Doctor G Sports Therapy

Spring Cleaning

2017-03-09T11:37:00.001-08:00

I was lucky enough to be asked to contribute to another excellent article by Gabriella Boston which was featured in today's Washington Post-

https://www.washingtonpost.com/lifestyle/wellness/?nid=menu_nav_lifestyle-wellness&utm_term=.0607a07d7e78

I encourage you to give it a view. It was nice to see that many of the key points I shared with Gabriella were also mentioned by other local experts. Two of these key points were the importance of sleep habits, and proper nutrition.

The value of sleep can't be overestimated. The body heals when we sleep, and without it we are on borrowed time. I see this time and time again. When an athlete or patient is not able to get adequate sleep, I don't want to see them in the clinic. I value you them using that time to set the balance straight with their sleep. I also advocate for setting a threshold of sleep time under which you skip workouts. To me, it makes sense.

For the athlete, the next workout is going to compromised if adequate rest since the last effort has not occurred. If the goal is to build or progress fitness, then short changing sleep/rest prior to the workout is madness.

For the patient, a similar pattern is true. We want the body's "environment" to be conducive for healing. If the body is robbed of sleep time, or adequate rest/recovery, it will simply to less effective at reaping the benefits from exercise. My feeling is a cornerstone of athletic success is rest first, workouts second.

Another key part of reviewing our exercise routine for a spring cleaning includes nutrition. I tell folks that a PT is a mechanic and their body is the machine. Nutrition is simply the fuel we put in it. Making sure the fuel is as pure and healthy as possible will optimize the function of the engine. Simple enough. What we use to fuel, and when we fill the tank are widely discussed topics. I would encourage you to explore these topics to ensure you are firing on all cylinders! Be well, Robert

Things are warming up

2017-02-28T13:04:00.002-08:00

Warming Up...

The weather here in DC is downright spring-like. At least for a day or two. People are outside soaking up the vitamin D, and the blooming redbuds too. To follow up on the last post of gently getting back into run training for the Cherry Blossom 10 miler, let's talk about warming up for runs.

It's worth starting with a simple question: why warm up? Traditionally people have looked at a warm-up as an opportunity to prepare the body to perform. To achieve this goal we are going to look at our warm-up as a means to gently increase the heart rate which increases blood flow, and temperature of the involved muscles. It makes sense that a set of warm muscles will facilitate improved range of motion and flexibility, both of which are important for running. Liken it to starting your car on a cold day. If you want to see the engine perform without sputtering, better to let the core temperature come up before stomping on the gas pedal.

Another goal of a warm-up would be to make it sport specific. For running, we want most of our focus on the legs. I would suggest getting into a routine of body weight movements to encourage muscle getting warm, but also joints moving through a full range, and tissues moving freely.

Some basic movements which could be couple together to represent a warm up for running include:

*Squatting- Keep the hips back such that the shin stays close to perpendiculuar to the ground. This keeps the glutes active during the movement. Also, be mindful the knees do not drift togther throughout the range

*Lunging- This is perfect for running as we get one leg moving forward, and the other one back, which is essentially running. Just like with the squat, be mindful of posture- don't lean forward excessively, or let the knees drift inward towards midline. Also be sure to move the opposite arm forward which mimics natural patterns of movement. You can also lunge to the right and left to get the lateral glutes going!

*Marching/high knees- A great way to get the hip flexors going which is a key part of propulsion. Think of this a an exaggerated march where the knee is coming above the waistline. Also use this as a balance drill by moving slowly and forcing single leg control. Remember that you should feel the glute engaged on the leg you are standing on!

*Leg swings- This is just gently swinging the leg forward and back like a pendulum. Focus on moving through the hip. The lower back should not move during this motion. You can also do swings moving across the body left and right (think 9 o'clock to 3)

*Butt kicks- This gets close to actually jogging in place where you are actively pulling the heel up towards your bottom. This engages the hamstring which tends to be very active in normal running.

*Heel raises- A perfect way to get the calf, and achilles warm. A very easy means of avoiding strain to these critical areas of the leg.

*Skipping- Remind you of your school days? It should! Think of it as bounding from one high knee to the next. It is one to do at the end after you are already warm.

Each of the above could be done for 30-45 seconds, which would bring you to a focused 5 minutes of a warm up. If you are doing an easier run, you could head straight into it. If you are doing a focused workout, probably best to go from the above into some easy jogging where you could gently cut down your pace to task the legs a bit more before pushing into your workout.

Of course, after you warm up , and do your training run, next comes the cool down. Let's discuss a focused cool down next time, including common stretches for the legs.

Six weeks til Cherry Blossom

2017-02-19T10:01:00.002-08:00

Can you believe the Cherry Blossom 10 miler is only six weeks away? The problem is these days a runner needs to register for an event months in advance of an event. This ineveitably results in an "oh, shoot" moment for many participants. You wake up one day to realize your fitness level has plummeted since you clicked the REGISTER button. The holidays, the weather, the "fill in the blank excuse du jour" all conspire to get us off our training game. The important thing at this juncture is to remain calm, and avoid one of the most common causes of injury: overtraining. That's right folks, I would say up to half of the running related injuries I see in the clinic are self inflicted. (http://journals.sagepub.com/doi/abs/10.3113/FAI.2008.0671) The classic scenario is with some warm weather people go from 0-60 with their training, which the body generally does not tolerate.
Common training pitfalls include ramping up the distance, pace, or terrain too quickly. My perspective is that with a race looming 6 weeks away, most of us would be better served to undershoot vs overshoot with their training efforts. Let's review some sound recommendations in each category to help you get to the start line injury-free.

Regarding distance, it is probably best not to try to increase you weekly mileage greater than 10% per week. This rule can be modified based on a runner's experience, and injury history. That said, the 10% rule actually forces you to plan your training in a way which allows the body to be gently stressed by the running. This gentle stress is good. In fact, our joints, muscles, and tendons, will adapt to it, and be able to tolerate the stress without breaking down. Time is a key factor in this adaptation which is why we should not rush the training. Another factor to consider with running a distance like 10 miles is that your longest run per week should be less than 50% of your weekly mileage. This pricinple is much like the 10% rule in that we are trying to minimize the likelihood of overwhelming the body. Many tissues and joints such as the achilles tendon, and the knee joint, are sensitive to the repetitive loading stresses of running. Let's not forget that an average runner might take 90 minutes to run 10 miles. This can easily represent 15,000 foot strikes so we need to be kind to the tissues to avoid injury. Slow and steady wins the race here.

When you consider pace as you ready yourself for the 10 miler, it's probably best to consider your breath. What I mean is 10 miles is a long way. No need to rush your pace during the race, or in your training. Most of your training runs should be done at a conversational pace. If you are running at a gentle pace such that you can get a sentence of conversation out between your breaths, chances are you are at an approprite pace. When we are trying to return to fitness, I have found that your natural training pace is all over the place. You most likely start out too quickly, and finish too slowly as you run out of gas. Besides minding your breathing as a guide, a GPS watch is a very useful tool to keep you honest. Most watches will give you a real-time pace which you can use as a benchmark. A spot check of the watch can reveal what our breath tells us: too fast as pace= huffing/puffing, just right= control non-strugglinng belly breathing. If you are short on time preparing for an event like the Cherry Blossom, you are probably better off building up your base fitness by long slow running in an effort to start by targetinng your endurance.

