Emptying out the mailbag and clearing the history #3

Posted on November 2, 2014

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Before the mailbag, I put out a new manual a few days ago, but I put it out late Thursday evening, and Friday was Halloween. In case you missed it, it’s called A Guide To Footwear, and you can check it out here.

Other mailbags can be found hereKeep in mind a lot of this is email conversations and comment replies. By their nature they are not as thorough or complete as a post on one topic.

Here’s what’s covered in this installment (click to be taken to the section):

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Emily

Emily was my first ever paying client. Her before and after photos are still up on my site all these years later.

Emily Before Front

Emily After Front

She happens to also have quite the voice, recently using her talents to help raise some more money for breast cancer. She has a family history, and I have a very strong family history as well. See what you think of her song:

If you’re interested in more of her music, she’s currently updating her website, but you can check out her iTunes page. 

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Conversation about retroversion

From an email:

“A little while ago I noticed that my right foot pointed further outward than my left. Since, I have gone to a PT and, based on my Craig’s Test results, have been diagnosed with femoral retroversion (x-rays to confirm have been scheduled). This is a huge concern to me as I am a very active person. Also, lately I have been getting into weightlifting and have noticed that no matter how I plant my feet my squats and deadlifts are uneven. I hate having my right foot bug me in all forms of exercise (weightlifting, soccer, biking, running, etc.) and am wondering how bad I have it.

I understand that I can’t do much, barring surgery and stretching, but what long term consequences am I looking at regarding my right leg’s health?

Do I have any other options to fix my foot positioning?

Is my ability to maintain good form in all sports essentially impossible?

Lastly, is it possible to replace squats/deadlifts with machine exercises that put less stress on my legs?

I know these are pretty heavy questions, but I really feel helpless against this unfortunate bone structuring and would appreciate any insight.

Sorry for the lack of organization in this message, and I don’t know if this is necessary information, but I am 19 y/old, 6′, and ~160lbs.”

I’m not sure why you would be so concerned. Plenty of athletes have retroversion. It’s typical for instance in baseball pitchers (their plant leg), and they do just fine. You simply have to learn to roll with it, embrace your structure, and not fight it.

(You almost assuredly cannot stretch your way out of it.)

Retroversion is also common in anybody who has a strong history of throwing activities. In fact, it’s what enables a person to throw a ball harder. The humerus retroverts so a person can rotate their arm further back. In this case, it’s not an unfortunate structure, it’s a helpful adaptation. This is where the expression “throw like a girl” comes from. Many women, particularly older women (before sports were more common for females), grew up without regular throwing. So they never acquired this bone structure, hence, they throw with more of a push rather than a rotation of the humerus.

“Thank you for the response,

I understand that I can work around it with weightlifting (using machines for legs), but for distance running I fear for long term issues and was wondering what your thoughts on that would be.

Doesn’t having only one hip being retroverted throw my body off balance, and since my leg is kind of pushed in when I run, am I asked for future hip/knee problems?

I can’t imagine a future in which I can neither play soccer nor run, do you have any experience with long distance runners with this issue?”

I have a retroverted hip and just ran a 10k race, and I run a few miles multiple times per week. It’s something to be mindful of, but It’s nothing to worry about. (Unless the hip is really, really retroverted. Which is incredibly rare. Even then, not sure there’s anything to worry about.) Things with deep hip flexion are where you need to pay more attention. e.g. sumo deadlift rather than regular deadlift.

If you’re having issues, pain, discomfort, etc. it’s likely due to something besides having a retroverted hip.

“This should be last question.

When I bike (my main form of transportation) I feel like I can’t get my retroverted side into a comfortable position. There isn’t much space for my foot to be pointed outward without my heel hitting the chain and the more I point it inward the further my knee is pushed inward. I feel like my legs are doing two completely different motions. Also, as a result I feel a kind of discomfort in my knees and hip (on my retroverted side) especially after longer, hilly rides.

Do you have any advice on what would make biking more comfortable?

Lastly, I see myself needing to bike for at least the next 6 years or so and was wondering if this discomfort is anything to be worried about?

Sorry for all the questions.”

I would play around with adjusting the seat height. A higher height will likely be more comfortable.

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Lack of ankle push-off

Researchers study the biomechanics of locomotion:

“In 2012 and 2013 Kram and then-CU-Boulder doctoral student Jason Franz conducted a series of experiments on how the human ability to walk diminishes with advanced age. They found older people walking over level ground tended to rely on more on their gluteus maximus muscle in the buttocks and much less on the calf muscle.”

I talk about this at length, along with how to spot someone with poor ankle push-off, in Relieving hip pain while walking.

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Opiod induced hyperalgesia

I talked about how various medications can cause pain in Medication as cause of chronic pain; antibiotics and exerciseI knew there was something out there on how opioids can cause issues as well. (I couldn’t find the term at the time.) This may be even more poignant for some as opioids are different from something like Crestor -a cholesterol drug known to cause pain- in that opioids are supposed to decrease pain!

Here is a short, non-technical look at this:

And there is a good research paper, A comprehensive review of opiod induced hyperalgesia. This paper is very technical though. Unless you’re a drug maker, I’m not sure knowing all the nuances of this are necessary. Here are some takeaways I do think are important:

“Further, there are no well-known strategies which are effective in preventing, reversing, or managing OIH.”

