Training errors in the athlete, part 4

Underestimating the importance of proper recovery. When it’s time to work hard in a workout or competition you need to have some gas in the tank. That tank doesn’t get filled up without good recovery techniques like full days off, active recovery days, consistent sleep, compression, nutrition quality and timing, proper hydration and muscle maintenance.

If you start every competition or workout on a half tank, guess what happens? You go half as far with half the intensity. Sometimes that's intentional and planned. But many times it's not. Then as injury and overtraining occur, you have to ask yourself, “What am I really getting out of this?” In order to feel your best, remain healthy, and perform at your best, recovery is a huge part of the equation. Don't dig yourself into a hole that you can't get out of. 

Not working hard enough to produce a strong stimulus that the body wants to adapt to. Athletes are supposed to be constantly pushing their bodies on many of their training days. That’s how you become better, right? Unfortunately it’s also how you become overtrained, injured, stale, and burned out.

This leads you to constant training at a moderate effort on “dead” muscles. Or running the same distance every day. Monotony is the straw that broke the camel’s back. For runners, yes, you need days to emphasize aerobic conditioning in easy efforts ranging from 30 minutes to 3 hours. Other days you can have interval training that emphasizes anaerobic work at a really high effort for anywhere from 30 seconds to 5 minutes. Sure there’s a place for a moderately paced tempo run of 15 to 60 minutes, but not every day.

Strength training athletes need to avoid constantly using a weight that causes failure at 10, 12 or 15 repetitions. Or always doing just one set. If you are really after a change in performance, there needs to be a training cycle where the weight is significant enough to cause failure at other points, like 8, 5, or even 3 repetitions. And other times it’s fine to do 20 repetition sets. The point is, change the stimulus.

Indoor general fitness athletes are often one of the most guilty of this mentality. Three and four times per week they bounce from one cardio machine to another, being sure to start breathing harder and break a sweat at each machine for 10 or 20 minutes. They occasionally check their heart rate and compare it to the machine’s chart. No surprise to see a heart rate of 70% of the predicted maximum. And they wonder why they never see significant fitness changes.

Then there are the athletes that push a little harder but it’s just to that 85% level, which definitely hurts more. But then they struggle to sustain it as one steady effort for longer than 10 minutes (because it hurts) at which point the effort drops a notch. Meanwhile, other people in the gym are barely working at all.

In any sport, the key is variety. Variety in intensity, duration, training surface, speed, force produced, and direction of movement. Yes, you want adaptation to a consistent stimulus for a while but then you have to change that stimulus to continue making gains. 

Ignoring injuries when you first begin to have symptoms. Some injuries classically only hurt at certain times in their formation. That doesn’t mean they aren’t a problem. It doesn’t have to hurt all of the time to be a problem. Don't ignore it. Never ignore it. Yes, you can try to treat it yourself for a little while. That really might work.

But please make your life and my life easier by just coming to Physical Therapy within a couple weeks of the problem onset, even if it’s just for a consultation. If you don’t like what I have to say about it then seek another opinion. Regardless, if you intervene early, and start the right treatments, your recovery time is going to be drastically different.

For instance, if I see someone with back pain from a sacroiliac joint sprain in the same week they are injured, then they often recover in well under a week. If the sacroiliac joint has been a problem for 2 months and had no proper treatment, then buckle up for at least a month of consistent work. #getPT1st

Training errors in the athlete, part 1

Which of these are you guilty of performing?

Specializing in a sport and being entirely unwilling to deviate: Variety is critical for injury prevention, mental outlook, and general health. Unless you are a triathlete, pentathlete, or decathlete, you might find yourself unwilling to stray from the single sport you know. First off, you should strength train. Strength training is no longer an option; it is a requirement. Crosstrain before you get hurt (and you might not get hurt in the first place). Try something that is non-competitive and don’t turn it into a competition. (Yes, that’s probably hard.) Take a yoga class. Play pickup basketball with a couple friends or just shoot around. Try swimming. Just do something that is very different than your normal and do it often. This is especially true for young athletes who aren’t finished maturing. Research suggests that athletes who didn’t specialize at a young age can perform better as long as they were performing some form of athletics. The key for all of us is simply being an athlete.

Assuming your skills and technique don’t need further work: Skill work is primarily about training your nervous system to use a specific pattern. A good overall athlete has more options for movement patterns. Some patterns are highly ingrained and some are not. You want instinctive patterns to be close to an ideal. That way, when fatigue occurs you still demonstrate precision and efficiency. Every athlete could improve their performance with at least weekly emphasis on movement drills, strengthening specific motions, increasing muscle power output, and basically fine-tuning they way the nervous system creates each sports-specific motion. Regardless of sport, there’s room for greater efficiency and adding skills to your repertoire. Even running, which some people assume is innate, is a skill that should be broken into components for drill work. 