Lastly, with the terrain you are running on, try to adhere to the slow and steady mantra we have already proposed. In fact, try to keep terrain out of the equation all together. Until you have build a base of miles, it is probably best to avoid an emphasis on hilly terrain. Additionally, if you have spent most of the winter training on a treadmill, there's even more incentive to get some time of your feet running outdoors in the spirit of letting the body adjust. I recognize that hill repeats are great stimulus for our leg and cardiovascular muscles. However, when short on time, best way to avoid seeing me in the clinic, is to focus on easing on down the road, especially the flatter one!

Let's look at the next six weeks as an opportunity to get the legs going a bit as we strive to get the start line injury free. Better to undershoot, than to overshoot with your training efforts. This mindset, as well as #slowandsteady is the perfect recipe for gearing up for a classic DC running event.
To help with your preparations, I will review some useful tips over the coming weeks to keep you on track.

Out of the basement!

2017-02-17T06:52:00.001-08:00

I am happy to report a change in my professional life. After nearly seven years in Foggy Bottom, I have moved practice to Bethesda, Maryland. I have joined the team at Point Performance Therapy. (http://www.pointperformance.com/) It is a great team of experienced clinicians so I am pleased to be part of it. I want thank Sarah Thorpe for many fufilling years at Sports and Spinal PT. My growth at SSPT helped me to be positioned to make an upgrade such as joining Point Performance. I look forward to renewing the blog as part of my inspiration with this change of scenery. Be well, Robert

Point Performace Therapy
6400 Goldsboro Rd Suite 340
Bethesda MD 20817
301.244.9099
rgillanders@pointperformace.com

Glutes, activate!

2015-02-19T06:54:00.001-08:00

Tiger Woods recently continued his injury woes with yet another withdrawal from a golf tournament. When asked about his reason early departure, Woods explained the blame is on his glutes being "deactivated". He went on to explain that when his glutes don't activate, his lower back problems will soon follow. His explanation has been fodder for many a late-night joke, but there is much truth to his stance. In the therapy world, we deal with these types of issues all the time. Additionally, in the therapy world, we firmly (!) understand the value of a well functioning glute muscle.

The glute max is a vital muscle. Not only does it provide an anchor for the hip, but it also is a key stabilizer of the lumbar spine, aka the lower back. For the hip, the glute max provides movement in three different planes. Even for the lay-est of lay people, this should speak to its relative importance. This glute muscle, along with the gluteus medius and minimus, provide are the foundation of stability for the leg below it. We know that stability of the foundation will help the first floor to be stable too. In the case of the glutes, the 'first' floor includes the knees, as well as the lower back. With a muscle in a weakened or dysfunctional state, normal patterns of firing are unlikely to follow. Thus, it is not that difficult to connect the dots in Tiger's case. If the mighty glute is not firing, it is hard to imagine optimal function can happen. Let's also not lose perspective on the game being play. Golf, particularly professional golf, is a sport which requires its participants to generate huge rotational forces during the standard swing movement. If there is a relative instability because of 'core' muscle dysfunction, excessive strain will follow. Even if this is a microstrain, golf is such a repetitive sport that there is likely to be a cumulative effect that creates a macro issue. The same is often true for runners- a small problem multiplied by thousands of reps leads to a bigger problem.

One might wonder what causes a muscle not to fire appropriately, to not activate? Good question, and one with many answers. Pain tends to have an inhibitory influence on a muscle. Swelling will also shut a muscle down. Many have experienced this combination with a knee strain where the knee feels like it is going to buckle going down stairs as the quad muscle is not working properly. If a nerve's signal is not getting to the muscles, then the message to fire is never received. A muscle will not fire on its own. It needs to be told to fire by the nervous system. This begins to dabble in the space of 'motor control' which involves the brain, the nervous system, and the muscles. We have learned in rehab that just because a muscle can fire, it will fire. We have learned that if a muscle that is not firing, faulty patterns of movement typically result. The faulty patterns of movement do not improve spontaneously, but have to be re-educated into proper firing, control, and movement. This is a great follow-up post to pursue.

One final thought regarding the glutes relates to relevant exercises to 'activate' them. The basic bridge is a great place to start.

The bridge teaches us how to fire the glutes while the hips go into extension as they are lifted off the floor. The bridge also opens the front of the hip through reciprocal inhibition- i.e. when you strongly contract the glutes, the opposing muscles, namely the hip flexors, will naturally be turned off. This is useful as many desk jockeys tend to be tight in this area from hours of sitting. Another great exercise for the glutes is the squat, particularly when done properly. I encourage people to squat such that their hips and knees stay back. This cues the glutes to be active, and also to minimize the strain on the knee joints. Many folks have spent many a minute in the clinic with me relearning how to do some basic movements. Frustration often occurs but recognize that in PT, we are trying to change things that have led to injury. Underusing the glutes is never good but can be corrected with consistent work. So, after two years of being blog free, I leave you with a good looking glute squat. (And thanks to the barefoot wonder for inspiring me to post...)

Enjoying the process

2012-04-29T08:19:00.002-07:00

Two weeks ago tomorrow was the scorcher known as the 2012 Boston Marathon. With the temps creeping close to 80 before the start of the race, I suspect most racers knew it was not a day to go for a personal best. The BAA certainly did their part to give participants adequate warning about the risks of exertion in higher temperatures. They even allowed people to defer their entry to 2013 with presumably cooler temps. The situation raised one of the many truths about marathoning: enjoy the process. After months of training, there are many things completely out of a racer's control. One of the biggest factors is weather. The way of the champion is to train for all the things that can be controlled: mileage, intensity, recovery, rest, diet etc. The way of the champion is also to expect those things that can't be control:weather, illness, etc. If you can plan for these things, then you are not as off your game when they become reality. Boston this year was the perfect example of that. I trained hard with an emphasis on distance. My last race in Philly was good, but I felt the lack of adequate endurance took its toll at the end. I mixed up my training to accommodate for the deficit. I had a great simulator a month prior where I ran part of the National marathon with Chris Farley from Pacers running stores. I hung onto his wheel for 15 miles at 630 pace. Not that is was easy, but I got it done and that is what counts. So, you hate to go into a race like Boston ready to roll only to have some steamy temps push you way back off your pace. That is the cruelty of the marathon. It is what makes me want to retire from distance running. It is also what makes me want to come back. So while you prep for your next race, make sure you are having fun. Makes sure that you have a schedule that enables you to have life balance so you can gain fitness, but also smell the roses along the way.
My race ended up 20 minutes slower than last year. But in a way, this year was more fun than the past 4 Bostons. I soaked up the crowd and ran the race more like I was doing an ultra than a road marathon. It was the first year I had the smarts to stop in Wellsley for some pucker time. That was fun, and at the end of the day, that is what it should be all about.

