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.

NSCA Endurance Clinic Summary: Day 2 (I forgot to summarize the final presentation.)

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Maybe I was in a rush to post the Day 2 summary, I’m not sure.  I forgot to summarize the final presentation of the day.

Dr. Jeff Matthews: Running Injuries – The Big Picture

  •  DC, CCSP, CCEP, 1996 USAT National Team, high school track coach
  • Primary shock absorber of the body: FOOT PRONATION
    • Pronation isn’t a bad thing–it’s supposed to happen.
    • Posterior tibialis controls pronation via eccentric contraction
  • Secondary shock absorber: knee flexion
  • Aches & pains of the leg, foot and toes
    • Metatarsalgia
      • Pain at the metatarsal phalangeal joint as the heel leaves the ground too early.
        • Causes
        • limited ankle dorsiflexion
        • tight gastrocnemius
        • weak digital plantar flexors
      • Treatment
        • stretch gastroc with straight leg
        • increase distal plantar flexor strength
        • rigid forefoot in shoes
        • decrease stride length & employ heel strike
      • I have off and on metatarsalgia.  I’m going to work the toe flexors, particularly the flexor hallucis brevis.  I’ll use a band.
    • Hallux limitus and rigidus (aka Turf Toe)
      • Dancers and defensive backs get this as a result of doing a lot of stuff on their toes.
      • Loaded dorsiflexion of the big toe should be 42 degrees at toe off.
      • To check: Sit with knees bent at 90 degrees.  Lift toe with finger while foot is flat on the ground.  If it’s less than 30 degrees then you’ve got a problem.
      • Stretch toe flexors: Pull toe back 20-30x/day.
      • Restore joint motion to big toe.  I’ve been playing with this stuff quite a bit lately.  I’ve got a constantly tight left calf.  I’m wondering if restricted toe dorsiflexion is part of the problem.
      • I’m not only working to stretch the FHB, but also to strengthen it so my big toe can grip the ground.
      • Here’s a good big-toe mobility video:

    • Insertional Achilles tendonitis
      • occurs near the base of the AI
      • common in high-arched, stiff feet
      • common with Haglund’s Deformity.
      • Seems I have a bit of this; more along the lines of a bursitis from what I cant tell.
      • Strengthen with eccentrics.
      • He says “Work on the front of the tendon,” as that’s where the blood flow comes from.
    • Achilles Paratendonitis
      • He describes this as occurring with an audible squeak or creak–I’ve had that!
      • An inflammation of the sheath around the tendon
      • Work on the front of the tendon to increase blood flow.
    • Achilles non-insertional tendonosis
      • degenerative non-inflammatory condition from repeated trauma
      • treatment
        • rest
        • muscle work to stimulate fibrolasts to remodel
        • when appropriate, strengthen posterior tibialis and flexor digitorum longus
        • How do we strengthen the FDL?  Here’s one way:

    • Patellofemoral Pain Syndrome aka runner’s knee
      • comes from abnormal femoral movement
      • hip muscle weakness is the cause; increases with fatigue
      • Testing for PFS: 1-leg squat & check for 3 things:
        • leaning toward stance leg to maintain balance
        • knee caving in
        • falling
      • Treatment
        • retro patellar pain: recruit/strengthen the vastus medialis oblique (VMO)
        • stretch hips, foam roll quads, increase hip flexor strength
    • IT Band Syndrome (ITBS)
      • strengthen hip abductors
      • decrease tension on the tendon with soft tissue therapies
      • stretch glute max and TFL
      • may take 6 weeks (Didn’t take me that long to overcome mine.)
      • Check out my post on IT Band issues for more help.
    • Popliteus tendonitis
      • The popliteous unlocks the knee from the extended position.
      • inserts under the IT band and can cause lateral knee pain
      • if weak then knee may stay locked and send shock to the back
    • Treatment
      • Strengthen the popliteous
      • soft tissue therapy
      • control pronation (probably with foot strengthening drills and more importantly, HIP ABDUCTOR exercises)
      • Here’s a video on recruiting and strengthening the popliteous

  • Hamstrings
    • Hamstring strains have the highest recurrence rate and can take 4 months to resolve
    • Semimembranosus protects the medial meniscus during knee flexion
    • long head of biceps femoris helps stabilize SI joint and is most frequently injured in runners because of the long lever arm decelerates knee extension
    • more proximal the injury the harder to treat
    • Treatment
      • increase length, strength and flexibility
      • evaluate pelvis
      • strengthening abs/stabilizing pelvis can position pelvis correctly thus putting hamstrings at proper length
  • Low back pain
    • Pain causes weakness/looseness
    • Internal or external femoral rotation may become problematic.
    • Treat hips
    • A TFL problem = a glute medius problem.  This is huuuuge to me!
    • Seems to me that sitting too much is maybe the main problem here.

