More Achilles Tendon-itis/-osis/-opathy (or Whatever It Is)

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About three weeks ago I went for a run in the snow. Part way through I felt some irritation in my left Achilles tendon. Like anyone who loves/needs to exercise, I kept running and I tried to convince myself that it wasn’t too bad, that it would probably go away soon or maybe if I changed my stride slightly it would resolve during the run.

I was wrong! I really irritated the thing and had to walk about a mile. This was the latest flare-up of a years-long lingering issue. (I’ve discussed the Achilles here and here, as well as left heel pain/plantar fasciitis hereherehere, here, here and probably in some other places… You’d think for someone who’s considered this issue so much that I wouldn’t have it anymore.)

Prior to this Achilles flare-up, I’d had some of some old familiar heel pain. It wasn’t debilitating but it was a signal that something wasn’t as it should be. Again, I ignored it to a large degree and figured it would resolve. I should’ve paid closer attention to it. Essentially, it wasn’t a problem until it was a problem. Time to get back to work on this thing.

Tendon injury: A complex issue

Why do we get injured? How do our tissues (like tendons) become damaged? If we administer the right amount of stress and then recover we get a positive adaptation–we get stronger. In contrast, if we administer too much stress and we don’t recover then we get some type of injury. Thus too much stress delivered too often and/or too fast has been my problem. I need to increase my tissue tolerance to the forces of running.

A recent article from Alex Hutchinson is titled Pro Tips on Treating Tendon Injuries. This article covers a debate among members of the Canadian Association of Sports and Exercise Medicine in Ottawa. Several top sports physicians and therapists were asked: Which therapy should the squash player try next? (I’m not a squash player but I have the injury they discussed.) If you’re dealing with this issue it’s definitely worth a read. It discusses several methods: eccentric strengthening, nitroglycerin patch, dry needling, cortisone, and platelet-rich plasma.

There wasn’t 100% agreement on anything much, but Hutchinson’s concluding statement was this (emphasis is mine):

“So what should the poor squash player do? In the question period following the debate, most participants conceded that strengthening exercises are the path to long-term health. Depending on the specifics of your tendon injury, other techniques may provide relief to allow you to exercise, but they’re not permanent cures.”

Cures I like. I have no interest in simply treating symptoms. Thus I decided it was time to implement something with which I’d been familiar but which I knew wouldn’t be very exciting at all: the eccentric strength protocol.

Eccentric strengthening

First, what does “eccentric” mean?An eccentric contraction is one in which the muscle is contracted but it’s also lengthening. Think of doing a bicep curl. You know the part where you yield to gravity and lower the weight? That’s the eccentric portion of the movement. (In contrast, the concentric portion is where you overcome gravity and bring up the weight.) For this particular protocol, we want to fight against the lowering action and lower very slowly.

I found a very thorough resource for this project from Jeff Gaudette at RunnersConnect.net. It’s titled The Ultimate Runner’s Guide to Achilles Tendon Injuries: The Scientific Signs, Symptoms, and Research Backed Treatment Options for Achilles Tendonitis and Insertional Achilles Tendinopathy. (The title of this thing just screams ACTION!! doesn’t it?) You can download both the Injury Treatment PDF and the Injury Prevention PDF. As the title suggests, this is a thoroughly researched guide to dealing with tendon injuries. I appreciate very much that there is both a treatment and prevention strategy. I won’t go into the whole thing but here are the basics:

The strength protocol consists of two exercises: a straight-kneed and a bent-kneed
eccentric heel drop. The protocol calls for three sets of fifteen heel drops, both bent- kneed and straight-kneed, twice a day for twelve weeks.

Standing on a step with your ankles plantarflexed (at the top of a “calf raise”), shift all of
your weight onto the injured leg. Slowly use your calf muscles to lower your body down,
dropping your heel beneath your forefoot. Use your uninjured leg to return to the “up”
position. Do not use the injured side to get back to the “up” position! The exercise is
designed to cause some pain, and you are encouraged to continue doing it even with
moderate discomfort. You should stop if the pain is excruciating, however.

Once you are able to do the heel drops without any pain, progressively add weight using a backpack. If you are unlucky enough to have Achilles tendon problems on both sides,
use a step to help you get back to the “up” position, using your quads instead of your
calves to return up.

The eccentric exercises are thought to selectively damage the Achilles tendon, stripping
away the misaligned tendon fibers and allowing the body to lay down new fibers that
are closer in alignment to the healthy collagen in the tendon. This is why moderate pain
during the exercises is a good thing, and why adding weight over time is necessary to
progressively strengthen the tendon.

You do these exercises for 3 sets of 15 reps, twice daily. There are photos showing these exercises including a modification if you have what’s known as insertional Achilles tendonitis. Again, read the whole thing if you want the full rundown of this protocol.

More thoughts

Part of why I haven’t done this in the past is that it is slow and tedious! Three sets of 15 slow reps makes time crawl like some sort of crippled tortoise. It ain’t fun! Plus I’ve never cared much for doing calf work. That said, I need to fix this problem. This process seems to be the best way to go about it, so I’m on board.

Something else I realize is that if I’m prone to this injury and I want to avoid it then I need to do the preventive work. That means setting aside time throughout the week and during my workouts to do some of this stuff.

I’ve been doing this work for about the past three weeks and I am getting better. I’ve done a couple of short run/walks and I’m not in the clear just yet. The only option I see is to continue doing what I’m doing.

Update

I just went on a run of a little over two miles and the Achilles feels fantastic. No pain! Felt like I could’ve run all day–which would’ve been stupid of me. This protocol is working for me right now.

Techniques to Help You Run Pain Free

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I’ve used a few simple techniques to help a few of my clients with their running technique.  These ideas have also helped me overcome a long-term bout of heel and Achilles trouble.

My clients often hurt when they ran so if nothing else, I figured they needed to run differently somehow. There was no guarantee that what I would show them would solve their problems but clearly the way they were running wasn’t quite working.

