INTRODUCTION I have read the original and restructured it plus finishing this sector. I hope it works for you all. I thought this title would do to set the scene. This is a preamble. I’ll talk about what I am doing and why specifically in relation to this condition.
Being a keen cyclist, leg strength and lung capacity, distributing oxygen to the muscles, have been the rock which enabled me to achieve what I’ve done up to this point. Losing muscle and full blown PE (yes blood clots both lungs)removed that rock almost overnight. It has become an effort to push my own body weight up on the stairs or a ladder carrying any reasonable weight. Something I never even considered pre PMR/GCA. Add to this the feeling that my legs feel stuffed with the residual waste the body shunts each morning seemingly settling in my lower legs. We need balance and that in large part hinges on the responsiveness and strength of our legs. I am not a trained professional in this so it is as much about what is sensible for you to attempt as it is for me to offer suggestions that are practical realistic and safe. Some examples of approved stretches, promoted by the professional “trainers” and even some physio’s, I consider inappropriate and even damaging. More on that when we come to specifics.
I don’t believe in copy the instructor, do it precisely as shown, keep with the rhythm or at pace sites seen and heard on you-tube , television or even in the gym. Most are by narcissistic fit showoffs trying to sell you something. Mostly their vanity. You can take the exercise and posture from these sites and understand which muscle groups they work to improve. That is fine. If they are good they will explain each and its purpose. There are a range of exercises called plyometrics. Guide to the 8 Best Plyometric Exercises to Try (healthline.com) Please avoid these like the plague. They are for fit, young people with supple elastic tendons and ligaments. They are “explosive” and dynamic exercises and can strain, tear or even snap ligaments and tendons. As we get older our bodies cannot respond in the same way, even I concede this.
My exercises are about managing what you have better and trying to augment that with more and better toned muscle. Don’t be alarmed at this . We are not talking extreme effort, but we must recognize that Prednisolone has a devastating wasting effect on muscle mass and therefore our strength to do anything.
Just a note on PAIN before we move on. We all use the word many times in posts and for me there are two types. The BAD or unwanted kind that comes from an injury or condition like PMR and the GOOD type that comes from sensible every day or structured exercise. Sometimes the good pain can feel bad especially when training for a specific purpose or pushing muscles to their limit in order to build beyond the present level. We are not talking that level here. Some of you may understand and have experienced this but for our needs now we will stay within our own acceptable tolerance level.
That’s the generalization and idea behind this post. Now let us examine why we need to do this.
Balance and stability. Without this you stumble, maybe fall over, snag an obstacle, start to overbalance and have to swiftly or not swiftly enough correct. You find that your limbs don’t respond as fast as the correction in your brain or your usual expectation determines. Ring any bells? I’ve had all of these and more. You can add dizzy, woozy, even disconnected, to the list but that’s a different cause from what I am going to try and help us with in this post. I think they are drug or inner ear issues with a different route. Often the same outcome but different cause and solution. I sometimes get a feeling I’m going to topple forward when descending stairs and that’s another one I’ve got to figure out. I lost hearing in the right ear ,another trigger for GCA but missed. The 8th cranial nerve if starved of blood can affect this. The inner ear is responsible for balance issues and I don’t doubt this has some relevance. I now have recovered some 60% of the hearing but the way each ear perceives and I hear is different between them so I adapt. Anyway, it all adds up to, we’re not too steady on our pins. I’m not ready for a zimmer frame just yet so why is this happening? Our basic ability to correct these stumbles and imbalances requires several things. The more mobile our joints and especially the ankles then the more leeway we have to correct. If the ankle, for example, has been pinned, as some are, then it is fixed in a forward in-line position and can only point in the direction of the shin. This limits stability and balance options. So we need exercises to free up and extend the ankles ability to rotate as far as possible. The ankle joint needs the powerful muscles and tendons in the lower leg to support, balance and drive us. So the calves, lower leg, ankle and feet are the area I want to concentrate on first. Thighs, hips and bottom for another. However, just to touch on hips for a moment it’s worth saying that the freer they are the easier it will be to adjust your stance for balance. As to knees, knobbly or otherwise they are crucial. They only operate in line forward and backwards and angle outwards courtesy of your hip rotation. Any variation on this please visit A&E quickly. They are supported and are kept tight by lateral muscles wrapped either side which you can improve. The main power in the legs essential for pushing your body weight and anything you choose to carry is in the thighs and bottom. No need to get technical or medical as this is a generalized run around what this is about. I’ll give you some names and diagrams later on which will help and inform.