 

 

Summary of the NSCA Endurance Clinic: Day 2

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Day 2:

  • Dr. Carwyn Sharp – Role of Strength Training & the Endurance Athlete
    • Factors determining successful endurance performance
      • VO2Max – Not nearly as important as we’ve thought for years
      • Lactate/Anaerobic Threshold
      • Economy of Movement
      • Velocity at onset of blood lactate accumulation (vOBLA) – This may be the most important.
      • We need to think of ways to increase performance, not just measurements like VO2Max.
    • Improving Running Economy (RE)/Economy of Movement (EM):
      • strength
      • speed
      • power
      • More force into the ground/pedals/water = speed
      • More force comes from more strength
      • Heavy strength training and plyometrics are best
      • Both are shown to improve vOBLA
      • Plyometrics need to look like running: 1-leg hops, bounds, skipping.  This is SPORT SPECIFIC TRAINING.
    • Good idea to cut strength training during a taper.
    • Strength training guidelines
      • heavy weight training:
      • 3-5 sets of 3-6 RM
      • with 3-5 minutes rest between sets
    • Plyometrics: most convincing performance results.
      • varies depending on training status, mode and intensity
      • work: rest of 1:5 to 1:10
      • 80-140 foot contacts per session; fewer for beginners
        • 2-foot landing counts as 2 contacts
        • 1-foot landing is 1 contact
      • FIRST THERE MUST BE A SOLID STRENGTH BASE!
      • Donald Chu, Jumping Into Plyometrics
  • Coach Jay Johnson, MS – The Strength & Conditioning Coach Meets the Running Coach
    • former collegiate runner and running coach at CU Boulder
    • coached 3 U.S. Track & Field champions
    • 6 main points
      • Athleticism
      • Runners (and everyone else) need to first have a base of athleticism
      • good movement in 3 planes of movement
      • full ROM at the joints
      • strength
      • He builds aerobic metabolism on top of this foundation of athleticism.
      • The idea of athleticism is massively important!
    • Why did your athlete/client get better?
      • Did they simply go from being sedentary to being active?
      • Or did they get better because of the program you designed?
    • Understand the role of glycogen
      • The body must be trained to use lipids as fuel
      • This syncs with Seebohar’s discussion on glycogen.
    • Development of the aerobic metabolism is the most important factor for peak running performance.
    • Runners must  do non-running work to stay healthy.
      • GSM (General Strength & Mobility Work)
      • Gary Gray’s 3D lunge matrix.  I’ve played with this in the past.  I’ve returned to it.  Here’s a video

  • Keep the easy days easy and the hard days hard.
    • Do the intense strength/plyometric work on the hard running days.
    • Take it easy on the off days.
    • This is a key part of the periodized plan
    • His discussion on periodization was very helpful to me
    • Macrocycle
      • When it’s time to progress the runs, do so on the hard days.
      • Run easy or rest on the easy days.  Never up the intensity of easy days.
      • A complete day off every 14 days is a good idea
      • Take an active rest week after every 5k, 10k, and half-marathon
      • He takes three weeks after a marathon.
    • Microcycle
      • 4 days/week running
      • Monday – recovery day: Do strides on Monday; 4-5 x 20-30 seconds at 5k pace with 1 minute easy jogging between reps.
      • Tuesday – workout: High level aerobic workout or race pace workout.  Can include:
        • Threshold/tempo run or
        • Fartlek run or
        • Progression run or
        • Long repetitions or
        • Alternate the above with race pace workouts week to week
      • Wednesday – aerobic cross-training
      • Thursday – off or cross-training
      • Friday – easy run day w/strides
      • Saturday – long run
      • Sunday – brisk walk
    • The lunge matrix is done before every run
    • Runs follow with general strength and mobility work and Active Isolated Stretching
    • Here’s a link to Johnson’s 8-week strength progression.
    • This may have been my favorite lecture.  Johnson did a fantastic job of taking academic information (physiology, periodization, race pace training) and telling us in simple terms how he implements these things.  His point on athleticism was HUGE to me. I plan to contact him for coaching this coming season.
  • Nick Clayton, MS, MBA, CSCS,*D, RSCC – Functional Training for the Endurance Athlete
    • This was an active demonstration in the performance center, not a lecture.
    • Sport specific movement that mimics body position, speed of contraction contraction type of said sport
    • trains the body as an integrated unit
    • Primal movement patterns
      • squat
      • lunge
      • lift
      • push
      • pull
      • twist
      • Squat progression
        • 1-leg balance
        • 1-leg squat
        • 1-leg squat in multiple planes and with other body movement
        • 1-leg squat jump to deceleration
      • Lunge progression
        • stationary with narrow base
        • multi-planar
        • multi-planar with reaching
        • split squat jumps with focus on quiet deceleration
      • Lift (deadlift related movements)
        • hip hinge and balance progression
        • 1-leg Romanian deadlift/deadlift
        • kettlebell swings
      • Push/Press: Discussed mainly addressing the postural and scapular considerations of safe and effective pushing in sport training
      • Pull:
        • Shoulder stability patterns:
        • Y, T, I, W, stability ball roll-out
        • I liked these patterns.  I’m using them now as part of the warm-up or as correctives as needed.
      • split stance dumbbell row
      • cable “lawnmower”
        • It’s a single-leg cable row with a hip hinge.
        • This is a running pattern. Here’s a demo

