Archive for August, 2011

Case of the Week – Severe low back degeneration

Monday, August 15th, 2011

55-year-old male patient presents with significant numbness of the outside of the left lower leg and foot, history of falls, mild lower back pain.  Surgical history notable for a disc surgery 20 years in the past, due to lower back and left leg pain. 

MRI and X-rays find severe degenerative arthritis and disc space loss at the two lowest levels in the patient’s lower back, as well as degenerative arthritis in the left knee. 

Physical examination is notable for a man who walks with a very pronounced hitch in his left leg gait.  Also notable for loss of sensation to pin prick and light touch over much of the lateral calf, the outside of the foot and the big toe.  Knee and ankle reflexes are both diminished.  Measurements of the left calf girth confirm loss of mass comparative to right (atrophy).

Referrals are made to neurology for further work-up.  In the meantime it is decided to embark upon a course of conservative care with the stated goal of potentially slowing the progression of the lumbar degenerative disc disease, the resulting atrophy and loss of sensation.

Six visits are scheduled with treatment measures including mild manual (doctor-assisted) traction, massage, mechanical chiropractic adjustments, along with instruction in exercises, diet and stretching.  The patient was advised to lose 10-15 pounds.

Current progress: Now into the third week of care, four visits, the patient has reported feeling intermittent pain in a formerly numb area of his left foot.  His left leg continues to feel week, but he has been able to ride an exercise cycle and is walking 3-4 blocks daily without falling.  These are positive signs. 

 The patient will consult with neurology as recommended, to see what they suggest, but in the meanwhile is gaining strength in his weak, atrophied leg, appearas to be maintaining his health, as well as showing a glimmer of restored sensation, even if it is ‘pain’.

Running with a Stroller

Monday, August 15th, 2011

Will add time to your 5K!  Large wheels are key to a smooth ride for the kids and runner.  Getting used to running without pumping the arms is required, but not at all difficult.  Use a tether so the stroller doesn’t lose control if you do.  Some models offer hand brakes, which may be helpful should an emergent stop be necessary, otherwise I think the feet work well enough.

There is debate in the jogging-stroller-running community whether a jog stroller’s front wheel should swivel/turn.  In fact, if it swivels it will be easier to take sharp corners.  Turning a non-swivel requires you lift the front wheel up, typically by pushing down on the handlebar.  The reasoning against swiveling front wheels are most all safety concerns, they say should a swivling type wheel strike a rock, it may veer sideways.  I’ve never seen or had it happen, but it seems plausible.

Maintenance: Jogging strollers or those strollers with larger diameter wheels typically use pneumatic tires with air inflated tubes, exactly like a bicycle.  But they can be harder to fix than on a bike.  As an avid mountain and road biker, I’ve changed dozens of flat tires.  I had the opportunity recently to fix a flat on a 12″ stroller wheel.  I don’t mind admitting it took quite a bit of muscle finesse, and wouldn’t have been easy for an inexperienced person to do, especially without the proper tools.

Changes to the Workout:  You’ll gain a bit of momentum on declines, but the real work comes when going uphill.  My personal experience is with a double-wide Bumbleride.   My kids + stroller + miscellaneous = 100+ lbs.  Moving this sort of weight uphill at a run adds an anaerobic/strengthening segment to your otherwise purely aerobic session.  Quite obviously.

Injury potential:  Adding weight resistance to running increases the risk of stress/strain injury to the running muscles as well as the lower back.  The degree of risk is somewhat nebulous, as with any exercise, the greater the effort the greater the risk.  Long runs down inclines, slowing the stroller, may put additional stress on the hamstrings, mid back and lower back.  There is an increased risk of injuries related to crashes and accidents, should they occur.  Overall, the added impact/shock strain on the feet and knee joints would be minimal, in my opinion.

For those that aren’t running barefoot..

Tuesday, August 9th, 2011

Runner’s World recently rated the Saucony ProGrid Ride 4, a “best update” for 2011.  It’s a running shoe I was well familiar with prior to the magazine’s accolade.  I’m a mid-short distance runner, weekly milage in the range of 14-20.  Right knee ACL is gone. 

Since part of my practice is running injuries, I trial *a lot* of shoes to see how they behave.  These ProGrids are among my own regulars as they provide great neutral cushioning, a plush ride, and are light weight.  Ideal for the 4-6 mile runs I typically take.  Even boasts such a comfortable interior fit that you could get away without wearing socks, so I was told…which I don’t recommended.

Saucony Pro Grid – Excellent neutral handling, shock absorbing, and overall comfort, for mid to high distance training.