Are you bonking?

Anyone who exercises for an extended period is at the mercy of their stored energy and blood sugar levels. Glucose is the basic sugar circulating in the bloodstream and it is well controlled within a specific range for a healthy person. Stored sugar, glycogen, from your liver and muscles, can be used to keep the blood glucose regulated.

If your blood sugar decreases to lower levels during prolonged activity and can’t be stabilized, your brain will prioritize itself over anything else because glucose is its primary fuel source. This means working muscles are not exactly high on the list. You are in the process of bonking, otherwise known as non-diabetic hypoglycemia or exercise-induced hypoglycemia.

Risk of bonking increases with the following:

1. Longer duration of exercise
2. Higher exercise intensity
3. Exercise in a hot environment
4. Insufficient calorie intake during the day of exercise
5. Chronically insufficient calorie intake over a period of days
6. Insufficient recovery time from a prior bout of exercise or multiple days of exercise as it takes nearly a day to restore glycogen after it has been used (in ideal conditions)
7. Another recent episode of bonking
8. Dehydration
9. Limited prior exposure to depleting exercise
10. Athlete inexperience

Athletes are not always aware of the signs and symptoms of bonking until they become more dramatic. Some symptoms of the blood sugar drop are mental and others are physical. The initial cues can be subtle but the symptoms can progress to more severe levels rapidly. Many marathoners know this as the feeling of “hitting a wall” around mile 18 to 20.

When bonking, pace per mile might initially change by something small, like 15 or 20 seconds. But if the effort continues and no calories are consumed, you could easily slow by 1-5 minutes per mile or even more.

I’ve known many hard-working, well-trained marathoners that train months for an “A” race, doing tons of distance and maybe even trained up to 23-26 miles. They feel strong but depleted at the end of those long training runs but they train more slowly than they race. So by running faster in the actual race they burn through their energy stores sooner and completely crash despite decreasing mileage for several days in advance of the marathon. That’s tons of training wasted because they refused to learn to eat a little something in the marathon.

Bonking happens around the same point for most people because we all store similar amounts of glycogen that are used up at similar rates. It’s possible that years of training could allow someone to burn a greater percentage of fat for energy, but harder efforts always require higher glycogen dependence. And having run for just a couple years isn’t long enough to perfect a fat burning metabolism.

The signs and symptoms of declining blood sugar, in a general classification order of increasing severity:

Your job is to detect symptoms as soon as possible in order to keep your state from declining further. Ignoring the symptoms and hoping for the best is never going to end well. If you have signs and symptoms consistent with the green items, there’s a good chance you can pull things back together if you take appropriate action, though it won’t be a day of personal best performances.

A few experienced and lucky athletes might be able to come back quickly from the yellow zone but nobody is bouncing back from the red zone. Only the more stubborn people will even push themselves far into the yellow zone. It’s a super dangerous, slippery slope. Don’t do it. You can’t win against physiology.

Many people don’t have the motivation to put themselves deep into the pain cave, so they just automatically slow down in order to feel better when they feel uncomfortable and have persistent negative thoughts. Kudos to you for not being a ridiculously stubborn fool like some of us!

Simply slowing down may be sufficient to finish out the workout or competition. If you don’t want to slow down, then you need to eat something containing carbohydrates as soon as possible. Ideally this would be something with simple and complex carbohydrates. There are receptors in your mouth that detect sugars and just the act of eating can immediately reduce the brain’s stronghold on protecting you… from you.

But there’s a good chance that you need to slow down AND eat something, depending on how long you are planning to exercise. If you are bonking after 90 minutes and planned to be active for 3-4 hours then it’s going to be unreasonable to sustain the same effort without eating many more calories.  

Three truths about bonking:

1. You have to learn to eat during prolonged activity, even though you often won’t feel like eating, or the bonk will occur.
2. If you don’t eat and your intention is to maintain both a high intensity and a prolonged duration of greater than 2 hours, the bonk will occur.
3. Bonking is completely preventable.

Thanks for reading! Please let me know if you have any questions at derek@mountainridgept.com.

Sunday Q and A

I recently had the pleasure of meeting with a few parents and students on the Mountaineer Middle School cross country team as they were getting ready to start their season. I wanted to touch upon a couple questions that were asked because I imagine multiple people, of any age, can gain value from the answers.

Question #1

One runner asked if there was anything he can do to change the fact that his legs become tired far before his breathing or heart feel fatigued during a race. This typically occurs for him halfway through, but then about 75% of the way in, he is able to overcome the leg fatigue to finish strong. This was especially problematic for him on flat courses.

First off, I expect this to occur to some extent, especially in a younger, less-trained, or less-experienced group of runners. It’s common to feel good and be excited, so you barrel off the line. It happens to everyone from ultra-marathoners all the way down to 400-meter runners. Let’s say we apply an old coaching philosophy: run the first one-third with your head (smarts), the second one-third with the legs (fitness), and the final one-third with your heart (desire).

Sounds like this young man has the final portion down but there’s a good chance his first one-third is faster than ideal. Young runners are notorious for going out too hard, which makes the later stages of the race more uncomfortable. One problem is that in a cross country race these kids almost always have to do this because the area available to run shrinks down to a narrow path where real estate is at a premium.

So let’s just leave the “going out too hard” concept alone for now, because it’s not a road race where you can easily pass people. This student has to go a little harder than ideal in order to be competitive in a 3K race. In order to get through that middle one-third, there will be discomfort, but it’s the point where the person with the most fitness will excel because he can recover on the move from the slightly too quick first third. Plus, there is research at the 5K distance to show that starting out 3-6% faster than average total race pace results in faster overall times. (http://www.ncbi.nlm.nih.gov/pubmed/17149992)

I suggested that this young man focus on his cadence just prior to the point where he feels the leg fatigue. As we fatigue, our cadence tends to slow down. There’s a good chance he ran the first one-quarter to one-half mile with a quicker cadence but then settles into a longer, more loping stride. At the same time, the pace drops a bit. To take some of the stress off of the painful quadriceps and calf muscles you can decrease your stride length and increase your turnover.

One good thing is that cross country around this region generally means terrain changes. Hill climbs are the perfect time to increase cadence. This is easily achieved by pumping the arms more quickly. The legs and arms will always be in sync. If you think about increasing speed of arm movement, the legs must follow. The steeper the incline, the shorter your stride should become. A single leg turnover of 96 per minute going up super steep hills wouldn’t be crazy. A gradual incline might demand something in the range of 88-94 foot strikes per minute.

Even on a flat course you can make the conscious choice to fluctuate your cadence. It’s a nice distraction, if nothing else. Hopefully it is done in a preventative manner prior to the leg muscles feeling highly fatigued, but better late than never. A flat cadence could be more like 84-90 per minute. On downhills it could easily drop into the upper 70s.