Prior to the strength and plyo demos, we went through a really cool walking/lunging mobility process. Nick said he was going to email out videos of the warm-up and when/if he does, I’ll post them here.  I may video it myself.

Getting out on the floor to play with these exercises was a lot of fun.  I really liked the 1-leg plyo work.  I definitely got some valuable ideas that I’ll implement in my own training and with my clients. I also liked the shoulder patterns a lot.  I’ve seen the Y, T, I, W patterns before but I understand them better now.  I think it’s key to KEEP THE SHOULDERS AWAY FROM THE EARS WHILE YOU DO THESE.

  • Randall Wilber – Training and Competing in a Hot and Humid Environment
    • Dr. Wilber discussed in great detail how he helped Deena Castor (bronze) and Meb Keflezighi (silver)  prepare for the Athens Olympic marathons in 2004.
    • While not terribly important to my goals, some of this information was new and very interesting.
    • 2 ways to prepare for heat/humidity:
      • Natural acclimatization
      • Arrive 10 days to two weeks out
      • Gradually adjust timing of high-intensity and low-intensity workouts (two-a-days)
      • Gradually creep the workouts towards the heat of the day such that the final day has a HI workout near noon and a LI intensity workout in the evening.
      • Pre-acclimatization (Deena and Meb both did this prior to Athens.)
        • Very simple: Train in more clothing to make the body hot and thus approximate the hot conditions in which you’re to compete.
        • Arrive a few days ahead of the event and do your final workouts.
      • Cooling strategies
      • clothing
        • no cotton
        • lightweight and light color
      • sunscreen: avoid it as much as possible as it clogs pores and inhibits sweating
      • ice packs/towels
      • ice vest
      • Apply cold/ice to hands and feet: I’ve noticed on my own how  in cold weather, I can put on gloves or take off gloves and experience a significant change in my overall temperature.
      • whole body immersion: showers, tubs
      • ice drinks (like Slurpees)
      • Stay as cool as possible right up to the event.
      • Consume more sodium while training in the heat.
  • David Bertrand – Managing the Endurance Athlete
    • MS, USA Triathlon Level II Coach, lectures at SMU in the Applied Physiology Dept, head of DFI Tri Club, Dallas
    • Athlete selection:
      • Very important to coach people with whom you mesh
      • You may not be the best coach for everyone
      • Curiosity: He needs to feel curious about his clients and their goals.
      • “Training with David” document: This was very insightful
        • What does training with David bring…
        • coaching philosophy
        • requirements
        • rates
        • weekly training availability
        • how training is delivered
        • training jargon and abbreviations
        • I need to develop a document like this w/my name in place of David’s
    • Coaching styles and methodologies
      • autocratic: best for groups with both high and low cohesion
      • democratic: best for groups with moderate cohesion
      • Display a vision.  Express belief in the athlete
      • Buy-in: “Here’s how were going to do it.”
    • Communication
      • How am I most effective?  1-on-1?  Small groups?  Big groups?  Ask my clients.
      • LISTENING IS VITAL!
    • Training intensities
      • Most people go too hard.
      • This is in sync with Wilber’s advice that a little undertrained is far better than a little overtrained.
      • HR monitor can help keep athletes in check.
    • Writing and adjusting the plan
      • Adjusting the plan: This is your greatest value to them.  This separates you from the cookie cutter programs.
      • Most people need MORE RECOVERY, not more work.
    • Best practices
      • Don’t over-coach: Take 1 or 2 things and ask, “What did we focus on today?”  Less is more
      • Strive to learn.  Stay curious.  He told a great story about Jon Wooden.
      • Select days of the week for specific tasks.  Get organized.
      • Help athletes with something beyond just training.  Can you inspire them?
    • David gave a really superb lecture on what I call “filling in the cracks.”  That is, he spoke to issues beyond just physiology, heart rate, strength programs and other science. He talked about his time in the trade and how to actually work with human beings. I got a lot out of the lecture even though I’m not a tri coach nor do I plan on becoming one.

