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.

The Quadratus Lumborum (QL)

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Get to know your QL.

Recently I’ve been investigating and working on my quadratus lumborum or the “QL.”  This muscle attaches to

the top of the hip bone (illiac crest), the 12th rib, and parts of the lumbar spine. For a long time I’ve had a bit of pain (ranging from a lot of pain to just a pinch) in the neighborhood of my right low back.  At one point in time I was also told I have a right leg-length discrepancy.  (Most leg-length discrepancies are functional rather than structural.  That is, the discrepancy is typically due to contracted muscles pulling the leg up rather than one leg bone being longer than the other.)

A gimpy QL can cause various problems including low-back pain, shoulder dysfunction, breathing problems and balance problems.  Problems in the QL can affect hip position, ribcage position, spine position–all kinds of things. A tight QL can contribute to pinched nerves in the back, the symptoms of which I’ve had sporadically.

I’ve been digging around my low back with a Rumble Roller, the Stick and a lacrosse ball; and I’ve been working to lengthen the QL.  I’ve also been directly working the QL via side bends, side bridges, and 1-arm farmer walks.  I’m liking the results.  If you’ve got back pain you may want to work on your QL.

Here’s a link to a fairly good QL stretch and further information on the QL.

Below are some videos discussing and demonstrating ways to address the QL. The first video is a very thorough rundown of what the QL is, what it does, and common symptoms of QL dysfunction. The next two videos are from Kelly Starrett at MobilityWOD.  He discusses some ways to address a tight, gunked-up QL.  Next comes a video from chiropractor Dr. Craig Liebenson and strength coach Chad Waterbury. They present a way to test your QLs and then present a nice progression of strength exercises.  I’ve just started using this process with myself and some clients.  Finally, there’s a very brief QL stretch.  I like to use a stretch like this to test each QL and see if one is tighter than the other.  There are lots of ways to stretch the QL.  This is just one.

I personally have had some good, quick success in playing around with some of these strategies. I make no guarantees but maybe some of this stuff will help you too.





 

 

 

 

 

 

 

“Body Talk” Lecture Series by Rick Olderman

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If you’re in Denver and you’re either in pain or your a trainer/therapist who’s interested in helping people who are in pain, then I highly suggest you attend one or more of the following lectures from Denver physical therapist and certified personal trainer Rick Olderman.  I’ve mentioned Rick before (here, and here) and his hugely important role in helping me recover from back pain and regain my running ability.  Without question he’s one of the main reasons I was able to resume running and run my first marathon last year.  He’s part of the Body in Balance physical therapy office. The information here will be practical and probably very powerful in helping you or someone you know get out of pain.  And it’s free!

  • Neck Pain & Headaches: Innovative answers you’ve been missing.
    Tuesday, 4/9, 6pm
    Presented by Rick Olderman MSPT, CPT.
  • Trauma, Pain, and the Brain: How to use your brain to fix your pain.
    Saturday, 4/13, 1pm
    Presented by  Rick Olderman MSPT, CPT.
  • 3 Patterns Causing Back Pain and How to Change Them.
    Tuesday, 4/16, 6 pm
    Presented by Rick Olderman MSPT, CPT.
  • Accidents and Chronic Pain: Why you’re not getting better and how can you change your outcome.
    Saturday, 4/20, 1pm
    Presented by Rick Olderman MSPT, CPT.
  • How You Walk Can Fix Your Back, Hip, Knee, and Foot Pain.
    Tuesday, 4/23, 6pm
    Presented by Rick Olderman MSPT, CPT.
  • Stretching: Is there a better way to lengthen muscles?
    Saturday, 4/27, 1pm
    Presented by Rick Olderman MSPT, CPT.
  • Core Performance Versus Core Strength: Common mistakes with abdominal strengthening.
    Tuesday, 4/30, 6pm
    Presented by Rick Olderman MSPT, CPT.
  • How Does Walking Contribute to Chronic Foot and Ankle Pain?
    Saturday, 5/4, 1pm
    Presented by Rick Olderman MSPT, CPT.
  • Carpal Tunnel Syndrome and Thoracic Outlet Syndrome: A unique approach to solving pain.
    Tuesday, 5/7, 6pm
    Presented by Rick Olderman MSPT, CPT.
  • Running Injuries: It’s more than just foot-strike patterns.
    Saturday, 5/11, 1pm
    Presented by Rick Olderman MSPT, CPT.
  • Dry Needling: How is it different than acupuncture and how can it help you?
    Tuesday, 5/14, 5:30pm
    Presented by Aline Thompson PT, MSPT, OCS.

