A Running Evaluation from a New Physical Therapist

>> Saturday, December 07, 2013

I saw a new PT on Wednesday. In that last 3 months, that's my 2nd PT (along with 3 Chiropractors, 2 Sports Med Docs, and 1 Orthopedic Doc). Two big shockers: First, he doesn't know what's wrong with me. (Join the club.) And second, my butt is weak. (Something I've known since 2007 and was confirmed with another injury in 2011.)

He set up the camera and filmed me walking and running (and stepping and hopping).

One of the new interesting things he discovered was that my overall strength is average to great (and pretty equal side-to-side when he tested me with static exertion). But when it comes time using those muscles (like while hopping or running - anything dynamic), everything just falls apart. Here, look at this:

That's a screenshot from a video of me hopping on my "good" leg when I'm at the lowest point. Notice my knee is buckling in just a bit. Compare that image to this one:

Look at how much my "bad" leg buckles in at the knee during the hop! It's still much better than it was a month ago when I did that for Dr. Sevilla, but it's still noticeably worse on the right.

Then the PT had me take off my shirt and do some running:

He noted that my hips drop pretty similarly, with just a SLIGHT bit more of drop of my right, but it was still within the "OK" range. And my back and arms and everything from the pelvis up was good.

When he filmed my legs, we saw the side-to-side imbalance issue again. Here's my "good" leg hitting, and note that my left ankle is turning a LITTLE and that there's a little space between my knees:

When my "bad" leg hits, my ankle turns in a LOT more, my toes point out more, and my knees actually touch and brush past each other:

So he added to my list of exercises with some modified squats and some side-to-side work as well. I have an INSANE amount of PT exercises and stretches to do. Seriously, if I were to do them all in 1 day, it'd take me 90 minutes to 2 hours. I'm not exaggerating. I try to do about half most days, and then the other half the next day.

And I'm supposed to try running more: instead of 3 minutes of running for 4 reps, I'm now supposed to try 8 minutes of running, 2 minutes of walking, for 2 reps. (And I'm supposed to try that every 2 days.) I'm actually pretty optimistic that it will go OK.

Anyway, when I was done at the PTs office, I instagrammed this photo:

First topless running evaluation. #StillRockinTheChops

(I don't often take topless selfies, so don't judge me as being TOO douchey. Thanks.) Oh, and you can see my chops / sideburns that I left after shaving the beard earlier this week. I'm not sure how long I'll be keeping those. As I tweeted earlier today, a security guard told me they looked "festive."

Anyway, the majority of this post could read "as learned in 2007 and 2011, I'm weak in the butt on 1 side." Time to work on that some more. Now pardon me while I go "blast my ass."


SteveQ 12:11 PM, December 08, 2013  

If I can find it, I'll send you a photo of me with the same sideburns from when I was 17 (with feathery 1980's hair, to boot).

When I started rehabbing injuries almost six months ago, it was 6-8 hours per day. No kidding. Pro athletes should be cutting me checks, saying, "Dude, you earned this more than me." The more you do them, the less you have to do them, so the time spent rehabbing is sort of front-loaded. Hang in there.

Anonymous,  3:34 PM, December 08, 2013  

I have a different issue (patellar tendonitis), but due to a kind of similar issue of an imbalance. The best exercise I've done for this is single leg squats. It evens out any imbalances you have (e.g. the knee buckling in during your hops) and has helped me greatly.

The best way to start is with eccentric single leg squats on your bad leg, on a decline. Just lower yourself half way down on your bad leg, then use both to stand up… repeat 3x15, 1-2times per day. After a couple weeks, add weight and start pushing up a little bit with the bad leg. Go from just down, to down/up, then down/up to the floor (follow the 'pistolero' progression for that… look up Steve Maxwell).

If you can do pistoleros with each leg, then you should have no issues any more and equally strong butt cheeks.