MOBILITY 1 lower leg, foot to calf.
To begin, no need of illustration. Simply Stretch your legs out forward from a sitting or lying down position and rotate your feet outwards in as large a circle motion as you are able. After 2 to 3 minutes reverse the rotation and repeat. Don’t do it fast but very slow and all the time pushing the maximum possible extension through each phase of the rotation. I do about 10 minutes of this first thing when I wake and last thing at night. Any time when sitting, having a meal or just using the computer. It aids the circulation, improves muscle tone, increases rotation and exercises calf muscles.
Feet next, those things on the end of your legs. They seem a lot further away these days than when I was younger. Some of us seem able to reach them with straight legs and some of us can just about reach the ankles with finger tips and some of us reach down and look. Whatever your level it can be improved because being able to reach them means two things. We have stretched the tight hamstrings and calf muscles to give the length and we can hold our feet with comfort to help manipulate the foot and sole. You probably noticed in rotating your feet and ankles in the first exercise quite a pull on the calf muscles and also some tightening contraction at the point where you stretched the foot forward in its rotation. There will also have been contracting twinges in the foot muscles and especially the sole which is a flattish powerful muscle connecting heel to large toe. We need to address this because these muscles have tightened and contracted. Next time you do this try to exaggerate the stretch at each point you feel any tightening or resistance of the lower leg calf muscles. You may feel a small cramp beginning to form when pointing toes. Try not to pull back but stay with it. At the cusp of cramping you will find that the muscle will release itself and then allow you to continue the stretch. This way you gradually extend the range and therefore tone of the muscle. It's a good pain and the release is a plus. As you continue the rotation which brings the toes up you stretch the achilles tendon and the large calf muscle group. Use the leg muscles to do the pulling and pushing all the time trying to exert as much force as they naturally produce without augmenting the action mechanically. This is using opposing muscle groups in a push pull routine to exercise themselves with a little will power from you to make them work harder. That’s it for this session. Go to it and see if you feel an improvement.
How is it going now? Thinking of packing it in? Please don’t as the fun is only beginning.. So, let’s put these together in the next one.
MOBILITY 2 calf stretch and ankle mobility.
Something to lean on and reach out and hold is a useful prop for this. You can do it standing and extending just on your legs, but let’s do it the easy way first eh. A worktop or small cupboard will do. If the top is roughly level with your sternum it works best. A cushion/pillow to take the edge off when pushing might help. Stand at arms-length and press heel palm on top. Slide one leg back until you feel the calf muscle going taught and you can feel the first tight muscle/ligament. The other leg bend at the knee sufficient to apply stretch to the area affected by stiffness. The more you bend it the more stretch. You should feel no stretch in the bending leg/knee. It’s the extended one should be working The ligament is at the connection of the muscle to the bone and often quite tender. The muscle may also feel sore/tight. You are stretching the achilles tendon/ligament/muscle in the leg and at the ankle. The angle between the sole and your shin may be slight or very acute. It all depends how tight your muscle/ligament is and how much movement you can persuade it to make. This is a stretch, it’s a dynamic exercise and you need to extend to a level you can tolerate, just. Hold that for as long as you can bear, hopefully a minute but any amount is good provided you try and extend it. Gently slide the leg back to the other one and stand up. Repeat this for the other leg. When both legs have been stretched centrally repeat exercise but shift hips slightly sideways and you will feel the outer calf muscles tighten and register soreness/pain. Repeat for each muscle that you can feel needs stretching just as the first one.
