The Benefits of the Single-leg Tubing Squat is for runners who want to build leg and hip strength that will transfer to running. This exercise may help you overcome knee and hip pain as well whether you’re a runner or not. There are three variations on this exercise and all are discussed in the article. This is my second article for Competitor Running. (Those pretty pictures were taken by my wife with her fancy new camera.)
This post is mostly the same as my recent article in CompetitorRunning.com. I discuss several exercises in the article designed to help runners overcome common painful issues related to running. For this post, I include pics and videos of the exercises. Here it is.
Pain Science for Runners
Acute vs Chronic Pain
Chronic pain is frustrating. Painful feet, ankles, knees, hips, and low-backs are common in runners. Chronic pain may bring fear that you’re broken, weak, and fragile. Thus you avoid many meaningful activities. You may obsess over your pain. This is the fear-avoidance cycle and it fuels itself.
Chronic pain is different from the pain of an acute injury such as a bone fracture; dislocation; or a cut, scrape, burn, or puncture. Chronic pain lasts long after an acute injury has healed.
Pain serves a valuable purpose but with chronic pain, the pain remains after it has served its purpose. Chronic pain comes from a “broken pain system,” akin to a car alarm that goes off for no reason. Fortunately, you can overcome chronic pain and start running again.
Tissue stress: Tissue stress can definitely contribute to pain. Remember though, tissue damage is typically a minor contributor to sensitization.
All of the above factors may be kindling for a pain fire. One too many stressors may spark the fire. You feel pain when the accumulation of stress exceeds your brain’s perceived ability to cope. There are two ways to tackle pain. One way is to decrease the stress that contributes to pain. Another way is to increase your resilience and get strong.
Confront your pain
You can lower nervous system sensitization in several ways:
General physical activity
Talk with a counselor
Various therapeutic techniques: massage, foam rolling, manual therapy, hot, cold
Consistent sleep schedule
Improve your diet
Load and strengthen the place that hurts.
Your bones, connective tissue, joints, and muscles are very strong and they respond well to loading. If you’ve been guarding and resting part of your body then it gets weaker. Structures like the Achilles and patellar tendons need strength, not more rest. Physiotherapist, chiropractor and pain expert Greg Lehman favors gradual strengthening as one of the best ways to reduce pain.
Get strong – Load it!
Loading strengthens muscles and connective tissue while and provides an analgesic effect. Physical activity boosts your mood, builds self-efficacy, and shows that you’re not broken. By engaging in exercise you break the fear-avoidance cycle. Here are several exercises to help with several conditions. A comprehensive guide is beyond the scope of this article.
Isometrics work well to calm pain. Contract and hold with no motion for 30-60 seconds. Perform isometrics frequently throughout the day.
Right: Heel raise loaded with a kettlebell for Achilles and plantar
fascia pain. Use a bent or straight knee.
Below: Wall sit for patellar pain. Progress from two to one leg.
Below: Straight-leg bridge for glute/hamstring pain. Progress from two to one leg.
HSR (Heavy Slow Resistance) training:
Exercises should be exhausting in 5-10 slow, deliberate reps. (Most of these can also be done as isometrics too.) Start with bodyweight then add weight via barbells, dumbbells, kettlebells, weight vests, machines, or rubber tubing/bands. Persist into pain no higher than a 4 on a 1-10 scale.
Heel raises for Achilles tendonitis can be done with a straight or bent knee.
Loading the knee and hip reduces knee pain.
Band knee & hip extension
Side bridges target abs and hip
Band leg press (A squat can be done in a similar way.)
IT Band syndrome
Band leg press (A squat can be done in a similar way.)
Exercise is medicine. If you’ve avoided running for a while then it’s time to run! A little bit of running will help you understand that you’re not broken and the physical activity will help calm your nervous system. You’ll use the process of graded exposure. Add work gradually, keep pain at a minimum, and you’ll increase your capacity for activity.
Try a run/walk protocol like this:
Week 1: 1 min. run/3 min. walk, repeat 10x
Week 2: 2 min. run/2 min. walk, repeat 10x
Week 3: 3 min. run/1 min. walk, repeat 10x
Week 4: 40 min. run
Perform each workout twice per week on non-consecutive days. Pain should be no higher than a 4 on a 10-scale (1 = no pain, 10 = very painful) and pain should not alter your running form. Don’t push through severe pain.
