Running Injuries and Running Performance: A Podcast and an Article

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Injury and performance exist on a sliding scale. At one end we are completely broken down, hurt, and unable run/bike/swim/lift/fight/hike/etc. At the other end we’re performing at our peak. Probably every active person has been injured and I’m willing to bet that every active person would like to perform their very best. This post is for runners in either or both camps.

Runners are often injured. According to a review of literature in the British Journal of Sports Medicine, rates of lower-leg injury ranged from 19.4% to 79.3% among study subjects. The magic questions are 1)Why do we get injured? and 2) How do we overcome injuries?

I think it stands to reason that if we hurt while running then very likely it’s the way we run that’s the problem. Running requires complex coordination among many parts and systems. It is mind boggling to try and dissect running form, find the problems and then either teach or learn new, helpful techniques.

Meanwhile, if we’re not injured and we’re able to run, then we probably want to know how to run faster and more efficiently. How do we we achieve these goals? These questions aren’t easily answered. With all that in mind, I found two resources that may offer some very valuable information on these issues.

The first is the Physio Edge Podcast 049, Running From Injury with Dr. Rich Willy. At about the 20:30 mark Dr. Willy gives some good external cues to help promote running form that may help with IT band pain. The cues involve the knees and the hips:

  1. If the knees cave in too much while running: He puts brightly colored tape on the outside He has the patient run on a treadmill facing a mirror. He tells the patient to push the tape out toward the walls.
  2. If the hips are adducting too much: The runner runs on a treadmill facing a mirror with the waistband of their shorts clearly visible. He instructs the runner to keep the pelvis level by keeping their waistband level.

Listen to the podcast to get all the details.

Next is an article from the always informative Alex Hutchinson at the Sweat Science column at Runner’s WorldWhat Makes a Running Stride Efficient? Hutchinson discusses a study from Loughborough University in England that looked at biomechanical factors

“For running economy, three variables stood out: vertical oscillation (measured by the up-and-down motion of the pelvis; less is better); how bent your knee is when your foot hits the ground (more bent is better); and braking (also measured by looking at the motion of your pelvis; less slowdown as your foot hits the ground is better).

“Overall, these three variables explained 39.4 percent of the individual differences in running economy—and the vast majority of that (27.7 percent) came from vertical oscillation.

“For running performance, four variables stood out: braking (as above); the angle of the shin when your foot hits the ground (closer to vertical is better); duty factor (basically a measure of how long your foot stays on the ground relative to your overall stride; quicker is better); and the forward lean of your trunk (more upright is better).

Overall, these four variables explained 30.5 percent of individual variation in race times, with shin angle (10 percent) and braking (9.9 percent) as the biggest contributors.”

Something I always appreciate about Hutchinson’s writing is that he lays out some of the errors in thinking that we might encounter when we assume that employing new running techniques will automatically equal better, faster, pain-free running. Are these characteristics of efficient runners chickens or eggs?

“For example, you could imagine a study that compared elite runners to ‘regular’ runners and found that the elite tend to have more highly defined calf muscles. It doesn’t necessarily follow that doing a whole bunch of hardcore calf exercises will make you faster. It’s more likely that a whole lot of training, combined with some genetics, has given elites more defined calves. Fixating on getting better calf muscles would be distraction that’s unlikely to help you, and takes away from things that really would make you faster, like running more.”

That said, (and he mentions this) it may well investigating new strategies based on these findings. From my experience in helping people with their running, aiming to achieve these biomechanical outcomes can help. (This post offers a few cues that I’ve found useful to use with runners.)

Ideally, you should be videoed while running.Trying to adjust your gait without knowing how you’re currently running might be near impossible. Video is a very powerful tool when it comes to making adjustments to sporting techniques and I highly recommend it.

Definitely read the article and listen to the podcast if you think you need help with your running or if you’re a coach who works with runners. And if doing it yourself isn’t getting you the results you want then I strongly suggest you employ some sort of running coach to help.

Sometimes It’s Simple

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I’ve taken lots of courses, read lots of books and articles, listened to podcasts, and attended seminars dedicated to helping my clients move better and get out of pain. I’ve spent time and money learning about so-called corrective exercises. I’ve learned that rarely is the site of pain the site of the problem. I recognize that the body is a highly interconnected system of systems and that what happens at one end can have powerful effects way out at the other end. I’ve tried to absorb and apply all sorts of complex information and sometimes, my brain gets in the way and I overlook simple solutions.

Patty is one of my senior clients. We’ve worked together for several years. She has intermittent knee pain on both, but mostly her left knee. It’s not terrible but it bothers her after tennis games and often while climbing and descending stairs.

It’s important to recognize that the knee is caught between the hip and the ankle. Rarely is it the fault of the knee that’s causing the knee pain. (An obvious exception would be an acute injury like a ligament sprain or some sort of impact to the knee.)