Do one thing

2012-01-16T12:20:00.000-08:00

Do one thing

A common question I pose to new clients in the clinic is “what do you do besides just run?” Most times my inquiry is met with a confused look. The same question applies to triathletes: what do you do besides swim, bike, or run? What I am fishing for as I begin the initial evaluation is does this person work on flexibility, address strength training with a consistent gym routine, or even work on postural balance by working on core muscles? The answers I receive cover a broad spectrum. However, the majority of people respond with chesire cat grin as they confess they do nothing more than train for their particular sport. I do not fault them for this, yet try to ultimately help them to recognize that this approach only works for so long. Particularly with Masters athletes, I find this approach to place most folks on the path to injury.

Though most of the physical therapists at Sports and Spinal have worked with pro athletes in some capacity, I would argue that we work most consistently with “professional” athletes all day long. These are the spirited club runners who train early in the morning before they then sit all day at work. This group also includes the triathletes who train before work, sit, then train more after work! Needless to say, this group is a dedicated bunch. They are concerned about their race times, and their training time, but first and foremost is their time commitments to work. At Sports and Spinal, we see certain deficits afflicting many different types of clients. One example we see is that for people who are seated all day, certain muscles groups are almost always tight. It actually makes sense when you consider which muscles are placed in a shortened position when seated. This group includes the hamstrings which are shortened by virtue of the knees being flexed while seated. The hip flexors are also placed in a shortened position because the hips are moderately flexed when seated, particularly when using poor posture strategies.

We know that the “professional” athlete is usually short on time. Therefore we start off the New Year with a new column entitled “Do one thing” which gives the reader one exercise to focus on adding to their existing routine. The goal will be to make it a simple task which can be done with time efficiency, and in any location. The first target will be the tight hip flexors mentioned above. Maintaining flexibility in the hip flexors will reduce strain on the lumbar spine, as well as enable full hip range of motion for the running athlete. The hip flexor group, made up of the iliacus and psoas muscles, originates directly attached to the vertebrae of the lumbar spine(lower back), and the inside of the pelvis. The muscle inserts onto the inside of the of the femur, or thigh, bone. These details are mentioned because they will factor into the posture one assumes when stretching the muscles.

To stretch the left hip flexors, assume a partial kneeling position such that the left knee is on the ground, and the right foot is on the ground with the knee flexed at a 90 degree angle. The right foot should be facing straight ahead. Both sides of the pelvis, and the shoulders should also be positioned in the same manner. A person should actively try to assume a tall posture with a gentle bracing of the core muscles. Imagine the pelvis is a bucket. The gentle bracing of the core muscle should keep that bucket level via a subtle backward tilt. Holding this posture, the person will shift their weight forward toward the right foot. The pelvis and shoulders should move forward equally such that the ‘tall’ posture is maintained. A gentle stretch should be felt in the front of the right hip. For a gentle increase in the stretch, a person can sidebend to their left side which will lengthen the muscle being stretched. As needed, further stretch can be applied by reaching the right arm overhead toward the left side. Hold the stretch 30 seconds, repeat twice each side.

Trigger point dry needling

2011-12-19T16:47:00.000-08:00

I recently attended a Trigger point dry needling course in Baltimore. It was an excellent course by Kinetacore. You may ask "what the heck is dry needling?". As illustrated by the photo on the left, it is a technique where you us an acupuncture needle to elicit a spasm twitch response from a trigger point within a muscle. It is not acupuncture because, as many of you know, I am trained as a physical therapist not some eastern medicine guru. I do not have much of a clue about treating the energy fields of the body. However, I have plenty of experience in treating musculoskeletal problems.

With dry needling, a PT is targeting trigger points within a muscle. Trigger points are taut bands within a muscle which can be painful to direct palpation. Research has shown that different muscles have consistent pain patterns within their most common trigger points. Recognizing these patterns is something of a fine art because they can be far removed from the actual involved muscle. An example could be the tensor fascia latae:

Looking at the image to the left, the X marks the trigger point within the TFL muscle, and the red represents the pain referral pattern. Pretty cool stuff. If you had a runner come into the clinic reporting pain in the red area to the left, what would you think? IT band syndrome probably. However, if all you did was foamroll, or massage the ITband, you really would not get far. So, back to my point of recognizing the trigger point patterns being important, just like treating them.

How does trigger point dry needling work? Pretty simple really! After evaluating a client via a history, plus strength and flexibility checks etc, I would examine the muscle tissue for trigger points. Once identified, I would use a sterile acupuncture needle to mechanically disrupt the taut band by penetrating it, and pistoning the muscle tissue. Pistoning is just fancy speak for moving the needling up and down within the muscle to try to elicit a twitch response. This response causes the muscle to release the tightness, essentially hitting the reset button on it! The technique will cause these mechanical changes, as well as chemical changes within the involved muscle cells. Releasing the muscle makes it more ready to benefit from the exercises being prescribed. It can also immediately change the range of motion around the involved joints, the flexibility of the involved muscles, and also diminish pain. Pretty great list of benefits.
The acupuncture needles are cone shaped so they are not as painful as syringe needles. That said, the treatment can result is some muscle soreness. A day later, with motion restored and pain decreased, you hardly notice it.

I expect this treatment to be a game changer for my practice as a PT. I have been treated for numerous running injuries myself by colleagues using dry needling. I can speak to its value on a personal level. I have also begun to treat patients myself using the technique and have seen positive results. If you are in DC and would like to know more about it, or give it a try, call me at Sports and Spinal PT at 202-463-7611.

Thanks for reading....

Managing expectations

2011-12-18T14:54:00.000-08:00

A month ago I ran the Philadelphia marathon with my buddy Chris Farley of Pacers Running stores fame. My goal was to have it be a different race than my typical marathon. What I mean is that the past few marathon races for me have been a bit less fun than I would liked. I have trained hard, and put in plenty of miles to prepare. Racedays have been somehow disappointing which has left me a bit off my game. Most commonly the disappointment has been related to missing a time goal, or some other performance based goal which was missed. After considering scraping marathons all together, I focused instead on getting back to the root of why most of us do these races in the first place: fun.

Going into the training cycle for Philly, I decided to train without strictly following a training program. Instead, I was committed to kinda winging it. I had join a local run club called The dojo of pain which gave me plenty of opportunities to run very hard. The group was great- cool folks with a common passion for running, and doing it fast. I went into the race feeling speedy and fit. When your primary goal is to have fun, don't make the same mistake I did which was to attach a time goal to it. This basically screwed that plan all together. I have learned that basing your goals on time really does not work for me. The reason this is the case is because if you miss your time goal, then it is hard to be satisfied. At the end of the day, this attitude is just plain silly.