It’s not uncommon for pain to flare up after activity. Don’t be alarmed. You haven’t done more damage. You’ve pushed a boundary and your nervous system has overreacted. Reduce your activity level a little bit next time you exercise.
You may need more information beyond this article. A physical therapist or other medical professionals can help guide you through recovery. Injuries such as stress fractures definitely need to be unloaded and rested. If your pain gets worse with activity then seek medical care.
We typically visit a doctor, physical therapist, chiropractor or some other medical professional because we hurt. We go to be fixed. As part of the diagnostic process, he or she may tell us what’s wrong. Similarly, many personal training assessment protocols have the trainer take clients through some sort of movement assessment and we get to tell our new client where they’re tight, where they’re immobile, and what movement skills they lack. (Often the movements that make up these assessments are highly unusual to most people and they have little resemblance to anything we do in real life. No wonder so many people don’t score well.)
By framing the discussion in terms of “what’s wrong,” we enter into a negative state of mind. We may have walked in feeling fear, hesitation, shame, and pessimism about our inability to get out of pain and get in shape. When we’re labeled as “dysfunctional” then we will only feel worse — yet we came in seeking help! There’s a better way to discuss patent and client health.
Physiotherapist, chiropractor, and strength coach Greg Lehman advocates for being a “movement optimist.” In his seminar Reconciling Biomechanics with Pain Science, he suggests a better way to help our clients and patients is to start by telling them what they can do rather than what they can’t. People come to health and fitness professionals to feel good, get out of pain, and be strong. Our words matter. We can have a tremendous impact by setting the stage for success.
Lehman’s optimistic outlook mirrors some ideas from physical therapist Gary Gray. He advocates that in working with clients we start where he or she is successful. That means we find a movement with which they’re comfortable. We start where it’s easy. Then we progress gradually toward more challenging or painful movements.
For instance, if someone can’t balance well on one foot, we allow him or her to hold on to something or use their other foot to help with balance while he or she performs a movement task. Or, if someone feels knee pain with a forward lunge, but has no knee pain in a lateral lunge, then we start with lateral lunging and gradually progress to the forward lunge. If we start with success then we build confidence. If we allow the nervous system to move without pain then we help calm fears about pain and we facilitate more pain-free movement.
Research: Positive self-talk works.
Movement optimism isn’t just for clinicians and trainers. Patients, clients, and athletes have the power to help themselves. Research on positive self-talk shows that it has a measurable positive effect on strength and endurance.
“Adding mental training to your current program will likely boost your strength gains and may even decrease markers of physiological stress. Positive self-talk and first-person kinesthetic mental imagery absolutely don’t replace slinging around heavy iron, obviously, but they can help you get larger gains from your training program.”
“Take 24 volunteers and have them do a cycling test to exhaustion; give half of them a two-week self-talk intervention; and then do another cycling test to exhaustion and see if they’ve improved relative to controls. In this case, the answer was yes: the self-talk group lasted 18% longer (637 to 750 seconds) while the control group stayed the same. The rating of perceived exertion (RPE) on a 10-point scale also climbed more slowly in the self-talk group; in other words, they were able to convince themselves that the exercise felt easier.”
Hutchinson also discusses the effect of smiling (yes smiling!) while running:
“A new study in the journal Psychology of Sport and Exercise from Noel Brick and his colleagues at Ulster University explores precisely this question. They had 24 runners complete a series of four six-minute runs and measured their running economy (an efficiency metric based on how much oxygen you consume at a given pace), as well as perceptual outcomes, like effort. During the runs, the volunteers were instructed to smile, frown, relax their hands and upper body (by imagining, for example, that they were carrying potato chips between their thumb and forefingers without breaking them), or just think their usual thoughts.
“The results more or less supported the benefits of smiling. Running economy was a little more than 2 percent better when smiling—an improvement that’s comparable to what you see in studies of weeks or months of plyometrics or heavy weight training.”