I’ve had her do all sorts of exercises and mobility drills for her hips. We’ve done glute drills in all three planes of motion. We’ve done all sorts of lunges in all sorts of directions. We’ve done a bunch of ankle and foot mobility work too. In the past, I spent way too much time giving her a bunch of instructions to squeeze the glutes when she walks and to try and make her leg do this or that as she moves. (These are examples of intrinsic cues. They’re usually not the best cues.)

Sometimes her knee(s) feel better but for the past several weeks she’s reported fairly consistent knee pain, particularly on stairs. This was frustrating to me in that last week we did a variety of drills and exercises such that she was able to take the stairs without pain. I was hopeful though. If we could eliminate her pain last week then we could do it again.

We went to the stairs. I planned to review a couple of things we did the prior week. My mind filled with cornucopia of lunges, stepping drills, and ankle mobility exercises. How would I tweak the exercises? How would I load them? There were many options. My brain started to overheat as I tried to contemplate them all.

Then I paused and thought, “What’s the simplest possible way to find success?”

Coach her to walk the stairs differently. No drills, no exercises, nothing special. I would give her a minimum of instructions on how to walk the stairs in a different way than when she arrived.

There were two tactics from last week I wanted to try. If those didn’t work then we could move to all the wacky, exotic stuff. The two main instructions were these:

  1. Ascending: Lean forward a little. By leaning forward I expected the glutes to work more than if she stood fully upright. It didn’t need to be a big lean forward, just somewhat of a lean. Don’t think about the glutes either. Jus lean forward.
  2. Descending: Let the heel of the rear foot stay flat longer. That way the ankle would dorsiflex more thus taking some of the load from the knee. Also, try and descend softly. Try not to slam and clunk down to the next step. My hope was that this would prompt a controlled descent as opposed to a sort of lurching slam into the step.

(I’ve seen this ankle/knee relationship several times in the past. A few of my clients have presented with knee pain and limited ankle dorsiflexion. The knee pain diminished or vanished once dorsiflexion was restored and then used during gait.)

Both strategies worked immediately! How cool! For the next 5-10 minutes I had her practice the new stair walking strategies. The only time the knee pain popped up was when she let the heel rise too early during the descent.

I didn’t tell her anything about her glutes or her knee or any other muscles or joints. Just, “lean forward,” and “keep your heel down longer.” I need to remember that sometimes giving simple cues can do world of good. I don’t always need to go through a rigamarole of creative exercises to help someone move and feel better.

Reading & Learning: “Real Movement” by Adam Wolf, PT

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I am reading with much enthusiasm the book Real Movement by physical therapist and massage therapist Adam Wolf, aka the Biomechanical Detective. In a big way, it’s like re-reading a very good book that I’ve enjoyed in the past. I am familiar with a lot of the concepts discussed by Adam and what I enjoy immensely is coming back and examining those concepts through his eyes and his experiences.

Wolf is among other things, a Fellow of Applied Functional Science (FAFS) by way of the Gray Institute. I also study and apply Gary Gray’s material. I always like to see how other practitioners apply the principles of 3D movement. I love gaining new perspectives on how to create functional exercises, or exercises that most translate to real life. You can see a lot of examples of this at the Adam Wolf, PT, Biomechanical Youtube Channel.

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If you ain’t got that sling then you ain’t got that swing.

Something I just learned is that Adam’s dad is Chuck Wolf, another functional exercise and movement professional. Many years ago I was introduced to the concept of Flexibility Highways at one of Chuck’s seminars. These highways aka muscle slings, aka myofascial lines, are networks of muscle and fascia that often  work together during real-world, whole-body movements. (“Real-life” movements are in contrast to many of the artificially isolated movements that we see in gyms, especially those performed on machines.) One example is the posterior oblique sling as used in a golf swing. Another example is the anterior oblique sling used when throwing.

The anterior X sling is a big part of throwing, batting, golfing, running, punching and all sorts of things.

The anterior X sling is a big part of throwing, batting, golfing, running, punching and all sorts of things.

The fascial sling system was an interesting concept to me at the time but it has sort of faded from my thinking in recent years. Now, reading Adam’s book and watching his videos has brought those flexibility highways or slings to the front of my mind. These sling concepts are informing both the mobility work I’m doing with clients as well as my exercise selection. In working along and within these sling systems I feel like I’m capturing just about all of the movement we humans are capable of. Check out the following videos from Adam Wolf where he discusses how you can move better by following these fascial lines.

Hip Adduction Part II: Solutions to Mobility and Stability

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In Part I of this series, I discussed what hip adduction is and why it’s crucial for good movement, balance and sports performance. In this post I’ll give some ways to self-assess your hip adduction and increase your hip adduction mobility, stability and power.

There are many ways to investigate and train hip adduction. I do not propose to cure what ails you with any of these exercises. If you’re in real pain then you need to see a physician.

(I realize now in watching the videos that I use the term “frontal plane” more than I say “hip adduction.” Please consider the terms interchangeable for the purpose of this post.)

Check your ability to move into hip adduction. Check both right and left sides. How do they compare?

Now check your stability. Can you control your hip adduction?