The Problem(s) With Surgery

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“In America the scalpel reigns supreme. Some patients accept that surgery isn’t for them and gladly follow the non surgical recommendations, but others go from surgeon to surgeon until they get the surgery they think they need.”
– Dr. Jennifer Gunter MD, FRCS(C), FACOG, DABPM

I just read a very enlightening post from an MD regarding surgery vs physical therapy.  In To cut isn’t always to cure: knee surgery, health care, and our love affair with the scalpel Dr. Jen Gunter hits several nails very squarely on the head.  First, she discusses research comparing physical therapy alone vs arthroscopic surgery for treatment of knee miniscus repair and osteoarthritis.  What did the study find?  Dr. Gunter says,

“Patients over 45 with OA and a meniscus tear were randomized to typical arthroscopic surgery (which included post operative physical therapy) or physical therapy (PT). They were allowed to cross over to the other group if they so desired. At 6 months and at 12 months those who had surgery were no better off pain or function wise than those who stuck with the physical therapy regimen (30% of people decided to switch from PT to surgery).”

She goes on to discuss our view of surgery, and that we often view surgery as the ultimate best solution for pain.  Couple that view with our widely available yet very expensive MRI technology and we are a society hungering for surgery even when it’s clearly a questionable solution in many cases.  More from Dr. Gunter:

“A lot of people have arthritis of the knee (we know this because of all the knee MRIs that we do in this country at $1200 or so a pop). According to the NEJM study, 9 million Americans have osteoarthritis of the knee confirmed by x-ray or MRI and 35% of people over the age of 50 will have a meniscus tear on MRI. A torn meniscus itself doesn’t necessarily identify the cause of the pain because 2/3 of meniscus tears are totally asymptomatic. MRIs are so sensitive they identify tons of things that are not causative as far as pain is concerned.

Because we have an aging population, because we MRI everyone, because we have a problem with obesity (a major co-factor in osteoarthritis), and because surgery is highly reimbursed almost 500,000 people get their partially torn meniscus trimmed by a minimally invasive surgery called arthroscopy (using a surgical telescope) each year in the United States.

However, recent studies have called into question the value of arthroscopic knee surgery. For example, we know that arthroscopic surgery for osteoarthritis (OA) alone is no better than sham surgery. Yup. Put a patient to sleep, nick the skin with a scalpel. squirt water on his leg or stick a telescope into it and fix what you think needs to be fixed… the outcomes are identical.”

Dr. Gunter makes a great point regarding treatment of arthritis and by addressing obesity via lifestyle:

“And what about diet and lifestyle? Obesity is a major co-factor in osteoarthritis of the knee. Not only because the knee is load bearing, but the fat pad in the knee is metabolically active like the fat around the belly and contributes to the inflammatory changes of arthritis. The average body mass index in the NEJM study was 30. That means that obesity was the norm.”

I’m very pleased to see an MD making these kinds of observations.  The big message is that surgery isn’t always the best solution is tremendously valuable.  We love to think American medical care is wonderful but in so many cases it’s just incredibly wasteful.  We spend the most of any 1st world country on medical care yet our outcomes are questionable when compared to other modern countries.  We spend too much on things we don’t need when there are practical ways to reduce costs and maintain a high quality of care.

