Darn rocks

My New Year began with a feeling of being well rested. I just completed my downtime month and started my January training with a couple of nice long runs. I was thinking about running a couple winter cross country races. That all came to a screeching halt on Sunday. I had decided that I would go out for a nice easy 3 miler on my favorite trail. After about a half mile I felt a sharp pain in my ankle dove to the ground. Yep, I rolled my ankle. After a few choice expletives, I looked back to see what I got me. I expected to see an unknown stick or root. No, it was a perfect round rock in the middle of my beautiful dirt trail and it didn't belong there. I promptly threw it back into the creek. I have no ligament issues, no severe swelling and no knee issues. I am fairly confident I strained my Peroneal Brevis. This can be a serious injury if it is not treated carefully.

So, time for me to try to listen to my own medicine! I will be hitting the ice bucket, iontophoresis and kinesio tape. No running until pain-free with everyday activities. Time to hit the pool!

Pilates vs. Yoga

Photo credit: Chris Fanning, www.fitnessmagazine.com







Pilates and Yoga have gained significant popularity over the last 10 years with athletes of all sports, genders, and ages. Many studios are now offering pilates and yoga for kids. They have both become the cross-training choice of many endurance athletes. I have taken a series of classes in both basic yoga and pilates. Yoga, the older of the two disciplines (originated in India over 26,000 years ago), literally means "union". This union is between the mind, body, and spirit. There are several different branches of yoga (8), but the one we mostly identify with is described as Hatha Yoga, which refers to the practice of physical postures and poses (asana). Depending on the tradition of the instructor, classes can combine these postures and poses with relaxion and meditation to acheive a therapeutic healing of the mind, body, and spirit. Pilates, originally developed and taught by Joseph Pilates 80 years ago, is a series of exercises that are performed with the goal of elongating the muscles of the spine, developing core strength (the powerhouse: abdominals, postural muscles, gluteals), muscular control, and balance. Both disciplines are very concerned with quality of movement and being connected with your body in order to control movement. A meditative state of body awareness can be acheived with both disciplines in order to have a therapeutic stress relieving component.


All of that being said, I find that there are great benefits to both. As with all types of fitness and strength activities, I believe one has to identify their own goals when beginning a program whether it be going to the gym for a workout or starting a yoga class. The word that comes to my mind is balance. In my experience, yoga poses tend to focus more on flexibility. This is not to say that the poses don't require strength, because I can tell you that this is far from the truth. There are several poses that I couldn't even start because i didn't have the strength to hold the position. On the other hand, Pilates classes seem to focus on strength and control. To be honest though, some of the movements in the class I had trouble performing because, you guessed it, I wasn't flexible enough. To solve these dilemmas, I found that many of the pilates and yoga instructors would incorporate movements from both disciplines to supplement those deficits. I'm by no means an expert in either of the disciplines, so I don't know to what extent they overlap, but I did find that many of the movements overlapped each other i.e. flexibility movements in pilates and core strength movements in yoga.


Balance is the key. In my field, I see muscle imbalances everyday. I can see a muscle imbalance from a mile away when i'm watching a track meet. There's millions of opinions out there as to the cause of these imbalances. Is one muscle too tight? Is one muscle weak? Is the joint or joints hypermobile (too flexible)? Why are they in this state? Do they have a faulty postural habit (sitting on feet)? Do they have a faulty movement pattern (squatting or bending)? Have they had an injury or surgery that caused this compensation? Do they have a genetic trait (true leg length difference)? The list goes on and on. I believe that in most cases the cause of muscle imbalance is a combination of two or more of these.


Too often, I see athletes that have chosen to focus on only one part of the puzzle. For example, a runner who runs 50-60 miles a week and does yoga twice a week comes into the clinic with hip pain. In this situation the person was focusing on flexibility and neglecting stability. Their hamstrings, glutes, piriformis, and lower back muscles were above average for range of motion and flexibility, but their hip strength (buttock muscles and abdominals) were weak leaving muscles that were being overworked in order to control the hip and pelvis while running. Correcting the muscle imbalance with functional hip and core strength allowed them to return to running. This is just one example of many.


I am not saying that everyone who does either yoga and pilates and is a runner is going to end up injured or with a muscle imbalance. I know many athletes who do both, just one, or neither and never have a problem. My goal is to make people more aware of balance between strength and flexibility in order to perform better. I did both at separate times and felt stronger while running. I felt like my body was more stable and was able to be more efficient during workouts. Yoga definitely made me more fluid and relaxed while pilates made me feel longer and more powerful.