I find this clears the lower leg partially and gives it more mobility and tone. It opens it up to assist blood flow and therefore more work/exercise than possible before. If you can hold the stretch and then slide the foot further please do and repeat the exercise as many times as you can stand if that’s what you want to concentrate on. We are all different, but this bit of the leg I feel needs more attention. You need to balance this stretch by contracting and retracting the calf muscles, so sit down on the floor with your arms slightly behind you and your torso upright making a right angle with your legs and body upright and your legs fully extended. Simply point your toes forward and hold as long as you can keeping the pressure on. Then relax, pull the toes towards you and repeat as many times as you want. You will feel the sole muscle contract to enable the toes to stretch forward and curl. It may even feel as if it wants to cramp, just as the calf muscle will. Stop at the cusp of this feeling and hold. It will pass and relax, allowing you to extend the stretch. Repeat this and relax pulling the toes back up towards you again to clear the stretch. That’s all for this one so have fun. Hips and their rotation, with some freeing up exercises next.
Still with the program?? nothing too strenuous so far eh! 
Just a quick cautionary note to avid users of website training programs. Please consider what and HOW they ask you to do any exercise. Relate it to how you feel and how you react to the extent they require you to meet their stretch, extension. TOO far is definitely TOO far. DON'T. I saw an exercise to improve ankle mobility and rotation which asked people to stand on the bottom stair, swivel the body weight back on the toes until the majority of foot was beyond the edge of the stair tread with the majority of the body's weight taken by the toes and some portion of the feet. They were then told to push their weight up on the toes and lower their weight down beyond the stair tread edge so as to improve the angle between the ankle and the shin and improve muscle strength and stretch the calf all in one. I even know of one physio who advised this exercise and gave it to a person with a pinned ankle. I'll say no more. DON'T ever do this exercise. It is dangerous and harmful to anyone and completely unnecessary. My exercise above does all that and more without risk.
MOBILITY 3 hip drop
Now, to the next exercise. It is totally passive and relaxing so I think may be popular. You need to set aside 20 minutes to 30 minutes minimum without interruption. Select some music , my favourite for this is Beethoven’s Pastoral. Sets the right tone for me. Don't worry if you drop off to sleep. Set an alarm for 20 to 30 minutes and enjoy. A good time to do this would be when you need a rest and actually often drop off. It will also help clear fluid in legs and improve circulation. This has to be done by the book though. Angles are VERY important so get a friend/partner/spouse to help set this up and know there should be no interruptions. You need to lie on your back flat rest your head in line an gently keep it in line, raise your hips at as near a right angle as humanly possible to you and angle your lower legs at a right angle to your hips. Set up some props to achieve this so you can always repeat the position precisely. It is important to set the height to match your physique especially to support the lower leg/calves. The legs must rest naturally at the correct angle and not be forced slightly up or rest down by cushions etc. It's a faff setting up the first time but easy once you've sussed it. Likewise the back, as near without cushioning save a little comfort as possible. The idea is to let the posture settle gradually and naturally into a relaxed position. After a few of these you may need to increase the height slightly at which you set the thigh length to rest the lower legs. You are now lying on the floor, hips and bottom tight against a right angle object like a box or sofa, with your lower leg resting on a hard surface at right angles to your thighs. Stretch both arms out at right angles to your shoulders, close your eyes and listen to your chosen relaxing music. That's it. Nothing else, just lie there, but in that position for the allotted time. It will gradually over a few sessions open the hips and free them to some extent allowing us to extend and improve rotation and posture, It will also help reset bad habits and relax the joints which are constantly being battered by daily chores. That is why so much time is set aside for this. It takes time to correct. Until this is done any exercises to swivel flex or whatever are simply wasted. You are trying to move something that is incorrectly aligned and contracted.
That’s it for this session so have fun relaxing. Did anyone feel any benefit from this yet? Maybe too early to tell. It's been quiet lately so I presume you all tried the exercise and fell asleep
MOBILITY 4 knees to buttock
Before we get to hip rotation we need to consider the thighs and the knees. These are the powerhouse muscles. They help lift you off the toilet, or out or the chair. You can’t squat and rise without a good set of them. Muscles of the hips and thighs | Human Anatomy and Physiology Lab (BSB 141) (lumenlearning.com)
The two most powerful which move the leg from the hip are the gluteus muscles in your bottom. More on those later. The internus I call the hip flexor the externus also. These two muscles plus the quad. femoris seriously affect your stride length. Remember this. I’ll just talk of hip flexor in exercise. Moving down we have the thigh muscles commonly referred to as quads. and hamstrings. See how they are attached to pelvis, femur and patellar(knee cap). Abductor set are inside thigh, tensor are outside thigh, quadriceps are front thigh, and hamstrings are back thigh. In exercises I’ll just say inside, outside, front, back and flexor. The front and back muscles also attach around the knee and give lateral stability to the knee joint pulling it all together. I said we wouldn’t get technical, but there’s a lot going on here and it is also wonderful to see how cleverly we are put together by nature let alone how all the instructions get down to the exact muscle to do what we need to stand let alone walk.