I would add that surgery often only treats a symptom rather than the cause of something like arthritis.  Osteoarthritis is typically related to poor movement patterns.  If we can use our muscles to correctly control our joints then we have sloppy movement.  The result is friction within the joint and thus a buildup of bone–arthritis.  The process is similar to the formation of a callous on the skin.  If we only clean up the arthritis and we do nothing to correct movement, then we should expect to continue to have pain.  Surgery doesn’t correct movement.  That’s what physical therapy and similar modalities are for.

 

An FMS Discussion Part II

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The corrective strategy

Test. Apply a corrective exercise. Re-test.  This concept is HUGE.  The test/re-test process is just massively important in any situation (technology, medicine, cooking, and yes, human movement) if you want to know if a particular intervention works.  Dr. Eric Cobb of Z-Health first introduced the importance of the test & re-test to me.  The concept is equally important in the FMS.  What does it mean and what does it look like?

We can test all sorts of things.  We can test a movement pattern for pain or tightness.  As it pertains to the FMS, we want to at some point test and re-test the seven different movement patterns.  Beyond that, I could use stepping up and down stairs to test for knee pain.  We could bend forward or backward to test for back pain.  I could go into a hip flexor stretch on each leg to compare tightness in each thigh.  I could stand on one leg to test balance.  If you’ve got some sort of difficulty with a particular exercise then that’s a test.  So we test something. Then we apply some sort of corrective.  Then we re-test.

We might foam roll and/or stretch to increase mobility of a joint.  Then we could re-test.  Did anything change?  We might then employ a stabilization exercise.  Then we re-test.  Did things improve or not?  We could move from static stabilization to dynamic stabilization, that is, we can look at stabilizing a joint while moving other joints.  If we see improvement and it holds, then we should practice our new and improved movement.  A phrase I heard at the FMS is “Move well then move often.”  We want to ingrain these new, good movement patterns.  We want to make them habitual.  If we load the movement pattern with weights then we look to get stronger in these new movement patterns.  We can continue to re-test over the course of time to ensure we haven’t regressed back to poor movement.

My strategy: addressing the ankle, knee and hip

Some of my years-long issues regarding my low back, my right knee and left heel/Achilles are still lingering.  These issues aren’t terrible and they hardly limit me but I still would like to clean them up a bit.  My right hip tends to be tight.  I have intermittent moderate right lateral knee pain.  My left calf tends to be tight.  I’ve got some impingement in my right ankle.  Fortunately, my FMS score is a solid 18 out of a possible 21 which means that it’s safe to exercise and work out vigorously.

Mobility restoration

I’ve employed several tools to restore lost mobility and overcome some movement restrictions.  I mentioned in a previous post that I’ve had some dry needling done to my right thigh and hip flexor area.  (I’ve since had some done on my right shoulder as well.)  This has done a very nice job of relaxing some muscles that were in spasm, thus enabling a greater range of hip extension.  I’ve also been using a foam roller, lacrosse ball, and a barbell to get into the gunked up areas of my quads, calves and low-back/quadratus lumborum area.  As I mentioned, my right hip and low back are troubled areas, so I’ve spent more time working there than on my left side.  (Kelly Starrett of MobilityWOD has some great ideas on addressing restricted tissue.  Check out pages 34-37 of his new book Becoming a Supple Leopard for a variety of ways to smash the quad and un-glue matted-down tissues.  I’ve been doing a lot of this stuff to great effect.)

A lacrosse ball has been especially useful in getting into my glute minimus and tensor fasciae latae (TFL).  I’ve also been using the Stick on my calves and posterior tibialis.  You can really experiment with a variety of objects, angles and positions when going after these tight, sore areas.  With regard to the test/re-test scheme, it’s  a good idea to mash out one side of your body–your right glute for instance– then mash out the other side.  How do they compare?  Is one side more beat-up than the other?  If so, spend more time working there.  See if over time you can even them out.