If you are injured or question whether you might have a muscle imbalance that might be hindering your performance there are many good (and some, not so good;) articles on the internet. Consult a sports medicine physician, physical therapist, or athletic trainer for a postural analysis or movement screen to identify problem areas.


Both pilates and yoga are great options for cross-training. Just remember to keep balance.

Be Hip!

(c) http://www.physiotherapy.co.uk/
This weeks topic on take and run Thursday is running injuries. This guy has a problem. Check out that hip position. This is a great picture of hip drop which is a problem we see often. The left hip drop is most likely because of right Gluteus Medius weakness. The primary function of this muscle during gait and running is to help stabilize the hip when the foot is in contact with the ground. It controls stance leg hip adduction. This can lead to multiple running injuries including ITBFS, knee, groin, lateral hip & lower back pain. The best way to correct this problem is to train/strengthen this muscle the same way it functions during gait. That is with the right foot on the ground. With my left groin strain last year, we noticed that my pain would increase in cushioned running shoes which allowed more pronation. We also noted that along with that I had more right hip drop (left gluteal medius weakness). I initially worked on left single leg stance exercises while simulating where my hip should be during stance (level hips). This is done by contracting or squeezing my left buttock/ leveling the pelvis. I would hold this position for 5 to 10 seconds and would fatigue very quickly. I then progressed to higher level functional exercises but only if I could maintain this position. In my case, flexibility had very little to do with why I was having pain with running. With a different neutral running shoe and increased functional strength of my hip I was able to return to pain-free running.

Our previous post on the step down, is an example of one of the higher level exercises. We will post some more video of others. Check out this related post. Got strength?
I hope this helped to explain this common hip issue.
Be hip!

More on Running injuries

Here is a link to a good post on Universal Truths about Running Injuries. I am pleased with the praise for physical therapy! I want to expand on the comment of "best PT". It is important not to automatically assume a MD or PT who tells you not to run is a bad one. I don't believe this was the intent of the author of this linked post. As I've previously posted, rest is a very important part of training but also of rehab. We must give the body time to respond to rehab without the stress that helped to cause it originally. As a PT, I often have my running patients stop running. In our current health care system, by the time they get to me it is not in their best interest to continuing to try to run through it. Most have already tried that and it hasn't worked. One of my biggest battles is to get my runners to actually stop "testing it out". I try to get my patients back to running as fast as possible but very carefully. I follow the rule of, if I feel my symptoms walking around doing my daily activities, then I have no business trying to run. I start back at a very low level/ walking then progressing to walk /jog then to continuous running. Each phase of this must be symptom free before progression to the next phase.

Please visit our other posts on strengthening, running injuries, prevention & rest.

Learn how to read!

This week's topic in the Runner's lounge: "Take It and Run Thurday" is Building the miles and going long!

My input this week involves learning how to read your body. As the weather finally warms up and the spring races draw nearer, most of us are adding to our training. We are either adding some miles and or introducing some quality (speed). During any change in our training which requires an increase in effort it is important to determine how our bodies are responding to this change in stress levels. We must learn to read our bodies / to be able to determine what we can ignore versus what is trouble brewing.

Here is a common scenario:

Fred ran 4-8 X's 400 in the first week and that this is the first time he has done any up tempo workouts this season. He wore the same shoes that he has been wearing all winter (250 miles) and they are showing some wear. On this workout, he felt really good and went quicker than scheduled. The next day was an easy run and he felt just a little tight. The next time he ran, his legs felt great so he pushed a little, but toward the end of the run he noticed a slight tightness or pinch in his distal Achilles. After the run, he gave it a good stretch. The next day he felt slight soreness during the day but a mile into his scheduled 10 miler it went away. At 3 miles it comes back and by the end of the run it is more of an aching pain. After he stopped, it goes away so he stretches it out some more. The next AM, Fred can barely walk as his Achilles is very sore and tight.

Where did Fred go wrong in this scenario? How could he have avoided this injury?