The following are drills and cues that I’ve used.  Effective cueing can be challenging.  I have in my mind a movement a feeling and an experience that I’d like you to have.  I have to translate what I feel into English and transmit that message to you.  My words may hit the mark or you may have absolutely no idea what I’m talking about!

Hop up and down.

Hop up and down.  How do you land?  On your heels?  Most people land on their toes and to some degree their heels settle to the ground.  It happens naturally.  Your probably don’t need to think about it too much.  In this way, we effectively dissipate the impact forces and avoid too much jarring and banging into the ground.

Run in place.

Now run in place–quickly!  Again, how do you land?  I think most people land similar to the way described above.  It’s a light landing on the toes, not heels first.  This is pretty much one-footed hopping.

Where do your feet land?  Directly under your hips.  That’s about where we want the feet to land.  In contrast, what we don’t want is for your feet to fling out in front and slam into the ground.  To that point…

Quick Pace

Overstriding is a frequent issue in injured runners. By overstriding the foot lands out in front of the runner and he or she slams hard into the ground with every foot fall. This can cause lots of stress to various tissues and joints and it’s likely a cause of pain.

This is a good contrast in foot placement.  The guy in back is overstriding.

This is a good contrast in foot placement. The guy in back is overstriding.

By running at a quick(er) pace we facilitate the feet landing under us, not out in front.  We create shorter loading times of the bones and joints and thus reduce the stress that may be causing our pain.  It’s difficult to overstride with a quick cadence.

For a most runners this means consciously picking up the pace. This can feel awkward at first and may feel inefficient.  One way to start to adjust your cadence is by using a metronome when you run.  Start at your normal pace and sync the metronome to your pace.  From there you can up the beat and match your pace to the metronome.  This takes time and practice.  If it’s important then you’ll do it.

Again, this all may feel very strange–and it should.  After all, if our current chosen running technique is causing pain, then it stands to reason that a new and better running technique should feel weird.  As with any new skill, it won’t feel strange forever.

Lean forward from the ankles.

chi_postureLearning to lean from the ankles–not the hips!–is important.  By leaning from the ankles we sort of fall forward.  We keep the hips under us, not poked out behind.  When leaning from the ankles it’s difficult to overstride and slam the foot into the ground. Here’s a drill to learn how to lean from the ankles.

Run tall.  Keep eyes on the horizon.

The simple cue to “run tall” seems to work well for a lot of runners.  I’ll keep it simple and leave that phrase as is.

Keep your eyes on the horizon.  This works well to help keep you tall.  Your body tends to go where your eyes go.  If you stare at the ground then you’re likely to slump forward.  You won’t be running tall.  Learn to use your peripheral vision to see the ground. The guys below are running tall and gazing out.

These guys are RUNNING REALLY TALL!!  You should do it too!

These guys are RUNNING REALLY TALL!! You should try it!

Run lightly.  Quick pace.  Lean from the ankles.  Run tall. Eyes on the horizon.

Here’s a good graphic.

I’m not going to say a lot more other than I like the information presented here:

better-running

Skipping

Finally, here’s a skipping drill that may help you get a feel for running tall, running lightly and not pounding your heel into the ground. My hope is that this drill will transfer to your actual running. Skipping involves an exaggerated running gait and you don’t actually want to bound and prance to an extreme degree.

Worth Reading: What Makes a Great Personal Trainer? Recovery, Pronation, Bringing Up Your Weak Spots

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What makes a great trainer?

The Personal Training Development Center (PTDC) has a lot of useful, informative articles for personal trainers.  Are Personal Trainers Missing the Point is a recent piece with which I agree. The key observation is this:

“The ability to correctly coach exercises is slowly becoming a lost art in the training world, despite that it’s the most fundamental component of being a personal trainer/coach.”

The article advocates for trainers to teach the squat, deadlift, bench press, standing press and pull-up.  (I would ad the push-up to the list.) It’s also suggested that trainers learn to teach regressions and progressions of these exercises. These exercises are the essentials. They have been and still are the basic building blocks of effective exercise programs and they offer the most return on investment of a client’s training time. Read the article to learn three steps to becoming a better coach.

Running recovery

Alex Hutchinson writes for Runner’s World and the Running Times. He recently wrote an article called the Science of Recovery.  He briefly discusses six methods: antioxidants, jogging (as during a cool down), ice bath, massage, cryosauna and compression garments. Anyone who trains hard–runner or not–may find the article interesting.

Pronation

Pete Larson at Runblogger.com gives us Do You Pronate? A Shoe Fitting Tale. Here, he describes overhearing a conversation between a confused shoe store customer and the mis-informed employee who tries to educate her on pronation. Contrary to what many of us believe, pronation is not a dire evil problem to be avoided at all costs. Larson says it well:

 “The reality is that everybody pronates, and pronation is a completely normal movement… We might vary in how much we pronate, but asking someone if they pronate is like asking them if they breathe. I’d actually be much more concerned if the customer had revealed that no, she doesn’t pronate. At all. That would be worrisome.”

If you’re a runner then I highly suggest you learn about the realities of pronation.

Supplemental strength

I love strength training. I love all the subtleties and ins & outs of getting stronger. One area that I’m learning about is supplemental work (aka accessory work). This is weight training used to bring up one’s strength on other lifts (typically the squat, deadlift, bench press or standing press).  With supplemental work, we’re looking to find weak areas and make them stronger.
Dave Tate at EliteFTS is one of the foremost experts on all of this. Thus, his article Dave Tate’s Guide to Supplemental Strength is very much up my alley, and it should be up yours if you’re serious about getting stronger. He discusses several categories of exercises and how to incorporate them into a routine. Below, the term “builders” refers to exercises that build the power lifts (squat, bench press, deadlift):
  1. Always start with the builders. Do not start with the main lift.
    Examples: Floor press, box squat. Sets: 3-5. Reps: 3-5.
  2. Move to supplemental exercises — exercises that build the builders.
    Examples: 2-board press, safety-bar close-stance squat. Sets: 3. Reps: 5-8.
  3. Accessories — Either muscle-based (for size) or movement-based (for strength). Use supersets and tri-sets, as needed.
    Examples: DB presses, biceps curls. Sets: 3. Reps: 10-20.
  4. Rehab/Pre-hab — Whatever you need, nothing more or less. Examples:
    External rotation, face pulls. Sets: 2-3. Reps: 20-30.
This is just a little bit of the article. It’s very detailed. There may not be much here for recreational lifters but for coaches and those of us who have gotten a little deeper into our lifting, it’s a superb article.