 

Interesting and Informative Information: Fat Isn’t So Bad, Skimpy Research on Injury Prevention in Runners

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Read this!  Learn things!

What if bad fat isn’t so bad?

“Ronald Krauss, M.D., won’t say saturated fats are good for you. ‘But,’ he concedes, ‘we don’t have convincing evidence that they’re bad, either.'”

I’ve written here that I’ve been persuaded that not only is fat good for us, that “bad” saturated fat is also at the very least not as bad for us as we’ve been led to believe.  I found another article to further support my thoughts.  What if fat isn’t so bad? is a 2007 article from NBC News.  In it, we get a good dissection of the various flawed studies by which we’ve arrived at the idea that fat–particularly saturated fat–is pure evil.

The article discusses among other things Ancel Keys’s landmark Seven-Countries Study from 1970. This study did more to advance the fat/cholesterol/heart disease link than anything else around. This study went on to frame our current low-fat guidelines. Seems the conclusions that were drawn were quite inaccurate.  From the article (emphasis is mine):

“The first scientific indictment of saturated fat came in 1953. That’s the year a physiologist named Ancel Keys, Ph.D., published a highly influential paper titled “Atherosclerosis, a Problem in Newer Public Health.” Keys wrote that while the total death rate in the United States was declining, the number of deaths due to heart disease was steadily climbing. And to explain why, he presented a comparison of fat intake and heart disease mortality in six countries: the United States, Canada, Australia, England, Italy, and Japan.

The Americans ate the most fat and had the greatest number of deaths from heart disease; the Japanese ate the least fat and had the fewest deaths from heart disease. The other countries fell neatly in between. The higher the fat intake, according to national diet surveys, the higher the rate of heart disease. And vice versa. Keys called this correlation a “remarkable relationship” and began to publicly hypothesize that consumption of fat causes heart disease. This became known as the diet-heart hypothesis.

At the time, plenty of scientists were skeptical of Keys’s assertions. One such critic was Jacob Yerushalmy, Ph.D., founder of the biostatistics graduate program at the University of California at Berkeley. In a 1957 paper, Yerushalmy pointed out that while data from the six countries Keys examined seemed to support the diet-heart hypothesis, statistics were actually available for 22 countries. And when all 22 were analyzed, the apparent link between fat consumption and heart disease disappeared. For example, the death rate from heart disease in Finland was 24 times that of Mexico, even though fat-consumption rates in the two nations were similar.”

The large-scale Women’s Health Initiative is discussed:

“We’ve spent billions of our tax dollars trying to prove the diet-heart hypothesis. Yet study after study has failed to provide definitive evidence that saturated-fat intake leads to heart disease. The most recent example is the Women’s Health Initiative, the government’s largest and most expensive ($725 million) diet study yet. The results, published last year, show that a diet low in total fat and saturated fat had no impact in reducing heart-disease and stroke rates in some 20,000 women who had adhered to the regimen for an average of 8 years.”

Several other studies are discussed.  The comment from the article on these studies is this:

“These four studies, even though they have serious flaws and are tiny compared with the Women’s Health Initiative, are often cited as definitive proof that saturated fats cause heart disease. Many other more recent trials cast doubt on the diet-heart hypothesis. These studies should be considered in the context of all the other research.”

The article goes on to discuss the subtle differences between the types of LDL or “bad” cholesterol.  Seems that all LDLs aren’t created equally:

“But there’s more to this story: In 1980, Dr. Krauss and his colleagues discovered that LDL cholesterol is far from the simple “bad” particle it’s commonly thought to be. It actually comes in a series of different sizes, known as subfractions. Some LDL subfractions are large and fluffy. Others are small and dense. This distinction is important.

A decade ago, Canadian researchers reported that men with the highest number of small, dense LDL subfractions had four times the risk of developing clogged arteries than those with the fewest. Yet they found no such association for the large, fluffy particles. These findings were confirmed in subsequent studies.

Link to heart disease
Now here’s the saturated-fat connection: Dr. Krauss found that when people replace the carbohydrates in their diet with fat — saturated or unsaturated — the number of small, dense LDL particles decreases. This leads to the highly counterintuitive notion that replacing your breakfast cereal with eggs and bacon could actually reduce your risk of heart disease.”

In much of the medical community, this talk of fat being healthy (or at least not un-healthy) is heresy. There seems to be a strong bias against openly discussing evidence to the contrary.:

“Take, for example, a 2004 Harvard University study of older women with heart disease. Researchers found that the more saturated fat these women consumed, the less likely it was their condition would worsen. Lead study author Dariush Mozaffarian, Ph.D., an assistant professor at Harvard’s school of public health, recalls that before the paper was published in the American Journal of Clinical Nutrition, he encountered formidable politics from other journals.