Training alone all the time: Sure, you are probably mentally tougher than the average bear, but this problem allows you to slack off occasionally when there’s no one there to push you. Which means you drop into the dreaded moderate efforts that lead to “dead” muscles, overtraining, and slower than optimal nervous system patterns. My motto is “there’s always someone faster and stronger.” Go train with that person at least once a week. A coach could assume part of the role of a training partner, so I’ll give that half an exception.

Footwork Friday - Why am I developing black toenails?

Many runners develop black toenails, especially after longer runs. This is a very specific type of bruising known as a "subungual hematoma." It has often been believed that this is caused by the shoe's toe box size restricting the toes to so much that direct trauma and bruising develops. This isn't always the case, and The Gait Guys suggest that there is another cause in one of their older blog posts.

Many runners tend to curl their toes downward in an effort to grip the inner surface of their shoe. In addition to black toenails, another sign of this habit is the presence of a callus on the very tip of the toe. Curling your toes downward requires heavy use of the flexor digitorum longus and/or flexor hallucis longus muscles. Using these muscles is a way to gain stability within the shoe, but it is not a good habit. Regardless of the presence of black toenails, this should be avoided because these muscles are not built to produce larger amounts of power or engage in constant stability control.

The area under a toenail has a large blood vessel supply close to the nail bed, so bruising occurs more easily with any vessel damage. Gripping downward combined with a small forward/backward movement of the shoe causes a shearing force through the skin and fatty tissue of the toes. That repetitive pressure with this shearing force against the insole is thought to be enough trauma to disrupt the blood vessels. The solution? Don't grip the shoe with your toes.

Shorter runs usually aren't enough repetition to harm the vessels, but longer runs will. Especially as we fatigue we  rely more heavily on muscles that aren't fatigued as much during shorter runs. Trail running could cause a greater problem because the trail surfaces are unstable and the runner will more frequently seek stability by gripping with the toes. Also, there is a greater likelihood of steeper inclines and declines that will cause more sheer force of the foot against the insole.

Although there isn't existing research to back up this idea yet, it makes good sense. Next time you are running, think about what your toes are doing. If you are gripping the inside of your shoe then STOP IT!

Let me know if you have any questions at mountainridgept@gmail.com. 

Balance and proprioception: overlooked training for runners and athletes with knee pain and other leg overuse injuries

After reading the title you’re probably wondering a few different things:

1. “What does balance have to do with being a good athlete?”
2. “What the heck is proprioception?”
3. “What’s for lunch today?”

These issues come up time and time again when I work with injured athletes from many different sports. I’ll address the first two questions and you are on your own for that last one.

Let’s review some anatomy first. There are specialized nerves in your joints, ligaments, muscles and tendons that help sense position and movement of your body. That sense is referred to as proprioception. Without these and other specialized nervous system parts you couldn’t close your eyes and know how your body is positioned at any instant. And you couldn’t stand up or walk in a stable manner. Clearly you don’t absolutely need vision to know where your body is or you would be watching your feet while you walk or run, right? By sensing position, these special nerves are also part of what keeps us stable so we aren’t just stumbling around like a drunk college student on Friday night. But many of us, even some of the best athletes, have poor proprioceptive awareness. For so many of us these proprioceptive pathways aren’t challenged often, and then the “use it or lose it” principle kicks in. Especially as we age, we begin to lose the efficiency of these specialized nerves. As these nerves degrade we can’t precisely place each leg with athletic movement. This decreased precision leads to poorer biomechanics that can be related to overuse injuries. Also, a previous or current sprain at the knee or ankle ligaments will negatively impact your positional awareness and movement precision because of the damage that a sprain will do to these special nerve endings. All in all, aging, previous injury and a lack of training stimuli are going to degrade the quality of your movement precision.

Do you think you have good balance and stability? Let’s find out in a couple simple steps. Try these in your bare feet.

1. Stand on one leg as long as you can without touching anything and count slowly. How many seconds can you last on each one? Less than 30 seconds? In that case you’ve got a lot of hard work to do. More than 30 seconds? Well that’s a good start but we’re only getting started.
2. Now stand on one leg as long as you can with your eyes closed. I bet most of you aren’t going to brag about this one. If you don’t make it to 30 seconds on one leg with your eyes closed then there’s likely to be some room for improvement in this aspect of your training.
3. If you have some kind of superhero balance, try standing on one leg, keeping the eyes closed and tilt your head backward or turn your head to each side. This is really hard and will likely stop all but the best balancers.