3/13/14 Workout

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The barbell/kettlebell class I like so much is Tuesday/Thursday mornings. My track workout is also on Tuesday and my tempo run is Thursday. It’s good to put a bunch of hard work on the hard days, and do easy stuff on easy days.

The class is a very tough class. I think it may be impacting my tempo runs, thus today I decided to forego the class and do the tempo run then lift later in the day. Here’s what the day looked like:

  • 7 am 2 mi. run: easy & slow with Diva the Dog.
    • I love running with my dog!! The vet listens to her low heart rate and calls her an athlete. I love that!
    • This was a warm-up for the tempo run.
  • Tempo run: 6 mi. at 8:26 pace.
    • This was rugged! It was supposed to be an 8:23 pace but such is life.
    • I’m not certain the class damages my tempo run.  The tempo run is just tough.
    • For the next tempo run, I plan to skip the class again, run the exact same route but this time I will fuel beforehand with Ucan. Curious to see if fueling with the slow-drip carbs will improve performance.
  • 3 pm: weights
    • This was late in the day for me to be lifting.
    • According to the 5/3/1 plan I’m following, this is a de-load day on deadlifts, so I decided to do power cleans in place of deads.  (You can’t clean as much as you can deadlift.)
    • power cleans: 175 lbs x 5 – 185 x 5 – (and because I read this article from Dan John) 205 x 3 x 2 sets. In reality, I got 2 sets of 2 and that third set… I only got one. It whopped my a$%…
    • 1-leg box jumps: 4 x 4 sets. Trying to create more 1-legged power for running.
    • pull-ups: 24 kg x 5 x 5.  I don’t do pull-ups regularly (I used to) and these were tough.
    • kettlebell snatches: 24 kg x 120 reps (60 each arm)
      • We typically do 200 reps in the class.
      • I have a nice big, hot blister on my left hand and an almost-healed blister on the right.
      • I taped my left hand and that didn’t quite help me enough.
      • I was smoked at this point and I’m a big girlie sissy thus, only 120 reps.
      • Oh well…
  • The big thing: Regarding the run, I’m quite interested to see what putting some carbs in the mix does for my run next week. I’m doing my best to be in ketosis. Lack of carbs may negatively impact these types of efforts–but my track workouts don’t seem to be suffering. There’s a question here that I’m very interested in answering. Next Thursday might reveal that answer…

The Final Victory Against My Heel Pain Part I: Addressing the Biomechanics

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I’m really thrilled to be writing this post because it seems I’ve finally truly gotten rid of a chronic heel/Achilles/plantar fasciitis issue that has been with me for a long time. (I’ve said this before and I’ve been wrong, but for the record I’ve been running a lot and my heel hasn’t felt this good for this long in years.)

This thing has been with me for maybe three years. It’s never been enough to really knock me out. It didn’t derail me from my first marathon and subsequent 10-milers and half-marathons. However, several weeks ago I did a long trail run and it felt like a nail had been driven into my heel. I figured it was time to sort this out. The solution has been a mix of biomechanical and running technique adjustments, and a deeper understanding of pain science.

Before I met with anyone I put a green Superfeet insert into my shoes. I’m a minimalist shoe advocate.  I don’t want to rely on a crutch but I’m also very much willing to do whatever is appropriate to solve a problem. A lot of what I’ve read for addressing heel and Achilles problems suggests putting some sort of insert into a shoe. The idea here was to unload some of the muscles and structures that hold up the foot, including the Achilles. I’m still using the inserts on a lot of my runs but I rarely wear them at work and I do some of my runs with without the insert.

I next met with a couple of guys with a lot of great knowledge and experience. Mike Terborg and Nick Studholme were both very instrumental in my progress.  Mike is a performance and injury recovery specialist in Boulder and Nick runs Studholme Chiropractic. Mike is heavily influenced through John Hardy and the principles of FASTER Global which teaches a process of biomechanical reasoning. Nick studied under the innovative physical therapist Gary Gray. Both guys speak much the same language when it comes to movement and movement analysis.

They both have tremendous ability to explain what they see and communicate the changes they thought I should make. They both used a fantastic and powerful video program called Spark Motion which was created by Nick and a group of other guys. This was just an amazing way to record and analyze movement. Spark is a great tool that I need to look into.

The visit with Mike Terborg: Running adjustments

I first visited with Mike in Boulder a few weeks ago. We spent a couple of hours looking at how I moved. The major issue we found was prolonged eversion of my left foot. The foot stayed in contact with the ground for what seemed a long time. Mike explains his observations and thought process:

“Adhering to the Biopsychosocial or BPS model of pain (vs the Postural-Structural-Biomechanical model), we couldn’t say for sure what was causing the pain other than it could be a combination of things including but not limited to biomechanics. You had chronic pain of the plantar fascia, like to run, and wanted to be able to run more without aggravating this injury so we needed to look at your physiological skills and tendencies relative to gait. We cannot say for sure that eversion and dorsiflexion of the subtalar joint caused the injury (because these are natural motions of subtalar joint and thus normal motions for the PF to decelerate), but we can deduce that less loading of the plantar fascia (less dorsi/eversion) might be helpful in reducing the amount of stress on the PF during running. Our hope was that less stress/load during gait may allow you to run pain free for longer. In sum, we can say for sure that we crossed some type of stress threshold (bio, psycho and or social), so we wanted to ask your body what happened if we backed off on the biomechanical load to the pissed off tissue. 

