Thoughts from the journey… Excerpts from a day in the life of Sherry McLaughlin

3Dec/090

Patellofemoral Pain – Runner’s Knee 501

After a week hiatus due to the Thanksgiving holiday, I am back into blogging action. Today's post will wind up our look at the five most common running injuries, and we picked the best for last.

Patellofemoral pain got it's nickname for obvious reasons. It is prevalent in runner's and information regarding its diagnosis, cause or treatment are vague at best. I thought I would start with a lesson about how the knee is built.

Crash Course in Knee Anatomy:

The knee is made up of the femur (thigh bone) and the tibia (shin bone) and the patella (knee cap). The patella has an interesting position in that sits between two big bumps of the femur (the femoral condyles), but it is tied to the tibia via the patellar tendon. Therein lies the rub (no pun intended). The femur takes it's cue from the hip. That is to say, the position of the seat the patella sits on is controlled from the hip above. The tibia takes its cue from the ankle and subtalar joint. The knee really is stuck in the middle with nowhere to run and nowhere to hide.

Can it be fixed?

Enough of that. Here is the point. It can be fixed, but not with just rest or medications. Sure, stopping running will eliminate the pain. But the pain will resume once you start running again if you don't address the cause of the problem.

For you runners out there, this means normal hip flexibility and normal ankle flexibility.

Try this test!

The squat test is a great test to try. Stand with your feet shoulder width apart and toes pointed straight ahead. Squat down as far as you can without your heels coming up off of the floor. What happens?

- If your knee falls in - stretch your calf muscle and strengthen the gluteus medius and maximus (your butt)

- If your knee falls out - stretch your ITB and gluteus medius and work on balancing on a foam roll to unlock your subtalar joint

- If your toe turns out - stretch your calf muscles and your lateral hamstring (the revolving triangle is our favorite for this)

- If you feel like you have to lean way forward or throw your arms in front or you will fall backwards, this is a sign of tight proximal hamstrings. We love the downward dog, the triangle and the revolving triangle for this!

To the clinicians:

Most people with unilateral patellofemoral pain have a pelvic asymmetry stemming from an SI joint problem. This will create a functional leg length discrepancy that can cause medial or lateral patellofemoral pain.

On your patient with this problem, make sure to check the following:

1. The Three Key Hip Test - 90/90 hamstring, piriformis and FABERS - and fix what you find!

2. Pelvic alignment - innominate flares, upslips, rotations and sacral torsions

3. Ankle dorsiflexion - in standing with gravity drop or anterior reach with the leg

4. Subtalar joint eversion - in standing with medial reach w/ the leg

Fix what you find on the table and then support your findings with a solid exercise program. Remember, if it is done right, exercises to solve patellofemoral pain rarely should be focused on the knee.

Now, get to work... there are a lot of laid up runners out there!

Until next time...

19Nov/092

Plantar Fasciitis 501

And then there were four...

Plantar fasciitis is number four in the series on the top five running injuries, but certainly at the top of the list for many runners out there. When you climb out of bed in the morning and your first steps are plagued with excruciating heel pain, you just might have this problem.

Here's the thing... the cause of the problem has little or nothing to do with your heel.

The plantar fascia is located at the bottom of your foot and attaches to your calcaneus (the medial calcaneal tubercle, specifically). It's job is to help add spring to the arch of your foot and dissipate the forces of your body weight when your foot hits the ground.

If it is crying out in pain, it is probably overstretched. So don't stretch it! This is a common misconception. Instead, make sure you stretch your calf and hamstring muscles and wake up the gluteus maximus (your butt muscle) on that leg!

For you clinicians out there, here is a short list of things to check on someone with plantar fasciitis:

1. Tight gastroc/soleus - Make sure they stretch with their toes pointed straight ahead

2. Weak gluteus medius - The gluteus medius is responsible for limiting valgus at the knee. Test this with a medial reach with contralateral arm at waist level. Strengthen it with some good mini-band lateral walking or hurdle step 0vers.

3. Tight medial hamstring or gastrocnemius - Trigger points or myofascial restrictions are often found in these muscles on people with plantar fasciitis. For the more curious of you, here is the breakdown:

- Medial hamstring or medial gastroc trigger point signals an internally rotated femur (strengthen the gluteus maximus in the short position)

- Lateral gastrocnemius trigger point signals increased knee valgus (probably due to a lack of ankle dorsiflexion)

4. Anteriorly rotated innominate (creating a functionally longer leg) - fix this with muscle energy techniques

5. An opposite leg that won't pronate (check subtalar joint eversion)

Remember, if the plantar fascia is screaming at you, keep your ears on it, but put your eyes somewhere else. Good luck!