Colafos 5:42 PM, December 08, 2013  

Did those PTs and docs work with Priscah Jeptoo to tell her exactly what to do so she can win a marathon now and then?

Steve Stenzel 9:05 PM, December 08, 2013  

SteveQ, that's crazy! Yep, trying to put some time in and get things moving in the right direction.

Anon: I used to do a lot of those, and I should work them back in. But I can't just yet - a PT from 6 weeks ago wanted me to do them, but I had a lot of pain. I'll get a little better, and then start doing those again. Thanks!

Jumper 2.0 9:27 PM, December 08, 2013  

I'm confused about how they (and you) say that you have a weak butt and they don't know whats "wrong" with you. Yes they do, it's your weak butt. It affects everything downstream!
Keep at it Steve, you're doing great! And you'll be all the more better of a runner when this is all done.

drdave 9:48 AM, December 09, 2013  

Has anyone checked for a short leg. I hyperpronate on my right foot (as yours is doing in the photos) but it's because of my shortened left leg. A 3mm lift resolved it all. Custom supports with the lift built in and added pronation protection in both orthotics has resolved the episodic lower back pain, knee pain and chronic ITB syndrome.
Have one of your Chiropractors take an AP pelvis, evaluate the height of the femoral heads. If uneven, take one with a lift under the left foot. If the lower lumbars over-rotate because of the lift, you cannot use it. Chances are, they will not.
Good luck! Injuries suck!

Carolina John 11:20 AM, December 09, 2013  

I'm most impressed with those chops. You'll be back to 6 minute miles in no time, sure. But those chops are immortal.

Anonymous,  11:34 PM, December 09, 2013  

I came across this, and it seems like exactly what you have! A diagnosis with a name, finally! DEAD BUTT SYNDROME
The gluteal muscles (glutes, buttocks) are a group of three muscles (maximus, medius, minimus) that play an integral role not just in propelling you forward but in keeping your pelvis stable, none more so than the gluteus medius.

When the gluteus medius is weakened - whether through prolonged sitting, or through repetitive motion (e.g. running) in the absence of strengthening exercises - what often results is a condition known as dead butt syndrome. Dead-butt syndrome is inflammation of the gluteus medius muscle due to irritation. A weak muscle is unable to properly perform its function, which in this case is to keep the hip level. The result is pelvic instability, identifiable with the hallmark "sagged" gait, called the Trendelenburg sign in the medical community.

Dead butt syndrome and resulting pelvic tilt can cause a cascade of inflammation and irritation of adjacent muscles, which can lead to other injuries such as iliotibial band strain, plantar fasciitis, lower back pain and shin splints, as well as postural problems, head and neck pain, even discomfort in the seated position. Which is ironic, because prolonged sitting is often part of the problem.

What is the remedy? If you're a runner, cross-training, especially time on the bike, can help to strengthen the butt muscles and maintain postural stability. Hiking or climbing hills also works well. If you're not an endurance athlete and have no wish to become one but feel your glutes could use some strengthening, resistance exercises are great.

Body-weight squats
Stand with your feet about shoulder width apart, toes pointed slightly out. Sink into your calves until your thighs are about level with the floor, then return to the standing position, tightening the glutes throughout. Do three sets of ten repetitions. Stronger individuals may wish to hold dumbbells or use resistance bands to increase tension.

The bridge
Lie on the floor with your knees bent and your feet on the ground, about 12 inches from your buttocks. Thrust the hips into the air, flexing your glutes. Hold for a count of three, and do three sets of ten repetitions.

Begin from a standing position, feet shoulder-width apart. Step your right foot about 2 feet in front of you. Bend your right knee, making sure to keep your knee directly over your foot. Sink into the lunge until your left knee touches the floor, then return to standing position. Work up to three sets of ten repetitions.

For runners and non-runners alike, taking the stairs instead of the elevator is an easy way to improve cardiovascular fitness as well as strengthen the glutes.

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