in order to prevent the collapse."

Check, check, and check. During my many many months of PT, my right knee was constantly collapsing inward, yet I was passing all the hip & core strength tests with flying colors, and no one could figure out how that made any sense.

    "But whose fault is it, really? It’s the [opposite] foot, for pushing the trunk too far [in the other direction]! The linchpin to the issue is the [asymptomatic] leg strength and stability. Conversely, any efforts to shore up the [symptomatic] leg usually result in only temporary relief."

Which reminded me of what A.T. had said the first time she watched video of me running and then watched me do squats--that I clearly had some kind of strength imbalance/asymmetry, but if the problem was my right leg (the one where I tore the muscle & that has continued to grumble at me on & off in the ensuing two years), then all my symptoms were backwards. (When I run & do squats, it's my left hip that drops; if the right leg is weaker, then the right hip should drop.) Her theory has always been that for some reason it's my left glute/hip/whatever that's weaker, and the problems in my right leg came from overcompensating.

The one problem with that theory was that in all the strength testing I've had off my feet in the last couple of years, neither side has ever seemed particularly weaker than the other.

So, what if the problem is on the left side, but instead of glute weakness, it's actually glutes not activating properly because of what my left foot is doing?

Uhan then went on to describe an informal experiment that he tried in his practice, involving 10 patients with ongoing leg pain in one side, who had also had a previous foot and ankle injury on the other side:

    "I video-recorded the side view of each trial. No running cues were given, nor were they given any information as to why I was taping his or her foot. Hip-extension angles-–the range of motion measure correlated to push-off power–-were measured. For each subject, I conducted three running trials:
    • A pre-test running trial. I tested each runner at a comfortable speed, wearing their preferred shoes.
    • A supported-foot running trial. For each runner, I then kinesio-taped the previously injured foot, such that the medial arch was maximally supported and facilitated to engage The Power Ray. They ran at the same speed.
    • A post-test running trial. The tape was removed, and they once again ran at the same speed.

    The results: in nearly every subject, hip-extension range of motion improved by 10% with supportive foot taping. This effect disappeared when they were re-recorded, without foot support. Both the runners and I were shocked at the automatic improvement in hip extension push-off when the foot was placed in a supported, optimal-loading position. What I concluded was that simply getting The Power Ray to engage the ground was enough to improve hip activation and push-off."

And if the problem is that the symptomatic leg has been over-compensating for the other leg's lack of hip extension all this time (because of what the foot was doing), then that should solve the problem.

For the last 6-8 weeks or so, I've had more pain & tightness in my upper right leg than usual, and even though I wasn't truly racing in either case, it was definitely worse after both Parkway Half & Bay To Breakers (I'm sure because I still ran both of them significantly harder than my typical "easy" pace). I could rest it or take it easy for a few days & the pain would subside a little, but as soon as I went back to my normal amount of running, it always came back to some extent.

Case in point: This week.

~*~*~SRM WEEK 7 OF 20~*~*~

Grand Total: 32.5 miles

    * 18.5 easy
    * 14 long
    * 2 x 45:00 strength

Monday: a.m. roll/stretch/strength; p.m. karate.

    My epic 17-mile Bay To Breakers Sunday was great fun, but also kind of wrecked me for the rest of the day. When I got up Monday morning to head to the gym, I definitely had that tight, worn out feeling in my legs the next day that let me know that I had probably done some combination of too much/too fast/too soon. In particular, my right quad & adductor were #notamused. So instead of 45 minutes of strength I did more like 25 minutes of stretch & roll alllllll the things (especially the right leg) + 20 minutes of non-leg strength stuff.

Tuesday: 2.5 easy.

    Prior to Tuesday, I had been thinking, "FINALLY! This week, I will start my four weeks of baby-steps intro-to-speed." Hahahaha no. Barely a mile into this run, I felt like I'd run ten, plus my right leg (quads this time) was waving the big fat NOPE banner. So, instead of an 8 mile progression run, I spent like an hour aggressively rolling every muscle in my right leg while watching The Daily Show.

Wednesday: Karate.

    I meant to get up & do real actual strength work but instead I decided I needed to sleep some more. Before karate = another hour of aggressively rolling every muscle in my right thigh PLUS all the glute/hip muscles (which were feeling tight & unhappy).

Thursday: 8 easy.

    This run actually would have been awesome, except for the near-constant aching in my right quad. Though to be fair I actually also kind of suspect that I may have rolled my quads a little too aggressively & so at that point they were just kind of bruised & beat up. Still - 7 miles including 12-15 fartleks 1:00/1:00?

Friday: 8 easy.

    GOD. The right leg. I was so frustrated at this point. Basically it seemed like, ok, sure, I can run a hard workout or a semi- (not actually) hard race every once in a while and maybe my leg won't self-destruct if I then take like 3 rest days and roll the heck out of it, but that's not exactly what you call ideal training for a PR marathon. It felt better than it had Monday, but still, things were unhappy, in that way where you can tell they're maybe kind of threatening to do more than just be mildly unhappy.

