Comments for SRCPT http://www.srcpt.com/blog Just another WordPress weblog Sat, 29 May 2010 19:11:41 -0700 hourly 1 http://wordpress.org/?v=3.0 Comment on That Crazy Pain in My Shoulder!! by Neil Chasan, PT, MMT http://www.srcpt.com/blog/2008/12/that-crazy-pain-in-my-shoulder/comment-page-1/#comment-139 Neil Chasan, PT, MMT Sat, 29 May 2010 19:11:41 +0000 http://www.srcpt.com/blog/2008/12/that-crazy-pain-in-my-shoulder/#comment-139 Jim wrote: I read a blog you posted on SLAP repair. Just a quick question for you. I have surgery scheduled. I'm a 42 y.o. h.s.coach/rec baseball player. My doc is planning on doing the same surgery that Favre had. Release of the biceps tendon and clean out spurs while re-creating the AC gap. What is your opinion on biceps tendon release? Pros and cons... Thanks. The answer is: The reason that the surgeons release the biceps tendon in people who are not young and active is that there is a high incidence of frozen shoulders with a strict repair. Some surgeons simply repair the labral tear, some release the biceps tendon allowing it to retract which can cause the Popeye muscle deformity, and others sew the tendon down in the biceps groove with good result. The Popeye deformity is no big deal functionally, but if it were me, I would ask for the tendon to be secured in the groove. Jim wrote: I read a blog you posted on SLAP repair. Just a quick question for you. I have surgery scheduled. I’m a 42 y.o. h.s.coach/rec baseball player. My doc is planning on doing the same surgery that Favre had. Release of the biceps tendon and clean out spurs while re-creating the AC gap. What is your opinion on biceps tendon release? Pros and cons… Thanks.

The answer is:
The reason that the surgeons release the biceps tendon in people who are not young and active is that there is a high incidence of frozen shoulders with a strict repair. Some surgeons simply repair the labral tear, some release the biceps tendon allowing it to retract which can cause the Popeye muscle deformity, and others sew the tendon down in the biceps groove with good result. The Popeye deformity is no big deal functionally, but if it were me, I would ask for the tendon to be secured in the groove.

]]> Comment on What is a Forefoot Varus? by Neil Chasan, PT, MMT http://www.srcpt.com/blog/2008/12/what-is-a-forefoot-varus/comment-page-1/#comment-124 Neil Chasan, PT, MMT Mon, 08 Mar 2010 15:22:03 +0000 http://www.srcpt.com/blog/2008/12/what-is-a-forefoot-varus/#comment-124 If you believe you have a flat foot, AND you show unusual wear on the outside of the forefoot, which is what I take your post to suggest, then I suspect that you might have a forefoot varus or a forefoot supinatus. In my opinion, this would not be overcompensation as you suggest, but just the natural tendency of the forefoot to encounter the ground in its natural posture. In normal wear patterns, we expect to see the transition to the inside of the forefoot begin across the midfoot in normal gait, which would suggest that lateral wear implies lateral contact first...Make sense? If you believe you have a flat foot, AND you show unusual wear on the outside of the forefoot, which is what I take your post to suggest, then I suspect that you might have a forefoot varus or a forefoot supinatus. In my opinion, this would not be overcompensation as you suggest, but just the natural tendency of the forefoot to encounter the ground in its natural posture. In normal wear patterns, we expect to see the transition to the inside of the forefoot begin across the midfoot in normal gait, which would suggest that lateral wear implies lateral contact first…Make sense?

]]> Comment on What is a Forefoot Varus? by ralph http://www.srcpt.com/blog/2008/12/what-is-a-forefoot-varus/comment-page-1/#comment-123 ralph Wed, 03 Mar 2010 17:39:37 +0000 http://www.srcpt.com/blog/2008/12/what-is-a-forefoot-varus/#comment-123 This is interesting.... could it account for a flat-footer showing wear patterns on the outside of the shoe? I am in pretty neutral shoes (ds trainers) but still shoe forefoot wear on the outside (lateral) part of the shoe. Is this overcompensation? This is interesting…. could it account for a flat-footer showing wear patterns on the outside of the shoe? I am in pretty neutral shoes (ds trainers) but still shoe forefoot wear on the outside (lateral) part of the shoe. Is this overcompensation?

