So, I’m having a dilemma, and I hope to gain some clarity by writing about it. And if any of you out there have any suggestions, I’d love to hear them too!

As some of you know, I started experiencing significant hip, ankle, and foot issues during the last third of the CIM training cycle. I vowed to get these things fixed after finishing the marathon. I went to my doctor on Tuesday and secured a physical therapy referral. While I was waiting for that appointment, I scheduled another one with a certain ART/neurokinetic therapist who was highly recommended to me by a friend. (The therapist shall remain unidentified until I come to a conclusion about what I’m going to do. For the record, I’ve had nothing but good experiences with this therapist — whom I’ll call Jeff.)

Last Monday (the 10th) was my first appointment with Jeff. My friend told me that Jeff was like a neuromuscular savant — that he could diagnose by feel and may say semi-random things along the way. (If you’ve never heard of neurokinetic therapy, here’s an informative post about it I found on the interwebz.) I arrived with high hopes that Jeff could unlock my ankle and free up its range of motion. We did work on some of that, but he also discovered many, many issues in my post-marathon body that need to be addressed. Specifically, my hip flexors and diagphram were overcompensating for a lot of other muscle groups and my hamstrings were very, very weak. He gave me some exercises and stretching to do on my own, and recommended another session the following week. While I wasn’t 100% sold on another session, I did feel like Jeff provided 3 services in one: ART (Active Release Therapy), neurokinetic therapy, and physical therapy. So, I decided that one more session wouldn’t hurt anything, except for my pocketbook.

Today was my second session with Jeff. Frankly, I thought the session itself was more useful than my first, in that he really helped to work out some of the knots in my hip and glutes (and there were some pretty big knots in there, let me tell you… I was crying out for mercy at one point). He did his neuromuscular savant thing and found that my whole left side, from my shin up to my neck, was probably compensating for my right ankle’s limited range of motion. He also found that my right hip was causing a lot of the imbalance on both sides (if that makes any sense). Somehow, working out my right hip addressed the fact that my left hip was too low. Weird. Anyway, I could definitely feel my sacroiliac (SI, or hip) ligament releasing, even if it did take several sets of Jeff patiently pushing on my leg for 2-3 minutes each. So that was the good part.

The bad news was that he thought we had more work to do. A lot more work — at least a few more sessions he said. Now, each session costs $100 for an hour… add on gratuity and that’s a lot more than I was budgeting to “fix” my ankle. To be fair, he has been extremely focused each session; we often go over the 1 hour limit in order for him to feel like he’s properly addressed the problem areas he had set for the day. The other piece of bad news is that he wants me to cut back on my running — both in intensity and in quantity — for the sake of letting my body recover. He said that my body has found all of these different ways to compensate for the bad ankle and if I run too much and too hard, those compensation mechanisms will only get stronger, which in turn will continue to throw my biomechanics/running form out of whack. He did seem optimistic that if we work together that I’d be able to get back to serious training in time for the Oakland Half.

I left Jeff’s office with a heavy heart, knowing that at least most of what he said was right. I DO need to address my biomechanics if I want to keep running for a long time. However,  part of me is doubting that this (read: Jeff) is the solution. Like, even if Jeff is able to get me into a balanced state neuromuscularly, I’m wondering how he’s going to fix my ankle, because isn’t that the main problem here? Reading his Yelp reviews, it seems like Jeff has a cadre of happy clients who speak very highly of his bodywork prowess. Also, for what it’s worth, Jeff didn’t suggest multiple sessions to my friend (the one who had initially recommended him to me). So, it’s not like he automatically tells every client to come back. Regardless of whether I see Jeff again, I will definitely take the advice of cutting back mileage and intensity for the coming weeks, strengthening my hamstrings, and massaging my glutes with a tennis ball.

What do you think? Should I take the leap of (expensive) faith and trust that he’ll help me? Or should I cut my losses and try physical therapy for now? (Which, BTW, will still be expensive because I have crappy medical insurance.)



Howdy! My name is Jen and I live in the San Francisco Bay Area. I like to eat, run, and blog, but not usually at the same time.

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Posted in Injuries, random
16 comments on “Dilemma
  1. bt says:

    Super difficult dilemma, but I think if the ankle is the root of the problem, you’ll have to address it, period, so you may want to try that first in hopes that everything else melts away in response…

    • Jen says:

      I agree, but the question is, what do I do to address the ankle problem? I think my strength and balance are pretty good. I’m just not sure how to get more range of motion. I think it’s time to at least try the PT.