One key to all of this is to experiment and train with the cadence fluctuations. It’s not going to come naturally in a race if you’ve never done it before. Instead, it’s just another burden to add stress and you might just forget to do it. Plus you are more likely to waste energy if it’s extremely new. Your nervous system has to practice the quicker turnover in order to make it efficient.

The more recent GPS training watches, like the Garmin Forerunner series, have a cadence measure. It’s worth paying attention to this number while running. And if you upload the data onto the Garmin Connect website or other training sites, you can see where the cadence tended to slow down or speed up during training or racing. It wouldn’t be surprising to see the turnover slow just as the point of heavy leg muscle fatigue approached.

Here’s a fun little experiment. Go find your favorite hill for repeats. Something at least 100 yards long and hopefully more gradual. Run it hard once with your normal turnover rate. Run it again while trying to maintain the same pace but while really trying to stretch your stride out extra long with a slow turnover. Do it a third time while focusing on a super quick turnover, again maintaining the same pace. Now there’s going to be some fatigue by that point, no doubt, but can you feel the difference in the demands that it places on your body?

Question #2

One parent wanted to know if their child needed to drink a sports drink before their cross country meets. Not that I have a perfect diet, but I’m not a big fan of mainstream sports drinks in the first place because they are often loaded with tons of processed simple sugars.

In shorter races like the 3K or 5K, the runner is primarily relying on stored energy, glycogen, within the muscle fibers. For a short event there should be plenty of that stored glycogen available unless you haven’t eaten for several hours or maybe you exercised really hard in the 1-2 days prior.

Some sports drink sugars, like fructose, are known to cause stomach upset if consumed before, during, or after exercise. That’s not very conducive to performance (or a pleasant child, for that matter.)

A snack or lunch two to three hours prior to the event should be sufficient for topping off the calories needed to get through these shorter events. Drinking water after that point is plenty sufficient.

I’ve seen parents “grasping at straws” when their child has succeeded in the main season and is headed to a big event, like a state meet. Instead of sticking to the same nutritional plan that the runner had used all season, the well-meaning parent has their child drink some new mysterious sports drink 15 minutes before their race. Maybe the runner tolerates it. Maybe they don’t and fail miserably. That’s the equivalent of playing with fire in my mind. Go with what has worked in the past.

The one instance where I can think a sports drink might be appropriate is if the runner had missed their lunch or breakfast for some reason. And that should not be happening. Plus, the runner has hopefully tried the same sports drink on an earlier occasion. It might be smarter to have the individual carry an emergency “real food” snack. That’s a good idea anyway because you should avoid becoming hungry on race day.

Do you have any questions about training, racing, recovery, or injuries? If you do, shoot me an email at derek@mountainridgept.com and you might get to see the answer in a future blog post.

Three common overuse injury mistakes you are making and how to avoid them

Using the “wait and see” method:

There are two ways to go wrong with the “wait and see” method. In the first, an athlete, believing “rest” is the critical factor in injury recovery, takes a large amount of time off after the initial onset of pain. When they do finally return to activity, having had no pain for a day or two, they often start out with way too much intensity or time. If you haven’t run in 2 weeks, then the first run back should not be a 5-mile excursion. In fact, it should be quite brief. And of course, instead of running an easy 10-minute mile pace, your legs are fresh, so 7- or 8-minute miles seem suddenly more comfortable than ever.

Few people ever follow this advice because there is a misconception that rest fixes all. (Same assumption goes for surgery fixing everything, but that’s another story.) And then the athlete can’t figure out why the injury came back a couple weeks later. Of course that recurrence is followed by yet another solid block of rest and the cycle of inconsistency continues. The body WANTS to heal. I find that to be pretty amazing. The key is providing consistent exercise loading to not only maintain fitness but to improve tissue integrity.

Don’t get me wrong. Rest is extremely important in recovery from training and from injury. But it should all be administered in appropriate doses. If you know, deep down, that rest is powerful then you should be doing a better job of resting prior to any symptom onset, not waiting until something hurts. Rest should never be considered as the primary method to address injury.

In the second scenario, the athlete ignores their initial injury symptoms and continues to exercise, waiting for the injury to spontaneously resolve. This can stack too much stress onto an already injured area. It’s often easy to do with running, because so many muscle and tendon injuries actually feel better once the tissues have warmed up a bit. That’s why overuse injuries are so deceiving. If the pain is gone while exercising, you must be doing okay, right? Well, no, it’s not that easy.

If we were to classify the onset of pain from overuse injury, there’s typically a progression:

1. Pain only after exercise.

2. Pain during exercise, though not at a high enough level to stop.

3. Pain during exercise that does limit time or performance.

4. Pain so severe you absolutely cannot exercise.

Athletes often become stuck at the second phase. Sometimes for months at a time. When they approach the third phase, they suddenly become desperate and finally begin addressing the things they knew were problems in the first place. Don’t be “that guy.”

Consider yourself only as good as your last successful, pain free run. Best not to worry about progressing when injured if you want a long career. Best to worry about preventing regression and working on your known problem areas, like hip strength or ankle range of motion. If you don’t know where your problem areas are, seek guidance from a movement expert.

Relying on pills and injections:

Everybody loves a “quick fix.” Some like it because it requires no real effort or time to take a pill. Others like it because it might reliably take pain away and they are unaware of any other treatment option. For some people, they feel they don’t have time for proper injury treatment. In any case, once the pain decreases you expect to go on about your training as soon as possible without any other care.

But think about this for a moment. If a mechanical stress led to your painful tissue damage, then there’s good reason to focus on a mechanical solution when there is one available. Medicines aren’t typically designed to alter mechanical stress. Let’s say the medication did stop the pain. Just because the pain stopped doesn’t mean the underlying problem went away.

Unfortunately, rarely is the proper solution a quick one. Pills and injections are not a reasonable long-term solution. Just like appropriate doses of rest, NSAIDs and corticosteroid injections certainly have a place in treatment. But they are not a valid long-term option for relief of overuse damage.  

Blaming the shoes:

I am guessing the shoe industry is at fault for this perception. It’s not about the shoes. Overuse injuries are likely to be caused by a variety of factors but most frequently by training errors. This means your intensity was too high, distance too long, or the rest was insufficient. (This is the third time I have mentioned rest!)

Even the biomechanical flaws that I might address in the clinic take a back seat to poor program design. We are highly adaptable. Each running technique is known to stress specific tissues.

What might be considered horrible running technique can be safely performed if you progressed slowly enough and were strong in all the right muscles, tendons, and ligaments.

Summary:

Like the cause of the injury, resolution should be a multifactorial approach. The trick is going to be exercising within the tolerances that the injured area allows while also working on any related deficits. Back the distance and pace down.