19Nov/090

How to Have an Open House

Let me live in my house by the side of the road, where the race of men go by;

They are good, they are bad, they are weak, they are strong,

Wise, foolish—so am I;

Then why should I sit in the scorner’s seat, or hurl the cynic’s ban?

Let me live in my house by the side of the road,

And be a friend to man.

—Sam Walter Foss

My earliest recollection of being alive was when we lived in a tiny apartment on the East side of Detroit. My father and mother worked opposing shifts at Doctor’s Hospital, located a block or so away from our home in the Pasadena Apartments on Jefferson Ave. I remember it being small and the hallways dark. I even recall having to step over a drunken guy who used to pass out in front of our door occasionally.

Considering my father was born and raised in a one-bedroom home, the apartment was a step up. It was actually big enough to entertain friends and family—and he didn’t hesitate to invite people over.

By the time I was 7, we moved to the northwest suburbs of Detroit, into a house that must have felt like a castle to my father—a large, gray brick home with 5 bedrooms, 2 ½ baths and a basement. Each of us kids had our own room, fully furnished and tailored to our personalities.

Being slight in stature, Filipinos don’t usually require a lot of square footage to be comfortable. They might long for a bigger kitchen, but the bedroom situation is often times negotiable. Truth be told, our family of six didn’t really occupy all of those rooms—at least not in the traditional sense. On the nights my father worked a 24-hour shift, all of us kids would pile onto the king size bed in my parent’s room.

You might wonder how we all fit. We simply oriented our bodies horizontally across the bed—you can do that when everyone stands less than 5 feet tall. Sometimes, I woke up with an arm lying across my face or my toe stuck in someone’s mouth—but the tradition continued and it didn’t occur to any of us that sleeping in another room would even be an option. When my oldest brother broke the 5-foot barrier, he simply laid some blankets on the floor and continued to occupy the same room as the rest of us.

That left a lot of empty rooms in our house and what good was a house with empty rooms?

I don’t think it was so much the empty room situation as the generosity of my father’s heart that began to fill those spaces. First it was an uncle that moved in—he was going to dental school and needed a place to stay. Years later, I found out that my father not only provided him a rent-free space, he also footed part of his college tuition.

Then, there was another uncle—well, he wasn’t really an uncle, we just called him that. That’s another thing about Filipino families—if you meet someone that is Filipino, male and a little older, you call him Uncle. If he is Filipino, male and a lot older, you call him Lolo (grandpa). The same goes for Filipino females, you just change the titles.

I’m not sure why this particular uncle came to stay. All I know is that he occupied my younger brother’s room, and he used to play the guitar and sing. We would all huddle outside the door and giggle as he sang, “Sunshine on my shoulder makes me happy.” There’s nothing like hearing John Denver with a Filipino accent. Really. Nothing like it.

People would come and go. Some would stay for a week. Most would stay for months at a time. A room was offered to anyone who needed a place to stay, a helping hand or a listening ear.

The most memorable houseguests were a family from California. That’s right, an entire family. Turns out, the mom and dad were having marital problems. Somehow, my parents caught wind of it, an invitation was extended and before I knew it, I had 4 new brothers and sisters. They arrived with their mother—two boys and two girls—about the same ages as my siblings and me.

What fun that was! It was sort of like the Brady Bunch, only there were eight of us—and we had better tans. Imagine the first day of school. The bus pulled up in front of our house and six kids came flying out of the house, with the two little ones waving good-bye. The bus driver almost had a heart attack. My father not only shouldered the added grocery bill, he treated those kids like they were his own. Bought them presents, threw birthday parties, took them on family vacations and paid for their tuition at our local church school.

Late at night, I would find my parents and the mother of these kids sitting at the kitchen table. I didn’t know exactly what they were talking about, but their tones were hushed and sometimes there were tears.

A few months into their stay, the father came to visit—and moved in as well. Two complete families under one roof—now there were four adults at the kitchen table late at night in deep discussion. It would be years before I realized what my father had done. He was not only a physician and a provider—he evidently was also a marriage counselor.

Nine months later, the family packed up their car in preparation for their journey back to California. Relationships mended. Hearts healed.

I remember that day. They tried to leave once, but as we all kneeled in the family room to pray for their safe travel, we were all crying so hard that they ended up staying one more night and leaving the next morning.