“‘In the nutrition field, it’s very difficult to get something published that goes against  established dogma,’ says Mozaffarian. ‘The dogma says that saturated fat is harmful, but that is not based, to me, on unequivocal evidence.’ Mozaffarian says he believes it’s critical that scientists remain open minded. ‘Our finding was surprising to us. And when there’s a discovery that goes against what’s established, it shouldn’t be suppressed but rather disseminated and explored as much as possible.'”

Go here to read the full article.

Injury prevention in runners – “skimpy research”

The smart people at Running-Physio have done a good job of summarizing a research review of studies looking into injury prevention in runners. In all, 32 studies involving 24,066 participants were examined. The relationship between injury and running frequency, volume, intensity and duration were examined. The results? I’ll let the writers tell you;

“Regular followers of RunningPhysio will know of the ongoing debate we have with those staunch supporters of research who insist we must be evidence based. Surely this shows us just how unhelpful research can be in reality – over 30 studies, involving 24,000 runners and no firm conclusions on injury prevention! No wonder Verhangen (2012) described it as “skimpy published research” and went on to conclude,

‘Specifically for novice runners knowledge on the prevention of running injuries is practically non-existent.’

Nielsen et al. isn’t the first review of its kind in this field – a Cochrane Review in 2001 reached a very similar outcome and was updated in 2011 with equally negative conclusions; Yeung, Yeung and Gillepsie (2011) completed a review of 25 studies, including over 30,000 particpants and concluded,

‘Overall, the evidence base for the effectiveness of interventions to reduce soft-tissue injury after intensive running is very weak.’

They go on to make the very wise observation that, “More attention should be paid to changes in training charactisitcs rather than the characteristics themselves.”  Based on their reading of the research review, Running-Physio makes the following suggestions:

Novice runners should be especially cautious with increasing volume or intensity of training.

Increase in weekly mileage should be done gradually. The higher the weekly mileage the more caution needs to be applied in increasing this distance. Running expert Hal Higdon talks about runners having a ‘breaking point’ – a weekly mileage above which they start to develop injuries. For every runner this is different but with experience you can find your breaking point and aim to work below it. A gradual increase in mileage helps avoid crossing this point and picking up an injury.

Changes in intensity of training should be added in isolation, rather than combined with increase in distance. Be cautious when adding interval training or hill work and use each training session for its specific goal (i.e.long slow runs at an appropriately slow pace).

Be aware of signs of injury – look out for persistent or severe pain, swelling, restricted movement or sensations of giving way.

Use rest sensibly – don’t be afraid to rest or replace running with cross training when your body needs it.

Seek help – the right GP, Physio or health care professional can make a real difference!

Something I observe here is that we’re often looking for the  (training variable) that causes the one thing (an injury).  In reality, it’s typically many variables (some of them unseen) that bring on an injury. Also, nowhere in the article or the research is the discussion of running technique. I would think that how someone runs probably has a big effect on whether or not he or she becomes injured. I’ve mentioned previously that where the foot lands in relation to one’s center of mass is quite important as it pertains to impact and running efficiency.  I’d be interested in an analysis of the foot placement (and stride length and cadence) in the role of injury.

 

Lower Trap/Scapula Mobility & Strength Process

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I’ve had some on and off right shoulder pain for a while. Along with it has been some wrist and elbow pain.  I’ve worked wrist mobility, elbow mobility and I’ve worked shoulder internal rotation as well as elevation and retraction of the scapula.  Like I said, the pain comes and goes so I figure I’ve been knocking on the door of the issue, but I haven’t yet nailed it.  I’ve employed the following process to very good effect.  I’ve used the same process with several clients and seen some very nice changes in shoulder pain and mobility, and neck pain and mobility.

An elevated shoulder

Recently, I asked my wife to look at my shoulders from the back and see if there were any discrepancies or anything that seemed out of place.  She quickly said my right shoulder was higher than my left.  I took a wild guess and figured I had an elevated scapula and that perhaps my lower fibers of my trapezius muscle weren’t doing their job.

The trapezius

The trapezius (or “trap”) is an interesting muscle.  As the name implies, it is a trapezoid.  From the picture you

The multi-talented trapezius

can see the superior fibers originate from the base of the skull and attaches at the lateral clavicle, acromion process, and the spine of the scapula.  The  middle fibers originate from C7 and T1-3 and attach at the acromion and scapular spine.  The inferior fibers originate from T4-T12 and run upwards to attach to the lower scapular spine.

 

The traps do several things.  Largely, they shrug your shoulders up (elevation), shrug them back (retraction) or shrug them down (depression).  The traps also play a role in rotation, lateral flexion, and extension of the neck.  The traps work closely with lots of other muscles including the lats, the levator scapula, deltoids, rhomboids, the muscles of the rotator cuff and a host of neck muscles.  Consequently, if some part of the traps are too tight, too long or offline in some way, the result may be shoulder pain, neck pain or other issues down the line such as elbow, wrist or possibly jaw pain.