It’s unreasonable to believe that you don’t have mechanical deficits somewhere that contribute to the injury. Training errors in speed and time just make those flaws more prominent. You must look outside the area of injury. The body relies on an integration of systems for movement so if just one system fails at its job then you have a problem. And that problem probably isn’t where your pain is occurring. Is your balance perfect? Movement awareness stellar? Posture perfect? Strength out of this world? Have the joint motion of a 10 year old? Unlikely. Bring home those new shoes and get to work on the right things.

Strength Training for Runners, Part 5: Exercises

To finish up this series of posts on strength training, let’s cover a few examples of exercises that you can incorporate into your routine. Most of the videos focus on the lower body and trunk, though you should certainly work the upper body. With several of the lower body exercises, you can integrate in an upper body component to add an additional challenge. The Mountain Ridge Physical Therapy YouTube page contains several variations of these exercises, from basic to advanced versions. 

Quadriceps

Lunges, Bulgarian split squats, Squats, Step ups, Step downs, Plyometrics

Hamstrings

Squats, Hamstring curl with swiss ball, Hamstrings heel slide, Deadlift, Single leg deadlift, Plyometrics

Lateral gluteals

Side lying leg lift, Single leg pelvic drops, Airplane, Clamshell

Gluteus maximus

Lunges, Squats, Step ups, Single leg bridges, Double leg bridges, Glute thrusts, Plyometrics

Gastrocnemius/soleus

Calf raises, Plyometrics

Hip rotators

Single leg hip rotation

Abdominals

Front plank, Side plank, Anti-rotation walkout

Low and mid back extensors

Prone trunk extensions (Superman), Thoracic rotations, Front planks, Side planks

Please let me know if you have any questions at derek@mountainridgept.com. If you enjoy reading these articles and applying the information to your training, please “like” the Mountain Ridge Physical Therapy Facebook page.

The art and science of exercising in the summer heat

Your body is finicky about its temperature, which means it will carry out whatever processes are necessary to stay within the best working range. And that includes slowing you down when you go outside to exercise.

In a hot environment, at rest and with activity, blood is diverted to the skin for cooling purposes via increased sweat production. The sweat on the surface of the skin leads to a loss of heat via convection and evaporation (hooray for science). It’s a pretty awesome and effective system - as long as you aren’t working at really high effort levels or in a really hot and humid environment.

Sustained exercise causes a shift of a portion of our blood volume to the working muscles. And the bigger the muscle used, the bigger the blood supply required to keep it going. Harder efforts will inevitably use more energy at a quicker rate and therefore increase your core temperature to even higher levels than easy efforts. That’s where the sweating mechanism gets a little more inefficient as you are generating more heat than you can get rid of. High humidity also affects the cooling mechanism because the evaporative efficiency of sweating is reduced.

And then we add a third concern: dehydration. Dehydration decreases overall blood volume which magnifies the blood distribution problem further. This means there’s less blood volume for cooling and less blood volume for working muscles. This does not mean you need to go overboard with drinking water, as you could end up in a dangerous state of hyponatremia where you have actually diluted your body’s electrolytes. This ultimately wreaks havoc on your brain function and can lead to death. Some level of dehydration is expected during hard exercise in hot conditions, you just don’t want it to get out of control. Drink to quench your thirst and do not try to drink excess amounts to “stay ahead” of water losses.

Unfortunately, when it’s hot, the body uses more of its stored carbohydrate, glycogen, for energy. This may not be much of a factor for a 30-minute run, but if you intend on racing a marathon you must consider it a factor because you are hoping for your glycogen stores to last as long as possible.

You might think you can compensate for that increased glycogen loss by eating more during longer runs, but there are still a couple problems. One problem is that when the core blood volume is reduced to maintain cooling and supply working muscle, there isn’t much blood left for the internal organs, particularly the intestines and stomach. The other problem is that any carbohydrate you take in while exercising in the heat is used at a slower rate.

With the loss of blood volume to the digestive organs, your stomach might feel like it has a brick in it after deciding (too late) to eat that first gel at mile 10 when you realize you are suddenly feeling woozy. Is it the heat? Are you dehydrated? Was it the pre-race pasta dinner? It’s just poor planning and underestimating Mother Nature.

Those gels are meant to be consumed with large amounts of water: 6-10 ounces. Guess how much water is in one of those little aid station Dixie cups? Probably 1-2 ounces. Gels are a very concentrated source of calories, so the proper amount of water needs to be included to dilute them or it will often upset your stomach.

Once the woozy bonking has started, it’s usually too late to get those calories in quickly and maintain your pace, at least for a few minutes. So back off the pace, eat, and then reassess. You can keep the workout from being a complete disaster by making that choice to slow down for a mile and getting in some extra calories and fluids when you first notice a decline in performance and mental state. A slower than expected race finish is better than a DNF, and slowing down on a training day is better than needing your significant other to come pick you up in the car. Nobody needs to see your Road ID bracelet today.

Prevention is the optimal solution for feeling well and having a decent race or training day when the heat is brutal.

Most of us are capable of absorbing around a liter of water per hour but for prevention all you would need to do is drink 16-20 ounces of fluid per hour. I’m saying “fluid” because you may like energy drinks, but realize those don’t always work well in the heat for the same reason the gels can be a problem; too many calories and not enough pure water can slow the rate that fluids are absorbed in an already stressed digestive system.

You should also consume a small amount of calories early and often. Maybe you normally take in 100 calories per hour starting at 45 minutes in a 2- or 3-hour event. Well, you might start at 25-30 minutes instead and try to do it in smaller quantities and at more regular intervals. You might see if you can get in 110-130 calories in an hour instead. And preferably use something you have eaten in hot weather and at a high effort before. There’s nothing worse than experimenting on the day of a competition. Don’t blame me if you haven’t tried these things out before race day.

If you can pull it off, it is wise to use ice and cold water to help regulate your body temperature before and during exercise. During my most recent long run, which lasted 2.5 hours in the middle of a humid 90-degree day, I sat or stood in four creeks for 1-2 minutes each. I’m sure some purist runners would have a problem with mid-run stops, but I consider it a way to ensure success and consistency in pacing for the remainder of the run. You can also chew on ice, use wet sponges or clothing, and place ice within your hat and clothing. If nothing else, the cold is a nice distraction.

Proper pacing or effort dosing is critical in prevention. Expect the worst if you plan to start out at your PR pace on a humid 85-degree day. The calculator at this link can help guide pace adjustments. It’s probably not going to be a PR kind of day but finishing strong would be nice wouldn’t it? It’s also not the kind of day to do speedwork or long, hard pushes in a competition.