We still hear from them. The kids are all grown up and they have kids of their own. We’ve attended weddings and graduations. One is an architect, another a civil engineer and the two girls are raising beautiful, happy families of their own. The mother and father? Still together after all of these years.

When my father became ill, it was this very couple that dropped what they were doing and flew to Michigan—to cook, clean and sit beside my dad and talk. They did it several times, without hesitation. When my father passed away, I remember seeing the father of this family sitting alone in the corner of the funeral parlor. Broken. Sobbing. Mourning the loss of a friend who was closer than a brother.

I went over and put my arm around him and he looked up at me. In that silent gaze, I felt the depth of his gratitude to the man that saved his family—and his life. It made me proud of where I came from. I will never forget that moment.

I think God grants people big houses for a reason. When it boils down to it, people require about three square feet of space to not feel violated. What you do with the rest of the square footage is entirely up to you. You can fill it with furniture that never gets used. Or you can open your house to the ones that need some food, shelter and a kitchen table.

If you choose the latter, there will be relationships formed and history made that will outclass and outlast the best furniture money could buy. And if you are ever witness to that kind of generosity, you are given a gift that you feel compelled to pass on.

It changes lives. It changes you. Trust me, I know.

3523380-R2-014-5A

Life Lesson #5

Have an open house.

Whether you charge rent or not,

The lessons learned and relationships built

Will be more than enough to cover the cost…

For a lifetime.

6Nov/091

Sing a Song

“The aim and final end of all music should be none other than the glory of God and the refreshment of the soul.” –Johann Sebastian Bach

I’m a closet singer. You know, the kind of person who can really cut loose and get into the music—only in my car or an empty house. My dad, however, was quite the opposite. He was known for his beautiful tenor voice. His vocal chords served him well—right down to finding him a wife.

As the story goes, my mother was the pianist for the church choir my dad sang in. Each time they would meet for practice, my father would have one eyeball on the director, and one on my mother. It wasn’t long before they knew they were meant to be together. He was 16 and she was 14 and ten years later, they would be married.

They spent their honeymoon on a cruise ship and, of course, my father signed up for the talent show. I saw a picture of his performance. Standing boldly on stage, belting out a tune with my mom accompanying him on the piano, it was a sign of the future. That would be the first of many performances as a married couple.

There was hardly a day that went by that I didn’t hear him humming or singing. First thing in the morning, he would sing a tune in the shower. Funny thing is, rarely did he ever finish an entire song or know every single word. But that didn’t stop him. When he came to a part he forgot, he continued the melody, and without missing a beat, would fill in the missing words with a sound like, “Rrra, rrra, rrra…” Just like it was meant to be like that.

My brother and I often accompanied him to choir practice on Friday evenings. On the ride home, he would lead us out in song. You have never heard the Hallelujah Chorus until you’ve heard it sung in a station wagon with a tenor and two pre-adolescent kids. At least, you’ve never heard it quite like that. I imagine that Handel would be mortified. But the funny thing is, in the midst of the noise, God was glorified.

By the time I became pregnant with my son, my father had already become quite ill. Legally blind, battling congestive heart failure and kidney failure as complications of diabetes, we were praying he would live to see his first grandchild. I remember the day I brought Joshua over for his first visit with my dad. Feeble from a recent hospital stay, my father held up my son closely so he could see his face, and began to sing with a voice untouched by disease. It is a moment I will never forget.

Two and half years later, my son was diagnosed with autism. Amidst the confusion of such a revelation, it was my father who repeatedly said to me, “Don’t worry, Shei. He is smart. Just keep singing to him.” And with that he would hoist his grandson into his lap and shower him with music.

My son was virtually silent for the first 4 years of his life. He would ignore the human voice—you could literally be standing right next to him calling his name and not receive a response. Some thought he was deaf. But to those I would say, “Sing a song.” And the minute they did—he would look up and smile. A majority of his speech as a young child was in the form of music. My son, who is not conversational, could sing entire songs with perfect pitch and enunciation. It isn’t uncommon for him to dance in the middle of the sidewalk or tilt his head in appreciation of a tune. He snaps his fingers to songs on the car radio.

He feels the music—just like my dad did. In a world of silence, it speaks to his soul.

“Music expresses that which cannot be said

and on which it is impossible to be silent.”—Victor Hugo

Music is a universal language, just like food. We can all relate to it and even if we don’t understand the words, somehow we can understand the emotion. It was once said that, “Music washes away from the soul the dust of everyday life.”