Mobilize & strengthen

To get things feeling and moving correctly, I like to start with soft tissue work via a lacrosse ball, the Stick, a foam roller, or whatever tool you like to use to soften tight tissue.  I’ve found the stick rolled along the upper trap to be quite effective.  An example is below.  Also, I like to pin a lacrosse ball against my shoulder blade and the wall to get at the external rotators, mid traps, rhomboids, etc.  I like to use the lacrosse ball in a similar fashion to work the pecs, but facing the wall instead of backing into the wall.  Then, I’ve been using the following combination of stretches and strength work to put things in working order.

First are a couple of stretches I stole from Kelly Starrett at MobilityWOD.com.  Both are useful ways to work on internal rotation and tie in some neck mobility.  We often see poor shoulder movement that includes poor internal rotation and tight neck muscles–whether the lower trap is messed up or not.  Working some internal rotation, moving the neck and loosening the tissue in that neighborhood seems to help facilitate good shoulder movement.

Second, I use the prone-Y simply to get a feel for what it feels like to use the lower traps.  It’s nearly impossible to do this one wrong.  Make sure to keep the glutes engaged so the low back doesn’t arch too much.  Put a cushion under the forehead so as not to mash your face into the ground, bench, or table.  I like to go to mild exertion.  This isn’t something to make you grimace.  It’s simply to get you connected to your lower traps.

The face-pull comes next.  Take a staggered stance so as not to lean back.  Keep the upper arms parallel to the ground.  Keep the shoulders down–but don’t let the elbows drop.  This may be a challenging skill for some.  You may find your brain gets a tougher workout than any of the muscles involved.  Again, no need to go to use a lot of weight or go to high exertion.  Technique is #1 here!

Then I go to something I call a shrug-down.  You can do this with a lat pull-down or cables or tubing of any sort positioned overhead.  It can also be done with an assisted pull-up machine or unassisted hanging from a bar.  The important thing is not to go too heavy.  Just like the other exercises, this should feel too easy to start with.  Many people find it quite difficult to shrug the shoulders down without bending the elbows. This is a skill and it may take some time, some steam coming out of your ears, and sticking out your tongue to master it.

Finally, I like going to a full cable pull-down or pull-/chin-up.  Just like the other exercises, I suggest you go light.  Try to separate the scapular depression (the shrug down) from the elbow flexion.  See if you can make it sort of a two-part exercise: shrug down, pull up, lower yourself back down, un-shrug. Let me know if this helps your shoulder and/or neck issues.

More Hip Mobility

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Recently I mentioned that you sit too much, and we looked at a hip mobility complex to help you combat the effects of sitting.  Here’s another very good hip mobility process from Kelly Starrett at MobilityWOD.com.

I’ve been doing this drill myself and with other clients and we’ve been seeing very nice results from loosening tight low backs to improving squat performance and generally realizing that we’ve got all kinds of tight, gunked-up tissue in our hips. All this tightness and restriction can mean trouble for knees, ankles, low backs, shoulders–all sorts of parts. Try this drill. Keep working on it. Do it frequently especially after long bike rides or any long period of sitting and before your workouts.

Running News

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The New York Times Phys-Ed section discusses a recent Harvard study on running form.  The study examined injury rates among heel strikers vs forefoot strikers.  The subjects were 52 runners on the Harvard cross-country team.  Researchers looked at four years worth of data on injured runners.  The pertinent finding is this:

“About two-thirds of the group wound up hurt seriously enough each year to miss two or more training days. But the heel strikers were much more prone to injury, with a twofold greater risk than the forefoot strikers. (Emphasis is mine.)”

Be careful though.  This finding doesn’t necessarily mean that everyone should immediately change their running form.  The article quotes says:

“Does this mean that those of us who habitually heel-strike, as I do, should change our form? “If you’re not getting hurt,” Dr. Daniel Lieberman says, “then absolutely not. If it’s not broke, don’t fix it.”

But, says researcher Adam I. Daoud, who was himself an oft-injured heel-striker during his cross-country racing days, “if you have experienced injury after injury and you’re a heel-striker, it might be worth considering a change.”

For further discussion and analysis on these findings, have a look at Runblogger’s post (and how these findings are being misused in advertising) and the post at Sweat Science.  Both of these guys do a great job of telling us what the data does and does not show.

Know When to End Your Run (or Ride or Workout, etc.)

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“Runners who continue running when they are exhausted unknowingly change their running form, which could be related to an increased risk for injury.”

