Running Rehab – Part 2

 

In conjunction with the previous post – Running Rehab Part 1 – I will describe the places on my lower body where I have used a foam roller to work out tight and painful spots, which has released me to run pain-free again.

First, the points on my body which have caused me problems…

Notice the markings on this drawing. The red spot indicates a point at which I have felt pain. The connected yellow zone indicated the area of muscle tightness or knotting I worked on which then removed the pain at the red spot. The lesson from this: the point of pain is not necessarily the location of the problem.

The thing that has become so clear in my experience, first in working out the muscle knots in my upper back (in Spot A, described in this post), and now in my legs, is that it is not enough to stretch individual muscles to get ready for an activity – these are whole systems of muscles and nerves, wrapped and connected by fascia tissue, which all must be free to move and work together in a lose and unified way. When even one member of the team is tightened up, restricted or out of sync with the rest of the tissues in that system the body will do its best to compensate for a while, until it can’t do it any more. A certain kind of pain is the warning this compensation is happening and if it is not addressed, another kind of pain will come to let me know the system has broken down. Distinguishing the first kind of pain from the second kind is a critical self-maintenance skill.

When I read this article on shoulder pain in young swimmers I was so grieved to think that basic pain-interpretation and response skills are still not being taught to beginners in the sport of swimming (or in other sports?). To me this is one of the fundamental responsibilities of the coach who is introducing someone to the sport, especially on a team where the athlete will have months of action in which to discover and practice these sensations and injury-prevention skills. The coach needs to teach the swimmer or runner not just what looks correct, but how it feels when it is correct and correspondingly, how it feels when things are incorrect and how to fix it immediately. This internal detection system is the first line of defense for an athlete, and every new one should learn it immediately.

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For sake of curiosity, I will show each one of the main rolling areas I do. I am not claiming that this foam roller device is the answer to all one’s pains, but I am so pleased that one simple and inexpensive tool did so much to relieve nearly all my major legs problems.

I am going to state for the record – this post is not intended to teach you how to do any of these rolls or stretches. Done well, and these will help heal. Done poorly and it can make things worse. Be very careful and get some good instruction on how to do this. I can recommend Kelly Starrett’s stuff at MobilityWOD.com as a start, and his book, Ready To Run.

BACK OF LEG

I roll out the achilles area (Spot B, the tendon and lower part of the gastrocnemius muscle), long slow rolls up and down, sometimes stopping and holding for 15-20 breaths if I feel an unusual tight spot. My wife has taught me that it may take 45-90 seconds of pressure to get a muscle to release.

I roll out the calf muscles (Spot B, I think the main problem was the soleus muscle a bit deeper down, and often in one particular point) which would often get tight when I transitioned to a forefoot running style and after over-doing certain drills. It is mostly gone now, but I roll this area on both legs because I know they are working a lot more in this new style of forefoot running.

I roll out the back of the leg, above the knee (Spot C, I think it is the Biceps femoris that is the main spot) where the main ‘shut-down-my-run’ problem would come from in these recent years. I would go out running, feel fine for 10-15 minutes, the suddenly get these sharp tight pain in the tendon outside and behind the knee (lateral side, posterior). For years I couldn’t figure out why this was hurting or what was aggravating it so I didn’t know how to prevent it. Normal stretching (and I am quite flexible) wouldn’t touch it. But then, when I started to use the roller in January, and hit this vertical line of sore muscle in the hamstring above that spot, I could feel its relation to that very spot on the tendon. Bingo! It released!

I do it each day for security, but it took a couple weeks of rolling until the problem was finally gone.

I know quite a few people with pain in the sciatica nerve region of the bottom (Spot D). Last winter I developed really bad nerve pain on the left side from sitting in my office chair too much which prompted me to convert to a standing desk. That is a permanent arrangement for me now. It got so bad that I was in a lot of pain to even drive our car, but I couldn’t convert that to a standing car unfortunately.

I roll out the whole back end. I didn’t locate a single problem muscles- it seemed to me that I could be tight in the whole region or in slightly different areas on different days. But this too loosened up after several days of rolling. And, after a year of gradually worsening nerve pain, rolling this area before each run and it is mostly gone (though easily re-irritated if I sit too long or in the wrong way).

 

FRONT OF LEG

I have good backward flexibility in my leg-hip joint (extension) and maintaining hip mobility has been an emphasis in my stretching routine for decades. But when I started running again this winter I found sore spots in the hip flexor region – it was a good kind of soreness, and it felt good to roll this area too. The tightness here too dissipated after a couple weeks of consistent rolling. But I like to do this roll because it just feels good.