Saturday: Rest. And to be honest, at that point it hurt bad enough that I was considering just skipping my long run on Sunday so that maybe my leg would fully recover & I'd be able to get a solid week in next week.

But. Then I read this article.

Now, I had no kinesio tape, and wouldn't know how to tape my foot in the way he described even if I did. But I do know that I tend to avoid bearing my weight fully on my left arch (my foot gets sore when I do), so I thought maybe I would try a few miles Sunday anyway, making a conscious effort to run on "The Power Ray" and not the outside/middle of my left foot as I normally tend to.

Sunday: 14 long

This wasn't easy, but WOW. Even in just the first few miles, I could feel a) my left foot getting sore and b) the glutes on my left side engaging almost without any extra effort on my part. At the same level of effort as usual (aside from thinking about my left foot), my pace dropped by 30-45 seconds per mile. And?

No pain in my right leg.

None. Not even a little.

Originally I had thought I wouldn't push it more than 10 miles, but everything felt so good that I decided to go to 14. I kept waiting afterward for the stiff, achey soreness I've been inevitably dealing with in my right leg after only 6-8 miles, but again, it just never happened. In spite of running close to double the distance I had earlier that week, my leg felt completely normal.

All I'm saying is, there may have been some celebrating.

Uhan again:

    "Efficient push-off–both power and direction–begins at the foot. Simply put, optimal foot and lower-leg alignment is loading The Power Ray, with the foot straight ahead, rolling through a strong arch, and pushing the foot straight behind. 'Elite Feet' is the term for this action, as elite runners do this flawlessly:
    • Loading the ball of the foot and big toe,
    • Rolling straight through, and
    • Pushing the foot straight behind.

    It’s that simple. But to do so successfully and consistently requires focus, and a great deal of strength development of both the foot and the lower leg.

So, if indeed this has been my problem all along, I probably do need to actually do something about my left foot so that I don't just end up with a busted arch.

What To Do?

Uhan has three main suggestions for strengthening/stabilizing feet & arches.

1) Heel Raises. Like standard calf raises, but bending your knee a little so that the "Power Ray" is doing the work. (More details on exactly how to do this correctly in the article.) He suggests working up to 50 on each leg and 100 on both legs together. This seems like a pretty easy one to throw into my usual routine.

2) Ankling Drills. Apparently you can find lots of examples of these on YouTube. This one is new to me, but it looks like it would fit right in with the skips/bounding/etc. I do before track workouts. (Y'know, back when I did track workouts...)

3) Squats/Other Single-Leg Exercises/Drills. Basically do whatever it is normally, except pay close attention to what your feet are doing. Lunges/step-ups/step-downs/squats/monster walks/etc. will all work; just be sure that with every step or use of your leg, you're rolling through to bear your weight on the arch (while keeping the knee aligned above the 3rd toe, more or less). I do a bunch of this stuff anyway; I should just start paying close attention to my left foot to make sure I'm using my arch correctly.

So...yeah. For now, I'm cautiously optimistic. We'll see what my baby-intro-speed sessions bring.


  1. This is all fascinating to me and a bit scary, haha. I have bunions so it would make sense for me to favor the outside of my feet too. (Those photos of you running are strikingly similar to mine-- pun intended.) THIS EXPLAINS SO MUCH.

  2. It's a little bit exciting that you've found out what might be causing your problems. Even more exciting that you got your long run done without pain.

  3. Wow, that is impressive. I do not supinate at all, but I'm sure my foot strike does lead to damage: I significantly heel strike on my right, but not so much on my left. That's odd!
    My question is always - how do you bear weight on your arch? My arch is very high, and at no time does it touch the ground. Whenever someone says, "Land on your midfoot" I'm like, "On air?"

    1. Yeah, I think it's not about your arch touching the ground (because that's a serious problem, right?) so much as supporting your weight over that part of your foot, even if only the ball of your foot is actually. Like the middle/outside of your foot may still be touching the ground, but it's not actually supporting most of your weight.

  4. This does sound very intriguing and our pains, like you noticed, are very, very similar! My right leg is always the one that feels off and it actually feels "short" when I run. I'm going to read that article and implement these exercises immediately! THANK YOU!

  5. Exciting! Fingers crossed that the "Power Ray" is the answer! (what a weird/awkward name, though)

  6. Yes, I tab everything and then I have to purge regularly.

    So, did you actually try taping your foot?

    1. So I did get some tape & internetted how to tape it up, but there seem to be different opinions so I'm not sure if one way or another is better for this (since he wasn't more specific in the article). I tried taping it one way for a trail run Saturday, but it didn't really feel like anything, so I'm not totally sure I'm doing it right.