Try this mobility matrix to gain more hip adduction. You may need more on both sides. The great thing about this matrix is that you’re not only address the hip but you’ll also be mobilizing other joints in concert with the hip.

This movement series is a more aggressive way to challenge hip adduction while at the same time getting an upper body workout.

The next three exercises are a few ways to challenge and develop hip adduction mobility, stability and power. These can be used for athletic training purposes or simply as fun ways to tweak familiar exercises. All sorts of implements can be used:

Achilles Pain. Time to Take Action!

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I’ve had periodic issues with my left Achilles tendon. I’ve never had trouble with my right Achilles until just lately. I felt a bit of soreness one morning and found some swelling. I knew it probably wouldn’t “work itself out” (I sort of hate when someone says that about something. Nothing “works itself out.” Someone has to put in work in order to see progress.) The upside to having had this problem before is that I know how to address it now.

I believe my trouble may have started because of the long trail run/hike I did a couple of weekends ago in Telluride. It was about 12 miles which was a sizable jump from my prior long run of 7 miles. (Sometimes I’m not smart.)

I have attacked the injury with a fairly conventional strategy of slow and controlled heel raises. Here’s what it looks like:

I’m doing these exercises frequently throughout the day. If I can hit 15 reps then I add weight. Fifteen reps isn’t a magic number by the way. Most importantly I work to a high level of exertion, pretty much to failure.

I’ve run several times since feeling pain and doing the calf raises and I feel fine. That’s a good sign. I probably don’t need to take time off from running.

This exercise is boring and I hate doing it. (Sounds like what a lot of people say about going to the gym.) I have shown a propensity for weakness in my Achilles tendons in the past though. This is exactly the type of thing I need to do and I should be doing continually. It’s easy to skip this stuff because I don’t enjoy it. My body doesn’t  though even though there are potential negative consequences to this course of non-action.

There are lots of things in life like that.

Running Technique: 3 Simple Cues

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Running form is a frequently discussed topic among injured runners and runners looking to perform better. How should we run? Is there one ideal way to run? Should we run on the forefoot, mid-foot or heel? Does our core matter? What should our upper body do when we run?

There are many schools of thought in the running world and there doesn’t seem to be any ironclad consensus on any of these questions. If you’re running pain-free and you’re performing as well as you’d like then I don’t believe you should change your running form. In other words, if it ain’t broke, don’t fix it.

If, on the other hand, you experience pain when you run or if you’re not as fast as you’d like to be then some technique changes may be in order.

Run tall.

A lot of us run in a hunched type of posture that resembles the way we sit (and sit and sit…) in our work chairs or in our cars. This hunched position may be problematic and may be contributing to running problems. To address this issue:

Imagine a chain is attached to the top of your skull. That chain pulls you up. It lengthens your spine and makes you tall. See if you can feel this long, tall spine as you run. As part of this process, keep your gaze up and out toward the horizon. Don’t stare at the ground directly in front of you. This tall posture should help with some of our other running form considerations.

Tight hip flexors may contribute to a hunched posture. The following stretch sequence may help.

Run light.

The impact of the foot hitting the ground is worth considering as it concerns injuries. Recent evidence suggests runners who hit the ground lightly are injured less than runners who hit the ground hard.

You may run with earphones and you may be unaware that you stomp and pound the ground with each footfall. So to run light, remove the earphones and pay attention to the sound you make.

Imagine you’re weightless. Your strides are feathery light, and energetic. You don’t pound the ground but rather you glide across gossamer.

Another way to run lightly comes through this skipping drill:

Use a short, quick gait.

One way to lighten the impact of running is to drop the foot very nearly under your hips. This should result in your shin being vertical or near-vertical. Look at the picture. Try running like #2. The skipping drill from above can help you feel that foot landing directly below your hips.

Runner #1 is pounding. Runner #2 is running lightly.

Want to run lightly? Run like #2.

Don’t concern yourself with whether or not you’re hitting on the heel, mid-foot or forefoot. Where the foot lands is more important than on what part of the foot hits first.

Quickening your cadence too much can be a problem. There is an obvious point at which gait can becomes too quick and inefficient. An excellent way to work on your cadence is to use a metronome. Kinetic Revolution has a great article that discusses research on cadence as well as how to introduce metronome running into your training. The article also links to a digital metronome that you can download.

Change takes work.

Running may seem like something we should all be able to do. In fact, most of us can execute some version of movement in which we rapidly put one foot in front of the other. Kids learn to run without detailed instruction and without much in the way of typical running injuries. Shouldn’t adults be able to do the same thing? Maybe or maybe not… If we hurt while running or if we think we’re too slow, then some sort of alteration to our running style may make sense.

Changing your gait takes some tinkering, some awareness and mindfulness. It won’t happen automatically. Physical therapist Rick Olderman helped me to change my running gait. He once said that “if it feels normal, then you’re doing it wrong.” He meant that in the early stages of changing how we move, it should feel weird and unnatural to us. Learning any new skill requires some struggle and awkwardness. If you practice frequently and work at it then things should improve at a reasonable rate.