Once I’ve spent a few minutes going after soft-tissue restrictions, I go into some joint mobility drills.  Here are some examples:

3D ankle mobility

Hip flexor stretch, pigeon stretch, hip slide

Stability restoration

half-kneeling with rotation

chop & lift

half-loaded lunge

 

Reactive neuromuscular training:

The only way to do it right is to do it at all.  There is often a bit of frustration or struggle with this process–but that’s good!  Here, we actually help facilitate bad form–we “feed the mistake” in other words.  In this way the unconscious movement fault is made conscious.  Now we have a chance to correct the thing.  What does this look like? (squat w/band around knees, split squat w/tube)

 

 

 

 

An FMS Discussion: Part I

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The Functional Movement Screen is a subject I’ve been studying (and writing about) recently. I recently had the pleasure of traveling to San Francisco to attend the Functional Movement Screen (FMS).  I got to meet some interesting, smart people and some great information found its way into my brain.  So what is the FMS?  From the FMS site:

Put simply, the FMS is a ranking and grading system that documents movement patterns that are key to normal function. By screening these patterns, the FMS readily identifies functional limitations and asymmetries. These are issues that can reduce the effects of functional training and physical conditioning and distort body awareness.

The FMS generates the Functional Movement Screen Score, which is used to target problems and track progress. This scoring system is directly linked to the most beneficial corrective exercises to restore mechanically sound movement patterns.

Movement patterns vs. Muscles

A key component of the Functional Movement Screen (FMS) paradigm is the idea of training movement patterns rather than individual muscles. For example, what muscles does the squat use?  Pushups? The deadlift?  For that matter, what muscles does basketball, gymnastics, swimming, or raking leaves use?  The answer is a lot of muscles, and these muscles must work together in sequence to create movement. (A better question might be “What muscles don’t these activities use?) This concept of addressing and thinking in terms of patterns rather than muscles is important in terms of how our brain works.  When we walk, our brain doesn’t say, “Fire the glute max, and medius, now the semimembranosus, now the semitendinosis, biceps femoris, now the gastroc, soleus…”  The brain says, “Extend the hip.”  The brain has a map of our movement patterns and it executes our movements based on that map.  An analogy might be a song.  When we hear a song we hear a song.  We typically don’t listen to the individual instruments absent the other instruments.  We hear a cohesive, coordinated song. While it may be appropriate and necessary to analyze individual muscles in some therapeutic processes, remember that our brain drives our movements via coordinated patterns.  Very typically our pain and dysfunctional movement is due to faulty movement patterns in our brain.  The FMS strategy helps restore those patterns.

Mobility first.  Stability second.

World-class mobility and stability

Gray Cook discusses developmental movement from infancy on up.  Babies start as helpless, wiggly blobs with no balance or coordination of any sort.  At some point in their lives they may become gold-medal gymnasts, top professional tennis players, surfers, piano players, chansaw jugglers, stilt walkers–who knows what?!  In other words they go from a highly mobile yet uncoordinated state to a much more stable and coordinated state.  This ability to blend mobility and stability into movement is called motor control. (Unfortunately due to the Western lifestyle which is chock full of sitting, these former masters of motor control often turn into weak, rigid, unbalanced, uncoordinated zombies racked with pain.  It’s not simply “age” that robs us of motor control.  We choose to avoid moving–and then we become unable to move well.)  The big point here is mobility precedes stability, and we certainly need both.

It’s important to understand that joint stiffness isn’t the same as stability.  A joint often stiffens due to injury or lack of movement.  If we are unable to effectively stabilize a joint, then that joint may stiffen as a sort of a plan B by the nervous system.  A stiff, poorly moving joint is not a healthy joint.  Why?  Primarily a stiff joint brings on poor proprioception.  In the grand scheme, a stiff joint is a poor transmitter of information to the brain, and a poor receiver of information from the brain.  It doesn’t pay attention well.  If you have trouble standing on one leg, it’s very likely that one or more of your joints are stiff.  For an illuminating discussion of the mobility/stability concept, please read the Joint by Joint Approach from Gray Cook.  The concept was born out of the observation that as we look at the skeleton from the ground up, we tend to see an alternating pattern from joint to joint in which one joint tends to be stiff and the next joint tends to be loose and sloppy. It might be a bit technical for some people but the big chunks of information will be digestible for most and it’s a very powerful concept when thinking about movement dysfunction.

