The Blog

Are you running with a limitation? The four most important places to have mobility for a runner. Part 3

We all like to think that if we train more or harder we will get faster and running will feel more effortless. For some that may be the case , but for the masses it may feel like you have to work hard all the time.. Maybe you are working too hard and muscling through your workouts , receiving some rewards for your work, but not quite what you expected….

In my last 2 blogs we looked at the topics of posture, core strength and tissue mobility.

Now we must look at flexibility in the joints and the muscles . How much range of motion is needed to run efficiently?

One of the biggest concerns in the runners I treat is the idea that they think they are not flexible enough and they show me this by demonstrating their inability to touch the ground when standing and bending forward. The real problem I see in most runners is the inflexibility at the hips not the hamstrings. Yes you do need at least 70 degrees of flexibility at the hamstrings to run efficiently , but most runners have this.

We live in a society that sits for large portions of the day for work ; computers, phones, driving , eating and social entertainment . What happens is we put our tissues / joints in positions that start to adapt? This adaptation produces limitations in our ability to extend our hips. In running, this is a very important movement . When we run, one leg is moving forward while the other is behind. If there is not adequate range of motion there will be some compensation in the body to make that movement happen This compensation may go on for quite some time as the miles increase and the intensity of training increases. After thousands of repetitive movements in this dysfunctional pattern in the kinetic chain, the body breaks down and pain / injury presents. Where the injury or pain exists will most likely not be the source of that problem , it will be the symptom of it.

In my profession I see a lot of runners that continually chase pain , never getting to the source of the problem which is the compensation due to inadequate range of motion in a joint. The following is a way for you to test yourself and fix the four areas that are imperative to have enough range of motion when running.

1) How to test your hip extension

The testing position is the correction for lack of hip extension. Studies show that if you are lacking hip extension stretching must be done daily with holding 3 minutes to achieve a length in these tissues. This will most likely take weeks to get that range of motion back . The payoff for having this flexibility is great! not only will you have the range of motion essential for running , but you will much less likely break down along the kinetic chain ( your body).

Another positive thing is that in this stretching position you can easily multitask: text message, email or talk on the phone at your desk. Most people are on the phone for at least 10 minutes at a time ; Plenty of time to get that stretch in..

2) The next important area is the big toe. Your big toe provides 85% of your stability when running. Without adequate extension in the big toe, the body can not move forward efficiently. One of the ways to improve this mobility is to also improve the mobility of the plantar fascia .

In the first video you will see it done manually and in the second one you will see how to do it with a mobilization ball.

3) The third area is the ankle . Having enough dorsiflexion allows the body to move forward over the ankle efficiently. Here is a way to test that mobility and to correct the deficit and to test the great toe mobility as well:

4) The fourth area is the thoracic spine . We as a society spend a lot of time sitting : whether it be driving or at a computer. Our common sitting postures lead us to dysfunctional positions that hinder our mobility at the spine . This is where the foam roller comes into play . Try this exercise to get your back moving . Don’t be concerned if you feel a crack – consider it a free adjustment (don’t tell my husband I said this – He is a chiropractor )

There you have it : a way to check the major areas in the body that are essential to have when running .

Runners really need more than just running to keep a healthy, efficient body. Running puts a lot of force on the body ( 2-3 times one’s body weight, depending on their running form) It is important to assess these areas as well as core strength needed in part 2 of my blog. You are putting money in the bank as you become more efficient and stronger. The pay off is getting to the finish line without your body breaking down. I wish you all well in training and racing !

Run on!

Cathy Parbst-Accurso PT, CKTP

October 23, 2013 0 Comments

Injuries in Runners / Triathletes : Normal? Part 2: Posture And Strength

Are you strong enough for your sport? How to test it and why posture matters.

A very common phrase among athletes and athletic people is “core strength”.  What does that really mean? Does it mean to have ripped abs and buns of steel? A true definition of core strength is the strength of the underlying muscles of the torso which help determine posture. I like a definition I read recently from a cross-fit site that said it was midline stability during functional movements.

How your body performs when running has more to do with the posture you keep during the day than how strong your abs are or how many crunches you can do .  Your stabilizing muscles that control your form when running actually “turn on” milliseconds before you even start your activity. Athletes that sit all day at a desk or keep poor postural positions run into serious problems that they wont relate to their reocurring injuries. Their spinal stabilizers become inhibited and their muscles fire too late and don’t stabilize when they are needed . So here is the case where you can have a 6 pack and you may be a crossfit king, but if your muscles that are key stabilizers around the spine fire too late, your foundation will not be supported as needed and your body will compensate by having your extremities do the work. This leads to Injury.