“Your ranges and sequencing in the breakout evaluation all looked good, so we went straight to your running technique. Using Spark Motion for gait analysis, we deduced that it was possible for you to run in a way that reduced the stress to your PF and apparently that helped. The drills were all part of a progression to not only teach your body the skills and sequence of a more rapid gait but to train your ability to sustain that gait for longer periods of time (strength endurance of a skill). Nothing fancy, just following biomechanical reasoning to look for clues and strategies.” 

I really like Mike’s explanation of the process. He puts his explanation in a very honest way. In saying that we don’t know for certain why the pain is there, nor do we understand exactly how or why it might go away, he reflects the current cutting edge of pain science which reveals that pain is in many ways a baffling mystery.

He directed me to several exercise progressions of which here are three:


We changed my running gait along these lines:

  • Put less pressure through the heel into the ground. Let the heel touch the ground but only lightly.
  • Quicken the stride so the foot stays in contact with the ground for less time.
  • Swing the right leg through faster to facilitate less time on the ground of the left foot.
  • Run with a metronome set somewhere between 170-190 bpm.  This quickens the stride rate. Experiment.

The resulting new gait felt like I was some sort of prancing fool–La la la la laaaa!!!–dancing through the daisies.  Fortunately the video Mike shot of me indicated that in fact I just looked like I was running with a quicker step. (I could in fact go running in public this way.) Finally, Mike also suggested I visit with Nick so I did.

Analysis from Nick Studholme & fine tuning the lower leg

Nick put me through a muscle testing process and winnowed out some weak and unstable muscles in my lower leg. Specifically, big toe muscles known as flexor hallucis longus, and flexor hallucis brevis weren’t working up to par. The fibularis muscles (aka peroneals) were also a bit off line.

Taken together, when these muscles work they create and control plantar flexion and inversion of the foot as in the push-off of running or walking, and they create/control dorsiflexion and eversion of the foot as when the foot hits the ground.

Of great importance is the ability to anchor the big toe to the ground while the body passes over the foot. I was missing the mark. Nick taped my foot in a way to help facilitate this anchoring and he showed me several exercises to help me feel, create and control better big toe function while running. These exercises were similar in nature to what Mike showed me.

It’s several weeks later and what are the results? The heel and Achilles quickly started feeling better. I did a series of short interval type runs. The quicker pace (around 175-180 bpm) was challenging at first. I didn’t want to become exhausted while running and lose the technique, thus I only ran 1 or 2 minutes at a time. and walked in between. (Running with my dog tends to be a good way to break up the running with walking.)

Some discomfort remained for a couple of weeks in a stubborn way. It wasn’t terrible but it was hanging around like it was ready to pounce. I was worried that there was something we might be missing. This last bit of hanging-around heel trouble would be gone within 48 hrs after I reviewed the current ideas on pain and the brain. I’ll discuss that in the next post.

 

 

The Big Running Plan Begins

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There’s a big event that I’ve had on my mind for years.  It’s the Gore-Tex Transrockies Run. This year’s gig is six days, 120 miles with 20,000 feet of elevation gain. I’m looking at running the 2015 race so I figure the mileage and such should be about the same. Go here for maps and descriptions of this year’s stages.

Preparation for the Transrockies run means a whole lotta running this year.  I need to do more trail races and another marathon, most likely a trail marathon. I’m running a lot (for me) right now. I’m up to about 30 miles per week. I’ve got a 5k this weekend and more races planned (more on that in a moment.) The very good news is that everything is feeling solid and strong, including my stubborn, chronic Achilles/heel trouble.

I’ve also consulted with Denver-area running coach Jay Johnson. I saw him speak at the NSCA Endurance Clinic a few months ago and I became very interested in picking his brain a bit. I’ll be communicating with him every month or so to fine tune my workouts and run plan. Speaking of which…

My first and only marathon (two years ago) was based on the FIRST Run Less, Run Faster plan.  This plan has only three run days per week: a track workout, tempo run, and a distance run.  Two days a week were devoted to a cross-training workout on a bike or rower.  I also ran the Ft. Collins Half-Marathon and Park-to-Park 10-Miler based on this plan. It’s a minimalist running plan. It’s very useful if there’s limited training time available. This plan got me through several races but I want to know if a different type of plan will increase my performance. I’m curious if more running will make me a better runner.

The Transrockies run is a lot of running for several days in a row, thus with the SAID Principle in mind, it makes sense to me that I should train in as close a fashion to the race as possible. This time around, I’m going the maximalist route with the Hansons Marathon Method.  (I also need to get the Hansons Half-Marathon Method.)

Something to consider with this high-volume plan is the opportunity to practice running. That is, with all the miles and the recovery runs, I get the chance to refine my running skills. Running is a skill just like playing a horn or driving a golf ball. Running improvements don’t come just from the obvious increases in fitness that come from speed work, tempo runs and tough long runs. Matt Fitzgerald discusses this idea in a Running Times article called Rethinking Junk Miles:

You see, running is a bit like juggling. It is a motor skill that requires communication between your brain and your muscles. A great juggler has developed highly refined communication between his brain and muscles during the act of juggling, which enables him to juggle three plates with one hand while blindfolded. A well-trained runner has developed super-efficient communication between her brain and muscles during the act of running, allowing her to run at a high, sustained speed with a remarkably low rate of energy expenditure. Sure, the improvements that a runner makes in neuromuscular coordination are less visible than those made by a juggler, but they are no less real.

For both the juggler and the runner, it is time spent simply practicing the relevant action that improves communication between the brain and the muscles. It’s not a matter of testing physiological limits, but of developing a skill through repetition. Thus, the juggler who juggles an hour a day will improve faster than the juggler who juggles five minutes a day, even if the former practices in a dozen separate five-minute sessions and therefore never gets tired. And the same is true for the runner.

 (BTW, Russian kettlebell and strength expert Pavel Tsatsouline discusses the exact same principle but with regard to strength training.)

The Hansons Plan has me running often in a fatigued state. The longest run I do though is 16 miles. Most marathon plans feature a 20 mile run. So why only 16 as a longest run? This 16-miler will take place after several days of running. I’ll have a tempo run then an 8 or 6 mile run the day before the 16-miler. The idea as they say in the Hansons book is that I’ll be training to run the last 16 miles of the marathon. Sounds interesting and plausible to me. That goes along with something Coach Johnson suggested. He said that at some point, in preparation for the Transrockies Run, that every other week I should run back-to-back long trail runs. Again, this goes to the idea of training specificity. I imagine I’ll do that next year.