There is something healing about being able to belt out a tune with expression and fervor, even if you feel you can’t carry one. I believe it is one of the reasons cars and elevators were made to be sound proof. And if you are one of those who neither owns a car or rides in elevators alone regularly, there is always the woods or a mountain trail, where your only audience is God. He gave you that voice—I bet He’d enjoy hearing it every now and then.

Some would say my father suffered. But if you asked my dad, I’m sure he would have told you that he was blessed. His heart might have gone bad, and his eyesight lost. His legs were amputated and he was left bed ridden. But in the end, he still had his voice—that glorious tenor voice. A gift to him. A gift to this world.

It’s been years since I’ve heard him sing, but when I hear one of his favorite songs, his voice resonates in my head. This world is a better place because of my dad and his voice.

He sang for himself. He sang for others. He sang with a passion fueled by gratitude. Everyday. Often and loud—as if to make sure that the God that granted him that voice could enjoy the music, too.

Life Lesson #4

Don't let cars and sound proof elevators go to waste.

Sing a song.

Everyday.

Sing with gratitude, even if you don't feel like it.

I promise you, God loves to hear it...

And the sound just might touch a few lives on its way to the heavens.

6Nov/090

Achilles Tendonitis 501

I am kind of enjoying putting 501 at the end of my blog titles. I realize that is a weird way to start a blog, but at 5:30 in the morning anything can happen.

Today I wanted to talk about an often very misunderstood problem, Achilles Tendonitis. This is #3 on the top 5 running injuries.

Achilles tendonitis is defined as inflammation of the Achilles tendon. Often, the patient will complain of pain along the length of the tendon or at the insertion into the calcaneus. These, in fact, can be two very different problems.

The role of the Achilles tendon is to help decelerate dorsiflexion at the ankle shortly after heel strike by way of the gastroc/soleus complex. During running or stair climbing, forces in the lower extremity can reach upwards of seven times a person's body weight. Due to the shape of the calcaneus and its insertion point, it is also a mild decelerator of pronation of the foot.

If that was all it had to do, then there probably would never be a problem.

To solve the case of Achilles tendonitis, one must look up. Up to the knee, that is. The gastrocnemius muscle plays a role in the transverse plane at the knee, with the lateral head assisting in deceleration of internal rotation of the femur, which also occurs at heel strike. That means the lateral gastrocnemius (LG) is functionally synergistic with the gluteus maximus.

If the gluteus maximus is insufficient or neurologically inhibited (which can happen with trigger points in the iliopsoas or piriformis), then the LG has to work eccentrically at both ends during pronation of the limb. This creates a huge potential overuse scenario and may be classified as an overuse injury.

In common language, your Achilles tendonitis may be injured because of your weak butt!

The other scenario, the one which often causes pain at the insertion on the calcaneus is quite different. Usually, when the weak point of the tendon is its insertion at the calcaneus, this means the Achilles tendon is too tight. Adaptive shortening of the tendon usually occurs with a lack of pronation at the foot...an over supination problem.

When the foot hits the ground, the first contact point is the lateral calcaneus. This helps facilitate a fall into pronation, thereby eccentrically loading the lower extremity muscles. However, in the presence of subtalar joint eversion hypomobility (which may originate in the joint, or be due to a trigger point in the medial gastrocnemius), the weak link becomes the insertion point.

So, to recap. There are at least two possible causes for Achilles tendonitis:

1. Over pronation due to lateral gastroc overload from a weak gluteus maximus. Strengthen the gluteus medius first, then the gluteus maximus (first in the saggital plane) to help take the stress off of the tendon. This also tends to show up in a functionally longer leg (i.e. anteriorly rotated innominate).

2. Over supination due to subtalar joint hypomobility, a leg that feels to short or a medial gastroc tender point. Teach the subtalar joint to evert, lengthen the gluteus medius and load the gluteus maximus first in the transverse plane. If this is the case, ditch the motion control shoes!

In Greek mythology, Achilles was a war hero and the central figure of Homer's Iliad. He was known to be strong, handsome and a mighty warrior. When he was little, his mom, Thetis, tried to make him immortal by dipping him head first into the river, Styx. As a warrior, he was fierce, but he was taken down by an arrow shot through his heel, the only part of his body that didn't get dipped in the river.

I'm not trying to change Greek mythology, but perhaps someone should look into the story. I'm thinking his mom grabbed onto his waist and dipped him in head first...leaving his derriere high and dry.

Until next time...