In this case an athlete will have injuries ” pop up” in different areas and is forever “chasing pain” by trying to rub it out, stretch it, inject it or medicate it.  Sound familiar? Instead of chasing pain, find the source of the problem. In part 1 in this series we spoke about self mobilizations and how to find those spots before they become a problem.  This blog will focus on evaluating your stability and posture, and will show you some simple tests you can perform to see if you have what it takes to stay injury free. ( click onto link to view pictures of self tests)

Posture:  What postures do you keep most of the day? do you sit at a desk? stand?

If you sit at a desk most of the day, have a college/friend take a side view picture of yourself after you have been sitting awhile and not trying to correct any bad form. You should be sitting on your “sit” bones and not your sacrum. Your hips, shoulders and ears should be in alignment.  Your head should not be way in front of your shoulders.  When sitting, do you cross your legs the same way all the time or sit cross-legged for long periods?   Is your weight more on one hip than the other? Now of course you may slump and change position from time to time.  The rule is 80% in good/better postures and 20% in non ideal postures.  If you stand : Do you typically keep your weight on one leg as a habit?  keeping postures for long amounts of time( greater than 20 minutes) and doing this frequently lead to imbalances that effect your training and performance for the reasons stated in paragraph 2. Becoming more aware of your posture and making these little corrections can be huge! Just take a day and do an internal assessment of what you feel and see in your posture. Awareness is the key!
Do you have an imbalance in strength ? Test yourself

Core Strength pictures Part 2

1) Single leg squats: Stand on one leg and watch yourself in a full length mirror. Keeping your hands on your hips , slowly perform a single leg squat. Does your knee plunge inward? does your trunk shift to one side to keep your balance? Does your pelvis drop and not stay level with the other side, or do you just not have the strength to lower yourself slowly on that leg? These are all signs of an instability and you can be sure that your body will compensate one way or another when you are running. It’s just an injury waiting to happen.
2) Side plank : left vs. Right. Come into a side plank position keeping good form. Hips and shoulders stacked, head in alignment with body and arm perpendicular to the ground. Is one side stronger? – Can you hold one side longer? Can you at least hold for 30 seconds?
3) Bridge with single leg lifts: Lying on your back with your feet hip distance apart and knees bent. Lift your buttock without using your back. Once in a bridge position keep your hips level and bend one knee up towards the chest. (Is this difficult already?) Slowly lift and lower your hips ( remember to keep the hips level) on one leg. You should feel this in your glutes. The goal is 3×10 each side. Notice if one side is stronger than the other .
4) Single leg balance in bare feet: Standing on one leg , get your balance. Can you hold that position for 30 seconds?  Now close your eyes. Can you at least keep your balance for 20 seconds?  Compare it to the other leg. You can easily work on this by standing on one leg at all different times during the day : brushing teeth , doing dishes etc…Get a tennis ball and stand on one foot and throw the ball against the wall and catch it . Or have someone throw the ball to you and challenge your balance.

5) Quadruped single leg lifts: Get into a quadruped ( on hands and knees) position. Make sure your arms and legs are perpendicular to the ground. Place a 3- 4 foot pole across your back to balance it. Keep this pole still and reach one leg back and slightly to the side. Rocking your body or the pole means you are lacking stability. make sure that the leg that is on the ground is perpendicular to the floor. goal is 50 reps for each leg.

These are all simple tests to see if you have any imbalances that can lead to an injury or prevent you from peak performance. If you have found your weaknesses, what do you do? If you try to perform the very tests you failed as exercises you may run the risk of reinforcing poor form because you lack the strength . You must start with exercises that are less challenging and don’t let your body cheat.

This is where an experienced physical therapist that knows how to treat runners can help. A good assessment and video of your running mechanics and functional movements can make the difference in treating the source of your problem or just fixing the pain. Fixing pain is always short-term , which will return in a different place in your body because the real source comes from a compensation that is never where the pain is.

A full evaluation of your posture using an Egoscue approach is imperative to identify the postures that prevent peak performance and lead to injuries. The Egoscue approach looks at posture and functional movement patterns and gives a daily menu of exercises to take you out of your postural dysfunctions.The truth is that we are all getting older and gravity is always working on us . We need specific exercises that counteract all the dysfunctional positions and movements we do throughout the day. This treats the source of all injuries.