Here’s a list of races and potential races I plan to run this year:

  • 3/2/14 – That Dam 5k – Denver: I need to run a 5k so I can derive my training paces for the marathon plan.
  • 4/6/14 – XTERRA Cheyenne Mt. Trail Run 12km – CO Springs: Don’t know anything about this race but I’m looking fwd to it.
  • 5/4/14 – Ft. Collins Marathon 13.1: Ran this one last year and had a great time.  Went out a tiny bit too fast though.  Hope to better my time of 1:47.
  • 6/7/14(maybe) – Boulder Sunrise Duathlon 3.1 mile run / 17.3 mile bike / 3.1 mile run – Boulder: My wife is doing this triathlon. I don’t swim well enough to do a tri but I’ve done some duathlons and this might be fun and a change of pace.
  • Summer – 5k: Coach Jay Johnson suggested I train for and race a 5k. He said putting in that speed work would be useful for a Fall marathon.
  • 8/23/14 (maybe) – Continental Divide Trail Race 15.5 mi. – Steamboat: Ran this one a couple of years ago and it was brutal but beautiful and a very laid-back kinda thing.  Wouldn’t mind taking it on again in a better pair of shoes. Not sure if this one fits into the overall race plan.
  • 9/20/14 – Aspen Golden Leaf Trail Half-Marathon – Aspen: This race got a great write-up in some running magazine (Runner’s World?  Competitor?) recently. We’ve never been to Aspen. Sounds interesting. Should be good preparation for the marathon.
  • 11/8/14 – Moab Trail Marathon: This is my main race. We’ve never been to Moab and this is a great reason to go.

That’s my plan right now. I’m very excited about this! I’m feeling great right now. I really love the process of getting to these races. I love the anticipation and the training. We’ll see what happens.

NSCA Endurance Clinic Summary: Day 3

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David Barr: Nutritional Supplements & Ergogenic Aids

  • NSCA CSCS, USA Track & Field, Precision Nutrition Certified, participated in research with NASA
  • High Return On Investment Supplements
    • Caffeine
      • blocks adenosine which results in
      • less fatigue and
      • lower feeling of exertion during activity
      • concerns include GI distress and diuresis (exessive urination)
    • Carbs
      • type: glucose, fructose, maltodextrin
      • timing: during exercise
      • beneficial in events lasting >2.5 hrs
      • dosing by duration: 60g/hr for 2-3 hrs, 30g/hr if <2 hrs
    • Fish oil
      • effects
        • increased muscle anabolism
        • may enhance recovery
      • Don’t look at total Omega 3s
        • You want EPA = 180 and
        • DHA = 120
      • If eating a high-fat diet (me) then up the Omega 3s.
      • potential synergy with Vitamin E
    • Protein (He seems to be a big protein guy.)
      • Don’t use during exercise (but what about Accelerade?  No good?  Didn’t get a chance to ask.)
      • Consume up to 2 g per kg of body weight or 1 g per lb.
      • Whey post workout: 20-25 g is the limit
    • Nutrient timing:
      • Protein pulse feeding
        • multiple protein feedings per day of 20-30 g
        • ups protein storage
        • Seems the effect of this is separate from the training effects from the workout.
      • Take about 40 g of casein before sleep to help blunt catabolism
      • Carb timing:
      • If you need rapid glycogen replenishment then consume carbs soon.
      • If you have 24 hrs before the next workout then it’s not an issue.
      • Protein and the workout
        • If you’ve eaten soon before a workout then don’t worry.
        • If you haven’t eaten in a while then eat protein pre-workout.
    • Keys to hydration
      • specific prescription better than ad libitum or drinking at will.
      • (Dr. Tim Noakes disagrees and I side with Noakes.)
      • flavor enhances consumption
      • cold increases palatability
      • drink early/often
    • Building the optimal endurance drink
      • 200 ml water/15 minutes
      • sodium: 450 mg/L
      • Carbs: 8-10%, 90 g/hr: glucose and fructose
      • Protein (potentially): 7%
      • You must “train the gut” or use this stuff while training in order to condition the digestive system to put up with it.
    • Antioxidants
      • mitigate free radical damage and aid recovery
      • Don’t take directly after workouts.
      • May be a case for taking antioxidants during activity
    • Lactate
      • Lactate is used as energy.
      • Doesn’t cause burn/fatigue
      • Cytomax makes some sort of drink w/lactate in it.
    • Buffers
      • bicarbonate
        • 300 mg/kg
        • potential GI trouble
      • Beta alanine
      • Theoretically: use both for a systemic effect
    • Nitrates
      • may help power output
      • may mitigate effects of altitude
      • Improved time trial performance in cyclists
    • Immunity
      • CHO
      • Vit C
      • Vit D
      • Zinc
    • Common deficiencies
      • Vit D
        • No toxicity
        • 6000-10,000 IU/day
      • Iron: Test for it.
      • Magnesium
    • Experimental considerations
      • hyperhydration
      • “train low” (carbs): unclear if this benefits performance
      • echinacea: increases EPO
      • ketones: novel energy source
    • Future prospects
      • cobalt chloride
      • guanidinopropionic acid
    • Other resources

