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

31Oct/091

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...

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31Oct/090

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.

22Oct/091

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...

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22Oct/090

True Liberty

The love of liberty is the love of others. –William Hazlitt

As a new immigrant to the U.S., my father traveled to New York City on a quest to view a symbol. Hopping in his car and making his way toward the East Coast, he fought the traffic jams and hordes of people to make his way to Liberty Island. Though he had been in the States for several months, I believe that was the day my father first felt his freedom. Gazing up at the 250,000 lb. statue with tears in his eyes, that was also the day he vowed he would share it with everyone he met.

My dad was a visionary and a “get-it-done-er”. He was notorious for dreaming up grand schemes and making sure they came to fruition. No task was too small when it was a great idea coupled with some good, old-fashioned passion.

In the late summer of 1973, my father was a young physician practicing in Michigan. During his day, he would come in contact with other immigrant Filipinos, many of whom were employed at the same facility. He quickly recognized that the Land of Opportunity was doling out some hard lessons to most of them. Freedom came with a price and many young Filipinos were struggling to make ends meet.

He commiserated with a couple of his fellow Filipino physicians. “It is a shame that people come to this country and never get a chance to really see it,” he said. “I have a great idea. Why don’t we rent three Greyhound buses and take as many Filipinos as we can to the Cherry Blossom Festival in Washington D.C.? We can pick up some extra hours moonlighting in the ER to pay for the buses.” I can picture my dad saying it with a twinkle in his eye. I imagine his friends laughed until they realized—he wasn’t kidding.

So, the plan was put into motion. They divided the cost by three and arranged for the buses to be rented. They proceeded to invite every Filipino they ran into—some friends and some strangers—to come along for the trip of a lifetime. As the deadline for the big payment approached, his two comrades realized they would fall short of the goal. They had not been able to work the extra hours they had planned on. It appeared the big trip was off.

I imagine my father sat for a moment, picturing the disappointed looks of all the people they had invited. Not to be deterred, he flew into action. He applied for an American Express card and rented the buses. He shouldered the cost by working even more hours in the month he had to repay his debt, and I imagine he did it with joy in his heart.

The trip must have been incredible. Can you imagine being one of those invited who had never before met my dad?

“Hi. I notice you are Filipino. Would you like to go on a trip to Washington DC?... No…it won’t cost a thing…really.”

Actually, that is my version of how I think the conversation would have transpired. In reality, my father probably greeted them in his native tongue and if they answered back—they were in. Young and old. Professional and non-professional. Old friend and soon to be new friend. All were handed the gift of freedom to move about a free country.

The details of the trip are sketchy to me. I was too young to remember much of it. But at his funeral, someone told the story—and I saw the picture.

If you think you can fit a lot of Filipinos into an averaged size kitchen, just imagine how many you can pack into three Greyhound buses. The picture was worth a thousand words and probably a thousand stories since. A sea of brown-skinned people with cameras slung around their necks, grinning from ear to ear, standing aside the giant vehicles. Happy. Eager. Proud.

I looked at the photograph and smiled. So, that’s what freedom looks like.

14Oct/090

A Revolution of One

“The only freedom I have is the freedom I take for myself.” That’s what one young man once said. And I believe him.

Freedom is more than just carrying on without permission, or existing without rules. True freedom requires a choice to move in any given direction – preferably a direction that calls you with a passion.

Have you ever felt the tug of a passion? If you haven’t, then I don’t think you’re paying attention. And if you have and you aren’t chasing it, then get moving.

I say this a bit tongue-in-cheek, as I am just as guilty as the next guy for squelching these pangs of adventure in favor of a more calculated decision. I mean, let’s face it. The world is chaotic enough, and yet technologically advanced enough, that many believe that the only infallible choice is one made by a machine. We consult numbers and machines for just about every major decision we make. We attempt to rein control in an uncontrollable world – and in the process, we sometimes play it too safe.

The thing is…calculation sometimes squelches momentum. The physical principle governing inertia works both ways. A body in motion, tends to stay in motion. A body at rest, tends to stay at rest. If we spend our days preventing the future, then maybe there never is a now. And if there never is a now – a time to make a decision to navigate toward a passion – then the biggest tragedy is that we have lost our freedom. And the world never gets the gift that is us.

I’ve recently been caught in that battle between passion dreaming and “what if” reasoning. Much like a small boat is tossed in the winds of a storm. And though I’m not sorry that I questioned, I’m more thankful that I stumbled on a little book that helped me find my way out. It’s called, First you have to row a little boat by Richard Boden. In closing, I share with you one of my favorite passages from this book:

“If every man and woman were to take the meaning of their life and pursue it passionately, they would alter the social landscape overnight. In fact, that’s how lasting revolutions are made—not by the raised arm of the masses, not by the military seizure of power, not by the political coup d’etat, but by individuals asserting who they are…one at a time.”

Chase that passion now. The world thanks you in advance.