The major spot that I am continuing to work on is the left thigh (Spot E). This is the knee I injured in 1994, had surgery on and have a synovial fluid build up and inflammation in, and subsequent pain. (2 years ago I had an MRI to make sure it was known what was happening in there). I can run on it, and as long as I stay carefully within the bending range of a normal stride I am ok. But I can’t bend lower under load without the knee collapsing in self-protection (or preventing me from bending in fear of collapsing). It’s like something is pulling the kneecap too tight against the socket.

I have discovered the deeper thigh muscles (particularly Rectus femoris, Vastus intermedius, and Vastus medialis) on the left are so tight and wiry that I wince and hold my breath sometimes as I am rolling or holding pressure carefully on one of these strands. There is no pain, just soft, supple tissue on the right thigh under the exact same treatment. I can imagine tight, hard meat inside these left-side muscles that needs to be persistently tenderized. I think the muscles must have deformed in this way from over years of protecting the left knee the brain is not confident in.

But, once I discovered this connection and started rolling it, I would notice an immediate reduction in the amount of pressing I feel on that knee cap. The muscles are not totally relieved yet (they seem to tighten back up after a few hours), but after several weeks this is making a significant difference in increasing my pain-free range of motion under load. The muscles are not as painful to work on. I have been giving this zone extra attention, sometimes rolling twice a day. The muscles seem a bit stubborn but the gradual progress encourages me that I am working in the right direction.

 

And this is my favorite. I have a special love for spine maintenance. I have worked for years on my forward bending (global flexion) but I have never known a safe way to work on extension (bending backwards) until I found the roller. (Note: I am not talking about the extreme back bending that gymnasts do!).

My posture has noticeably improved in the last several years as I refined my spine alignment in TI practice. I have, in the last couple years, worked on my posture on land as well and have a good habit now of setting my posture while sitting, standing or walking. This practice has virtually eliminated all my neck pains I used to get (and the need for a chiropractor’s help to remove). Now, I can carefully roll my thoracic section of the spine, slowly extending vertebrae by vertebrae, to complement my flexion work. It feels WONDERFUL. If I do nothing else on a lazy morning I will roll my upper spine (working on extension) and then balance it with stretching in the opposite direction (flexion).

***

I have noted that most of these spots don’t seem to get very tight now – the combination of pre-run rolling and post-run rolling (as needed) has, over a few weeks kneaded these muscles into shape and now they seem to like the action.

That is, except for the calf and the thigh on the left leg. I attribute this to the extreme self-protective reaction inside my left leg due to the knee injury (and arthroscopic surgery). I work these areas persistently each day, and keep a close eye on them while running. And they are responding to the treatment, just taking longer to come around.

After 3 months, even without tightness or pain in most of these areas, before heading out for a run I roll all these areas out of routine now. This is insurance against tightness I may not feel until I start the movements. I can feel what may be happening inside the muscles but I cannot feel what is happening inside the fascia tissues that encapsulate and connect them into unified groups (there are no nerve cells in fascia, if I understand correctly) but indirectly by effects on my posture and mobility. These fascia tissues can get stuck, or lose flexibility too – and they need attention and maintenance as much as the muscles they hold.

Some lessons:

• There is a season of time needed to slowly, carefully work out tight spots and knots. They take persistent daily attention – maybe weeks – until they soften and stay that way.
• The whole tissue system needs regular maintenance. Even with pain gone, tightness might still be there and I won’t feel it unless I probe for it with a finger, ball or foam roller. If I run on it unknowingly, it could flare up suddenly, and perhaps while I am a long ways from home.
• But this daily (pre-run and post-run) maintenance can take less time if I remain consistent in my routine caring for them.
• I need to stay sensitive to the subtle tightness and pain signals while running – and remain loyal to tissue health rather than to finishing a run.

Not just pain, but many more subtle, sub-pain sensations are the warning lights on my control panel. If I want to keep this body running for years to come I had better learn to read those and pilot this thing better than I ever did before.

One of the nice things about getting older is I feel so much more responsible – so much more motivated to be a good manager of my body than I was 20 or even 10 years ago – and it’s not too late. I’ve still got a lot of good things going for me and worthy of my protection.  I hope you see the things you’ve still got going for you too.

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