So, to the exercise. Start from waking in bed. Roll on front legs straight slightly apart and stretch one leg down as far as you can pulling toes up with muscles as hard as you can. Remember we are trying to make our own muscles work for us at the same time as extending the joint mobility. The muscles in the opposite buttock will contract and the calf of that leg will stretch. Reverse the push to pull and do the other leg keeping the toes pulling. You are effectively pulling and pushing your hips up and down in a prone position. Now repeat the exercise but with pointed toes again stretching the toes as hard as you can by contracting the calf muscles. This may feel like the calf is going to cramp so ease into the stretch and allow the muscle to relax a little. It will free up allowing you to do more and repeat this until you have stretched the toes as far as you can. Then repeat the hip motion leg pull push. You may also feel the muscle on the sole wanting to cramp so as with the calf ease into it. It will release. Be patient as each release allows you to push and pull a little more. This way you progressively increase your range and flexibility as you retrain your muscles to go that little extra and get used to it. Muscles have a memory and when they have been chronically affected it takes time and effort to retrain them in better ways. Now roll onto your back and pull the legs together towards your bottom pulling the soles of your feet together as far up as you can. Lie back and press the knees of both legs firmly into the mattress using only your leg muscles. Try to get them down as close to the mattress as possible. This will stretch the inside thigh and hip flexor which will help your stride length. Now roll onto your side and reach down to the ankle pulling the foot up to your bottom. Try and push the knee back so the thigh is in line with the body with the lower leg folded as tightly as you are able to the thigh. However tightly you can manage this is fine. It will stretch the front thigh. Now release the ankle and straighten the leg pulling and pushing the toes and you will release tension in the calf. Repeat for the other leg. Some of you may eventually be able to lie back with your lower legs completely folded under you and stretch back. I am just able to do that now, but I have healthy knees, I don’t have a high build-up of fluid retention and I have eased the tension and contraction in all the muscles sufficiently. It is an extreme position and not to be tried at the early stages if ever. We are looking at ways of rehabilitating joints and muscles with these exercises and a comfy way to wake the legs up and stretch before getting up. This set is now finished and you can move on.
MOBILITY 5 hip rotation
You are now ready to get up. Stand with legs apart and hands resting on hips. In an upright position push the hip right and left as far as you can but slowly We are trying to increase mobility of the joint and slow is best. Now push hips forward and sideways right and left while leaning back. Then lean forward and push bottom back and sideways right and left. Lastly combine all these actions and rotate hips in a clockwise and anticlockwise direction. This means you are moving your hips in a circular motion. Repeat in the opposite direction and the rotation exercise is now complete. The final stretches are for the outer thigh and back thigh(hamstring) muscles. Stand upright, and reach down with one hand to try and touch the knee with that hand. Don’t snatch at it but just ease the hand down the thigh. Rise slowly and repeat in the opposite direction. Repeat this until the legs feel eased. Now stand upright, reach forward and try to bend from the hips forward to touch your toes keeping your legs straight. Reach down as far as possible slowly. Hold there for 10 seconds and then rise slowly. Repeat this a few times and then relax by rotating the hips to free up the waist.
That’s it for freeing up the thigh and hip region. This combined with the hip drop should over a few weeks bring you a much freer range of motion and comfort.
The internet is overflowing with any number of ways and ever more extreme positions for doing these and other exercises. For our purposes the exercises I have outlined are more than sufficient and will achieve our purpose. I want us to find the easiest path to improvement and encourage people to give it a try. The more you can manage the better but don’t overdo it. Just try and push a little harder each time. Every little improvement is just that.
Now we are ready to put it all together into the crowning glory of homo sapiens walking.