Want to take your race results up a notch or just not have all these injuries pop up during training? Take some time to perform these tests and improve your postural awareness.

Happy Training 🙂

Cathy Accurso PT, CKTP, certified Rock Doc

Injuries in Runners and Triathletes: Normal vs.Common- Part 1: Self Mobilization

I will be writing monthly blogs that I hope will stimulate some questions and offer answers for you in your goals to be a better athlete- and to be injury free. 

Question:  “Is it normal to experience injuries such as ITB pain, plantar fasciitis, knee pain etc? 

AnswerNot normal, but very common.  82% of runners get injured, and one study even notes that there is a 90% injury rate among triathletes.  “Overuse Injuries in Ultraendurance Triathletes,” American Journal of Sports Medicine, Vol. 17, pp. 514-518. I am going to help dispel that Myth and give you the secrets on how to avoid the common injuries that athletes seem to  “get “.

Much of what I am writing about can be found in Jay Dicharry’s book “Anatomy for Runners” A must for any runner – great gift for your favorite runner. Jay is a PT and  educator in the treatment and prevention of running injuries.  His book offers great ways to “treat yourself into better performance” and prevention of injuries. Like myself he has been evaluating and treating runners and has seen these problems as common and preventable.

First off , we know that once there is pain somewhere you want to find out what is causing it. The problem is that almost all injuries of overuse start way before the pain starts….Some of you may say : “But My pain started the day I did my long run on Saturday”.   Yes, that is when you first felt pain, but the problem existed way before that.. In other words, the true source of the problem started much sooner than the symptom of pain.. Hmmm… To find the source can be tricky.  The reality is that it is very difficult to diagnose yourself. Trust me, I treat runners for a living and have raced competitively on a professional level and have had my share of injuries until I started to look and evaluate at a deeper level.  So , how do you find the source?

The time is now  to start to uncover some of those sources before you body starts to break down. (it is never just one thing ) When you can clean up the sources to the pain you can avoid chasing pain every time you start training for a new race. Wouldn’t it be nice to have no pain through your whole training leading up to your next race?  If you are already in this category –I congratulate you . If you do this with heavy doses of Ibuprofen, it may be time to re-think.. Research is now showing us that taking such drugs not only masks the pain but  actually slows down the healing, taking it longer to recover fully from an injury .

 Uncovering the first source : Over worked soft tissues that are not given a chance to heal and scar down.  This month we will look into soft tissue restrictions that lead to injury and how to self mobilize to prevent injury.   self mobilzation pictures part 1   (click onto to view self mobilization techniques)

Why should you self mobilize?  The training of endurance athletes will always lead to soft tissue adhesions from scarring . Training breaks down the body and it takes 11-14 days for the contractile proteins to fully repair the damage. . Most all of you work out more than once every 11-14 days . This means that the training you do day after day , week after week builds up scar tissue ( some of us call it fascia restrictions)  This poor healing leads to poor mobility that then leads to injury and poor recovery and performance.

self mobilzation pictures part 1

Where & How to self mobilize- Self mobilization techniques have been uses for years such as Graston, ART, ASTYM,. The name doesn’t matter – The goal does: Break up that scarred down tissue.  Jay states in his book “Periodic self-Assessment of your body is critical and your responsibility as an athlete. “  And like Jay I agree that if you catch these little issues early , you can prevent them before it turns into an injury.   I call it Scanning your body for those areas of restriction .  When done on a regular basis you can prevent minor problems turning into chronic ones .

The key is to not wait until an area is painful. Find something that is sore or feels “lumpy and stiff” and work it out. Attached are pictures to help guide you.

 Many people use a Lacrosse ball. I have a ball in my office that has nubbies on it that I like and is not as hard.  In some cases you need to just use your hands. ( see attachments ) Remember –running puts a lot of cumulative stress on the body and the body is going to lay down scar tissue to heal it.

There are 3 ways to mobilize an area:

1) Rolling along the muscle fibers -make sure you address the whole muscle

2) Transverse rolling perpendicular to the muscle –

3) Trigger point release: direct pressure for 90 seconds.

  Shin splints are a common complaint in runners .Try the self mobilization technique for this area –find a sore spot? I bet you did! This is one of the areas that gets over worked.  Compressing parts of the body should not be painful!  If it is then It needs work!

So get to work! Next post will be finding source 2 : inadequate stability / strength – Don’t miss it!

Run On !

Cathy Parbst-Accurso PT, CKTP