A huge part of prevention is regularly having heat exposure during exercise leading up to a particular event. This is the reason why you will experience a disaster day if you always train early in the cool mornings or only exercise indoors at a 65-degree gym. Your body is exceptionally good at adapting to the stressors consistently placed upon it. Try to have the heat exposure for at least two weeks prior to a hot competition or big training day.

Some other thoughts:

• Plan ahead by checking the weather forecast before you head outside.
• Try to exercise in shaded areas to avoid direct sun exposure that will heat you more.
• Figure out ahead of time if you are going to develop blisters from wet socks and shoes by going for multiple brief runs with the shoes and socks wet. Shoes that are well broken-in are less likely to be a problem.
• Wear light-colored clothing.

Clearly, exercising in a hot environment requires your body adjust to not one but many stressors: your working muscles, increased need for temperature regulation, and increased demand on glycogen energy stores. Training or competing in the heat doesn’t have to be dangerous if you are otherwise healthy, well prepared, and plan appropriately.

Seek medical attention if you have any of the signs and symptoms of heat illness:

• Headache
• Nausea
• Vomiting
• Pale, ashen, or flushed skin
• Loss of sweating
• Confusion
• Loss of or changes in consciousness
• Excessive fatigue
• Sudden onset of weakness
• Visual disturbances
• Chills
• Severe muscle cramping
• Severe stomach cramping

Stay safe out there. Share this article with all of your exercise buddies. If you have any training questions contact me at derek@mountainridgept.com.

Strength Training for Runners, Part 3: How?

So hopefully I’m persuading a few runners to try adding strength training to their regimen. Let’s go over some general strength training tips and the primary objectives to consider for the various muscle groups.

Strength training tips and objectives

1. Your primary goal is to place a stress on the body that it isn’t accustomed to and that, in some ways, exceeds the stress that running places on the body. This demand is what leads to positive adaptations.

• Efficient running is stressful for the muscles, tendons, bones, joints, and other tissues in the body.

• Inefficient running is even more stressful on many of these structures, which means you want to either get rid of the inefficiency (ideal) or make your body more tolerant of it (not ideal).

2. The progression should go as follows: mobility → skill → stability → endurance → strength → power

• This means you need to master the basic movement pattern with a full range of motion far before you attempt to move heavy amounts of weight or move explosively.

• Running requires tons of repetitions of a powerful movement yet many people don’t have the basic mobility and strength down to safely use that power.

3. Circuit train, especially if you aren’t accustomed to strength training yet.

• Runners love to stay moving, so your earliest forays into strengthening can emphasize circuit training of the entire body. Circuit training allows you to move right from one exercise into another, bringing the heart rate up and providing a similar feel to the constant work of running that we crave.

• Circuit training is more reasonable from a time-management perspective.

• If you are new to strength work, alternate upper body, lower body, and core exercises to let each muscle region recover effectively in between exercises.

• More experienced athletes can stack a single set of two or three similar exercises together to increase the muscle demand. For example, lunges followed by single leg squats and then on to step-ups.

• You can add plyometric and agility drills throughout the strength session to keep the heart rate up and integrate running with speed, which is discussed next.

4. Integrate strengthening into your run workouts to improve your awareness of how to use those muscles while running.

• Going back to circuit training, here’s one of my favorite winter activities when the weather is horrible and I must run inside:

  • Treadmill run 5 minutes

  • Hip strengthening and stability 1-2 minutes

  • Core strengthening and stability 1-2 minutes

  • Leg strengthening 1-2 minutes

  • Wash, rinse, and repeat for 45 to 90 minutes total

• Perform a couple of bodyweight resisted exercises like leg raises or planks during your warm up to emphasize core and hip stability, strengthening, posture correction, and muscle awareness.

5. The abdominals (and actually some hip muscles) are primarily stabilizers when you run so learn to use them in that way.

• Instead of crunches or sit-ups, use variations of planks and bridges.

• Emphasize single leg activities with the pelvis held in a level position. I reviewed the pelvic position last week with the Trendelenburg's sign.

6. Work one side of the body at a time.

• Symmetry in muscle strength is a key point. Working both sides of the body at the same time is less challenging and less productive because you will inevitably use a more dominant side without even realizing it.

7. Work multiple muscle groups simultaneously by emphasizing “closed chain” movements.

• Closed chain implies the end of the leg or arm will be in contact with the ground or fixed object. Examples include squats, lunges, push-ups, step-ups, power cleans, planks, pull-ups, and most plyometrics like jumping and hopping.

• Closed chain movements mimic running and normal daily activity. Open chain exercises, like leg extensions, do not often duplicate our day-to-day movement.

8. Think about performing exercises by the plane of movement that you move each joint through and then do a little work for each plane.

• Squats and lunges emphasize a forward/backward plane at the knees and hips.

• Single leg hip rotations emphasize a horizontal plane at the hips.

• Pelvic drops emphasize a side-to-side plane at the hips and trunk.

9. When an exercise has become too easy, add an element to decrease stability and see if that doesn’t increase the difficulty.

• For example, a standard front plank is easily advanced by lifting one leg, one arm, or both at the same time. The idea is to increase the wobble factor.

• Some equipment options to increase instability include swiss balls, BOSU balls, and wobble boards.

• Many standing exercises can be performed on a single leg to challenge the stability but you need to be proficient with their double-legged versions first.

10. Avoid using machines, emphasize free weights.

• The limited range of motion keeps you from working in the positions that you actually need to gain usable strength.

• Machines do not challenge the stabilizing muscles and nervous system components that can be beneficial for injury prevention and optimal performance.

• Free weights are more likely to mimic the tasks that we perform in daily life because we commonly lift and move heavy objects.

11. Reduce strength training loads primarily in the week before your “A” races but not before “B” or “C” races.

• Strengthening is part of the constant stimulus that you are trying to adapt to, so you don’t want to recover excessively before your low priority events. Train on through.

• While training just before a low priority event you can decrease the number of repetitions in a set by 3-5 but keep the weight the same.

• Before an “A” race, decrease both the sets, resistance, and repetitions if you have been working with resistances that cause failure at higher repetitions (i.e., do only 1-2 sets of 15-30 repetitions instead of 2-3 sets of 15-40 repetitions). If you have been gearing up with really high loads and performing more powerful, explosive moves, then back the sets down and the resistance only slightly (ie. do 2-5 sets of 3-8 repetitions instead of 5-6 sets of 3-8 repetitions).

12. Once your priority event has passed, back off of the rapid power and agility movements and encourage basic strength and strength endurance again for 2-4 weeks.

13. Perform strength training on shorter or less intense running days, especially if you have never strength trained before.

• We don’t need too much of a good thing. Too much exercise stimuli in a day or series of days is a recipe for injury.

• I often still use running as a brief warm-up before strengthening and, as mentioned, incorporate running drills throughout the strength workout.