I ran a 2:59 at philly, which basically equaled my PR. It felt good to get to the finish under three hours, though I had expected to be there a bit sooner. Missing my goal by 1% should feel like more of a victory than it did. Changing this will be a goal for 2012. How do you balk at an A-? You don't, right!?!

What I love about sports are the hidden life lessons within the training and competition. Running a marathon teaches you that with adequate time and preparation most anything is possible. This carries over for me to work, and even my relationships. Certainly being married teaches you that sometimes you have to dig a bit to get to that great feeling of crossing the finish line. Missing a goal by 1% teaches us things too. It teaches that we can't hit it out of the park every time. It teaches us that we need to be happy with this . The more we can do this, I feel, the more we can come back stronger the next time. We look to the horizon for the next opportunity while focusing on the next step to prepare, and do the best we can to be ready. Sorry for the corn but thanks for reading.

Ground and pound

2011-11-01T18:32:00.000-07:00

This past weekend was the Marine Corps marathon which draws approximately 25000 folks. The MCM is great because it is an accessible race which tends to draw many first timers to take their chances at the marathon distance.
In the clinic , we tend to see a surge in clientele leading up to raceday. Most of the runners coming in to the clinic are at the end of a long cycle of training. Many of the rookies have dealt with building a base, then starting marathon specific training. This combination can take upwards of 6 months. More experienced runners will still put in 3-4 months of specific training. Bottomline is that anyone showing up to the start of a marathon has some miles on 'em! The surge we see in the clinic represents the rather cruel side of marathoning. Simply stated, the miles add up. We see the folks who have broken down along the way. Consider that a long run, which is the cornerstone of any marathon program, can have a runner pounding the ground 12-15thousand times. We see that a tiny imbalance leads to something much larger when it is stressed so many times. This is where we start to see things like IT band syndrome, and anterior knee pain creep up on people. Both of these common conditions are often from mechanical strain dues to abnormal movement patterns in a runner's legs. The movement deviation is typically subtle, say 5-10 degrees off course. However, even 5 % of drift of the leg towards midline of the body can lead to 80% increased strain on the lateral part of the patella. Understanding this makes is easy to see why common running injuries can be so common. There is the ground, there is the pound, and then there is repetition. This cycle, my friends, is what leads to injury and pain. If the painful flareup happens at the start of a cycle, usually it is a runner starting too aggressively and the body can't catch up to the stress. If the injury happens at the end of a cycle, usually the cumulative stress has broken down the body's stress tolerance and this leads to injury. A great example is a stress fracture. This injury is effectively the stress of training causing breakdown of the bone which exceeds the body's ability to remodel the bone. As I said, the marathon is cruel. So much goes into getting ready, and the training is fraught with pitfalls. Overtrain and you are guaranteed to be injured. Undertrain and you are certain to underperform. Guess it is time to start training like Goldie Locks! Just right! From a PT's perspective, this is all about specific and purposeful running. It is also about doing active recovery cross training, targeted strengthening and stretching, plus recovery. If a runner rounds out their schedule to cover these targets, the ground and pound can be minimized.

How did we get here?

2011-09-25T17:36:00.000-07:00

I have recently been inspired to get my blog on. When I started the Doctor G blog, it was a means to consolidate my thoughts after talks to a local team or group. I found it easier to have my key points listed on the blog before the talk so I could refer people to a central place after the talk. More recently, I find the inspiration for my posts to be for the purpose of shaping something bigger such as a book. As I stew over this great idea, I have taken pause to reflect on why physical therapy and running are such a great match. Research has taught us that injuries are very prevalent amongst runners. We have also learned along the way that many physical therapy interventions such as strength training, and movement pattern retraining can change a runner in a very short period of time. Often, PT interventions will help a runner continue to run with diminished or no pain. Keeping a runner running keeps all involved happy.

Overall, I think one of the most important concepts we have learned in sports medicine research is that most runners are vulnerable to injury because of training errors, and also relative instability. Let's review both:

Training errors- This is a simple one. Think too much, too fast. The tissues involved are overwhelmed by the cumulative stress of these increases. A question I always ask runners is what's different? I want to know if they have changed their training distances, surfaces, intensities, frequencies, or shoes. Usually something has changed. Usually something has increased such as one or more of the above components. It is also likely that something has decreased such as recovery, or consistency with stretching or strengthening. These changes cause the involved tissues to be overloaded. Tissue breakdown leads to pain which leads people to the clinic.

Relative instability- This is my favorite point to runners. Most runners are used to running straight ahead. The muscles that lead them in this direction are very well developed. They are very smart in that they know how to work to bring the body forward very well because that pattern of movement has been repeated over and over again. A runner can put thousands of reps on their legs during a race or training run so the concept of muscle memory is very real. However, this repetition is what really dupes most runner into thinking that running is all they need to do. From a stability perspective, the muscles that help a runner remain stable, and "in alignment", are oriented in planes of motion not isolated in running. Think of it this way: If you run North/ South but the stabilizing muscles go East/ West, why would a runner expect to be free of injury? This point highlights why runners need to add to their training some component of strength drills for the hips and core. The hips, specifically the glutes and hip rotators, are the cornerstone of controlling leg movements in standing. Consider them the foundation of the leg, to a degree. I make that qualifier because really the foundation needs to be designated as the glutes, which is part of the larger group of muscles called the core. Strength and stability in these areas position a runner to avoid most common running injuries. Strength and stability in these areas come from doing strengthening exercises moving in planes other than just straight ahead. Consider side stepping with a resistance band, rotating the hips against a resistance band, and adding to that balance work. Balance work is a great equalizer as it teaches a runner to control the strength they are developing. Remember, our goal is strong and smart.

Midstance stability

2011-09-19T11:41:00.000-07:00

One concept we emphasize with runners in the clinic at Sports and Spinal physical therapy is midstance stability. Research tells is that the middle point of a runner's stride is the point at which the ground reaction force up the leg is greatest. This point in the stride is appropriately termed "midstance". Think of it as after "initial contact", which is when a runner's foot first contacts the ground. Midstance comes when the foot is completely flat, and the opposite leg is swinging forward past the stance leg( see below). It is literally the middle point of the stride. Given the forces up the leg are largest at this time, we need to ensure that the runner's leg remain stable to the ground reaction forces. Even the slightest deviations, such as the kneecap turning inward, can dramatically increase strain to the involved tissues. The end result of this overload of stress could be one of the many mechanical problems runner's have such as ITB syndrome, or patellofemoral pain syndrome.