Personally, I never listen to music while running. I pay attention to how I run, where my foot falls, how I move. I don’t want to fall back into bad habits.

Finally

I can’t guarantee that any of these changes will result in either a pain-free running experience or a podium finish in a race.Time with a physical therapist, podiatrist, chiropractor and/or a running coach may be what you need.  That said, these cues have helped my running as well as several of my clients’ running experience. I’ve also incorporated things like the short foot drill, ankle dorsiflexion work, and a wide variety of single-leg squats and lunges (here, here, here for instance) to improve my movement competence. Clearly, there are a lot of moving parts to consider when we run!

Got Dorsiflexion?

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The toes, feet and ankles get no respect. I’m not sure a lot of people walk into the gym and say, “Okay, today is foot and ankle day! Gonna work those parts hard and make ’em strong!”  We throw shoes on them and ignore them. Think about this though: It’s only every single step that we need those obscure parts to work correctly.

If we look at the body as a kinetic chain then we start to see that the feet and ankles don’t live in isolation. Movement or lack there of at the feet and ankles may create problems all the way up through the legs, hips, spine and shoulders. If an athlete doesn’t have sufficient motion at the ankles then he or she may not perform at his or her best.

Similarly, limited foot and ankle motion may be a contributor to pain. I’m not just talking about foot pain either. Again, if we consider the interconnectedness of all the joints and limbs of the body then it may not surprise us that faulty foot/ankle movement could contribute to back knee pain, hip pain, back pain — even shoulder or neck pain!

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Dorsiflexion: There’s no substitution for it!

In my observing both my clients and myself, I see a lot of us don’t quite have optimal  dorsiflexion. It’s easy to overlook but as I’ve argued, it’s very important. I know in my case, my various plantar fasciitis/Achilles tendon issues have improved as I’ve worked on my dorsiflexion. (Strictly speaking, I don’t know if limited dorsiflexion was a cause or effect of my foot and Achilles pain. That said, working on improving dorsiflexion
has coincided with those problems fading out.)

Dorsiflexion is more than just forward and back motion. There is always a 3D aspect to movement and we want to consider that. Also, We have a couple of different muscles (well… more than a couple but we’re considering mainly just two) that cross at the ankle. The following drills emphasize both the gastrocnemius muscle (the straight-leg drills) and the soleus muscle (the bent knee drills.)

Thoughts on 3D MAPS & Functional Training: Part I

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I recently attended a course called 3D MAPS. The course was presented by Dr. David Tiberio and it was offered through Gary Gray’s Gray Institute. I enjoyed the course and learned a lot. I’m now applying the concepts I learned in both my own training and in my clients’ programs. Here’s a rundown.

Overview

What is 3D MAPS all about? The Gray Institute describes it as such:

  • 3D – The human body moves three-dimensionally. All proprioceptors respond, all muscles react, and all joints move three-dimensionally. It only makes sense to analyze and progress the body three-dimensionally. 3DMAPS facilitates functional assessment and much, much more!
  • Movement – 3DMAPS leverages movements – lunges, reaches, squats – that are paramount to common, everyday movements and activities. These movements are authentic to the individual and relevant to what the individual does. While other screens, scans, analyses, claim to be functional, 3DMAPS actually is.
  • Analysis – 3DMAPS analyzes the entire body’s mobility (flexibility, range of motion) and stability (strength, control of motion) and then identifies a Relative Success Code specific to individual – based on symmetries, asymmetries, and disabling pain within the movements.
  • Performance – 3DMAPS enhances the function of the individual and progresses systematically and scientifically for optimal function and improvement.
  • System – Performance Movements parallel Analysis Movements, thus creating a seamless and intuitive process for both the practitioner and the patient / client.

As I see it, 3D MAPS is a movement analysis method that asks the client or patient to move through a wide range of motion in all three planes. As the client moves, the trainer continually asks “Is he/she showing adequate mobility?” and “Is he/she showing adequate stability?”

3D MAPS uses six lunges in three planes of motion to check mobility. In the saggital plane we have anterior/posterior lunges. In the frontal plane we have same-side lateral and opposite-side lateral. In the transverse plane we have same-side rotational and opposite-side rotational.

Six variations on one-legged squats are used to check stability. The same planes of motion are used as the lunges but instead of taking a full lunge step the client balances on one leg while reaching the other leg in the various different directions described above. These single-leg movements can be quite challenging and putting the foot down is allowed if needed.

In addition to the lunges and one-legged squats, clients swing their arms in the same three planes of motion as the lunges and squats.

3D MAPS movement patterns used to evaluate mobility and stability: anterior lunge, posterior lunge, opposite side lateral lunge, same side lateral lunge, opposite side rotational lunge, same side rotational lunge.

3D MAPS movement patterns used to evaluate mobility and stability: anterior lunge, posterior lunge, opposite side lateral lunge, same side lateral lunge, opposite side rotational lunge, same side rotational lunge. The lunge images are in black. The 1-leg squats are red.