Asymmetries

Might an asymmetry be hiding in this athlete?

A key part of the FMS is the recognition of and correction of asymmetries. Often when someone goes through the FMS we’re able to expose asymmetries in range of motion (ROM), balance, coordination, strength, etc. One side of the body is good at a movement while the other side isn’t.  (The half-kneeling exercise often exposes an asymmetry.) Typically the test subject has no idea the asymmetry exists. He or she has been moving through life unconscious that they’re lopsided and out of whack.  In other words, we’re helping create awareness.

 

But why do we care about asymmetries?  Think about this: If we go to perform a squat, a deadlift, a jump, a press–some sort of movement that requires strength, power and coordination–but we’ve got one side of the body that can’t handle the job, do you think at some point we might incur an injury?  If one side is mobile, stable, and strong while the other side isn’t, what do you think might happen?  Could we see a situation where lifting something off of the ground might cause some weird torquing forces through the hips or spine?  Hello herniated disk.

Next I’ll discuss the corrective process and use some of my own issues as examples.


Good Core Strength Artice

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“I have a section called, ‘Stop doing crunches,'” said Westfahl. “If your core routine mainly consists of crunches, you are training for bad posture.”
– Alison Westfall personal trainer, Boulder

Briefly, if you’re an athlete (particularly a cyclist), a fitness enthusiast and/or interested in addressing back pain, you should check out a recent article from the Denver Post titled, Tom Danielson, Tour de France cyclist from Boulder, focuses on core strength, writes book to address back pain. The article covers former pro cyclist Tom Danielson and his trainer Alison Westfall and their approach to addressing Danielson’s back pain.  The two teamed to write a book called Core Advantage: Core Strength for Cycling’s Winning Edge.

Five clients mentioned this article to me and it definitely has some useful information in it.  The admonition to quit doing crunches is the first good piece of advice.  The second is the inclusion of the glutes as part of the core:

“Pain in Danielson’s spine compelled him to see Westfahl, who found his problem wasn’t rooted in his back, but in his glutes. She had him stop doing crunches — his primary core workout — and switch to other exercises, ones that, among other things, would persuade his glutes to start working properly when he rode.”

There’s more good information in the article including descriptions of three core exercises.  Have a look.  The book sounds interesting to me as well.  Probably need to put it on my wish list.

Gray Cook, FMS & Dry Needling

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The true champion will spend more time working on weakness than showing off strength.
– Gray Cook, Athletic Body in Balance

Gray Cook

I’ve taken great interest recently in Gray Cook’s material including the FMS or Functional Movement Screen as well as two books by Gray, Movement and Athletic Body in Balance.  Gray is a physical therapist, strength coach and kettlebell instructor.  Much of his work focuses on identifying our weaknesses and improving our poor movement patterns.  He’s been in the fitness/rehab world for a while and I’ve known of his work for a while but just recently have I really dug into it and I’m finding it very fascinating.

Functional Movement Screen

The FMS consists of several movement patterns: the overhead squat, inline lunge, hurdle step, shoulder mobility reaching, straight-leg raise, trunk stability pushup, and rotary stability pattern.  These movements are fundamental to the way we move.  They combine elements of stability and mobility.  The purpose of the screen is to identify deficient movement patterns, asymmetries (this is a potentially HUGE issue) and pain.  If someone test poorly on any of these tests then we know what areas need corrective exercise.  This is a process of identifying weaknesses and making them strong.