The biggest issue here, was his inability too read and listen to his symptoms. When he felt the tightness the first time, he should have used ice on his Achilles and avoided the aggressive stretching. But the biggest mistake was continuing to run during the long run when his symptoms got worse. I advise that when symptoms are felt during a run and they don't go away or they worsen, stop. At least slow down and shorten the work out. ICE and avoid aggressive stretching. If the symptoms had gone away and not returned, he could have finished the work out. It still would have been prudent to shorten the run and ice. If symptoms are felt during the day just walking around, it is better to not run. REST and ICE! No running until pain-free during everyday activities. Then the return to running needs to be a short and easy, followed by a rest day. This will allow Fred to evaluate how the Achilles is handling the return to running with less of a chance for re-injury.
Learn to read your body!

Other contributing factors:
Stick to the scheduled pace especially on the first quality run of the season.
Never a bad idea to break out a newer pair of shoes when doing quality runs or long runs.

I hope this is helpful!

The Squat

A good squat with correct form starts at the head and ends at the feet. One can use a stick behind the neck or above the head. We prefer to use something overhead to "kick in" or activate the core muscles. A little forward bend is allowed to keep center of gravity. Too much forward bend can indicate muscle imbalance (In the video, you can observe some core weakness as I perform the squat and the stick comes a little too far forward ;)). Knees, hips, and ankles should stay in alignment throughout the movement. If performing in a mirror, observe "favoring" one side to the other or rotating one way to another. This can be a sign of weakness or decreased mobility or both. Varying opinions are out there about proper foot alignment. I like to have my feet straight or rotated out slightly. More importantly, the heels should stay flat on the floor. How far should I go? Lots of opinions on this one also. If you look at the activity you are training for, let's say running, you'll see that your knees go out over your toes and your hips need mobility and stability (for efficient stride). I like to go to 90-90 (that is, thighs to parallel). Take note: I would rather do a smaller range of movement (not so far down) correctly, than doing a larger movement incorrectly. Quality of movement over quantity. Later we will show some simple exercises to help correct some of the imbalances commonly observed during a squat.

In Line Lunge

The In-Line Lunge is one of our favorite exercises to do as a part of a structured functional strength program to supplement running/cardiovascular training. If you look at the picture of the girl running under the title of our blog, you can see the similarities between the exercise and running. Running requires functional strength in the hips, knees, ankles, and trunk. These muscles have to know how to work together to accomplish the given movement, in this case, running. Lots of variations of this exercise are out there, however, most of the time, simple is better. This exercise can also be easily modified for someone who has knee problems by making the distance between feet larger and not going down as deep. Things to watch for are loss of balance, too much forward bending, losing knee alignment (in or out), and pain. I like to do this exercise 1-2 times per week along with a few other exercises that we will discuss later. Usually, I am performing only 3-5 repetitions for 2-4 sets on each leg....again, quality over quantity. When I'm doing these exercises regularly, I feel like I run stronger and more solid.



Note to readers: Always consult a physician before starting any exercise program. The posts on this blog are purely for educational purposes only. The information written in the posts is the opinion of the authors and should not be taken as medical advice.

Retro shoes?

There are many factors that lead to a running injury. I feel that one of the largest contributing factors is our luck in finding the right running shoe to match the needs of our body. In my view this is becoming harder, in a large part because of all the choices with the latest "technology". More and more shoe companies are trying new combinations of light weight midsole materials and thinner outsoles. Many have large and soft crash pads on the outer edge of the midsole. Some of the running population may get away with their choices. Many, I fear will make choices that may initially feel and look good. But, as the miles accumulate and the thin outsoles prematurely wear down their biomechanics will change for the worse. This change will help increase stress to their lateral hips, knees, shins, achilles and plantar fasicia. With cumulative stress overload, an overuse injury is more likely to develop. I have switched many runners from these types of shoes with a shoes that have more traditional construction. Be careful with the softness of the midsole and the crash pad. Be careful with outsole splits in the lateral heel.
Seek help from a running speciality store and/or a running friendly health professional. Best yet, learn to look for yourself. All you need is a treadmill and a video camera. Film from behind in your old shoes, and a couple of new shoes. Study how your foot lands and how you push off. Look at the crash pad (lateral heel of the midsole) and get an idea of how much it compresses compare to a stiffer shoe.

Again, shoes are only one of the contributing factors for an overuse injury. If you find one that works, stick with it! Remember not to stay in a shoe too long. Inspect the outsole wear pattern. If it is starting to look worn in one area, you better get another new shoe going soon.
More on shoes later. Perhaps some pictures will help illustrate my point.