If I had just a few minutes to examine an injured runner, I would undoubtedly check their midstance stability. How would I do that you ask? Simple, just take the runner through a series of tests that evaluate how stable they are in midstance. A few of my favorite tests include:

1) Single leg balance: Ask a runner to stand on one leg while maintaining a balanced position. Typically, once a runner is set in a balanced position, I ask them to close their eyes.
I would like to see a runner maintain a balanced position for 30 seconds. My idea of a balanced position is where all components of the kinetic chain ( think from the foot up to the lower back) are stable, i.e. not teeter tottering. I will look at the foot/ankle to see if it remains in contact with the ground, or if the toes come off the ground. I will look at the knee to see that it maintains it position. A common deviation is the kneecap is turning inward and outward as the runner tries to maintain balance. I would look at the thigh bone to see if it is following the knee inward. The reason balance is so important is because it indicates a solid connection between the joints of the leg and the brain. We want the body to rely on the balance feedback it receives from the joints of the leg, versus just taking input from the vision and inner ear. The reason behind this desire is that is establishes a very quick feedback mechanism for the runner.

2) Single leg swing- This test takes the balance test above and makes it functional. I will ask a runner to stand on one leg and swing the opposite leg forward and back as if they were going through a running type motion. The test shows me how stable the runner is in a more dynamic fashion, one that mimics running. I will watch the leg the runner is standing on to look for instabilities. I will also watch the leg that is swinging to get a gross sense of range of motion of the hip. I will also look at how the swinging leg influences the lower back. I hip that is overly tight often results in a more stressful moment being imparted on the lower back. This is an important point we see time and time again in physical therapy : a stiff joint will typically adversely influence joints above and below.

3) Single leg squat- This is another functional test for runners. I ask the runner to stand on one leg. Once balanced, I ask the runner to squat to 45 degrees times 10 repetitions. Guess what I look for? You guessed it! I look for what is happen with the kinetic chain. Mainly what I look for is whether the chain stays stacked on top of itself. Notice the difference between the two images below. Obviously the B image is less stacked as the knee drifts toward midline, and the thigh rotates inward. Note how the torso is influenced also. I find that instabilities in the leg can influence any part of the leg, but can extend all the way up to the spine too.

4) Step down test-This test is similar to the single leg squat. I ask the runner to stand on top of a step. The test has a runner lowering one foot toward the floor. The foot comes slowly down to the floor without actually stepping off the step. I ask runners to do 10 reps on one side before they switch. I look at the chain just like I do in the squat test above. I often notice a runner doing fine with the squat test, only to flail on the step-down. Consider that the leg is being asked to do something different that just squat. The ankle is going through a greater range of motion which can be a limiting factor. The same applies to the knee.

Collectively, the above tests give me much useful information. They tell me how strong a runner is, how well they control their movements, where they are limited in flexibility, and ultimately what their MIDSTANCE stability is. This information can help me to understand why they are injured, and how I am going to help them recover.
I often cue runners to hold their foot in a "neutral " position such that the runner is actively maintaining the arch in their foot in a mid line position.

Running form

2011-09-16T07:14:00.000-07:00

It seems the buzz of barefoot running has been replaced by the minimalist movement. With this change has come an ongoing discussion on running form and how to ensure efficiency/prevent injury. Though I agree that running form is a subject worthy of discussion, it should be noted that distinct research showing that injury rates diminish based on proper running form is not quite there. We have seen good results with changing form to diminish loading rates which will make a runner less vulnerable to common injuries. However, as is often the case, we need to allow the research to catch up to the buzz.

I recently gave a talk about running form which I would like to review. My goal was to keep things simple which seems to always work best, especially when changing an ingrained habit like running.

Run Softly: As crazy as it sounds, listen to what you sound like when you are running. Do you hit harder on one side versus the other. If you do, chances are that is the side which will be more vulnerable to injury. Do you land so hard that you would be considered a "godzilla" runner!?!
All joking aside, studies show that if you focus on landing softly, you can diminish ground reaction forces considerable. That, my friends, is a good thing. When I give the cues to "run softly" most folks look at me like I am nuts. No sooner do they give me the stink eye do they concentrate and really make a change. You can hear them get soft. It might be only for a few strides, but they do it. Give it a try! What is happening when you do this is likely the foot is moving back closer to the center of mass such that the foot is not slamming into the ground so hard. Moving the foot closer also causes cadence to increase, and stride length to decrease. Both of these are good for decreasing stress up the legs. The initial contact point will also change when you get "soft". Usually as the foot comes back closer to COM, the initial contact point is more on the mid foot or forefoot.

Run Tall-Another topic discussed in the running form mix was the value of good upright posture. If a runner is overusing his/her lower back muscles, the curve in the lower back tends to increase. As a result of the abnormal position, the spine is under more stress/strain. Also, running with an increased lower back curve moves the center of mass posteriorly. This scenario causes the foot to be brought anterior to the COM. This is known as "overstriding"( see photo). Think about actively having an upright posture with a gentle bracing of the core muscles. Add to this 'tall' posture as slight forward lean from the ankles(see photo of runner outside below), and you are ready for action. If you are tall with a slight lean forward, the foot automatically stays underneath you.
Another point about posture is to remember that you can't sit slouched at your desk all day, and then expect the body to come to perfect erect postures. Another incentive to double check your desk set-up to ensure that it is facilitating upright posture. it does not hurt to get up and move around a bit multiple times per day for a change.

Cadence- Another discussion point from the run clinic was consider a runner's cadence, or their RPM. A gold standard is 90 strikes per minute on one side. Most runners I see in the clinic are moving much more slowly than this. It is important to not try to dramatically change your cadence. If you count your contacts on one side and you get 160 when you double it, try to increase by 5-10%. Research shows that increasing cadence by as little as 5% will diminish the impact stress up the leg, which is what we want. You can use music that has 180 beats per minute to help, or a metronome app for your iPhone. Think about increasing your turn over if you need to. This change typically causes stride lengths to decrease, runners to land less often on their heels etc.

KISS- Notice a trend here? If you change one component of running form, it invariably changes another. I see in the clinic that one client will respond well to one verbal cue, and the next client flounders with the same cue. With each run, consider focusing on one thing, and don't try to maintain that focus for the whole run. If you are focused on being "soft", do so for a minute, and then run normally. Come back to that cue every 10-15 minutes such that you get in a few rounds of practice. Next time, practice the next one!

Overall, my perspective on running form is biased by what I see in the clinic and what I read in the research. In the clinic, I see injured runners. These injuries tend to be around the knees, pain under knee cap or IT band. Both of these injuries will be strained by overstriding so I commonly ask runners to be aware of keeping their initial contact point closer to their center of mass. I can achieve the same goal with increasing their stride contact. These changes seem goofy but the research supports that real changes can be made in running form just by being more aware of how you are running. have fun out there!

Hometown rocket

2011-09-16T07:05:00.000-07:00

After nearly a year of being dormant, it is high time to kick start the DGST blog. What better way to get rolling than to speak of Matthew Centrowitz Jr, and the ever growing CentroNation. If you were under a rock during the recent track and field world championships, you missed some spectacular racing by the US team. Of note was a bronze medal by Matthew in the men's 1500m. He performance was inspiring for many, and seemed to be a shock to the racing community given Jr is only 21 years old. However, given Centro won the NCAA title this spring, and outkicked Lagat to win Nationals, the kid has some serious chops. He raced a smart race, and really hung it out there. What I love is that he hung in there over the last 300m. He held steady and reeled in enough competitors to place himself on the podium. Digging deep! Gotta love that. So, kudos to Matthew Jr. for making us all proud. Well done!