Runners get injured.  I’m a runner and I’ve been injured–a lot. If you’re a runner then you either have been, are or are going to be injured. According to one source, 60-65% of all runners are injured during an average year (by definition, an ‘injury’ is a physical problem severe enough to force a reduction in training).

If you’ve encountered a running injury then you probably know that it’s rarely a simple solution to fix what ails you.  From shoe changes to barefoot running to stretching to foam rolling to foot strengthening exercises, to physical therapy to acupuncture to chiropractic to massage and on and on… This is a huge hassle and it would be wonderful to avoid this kind of aggravation!  So with some particle of optimism, I present an article from Science Daily that may help us avoid injury: When to End a Run to Avoid Injury: Runners Change Form When Running Exhausted.

The article discusses a study from Indiana University published in the Journal of Biomechanics in November 2010.  Researchers observed that subjects demonstrated biomechanical changes as they fatigued during a run.  Runners tended to display excessive motion at the hips, knees and ankles.

The study had subjects run on treadmills until they either reached 85 percent of the subject’s heart rate maximum or a score of 17 (out of 20) on the rating of perceived exertion (RPE). By the end of their runs, all of the runners reported an RPE of at least 15 — studies have shown that RPEs between 13-15 indicate fatigue.  Here’s what you need to pay attention to.  The article states, “Runners’ RPEs could provide some answers, with RPEs of 15-17 indicating runners’ have reached a point where their mechanics have likely begun to change in an undesirable way.”

The RPE scale is shown below.


What does this mean to you the runner?  Don’t run to the point of exhaustion.  Stop when you’re feeling good and strong, not when you feel beaten to hunched-over death.

I’m going to go out on a limb and suggest that we might take this advice for any type of exercise: lifting weights, cycling, martial arts–whatever.  This isn’t to say we should avoid tough workouts but most of our workouts should be comfortably challenging, not torture.  (I’ve mentioned this concept in previous posts; look here and here.)   

Facial expressions can be very useful in gauging our exertion levels.  When I’m working with clients I watch their faces.  When a grimace starts to show we stop the set.  The “scary face” is a transmission from one human to the other humans that something isn’t going all that well.  (Next time you’re in the gym, have a look around and see how many people have a look on their face like they’re being stabbed.  Don’t be that person.) It means we’re butting up against certain physiological limitations.  If we spend enough time doing this we’ll likely end up in some type of pain.  Heed your body’s warnings and you can stop injuries before they start.

I Need More Rest & Recovery

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Sometimes I tell my clients, “I make all the dumb mistakes so you don’t have to.”  Well, I continue to make less-than-intelligent decisions from time to time when it comes to exercise.  I’ve been working out very hard for several weeks and I seem to have overstepped my boundaries.  I’ve got some aches and pains that are proving difficult to resolve. Therefore it’s time to dial back my efforts, prioritize rest, and let all my various tissues and functions restore themselves.

I want to deadlift 500 lbs.  That’s my big goal this year.  In order to hit this goal I must put in very hard work.  Hard workouts must be balanced by adequate rest–but not total rest.  I’ve been lifting three days per week with the idea that I’m doing one heavy workout, followed by a light workout 48 hours later, then a medium workout again 48 hours after that.  Then it’s two days off lifting and I start it all over. As important as it is to lift hard on the hard day, it’s equally (maybe even more) important to ease up on the other days, especially the light day.  So while I’ve definitely been hitting the hard days, I believe I have fallen short of my goal of lifting light.

So here’s my strategy. I’ve based the next few weeks on a variation of the Texas Method as discussed in Practical Programming for Strength Training, the brilliant book by Rippetoe and Killgore.  This calls for a Monday/Wednesday/Friday type of pattern with a medium workout on Monday, a light workout on Wednesday and and the heavy workout on Friday.  Here’s my plan:

Monday: Medium Day

  • Back squat: 3 x 8 reps
  • Pushups:  3 x to exertion (10-25) but not exhaustion; alternated each workout with
  • chin-ups: 3 x 5 (I may play around with band chin-ups to get more reps; I’m not terribly strong on the pull/chin-ups and my forearm is banged up.)
  • Back extension: 3 x 8-10 reps
  • I must stay far away from anything that feels like exhaustion or muscular failure.
  • I’ll likely add back bench press and/or overhead presses once my wrists and shoulders feel better.

Wednesday: Light Day

  • Turkish Get-Ups: 1×5 reps each arm–AND THAT’S IT!