Considering the degree to which 1) Opioids are prescribed and 2) To which they are used, this is distressing.

“The type of pain experienced might be the same as the underlying pain or might be different from the original underlying pain.”

When talking about chronic pain patients:

“While reducing the opioid dose, patients might experience transient increases in pain or mild withdrawal which can exacerbate pain.”

Making matters worse:

“Further, they also concluded that detoxification from opioids does not reset pain perception for at least one month.”

Hence:

“While reducing the opioid dose, patients might experience transient increases in pain or mild withdrawal which can exacerbate the already exacerbated pain. Further, the hyperalgesic effect might not be mitigated until a certain critical dose of opioid is reached. During this process, patients and physicians become frustrated and develop differences in philosophy, which could require multiple office visits or could even sever the relationship between the patient and physician. These patients often seek opioid treatment elsewhere.”

This is one of the issues with any long-term drug route in solving any problem: The body adapts. If you inject a ton of testosterone in your body, eventually the body will compensate by increasing estrogen levels to even things out. This is part of the problem when trying modalities around “Just work on this one hormone / receptor / channel / cell / thing.” The body sees this, and gets everything else that’s not that one thing, to adapt to try and bring things back to normal.

Take enough pain medication for long enough, and the body may very well make the pain signal stronger.

This can turn into a vicious cycle. Take pain meds => Pain gets worse => More pain meds => More sensitization => Harder to get off pills => Keep taking them. And so on. Per the above quotes, the longer this goes on, the harder it can be to get off the pills due to the withdrawal.

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If your treadmill’s tread keeps having issues

I’ve recently had more of my clients on the treadmills at the facility I work out of. It was becoming more and more common for the tread on the treadmills to move out of alignment. Eventually the manager of the gym talked to me about this and asked if I could really make sure my clients weren’t doing anything to cause this. For instance, I have a couple bigger people, and perhaps they were somehow pushing the tread a certain direction. Maybe pushing more one leg than the other; something of that nature.

I asked the clients to be on the lookout for this as well. For instance, where was the tread when they got on the treadmill versus when they got off. After asking a few clients, two of them, twins, eventually go, “Oh, that’s not the tread. That’s the rollers.” These two clients had many years working in facilities where giant rollers and treads were used. It never occurred to me to think of the roller.

Of course, it makes perfect sense. If the roller has worn down more on one side, which can happen due to various reasons (ground is slightly tilted one direction), then the tread will eventually succumb to that side.

Something to keep in mind before you venture off to buy a new tread.

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Quitting football

“Greetings all the way from the cold Finland!

I stumbled upon your blog tonight while laying in bed trying to find stories about acl surgery rehab. I had an injury to my knee a few weeks ago and I’m going to surgery in three days. Your story about the biggest mistakes people make when rehabing was a good read – I’ll definitely try not to make those mistakes.

I find your blog interesting in a number of other ways too. I am a 22 y/o business student in Helsinki and I play amateur football in Finland (the only kind we have) with hopes of doing my master’s studies somewhere in the States and maybe playing for a year or two in d1 or d2. Perhaps in the future I’ll get to play in Germany too. They have the only pro-league in Europe called GFL – a remnant of the old NFL Europe. I only have played for a few years starting at a relative old age of 19 with a year of not playing at all because of our mandatory national service, but I have already made it pretty far (two-time league all-star) because of my athletic background as a soccer goalie and intensive studying of the game.

However, like you, I too have had a lot of issues with the violence of the game and have started to question myself lately. How was it for you to quit playing? Here in Europe most sports are club based and one can basically play pretty competitively as long as they can, not having to call it a career after college. I understand you only played for two years in college? You didn’t quit because of injuries, and it’s not like I’m afraid of them either. I’ve had a number of them but my list is not quite as extensive as yours. My fear however is that I’ll injure myself worse than this – severe concussion or a spinal injury could be life changing, and I don’t know if I want to risk it any more. My knee injury was just an unlucky twist with no while trying to catch a poorly thrown football, and those can and will happen in any sport.

It would be nice to get a reply from you when you have time. Judging by your blog you seem like a like-minded guy. I guess I also wanted to congratulate you on your interesting blog and to say that you now have a reader across the pond too. Keep it up!

Regards,

Akseli”

Hey Akseli,

Nice to meet you and thank you for the nice words.

I was pretty obsessed with (American) football for a long time. But when I quit, I never regretted it or had any issues leaving. I knew I was done. I was burnt out on it, didn’t enjoy college nearly like I did high school, and the brutality just got to be too much. I couldn’t justify what I was doing anymore.

My two years in division I were miserable. Many, many (most) of my teammates were miserable as well. You only get to play in maybe 9 or 10 games a year, and that’s if you’re lucky to play in all games, yet you have to do 12 months of work for those games. It was a huge time commitment and just draining. You miss out on a lot of regular aspects of going to college. It still irks at me that I never feel like I got to be a regular college student.

The head trauma is certainly a huge factor. There is just no way to cut it, football is not a good thing to do to your brain. It doesn’t have to be concussions either. The lower level, yet repetitive, blows to the head, can add up to be just as bad. (There is research on this out there.) The head trauma wasn’t big on the scene when I was still playing, unfortunately. That’s only become a bigger deal the last few years. Everything else was enough to get me to stop playing. The head trauma factor is a big reason I would not let my son, should I ever have one, play football though.

Sorry to be a downer!

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