Wednesday, August 31, 2011

Running with a Hip Labral Tear - Avoid / Postpone Hip Arthroscopy


Running with a Hip Labral Tear –Avoid Hip Labral Tear Surgery

Watch the video:

http://www.compasschiro.com/run-running-hip-labral-tear
 
After developing a set of symptoms consistent with a labral tear, I spent some time reading online running forums. I got the feeling that I am not alone in being very frustrated with a likely diagnosis of labral tear and being very motivated to continue with the running that I have grown to love (and am quite possibly addicted to). With that in mind, I wanted to share my experience in the hopes that it might help other runners facing a diagnosis of hip labral tear get back to doing what they love, even if it’s modified a bit. So with that, let’s dive into my history.
I was half way through my first marathon training program and making phenomenal progress (gunning for a Boston Qualifier on my debut) when during a tempo run I experienced some pain in my left hip. This was on perhaps a Tuesday before my first big tune-up race, the Drake Half Marathon. I ran this relatively hilly race with a pace of 6:31. I was proud of my progress (I was running a 7:30 5K a year or so before but had made major strides by implementing a combination of Chi Running and Evolution Running and dropping 35 pounds through the Standard Process Purification Program and overall improved diet) but aware that my hip felt worse by the end of it. My training plan from Advanced Marathoning by Pete Pfitzinger called for a 20 mile run the next day so I went out to do it. My hip got worse over the first 3 miles to the point where it was giving me a sharp stab deep in the joint radiating to the groin with each step so I stopped and walked dejectedly back to my car. I stopped running for 2 or maybe 3 weeks while I aggressively stretched my hips and focused on keeping my cardio up with cycling. I focused on stretching the adductors, piriformis, and hip flexors but was aware that stretching did not necessarily feel beneficial. Being a chiropractor, Active Release Techniques Provider, and active person, I think of myself as quite in tune with the different types of pain and was aware that with the stretching I felt a “block” sensation within the ball and socket joint on adductor stretching rather than a beneficial feeling stretch of the hip flexors or adductors. With that I started looking into hip labral tears online. Quite frankly, the information on the forums was quite depressing. As a chiropractor, I am the sole source of income for my business and I was reading articles of people needing crutches for 6 or more weeks after hip labral tear surgery. That kind of time out of my practice was impossible. I considered having an MRI with contrast done to confirm the diagnosis, but came to the conclusion that it was irrelevant as it wouldn’t change my actions. I wasn’t currently interested in surgery or a steroid injection, so I would be resting my hip no matter what. With a high deductible health insurance plan it didn’t make sense to pay for a test that wouldn’t change my actions at all.
After 2-3 weeks I was walking relatively pain free so I started running again. After all, I was in the middle of a training program. On Monday I ran two miles, Wednesday - five, and Friday - seven, but when I got to 10 my hip started to give me a sharp pain again. I stopped but at that point I had aggravated the hip to the point where I was getting a sharp stab even during normal walking and while giving low back chiropractic adjustments to patients. That lasted for about 10 days. I resigned myself that I would not be doing the Dam to Dam 20K or the Duluth Marathon and tried to tell myself I enjoyed cycling and open water swimming as much as running. It didn’t work. I got my wake-up call over a Fourth of July camping weekend when hot humid weather woke me up frequently during the night causing me to remember my dreams. Normally I don’t remember them. My dreams were all about running and they were good. I was fast. I resolved to find a way to start running again.
Below is the plan I followed to get back to running. I can’t say it’s been totally successful because I’m in the middle of it. I’ll update it if I reach my goal. I do want to be clear that this is not medical advice. Running with a labral tear could certainly result in short term pain or possibly make your situation worse. Your individual situation is certainly different than mine. There’s also a possibility that you could accelerate degenerative changes in your hip. Consult your sports doctor if you have questions about any of these ideas I used.
I let my hip get relatively pain free during walking and short runs.
I had already watched the videos Chi Running and Evolution Running. For those of you out there reading this article and feeling hopeless, I strongly recommend that you watch these two videos. They show you how to minimize stress into the various parts of the body. They have many similarities but just enough differences where I really have to recommend that you watch them both and implement elements of each of them.
I recognized some goals to minimize labral tear aggravation during running. The stretches I was doing seemed to make things worse so I stopped doing them and the hip improved. This seemed to indicate that the labrum was actually aggravated by being taken through full range of motion. From the perspective of running with a labral tear, I saw three main goals. The first is to minimize the shock into the hip ball-and-socket joint. The second is to minimize the forward and backwards movement of the upper leg bone within the ball and socket joint. The third is to minimize inflammation. With those goals, I set up my rules for running.
My rules for running
a. Forward lean – I was already using a forward lean. This concept is mainly taught in the Chi Running DVD. With a forward lean you let gravity pull you forward. Your foot lands under your center of gravity as you are moving forward which prevents the major shock from traveling up your leg. When your foot strikes in front of your center of gravity (in particular with the heel first) you have a major impact as the weight of your core body is moving down and forward at the time the heel strikes. An impact shock travels up the leg when your heel strikes and would certainly affect the hip ball and socket joint. Running upright with the heel striking in front of the body can be thought of a bit as stomping on the car brake for an instant with every step. With a forward lean you minimize shock into the ball-and-socket hip joint.