Fall marathon season

2010-10-13T18:14:00.000-07:00

The fall marathon season is finally under way. All that summer mileage is starting to show its worth as many DC runners taper for MCM, as well as the assortment of nearby races. Steamtown, Wineglass, New York are on the schedule for marathoners in the mid-Atlantic region. There seems to be a bit more buzz about this fall season as people try to avoid getting boxed out at Boston like last year. Registration opens October 18th so get your mouse clicking fingers stretched out and ready to go. My fall marathon season is over before it even started. A summer calf injury forced me to take off most of July so I am just now starting to train with some purpose. It might be a blessing in disguise as I am coming back with a bit more focus and motivation. Time off is actually a good thing. Many people try to train with purpose all year round which ultimately just creates stagnation. I have signed up for a couple half marathons, Richmond and Kiawah. My hope is that racing the shorter stuff will help me be more comfortable racing at a faster pace. And its all about being fast, right? well, it is really all about having fun. My days of being fast are not over cuz they never actually really started. Fast is Sammy at Chicago, as seen above. If you want some inspiration to kick off your Boston training program, go to flotrack and watch the finish of the men's marathon in Chicago. These guys are literally duking it out over the final mile, back and forth, til Wanjiru finally pulls away. What a great photo above: the crowd, the fading Lel with the yellow lights in the back, the 26 mile mark, and of course Sammy in full stride. Here's to a finish strong for us all in your next race, clink.

What I did on my summer break.....

2010-07-05T15:20:00.000-07:00

I am excited to have the opportunity to speak to some high school runner at a local running store this summer. My experience as a long time PT, and a 25+time marathoner, gives me a relatively unique perspective of running. I admit my outlook is biased, based on working with many injured runners and seeing consistent trends of imbalances and weakness. One thing I love to share with fellow runnersis the concept of doing more than just running. In fact, that is my favorite questions for an injured runner I am seeing in the clinic : what do you do besides just run?

A well rounded runner, one who is going to be less vulnerable to injury, and better able to handle to stress of intense training, needs to consistently do form drills, stretch, cross train, and work on strength training. This post will focus on the last component, strength training.
When you read the research on run related injuries you see that the knee is the most commonly injured area. Anterior knee pain is the most common injury, followed closely by lateral knee pain, or IT band syndrome. Hip weakness is a consistent finding with these injured runners. As a result, a good introduction to strength training for runners would start with hip/glute strengthening. I like to focus on strengthening the glute max, the glute medius, deep hip rotators, and the core muscles. I also like to incorporate functional movements into the warm-up before I reach for exercises which isolate specific muscle groups.

The following is a brief list of helpful exercises which can be done 2-3 times per week in the off season as cross country preparations continue. Try to focus on good form in the first month, controlling the speed and form of the movemnts, with light resistance and high repetitions.

For the young athletes tonight we will do :

Forward lunge walking x 1 minute
Backward lunges x 1 minute
Side lunges x 1 minute
Skier squats with theraband at knees x 1 minute
Heel raises x 1 minute
Sidestepping with band times 1 minute
clam with band x 1 minute each side
plank x 1 minute
deadbug times one minute

Short and sweet, but it targets muscles that when weak typically lead to injury. Many of these exercises are in video format in my older posts on this blog. Enjoy, and train smart!

Sports and Spinal Physical Therapy

2010-07-05T15:00:00.000-07:00

Doctor G has landed at Sports and Spinal Physical Therapy (www.ssptdc.com), located in the Foggy Bottom area of Washington DC. It has been a great move for me for a variety of different reasons. One reason is strength in numbers- there are six other therapists on staff at SSPT. Each therapist has different talents to use. Sonja does dry needling, Steve is a skilled manual therapist, Jen is savy with real-time ultrasound, and so on. The reality is this experienced staff offers a many different skill sets which ultimately benefits the clients the most. Another reason I am to be at Sports and Spinal is the experience of the staff outside of the clinic . Most of the other therapist are passionate about being active. We have runners, triathletes, crew athletes, swimmers, paddlers, and cyclists on staff. I firmly believe it is ideal for an athlete to see another like minded athlete when doing their rehab. I could go on and on about SSPT but humor me and hear about a couple other things. One is that the clinic is very active in the community. We recently assisted athletes at the DC tri. Another exciting community event will come in the form of helping the cast of Mary Poppins while in town performing at the Kennedy Center. And finally, another benny of being at Sports and Spinal is having access to the dartfish software. This powerful video analysis tool is a great help to clients, particularly runners, when explaining their injury. I find I can tell an athlete they are weak, but if i show them how their form is breaking down on dartfish video analysis, it makes much more sense and they are usually(!) more compliant with their exercises. Stop by the clinic at 2175 K St for a quick visit, or if you need a check-up, call 202-463-7611 for a complementary screening.

Boston marathon 2010- the three F's.

2010-05-19T17:26:00.000-07:00

The Boston marathon was another classic for me. As I have previously mentioned, I view this race a bit differently. It is a way to celebrate the past year of training, while competing with some of the best marathon runners out there. For me, it is also a way to get together with family and friends to celebrate life. Julie and I have gone to Boston for three consecutive years. Each year has a different story to tell but it all come back to the 3 F's: family , friends, and fun.

This year for the race we stayed with Julie's brother David and his family. We were right in Newton so being close to the race course was a bit of a thrill. David was nice enough to take us on a scouting mission over the Newton hills which was great. not matter how many times you have run a course, it helps to see it up close and personal right before you race it. It certainly helped me when I got to the hills to have a good visual about what as around the corner because I had seen it the day before.

Also new for this year was the fact that my college friend Rupert was staying with us. His Scottish charm was a welcomed addition to the house. We talked strategy leading up to the race as we had done many training runs leading up to race day. It was also fun being able to see Bill Potts and Angela doing their first Boston, and Nick lighting up the course as usual.

The race is one that requires strategy. Though most runners do tons of running leading up to race day, most don't have a firm race strategy. I had experienced going out too fast on the course so Rupert and I had a conservative start. We hit half way right on schedule in 1:26 high. In fact, we kept hovering at least a minute ahead of schedule. I tried to ease back knowing the hills were coming. We hit the Newton firehouse right on time. The only problem was that I essentially lost 60-90 seconds on each hill. I managed not to explode but I was not able to maintain the pace I wanted to run a 2:55. I fought hard through the end and came in at 2:59:09, a PR. I was happy to go sub 3 for the first time, but disappointed to not finish stronger.

Each marathon is a learning experience. Though I felt I had trained to a higher level of speed fitness, looking back I suspect I skimped on the endurance work. This is an area I took for granted and it made my finish a bit soft. Most sports psychologists talk about the importance of having a short memory with races. Rather than dwell on the few minutes I left in the hills, I will try to lock in on the new speed, as I dial the endurance back in. Thanks to all for a great race weekend.