• Strength days are a great time to do other cross training on a bike, elliptical, rower, rock wall, or anything that allows you to experiment and break up the monotony of running.

14. A general initial strengthening structure could consider spending:

• 50% of the time on the large primary movement muscle groups that undergo heavy use in running to improve overall movement strength and strength endurance.

  • These muscles, like the quadriceps, gluteus maximus, and hamstrings, can be pushed harder with higher resistances.

• 25% of your time focusing on the muscle groups that are not dominant and become neglected in the running motion to prevent injury.

  • These muscles, like the deep gluteals, usually require very little resistance because they are not large or power producing.

• 25% of the time integrating plyometric drills to increase power output, speed, and agility.

15. Allow at least 6-8 weeks of working at least 1x/week for noticeable performance changes.

In next week's blog I'll go over more application specifics and exercises. 

Please let me know if you have any questions at derek@mountainridgept.com. If you enjoy reading these articles and applying them to your training, please “like” the Mountain Ridge Physical Therapy Facebook page.

Strength Training for Runners, Part 2: Why?

Why strength and plyometric train?

Why not strength and plyometric train? That’s a better question. My personal excuse is that it’s not as fun as running, partly because it’s not done outside and nowhere near the woods. I’d rather move me, not a dumbbell. Although I’m sure some would say by moving myself I am indeed moving a dumbbell. *Sigh*

For myself and many other runners, strengthening is a necessity if you want to run long, hard, or into old age. I will gladly give up 3-6 junk miles every week to take the time for this type of cross training. Strength training gets me to a point that makes the other runs more enjoyable. How does it improve my running enjoyment? Largely because I stay less injured overall, my back doesn’t hurt during long runs anymore, I recover quicker, and my legs never get that completely destroyed feeling in long races that they once did.

I would argue that running itself is a series of plyometrics. (The Merriam-Webster definition of a plyometric activity is “exercise involving repeated rapid stretching and contracting of muscles”). Plyometrics are just high speed strengthening.

Here are a few reasons runners should consider strength training:

1. Strength training improves performance. Every runner can benefit from strength training. Competitive trail runners, marathoners, and speed demons who compete at any distance could reap very significant gains. At the same time, the less competitive folks running just for fun could benefit too.

The mechanisms of improved performance can be attributed to any one or a combination of the following factors:

• Increased hip and core stability
• Increased force production of the muscle fibers (aka strength)
• Increased fatigue resistance of the larger leg muscle groups (aka endurance)
• Increased endurance of the core, hip, and leg muscle groups while producing greater force (aka strength endurance)

Increased hip and core stability

Having a strong core and hips takes unnecessary trunk motions out of the equation. You can then move the arms and legs more quickly and with greater force without disrupting the stable base. I noticed this in the 2016 women’s 10,000 meter U.S. Olympic trials. Molly Huddle maintains a very stable trunk posture. As a result, there is less energy wasted during the early and middle part of the run and that energy can be put to use in the closing laps. And at that point many of the competitors are flailing anyway.

Increased force production

As far as the prime movers of the legs go, if you want to move faster while running, your options are to:

• increase turnover while maintaining the same muscle force output,
• increase force from the muscles while maintaining the same turnover, or
• increase both muscle force and rate of turnover.

Strength (and plyometric) training is a great way to teach your larger leg muscles to generate that force in an efficient manner. Many of the changes that we would refer to as increased strength are actually the result of the nervous system’s ability to refine how the muscle fibers fire. It’s definitely not all about making the muscles bigger. By increasing the ease and efficiency of force production, you can become faster.

Increased fatigue resistance of the larger leg muscle groups and increased endurance of the core, hip, and leg muscle groups while producing greater force

Greater total muscle strength can lead to greater strength endurance capacity. Strength endurance is concerned with the ability to generate a certain force for a prolonged period. In other words, after strength training for a few weeks I can make a muscle produce the same or greater force for a longer period of time before it begins to fail. This is a huge benefit if you have reached the limits of what your fast-twitch muscle fibers are willing to perform with standard running interval training techniques.

Racing and hard efforts can rely heavily on the fast-twitch muscle fibers, and slow endurance training does very little to train these muscle fibers because slow training is primarily using slow-twitch muscle fibers. You can only perform so much high intensity interval work while running so strength training is another way to stimulate these muscle fibers. By regularly training the fast-twitch muscle fibers, you can improve movement economy and improve fatigue tolerance. Better fast-twitch muscle fiber use will help you when bridging a gap in a race, moving at faster speeds, and climbing hills.

2. Strength training can help you prevent injury. There is research citing decreased injury incidence in athletes with consistent strength training routines (http://bjsm.bmj.com/content/early/2013/10/07/bjsports-2013-092538.abstract). Stretching, on the other hand, has no consistent research support in injury prevention. For one, as mentioned, proper strength training helps to increase hip and core stability so that the legs and arms are moving on a stable base. My theory would be that it’s mostly the strength, stability, and muscular endurance of the hips and core that help to keep a runner away from injury though it's certainly important to train the rest of the leg as well. This is where many runners have the wrong idea of what strengthening should really be about. The primary objective is to take the unnecessary motion out of the system in order to reduce the injury causing “slop.”

3. Strength training can help you recover from injury. Often, strengthening of specific muscles is a vital component of any patient’s injury recovery in my clinic. In the case of both injured and uninjured tissues, the intention is to rely on these primary concepts:

• Improved structural integrity of muscle, tendon, ligament, and bone, and
• Improved strength and neurological activity in weak muscles

4. Strength training changes your perspective on higher training intensities. If you can perform enough repetitions with a high resistance that you reach a point of true muscle failure, you begin to understand what it’s like to really push that extra bit of effort from yourself. That can make a finish line sprint or track workout feel a little easier, for the muscles at least.

5. Strength training helps decrease age-related strength loss. Aging causes a loss of the fast-twitch types of muscles fibers and their associated nerves. Frequently demanding work from those muscle fibers slows the rate of loss. Nobody wants to lose the strength necessary to do daily tasks but I assure you that it will happen if you let it. I didn’t think about this until I started approaching 40 years of age (and the girls stopped whistling at me.)

6. Increasing strength makes you a generally healthier individual and a well-rounded athlete. There’s nothing better than being able to confidently lift a 50-pound bag of potting soil from the ground without fear of hurting your back. And being able to randomly and confidently play a pickup game of {insert any sport here} is pretty awesome too.

7. Variety and changes in your training program prevent burnout and staleness. The same old, same old becomes dull and demotivating for most people. There is so much variety possible with strength and plyometric training that it can really freshen up your outlook.

8. Strength training can boost you through a performance plateau. The repetition associated with some endurance training programs will inevitably lead to a plateau in many athletes. In order to bust through the plateau you need a new type of training stimulus. Resistance training can be that stimulus if delivered correctly over a 4-8 week period of time, especially if you add the plyometrics and change up your running interval program.