b. 200 steps per minute – both the Chi Running and Evolution Running DVDs recommend a running cadence of about 180 steps per minute. This would be if you were counting both foot strikes. If you were only counting your right foot strikes it would be 90 steps per minute. I personally go beyond their recommendations and shoot for 200 steps per minute. The reason this is recommended is that speeding up your running cadence decreases the amount of up and down movement of the core body. Ideally, we’d like to see the top of your waist and your head move up and down as little as possible. A person who runs at a cadence of 120 steps per minute might have 2-3 inches of up and down movement at the hips and head. This up and down movement can be viewed as shock and stress into the hip joint as it lets the weight of your upper body crash down into the legs with every step. When I run at 200 steps per minute, I only feel my hips and head move up and down perhaps a half a centimeter. Compare your running to bicycling. Bicycling is considered low impact and efficient because on a bicycle your hips don’t move up and down at all. The second benefit of a faster cadence is that for any given running speed, it shortens your stride. This minimizes movement into the hip ball-and-socket joint. Try to use a faster cadence to minimize vertical motion of the hips and core body and to minimize forward and backward movement of the upper leg. There are many free metronome apps for iPhone and Android phones. I strongly recommend you run with a metronome all the time as you start this process. I use a iTick on my iPhone almost every time I run. I have the sounds set to cowbell so I can imagine Will Ferrell cheering me on as I run.
c. Ball of Foot (Forefoot) Strike – The Evolution Running DVD recommends forefoot strike where your heel never touches the ground. It highlights that with a forefoot strike all the impact stress is absorbed by the calf muscles, Achilles tendon, and plantar fascia. Try standing still and try to stomp the ground as hard as possible, but don’t let your heel touch the ground. Now try stomping down heel first. You’ll feel that as long as you don’t let the heel touch the ground it’s impossible to generate significant impact shock up into the hip. Forefoot strike minimizes shock but I’ll be honest, it can be a bear to adapt. At first you’re going to think your calves hate you. However, you have to remember that it’s better that your calves hate you than that screwed up hip. You have to ease into this one. If you’ve never run with a forefoot strike I recommend a very gradual progression.
d. Lift the lower leg off the ground rather than push your body forward – If you get the lean and the cadence down right, you can focus on keeping your upper legs relatively still while lifting your lower leg off the ground. This will minimize movement into the hip ball and socket joint. To integrate this, first practice running in place with a metronome trying to keep your upper leg still and just lift the lower leg off the ground. Then while you’re out for a run, pick a point in the distance and imagine a bungee cord from your chest to the point. Imagine that the tight bungee is pulling you forward. All you have to do is lift your feet and lower legs below the knees off the ground fast enough and you will move toward that point. This visualization should help you do a proper forward lean which combined with the quick cadence moves you forward and minimizes motion into the hips.
e. Day in between each run – If you’re used to running daily for fitness or to follow one of the popular running training guides, I know it can be hard to skip a day. However, I personally had to come to terms with the fact that despite all my steps to change my running style, there was still some amount of inflammation in the hip every time I went for a run. I had to be thankful I wasn’t getting the sharp pain. By leaving a day in between each run I’ve been able to build up to a consistent three to four mile run three to four times per week. On the positive side, faster seems to be less stressful on the hip so it’s not as if I’m plodding along slowly. I ran my fastest 3 mile ever on the trail recently and felt no worse for it. I’ve recently drawn up a training program that will take me up to 6 mile runs (and hopefully a sub-18 minute 5K). The training plan is based on the book Run Faster from 5K to Marathon by Hudson which is great for my situation as he recommends an adaptive training plan where you listen to your body every day, your plan is in pencil, and you anticipate that you will make changes to the plan to maintain your health.
f. Listen to your body – I am very focused on my hip. For me, mild dull aches are ok but if I feel even a hint of sharp pain, my training plan is off until it’s gone. Let’s hope that doesn’t happen.
g. Gradual build – I set out the above rules and stuck to them. If my cadence dropped below 195 steps per minute I stopped and walked. If blisters on the ball of my foot stopped me from doing my forefoot strike I stopped and walked. If I had never done any forefoot striking I would have followed the best progression for true beginners – (1 min run, 3 min walk) and repeat for the first week, (2 min run, 2 min walk) for the second week, (3 min run, 1 min walk) for the third week and progress to some short continous running. I have actually been following the rule that you should only increase your running by 10% per week. I’m trying to learn from my past stubborn foolishness and I’m very motivated to stay healthy while running.
h. Minimal shoes – Personally, I am using Vibram FiveFinger Bikilas. I find that they help me make sure that I never let my heel touch the ground. Also, they are conducive to that super quick cadence as there is no foam to slow down my foot-ground contact time. However, I do get some soreness in my feet. For people reading this, I’d consider minimal shoes like the FiveFingers but otherwise at least get some shoes with a minimal heel-toe height difference which are conducive to forefoot strike such as the Saucony Kinvaras or perhaps some Newtons.
I hope my experience and plan help you form a plan to run with a labral tear. I’m sure there are true surgical cases but I hope that my game plan laid out here keeps me running for a while and possibly forever without what I view as a risky surgery. Feel free to give feedback in the comments section.