Above are the basic movement patterns used in 3D MAPS. Trainers can “tweak” (in Gary Gray speak) in our out a wide variety of movement variables to make the movements more or less challenging. For instance, clients may lunge or one-leg squat without the arm swings or they may swing the arms without the lunges and one-leg squats. Lunges and one-leg squats may move in different planes from the arm swings.

The ground reaction force of the lunge may prove too challenging for some clients. A trainer can then simply ask the client to get in the lunge position and oscillate into and out of the lunge position.

The one-leg squat variations are designed to challenge the client’s balance and stability skills. They may be too challenging especially when the arm swings are used. Therefore a trainer may allow the free foot to tap down, tweak out the arms, keep the head steady (as opposed to moving with the trunk) or allow the client to hold lightly on to something for a little more stability. The idea here is to find the limits of someone’s stability but not to totally push them over the edge of his or her ability.

As we observe the client move we take note of the right/left symmetry of the client’s mobility, stability, and whether or not there’s pain present during the process. We note their successes and deficits as part of something called the Relative Success Code. This is a way of ranking their abilities from most to least successful and it helps determine our training or treatment process.

Strengths

Based on real-life

I feel the 3D MAPS process lives up to its “functional” billing. That is, it allows us to observe movements that are specific to many real-life situations. 3D MAPS speaks to the SAID Principle which says our bodies adapt specifically to the demands imposed on us. Real-life demands us to move in three dimensions, react to gravity and that our joints, limbs and muscles all work together to accomplish various tasks. We tend to stand on one or two legs while doing these tasks. For all these reasons I feel like 3D MAPS is superior to something like the Functional Movement Screen (FMS), sit-and-reach tests, 3-minute step test, crunch test, pushup test, timed plank test, etc.

(The concept of “functional” training has stimulated my thinking. I’m writing a blog post on that concept right now.)

Feels like exercise

Most of my clients find themselves working fairly hard as we’ve gone through 3D MAPS. It feels like exercise. Not all movement analysis systems deliver this feeling to the participants. The reality is that many of our clients come to us because they want to exert and sweat. If we can gain valuable information and give our clients a workout then that’s a very good thing.

Easy to teach

The Gray Institute does a good job of teaching how to teach. Dr. Tiberio and the online videos made it easy to understand the breakdown of the movement patterns and how to progress and regress them.

Opens clients’ eyes

If 3D MAPS reveals a mobility and/or stability deficit then my clients typically perceive it. They often very clearly recognize that they’re lacking in their ability to lunge and they can always tell if they have poor balance. This is valuable in getting a client to buy into the 3D MAPS process.

Further, I’ve found that following the 3D MAPS intervention blueprint often results in noticeably better stability and/or mobility. It’s always exciting to see results!

The search for success

A very interesting aspect of the 3D MAPS methodology (and the Gray Institute process in general) is that we first want to find where and how the client can move successfully. We then want to to gradually move in on their lack of success. This is in contrast to what I think most of us want to do and that’s dive right into the task that gives us the most trouble. I think we typically want to climb the biggest, toughest obstacle before we tackle anything less significant. (Maybe that’s just me…. Nah.)

There are a couple of ideas behind the process of moving from the most successful down to the least successful movement task. One is that we want the client to feel successful and confident. If he or she can do something well and feel competent and confident then they will likely have a generally good workout experience. He or she may feel encouraged to try more difficult work.

The other idea informing the most-to-least-successful process is based on the possibility that the nervous system will best be able to solve the most difficult movement task if we very gradually expose it to increasingly difficult work. This makes sense if we think of learning anything from a language to music to driving a car to skiing. We do best if we start with very simple tasks and then progress toward more difficult territory. This process makes sense to me.

Many options

As I mentioned earlier, there are many ways to “tweak” the lunges, one-leg squats and the arm swings. Trainers can have clients move their head or not. We can ask clients to speed up, slow down, and lunge or squat farther out or closer in. We can go with lower-body or upper-body movements only and we can have clients use either the upper or lower body in ways to increase or decrease stability requirements. Beyond the assessment aspect of 3D MAPS, we can have clients hold weights, medicine balls, cables, bands, etc. if we want to create a greater challenge.

Weaknesses

Not a great upper-body assessment

3D MAPS is a very good lower-body assessment but it seems limited as an upper-body assessment. It’s very difficult to observe scapular movement quality or humeral internal/external rotation quality. Further, while we can observe mobility and stability in the lower-body, 3D MAPS gives us virtually no indication of upper-body stability.

Better for global movement assessment than local assessment

For now, 3D MAPS gives me a big picture of how the person is moving. It doesn’t reveal a lot about individual joints. My criticism here will probably lessen as I become more familiar with and more skilled at using 3D MAPS. Proper use of “tweaks” should help reveal individual joint limitations.

Relative Success Code is difficult

The Relative Success Code is supposed to be simple but it’s not and from what Dr. Tiberio said, the Gray Institute knows that there’s more work to be done. We’re supposed to score the client’s movement from their best success down to their least and then start working from their best to worst movements. But with six lunge variations and six one-leg squat variations for both sides of the body there is a lot to try and see and score. The issue as I see it is that human movement is complex and we can only simplify it so much.

