Spring Cleaning

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

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

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!

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!

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

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

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.