Tuesday, August 30, 2011

Waukee, Iowa Chiropractic Page

We have optimized our Waukee, Iowa Chiropractic Page to ensure that people in Waukee can easily find us when they are in pain.

Clive, Iowa Chiropractic Page

We have optimized our Clive, Iowa Chiropractic page to help people in Clive find us easily if they are in pain and looking for a Clive chiropractor.

West Des Moines Chiropractic Page

Our West Des Moines chiropractic page has been updated to help those in pain find us better when they search for us online.

Sunday, August 7, 2011

Des Moines Chiropractic Newsletter - August

Our August, 2011 newsletter will be available online at Compass Chiropractic Newsletters. If needed, please use the links in the footer to opt out or change your account.
Compass Chiropractic August, 2011 E-Newsletter

The dog days of summer have arrived!


Special Olympics Over the Edge Fundraiser

How would you like to be pain-free and rappel down the side of the Financial Center in downtown Des Moines? Our Over the Edge Fundraiser may let one or two lucky Central Iowans do just that!

Through September, any new patient who donates $50 or more to our Over the Edge Fundraiser will receive a complementary first visit (exam, any needed spinal X-rays, and mechanical table massage up to $300 value).

For every $1,000 we raise, we can send a person over the edge of the Financial Center downtown on September 21. We will add new patients as well as our established patients who refer them to our office into a drawing to see who gets to go over the edge for Special Olympics.

Call (515) 309-1217 to schedule an appointment!

Introducing Jeanne

Background: Helping others achieve their needs has always been a goal of mine. My bachelor’s degree is in Elementary Education. After Brad and I got married and started a family, I chose to operate a Daycare in our home. After 12 years, I re-entered the hospitality and sales/retail industries and worked my way up to middle management and I remained there for the next 10 years. Customer service has always been a passion of mine. I love making people feel “taken care of.”

Favorite aspects of working at Compass Chiropractic: The patients are my favorite! I love developing new relationships with people. Everyone has something interesting about them and it’s a joy for me when they choose to share it. Second best part is having such a great boss! Dr. Krohse is such a terrific person to work with; he always makes me feel like everything is a team effort! This is a GREAT work environment!!

What I enjoy outside of work: My family!! We have 4 children whom are all young adults now. Brad and I just celebrated our 25th wedding anniversary and are looking forward to adjusting to having an “empty nest” this fall. We enjoy listening to live music, going to movies and spending time outdoors.

How I give back to the community: When the kids were growing up, I was the mom who chaired every committee and ran every major fundraising event! Since they have graduated, I have turned my attention to helping other women deepen their spiritual relationships by facilitating several bible study groups.

Words to live by: Love is the most precious treasure any of us ever have. An attitude of gratitude is the key to living a happy healthy life.

Favorite local restaurant: Anywhere that offers a great steak and seafood combination!!

Something most patients don’t know about me: Baking, bible studies, reading and quilting are my hobbies.