]]> Comment on What is a Forefoot Varus? by Neil Chasan, PT, MMT http://www.srcpt.com/blog/2008/12/what-is-a-forefoot-varus/comment-page-1/#comment-115 Neil Chasan, PT, MMT Wed, 10 Feb 2010 15:56:47 +0000 http://www.srcpt.com/blog/2008/12/what-is-a-forefoot-varus/#comment-115 You know Ryan, its not that the uncompensated forefoot should resist wearing vibrams, it's more that use of the minimal footwear should be more limited in that case because of the increased loading in the joints up the chain. My thought is that the next major joint to suffer would be the patello femoral joint because of the tendency of the tibia to follow the sub-talar joint in the frontal plane. Since you would be running on your forefoot already, the PF should be protected regardless. As for rear foot issues and minimal footwear, I think that the rear foot is largely off the ground when running barefoot, and so this should not be an issue. The view point is that the rear foot valgus is compensatory to forefoot issues, and the rear foot varus would be more indicative of a supinated foot in general. In any event you would be on your forefoot so the rear foot issues would be negligible. You know Ryan, its not that the uncompensated forefoot should resist wearing vibrams, it’s more that use of the minimal footwear should be more limited in that case because of the increased loading in the joints up the chain. My thought is that the next major joint to suffer would be the patello femoral joint because of the tendency of the tibia to follow the sub-talar joint in the frontal plane. Since you would be running on your forefoot already, the PF should be protected regardless.

As for rear foot issues and minimal footwear, I think that the rear foot is largely off the ground when running barefoot, and so this should not be an issue. The view point is that the rear foot valgus is compensatory to forefoot issues, and the rear foot varus would be more indicative of a supinated foot in general. In any event you would be on your forefoot so the rear foot issues would be negligible.

]]> Comment on What is a Forefoot Varus? by ryan http://www.srcpt.com/blog/2008/12/what-is-a-forefoot-varus/comment-page-1/#comment-111 ryan Sat, 30 Jan 2010 13:40:29 +0000 http://www.srcpt.com/blog/2008/12/what-is-a-forefoot-varus/#comment-111 Nice blog! So would you say an uncompensated forefoot varus should probably resist wearing vibrams? It seems that if the the forefoot can't bring the first ray down during propulsion then the either the 1st MTP and/or the plantar fascia will take the hit. Yes no maybe so? What are your thoughts on minimalist footwear and Pes Cavus (Rear foot varus and forefoot valgus) Thanks, Ryan Nice blog! So would you say an uncompensated forefoot varus should probably resist wearing vibrams? It seems that if the the forefoot can’t bring the first ray down during propulsion then the either the 1st MTP and/or the plantar fascia will take the hit. Yes no maybe so?
What are your thoughts on minimalist footwear and Pes Cavus (Rear foot varus and forefoot valgus)

Thanks,
Ryan

]]> Comment on Capitalizing on the Coming Wellness Revolution by Nellie http://www.srcpt.com/blog/2009/10/capitalizing-on-the-coming-wellness-revolution/comment-page-1/#comment-110 Nellie Wed, 20 Jan 2010 18:07:47 +0000 http://www.srcpt.com/blog/?p=112#comment-110 Hi Neil, thanks for the response on Piriformis Syndrome! No one has been able to explain this to me before, and to get to the bottom of the problem by asking a very simple question, "why is the Piriformis complaining". It just so happens that I will be visiting my chiropractor today and I intend on printing your email and taking it to him. He's sports oriented so he should understand this. Tackling this problem will help me go a lot farther in my running endeavors. Your articles are informative and helpful! Hi Neil, thanks for the response on Piriformis Syndrome!

No one has been able to explain this to me before, and to get to the bottom of the problem by asking a very simple question, “why is the Piriformis complaining”. It just so happens that I will be visiting my chiropractor today and I intend on printing your email and taking it to him. He’s sports oriented so he should understand this. Tackling this problem will help me go a lot farther in my running endeavors.

Your articles are informative and helpful!