Tim CrowleyProgram Design: Strength Training for Endurance Athletes

  • CSCS, NASM-PES, USA Cycling Elite Level Coach, 2008 US Olympic Triathlon Coaching Staff, USAT Elite Coach of the Year and Development Coach of the Year, Owner TC2 Coaching, Head Strength Coach at Montverde Academy
  • Huge need for endurance strength & conditioning coach
  • “Great swimmers are great athletes that swim fast and great athletes are strong.” – Richard Shoulberg, Germantown Academy
  • STRENGTH MUST BE THERE FOR SPEED!
  • Program Goals
    • Reduce injury incidence
    • Reduce injury severity
    • Increase athletic performance
    • Improve athleticism
  • If you can read/learn 1 hr per day then you’re way ahead of the crowd.
  • Try stuff out before we give it to athletes: workouts, tools, food
  • Book: Endurance Training Science & Practice, Mujika
  • He covered various research evidence showing that strength training aids runners, cyclists and other endurance athletes
    • Reasons strength training works for endurance athletes:
      • conversion of type IIX fibers into fatigue resistant type IIA fibers
      • improves strength (like money in the bank)
      • rapid force production
      • improved neuromuscular function
      • tendon stiffness (essential for running)
      • improved max speed for fast starts or finishes
    • Common myths
      • Heavy weights make you big
      • Weight training hurts young athletes
      • Endurance athletes need light weight/high reps
      • Heavy weight training reduces ROM
      • Lifting equals bodybuilding
      • Squats hurt knees
      • Only for use in off-season
      • Endurance training will build strength
    • Important considerations
      • Strength work often isn’t to improve the engines of endurance (legs for running for example) but rather to address weaknesses, increase overall athleticism, and avoid injury
      • As pressure mounts on an athlete, find ways to coach less and simply get them to perform at their ability.
      • Time:
        • an obstacle for endurance athletes
        • goal is 30-40 min 2x per week
        • Try high-intensity/low-volume workout to increase muscle activation prior to a track workout
      • Energy
        • finite amount of energy for training
        • can’t interrupt endurance sport training
        • DOMS can be a problem
        • physical effects of high-vs low-volume
        • psychological effects
      • Reciprocal Inhibition
        • Reduced neural drive to opposing muscles
        • Areas of concern
          • scapula/thoracic spine
          • hip flexors/glutes
          • hip adductors/glute medius
          • anterior core/low back
      • Pattern Overload
        • Endurance sports are cyclical
        • high incidence of overuse injury
        • lots of “itises”
      • Force Couplings
        • Key body regions for multisport athletes
          • internal vs. external shoulder rotators
          • hips in saggital plane (flexors vs. extensors)
          • hips in frontal plane (glute medius and quadratus lumborum)
        • Eliminate power leaks
        • Improve movement economy = free speed
      • Masters athletes
        • strength development/maintenance is vital to success
        • loss of power declines faster than strength
        • mobility is crucial
        • compensation patterns
        • slower recovery from injuries
      • Program design
        • foam rolling/movement prep
        • mobility
        • corrective exercise
        • strength
        • keep it simple
        • less is more
        • quality over quantity
        • develop power
      • Self-myofacial release (SMR)
        • foam rollers
        • tennis/LAX balls
        • golf balls
        • the Stick
      • Mobility
        • May be the most important component in the beginning
        • a must for masters athletes
        • Vital concerns:
          • hip mobility
          • thoracic spine
          • ankles
          • 1-leg squat
          • split squat every workout
          • His ACL injury rate is almost 0.
      • Overuse injuries
        • Be proactive
        • shoulders
        • low back
        • glutes/glute medius
        • lower leg/ankle
      • His go-to exercises
        • inverted/TRX rowing
        • anterior core
        • core dynamic stabilization
        • single-leg squatting (priority goes to 1-leg over 2-leg work)
        • glute/hamstring and glutes
        • trap bar deadlifts
        • ankle band walking
        • eccentric calf raises
      • Mobility and Stability
        • Mobility is the combination of muscle flexibility, joint ROM, and the body segment’s freedom of movement
        • 2 types of stability
          • static 1-leg stance
          • dynamic core stabilization during athletic movement
        • Example: Hips are stiff so lumbar spine becomes too mobile/unstable and injury is incurred.
      • 10 exercises to include
        • Cook hip lift

      • Hip flexor stretch
        •  X Lat pull (couldn’t find a video)
        • Reverse cable fly

        • single-leg squat

        • single-leg deadlift

        • stability ball pushup or TRX pushup (unstable surface)

        • lawnmower row

        • cable and tubing lifts and chops (and other similar exercises)

      • single-leg heel raise
  • Resources

Nick Clayton, Power Training for Endurance Athletes

  • Objectives
    • Explain how training with explosive movements benefits endurance performance
    • Correctly perform variations of the Olympic lifts and plyometrics specific to performance in endurance activities
    • Lecture
    • Practical
      • dynamic warm-up
      • Olympic lift variations
      • Plyometrics
    • Why train for power?
      • Rate of force development
      • eccentric strength
    • Non-barbell Olympic lifting
      • Clean, snatch, jerk variations
        • kettlebells
        • dumbbells
        • medicine balls
      • Plyometrics: various 1 and 2 leg jumps, hops, skips
      • Nick said he would create videos of all the exercises and post them.  When/if they’re available I plan to post them here.
      • This was a fantastic session from warm-up to all exercises.
      • It was very much in line with the idea of creating athleticism.
      • These drills exposed a lot of weaknesses and lack of athleticism in a lot of the participants.
      • Exposing these weaknesses could be a huge opportunity to improve athletic performance.

Conclusion:

This clinic was just excellent!  It far surpassed my high expectations and that’s a rare thing.  The combination of theoretical/academic/”sciencey-type” stuff, practical application of the science, and physical participation kept the whole thing extremely interesting.  I came away with my mind overflowing with ideas.

Several things are prominent in my mind right now:

  1. I was re-introduced to some of Gary Gray’s concepts.  I’ve returned to doing the 3D lunge matrix with much greater understanding of hip, spine and knee position, plus how to tweak the lunge matrix in all sorts of ways.  I’m doing it again and all my clients are doing it now.
  2. The concept of athleticism as a necessary foundation is a HUGE concept to me.  We tend to specialize too much.  We devote ourselves to endurance sports which go one direction (saggital plane) and we neglect 3D movement.  We avoid crawling, climbing, rolling, hopping, jumping and engaging in unpredictable movement situations.  Check out the people going into and out of Spinning classes and you’ll see a lot of broke-down people who can barely hobble.  They aren’t athletic.  And I have been one of those people–but not anymore! Every one of my workouts now has a dedicated 3D movement component, power component and I try to do something that I don’t typically do.  Athleticism deserves a blog post of its own.
  3. I’m going to contact Jay Johnson for some coaching.  He did such a fantastic job of distilling academic information into practical application.  I can only coach myself so far.  I need someone who’s been through the process both as a runner and a running coach.