So what are you doing to train this aspect of your abilities? I imagine several folks are going to say “nothing” because they didn’t know it was important. For what is essentially very little effort, I’d suggest working on your balance, stability, and proprioception to improve your running and prevent injury. Here are a couple ideas to address this area:

1. Stand on one leg with your eyes closed. Sound familiar? If you are able to stand steadily on one leg with your eyes closed on a flat floor then stand on an unstable surface like a folded towel or pillow with your  eyes closed. Or, you could try moving your head as mentioned earlier. Aim for 30 seconds of the most difficult, but achievable, level. Switch sides.
2. Single leg Russian dead lift. One of my favorite exercises. In a standing position pivot your trunk forward from the hip of the weight-bearing leg. The other leg raises up behind you for every same degree the trunk goes downward. Don’t round your back. Repeat 8-15 times until the hamstrings and buttock muscles tire. Switch sides. You can do this with and without weight. 
3. Single leg step down. Stand on a single leg on the edge of a step. Drop down very slightly by bending the weight-bearing leg, keeping your weight back on your heel. Return to the start position. Don’t let your bending knee travel too far forward beyond the front of your foot. Think about keeping your buttock back. Repeat 8-15 times, at least until your hip muscles and quadriceps are getting tired. Switch sides. You can also do this with and without weight. 

Let me know how you do with these activities at mountainridgept@gmail.com. Easy? Hard? These skills become particularly important for runners and other athletes with overuse related knee pain, ankle pain and foot pain.

Footwork Friday - Runner's bump

I thought I would throw this one out there since it's recently affected my running on a small level. A couple weeks ago I noticed I was developing a small bump at the base of my anterior tibialis tendon after a long run. Getting old is such a great thing isn't it?! It hasn't really been painful but the bump will snap up and down if I have my shoes laced tightly. It's a synovial sheath irritation in the slick layer that allows the tendon to glide smoothly. 

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Runner's Bump

Ultimately, excess lacing tightness is what caused the bump to form. I have a habit of really cinching down on my shoe laces and this caused some increased stress on this area. Now, if I was to over-tighten the laces, it would cause the little bump to snap up and down under the laces and eventually swell even larger. So that's clearly not ideal. The repetitive snapping is annoying and might become painful with enough exposure. I'm not waiting to find out. Another factor that could contribute is frequent uphill running because it would cause you to increase the use of the anterior tibialis muscle and tendon, close the ankle joint up further and increase the friction across the front of the tendon against the shoe. My right foot collapses inward slightly more so the tendon may experience slightly more stress from that as well. 

As a result I've done a slight modification to my lacing pattern to relieve the area of its pressure. By changing the lacing pattern the bumped area reduced significantly in swelling and overall size. Applying ice is another good measure to help decrease localized swelling and pain. 

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These types of bumps will also sometimes occur at the Achilles tendon from the heel cup of the shoe rubbing the tendon repetitively. In any case you could modify the shoe by cutting out a small portion of the heel material that is rubbing or get into another pair of shoes that doesn't stress the area. 

Please let me know if you have any questions about shoe lacing patterns or tendons forming mysterious bumps at mountainridgept@gmail.com. 

Footwork Friday - Basic Lateral Agility Drills

Welcome to Footwork Friday where we introduce agility drills, strengthening, and muscle care techniques for the athlete who understands how important their feet and legs are in carrying them through to the next step in their active lifestyle. 

Runners and many other athletes don't get enough lateral movement in their training. This is why we tend to weaken in side-to-side movements and we also tend to become injured because of instabilities side-to-side. Even in an uninjured state, learning to stabilize the body to prevent lateral movement can be very useful to move quickly and safely across unstable surfaces like rocks, roots, grass and mud. As far as pure performance is concerned, increased lateral movement is an energy waste when you are trying to move quickly forward.

The agility efforts do not need to be long. The technique just needs to be as accurate as possible. Like I've shown in the videos, a 10-15 yard section is plenty long enough. Go through each drill 2-4 times. For any agility drill I recommend fully recovering between efforts because you are ultimately trying to train your nervous system, not your heart or lungs.

Initially, for the first drill, focus on keeping the contact light and not crossing one leg over the other. Strive for keeping the body tall. As you learn what it feels like to "stick" the outer leg, try to make sure your knee is staying straight over top of your foot. In other words, the knee doesn't bow inward or outward. It does need to be bent for a soft landing though. This is commonly done with an agility ladder but I prefer to do them in the middle of a short and easy run or a moderate distance run to keep the right muscles awake. As you get faster you can focus on lowering your body closer to the ground. 

For the second drill focus again on light and quick contact with the ground. Emphasize keeping your stance wide and pumping the arms directly forward and backward. I like to do this in the middle of my runs as well. Just be careful because it will skyrocket your heart rate and effort levels very quickly.

Have fun and let me know if you have any questions at mountainridgept@gmail.com