(A note to curmudgeons: Your act is tired and childish. It’s a cry for attention that helps no one. Enough with the nonsense! Try something new! Do something that works. Or don’t…)
The brain is central to everything I’ve discussed. Pain science tells us that we are less apt to hurt if we feel relaxed, confident, and safe. In contrast, we’re more likely to feel pain if we’re stressed, anxious, and fearful. Clinicians and coaches have a huge opportunity to help people if we communicate in a positive way. Patients, clients, and athletes have the same opportunity when they communicate with themselves.
Poke the bear. (But don’t hump the s%it out of the bear.
I’ll get to the above statement in a moment. (Mom, I apologize but blame Greg for it. I’m just quoting what he said.)
I recently attended Reconciling Biomechanics with Pain Science, a two-day seminar with chiropractor and physiotherapist. Greg Lehman. (There aren’t too many people schooled in both disciplines.) The course was superb! I recommend the course to anyone involved in helping people move and get out of pain, whether you’re a trainer, coach, massage therapist, chiropractor, physical therapist, etc.
This is the cutting edge of pain science. The information may challenge what you hold near and dear as pain gospel, most importantly, pain doesn’t always equal damage. Nor should painful movements always be avoided. In fact, engaging in painful movement is part of getting past the pain and back to living.
This was another big dose of information with which I was familiar. Much like reading a book for the second, third, or 19th time, it’s always useful to revisit and re-examine important information. I came away with a deeper understanding of how pain works and how to work with it.
I’ll discuss what I learned and how I’ll apply this information to over the next several blog posts. Here’s my first takeaway:
You’re free to poke into pain
One of the best ways to overcome pain, regain function, and have fun doing what you love is to load the affected area. Does something hurt when you move it? If so, do the movement slowly and safely to the edge of your ability. Add a little more work over time. Work to the level of pain that you can tolerate. Load the movement to your tolerance. The idea and the expectation is that your tolerance will increase, your pain will decrease, and your life will improve. It may take time, but it’ll happen. This is called graded exposure. Pain is the bear that was mentioned at the top of the post. The concept is that you are free to gradually work to a tolerable level of pain but don’t grind and bash your way into severe pain. You shouldn’t limp, flinch, or recoil from the pain. No white knuckles, please.
If it’s a sore knee, then we’re going to use those parts and make them work. We may do squats, lunges, one-leg squats, hopping—whatever is tolerable. By poking into pain you can habituate to it and decrease the severity. Same with a sore ankle, shoulder, back, etc. Some other examples of pain that diminishes upon exposure:
You sprain your ankle and you “walk it off.” It hurts but you move it, load it, and resume activity to a tolerable level and you’re fine. The ankle might be sore so take it easy but don’t just rest it for days or weeks without using it.
You step into a hot shower and—Wow! It’s hot!—but it feels fine in a few moments. You accomodate. Similarly…
You get into a swimming pool and—Whoooo! It’s chilly!—and you’re fine in a few minutes. You adapt. (Strangely, the same process happens when you step out…)
You start a bike ride or a run and you knee bugs you a little. The pain vanishes in a few minutes. Did you suffer an injury that suddenly healed? No, but you had pain and your nervous system changed and then there was no pain. You’re fine.
Movement is a great way to desensitize the nervous system! Anyone who’s gone through post-surgical rehab for something like an ACL tear (me) has gone through this process. We’ve had to work through a certain amount of pain and discomfort as we progressed out of the injury and back into normal living. The crucial point is this: PAIN DOESN’T EQUAL DAMAGE. You’re not broken.
*****IMPORTANT DISCLAIMER***** I’m not talking about loading an acute, severe injury. If a bone is fractured, if you have a dislocation, if you suspect organ damage or if you’re bleeding then please don’t load it. In this case, you ARE damaged and you need medical help, not a trip to the gym. These conditions should be obvious.
I have vanquished the foe!
In my case, I’ve had some foot and heel pain which has been severe at times. I’ve curtailed my running and I’ve had to face the prospect of missing several big races this year. I’ve spiraled down a drain of negative thoughts and dread. Most runners have faced this overflowing toilet of fear, self-hate, and psychological nastiness. All that stress has only contributed to my pain. What will I do with this crisis? Can life go on???