Scoring should be divided into mobility and stability

This is related to the previous criticism. 3D MAPS provides tests for both mobility and stability yet we’re only supposed to give the client a “+” if they show good mobility and stability, a “-” if they show poor mobility/stability or “- P” if they have pain on any test.

If we’re testing two things it seems we should give two separate scores on each test for stability and mobility. I imagine that every trainer and therapist who uses 3D MAPS will create their own two-part score. Dr. Tiberio acknowledged this during the presentation so I’m betting the scoring system will change soon.

Many options

One of its strengths can also be a weakness. There are near infinite ways to change the testing process as well as the training/treatment process derived from 3D MAPS. Initially it’s daunting when considering all the options. Like most any new skill, the more we use it the better we get at using it. This is a minor criticism.

My overall opinion

3D MAPS gets a thumbs-up from me. I use some portion of it daily with practically all my clients. More than anything I appreciate that the driving force behind 3D MAPS is actual real-life movement requirements. I love the emphasis on three-dimensional movement. Gary Gray maybe more than anyone in the industry insists that we always look at movement through a 3D lens.

Some of this gets complicated. It does take a lot of thinking and practice to feel comfortable using the system–but what new skill doesn’t take a lot of work to master?

Dr. Tiberio said something during the 3D MAPS presentation that I found wise and valuable to me. He said, “Don’t give up what got you here.” With that he meant don’t throw out all the training methods and tools that we’ve used to become successful trainers. Don’t rush too headlong into the shiny, brand-new, hottest thing that we’ve just learned (and likely not yet mastered).

His words spoke to me and some of my past experiences as a trainer. To my regret, I’ve thrown several babies out with various tubs of fitness bathwater. There were times I was convinced that I found the absolute best, most incredible absolutely most effective tool, exercise or system and I just had to push all my clients in the direction of said new-cool-thing. While in reality two things were probably true: A) Said new-cool-thing may not have been the miracle answer to all things I thought it was, and B) Some of my previous tools, exercises and systems were still valuable. The result was that sometimes either I, my clients or both of us were frustrated. With both Dr. Tiberio’s words and my own experiences in mind, I am trying to fold 3D MAPS into my training process in a way that’s both amenable to my clients and that doesn’t frustrate me as I get familiar with 3D MAPS.

What that means is that I typically work on some of the mobility/stability issues that I see in my clients but we may not spend the whole session on 3D MAPS-related issues. We still use barbells, kettlebells, the TRX and other training tools to perform non-3D MAPS-type exercises. I have found that a very good way to work on clients’ mobility/stability issues is to put 3D MAPS exercises in between sets of say bench press, deadlift, pull-ups, etc.

Further, if someone is preparing for an athletic tasks (I train several skiers and snowboarders for instance) then their sport dictates that they exhibit athletic skill during times of fatigue. I believe an effective way of training these athletes is to fatigue them in some way (with kettlebell swings for instance) and then require them to exhibit skilled mobility/stability (with some sort of one-legged squat for instance). Thus I’ve found that 3D MAPS work can easily be used alongside whatever other training modalities a trainer and his or her clients enjoy, so hooray for everyone!

That’s about it for now. My next post will speak to the idea of functional training and exactly what that term might mean.

 

 

Health & Fitness News: Pain Science, Breakfast – To Skip or Not to Skip?, Carbs vs fat (Whither protein?), 8 Glasses of Water Mythology

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Several articles have grabbed my attention. One is a concise summary of the current understanding of pain. Another discusses breakfast and the flimsy evidence supporting its importance. Next, science looks at the efficacy of reducing carbs vs fats for weight loss. Finally, drinking eight glasses of water a day is based on nothing.

Pain and lifting

The issue of pain is a continual theme in this blog. I’ve dealt with periodic bouts of lingering pain. The upside to this is that I’ve learned a lot about pain. Whether we’re an athlete or not, most of us will encounter non-acute or chronic pain.

It can be scary and depressing to us especially if it limits our ability to train. Interestingly, learning about how pain works can actually help us feel better (low-back pain in this case). Pain is NOT simply an indication of tissue damage. It’s very much a product of the brain. How we perceive our bodies (damaged or strong), our pain (threatening and scary or just a nuisance) and our expectations (“I’m broken and ruined,” or “I’ll be fine.”) are major influences on the pain process.

In that direction, Elitefts.com has a worthwhile article called 3 Things Lifters and Coaches Need to Know About Pain. It’s concise and fairly easy to understand for non-scientists. I think this information is useful for coaches and trainers who will certainly come across an athlete or client in pain. It may also prove helpful to you if you’re in pain. Here is a summary:

1. You are not your MRI or your X-Ray. Many people have tissue damage or degeneration on imaging but walk around without pain everyday. If you’re dealing with pain or an injury, get a thorough medical history and functional examination done by a qualified health professional, preferably one that works with athletes and lifters (they are out there).