Friday: Heavy Day

  • Deadlift: work up to 1 x 2 reps near goal max
  • Speed deadlift: 3 x 3 around 70% of goal max alternated each workout with kettlebell swings
  • Romanian Deadlift: 3 x 5 reps
  • chin-ups: 3 x 5 alternated each workout with
  • pushups: 3 x to exertion (10-25 reps)

The key to all this is paying attention to how I test during each workout after every exercise.  I’ll be assessing and re-assessing my range of motion frequently (most likely with a standing toe-touch type of assessment), and I’ll be performing Z-Health joint mobility drills often.  If I tighten up at all or if I feel any pain then I MUST stop and call it a day.  This is of course counter-instinctive to me but I know I’ll feel better if I do.  The ultimate goal is 500 lbs. on that deadlift and I won’t get there if I’m beat up.

Orthotics Are a Mystery

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“I guess the main thing to note is that, as biomechanists, we really do not know how orthotics work.”
– Dr. Joseph Hamill, University of Massachusetts professor of kinesiology

Orthotics.  Some people swear by them.  Some people swear at them.  (That would be me.)  Some of them cost a few bucks at the grocery store.  Others cost several hundred dollars and must be fitted at a podiatrist, physical therapist or chiropractor.  So what about them?  Do we need them or not? (And if they are important for our health, how did the Egyptians, the Romans, Gengis Kahn, the Vikings, etc. ever manage march across the earth and conquer everything in site without them?)

All runners and other fitness enthusiasts–anyone who wears shoes really–must read the latest dispatch from the New York Times Personal Best section titled Close Look at Orthotics Raises a Welter of Doubt.  It’s a fascinating discussion on how and why orthotics may or may not work.  As the quote above indicates, no one really seems to know what these things actually do for the feet.  There are several important points in the article.

Analysis of Orthotics

Dr. Benno Nigg, professor of biomechanics and co-director of the Human Performance Lab at the University of Calgary in Alberta has made a career of researching orthotics. He makes a point that I’ve observed in my own experience with orthotics, namely that they tend to work in the short-term.  However he says that idea that they are supposed to correct mechanical-alignment problems does not hold up.

Further Dr. Nigg says, “If you do something to a shoe, different people will react differently.”  Different feet react differently: One person might respond by increasing the stress on the outside of the foot, another on the inside. Another might not respond at all, unconsciously correcting the orthotic’s correction.

The article discusses something I’ve heard discussed among those who make orthotics.  That is, there are different ways to make orthotics.  Depending on where you go, you’ll likely get a different device.  Dr. Nigg conducted a study in which a runner went to several different orthotics makers and each one made him a distinctly different orthotic to “correct” his pronation.  He liked two of them–yet they each were made differently.  More research by Dr. Nigg yielded the following:

“They (orthotics) turn out to have little effect on kinematics — the actual movement of the skeleton during a run. But they can have large effects on muscles and joints, often making muscles work as much as 50 percent harder for the same movement and increasing stress on joints by a similar amount.”

“As for ‘corrective’ orthotics,” Dr. Nigg says, “they do not correct so much as lead to a reduction in muscle strength.”

Support for Orthotics

Several seemingly well-educated people voiced support for the use of orthotics.  Jeffrey P. Wensman, director of clinical and technical services at the Orthotics and Prosthetics Center at the University of Michigan makes a sound argument when he says the key measure of success is his patients feel better in orthotics.

(On that note, I think it’s wise that if you’re in an orthotic and feeling good, running fast and all is well, then don’t change anything.)

Seamus Kennedy, president and co-owner of Hersco Ortho Labs in New York says there are hundreds of papers and studies showing that orthotics can treat common foot ailments.

So maybe there’s a lot of solid evidence in favor of orthotics right?  Well… The article states:

“In one recent review of published papers, Dr. Nigg and his colleagues analyzed studies on orthotics and injury prevention. Nearly all published studies, they report, lacked scientific rigor.”

Maybe the lesson is to be skeptical of orthotics makers who show you evidence of the benefits of orthotics.

What About Flat Feet?

The article goes on to profile someone who has flat feet and his quest to “correct” this issue.  Every orthotics provider he went to attributed his injury to his previous poorly made orthotics and goes on to provide him with different orthotics.

(The article mentions this fellow has an “injury” though there’s no mention of what this injury is.  I’m not sure if we’re to take his flat feet as an injury.)

Dr. Nigg explains that flat feet shouldn’t be any problem.  Our arches are an evolutionary leftover of when we used to grip trees with our feet.  This is interesting to me because I recall reading elsewhere a study of third-world populations that never wear any sort of supportive shoes.  Their feet tend to be flat yet there are far fewer numbers of the type of musculoskeletal injuries we have in the U.S.  So maybe these all important arches aren’t all that important?

My view on all this is that orthotics are of limited use and the science behind them is quite murky.  I’ve used several different types of orthotics and I’ve had either no results or I’ve experienced increased discomfort.  I think they are far from an essential component for human health and performance.  That said, on an individual basis, an orthotic may be very helpful.