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.
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...
Shin Splints 501
I just read a series of short articles on Active.com entitled Shin Splints 101 which contained some conventional thinking on this common running injury. I just wanted to contrast and compare ideas for evaluation, treatment and exercise based on our findings at the MIHP Think Tank. Are you ready for an advanced course on shin splints? Here we go:
Our work in muscle injury revolves around two basic physiologic principles:
1. Sherrington's concept of reciprocal innervation: If one muscle is short and tight (or over facilitated), then it's antagonist will neurologically become long/weak (inhibited)
2. Synergistic dominance: If one muscle become over facilitated, then it's synergist may become inhibited
Another premise uphold when looking at muscle injury is this: The muscles that come in crying out in pain are not usually the short/tight ones, but the ones that are long and weak. The underfacilitated. The overused.
What is a shin splint? It is an injury resulting from overload to the anterior compartment muscles of the lower leg (primarily tibialis anterior and tibialis posterior). These muscles are responsible for decelerating dorsiflexion (tibialis posterior), plantar flexion (tibialis anterior) and pronation (both of them).
Who are their antagonists? The gastrocnemius is the antagonist to tibialis anterior. That is, if the gastrocnemius (calf muscle) is short/tight, then the tibialis anterior becomes long and weak, and thereby prone to injury.
Who are their synergists? The gastrocnemius is the synergist to posterior tibialis (i.e. they both decelerate dorsiflexion). If the gastrocnemius become short and tight, then the posterior tibialis may become inhibited.
Pronation v. supination: Because both the TA and TP are located on the medial side of the ankle, they are prone to injury in someone who over pronates. Remember, pronation should only occur for 25% of the stance phase. Any more time spent pronating will result in overload to the tendons and ligament on the medial side of the ankle and lower leg.
The two most common causes of over pronation: Believe it or not, it isn't a lack of an orthotic in your shoe! Before you slip an orthotic in your shoe or invest in motion control running shoes, consider that the two most common causes of over pronation are a weak gluteus medius (hip abductor) and a lack of ankle dorsiflexion (tight calf muscles).
Conventional wisdom says: Strengthen the gastrocnemius (calf muscles) by doing heel raises and the tibialis anterior by doing toe raises. Stop over pronation by purchasing supportive shoes.
ReBUTTal on conventional wisdom: The tibialis anterior didn't get hurt because it was too weak. It got hurt because it was inhibited and/or overworked. Don't work an already overworked muscle. Instead stretch the gastrocnemius (calf muscles) with the toes pointed straight ahead AND strengthen your gluteus medius and maximus (your butt muscles).
For you clinicians out there:
1. Check pelvic alignment. An anteriorly rotated innominate or inflare can create a functionally longer leg, creating an over pronation scenario.
2. Check for trigger points in the iliopsoas and piriformis as these will externally rotate the leg (creating over pronation forces) and inhibit the gluteal muscles. Counterstrain them.
3. Check for trigger points in quadratus lumborum. The quadratus lumborum and gluteus medius are functionally antagonistic in the frontal plane. If QL is short/tight, then GM becomes long and weak. Counterstrain it and then teach QL to work long and GM to work short.
4. Normalize ankle dorsiflexion. If this is just due to tight gastrocnemius, the gravity drop or downward dog exercise are excellent. If the restriction is felt in the anterior ankle then a posterior talar glide will be necessary to normalize dorsiflexion.
Enough said. Now, go and chase those runners down and help get rid of their pain!
Until next time...
Plant a Tree
And this, our life, exempt from public haunt, finds tongues in trees,
books in the running brooks, sermons in stones, and good in everything.
–William Shakespeare
“C’mon, Shei (my nickname)! Let’s go to Bordines!” The tone in his voice was unmistakable—and a sure sign that spring had sprung. The local nursery was calling his name and he was ready to go and spend some serious money on plant life.
My father would commandeer my services several times a year. I’m not sure why I was the one chosen. My hunch is that I was the one least likely to complain. So there I would find myself, riding shotgun in the family station wagon headed to a large nursery.
Once we arrived, he would jump out of the car and begin eagerly perusing the aisles. I would grab one of those bulky, flat carts and attempt to keep up with his quick step. He would stop and survey the trees and shrubs and when he found one he wanted he would point to it.
“That one. That one is nice,” he would say.
I would walk over, bend down and hoist the plant onto the cart and we would continue on. In a matter of 20 minutes, the cart would be loaded to overflowing with plants of all sizes and shapes.
Oh, yeah, and we couldn’t forget the peat moss. Those giant bags of decomposed greenery that were never easy to maneuver. I would look at his face, smiling and eager, and I would look at the cartload of stuff and think, “There is something wrong with this picture. We are going to have a ton of work ahead of us.”