2. Understand that pain (particularly chronic pain) isn’t purely related to biomechanics or injury. Biological and psychosocial factors both contribute to a person’s pain experience.

3. When working with clients, don’t create fear or a nocebo effect by berating your clients on their lifting technique, posture, or movement capabilities. Instead, work through your client’s issues with positive coaching and cueing to build a great training effect.

Read the article to get more detail.

Breakfast and weight loss

“Breakfast is the most important meal of the day.”

You’ve heard it. You believe. I’ve preached it to clients. It seems the earth rotates around this statement. But, is this bit of gospel based on anything of substance? Not really.

In The science of skipping breakfast: How government nutritionists may have gotten it wrong the Washington Post discusses research that shows the following:

“In overweight individuals, skipping breakfast daily for 4 weeks leads to a reduction in body weight,” the researchers from Columbia University concluded in a paper published last year.”

Another golden idol knocked from its pedestal! How can this be? Why would the USDA Dietary Guidelines for Americans tell us something that isn’t supported by good evidence?

The Post article does a good job of discussing the answer.

One of the key pieces of evidence, for example, examined the records for 20,000 male health professionals. Researchers followed the group for 10 years and published results in 2007 in the journal Obesity. They showed that after adjusting for age and other factors, the men who ate breakfast were 13 percent less likely to have had a significant weight gain.

“Our study suggests that the consumption of breakfast may modestly lower the risk of weight gain in middle-aged and older men,” the researchers said.

The advisory committee cited this and similar research, known as “observational studies,” in support of the notion that skipping breakfast might cause weight gain. In “observational studies,” subjects are merely observed, not assigned randomly to “treatment” and “control” groups as in a traditional experiment.

Observational studies in nutrition are generally cheaper and easier to conduct. But they can suffer from weaknesses that can lead scientists astray.

One of the primary troubles in observational studies is what scientists refer to as “confounders” — basically, unaccounted factors that can lead researchers to make mistaken assumptions about causes. For example, suppose breakfast skippers have a personality trait that makes them more likely to gain weight than breakfast eaters. If that’s the case, it may look as if skipping breakfast causes weight gain even though the cause is the personality trait.

It’s a reminder of the very important rule: Correlation doesn’t equal causation. Just because one detail appears alongside another detail, it doesn’t mean the one detail causes the other. (Tall people play basketball. Therefore one might conclude that playing basketball makes people tall. Is that right?)

Similarly we’ve seen a recent revision on dietary fat and cholesterol guidelines. We once thought that fat (particularly saturated fat) and cholesterol were the most evil of edible substances. Based upon flawed science, we were told to replace fat with carbohydrates and we’d all be well. Upon further review, it seems we may have been very wrong.

Low-carb vs. low-fat

Sticking with the diet and science theme, there’s been a lot of discussion on a recent study in Cell Metabolism that looks at low-carb vs. low-fat diets. This was a six-day study in a carefully controlled lab environment. The study had the same group of 19 obese participants spend six days on either a restricted-carb or restricted-fat diet. They then went home for several weeks for a “wash-out” period where they resumed their normal eating habits. The participants then returned and they were switched to the other diet. The same number of calories were cut from both diets, the difference being the calories came specifically from either carbs or fat. The participants were observed in a metabolic chamber and their caloric expenditure was very closely monitored. It was a well-designed study.

The result? The low-fat group lost more fat. Discussion over right? If you saw most of the popular-press headlines you’d think so. But there’s more to the story.

First question in my mind is “What about protein?” Though the jury is still out on some aspects of high-protein diets, several studies (here, here, here and here among others) suggest that high-protein diets can be useful for weight loss. The study doesn’t mention protein at all. Seems odd to me in that carbs, fat and protein are the main macronutrients in food. Why would we want to manipulate and study the effects of just two?

A good discussion of the low-carbs vs. low-fat study can be found at Examine.com. Really-low-fat vs somewhat-lower-carb – a nuanced analysis goes into some of the limitations of the study. This article is quite detailed. Read it all if you’re up for it. I won’t go into all of it but here’s a little bit.

One point to remember that this low-carb diet could be called a “lower-“carb diet in that some low-carb diets go much lower than this one. The Examine.com article says:

“The carb levels ended up being 352 grams for Restricted Fat versus 140 for Restricted Carb, and the fat levels 17 versus 108. In other words, (moderately lower carb than typical diets) versus (oh my goodness I can count my fat gram intake on my fingers and toes!).

This trial wasn’t designed to explore a real-life 100-gram-and-under low carb diet and especially not a ketogenic diet. Rather, it was a mechanistic study designed so that they could reduce energy substantially and equally from fat or carbs, but without changing more than one macronutrient. If they lowered carbs much more in the Restricted Carb group (like under 100 grams), they’d then have to go into negative fat intake for the Restricted Fat group. And negative fat intake is impossible (*except for in quantum parallel universes). One more note: all participants kept dietary protein constant and exercised on a treadmill for an hour a day.”