On the first day of the lecture, I started loading those hurt areas. I sought out the sore spots and made them work. I did both isometric contractions and heel raises with bent and straight knees. I worked various angles and speeds. I worked to the point of local fatigue. My pain started to recede before the lecture was over. My nervous system was changing and my pain was retreating. My hurt spots hurt less.
The next day before the second lecture I went for an easy run. I continued with heel raises and toe work and I added weight to the exercises. My symptoms have only improved. Two days later I did a hard hill workout, a workout that would’ve been seriously painful and nearly unthinkable prior to my new hopeful mindset. I’m not broken! In fact, wouldn’t be surprised if I was made of vibranium… Maybe adamantium. You probably are too!
If there’s a foot problem then I’ve either had it or I’m going to get it. Currently, I’m battling a tasty little bit of metatarsophalangeal joint pain in my left foot. My symptoms are described to a T in this article from Merck.
I am frustrated but I can overcome it. I’ve overcome a host of other frustrating aches and pains. On that note, I’ve found a series of strength and mobility drills that I’m going to play with and see what happens. It’s from the innovative people at GMB.io. The full article is here. There are three videos in the article. I’m exploring this one now:
It’s easy to get confused when reading and listening to information about health, wellness, fitness, and exercise. We are often caught in the collision between valid science and pseudoscientific snake oil mumbo jumbo. Even when good research is discussed in the press it’s often reported without nuance by reporters who don’t understand the statistical methodology.
With that in mind, here are three recent articles which overlap in their coverage of back pain. Two reflect the current evidence on back pain. The other, in my opinion, is off the mark and may actually help reinforce back pain and the fear of pain.
“O’Sullivan says that rather than focus on the right posture, the ability to vary it and shift easily may be more important: ‘While it is appealing to think that if you sit up straight you will not get back pain, this is not supported by big studies across many countries.’ Indeed, while many websites swear that bad posture (usually defined as slumping, leaning forwards or standing with a protruding belly) causes everything from back pain to varicose veins and indigestion, there is no evidence that it causes general health problems.”
“…If you don’t have back pain, then do not give your posture one second’s thought – think about being healthy. Sleep deprivation and stress are more important than the lifting you do. Stress has a strong inflammatory role; it can make muscles tense. Most people don’t get that their back can become sore if they are sleep deprived.”
One thing to think about is the chicken-or-egg paradigm. That is, does “bad” posture cause back pain? (Evidence suggests it doesn’t.) Or could pain force us to adopt a certain type of posture that looks bad? My bet is on the latter. Related to low-back pain misinformation is the fearmongering around the myth of “text neck.”
If our concept of what causes back pain is misguided then it’s no surprise that many diagnostic and treatment strategies are ineffective. An article from the BBC titled Many back pain patients ‘getting wrong care’ discusses guidelines from a series of papers written by pain experts for the Lancet, a British medical journal. Several points to consider:
Strong drugs, injections and surgery are generally overkill, they say, with limited evidence that they help.
Most back pain is best managed by keeping active, they advise.
UK guidelines recommend a mix of physical exercise, advice, and support to help patients cope with symptoms and enjoy a better quality of life.
Health staff should not treat back pain or sciatica with equipment such as belts, corsets, foot supports or shoes with special soles.
The article suggests that we in the US bend forward “incorrectly” and thus we suffer more back pain than agrarian societies where they bend forward “correctly” and thus suffer less back pain. Is this claim true? Do we suffer more back pain than less-developed countries? Do people in other cultures bend forward differently than we do? The article offers no evidence beyond the writer’s casual observations to support the claims. Ironically, the article shows a picture of two rice farmers in Madagascar. One is bent forward “correctly” with a hip hinge, the other is bent “incorrectly” more through the low-back. I’m not sure how to interpret that picture.
My problem with the article is that it suggests there is a wrong way to lift and implies that doing so is a direct cause of back pain. Such fears lead to fear-avoidance beliefs (FABs). I’ve experienced this phenomenon and I’ve seen it in others.