Visit to PT Mike Kohm & dry needling

I wanted to get a first-hand exposure to the FMS and the clinical companion to the FMS which is known as the Selective Functional Movement Assessment (SFMA).  (The SFMA is used by physical therapists, chiropractors, osteopaths, etc. to further investigate painful and dysfunctional movement.)  I looked up FMS/SFMA certified practitioners in the Denver area and I selected Mike Kohm of Neuromuscular Strategies.  Mike is a PT and a yoga instructor who has experience with runners and cyclists. When I made my appointment I had nothing much wrong with me.  I’ve had a little bit of right shoulder pain which has improved recently, but mainly I just wanted to see if there were any odd movement issues that I might want to take care of.  A few days prior to my appointment I strained my right hip flexor while running sprints.  Perfect time to see a PT.

I won’t go into every aspect of the assessment but it was a very thorough examination that did indeed expose some less-than-optimal movement patterns.  He ID’d some funny movement at my right tibia and we figured out more about my right shoulder.  We looked at some exercises to improve both areas.  Just a couple of days later and both areas are moving much better.

As for my hip flexor, he did some dry needling on the strained area. This procedure is similar to acupuncture but it doesn’t rely on quite the same method.  It involves inserting an acupuncture needle into a tight, spasming muscle.  Sound like fun?  It wasn’t as bad as it sounds, though it wasn’t any party either.  I felt a stick and then a sudden but very brief cramp and then the muscle relaxed.  Mike used the needle in three spots.  It definitely felt better afterward.  Mike said he thought dry needling could cut down by half the healing time for strained muscles.  Sounds good to me.

FMS Self-Assessment & the Bretzel

Finally, there are a lot of interesting and informative Youtube videos discussing the FMS and corrective strategies.  Here are a couple.  The first is an abbreviated version of the FMS that you can use to evaluate your own movement patterns.  The second is a very useful thoracic spine mobility drill known as the Bretzel.  There are two versions of the Bretzel.  These drills can be quite useful in addressing shoulder pain among other things. Try some of this stuff out and see what happens.

Book Review: Anatomy for Runners

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Are you a runner?  Do you know a runner?  If yes, then I HIGHLY recommend Anatomy for Runners by Jay Dicharry. MPT, CSCS.  It’s simply a fantastic book on the hows and whys of overcoming running injuries and increasing your performance.

Dicharry hits numerous nails very solidly on the head.  He doesn’t just talk about treating the symptoms of our injuries. Rather, he gets at the true causes of our injuries–namely we don’t know how to stabilize our spine, hips, knees, ankles and feet appropriately.  We’ve forgotten how to move!  The book covers anatomy, gait mechanics, soft tissue maintenance, corrective exercises, footwear, orthotics, stretching, strength. Chapter 9 is a self-assessment process to help you figure out if you’re both mobile and stable enough to run.  If you’re lacking in those departments, he presents strategies and exercises to shore up your weak areas.  Impressively, he presents all this fairly technical information in a very easy-to-read kind of way.  This isn’t a dry, boring textbook.

Dicharry is a physical therapist, strength coach, running coach and a cycling coach; so he knows his science.  But, I think one of the most important aspects of Anatomy for Runners is that Dicharry writes from the perspective of a formerly often-injured runner.  This point-of-view is one with which I and probably a lot of other people will identify.  He cites numerous conversations with doctors that told him to rest and he’d get better.  He’d rest, run again, then he’d be injured again.  (Guess what, resting doesn’t fix anything!  If you’ve got a flat tire and you quit driving the car, the flat won’t fix itself.)  Other docs told him him he should probably quit running.  If you’ve heard that then you know how maddening and disheartening that advice is!  He didn’t quit.  He did the good work of figuring out how to run properly. I think his words will give hope to people who may have arthritis, worn cartilage, worn menisci (that’s plural for miniscus) and other “injuries” that may have lead physicians to tell you to quit running.

So it’s almost Christmas.  People are asking you what you want and you’re wondering what to buy for them.  Click the link below and get this book!

Just Over A Week ‘Til Race Day

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The marathon is close and I’m feeling it. What does that phrase mean? I’m worn out! A summer of hard training, long runs, fast runs, a brutal trail race and the big 20 mile run Saturday-before-last means the organism that is me is feeling shagged out. My sleep patterns have been off a little lately, I’ve been a bit grumpy, and I’ve had two runs that were tougher and slower than they should’ve been. In other words I’m not in optimal condition.