]]> Comment on The Case for Barefoot Running by Neil Chasan, PT, MMT http://www.srcpt.com/blog/2009/07/the-case-for-barefoot-running/comment-page-1/#comment-87 Neil Chasan, PT, MMT Tue, 17 Nov 2009 02:48:09 +0000 http://www.srcpt.com/blog/?p=65#comment-87 You are welcome Rich, and no, not at all. I think that you sound like a person with a forefoot dysfunction that with a forefoot post properly constructed it should allow you to run in a neutral shoe You are welcome Rich, and no, not at all. I think that you sound like a person with a forefoot dysfunction that with a forefoot post properly constructed it should allow you to run in a neutral shoe

]]> Comment on The Case for Barefoot Running by Rich Shawver http://www.srcpt.com/blog/2009/07/the-case-for-barefoot-running/comment-page-1/#comment-86 Rich Shawver Tue, 17 Nov 2009 02:42:52 +0000 http://www.srcpt.com/blog/?p=65#comment-86 Neil, Thank you for the detailed suggestions. I will relay them to my podiatrist. So you don't think I'm a good candidate for going to a shoe with a less elevated heel (like a Nike Free, for ex.) and getting rid of my orthotics altogether as I continue to work on the forefoot/midfoot landing? Of course, I'm not talking about going out & doing 4 or 5 miles w/o the orthotics. I'm thinking of dropping back to 1.5 miles & sort of "starting over." Thanks.....Rich Neil,
Thank you for the detailed suggestions. I will relay them to my podiatrist.

So you don’t think I’m a good candidate for going to a shoe with a less elevated heel (like a Nike Free, for ex.) and getting rid of my orthotics altogether as I continue to work on the forefoot/midfoot landing?

Of course, I’m not talking about going out & doing 4 or 5 miles w/o the orthotics. I’m thinking of dropping back to 1.5 miles & sort of “starting over.”

Thanks…..Rich

]]> Comment on The Case for Barefoot Running by Neil Chasan, PT, MMT http://www.srcpt.com/blog/2009/07/the-case-for-barefoot-running/comment-page-1/#comment-85 Neil Chasan, PT, MMT Mon, 16 Nov 2009 19:15:47 +0000 http://www.srcpt.com/blog/?p=65#comment-85 Hi Rich, sounds like a challenge. The Metatarsus Adductus is typically associated with a plantar flexed first ray. In the event that the first ray is also rigid, then you would be better off with an orthotic device with a forefoot post and a first ray cut out. Often, because the drop off is too big, I refill the first ray cut out with a light foam like poron. You might also need a metatarsal arch pad to increase the available "range" of the first ray. With this type of orthotic device, you should be able to execute a forefoot strike without much difficulty. Another suggested accommodation is the 2-5 bar post to further accentuate the well for the first ray to drop into. I also like to use a deep heel seat and some mid foot posting as well to spread the wealth as it were. With such a device, you should also make sure to use a neutral shoe because you don't want correction on top of correction if that makes sense. Let me know if this helps. Hi Rich, sounds like a challenge. The Metatarsus Adductus is typically associated with a plantar flexed first ray. In the event that the first ray is also rigid, then you would be better off with an orthotic device with a forefoot post and a first ray cut out. Often, because the drop off is too big, I refill the first ray cut out with a light foam like poron. You might also need a metatarsal arch pad to increase the available “range” of the first ray. With this type of orthotic device, you should be able to execute a forefoot strike without much difficulty. Another suggested accommodation is the 2-5 bar post to further accentuate the well for the first ray to drop into. I also like to use a deep heel seat and some mid foot posting as well to spread the wealth as it were. With such a device, you should also make sure to use a neutral shoe because you don’t want correction on top of correction if that makes sense. Let me know if this helps.