Please let me know if you have any questions by emailing me at derek@mountainridgept.com.

Strength Training for Runners, Part 1: Myths

Middle and long distance runners have a long history of neglecting proper strength training, partly because they don’t enjoy it as much as running and partly because of the myths surrounding the concept. Those myths need to be broken.

Myth #1: Strength training will make my muscles bigger and then I'll be heavier.

You will not automatically gain weight and become huge because you start strength training. In the strength training world this increase of muscle size is referred to as “hypertrophy.” Many runners don’t want to gain size because that’s extra weight to carry in every step. The reality is your body will best adapt to the stresses you place on it most often. If you run once per week but lift weights on 3-4 days then yes, you might bulk up. But if you run 3-4 days each week and strength train during just one day then you aren’t going to add muscle mass. Age, sex, and genetics each play a role in gaining muscle size as well. And the type of strengthening stimulus matters. Larger muscle size tends to come from an emphasis on multiple sets of an exercise using a weight that is 50-75% of your one repetition maximum.

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Myth #2: Strength training requires weight equipment.

Fortunately, resistance training does not always require equipment. It is possible to use your bodyweight to provide a decent stimulus for many of your muscle groups. For instance, it is critical to emphasize hip strength and core stability in any runner’s program. This type of strengthening requires nothing more than challenging positions that start with a basic plank. Advancements of difficulty can be made by isolating the muscles you are trying to work, working only one side of the body at a time, or adding stability challenges (i.e. balance).

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Myth #3: Strength training requires special machines.

It definitely does not require special machines. In fact, I am a huge proponent of avoiding machines altogether. Machines are inferior to free weights in so many ways. They do not challenge the parts of your nervous system that monitor your body’s stability and positional awareness. Machines also restrict your range of movements. Freeweights can moved through any available range. And for those that like to workout at home, free weights can be cheaper and take up less space than machines.

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Myth #4: Strength training means I have to workout inside a gym.

Strength work doesn’t always have to involve an indoor gym. For running, steep hill repeats with an intentionally slow, bounding cadence can engage a large number of fast-twitch muscle fibers in the hips and legs. It’s those fast-twitch muscle fibers that can improve your sprint speed, surge speed, and overall pace in races like a 5K. The scenario is the same with plyometric training as you don’t need equipment or a special location to bust out a few quick jumps or hops.

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Myth #5: Strength training will slow me down.

If done correctly, strength work will not slow you down and actually has the potential to make you faster. In one recent study, even when very heavy amounts of weight were used (3-4 sets of 4-10 repetitions to failure), female runners maintained their race speeds after 11 weeks of training. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4783109/) In application, I would never expect a competitive or recreational runner to train with that heavy of a resistance for such a tremendous amount of time. However, it is good to know that even after several weeks of heavy weight training these women sustained their speed. I would expect runners of any ability level to spend their time performing supplemental work to gain hip and core stability and fatigue resistance of their primary movers (hamstrings, quadriceps, calf group).

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Myth #6: I won’t gain anything from strength training only one or two days a week.

As little as one day per week is sufficient to have a positive impact on strength and strength endurance. Some athletes think that strength training has to occur at a high frequency to result in a change. That’s simply not true. Working hard on your weakest areas just one to two days each week can have a tremendous impact. If those muscles were minimally challenged beforehand, then any stimulus greater than their normal level of activity is going to cause a positive change. Even if you prevented just one injury, it would be worth the extra effort of as little as 30 minutes each week. 

Next week I’ll dive into the benefits of adding strength training to your running program. In the meantime, if you have any questions, email me at derek@mountainridgept.com.

Should you exercise while taking antibiotics?

Did you know that there are some prescription drugs that can have a negative impact on exercise capacity, recovery, and injury?

As if most of us didn’t already dislike taking antibiotics, now you might want to think about the documented exercise-related side effects from a specific family of antibiotics known as fluoroquinolones. These drugs have been associated with a risk of tendon rupture and tendon overuse injury.

Fluoroquinolones are frequently used to treat sinus infections, bronchial infections, and urinary tract infections, and work well against a large variety of bacteria. Which means many of us have taken these drugs.

Examples of these drugs include:

• Levaquin (levofloxacin)

• Cipro (ciprofloxacin)

• Avelox (moxifloxacin)

• Floxin (ofloxacin)

• Factive (gemifloxacin)

Despite the consistently positive effects, in May 2016 the FDA made this statement available: “An FDA safety review has shown that fluoroquinolones are associated with disabling and potentially permanent, serious side effects that can occur together.  These side effects can involve the tendons, muscles, joints, nerves and central nervous system. As a result, the FDA is also requiring label changes for all systemic fluoroquinolone antibacterial drugs to reflect this new safety information.”

The FDA is not suggesting that doctors should stop prescribing these drugs. They are suggesting that they should not always be the first line treatment.

These side effects have been researched since 1996 (and one source documented tendon damage from the use of one of these drugs in 1983). Often the individuals begin to have tendinitis-like symptoms that quickly progresses to partial or full tearing of the involved tendons. Achilles tendon damage has been particularly well documented with tendinitis and ruptures.

Does this mean you will definitely have a torn tendon after taking these antibiotics? No. But as an individual with a more active lifestyle that heavily stresses your connective tissues, you should be aware and concerned if you begin to have tendon pain while taking or shortly after taking a course of these drugs.

Before taking these drugs, you may want to discuss the need for that particular prescription with your doctor, as you might qualify for another option. Should you begin taking these antibiotics while having an already existing tendon injury, be extra cautious with your activity for at least a month (negative effects have reported up to three months later). If you begin to have tendon pain while taking them, get in touch with your prescribing physician.

Having seen many patients who underwent surgical tendon repair procedures, a tendon rupture is not an injury that you want to deal with if it can be avoided. The likelihood of rupture is rare with 15-20 cases per 100,000 drug uses. If you must use that specific family of drugs be sure to monitor yourself, cut back on your exercise routine and talk to your physician if you should start to develop tendon region symptoms.

The information provided here is for informational purposes only. If you are concerned with your antibiotic use, seek further guidance from your primary care medical professional. 

Geek out:

• http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm500325.htm

• http://www.runnersworld.com/injury-treatment/fda-warns-of-tendon-damage-linked-to-antibiotics

• http://www.medscape.com/viewarticle/410546_3

• http://www.ncbi.nlm.nih.gov/pubmed/15777120

• http://www.ncbi.nlm.nih.gov/pubmed/12587511

• http://www.ncbi.nlm.nih.gov/pubmed/8863030

• http://www.ncbi.nlm.nih.gov/pubmed/8832995

• http://www.ncbi.nlm.nih.gov/pubmed/11409663

• http://www.ncbi.nlm.nih.gov/pubmed/21686678

Training errors in the athlete, part 6

Too much, too soon, particularly after an injury. Most athletes understand that progressing too quickly in their regular training can cause injury. What they don’t often understand is how to return to sport after an injury. This is the easiest time to go too hard or too long. You can have the “I’m all better” concept down too well.