My father was notorious for working a lot—and loving it. He applied the same kind of fervor to his gardening as he did to his work in the emergency room. On our spring planting days, it wouldn’t be unusual for us to be in the garden digging, fertilizing, planting and watering until late into the evening. I think he purposely had the front yard adequately lit so that our workday could continue past sundown. After all, he was used to pulling 24-hour shifts in the ER—working a 12-hour day in the garden was practically a vacation.
As we worked, he would talk. Topics would range from what I wanted to do when I grew up, to travel ideas to singing songs to why it was important to put plastic down before we dumped rocks in strategic places according to his landscape plan—all intermixed with directions on where I should haul the next tree or plant to be inserted into the ground. Periodically, he would pause, stand up and admire a tree that he had just planted.
I mean, really admire it. For a really long time.
You know, chest out, hands on hips and dirt smudged on his smiling face. Sheer satisfaction. Five minutes might pass before anything was said.
Being the impatient youngster that I was and feeling the exhaustion of a long day, I would look up at the setting sun and then look over at my dad and think…it’s just a tree.
“Doesn’t that look nice?” he would ask with a gleam in his eye.
“Yeah, dad. Looks great,” I would reply.
By the end of the day, our yard would be transformed into something fitting of a famous garden in Paris. Those are not my words. Friends, family and neighbors passing by would pause at the masterpiece. Some would just shake their heads. But all would smile.
Back then, to me that garden represented a lot of work. Some completed—and a lot more on the way. Since he passed away, I’ve looked at that garden with different eyes. It was a place where I grew up—where I got to see a side of my dad that many didn’t. A place where stories were told and songs were sung. A place where I learned how to work until dark, plant a tree—and take the time to admire it. It was a place where history was made between my dad and I. Thank God I never complained.
I think he knew I would stop to really admire it one day. Somehow, I think he knew—one day I would need to.
The majestic garden with its flowers, bricks, rocks and fountains has since been overhauled and simplified. But what remains are six of the most beautiful Japanese maple trees I have ever seen. Proud. Dependable. History.
I now have a house of my own with three Japanese maple trees planted in the yard. Funny thing. After a hectic day of work, chores and life in general, I find myself sitting on my front step or in the back yard just staring at those trees—sometimes for an hour—silent and smiling inside and out.
And I know my son probably looks at me and thinks, “Mom, it’s just a tree.”
The wonder is that we can see these trees and not wonder more.
–Ralph Waldo Emerson
Life Lesson #3
Plant a tree with someone you love.
Long after you are gone,
The lessons of work, life and love
Will go a long way to healing a soul.
Iliotibial Band Friction Syndrome
Iliotibial band friction syndrome is often described as an overuse injury that produces pain on the lateral knee. In fact, it is listed among the Big Five of running injuries, along with Achilles tendonitis, chondromalacia, plantar fasciitis and shin splints.
Unfortunately, it is also often misunderstood.
For instance, the quick fix for this injury (and many of the others in the list) is simply to stop running for awhile. Just rest the area and let it recover. The premise is that running, in and of itself, created the problem.
But the question that really needs to be asked is, how come the other knee isn't hurting if both legs ran the same mileage? Is it simply a cause of overuse?
Yes and no. Running isn't bad for you. Bad running is bad for you.
The most common scenario that causes ITBFS is a limb that won't pronate. Under pronation. You won't see that too much in the literature.
The normal gait pattern is such that heel strike is designed to occur on the lateral (outside) of your heel with pronation occurring for 25% of the stance phase. This act of pronation not only acts as a shock absorbing mechanism, but also transfers the force to the thicker and larger structures of the medial knee.
Someone so spends more than 25% of stance phase in supination is going to make the ITB very angry. After all, it isn't designed to have to cushion the blow of force dissipation for such a long time.
Some common causes of a limb not pronating?
• Tight gluteus medius (lateral hip muscle) - See the photo? Can you do this move equally on both sides?
• A leg that feels too short (pelvic malalignment, quadratus lumborum or iliopsoas trigger points)
• A subtalar joint that won't evert (Is there a history of ankle sprains in the past?)
• A tight lateral hamstring (Does the revolving triangle in yoga class make you fall over?!?)
• And... a shoe that offers too much support (Check to see if there is a gray bar on the medial side of your shoe last!) We are fans of neutral shoes for these folks.
The good news is... it's fixable! And it doesn't require tons of time away from running.
Oh, and by the way... if you understood what I just said, then you will realize that the ITB is overworked and overstretched in this scenario. Why on earth would you want to stretch an already over stretched muscle?
If you have this problem, or know of someone who does... do them a favor and look up at the hip and down at the subtalar joint. Fix that stuff and then send them back out on the road.
Until next time...