Recall that in the first article I discussed, we learned that sitting posture doesn’t relate much to back pain and that in fact emotions and lack of sleep were stronger predictors of back pain. My bet is that we might see a similar dynamic with regard to lifting posture.
Some of the information is useful, specifically the instructions on hip-hinging (a technique I regularly teach to clients) are worth knowing. By using a hip-hinge method to lift things from the ground, you will engage the glutes and hamstrings which are big, strong muscles. The hip hinge should allow a lifter to generate more force so he or she can lift a heavier object. The hip hinge also effectively distributes the forces of the lifting of a heavy object throughout the body rather than concentrating it in one place.
As a counterpoint to my own statement though, look at this. It’s Austrailian strong-woman Sue Metcalf picking up 246 lb. atlas stone with a technique that the NPR article would call unsafe.
I think that if lifting a heavy object, then it’s prudent to use as many muscles as possible to do the job and to generally be careful. Nothing wrong with that. But if bending down to pick up a pen, a shoe, a ball — or possibly a giant atlas stone— and if there’s no underlying acute injury, then we should feel free to move the spine. The spine is comprised of 33 bones, 24 of which are moveable. So why not move them? I wish the press were better at discussing these nuances.
If the problems inherent to bad science interest you, then you might want to pay attention to the words of Dr. Ben Goldacre, epidemiologist, has to say.
Springtime is hurtling our way and that means it’s time to trail run! I’m working up to what is for me a pretty giant bite of a trail race this fall. I have several races on the schedule as I work up to the final big event in September. They are these:
Dirty 30, June 3, Golden Gate Canyon, CO – I’m running the 12-miler
Pikes Peak Ascent, August 18, Colorado Springs – 13.32 miles. I’m not running the full marathon, I’m only “running” up to the top.
The Grand Traverse Run, September 1, Crested Butte to Aspen – 40.7 miles!? My god, is that right?! Amazingly, 40-ish miles is sort of small potatoes in the world of ultra-running.
The best part of this is that I love trail running and I love the process! I love the training I did last year for the Imogene Pass Run. Being in the mountains is… exquisite. Language doesn’t suffice… It’s more than fun. Trail running is a deeply spiritual thing for me. I have enormous enthusiasm toward the preparation for the Grand Traverse, and I’m grateful to get to do it.
Time to suffer
I’m reading Endure by Alex Hutchinson. It’s an excellent book. An ever-present concept, maybe the foundation of the whole book, is the experience of suffering. Suffering defines endurance. We don’t have to endure that which doesn’t induce suffering.
As it pertains to my races: There will be suffering…. especially in the Grand Traverse. I’ve suffered in two marathons and the Imogene Pass Run. I suffered through a bad half-marathon. I’ve biked up Mt. Evans twice. There’s some suffering. Two-a-day football practice in the Texas summer = suffering. The Grand Traverse is almost 41 miles, about 6200 ft. of climbing and 7000 ft. of descending. That equates to more suffering than I’ve ever experienced. I will suffer for many hours. Every bodily fiber from my toes to my eyebrows will be in agony. I will despair, get angry, and maybe feel hopeless. I’ll want to quit, maybe multiple times. How do I get through that?
One thing I won’t do is try to ignore the pain. It can’t be done. Research has shown a more effective way to manage pain and suffering is to inspect your pain in a clinical way and have a calm conversation about your suffering. There’s a difference between pain and the emotions we feel about pain. Awareness and examination of this divide can help lower the perception of pain and suffering. I am in control of my thoughts on pain. This will help.
Much of Endure compares “mental” vs. “physical” endurance. (In truth, there is no difference between mental and physical. It’s all atoms and molecules. It’s all connected. There should be no delineation. Try having a mind without a body or vice versa. Rene Descartes was wrong. Maybe it’s useful to say “psychological” vs. “mechanical” endurance to indicate the perception of pain by the brain vs. the muscles’ inability to generate high force.) I’m learning about the multitude of ways and the degree to which the brain generates feelings of effort, pain, and suffering during exertion. The best athletes don’t suffer less than everyone else. They are able to suffer more and manage their suffering better than the rest of us. Hutchinson gives evidence that we are probably capable of far more effort than we believe possible. Based on my learning, I plan to make my difficult runs very difficult. I plan to push myself harder than I have in the past when the time is appropriate. The idea is to get intimately acquainted with a high level of suffering That’s not to say most of my running should be grueling. That’s not the right way to train. But when it’s time to push hard, I’m going to push hard. I’ll be testing this strategy in the races leading up to the Grand Traverse. I need to find out how hard I can push, how hard I can suffer.