]]> Comment on The Case for Barefoot Running by Rich Shawver http://www.srcpt.com/blog/2009/07/the-case-for-barefoot-running/comment-page-1/#comment-84 Rich Shawver Sat, 14 Nov 2009 02:23:22 +0000 http://www.srcpt.com/blog/?p=65#comment-84 I ran for 5-1/2 years, from age 35 to age 40, but then had to give it up because of my work schedule. I was at 6 miles, 6 days weekly. I never lost the desire, and in Jan. 2009 I began running again after a 15 year interlude. I was only running 3 days a week, and I was wearing custom orthotics and good Asics shoes. I noticed that I still had the stiff legs & hips, so I immediately started stretching. That helped a little. Then I decided to incorporate forefoot running into my runs. I started out while running only about 2-1/2 miles total. I would run about 1-1/4 mile with a heel strike, then I could convert to forefoot running while going up a hill, and would finish the rest of the run w/a forefoot landing. I gradually began increasing my mileage, staying well within the 10% rule. I experienced occasional bouts of tender pads on the balls of my feet, but never true pain. My feet would be better by the next morning. I was doing great - no stiff legs or hips, no strange knee pains, no calf or Achilles Tendon problems - just the occasional tenderness on the balls of the feet (which seemed to be improving). One evening in very early October '09 I felt so good that I increased my mileage (still within the 10%), and increased my speed. I felt some actual pain underneath the 4th metatarsal of my left foot near the end of my run. I stopped running for a week, then went back at it again. The pain held off for about a mile, then it came back. I decided to try to run through it - bad idea. I got about 3-1/2 miles into my nearly 5 mile run, and had to walk back home, limping all the way. I went to a podiatrist, briefly telling hm about my experience above. When I got to the part about the forefoot strike, he said, "Why did you do that? Where did you get that idea?" Let's just say he had never heard of the forefoot running strike, and I don't think he's too conducive to a paradigm shift. He said it sounds like a stress fracture, so he took X-rays. He showed me the X-rays and said the shape of my foot sets me up for metatarsal injuries (using the heel strike). He said I have Metatarsus Adductus. He said no running or fast walking for 8 weeks minimum, and had me in an aircast for 4 weeks. I'm okay with that, because I don't want to do permanent damage. I've been doing some looking on the Internet, and I believe I have a mild case of Metatarsus Adductus. The bones are somewhat curved, but not skewed or twisted drastically. Should I try a newer, better pair of orthotics & go back to heel strike? Or should I continue with working on the forefoot strike and just back off a little, but this time do it without the orthotics? Is a foot with mild Metatarsus Adductus one that should never, EVER be subjected to forefoot running? I know this has been a long post, but I'm at my wit's end trying to figure out what to do. I loved running without the leg/knee/hip issues when I was running with the forefoot strike, but at least I was able to stretch after running & keep on going 3X a week with the mild/moderate aches/pains. Please - HELP! Rich I ran for 5-1/2 years, from age 35 to age 40, but then had to give it up because of my work schedule. I was at 6 miles, 6 days weekly. I never lost the desire, and in Jan. 2009 I began running again after a 15 year interlude. I was only running 3 days a week, and I was wearing custom orthotics and good Asics shoes.

I noticed that I still had the stiff legs & hips, so I immediately started stretching. That helped a little. Then I decided to incorporate forefoot running into my runs. I started out while running only about 2-1/2 miles total. I would run about 1-1/4 mile with a heel strike, then I could convert to forefoot running while going up a hill, and would finish the rest of the run w/a forefoot landing.

I gradually began increasing my mileage, staying well within the 10% rule. I experienced occasional bouts of tender pads on the balls of my feet, but never true pain. My feet would be better by the next morning.

I was doing great – no stiff legs or hips, no strange knee pains, no calf or Achilles Tendon problems – just the occasional tenderness on the balls of the feet (which seemed to be improving).

One evening in very early October ’09 I felt so good that I increased my mileage (still within the 10%), and increased my speed. I felt some actual pain underneath the 4th metatarsal of my left foot near the end of my run. I stopped running for a week, then went back at it again.

The pain held off for about a mile, then it came back. I decided to try to run through it – bad idea. I got about 3-1/2 miles into my nearly 5 mile run, and had to walk back home, limping all the way.

I went to a podiatrist, briefly telling hm about my experience above. When I got to the part about the forefoot strike, he said, “Why did you do that? Where did you get that idea?” Let’s just say he had never heard of the forefoot running strike, and I don’t think he’s too conducive to a paradigm shift.

He said it sounds like a stress fracture, so he took X-rays. He showed me the X-rays and said the shape of my foot sets me up for metatarsal injuries (using the heel strike). He said I have Metatarsus Adductus. He said no running or fast walking for 8 weeks minimum, and had me in an aircast for 4 weeks. I’m okay with that, because I don’t want to do permanent damage.

I’ve been doing some looking on the Internet, and I believe I have a mild case of Metatarsus Adductus. The bones are somewhat curved, but not skewed or twisted drastically.

Should I try a newer, better pair of orthotics & go back to heel strike? Or should I continue with working on the forefoot strike and just back off a little, but this time do it without the orthotics? Is a foot with mild Metatarsus Adductus one that should never, EVER be subjected to forefoot running?

I know this has been a long post, but I’m at my wit’s end trying to figure out what to do. I loved running without the leg/knee/hip issues when I was running with the forefoot strike, but at least I was able to stretch after running & keep on going 3X a week with the mild/moderate aches/pains. Please – HELP!

Rich

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