10 minute core routine

2010-04-09T07:28:00.000-07:00

I attended a Triathlon expo recently which had the usual assortment of vendors and tchochokes. They had a speaker series which had experts discussing topics related to triathlon. I was able to catch Kerri Kramer talking about core strengthening for the multi-sport athlete. Kerri and I worked together for years "back in the day". We had lots of laughs in the clinic and the clients benefitted from having two eperienced and passionate clinicians guiding them. Kerri is now running her PT business, Fast Track Physical Therapy, http://www.fasttracktherapy.com/, where she focuses on treating endurance athletes. During her talk she presented a 10 minute core workout. She essentially highlighted the fact that this type of training does not need to complicated, or elaborate. It needs to be focused, and present! What I mean by this is that core work HAS to be a part of all serious athletes' regular routine. This is particularly true for endurance athletes. The research tells us that as a runner fatigues, their movements patterns change. We instinctively know this. We feel our knees clanking together in the third hour of a marathon. We see our finishline photos which show out posture gone to pot. We know this. So, the question is what to do about it. When I see runners in the clinic, one things I want to know is what do they do besides run. For most, this is not a whole lot. Maybe yoga, maybe pilates, or bike. Rarely is a specific and focused core and hip strengthening routine described. Odd. Strange because this is what the research tells us is what a runner or endurance athlete need to avoid many common injuries. This was the point Kerri was trying to make at the expo- do something! Even if it is only 10 minutes, do something.

The 10 minute routine sounds good, and it is. Basically look at it as targeting the top 5 exercises, doing them each twice for nearly a minute each time, and then moving on. Common exercises to reach for would include the forward plank, the side plank, the bridge, the clam, and sidestepping with resistance bands(pictured above). Ok, so you ask why these exercises? Quite simply, these represent a start to building a foundation of strength in the areas of greatest importance. For example, most research on running injuries describe weakness in the hip external rotators and abductors. That is why we do the sidestepping and the clam exercises. There is a method to the madness! the research also says that a strong core helps create a strong foundation to perform upon. That is why we add the planks. Starting to make sense? Good. Many of these exercises have been presented in video format on this blog so be sure to go back into the older posts to review.

Less thanTwo weeks to Boston

2010-04-05T06:45:00.001-07:00

Get your parade wave ready. This is basically my approach to running the Boston marathon. It is a victory lap for the marathon runners out there. Though the qualifying standards have been eased a bit over the years, the reality is still that you can't just sign up for the Boston marathon. You have to earn it. For most people, myself included, this fact makes the trip to the Hopkinton start line that much sweeter.
The first time I qualified for Boston, it was a real chore getting there. I raced the Shamrock marathon in VA Beach to drop 20 plus minutes off my previous marathon PR. The only bummer was that I qualified in March and had to wait 13 months to race the marathon. When I finally got to race day, I was so psyched I could hardly stand it. The race weekend was a blur. You tell yourself to rest and stay off your feet but it is amazing how hard that can be. The expo is huge, as is the buzz leading up to Patriot's day.
Back to the parade wave. My feeling in '08 still holds true today- this is a celebration of a race to toast all the work I put in to get to that place. I worked so hard to prepare that I felt I should celebrate that fact. The race was the perfect venue since the vast majority of the other people there had done the exact same thing. When you are racing, it is easy to put your head down and just focus on your pace/nutrition/strategy etc such that you do not really experience the surroundings. I made the point in my first Boston to take it all in. Again, my mindset was that this was something I had earned so I was going to enjoy it! Not to say that I was high-five'n all the Wellsley girls but if you can't at least smile and wink at a few then what the hell! It is a great race with much history. The feeling of starting with a corral of 1,000 similarly paced runners is pretty cool. Cool, that is until you blow through the first mile under six minutes. Ouch.
So, to Angela, to Bill, to Roo, to Nick, to Timmy, to maybe Chris, to maybe Isabelle, to Elyse, Naoko and all the other runners, let's take a moment to celebrate while in Boston. We have put in the work to get to Boston. We deserve a victory lap. Be a warrior out there, especially up to that left turn on Boyleston St......

Champion Story

2010-03-29T07:35:00.000-07:00

I love this picture. That is George on the right with his bling. He recently returned from the World Masters track and field championships after winning medals in three sprinting events. The reason I love this picture is because George is a great guy who displays many behaviors of a true champion.

George came to me after seeing my flyer for the "best run ever" running evaluation. We talked about my experience as a PT, and as a endurance athlete which left him curious. He asked me what a distance runner could offer a sprinter. Good question, I thought. I explained that I work with all clients, athletes and non-athletes, by looking at the body as a machine. A thorough exam tells me where the machine is out of balance from a strength or flexibility standpoint, for example. I reassured George that by doing so I could help him to identify areas of weakness within his machine with the goal of making him stronger, and faster. So, back to what I love about George. It is the willingness to think outside his training box. This is a challenge for most athletes, especially ones who have had some measure of success. A true champion, however, is open to trying new things in training to improve. This is exactly what George did. Over the span of a couple months I gave George a progression of exercises which allowed him to get stronger in a sport specific way. Obviously, for a sprinter, having explosive strength is key. The same should be said for having upper level dynamic core strength because this is what allows a sprinter to use that aforementioned lower extremity strength. Added core and hip strengthening to his training regime helped George fine tune his machine to tolerate more training stress without the wheels coming off. He was able to parlay this new strength into more training, ultimately leading to more success at a very high level.
Just wanted to share the George story as it inspires me to think about my own training. Am I open to changes to get stronger and faster. I think about what weakness I have, and creating a plan to address them. It is common to focus on strengths, but with such an approach I would argue that you are setting yourself up for less true growth.

Though I will likely never have World's medals around my neck, I can still display the behaviors of a champion. This approach will help us to achieve our own measure of success. Here's to a PR at Boston!

hamstring injuries

2010-03-15T13:12:00.001-07:00

I had the opportunity to talk last week at the Pacers running store in Clarendon (http://www.runpacers.com). Actually, it was the first in a series of talks to be given at the store each month. This month, the topic of discussion was hamstring injuries in runners. I chose this topic because it is a common problem which I frequently see in clinic. JOSPT, which is the sports medicine PT journal, also recently feature an article about a runner who strained their hamstring because of weakness of their glutes.