Also, in 2-3 weeks I’ll have an article appearing on Tnation.com — and they’re paying me for it! I’m not sure I’ll win the Pulitzer but I’m very excited that I can technically call myself a professional writer. I’ll post a link to the article here when it comes out.
The posterior tibialis (PT), and the gastrocnemius, soleus, and plantaris, (all muscles that attach to the Achilles tendon) overlap to some degree in how they function in gait. What do those muscles do you ask?
Concentric function (when the muscle contracts and shortens): plantar flexion (points the foot), inversion (sole of the foot turns in)
Eccentric function (when the muscle lengthens): decelerates dorsiflexion (bending of the ankle), decelerates eversion (sole of the foot turns out)
In the case of my Achilles pain, I found relief from strengthening those calf muscles through doing a lot of slow, controlled heel lifts. I thought the same approach would resolve my PTT. I was wrong. I believe that my efforts at strengthening the PT and the PT tendon aggravated the problem and caused more foot pain. I believe my PTT was rooted in a rigid left arch and rigid plantar fascia.
Plantar fascia flexibility, pronation, and force distribution
For years I’ve noticed that my left arch doesn’t pronate (collapse) as much as the right. I believe this lack of movement is part of my problem. In my prior post, I asked the question, “Do you have the mobility to get into the position required by your activity?” As it regards my left arch and running, my answer was, “No.”
Among many runners, the word “pronation” equates to “bad.” That’s wrong. (Uncontrolled or excessive pronation is bad.) Pronation is a necessary movement that contributes to deceleration of the foot, lower leg, and the rest of the body during foot strike. As the arch collapses, the plantar fascia acts as a leaf spring, storing then returning valuable energy that helps propel the runner forward. This energy return occurs as the foot supinates with the arch lifting as the runner pushes away from the ground.
The plantar fascia isn’t the only participant in this process of energy absorption and return. All the muscles and connective tissue throughout the body contributes to the process. The tendons of the lower leg, such as the Achilles tendon and the posterior tibialis tendons, are highly active during this process. If everything is moving correctly, in control, and in a coordinated fashion then the impact forces of running are distributed efficiently among all of the muscles and tendons.
Now imagine if some link in this kinetic chain isn’t moving the correct way. If that happens then other regions and other structures of the body will be forced to handle more than their fair share of the load. Some sort of overload, injury, and pain is likely in this scenario. Specific to my case, I believe the lack of mobility of my left plantar fascia has contributed directly to my past Achilles tendon problems, plantar fasciitis, and to my recent bout with PTT. Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice is a literature review from the Journal of Athletic Training. This reviewprovides the following pertinent comments:
“Researchers have also reported faulty biomechanics and plantar fasciitis in subjects with a higher-arched foot.16–18 A higher-arched foot lacks the mobility needed to assist in absorbing ground reaction forces. Consequently, its inability to dissipate the forces from heel strike to midstance increases the load applied to the plantar fascia, much like a stretch on a bowstring.4
“A review of the literature reveals that a person displaying either a lower- or higher-arched foot can experience plantar fasciitis. Patients with lower arches have conditions resulting from too much motion, whereas patients with higher arches have conditions resulting from too little motion.4,16,19 Therefore, people with different foot types experience plantar fascia pain resulting from different biomechanical stresses.”
(The article is thorough and informative about foot mechanics. If you’re a runner suffering from foot problems, a running coach, or a clinician who treats these issues then I think it could be valuable to you.)
Exercises that helped
I foam rolled the calf. You probably know how to do that. If not, look on Youtube.
Band eversion/dorsiflexion: It’s one of the exercises discussed here. I did and continue to do the exercise with very high reps. It looks like this:
Dorsiflexion/Eversion. Think of pulling the pinky toe up and to the outside of the knee.
