Wednesday, February 17, 2016

Two Month Update

Been a couple months since my last update.  Sounds about right...

My MRI test on my shin taken Dec 10 came back negative.  Everything was heeled up.  I went back to the orthopedist and discussed doing test for Compartment Syndrome.  He didn't have the equipment necessary but he did know how to obtain one.  He was going to call me to schedule once he got access to it.

He actually never called me.  I was OK with this because this green lighted me going back to the Sports Medicine Doctor.  It was after the first of the year when I had my appointment.  We discussed three tests: Compartment Syndrome test, Gait Analysis, and popliteal artery entrapment syndrome (PAES) test.  I have finally completed all of those.

Compartment Syndrome Test
So I had this done back in middle of January.  I showed up prepared to do some running; however, you first do a baseline test.  This involves sticking a long needle in different sections of your lower leg.  After this and applying some bandages, we went across the hall and ran on a treadmill at the physical therapy center.  He told me to run until my shin pain started and then run for five more minutes.

Uhhh, OK.  Well, the pain rarely bothers me during a run.  If it does, it's because it was bothering me before the run, which wasn't the case here. So I ran for about 15 minutes and, sure enough, I had some pain.  Well, that pain was because he STUCK ME WITH NEEDLES right before the treadmill. I did my best though.  So once it was time, I hoped off the treadmill and literally ran back to the doctor's office where they proceeded to perform the test again.

The purpose is to tell how the pressure in each of the muscle compare has changed during the run and if there is an imbalance of that pressure.  So the needle is basically checking my "tire pressure".

The test actually came back borderline positive. Sports Doc wanted to talk with a Foot/Ankle surgeon before going forward with any action.

Gait Analysis
Back in February 2015, my coach recommended I attend the iRunSafe clinic when issues started.  Well, that recommendation is why I started seeing this Sports Doc; however, I hadn't participated in the clinic yet.  I finally did near the end of January.

Basically you show up ready to do some running but they have you go through four specific stations:

  • Strength and Flexibility
  • Treadmill Running videoed from side and back
  • Foot and Ankle Specialist
  • Nutritionist

When I arrived at the physical therapist center, I was pretty amazed.  Waiting there was about 10 - 15 doctors and specialist.  I felt like I had an entire team of people looking out for me.  It probably took an hour and 15 minutes to finish all four stations.  The one that surprised me the most was the nutritionist.  TKB and I eat fairly well so I wasn't too interested in what she might have to say; however, I found out she was an ultra marathoner and so we discussed race day nutrition and just endurance racing in generally.

After you complete the four stations (with 3 other participants) we sat out in the lobby of the center while the doctors and specialists discussed each participant.  They then bring us back in and watch the videos and present analysis.

During the tests and during the analysis, it was pretty obvious I had issues with my right leg.  Poor flexibility and strength.  I pronate pretty hard on my right foot when it lands.  In other words, my foot rolls in when it lands.  The recommendations were to be more forefoot running to take pressure of the bones/joints, try to create a window between the knees, increase cadence (I was about 174 steps per minute as opposed to recommended 180), and a little more increased lean at the waist.

The foot and ankle specialist recommend inserts in my shoes to help with the pronation.

After the analysis I talked with my Sports Doc and he had already followed up with the Foot/Ankle surgeon who did not recommend any corrective actions on my compartment syndrome tests, whew!  We discussed physical therapy to get my gait "straightened out".  I decided that I would get the inserts in my shoes as soon as possible and then run for the next three weeks leading up to my PAES.  Then I would have a follow-up with the Sports Doc and go from there.

The next day I called the foot/ankle specialist (orthotist) and she gave me some inserts to try.  I ran with those for about 9 days with no improvement on shin discomfort so I was fitted for custom orthotics.  (I'm still waiting for those to come in).

Popliteal Artery Entrapment Syndrome (PEAS)
I really had no clue what this was about.  I thought it was related to finding scare tissue in my calf but really it was doing an ultrasound of my circular system while sections of my legs undergo pressure... I think.

Basically I laid on an exam table with 10, yes TEN, blood pressure cuffs on my body.  4 on each leg and 1 on each arm.  The technician used an ultrasound wand to listen/watch my blood as each cuff filled with air.  They compare that to my arm pressure and build a ratio.  I don't really know much more than that except that my tests came back negative.  We didn't really discuss what the corrective procedures are and I don't really want to know anyway.

So What Now?
Two months later, I don't really know anything more in terms of what's causing my shin pain.  Based on the gait analysis, it could very easily be some form problems.  What I do know is that I don't have compartment syndrome or PEAS, so no more surgery talks.  What I also know is that since I made the decision to not have the hip surgery, my hip is pretty much an after thought.  It rarely bothers me.

I have my next follow up with my Sports Doc on Friday in which most of the conversation is going to be about my right leg/foot and running/walking gait.  I noticed last week that when I simply walk, I have a tendency to "push off" with the outside toes of my right foot while my left foot is more off the big toe.  It kind of felt like mid-stride my weight shifts from the inside of my foot to outside of foot and that could be causing some weird torque in my lower leg.  I've been focusing really hard on walking with my right foot pushing off from my big toe instead.  With my forefoot running, that should take out the concern as well but we'll see.  I'll probably push for some Physical Therapy sessions.

Am I Back?
I'm not calling this a win yet.  I still have some occasionally discomfort and when it comes, it will take a few days to ease back off.  I'm hoping these custom orthotics will help.  I'm also debating about doing another bike fit just to make sure cycling shoes are setup correctly and that those aren't causing some kind of discomfort as well.

So that's the latest.  Thanks for reading.  If you have any questions about the iRunSafe clinic, feel free to ask in the comments.

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