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.

 

 

Making Stuff Faster

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Here’s a very interesting video from PBS by way of Scientific American.  It’s part of the 4-part Nova series Making Stuff…  This discussion is on making stuff faster. Here, the host explores how to make faster runners.

The big takeaways here are:

  • 1) Hit the ground harder and
  • 2) Keep the torso stiff.

I haven’t seen the actual episode yet but I love the analysis and advice.  A lot of runners think that simply running more will yield better running.  But if you run the same way more and more then you should expect more of the same.  In this video, the host is given a few instructions on how to run.  The result?  He gets about 2 seconds faster on a 100m sprint.  That’s a great result!

Strength isn’t discussed in this video but I think we can very safely assume that a stronger runner can strike the ground harder than a weak runner.  So squats, deadlifts, 1-leg squats and jumping should aid in this endeavor.  Also, the advice to keep the core rigid falls right in with the research and teaching of experts like Stuart McGill.

Really, though in the end, it’s the brain that’s the target here.  The runner is able to recognize faults in his running technique and alter how he runs.  Thinking and awareness are vital!

IT Band Syndrome: We Have A Weak Link

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“The single most important factor in predicting and possibly treating IT band problems is hip abductor strength.” John Davis, Running Writings

A weak link is found

My last post discussed finding and fixing our weak links. Well, during a trail run I found a weak link and the quest is on to bring it up to a respectable level. At this point I’ve boiled it down to poorly functioning glutes–the glute medius to be specific. Glute dysfunction is fairly common and I’m realizing more and more that I’ve had a good dose of it for quite some time. It’s gotten better but I’ve got to make it better yet. Right now this weak point is causing me some knee pain.

Inside IT band syndrome

Lateral epicondyle; where IT Band pain is typically felt

Lateral epicondyle; where IT Band pain is typically felt

Recently, while finishing a long trail run, I began to feel the dreaded symptoms of IT band syndrome (ITBS). Chances are, if you’re a runner then you either have or you will experience this issue too. If you look at the Wikipedia entry on ITBS you realize this is a mysterious ailment that might be caused by a myriad of issues from the feet to the hips, from the muscles to the bones, from too much running or cycling or rowing or dancing or whatever else you might do on one or two legs. Conventional treatment ranges from ice to ultrasound to stretching to orthotics and various pain drugs like ibuprofen.  (Do we really think that ITBS was caused by a lack of ibuprofen or an absence ice sitting on our knee?) I want to fix this issue and clarify what’s at work here. Let’s see if I can make some sense.

IT Band insertion

IT Band insertion

ITBS symptoms

The most typical symptom of ITBS is lateral knee pain, somewhere in the neighborhood of what you see on these two pictures. That’s where the IT or iliotibial band inserts. As is typical, I felt a sudden onset of pain at this site while running downhill. It’s a fairly sharp pain. Knee flexion while stepping down off a step often brings it on. Apparently, ITBS can be felt elsewhere along the IT band.

  The research: It’s all about the hip abductors.

I found some superb articles with some very valuable information regarding the root cause(s) of ITBS and how to address the issue. Biomechanical solutions for iliotibial band (IT band) syndrome / ITBS comes from RunningWritings.com.  Glutes rehab – recent research and Gluteus medius – evidence based rehab come from Running-physio.com. There is some overlap between these articles and they all refer to quite a bit of important research.  If you’re a trainer who’s working with someone who has ITBS or if you’re suffering from ITBS, I strongly suggest you read these articles. I’ve summarized some things but definitely go to the sources for a thorough rundown.

Both sources cite a study from Stanford, and here’s what you need to know:

“Long-distance runners with ITBS have weaker hip abduction strength in the affected leg compared with their unaffected leg and unaffected long-distance runners. Additionally, symptom improvement with a successful return to the pre-injury training program parallels improvement in hip abductor strength.”

Some sources suggest that foot/ankle dysfunction–specifically over-pronation–is at the cause of ITBS rather than hip dysfunction. Irene Davis and others of the University of Delaware studied both the hips and feet/ankles. They stated:

“However, aside from this variable [an increase in rearfoot inversion moment], these results begin to suggest that lower extremity gait mechanics [i.e. foot and ankle] do not change as a result of ITBS. Moreover, the similar results of the current study […] suggest that the aetiology of ITBS is more related to atypical hip and knee mechanics as compared to foot mechanics. Therefore, the current retrospective study provides further evidence linking atypical lower extremity kinematics and ITBS. (Ferber et al.)”

The Running Writings article discusses several other studies that had similar findings to the Stanford study. The writer reached this conclusion:

“At this point, the evidence overwhelmingly points to a biomechanical fault in the abductor muscles of the hip as the root cause for IT band syndrome.  Weak or misfiring gluteus medius, gluteus minimus, or tensor fasciae latae muscles are unable to control the adduction of the hip and internal rotation of the knee, leading to abnormal stress and compression on the IT band.  This muscular dysfunction manifests as excessive hip adduction and knee internal rotation, both of which increase strain on the iliotibial band and compress it against the fatty tissue between the lateral femoral epicondyle and the IT band proper, causing abnormal stress and damage. But although the pain is coming from the lateral knee, the root of the problem is coming from the hip muscles.”

(By the way, the hip abductors of which I speak consist of the gluteus maximus, gluteus medius, gluteus minimus and the tensor fascia latae or TFL.  See below.

Here’s something important: Very often the glute medius doesn’t do its share of the work and the TFL does too much work. Therefore it becomes important to condition the glute medius while de-emphasizing TFL activity. The side-lying hip abduction exercise (described below) works particularly well for activating the glute med while minimizing TFL activation.)

Hip abductors.  If they're weak, your knees will probably hurt.