As with most running injuries, a hamstring injury is typically multifactorial. This injury has historically plagued sprinters because of the huge forces stressing the hamstring during an all-out effort. Most of the research published on hamstring injuries has, consequently, been done on sprinters. However, there is a growing amount of research on middle and long distances runners.The hamstrings are the 3 muscles on the backside of the thigh, just below the glutes. The muscles attach to the sit bone on the pelvis, and inserts below the knee. As a result of crossing two joints, this muscle group performs a variety of functions. The role they play in running is two fold: when the leg is in the air advancing forward, the hamstring controls how quickly the knee extends, and the hip flexes; with the leg on the ground, the hamstring will flex the knee and extend the hip. This is a key distinction because the hamstring muscles must quickly transition from one role to another once the foot strikes the ground. It is during this transitional period that injuries frequently occur.
There are a variety of factors which predispose an athlete to a hamstring injury. One is hamstring weakness. The leg which has weaker hamstrings, especially in eccentric strength, is more vulnerable. A previous hamstring injury will certainly predispose an athlete to re-injury. The reason this is the case is that when a hamstring injury heals, the body lays down scar tissue which is ultimately less pliable than normal tissue. Given the stress that this muscle takes, it is easy to see how this can be a weak link. Poor flexibility in the hamstrings can be another predisposing factor. Poor running form is on the list too. Additionally, poor desk posture can cause an athlete to have tight hamstring muscles which then get strained during running. Poor glute strength will force the hamstrings to work harder. The reason for this is that the glute max and the hamstrings both extend the hip. When the glute is weak, the hamstring will try to compensate. In endurance athletes, a weak glute max can overstress the hamstrings. No amount of stretching or massage will cure this problem til the glutes get stronger.

Given the variety of causes of a hamstring strain, the prevention of them needs to be broad reaching. Here are a few areas to focus on:
1) Strengthen: In particular, focus on strengthening the hamstrings eccentrically. This means working them while they elongate. Use the bicep as an example: you curl the weight up (concentric), and slowly lower (eccentric). A good example of this is placing your heels on a swiss ball, bridging your hips off the ground, curling your knees back, and then SLOWLY letting the legs go straight. Having strong glute muscles will help also so don't forget those.2) Stretch: There are a variety of ways to stretch: actively, passively, and active assisted/dynamically. Think of your warm up as a way to take the leg through a full range of motion to get the blood flowing. Do this prior to your run. Common exercises I do for a dynamic warm up include squats, lunges, and running drills like leg swings, high leg lifts like going over a hurdle, and leg kick outs.Passive stretching is best done after a run. Posture is key with this type of stretching. The hamstring starts at the sit bone and extends down below the knee. As a result, it is important to be aware of what posture the lower back is in. Most runners keep their knees straight and bend over at the waist to stretch their hamstrings. problem is that they are also flexing their lower back which puts slack in the muscle you are trying to stretch. It also puts unnecessary strain on the back. Instead, think of a dowel rod strap to your back so you are forced to hinge at your hips to take a bow. This will certainly elongate the hamstring. Hold 30 seconds, a couple times each side.

Another way to stretch is using a rope around the foot while on your back. The thigh is held perpendicular to the floor. You can use the quad to gently straighten the knee stretching the back of the thigh in the process. When the quad contracts, it naturally shuts down the hamstring so it can be stretched. This is more of an active movement where you straighten the knee as much as you can with the normal curves in the low back being maintained. I typically have people cycle into the stretch and back out versus the prolonged hold on the previous stretch. 10 reps is usually good to go.
3) Posture- Keep in mind it is hard to sit at your desk with suboptimal posture strategies( read -crap) and then expect to go out and have great form and flexibility while running. It is all related. Go back to my post on desk posture and make sure you are in compliance! Also, keep in mind it is a process. You need to create a routine that allows you to consistently come to these exercises and stretches. Over months, not days, these will have an impact.

Sorry for the delay with this, but thanks for reading. As I frequently say, being a good runner requires more than just more miles. When you look at the successful runners, you frequently see a comprehensive training routine that includes quality runs with a focus, plus stretching, strengthening, balance and core work, and form drills. If your head was not already spinning, consider the need for quality nutrition and rest. If these two are not optimal then all other areas will suffer.

Doctor g videos: wall slide with ball

2010-01-31T19:01:00.000-08:00

The wallslide with the ball ties together some of the other exercises already introduced. The runner will learn to move through their hips while the back stays straight. The is a key element of low back health: always bend from the hips and knees versus the back. This exercise targets glute and quad muslces, as well as encouraging control of movement patterns.

Place the ball against wall and lean against it. The ball should be between the shoulder blades. Braces stomach muscles, bend at hips and lower down to approximately 85 degrees of knee bend. Pause, and slowly raise back to the top. Emphasize the lowering portion of the exercise as it teaches many muscles to be active and controlling as the musccles get longer. The type of contraction that occurs when a muscles contracts as it gets longer is call a eccentric contraction.

Repeat 15x. This exercise can be done with a theraband around the knee. The strength of the theraband wants to pull the knees together. It is required of the participant to contract against the band, thereby engaging the hip external rotators. This is a very function exercise because the feet are on the ground, aka closed chain, and you move in a very functional motion- a squat. Use this exercise to get strong, AND, more importantly, also change a movement pattern. It is possible to be strong and have crummy movement patterns. We are trying to avoid that by engaging in exercises like this. Enjoy!

Doctor G videos: sidestepping with band

2010-01-31T18:51:00.000-08:00

Another solid exercise I commonly give to runners is the sidestepping exercise using a theraband. The reason I like this exercise is that is does a great job of stengtheing the hip abductors. As I have previously mentioned in the clam video, having strong hips is vital for runners staying injury free. Consider that 50% of all running injuries occur at the knee. Common examples include IT band syndrome, and patellofemoral syndrome aka runner's knee. Both of these injuries have been shown to be associated with hip weakness. More specifically, both syndromes have been shown to be commonplace in runners that have weak hip abductors. When the abductors are weak, the knee tends to drift into adduction creating strain on the knee.

This exercse is performed in standing with a theraband around the ankles. Gently brace you ab muscles and pull right leg away from the left against the resistance of the band. The left leg follows making sure not to drag it or let them snap together. This is repeated multiple times after which the direction is changed. Initiate the movement from the power in the hips, not by sidebending the torso, or hiking the hip. Work the motion back and forth in a room to the point of fatigue.

Doctor G video: the clam

2010-01-31T18:19:00.000-08:00

The "clam" exercise depicted in the attached video is a great way to strengthen your hip external rotators. Many of the common movement faults seen with injured runners entail excessive internal rotation. By strengthening the muscles that oppose this internal rotation, namely the external rotators, you start to see the value in this exercise. This concept is at the cornerstone of running sports medicince today: when you have a strong hips, you have happy knees. A strong hip give a runner better control of how the leg is moving, thereby minimizing the abnormal stressors crossing the knee.

The "clam" exercise is performed in a sidelying position with knees and hips flexed as shown. Brace your abdominal muscles and slowly raise the top knee against the resistance of the band. Pause at the top of the motion and then slowly and smoothly lower down. The top knee should lift up without the pelvis moving. At the start, the pelvis is perpendicular to the floor. This position should be consistent throughout the exercise. As muscles fatigue, there is a greater tendancy to use the trunk muscles versus the hip muslces to lift the leg. This will be evident by the pelvis rocking backward leading the leg. Repeat the up and down 10+ times focusing on control and apropriate movement patterns.