Compass Chiropractic Cutest Pet Contest

Through the end of August we’ll have a binder in our waiting room where patients can vote on whose pet is the cutest. The winner of the contest will receive a $100 pet store gift card! Check some of the pictures submitted!



Raider (available to adopt through the Great Plains Pointer Rescue)



Boston



Buddy



Jax



Luca





Rosie



Semper Fi
Dr. Krohse Recommends Unbroken

On a friend and fellow runner’s recommendation, I recently picked up the book Unbroken by Laura Hillenbrand through the Clive Library’s WILBOR audiobook system. This is one powerful, true story written by the same author who penned Seabiscuit. It tells the story of Louie Zamperini, who became the pride of the United States with his running performance in the 1936 Berlin Olympics. Following his success there, Louie ended up flying in the South Pacific where his plane crashed down. His trials on a life raft and in prisoner of war camps will leave you holding your breath as you will Louie to remain unbroken. I highly recommend this book to everyone!

&

J&Company Photography

When I needed new professional portraits for our office, I knew who to call. I’d been following J&Company Photography on Facebook and was impressed with Jennifer Marinangeli’s portfolio. She made our portraits fun, yet professional. I’d recommend her to anyone looking for great family, children, senior, professional, or wedding portraits.

Condition of the Month – Nutrition & Weight Management

The Standard Process Purification Program has enabled staff members and patients of Compass Chiropractic to get their nutrition on the right track. This 21 day program has generally resulted in people losing eight to nine percent of their body weight with most of the 30+ people who have purchased it at Compass Chiropractic reporting 14-18 pounds lost during the program. Along with the excitement of that rapid change, people have reported increased energy, improved digestion, decreased allergies, and other positive changes. Most importantly, this program allows you to eat an unlimited variety of vegetables and fruit, with the stipulation that you need to keep them in a 2:1 ratio. Because of this, many have been able to successfully transition into a healthier lifestyle and make the long term changes needed for continued successful maintenance of a healthy weight and body shape.

Dr. David Krohse at Compass Chiropractic is a great example of how this program can work. Though remaining active and participating in both the Hy-Vee Triathlon and the Des Moines Half Marathon in 2009, his weight on New Years Eve, 2009 put him at a BMI of 27.3: well into the overweight range. He started the program on January 2 and lost 15 pounds in 21 days. Over the next three weeks he lost another 10 pounds through continued better nutrition.

Through August 2011, Dr. Krohse has maintained between 25 and 35 pounds less weight than before going through the purification program.

Though our main specialties are neck pain, back pain, headaches, shoulder pain, hip pain, and sports injuries, we strive to empower our patients to whole life long-term wellness and better health. During the month of August, we have reduced the cost of the Standard Process Purification Program by $50 to $173 + tax.

Spotlight on Team Compass Chiropractic Athlete Marina McCollom

Sport: Tennis

Day Job: Director of Junior Tennis at 7 Flags Fitness & Raquet Club

Background: I am a professional tennis player competing on the USPTA national circuit for tennis teaching professionals. I am currently ranked #1 in singles in the Women's Open division. In the last couple of years I have won 9 out of the 10 national tournaments I entered, including the National Indoor Championships in Minneapolis, National Clay Court Championships in West Palm Beach, FL, International Championships in Palm Springs, CA and Marco Island, FL, and Hard Court Championships in Tyler, TX. I have also won the Player of the Year award for Women's Open division under the USPTA in 2008 and 2009.

Future Goals: My future goals include competing on the WTA tour (the most prestigious women's tennis organization) and earning a world ranking and recognition.

Experience at Compass Chiropractic: Before starting care with Dr. Krohse I hadn't tried chiropractic care. I was surprised how simple adjustments can positively affect your overall physical condition. I have had a chronic lower back pain for about a year. After starting treatment at Compass Chiropractic I haven't experienced any major problems in that area.

Dr. Krohse was friendly and professional. He took the time to develop a personal program for me so I can strengthen my body and prevent future problems. I feel that I have improved my flexibility and strengthened my core, which is very important to tennis players.

I would definitely recommend Compass Chiropractic to other athletes. Dr. Krohse is very knowledgeable and, as an athlete himself, understands the importance of ultimate physical condition to outstanding performance.

Calendar

1st Tues each Month – Kid's Day – Children under 13 receive ANY needed services (exams, adjustments, ART) at no charge

2nd Tues each Month – Athletes Day – Athletes any age bring a team picture or action picture and receive 1st day services (exam and any needed X-rays) at no charge