Hip abductors. If they’re weak, your knees will probably hurt.

The Running Writings piece also says, “a doctoral thesis by Alison Brown at Temple University also investigated (hip abductor) muscle strength in runners with and without ITBS; interestingly, she found no difference in maximal strength, but a significant difference in endurance.”

On a slightly different note, a recent study in Medicine and Science in Sports and Exercise indicates excessive hip adduction (adduction is the opposite of abduction; If you adduct too much then you’re not abducting enough.) is a precursor to patellofemoral pain or PFP. So again, we see abnormal hip mechanics playing a role in knee pain in runners.

Finally, the Running Writings article does a nice job of dispelling some myths about ITBS, among them the idea of foam rolling and/or stretching the IT Band. I won’t go into all of it but the bottom line is: Don’t bother. The IT band isn’t the problem–it’s the hip abductors! Work on them.

Tredelenburg gait

What happens when those hip abductors fail to do their job? We get what’s called Trendelenburg gait. Here’s a picture of it.  Notice the right

Trendelenburg gait

Trendelenburg gait

hip drops. When that happens the hip muscles on the left are stretched which puts prolonged tension on the IT band. That excess tension may cause pain at the IT band insertion located on the knee. There’s your pain.

Testing the abuductors

Heeding the observation that hip abductor endurance is key to ITBS, I tested that endurance using the old-fashioned, Jane Fonda-style side-lying hip abduction. (I elected to forgo leg warmers.) I got to almost 30 reps on my right leg (the affected side) and the hip was dying. I got to 30 reps on the left leg and with only moderate fatigue. I’ve seen similar performances in several other clients and my wife who also has some ITBS. This all fits in line with what this research found.

The exercises

The two articles from RunningPhysio do a great job of discussing a wide variety of exercises that engage the glutes. In Glutes rehab: recent research we see research on the exercises that elicit the most contraction from both glute medius and glute max. Look at the tables below to see which exercises get the most out of these muscles. (I’m not sure exactly how all of these exercises were performed.)

wpid-Photo-5-Nov-2012-1944 wpid-Photo-5-Nov-2012-2022

Here’s RuningPhysio’s take on how to apply this information:

Practical application

From the research findings a good programme for runners wanting to target GMed would be starting with single leg mini-squat, side-lying abduction and pelvic drops and progressing to single leg dead lift, single leg squat and side-lying bridge to neutral. For advanced work you could add leg weight to side-lying abduction or combine side plank with upper leg abduction. This set of exercises would start with at least moderate GMed activation and progress to in excess of 70% MVIC. It would contain both functional weight-bearing exercises that are a closer fit to the activity of running, and non-weight bearing activities like side-lying abduction which has been shown to activate GMed without increasing unwanted activity in TFL and anterior hip flexors (McBeth et al. 2012) and has been used successfully to rehab runners with ITBS (Fredericson et al. 2000).

Runners wanting to improve GMax could start with single leg bridge, lunge with neutral trunk and single leg mini-squat and progress to single leg squat, single leg dead lift and forward step up. All of these exercises are ‘closed chain’ single leg activities where the GMax provides power to extend the hip but also works to help stabilise the hip and pelvis. As a result they are fairly functional for runners as GMax has a similar role during running.

In Gluteus Medius: Evidence-based rehab, the writer very wisely discusses differences in what we might call “functional” vs “non-functional” exercises. (This article also describes most of the exercises you’ll want to employ.) Generally, we might say a functional exercise would look like something we do in real life. A 1-leg squat or 1-leg deadlift is an example. These exercises have us standing (weight bearing) and using the whole body in concert. We don’t isolate a muscle in a functional exercise but rather we train a movement pattern and integrate lots of muscles together. In contrast, a non-functional exercise tends to isolate a muscle. The side-lying abduction or side plank are examples of non-functional exercises. These exercises don’t much resemble anything we do during most of our daily activities or sports. That doesn’t mean they don’t have value though, and the article does a nice job of discussing this issue.  The article states:

“Closing thought, from the research I’ve read and patients I’ve seen, a combination of both functional weight bearing and less functional (sidelying) exercises is most likely to be effective in glutes rehab.”

My process

Like I said, my right glute med is indeed easier to exhaust than my left. I figure though that I should work both sides with a little extra work on the right. I’ve been doing lots of the side leg raises and side planks.  I can’t yet do a good side plank while abducting the top leg. That’s a tough one. It’s one to shoot for in the future. I’m also doing a lot of band walks.  I don’t loop the band around my ankles though, I loop it around my feet. This study determined that placing the band around the feet recruits more glutes and less TFL. These are sort of the non-functional exercises that I do pre-workout or first thing in the morning.  

Pre-workout or throughout the day:

  • side-lying hip abduction: 2-3 sets x 10-20 reps.  I go to exertion.
  • side planks: 2-3 sets x 10-20 seconds
  • band walks: I side shuffle as well as walk forwards and backwards. I go to exertion.
  • Hip hikes: Easy to do. This movement has you lifting the pelvis away from the Trendelenburg gait pattern.

Functional/main exercises:

  • 1-leg squat: 3 x 8-15 reps. I recently used a kettlebell in the arm opposite my stance leg.  I focus on keeping my pelvis level, knees somewhat apart and I don’t let my non-stance side hip drop which is very important. I also throw several reps in randomly throughout the day.

  • 1-leg deadlift 3 x 8-15 reps: I often hold one or two kettlebells, dumbbells or a barbell.

  • Off-set step up: 3 x 6-12 reps use a knee-high plyo box for this. I hold a dumbbell on the side opposite my stance leg. I drive up powerfully with the stance leg then do my best to control my descent back down. I don’t plummet back down uncontrolled.

  • ice skaters: 3 x 12-20 reps. This is a power exercise in which I drive side to side in an explosive manner. There’s no way to do this without using the glute medius.

  • 1-arm carries/farmer walks: I carry a kettlebell in one hand and walk. Very functional and simple to do.

These exercises do a great job of conditioning our movement sling system. Read here and here to learn more about these systems of muscles that work together as we move.