So it’s possible that if carbs were lowered further, we might see a different outcome of the study. Also, this was a six-day study. We must wonder what might happen over the course of six weeks, six months or six years.

Another very important point to remember is that this was a very tightly controlled experiment. It didn’t reflect the real world in which people trying to lose weight have to make their own food choices. Examine.com says:

And to repeat a very important point: this study was not meant to inform long-run dietary choices. In the long-run, the choice between restricting fat or restricting carbs to achieve a caloric deficit may come down to one thing: diet adherence.

While preference for certain foods may dictate which diet is easier to adhere to, this isn’t always the case. For instance, it seems that insulin-resistant individuals have an easier time adhering to a low-carbohydrate diet. Nowadays, new dieters often pair low-carb with higher protein, the latter of which can boost weight loss. And since there are plenty of high-sugar but low-fat junk foods (see Mike and Ike, et al.) but not so many high-fat but low-carb junk foods, low carb intakes can sometimes mean an easier time staying away from junk food when compared to low fat diets.

So we should remember that the dietary rubber meets the road when someone seeking weight loss can modify their diet in any healthy way and then stick to it for the long haul. If it’s less fat then great. If it’s fewer carbs, also great. If it’s some other improvement to the diet then wonderful!

Eight glasses of water a day is arbitrary

Another sacred cow of health and longevity is the admonition to drink at least eight glasses of water a day. That bunk has been debunked but much like a bell that’s been rung, it’s hard to change people’s minds once they’ve heard this information. The New York Times gets into this topic in No,You Do Not Have to Drink 8 Glasses of Water a Day. This one is simple. If you’re thirsty then drink. If you’re not then don’t. (How else would we have made it to the year 2015 if we didn’t have some sort of very good water gauge built into our physiology? Do my cat or dog think about the measured quantity of the water they drink?)

My Chronic Injury is an Addict

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I'm getting off the wheel.

I’m getting off the wheel.

I’ve had recent discussions with two clients about lingering injuries. The talks brought to mind how my approach to my Achilles tendon pain. I think this new mindset will prove essential to my staying healthy and avoiding future Achilles problems. Maybe it’ll be useful to you.

To be clear, I don’t currently have any Achilles pain. I’m able to run long, sprint, and trail run consistently with no trouble. I want to keep it that way for the rest of eternity and that’s what brought up these thoughts.

Both my clients and I have battled aches and pains in particular regions that have come and gone… and come and gone again over the course of time. Our shared narratives go something like this:

I have pain. I see a physical therapist or chiropractor. He/She prescribes exercises that help. They help. I quit doing said exercises. (Those exercises are BORING as hell. They don’t feel like exercise. They don’t feel like they’re making me stronger, leaner, or more powerful.) Pain comes back at some point. Repeat the process.

Does this chain of events sound familiar?

My aches and pains have caused me to miss training, miss races and forced me out of some of the activities that I enjoy with passion. I’d like to avoid this process, thus I need to do something different from how I’ve done things in the past, otherwise I can expect the same result as before. (We all know about the definition of insanity right?)

I’ve decided that my Achilles tendon is… well… my Achilles heel. It’s my weak spot. For whatever reason, this part of my body is susceptible to problems. Therefore it needs special consideration and care. I’m now motivated to continually do the things that seem to strengthen my Achilles tendon. I want to turn that weak spot into a bulletproof, iron-clad appendage that’s nearly indestructible.

That means almost every day I’m doing standing heel raises. Some days I do high-reps/low-weight. Other days it’s heavy-weight/low-reps. I do bent-knee heel raises and straight-knee heel raises. I do heel raises with a straight foot and with my foot turned in and out. Some days I do lots of heel raises. Some days I do fewer.

My point has less to do with heel raises to cure Achilles problems and more with my behavior and thinking around the problem. The point is that I now constantly tend to this thing that has been a problem for me. I view it as an ongoing project that will never really be complete.

The analogy I’ll make is to that of an addict. Overcoming addiction is an ongoing process. An addict is either getting better or getting worse but he’s never treading water and staying put. An alcoholic/coke addict/sex addict/shopping addict/whatever-addict is an addict forever. Like an addict, it would probably be more enjoyable for me to quit doing my dinky, boring exercises and tell myself that I’m OK. I could easily do whats comfortable and easy.

I could say, “I’m fine. I’m cured. I don’t need to worry about this problem. It’s behind me forever now.”

If I take that tact though I should expect my problem to creep back in, and I hate that thought.

Losing the ability to run and jump is a powerful source of motivation for me. With proper motivation comes the ability to apply willpower to the problem. With this mindset, the boring and tedious exercises become easy. Doing them isn’t an issue at all now.

As with almost everything we do in fitness (and everything else in the world) the real target here is the brain, not the injured/painful area. If I want continued success and progress then I must decide to take the appropriate action. If I want a specific outcome (Achilles pain gone forever, weight loss, muscle mass, etc.) then I must adopt the behaviors that will get me there. I need to make new habits. That requires conscious thought and deliberate action. The work won’t do itself.

So there.