Injured or not, the body is only capable of adapting at a certain rate. Some tissues can adapt in a few days (cardiovascular system, nervous system pathways), some in a few weeks (muscles), and others in a couple months (tendon, bone). Depending on the location of the injury you must consider what are known as “tissue healing constraints.” For example, a tendon overuse injury can take 1-3 months to resolve with correct progression. A low-grade muscle strain could take 1-4 weeks.

If a runner has tendon pain from a new tendinitis that has been present for 3-4 weeks then I would expect it is going to take weeks, not days, before returning to their pre-injury mileage. It doesn’t always mean you can’t run at all during recovery. It must be a controlled progression. And there is always some type of cross training you can do.

The first day back to running should not be a 5 or 7 mile long run, regardless of terrain or intensity. And that’s what I see many people try to do when they return from injury. They want to get right back up that mountain quicker than they came down it. Stay in the valley for a couple days. For every week away from running I would expect a need for at least a 30% drop in average weekly mileage upon return.

It’s going to take at least a week of no exercise before you actually have a loss of fitness. The fitness losses from 2 weeks of inactivity are similar to those of 4 weeks. And I’m sure you have been cross training to minimize those losses. Point being, don’t rush back into it simply to regain fitness that doesn’t really need to be regained.

Not listening to your body’s warning signs of insufficient recovery. This is similar to what I mentioned last week about not respecting a specific injury early. But you also need to consider a whole body factor. Something is up when your muscles have been feeling constantly tired before, during, and after workouts. You might wake up more groggy than usual or old injuries start to reappear. You need to consider what your body is trying to tell you.

It’s normal to feel a little stiff and achy in your muscles when you start to push them. But when a slow, easy warm-up doesn’t put some pep back in your step after 20-30 minutes then there’s a good chance you could be digging yourself into a hole. If you feel good at that point, then a hard workout is reasonable. If you still feel slower than normal and better yet, are actually slower than your normal, then it’s not a day to push your effort.

For the uninjured, refrain from making any judgments about how your workout is going to proceed until your system is well warmed-up, at least 15 minutes into exercise.

Not performing regular soft tissue maintenance like foam rolling, massage, and compression in recovery, especially after the hardest and longest efforts. Repetitive wear and tear beats up your muscles. Unhealthy muscle tissue equals decreased performance and even pain. As athletes, we surely can’t expect that pushing into exercise-related discomfort multiple days per week generates only 100% positive adaptations in the muscles and other tissues. There are gradual negative adaptations too, like trigger points, adhesions, and loss of muscle tissue length.

Show those muscles a little love with self-massage. Help your lymphatic system function at its best by preventing fluids from accumulating in the spaces around your muscles and other tissues with compression. Options for compression include compression socks or for a more massage-like treatment, a pneumatic compression system, like the Normatec. Most athletes find that massage and compression simply feel good after prolonged exercise.

Let me know if you have any questions: derek@mountainridgept.com

Running technique: 3 reasons why runners develop shin splints and 7 ways to fix them

I really dislike the term "shin splints." Probably more than you dislike actually having pain from shin splints. That's because the term has been used to describe about five different problems that occur in the lower leg. It's terribly vague.

The term "shin splints" has been applied to injuries that are more specifically described as medial tibial stress syndrome, tibial stress fractures, and exertional muscle pain. Exertional muscle pain is the most common type of problem, so for the sake of this article, I will refer to the shin muscle and tendon pain from exertion as “shin splints."

One of the shin muscles is the anterior tibialis, which is the biggest muscle on the front of your shin region. It’s main function is to pull the front of your foot upward. That's called dorsiflexion (see photo). It's helped by the neighboring extensor hallucis longus (EHL) and extensor digitorum longus (EDL) muscles.

While walking and running, they keep you from catching your foot and toes on rugs, roots, stones, steps, and generally rough surfaces. We’ve all caught a toe, tripped, fallen and groaned in pain as we lie on the ground. These are the muscles you can thank for keeping you from biting it everyday.

There are several reasons why runners will develop exertional shin splints. Some of them include:

Heavy reliance on heel striking. This is the most likely reason a runner, especially a new runner, would develop shin muscle overuse pain. With a heel strike, you must increase use of the anterior tibialis muscle or your foot will slap down to the ground. Runners who heel strike demonstrate a greater dorsiflexion (pointed up) angle upon ground contact compared to a runner who lands with their entire foot flatter or on their forefoot.

In the picture below the ankle is pulling up into dorsiflexion 15 degrees above a neutral ankle position. This is in contrast to the midfoot strike images below where the foot is contacting the ground in a slightly plantarflexed (pointed down) angle. In order to lower the front of the foot to the ground from a heel striking position, the anterior tibialis muscle needs to work extra hard. All of that extra work results in a chronic state of overuse in the shin muscles and tendons, which is easy to imagine when you are asking them to perform 700 contractions per mile. 

Initial contact with heel strike pattern

Overstriding in the forward direction. Along with the heavy heel striking pattern, reaching the leg too far forward with each step will increase the stress on the shin muscles. You can use a heel strike pattern without causing shin splint pain if your foot contacts close to your center of mass. Imagine your center of mass being a line drawn straight down from the center of your hips, as in the following picture. If the foot contacts the ground 12 inches in front of the line instead of 10 inches, the demands are much different on the muscles, tendons and joints.

Most runners who shorten their stride in the forward direction start to land on their midfoot instead of their heel. Compared to the heel strike picture above, using a midfoot or forefoot strike pattern (and sometimes a slightly quicker turnover) causes the stride to be slightly shorter in the forward direction. That's evident with the lower hip flexion degree value. But it's most noticeable that the distance line to the point of contact at the bottom of the picture is clearly shorter than in the previous heel striking picture. It is possible to make an initial contact at this same closer point and use any of the three types of contact patterns. 

Initial contact with midfoot strike pattern

Short/tight calf muscles. If the muscles on the back of your lower leg are so short that you can’t take your ankle into the normal level of upward dorsiflexion motion, the shin muscles are going to need to work harder to overcome that passive resistance. One quick way to assess whether the muscles on the back of the lower leg are too short is to do a full squat. Barring any unusual knee or ankle joint and bone issues, if the feet can't stay flat on the floor, especially without turning the feet out or the arches collapsing, you may have a limitation in the length of those muscles.

Tips for correcting these issues.