Bent-knee heel raises: I used high reps but there is probably benefit to using heavier weight with fewer reps. There are machines for this exercise at many gyms. I don’t have access to such a machine so I did it by stacking up some sandbags under the front of my foot and putting a dumbbell on my knee. I worked to high exertion for several sets:
Arch mobilizer: It takes time to make changes to tissues so I do this frequently throughout the day.
Gait check: This is HUGE! In my first meeting with running coach Andrew Simmons of Lifelong Endurance, he noticed several problems with my gait. These were problems seen in the past with my gait.
(This illustrates the immense power of working with a coach. I don’t know what I don’t know and I can’t see what I can’t see—and neither can you! My technique had slipped and I didn’t know it.)
My ground contact time (or how long my foot was on the ground) was too long. Thus, my feet and lower legs spent a lot of time transmitting stress through my lower leg. That may have been a part of overloading the PT tendon. This long contact time was probably a result of…
A low-energy gait. My legs weren’t rebounding off of the ground sufficiently and the whole gait cycle was sluggish. Now, as I run, I think of a strong, quick, powerful push into the ground. I drive the leg behind me, and I push the ground behind me.When I run correctly, my foot spends less time on the ground and the tissues spend less time under stress and I’m more efficient. Read How to Run: Running With Proper Biomechanics by Steve Magness for details on running technique including the need for hip extension.
Solving the riddle of the sore left foot has been a prolonged, tricky struggle. Every time I find relief I think I’ve solved the problem only to have some other problem pop up later. That said, I now think I’ve figured it out. I could be wrong. Maybe some of this information will help other runners overcome their foot and ankle troubles too.
1. Do you have the mobility to get into the position required by your activity?
For example, if you’re a powerlifter, can you squat to the depth required for competition and maintain the posture required to keep the bar on your back? Or, if you’re an Olympic lifter, can you drive the bar directly overhead during the jerk? If you’re deadlifting, cleaning, or snatching, can you get into the start position without excessive rounding of the spine? If you work in the garden can you kneel down to the ground and get back up without pain? If you swim or play tennis then can your shoulders move through the overhead position needed for a swim stroke or a tennis serve? Why is this question important? If one joint doesn’t have enough mobility for your chosen movement, then you’re still going to perform the movement somehow. The poorly moving joint(s) will steal movement from your healthy joint(s). If that happens then it’s a set-up for pain and weakness as the victimized joints and tissues will be overstressed and your ability to move will be compromised. That ain’t good! If you can restore range of motion to those limited joints then you’ll feel better, move better, and you’ll be stronger.
2. Can you control the mobility that you have?
Can you control your knees at the bottom of the squat, or do your knees crash inward suddenly? During a lunge, can you step out and come back home in control, or do you lose balance during some portion of the movement? While bench pressing, dipping, or pressing, do your elbows stay in alignment or do they flare and wiggle around during some portion of the lift? During any lift, are you in control of the weight or is the weight controlling you?
I compare poor movement control (aka motor control) to a door hanging on loose hinges. The door can still open and close but the door bangs around, the hinges and the wall sustain damage, and eventually, the door falls off. Similarly, if you’re not controlling your limbs then your joints and connective tissue will take a beating and eventually you’re going to hurt. Lack of control is often seen at the end-range of motion. (End-range is where you feel a big stretch.) If you follow the work of physical therapist Gary Gray, then you may know end-range as the “transformation zone.” That’s where a limb stops and changes direction. For example, think of a weightlifter at the bottom of a squat before he/she drives back up. Or think of a baseball pitcher or a quarterback with his arm cocked back right before he brings the ball forward. Two dynamics are at play at end-range.
First, we don’t spend a lot of time at end-range of motion. End-range is where our nervous system has the least experience and thus the least ability to control our limbs. It’s sort of like being in an unfamiliar city and not knowing how to navigate.
Second, we have the fewest number of cross-bridges available for muscular contraction at end-range. Fewer cross-bridges means our muscles can’t generate as much force as they can at mid-range. That makes it more difficult to control end-range
Ask yourself these two questions as you workout and move through your day.