MOBILITY 6 Walking.
That thing we do when we intentionally control loss of balance. However you do it any amount is better than none but it would be nice to use this to incorporate everything you've done so far and develop further. I was shocked to discover after the prednisone stopped my body curling up and allowing me to move again that I couldn't walk or even stand properly. I shuffled and was stooped. As the muscles freed and began working I realized they were not responding automatically as they used. The first walk was very painful and interspersed with lots of stops to rest and recover enough to walk on. Previously tireless muscles used to continuous work couldn't sustain more than 5 minutes at a time. No stamina and slow to clear the lactic acid as the blood flow to the muscles was only just beginning with their release from inflammation to function. That obviously improved daily and allowed me to extend the walking and effort a little more each day. So what did I do and how ? I made the effort to recover my stride length from shuffle to full stride and that hurt a little as the muscle sets that allow this had become shortened and very tight. These are the hip flexors on the inside of the groin. The tighter they are the shorter your stride, so it is essential to stretch these to help. The gluteus muscles in your bottom, hamstrings and quads the main ones in the thigh and the calf muscles anchored to the ankle connecting with the foot make for a potpourri of individual areas and each one objected to being made to work again. They all tired and had to be gently persuaded to work as they used to.
I'm hoping none of you are now at that stage but I suspect many of you have become conditioned to accept a poorer pattern of walking due to these limitations and muscle conditioning from the way PMR has shortened and starved the muscle of nutrition. This isn't a scientific explanation, just the way I see cause and effect. Unfortunately, to make the muscles work further and harder requires effort and a little exertion and even some "good" pain because you are making them do things they would rather not do having settled into a condition which requires little or no movement.
So, the simple answer is to try with each step to make the leg stride a little longer each day. Remembering the ankle exercises try to walk with a heel to toe action by starting each step from the heel and then pushing through the step using the toes. That's why we have been trying to improve the ankle rotation and mobility to increase the angular range for the foot. Don't worry about how fast you walk but concentrate on how long you can make each stride length. The inside leg muscles in the thigh will resist so don't jar them quickly . The slower you do it the quicker they will release a little and allow you to improve. It may take some days of effort to improve a little, but once started it improves much more rapidly as the muscles remember how they used to work. Once you have a stride length you are happy with you can gradually increase the pace of each stride. This will probably increase your pulse and make you sweat and puff a bit. It took me 4 weeks of effort to re-establish a proper walk and stride length sufficient to get me back to how I used to walk. I can now do a brisk walk for 2 kilometres each morning uphill without a break or needing to rest and recover afterwards. I have stamina as well as function.
This improvement has taken some 12 weeks in all since I have been able to shuffle slowly. Every day I do these exercises and stretches and every day there are differences. The way each leg responds differently depending on what I have been doing the day before and each twinge and stiffness makes me consider whether it is a result of my now tapering the pred. or my activities the previous day. I think we can all identify with that.
Can I ask you to give me some feedback at this stage please. I am happy to receive PM's in chat if you prefer. This is new to me as I do all these exercises and many more but have never put them to print being a natural part of what I have always tried to do. The difference is that PMR and GCA have radically affected my physical abilities and I have had to rethink everything I previously took for granted. This I see as an opportunity to correct some bad habits and improve ways to develop better routines. Please share your ideas and progress with me as I am learning too and welcome your input. We are all on a journey and I am starting this from ground up. I would appreciate any feedback to assist. Thank you.
As posted this is the last little portion of this area of concern so here goes.
I have had some feedback and need to clarify one area before the last portion of these mobility exercises. CALF stretching and ankle extension. I am most concerned ONLY with the particular exercise I saw and was told about which is standing on a stair and with toes on the tread edge lowering your weight and thus achieving a stretch which increases the angle of movement between the shin and foot. One could slip and the weight of some might put unnecessary strain on unprepared or weakened ligaments. Pushing up might excessively strain the achilles tendon and risk a tear or certainly a pulled muscle. It is a completely unnecessary specific exercise to achieve any of these things. The latter a calf riser exercise is designed to strengthen the muscle. There are safer and better ways of doing it. End of, and I hope that clarifies MY position. If you are fit toned and already doing such then these exercises are probably not what you are seeking.
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