1. In the cases of both heel striking and overstriding, the solution is much the same. The foot needs to land closer to your center of mass. You could simply think about taking shorter steps. You can think about it landing directly beneath you (which will never actually happen). A one-inch change in the initial contact point is going to feel like a 12-inch change but I assure you that the awkward feeling is normal at first.

2. Some runners need an external focus to prevent overstriding forward, so matching their cadence to the beat of a metronome can be helpful. Count the number of steps you take with one leg in one minute of running. Those who overstride are often taking less than 82 steps each minute. The metronome can be set for a value greater than 82 while you try to match the step rate with one leg.

3. For tight calf muscles, everyone’s first thought is “stretch.” Stretching is fine if you hold the stretch for at least 1 minute but 2-3 minutes is more effective to mechanically lengthen these tissues. And you would have to do it daily for at least a month to get much change. It can be more effective to perform soft tissue work with a foam roller, massage stick, tennis or lacrosse ball, massage therapist, or manual therapy from a Physical Therapist. Regardless, just try something! Lessons on muscle rolling here.

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4. Relax the anterior tibialis muscle with consistent soft tissue maintenance. Trigger point dry needling or myofascial release can work wonders to make the muscle happy and decrease pain quickly. The massage stick can be great too. Lessons on muscle rolling here.

5. Practice engaging the anterior tibialis muscle by walking on your heels for 30-60 seconds continuously each day. Preferably after your symptoms have calmed down a bit.

6. Progressively increase your mileage. Going for a 4 mile run after a month of no running is a huge training error. Sometimes those muscles just need to be conditioned correctly. 

7. Try a different shoe with a lower heel height. Pair this with the other solutions. A thicker heel can mean greater shin muscle load. And that thick heel is often the reason people heel strike hard in the first place. 

If you battle repeatedly with shin splints, consider having a thorough running technique and gait evaluation. Yes, I can get the pain to go away easily with a couple treatments but don’t you want to keep it away permanently? A couple of small changes can mean a huge difference in your pain onset.

I can be reached at derek@mountainridgept.com if you have any questions. 

Please share this article with your running friends! To receive updates as each blog comes out, complete the form below. I can be reached at derek@mountainridgept.com if you have any questions. 

Training errors in the athlete, part 5

Training with other people all the time. Do you thrive on attention and praise in order to push through a workout? Sometimes you just need to go it alone to build the mental fortitude required to perform at a higher level. I mean Rocky Balboa trained alone most of the time and he seemed pretty talented so that has to be a sign it will work for you too. Gonna fly now...

I don't see anyone else around, do you?

Moving on to the other end of the spectrum, there’s the chance that other athletes can push you too hard, too often. Peer pressure kicks in and although your instinct says “that’s enough,” you go beyond your safe limitations and become injured. Save it for the competition. That’s where it is nice to have a coach to tell you when to shut it down.

Skipping the warm-up. Warm your muscles up slowly and they will perform better. A gradual warm-up can improve performance. Research indicates muscle fiber exposure to lactic acid just before intense exercise allows the fibers to tolerate even more lactic acid production. The physiology of the muscle fiber can function better at a higher temperature too (up to a point of course).

According to a 2012 literature review in BioMed Central Medicine, a proper warm-up containing “stretching, strengthening, balance exercises, sports-specific agility drills and landing techniques” can be effective for preventing injury. This is unfortunately more involved than many athletes envision when thinking about a warm-up routine and they shy away from it as a result. 

At the least, warming-up should be a whole body routine that emphasizes full joint mobility, a gradual increase in heart rate, directional changes, and most importantly, rock music. The warm-up period, especially just before a competition, can be a powerful psychological motivator.

Ignoring joint mobility and flexibility. Some people have really poor mobility. I don’t mean, can you bend over and touch your toes? I mean will your hip flex to a full 120 degrees to allow you to squat all the way down at Crossfit? Do your ankles have the full range of motion necessary to prevent your arch from collapsing while running? Limits in mobility set by a single joint or muscle can impact movement further away than you might realize (ie. ankle movement can change hip movement).

The type of exercise you expect to participate in should dictate what motions you need to improve. If there are specific known limitations, they should be addressed in order to decrease stress on adjacent tissues and regions. Mobility limitation is the reason that the Crossfit “Mobility WOD” exercises exist. The point is that you have to take care of your body with a little routine supplemental work in order to enjoy your regular sport safely and improve performance. 

To Foam Roll the IT Band or Not to Foam Roll the IT Band?

There are about 50,000 articles on rolling or not rolling the IT band, or iliotibial band, on the internet right now. So now there’s 50,001 with my addition. There’s every topic from “you’ll never get the ITB to stretch out” to “don’t roll it because the problem is actually at your hip” to “keep rolling the ITB.”

I agree, the ITB is so thick and strong you are wasting your time to try to specifically stretch it or roll it out. According to an older article (1931) from the Journal of Bone and Joint Surgery by C.M. Gratz, MD:

“The specific gravity of fascia lata is about 1.31 and the average ultimate tensile strength is approximately 7,000 pounds per square inch. Soft steel has a specific gravity of 7.83 and an ultimate strength of about 45,000 pounds per square inch. Thus fascia lata is nearly as strong as soft steel, weight for weight.”

Image courtesy MedBridge Education

The IT band needs to be a strong material. The IT band functions are to stabilize your knee and produce hip movement by working along with the tensor fascia latae and gluteus maximus muscles (refer to the image below). And yes, lateral knee overuse injuries, including IT band region problems, tend to be related to weakness or abnormal activity at the hip and trunk muscles. Maybe something is wrong down at the ankle and foot too.

You shouldn’t be relying on the rolling, or any soft tissue technique for that matter, to make up for lost strength or bad exercise mechanics. Those body mechanics need addressed and your strength needs to improve. It wouldn’t surprise me that a lateral knee pain sufferer would also have weak gluteus medius and gluteus maximus muscles. Most people could use stronger glutes. And maybe you shouldn't have suddenly done a 2 hour long workout when your longest had been 1 hour. 

What the anti-rolling crowd is forgetting is the fact that the IT band is covering a pretty big portion of quadriceps muscle. Because it’s generally a positive to routinely roll or massage the rest of the quadriceps, why would you suddenly neglect such a big part of it? I wouldn’t, personally.

And what if that lateral knee pain is actually coming from trigger points in the quadriceps? At least the rolling was helping to keep the quadriceps relaxed and generally making the nervous system happier.

If you bought into the “no ITB rolling” philosophy, think it over again. At the very least, use a tennis or lacrosse ball to roll the thigh directly in front of the IT band and directly behind it. Take care of your quadriceps and hamstrings muscles. Use the ball, massage stick, or foam roller on the tensor fascia latae muscle too, up at the front/side of each hip.

Strengthen your hips and keep on rolling.

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