  2. Dominick S. says:

    Eeek, that is a difficult decision. It sounds like he knows what he is doing and if you trust the friend that recommended you there in the first place then I think that should be enough to justify the credibility. Now the question is cost. When weighing cost, do you feel that you could get similar treatments for less? Do you think there are things you could do on your own? If the answer to these things is no then you should strongly consider it. If you feel like you can correct some of these things yourself then get to it! Physical Therapy may help, but it sounds like he can fill the void of PT, right? So tough because if your saying that it could take anywhere from 3-5 sessions then that is about $300-$500 bucks…that is a lot of chedda! If you think he can really make a difference and his practices will be effective then do it. If you are unsure then save the money, start foam rolling, swimming, strenghten those hips with Pilates, hit the weights and start figuring out a way to strengthen that ankle!

    • Jen says:

      Yeah, I think you make some good points. Since I don’t have any definite goals until the end of March, I have some time to see how much work I can do on my own. A PT might be more focused on correcting my ankle, whereas Jeff is looking at my body in a more holistic POV.

  3. Angela says:

    Funny (not in the ha-ha way, obviously) how everything really is connected. And how it’s just almost never just one thing and one solution.

    In my (very limited, non-professional, sample size one) experience, I’ve found going to body workers frustrating because everyone seems to have someone who has worked miracles for them, and once I’ve gone to four different people I’ve got four different opinions on what is wrong and how to fix it. (And the wallet very quickly does become an issue.) I have sometimes gotten help from people by just being straight with them about what I can & can’t afford & to what extent I can realistically follow the visit schedule they’re suggesting, & if asking there’s anything I can do on my own to supplement at home. (Sometimes yes, sometimes no.)

    Everything I’ve figured out that works for me has really been by trial and error, and I’ve also just kind of resigned myself to setting a bar where I say, “I can live with x amount of pain / discomfort” and just suck it up as long as it doesn’t get worse or cause additional problems.

    So….that’s kind of reality for me. Sorry it isn’t more positive or useful. :/ Sorry you’re dealing with all this & hope you get some relief!

    • Jen says:

      No, that’s very useful, actually. It’s good to know that everyone is different, even though it should be painfully obvious that bodywork is not one size fits all. I’m just horrible at talking about money, but I know I should be more honest about it. It would benefit all parties in the long run.

  4. Cathryn says:

    I’d start with the ankle and hope it magically fixed itself. Ugh, you poor thing!

  5. bt says:

    If I were you and I knew I had less ankle range of motion on one side than the other, then I’d definitely go to PT first. I’d work on the thing I knew I needed to work on before I paid someone to address the secondary and tertiary damage.

    However, if I was suffering from ROM issues and tight on cash, I might just search ye olde Internet for Ankle Range of Motion and Rehabilitation programs and see if I could cobble something together that worked for me before spending the cash on PT. (This is not advice, of course ;P).

    • Jen says:

      Yes, all good ideas. I’ve done the internet searching, but it didn’t really tell me anything I didn’t already know. I think I will make an appt to see the PT. I’ve already cancelled my Thurs appt with Jeff.

  6. lizzyj1305 says:

    eek this is a tough dilemma!
    could you go to one more 100$ session, get as much in as possible, explain to Jeff that his services are expensive and ask if there are some at home things you could do to heal/strengthen your hips/glutes/quads? a lot of the time the ankle is compensating for weaker legs muscles.
    …you won’t lose measurable fitness if you cut back for a week. You might actually feel a lot better and be able to train a lot harder. You don’t want to be dragging injury into the Oakland half, so it might be a good idea.
    I’m hoping you’re all healed quick and feeling back to your healthy self before the half!!

    • Jen says:

      Thanks for your input, Lizzy! Yeah, I’ve actually decided to cancel my appt with Jeff and see how far I can go on my own. I actually have quite a bit of rehab experience, so if I put my mind to it, I’m sure I can make a lot of progress on my own. I’m going to schedule a PT appt as well.
      Thanks for stopping by and commenting!

  7. XLMIC says:

    A minor detail but I’m throwing it out there anyway…I don’t think that a gratuity is expected for his services (small potatoes in the big picture, I know). I’m all for addressing the whole picture, or you’ll wind up dealing with this for a really long time. I’ve been there (still am there). Patience is KEY…whatever route you take. And leaving it up to the professional to ‘fix’ you…don’t. It’s gotta be seen as a joint venture. I’m a firm advocate for more rest-from-running days, along with an increase in cross-training and strength training. Throw a little yoga in there to develop more flexibility in mind and body 😉 Not everyone’s body is happy with loads of mileage. Doesn’t mean it never will be…if that’s what you’re wanting.

    Oh, and I am still struggling with walking the walk I talk 😉

    • Jen says:

      Appreciate the input. I definitely agree with a lot of what you wrote. Even though 20 miles/week isn’t a lot to most people, it was to me (coming from running zero miles for a long time) and I need to recognize that. I have a feeling that ramping up on mileage will probably be easier in the future, but if it isn’t, no big deal.

  8. […] month, I went on and on about my dilemma with a certain massage therapist. My sister JS, who reads my blog (bless […]

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