As they sometimes ask on ESPN, “Is it time to panic?”

I went to a former client and good friend of mine to get his take on my condition. (This guy is a multiple-Ironman competitor and veteran of numerous Olympic distance triathlons, marathons and various very demanding and ugly adventure races.) I told him about all this. His words were, “Congratulations, you’re two weeks out from a marathon. You’ve been training hard. Feeling beat up and tired is completely normal.”

Wonderful! I’m normal! Psychologically, it’s very comforting to have someone who’s gone through this process tell me that all is probably very well. Seems like it’s a good time to discuss exactly what’s going on here and why I might be feeling a bit run over and rundown.

Whether we’re looking at strength training or endurance training, a process known as the General Adaptive (or Adaptation) Syndrome is at work. Rather than try to explain this myself, (I am tired after all) I’ll borrow from Cedric Unholz, a Vancouver-based collegiate strength coach and manual therapist. The following comes from his document, Resistance Training Theory and Adaptation Fundamentals. (Never mind that this is directed at resistance training.  As I said earlier, endurance training processes are essentially the same.)

The Stress-Response Model

The fundamental model underpinning all training and adaptation processes is derived from the ‘General Adaptation Syndrome’ initially outlined by Hans Selye in 1936, and later refined by the same author in 1956. In most training literature this concept is commonly referred to as the ‘supercompensation cycle’.

These models very clearly highlight that training is ultimately about applying appropriate stress to take advantage of the body’s subsequent adaptive responses. Any stimulus/stressor or recovery method, regardless whether acute or chronic in nature, will cause a response that will correspond to the principles of this concept and shape the response curvature. Similarly, a lack or over-application of stimulus will also be accompanied by a corresponding response profile.

In essence, this stress-response model (Figure 2) consists of four phases:

1. ‘Alarm reaction’ following a disruption in homeostasis (e.g. a training stimulus).

2. ‘Resistance’ where the body responds to the stimulus by recovering, repairing itself, and instigating a return towards the initial baseline.

3. ‘Supercompensation’ where the body adapts to the initial stimulus by rebounding above the previous baseline, in order to better cope with the initial disruptive stimulus should it present itself again.

4. ‘Exhaustion’, which could also be termed ‘Detraining’, sees a drop to the initial level of homeostasis (or below) if there is an inappropriate application of following stimulus; whether too much, too soon, or not enough.

Figure 2. The Stress-Response Model based on Hans Selye’s ‘General Adaptation Syndrome’

So in my case, my recent poor runs suggest that I’ve had a little too much stimulation and I was somewhat deep in the alarm phase of this model–somewhere in the A/B range of the curve. The strategy now is to get well into the C part of the curve for the race.

Recovery strategy

The key word here is REST. I need to back off of the running, lifting, cycling, etc. in order to allow for supercompensation. That means lying around a good bit, sleeping in a bit, looking for any opportunity to sit. I’ve also been overeating a bit. I haven’t been too terribly gluttonous but I’ve definitely been taking in more good quality calories.  I’ve also been drinking a bit of delicious tart cherry juice from I got at the local farmer’s market.

Beyond rest and eating, I’ll modify my running plan for the final week before the race. I will likely do a long run on Saturday or Sunday of 6-8 miles and I’ll run it slow and easy. Next week I’ll probably do some speed work early in the week but I’ll cut down the reps. Then the mid-week three mile run at marathon pace sounds about right.

I’ve already cut back my weight workouts and I might do one upper-body focused workout next week but even just working the upper body can tax the whole system, so less is more in this regard.

Finally, if any of this is of interest to you, then definitely have a look at this Running Times article titled How Long Does It Take To Benefit From A Hard Workout? The information here should prove very valuable to anyone trying to strategize their race training.

***UPDATE***

Today I did a 3 mile tempo run and I felt good. I hit my pace without too much discomfort. All seems well.  I believe I’m right where I need to be.